Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273520181001Study of Dyslipidemia in Patients with Systemic Lupus Erythematosus and its Correlation to Disease Activity658665951558810.21608/ejhm.2018.15588ENFarag Khalilinternal Medicine Department, Faculty of Medicine, Al–Azhar University, Cairo, EgyptMohamed Nabil Rafatinternal Medicine Department, Faculty of Medicine, Al–Azhar University, Cairo, EgyptNader T. El- Beltagyinternal Medicine Department, Faculty of Medicine, Al–Azhar University, Cairo, EgyptHassan A. Abdel Aziz Gaberclinical Pathology Department, Faculty of Medicine, Al–Azhar University, Cairo, EgyptJournal Article20181001<strong>Background</strong>: Cardiovascular events and accelerated atherosclerosis in patients with active systemic lupus erythematosus results in significant increased morbidity and mortality. The non-traditional risk factors induce alteration in lipoprotein metabolism and the constant inflammatory and immune activity can lead to accelerated atherosclerosis. <strong>Aim</strong>: To assess prevalence of dyslipidemia in systemic lupus erythematosus patients and to study the relation of dyslipidemia to disease activity. <strong>Patients and methods</strong>: The presented study included 60 SLE adult patients (56 females and 4 males) and they were classified according to disease activity into two groups: Active Lupus: Included 30 lupus patients. Inactive Lupus: Included 30 lupus patients. 20 healthy subjects with matched age, sex and BMI were included as healthy controls. Methods: Patients underwent clinical assessment. Total cholesterol, (LDL, HDL) and triglyceride were measured.
Results: Cholesterol, LDL, and TG levels were elevated in the active group compared to that in the inactive group and healthy controls. This elevation was significant (P< 0.001). But HDL level decreased in the active group compared to the inactive and healthy controls groups. The decrease of HDL was the active group is significant (P< 0.001). <strong>Conclusion</strong>: The elevated levels of Total cholesterol, LDL, and TG and decreased level of HDL in SLE patients are considered an independent risk factor for cardiovascular disease. The dyslipidemia and inflammatory process predispose to premature atherosclerosis and disease activity contribute to dyslipidemia and hence cardiovascular risk associated with SLE. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273520181001Correlation of Serum Neopterin level with Complement C3, C4 in assessment of Systemic Lupus Erythematosus Activity659666071559010.21608/ejhm.2018.15590ENFarag KhalilInternal Medicine Department Faculty of Medicine Al Azhar University, Cairo, EgyptAbd Elwahab M. LotfyInternal Medicine Department Faculty of Medicine Al Azhar University, Cairo, EgyptAhmed A. Abd ElshafyaInternal Medicine Department Faculty of Medicine Al Azhar University, Cairo, EgyptMohammad A. KhedrClinical Pathology Department Faculty of Medicine Al-Azhar University, Cairo, EgyptJournal Article20181001<strong>Background:</strong> Systemic lupus erythematosus (SLE) has a recurrent disease activity throughout the natural course of the disease. Assessment of this activity is often complex and time consuming. To date no measures have been created specifically for SLE. Studying serum neopterin and comparing it with other established parameters C3, C4 may add benefit for SLE follow up. <strong>Aim: </strong>The aim of our study is to evaluate the level of serum neopterin in patient with systemic lupus erythematosus (SLE) as a marker of disease activity and its correlation with other parameters of disease activity. <strong>Patients and methods:</strong> Seventy five subjects; 60 patients with (SLE); 30 of them are active and another 30 with no activity and 15 healthy subjects as a control group. <strong>Results:</strong> Serum neopterin was higher in the active group than the inactive group and a significant difference between the patients with SLE group than controls group was also reported.Our results shows thatthe mean value of serum neopterin in whole SLE patients (21.9 ng/ml)and the serum neopterin in the active and inactive groups was 33.9 ng/ml and 3.45 ng/ml respectively which were highly significant than the mean value of the control group (P<0.001).Also the differences between the three groups was highly significant (P<0.001). <strong>Conclusion:</strong> As increased serum neopterin levels were found in patients with SLE and were correlated with certain clinical and laboratory immunoinflammatory parametersthen estimation of serum neopterin levels seems beneficial in the assessment of disease activity and evaluation of the efficacy of various treatment regimens used.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273520181001Effect of hemodialysis on blood ammonia level among cirrhotic patients undergoing hemodialysis660866151559110.21608/ejhm.2018.15591ENAtef Aboelfetouh IbrahimNephrology Unit, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAhmed Mohammed AlashkarNephrology Unit, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAhmed KhairallahNephrology Unit, Faculty of Medicine, Al-Azhar University, Cairo, Egypt0000-0002-4701-1714Journal Article20181001<strong>Background</strong>: Uremia results in a characteristic breath odor (uremic fetor) which is largely due to its high ammonia content. Earlier studies have shown a strong correlation between breath ammonia and blood urea levels and a 10-fold reduction in breath ammonia after hemodialysis in patients with chronic kidney disease. Potential sources of breath ammonia include: (i) local ammonia production from hydrolysis of urea in the oropharyngeal and respiratory tracts by bacterial flora, and (ii) release of circulating blood ammonia by the lungs. While the effects of uremia and hemodialysis on breath ammonia are well known while their effects on blood ammonia are unknown and were explored here.<br /> <strong>Methods</strong>: Blood samples were obtained from 56 hemodialysis patients (immediately before and after dialysis). Blood levels of ammonia, creatinine, arterial blood gases, and electrolytes were measured.<br /> <strong>Results</strong>: There was significant fall in serum creatinine following hemodialysis with significant increase in blood ammonia. Moreover, cirrhotic patients with high-bicarbonate showed a significant more increase in ammonia and significant increase in incidence of hyper-ammonemia to that of non-cirrhotic and low-bicarbonate. Furthermore, the increase in serum bicarbonate showed a significant correlation to the change of blood ammonia following dialysis.<br /> <strong>Conclusion</strong>: The fall in blood creatinine concentration following hemodialysis is paradoxically accompanied by a rise in blood ammonia in hemodialysis subjects, contrasting the reported effect on breath ammonia. The mechanism of the post-hemodialysis rise in blood ammonia may be due alkalotic change in PH. The observed rise in blood ammonia level was directly related to the rise in blood bicarbonate and with aggravation of alkalotic state in cirrhotic patients. The rise in blood bicarbonate is associated with increased incidence of hyper-ammonemia among cirrhotic patients.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273520181001Low-Molecular–Weight Heparin versus Unfractionated Heparin in Pregnant Women with Recurrent Abortion associated with Antiphospholipid Syndrome661666201559210.21608/ejhm.2018.15592ENAbdel–Qader Farag Abdel-QaderDepartment of Obstetrics and Gynaecology, Faculty of Medicine, Alazhar University, Cairo, EgyptFarid Ibrahim HassanDepartment of Obstetrics and Gynaecology, Faculty of Medicine, Alazhar University, Cairo, EgyptMofeed Fawzy MohammadDepartment of Obstetrics and Gynaecology, Faculty of Medicine, Alazhar University, Cairo, EgyptJournal Article20181001<strong>Objectives: </strong>to compare the efficacy and safety of the combination of unfractionated heparin <strong> </strong><strong>)</strong>UFH( and Low Dose Aspirin (LDA) with that of low-molecular-weight heparin )LMWH( and LDA in the management of pregnant women with recurrent pregnancy loss secondary to antiphospholipid syndrome (APS). <strong>Methods :</strong> In a randomized prospective study, 60 women with a history of 3 or more consecutive spontaneous abortions and positive antiphospholipid antibodies were assigned in equal numbers to receive either UFH (5000 units, twice daily) plus LDA, or LMWH (enoxaparin 40 mg, once daily) plus LDA as soon as pregnancy was diagnosed. <strong>Results: </strong>Twenty-four women in the LMWH group (80%) compared to 20 women in the UFH group (66.67%) delivered a viable infant (p >0.05). There was no significant difference in pregnancy complications or neonatal morbidity between the 2 groups. There were no incidences of excessive bleeding, thrombocytopenia, or osteoporotic fractures of excessive bleeding, thrombocytopenia, or osteoporotic fractures in either group. <strong>Conclusion: </strong>In this study, the use of LDA in combination with LMWH during pregnancy for the prevention of recurrent pregnancy loss in women with antiphospholipid syndrome seems to be as safe as UFH plus LDA. Large randomized trials will be required to determine differences in outcome with LMWH and LDA compared with treatment with UFH combined with LDA in this group of patients.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273520181001Is Neutrophil/Lymphocyte Ratio A Useful Marker to Predict the Severity of Pre-Eclampsia?662166251559410.21608/ejhm.2018.15594ENM Abd-AlazimDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAshraf H MohammadDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohammad S RadwanDepartment of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAhmed A ShokrDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20181001<strong>Background: Preeclampsia</strong> refers to the new onset of hypertension and proteinuria or hypertension and end-organ dysfunction with or without proteinuria after 20 weeks of gestation in a previously normotensive woman.
