c:\work\Jor\vol709_1 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (9), Page 1421-1430

Systemic Review: Role of Lifestyle Interventions for The
Treatment of Non-Alcoholic Fatty Liver Disease
Norah Ibraheem Almanie1, Reem Ali Almanie1, Roaa Fahad Alshabanah1 , Tahani Saeed
Almohayya1,Ebtesam Mohammed Alahmari1, Amal Nasser Alqahtani1, Mohammed Ali
Alzubaidi2,Abdulhakim Ali Alkhodair3, Anas Rafik AlShaer4,Haneen Ahmad Khouja5
1-King Khalid University, 2-Umm Alqura University , 3-King Saud Bin Abdulaziz University for
Health Sciences, 4-Misr University for Science and Technology, 5-Battarje Medical College

Background: Non-alcoholic fatty liver sickness (NAFLD) is a variety of liver pathological conditions that
intensely related to other chronic diseases including obesity and diabetes.
Objectives: Systematically evaluating the role of lifestyle interventions on reducing the activity of NAFLD.
Methods: Collecting all the studies regarding the effects of changing the diet, exercise or combination of both
on the activity or markers of NAFLD during the period from 2006 to 2017.
Results: Database searches returned 122 citations with 92 included in more than one search then the final
studied which include in this study was 19 articles. Five articles studied the effects of a combination of dietary
and exercise interventions, four of these articles showed positive results regarding the Dietetic Association
(ADA) Quality Criteria Checklist, while only one article showed a neutral results, i.e. 80.0% of the articles
showed a positive effect of the combination of diet and exercise on the effect of NAFLD patients.
Conclusion: This review showed that the combination of healthy life interventions, including exercise and
health diet, are effective in reducing the activity of NAFLD and could result in complete reversal of the
condition. Thus NAFLD patients are advised to lose about 10% of their weight and engaging in regular
exercises for 5 days per week.
Keywords: Systemic review, Lifestyle interventions, Management, Non-alcoholic fatty liver disease.


improvement in the metabolic syndrome thus
Non-alcoholic fatty liver sickness (NAFLD) is a
reducing steatosis(6-9).
variety of liver pathological conditions that intensely

related to other chronic diseases including obesity
The aim of this systemic review is to evaluate the
and diabetes. It is also defined as the hepatic factor
interventions involving eating regimen, weight
for metabolic syndrome and the most long-
reduction and exercise which could decrease the
established etiology for international chronic
activity and biomarkers of NAFLD in adults.
diseases of liver (1). The prevalence of NAFLD is as

about 45% of the adult population around the world
but also its incidence could differ depending the
Information sources and search strategy
ethnicity and development of populations(2). About
Methods of the analysis and eligibility criteria
50% of NAFLD patients could develop
were specified prior to the literature search with
complications as steatohepatitis, cirrhosis, fibrosis,
Prospero (CRD42016032764). The review was
liver failure and hepatocellular carcinoma (3, 4).
conducted by SK according to Preferred Reporting
The NAFLD diagnosis can best be made in the
Items for Systematic Reviews (PRISMA) guidelines
absence of high ethanol intake and the exclusion of
at the 10 last years. The search terms were `role of
Lifestyle interventions for the treatment of non-
malnutrition and inflammatory bowel disease as well
alcoholic fatty liver disease.', `NAFLD and weight
as excluding the other causes of steatosis,(4, 5).
loss' and `NAFLD and diet/diet, reducing' for all
Importantly, the disease can be delayed or even
available database. The searches were limited to
reversed during early stages using therapeutic agents
clinical trials, human studies, English language and
and nutritional supplementation (6). Although, there
journal articles only.
is no specific medication for NAFLD till now;
RCTs in human adults of any gender/ethnicity
changing the lifestyle and weight loss are still the
with a diagnosis of NAFLD, non-alcoholic
best clinical management in all guidelines(4, 5).
steatohepatitis (NASH), fibrosis or NAFLD-based
Many studies showed that weight loss and
increasing the physical activity pattern are related to
radiological or histological evidence were included;
Received: 20/12/2017 DOI: 10.12816/0044663
Accepted: 30/12/2017

Full Paper (vol.709 paper# 1)

The Role of Urinary Cyclophilin A as a New Marker for Diabetic Nephropathy The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (9), Page 1431-1439

The Role of Urinary Cyclophilin A as a New Marker for Diabetic Nephropathy
Hanan Mohamed Ali Amer, Inas Mohamed Sabry, Meram Mohamed Mahmoud Bekhet,
Reham Nabil Sayed Mohammed
Department of Internal Medicine and Endocrinology, Faculty of Medicine, Ain Shams University

Type 2 diabetes mellitus is the most common single cause of end-stage renal disease (ESRD),
where diabetic nephropathy (DN) is considered the cause in almost half of all patients with ESRD. Despite the
availability of many modern therapies for glycemic control, there are no specific curative treatments yet for DN
and many diabetic patients still progressed to severe renal damage. Currently, albuminuria is the most commonly
used marker to predict onset and progression of DN clinically. However, this traditional marker for DN lacks
both sensitivity and specificity to detect early stage of DN. Furthermore, there is a lack of a strong association
between albuminuria and glomerular filtration rate (GFR). As such, it is crucial to find earlier and reliable
markers for DN diagnosis and intervention providing an opportunity to stop the permanent damage caused by it.
Objective: This study focuses on Cyclophilin A (CypA) in urine. CypA is a protein with ubiquitous
characteristics, mostly distributed in the cytoplasm and facilitates protein folding and protein trafficking. It has
relatively high expression level in normal kidneys. Recently, CypA has been reported to be a reliable novel
marker for early diagnosis of DN.
Subjects and Methods: Our study was conducted on 90 subjects of comparative age and sex. They were selected
from Endocrinology Clinic after written consent at Ain Shams University Hospital and Railway Hospital. Participants
were divided into: Group I: 30 healthy control subjects, Group II: 30 T2DM patients without albuminuria
(normoalbuminuric), and Group III: 30 T2DM patients with albuminuric DN.
Our study showed that regarding the level of urinary CypA there was a highly statistical significant
difference between the three groups (F= 221.730, p< 0.01), being higher in GII (normoalbuminuric) (1.690.87
ng/ml) than in GI (control) (0.550.14 ng/ml) (t= 7.04, p< 0.01) and higher in GIII (albuminuric DN)
(6.011.61 ng/ml) than GII (t= 12.93, p< 0.001) and GI (t= 18.55, p< 0.0001). In addition, we found that urinary
CypA was significant higher in GIIIb (macroalbuminuria) (7.230.76 ng/ml) than in GIIIa (microalbuminuria)
(4.791.25 ng/ml) (t= 6.49, p< 0.01). It worth mentioning that, the level of urinary CypA started to increase
significantly in stage 2 DN (2.490.50 ng/ml) in spite of normal level of albuminuria (no albuminuria)
comparing with each of stage 1 DN (1.030.15 ng/ml), diabetics with no renal affection (0.990.45 ng/ml) and
GI (healthy control) (0.550.14 ng/ml). There was significant positive correlation between urinary CypA and
each of: sCr in GII (r= +0.39, p< 0.05), GIIIa (r= +0.89, p< 0.001) and GIIIb (r= +0.99, p< 0.001) and ACR in
GIIIa (r= +0.93, p< 0.001) and GIIIb (r= +0.98, p< 0.001).
Conclusion: Our study showed that there was a high significant difference in the level of urinary CypA between
diabetic patients with any degree of renal affection and healthy subjects being higher in diabetics with renal
affection even without the presence of albuminuria.
Keywords: Cyclophilin A Diabetic nephropathy Type 2 Diabetes Albumin/ Creatinine ratio.


Diabetes mellitus (DM) is a group
common single cause of end-stage renal disease
of metabolic diseases in which there are
(ESRD). ESRD in almost half of patients is due to
hyperglycemia over prolonged period, it is due to
diabetic nephropathy (DN), and these cases have the
either lack of endogenous insulin secretion by the
worst outcome compared to patients with other
beta cells of the pancreas or resistance to the action
causes of ESRD. Reasons for poor outcome include
of insulin in insulin dependent cells (liver, muscles,
inadequate markers for early detection of DN, the
and adipose tissues) (1). Diabetic nephropathy is a
complicated mechanisms of DN and there are no
progressive kidney disease caused by long standing
specific curative treatments yet for DN (4).
hyperglycemia that contribute in non-enzymatic
Currently, the stage of severity of DN is
glycation reactions of proteins and peptides with
determined according to the levels of albuminuria
production of advanced glycation end-products
which lacks both sensitivity and specificity to detect
(AGEs) which are associated with inflammation and
early stage of DN. Furthermore, some DN patients
damage of renal glomeruli resulting in progressive
with ESRD do not present with significant albuminuria
proteinuria, hypoalbuminemia, edema, hypertension,
(5). The lack of strong association between
and finally may lead to chronic renal failure
glomerular filtration rate (GFR) and albuminuria, in
(2,3).Type 2 diabetes mellitus (DM) is the most
addition to the need for early diagnosis of DN to
Received: 20/12/2017 DOI: 10.12816/0044664
Accepted: 30/12/2017

Full Paper (vol.709 paper# 2)

c:\work\Jor\vol709_3 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (9), Page 1440-1444

Evaluation of Prevalence and Associated Factors of Restless Leg
Syndrome among Medical Students at University of Tabuk -2017
Abdullah Hamad Almutairi1, Ahmad Aawad Alatawi1, Saud Abdulaziz Binsufayan2, Ibrahim Sami
Abunohaiah2, Alqarni Ayeshah Beeshi S3, Mohammed Saleh Alatawi4, Waleed Jamal Aloqbi1
1- Faculty of Medicine, University of Tabuk, Tabuk/ KSA,2- Faculty of Medicine,
King Saud University, Alriyadh/ KSA,3 - Faculty of Medicine, Taif University, Altaif/ KSA,
4- Surgery Department, King Fahad Specialt Hospital, Tabuk/ KSA
Corresponding Author: Abdullah Hamad Almutairi, Medical Intern, Email:qqqzy0@gmail.com , Telephone: +966 544918175

Restless leg syndrome (RLS) is a disorder affecting a significant portion of the general population. The
syndrome has a strong family component and several comorbid conditions may be associated with RLS.
Researches over the past 10 years had highlighted its heritability and had shed some interesting light to this
disorder. Restless legs syndrome (RLS), or Willis-Ekbom disease, is a neurological disorder that is
characterized by unpleasant or painful sensations in the legs and a distressing, irresistible urge to move them.
RLS symptoms worsen during inactivity and at night. Partial or complete relief may result from movement such
as walking, stretching, or bending of the legs. Yet, the relief is often temporary and symptoms return when
movement ceases. Aim of the work: this study aimed to evaluate the prevalence and associated factors of
restless leg syndrome among Medical Students at University of Tabuk. Methods: we have conducted a
descriptive cross-sectional study in Tabuk city population, Saudi Arabia. The study was conducted during the
period from July to December 2017. The participants who attended the college of medicine at university of
Tabuk were included in the study. The total sample obtained was 151. A self-administered questionnaire about
restless leg syndrome was filled by the participants. Results: age of the participants was ranged from 18 to 27
years old, with a mean (SD) of 22.72 (1.837), the majority were 6th year medical students (39.7%). 39.7%
reported that they had urge to move the legs with unpleasant sensations in the legs, from those who reported
they had urge to move the legs with unpleasant sensations in the legs, 80% of them reported that it is relieved
by movements. Conclusion: more attention is needed on recognition of RLS among medical students and to
manage the aggravating factors of RLS.
Keywords: restless leg syndrome, prevalence, symptoms, associated factors.


distressing, irresistible urge to move them (4). RLS
Restless Legs Syndrome (RLS) was first
symptoms worsen during inactivity and at night.
depicted in 1685 by Sir Thomas Willis, an English
Partial or complete relief may result from
physician, in a sharp description of patients who
movement such as walking, stretching, or bending
cannot fall asleep because of leapings and
of the legs. Yet, the relief is often temporary and
contractions of the arms and legs. Sir Willis wrote
symptoms return when movement ceases. If the
that restlessness and tossing could be so severe that
disease progresses, symptoms may occur earlier in
the patients were no more able to sleep than if they
the day and intensify even further at night and/or
were in a place of a greatest torture (1). In the
extend beyond the legs to the arms and/or trunk.
nineteen century, RLS was termed as anxietas
The clinical course of RLS varies and periods of
tibiarum in Germany by Wittmaack(2).
remission are common. Severe restless legs
In 1945 a group of eight patients was studied by
the Swedish neurologist Karl-Axel Ekbom who
term treatment (5).
coined the term "Restless-Legs syndrome"
In the general population, the prevalence of RLS
apparently unaware of Willi's previous description
increases with age and women are more frequently
indicating the syndrome could also involve the
affected than men. RLS was associated
upper extremities(2). RLS is a disorder affecting a
significantly with social status, worse somatic and
significant portion of the general population. The
mental health and diabetes (6,7). Other potential
syndrome has a strong family component and
correlates of RLS in both the general population
several comorbid conditions were associated with
and in patients with kidney disease are anemia and
RLS. Researches over the past 10 years had
iron deficiency (6). RLS was diagnosed clinically,
highlighted its heritability and had shed some
on the basis of 2012 revised International restless
interesting light to this disorder (3). Restless legs
legs study group (IRLGSG) diagnostic criteria
syndrome (RLS), or Willis-Ekbom disease, is
(8). This criteria consists of five cardinal symptoms
a neurological disorder that is characterized by
all of which were present in patients who were
unpleasant or painful sensations in the legs and a
diagnosed as suffering from RLS this includes: 1-
Received: 20/12/2017 DOI: 10.12816/0044665
Accepted: 30/12/2017

Full Paper (vol.709 paper# 3)

c:\work\Jor\vol709_4 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (9), Page 1445-1447

A 6-Year-Old Saudi Boy with Myotonia Congenita
Abdullah Ali Z Alshahrani 1, Husam Kayyali2
1.Medical Intern, 2.Pediatric Neurology Section,King Faisal Specialist Hospital and Research Center-Jeddah
Corresponding author: Abdulla Shahrani,email: abdulla.shahrani@gmail.com

myotonia congenita is an inherited form of myotonia that is due to mutations in the skeletal
muscle chloride channel CLCN1. These mutations lead to reduced sarcolemmal chloride conductance,
causing delayed muscle relaxation that is evident by clinical exam and myotonic discharges on
electromyogram. Two forms of myotonia congenita are recognized: autosomal recessive (Becker variant) or
autosomal dominant (Thomsen variant). The recessive form tends to be more severe and has an earlier onset
than the dominant one. The dominant form varies in severity from asymptomatic to moderately severe. These
two forms may be distinguished by clinical presentation, inheritance pattern and age of onset.
Methods: we described the clinical presentation and genetic testing results of one individual with the
autosomal recessive variant of myotonia congenita.
Results: the initial diagnosis was made based on the clinical presentation then it was confirmed based on
electromyographic findings of myotonic discharges and CLCN1 gene sequencing which revealed
homozygous disease-associated C ->A transverse mutation. The patient achieved a modest response to
treatment with phenytoin, carbamazepine or acetazolamide. His condition remained stable with minimal
weakness and muscle hypertrophy.
Conclusions: myotonia congenita is a rare genetic disorder of muscle relaxation. The diagnosis is made based
on clinical features and is confirmed by sequencing CLCN1 gene. Response to treatment is variable.
Recommended medications included mexiletine, phenytoin, carbamazepine and acetazolamide among others.
Kew words: myotonia, congenita, CLCN1.

