c:\work\Jor\vol708_1 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (8), Page 1248-1253

Absenteeism among Saudi Medical Students
Mahmoud F. Qutub1*, Mohammad A. Bafail1, Ahmad S. Alomari1,
Abdulaziz A. Azahrani1, Wesam T. Abuznadah2, Fadi M. Munshi3, Basim S. Alsaywid1,2
1 King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), 2King Abdulaziz Medical City,
National Guard Health Affairs, 3Saudi Commission for Health Specialties, Jeddah
*Corresponding Author: Mahmoud Fareed Qutub, Mobile No. :+966558550995,Email: qutub.mahmoud@gmail.com

Student absenteeism refers to the frequent absence from classes without any good reason and
thought to be the primary concern in health profession education worldwide mainly in medical school.
Methods and Material:
This study is a cross sectional design conducted in 152 medical students of King
Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Saudi Arabia. A self-reported questionnaire
was used to determine absenteeism behavior, contributing factors of absenteeism, and level of satisfaction of
medical students towards the medical program of the university. Adapted questionnaire from Timmins and
Kaliszer (9) was also utilized to examine factors of stress among medical students. Descriptive statistics, linear
correlation and Pearson correlational coefficient utilizing SPSS v22 for the analysis of data.
A total of 143 (92.76%) participated in the study. 104 or 72 % were male, and 28% were female
with mean age of 22.5 (±2.02) and a mean GPA of 4.4 (±0.4). 77 (53.8%) of students were absent for 5 times
or more in lectures/basic and clinical sciences sessions and clinical diagnostic sessions. These absences are
mainly because of study (n=36, 25.2%) and course dissatisfaction (n=32, 22.4%). However, only 3 (2.1%)
who had an absence for 5 times or more in Problem Based Learning (PBL) sessions. These absences in PBL
sessions are mainly because of sleep (n=11, 7.7%) and family commitments (n=10, 7.0%). There is an inverse
correlation between absenteeism and academic performance.
Absenteeism has a negative impact on the academic performance of medical students.
Keywords: Absenteeism, Medical Students , AcademicPperformance,Pproblem-based learning, Lecture


Student absenteeism refers to the frequent
Also, student-lecturer interaction during a lecture
absence from classes without any good reason and
or clinical session may provide priceless
thought to be the primary concern in health
information and specific examples that make
profession education worldwide mainly in medical
learning a subject more intuitive (2). Therefore,
school (1). Absenteeism behavior may negatively
absentees are subject to miss these rich educational
affect the general educational process and personal
resources. This loss may negatively impact student
academic achievement of students. The teaching
academic performance.
and learning environment will be affected as it may
In spite of compulsory attendance rule, every
form an unwelcoming and dull learning
student's parents, institute, and society suffer when
environment for both teachers and students(2).
students do not attend classes in medical college on
Student attendance is essential in the academic
a regular basis (3). Poor execution of lecture among
performance and professional development of
teachers, ineffective teaching strategies, and
medical students. The completion of the total credit
availability of learning resources on the internet
hours in the aspect of academic and clinical contact
were some of the most common reasons of
is necessary to gain competence and ability to
student's absenteeism (4). Also, studying while
obtain Bachelor of Medicine and Bachelor of
working has a considerable reason for the absences
Surgery (MBBS). Lectures, laboratory, and clinical
of students (2, 5, 6). Other factors such as
sessions provide an invaluable learning experience
sleeplessness, poor health status, busy social life,
and in-depth information that are crucial for
and stress due to overload in learning task and
medical students' academic success. Lecturers offer
assignments were reported that lead to absenteeism
a personal, professional experience that accentuate
among students in medical and other health
the factual knowledge provided in each learning
sciences related higher education (4,5).
session which cannot be provided via textbooks (3).
Received: 14/12/2017 DOI: 10.12816/0044631
Accepted: 24/12/2017

Full Paper (vol.708 paper# 1)

c:\work\Jor\vol708_2 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (8), Page 1254-1258

An Overview with Noninvasive Body Countering in The
Management of Cellulite
Reem M. Alomairi, Lama N. Alotaibi and Mohammed Al Jamal
Almaarefa Colleges For Health Sciences,Riyadh, Saudi Arabia
Corresponding author: Reem M. alomairi Email: dr.romairi@hotmail.com ,Phone number: +966567514550

Nowadays cellulite, or gynoid lipodystrophy (GLD) is the most concerning and displeasing skin problem. It
is a condition in which the skin appears dimpled, bumpy and "orange peel-like." It's caused by changes in the
structure of the connective tissues and fat cells that lie underneath the skin's surface [1]. This article aimed at
reviewing the classification, pathophysiology and treatment in general, as well as the management of
cellulite with non-invasive body countering.
Keywords: Cellulite, Adipocyte, connective tissue septae, noninvasive devices.


Cellulite is a topographic and localized skin
Classification of cellulite
condition that is most commonly found on the
Nürnberger and Müller [2] described four stages
posterolateral thighs, buttocks, and abdomen. It is
of cellulite:
often identified by a dimpled or orange-peel
Stage O:
appearance of the skin`s surface.
Skin on thighs and buttocks is smooth surface
In 1978, Nürnberger and Muller [2] first
with patient standing or lying. Pinch test
described cellulite as a result of sex-related
throws the skin into folds and furrows.
differences in the structure of skin and
Stage I (or one plus):
subcutaneous tissue. Cellulite affects all races, and
Skin surface is smooth while patient stands or
it is estimated that 85% of women older than 20
lies. Pinch test clearly positive for mattress
years have some degree of cellulite. Despite its

high prevalence (80%­90%) in postpubertal
Stage II (or two plus):
female patients of all races, little epidemiological
Skin surface is smooth while lying down.
data on its exact prevalence, incidence, and
Mattress phenomenon (dermo-panniculosis
associating factors have been published [3].
deformans) when standing.
Several therapies have been designed,
Stage III (or plus three):
marketed, and/or purported to improve cellulite,
Mattress phenomenon (dermo-panniculosis
including topical therapy, injectable (e.g., chemical
deformans) positive in both lying and
septolysis with collagenase), lymphatic or vacuum-
standing positions.
assisted massage, acoustic wave therapy, light
therapy, external noninvasive lasers, and
Physiology of cellulite
radiofrequency (RF) devices [4].
"The four leading hypotheses that purport to

explain the physiology of cellulite include sexually
dimorphic skin architecture, altered connective
This review was conducted using online
tissue septae, vascular changes and inflammatory
research by reviewing all articles which were
published between1976 to 2017. Different terms as
Sexually dimorphic skin architecture
following were used to obtain the articles related to
The anatomic` hypothesis of cellulite is based
the current subject: cellulite, body counting,
on gender-related differences in the structural
noninvasive devices, fat reduction .
characteristics of subcutaneous fat lobules and the
The study was done after approval of ethical
connective tissue septa that divide them.
board of King Abdulaziz university.
According to this theory, originally detailed by

Nürnberger and Müller [2] , the appearance of
cellulite, i.e. pits` and dells`, or dimpled skin, is
The management of cellulite by using noninvasive
caused by herniations of fat, termed papillae
body countering devices play a role in reduction of
adipose`, that protrude from the subcutis through
cellulite. Studies have shown effectiveness of fat
the inferior surface of a weakened dermis at the
reduction in the improvement of cellulite. Further
dermo-hypodermal interface. These herniations of
studies are needed to be done on this subject.
fat into the dermis are a characteristic of female

anatomy, and their presence has been confirmed by
Received: 14/12/2017 DOI: 10.12816/0044632
Accepted: 24/12/2017

Full Paper (vol.708 paper# 2)

c:\work\Jor\vol708_3 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (8), Page 1259-1265

Prevalence of Early Childhood Caries
Faisal Ali Aljarallah1, Hebah Zaki Alghanim2, ALwaleed Bin Tala Alanazi2, Khalid Abdulaziz
Alrafie2, Abdullah Ibrahim Bin Jammaz3, Ashwaq Hussain Alhakami3, Samar Abdul Majeed
Aldurgham3, Rakan Mohammed Abulaban3, Shahad Hashem Alsaggaf4, Sawsan Badr Suhaqi4,
Futun Abdulrahman Alqahtani5, Sultana Nasser Alhunaki6, Ablah Nawaf Aljazi7,
Mohammed Khashman Almutairi8, Rakan Mohammed Abulaban3
1-Saudi German Hospital,2-Riyadh Colleges of Dentistry and Pharmacy,3-Ministry of Health,
4-Batterjee Medical College for Sciences and Technology, 5-Ibn Sina National College,
6-Prince Sultan Medical Military City,7-Future University(Egypt), 8-Alkharj Armed Forces Hospital
corresponding author: Faisal Ali Jarallah Aljarallah, E-mail: F_uoh@hotmail.com, mobile: 0555156989

Early childhood caries (ECC) is a severe form of dental decay with multi-factorial origin. ECC
can significantly affect the child's quality of life, as it may lead to infection, swelling, pain, and other symptoms.
The ECC affects children after eruption of primary teeth until age of around 5 years.
Aim of the study: I
nvestigating the etiology and risk factors predisposing ECC among children and the optimal
interventions for prevention.
Methods: We searched the medical literature to retrieve studies for the review to 30 November 2017. We
searched Medline, Embase, the Cochrane Library websites for English Publications that were obtained from both
reprint requests and by searching the database. Data extracted included authors, country, year of publication,
characteristics of patients, pathophysiology, risk factors, clinical manifestations, different diagnostic approaches
and prevention modalities.
Conclusion: The increase in the prevalence over time is mainly behind increased exposure to risk factors and
increased number of teeth at risk. Predisposing and risk factors include living in a non-fluoridated county, low
socioeconomic status and poor dietary behaviors. Preventive measures involve community, homecare and
professional interventions to avoid risk factors which require to be followed with discipline in order to avoid
potential incidence of ECC in the first place. We further recommended preventive strategies by increasing public
awareness such as promotion of community-based interventions conducted by dental hygienists and the Inclusion
of oral health screening in new child health immunization schedules and insurance legislation for children.
Keywords: Children, Early childhood caries, Fluoride, Nursing caries, Pediatric dentistry.


Dental caries is a complex multifactorial disease
primary tooth in a child up to 71 months of age or
that begins with microbiological shifts within the
younger. The term "Severe Early Childhood Caries
complex biofilm- biofilm-mediated-which is greatly
(S-ECC)" refers to "atypical" or "progressive" or
influenced by the composition and flow of Saliva ,
"acute" or "rampant" patterns of dental caries.
exposure to fluoride, dietary factors especially
Moreover, from ages 3 to 5, it is defined as having 1
Sugar consumption, and by preventive behaviors.
or more cavitated, missing or filled smooth surfaces
The disease is initially reversible and can be halted
in primary maxillary anterior teeth or decayed,
at any stage, even when some cavitation occurs,
missing, or filled score of 4 (age 3), or 5 (age
provided enough biofilm can be removed[1].
4), or 6 (age 5) surfaces constitutes S-ECC [3].
Early childhood caries (ECC) is a form of dental

caries that starts early in life as the name implies. It
is a complex disease that involves the maxillary
primary incisors within a month after eruption and
spreads quickly to include other primary teeth[2]. It
is a serious socio-behavioral and dental problem that
afflicts infants and toddlers worldwide.The
definitions of ECC in the published literature vary,
making comparisons among studies difficult[2]. Yet
they all have incisor involvements with decay as a
common ground[3].
The American Academy of Pediatric Dentistry

Figure 1: Initial stages of ECC- the lesion can be
(AAPD) came with a definition for ECC in 2003 as
arrested by the application of fluoride and improved
the existance of one or more decayed (noncavitated
OH habits[4].
or cavitatedlesions) or filled tooth surfaces in any
Received: 16/12/2017 DOI: 10.12816/0044633
Accepted: 26/12/2017

Full Paper (vol.708 paper# 3)

c:\work\Jor\vol708_4 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (8), Page 1266-1274

Fixed Zirconia Partial Denture
Sarah Nassar Almadani1, Zahra Abdulkhalek Alhammadi1, Latifah Mohammed Alfrihidi1, Marwa
Rashad Khairi1, Abeer Hamed Almutairi1, Zainab lutfi Alsadiq1 , Bader Abdullah Alotaibi1,Hussein
Mohammed Alhelaly2,Abdullah Zamil Alanazi2, Rasha Nabeel Halal2 ,Reham Tariq
Tallab3,Mohammed Fareed Sannan3,Sultana Nasser Alhunaki4
1-Alfarabi College for Dentistry and Nursing, 2-Ministry of Health,
3-Ibn Sina National College for Medical Studies, 4-Prince Sultan Medical Military City
Corresponding author: Sarah Nassar Hasan Almadani,email: eso000qi@gmail.com,mobile: +966 56 285 6248

Ceramics have anextended history in fixed prosthodontics of attaining optimal esthetics.
Yttrium tetragonal zirconia polycrystal (Y-TZP)-based systems are a recent addition to the high-strength, all-
ceramic systems used for crowns and fixed partial dentures, the highly esthetic nature of zirconia coupled
with its superior physical properties and biocompatibility have resulted in restorative systems that meet
optimal recent demands.
Aim of the study: systematically review relevant contemporary literature regarding investigating the
strength and accuracy of fit of zirconia fixed partial dentures (FPD).
Methods: A systematic review of the scientific literature from 2000 to 2017(PubMed,Embase and
CENTRAL Cochrane Central Register of Controlled Trials, CINAHL, Google Scholar as well as individual
Dentistry journals such as International Journal of Prosthodontics, International Journal of Periodontics and
Restorative Dentistry. We followed PRISMA/STROBE guidelines. Medline abstracts were retrieved using
an algorithm comprising relevant MeSH terms.
Results: The search yielded 11 studies enrolling 231 cases that met the inclusion criteria of the review.
Absolute, Vertical and Horizontal margin gaps were recorded . Four of them were in- vivo studies while
seven were in Vitro.The study outcome was focused on the assessment of the internal fit as well as the
Marginal fit of zirconia FPDs versus the effect of various parameters of CAD / CAM and CAM systems,
post-sintered and pre-sintered milling, framework configuration, veneer application and ageing. Average
absolute marginal(AM) gap= 92 microns. For each system, the values were; Everest= 121 , Lava= 71,
Cercon = 93.5, Procera = 51, Xawex = 147, CerecInLab = 88.8
Conclusion: It was concluded that CAD/CAM have more accurate marginal and internal fit compared to
CAM in fabricating zirconia frameworks. Moreover, post-sintered milling will most likely result in complex
geometry and longer span FPDs. Nevertheless, the clinical implications of this difference have yet to be
determined, and the pros and cons need to be taken into account first provided the hardship of post sintered
milling. Veneering zirconia frameworks resulted in deterioration in fit, ageing of zirconia had no
implications on the fit.
Keywords: Zirconia , fixed partial dentures, Flexural strength; Framework design, ceramic restorations.


