The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (4), Page 2836-2836

Pattern and frequencies of patients with abdominal trauma admitted to
ICU of tertiary care center (southern region, Saudi Arabia)

Ali Albshabshe, Fahad Abdullah Saeed Al Jarad, Jubran Safar Mater Al Shahrani , Salah
Saeed al Jathnan Al Qahtani, Saeed Mohammed Saeed Alghamdi, Ali Ahmad Saeed Alsaleem,
Mohammed Saeed Abdullah Alqahtani

Department of Internal Medicine, College of Medicine, King Khalid University (KKU)
Correspondence Author: Ali Albshabshe, NUMBER: 0504740409, Email albshabshe@YAHOO.com

Traumatic injuries are a significant threat to public health worldwide, nowadays trauma
has become the greatest reason of death particularly in the under developing countries. As per the
Korean emergency medicine report, the ratio of trauma patients increased from 1.87% in 2007 to
2.71% in 2011. It remains a major public health problem in every country.
: In a cross sectional retrospective study design, we reviewed randomly selected 200 poly
trauma patient's files during the period from June 2016 till May 2017.
Results: A total of 200 patient's data were randomly retrieved, 162 (81%) were between age of 18-45
years of, 126 (63%) less than 30 years.184 (92 %) were males. 168 (84%) were motor vehicle
accidents and the rest between gunshot, stab wounds and falls.
Abdominal trauma is common among young poly trauma patients and the commonest
cause is the motor vehicle accidents. We need an urgent and effective intervention at regional and
national level to drop and stop car accidents.
Trauma, accident, mortality

traffic accidents, assaults and accidents in
In Saudi Arabia (SA), injuries are the second
industries, study stated that the abdomen is
leading cause of death; however, little is
almost the 3rd commonest injured organ 6.
known about their frequencies and outcomes.
In southern region of Saudi Arabia nearly
In previously published study we noticed that
every day there are an ICU admission related
road traffic accidents created 83.6% of blunt
to trauma especially motor vehicle accident.
abdominal trauma. Death rates increased in
During these days trauma became the greatest
patients with blunt abdominal trauma as
reason of death particularly in the under
compared with other injuries 7.
developing countries, As per the Korean
The study is designed to fulfill the gap in data
emergency medicine report, the ratio of trauma
regarding the outcome and prognosis of
patients increased from 1.87% in 2007 to
abdominal trauma in patients admitted to
2.71% in 20111 .It remains a major public
intensive care unit of tertiary care center in
health problem in every country. An
approximate estimation tells us that five
southern region Saudi Arabia.
million peoples died per year due to the
trauma2. WHO published that near or in 2020,
possibly trauma will be the highest or second
A cross sectional retrospective study of
highest reason for disabilities and wastage of
patients admitted to ICU of a tertiary care
the precious time of the life. A higher
critical care unit in southern region with
prevalence of injury & death was observed due
abdominal trauma in which a chart review
to the BTI 3. The prevalence of BTI is
performed for all study subjects. This review
increasing day by day in the Gulf region. The
was from June 2016 till May 2017.
frequency of abdominal trauma in patients is
The main outcome was to determine the
lying between 7-10% 4. Italian study stated
pattern of abdominal trauma in patients
that out of 844 patients 79 of them (9.3%)
admitted to the critical care department during
have abdominal trauma 5. Communal causes of
the study period.
blunt abdominal trauma are, falls from height,

Received: 08/8/2018
Accepted: 12/8/2018

Full Paper (vol.734 paper# 1)

c:\work\Jor\vol734_2 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (4), Page 6385-6391

Improvement of safe injection practices among nurses in Zagazig
University Hospitals

Ghada M. Khalil
Public Health and Preventive Medicine, Faculty of Medicine, Zagazig University, Egypt.
Corresponding author: Ghada M. Khalil, Email: ghadamahmoud1@hotmail.com

Aim of the work:
this study aimed to detect assessment of injection practice using WHO safe
injection tool then implantation of education program and post intervention evaluation. Methods: this
study was anon randomized intervention study performed in Zagazig University Hospitals and
targeting nurses , 700 observation before and 700 observation after intervention starting by evaluation
of injection practice using WHO safe injection tool then training on safe injection practice applied for
nurse staff then post training evaluation of practice. Results: hand hygiene soap and alcohol rub was
available in hospitals sitting in 80%,85% of observation and after intervention increased up to 95%
and98% with a significant difference. Safety boxes were available for sharp disposal before
intervention and become 100% available after intervention. Hospital supply 100% percent single use
syringes for each patient, but the problem was for drug administration process due to deficient in
cleaning of drug preparation area 88% of pre intervention observation, but practice improved to 98%
after intervention with a significant difference; sharp disposal practice was improved after
intervention up to 98% with significant difference. 67% of observation used non touch technique and
changed to 95% after intervention with high significant difference .Vaccination coverage reached
100% after intervention and percent of nurses who received training on safe injection was 45%
increased to 100% after intervention, also post needle stick injury counseling was 57% reached
100%after intervention. Conclusions: training and education of nursing staff on safe injection
practice was crucial for improvement of safe injection practice and improved both staff and patient
Keywords: safe injection, needle stick, hand hygiene, sharp disposal

needle and cannula) for drug injection,

practicing sterile technique by a qualified
Injection is a crucial health care procedure
trained person and discarding the used devices
used worldwide for drug administration.
in safe sharp container specially designed for
Billions of injections are used worldwide for
sharp disposal. Any breach in the process
both curative care and immunization (1).In
makes the injection unsafe (1).
developing countries, approximately 16
thousand million injections are administered a
Safety of recipient
rate of 3.4 (Range 1.7-11.3) injections per
person per year(2). Majority of the injections
The risk of harming recipient can be avoided
can be replaced by oral drugs(2,3) and are not
by administering useful medication with a
used safely. Reuse of injection equipment
sterile single use device, and practicing proper
without sterilization is common(4).Unsafe
technique by qualified and well trained health
injection practices which can transmit hepatitis
workers to ensure that safety there should be
B, hepatitis C, human immunodeficiency virus
sufficient supply of single use devices
(HIV) and other blood borne pathogens have
throughout the year(8).
resulted in worldwide burden of preventable
blood borne viral diseases (BBVDs(5).The
Safety of the provider
transmitted BBVDs remain silent for many
years without risk identification(6) .An injection
Needle stick injury (NSI) is commonly
is said to be safe if it does not harm the
encountered by the provider especially during
recipient, does not expose the provider to
recapping and it can be reduced by disposing
avoidable risk, and does not result in wastes
used syringe in a puncture proof closed
that is dangerous for the community(7). This is
container immediately after use without
achieved by using a sterile device (Syringe,
recapping. About thirty infectious diseases
Received: 02/7/2018
Accepted: 11/7/2018

Full Paper (vol.734 paper# 2)

c:\work\Jor\vol734_3 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (4), Page 6392-6400

Correlation Between Anti Mullerian Hormone Level and Antral Follicle
Count Using Three-Dimensional Ultrasound in Cases of Recurrent
Spontaneous Abortion
Khaled Zakaria El-Sheikha 1, Abd El Monsef Abd Elhamid Sedek 1,
Ibrahim Hassan Mohammed 2, Ahmed Mohamed Hussein Hafez 1
1 Obstetrics & Gynecology Department and 2 Biochemistry Department, Faculty of Medicine,
Al-Azhar University, Cairo, Egypt
* Corresponding author: Ahmed Mohamed Hussein Hafez, E-mail: drahmedhussin8@gmail.com

Background: abortion is one of the most common complications of pregnancy, occurring in 10­15%
of pregnant women, whiles recurrent spontaneous abortion, rate of 2­5%, is defined as 3
spontaneous abortions.
Aim of the Work: was to try to find relationship between serum AMH concentration which represent
ovarian reserve, Antral Follicular count and any pelvic Structural abnormality using 3D ultrasound in
assessment cases with spontaneous recurrent abortion.
Patients and Methods: A multicenter, randomized trial included 100 women who were divided into
2 groups; Group 1, included 50 patients with 3 recurrent abortions and Group 2, included 50 parous
women with regular menstrual cycles and having one or more living child without any history of
pregnancy loss or pelvic structural abnormality. Every subject was subjected to assessing hormonal
profile including anti-müllerian hormone (AMH) and Transvaginal ultrasonography.
Results: AMH was found to have negative correlation with age, number of abortions, FSH and LH.
Conclusion: It could be concluded that Anti-Müllerian hormone is the best indicator of ovarian
reserve with a high sensitivity and specificity, so ovarian reserve of women with recurrent
spontaneous abortions is not defective.
Keywords: Anti Mullerian Hormone Level, Antral Follicle Count, Three-Dimensional Ultrasound,
Recurrent Spontaneous Abortion
Abortion is one of the most common
of determining when evaluation and treatment
complications of pregnancy, occurring in 10­
for infertility or for recurrent pregnancy loss is
15% of pregnant women. It is defined as
appropriate, pregnancy is defined as a clinical
pregnancy that fails to progress resulting in
pregnancy documented by ultrasonography or
death of the fetus before age of fetal viability
histopathologic examination (2).
(20th week (weight of 500 g) in developed
Anti müllerian hormone (AMH) is a
countries and 28th week (weight of 1 kg) in
dimeric glycoprotein made up of two
developing countries) (1).
monomers attached to each other by disulfide
Recurrent abortion, rate of 2­5%, is
bonds. The 72-kd molecule belongs to the
defined as 3 spontaneous abortions. In these
transforming growth Factor-B superfamily,
women, it is necessary to conduct a
comprehensive evaluation so that a plan of
differentiation. Sertoli cells in the male
care can be outlined (1).
On January 2008 has defined recurrent
degeneration of the müllerian ducts and
pregnancy loss by two or more failed
provides the normal formation of the male
pregnancies. When the cause is unknown, each
genital system. Sertoli cells' secretion of AMH
pregnancy loss merits careful review to
continues for a lifetime, but the significance of
determine whether specific evaluation may be
AMH in adult male is not known. In females,
appropriate. After three or more losses, a
the granulosa cells of the ovary express AMH
thorough evaluation is warranted. For purposes
postnatally. Serum AMH levels are lower in
Received: 23/7/2018
Accepted: 03/8/2018

Full Paper (vol.734 paper# 3)

c:\work\Jor\vol734_4 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (4), Page 6401-6405
Comparing non-operative management and surgical fixation in treatment
of clavicle fractures
Mohammad Abdallah Yahya Alhakamy(1), Ahmad Sameer Ahmad Alrefaie(1), Alhassan, Mahdi
Ali Kariri(1), Ali Mahdi Ali Kariri(1), Nedaa Sameer Abdo Jelan(1), Mohammed Bahkali Ali
Altherwi(1), Alaa Ahmad Hassan Allayl(1), Asim Bishi Mohammed Hakami(1), Hiba Salah
(1)Faculty of Medicine, Jazan University, Saudi Arabia, (2) Family Medicine, Public and Tropical Health
Program, University of Medical Sciences and Technology, Khartoum, Sudan
Corresponding author: Mohammad Abdallah Yahya Alhakamy, dr.research222@gmail.com
Clavicle fractures are common among males from sport injuries and the non-operative
treatment has been indicated as treatment of choice. Recently, delayed healing, pain and shoulder
weakness have reported as frequent complications of non-operative treatment and many studies found
better outcomes with surgical treatment. This review aimed at evaluating evidence that compared non-
operative treatment and surgical intervention in management of clavicle fractures to provide evidence-
based data about the best modality of treatment aiming to improve patients' outcome. Methods: A
web-based search was achieved in MEDLINE resulted in 40 eligible studies. The reference lists of the
articles and reviews were screened for relevant articles. After exclusion of irrelevant, duplicated and
review studies, 7 studies were included in this review. Results: The outcome and success after
surgical intervention compared to non-operative treatments was reported in all of the included studies.
Most of the interventional studies found significant improvement in the surgical in treatment, while
the majority of the non-operative group showed no improvement. Conclusions: The review of the
evidence suggested that use of surgical fixation in treatment of clavicular fracture is superior to the
non-operative treatment if there are no contraindications to the surgery.
Keywords: Clavicle, Fracture, Management, Surgical, Healing


studies found the surgical treatment for
The clavicle fractures are common fractures in
clavicle fractures has better outcomes (1, 13, 14).
the upper limb, accounting for 2.6 to 10% of
This review aimed at evaluating all the studies
all fractures and about 44.1% of the upper
that compared non-operative treatment and
limb fractures (1, 2). Clavicle fractures are
surgical intervention in management of
common among males from sport injuries. The
clavicle fractures to provide evidence-based
most common cause of clavicle fracture in
data about the best modality of treatment
adults is falling down, while sport injuries is
aiming to improve patients' outcome.
the most common cause in young and
teenagers (3).
A web-based search was achieved in
Majority of the clavicular fractures occur in
MEDLINE using the following search strategy
the mid shaft, and most of these fractures are
clavicle fracture" AND ("threaded Kirschner
displaced (4, 5). The mid shaft fractures is
wire " OR open fixation OR fixation) AND
thought to occur as a result of direct trauma (3).
(non-operative OR nonoperative OR non-
Habitually, non-operative treatment is a
surgical OR nonsurgical) AND (failure OR
treatment of choice in mid shaft clavicle
breakage OR success OR cure OR healing OR
fractures (6, 7). The non-operative treatment for
union OR complications OR osteomyelitis)
the clavicle fractures has good outcome (8).
which resulted in 40 studies. The reference
lists of the articles and reviews were screened
Recently it was noted that; the non-operative
for relevant articles. After exclusion of
management of clavicular fractures result in
irrelevant, duplicated and review studies, 7
high nonunion rates, especially in displaced
studies were included in the review as they
fractures. Furthermore, the non-operative
met the inclusion criteria, Figure (1). Included
treatment is found to be associated with
studies aimed at comparing the surgical
delayed healing, pain and shoulder weakness
treatment of clavicle fracture with the non-
(9, 10). Surgical treatment in the past is
operative management.
indicated in presence of open fractures or

fragments dislocation (11, 12). Recently, many

Received: 30/7/2018
Accepted: 10/8/2018

Full Paper (vol.734 paper# 4)

c:\work\Jor\vol734_5 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (4), Page 6406-6411