<strong>Objective: </strong>This study was aimed to evaluate the relationship between Neutrophil/Lymphocyte ratio (NLR) in patients with pre-eclampsia (PE) and severity of preeclampsia. <strong>Subjects and methods: </strong>This prospective study comprised a total of 150 pregnant females divided in 3 groups "50 healthy pregnant females (Group 1), 50 females with mild pre-eclampsia (Group 2) and 50 with severe pre-eclampsia (Group 3)".All the study participants were statistically compared in respect to Neutrophil/Lymphocyte Ratio (NLR) and the baseline data including age and BMI. <strong>Results: </strong>Maternal NLR was determined to be significantly high in the pre-eclamptic patients (Groups 2 and 3) compared to those with healthy pregnancies (Group 1) (p = 0.0003).NLR was significantly higher in the severe pre-eclampsia group than in the mild pre-eclampsia group (p = 0.042). <strong>Conclusion: </strong>It could be concluded that while NLR was determined as significantly high in patients with pre- eclampsia, to be able to use this in the classification of the severity of pre-eclampsia, there is a need for further studies on a more extensive population.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273520181001Autologous Serum in Dry Eye Disease662666321560210.21608/ejhm.2018.15602ENMohammed Zakaria EidDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAhmed Nabil El-SayedDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAlaa El-Din Ibrahim MohammedDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20181002<strong>Background: </strong>The tear film overlays the ocular surface and provides the interface between the eye and the external environment. The tear film is essential for the nutrition and protection of the ocular surface and for clear vision as the tear film is the first refractive surface of the eye.
<strong>Aim of the Work: </strong>the purpose of this study was to review the efficacy, complications and safety of using autologous serum in dry eye.
<strong>Patients and Methods: </strong>thirty patients of moderate to severe dry eye selected from Ophthalmology Out-Patient Clinics, Al-Hussein University Hospitals.<em> All patients were subjected to </em>Schirmer 1 test, Tear break – up time (TBUT), and Fluorescein clearance test
<strong>Results: </strong>The mean value of Schirmer 1 test before the use of autologous serum was 2.83 mm ± 0.83 SD while after use of autologous serum was 5.33 mm ± 9.99 SD. The mean value of TBUT test before the use of autologous serum was 9.50 sec ± 1.20 SD while after use of autologous serum was 9.433 sec ± 1.52 SD. The mean value of FCT before the use of autologous serum was 100 % positive while after use of autologous serum was 76.7 % positive. The difference between before and after use of autologous is statistically significant as P-value < 0.001.
<strong>Conclusion: </strong>this study revealed that autologous serum eye drops were found effective and safe in treatment of severe dry eye disease, as evidenced by improvement in subjective assessment of symptoms, Schirmer’s 1teast, tear film break-up time (TBUT) and fluorescein clearance test (FCT).Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273520181001Effectiveness of Alizapride for Prophylaxis of Nausea and Vomiting after Spinal Anesthesia for Cesarean Section663366401560310.21608/ejhm.2018.15603ENAyman Hussein Fahmy KahlaDepartment of Anesthesia & Intensive Care, Faculty of Medicine, Al-Azhar UniversityNasr Abdel-Aziz Mohammad SaadDepartment of Anesthesia & Intensive Care, Faculty of Medicine, Al-Azhar UniversityIslam Mahmoud Mohamed MahmoudDepartment of Anesthesia & Intensive Care, Faculty of Medicine, Al-Azhar UniversityJournal Article20181002<strong>Background:</strong> Nausea and vomiting are common side effects in parturients undergoing cesarean delivery performed under spinal anesthesia can be very unpleasant to the patients. The reported incidence of nausea and vomiting during cesarean performed under regional anesthesia varies from 50% to 80% when no prophylactic antiemetic is given. Therefore, use of prophylactic antiemetics in parturients undergoing cesarean delivery is recommended by some authors.
<strong>Objective:</strong> In this study, alizapride was evaluated, as a D2 receptor antagonist, on the prevention of nausea and vomiting following Spinal Anesthesiain parturients undergoing elective cesarean section.
<strong>Patients and Methods:</strong> The study was carried out in AL-Azhar University Hospitals, Obstetric and gynaecology department on 90 patients undergoing an elective, lower segment cesarean section (LSCS). All patients were identified by code number to maintain the privacy of the patients. Any unexpected risks appeared during the course of the research was cleared to the participants and the ethical committee on time. A written informed consent was obtained from all patients. Patients were divided into 3 groups, 30 patients for each group. Group I (Alizapride 50 group): Received intravenous (IV) Alizapride 50 mg diluted in 10 ml of normal saline over 1-5 minutes, immediately after clamping umbilical cord. Group II (Alizapride 100 group): Received intravenous (IV) Alizapride 100 mg diluted in 10 ml of normal saline over 1-5 minutes, immediately after clamping umbilical cord. Group III (Saline group): Received normal saline 10 ml, immediately after clamping umbilical cord.
<strong>Results:</strong> The incidence of nausea and vomiting was significantly decreased in group 2 (Alizapride100 group) compared with group 1 (Alizapride 50 group) and both group was better than group 3 (control group). The use of ondansetron and chlorpheniramine was significantly decreased in group 1 and 2 when compared with group 3.