Myotonia is an impairment of muscle relaxation
after voluntary forceful contraction. It could be
We reported the clinical presentations of a child
found in several clinical disorders with different
with Myotonia Congenita (MC). The study was
etiologies. One of these disorders, Myotonia
done after approval of ethical board of King Faisal
Congenita (MC), which is inherited myotonia due
Specialist Hospital and Research Center-Jeddah.
to a mutation in the skeletal muscle chloride

channel CLCN1.
Genetic Testing
A defect in CLCN1 (a gene coding for the
After having obtained written informed consent
chloride channel ClC-1) leads to reduced
from patient's parents, blood samples were
sarcolemmal chloride conductance, which in turn
collected and genomic DNA was extracted
allows the muscle to be hyperpolarized, causing
according to standard methods. Molecular analysis
delayed relaxation evident as clinical and electrical
of the CLCN1 gene was performed by PCR
myotonia [1].
amplification of highly purified genomic DNA,
MC is inherited in autosomal dominant or
followed by automated uni-directional DNA
recessive forms. The recessive form, known as
sequencing of the coding region (23 exons, 3093
Becker MC, tends to be more severe and has an
bp) of the CLCN1 gene.
earlier onset than the dominant one. The dominant
Also, ten bases of intronic DNA surrounding
form varies in severity from asymptomatic to
each exon including the highly conserved flanking
moderately severe and is known as Thomsen MC.
intronic sequence of the exon-intron splice
These two forms may be distinguished by
junction for all 23 exons were also sequenced. All
clinical presentation, inheritance pattern and age
abnormal sequence variants were confirmed by bi-
of onset. Patients with the Becker variant usually
directional sequencing. Studies conducted by
Athena Diagnostics, Inc. indicate that mutation in
pronounced muscle hypertrophy and typically
this gene and similar sequencing test are
have transient (and occasionally permanent)
detectable at an overall sensitivity approaching
weakness. Patients affected by the Thomsen
99%. All test result was reviewed, interpreted, and
variant did not characteristically show significant
reported by ABMG certified Clinical Molecular
muscle hypertrophy and the age of onset varied
from infancy to adulthood [2].

Received: 20/12/2017 DOI: 10.12816/0044666
Accepted: 30/12/2017

Full Paper (vol.709 paper# 4)

c:\work\Jor\vol709_5 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (9), Page 1448-1454

Quality of Life of Patients after Total Knee Arthroplasty at King Abdulaziz
University Hospital, Jeddah, Saudi Arabia
Maram Abdullah Batarfi, Ammar Yaser Alkhiary , Orjwan Anas Abulaban ,
Noha Ahmed Alzahrani , Shahad Khalid Bagais , Abdullah Kermily
King Abdulaziz University Hospital, Jeddah, Saudi Arabia
Corresponding author: Ammar AlKhiary,email: ammar.alkhiary@gmail.com


Background: osteoarthritis is a degenerative disease affecting both genders and is more prevalent in females. The
incidence of osteoarthritis in Saudi Arabia is up to 60%. Management is initially conservative with medications and
lifestyle changes. Total knee arthroplasty (TKA) is the surgical option for patients who complain of severe pain and
functional disabilities. TKA is correlated with improving quality of life, but despite this evidence, some patients
complain of residual symptoms postoperatively which don't meet their pre-operative expectations.
Aim of the work:
this study aimed to determine health related quality of life of patients after total knee arthroplasty
and to assess the psychological factors affecting the patients after the procedure
Methodology: this retrospective cross-sectional study analyzed all the files of patients who underwent unilateral or
bilateral TKA in KAUH from 2010-2017. A total of 78 patients were interviewed by phone using the Western
Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and short form quality of life (SF-36)
Result: a total of 78 patients (60 Females and 18 males) were participated in this study. The mean age was 65.7
years old. In general, 41.6% of the patients were satisfied with their usual daily activity, where on the other hand
5.2% of patients reported poor satisfaction and were much worse than before. 59.7% of the patients reported great
improvement in comparison with the previous year and 22.1% of the patients reported a somewhat better
improvement. 53.2% reported no limitation in their social life regarding physical activity and emotional problems,
while 9.1% had physical and emotional problems interfering with their life.
Conclusion: TKA is a very successful and cost effective therapeutic option for treating knee osteoarthritis.
Improvement in the quality of life and physical activity of patients supports other conducted previous studies.
total knee arthroplasty; Saudi Arabians; quality of life; orthopedic surgery

quality [6]. Unfortunately, some patients who were
Osteoarthritis is a degenerative joint disease
undergone TKA have residual symptoms such as mild
affecting both gender, but is more common in females.
stiffness, leg numbness and exercise-related pain [2],
It's incidence increases about 10% with aging [1-3]. The
which do not meet their pre-operative expectations.
incidence of osteoarthritis in Saudi Arabia is high and
Most patients expect to return to a completely normal
it reached 60% [2] . Management of osteoarthritis
life, as if their joint hadn't been affected. This
usually begins with conservative options such as
misperception led to high postoperative expectations is
physiotherapy, medications such as NSAIDs, and
multifaceted including factors involving the surgeon
lifestyle changes. Conservative management usually
[6,7]. Quality of life according to the WHO is defined as
delays surgery for a few years, but the pain of OA
"the individual perception of complete physical,
causes more functional disabilities which affects the
mental and social well-being" [8]. QOL consists of
quality of life (QOL) of those patients [2,3,4]. For this
positive, negative and bidirectional aspects [9]. Even
reason, Total Knee Arthroplasty (TKA) is
with the postoperative advantages, QOL continues to
recommended to facilitate patient's quality of life as a
be a concern in deciding the effectiveness of TKA [2].
therapeutic option in severe cases [3]. Unilateral or
In general, total knee arthroplasty correlates
bilateral TKA is a common orthopedic procedure that's
with improving QOL of patients; their sleeping cycle
performed in Saudi Arabia [4]. TKA is considered as
has greatly improved, along with ease of daily physical
one of the cost-effective procedures for improving
activity and elimination of permanent joint pain [3]. The
patient's quality of life [5]. The main outcomes of total
correlation between TKA and QOL was examined in
knee arthroplasty are relieving patient's symptoms and
many studies, their findings and results among patients
pain, restoring physical activity and improving sleep
must be considered. There were few studies assessted
Received: 20/12/2017 DOI: 10.12816/0044667
Accepted: 30/12/2017

Full Paper (vol.709 paper# 5)

c:\work\Jor\vol709_6 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (9), Page 1455-1463

Prevalence and Potential Risk Factors of Diabetic Retinopathy among
Type 2 Diabetics Patients in Diabetic Center, Taif City, KSA
Ahmad S. Alharthi1*; Maha Zuwayyid K. Almutairi1; Abdulaziz Hameed K. Alswat1;
Hajer A. Al-Wagdani1; Abdulhamid Al Ghamdi2
1Taif University School of Medicine Taif, 2Department of Ophthalmology, Faculty of Medicine,
Taif University, Taif, Saudi Arabia
*Corresponding Author: Ahmad S. Alharthi, E-Mail: a7mad.al0rabi@gmail.com, Phone: +966595677880

diabetic retinopathy is the most common microvascular complication of diabetes mellitus (DM)
and a primary leading cause of irreversible visual impairment. Timely risk based screening of DR progression is
Materials and Methods:
a cross-sectional study was conducted between October-December 2016 at Diabetic
Center, Taif city by assessing fundus photographs of type 2 Diabetics. Furthermore, we analysed the DR potential
risk factors including demographic, duration of diabetes, [HbA1c], type of anti-diabetic drugs, dyslipidemia,
Results: a total of 213 diabetic patient were included, 34 (16%) have DR with mean years of age 54.14 (13.12)
and males were 19 (55.88%) and females 15 (44.12%). its mean of duration was 4.4 (4.5) months. DM duration's
mean was 15.6 year and SD was (10.26). Also, HbA1c mean (SD) was 8.11 (1.99). HbA1c% mean (SD) was 8.57
(1.88). Insulin only was the management of DM in 8 (23.53%) while oral hypoglycemic drugs only were used by
6 (17.65%) and the use of both was the treatment of 19 (55.88%) patients. Systematic diseases as dyslipidemia,
hypercholesteremia and hypertension were prevalent among 15 (44.12%), 5 (14.17%) and 11 (32.35%) patients;
respectively. Nephropathy presented in 12 (35.29%) patients. There were no underweight patients, 4 (2.23%)
normal, 19 (55.88%) obese and 11 (32.35%) overweight.
We conducted multivariate analysis of variance (MANOA) to compare the effect of age, duration of DM,
HGA1c%, TRIGLYCERIDE (mg/dl), LDL-Cholesterol (mg/dl), diastolic blood pressure, systolic blood pressure
and GFR on the prevalence of DR. Also , A univariate analysis of variances (two-way ANOVA) was also
conducted for each dependent variable.
Conclusion: Among the participating patients , our study showed a high prevalence of diabetic retinopathy
especially with male patints , high (HbA1c) and longer duration of diabetes. We have recommended a national
plan for educational programs about diabetic retinopathy and important of Eye examination .Also,our study
showed that certain risk factors may enhance the progression of DR. Furthermore, our study highlights the
importance of risk based screening for DR.
Keywords: Diabetic retinopathy, Risk factors ,Visual impairment, Type 2 diabetes mellitus.

mg/dL (11.1 mmol/L) or higher during an (OGTT) or
The term diabetes mellitus describes a
4-In a patient with classic symptoms of
hyperglycemia or hyperglycemic crisis,a random
characterized by chronic hyperglycemia with
plasma glucose 200 mg/dL (11.1 mmol/L). WHO (3)
disturbances of carbohydrate, fat and protein
describes diabetes mellitus as most common
metabolism resulting from defects in insulin
endocrine disease in the World.. If the prevalence of
secretion, action, or both. Type 2 diabetes (called
diabetes mellitus type 2 (DMT2) continues to
increase at the current rate, the global burden of this
combinations of decreased insulin secretion and
disease will swell between 2000 to 2030 from 171
decreased insulin sensitivity (insulin resistance),
million to 366 million patients (4). In the Kingdom of
augmented by lifestyle habits (1).
Saudi Arabia (KSA), the rise in the prevalence of
The American
DMT2 started to gain attention years after rapid
(2) criteria for the diagnosis of diabetes are any of the
industrialization took place in the country(5). Diabetes
following: 1- A hemoglobin A1c level of 6.5% or
has emerged as a major public health problem that
higher;, 2- fasting plasma glucose level of 126 mg/dL
has reached an epidemic stage(6). The crude
or higher, 3- an 2-hour plasma glucose level of 200
prevalence of diabetes has been documented as
Received: 20/12/2017 DOI: 10.12816/0044668
Accepted: 30/12/2017

Full Paper (vol.709 paper# 6)

c:\work\Jor\vol709_7 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (9), Page 1464-1467

Pelvic Inflammatory Disease
Bayan Khalid Sabb Gul1, Zainab Ali Albati2, Rawan Rafat Ismaeel Badr3,
Zainab Mohammed Alfaraj4, Ali Shuja Almatrafi1, Ahmad Abdullatif Banoun5,
Razan Mohammad Hassan Maki6, Sara faisal bagdood5, Amro Sulaiman AlJuhani7, Asma Saad
1 Umm Alqura University, 2 Pavol Jozef Safari, 3 Maternity And Children Hospital In Makkah, 4 Maternity And
Children Hospital Dammam, 5 Ibn Sina National College, 6 University Of Kassala, 7 King Abdulaziz University,
8 King Khalid University
Corresponding Author: Bayan Khalid Sabb Gul - Bayan_sabb@hotmail.com - 0544234404

Pelvic inflammatory diseases (PID) is caused by infections in the female reproductive tract that
includes pelvic peritoneum, ovaries, fallopian tubes, and the endometrium. These infections are commonly caused
by Chlamydia trachomatis, Neisseria gonorrhea, or other sexually transmitted infections. 800,000 women get a
diagnosis of pelvic inflammatory disease annually in the United States. PID usually causes irreversible damage to
the reproductive tract, and treatment mainly depends on preventing further scarring or complications. Immediate
broad spectrum antibiotics are indicated. Treatment can include hospitalization as well as surgery.
Methodology: We conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE,
from January 1985 to February 2017. The following search terms were used: pelvic inflammatory diseases,
pathogens causing pelvic inflammatory diseases, causes of infertility, treatment and diagnosis of pelvic
inflammatory diseases. Aim: In this review, we aim to study the pathophysiology and etiology of pelvic
inflammatory diseases, as well as to study the diagnosis, treatment, and possible complications of this condition.
Conclusion: It is essential to raise the awareness and knowledge of females in general regarding PID and its
symptoms, as early detection will significantly decrease the likelihood of severe complications. Other than
infertility, complications of pelvic inflammatory disease include chronic pain. More research is needed in this
field to improve management and care of patients suffering from this condition.
Keywords: pelvic inflammatory diseases, women health, infertility, sexual health awareness, pathogens pelvic
inflammatory diseases.

Chlamydia trachomatis, Neisseria gonorrhea, or
More than eight hundreds thousands women get
other sexually transmitted infections (STIs).
a diagnosis of pelvic inflammatory disease (PID)

annually in the United States. According to the
Due to the various clinical manifestations, it is
Centers for Disease Control and Prevention (CDC),
not easy to make a diagnosis of PID. Many PID are
when considering missed PID cases, the number of
asymptomatic with subclinical PID; which is
cases can reach up to a million a year. The serious
defined as the presence of an inflammation in the
complications of PID make these rates of a huge
upper female reproductive tract, without the
concern. These complications include ectopic
presence of any signs and symptoms. Patients with
pregnancy, chronic pelvic pain (CPP), and tubal
severe disease can present with a severe abdominal
infertility [1].
pain that may require surgery to resolve. Guidelines
The rate of complication increases in
published by CDC in 2015 concluded that PID
insufficiently treated PID cases or if treatment is
treatment should be considered in any female with
missed. A recent study reported that most young
lower pain with no obvious cause, and at least one
women expressed their willingness to give up two
of the following criteria: tender uterus, tender
years of their life to prevent PID and its
cervix, and tender adnexa] [3 .
complications, thus, making this disease an essential

concern affecting the quality of life significantly [2].
PID is caused by infections in the female

Data Sources and Search terms
reproductive tract that includes pelvic peritoneum,
We conducted this review using a comprehensive
ovaries, fallopian tubes, and the endometrium.
search of MEDLINE, PubMed, and EMBASE, from
These infections are commonly caused by
January 1985, through February 2017. The
Received: 20/12/2017 DOI: 10.12816/0044669
Accepted: 30/12/2017

Full Paper (vol.709 paper# 7)

c:\work\Jor\vol709_8 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (9), Page 1468-1470
Pneumonia in Elderly and Intensive Care Management
Abdulhadi Salem Towairqi1, Lujain Hamed Mutwally2, Yasser Ali Baateiyyah3,
Rakan Ahmed I Alshuwaier4, Ismail Nizar O Kraiz4, Hamzah Mohammed Alarfaj5,
Ohood Abdulrazaq Alsomali6, Rahaf Sadiq Omar Bukhari7
1 University of Jeddah, 2 King Fahad Hospital Jeddah, 3 Umm Alqura University, 4 King Saud University,
5 King Faisal University In Alahsaa, 6 Yanbu General Hospital, 7 King Khalid University
Corresponding author: Abdulhadi Salem Towairq - LL2007LL@hotmail.com - +966 56 256 2566