Maternal behavior as a risk factor for growth and development retardation
in infant and toddlers up to 18 months

Ghada M.Khalil1*and Eman M. Salama2
1Public Health and Preventive Medicine, Faculty of Medicine, Zagazig University, Egypt
2Family Medicine, Ministry of Health

*Corresponding author:
GhadaMahmoudKhalil, E-mail: ghadamahmoud1@hotmail.com, Phone: 01062234831


Background: early 18 months of life characterized by the most rapid growth and development and
mainly affected by mother behavior and traits Objectives: to promote child development to
improve the quality of life for our children in the future through assessment of child development
in the first eighteen months of life, to identify factors affecting early childhood development.
Subjects and Methods: cross section study takes infant from birth to 18 month, attending Family
Unit at Kafr Mohamed Ismail, Fakous, Sharkia governorate. Sample size 140 infant, using structured
growth and development sheet and structured mother's interview. Result: The study found that male
children retardation were 13.2%and female children retardation were 15.3%, artificially feed children
were 100% retarded , low social class children were 100% retarded, children of illiterate mother
100% were retarded , Breast feeding, rapid response to child needs when crying, stimulating
activities during feeding the child and giving different types of toys are factors having good
impact on child development with significant difference. Conclusion: Program for early detection
of developmental delay through screening of children attending PHC and family medicine
units are important to assess development risk factor and Maternal stimulation for promoting early
child development through better attachment and communication with infants.
Keywords: maternal behavior, growth retardation, infant, toddler, development.
Growth and development, especially 1st year of
Postnatal mother's factors stress on mother's
life depend mostly on affection, attention and
socioeconomic status, family structure which
stimulation in addition to good nutrition,
include both family size and type of family ,
proper health care and protection which all
number and order of siblings, home
mainly given by mothers (1).Motherhood
environment both cognitive and psychological
practice affect infants starting form prenatal
, mothers perception and practice of play and
period through natal and post natal (2).
mother's nutritional practice(4).
Prenatal mother's factors include; genetics,
Measuring motherhood practice directly is
exposure to teratogenes, maternal health,
difficult but not impossible, family physician
maternal nutrition, maternal emotions and
carries load of providing physical, social and
stress, age of mother and mother education (3).
psychological care for mothers and their infant
Natal mothers factors are affected by natal
through family context (5). Also family
environment and health service provided to
physician hasa powerful tool to assess
mother before , during and after delivery
motherhood practice through prenatal to post
which give impact on neonatal health specially
natal period , mothers' practice watched and
neonatal hypoxia, prematurity ,and birth
corrected by family physician pre and
postnatal is a great opportunity for
Received: 28/7/2018
Accepted: 08/8/2018

Full Paper (vol.734 paper# 5)

c:\work\Jor\vol734_6 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (4), Page 6412-6416

Intravenous Thrombolysis with rt-PA in Patients with Acute Ischemic
Stroke: Experience of Al-Azhar University Hospitals and Almaadi Military
Hospital Stroke Units

Nabil H Mohamed1, Ahmed A Nemr2, Hussein A Elghareeb1, Elsayed E Abed1

1Departments of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
2Departments of Neurology, Military Medical Academy, Cairo, Egypt
Corresponding author: Elsayed Elsayed Ahmed Mohamed Abed; Mobile: 01062635615;
Email: sayed_neuro@outlook.com
Background: Ischemic stroke (IS) is defined as a focal neurologic deficit of sudden onset and of
presumed ischemic origin that lasts at least 24 hours and is not associated with hemorrhage on
computed tomography (CT) or magnetic resonance imaging (MRI) of the brain. About 87% of
strokes are ischemic, the rest being hemorrhagic. Bleeding can develop inside areas of ischemia, a
condition known as "hemorrhagic transformation" (HT). Definitive therapy within the first few hours
is aimed to removing the blockage by breaking the clot down (thrombolysis), or by removing it
mechanically (thrombectomy). Aim of the Work: was to correlate the safety of recombinant tissue
plasminogen activator (rt-PA) in acute ischemic stroke (AIS) patients in Egypt. Subjects and
: A number of case series of patients with AIS who were treated at Stroke Units of Al-Azhar
University Hospitals and Almaadi Military Hospital over a period of 1years within a time window
were reported. Results: we observed a statistically significant correlation between AIS patients who
were treated by thrombolysis in time window and vascular risk factors and many important
infrastructure-logistic factors. Conclusions: It could be concluded that thrombolytic therapy is a good
standard treatment in time window but many barriers in developing countries were found.
Keywords: Ischemic stroke, time window, rt-PA.
approved therapy for AIS by the FDA. A
Stroke is a clinical syndrome of
strong correlation has been shown between
rapidly developing symptoms and signs of
arterial recanalization and neurological
focal loss of cerebral function with no
improvement in acute cerebral ischemia(4).
apparent cause other than vascular origin,
The aim of the current work was to correlate
lasting more than 24 hours, or may lead to
the safety of rt-PA in AIS patients and search
death before this(1).Stroke is the rapidly
for cause of low number of patients who were
developing loss of brain functions due to a
treated by thrombolysis with rt-PA in Egypt.
focal or global disturbance in the blood vessels
supplying blood to the brain and retina. This
can be due to ischemia caused by thrombosis
This study included a total of 29AIS
or embolism or due to a hemorrhage, thus the
patients treated with rt-PA within a time
affected area of the brain is unable to function,
window attending at At Stroke Units of Al-
leading to inability to move one or more limbs
Azhar University Hospitals and Almaadi
on one side of the body, inability to understand
Military Hospital. Approval of the ethical
or formulate speech or inability to see one side
committee and a written informed consent
of the visual field(2).Because the vast majority
from all the subjects were obtained. This study
of strokes are ischemic in etiology, the
was conducted over 1 year between 2016and
development of an effective treatment for clot
2017. The study was approved by the Ethics
dissolution was ground breaking. rt-PA was
Board of Al-Azhar University.
approved by the FDA in the mid-1990s for the
Inclusions criteria, Clinical diagnosis of
rapid lysis of IS(3).I.V administration of rt-PA
and CT brain consistent with AIS.
remains the only proven intervention for
emergency management of AIS and the only
Received: 28/7/2018
Accepted: 08/8/2018

Full Paper (vol.734 paper# 6)

c:\work\Jor\vol734_7 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (4), Page 6417-6422

Comparative Study between Drained and Drainless Sub-rectal Mesh
Hernioplasty in Paraumbilical Hernia
Raouf Mahmoud Sallam, Ahmed Mohamed El-sayed, Abdou Mahmoud Abdou
Department of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Corresponding author: Abdou Mahmoud Abdou, Tel: 00201277700794, Email: abdoumahmoud1986@gmail.com

The evolution of para-umbilical hernia repair has a very long history, from the
Recognition of para-umbilical hernias to its current management, with significant contributions from
different authors. Advances in surgery have led to more cases of para-umbilical hernia formation, and
this has required the development of new techniques and new materials for para-umbilical hernia
Objectives: To compare between the results of drained and drainless sub-rectal mesh hernioplasty
in paraumbilical hernia (PUH), to achieve the most accepted post-operative condition.
Patient and methods: This comparative prospective study included a total of 50 patients with a
follow up of 6-month time interval who were all complaining of an uncomplicated para-umbilical
hernia and all are treated with the sub-lay repair technique with 25 patients with suction drain
placement and 25 patients with no suction drain placement, attending at Al-Azhar University
Results: Sub lay (sub-rectal) mesh repair is a good alternative to other traditional repairs, this study
advocates this method of Para-umbilical hernia repair as it is applicable type of repair, the
complication rate is low and there is a no recurrence rate or seroma formation and suction drain usage
on hazardous patients are beneficial to avoid fluid accumulation or further complication to occur.
Conclusion: Placing mesh in the sub-muscular or sublay position is claimed to be more challenging
but not beyond the competence of a trained general surgeon. Placing mesh in this plane has
mechanical and physiologic advantages. The sub-lay technique proves itself as one of the best surgical
technique in management of para-umbilical hernia.
Keywords: Sublay, retromuscular, submascular and mesh.
Para-Umbilical Hernia (PUH) is one
only to the understanding of the development
of the most common surgical problems with
of this hernia but also to the rational and
rise in the repair rate annually (1, 2).
optimal surgical management of the condition

Previously PUHs were repaired by
tension-free suture technique. Due to a high
The general consensus regarding the
unacceptable recurrence rate this procedure
development of a para-umbilical hernia is the
lost popularity (3). Real change in view of PUH
weakening of the fabric of the midline
repair came with the introduction of
aponeurotic zone by prolonged stretch
meshplasty (4).
(continuous as ascites or temporary as repeated
Para-umbilical hernias are large
pregnancy). The turn-key event for herniation
abdominal defects through the linea alba in the
is tearing of the medial attachment of the third
region of the umbilicus and are usually related
tendinous intersection to the midline
to diastasis of the rectus abdominis muscle (5).
aponeurotic zone (7).
A para-umbilical hernia protrudes through the
Repetitive stress as a factor in hernia
midline aponeurotic zone of the anterior
development is suggested by clinical
abdominal wall. The detailed and critical re-
examination of the functional anatomy of the
pressure is seen in a variety of disease states
rectus sheath and its contents are crucial not
and seems to contribute to hernia formation in

Full Paper (vol.734 paper# 7)

