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Item Pain knowledge and attitude survey among health-care professionals at a university hospital in Saudi Arabia(2017) Fallatah, SummayahBackground: There is growing awareness in the hospital setting toward pain management to decrease patients' suffering, improve postsurgical outcomes and to decrease cost. Objective: The aim of this study was to get an overview of the knowledge and attitude among health-care professionals toward pain management in the King Fahd Hospital of the University, and the need for an educational plan to improve pain service in hospitals. Materials and Methods: We conducted a survey over a 3-month period based on a 30-question questionnaire to test pain knowledge and attitude among nurses and physicians of different specialties, the level of education and years of experience. Results: The results of the data showed that knowledge and attitude of pain were deficient and unsatisfactory. Conclusion: We concluded that efforts to spread knowledge and education of proper pain management among health-care professionals are required. Further surveys involving more hospitals are warranted.Item Adult desmoplastic medulloblastoma(2017) Al Anazi, Abdulrahman; Hendam, Ahmed; Al Nemer, Areej; Al Anazi, RawanMedulloblastoma is more common in young age and rare in adult age. Some characteristics that characterize medulloblastoma in adults compared with children: Lateral cerebellar location, heterogeneous signal intensity on magnetic resonance imaging, desmoplastic histological variant and more favorable prognosis. Preoperative diagnosis is important for correct management of these patients. However, because of the low incidence of medulloblastoma in adults, preoperative diagnosis still challenging and prognostic factors and best treatment options are still controversial. We report a case of a 31-year-old male patient who presented with a rare case of posterior fossa medulloblastoma.Item Furuncular myiasis in a child: A case report and literature review(2017) Al Juaid, AlaaAl Zahrani, WaheedMyiasis is an ectoparasitic infestation of tissue. Most cases of furuncular myiasis in Saudi Arabia are acquired from the Southern region of Saudi Arabia, including the Al Baha and Asir regions. Some authors consider these areas to be part of the Afro-tropical zoogeographical belt where infection is most likely to occur. Some studies have reported posttrauma myiasis in oral cavities in children. However, myiasis is rarely reported in children who do not suffer from skin erosion or trauma. We are reporting the case of a young, otherwise healthy girl who visited Al Taif, in the Western region of Saudi Arabia, who acquired an accidental infestation of fly larvae. To the best of our knowledge, this is the first report of indigenously acquired myiasis outside the Southern region of Saudi Arabia. This is significant in the epidemiology of this parasite, which appears to have expanded from the Southern to the Western region of Saudi Arabia.Item Depression in Patients with Systemic Lupus Erythematosus: A Multicenter Study(2017) Al-Homood, Ibrahim; Omran, Narges; Alwahibi, Abdulrahman; Aldosoghy, Maha; Alharthy, Amal; Aljohani, GhassanBackground and Objective: Neuropsychiatric disorders including depression are common clinical manifestations of systemic lupus erythematosus (SLE). Depression in patients with SLE is under-recognized, although it is a treatable clinical entity. The present study aimed to determine the prevalence of depression and identify the relationship between depression and SLE disease characteristics. Patients and Methods: This multicenter cross-sectional study was conducted in the rheumatology clinics of four tertiary referral hospitals in Saudi Arabia between April and September 2014. Patients' demographic data and SLE disease characteristics such as disease duration, severity and drug treatments were collected. A validated Arabic Beck Depression Inventory (BDI) score was used to estimate the prevalence of depression. Results: A total of 68 patients with SLE (64 women, 4 men) were enrolled in the study. Forty-six (67.6%) patients were found to have BDI scores indicating depression; of them, only four patients (8.7%) were receiving antidepressant treatments. Higher prevalence of depression was associated with steroid