The incidence of pneumonia among elderly is 4 times higher than younger individuals, with
elevated risks of hospital admissions and high mortality rates. The most important and common infectious cause
of death among old patients remains to be community acquired pneumonia. It is essential to properly assess
severity of the disease to decide appropriate management ranging from antibiotics, hospitalization, and intensive
care. Methodology: We conducted this review using a comprehensive search of MEDLINE, PubMed, and
EMBASE, January 1985, through February 2017. The following search terms were used: pneumonia, elderly
pneumonia, intensive care unit, community acquired pneumonia, management and prevention
Aim: In this review, we aim to study the prevalence, etiology and intensive care management of pneumonia in
the elderly. Conclusion: Community acquired pneumonia continues to be the leading cause of death due to
infectious diseases among patients older than 65 years. It is also associated with significant amounts of long term
morbidities. Proper assessment will have a significant impact on the burden of healthcare use, diagnostic and
therapeutic approaches, and consequently, clinical and survival outcomes.
Keywords: community acquired pneumonia, pneumonia in elderly, ICU management, pneumonia vaccination


Pneumonia is a more important concern in old
care unit, community acquired pneumonia, management
people older than 65 years than younger individuals.
and prevention
Actually, the incidence of pneumonia among elderly is 4

Data Extraction
times higher than younger individuals, with elevated
Two reviewers have independently reviewed the studies,
risks of hospital admissions and higher mortality rates.
abstracted data, and disagreements were resolved by
A previous study found that incidence of community
consensus. Studies were evaluated for quality and a
acquired pneumonia can be as high as 18.2 and 52.3 per
review protocol was followed throughout.
1000 among patients aged 65-69 years, and older than
The study was done after approval of ethical board
85 years, respectively, making the incidence
of University Of Jeddah.
corresponds with the age. The most important and

common infectious cause of death among old patients
remains to be community acquired pneumonia (CAP).
Causative organism of pneumonia in the elderly
Moreover, mortality from community acquired
population is very similar to younger populations. The
pneumonia among elderly can be as high as 30%
most common organism responsible for CAP in an old
making it significantly higher than mortality among
patients remains to be streptococcus pneumonia;
young patients. It is essential to properly assess severity
streptococcus pneumonia is identified in up to 58% of
of the disease to decide appropriate management of
cases. Another frequently identified organism is
elderly with pneumonia. Thus, proper assessment will
haemophilus influenza that accounts for up to 14% of
have a significant impact on the burden of healthcare
CAP among elderly, and is associated with chronic
use, diagnostic and therapeutic approaches, and
obstructive pulmonary disease `COPD'. Moraxella
consequently, clinical and survival outcomes [1].
catarrhalis and methicillin-sensitive staphylococcus

aureus can also be found in CAP cases but with
relatively lower incidence (about 7%) [2]. When it comes

Data Sources and Search terms
to gram-negative organisms, there are usually
We conducted this review using a comprehensive search
responsible for hospital acquired pneumonia cases
of MEDLINE, PubMed, and EMBASE, January 1985,
(HAP) rather that CAP. The most common gram-
through February 2017. The following search terms
negative organisms responsible for HAP include
were used: pneumonia, elderly pneumonia, intensive
Received: 20/12/2017 DOI: 10.12816/0044670
Accepted: 30/12/2017

Full Paper (vol.709 paper# 8)

c:\work\Jor\vol709_9 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (9), Page 1471-1474

Gallstone Ileus: Case Report of a Rare Cause of Intestinal
Obstruction in An Unexpected Age Group
*Bashaer Ahmed Shafei1, Rami Issam Arabi1, Ahmed Abdulrahim Fallatah2
1Ibnsina National College for Medical Studies, 2King Abdulaziz Hospital and Oncology Center
*Corresponding author: Bashaer Ahmed Shafei,email: bashaer.shafei@hotmail.com, Tel no: 00966566200082

gallstone ileus is a rare complication of cholelithiasis and considered as a type of mechanical
bowel obstruction in which a gallstone is impacted in the gastrointestinal tract. This condition is seen more
frequently in old patients with females' predominance. Gallstone ileus is responsible for 1%-5% of
mechanical intestinal obstruction.
Case presentation: we report a case of 48 years old medically free, male patient presented to Emergency
Department with severe abdominal pain, distention, constipation, multiple attacks of vomiting associated with
nausea and with a chronic history of cholecystitis. The diagnosis of gallstone ileus was confirmed by
abdominal X-ray and abdominal computed tomography (CT) scan findings. The patient was stabilized before
doing an exploratory laparotomy.
Conclusion: gallstone ileus is an emergency condition associated with high morbidity and mortality rates. To
get the most favorable outcome, high clinical suspicion aided by the use of diagnostic modalities such as CT
abdomen is needed to reach the diagnosis since it is usually present with nonspecific signs and symptoms.
gallstone ileus, intestinal obstruction, fistula, pneumobilia, male patient, and middle age


Gall stone ileus is a mechanical bowl obstruction typically affecting the elderly female patients
caused by gallstone passing through fistula between the gall-bladder and intestine known as cholecystoenteric
fistula allowing the gall stones to enter the GI tract (1,2). The most common fistula forms between the
gallbladder and duodenum and the most common site of gallstone impaction is the terminal ileum (1-4).
Surgery is considered as the cornerstone to manage gallstone ileus aiming to relieve the obstruction as soon as
possible, and enterotomy with stone extraction alone without approaching the fistula is the most common
surgical method used to manage this condition due to low incidence of complications (1).

g/dl, platelets (Plt) : 456*109/L, Na: 137 mmol/L,
A 48 years old medically free, male patient,
K: 4.1mmol/L, Urea: 8 mmol/L, Creatinine (Cr):
presented to ER complaining of moderate to
95umol/L, Amylase: 60 U/L, liver function test
thesevere abdominal pain of one-week duration.
(LFT), coagulation profile and arterial blood gases
The pain started gradually and became severe one
(ABG) were normal. The patient was resuscitated
day before presentation in which the patient
with intravenous (IV) fluids, X-ray and CT
developed abdominal distention, constipation,
abdomen with oral and IV contrast were done for
multiple attacks of vomiting and worsening of his
the patient. X-ray showed multiple air fluid levels
symptoms. There was no history of fever, loss of
with dilated bowel loops which suggested
weight, anorexia, melena or hematemesis. He had
intestinal obstruction (figure 1), while CT scan
a history of gallstones and gastric ulcer in which
demonstrated large stone impacted in the distal
he was treated as a case of peptic ulcer disease and
ileum, causing small bowel obstruction, evidence
chronic cholecystitis. Upon presentation, the
of pneumobilia was noted as well. Upon the X-ray
patient was conscious, alert, oriented, looks ill and
and CT findings of intestinal obstruction due to a
in pain. Vital signs: Blood pressure: 120/60 mmHg,
gallstone, the patient was prepared for exploratory
pulse: 70 beats per minute and temperature: 37.3
cesius. The abdomen was distended, soft and lax
Intra-operatively, no collection or perforation
but with tenderness on the right side, Murphy sign
were noticed, yet, a stone 7cm x 3cm x 2.5cm was
was negative and right inguinal swelling was
lodged in the terminal ileum and decision was
noted. On auscultation, the bowl sound was
made to perform enterotomy and stone extraction.
sluggish, and per-rectal examination was
Enterotomy was performed proximal to the site of
unremarkable. Initial labs showed white blood
the stone, and successful milking with extraction
cells (WBC) 11.7 billion/L, hemoglobin (Hb): 13
of the gallstone was achieved. (figure 2).

Received: 20/12/2017 DOI: 10.12816/0044671
Accepted: 30/12/2017

Full Paper (vol.709 paper# 9)

c:\work\Jor\vol709_10 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (9), Page 1475-1479

Primary Health Care Physicians' Knowledge, Attitude and
Practice towards Evidence-Based Medicine in Tabuk City, KSA
Abdullah H. Altemani1*, Assem H. Altemani2
1Department of Family and Community Medicine, Faculty of Medicine, University of Tabuk, Kingdom of
Saudi Arabia, 2Medical Resident, Medical Administration, University of Tabuk, Kingdom of Saudi Arabia
*Correspondence: Abdullah H. Altemani, Tel No.: 00966144562511, E-mail: atemani@ut.edu.sa


Background: Evidence-based medicine (EBM) is an essential component of modern medical practice and
crucial for patient safety and high-quality health care services.
Objectives: This study was conducted to assess the knowledge, attitude and practice towards evidence-based
medicine and the barriers against its application in daily medical practice.
Subjects and Methods: This is a cross-sectional survey using a self-administered validated questionnaire
among 68 primary health care physicians in Tabuk city, Kingdom of Saudi Arabia during the period from
December 2016 to June 2017. Validated questionnaire was used to collect data from the respondents. The
Statistical Package for Social Sciences (SPSS) was used for data analysis. P-value of <0.05 was considered as
significant. Result: There are 62.2% male participants, the age of the majority were from 30 to 50 years
(73.5%) and (72.1%) did not have board qualification, the primary literature review and summaries were the
popular methods for EBM. The knowledge and attitude were suboptimal; some did not even access Medline.
The unavailability of time and internet access were the most frequent barriers reported. Only a minority
received formal EBM training.
Conclusion: The knowledge and attitude regarding EBM were suboptimal among the primary health care
physicians, the time factors, unavailability of the internet and the lack of letters, access to journals, and
guidelines were the principal barriers to EBM incorporation in the clinical practice.
Keywords: Evidence-based medicine, primary health care physicians, knowledge, attitude, practice, barriers


Evidence-based medicine is a process of turning
clinical experience, colleagues' opinion, and
clinical problems into questions and then
electronic resources of information rather than
systematically locating, appraising, and using
directly referring to evidence-based medicine.
contemporaneous research findings as the basis for
Others may distrust evidence-based information
clinical decisions (1). It is the integration of
and have the perception that it is not applicable to
evidence from proper medical research with
their practice (4-6).
patients' values and clinical expertise. It has been
A review of several studies assessed the
shown to reduce mortality and hospital stay.
performance of physicians showed that many
However, more than one-third of patients do not
factors could be used to raise the awareness and
receive evidence-based health care, and a similar
maintain the level of knowledge about medical
proportion receives harmful or unnecessary care (2).
advances, and enhance clinical performance of
Medical practitioners are continuously required to
practitioners. Such factors include the learning of
update their knowledge and skills concerning new
how to practice EBM, the skills of adopting the
modalities of diagnosis and management. In the
protocols related to evidence-based practice
face of the massive amount of new products
developed by respected medical colleagues, and the
regarding the management, it is virtually impossible
ability to seek out and apply the findings of EBM
for primary healthcare physician to keep track and
(7). Research about EBM among practitioners
update. Thus, it is vital to implement evidence-
started earlier. One pioneer study about the reaction
based medicine to optimize patient's care (3).
of general practitioners towards EBM was
The implementation of EBM is challenging. It is
conducted in the UK in 1996. Although there was a
faced with numerous barriers including lack of
low-level of awareness about extracting journals,
resources, suboptimal knowledge, lack of skills,
reviewing publications and databases relevant to
and time. In spite of being overloaded with
EBM, most of GPs welcomed and agreed that EBM
information, primary health care physicians are not
improves patient care. There was considerable
able to provide services that give the most
variation in attitudes to the promotion of EBM and
significant benefit to the community served. The
the major perceived barrier to its practice was lack
primary healthcare physicians are under continuous
of personal time. Respondents stated that the best
time pressure and may prefer to rely on their
way to move from opinion-based practice towards
Received: 20/12/2017 DOI: 10.12816/0044672
Accepted: 30/12/2017

Full Paper (vol.709 paper# 10)

c:\work\Jor\vol709_11 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (9), Page 1480-1483

Post-operative Bleeding and its Management
Eyaad Talat Ghallab
King Abdullah Medical Complex, Jeddah
Corresponding Author: Eyaad Talat Ghallab Eghallab3257@gmail.com 00966505683184

one of the most feared complications of surgery is bleeding. Substantial gastrointestinal
bleeding in the postoperative time is an unusual complication of both GI and non-GI surgery. If not managed
properly and promptly, the patient can suffer from hypovolemic shock and so it is considered a life-threatening
emergency until proven otherwise. Aim of the work: In this review, we aimed to study post-operative
bleeding with special reference to gastrointestinal surgery and also to understand the major causes and explore
the approach to its management. Methodology: we conducted this review by using a comprehensive search of
MEDLINE, PubMed and EMBASE, January 2001, through February 2017. The following search terms were
used: post-operative bleeding, gastrointestinal surgical hemorrhage, gastrointestinal bleeding, hypotensive
shock and bleeding management. Results: immediate surgery must be performed to save the patient in case of
bleeding after surgery. Conclusion: to prevent postoperative hemorrhage, thorough evaluation must be done.
When bleeding occurs, it is essential to recognize it immediately as prognosis and survival are significantly
affected with delayed proper management. If needed, immediate surgery must be performed to save the
Keywords: post-surgical bleeding, gastrointestinal hemorrhage, bleeding management, surgical complications


Substantial gastrointestinal (GI) bleeding in the
surgery and plans a systematic evaluation for the
postoperative time is an unusual complication of
patient, management options, and evaluation of
both GI and non-GI surgery. Even though not as
risk/benefit ratio for several treatment options [3].
common, its management in the postoperative
Even though most incidents of postoperative GI
period is more intricate than that occurring beyond
bleeding are self-limiting, decisions of whether or
the perioperative period due to a larger possibility
not bleeding describes another unrecognized
for the source of bleeding and a more complicated
postoperative complication is supreme to permit
risk vs. benefit analysis. There are not many
appropriate treatment. Minor postoperative bleeding
published literatures concerning management of
can occur commonly and without complication.
postoperative GI bleeding, and the rarity,
Significant bleeding, often defined as overt
complexity and unpredictability of the clinical
bleeding, where nasogastric drainage showed
setting of this complication confuse understanding
of its cause and treatment [1]. Postoperative GI
hematochezia, hematemesis or melena, complicates
bleeding can occur secondary to three situations [2]:
hemodynamic instability, or lead to a decrease in
1) when surgery or complications of the surgery
hemoglobin by greater than 2 g/dL, or transfusion of
prevail the pathophysiologic cause of bleeding, 2)
blood products is needed, or those that require
bleeding that happens due to causes unrelated to
invasive therapeutic intervention, happens much
surgery and that usually occur rarely in the
less commonly but is related with noteworthy
postoperative period and 3)surgical complication or
morbidity and mortality. In case of severe bleeding
surgical stress contribute to the exacerbation of a
that demand therapeutic intervention, the risks and
previous GI bleeding source.
benefits of different therapeutic interventions must
GI bleeding in the early or immediate postoperative
be measured in each postoperative setting [4].
period is more commonly the result of the first

situation outlined, especially when the patient has a
serious illness or has other severe postoperative
Data Sources and Search terms
complications. Therefore, this article emphasizes on
We conducted this review by using a
scenarios in which the GI bleeding happens
comprehensive search of MEDLINE, PubMed and
secondary to surgery or other complications of
EMBASE, January 2001, through February 2017.
Received: 20/12/2017 DOI: 10.12816/0044673
Accepted: 30/12/2017

Full Paper (vol.709 paper# 11)

c:\work\Jor\vol709_12 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (9), Page 1484-1493

