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Superior mesenteric artery syndrome and nutcracker phenomenon
(2014) Qattan, Abeer; Hamad, Ahmed; Obaid, AlAlenezy, Awwad
The superior mesenteric artery (SMA) syndrome is a rare cause of proximal intestinal obstruction in which the third part of the duodenum is compressed between SMA and the aorta due to narrowing in aortomesenteric angle. High index of suspicion, in the presence of known risk factors, is the key to early diagnosis. We describe a case of SMA syndrome in a 17-year-old boy who admitted with a long history of abdominal pain and intermittent vomiting. The computed tomography (CT) features were diagnostic of SMA syndrome. The CT also showed partial compression of the left renal vein by SMA with more proximal dilatation (nutcracker phenomenon). He received conservative medical treatment, with a favorable outcome. Our case is unique in that two rare syndromes which rarely coexist found together in our patient.
Effect of time on electronic working length determination with a novel endodontic module in preclinical endodontic training
(2014) AlShwaimi, EmadNarayanaraopeta, Udaya
To evaluate electrical conductivity of the medium provided with ModuPRO endodontic modules, and compare it with those of alginate and vinyl polysiloxane impression materials over varying time intervals. Materials and Methods: A 24 Real Endo-t teeth were mounted in the ModuPRO Endo™ modules using three different mounting media [Groups A (Apex Putty), B (alginate), C (extra-light body vinyl polysiloxane)]. The working lengths were predetermined by microscopy, and the root canals were prepared with ProFile rotary instruments before mounting. Working lengths were checked with an electronic apex locator at 24 and 48 hours; 1, 4, and 6 weeks; and 6 months. Data were analyzed using one-way analysis of variance (ANOVA), the Tukey-Kramer multiple comparison tests, and the Wilcoxon Signed Rank Sum test, with significance set at P < 0.05. Results: Group C showed higher measurements and significant differences from groups A and B for up to 6 weeks (P < 0.05). There was no difference between groups A and B (P > 0.05). After 6 months, all groups showed significantly higher working lengths from those predetermined, but no statistically significant differences were observed among them (P > 0.05). For all groups, differences from predetermined working lengths were lowest at the 1-week interval. Conclusions: Both alginate and the Apex Putty can be used for determining the working lengths using an apex locator over a longer time period. Our study has shown that ModuPRO Endo™ modules, along with the Apex Putty, are effective tools for teaching working length determination with apex locators in preclinical endodontic training.
Metaplastic breast carcinoma with osteogenic component
(2014) Al-Amri, Ali; Ghallab, Khalid; Abdel Hadi, Maha; Al-Madi, MahaWahba, Thamer
Metaplastic breast carcinomas (MBC) are rare primary breast malignancies characterized by the co-existence of carcinoma with non-epithelial cellular elements. They can be classified as monophasic spindle cell (sarcomatoid) carcinoma, biphasic carcinosarcoma, adenocarcinoma with divergent stromal differentiation (osseous, chondroid and rarely rhabdoid) as well as adenosquamous and pure squamous cell carcinomas. Nearly all reports portrait women in their forties or older, yet younger affected females in their twenties have been reported. The usual presentation included firm painless breast mass ranging between 1.4 and 14 cm in diameter, with no evidence of loco-regional or distal metastasis. Mammary osteosarcomas are aggressive tumors with a propensity for blood-borne rather than lymphatic spread. Metastatic disease expected to develop at a mean of 10.5 and 14.5 months from the initial diagnosis and demise followed within 20 months of the onset of metastasis. MBC remains a rare entity with poor response to both chemo-radiotherapy, histological diagnosis is challenging yet it is the main stay in outlining the management. The surgical option remains the only successful current treatment in the form of simple Mastectomy to achieve negative margins sparing the patients axillary node dissection.