There is a compelling need from patients
as well as in the field of computer-aided
worldwide to an aesthetic ideal of the restorations
placed in the mouth, which has pushed the
(CAD/CAM)in dentistry has paved the way for
scientific research towards the finding of a
high fracture toughness zirconia-based ceramics[2].
material that has the necessary mechanical
Y-TZP (Yttria partially stabilized tetragonal
strength suitable to withstand masticatory loads
zirconia) frameworks are manufactured with the
that develop in the posterior areas of the oral
use of CAD-CAM technology, by milling
cavity in addition to the aesthetic characteristics.
partially or densely sintered pre-fabricated blocks.
Non-metallic restorations have always represented
Milling densely sintered blocks produced by hot
a challenge for dentistry and only in recent years,
isostatic pressure (HIP) has the advantage of
with the introduction of zirconia, has achieved this
ensuring better adaptation of the final crown. Yet,
milling hard structures is quite slow, inefficient
High stress-bearing posterior fixed partial
and causes excessive wear of the milling burs.
Contrariwise, using partially sintered blocks
increases the efficiency of the milling process. In
Nevertheless, the use of ceramic materials to
such cases, the CAD-CAM system should
produce large frameworks and developments in
produce larger restorations to compensate the
ceramic materials such as zirconium oxide cores,
Received: 20/12/2017 DOI: 10.12816/0044634
Accepted: 30/12/2017

Full Paper (vol.708 paper# 4)

c:\work\Jor\vol708_5 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (8), Page 1275-1281

The Effect of Different Surface Treatments of
Carbon Fibers and Their Impact on Composites
Mohammed Khashman Almutairi1, Reham Abdulkhaleq Felemban2, Shahad Esmail Pasha2,
Nuha Talal Abo khashaba2, Heba Ibrahim Mubaraki3, Rawan Ahmed Yankesa4, Alaa Yahya
Algamdi4, Afnan Mohammed Bakkar4, Amal Abdulkarim Aldouweghri4, Mohammed Fareed
Sannan4, Danah Saeed Basaad4,Mohamed Fawzi Almaghmsi5, Majid awad Alonazi5, Mohammed
Musayyab Alruwaili7,Hawra Mohammed Alhamad8
1-Alkharj Armed Forces Hospital, 2-Alfarabi College for Dentistry and Nursing, 3 -Batterjee Medical
College for Sciences and Technology,4 -Ibn Sina National College for Medical Studies,
5-Future University, Egypt, 6-October 6 University,7-Imam Abdurrahman Bin Faisal University.
Corresponding author: Mohammed Khashman Almutairi, E-mail: drkhashman90@gmail.com, mobile: +966561675948

The performance of composites profoundly depends on the quality of the fiber-matrix interface.
Good interfacial adhesion provides composites with structural integrity and efficient load transfer between
fiber and matrix. Nevertheless, untreated carbon fibers are extremely inert and hence have low adhesion to
resin matrices. In the meantime, the relatively weak transverse and interlaminar properties significantly limit
the composite performance and service life. To overcome these barriers, a fiber-based reinforcement which has
strong interfacial adhesion to the matrix is highly desired to improve the overall composite properties.
Aim of the study: was to assess the Effect of different surface Treatments of Carbon fibers and their influence
on the interfacial properties of carbon fiber/epoxy composites.
Methods: A review of the scientific literature (from 1970 to 2017).
Pubmed, Embase and CENTRAL were searched to identify studies that investigated the different types of
surface treatment of carbon fibers and how this can affect the quality of carbon fiber composite. Identification
of papers and data extraction were performed by different independent researchers.
Conclusion: Various combinations of surface treatment of carbon fibers are crucial to improve its adhesion
with various matrices. Treatment significantly influences fiber characteristics. Nevertheless, optimization is
required to select appropriate treatment method per application and desired properties.
Keywords: Carbon fibers, surface treatment, composites.

Thus, CF composites are suited to
Carbon fibers are defined as a fiber materials
applications where strength, stiffness, lower
containing at least 92 wt % carbon in composition,
weight, and outstanding fatigue characteristics are
however the fiber containing at least 99 wt %
critical requirements. They are also finding
carbon is usually called a graphite fiber (1). Carbon
applications where high temperature, chemical
fibers generally have superior tensile properties,
inertness and high damping are important criteria.
low densities, high thermal and chemical stabilities
CFs also have good electrical conductivity, thermal
in the absence of oxidizing agents, good thermal
conductivity and low linear coefficient of thermal
and electrical conductivities, and excellent creep
resistance (1). CFs have been extensively used for
One problem that can seriously compromise the
manufacturing of thermoplastic composites, such
performance of this material (when no previous
as carbon-reinforced polyetherimide (CF/PEI).
surface treatment of CFs is applied) is to obtain
This high-performance material has found multiple
composites with low interlaminar shear strength (2).
applications in aerospace, marine and automobile
Polyacrylonitrile (PAN) and mesophase pitch (MP)
industry due to its favorable engineering properties,
are the two most important carbon fiber precursors.
such as lower density, enhanced toughness,
Optimizing the carbon fiber microstructure can
excellent fire resistance and easy recyclability.
improve carbon fiber strength through decreasing
Furthermore, they have been extensively used in
its flaw sensitivity. The carbon fiber microstructure
composites in the form of woven textiles, prepregs,
is dependent on the precursor morphology and
continuous fibers/rovings, and chopped fibers. The
processing conditions. Research in these two areas
composite parts can be produced through filament
will aid in the development of carbon fibers with
winding, tape winding, pultrusion, compression
improved performance (4).
When CFs are used without surface treatment ,

they result in composites with low interlaminar
vacuum bagging, liquid molding, and injection
shear strength (ILSS). This has been attributed to
molding (2).
weak adhesion and poor bonding between the fiber
Received: 20/12/2017 DOI: 10.12816/0044635
Accepted: 30/12/2017

Full Paper (vol.708 paper# 5)

c:\work\Jor\vol708_6 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (8), Page 1278-1288

Anti-Mullerian Hormone: An Indicator for the Severity of
Polycystic Ovarian Syndrome
Yehia Abd-Elsalam Wafa 1, Mohamed El-Sayed Hammour1,
Ahmed Fathy Abd-elaziz 2, Dalia Abdallah Hamoda 1
Departments of Obstetrics & Gynecology1 and Clinical Pathology2, Faculty of Medicine, Al Azhar University
*Corresponding author: Dalia Abdallah Hamoda, e-mail: daliaapdallah@gmail.com

Background: Polycystic ovarian syndrome (PCOS) is a common endocrinopathy that accompanied with long
term complications. Purpose Features of PCOS including sonographic aspects, androgens, luteinizing hormone
(LH) and lutenizing and follicular stimulating hormones ratio LH/FSH ratio as well as Anti-Mullerian Hormone
(AMH) were evaluated according to their diagnostic potency in detecting different degrees of PCOS severity.
Objective: The aim of this study to assess the possible role of AMH as the diagnostic marker for different
degrees of PCOS.
Materials and Methods: In this cross-sectional study, a total of 150 women aged 18­46 years Patients were
consecutively included as they presented in our clinic. 50 patients were diagnosed with sever PCOS (based on
Rotterdam criteria consensus), 50 patients were diagnosed with mild PCOS, and 50 women served as controls. In
day 2-4 of cycle, transvaginal sonography was performed and serum hormonal level of AMH, LH, FSH,
testosterone. PCOS patients fulfilling all Rotterdam criteria were defined as having severe PCOS (n = 50), while
patients showing oligo-/amenorrhoea and polycystic ovaries but without hyperandrogenemia were defined as
having mild PCOS (n =50). And control group (n= 50). All patients were treated at the University Hospital of El-
Hussein, Al-azhar university and at Ain Shams General Hospital Cairo Egypt.
Results: The strongest group difference between controls and severe PCOS patients was observed for AMH
showing an age-adjusted odds ratio of 2.56 [95 % confidence interval (CI) 2.00­3.27; p < 0.0001]. Age-adjusted
receiver operating characteristic analysis showed that the area under the curve (AUC) of 0.88 (95 % CI: 0.80­
0.95) for AMH and 0.94 (95 % CI 0.88­0.98) for antral follicle count did not differ significantly in their ability
to discriminate between severe PCOS patients and controls. AMH showed higher AUC estimates than
androgens, ovarian volume, LH and LH/FSH ratio and an AUC of 0.80 (95 % CI: 0.65­0.91) for detecting mild
Conclusions: this study comparing the diagnostic potency of AMH, sonographic aspects, androgens and
LH/FSH ratio according to different PCOS subgroups while accounting for the age-dependency of AMH. In
cases where vaginal scans are not feasible or in patients without hyperandrogenemia AMH may be used as a
surrogate parameter in PCOS diagnosis, superior to androgens and gonadotropins.
Keywords: diagnosis of PCO, PCO and antimulleian hormone, diagnosis of PCO phenotypes.

women with PCOS and were positively related with
Polycystic ovary syndrome (PCOS), which is the
small antral follicle number (3). Prevalence of the
most common endocrine disorder in reproductive-
syndrome varies according to diagnostic consensus
aged women, affects 6% to 10% of premenopausal
used, with estimates ranging from 9% according to
women (1). The diagnosis of PCOS is based on a
National Institutes of Health consensus, up to 18%
combination of clinical, biochemical, and ultrasound
with the Rotterdam consensus(4).
criteria, and the main diagnostic criteria of PCOS are
In females, FSH initiates follicular growth,
polycystic ovarian morphology (PCOM), oligo-
specifically affecting graffian follicles (GCs). It is
anovulation, and hyperandrogenism (HA) (2).
thought that each follicle has its own threshold FSH
However, the diagnosis of PCOS can be subjective,
concentration varying from hypo-response to a risk of
because counting the ovarian follicular number and
ovarian hyperstimulation and this concentration has
measuring the ovarian volume using ovarian
to be exceeded to ensure dominant follicle selection.
ultrasound are technique-dependent and because
It is reported that AMH inhibits FSH-stimulated
obtaining standardized measurements is difficult.
follicle growth in the mouse(5). and is one of the
Serum AMH levels were markedly increased in
factors restrains the sensitivity of ovarian follicles for
Received: 19/5/2017 DOI: 10.12816/0044636
Accepted: 28/5/2017

Full Paper (vol.708 paper# 6)

c:\work\Jor\vol708_7 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (8), Page 1289-1294

Screening for Psychological Burden of Vitiligo Using Vitiligo Impact Scale
Rawan Gaafar
Department of Dermatology, Umm Al-Qura University
Email: rawanjafar1414@gmail.com , Mobile: +966565606385

Chronic skin diseases conditions have been well reported to affect a patient's quality of life on
multiple dimensions, including the psychosocial domain. Patients can suffer from lowered self-esteem, anxiety,
or depression. The assessment of the psychosocial impact of skin disease on a patient could facilitate the
treatment plane and procedure to be carried out by the dermatologists to deal with the disease. Aim: the aim of
this study was to assess the psychological burden of vitiligo using Vitiligo Impact Patient scale (VIPs).
Materials and methods: A descriptive study was conducted on 60 vitiligo patients. All patients were assessed
using Vitiligo Impact Scale. Data collected were analyzed using SPSS software. Results: Among the studied
patients, 68.3% were females. Almost half of the patients (43.3%) were single, whilst only 28.3% were
married. Half of the patients had generalized vertigo, and 51.7% had vertigo on their faces. According to the
VIP, the vast majority of patients (56.7%) were moderately affected, one fourth (25%) of them were highly
affected, and only 8.5% were slightly affected. There was a statistically significant correlation between the VIP
score and patient's age, sex, disease duration, marital status, vitiligo on the face, and percentage of the involved
area. Conclusions: Vitiligo is considered as a major psychological impact on patients. This psychological
impact is significantly correlated with patient's age, sex, duration of disease, marital status, the presence of
vitiligo in the face, and percentage of area involved. However, there is no significant correlation between the
family history of vitiligo, level of education and psychological impact of vitiligo.
Keywords: Psychological burden, vitiligo, vitiligo impact score.


Chronic skin diseases conditions have been
psoriasis [8] and many various chronic skin
well reported to affect a patient's quality of life
diseases. Indeed, in a recent paper,
(QOL) on multiple dimensions, including the
Ramam et al. [9] estimated the global burden of
psychosocial domain. Because many skin
15 skin diseases in 187 countries. This global
conditions are commonly associated with social
estimation includes social integration, emotional
stigmatization, patients can suffer from lowered
state, everyday-life organization, and the use of
self-esteem, anxiety, or depression. The assessment
medical resources including consultations and
of the psychosocial impact of skin disease on a
medication.To the best of our knowledge, there are
patient can help in the direction of the
few studies available for assessing the burden
dermatologists' in the treatment goals of the disease
experienced by individuals affected by vitiligo,
[1, 2]. Vitiligo is the most common depigmenting
although there is a need for conducting such a study
disorder, with a prevalence of approximately 1% in
that would be beneficial for clinicians and patients
the world population [3]. In some countries, vitiligo
alike and which would also allow for an evaluation
is still confused with leprosy with a considerable
of the impact of vitiligo treatment. Therefore, the
social stigma. Indeed, many studies have
aim of this study was to assess the psychological
documented significant effects of vitiligo on health-
burden of vitiligo using Vitiligo Impact Patient
related quality of life (QoL), using validated
scale (VIPs).
generic and dermatology-specific health-related

QoL scales [3, 4].
The concept of "burden" has played an
A descriptive study research design was used
increasingly important role in evaluating the care of
to assess the psychological burden of vitiligo. The
chronic diseases, and more specifically skin
study was conducted on 60 vitiligo patients
diseases [5]. The notion of global burden was
attending to the dermatology outpatients' clinic at
introduced by the WHO and is useful in quantifying
Alnoor clinic, Alzahir clinic and Hera'a clinic for a
the health of a population and determining priorities
period of three months, commencing from July
of action in the public health domain [6, 7]. The
2017 To September 2017. All included vitiligo
notion of burden has recently been extended to
patients were assessed using Vitiligo Impact Scale.
individuals and their families, to assess disability in
This tool was adapted from Kostopoulou et al. [10],
a broad sense (psychological, social, economic, and
after reviewing of the current related literature. The
physical), related to various diseases including
tool was translated into the Arabic language by the

researcher to ensure that all patients fully
Received: 14/12/2017 DOI: 10.12816/0044637
Accepted: 24/12/2017

Full Paper (vol.708 paper# 7)

c:\work\Jor\vol708_8 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (8), Page 1295-1304

Effect of Sociodemographic Characteristics on the Attitude and
Practice of Adult Cancer Patients Treated in the General Hospitals,
Tabuk Region, Saudi Arabia
Asma Eid Alhawiti, Asma Mohammed Alhawiti, Latifah Mohammed Alanzi
Faculty of Medicine, University of Tabuk, Tabuk, Kingdom of Saudi Arabia

many types of cancer are easily prevented through screening that can detect the disease during
its early stages, resulting in better prognosis and long-termsurvival. Moreover, compliance of cancer patients
with treatment instructions is crucial for better prognosis. Little is known about the effect of
sociodemographic factors on attitude and practice of cancer patients.
Objective: The aim of this study was to assess the effect of sociodemographic status on the attitude and
practice of adult patients with cancer towards the intent to start the treatment, the adherence to treatment
regimen and the prognosis of the disease.
Methods: this study was carried out inthe generalhospitals, Tabuk Region, Saudi Arabia. Participants were
selected from the Oncology Center Outpatient Clinics. A questionnaire designed for cancer patients was used
for data collection via direct interview. The questionnaire included questions to record sociodemographic
factors, patient's attitude (towards early diagnosis, treatment, and follow up), practice and general health
Results: attitude score was significantly higher in the married respondents (p = 0.015). Practice score was
higher in those aged less than 20 and above 60 years-old (p = 0.016), those who were in early stages of
cancer (p = 0.004) and respondents with positive family history of cancer (p = 0.019). The attitude and
practice scores were found to have a significant positive and moderate correlation (r = 0.487; p <0.001).
Conclusion: the overall attitude and practice of the respondents towards cancer was fair in most of the
points. However, their attitude and utilization of screening methods was less than satisfactory. This calls for
an action to encourage Saudi population, particularly those at high risk, to seek and receive screening
services. Explaining the benefits and the access to free screening services is crucial. Barriers that are
responsible for this attitude and practice should be explored and addressed.
Keywords: cancer, attitude, practice, diagnosis, treatment, questionnaire.


