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Acute generalized exanthematous pustulosis in a patient with plaque psoriasis
(2014) Al Raddadi, Ali; Alharbi, Aymen; Jan, Hawazin; Al Hawsawi, Khalid; Al Jabri, MazinSatti, Mohammed
Acute generalized exanthematous pustulosis (AGEP) is an acute febrile drug eruption characterized by sudden occurrence of numerous, non-follicular, pinhead-sized pustules. This usually occurs 3-5 days after the commencement of treatment. Development of pustular eruptions in patient with plaque psoriasis raises the differential diagnosis of AGEP versus pustular psoriasis of the Von Zumbusch type. Herein, we report a 56-year-old male who came into hospital with history of vomiting fresh blood. The patient was then admitted for management of hematemesis. He is a known case of psoriasis vulgaris, which was still present during admission. During admission, the patient developed pustular skin eruptions associated with fever 4 days after using clindamycin and ceftriaxone. Laboratory investigations revealed leukocytosis and neutrophilia. Histopathological examination showed sub-corneal neutrophilic collection and eosinophils in the papillary dermis. The pustular eruption disappeared completely within ten days after stopping clindamycin and ceftriaxone, confirming the diagnosis of AGEP.
Acute lower abdominal pain in a young female patient
(2014) Al-Mulhim, Abdulmohsen; Al-Saffar, Ali; Aldhafery, Bander; Al-Bisher, HassanAl-Saleem, Hassan
Anatomic and anaesthetic considerations of greater palatine nerve block in Indian population
(2014) Sharma, Nidhi; Varshney, RohitRay, Sudhakar
Greater palatine nerve block holds its importance for anaesthesia and analgesia in different maxillofacial surgical procedures. Accuracy in localization of greater palatine foramen is required for its successful implication in regional block, although racial variations exist in various population groups. Aims: To study the morphometry of greater palatine foramen and its location with nearby anatomical landmarks in Indian population. Material and Methods: A total of one hundred dry skulls (60 males and 40 females) were collected and observed for the study. Various parameters were noted from greater palatine foramen on both sides, together with its location with respect to maxillary molar tooth. Along with that the angle between midline maxillary suture and Incisive foramen-Greater palatine foramen is measured. Results: 198 sides were measured and the most common location of greater palatine foramen was found to be medial to third molar tooth (71.21%). The mean distance from greater palatine foramen to midline maxillary suture on right and left sides were 14.82 ± 1.34 mm and 14.79 ± 1.57 mm, statistically insignificant. The angle between midline maxillary suture and incisive foramen-greater palatine foramen was 20.81° ± 2.47°on right side and 20.58° ± 2.69°on left side.The direction of the opening of greater palatine canal onto the hard palate was observed to be antero-medial in 60.10% of cases. Conclusions: Our study reveals the importance of usage of various anatomical parameters for precise location of greater palatine foramen, establishment of specific measurements in each population group and thereby applying such measurements for successful greater palatine nerve block.
Association of NOD2/CARD15, DLG5, OCTN1 and toll-like receptor 4 gene polymorphisms with inflammatory bowel disease: A university hospital experience
(2014) Al-Quorain, Abdulaziz; Al-Ali, Amein; Hussameddin, Anas; Al-Nafie, Awatif; Yasawy, Mohammad; Akhtar, Mohammed; Ismail, Mona; Abdelrashid, Muzaheed; Al-Sulaiman, RaedAl-Ateeq, Suad
Both genetic and environmental factors play major roles in the development of inflammatory bowel disease (IBD). Recent studies have identified a number of genetic susceptibility loci for Crohn's disease (CD) and ulcerative colitis (UC). Objectives: The present study aimed at examining the association of nine polymorphisms in four different genes with the development of CD and UC in a sample of Saudi patients with IBD. Materials and Methods: All gene polymorphisms were identified by polymerase chain reaction and by direct sequencing. Allele and genotype frequencies of polymorphisms of NOD2/CARD15 (R702W, G908R, L1007finsC), Toll-like receptor 4 (TLR4) (D299G, T399I), OCTN promoter (C1672, G207C) and DLG5 (G113A, C4136A) genes were determined in Saudi subjects with CD (51), UC (26) and in 75 normal controls. Results: Out of the nine polymorphisms studied in four loci, only two polymorphisms in two different loci were found to have increased in patients compared with the control subjects. The CT genotype of TLR4 T3991 was over represented in patients with CD or UC compared to that in controls (odds ratios [OR], 5.63:95% confident interval [CI], 1.19-26.69; P = 0.03). In addition, the GA genotype of DLG5 G113A was over represented in patients with CD or UC compared with that in controls (OR, 4.72:95% CI 2.30-9.66; P = 0.0001). However, there were no significant associations found between all other polymorphisms studied and the susceptibility of CD or UC found in the Saudi population. Conclusion: Our finding indicates that association of IBD with nine gene polymorphisms was only significant in two of these polymorphic variants.