Global plan for the decade of action for road safety: Expectations from developing nations
(2014) Ramasamy, Jegadeesh; Shrivastava, PrateekShrivastava, Saurabh
Globally, 1.24 million people die every year because of road traffic accidents (RTAs) and almost 20-50 million people sustain non-fatal injuries. Realizing the magnitude and the global distribution of the problem, the current decade 2011-2020 has been proclaimed as the Decade of Action for road safety, with a target of first stabilizing and then decreasing the estimated magnitude of morbidity and mortality by intensifying the global efforts on national and international platform. The primary step is to develop a surveillance network for data collection to identify the causative factors and estimate the accurate magnitude of RTA so that rational policy can be planned for achieving the best possible allocation of limited resources, especially in developing countries. Other measures such as creating public awareness; strict enforcement of road safety legislations; establishing prompt and good quality post-crash response; and establishing monitoring and evaluation system to assess the outcome of implemented measures can be strategically implemented to counter the burden of road traffic accidents.
Variceal bleeding: Current issues
(2014) Al Mofleh, Ibrahim
Portal hypertension (PHT) is a serious sequel of liver cirrhosis. Eventually, varices develop, grow in size, and bleed. Several diagnostic modalities including transient elastography (TE), capsule endoscopy, CT scanning, and platelets count/spleen diameter ratio (PSR) have recently been introduced. Predictors of bleeding include large varices, red signs, severe liver disease, and hepatic venous pressure gradient (HVPG)12 mmHg. Oral nonselective (NSBB) are recommended for primary prophylaxis in patients with medium-to-large size esophageal varices (EV) that have not bled. Patients with acute variceal bleeding (AVB) should be resuscitated and managed in an intensive care unit. Vasoactive drugs should be started immediately aimed at a better control of bleeding and facilitation of a subsequent endoscopy. Terlipressin controls bleeding and mortality and is considered as the drug of choice. Antibiotic prophylaxis significantly improves survival compared with placebo. Early diagnostic and therapeutic endoscopy in patients with major bleeding enhances control of bleeding, reduces risks of rebleeding and mortality. The use of erythromycin prior to endoscopy clears the stomach, reduces the need for second endoscopy and blood transfusion, and shortens the length of hospital stay. Restricted transfusion strategy prevents portal pressure rise and improves the survival rate. The current recommendation is to treat AVB with a combination of vasoactive agent, EVL, and antibiotics. All patients who survive an episode of AVB should undergo secondary prophylaxis. Transjugular intrahepatic portosystemic shunt (TIPS) using covered stent represents the first-choice rescue treatment. Early TIPS insertion significantly reduces treatment failure, rebleeding, and mortality. Also, insertion of esophageal SX-Ella Danis stent in patients with refractory VB effectively controls bleeding. The data required for this review were obtained mainly through PubMed and Google search.
Unusual presentation of kimura's disease
(2014) Diwan, Amol; Godbole, Gauri; Pophale, HimanshuKulkarni, Suhas
Kimura's disease is a rare form of chronic eosinophilic inflammatory disorder with associated lymphadenopathy in head and neck region and serous cavity effusions and marked predilection for the head and neck with a tendency to present as a discrete, enlarging mass. Although many cases of Kimura's disease with head and neck lymphadenopathy and nephrotic syndrome have been described in the literature, only two cases of Kimura's disease presenting with pleural effusion have been reported recently. There are no reports of Kimura's disease with ascites. We report the case of a 38-year-old nondiabetic, normotensive man who had undergone inguinal node biopsy consistent with Kimura's disease, 8 months before he presented to us. On admission, he had right moderate pleural effusion, but no ascites or any lymph nodal involvement. He developed recurrent pleural effusion and ascites in the ward. Initially he showed good remission with systemic steroids, but later on was refractory to further necessary treatment. He also rapidly developed signs of nephrotic syndrome. In spite of vigorous treatment, patient died of severe hypovolemia, hypoproteinemia, and nephropathy.