Cancer is one of the most common
leading causes of death and represents a
improvement in early detection and treatment for
significant health burden. In spite of the recent
several cancers, socioeconomic inequalities
advances in cancer therapy, it remains a
persist in cancer incidence, morbidity, mortality
challenge to prevent and treat(1). One of the
and survival(6,7).
strongest prognostic factors is disease stage at the
Population-based cancer registry data
time of diagnosis.Evidence for the link between
from the Surveillance, Epidemiology and End
socioeconomic status (SES) and health/disease
Results(SEER) Program at the National Cancer
has accumulated over the years(2).
Institute (NCI) are generally the authoritative
Several investigators examined the effect
source of data for describing disparities in cancer
of income and education on survival in the
burden among racial/ethnic groups. However,
general population(3).SES is most commonly
these data are mainly based on medical records
measured by occupation, place of residence and
and administrative informationand thus lack
level of education. More deaths have been noted
individual-level data on SES. Sociodemographic
among cancer patients with lower SES as
information on individual cancer patients in the
compared with patients with higher SES(4). Some
NCI's SEER database is limited to age, sex,
authors suggested that differences in education
race/ethnicity, marital status and place of birth
may affect mortality rates, especially among high-
and residence. Key measures of individual SES,
income patients. It was noted that patients with
such as educational attainment, occupation,
lower SES usually seek treatment at a more
incomeand employment status were not
advanced stage of the disease, which may reduce
available(8). Educational level also may influence
survival in this group of patients(5).
the risk of cancer in several ways. Education is an
important guide in the selection of occupation.
Received: 14/12/2017 DOI: 10.12816/0044638
Accepted: 24/12/2017

Full Paper (vol.708 paper# 8)

c:\work\Jor\vol708_9 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (8), Page 1305-1311

Association between Overuse of Social Media and Depression among
Medical Students at King Khalid University, Kingdom of Saudi Arabia
Abdullah Alsabaani,1 Abdullah Ali Alshahrani,2 Abdullah Saeed Abukaftah,
2 Saleh Fahad Alqahtani, 2 Fares Mohammed Alzahrani 2
1 Department of Family and Community Medicine, College of Medicine, King Khalid University,
Abha, Saudi Arabia, 2 College of Medicine, King Khalid University, Abha, Saudi Arabia
Correspondence author: Abdullah Alsabaani, Email: dr.alsabaani@hotmail.com, aalsabaani@kku.edu.sa

Previous studies of the association between the use of social media and depression have yielded
conflicting results. Some studies have reported that social media use may reduce depression, whereas other
studies have observed that frequent use of social media may be associated with depressive symptoms.
Objectives: To assess the relation between overuse of social media and depression and to identify other risk
factors related to depression among medical students.
Subjects and methods: A cross-sectional, comparative study was carried out among a representative random
sample of male and female medical students at King Khalid University, Abha, Kingdom of Saudi Arabia
(KSA). An anonymous, self-administered questionnaire was utilized to collect data on socio-demographic
characteristics, details of social media use and depression based on the PHQ-9 instrument among the
participants. Data were collected online by sending the questionnaire to a specific WhatsApp group created for
the participating students.
Of the 297 students invited to participate in the study, 239 responded by completing the
questionnaire, corresponding to a response rate of 80.5%. Their ages ranged between 19 and 26 years with a
mean±SD of 21.7±1.5 years. Depression was reported by 67.4% of the participants based on the PHQ-9
instrument and was mild in 41.8% and severe in 9.6% of the participants. Depression was reported more
frequently by female students than by male students (74.1% versus 63.6%, p=0.034). Students who did not
exhibit depression were higher in age (22.1±1.3 years) than those who exhibited moderate depression
(21.3±1.7 years), and this difference was significant (p=0.01). Histories of family problems (p<0.001),
financial problems (p=0.001), study problems (p<0.001), physical or emotional abuse (p<0.001), and
psychiatric problems (p=0.007) and family histories of depression (p=0.047) were significantly associated with
depression and depression severity among the participants. Among the studied social media-related factors,
none of the studied factors was significantly associated with depression.
Conclusion: Depression is a common hidden health problem among medical students in Saudi Arabia. The
prevalence of depressive symptoms was not significantly associated with the duration of social media use.
Keywords: Social Media, Depression, Medical Students, PHQ-9.


In Saudi Arabia, a notably high prevalence
media users, with approximately 11 million
of depression has been documented among medical
Facebook users and 9 million Twitter users10.
students, representing a hidden problem in this
Previous studies of the association between
population 1, 2. Globally, it has been estimated that
the use of social media and depression have yielded
depression will be the second most common cause
conflicting results11, 12. Some studies have reported
of disability by the year 2020 3. The economic
that social media use may reduce depression,13 as a
burden of depression is very large due to reduced
result of increased perceived social support, and
productivity and increased medical expenses 4.
increased life satisfaction,14, 15 whereas other
Depression usually begins in adolescence 5,
studies have observed that frequent use of social
6. Multiple risk factors are usually associated with
media may be associated with depressive
depression;7 however, interest has recently
symptoms12, 16.
increased in the association of over-utilization of
Generally, it has been noticed that medical
social media, such as Facebook, Twitter,
students at King Khalid University, Saudi Arabia,
WhatsApp, Snapchat and YouTube, with
intensively use social media applications.
depression. Currently, social media has become an
Therefore, this study was carried out to assess the
essential part of daily life, connecting individuals
relation between overuse of social media and
with others, and represents a major source of news
depression and to identify other risk factors related
8, 9.
to depression among these students.
In the Kingdom of Saudi Arabia, Facebook

and Twitter have the largest numbers of social

Received: 14/12 /2017 DOI: 10.12816/0044639
Accepted: 21/12 /2017

Full Paper (vol.708 paper# 9)

c:\work\Jor\vol708_10 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (8), Page 1312-1316

Prevalence of Thyroid Dysfunction among Type2 Diabetic
Patients (T2D) in Makkah And Jeddah-KSA
Sami H Hammadi(1), Razan S Aljawi(2), Samar S Alahdal(2), Maram M Allahyani(2),
Nuha K Jazzar(2), Sara M Maqbol(2), Bayan Z Fatani(2), Rzan W Melibari(2), Bushra W Melibari(2),
Bashair W Melibari(2), Walaa A Almaghrabi(2),
Clinical Pharmacology-Internist Faculty of Medicine, Umm Alqura University ((UQU)(1), Interns at UQU (2)
Corresponding Author: Samy Hussein Mahmoud Hammady,Mobile: +966561234625,email:hammady.samy@gmail.com


Background: The association between diabetes mellitus (DM) and thyroid dysfunction is well known.
However, the prevalence of having DM with thyroid dysfunction is extremely variable from one study to
another. Clinical relevance of thyroid disorders in diabetic patients leads to serious consequences with
metabolic compensation of diabetes.
Objectives: to find the prevalence of thyroid dysfunction in T2D retrospectively through the data available in
our diabetic centers among those who attended the diabetic clinics for routine checkup.
Patients and methods: This is a retrospective cohort study conducted from January to August 2017 at three
diabetic centers in Makkah and Jeddah, Kingdom of Saudi Arabia. Nine hundred and seventy-nine patients
aged between 30 and 65years, of both genders with T2D were randomly selected. The participants` data were
collected from their files, using a data collection checklist prepared for the study.
Results: The study included 979 T2D patients. The prevalence of thyroid dysfunction among T2D patients
was 13.1%. Mean age amongT2D patients with thyroid dysfunction was 48.8 years whereas the mean age
among T2D patients with hypertension was 58.5 years. Females were significantly more presented with T2D
and thyroid dysfunction. Again, T2D associated with thyroid dysfunction and hypertension was significantly
more in females than males. Duration of diabetes was significantly more among patients having T2D, thyroid
dysfunction and hypertension than those with only T2D and thyroid dysfunction. Oral antidiabetics (OADs)
were more frequently used than combination of OADs and insulin while diet and exercise only were less,
however thyroid dysfunction was more among them. Majority of our participants with T2D and thyroid
dysfunction reported the occurrence of T2D first
Conclusion: The prevalence of thyroid disorder is quite high amongT2D patients. Prevalence was higher in
female patients and relatively younger ages. Early detection of thyroid dysfunction in patients with T2Dis of
great importance and consequences.
Keywords: Thyroid dysfunction, Type 2 diabetes, Saudi Arabia.


Diabetes mellitus (DM) is one of the most
The association between DM and thyroid
common endocrine disorders worldwide, according
dysfunction is well known (4, 5). The prevalence of
to the world health organization. The prevalence of
having DM with thyroid dysfunction is extremely
DM in adults worldwide was estimated to be 4.0%
variable from one study to another. Other studies
in 1995 and is predicted to rise to 5.4% by the year
have discussed the impact of thyroid dysfunction in
2025 which means that the number of adults with
the control of diabetes and the severity of its
DM in the world would increase from 135 million in
complication (6,7).
1995 to 300 million in the year 2025 (1).
Clinical relevance of thyroid disorders, in
In Saudi Arabia, DM has become one of the
diabetic patients, leads to serious consequences with
most common reasons of hospital admissions due to
metabolic compensation of diabetes according to a
its cardiac, renal, and vascular complications. A
study in 2005. In spite of that, little attention has
study was conducted in Saudi Arabia has found that
been paid to the diagnosis of thyroid dysfunction in
the overall prevalence of DM in adults in KSA is
diabetics (8).Thyroid disease should be screened at
23.7% (2). Furthermore, DM have been linked to
the diagnosis of type 2 diabetes (T2D) and then
other chronic endocrine disorders by different
mechanisms, among which is overproduction of the
dysfunction. Diabetic patients have susceptibility to
counter-regulatory hormones that may induce
different types of thyroid dysfunction, whether
hyperglycemia and other metabolic disturbances,
hypothyroidism or hyperthyroidism; at the same
particularly thyroid dysfunctions (3).
time, patients with thyroid dysfunction are

susceptible to suffer from either Type 1 or Type 2
Received: 14/12/2017 DOI: 10.12816/0044640
Accepted: 24/12/2017

Full Paper (vol.708 paper# 10)

c:\work\Jor\vol708_11 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (8), Page 1317-1322
Symptoms and Prevalence of Constipation among Adult
Population of Riyadh City: An Internet Based Survey
Yazeed Abdullah Alhusainy1, Ahmad Raed Tarakji2, Nasser Yousef Alhowaish1, Hussam Zaid
Alorabi 1, Abdullah Abdulaziz Alsebti1, Hamad Sulaiman AlJutaili 1, Shabana Tharkar3
1 College Of Medicine, King Saud University,2 Department of Medicine, College of Medicine, King Saud
University,3 Prince Sattam Chair for Epidemiology and Public Health Research, Department of Family and
Community Medicine, College of Medicine, King Saud University.
Corresponding Author:Hamad Sulaiman Aljutaili,Email: haljutaili@gmail.com,Contact number: 00966569137255

Constipation is commonly encountered in clinical practice. The global population is witnessing a rapid
increase in its occurrence. Objectives: Since there is paucity of data in Saudi Arabia, there is a need to assess its
prevalence in Saudi population. This study was performed as a pilot to determine the symptoms and prevalence of
constipation among adult population of Riyadh city.
Materials and Methods: A questionnaire based cross sectional survey was done through twitter among Riyadh
based accounts. The study was conducted among 388 adults older than 20 years, between November 2016 and
January 2017. For the diagnosis of constipation three criteria were used; self-perception, Rome III and Bristol's
criteria. Results: Our study showed that the prevalence of constipation in general population is 43%, 60% and 25%
according to the three criteria, respectively. Females tend to have greater prevalence than males though not
statistically significant. Multivariate analysis showed low dietary intake of fruits and vegetables, middle age (40-
49years), and strained defecation significantly associated with constipation. As per Bristol's criteria the most
common stool form was Type 3 (sausage shaped with cracked surface).
Conclusion: These findings suggest high prevalence of constipation among Saudi population. A wider margin of
variation in rates by the three criteria is obtained. Limitation: This twitter based survey may only be considered as a
pilot study and is non-representative of general population.
Keywords: Constipation, Prevalence, Symptoms, Saudi adults.

reported a prevalence of 8%, 17% and 28%
The modern lifestyle in terms of diet and physical
respectively (10-12). The factors associated with
activity has led to huge transition in the occurrence of
constipation in those studies were female gender, poor
diseases that has become more pronounced with the
diet habits and lower socio economic status in addition
advent of the current century (1). Constipation is the
to certain geographic regions, race and ethnicity. Such
commonest gastric disorder encountered in clinics (2).
prevalence data on constipation are scarce in Saudi
Constipation is a disturbing symptom with lower
Arabia. One population based study trying to
quality of life. Chronic constipation poses serious
determine the irregularities of bowel function among
health issues in terms of economic burden for both the
Saudi adults showed that 18% of the respondents
patients and the healthcare systems (3, 4). The
experienced abnormal bowel habits, but direct data on
prevalence of constipation has been on the constant
constipation was not enumerated(13). Due to absence of
rise worldwide (5). It is still largely under-reported and
uniform diagnostic criteria, there is a discrepancy in
complaint surfaces only with severe sickness (6, 7).
the reported rates. Bristol's chart and Rome III criteria
Studies report wide variation in prevalence of
are commonly used among the gastroenterologists to
constipation differing from one region to the other. A
diagnose constipation(14, 15) while some prefer using
review published from European region reported
self-perception for constipation diagnosis in surveys(7,
prevalence with wide range between 1 and 81 %
10). The present survey as a pilot to provide initial
among thirty four populations of different ethnicity,
information on the topic, was carried out to study the
race and country origin with a mean of 17% (8).
symptoms of constipation and its risk factors among
Studies from western countries like Canada
Saudi population based on the three criteria using
reported that chronic constipation affected nearly 2 to
internet as a mean of data collection.
27% of the Canadian population. While a recent cohort
study reported 16 % overall prevalence in the United
The study was conducted in the capital city Riyadh
States (3, 9). Asian studies from China, India and Japan
during the period between November 2016 and
Received: 16/12/2017 DOI: 10.12816/0044641
Accepted: 26/12/2017

Full Paper (vol.708 paper# 11)

c:\work\Jor\vol708_12 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (8), Page 1323-1326

Hairy Leukoplakia as An Early Oral Manifestation of HIV: A Case
Report and Review, Kingdom of Saudi Arabia, 2017
Al-Sharif Abdulrhman
Dental Department, Al-Sulaimaniya Primary Health Care Center, Ministry of Health,
Kingdom of Saudi Arabia.
Corresponding author: Al-Sharif Abdulrhman, E-mail: vip1918@hotmail.com

Oral hairy leukoplakia was reported in 1984 for the first time. It is caused by the Epstein Barr Virus, and it
is an early indicator of an immune deficiency status. This lesion is usually asymptomatic and it is common
in people with HIV infection. For all HIV patients, a comprehensive periodontal and dental treatment
should be done because oral tissues may reflect immune deficiency status. And nearly all HIV-infected
individuals develop oral lesions at some time during their illness. checkups allow detecting any potential
problems that may not even be aware of it. So, detailed history and clinical examination can allow the
dentist to diagnose a life-threatening disease.
Keywords: Oral hairy leukoplakia, human immunodeficiency virus, dentist.