<strong>Conclusion:</strong> This study concluded that Alizapride 100 mg, given intravenously immediately after clamping umbilical cord would reduce PONV and pruritus in parturients undergoing an elective cesarean section under spinal anesthesia.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273520181001Prevalence and Pattern of Peripheral Arterial Disease among Diabetic Individual in Al-jouf Region664166452867510.21608/ejhm.2018.28675ENJarid Saleh AljaridDepartment of Family and Community Medicine, Al-jouf UniversityAnwar Mohammed AlazmiDepartment of Family and Community Medicine, Al-jouf UniversityAhmed Hammad AlmaeenDepartment of Family and Community Medicine, Al-jouf UniversityAbdullah Odhayb AlruwailiDepartment of Family and Community Medicine, Al-jouf UniversityMostafa Mohamed RaghebDepartment of Family and Community Medicine, Al-jouf UniversityNaif Mousara AlmousaraDepartment of Family and Community Medicine, Al-jouf UniversityJournal Article20190313Introduction: Peripheral arterial disease (PAD) is a common vascular disorder in Saudi Arabia where diabetes mellitus, hypertension and smoking are common risks. As this disease carries significant morbidity and mortality. Objective: This study aimed to screen for PAD in the community among diabetics, determining its prevalence, severity and associated risk factors. Patients and Methods: This study was done at 3 primary health care centers (PHCCs) at Domat Aljandal and two centers at Quraiat, Aljouf region. The included patients were 149, all were diabetic, 114 males and 35 females. The sociodemographic data, special habits, symptoms of peripheral ischemia and biochemical profiles [including blood lipids and fasting sugar] were extracted from the medical files and asked during interview. After clinical assessment, the ankle brachial index (ABI) was bilaterally determined on supine position using 8 MHz vascular Doppler. PAD was diagnosed if an ABI was <0.9. Results: The means of age, duration of diabetes and body mass index were 59.2, 9.13 years and 30.07 kg/m2 respectively. Of all, 47% were smokers and 56.7% had hypertension. Out of the 149 studied patients, 21 (14.1%) were previously diagnosed to have PAD and had undergone angioplasty. Symptoms of PAD were found only in 10 of these 21 and none of the remaining 128. By the ABI measurement, PAD was diagnosed in 48 patients (32.2%), being unilateral in 27 and bilateral in 21 patients. Most of PADs (79.2%) were mild to moderate severity while it was severe 20.8%. The frequency of PAD was nonsignificantly more among females, patients with co-morbid hypertension, patients on oral hypoglycemic drugs and smokers (P>0.05 for each). The frequency of low ABI was significantly more frequent among patients with history of vascular surgery (P=0.001). Patients with PAD had significantly higher mean ages (P=0.048) and non- significantly higher mean of duration of DM. If patients known to have PAD are excluded, new diagnosis of PAD was made in 30 of 128 naïve patients (23.4%). Conclusion: The prevalence of PAD in diabetic individuals in the community is high, probably due to the high frequency of other risks such as smoking and hypertension. These finding warrants activation of the nationwide screening program for prevention of cardiovascular diseases to decrease the morbidity and mortality of this diabetic complication.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273520181001The Impact of "CYP2C9" and "VKORC1" Genetic Polymorphism upon Oral Anticoagulation Requirements664666541585610.21608/ejhm.2018.15856ENHossam Yousef Kamal MohammedClinical Pathology, Faculty of Medicine – Al Azhar UniversityYousry Zaki Al-zohairyClinical Pathology, Faculty of Medicine – Al Azhar UniversityMahmoud Abd El-latif HashishClinical Pathology, Faculty of Medicine – Al Azhar UniversityJournal Article20181004<strong>Background:</strong> Polymorphisms in the gene encoding the cytochrome P-450 2C9 enzyme (CYP2C9) are known to contribute to variability in sensitivity to Marevan. CYP2C9 is the enzyme primarily responsible for the metabolic clearance of s-enantiomer of Marevan. The VKORC1 is the target of Coumarin anticoagulants, and its common genetic variants result in altered sensitivity to Marevan. VKORC1 polymorphisms are associated with a need for lower doses of Marevan during long-term therapy.
<strong>Aim of work:</strong>This study aimed to assess the allelic frequencies and to investigate the relationship between "CYP2C9" and "VKORC1" genotype and vitamin K antagonist anticoagulation.
<strong>Subjects and Methods:</strong> This study was conducted on 40 patients. They were 24 females and 16 males with a male to female ratio 2:3. Their ages ranged from 28 to 72 years old. All the studied subjects were laboratory investigated with international normalized ratio (INR), complete blood count (CBC) and detection of vitamin K epoxide reductase complex 1 (VKORC1) and cytochrome P450 2C9 (CYP2C9) by polymerase chain reaction (P.C.R.) reverse hybridization method using PGX thrombo strip assay (Vienna Lab., Austria).
<strong>Results:</strong> Regarding the distribution of patients according to frequency of deep venous thrombosis (DVT) attacks, 16 (40%) patients showed single attack of DVT and 24 (60%) patients showed recurrent attacks. Patients with single attack of DVT were 12 (75%) females and 4 (25%) males with male to female ratio of 1:3. As for patients with recurrent attacks of DVT, they 13 (54.2%) females and 11(45.8%) males with a male to female ratio of 1:1.2.
<strong>Conclusion: </strong>Detection of genetic polymorphisms in CYP2C9 and VKORC1 genes prior to onset of warfarin therapy, greatly influenced response to warfarin and shortened the time required to reach target INR, and hence reduced the risk of recurrence of deep venous thrombosis.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273520181001An Assessment of Knowledge, Attitude and Practice towards Diabetic Retinopathy among General Practitioners of Tabuk City665566601585710.21608/ejhm.2018.15857ENFahad S. AlanaziCollege of medicine, Tabuk University, Tabuk City, Saudi ArabiaTariq H. MerghaniCollege of medicine, Tabuk University, Tabuk City, Saudi ArabiaAla M. AlghthyCollege of medicine, Tabuk University, Tabuk City, Saudi ArabiaReem H. AlyamiCollege of medicine, Tabuk University, Tabuk City, Saudi ArabiaJournal Article20181004<strong>Background:</strong> Diabetic retinopathy (DR) is the leading cause of blindness in the working population. Adherence to screening guideline will help in the prevention of blindness. General practitioners (GPs) are the 1st line in management of diabetic patients. <strong>This study aims</strong> to determine their knowledge, attitude and practice toward diabetic retinopathy and to identify factors that affect their practice. <strong>Material and method: </strong>We conducted a cross-sectional study among a comprehensive sample of the GPs who work at primary health care units of Tabuk city from July to December 2017. A validated self-administered questionnaire was used for data collection. Statistical analysis was performed by using Statistical Package for the Social science (SPSS) version 20. <strong>Results: </strong>A total of 87 general physicians completed the questionnaire (a response rate of 100%). Only 24.1% of GPs could identify pregnancy as a risk factor. Only 43.7% and 28.7% were aware of retinal detachment and vitreous hemorrhage as complications of DR, respectively. Only 27.6% of the GPs referred type I diabetic patients to an ophthalmologist as per the guideline. The gender difference in referral pattern was found to be statistically significant (p=0.041). Major challenges that may prevent GPs from doing funduscopy were unavailability of ophthalmoscope (42.5%) and lack of skills to detect signs of DR (40.2%). <strong>Conclusion: </strong>This study found areas of weakness in the knowledge of GPs toward DR including risk factors, complications and screening guideline. Courses and training sessions are recommended as suitable remedial measures.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273520181001Awareness of Dealing with Multiple Trauma Patients in Madinah, Saudi Arabia666166651585910.21608/ejhm.2018.15859ENMoayad A. KarboujiOrthopedic department, college of medicine, Taibah University, Al-Madinah, Saudi ArabiaYousef A. AlrashidiOrthopedic department, college of medicine, Taibah University, Al-Madinah, Saudi ArabiaMohanad I. KashkariOrthopedic department, college of medicine, Taibah University, Al-Madinah, Saudi ArabiaMujahed A. TurjomanOrthopedic department, college of medicine, Taibah University, Al-Madinah, Saudi ArabiaSultan F. MadaniCollege of Medical Rehabilitation Sciences, Taibah University, Al-Madinah, Saudi ArabiaFahad A. AlmukhlifiCollege of Medical Rehabilitation Sciences, Taibah University, Al-Madinah, Saudi ArabiaJournal Article20181004<strong>Background: </strong>Motor Vehicle Accidents (MVAs) are major health hazards in Saudi Arabia and may result in multiple injuries. Moreover, it is one of the most common causes of morbidity and mortalities, worldwide. Thus, the awareness of the bystanders who are the first to witness the MVAs is important.
<strong>Objective: </strong>The purpose of this study was to evaluate of the level of the knowledge among the adults in Al-Madinah in terms of dealing with multiple trauma victims at the scene of the accident.
