c:\work\Jor\vol736_1 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (6), Page 6797-6801

Breast Cancer Awareness And Attitude Among Adult Females, Eastern
Province, Saudi Arabia
Mohammed J Alnuwaysir, Taleb A Alali, Salman M Alhajri, Husain A Bukhamseen, Ahmed H
Aldandan, Mohammed H Alomrani
King Faisal University & AlDammam University
Corresponding author: Mohmmed J Alnuwaysir, Mobile: +966564477984, Email: alnowaysir@gmail.com
Abstract
Background:
Breast cancer (BC) is the most common type of malignancy in women around the world.
In Saudi Arabia, a total of 6,922 female BC cases were recorded in the Saudi Cancer Registry during
the period from 2001-2008. Eastern province has the highest prevalence rate in Saudi Arabia at 26.6
per 100,000 women, followed by Riyadh 20.5 then other regions. Materials and Methods: Cross
sectional study, was carried out on random, adult females 18 years old or more in eastern province,
Saudi Arabia. They were approached to participate in a questionnaire about BC. The questionnaire
(either paper or online), consent forms were taken. Data were analyzed by demographic criteria,
including age, gender, marital status, and level of education, to determine if there are any difference
between them. Statistical analysis: Data were analyzed using Statistical Package for Social Sciences
version 23 (SPSSv23). Results: In total, 555 participants completed the survey. Most of them believed
that screening should begin before the onset of the symptoms (63%). less than one third of participants
believed in early menarche, late menopause, and nulliparous. Their answers were varied according to
their education levels. Even though, there were some misconceptions with high educated people.
Conclusion: Although higher education and older individuals tended to answer questions correctly
more than others, there is a need to improve the knowledge about the BC and its screening guidelines
to encourage them to go through these tests. A national education program in Saudi Arabia is
recommended to improve BC knowledge.

Introduction
Breast cancer (BC) is the most common type of
rectal carcinoma, and breast cancer is
malignancy in women around the world,
sometimes associated with predisposing
Information on the incidence and mortality of
mutations in the germ line but is essentially a
BC is essential for planning health measures,
somatic cell genetic disease (4).
According to GLOBOCAN, it is the most
The incidence and mortality rates for BC differs
common cancer in women, for 25.1% of all
according
to
ethnicity,
despite
huge
cancers (1). In the Western world, BC is the most
improvements in BC treatment and overall
frequent cancer type in females1, in Saudi
survival rates, there still remains some
Arabia, a total of 6,922 female BC cases were
interesting differences according to racial
recorded in the Saudi Cancer Registry during
background, and by race. In general, it is safe to
the period from 2001 to 2008(2). The highest
say that the incidence of BC has increased over
overall percentages (38.6% and 31.2%) of
the years, while the mortality rates have
female BC cases were documented in women
decreased (5). In general, BC incidence in
who were 3044 and 4559 years of age,
developed countries is higher, while relative
respectively. Eastern province has the highest
mortality is greatest in less developed countries.
prevalence rate in Saudi Arabia at 26.6 per
This is probably due to better screening
100,000 women, followed by Riyadh 20.5 and
programs and increase awareness about the
Makkah at 19.4, then other regions (3). Our
importance of Self Breast Examination (BSE)
knowledge and understanding of the molecular
and improves targeted therapy (6).Some studies
events relating to BC biology and pathogenesis
speculated that certain racial groups are
has greatly increased over the last 10 years (4).
genetically more or less predisposed to BC
The development of BC involves several types
development. However, other medical experts
of genes that need to be inactivated or activated
point to socio-economic factors to explain the
in order to promote malignancy. The sequential
difference in BC incidence and mortality rates
steps in gene alterations with respect to tumor
(5). Geographic differences for BC incidence
progression are not clear and are far less well
were explained by environmental exposures
understood than what is currently the best
and dietary habits (7). This information was
example of tumor progression that is, colo-
provided by some researches of migrants
7676
Received: 07/9/2018
Accepted: 17/9/2018

Full Paper (vol.736 paper# 1)


c:\work\Jor\vol736_2 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (6), Page 6802-6811
Comparative and functional study of integumentary system of two
different reptiles: adaptation to their different modes of life
Samy A. Saber1, Boshra A. ElSalkh2, Ali G. Gadel-Rab3, Fatma A. Mahmoud4, Asmaa A. El-
Dahshan2, Doaa I. Gewily2
1Department of Zoology, Faculty of Science (Boys branch), Al-Azhar University, Cairo, Egypt
2Department of Zoology, Faculty of Science (Girls branch), Al-Azhar University, Cairo, Egypt
3Department of Zoology, Faculty of Science, Al-Azhar University, Assiut, Egypt
4Department of Zoology, Faculty of Science, Assuit University, Assiut, Egypt

Corresponding author: Doaa esmail,email: doaa_esmail2000@yahoo.com
Abstract
Aim of the work: the present study aimed to illustrate the structure and function of the
integumentary system of two reptile's species (Bosc's fringe toed-lizard (Acanthodactylus boskianus,
A. boskianus
) and spotted fan-fingered gecko (Ptyodactylus guttatus , P. guttatus) and discussed the
influence of different behaviors on their structure (keratinzation and pigmentation, claws, adhesion pads
and sensory hairlets). Material and methods: the present study used light and scanning electron
microscopy to investigate the structure of skin layers of A. boskianus and P. guttatus. Results: the thin
epidermal layer of Acanthodactylus boskianus was covered by hard keratinized horny epidermal scales,
while the epidermal layer of Ptyodactylus guttatus was well distinguished and covered by soft
keratinized layer. Moreover, in P. guttatus the scales were non-overlapping along the whole length of
the body with dome-like shaped on head region, while in A. boskianus the scales were overlapping and
articulating with each other by thin hinge. In the present study the dermis of A. boskianus, was the
deeper layer of collagenous connective tissue with a rich supply of blood vessels and nerves, while, the
dermis of P. guttatus was formed of both collagenous and adipose tissues. Three types of
chromatophores (melanophores, iridophores and xanthophores) were distinguished in the skin of both
studied species. In A. boskianus, the melanophores were black, large and have dendrites invaginates in
the stratum basale of epidermis. The iridophores (reflecting pigments) were scattered in the dermis with
large number in the ventral skin than the dorsal one. In P. guttatus, melanphores they were larger,
blackish brown and scattered within dermis beneath the iridophores with less number in P. guttatus than
that of A. boskianus. Xanthophores (absorbing pigment) were more prominent in P. guttatus than that
of A. boskianus. Conclusion: examination of the skin of the two studied reptile species revealed great
variations in distribution of chromatophores through the whole body reflecting the adaptation of each
animal to different modes of life.
Keywords: skin, scales, chromatophores, foraging activities, reptiles
Introduction
Skin is phylogenetic source of surface
ultraviolet protection. For better mechanical
specialization which reflects a greater
protection, diverse reptilian scale types have
commitment of animals to a terrestrial existence
evolved [2]. Starting from these basic needs,
[1]. Perhaps the focus of evolutionary events in
different types of reptilian scales are evolved in
the integument has been as much on this
the Mesozoic period to serve different functions
interaction as on layers themselves. The
[3] and adapt diverse species to the different
epidermal-dermal interaction is evident even in
niches. The pigmentation on the integument of
tissue transplants between species from
animals forms one of the most dramatic and
different classes. Reptiles represent the first
conspicuous biological patterns. The epidermis
amniotes. From stem reptiles, extant reptiles,
of lepidosaurians (lizards, snakes, and
birds and mammals have evolved. When
sphenodontids) is of particular complexity and
reptiles established themselves on land, their
interest [4]. It has very colourful scales and is
integument can adapt to the challenges of
organized in an attractive pattern with hard
terrestrial life, developing a multi-layered
(beta) and soft (alpha) layers [2]. A scaly,
stratum corneum which is capable of barrier
keratinized integument is one of the
function and protects the body from abrasion,
characteristic features that airproof the skin of
dehydration,
microbial
infections
and
reptiles [4]. In the dermal skin of reptiles four
6802
Received: 07/9/2018
Accepted: 17/9/2018

Full Paper (vol.736 paper# 2)


c:\work\Jor\vol736_3 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (6), Page 6812-6817

Peptic Ulcer among Patient with Ischemic Heart Disease at Taif City
1Anood Qalil Awwad Althubaiti, 1Mohammed Ateih Awwad Alsofyani , 1Nawal Swailem
Alotaibi, 1Fahad Mahdi Moeidh Alsuwat, 1Samaher Abdullah Marzouq Alnefaie, 1Raghad
Hasan Ahmad Almosauie, 1Hadeel Salem Alwagdani, 2 Mohammed Moughrabi
1Taif University, 2 King Faisal Medical Complex
Corresponding author's: Anood Qalil Awwad Althubaiti, email:althubaitianood@gmail.com, mobile:+966569092314

Abstract
Objectives: A peptic ulcer is a common problem that occurred because of H. pylori infection and the
use of nonsteroidal anti-inflammatory drugs. Epigastric pain is the most common symptom. It is
characterized by burning sensation occur after meals. This study was conducted to assess peptic ulcer
among patient with ischemic heart disease at TAIF city. Methods: We conducted a cross sectional
study on 426 ischemic heart disease patients. The data were collected through interview with the
patients and self-report questionnaire which include a set of socio-demographic variables (gender, age,
sex, weight, city, smoking, drinking tea and coffee) and clinical variables (systolic, diastolic, pulse,
respiratory rate, oxygen saturation) in 1/8/2017 to 17/9/2017 and approved by King Faisal medical
complex in Taif city. Both genders above 40 years were included and excluded patients below them
and patients without ischemic heart disease. Statistical analysis was performed using SPSS. Results:
Of the 426 ischemic heart disease patients at TAIF city who were investigated, 229 (53.8%) were female
and 197 (46.2) were male. The mean age was 64.5 years (SD=12), ranging from 25 to 100 years. As for
BMI, 297(69.7%) had overweight and obese. The mean systolic was 143.49 (SD=22.9). The mean
diastolic was 76.31. In total, 24.2% of patients were classified as Peptic ulcer and 75.8% had Non-
Peptic ulcer symptoms. No statistical significance was found between the mean of Non-Peptic ulcer
and Peptic ulcer patients in terms of oxygen saturation, systolic, diastolic, age, pulse and respiratory
rate. A significant statistical relation was found for City that they lived in (P=.027), type of oils that
he/she use it for cooking at home (P=.008), stress (P=0.002) and sex (P=.032) for Non-Peptic ulcer
symptoms and Peptic ulcer symptoms. Conclusion: This study demonstrated a low prevalence of peptic
ulcer among ischemic heart disease patients at TAIF city. Insomnia was associated with gender, type of
oil, stress and city that they lived in but no significant association with BMI, taking aspirin, doing
exercise and smoking.
Keywords: Ischemic heart disease, Awareness, Attitude, Knowledge, Taif and Saudi Arabia.

Introduction:
Peptic ulcer can be defined as mucosal lesions
(called the "duodenum"). The most common
that penetrate the muscularis mucosae layer and
causes of peptic ulcers are infection with the
form a cavity surrounded by acute and chronic
bacterium Helicobacter pylori (H. pylori) and
inflammation. Gastric ulcers are in the stomach,
long-term use of aspirin and certain other
often along the lesser curvature in the transition
painkillers, such as ibuprofen. NSAIDs,
zone from corpus to antrum mucosae. Duodenal
including aspirin, significantly increase the risk
ulcers are in the duodenal bulb (1).H. pylori
of adverse gastrointestinal events, particularly
infection and the use of nonsteroidal anti-
those related to gastric and/or duodenal
inflammatory drugs (NSAIDs) are the
mucosal injury: erosions, ulcers and ulcer
predominant causes of peptic ulcer disease in
complications, especially bleeding. Patients
the United States, accounting for 48 and 24
taking low-dose aspirin for the prevention of a
percent of cases, respectively. Smoking
cardiovascular event, such as myocardial
increases the risk of ulcer recurrence and slows
infarction or thrombotic stroke, are also at
healing (2). In other researches, Peptic ulcers can
increased risk of gastrointestinal injury and
be defined as open sores in the upper part of the
complications. In asymptomatic patients taking
digestive tract that can cause stomach pain or
low-dose aspirin (75-325 mg/day) for 3
stomach upset, and that can lead to internal
months, endoscopically observed ulcers or
bleeding. There are two types of peptic ulcers:
erosions. The risk of upper gastrointestinal
Gastric ulcers, which form on the lining of the
bleeding events is dependent on the dose of
stomach, And Duodenal ulcers, which form on
aspirin (3,4).
the lining of the upper part of the small intestine
Literature review:
2186
Received: 08/9/2018
Accepted: 18/9/2018

Full Paper (vol.736 paper# 3)


c:\work\Jor\vol736_4 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (6), Page 6818 6827
-