A 38 years old Saudi male patient came to the
summer vacation out of the Kingdome about 6
dental clinic complaining of gum pain in the upper
months ago. And he took medication but he didn't
left side for the last week. The pain is continuous
improve completely.
aggravated by acidic and spicy food, and relieved
On examination, the vital signs were within
by paracetamol. And he reported that he had a
normal ranges. The face is looked normal without
white patch on the lateral surface of his tongue
apparent swelling (figure 1). In oral cavity
with burning sensation. And he had unknown mild
inspection the mouth opening was 4.8 cm,
fever for 2 months back. He reported unintended
complete set of teeth, dental caries with
weight loss with normal to decreased appetite.
generalized stain was present.
He is a hypertensive patient on calcium channel
He had thick, hard, irregular white non-painful
blocker drug. He is smoking about one pack of
patches on the left lateral side of the tongue (figure
cigarette per day.
2). The patches look raised surface corrugated in
The patient has history of previous dental visit
appearance with no erythema or ulceration. And
due to similar pain episode when he was in
he had gingivitis on the upper left side of the gum.

Fig. 1: extra oral picture
Fig. 2: Irregular white patches on the left

lateral side of the tongue

Two submandibular lymph nodes on the left side were palpable measuring around (2 x1.5), (1x1) cm, and
they were soft movable and tender.
Received: 16/12/2017 DOI: 10.12816/0044642
Accepted: 26/12/2017

Full Paper (vol.708 paper# 12)

c:\work\Jor\vol708_13 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (8), Page 1327-1332

Helicobacter Pylori Infection: Independent Risk Indicator of
Gastric Adenocarcinoma and The Role of Surgery
Bassam Hmoud Alsuaidan1, Ghaliah Hamdan Albugami1, Sahar Matter Alshammery2, Abdulmalek
Rshood Al-Qwizani3, Khawlah Fraih Aloqalaa4, Faris Ali Abdullah Alrashed5, Abrar Anas A Tayeb4,
Dalia Abdulaziz Felemban4, Mohammed Suwaileh Alrehaili1, Mohammed Zuhair Ismael4
1 Almaarefa Colleges, 2 Princess Nourah University, 3 Imam Mohammed Bin Saud Islamic University,
4 King Abdulaziz University, 5 Imama Abdulrahman Alfaisal University
Corresponing Author: Bassam Hmoud Alsuaidan - Balsuaidan@gmail.com ­

Helicobacter pylori is a ubiquitous organism that is current in about half of the global
population. Chronic infection with helicobacter pylori causes atrophic and even metaplastic changes in the
stomach, and it has a known association with peptic ulcer disease. This bacterial species colonizes the
stomach of the greater part of the total populace; notwithstanding, only a very small proportion of infected
subjects improve adenocarcinoma. helicobacter pylori causes a chronic gastritis that might last periods, and a
multistep precancerous process is documented for the most common histologic type of gastric
adenocarcinoma: the intestinal type.
Objectives: Distinguishing of individuals at high risk for gastric cancer.
Conclusion: This article briefly summarizes the main aspects concerning gastric adenocarcinomas and the
carcinogenic effects of HELICOBACTER pylori infection.
Keywords: Gastric Cancer, Gastric Adenocarcinoma, Helicobacter Pylori, Multifocal Atrophic Gastritis,


Helicobacter pylori is a ubiquitous organism
far, only one bacterial species has been implicated:
that is current in about half of the global population.
helicobacter pylori in gastric carcinoma [5]. It has
Chronic infection with helicobacter pylori causes
been assessed that 17.8% of cancers globally are as
atrophic and even metaplastic changes in the
a result of infectious agents, and helicobacter pylori
stomach, and it has a known association with peptic
is assessed to be accountable for 5.5% of all cancer
ulcer disease. The most common route of
cases and more than 60% of gastric cancer cases [6].
helicobacter pylori infection is either oral-to-oral or
Even though helicobacter pylori is correspondingly
fecal-to-oral contact [1]. Even though gastric cancer
occupied as a causative agent in gastric mucosa-
frequency and mortality rates have been slowly
associated lymphoid tissue lymphoma.
reducing in many countries over the last decades,
gastric cancer is still the second most common cause
adenocarcinomas, which represent more than 90%
of cancer-related deaths and the fourth most
of gastric cancer cases. Other infectious agents
common malignancy worldwide. Approximately
categorized as carcinogens by the International
one million cases were estimated for 2008, 70% of
Agency for Research on Cancer (IARC) are:
them in less developed areas [2] (Table 1).
Epstein-Barr virus (EBV or HHV4) in lymphomas
Generally, gastric cancer has a poor prognosis.
and nasopharyngeal carcinoma, herpes virus 8
In the US, 66% of the cases are diagnosed when the
(HHV8) in Kaposi's sarcoma, Schistosoma
tumor has extended some degree of dispersal
haematobium in bladder carcinoma, human T-cell
through the gastric wall, and the general five-year
lymphotropic virus type I (HTLV-1) in adult T-cell
survival rate is 25% [3]. For most of the twentieth
leukemia lymphoma, and Opistorchis viverrini in
century the search for the causes of cancer
cholangiocarcinoma [7]. Moreover, chronic
highlighted the role of ionizing radiation and
inflammation is known as a risk factor for
exposure to chemical carcinogens, particularly
increasing numerous types of cancer, containing
tobacco smoke, which is a familiar risk factor for
gastric, esophageal, intestinal, prostate, and others [8].
malignancy in multiple organs, comprising the
Macrophages, dendritic cells, and lymphocytes are
stomach [4]. The twenty-first century has carried
effectors of the inflammatory role in the initiation
more care to infectious agents and chronic active
and promotion of the neoplastic procedure, regularly
inflammation as primary causes of some cancers.
mediated by cytokines and chemokines [9]. This
Considerable indication has become obtainable for
article briefly summarizes the main aspects
the oncogenic role of two virus families: papilloma
concerning gastric adenocarcinomas and the
viruses in carcinoma of the uterine cervix and
carcinogenic effects of HELICOBACTER pylori
hepatitis viruses in hepatocellular carcinoma. Thus
Received: 20/12/2017 DOI: 10.12816/0044643
Accepted: 30/12/2017

Full Paper (vol.708 paper# 13)

c:\work\Jor\vol708_14 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (8), Page 1333-1340

Awareness, Attitudes And Background Information about
The Surgical Options in The Treatment of Obesity Among The
General Adult Population in Riyadh City, Saudi Arabia
Mohammed Obaid Alshammari (1), Hala Ahmed Abuhomoud(1), Khalid Saeed Alanazi (1), Saad
Mohammed AlQahtani (1), Bandar Saeed Alanazi (2), Mohammed Tarek Aiman Halabi(3), Ayat Sami
Qabaja (1), Mohammed Mesfer Al yasin(1), Rawan Adel Shafaay (1), Dalal Sameer Mohamed(1)
1-Almaarefa Colleges, 2- King Saud University, Saudi Arabia,
3-Hadramout university college of medicine, Yemen
: To assess the awareness, attitudes and background information about the surgical options in the
treatment of obesity among the general adult population in Riyadh city, Saudi Arabia
Methods: In this cross-sectional study 420 adult residents from Riyadh from both genders were interviewed
and given specifically designed questionnaire to assess their awareness about weight loss surgery and the
attitude toward it as a method used in the treatment of obesity. Data were collected between September 2017
and December 2017. The questions highlighted 3 health status scales; 4 aspects including subject's
demographics characteristic, personal weight, height and BMI, and their understanding about obesity and its
causes and beliefs about weight loss surgery. Scores were analysed using SPSS.
Results: More than 90% of the participant in this research identified at least three risk factors of obesity, and
more than 90% of the participants had good knowledge about the lifestyle modification to prevent or reduce
obesity, regarding the knowledge about bariatric surgery. Although (79%) of them knew the effectiveness of
bariatric surgery as a method of reduction of weight; only (37.6%) thought that it will reduce mortality among
obese people, (21.4%) knew that weight loss surgeries can result in complications but on the other hand
(42.9%) of subjects thought that bariatric surgery can result in death.
The overall beliefs among the participants regarding the use of bariatric surgery as a method in the treatment
of obesity was poor and only 38% had favourable beliefs about the surgery.
Conclusion: the knowledge of subjects about obesity and its preventive measures were high but the
favourable perceptions about Bariatric surgeries were low. These results indicated that efficient educational
programs about obesity and bariatric surgeries are needed for control of obesity and its complications as well
as increasing the availability of weight loss surgeries.
Bariatric, surgery, awareness, attitude, background information, knowledge


Obesity has become an enormous problem both
adjuncts to lifestyle modification. The third step,
worldwide and in Saudi Arabia. More than 20 % of
and the most invasive one is bariatric surgery [2].
the world population is obese according to the
Many studies have evaluated these three types of
WHO and according to some studies done to
treatments; most of which have demonstrated that
evaluate obesity in Saudi Arabia the percentage is
diet & lifestyle modifications and pharmaceutical
much higher than this. For example, a study was
methods are relatively ineffective in treating morbid
done in Saudi Arabia in 2013 by Habib and his aim
obesity in the long term and that bariatric surgery is
was to assess the obesity prevalence in Saudi adult
the only effective therapy for sustained weight loss
population according to the international standards
in the morbidly obese. Furthermore it will results in
of body mass index (BMI) and body fat percentage
greater improvement in weight loss outcomes and
(BF%). The results showed the prevalence of
obesity-related comorbidities when compared with
obesity in Saudi adults according to the BMI criteria
nonsurgical interventions, and that most patients
(30 kg/m² and above) to be 33.8%, whereas the
with diabetes, hyperlipidaemia, hypertension, and
obesity prevalence was 60% in Saudi adults
obstructive sleep apnoea experience complete
according to the BF% criteria. Many other studies
resolution or improvement of obesity-related
demonstrated an approximate prevalence rate [1].
comorbidities after undergoing bariatric surgery
The treatment of obesity can be classified into 3
regardless of the type of surgical procedure used ]3[.
steps. In the first one the patient grows throw to

reduce his weight is lifestyle approaches that
Although weight loss surgery has been proven to
include diet, physical activity and behaviour
be the most effective method in the treatment of
change therapies. The second step is the
obesity; less than 1 % of eligible patients undergo
pharmacological agents which can be used as
bariatric surgery worldwide and it can be due to the
Received: 16/12/2017 DOI: 10.12816/0044644
Accepted: 26/12/2017

Full Paper (vol.708 paper# 14)

c:\work\Jor\vol708_15 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (8), Page 1341-1345

Laparoscopic Versus Open Adhesiolysis in
Patients with Bowel Obstruction
Mohammed Sunaytan Al Otaibi1, Sama Mohammed Rashad Saleh2, Mohammed Essam Sabbahi3,
Albatul Ahmed Alghamdi4, Hassan Habib Aljurfi2, Nouf Talal Alsufyani5, Moaiyyad Mohammed Kousa6,
Areen Yousef Bouq4, Mohammed Moaed Alghamdi4, Ebtihal Mohammad Al-Khider7, Alaa All
Alrashid2, Sulaiman Ahmed Alhirbish8, Nasser Abdullah Alhazzani9, Alhassan Abdulhameed Alyami10,
Abdullah Mansour Alharthi11, Siddiqa Mahmoud Bahaziq12
1- Security Forces Hospital, 2- King Fahad Genera Hospital, 3- King Abdulaziz University Hospital, 4- Ibn
Sina National College, 5- Battarjee Medical College, 6- King Abdulaziz University, 7- Prince Mohammed Bin
Nasser Hospital, Gizan, 8- Imam Abdulrahman Bin Faisal University, 9- King Saud Bin Abdulaziz University
For Health Sciences, 10- Royal College Of Surgeons In Ireland, 11- King Abdulaziz Medical City For National
Guard, Jeddah, 12- International Medical Center, Jeddah
Corresponding author: mohammed sunaytan Al otaibi - mohammedalfelo624@gmail.com - 0505184655

Adhesions are bands of scar tissue that form between organs. In the abdomen, they form after an
abdominal surgery or after a bout of intra-abdominal infection (i.e., pelvic inflammatory disease, diverticulitis).
More than 95% of patients who undergo abdominal surgery develop adhesions; these are nearly inevitably part
of the body's healing process. Though most adhesions are asymptomatic, some can cause bowel obstructions,
infertility, and chronic pain.
Objectives: Concerning whether patients with chronic pelvic pain benefit from laparoscopic adhesiolysis or
whether any appearing advantage is a placebo effect.
Materials and methods: This review was conducted using a comprehensive search of MEDLINE, PubMed,
EMBASE, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials
from January 1, 1990, through October 31, 2017.
Results: The spectrum of treatments for a small-bowel obstruction ranges from conservative management with
bowel rest to surgical intervention, sometimes involving bowel resection. The caveat with regard to surgical
treatment is that while surgery may be required to release symptomatic adhesions, postoperative reformation of
these adhesions is common. Debate continues as to whether laparoscopic adhesiolysis yields added benefit in
terms of decreasing postoperative adhesion reformation; however, promising results have been obtained with
Open approach.
Conclusion: Laparotomy with open adhesiolysis has been the treatment of choice for acute complete bowel
obstructions. Patients who have partial obstructions, with some enteric contents traversing the obstruction,
might similarly require surgery if nonoperative measures fail.
Keywords: Open Adhesiolysis, Laparoscopic, Bowel obstructions.