<strong>Methodology: </strong>A cross sectional study was conducted in Al-Madinah, Saudi Arabia during October and November 2017 on a university 621 persons participated in the study. A self-administered questionnaire was used. The average age of participants was ranged from 18 to -49 years with male: female ratio of 1.18:1.
<strong>Results: </strong>Out of 621 participants, 107 (17.2%) exhibited a low level of knowledge, 311 (50.1%) have a good level, and 203 (32.7%) showed an excellent level. Gender was found to be statistically significant in favor of male participants (p=0.004). Participants with a high degree of education had been found to have a better knowledge in dealing with trauma patients at the scene of the accident (p=0.009). Participants who attended a training course showed a better knowledge in dealing in such situations (p=0.001).
<strong>Conclusion: </strong>Promoting courses that target educating and training public on the appropriate way of dealing with trauma victims may be helpful.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273520181001Clinical audit on Management of Infants of Diabetic Mothers in Neonatal Intensive Care Unit Assiut University Children Hospital666666711586110.21608/ejhm.2018.15861ENSomia M. Abd-El HameedAssiut University Children Hospital, Faculty of Medicine, Assiut University, Assiut, EgyptAmira M. ShalabyAssiut University Children Hospital, Faculty of Medicine, Assiut University, Assiut, EgyptSafiea A. El-DeebAssiut University Children Hospital, Faculty of Medicine, Assiut University, Assiut, EgyptJournal Article20181004<strong>Background: </strong>infants of diabetic mothers (IDMs) are at increased risk of morbidity and mortality as well as poor perinatal outcome. <strong>Aim</strong><strong>:</strong>it was to measure how much the staff in the neonatal intensive care unit at Assiut University Children Hospital are sticking to the agreed upon unit′s protocol in management of infants of diabetic mothers. <strong>Patients</strong><strong> and Methods: </strong>twenty five IDMs admitted to NICU with hypoglycemia were included in this study. The unit´s protocol was followed for the management of asymptomatic as well as symptomatic hypoglycemia in IDMs. <strong>Results: </strong>symptomatic hypoglycemia was present in 76% of IDMs. The rest of cases were asymptomatic hypoglycemia. The unit′s protocol was completely followed in 76% of cases. However serum calcium was not measured in 24% of the cases. <strong>Conclusion: </strong>most (76%) of our cases of IDMs had symptomatic hypoglycemia. Maternal hyperglycemia is thought to lead to excess fetal glucose exposure and fetal hyperinsulinemia.<strong> Recommendation: </strong>close liaison with obstetricians in care of diabetic mothers particularly with monthly measurement of HbA1c during pregnancy and during labor with good adjustment and control of the maternal level of blood glucose.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273520181001Sutureless 23-gauge Versus Sutureless 20-gauge Pars Plana Vitrectomy667266821586310.21608/ejhm.2018.15863ENMohamed I. EL-KasabyDepartment of Ophthalmology, Faculty of Medicine for girls, Al-Azhar University, Cairo- EgyptJournal Article20181004<strong><em>Aim:</em></strong> To compare sutureless 23-gauge versus sutureless 20-gauge system for pars plana vitrectomy as regarding safety and efficacy in pars plana vitrectomy. <strong><em>Patients and methods:</em></strong> A prospective non –randomized interventional study comparing the two vitrectomy systems in a group of disease requiring uncomplicated vitreoretinal surgery was carried out at Nour- EL–Hayaha Eye Center (Cairo) between August, 2015 and June, 2017. Patients were divided into two groups. Group (A) 23 –gauge group: included thirty eyes of 20 patients, ten patients had bilateral pars plana vitrectomy (PPV), while in group (B): included twenty five eyes of 20patients, five patients had bilateral operations. Ocular examinations included measurements of best corrected visual acuity (BCVA) at a distance using a logarithm of the minimum angle of resolution (logMAR) scale, refractive status using an autorefractometer (KR-8100; Topcon corporation, Tokyo, Japan), IOP was measured pre and postoperative by Goldman applanation tonometry (CT-80; Topcon corporation, Tokyo, Japan), and fundus evaluation using an indirect ophthalmoscope were obtained. Surgical indication, outcome, intraoperative and postoperative complications were evaluated. Patients with vitreoretinal pathology such as preretinal membrane, vitreous haemorrhage with fibrovascular proliferation (FVP), persistent vitreous haemorrhage ,tractional retinal detachment, persistent macular edema or macular hole were enrolled in this study. Furthermore, postoperative subjective pain, conjunctival injection, retinal function and situation of retina were evaluated. Follow up was performed at the 1st day, 1st, 2nd week and 1st, 3rd and 6th month after surgery. <strong><em>Results: </em></strong>All the fifty five eyes completed the regularly follow up visits up to 24 months. 55 eyes of 40 patients divided into 2 groups: <strong><em>Group (A)</em></strong> 30 eyes of 20 patients (6 males, 30% and 14 females, 70%, the mean age of the participants ± SD was 54.62±3.12 years Range: 46-60 years;were treated with 23-gauge PPV .While in <strong><em>Group (B)</em></strong> twenty five eyes of 20 patients (13 males, 65% and 7 females, 35%, the mean age of the participants ± SD was 49.72±3.06 years Range: 50-58 years; were treated with sutureless 20-gauge PPV. The mean age of both groups ± SD was 52.67±5.14 years (Range: 47-62 years). Statistically, the differences between both groups regarding age and sex were insignificant. <strong><em>Conclusion:</em></strong> Advantages of sutureless vitrectomy include a reduction in operating time, less subconjunctival adhesion facilitating any subsequent vitreoretinal surgery or filtration surgeryPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273520181001Uterine and Subendometrial Arteries Doppler in Patients with Recurrent First Trimestric Abortion668366901601310.21608/ejhm.2018.16013ENIsmail T. El GarhyDepartment of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar UniversityAshraf H. MohamedDepartment of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar UniversityAhmed S. SultanDepartment of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar UniversityJournal Article20181005<strong>Background: </strong>Unexplained Recurrent miscarriage remains a frustrating problem for the clinician and a distressing condition for the affected couple. Recurrent pregnancy loss is defined as three or more successive spontaneous abortion. The incidence of recurrent pregnancy loss is 1-2% in the fertile population.
<strong>Aim of the Work:</strong> This study aimed to find out any difference in uterine artery pulsitility index (PI) between women with history of recurrent unexplained first trimestric abortion and women without this history. <strong>Patients and Methods: </strong>One hundred cases from Al-Azhar University Hospitals (Al-Hussein and Sayed Galal)were included in the study and classified into two groups: Recurrent pregnancy loss (RPL) group: 50 cases with history of recurrent unexplained abortion.Control group: 50 cases with no history of abortion and one full term child at least. Uterine artery Doppler [<strong>Pulsatility Index (PI)</strong>] assessment was done to all patients in the study during the luteal phase of spontaneous menstrual cycle.
<strong>Results: </strong>PI in the RPL group was found to be elevated compared to the control group.
<strong>Conclusion: </strong>Assessment of uterine perfusion through measurement of uterine artery Doppler (<strong>PI</strong>) could be of value in cases with recurrent unexplained first trimestric abortionPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273520181001Driving Eligibility among Epilepsy Patients in Saudi Arabia669166951601410.21608/ejhm.2018.16014ENAli Jaffr Al TahoImam Abdulrahman Alfaisal Hospital, Riyadh, Saudi ArabiaJournal Article20181005<strong>Background:</strong> epilepsy is prevalent neurological disorder in Saudi Arabia and listed as temporary or permanent driving interdiction. In line with other countries rules and requirements, would be safer, for the patient and community, if the seizures are controlled (Seizure free remission) for about 12 months prior to granting unlimited driving license.
