c:\work\Jor\vol716_1 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (6), Page 3273-3284

Correlation between Corneal Biomechanics and Intraocular Pressure
Mahmoud Ibrahim Elgammal, Mohammed Abdel-Monem Mahdy, Mahmoud Mohammad Saleh
Department of Ophthalmology, faculty of medicine, Al-Azhar University, Cairo, Egypt
Corresponding author Mahmoud Ibrahim Elgammal, E-Mail: gammal89@gmail.com, 00201119422532

measurement error in goldman applanation tonometry (GAT) may be due to the differences in
central corneal thickness (CCT) or corneal stromal rigidity. Corneal hysteresis (CH) and corneal resistance factor
(CRF) may prove a helpful guide to measure this relationship.
Purpose: To study the correlation between cornea biomechanical parameters as measured with the Ocular
Response Analyzer (ORA) and intraocular pressure (IOP).
Patient and Method: The study is a comparative prospective cross-sectional clinical trial included 60 eyes of
patients subdivided into three groups; 20 with primary open angle glaucoma (POAG), 20 with ocular hypertension
(OHT) and 20 as normal population. They underwent measurement of IOP, CCT and corneal biomechanical
parameters (CH, CRF) using GAT, ORA and ultrasound pachymetery.
Results: Thirty patients were enrolled in the study, 22 males (73%) and 8 females (27%). The mean age of patients
involved is 44.2 12.6 ranging between 25 and 60 years old. The IOP by GAT, IOPg and IOPcc were 21.6 5.1,
21.5 5.1, 22.1 5.1 respectively. The CH and CRF were 14.2 9.3 and 18 11.2. The CCT was 531.97 20.4.
The correlation is insignificant between all parameters of IOP and CCT (P >0.05) while the correlation is
significant between IOP and corneal biomechanics and between CCT and corneal biomechanics (P < 0.05).
Conclusion: CCT affect corneal biomechanical properties, the higher CCT the higher were CH and CRF and vice
versa. Corneal biomechanics affect IOP more than CCT. The higher CH the lower was IOP while the higher CRF
the higher was IOP. CH affect IOPcc more than GAT while CRF affect GAT more than IOPcc. CH decrease in
glaucoma and in OHT more than normal while CRF increase in glaucoma and OHT more than normal.
Keywords: Intraocular pressure Ocular Response Analyzer Goldmann Applanation Tonometry Corneal

deformation of the globe and equating it to the force
During the 16th century, when Bannister
responsible for this shape change. This is carried out
described a subset of blind patients with eyes that were

firm to the touch, intraocular pressure has been
either by contact, from the tonometer apparatus, or by
regarded as a core vital sign of the eye, along with
non-contact, from a stream of air 3. All clinical
visual acuity, the pupillary exam, and the visual field.
measurements are an `estimate' we can never approach
Measurement of IOP (tonometry) in a consistent and
the true underlying value of a clinical measurement
reliable manner is fundamental to the diagnosis and
without first understanding the pitfalls and limitations
management of glaucoma 1.
of a given measurement technique.

Goldman applanation tonometry
Tonometry is the clinical measurement of IOP. It can
Practically, for years, Goldman applanation
be carried out using a range of different instruments
tonometry (GAT) has been considered to be the most
but the single method with ultimate accuracy is
accurate non invasive method of IOP measuring in
cannulation of the anterior chamber and measurement
spite of being affected by the corneal properties 4.
of the intraocular pressure by direct manometry. As
The GAT is based on the Imbert-fick law,
obvious as it sounds this method is excessively
which is demonstrated, by the following equation: (W
invasive, impractical and risky rendering it out of use
= P X A) where p = pressure, A = area applanated and
except for academic and research purposes 2.
W = force needed for applanation. However, this
All non-invasive tonometer follow a similar
equation in its current form assumes that the cornea is
principle in that the higher the pressure in a sphere, the
indefinitely thin, dry and perfectly elastic which is not
greater the force will be required to indent it.
the case. So, the equation was modified to match the
Tonometry measures IOP by quantifying the
corneal physical properties: (W + s = P X A + b)
where s = surface tension caused by the tear film, b =
Received:20 / 3/2018 DOI: 10.12816/0047242
Accepted:30 / 3 /2018

Full Paper (vol.716 paper# 1)

c:\work\Jor\vol716_2 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (6), Page 3285-3289

Assessment of Malocclusion Pattern and Dentofacial
Characteristics in Al-Jouf Population
Faisal Fahad Al-Musayyab, Adel Hamuod Al-Anazi,
Hussam Mowfak Al-Ruwaily, Fayez Mohammed Al-Azmi
College of Dentistry, Al-Jouf University
Corresponding author: Faisal Fahad Al-musayyab, E-mail: Krkosh_14@hotmail.com

To assess the pattern of malocclusion and dentofacial characteristics among Al-jouf Population.
Materials and Methods: Individuals in the age group of 7 years and above were incorporated in this study. Pre-
treatment orthodontic records of a total of 120 patients were obtained. Data recorded was established on case
records, study models, cephalometric x rays and photographs of those patients presently and clinical examined.
The data were analyzed by SPSS software (Statistical Package for Social Sciences, version 20.0, Chicago,
Illinois, USA). Calculation of descriptive statistics was done and Chi-square was applied.
Results: In this study Angle's Class I malocclusion being more prevalent as contrasted with alternate sorts of
malocclusion. Increased overjet and crowding were the major occlusal finding. Most patients had orthognathic
and retrognatic profile, the difference or association is found to be between malocclusion classes and facial
profile. Conclusion: This study has attempted to highlight various components which assume an essential part in
settling on the choice to begin orthodontic treatment and might give a pattern information for arranging
orthodontic treatment to strategy planners and orthodontists with suggestions on the procurement of
consideration and the utilization of constrained assets.
Keywords: Malocclusion, Dentofacial Characteristics, Al-Jouf.


Malocclusion bargains the soundness of oral tissues
orthodontic patients, to discover the frequencies of
furthermore can prompt psychosocial issues1. A
Angle's classes and other dentofacial attributes
methodical and very much sorted out dental care
alongside the gender orientation contrasts.
program over any objective populace in a group

requires some essential data, for example, the
pervasiveness of the condition while various
This study was a descriptive cross-sectional study.
components can depict the impediment and position of
Individuals with age of 7 years and above, orthodontic
teeth, troubles in the meaning of criteria and the
patients with complete pre-treatment records and
institutionalization of analysts have made dependable
undergoing orthodontic treatment were included. Data
evaluations of dentofacial attributes troublesome2,3.
recorded was established on case records, study
Numerous researches to investigate the prevalence of
models, cephalometric x- rays and photographs of
malocclusion in diversified ethnic groups have been
those patients presently and clinically examined.
carried out among various population of the world.
Based on the above selection criteria, pre-treatment
The studies revealed the prevalence of malocclusion
orthodontic records of 120 patients were obtained and
in the range between 11 to 93%4. The evaluation of the
used for the study.
malocclusion in connection to orthodontic treatment
This sample of 120 records of orthodontic patients
need would be essential to orthodontists with
included 72 males and 48 males with a mean age of
suggestions on the procurement of consideration and
13.2 1.9 years. An orthodontic assessment of
the utilization of constrained assets. It will likewise
occlusion and dentofacial characteristics was carried
encourage in evaluating the proper assets required, for
out in all subjects.
example, man power, expertise, time, offices and
The individual traits of malocclusion and dentofacial
materials. As there is an absence of factual
characteristics, including sagittal molar relationship,
information on malocclusions in this specific
posterior crossbite, overjet, overbite, crowding and
topographical territory, this study was directed in the
spacing of upper and lower arches, habits,
Sakaka, a city in the Al-Jouf province of Saudi
temporomandibular joint problems, centric occlusion
and centric relation discrepancy, facial type, facial
profile and facial asymmetry were assessed in the
This study aimed to assess the pattern of
studied participants.
malocclusion and dentofacial attributes among the
The data were analyzed by SPSS software (Statistical
population, who visited for orthodontic treatment and
Package for Social Sciences, version 20.0, Chicago,
to give quantitative data in regards to the pattern of
Illinois, USA). Calculation of descriptive statistics
malocclusion and dentofacial qualities in Al-Jouf
was done and Chi-square was applied.
Received:7 / 2 /2018 DOI: 10.12816/0047245
Accepted:17 / 2 /2018

Full Paper (vol.716 paper# 2)

c:\work\Jor\vol716_3 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (6), Page 3290-3294

Prevalence of Malocclusion and Its Association with Deleterious
Oral Habits in Saudi School Children
Adel Hamoud Nafea Alanazi, Faisal Fahad al Musayyab, Yousef Anad Alshraray,
Hamza Abdullah Aljuwaid
College of Dentistry, Al-Jouf University
Corresponding author: Adel Hamoud Nafea Alanazi, E-mail: dradel.b52@gmail.com

To evaluate the prevalence of malocclusion and its association with deleterious oral habits in
school going children from 9 to 11 years old, in Sakaka region of Saudi Arabia
Material and Methods: The present cross- sectional study was undertaken to evaluate the prevalence of
malocclusion and its association with deleterious oral habits in school going children from 9 to 11 years old, in
Sakaka region of Saudi Arabia. Data were collected using a questionnaire and orthodontic examination chart.
Results: 46% of the examined children had normal occlusion. Deleterious oral habits which are deemed to be
the greatest culprits in the causation of occlusal discrepancies were found to be prevalent in 79.2% of the
children evaluated in the study. The highest prevalence was seen for thumb sucking, which was common in
more than 70% of the subjects and the lowest prevalence was for nail biting which was common in only 9% of
the subjects. Conclusions: habit of mouth breathing was seen among 21% of the studied population. The
variables that were most strongly associated with the presence of oral habit were malocclusion and mandibular
spacing although the number of subjects with oral habits displayed more occurrence of all the variables that
were under consideration. Midline shift and maxillary and mandibular crowding, illustrated in this study were
higher compared to those obtained from other developing countries.
Keywords: Malocclusion, Deleterious, Prevalence


Increased concern about dental appearance during
and distribution in a community. The prevalence of
childhood and adolescence to early adulthood has
malocclusion varies from country to country and
been observed. The public equates good dental
between different age and sex group "Habit" is a
appearance with success in many pursuits. In
practice acquired by the frequent repetition of the
general, societal forces define the norms for
same act, which occurs consciously at first, then
acceptable, normal, and attractive physical ap-
unconsciously7. Pacifier sucking, followed by finger
sucking are the most common harmful habits in
The word malocclusion literally means "bad
childhood, mainly from 0 to 3 years, due to the
bite"2,3. Malocclusion can be defined as an occlusion
process of development. These oral habits are major
in which there is a malrelationship between the
risk factors for malocclusion and their harmful
arches in any of the planes of spaces or in which
consequences have been reported in several
there are anomalies in tooth position beyond normal
epidemiological studies8,9,10.
limits3. An individual with malocclusion might
Thus the present study was undertaken to
develop a feeling of shame about their dental
evaluate the prevalence of malocclusion and its
appearance and may feel shy in social situations or
association with the presence of deleterious oral
lose career opportunities4.
habits in children of the sakaka region of Saudi
Malocclusion has not been thoroughly inves-
tigated because the related pain and misery are

seldom acute. However, malocclusion has a large
impact on both individuals and society in terms of
To evaluate the prevalence of malocclusion and its
discomfort, quality of life, and social and functional
association with deleterious oral habits in school
limitations2,5,6. Hence, it is important to determine
going children from 9 to 11 years old, in Sakaka
the prevalence of malocclusion and its occurrence
region of Saudi Arabia.

Received:8 /2 /2018 DOI: 10.12816/0047246
Accepted:18 / 2 /2018

Full Paper (vol.716 paper# 3)

c:\work\Jor\vol716_4 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (6), Page 3295-3298

Prediction of Successful Labor Induction in Multiparas Women
Gasser M El Bishry1, Ihab F Allam1, Radwa R Ali1, Abdelrahman F Mahmoud2
1- Department of Gynecology and Obstetrics Faculty of Medicine,
2- Ain Shams University.2-Johina Hospital Sohage Ministry of Health
Corresponding author: Abdelrahman F Mahmoud; Mobile: 01011210830; Email: khidrsalman@gmail.com


Background: Induction of labor (IOL) is the intervention used to artificially initiate uterine contractions leading to
progressive dilatation and effacement of the cervix to accomplish delivery prior to the onset of spontaneous labor.
Aim: to assess predictors of successful labor induction in multiparous women. Method: This was a prospective cross
sectional study. The study population was a consecutive series of participants attending Ain Shams University
Maternity Hospital. Pre-induction assessment was done using Bishop scoring system on 57 participants. Result: in
out of 57 women underwent induction of labor 51 women had successful labor induction (88.3%) and 6 cases had
failed (11.7%) labor induction. Conclusion: Main predictors of successful labor induction were BMI, gestational
weight gain and Bishop score 6.
induction of labor (IOL), multiparas women, Bishop score.

may improve the prediction of vaginal delivery after
Induction of labor refers to the initiation of
labor induction (7).
uterine contractions before the spontaneous onset of
Bishop score is the most popular method and
labor by medical and/or surgical means aiming to
is considered the gold standard traditional method of
vaginal delivery (1).
assessing favorability of the cervix (8).
It is considered one of the most commonly
Aim of the Work:
performed obstetrical procedures, as its percentage
To assess predictors of successful labor
reaching 20% in pregnant women for various reasons
induction in multiparous women.
by several medical and surgical methods (2).

