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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 Adult intussusception(2017) Almaghrabi, Ahmad; Alddin, Aiman; Alzamzami, AbdulrahmanSalih, MohamedAdult intussusception is rare. We report the case of an elderly female patient with an ileocecal intussusception who underwent resection and ileocolic anastomosis. The histology revealed chronic inflammation of the ileum and cecum and there was no evidence of malignancy. There was no evidence of malignancy. The appendix showed fibrous obliteration of the lumen.Item Author's reply(2017) Aliyu, Ibrahim; Kyari, FatimeIbrahim, ZainabItem Bronchiectasis and Focal Segmental Glomerulosclerosis in Rheumatoid Arthritis(2017) Chaudhuri, Arunabha; Tapadar, Sumit; Kar, Saurav; Saha, SayantanA 28-year-old male patient who was a nonsmoker presented with bilateral symmetrical polyarthritis and polyarthralgia, suggestive of rheumatoid arthritis (RA), along with shortness of breath, fever and cough, suggestive of chronic renal failure and nephrotic range proteinuria. The chest radiograph was suggestive of panacinar emphysematous changes with bilateral central bronchiectasis. The patient reported that two of his brothers had died in their third decade because of renal failure. Renal biopsy showed focal and segmental glomerulosclerosis (FSGS). FSGS with panacinar emphysema and bronchiectasis is a rare entity in RA patients, and considering the possibilities of a familial pattern of FSGS, transient receptor potential cation channel 6 channelopathy was the most valid diagnosis.Item Challenges in providing compassionate health care in current modern era of advanced technology(2017) Qidwai, WarisAbstract Not AvailableItem Clinicopathologic Patterns of Adult Renal Tumors(2017) Albasri, Abdulkader; El-Siddig, Abeer; Hussainy, Akbar; Alhujaily, AhmedBackground and Aim: Adult renal tumors (ARTs) are rare as compared with tumors of other organs and systems; however, it is important to have demographic and pathology data of rare tumors, including ART. No such data are available from the Kingdom of Saudi Arabia (KSA). Therefore, we aimed to study the demographic and pathological data of ART from King Fahad Hospital, Al-Madinah, KSA. Materials and Methods: This is a retrospective study of computerized data from the histopathology laboratory of King Fahad Hospital during a 10-year period (January 2006-September 2015). Results: There were 42 cases of ART, comprising 28 males and 14 females (male:female ratio of 2:1). The study group ranged in age from 17 to 83 years, with a mean of 54.5 years. In the study cohort, 93% of the patients had malignant tumors and 7% had benign lesions. Renal cell carcinoma (RCC) accounted for 85.8% of cases, followed by squamous cell carcinoma and sarcoma. The benign tumors recorded in our series were oncocytoma (4.7%) and angiomyolipoma (2.4%). The tumor size of RCC ranged from 4 to 17 cm, with a mean of 7.4 cm. The majority of patients (68%) had Fuhrman Grade II tumor. Gross capsular invasion, renal vein invasion and lymph node metastases were present in one case each. Conclusion: We conclude that the pathological findings of ART from the Madinah region are in concordance with studies in national and international literature.Item Common Findings in Blunt Thyroid Fracture(2017) Al-Khalifa, Muneera; Buali, Fatima; Alshehabi, MohamedAlthough blunt neck trauma is known to be rare, occurring in approximately 5% of all neck traumas, undiagnosed cases may have a devastating outcome. Physicians need to fully understand the mechanism of the injury and the external laryngeal trauma signs. A physician's precise diagnosis and proper management are necessary to avoid long-term complications or death. Although blunt laryngeal injuries are uncommon, prompt recognition of the subtle signs is crucial to avoid the catastrophic complications associated with such injuries. This case report aims to demonstrate the symptoms and signs of laryngeal injury in a young healthy male following a road traffic accident.