<strong>Objective:</strong> to evaluate the eligibility of male epileptic patients aging more than 18 years old to drive cars based on achieving one year seizure free remission in a statistically representative sample for Saudi population.
<strong>Subjects and methods:</strong> a cross sectional study design in which eligible patients attending hospitals in Saudi Arabia were requested to take part in a survey about their driving status. Sample size was calculated assuming that one-year seizure free remission of 80% based on literature review, with a precision of ± 5.9%. A sample size of 170 individuals was sufficient to perform 2-tailed test with 95% confidence level.
<strong>Results:</strong> 170 consenting patients participated in the survey. The mean age was 38.7 (range 18-90 years). Seizure types encountered were generalized tonic-clonic seizure 98 patients (57.6%), Absence 27 patients (15.9%), unclassified 26 patients (15.3%) and clonic 14 patients (8.2%). The dominant underlying etiology was idiopathic in 90.6%. Despite that only 106 patients (62.4%) achieved one year seizure free remission, 161 patients (94.7%) hold a valid driving license and 146 patients (85.9%) are currently driving. 35 patients (20.6%) reported experiencing seizure while driving and 46 patients (27.1%) received advices from healthcare professionals regarding driving.
<strong>Conclusion:</strong> Among our study population, relatively lower control of epilepsy was observed with increased risk of seizures during driving that may lead to serious consequences. Health education regarding driving especially for uncontrolled patients is a key area for improvement till achieving higher seizure remission rate. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273520181001Poor Compliance to Anti-Hypertensive Drugs in Saudi Arabia669667011601510.21608/ejhm.2018.16015ENMohsen Jaber Yahya AlotayfiJazan University, Saudi ArabiaSalem Abdullah AlsohaimiJazan University, Saudi ArabiaBushra Khalid AL-QadiJazan University, Saudi ArabiaSalma Mosa KamilJazan University, Saudi ArabiaAlaa Jabril H AththiJazan University, Saudi ArabiaGhalia Alhussain Ahmed AlhazmiJazan University, Saudi ArabiaHalima Ahmed Othman QasemJazan University, Saudi ArabiaAmjad Ahmed BugisUmm Al Qura University, Makkah, Saudi ArabiaJournal Article20181005<strong>Background:</strong> Poorly controlled hypertension may lead to several serious health problems, including stroke, aneurysms, coronary artery disease, kidney disease and peripheral artery disease.
<strong>Objectives:</strong> This study aimed at exploring the magnitude of the problem of non-compliance with antihypertensive drugs among patients in Saudi Arabia and identifying the associated factors.
<strong>Subjects and Methods:</strong> a cross-sectional study was carried out during the period January to August 2018 through social media sites including a sample of adult patients from different regions of the kingdom (Saudi and none-Saudi). Data were collected online through a questionnaire. The questionnaire included socio-demographic characteristics of hypertensive patients, history of smoking, and hypertension-related history. Adherence of patients to anti- hypertensive drugs was assessed utilizing an 8-item modified Morisky Medication Adherence Scale (8-MMMAS).
<strong>Results:</strong> The study included 267 hypertensive patients. About half of them (48.5%) aged over 50 years. More than half were females (58%), high educated (62.3%) and employed (46.7%). Approaching half of them, 42% has health insurance and 6 years or more of hypertension (47.6%). About two-thirds of them (68.8%) reported history of taking between one and three drugs/day and one dose of antihypertensive medication/day (64.8%). High level of compliance with anti-hypertensive medications was observed among 6.2% of patients whereas medium and low levels were observed among 67.4% and 26.4% of them. High level of compliance was reported among patients aged over 50 years (p<0.001), females (0.033), widowed (0.001) and those haven’t history of chronic diseases (p<0.001).
<strong>Conclusion:</strong> high compliance to anti-hypertensive medications in Saudi Arabia is low, particularly among male and young patients.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273520181001Relationship between Renal Failure and Hypertension among Patients in Riyadh, Saudi Arabia670267071601610.21608/ejhm.2018.16016ENAhmed Abdulrahman AldhahiImam Muhammad Ibn Saud Islamic University, RiyadhHassan Ramzi Al-SulimanKing Fahad Hospital, Al-HofufAbdulaziz Abdullah S. Al NahdiUniversity of JeddahAbdulrahman Abdulwahab AsiriKing Khalid University, Abha, Saudi ArabiaIbrahim Nasser AsiriKing Khalid University, Abha, Saudi ArabiaAbdullah Mohammed KhudhayriKing Khalid University, Abha, Saudi ArabiaMohammed Ahmed AsiriKing Khalid University, Abha, Saudi ArabiaJournal Article20181005<strong>Background:</strong> chronic kidney disease (CKD) is common in Saudi although there are few data on the prevalence of this disorder. Therefore, we initiated a multicenter screening study to identify the prevalence and staging of CKD in 712 patients with known hypertension in four hospitals in Riyadh, Saudi Arabia.
<strong>Method: </strong>we measured estimated glomerular filtration rate by the six-variable modification of diet in renal disease equation and proteinuria by the protein/creatinine ratio. All the subjects studied were Saudis.
<strong>Results:</strong> of the 712 patients studied, the median age was 59 years (range 19-90 years) and 560 (78.7%) of the patients were female. The mean duration of hypertension was 4 years (range 0.1-50). The overall prevalence of CKD was 46.9% (95% CI: 43.2–50.7%); 19.1% had CKD stages 1-2 and 27.8% had CKD stages 3-5. There was no difference in age between patients with or without CKD (p = 0.12). The overall prevalence of proteinuria was 28.9% (95% CI: 25.6-32.4%); 14.7% of subjects had preexisting diabetes mellitus and their prevalence of CKD (55%; 95% CI: 42.4-62.2) did not differ from those without diabetes (46%; 95% CI: 41.9-50.0, p = 0.133).
<strong>Conclusion:</strong> CKD is common in hypertensive patients in Riyadh, Saudi Arabia with a prevalence of 46.9%. This provided justification for the inclusion of this group in CKD screening programs in Saudi.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273520181001Knowledge, attitude and practice of pharmacists regarding dietary supplements in Riyadh, Saudi Arabia671967231617310.21608/ejhm.2018.16173ENQasem Ali Bahriking fahad central hospitalAgeeli Rabea Mussa Rking fahad central hospitalAshwaq Abdulhamid AlahmadiAl noor specialist hospitalJournal Article20181008<strong>Background:</strong> Dietary supplements are a term that refers to several products such as vitamins, minerals and high energy compounds<strong>.</strong> Using these supplements is very common among individuals in different communities. Pharmacists had important effect on the public health as they help individuals to choose supplements and provide them with information.
<strong>Aim:</strong> To assess knowledge, attitude and practice of pharmacists toward dietary supplements.
<strong>Methods:</strong> This study is cross sectional, it was conducted on pharmacists in Riyadh region, Saudi Arabia, using an online survey.
<strong>Results:</strong> There were 500 pharmacists included in this study, 75.4% had good knowledge, 71.6% had positive attitude and 50.8% had good practice. Both of knowledge and attitude were significantly affected by age, experience years and level of education, whereas practice was significantly affected by experience years only (P-value˂0.05).
<strong>Conclusion:</strong> There were good knowledge and positive attitude toward dietary supplements among pharmacists, however close percents had either good or bad practice.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273520181001Prevalence of Using Hormones and Nutritional Supplements among Gym’s Trainee in Saudi Arabia672467331617410.21608/ejhm.2018.16174ENYasser Youssef KhojahKing Abdullah Medical Complex in Jeddah, Saudi ArabiaJournal Article20181008<strong>Background: </strong>worldwide, studies have shown a high prevalence of hormones and nutritional supplements use by athletes and gym members. Many athletes consume unproven, potentially harmful or even banned supplements.