According to Laughon et al. (3) IOL was
performed in 42.9% of the nulliparous and 31.8% of
Study place: The study population was a consecutive
the multiparas women while elective induction at
series of participants attending Ain shams University
term occurred in 35.5%. Elective induction at term in
Maternity Hospital. The study was approved by
multiparas was highly successful (vaginal delivery
the Ethics Board of Ain Shams University.
97%) compared to nulliparous (76.2%).
Sample size: 57 multiparous women underwent
IOL usually used when it is more beneficial
induction of labor.
to mother and to the fetus to terminate the pregnancy,
Inclusion criteria:
however, the percentage of marginally indicated and
Multiparas women, singleton gestation at 37
elective labor induction is increased (4). IOL most
completed weeks or greater, cephalic presentation,
commonly used to decrease fetal or neonatal morbidity
longitudinal lie, living fetus and intact membrane.
and mortality as with post-term pregnancy,
Exclusion criteria:
oligohydramnios, suspected intrauterine growth
Nulliparous, previous cesarean delivery or
restriction (IUGR), as well as it can reduce maternal
rupture uterus, antepartum hemorrhage including
morbidity as in female with some medical disorders
(abruptio placenta, placenta previa or vasa previa),
like preeclampsia or to benefit both mother and fetus as
abnormal fetal lie or presentation, pervious uterine
in case of prelabor rupture of membranes (PROM) at
surgery as myomectomy, category II, III non-stress
term (5). Labor induction by using of prostaglandin
test, pelvic structural deformity, intrauterine growth
has several benefits as increasing the rate of
retardation or macrosomia (estimated fetal weight
successful vaginal delivery, decreases cesarean
than 4 kg), patients who received any pre induction
section rate, lowers the use of regional analgesia and
ripening, active genital herpes, and invasive cervical
increases maternal satisfaction (2).
Assessment of cervical status is the main
predictor for estimating the likelihood of a successful
Informed written consent obtained from the
vaginal delivery (6).
participant, history taking and assessment of the
However, integrating leading factors for
indication for induction of labor was done, general
failed labor induction other than cervical status, such
examination, non-stress test for 30 minutes, digital
as parity, maternal age and weight, and fetal weight
examination was done by using Burnett modification
of Bishop score (9) with a score of zero to maximum
Received:20 / 3 /2018 DOI: 10.12816/0047264
Accepted:30 /3 /2018

Full Paper (vol.716 paper# 4)

c:\work\Jor\vol716_5 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (6), Page 3299-3303

Confidence, Perception, and Attitude towards Prescribing Antibiotics among
Medical Students and Interns in Jeddah, Saudi Arabia
Fahdah Al-Musallam, Abrar Al-Aidaros, Fatmah Awn, Wa'ed Al-Tawabini,
Thikra Al-Zhrani, Bashayer Bamashmos
Department of Medicine, Batterjee Medical College, Jeddah, Saudi Arabia

According to the World Health Organization, antibiotics are the most frequently prescribed
drugs worldwide. The development of antibiotics has successfully overcome the threat of infectious diseases,
but they are often misused, leading to the spread of resistant bacteria strains. This study aimed to assess the
perception and attitude toward antibiotic prescription among medical students and interns in Jeddah, Saudi
Arabia, in both governmental and private medical colleges.
Methods: This was a cross-sectional multi-site study involving 249 participants, comprised of sixth year
medical students and interns sampled using a convenience sampling technique. Data were obtained using a
validated questionnaire used in a previous study to assess the perception and attitude toward antibiotic pre-
scribing and antimicrobial resistance.
Results: Out of 249 respondents, 92.4% said they would like more education on antibiotic selection, 81.5%
believed that prescribing inappropriate or unnecessary antibiotics was professionally unethical, 66.3% felt
confident in their ability to make an accurate infection diagnosis, and 54.4% were not confident about correct
dosages and administration intervals. In all, 79.1% of the participants thought that antibiotic resistance is a
nationwide problem, and 46.8% believed the problem does exist in their hospital.
Conclusion: Medical students in Saudi Arabia seem to have problems with their confidence, perception, and
attitude toward using antibiotics. More rigorous training on antibiotic prescription is needed for sixth year
students and interns in Saudi Arabia, and a standardized curriculum should be considered for private and
governmental medical colleges.
Keywords: antibiotics, antibiotic resistant, bacteria strains, infectious diseases.

towards prescribing ABs. One study was set in
According to the World Health Organization
seven European countries, while others were car-
(WHO), antibiotics (ABs) are the most frequently
ried out in China, the Democratic Republic of
prescribed drugs worldwide [1] . The development
Congo, India, the United States of America,
of antibiotics has successfully overcome the threat
Bangladesh, and Jordan [6-13]. Most of these stud-
of infectious diseases, leading to a global increase
ies indicated a lack of information on prescribing
in the average life expectancy and quality [2], but
and using AB.
they are frequently misused, causing the spread of

numerous resistant bacterial strains [1].
In the Arab Gulf region, previous studies on AB
The WHO defines antimicrobial resistance
prescription have demonstrated a crucial
(AR) as the change in a microorganism that
knowledge problem among the Arab population
causes it to become resistant to an antimicrobial
[14]. In Saudi Arabia, ABs are prescribed exces-
drug that was previously effective against it [2].
sively and are often available over the counter [15].
AR has become a global public health problem,
In fact, ABs can be accessed so freely in Saudi
with a significant economic and clinical burden
Arabia that the self-directed use of these drugs
estimated at 25,000 deaths per year in European
and its adverse effects might put the entire popu-
hospitals alone, and costing about 1.5 billion Eu-
lation at risk [16,9]. To the best of our knowledge,
ros [1].
only one study has been conducted in Riyadh to
Research has shown that a significant percent-
assess the knowledge and attitudes toward AB
age of AB prescriptions was not based on scien-
drugs among physicians, and research focusing on
tific evidence, and most of them were unnecessary
medical students and interns is lacking [17]. This is
or questionable [3,4]. Physicians have been known
a major omission, considering that they comprise
to breach the principles of excellent clinical prac-
the future healthcare workforce. This study thus
tice when concerned about complications of infec-
aimed to assess the knowledge, perception, and
tion, or when desiring to achieve patients' expec-
attitude towards AB prescription among medical
tations [1,5]. Such practices might be factors in the
students and interns in Jeddah, Saudi Arabia.
development of AB resistance.
Several studies have been conducted to evaluate
This research was a cross-sectional study that
the perception and attitude of medical students
took place in the Faculties of Medicine at Batter-
Received:20 /12 /2017 DOI: 10.12816/0047267
Accepted:30 / 12 /2017

Full Paper (vol.716 paper# 5)

c:\work\Jor\vol716_6 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (6), Page 3304-3307

Accidental Displacement of Nasopharyngeal Airway in a Child on
Non-Invasive Ventilation (Case Report)
Mohamad-Hani Temsah
Pediatric Intensive Care Unit, Department of Pediatrics (39), College of Medicine,
King Saud University ,Saudi Arabia
Corresponding author: Mohamad-Hani Temsah, Mobile: +966554124457, Fax: +966 (11) 469-1512, E-mail:
Effective and prompt pediatric airway management is an essential component of the successful management of
acute respiratory failure in children. Applying Non-Invasive Ventilation (NIV) with Nasopharyngeal Airway
(NPA) can facilitate managing these children with acute respiratory dysfunction, till the pathophysiological process
resolves. Observation of potential complications of NPA is warranted, as displacement into the esophagus occurred
in this reported patient. Integrating proper fixation method for these nasopharyngeal airways in children
undergoing non-invasive mechanical ventilation may help in maintaining patent upper airway, as well as limiting
potential complications of airway adjunct displacement.
Keywords: Displaced nasopharyngeal airway, pneumonia, Non-Invasive Ventilation.


Effective and prompt airway management is an

essential component of the successful management of
This patient was an 11-year-old boy, with genetically-
acute respiratory failure. If the airway is not well
confirmed Neuronal Ceroid Lipofuscinosis. He was
established, respiratory failure may rapidly progress to
admitted to the PICU for pneumonia with moderate
cardiopulmonary arrest. Airway management is even
respiratory distress, for which he was placed on NIV
more unique in the pediatric population as pediatric
with moderate mechanical ventilator settings. Due to
airway problems are commonly seen in these
high upper airway resistance, a nasopharyngeal airway
patients. It is reported that respiratory distress is the
(Fig.1) was inserted into his right nostril, which
fourth most common complaint in children seen in the
facilitated NIV.
emergency department 1.
Next day, during routine clinical care at 10 pm, the
Maintaining patent upper airway can be lifesaving
nurse noted the tip of the nasopharyngeal airway was
especially in children with upper airway compromise,
not in the nostril. PICU physician also confirmed that
such as those with Pierre Robin Sequence. Therefore,
the NPA was not visualized in the oral cavity. Urgent
airway adjuncts, such as nasopharyngeal airway
Chest X-ray (Fig. 2a) showed radiopaque elongated
(NPA), to maintain their patency were included in
shape along the esophagus; measuring approximately
algorithms for airway management in such patients 2.
11 cm, with the proximal tip at T2 and the distal end at
Utilization of nasopharyngeal airways can help in
T9 level.
providing non-invasive mechanical ventilation (NIV)
As the child remained clinically stable (same
in children. It was previously reported that using NPA
respiratory status, no drooling of saliva and stable vital
and a continuous positive airway pressure circuit was a
signs), he was observed closely in the PICU overnight.
practical alternative to a tight fitting nasal or face mask
Next morning, the child underwent upper GI-
for delivery of continuous positive airway pressure in
endoscopy under general anesthesia with endotracheal
adults 3. However, it was also reported that nasal
intubation. The foreign body was removed smoothly by
trauma, discomfort, and mouth breathing were the
forceps endoscopy from the mid-esophagus, with no
main disadvantages. We hereby report NPA
complications, as shown on the Chest X-ray in Fig. 2b.
displacement into the esophagus as another potential
On the same day, the child was extubated again to
complication of such airway adjunct in children
NIV, and managed according to his clinical condition.
undergoing NIV in the Pediatric Intensive Care Unit

Received:4 / 2 /2018 DOI: 10.12816/0047250
Accepted:14 /2 /2018

Full Paper (vol.716 paper# 6)

c:\work\Jor\vol716_7 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (6), Page 3308-3313

Knowledge, Attitude and Practice of Doctors and Medical Students towards
Stem Cell Use in The Management of Diabetes Mellitus
Manal Mohammed ALmashori 1, Bayan Ibrahim ALaradi1, Lamis majed ALtoairqi1, Fatimah Ali
Swead1,Marwan Fahad ALtemani1, Maha ELBeltagy2, Yasin Ibrahim3, Hyder Osman Mirghani 4.
1Medical Students, Medical College, University of Tabuk, Saudi Arabia,2Department of Anatomy, Medical
College, The University of Jordan, Amman. Faculty of medicine, Menoufia University, Egypt,3 Department
of Community Medicine, Medical College, University of Tabuk, Saudi Arabia,4 Medicinal department,
Medical College, University of Tabuk, Saudi Arabia.

To assess the Knowledge, attitude, and practice of Doctors and Medical Students towards Stem
Cell use in the Management of Diabetes Mellitus. Methods: This cross-sectional descriptive study was
conducted to assess the knowledge, attitude and practice of stem cell therapy among 120 Doctors and medical
students in Tabuk City, Saudi Arabia during the period from April to December 2017, participants signed a
written informed consent, then responded to a self-reported twenty-six item questionnaire. (Ten questions to
assess knowledge, 6 questions to assess practice, and 10 questions to assess attitude). The data were analyzed
by The Statistical Package for Social Sciences (SPSS), and the independent-samples t-test was used to
compare men and women, doctors and students. A P-value of <0.05 was considered significant.
Results: Out of 120 doctors (n=75) and medical students (n=45), the male dominance was evident (81.6%).
The knowledge was poor in 21%, fair in 76.5%, good in 2.5%, while no one scored excellently. The attitude
score was excellent in only 0.8%, good in 9.2%, fair in 73.1% and poor in 16.8%. Regarding practice,
excellent, good, fair, and poor were reported in 14.3%, 52.9%, 21.8%, and 10.9% respectively. No significant
statistical gender differences were evident between doctors, and medical students. Conclusion: The
knowledge, attitude, and practice were suboptimal among doctors and medical students in Tabuk, Saudi
Arabia. An educational intervention to upgrade the knowledge is highly needed.
Keywords: Knowledge, attitude, practice, doctors, medical students, KSA.


type 2 diabetes results from peripheral tissue
Diabetes Mellitus (DM) is one of the
insulin resistance and cell dysfunction [2] .
fastest-growing health problem in the world,
Strategies to restore regulated insulin
which is now reaching to epidemic proportion in
some countries. It is mainly due to consequence of
regeneration of endogenous pancreatic -cells via
life-style as lack of exercise, unhealthy diet,
neogenesis from a resident progenitor cell
obesity and overweight. Over the past four
population, proliferation of pre-existing -cells or
decades major socio-economic changes have
trans-differentiation from a closely related non -
occurred in Saudi Arabia. The growth and
cell type. Alternatively, an exogenous source of
prosperity have brought pronounced changes in
insulin-secreting -cells, such as cadaveric human
the lifestyle of the people. Most notably, eating
islets, porcine islets or human embryonic stem cell
habits are less healthful and the level of physical
(hESC)-derived cells could be transplanted into
activity has declined. There is increased
diabetic patients to restore insulin secretion [3].
consumption of fast foods and sugar-dense
considerable promise as a physiological means of
technological advances cars, elevators,
insulin replacement for type 1 diabetes, although
escalators, remotes - have led to a decrease in level
donor availability and progressive loss of graft
of activity. Traditional dependence on locally
function continues to hamper more widespread
grown natural produce such as fruits, vegetables
implementation. Pluripotent stem cells (PSCs) by
and wheat has also shifted. This has resulted in the
definition can form all tissues of the body
dramatic increase in the diabetes prevalence [1].
including insulin-secreting pancreatic -cells. This
Diabetes Mellitus is an example of the
potential has led many academic and industry
rapidly growing diseases that may be treatable by
groups to examine methods for efficient
stem-cell-derived tissues, diabetes mellitus affects
production of functional insulin-producing cells
>300 million people worldwide. Type 1 diabetes
from PSCs [4]. Engineered in vitro differentiation
results from autoimmune destruction of cells in
protocols mimic known pancreatic developmental
the pancreatic islet, whereas the more common
cascades, which convert undifferentiated cells,
Received:9 /2 /2018 DOI: 10.12816/0047254
Accepted:19 / 2 /2018

Full Paper (vol.716 paper# 7)

c:\work\Jor\vol716_8 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (6), Page 3314-3321

Comparative Study between Intravenous Paracetamol and
Pethidine as Post-Cesarean Section Analgesia
Abd El-Moneim M Zakaria, Ashraf H Mohammed,
Mohammed E Hammour, Mohammed A Refaie
Department of Obstetrics & Gynecology, Al-Azhar University
Corresponding author: Mohammed A Refaie, Mobile: 01002893959, Email: rfay1616@hotmail.com