Maternal Vitamin D Level in Preterm and Term Labouras a Risk Factor

Ahmed Mohammed Tahoun*, TarekAbdElkareim El-Dahshan*, HishamFekry Ahmad Abu-
Senah* & Ahmed Sayed Ahmed Mohammed*
*Department of Clinical Pathology, Faculty of Medicine, Al- Azhar University
Corresponding author: Ahmed Sayed Ahmed Mohammed, Mobile: 00201096343038, E-Mail: ahm_mido88@yahoo.com
Abstract
Background: Preterm birth constitutes 5-18% of all deliveries and very low birth weight infants
comprise 4-8% of all live births. Significant advances in neonatal care have increased the survival rate
of premature infants. However, the associated morbidity continues to affect these infants despite the
increased survival rate. Preterm birth is the most important problem in modern obstetrics. More than 1
million infants born preterm (at less than 37 weeks of gestation) died worldwide, making it the second
leading cause of death in children under the age of 5 years.
Aim: The aim of this work was to study the role of vitamin D in Egyptian pregnant women at labour to
evaluate its predictive value in preterm labour.
Methodology: This study was conducted on 90 subjects of pregnant females at labor. Their ages ranged
from 14 to 40 years old. This study was carried out in collaboration of the Clinical Pathology and
Obs/Gyna Departments at Al-Hussein and Bab-Elshareyia University Hospitals, Faculty of Medicine,
Al-Azhar University. All participants were selected from the Obs/Gyna Department, Al-Hussein and
Bab-Elshareyia University Hospitals over a period from April, 2018 to July, 2018. In the present study
an attempt was done to determine whether the level of vitamin D in Egyptian pregnant females
correlates with preterm labor or not.
Results: Group 1 (study group): Mean vitamin D level is 10.93 ng/ml. 27 patients of this group (60%)
were suffering from vitamin D deficiency while the other 15 (33.3%) suffered from vitamin D
insufficiency and other 3 (6.6%) had normal vitamin D level. Group 2 (control group):.Mean vitamin
D is 16.15 ng/ml. This study showed highly statistically significant decrease (p value <0.001) in vitamin
D in the study group as compared to control group. 93% showed abnormally low 25-(OH) D levels for
cases having preterm labor where 60% of patients shows deficient 25-(OH) D (<12 ng/ml), 33% of
patients showed insufficient 25-(OH)D (>20 and <30 ng/ml), while 7%of cases showed normal vitamin
D level.
Conclusion: Vitamin D deficiency occurs in the majority of preterm labour cases in Egypt and therefore
decreased serum vitamin D levels are considered an additional risk factor in the pregnancy outcome.
Recommendation: For better assessment of vitamin D status, future studies should be done to evaluate
serum levels of Ca, Ph and PTH to assess the cause of deficiency, which will help in better management.
In addition, it is recommended to consider vitamin D supplementation and its efficacy as a new
important line of prophylaxis in pregnant females. Thereby prophylactic administration of vitamin D
could be useful and researches have to be done to approve this theory. Screening for vitamin D
deficiency seems of value in pregnant females.
Keywords: Vitamin D, Preterm labour, Pregnant women
Introduction:
Preterm birth constitutes 5-18% of all deliveries
Preterm infants who survive are at risk of
and very low birth weight infants comprise 4-
chronic lung disease, deafness, blindness or
8% of all live births. Significant advances in
other visual impairment, and learning and
neonatal care have increased the survival rate of
cognitive disabilities. The 12% rate of preterm
premature infants. However, the associated
birth in the United States ranks 131 of 184
morbidity continues to affect these infants
countries, behind many developing nations (3).
despite the increased survival rate (1)
The past 3 decades in the United States showed
.
little decline in preterm births, including the
Preterm birth is the most important problem in
earliest deliveries, which cause the most
modern obstetrics. More than 1 million infants
morbidity and mortality. Identifying potential
born preterm (at less than 37 weeks of
targets for preterm birth prevention is a public
gestation) died worldwide, making it the second
health priority (2). Preterm birth, as the largest
leading cause of death in children under the age
cause of neonatal deaths worldwide puts
of 5 years (2).
surviving children at risk for cerebral palsy,
6818
Received :
9
/
08 /2018
Accepted: 18/9/2018

Full Paper (vol.736 paper# 4)


c:\work\Jor\vol736_5 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (6), Page 6828-6837

Sleep and Academic Performance among Female Students in Al-Maarefa
Colleges, 2015-2016

Abrar Sayer Al-mutairi*,Shrouq Ahmad Rahhal, Meriam Sadiq Al-abdullah, Zainab Hussain
Al-ibrahim, Mada Bejad Al-mutairi, Rawan Adel Shafaay, Reem Ahmad Alanazi, Handi Adnan
Al-mshel, Hadeel Maher Moqbel, Norah Abdullah Al-habshan.
College Of Medicine, Al-Maarefa Colleges for Science & Technology, Riyadh, Saudi Arabia
*Corresponding author Abrar Sayer Al-mutairi, Email: abrarsayer@gmail.com, Mobile number: +966558178877

Abstract
Background:
College students experience a number of sleep problems, which may impact academic
performance, health, and mood. A common sleep problem among college students is sleep deprivation
and resulting in excessive daytime sleepiness (EDS).
Objective: To identify the relationship between sleep and academic performance of female students.
Methods: An observational cross-sectional study was done in Al-Maarefa colleges during the time of
2015 to 2016. Information on sleep period and quality was collected by a self-administered
questionnaire distributed on a sample of 150 students.
Main findings: Almost 71% of the students felt tired many times a week and felt sleepy during the
day. Moreover, 87% of the students felt sleepy in lectures long time within the week. 68% of the
students had 3.1-4 GPA on the preparatory year, and only 35% of the students had 6-8 hours of the
sleep per day. A strong relation was found between sleep hours on exam days and last GPA (p=
0.005). Another relation was found between sleep hours on weekdays and the last GPA (p= 0.04).
Conclusion: the data collected showed a high prevalence of insufficient sleep hours generally, and
on nights before the exam specifically and a strong relationship between exam day sleeping hours and
the final GPA. The average GPA is still high compared to the preparatory year GPA, even when the
number of sleeping hours declined compared to a preparatory year.
Keywords: Sleep, Academic Performance, Female, Students
Introduction
College students experience a number
process. Sleep deprivation experiments
of sleep problems, which may impact
conducted on humans have shown that
academic performance, health, and mood (1)
sleep deprivation causes impairment of
.A common sleep problem among college
performance,
vigilance,
attention,
students is sleep deprivation and resulting
concentration and memory (5).
in excessive daytime sleepiness (EDS).
Sleep is defined by the medical
Both biological and social factors
dictionary as a period of rest for the body
contribute to deprivation. Many college
and mind, during which volition and
students are older adolescents and are still
consciousness are in partial or complete
dealing with adolescent physiology such as
abeyance and the bodily functions partially
a biologically driven delayed sleep phase (2).
suspended (6). The sleep cycle is divided into
59% of adults 18 to 29 years of age describe
5 stages starting from a light sleep and
themselves as night-owls. Unable to fall
ending in the REM stage. For a person to
asleep earlier in the evening, they cannot
have a good quality sleep they must sleep
get enough sleep if they must get up early.
through the 5 stages without any
In addition, sleep may be voluntarily
interruptions. Other factors affecting sleep
sacrificed due to social factors or
is the time of sleep and number of hours
involuntarily curtailed because of living in
slept (7). According to the National Institutes
a noisy residence hall or apartment (3). A
of Health, the average adult sleeps less than
typical coping technique for dealing with
seven hours per night. In today's fast-paced
sleep deprivation is to attempt to make up
society, six or seven hours of sleep may
for lost sleep by increasing sleep on the
sound pretty good, Most healthy adults
weekends, a practice that actually worsens
(students) need between seven and a half to
the problem (4). Sleep is believed to have
eight hours of sleep per night to function at
facilitating role in learning and memory
their best. The healthy duration for healthy
6828
Received: 16/9/2018
Accepted: 26/9/2018

Full Paper (vol.736 paper# 5)


c:\work\Jor\vol736_6 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (6), Page 6838-6843

Attitude and practice regarding the use of multivitamins for hair fall: Cross
sectional study in Saudi Arabia

Shahad D. AlGhamdy, Bushra A. AlGarni, Faten Albukhari
Princess Nora bint Abdul Rahman University
Corresponding author:Shahad D. AlGhamdy,email:alghamdi.shahadd@gmail.com,mobile:0556866650

Abstract:
Background:
Despite the lack of evidence which support the hypothesis that usage of multivitamins are
effective in preventing hair fall, their use are still prevailing. Although recent studies demonstrated
interference of certain vitamins with certain analytical investigations, they are still practically in use without
medical supervision and/or control. Aim: To assess the Attitude and Practice of Using Multivitamins for
treatment of Hair Fall. Methods: A total number of 1015(females and males) were participated in this
study. They aged 18 or more responded to questionnaires on their perception and previous experience with
the use of multivitamins. Results: 44% of the participants used multivitamins for hair fall treatment, and
only 37.4% recommended using them under medical supervision. The rest were influenced by social media
(18.7%) friends and family (17.3%) by themselves (15%), and pharmacists (10.6%). 33.3% carried out
blood tests prior use and only (15.3%) had a follow up blood test. Figure 1. Shows side effects such as
abdominal pain, diarrhea and constipation were observed in (18.5%). (57.3%) reported noticeable
improvement in hair fall and it was significantly associated with the use of multivitamins for more than 3
months (p<0.01). Figure 2. Indicates that (63.5%) agreed on their effectiveness for hair fall treatment and
(61.4%) would attribute the effect to other factors. Conclusion: Additional studies are required towards to
validate and justify the benefit or downside of multivitamins for hair fall. Knowledge about the misuse of
multivitamins is crucial to avoid unnecessary harm.
Keywords:
Attitude; Practice; Multivitamins; Hair Fall
Introduction:
Hair fall (alopecia) in medical terms, is one of the
stress, hormonal changes, or medications.
common causes to visit the dermatology clinic.
Furthermore, some events could trigger (TE)
It's a problem of women, men and children.
including acute febrile illness; severe infection;
Almost one-half of men and one-third of women
major surgery; severe trauma; postpartum
experience hair falling during their lifetime1,2.
hormonal
changes,
hypothyroidism;
Hair fall can be divided to scarring and non-
discontinuing estrogen-containing medication;
scarring.
crash dieting; low protein intake; heavy metal

Non-scarring alopecia include androgenetic
ingestion; and iron deficiency8.
alopecia (AGA), telogen effluvium (TE), and
Different treatments are used in treating the
alopecia areata (AA), with androgenic alopecia
different types of hair fall. Most known and used
being the most common among men and
and prescribed treatments are supplements and
women3,4. AGA is an androgen-related condition
vitamins. In a study conducted in Saudi Arabia
in genetically predisposed individuals, different
2012, the attitude and practice of dermatologists
presentation could be noticed in men and women,
was assessed regarding prescribing minerals and
in women usually it's confined to the crown,
vitamins for their patients who suffer from hair
sparing the frontal hairline 1, while in men the
fall. Out of 144 dermatologists 60%
frontal hairline and the crown are the usual sites
recommended using vitamins and minerals for
of hair thinning2,5. Alopecia areata (AA) is an
treating at least one type of hair loss. The used
immune-mediated disease causing temporary or
and
supplements include: zinc, iron, vitamin D
permanent hair loss. It's well-defined round

patches mainly affecting the scalp6,7. Telogen
biotin. It was mainly prescribed for acute telogen
effluvium (TE), is a form of non-scarring
effluvium (62%)9.
alopecia characterized by diffuse, often acute hair
Unfortunately, sufficient studies are few that
shedding. It could be triggered by metabolic
assess the knowledge and practice of the
6838
Received: 10/9/2018
Accepted: 20/9/2018

Full Paper (vol.736 paper# 6)


c:\work\Jor\vol736_7 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (6), Page 6844-6846

Public Awareness toward Cervical Cancer among Saudi Females in AL-
Ahsa city, Saudi Arabia

Mahdi Mousa Al-Muhanna, Sadiq Jawad Alkhalifah, Mufeed Mohammed Al-Muhanna, Jawad
ahmad alkhars, Afnan Tawfiq Hanfish, Zainab moosa Al-yousif, Sukaina Hussain ALIbrahim,
Sakinah Salman ALHumud, Rabab abdrab alnabi AlMajed, Fatimah basim bin alshaykh,
Khadijah Jassim AlHassan

Maternity and children hospital in Al-Ahsa city, Saudi Arabia
ABSTRACT
Background:
Cervical cancer is the third most common malignancy in women worldwide, and
it leads to death if not diagnosed early and treated properly. Also, it is considered as one of the
most common cancer related death in developing countries.
Objectives: To assess the level of awareness toward cervical cancer, risk factors, early detection
and prevention among Saudi females.
Methods: a cross-sectional study was carried out among 450 Saudi females aged 18-60 years old
in the period from August 2018 to September 2018. The participants were randomly chosen for
this study.
Results: 450 participated Saudi females have filled the questionnaires. The vast majority of
participants had heard about cervical cancer (86.7%) but most of participants (80%) do not know
if HPV infection could transmit from husband to wife. More than half of participants (61%) knew
that there is available vaccine against human papilloma virus. 90% of participants have never
done cervical screening to detect HPV or cervical cancer.
Conclusion: There is low level of awareness towards cervical cancer and its prevention's
methods among Saudi females. Thus, we need to increase the educational campaigns to increase
the level of awareness about this fetal disease and its prevention methods.
Keywords: Cervical cancer, Female, Saudi Arabia, Awareness.
INTRODUCTION
Cervical cancer is the third most
September 2018. The participants were
common
malignancy
in
women
randomly chosen for this study.
worldwide, and it leads to death if not

A structured questionnaire was
diagnosed early and treated properly.
designed to assess the awareness of
Also, it considered as one of the most
cervical cancer, early detection, and
common cancer related death in
prevention of risk factors.
developing countries. (1).

