Saudi Journal of Medicine & Medical Sciences|المجلة السعودية للطب والعلوم الطبية

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Epidemiology and outcome of congenital diaphragmatic hernia in a tertiary care university hospital: 10 Years' Experience
(2013) Al-Turkistani, Hatim
Congenital diaphragmatic hernia (CDH) is a major birth defect, which continues to be associated with significant rate of morbidity and mortality. CDH-local studies are limited. The objective of this article is to determine the epidemiology and demographics of CDH; and if the introduction of nitric oxide has influenced the outcome. Materials and Methods: A retrospective 10-year medical records review of neonates with CDH admitted to the neonatal intensive care unit (NICU) of a tertiary care hospital. Results: A total of 29 infants had been admitted to the NICU with CDH between January 2001 and December 2010. The mean gestational age was 38.58 ΁ 2.6 weeks and the mean birth weight was 2821 ΁ 682 g. The incidence of CDH among the inborn infants was 1/250 live births (P < 0.05) and the overall male to female ratio was 0.7. Of the 12 infants (41%) were inborn and 17 (59%) were referred from other centers. Out of the 29 infants, 23 (79%) were Saudis; the same figure was true for the vaginal deliveries and those born at term. Only 10 infants (34%) were diagnosed antenatally. The mean Apgar scores were 5 and 7 at the 1 ^st and 5 ^th min respectively. Two infants (7%) had right-sided defect against 27 (93%) who had it left-sided. Moreover, 18 infants had survived and were discharged home, with an overall mortality rate of 38% (compared with 45% before introducing inhaled nitric oxide [iNO]), P > 0.05. Conclusion: The incidence of CDH was found much higher than the reported cases in literature; and although the mortality rate has improved after the introduction of iNO, the difference was not statistically significant. Both interesting findings necessitate further studies.
Indeterminate cell tumor (Histiocytosis)
(2013) Ahmed, Ayesha; Al-Tamimi, Dalal; Al-Saleh, Eman; Shawarby, Mohamed; El-Sharkawy, Tarek; Hashem, TarekAl-Ruwai, Zainab
Indeterminate cell tumor (ICT; histiocytosis) is a rare disorder characterized by accumulation of histiocytes that do not fulfill the phenotypic criteria designated for Langerhans cells (LC). The cells classified as "indeterminate" exhibit overlapping features between dendritic cells and histiocytic cells by showing variable reactivity for CD1a and positivity for S-100 protein and CD68. Ultrastructurally, absence of Birbeck granules, a feature consistent with LC, epitomizes the lesional cells. Herein, we report a case of ICT in a new born emphasizing its histogenesis and clinical, morphologic, immunohistochemical, and ultrastructural features.
Insulin lipohypertrophy: A non-fatal dermatological complication of diabetes mellitus reflecting poor glycemic control
(2013) Dar, Ishrat; Dar, ShowkatWani, Sumayya
Lipohypertrophy has been a recognized complication of insulin therapy. Despite improvements in insulin purity and the introduction of recombinant human insulin, its prevalence has remained high particularly in those with a poor glycemic control. Injection of insulin into a site of lipohypertrophy, although painless, may lead to erratic absorption of insulin, with the potential for poor glycemic control and unpredictable hypoglycemia. Rotation of injection sites can reduce the frequency of the problem but does not abolish it. The importance of this complication is not only cosmetic but also in its impact on insulin absorption, and hence glycemic control. Lipohypertrophy is characterized by a benign "tumor-like" swelling of fatty tissue secondary to subcutaneous insulin injections. A strong association of lipoatrophy and lipohypertrophy with insulin antibodies might suggest that autoimmune phenomena with insulin play a role in the development of both. Presented here is a young type 1 diabetic on human insulin with poor glycemic control who developed lipohypertrophy at the injection sites around the umbilicus.
Cutaneous leishmaniasis in Al-Ahsa Oasis in Saudi Arabia and in Sudan: A comparative study
(2013) El Hassan, Ahmed
This is a comparative study of cutaneous leishmaniasis (CL) in the Eastern Province of the Kingdom of Saudi Arabia and Sudan. The disease in both countries is caused by Leishmania major of different syndromes and the vector is Phlebotomus papatasi. The animal reservoir host in Saudi Arabia is Psammomys obesus and the Nile rat in Sudan. The clinical manifestations are similar, but some forms encountered in Sudan were not seen in Saudi Arabia. The pathology, immunology, diagnosis and treatment of CL are discussed.