Management of acute pain after cesarean section has evolved considerably over the past
decade. The general approach to pain after cesarean section is changing, shifting away from traditional
opioid-based therapy. Typical analgesic regimens include opioids and nono-pioid analgesics, such as
paracetamol and NSAIDs, with the variable addition of local anesthetic techniques. Aim of the Work: The
aim of this study is to compare the efficacy of intravenous infusion of paracetamol in comparison with
meperidine (pethidine) as post cesarean section analgesia, as demonstrated by the degree of pain relief.
Patients and Methods: This terventional prospective randomized study was conducted at El- Helal Hospital
for Health Insurance, Damitta. It comprised (90) labouring women who seek post C.S analgesia. They were
divided into two groups: 1st group (group A, 45 women): They received 100 ml intravenous perfalgan
containing 1000 mg paracetamol. Second group (group B, 45 women): They received 50 mg meperidine
hydrochloride Intramuscular. Results: There was a statistically significant lower pulse rate in the pethidine
group 84.3 5.18 as compared to paracetamol group 87.3 6.85 (p=0.024). While systolic and diastolic
Blood pressure showed non-significant difference between the two groups. The mean visual analogue scale
(VAS) after 1hour of receiving analgesia in the paracetamol group was 2.19 0.79 while in the pethidine
group it was 2.09 0.72 and this was statistically significant (p=0.039*). As regards side effects, in the
pethedine group, 3 (6.7%) patients had nausea and vomiting, 2 (4.4%) patients had hypotension and 1 (2.2%)
patient had a decreased respiratory rate, While, no side effects noticed in the paracetamol group. This
difference was statistically highly significant (p=0.037*). Conclusion: Paracetamol is as effective as
pethidine in relieving pain after cesarean section. Prescribing paracetamol in the form of intravenous infusion
can be suggested as a suitable alternative for opioid after the operation. No side effects were noticed in
patients who received paracetamol making it highly safe. Recommendations: Further studies on a larger
scale of patients are needed to confirm the results obtained by this study.
Keywords: intravenous paracetamol, pethidine, cesarean section, analgesia.

cesarean section (C/S) or any other surgery is very
Pain is an unpleasant sensory and
important (3).
emotional experience associated with actual or
Opioid analgesia includes morphine,
pethidine, fentanyl, tramadol, butorphanol,
technological advances have made pain more
remifentanil, and ketamine, which is currently the
manageable today than ever before. Pain
gold standard for obstetric analgesia (4).
management has been established as one of the
Whilst opioids are the main stay for relief
benchmarks of health care quality (1).
of severe pain, they are far from perfect analgesics
Pain is a major problem in surgery
as they have many significant adverse effects (5).
including cesarean section. Post cesarean section
The common opioid side effects include
pain is a common cause of acute pain in obstetrics.
respiratory depression, sedation, depression of
Pain relief and patient satisfaction are still
gastrointestinal motility, nausea and vomiting (6).
inadequate in many cases. Today, cesarean section
Pethidine, like morphine exerts its
is one of the most frequently performed surgeries
analgesic effects by acting as an agonist at the mu
in the world. Cesarean births are more common
opioid receptor. It also has a kappa opioid receptor
than most surgeries, due to many factors. The first
action, which is of unknown clinical significance.
factor of course is that nearly 50% of the world
It has structural similarities to atropine and other
populations are women, and pregnancy is still a
tropane alkaloidsand may have some of their
very common condition. However, more
effects and side effects. In addition to these
important is the fact that a cesarean section may
opioidergic and anticholinergic effects, it has local
be life saving for the baby, or mother or both (2).
anesthetic activity related to its interactions with
Pain in the postoperative period is an
sodium ion channels (7).
important impediment to recovery from surgery
Paracetamol is another type of analgesics
and anesthesia. Hence, reducing the pain after
and is the most commonly prescribed analgesic
Received: / /2018 DOI: 10.12816/0047256
Accepted: / /2018

Full Paper (vol.716 paper# 8)

c:\work\Jor\vol716_9 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (6), Page 3322-3327

Acute Compartment Syndrome Prevalence and Outcome in Aseer Central Hospital
Ahmad Hussain M Alqahtani, Fareed Alfaya, Abdulelah Hussain Alhamid,
Afaf Mohammad Saad Al-Mugared, Asma'a Mesfer Al-Shehri, Saeed Ali Alwadei,
Afnan Musleh Alshahrani, Safiyh Ahmad Al-Asiri
King Khaled University
Corresponding author: Ahmad Hussain M Alqahtani, Email: ahmad.alqahtani19@gmail.com

Acutecompartment syndromeis a painful condition caused by the increased interstitial pressure,
itone of the most critical emergencies cases in both trauma cases and orthopedics. The leg is themost common
site, but forearms, hands, feet, and buttocks are also places of occurrence. There are several risk factors for this
syndrome and its outcome is depending on time of diagnosis.
To assess the risk factors and outcomes of acute compartment syndrome.
This retrospective study was conducted in Aseer central hospital, Abha, Saudi Arabia. The study
included 77 patients who suffered acute compartment syndrome.
The mean age of patients was 28.3114.68 years old, males represented 92.2%, and females represented
7.8%. The fracturewas presented in 79.2%; the most common cause was RTA representing 57.1%, 53.2% of
patients had no injuries. Mostpatients had no complications (63.6%), the only significant factor between patients
with and without complication was open fixation (P-value=0.001).
Acute compartment syndrome was more common in males, and themost common site was in theleg,
the most important cause was RTA and the more dominant associated injury was avascular injury.
ACS, Complication of ACS, ACS risk factors.


Acutecompartment syndrome(ACS) is one of
intervention. Rorabeck and Macnab reported almost
the most serious emergencies cases in orthopedics
complete recovery of limb function if fasciotomy
and trauma cases. It is a painful condition caused by
was performed within first six hours[6].Matsen found
the increase interstitial pressure (intracompart-
necrosis after first six hours of ischemia, which
mental pressure - ICP) within a closed oste
currently is the accepted upper limit of
fascialcompartmentwhich impairs local circulation
viability[7].When fasciotomy was performed within
[1]. The leg is themost common site for ACS, but it
12 hours after the onset of ACS, Sheridan and
can occur in the forearms, hands, feet, and buttocks.
Matsen reported that normal limb function was
In one case series of 164 patients with ACS, fracture
regained in 68% of patients[8].However, when
was the cause in (69 percent) of cases. Fractures of
fasciotomy was delayed 12 hours or longer, only 8%
the tibial diaphysis (36 percent) and the distal radial
of patients had normal function. Thus, little or no
fracture (9.8 percent) and diaphyseal fracture of the
return of function can be expected when the
radius and ulna (7.9 percent) and after femoral
diagnosis and treatment are delayed. Tendon
fracture (3 percent), and (3 percent) after tibial
transfers and stabilization may be indicated as a late
plateau fracture .Soft tissue injury without a fracture
treatment for CS.Infection is a dangerous
was the cause in( 23 percent) of patients[2].DeLee
complication of compartment syndrome. Matsenet
and Stiehl found that 6% of patients with open tibial
al.,reported in retrospective study 11 of 24
extremities that had late surgical decompression
compared with only 1.2% of patients with closed
developed infections, and 5 of these infections led to
tibial fracture [3]. The incidence of compartment
an amputation[9].
syndrome is much higher in patients who have an
Up to our knowledge, NO studies describes
associated vascular injury. Feliciano et al. reported
the acute compartment syndrome among traumatic
that 19% of patients with vascular injury required
patient in Aseer Central Hospital.The rationale of
our study is to estimate theprevalence of ACS and
It occurs more in male than female,andthe
outcome of the patient in Aseer central hospital.
mean age is also different, about 30 years for men

and 44 years for women. A lot of unknown causes
can create this problem thatsuggests surgeons pay
It is a retrospective case series study using
great attention to this serious complication. There
medical records of the patients admitted on
was study by Schwartz et al.[5]reported a mortality
rate of 47% after ACS of the thigh .The outcome of
ACS(FASCIOTOMY) at Aseer Central Hospital
ACS depends on the time of diagnosis from injury to
(ACH), Abha, Saudi Arabia.The inclusion
Received:20 /12 /2017 DOI: 10.12816/0047257
Accepted:30 / 12 /2017

Full Paper (vol.716 paper# 9)

c:\work\Jor\vol716_10 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (6), Page 3328-3331

Knowledge and Attitudes towards Infection Control Protocols among the
Students of Al-Jouf University in Saudi Arabia
Abdulkarim Owaid Alanazi, Yunus Kassab Alrawili, Yousef Mazki Alanazi, Fayyaz Alam Shah
Al-jouf University, College of Dentistry
Corresponding author: Abdulkarim owaid alanazi, E-mail: kakalenazy@gmail.com, Tel. No. +96656400240

The aim of the paper is to assess knowledge, attitude and practice towards infection control of
dental students, in Al-Jouf University, College of Dentistry.
Materials and Methods: A questionnaire was distributed among the students and interns (n=65) of Al Jouf
university, College of Dentistry, to determine their level of knowledge, attitude and practice towards
infection control. A self-administered questionnaire comprising of three parts knowledge, attitude and
practice towards infection control. The data was collected and statistically analyzed. Results were calculated
on the basis of frequencies and percentages.
Results: In our study, we found that 97% of the students have knowledge about infection control. Only 8 %
of the students disinfect the dental chair after each patient. 80 % of the students did not know that clinical
waste should be discarded in specially designated and colour coded bins. 94% of the students wear
examination gloves during surgical procedures. Only 8% of students change their mask after each patient and
only 12% wear safety glasses during treating patients. Conclusion: The findings of this study revealed that
the attitude of the dental students towards cross infection control was positive but greater compliance was
needed. Knowledge and practice parameters in certain key areas were lacking. Strict adherence to the
standard protocols of infection control should be implemented and continuous education to the students and
staff should be provided.
Keywords: infection control, attitude, practice.


In the dental clinic transmission of infection may
dental clinics at the Al Jouf University, College of
occur through multiple routes, such as direct
Dentistry, Saudi Arabia.
transmission through contact with infected blood,

oral fluids, or other bodily secretions; indirect
transmission through contact with contaminated
The aim of the study is to assess knowledge,
instruments, materials, or environmental surfaces;
attitude and practice towards infection control of
or through inhalation of airborne contaminants
dental students, in Al-Jouf University, College of
present in splattered droplets or aerosols of oral and
respiratory fluids1.

For prevention of cross infection in dental
clinics, strict adherence to the principles of standard
A questionnaire was distributed among the
precautions is paramount for all dentists and
senior students and interns (n=65) of College of
auxiliary This includes wearing of personal
Dentistry, Al-Jouf University, to determine their
protective equipment(PPE) such as gloves, face
level of knowledge, attitude and practice towards
masks, protective eye wear and clothing. Despite
the emphasis being placed on implementation of
questionnaire consisted of three parts- knowledge,
standard precautions, it seems that few dentists
practice and attitude towards infection control.
adhere to these guidelines in the clinical practice2,9.
Before distributing the questionnaire, a pilot study
Various studies have also indicated that the
was performed on a random sample of students
adherence to these infection control protocols
(n=15), and the questionnaire was modified
amongst the dental students is not sufficient10,15.
according to the feedback obtained. The
Proper education in this field can play a paramount
anonymous self-administered questionnaire was
role in training our future dentists and it can help
about key aspects of infection control, sterilization
them acquire knowledge and inculcate proper
and disinfection of dental equipment, personal
attitudes regarding implementing infection control
protection barriers, infectious diseases and their
measures. Keeping this in mind, the goal of this
modes of transmission. Each correct answer was
study was to assess and analyze the knowledge,
graded as one point and incorrect answer was
attitudes, and practice regarding infection control
assigned zero mark. The data collected was
measures among dental students working in the
tabulated and statistical analysis was performed.

Frequencies and percentages were calculated.
Received:13 /2 /2018 DOI: 10.12816/0047260
Accepted:23 /2 /2018

Full Paper (vol.716 paper# 10)

c:\work\Jor\vol716_11 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (6), Page 3332-3342

Detection of Cytotoxin-Associated and Vacuolating Cytotoxin Genotypes of
Helicobacter pylori in Patients with Peptic Inflammatory/Ulcerative Disorders
Mohammad Mostafa Alsaadawy,1 Mohammad Samy Alhakim2, Almahdy Mohammad Alatrouny1,
Ali Monis Yasin3 and Mohammad Mostafa Alkherkhisy1
1Department of Microbiology and Immunology, Faculty of Medicine, Al-Azhar University,
2Department of Pathology, Faculty of Medicine, Al-Azhar University and
3Department of Internal Medicine, Faculty of Medicine, Ain Shams University
Corresponding author: Mohammad Alkherkhisy, Email:mohammadalkherkhisy@azhar.edu.eg

Background: Helicobacter pylori is a Gram negative, spiral, rod-shaped, and flagellated bacteria that colonizes
the human gastric mucosa and can cause a strong inflammatory state and lesions. However, genomic and
phenotypic features of different strains allow the expression of virulence factors which enable some strains,
rather than others, to cause disease. Aims: The aim of the present study was to evaluate the role of the
cytotoxicity genes, CagA and VacA, of H. pylori in patients with peptic inflammatory/ulcerative disorders and
correlate between different genotypes and peptic lesions. Patients and methods: Upper gastrointestinal
endoscopy and histopathological examination of gastric biopsy samples were done for 112 patients complaining
of upper gastrointestinal symptoms and clinically suspected to have H. Pylori infection. CagA and VacA
genotyping by PCR were done for 50 H. pylori +ve patients (diagnosed by histopathology). Results: CagA gene
and VacA gene were detected in 42.0% and 70% of H. pylori +ve patients respectively. There was a significant
positive correlation between CagA and duodenal erosion and ulceration visualized by endoscopy. There was also
a positive correlation between CagA and gastric erosion and ulceration visualized by endoscopy, but it didn`t
reach a significant level. There was also a significant positive correlation between the VacA m1s1 subtype and
duodenal erosion and ulceration detected by endoscopy. VacA m2s2 was correlated to presence of both gastric
erosions and ulcerations and presence of metaplasia and atrophy. There was only one H. pylori +ve patient with
gastric cancer. This patient was positive for both CagA and VacA m2s2. Conclusions: The CagA gene is
associated with severe forms of gastric pathology (peptic ulcer disease "PUD" and precancerous gastric lesions)
and the VacA m2s2 subtype is associated with variable forms of gastric pathology rather than other VacA gene
subtypes. Recommendations: Genotyping for VacA and CagA of H. pylori infected patients is helpful to
determine the patients at more risk. Further studies are needed to evaluate the virulence factors in H. pylori with
emphasis on role of CagA and VacA m2s2 both in vivo and in vitro.
Keywords: Cytotoxin-Associated, Vacuolating Cytotoxin, Genotypes, Helicobacter pylori, Peptic Inflammatory,
Ulcerative Disorders.

mitochondria leading to apoptosis, and binding to
Helicobacter pylori is a Gram negative,
cell-membrane receptors followed by initiation of a
spiral, rod-shaped, and flagellated bacteria that
proinflammatory response3. Most studies about the
colonizes the human gastric mucosa and can cause a
association between genotypes of H. pylori and
strong inflammatory state and lesions. However,
chronic gastritis, peptic ulcer (PU) disease have been
genomic and phenotypic features of different strains
conducted in the Western populations, and very few
allow the expression of virulence factors which
studies had examined these associations in the Middle
enable some strains, rather than others, to cause
East. However, there appears to be a geographic
disease1. The CagA is toxic to the cell by different
variation in the association between H. pylori
mechanisms including induction of cellular hyper
genotypes and gastric inflammatory response4. In this
proliferation, apoptosis and failure of gastric
work we are willing to study the frequency of H.
epithelial cell ability to maintain its normal
pylori CagA and VacA genotypes and their
cytoskeletal structure, an important prerequisite for
correlation to gastroduodenal lesions. So that this
neoplastic transformation2. VacA is the second most
cross sectional study aimed to evaluate the role of the
extensively studied H. pylori virulence factor. In
cytotoxicity genes, CagA and VacA, of Helicobacter
addition to inducing vacuolation, VacA can induce
pylori in patients with peptic inflammatory/ulcerative
multiple cellular activities, including membrane-
disorders and correlate between different genotypes
channel formation, cytochrome c release from
and peptic lesions.
Received:20 / 3 /2018 DOI: 10.12816/0047261
Accepted:30 / 3 /2018