ABSTRACT The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (4), Page 6423-6430
Comparative Study between "Onlay" Versus "Retrorectus" Hernioplasty in
Management of Uncomplicated Venteral Hernias
Seif El-Deen Mahmoud Alsoudany, Osama Osman Ali Khalil, Ahmed Mohamad Abdel-
Ghany Shebl*
Department of General Surgery, Faculty of Medicine, Al-Azhar University
*Corresponding author: Ahmed Mohamad Abdel-Ghany Shebl, Mobile: 01068490854;
E-Mail: sheblphone@gmail.com
Background: Hernias of the anterior abdominal wall, or ventral hernias have a various types
that can be categorized into either congenital or acquired, also can be categorized according to
various locations into primary ventral hernias (true ventral- non incisional hernias) which
include two subtypes lateral ventral hernia, and midline ventral hernias. Objective: The aim
of the study was to compare between two techniques of mesh placement in uncomplicated
ventral hernias, onlay (mesh on external oblique) versus sublay (mesh in the retromuscular
space), regarding the operative technique and the postoperative complications. Patients and
In this study, a comparative study between two methods of surgical treatment for
ventral hernia was made. The study included 40 adult patients with uncomplicated ventral
hernia divided randomly into two groups according to the surgical technique used for the
repair, without any specific criteria used in selection for any technique as follows: Group A
(Onlay mesh repair): Twenty patients were operated by placing the mesh above the anterior
rectus sheath and the external oblique muscle. Group B (Sublay "Reteromuscular" mesh
repair): Twenty patients were operated by placing the mesh in the retro- muscular space.
Results: In this study no significant difference found between both methods as regarding:
Age and gender, type of ventral hernia. Duration of the operative procedure. Amount of intra-
operative blood loss. Postoperative hospital stay. Hernia recurrence. Conclusion: Sublay
(Retromuscular) mesh repair is a good alternative to onlay mesh repairs, this study advocates
this method of ventral hernia repair as it is applicable to all sites of ventral hernia, the mesh is
mostly hidden and anchored behind the rectus sheath, the complication rate is low and there is
a low recurrence rate and finally We suggest carrying out more trials on the retromuscular
mesh repair technique to include a bigger number of cases and a longer period of follow up.
Keywords: Onlay, retrorectus, Laparoscopic ventral hernia repair
Ventral hernias of the anterior
have two subtypes, lateral and midline
abdominal wall either de novo or recurrent
ventral hernias (2).
are relatively a common surgical problem,
The cause of a primary ventral
defined as any fascial defect of the
hernia is far from completely understood,
anterolateral parietal abdominal wall
but it is undoubtedly multifactorial.
fascia and muscles, through which
Familial predisposition plays a role (3).
intermittent or continuous protrusion of
intra-abdominal or preperitoneal contents
Ventral hernia also can be
occurs (1).
characteristics into reducible, irreducible
These hernias have a various types
or incarcerated, strangulated and recurrent
that can be categorized into either
ventral hernia (4).
congenital or acquired, also can be
categorized according to various locations
They are considered as a leading
into primary ventral hernias (true ventral-
cause of abdominal surgery account for
non-incisional hernias) and incisional
15- 20% of all abdominal wall hernias (5).
hernias (acquired hernias); occur at the site
Most studies now support the
of a pervious surgical scar. Both types
theory that acute fascial separation occurs

Full Paper (vol.734 paper# 8)

c:\work\Jor\vol734_9 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (4), Page 6431-6438

The Influence of Fetal Head Circumference and Fetal Weight Measurement Assessed By
Intrapartum Ultrasound on Labor Outcome
Mohamed Taher Ismail, Yousef Abo-Shady, Hamdy Aly Abd-El Fattah*
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
*Corresponding author: Hamdy Aly Abd El Fattah; Mobile: 01065025878; Email:hamdyaly.alex@yahoo.com
labor is a clinical diagnosis characterized by regular, painful uterine contractions
that increase in frequency and intensity is associated with progressive cervical effacement or
dilatation. More specifically, it is associated with a change in the myometrial contractility pattern
from irregular "contractures" (long-lasting, low-frequency activity) to regular "contractions"
(high-intensity, high frequency activity).
Aim of the work: it was to determine if fetal head circumference and fetal weight could
predict the rate of caesarian section and operative vaginal deliveries in nulliparous women in
Patients and Methods: this study was carried out at Al Alamein Hospital from January
2017 to January 2018 on two hundred (200) primigravida women; their ages ranged from 20 to
30 years and the gestational ages ranged from 38-40 weeks with normal singleton pregnancy
with cephalic presentation in labor.
Results: there were highly statistically significant relations between mode of delivery
and fetal head circumference and estimated fetal weight as p value (0.001).it was found that large
fetal head circumference relative to maternal pelvic diameter is the main cause of prolonged
labor and therefor increased risk of primary caesarian section.
Conclusion: the numerical data have a significant relation between intra partum head
circumference and fetal weight and the incidence of primary caesarian section, maternal and fetal
Recommendations: according to numerical results obtained from this study. The study
recommends strict labor monitoring by partogram in cases where fetal head circumference is
more than 35cm or fetal weight is more than 3950gms.
Keywords: fetal head circumference, fetal weight, intrapartum ultrasound, labor outcome.
procedures arising from prolonged labor

increase maternal morbidity, fetal morbidity,
Birth represents one of the most
and the cost of care. Cephalopelvic
important of all the experiences of the
disproportion (CPD), due to narrow
human kind. Despite the complexity and
maternal pelvic diameter relative to fetal
sophistication of modern obstetrics it is
head circumference (FHC) or large FHC
important to remember the simple objective
relative to maternal pelvic diameter, is the
of every pregnancy, namely the delivery of a
main cause of prolonged labor (2). High birth
healthy baby to a healthy mother. The fullest
weight increases the risk of prolonged labor
possible understanding of the birth process,
(3), and instrumental or operative delivery (4).
A consistent increase in the mean birth
management policies is central to that
weight and in the proportion of fetal
objective (1).One of these complexities is
macrosomia, defined as a birth weight
greater than 4000 g, has been reported since
Received: 26/7/2018
Accepted: 06/8/2018

Full Paper (vol.734 paper# 9)

c:\work\Jor\vol734_10 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (4), Page 6439-6445

Assessment and Management of Pain in the Intensive Care Unit

Mohammad Ibrahim Aljumah 1 , Enass Farouk Aboshoushah 2 , Daniel Coric 3 , Alaa Matuq
Alaithan 4, Abdullah Abdulmohsen Abdullah Almulhim 5, Naif Matar AlOtaibi 6, Mazen Hassan
Sadoun Alaslani 7, Fahad hussain kammas 8, Ayat Salman al saeed 9 , Ali breek alharthi 10

1- Western Sydney University, 2-King Abdulaziz University Hospital, 3-Nepean Hospital, NSW,
Australia, 4- King Fahad Hospital Hofuf,5- ER resident in King Fahad Hospital Hofuf, 6- Prince
Sultan Military Medical City, 7- GP of Comprehensive Clinics of Ministry of Interior-Riyadh , 8-
King Fahad General Hospital Jeddah , 9- Alfaisal University , 10- King Abdullah Hospital . Bisha
city-ICU resident

Management and assessment of pain in patients in critical care unit is a daily
challenge for the health care professionals, particularly in the intubated patients, patients on
mechanical ventilation, or patients who are on analgesia as such patients are unable to self-assess
existence and intensity of pain. It is crucial for physicians to follow guidelines that help in pain
assessment and management effectively.
Aim of the work: Our aim in this study was to study how to evaluate and manage pain in an intensive
care unit patient, predominantly those patients who are unable to self- report or assess.
Materials and methods: We conducted this review using a comprehensive search of MEDLINE,
PubMed, and EMBASE, January 1994, through March 2017. The following search terms were used:
pain in ICU, pain management in ICU, pain assessment methods, pain assessment in intubated
Conclusion: Physical clues, which are given by comatose and intubated patients in critical care unit,
should be taken in consideration, as they can be used as a method to identify existence of pain, and
must be followed by effective management to decrease discomfort and prevent acute and chronic
adverse effects.
Keywords: Pain in ICU, Intensive care unit assessment of pain, ICU pain management, guidelines to
pain management.

According to the International Association for
comorbidities, dementia, psychosis, delirium,
Study of Pain (IASP), pain is the emotional
along with other mental and neurological
and sensory unpleasant experience that is
disorders [2].
associated with the presence of potential (or
actual) damage. From this previous definition,

we can conclude that the nature of pain is
Data Sources and Search terms
subjective, meaning that the person who is
We conducted this review using a
feeling it can only assess its intensity.
comprehensive search of MEDLINE, PubMed,
However, there are categories of patients who
and EMBASE, January 1994, through March
are not able to assess the intensity of their
2017. The following search terms were used:
pain, or even report it [1]. These include, for
pain in ICU, pain management in ICU, pain
example, patients who are intubated, patients
assessment methods, pain assessment in
who are on mechanical ventilation, patients
intubated patients.
who are admitted to the intensive care unit,

and other patients. Therefore, the proper
Data Extraction
assessment of pain in intensive care unit
Two reviewers have independently reviewed
patients is considered a challenge for
the studies, abstracted data, and disagreements
clinicians. This challenge adds to other
were resolved by consensus. Studies were
evaluated for quality and a review protocol
challenges faced when dealing with intensive
was followed throughout. The study was done
care unit patients in general, like existing
Received: 01/8/2018
Accepted: 11/8/2018

Full Paper (vol.734 paper# 10)

c:\work\Jor\vol734_11 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (4), Page 6446-6451

Outcome of delayed surgery in developmental hip dysplasia in a tertiary
care setting
Mohammad Khabti Alnamshan, Ayman H. Jawadi, Yazeed Adeeb Alshoaibi, Afaf Moukaddem*
King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City

*Corresponding author: Afaf Moukaddem, email: afafmoukaddem@gmail.com, Telephone: 966-11-429-9999

: The delay in the detection of developmental dysplasia of the hip (DDH) can lead to
incomplete hip stabilization and poor outcomes. This might also infer that the delay in DDH surgery
can also be associated with unfavorable consequences. The purpose of this study was to compare the
outcome of delayed versus early surgery on DDH patients with respect to clinical and radiological
factors. Methods: This is a retrospective cohort study in which the charts of patients who underwent
DDH surgery and whose age was less than 5 years at the date of referral to the orthopedic clinic,
between 2008 and 2011 were reviewed. Results: This study included 62 patients, 34 of which
presented with unilateral joint involvement and 28 affected bilaterally. Half of the patients underwent
early surgeries (<6 months) and the other half had delayed surgeries (6 months).
Post-operatively the range of motion was significantly limited in the late surgery group (P=0.001).
Limping gait was also significantly associated with late surgery (P=0.005).
Radiological abnormalities of all the X-Ray findings didn't reveal any statistically significant
difference between early and delayed surgery except for the reduction in acetabular angle in the right
hip post-op (P=0.04). Conclusion: Delayed DDH surgery can lead to a worse clinical outcome,
physical disability and possible radiological effects on the patients. Poor outcome was significantly
associated with the timing of the surgery. It is therefore recommended to perform DDH surgeries as
early as possible to decrease the morbidity and prevent adverse clinical and radiological outcomes.
Key words: developmental dysplasia of the hip; surgery; pediatrics


should be in the lower medial quadrant formed
Developmental dysplasia of the hip (DDH) is a
by the Hilgenreiner's and Perkin's lines (11).
dislocation of the hip, which is usually found

at birth, but can also be detected later in life(1
Treatment of DDH differs according to the
).The hip joint which is a synovial ball-and-
patient's age of presentation. The standard
socket joint articulates two boney parts, the
treatment for infants less than 6 months of age
femoral head and the acetabulum of the pelvic
is the Pavlik harness which is used to hold the
bone, which is a crucial component of hip
hip joint as the child grows and mainly aims to
stability(2) . In this condition, the acetabulum is
reduce the hip (12,13); an abduction brace has
too shallow, and the femoral head may slip out
also been indicated for use in infants less than
affecting one or both joints(1) . The incidence
6 months of age (!4). If the patient presents
of DDH varies and is reported to be 1 to 5 per
between 6 and 18 months of age or in case the
1000 children(3-5) .Risk factors of DDH
harness was not beneficial, a closed surgical
include low amniotic fluid levels, being the
reduction is indicated, and a cast is needed
first child, female gender, breech position of
afterward (15). However, in refractory cases and
the baby during delivery and family history(5-7)
in children older than 18 months an open
. As for diagnosis, it is mainly based on
reduction is required (16-18). As for children
clinical examination and ultrasound (8, 9).
older than 3 years, several types of pelvic

osteotomies are performed according to the
Ultrasonography is used in DDH to monitor
patient's age (19).
the condition especially in high-risk children
DDH can be easily corrected once detected
following treatment (5). One of these radiologic
and treated, otherwise the condition might not
parameters is the Shenton's line used in the
become evident until the child starts walking
diagnosis of acetabular dysplasia which is
after which the correction of the dislocation is
smooth in the normal hip and steps off in DDH
more complicated and yields poorer outcomes
(10). A high acetabular index might also
(20). In this case, this treatable condition can
indicate hip dysplasia (10, 11). Adding to the
progress into an anatomically abnormal hip
radiological parameters, the femoral head
which is a major source of disability in
Received: 2/8/2018
Accepted: 12/8/2018

Full Paper (vol.734 paper# 11)

c:\work\Jor\vol734_12 retracted

Full Paper (vol.734 paper# 12)

c:\work\Jor\vol734_13 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (4), Page 6457-6462
Imaging in blunt abdominal trauma; a review in current literature

Mojahed Hadi Ali Rudainee 1 , Tahani Saleh A. Alsaery 2 , Ghaida Wael Khayat 3 , Majed
mohammed fahed Alharbi 4 , Mazen Hassan Sadoun Alaslani 5 , Sarah Mohammed Mahrous 4 ,
Muhammad Al Ahmad 6 , Yara Mofarih Assiri 7 , Arwa Musaad Alsubhi 4 , Nader Awad
Alanazi 8

1-Aseer Central Hospital , 2- Resident at KFAFH , 3-Ibn Sina National College for Medical Studies ,
4- Taibah University , 5- Gp of Comprehensive clinics of minstory of interior-Riyadh , 6- Oyun City
Hospital , 7- King khalid university , 8- Imam Muhammad Ibn Saud Islamic University

The common imaging modalities used for the diagnosis of pelvic and abdominal
trauma range from ultrasonography, X-ray, computed tomography, and others. In each different kind
of abdominal condition, a different modality is preferred depending on the nature of condition, the
patient, and the hospital facility where the management is provided. Some conditions require more
than one source of imaging. Aim of the work: In this study, our aim was to discuss various
abdominal and pelvic pathologies separately to explore the preferred type of imaging modality.
Methodology: we conducted this review using a comprehensive search of MEDLINE, PubMed and
EMBASE from January 1994 to March 2017. The following search terms were used: ultrasound
versus CT, abdominal radiology, acute abdomen imaging, pelvic pain diagnosis. Conclusion: Blunt
abdominal traumas are very common with many causes including motor vehicle accidents, bicycle
accidents, and falls. Appropriate and early management of blunt abdominal trauma is essential to
prevent the occurrence of significant long-term morbidities and high mortality rates. Due to non-
specific clinical manifestation, establishing a proper diagnosis mainly depends on radiologic
Keywords: abdominal trauma, ultrasound, computed tomography, acute abdomen, gynecologic
emergency, abdominal imaging.