<strong>Objectives: </strong>to assess the prevalence of the use of hormones and nutritional supplements by people who exercise in gyms in Saudi Arabia, and the types of supplements they most commonly use and to obtain a general view of the main reasons for using these enhancements.
<strong>Materials and Methods: </strong>a cross-sectional study using a self-administered questionnaire was conducted at gyms in Saudi Arabia that were selected randomly from different sectors. The sample size was estimated at 289, but the actual number of randomly selected participants in the study was 457.
<strong>RESULTS: </strong>the number of gym members who participated in this study was 457. Approximately 47.9% of the sample reported an intake of nutritional supplements and 7.9% reported that they took hormones. Protein powder was consumed by 83.1% of the participants. Approximately 16.8% of supplement users had noticed some side effects, and 25.7% of those who took hormones had stopped taking them because of adverse effects. Only half of the hormone users (54.2%) reported that they had had medical checkups. The major source of information on supplement and hormone use was non-health professionals, friends being major source (40%) of information on the use of hormones. The use of nutritional supplements was significantly associated with BMI (OR = 1.89, CI = 1.06-3.39), duration of daily exercise (OR = 4.23, CI = 2.06-8.68), and following a special diet (OR = 8.42, CI = 5.37-13.2). There was a very strong association between nutritional supplements consumption and hormone use (<em>P </em>< 0.001).
<strong>CONCLUSION:</strong>approximately half of the participants who regularly exercised in gyms took nutritional supplements, and most had received their information from non-health professionals. There was an association between the duration of exercise and the use of hormones and supplements. Fewer than half of hormone users had obtained a health-care provider’s advice before taking it. The atmosphere in the gym can play an important role in members’ decisions. Educating gym employees and members may have a positive influence on the use of supplements and hormones.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273520181001Evaluation of knowledge, attitude, and practice about first aid of spinal injury among medical students in Saudi Arabia, 2018673467371617510.21608/ejhm.2018.16175ENEradah Ali AlMarhoonAlmaarefa universityRenda Ali AlhabibUnaizah College of medicineAbdullah Ali AlshaalanPrince Sattam Bin Abdulaziz UniversityJournal Article20181008<strong><em>Background: </em></strong>Spinal cord injury (SCI) is always a medical emergency as it could lead to chronic painful conditions, permanent paralysis or even death. <strong><em>Objectives:</em></strong> Assessing the knowledge, attitude and practice (KAP) regarding the first aid of spinal injury in Kingdom of Saudi Arabia (KSA). <strong><em>Methods: </em></strong>A prospective randomized controlled study based on a questionnaire sheet that was conducted at Saudi Arabia, from March to July 2018.The study included 390 medical students randomly chosen from different faculties of medicine around KSA. <strong><em>Results</em>: </strong>The level of knowledge was sufficient among 84.9% of medical students. The attitude of the medical students was good among most of the participants regarding calling help and starting CRP immediately, taking care while moving the patients and applying direct pressure on the side of bleeding. The level of practice among most of medical students was good toward patients with spinal injury even conscious or not. <strong><em>Conclusion</em></strong><strong>: </strong>The KAP level was sufficient among medical students about first aid of spinal injury. The proper knowledge, positive attitude and practice skills towards first aid can make a significant difference in Saudi Arabia.
<strong><em> </em></strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273520181001Immediate Vicryl mesh insertion after lumpectomy, advantage overview673867431617610.21608/ejhm.2018.16176ENAbdullah Salem Al HaiderNajran University, Medical CollageMana Ali Mueidh Al HajlanNajran University, Medical CollageAbdulaziz Abdullah AlhazmiNajran University, Medical CollageYaqoub Mubarak Ali AlhamamiNajran University, Medical CollageNasser Naji Mohsen Al HarthiNajran University, Medical CollageMohammed Hundur AlasmariNajran University, Medical CollageAlhussain Abdullah Jarullah AlbudaydiNajran University, Medical CollageJournal Article20181008<strong>Background: </strong>oncoplastic surgical treatment is defined as mix of excision of a tumor, with proper margin consisting of lumpectomy or mastectomy and prompt reconstruction of the bust, this may require applying mesh to stabilize the structure beneath the skin. <strong>Objective:</strong> we discussed the efficiency of Vicryl mesh and it usage in surgery after lumpectomy. <strong>Method:</strong> we searched in detailed following electronic databases; (PubMed, Embase, Google scholar) for relevant studies published in English language with human subject only up to July,2018.<strong>Results:</strong> absorbable surgical mesh is the most current method in oncoplastic surgery. The simpleness of the time-preserving method that is comfortably appropriate has actually been reported to have substantial benefits for specialists in addition to a fairly affordable and acceptable aesthetic end results.<strong> Conclusion:</strong> elimination of just the area of cancer by lumpectomy intends to keep most of the bust tissue, is much less of a modification to your body compared to mastectomy and has a healing time of a couple of weeks. Immediate Vicryl mesh insertion is a simple approach. Additionally, surgeons ought to think about mesh use when constructing patients who are mosting likely to or have actually obtained radiotherapy to the bust; vicryl mesh is a reliable choice to acellular dermal matrix in non-irradiated bust reconstruction and is accessible at approximately one twentieth the expenses. Acellular dermal matrix or complete muscular tissue coverage could be preferable in irradiated reconstructions.
Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273520181001Prevalence of Iron Deficiency anemia in Obese Children in Taif Area - Saudi Arabia674467521617710.21608/ejhm.2018.16177ENMalak Eidha AloufiDepartment of pediatrics, Faculty of Medicine, Taif UniversityNejood Metaeb AljaedDepartment of pediatrics, Faculty of Medicine, Taif UniversityRawan Abdulrahman AloufiDepartment of pediatrics, Faculty of Medicine, Taif UniversitySuzan Abdullah JafriDepartment of pediatrics, Faculty of Medicine, Taif UniversitySumayyah Abdullah JafriDepartment of pediatrics, Faculty of Medicine, Taif UniversityManal Ahmed ElnasharDepartment of pediatrics, Faculty of Medicine, Taif UniversityJournal Article20181008<strong>Background:</strong> The growing global health problem is obesity which has increased dramatically in recent years. The prevalence of obesity continues to rise in developed and developing countries, Poor iron status are affecting millions of people worldwide. Iron deficiency is the first nutrient deficiency all over the world and both obesity and iron deficiency may lead to adverse health issues. In 2013, an estimated 42 million children aged under 5 years (6.3%) were overweight, an increase from around 5% in 2000 to 6% in 2010 and 6.3% in 2013, with the highest rates of increase being observed in Africa and Asia. Rapid changes from traditional to new diets, which contain large amounts of fat, sugar and oil is one of the major causes of obesity. Obesity has been associated with higher rates of death driven by co morbidities. According to the recent researches, the rate of obesity is significantly high in Saudi Arabia, and expected to increase in future.