Adhesions are bands of scar tissue that form between
treatment is that whereas surgery may be required to
organs. In the abdomen, they form after an
release symptomatic adhesions, postoperative
abdominal surgery or after a bout of intra-abdominal
reformation of these adhesions is common. Debate
infection (i.e. pelvic inflammatory disease,
continues as to whether laparoscopic adhesiolysis
diverticulitis). More than 95% of patients who
yields added benefit in terms of decreasing
undergo abdominal surgery develop adhesions; these
postoperative adhesion reformation; however,
are almost inevitably part of the body's healing
promising results have been attained with open
process [1, 2]. The morbidity from adhesions can
technique [5, 6]. Laparoscopic adhesiolysis was first
range from chronic abdominal pain to female
defined by a gynecologist for the treatment of
infertility [3]. The most common of these conditions
chronic pelvic pain and infertility [7]. In the early
is partial or complete intestinal obstruction, for
days of laparoscopy, previous abdominal surgery
which the small bowel is the most common location.
was a relative contraindication to perform most
Postoperative adhesions account for as many as 79%
laparoscopic procedures. Laparoscopic surgery to
of acute intestinal obstructions [4]. The spectrum of
relieve bowel obstructions was not routinely
treatments for a small-bowel obstruction ranges from
performed. Nevertheless, in 1991, Bastug et al.
conservative management with bowel rest to surgical
described the successful use of laparoscopic
intervention, from time to time containing bowel
adhesiolysis for small-bowel obstruction in one
resection. The caveat with regard to surgical
patient with a single adhesive band [8].
Received: 25/10/2017 DOI: 10.12816/0044645
Accepted: 05/11/2017

Full Paper (vol.708 paper# 15)

c:\work\Jor\vol708_16 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (8), Page 1346-1351
Awareness and Attitude toward Smoking E-Cigarettes (Vape) among
Smokers in Saudi Arabia 2017
Mohammad Ali Karbouji, Alhasan Mohamed Abduldaem, Abdulrahman Muslim
Allogmani, Ahmad Salem Alharbi, Omar Alnozha, Abdulmohsen H. Al-Zalabani
College of Medicine, Taibah University, Almadinah Almunawarah, Saudi Arabia
E-cigarettes was described as battery-operated products designed to deliver nicotine. Its use is
rapidly increasing worldwide specially among youth owing to marketing and media which play a major
important role in making people believe that smoking vape is less harmful than the tobacco cigarettes.
However, chemical analysis of e-cigarettes juices has shown that many carcinogens present in cigarette smoke
are also found in a range of e-cigarette products. Therefore, this study was conducted to evaluate the
awareness and the attitude toward the risk of smoking e-cigarettes vape among smokers in Saudi Arabia.
Method: this cross-sectional study involved 1404 individual living in Saudi Arabia. Adult smoker participants
involved in this study were in the age range 18-60 years old. A self-administrated web-based questionnaire
that include questions about smoking e-cigarettes vape was used to collect data. The collected data were
analyzed using SPSS version 22.0.
Result: our sample study involved 95% males and 5% females. 68.9% were using e-cigarette, with 58.7%
admit to use it daily. 31.1% had never experienced vaping. Those who thought that vaping is absolutely safe
represented 13.7% of our sample study. While 67.5% regarded it dangerous.
Conclusion: there was a high degree of awareness among Saudis about e-cigarettes and vaping, which
highlights the importance of health programmes as well as media targeting youth and the government role
toward the Saudis health.
Keywords: electronic cigarettes, E-cigarettes, vaping, nicotine, youth, electronic nicotine delivery systems
(ENDS), Saudi Arabia

vapor) have shown that many carcinogens present
The Food and Drug Administration (FDA,
in cigarette smoke are also found in a range of e-
cigarettes or e-
cigarette products. To date, the cancer-causing
cigarettes as battery-operated products designed to
potential of e-cigarettes has not been investigated
deliver nicotine, flavor and other chemicals. Using
in e-cigarettes users (i.e., vapers). Use of e-
of these cigarettes is known as Vaping (1). Unlike
cigarettes without a prior history of smoking is
tobacco cigarettes, e-cigarettes (Vaping) do not
currently a rare phenomenon in adults, but is
burn tobacco. Instead, they turn a flavored liquid
increasingly common among youth (9). Because of
into a vapor. Users inhale, or vape, the mist. The
the marketing and publicity, the awareness about
liquid usually contains nicotine. That is a highly
smoking the e-cigarettes vape and their potential
addictive substance naturally found in tobacco (2).
competitive advantages to the traditional cigarettes
Compared to tobacco cigarettes, they are likely to
has increased as well (10).
be safer (3,4), but its use is unsafe and hazardous to
There has been much research conducted to
human health (5,6). E-cigarettes vaping is rapidly
determine the prevalence and to assess the
increasing worldwide (7) especially among youth,
awareness of using the e-cigarettes vaping in the
high-income and urban population. Marketing and
developed countries. In New York City, USA, a
media play a major role in making people believe
study was conducted in 2015, showed that 27% of
that smoking vape is less harmful than tobacco
the participants claimed that they used e-cigarettes
cigarettes and they facilitate to smoking cessation.
every day, while 35% used them because they
In addition, e-cigarettes vaping has multiple
wanted to quit smoking (11).
attractive flavoring options. All these causes make
In Great Britain, a study conducted in 2014
people appealed to use e-cigarettes vaping (5,8). E-
showed that 20% of the participants were currently
cigarettes are highly popular among cigarette
using e-cigarettes and 93% of current and recent
smokers who are unable/unwilling to quit, but are
ex-smokers were aware of e-cigarettes (12). In
willing to switch to putatively less-harmful
Ireland, a study was conducted in 2016, showed
tobacco substitutes. E-cigarettes are also becoming
that 12% of all respondents had tried e-cigarettes
increasingly popular among youth who have never
and 33% regarded e-cigarettes as safer than
conventional cigarettes (13). In Canada, a study was
However, chemical analyses of e-cigarettes juices
conducted in 2014, showed that 16.1% of the
(both in liquid form and after being heated into
participants reported trying an e-cigarette (13). In
Received: 16/12/2017 DOI: 10.12816/0044646
Accepted: 26/12/2017

Full Paper (vol.708 paper# 16)

c:\work\Jor\vol708_17 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (8), Page 1352-1355

Prevalence and Associated Risks of depression Among Patients
Attending the Primary Healthcare Centers in Tabuk, Saudi Arabia
Abdulhadi Turki Alsubaie 1, Hyder O. Mirghani 2
1College of Medicine, University of Tabuk, Tabuk, 2 Department of Medicine,
University of Tabuk, Tabuk, Saudi Arabia
Correspondent author: Abdulhadi Turki Alsubaie, E-mail: Hadi1413x@hotmail.com,Phone No:+966542466533

Depression is on the rise globally and is associated with a high rate of mortality, morbidity,
and suicide.
Objective: To evaluate depression and associated risk factors among patients visiting primary healthcare
centers in Tabuk, Saudi Arabia.
Subjects and methods: This cross-sectional study conducted in Tabuk, Saudi Arabia during the period
from June 2016 to July 2017, 560 participants were recruited from primary health care centers by a
stratified sampling technique. Participants were invited to sign a written informed consent, then
interviewed using the PHQ-9 questionnaire. The questionnaire consisted of nine questions with four
choices each and asking about interest or pleasure in doing things, feeling down or hopeless, the pattern of
sleep, tiredness, appetite, the degree of movement or speaking, concentration, or thought of better dead off
or hurting self. The Statistical Package for Social Sciences (SPSS) was used for data analysis and the
ethical committee of the Medical College, the University of Tabuk approved the research.
Results: Participants (61.2% females), 63.9% were in the range of 18 and 24 years; the majority had
higher education, nearly two thirds 66.3% were single. Mild depression was evident in 21.6%, moderate
depression in 21.3%, while 4.1% had severe depression. Women had more depression than men with a
significant statistical difference (P-value<0.05, no differences in severity of depression was found
regarding age, and marital status (P-value>0.05).
Conclusion: Depression is prevalent among patients attending primary healthcare centers in Tabuk and
was commoner among females. No relationship was observed between depression severity, marital status,
and age.
Keywords: Depression, Associates, Tabuk, Saudi Arabia

primary healthcare visitors. The rates differ
Depression is on the rise globally; this mental
according to geographical location, the time of
health disorder is associated with various organic
the study, and population ages. The Kingdom of
diseases and 69% of patients with depression
Saudi Arabia is a vast country with different
present with somatic symptoms(1). Although
culture and ethnicity. The study conducted in
Western countries and other regions of the
developing countries are harboring the greatest
Kingdom may not apply to Tabuk region. Thus
burden; this serious mental health disorder is
we conducted this research to assess depression
associated with high morbidity and mortality(2).
among patients visiting the primary healthcare
Depression has multiple underlying risk factors
centers in Tabuk City, Saudi Arabia
including stress, chronic medical illness, family

history, low income, job loss, substance abuse,
and female gender(3).
This cross-sectional study was conducted in
The prevalence of depression varied across
Tabuk City, Saudi Arabia during the period from
the globe with the lowest rate (8.5%) reported in
June 2016 to July 2017. Five hundred and sixty
Europe(4) and rate as high as 44% in developing
participants were selected from patients attending
countries with only one third receiving medical
the primary health care centers using multistage
care(5,6). The prevalence of depression increased
randomization. The participants were asked to
significantly in the last decade, and the World
sign a written informed consent form, then a face
Health Organization stated that nearly 15% of
to face interview was conducted using a
patients with major depression have a lifetime
structured questionnaire based on the PHQ-9
risk of committing suicide(7). Previous studies
questionnaire; a well-validated questionnaire.
conducted in the Kingdom of Saudi Arabia(8)
The questionnaire consisted of nine questions
reported prevalence between 30-40% among
Received: 16/12/2017 DOI: 10.12816/0044647
Accepted: 26/12/2017

Full Paper (vol.708 paper# 17)

c:\work\Jor\vol708_18 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (8), Page 1356-1361

Updated Review on Surgical Management of Male Hypogonadism
Moaz Hassan Alharbi , Mohammad Abdullah Alelyani , Mohammed Walidadham ,
Ahmad Abdullah Algarni , Khaled Faisal Algahtani , Sultan Jaberalfaifi
Prince Sattam Bin Abdulaziz University
Corresponding author: Moaz Hassan Alharbi. E-mail:Moaazalharbi@hotmail.com, Phone Number:+966545843177

In this review, we discuss the treatment options for male hypogonadism and the associated benefits and potential
short- and long-term risks. The choice for treatment may depend on the cause of hypogonadism and the desire for
maintaining or improving fertility. We also highlight surgical management of male hypogonadism. Comprehensive
searching strategy through Well-known medical databases (MIDLINE/ PubMed, and Embase) searching articles that
published in English language up to December 2017, and discussing the surgical management of male
hypogonadism. Malehypogonadism is identified by the presence of symptoms or signs of male hypogonadism and
consistent serum testosterone levels that are below the normally accepted adult male range. Once the medical
diagnosis is confirmed, the primary goal of treatment is testosterone substitution to accomplish serum testosterone
levels that remain in the mid-adult range and the symptoms and signs of hypogonadism are eliminated. Recent
developments led to numerous delivery systems for testosterone. For patients with primary hypogonadism
testosterone therapy is the approach of choice. The patient needs to be completely informed about expected benefits
and side-effects of the treatment option. The option of the preparation should be a joint decision by a notified patient
and the doctor.
Keywords: surgical management , male,hypogonadism.

unusual in clinical practice except in tertiary referral
Male hypogonadism is defined as the failing to
centers. Hypogonadotropichypogonadism could be
generate sufficient flowing testosterone and/or
because of congenital and/or acquired problems.
spermatozoa in the ejaculate, resulting in symptoms
Congenital hypogonadotropichypogonadism can occur
and signs of testosterone deficiency and/or infertility
as a result of problems in gonadotropin releasing
[1].Male hypogonadism needs to be identified and
hormone (GnRH) nerve cells, GnRH controlling
treated, since when neglected, hypogonadal men may
neurons, luteinizing hormone (LH) and follicle
develop a clinical disorder of lowered sexual function,
stimulating develop (FSH) secreting cells.
infertility, tiredness, damaged sense of well-being,
These could include genetics anomalies that affect
anemia, decreased bone density, decreased lean body
the movement of GnRH nerve cells (e.g., Kallmann
mass (LBM) and muscle strength, as well as enhanced
syndrome) and mutations in genes that impact signals
fat mass and visceral adiposity, which might be
regulating GnRH neurons.
associated with metabolic disorder [1,2].The reduced
Separated hypogonado-tropichypogonadism could
practical capability of the testis to produce adequate
also take place due to focal flaws in LH and FSH
amounts of testosterone and/or mature spermatozoa
secreting cells. Obtained problems can develop from
can be due to issues in the testis, pituitary and/or
architectural defects or reversible reasons. Acquired
hypothalamus, or at numerous degrees.
architectural defects can include damage of GnRH
Primary hypogonadism results from disorders of
nerve cells (e.g., meningioma, craniopharyngioma,
the testes that result in low testosterone production and
vascular injury), tumors in the pituitary or suprasellar
damaged spermatogenesis. The more typical causes of
region that hinders typical transportation of
hypothalamic releasing or hindering variables getting
to the pituitary, damages from trauma or radiation,
chromosomal defects (e.g., Klinefelter syndrome),
infections (e.g., abscesses, tuberculosis) and
testicular injury (e.g., chemotherapy, radiation,
infiltrative illness that impact the hypothalamus and
surgical procedure, trauma) and infection. The
pituitary (e.g., sarcoidosis, hemochromatosis).
occurrence of Klinefelter syndrome is thought to be in
Potentially relatively easy to fix causes of
between 0.15 and 0.2% in males [3].
The frequency of hypogonadism due to genetic or
medications (e.g., metoclopramide, opioids, GnRH
idiopathic problems in the pituitary or hypothalamus is
agonists and villains), acute systemic ailment, chronic
Received: 16/12/2017 DOI: 10.12816/0044648
Accepted: 26/12/2017

Full Paper (vol.708 paper# 18)

c:\work\Jor\vol708_19 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (8), Page 1362-1364
Prevalence of Gall bladder Disease in King Faisal Medical
Complex (Taif): A Retrospective Study
Samah Saud Al Juaid, Fatmah Meteb Al.Nofei, Hanan Abid Al Qurashi, Adel Dakhel
Almaymuni, Mohamed Abdul Samie Mitkis, Muhammad Asadullah, Mohamed Ghilani
Taif University, College of Medicine
Coressponding outhor: Samah Saud Al juaid, email: samahsaud@hotmail.com, phone number: 00966533872708

gallstone disease is defined as the presence of gallstones accompanied by symptoms
attributable to their presence (Biliary colic) or complications such as cholecystitis,cholangitis and biliary
pancreatitis. In addition, the disease is thought to be a risk factor for developing pancreaticobiliary cancer.
Objective: this study aimed to determine the rate of biliary disease in King Faisal Medical Complex as a
reflection of the prevalence of the disease in Taif region.
Methods: this a cross sectional retrospective analysis included 565 patients with gallstone disease , in King
Fisal Medical Complex during 1 year (from 1 July 2015 to 30 Jun 2016). Data of the patients were collected
from patient's files which included 4 departments. 1-Emrgency Room 2-Surgical Outpatient Department 3-
Operating Room and 4-Histopathological Department. Result: this study included 565 patients with gallstone
disease, (10 years and above) . 398(70%) females, 167(30%) males. Mean age for females was 44.89 years
(SD+15.93), Mean age for males was 48.45 years (SD+19.67). The overall ratio of gall bladder disease to all
general surgery operation was 24%. The Majority of them diagnosed with chronic cholecystitis present to
OPD (57%), while acute cholecystitis presented to ER was 43%. Most of them were females (77%)while,
males were 23%. 85% of patients underwent to lap cholecystectomy with 1% rate of conversion. 14% of
patients underwent ERCP and 1% open cholecystectomy.There was significant gender differences in type of
operation (P value=.013). 38% of male patients with gallstone disease came to the emergency department
compared to 62 % of females.Variety of GBD diagnosis was observed , chronic calculous cholcystitis (50%)
acute calculous cholecystitis and empyema (30%), obstructive jaundice (14%), Biliary colic (5%),GB mass
(1%). Conclusions: the number of patients presented with gall stones disease and it's complications to King
Faisal Medical Complex, Taif alone showed significant high number, mostly due to hypoxia as our region is
one of the highest altitude region in the Middle East. Prevalence of disease was more in female population
and it showed the target population which should be educated regarding prevention of disease.
Keywords: gallbladder disease , prevalence , high altitude , Saudi Arabia .


