Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200270920180101Systemic Review: Role of Lifestyle Interventions for The Treatment of Non-Alcoholic Fatty Liver Disease1421143010475ENNorah Ibraheem AlmanieKing Khalid UniversityReem Ali AlmanieKing Khalid UniversityRoaa Fahad AlshabanahKing Khalid UniversityTahani Saeed AlmohayyaKing Khalid UniversityEbtesam Mohammed AlahmariKing Khalid UniversityAmal Nasser AlqahtaniKing Khalid UniversityMohammed Ali AlzubaidiUmm Alqura UniversityAbdulhakim Ali AlkhodairKing Saud Bin Abdulaziz University for Health SciencesAnas Rafik AlShaerMisr University for Science and TechnologyHaneen Ahmad KhoujaBattarje Medical CollegeJournal Article20180807<strong>Background: </strong>Non-alcoholic fatty liver sickness (NAFLD) is a variety of liver pathological conditions that intensely related to other chronic diseases including obesity and diabetes.
<strong>Objectives: </strong>Systematically evaluating the role of lifestyle interventions on reducing the activity of NAFLD.
<strong>Methods: </strong>Collecting all the studies regarding the effects of changing the diet, exercise or combination of both on the activity or markers of NAFLD during the period from 2006 to 2017.
<strong>Results: </strong>Database searches returned 122 citations with 92 included in more than one search then the final studied which include in this study was 19 articles. Five articles studied the effects of a combination of dietary and exercise interventions, four of these articles showed positive results regarding the Dietetic Association (ADA) Quality Criteria Checklist, while only one article showed a neutral results, i.e. 80.0% of the articles showed a positive effect of the combination of diet and exercise on the effect of NAFLD patients.
<strong>Conclusion: </strong>This review showed that the combination of healthy life interventions, including exercise and health diet, are effective in reducing the activity of NAFLD and could result in complete reversal of the condition. Thus NAFLD patients are advised to lose about 10% of their weight and engaging in regular exercises for 5 days per week. https://ejhm.journals.ekb.eg/article_10475_a53a1fa08819110e276d8eb3a6439e53.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200270920180101The Role of Urinary Cyclophilin A as a New Marker for Diabetic Nephropathy1431143910476ENHanan Mohamed Ali AmerDepartment of Internal Medicine and Endocrinology, Faculty of Medicine, Ain Shams UniversityInas Mohamed SabryDepartment of Internal Medicine and Endocrinology, Faculty of Medicine, Ain Shams UniversityMeram Mohamed Mahmoud BekhetDepartment of Internal Medicine and Endocrinology, Faculty of Medicine, Ain Shams UniversityReham Nabil Sayed MohammedDepartment of Internal Medicine and Endocrinology, Faculty of Medicine, Ain Shams UniversityJournal Article20180807<strong>Background:</strong>Type 2 diabetes mellitus is the most common single cause of end-stage renal disease (ESRD), where diabetic nephropathy (DN) is considered the cause in almost half of all patients with ESRD. Despite the availability of many modern therapies for glycemic control, there are no specific curative treatments yet for DN and many diabetic patients still progressed to severe renal damage. Currently, albuminuria is the most commonly used marker to predict onset and progression of DN clinically. However, this traditional marker for DN lacks both sensitivity and specificity to detect early stage of DN. Furthermore, there is a lack of a strong association between albuminuria and glomerular filtration rate (GFR). As such, it is crucial to find earlier and reliable markers for DN diagnosis and intervention providing an opportunity to stop the permanent damage caused by it.
<strong>Objective:</strong> This study focuses on Cyclophilin A (CypA) in urine. CypA is a protein with ubiquitous characteristics, mostly distributed in the cytoplasm and facilitates protein folding and protein trafficking. It has relatively high expression level in normal kidneys. Recently, CypA has been reported to be a reliable novel marker for early diagnosis of DN.
<strong>Subjects and Methods:</strong> Our study was conducted on 90 subjects of comparative age and sex. They were selected from Endocrinology Clinic after written consent at Ain Shams University Hospital and Railway Hospital. Participants were divided into: <strong>Group I: </strong>30 healthy control subjects,<strong> Group II:</strong> 30 T2DM patients without albuminuria (normoalbuminuric), and<strong> Group III: </strong>30 T2DM patients with albuminuric DN.
<strong>Results: </strong>Our study showed that regarding the level of urinary CypA there was a highly statistical significant difference between the three groups (F= 221.730, p< 0.01), being higher in GII (normoalbuminuric) (1.69±0.87 ng/ml) than in GI (control) (0.55±0.14 ng/ml) (t= 7.04, p< 0.01) and higher in GIII (albuminuric DN) (6.01±1.61 ng/ml) than GII (t= 12.93, p< 0.001) and GI (t= 18.55, p< 0.0001). In addition, we found that urinary CypA was significant higher in GIIIb (macroalbuminuria) (7.23±0.76 ng/ml) than in GIIIa (microalbuminuria) (4.79±1.25 ng/ml) (t= 6.49, p< 0.01). It worth mentioning that, the level of urinary CypA started to increase significantly in stage 2 DN (2.49±0.50 ng/ml) in spite of normal level of albuminuria (no albuminuria) comparing with each of stage 1 DN (1.03±0.15 ng/ml), diabetics with no renal affection (0.99±0.45 ng/ml) and GI (healthy control) (0.55±0.14 ng/ml). There was significant positive correlation between urinary CypA and each of: sCr in GII (r= +0.39, p< 0.05), GIIIa (r= +0.89, p< 0.001) and GIIIb (r= +0.99, p< 0.001) and ACR in GIIIa (r= +0.93, p< 0.001) and GIIIb (r= +0.98, p< 0.001).
<strong>Conclusion:</strong> Our study showed that there was a high significant difference in the level of urinary CypA between diabetic patients with any degree of renal affection and healthy subjects being higher in diabetics with renal affection even without the presence of albuminuria.https://ejhm.journals.ekb.eg/article_10476_cf46a1752b69b8787cc9702b0b361176.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200270920180101Evaluation of Prevalence and Associated Factors of Restless Leg Syndrome among Medical Students at University of Tabuk -20171440144410477ENAbdullah Hamad AlmutairiFaculty of Medicine, University of Tabuk, Tabuk/ KSAAhmad Aawad AlatawiFaculty of Medicine, University of Tabuk, Tabuk/ KSASaud Abdulaziz BinsufayanFaculty of Medicine, King Saud University, Alriyadh/ KSAAlqarni Ayeshah BeeshiFaculty of Medicine, Taif University, Altaif/ KSAIbrahim Sami AbunohaiahFaculty of Medicine, King Saud University, Alriyadh/ KSAMohammed Saleh AlatawiSurgery Department, King Fahad Specialt Hospital, Tabuk/ KSAWaleed Jamal AloqbiFaculty of Medicine, University of Tabuk, Tabuk/ KSAJournal Article20180807 Restless leg syndrome (RLS) is a disorder affecting a significant portion of the general population. The syndrome has a strong family component and several comorbid conditions may be associated with RLS. Researches over the past 10 years had highlighted its heritability and had shed some interesting light to this disorder. Restless legs syndrome (RLS), or Willis-Ekbom disease, is a neurological disorder that is characterized by unpleasant or painful sensations in the legs and a distressing, irresistible urge to move them. RLS symptoms worsen during inactivity and at night. Partial or complete relief may result from movement such as walking, stretching, or bending of the legs. Yet, the relief is often temporary and symptoms return when movement ceases. <strong>Aim of the work: </strong>this study aimed to evaluate the prevalence and associated factors of restless leg syndrome among Medical Students at University of Tabuk. <strong>Methods:</strong>we have conducted a descriptive cross-sectional study in Tabuk city population, Saudi Arabia. The study was conducted during the period from July to December 2017. The participants who attended the college of medicine at university of Tabuk were included in the study. The total sample obtained was 151. A self-administered questionnaire about restless leg syndrome was filled by the participants. <strong>Results:</strong> age of the participants was ranged from 18 to 27 years old, with a mean (SD) of 22.72 (1.837), the majority were 6<sup>th</sup> year medical students (39.7%)<em>. </em>39.7% reported that they had urge to move the legs with unpleasant sensations in the legs, from those who reported they had urge to move the legs with unpleasant sensations in the legs, 80% of them reported that it is relieved by movements. <strong>Conclusion</strong><em>: </em>more attention is needed on recognition of RLS among medical students and to manage the aggravating factors of RLS.https://ejhm.journals.ekb.eg/article_10477_a5cd7c0e939056fa47e0558fd008b969.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200270920180101A 6-Year-Old Saudi Boy with Myotonia Congenita1445144710478ENAbdullah Ali Z AlshahraniMedical Intern, King Faisal Specialist Hospital and Research Center-JeddahHusam KayyaliPediatric Neurology Section,King Faisal Specialist Hospital and Research Center-JeddahJournal Article20180807<strong>Background:</strong> myotonia congenita is an inherited form of myotonia that is due to mutations in the skeletal muscle chloride channel CLCN1. These mutations lead to reduced sarcolemmal chloride conductance, causing delayed muscle relaxation that is evident by clinical exam and myotonic discharges on electromyogram. Two forms of myotonia congenita are recognized: autosomal recessive (Becker variant) or autosomal dominant (Thomsen variant). The recessive form tends to be more severe and has an earlier onset than the dominant one. The dominant form varies in severity from asymptomatic to moderately severe. These two forms may be distinguished by clinical presentation, inheritance pattern and age of onset.