<strong>Aim of the study:</strong> To evaluate the association between the obesity and iron deficiency anemia among children in Al-Taif Region, Kingdom of Saudi Arabia and to increase the awareness about the hazards of obesity on the general health. <strong>Method<em>: </em></strong>A cross sectional study design. A structured questionnaire was designed to obtain the necessary information from a convenient sample of 200 child aging from (5-12 years) attending the pediatric outpatient clinics of pediatric hospital in Taif region - Saudi Arabia from August till November 2016. Information about weight, height, Body Mass Index (BMI), Hemoglobin levels and the serum iron. The assessment of obesity with BMI index using the CDC2000 reference percentile was divided into four categories5th, 50th, 85th and 95th, namely; underweight, normal, overweight and obese respectively. Iron Deficiency was defined as Transferrin Saturation lower than 16% and Iron deficiency anemia was defined as Transferrin Saturation lower than 16% and hemoglobin (Hb) concentration lower than 12 g/l or 12 mg/dl for children. <strong>Results: </strong>This study shows negative significant correlation between hemoglobin level with the BMI ( r -0.429 p value 0.017 ) delayed weaning & no iron supplements ( r -0.338p value 0.023), bad food habits (r -0.309 p value 0.012) and warm disease, ( r --0.406 p value 0.028), suffering from poor food absorption disease (r 0.266p value 0.033) and chronic diarrhea ( r -0.311p value 0.011) . The prevalence of anemia among the study group shows 60% of its group are suffering from high BMI 79.2% of them suffering from IDA, while 20.8% are healthy. 40% of study group are with normal BMI 21.25% of them are suffering from anemia while 63% are healthy. <strong>Conclusions:</strong>Hepcidin plays a central role in the anemia of chronic disease and Hepcidin overproduction even in mild inflammatory disorder as obesity may explain the association of poor iron status with obesity. IL6 and Leptin may be part of the axis that links obesity, inflammation, and Hepcidin with poor iron status. This study suggests that the higher levels of total obesity should be taken into account when assessing the children’s body iron status and should be treated before providing dietary recommendations to correct anemia.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273520181001Diagnostic Performance of Point of Care Ultrasonography in Identifying Etiology of Respiratory Distress in Neonates675367621617810.21608/ejhm.2018.16178ENHany Abdul-Hady El-KhaleegyDepartment of Pediatrics, and Department of Radiology, New Damietta Faculty of Medicine, Al-Azhar University, Damietta, EgyptElsayed Mohamed Abd El-Hamid HassanDepartment of Pediatrics, and Department of Radiology, New Damietta Faculty of Medicine, Al-Azhar University, Damietta, EgyptHoda Abd El Hareth Ibrahim ShehataDepartment of Pediatrics, and Department of Radiology, New Damietta Faculty of Medicine, Al-Azhar University, Damietta, EgyptJournal Article20181008<strong>Background:</strong> Numerous studies have shown the role of lung ultrasound in identifying etiology of respiratory distress in neonates.<strong> Aim of the Work:</strong> was to detect the efficacy of ultrasonography versus x-ray in identifying the etiology of respiratory distress in neonates.<strong> Patients and Methods:</strong> A cross sectional study that includes 50 neonates with respiratory distress. Each included subject was submitted to history taking, complete clinical examination and laboratory investigations including complete blood count and chest radiograph & US images.<strong> Results:</strong> In the present work, there was no significant difference among sex distribution and mode of delivery but male sex and cesarean sections are the predominant in each group. The reasons for respiratory distress from the clinical diagnosis were respiratory distress syndrome (n = 22), transient tachypnea of newborn (n = 23) and pneumonia (n = 5). The chest radiograph diagnosis of respiratory distress was RDS in 22 neonates, transient tachypnea of newborn in 24 neonates, pneumonia in 2 neonates and RDS or pneumonia in 2 neonates. Overall from the clinical scenario and radiological findings, the final diagnosis was RDS in 24 neonates, TTN in 24 neonates and pneumonia in 2 neonates. The ultrasound diagnosis of respiratory distress was RDS in 24 neonates, TTN in 24 neonates and pneumonia in 2 neonates. <strong>Conclusion: </strong>This study shows a clear superiority of lung ultrasound over the chest x-rays for the diagnosis of RDS, TTN and pneumonia. Chest Ultrasound cannot replace standard chest X-ray in detecting severity of neonatal RDS because of its tendency to overestimate RDS.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273520181001Assessment knowledge and attitude and practice toward GERD among smoker in Riyadh City, 2018.676367661617910.21608/ejhm.2018.16179ENSaad Mohammad AlshahraniImam Muhammad ibn Saud Islamic universityAbdullah Odah AlahmariImam Muhammad ibn Saud Islamic universityAbdulaziz Jarallah N AlobaidiImam Muhammad ibn Saud Islamic universityJournal Article20181008<strong><em>Background: </em></strong>The risk of GERD is significantly associated with smoking which could increase the reflux symptoms.
<strong><em>Objectives: </em></strong>Assessing the knowledge, attitude and practice (KAP) toward GERD among smokers at Riyadh, Kingdom of Saudi Arabia (KSA).
<strong><em>Methods: </em></strong>A prospective randomized controlled study based on a questionnaire sheet that was conducted at Saudi Arabia, from March to July 2018.The study included 390 medical students randomly chosen from different faculties of medicine around KSA.
<strong><em>Results</em></strong><strong>: </strong>Most of the subjects have adequate knowledge and good attitude about the GERD disease, its causes, symptoms, the association of drinking and smoking with initiation of the disease and the effect of life style modifications on the management of GERD. The level of practice was inadequate among most of the participants as the majority of them won’t stop smoking, change their lifestyle and eating habits even they had GERD.
<strong><em>Conclusion</em></strong><strong>: </strong>The Knowledge level was significantly adequate which resulted in positive attitudes among most of the subjects. However, the level of practice was insufficient which may result in impairing the quality of life and increasing the prevalence of the disease.
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Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273520181001Rules of induction of labor, complication and benefits676767721618010.21608/ejhm.2018.16180ENAbdulaziz Abdullah AlhazmiNajran University, Medical CollageMana Ali Mueidh Al HajlanNajran University, Medical CollageAbdullah Salem Al HaiderNajran University, Medical CollageYaqoub Mubarak Ali AlhamamiNajran University, Medical CollageNasser Naji Mohsen Al HarthiNajran University, Medical CollageMohammed Hundur AlasmariNajran University, Medical CollageAlhussain Abdullah Jarullah AlbudaydiNajran University, Medical CollageJournal Article20181008<strong>Background:</strong> induction of labor is a usual obstetric method and it is applied when the benefits to either mother or fetus outweigh those of continuing the pregnancy. <strong>Objective:</strong> in this review we discussed the advantages and disadvantages and specifically mention about indications. <strong>Methodology:</strong> we searched MEDLINE and the Cochrane Library up to June 2018. Through our search we used multiple terms and combinations including labor, induced/or induction of labor. <strong>Result:</strong> for uterine hyperstimulation, double-balloon catheter had the highest probability of being among the best three treatments, whereas vaginal misoprostol (≥ 50 µg) was most likely to increase the odds of excessive uterine activity. For other safety outcomes there were insufficient data or there was too much uncertainty to identify which treatments performed 'best'. <strong>Conclusion:</strong> elective IOL needs to only be done in rare or extraordinary circumstances, only when the mom has actually completed 39 weeks of pregnancy, and only when it would be beneficial to the mom and not cause damage to the newborn. Ladies with uncomplicated maternities must be given every opportunity to go into spontaneous labor. Women with uncomplicated pregnancies should typically be offered induction of labor in between 41 +0 and 42 +0 weeks to avoid the threats of prolonged pregnancy.