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Acetabular Remodeling after Closed Reduction of Developmental Dysplasia of the Hip
(2018) Al Shehri, Hayazi; Mahmoud, Asim; Ateeq, Saleh; Alamrani, Amal
Objectives: This study aims to assess the radiographic development of the acetabulum after closed reduction of developmental dysplasia of the hip in patients with different follow-up periods. Methods: The authors undertook a retrospective review of clinical records and radiographs of children who were diagnosed with developmental dysplasia of the hip and underwent closed reduction (mean age at closed reduction: 8.6 months) at King Khalid Civil Hospital, Tabuk, Saudi Arabia. Patients with a follow-up period <12 months were excluded from the study. Acetabular index angles for anteroposterior pelvic radiograph before treatment and at the final follow-up were used to assess acetabular development. Patients were divided into four groups according to the follow-up period and then the acetabular index was compared. Results: A total of 64 dislocated hips of 40 patients were included in the study. The average follow-up period was 33.9 months (range: 12–82 months). Mean acetabular index before closed reduction was 34.37° (range: 25–46°), whereas the mean acetabular index after closed reduction was 23.8° (range: 10–37°). All groups showed improvement in the acetabular coverage and the acetabular index was significantly higher in groups with a longer follow-up period. Conclusions: This study found that successful closed reduction of congenitally dislocated hips within the recommended age results in better acetabular development (coverage) and this improvement is more evident in patients with a longer follow-up period. Further studies can consolidate these results and help define the criteria for deciding early acetabuloplasty.
Adhesive Small Bowel Obstruction Due to Pelvic Inflammatory Disease: A Case Report
(2018) Al-Ghassab, Razan; Tanveer, Shumaila; Al-Lababidi, Noor; Zakaria, Hazem; Al-Mulhim, Abdulmohsen
We report a rare case of a 32-year-old woman with adhesive small bowel obstruction due to pelvic inflammatory disease. She had no history of abdominal surgery, gynecological complaints or constitutional symptoms of chronic illness. The diagnosis was based on the laparoscopic findings of small bowel adhesions, free peritoneal fluid, “violin string” adhesions of Fitz-Hugh–Curtis syndrome and left hydrosalpinx. Laparoscopic adhesiolysis was performed successfully, and the patient had an uneventful postoperative course. The authors conclude that pelvic inflammatory disease should be included as a cause of adhesive small bowel obstruction in sexually active young women with no history of abdominal surgery or constitutional symptoms of chronic disease. When performed by experienced surgeons, laparoscopy in such patients is feasible and safe.
Association of Flying Time with Hearing Loss in Military Pilots
(2018) Al-Omari, Abdulrhman; Al-Khalaf, Hani; Hussien, Naglaa
Background: Military pilots are exposed to harmful noise levels, and the two possible effects of this are hearing loss and tinnitus. Objective: This study was conducted to determine the prevalence of noise-induced hearing loss among Saudi military pilots and to determine its association with total flight hours and aircraft type (i.e., fixed and rotary wing). Materials and Methods: This cross-sectional study was conducted at the Armed Forces Aeromedical Centre, Dhahran, Saudi Arabia, between November 2015 and October 2016. A total of 150 Saudi military pilots were interviewed using a structured questionnaire. Pure-tone audiometry was used to measure hearing thresholds. Hearing threshold levels were compared between age groups and aircraft category. The association between total flying hours and the development of noise-induced hearing loss was analyzed. Results: The overall prevalence of noise-induced hearing loss in the military pilots was 18.4%, with a higher prevalence among fixed-wing pilots (42%) as compared with rotary-wing pilots (23%). Pilots with ≥2000 flying hours had a significantly higher hearing threshold compared with those in other categories. Age was a statistically significant risk factor. Conclusions: This study found that active pilots of both fixed- and rotary-wing aircrafts are at a high risk of noise-induced hearing loss; however, fixed-wing pilots with ≥2000 flying hours are at a higher risk. These findings support recommendations requiring instructions on the proper use of hearing protection devices to avoid noise-induced hearing loss.