<strong>Methods:</strong> we described the clinical presentation and genetic testing results of one individual with the autosomal recessive variant of myotonia congenita.
<strong>Results:</strong> the initial diagnosis was made based on the clinical presentation then it was confirmed based on electromyographic findings of myotonic discharges and CLCN1 gene sequencing which revealed homozygous disease-associated C ->A transverse mutation. The patient achieved a modest response to treatment with phenytoin, carbamazepine or acetazolamide. His condition remained stable with minimal weakness and muscle hypertrophy.
<strong>Conclusions:</strong> myotonia congenita is a rare genetic disorder of muscle relaxation. The diagnosis is made based on clinical features and is confirmed by sequencing CLCN1 gene. Response to treatment is variable. Recommended medications included mexiletine, phenytoin, carbamazepine and acetazolamide among others.https://ejhm.journals.ekb.eg/article_10478_7de00bafe1b45f1fae7b9157ca5852cc.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200270920180101Quality of Life of Patients after Total Knee Arthroplasty at King Abdulaziz University Hospital, Jeddah, Saudi Arabia1448145410479ENMaram Abdullah BatarfiKing Abdulaziz University Hospital, Jeddah, Saudi ArabiaAmmar Yaser AlkhiaryKing Abdulaziz University Hospital, Jeddah, Saudi ArabiaOrjwan Anas AbulabanKing Abdulaziz University Hospital, Jeddah, Saudi ArabiaNoha Ahmed AlzahraniKing Abdulaziz University Hospital, Jeddah, Saudi ArabiaShahad Khalid BagaisKing Abdulaziz University Hospital, Jeddah, Saudi ArabiaAbdullah KermilyKing Abdulaziz University Hospital, Jeddah, Saudi ArabiaJournal Article20180807<strong>Background: </strong>osteoarthritis is a degenerative disease affecting both genders and is more prevalent in females. The incidence of osteoarthritis in Saudi Arabia is up to 60%. Management is initially conservative with medications and lifestyle changes. Total knee arthroplasty (TKA) is the surgical option for patients who complain of severe pain and functional disabilities. TKA is correlated with improving quality of life, but despite this evidence, some patients complain of residual symptoms postoperatively which don’t meet their pre-operative expectations.
<strong>Aim of the work: </strong>this study aimed to determine health related quality of life of patients after total knee arthroplasty and to assess the psychological factors affecting the patients after the procedure
<strong>Methodology: </strong>this retrospective cross-sectional study analyzed all the files of patients who underwent unilateral or bilateral TKA in KAUH from 2010-2017. A total of 78 patients were interviewed by phone using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and short form quality of life (SF-36)questionnaires.
<strong>Result: </strong>a total of 78 patients (60 Females and 18 males) were participated in this study. The mean age was 65.7 years old.In general, 41.6% of the patients were satisfied with their usual daily activity, where on the other hand 5.2% of patients reported poor satisfaction and were much worse than before.59.7% of the patients reported great improvement in comparison with the previous year and 22.1% of the patients reported a somewhat better improvement.53.2% reported no limitation in their social life regarding physical activity and emotional problems, while 9.1% had physical and emotional problems interfering with their life.
<strong>Conclusion: </strong>TKA is a very successful and cost effective therapeutic option for treating knee osteoarthritis. Improvement in the quality of life and physical activity of patients supports other conducted previous studies. https://ejhm.journals.ekb.eg/article_10479_686e26699451fc99649ed083e73cf6ac.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200270920180101Prevalence and Potential Risk Factors of Diabetic Retinopathy among Type 2 Diabetics Patients in Diabetic Center, Taif City, KSA1455146310480ENAhmad S. AlharthiTaif University School of Medicine Taif, Saudi ArabiaMaha Zuwayyid K. AlmutairiTaif University School of Medicine Taif, Saudi ArabiaAbdulaziz Hameed K. AlswatTaif University School of Medicine Taif, Saudi ArabiaHajer A. Al- WagdaniTaif University School of Medicine Taif, Saudi ArabiaAbdulhamid Al GhamdiDepartment of Ophthalmology, Faculty of Medicine, Taif University, Taif, Saudi ArabiaJournal Article20180807<strong>Background: </strong>diabetic retinopathy is the most common microvascular complication of diabetes mellitus (DM) and a primary leading cause of irreversible visual impairment. Timely risk based screening of DR progression is crucial<strong>.</strong>
<strong>Materials and Methods</strong><strong>:</strong>a cross-sectional study was conducted between October-December 2016 at Diabetic Center, Taif city by assessing fundus photographs of type 2 Diabetics. Furthermore, we analysed the DR potential risk factors including demographic, duration of diabetes, [HbA1c], type of anti-diabetic drugs, dyslipidemia, [BMI].
<strong>Results</strong><strong>:</strong>a total of 213 diabetic patient were included, 34 (16%) have DR with mean years of age 54.14 (13.12) and males were 19 (55.88%) and females 15 (44.12%). its mean of duration was 4.4 (4.5) months. DM duration’s mean was 15.6 year and SD was (10.26). Also, HbA1c mean (SD) was 8.11 (1.99). HbA1c% mean (SD) was 8.57 (1.88). Insulin only was the management of DM in 8 (23.53%) while oral hypoglycemic drugs only were used by 6 (17.65%) and the use of both was the treatment of 19 (55.88%) patients. Systematic diseases as dyslipidemia, hypercholesteremia and hypertension were prevalent among 15 (44.12%), 5 (14.17%) and 11 (32.35%) patients; respectively. Nephropathy presented in 12 (35.29%) patients. There were no underweight patients, 4 (2.23%) normal, 19 (55.88%) obese and 11 (32.35%) overweight.
We conducted multivariate analysis of variance (MANOA) to compare the effect of age, duration of DM, HGA1c%, TRIGLYCERIDE (mg/dl), LDL-Cholesterol (mg/dl), diastolic blood pressure, systolic blood pressure and GFR on the prevalence of DR. Also , A univariate analysis of variances (two-way ANOVA) was also conducted for each dependent variable.