Gallstone disease is defined as the presence of
gallstones accompanied by symptoms attributable
to their presence (Biliary colic) or complications
Histopathological Department. The study was
such as cholecystitis,cholangitis and biliary
done after approval of ethical board of Taif
pancreatitis. In addition the disease is thought to be
a risk factor for developing pancreaticobiliary
Data analysis for different variables was done.
cancer (4). Cholecystectomy is one of the most
The categorical variables were presented with
common operations performed in general surgical
frequency and percentage. T-test was used to
units throughout Saudi Arabia and this rate
analysis continuous data . The categorical variables
increased after introduction of laparoscopic
were analyzed using the Chi square test. A P-value
.013 was considered significant. Data were
analyzed by the Microsoft XL 2010.
The aim of this study was to determine the rate
of biliary disease in King Faisal Medical Complex
This study included 565 patients with gallstone
as a reflection of the prevalence of the disease in
disease, (10 years and above) . 398(70%) females,
Taif region.
167(30%) males. Mean age for female was 44.89
years (SD+15.93), mean age for male was 48.45
This study is retrospective analysis of 565
years (SD+19.67).
patients with gallstone disease , in King Fisal
Age descriptive analysis Mode 40 , largest age 98 ,
Medical Complex during 1 year (from 1 July 2015
smallest 10 .The overall ratio of gall bladder
to 30 Jun 2016) .Data of the patients were collected
disease to all general surgery operation was 24% .
from patient's files which included 4 departments.
Received: 16/12/2017 DOI: 10.12816/0044649
Accepted: 26/12/2017

Full Paper (vol.708 paper# 19)

c:\work\Jor\vol708_20 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (8), Page 1365-1370

Assessment of Adherence to Hypertension Medications and Awareness of
Hypertension Medications among People with Hypertension in Tabuk
Abdulelah Mohammed Alqarni, Alhawiti Saleh Hammad M, Mohammed Ahmed Alhejaili,
Ahmad Awadh Alatawi, Mohammed Hamad Alrashedi, Meshari Faisal Alenezi,
Khalid Awd Albalawi, Meshal Saleh Alatawi
Faculty of Medicine, University of Tabuk, Tabuk/ KSA
Corresponding author: Abdulelah Mohammed Alqarni, Email: Drjash57@hotmail.com, Telephone: +966 535909935

in 2015, there were 1.13 billion people living with high blood pressure worldwide. The
prevalence of hypertension worldwide is of about 40%. In Saudi Arabia it reached 3.2% among those aged
between 15-24 years, 51.2% among those aged 55-64 years and up to 70% among those aged 65 years and
older. It has been observed that there is an increase in prehypertension cases, reaching 46.5% (3 millions)
among males and 34.3% (more than 2 million) among females. Worldwide, raised blood pressure is
estimated to cause 7.5 million deaths, about 12.8% of the total of all deaths. Aim of the work: this study
aimed to assess knowledge of hypertension and to determine factors affecting the compliance of hypertensive
patients to their antihypertensive drugs. Methods: we have conducted a descriptive cross-sectional study in
Tabuk city population, Saudi Arabia. This study was conducted during the period from August to December
2017. The participants were selected by random sampling. Sampling included the different geographical
areas of the city. The total sample included 108 pupils. All the pupils were approached to obtain the desired
sample size. A self-administered questionnaire about hypertension and complications was filled by the
Results: in this study, participants classified to three groups according to age: less than 40 years old from 40
to 65 years old and 65 years old or above. Male and female groups contributed to 72.2% and 27.8%
respectively. The majority of participants were university graduates (55.6%) and about 33.3% were
secondary education. The majority of participants with hypertension were on one medications prescribed for
treatment of their high blood pressure and the majority of participants(66.7%) were poorly compliant to their
hypertension medication.
more attention is needed on preventive educational programs that focus on awareness and
assessment of the hypertension medications adherence, complications of hypertension, and the danger of
poor control of it.
: Hypertension, adherence, control, perception

risk of cardiovascular disease doubles for each
In 2015, there were 1.13 billion people living
increment of 20/10 mmHg of blood pressure,
with high blood pressure worldwide [1]. The
starting as low as 115/75 mmHg. In addition to
prevalence of hypertension worldwide is of about
coronary heart diseases and stroke, complications
40% [1]. In Saudi Arabia it reached 3.2% among
of raised blood pressure include heart failure,
those aged between 15-24 years, 51.2% among
peripheral vascular disease, renal impairment,
those aged 55-64 years and up to 70% among
retinal hemorrhage and visual impairment.
those aged 65 years and older. It has been
Treating systolic blood pressure and diastolic
observed that there was an increase in
blood pressure until they are less than 140/90
prehypertension cases, reaching 46.5% (3
mmHg is associated with a reduction in
millions) among males and 34.3% (more than 2
cardiovascular complications[3].
million) among females [2].
Adherence to prescribed medication is an
Worldwide, raised blood pressure is estimated
imperative issue which can be directly linked with
to cause 7.5 million deaths, about 12.8% of the
the management of chronic diseases like
total of all deaths. This accounts for 57 million
hypertension; failure to adhere can affect the
disability adjusted life years (DALYS) or 3.7% of
effectiveness of medication as well as the
total DALYS [3]. Blood pressure tends to rise as
efficiency of the health care system. There is
people get older, Raised blood pressure is a major
scarcity of information regarding the level of drug
risk factor for coronary heart disease and ischemic
adherence for antihypertensive medications and its
as well as hemorrhagic stroke. Blood pressure
determinants in Ethiopia, particularly in the study
levels have been shown to be positively and
area[4]. Adherence to antihypertensive medications
continuously related to the risk for stroke and
is a crucial mediator of favorable outcomes in
coronary heart disease. In some age groups, the
treating HTN, and non-adherence, in turn, halts BP
Received: 25/10/2017 DOI: 10.12816/0044650
Accepted: 05/11/2017

Full Paper (vol.708 paper# 20)

c:\work\Jor\vol708_21 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (8), Page 1371-1376
Relationship Between Corneal Astigmatism and Intraocular Pressure
Abdulrahman E. Algarni1, Mohammad Abahussin2, Nuha S. Al Salameh3,
Ahmad S. Alomari4, Yara M. Mokarki5
1- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, 2- Optometry
Department, College of Applied Medical Sciences, King Saud University, Riyadh, 3- Collage of Medicine,
King Saud University, Riyadh, 4- Collage of Medicine, King Saud Bin Abdulaziz University for Health
Sciences, Riyadh, 5- College of Medicine, Jazan University, Jazan University
Corresponding Author: Abdulrahman E. Algarni, E-mail: Algarni004@KSAU-HS.EDU.SA

Aim of the work:
this study aimed to investigate the relationship between the Intraocular Pressure(IOP)
readings measured by Goldmaan Tonometry and the amount of corneal astigmatism in healthy young
subjects and to assess the reliability of the measurements obtained with the instruments.
Method: intraocular pressure measurements were obtained by Goldmann Applanation Tonometer (GAT)
(Haag-Streit International, Koeniz, Switzerland), while keratometry readings for corneal curvature were
obtained by an Auto-Kerato-Refractometer (ARK-KR.8800, Topcon, Tokyo, Japan). An interval was kept
between the keratometric measurements and the IOP measurements. The sequence of measurement was
randomized with all participants. Three measurements were taken within ten minutes and the reading was set
to one immediately after any measurement were taken.
Result: the average age of the volunteers was 22.4 ± 1.5 years (mean age ± SD; range: 20­26 years). Mean
Intraocular Pressure (IOP) of the right and left eyes in the first visit (Paired t-test: P = 0.6471) and second
visit (Paired t-test: P = 0.5805). The session one means GAT ; IOP was 16.48 ± 3.33 mmHg and 16.59
±3.47mmHg (right and left eye respectively), while in session two it was15.714±3.10 mmHg and 15.82 ±
2.76 (right and left eye respectively) . The mean corneal astigmatism was -0.24 ± 1.48D, -0.38 ± 1.53 D,
right and left respectively in the first visit and -0.34 ± 1.44D, -0.40 ± 1.64D right and left eye second visit
Conclusion: the GAT-IOP was less affected by the amount of corneal astigmatism and GAT-IOP was not
significantly higher in eyes with greater corneal astigmatism and the repeatability results, although the
differences were stastistically significant, they were not clinically significant.
Keywords: glucoma corneal astigmatism, Goldmann tonometry, auto-refractometer.

Most people who wear glasses have astigmatism.
When the drainage tubes (Trabecular
Intra Ocular Pressure (IOP) measurement is the
meshwork) within the eye become slightly
base in the diagnosis and management of most of
blocked, glaucoma can occur. Glaucoma can badly
the ophthalmology diseases. For many years
affect the eye to blindness. Early treatment of
Goldmann Applanation tonometry (GAT) is the
glaucoma can prevent eye damage (1).
method that is used to measure the IOP through
When the fluid of the eye cannot drain properly,
Imbert­Fick law, as the force required to
pressure builds up. This is called intraocular
applanate, is the same as the IOP times the
pressure. This can damage the optic nerve, which
applanated area (7.35 mm2 ) (6).
connects the eye to the brain and the nerve fibers
Also, Goldmann reported that central corneal
from the retina (the light-sensitive nerve tissue that
thickness (CCT) could affect the IOP. However, it
lines the back of the eye) (2). The corneal
was reported that this method has some errors in
astigmatism was determined as the dioptric
the measurement IOP because of corneal thickness
difference between the steep and flat meridians.
(7) corneal curvature, or the tear film (8,9) So, it is
Corneal curvature is typically measured by
obviously that GAT-IOP readings are influenced
keratometry or videokeratography.
by corneal astigmatism [0.25 to 0.67 mmHg per
Both methods have been shown to be repeatable
diopter (D)](10,11) .
in measuring spherical surfaces, such as steel balls,

to within 0.25 diopter (3). For normal human
corneas, keratometry has been shown to be
This study aimed to investigate the relationship
(4) and
between the Intraocular Pressure(IOP) readings
videokeratography to within 0.50 D (5).
measured by Goldmaan Tonometry and the
Astigmatism is a minor condition of the eye that
amount of corneal astigmatism in healthy young
causes blurred vision. It occurs when the cornea is
subjects and to assess the reliability of the
not a perfectly curved shape.
measurements obtained with the instruments.
Received: 16/12/2017 DOI: 10.12816/0044651
Accepted: 26/12/2017

Full Paper (vol.708 paper# 21)

c:\work\Jor\vol708_22 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (8), Page 1377-1380

Assessment of Knowledge, Attitude and Practice towards Irritable
Bowel Syndrome and Risk Factors in Riyadh City, 2017
Ghadah Abdulrahman Algabr 1, Turki Khalid Alotaibi2, Afnan Mutlaq Alshaikh3,
Yasmen Taha Maimani3, Mosab Shaher AlShehri4
1-Pavol Jozef safárik University 2-King Saud University
3-Ibn Sina National College 4-Al-Imam Muhammad Ibn Saud Islamic University
Irritable bowel syndrome (IBS) is a worldwide problem which affect the health and the economy
of countries; thus it is the focus of many researchers till now.
Objectives: Evaluating the knowledge, attitude and practice (KAP) of the Saudi community in Riyadh City
toward the signs and risk factors of IBD in Kingdom of Saudi Arabia (KSA).
Methods: A cross sectional study conducted at 12 different malls in Riyadh city from October to December
2017 among 977 Saudi adult educated subjects from both genders aged from 20-60 years old.
Results: The prevalence of IBS among the Saudi community was 10.8% (106 out of 97 subjects).
The majority of the subjects has proper awareness regarding the IBS and its risk factors (81.1%) while only
18.9% had poor knowledge about the syndrome. Most of the subjects had positive attitude toward using diet,
medications and counselling as the proper management of IBS. The level of knowledge showed a significant
association with the higher level of education. Conclusion: The majority of subjects had proper knowledge
about the nature, prognosis and risk factors of the disease. Other studies should be conducted to measure the
KAP of other Saudi population toward IBS from different regions of KSA.
Keywords: Knowledge, Attitude, Practice, irritable bowel syndrome (IBS), Risk factors, Riyadh city, KSA.


Riyadh City toward the signs and risk factors of
The irritable bowel syndrome (IBS) is
defined as gastrointestinal disorder associated with
chronic discomfort and abdominal pain with
Study design
alteration of the bowel without pathological
A cross sectional study conducted at 12 different
condition (1, 2). It is a worldwide problem which
malls in Riyadh city from October to December
affect the health and the economy of countries, thus
it was the focus of many researchers but till now its
Study population and sample size
etiology is still a debate. However, this condition
The study population were Saudi adult subjects
was usually combined with noncolonic symptoms(3,
from both genders aged from 20-60 years old and
. About 12% of the primary health care visits as
were able to read and write. The Riyadh city was
well as 28% of visiting gastroenterologists were
divided into four parts then 12 random malls were
associated with IBS (1, 5).
chosen from different parts of the city using multi-
This condition could result in many direct
randomized sampling technique. The study included
and indirect economic burdens because of the need
977 Saudi subjects who were interviewed at
to continuous management which is expensive and
shopping malls and were asked to fill up the
should not be underestimated(4, 6). This condition
also utilizes more healthcare resources with more
frequent physician and primary health care visits,
Study tools

medications, surgery and laboratory investigations
The questionnaire was developed and validated
(7, 8). IBS impairs the quality of life and could affect
by the supervisors after reviewing the available
the physical function, emotional and social life
online studies on the research engines that were
resulting in depression, loss of confidence and
conducted in KSA to study the KAP of Saudi
retardation in work status (9, 10). However being
subjects toward IBD and its risk factors. The
simple condition, its symptoms present as serious
questionnaire was translated into simple Arabic to
conditions and may be serious than diabetes and
provide access for all subjects who can't read
hypertension (11, 12). The diagnosis is based on the
English. The questionnaire included 4 parts divided
symptoms but some other diseases may share the
as demographics, knowledge, attitude and practice
same signs as colon cancer and diarrhea, thus
of the subjects.
optimal management is based on proper and correct
Ethical approval
diagnosis (8, 13). The present study aimed at
The questionnaire was revised and approved by the
assessing the KAP of the Saudi community in
supervisors and the ethical committee of the Faculty
of Medicine. All the included subjects gave an
Received: 15/12/2017 DOI: 10.12816/0044652
Accepted: 25/12/2017

Full Paper (vol.708 paper# 22)

c:\work\Jor\vol708_23 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1381-1387

DWI in Assessing Aggressiveness of Rectal Cancer
Muhammad Yusuf Abd El-Kader, Rasha Salah El-Din Hussein, Waseem Mohamed
Mahmoud El-Gendy, Hanaa Abd El-Kader Abd El-Hamid
Radiology Department, Faculty of Medicine, Ain Shams University
Corresponding author: Muhammad Yusuf Abd El-Kader, muslim_doctor_asu@yahoo.com

diffusion-weighted magnetic resonance imaging (DW-MRI) permits non-invasive assessment of
tumor characteristics.
Aim of the work: this study was aimed to emphasize the role of DWI in assessing aggressiveness of rectal
cancer with the histopathological correlation.
Patients and methods:
this was a prospective study that included thirty patients with histopathological proved
rectal carcinoma referred from the Surgical Department, Ain Shams University Hospitals to the MRI
Radiology Unit for Rectal Cancer Staging.
Pelvic MRI study with conventional sequences and DWI were performed.
Results: 81% of moderately differentiated adenocarcinoma (ADC) (grade II) showed restricted diffusion with
low signals in ADC sequence, while none of the poorly differentiated adenocarcinoma (grade III) showed
restricted diffusion with high signals in ADC sequence (T2 shin-through). There was a high statistically
significant difference in characterization of poorly (grade III) and moderately differentiated adenocarcinomas
(grade II).
Conclusion: significant correlations were detected between mean ADC values and differentiation grade. ADC
may be useful as an imaging tool for re-staging of tumor aggressiveness, but it cannot serve as an independent
tool for primary staging of rectal cancer.
magnetic resonance imaging, MRI, diffusion weighted imaging, DWI, rectal cancer, diagnosis,
pathology staging and disease assessment


pelvis by delineating rectal tumors through
Colorectal cancer is the second most
increases in spatial and contrast resolution.MRI
common cancer in women and the third most
has overall accuracies for T staging of 65­86% [4].
common cancer in men. In recent years, mortality
Due to its ability to detect and characterize
rates have decreased due to major changes in
tumors diffusion weighted imaging (DWI) is
therapeutic management, in particular the
increasingly incorporated into standard magnetic
standardization of the operative procedure and
resonance imaging (MRI) protocols for tumor
more important accurate pre-operative strategy
imaging [5].
depending on imaging [1].
Moreover, when the DWI is co-registered
Around 40­50% of colorectal cancers are
with T2W images, the T-staging can be performed
located in the rectum. Rectal cancer is defined as a
with high accuracy [6].
tumor whose margin measured with the rigid

rectoscope was 16 cm or less from the cutaneous
The aim of the current work was to emphasize
line [2]. Preoperative imaging for rectal cancer
the role of DWI in assessing aggressiveness of
staging is also useful to determine which surgical
rectal cancer with the histopathological correlation.
technique would be more appropriate. Ideal

imaging modality should accurately assess the
depth of tumor penetration (T), lymph node

involvement (N), presence of distant metastatic
This prospective study was approved by an
disease (M), mesorectal fascia involvement, and
institutional review board; informed consent was
anal sphincter involvement which affect the
obtained from all patients. The study population
prognosis of rectal cancer [3].
included 30 patients with rectal cancer referred
MRI is currently one of the most accurate
from the Surgical Department, to the MRI
noninvasive modalities for staging rectal
Radiology Unit, Ain ham Univerity Hopital,
carcinoma. The introduction of phased-array coil
Cairo, Egypt, for Rectal Cancer Staging, during the
and the development of T2-weighted fast-spin
period of Dec 2016 to Oct 2017.
sequences have enabled accurate determination of
Inclusion criteria were patients who had
prognostic factors and anatomic assessment of the
histopathologically proved rectal cancer and were
Received: 25/10/2017 DOI: 10.12816/0044653
Accepted: 05/11/2017