A Case of Trigeminal Schwannoma Presenting as a Parasellar Mass
(2018) Al Anazi, Abdulrahman; Hendam, Ahmed; Al-Nemer, Areej; Al Anazi, Feras
Schwannoma's of considerable size arising from the trigeminal nerve are very rare. Here, a case of a large right-sided parasellar mass diagnosed as a trigeminal schwannoma is reported. Complete resection of the tumor was successfully achieved. The patient had an excellent postoperative course.
Clinical Profile and Outcome of Parathyroid Adenoma-Associated Pancreatitis
(2018) Aslam, Mohsin; Talukdar, Rupjyoti; Jagtap, Nitin; Rao, G; Pradeep, Rebella; Rao, Upendar; Reddy, D
Background: Primary hyperparathyroidism due to parathyroid adenoma presenting with pancreatitis as the initial manifestation is rare. The causal relationship between pancreatitis and primary hyperparathyroidism is debatable. Objective: To study the clinical and biochemical profile of patients with parathyroid adenoma-associated pancreatitis as well as the outcome following parathyroidectomy. Methods: The authors retrospectively studied the clinical and biochemical parameters of patients with acute, recurrent acute and chronic pancreatitis who underwent parathyroidectomy for parathyroid adenoma at Asian Institute of Gastroenterology, Hyderabad, India, between April 2010 and June 2016. Results: Of the total 3962 patients who presented with recurrent acute and chronic pancreatitis, 77 (1.94%) patients had parathyroid adenoma-associated pancreatitis and were included in this study for further analysis. Of these, 41 (53.2%) had recurrent acute pancreatitis and 36 (46.8%) had chronic pancreatitis. Serum calcium (12.4 ± 1.7 mg/dl) and parathyroid hormone levels (367 ± 286.4 pg/ml) were found to be elevated. Left inferior parathyroid adenoma (37.7%) was the most common finding on neck imaging. Patients with chronic pancreatitis had a longer disease duration (3.8 ± 5 years) and more pain episodes (10.7 ± 10.2) than those with recurrent acute pancreatitis (0.62 ± 0.7 years and 2.6 ± 2.7, respectively) (P = 0.0001). In all the patients, following parathyroidectomy, there was a significant decrease in serum calcium (12.4 ± 1.7 mg/dl vs. 9.7 ± 1.9 mg/dl; P = 0.0001) and serum parathyroid hormone levels (367 ± 286.4 pg/ml vs. 116.4 ± 47.1 pg/ml; P = 0.0001) as well as there was a reduction in the number of episodes and severity of pain. Conclusions: Estimating serum calcium after an episode of unexplained pancreatitis is important and can help minimize delay in diagnosing primary hyperparathyroidism, and possibly prevent the progression of pancreatitis. Parathyroidectomy improves the clinical outcome of primary hyperparathyroidism and prevents further attacks of pancreatitis.
Closing Gaps in Diabetes Care: From Evidence to Practice
(2018) Ba-Essa, Ebtesam; Abdulrhman, Sahar; Karkar, Mayson; Alsehati, Basima; Alahmad, Saleh; Aljobran, Ali; Aldijwi, Abdulaziz; Alhawaj, Ali
Background: Tracking progress in diabetes care may help in evaluating the quality of efforts and identifying gaps in the care. Objectives: To demonstrate that tracking important clinical indicators of diabetes mellitus can result in improved care as well as help identify and close gaps between evidence and practice in diabetes care. Subjects and Methods: The study is an observational, random audit of medical records of patients with diabetes who received care at the Diabetes Center, Dammam Medical Complex. Thirteen process and four outcome key performance indicators were studied using the quality improvement Plan-Do-Study-Act model, for the period between October 2012 and March 2016. Individual physician performance was also measured for the same duration. All data were benchmarked against peer organizations worldwide. Results: Urine examination for proteinuria, foot examination, annual influenza vaccination, aspirin prescription, structured education, personalized nutritional advice and self-monitoring of blood glucose significantly improved between baseline and the final observation of the study (P < 0.001). The proportion of patients with hemoglobin A1c >9% decreased, and that of those who achieved the recommended levels of hemoglobin A1c (<7%), low-density lipoprotein cholesterol (<2.6 mmol/L) and blood pressure (<140/90 mmHg) significantly increased (P < 0.001). Benchmarking against peer organizations worldwide showed comparable results overall, and better results for certain indicators. Conclusion: Quality improvement strategies and key performance indicators can be utilized to improve the quality of diabetes care delivered, and thus reduce gaps and barriers that exist between recommended diabetes care and practice.
