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Acute back pain: A survey of primary health care physicians' awareness and knowledge of "red flag" signs
(2016) Alluhaidan, Abdullah; Chaudhry, Habib; Alrefayi, Hesham; Alsaleh, Khalid; Algarni, Nizar; Alsaran, YazeedShakoor, Zahid
The failure to detect "red flag" signs in patients presenting with acute low back pain can adversely affect the outcome of management. This can seriously affect the quality of life and productivity of the patient. Objective: The present questionnaire-based study was performed to assess the knowledge and awareness of red flag signs among primary health care physicians managing patients with acute back pain in Riyadh, Saudi Arabia. Materials and Methods: The study sample size was comprised of 80 subjects. The level of knowledge was assessed by means of a new structured self-administered questionnaire. The design of this questionnaire was based on the Agency for Health Care Research and Policy (AHCRP) guidelines for detection of red flag signs. Physicians were asked about red flag signs that indicate the presence of tumor, infection, spinal fracture, or cauda equina syndrome. Results: Sixty-eight (85% of total) physicians were aware of red flag signs. Of the 68 physicians who were aware of the red flag signs, 58 (72%) were aware of neurological deficit, 36 (45% of total) were aware of extremes of age (<10 years and >50 years), and 33 (41% of total) were aware of and routinely inquired about the history of spinal trauma, whereas only 24 (30% of total) were aware of and inquired about constitutional symptoms in their patients with acute back pain. Conclusion: Although low back pain is extremely common, knowledge and awareness of red flag signs of primary health care physicians managing patients with acute back pain in Riyadh appear to be inadequate. This indicates a lack of adherence to the international guidelines. Specific educational programs should target these deficiencies and increase awareness.
Acute fatty liver of pregnancy mimicking puerperal sepsis: Report of a case with literature review
(2016) Wani, Abdullah; Al-Lehibi, Abed; Alqutub, AdelMasoodi, Ibrahim
Puerperal pyrexia is defined as fever in a woman within 6 weeks of giving birth, which is ≥38°C. We describe the clinical scenario of fever and progressive jaundice in a 32-year-old female in the postpartum period. The laboratory data showed normal leukocytic counts and all her septic screen was noncontributory. While in the hospital, her bilirubin levels progressively increased and showed a mild elevation of liver enzymes. There was no evidence of biliary obstruction. A liver biopsy clinched the diagnosis of acute fatty liver. Acute fatty liver of pregnancy is a rare but serious complication of pregnancy. It typically presents in the third trimester and can lead to multi-organ failure and death. This report highlights the importance of liver biopsy and an atypical presentation of fatty liver of pregnancy.
Acute painful polyneuropathy after bariatric surgery
(2016) Al-Sulaiman, Abdulla
The prevalence of morbid obesity is increasing worldwide, which over the past decade, has resulted in an increase in the number of obese patients undergoing bariatric surgery. All surgical procedures carry a varying degree of risk; however, bariatric surgery is specifically associated with a number of metabolic, nutritional, and neurological complications. The neurological complications include encephalopathy, peripheral neuropathy, myelopathy, plexopathy, and radiculoneuropathy. This case report involves an 18-year-old female who underwent successful bariatric surgery for morbid obesity. Postoperatively, the patient developed severe painful weakness of the lower limbs and was found to have diffused sensory motor polyneuropathy. It was concluded that sensory-motor polyneuropathy was the most likely cause of the patient's weakness. Reporting this case is important as the author believes that the consequences of bariatric surgery may not be well-known to both patients and surgeons.
Adrenal insufficiency and mild rhabdomyolysis revealing a human immunodeficiency virus infection: A case report
(2016) Berkhli, Hayat; Haddiya, Intissar; Hamaz, SihamBentata, Yassamine
The spectrum of human immunodeficiency virus (HIV) endocrinopathy is large. Adrenal insufficiency (AI) is common in both early and late stages of HIV syndrome, resulting in significant morbidity and mortality. However, rhabdomyolysis is a muscle disease in which striated muscle fibers disintegrate, excreting myoglobin in the urine, leading to acute kidney failure. It is currently reported that rhabdomyolysis may be a direct result of the HIV infection, especially in the advanced stages of HIV/AIDS disease. This case study reports AI and a mild rhabdomyolysis in a patient with no medical history and no medicine or toxic intake. Laboratory assessment revealed HIV infection.
Attitude and experiences of undergraduate dental students and interns towards research
(2016) Rejaie, Aws; Farooqi, Faraz; Moheet, ImranKhan, Soban
This study was designed to evaluate the perception of students and interns toward research. Materials and Methods: The study was conducted in January 2014. Participants of the study were fourth, fifth, and 6 ^th year students and interns. A questionnaire comprised thirteen questions was distributed to evaluate students' and interns' perception about the importance of research in their learning. Results: The results showed that interns and 6 ^th year students were more interested in research as compared to their junior counterparts as they realized the importance of research in their educational growth. This was reflected by the number of interns who completed the questionnaire. Conclusion: Dental students realized the importance of research in the education, but it was found that the proportion of students who did research as part of their course was very low. Students should be actively engaged in research, which can be achieved by introducing research as a compulsory component of their course.