treatment (P = 0.046). Conclusions: The study results revealed high prevalence of depression among Saudi patients with SLE. Most of the study population were not adequately treated, suggesting inadequate recognition and treatment of depression in SLE.Item Polyglandular autoimmune syndrome iii with hypoglycemia and association with empty sella and hypopituitarism(2017) Bokhari, Samia; Khan, Patan; Al Jabri, KhalidGalal, MohammedA 25-year-old Saudi female with a known case of autoimmune thyroiditis presented to the Emergency Room in stuporous condition. A blood test revealed a blood sugar level of 1.7 mmols/l (30.6 mg/dl). The patient was resuscitated with intravenous glucose. Further evaluations of the patient revealed celiac disease and idiopathic thrombocytopenia with preexisting autoimmune thyroiditis (polyglandular autoimmune syndrome III [PAS III]). The severe hypoglycemia, coupled with 6 years of infertility evaluation, revealed a rare association of empty sella syndrome with hypopituitarism {PAS II}.Item Sudden Visual Loss as an Initial Manifestation of Chronic Myeloid Leukemia(2017) Buzaid, Ahmed; Al-Amri, AliChronic myelogenous leukemia (CML) is a pluripotent stem cell disease characterized by anemia, granulocytosis and granulocytic immaturity, basophilia, thrombocytosis and splenomegaly. It is associated with a reciprocal chromosomal translocation t (q34; q11), resulting in a breakpoint cluster region-Abelson fusion gene (Philadelphia chromosome). Ophthalmic manifestations as the first and the only presentation of CML in patients are very rare. Ocular lesions in CML patients are frequently asymptomatic, and thus all patients should undergo an eye evaluation at the initial diagnosis. Here, we report a previously healthy 36-year-old Saudi male who initially presented with progressive loss of vision. On examination, he was found to have a bilateral retinal hemorrhage. The investigations revealed findings consistent with CML. The patient was treated with tyrosine kinase inhibitors, and he had complete remission, including full recovery of his vision.Item Spinal muscular atrophy and ependymoma(2017) Albakr, Aishah; Abbas, Faisal; Al-Jehani, Hosam; Ammar, AhmedSpinal muscular atrophy (SMA) is an autosomal recessive disorder, characterized by a progressive degeneration of anterior horn cells of the spinal cord resulting in hypotonia, skeletal muscle atrophy and weakness. We report the case of a 33-year-old female with SMA type IV (SMA4) who presented with symptoms of spinal cord lesion that was initially missed. Further evaluation resulted in the diagnosis of ependymoma. To the best of our knowledge, this is the first time that the coexistence of SMA4 and ependymoma has been reported.Item Challenges in providing compassionate health care in current modern era of advanced technology(2017) Qidwai, WarisAbstract Not AvailableItem Musculoskeletal disorders due to poor ergonomic practice in dentistry(2017) Shamim, ThorakkalAbstract Not AvailableItem Management of liver trauma(2017) Alghamdi, HananIn the last 30 years, the management of liver injury has evolved significantly. The advancement of imaging studies has played an important role in the conservative approach for management. A shift from operative to nonoperative management for most hemodynamically stable patients with hepatic injury has been prompted by speed and sensitivity of diagnostic imaging and by advances in critical care monitoring. In this review article, the up-to-date recommendation on the management approach of liver trauma will be discussed.Item Uncommon optic nerve course in the sphenoid sinus(2017) Dalati, Hatem; Jabbr, Muhammad; Hammadi, IyadWe present a case of bilateral, free optic nerves passing through the sphenoid sinus associated with bilateral anterior clinoid process pneumatization, in addition to bilateral vidian nerves protrusion with pterygoid process pneumatization.Item Early-Onset Evans Syndrome in a 4-Month-Old Infant: A Case Report and Review of Literature(2017) Al-Mendalawi, MahmoodAbstract Not AvailableItem Primary umbilical endometriosis: Case report with literature review(2017) Al-Quorain, SaraAl-Yahya, TariqVillars nodule, also known as umbilical endometriosis, is a rare umbilical disorder, usually affecting women of child bearing age. Endometriosis is a functional endometrial tissue found