Full Paper (vol.716 paper# 11)

c:\work\Jor\vol716_12 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (6), Page 3343-3350

Migraine among Medical and Non-Medical Students of Hail University
Abdullah Abdulhadi Hammad Alharbi1, Saleh H. Alharbi2, Alanoud Mansour Ayed Albalawi1, Ali M.
Alshdokhi1, Waad Alazri S Alanazi3, Munirah Nasser Nayed Alsiraa1, Munirah Hamdan Alkhrisi4,
Sama Ahmad Al-Ostaz5, Dalal Ayedh Al-Harbi5 , Rahaf Mohammed Alruwaili6
1 University Of Hail, College Of Medicine, 2 Internal Medicine Department, Alimam Mohammed Bin Saud
Islamic University, 3 Faculty of Medicine, Northern Border University, 4University of Tabuk, faculty of
medicine, 5 Battarje Medical College BMC, 6 Jouf University, faculty of medicine

Migraine is a common neurological disorder with significant impact on quality of life. The
unpredictable nature of the disease leads to frequent absenteeism or decreased productivity at work. The aim of
this study was to investigate the prevalence and characteristics of migraine in medical and non medical
students of Hail University, KSA and to assess their knowledge about the disease. Methods: The present cross
sectional community based study was conducted in Hail University. Materials and Methods: The study
included 800 students; 332 medical and 468 non medical students formed the study group. Students filled a
detailed questionnaire focusing on demographics, pain characteristics, accompanying factors, triggers, and
knowledge about migraine. Lifestyle variables were enquired and migraine associated absenteeism. The
diagnosis of migraine was made according to the International Headache Society criteria. Results: The
students' awareness of migraine was good, as 48.9% of non medical and 84.6% of medical students had a good
background. Twelve point seven percent of medical and 51.5% of non medical students had headache. The
prevalence of migraine in all students was 35.4%; however the prevalence was 80.1% of males and 61.9% in
females. About half (44.4%) of medical and 45.2% of non medical had the first attack at 18-22 years. In 20.7%
of non medical and 31.0% of medical had migraine attack lasting 5-12 hours. Forty one point five percent of
non medical and 38.1% of medical students had neck stiffness as accompanying symptoms. Trigger factors
were prolonged sleeping and irregular exercises in 29.5% of non medical and 16.6% of medical students . Pain
of migraine radiated to the back of the head in 26.1% of non medical and 14.3% of medical students.
Acetaminophen, NSAIDs, Ergotamine, Opioids, non pharmaceutical was used in 19.9% of non medical and
42.9% of medical students. Conclusion: Our study found a high prevalence of migraine in non medical and
medical students. The students' awareness of the disease was good and most of the students resorted self-
medication. Our study identified previously less-recognized triggers like prolonged sleeping hours and
accompanying symptoms like neck stiffness.
Keywords: Medical and non medical students, migraine, Hail university.

recognized and undertreated, even in developed
Migraine is known to be one of the most common
countries [4].
primary headache disorders. It is prevalent among
University students represent an important
about 11% in the general population, being
focus for the study of migraine prevalence. Since
prevalent in females twice or thrice higher than in
university students are subjected to psychological
males, and it is also ranked as the seventh most
and physical stress, migraines are more common
disabling disease worldwide [1] .
among them, especially medical students [5] .
The prevalence of migraine among medical
students ranges from 11 to 40% worldwide [6].
photophobia, phonophobia and in some cases,
Migraineurs may suffer from functional
visual or sensory disturbances. Migraine is
comorbid conditions such as depression, anxiety
associated with high costs, mostly indirectly
and post-traumatic stress disorders [7] which if
including unproductivity and wastage of work time
untreated can turn episodic migraine into chronic
migraine (more than fifteen headache days per
It has been estimated that headaches, especially
month over a three months period of which more
migraine, have caused the loss of 112 million days
than eight are migrainous, in the absence of
of work or school every year for the US population
medication over use, according to the International
and 25 million days for the UK population [3].
Headache Society).
Despite its high prevalence and disabling
In this study, our aim was to determine the
nature, migraine has continued to be under
prevalence and characteristics of migraine in

Received:11 / 2 /2018
DOI: 10.12816/0047269
Accepted:22 /2 /2018

Full Paper (vol.716 paper# 12)

c:\work\Jor\vol716_13 Rasha Almotairi et al.

Full Paper (vol.716 paper# 13)

c:\work\Jor\vol716_14 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (6), Page 3356-3363

Cerebrovascular Stroke among Senior Adult Population in Arar, KSA
Alaa Jameel A Ahmed1, Salma Abdalla Mohamed Ali Abdalla2, Sahar Sattam Alshammari3, Amal
Mahmoud R Abdullah4, Ahmed Mahmoud R Abdullah1, Alanazi, Manar Huzaym A1, Alruwaili, Abeer
Nahi K1, Alanazi,Shahad Mohammed S1, Alenezi , Fadih Nada M1, Alruwaili, Maha Nahi K1
1 Students, Faculty of Medicine, Northern Border University, Arar, 2Internal Medicine Department Northen
Border University, Arar, 3Arabian Gulf University, Bahrain, 4Internal Medicine Department King Faisal
Specialist Hospital and research center, Riyadh, KSA
In the Kingdom of Saudi Arabia, stroke is a rapidly growing problem and a major cause of illness
and death. This increasing incidence is due to the changing life style in the country and high prevalence of
diabetes mellitus, obesity, dyslipidemia, and hypertension, all considered to be important. The aim of this study
is to determine the prevalence and determinant factors of cerebrovascular stroke among Saudi senior adults
(above 50 years) in Arar, KSA. Methods: The present study is a descriptive cross sectional survey conducted
on a representative sample of elderly people in the Northern Province of Saudi Arabia. Results: The overall
prevalence rate of first-time stroke or repeated cerebrovascular stroke observed in this study was 4.3%.Mean
age ( SD) of the cases was 619.25 and 50% of cases were 70-79 years old. Males constituted 83.3% of the
cases and 50.0% ex-smokers. Regarding the associated cardiovascular diseases, arrhythmias was found in all
cases, hyperlipidemia in 83.3%, hypertension in 50% of the cases and myocardial infarction in 50%. The
majority (66.7%) were diabetics, 33.3% were obese, 33.3% had renal insufficiency and 50% had
hypothyroidism. Stroke was significantly related to old age, male sex, hyperlipidemia, ischemic heart diseases
and smoking (P<0.05) while non-significantly related to hypertension, diabetes and Body Mass Index (kg/m2)
status. Conclusion: In Arar, Northern Saudi Arabia, the prevalence of cerebrovascular stroke among senior
adult population was 4.3%, which is relatively high. In addition, there is definite lack of published researches on
stroke. However, such research is vitally essential to plan for appropriate management programs to be set up,
effective implementation of primary prevention strategies and proper allocation of health resources in this area.
Keywords: prevalence and risk factors, cerebrovascular stroke, senior adults, Arar, KSA.


The Middle East region faces a variable burden of
Stroke is a medical emergency that can cause
stroke. The incidence rate for all strokes ranged
permanent neurological damage, complications,
between 22.7 and 250 per 100,000 people per year
and disability [1]. It is not only the second leading
in this region [10]. Because of the dramatic
cause of death worldwide but also one of the main
transformation of the social, economic, and
causes of adult-acquired disabilities [2]. The
environmental conditions over the past few
worldwide prevalence rate for cerebrovascular
decades in this region, the lifestyle has changed
diseases is between 500 and 700/100,000
rapidly, which has caused a transition to a high
populations [3]. There have been numerous recent
burden of stroke.
research reports regarding the risk factors for
Studies in Saudi Arabia have provided a hospital-
stroke, which include not only unhealthy lifestyle
based crude annual incidence rate of stroke of 15.1
habits such as smoking and drinking but also
per 100,000 persons in Jizan [11], 29.8 per 100,000
hypertension, diabetes, and a family history of
persons in the Eastern province [4] , and 43.8 per
diseases, among other traits [4,5]. Nevertheless, the
100,000 persons in Riyadh [12].
heterogeneity of the pathology and nature of

different countries and populations may evidence
In Aseer region, an overall minimal incidence rate
new risks for stroke like; socioeconomic variables
of hospitalized first-time stroke of 57.64 per
[6], ethnic factors, dietary habits and even endemic
100,000 persons per year. A steady increase was
diseases [7] can pose risks for stroke. Family history
noticed depending on the patients' age, reaching a
of stroke in a first-degree relative also increases the
figure of 851.81 for those patients aged 70 years
and more. Overall, the incidence rate for females
cerebrovascular event even after adjusting for other
was lower compared to males [13].
vascular risk factors [8]. The etiology of stroke is
A previous study in northeast China found that; the
multifactorial, and therapeutic actions focused on
overall prevalence of stroke in Jilin Province was
vascular risk factors, particularly in secondary
7.2%. Of all stroke cases, 91.7% were ischemic
stroke prevention have been shown to reduce the
stroke and 8.3% were hemorrhagic stroke. The
risk of recurrent stroke, as well as the risk of any
prevalence rates of dyslipidemia, smoking and
other coronary or peripheral vascular episode [9].
hypertension were ranked as the top three
Received:12 / 2 /2018 DOI: 10.12816/0047274
Accepted:22 / 2 /2018

Full Paper (vol.716 paper# 14)

c:\work\Jor\vol716_15 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (6), Page 3364-3367

Unilateral Optic Disc Swelling Demographic Study, Ocular and
Systemic Association
Ahmed Mohammed Youssef, Ehab Abd-El Samie El Sheikh, Amr Tarek El Saed
Ophthalmology Department, Faculty of Medicine, Al- Azhar University, Cairo, Egypt
Corresponding author: Amr Tarek,Tel: 01095028526, email: amraboshamiya@yahoo.com

this study aimed to investigate the most common causes of unilateral optic disc swelling and also to
identify the ocular and systemic factors associated with each case.
Study design: this was a prospective study in El-Hussein University Hospital and National eye Center (Rod El-
Farag).Population: 50 eyes of 50 patients who were suffered from unilateral optic disc swelling were included in
this study. Method: personal, medical, family, systemic illness history, smoking, drug and alcohol intake, visual
acuity assessment, clinical assessment of the optic nerve function, anterior segment examination, fundus
examination, visual field testing, magnetic resonance imaging (MRI) of the orbit and brain and laboratory
investigation including fasting blood glucose and 2 hours postprandial, lipid profile, complete blood picture , C
reactive protein and ESRwere included. Results: non arteritic anterior ischemic optic neuropathy (NAION) was
the most common cause of unilateral disc swelling reported in this study (72%) followed by traumatic optic
neuropathy, optic neuritis, disc swelling associated with orbital mass, disc swelling associated with brain mass in
the same percentage (6%) followed by disc swelling associated with thyroid ophthalmopathy, disc swelling
associated with cilio retinal artery occlusion in the same percentage (2%) with different ocular and systemic
associations in each group.Conclusion: the most common cause of unilateral disc swelling In the present study is
(NAION), it caused mainly by systemic vascular disorders (DM, HTN and hyperlipidemia).
Keywords: non arteritic anterior ischemic optic neuropathy, optic disc, disc swelling, funduscopy,visual field.


decreased color vision were common, inflammation
Unilateral optic disc swelling is a general
of the optic nerve head or papillitis was presented
term used to describe the optic nerve head affection
with hyperemic and edematous disc (3).Cavernous
by a variety of local and systemic causes,
hemangiomas were the most common intraorbital
accumulation of axoplasmic flow especially slow
tumors found in adults. These benign, vascular
anterograde flow component at the lamina cribrosa
lesions were slow growing. Most of these
produces disc swelling and retinal nerve fiber
tumefactions were exceedingly unilateral. Dilated
opacification (1).
funduscopic examination may elucidate choroidal
Generally, there are multiple causes related to
folds secondary to compression of the globe by the
unilateral disc swelling such as anterior ischemic
mass, If the tumefaction is in close proximity to the
optic neuropathy, which was the most common
optic nerve, visible changes may include edema,
cause of acute optic neuropathy in older age groups.
elevation, pallor and even atrophy in severe cases (4).
It can be non arteritic optic neuropathy or arteritic,
Traumatic optic neuropathy is an uncommon
the latter being associated with giant cell arteritis
cause of visual loss following blunt or penetrating
and sever visual loss, anterior ischemic optic
head trauma.
neuropathy was characterized by visual loss
Although the majority of patients were young
associated with optic disc swelling and pallor, Visual
adult males, about 20% of cases occur during
loss is usually sudden or develops over a few days at
childhood. Traumatic optic neuropathy refers to any
most and is commonly unilateral, although second
insult to the optic nerve secondary to trauma (5).
eye involvement may occur later, Altitudinal field
Optic nerve sheath meningioma usually arises
loss is common (2).
from the intraorbital part of the optic nerve sheath
Optic neuritis is inflammation of the optic nerve
and accounts for approximately 2% of all orbital
which leads to subacute visual loss and commonly
tumor, optic disc abnormalities are nearly always
affects young white females, Symptoms included
visible at the time of presentation (98%), chronic
monocular visual loss developing over days to
disc swelling occurs when the tumor surrounds or
weeks, periorbital pain with eye movement is a key
compresses the intraorbital part of the optic nerve (6).
symptom, clinically central field defects and

Received: / /2018 DOI: 10.12816/0047276
Accepted: / /2018

Full Paper (vol.716 paper# 15)

c:\work\Jor\vol716_16 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (6), Page 3368-3372

Relation between Drug Use And Age-Related Cataract
Alaa Mohammed Ali Alshahrani 1 , Fahd B. Altherwi 2 , Rakan Mosa Algorinees 3 ,
Lujain Abdulaziz A Alrajhi 2 , Anas Hassan Saeed Alzahrani 2 , Nouf Mohammed Alrefay 2 ,
Moath Jamaan Al-Ghamdi 4 , Baraah Marwan Mohammed Lutfi AlSawaf 2 ,
Lujain Ahmed Ali Asiri 1 , Rawan Mohammad A AlMuhanna 2
1- King Khalid University , 2- King Abdulaziz University ,
3- King Khalid eye Specialist Hospital-Riyadh , 4- Intern, Albaha University

