c:\work\Jor\vol735_1 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (5), Page 6586-6595

Study of Dyslipidemia in Patients with Systemic Lupus Erythematosus and
its Correlation to Disease Activity

Farag Khalila, Mohamed Nabil Rafata, Nader T. El- Beltagya, Hassan A. Abdel Aziz Gaberb

Ainternal Medicine Department, Faculty of Medicine, Al­Azhar University, Cairo, Egypt
Bclinical Pathology Department, Faculty of Medicine, Al­Azhar University, Cairo, Egypt

Corresponding author:Farag Khalil, Email: dr.farag7070@azhar.edu.eg
Background: Cardiovascular events and accelerated atherosclerosis in patients with active systemic
lupus erythematosus results in significant increased morbidity and mortality. The non-traditional risk
factors induce alteration in lipoprotein metabolism and the constant inflammatory and immune activity
can lead to accelerated atherosclerosis. Aim: To assess prevalence of dyslipidemia in systemic lupus
erythematosus patients and to study the relation of dyslipidemia to disease activity. Patients and
: The presented study included 60 SLE adult patients (56 females and 4 males) and they were
classified according to disease activity into two groups: Active Lupus: Included 30 lupus patients.
Inactive Lupus: Included 30 lupus patients. 20 healthy subjects with matched age, sex and BMI were
included as healthy controls. Methods: Patients underwent clinical assessment. Total cholesterol, (LDL,
HDL) and triglyceride were measured.
Results: Cholesterol, LDL, and TG levels were elevated in the active group compared to that in the
inactive group and healthy controls. This elevation was significant (P< 0.001). But HDL level decreased
in the active group compared to the inactive and healthy controls groups. The decrease of HDL was the
active group is significant (P< 0.001). Conclusion: The elevated levels of Total cholesterol, LDL, and
TG and decreased level of HDL in SLE patients are considered an independent risk factor for
cardiovascular disease. The dyslipidemia and inflammatory process predispose to premature
atherosclerosis and disease activity contribute to dyslipidemia and hence cardiovascular risk associated
with SLE.
Keyword: SLE, Dyslipidemia, Cholesterol, TG

Systemic lupus erythematous (SLE) is an
antibodies, and immune cell activation. A
autoimmune, chronic, relapsing, inflammatory,
modification of Framingham risk score, where
and often multi-systemic disorder of connective
each item is multiplied by two, estimates more
tissue, characterized by involvement of the
accurately the risk for coronary artery disease
skin, joint, kidney and serosal membranes (1).
in lupus patients (3).
Patients with SLE have higher
Additional mortality in SLE patients
mortality and morbidity rate compared to
shows a bimodal pattern, with an early peak due
general population. The major causes of death
to the consequence of active lupus and a later
remain to be infection, lupus nephritis (LN),
peak attributable mainly to atherosclerosis (4).
and cardiovascular disease (CVD) (2).
Abnormal plasma concentration of
CVD in autoimmune rheumatic
lipids is common in patients with SLE.
diseases is caused by traditional (increasing age,
Dyslipidemia usually refers to elevated total
cholesterol (TC), triglycerides (TG), low-
hypercholesterolemia, diabetes) and the so-
density lipoprotein (LDL), and decreased high-
called non-traditional risk factors (3). There are
density lipoprotein (HDL) level (4).
statistically significant increases in coronary
Lupus nephritis (LN), a common and
heart disease and stroke in SLE patients that
potentially life-threatening manifestation of
cannot be fully explained by Framingham risk
SLE, occurs in almost half of the lupus patients
factors (3). These non-traditional factors are
(5). Patients with LN have a higher TC, TG, and
disease related, such as disease activity,
LDL and lower HDL and apolipoprotien B
glucocorticoid, hydroxychloroquine (HCQ)
levels, than patients without renal manifestation
used to control disease activity, impaired renal
Received: 06/8/2018
Accepted: 16/8/2018

Full Paper (vol.735 paper# 1)

c:\work\Jor\vol735_2 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (5), Page 6596-6607

Correlation of Serum Neopterin level with Complement C3, C4 in
assessment of Systemic Lupus Erythematosus Activity
Farag Khalila, Abd Elwahab M. Lotfya, Ahmed A. Abd Elshafya, Mohammad A. Khedrb
aInternal Medicine Department Faculty of Medicine Al Azhar University, Cairo, Egypt.
bClinical Pathology Department Faculty of Medicine Al-Azhar University, Cairo, Egypt.
Correspondence to: Farag Khalil, Lecturer of internal medicine, Faculty of Medicine Al-Azhar University, Alhusein
University Hospital, Internal Medicine Department Cairo, Egypt.
Email: dr.farag7070@azhar.edu.eg

Systemic lupus erythematosus (SLE) has a recurrent disease activity throughout the
natural course of the disease. Assessment of this activity is often complex and time consuming. To date
no measures have been created specifically for SLE. Studying serum neopterin and comparing it with
other established parameters C3, C4 may add benefit for SLE follow up. Aim: The aim of our study is
to evaluate the level of serum neopterin in patient with systemic lupus erythematosus (SLE) as a marker
of disease activity and its correlation with other parameters of disease activity. Patients and methods:
Seventy five subjects; 60 patients with (SLE); 30 of them are active and another 30 with no activity and
15 healthy subjects as a control group. Results: Serum neopterin was higher in the active group than
the inactive group and a significant difference between the patients with SLE group than controls group
was also reported. Our results shows that the mean value of serum neopterin in whole SLE patients
(21.9 ng/ml) and the serum neopterin in the active and inactive groups was 33.9 ng/ml and 3.45 ng/ml
respectively which were highly significant than the mean value of the control group (P<0.001). Also
the differences between the three groups was highly significant (P<0.001). Conclusion: As increased
serum neopterin levels were found in patients with SLE and were correlated with certain clinical and
laboratory immunoinflammatory parameters then estimation of serum neopterin levels seems beneficial
in the assessment of disease activity and evaluation of the efficacy of various treatment regimens used.
Key words:
SLE, Serum Neopterin, Lupus nephritis

Systemic lupus erythematosus (SLE) is a
autoimmune disease and malignant tumor
multisystem autoimmune disease characterized
cells). The neopterin level provides appropriate
by chronic inflammation and the production of
information regarding the extent and activity of
autoantibodies directed against numerous
the pathological process (3) .
antigen which target multiple organ systems
The complement has been recognized one as
including joints, skin and kidneys. The
pivotal part of innate and adaptive immune
relapsing-remitting pattern of disease, along
system and it had three well-known
with the clinical heterogeneity makes SLE not
physiological activities including host defense
only one of the challenging autoimmune
against infection, bridging interface between
disorders to diagnose but also to treat and assess
innate and adaptive immunity, and disposal of
drug efficacy (1).
waste immune complex or apoptotic cells (4).
Human monocyte- derived macrophages
The significantly increase of serum neopterin
upon stimulation with the cytokine interferon
level in SLE while the complement C3, C4
gamma (INF- ) released from activated T-
levels was significantly lower than those of
lymphocytes produce a substances called
healthy controls make neopterin as one of the
neopterin (6-D-erytro-trihydroxypropylpterin)
parameters that showed significantly higher
levels in SLE with mild activity (5).

interleukin-1 (IL-1), tumor necrosis factor-
Subject and Methods
(TNF-) and lipopolysaccharides affect
Type of the study: a cross-sectional
neopterin production (2).
observational study.
The concentration of neopterin have been
Site and time of the study: Internal Medicine
increased in vivo in patients with diseases
Department, Faculty of Medicine, Al-Azhar
associated with the activation of cell-mediated
University Cairo and Tanta Dialysis Unit.
immunity (e.g., during allograft rejection, acute
Subjects: This study was carried out on sixty
viral infection, intracellular bacteria, parasites,
female patients suffering from systemic lupus
Received: 06/8/2018
Accepted: 16/8/2018

Full Paper (vol.735 paper# 2)

c:\work\Jor\vol735_3 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (5), Page 6608-6615

Effect of hemodialysis on blood ammonia level among
cirrhotic patients undergoing hemodialysis
Ahmed Mohammed Alashkar, Ahmed Khairallah, Atef Aboelfetouh Ibrahim
Nephrology Unit, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Corresponding author: Ahmed Abdo Khairallah, E-mail: ahmed.abdo.khairallah@gmail.com

: Uremia results in a characteristic breath odor (uremic fetor) which is largely
due to its high ammonia content. Earlier studies have shown a strong correlation between
breath ammonia and blood urea levels and a 10-fold reduction in breath ammonia after
hemodialysis in patients with chronic kidney disease. Potential sources of breath ammonia
include: (i) local ammonia production from hydrolysis of urea in the oropharyngeal and
respiratory tracts by bacterial flora, and (ii) release of circulating blood ammonia by the
lungs. While the effects of uremia and hemodialysis on breath ammonia are well known
while their effects on blood ammonia are unknown and were explored here.
Methods: Blood samples were obtained from 56 hemodialysis patients (immediately before
and after dialysis). Blood levels of ammonia, creatinine, arterial blood gases, and
electrolytes were measured.
Results: There was significant fall in serum creatinine following hemodialysis with
significant increase in blood ammonia. Moreover, cirrhotic patients with high-
bicarbonate showed a significant more increase in ammonia and significant increase in
incidence of hyper-ammonemia to that of non-cirrhotic and low-bicarbonate.
Furthermore, the increase in serum bicarbonate showed a significant correlation to the
change of blood ammonia following dialysis.
Conclusion: The fall in blood creatinine concentration following hemodialysis is
paradoxically accompanied by a rise in blood ammonia in hemodialysis subjects,
contrasting the reported effect on breath ammonia. The mechanism of the post-
hemodialysis rise in blood ammonia may be due alkalotic change in PH. The observed
rise in blood ammonia level was directly related to the rise in blood bicarbonate and
with aggravation of alkalotic state in cirrhotic patients. The rise in blood bicarbonate is
associated with increased incidence of hyper-ammonemia among cirrhotic patients.

Keywords: Uremia, chronic kidney disease, urea, inflammation, dialysis
Prior to the advent of modern laboratory
was accompanied by a 10-fold drop in
techniques, characterization of the smell of
breath ammonia level, from 1500 to 2000
patients' breath was a common tool used by
ppb before hemodialysis to 150­200 ppb
ancient clinicians for the diagnosis of
after hemodialysis (2).
various diseases. A prime example of a
Ammonia in the body is derived from two
disease with a characteristic breath odor is
sources: (i) Cleavage of the amino groups of
renal failure. The fishy smell of these
amino acids followed by its conversion to urea
patients' breath, which is commonly
by the liver and to ammonium (NH4) by the
described as uremic fetor primarily due to
renal tubular epithelial cells (3, 4). Conversion of
the presence of large amounts of ammonia
ammonia to ammonium [NH3 + H+
in their exhaled air (1). In an earlier study
NH4 ] in the renal level have not been
Narasimhan et al. (2) found marked
previously investigated. The present study
elevation of ammonia (NH3) concentration
was undertaken to address this issue.
in the breath of a group of end-stage renal
disease (ESRD) patients. Breath ammonia
level in the study population is directly
In this study, Patients were divided into
4 groups:
concentration. The fall in urea concentration
1- Group I: indicated ESRD, non-cirrhotic
with low serum bicarbonate following
Received: 10/8/2018
Accepted: 20/8/2018

Full Paper (vol.735 paper# 3)

c:\work\Jor\vol735_4 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (5), Page 6616-6620

Low-Molecular­Weight Heparin versus Unfractionated Heparin in Pregnant
Women with Recurrent Abortion associated with Antiphospholipid Syndrome
Abdel­Qader Farag Abdel-Qader, Farid Ibrahim Hassan, Mofeed Fawzy Mohammad
Department of Obstetrics and Gynaecology, Faculty of Medicine, Alazhar University, Cairo, Egypt
Corresponding auther: Abdel ­ Qader Farag Abdel - Qader
Email: dr.abdelqader.egypt@gmail.com
to compare the efficacy and safety of the combination of unfractionated heparin )UFH( and
Low Dose Aspirin (LDA) with that of low-molecular-weight heparin )LMWH( and LDA in the
management of pregnant women with recurrent pregnancy loss secondary to antiphospholipid
syndrome (APS). Methods : In a randomized prospective study, 60 women with a history of 3 or more
consecutive spontaneous abortions and positive antiphospholipid antibodies were assigned in equal
numbers to receive either UFH (5000 units, twice daily) plus LDA, or LMWH (enoxaparin 40 mg, once
daily) plus LDA as soon as pregnancy was diagnosed. Results: Twenty-four women in the LMWH
group (80%) compared to 20 women in the UFH group (66.67%) delivered a viable infant (p >0.05).
There was no significant difference in pregnancy complications or neonatal morbidity between the 2
groups. There were no incidences of excessive bleeding, thrombocytopenia, or osteoporotic fractures
of excessive bleeding, thrombocytopenia, or osteoporotic fractures in either group. Conclusion: In this
study, the use of LDA in combination with LMWH during pregnancy for the prevention of recurrent
pregnancy loss in women with antiphospholipid syndrome seems to be as safe as UFH plus LDA. Large
randomized trials will be required to determine differences in outcome with LMWH and LDA compared
with treatment with UFH combined with LDA in this group of patients.
Keywords: recurrent pregnant loss, antiphospholipid antibodies, low molecular weight heparin,
unfractionated heparin