outside the uterine cavity, which affects the umbilicus in 0.5–1% of all extragenital sites. Correct diagnosis is challenging and commonly missed, but once a diagnosis has been made, the recommended management is surgical excision. We are reporting a case of primary umbilical endometriosis in a 31-year-old nulliparous patient, who presented with an umbilical mass of one year duration. Histopathology confirmed the diagnosis of endometriosis and the mass was widely excised.Item Author's reply(2017) Aliyu, Ibrahim; Kyari, FatimeIbrahim, ZainabItem Zika virus: An emerging pathogen(2017) Al-Quorain, AbdulazizItem Prophylactic Endotracheal Intubation in Patients with Upper Gastrointestinal Bleeding Undergoing Endoscopy: A Systematic Review and Meta-Analysis(2017) Alshamsi, Fayez; Jaeschke, Roman; Baw, Bandar; Alhazzani, WaleedBackground: Patients with upper gastrointestinal bleeding (UGIB) often require urgent or emergent esophagogastroduodenoscopy (EGD) and are at risk of complications such as aspiration of gastric content or blood. The role of prophylactic endotracheal intubation (PEI) in the absence of usual respiratory status-related indications is not well established. Methods: We searched Medline, EMBASE, Cochrane Library's Central Register of Controlled Trials (CENTRAL) and SCOPUS from inception through July 2017 without date or language of publication restriction. We included studies that compared PEI with usual care (UC) in patients with acute UGIB, and reported any of the following outcomes: aspiration, pneumonia, mortality and length of stay. We excluded studies in which majority of included patients required intubation due to respiratory failure or decreased level of consciousness. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the quality of evidence for each outcome. Results: We did not identify any randomized trials on this topic. We included 10 observational studies (n = 6068). We were not able to perform any adjusted analyses. PEI was associated with a significant increase in aspiration (OR 3.85, 95% CI, 1.46, 10.25; P = 0.01; I(2) = 56%; low-quality evidence), pneumonia (OR 4.17, 95% CI, 1.82, 9.57; P = 0.0007; I(2) =52%; low-quality evidence) and hospital length of stay (mean difference 0.86 days, 95% CI 0.13, 1.59; P = 0.02; I(2) = 0; low-quality evidence), without clear effect on mortality (OR 1.92, 95% CI, 0.71, 5.23; P = 0.2; I(2) = 95%; very low-quality evidence). Conclusions: Low- to very low-quality evidence from observational studies suggests that PEI in the setting of UGIB may be associated with higher rates of respiratory complications and, less likely, with increased mortality. Although the results are alarming, the lack of higher quality evidence calls for randomized trials to inform practice.Item Early-onset Evans syndrome in a 4-month-old infant: A case report and review of literature(2017) Mohamed, Khaled; Al-Qurashi, Faisal; Al-Qahtani, Mohammad; Osman, YasserEvans syndrome (ES) is a rare autoimmune disorder characterized by autoimmune hemolytic anemia (AIHA) and immune thrombocytopenic purpura (ITP). We report a case of a 4-month old infant who presented with a history of acute pallor and jaundice. She had no family history of any hematological or autoimmune disorders. Her laboratory investigations revealed a positive direct Coombs test with immunoglobulin G autoantibodies, anemia and thrombocytopenia. She was managed initially by blood transfusion and started on high-dose steroid therapy with marked improvement. Very few cases of ES in infants have been reported in the literature. We concluded that this case report may support the possibility of an early-onset ES among infants <6 months of age.Item Hospital prevalence of retinopathy in patients with newly-diagnosed type 2 diabetes(2017) AL-Zamil, WaseemTo determine the period prevalence of diabetic retinopathy (DR) and the associated factors in patients with newly-diagnosed Type 2 diabetes mellitus (T2DM). Subjects and Methods: In this prospective study, all newly-diagnosed T2DM patients who attended the ophthalmology clinic at King Fahad Hospital of the University between January 2012 and January 2015, were examined for DR. After pupillary dilation, the ophthalmic fundus was examined by a retina consultant using slit-lamp indirect ophthalmoscopy. Risk factors such as