Acute lower abdominal pain in a young female patient
(2014) Al-Mulhim, Abdulmohsen; Al-Saffar, Ali; Aldhafery, Bander; Al-Bisher, HassanAl-Saleem, Hassan
Using proportional assist ventilation to wean a prolonged mechanically ventilated patient with chronic obstructive pulmonary disease
(2014) Alotaibi, Ghazi; Gazwi, Hassan; Al-Jarodi, LeilaAl-Basha, Malak
Long-term mechanical ventilation (MV) increases heath care cost. Difficult-to-wean patients represent a challenge to health care providers and patient's family. Patient with chronic obstructive pulmonary diseases (COPDs) are usually difficult to wean off mechanical ventilators for many pathophysiological reasons. Modes of ventilation used in MV weaning have produced variable results. The main shortcoming of currently available modes of weaning is inability to meet patient's changing ventilator demand. Proportional assist ventilation (PAV) is a new mode of ventilation designed to keep up with patient's breathing demand and unload work of breathing. In this case report, we have shown that PAV was able to wean off a patient with COPD who had been on the ventilator for 37 days.
Chronic Hepatic Disease
(2014) Al-Quorain, Abdulaziz
Bilateral congenital absence of the alae nasi with bilateral auricular sinuses in an albinic child
(2014) Ibrahim, Aliyu
The nose forms from the frontal, medial and lateral nasal prominences of the nasal placode and the maxillary processes. Malformation of the nose is variable; it may be unilateral or bilateral and may be complete absence of the nose called arhinia or isolated absence of the alae narsi. Anomalies of the nose may be associated with defects involving structures that originate from the first and second branchial arches but its association with cutaneous pigmentary disorder and anasarca is a rare occurrence. Therefore a case of a three-month-old girl with such combination is reported.
Using etanercept to maintain remission of psoriatic arthritis during pregnancy
(2014) Al-Homood, IbrahimSomaily, Mansour
In recent years, biological drugs have been widely administered to treat rheumatic diseases including psoriatic arthritis (PsA). However, the safety of these drugs has not been adequately established in pregnancy. We report a case of a pregnant PsA patient treated with etanercept, an anti-tumor necrosis factor (TNF-α) agent. She continued to receive etanercept treatment during pregnancy without any complications, finally giving successful birth to a baby girl at 39 weeks. This suggests that etanercept may be selected to treat PsA patients with active arthritis who desire pregnancy with lower risks.
To treat or not to treat asymptomatic hyperuricemia
(2014) Mustafa, Hamid
Hyperuricemia is a term given to serum uric acid levels higher than 7.0 mg/dL; asymptomatic hyperuricemia may precede gouty attacks with several years. This progression is variable from a person-to-person and may not even develop. Owing to this, there is a great controversy in whether to treat asymptomatic hyperuricemia or not. Objective: The objective of the following study is to determine the treatment habits of asymptomatic hyperuricemia in Makkah Region, Kingdom of Saudi Arabia. Materials and Methods: This survey was carried out using a structured questionnaire that was answered through face-to-face interviews with 104 physicians who diagnose and treat hyperuricemia. The data was collected on the second half of 2012. The specialties included in the study were general practitioners, family physicians, orthopedicians and rheumatologists. Results: Half of the doctors in our study (50.9%) chose to observe and follow asymptomatic hyperuricemic patients and 84% depend on the serum uric acid levels to help them decide when to start their treatment, 53% asked about co-morbid diseases as renal stones, diabetes mellitus and ischemic heart disease whereas 49% asked about family history. When doctors are to start the treatment, 84.1% will start with allopurinol and 42.5% will advise on the change of dietary and life-style habits. Conclusions: The results showed that the doctors in Makkah Region depend on the serum uric acid levels to decide when to start the treatment, not abiding by the international guidelines. They still chose the life-style and dietary modification, as well as starting treatment with allopurinol with a starting dose of 100 mg/dL daily.