The antiphospholipid syndrome (APS) is an
osteoporosis (5).
autoimmune disease characterized by recurrent
arterial or venous thrombosis, pregnancy
Patients and Methods
morbidity and the persistence of positive
The present study was a 2-arm, prospective,
randomized controlled trial of 60 women with a
Antiphospholipid syndrome may occur either
history of 3 or more consecutive pregnancy
isolated (primary syndrome) (2), or in the setting
losses before 10 weeks of gestation and positive
of an underlying disease, mainly systemic
antiphospholipid antibodies on 2 or more
lupus erythematosus (secondary syndrome)(3).
occasions at least 12 weeks apart. The study was
Women with antiphospholipid syndrome
performed at Al-Azhar University Hospitals (Al-
(APS) have live birth rates as low as 10% to
Hussin and Sayed Galal Hospitals), Cairo, Egypt.
50% in pregnancy without pharmacological
In the period from 1 Jan to 1 Sep 2018 .The study
treatment. Fetal losses in APS have been
protocol was approved by the ethics committee
attributed to thrombosis of the uteroplacental
of the hospital, the women were counseled about
vasculature, placental infarction. Not
the benefits and risks of heparin and aspirin
surprisingly, therapy for pregnant women with
therapy, and informed consent was obtained from
APS is now focused on preventing thrombosis
all participants.
at the maternal-fetal interface (4).
We evaluated data from 242 women who
Although low molecular weight heparin is
were complaining of recurrent abortion to
more expensive than unfractionated heparin, low
identify those who could be included in the study.
molecular weight heparin has the advantage over

unfractionated heparin of a longer plasma half-
life and a more predictable dose response and
The inclusion criteria:
therefore the potential for once daily
1. History of 3 or more consecutive
administration. Furthermore, low molecular
spontaneous abortions before 10 weeks of
weight heparin causes less heparin induced
gestation, and positive lupus anticoagulant
Received:11/8/2018 accepted:21/8/2018

Full Paper (vol.735 paper# 4)

c:\work\Jor\vol735_5 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (5), Page 6621-6625

Is Neutrophil/Lymphocyte Ratio A Useful Marker to Predict the Severity
of Pre-Eclampsia?
Abd-Alazim M1, Ashraf H Mohammad1, Mohammad S Radwan2, Ahmed A Shokr1

1Department of Obstetrics and Gynecology and 2Department of Clinical Pathology, Faculty of
Medicine, Al-Azhar University, Cairo, Egypt
Corresponding author: Ahmed A Shokr, Email: dr.ah.shoker@gmail.com
Background: Preeclampsia
refers to the new onset of hypertension and proteinuria or hypertension
and end-organ dysfunction with or without proteinuria after 20 weeks of gestation in a previously
normotensive woman.
This study was aimed to evaluate the relationship between Neutrophil/Lymphocyte ratio
(NLR) in patients with pre-eclampsia (PE) and severity of preeclampsia. Subjects and methods: This
prospective study comprised a total of 150 pregnant females divided in 3 groups "50 healthy pregnant
females (Group 1), 50 females with mild pre-eclampsia (Group 2) and 50 with severe pre-eclampsia
(Group 3)". All the study participants were statistically compared in respect to Neutrophil/Lymphocyte
Ratio (NLR) and the baseline data including age and BMI. Results: Maternal NLR was determined to
be significantly high in the pre-eclamptic patients (Groups 2 and 3) compared to those with healthy
pregnancies (Group 1) (p = 0.0003). NLR was significantly higher in the severe pre-eclampsia group
than in the mild pre-eclampsia group (p = 0.042). Conclusion: It could be concluded that while NLR
was determined as significantly high in patients with pre- eclampsia, to be able to use this in the
classification of the severity of pre-eclampsia, there is a need for further studies on a more extensive
Key words:
Leukocytes, Neutrophils, Neutrophil/Lymphocyte ratio, Pre-Eclampsia.


Preeclampsia refers to the new onset
systemic vascular tissue in women with pre-
of hypertension and proteinuria or hypertension
and end-organ dysfunction with or without
proteinuria after 20 weeks of gestation in a
Maternal neutrophil/lymphocyte ratio
previously normotensive woman. Severe
has come into current use to predict
hypertension "systolic blood pressure is 160
preeclampsia (6).
mmHg or diastolic blood pressure is 110
This study was aimed to evaluate the
mmHg" or signs/symptoms of end-organ injury
relationship between Neutrophil/Lymphocyte
"with Systolic blood pressure 140 mmHg or
ratio (NLR) in patients with pre-eclampsia (PE)
diastolic blood pressure 90 mmHg"
and severity of preeclampsia.
represent the severe end of the disease spectrum
Patients and Method
This prospective study included a total of 150
Pregnancy is a controlled inflammatory
pregnant females attending at the Obstetrics
state. It is believed that an excessive systemic
and Gynecology Department of Mansoura
inflammatory response is the basis of the
General Hospital. Approval of the ethical
clinical manifestations of PE (2).
committee and a written informed consent
Maternal circulating leukocytes are
from all the subjects were obtained. This study
activated in pregnancy and further activated in
was conducted between April 2017 and April
Oxidized lipids are potent activators of
The 150 pregnant females were divided
neutrophils, leading to expression of
in 3 groups "Group 1: 50 healthy pregnant
cyclooxygenase-2 (COX-2) which regulates the
females (the control group), Group 2: 50
release of thromboxane, TNF and superoxide
pregnant females with mild preeclampsia and
Group 3: 50 pregnant females with severe
Neutrophils are usually thought to be
the first line of defense against infection at the
Every case was selected as an Egyptian
site of a wound, but as has been reported in
pregnant woman after 20 weeks of gestation
recent studies, neutrophils also infiltrate
Received: 06/8/2018
Accepted: 16/8/2018

Full Paper (vol.735 paper# 5)

c:\work\Jor\vol735_6 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (5), Page 6626-6632
Autologous Serum in Dry Eye Disease
Mohammed Zakaria Eid, Ahmed Nabil El-Sayed, Alaa El-Din Ibrahim Mohammed*

Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Corresponding author: Alaa El-Din Ibrahim Mohammed,Email: 3la2.el.din8@gmail.com
Background: The tear film overlays the ocular surface and provides the interface between the eye and
the external environment. The tear film is essential for the nutrition and protection of the ocular surface
and for clear vision as the tear film is the first refractive surface of the eye.
Aim of the Work: the purpose of this study was to review the efficacy, complications and safety of
using autologous serum in dry eye.
Patients and Methods: thirty patients of moderate to severe dry eye selected from Ophthalmology
Out-Patient Clinics, Al-Hussein University Hospitals. All patients were subjected to Schirmer 1 test,
Tear break ­ up time (TBUT), and Fluorescein clearance test
Results: The mean value of Schirmer 1 test before the use of autologous serum was 2.83 mm ± 0.83 SD
while after use of autologous serum was 5.33 mm ± 9.99 SD. The mean value of TBUT test before the use
of autologous serum was 9.50 sec ± 1.20 SD while after use of autologous serum was 9.433 sec ± 1.52 SD.
The mean value of FCT before the use of autologous serum was 100 % positive while after use of autologous
serum was 76.7 % positive. The difference between before and after use of autologous is statistically
significant as P-value < 0.001.
Conclusion: this study revealed that autologous serum eye drops were found effective and safe in
treatment of severe dry eye disease, as evidenced by improvement in subjective assessment of
symptoms, Schirmer's 1teast, tear film break-up time (TBUT) and fluorescein clearance test (FCT).
Keywords: Autologous Serum, Dry Eye Disease
*Corresponding author: Alaa El-Din Ibrahim Mohammed, E-mail: 3la2.el.din8@gmail.com

The positive effects of the application
epithelial defects. In such cases surgical
of autologous serum in the treatment of dry eye
attempts as punctual occlusion, frequently fail
patients are known since 1984 according to the
research of Fox et al. However, the lack of
Also, with increasing severity of aqueous
knowledge about its action mechanism at the
deficiency, the application frequency of tear
eye surface level kept its utilization in clinical
substitutes increases, their turnover is reduced,
practice from growing until the end of the
and the ocular surface becomes more
decade when Tsubota in 1999 described its
susceptible to toxicity from preservatives
successful use in eyes with persistent epithelial
resulting in corneal blindness. Autologous
defects (1,2).
serum is an unpreserved artificial tear
Dry eye disease (DED) is also called
substitute, with slightly hypotonic or
keratoconjunctivitis sicca or, more recently,
physiologic electrolyte composition and
dysfunctional tear syndrome. In 2007, the
biologic buffers, which improves corneal
International Dry Eye Workshop defined it as a
epithelial barrier function, patient comfort and
multifactorial disorder of the tear film and
may address parts of the underlying
ocular surface that results in eye discomfort,
multifactorial pathogenesis of dry eye (7,8).
visual disturbance, and often ocular surface
Since autologous serum preparation is
a body fluid, it is able to transmit infections;
Autologous serum contains various
another drawback of autologous serum
factors that are also present in tears including
treatment lies in the frequent blood extractions,
Vitamin A, Epidermal growth factor,
mainly in the groups requiring prolonged
transforming growth factor- (TGF-), basic
treatment (9).
fibroblast growth factor, Insulin like growth
The purpose of this study was to review
factor, Substance P as well as proteins such as
the efficacy, complications and safety of using
lactoferrin and lysozyme (4).
autologous serum in dry eye.
The lack of these epitheliotrophic

factors e.g., in dry eye, can result in severe
ocular surface disorders such as persistent
Received:6/8/2018 accepted:16/8/2018

Full Paper (vol.735 paper# 6)

c:\work\Jor\vol735_7 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (5), Page 6633-6640

Effectiveness of Alizapride for Prophylaxis of Nausea and Vomiting after
Spinal Anesthesia for Cesarean Section
Ayman Hussein Fahmy Kahla, Nasr Abdel-Aziz Mohammad Saad, Islam Mahmoud
Mohamed Mahmoud
Department of Anesthesia & Intensive Care, Faculty of Medicine, Al-Azhar University
Corresponding author: Islam Mahmoud Mohamed Mahmoud, Mobile: 01099066287, Email: shamosa2014@gmail.com
Nausea and vomiting are common side effects in parturients undergoing cesarean
delivery performed under spinal anesthesia can be very unpleasant to the patients. The reported
incidence of nausea and vomiting during cesarean performed under regional anesthesia varies from 50%
to 80% when no prophylactic antiemetic is given. Therefore, use of prophylactic antiemetics in
parturients undergoing cesarean delivery is recommended by some authors.
Objective: In this study, alizapride was evaluated, as a D2 receptor antagonist, on the prevention of
nausea and vomiting following Spinal Anesthesia in parturients undergoing elective cesarean section.
Patients and Methods: The study was carried out in AL-Azhar University Hospitals, Obstetric and
gynaecology department on 90 patients undergoing an elective, lower segment cesarean section (LSCS).
All patients were identified by code number to maintain the privacy of the patients. Any unexpected
risks appeared during the course of the research was cleared to the participants and the ethical committee
on time. A written informed consent was obtained from all patients. Patients were divided into 3 groups,
30 patients for each group. Group I (Alizapride 50 group): Received intravenous (IV) Alizapride 50
mg diluted in 10 ml of normal saline over 1-5 minutes, immediately after clamping umbilical cord.
Group II (Alizapride 100 group): Received intravenous (IV) Alizapride 100 mg diluted in 10 ml of
normal saline over 1-5 minutes, immediately after clamping umbilical cord. Group III (Saline group):
Received normal saline 10 ml, immediately after clamping umbilical cord.
Results: The incidence of nausea and vomiting was significantly decreased in group 2 (Alizapride100
group) compared with group 1 (Alizapride 50 group) and both group was better than group 3 (control
group). The use of ondansetron and chlorpheniramine was significantly decreased in group 1 and 2
when compared with group 3.
This study concluded that Alizapride 100 mg, given intravenously immediately after
clamping umbilical cord would reduce PONV and pruritus in parturients undergoing an elective
cesarean section under spinal anesthesia.
Keywords: Postoperative nausea and vomiting, cesarean section, alizapride
Postoperative nausea and vomiting
increase in risk of adverse effects can give rise
(PONV) is a common complication for patients
to additional treatment, monitoring and nursing
undergoing operation. The reported incidence
care, thus, the duration of hospital stay and
of nausea and vomiting during cesarean
medical expenses are increased (2).
performed under regional anesthesia varies
from 50% to 80% when no prophylactic
administration of antiemetic is the most
antiemetic is given. Therefore, the use of
common strategy to relieve PONV, but it
usually leads to the side effects of antiemetic
undergoing cesarean delivery is recommended
like fatigue, hypotension and dizziness (3).
by some authors (1).
Moreover, pharmacological treatment requires
It causes both the physical and
a significant cost and extra management and
psychological distress to the patients as it
nursing care, and hence probable lengthening
involves uncontrolled vigorous contraction of
the hospitalization day. Non-pharmacological
muscle, which induces potential adverse effects
treatment is suggested to be another way out for
such as aspiration, dehydration, electrolyte
the patient with PONV (4). A number of
disturbance and surgical site disruption (1). The
treatments have been introduced in order to
Received: 06/8/2018
Accepted: 16/8/2018