Axillary fibroadenoma: Case report and review of literature
(2014) Bhargava, AnujSingh, Suryapratap
Fibroadenoma of breast and ectopic breast tissue is common pathology. Sometimes, it may be associated with hormonal imbalance. However, the presence of fibroadenoma in the axilla without ectopic breast tissue and hormonal imbalance is a rare presentation. We are presenting a rare case report of fibroadenoma developing in the right axilla in a 28-year-old woman. Clinical examination of both breasts revealed no abnormalities and no lymph nodes or supernumerary breasts were detected in the axilla or the neck. No associated urologic or cardiovascular abnormalities were found and the histopathological examination of the excisional biopsy samples showed a well-defined, capsulated type of fibroadenoma similar to that of ectopic mammary tissue.
Bilateral cervical chondro-cutaneous remnants
(2014) Deore, Nitin; Ansari, Sameer; Gupta, ShaliniRamraje, Sushma
Cervical chondro-cutaneous brachial remnant (CCBR) is a developmental anomaly presenting at birth and are usually seen on the lateral aspect of neck, anterior to sternocleidomastoid muscle. Bilateral appearance of this lesion is extremely uncommon. These lesions are painless and lack any inflammation or discharge. Since there is no connection with underlying deeper structures, complete surgical excision is the standard treatment in such cases. It is associated with several other congenital anomalies in 70-80% of cases. Hence, thorough evaluation of patients (clinical and investigation) becomes mandatory in such cases to detect any additional anomaly. We report a case of a 6-year-old female with bilateral cervical chondro-cutaneous remnant located at the lower third of lateral aspect of neck, anterior to sternocleidomastoid muscle, and discuss the embryologic and diagnostic aspects considering the common differential for this lesion at this site.
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.
Chronic Hepatic Disease
(2014) Al-Quorain, Abdulaziz
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.
Complete heart block with ventricular tachycardia in a patient with hemochromatosis
(2014) Kader, Muneer; Mangalachulli, Ranjith; Kalathingathodika, SajeerChakanalil, Sajeev
Hereditary hemochromatosis is an inherited condition of dysregulated iron absorption, and usually presents with clinical features of hepatic dysfunction. Cardiac involvement as the presenting manifestation of hereditary hemochromatosis is rare. We report a young male who presented with complete heart block and ventricular tachycardia and was subsequently diagnosed as hemochromatosis. He was managed with permanent pacemaker implantation, oral antiarrhythmic and chelation therapy.
Complications of Circumcision
(2014) Raashid, Hamid; Rashid, KumarBhat, Nisar
Circumcision is one of the most frequently performed elective procedures in male. In general, post circumcision complications are minor and treatable but complications requiring expert intervention are seen when the circumcision is perrformed by inexperienced/untrained person and in non-sterile setting and inadequate equipments. Materials and Methods: From March 2008 to May 2012, 59 patients with circumcision related complications were received at age range of 6 months to 5 years with a mean age of 2.4 years. The most common complication was urethra-cutaneous fistulae in 18 patients, followed by meatal stenosis in 9, bleeding in 6, incomplete circumcision in 6, buried penis in 5, glanular injury in 4, skin bridge in 4, complete amputation of phallus 3, hole in the prepuce in 3 patients and one patient with coronal constriction and fistula. Results: Urethral fistulae were closed in all 18 patients with recurrence in 16%. Two patients with extensive bleeding required blood transfusion and all 6 children required hematoma evacuation under general anesthesia in the operating room. The circumcision was revised in those with an incomplete procedure, a hole in prepuce, burried penis and residual skin bridge. Meatotomy was the procedure of choice in 6 of 9 patients with meatal stenosis, but in the remainder meatal dilatation was efffective. Glanular injuries were managed conservatively. A short residual after glanular injury needed grafting. Conclusion: Circumcision is considered a simple and minor surgical procedure, yet it needs to be performed competently by only medically qualified and trained personnel and with a great care.
Coping with stress among health care professions
(2014) Al-Turki, Yousef
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.
Eosinophilic gastroenteritis: A case report with review of the literature
(2014) Al-Quorain, Abdulaziz; Al-Musa, Abdulla; Hussameddin, AnasPallippath, Muhammed
Eosinophilic gastroenteritis (EG) is a heterogenous disorder affecting adults, and is characterized by the presence of eosinophilic infiltration in the gastrointestinal tract. The clinical features of EG are related to the layers and extent of bowel involved from the esophagus to the colon. The diagnosis is typically confirmed by biopsy, which should reveal 20-25 eosinophils per high-power field on microscopic examination. We report a 38-year-old man who presented with a 2-month history of dyspeptic symptoms. On examination, he was found to have only moderate ascites. The investigations revealed peripheral eosinophilia with markedly elevated eosinophils (95%) in the ascitic fluid. The imaging studies showed diffuse concentric bowel wall thickening involving the entire small bowel. The diagnosis was confirmed by biopsy from the antrum of the stomach. The patient was managed with steroids.