Assessment of Knowledge, Attitude and Practice of Safety, Effectiveness and
Consequences of Bariatric Surgery among Community in Riyadh City
Tariq Abdullah Aldawqi1 , Ahmed Emad alghamdi1 , Youssef Ahmed alishi1 ,
Mohammad Fahad alzahrani1 ,Ahmed Yahya Aseri2,Ahmed A Albariqi2
1-Imam Muhammad ibn Saud Islamic University,2-King Khalid University
Obesity is a public health problem and its prevalence is escalating in the recent years in Saudi
Arabia. Bariatric surgery is the most effective treatment for the morbidly obese.
Aim of the Work: The aim of this studywas to examine community health beliefs regarding obesity and
bariatric surgery, and to evaluate the potential associations between demographic characteristics and
agreement to bariatric surgery.
Material and Methods: A self-administered questionnaire was distributed to adult citizens of Riyadh city.
The questionnaire included questions about obesity, its causes, lifestyle, and beliefs about the effectiveness
of bariatric surgery and its complications.
Results:27.6% of respondents were overweight and 33.6% were obese. The overweight/obese respondents
were significantly inclined to be in the older age groups, married, and have high income and a family
history of obesity. Most respondents showed good knowledge about obesity, its risk factors, and healthy life
style, and they recognized the efficacy of bariatric surgery in reducing weight. However, more than half of
the respondents doubted its safety and only 16.2% believed it to be the best choice. Male subjects - who
were in older age groups, had a secondary school education and a body mass index above normal range -
were more likely to regard surgery as the best choice for weight loss.
Conclusion: Most of respondents overestimated the risks of bariatric surgery and did not consider it as the
best choice for weight loss. Health education is recommended to address these misconceptions and
convince the public of its relative safety and the expected health benefits.
Keywords: obesity; overweight; body mass index; bariatric surgery; attitude; knowledge.

refined foods in the diet at the expense of
The prevalence of obesity is increasing
vegetables and fruits(5).
worldwide at an alarming rate in both developing
Several studies reported that, medical and
and developed countries. It has become a serious
surgical treatment programs are occasionally
epidemic health problem, estimated to be the fifth
applied to treat morbidly obese patients. Surgery
leading cause of mortality at global level. In
seems to have the successful and the longest
addition, 44% of the diabetes burden, 23% of the
period of sustained weight loss. Primary reasons
ischemic heart disease burden, and between 7%
for improved safety are the increased use of
and 41% of certain cancer burdens are
laparoscopy and advancements in surgical
attributable to overweight and obesity (1).
techniques. Overall mortality rate is about 0.1%,
Obesity is a syndrome with multifactorial
which is obviously less than that of gallbladder
(0.7%) and hip replacement (0.93%) surgeries,
environmental, social, and cultural interaction.
and the overall likelihood of major complications
Obese persons have increased risk of
is about 4.3%(6). Patients may lose as much as
hypertension, diabetes, metabolic syndrome,
60% of excess weight six months after surgery
stroke, certain types of cancer (such as
and 77% of excess weight as early as 12 months
endometrial, breast, prostate, and colon cancers),
after surgery. On average, five years after
dyslipidemia, gall bladder disease, sleep apnea,
surgery, patients maintain 50% of their excess
osteoarthritis, emotional distress, discrimination,
weight loss, which helps to improve or resolve
and social stigmatization(2).
more than 40 obesity-related diseases and
The rapid cultural and social changes that
conditions, including type 2 diabetes, heart
have occurred in the Arabian Gulf region, since
disease, certain cancers, sleep apnea, gastro
the discovery of oil and the economic boom, were
esophageal reflux disease, hypertension, and joint
associated with an alarming increase in obesity(3).
One of the major causes of obesity is the changes
In Saudi Arabia one out of three adults
in the diet, in terms of quantity and quality, which
suffers from obesity and at least one out of ten
has become more "Westernized"(4). In the
adults has morbid obesity(8). Although bariatric
Kingdom of Saudi Arabia, recent studies revealed
surgery was and still is the only available
increasing consumption of animal products and
technique with established long-term effects on
Received: 16/12/2017 DOI: 10.12816/0044674
Accepted: 26/12/2017

Full Paper (vol.709 paper# 12)

c:\work\Jor\vol709_13 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (9), Page 1494-1507

Antimicrobial Activity of Bio and Chemical Synthesized
Cadmium Sulfide Nanoparticles
Soheir S. Abd Elsalam1, Rania H. Taha2*, Amany M. Tawfeik3,
Mohamed O. Abd El-Monem4, Hanady A. Mahmoud5
1 Microbiology Department, Faculty of science, Benha University, 2Chemistry Department, Faculty of
Science for Girls, Al-Azahar University, 3 Microbiology and Immunology Department, Faculty of
Medicine for Girls, Al-Azhar University, 4 Botany Department, Faculty of science, Benha University, 5
Botany Department, Faculty of science, for Girls, Al-Azahar University, Egypt
Corresponding author: Hanady A. Mahmoud, Dr.hanady_2010@yahoo.com
Background: The green synthesis of cadmium sulfide (CdS) nanoparticles has been regarded as the most
promising technique for their prospective applications in biological system. Aim of the work: In this study
isolation of different bacterial strains from stool samples of healthy volunteer, selection of the most
efficient bacterial strains able to reduce cadmium sulfide metal into nanoparticles. Characterization of
biosynthesized metal nanoparticles by standard analytical methods. Mediating the biosynthesized cadmium
sulfide nanoparticles in medical applications in comparison to those produced by chemical methods.
Materials and methods: Extracellular Escherichia coli E-30 and Klebsiella pneumoniae K-6 isolated from
stool samples were the strains used for biosynthesis. Cadmium sulfide nanoparticles were also produced by
wet chemical method. The characterizations of cadmium sulfide nanoparticles were done by using UV-
Visible Spectroscopy, Transmission electron microscopy (TEM), energy dispersive x-ray (EDX) and
Fourier transform infrared spectroscopy (FT-IR). Results: Escherichia coli E-30 has shown to be efficient
in synthesizing cadmium sulfide nanoparticles where CdS nanoparticles were with average size ranging
from 3.2 to 44.9 nm while average size of CdS nanoparticle was synthesized by Klebsiella pneumoniae K-6
ranging from 8.5 to 44.9 nm. While cadmium sulfide nanoparticles synthesized by wet chemical method,
ranging from 8.77 to 16.50 nm. Biosynthesized cadmium sulfide nanoparticles by Escherichia coli E-30
showed highest antimicrobial activity on Aspergillus fumigatus, Geotricum candidum, Bacillus subtilis,
Staphylococcus aureus
and Escherichia coli than chemical synthesized of CdS nanoparticles.
Conclusion: Escherichia coli and Klebsiella pneumoniae isolated from stool samples had the ability to
produce cadmium sulfide nanoparticles. This kind of microorganisms can be used for synthesis of
nanoparticles and heavy metal absorption for detoxification of environment.
Keywords: biosynthesis cadmium sulfide nanoparticles, Escherichia coli and Klebsiella pneumoniae, wet
chemical synthesis cadmium sulfide, antimicrobial activity.

enzyme sulphate reductase present in most of the
Nanotechnology is the creation, manipulation
bacterial species [4, 5]. In the intracellular production
and use of materials at the nanometer size scale (1
of nanoparticles the transport of ions takes place
to 100 nm). At this size scale there are significant
into the cell which utilizes the intracellular enzymes
differences in many material properties that are
for the production, whereas in extra cellular
normally not seen in the same materials at larger
production of nanoparticles the metal ions and
scales. Although nanoscale materials can be
enzymes are trapped on the cell surface to produce
produced using a variety of traditional physical and
nanoparticles [6, 7]. The decrease in the size of
chemical processes, it is now possible to
nanoparticle provides more surface to volume ratio
biologically synthesize materials via environment-
which increase the chance of Cd+2 exposure to the
friendly green chemistry based techniques [1, 2]. The
bacterial cells. Nanoscale materials have emerged
microorganisms have the ability to produce
up as novel antimicrobial agents owing to their high
nanoparticles either extracellular or intracellular
surface area to volume ratio and its unique
depending on the type of organism used [3, 4]. The
chemical and physical properties [8]. There are
reports on antimicrobial activity of nanoparticles
nanoparticles involves the reduction of inorganic
such as Ag, Au, MgO, CuO, Cd, Al, TiO2, etc.
metals in the solution which is facilitated by the
which are effective against different drug resistant
Received: 17/11/2017 DOI: 10.12816/0044675
Accepted: 27/11/2017

Full Paper (vol.709 paper# 13)

c:\work\Jor\vol709_14 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (9), Page 1508-1510
Emergency Management of Subdural Hematoma
Abdulrahman Mubarak Almutairi1, Hassan Mohammed Barnawi2, Ebtesam Mohammed
Alahmari3, Tahani Saeed Almohayya3, Roaa Fahad Alshabanah3, Huda Hussain Mohammad Radwan4
1- Majmaah University, 2- Taibah University, 3- King Khalid University, 4-Ibn Sina National College
Corresponding author: Abdulrahman Mubarak Almutairi - a.m.almutairi@live.com 0564804048

subdural hematoma is extra-cerebral accumulation of blood between the dura matter and the
subarachnoid layer. It is almost always caused by trauma or due to blood thinning therapies and occurs due to
rupture of bridging veins. Acute subdural hematoma is an emergency situation and requires prompt diagnosis
using CT most of the time and management requires surgery as well as reversal of anticoagulants.
Aim of the work:
In this review, we aimed to study the etiology of subdural hematoma, explore how to
diagnoses and manage it in the emergency department. Methodology: we conducted this review using a
comprehensive search of MEDLINE, PubMed and EMBASE, from January 1985 to February 2017.
Results: surgery is most important intervention in managing subdural hematomas. Conclusion: subdural
hematoma is an important clinical presentation that needs proper and prompt surgical management and
treatment. Treatment should be as less invasive as possible, with higher efficacy and lower recurrence rates.
No-surgical approaches are still being studied with no proven efficacy for them until now.
Keywords: subdural hematoma, diagnosis in emergency room for subdural hematoma, CT vs. MRI,
management of subdural hematoma.

January 1985 to February 2017. The following
Extra-cerebral accumulation of blood (whether
search terms were used: subdural hematoma,
liquid or clotted) between the dura matter and the
emergency management of subdural hematoma, CT
subarachnoid layer is called subdural hematoma.
vs. MRI in diagnosis of subdural hematoma,
This hematoma does not cause expansion of the
treatment of subdural hematoma
subarachnoid area. The cause of this hematoma is
Data Extraction
almost always trauma. Hematoma will cause an
Two reviewers have independently reviewed the
accumulation that will lead to compression of the
studies, abstracted data, and disagreements were
brain and focal neurological manifestations.
resolved by consensus. Studies were evaluated for
Moreover, it causes an increase in intracranial
quality and a review protocol was followed
pressure (with subsequent sequelae) and can affect
consciousness [1]. The classification of subdural
The study was done after approval of ethical
hematomas depends mainly on the time between the
board of Majmaah university.
causing trauma and the onset of clinical signs of

symptoms. Subdural hematomas can be classified as
the following: [2]
Subdural hematomas constitute up to 3% of cases
Acute subdural hematoma: onset of clinical signs
presenting to neurosurgery clinics and are most
and symptoms is within three days following
likely due to preceding trauma. Usually, trauma
Subacute subdural hematoma: onset of clinical signs
anteroposterior and is associated with emissary
and symptoms is within 4-21 days following
veins rupture. The long term use of antiplatelets and
anticoagulants has been linked to the occurrence of
Chronic subdural hematoma: onset of clinical signs
subdural hematomas and had been shown to affect
and symptoms is after more than 21 days following
manifestations and complications, especially in
chronic hematomas. Moreover, a study had found

that anti-platelets and anticoagulants may be
responsible for the occurrence of spontaneous (also
Data Sources and Search terms
known as non-traumatic) subdural hematoma.
We conducted this review using a comprehensive
However, the use of these drugs is still considered a
search of MEDLINE, PubMed and EMBASE, from
predisposing factor rather than a causing etiology [1].
Received: 16/12/2017 DOI: 10.12816/0044676
Accepted: 26/12/2017

Full Paper (vol.709 paper# 14)

c:\work\Jor\vol709_15 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (9), Page 1511-1517

Parental Awareness Regarding Aerodigestive Pediatric
Foreign Bodies. Eastern Province, Saudi Arabia
Fatimah A. AlShakhs1, Khalid A. AlYahya2, Asmaa S. AlSaeed1, Marwah S. AlSultan1
Faculty of medicine, King Faisal University, Al-Sharqiya, Saudi Arabia1, Otolaryngology Head and
Neck Surgery. King Faisal University Ahassa, Saudi Arabia

Aerodigestive foreign bodies are common clinical problem that may lead to life threatening
complications or sudden death. It's commonly seen in children since they are curious to explore environmental
objects with their mouth, while the development of airway protection reflexes and chewing capacity are
This study aims to assess the extent of parents' awareness about the danger of foreign objects that
can be swallowed or inhaled by their children and how to manage such cases.
Materials and Methods: A cross sectional study was used to assess the level of parents' awareness about the
danger of swallowing or inhaling foreign objects by their children and to assess their knowledge about dealings
with such cases. The data were collected from 459 by a distributed questionnaire among parents in Al-sharqiya.
Results: 60.3% of participants were aware of aerodigestive foreign bodies.Regarding the management of child
with aerodigestive foreign bodies in different age groups. For child with age group 1 year and less, about
(34.9%) of participants were aware of the managment. However, there is misunderstanding of managing child
with age 5 years and less where only 5.6% of participants were aware of the management in this age group. As
regards the children more than 5 years old, only 36.2% of parents were aware of the management.
Conclusion: The current study showed that most parents are lacking knowledge about the managment of this
problem which reflect the importance of education and increasing the awareness among them to reduce the
morbidly and mortality rate among children.
Keywords: Aerodigestive tract, foreign body, pediatric, Parental awareness, Saudi Arabia, Eastern province.

even death [7, 8]. Radiological investigations should be
Aerodigestive foreign bodies are common clinical
used to identify the object but
problem that may lead to life threatening

complications or sudden death. The foreign body can
not to exclude it. Bronchoscopy also should be done
be lodged either in airway tract or digestive tract. It's
as diagnostic, therapeutic tool or both [9]. Since
commonly seen in children since they are curious to
pediatric aerodigestive foreign bodies are common
explore environmental objects with their mouth in
worldwide; prevention is the best way to decrease the
spite of insufficient airway protection reflexes, and
incidence, morbidity and mortality as well. The aim
immature development of chewing capacity [1]. The
of this study is to assess the level of parents'
majority of those children are under age of five years
awareness regarding swallowing or inhalation of
old [2]. Early recognition of foreign bodies is essential
foreign objects by their children and how to deal with
to prevent serious problems such as atelectasis,
such cases.
pneumonia and bronchiectasis or even asphyxia and

death [3]. The presentation varies depending on the
location, size and type of foreign body. It may
Study design
manifest as coughing, difficulty in breathing,
A cross sectional study was used to assess the level of
vomiting, chocking or fever [4]. Most of these foreign
parents' awareness of danger of swallowing or
bodies are coins, batteries and small toys [5]. One of
inhaling foreign objects by their children and to
the fatal foreign objects is button battery that's
assess their knowledge about dealings with such
commonly used for hearing aids, watches and some
toys [6]. It's small, shiny and smooth object which
Study area and population
attract most children who handle it. It contains
The data were collected by a distributed questionnaire
materials that are strong enough to cause rapid
among parents in Al-sharqiya. The study included
liquefaction necrosis of tissue leading to serious
parents who have children under age of five years
complications such as perforation, mediastinitis, or
old. The sample size was calculated by Creative
Received: 17/12/2017 DOI: 10.12816/0044677
Accepted: 27/12/2017

Full Paper (vol.709 paper# 15)

c:\work\Jor\vol709_16 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (9), Page 1518-1528

Role of S-Iron and Ferritin to Predict the Response to Recent New
Antiviral Treatment in Chronic Hepatitis C Patients
Khaled H Hemaida, Hany H Kayser, Rasha S Mohamed, Amr M Abdel Wahab
Department of Internal Medicine, Faculty of Medicine Ain Shams University
Corresponding author: Amr M Abdel Wahab; Mobile: 01143742271: Email: amrabdelwahab68@yahoo.com

Chronic hepatitis C (CHC) is an important liver disease, which may progress to cirrhosis or
hepatocellular carcinoma. The current treatment regimen for CHC includes pegylated interferon- (PEG-
IFN) combined with ribavirin Ferritin is the major iron storage protein and provides an indirect estimate of
the body's iron stores. It is also an established marker for liver iron deposition. Aim of the Work: The aim
of this study is to configurate the distribution of iron and ferritin levels in patients with chronic hepatitis C
virus infection and to conduct a comparative study between the pretreatment and the post treatment iron
profile after direct acting antiviral therapies in chronic HCV patients. Patients and Methods: This
Randomized Controlled Clinical study was conducted on 100 subjects aged from 18 to 60 years selected
from Gastroenterology and Hepatology department at Ain Shams University Hospital, Cairo, Egypt, from
January 2017 to April 2017 and was approved by the ethical committee. Results: The current study suggests
that a 12 weeks course of Sofosbuvir / Ledipasvir combination drug therapies showed a higher SVR 12 (92
%) and have significant decrease of the elevated serum iron and ferritin and transferrin saturation to the
normal level more than sofosbuvir / Daclatasvir which showed a SVR 12 (88%). In both study groups,
patients who showed SVR had significant lower values of Iron, Ferritin and transferrin saturation levels than
patients who were non-SVR after end of therapy. Conclusion: This study may also shed light on how the
changes in serum iron and ferritin levels in chronic hepatitis C patients may be related to HCV treatment.
Sofosbuvir / Ledipasvir 12-weeks course is more recommended than Sofosbuvir /
Daclatasvir 12 weeks course in patients with chronic HCV infection. As serum Iron, serum Ferritin and
Transferrin saturation showed more significant improvement with SOF/LED combination therapy than
SOF/DAC combination therapy, they are a good markers of highly predictive value in treatment of chronic
HCV infected patients with DAAs.
Keywords: serum iron, ferritin, antiviral treatment, CHC.