Prevalence, severity, and secular trends of dental caries among various saudi populations: A literature review
(2014) Al-Ansari, Asim
The prevalence of dental caries is increasing across different nations around the globe. A review of the literature shows that dental caries is adversely affecting the oral health of children, adolescents, adults and elderly populations in Saudi Arabia. The objective of this review is to report the prevalence, severity, and progression of dental caries in different age groups of Saudi communities. Digital databases such as PubMed, Medline, Google scholar, and the Saudi Dental and Medical Journals were searched to retrieve the published articles and reports on dental caries in Saudi Arabia. Search strategy included key words such as "dental caries," dental decay, decayed missing filled teeth (dmft/DMFT), and oral health. Cross-sectional, retrospective and cohort studies (from 1982 to 2012) reporting the prevalence, incidence and severity of caries among children, adults and older individuals were included in the review. In children with primary dentition ages 3-7 years, the highest caries prevalence was almost 95% and maximum estimate of dmft was 7.34 during the last decade. Approximately, 91% was the highest caries prevalence and greatest DMFT value was 7.35 among the children/adolescents ages 12-19 years. The adults with a mean age between 30 and 45 years had maximum caries prevalence of 98% and DMFT of 14.53 while older individuals had greatest DMFT score of 24.3. Children, adults, and elderly populations demonstrate a higher prevalence and greater severity of caries, and secular trends also show a striking increase in dmft/DMFT and caries prevalence rates over the past few decades in Saudi Arabia.
Migrated guide wire during femoral vein catheterization
(2014) Qutub, Hatem
Central venous line catheterization is the main route for therapeutic intervention in critically ill patients. Despite the relatively common complications, the femoral vein is a standard route for catheterization. This is a case report of a rare preventable complication of migration of the guide wire and catheter from the femoral vein through the systemic circulation in a 75-year-old critically ill man in a university hospital in Saudi Arabia.
A comparison between estimates of glomerular filtration rate using technetium-99m-diethylene-triamine-pentaacetic acid clearance and modification of diet in renal disease equation
(2014) Javaid, Amrah; Munir, Iqbal; Qazi, Muhammad; Nawaz, MuhammadJaffri, Saghir
More than half of cancer patients have unrecognized renal insufficiency, which is a reduced glomerular filtration rate (GFR) and is a disease complication factor. Aims and Objectives: The objective of the present study is to compare the accuracy of GFR with two methods, i.e., GFR by Gates' method (gamma camera uptake method with technetium-99m-diethylene-triamine-pentaacetic acid (Tc-99m-DTPA) and GFR by modification of diet in renal disease (MDRD) equation in cancer patients. Materials and Methods: A total of 50 cancer patients with abnormal serum creatinine were included in the study. 50 age matched cancer patients with normal creatinine, blood urea nitrogen (BUN) and serum albumin were taken as controls. History of patients including site of cancer, chemotherapy regime and dose of chemotherapy was recorded. Serum creatinine was estimated by auto analyzer using Jaffe's method. Glomerular filtration rate (GFR) was calculated using camera based modified gates method with (99mTc-DPTA) and MDRD equation. Results: Mean age of patients was 50 year. Level of serum creatinine and BUN were significantly increased (P < 0.001) in patients when compared to controls. Level of serum albumin was non-significantly (P > 0.05) decreased in cancer patients and body surface area also increased, but differences were non-significant (P > 0.05) in cancer patients when compared to controls. Mean GFR was estimated by camera based modified gates method which increased in cancer patients as compared to GFR by MDRD equation but differences were not significant (P > 0.05). Cost, time duration and time for reagent preparation was very high using Renogram (Gate's method) as compared to the cost and other factors involved in estimation of GFR by MDRD equation. Conclusion: It is concluded that the MDRD equation is more suitable, economical and time saving for the estimation of GFR as compared to Renogram using Tc-99m-DPTA. However future prospective studies are required to the estimation of GFR in those tumors, which may cause kidney damage such as cisplatin or carboplatin, methotrexate.
Public health in the saudi health system: A search for new guardian
(2014) Milaat, Waleed
Saudi Arabia has witnessed a significant improvement in its health indicators. The kingdom has spent generously on the curative health services and established hundreds of hospitals and primary health care centers. However, we believe that this huge health expenditures and the presence of curative services is not the only reason for this improvement. Public health services have also had a significant impact on people's health and that this improvement is due to a combination of public health programs such as immunization, environmental sanitation and health education with good formulation of sound health policies and health delivery systems. It is noted that health plans and expenditure in the health system are concentrating on the curative aspects and there is a significant weaknesses in public health services. Additionally, most jobs are allocated for curative care and there is scarcity of job titles related to public health in the health structure, such as public health officers, public health inspectors and public health specialists. A suggested body namely, Ministry of public health, will work to confirm that all issues related to health of the public in every aspect of daily life in the kingdom are within the genuine interest of all policy makers.
