Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269820171001Study of Antibiotic Use in a Tertiary Care Hospital in Tabuk City, Northern West, Saudi Arabia294429471245110.12816/0042831ENAmjad Saud MhrbAlrowiliPharmacist at King Salman Hospital for Armed Forces in Tabuk city, Northern West,
Kingdom of Saudi ArabiaJournal Article20180904<strong>Background</strong>: Inappropriate use of antibiotics is known as an important risk factor in the development of antibiotic resistance, which increases the morbidity and mortality. We aimed to determine the prevalence and characteristics of antibiotic use in a Tertiary Care Hospital in Tabuk city, Northern Saudi Arabia.
<strong>Methods:</strong> A cross sectional study was conducted in a Tertiary Care Hospital in Tabuk city, during October 2017. <strong>Results:</strong> A total of 120 participants, 107 of them had antibiotics in their prescriptions with antibiotic use prevalence 89.2%. Most of patients were males (62.6%) and children and adolescents (0-19 years) constituted 4.8%. The most attended department was internal medicine (32.7%). 21 diseases were identified, upper respiratory tract infection (URTI), followed by urinary tract infection (UTI) 8.4%. Among the antibiotics, ampicillin, cephalosporin and metronidazole were the most prescribed antibiotics as each of them was found in 16.8% of cases, followed by quinolones in 12.1% and macrolides in 11.2%. In addition, Augmentin (9.3%), aminoglycosides (7.5%) and chloramphenicol (1.9%). Regarding the combined therapy, 31.8% of patients received combination of two antibiotics, 4.7% received three antibiotics and only one antibiotic was prescribed in 68% of patients. The most common route of administration was the oral tablets in 48.6% and syrup in 14% of patients. <strong>Conclusion and recommendations:</strong> The prevalence of antibiotic use in Tabuk Tertiary Care hospitals was very high (89.2%) which could be a risk factor for the development of antibiotic resistance. We advocate public health measures targeting healthcare providers on the use and misuse of antibiotics.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269820171001MR Imaging Features of Chemotherapeutic Neurotoxicity in Cancer Patient2948295412618ENSalwa Taha Ahmed IsmailDepartment of Radiology, Faculty of Medicine, Ain Shams University, Cairo, EgyptMohammad Sobhi HassanDepartment of Radiology, Faculty of Medicine, Ain Shams University, Cairo, EgyptAhmed Mohamed BassiounyDepartment of Radiology, Faculty of Medicine, Ain Shams University, Cairo, EgyptAyda Aly YoussefDepartment of Radiology, Faculty of Medicine, Ain Shams University, Cairo, EgyptAmr Mostafa ElkatatnyDepartment of Radiology, Faculty of Medicine, Ain Shams University, Cairo, EgyptDina Mahmoud Al NajjarDepartment of Radiology, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20180905<strong>Aim of the work</strong>: this study aimed to display the role of imaging by MRI in early detection and accurate diagnosis of chemotherapeutic neurotoxicity in neoplastic patients under chemotherapy.<br /> <strong>Patients and methods:</strong> this study included 50 cases of different cancers with CNS radiological manifestations. It included any cancer patient, regarding the age, sex and primary cancer and received any type of chemotherapy. The entire patients were evaluated by CEMRI technique, MR venography as well as diffusion weighted MRI.<br /> <strong>Results:</strong> our result showed different forms of neurotoxicity that occur in cancer patients due to the effect of chemotherapy such as posterior reversible encephalopathy syndrome and cerebral venous sinus thrombosis.<br /> <strong>Conclusion:</strong> all survivors of cancer patients should have lifelong follow-up, preferably with magnetic resonance imaging which provided greater anatomic detail and early detection of any abnormality.<br /> <strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269820171001The Prevalence of Middle Ear Disease in The Adult Population295529591262110.12816/0042834ENTalal Saad AlmutairiImam Muhammad Ibn Saud Islamic UniversityHusam Khalid Algayed,Imam Muhammad Ibn Saud Islamic UniversityFawaz Mohammed AlharbiNorthern Borders UniversityHadil Mohammed AleneziAlmaarefa Colleges for Science and TechnologyRead Alzahrani5King Saud Bin Abdulaziz University for Health SciencesAbdullah Fahad Al QudhybiJournal Article20180905<strong>Background: </strong>otitis media (OM) also known as middle ear disease is an inflammation of the middle ear cleft, where infection leads to the effusion of fluids into the middle ear. In developing countries, otitis media is the main cause of hearing impairment. There are several factors that enhance the presence of otitis media, including genetic, environmental and demographic.
<strong>Aim of the study: </strong>this study aimed to investigate the prevalence and risk factors of otitis media in adults.
<strong>Methods: </strong>this study included 117 participants and it based on an online survey, the survey was divided into two parts. The data were collected in excel sheet and analyzed by SPSS.
<strong>Results: </strong>the prevalence rate of OM was 40.2%, there were significance differences between health individuals and OM patients regarding chronic diseases (P value=0.01) and allergy (P value=0.001).
<strong>Conclusion:</strong> the prevalence of OM was low, chronic disease and allergy were risk factors for OM.
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<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269820171001Study for The Relationship between Lupus Nephritis and Anti-C1q Antibodies296029741262210.12816/0042836ENAshraf Abdel-Maged DoniaUrology and Nephrology department, National Institute of Urology and NephrologyAhmed Ibrahim AminBiochemistry department, Faculty of Science, Cairo UniversitySameh Soliman Dawoud MohamedDesert Research Center, Cairo, EgyptJournal Article20180905<strong>Background</strong>: lupus nephritis (LN) is an inflammation of the kidney caused by systemic lupus erythematosus (SLE), a disease by the immune system.<br /> Anti-C1q antibodies have been found in many different systemic autoimmune diseases, they are strongly linked to immune complex disorder most prominently SLE and severe rheumatoid arthritis and have been suggested to be closely associated with lupus nephritis (LN).<br /> Generally anti-dsDNA antibodies have been acknowledged as an important tool in the diagnosis of SLE, however their predictive value as to the activity of the disease remains controversial, on the contrary anti-C1q antibodies appear to have a clear-cut relationship with renal complications of SLE not only have they been shown to play a pathogenic role in the development of lupus nephritis but also their serum levels correlate with the presence of active proliferation lupus nephritis.<br /> <strong>Aim of the study: </strong>this study aimed to investigate association between serum titer of anti-C1q antibody and disease manifestation of SLE. <strong>Methodology</strong>: the study was carried out in three different groups: healthy group, rheumatoid arthritis group and lupus nephritis group. All groups were subjected to determination of anti-C1q antibody, blood urea nitrogen (BUN) and serum creatinine.<br /> <strong>Results: </strong> there was no significant difference in BUN levels between the normal and rheumatoid arthritis groups in contrast there was a highly significant difference in BUN between the normal and lupus groups also, between the rheumatoid arthritis and lupus nephritis groups (p˂0.001). No significant difference was detected in serum creatinine levels between the normal and rheumatoid arthritis groups in there was a highly significant difference in serum creatinine between the normal and lupus groups and also between the rheumatoid arthritis and lupus nephritis groups (p˂0.001). No significant difference was realized in serum anti-C1q antibodies levels between the normal and rheumatoid arthritis groups in contrast there was a highly significant difference in serum anti-C1q antibodies between the normal and lupus groups and also between rheumatoid arthritis and lupus nephritis groups (p˂0.001). In the control group and rheumatoid arthritis groups, only BUN showed a highly significant positive correlation with serum creatinine concentration (r=0.906, r=0.404) and (P˂0.001, P˂0.05) respectively, while in lupus nephritis group, BUN showed a highly positive correlation with serum creatinine concentration (r=0.773, P˂0.001) also serum creatinine concentration showed a positive concentration with serum anti-C1q antibody (r=0.513, P˂0.05).<br /> <strong>Conclusion: </strong>the present study suggested that anti-C1q antibody might be a new parameter for the development of lupus nephritis since the increased of anti-ds DNA antibody and hypocomplementemia (C3 and C4) are serological markers of SLE activity, but they are not enough to identify which organ may be affected, while anti-C1q antibody either alone or in combination with other serological markers could give information of the diagnosis of a renal flare with 100% sensitivity and specificity.<br /> <strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269820171001Causes and Treatment of Tonsillitis297529801262410.12816/0042838ENNuha Saad H AlasmariIbn Sina National CollegeRyan Omar M BamashmousKing Abdulaziz UniversityRakan Mohammed Ahmed AlshuwaykanTabuk UniversityMajed Ali Mohammed AlahmariImam Muhammad