Moreover, iron deposition in hepatocytes
Hepatitis C virus (HCV) infection which
enhances HCV replication thus facilitating the
affects nearly 2% of the human population is a
viral infection in the liver (6).
major cause of liver disease worldwide. Following
acute HCV infection chronicity is 80%. Although
promutagenic substances such as 8-hydroxyl-2`-
many individuals carrying the virus remain
deoxy-gusuosine (8-0HDG) which have been
asymptomatic, chronicity is accompanied by
implicated in spontaneous DNA mutagenesis and
altered liver function and progressive liver disease
carcinogenesis (7). Therefore, there is need to
ending in cirrhosis or hepatocellular carcinoma in
configurate the distribution of iron and ferritin
up to 20% of infected subjects (1).
levels in patients with chronic HCV.
Mild - to - moderate iron overload is a
common finding among patients with chronic
The aim of this study is to configurate the
HCV infection where up to 30-40% of them may
distribution of iron and ferritin levels in patients
show increased serum transferrin-iron saturation
with chronic hepatitis C virus infection and to
and serum ferritin or increased hepatic iron
conduct a comparative study between the
concentration (2). Elevated iron indices is
pretreatment and the post treatment iron profile
correlated with progression of liver disease and a
after direct acting antiviral therapies in chronic
decreased response to antiviral therapy (3,4).
HCV patients.
Excess iron increases the formation of reactive

oxygen species (hydroxyl radicals) leading to
lipid peroxidation and damage to protein and
Study Design
DNA resulting in cell membrane and genomic
This study was a Randomized Controlled
damage and hepatic stellate cell activation and
Clinical Trial conducted on 100 subjects aged
proliferation and upregulate synthesis of smooth
muscle actine and collagen thus leading to hepatic
Gastroenterology and Hepatology department at
fibrogenesis (5).
Ain Shams University Hospital, Cairo, Egypt,
Received: 20/12/2017 DOI: 10.12816/0044678
Accepted: 30/12/2017

Full Paper (vol.709 paper# 16)

INTRODUCTION The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (9), Page 1529-1538

Soluble P-selectin Level in Patients with Deep Venous Thrombosis
Abeer A Saadeldin (1), Yasmin N El-Sakhawy (1), Hany A Hussien (2), Doaa A Shalaby (1)
(1) Department of Clinical and Chemical Pathology, (2) Department of Internal Medicine
Faculty of Medicine-Ain Shams University
Corresponding author: Doaa A Shalaby; Mobile: 01022368110; Email: dr.doaa45@gmail.com

Venous thromboembolic disease (VTE) remains a significant source of morbidity and
mortality. As non-specific subjective complaints and a lack of objective clinical examination findings
complicate the diagnosis of both deep venous thrombosis (DVT) and pulmonary embolism. Objective
diagnostic testing is required to confirm or exclude the presence of venous thromboembolism before
subjecting patients to unnecessary long-term anticoagulation. Aim of the Work: This study was aimed to
measure the level of soluble P-selectin (sPsel) in Egyptian patients with DVT and asses its diagnostic value
in relation to other clinical data and radiological examination. Subjects and Methods: This study was
carried out on 80 individuals, attending Ain Shams University Hospitals between October 2015 and March
2016 after Ethical committee approval. They were divided into two groups.: Group I, 50 patients who were
positive for DVT by duplex ultrasound. They were 41 males and 9 females. Their ages ranged 20 - 77 years,
with a mean of 46.20 11.78 years. They were 41 (82%) males and 9 (18%) females, with a male to female
ratio of 4.55:1. Group II: 30 healthy subjects with no clinical signs, symptoms, or history of DVT. They
were 23 (76.7%) males and 7 (23.3%) females, with a male to female ratio of 3.28:1. Results: There was a
highly significant difference between patients (group I) and controls (group II) as regards P-selectin, the best
cut off was70.5 ng/ml with 98% sensitivity, 100% specificity, a NPV of 96.8% and a PPV of 100%.
Conclusion: Diagnostic cut-off levels of P-selectin in cases with DVT is 70.5 mg/L that can safely
differentiate patients who are free from DVT from others who are positive for DVT or those who would
eventually develop thrombosis regardless their primary duplex ultrasound scanning results.
Recommendations: As our study recommends the use of serum P-selectin as diagnostic biomarker in DVT
alone; in addition to the newly estimated cut-off levels for these biomarker, further studies on larger number
of cases are needed for more evaluation of these cut-off values and to establish whether they could be used to
guide anticoagulation therapy when duplex ultrasound is unavailable.
Keywords: P-selectin, DVT, VTE, clinical data, radiological examination.


Venous thromboembolism (VTE) remains
biomarker or combination of biomarkers and
a significant health problem of which Deep vein
clinical presentation that can confirm the
thrombosis (DVT) is a common life-threatening
diagnosis, when ultrasound is unavailable (4).
disorder, affecting approximately 1-3 per 1,000 of
In the 1970's, Gwendolyn J. Stewart suggested a
the population each year (1).
Deep vein thrombosis (DVT) usually
thrombosis (5).
refers to the formation of a thrombus in the deep
Several studies, despite the small sample
veins of the leg, although DVT may also occur in
size, have demonstrated elevated levels of soluble
the veins of the upper limbs. DVT can occur
P-selectin (sPsel) in patients with deep venous
spontaneously without a known underlying cause
thrombosis (7).
or after provoking events, such as trauma, cancer,
P-selectin, a protein from the lectin family
surgery or acute illness (2).
and a cell adhesion molecule is the first up-
Timely and accurate diagnosis of DVT is
regulated glycoprotein on activated endothelial
often difficult due to the diffuse symptoms a patient
cells and platelets and has procoagulant
may manifest. Currently, scoring systems based on a
properties. P-selectin, stored in the platelets (alpha
patient's presentation are used to establish the
granules) and in the endothelial cells (Weibel-
probability of having a venous thrombosis and to
Palade bodies), is translocated to the cell surface
determine if further diagnostic testing is warranted (3).
after activation and partially released into the
In the majority of cases, diagnosis is
circulation in its soluble form. The binding of P-
based upon confirmatory compression duplex
selectin to its specific counter-receptor, P-selectin
ultrasound. However, ultrasound is not always
specific ligand-1 (PSGL-1, present on the surface
available. Use of plasma D-dimer testing has
of leukocytes and platelets), initiates various
proved successful in excluding the presence of
procoagulant mechanisms (8).
venous thrombosis. However, there is no current
Received: 20/12/2017 DOI: 10.12816/0044679
Accepted: 30/12/2017

Full Paper (vol.709 paper# 17)

c:\work\Jor\vol709_18 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (9), Page 1539-1543
Glycogen Storage Disease in Pediatric Population
Yara Mofarih Assiri1, Marium Mohammed Iqbal2, Reem Ali Almanie1, Atheer Eed Alotaibi1,
Faris Abdullah S Alharbi3, Bayan Sultan Al Jobran1, Huda F. Abbag1, Mohammed Younes Almoghrabi2,
Fahad Abdulaziz Jarad1, Ashwaq Y. Asiri 1, Mohammad Abdullah Alotaibi4, Wejdan Hamed Alshammari5,
Hadil Mohammed Alenezi6, Badoor Abdrabalameer Alghafli7, Saad Mahmoud Tobaigi2, Amro Sulaiman
AlJuhani8, Maram Mohammed Bajoaifur9, Emtenan Al Ansari9
1 King Khalid University, 2 Batterjee Medical College, 3 University of Gezira, 4 Imam Muhammad
Bin Saud Islamic University, 5 Hail University, 6 Northern Border University, 7 Arabian Gulf University,
8 King Abdulaziz University, 9 Ibn Sina National College
Corresponding Author: Yara Mofarih Assiri - Yara.Mm.Aa@Gmail.Com - +966 54 492 8313
The pathway of glycogen metabolism is regulated by many hormones such as insulin, glucagon, and
corticosteroids. Glycogen storage diseases (GSD) most commonly affect muscles, liver, or both and occur in each
20000 to 43000 live birth. They are classified into 12 subtypes, but types I, II, and IX are the most common.
Methodology: We conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE,
from January 2001, through February 2017. The following search terms were used: glycogen storage diseases, Von
Gierke disease, Pompe's disease, Cori Disease, Forbes disease, Andersen's disease, McArdle disease, neonatal
hypoglycemia, neonatal hepatomegaly. Aim: In this review, we aim to study the genetic basis, diagnosis,
presentation, and different management approach to various common types of glycogen storage diseases prevalent
in pediatric population. Conclusion: There are no cures for any type of glycogen storage diseases presently. Most
treatments are designed to control signs and symptoms. The overall goals are primarily avoiding hypoglycemia,
hyperlactatemia, hyperuricemia, and hyperlipidemia. Liver transplantation should be deliberated for patients with
GSD type IV and for other progressive hepatic types of GSDs in order to avoid hepatic failure or malignancy.
More research must be carried out to develop newer and more effective ways of management.
Keywords: neonatal hypoglycemia, glycogen storage diseases, Von Gierke disease, Pompe's disease, Cori
Disease, Forbes disease, Andersen's disease, McArdle disease.


Inherited diseases that involve the glycogen
Data Sources and Search terms
metabolism pathway are called glycogen storage
We conducted this review using a comprehensive
diseases (GSD). This pathway of glycogen
search of MEDLINE, PubMed, and EMBASE,
metabolism is regulated by many hormones including
January 2001, through February 2017. The following
insulin, glucagon, and corticosteroids. GSDs most
search terms were used: glycogen storage diseases,
likely affect muscles, the liver, or both. A GSD can
Von Gierke disease, Pompe's disease, Cori Disease,
occur in each 20000 to 43000 live births. GSDs are
Forbes disease, Andersen's disease, McArdle disease,
classified according to the enzyme defect, and there
neonatal hypoglycemia, neonatal hepatomegaly
are about twelve subtypes.
Data Extraction

Two reviewers have independently reviewed the
For example, type Ia can affect the liver, kidney,
studies, abstracted data, and disagreements were
and/or intestines. Type Ib affects the same organs like
resolved by consensus. Studies were evaluated for
type Ia, with addition to leukocytes. Both type Ia, and
quality and a review protocol was followed
Ib present classically with failure to thrive,
The study was done after approval of ethical
hyperuricemia, and hyperlipidemia. Another example
board of King Khalid university.
is type III, where type IIIa affects liver and muscles,

and type IIIb affects only the liver. As patients age,
Glycogen storage disease type I
liver symptoms improve gradually. Type IV is
Glycogen storage disease type I (also known as Von
typically diagnosed in infants, and presents with
Gierke disease, or Hepatorenal glycogenosis) is an
failure to thrive and hepatomegaly, that gradually
autosomal recessive disease that occurs due to
progresses to cirrhosis. Type I, III, and IX constitute
deficiency of the glucose-6 phosphatase (G6Pase)
about 80% of cases of GSD with liver involvement
enzyme, causing disruption in both glycogenolysis
Received: 16/12/2017 DOI: 10.12816/0044680
Accepted: 26/12/2017

Full Paper (vol.709 paper# 18)

c:\work\Jor\vol709_19 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (9), Page 1544-1551

Childhood Oral Health: Maternal Knowledge and
Practice in Tabuk, Saudi Arabia
Sharifah Sulaiman Alzaidi1, Ibrahim Abdullah Alanazi2,
Omar Mohammed Abo Nawas2, Mohammed Abdulhai Mulla2
1King Khalid Military hospital, Tabuk, 2Adham General hospital, Ministry of Health, Tabuk, Saudi Arabia
Correspondence author: Sharifah Sulaiman Alzaidi,General dentist, King Khalid Military hospital, Tabuk, Saudi Arabia

Dental cares is a prevalent health problem among preschool children, despite the fact that oral
health is a main component of preschool childrens well-being.
Objectives: To assess the knowledge and practice of mothers in Tabuk city, Saudi Arabia towards their
preschool children oral health.
Methods: This cross-sectional study was carried at Tabuk city, Kingdom of Saudi Arabia. It was carried out
in King Khalid military. All mothers having children aged between 3 and 6 years and attended the out-
patients` clinics of King Khalid military hospital during the period of Augusr1st-October 31st, 2017 and
accept to participate were invited to be included in the study sample. Arabic self-administered structured
questionnaire was utilized for collecting data. It includes two main sections. The first section includes socio-
demographic information and the second section includes ten knowledge and nine practice questions
regarding children`s dental health and hygiene.
The study included 389 mothers. More than half of children were males (50.4%). Nearly one-third
of mothers (34.3%) were in the age group 30-34 years whereas 10.3% of them aged above 45 years. Almost
half of mothers (49.4%) reported all of social media, dentist and mass media as a source of information
regarding oral health and hygiene whereas social media and dentist alone were reported by 17.2% and
21.3% of them, respectively. Collectively, sufficient knowledge was observed among 26% of the
participants whereas adequate practice regarding oral health was reported by 36.5% of mothers. Dental cares
was reported among 115 children (29.6%) whereas dental deformity was reported among 171 children
Conclusion: This study revealed insufficient knowledge and inadequate practice of mothers regarding their
children oral health and hygiene. Some factors were identified affecting both child`s oral health knowledge
and practice.
Keywords: Teeth decay, Mothers, preschool children, Oral health, Oral hygiene, Knowledge.