When suffering from a blunt abdominal
mesenteries and bowels injuries are considered
trauma, the liver is the most common organ to
to be challenging for radiologists. Findings of
be injured followed by the spleen and then the
mesenteries and bowels injuries are not always
mesenteries and bowels (1). Radiologists who
clear on a CT scan, making it difficult to make
are not sufficiently experienced can sometime
the decision of operating or not. Therefore, it
miss the presence of mesenteries or bowels
is essential to obtain sufficient experience that
injuries. The main reason behind this is that
allows radiologists to be able to distinguish
these injuries are not the most common, thus
between cases and make the right decisions.
radiologists do not think of them immediately.
All this make the role of abdominal
In fact, the incidence of a bowel injury in the
imaging extremely essential in the work up of
bowels is reported to be about 3% in cases of
blunt abdominal trauma. Radiologists, in these
blunt abdominal trauma. This incidence
cases, are responsible to make the final
increases in cases of the presence of other
decision regarding diagnosis, management,
visceral injuries and can reach 34% when there
and possible treatment (4).
are injuries in more than three organs
following a blunt trauma (2). Moreover, signs
We did a systematic search for blunt
and symptoms associated with them are not
abdominal trauma and imaging using PubMed
always clear and specific, leading to relatively
search engine (http://www.ncbi.nlm.nih.gov/)
high rates of missing the diagnosis.
Unfortunately, this delay in diagnosis, even for
few hours, can lead to the development of
looked for radiology modalities that are used
significant long-term morbidities, and high
in cases of blunt abdominal trauma. All
rates of mortality. Complications can include
relevant studies were retrieved and discussed.
(3). Therefore,
We only included full articles. The following
Received: 04/8/2018
Accepted: 14/8/2018

Full Paper (vol.734 paper# 13)

c:\work\Jor\vol734_14 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (4), Page 6463-


Comparison between Trans-cerebellar Diameter, Bi-parietal Diameter and
Femur Length for Gestational Age Measurement Accuracy in Third
Trimester of Pregnancy
Ahmed Taha Abd El Fattah 1, Hazem Sayed Shaban 2,
Eman Ahmed Abdelsalam Younis 1
Obstetrics and Gynecology Department, 1 Faculty of Medicine, Al-Azhar University,
2 Police Authority Hospital
* Corresponding author: Eman Ahmed Abdelsalam Younis, E-mail: amr_pharm1234@yahoo.com

Background: the provision of obstetric and neonatal care, as well as the public health monitoring of
pregnancy outcomes, relies upon the accurate determination of gestational age. Uncertain gestational
age has been associated with adverse pregnancy outcomes including low birth weight, preterm
delivery and perinatal mortality, independent of maternal characteristics.
Aim of the Work: was fine out an accurate method for assessment of gestational age in third
trimester of pregnancy comparing the Transcerebellar diameter, Biparietal diameter and femur length.
Patients and Methods: a total of 200 pregnant women in third trimester pregnancy were assessed in
this prospective observational study held at Al-Hussein University Hospital and New Cairo Police
Hospital using two-dimensional ultrasound technique during the period from January to June 2018 in
order to assess an accurate method for assessment of gestational age in third trimester of pregnancy.
Examinations were performed after a written consent received from the patients lying in the dorsal
supine position. Two-dimensional ultrasound examination was carried out. Fetal biometry and
amniotic fluid volume were assessed. These ultrasound parameters were done under the supervision
of a certified gynecologist to exclude bias.
Results: the majority of the patients in our study belong to the age group 20 to 30 years (65%) with
minimum of 15 years and maximum of 35 years. In our study, also 55 patients out of 200 were
primigravida and 145 patients were multigravida. Our patients showed that the percentages of
accurate assessment of gestational age within 3 days were as follow: Out of 200 patients, TCD gave
accurate assessment within 3 days in 118 patients (59%), FL gave accurate assessment within 3 days
in 92 patients (46%), while the BPD gave accurate assessment within 3 days in 59 patients (29.5%).
Conclusion: we concluded that TCD is the most accurate method for the assessment of gestational
age in third trimester followed by FL, and the least accurate is the BPD. Also by combining accuracy
of TCD (90%) and that of FL (80%).
Keywords: Trans-cerebellar Diameter, Bi-parietal Diameter, Femur Length, Gestational Age, Third
The use of ultrasonography has
parameters of GA assessment are compared. It
significantly improved the evaluation of fetal
is one of the most commonly measured
growth and development and has permitted
parameters in the fetus. The BPD may be
prenatal diagnosis of a variety of congenital
rapidly and reproducibly measured by
ultrasound examination from 12 weeks'
biometry is highly reliable in first and second
gestation until the end of pregnancy. The BPD
trimester of pregnancy but reliability of any
is imaged in the transaxial plane of the fetal
ultrasound method greatly diminishes as
head at a level depicting thalami in the
gestational age advances, in third trimester,
midline, equidistant from the Temporoparietal
reliability of any single ultrasound parameter
bones and usually the cavum septum
alone is poor without correlation with other
anteriorly. Although
parameters. The biparietal diameter (BPD)
methods have been used to measure BPD, the
remains the standard against which other
Received: 24/7/2018
Accepted: 04/8/2018

Full Paper (vol.734 paper# 14)

Introduction The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (4), Page 6470-6480

Role of Serum Cystatin­C in Prediction of Acute Kidney Injury in
Critical ILL Patients

Mahmoud Maged Hlemy 1, Gamal Lotfy Abd-Elrahman 1, Salama Saad Abd El-lateef 2,
Saeed Mostafa Abd El-hameed 1, Ahmed Shafek Nabil 1

1 Anesthesia and Intensive Care, and 2 Clinical Pathology Departments,
Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Corresponding author: Ahmed Shafek Nabil,email: ahmedshafek123@gmail.com


Background: acute kidney injury (AKI) is a syndrome characterized by a rapid (hours to
days) deterioration of kidney functions. It is often diagnosed in the context of other acute
illnesses and is particularly common in critically ill patients. The clinical consequences of
AKI include the accumulation of waste products, electrolytes, and fluid, but also less obvious
effects, including reduced immunity and dysfunction of non-renal organs (organ cross-talk).
Aim of the Work: was to assess the role of serum Cystatin C in early prediction of Acute
Kidney Injury in critically ill patients. Patients and Methods: This a prospective cohort
study included a total of 30 critically ill patients who suffered of Acute Kidney Injury and
30 subjects confined to the same age as control, attending at ICU, Al-Azhar University
Hospitals. Blood samples were taken for estimation of serum cystatin C and serum creatinine
at (2, 24, 48 and 72 hours). Results: showed that at day zero at 2 hours all patient showed
normal kidney functions, and no one has acute kidney injury after 24 hours about 10 patient
developed acute kidney injury according to KDIGO classification with a percentage of 33.3%.
after 48 hours all 30 patients developed acute kidney injury according to KDIGO
classification with a percentage of 100% and after 72 hours the patients state began to
improve and only 28 patients have acute kidney injury with a percentage of 93.3% and level
of serum creatinine started to decrease to all patients. This was due to treatment and
interference to the patients. Conclusion: Cystatin C level is a valuable biomarker in
prediction and early detection of acute kidney injury. Moreover, cystatin C level may be also
used for prognosis of cases of acute kidney injury. Further a large-scale study may be needed
to validate its predictive value.
Keywords: Serum Cystatin­C, Acute Kidney Injury, Critical ill Patients
level and urine output are the standard
Acute kidney injury (AKI) is
indicators of decreased kidney function
commonly encountered in various patient
despite their known limitations. They have
populations, including critically ill patients,
limited sensitivity and specificity and
those after cardiac surgery, and those
creatinine level change is delayed in
receiving contrast agents. These patients
response to kidney impairment, thus
usually have a worse clinical outcome than
limiting their usefulness in the early
their non-AKI counterparts (1).
detection of AKI (3).
Therefore, the need for an accurate
prolonged hospitalization, need for renal
and timely biomarker to predict AKI
replacement therapy, development of
development after renal insult is urgent.
chronic kidney disease, and increased
Cystatin C (Cys C), a 13-kDa endogenous
mortality rate (1, 2).
cysteine proteinase inhibitor, is a member
The poor outcome is caused in
of the family of proteins that has an
part by the lack of a timely and accurate
important role in intracellular catabolism
biomarker to predict the occurrence of
of various peptides and proteins (4).
AKI. Currently, serum creatinine (SCr)


Received: 03/8/2018
Accepted: 13/8/2018

Full Paper (vol.734 paper# 15)

c:\work\Jor\vol734_16 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (4), Page 6481-6488

Comparative Study between Naloxone as an Additive to Lidocaine and
Naloxone Infusion in Intravenous Regional Anaesthesia for Short
Procedures of Upper Limb Surgeries
Ali Abdalla Ali Eissa, Alaa El-Din Mahmoud Sayed,
Mohammed Mohammed El-sayed Ameen Hegab*
Department of Anesthesiology and Intensive Care,
Faculty of Medicine, Al-Azhar University
*Corresponding author: Mohammed Mohammed El-sayed Ameen Hegab, Mobile: 01001026864; Email:
intravenous regional anesthesia (IVRA) was first described by August Bier in 1908. IVRA
is an anesthetic technique for surgical procedures on the body's extremities where a local anesthetic is
injected intravenously. The local anesthetic diffuses from the peripheral vascular bed to nonvascular tissue
such as axons and nerve endings.
The aim of the present study was to compare the effect of adding ultra-low dose of
naloxone to lidocaine for IVRA and the effect of using intravenous naloxone infusion with IVRA for
elective short procedures in the upper limb.
Patients and Methods: This is Prospective; randomized, controlled, multicenter, double blind study that done
in Alazhar University hospitals. Each group contains 30 patients. The lidocaine in the study is 2% 3mg/kg in
all groups. In all groups 0.9% NaCl is added to make up a total volume of 30 ml.
Results: The result of our study showed that local intravenous adjuvant naloxone (100 or 50ng) with
lidocaine 1 % shortens the onset of blocks and prolongs the recovery from anesthesia. Moreover, it
reduces the amount of opioids consumption and intraoperative pain score in patient undergoing short
upper limb surgeries.
Conclusion: Naloxone IV infusion not improves the analgesic effect of intravenous anesthesia or
prolongs the recovery from anesthesia. Regarding safety, adjuvant naloxone appears to be safe with
no recorded side effects.
Keywords: Lidocaine, naloxone, intravenous regional anesthesia
(IVRA) is simple, reliable, and cost-effective,
with a success rate varying between 94% and
The aim of the present study is to
98% (1).
compare the effect of adding ultra-low dose of
IVRA is a favorable choice among
naloxone to lidocaine for IVRA with lidocaine
anesthesiologists for extremity operations
IVRA combined with ultra ­ low dose and the
lasting around one hour. However there are
effect of using intravenous naloxone infusion
some concerns associated with IVRA such as
with IVRA for elective short surgical
tourniquet pain, inadequate muscle relaxation,
procedures in the upper limb (hand and
insufficient postoperative analgesia and local
anesthetic toxicity (2).
Naloxone has proved to have
paradoxical effects as it antagonizes the opioid
analgesia if given in high doses (microgram
randomized, controlled, multicenter, double blind
range) and produces anti-nociceptive effect if
study ,After obtaining approval from the
given in ultra-low doses (nanogram range) (3).
Ethical Committee, patients of ASA grade I or
Different mechanisms have explained
II age between 20-60 years who were
the effect of ultra-low dose naloxone including
scheduled for forearm and hand surgery lasting
selective inhibition of the impulses from
for less than 60 minutes are included in this
excitatory opioid receptors and release of
study.This study conducted in Al-Azhar
enkephalin (4).
University Hospitals on Hundred and fifty
Received: 08/8/2018
Accepted: 18/8/2018