Full Paper (vol.735 paper# 7)


Full Paper (vol.735 paper# 8)

c:\work\Jor\vol735_9 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (5), Page 6646-6654

The Impact of "CYP2C9" and "VKORC1" Genetic Polymorphism upon Oral
Anticoagulation Requirements
Hossam Yousef Kamal Mohammed, Yousry Zaki Al-zohairy, Mahmoud Abd El-latif Hashish
Clinical Pathology, Faculty of Medicine ­ Al Azhar University

Background: Polymorphisms in the gene encoding the cytochrome P-450 2C9 enzyme (CYP2C9) are
known to contribute to variability in sensitivity to Marevan. CYP2C9 is the enzyme primarily responsible
for the metabolic clearance of s-enantiomer of Marevan. The VKORC1 is the target of Coumarin
anticoagulants, and its common genetic variants result in altered sensitivity to Marevan. VKORC1
polymorphisms are associated with a need for lower doses of Marevan during long-term therapy.
Aim of work: This study aimed to assess the allelic frequencies and to investigate the relationship between
"CYP2C9" and "VKORC1" genotype and vitamin K antagonist anticoagulation.
Subjects and Methods: This study was conducted on 40 patients. They were 24 females and 16 males with
a male to female ratio 2:3. Their ages ranged from 28 to 72 years old. All the studied subjects were
laboratory investigated with international normalized ratio (INR), complete blood count (CBC) and
detection of vitamin K epoxide reductase complex 1 (VKORC1) and cytochrome P450 2C9 (CYP2C9) by
polymerase chain reaction (P.C.R.) reverse hybridization method using PGX thrombo strip assay (Vienna
Lab., Austria).
Results: Regarding the distribution of patients according to frequency of deep venous thrombosis (DVT)
attacks, 16 (40%) patients showed single attack of DVT and 24 (60%) patients showed recurrent attacks.
Patients with single attack of DVT were 12 (75%) females and 4 (25%) males with male to female ratio of
1:3. As for patients with recurrent attacks of DVT, they 13 (54.2%) females and 11(45.8%) males with a
male to female ratio of 1:1.2.
Conclusion: Detection of genetic polymorphisms in CYP2C9 and VKORC1 genes prior to onset of
warfarin therapy, greatly influenced response to warfarin and shortened the time required to reach target
INR, and hence reduced the risk of recurrence of deep venous thrombosis.
Keywords: CYP2C9, VKORC1, P.C.R, Warfarin (Marevan) oral anticoagulant.


Oral anticoagulation with the vitamin K
known to contribute to variability in sensitivity to
antagonist "Marevan" reduces the rate of
Marevan (4).
thromboembolic events in patients with deep
CYP2C9 is the enzyme primarily responsible for the
venous thrombosis "D.V.T." (1). However,
metabolic clearance of s-enantiomer of Marevan (5).
Marevan is one of the most widely used
Patients with certain common genetic variants of
anticoagulants, yet interindividual differences in
CYP2C9 require a lower dose of marevan and a
drug response, a narrow therapeutic range and a
longer time to reach a stable dose. They are also
high risk of bleeding or stroke complicate its use.
at higher risk for over- anticoagulation and
To achieve and maintain an optimal Marevan
serious bleeding (6).
dose, the prothrombin time and international
The vitamin K-dependent (VKD) blood
normalized ratio "INR" are monitored, and doses
coagulation proteins are components of the
are adjusted to maintain each patient's INR within
calcium-binding proteins family, which includes
a narrow therapeutic range. An INR of less than
prothrombin, factors VII, IX, and X, and proteins
2 is associated with an increased risk of
C, S and Z. These seven proteins have an essential
thromboembolism (2) and an INR of 4 or more is
role in the initiation and regulation of blood
associated with an increased risk of bleeding (3).
coagulation. Vitamin K epoxide reductase
Polymorphisms in the gene encoding the
(VKORC1) recycles the vitamin K epoxide to the
cytochrome P-450 2C9 enzyme (CYP2C9) are
reduced form of vitamin K, an essential co- factor
Received: 09/8/2018
Accepted: 19/8/2018

Full Paper (vol.735 paper# 9)

c:\work\Jor\vol735_10 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (5), Page 6655-6660

An Assessment of Knowledge, Attitude and Practice towards Diabetic
Retinopathy among General Practitioners of Tabuk City
Fahad S. Alanazi1, Tariq H. Merghani1, Ala M. Alghthy1, Reem H. Alyami1
1College of medicine, Tabuk University, Tabuk City, Saudi Arabia
Corresponding author: Fahad Alanazi; E-mail address: enezifahad@hotmail.com, Mobile Number: 0966582137150

Diabetic retinopathy (DR) is the leading cause of blindness in the working population.
Adherence to screening guideline will help in the prevention of blindness. General practitioners (GPs)
are the 1st line in management of diabetic patients. This study aims to determine their knowledge,
attitude and practice toward diabetic retinopathy and to identify factors that affect their practice.
Material and method: We conducted a cross-sectional study among a comprehensive sample of the
GPs who work at primary health care units of Tabuk city from July to December 2017. A validated self-
administered questionnaire was used for data collection. Statistical analysis was performed by using
Statistical Package for the Social science (SPSS) version 20. Results: A total of 87 general physicians
completed the questionnaire (a response rate of 100%). Only 24.1% of GPs could identify pregnancy
as a risk factor. Only 43.7% and 28.7% were aware of retinal detachment and vitreous hemorrhage as
complications of DR, respectively. Only 27.6% of the GPs referred type I diabetic patients to an
ophthalmologist as per the guideline. The gender difference in referral pattern was found to be
statistically significant (p=0.041). Major challenges that may prevent GPs from doing funduscopy were
unavailability of ophthalmoscope (42.5%) and lack of skills to detect signs of DR (40.2%). Conclusion:
This study found areas of weakness in the knowledge of GPs toward DR including risk factors,
complications and screening guideline. Courses and training sessions are recommended as suitable
remedial measures.
Keywords: Diabetic retinopathy, General practitioner, Screening guideline, Knowledge, Practice

Diabetes mellitus (DM) is a common metabolic
The global prevalence of DR among diabetic
disorder and the number of diabetic patients is
patients was 34.6%[3] .In Saudi Arabia, several
increasing. In 2015, Diabetes was responsible
studies were conducted in variable regions to
for 342,000 deaths in the Middle East and North
determine the prevalence of DR. The overall
Africa Region (MENA) and Saudi Arabia had
prevalence is 19.7% based on Saudi National
the highest prevalence of 17.6%[1] .
Diabetes Registry (SNDR) [4]. The highest
Diabetic retinopathy (DR) is a microvascular
prevalence of DR was found in Taif province
complication of diabetes that can affect the
(36.8%)[5]. whereas the least prevalence of DR
peripheral retina, the macula, or both; and is a
was found in Riyadh region (16.7%)[6].Other
leading cause of visual disability and blindness
regions with high prevalence were Al-Madinah
in people with diabetes. The severity of DR
and Al-Hasa (36.1% and 30% respectively) [7,
8] .
preproliferative (moderate or severe non-
Tight control of blood pressure and blood sugar
proliferative) to more severely proliferative
level are effective measures to reduce the risk
DR, in which the abnormal growth of new
of developing DR. A previous study showed
vessels occurs. The duration of diabetes is the
that intensive glycemic control reduced the risk
most important risk factor. Other contributory
of developing retinopathy by 76% and slowed
risk factors include hypertension, poor
progression of retinopathy by 54% whereas
glycemic control, obesity, tobacco use, insulin
controlled blood pressure had a 37% reduction
treatment, hyperlipidemia, pregnancy and
in microvascular changes[9]. Advanced cases
can be picked up and treated through Pan-
Received: 06/8/2018
Accepted: 16/8/2018

Full Paper (vol.735 paper# 10)

c:\work\Jor\vol735_11 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (5), Page 6661-6665

Awareness of Dealing with Multiple Trauma Patients in Madinah, Saudi
Moayad A. Karbouji 1, Yousef A. Alrashidi 1, Mohanad I. Kashkari 1, Mujahed A. Turjoman 1,
Sultan F. Madani 2, Fahad A. Almukhlifi 2

1 Orthopedic department, college of medicine, Taibah University, Al-Madinah, Saudi Arabia
2 College of Medical Rehabilitation Sciences, Taibah University, Al-Madinah, Saudi Arabia
Corresponding Author: Moayad A. Karbouji - email: Moayad-A-Karbouji@hotmail.com - mobile: +966562101449
Motor Vehicle Accidents (MVAs) are major health hazards in Saudi Arabia and may
result in multiple injuries. Moreover, it is one of the most common causes of morbidity and mortalities,
worldwide. Thus, the awareness of the bystanders who are the first to witness the MVAs is important.
Objective: The purpose of this study was to evaluate of the level of the knowledge among the adults in
Al-Madinah in terms of dealing with multiple trauma victims at the scene of the accident.
Methodology: A cross sectional study was conducted in Al-Madinah, Saudi Arabia during October and
November 2017 on a university 621 persons participated in the study. A self-administered questionnaire
was used. The average age of participants was ranged from 18 to -49 years with male: female ratio of
Results: Out of 621 participants, 107 (17.2%) exhibited a low level of knowledge, 311 (50.1%) have a
good level, and 203 (32.7%) showed an excellent level. Gender was found to be statistically significant
in favor of male participants (p=0.004). Participants with a high degree of education had been found to
have a better knowledge in dealing with trauma patients at the scene of the accident (p=0.009).
Participants who attended a training course showed a better knowledge in dealing in such situations
Conclusion: Promoting courses that target educating and training public on the appropriate way of
dealing with trauma victims may be helpful.
Keywords: Motor vehicle accidents, multiple trauma patients, First aid, First aid awareness.

Motor vehicle accidents (MVAs) are a
in addition to limited data on burden of injuries
major health hazard and one of the most
(7). In addition, driving cars in a high speed, not
common causes of multiple traumas (1).
following the road instructions such as seatbelts
Globally, MVAs is the leading cause of all
and poor road conditions were shown to
trauma admissions in the hospitals (2).
contribute in increasing rate of MVA's (8). At the
According to The World Health Organization
scene of the accident, first aid delivered by
(WHO) report in Feb 2018, MVAs are one of
bystanders can save lives and limit the damage
the leading causes of deaths and disabilities to
until professional help had arrived (9-10). In fact,
millions of people worldwide which cause
the first four hours after the accident (i.e. the
economic losses to individuals, families and the
golden hour) should have the highest concern as
nations (3). A significant proportion of MVA
victim's lives can be saved during this period if
victims are aged 15-44 years, which has a major
they receive a prompt medical care (11).
impact on productivity as this is the age-range
of the most active population in societies (4).
A cross sectional analytical study was
Kingdom of Saudi Arabia (KSA) has a total
conducted in Al Madinah, KSA during the
population of approximately 31 million in 2016
period from October to November 2017, at a
(5) and it has been estimated that MVAs were the
university during a campaign about the
second most common cause of mortality in
awareness of first aid. Written informed
KSA (10% of all deaths in 2016(1). over the last
consent was obtained voluntarily from the
decade, the mortalities caused by MVAs in
participants after explaining the aim and nature
KSA have increased (6). There are several
of the study. Privacy and confidentiality was
factors that may contribute to the mortality
assured. All participants are citizens of Al
from MVAs in KSA such as significantly
Madinah (Age range of 18-49 years). A random
severe injuries, and possible deficits in
sample of 621 participants was involved (336
healthcare quality in cases of multiple traumas
males and 285 females). They were given a
Received: 23/8/2018
Accepted: 03/9/2018

Full Paper (vol.735 paper# 11)

c:\work\Jor\vol735_12 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (5), Page 6666-6671

Clinical audit on Management of Infants of Diabetic Mothers in Neonatal
Intensive Care Unit Assiut University Children Hospital

Somia M. Abd-El Hameed*, Amira M. Shalaby, Safiea A. El-Deeb
Assiut University Children Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
*Corresponding author: Somia M. Abd-El Hameed, visiting resident in pediatric department at Assiut University Children
Hospital, Assiut, Egypt, E-mail: somia2mohamed@gmail.com

infants of diabetic mothers (IDMs) are at increased risk of morbidity and mortality as
well as poor perinatal outcome. Aim:it was to measure how much the staff in the neonatal intensive
care unit at Assiut University Children Hospital are sticking to the agreed upon units protocol in
management of infants of diabetic mothers. Patients and Methods: twenty five IDMs admitted to
NICU with hypoglycemia were included in this study. The unit´s protocol was followed for the
management of asymptomatic as well as symptomatic hypoglycemia in IDMs. Results: symptomatic
hypoglycemia was present in 76% of IDMs. The rest of cases were asymptomatic hypoglycemia. The
units protocol was completely followed in 76% of cases. However serum calcium was not measured in
24% of the cases. Conclusion: most (76%) of our cases of IDMs had symptomatic hypoglycemia.
Maternal hyperglycemia is thought to lead to excess fetal glucose exposure and fetal hyperinsulinemia.
close liaison with obstetricians in care of diabetic mothers particularly with monthly
measurement of HbA1c during pregnancy and during labor with good adjustment and control of the
maternal level of blood glucose.