SPSS version 21was used for data
More than half million new cases are
entering and analysis.
diagnosed each year around the world with
Ethical and privacy purposes were
cervical cancer and about (80%) of cervical
ensured for every participants and this
cancer cases occur in low socioeconomic
study was done by residents from the
countries where it is the most common type of
maternal hospital in Al-Ahsa city.
cancer (2). In Saudi Arabia Cervical cancer is

the 12th most common cancer among women
RESULTS
(3). Human Papilloma Virus (HPV) infection

known as risk factor for cervical cancer, thus
Four hundred and fifty participants were
prevention of HPV infection will lead to
included in this study; all of the
decrease the incidence of cervical cancer. In
participants were female (100%) and
addition, there is available vaccine against
more than half of respondents aged 31-
HPV and should be used for both males and
40 years old (51.5%). Regarding the
females (4).
education level, the vast majorities of

participants (71%) were still in college or
METHODS
had college degree. (table1)



A cross-sectional study was distributed

among 450 Saudi females aged 18-60 years old

in the period between August 2018 and
6844
Received: 10/9/2018
Accepted: 20/9/2018

Full Paper (vol.736 paper# 7)


c:\work\Jor\vol736_8 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (6), Page 6847-6853

Evaluation of Anterior Cruciate Ligament Partial Tear Injury
Management
Asma Soud Badr1, Bodoor Salmi Almotairi2, Abdulrahman Ahmed Alamir3, Abdulrahman
Mohammed Fahad Aldawsari4, Ammar Osama Alaaddin5, Ayman Khalil Alrushaydan6, Ahmed
Muteb Alanazi6, Abdalrashid Faisal Halawani7, Zead Ibrahim Alhussain8, Mansour Mana Al-
ghufaynah9


1-King Faisal Hospital_ Makkah, 2- Taibah University, 3- Majmaah University,4- Prince Sattam
Bin Abdulaziz University, 5- Umm Al-Quraa University, 6- Aljouf University, 7- King Abdulaziz
University, 8- Arabian Gulf University,9- Alexandria University

Abstract
Background:
Cruciate ligament is divided into two ligaments (Anterior Cruciate Ligament & Posterior
Cruciate Ligament) and is attached to the femur and tibia. The rate Anterior Cruciate Ligament partial
tear is high among athletes and it is relatively high in comparison to other knee injuries. Anterior
Cruciate Ligament partial tear commonly associated with hem-arthrosis of the knee and can evolve into
complete tear. Various approaches have been suggested to treat Anterior Cruciate Ligament partial tear.
However, deciding which approach to follow is still controversial. Objective: In this study we aimed
at reviewing the current available literatures reporting on the management of partial tears of the ACL.
Methods: PubMed database was used for articles selection, and the following keys used in the mesh
("Anterior Cruciate Ligament /partial tear"[Mesh] OR "Anterior Cruciate Ligament
/management"[Mesh] OR "Anterior Cruciate Ligament /outcomes"[Mesh]). 10 studies were enrolled
according to our inclusion, and exclusion criteria. Conclusion: The initial treatment after an ACL injury
is rest, ice and usually crutches. Immobilization is important while the patient remains symptomatic. A
course of conservative treatment by physiotherapy can be successful in patients not participating in
strenuous physical activity. In patients with a high functional demand, even after a conservative
program, surgical treatment is often required. Keeping ACL remnants when reconstructing the ACL is
recommended. It might be beneficial on knee function because it preserves numerous mechanoreceptors
that favor knee proprioception. In prepubescent children with several years of growth ahead, physical-
sparing technique like Micheli technique is recommended. Less invasive techniques such as Thermal
modification of knee's connective tissues can be suggested in order to reduce the dilemma and difficulty
of the operation for the surgeon.
Key words: Anterior Cruciate Ligament, tear, athletes, knee injuries, physiotherapy, reconstruction.

INTRODUCTION

Cruciate ligament is divided into two ligaments
Patients often reports to feel a `pop' and
(Anterior Cruciate Ligament & Posterior
develop an immediate or sub-acute effusion.
Cruciate Ligament) and is attached to the femur
Often, athletes are not able to continue to play
and tibia. The tibia insertion is located
because of instability (1, 3).
anteriorly and close to the medial tibia
ACL injuries are more frequently complete
eminence. The femoral attachment of the ACL
partial injuries have also been described. Partial
is oval, on the posteromedial aspect of the
injuries of the ACL are detected by magnetic
lateral femoral condyle (1). Both parts of
resonance imaging and frequently present with
cruciate ligament function as a knee stabilizer
a negative Lachman test (6-7). Higher sensitivity
and allow gliding movements during leg bend
is given by the pivot shift test. A definitive
and straighten process. ACL (ACL) as
diagnosis of a single-bundle ACL lesion can be
mentioned previously help in maintaining knee
obtained by arthroscopy (9).
stability, also creates the connection between
In USA, the annual incidence is about 200,000,
the femur and the tibia, and serves to prevent
with at least 100,000 receiving arthroscopic
anterior translation of the tibia relative to the
reconstruction (10). In KSA, a study done in
femur (2-3).
Riyadh reported that the prevalence of ACL
ACL injury occurs mostly with athletes as a
injury is about 31 per 100,000 individuals.
result of noncontact pivoting injury, typically a
Also, they reported that ACL injury is the most
change of direction or deceleration maneuver(5).
prevalent knee related injury (53%), with young
6847
Received: 10/9/2018
Accepted: 20/9/2018

Full Paper (vol.736 paper# 8)


c:\work\Jor\vol736_9 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (6), Page 6854-6858

Blood groups as risk factor of hypertension in Arar population, Northern
Saudi Arabia
Taif Shayish N Alanazi, Khalid Nadi M Alanazi, Wael Ayad O Alruwaili, Mohammed
Abdullah A Alanazi, Ahmed Nawfal M Alshammari, Abdulaziz Saqer A Alanazi, Zuhur Naif
Alazmi, Anwar Ayed Thani Alanazi, Ruba Mohammed Mahdi Almijlad, Anwar Suwailem
Almutairi, Almajd Mateb Nafa Alenzi
Faculty of Medicine, Northern Border University, Arar, kingdom of Saudi Arabia
Abstract:
Background:
Hypertension is a disease that has a huge impact on the health of communities. Familial
patterns of hypertension suggests genetic factor as an another important non-modifiable predisposing
factor, and ABO blood group is one of such factors which needs to be investigated in more details.
Objective: to evaluate the prevalence of hypertension in various ABO and Rh blood group subjects,
and to explore any association between ABO and Rh blood groups with hypertension. Methods: A
cross-sectional study was conducted in Arar city, Northern Saudi Arabia. It included 312 participants
from the general population of Northern Saudi Arabia. Data were collected by a pre-designed online
questionnaire which was distributed among the population. It was self-administered, after a brief
explanation of the idea of the research. The questionnaire included the clear questions to collect the
relevant data. Results: the study included 312 participants 28.8% aged 30-39 years, 26.0% aged 40year
or more, 85.3% were females and 79.2% were highly educated. In the studied sample, 38.1% had O
blood group, 30.1% had B blood group, 26% had A blood group and 5.8% had AB blood group. About
fifth (20.5%) of studied sample had hypertension; from them 20.3% group A, 7.8% AB, 25% B and
46.9% group O. The present study found that there was no significant association between hypertension
and blood groups as risk factors (P = 0.274). Among hypertensive cases 85.9% Rh+ve, 14.1% Rh-ve,
there was no significant association between hypertension and Rh factor (P = 489). Conclusion: The
findings of the present study indicated that in Arar city population, we could not find any evidence that
particular ABO blood group was more susceptible to develop hypertension.
Key words:
ABO blood group, blood pressure, hypertension, Arar city, positive Rh and negative Rh,
risk factor, association.
Introduction:
Hypertension is a disease that has a huge impact
hypertension suggest that there could be some
on the health of communities. It is widespread
genetic factors for the development of
in the Arabian Gulf area, Middle East region,
hypertension. There are reports of increased
and the whole world [1]. Since uncomplicated
cardiovascular (CV) risks in different blood
hypertension is an asymptomatic condition,
groups and increase in BP is considered as
many people are unaware that they have high
a common CV risk. The ABO system is one
blood pressure. Therefore, diagnosis of
such genetic make-up that can provide much
hypertensive patients is of paramount
valuable information for early detection of
importance.
However,
to
diagnose
vulnerable groups [5].
hypertension, recognition of its probable risk
The objectives of this study were to evaluate the
factors would be important [2]. The ABO blood
prevalence of hypertension in various ABO and
group system, which was the first human blood
Rh blood group subjects, and to examine any
group system to be discovered, is exclusively
association between ABO and Rh blood groups
and integrally heritable, genetically determined
with hypertension.
at conception and remain fixed for the life.
Methods:
Hence, its frequency distribution follows a
Study design: A cross-sectional study was
known pattern governed by gene transmission
conducted in Arar city, Northern Saudi Arabia.
from generation to generation and varies with
The study included 312 participants from the
the race and geographical distribution of the
general population of Northern Saudi Arabia.
human being [3]. There is strong evidence in
Data collection: They were collected using a
the literature to suggest that there is an
pre-designed online questionnaire which was
association between ABO blood group and
certain diseases [4]. Familial patterns of primary
distributed among the population. It was self-
administered by participants after a brief
4586
Received: 12/9/2018
Accepted: 22/9/2018

Full Paper (vol.736 paper# 9)


c:\work\Jor\vol736_10 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (6), Page 6859-6863

Evaluation of Pyloric Stenosis Management, Laparoscopic versus Open
Pyloromyotomy

Awath Fahim Alsulami1, Abdulrahman Abdullah Alzahrani1, Ahmed Bakr Ibrahim2, Ali
Abdulla Almazeedi3, Abdullah Saud Alfaraj3, Asma Mutni Al-Mutairi4, Razan Mohammad S
Almuallad5, Maram Mudhhi Alabdali5, Hadeel Taha Alsaadi5, Bodoor Salmi Almotairi6


1- Umm Al- Qura University, 2- King Saud bin Abdulaziz University, 3- Mansoura University,
4- Al-Qassim University, 5- Ibn Sina National College, 6- Taibah University
Abstract
Background:
Hypertrophic pyloric stenosis (HPS) is associated with gastric outlet obstruction that
occurs as a result of pylorus muscular layers hypertrophy. HPS is considered as the most common cause
of vomiting in infancy that requires surgical intervention. Despite advances in neonatal and surgical
care, still there is a debate between the pediatric surgeons about the approach that can provide better
outcomes for the patients. Objective: In our paper, we aimed to review the recent randomized clinical
trials and reviews that compared between laparoscopic and open pyloromyotomy to assess their
outcomes, merits and pitfall of each. Methods: PubMed database was used for articles selection, and
the following keys used in the mesh ("Hypertrophic Pyloric Stenosis /management"[Mesh] OR "\
Hypertrophic Pyloric Stenosis /outcomes"[Mesh]) AND ("Mortality/Morbidity"[Mesh]). A total of 12
studies were enrolled into our review according to our inclusion and exclusion criteria. Conclusion:
We found that overall Laparoscopic pyloromyotomy procedures were as safe and effective as Open
pyloromyotomy procedures for infants with hypertrophic pyloric stenosis. However, there was a trend
in the LP group towards shorter time, especially with regard to the full time to feeds, length of stay after
surgery, operating time. We think that our findings justify the continued use of laparoscopic
pyloromyotomy for the management of infantile hypertrophic pyloric stenosis, and recommend its use
in centers with appropriate laparoscopic experience.
Key words:
pyloric stenosis, management, laparoscopic pyloromyotomy, open pyloromyotomy.

INTRODUCTION
Hypertrophic pyloric stenosis (HPS) is
may play a role; Ghazwany et al. [4] found that
associated with gastric outlet obstruction that
the incidence of 2.99/1000 occur in preterm
occurs as a result of pylorus muscular layers
infants compared to 2.25/1000 in term infants.
hypertrophy [1]. HPS is considered as the most
Examination of the pylorus itself has revealed
common cause of vomiting in infancy that
deficiency or abnormality in the nerve cell
requires surgical intervention. This condition
fiber, decreased levels of nitric oxide
was described in 1888 for the first time by
synthase,and increased levels of growth factors
Hirschprung [2]. Since that time its incidence
(insulin-like growth factor and platelet derived
has been increasing. Worldwide the incidence
growth factor), which, individually or in
of HPS is approximately 13 per 1,000 live
combination, may result in failure of pyloric
births, although rates and trends vary markedly
relaxation and/or muscle hypertrophy [5].
from region to region [3]. Ghazwany et al. [4]
The gold standard management for HPS is
estimated the incidence rate in Saudi Arabia to
surgical pyloromyotomy, which used to be
be 1.4/10 000 live births [3]. HPS is more
done via open right upper quadrant or supra-
common in males than females (4:1 to 6:1), and
umbilical incision. However, with the recent
more frequent in preterm infant than full term
advances in the medical field, a laparoscopic
[5].
technique for pyloromyotomy was introduced
Until now the etiologies that stand behind the
in 1991, and both techniques are now widely
development of HPS is still unclear. Several
utilized.
theories have been postulated, but none has
Despite advances in neonatal and surgical care,
been proven. The recent literatures found that
still there is a debate between the pediatric
HPS is multifactorial, involving genetic
surgeons about the approach that can provide
predisposition and environmental factors.
better outcomes for the patients. In our paper
Neonatal
hypergastrinemia
and
gastric
we reviewed the recent randomized clinical
hyperacidity may play a role [4]. Premature birth
trials and reviews that compared between
6859
Received: 13/9/2018
Accepted: 23/9/2018

Full Paper (vol.736 paper# 10)


c:\work\Jor\vol736_11 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (6), Page 6864-6869

Effect of lipid-lowering therapy on the mortality among patients with
coronary heart diseases: A systematic review

Abdullah Talal Almaghrabi (1), Waleed Mohammed Alghamdi (1), Salah Mohammed Almuyidi
(2), Hadil Hilal Abuzaid (3)
(1) University of Debrecen, (2) Faculty of Medicine, Taif University, (3) Applied Science Private
University
Abstract:
Introduction:
Studies supported the use of lipid lowering therapy such as statin as a treatment of
hypercholesterolemia for prevention of CHD. However, the use of lipid lowering therapy is not well
established in clinical practice due to lack of robust evidence and contra-indications in patients with
heart failure (HF). This review aimed at evaluating the evidence about preventive effect of lipid
lowering therapy on the mortality caused by coronary heart diseases. Methods: A comprehensive
electronic search was carried out using MEDLINE, EMBASE, Cochrane databases to identify articles
which aimed at assessing the preventive effect of lipid lowering therapy for coronary heart diseases.
The data were collected from included studies using data collection sheets using specific items such as
mean patient age, type of coronary disease, mean duration of the disease, drugs of lipid lowering
therapy, regime of lipid lowering therapy, duration of lipid lowering therapy, reduction in mortality
rate, and associated side effects. Results: Following evaluation of the eligible articles, 11 articles were
included with randomized controlled trials investigating the effect of lipid-lowering therapy on the
mortality of patient suffering from coronary heart diseases. The sample size in the included studies
ranged from 106 to 10355 participants, and the total number of participants among all included studies
were 50830 with mean age ranging from 31 to 82 years old. Conclusions: Despite the overall good
outcome that is attributed to the use of statins that is not clear weather this benefit is credited to its anti-
inflammatory or direct LDL lowering effect.
Keywords: Lipid, Therapy, Statin, Heart failure, Myocardial infarction
Introduction:
Coronary heart disease (CHD) has been
lack of robust evidence and contra-indications
considered as a major factor that contributes to
in patients with heart failure (HF) (7, 8).
morbidity and debility, particularly among
This review aimed at evaluating the evidence
middle aged men (1). Thus, the cardiologist and
about preventive effect of lipid lowering
public health specialists have directed their
therapy on the mortality caused by coronary
efforts toward diagnostic and therapeutic
heart diseases.
methods with continuous updating of the
Methods:
guidelines (2). Recently, the preventive
A comprehensive electronic search was
interventions have been found to be more cost-
conducted in MEDLINE, EMBASE, Cochrane
effective than curative approach in reduction of
databases to identify articles which aimed to
morbidity and mortality associated with CHD
assess the preventive effect of lipid lowering
(3).
therapy in CHD. Search terms included
The corner stone of preventive approach is
("coronary artery diseases" OR "heart disease"
targeting modifiable risk factors of CHD such
OR "ischemic heart disease") AND ("lipid-
as hyperlipidemia, hypertension and smoking
lowering therapy" OR "cholesterol-lowering
(4). Guidelines for management of hypertension
therapy" OR ezetimibe OR statin OR
and hyperlipidemia were postulated to provide
pitavastatin OR pravastatin OR anacetrapib)
basis for CHD prevention (5). Hyperlipidemia is
AND (mortality OR death). The titles and
a significant risk factor that is characterized by
abstracts of the resultant articles were read by
elevated low-density lipoprotein or triglyceride
two independent reviewers to identify relevant
and occasionally low level of high-density
articles as a primary screening step and to
lipoprotein (6). Studies supported the use of lipid
exclude irrelevant, duplicated or review
lowering therapy such as statin as a treatment of
articles. The full texts of these relevant articles
hypercholesterolemia for prevention for CHD
were retrieved and the in-depth reading was
(7). However, the use of lipid lowering therapy
conducted to exclude the irrelevant articles as a
is not well established in clinical practice due to
secondary screening step. The articles were
assessed against inclusion criteria such as
6864
Received: 13/9/2018
Accepted: 23/9/2018