Hormonal, metabolic and clinical profile of Saudi women with polycystic ovary syndrome
(2013) Al-Mulhim, Abdulaziz; Abul-Heija, Adel; Al-Talib, Ayman; Al-Turki, HaifaGasim, Turki
bjective: To establish the hormonal, metabolic and clinical profile for Saudi women with polycystic ovary syndrome (PCOS). Design: This is a prospective, cross-sectional study conducted at the University Hospital. All women were seen at the gynecology clinic. One hundred women aged between 18 and 45 years were included in the study; 50 women with polycystic ovary disease (PCOS) comprised the study group and 50 women without PCOS comprised the control group. The hormonal, metabolic and clinical profiles were assessed for both groups. Results: There are significantly higher levels of luteinizing hormone, prolactin, free testosterone dehydroepianosterone sulfate, 17?-hydroxy progesterone and fasting insulin in the study group. There were no differences in the levels of total testosterone, estradiol and cortisone levels between both groups. The levels of follicular stimulating hormone and sex hormone binding globulin were significantly lower in the study group. There were no differences in the blood sugar level, cholesterol, triglycerides and low- and high-density lipoproteins. The womens' ages, body mass index, blood pressure, uterine dimensions and endometrial thickness were similar in both groups. The size of both ovaries was significantly greater in the study group. There were more follicles in the ovaries of the study group. Conclusion: Hormonal profile of Saudi women with PCOS was similar with what is already published in the medical literature. But, despite the fact that Saudi women with and without PCOS are overweight, they do not suffer from raised blood pressure and metabolic syndrome; this may be due to the fact that women included in this study were relatively young and the sample size might be too small to draw effective conclusions.
Myalgic encephalomyelitis chronic fatigue syndrome Review of history, clinical features, and controversies
(2013) Speight, Nigel
Myalgic encephalomyelits/chronic fatigue syndrome (ME/CFS) has been both a medical mystery and a source of controversy in Western medicine for over 50 years. This article reviews the major historical developments over this period, describes the clinical pattern and spectrum of severity, and then explores the current major controversies surrounding the subject.
An encouraging start
(2013) Al-Quorain, AbdulazizBella, Hassan
Should we screen diabetic patients for vitamin D deficiency?
(2013) Al Turki, Yousef
A new Journal of Medicine and Medical Sciences
(2013) Al-Quorain, AbdulazizBella, Hassan
Role of universities in postgraduate training programs
(2013) Parashar, Shyam
Launching the Official Scientific Journal of the University of Dammam
(2013) Al-Rubaish, Abdullah
Factors associated with diabetic septic foot among patients attending the diabetic septic foot unit in the military hospital, Khartoum State, Sudan
(2013) Ahmed, Haidr; Balla, SihamAlhassan, Suzan
Diabetic septic foot (DSF) is a serious outcome complication of diabetes mellitus. Patients having DSF are at a high risk of amputations and surgical hazards. Aim: The aim of this study was to identify the self-care of foot and factors associated with DSF among diabetic patients attending the DSF unit in the Military Hospital. Materials and Methods: A case-control study was conducted among diabetic patients attending the diabetic clinic in the Military Hospital during May-June 2012. Thirty DSF cases and 30 controls were interviewed using a structured questionnaire and DSF was observed and graded by Wagner's classification. Statistical Analysis: Descriptive statistics of the cases was presented and Fisher's exact test was used to test the risk factors associated with DSF. Results: The mean age for the study groups was 55.60 ΁ 11.9 years. Based on the Wagner classification, 83.3% of septic feet were classified as grades 3, 4 and 5. Considering the delay in presentation with DSF to the hospital, 86.7% presented after 1 week up to more than 2 months from the start of the lesion. Low socioeconomic status, lack of self-care of foot, peripheral neuropathy and foot ischemia and deformity were associated with developing DSF (P-value < 0.05). Conclusion: Most patients with DSF seek care late and present with advance grade lesions. Lack of self-care of foot, peripheral neuropathy and foot ischemia and deformity are the risk factors of DSF.
Journal Impact Factor
(2013) Bella, Hassan
Multiple nasal polyps in an 11 year old asthmatic child: A case report
(2013) Helen, AkhiwuAliyu, Ibrahim
Childhood asthma is a common chronic respiratory disease; it may be associated with other co-morbidities which may influence its severity. Among these is chronic rhino sinusitis, conjunctivitis, or gastroesophageal reflux disease. However, nasal polyps are rare in asthmatic children, being more common in those more than 20 years. Its exact cause is not completely understood and it has been associated with sensitivity to non-steroidal anti-inflammatory drugs. In this communication we report a case of a 11-year-old boy with multiple nasal polyps and difficult to manage asthma.
Gastroesophageal reflux disease in children: A 2013 update
(2013) El Mouzan, Mohammad
Gastroesophageal reflux (GER) refers to the passage of gastric contents (acid, pepsin, etc) in the esophagus. It is a worldwide physiologic condition most common in infants. This physiologic condition (GER) should be differentiated from the pathologic reflux called gastroesophageal reflux disease (GERD). The distinction between GER and GERD is based on severity of the reflux episodes. ^[1],[2] The most common mechanism of reflux is transient lower esophageal sphincter relaxation (TLESR) and less commonly low resting LES pressure. ^[3] GER presents with regurgitation and occasional vomiting only without effects on growth and development whereas GERD usually has additional presentations. The objective of this review is to provide update on recent developments in the diagnosis and management of this condition.