: Infants of diabetic mothers, Neonatal intensive care unit's protocol, Assiut university
children hospital and audit


The problems in infants of diabetic
inability to maintain glucose homeostasis.
mothers (IDMs) include respiratory distress,
Glucose is an essential primary substrate for the
growth abnormalities, premature birth, hyper
brain and its consumption by the brain is high
viscosity secondary to polycythemia, metabolic
and as a result, neurons and glial cells are
susceptible to hypoglycemia. Therefore,
glucose homeostasis is crucial for the overall
hyperbilirubinemia as well as increased risk in
physical development of newborns(4).
IDMs of the occurrence of congenital
Maternal diabetes mellitus (MDM) has
malformations including congenital heart
been reported to occur in 8% of all pregnancies.
Women with diabetes in pregnancy (type 1,
type 2, and gestational) are at increased risk for
Infants born to diabetic mothers are still
adverse pregnancy outcomes. Adequate
at high risk for morbidity and mortality in spite
glycemic control before and during pregnancy
of the advance and progress in the specialized
is crucial for improving outcome. The
maternal, fetal and neonatal care units. Poor
measurement of glycosylated haemoglobin
metabolic control in the mother of the blood
(HA1c) throughout pregnancy is of at most
sugar exposes the fetus to maternal
hyperglycemia, which seems to be the basic
Diabetic mothers have a high
mechanism responsible for a wide range of
incidence of preterm labor. Fetal mortality rate
perinatal, natal and postnatal complications in
is greater than that of non diabetic mothers
especially after 32 week of gestation. Most
Hypoglycemia in IDMs is either
infants born to diabetic mothers are large for
symptomatic or asymptomatic. Thus for
gestational age. If the diabetes is complicated
asymptomatic or symptomatic hypoglycemia in
by vascular disease, infants may be growth
IDMs the neurological outcome is unknown(3).
restricted, especially those born after 37 wk. of
Neonatal hypoglycemia is a common
metabolic abnormality in newborns, due to
Received: 23/8/2018
Accepted: 03/9/2018

Full Paper (vol.735 paper# 12)

c:\work\Jor\vol735_13 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (5), Page 6672-6682

Sutureless 23-gauge Versus Sutureless 20-gauge Pars Plana Vitrectomy
Mohamed I .EL-Kasaby
Department of Ophthalmology, Faculty of Medicine for girls, Al-Azhar University, Cairo- Egypt
Corresponding author:Ammarelkasaby@yahoo.com, Mobile :+2 01001241403 - 010423513,email:
To compare sutureless 23-gauge versus sutureless 20-gauge system for pars plana vitrectomy
as regarding safety and efficacy in pars plana vitrectomy. Patients and methods: A prospective
non ­randomized interventional study comparing the two vitrectomy systems in a group of disease
requiring uncomplicated vitreoretinal surgery was carried out at Nour- EL­Hayaha Eye Center
(Cairo) between August, 2015 and June, 2017. Patients were divided into two groups. Group (A)
23 ­gauge group: included thirty eyes of 20 patients, ten patients had bilateral pars plana vitrectomy
(PPV), while in group (B): included twenty five eyes of 20patients, five patients had bilateral
operations. Ocular examinations included measurements of best corrected visual acuity (BCVA) at
a distance using a logarithm of the minimum angle of resolution (logMAR) scale, refractive status
using an autorefractometer (KR-8100; Topcon corporation, Tokyo, Japan), IOP was measured pre
and postoperative by Goldman applanation tonometry (CT-80; Topcon corporation, Tokyo, Japan),
and fundus evaluation using an indirect ophthalmoscope were obtained. Surgical indication,
outcome, intraoperative and postoperative complications were evaluated. Patients with vitreoretinal
pathology such as preretinal membrane, vitreous haemorrhage with fibrovascular proliferation
(FVP), persistent vitreous haemorrhage ,tractional retinal detachment, persistent macular edema
or macular hole were enrolled in this study. Furthermore, postoperative subjective pain,
conjunctival injection, retinal function and situation of retina were evaluated. Follow up was
performed at the 1st day, 1st, 2nd week and 1st, 3rd and 6th month after surgery. Results: All the
fifty five eyes completed the regularly follow up visits up to 24 months. 55 eyes of 40 patients
divided into 2 groups: Group (A) 30 eyes of 20 patients (6 males, 30% and 14 females, 70%, the
mean age of the participants ± SD was 54.62±3.12 years Range: 46-60 years;were treated with 23-
gauge PPV .While in Group (B) twenty five eyes of 20 patients (13 males, 65% and 7 females,
35%, the mean age of the participants ± SD was 49.72±3.06 years Range: 50-58 years; were treated
with sutureless 20-gauge PPV. The mean age of both groups ± SD was 52.67±5.14 years (Range:
47-62 years). Statistically, the differences between both groups regarding age and sex were
insignificant. Conclusion: Advantages of sutureless vitrectomy include a reduction in operating
time, less subconjunctival adhesion facilitating any subsequent vitreoretinal surgery or filtration
Keywords: Sutureless gauge vasectomy, Tractional retinal detachment, Fibrovascular proliferation.
The principles that guide the development of
surgical cost. The illumination systems
any given surgical procedure is the desire for
because of the smaller gauge are not very
less invasive approaches that will achieve the
bright. Wound construction is the essential
same or better outcomes. The advantages of
step in ensuring postoperative wound
smaller surgical incisions have resulted in
stability. Key points include an oblique,
faster postoperative rehabilitation (1).
tunneled approach to ensure a valve-like
Evolution of instrumentation used in pars
effect as well as misalignment of
plana Vitrectomy is desirable to minimize
conjunctival and scleral wounds by
ocular trauma and improve post-operative
comfort. Smaller instruments have been
evolved to perform sutureless vitrectomy
sutureless vitrectomy was developed by
using an obliquely entering trocar cannular
However, the instruments used are fragile
system and this evolution in vitreoretinal
and less reusable thereby increasing the
Received: 1/3/2018
Accepted: 11/3/2018

Full Paper (vol.735 paper# 13)

Introduction The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (5), Page 6683-6690

Uterine and Subendometrial Arteries Doppler in Patients with Recurrent First
Trimestric Abortion
Ismail T. El Garhy, Ashraf H. Mohamed, Ahmed S. Sultan*
Department of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar University
*Corresponding author: Ahmed S. Sultan*; Mobile: 01017792934 Email: ahmdsalem103@gmail.com
Unexplained Recurrent miscarriage remains a frustrating problem for the clinician and a
distressing condition for the affected couple. Recurrent pregnancy loss is defined as three or more successive
spontaneous abortion. The incidence of recurrent pregnancy loss is 1-2% in the fertile population.
Aim of the Work: This study aimed to find out any difference in uterine artery pulsitility index (PI) between
women with history of recurrent unexplained first trimestric abortion and women without this history. Patients
and Methods:
One hundred cases from Al-Azhar University Hospitals (Al-Hussein and Sayed Galal) were
included in the study and classified into two groups: Recurrent pregnancy loss (RPL) group: 50 cases with
history of recurrent unexplained abortion. Control group: 50 cases with no history of abortion and one full
term child at least. Uterine artery Doppler [Pulsatility Index (PI)] assessment was done to all patients in the
study during the luteal phase of spontaneous menstrual cycle.
PI in the RPL group was found to be elevated compared to the control group.
Conclusion: Assessment of uterine perfusion through measurement of uterine artery Doppler (PI) could be of
value in cases with recurrent unexplained first trimestric abortion
Key Words: Recurrent pregnancy loss - Doppler US - Pulsatility index
Abortion is defined as expulsion or removal of
as hypercoagulable states, autoimmune diseases,
products of conception from the uterus before viability
endocrine disturbances or maternal anatomic
of the fetus or if fetus weight is less than 500 g or its
abnormalities, and the high proportion of cases (up to
length is less than 25 cm. Although the true incidence
40­50%) have unidentifiable causes (6).
of spontaneous abortion is unknown, approximately
Recurrent abortion is best investigated
15% of clinically evident pregnancies and 60% of
before another pregnancy occurs (5). Uterine
chemically evident pregnancies end in spontaneous
receptivity is likely to be regulated by a number of
abortion. Eighty percent (80%) of spontaneous
factors including uterine perfusion and is of great
abortions occur prior to 12 weeks gestation (1).
importance in achieving a normal pregnancy.
Moreover, recurrent pregnancy loss is defined as
Studies suggest that uterine artery perfusion may
three or more successive spontaneous abortion (2).
regulate endometrial receptivity, and that poor
uterine perfusion could be one of the causes of
Reproductive Medicine recently redefined recurrent
unexplained abortions and, probably, of faulty
pregnancy loss as two or more failed clinical
implantation. Before pregnancy, blood flow of the
pregnancies as documented by ultrasonography or
uterine artery demonstrates high resistance to absent
histopathological examination (3).
or reversed diastolic flow (7). Transvaginal pulsed
The etiology is often unclear and may be
Doppler ultrasound allows noninvasive evaluation
multifactorial, with much controversy regarding
of uterine circulation (8).
diagnosis and treatment. Reasonably accepted etiologic
causes include genetics, anatomical, endocrine,
Color Doppler is used in obstetrical
placental anomalies, hormonal problems, infections,
ultrasound as a complementary tool to gain
smoking, alcohol consumption, exposure to
information about the presence, direction and
environmental risk factors, psychological trauma,
velocity of blood flow. The pulsatility index (PI)
stressful life events, certain coagulation conditions and
of uterine artery has been known to diminish
immunoregulatory proteins defects (4).
progressively during the luteal phase during which
implantation occurs (8, 9).
The incidence of recurrent pregnancy loss is
1-2% in the fertile population (5). The risk of
Therefore, it has been proposed that
recurrence increases with the maternal age and
measurement of uterine artery pulsatility index
number of successive losses. Recurrent pregnancy
(PI) in the mid luteal phase of spontaneous cycles
losses may be attributable to treatable conditions such

Full Paper (vol.735 paper# 14)

c:\work\Jor\vol735_15 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (5), Page 6691-6695

Driving Eligibility among Epilepsy Patients in Saudi Arabia

Ali Jaffr Al Taho

Imam Abdulrahman Alfaisal Hospital, Riyadh, Saudi Arabia
*Corresponding Author: Ali Jaffr Al Taho, E-mail; Alirap88@hotmail.com

epilepsy is prevalent neurological disorder in Saudi Arabia and listed as temporary or
permanent driving interdiction. In line with other countries rules and requirements, would be safer, for
the patient and community, if the seizures are controlled (Seizure free remission) for about 12 months
prior to granting unlimited driving license.
Objective: to evaluate the eligibility of male epileptic patients aging more than 18 years old to drive
cars based on achieving one year seizure free remission in a statistically representative sample for Saudi
Subjects and methods: a cross sectional study design in which eligible patients attending hospitals in
Saudi Arabia were requested to take part in a survey about their driving status. Sample size was
calculated assuming that one-year seizure free remission of 80% based on literature review, with a
precision of ± 5.9%. A sample size of 170 individuals was sufficient to perform 2-tailed test with 95%
confidence level.
Results: 170 consenting patients participated in the survey. The mean age was 38.7 (range 18-90 years).
Seizure types encountered were generalized tonic-clonic seizure 98 patients (57.6%), Absence 27
patients (15.9%), unclassified 26 patients (15.3%) and clonic 14 patients (8.2%). The dominant
underlying etiology was idiopathic in 90.6%. Despite that only 106 patients (62.4%) achieved one year
seizure free remission, 161 patients (94.7%) hold a valid driving license and 146 patients (85.9%) are
currently driving. 35 patients (20.6%) reported experiencing seizure while driving and 46 patients
(27.1%) received advices from healthcare professionals regarding driving.
Conclusion: Among our study population, relatively lower control of epilepsy was observed with
increased risk of seizures during driving that may lead to serious consequences. Health education
regarding driving especially for uncontrolled patients is a key area for improvement till achieving higher
seizure remission rate.
KEYWORDS: Epilepsy; Driving; Saudi Arabia