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 Direct-Acting Oral Anticoagulants: An Overview(2017) Salem, HatemIn today's practice, an increasing number of patients are prescribed anticoagulant therapy. Short-term anticoagulation as a primary or secondary prophylaxis of thrombosis is standard of care in many clinical indications. In addition, there has been a significant increase in the number of patients receiving long-term full therapeutic anticoagulation, particularly among patients with atrial fibrillation and those with venous thrombosis having a high risk of recurrence. Therefore, clinicians and patients warmly accepted the timely introduction of non-Vitamin K antagonists to clinical practice. Anticoagulants such as anti-Xa and antithrombin have been found to be effective and safe as compared with the standard of care using low-molecular-weight heparin and warfarin. Importantly, the new anticoagulants exhibit rapid onset of action and do not require regular monitoring, making them convenient and user-friendly. Another interesting and consistent observation is that the new anticoagulants have a lower incidence of intracranial bleeding as compared with warfarin therapy. However, before prescribing these drugs, clinicians should check and periodically monitor the renal function of their patients, particularly when new drugs known to affect renal function are introduced. Clinicians should also be aware that these new anticoagulants cannot be considered as a replacement for warfarin in all indications. For example, warfarin remains the drug of choice in patients with prosthetic valves and in those suffering from the antiphospholipid syndrome. Finally, clinicians should be aware and adhere to the appropriate indications for the use of these new anticoagulants and use them at their approved dosage.Item Does Endotracheal Intubation Reduce the Incidence of Cardiopulmonary Complications in Upper Gastrointestinal Bleeding?(2017) Al-Quorain, AbdulazizAbstract Not AvailableItem Early-Onset Evans Syndrome in a 4-Month-Old Infant: A Case Report and Review of Literature(2017) Al-Mendalawi, MahmoodAbstract Not AvailableItem 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 Environmental protection procedures in improving air quality in the University of Dammam campuses(2017) El-Sharkawy, Mahmoud; Sebiany, AbdulazizContext: Campuses of the University of Dammam (UOD) have several sources of air pollution that can adversely affect human health, welfare and the overall efficiency of the educational process. Aims: This study was aiming to assess the role of environmental protection procedures in UOD and evaluate their impact on improving the air quality inside its campuses. Settings and Design: In both the new and old campuses, three different sites were selected to assess air quality level. Methods: Five air pollutants, in addition to environmental noise, were measured at all selected sites. These pollutants included particulate matter less than 10 microns (PM10), carbon monoxide (CO), sulfur dioxide (SO2), volatile organic compounds (VOCs) and nitrogen dioxide (NO2). The data were compared to pollutant levels, in the same locations, that were measured during a previous 6-year period, starting from 2008. Statistical Analysis Used: Results of this research were statistically analyzed by the Statistical Package for the Social Sciences (Version 16, SPSS Inc., Chicago, USA). Results: The highest mean ± standard deviation of PM10 (124.5 ± 25.0 μg/m3), CO (1.9 ± 0.7 ppm), VOCs (0.12 ± 0.09 ppm), NO2 (0.039 ± 0.022 ppm), SO2 (0.036 ± 0.047 ppm) and environmental noise (71.8 ± 4.1 dB) were found in the old UOD campus. Levels of all pollutants, except environmental noise, during the morning period were higher than those in the afternoon period. In addition, the level of the five air pollutants gradually reduced from 2008 to 2013, and reached to lower than their air quality guidelines. Conclusions: The administrative policies and management procedures of UOD had a positive effect on the level of ambient air quality and reflect the presence of a healthy and safe educational environment inside its campus.Item Evaluation of cathodic antigen urine tests for diagnosis of schistosoma mansoni infection in Sudan(2017) Amin, Mutamad; Elsadig, AbdelhafeizOsman, HussamKato–Katz is the preferred method for the detection of Schistosoma mansoni eggs in stool. However, the sensitivity of this method is low and affected by day-to-day variation in egg excretion. Cathodic antigen urine tests have been proven to be sensitive for the diagnosis of S. mansoni infection in limited studies. Aim: To evaluate the accuracy and sensitivity of cathodic antigen urine tests for the diagnosis of S. mansoni infection. Setting and Design: This study was conducted in the Gezira Irrigation Scheme in the Gezira State, Sudan. Both S. mansoni and Schistosoma haematobium are endemic in the Gezira