Full Paper (vol.734 paper# 16)

c:\work\Jor\vol734_17 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (4), Page 6489-6493

Knowledge, Attitude and Practice of Family Planning Methods among
Husbands in a Village of Assiut Governorate
Zeinab F. Hamed*, Amira F. EL-Gazzar, Farag M. Moftah
Department of Public Health and Community Medicine Faculty of Medicine, Assiut University,
Assiut, Egypt

*Corresponding author: Zeinab F. Hamed, Family Planning Physician at El- Qusiya Central Hospital, Assiut, Egypt, e-
mail: Zainabfarag2016@gmail.com
husbands usually are the decision makers about sexual activity, and the desired number
of children. They often know very little about the health benefits of planning and spacing pregnancies.
Without accurate information on the benefits and various methods of family planning (FP), they resist
supporting FP use because of misinformation. Aim: it was to assess the knowledge, attitude and
practice of family planning among husbands in El-Mansheah El-Kobra village, El-Qusiya District,
Assiut Governorate. Subjects and Methods: a cross-sectional study was conducted in El-Mansheah
El-Kobra village, from January to March 2017. A semi-structured questionnaire was used to collect
data from husbands with wives in reproductive age group (15-49 years). Results: more than fourth
(28.5%) of studied husbands have a good knowledge about FP and 54.9% of them have positive
attitude towards FP. The contraceptive prevalence among studied husbands was disappointly low
(16.2%), of that low percentage of the husbands 11.9% were currently users of male method. The
level of husband involvement in FP in the current study was high (71.5%). Conclusion: some
(28.5%) husbands have good knowledge about FP and 60% have positive attitude towards FP. The
health team is the main source of information. The current use of FP methods is low.
Recommendation: the study recommended that FP physicians should provide proper counseling and
support to their male clients not only females; this will increases husband involvement in FP.
Family planning, Husbands involvement, Egypt.


Child bearing is one of the most
planning among husbands in El-Mansheah El-
important and fulfilling roles of a woman,
Kobra village, El-Qusiya District, Assiut
however, for a physiological process,
pregnancy is a surprisingly hazardous,
unwanted, unplanned and poorly planned
The current study was a cross-
pregnancy can cause disability and death(1).
sectional study. It was conducted in El-
The benefits of family planning (FP)
Mansheah El- Kobra village, El-Qusiya
for the survival and health of mothers and
District, Assiut Governorate, from January to
children are fairly straightforward. In 2000,
March 2017. We collected data from husbands
about 90% of global abortion-related and 20%
living in El-Mansheah El-Kobra village, we
of obstetric-related mortality and morbidity
included husbands whose wives were in
could have been averted by use of effective
reproductive age group (wife age 15-49 years).
contraception by women wishing to postpone
We excluded husbands whose wives not in the
or cease further childbearing(2).
reproductive age. The study was conducted on
It is well documented that husband's
284 husbands; a semi-structured questionnaire
general knowledge and attitude concern the
was designed for data collection; first literature
ideal family size, gender preference of
was sought on available questionnaires on
children, ideal spacing between child births,
husband involvement in FP. Then the
and contraceptive methods used; greatly
questionnaire was developed to cover the
influence women's preferences and opinions.
Husband involvement helps not only in
characteristics of the study participants (Age,
accepting a contraceptive method but also in
religion, literacy status, age at first marriage,
its effective use and continuation(3).
age at first born, number of children ever born,
Aim of the study:
number of children alive, ideal children
This study aims to assessing the
knowledge, attitude and practice of family
awareness and knowledge of FP methods and
Received: 25/7/2018
Accepted: 5/8/2018

Full Paper (vol.734 paper# 17)

c:\work\Jor\vol734_18 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (4), Page 6494-6501

Peptic Ulcer Disease in Elderly Population of Arar City, Northern Saudi

Mashael Jaza H Alshammari 1, Omar Mohamed Bakr Ali 2, Samar khaled al-shamlani 1, Shada
Khaled Bashantoof 3, Zahra Ali Qalib 4, Bashayr Zayed Al-Amri 5, Nora Henaf Hia Alrwely 5,
Sulaiman Zayed S Alamri 5, Abduljawad Salem S Alharbi 6, Elham Hamid O Alfallaj 7

1 Faculty of Medicine, Northern Border University, KSA,2 Faculty of Medicine, Sohag University,
Egypt, 3 Faculty of Medicine, Hail University,4 Faculty of Medicine, Uclan University,5 Faculty of
Medicine, Al Jouf University,6 Faculty of Medicine, King Abdulaziz University,7 Faculty of Medicine,
Almaarefa University
peptic ulcer disease (PUD) is a common disease of the digestive system. Peptic ulcer
disease is a problem of the gastrointestinal tract characterized by mucosal damage secondary to pepsin
and gastric acid secretion. It usually occurs in the stomach and proximal duodenum; less commonly, it
occurs in the lower esophagus, the distal duodenum, or the jejunum. IT is a multifactorial health
problem affecting almost all populations worldwide. The number of people who are 60 years old
increased worldwide. The elderly population is susceptible to various benign and malignant diseases.
Peptic ulcer is among the common health problems that affect the elderly. Aim of the study: this
study aimed to determine the prevalence and risk factors of PUD in elderly population of Arar city,
Northern Saudi Arabia. Subjects and methods: this was a cross sectional study and conducted in five
randomly selected primary healthcare centers in Arar city (KSA), from September 2017 to March
2018. It included 217 elderly patients. A questionnaire was designed for data collection about socio-
demographic variables, smoking, BMI, chronic diseases and physician diagnosed peptic ulcer among
participants. Results: our findings showed that out of 217 of the studied elders, 55.3% were females
and 21.2% were suffered from peptic ulcer. There were significant relations between peptic ulcer with
gender, marital status, educational level and smoking status, while there was an insignificant relation
between peptic ulcer with age group and BMI group. On the other hand, there were significant
relations between peptic ulcer and musculoskeletal disorders, kidney diseases and insomnia. While,
there was insignificant relations between peptic ulcer and cardiovascular diseases, ischemic heart
diseases, hypertension, neurological disorders, diabetes mellitus and psychological disorders.
Conclusion: among the elderly participants 21.2% were suffered from peptic ulcer. There was a
significant relation between peptic ulcer with gender, smoking status, musculoskeletal disorders,
kidney diseases and insomnia. While, there was insignificant relations between peptic ulcer with age
group and BMI group.
Keywords: peptic ulcer, smoking, obesity, pattern, elderly, Arar, Northern Saudi Arabia

Peptic ulcer disease (PUD) is defined as a
cases identified as asymptomatic [3]. PUD was
break in the inner lining that usually occurs in
a significant cause of morbidity and mortality
the stomach and proximal duodenum. An ulcer
in the elderly [4]. Increased incidence of side
in the stomach is known as a gastric ulcer
effects and medication interactions makes
while, that in the first part of the intestines is
complications course much more serious in the
known as a duodenal ulcer [1].Peptic ulcer
elderly although their incidence was similar in
disease is a common condition, although the
younger patients [5]. H. pylori infection and the
majority of studies reported a decrease in the
use of nonsteroidal anti-inflammatory drugs
incidence or prevalence of PUD over time.
(NSAIDs) were the predominant causes of
The results of prevalence cross-sectional
peptic ulcer. Kurata et al. [6] in their study
studies vary from a study to another [2]. A
showed these two causes to account for 48 and
study from Sweden, reported cross-sectional
24 percent of cases, respectively. However,
data and represented the general population;
the study thus included both symptomatic and
disease, hepatic cirrhosis, chronic renal failure,
asymptomatic PUD, the overall prevalence of
sarcoidosis and myeloproliferative disorder
PUD observed was 4.1%; 19.5% of all PUD
were all associated with a greater risk of peptic
Received: 05/8/2018
Accepted: 15/8/2018

Full Paper (vol.734 paper# 18)

c:\work\Jor\vol734_19 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (4), Page 6502-6506

Laparoscopic versus Open Appendectomy in Adults

Rohiya E. Hejazi1, Rakan M. Aljedaani2, Mohammed A. Alshehri2.
1Faculty of Medicine, Ibn Sina College
2Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences
*Corresponding Author: Rohiya E. Hejazi, Ibn Sina College, Jeddah, Saudi Arabia. Email: Rohiya.hejazi@gmail.com
Phone: 0555507294

Appendicitis is the most frequent surgical emergency. It affects people of all ages and
gender. Methods to manage appendicitis are either medically by antibiotics and watchful waiting or
surgery. The surgical approach includes laparoscopic and open appendectomy; neither surgical
technique was proved to be the most efficient method to do an appendectomy. Objectives:
comparison between laparoscopic appendectomy versus open appendectomy in regards to the
complications, applicability, cost and hospital stay. Material and Methods: In this review, we used a
comprehensive search of EMBASE, Pubmed, MEDLINE, Cochrane Central Register of Controlled
Trials, and Cochrane Database of Systematic Reviews from January 1, 1995, to July 17, 2018.
Conclusion: Open appendectomy is the preferred choice in case of a perforated appendix or severe
inflammation. Laparoscopic appendectomy offers fewer complications, hospital stay and lesser time
in the operation room.
Keywords: appendectomy, laparoscopic, technique, appendicitis.

Appendicitis is an inflammation of the
appendectomy (OA) has shown to have low
appendix, which is a 3 1/2-inch-long tube of
tissue that extends from the large intestine1.
controversy in literature will remain regarding
Appendicitis is the most common cause of
the best method of an appendectomy.
acute abdomen. Almost 40,000 hospital
In this study, we aimed at comparing the
admissions in England are due to appendicitis2.
advantages and disadvantages of LA versus
It also affects 5.7-57/100,000 individuals and
OA. Our objectives included a comparison
mostly adolescents and children3,4. The leading
between both types in regards to the
causes of variation in incidence are age,
complications, applicability, cost and hospital
gender, and ethnicity4-6. The incidence of acute
appendicitis peaks at the age of 10 and 30

years old7,8.
Appendectomy is considered the most
Data Sources and Search terms
common emergency surgery9,10. It is mainly
The review was conducted using a
diagnosed by ultrasound or computed
comprehensive search of EMBASE, Pubmed,
tomography (CT) scan11,12. An adjournment in
MEDLINE, Cochrane Central Register of
diagnosis and management has been reported
Controlled Trials, and Cochrane Database of
in cases where pre and post-admission delay
Systematic Reviews from January 1, 1995, to
have occurred13. A study has shown that
July 17, 2018. The used search terms were
postponing appendectomy has a higher risk of
appendectomy, laparoscopic appendectomy,
progression to advanced disease13. If left
open appendectomy, laparoscopic versus open
untreated, the patient may develop appendix
abscess, rupture, or generalized peritonitis11.
Laparoscopic appendectomy (LA) is
Data Extraction
considered the first therapeutic choice for
Two independent individuals reviewed
acute appendicitis13,14. It has been linked to
studies, abstracted data, and resolved the
have a short hospital stay, less postoperative
disagreement by consensus. Studies were
pain, and better wound healing15,16. In contrast,
evaluated for quality. A review protocol was
some studies have established that LA has a
followed in every part.
higher incidence of intra-abdominal abscesses

and difficult applicability in complicated

appendicitis surgery17. On the other hand, open

Received: 03/8/2018
Accepted: 13/8/2018

Full Paper (vol.734 paper# 19)

Full Paper (vol.734 paper# 20)

c:\work\Jor\vol734_21 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (4), Page 6515-6521

A Comparison between Oral Hypoglycemic Agents and Insulin in treating Gestational
Diabetes Mellitus regarding their Safety and Efficacy

Mahabbat, Nadin Anam A1, Jannah Abdulrahman Alkinani2, Hadeel Taha Yahya Alsaadi2, Ahdab Faisal
Nono2, Sara Mutni Almutairi3, Narjes Hassan Alawami4, Shahad Abdullah Almagboul5, Ammar Osama
Alaaddin5, Talha Kamal Shagdar6, Ziyad Abdullah Mandura6
1- King Saud Bin Abdulaziz University For Health Sciences, 2- Ibn Sina National College 3- Al-Qassim
University, 4- Jordan University of Science and Technology, 5- Umm Al-Qura University,
6- King Abdulaziz University
Background: Gestational Diabetes Mellitus (GDM) is one of the most common comorbidities of
pregnancy. It can cause a various complications for both mother, and fetus. Therefore, many studies
have been done to evaluate different management measures. Objective: In this study, our objective
was to assess the recent literatures regarding the comparison between oral hypoglycemic and insulin
in treating GDM regarding the safety and the efficacy. Methods: PubMed database was used for
articles selection, and the following keys used in the mesh ("Gestational Diabetes
Mellitus/management"[Mesh] OR "Gestational Diabetes Mellitus /metformin"[Mesh] OR
"Gestational Diabetes Mellitus /insulin"[Mesh]). A total of 99 articles were found, with further
restriction by PubMed filters, and reviewing the articles titles and abstracts the final results were 7
articles. Conclusion: Oral hypoglycemic can be an effective and safe alternative treatment to insulin
for women with GDM. There was no significant risk of maternal or neonatal adverse outcome with
the use of metformin or glyburide. Treatment with metformin or glyburide was found to be equivalent
for both women and newborns. However, metformin was found to be associated with a higher failure
rate than glyburide in treating GDM.
Key words:
Gestational Diabetes Mellitus, Oral hypoglycemic, Insulin, Safety and the efficacy.