<strong>Conclusion</strong><strong>:</strong>Among the participating patients , our study showed a high prevalence of diabetic retinopathy especially with male patints , high (HbA1c) and longer duration of diabetes. We have recommended a national plan for educational programs about diabetic retinopathy and important of Eye examination .Also,our study showed that certain risk factors may enhance the progression of DR. Furthermore, our study highlights the importance of risk based screening for DR.https://ejhm.journals.ekb.eg/article_10480_9771456f0f114468046af80641fffab0.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200270920180101Pelvic Inflammatory Disease1464146710481ENBayan Khalid Sabb GulUmm Alqura UniversityZainab Ali AlbatiPavol Jozef SafariRawan Rafat Ismaeel BadrMaternity And Children Hospital In MakkahZainab Mohammed AlfarajMaternity And Children Hospital DammamAli Shuja AlmatrafiUmm Alqura UniversityAhmad Abdullatif BanounIbn Sina National CollegeRazan Mohammad Hassan MakiUniversity Of KassalaSara Faisal BagdoodIbn Sina National CollegeAmro Sulaiman AlJuhaniKing Abdulaziz UniversityAsma Saad AlahmariKing Khalid UniversityJournal Article20180807<strong>Introduction:</strong> Pelvic inflammatory diseases (PID) is caused by infections in the female reproductive tract that includes pelvic peritoneum, ovaries, fallopian tubes, and the endometrium. These infections are commonly caused by <em>Chlamydia trachomatis</em>,<em> Neisseria gonorrhea, </em>or other sexually transmitted infections. 800,000 women get a diagnosis of pelvic inflammatory disease annually in the United States. PID usually causes irreversible damage to the reproductive tract, and treatment mainly depends on preventing further scarring or complications. Immediate broad spectrum antibiotics are indicated. Treatment can include hospitalization as well as surgery.<br /> <strong>Methodology:</strong> We conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE, from January 1985 to February 2017. The following search terms were used: pelvic inflammatory diseases, pathogens causing pelvic inflammatory diseases, causes of infertility, treatment and diagnosis of pelvic inflammatory diseases. <strong>Aim:</strong> In this review, we aim to study the pathophysiology and etiology of pelvic inflammatory diseases, as well as to study the diagnosis, treatment, and possible complications of this condition. <br /> <strong>Conclusion:</strong> It is essential to raise the awareness and knowledge of females in general regarding PID and its symptoms, as early detection will significantly decrease the likelihood of severe complications. Other than infertility, complications of pelvic inflammatory disease include chronic pain. More research is needed in this field to improve management and care of patients suffering from this condition.https://ejhm.journals.ekb.eg/article_10481_0eeef08e5fab25561a6ee22b2eeb026f.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200270920180101Pneumonia in Elderly and Intensive Care Management1468147010482ENAbdulhadi Salem TowairqiUniversity of JeddahLujain Hamed MutwallyKing Fahad Hospital JeddahYasser Ali BaateiyyahUmm Alqura UniversityRakan Ahmed I AlshuwaierKing Saud UniversityIsmail Nizar O KraizKing Saud UniversityHamzah Mohammed AlarfajKing Faisal University In AlahsaaOhood Abdulrazaq AlsomaliYanbu General HospitalRahaf Sadiq Omar BukhariKing Khalid UniversityJournal Article20180807<strong>Introduction:</strong> The incidence of pneumonia among elderly is 4 times higher than younger individuals, with elevated risks of hospital admissions and high mortality rates. The most important and common infectious cause of death among old patients remains to be community acquired pneumonia. It is essential to properly assess severity of the disease to decide appropriate management ranging from antibiotics, hospitalization, and intensive care. <strong>Methodology:</strong> We conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE, January 1985, through February 2017. The following search terms were used: pneumonia, elderly pneumonia, intensive care unit, community acquired pneumonia, management and prevention<em><br /> </em><strong>Aim:</strong> In this review, we aim to study the prevalence, etiology and intensive care management of pneumonia in the elderly. <strong>Conclusion:</strong> Community acquired pneumonia continues to be the leading cause of death due to infectious diseases among patients older than 65 years. It is also associated with significant amounts of long term morbidities. Proper assessment will have a significant impact on the burden of healthcare use, diagnostic and therapeutic approaches, and consequently, clinical and survival outcomes.https://ejhm.journals.ekb.eg/article_10482_174980026ae55e94ae31d35c0a35bab5.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200270920180101Gallstone Ileus: Case Report of a Rare Cause of Intestinal Obstruction in An Unexpected Age Group1471147410483ENBashaer Ahmed ShafeiIbnsina National College for Medical StudiesRami Issam ArabiIbnsina National College for Medical StudiesAhmed Abdulrahim FallatahKing Abdulaziz Hospital and Oncology CenterJournal Article20180807<strong>Background: </strong>gallstone ileus is a rare complication of cholelithiasis and considered as a type of mechanical bowel obstruction in which a gallstone is impacted in the gastrointestinal tract. This condition is seen more frequently in old patients with females’ predominance. Gallstone ileus is responsible for 1%-5% of mechanical intestinal obstruction.
<strong>Case presentation: </strong>we report a case of 48 years old medically free, male patient presented to Emergency Department with severe abdominal pain, distention, constipation, multiple attacks of vomiting associated with nausea and with a chronic history of cholecystitis. The diagnosis of gallstone ileus was confirmed by abdominal X-ray and abdominal computed tomography (CT) scan findings. The patient was stabilized before doing an exploratory laparotomy.
<strong>Conclusion: </strong>gallstone ileus is an emergency condition associated with high morbidity and mortality rates. To get the most favorable outcome, high clinical suspicion aided by the use of diagnostic modalities such as CT abdomen is needed to reach the diagnosis since it is usually present with nonspecific signs and symptoms.https://ejhm.journals.ekb.eg/article_10483_db9a8c6052eef9fe14c8f1d8802305d8.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200270920180101Primary Health Care Physicians' Knowledge, Attitude and Practice towards Evidence-Based Medicine in Tabuk City, KSA1475147910484ENAbdullah H. AltemaniDepartment of Family and Community Medicine, Faculty of Medicine, University of Tabuk, Kingdom of Saudi ArabiaAssem H. AltemaniMedical Resident, Medical Administration, University of Tabuk, Kingdom of Saudi ArabiaJournal Article20180807<strong>Background: </strong>Evidence-based medicine (EBM) is an essential component of modern medical practice and crucial for patient safety and high-quality health care services.
<strong>Objectives: </strong>This study was conducted to assess the knowledge, attitude and practice towards evidence-based medicine and the barriers against its application in daily medical practice.
<strong>Subjects and Methods:</strong> This is a cross-sectional survey using a self-administered validated questionnaire among 68 primary health care physicians in Tabuk city, Kingdom of Saudi Arabia during the period from December 2016 to June 2017. Validated questionnaire was used to collect data from the respondents. The Statistical Package for Social Sciences (SPSS) was used for data analysis. P-value of <0.05 was considered as significant. <strong>Result: </strong>There are 62.2% male participants, the age of the majority were from 30 to 50 years (73.5%) and (72.1%) did not have board qualification, the primary literature review and summaries were the popular methods for EBM. The knowledge and attitude were suboptimal; some did not even access Medline. The unavailability of time and internet access were the most frequent barriers reported. Only a minority received formal EBM training.