A small number of studies have described the role of antidepressants as cataractogenic in humans,
nevertheless, it residues unclear whether this possibility also prevails with the utilization of antidepressants.
Methods: We conducted this meta-analysis using a comprehensive search of PubMed, MEDLINE, Cochrane
Database of Systematic Reviews, EMBASE and Cochrane Central Register of Controlled Trials till 01 February
2018 for studies that evaluated the relation between drug use and age-related cataract.
Results: Six studies were recognized with a total of 240,145 cases. The results for serotonin noradrenalin
reuptake inhibitors (OR 1.32; 95% CI: 1.141.31) P=0.026, I2=65.2%, and selective serotonin reuptake
inhibitors (OR 1.42; 95% CI: 1.191.21) P<0.001, I2=89.4%, tricyclic antidepressants (OR 1.41; 95% CI:
1.191.42) P=0.08, I2=55.3%
Conclusion: There is a possible risk of the relation between drug use and age-related cataract. The utilization of
antidepressants for more than 1 year or longer had increased risk for development of cataract.
Keywords: Age-related cataract, drug utilization, tricyclic antidepressant.

have been observed to be related with expanded
Cataracts are one of the primary reasons of vision
danger of cataract advancement. An examination
loss worldwide, and are a main public health
establish an expanded danger of future cataract
problem 1. Oral and inhaled steroids increase risk of
diagnosis in present users of venlafaxine and
cataract 2. Beaver Dam Eye Study suggested the
fluvoxamine, and additionally an expanded rate of
relationship of amitriptyline with increased risk of
surgery in present users of paroxetine in those
cortical cataract 3. Lately, beta blockers are found to
matured 65 years 8. In the Beaver Dam Eye study,
be cataractogenic. The risk of cataract with newer
amitriptyline, a tricyclic antidepressant, was found
generation antidepressants is unclear. Selective
to be associated with an increased risk of cortical
serotonin reuptake inhibitors (SSRIs) are the third
cataracts 3. Another examination discovered that
most suggested class of medication in the world and
selective serotonin reuptake inhibitor (SSRI) use for
are related with cataract gastrointestinal bleeding
more than 1 year was related with an expanded
and fractures 4, 5.
danger of cataract surgery in individuals matured 50
The genuine component of cataract advancement
years 9.
stays obscure, however, numerous hazard factors,
As a result of the irregularity, we aimed to conduct
for example, age, gender, corticosteroid utilize,
the current meta-analysis to evaluate the relation
diabetes mellitus, hypertension, intraocular surgery,
between drug use and age-related cataract.
visual injury, uveitis, and smoking have been

distinguished. As of late, various examinations have
concentrated on the potential cataractogenic danger Search methodology
of professionally prescribed medications 6, 7.
A comprehensive search of PubMed, MEDLINE,
Selective serotonin reuptake inhibitors (SSRIs),
Cochrane Database of Systematic Reviews,
extensively professionally prescribed medications
EMBASE and Cochrane Central Register of
for the treatment of bulimia, depression, anorexia
Controlled Trials till 01 February 2018 was done for
nervosa, obsessive-compulsive disorder, anxiety,
studies that evaluated the relation between drug use
social phobia, and panic disorder, have a high
and age-related cataract.
therapeutic to toxicity ratio. Nevertheless, while

selective serotonin reuptake inhibitors are related Data collection
with less toxicity than tricyclic antidepressants
Two reviewers screened abstracts according to
(TCAs), selective serotonin reuptake inhibitors are
predefined study inclusion criteria. Full text articles
frequently complicated in co-ingestions that can
were retrieved and reviewed if a decision on
precipitous the potentially lethal serotonin syndrome.
inclusion could not be made solely based on the
As of late, a few epidemiological examinations have
abstract. Any disagreements were resolved by
concentrated on the danger of cataractogenic impacts
consensus between the two reviewers.
of antidepressants, and a few sorts of antidepressants
Received: / /2018 DOI: 10.12816/0047279
Accepted: / /2018

Full Paper (vol.716 paper# 16)

c:\work\Jor\vol716_17 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (6), Page 3373-3377
CD86: A Novel Prognostic Marker in Acute Lymphoblastic Leukemia Patients
Mona Ahmed Wahba, Heba Mostafa El-Maraghy, Asmaa Mohamed Abdel-Razik
Clinical Pathology Department, Faculty of Medicine, Ain Shams University
Acute lymphoblastic leukemia (ALL) is the most common malignancy diagnosed in patients
younger than 15 years, accounting for 76% of all leukemias in this age group. It accounts for only 20% of adult
acute leukemias. The B7-family molecule CD86 is a type I transmembrane glycoprotein expressed on the surface of
antigen presenting cells (APCs). Cell surface expression of CD86 provides an important co-stimulatory signal that
profoundly influences immune responses. Optimal T-cell activation needs costimulatory signals via the interaction
between costimulatory molecule CD28 on T lymphocytes and its ligands the B7-family molecules B7.2 (CD86) on
APCs. Activation and differentiation of T lymphocytes plays an important role in mediating the pathogenesis of ALL.
Objective: This study aims to assess the expression of CD86 in acute lymphoblastic leukemia patients and
correlate its expression with the clinical, hematological findings and response to therapy.
Subjects and methods: CD86 was measured in 35 newly diagnosed acute lymphoblastic leukemic patients and 20
age and sex matched healthy controls.
Results: A significant statistical difference between CD86 expression levels in patients versus controls was
determined. There was a high statistically significant association between CD86 expression and poor outcome.
Conclusion: High CD86% and mean fluorescence intensity (MFI) expression appears to be a powerful prognostic
indicator of unfavorable outcome in ALL. Analysis of CD86 percentage and MFI expression in addition to other
standard prognostic markers at diagnosis may contribute to improve the management of ALL patients.
Keywords: Acute lymphoblastic leukemia, CD86.

(AML) and it was reported as a marker of poor
Leukemia is a hematopoietic malignancy
prognosis in it 6. Some of the most recent
that results from the clonal proliferation of bone
therapeutic developments for acute leukemia
marrow cells with impaired differentiation,
depend on the involvement of costimulatory
regulation, and cell death 1.
pathways and molecules including CD86 7.
Acute lymphocytic leukemia (ALL) is the

most common hematological malignancy in
childhood and accounts for about 20% of acute
leukemia in adults 2. Based
Patients group:
classification, ALL is divided into T-lineage ALL

The present study was carried out on
and B-lineage ALL. T-cell acute lymphoblastic
thirty-five (35) newly diagnosed ALL patients,
leukemia (T-ALL) is a rare, aggressive malignancy
presented to the Hematology/Oncology Clinic, Ain
of thymocytes and corresponds to a heterogeneous
Shams University Hospitals from June 2016 till
group of leukemia arrested at various stages of
September 2017. Patients were 22 children and 13
lymphoid development 3. CD86 is a member of B7
adults. They were 21 males and 14 females.
family, which consists of cell-surface proteins that
The study was approved by the Ethics
regulate costimulatory or coinhibitory signals by
Board of Ain Shams University.
binding to their ligands 4.
The studied patients were subjected to
Recognition of CD86 ligand by co-
complete history taking, clinical examination,
stimulatory CD28 and co-inhibitory CTLA-4
complete blood picture (CBC), bone marrow (BM)
receptors plays an important role in influencing
immune responses by proliferation and suppression
immunophenotyping by Coulter (Epics-XL) FCM
of effector T cells respectively 5.
using the routine panel for acute leukemia. The CD86
CD86 is expressed on the surface of
expression was also detected by FCM.
antigen presenting cells (APCs) as monocytes and
Control group:
dendritic cells (DCs), its expression was found to
Twenty (20) healthy controls were enrolled
into the study. 12 of them were males & 8 were
malignancies such as acute myeloid leukemia
Received:20 / 3/2018 DOI: 10.12816/0047281
Accepted:30 / 3 /2018

Full Paper (vol.716 paper# 17)


Full Paper (vol.716 paper# 18)

c:\work\Jor\vol716_19 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (6), Page 3386-3389

Pharmacokinetics of a Once Daily Dosing Regimen of Gentamicin in
a Patient with Delayed Wound Healing
Saeed F Algahtani1, Fahad M AlQahtani2, Mohammed Qahl3
1. Department of Clinical Pharmacy, Al Kharj Military Industries Corporation Hospital, 2. Drug Information
and Poisoning Center, Al Kharj Military Industries Corporation Hospital,3. Department of Pharmacy,
Northern Area Armed Forces Hospital
Corresponding author: Saeed F Algahtani, Email: dr2sfg@hotmail.com, Phone number: 00966543222307

Gentamicin is used for the treatment of serious gram-negative infections and has low
therapeutic index. This may lead to several side effects, though therapeutic drug monitoring (TDM) is
important in gentamicin therapy.
: To report the pharmacokinetics of gentamicin using a once-daily dosing regimen.
Clinical presentation and intervention: The patient was a 78-year-old male. His weight was 78 kg and he
was 1.75 m in height. He was admitted to the hospital complaining of an infected wound secondary to chronic
limb ischaemia. Once-daily dosing of gentamicin (360 mg by infusion over 30 minutes) was prescribed to this
patient, in combination with flucloxacillin. A gentamicin blood sample was taken every day for four days (day
1 = 1.4 mg/L, day 2 = 2.1 mg/L, day 3 = 2.1 mg/L, day 4 = 1.6 mg/L). The patient's serum creatinine was 88
mol/L during the four days. The Hartford nomogram was used to estimate the dosage and interval for
administration of gentamicin.
Conclusion: The Hartford nomogram is a valid tool to monitor the once-daily dosing regimen of gentamicin.
Keywords: Pharmacokinetics; Dosing Regimen; Gentamicin; Wound Healing.


twice weekly. Three days prior to admission, a nurse
Gentamicin is an aminoglycoside and is commonly noticed the wound looked infected and she informed a
used for the treatment of serious gram-negative general practitioner (GP). The GP prescribed
infections. Loading and maintenance doses are ciprofloxacin for the patient. On the day of admission,
calculated depending on the patient's weight and renal the wound looked worse and was painful and leaking.
function1. Gentamicin has a low therapeutic index,
which may lead to dose-related side effects, such as
Past medical history
nephrotoxicity or ototoxicity.
The patient's medical history included a
Consequently, therapeutic drug monitoring (TDM)
femoral artery stenosis of the left foot ten
is important in gentamicin therapy to avoid these toxic
months prior to admission, bypass surgery of
side effects. Once daily dosing of gentamicin is
the left foot nine months prior,
preferred rather than conventional multiple dosing as

it may reduce the accumulation of gentamicin in renal
Drug History
tissue. In addition, some trials have reported similar
The patient's drug history included:
efficacy with less nephrotoxicity in once daily dosing
- Paracetamol 1 g qid
compared with multiple dosing2.
- Clopidogrel 75 mg od

- Ciprofloxacin 500 mg bid (started three days
before admission)

Patient identity
Patient is a 78-year-old male, weighing 78 kg and is
Medications prescribed for the patient in the
1.75 meters in height.
hospital included:
- Enoxaparin 40 mg sc od
Presenting complaint
The patient was admitted to the accident and
- Flucloxacillin 2 g IV as a first dose, then 1 g
emergency (A&E) unit complaining of an infected
IV qid
wound of his second toe on the right foot.
- Gentamicin as the chart (table 1)

- Clopidogrel 75 mg od
- Morphine sulfate 5-10 mg IV prn
History of presenting complaint
A month prior to admission, he grazed the second toe
- Morphine sulfate 10 mg po bd
on his right foot. He was renewing the dressing triage

Received:16 / 2 /2018 DOI: 10.12816/0047288
Accepted:26 / 2 /2018

Full Paper (vol.716 paper# 19)

c:\work\Jor\vol716_20 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (6), Page 3390-3392

Dilated Cardiomyopathy and Hypothyroidism: A Case Report
Ali Hamoud Alenazi, Fawaz Rawi Alfuhigi, Anwar Mohammed Alazmi, Ahmed Sanad Alrashidi,
Ayman Khalil Alrushaydan, Ibrahim Mohammed Alshitwee, Faisal Mohammed Alarjan,
Ahmed Hammed Almaeen, Yazeed Ahmed Aljudaya
Al-Jouf University, College of Medicine
Corresponding author: Ali Hamoud Alenazi , Tel.: +966546914390 E-mail: Ali.vip.2011@hotmail.com

The exact mechanism of developing dilated cardiomyopathy DCM in hypothyroidism is still unclear.
The possible influence of hypothyroidism on the etiology and progression of DCM is controversial. We have
experienced a case of a 32-year-old female with DCM secondary to hypothyroidism that was improved after
hormone replacement therapy.