Diabetes mellitus (DM) is a metabolic disorder
is among the top ten countries in the world
occurs as a result of multiple risk factors and
with the highest prevalence of diabetes (3-4). A
etiologies. DM is associated with chronic
recent report from Saudi Arabia estimated the
hyperglycemia as a result of a defects in
prevalence of pregestational diabetes mellitus
insulin secretion, insulin action, or both, which
(Pre-GDM) and gestational diabetes mellitus
lead to disturbance of carbohydrate, fat and
(GDM) in Riyadh, the capital city of Saudi
protein metabolism (1). In pregnancy, DM is
Arabia, to be 4.3% and 24.3%, respectively (5).
considered as a common comorbidity, and
This prevalence reflects high burden of
places the both mother and baby at risk for a
diabetes among pregnant women compared to
variety of antenatal, intrapartum, and neonatal
other populations in the world (6-7). As a result
complications such as, cesarean section
of the various complications that can occur
delivery, macrosomia, and admission to
due to gestational DM, several studies have
neonatal intensive care unit (NICU) (2). The
been done to assess the various measures that
can help in controlling pregnant women blood
recommended that Gestational diabetes
sugar levels with any harm to the fetus. In this
review we evaluated the various options that
hyperglycemia is noticed for the first time at
help in controlling blood sugar.
any stage of the pregnancy with one or more
of these abnormal values on 75 g oral glucose
tolerance test- fasting plasma glucose 5.1­6.9
PubMed database was used for articles
mmol/L, 1-hour plasma glucose 10.0 mmol/L
selection, and the following keys used in the
or 2-hour plasma glucose 8.5­11.0 mmol/L (1).
According to the International Diabetes
Federation (IDF), the epidemiology of diabetes
during pregnancy is unknown in many
countries in the world (3). Nevertheless, more
Diabetes Mellitus /insulin"[Mesh]). A total
than 21 million pregnancies were affected by
of 99 articles were found, with further
diabetes during the year 2013 (3). Saudi Arabia
restriction by PubMed filters, and reviewing
Received: 07/8/2018
Accepted: 17/8/2018

Full Paper (vol.734 paper# 21)

c:\work\Jor\vol734_22 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (4), Page 6522-6530

Prevalence and some of determinant factors of chronic kidney diseases
among Saudi elderly in Arar, KSA
Ajaweed Saud Muharrab Alruwaili 1, Amjad Saud Mhrb Alrowili 2, Manal Nashi O Alshammari 1,
Fahad Saad Salem Alanazi 1, Nouf Saad Alanazi 1, Mona Theyab Alanazi 1, Reem Abdullaha Alanazi 3,
Mubark Saleh Mubark Almarjan 1, Mohammad Humood Meshref Alenezi 1, Mohammed Sulaiman
Aljamal 4
1 Faculty of Medicine, Northern Border University, KSA,2 PhD clinical pharmacy, Northern Border University,
KSA,3 Faculty of Applied Medical Scinse, Northern Border University, KSA 4 BPharm, MSc., PhD Clinical
Pharmacy, University of Manchester
Background: Chronic kidney disease (CKD) is a global public health problem, affecting more than
10% of the world's population and more than half of adults older than 70years. It is one of several
conditions that are common in older people, such as hypertension, diabetes, and hyperlipidemia, and
are associated with an increased risk of cardiovascular disease. The aim of this study was to
determine the prevalence and some of determinant factors of chronic kidney diseases among Saudi
elderly in Arar, KSA. Methods: The present cross sectional community based study was conducted in
Arar city, the capital of Northern Borders Governorate on 276 participants, of age 60 years and more.
Systematic random sampling technique was followed. Data was collected through personal interviews
with the sampled population and filling the questionnaire which guided us to the data of socio-
demographic characteristics such as age, sex, educational status and marital status, it also included
smoking status and certain types of diseases that may be prevalent among elderly suggested affecting
renal diseases such as hypertension, diabetes millets and obesity. Results: The majority of the
participants was females (55.2%), had mean age (±SD) of 60 (±9.25) years, 6.5% had renal
insufficiency, 5.8% diabetic nephropathy, 1.4% chronic kidney failures. Only 3.2% had both
hypertension and kidney resection, 3.2% hypertension with diabetic nephropathy and 6.3% had
hypertension and renal insufficiency, 13.7% had diabetes with diabetic nephropathy, 3.9% had
diabetes with chronic kidney failure and 7.8% had both diabetes and renal insufficiency. 3.2% were
obese and had kidney resection, 6.3% obese with diabetic nephropathy, and 3.2% obese with chronic
kidney failure and 4.8% obese with renal insufficiency. Conclusion: Chronic kidney diseases are
common in older people in Arar city, Northern Saudi Arabia. 6.5% had renal insufficiency, 5.8% had
diabetic nephropathy, 1.4% had chronic kidney failures and 1.4% had Kidney resection. Large scale
community based studies with detailed investigations are needed. Health education directed to elderly
population and their care givers about renal diseases and its risk factors are mandatory.
Key words: Prevalence, determinants, factors, chronic kidney diseases, Saudi elderly, Arar, KSA
Chronic kidney disease is a very common
albuminuria being used to define the stages of
clinical problem in elderly patients and is
the illness [2]. Chronic kidney disease is one of
associated with increased morbidity and
several conditions that are common in older
mortality [1]. It is defined as an abnormality in
people, such as hypertension, diabetes, and
renal structure or function which is present for
hyperlipidemia, and are associated with an
a period of three months or longer and has
increased risk of cardiovascular disease [3].
resultant implications for health, with
Although considerable interest continues to
mount on diseases of the elderly, there is no
Received: 08/8/2018
Accepted: 18/8/2018

Full Paper (vol.734 paper# 22)

c:\work\Jor\vol734_23 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (4), Page 6531-6534

Assessment of knowledge and attitude and practice towards migraine
prevention and treatment among general population in Saudi Arabia
Osama Sulaiman Alkhudhairi1, Ala Musa Alghthy2,Wejdan Saddiq Mohammed Hindi3,Shatha
Ibrahim Qassim Alqassemi3

1-Imam Muhammad Ibn Saud Islamic University 2-Tabuk University 3-Jazan University

migraine is considered as one of the most common chronic neurological disorder with a
high prevalence among adults worldwide. Objective: this study aimed to detect the knowledge and
attitude and practice towards migraine prevention and treatment among general population in
Kingdom of Saudi Arabia (KSA). Methods: this was a descriptive cross sectional questionnaire study
that was conducted at Saudi Arabia, from April to July 2018 among a random sample consisted of 600
adults in distributed in different parts of KSA. Results: the awareness level among the respondents
was inadequate among most of the subjects regarding, the gender effect, the triggering factors of
migraine and the prophylactic treatment.The attitude and the level of practice were also improper
among most of the subjects as most of them don't consider migraine as a disorder that needs
consultant and the majority would take medication without consultation.
Conclusion: the KAP level regarding migraine prevention and treatment was in adequate among most
of the included subjects however the majority of included subjects were highly educated.
knowledge, attitude, practice, migraine, prevention, treatment, KSA.

Migraine is considered as one of the
most common chronic neurological disorder
Study design:
with a prevalence rate of 1-year among 10% of
This was a descriptive cross sectional
adults worldwide (1, 2). Its prevalence ranged
questionnaire and it was conducted at Saudi
from 6% among males to 18% among females
Arabia, from April to July 2018.
(3, 4). Diagnosing migraine is not at such ease as
Study population and sample size:
it relies on several criteria and may be
A simple random sample consisted of 600
improperly diagnosed (5, 6). A study showed
subjects were interviewed in different
that about 33% of migraine patients were
shopping malls scattered in different parts of
properly diagnosed which result in affecting
KSA. The inclusion criteria were Saudi Adult
the quality of life (7). Also, it is related to some
subjects and can read and write. All the
psychiatric conditions as anxiety and
respondents answered the questions of the
depression (8).The first step for proper and
questionnaire and gave a written approval for
efficient treatment of migraine is accurate
participating in the study.
diagnosis, excluding alternative causes,
Study tools:

educating the patient and finding the best
The questionnaire was developed after
medication for management of pain (9).The
reviewing the search engines including
pharmacologic treatment has two approaches
Science Direct, Scopus, Pub Med ...etc. The
that can be used separately or together for
questionnaire was then validated by three and
patients with severe migraine including acute
the ethical committee of faculty of medicine.
or preventive measures. The preventive
The questionnaire included 4 parts regarding
therapy can be used for decreasing the intense,
subject's demographics, knowledge, attitude,
duration and severity of migraine attacks (10).
and practice regarding migraine.
Improving the knowledge and practice pattern
Ethical approval:
among adult population can result in
The ethical committee of Faculty of Medicine
prevention of migraine episodes and its effect
approved the study and the questionnaire
on quality of life. This study aimed at
sheet. A written informed consent was
assessment of knowledge and attitude and
provided from the participants included in the
practice towards migraine prevention and
treatment among general population.
Statistical analysis:

The data processing was done by

using the Statistical Package for Social
Received: 09/8/2018
Accepted: 19/8/2018

Full Paper (vol.734 paper# 23)

c:\work\Jor\vol734_24 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (4), Page 6535-6540

Association of Diabetes Mellitus with ABO Blood Groups & Rh with
Mohammed Abdullah A Alanazi 1, Mohammed Abdullah S Alkhidhr 1, Alhadhari, Anwar
Mohammed O1, Amjad Waleed Al-Hathloul 2, Elaf Jameel Alsharif 3, Sarah Fahad AlOwaywid
Albahli 4, Saud Abdullah Saud Alshagraawi 5, Fatimah Mohammed AlJerani 6, Ibrahim Saleh
Almesned 7
1 Northern Border University, 2 King Faisal University, 3 Ibn Sina National College
4 Princess Nora University, 5 Prince Sattam Bin Abdulaziz University, 6 Imam Abdulrahman Bin
Faisal University, 7 King Saud bin Abdulaziz University for Health Sciences