<strong>Conclusion:</strong> The knowledge and attitude regarding EBM were suboptimal among the primary health care physicians, the time factors, unavailability of the internet and the lack of letters, access to journals, and guidelines were the principal barriers to EBM incorporation in the clinical practice. https://ejhm.journals.ekb.eg/article_10484_13b272d6eb6da9ad5a86e04eb487a353.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200270920180101Post-operative Bleeding and its Management1480148310485ENEyaad Talat GhallabKing Abdullah Medical Complex, JeddahJournal Article20180807<strong>Background: </strong>one of the most feared complications of surgery is bleeding. Substantial gastrointestinal bleeding in the postoperative time is an unusual complication of both GI and non-GI surgery. If not managed properly and promptly, the patient can suffer from hypovolemic shock and so it is considered a life-threatening emergency until proven otherwise.<strong> Aim of the work:</strong> In this review, we aimed to study post-operative bleeding with special reference to gastrointestinal surgery and also to understand the major causes and explore the approach to its management. <strong>Methodology:</strong> we conducted this review by using a comprehensive search of MEDLINE, PubMed and EMBASE, January 2001, through February 2017. The following search terms were used: post-operative bleeding, gastrointestinal surgical hemorrhage, gastrointestinal bleeding, hypotensive shock and bleeding management. <strong>Results:</strong> immediate surgery must be performed to save the patient in case of bleeding after surgery. <strong>Conclusion:</strong> to prevent postoperative hemorrhage, thorough evaluation must be done. When bleeding occurs, it is essential to recognize it immediately as prognosis and survival are significantly affected with delayed proper management. If needed, immediate surgery must be performed to save the patient.<br /><br />https://ejhm.journals.ekb.eg/article_10485_36d81684b9ec06500e8741bb57a83bdd.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200270920180101Assessment of Knowledge, Attitude and Practice of Safety, Effectiveness and Consequences of Bariatric Surgery among Community in Riyadh City1484149310486ENTariq Abdullah AldawqiImam Muhammad ibn Saud Islamic UniversityAhmed Emad AlghamdiImam Muhammad ibn Saud Islamic UniversityYoussef Ahmed AlishiImam Muhammad ibn Saud Islamic UniversityMohammad Fahad AlzahraniImam Muhammad ibn Saud Islamic UniversityAhmed Yahya AseriKing Khalid UniversityAhmed A AlbariqiKing Khalid UniversityJournal Article20180807<strong>Background: </strong>Obesity is a public health problem and its prevalence is escalating in the recent years in Saudi Arabia. Bariatric surgery is the most effective treatment for the morbidly obese.<br /> <strong>Aim of the Work:</strong> The aim of this studywas to examine community health beliefs regarding obesity and bariatric surgery, and to evaluate the potential associations between demographic characteristics and agreement to bariatric surgery.<br /> <strong>Material and Methods: </strong>A self-administered questionnaire was distributed to adult citizens of Riyadh city. The questionnaire included questions about obesity, its causes, lifestyle, and beliefs about the effectiveness of bariatric surgery and its complications.<br /> <strong>Results:</strong>27.6% of respondents were overweight and 33.6% were obese. The overweight/obese respondents were significantly inclined to be in the older age groups, married, and have high income and a family history of obesity. Most respondents showed good knowledge about obesity, its risk factors, and healthy life style, and they recognized the efficacy of bariatric surgery in reducing weight. However, more than half of the respondents doubted its safety and only 16.2% believed it to be the best choice. Male subjects - who were in older age groups, had a secondary school education and a body mass index above normal range - were more likely to regard surgery as the best choice for weight loss.<br /> <strong>Conclusion:</strong> Most of respondents overestimated the risks of bariatric surgery and did not consider it as the best choice for weight loss. Health education is recommended to address these misconceptions and convince the public of its relative safety and the expected health benefits. https://ejhm.journals.ekb.eg/article_10486_e53e691ecd90a3d9acc832e17364841d.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200270920180101Antimicrobial Activity of Bio and Chemical Synthesized Cadmium Sulfide Nanoparticles1494150710487ENSoheir S. Abd ElsalamMicrobiology Department, Faculty of science, Benha UniversityRania H. TahaChemistry Department, Faculty of
Science for Girls, Al-Azahar UniversityAmany M. TawfeikMicrobiology and Immunology Department, Faculty of Medicine for Girls, Al-Azhar UniversityMohamed O. Abd El-MonemBotany Department, Faculty of science, Benha UniversityHanady A. MahmoudBotany Department, Faculty of science, for Girls, Al-Azahar University, EgyptJournal Article20180807 <strong>Background:</strong> The green synthesis of cadmium sulfide (CdS) nanoparticles has been regarded as the most promising technique for their prospective applications in biological system. <strong>Aim of the work: </strong>In this study isolation of different bacterial strains from stool samples of healthy volunteer, selection of the most efficient bacterial strains able to reduce cadmium sulfide metal into nanoparticles. Characterization of biosynthesized metal nanoparticles by standard analytical methods. Mediating the biosynthesized cadmium sulfide nanoparticles in medical applications in comparison to those produced by chemical methods. <strong>Materials and methods: </strong>Extracellular <em>Escherichia coli</em> E-30 and <em>Klebsiella pneumonia</em>e K-6 isolated from stool samples were the strains used for biosynthesis. Cadmium sulfide nanoparticles were also produced by wet chemical method. The characterizations of cadmium sulfide nanoparticles were done by using UV-Visible Spectroscopy, Transmission electron microscopy (TEM), energy dispersive x-ray (EDX) and Fourier transform infrared spectroscopy (FT-IR). <strong>Results</strong>: <em>Escherichia coli</em> E-30 has shown to be efficient in synthesizing cadmium sulfide nanoparticles where CdS nanoparticles were with average size ranging from 3.2 to 44.9 nm while average size of CdS nanoparticle was synthesized by <em>Klebsiella</em> <em>pneumoniae</em> K-6 ranging from 8.5 to 44.9 nm. While cadmium sulfide nanoparticles synthesized by wet chemical method, ranging from 8.77 to 16.50 nm. Biosynthesized cadmium sulfide nanoparticles by <em>Escherichia coli</em> E-30 showed highest antimicrobial activity on <em>Aspergillus fumigatus</em>,<em> Geotricum candidum</em>, <em>Bacillus subtilis</em>,<em>Staphylococcus aureus </em>and<em> Escherichia coli</em> than chemical synthesized of CdS nanoparticles. <strong>Conclusion</strong>: <em>Escherichia coli</em> and <em>Klebsiella pneumoniae </em>isolated from stool samples had the ability to produce cadmium sulfide nanoparticles. This kind of microorganisms can be used for synthesis of nanoparticles and heavy metal absorption for detoxification of environment.https://ejhm.journals.ekb.eg/article_10487_810da2bd030e463e4f2cbb35c4be3c1a.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200270920180101Emergency Management of Subdural Hematoma1508151010488ENAbdulrahman Mubarak AlmutairiMajmaah UniversityHassan Mohammed BarnawiTaibah UniversityEbtesam Mohammed AlahmariKing Khalid UniversityTahani Saeed AlmohayyaKing Khalid UniversityRoaa Fahad AlshabanahKing Khalid UniversityHuda Hussain Mohammad RadwanIbn Sina National CollegeJournal Article20180807<strong>Background:</strong> subdural hematoma is extra-cerebral accumulation of blood between the dura matter and the subarachnoid layer. It is almost always caused by trauma or due to blood thinning therapies and occurs due to rupture of bridging veins. Acute subdural hematoma is an emergency situation and requires prompt diagnosis using CT most of the time and management requires surgery as well as reversal of anticoagulants.<br /> <strong>Aim of the work:</strong> In this review, we aimed to study the etiology of subdural hematoma, explore how to diagnoses and manage it in the emergency department. <strong>Methodology:</strong> we conducted this review using a comprehensive search of MEDLINE, PubMed and EMBASE, from January 1985 to February 2017.<br /> <strong>Results:</strong> surgery is most important intervention in managing subdural hematomas. <strong>Conclusion:</strong> subdural hematoma is an important clinical presentation that needs proper and prompt surgical management and treatment. Treatment should be as less invasive as possible, with higher efficacy and lower recurrence rates. No-surgical approaches are still being studied with no proven efficacy for them until now.https://ejhm.journals.ekb.eg/article_10488_63d22aece90346307534c976031cc2e2.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200270920180101Parental Awareness Regarding Aerodigestive Pediatric Foreign Bodies. Eastern Province, Saudi Arabia1511151710489ENFatimah A. AlShakhsFaculty of medicine, King Faisal University, Al-Sharqiya, Saudi ArabiaKhalid A. AlYahyaOtolaryngology Head and