State. Kab-Algidad Village situated in Al Kamleen locality was selected for the study. This is a school-based, cross-sectional, comparative study. Subjects and Methods: Female school children, aged between 11 and 14 years who consented to participate, were enrolled in the study. Stool samples were examined using Kato–Katz technique and sodium dodecyl sulfate (SDS) digestion method. Urine samples were tested using the circulating cathodic antigen assays for the diagnosis of S. mansoni, and by centrifugation for S. haematobium. Statistical Analysis Used: Data were analyzed using the Scientific Package for Social Sciences version 15. Results: Cathodic antigen urine tests showed similar sensitivity to SDS and higher sensitivity compared to six Kato–Katz (reference diagnostic test). Conclusion: Cathodic antigen urine tests is a useful tool for mapping S. mansoni and may be used to evaluate the interruption of transmission.Item Evaluation of Response to Hepatitis B Vaccination in Chronic Hemodialysis Patients(2017) Almueilo, SamirBackground: Hemodialysis (HD) patients are at an increased risk of acquiring hepatitis B virus (HBV) infection. Active HBV immunization in these patients is recommended. A response rate in HD patients is variable but generally lower than healthy individuals. Objective: The aim of this study is to assess the response of HD patients to the HBV vaccine and correlate response and long-term immunity to various clinical and biomedical factors. Patients and Methods: One hundred and one patients, with a mean age 48.7 +/- 18.5 years, received 40 mug of HBV vaccine administered intramuscularly in the deltoid region at 0, 1, 2 and 6 months. The patients' responses to the vaccine were determined by measuring hepatitis B surface antibody (HBsAb) 6 weeks after the last injection and monitored thereafter at 3-month intervals. Results: Seventy-one patients (70.3%) mounted a response with HBsAb >10 mIU/ml 6 weeks following the fourth dose of vaccine, and thus were considered considered as adequate responders. Forty-nine (48.5%) patients mounted an excellent response with HBsAb >100 mIU/ml 6 weeks after the fourth dose. Thirty patients (29.7%) were nonresponders. Responders were significantly younger than nonresponders (P = 0.01). Gender, hemoglobin level, serum albumin, ferritin, parathyroid hormone level and hepatitis C virus infection had no effect on the response to the vaccine. Similarly, there was no difference in diabetic state and adequacy of HD between the two groups. Fifty-nine patients (88%) had persistent protective antibodies at 1 year, while eight (12%) lost such protection. Predictors of persistent immunity at 1 year were high HBsAb level at the completion of the vaccination regime and, to a lesser extent, young age. Conclusion: A 70% response rate to HBV vaccine was observed in the cohort of this study. Young age predicts a favorable response to HBV vaccine in HD patients. High (>100 mIU/ml) HBsAb levels achieved at vaccine completion predict persistent immunity at 1 year.Item Frequency of root canal treatment among patients attending a teaching dental hospital in Dammam, Saudi Arabia(2017) Khan, Soban; Khabeer, Abdul; Al Harbi, Fahad; Arrejaie, Aws; Moheet, Imran; Farooqi, Faraz; Majeed, AbdulObjective: The purpose of the study was to evaluate the frequency and status of root canal-treated teeth in patients treated at the College of Dentistry, University of Dammam in the Eastern Province of Saudi Arabia. Materials and Methods: A total of 3701 patients visited the clinics during the study period. Through the use of radiographs, 161 patients were initially selected who had endodontically treated teeth. However, after applying the inclusion criteria, the total number of eligible cases was reduced to 155. Patients were divided into three groups according to age (children 1–12 years, adults 13–65 years and geriatrics >65 years). Results: On average, each patient had 2.28 ± 1.88 root canal-treated teeth and 24.02 ± 5.03 teeth without root canal treatment. The average number of endodontically treated teeth increased with an increase in age. The adult group showed the highest number of root-filled teeth 314 (93.4%). Of the 336 endodontically treated teeth, only 75 (22.3%) teeth exhibited periapical radiolucency. First molars (28.43–36.36%) and second premolars (20.1–27.27%) were the most frequently root-filled teeth in both jaws, followed by the first maxillary premolars (11.76%). Periapical lesions showed an almost similar pattern with the highest number of radiolucencies found in the first molars in both jaws (29.3–33.3%) followed by the second premolars in the mandible (30.6%) and first premolars in both jaws (20.8–25%). Conclusion: The first molars and second premolars were the most frequently root-filled teeth in both jaws, followed by maxillary first premolars. Periapical lesions showed an almost similar pattern among teeth with a higher number of radiolucencies found in the first molars in both jaws, followed by the second premolars in the mandible and the first premolars in both jaws.