Author's Reply
(2016) Al-Zahrani, Mai
The broken link: Admission criteria for inpatient rehabilitation and some common misconceptions
(2016) Qureshi, Ahmad; Williamson, LaneitaJenkins, Randolph
A case report of a patient with linear verrucous hemangioma
(2016) Singh, HarneetSandhu, Ivy
Verrucous hemangioma is a structural variant of capillary or cavernous hemangioma in which reactive epidermal acanthosis, papillomatosis, and hyperkeratosis are secondary developments. It usually presents at birth, but may appear later in adult life. Often misdiagnosed clinically as angiokeratoma, its distinct histopathology helps to differentiate the two. It has the tendency for recurrence if not treated by wide excision. We report a case of 22-year-old male who had linear verrucous hemangioma on his left leg since childhood. The purpose of reporting it is the rarity of the case and the possibility of recurrence, if not treated by wide excision and skin grafting.
Chronic foreign body aspiration in a Saudi child - an occult cause of chronic pulmonary disease: Case report and literature review
(2016) Al-Mendalawi, Mahmood
Climate change and potential impact on disease: What are the public health agenda?
(2016) Taha, Taha
Globally, the impact of climate change on human health is widely discussed. There are several mechanisms how environmental variability can influence the occurrence of diseases that are communicable or noncommunicable. The biophysical underlying causes of climate changes are not proportionately distributed between developed and developing countries. Developed countries contribute more greenhouse emissions, but the population health effects of climate change are estimated to be higher in developing countries compared to developed countries. Therefore, examination of challenges associated with climate change should be a priority. In the countries of North Africa and the Middle East, a clear public health agenda needs to be developed, even if local/regional factors contributing to unpredictable climatic changes are not well-known. Targeting risk factors associated with noncommunicable diseases, and adopting lifestyle changes are interventions to consider.
The controversial health effects of the mobile phone on cognitive function, sleep, brain tissues, hearing, fertility and reproductive system
(2016) Al Turki, Yousef
Cyclic vomiting syndrome
(2016) Kundal, Bharti; Chopra, GurikaAiman, Shah
Cyclic vomiting syndrome (CVS) consists of recurrent paroxysms of severe nausea and vomiting separated by symptom-free periods. A 12-year-old boy presented with recurrent vomiting over a period of 3 years. Episodes occurred over a period of 6 months, and the patient remained normal for next 6 months. About 8 such episodes occurred in the last 6 months. Physical and neurological examinations were normal. All routine investigations were normal. He was started on cognitive behavioral therapy and cyproheptadine and improved gradually. CVS is considered a functional brain-gut disorder and is characterized by recurrent, sudden, stereotypical, disabling, discrete episodes of intense nausea and vomiting that can last a few hours to days interspersed with varying weeks of symptom-free intervals. Integrated treatment combining pharmacological, psychotherapeutic, psycho-educational and lifestyle aspects as well as family therapy provides the best chances of successful treatment.
Delivering pulmonary rehabilitation for patients with chronic obstructive pulmonary disease at home using telehealth: A review of the literature
(2016) Almojaibel, Abdullah
Pulmonary rehabilitation is recommended to restore chronic obstructive pulmonary disease (COPD) patients' abilities to the highest level of independency and functionality. Telehealth has the potential to improve rehabilitation programs and to enhance patients' participation. However, little is known about the potential benefits of using telehealth in providing rehabilitation for COPD patients at home. The purpose of this review was to provide a narrative synthesis of literature of studies, which use telehealth with video components to provide real-time pulmonary rehabilitation for COPD patients. An electronic database search was performed in the Ovid Medline, CINAHL, and PubMed databases. Seven eligible studies were included based on the inclusion criteria. Based on the included studies, using telehealth to provide real-time interactive pulmonary rehabilitation for COPD patients at home is feasible and acceptable, and can provide clinical and social positive benefits. A knowledge gap regarding feasibility, acceptance, and benefits of using telehealth to provide real-time pulmonary rehabilitation services still exists.
Does serum albumin level affect the healing outcomes of simple diaphyseal tibial fractures?
(2016) Mahdi, Abbas; Singh, Ajai; Shantanu, Kumar; Srivastava, RajeshwarAli, Sabir
To quantify the serum albumin level and its correlation with fracture healing progression and outcomes in adult patients. Settings and Design: A prospective cohort study at an institutional trauma center. Materials and Methods: A total of 50 adult patients with simple, fresh traumatic diaphyseal fractures of both bones of the leg managed conservatively were included in the study. Serum albumin was measured initially and at the 6 ^th week postfracture. The clinico-radiological follow-up was done to analyze the fracture healing progression and their final outcomes, which were correlated with the quantified serum albumin level of the patients. Statistical Analysis Used: Student t-test, Mann-Whitney U-test and Pearson correlation coefficient. Results: As per the last clinico-radiological follow-up at the 24 ^th week, patients were grouped into two groups: Group I (normal union n = 38) and Group II (impaired healing n = 12). The mean serum albumin levels were significantly higher in Group I when compared to Group II. The association between the serum albumin level at baseline and at the 6 ^th week was moderate. The best cut-off measure of serum albumin level was 3.45 g/dL, both at baseline and at the 6 ^th week after fracture to predict the healing outcome. The correlation of serum albumin levels with fracture healing outcomes was statistically significant. Conclusion: Serum albumin is moderately associated with the baseline and 6 ^th -week values and showed a positive correlation with the bony healing progression and may provide an early predictor of the healing outcomes of simple diaphyseal tibial fractures.