Public health: The birth of a new era
(2014) Bella, Hassan
Study of environmental noise pollution in the university of dammam campus
(2014) Alsubaie, AliEl-Sharkawy, Mahmoud
Noise pollution has been well-recognized as one of the major trepidations that can adversely affect public health and quality-of-life in urban areas across the globe. Community noise, or environmental noise, includes the primary sources of road, rail and air traffic, industries, and public works. Aims: The main aim of this study is to assess the noise level inside the University of Dammam (UD) campus. Settings and Design: Three different locations were selected for measuring noise levels during this study; outside walls, the internal streets, and inside several buildings of the UD campus. Materials and Methods: Levels of the environmental noise pollution were measured at three different periods of the academic year 2011-2012; during study days, final exams and the holiday periods. Statistical Analysis Used: Results of this research were statistically analyzed by the Statistical Package for the Social Sciences SPSS program. Results: Levels of noise outside walls of the UD campus were higher than those inside the campus walls at all periods. Inside the UD campus, levels of noise were the highest at locations that are characterized by the high traffic movement. In addition, the highest level of noise was recorded during the studying period, while the lowest level was obtained during the holiday period. Levels of the indoor noise inside buildings of the campus were nearly the same or very slightly higher than those of the outdoor levels which indicate that the effect of human activity inside university buildings on noise pollution can be neglected comparing with the outdoor sources. Conclusion: Both levels of noise inside and outside buildings were higher than their guideline values. These high noise levels require effective environmental control strategies and increasing awareness between all staff members inside universities camps.
Lateral sinus thrombosis in children: Case series
(2014) Alsanosi, Abdulrahman; Almazrou, Khalid; Alshehabi, MohamedAlqahtani, Munahi
Lateral sinus thrombosis is rare but potentially fatal condition. The consequences of misdiagnosis of this condition are detrimental. Aims: To review our experience in lateral sinus thrombosis secondary to otogenic disease in pediatric population. Settings and Design: Retrospective study of case series treated in two teaching hospitals over five years. Materials and Methods: Clinically and radiologically diagnosed cases of lateral sinus thrombosis were identified through database search. Results: Lateral sinus thrombosis was the result of chronic suppurative otitis media in 7 cases, with 3 patients (42.85%) having cholesteatoma. There were no associated intracranial complications in any of the patients. Two patients (28.57%) underwent medical treatment, and 5 patients (71.43%) had surgical treatment. Aggressive and early surgical intervention treatment was initiated according to evaluation of preoperative findings. The sigmoid sinus was aspirated in three patients. Complete re-canalization or lysis of the thrombus was achieved. Anticoagulant agent was used in 1 patient (14.28%). Six patients (85.82%) presented with the typical lateral sinus thrombosis clinical features, and 1 patient (14.28%) presented with otorrhea solely. Mastoidectomy was undertaken in 5 patients (71.42%) with canal wall up in 2 patients (28.57%) and canal wall down in 2 patients (28.57%). Myringotomy, ventilation tube insertion, and cortical mastoidectomy were done in 1 patient (14.28%). Conclusions: Early and aggressive surgical intervention of lateral sinus thrombosis otogenic complication can minimize mortality, hospitalization period, and length of medical treatment. High index of suspicion is important.
The uses of melatonin in anesthesia and surgery
(2014) Mowafi, HanyIsmail, Salah
Melatonin is a hormone secreted by the pineal gland. It is available as a dietary supplement, taken primarily for the relief of insomnia. Increasing evidence from human and animal studies suggests that melatonin may be efficacious as a preoperative anxiolytic, a postoperative analgesic, and a preventative for postoperative delirium. It has also been reported to decrease intraocular pressure. Melatonin's high efficacy, wide safety profile in terms of dose, and virtual lack of toxicity make it of interest in anesthetic and surgical practice. This review examines clinical trial data describing the efficacy and safety of melatonin in the perioperative anesthetic and surgical settings. We shall, also, focus attention on animal and human experimental studies that concern these issues.

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