Full Paper (vol.736 paper# 11)


c:\work\Jor\vol736_12 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (6), Page 6870-6877

Transvaginal Ultrasound Measurement of Cervical Length and Posterior Cervical
Angle versus Bishop Scoring in Assessment of Induction of Labour
Mohamed Mohamed Gibreil, Adel Aly Elboghdady,
Ahmed Mohamed Samy AL-Bohy*
Obstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar University
*Corresponding author: Ahmed Mohamed Samy AL-Bohy, E-mail: dr.ahmed_bohy@yahoo.com
ABSTRACT
Background:
Induction of labour is a widely used intervention on the modern labor. The Bishop score,
since its description in 1964, remains the gold standard for assessing favorability for induction of labor.
However, the preinduction `favorability' of the cervix as assessed by the Bishop score is very subjective
and several studies have demonstrated a poor predictive value for the outcome of induction especially
in women with a low Bishop score.
Aim of the work: The objective of the study was to evaluate the Transvaginal ultrasonographic
measurements in predicting the success of induction of labour.
Patients and Methods: In this study 70 women 35-42 weeks pregnancy underwent induction of labor.
Before induction a digital examination of the cervix was performed & the Bishop score noted. Cervical
length, posterior cervical angle& cervical funneling were then assessed by a transvaginal ultrasound.
Results & conclusion: successful induction correlated significantly with the Bishop score and
ultrasonographically measured cervical length, and the posterior cervical angel and ultrasound
measurements were suggested to be better than the Bishop score in prediction of successful vaginal
delivery.
INTRODUCTION
Induction of labor is defined as an
been used widely for the prediction of preterm
intervention designed to artificially initiate
delivery in patients at risk for or with preterm
uterine contractions leading to progressive
labor(4) .
dilatation and effacement of the cervix and birth
AIM OF THE WORK
of the baby (1) . Induction of labor is indicated
The objective of the study was to
when benefits to the mother or the fetus
evaluate ultrasonographic measured cervical
outweigh those of continuing the pregnancy
length and posterior cervical angle in predicting
such as post-dated pregnancy, premature
successful labour induction as alternative
rupture of the membranes before onset of labor,
method to Bishop Score.
maternal diseases such as diabetes mellitus,
PATIENTS AND METHODS
hypertension with pregnancy, or fetal growth
This was a prospective randomized
restriction; these are the most common
study which was conducted on 70 pregnant lady
indications for induction of labour(2) .
not in labor indicated for termination of
Approximately 20% of pregnant
pregnancy who were admitted to Obstetric-
women undergo induction of labor around term.
Gynecological Dept. at Sayed Galal Hospital,
However, not all of these inductions result in
Al-Azhar University from July 2017 till March
vaginal delivery, and some result in emergency
2018 with informed written consent.
Cesarean sections (3) .
All were recruited according to the
Transvaginal ultrasonography is a
inclusive criteria.
known objective method for assessing cervical
Inclusion criteria:
length. It is not a sophisticated procedure to be
1. Age between 18-37 years.
done in obstetric units and clinics. Attempts
2. Singleton pregnancy.
have been made in the past to use transvaginal
ultrasonography for prediction of type of
3. 3542 weeks gestation.
delivery, and efforts have been made to explore
4. Living fetus.
if its predictive value is higher than that of the
5. Cephalic presentation.
Bishop score or not. However, controversial
Exclusion criteria:
results have been published, and not enough
1. Extremes of age (below 17 and above 38).
evidence is available to consider it as a strong
2.
alternative to the Bishop score. Measurement of
Fetal macrosomia (more than 4500).
cervical length and the presence of cervical
3. Malpresentation.
funneling by transvaginal ultrasonography have
4. Dead fetus.
0786
Received: 13/9/2018
Accepted: 23/9/2018

Full Paper (vol.736 paper# 12)


c:\work\Jor\vol736_13 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (6), Page 6878-6885

Evaluation of Natural Tissue Reinforcement of Inguinal canal For
Inguinal Hernia Repair (Desarda Inguinal Herniorraphy)
Ahmed Shawky Abd-Elaziz, Yasser Ahmed Amer & Mohammed Ramadan Saad Abd-Elaty*
Department of General Surgery, Faculty of Medicine, Al-Azhar University
*Corresponding author: Mohammed Ramadan Saad, Mobile: 00201011257752, E-Mail: mohammedsaad99@yahoo.com
Abstract
Background:
Inguinal hernia repair is one of the cornerstones of a general surgery practice and is one
of the most commonly performed procedures. Although there are no exact figures totaling the number
of inguinal hernia repairs performed annually, it has been estimated that approximately 800,000 cases
were performed annually in 2003, not including recurrent or bilateral hernias. Aim: To report our
experience in recording and evaluating the short-term outcome of inguinal hernia repairs with Desarda's
technique. Patients and Methods: A total of 20 adult male patients with primary inguinal hernias were
randomly allocated intraoperatively to undergo Desarda inguinal herniorraphy. Results: According to
our scale evaluating outcome, desarda technique is effective and safe with least post-operative
complications regarding inguinal hernia repair. Conclusion: Desarda repair is easy to perform and has
shown to take shorter operative time. Also, there is no need of mesh with less suture material
requirement. So, this method proves cost effective than the Lichtenstein method. Desarda hernia repair
was found to be superior to Lichtenstein repair in terms of post-operative pain and foreign body
sensation. It can be recommended for younger patients.
Keywords: Inguinal Hernia, Desarda
Introduction
Widespread and easily tolerated, the
require complicated dissection or suturing.
inguinal hernia is seen as a minor disorder.
There is no tension on the suture line. It does
Because hernia surgery may be performed
not require any foreign material and does not
easily and successfully in both in-and out-
use weakened muscles or transversalis fascia
patient environments it is too often dismissed as
for repair. The results are superior to those
a trivial complaint. On the other hand, in many
previously published in the field of hernia
countries it is considered a specialization.
surgery (3).
Unless inguinal hernia is treated properly, in
Desarda technique is a recently
fact, it may turn out to be very disabling.
introduced tissue based repair that addresses
Inguinal hernia is a frequent case to come
physiology of the inguinal canal as well as the
across in the outpatient clinic as well as in
anatomy. Tissue-based repairs like Bassini and
emergency. Because of its frequency, it remains
Desarda confer an advantage of using less
a common, yet an important medical problem.
prosthetic material. Desarda technique, like
For men, there is a 27% lifetime risk to develop
Lichtenstein, is a tension free repair with less
inguinal hernia, while in women it remains at
recurrence rates comparable to Lichtenstein,
3% (1).
and requires less per-operative time(4).
Several techniques of tissue and mesh
The effectiveness of the Desarda
repair for inguinal hernia have been developed
technique has not been well investigated. There
over the last decades but still drawbacks are
are no sufficiently large data from randomised
present. Although European Hernia Society
comparative studies to consult. There are
promotes Lichtenstein repair to deal with this
reports of its excellent results from the ongoing
frequent clinical case, Shouldice repair is also
clinical trials in Poland, Cuba, South Korea,
being popularized (2).
Albania and India(5).
Desarda, who has used a new technique
Factors that are said to prevent
since 1990, seeks to get over the challenges
herniation are not restored in the traditional
faced with the use of the tissue repair and mesh
techniques of inguinal hernia repair and yet 70-
repair techniques. It is based on the concept of
98% of patients are cured (3).
providing a strong, mobile and physiologically
The problem of our age is to find an
dynamic posterior inguinal wall. The technique
operation that is simple, does not require
is simple, easy to learn and do. It does not
implantation of a foreign body like a mesh, has
6878
Received: 18/8/2018
Accepted: 28/8/2018

Full Paper (vol.736 paper# 13)


c:\work\Jor\vol736_14 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (6), Page 6886-6896

Role of Prophylactic Tranexamic Acid in Reducing Blood loss during
Elective Caesarean section in Rural Area
Hossam Elden H. Kamel (1), AbdAlsattar M. Farhan (1), Hesham F. Abou Senna (1), Mohammed
A. Khedr (2), Ahmed A. Albhairy (1)
(1) Department of Obstetrics & Gynecology, Faculty of Medicine Al-Azhar University
(2) Department of Clinical Pathology, Faculty of Medicine Al-Azhar University
Corresponding author: Ahmed A. Albhairy; Mobile: 01006100873; Email: daelbhery@gmail.com

Abstract
Background:
To reduce maternal mortality and morbidity caused by bleeding, it is important to reduce
the amount of bleeding during and after lower segment caesarean section (LSCS). Tranexamic acid
helps to reduce bleeding during and after Caesarean section. Aim of the Work: To analyse the
effectiveness of Tranexamic Acid (TXA) in reducing blood loss during elective caesarean section.
Patients and Methods: The current study was conducted as a double blinded, randomized, controlled
trial on 300 women recruited from labor ward in Kafr Elsheikh General Hospital whom planned to have
scheduled casaerean section. A total number of 150 patients received tranexamic acid before induction
of anesthesia in addition to oxytocin after delivery of the baby; the other 150 patients received oxytocin
only. Results: In the current study, no significant difference between study and control groups as
regards age (p 0.374). In the current study, no significant difference between study and control groups
as regards gestational age (p 0.335). In the current study, number of soaked towels and amount of blood
in suction set, which reflect the volume of blood loss from placental delivery to the end of surgery was
significantly lower in study group than control group. In the current study, no significant difference
between study and control groups as regards preoperative hemoglobin (p 0.614). Postoperative hemoglobin
was significantly higher in study group than control group (p<0.004). Reduction in hemoglobin was
significantly less in study group than control group (p<0.001). In the current study, no significant
difference between study and control groups as regards preoperative hematocrit (p 0.527). Postoperative
hematocrit was significantly higher in study group than control group (p0.17), Reduction in Hematocrit
was significantly less in study group than in control group (p<0.001). In the current study, need to iron
replacement or blood transfusion was significantly less frequent in study group than in control group
(p<0.031). Conclusion: The use of tranexamic acid prior to cesarean section is significantly effective
in reducing blood loss during caesarean section with no observed maternal or neonatal side effects.
Recommendations: Further studies are needed to assess possibility of use of tranexamic acid for
treatment of postpartum hemorrhage.
Key words: prophylactic tranexamic acid, blood loss, elective cesarean section
Introduction
Every year over five million women die
factors differed between women with PPH and
worldwide due to causes related to pregnancy and
those without (2).
delivery. Postpartum Haemorrhage (PPH)
accounts for the major part of the mortality as well
The occurrence rate of caesarean
as morbidity like severe anaemia needing blood
section (CS) has increased in both developed
transfusion, hospital stay and infection (1).
and developing countries, which would result in
Millennium development goal 5 targets
an increased risk of PPH. Although there has
for reduction of maternal mortality rate by 75%
been a remarkable improvement in the
by 2017, which means 5.5% reduction per year
prevention and treatment of PPH in recent
is required. People at high risk of PPH account
years, deaths due to PPH remain relatively
for only small percent of all maternal deaths.
common in some parts of the world. To lower
Majority of morbidity and mortality happen in
the occurrence rate of major morbidity and
those with no risk factors and cannot be
mortality due to PPH, it is very vital to reduce
predicted. In an analysis of 1620 women in
blood loss in CS and vaginal delivery (VD) (3).
rural India, it was found that 9.2% experienced
PPH. No maternal or socio-demographic
6886
Received: 13/9/2018
Accepted: 23/9/2018

Full Paper (vol.736 paper# 14)


c:\work\Jor\vol736_15 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (6), Page 6897-6899

Assessment of knowledge, attitude and practice towards scabies among
medical students in Kingdom of Saudi Arabia, 2018
Ohoud Mohammed ALshehri1,Rawabi Abdullah Alharbi2,
Bayan Mohammed ALsoraya3

1-Taif University, 2-Umm al qura University, 3-Qassim University (Unizah college of medicine)

Abstract
Background:
The adequate knowledge about scabies and its preventive measures are important for
diagnosis and managing scabies.
Objectives: Evaluating the knowledge, attitude and practice of scabies among medical students in
Kingdom of Saudi Arabia (KSA).
Methods: A cross sectional study that was conducted at KSA, for 4 months from May to August 2018.
The study included 445 medical Saudi students from both genders. A self-administrated questionnaire
was distributed among all the participants.
Results: The study included 445 medical students from different parts of KSA in which the level of
knowledge among them regarding scabies and its preventive measures was adequate among most of the
participants regarding the causative agents, features of scabies, its associated spreading factors and
diagnosis. The attitude and practice of most of the subjects were positive.
Conclusion:
This study showed a satisfactory level of knowledge, attitude and practice among medical
students in KSA regarding scabies, clinical characteristics and its preventive measures.
Keywords:
Knowledge, Attitude, Practice, scabies, medical students, Kingdom of Saudi Arabia
(KSA).
Introduction:

Scabies is a skin infestation caused by parasitic
This was a across sectional study that was
mite which is associated with itching, lesions
conducted at KSA, for 4 months from May to
and rashes (1). It is not a life threatening disease
August 2018.
but its incidence is high reaching about 300
Study population and sample size:
million around the worldwide(2). Its infestation
The sample size was randomly selected from 13
and outbreaks cause high burden on the
random Universities from which 35 medical
authority health costs which is hard to be
students were randomly chosen from the
controlled and treated (3, 4).
6thclass. The study included 445 medical Saudi
Scabies can affect both genders and all ages
students from both genders.
from children to adults as well. It is associated
Study
with poor health conditions as poverty,
tools:
overcrowding and poor hygiene (5, 6).