Cutaneous Polyarteritis Nodosa Treated with Pentoxifylline and Clobetasol Propionate: A Case Report
(2018) A. Alquorain, Nada; H. Aljabr, Abdullah; Alghamdi, Nada
Cutaneous polyarteritis nodosa (cPAN) is a rare type of cutaneous vasculitis. It affects the small- and medium-sized arteries of the dermis and subcutaneous tissue without extracutaneous involvement. The diagnosis is by skin biopsy, and the characteristic finding is a leukocytoclastic vasculitis. We report a case of a 14-year-old Saudi girl who was referred to the dermatology service because of multiple ulceronecrotic lesions on the frontal aspects of the distal lower limbs. She had past medical consultations and treatment but without improvement. The histopathology confirmed the clinical diagnosis of cPAN, and ultimately, she responded to treatment with pentoxifylline and topical clobetasol propionate. It is important to be aware of this disease and refer the patient to the dermatology service for the appropriate evaluation and treatment. Cutaneous polyarteritis nodosa is a rare type of cutaneous vasculitis. It affects the small- and medium-sized arteries of the dermis and subcutaneous tissue without extracutaneous involvement. The diagnosis is by skin biopsy, and the characteristic finding is a leukocytoclastic vasculitis. The authors report a case of a 14-year-old Saudi girl who was referred to the dermatology department because of multiple ulceronecrotic lesions on the frontal aspects of the distal lower limbs. She had past medical consultations and treatment, but without improvement. Histopathology confirmed the clinical diagnosis of cutaneous polyarteritis nodosa, and ultimately, she responded to treatment with pentoxifylline and topical clobetasol propionate. It is important to be aware of this disease and refer the patient to dermatologists for the appropriate evaluation and treatment.
Dental Visit Patterns and Oral Health Outcomes in Saudi Children
(2018) AlHumaid, Jehan; El Tantawi, Maha; AlAgl, Adel; Kayal, Shaden; Al Suwaiyan, Zainab; Al-Ansari, Asim
Background: Health education advocates regular dental visits to improve oral health. There is a need to verify the outcomes associated with various dental visits patterns. Objective: To assess the relationship of reported and clinically assessed oral health outcomes in Saudi children with their dental visits' pattern. Methods: This cross-sectional study included 6–12-year-old schoolchildren from six cities in the Eastern Province of Saudi Arabia in 2015. Parents responded to a questionnaire about dental visit patterns. Through a clinical examination, the presence of caries, sealants and need for referral was assessed. Univariate and multivariate regression was used to assess the association between dental visit patterns and pain in the past 6 months, presence of untreated caries and need for referral after controlling for confounders. Results: Of the 3000 questionnaires distributed, 2306 (76.9%) parents responded. Significantly higher odds of pain were associated with visiting when in dental pain (odds ratio = 6.81) and never visiting a dentist (odds ratio = 3.44), whereas significantly lower odds were associated with regular checkups (odds ratio = 0.28). No significant association was observed with visits after recall by dentists. Conclusion: Regular checkups initiated by parents are associated with better reported oral health outcomes in terms of pain, while recall by dentists has no impact on oral health.