On physical examination, the patient was
cardiovascular diseases are caused by thyroid
on semi-setting position with puffy face, loss of
dysfunction have been reported (1). It is well
lateral third of the eye brow, and coarse features.
established that thyroid hormones alternate cardiac
Her blood pressure was 101\95 mmHg, her pulse
was 95/minute, her O2 saturation was 98% on room
Hemodynamic changes in hypothyroidism
air and respiratory rate was 24 per minute. Juglar
includes bradycardia, decreased cardiac output by
venous pressure JVP was elevated measuring 7 cm
30% to 50%, mild diastolic hypertension, narrow
from sternal angle, no goiter was appreciated. Chest
pulse pressure, slightly increased mean arterial
examination revealed bilateral basal crackles. Apex
pressure and an incensement in serum cholesterol
was felt in the 6th Intercostal space anterior axillary
and homocysteine (2,3). Fortunately, most of these
line with pansystolic murmur grade 4/6 at the apex
radiating to axilla, blowing in character. Abdominal
hypothyroidism was diagnosed and treated early;
examination was normal. There was a reduced deep
although rare, but dilated cardiomyopathies (DCM)
tendon reflexes at the knee with delayed relaxation
has been well documented in patients with
phase. Skin examination was shown as dry and
rough skin with bilateral lower limb edema.
A link between CMD and hypothyroidism was first
ECG showed low voltage, with poor R
reported in 1918 in four patients with heart failure
refractory to digitalis and diuretics treated
cardiomegaly with mild hilar congestion.
successfully with substitutive hormonal therapy (4).
Echocardiogram showed a significant dilation and

global hypokinesia of left ventricle (LV) with
severely impaired systolic function and ejection
A 32 years old female who is known as a
fraction (EF) of 20-25%. Right atrium RA, and left
case of sickle cell trait presented to the emergency
atrium LA were markedly dilated with severe mitral
room complaining about the difficulty of breathing
and tricuspid regurgitation were present with
for 1 month. The dyspnea, according to NYHA, it
normal valves morphology. Right ventricular
began with grade III but progressed to grade IV
systolic pressure RVSP was about 40-45 mmHg.
making the patient in a symptomatic case even at
However, moderate pericardial effusion was noted.
rest. Moreover, her dyspnea was associated with a
Hematologic and biochemical profile
dry cough, orthopnea, and PND over the last month
showed leucopenia of 2.32 x109 /L. Hemoglobin
as well.
was 11.4 g/dl. In peripheral blood film, there was a
To explain, she had a history of a dry skin,
microcytosis and target cells. Her serum creatinine
puffiness of the face, changing of voice tone, with
was raised 94 umol/L, but blood urea nitrogen BUN
increasing of weight and she also gave history of
was normal. Serum calcium was low as 2.07
amenorrhea for the last 18 months. The patient had
mmol/L. Furthermore, she had normal lipid profile,
a history of irregular menstruation before 18\12 so
LDH of 235 U/L, Creatine Kinase (CK) of 333
she went for a medical advice when she discovered
U/L, and her ALT was elevated with 79,32 U/L.
to have hypothyroidism. She was given thyroid
The patient had significant elevated level of thyroid
replacement therapy for 3 months; after that, she
stimulating hormone (TSH) of (100 IU/mL),
stopped taking the medications on her own and she
decreased serum levels of free T4, free T3 (0.436
didn't go for following up since then.

establishing a diagnosis of primary hypothyroidism.
Received:17 /2 /2018 DOI: 10.12816/0047290
Accepted:27 /2 /2018

Full Paper (vol.716 paper# 20)

c:\work\Jor\vol716_21 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (6), Page 3393-3397

Effect of Mass Casualty Training Program on Prehospital Care Staff in Kuwait
Ahmad Abdullah Alharbi
Head of Clinical Audit Section, Kuwait Emergency Medical Services Department

An intensive training is required for prehospital staff, emergency medical technicians and
paramedics to deal with major incidents. Despite the fact that Kuwait has experienced many major incidents
and located into a politically conflict zone, there is no standardized preparedness training for prehospital care
providers to disasters or major incidents. This study aimed to assess the effect of a training intervention in
improving the knowledge and awareness of EMTs and paramedics in the Kuwait Emergency Medical Service
An interventional study was conducted in Kuwait Emergency Medical Services. Thirty-one
participants from different ambulance districts were included in two educational interventions. Repeated
measures analysis of variance (ANOVA), t-test, and one-way ANOVA test were used to analyze the data.
The mean score was significantly higher immediately after first training program (18.2; standard
error (SE):1.9) than before (12.4; SE: 2.8) (P <0.001). The mean score three months later was significantly
higher (19.8; SE: 0.5) immediately after the intervention program (P <0.001).
The primary aim of improving preparedness among prehospital care providers was achieved
through the training program. The tests results showed an improvement in score achieved by the participating
prehospital care providers. This type of training courses would increase the competency and the confidence of
prehospital care providers in providing emergency services.
Training Program, Emergency, Mass Casualty, Prehospital, Kuwait.


improving preparedness in EMS will support the
Emergency Medical Services (EMS) play a
national preparedness
pivotal role in disaster planning, response and

recovery. Prehospital care agencies take the
efforts. This is despite the clear need for
primary responsibility in dealing with disasters and
prehospital training in a high-risk setting (1).
major incidents. Their role during disasters exceed
that in normal every day single emergencies. They
knowledge, skills, confidence and awareness and
will be the first responders who deal with stressful
most importantly the adaptive and psychological
and disturbance situations with maybe or without
preparedness capabilities to manage high
risky weather hazardous conditions (1). There is a
magnitude events. Studies indicate that prehospital
consensus that prehospital providers should be
staff, Emergency Medical Technicians (EMTs)
trained to implement appropriate responses using a
and paramedics, need appropriate training to deal
formal major incident management command
with major incidents especially those that involve
chemical and biological agents (3). When quality
The evidence indicates that the health care
training is provided preparedness and willingness
sector needs to be involved in a periodic and
to respond to MCIs is enhanced (4). If the
systematic preparedness training to be able to
prehospital providers are not well trained they will
reach required standards to enable them to have
be hesitant and unwilling to participate in such
the competencies to swiftly and effectively
events(5). This reluctance affects negatively on the
manage any major incidents. This generally
overall health care system's ability to cope with
includes both didactic training and simulated
the surge volume of these incidents (6).
disaster exercises, with the latter including
While the education and training for mass
extensive exercises or more economical table-top
casualty events is growing in both entry-level and
exercises (1). Addressing emergency medical
post-graduate education, there is no universal
readiness and developing a way to measure its
consensus on the validation of program content (7-
level of preparedness is a fundamental step to
9). Additionally, there is no any consistency in the
enhance and strength emergency medical
types of interventions used to improve response
preparedness(2). Indeed, EMS is the first line in any
competency(10). Although a variety of training
emergency management activities and an essential
courses are offered in different regions worldwide
component of medical readiness and hence,
, the validly and effectiveness of this training is not
(7). This research
Received:18 / 2 /2018 DOI: 10.12816/0047293
Accepted:28 /2 /2018

Full Paper (vol.716 paper# 21)

c:\work\Jor\vol716_22 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (6), Page 3398-3404

Comparative Study between Residual Prostatic Tissue Size after Bipolar
Vaporization of The Prostate versus Transurethral Resection of Prostate in Saline
Mohammed Sherif Mourad, Kareem Omar El Saeed, Mohammed El Sayed Hassona
Urology Department, Faculty of Medicine, Ain Shams University
Corresponding author: Mohammed El Sayed Hassona, Mobile: +201065028666; E mail: kinghassona@gmail.com

To compare the outcomes of plasmakinetic vaporization of the prostate (PKVP) with transurethral
resection of the prostate in saline (TURis), mainly residual prostatic tissue size after 3 months.
Materials and Methods:
In a randomized controlled trials, 30 patients with moderate to severe lower urinary
tract symptoms secondary to benign prostatic hyperplasia (BPH) underwent PKVP (N = 15) and TURis (N =
15) between 2017-2018. The inclusion criteria were age between 40 and 80 who were indicated and
scheduled for prostatectomy, prostate volume of 30-90 ml, serum prostate specific antigen (PSA) < 4 or
free/total PSA <0.25, if total PSA between 4 and 10, IPSS (The International Prostate Symptom Score) 20,
Qmax 10 mL/s, and failed BPH-related medical therapy. Exclusion criteria were abnormal digital rectal
exam (DRE) or ultrasonography with suspicion of prostate cancer, history of prostate cancer, bladder cancer,
serum PSA < 10 ng/ml or free/total PSA ratio >0.25 if total PSA between 4 and 10, previous urethral or
prostate surgery, urethral stricture, neurogenic bladder, bladder calculi, BPH-related hydronephrosis,
preoperative hematuria due to any local or general cause, anticoagulant therapy or coagulation disorders. The
perioperative and postoperative outcomes were evaluated and the residual prostatic tissue size, IPSS and Qmax
were assessed preoperatively and 3 months after procedure in all cases. Results: Both groups were nearly
similar in patient age, prostate volume, preoperative IPSS, Qmax, hospital stay and catheterization period. The
PKVP group had significantly higher mean values of operative time, IPSS. Modified Clavien classification of
complications was used to assess complications. No significant changes were seen between the two groups
regarding complications (PKVP = 20%; TURis = 26.7%), no cases of TUR syndrome, obturator reflex, urethral
stricture, clot retention or epididymitis occurred in both groups. In the transurethral resection in saline (TURis)
group, 2 cases were presented by acute retention 2 weeks postoperative, only one case presented with mild to
moderate dysuria 1 month post-operative, resolving with anti-inflammatory medication, mild hematuria was
seen in 1 case 2 weeks postoperative. In plasma vaporization group, 1 patient had urinary retention which
needed catheterization, urinary tract infection and significant bacteriuria occurred in one case which was
treated by antibiotics and a mild to moderate dysuria after 1 month was seen in one case. Three months after
surgery, two groups had significant improvement in IPSS (more in TURis group), post voiding volume, serum
PSA, and mainly in residual prostatic tissue size.
Conclusions: Bipolar electrosurgical technology is a promising modality for surgical treatment of BPH.
Regarding bipolar prostatic surgeries we can conclude the following: No significant difference between bipolar
plasma vaporization and TURis regarding residual prostatic tissue size, no TUR syndrome, less blood loss
especially in vaporization technique, more easy learning curve either in vaporization technique or resection
technique (no fear of TUR syndrome so time factor isn't an issue) enabling the surgeon to work slowly and to
do adequate hemostasis, vaporization technique is ideal modality for high risk patients (multiple co morbidities,
bleeding tendency and patient on anticoagulants). Large prostate volume can be treated either by resection or
vaporization technique). We can conclude that the bipolar plasmakinetic energy will be the gold standard in
surgical management of BPH in the near future if it not yet.
Keywords: BPH, plasma vaporization, TURis, PKVP, Qmax, IPSS, post voiding volume, serum PSA.

hyperplasia (BPH). The high success rate of TURP,
Benign prostatic hyperplasia (BPH)
proven by substantial and sustained improvements
becomes increasingly common as men age. Men
of symptom scores, urinary flow rate and other
with clinically significant lower urinary tract
functional parameters, is still associated with
symptoms (LUTS) suggestive of BPH who do not
significant morbidity, including perioperative or
find adequate relief with medical treatment may
postoperative bleeding, transurethral resection
benefit from transurethral resection or ablation to
(TUR) syndrome, prolonged hospital stay, and
enlarge the urethral channel by reducing the
even urinary incontinence, retrograde ejaculation,
amount of prostate tissue around the urethra (1).
and erectile dysfunction (2).
Transurethral resection of the prostate
As a consequence, a large number of new
(TURP) is still considered the reference `gold
minimally invasive therapeutic alternatives have
standard' surgical procedure for low urinary tract
been tested in the last 30 years, including (but not
symptoms (LUTS) due to benign prostatic
being limited to) laser enucleation, resection or
Received:20 /3 /2018 DOI: 10.12816/0047295
Accepted:30 /3 /2018

Full Paper (vol.716 paper# 22)

c:\work\Jor\vol716_23 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (6), Page 3405-3415

Toxicity of Thymol on the Ultra-Scanning Structure of Skin and Digestive Gland
Proteins of the Two Slugs `Limax maximus and Lehmannia marginata'
Omaima M. Mustafa
Department of Biological and Geological Sciences, Faculty of Education, Ain Shams University, Egypt
Corresponding author: Omaima Mustafa, Email:omayma_moustafa@yahoo.com

: thymol is a natural derivative of herb thyme and extracted from Thymus vulgaris.
Aim of the work: the present investigation was carried out to study the side effects of thymol on the skin and
protein content in the digestive gland of both slugs: Limax maximus and Lehmannia marginata.
Materials and Methods: the slugs are classified into three groups: the first one served as a control, the second
and third groups fed on LC50 and LC90 of thymol for 48 hours.
Results: the histological and scanning electron microscopic (SEM) observations of skin of LC90-treated slugs
exhibited erosion of the epithelial cells, hypoplasia of the connective tissues with increased mucus secretion.
Moreover, the different protein bands of the control and treated slugs with LC50 and LC90 of thymol were
demonstrated by SDS-PAGE technique. A total number of 37 different protein bands were ranged from 5.181 to
84.375 kDa.
Conclusion: the present study supported the use of thymol as a molluscicide agent on the skin and digestive
gland proteins of both slugs (Limax maximus and Lehmannia marginata) that offers a safe alternative to other
more persistent chemical pesticides that can be dispersed in runoff and produce subsequent contamination.
Digestive Gland, Proteins, Skin, SEM, Slugs, Thymol


comparative analysis of soluble protein extracts of the
The development of botanical molluscicides as a
digestive gland and female gonads by using SDS-
possible substitute for chemical molluscicides are
PAGE on the freshwater Bivalves Caelatura
gaining wide attention. Molluscicides of plant origin
teretiscula and Caelatura nilotica. Bakry (11) studied
are environmentally friendly, culturally more
the effect of LC25 of the menthol extract from the
acceptable than synthetic ones, less expensive,
plants: Guayacum offcinalis, Atrplex stylosa and
rapidly biodegradable and have low toxicity to non
Euphorbia splendens for two weeks on the snail
target organisms (1&2). Thymol (also known as 2-
Biomophalaria alexandrina.Analysis of snail's soft
isopropyl-5-methylphenol) is a natural monoterpene
tissues indicated that the tested plant extracts effected
phenol derivative of cymene, C10H14O, found in oil of
on the protein patterns. The electrophoretic pattern of
culinary herb thyme and extracted from Thymus
total protein of snail's soft tissues showed differences
vulgaris (3). The Native Americans recognized this
in number and molecular weights of protein bands.
plant as strong antiseptic plant, and used poultices of
Moreover, Yousef (1) studied the effect of LC25 and
the plants for skin infections and minor wounds (4).
LC50 of the mnotrpenoids, thymol and nicotine on the
Moreover, Nieto (5) reported that thymol was also
electrophoretic pattern of total protein of the digestive
used as a rapidly degrading, non-persistent pesticide.
gland of Eobania verniculata. Saidi et al. (12) used
Some monoterpenoids (such as camphor, menthol
antifungal, molluscicidal and larvicidal assessment of
and limonene) consist of two isoprene units and have
anemonin and Clematis flammula extracts against
the molecular formula C10 H16.
mollusks Galba truncatula and intermediate host of
The skin of gastropods especially in the foot
Fasciola hepatica in Tunisia. Faria et al. (13) reported
regions is composed of three main regions: epithelial
the molluscicide (Manikara subseicea) crude extract
layer, compact fibrous and muscular layer. Such
from leaves showed an efficient method to control the
observations were carried out by the most extensive
schistosomiasis disease and being able to reduce
studies on the skin of gastropods such as Prior and
intermediate host snail Biomphlaria glabrata number.
Gleperin (6) and Mustafa (7) on Limax maximus;

Godan (8) on the terrestrial pulmonates. Wilbur (9)
studied the Mollusca skin and found that the
Experimental Animals
epidermis was a single layer of cells resting on a
The two terrestrial pulmonate slugs Limax
basement membrane and supported by a sheet of
maximus and Lehmannia marginata had been
connective tissue. The epithelium itself consisted of
collected from the garden of Faculty of Education,
three main types, namely epidermal, ciliated and
Ain Shams University, Cairo, whereas the used plant
glandular cells. Mohamed and Sheir (10) studied the
molluscicide (thymol) was obtained from Sigma-
Received:20 / 3 /2018 DOI: 10.12816/0047298
Accepted:30 /3 /2018

Full Paper (vol.716 paper# 23)

c:\work\Jor\vol716_24 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (6), Page 3416-3423
Fecal Microflora and Calprotectin in Infants with Colic
Soheir B. Fayed*; Radwa S. Ibrahim**; Marwa Elhady*; Manal Tantawy***.
*Pediatric department, **Clinical pathology department, Faculty of Medicine for girls -Al Azhar University,
***Pediatric department, Atfeeh central hospital, Egyptian ministry of health.
Corresponding author: Manal Tantawy, Email: dr_manaltantawy@yahoo.com
Colic is a common distressing problem of infancy. The underlying etiology has not determined
yet, however several hypotheses were suggested including gastrointestinal inflammation and disturbed gut
microflora. The aim of this study was to explore the role of gut microorganism and fecal calprotectin in infantile
Methods: Ninety healthy infants aged 14 to 90 days were included. Forty five of them have infantile colic.
Detailed medical history and examination in addition to stool culture and measuring fecal
calprotectin level by enzyme linked immunosorbent assay (ELIZA) were done for all included infants.
Results: Colicky Infants have significant higher rate of Escherichia coli infection than non-colicky infants
(57.8% vs 17.8%) do. Fecal calprotectin was significantly higher in colicky Infants than non-colicky infants
and in infants with Escherichia coli infection than non-infected infants. Vomiting, umbilical hernia, maternal
stress, previous sibling with infantile colic, increased body weight and herbal intake were significantly associated
with infantile colic. Types of feeding in first 3months of life were not related to infantile colic, E-coli infection
and fecal calprotectin level. Regression analysis revealed that elevated fecal calprotectin, Escherichia coli
infection, vomiting and higher weight were the main predictors for infantile colic.
Conclusion: Fecal calprotectin level and Escherichia coli infection are increased in colicky infants reflecting
the role of gastrointestinal inflammation and infection in infantile colic. Advice the mothers to avoid
stressful conditions, over feeding or introduction of any remedy food during the first 3 months of life.
Keyword: Fecal calprotectin, Escherichia coli, infantile colic, feeding.