It can be transmitted by person to person by
A self-administrated questionnaire was
direct contact and its classic symptoms are
conducted, reviewed and developed to assess
pruritus which become worth during night,
the medical students' knowledge attitude and
hypersensitivity and other complications
practice pattern.
including impetigo, septicemia,abscesses,
Ethical approval:
folliculitis, cellulitis, and may result in death(7,
The study was approved by the Ethical
8).
Committee of Faculty of medicine. The
The scabies can be misdiagnosed as it can
participants provided a written informed
mimic other skin diseases thus, kin scraping is
consent of their approval.
the best diagnostic method (9).The adequate
Statistical analysis:
knowledge about scabies and its preventive
The data were processed using the
measures are important for managing scabies.
Statistical Package for Social Sciences (SPSS,
Thus, this study aimed at evaluating the
version 22) for windows. The variables were
knowledge, attitude and practice of scabies
presented as frequencies and percentages.
among medical students in KSA.
Results:
Methods:
Study design:

Assessment of knowledge:
7986
Received: 13/9/2018
Accepted: 23/9/2018

Full Paper (vol.736 paper# 15)


c:\work\Jor\vol736_16 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (6), Page 6900-6904

The Prevalence of People Knowing the Importance of Vitamin D to The
Skin in Saudi Arabia
Talal Hassan Alsawyan 1, Adnan Meteb Mohamed Almezani 2, Mohannad Yousef Aljarallah 2,
Nouf Awwad Algharbi 2
College of Medicine Al-Imam Muhammad Ibn Saud Islamic University 1, College of Medicine
University of Hail 2
Corresponding author: Talal Hassan Alsawyan, E-mail: Talal.alsawyan@hotmail.com, Phone no: +966501444888


ABSTRACT
Background:
despite the availability of knowledge and multiple educating social medias, the
prevalence of people who know the importance of vitamin D to the skin in Saudi Arabia is decreasing
these days.
Objectives:
This study was done to know the prevalence of people knowing the importance of vitamin
D to the skin in Saudi Arabia.
Methods: a cross-sectional study on knowing the prevalence of people knowing the importance of
vitamin D to the skin in Saudi Arabia was done from January to April 2018 on 864 participants within
many different social media platforms.
Results: only (36%) of the participants know the importance of vitamin D to the skin, (36.7%) of the
participants have checked their vitamin D level at a certain time of point, (25.1%) of the participants
have been diagnosed with a vitamin D deficiency,( 66%) of the participants know the sources of vitamin
D, (63.1%) of the participants know the consequences of vitamin D deficiency, (42.9%) of the
participants usually get exposed to the sunlight, only (18.3%) of the participants use vitamin D
supplements, (47.3%) of the participants know the symptoms of vitamin D deficiency, (37.8%) of the
participants have a current skin disease and more than half of the participants (55.9%) think that the
society has a role in educating people about the importance of vitamin D.
Conclusion: at the end of this study, there is a decrease number of participants who know the
importance of vitamin D to the skin in Saudi Arabia.
Keywords: vitamin D, skin, supplements.

INTRODUCTION
Vitamin D is very unique because it can be
intestinal calcium absorption (3). Without the
made in the skin from the exposure to the
availability of vitamin D, only 1015% of
sunlight (1). Vitamin D has two forms. Vitamin
dietary calcium and about 60% of phosphorus
D2 which is made from the UV irradiation of
are absorbed. Vitamin D availability enhances
the yeast sterol ergosterol and is found naturally
calcium and phosphorus absorption by 3040%
in sun-exposed mushrooms. UVB light from
and 80%, respectively (4).
the sun insert the skin, and humans synthesize
Vitamin D receptor (VDR) is present in most
vitamin D3, so it is the most natural form of
tissues and cells in the human body (5,6).
vitamin D. Human beings do not make vitamin
1,25(OH)2D has multiple biological functions,
D2, and most oil-rich fish like mackerel and
such as inhibition of cellular proliferation,
salmon contain vitamin D3. Vitamin D that is
inhibiting angiogenesis, stimulating insulin
ingested in the human body is incorporated into
production, inhibiting renin production,
chylomicrons, which are absorbed into the
stimulating
macrophage
cathelicidin
lymphatic system and enters the venous blood.
production
and
inducing
terminal
Vitamin D that comes from the skin or diet is
differentiation (7). 1,25(OH)2D may be
biologically not active and requires its first
responsible for regulating up to 200 genes that
hydroxylation in the liver by the vitamin D-25-
may facilitate many of the pleiotropic health
hydroxylase (25-OHase) to 25(OH)D (2).
benefits that have been reported for vitamin D
However, 25(OH)D requires a further
(8,9). Vitamin D has a role in skin differentiation,
hydroxylation by the 25(OH)D-1-OHase
1,25(OH)2D has an important and interacting
(CYP27B1) in the kidneys to form the
functions in regulating the skin differentiation
biologically active form of vitamin D
process. 1,25(OH)2D increases the expression
1,25(OH)2D
(2).1,25(OH)2D
stimulates
of loricrin, involucrin, transglutaminase and
6900
Received: 15/9/2018
Accepted: 25/9/2018

Full Paper (vol.736 paper# 16)


c:\work\Jor\vol736_17 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (6), Page 6905-6909

Knowledge about the prevalence and attitude of patients experiencing
epistaxis in Saudi Arabia

1
2
Faisal Fahad Aljuaid
,
2
, Adnan Meteb Mohamed Almezani Nouf Majed Abdulaziz Alghris ,

3
Abrar Fahad Alotaibi
College of Medicine Prince Sattam bin abdulaziz
C
,
1
University
ollege of Medicine University of
2
3
Hail , College of Medicine Taif Unevirsity
Corresponding author: Faisal Fahad Aljuaid, E-mail: fasal_999@hotmail.com, Phone no: +966549717153

ABSTRACT
Background
: Despite the modern society, nasal bleeding has been increased these days in Saudi
Arabia people these days due to multiple factors. People knowledge about this important situation is
not quit enough. Attitude toward nasal bleeding is different from one person to another which may
reflect the outcomes of nasal bleeding
Objectives: Nasal bleeding (epistaxis) is causing trouble to the patients in a multiple aspect. This
study aimed at assessing the prevalence of nasal bleeding (epistaxis) in Saudi Arabia and to know the
participants attitude towards it.
Methods: A cross-sectional study on the prevalence of nasal bleeding (epistaxis) and the attitude
towards it was randomly investigated among men and women (392 participants) within different
social media platforms in Saudi Arabia during the period from January to March 2018.
Results: in 27% of the participants have been suffering from nasal bleeding, only 17.4% seek medical
help, 16.3% tried traditional medicine to stop the nasal bleeding, 5.6% are using anticoagulants, 49%
had a positive family history of nasal bleeding and 9.4% had a chronic illness.
Conclusion: Our result showed that huge number of the participants was suffering from nasal
bleeding (epistaxis) in Saudi Arabia.
Keywords: Nasal bleeding, Epistaxis, Hypertension.

INTRODUCTION
Epistaxis is about acute bleeding from the nasal
individuals were admitted to medical treatment
cavity, nasopharynx or the nose (1). Nasal
to control the nasal hemorrhage, while 60% of
septum bleeding is the most responsible for
them had at least one episode of epistaxis
most of cases of epistaxis (2). Epistaxis is very
throughout their lifetime and it mentioned that
common in accident, emergency and
males were more likely to experience epistaxis
otorhinolaryngology (ENT) departments (3,4).
than females (10). Epistaxis is common among
There are two anatomical areas within the nose
young adults and children, while it is very rare
which are often providing epistaxis (5). Epistaxis
among neonates and reaches its highest
is divided into systemic and local causes (5). The
susceptibility in the sixth decade of life (11). The
common causes of systemic epistaxis are
majority of patients who are exposed to
hypertension which may contribute to bleeding,
epistaxis can be managed with standard first aid
inherited bleeding disorders, cardiovascular
measures. However, some epistaxis episodes
disorders like congestive heart failure, vascular
required hospital admission (12). First aid is the
malformation of the nose and rarely nasal tumor
emergency treatment of injury or illness to
(5,6). Regarding local causes of nose bleeding,
prevent deterioration of condition and to
trauma is the most common cause followed by
decrease pain until professional medical help
other causes like exposure to dry warm air for a
arrives (13), to reduce mortality and morbidity of
long period of time, nasal infection, allergic
the emergency case (12) especially in persistent
rhinitis, nasal surgeries, foreign body,
bleeding cases (12).
perforated nasal septum and cocaine use (7).

Furthermore, weather has also an impact on
MATERIALS AND METHODS
causing epistaxis. Cold dry winter season leads
A cross-sectional study involving 392
to a decrease in nasal humidification and the
participants from all over Saudi Arabia was
nasal septum will be prone to bleeding (8). The
done during the period between February-
incidence of epistaxis was reported to be ranged
March 2018. The selected sample size for this
from 10% to 60 % of individuals (9). 6% of the
study was randomly determined. A self-
6905
Received: 15/9/2018
Accepted: 25/9/2018

Full Paper (vol.736 paper# 17)


c:\work\Jor\vol736_18 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (6), Page 6910-6914

Knowledge about The Overall Patient's Satisfaction of The Primary Health
Care in Saudi Arabia and Common Complains That Brings Patients to The

Primary Health Centre
Yousef Ateeg Awad Alsadi 1, Adnan Meteb Mohamed Almezani 1, Abdulaziz Ayed M
Alshammari 1, Abdulaziz Ayed Abed Alrashidi 1, Abdulrahman Saeed Saad Alharbi 1, Intesar
Hadi Eisa Alshammari 1, Ahmad Hassan A Albargi 2, Saleh Ali Saleh Kharshan AL Ghamdi 3
College of Medicine University of Hail 1, KAAU 2, Rawalpindi Medical College 3
Corresponding author: Yousef Ateeg Awad Alsadi, E-mail: yousefalsaadi94@gmail.com, Phone no: +966538047705

ABSTRACT
Background: Despite the
modern life and the availability of great facilities, patients are not satisfied
with the health care offered in the primary health care center in Saudi Arabia. Common complains that
bring patients to the primary health care center are usually hypertension, headaches or back pain but
there are others that are unknown and common like abdominal pain.
Objectives:
This study was done to explore the overall patient's satisfaction of the primary health care
in Saudi Arabia and the common complains that bring patients to the primary health centre.
Methods:
A cross-sectional study was carried out during the period from January to April 2018 on 864
participants chosen from many different social media platforms to investigate the overall patient's
satisfaction of the primary health care in Saudi Arabia and the common complains that bring patients
to the primary health centre.
Results:
48.1% of the participants had visited the primary health care center at a certain point of time,
33.6% of the participants went to the primary health center first before going to the hospital, 43.7% of
the participants received a professional health care whenever they enrolled to the primary health care
centers, 51.9% of the participants usually found the prescribed medications at the primary health care
center and 30% of the participants claimed abdominal when they visited the primary health care center.
Regarding patient's satisfaction, 18.8% of the participants rate the primary health care center 5 out of
10. Finally, 90.6% of the participants thought that the ministry of health should pay more attentions to
the primary health care centers.
Conclusion: overall patient's satisfaction about the primary health care center in Saudi Arabia was as
great as we could expect. The main complain that brings participants to the primary health care centers
was abdominal pain.
Keywords: satisfaction, centre, abdominal pain.

INTRODUCTION
Time is an important factor in primary
like the time that is spent waiting for a primary
healthcare since it is associated with improving
healthcare appointment can often lead to a
health outcomes and contributing to cost
physical and emotional stress on the patient
control (1,2). Availability and accessibility are
who is in pain or worried about a serious health
essential characteristics of efficient and
condition (6). Recent studies have shown that
effective primary healthcare systems (3,4,5). The
adverse consequences maybe established from
use of ambulatory primary healthcare services
prolonged waiting for primary health care
for multiple reasons, including but not limited
appointments (7,8). For example, prolonged
to routine care, mental health, child and
waiting times for serious conditions like heart
maternity care, liaison with home care, health
disease and cancer have been associated with an
promotion and disease prevention, end of life
increased risk of morbidity and mortality due to
care and having timely access to primary care
a delay in care (9,10,11). Furthermore, patients
has been shown to increase patient satisfaction
who are suffering from mental health issues and
as well as the quality of care provided in
who do not receive a professional care, often
countries like Canada (5). However, recent
experience a rapid decline in their health
studies have shown that access to family
condition and a lost opportunity for effective
physicians is becoming difficult due to
and efficient treatment (7). Patients satisfaction
physician shortages and increasing rates of
with the health care is a basic component in
disability and chronic disease (5). There are
evaluating health care quality (12). The
many issues in the primary health care center
importance of the patient's opinion and his
6910
Received: 16/9/2018
Accepted: 26/9/2018

Full Paper (vol.736 paper# 18)


c:\work\Jor\vol736_19 T
he Egyptian J
ournal of H
ospital Me

dicine (
October 2018) V
ol.
(

73

6), Page 6915 6920
-

Early Versus Delayed Reversal of Covering Stoma after Low Anterior Resection
for Colorectal Carcinoma

Taha Mohamed Fayed, Ayman Mohammed AbdulMohaymen, and Eid Rizk El Gammal

Surgical Oncology Unit, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Corresponding author: Taha Mohamed Fayed, Email: tahafayed40@gmail.com

Abstract
Background: A defunctioning stoma is used primarily to protect the anastomosis and prevent pelvic
sepsis after bowel surgery.
Aim of the work: This study was aimed to compare early stoma closure with conventional stoma closure
following defunctioning diversion stoma surgery with respect to the frequency of complications,
healthrelated quality of life (QOL), and length of hospitalization (LOH).
Patients and Methods: This study was designed as a prospective parallelarm randomized controlled
trial. 40 patients who underwent temporary stoma following colorectal cancer surgery were enrolled in
this study. The rate of complications (medical and surgical) following early (20 patients) and
conventional (20 patients) stoma closure was assessed. Healthrelated QOL and LOH were also
measured.
Results: Forty patients were included, with 20 cases in each group. Postoperative complications
including wound dehiscence (15% vs. 15%; P = 1.00), wound infection (40% vs. 5%; P = 0.023),
intraabdominal collection (15% vs. 30%; P = 0.449), anastomotic leak (15%vs. 30%; P = 0.449) were
comparable. The length of hospital stays and overall mortality and morbidity were similar across the two
groups. There was a significant reduction in the cost towards stoma care in the early stoma closure group.
Furthermore, Patients in the early stoma closure group also had a significantly better QOL.
Conclusion: Early stoma closure does not carry an increased risk of postoperative complications, reduces
cost towards stoma care, and leads to better a QOL.
Keywords: Colorectal carcinoma, Stoma, Early closure, Delayed closure.