Bin Saud UniversityAmjad Awdah Mohammed AlshahraniKing Khalid UniversitySaad Ahmed AlqarniKing Abdulaziz UniversityAbdulrahman Saleh AlhadlagSulaiman Al Rajhi CollegesFaisal Ali A AlotaibiTaif UniversityAbdulaziz Suleman Abdulaziz AlassiriTabuk UniversityAhmed Abdu Hassan AlnajiTabuk UniversitySaleem Othman Rafi AlamriOhud Hospital AlmadinahJournal Article20180905Sore throats can have a range of causes. Common cold viruses are usually to blame. In rarer cases, sore throats are caused by an infection of the tonsils (tonsillitis). This infection is often bacterial, or sometimes viral. But it isn’t easy to tell what kind of germs are responsible for the infection. Children and teenagers are much more susceptible to tonsillitis than adults are. Tonsillitis is inflammation of the pharyngeal tonsils. The inflammation usually extends to the adenoid and the lingual tonsils; therefore, the term pharyngitis may also be used. Most cases of bacterial tonsillitis are caused by group A beta-hemolytic Streptococcus pyogenes (GABHS). Tonsillitis of viral origin is usually treated with supportive care. We describe the anatomic features and the immunologic function of the palatine tonsils, including a detailed discussion of history and physical examination findings, treatment, and possible complications of acute tonsillitis. Establishing an accurate diagnosis and initiating appropriate treatment are key components of managing this common pathologic process.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269820171001A Study to Evaluate KM/Propofol versus KM Alone for Procedural Sedation in Children298129851263010.12816/0042839ENAbdulrahman Fayez KinsaraKing Faisal Hospital MakkahAhmad Abdulaziz M. AlmehmadiIbn Sina National CollegeTurki Jafar AbdulmajidAl Immam Abdulrahman Al Faisal HospitalMotaz AshoorKing Abdulalziz General Hospital Jeddah Radiology DepartmentQusai Abdullah Al SaqabiAl Jouf UniversityRakan Abdulrahman AlrzoqImam UniversityBadr Wadee S AbulhamailKing Abdulaziz University HospitalRanda Fahad AlmatrafiAl-Noor Specialty HospitalBasim Salman W AlmazruiGP in Aseer HospitalBasem Abdullah AlghamdiGP - Najran University HospitalFawaz Sulaiman Ayed AlshammariUniversity of HailJournal Article20180905<strong>Background: </strong>The co-administration of ketamine and propofol (CoKP) is thought to maximize the beneficial profile of each medication, while minimizing the respective adverse effects of each medication.
<strong>Objective: </strong>Our objective was to compare adverse events between ketamine monotherapy (KM) and CoKP for procedural sedation and analgesia (PSA) in a pediatric emergency department (ED).
<strong>Methods: </strong>This was a prospective, randomized, single-blinded, controlled trial of KM vs. CoKP in patients between 3 and 21 years of age. The attending physician administered either ketamine 1 mg/kg i.v. or ketamine 0.5 mg/kg and propofol 0.5 mg/kg i.v. The physician could administer up to three additional doses of ketamine (0.5 mg/kg/dose) or ketamine/propofol (0.25 mg/kg/dose of each). Adverse events (e.g., respiratory events, cardiovascular events, unpleasant emergence reactions) were recorded. Secondary outcomes included efficacy, recovery time, and satisfaction scores.
<strong>Results: </strong>Thirty-two patients were randomized to KM and 29 patients were randomized to CoKP. There was no difference in adverse events or type of adverse event, except nausea was more common in the KM group. Efficacy of PSA was higher in the KM group (99%) compared to the CoKP group (90%). Median recovery time was the same.
<strong>Conclusions: </strong>We found no significant differences in adverse events between the KM and CoKP groups. While CoKP is a reasonable choice for pediatric PSA, our study did not demonstrate an advantage of this combination over KM.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269820171001Meta-Analysis for The Treatment of Helicobacter Pylori298129851263110.12816/0042844ENBader Abdulrahman AlageelKing Saud,Medical City-RiyadhRayyan Abdullah S. AlyahyaAl ImamHanan Abdullah A AlrashediAlmaarefa College for Science and TechnologyLamma Abdulmohsen A AlghiryafiUniversity of Um AlquraElham Hamid AlfallajAlmaarefa College for Science and TechnologyAhmed Ibrahim Ahmed AlJuraysanKing Faisal UniversityWaleed Khalid M AlqurashiKing Abdul Aziz UniversityIsmail Hassan H AlmakramiKing Abdul Aziz UniversityAdel Ahmed S AlmuzainiKing Abdul Aziz UniversityAzzam Khalid A LaskarKing Abdul Aziz UniversitySultan Khalid A AbdullahKing Abdul Aziz UniversityIbrahim Ahmed M AlnashriKing Abdul Aziz UniversityJournal Article20180905<strong> </strong>
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<strong>Purpose</strong>: To assess whether Helicobacter pylori (H. pylori) eradication therapy benefits patients with functional dyspepsia (FD). <strong>Methods: </strong>Randomized controlled trials (RCTs) examining the efficacy and safety of H. pylori eradication therapy for patients with functional dyspepsia published in English (till November 2016) were recognized by searching PubMed, EMBASE, and The Cochrane Library. Pooled estimates were measured using the fixed or random effect model. Overall effect was expressed as a pooled risk ratio (RR) or a standard mean difference (SMD). All data were analyzed with Review Manager 5.3 and Stata 12.0.
<strong>Results:</strong> This analysis involved 15 RCTs with a total of 3567 patients with FD. These studies were used to assess the benefits of H. pylori eradication therapy for symptom improvement; the pooled RR was 1.26 (95%CI: 1.10-1.40, P < 0.0001). H. pylori eradication therapy demonstrated symptom improvement during long-term follow-up at ≥ 1 year (RR = 1.27; 95%CI: 1.13-1.41, P < 0.0001) but not during short-term follow-up at < 1 year (RR = 1.26; 95%CI: 0.83-1.92, P = 0.27). Four studies showed no benefit of H. pylori eradication therapy on quality of life with an SMD of -0.01 (95%CI: -0.09 to 0.07, P = 0.74). Four studies demonstrated that H. pylori eradication therapy reduced the development of peptic ulcer disease compared to no eradication therapy (RR = 0.34; 95%CI: 0.17-0.67, P = 0.002). Three studies showed that H. pylori eradication therapy increased the likelihood of treatment-related side effects compared to no eradication therapy (RR = 1.87; 95%CI: 1.08-3.47, P = 0.02). Ten studies demonstrated that patients who received H. pylori eradication therapy were more likely to obtain histologic resolution of chronic gastritis compared to those who did not receive eradication therapy (RR = 7.05; 95%CI: 3.59-13.74, P < 0.00001).
<strong>Conclusion: </strong>The decision to eradicate H. pylori in patients with functional dyspepsia requires individual assessment.
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<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269820171001Griseofulvin vs. Terbinafine in the Treatment of Tinea Capitis299229961263210.12816/0042845ENHumoud Mansour AlKhalafRoyal college of surgeons in IrelandAdnan Meteb Mohamed AlmezaniHail university , College of MedicineYoussef Mohammad AlmodhaibriQassim UniversityMustafa Mohamed Ali AlmusallamiHera General HospitalJumanh Khalid Attiahibn sina national collegeAbdulaziz Mohammed AlsahliKing Abdulaziz universityMaha Fahad Alluqmaniibn sina national collegeFatimah Mohammed Saeediibn sina national collegeAli Hassan Jaber Alzahraniing Abdulaziz university-Rabigh branchIbrahim Abdullah Al TahaOyun City HospitalSomaya Khalid AlsharifUmm Al-Qura UniversityFatema Hassan A. ALAjwadImam abdulrahman bin faisal universityNawal Hatem HerzallahRoyal college of surgeons in IrelandJournal Article20180905<strong>Background: </strong>Two oral antifungal agents, griseofulvin and terbinafine, have regulatory approval but it is unknown whether one has superior overall efficacy. Genus-specific differences in efficacy are believed to exist for the two agents. It is not clear at what doses and durations of treatment these differences apply.