Dreadful twins: Twin unruptured aneurysms of bilateral intracranial arteries
(2016) Sharma, Ankush; Gupta, Munish; Gupta, NitinSharma, Shivam
Intracranial aneurysms are the most common cause of subarachnoid hemorrhage which carries a significant risk of mortality. Mirror aneurysm constitute between 5-12% of all the intracranial aneurysms. These are uncommon entities with poorly understood pathogenesis and clinical significance.
Effects of chocolate intake on oxidative stress/oxidant-antioxidant balance in medical students: A controlled clinical trial
(2016) Alsunni, AhmedLatif, Rabia
Cocoa polyphenols have been shown to exhibit antioxidant properties in vivo and in vitro. This study aimed to determine whether commercially available chocolate could improve oxidant/antioxidant balance in medical students. Materials and Methods: Sixty students (30 males and 30 females) were given three different types of chocolate. Subjects were divided equally into three groups of 20 students (10 males and 10 females) as follows: (i) Dark chocolate group (DC), (ii) milk chocolate group (MC), and (iii) placebo group (PC). The placebo group was given white chocolate. Blood was drawn at baseline and after consumption of chocolate (40 g/day) for 2 weeks. Serum was analyzed for DNA/RNA oxidative damage, thiobarbituric acid reactive substances (TBARS), superoxide dismutase (SOD), and glutathione peroxidase (GPX) enzymes. Descriptive analyses were conducted to determine the frequency distributions of the study variables. Means were compared across the study groups by one-way Analysis of Variance and within the same group by paired t-test. Results: Mean serum DNA/RNA damage, TBARS, SOD, and GPX enzymes compared between the groups revealed insignificant differences after 2 weeks of chocolate consumption (P = 0.46, 0.19, 0.11, and 0.06). Comparison within the same group also exhibited statistically insignificant differences in DNA/RNA damage in DC and MC groups (0.29 and 0.46, respectively); TBARS in DC and MC groups (0.11 and 0.19, respectively); SOD in DC and MC groups (0.06 and 0.11, respectively); and GPX in DC and MC groups (0.68 and 0.78, respectively). Conclusion: Consumption of 40 g of DC or MC daily for a period of 2 weeks appears to be an ineffective way of improving oxidant/antioxidant balance in medical students.
An enigma of the gallbladder
(2016) Al-Mulhim, Abdulmohsen; Alaqeel, Faten; Saleh, KhaldoonAlaqeel, Saja
Etiology of recurrent pregnancy loss in Saudi females
(2016) Al-Ghamdi, AhlamMakhashen, Sawsan
The aim of our retrospective study was to assess the etiology of recurrent pregnancy loss (RPL) in Saudi couples attending a specialized RPL clinic at King Fahad Hospital of the University, Al-Khobar, Saudi Arabia. Patients and Methods: A total of 59 couples attending the RPL clinic between January 2010 and December 2013 and who had completed their workup and investigations for RPL were included in the study. Data were collected from patients' charts and computer-based laboratory results. Results: Protein S deficiency was found in 47% of patients, a chromosomal abnormality in 6.7%, uterine abnormality in 12%, antiphospholipid syndrome (APS) in 12%, and antithrombin III and Protein C deficiency in 1.7%. However, no patient had Factor V Leiden mutation. In 39% of the patients, there was no identifiable cause, and therefore, they had been diagnosed as unexplained RPL. Conclusion: The most common cause of RPL was Protein S deficiency followed by congenital uterine anomalies and APS. Almost 40% of couples with RPL remain with unknown etiology.
Familial intracranial aneurysm
(2016) Ammar, Ahmed
Familial intracranial aneurysms in Saudi Arabia: What do we need to do?
(2016) Shiekh, Bassem; Al-Jehani, Hosam; Yamani, MahmoudOrz, Yasser
Aneurysmal subarachnoid hemorrhage (SAH) is a devastating event with significant morbidity and mortality. The incidence of SAH might be influenced by environmental factors but genetic predisposition is evolving as an important effector in the risk of development of intracranial aneurysms and rupture of aneurysms. This requires strategies for effective screening of family members at risk of developing such a phenotype, in order to deliver preventive treatment to these target lesions. We discuss the potential for implementing these strategies in the Saudi Arabian health system and the future implications on our care for such a vulnerable group of subjects.

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