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273520181001Comparative Study between Fibro-Test and Egy-Score as Non-Invasive Markers for Assessment of Hepatic Fibrosis in Chronic Hepatitis C677367841618110.21608/ejhm.2018.16181ENFathy Ghamry Abd El Razek ElghmaryDepartments of Internal Medicine Al-Azhar UniversityHosni Abd El Kariem YounisDepartments of Internal Medicine Al-Azhar UniversityMohammed Mahmoud NoserDepartments of Internal Medicine Al-Azhar UniversityAyman Abd Al Aziz Abd Al RahmanDepartments of Internal Medicine Al-Azhar UniversityAhmed Mohammed MostafaDepartments of Internal Medicine Al-Azhar UniversityMohammed Yousri ShaheenClinical Pathology ,Faculty of Medicine, Al-Azhar UniversityJournal Article20181008<strong>Backgound: </strong>Liver fibrosis (LF) occurs in response to almost all causes of chronic liver injury. Assessing LF is important for both predicting disease progression and monitoring efficacy of therapeutic measures. Most noninvasive tests of liver fibrosis were developed with the aim of discriminating between “insignificant”, (F0-F1) by METAVIR and clinically “significant” fibrosis (≥ F2) by METAVIR or for identifying or excluding established cirrhosis in patients with well compensated chronic liver disease. Both these aims are clinically the most relevant. <strong>Aim:</strong> We aimed to compare the diagnostic accuracy of FibroTest and Egy-Score as predictors of stage of hepatic fibrosis in a prospectively enrolled cohort of Egyptian patients with chronic hepatitis C. <strong>Patients and Methodlogy:</strong> Twenty patients, treatment naïve chronic hepatitis C patients were enrolled. They were 16 males (80%) and 4 females (20%) mean age of these patients was 53.55 +14.3 (rang 18_73 years). The study was carried out in the Department of Gastroenterology and Hepatology, Elhussin hospital, Al-Azhar University during the period between March 2016 and March 2018. <strong>Results:</strong> Our results showed a highly significant positive correlation between stage of hepatic fibrosis by METAVIR and fibrotest. Our results showed a highly significant positive correlation between stage of hepatic fibrosis by METAVIR and EGY-SCOR. Our scores depend mainly on simple routinely used laboratory parameters (total bilirubin, albumin, platelet count) in addition to age and 2 non routine tests (CA 19-9 and Alpha-2-Macroglobulin). Although this panel needs to be done in validated laboratories, the cost of our score is much cheaper than other well-known and patented tests such as FibroTest and the net results of both methods nearly the same. <strong>Conclusion:</strong> Egy-Score can be applied easily in clinical practice to exclude severe hepatic fibrosis/cirrhosis in patients with contraindication for liver biopsy or those who are reluctant to do it. Egy-score would need further validation to be regarded as an alternative to liver biopsy. <strong>Recommendations: </strong>Physician should be careful when interpreting elevated levels of tumor markers CA 19-9 and CA 125 in patients with chronic liver disease as this could be a benign elevation related to hepatic fibrosis and not necessarily due to underlying malignancies. Elevation of the tumor markers such as CA19.9 have been associated with cholestasis in liver disease patients and this may give false positive results for our scores which give Limitations to our study.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273520181001Fear of falls among nursing homes residents and community dwelling elderly678567881618210.21608/ejhm.2018.16182ENMotassem S. AmerDepartment of Geriatrics and Gerontology, Faculty of Medicine, Ain shams university, Cairo, EgyptAsmaa F. AbdellahDepartment of Geriatrics and Gerontology, Faculty of Medicine, Ain shams university, Cairo, EgyptEman S. ElsayedDepartment of Geriatrics and Gerontology, Faculty of Medicine, Ain shams university, Cairo, EgyptJournal Article20181008<strong>Background: </strong>fear of falling is common among elderly faller and it has been associated with impaired mobility and decreased functional status. As a result, older adults who have fallen are at greater risk of becoming institutionalized regardless of whether they have experienced an injurious fall.
<strong>Objectives</strong>: the aim of the study is to assess the prevalence of fear of falls in elderly in geriatric home and in community dwelling elderly.
<strong>Subjects and Methods:</strong>
<strong>Design:</strong> A comparative study.
<strong>Participants</strong>: 100 resident in nursing homes in Cairo and another 100 in community.
<strong>Measurements</strong>: comprehensive geriatric assessment (CGA) including Minimental status examination (MMSE-30)<strong>, </strong>Geriatric Depression scale (GDS-15), Mininutritional assessment (MNA), time up and go test (TUGT), activity of daily living (ADL), instrumental activity of daily living (IADl), Single item question “are you afraid of falling?”
<strong>Results:</strong> the study showed that the prevalence of fear of falls in elderly living in nursing homes in Cairo is higher than others living in community, also showed that a higher percentage of environmental factors of falling among elderly in nursing homes compared to community, higher percentage of elderly with risk of fall living in nursing homes.
<strong>Conclusion:</strong> prevalence of fear of falls is higher in elderly living in nursing homes in Cairo than others living in community.
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<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273520181001Cruciate ligament injury among students of Northern Border University, Saudi Arabia678967961618310.21608/ejhm.2018.16183ENAbdurhman Aiash AlrwailiFaculty of Medicine, Northern Border University, ArarMalik Azhar HussainDepartment of Surgery, College of Medicine, Northern Border University, ArarNagah Mohamed Abo El-fetohCommunity Medicine Department, Sohag University, Egypt and Northern border university, ArarOmar Nasser S AlrawiliFaculty of Medicine, Northern Border University, ArarKhalid Saud M AlruwailiFaculty of Medicine, Northern Border University, ArarFaisal Saleh Q AlanaziFaculty of Medicine, Northern Border University, ArarSaif Khamees F AlmutrafiFaculty of Medicine, Northern Border University, ArarFaisal Eid N AlanaziFaculty of Medicine, Northern Border University, ArarOmar Mohammed AleneziFaculty of Medicine, Northern Border University, ArarAbdulaziz Ayad ALanaziFaculty of Medicine, Northern Border University, ArarAlshammari Taleb MukhlefFaculty of Medicine, Northern Border University, ArarFahad Safar AlshaibaniFaculty of Medicine, Northern Border University, Arar,Abdullah Asaad Al HerzImam Abdurrahman Bin Faisal University, Dammam, Saudi ArabiaJournal Article20181008<strong>Background:</strong> cruciate ligament consists of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) and they go from the femur to the tibia. The cruciate ligaments function is mainly to stabilize the knee and these ligaments have a risk to be injured in the athletes as well as non-athletes. <strong>Objective:</strong> address the prevalence of cruciate ligament injuries and its association with different types of injuries among Northern Border University students, Arar, KSA. <strong>Methods:</strong> A cross-sectional study was conducted among a representative sample of Northern Border University students in Arar City, Kingdom of Saudi Arabia, during the academic year 1439–1440. The students received the questionnaire to complete it. The parameters included in the questionnaire included age, sex, cause of cruciate ligament injury as during football playing, motor car accident, side and type of injury, type of treatment whether surgical treatment, physiotherapy or medical treatment. <strong>Results</strong>: This study reported the prevalence of cruciate ligaments injury among the studied Northern Border University students in Arar city, Kingdom of Saudi Arabia was 5.7%. The age of the studied ACL injury cases ranged from 18 to 30 years with mean age (±SD) was 23.0 ± 4.2 years. Most of cases (98.6%) were males. Playing football was the most common cause by 78.9% followed by motorcar accidents 7%, fall from stairs 5.6%, swimming 4.2% and fall from height 2.8%. As regards the side of the injured cruciate ligament, 60.6% had anterior cruciate ligaments injury, 8.5% had posterior cruciate ligament injury, and 18.3 % had injury in both sides. In the majority (54.9%) of cases, ACL tear was complete; partial in 38.0%. 14.1% received medical treatment, surgical treatment and physiotherapy by the same percent 32.4%, medical treatment and physiotherapy 15.5%. As regards outcome of treatment, this study reported 74.6% of patients become good and stable, 23.9% still complaining and 1.4% suffering from disability. <strong>Conclusion:</strong> This study reported the prevalence of cruciate ligaments injury among the studied Northern Border University students in Arar city, Kingdom of Saudi Arabia was 5.7%. Most of cases (98.6%) were males. Playing football was the most common cause by 78.9% followed by motorcar accidents 7%. As regards outcome of treatment, this study reported 74.6% of patients become good and stable, 23.9% still complaining and 1.4% suffering from disability.
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