Epidemiologic studies on epilepsy show wide
community, if the seizures were controlled
variations in prevalence rates (PRs) from 0.9 to
(Seizure free remission) for about 12 months
57 per 1000 population (1-7). The noticeable
prior to granting unlimited driving license. Data
variability in the reported prevalence rates
from single center in Saudi Arabia showed that
across the globe is a result of many factors such
one-year seizure free remission is achievable in
as diagnostic accuracy, level of case
80% of patients (12).
ascertainment, selection criteria, tool used, and
There is only one study, published in 2000,
people selection. In 1982, the world health
about epilepsy and driving conducted in the
organization (WHO) published its protocol for
central region, Saudi Arabia which showed
epidemiological research of neurological
descriptive analysis of the driving status in
illnesses in emerging countries (8), which has
relation to epilepsy and the main limitation for
been an advance in the setting of
this study was the small number of subjects and
epidemiological exploration on epilepsy. Until
that it was not statistically powered to be
recently, all the evidence on epilepsy disorders
generalized to the country (13).
in the Gulf States was obtained from hospital-
The aim of this research was to evaluate the
based populations, which may not be
eligibility to drive cars based on achieving one
illustrative of the burden in the community (9-10).
year seizure free remission among male
Epilepsy prevalence in Saudi Arabia is
epileptic patients aging more than 18 years old
estimated to be 6.54 per 1000 (95% confidence
in a statistically representative sample to the
interval 5.48­7.60) (11).
Saudi population.
In line with other countries rules and
requirements, it would be safer for patients and
Study Design: a cross sectional study design
Received: 27/8/2018
Accepted: 7/9/2018

Full Paper (vol.735 paper# 15)

c:\work\Jor\vol735_16 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (5), Page 6696-6701

Poor Compliance to Anti-Hypertensive Drugs in Saudi Arabia

Mohsen Jaber Yahya Alotayfi1*, Salem Abdullah Alsohaimi1, Bushra Khalid AL-Qadi1,
Salma Mosa Kamil1, Alaa Jabril H Aththi1, Ghalia Alhussain Ahmed Alhazmi1, Halima
Ahmed Othman Qasem1, Amjad Ahmed Bugis2

1 Jazan University, Saudi Arabia
2 Umm Al Qura University, Makkah, Saudi Arabia
*Corresponding Author: Mohsen Jaber Yahya Alotayfi, E-mail; mjyo545@hotmail.com

Poorly controlled hypertension may lead to several serious health problems,
including stroke, aneurysms, coronary artery disease, kidney disease and peripheral artery disease.
Objectives: This study aimed at exploring the magnitude of the problem of non-compliance with
antihypertensive drugs among patients in Saudi Arabia and identifying the associated factors.
Subjects and Methods: a cross-sectional study was carried out during the period January to
August 2018 through social media sites including a sample of adult patients from different regions
of the kingdom (Saudi and none-Saudi). Data were collected online through a questionnaire. The
questionnaire included socio-demographic characteristics of hypertensive patients, history of
smoking, and hypertension-related history. Adherence of patients to anti- hypertensive drugs was
assessed utilizing an 8-item modified Morisky Medication Adherence Scale (8-MMMAS).
Results: The study included 267 hypertensive patients. About half of them (48.5%) aged over 50
years. More than half were females (58%), high educated (62.3%) and employed (46.7%).
Approaching half of them, 42% has health insurance and 6 years or more of hypertension (47.6%).
About two-thirds of them (68.8%) reported history of taking between one and three drugs/day and
one dose of antihypertensive medication/day (64.8%). High level of compliance with anti-
hypertensive medications was observed among 6.2% of patients whereas medium and low levels
were observed among 67.4% and 26.4% of them. High level of compliance was reported among
patients aged over 50 years (p<0.001), females (0.033), widowed (0.001) and those haven't history of
chronic diseases (p<0.001).
Conclusion: high compliance to anti-hypertensive medications in Saudi Arabia is low, particularly
among male and young patients.
KEYWORDS: Anti-Hypertensive; Compliance; Saudi Arabia; Online


The eighth report of the Joint National
mortality (8). Poorly controlled hypertension
may lead to several serious health problems,
Evaluation, and Treatment of High Blood
including stroke, aneurysms, coronary artery
Pressure (JNC - 8) recommended achieving
disease, kidney disease and peripheral artery
blood pressure lower than 140/90 mmHg. or
disease (9, 10). It has also a major economic
130/80 mmHg in hypertension without
impact ranging from medical costs to decrease
diabetes, or <130/80 mmHg in patients with
in productivity (11,12).
diabetes and chronic kidney diseases (1).
The treatment of hypertension depends on drug
Prevalence of hypertension among general
therapy and non- drug therapy, which mean life
population in western countries ranged between
style modifications to decrease blood pressure
28 and 44% (2), while its prevalence in Saudi
and prevent its complications (13). Low-
Arabia (3) was 26% and in other Arabic
compliance with anti- hypertensive medication
puts patients at higher risk of cardiovascular
countries, it was 26.3% in Kuwait (4), 20.1% in
events than high-compliant patients (14). There
Egypt (5), 33% in Oman (6) and 32.1% in Qatar
are various factors affecting antihypertensive
patient's compliance; patient-related and non-
Hypertension is a major risk factor for
patient related (factors related to physicians,
disease characteristics and drugs) (15).
Received: 26/8/2018
Accepted: 6/9/2018

Full Paper (vol.735 paper# 16)

c:\work\Jor\vol735_17 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (5), Page 6702-6707

Relationship between Renal Failure and Hypertension among Patients in
Riyadh, Saudi Arabia

Ahmed Abdulrahman Aldhahi1*, Hassan Ramzi Al-Suliman2, Abdulaziz Abdullah S. Al Nahdi3,
Abdulrahman Abdulwahab Asiri4, Ibrahim Nasser Asiri4, Abdullah Mohammed Khudhayri4,
Mohammed Ahmed Asiri4

1 Imam Muhammad Ibn Saud Islamic University, Riyadh, 2 King Fahad Hospital, Al-Hofuf, 3
University of Jeddah, 4 King Khalid University, Abha, Saudi Arabia
*Corresponding Author: Ahmed Abdulrahman Aldhahi, E-mail; Aldhahi_93@hotmail.com

chronic kidney disease (CKD) is common in Saudi although there are few data on the
prevalence of this disorder. Therefore, we initiated a multicenter screening study to identify the
prevalence and staging of CKD in 712 patients with known hypertension in four hospitals in Riyadh,
Saudi Arabia.
Method: we measured estimated glomerular filtration rate by the six-variable modification of diet in
renal disease equation and proteinuria by the protein/creatinine ratio. All the subjects studied were
Results: of the 712 patients studied, the median age was 59 years (range 19-90 years) and 560 (78.7%)
of the patients were female. The mean duration of hypertension was 4 years (range 0.1-50). The overall
prevalence of CKD was 46.9% (95% CI: 43.2­50.7%); 19.1% had CKD stages 1-2 and 27.8% had CKD
stages 3-5. There was no difference in age between patients with or without CKD (p = 0.12). The overall
prevalence of proteinuria was 28.9% (95% CI: 25.6-32.4%); 14.7% of subjects had preexisting diabetes
mellitus and their prevalence of CKD (55%; 95% CI: 42.4-62.2) did not differ from those without
diabetes (46%; 95% CI: 41.9-50.0, p = 0.133).
Conclusion: CKD is common in hypertensive patients in Riyadh, Saudi Arabia with a prevalence of
46.9%. This provided justification for the inclusion of this group in CKD screening programs in Saudi.
Keywords: Hypertension; chronic kidney disease; Riyadh

In studies published in the United States,
autopsy study, we showed that hypertension
Europe, Asia, and Australia, it was found that
was an important cause of end-stage renal
chronic kidney disease (CKD) affects between
failure in Saudi, accounting for 33 out 78 (42%)
5% and 15% of the adult population (1-4),
cases (11). This apparent high prevalence of
making this a major public health problem (5).
CKD in patients with hypertension is important
The more severe stages of CKD (3-5) are a
for one reason. First, hypertension is common
major risk factor for cardiovascular disease as
in many parts of Saudi with prevalence in adults
well as for more severe renal failure (CKD
in Riyadh of over 28%(13,14). For this reason, a
stages 4 and 5) (6). Although CKD is common
study of the prevalence of CKD in patients with
in Saudi, there are few data on prevalence and
hypertension and the institution of measures to
little is known about progression in patients
slow its progression is of great importance in
with this disease. Previous studies from Saudi
these areas.
showed a prevalence of CKD of 10.4%7 and

proteinuria of 12.4% (8). Hypertension is
recognized as an important cause of CKD. In a
This study was a prospective cross-sectional
study carried out in Ghana, of 365 outpatients
survey of hypertensive patients aged over 16
with hypertension, 110 (30.2%) had serum
attending four hospitals in Riyadh, Saudi
creatinine >140 mol/L (1.6 mg/dL), 48 had
Arabia. The subjects enrolled in this study were
serum creatinine >400 mol/L (>4.5 mg/dL),
all being followed up for hypertension and were
and 96 (25.5%) had proteinuria (9). In another
on treatment. After obtaining informed consent,
study from Burkina Faso, 117 out of 317 (44%)
demographic data were obtained using a
patients were with hypertension were
hospitalized had chronic renal failure (10). In an
The blood pressure was recorded after a 5 min
Received: 28/8/2018
Accepted: 8/9/2018

Full Paper (vol.735 paper# 17)


Full Paper (vol.735 paper# 18)

c:\work\Jor\vol735_19 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (5), Page 6712-6718

Awareness about Bell's palsy common risk factors among males and
females, Alhasa region of Saudi Arabia, a cross-sectional study

Khalid AlYahya(1), Alhanouf Al-qernas , Alaa Al-shaheen(2)

(1)assisstant professor of otolaryngology, head and neck surgery, King Faisal univrsity, (2)medical
students, King Faisal univrsity, Saudi Arabia

Summary: Bell's palsy is an idiopathic, acute, unilateral peripheral nerve dysfunction that involves the
facial nerve (7th CN) which is responsible for innervation of the muscles of facial expressions. The
facial nerve also innervates lacrimal glands, some salivary glands and anterior two thirds of the tongue.
The clinical presentation of Bell's palsy includes unilateral facial muscle weakness, otalgia,
hypersensitivity to sounds, dropping of the corner of the mouth and dryness of the eye. It is difficult to
establish a statistically significant benefit of treatment in placebo-controlled trials because Bell's
palsy has a high rate of spontaneous recovery. The objective of this study was to investigate the
community awareness of Bell's palsy risk factors in Al-Hasa region of Saudi Arabia.
Method and study design:
A cross-sectional sampling was used to collect the data. The data were
collected from 384. However, 19 of the participants were excluded from the study because; they were
not from Al-Hasa. Relevant information obtained from the participants by using a standardized paper
andcomputerized questionnaire. The collected data were analyzed using SPSS version 17.
Perspectives &implications
: The study concluded that the level of knowledge about Bell's palsy risk
factors and its treatment was poor in Al-Hasa. For that, it requires further attention from the healthcare
workers, practitioners and medical students to raise the awareness about this disease.
Keywords:Bell's palsy, KFU, Al-Hasa, Saudi Arabia

Bell's palsy is an idiopathic, acute, unilateral
peripheral nerve dysfunction that involved the
demyelination of the facial nerve(7).
facial nerve (7th CN) which is responsible for
Peitersen E. demonstrated that, a less common
innervation of the muscles of facial expressions
etiologies of bell's palsy including ear
(1).The facial nerve innervates other structures
infection, Lyme disease, HIV infection and
including the lacrimal glands, some of salivary
brain tumors.
glands and anterior two thirds of the tongue(1).
Bell's palsy is a relatively common condition
According to the previous studies done by
among people at the age of 15-45 years old .
BrandenburgNA , Abraham-InpijnL. Reported
Previous studies carried by Peitersen E ,
that, a family history of bell'spalsy, diabetes
MORRIS AM , Rowlands S , Hauser WA ,
and hypertension are considered to be risk
Yanagihara N. reported that the global
factors for developing bell's palsy(8,9). In
incidence of bell's palsy was 23 to 32 cases per
addition to these risk factors, HilsingerRLJr,
100,000 per year with an equal distribution
found a strong association between pregnancy
between male and female and there was no
and the risk of developing bell's palsy(10).
predilection for either side of the face(2-6).