Primary torsion of the omentum mimicking acute appendicitis in a female child Case report and review of literature
(2013) Mitra, Dilip; Al Buainain, Hessah; Elshafei, HossamPal, Kamalesh
Primary torsion of the omentum is an unusual cause of an acute abdomen and commonly mimics acute appendicitis. A case of primary omental torsion seen in a seven-year-old girl is discussed. All the signs and symptoms mimicked acute appendicitis. The patient underwent emergency laparotomy in which a normal appendix and serous fluid in the pelvis were observed. The pathological diagnosis was a primary torsion of the omentum which was excised. This case helps to emphasize the importance of a routine exploration of the abdomen when finding a normal appendix at the time of laparotomy.
Brain drain or brain retain?
(2013) Parashar, Shyam
Kawasaki disease A university hospital experience
(2013) Lardhi, Amer
Kawasaki disease (KD) is an acute vasculitis of unknown etiology; it is the leading cause of acquired heart disease in children. KD is poorly understood in the Kingdom of Saudi Arabia (KSA). bjective: To examine the epidemiological, clinical characteristics, and outcomes of KD in children diagnosed and treated at a tertiary care hospital in eastern province of the KSA. Materials and Methods: A retrospective study of 35 patients admitted to the hospital with the diagnosis of KD was conducted at King Fahd Hospital of the University, Al-Khobar, KSA, from 1992 to 2012. Demographics, clinical features, laboratory findings, treatment, and patient outcome were analyzed. Results: The incidence was 7.4 per 100,000 children under five. The male-to-female ratio was 1.9:1. The median age at diagnosis was 15 months, and the diagnosis was made after a mean of 8.1 days of fever. A seasonal peak during the winter-spring months was observed. Thirty-two patients (91%) had classical presentation of KD. Conjunctivitis, changes in the oropharynx, and a polymorphous rash were the most common manifestations. Cardiac involvement was detected in 51%, with coronary artery abnormalities (CAA) noted in 34%. Patients were treated with immunoglobulin and aspirin. The CAA regressed in all patients but one by 12 months. This one child still had persistent aneurysms at 2 years of follow-up. Conclusion: The findings of this study showed that the basic clinical and epidemiological features associated with KD, in the KSA, were similar to those reported from regions in other parts of the world. A nationwide survey, however, is necessary to investigate the overall incidence, potential risk factors, and magnitude of KD disease in the KSA.
β 2 adrenergic receptor gene polymorphisms in normal and in patients with myocardial infarction in the eastern province of Saudi Arabia
(2013) Al-Rubaish, Abdullah; Al-Shehri, Abdullah; Al-Ali, Abdullah; Al-Ali, Amein; Al-Nafaie, Awatif; Larbi, Emmanuel; Al-Muhanna, Fahd; Asselberg, Folkert; Al-Faraidy, KhalidShakil, Mohammed
Single nucleotide polymorphisms (SNPs) of the ?₂ -adrenergic receptor (?₂ -AR) gene have been implicated in the pathogenesis of cardiovascular diseases. This study evaluated two ?₂ -AR SNPs in association with myocardial infarction (MI), namely arginine-glycine (G16R) substitution at codon 16 and glutamine-glutamic (Q27E) substitution at condon 27. bjectives: Therefore, our main objective was to determine the association of these two SNPs among patients with MI with and without type 2 diabetes (T2D). Materials and Methods: Blood samples were collected from 201 MI patients with and without diabetes and from 115 controls and the ?₂ -AR gene polymorphisms at codon 16 and codon 27 were assessed by restriction fragment length polymorphism. The ?² test was used to compare differences between groups. Results: The SNPs did not deviate significantly from Hardy-Weinberg equilibrium in the control population. The allele and genotype frequencies of the ?₂ -AR gene polymorphism at codon 16 (G16R) was significantly different between MI cases and controls (?² = 10.495, P < 0.05 and ?² = 8.849, P < 0.05, respectively). No significant difference in genotype and allele frequencies at codon 27 was shown between these two groups (?² = 2.661, P ? 0.05 and ?² = 1.587, P ? 0.05, respectively). When the MI patients with and without T2D were pooled together, genotype distribution was different between cases and controls at codon 16 (?² = 4.631, P = 0.099) and codon 27 (?² = 7.247, P = 0.027). However, no significant differences were found in allele frequencies for codon 16 and codon 27 between the two groups (?² = 0.628, P = 0.428; ?² = 0.33, P = 0.565, respectively). Conclusion: Our findings indicate a moderate association of the ?₂ -AR G16R gene polymorphism with MI suggesting that this gene plays a universal role in the development of MI across ethnicities. However, there was no association of ?₂ -AR G16R gene polymorphism with diabetic patients with MI.
A perspective on wellness A physicians prescription for enhanced patient care
(2013) Vuturo, Anthony
With the beginning of the 21st century, medicine has seen the expansion of clinical interventions that could not have been predicted. Physicians trained in allopathic medicine embrace integrative medicine, prospective medicine, holistic medicine, and various permutations on comprehensive medicine. Recommendation for promoting wellness is often ignored. Wellness prescription complements every physician's practice irrespective of specialty. It requires physician to incorporate wellness strategy as a primary intervention. A prescription for wellness should include promotion of physical activity, healthy nutrition practices, management of stress, enhancements of individual relationships and recognizing awareness between mind, body, and spiritual components.

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