<strong>Purpose</strong>: The purposes of this meta-analysis were to determine whether a statistically significant difference in efficacy exists between these agents at a given dose and duration of each in tinea capitis infections overall and to determine whether a genus-specific difference in efficacy exists for these two treatments at a given dose and duration of each. We performed a literature search for clinically and methodologically similar randomized controlled trials comparing 8 weeks of griseofulvin (6.25–12.5 mg⁄kg⁄day) to 4 weeks of terbinafine (3.125–6.25 mg⁄kg⁄day) in the treatment of tinea capitis. A meta-analysis was performed using the Mantel–Haenszel method and random effects model; results were expressed as odds ratios with 95%.
<strong>Results</strong>: Meta-analysis of randomized controlled trials did not show a significant difference in the overall efficacy of the two drugs at the doses specified, but specific efficacy differences were observed based on the infectious species. For tinea capitis caused by Microsporumspp., griseofulvin is superior (p = 0.04), whereas terbinafine is superior for Trichophyton spp. infection (p = 0.04).
<strong>Conclusion</strong>:Our results support species-specific differences in treatment efficacy between griseofulvin and terbinafine and provide a clinical context in which this knowledge may be applied.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269820171001Anemia of Chronic Disease299730021263310.12816/0042846ENAyman Ali AlhboobTaiz UniversityKhuludyahyam. KhatiBatterjee Medical College for Sciences and TechnologySAMAHER Sahal MalibariUmm Alqura UniversityBariahyahya DrainIbn Sina National College for Health SciencesFaisal Abdulmohsen AlhusayniKing Saud Bin Abdulaziz University for Health SciencesWafa Abdullah AlshamraniKing Fahad Medical Military HospitalAbdullah Mohammad AlmarzooqImam Abdulrahman Bin Faisal UniversityNouf Mohammed Al MutairiKing Fahad Medical Military Complex in DahranDuaamunir AlsafwaniArabian Gulf UniversityZiyadwaleed IskanderIbn Sina National College for Health SciencesWaleed Eid AlraddadiIbn Sina National College for Health SciencesAqeelasaad AlshubiniWarsaw Medical UniversityAmal Ali FaheemIbn Sina National College for Health SciencesJournal Article20180905<strong>Introduction: </strong>Anemia of chronic disease has a widespread impact on patients with chronic disorders such as chronic inflammation, infection, malignancy etc. The pathophysiology behind it is largely due to involvement of hepcidin levels which are high as a result of the underlying chronic disorder, but negatively affects iron metabolism and erythropoiesis. <strong>Aim of the work: </strong>We tried to understand the pathogenesis, impact, diagnosis, and management of anemia due to chronic diseases. <strong>Methodology:</strong> We conducted this review using a comprehensive search of MEDLINE, PubMed and EMBASE from January 2001 to March 2017. The following search terms were used: anemia of chronic disease, anemia of inflammation, types of anemia, management of chronic anemia<br /> <strong>Conclusion: </strong>Since absolute treatment for the underlying chronic conditions are not available, various other modalities aimed at treating the anemia are developing. They include conventional and novel therapies. More researches must be done in order to manage the condition by treating the underlying cause, or for finding therapies with least side effects.
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<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269820171001Posterior Pericardial Drainage in Patients with Heart Surgery3003301012714ENYazid Ali M AlgadhiKing Khalid UniversityAbdullah Mohammed Ibrahim MosaKing Khalid UniversityIbrahim MohammedMahdi KhayyatKing Saud UniversityMohammed Baqer Al KhalafKing Faisal UniversityMohammad Noor QadrouhMaastricht UniversityBadr Fouad H MogharbelKing Faisal UniversityRaed Saleh G AlanaziQassim UniversityAlsuhaymi Zuhair Hamdan AMikhwah General HospitalKhalid Saeed Ahmed AlghamdiAl Baha UniversityMojahid Ibrahim H GhaziUniversity Of JeddahTamanni Muhsen M. AlghamdiKing Abdulaziz HospitalAfnan Hedian M AlsofyaniTaif UniversityJournal Article20180905<strong>Aim of the Study:</strong> To assess the merits and demerits of posterior pericardial drainage in patients undergoing heart surgery.
<strong>Materials and Methods:</strong> A systematic review and meta-analysis of observational studies and randomized controlled trials was conducted. We searched for relevant trials in the Cochrane Library, MEDLINE (from 1980), Embase from 1970 the Transfusion Evidence Library from 1980, and ongoing trial databases; all searches current to 30 September 2017.
<strong>Results: </strong>The search yielded Sixteen randomized controlled trials which included 2755 patients. Results revealed that Posterior pericardial drainage was associated with a significant 90% reduction of the odds of cardiac tamponade versus the control group: (OR 95% confidence interval) 0.13; <em>P</em> < 0.001. The ORs of death or cardiac arrest were significantly decreased by approximately 50% in the posterior pericardial drainage group compared to controls: OR (95% CI): 0.47, P = .028; I2 = 0%
<strong>Conclusion: </strong>Posterior pericardial drainage has been reported in the literature to significantly reduce the prevalence of early pericardial effusion as well as cardiac tamponade. A significant enhanced survival rate was recorded postcardiac surgery.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269820171001The Occurrence of Hip Fractures among Old Patients in KSA301130151271510.12816/0042848ENBader Saad AlkhathamiKing Khalid UniversityHussam Ahmed Mohammed AlghamdiAlbaha UniversityMotaz AshoorKing Abdulaziz General Hospital Jeddah Radiology DepartmentAbdulrahman Anis Kh. KhanKing Abdulaziz General Hospital JeddahMohammad Ahmed AbdulkarimService Resident Ortho, Prince Sultan Medical Military Hospital RiyadhMohammed Abdullah Mohammed AlrobieQassim UniversityKhalid Mohammed A. AlhazzaziKing Saud Bin AbdulazizAbdullah Adel AlomairService Resident Ortho, Prince Sultan Medical Military Hospital RiyadhMohammed Ammar A AlmoabadiMassachusetts General HospitalAlaa Adel ShabekniIbn Sina College,Rayan Othman M AlsadiqiAl-Imam Mohammed bin Saud Islamic UniversityJournal Article20180905<strong>Background: </strong>Associated with the increase in the aging population, there is an increase in the occurrence of hip fractures worldwide. Result following such fractures is influenced by age of the patient.
<strong>Purpose: </strong>This study purposes to evaluate the incidence and early outcome of hip fractures, comparing between different age groups.
<strong>Materials and Methods: </strong>Data of hip fractures collected over a period of five years was analyzed. Patients were divided into three groups, group A (patients under the age of 64), group B (patients between 65 and 84 years of age), and group C (patients over the age of 85).
<strong>Results: </strong>Of the 588 patients included in the study, there were 45 patients in group A, 351 patients in group B and 192 patients in group C. There was a female preponderance across all age groups, and this increased as age advanced (p < 0.0001). A significantly larger number of older patients lived alone and needed aids to walk before the injury (p < 0.0001). There was no significant difference in the type of fracture across the three groups (p = 0.13). A higher proportion of the elderly with intracapsular fractures were treated by replacement arthroplasty. Older patients who had internal fixation of intracapsular fractures had a better walking ability at 4 months. The overall deterioration in mobility was greater in older patients (p < 0.0001). Mortality was higher in older patients.