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 Health professionals' perspectives on breastfeeding support practices(2017) Al-Madani, Maha; Abu-Salem, LailaBackground: The decrease in rates of exclusive breastfeeding has resulted in increased rates of infant mixed feeding. The WHO Baby-Friendly Hospital Initiative (BFHI) has been associated with significant increases in breastfeeding initiation and duration in maternity hospitals. However, little is known about whether or not the teaching hospital of the University of Dammam, Saudi Arabia, followed the ten steps recommended in the BFHI. O bjectives: This study was carried out to assess healthcare professionals' perspectives and opinions about the breastfeeding support practices at the teaching hospital. Materials and Methods: This research is a mixed methodology cross-sectional study carried out in the King Fahd Hospital of the University, Al-Khobar, Saudi Arabia. The first phase used a self-administered questionnaire to assess professionals' awareness and opinions about actual breastfeeding practices. The first phase results led to a qualitative interview design for the second phase. Descriptive statistics were used to describe and summarize the data. The chi-square test was used to examine the difference between the observed and expected frequencies of normal data. Results: There were no breastfeeding supporting policies followed at the hospital as per those recommended by BFHI. Mothers with breastfeeding problems were not referred for help and follow-up phone calls were not made to postpartum women after discharge. Healthcare professionals indicated that there were no hospital-based breastfeeding support groups, lactation consultants/specialists or lactation management unit available. Conclusions: There is a need for breastfeeding support policies, practices and staff education to facilitate care consistent with the ten steps of the BFHI. Further study is needed to assess mothers' perspectives on breastfeeding approaches at the King Fahd Hospital of the University.Item Hepatitis B and C viral infections in Tihamet Aseer, south-western Saudi Arabia: Are there gender differences?(2017) Al-Humayed, SulimanBackground: Hepatitis B virus (HBV) infection is endemic in Saudi Arabia. Many studies have shown varying results in gender differences in HBV and hepatitis C virus (HCV) infection. The objective of this study was to determine if gender differences exist in HBV and HCV infection and to elucidate any related risk factors in Tihamet Aseer, south-western Saudi Arabia. Materials and Methods: The study was a cross-sectional study of a representative sample of males and females in Tihamet Aseer, south-western Saudi Arabia. A comprehensive questionnaire was completed by all participants. Blood samples were taken and sera were tested for hepatitis B surface antigen and HCV antibodies by fourth-generation enzyme immunoassays. Results: The study included 1532 participants from the Tihamet Aseer area. An overall seroprevalence of 7.9% and 1.7% was found for HBV and HCV infections, respectively. In logistic regression analysis, no gender differences were found for HBV seroprevalence. Identified risk factors for HBV infection included a history of blood transfusion and lack of hepatitis B vaccination. On the other hand, females were more prone to become seropositive for HCV (adjusted odds ratio = 5.034, 95% confidence interval: 1.042–9.321). Other identified risk factors for HCV infection were illiteracy and a history of blood transfusion. Conclusion: The prevalence and HBV and HCV infection is high compared to the national figures. Gender differences were only observed in HCV infection. It is recommended to have an active educational and media campaign. A “catch-up” vaccination program against HBV should be introduced for adults as a strategy to achieve the herd immunity effect in the affected area.