ABO blood groups are associated with some important chronic diseases. Previous
Studies have observed an association between ABO blood group and risk for obesity. Objective: to
evaluate the prevalence of DM in various ABO and Rh blood group subjects, and to explore any
association between ABO and Rh blood groups with DM. Methods: A cross-sectional study,
conducted in Arar city, Northern Saudi Arabia. It included 312 participants from the general
population of Northern Saudi Arabia. Data were collected by a pre-designed online questionnaire
which was distributed among the population. It was self-administered, after a brief explanation of the
idea of the research. The questionnaire included the clear questions to collect the relevant data.
Results: the study included 532 participants, 318 (59.8%) were males and 119(22.4%) were suffering
from diabetes mellitus. Surprisingly, more than half the cases were Type 1 diabetics (53.8%). The
majority (38.7%) of the studied population had O blood group, 26.1% had B, and 23.5% had A, while
AB were only observed in 11.8%. Around three-quarters (74.8%) were Rh positive and 23.5% were
hypertensive. The results showed insignificant relations between ABO blood group with gender, DM
and type of DM. There was a highly significant relation between DM and (Rh) blood group, while it
showed insignificant relations between gender and type of DM with (Rh) blood group. Conclusion:
The finding of the present study indicated that, in Arar city population, no evidence was found that
particular ABO blood group was more susceptible to develop diabetes mellitus. While the study
showed a highly significant relation between DM and (Rh) blood groups.
Key words: ABO blood group, diabetes mellitus, Arar city, Rhesus factor (Rh), risk factor,
The phenotypic ABO blood groups are
The Rh blood group system consists of 49
polymorphic, inherited, antigenic substances
defined blood group antigens; D, C, c, E, and e
found on the surface of red blood cells in
are the most important among which. Rh (D)
addition to other tissues [1]. The term "blood
status of an individual is normally described
group" refers to the entire blood group system
a positive or negative suffix
comprising red blood cell (RBC) antigens
the ABO type [5]. There are more than 36 blood
whose specificity is controlled by a series of
group systems involving over 379 antigens
genes which can be allelic or linked very
listed by the International Society of Blood
closely on the same chromosome [2].
Transfusion in which ABO is the most studied
Red blood cell antigens, which are the basis of
group in the human population [6].
blood grouping, consist of proteins and
It was reported that there are various
carbohydrates attached to lipids or proteins.
phenotypes and an increased susceptibility to
determined and plays a vital role in transfusion
disease [3]. For example, gastric cancer is
safety, understanding genetics, inheritance
found to be more common in blood group A
pattern, and disease susceptibility [3].
individuals, whereas gastric and duodenal
Rhesus factor (Rh) is the most well-recognized
ulcers or Schizophrenia occur more commonly
blood group system after ABO, probably
among the O blood group individuals [7], while
because of the dramatic presentation of a fetus
Rh antigens were reported to be a risk factor of
suffering hemolytic disease of the newborn
different diseases such as noise-induced
(HDN) following maternal alloimmunization
hearing loss (NIHL) [8]. Some epidemiological
to the D antigen [4].
studies demonstrated significant association
between the "ABO" blood group and the risk
Received: 06/8/2018
Accepted: 16/8/2018

Full Paper (vol.734 paper# 24)

c:\work\Jor\vol734_25 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (4), Page 6541-6554

Diagnosis of Minimal Hepatic Encephalopathy of Cirrhotic Patients Using a
Combination of Neuropsychiatric and Neurophysiological Tests
Assem Mahmoud El-Sherif*1, Fathy Ghamry Abdelrazik1, Ahmed Elwassief Helal1, Ahmed Essmet
Ali2 and Mohamed Mahmoud Abdelsayed1
1Department of Internal Medicine, 2Department of Neurology,Faculty of Medicine, Al-Azhar University
Corresponding author*: Assem Mahmoud El-sherif, E-Mail:assem@gmail.com, Mobile: 01223406605

Minimal Hepatic Encephalopathy (MHE) is characterized by mild cognitive impairment,
attention deficits, psychomotor slowing and impaired vasomotor and bimanual coordination. These non-
evident symptoms can be revealed with neuro psycho metric and neuro physiological testing. Aim: to
validate a comprehensive set of neuropsychiatric test battery in addition to the neuro physiological tests in
detecting MHE. Patients and Methods: Thirty patients with liver cirrhosis and no clinical evidence of HE
were selected for this study. Patients underwent laboratory screening, Neuropsychiatric and Neuro
physiological tests. Results: Impairment of at least one psychometric test was documented in 50% of
patients, with 50% abnormal NCTA, 46.7% abnormal DST and 40% abnormal LTT. VEP records showed
prolonged P100 in 46.7% of patients with 40% prolongation of P100 in the right eye and 46.7% in the left
eye. EEG recording was abnormal in 43.3% patients and the recorded abnormalities included; slow theta
waves in 33% of patients, slow delta waves 10%, and 56% had normal EEG. Conclusion: The incidence of
MHE can vary according to the strategy of diagnosis and while strict dependence on neuropsychiatric tests
can diagnose MHE in 50% of patients, adopting a more strict policy that incorporate neuro physiological
tests can limit the diagnosis 40% of patients. There is moderate concordance between neuropsychiatric and
neurophysiologic tests.
Cirrhosis of liver, Psychometric tests, electroencephalogram, visual evoked potential, Minimal
hepatic encephalopathy.

Hepatic encephalopathy is a brain
to do(6)so, the diagnostic methodologies were a
dysfunction caused by liver insufficiency and/or
combination of neuropsychometric (NP) and
Porto systemic shunting; it manifests as a wide
neurophysiologic testing strategies(4). MHE is
manifested by impairment in specialized testing
abnormalities ranging from subclinical alterations
and is considered by most of the clinicians to
to coma (1).Along with its cognitive impairment,
predict the development of OHE (6).Patients with
liver cirrhosis results in utilization of more health
evidence of MHE poses a potential danger to
care resources in adults than any other
themselves or to the community in the operation
manifestation of liver diseases (2). Traditionally
of heavy equipment and motor vehicles (7).
HE was graded into four stages of severity,
Moreover, MHE can have a far-reaching impact
ranging from abnormal behavior to coma. In
on the quality of life and the ability to function in
addition, a subclinical stage has been described, in
daily life (8).
which patients of cirrhosis show a number of
quantifiable neuropsychological defects, yet has a
In this study we aimed to the validity of a
normal mental and neurological status on global
comprehensive set of neuropsychiatric test battery
clinical examination (3).This subclinical stage
[NCT, DST and LTT] in addition to the
started to
neurophysiologic tests; EEG and VEP in detecting
come into light when several studies
showed that many liver cirrhosis patients without
clinical signs of encephalopathy (normal
This is a prospective cohort study that
conventional neurological and mental assessment)
was conducted at the internal medicine
performed significantly worse in psychometric
department of El-Hussein university Hospital in
tests as compared to healthy controls(4).They were
Cairo, Egypt, thirty patients with liver cirrhosis
initially labeled as suffering from ,,latent or
and no clinical evidence of HE were selected for
,,subclinical HE for which the recent term
this study. Patients underwent laboratory
,,minimal hepatic encephalopathy (MHE) is
screening, EEG scans, visual evoked potential and
used(5).MHE is more difficult to diagnose and
neuropsychiatric tests (Number connection test A,
more often to require the use of specialized testing
Digit symbol test and Line tracing task).
Received: 06/8/2018
Accepted: 16/8/2018

Full Paper (vol.734 paper# 25)

c:\work\Jor\vol734_26 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (4), Page 6555-6561

Total intravenous anaesthesia versus volatile induction and maintenance
anaesthesia for controlled hypotension in lumbar spine fixation surgery:
Comparative clinical study
Mohammed Mohammed Salah Eldin Shamloul, Ahmed Mohamed Abd-Elgaleel, Islam Essam
Hosseiny Ibrahim Askar
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar University
Corresponding author: Islam Essam Hosseiny Ibrahim Askar, Mobile: 01148636664; Email: islamaskar94@gmail.com
Controlled hypotension during general anesthesia aims to lower the mean arterial blood
pressure (MAP) to values between 55 and 65 mmHg in patients with normal blood pressure, with the goal
of significantly reducing blood loss by maintaining it at this level throughout the operation process.
Controlled hypotension is frequently used for obtaining better exposure during spine surgery as small
bleeding areas can produce better surgical field visibility and result in decreased time of surgery.
This study was done to compare the efficacy and safety of TIVA and VIMA to induce
hypotensive technique during spine surgery, with attention on the amount of blood loss, blood
transfusion, hemodynamics, time of recovery and postoperative nausea and vomiting. Patients and
This study included 40 patients of both sex, admitted for lumbar spine fixation surgery
carried out at Al- Azhar University Hospitals (El-Hussein and Bab El-Sharia). They were randomly
allocated into two equal groups, 20 patients each (n= 20): Group I (TIVA); Total intravenous
anaesthesia using (fentanyl and propofol). Group II (VIMA); Volatile induction and maintenance
anesthesia (Inhalational anaesthesia) using (fentanyl and sevoflurane). Results: The following
parameters were assessed between the 2 groups: Hemodynamics (HR, SBP, DBP and MAP), SPO2
and ET CO2 were continuously monitored and recorded at 15 min interval. Intraoperative blood loss,
blood transfusion, duration of surgery, time of recovery and postoperative nausea and vomiting were
monitored in all patients. Conclusion: this study showed that both TIVA and VIMA were effective in
producing controlled hypotension for lumbar spinal fixation surgery. However, only TIVA was
beneficial, allowing properly controlled hypotension, minimized intraoperative bleeding, and
improved surgical field visibility compared to VIMA.
Keywords: Controlled hypotension, propofol, fentanyl, sevoflurane.
Spinal fixation surgery may be
associated with significant blood loss up to
Hypotensive technique was achieved by
requiring transfusion of blood or its
reducing both the peripheral vascular
products (1).
resistance with maintaining or slight decrease
In the operations blood loss varies in
of the heart rate within safety margin (5).
volume depending on many factors including
Total intravenous anaesthesia is used
underlying pathology, patient's positioning and
to achieve that (fentanyl with propofol), or
venous return affection (2).
inhalational anaesthesia by using fentanyl with
Maintaining a patient's hemodynamic
an inhalational agent such as sevoflurane,
stability and decrease in bleeding in the
isoflurane, or desflurane (6).
surgical field leading to highly surgeon
satisfaction, also improve the results and
outcome (3).
The aim of the present study was to
It also reduces the need for blood
compare between total intravenous anaesthesia
transfusion with its associated complications
(fentanyl with propofol) versus volatile
and the increase in consumption of financial
maintenance anaesthesia
resources (4).
(fentanyl with sevoflurane) to induce
permissive hypotension during spine surgery.
modality for reduction in bleeding during these
Patients and Methods
surgeries, as this technique must be gradual
and within limits where mean arterial blood
Received: 03/8/2018
Accepted: 13/8/2018

Full Paper (vol.734 paper# 26)

c:\work\Jor\vol734_27 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (4), Page 6562-6570

Assessment of Left Atrial Function in Patients with Non-ST-Segment
Elevation Myocardial Infarction Using Two-Dimensional Speckle Tracking
Mansour M. Mostafa*, Wael M. Attia*, Mohamed O. Taha**, and *Mohamed N. Mahmoud

*Cardiology Department, Faculty of Medicine, Al-Azhar University and **National Heart Institute
(NHI), Cairo, Egypt
Corresponding author: Mohamed Nasem Mahmoud, E-mail: dr.mohamednassim@gmail.com
Background: the left atrium (LA) plays a major role in Left ventricular (LV) performance. LA
function is a surrogate marker of LV diastolic dysfunction. LA mechanical dysfunction occurs in LV
systolic and diastolic dysfunction, coronary artery disease, myocardial infarction (MI), hypertension,
aortic stenosis and cardiomyopathies. In the MI process, the contribution of the LA to LV function
may increase if the cardiac myocytes are not affected by direct ischemia. However, myocyte necrosis
or ischemia of the LA or significant LV systolic/diastolic dysfunction affects this booster effect.
Assessment of LA size and function provides prognostic data for the outcome of patients with MI or
ischemia. Aim of the Study: was to evaluate LA function in patients with non-ST-segment elevation
myocardial infarction (NSTEMI) by two-dimensional speckle tracking echocardiography (2D STE). Patient
and Methods:
60 patients with NSTEMI and 20 age-matched normal control individuals were
enrolled in this study. Conventional echocardiographic parameters and global longitudinal strain rate
(GLSR) were measured at left ventricular (LV) and LA segments. Results: Compared with healthy
subjects, patients with NSTEMI had significantly increased LA volumes but significantly decreased
LA emptying fraction and GLSR. LA-GLSR had significant correlations with the 2D Doppler
echocardiographic parameters of LA function. In particular, global LA peak negative strain rate
during early ventricular diastole (LA-GLSRe) was significantly correlated with both LA 2D Doppler
echocardiographic parameters and LV contractile function. This could be suggested as a better
indicator to evaluate LA function as a preferred parameter of STE. Conclusion: It could be concluded
that two-dimensional speckle tracking echocardiography represented a non-invasive, relatively simple
and reproducible technique to assess left atrial myocardial function in patients with NSTEMI.
Keywords: two-dimensional speckle tracking echocardiography, strain rate, non-ST-segment
elevation myocardial infarction, left atrial function
Myocardial infarction is a major cause of
volume. As a continuum of the LV, especially
death and disability worldwide. MI may be the
during diastole, its size and function are very
first manifestation of coronary artery disease
much influenced by the compliance of the
(CAD) or it may occur, repeatedly, in patients
with established disease(1). Left atrial function
Traditionally, assessment of LA
is one of the most important clinical
function has been performed by measuring LA
parameters of two-dimensional speckle
size or volume with two-dimensional (2D)
tracking echocardiography (2D STE), which is
echocardiography. Doppler echocardiographic
an innovative tool for more comprehensive
measurements such as transmitral and
and reliable echocardiographic evaluation of
pulmonary venous flow can also be used (4,5)
myocardial function(2)
Currently, a method known as strain imaging
LA function has been conventionally
is used for the quantitative assessment of
divided into three phases first, as a reservoir,
myocardial deformation (6). It has been shown
the LA stores pulmonary venous return during
that non-Doppler strain imaging is a feasible
LV contraction and isovolumetric relaxation.
and reproducible method to assess LA function
Secondly, as a conduit, the LA transfers blood
passively into the LV. Thirdly, the LA actively
The LA function is closely related to
contracts during the final phase of diastole and
the ventricular function throughout the cardiac
contributes between 15 and 30% of LV stroke
cycle. During ventricular systole, the
Received: 03/8/2018
Accepted: 13/8/2018

Full Paper (vol.734 paper# 27)

c:\work\Jor\vol734_28 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (4), Page 6571-6576

Assessment of High-Sensitive Cardiac Troponin I in Coronary Artery
Disease Patients Undergoing Regular Hemodialysis

Mostafa A. ElBallat, Alsayed M. Rashed, AbdElraouf A. Abonar and Ahmad M. Hegazy.