<strong>Conclusions: </strong>Hip fractures are more common among females irrespective of age group. Older patients have a higher mortality and a greater deterioration of walking ability after such injuries. Internal fixation of intracapsular fractures have demonstrated satisfactory early outcome in the immediate period. This might be attributed to retention of native bone, better proprioception and shorter operation time.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269820171001Natural History and Surgical Management of Oral Malignant Melanoma301630201271610.12816/0042849ENRahmah Hameed Al SalmanAlfarabi CollegeMohammed Essam FagehaAl-Farabi College for Nursing and DentistryKhalid Abdulrahman S Alghamdiordan university of Science and technologySuzan Sulaiman Hamad Shamlan5th years general dentist on batterjee medical collegeAlaa Omar D Almalkiordan university of Science and technologyWajdi Mohammed Bardisiumm al-qura university faculty of dentistryKhaled Hamad M AlbaradiIntern in KAUMajid Gais Faisal AlsharifBatterjee medical collegeYara Tareq Mohammed Talab5th years general dentist on batterjee medical collegeJournal Article20180905Pigmented entities are relatively common in the oral mucosa and arise from intrinsic and extrinsic sources. Conditions such as melanotic macules, nevi, smoker's melanosis, amalgam and graphite tattoos, racial pigmentation, and vascular blood-related pigments occur with some frequency. Addison disease, Peutz-Jeghers syndrome, and Laugier-Hunziker syndrome also appear in perioral and oral locations as pigmented macules. Detailed knowledge of melanoma at the molecular level allows the development of new treatment alternatives and to design effective new drugs. Addison disease presents as adrenal cortical hypofunction along with splotchy or generalized bronzing of the mucosa and skin. Peutz-Jeghers syndrome has periorificial freckling along with hamartomatous intestinal polyps, and, as a differential diagnosis, Laugier-Hunziker syndrome presents with macular mucocutaneous hyperpigmentation and melanonychia with no known systemic disease association. We conducted this review using a comprehensive search of MEDLINE, PubMed, EMBASE, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials from January 1, 1970, through February 28, 2017.
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Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269820171001Assisted Arthrscopic Microfracture Treatment of Osteochondral Lesions of The Knee302130281271810.12816/0042850ENAhmed El-Badawy ShaheenDepartment of Trauma and Orthopedic Surgery, Menofia University HospitalAmr Saber El-SayedDepartment of Trauma and Orthopedic Surgery, Menofia University HospitalSameh Selim MankoulaDepartment of Trauma and Orthopedic Surgery, Menofia University HospitalJournal Article20180905<strong>Background</strong>: chondral injuries in the knee are a common source of pain and morbidity. Treatment of symptomatic chondral defects is challenging due to the limited healing capacity of articular cartilage. Microfracture is the most common surgical technique used to treat chondral defects in the knee and utilizes marrow stimulation to generate a fibrocartilage repair. Microfracture has demonstrated good short-term postoperative outcomes. Long-term outcomes following microfracture are variable, with loss of improvement attributed to the poor mechanical qualities of the fibrous repair tissue.
<strong>Aim of the work</strong>: this prospective study with a 12 months follow-up was conducted to determine the efficacy of microfracture in the postoperative follow-up. We prospectively followed up these patients preoperatively and postopertively, clinically and radiologically. The final diagnosis was confirmed during arthroscopy.
<strong>Patients and Methods</strong>: thirty symptomatic patients with articular cartilage defects of the knee were treated with the microfracture technique. Prospective evaluation of patient outcome was performed for a minimum follow-up of twelve months with a combination of validated outcome scores, subjective clinical rating and cartilage-sensitive magnetic resonance imaging.
<strong>Results</strong>: at the time of the latest follow-up, knee function was rated good to excellent for twenty patients (60%), fair for four patients (13%) and poor for eight (26%). A lower body-mass index correlated with higher scores for the activities of daily living, with the worst results for patients with a body-mass index of >30 kg/m2. Significant improvement in the activities of daily living score was more frequent with a preoperative duration of symptoms of less than twelve months (p < 0.05). Magnetic resonance imaging in 15 knees demonstrated good healing in tissue fill of eight patients (54%), moderate fill in four (29%) and poor fill in three patients (17%). The fill grade was correlated with the knee function scores. All knees with good fill demonstrated improved knee function, whereas poor fill grade was associated with limited improvement and decreasing functional scores after twelve months. <strong>Conclusions</strong>: microfracture healing of articular cartilage lesions in the knee results in significant functional improvement at a minimum follow-up of one year. The best short-term results were observed with good fill grade, low body-mass index and a short duration of preoperative symptoms. A high body-mass index adversely affects short-term outcome, and a poor fill grade was associated with limited short-term durability.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269820171001Role of Chest Ultrasonography in Pleural Diseases302930351271910.12816/0042851ENHanan M. AbuZeid, Mohamed S. GhazyDepartment of Radiology, Faculty of Medicine, Ain Shams UniversityMohamed S. GhazyDepartment of Radiology, Faculty of Medicine, Ain Shams UniversityAhmed H. SolimanDepartment of Radiology, Faculty of Medicine, Ain Shams UniversityAlyaa A. AbdulrahmanDepartment of Radiology, Faculty of Medicine, Ain Shams UniversityJournal Article20180905<strong>Background: </strong>lung ultrasound is a part of the diagnostic armamentarium in Resuscitation and Recovery Units with an enormous potential due to its advantages capacity to diagnose more precisely than conventional radiology, earlier diagnosis, convenience due to being able to perform at the bedside, possibility of being performed by one person, absence of ionizing radiation and due to its dynamic character. <strong>Aim of the Work:</strong> this study aimed to assess the impact of chest ultrasonography in detecting, differentiation and management of the different pleural diseases. <strong>Patients and Methods: </strong>this prospective study included 50 patients who were presented with suspected clinical and/or radiological evidence of pleural disease in the Chest Department of Demerdash Hospital, during the period between November 2014 and June 2017. Patients with pleural diseases with lung involvement were excluded. <strong>Results:</strong> US was more statistically significantly sensitive and specific in the detection of pleural effusion compared to chest radiography. A sensitivity of 0.92 for US examination against 0.74 for chest radiography in detection of pleural thickening was noted. There were no statistically significant differences between the sensitivity and specificity of chest US and chest CT in detection of different pleural pathologies. <strong>Conclusion:</strong> US is an efficient and suitable method for the evaluation of different pleural diseases in critically ill patients in the RICU. US is mostly sensitive and specific in diagnosing pleural effusions. US-guided diagnostic and therapeutic pleural interventions are successful in achieving their goal with favorable outcomes and minimal complications. <strong>Recommendations: </strong>US accessibility was difficult for some patients because of tissue edema, subcutaneous emphysema and obesity. Thus further studies are needed in order to generalize these results.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269820171001Relation of Breast Milk Adiponectin Level to Infant Growth303630411272010.12816/0042852ENAhmed M HamdyDepartment of Pediatrics, Faculty of Medicine - Ain Shams UniversityYasmin G. AlgendyDepartment of Pediatrics, Faculty of Medicine - Ain Shams UniversityMenat Allah ShaabanDepartment of Clinical and Chemical Pathology, Faculty of Medicine - Ain Shams UniversityAdel M El ShalabiDepartment of Clinical and Chemical Pathology, Faculty of Medicine - Ain Shams UniversityJournal Article20180905<strong>Background: </strong>Studies on the physiology of breastfeeding revealed the presence of the adipokines as adiponectin in mothers’ milk. In full-term neonates, during the first few days of life, serum and plasma adiponectin levels correlate positively with birth weight and length, neonatal adiposity. While, circulating adiponectin levels correlate negatively with the degree of adiposity in children aged between 5 and 10 years.
<strong>Patient and Methods: </strong>In the current cross sectional study patients and their mother were recruited from out patient clinic in Ain Shams Hospital. Questionnaire was done for maternal age, maternal diseases, gestational age, mode of delivery, infant sex and type of feeding. Also in this study maternal body mass index and infant anthropometry were calculated and breast milk adiponectin levels were measured at 1<sup>st</sup> week, one month and at six months. <strong>Results: </strong>Maternal body mass index ranges from (19-29). Infant weight z-score ranges were (-1.77-1.84), (-1.76-1.9) and (-2.02-1.62) at one week, one month and six months respectively. Infant length z-score ranges were (-1.45-2.72), (1.43-3.01) and (-1.61-1.54) at one week, one month and six months respectively. Breast milk adiponectin ranges were (12.8-38.4 ng/dl), (8.8-30.8 ng/dl) and (5.5-25 ng/dl) at one week, one month and six months respectively.
<strong>Conclusion: </strong>The results of the present study confirm that human milk adiponectin was significantly associated with lower infant WAZ score at one month, with high significant association with lower infant WAZ score at six month. However, not associated with infant weight at baseline.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269820171001The Effect of Time Management on Academic Performance among Students of Jazan University304230491272110.12816/0042853ENWasan Siddiq Yahya AlsalemMedical Intern, Faculty of Medicine, Jazan University, JazanLujain Abduh AlamodiMedical Intern, Faculty of Medicine, Jazan University, JazanAisha Taher Mohammed HazaziRadiology Resident, Faculty Of Medicine, King Fahad Central Hospital, JazanAmal Mousa ShibahFaculty of Medicine, Jazan University, JazanShagra Abdullah JabriMedical Intern, Faculty of Medicine, Jazan University, JazanZainab Ali AlbosruorAlfaisaliah Primary Health Care, Al Ahsa, Saudi ArabiaJournal Article20180905<strong>Background:</strong> Many students could not manage their times efficiently before being students in college since they did not have any challenges or difficulties in high school. However, the case changed completely when they are attending college. Being a student in college means that the responsibility is bigger and the courses are more difficult than what they were in high school.