Introduction
A defunctioning stoma is used primarily to
varying from 4% to 30%, requiring reoperation
protect the anastomosis and prevent pelvic sepsis
[16].
after bowel surgery [14]. A Cochrane review
The reports on early versus conventional stoma
reported that temporary ileostomy is associated
closure are conflicting [2022]. Hence aim of this
with fewer anastomotic leakages [5]. Matthiesen
study was to compare early versus late closure of
et al. reported that a defunctioning stoma reduces
stoma in cases of low anterior resection for
the need for urgent reoperation [6]. Stoma closure
colorectal carcinoma as regarding hospital stay,
is usually performed after 812 weeks. However,
quality of life, and post-operative complication.
quality of life (QoL) is affected due to

stomarelated complications during this time
Patients and Methods
period [7-10].
This randomized controlled trial included a
Early closure of temporary stoma might reduce
total of 40 patients who underwent temporary
both stomarelated morbidity and patient
stoma following colorectal cancer surgery
discomfort. Alves et al. reported that reversal of
attending at Department of Surgical Oncology,
temporary stoma 810 days after surgery is
Bab-Elshaarya University Hospital. Approval
feasible; however, with higher wound
of the ethical committee and a written informed
complications [15]. Other studies have also found
consent from all the subjects were obtained.
that outcome did not differ significantly between
This study was conducted between September
early and late stoma closure regarding morbidity
2017 and September 2018.
and mortality [1618].


Restoration of intestinal continuity is generally
The patients (40) were divided into two groups,
associated with a low mortality [19]. However,
20 each; early and late (conventional). The rate
stoma reversal may cause major complications
of complications (medical and surgical)
ranging from 0% to 9% and minor complications
following early (before three months) and late
6915
Received: 16/9/2018
Accepted: 26/9/2018

Full Paper (vol.736 paper# 19)


c:\work\Jor\vol736_20
Ahmed Saad et al.

1


Full Paper (vol.736 paper# 20)


c:\work\Jor\vol736_21 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (6), Page 6928-6935

Evaluation of Gout Diagnosis and Management in Primary Health Care
Centers
Alaa Ahmed Al-Zahrani1, Afnan Ateeg Batwie1, Ammar Mohammed Jamal1, Emtenan
Khadir Alharbi2, Marwan Omar Alahmadi3, Abdulaziz Mohammed Bakhsh3, Abdulhamid
Ahmed Sulaimani3, Faisal Mohammed Baqarwan3, Amgad Ismaeel Gholam3, Naif Muhaysin
Alharbi3
1- King Abdulaziz University, 2- Ibn Sina National Medical College, 3- Umm Al-Qura University

Abstract


Background: Gouty arthritis is a type of metabolic disorder that is associated with joint inflammation
as a result of accumulation of monosodium urate in the synovial fluid. It's considered as one of the
commonest presentations in primary care centers, in which a patient's present complaining of rapid pain
development, redness and swelling of the effected joint. Objective: In our review, we focused upon
discussing the clinical presentation of gouty arthritis, and recent updates in diagnosis and management
in primary health care center. Methodology: A comprehensive search was done using biomedical
databases; Medline, and PubMed, for studies concerned with assessment of Gouty Arthritis. Keywords
used in our search through the databases were as; "Gout arthritis evaluation", "Diagnosis",
"Management", and "Primary health care center". Conclusion: Acute gouty arthritis attacks occur as a
result of accumulation of monosodium urate crystal deposits into the joint space which associated with
inflammatory reaction development. The condition can cause severe pain at the start of the attacks, later
on as the condition progress a patients may develop deformity in the effected joint and functional
impairment. Primary health care physicians should have a full knowledge regarding gouty arthritis
diagnosis, evaluation, and management options. Gout management aims to reduce serum urate level
below 6mg/dL, to avoid/ prevent formation of new crystals and promote the dissolution of existing
crystals. In general gout management can be difficult as a result of patient's incompliance, poor medical
care provided by the health care system, and the presence of comorbidities. A physician should inform
the patients about their condition, and the importance of patient's compliance with management plan to
prevent attacks development.
Key words:
Acute gouty arthritis, inflammatory reaction, urate crystal, joint space, management,
primary health care centers.

Introduction
Gouty arthritis is considered as a metabolic
Most often the attacks are self- limiting lasting
disorder that occurs as a result of accumulation
3- 14 days (4). With time, the attacks become
of uric acid in the synovial fluid and cartilage in
less painful, but last longer and tend to involve
a form of monosodium urate crystals, which
more than one joint and tendons1. The chronic
finally result in arthritic inflammation (1).
deposition of crystals damage the joints, and
Gouty arthritis described for the first time by
lead to formation of tophi (urate crystal deposits
the ancient Egyptians, then in the fifth century
in tissues), with chronic stiffness and swelling
BC Hippocrates identify it and referred to it as
of the joints (1). With the chronic inflammation
"The Un-walkable disease" (2). Gout also was
and swelling of the joints gouty arthritis can
described as a "Disease of Kings", because of
resemble rheumatoid arthritis and lead to
the relation between eating and drinking certain
intense inflammation, deformities, tophi, stones
foods and beverages that mostly can be offered
formation in the kidney, and renal insufficiency
by affluent people (2).
(5).
Gout acute attacks are triggered by the
Gouty arthritis considered as the most common
accumulation of sufficient amount of
type of inflammatory arthritis in Western
monosodium urate crystals inside the joint
countries1. According to the National Health
space. Clinical symptoms are characterized by
and Nutrition Examination Survey (NHANES
rapid onset of pain that is very difficult to bear.
2007-2008), the prevalence of gout US adults
Other signs and symptoms include redness,
were 3.9% (7). The results showed that there
swelling, warmness of the effected joint. In
was a significant increase in the prevalence of
most of the time the acute attacks involve the
gout compared to the same study done in 1988-
first metatarsophalangeal joint of the great toe.
1994 which accounted for 2.7%. Most of the
6928
Received: 13/9/2018
Accepted: 23/9/2018

Full Paper (vol.736 paper# 21)


c:\work\Jor\vol736_22 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (6), Page 6936-6942

Diagnostic Validity of Cone Beam Computed Tomography Radiography in
Detection of Dental Caries
Ghaida Abbas Katib1and Reem Mazen Alfuraih2
(1) Ibn Sina National Collage, General Dentist in Primary Health Care, (2) Alfarabi Colleges, Saudi
Arabia

Abstract
Introduction:
Comparison between tomography and one or more digital intra-oral systems have been
conducted with histological sectioning of the offending teeth as gold standard for comparison. The
findings in the literature are contradicting, since some studies showed superiority of tomography. This
systematic review aimed at evaluating the evidence in relation to the diagnostic accuracy of cone beam
computed tomography compared to the digital and film-based intra-oral radiography.
Methods: An electronic search was conducted on Medline Plus, PubMed, Science Direct, and Wiley
databases. All articles published in English language up to October 2017 were eligible to be included
in this review. Search on different search engines and different database websites including hand search
revealed 496 articles. After reading titles and abstracts, irrelevant and duplicated articles 459 were
excluded. The resulting articles were read carefully for comparison of accuracy between CBCT and
other intra-oral radiographic systems and the references lists of the resulting articles were screened for
additional studies.
Results: A total of 22 articles, available according to the inclusion criteria, were included in this
systematic review. Most of the studies (13 articles) were conducted on premolars and molars while, 5
studies were conducted on molars, one study was conducted on premolars, one study was on incisors,
and two studies did not report the type of teeth used. The majority of the studies (21articles) were
laboratory experiments (in-vitro) while, only one study was in-vivo. The sample size for the studies
(number of teeth) ranged from 30 to 257 teeth.
Conclusions: CBCT has similar diagnostic accuracy as other intra-oral systems for diagnosing dental
caries. CBCT is not recommended for caries diagnosis unless the CBCT was undertaken for any other
procedures where the dental caries should be included in the final report.
Keywords: Tomography, Radiography, Dental caries, Accuracy, Intraoral

INTRODUCTION
Dental caries is considered one of the most
different tools for adjusting and optimizing the
chronic
diseases
worldwide,
causing
images for different diagnostic tasks. The
demineralization of dental hard tissues. This
diagnostic performance of digital radiography
lesion will progress under the microbial biofilm
has been widely studied in laboratory
unless the biofilm is totally removed (1). Various
experiments. Some studies reported that digital
classification systems have been reported to
radiography have more accuracy than film
facilitate the diagnosis of carious lesions by
radiography in detecting caries while some
clinical visual examination. This method is
other studies reported that digitized films have
reliable and possible for visible surfaces such as
the same accuracy of charge-coupled device
occlusal, buccal or lingual surfaces whereas its
(CCD) system. In contrast, paper-print images
ability is limited for diagnosis of the carious
of CCD system have less accuracy than film
lesions in the proximal surfaces. Less than 50%
images (3). One drawback of the laboratory
of cavitated lesions on the proximal surfaces
experiments is that the mechanically created
can be detected by clinical visual examination
lesions have the opportunity to be detected by
(2).
radiography more than those created naturally
Digital radiography is used widely in dental
(3). This will reflect negatively on the results of
practice and there is considerable increase in
these types of studies and should be taken with
the number of clinics which tend to use it. It has
precautions. Three-Dimensional radiographic
shown
several
advantages
over
the
modality is or cone beam computed
conventional film images. Display of the digital
tomography (CBCT) is a new radiographic
images has been facilitated by providing
modality in the dental clinic. It is a volumetric-
software programs working on conventional PC
based image where the tomographic sections
monitors (3). These programs have many
are obtained in given resolutions which then are
6936
Received: 14/9/2018
Accepted: 24/9/2018

Full Paper (vol.736 paper# 22)


c:\work\Jor\vol736_23 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (6), Page 6943-6947

The Prevalence of Rickets Disorder among Children in Saudi Arabia
Omar mohammad obaid alshammari 1, Adnan Meteb Mohamed Almezani 1, Amjad Salem
Alshlaqy 1, Munirah Nasser Nayed Alsiraa 1, Ghadeer Awad Gadeb Alenazy 1, Saleh Ali Saleh
Kharshan AL Ghamdi 2
College of Medicine University of Hail 1, Rawalpindi Medical College 2
Corresponding author: Omar mohammad obaid alshammari, E-mail: Omaaarzx@yahoo.com, Phone no: +966530515177

ABSTRACT
Background:
Despite the modern life and the availability of nutrition, the prevalence of children
suffering from rickets in Saudi Arabia is increasing these days. Rickets can cause an effect to the
children growth and cause an impaction on their later life. Identifying the prevalence of rickets in Saudi
Arabia and comparing it with other countries can bring useful information about it in reaching the
causes, risk factors and prevention methods that have been done in the community to avoid it.
Objectives:
This study was done to investigate the prevalence of rickets among children in Saudi
Arabia. Methods: A cross-sectional study on knowing the prevalence of rickets among children living
in Saudi Arabia was carried out on 864 participants within different social media platforms during the
period from February to April 2018. Results: 15.3% of the children were diagnosed with rickets,
50.5. % of the diagnosed children was between the ages of 0 to 5. Regarding risk factors, 41.9% of the
children drink soft drinks and 15.4% of them were obese. Only 55% of the participants breast fed their
children, 35.9% of the participants know what rickets is, 45.3% ask for medical help once their child
has been diagnosed and 70.5% of the participants thought that vitamin D can prevent rickets.
Conclusion:
At the end of this study, there were an increased number of children that have been
diagnosed with rickets in Saudi Arabia.
Keywords:
rickets, vitamin D, breast feeding.