Patients with Bell's palsy will complain of
Bell's palsy has been defined as an idiopathic
weakness or complete paralysis of all the
condition,however, there are several possible
muscles on one side of the face. Also, there will
etiologies suggested by several studies. The
be disappearing of the facial creases and
reactivation of herpes simplex virus type 1
nasolabial fold, the forehead unfurrows, and the
(HSV-1) within the sensory ganglion is one of
corner of the mouth droops(11-14).
the possible etiologies of bell's palsy as
suggested by McCormic in 1972. The
Regarding the treatment of Bell's palsy, recent
reactivation of latent herpes simplex virus type
meta-analyses of research databases and trials
1 (HSV-1) within the sensory ganglion lead to
supported the use of oral corticosteroid
(prednisolone) within 72 hours of the
Received: 20/8/2018
Accepted: 30/9/2018

Full Paper (vol.735 paper# 19)

c:\work\Jor\vol735_20 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (5), Page 6719-6723

Knowledge, attitude and practice of pharmacists regarding dietary
supplements in Riyadh, Saudi Arabia
Qasem Ali Bahri 1, Ageeli Rabea Mussa R 1, Ashwaq Abdulhamid alahmadi 2
1king fahad central hospital,2Al noor specialist hospital
Corresponding author: Qasem Ali Bahri, email:Qassem91.qb@gmail.com,mobile:00966531579899

Dietary supplements are a term that refers to several products such as vitamins, minerals
and high energy compounds. Using these supplements is very common among individuals in different
communities. Pharmacists had important effect on the public health as they help individuals to choose
supplements and provide them with information.
To assess knowledge, attitude and practice of pharmacists toward dietary supplements.
This study is cross sectional, it was conducted on pharmacists in Riyadh region, Saudi
Arabia, using an online survey.
There were 500 pharmacists included in this study, 75.4% had good knowledge, 71.6% had
positive attitude and 50.8% had good practice. Both of knowledge and attitude were significantly
affected by age, experience years and level of education, whereas practice was significantly affected by
experience years only (P-value0.05).
There were good knowledge and positive attitude toward dietary supplements among
pharmacists, however close percents had either good or bad practice.
Dietary supplements, Pharmacists, KAP.

Dietary supplements involve several products
enough knowledge about the advantages and
such as minerals, vitamins, high energy
risks of each treatment method [13]. This study
compounds and herbal products [1]. Dietary
was performed to investigate the knowledge,
supplements aren't considered part of
attitude and practice of pharmacists toward
conventional medicines [2]. Using these
dietary supplements.
supplements is affected by characteristics of

individuals and the diseases they suffer [3].
Subjects and methods:
Individuals who seek for weight loss or weight
Subjects and study design:
gain use supplements commonly [4]. These
This is cross sectional study which was
supplements are sold very widely in pharmacy,
conducted on pharmacists in Riyadh, Saudi
although there is no specific approval or
Arabia, in the period from June 2018 to August
scientific usage for these products [5]. It was
2018. The study was performed using an online
reported by American Society of nutrition that
survey which included 4 parts to assess
dietary supplements are used by large
demographics of participants, knowledge,
proportion of population in their routine life [6].
attitude and practice regarding dietary

Dietary supplements or complementary
Statistical analysis:
alternative medicine (CAM) is an issue that
Software package for statistical analysis
pharmacists face [7]. Pharmacists are most
version 20 was used to analyze the data.
important interface of the medicine field [7], they
Frequency and percent were used for
have great impact on public health [8] as they
categorical variables. Chi-square was used to
help patients and individuals to choose dietary
find associations and correlations between
supplements safely [9]. Also, they can provide
different variables. P-value 0.05 was
information to patients regarding their
considered significant.
interaction with conventional medicine [10]. It
was found that persons who consume dietary
The present study included 500 pharmacists
supplements ask pharmacists about theses
from Riyadh city, Saudi Arabia. Males were
supplements [11]. It was found in Australia that
more dominant 350(70%) than females
87% of consumers thought that pharmacists
150(30%), and those with age less than 25 years
were able to know the effectiveness of dietary
old were more dominant 170(34%) among
supplements [12]. Pharmacists should have
other age groups. Those with experience less
Received: 30/8/2018
Accepted: 10/9/2018

Full Paper (vol.735 paper# 20)

c:\work\Jor\vol735_21 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (5), Page 6724-6733

Prevalence of Using Hormones and Nutritional Supplements among Gym's
Trainee in Saudi Arabia

Yasser Youssef Khojah1*

1 King Abdullah Medical Complex in Jeddah, Saudi Arabia

*Corresponding Author: Yasser Youssef Khojah, E-mail; Khojah@msn.com

worldwide, studies have shown a high prevalence of hormones and nutritional
supplements use by athletes and gym members. Many athletes consume unproven, potentially harmful
or even banned supplements.
Objectives: to assess the prevalence of the use of hormones and nutritional supplements by people
who exercise in gyms in Saudi Arabia, and the types of supplements they most commonly use and to
obtain a general view of the main reasons for using these enhancements.
Materials and Methods: a cross-sectional study using a self-administered questionnaire was
conducted at gyms in Saudi Arabia that were selected randomly from different sectors. The sample
size was estimated at 289, but the actual number of randomly selected participants in the study was
RESULTS: the number of gym members who participated in this study was 457. Approximately
47.9% of the sample reported an intake of nutritional supplements and 7.9% reported that they took
hormones. Protein powder was consumed by 83.1% of the participants. Approximately 16.8% of
supplement users had noticed some side effects, and 25.7% of those who took hormones had stopped
taking them because of adverse effects. Only half of the hormone users (54.2%) reported that they had had
medical checkups. The major source of information on supplement and hormone use was non-health
professionals, friends being major source (40%) of information on the use of hormones. The use of
nutritional supplements was significantly associated with BMI (OR = 1.89, CI = 1.06-3.39), duration
of daily exercise (OR = 4.23, CI = 2.06-8.68), and following a special diet (OR = 8.42, CI = 5.37-
13.2). There was a very strong association between nutritional supplements consumption and hormone
use (P < 0.001).
CONCLUSION: approximately half of the participants who regularly exercised in gyms took nutritional
supplements, and most had received their information from non-health professionals. There was an
association between the duration of exercise and the use of hormones and supplements. Fewer than
half of hormone users had obtained a health-care provider's advice before taking it. The atmosphere in
the gym can play an important role in members' decisions. Educating gym employees and members
may have a positive influence on the use of supplements and hormones.
KEYWORDS: Gyms; hormones; Saudi Arabia; nutritional supplements

The use of hormones and nutritional
A study was conducted in Riyadh to understand
supplements has become prevalent worldwide.
the attitudes of professional footballers on
Even more alarming is the fact that multiple
supplements use. The researchers distributed
studies have shown that a considerable number
the questionnaires in three famous local sports
of people who consume these enhancements
clubs. Of the105 athletes studied, 93.3% used
sought no medical advice before taking them (1-
different dietary supplements throughout the
5). Different rates of the use of nutritional
season. Most of the participants (88.7%) had
supplements and hormones have been reported
sports drinks, but only 26.5% took amino acids.
throughout the world. However, limited data
Although all individuals were professional
are available on the prevalence of their use by
footballers, only 45.9% of them had their
regular gym members in Saudi Arabia.
information on dietary supplements from a
physician (3).
Received: 01/9/2018
Accepted: 11/9/2018

Full Paper (vol.735 paper# 21)

c:\work\Jor\vol735_22 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (5), Page 6734-6737
Evaluation of knowledge, attitude, and practice about first aid of spinal
injury among medical students in Saudi Arabia, 2018

Eradah Ali AlMarhoon1, Renda Ali Alhabib2, Abdullah Ali Alshaalan3

1-Almaarefa university, 2-Unaizah College of medicine, 3-Prince Sattam Bin Abdulaziz University
Background: Spinal cord injury (SCI) is always a medical emergency as it could lead to chronic painful
conditions, permanent paralysis or even death. Objectives: Assessing the knowledge, attitude and
practice (KAP) regarding the first aid of spinal injury in Kingdom of Saudi Arabia (KSA). Methods: A
prospective randomized controlled study based on a questionnaire sheet that was conducted at Saudi
Arabia, from March to July 2018.The study included 390 medical students randomly chosen from
different faculties of medicine around KSA. Results: The level of knowledge was sufficient among
84.9% of medical students. The attitude of the medical students was good among most of the
participants regarding calling help and starting CRP immediately, taking care while moving the patients
and applying direct pressure on the side of bleeding. The level of practice among most of medical
students was good toward patients with spinal injury even conscious or not. Conclusion: The KAP level
was sufficient among medical students about first aid of spinal injury. The proper knowledge, positive
attitude and practice skills towards first aid can make a significant difference in Saudi Arabia.
Knowledge, Attitude, Practice, medical students, first aid, spinal injury, KSA

First aid is defined as some simple and
lack of studies contributing the awareness of
quick steps that can be performed outside the
medical students regarding first aid thus, the
hospital without or with minimal medical
practice of some junior doctors may be non-
equipment to save someone who in risk or
satisfactorily (12, 13).
relive hispain until the arrival of ambulance (1,
Study design:
Spinal injury is a lethal clinical
A prospective randomized controlled study
condition that can occur frequently among
based on a questionnaire sheet that was
adults. The treatment is often difficult and
conducted at Saudi Arabia, from March to July
resulted in high incidence of disabilities and
death around the world(3). The most effective
Study population and sample size:
management of spinal injury begins with
The study included 390 medical students
adequate first aid and rehabilitation (4, 5).
randomly chosen from different faculties of
Also, cervical spinal cord injury is a
medicine around KSA. As 13 universitieswere
severe problem that alter the neurological
randomly chosen from each district then 30
function resulting in compromising the
medical students from the 4th, 5th and 6th
cardiovascular and respiratory systems (6-8)
curriculum were randomly chosen from each
especially during the 3-8 hours.It must be
managed properly within the accurate time
otherwise; theseconditions could result in
death. If not managed adequately in a timely

manner, these conditions can be life-
The study was based on a questionnaire
threatening. The patient must be stable to avoid
sheet that was designed after conducting a
further damage thus the secure mobilization is
systemic search on all online medical search
an indispensable must for definitive treatment
engines then was tested in a pilot study among
and recovery (9).
50 medical students to be tested, modified and
Most of Universities teach bout
validated. The questionnaire was reviewed by
handling emergencies in hospital and pre-
supervisors and the committee of university.
hospital which could be lifesaving. Although,
Ethical approval:
the adequate knowledge regarding the
emergency handling at the site of emergency
The study was approved by the ethical
was found to be insufficient which is supposed
committee of Faculty of medicine. All the
to be very life wasting (10, 11). Also, there is a
Received: 02/9/2018
Accepted: 12/9/2018

Full Paper (vol.735 paper# 22)

c:\work\Jor\vol735_23 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (5), Page 6738-6743

Immediate Vicryl mesh insertion after lumpectomy, advantage overview

Abdullah Salem Al Haider, Mana Ali mueidh Al hajlan, Abdulaziz Abdullah Alhazmi, Yaqoub
Mubarak Ali Alhamami, Nasser Naji Mohsen Al harthi, Mohammed Hundur Alasmari,
Alhussain Abdullah Jarullah Albudaydi

Najran University, Medical Collage

oncoplastic surgical treatment is defined as mix of excision of a tumor, with proper
margin consisting of lumpectomy or mastectomy and prompt reconstruction of the bust, this may
require applying mesh to stabilize the structure beneath the skin. Objective: we discussed the efficiency
of Vicryl mesh and it usage in surgery after lumpectomy. Method: we searched in detailed following
electronic databases; (PubMed, Embase, Google scholar) for relevant studies published in English
language with human subject only up to July,2018.Results: absorbable surgical mesh is the most current
method in oncoplastic surgery. The simpleness of the time-preserving method that is comfortably
appropriate has actually been reported to have substantial benefits for specialists in addition to a fairly
affordable and acceptable aesthetic end results. Conclusion: elimination of just the area of cancer by
lumpectomy intends to keep most of the bust tissue, is much less of a modification to your body
compared to mastectomy and has a healing time of a couple of weeks. Immediate Vicryl mesh insertion
is a simple approach. Additionally, surgeons ought to think about mesh use when constructing patients
who are mosting likely to or have actually obtained radiotherapy to the bust; vicryl mesh is a reliable
choice to acellular dermal matrix in non-irradiated bust reconstruction and is accessible at
approximately one twentieth the expenses. Acellular dermal matrix or complete muscular tissue
coverage could be preferable in irradiated reconstructions.
Vicryl mesh, insertion, advantage, lumpectomy, area of cancer.