<strong>Aim: </strong>The research aimed to determine the relationship between the time management skills and academic performance of students, to assess time management and practice among students, to determine patterns of time management among Jazan University students. In addition to determine whether student participation in extra-curricular activities and social media correlates to his or her cumulative grade point average (CGPA).
<strong>Method:</strong> The study design is a cross-sectional study of the effect of time management on academic performance. Conducted it in Jazan University for medical and non-medical students.
<strong>Results:</strong> The study conducted on 491 participants of female (53.80%) and male (46.20%) students. The Applied Medical Science students (24.20%) stated that they just consumed their time to complete homework, while Faculty of Science students (9.40%) reported that they rarely have time to do. We find that 44.2% of male and 65% of female never participate in student club, while 43.50% of male and 15.60% of female always do sports and 12.90% of male and 4.20% of female always planning for these activities.
<strong>Conclusion:</strong> Students who had opportunities to practice time management skills revield better academic performance in addition to the differences in the time management level between students according to faculty, gender and curriculum.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269820171001Predictors of Length of Stay, Complications and Patient’s Satisfaction after Appendectomy305030531272210.12816/0042854ENFawaz Mohammed AlharbiImam Muhammad Ibn Saud Islamic UniversityTalal Saad AlmutairiImam Muhammad Ibn Saud Islamic UniversityHusam Khalid AlgayedImam Muhammad Ibn Saud Islamic UniversityMohammed Saleh AlaskarImam Muhammad Ibn Saud Islamic UniversityOmar Ahmad AlkhayariImam Muhammad Ibn Saud Islamic UniversityMuath Khalid AbaalkhailAlmaarefa Colleges for Science And TechnologyAbdulilah Mokhtar AlshenghitiKing Salman Hospital RiyadhJournal Article20180905<strong>Background: </strong>appendicitis is the inflammation of appendix whichrequires appendectomy for treatment. Appendectomy involves the surgical removal of the appendix<strong>. </strong>Early diagnosis and early appendectomy performing results in a good outcome of the surgery. The traditional strategy was an open surgery, while the modern one is laparoscopic appendectomy. However both have complications.<strong> Aim of the work: </strong>this study aimed to investigate the predictors of length stay, complications and patient satisfaction after performing an appendectomy. <strong>Methods: </strong>this study based on a simple online survey which composed of 2 parts. The data were collected using an excel sheet and analyzing data were performed using SPSS. <strong>Results: c</strong>omplication after surgery included presence of abscess which represented 88.7%, suffering from complications which represented 69.3% and wound infection which represented 5.7%. The range of hospital stay was 1 to 10 days with a mean<strong>±</strong> SD of 3.9<strong>±</strong> 2.4 days. 39.6% of participants had good satisfaction, 35.8% had very good satisfaction, 15.1% and 9.4% had a fair and bad level of satisfaction. Males had mean<strong>±</strong> SD of hospital stay = 4.69 days, while females had mean<strong>±</strong> SD 2.9 days. Mean <strong>±</strong> SD of hospital stay for patients with chronic diseases was 5.14<strong>±</strong>2.34, while for those without chronic diseases it was 3.56<strong>±</strong>2.31. <strong>Conclusion: </strong>the most common complication for appendectomy was abscess after the operation, individuals reported good level of satisfaction. Male gender had chronic disease were associated with longer hospital stay.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269820171001Prevalence of Dyslipidemia in Obese Patients in Saudi Arabia305430571272310.12816/0042855ENHusam Khalid AlgayedImam Muhammad Ibn Saud Islamic UniversityFawaz Mohammed AlharbiImam Muhammad Ibn Saud Islamic UniversityTalal Saad AlmutairiImam Muhammad Ibn Saud Islamic UniversityMohammed Saleh AlaskarImam Muhammad Ibn Saud Islamic UniversityAhmad Fawzi RammalKing Saud UniversityMohanned Mohammed AlrahiliKing Saud Bin Abdulaziz University for Health SciencesJournal Article20180905<strong>Background: </strong>Dyslipidemia is defined as defect or over production of lipoprotein, it is a consequence of obesity. Dyslipidemia can result in several complications and diseases including stroke, cardiovascular diseases and arthrosclerosis. The prevalence of both obesity and dyslipidemia are increasing as a result of change in dietary content and change in life styles.
<strong>Aim:</strong> To investigate the prevalence of dyslipidemia in obese patients.
<strong>Methods:</strong> The study included 150 participants who were divided into 2 groups; the obese group and non-obese group. Total cholesterol, LDL, HDL and triglycerides were estimated for all individuals.
<strong>Results: </strong>There were 90 obese person and 60 non-obese individuals. The mean± SD of TC for non-obese participants and obese was 191±12.7 mg/dl and 234.5±14.2 mg/dl respectively (P-value=0.04), while for LDL was 97.2± 5.4 mg/dl for non-obese and 166± 7.3 mg/dl for obese (P-value=0.02). Triglycerides mean ± SD for non-obese was 117.7±5.3 mg/dl and for obese was 160.7±12.4 mg/dl (P-value=0.012), regarding HDL mean± SD was 117.7± 7.2 mg/dl for non-obese and 160.8± 12.6 mg/dl for obese individuals (P-value=0.044).
<strong>Conclusion: </strong>The prevalence of dyslipidemia was high in obese patients and the most common type was hypertriglyceridemia.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269820171001Barriers that Impede Primary Health Care Physicians from Screening Women for Domestic Violence at Makkah ALmukarramah City305830651272410.12816/0042856ENJumanah Ahmed AlsaediUmm AlQura University, MakkahWagih GamalEldin ElbarranyUmm AlQura University, MakkahWaad Ahmed AL MajnonDepartment of Anatomy, Faculty of Medicine,
Umm AlQura University, Makkah, Saudi ArabiaAfnan Abdullatif Al-NamankanyUmm AlQura University, MakkahJournal Article20180905<strong>Background: </strong>Nowadays, violence against women represents a major public health concern despite the efforts to raise awareness about it at the local and the global level. Doctors have a crucial role to play in detecting violence against women but they are confronted to many barriers.
<strong>Objective:</strong> To identify the barriers that impede physicians from screening women for domestic violence.
<strong>Subjects and methods: </strong>A cross-sectional study was conducted using a questionnaire to collect data from 62 primary health care physicians at Makah Almukarramah city.
<strong>Results: </strong>More than a half of the physicians, working at primary health centers at Makkah and who participated in our survey, dealt with a case of a women abused by her partner. Many participants agreed that there were barriers that impeded them from screening violence like insufficient training, feeling of embarrassment, shame of asking question about abuse and fear of revenge by the husband or relatives.
<strong>Conclusion: </strong>Implementing training program with intervention could help in managing and preventing violence against women.
Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269820171001Knowledge and Attitude of Basic Life Support among Medical Students at King Abdul-Aziz University306630761272510.12816/0042857ENYousef Zaki KhedherKing Abdul-Aziz University Jeddah-Saudi ArabiaLana ShawwaKing Abdul-Aziz University Jeddah-Saudi ArabiaAhmed Abdullah AlamriKing Abdul-Aziz University Jeddah-Saudi ArabiaMuhannad Mohammed FarrajKing Abdul-Aziz University Jeddah-Saudi ArabiaMohamed Emad BayoumiKing Abdul-Aziz University Jeddah-Saudi ArabiaJournal Article20180905<strong>Aim of the work:</strong> basic life support (BLS) refers to the skills that require few tools to save lives of the victims of cardiac or respiratory arrests. All healthcare providers are required to master these skills in order to maximize the care to those who experience such emergencies. This study aimed to assess the knowledge and attitude toward BLS in King Abdul-Aziz University among 3<sup>rd</sup> to 6<sup>th</sup> year medical students.