Depression among Sickle Cell Anemia Patients in the Eastern Province of Saudi Arabia
(2018) Alhomoud, Mohsen; Gosadi, Ibrahim; Wahbi, Hayfaa
Objectives: To determine the prevalence of, and factors associated with, depression among sickle cell anemia adult patients in the Eastern Province of Saudi Arabia. Materials and Methods: A cross-sectional study was conducted between December 2014 and May 2015 among sickle cell anemia patients aged 16–70 years from the outpatient hematology clinics at Qatif Central Hospital. A total of 110 successive participants consented and answered an anonymous, self-administered, questionnaire and the Arabic version of the Beck Depression Inventory-II. Individuals were considered depressed if they scored ≥14 in Beck Depression Inventory-II. Simple logistic regression was used to compare differences between the depressed and nondepressed groups. Odds ratios (ORs) with 95% confidence intervals (95% CI) were reported. Results: Depression was detected in 53 participants (48.2%). Bivariate analysis showed that lower educational qualification (OR = 2.5; 95% CI = 1.1–5.3; P = 0.021), higher frequency of vaso-occlusive crises (OR = 3.4; 95% CI = 1.3–8.7; P = 0.008) and frequent visits to the hematology clinic (OR = 5.3; 95% CI = 1.4–19.9; P = 0.008) were significantly associated with depression. Conclusion: This study revealed that there is high prevalence of depression among sickle cell anemia patients in the Eastern Province of Saudi Arabia.
Diagnosing Incomplete Kawasaki Disease
(2018) Aljishi, Fatimah; Alsinan, Adil; Almadan, Bashayer; Almokhtar, Reem; Alsinan, Tuqa
Abstract Not Available(Letter to the Editor)
Diagnostic and Therapeutic Applications of Endoscopic Ultrasound
(2018) Aljahdli, Emad
Abstract Not Available( Editorial)
Effect of erbium laser on microtensile bond strength of fissure sealant in primary teeth: An in vitro study
(2018) AlHumaid, Jehan; Alagl, Adel; Bedi, Sumit
Background: Laser etching has several advantages as compared with conventional acid etching. However, results of earlier studies on conditioning surfaces with erbium, chromium:yttrium–scandium–gallium–garnet (Er, Cr:YSGG) before application of the fissure sealant have been inconclusive. Aim: The study aimed to evaluate the microtensile strength of resin-based fissure sealant bonded to primary enamel conditioned by Er, Cr:YSGG laser with varying power outputs. Materials and Methods: Fifty sound primary first molars were randomized into the following five groups based on pretreatment choice: Group 1: 3.5 W laser etching + acid etching; Group 2: 2.5 W laser etching + acid etching; Group 3: 3.5 W laser etching with no acid; Group 4: 2.5 W laser etching with no acid and Group 5: acid etching with no laser. Acid etch was performed with 35% orthophosphoric acid for 30 s. Laser etching was performed with Er, Cr:YSGG (2780 nm) laser using G6 tips and 600 μm diameter, 2.5 W or 3.5 W power outputs, pulse duration of 140 μs and a repetition rate of 20 Hz. Sealant was applied on the buccal surface followed by an incremental buildup with composite resin. Microtensile bond strength was assessed and compared among the five groups using one- and two-way ANOVA. Results: There was no statistical difference in the mean bond strength between groups except in Group 4 (9.66 MPa) (Group 1: 15.57 MPa; Group 2: 14.18 MPa; Group 3: 14.78 MPa; Group 5: 14.63 MPa). Conclusion: Pretreatment with 3.5 W Er, Cr:YSGG laser alone results in microtensile bond strengths similar to that produced by acid etching, indicating that enamel etching using 3.5 W Er, Cr:YSGG laser would result in the long-term success of pit and fissure sealants in primary teeth.