Breast cancer is one of the most diagnosed
reconstruction are crucial parts of the therapy of
cancer in women worldwide, with almost 1.7
breast cancer. Acellular dermal matrices
million new situations identified in 2012 [1].
(ADMs) have been utilized for the
Breast cancer happens when unusual cells in the
reconstruction of the lower pole as a result of
breast multiply uncontrollably to create a
numerous advantages; however, its cost is
tumor. While , most cases of breast cancer
considered as a major disadvantage in this era
happen in females it does happen in men too,
of concern for the allocation of health-care
although this is rare (concerning 1% of
funds. Recently, polyglactin 910 (Vicryl) mesh
instances) [1]. Oncoplastic surgical treatment is
has been released as an alternative. We
defined as mix of excision of a tumor, with
discussed the efficiency of Vicryl mesh and it
proper margin consisting of lumpectomy or
usage in surgery after lumpectomy.
mastectomy and prompt reconstruction of the
bust [2]. This method has really ended up being
We searched in detailed following electronic
promptly a lot more accepted throughout
databases; (PubMed, Embase, Google scholar)
Western countries, permitting the achievement
for relevant studies published in English
of oncologically secure margin and also enough
language with human subject only up to July
aesthetic results [3]. Lately, similar results have
2018. Our search method performed using
actually been reported for local reappearance as
mesh terms as breast cancer lumpectomy
well as survival result [2,3]. Absorbable surgical
reconstruction breast surgery with absorbable
mesh is the most current method in oncoplastic
mesh insertion (Vicryl mesh).
surgery. The simpleness of the time-preserving
method that is comfortably appropriate has
What is a lumpectomy?
actually been reported to have substantial
Lumpectomy is a surgical procedure that entails
benefits for specialists in addition to a fairly
eliminating a presumed malignant (malignant)
affordable and acceptable aesthetic end result
tumor or various other uncommon tissues as
[2]. Oncoplastic surgical treatment and breast
well as a small portion of the surrounding bust
Received: 03/9/2018
Accepted: 13/9/2018

Full Paper (vol.735 paper# 23)

c:\work\Jor\vol735_24 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (5), Page 6744-6752

Prevalence of Iron Deficiency anemia in Obese Children in Taif Area -
Saudi Arabia

Malak Eidha Aloufi, Nejood Metaeb Aljaed, Rawan Abdulrahman Aloufi, Suzan Abdullah
Jafri, Sumayyah Abdullah Jafri, Manal Ahmed Elnashar.
Department of pediatrics, Faculty of Medicine, Taif University
Corresponding author: Malak Eidha Aloufi, E-mail: Malak.aloufi@hotmail.com, Tel: +966581313887

The growing global health problem is obesity which has increased dramatically in recent
years. The prevalence of obesity continues to rise in developed and developing countries, Poor iron
status are affecting millions of people worldwide. Iron deficiency is the first nutrient deficiency all over
the world and both obesity and iron deficiency may lead to adverse health issues. In 2013, an estimated
42 million children aged under 5 years (6.3%) were overweight, an increase from around 5% in 2000
to 6% in 2010 and 6.3% in 2013, with the highest rates of increase being observed in Africa and Asia.
Rapid changes from traditional to new diets, which contain large amounts of fat, sugar and oil is one of
the major causes of obesity. Obesity has been associated with higher rates of death driven by co
morbidities. According to the recent researches, the rate of obesity is significantly high in Saudi Arabia,
and expected to increase in future.
Aim of the study: To evaluate the association between the obesity and iron deficiency anemia among
children in Al-Taif Region, Kingdom of Saudi Arabia and to increase the awareness about the hazards
of obesity on the general health. Method: A cross sectional study design. A structured questionnaire
was designed to obtain the necessary information from a convenient sample of 200 child aging from (5-
12 years) attending the pediatric outpatient clinics of pediatric hospital in Taif region - Saudi Arabia
from August till November 2016. Information about weight, height, Body Mass Index (BMI),
Hemoglobin levels and the serum iron. The assessment of obesity with BMI index using the CDC2000
reference percentile was divided into four categories5th, 50th, 85th and 95th, namely; underweight,
normal, overweight and obese respectively. Iron Deficiency was defined as Transferrin Saturation lower
than 16% and Iron deficiency anemia was defined as Transferrin Saturation lower than 16% and
hemoglobin (Hb) concentration lower than 12 g/l or 12 mg/dl for children. Results: This study shows
negative significant correlation between hemoglobin level with the BMI ( r -0.429 p value 0.017 )
delayed weaning & no iron supplements ( r -0.338p value 0.023), bad food habits (r -0.309 p value
0.012) and warm disease, ( r --0.406 p value 0.028), suffering from poor food absorption disease (r
0.266p value 0.033) and chronic diarrhea ( r -0.311p value 0.011) . The prevalence of anemia among
the study group shows 60% of its group are suffering from high BMI 79.2% of them suffering from
IDA, while 20.8% are healthy. 40% of study group are with normal BMI 21.25% of them are suffering
from anemia while 63% are healthy. Conclusions: Hepcidin plays a central role in the anemia of chronic
disease and Hepcidin overproduction even in mild inflammatory disorder as obesity may explain the
association of poor iron status with obesity. IL6 and Leptin may be part of the axis that links obesity,
inflammation, and Hepcidin with poor iron status. This study suggests that the higher levels of total
obesity should be taken into account when assessing the children's body iron status and should be
treated before providing dietary recommendations to correct anemia.
Keywords: Iron Deficiency anemia, Obese Children, hemoglobin level, Hepcidin.


The growing global health problem is obesity
obesity and iron deficiency may lead to adverse
which has increased dramatically in recent
health issues2.
years 1. The prevalence of obesity
In 2013, an estimated 42 million children
continues to rise in developed and developing
aged under 5 years (6.3%) were overweight, an
countries, Poor iron status are affecting millions
increase from around 5% in 2000 to 6% in 2010
of people worldwide. Iron deficiency is the first
and 6.3% in 2013,with the highest rates of
nutrient deficiency all over the world and both
increase being observed in Africa and Asia3.
Received: 11/8/2018
Accepted: 21/8/2018

Full Paper (vol.735 paper# 24)

c:\work\Jor\vol735_25 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (5), Page 6753-6762

Diagnostic Performance of Point of Care Ultrasonography in Identifying
Etiology of Respiratory Distress in Neonates
Hany Abdul-Hady El-Khaleegy, Elsayed Mohamed Abd El-Hamid Hassan, Hoda Abd El
Hareth Ibrahim Shehata
Department of Pediatrics, and Department of Radiology, New Damietta Faculty of Medicine,
Al-Azhar University, Damietta, Egypt
Corresponding author: Hany Abdul-Hady El-Khaleegy, Email: hodaabdelhareth@gmail.com

Numerous studies have shown the role of lung ultrasound in identifying etiology of
respiratory distress in neonates. Aim of the Work: was to detect the efficacy of ultrasonography versus
x-ray in identifying the etiology of respiratory distress in neonates. Patients and Methods: A cross
sectional study that includes 50 neonates with respiratory distress. Each included subject was submitted
to history taking, complete clinical examination and laboratory investigations including complete blood
count and chest radiograph & US images. Results: In the present work, there was no significant
difference among sex distribution and mode of delivery but male sex and cesarean sections are the
predominant in each group. The reasons for respiratory distress from the clinical diagnosis were
respiratory distress syndrome (n = 22), transient tachypnea of newborn (n = 23) and pneumonia (n = 5).
The chest radiograph diagnosis of respiratory distress was RDS in 22 neonates, transient tachypnea of
newborn in 24 neonates, pneumonia in 2 neonates and RDS or pneumonia in 2 neonates. Overall from
the clinical scenario and radiological findings, the final diagnosis was RDS in 24 neonates, TTN in 24
neonates and pneumonia in 2 neonates. The ultrasound diagnosis of respiratory distress was RDS in 24
neonates, TTN in 24 neonates and pneumonia in 2 neonates. Conclusion: This study shows a clear
superiority of lung ultrasound over the chest x-rays for the diagnosis of RDS, TTN and pneumonia.
Chest Ultrasound cannot replace standard chest X-ray in detecting severity of neonatal RDS because of
its tendency to overestimate RDS.
Key words: Point of care ultrasonography, chest x-ray, RDS, TTN, pneumonia

Respiratory distress is one of the most common
of gestational age, in 15-30% of those between
reasons of admission to the neonatal intensive
32 and 36 weeks, in about 5% beyond 37
care unit. Fifteen percent of term infants and
weeks, and rarely at term (5). Transient
29% of late preterm (1). Respiratory distress in
tachypnea of the newborn (TTN) is a
the newborn is recognized as one or more signs
parenchymal lung disorder characterized by
of increased work of breathing, such as
pulmonary edema resulting from delayed
tachypnea, nasal flaring, chest retractions, or
resorption and clearance of fetal alveolar fluid
grunting. If the newborn cannot sustain the
(6). Neonatal pneumonia is a serious respiratory
extra work of breathing to meet its respiratory
infectious disease caused by a variety of
needs, respiratory failure follows. This failure
microorganisms, Group B Streptococcus
may manifest as impaired oxygenation
accounts for most cases. Reported frequencies
(cyanosis) or ventilation (respiratory acidosis)
of neonatal pneumonia range from 1 to 35 %,
(2). Transient tachypnea of newborn (TTN),
the most commonly detouq figures being 1
respiratory distress syndrome (RDS) and
percent for term infants and 10 percent for
Pneumonia are the most common etiologies of
preterm infants (7). Radiographs are considered
respiratory distress in newborn. Due to their
gold standard in understanding the etiology of
similar clinical presentations, it is often difficult
RD in newborns. However excess exposure to
to differentiate one from the other (3). RDS is
radiation in a growing neonate in early part of
the most common cause of respiratory distress
life may have long term consequences. So there
in newborn. It occurs almost primarily in
is a need for a non-invasive, bedside test, more
preterm infants and its incidence inversely
baby friendly, and even if repeated multiple
proportional to gestational age and birth weight.
times is safe for the newborn. ultrasound chest
It occurs due to deficiency, inactivation or
appears to be the ideal choice diagnostic tool in
dysfunction of pulmonary surfactant (4). It
etiology of respiratory distress in newborn (3).
occurs in 60-80% of infants less than 28 week
Point-of-care ultrasound refers to the use of
Received: 11/9/2018
Accepted: 21/9/2018

Full Paper (vol.735 paper# 25)

c:\work\Jor\vol735_26 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (5), Page 6763-6766

Assessment knowledge and attitude and practice toward GERD among
smoker in Riyadh City, 2018.

Saad Mohammad Alshahrani, Abdullah Odah Alahmari, Abdulaziz Jarallah N Alobaidi

Imam Muhammad ibn Saud Islamic university

The risk of GERD is significantly associated with smoking which could increase the
reflux symptoms.
Objectives: Assessing the knowledge, attitude and practice (KAP) toward GERD among smokers at
Riyadh, Kingdom of Saudi Arabia (KSA).
Methods: A prospective randomized controlled study based on a questionnaire sheet that was conducted
at Saudi Arabia, from March to July 2018.The study included 390 medical students randomly chosen
from different faculties of medicine around KSA.
Results: Most of the subjects have adequate knowledge and good attitude about the GERD disease, its
causes, symptoms, the association of drinking and smoking with initiation of the disease and the effect
of life style modifications on the management of GERD. The level of practice was inadequate among
most of the participants as the majority of them won't stop smoking, change their lifestyle and eating
habits even they had GERD.
Conclusion: The Knowledge level was significantly adequate which resulted in positive attitudes
among most of the subjects. However, the level of practice was insufficient which may result in
impairing the quality of life and increasing the prevalence of the disease.
Knowledge, Attitude, Practice, Gastroesophageal reflux disease (GERD), smokers, Riyadh,


Gastroesophageal reflux disease (GERD) is the
most common gastrointestinal (GI) diseases
Study design:
among adults around the world especially
This is a prospective controlled study based on
western and Asian countries (1, 2). It is triggered
a questionnaire sheet that was directed at
by an irregular reflux of gastric contents to the
Riyadh City, KSA, from May to August 2018.
esophagus. Its symptoms include indigestion
Study population and sample size:
and acid vomiting (3, 4).
The sample size was determined using the web
GERD is not life-threatening but it is associated
calculator (10)after taking the total size of
with impairing the quality of life when
Riyadh population(11). The study was supposed
compared to other chronic diseases (5). The
to include 240 subjects who were randomly
chosen and interviewed in shopping malls
modification of lifestyle factors as obesity,
distributed at different parts of KSA. The
being overweight, eating habits, alcohol
inclusion criteria were Saudi male smokers
drinking and smoking (6).
aged from 20-60.
Many studies have shown that the risk of GERD
is significantly associated with smoking which
could increase the reflux symptoms (7-9). Also,

smoking cessation reduced the prevalence of
The study questionnaire was conducted
GERD, reduced the severity of reflux
after reviewing the available studies regarding
symptoms, and improved HR-QOL (9). This
the definition, risk factors, symptoms,
study aimed at assessing the knowledge,
management of the disease and its association
attitude and practice (KAP) toward GERD
with smoking. The questionnaire was revised
among smokers at Riyadh, Kingdom of Saudi
by 3 experts then translated into simple Arabic,
Arabia (KSA).
tested in a pilot study among 50 Saudi males

then modified and validated. The questionnaire

involved 4 parts regarding the demographics' of
Received: 05/9/2018
Accepted: 15/9/2018