<strong>Methods:</strong> this is a retrospective cross-sectional study conducted in King Abdul-Aziz University, College of Medicine in Jeddah-Saudi Arabia among the medical students, from June to October 2016 lasting for a period of 4 months. Data were gathered by using electronic Google forms questionnaires that were distributed to 3<sup>rd</sup>, 4<sup>th</sup>, 5<sup>th</sup> and 6<sup>th</sup> years medical students. Data analysis was done by using SPSS version 17 in July 2017
<strong>Results:</strong> 370 medical students at King Abdul-Aziz University (KAU) were participated to evaluate their knowledge and attitude toward Basic Life Support (BLS). 190 of the students were male students. 43% and 38.5% of female and male students scored all the right answers respectively. Both the total mean of correct answers of knowledge and attitude toward BLS were 40% for both variables. Students who had BLS courses other than the mandatory ones scored 41.5% of the correct answers, while the students who had only mandatory BLS courses scored 39% of the correct answers.
<strong>Conclusions:</strong> among KAU medical students, the data showed poor essential knowledge toward BLS. Overall attitude towards BLS was negative. However, the data also showed slight improvement when students had BLS courses other than the mandatory ones. Therefore, more focus may be placed for strengthening BLS skills. In addition, it is recommended to have an annual BLS simulation for all medical students to consolidate their skills and knowledge. We also recommend adding active learning to all medical students.
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<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269820171001Knowledge and Perception on Surgical and Invasive Procedure Protocols among Final Year Medical Students and Interns in A University Affiliated Hospital in Jeddah307730821272610.12816/0042858ENAdel D. AlmaymuniDepartment of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi ArabiaAbdullah A. AlamriDepartment of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi ArabiaMajed N. AlnefaieDepartment of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi ArabiaHatim A. Al-AbbadiDepartment of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi ArabiaJournal Article20180905<strong>Background: </strong>medical students and interns are exposed to training programs in the hospitals to enhance their knowledge, skills and attitudes in the different clinical situations. Their training should offer an opportunity to be aware of the safety protocols in each medical department so as to prevent the possibility of errors.
<strong>Objective:</strong> this study aimed to determine the level of knowledge and perception of final year medical students and medical interns on surgical and invasive procedure protocols in a university affiliated hospital in Jeddah, Saudi Arabia. <strong>Methods: </strong>this was a questionnaire was administered to final year medical students and interns of King Abdulaziz University Hospital in Jeddah City, Saudi Arabia. The questionnaire consisted of two sections: demographic profile in addition to knowledge and perception on surgical and invasive procedure protocols. A total of 264 participants answered the researcher-administered questionnaire.
<strong>Results: </strong>these results showed that there was a lack of knowledge on surgical and invasive protocols of the participants with a mean score of 65.68%, which represented their agreement to the 2009 World Health Organization guidelines for safe surgery. There was a significant association between the level of confidence of the participants and their ages and year levels (p-value <.05), but not with gender. All demographic factors investigated were significantly associated with participant’s belief on the importance of having knowledge on surgical and invasive protocols (p-value <.05). <strong>Conclusion: </strong>the results of this study call academic institutions to revisit their curriculum and training programs specifically on the area of surgery.
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<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269820171001Comparative Evaluation of Antioxidant and Hepatoprotective Effects of Three Olive Leave Species Cultivated in Aljouf Region, Saudi Arabia308330911272710.12816/0042859ENIsmail H. OsmanDepartment of Clinical Lab Sciences, Al Jouf University, Sakaka, Saudi ArabiaAhmed A. TantawyPathology Department,
Faculty of Veterinary Medicine, Benha, University, EgyptJournal Article20180905<strong>Aim of the work</strong>: the purpose of this study was to evaluate the antioxidant, anti-inflammatory and hepatoprotective effects of extract from 3 olive leave cultivars; K18, Nibali and Sorani growing in Aljouf region, Saudi Arabia.
<strong>Methods</strong>: all plants were extracted with 80% methanol and the extracts were used to determine the total phenolic content, the total flavonoid content, the DPPH radical and anti-lipid peroxidation scavenging activities. <em>In vivo</em> hepatoprotective effect of these olive leaves extracts (OLEs) was evaluated in rabbit intoxicated with CCl4. Expression of iNOS, caspase-3, TNF-α and IL-1β along with the histopathological findings of the examined liver were recorded to evaluate the extent of hepatoprotective of each extract.
<strong>Results:</strong> methanolic extracts of all plants exhibited DPPH and peroxyl radicals scavenging activity that was well correlated with their total phenolic and flavonoid contents. The phenolic, flavonoid contents, DPPH, and peroxyl scavenging activities were in the following orders: Nibali˃ K18 ˃ Sorani. Pretreatment with OLE (400 mg/kg) along with CCl<sub>4</sub> was significantly alleviated liver damage as indicated by improvement of the microscopic picture of liver and reduced hepatic iNOS, caspase-3, TNF-αand IL-1β expression compared to CCl<sub>4</sub> intoxicated group. However, the hepatoprotective effects of Nibali and K18 OLEs were more prominent compared to those exerted by Sorani OLE.
<strong>Conclusion</strong>: all OLEs had potent anti-inflammatory, antioxidant and antiapoptotic activities that preserved hepatic cells against CCl4-induced hepatic damage through attenuation of pro-inflammatory cytokines, oxidative stress and apoptotic pathways, however, these activities were probably species dependent.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269820171001Review on Liver Cirrhosis Complications and Treatment309231031277810.12816/0042860ENHaider Issa AlaqailiDammam Medical ComplexAhmed Ibrahim AlJuraysanKing Faisal UniversityRazan Mansour A HawsawiKing sau-HsFadia Abdulelah AbuzaidKing Abdulaziz University,Medicine-Basic Medical Sciences-Anatomy,Research Assistant King Fahad Medical Research CenterMuath Abdullah AlharbiMedical University of LodzAbdulrhman Ebrahim A. MughallisJazan General HospitalYazeed Abdullah H AlsubhiKing Abdulaziz UniversityMohammed Rraiy A AsiriSharg Almjaredah PHCCAbdullah Saleh S AlamerQassim UniversityAbdullah Mohammed S AzabKing Abdulaziz UniversityAbdullah Javed KhaleelKing Abdulaziz UniversityHanan Khalil Ibrahim Al-RajehKing Fahad HospitalJournal Article20180906<strong>Background:</strong> cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism. The liver carries out several necessary functions, including detoxifying harmful substances in your body, cleaning your blood and making vital nutrients. Cirrhosis occurs in response to damage to your liver. Each time your liver is injured, it tries to repair itself. In the process, scar tissue forms. As cirrhosis progresses, more and more scar tissue forms, making it difficult for the liver to function.
<strong>Objective of the Study:</strong> review and evaluate the best practices in diagnosis, complications and management of cirrhosis, and novel clinical and scientific developments.
<strong>Methods:</strong> electronic search in the scientific database from 1966 to 2017– (Medline, Embase, the Cochrane Library as well as NHS center websites were searched for English Publications obtained from both reprint requests and by searching the database. Data extracted included authors, country, year of publication, age and sex of patients, epidemiology, geographical distribution, pathophysiology, risk factors, clinical manifestations, investigations and types of surgical treatment.
<strong>Results:</strong> there is sufficient body of evidence suggesting that cirrhosis is a pathological diagnosis with no laboratory cutoff values for the diagnosis of cirrhosis.
However, it can still be diagnosed clinically, by history, physical examination laboratory analyses and ancillary testing such as ultrasonography. Early diagnosis has proven to give relevantly better case management results while late detection can only hardly manage the symptoms accompanied with cirrhosis.
<strong>Conclusion:</strong> Screening for chronic liver disease is a key factor for early detection of signs for liver damage, which can be performed inexpensively and easily with clinical history-taking, measurement of transaminase concentrations, upper abdominal ultrasonography, and transient elastography (where available). Abnormal findings should prompt specific diagnostic testing to determine the etiology of the underlying disease. In most patients, the dynamic process of progressive fibrosis, which could ultimately lead to cirrhosis, can be interrupted by the timely recognition of the risk, followed by appropriate treatment.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269820171001Systemic Lupus Erythematosus Presenting with Fulminant Autoimmune Hemolytic Anemia310431071278010.12816/0042861ENHanan Mothaqab MashiKing Fahad Central HospitalAhmed Ali JaafariKing Fahad Central HospitalZainab Ahmad JafariKing Fahad Central HospitalNourah Ali HomailyKing Fahad Central HospitalAhmed ShamakhiKing Fahad Central HospitalJournal Article20180906 We describe a female patient 9-year- old girl with Systemic Lupus Erythematosus (SLE) who developed a fulminant autoimmune hemolytic anemia (AIHA) as an isolated symptom of her underlying disease. On admission, laboratory investigations were conducted and revealed high ESR 150 mm\h, severe anemia Hb was 3.4 g/dl with reticulocytosis 9%, low platelet count 74 \ 10^3\uL and positive direct Coombs tests. Upon further examinations, a diagnosis of SLE complicated by AIHA was reached, and methylprednisolone IVIG therapy was prescribed, and remission was approached.
Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269820171001The Effect of Cigarettes on Acute Pancreatitis Among Patients in Saudi Arabia310831141278110.12816/0042862ENAmirah Abduallah M AlzahraniKing Abualziz HospitalHariri, Mohammad Zaki OPublic Health Center, MakkahNahlah Ali AlsubhiIbn Sina National CollegeMohammed Fayez Mohammed AlshehriKing Khalid UniversityHelal Jarallah AlharthiUniversity of Warmia and Mazury, PolandMuhannad Fahad W AlsahliAl Imam Abdulrahman Alfaisal Hospital in RiyadhFaisal Menwer AlqurashiUmm Alqura UniversityBadr Saad Dhawi AlghamdiBuljurashi Psychiatric HospitalSabah Abdulrahman KhozamKing Khalid UniversityAli Ibrahim Ali AlsalbiTaibah UniversityAhmad Ibrahim M AlbridiKing Khalid UniversityAlbayyali, Tariq Hassan HAl-Jouf UniversityModhi Saleh Ibrahim AlburaidiQassim UniversityJournal Article20180906<strong>Background and purpose: </strong>Questions remain unclear about the association of smoking status and the development of acute pancreatitis (AP). We performed a meta-analysis of observational studies to explore this association. <strong>Materials and Methods: </strong>A computerized literature search was performed in MEDLINE and EMBASE through October 15, 2016. We also searched the reference lists of pertinent articles. We used a rand om-effects model to calculate the summary relative risks (SRRs) and their corresponding 95% confidence intervals (CIs).
<strong>Results</strong>: A total of 8 observational studies (4 case control and 4 prospective cohort/nested case control studies) were identified. Compared with never smokers, the summary RR estimates were 1.49 (95% CI, 1.29-1.78) for ever smokers, 1.69 (95% CI, 1.42-2.21) for current smokers, and 1.19 (95% CI, 1.11-1.52) for former smokers. Smoking is found to be a potential risk factor for alcohol use, idiopathic factors and drugs related AP, but not for gallstone related AP, in the ever and current smokers. A dose response effect of tobacco use on the risk was ascertained: current smokers had a 40% (95% CI, 30%-50%) increased risk of AP for every additional 10 cigarettes per day.
<strong>Conclusion: </strong>The current analysis suggests that smokers have an elevated risk of AP development. Further studies, however, are warranted before definitive conclusions can be drawn.
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Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269820171001Accuracy of Diagnosis of Distal Radial Fractures by Ultrasound311531221278210.12816/0042863ENAhmad Saladdin SultanMosul Teaching Hospital, Emergency Medicine Department, Mosul, IraqMuddather Abdul AzizMosul Teaching Hospital, Emergency Medicine Department, Mosul, IraqYakdhan Z. AlsaleemMosul Teaching Hospital, Emergency Medicine Department, Mosul, IraqJournal Article20180906<strong>Background:</strong> although distal radial fracture account up to 20% of all fractures, it forms the most common fracture in upper extremities<strong>.</strong> Distal radial fracture has six types the most common one is Colle's fracture. The gold standard for diagnosis of distal radial fracture is conventional radiograph. Despite using ultrasound in tendon rupture, localizing foreign bodies, ultrasound started to be used for diagnosing bone fracture especially distal radius. <strong>Aim of the work:</strong> this study aimed to detect the accuracy of ultrasound in the diagnosis of distal radial fracture. <strong>Patients and methods:</strong> this was a selective prospective case series study in the Emergency Department, Al-Jumhoori Teaching Hospital,78 patients were included in this study, their age ranged between 6-45 years with mean age 17.1. 59 were males and 19 females. Duration of the study was one year (January2013 - January 2014). <strong>Results:</strong> by analyzing data of 78 patients for distal radial fracture ultrasound and comparing the results with the gold standard conventional radiograph we found that sensitivity of ultrasound in detecting fracture was 95.5%, specificity 100%, accuracy 96.15%, positive predictive value 100% and negative predictive value 80%.
<strong>Conclusion:</strong> results of the current work demonstrated that ultrasound can be considered as a promising alternative to routine radiograph in diagnosis of the distal radial fractures and the horizon still open for further studies of use of ultrasound in diagnosis of other types of fractures.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-2002698201710013D Ultrasonography Compared with Magnetic Resonance Imaging for the Diagnosis of Adenomyosis3123313312784ENAhmed M. HashadObstetrics and Gynecology Department, Faculty of Medicine, Ain-Shams UniversityNashwa E. HassanObstetrics and Gynecology Department, Faculty of Medicine, Ain-Shams UniversityAhmed E. ElbohotyObstetrics and Gynecology Department, Faculty of Medicine, Ain-Shams UniversityOmnia B. BakrObstetrics and Gynecology Department, Faculty of Medicine, Ain-Shams UniversityIbrahim M. IbrahimObstetrics and Gynecology Department, Faculty of Medicine, Ain-Shams UniversityJournal Article20180906<strong>Background:</strong> Adenomyosis is a common benign gynecological affecting premenopausal woman, in which there is increased overgrowth of the endometrium with invasion of the underlying myometrium. The precise pathogenesis of adenomyosis remains unknown with many theories being proposed that consider it to be a pathology that initially affects the endomyometrial junctional zone (JZ). <strong>Aim of the Work:</strong> The study aims to compare 3D transvaginal ultrasound with MRI in diagnosing adenomyosis in comparison with the gold standard histopathology. <strong>Patients and Methods:</strong> This cross-sectional study was carried out on 77 patients who were recruited from women presenting to the outpatient clinic at Ain Shams University Maternity Hospital planned to undergo hysterectomy (abdominal, vaginal or laparoscopic assisted hysterectomy) for adenomyosis according to the inclusion/ exclusion criteria. <strong>Results:</strong> Out of 77 patients included in the study, 67(87%) were +ve for adenomyosis by 3D TVUS, confirmed in 46(59.74%) by histopathology, while 52(67.53%) were +ve by MRI, confirmed in 39(50.64%) by histopathology.3D transvaginal US was able to diagnose adenomyosis in 67(87%) patients and fibroid in 23(29.9%) patients, while MRI was able to diagnose adenomyosis in 52(67.5%) and fibroid in 36 (46.8%). <strong>Conclusion:</strong> our study results indicated that, 3D transvaginal ultrasound is highly accurate as MRI in diagnosing adenomyosis and leiomyoma as a preoperative diagnostic tool. <strong>Recommendations:</strong> As the 3D ultrasonography is more available, cheaper, less time consuming and easier technique, it is recommended to be used in every day clinical practice, helping the clinicians to reach an accurate diagnosis, select an appropriate treatment, and individualize management for each patient to reach the best outcome therapeutic rates.<br /> <br /> Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269820171001Correlation between Vitamin D Deficiency and Depression313431431278510.12816/0042865ENAfnan Hedian AlsofyaniTaif UniversityAbeer Mohammed M AlharbiAlfaisal UniversityArwa Bader N AlanaziNorthern Border UniversityKhaled Abdul Aziz AlasousSattam Bin Abdulaziz UniversityRawan Ahmad AgeeliJazan UniversityAmirah Abduallah M ALZahraniKing Abdullaziz HospitalMoatez Khalaf AlmofarrehAljouf UniversityReham Awdah AlbalwiTabuk UniversitySamirah Nasser A MajrshiPrimary Health Care Al-Jumum- MakkahMuhannad Fahad W AlsahliAl Imam Abdulrahman Al Faisal Hospital in RiyadhAyat Essam ShabanAl Nahda Primary Health Care Center, JeddahGhaida Mohammad AhmadEast Jeddah HospitalJournal Article20180906<strong>Aim of the Study:</strong> To conduct a systematic review and meta-analysis of prospective cohort studies of the association of vitamin D deficiency with onset of depression in non- depressed individuals.