Effect of Vitamin D and Calcium Supplementation in Patients with Systemic Lupus Erythematosus
(2018) Al-Kushi, Abdullah; Azzeh, Firas; Header, Eslam; ElSawy, Naser; Hijazi, Haifa; Jazar, Abdelelah; Ghaith, Mazen; Alarjah, Mohammed
Background: Systemic lupus erythematosus is a chronic autoimmune disease that increases the risk of suboptimal vitamin D levels. Aim: To determine the effects of vitamin D and calcium supplementation on disease activity, related immune markers and bone mineral density in patients with systemic lupus erythematosus. Subjects and Methods: Eighty-one patients with systemic lupus erythematosus aged 20–70 years were recruited for this interventional study. Participants were enrolled into the following groups: no corticosteroid treatment (n = 21), corticosteroid treatment but without supplementation (n = 30) and corticosteroid treatment along with oral vitamin D and calcium supplementation (n = 30). Disease activity and laboratory parameters of all participants were measured at baseline and at 6 months. Bone mineral density was assessed using standardized dual-energy X-ray absorptiometry. Results: At baseline, none of the patients had a normal vitamin D status. There were no significant correlations between vitamin D status and the studied immune markers or disease activity values before and after supplementation. After 6 months, patients who received supplementation showed significant (P = 0.002) improvements in bone mineral density. In addition, frequency of osteopenia decreased from 40% to 16.7% and that of osteoporosis decreased from 26.7% to 13.3%. Conclusion: Vitamin D and calcium supplementation significantly improved the bone mineral density in vitamin D-deficient patients with systemic lupus erythematosus but did not significantly attenuate immune markers or disease activity. Further investigations are recommended with higher doses of vitamin D and longer durations to normalize the vitamin level and, possibly, achieve better disease control.
Endoscopic Treatment of Biliary Leak Following Gunshot Injury: A Case Report
(2018) Al Humayed, Suliman
This report describes the endoscopic treatment of a biliary leak, following a gunshot injury to the liver of a young Saudi female. She was admitted to the emergency unit having sustained an accidental gunshot on the upper part of her right shoulder when her spouse was maintaining his gun sitting on a higher level chair. She was intubated and immediately taken for exploratory laparotomy, which revealed right liver lobe laceration and significant hemoperitoneum. Bleeding was controlled surgically, and two peritoneal lavage catheters were inserted for drainage. However, about 300–400 ml of bile drainage was observed daily. Accordingly, endoscopic retrograde cholangiopancreatography (ERCP) was performed, which demonstrated a biliary leak. Sphincterotomy was performed and a stent was inserted, following which the biliary leak eventually subsided. A follow-up ERCP was performed 10 weeks later, and no further leak was observed. This is the first case report of a successful endoscopic treatment of traumatic biliary injuries due to a gun shot in Saudi Arabia. ERCP is a valuable method in the treatment of a traumatic bile leak. This report describes the endoscopic treatment of a biliary leak following a gunshot injury in a young Saudi female. She was admitted to the emergency unit having sustained an accidental gunshot on the upper part of her right shoulder when her spouse was maintaining his gun sitting on a higher level chair. She was intubated and immediately taken for exploratory laparotomy, which revealed right liver lobe laceration and significant hemoperitoneum. Bleeding was controlled surgically, and two peritoneal lavage catheters were inserted for drainage. However, about 300–400 ml of bile drainage was observed daily. Accordingly, endoscopic retrograde cholangiopancreatography (ERCP) was performed, which demonstrated a biliary leak. Sphincterotomy was performed and a stent was inserted, following which bile drainage gradually reduced, and stopped after 5 days. A follow-up ERCP was performed 10 weeks later, and no further leak was observed. This is the first case report of a successful endoscopic treatment of traumatic biliary injury due to a gunshot in Saudi Arabia. ERCP is a valuable method in the treatment of a traumatic bile leak.