Dental cares is a prevalent health problem
maintenance and fate of their children oral health
among preschool children, despite the fact that oral
by influencing their oral hygiene and healthy eating
health is a main component of preschool childrens
habits. Therefore, Mothers good knowledge and
well-being1. Oral health-related quality of life is
positive attitude toward oral health are very
usually lower in affected children if compared with
important in the prevention of dental problems6.
those not affected2. In addition, children who
The objective of the study was to assess the
developed caries often had associated health
knowledge and practice of mothers in Tabuk city,
problems such as oral pain and local infections that
Saudi Arabia towards their preschool children oral
resulted in difficulty in sleeping, eating,
psychological problems, reduced growth, and

increase in the risk of caries in permanent
dentition.2,3 Additionally, dental caries at such a
This cross-sectional study was carried at
very young age often treated under general
Tabuk city, Kingdom of Saudi Arabia. Tabuk is a
anesthesia, which carries its own adverse effects3,4.
city located 2200 feet above sea level and has
Early childhood caries is linked with
moderate climate in comparison with other Saudi
numerous risk factors including frequent,
cities. It has a population of 534,893 (2010 census)
prolonged and nocturnal bottle feeding, prolonged
breast feeding, birth order of the child, family
The study was carried out in King Khalid
history of cares, nutritional habits, oral hygiene
military. All mothers having children aged between
practices and timing for first dental visit5, 6.
3 and 6 years and attended the out-patients` clinics
It has been documented that mothers
of King Khalid military hospital during the period
knowledge regarding oral health affect
Received: 17/12/2017 DOI: 10.12816/0044681
Accepted: 27/12/2017

Full Paper (vol.709 paper# 19)

Role of MRI in the Evaluation of Anterior Knee Pain The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (9), Page 1552-1561

Role of MRI in Evaluation of Anterior Knee Pain
Hanan Mohammed Hanafi, Shaimaa El Metwally Eldiasty, Abdul Jabbar Amer Abbood
Department of Radiodiagnosis, Faculty of Medicine, Ain Shams University
Corresponding author: Abdul Jabbar Amer Abbood , E-mail:aldooryabod@gmail.com

the knee joint is one of the most commonly injured joints in the body. Because of its
complex structure, this joint is subjected to numerous pathologies and due to the recent increase in various
sport activities; there has been a parallel increase in sport-induced internal derangements of the knee.
Objective: the main objective of our work was to review several of the most common causes of AKP, with
emphasis on their MRI findings with the goal of allowing more accurate diagnosis and grading of some of
the most common pathologies, for understanding, better treatment and improvement of this common
complaint. Patients and Methods: this study included 20 patients (13 females and 7 males). Their ages
ranged between 10 - 70 years (average age 40.8 5.83 years). All were presented by anterior knee pain
and referred to Radiology Department of Ain Shams University Hospital or private centers for MRI
examination after orthopedic consultation. Results: this study included 20 patients, with their ages ranged
between 10-70 years, all of them were suffering from anterior knee pain. Conclusion: MRI is generally
safe, accurate, and specific modality which has been proven to be the modality of choice in the diagnosis
of different knee pathologies that cause anterior knee pain in different age groups
Keywords: magnetic resonance imaging, anterior knee pain.


AIM of the WORK
Anterior knee pain (AKP) is the most
The main objective of our work was to
common knee complaint, usually occurring in
review several of the most common causes of
adolescents and young adults (1). It is more
AKP and emphasis on their MRI findings with
common in athletic individuals, with the incidence
the goal of allowing more accurate diagnosis and
rate as high as 9% in young active adults and
grading of some of the most common
comprises up to a quarter of all knee problems
pathologies, for understanding, better treatment
treated at sports injury clinics (2).
and improvement of this common complaint.
AKP may cause chronic disability, limited

sports participation and may affect quality of life.
Despite its prevalence, AKP remains poorly
This study included 20 patients (13
understood, as it has not been well studied in the
females and 7 males). Their ages ranged between
literature, making its treatment one of the most
10 - 70 years (average age 40.8 5.83 years). All
complex among the various pathologies affecting
presented by anterior knee pain and were referred
the knee (3). Magnetic resonance imaging (MRI)
to Radiology Department of Ain Shams
in the recent decades has become the gold
University Hospital or private centers for MRI
standard imaging modality for different knee
examination after orthopedic consultation.
pathologies as it is safe and RF pulses used in
Inclusion criteria: any patient complaining from
MRI do not cause ionization. (3).
anterior knee pain.
With MRI, direct coronal and oblique
Exclusion criteria: any patient with absolute
image can obtained which is impossible with
contraindications to MRI examination as cardiac
radiography and CT particularly useful for
pace maker, aneurysmal clipping, cochlear
scanning and detection of abnormalities in soft
implants, hearing aids, intracranial aneurysmal
tissue structures like the cartilage tissues, tendons
clips, ferromagnetic surgical clips or staples,
and ligaments. MRI also can help determine
metalic foreign body in the eye, metal shrapnel or
which patients with knee injuries require surgery.
bullet and claustrophobia, patient who had
MR imaging is recognized as a standard
surgeries to joints and early pregnant patient.
All patients were subjected to: history taking,
arthroscopy as the primary diagnostic modality
plain X-ray of the affected knee joint (if clinically
for many knee pathologies. Moreover, MR
indicated) and MRI of the affected knee.
images can be used to assess anatomic variants
History taking (Personal history: it
that may contribute to chronic patellar instability
included age, sex and occupation. Present
history: included analysis of patient complaint
Received: 14/11/2017 DOI: 10.12816/0044682
Accepted: 24/11/2017

Full Paper (vol.709 paper# 20)

c:\work\Jor\vol709_21 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (9), Page 1552-1567

Prevalence and Risk Factors of Fatty Liver among Adults
Abdullah Obaid Binobaid 1, Mohannad Abdulrazzaq Alalwan 2, Abdullah Hussaen A Almalki 3,
Saad Khalid N Almaghrabi 3 , Mohanned Khder H Sharif 4 , Abdulrahman Adel N Alomair 5 ,
Murtadha Dhiya H. Alsultan 6 , Obaid abdullah O alhamid 7 , Rana R. AL-Rasheed 8 ,
Amro Mohammed Alamro 9 , Mohammed Ibrahim A Alsaleh 10 , Zahra Naji AlAithan 2
1- Alfaisal University, 2- Imam Abdulrahman Bin Faisal University, 3- King Abdulaziz University,
4- University of Jeddah, 5- Imam Mohammad ibn Saud Islamic University, 6- Primary Healthcare Center,
Dammam, 7- Hail University, 8- King Fahd Medical Research Centre, King Abdul-Aziz University,Jeddah,
Saudi Arabia , 9- Medical College of Qassim University , 10- Prince Sultan Cardiac Center, Al Hasa

Non-alcoholic fatty liver disease (NAFLD) is a heterogeneous condition that contains steatosis
and non-alcoholic steatohepatitis (NASH), in the nonexistence of significant alcohol consumption, reaching 30%
of the populace. The most common risk features are: age, ethnicity, gender, obesity, drugs, diabetes mellitus
(DM), insulin resistance (IR), predisposition, metabolic syndrome (MS), and polycystic ovary syndrome.
Materials and Methods:
Patients with non-alcoholic fatty liver disease were evaluated, with medical and
epidemiological data collected after informed consent at King Abdulaziz Hospital.
Of the 124 patients evaluated, 75.8% were women, and 88 were aged between 49 and 70 years and had
no symptoms. Ultrasonography results showed steatosis in 84%. NASH was diagnosed in 75 patients of the
sample. 42 patients underwent liver biopsy, of which 36% had cirrhosis, 1 had liver cancer, and 1 pure steatosis
(5% each). Risk factors were found in 70% of patients with metabolic syndrome, 87% with increased waist
circumference, 63% with dyslipidemia, 61% (n=76) with high blood pressure (HBP), 28% with DM, 52%
physically inactive, and 44% with insulin resistance (IR) (HOMA> 3.5). There was an association between IR
and NASH (p=0.011), IR and obesity (p=0.031), IR and MS (p=0.007), and MS and steatosis on medical
ultrasound (USG) (p=0.012).
Conclusion: The results indicated that the most frequent risk factors were MS and its variables: increased waist
circumference, dyslipidemia and HBP. This highlights the significance of metabolic control in non-alcoholic
fatty liver disease and confirms its role as the hepatic component of metabolic syndrome.
Keywords: fatty liver, obesity, diabetes mellitus.

mellitus (DM2), the frequency of fatty liver disease
Non-alcoholic fatty liver disease (NAFLD)
can reach 75% (8). Several individual features or
represents the spectrum of a heterogeneous
external conditions allied with NAFLD might play a
condition that includes steatosis and non-alcoholic
role in the etiology, pathogenesis, natural history and
steatohepatitis (NASH), in the nonexistence of
progression of this disease, for example: age, gender,
significant consumption of alcohol (1), which might
ethnicity (9), diabetes mellitus (10), obesity, family
progress into cirrhosis. Histologically, fatty liver
predisposition (11), metabolic syndrome and
peripheral insulin resistance (8).
macrovesicular steatosis and NASH, and is familiar
Some drugs, for example, tamoxifen, amiodarone,
when, in association to the accumulation of fat. One
diltiazem, cortisone and HAART have been
or more of the following features were found:
associated with NAFLD, and the induction of NASH
lobular inflammation, hepatocellular ballooning,
is connected with prolonged treatment more than 6
Mallory's hyaline bodies and zone 3 perisinusoidal
months and medicine accumulation (12-14). Processes
fibrosis (2). Even though NAFLD can persist stable
such as total parenteral nutrition, jejunoileal or
and stationary for long periods of time, the condition
gastric bypass have been related to fatty liver disease.
can progress to advanced stages of cirrhosis and
An association has been designated amid NAFLD
liver cancer (3-5). The predisposing factors to the
and rare genetic disorders, for example, Mauriac
progressive course of NAFLD remain unclear.
syndrome, lipoatrophy,
NAFLD prevalence is high, being stated in
abetalipoproteinemia, Andersen disease and Weber-
around 20 to 30% of the general population in
Christian disease (15). Environmental factors such as
studies based on imaging methods (6). For
numerous types of petrochemicals and solvents (16)
histological studies, in selected groups of patients
are related to the appearance of NAFLD. Data from
with risk factors for this disease, the prevalence may
the literature, in the first few studies and more,
be higher, with steatosis found in 70% of obese
showed the variability of the risk factors for NAFLD
patients and 35% of non-obese individuals, while
NASH is seen in 18.5% of obese and 3% of non-
(17), demonstrate the multiplicity of clinical, genetic
obese patients (7). In patients with type 2 diabetes
and environmental factors associated with the
Received: 18/12/2017 DOI: 10.12816/0044683
Accepted: 328/12/2017

Full Paper (vol.709 paper# 21)

c:\work\Jor\vol709_22 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (9), Page 1568-1571

Wound Infection after Laparoscopic Cholecystectomy
Sultan Ahmed M. Alburayk 1 , Mohammed Ahmed M ALamri 2 , Ali Abdo Ali Alkhiri 3 , Norah Ahmed
Ibrahim Al Mallohi 4 , Abdulhadi Mohammed A Alqahtani 5 , Mustafa Mohammed A Alwusaybie 6 ,
Meshari Awadh A. Almutairi 7 , Khlood Abdulali Alharbi 8 , Yazeed khaled A Binmahfoz 9 , Hesham
Faisal AlSaati 10 , Turki Khalid Alotaibi 11 , Mohmad Ahmed M Hamodah 9

1- King Salman Hospital , 2-King Khalid University , 3- Almodulif G.H , 4- Unaizah College of Medicine
(Qassim) , 5- King Abdulaziz Hospital, Makkah Service , 6- Prince Sattam Bin Abdulaziz University ,
7- King Saud bin Abdulaziz University for Health Sciences, college of medicine , 8- King Abdullah Medical
Complex , 9- Jeddah University , 10- AlFaisal University , 11- King Saud University, Riyadh

Surgeons are regularly not involved in the post discharge care of patients after uncomplicated
laparoscopic cholecystectomy. The purpose of the current study was to document the symptomatic recovery of
patients following laparoscopic cholecystectomy, because this has a bearing on the planning of a postoperative
care package.
Methods: The study was designed as a postoperative telephone questionnaire survey and was carried out
prospectively between June2016 and February2017 in King Abdulaziz Hospital, KSA.
Results: The study cohort comprised 51 patients who all completed the study. Postoperatively, only 3% of the
patients had postoperative nausea/vomiting lasting 2 days. Pain was symptomatic in 12% of patients. Port-site
wounds were a source of significant symptoms in 69% of the patients. Postoperative reviews by a nurse and
primary-care doctor were necessary in 76% and 34% patients, respectively, with a combined average of 3.1
reviews per patient. Less than 4% of patients believed that they would benefit from a surgeon's review 6 weeks
after LC. Median time taken to return to routine preoperative activity after surgery was 21 days (IQR, 16 to 33),
which was affected by the degree of activity undertaken, wound-related symptoms persisting for 3 weeks,
planned follow-up clinic appointment, and discharge as an outpatient.
Conclusion: Wound-related symptoms are common after LC, require substantial input from the community
health service in their management, and may delay return to preoperative routine.
Keywords: Laparoscopic cholecystectomy, Return to work, Postoperative symptoms.


Laparoscopic cholecystectomy (LC) is one of
which the operating surgeon misses in today's
the mutual elective laparoscopic procedures
world(3, 4).
implemented. Whereas a few years ago, patients

remained in the hospital for 1 or 2 days after
We therefore performed the current study with
a purpose to follow up patients closely after
progressively this procedure is being performed on
uncomplicated LC to document the postoperative
an outpatient basis. Improved primary care support
symptoms, evaluate their perceptions concerning
and increasing financial pressures have likewise,
return to preoperative routine and assessment the
reduced the postoperative follow-up of these patients
postoperative care they required from the
by the operating surgeon. Basically, the operating
community health services.
surgeon is no longer involved in the post discharge

care and follow-up of patients undergoing
laparoscopic cholecystectomy (1,2).
The study was designed as a postoperative

telephone questionnaire survey and was carried out
Though major complications after LC are well
prospectively between June2016 and February2017
recognized, data about the process of patients' short-
in King Abdulaziz Hospital, KSA.
term recovery after hospital discharge, perceptions
The local audit and patient information
of health, and the load of postoperative care
department approved the study proposal. All eligible
prerequisite in the community are not documented.
patients were informed about this follow-up study at
Awareness of this unnoticed recovery phase is not
the time of their discharge from the hospital and
only vital to organizing a community care package
were contacted every week for 6 weeks by using a
and improving service delivery and patient
telephone survey questionnaire (Table 1).
satisfaction, but also is very relevant feedback,

Received: 18/12/2017 DOI: 10.12816/0044684
Accepted: 28/12/2017

Full Paper (vol.709 paper# 22)

c:\work\Jor\vol709_23 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (9), Page 1572-1575

Cardiovascular Risk Factors among Cigarette Smokers
Faisal Saud A Yousuf 1 , Mazad Ali S Allehyani 2 , Turki Tawfik Alshaikh 1 , Malak Abdu
ALAamri 3 , Fady Shaker A Saati 4 , Zainab Mohammed A Alfaraj 5 , Hamoud Jadan M
Alruwaili 6, Ahmed Ali R. Alghamdi 7 , Ali Mosallam A Alsolami 8 , Maram Rami G Shami 9 ,
Mohammed Saleh Alhulayfi 10 , Khaled Yahya E Amrain 11
1- University of Jeddah, 2- Umm Alqura University, 3- King Abdullah Medical Complex, Jeddah,
4- East Jeddah Hospital Service, 5- Maternity and children Hospital Dammam, 6- Aljouf University,
7- Alamal Hospital, Jeddah , 8- Khalid Primary Care Center, Jeddah , 9- King Abdulaziz university,
Jeddah , 10- Dammam medical complex , 11- Ibn Sina National College