Full Paper (vol.708 paper# 23)

c:\work\Jor\vol708_24 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (8), Page 1388-1392

Metabolic Syndrome: Pathophysiology and Treatment
Amro Sultan Bokhari1, Mohannad M. Alshaya2, Mohannad Mobarak Omar Badghaish3, Mohammed
Anwar Albinissa4, Khalid Difallah Al-Harbi5, Mohammed Younes Almoghrabi6, Mustafa Fareed
Sannan5, Samih Ali Dawas7, Rayan Abdulshakur Niyazi5, Thamer Fahad Sallum8, Sokinh Ahmed
Almaghaslah9, Ahlam Ajlan Alshehri10, Sultan Hazem Alqarni3, Nasser Saeed Nasser Alasmari11,
Darwish Tariq Khizindar12, Anas Ahmed Almulhim13
1- Ibn Sina National College, 2- King Saud Chest Hospital, 3- King Abdulaziz University, 4- Primary Health
Care in Dammam, 5- Umm Alqura University, 6- Batterjee Medical College, 7- Armed Forces Southern
Region Hospital, 8- Majmaah University, 9- King Salman Bin Abdulaziz Hospital, 10- King Abdulaziz
Hospital, 11- King Khalid University, 12- King Abdulaziz University Hospital, 13- King Faisal University
Corresponding Author: Amro Sultan Bokhari - Amrbokhari99@Gmail.Com - 0566369392
Metabolic syndrome is a group of abnormal laboratory and physical findings, such as
dyslipidemia, hypertension, glucose intolerance, proinflammatory state, and prothrombotic state that results in
a patient having significantly higher risk for atherosclerosis, cardiovascular disease, and overall mortality.
There are slight differences between institutions in defining metabolic syndrome across the world. To achieve
adequate management and treatment and decrease the risk of subsequent diseases, proper identification of
symptomatic patients with metabolic syndrome is necessary.
Aim: In this review, we aimed to study the pathophysiology behind the development of metabolic syndrome,
and also to explore the approach to its management.
Materials and Methods: We conducted this review using a comprehensive search of MEDLINE, PubMed,
and EMBASE, January 2001, through February 2017. The following search terms were used: metabolic
syndrome, pro-thrombotic state, pro-inflammatory state, diabetes mellitus, insulin resistance, obesity and
cardiovascular mortality. Results: The major aspects of treatment include weight reduction by diet, medication,
as well as bariatric surgery (in some cases), and managing hyperglycemia and insulin resistance with diet and
medication. Conclusion: The most important intervention in managing patients with metabolic syndrome is
lifestyle modification with improved diet and exercise. To achieve adequate treatment and decrease the risk of
adverse outcomes, proper identification of symptomatic patients with metabolic syndrome is necessary.
Keywords: metabolic syndrome, diabetes mellitus, insulin resistance, obesity, cardiovascular mortality, pro-
thrombotic state, pro-inflammatory state.


used in clinical settings). On the other hand, the
Metabolic syndrome (MetS) consists of a
ATPIII use other more reliable measures for
collection of abnormal physical and laboratory
diagnosis, making this easier to clinicians. However,
findings that occur due to the integration between
the most concerning limitation of the ATPIII
biochemical, clinical, physiological, and metabolic
definition is its inaccuracy when applied to different
factors, resulting in a significant increase in
ethnicities, especially when dealing with obese
atherosclerosis, cardiovascular disease, and overall
patients. For example, the prevalence of obesity is
mortality. These abnormal findings include
higher in Europe than Asia, which will directly affect
dyslipidemia, hypertension, glucose intolerance, pro-
the risk of type 2 diabetes mellitus. Therefore, it has
inflammatory state, and pro-thrombotic state. This
been difficult to create a unified definition for MetS
definition of MetS is considered the most recent and
with unified criteria with specific cut-offs that can be
is based on the World Health Organization (WHO),
applied to different racial and ethnic groups. This
the National Cholesterol Education Program Adult
made IDF propose their new criteria that takes
Treatment Panel III (NCEP ATP III), American
varying populations, races, ethnicities, and
Association of Clinical Endocrinologists (AACE),
nationalities into consideration when evaluating
the European Group for the study of Insulin
body weight and waist circumference. These criteria
Resistance (EGIR), and the International Diabetes
also consider the differences between groups
Federation (IDF) [1].
regarding the association between these values, and
There are minimal differences between the
cardiovascular diseases risk [2].
definitions of MetS by each organization, which can
make a single definition harder. The definitions
· Data Sources and Search terms
suggested by AACE, WHO, and EGIR depend
We conducted this review using a comprehensive
mainly on insulin resistance. So, the diagnosis will
search of MEDLINE, PubMed, and EMBASE,
be done with an oral glucose tolerance test, and/or
January 2001, through February 2017. The following
hyperinsulinemic-euglycemic clamp (which is not
Received: 20/12/2017 DOI: 10.12816/0044654
Accepted: 30/12/2017

Full Paper (vol.708 paper# 24)

c:\work\Jor\vol708_25 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (8), Page 1393-1400

Neoplasms of the Palate: A Review
Naif A. Allah Abu Rass1, Emad Ridha Surougi1, Shahad Mohammed Baheydarah2, Albatool
Hassan Baroom3, Hannah ALGhamdi3, Hala Kamal AlTuwayjiri4, Nada Nasser AlMansour5
1 Ministry of Health, 2 King Abdulaziz University, 3 Batterjee Medical College for Sciences and
Technology, 4 Riyadh Colleges of Dentistry and Pharmacy, 5 University of Hail
Corresponding Author: Naif A. Allah Abu Rass, Tel no: +966543333898
The palate is defined as the roof of the mouth. It is alienated into soft palate which is essential for
nasal passage protection and formation of speech sound and the bony hard palate which acts as a barrier
between the mouth and the nasal cavity. A natural opening in the palate for nerves and blood vessels can create
a passage for neoplasms to spread into the nasal cavity such as epidermoid carcinoma, adenocarcinoma and
benign mixed tumors and rarely Melanoma, lymphosarcoma and Myosarcoma.
Neoplasms of the palates results in significant masticatory, speech and swallowing disturbance and surgery
remains the recommended treatment modality. However, provided the profound functional and cosmetic
importance of the oral cavity, management of Palates cancers requires a thorough understanding of disease
progression, approaches to management and options for reconstruction.
Aim of the study: was to review the different types of neoplasms of the Palates along with the etiology,
diagnosis and with emphasis on the surgical intervention.
Methods: electronic search of available Literature review in the scientific database of retrospective studies and
systematic reviews investigating incidence, prevalence, etiology, symptoms, risk factors, diagnosis and surgical
intervention of different types of oral cavity particularly palatal neoplasm from 1960 to 2017­ (Medline,
Embase, the Cochrane Library , NHS center websites as well as an individual Dentistry journals such as
International Journal of Prosthodontics, International Journal of Periodontics and Restorative Dentistry. Search
included English Publications which were obtained from both reprint requests and by searching the database.
Conclusion: Cancer of the oral cavity is mostly trigger by smoking, alcohol abuse. The most common
neoplasms of the hard palate are MSGTs and SCCs for the soft palate. Primary surgical resection with or
without postoperative adjuvant therapy remains the upmost recommended treatment approach. It is also critical
to have a Multidisciplinary treatment to help improve the oncologic and functional results in oral cancer
Keywords: Oral cavity, Hard palate, surgical intervention, carcinoma, neoplasm, tumors.


The oral cavity contributes to a complex array of
but with a distinct nasal vibration which makes their
functions that include speech, mastication,
diction very unclear [2].
salivation, early digestion, and oral/oronasal

competence. The anatomic subsides of the oral
Neoplams of the oral cavity
cavity include the labial mucosa, buccal mucosa,
Oral cavity cancer ranks among the top ten
floor of mouth, alveolar ridge and gingiva, anterior
most prevalent malignancies affecting patients
two-thirds of the tongue (anterior to the
worldwide [3].Cancer of the soft palate accounts for
circumvallate papillae), hard palate, and retromolar
approximately 2% of head and neck mucosal
trigone [1].The palate is divided anatomically into the
malignancies. Half of all hard palate cancers are
hard palate (part of the oral cavity) and the soft
squamous cell carcinomas (SCCs) as seen in the
palate (part of the oropharynx). The hard palate is
image below. Nonsquamous cell cancers, including
the anterior bony subsection of the palate of the
minor salivary gland cancers, sarcomas, and
mouth the most common site of minor salivary
melanomas, account for the other half (see the
gland tumors in the oral cavity.
histologic distribution of hard palate malignant
The function of the hard palate includes both
neoplasms and the histologic types and frequencies
feeding and speech. Before modern surgeries were
of minor salivary gland neoplasms of the palate
developed, infants with defective palates couldn't
below) [3]. Palatal tumors commonly arise from the
suckle and would often die. It is used to create a
minor salivary glands, and benign tumors account
vacuum which forces the liquid into the mouth so
for approximately half of all minor salivary gland
that it can be ingested. It is also essential, along with
tumors. Minor salivary gland tumors have an
the tongue, to create certain phonetic sounds. When
affinity for the posterior hard palate and soft palate
a person has a cleft palate for example, they are
and virtually never arise in the midline, probably
either unable to pronounce these sounds or they do
because of the distribution of palatal salivary glands.

The majority of benign salivary gland tumors of the
Received: 15/12/2017 DOI: 10.12816/0044655
Accepted: 25/12/2017

Full Paper (vol.708 paper# 25)

c:\work\Jor\vol708_26 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (8), Page 1501-1408

Review of Current Concepts Femoral of Head Osteonecrosis
Mazen Ali Alqahtani, Abdulrahman Jalwi Korkoman, Lamyaa Omar Saad Al-Gelban,
Asma Saad Alahmari, Dhuha Saeed Motlag
Collage of Medicine, King Khalid University
Corresponding author: Mazen Ali Alqahtani, 00966555187355, Email: Mazinalmosa@gmail.com

The avascular necrosis (AVN) or osteonecrosis of the femur head (ONFH), an illness with several
etiological factors, impacts young populace and otherwise handled prompt, causes the collapse of femur head
eventually requiring hip arthroplasty. Objective: the present article aims to provide an overview of
epidemiology, pathophysiology of osteonecrosis along with diagnosis methods and non-surgical in early stages
and surgical treatment methods. Methodology: Comprehensive search of the literature was conducted in the
following databases; PubMed, and SciVerse Scopus for studies published before November 2017. The PubMed
database was searched using an algorithm comprising relevant MeSH terms including "Osteoporosis", "femoral
head osteonecrosis" AND "management" "diagnosis".
Osteonecrosis is a destructive pathology that eventually results in bone death through loss of blood
to the bone, it involves almost every bone including the femoral head while early start of osteoarthritis could
ultimately demand hip arthroplasty when non-operative procedures and joint-sparing treatments fail.
Nevertheless, recent technological advances in surgical treatment methods have improved outcomes and should
help patients recover from this functionally debilitating joint disease.
Keywords: Avascular necrosis, Osteonecrosis, Etiological.


Avascular necrosis (AVN), aseptic necrosis,
between 1989 and 2003, was from 1.4 to 3 cases per
ischemic necrosis or Osteonecrosis of the femur head
100 000 inhabitants [5].
(ONFH) is a pathologic condition with several
The rise in the number of patients diagnosed with
underlying causes that eventually results in the
AVN has increased in recent years accross the world
collapse of femur head and hence demanding hip
as a result of the broad use of corticosteroids and the
arthroplasty[1]. Early presentation of AVN is usually
increase in alcohol consumption along with the high
painless with nonspecific signs and symptoms, yet
incidence of local trauma. Given that the life
pain develops gradually with a profound limitation of
expectancy of patients with associated diseases has
hip motion. The pain is not only localized to the
increased led to a higher incidence of this disease.
groin area, but can also extend to the knee, greater
There was an increased number of patients that had
trochanteric region or ipsilateral buttock. Pain has an
access to modern diagnostic imaging, which has
inverse relationship with rest while it can be
helped in the early detection of AVN through MRI
aggravated by weight gain [1,2].
and CT) [3].
The prevalence of avascular necrosis of the

femoral head is not clear however, but each year in
Noninvasive diagnostic tests used in detecting AVN
the USA there are approximately 10000-20000 new
include Plain radiography, magnetic resonance
cases diagnosed with AVN. It is considered that a
imaging (MRI), computed tomography (CT), skeletal
percentage between 5-18% of a total of 500 000 hip
scintigraphy, and single photon emission computed
replacement surgeries performed in a year are
tomography (SPECT). Location of the affected hip
performed on patients diagnosed with avascular
by AVN can be determined by antero-posterior
necrosis of the femoral head, the cost is estimated to
radiographs. Nevertheless, abnormalities in the
be about 1 billion dollars annually[3].
subchondral area might be missed due to the fact
meanwile, in Japan, there is a study revealing a
that the former and posterior acetabular margins
trend of 2500-3000 new cases of avascular necrosis
overlap the exceptional part of the femoral head.
of femoral head every year [4].
Hence, it's crucial to order a very good quality side
Another retrospective study conducted in
X-rays of the femoral head. Consequently, a cross
England, in 2009, the estimated incidence of disease,
table lateral radiograph is not as adequate as a frog

Received: 15/12/2017 DOI: 10.12816/0044656
Accepted: 25/12/2017

Full Paper (vol.708 paper# 26)

ABSTRACT The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (8), Page 1409-1415

Relation of Hepatitis C and its Severity Assessed by PCR to the Presence
and Severity of Coronary Artery Disease Assessed by Syntax Score
Ahmed Mohamed Onsy, Adham Ahmed Abdeltawab, Abd El-Salam Gebril Senussi
Department of Cardiovascular Diseases, Faculty of Medicine - Ain Shams University