Endoscopic Ultrasound-Guided Vascular Interventions: From Diagnosis to Treatment
(2018) Anastasiou, Jiannis; Berzin, Tyler
The development of endoscopic ultrasound was driven by the need to develop less invasive alternatives to surgical and radiologic interventions for a wide variety of gastrointestinal conditions. During the past decade, there has been a very rapid growth in the clinical role and capabilities of endoscopic ultrasound-guided therapeutic interventions. Endoscopic ultrasound offers both real-time imaging and access to structures within and adjacent to the gastrointestinal tract. The proximity of the gastrointestinal system to vascular structures throughout the abdomen and the mediastinum allows for endoscopic ultrasound-guided vascular access and therapy. The recent development of endoscopic ultrasound-guided vascular interventions has relied both on finding new applications for standard endoscopic accessories and on commandeering tools originally developed for use in interventional radiology. This article provides a review of the literature regarding the current state of endoscopic ultrasound for the management of variceal and nonvariceal bleeding, portal vein angiography and pressure measurements, intrahepatic portosystemic shunts, endoscopic ultrasound-guided fine-needle aspiration for portal vein sampling, drug administration and embolization as well as endoscopic ultrasound-guided cardiac access and treatment.
Epidermolytic Ichthyosis without Keratin 1 or 10 Mutations: A Case Report
(2018) Al Raddadi, Ali; Habibullah, Taha; Abdelaal, Ahmed; Felimban, Angie; Al Raddadi, Hosam; Satti, Mohamed
In this paper, the authors report a case of an 11-year-old boy with epidermolytic ichthyosis who presented with multiple scattered erosions and typical hyperkeratotic plaques over the face, upper and lower extremities, the trunk, palms and soles. Family history revealed an affected older male sibling and an affected first-degree female relative. In addition, there was a positive history of generations of consanguinity in the patient's family pedigree, increasing the probability of an autosomal recessive inheritance. The clinical diagnosis was confirmed by histopathology; however, mutations in the keratin 1 and 10 genes were absent. This case report addresses the importance of establishing correct diagnosis and mode of inheritance, with literature review of genetic mutations, possible differential diagnosis and the most common and successful treatment modalities for epidermolytic ichthyosis.
ERIC-PCR genotyping of Acinetobacter baumannii isolated from different clinical specimens
(2018) Aljindan, Reem; Alsamman, Khaldoon; Elhadi, Nasreldin
Background: Acinetobacter baumannii is a major cause of hospital care-acquired infections, and this bacterium poses a significant challenge to health care worldwide. At King Fahd Hospital of the University (KFHU), Al Khobar, Saudi Arabia, there had been a significant increase in the number of cases of A. baumannii infections. Objective: The objective of this study was to determine the clonal relationship between A. baumannii collected from different specimens of patients admitted to KFHU using the enterobacterial repetitive intergenic consensus–polymerase chain reaction (ERIC-PCR) fingerprinting method. Materials and Methods: A. baumannii strains were isolated from a total of 59 specimens from inpatients admitted to KFHU between January and September 2014. These specimens were mainly collected from wound, rectal and throat swabs and transtracheal aspiration. ERIC-PCR fingerprinting was used to determine the clonal relationship between the different isolated strains. Results: Using ERIC-PCR fingerprinting genotype analysis, 51 strains of A. baumannii were clustered into seven groups, while the remaining 8 were single strains. The genetic relatedness of A. baumannii isolated from admitted patients was high, indicating cross-transmission within the hospitalized patients. Conclusion: This study found that the increase in the incidence of A. baumannii in patients at KFHU was likely due to the spread of seven epidemic clones, thereby highlighting the need for intensifying the infection control measures to prevent nosocomial transmission of A. baumannii. These results also demonstrate that ERIC-PCR is a reliable and rapid method for studying the clonal similarity between A. baumannii isolated from different clinical specimens.
Erratum: Association of Nod2/Card15, Dlg5, Octn1 and Toll-Like Receptor 4 Gene Polymorphisms with Inflammatory Bowel Disease: A University Hospital Experience
(2018)
Abstract Not Available(Erratum)
Erratum: Frequency of Root Canal Treatment among Patients Attending a Teaching Dental Hospital in Dammam, Saudi Arabia
(2018)
Abstract Not available(Erratum)
Erratum: Obstetric Outcome in Obese Saudi Pregnant Women: A Cohort Prospective Study at a Teaching Hospital
(2018)
Abstract Not Available(Erratum)

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