Neck Surgery. King Faisal University Ahassa, Saudi ArabiaAsmaa S. AlSaeedFaculty of medicine, King Faisal University, Al-Sharqiya, Saudi ArabiaMarwah S. AlSultanFaculty of medicine, King Faisal University, Al-Sharqiya, Saudi ArabiaJournal Article20180807<strong>Background: </strong>Aerodigestive foreign bodies are common clinical problem that may lead to life threatening complications or sudden death. It’s commonly seen in children since they are curious to explore environmental objects with their mouth, while the development of airway protection reflexes and chewing capacity are immature.<br /> <strong>Objectives:</strong> This study aims to assess the extent of parents' awareness about the danger of foreign objects that can be swallowed or inhaled by their children and how to manage such cases.<br /> <strong>Materials and Methods:</strong> A cross sectional study was used to assess the level of parents' awareness about the danger of swallowing or inhaling foreign objects by their children and to assess their knowledge about dealings with such cases. The data were collected from 459 by a distributed questionnaire among parents in Al-sharqiya.<br /> <strong>Results:</strong> 60.3% of participants were aware of aerodigestive foreign bodies.Regarding the management of child with aerodigestive foreign bodies in different age groups. For child with age group 1 year and less, about (34.9%) of participants were aware of the managment. However, there is misunderstanding of managing child with age 5 years and less where only 5.6% of participants were aware of the management in this age group. As regards the children more than 5 years old, only 36.2% of parents were aware of the management.<br /> <strong>Conclusion: </strong>The current study showed that most parents are lacking knowledge about the managment of this problem which reflect the importance of education and increasing the awareness among them to reduce the morbidly and mortality rate among children.https://ejhm.journals.ekb.eg/article_10489_2c3eeab2db1b8abbb0b70808910e2307.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200270920180101Role of S-Iron and Ferritin to Predict the Response to Recent New Antiviral Treatment in Chronic Hepatitis C Patients1518152810490ENKhaled H HemaidaDepartment of Internal Medicine, Faculty of Medicine – Ain Shams UniversityHany H KayserDepartment of Internal Medicine, Faculty of Medicine – Ain Shams UniversityRasha S MohamedDepartment of Internal Medicine, Faculty of Medicine – Ain Shams UniversityAmr M Abdel WahabDepartment of Internal Medicine, Faculty of Medicine – Ain Shams UniversityJournal Article20180807<strong><span lang="EN-US">Background: </span></strong><span lang="EN-US">Chronic hepatitis C (CHC) is an important liver disease, which may progress to cirrhosis or hepatocellular carcinoma. The current treatment regimen for CHC includes pegylated interferon-α (PEG-IFN) combined with ribavirin Ferritin is the major iron storage protein and provides an indirect estimate of the body’s iron stores. It is also an established marker for liver iron deposition. <strong>Aim of the Work:</strong> The aim of this study is to configurate the distribution of iron and ferritin levels in patients with chronic hepatitis C virus infection and to conduct a comparative study between the pretreatment and the post treatment iron profile after direct acting antiviral therapies in chronic HCV patients. <strong>Patients and Methods:</strong> This Randomized Controlled Clinical study was conducted on 100 subjects aged from 18 to 60 years selected from Gastroenterology and Hepatology department at Ain Shams University Hospital, Cairo, Egypt, from January 2017 to April 2017 and was approved by the ethical committee. <strong>Results: </strong>The current study suggests that a 12 weeks course of Sofosbuvir / Ledipasvir combination drug therapies showed a higher SVR 12 (92 %) and have significant decrease of the elevated serum iron and ferritin and transferrin saturation to the normal level more than sofosbuvir / Daclatasvir which showed a SVR 12 (88%). In both study groups, patients who showed SVR had significant lower values of Iron, Ferritin and transferrin saturation levels than patients who were non-SVR after end of therapy. <strong>Conclusion:</strong> This study may also shed light on how the changes in serum iron and ferritin levels in chronic hepatitis C patients may be related to HCV treatment.<strong> Recommendations: </strong>Sofosbuvir / Ledipasvir 12-weeks course is more recommended than Sofosbuvir / Daclatasvir 12 weeks course in patients with chronic HCV infection. As serum Iron, serum Ferritin and Transferrin saturation showed more significant improvement with SOF/LED combination therapy than SOF/DAC combination therapy, they are a good markers of highly predictive value in treatment of chronic HCV infected patients with DAAs.</span>https://ejhm.journals.ekb.eg/article_10490_4fb29902157441f545fc583ec97f9aa9.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200270920180101Soluble P-selectin Level in Patients with Deep Venous Thrombosis1529153810492ENAbeer A SaadeldinDepartment of Clinical and Chemical Pathology, Faculty of Medicine-Ain Shams UniversityYasmin N El-SakhawyDepartment of Clinical and Chemical Pathology, Faculty of Medicine-Ain Shams UniversityDoaa A ShalabyDepartment of Clinical and Chemical Pathology, Faculty of Medicine-Ain Shams UniversityHany A HussienDepartment of Internal Medicine, Faculty of Medicine-Ain Shams UniversityJournal Article20180807<strong>Background: </strong>Venous thromboembolic disease (VTE) remains a significant source of morbidity and mortality. As non-specific subjective complaints and a lack of objective clinical examination findings complicate the diagnosis of both deep venous thrombosis (DVT) and pulmonary embolism. Objective diagnostic testing is required to confirm or exclude the presence of venous thromboembolism before subjecting patients to unnecessary long-term anticoagulation. <strong>Aim of the Work: </strong>This study was aimed to measure the level of soluble P-selectin (sPsel) in Egyptian patients with DVT and asses its diagnostic value in relation to other clinical data and radiological examination. <strong>Subjects and Methods: </strong>This study was carried out on 80 individuals, attending Ain Shams University Hospitals between October 2015 and March 2016 after Ethical committee approval. They were divided into two groups.: <strong>Group I,</strong> 50 patients who were positive for DVT by duplex ultrasound. They were 41 males and 9 females. Their ages ranged 20 - 77 years, with a mean of 46.20 ± 11.78 years. They were 41 (82%) males and 9 (18%) females, with a male to female ratio of 4.55:1.<strong> Group II: </strong>30 healthy subjects with no clinical signs, symptoms, or history of DVT. They were 23 (76.7%) males and 7 (23.3%) females, with a male to female ratio of 3.28:1. <strong>Results:</strong> There was a highly significant difference between patients (group I) and controls (group II) as regards P-selectin, the best cut off was70.5 ng/ml with 98% sensitivity, 100% specificity, a NPV of 96.8% and a PPV of 100%.<br /> <strong>Conclusion: </strong>Diagnostic cut-off levels of P-selectin in cases with DVT is 70.5 mg/L that can safely differentiate patients who are free from DVT from others who are positive for DVT or those who would eventually develop thrombosis regardless their primary duplex ultrasound scanning results. <strong>Recommendations: </strong>As our study recommends the use of serum P-selectin as diagnostic biomarker in DVT alone; in addition to the newly estimated cut-off levels for these biomarker, further studies on larger number of cases are needed for more evaluation of these cut-off values and to establish whether they could be used to guide anticoagulation therapy when duplex ultrasound is unavailable.https://ejhm.journals.ekb.eg/article_10492_fc664c47083dff26a5a4e8c670a81de8.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200270920180101Glycogen Storage Disease in Pediatric Population1539154310512ENYara Mofarih AssiriKing Khalid UniversityMarium Mohammed IqbalBatterjee Medical CollegeReem Ali AlmanieKing Khalid UniversityAtheer Eed AlotaibiKing Khalid UniversityFaris Abdullah S AlharbiUniversity of GeziraBayan Sultan Al JobranKing Khalid UniversityHuda F. AbbagKing Khalid UniversityMohammed Younes AlmoghrabiBatterjee Medical CollegeFahad Abdulaziz JaradKing Khalid UniversityAshwaq Y. AsiriKing Khalid UniversityMohammad Abdullah AlotaibiImam Muhammad
Bin Saud Islamic UniversityWejdan Hamed AlshammariHail UniversityHadil Mohammed AleneziNorthern Border UniversityBadoor Abdrabalameer AlghafliArabian Gulf UniversitySaad Mahmoud TobaigiBatterjee Medical CollegeAmro Sulaiman AlJuhaniKing Abdulaziz UniversityMaram Mohammed BajoaifurIbn Sina National CollegeEmtenan Al AnsariIbn Sina National CollegeJournal Article20180808<strong>Introduction:</strong> The pathway of glycogen metabolism is regulated by many hormones such as insulin, glucagon, and corticosteroids. Glycogen storage diseases (GSD) most commonly affect muscles, liver, or both and occur in each 20000 to 43000 live birth. They are classified into 12 subtypes, but types I, II, and IX are the most common. <strong>Methodology:</strong> We conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE, from January 2001, through February 2017. The following search terms were used: glycogen storage diseases, Von Gierke disease, Pompe’s disease, Cori Disease, Forbes disease, Andersen’s disease, McArdle disease, neonatal hypoglycemia, neonatal hepatomegaly. <strong>Aim:</strong> In this review, we aim to study the genetic basis, diagnosis, presentation, and different management approach to various common types of glycogen storage diseases prevalent in pediatric population. <strong>Conclusion: </strong> There are no cures for any type of glycogen storage diseases presently. Most treatments are designed to control signs and symptoms. The overall goals are primarily avoiding hypoglycemia, hyperlactatemia, hyperuricemia, and hyperlipidemia. Liver transplantation should be deliberated for patients with GSD type IV and for other progressive hepatic types of GSDs in order to avoid hepatic failure or malignancy. More research must be carried out to develop newer and more effective ways of management.https://ejhm.journals.ekb.eg/article_10512_91608ae056b383270f76daa34b6eb4ce.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200270920180101Childhood Oral Health: Maternal Knowledge and Practice in Tabuk, Saudi Arabia1544155110513ENSharifah Sulaiman AlzaidiKing Khalid Military hospital, TabukIbrahim Abdullah AlanaziAdham General hospital, Ministry of Health, Tabuk, Saudi ArabiaOmar Mohammed Abo NawasAdham General hospital, Ministry of Health, Tabuk, Saudi ArabiaMohammed Abdulhai MullaAdham General hospital, Ministry of Health, Tabuk, Saudi ArabiaJournal Article20180808<strong>Background: </strong>Dental cares is a prevalent health problem among preschool children, despite the fact that oral health is a main component of preschool children’s well-being.