Flexural strength of dental porcelains with thermocycling and different firing protocols
(2014) ArRejaie, Aws
This is an in vitro study comparing the flexural strength of two dental porcelain after thermocycling, repetitive multiple firings and peak firing temperature (PFT) modifications. Materials and Methods: Two types of dental porcelains were used in this study: Cercon® Cream Love and Cercon® Cream Kiss (DeguDent, Hanau-Wolfgang/Germany). A total of 50 specimens per porcelain were divided into five groups with ten specimens per group. The first group was fired following the manufacturer's recommendations (control). The second group was fired 10 times repetitively, and the third group was fired and then exposed to 3000 episodes of thermocycling. The fourth group was fired with the PFT modified by + 10°C. The last group was fired with the PFT modified by −10°C. All specimens were tested for flexural strength with the three-point bending test using a universal testing machine (Instron) with a crosshead speed of 0.5 mm/min. Results: The flexural strength, mean (standard deviation [SD]) MPa, of Cercon® Ceram Kiss were: Control, 59.6 (7.82); 10 firings, 82.37 (26.32); thermocycling, 68.93 (9.55); PFT (+10°C), 75.28 (5.63); and PFT (−10°C), 75.94 (2.85). The results for the flexural strength, mean (SD), of Cercon® Ceram Love were: Control, 59.33 (9.9); 10 firings, 106.07 (28.43); thermocycling, 69.87 (11.17); PFT (+10°C), 65.7 (10.46); and PFT (−10°C), 51.1 (16.56). Conclusion: There was no difference in the flexural strength between the two veneering porcelains. In addition, repetitive firings significantly improved the flexural strength of both porcelains. Thermocycling significantly increased the flexural strength of both porcelains. There were no significant differences in the flexural strength when changing the PFT for Cercon® Ceram Love. Increasing and decreasing the PFT significantly increased the flexural strength of Cercon® Ceram Kiss.
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.
Granulomatous reaction associated with breast carcinoma: A report of two cases
(2014) Shafi, Sheikh; Hamed, TahiraAlalshee, Timor
The presence of a granulomatous reaction in association with a breast carcinoma is a rare phenomenon. We present two cases of breast carcinoma, invasive ductal and invasive lobular carcinoma in which a non-caseating granulomatous response was present within the stroma of the breast carcinoma, followed by a discussion of its pathogenesis and practical significance.
The impact of valsalva's versus spontaneous pushing techniques during second stage of labor on postpartum maternal fatigue and neonatal outcome
(2014) Alkunaizi, Anwar; Aljama, Fathia; Al Turki, Haifa; Sobhy, SoheirHaseeb, Yasmeen
The objective of the following study is to find out the effects of two different pushing techniques in the second stage of labor on postpartum maternal fatigue and APGAR score of neonates in Saudi females, as very few such studies are available in these patients. Hence this study was carried out in this population to see the results and to do a comparison with other studies in literature as well as to find out how we can make labor awareness in our females. Design: Quasi experimental study. Settings: It was carried out in two hospitals in the eastern province of Saudi Arabia from 1 January, 2011 up to 31 December, 2011. One hundred Saudi women who fulfilled criterion were included in the study. They were randomized and the results seen. Results: There was a significant difference in postpartum fatigue within 60 min and 24 h in two groups as P = 0.001, P < 0.001 respectively. There was a significant difference of APGAR score of newborn in both groups, i.e., P < 0.001. Conclusion: It is concluded that physiological pushing technique has a better outcome with regard to postpartum maternal fatigue and neonatal APGAR score when compared to directed pushing during the second stage of labor.
Infants of diabetic mothers: 4 years analysis of neonatal care unit in a teaching hospital, Saudi Arabia
(2014) Al-Qahtani, Mohammad
Diabetes mellitus (DM) in pregnant ladies has consequences during the perinatal period, affecting the mothers' gestation and their mode of delivery. The infants of diabetic mothers (IDM) are also prone to spectrum of morbidity. This study aimed to evaluate the outcome of diabetic mothers, of both types; pregestational and gestational, and to determine the spectrum of morbidity pattern among their infants. Materials and Methods: This study is a retrospective analysis of 4 years period May 2008 to April 2012 at King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia. All the diabetic pregnant mothers admitted to the hospital and their babies within that period were included into the study. Results: The diabetic mothers constitute 2.9% of all the pregnant ladies. Multiparity was found in the majority of our diabetic mothers regardless of their type of diabetes. Around 70% of the IDM were born to mothers with gestational diabetes mellitus (GDM), while 26% were born to mothers with type 2 DM, and only 4.5% type 1 DM. Full term babies were 163 (92.0%), preterm were only 14 (8.0%). The most common IDM morbidities were Hypomagnesaemia, followed by macrosomia, which was found higher in infant of GDM. The least common complications were polycythemia and acute respiratory distress syndrome. A low percentage of asymptomatic hypoglycemia and hypocalcemia were found. There was no mortality among the IDM during the study period. Conclusions: As proven in this study Gestational DM continues as health care problem with risks for both the mothers and their offspring. It is recommended to follow the international guidelines for early detection, proper diagnosis and management of the gestational diabetic mothers to improve the outcome and limit the complications.
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.

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