Infantile colic was originally defined by Wessel
impact and shape the immune system and
in 1954 as crying lasting three or more hours a
inflammatory response [7]. The exact mechanism of
day, at least 3 days a week and for at least 3 weeks
how imbalanced colonization of the intestines by
[1]. In 2006, the Rome III criteria defined it as
noncommensal bacteria, or intestinal dysbiosis, may
,,episodes of irritability, fussing, or crying that
contribute to symptoms of infantile colic is not fully
begin and end for no apparent reason and last at
understood. However, researchers have proposed
least 3 h a day, at least 3 days a week, for at least
that the presence of pathogenic bacteria in high
1 week[2]. The incidence of infantile colic varies
numbers induces a chronic inflammatory response.
between 5 and 30%, and it is reported to occur
In turn,intestinal epithelial tissue releases cytokines
equally frequent in breastfed and bottle-fed infants
and chemokines both locally and systemically that
and in both sexes [3].
further mediate immune cell migration and
The aetiology of colic is multifactorial.
inflammation as well as sensitization of local nerve
Multiple hypotheses have been proposed,
tissues [8].
including alteration in fecal microflora and higher
Because of the much theories of infantile colic, it
levels of fecal calprotectin as a marker of
had been centered on the gastrointestinal habitat as a
gastrointestinal inflamation [4,5].
likely etiology, the potential influence of intestinal
Recent advances in genetic sequencing
dysbiosis presents a plausible explanation for the
expression of infantile colic symptoms and warrants
understanding of the molecular underpinnings of
further exploration.
human microbial habitats and their interactions
Calprotectin, a calcium and zinc binding protein
with host systems [6] . Of particular interest to
that belongs to the s100 protein family and is derived
infantile colic is the finding that microbes
predominantly from neutrophils and, to a lesser
involved in intestinal colonization during the
extent, from monocytes and reactive macrophages
.The functions of calprotectin are associated with the
communication with host cells to significantly
regulation of inflammation and apoptosis as well as
Received:20 / 3 /2018 DOI: 10.12816/0047300
Accepted:30 / 3 /2018

Full Paper (vol.716 paper# 24)

c:\work\Jor\vol716_25 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (6), Page 3424-3428

Phonological Awareness in Cochlear Implants Users
Nihal Hisham Abdelhamid (1), Mona Abdel-Fattah Hegazi (2), and Dina Ahmed Elrefaie (2)
(1) Phoniatric Department, Hearing and Speech Institute, Imbaba, (2) Phoniatric Department, Faculty of
Medicine, Ain Shams University, Cairo, Egypt
Corresponding author: Nihal Hisham Abdel-Hamid Mostafa, Mobile: 01004507597, Email:
Background: Phonological awareness (PA) refers to the explicit awareness of the abstract units that
compose spoken words, including syllables, onset and rime units, and individual phonemes. Phonological
awareness is a critical precursor to the acquisition of reading.
The aim of this work was to evaluate the phonological abilities skills in children with cochlear
implant users (CI), and if they need interventionor not.
Subjects and Methods: We assessed PA using certain skills of the Arabic phonological awareness test
(blending syllables into words (BSW), blending phonemes into words (BPW) and isolating initial sound (IIP).
Thirty children with cochlear implant (CI) and control group of 25 normal developed children. Inclusion
criteria: children aged from 5:8 years with IQ 80, and their language age at least 3-word sentence, Started
basic literacy skills, and their mother tongue was Arabic language. Exclusion criteria: Mental retardation and
any Neurological diseases. Results and conclusion: PA skills as regarding BSW, BPW is intact within the
study group, while IIP was defective in CI users children, which need further training throughout their
language therapy sessions.
Keywords: phonological awareness, cochlear implant, and learning problems.

Shams University. Approval of the ethical
Phonological awareness refers to the explicit
committee and a written informed consent from
awareness of the abstract units that compose
all the subjects were obtained. This study was
spoken words, including syllables, onset and rime
conducted between (August 2015, and January
units, and individual phonemes. Phonological
awareness is a critical precursor to the acquisition
We assessed PA using certain skills of the Arabic
of reading (1). Reading is the process by which
phonological awareness test (blending syllables
one constructs meaning from printed symbols. It
into words (BSW), blending phonemes into
is a language based activity; therefore deficits in
words (BPW) and isolating initial sound (IIP).
oral language will be reflected by deficits in

written language (2). Phonological awareness is
Inclusion criteria
not a unitary skill. Words can be broken down
Children age from 5:8 years, intelligent
into smaller units in at least three ways. The three
quotient (IQ) 80, their language age at least 3
phonological units that are most widely accepted
word sentence, Started basic literacy skills, their
include: syllabic, intra-syllabic, and phonemic.
mother tongue was Arabic, and all at the middle
Understanding the phonological awareness
socioeconomic class.
development of these group is especially
Exclusion criteria
important because of the well-established
Mental retardation, neurological diseases, and
any associated disorder with the specified
awareness abilities and later reading abilities of
children with normal development(3& 4).
Evaluation was carried out using the protocol of
The aim of this work was to evaluate the
assessment followed at Phoniatric Unit, Ain Shams
phonological abilities skills in children with
University: preliminary diagnostic procedures,
cochlear implant users (CI), and if they need
clinical diagnostic aids, and additional instrumental
intervention or not.
measures. The skills blending syllables into words

(BSW), blending phonemes into words (BPW), and
isolating initial sound (IIP) have been selected from
This study included a total of thirty children with
the list of Arabic phonological awareness test skills
an age range of (5-8 years) with cochlear implant
to be applied on children.
(CI) and control group of 25 normal developed
Statistical analysis
children, attending at Phoniatric Department,
Categorical variables were described using
Hearing and Speech Institute, Imbaba and
counts and percentages and presented graphically
Phoniatric Department, Faculty of Medicine, Ain
through tables and bar charts. Statistical tests
Received:20 /3 /2018 DOI: 10.12816/0047303
Accepted:30 /3 /2018

Full Paper (vol.716 paper# 25)

c:\work\Jor\vol716_26 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (6), Page 3429-3433

A Comparative Study of Platelet Parameters in Chronic Kidney Disease, End Stage
Renal Disease Patients Undergoing Hemodialysis and Healthy Individuals
Mahmoud Mousa Bazeed1, Mahmoud Abdel Rasheed Allam1, Mohamed Saied Bakeer1,
Ahmed Fathi Abdel Aziz2 and Ahmed Talal Ali Saad3
1- Department of Internal Medicine. Faculty of Medicine ,2-Department of Clinical Pathology .Faculty of Medicine,
Al-Azhar University, Egypt.3-Nephrology Unit , Al-Qabbary Hospital, Alexandria

With the rising trend of diabetes mellitus and hypertension, there is also a rise in chronic
complications like chronic kidney disease (CKD) and end stage renal disease (ESRD).
Cardiovascular complications remain the most common cause of death among ESRD patients and those on
hemodialysis (HD). Hemodialysis patients behave in a distinct way that they are relatively more prone for bleeding
than thrombotic manifestations. In recent days, abnormalities in platelet parameters are found to be an effective
tool in risk stratification of patients with chronic kidney disease (CKD) to develop coronary artery disease. Platelet
parameters are considered as inflammatory markers. The present study was taken to find the association of various
platelet parameters among hemodialysis patients and CKD patients.
Objectives: The aim was to study the platelet distribution width (PDW), mean platelet volume (MPV), plateletcrit
(PCT) and platelet large cell ratio (PLCR) among ESRD patients undergoing maintenance hemodialysis and
compare with CKD patients and healthy age and sex matched controls.
Methods: The present study was done on three groups. Group 1 included 20 healthy individuals from hospital
staffs and healthy volunteers matched for age and sex, Group2 included 60 CKD patients and Group 3 included 40
ESRD patients on maintenance HD. Results: The mean values of platelet distribution width (PDW), mean platelet
volume (MPV), platelet count, plateletcrit ratio (PCT) and platelet large cell ratio (P-LCR) were found to be higher
in CKD and ESRD patients when compared to healthy controls. PDW, PCT and L-PCR attained statistical
significance, while MPV did not. Conclusions: Abnormality in platelet parameters can be used as a predictor of
underlying inflammation and severity of atherosclerosis as all these parameters are lesser than that observed in
control population.
Keywords: Chronic kidney disease, Hemodialysis, Cerebrovascular disease, Platelet distribution width, Mean
platelet volume, Platelet large cell ratio and plateletcrit ratio.

has been proposed as a potential tool for identifying
Chronic kidney disease (CKD) and end stage
high-risk patients (4).
renal disease (ESRD) are considered inflammatory
As well as platelet size, the ratio of platelets to
processes as there are many inflammatory stimuli as
other circulating cells (PCT) has been used as tool for
uremia, anemia, and malnutrition (1).
identifying inflamed and subsequently high-risk
In (CKD) both bleeding and thrombotic
patients (5).
complications are observed. Early stages
The present work aimed to compare mean platelet
of chronic kidney disease are typically associated
volume (MPV), platelet distribution width (PDW),
with a pro thrombotic tendency.
plateletcrit ratio (PCT) and platelet large cell ratio (L-
Whereas, in its more advanced stages and ESRD
PCR) in normal individuals, chronic kidney disease
patients also suffer from a bleeding diathesis (2).
patients and end stage renal disease patients on
platelet parameters were found to be correlated
maintenance hemodialysis.
with inflammation as they are inflammatory markers
whereas platelets have been identified as being
This is descriptive cross sectional study conducted
effector cells that enhance inflammatory responses,
from March 2017 to march 2018. At AL-Hussein
with the ability to `cross-talk' with endothelial cells
University Hospital Internal Medicine Department,
and leukocytes (3).
Clinical Hematology and Nephrology Units and AL-
Interest has also been given to platelet size, which
Qabbary Hospital, Nephrology Department.
has been found to be linked with platelet activity.

MPV has been found to be associated with
The study included 20 normal subjects, 60 CKD
cardiovascular risk and, due to the relative ease of
patients (stage 2, 3 and 4) and 40 ESRD patients on
measuring (available with routine blood counts), it
maintenance hemodialysis.
Received:20 / 3 /2018 DOI: 10.12816/0047305
Accepted:30 / 3 /2018

Full Paper (vol.716 paper# 26)

MATERNAL LIPID PROFILE AS A RISK FACTOR FOR PRE-ECLAMPSIA The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (6), Page 3434-3438

Maternal Lipid Profile as A Risk Factor for Preeclampsia
Abdel Azim Mohamed Ahmed, Fahd Abdel Aal El Omda and Mohamed Samir Mohamed Mousa
Obstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar University

Preeclampsia occurs in about 3-5% of pregnancies and is an important cause of fetal and maternal
morbidity and mortality worldwide. Preeclampsia occurs during second and third trimester of pregnancy, and it is
more common in nulliparous women. It is characterized by blood pressure of 140/90 mmHg or rise in systolic
blood pressure of more than 30 mmHg or diastolic blood pressure of more than 15 mmHg after 20 weeks of
gestation, in conjugation with proteinuria >300 mg/24 hours or greater or equal to 1+ or 100 mg/dl by dipstick
response. Hypertriglyceridemia is traditionally defined as a serum or plasma triglyceride (TG) concentration above
1.6 mmol/l. It is found in 13% of woman aged 20-40 years. Objectives: Assessing the changes in lipid profile in
preeclampsia and as a marker of severity of the condition. Patients and Methods: This was a control study
conducted at Al-Hussien and Air Force Hospitals during the period from December 2016 to May 2017. Total 100
pregnant women of 18-36 years in the 2nd half of pregnancy (>20 weeks of gestation) were selected and grouped as
follows. Group-I (Controls): 40 Normotensive pregnant women; Group-II 30 Mild pre-eclamptic pregnant women
and Group-III 30 severe pre-eclamptic pregnant women. Conclusion: Preeclampsia has an association with
hypertriglyceridemia, and elevated cholesterol level, LDL and VLDL, and decreased HDL level. The more the
severity of preeclampsia the higher was the level of serum triglycerides, cholesterol, LDL and VLDL, and the lower
the HDL.
Keywords: Lipid Profile, Preeclampsia, Hypercholesterolemia, Hypertriglyceridemia

shown that endothelial dysfunction is related to
Preeclampsia occurs in about 3-5% of
hyperlipidemia (6)
pregnancies and is an important cause of fetal and
Significantly elevated plasma concentration
maternal morbidity and mortality worldwide (1).
of triglycerides (TG) were found in women with
Preeclampsia occurs during second and third
preeclampsia in comparison to normal pregnancy (7).
trimester of pregnancy and it is more common in
Plasma lipids and lipoproteins increase
nulliparous women. It is characterized by blood
during pregnancy. The mechanism for pregnancy-
pressure of 140/90 mmHg or rise in systolic blood
induced changes in lipids is not completely
pressure of more than 30 mmHg or diastolic blood
understood, but appears to be partly caused by
pressure of more than 15 mmHg after 20 weeks of
elevated estrogen, progesterone and human placental
gestation, in conjugation with proteinuria >300
lactogen (8).
mg/24 hours or greater or equal to 1+ or 100 mg/dl
Lipid levels in women with preeclampsia are
by dipstick response (2).
reported to be higher than those in healthy pregnant
Hypertriglyceridemia, traditionally defined
women (9).
as a serum or plasma triglyceride (TG) concentration
Women with preeclampsia present arterial
above 1.6 mmol/l, is found in 13% of woman aged
lesions at the uteroplacental implantation site. These
20-40 years (3).
morphological lesions are usually observed in cases
The association of alteration of serum lipid
of acute atherosclerosis, and are characterized by
profile in preeclampsia is well documented. Known
areas with fibrinoid necrosis surrounded by lipid-
to be strongly associated with atherosclerotic
laden macrophage (9). These microscopic lesions are
cardiovascular diseases and has a direct effect on
similar to atherosclerosis found outside pregnancy.
endothelial dysfunction. The most important feature
Lipid deposits are also seen in the glomeruli of pre-
in preeclampsia is hypertension which is supposed to
eclamptic patients, a finding known as glomerular
be due to vasospastic phenomenon in kidney, uterus,
endotheliosis. Glomerular lesions are associated with
placenta and brain (4).
proteinuria, a predictive indicator and marker of
Altered lipid synthesis leading to decrease in
disease severity(2).
prostacyclin (PGI2): Thromboxane A2 (TXA2) ratio
It has also been suggested that triglycerides may be
is also supposed to be an important way of
involved in this renal damage (13).
pathogenesis in pregnancy induced hypertension (5).
The severity of both hypertension and
Thus, abnormal lipid metabolism seems
proteinuria seems to reflect the degree of endothelial
important in the pathogenesis of preeclampsia.
damage (21). The possible correlation between the
Preeclampsia and related disorders are known to
altered lipid profile and the severity of renal lesions,
affect function of various organs involved in lipid
as reflected by proteinuria, may contribute towards
and lipoprotein metabolism. Several studies have
clarify the complex pathophysiology of preeclampsia.
Received:20 /3 /2018 DOI: 10.12816/0047307
Accepted:30 /3 /2018