<strong>Objectives: </strong>To assess the knowledge and practice of mothers in Tabuk city, Saudi Arabia towards their preschool children oral health.
<strong>Methods: </strong>This cross-sectional study was carried at Tabuk city, Kingdom of Saudi Arabia. It was carried out in King Khalid military. All mothers having children aged between 3 and 6 years and attended the out-patients` clinics of King Khalid military hospital during the period of Augusr1<sup>st</sup>-October 31<sup>st</sup>, 2017 and accept to participate were invited to be included in the study sample. Arabic self-administered structured questionnaire was utilized for collecting data. It includes two main sections. The first section includes socio-demographic information and the second section includes ten knowledge and nine practice questions regarding children`s dental health and hygiene.
<strong>Results: </strong>The study included 389 mothers. More than half of children were males (50.4%). Nearly one-third of mothers (34.3%) were in the age group 30-34 years whereas 10.3% of them aged above 45 years. Almost half of mothers (49.4%) reported all of social media, dentist and mass media as a source of information regarding oral health and hygiene whereas social media and dentist alone were reported by 17.2% and 21.3% of them, respectively. Collectively, sufficient knowledge was observed among 26% of the participants whereas adequate practice regarding oral health was reported by 36.5% of mothers. Dental cares was reported among 115 children (29.6%) whereas dental deformity was reported among 171 children (44%).
<strong>Conclusion: </strong>This study revealed insufficient knowledge and inadequate practice of mothers regarding their children oral health and hygiene. Some factors were identified affecting both child`s oral health knowledge and practice.https://ejhm.journals.ekb.eg/article_10513_c0a6de58f69abdb4998e5d7c958e5c6c.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200270920180101Role of MRI in Evaluation of Anterior Knee Pain1552156110514ENHanan Mohammed HanafiDepartment of Radiodiagnosis, Faculty of Medicine, Ain Shams UniversityShaimaa El Metwally EldiastyDepartment of Radiodiagnosis, Faculty of Medicine, Ain Shams UniversityAbdul Jabbar Amer AbboodDepartment of Radiodiagnosis, Faculty of Medicine, Ain Shams UniversityJournal Article20180808<strong>Background: </strong>the knee joint is one of the most commonly injured joints in the body. Because of its complex structure, this joint is subjected to numerous pathologies and due to the recent increase in various sport activities; there has been a parallel increase in sport-induced internal derangements of the knee. <strong>Objective: </strong>the main objective of our work was to review several of the most common causes of AKP, with emphasis on their MRI findings with the goal of allowing more accurate diagnosis and grading of some of the most common pathologies, for understanding, better treatment and improvement of this common complaint. <strong>Patients and Methods: </strong>this study included 20 patients (13 females and 7 males). Their ages ranged between 10 - 70 years (average age 40.8 ± 5.83 years). All were presented by anterior knee pain and referred to Radiology Department of Ain Shams University Hospital or private centers for MRI examination after orthopedic consultation.<strong> Results:</strong> this study included 20 patients, with their ages ranged between 10-70 years, all of them were suffering from anterior knee pain. <strong>Conclusion: </strong>MRI is generally safe, accurate, and specific modality which has been proven to be the modality of choice in the diagnosis of different knee pathologies that cause anterior knee pain in different age groups https://ejhm.journals.ekb.eg/article_10514_ccc9a709033654af045a5a35f4fd94ca.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200270920180101Prevalence and Risk Factors of Fatty Liver among Adults1552156710515ENJournal Article20180808<strong>Background: </strong>Non-alcoholic fatty liver disease (NAFLD) is a heterogeneous condition that contains steatosis and non-alcoholic steatohepatitis (NASH), in the nonexistence of significant alcohol consumption, reaching 30% of the populace. The most common risk features are: age, ethnicity, gender, obesity, drugs, diabetes mellitus (DM), insulin resistance (IR), predisposition, metabolic syndrome (MS), and polycystic ovary syndrome.
<strong>Materials and Methods: </strong>Patients with non-alcoholic fatty liver disease were evaluated, with medical and epidemiological data collected after informed consent at King Abdulaziz Hospital.
<strong>Results: </strong>Of the 124 patients evaluated, 75.8% were women, and 88 were aged between 49 and 70 years and had no symptoms. Ultrasonography results showed steatosis in 84%. NASH was diagnosed in 75 patients of the sample. 42 patients underwent liver biopsy, of which 36% had cirrhosis, 1 had liver cancer, and 1 pure steatosis (5% each). Risk factors were found in 70% of patients with metabolic syndrome, 87% with increased waist circumference, 63% with dyslipidemia, 61% (n=76) with high blood pressure (HBP), 28% with DM, 52% physically inactive, and 44% with insulin resistance (IR) (HOMA> 3.5). There was an association between IR and NASH (p=0.011), IR and obesity (p=0.031), IR and MS (p=0.007), and MS and steatosis on medical ultrasound (USG) (p=0.012).
<strong>Conclusion: </strong> The results indicated that the most frequent risk factors were MS and its variables: increased waist circumference, dyslipidemia and HBP. This highlights the significance of metabolic control in non-alcoholic fatty liver disease and confirms its role as the hepatic component of metabolic syndrome.https://ejhm.journals.ekb.eg/article_10515_7cc8c9638f3806fa3a6e61d8347f57f9.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200270920180101Wound Infection after Laparoscopic Cholecystectomy1568157110516ENJournal Article20180808<strong>Background: </strong>Surgeons are regularly not involved in the post discharge care of patients after uncomplicated laparoscopic cholecystectomy. The purpose of the current study was to document the symptomatic recovery of patients following laparoscopic cholecystectomy, because this has a bearing on the planning of a postoperative care package.
<strong>Methods: </strong>The study was designed as a postoperative telephone questionnaire survey and was carried out prospectively between June2016 and February2017 in King Abdulaziz Hospital, KSA.
<strong>Results: </strong>The study cohort comprised 51 patients who all completed the study. Postoperatively, only 3% of the patients had postoperative nausea/vomiting lasting ≥2 days. Pain was symptomatic in 12% of patients. Port-site wounds were a source of significant symptoms in 69% of the patients. Postoperative reviews by a nurse and primary-care doctor were necessary in 76% and 34% patients, respectively, with a combined average of 3.1 reviews per patient. Less than 4% of patients believed that they would benefit from a surgeon's review 6 weeks after LC. Median time taken to return to routine preoperative activity after surgery was 21 days (IQR, 16 to 33), which was affected by the degree of activity undertaken, wound-related symptoms persisting for ≥3 weeks, planned follow-up clinic appointment, and discharge as an outpatient.
<strong>Conclusion: </strong>Wound-related symptoms are common after LC, require substantial input from the community health service in their management, and may delay return to preoperative routine.https://ejhm.journals.ekb.eg/article_10516_126c27f0cbea0801c50dd8f19c4e5fc1.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200270920180101Cardiovascular Risk Factors among Cigarette Smokers1572157510517ENJournal Article20180808<strong>Objective: </strong>The aim of the study is to assess the effect of tobacco smoking on the risk of nonfatal acute myocardial infarction in young adults less than years.