<strong>Methods:</strong> A systematic review of the electronically searched publications of the scientific literature. We searched the Cochrane Hepato Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE (1946 to 2017), EMBASE (1974 to 2017), and Science Citation Index Expanded (1900 to 2017). Initially all randomized clinical trials which studied the correlation of Vitamin D with depression were included, articles were then selectively screened according to the eligibility criteria. <strong>Results:</strong> the search yielded 11 studies, A meta-analysis of all studies without flaws demonstrated a statistically significant improvement in depression with Vitamin D supplements (+0.72 CI +0.28, +1.31). Nevertheless, studies with biological flaws were mainly inconclusive
<strong>Conclusion: </strong>Our analyses are consistent with the hypothesis that Vitamin D supplementation (≥800 I.U. daily) was supported in the management of depression.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269820171001Postnatal Corticosteroids to Treat or Prevent Bronchopulmonary Dysplasia in Preterm Infants314431531278610.12816/0042866ENAlsuhaymi Zuhair Hamdan AMikhwah General HospitalZamil Mufleh Al-WahbiKhamis Mushait Maternity & Children Hospital (KMMCH),Abdulmohsen Abdulkarim AlanaziKing Abdullah Bin Abdulaziz University Hospital,Zayed Mohammed Z Al AlmathlmaMohayil General HospitalSamar Osama Mohamed Mahmoud KassemUmm Al Qura UniversityFaisal Ali A AlotaibiTaif UniversityGhadi Abdullah AljehaniIbn Sina CollegeMushari Aber F AlonaziAljouf UniversityAbdulrahman Sulaiman I AlshudokhiAlfaisal UniversityAlanoud Thamer Al DrasounyAlmaarefa Colleges For Science And TechnologyFatimah Fayiz AlghanimImam Abdulrahman Bin Faisal UniversityToqa Eissa AljowaidIbn Sina CollegeJournal Article20180906<strong>Background:</strong> The lungs of particularly newborn are fragile and can be easily damaged. With injury, scarring may follow which is translated into difficult breathing and increased oxygen needs, a condition called bronchopulmonary dysplasia (BPD) or Chronic Lung Disease (CLD). Since inflammation plays an important role in the pathogenesis of CLD, corticosteroids, especially dexamethasone, have been extensively used to avert or treat CLD. Thus, several studies suggest that systemic corticosteroids decrease the duration of ventilator dependence.
<strong>Aim of the Study:</strong> investigate the beneficial and harmful effects of the use of steroid in the prevention and treatment of BPD.
<strong>Methods:</strong> A systematic review and meta-analysis of observational studies and randomized controlled trials was conducted. A review of the scientific literature. Pubmed, Embase and Central were searched to identify randomized controlled trials that investigated postnatal corticosteroids treatment for BPD were the primary endpoints. Identification of papers and data extraction were performed by two independent researchers. We searched for relevant trials in the Cochrane Library, MEDLINE (from 1955), Embase (from 1970), the Transfusion Evidence Library (from 1980), and ongoing trial databases; all searches current to September 2017.<strong>Results:</strong> The search yielded seven RCTs which enrolled a total of 1862 participants eligible for inclusion in the present review. There were significant beneficial outcomes such as lower rates of failure to extubate and decreased risks of chronic lung disease at both 28 days (RR 0.84, 95% CI 0.83 to 0.87) and 36 weeks' postmenstrual age (RR 0.77, 95% CI 0.72 to 0.84), death or chronic lung disease at 28 days (RR 0.9, 95% CI 0.85 to 0.96) and 36 weeks' postmenstrual age (RR 0.91, 95% CI 0.87 to 0.96). Nevertheless, there were no significant differences in the rates of neonatal mortality (RR= 1.06, 95% CI 0.93, 1.26), periventricular leukomalacia (RR 1.16, 95% CI 0.9 to 1.46), necrotizing enterocolitis or pulmonary haemorrhage (RR 1.21, 95% CI 0.83 to 1.62). In contrast, gastrointestinal bleeding (RR 2.13, 95% CI 1.41 to 2.84) and intestinal perforation (RR 1.77, 95% CI 1.46 to 2.1) were imperative adverse effects. Moreover, many adverse neurological effects were found at follow-up examinations, including developmental delay (RR 1.72, 95% CI 1.4 to 2.05) and cerebral palsy (RR 1.56, 95% CI 1.03 to 2.1). Additionally, the rates of the combined outcomes of death or cerebral palsy (1.92, 95% CI 1.18 to 2.67), or of death or major neurosensory disability (RR 1.25, 95% CI 0.98 to 1.53), were not significantly increased. In subgroup analyses by type of corticosteroid, most of the advantageous and disadvantageous effects were related chiefly to dexamethasone whilst hydrocortisone had slight effect on any of the outcomes except for an increase in intestinal perforation and a borderline reduction in patent ductus arteriosus. The overall risk for bias was low as all were RCTs using robust methods.
<strong>Conclusion: </strong>despite the fact that early corticosteroid treatment can have beneficial outcome for BPD management through facilitation of extubation and decreasing the risk of chronic lung disease and patent ductus arteriosus, it ,on the other hand, results in short-term adverse effects including gastrointestinal bleeding, intestinal perforation, hyperglycaemia, hypertension, hypertrophic cardiomyopathy and growth failure.
<strong> </strong> Clinicians should carefully assess the risks of a short course of glucocorticoid therapy to mitigate BPD for premature neonates such that an individualized decision should be made in conjunction with the infant's parents.
Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269820171001Coexistence of Hypertension and Diabetes Mellitus in Elderly Population of Arar City, Northern Saudi Arabia315431591278710.12816/0042867ENThamer Owaid AlanaziKing Fahad Medical City, Al-DahrranYusef Muhana AleneziFamily and Community Medicine Department, Faculty of Medicine, Northern Border University, ArarMohammed Ibrahim Omar AlalawiInternal Medicine Department, King Khalid UniversityEssam Abdullah AlghamdiGeneral Surgery Department, Umm Alqura university,Assaf Nahar J AlsulamiMilitary Hospital, Al Madina, KSAAbdullah Khaled J AlzahraniFaculty of Medicine,Taif University, Taif,Bandar Ali Mohammed AlbarqiMilitary Hospital, Khamis MushaitSaleh Saad T AlotaibiFaculty of Medicine,Taif University, TaifAlanazi Ahmed Owaid ZMedical Student, Faculty of Medicine, NBU, Arar, KSAAlharthi Saleh Furayhan OFaculty of Medicine, University of Debrecen, Debrecen, HungaryAbdullah Hameed AlghanmiKing Fahad Military Hospital, JeddahSultan Hassan Y AsiriKing Khalid University, AbhaJournal Article20180906<strong>Background</strong>: Type 2 diabetes (DM) mellitus and Hypertension (HT) are among the most common chronic non-communicable diseases affecting at a higher prevalence in the older age group. The presence of hypertension in diabetic patients substantially increases the risks of coronary heart disease, stroke, nephropathy and retinopathy. The objective of this study is to determine the prevalence rate and risk factor associated with co-existence of hypertension and diabetes mellitus in elderly population in Arar city, Northern Saudi Arabia. <strong>Methods: </strong>A cross sectional study, included 181 elderly attending seven randomly selected primary healthcare centers in Arar city during the period from 1<sup>st</sup> January to 30<sup>th</sup> June 2017. Participants selected using a systemic random sampling procedure as we take every second elderly attending the PHC during the study period. Data collected by means of personal interview using a predesigned questionnaire covering the required items. <strong>Results:</strong> The prevalence of coexistence of diabetes and hypertension was 16.6% while coexistence of diabetes, hypertension and obesity were found in 9.9%. Two-thirds (66.66%) of cases of coexisting diabetes and hypertension were females (P value>0.05). The relation between coexisting diabetes and hypertension with smoking status was significant (P value<0.05) while the relation with BMI was non-significant (P value>0.05).
<strong>Conclusion:</strong> Coexistence of diabetes and hypertension were found in 16.6% of elderly population of Arar, Northern KSA. This association leads to several cardiovascular complications, so it is mandatory to adopt more strategies for the control of DM and HT in Arar elderly population by appropriate methods.
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