INTRODUCTION
Vitamin D has an important role in calcium
among the five most common diseases in
homeostasis, development and maintenance of
infants (5). In Saudi Arabia, even though having
human bones, and enhancement of the human
a great economic affluence and adequate
immune system (1). The initial result of vitamin
sunlight throughout the year, vitamin D
D deficiency is hypocalcemia, followed by
deficiency is slightly common in infants,
hypophosphatemia, and then a rise of alkaline
adolescents, as well as pregnant and lactating
phosphatase. These findings are known as
Saudi women (6,7). It is usually common practice
biochemical rickets or osteomalacia. Although,
for families to keep infants and young infants
the hypophosphatemia has an invariable finding
indoors with minimal or total avoidance of
in vitamin D-deficiency rickets, might not be as
direct sunlight. Even though there is an
effective as is the hypocalcemia in the early
awareness of the high prevalence of vitamin D
stage of the disease (2). Stimulation of the
deficiency in Saudi Arabia, a review of the
parathormone by hypocalcemia leads to bone
literature revealed a lack of data on the most
resorption in an attempt to maintain normal
common presentations.
serum calcium (3). In the growing bones, bone
MATERIALS AND METHODS
matrix continues to be produced but due to
A cross-sectional study involving 864
impaired calcification, its accumulation
participants all over Saudi Arabia was done
becomes abnormal leading to widening at the
between February to April 2018. The sample
epiphyseal ends of the bones which manifests
size for this study was selected and distributed
clinically in areas of fast bone growth like the
randomly. Self-administered questionnaires
wrist and costochondral junction. In weight-
were developed after a careful review of
bearing long bones, inadequate mineralization
literature on the subject and it included 17
may induce deformities of the bones in varying
questions demonstrated to people in Saudi
severity. Rickets is a term which stands for
Arabia. The questionnaires had two parts. Part
failure of mineralization of growing bone or
one; demographical data that includes age,
with characteristic changes of growth plate
gender and marital status. Part two; the
cartilage among infants before closure of their
participants were asked whether they have or
growth plate (4). Vitamin D deficiency rickets is
know a relative that has children who have been
increasing in the developing countries and it is
diagnosed with rickets or not, how old was the
6943
Received: 17/9/2018
Accepted: 30/9/2018

Full Paper (vol.736 paper# 23)


c:\work\Jor\vol736_24 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (6), Page 6948-6951

The Prevalence of People Underwent Appendectomy Procedure in Saudi
Arabia
Ziyad Ali s Alosayfir 1, Abdulaziz Ayed M Alshammari 1, Yousef Ateeg Awad Alsadi 1, Hamoud
Meshal Farhan Alshammari 1, Hussam Salem Alshammari 1, Marwan ahmed jaafari 2, Saleh Ali
Saleh Kharshan AL Ghamdi 3, Firas osama alghaffari 4
College of Medicine University of Hail 1, College of Medicine Prince sattam ben Abdulaziz
University 2, Rawalpindi Medical College 3, Mansoura university Egypt 4
Corresponding author: ziyad Ali s alosayfir, E-mail: Dr.zeiad.alo@gmail.com, Phone no: +966537700578

ABSTRACT
Background
despite the modern life and the availability of knowledge, the prevalence of people who
have had appendectomy procedures is increasing these days in Saudi Arabia in the previous years for
multiple different risk factors. Knowing the prevalence of people who underwent appendectomy
procedure in Saudi Arabia and comparing it with other countries could provide useful information about
these risk factors and how to avoid them. Objectives: This study was done to collect information upon
and investigate the prevalence people under went appendectomy procedure in Saudi Arabia. Methods:
A cross-sectional study was carried out on 864 participants from different social media platforms to
investigate the prevalence of people who have had an appendectomy procedure in Saudi Arabia from
February to April 2018. Results: 41.1% of the participants knew some information about appendicitis,
8.1% of the participants have had an appendectomy procedure, 33.3% of the participants who had an
appendectomy procedure suffered from post-surgery complication, 29.7% of the participants suffered
from gastrointestinal diseases. Recently, 41.4% of the participants do not eat food rich in fibers and
37.7% of the participants have a positive family history of appendectomy Conclusion: At the end of
this study, there were an increased number of people who have had an appendectomy procedure in
Saudi Arabia.
Keywords:
appendicitis, appendectomy, complications.

INTRODUCTION
The vermiform appendix is a about a tubular
common procedure. However, there are some
diverticulum
which
comes
from
the
risks associated with the surgery, including
posteromedial wall of the cecum which is
infection, bleeding, injury to the nearby organs
about30 mm below the ileocecal valve location
and blocked bowels. It's very important to
(1). The appendix's tip is variable in its location
know that the risks of an appendectomy
and might lie in a retroileal, retrocecal,
procedure are much less severe than the risks
subcecal, preileal or pelvic location. This
associated with untreated appendicitis which
variability in the appendix location may
may be fetal. An appendectomy needs to be
influence and affects the presentation of
done as quickly as possible to prevent abscesses
appendicitis clinically (2). Appendicitis is the
and peritonitis from developing (6).
inflammation of the vermiform appendix which

is the most common cause of acute abdomen in
MATERIALS AND METHODS
both adults and children all over the world (3).
A cross-sectional study involving 864
Appendectomy procedure is the gold standard
participants all over Saudi Arabia was done in
and best choice in treating the acute
the period between February to April 2018. The
appendicitis whereby, the inflamed appendix is
sample size for this study was selected and
removed to help the patients avoiding the
distributed
randomly.
Self-administered
complications that may rise from appendicitis
questionnaires were developed after a careful
(3). If untreated, appendicitis may lead to several
review of literature on the subject and it
clinical complications, which may be cause
included 9 questions submitted to people in
death to the patients eventually. Appendectomy
Saudi Arabia. The questionnaires had two parts.
is one of the most common surgical procedures
Part one; demographical data that includes age,
performed worldwide (4). There are many
gender and marital status. Part two; the
clinical studies that may show the best practice
participants were asked whether they have any
in the management of acute appendicitis (5). An
information about appendicitis or not, whether
appendectomy is a fairly easy, simple and
they have had an appendectomy procedure or
6948
Received: 17/9/2018
Accepted: 30/9/2018

Full Paper (vol.736 paper# 24)


c:\work\Jor\vol736_25 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (6), Page 6952-6954

Bacterial Susceptibility to Antibiotics in Urinary Tract Infections in
Children, KSAFH, Saudi Arabia, Tabuk
Salem K. Albalawi 1, Bushra K. Albalawi 2, Meznah O. Al Shwameen 3 Mohammed Huthayl H.
Alharbi 4
1. Department of Pediatrics, College of Medicine, King Saud University, Riyadh, 2.
Department of Medicine, College of Medicine, Tabuk University, Tabuk,3. Department of
Pediatrics, KFSH & RC, Riyadh, 4. Department of Medicine, Qassim University, AL Qassim,
Saudi Arabia
ABSTRACT
Objective:
this study aimed to determine the distribution and antibiotic susceptibility patterns of
bacterial strains isolated from patients with community-acquired urinary tract infections (UTIs) at King
Salman Armed Forces Hospital, Saudi Arabia, Tabuk. Urinary tract infections (UTIs) remain the
common infections diagnosed in outpatients as well as hospitalized patients. Early diagnosis and
comprehensive treatment can significantly decrease late serious complications. Current knowledge on
antimicrobial susceptibility pattern is essential for appropriate therapy. Methods: urinary isolates from
symptomatic UTI cases attending to King Salman Armed Forces Hospital were identified by
conventional methods. Positive urine cultures from 210 patients aged less than 14 years were studied.
Antimicrobial susceptibility testing was performed by Kirby Bauer's disc diffusion method. Results
were analyzed by using the NCCLS guidelines of the 210 samples that showed growth of pathogens.
Results: the most prevalent were E. coli (96.7%) followed by Klebsiella spp (3.3%). The majority
(81%) of the isolates were from females, while the remaining was from males. Among these gram-
negative enteric bacilli very high prevalence of resistance was observed against Ampicillin and Co-
trimoxazole. For E.coli the lowest resistant rate was that for Nitrofurantoin 10.3% followed by
Norfloxacin and Ceftriaxone (11.3% and 11.8% respectively). Resistance to Gentamicin and Nalidixic
acid was observed in 19.2% and 47.3% respectively. For Klebsiella, all organisms were sensitive to
Gentamicin and Norfloxacin and all organisms were resistant to Ampicillin. There was a high resistance
rate to Ceftriaxone (42.9%).Conclusion: this study revealed that E. coli was the predominant bacterial
pathogen of community-acquired UTIs at King Salman Armed Forces Hospital. Most of the organisms
were resistant to Ampicillin and Co-trimoxazole; it also demonstrated an increased resistance to
Nalidixic acid and Gentamicin. This study is useful for the clinician in order to improve the empiric
treatment.
Key words: pediatrics, antibiotics, infection, UTI, susceptibility, Ecoli, resistance

Introduction
Pediatric urinary tract infections (UTI) account
to be related to unrecognized UTI in childhood
for 0.7% of physician office visits and 514%
[5].Though UTI is a common problem
of emergency department visits by children
throughout the world the microbial isolates and
annually [1].In developed countries, urinary tract
their sensitivity pattern needs to be analyzed at
infection (UTI) in children is second onlyin
intervals to monitor the changing patterns of
frequency to upper respiratory tract infections
microbial flora and the development of
as a cause of morbidity [2]. Most UTIs in
resistance to drugs which may help physicians
children result from ascending infections,
to treat UTI in a better way and to prevent
although hematogenous spread may be more
further complications [6].
common in the first 12 weeks of life. Most UTIs
Material and methods
in children are monomicrobial [3]. UTI is caused
Urinary isolates from symptomatic UTI cases
mainly by colonic bacteria. In females 75-90%
attending pediatric OPC and those admitted in
of infections were caused by Escherichia coli
the pediatric ward of King Salman Armed
(E.coli) followed by Klebsiella and P ro t e u s.
Forces
Hospital
were
identified
by
In males, some series report that Proteus is as
conventional methods (supra-pubic bladder
common as E. coli, while others report a
aspiration in infants and clean catch midstream
preponderance of gram-positive organisms.
urine in older children).
Staphylococcus saprophyticuss is a proven
The study period was for one year from June
pathogen in both sexes [4]. Approximately 13-
2017 to June 2018. Children of both sexes
15% of end-stage renal diseases were thought
under the age of 14 years were included in the
2596
Received: 17/9/2018
Accepted: 30/9/2018

Full Paper (vol.736 paper# 25)


c:\work\Jor\vol736_26 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (6), Page 6955-6958

Awareness, Frequency and prevalence of DKA with D.M. type 1 children in
Al-Jouf Region

Atallah Fadel Alruwaili, Faisal Mohammed AlArjan, Abdulaziz Sayah Khafur Alruwaili,
Khalid sa'adi faleh alharbi, Faisal Abdulaziz Almulhim, Ali Hamoud Alenazi, Rayan Riyadh
Abdullah Aldandani, Ahmed Muteb Alhumidi Alanzi, Fawaz Rawi Alfuhigi, Ahmed Obaid
Aladham Alanazi
Pediatric Department, Al-jouf University
Corresponding author: Atallah Fadel Alruwaili Tel: +966 54 486 5509, E-mail: GLX-7077@hotmail.com

Abstract:
Background:
Diabetes Mellitus (DM) is a developing worldwide wellbeing concern. In 2000, diabetes
affected an expected 171 million individual's world-wide; moreover, by 2011 this had expanded to
more than 366 million and numbers are relied upon to surpass 552 million by 2030. Objective: The
present study aimed at increasing the awareness and prevents the complications of diabetes mellites
type 1 in children. Methodology: The current study was a cross-sectional community-based study of a
qualitative and quantitative approach. Our study enrolled 80 candidates, from both gender. Participants
were subjected to controlled self-administered close-ended study questionnaire all through the period
between July to August 2018; and one month for data analysis. Our current data were taken from Al-
jouf population in Saudi Arabia. Results: (58; 72.5%) of the participants were having children with
diabetes; where only 22; (27%) of them were not having children with diabetes. Moreover, 60; 75%
were answered that they have only one child with diabetes, while (14; 17.5%) answered that they have
two children and the lowest rate was for the third group who answered that they have more than three
children (6; 7.5%). Furthermore, the age ranges of the diabetic children were (1-5 years old) with
proportions of (14; 17.5%), (6-10 years old) with (28; 35%), and the highest range was (11+ years old)
with (38; 47.5%). Conclusion and Recommendation: the current study sheds light on a global and
nationwide health problem that affects children in the first stage of life which is diabetes type1. It has a
high rate in urban communities. The findings of the present study highlighted the need of raising and
improving the awareness through educational programs about management of self-care to prevent
and/or reduce the increasing numbers of children patients with DM1.
Keywords: diabetes, Mellitus, population, individual

Introduction
:
Diabetes Mellitus (DM) is a developing
deviations in way of life designs in the local (1).
worldwide wellbeing concern. In 2000,
The Kingdom of Saudi Arabia (KSA) is not
diabetes affected an expected 171 million
excepted from this international prevalent (4),
individuals world-wide; moreover, by 2011 this
consequently, diabetes is the furthermost
had expanded to in excess of 366 million and
challenging health problem fronting the
numbers are relied upon to surpass 552 million
kingdom (5).
by 2030 (1).
A report by the Saudi Arabian Ministry of
DM is a metabolic disease of numerous
Health, indicated that around 0.9 million
etiologies', portrayed by hyperglycemia coming
individuals were determined to have diabetes in
about because of imperfections in insulin
1992, however this figure increased to 2.5
emission, insulin activity or in cooperation, and
million individuals in 2010, on behalf of a 2.7
related with aggravation of sugar, fat and
time increment in the occurrence rates in under
metabolism (2). Furthermore, the three well-
two decades. Furthermore, in 2015, 4660
known forms of diabetes are Type 1 Diabetes
patients with diabetes went to the family and
Mellitus (T1DM), Type 2 Diabetes Mellitus
therapeutic facilities crosswise over Saudi
(T2DM) and Gestational Diabetes Mellitus
Arabia (6). This expanding number of diabetes is
(GDM) (3).
because of different variables, including a
The most noteworthy pervasiveness of diabetes
rising stoutness rate and a maturing populace (7).
generally is estimated to happen in the Middle
Moreover, patients with diabetes usually
East and North Africa because of quick
encounter other related chronic conditions,
financial advancement, development and
bringing about serious problems (3).
6955
Received: 17/9/2018
Accepted: 30/9/2018

Full Paper (vol.736 paper# 26)


c:\work\Jor\vol736_27 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (6), Page 6959-6966
Knowledge, Attitude and Practice among Jazan University Students in
Health Sciences Colleges Regarding Hepatitis B Virus and its Vaccine
Amani Yahya Ali Zaeri, Zaidyah Nasser Rihan Zaihi, Fatimah Ali Mohammed AbuDyab,
Eshraq Eissa Ibrahim Othman, Eman Hazza Hassan Somily, Amal ahmed Abdullah Zalah
Faculty of Medicine, Jazan University, KSA
Corresponding author: Amani Yahya Ali Zaeri, Email: amani.zaery.110@gmail.com

Abstract
Background:
Hepatitis B virus (HBV) is a blood-borne infectious disease. Patients with hepatitis B
may feel like influenza and might, in other cases, be asymptomatic, but blood analysis can detect the
disease. Hepatitis B usually starts to cure on its own after a few months, but the disease can turn into
chronic hepatitis if the virus is not cured and usually lasts a lifetime. Objective: this study aimed to
estimate the knowledge, attitude and practice about hepatitis B virus and its vaccine among health
science college's students of Jazan University, KSA. Methodology: this cross-sectional study
conducted targeting health sciences students of Jazan University in 2017. Data were collected using
self-administered questionnaire which has been distributed among 400 students using stratified
random sampling technique, the self-administration questioner aimed to estimate knowledge practice
and attitude towards HBV and its vaccination and whether the students were vaccinated or not.
Analysis has been done by using computer program (SPSS) for displaying frequency, mean and
percentage. Descriptive statistics and correlation analysis have been used to detect the association.
Results: this study found that overall knowledge about HBV hazards and prevention among students
was good and satisfactory (90.6%). The majority of the respondents (73.1%) had positive attitude
toward HBV and its vaccine, 58.5% had poor practice, 63.3% received vaccination and only 39.2%
were fully vaccinated.
Conclusion: Medical and health sciences students were at high risk of exposure to the HBV by direct
contact with patients and their body fluids or accidental injury by needles, that's why students should
be vaccinated upon entry to colleges or before starting clinical training and well-educated about post-
exposure prophylaxis when exposed to these injuries.