Full Paper (vol.735 paper# 26)

Full Paper (vol.735 paper# 27)

c:\work\Jor\vol735_28 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (5), Page 6773-6784
Comparative Study between Fibro-Test and Egy-Score as Non-Invasive
Markers for Assessment of Hepatic Fibrosis in Chronic Hepatitis C
Fathy Ghamry Abd El razek Elghmary1, Hosni Abd El Kariem Younis1, Mohammed
Mahmoud Noser1, Ayman Abd Al Aziz Abd Al Rahman1, Mohammed Yousri Shaheen2 &
Ahmed Mohammed Mostafa1*
Departments of 1Internal Medicine and 2Clinical Pathology ,Faculty of Medicine, Al-Azhar University
*Corresponding author: Ahmed Mohammed Mostafa, Mobile: 002010666866572, E-Mail: ahmedmostafa94@gmail.com
Liver fibrosis (LF) occurs in response to almost all causes of chronic liver injury.
Assessing LF is important for both predicting disease progression and monitoring efficacy of
therapeutic measures. Most noninvasive tests of liver fibrosis were developed with the aim of
discriminating between "insignificant", (F0-F1) by METAVIR and clinically "significant" fibrosis (
F2) by METAVIR or for identifying or excluding established cirrhosis in patients with well compensated
chronic liver disease. Both these aims are clinically the most relevant. Aim: We aimed to compare the
diagnostic accuracy of FibroTest and Egy-Score as predictors of stage of hepatic fibrosis in a
prospectively enrolled cohort of Egyptian patients with chronic hepatitis C. Patients and Methodlogy:
Twenty patients, treatment naïve chronic hepatitis C patients were enrolled. They were 16 males (80%)
and 4 females (20%) mean age of these patients was 53.55 +14.3 (rang 18_73 years). The study was
carried out in the Department of Gastroenterology and Hepatology, Elhussin hospital, Al-Azhar
University during the period between March 2016 and March 2018. Results: Our results showed a
highly significant positive correlation between stage of hepatic fibrosis by METAVIR and fibrotest. Our
results showed a highly significant positive correlation between stage of hepatic fibrosis by METAVIR
and EGY-SCOR. Our scores depend mainly on simple routinely used laboratory parameters (total
bilirubin, albumin, platelet count) in addition to age and 2 non routine tests (CA 19-9 and Alpha-2-
Macroglobulin). Although this panel needs to be done in validated laboratories, the cost of our score is
much cheaper than other well-known and patented tests such as FibroTest and the net results of both
methods nearly the same. Conclusion: Egy-Score can be applied easily in clinical practice to exclude
severe hepatic fibrosis/cirrhosis in patients with contraindication for liver biopsy or those who are
reluctant to do it. Egy-score would need further valida¬tion to be regarded as an alternative to liver
biopsy. Recommendations: Physician should be careful when interpreting elevated levels of tu¬mor
markers CA 19-9 and CA 125 in patients with chronic liver disease as this could be a benign elevation
related to hepatic fibrosis and not necessarily due to underlying malignancies. Elevation of the tumor
markers such as CA19.9 have been associated with cholestasis in liver disease patients and this may
give false positive results for our scores which give Limitations to our study.
Keyowrds: Fibro-Test, Egy-Score, Chronic Hepatitis C


Liver fibrosis (LF) occurs in response
fibrosis markers, liver stiffness measurement
to almost all causes of chronic liver injury.
using FibroScan (Echosense, Paris, France) (3),
Assessing LF is important for both predicting
various imaging methods and glycomics (4).
disease progression and monitoring efficacy of
Biochemical markers of LF, because they can
therapeutic measures (1).
be tested noninvasively, reproducibly, and
Invasive diagnosis using liver biopsy
reliably, may constitute a true alternative to
with histological examination is most
liver biopsies (5).
commonly used as reference standard for the
Several noninvasive direct and indirect
assessment of fibrosis but is hampered by
serum markers, capable to predict the presence
several disadvantages: large sampling error,
of significant fibrosis or cirrhosis in patients
consistent inter-observer disagreement, high
with chronic liver disease have been reported
emotional cost of patient and enormous health
care commitment in case of rare but possible
Fibro-Test is considered the most
severe complications (2).
widely used and validated noninvasive test for
assessment of hepatic fibrosis; especially in
measuring the degree of hepatic fibrosis have
chronic hepatitis C (2).
been developed, such as surrogate serum
Fibro-Test is composed of 6
Received: 16/8/2018
Accepted: 26/8/2018

Full Paper (vol.735 paper# 28)

c:\work\Jor\vol735_29 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (5), Page 6785-6788

Fear of falls among nursing homes residents and community dwelling

Motassem S. Amer, Asmaa F. Abdellah, Eman S. Elsayed*
Department of Geriatrics and Gerontology, Faculty of Medicine, Ain shams university, Cairo, Egypt
*Corresponding author: Eman S. Elsayed, Email: emansaad432@gmaill.com, Tel.: 01025438118

fear of falling is common among elderly faller and it has been associated with impaired
mobility and decreased functional status. As a result, older adults who have fallen are at greater risk of
becoming institutionalized regardless of whether they have experienced an injurious fall.
Objectives: the aim of the study is to assess the prevalence of fear of falls in elderly in geriatric home
and in community dwelling elderly.
Subjects and Methods:
A comparative study.
Participants: 100 resident in nursing homes in Cairo and another 100 in community.
Measurements: comprehensive geriatric assessment (CGA) including Minimental status examination
(MMSE-30), Geriatric Depression scale (GDS-15), Mininutritional assessment (MNA), time up and go
test (TUGT), activity of daily living (ADL), instrumental activity of daily living (IADl), Single item
question "are you afraid of falling?"
Results: the study showed that the prevalence of fear of falls in elderly living in nursing homes in Cairo
is higher than others living in community, also showed that a higher percentage of environmental factors
of falling among elderly in nursing homes compared to community, higher percentage of elderly with
risk of fall living in nursing homes.
Conclusion: prevalence of fear of falls is higher in elderly living in nursing homes in Cairo than others
living in community.
falls, fear of falls, elderly, community, geriatric homes

Older people make up a large and increasing
older adults. The reported prevalence of FOF
percentage of the population of countries
varied between 3­85% (3). However, when FOF
worldwide. As people grow older they are
results in avoidance of activities and reduction
increasingly at risk of falling and suffering
of physical fitness, it is a risk factor for future
injury from falling (1).
falls and associated mortality, dysfunctioning,
Upon aging there is a progressive decrease in
and premature nursing home admissions (3).
functional capacity, verified by reduced
strength of lower limbs, impaired balance and
FOF is defined as an exaggerated concern
agility. Such changes may impact a patient's
about falls or the belief that one cannot prevent
daily activities such as climbing and descending
a fall. Intense anxiety about falls can be
stairs or siting and standing up from a chair,
experienced by older adults who have fallen, as
besides reducing the ability of the elderly to
well as those who have not. Although studies
promptly respond to external disturbances, such
have shown that women are at an elevated risk,
as slipping and stumbling, and to restore
fear of falls affects both men and women(4).
balance (2).
FOF and activity avoidance may result in social
Fear of falling (FOF) is a major health problem
isolation and inactivity, and threatens the
among the elderly living in communities,
quality of life if preventive measures are not
present in older people who have fallen but also
taken in immediate future, the numbers of
in older people who have never experienced a
injuries caused by falls is projected to be 100%
fall. An estimated 30­55% of older persons
higher in the year 2030 (5).
acknowledge being afraid of falling, and
approximately one third of them report
Fear of falling may be a reasonable response to
restricting their activities. FOF has gained
certain situations, that may lead elderly persons
recognition as a specific health problem among
to be cautious, and can contribute to fall
Received: 06/9/2018
Accepted: 16/9/2018

Full Paper (vol.735 paper# 29)

c:\work\Jor\vol735_30 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (5), Page 6789-6796

Cruciate ligament injury among students of Northern Border University,
Saudi Arabia
Abdurhman Aiash Alrwaili 1, Malik Azhar Hussain2, Nagah Mohamed Abo El-fetoh 3, Omar
Nasser S Alrawili 1, Khalid Saud M Alruwaili 1, Abdullah Asaad Al Herz 4, Faisal Saleh Q
Alanazi 1, Saif Khamees F Almutrafi 1, Faisal Eid N Alanazi 1, Omar Mohammed Alenezi 1,
Abdulaziz Ayad ALanazi 1, Alshammari Taleb Mukhlef 1, Fahad Safar Alshaibani 1

1Faculty of Medicine, Northern Border University, Arar, 2Department of Surgery, College of
Medicine, Northern Border University, Arar, 3Community Medicine Department, Sohag
University, Egypt and Northern border university, Arar, 4Imam Abdurrahman Bin Faisal
University, Dammam, Saudi Arabia

Background: cruciate ligament consists of the anterior cruciate ligament (ACL) and posterior cruciate
ligament (PCL) and they go from the femur to the tibia. The cruciate ligaments function is mainly to
stabilize the knee and these ligaments have a risk to be injured in the athletes as well as non-athletes.
Objective: address the prevalence of cruciate ligament injuries and its association with different types
of injuries among Northern Border University students, Arar, KSA. Methods: A cross-sectional study
was conducted among a representative sample of Northern Border University students in Arar City,
Kingdom of Saudi Arabia, during the academic year 1439­1440. The students received the
questionnaire to complete it. The parameters included in the questionnaire included age, sex, cause of
cruciate ligament injury as during football playing, motor car accident, side and type of injury, type of
treatment whether surgical treatment, physiotherapy or medical treatment. Results: This study reported
the prevalence of cruciate ligaments injury among the studied Northern Border University students in
Arar city, Kingdom of Saudi Arabia was 5.7%. The age of the studied ACL injury cases ranged from
18 to 30 years with mean age (±SD) was 23.0 ± 4.2 years. Most of cases (98.6%) were males. Playing
football was the most common cause by 78.9% followed by motorcar accidents 7%, fall from stairs
5.6%, swimming 4.2% and fall from height 2.8%. As regards the side of the injured cruciate ligament,
60.6% had anterior cruciate ligaments injury, 8.5% had posterior cruciate ligament injury, and 18.3 %
had injury in both sides. In the majority (54.9%) of cases, ACL tear was complete; partial in 38.0%.
14.1% received medical treatment, surgical treatment and physiotherapy by the same percent 32.4%,
medical treatment and physiotherapy 15.5%. As regards outcome of treatment, this study reported
74.6% of patients become good and stable, 23.9% still complaining and 1.4% suffering from disability.
Conclusion: This study reported the prevalence of cruciate ligaments injury among the studied
Northern Border University students in Arar city, Kingdom of Saudi Arabia was 5.7%. Most of cases
(98.6%) were males. Playing football was the most common cause by 78.9% followed by motorcar
accidents 7%. As regards outcome of treatment, this study reported 74.6% of patients become good and
stable, 23.9% still complaining and 1.4% suffering from disability.
Keywords: cruciate ligament injuries, students, Northern Border University, Arar, playing football,

Knee joint is the largest joint of the body.
risk to be injured in the athletes as well as non-
Stability of the knee joint is very important,
athletes. The ACL is the ligament in the front.
depends mainly on four ligaments namely;
It is one of the main static and functional
medial, and lateral collateral ligaments, anterior
stabilizing structures of the knee, the one most
and posterior cruciate ligaments [1].
commonly injured, and its reconstruction is
Cruciate ligament consists of two large
frequently performed [1]. The incidence of
ligaments each about the size of little finger
anterior cruciate ligament injury, which
inside the knee that cross deep inside the joint.
accounts to be involved in the majority of
They are called the anterior cruciate ligament
cruciate ligament injury by 100,000 to 200,000
(ACL) and posterior cruciate ligament (PCL)
[2,3]. ACL reconstruction is essential to restore
and they go from the femur to the tibia. The
the rotational stability of the knee, but its role in
cruciate ligaments function is mainly to
prevention of knee joint degeneration remains
stabilize the knee and these ligaments have a
unknown [4].
Received: 04/9/2018
Accepted: 14/9/2018

Full Paper (vol.735 paper# 30)