<strong>Materials and Methods: </strong>We conducted a population-based case-control study with 164 occurrence acute myocardial infarction cases (21 women; 143 men), consecutively visited King Abdulaziz hospital, KSA, and 227 controls (81 women; 146 men), From February2016 till February2017. All women are non-Saudi women. Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated using unconditional logistic regression. <strong>Results: </strong>The commonness of present smoking was 81% in male cases and 54% in male controls (OR = 3.59, 95%CI: 2.49, 5.31) and 60% of female cases were smokers compared with 36% of controls (OR = 2.65, 95%CI: 1.40, 4.98). No interaction was found between current smoking and gender on myocardial infarction risk (<em>P</em> = 0.399). A dose-effect response was present, the odds favoring myocardial infarction reaching an eight-fold increase for those who smoked >25 cigarettes/day compared with never smokers. The risk estimate for former smokers was similar to never smokers.
<strong>Conclusions: </strong>Tobacco smoking is an important independent risk factor for acute myocardial infarction in young adults, with similar strength of association for both genders.https://ejhm.journals.ekb.eg/article_10517_f14cdb9ec56be185f10521f097b0d27d.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200270920180101Effect of Myrtus Communis Extract against Hepatotoxicity1676168110518ENWafaa M. EL-KholyPhysiology Division, Mansoura University, Mansoura, EgyptMamdouh R. F. EL-SawiPhysiology Division, Mansoura University, Mansoura, EgyptNadine A. GalalZoology Department, Faculty of Science,
Mansoura University, Mansoura, EgyptJournal Article20180808<strong>Background:</strong> Myrtle leaves extract (ME) has many antioxidants that protect against oxidative stress. The current study was conducted to determine whether ME can possibly exert hepatoprotective and antioxidant activity against monosodium glutamate (MSG) and acrylamide (ACR) that induced toxicity in rats.
<strong>Objectives: </strong>Our experiment was carried out to examine theeffect of <em>Myrtus communis</em><em>extract</em>against hepatotoxicity stimulated by monosodium glutamate (MSG) and acrylamide (ACR) in male rats.
<strong>Materials and methods:</strong> Rats were randomly assigned into eight groups, containing six each as following: group 1: rats received dist. water (control); group 2: rats were orally administered myrtle extract (ME) (300mg/kg b w) daily for 7 wks.; groups 3, 4 and 5: rats were orally administered MSG (100mg/kg b w), ACR (20mg/kg b w) and (MSG + ACR) respectively daily for 6 wks. ; groups 6 ,7 and 8:rats were orally administered ME daily for seven days alone then associated with MSG or with ACR or with (MSG+ACR) respectively for 6 wks.
<strong>Results: </strong>Our results proved that the treatment with MSG and/ or ACR resulted in a significant rise in TL, TC, TG, LDL-C, ALT, AST, ALP, GGT, TB and MDA. However, marked reduction in HDL-C, TP, Alb, GSH, TAC, SOD, CAT and GSH-Px. On the other side, the administration of ME improved the deviations resulted from MSG and/or ACR as confirmed by the marked improvement of antioxidants.
<strong>Conclusion:</strong> It is concluded that ME could protect the liver against damage induced by MSG and ACR.https://ejhm.journals.ekb.eg/article_10518_3375e48b8e6cfcad8c53402aa0c303a7.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200270920180101Evaluation of Saudi Arabian Parent’s Attitude towards Lumbar Puncture in Their Children for Diagnosis of Meningitis1582158510519ENZamil Mufleh AlwahbiAlnoor Hospital - MakkahAbdulraheem Ali AlzahraniAlnoor Hospital - MakkahMohammad Mane AlqhtaniKing Fahad Military Hospital-Khamis MushaitWalaa Ibrahim AsiriMaternity and Children Hospital - AbhaManal Ahmad AssiriKing Salman Hospital- Riyadh, Saudi ArabiaJournal Article20180808<strong>Background:</strong> although lumbar puncture is a safe procedure in experienced hands, some parents fear having it performed in their children and refuse consent. The factors associated with this refusal are unclear and any differences between consenting and non-consenting parents might provide clues as to how to address them.
Objective: this study aimed to predict the underlying factors that affect parent’s refusal of consent for lumbar puncture in their children with meningitisin southern Saudi Arabia.
<strong>Methods</strong>: We conducted a cross-sectional study, of 750 children with meningitis, who visited either the emergency department or the pediatric wards in three teaching hospitals (Khamis Mushait Maternity and Children Hospital, Abha Maternity and Children Hospital and Military Hospital (Khamis Mushait) in the southern region of Saudi Arabia from 20<sup>th</sup> February 2016to 6<sup>th</sup> January
<strong>Results: </strong>his study included 751 patients with meningitis. Their ages ranged between one month and 13 years (3.9±3.3 years); 42.7% presented with other symptoms (cough, sore throat, dyspnea and pneumonia); 28.7% had fever, 10% vomiting, 12.1% dyspnea, and 6.5% convulsions. Fifty-one per cent of children were accompanied by their fathers, 41.9% by their mothers and 6.9% by others. Accompanying people were asked for consent for lumbar puncture in their children; 44.3% disagreed and 55.7% agreed. Factors influencing disagreement were relative’s opinions (35.1%), media (30.4%) and their previous experience (12.3%).
<strong>Conclusion:</strong> based on the results of this study, the main reason for refusal of consent for LP in the children of the majority of parents was fear of side effects such as paralysis, as well as lack of awareness about the usefulness of LP in diagnosis and treatment of children. Informing parents of affected children is very important in the counseling for such diagnostic tests. Therefore, it seems that it is necessary to pay more attention for training in national health plans.https://ejhm.journals.ekb.eg/article_10519_07c8fe1f3b61232e28382a0e5519b23a.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200270920180101Assessment of Knowledge, Attitude and Practice of Saudi Parents towards Neonatal Jaundice (NNJ): A Cross-sectional Study1686169410520ENNorah M. AlfouwaisCollege of Medicine, University of Hail, Hail cityLaila S. SeadaKing Khalid Hospital, Hail CityRawan Y. AlahmadiCollege of Medicine, University of Hail, Hail cityAhmed A. AlassiriCollege of Medicine, Ibn Seena college, Jeddah cityAhmed A. AlenaziCollege of Medicine, Ibn Seena college, Jeddah cityMajed S. AljuaeedCollege of Medicine, Taif University, Taif city, Saudi ArabiaJournal Article20180808<strong>Background: </strong>Neonatal jaundice occurs worldwide and contributes significantly to neonatal morbidity and mortality. Recently, newborns are being discharged early from hospitals, so parents have the primary responsibility for early recognition, appropriate response and seeking proper treatment. Objectives: To assess parents’ knowledge, attitude and practice towards NNJ in different regions in Saudi Arabia. <strong>Methods:</strong> This is a cross-sectional study involving 4413 expectant parents during July- September 2017 had been performed. A self-administered questionnaire was created to obtain respondents information. Descriptive statistics were used to describe the answers of participants in the study. Comparing the answers to different questions within different groups was done using Pearson chi-square test. Statistical significance was set at p =< 0.01 and analysis was performed using IBM SPSS statistics, version 23 (IBM, Armonk, NY, USA).
<strong>Results: </strong>Out of 4413 participants, females were (79.4%) while (20.6%) were males. Participants were from all regions of Saudi Arabia, with the highest percentage from central region (29.5%), most of them lived in cities (89.6%). Age group 20-30 years constituted (46.6%), and age above 50 years was 4.5% (p= <0.01). Most of the participants had a university level of education (76.6%). Relatives and friends were the main sources of knowledge for (52.6%) of the participants, followed by treating doctor in (29.8%). In (34%) of the participants’ knowledge was gained after their child had NNJ, while in (42.1%) while their child was free of NNJ. Warning signs knowledge depended on the level of education and occupation where university graduates and health care workers were most knowledgeable and the difference was significant (p=<0.01). Awareness about necessity and effectiveness of treatment were dependent on older age, occupation, and place of residence (p=<0.01). Hospital treatment was done only by (23.4%), believing that it wasn’t a serious disease in (18.1%) of participants, while (5%) believed that it needed no treatment at all.