Full Paper (vol.716 paper# 27)

c:\work\Jor\vol716_28 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (6), Page 3439-3447

Associated Head Injuries and Survival Rate of Patients with Maxillofacial
Fractures in RTA
Omar Mufi Aldwsari 1 , Khalid Hadi Aldosari 2 , Musab Khader Alzahrani1 , Mohammed Waseem Mani
3 , Sameer Al Ghamdi 2 , Abdulrahman Hamoud Alanazi 5 , Khalid Mansour Alkhathlan 2 , Mohammad
Ghormallah Alzahrani 2 , Ali Hazzaa Alzahrani 1 Zaid Ali Alzahrani 4
1 - Riyadh Elm University, Colleges of Dentistry, Riyadh, 2 - Prince Sattam Bin Abdulaziz University, Colleges
of Medicine, Al-kharj, 3 - Riyadh Elm University , Endodontic Department, Colleges of Dentistry, Riyadh, 4
Al-Imam Muhammad Ibn Saud Islamic University, Colleges of Medicine, Riyadh, 5 - Majmaah University ,
Colleges of Dentistry , Majmaah, KSA .
Corresponding author : Khalid Hadi Aldosari, Email: h15k@hotmail.com

Every minute, an accident occurs in KSA, causing 39000 injuries and 7000 deaths annually. Facial
trauma or maxillofacial trauma (MFT) is a frequent presentation of RTAs, ranging from simple nasal fractures to
gross or severe maxillofacial injuries.
Aim: This study aims at determining the prevalence of associated head injuries and survival rate of patients with
maxillofacial fractures in RTA with respect to age, gender, mortality, the location of skull fracture, brain damage,
altered level of consciousness, scalp laceration, and shock.
A total number of 237 patients were included in this prospective study from May 2013 to January
2018. The following medical details were recorded for each case, gender, age, fracture location, the presence of
scalp laceration, the presence of brain damage, type of brain damage, shock degree, Glasgow Coma Scale (GCS),
number of units used for blood transfusions for documentation of patient survival rate. We followed up the patients
in their first appointment after 21 days of patient discharge from the hospital.
Results: Majority of the patients were young adults male. 59.1% of patients had cerebral damage. 38% (n=90) of
patients had at least, one scalp laceration. 43.5% (n=103) of patients had some degree of shock, while 27.8% of the
recruited patients needed at least 1 unit of blood transfusion. 14.3% of the patients died as a result of their injuries,
and the survival rate was 85.7%.
KSA is having a high incidence of RTAs leading to high mortality rate. Therefore, it requires a sound
evaluation of the risk factors for RTAs and establishment of guidelines to decrease the incidence of road traffic
injuries and reduce healthcare burden. Road safety campaigns focused on young population can help reduce RTAs
and subsequent mortalities. Prompt arrival at the hospital, early diagnosis, and timely management of maxillofacial
fractures and brain damages by skilled physicians will lower mortality rate in KSA.
Keywords: maxillofacial fractures , head injuries , survival rate.


MFT in KSA.5 . The management of severe MFT is
Road traffic accident (RTA) is one of the major
extremely challenging, increasing an extra burden on
contributors to mortality and morbidity, accounting
health system on the nation.
for more than 1.27 million deaths globally1 . World
KSA is a vast, high-income country having a
Health Organization (WHO) has reported that road
population of more than 27 million people. The
traffic crashes make up to 25% of all injuries. In the
primary source of transportation is motor vehicles.
Kingdom of Saudi Arabia (KSA), RTAs contribute
Therefore, approximately 6 million cars are found on
81% of deaths to hospitalized patients2 .In spite of
the roads of Saudi Arabia6 . KSA has rapid economic
active enforcement of rules and regulations, RTIs
growth, which made it construct additional roads and
(Road Traffic Injuries) are still occupying a larger
buy vehicles. Therefore, KSA is included among top
number of beds in tertiary care hospitals. Every
countries having a high incidence of RTAs. There is
minute, an accident occurs in KSA, causing 39000
a significant number of factors contributing to RTAs
injuries and 7000 deaths annually3. Facial trauma or
including human factors, road conditions, and
maxillofacial trauma (MFT) is a frequent
vehicle defects. However, the prevalence of RTIs
presentation of RTAs, ranging from simple nasal
varies by age, education, occupation, climate,
fractures to gross or severe maxillofacial injuries4 .
geography, poor eyesight, ethnicity, culture,
Mandible fracture is the most common fracture in
inadequate safety measures, long hours driving,
Received:20 / 2 /2018 DOI : 10.12816/0047309
Accepted:1 / 3 /2018

Full Paper (vol.716 paper# 28)

c:\work\Jor\vol716_29 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (6), Page 3448-3460

Morphological aberrations induced by Thymol in larvae of
Megaselia scalaris L. (Diptera: Phoridae)
Eman H. Ismail
Biological and Geological Sciences Dept., Fac. of Education, Ain Shams Univ., Egypt
E-mail: e_ismail2000@yahoo.com / emanismail@edu.asu.edu.eg,Orcid ID: https://orcid.org/0000-0003-3664-8450


Megaselia scalaris (Diptera: Phoridae), humpbacked, coffin or scuttle fly, is considered as a
cosmopolitan scavenging insect. Despite its profound value in Forensic Entomology and biological control, M.
is regarded as a medically notable insect worldwide because it is source of myiasis diseases. Further, it
was recorded as a parasitoid infesting some useful insects. On the other hand, it attacks some plants such as
corn, food and seed deposits, germinated seeds, cultivated and non-cultivated mushroom and fruits like bananas.
Feeding on such infected fruits, can cause intestinal and wound myiasis. Therefore, scuttle fly should be
controlled for human welfare and economic reasons. Phytochemical insecticides may be effective, safe and
acceptable alternative to traditional chemical insecticides. Thymol, a constituent of oil of thyme (Thymus
), is widely used as food flavorings, mouthwashes, pharmaceutical preparations, besides it has many
pesticidal uses; as insecticide, fungicides, rodenticide and antimicrobial effect. Moreover, it degrades rapidly
and has no negative effect on seed germination. Accordingly, the present study was conducted to investigate the
effects of thymol on the mortality, morphology and surface ultrastructure of the 3rd instar larvae of M. scalaris.
Results showed that thymol has larvicidal effect, as the estimated LC50 averaging 5.22 g/100g media, and the
response was a dose-dependent. Morphological observations revealed that thymol treatment resulted in different
morphogenic malformations in larval stage. Malformed larvae appeared sluggish and motionless, with
symptoms of distorted, darkened and dry bodies. On the other hand, at the ultrastructural level, thymol
treatment exhibited many morphological aberrations as compared with the controls. Such aberrations appeared
in the malformed structure of short spinous processes and spines of the body wall, bubble membranes, antennae,
mouth hooks, maxillary palp complexes and anterior and posterior spiracles. Based on the present results, it is
concluded that thymol can prevent adult emergence through killing maggots and protect against re-infestation.
Consequently, thymol could be suggested as a safe effective larvicide against the scuttle fly larvae.
Keywords: Megaselia scalaris, thymol, toxicity, morphology, ultrastructure, SEM.


Coleoptera, and Hymenoptera, some of which are of
Megaselia scalaris (Loew, 1866), (Diptera:
agricultural importance [4]. So, it can be a biocontrol
Phoridae), humpbacked, coffin or scuttle fly, has a
agent in biological control methods.
wide geographical distribution and can be found in
Despite its profound value in forensic
the tropics and subtropics [1]. The scuttle fly is a
entomology and biological control of other harmful
common species found amongst indoor and outdoor
insects, M. scalaris is considered as a medically
crime scenes and plays an important role in the
important insect worldwide. It affects humans in
decomposition of human remains and is useful in
different ways; it is an aggravating insect for humans
estimating postmortem interval particularly in indoor
and animals, also, a source of myiasis disease. It is
cases Accordingly, the presence of the larvae in a
well known that flies are transmitters of transmittable
corpse could be used as entomological evidence in
and parasitical diseases of both man and animal.
forensic investigations [2].
When a fly lands on a source of contamination (i.e. a
The larva of M. scalaris has scavenging
corpse, faeces, open wounds, contaminated food,
properties. It has been described as parasite,
etc.), it is possible for the fly to then transmit through
parasitoid, predator, terrestrial detritivore (consumes
direct or indirect contact an infectious agent to man
both animal and plant material), phytophagous, and
or animal. Myiasis refers to the infestation of living
coprophagous [3]. The parasitoid behavior of the
tissue from either animals or humans by Diptera
larvae gives this fly the ability to feed on a lot of
larvae. Myiasis caused by Phoridae have been
other insects of agronomic, veterinary and medical
reported as wound myiasis, and non-wound myiasis
importance. Such as insects of orders: Orthoptera,
such as nasopharyngeal, urinogenital myiasis and
Dictyoptera, Hemiptera, Diptera, Lepidoptera,
intestinal myiasis. Besides, it affected non-
Received:20 / 3 /2018 DOI: 10.12816/0047310
Accepted:30 /3 /2018

Full Paper (vol.716 paper# 29)

c:\work\Jor\vol716_30 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (6), Page 3461-3464

Diagnostic Procedures among Patients Undergoing Appendectomy: Findings
from A Tertiary Hospital In Saudi Arabia
Mohammed AlQahtani , Mudassir Maqbool Wani , Omar Aldhasee , Abdulrahman Alqahtani ,
Yazeed Alharthi , Suliman Alghnam
1. College of Medicine, King Khalid University Abha,2. Medical Student, College of Medicine, King Saud
University, Riyadh,3. Medical Student, College of Medicine, King Saud bin Abdulaziz University for Health
Sciences, Riyadh. 4. College of Medicine, Royal College of Surgeons in Ireland, 5. King Abdullah International
Medical Research Center, Riyadh
Acute appendicitis is a common surgical emergency. But often arriving at correct diagnosis is
challenging. CT scan has reduced the rates of negative appendectomies but it has radiation risk. We compared CT
with Alvarado score (AS) in acute appendicitis in terms of positive operative and histopathological findings with
the aim to use CT evaluation appropriately.
Patients and methods: We collected retrospectively data of 358 patients admitted in a single hospital over a
period of one year. All patients had Alvarado scoring done at the time of admission. CT was performed in 293
patients on consultant directions. CT and AS were compared in correlation with positive histopathological
Results: The study included 224 males (62.56%) and 134 females (37.43%). CT was
performed in 293 patients (81.84%) patients. 320 (89.38%) patients underwent surgery while 38 (10.615) patients
were managed conservatively. Among the operated group, 268(83.75%) patients had uncomplicated appendicitis
while 52 (16.25%) had complicated appendicitis. Histopathology was positive for appendicitis in 285 patients
Conclusions: An AS of 7 and above is as significant as CT scan so for these patients one can rely on AS score for
deciding surgery. On the other hand if scores are less than 6 and there is strong suspicion of Appendicitis one should
go ahead with CT.
Keywords: Appendectomy, CT, Alvarado score, Validity of CT, Appendectomy diagnosis.


With a lifetime risk of 8.6% for males and 6.7% for
necessary to have guidelines to use CT properly in
females, acute appendicitis is one of the most
patients with acute appendicitis9. One of the
common causes of acute abdominal pain requiring
alternative approaches is to use Alvarado scoring for
surgical intervention 1,2. Negative appendectomy
the suspected cases of acute appendicitis. Studies
rates in the range of 18- 20% were considered the
have also shown how the Alvarado score (AS) can
norm. However, in present era this is no longer
be used in guiding the usage of CT in appendicitis
acceptable because even though complication rates
patients (Table 1) 10.
in the setting of negative appendectomy are low, the

complications such as incisional hernias, intestinal
Table 1. The Alvarado Scoring System
obstruction secondary to adhesions, and stump
Mnemonic (MANTRELS)
leakages is not a rare occurrence.

Although acute appendicitis being a clinical

diagnosis, the computed tomography (CT) scan has
emerged as the dominant imaging modality for
evaluation of suspected appendicitis in adults
helping us with decreased negative appendectomies

. The rate of negative appendectomy has gone to
Tenderness in right lower quadrant
less than 10% 4-6 .But on the flip side the radiation
exposure with CT is a matter of concern as in most
Rebound pain
patients with appendicitis are young, hence most
Elevation of temperature >37.3 C
susceptible to the adverse effects of radiation 7,8.

Literature available has revealed that about 25
percent CT are not clinically warranted rather
Shift to the left
benefitting they do more harm9. As such it becomes
Total score
Received:21 /2 /2018 DOI: 10.12816/0047311
Accepted:2 /3 /2018

Full Paper (vol.716 paper# 30)