gender, age, hypertension, nephropathy, the level of glycated hemoglobin (Hb), microalbuminuria, and hyperlipidemia were evaluated for possible association with DR at the time of diagnosis. Results: The study included 112 newly-diagnosed T2DM patients. DR was present in seven patients (6.25%) with a mean age of 53.4 ± 6.4 years, four of whom were females (57%). Nonproliferative DR was present in all patients with DR, two patients (28.6%) presented with bilateral clinically significant macular edema requiring laser photocoagulation treatment and intravitreal anti-vascular endothelial growth factor therapy. In the study cohort, elevated hemoglobin A1C levels (HbA1C) were detected in 55 patients (49.1%), microalbuminuria in 28 (25.0%), hypertension in 31 (27.6%), hyperlipidemia in 65 (58.0%) and obesity in 43 (38.1%). At the time of T2DM diagnosis, uncontrolled HbA1C levels were significantly associated with the presence of retinopathy (P = 0.045); however, no statistical significance was observed for the remaining risk factors. Conclusion: The frequency of retinopathy in newly-diagnosed T2DM patients was similar to previous reports. Vision-threatening maculopathy was present in two of seven patients, requiring further intervention. Therefore, early screening is strongly recommended for all newly-diagnosed T2DM patients. Prospective studies with a large sample size are needed to verify the risk factors for these patients.Item Pediatric gastrointestinal basidiobolomycosis: Case report and review of literature(2017) Al-Juaid, Alaa; Al-Rezqi, Abdulqader; Almansouri, Walaa; Maghrabi, Hatim; Satti, MohamedBasidiobolus ranarum is an environmental saprophyte found worldwide. It is a member of the order Entomophthorales of the class zygomycete. The infection is generally restricted to subcutaneous tissues. However, the disease can involve visceral organs, causing gastrointestinal basidiobolomycosis (GIB). GIB usually has nonspecific clinical manifestations and its diagnosis is challenging. Missed and delayed diagnosis of GIB increases the risk of morbidity and mortality, especially in pediatric patient. Previously, most of the cases in Saudi Arabia have been reported from southern region (Tohama, Aseer Region); the current study reports cases from different regions. We report a case of severe GIB and four other cases of pediatric GIB in western region of Saudi Arabia. The aim of our report is to describe the wide range of clinical presentations, diagnosis, management and outcomes. Our case series includes the youngest case report of GIB, a 16-month-old infant and highlights two important points. First, the need of high index of suspicious for diagnosis of GIB and its inclusion in the differential diagnosis of any abdominal mass, fever and eosinophilia. Second, it gives additional supportive evidence that medical management with voriconazole without surgical intervention (intervention if the condition is diagnosed early) is curative.Item Prevalence of Self-Reported Medical Conditions among Dental Patients(2017) Javali, Mukhatar; Khader, Mohasin; Al-Qahtani, NabeehBackground: In general, it is important to assess the medical history of patients before initiating any treatment. In particular, patients seeking dental treatment could possibly have significant medical conditions that may affect the diagnosis and/or alter the treatment provided. However, many dentists assume that their patients are systemically healthy, and thus they do not record the medical history of their patients. Aim and Objective: This study aimed to determine the prevalence of medical conditions in patients seeking periodontal treatment at the dental teaching hospital of King Khalid University. Materials and Methods: Upon presentation at the periodontal clinics of the dental teaching hospital of King Khalid University, Asir Region, Saudi Arabia, patients' history from medical records was screened. Results: The medical history was taken for 455 periodontal patients. The most frequently encountered medical conditions were diabetes mellitus and hormonal disorders, followed by respiratory diseases and cardiovascular diseases. Conclusion: The results of our study found a high prevalence of medical conditions among patients seeking periodontal treatment, thereby highlighting the need to record patients' medical and dental care history in detail.