The aim of the study is to assess the effect of tobacco smoking on the risk of nonfatal acute
myocardial infarction in young adults less than years.
Materials and Methods: We conducted a population-based case-control study with 164 occurrence acute
myocardial infarction cases (21 women; 143 men), consecutively visited King Abdulaziz hospital, KSA, and
227 controls (81 women; 146 men), From February2016 till February2017. All women are non-Saudi women.
Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated using unconditional logistic
regression. Results: The commonness of present smoking was 81% in male cases and 54% in male controls
(OR = 3.59, 95%CI: 2.49, 5.31) and 60% of female cases were smokers compared with 36% of controls (OR
= 2.65, 95%CI: 1.40, 4.98). No interaction was found between current smoking and gender on myocardial
infarction risk (P = 0.399). A dose-effect response was present, the odds favoring myocardial infarction
reaching an eight-fold increase for those who smoked >25 cigarettes/day compared with never smokers. The
risk estimate for former smokers was similar to never smokers.
Conclusions: Tobacco smoking is an important independent risk factor for acute myocardial infarction in
young adults, with similar strength of association for both genders.
Keywords: Ischemic heart disease, smoking, young patients.

factor for early atherosclerosis[7, 8] and plaque
The pathologic process leading to coronary artery
instability[9], it has not been widelyassessed using
disease begins early in life, though the clinical
consequences of atherosclerosis are apparent
differences are particularly significant to take into
mainly in older adults[1]. Short-term mortality
account when considering the effect of smoking on
studies showed that younger patients have more
myocardial infarction. Numerous studies define an
favorable prognosis, but long-term studies showed
increase of myocardial infarction risk in young
an overall poor prognosis for individuals with
adults, with no gender differentiation[8-10]. Other
premature coronary artery disease[2].Myocardial
studies highlight differences by gender with a
infarction under the age of 45 years accounts for
mainly damaging effect of smoking amongst
almost 10% of all infarctions in the United States[1],
females [11, 12], but further information is required,
reflecting the perception of an uncommon event in
addressing the issue in the younger groups. The
this age group, and often has no evident relationship
with atherosclerotic plaque rupture[3]. Smoking
myocardial infarction events and the high influence
seems to be the most significant risk factor for
of smoking on the incidence of myocardial
infarction in young adults led us to conduct a
individuals[4].Actually, active and passive smokers
population-based case-control study in this age
are showing a wide range of substances with a
potential influence on atherogenesis.
The study objective was to assess the effect of
Smoking can trigger myocardial infarction in
tobacco smoking on the risk of nonfatal acute
individuals with minimal atherosclerosis or even
myocardial infarction in young adults (45 years),
with normal coronary arteries, particularly among
and whether there is modification of this effect by
the young[1-5], endorsing temporary coronary
vessel occlusion, as a consequence of thrombus
formation, coronary artery spasm, or both[5].
We conducted a population-based case-control
Moreover, smokers tend to extant other lifestyle
study with 164 occurrence acute myocardial
selections, regarding diet and physical activity that
infarction cases (21 women; 143 men),
have an independent effect on the risk of coronary
consecutively visited King Abdulaziz hospital, KSA,
disease[6]. Even though smoking is aentrenched risk
Received: 18/12/2017 DOI: 10.12816/0044685
Accepted: 28/12/2017

Full Paper (vol.709 paper# 23)

c:\work\Jor\vol709_24 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (9), Page 1676-1681

Effect of Myrtus Communis Extract against Hepatotoxicity
Induced by Monosodium Glutamate and Acrylamide in Male Rats
Wafaa M. EL-Kholy 1, Mamdouh R. F. EL-Sawi 1 and Nadine A. Galal 2
Physiology Division 1, Zoology Department 2, Faculty of Science,
Mansoura University, Mansoura, Egypt
Corresponding author: E-mail: n.a773@yahoo.com


Background: Myrtle leaves extract (ME) has many antioxidants that protect against oxidative stress.
The current study was conducted to determine whether ME can possibly exert hepatoprotective and antioxidant
activity against monosodium glutamate (MSG) and acrylamide (ACR) that induced toxicity in rats.
Objectives: Our experiment was carried out to examine the effect of Myrtus communis extract against
hepatotoxicity stimulated by monosodium glutamate (MSG) and acrylamide (ACR) in male rats.
Materials and methods: Rats were randomly assigned into eight groups, containing six each as following:
group 1: rats received dist. water (control); group 2: rats were orally administered myrtle extract (ME)
(300mg/kg b w) daily for 7 wks.; groups 3, 4 and 5: rats were orally administered MSG (100mg/kg b w), ACR
(20mg/kg b w) and (MSG + ACR) respectively daily for 6 wks. ; groups 6 ,7 and 8: rats were orally
administered ME daily for seven days alone then associated with MSG or with ACR or with (MSG+ACR)
respectively for 6 wks.
Results: Our results proved that the treatment with MSG and/ or ACR resulted in a significant rise in TL, TC,
TG, LDL-C, ALT, AST, ALP, GGT, TB and MDA. However, marked reduction in HDL-C, TP, Alb, GSH,
TAC, SOD, CAT and GSH-Px. On the other side, the administration of ME improved the deviations resulted
from MSG and/or ACR as confirmed by the marked improvement of antioxidants.
Conclusion: It is concluded that ME could protect the liver against damage induced by MSG and ACR.
Keywords: Myrtus communis , Monosodium glutamate, Acrylamide, Hepatotoxicity

ME ,myrtle extract; MSG,
acid asparagine and reducing sugars. ACR is
monosodium glutamate; ACR, acrylamide; TL, total
dangerous pollutant due to its neurotoxic,
lipids; TC ,total cholesterol; TG, triglycerides; HDL-
carcinogenic, hepatotoxic and may cause mutation in
C, high density lipoprotein cholesterol; LDL-C, low
male germ cells[2].
density lipoprotein cholesterol; TP, total protein; Alb,
Myrtus communis, commonly known as
albumin; TB, total bilirubin; AST, aspartate
myrtle, is an evergreen plant commonly scattered in
transaminase; ALT, alanine transaminase; ALP,
Europe, America, Africa and Asia. Myrtle is found
alkaline phosphatase; GGT, gamma-glutamyl
to be rich in polyphenolic compounds such as tannins
transpeptidase.; MDA, malondialdehyde; GSH,
and flavonoids. Several extracts of myrtle have been
reduced glutathione; TAC, total antioxidant
found to have anti-hyperglycemic ,anti-inflammatory
capacity, SOD, superoxide dismutase; CAT, catalase;
and antioxidant activities in different studies[3].
GSH-Px, glutathione peroxidase.


Monosodium glutamate (MSG) is the sodium
salt of glutamic acid , glutamic acid(78%) sodium
and water(22%). MSG is generally used as food
Monosodium glutamate was obtained from
additive or a flavor enhancer. Chronic administration
Metro market, Mansoura, Egypt. MSG was
of MSG can lead to oxidative stress, brain disorders,
dissolved in dist. H2O and orally administered
renal toxicity and hepatic damage[1].
(100mg/kg b w). The chosen dose of MSG was
Acrylamide (ACR) is an unsaturated
according to the previous studies[4]. Acrylamide was
carbonyl compound. It is used in grouts, packing,
purchased from Sigma Chemical Company (St.
water purification, paper manufactures, soil
Louis, MO, USA). ACR was dissolved in dist. H2O
stabilizers and cosmetic industries. Furthermore,
and orally administered (20mg/kg b w). The chosen
ACR is formed in foodstuff containing the amino
dose was according to the previous studies[5].
Received: 2/11/2017 DOI: 10.12816/0044686
Accepted: 14/11/2017

Full Paper (vol.709 paper# 24)

c:\work\Jor\vol709_25 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (9), Page 1582-1585

Evaluation of Saudi Arabian Parent's Attitude towards Lumbar
Puncture in Their Children for Diagnosis of Meningitis
*Zamil Mufleh Alwahbi, Abdulraheem Ali Alzahrani1, Mohammad Mane alqhtani2,
Walaa Ibrahim asiri3, Manal Ahmad Assiri4
1- Alnoor Hospital - Makkah, 2- King Fahad Military Hospital-Khamis Mushait, 3- Maternity and Children
Hospital - Abha, 3- King Salman Hospital- Riyadh, Saudi Arabia
Corresponding Author: Zamil Mufleh Alwahbi, Tel: 0566111858 ,Email: Alwahbi@dr.com

although lumbar puncture is a safe procedure in experienced hands, some parents fear having it
performed in their children and refuse consent. The factors associated with this refusal are unclear and any
differences between consenting and non-consenting parents might provide clues as to how to address them.
Objective: this study aimed to predict the underlying factors that affect parent's refusal of consent for lumbar
puncture in their children with meningitis in southern Saudi Arabia.
Methods: We conducted a cross-sectional study, of 750 children with meningitis, who visited either the
emergency department or the pediatric wards in three teaching hospitals (Khamis Mushait Maternity and
Children Hospital, Abha Maternity and Children Hospital and Military Hospital (Khamis Mushait) in the
southern region of Saudi Arabia from 20th February 2016to 6th January
Results: his study included 751 patients with meningitis. Their ages ranged between one month and 13 years
(3.93.3 years); 42.7% presented with other symptoms (cough, sore throat, dyspnea and pneumonia); 28.7%
had fever, 10% vomiting, 12.1% dyspnea, and 6.5% convulsions. Fifty-one per cent of children were
accompanied by their fathers, 41.9% by their mothers and 6.9% by others. Accompanying people were asked
for consent for lumbar puncture in their children; 44.3% disagreed and 55.7% agreed. Factors influencing
disagreement were relative's opinions (35.1%), media (30.4%) and their previous experience (12.3%).
Conclusion: based on the results of this study, the main reason for refusal of consent for LP in the children of
the majority of parents was fear of side effects such as paralysis, as well as lack of awareness about the
usefulness of LP in diagnosis and treatment of children. Informing parents of affected children is very
important in the counseling for such diagnostic tests. Therefore, it seems that it is necessary to pay more
attention for training in national health plans.
lumbar puncture, pediatrics, meningitis, parents, consent.


One of the indicators of child health is public
this may cause the public to avoid hospital
health reducing the incidence, early diagnosis and
attendance for fear of being forced
treatment of disease is an important objective of
to have procedures performed against their wishes.
global health plans. Viral and bacterial infections
Patients who refused LP were significantly more
are common in infants and children and these may
likely to discharge themselves from hospital.
spread to the central nervous system (CNS),
This would put them at risk as the diagnosis and
causing primary or secondary infection in nervous
treatment of meningitis might be further delayed
tissue. One of the diagnostic tests is concerning
the cerebrospinal fluid and the benefits of lumbar
A study by Wong et al. in 2010 showed the
puncture (LP).
main reasons for refusal of LP by parents was fear
The prevalence of parent's refusal to give
of paralysis in 48% and fear for mental retardation
consent for LP and some of their underlying
reasons, have only been reported in 2 studies [1, 2].
recommendations of relatives and friends[4].
When a child presenting with apparent febrile
Similarly, Deng et al. studied the parental views
convulsions is suspected of having meningitis,
on LP in their children with febrile convulsions,
parent's refusal of LP can put the doctor in a
and the authors reported that the main reasons for
difficult position. A firm diagnosis of meningitis
refusal were fear of paralysis, mental retardation,
cannot be made without a cerebrospinal fluid
child death, painfulness and weakened kidneys,
sample [1]. The refusal of a diagnostic LP was 25%
which is consistent with some our findings [2]. A
at Mulago Hospital in Kampala [3]. LP refusal is
study evaluated parent's beliefs about LP in their
commonly encountered and it is impractical to
children showed that the usual reason for refusal
obtain court orders in all these cases. Additionally,
or disagreement is fear of probable paralysis,

confusion due to incorrect popular guidance, fear
Received: 18/12/2017 DOI: 10.12816/0044687
Accepted: 28/12/2017

Full Paper (vol.709 paper# 25)

c:\work\Jor\vol709_26 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (9), Page 1686-1694

Assessment of Knowledge, Attitude and Practice of Saudi Parents
towards Neonatal Jaundice (NNJ): A Cross-sectional Study
Norah M. Alfouwais1, Laila S. Seada2, Rawan Y. Alahmadi1, Ahmed A. Alassiri3,
Ahmed A. Alenazi3, Majed S. Aljuaeed4
College of Medicine, University of Hail, Hail city1,King Khalid Hospital, Hail City2,College of Medicine, Ibn
Seena college, Jeddah city3,College of Medicine, Taif University, Taif city, Saudi Arabia4

Neonatal jaundice occurs worldwide and contributes significantly to neonatal morbidity and
mortality. Recently, newborns are being discharged early from hospitals, so parents have the primary responsibility
for early recognition, appropriate response and seeking proper treatment. Objectives: To assess parents'
knowledge, attitude and practice towards NNJ in different regions in Saudi Arabia. Methods: This is a cross-
sectional study involving 4413 expectant parents during July- September 2017 had been performed. A self-
administered questionnaire was created to obtain respondents information. Descriptive statistics were used to
describe the answers of participants in the study. Comparing the answers to different questions within different
groups was done using Pearson chi-square test. Statistical significance was set at p =< 0.01 and analysis was
performed using IBM SPSS statistics, version 23 (IBM, Armonk, NY, USA).
Out of 4413 participants, females were (79.4%) while (20.6%) were males. Participants were from all
regions of Saudi Arabia, with the highest percentage from central region (29.5%), most of them lived in cities
(89.6%). Age group 20-30 years constituted (46.6%), and age above 50 years was 4.5% (p= <0.01). Most of the
participants had a university level of education (76.6%). Relatives and friends were the main sources of knowledge
for (52.6%) of the participants, followed by treating doctor in (29.8%). In (34%) of the participants' knowledge
was gained after their child had NNJ, while in (42.1%) while their child was free of NNJ. Warning signs
knowledge depended on the level of education and occupation where university graduates and health care workers
were most knowledgeable and the difference was significant (p=<0.01). Awareness about necessity and
effectiveness of treatment were dependent on older age, occupation, and place of residence (p=<0.01). Hospital
treatment was done only by (23.4%), believing that it wasn't a serious disease in (18.1%) of participants, while
(5%) believed that it needed no treatment at all.
Knowledge, attitude, and practice of parents in our study, depended on age, level of education,
occupation, and place of residence might have contributed to the delayed appropriate management of severe
hyperbilirubinemia. We recommend the engagement of health professionals in educational settings like seminars,
workshops and periodical counseling sessions to provide appropriate knowledge to parents.
Keywords: Neonatal Jaundice, prevention, genetic factors.