<strong>Conclusion: </strong>Knowledge, attitude, and practice of parents in our study, depended on age, level of education, occupation, and place of residence might have contributed to the delayed appropriate management of severe hyperbilirubinemia. We recommend the engagement of health professionals in educational settings like seminars, workshops and periodical counseling sessions to provide appropriate knowledge to parents.https://ejhm.journals.ekb.eg/article_10520_f9ee90ddc586c3a1187596143977c56e.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200270920180101Assessment of Public Knowledge Regarding the Differences between Hyperthyroidism and Hypothyroidism1695170210521ENAsma Mohammed AlhawitiFaculty of Medicine, University of Tabuk, Tabuk, KSAAbeer Salah AlbalawiFaculty of Medicine, University of Tabuk, Tabuk, KSAAshwaq Abdullah AlghamdiFaculty of Medicine, University of Tabuk, Tabuk, KSAAfnan Atallah AlbalawiFaculty of Medicine, University of Tabuk, Tabuk, KSAJournal Article20180808<strong>Background:</strong> Thyroid hormones play a pivotal role in the metabolism of human body. Changes of the thyroid gland activity manifest in nearly all body systems. Appropriate knowledge of the public about thyroid disorders and their manifestations is essential for early detection. <strong>Objective:</strong> The aim of this study was to assess public knowledge regarding the differences between hyperthyroidism and hypothyroidism in Tabuk city, Saudi Arabia.
<strong>Methods: </strong>A cross sectional study was conducted on 300 randomly selected adult residents in Tabuk city. An Arabic self-administered questionnaire was filled by the participants through a link or softcopy. The questionnaire included questions about socio-demographic data of the respondents and other questions to assess knowledge about the type and functions of thyroid gland, its disorders, factors affecting thyroid disorders, and their common manifestations. <strong>Results: </strong>Respondents with good knowledge of thyroid gland and its disorders constituted 52%, while 45% had poor knowledge<strong>. </strong>Good knowledge was demonstrated in questions about the type of thyroid gland (71.4%), and the most susceptible individuals to have the disorder (90.4%). Manifestations of hypothyroidism were also recognized by most respondents, particularly weight gain (76%) as well as fatigability and sleepiness (74.9%). Inadequate and poor knowledge was found as regards the functions of thyroid gland, causes of thyroid hormonal disturbances, and symptoms of hyperthyroidism. <strong>Conclusion:</strong> The knowledge of respondents about thyroid disorders is poor. Inadequate knowledge can result in increased number of undetected cases. Health education should be launched by the health authorities and distributed through all available channels of information. Good knowledge of the general population about thyroid disorders is expected to decrease the incidence of preventable disorders and increase the detection of subtle undiagnosed cases.https://ejhm.journals.ekb.eg/article_10521_3dd6991744de7520f0e62e22fd22f918.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200270920180101General Awareness and Knowledge about Cataracts, Glaucoma and Diabetic Retinopathy in Saudi Arabia1703170910522ENMohammed Saud Bin ShibraynPrince Sattam Bin Abdulaziz UniversityAbdulhkam Moafak AljarbouPrince Sattam Bin Abdulaziz UniversityYousif Abdullah AlanaziPrince Sattam Bin Abdulaziz UniversitySaad Mohammed AlhaqbaniPrince Sattam Bin Abdulaziz UniversityJournal Article20180808<strong>Aim of the work</strong>: this study aimed to assess the awareness and knowledge for cataracts, glaucoma and diabetic retinopathy diseases in social media of Saudi Arabia.
<strong>Material and Methods</strong>: a total of 1021 people make an evaluation through internet. Various complaints were incorporated in this study. The data were collected from participants using a structured questionnaire. Questionnaire was done for gathering information on demographics, awareness, knowledge, attitudes and practices related to eye diseases.
<strong>Results</strong>: in this study, 63% males and 37% of females were participated.<br />Majority of the participants (52%) were aware of visual problems, 19.9% were aware of diabetic retinopathy, 2.5% of cataract and 1.2% of glaucoma. The percentage belonged to minimum than 20 years old, 37.5 % belonged to 21 - 30 age group, 22.1 % belonged to 31 - 40 age groups, 14.2 % belonged to 41 - 50 age group, 5.9 % were of 51 and above years of age. Further, 85.7 % of samples belonged to town people and 14.2 % belonged to village groups, 35.6 % of samples gone through secondary school or less education, 60.5% are in graduating from college and 3.9 % of samples were post graduated or qualified higher.
<strong>Conclusion</strong>: the present results showed that there is still a need for health education in the population of this region of Saudi Arabia to increase the level of awareness and knowledge of common eye diseases, through the social media.https://ejhm.journals.ekb.eg/article_10522_cdc64ed986f847fe17ff600ccd3d4f32.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200270920180101Case Report of Ocular Ischemic Syndrome, Taif, Saudi Arabia1710171310523ENAbdulmohsen Hamad Hamed AlhamyaniTaif medical college, Taif ,Saudi ArabiaSami Awd AlharthiTaif medical college, Taif ,Saudi ArabiaSara Hussein A GebrilKing Faisal hospitalMohamed Ahmed SiddigKing Faisal hospitalOsama A AlhajKing Faisal hospitalNuha Mohamed AhmedKing Faisal hospitalTalal Abdulrahman AlthomaliTaif university, Taif ,Saudi ArabiaJournal Article20180808 <strong>Background: </strong>Ocular ischemic syndrome (OIS) is more prevalent among male aged more than 50 years. Various disorders such as diabetes, hypertension, and peripheral vascular diseases are major risk factors responsible for OIS in aged male.
<strong>Case report: </strong>This case study involves a 57-year-old male patient having history of diabetes, hypertension, slurred speech, hemiparesis and hypoesthesia of the right side of the body. The patient came with complain of red eye, pain and decreased vision in left eye. Complete left internal carotid artery obstruction, rubeosis iridis of the left eye, dots of hyphema of the left eye, bilateral hard exudates, significant macular edema and non-proliferative diabetic retinopathy were observed in the patient. In this case, in consultation with ophthalmology, surgery and medicine departments multidrug treatment procedure was followed. This multi-drug based therapy successfully controlled the condition of patient and improved the vision of patient. https://ejhm.journals.ekb.eg/article_10523_68f410f9e7a45d00780ed1ed67f29a36.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200270920180101Postgraduate Hospital Educational Environment Measure in Urology Program in Saudi Arabia1714171810524ENAbdullah S. AlhussainImam Muhammad ibn Saud Islamic UniversityRayan S. AlMalkiImam Muhammad ibn Saud Islamic UniversityMohammed AlAbdulqaderImam Muhammad ibn Saud Islamic UniversityTurki AlAjmiImam Muhammad ibn Saud Islamic UniversityAbdulrahman AlRuwailydepartment of Urology, faculty of Medicine, Imam Muhammad ibn Saud Islamic University, Riyadh, Saudi ArabiaJournal Article20180808<strong>Purpose: </strong>The educational environment has a large influence on the success of medical education and overall outcome. There is little data on how the Saudi urological trainees perceive the educational environment in the hospital and the process of obtaining their skills. We conducted our study using validated questionnaire to evaluate the hospital teaching environment for urology residents in Saudi Arabia.
<strong>Methods: </strong>We have used the postgraduate hospital educational environment measure (PHEEM) to evaluate the perception of the hospital educational environment for residents of urology program. The results are compared between different regions of Saudi Arabia, different health sectors, and level of residency
<strong>Results: </strong>A total of 57 (55.9%) out of 102 registered residents responses were received. Overall, the residents perceived a good impression (98.2 ±18.3) but there is room for more improvement<strong>. </strong>There was a significant differences in perception among residents of different regions as the southern region has the lowest score (74.8 ± 22.9 p-value =0.01). Residency level significantly affected the perception of role autonomy (P-value=0.01), and overall score (P-value=0.02). However, residents of different health care sectors did not differ significantly in their scores.
<strong>Conclusion: </strong>Perception of educational environment by Saudi urology residents is reaching a satisfactory level but there’s still room for improvement. However, there is a variation of perception results between Saudi regions.https://ejhm.journals.ekb.eg/article_10524_078854e8f98a469cd9add995476d7380.pdf