Egypt has the highest prevalence rate of hepatitis C virus in the world, making it the most
challenging public health problem facing the country. Cardiovascular disease continues to be the principal
cause of death worldwide. Several studies have been conducted to confirm, or disprove, an independent
association between HCV infection and atherosclerotic disorders, including coronary artery disease.
the aim of this study was to assess the correlation between hepatitis C virus infection severity and
extent of coronary artery disease.
Patients and Methods:
this prospective study was carried out in the Cardiovascular Diseases Unit in Ain
Shams University Hospitals. This study involved sixty one patients with positive test for HCV antibodies.
Results: PCR level was highly correlated to the absolute Syntax score (SS) and to the Syntax score group,
yet it was not found to be significantly correlated to the presence of significant coronary lesion nor to the
number of vessels affected. On the other hand SS was highly correlated to the presence of significant
coronary lesion and to the number of vessels affected.
coronary artery disease, extrahepatic manifestation, hepatitis C virus , oxidized LDL - SYNTAX

evidence for variation in the course of infection
Hepatitis C has been declared as a global
associated with different HCV variants (genotypes)

Organization, with about 3% of the world's
and in response to treatment with interferon(6). In
population.The situation is quite worse in Egypt,
the Middle East almost all anti-HCV positive
the national prevalence rate of HCV antibody
individuals are infected with type 4 (7).
positively has been estimated to be 10-13 % (1).
After infection, the majority of HCV-infected
comorbidities such as cardiovascular diseases. It
patients develop chronic infection, manifested by
is unknown how infection with HCV affects
the persistence of HCV RNA in the blood (2).
coronary heart disease (CHD) progression and
The association between hepatitis C virus
outcomes (8). Infectious etiologies have been
(HCV) infection and coronary artery disease
hypothesized to contribute to the inflammatory
(CAD) is controversial. Very recent data have
cascade leading to atherosclerosis (9).
indicated that HCV infection was associated with
Hepatitis C virus (HCV) is the cause of
a higher risk of CHD, after the adjustment of
many different forms of heart disease worldwide
traditional risk factors , and seropositivity for
and yet few cardiologists are aware of it as an
HCV may have a role in the pathogenesis of
etiology of heart disease, or its treatment. The
carotid atherosclerosis (3).
burden of HCV-derived heart diseases is global,
with a higher prevalence in Asia, Africa, and low-
independently predict an increased severity of
and middle-income countries (10). Egypt has the
CHD (3). Approximately 150 million people
highest prevalence of HCV in the world, apparently
worldwide have chronic hepatitis C infection,
due to previous mass parenteral anti-schistosomal
roughly 1 person in 50 is infected with the
therapy (11).
hepatitis C virus (4).
Hepatitis C virus (HCV) RNA is the most
Egypt has the highest prevalence rate of
important indicator of viral replication in patients
hepatitis C virus in the world, making it the most
with hepatitis C. HCV RNA, which is a
challenging pupil health problem facing the
significant parameter in terms of detection of
country (5).
viremia in serum, the trend of the infection, can
A study showed that 14.7% of the
be quantitatively detected with polymerase chain
Egyptian population carry HCV antibodies and
reaction (PCR) (12).
9.8% have an active infection. There is an
Understanding the mutual relationship
between the liver and the heart is important for
Received: 25/10/2017 DOI: 10.12816/0044657
Accepted: 05/11/2017

Full Paper (vol.708 paper# 27)

c:\work\Jor\vol708_28 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (8), Page 1416-1420

Surgical Management of Cholelithiasis
Mahdi Hussain Al-Saad1, Ali Hussain Alawadh1, Ali Hussain Al-Bagshi1, Mohammed Hussain
Al Ali1, Ahmed Abdullah Alshehab1, Abdulraheem Abdulelah Alhodar1, Mustafa Hussain
Alshawaf1, Ahmad Metaib Aldhafeeri1, Khaled Waleed Alfarra2, Layla Samran Alyami3
1 King Faisal University, 2University of Gezira, 3 King Salman Hospital
Corresponding Author: Mahdi Hussain Al-Saad - m.h.alsaad.vip@gmail.com - +966 55 144 4227

15% of adults in the United States suffer from gallstones, with about 1 million cases diagnosed
each year. The risk factors leading to a higher risk of developing gallstones include obesity, along with older age
and females with multiple pregnancies where 60% of them undergo cholecystectomy. There are various different
managements, mainly including open cholecystectomy, laparoscopic surgery, as well as medical treatments.
Aim: In this review, we aim to study the diagnosis, presentation, and different management approach of gall
stones, along with their indication and contraindication.
Materials and Methods: We conducted this review using a comprehensive search of MEDLINE, PubMed, and
EMBASE, January 2001, through February 2017. The following search terms were used: cholelithiasis, open
cholecystectomy, laparoscopic surgery, prophylactic cholecystectomy, medical management of gall stones.
Conclusion: Gallstones are still a major cause of undergoing surgery worldwide. Correct recognition of gall
stone disease, with appropriate management technique results in high success rate. Most patients undergo
surgery only after they are symptomatic.
Keywords: gall stones, cholelithiasis, open cholecystectomy, laparoscopic surgery, prophylactic
cholecystectomy, medical management.


Cholesterol composes most gallstones, which are
search terms used: cholelithiasis, open
formed following cholesterol super saturation,
cholecystectomy, laparoscopic surgery, prophylactic
cholesterol crystal nucleation acceleration, and/or
cholecystectomy, medical management of gallstones.
gallbladder motility dysfunctions. It was estimated
The study was done after approval of ethical board
that up to 15% of adults in the United States (more
of King Faisal university.
than 20 million people) have developed gallstones,

with about 1 million cases diagnosed each year.
· Data Extraction
Obese, older, females with multiple pregnancies,
Two reviewers have independently reviewed the
have a higher risk of developing gallstones. Risk is
studies, abstracted data, and disagreements were
also elevated in specific racial and ethnic groups.
resolved by consensus. Studies were evaluated for
About 600,000 patients underwent cholecystectomy
quality and a review protocol was followed
in 1991 in the United States[1]. Although, most cases
may be asymptomatic, few cases may develop serious

The classic presentation of symptomatic gallstones
Asymptomatic gallstones are also known as `silent
is a patient with recurrent right upper quadrant pain
stones'. After introduction of laparoscopy, the
(sometimes epigastric), that is related to fatty food
management and treatment of gallstone has improved
intake, and most likely at night. This pain comes from
an impacted stone in the cystic duct. Pain might be

associated with nausea and vomiting, and increases
gradually. Pain may radiate to the area between the
· Data Sources and Search terms
scapula, or below the right scapula (also called Boas'
We conducted this review using a comprehensive
search of MEDLINE, PubMed, and EMBASE,
Sometimes, the initial presentation of gallstones
January 2001, through February 2017. The following
may be acute cholecystitis, with secondary infection

Received: 20/12/2017 DOI: 10.12816/0044658
Accepted: 30/12/2017

Full Paper (vol.708 paper# 28)

c:\work\Jor\vol708_29 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (8), Page 1412-1414

Case of Idiopathic Peripapillary Subretinal Neovascular
Membrane in an otherwise Healthy Young Male: A case report
Raed Awadh Alharthi, Ashwaq Mohammed Almalki, Faisal Ali Alotibi, Hatim Fozi Jabr.
Department of Ophthalmology, King Abdul-Aziz Specialist Hospital, Taif, Saudi Arabia.
Corresponding author: Raed Awadh Alharthi, E-mail: R.alharhi92@gmail.com

Aim of work:
to report a rare case of idiopathic peripapillary subretinal neovascular membrane (PCRNVM) in
an otherwise healthy young male
patient and method: A case report study of 31-years old healthy male came to ophthalmology clinic
complaining of blurred vision.
Result: Fundus examination revealed left idiopathic peripapillary subretinal neovascular membrane
(PCRNVM)and its presence was confirmed by optical coherence tomography (OCT) and fundus fluorescein
angiography (FFA).
Conclusion: Idiopathic peripapillary subretinal neovascular membrane(PSRNVM)is rare condition in healthy
young with no predisposing factors and our case was responded well to single dose of Anti-VEGF
Keywords: subretinal neovascular membrane, ranibizumab, peripapillary.

tearing or prior eye surgery. Best corrected visual
Idiopathic peripapillary subretinal neovascular
acuity (BCVA) was 20/20 in the right eye and
membrane(PCRNVM) is one of the types of
20/40 in the left eye. A planation tonometer was
choroidal neovascular membranes (CNVMs)
normal bilaterally. By bilateral slit lamp
characterized by collection of abnormal blood
examination there were no keratic precipitates and
vessels originating from choroid via break in bruch
the anterior chamber was deep quiet with no cells
membrane and located adjacent to the optic disc. It
or flare. Vitreous cavity was quiet and clear.
is typically found in patients older than 50 years
Funduscopic examination of the left eye (OS)
who are affected by exudative age-related macular
revealed a juxtapapillary peripapillary subretinal
degeneration (AMD) [1]. PCR-NVM is usually
neovascularization at the level inferotemporal
associated with predisposing conditions, such as
arcade associated with chorioretinal folds, retina
multifocal choroiditis
pigment epithelium atrophy, marked retinal edema
angoid streak, punctate inner choroidopathy,
and hard exudate involving optic disc, macula and
congenital (disc anomaly), optic disc drusen,
papillomacular bundle (Fig 1a). FFA showed
trauma (choroidal rupture), inflammation or
hypoflourescence area due to obstruction of the
infections (histoplasmosis, sarcoidosis) choroidal
background by hemorrhage and exudate (Fig 1b).
tumors (osteoma) and very few cases of PSRNVM
The right eye (OD) was unremarkable.
without detectable cause called (Idiopathic) [2].

Nowadays, intravitreal anti VEGF is the mainstay
Screening blood test was done to exclude
of treatment for CNV [3]. The visual outcomes are
antecedent causes CBC, inflammatory markers
promising and procedure generally well tolerated [4].
(CRP, ESR) Mantoux test, RA factor, TORCH
In this study, we reported an idiopathic
titres, RPR(VDRL), HIV, serum calcium and all
peripapillary subretinal neovascular membrane in a
results were normal.
31-year-old healthy male patient with no evidence

of predisposing factor and responded well with
He was treated with intravitreal ranibizumab
Anti-VEGF (ranibizumab).
(0.05 ml of 10 mg/ml) after obtaining a written

informed consent from him. At 4-week follow-up,
BCVA in the left eye improved to 20/20. Fundus
examination of the left eye revealed regression of
ophthalmology clinic (King Abdul-Aziz Specialist
PSRNVM with moderated resolution of subretinal
Hospital, Taif Saudi Arabia) complaining of blurred
fluid (Fig1 C). OCT revealed moderate reduced of
vision in his left eye over the last three months.
subretinal fluid (Fig 2b). The patient has scheduled
There was no history of pain and he denies
for more Anti-VEGF injection in next every 4-week
preceding trauma, photophobia ocular discharge,
follow-up visit until full resolution of edema.
Received: 20/12/2017 DOI: 10.12816/0044659
Accepted: 30/12/2017

Full Paper (vol.708 paper# 29)

c:\work\Jor\vol708_30 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (8), Page 1415-1420

Meta-Analysis of Liver Cirrhosis and The Risk of Fracture
Haitham Rasheed Alhaeti 1, Sara Mohammed A Maqbol 2, Abrar Ali S Al Dawood 3 , Abdulaziz
Abdullah Alsaqabi 4 , Anouf Fawzi Enani 5 , Feras Khalid A Mimarji 6 , Ahmed Abdullah Y
Alzahrani 6 , Hanan Showei H Fageeh 7, Fahad Saeed Mohmmed Alnwehedh 8, Abdulaziz Dhaifallah
SHAHI Alanazi 9, Hafsa Ibrahim Bilal 10 , Ali Hassan M Alhawaj 11
1- King Saud University, 2- UQU University, 3- King Khalid University, 4- Qassim University,
5- Prince Sultan Health Care, 6- Jeddah University, 7- East Jeddah Hospital, 8- Armed Forces Hospital in
South Region, 9- Aljouf University, 10- Batterjee Medical College,
11- Ibn Sina National College for Medical Studies

Cirrhosis is the irreversible fibrosis of liver, it continues to be a common cause of morbidity
and mortality. It is accompanied by inflammation and malnutrition and thus can have a negative effects on
bone metabolism and promote fractures accordingly.
Aim of the study:
to evaluate the risk of fractures among patients with cirrhosis.
Methods: A systematic review of the scientific literature following PRISMA/STROBE guidelines, Medline
Cochrane Library and Embase abstracts were retrieved using an algorithm comprising relevant MeSH terms
from 1980 to 2017. Publications on the association of cirrhosis/bone fracture were abstracted independently
by the authors and included in both gender and gender-specific meta-analyses, following recalculations of
published data as appropriate. The Newcastle-Ottawa scale was used to evaluate the quality of included
Results: st

8 udies met the inclusion criteria enrolling 988 patients (
286 of which are diagnosed with al
liver disease (
ALD). Overall, ALD demonstrated a el
ative risk (

RR of

95%CI: 1.370 2.28,
< 0.001


for the development of bone fractures. Bone mineral density (BMD) was not significantly different between
the ALD and control groups, although there was a trend toward lower BMD in patients with ALD. Sensitivity
analyses showed consistent results.
Conclusion: in accordance to the present meta-analysis, there is a significant correlation between bone
fractures and ALD independent of BMD.
Keywords: Cirrhosis, bone fracture, ALD, chronic Liver Disease, Fibrosis, Orthopedic.


Cirrhosis is defined as a significantly advanced
alcohol, and nonalcoholic liver disease. The exact
stage of liver fibrosis that can eventually leads to
prevalence of cirrhosis is unknown, owing to
end stage liver disease. It is associated with
symptom development later in the disease process
hepatic vasculature distortion which in turn results
(3). Alcoholic liver disease (ALD) encompasses a
in shunting of the portal and arterial blood supply
spectrum of injury, ranging from simple steatosis
directly into the hepatic outflow (central veins),
to frank cirrhosis. Typically, symptomatic patients
present with advanced liver disease, with
sinusoids and the adjacent liver parenchyma;
concomitant cirrhosis in more than 50%, and
hepatocytes (1,2).
superimposed acute decompensation. Even
patients with a relatively mild presentation,
of regenerative nodules surrounded by fibrous
however, are at high risk of progressive liver
bands in response to chronic liver injury. In such
injury, with cirrhosis developing in up to 50% (4).
condition that the hepatic sinusoids are lined by
Moreover, there is evidence of a clear dose-
fenestrated endothelia which rest on a sheet of
dependent relation between alcohol intake and the
permeable connective tissue (the space of Disse)
incidence of alcoholic cirrhosis. A daily intake of
which contains hepatic stellate cells (HSC) and
more than 60 g of alcohol in men and 20 g in
some mononuclear cells. The other side of the
women significantly increases the risk of cirrhosis.
space of Disse is lined by hepatocytes which
In addition, steady daily drinking, as compared
execute most of the known liver functions. In
with binge drinking, appears to be more harmful
cirrhosis the space of Disse is filled with scar
tissue and endothelial fenestrations are lost, a
Bone Fracture causes significant morbidity and
process termed sinusoidal capillarization(1,2).
mortality, and places an economic burden on
Noteworthy, in 2011 it was the 12th leading cause
societies (6). Although cirrhosis is associated with
of death in the United States. The main causes of
a broad spectrum of bone diseases, the most
cirrhosis are hepatitis B and C viruses, overuse of
common type of bone disease present in hepatic
Received: 16/12/2017 DOI: 10.12816/0044660
Accepted: 26/12/2017

Full Paper (vol.708 paper# 30)