Neonatal jaundice (NNJ) is the yellowish
incidence of NNJ could also be observed in
discoloration of newborn's skin and sclera due to
breastfed neonates receiving suboptimal milk intake
pathological hyperbilirubinemia, also often reflect as a
resulting in inadequate fluid and nutritional intake (6).
normal physiological phenomenon. Worldwide,
In Saudi Arabia, ABO incompatibility was observed in
newborn jaundice occurs in 60%and 80% of full and
31.6% of neonates with indirect hyperbilirubinemia,
preterm neonates respectively, the majority of which
resolves without any treatment (1). However, in about
deficiency was observed in 10.5% of neonates with
8-10% of newborns, neonatal jaundice can be severe
indirect hyperbilirubinemia, Rh incompatibility and
(2). A bilirubin level more than 85 mmol/l (5 mg/dl)
polycythemia were found in 2.6% of neonates with
manifests neonatal jaundice (3). Physiological jaundice
indirect hyperbilirubinemia and in 0.4% of all
occurs on the 2nd and 3rd day of life (4), and due to the
neonates (7).
breakdown of fetal hemoglobin and the inability of the
NNJ contributes significantly to neonatal morbidity
immature hepatic metabolic pathway to adequately
and mortality. Possible complications arising from
excrete bilirubin (5). Development of pathologic
unconjugated hyperbilirubinemia include acute
jaundice has perinatal, neonatal and genetic factors as
bilirubin encephalopathy, kernicterus, seizures,
well as administration of some drugs. Increased
cerebral palsy, mental retardation, and deafness (8).
Received: 18/12/2017 DOI: 10.12816/0044688
Accepted: 28/12/2017

Full Paper (vol.709 paper# 26)

c:\work\Jor\vol709_27 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (9), Page 1695-1702

Assessment of Public Knowledge Regarding the
Differences between Hyperthyroidism and Hypothyroidism
Asma Mohammed Alhawiti, Abeer Salah Albalawi,
Ashwaq Abdullah Alghamdi and Afnan Atallah Albalawi
Faculty of Medicine, University of Tabuk, Tabuk, KSA

Thyroid hormones play a pivotal role in the metabolism of human body. Changes of the thyroid gland
activity manifest in nearly all body systems. Appropriate knowledge of the public about thyroid disorders and their
manifestations is essential for early detection. Objective: The aim of this study was to assess public knowledge
regarding the differences between hyperthyroidism and hypothyroidism in Tabuk city, Saudi Arabia.
Methods: A cross sectional study was conducted on 300 randomly selected adult residents in Tabuk city. An Arabic
self-administered questionnaire was filled by the participants through a link or softcopy. The questionnaire included
questions about socio-demographic data of the respondents and other questions to assess knowledge about the type
and functions of thyroid gland, its disorders, factors affecting thyroid disorders, and their common manifestations.
Results: Respondents with good knowledge of thyroid gland and its disorders constituted 52%, while 45% had poor
knowledge. Good knowledge was demonstrated in questions about the type of thyroid gland (71.4%), and the most
susceptible individuals to have the disorder (90.4%). Manifestations of hypothyroidism were also recognized by
most respondents, particularly weight gain (76%) as well as fatigability and sleepiness (74.9%). Inadequate and
poor knowledge was found as regards the functions of thyroid gland, causes of thyroid hormonal disturbances, and
symptoms of hyperthyroidism. Conclusion: The knowledge of respondents about thyroid disorders is poor.
Inadequate knowledge can result in increased number of undetected cases. Health education should be launched by
the health authorities and distributed through all available channels of information. Good knowledge of the general
population about thyroid disorders is expected to decrease the incidence of preventable disorders and increase the
detection of subtle undiagnosed cases.
Keywords: thyroid; hyperthyroidism; hypothyroidism; knowledge; questionnaire.


safe and effective; however, poor response to
Thyroid hormones, thyroxin (T4) and
treatment may result from suboptimal dosing, patient
triiodothyronine (T3), are essential for the synthesis of
noncompliance, and pregnancy (5,6).
Hyperthyroidism increases with age and is
metabolism, and they are crucial for the growth and
more frequent in women and in iodine-deficient
development(1). Both iodine deficiency and iodine
areas. Commonly reported manifestations include
excess are known to interfere with thyroid hormone
palpitations, fatigue, anxiety, tremors, disturbed
synthesis(2,3). While severe iodine deficiency has been
sleep, weight loss, heat intolerance, and sweating.
eliminated, the number of countries with iodine
Serum TSH has the highest sensitivity and specificity
excess has increased over the past decade
in the diagnosis of thyroid disorders, but serum free
(4).Abnormal thyroid hormone levels may lead to
T4 or T3 can distinguish between subclinical and overt
hypo- or hyperthyroid states. Hypothyroidism is a
hyperthyroidism. The most common causes
common disorder that is potentially serious and
of hyperthyroidism are Graves' disease and toxic
usually passes clinically unnoticed. However, it can
nodular goiter. In addition, it may result from
readily be diagnosed by laboratory testing of serum
thyroiditis or ingestion of excess thyroid hormones,
thyroid stimulating hormone (TSH) and free T4. Its
and it may, sometimes, be iodine-induced. Treatment
causes include autoimmune thyroiditis, dietary iodine
options vary according to the case, and they may
deficiency, previous thyroid surgery or irradiation,
include antithyroid drugs, blockers, radioactive
intake of drugs such as lithium, and pituitary and
iodine therapy, and surgery. Thyroid storm is a
hypothalamic disorders. Hypothyroidism can present
special life-threatening condition that needs careful
with nonspecific constitutional and neuropsychiatric
assessment and meticulous treatment(7,8). Several
complaints and may end, in severe untreated cases,
studies from different countries reported high
with heart failure, psychosis, and coma. Thyroxine
prevalence of thyroid diseases with higher rates of
replacement therapy is the usual treatment, and it is
hypothyroidism than hyperthyroidism. Both overt and
Received: 18/12/2017 DOI: 10.12816/0044689
Accepted: 28/12/2017

Full Paper (vol.709 paper# 27)

c:\work\Jor\vol709_28 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (9), Page 1703-1709

General Awareness and Knowledge about Cataracts,
Glaucoma and Diabetic Retinopathy in Saudi Arabia
Mohammed Saud Bin Shibrayn, Abdulhkam Moafak Aljarbou ,
Yousif Abdullah Alanazi, Saad Mohammed Alhaqbani
Prince Sattam Bin Abdulaziz University
Aim of the work
: this study aimed to assess the awareness and knowledge for cataracts, glaucoma and
diabetic retinopathy diseases in social media of Saudi Arabia.
Material and Methods: a total of 1021 people make an evaluation through internet. Various complaints
were incorporated in this study. The data were collected from participants using a structured
questionnaire. Questionnaire was done for gathering information on demographics, awareness,
knowledge, attitudes and practices related to eye diseases.
Majority of the participants (52%) were aware of visual problems, 19.9% were aware of diabetic
retinopathy, 2.5% of cataract and 1.2% of glaucoma. The percentage belonged to minimum than 20
years old, 37.5 % belonged to 21 - 30 age group, 22.1 % belonged to 31 - 40 age groups, 14.2 %
belonged to 41 - 50 age group, 5.9 % were of 51 and above years of age. Further, 85.7 % of samples
belonged to town people and 14.2 % belonged to village groups, 35.6 % of samples gone through
secondary school or less education, 60.5% are in graduating from college and 3.9 % of samples were
post graduated or qualified higher.
Conclusion: the present results showed that there is still a need for health education in the population of
this region of Saudi Arabia to increase the level of awareness and knowledge of common eye diseases,
through the social media.
Keywords: cataracts, glaucoma, diabetic retinopathy.


Poor health awareness and knowledge of
level of health awareness was account
common eye disease lead to postponed diagnosis
approximately of 69% for cataract, and nearly
and seeking health care center for detection of
41% for glaucoma (4). Patients with diabetes
many ocular diseases like cataract, glaucoma and
increasing their susceptibility to develop eye
diabetic retinopathy, which are considered the
disease, Saudi Arabia ranks 7th country
leading cause of blindness worldwide. However,
worldwide affected with diabetes mellitus [DM],
public health awareness of eye disease plays a
with prevalence account 23.5% diabetic
significant role in raising apprehension for early
retinopathy which is considered to be a
intervention and delay complication through
devastating complication in 77% over 10 years of
regular follow up with appropriate management
diabetes. Additionally, cataract has shown an
increase in prevalence 26%, to 62% among
Many studies about awareness and
diabetic PT (5,6).
knowledge of eye disease have been reported
Second preventable cause of blindness in the
globally. Few studies were conducted regarding
world is glaucoma estimated over 65 million
awareness of eye diseases at Arabian Golf.
people all over the world (7), 50% of glaucoma
However, in developing countries such as Iran, a
patient are unaware of their disease, which may
study in Tehran was reported concerning
lead later to irresistible blindness(8). The
awareness level of eye disease (3). Although in
published based evidence proved that delayed
developed countries many studies on awareness
detection of glaucoma play an important risk
of eye disease were conducted like Canada, the
factor for subsequent blindness and usually
Received: 18/12/2017 DOI: 10.12816/0044690
Accepted: 28/12/2017

Full Paper (vol.709 paper# 28)

c:\work\Jor\vol709_29 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (9), Page 1710-1713

Case Report of Ocular Ischemic Syndrome, Taif, Saudi Arabia
Abdulmohsen Hamad Hamed Alhamyani1 , Sami Awd Alharthi, Sara Hussein A Gebril2 , Mohamed
Ahmed Siddig,Osama A Alhaj , Nuha Mohamed Ahmed2, Talal Abdulrahman Althomali3
Taif medical college1, King Faisal hospital2, Taif university3 ,Taif ,Saudi Arabia


Background: Ocular ischemic syndrome (OIS) is more prevalent among male aged more than 50 years.
Various disorders such as diabetes, hypertension, and peripheral vascular diseases are major risk factors
responsible for OIS in aged male.
Case report: This case study involves a 57-year-old male patient having history of diabetes, hypertension,
slurred speech, hemiparesis and hypoesthesia of the right side of the body. The patient came with complain
of red eye, pain and decreased vision in left eye. Complete left internal carotid artery obstruction, rubeosis
iridis of the left eye, dots of hyphema of the left eye, bilateral hard exudates, significant macular edema and
non-proliferative diabetic retinopathy were observed in the patient. In this case, in consultation with
ophthalmology, surgery and medicine departments multidrug treatment procedure was followed. This multi-
drug based therapy successfully controlled the condition of patient and improved the vision of patient.
Keywords: Ocular ischemic syndrome, left internal carotid obstruction.


prothrombin time 13.7 second were also
Ocular ischemic syndrome (OIS ) affects vision
determined to get comprehensive view of clinical
and if not timely treated it may cause vision loss
status of the patient. Complete blood count is
[1]. Diabetes, stroke, cardiac vascular diseases,
shown in table (1). Liver function tests and
hypertension, peripheral vascular and carotid
cardiac enzymes were within normal range and
artery diseases are some major causes for
are summarized in table (2) and (3) respectively.
development of ocular ischemic syndrome [2].
Eyes examination showed that visual acuity was
This disease is mainly characterized by the
6/36 right eye and counting fingers left eye.
presence of ischemic signs in both anterior and
Intraocular pressure was 9 mmHg right eye and
posterior segments of eye [3]. OIS is also
12 mmHg left eye. Anterior and posterior
associated with occlusion of the common carotid
segments examination of both eyes are shown in
artery (CCA) or internal carotid artery (ICA) [4].
table 4. Optical coherence tomography of macula
The following case study involves analysis of OIS
revealed increased macular volume of the right
patient as well as considering the input of patient
eye 11.7 mm3 and increased macular volume of
and case history. Furthermore, after the evaluation
the left eye 10.9mm3. Foveal thickness of the right
of pathological condition of patient, the treatment
eye equal to 373 m and foveal thickness of the
strategy was determined with consultation of
left eye equal to 256 m. Optical coherence
ophthalmology, surgical and medical departments
tomography of optic disc revealed bilateral
to control the condition.
normal retinal nerve fiber layers thickness.

Average cup /disc ratio .42 in the right eye and
average cup / disc ratio .51 in the left eye.
57 years old male patient known case of
Ultrasonographic assessment revealed complete
hypertension and diabetes type 2, presented to our
left internal carotid artery obstruction by
hospital at 25/12/2017 complaining from left eye
thrombus with picture of atherosclerotic changes
redness and pain with decreased vision. The
(Figure 1). This was also detected by computer
patient had history of slurred speech, hemiparesis
tomography with contrast (Figure 2). Dilated
and hypoesthesia of the right side of the body.
The patient was conscious and oriented to time,
significant macular edema, non-proliferative
place and persons. Blood pressure and oxygen
diabetic retinopathy and hard exudate (figure 3
saturation were 150/80 mmHg and 95%
and 4). B-scan ultrasonography of both eyes
respectively. Sodium and potassium were within
showed bilateral vitreous changes (Figure 5 and
normal range and their values were 135 mmol/L
6). After consultation with ophthalmology,
and 4.26 mmol/L respectively. Other clinical
general surgery and medical departments,
factors such as blood urea (35 mg/dL)) and
therapeutic drugs, dose and frequency were
determined. The patient received insulin
glucose136.2 mg/dL, hemoglobin A1c 10.036%,
injection, aspirin (81 mg once daily), ranitidine
partial thromboplastin time 22.70 second and
(150 mg twice in a day) and atorvastatin (20 mg
Received: 18/12/2017 DOI: 10.12816/0044691
Accepted: 28/12/2017

Full Paper (vol.709 paper# 29)

c:\work\Jor\vol709_30 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (9), Page 1714-1718
Postgraduate Hospital Educational Environment
Measure in Urology Program in Saudi Arabia
Abdullah S. Alhussain1, Rayan S. AlMalki1, Mohammed AlAbdulqader1,
Turki AlAjmi1, Abdulrahman AlRuwaily
1 Imam Muhammad ibn Saud Islamic University, 2 department of Urology, faculty of Medicine, Imam
Muhammad ibn Saud Islamic University, Riyadh, Saudi Arabia
Correspondence: Abdullah S. AlHussain, PO Box 50235 , Riyadh, 11523, Saudi Arabia, Tel +966
555975588, Email: abdullah0sh@gmail.com

The educational environment has a large influence on the success of medical education and overall
outcome. There is little data on how the Saudi urological trainees perceive the educational environment in
the hospital and the process of obtaining their skills. We conducted our study using validated questionnaire
to evaluate the hospital teaching environment for urology residents in Saudi Arabia.
We have used the postgraduate hospital educational environment measure (PHEEM) to evaluate
the perception of the hospital educational environment for residents of urology program. The results are
compared between different regions of Saudi Arabia, different health sectors, and level of residency
Results: A total of 57 (55.9%) out of 102 registered residents responses were received. Overall, the residents
perceived a good impression (98.2 18.3) but there is room for more improvement. There was a significant
differences in perception among residents of different regions as the southern region has the lowest score
(74.8 22.9 p-value =0.01). Residency level significantly affected the perception of role autonomy (P-
value=0.01), and overall score (P-value=0.02). However, residents of different health care sectors did not
differ significantly in their scores.
Conclusion: Perception of educational environment by Saudi urology residents is reaching a satisfactory
level but there's still room for improvement. However, there is a variation of perception results between
Saudi regions.
Keywords: PHEEM, Urology program, Educational Environment.


Urology program in Saudi Arabia is a 5-year
perceptions of Saudi urology residents' using
structured program which is supervised by the
validated questionnaire for this purpose. Hospitals
Saudi Commission for Health Specialties (SCFHS).
that provide a urology residency program for
The residents are required to learn and practice
postgraduates would benefit from the results and
professional attitude and behaviour towards
the feedback given by their trainees in order to
patients, colleagues and allied health personnel [1,2].
acknowledge their strength points and modify the
The hospital environment of clinical learning is a
areas that need improvement in order to develop
significant and persuasive factor of work-based
and further enhance their education and training
learning [3], and it is considered as an essential
component of medical education [4].

The hospital environment of the residency
program has been linked to program outcomes [5].
Subjects and study design
The good clinical, educational environment
Between August and
activates deep learning, encourages professional
September 2017, we conducted a cross-sectional
intelligence and ensures that both the learning and
study on 57 urology residents using an English
teaching processes are related to the patients in real
version of the questionnaire which was distributed
life [3]. However, there is little data on how the
both electronically and by hard copy to all urology
trainee's (residents) perceive the educational
residents of different regions of Saudi Arabia.
environment and the process of obtaining their
The study was done after approval of ethical
skills in the hospitals that provide the program.
board of Imam Muhammad ibn Saud Islamic
Environment Measure questionnaire (PHEEM) is a

validated reliable instrument to assess strengths and
The questionnaire
weaknesses of a certain educational environment as
The questionnaire used is The Postgraduate
well as the quality assurance process [6,7]. We aimed
Hospital Educational Environment Measure
Received: 18/12/2017 DOI: 10.12816/0044692
Accepted: 28/12/2017

Full Paper (vol.709 paper# 30)