The Department of Internal Medicine, Faculty of Medicine, Al-Azhar University
Corresponding author: Ahmad M. Hegazy, Email: name.on.the.sky@gmail.com

: to examine the prevalence of elevated cardiac troponin I level in asymptomatic and
symptomatic end-stage renal disease (ESRD) patients on regular hemodialysis (HD) as a strong
predictor of worse cardiovascular outcomes. Background: ESRD on regular hemodialysis patients
with elevated cardiac troponin I have a higher cardiac mortality rate, it is important to detect elevated
cardiac troponin I patients as predictor of worse cardiovascular outcomes. Methods: The patients
were divided into three groups: Group (A): ischemic heart disease patients (IHD) with normal kidney
function,Group (B): ischemic heart disease patients on regular hemodialysis,Group (C): non ischemic
heart disease patients on regular hemodialysis. Results: Our study revealed elevated serum cardiac
troponin I (CTnI) in group B, with normal level CTnI in other two groups (A and C). There was
significant positive correlation between elevated CTnI, ejection fraction, E/A ratio and regional wall
motion abnormalities. There was inverse correlation between CTnI elevation and EF%, also there was
direct correlation between CTn I elevation and E/A ratio in group B. Conclusion: Troponin I was
elevated in symptomatic IHD patients on regular HD and normal in IHD patients with normal kidney
function and in non IHD on regular HD patients. The elevated CTnI may play in past a role in
cardiomyopathies in IHD on regular HD and this could be related to some acute coronary syndromes
in these patients which carries worse cardiovascular outcomes.
Key words: Cardiac troponin I (CTnI) ­ hemodialysis ­ ischemic heart disease.
Cardiovascular disease accounts for roughly
There is increasing evidence that elevation in
50% of deaths in patients with chronic renal
serum cTnI and cTnT levels in stable
failure. Patients with renal failure are at higher
asymptomatic patients with end-stage renal
risk for silent ischemia (17%) and atypical
disease is predictive of worse long-term and
clinical presentation. Electrocardiogram results
short-term cardiovascular outcomes. The
are not reliable, because ST segment changes
reason for this correlation is unknown,
are difficult to interpret secondary to
although a correlation between increased
troponin levels and diffuse coronary artery
hypertrophy and medications[1] .Using a
disease in those patients has been reported[4].
second-generation assay, cardiac troponins
(cTns) was found to be elevated in up to 53%
of patients with renal failure with no clinical
The current study was carried out after
evidence of acute myocardial necrosis[2]. Any
obtaining a written consent from all patients
elevation of cTn levels in patients with ST
and an approval by the Faculty of Medicine,
elevation MI, non-ST elevation MI, unstable
angina, congestive heart failure and chronic
Committee. The study started from June 2016
kidney insufficiency portends a worse
to May 2017.
outcome. Patients with elevated cTns have a
higher cardiac mortality rate, are more likely
Inclusion criteria: Chronic renal failure
to have coronary thrombi, showers of emboli
patients on regular hemodialysis of at least 1
in the coronary microvasculature, and
year duration, mental competence, willingness
depressed ventricular function, it has been
to participate in the study
found that elevations in cTn levels from causes
other than ischemic heart disease are
Exclusion criteria: Diabetes mellitus patients,
associated with worse prognoses[3].
acute kidney injury patients, new hemodialysis
Received: 06/8/2018
Accepted: 16/8/2018

Full Paper (vol.734 paper# 28)

c:\work\Jor\vol734_29 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (4), Page 6577-6580

Iron defi

ciency a
nemia w
ith p
ica s


ears o
ld c
Nafea H

oud Alanazi, Ey
ad Ahmed
Bohassan, Ahmed Fak

hri Alsabi, Ridha H
Bohassan, Ali H


N lenazi
Pediatric D
epartment, C
ollege of

dicine, Al

- ouf U
g author: Nafe
a Hamoud Alanazi, +966 56

22 7
398, E-mail: Dr.nafea1@gmail.com

Pica is an irregular want for and ingestion of either palatable or unpalatable substances. The condition
has been distributed in medicinal diaries for quite a long time. The present case report is about a 5
years old female child reported to Department of General Pediatric with a chief complaint of high
fever and constipation. The fever was progressive course for 2 days and constipation for 5 days.
Furthermore, there was a history of abnormal behavior of ingestion of inedible substances like stones
and sand. We seek through our report to shed the lights on the importance of reminding the physicians
of diagnostic utility of pica side effects related with iron deficiency. As here in our case, if we ignored
these diagnoses that caused pica, the child may suffer from serious complications such as very low
hemoglobin, GIT abstraction, severe anemia and serious infection. Consequently, we concluded, that
detailed medical and individual history of kids, helps in a superior determination and a proper
treatment design.
Keywords: Pica, anemia, syndrome

Pica is an irregular want for and ingestion of
connected with iron deficiency anemia (5,8). As
either palatable or unpalatable substances. The
indicated by the 2001 World Health
condition has been distributed in medicinal
Organization (WHO) data, 30% of the kids
diaries for quite a long time (1,2). One of the
aged between 0 and 4 years and 48% of the
primary cases of pica was noted in sixth
kids aged somewhere in the range of 5 and 14
century AD and was seen in a pregnant lady (1).
years are anemic in developing nations (9).
From that point forward, numerous instances
of pica have been accounted for where patients
Case presentation:
have recognized ingesting ice 3D squares
(pagophagia), clay (geophagia), dried pasta
The present case report is about a 5 years old
(amylophagia), chalk, starch, glue, kayexalate
female child reported to Department of
tar (resinphagia), tomatoes, lemons, cigarette
General Pediatric with a chief complaint of
butts, hair, lead, and clothing starch (for
high fever and constipation. The fever was
instance, Argo out of the container) (1,3).
progressive in course for 2 days and
constipation for 5 days. Furthermore, there
In spite of the fact that pica is most
was a history of abnormal behavior of
conspicuous in people with formative
ingestion of inedible substances like stones
handicaps, it has been seen in people all things
and sand.
considered and ethnicity yet is more pervasive
On examination:
among the lower financial classes (2,4). Around
The child looked unwell, febrile, very pale, no
the world, 25% to 33% of all pica cases
include little kids, 20% are pregnant ladies,
Abdomen: tender, distended no organomegaly.
and 10% to 15% are people with learning
Eyes manifestation: pale conjunctiva
incapacities (5). A little more percentage of
patients have iron deficiency anemia. Pica
Laboratory test:
postures huge health dangers that frequently
Complete blood count: HB: 4.9 g/dl,
require medical interventions. These patients
hematocrit: 21.1%, MCV: 53.1 FL, WBC:9.88
are helpless to electrolyte and metabolic
Blood film: RBC: Anisocytosis with severe
hypokalemia (from resinphagia), parasitic
hypochromic, microcytosis and target cells.
Comment: Hypochromic microcytic anemia
impediment, and different issues of the
with lymphocytosis.
gastrointestinal tract (6,7). The correct etiology
Serum iron: 3.08 mcg/dl and serum
of pica stays vague, yet it is essentially
ferritin: 5.76 ng/ml
Received: 22/8/2018
Accepted: 2/9/2018

Full Paper (vol.734 paper# 29)

c:\work\Jor\vol734_30 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (4), Page 6581-6585

Effects of Irritable Bowel Syndrome (IBS) on the health-related quality of
Life among Saudi Males at Al-Jouf, Kingdom of Saudi Arabia
Ahmed Mari M Alruwaili, Khalid Salem A Albalawi, Fawaz Rawi D Alfuhigi, Atallah Fadel
Alruwaili, Bandar Abdulmohsen Ali Altaleb, Jarid Saleh Aljarid
Family Medicine Department, College of Medicine, Al-jouf University
Corresponding author: Ahmed Mari M Alruwaili, E-mail: ahmeed.gh71@gmail.com
ahmeed.gh71@gmail.com, Tel: +966 50 113 8343

Irritable bowel syndrome (IBS) is a functional disorder of the gastrointestinal tract.
Moreover, it is characterized by recurrent episodes of abdominal discomfort which may improve with
The objective of this study was to assess and evaluate the effect of IBS on the HR-QoL
among Saudi population at Al Jouf region (Northern Saudi Arabia) by using generic Arabic translated
Materials and methods:
This was a descriptive and cross-sectional survey study in which 70 patients
were enrolled in the investigation (all men, aged 20±4 years .All participants met the Rome criteria-II
for IBS. Furthermore, data were collected via structured questionnaires (25-IBSQoL).
The results showed that 63% of the study population consent that IBS is a health concern;
whilst 55% agreed that IBS restricted their activities and social life. Furthermore, 40% agreed that
IBS affecting their emotional mode. Equally important, 69.1% agreed that IBS restrict their food and
diet interest and 34.6% of the study population agreed that their sexual life is affected by IBS.
IBS is negatively affecting the quality of life of the study population. It constitutes to
remain a health concern for them restricting their diet interests and badly affecting their social life.
Hence, participants seem to be lacking knowledge and are unaware of their condition. Therefore, we
recommend the health authorities to launch an awareness-raising campaign and an initiative program
towards community awareness of this disease.
IBS, syndrome, HR-QoL.
Irritable bowel syndrome (IBS) is a functional
(10). Detailed frequency of IBS among countries
of the
is scarce; however, it may reach 10-15% in
Moreover, it is characterized by recurrent
Europe and North America, and even
episodes of abdominal discomfort which may
increased among countries in the Asia­Pacific
improve with defecation (1). There are no
region (14% in Pakistan and 22.1% in Taiwan
known structural abnormalities associated with
(11, 12).
IBS (2). The diagnosis of IBS is Symptom-
The prevalence of IBS might reach 31.8-
based, and many diagnostic criteria have been
40.7% among elders (13, 14). However, this
assigned to identify the cases of abdominal
varies according to age group and gender. In
bloating, distension, and change in stool
Al Jouf area the frequency of IBS recorded
consistency are the landmarks of case
8.9% among young adults at secondary
definition (3, 4). Severity of clinical
schools (15).
presentations and chronology are variable (5, 6).
The Pathophysiology of IBS is not very well
IBS is further classified into sub-entities
understood. However, there are some events
according to the clinical presentation:
that are associated with IBS such like
diarrhea-predominant (IBS-D); constipation-
abnormality in gut motor and sensory activity,
central neural dysfunction, with other
(constipation/diarrhea) (IBS-M) (7, 8).
psychological disturbances (16).
The global prevalence of IBS shows a great
Also, it is believed that IBS may be due to
variation (12 to 30%) and this may attribute to
consequence of deregulation of the brain-gut
the variation in case definition. The prevalence
axis with both central and peripheral
of IBS is strongly dependent on the
mechanism involved (17).
classification algorithm employed (9) Also, IBS
Patients with IBS have been found to have a
constitutes 40% gastroenterology clinics visits
considerable reduction in quality of life (18, 19).
Received: 20/7/2018
Accepted: 30/7/2018

Full Paper (vol.734 paper# 30)