Introduction
Hepatitis means inflammation of the liver.
months [3]. Health sciences college's students
This condition is often caused by a virus., the
may be at high risk of infection when they
most common causes of viral hepatitis are
become in contact with the patients inside the
hepatitis A virus (HAV), hepatitis B virus
hospital, so they should be aware of how to be
(HBV) and hepatitis C virus (HCV). Despite
more careful and eager to protect themselves
most HBV infected people do not develop
from infectious disease during interaction with
active liver disease, it's a dangerous infection
patients in the future [4].
that affects the liver and leads to serious
Lots of cross-sectional studies [4-6] have been
complication including change from acute to
conducted in the recent years about HBV
chronic
hepatitis,
liver
cirrhosis
and
prevalence and in spite of the variable results
hepatocellular carcinoma putting the patients
and they generally indicated high prevalence
at risk of death from the complication. Most of
specially among health care workers. Mueller
infected adults with the virus recover, but
et al. [5] studied 600 health care workers in a
(5%10%) are unable to clear the virus and
tertiary hospital in Tanzania at the Buganda
become chronically infected [1] and according
Medical Centre (BMC) and the authors found
to WHO, 240 million people were chronically
that one third of HCWs were susceptible to
infected with hepatitis B and more than
HBV infection, although 63.5 % stated in their
686,000 people die every year due to
questionnaires that they had been vaccinated
complications of hepatitis B [2] .The health care
against HBV which indicated high prevalence
workers are at high risk of HBV infection
of chronic HBV infection among Tanzanian
because of high rate of accidental exposure to
HCWs [5]. In Najran region a study found that,
body fluids of patients. HB vaccine is very
the overall seroprevalence of HBV of 1.7%
important to prevent the infection and it is safe
and 8.7% was found among HS and HCWs,
and effective given as 3-4 shots over a 6
respectively. Two-thirds of HS (66.7%, 200)
9696
Received: 17/9/2018
Accepted: 30/9/2018

Full Paper (vol.736 paper# 27)


c:\work\Jor\vol736_28 T
he Egyptian J
ournal of
Hospital Me

dicine (
October 2
018) V
ol. 73

(
6), Page 6967 6972
-

The Identification of Recurrent Laryngeal Nerve by Injection of Blue Dye
into the Inferior Thyroid Artery

Amr Salah, Mohamed Mamdoh, Nader Abd-Elhamid*

Surgical Oncology Unit, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
*Corresponding author: Nader Abd-Elhamid, E-mail: naderzaid1969@yahoo.com
Mohamed Mamdoh, E-mail: M_asar@windowslive.com

Abstract
Background: Thyroidectomy creates a potential risk for injury of the recurrent laryngeal nerve (RLN).
The identification and dissection of the RLN is the gold standard for preserving its function.
Aim of the work: was to evaluate the value of injection of methylene blue dye into the inferior thyroid
artery for help of the identification and dissection of RLN.
Patients and Methods: This study included 60 selected patients who underwent thyroid surgery
divided into 2 groups. In group A (30 patients) the branches of the inferior thyroid artery (ITA) near
to the capsule of the thyroid lobe were isolated, and then 0.5ml methylene blue dye was injected into
the artery. In group B (30 patients) the RLN identified without help of dye to be compared with group
A cases.
Results: During injection of dye bleeding from the ITA occurred in 7 patients. The identification of
the RLN within the painted tissue was succeeded 28 patients and failed in 2 patients due to
extravasation of the dye. Regarding the amount of blood loss, there was a significant difference
between the groups as the average amount of blood loss in group A was 8522 ml (range 70-120) and
in group B was 10537 ml (range 90-160) P = 0.01. Also, by comparing the time taken for RLN
identification in one side, there was a significant difference between the groups, as the median time
taken for single RLN identification in each case in group A was 92 min (range 7-12 min) and in group
B was 143 min (range 10-20 min) P = 0.008.
Conclusion: the injection of methylene blue dye into the inferior thyroid artery or its branches is a
feasible, effective, reliable way that can be used as a method for the identification of the RLN during
thyroidectomy.
Keywords: Methylene blue, recurrent laryngeal nerve, thyroid surgery
Introduction
Thyroidectomy is one of the most frequent
excessive strain during tracheal intubation,
operations performed in iodine-deficient
and post-operatively by edema, hematoma,
regions.
The
main
postoperative
and neuritis caused by scar tissue (4).
complications are recurrent laryngeal
In 1923, Frank Lahey emphasized the
nerve
(RLN)
palsy
and
importance of RLN and developed a
hypoparathyroidism (1). Although the
standard technique for its identification
incidence
of
RLN
injury
after
and exposure during thyroidectomy. Since
thyroidectomy widely varies in the
Lahey, identification and dissection of
literature, it was ranging from 0.4% to
RLN is the gold standard of preserving its
7.2% for temporary paresis and from 0% to
function. Identification of RLN has
5.2% for permanent paralysis (2). Several
decreased the rates of transient or
factors influence the likelihood of injury to
permanent nerve injury during thyroid
the nerve, including the underlying disease
operations (5). There are several approaches
(substernal goiter, malignancy, Graves
to identify the RLNs depending on the
disease, etc.), the extent of resection, and
surgeon preference. But in some cases it
the experience of the surgeon. The
may be still quite difficult to localize the
standard method for RLN preservation
RLNs, and in these situations, blue dye
during thyroidectomy is routine visual
injection into the inferior thyroid artery or
identification of the nerve (3). RLN palsy
its branches may be useful to identify the
includes intra-operative damage to the
RLN (6).
anatomic integrity of the nerve through
The aim of this work was to evaluate the
thermal injury or axon damage by
value of injection of methylene blue dye
6967
Received: 13/9/2018
Accepted: 23/9/2018

Full Paper (vol.736 paper# 28)


RELATIONSHIP BETWEEN SLEEP DISORDERED BREATHING AND PRO-INFLAMMATORY MARKERS IN ACUTE ISCHEMIC STROKE The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (6), Page 6973-6982

Effect of Intra-Muscular Administration of Dexamethasone on the
Duration of Induction of Labor in Primigravida Full-Term Pregnancy
Emad Maarouf Abdel Latif, Wael Soliman Taha & Ahmed Abd Rabou Ali Ahmed*
Obstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar University
*Corresponding Author: Ahmed Abd Rabou Ali Ahmed, Phone No.: (+2) 01147346106, E-mail:
ahmed.elarishy90@gmail.com
ABSTRACT
Background:
induction of labor refers to the process of artificially initiating uterine contractions prior
to their spontaneous onset to effects progressive effacement and dilatation of the cervix and ultimately,
delivery of the baby.
Aim of the Work: to establish whether a single dose of dexamethasone (8mg) intra-muscularly plays
a role in shorting the duration interval between initiation of labor induction and beginning of the active
phase of labor in primigravida full-term pregnancy.
Patients and Methods: this clinical interventional randomized case-controlled trial was conducted at
El Hussien University Hospital during the period from July 2017 to March 2018. One hundred twenty
full term & post-term ( 40 weeks) nulliparous women were included in this study and divided into the
following: Group I (Dexamethasone group) injected with 2 ml (8 mg) of the product (dexamethasone)
6 hours before initiation of labor induction and Group II (Control group) was not receive dexamethasone
or any other cervical ripening agent.
Results: our results showed that the intramuscular administration of dexamethasone appears to shorten
labor duration.
Conclusion: single intra-muscular injection of two ml. (8mg.) of dexamethasone before induction of
labour appears to shorten labor duration.
Keywords: Intra-Muscular Administration Dexamethasone - Primigravida Full-Term Pregnancy

INTRODUCTION

Induction of labor is one of the most
newborn infant. Therefore of major importance
common interventions practiced in modern
in handling compromised postdate pregnancies
obstetrics. In the developed World, the ability
is the use of a suitable method of labor
to induce labor has contributed to the reduction
induction (3).
in maternal and perinatal mortality and
A prolonged gestation is more likely to
morbidity (1).
occur when the fetus has congenital adrenal
The goal of labor induction is to
hyperplasia
caused
by
2l-hydroxylase
stimulate uterine contractions before the
deficiency, which may be due to an impaired
spontaneous onset of labor, resulting in vaginal
cortisol production (4).
delivery. The benefits of labor induction must
Glucocorticoids are now known to play
be weighed against the potential maternal and
key roles in fetal maturation for example in
fetal risks associated with this procedure. When
maturation of the lung in anticipation of extra-
the benefits of expeditious delivery are greater
uterine life and in several species appear to be
than the risks of continuing the pregnancy,
mediators in the initiation of labor. In humans,
inducing labor can be justified as a therapeutic
the placenta synthesizes CRH, and the
intervention (2).
exponential rise of this hormone in maternal
The success of induction and labor
plasma correlates with the timing of birth (5).
progression is dependent on the condition of the
Glucocorticoids derived from the
cervix before induction initiation (2).
maturing fetal hypothalamus-pituitary-adrenal
In primigravidae, the mean time taken
axis play a crucial role in triggering parturition
from induction to delivery is between 15 and 20
(6).
hours, of which up to 12 hours is spent in the
Different studies have shown the
cervical ripening phase before labor itself starts
paracrine
and
autocrine
effects
of
(1).
corticosteroids on the human uterus, and
About 10 percent of pregnancies may
receptors for these agents have been detected on
be prolonged. In general, the longer the truly
the human amniotic membranes (7).
post-term fetus stays in the uterus, the greater
The corticotrophin-releasing hormone
the risk of a severely compromised fetus and
(CRH), which has been identified in various
6973
Received: 13/9/2018
Accepted: 23/9/2018

Full Paper (vol.736 paper# 29)


c:\work\Jor\vol736_30 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (6), Page 6983-6986
Knowledge about the prevalence of Iron Deficiency Anemia and its
associated risk factors in females in Saudi Arabia
Sultan Ahmed Almallki 1, Adnan Meteb Mohamed Almezani 2, Abdulaziz Ayed M Alshammari
2, Ziyad Ali S Alosayfir 2, Ibrahim Homoud Alshammari 2, Adel Hamoud Hammad Alhammad 2,
Mohammed saud salem alsalem 2, Shahad Mohammed Awad Alhazmi 2, Faris mohammed
suliman alshammari 2, Nader Awad Alanazi 1, Saleh Ali Saleh Kharshan AL Ghamdi 3, Mona
Ahmed SID Ahmed Mohammed 4, Fares Ahmed S Aljohani 5
Imam Muhammad ibn Saud Islamic University 1, College of Medicine University of Hail 2,
Rawalpindi Medical College 3, University of Bahr Alghazal 4, College of Medicine King Saud
University 5
Corresponding author: Sultan Ahmed Almallki, E-mail: drsam842@gmail.com,
Phone no: +966535660600

ABSTRACT
Background
: despite the modern society and available healthy food, iron deficiency anemia is
common in Saudi Arabia woman. Iron deficiency anemia is very common in women due to many
risk factors like heavy menses and eating food that is not rich in iron. Knowing the prevalence of
iron deficiency anemia and its associated risk factors in Saudi Arabia can provide a useful
knowledge in avoiding these risk factors and improving the overall health.
Objectives: Iron deficiency anemia is increasingly common worldwide. This study aims to assess
the prevalence of iron deficiency anemia and its associated risk factors in women in Saudi Arabia.
Methods: Across-sectional study on the prevalence of iron deficiency anemia was randomly carried
out among women (1638 participants) in different social media platforms of Saudi Arabia during
the period from February to April 2018.
Results: In 43.5% of the participants have been suffering from iron deficiency anemia, only 10.1%
had a blood transfusion as a consequence of the anemia, 42.6% have sought medical help, 32.8%
had heavy menses, 48.5% had a positive family history of iron deficiency anemia, only 15.4% had
hypothyroidism disease, 57.2% don't eat iron rich food and only 7.9% were pregnant.
Conclusion: Our result showed that huge number of the participants was suffering from iron
deficiency anemia in Saudi Arabia.
Keywords: Iron deficiency anemia, Heavy menses, Hypothyroidism.

INTRODUCTION
Anemia is a public health issue in the world
induce an influence on an individual's iron
affecting
approximately
1.62billion
balance, either in combination or alone
individuals or approximately a quarter of the
(12) ranging
from
sociodemographic
world's population (1,2). There are different
characteristics including the individual's age,
types of anemia exist, and among these, iron
sex, marital status, level of education, income,
deficiency anemia (IDA)which is considered
and ethnicity to the amount, quality of the food
the most common worldwide spread (3,4). Iron
and beverages they consume, their mental and
deficiency anemia accounts for 75% of all
physical health, the medication they take, any
types of anemia in the third world, affecting
abnormalities they have, and their genetic
30% of population (5). IDA has reached
makeup (10, 11, 12). It is particularly true for
epidemic levels in many developing countries
women that if IDA is not quickly identified
(6) and is now the most prevalent micronutrient
and treated, it has lifelong effects, including
deficiency in the world (7,8). Iron deficiency
negative impacts on maternal and neonatal
anemia has a negative impact on individuals,
outcomes, and an increased risk of disability in
who are at risk of impaired growth, cognitive
later life (13). In the only relevant previous
development, lower mental, motor function,
study, Al Hassan (14) reported an estimated
poor work capacity, and generally lower
prevalence of IDA of 64% for a sample of
quality of life (9). Iron deficiency is caused by a
female university students of Saudi nationality,
prolonged period of imbalance between a
but their research ignored any consideration of
person's dietary intake of iron and their body's
the potential risk factors associated with IDA.
physiological need (10,11). Many risk factors

6983
Received: 17/9/2018
Accepted: 27/9/2018

Full Paper (vol.736 paper# 30)