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Appendiceal Endometriosis
(2013) Al-Talib, Ayman
Although appendiceal endometriosis is rare, appendix is the second most common site of intestinal endometriosis. Clinical diagnosis is difficult and histopathology is the only way to establish the diagnosis. We present a case of chronic pelvic pain secondary to appendiceal endometriosis and a review of the literature. There are no pathognomonic criteria to establish an accurate preoperative diagnosis. There is no specific radiologic test for diagnose. Laparoscopy provides detailed evaluation of the appendix but gross inspection of appendix alone is not enough to rule out the problem. The appendix may harbor endometriosis and could be a cause of chronic pelvic pain. When performing surgeries in a patient with chronic pelvic pain, surgeons should be aware of the possible contribution of the problem pelvic pain in patients with endometriosis. The appendix should be examined thoroughly during endometriosis-related operations. Appendectomy should be performed if the appendix looks abnormal.
Brain drain or brain retain?
(2013) Parashar, Shyam
A concise history of genome wide association studies
(2013) Al-Ali, Amein; Koeleman, Bobby; Asselbergs, Folkertvan der Laan, Sander
Genome-wide association studies (GWASs) have had a tremendous impact on the pace of genomic research of common diseases. The number of identified genetic variants associated has grown exponentially. For some diseases, such as coronary heart disease (CHD), the number of known susceptibility genes has grown from a handful to more than 45. A substantial number of genes point to unexpected mechanism involved, and functional data from the "Encyclopedia of Deoxyribonucleic Acid Elements" (ENCODE) project is helpful in uncovering the functional relevance to diseases. The rapidly evolving techniques have made the shift from family-based linkage studies to GWASs possible. Advanced single nucleotide polymorphism (SNP) arrays containing hundreds of thousands of variants efficiently assess the extent of genome-wide disease-associated genetic variation. Along with SNP arrays came breakthroughs in statistical analyses and study designs leading to the exponential growth of the GWAS catalog. Pathway analyses of GWASs results with manually curated software programs have been insightful. Next-generation sequencing (NGS) of the exome or even the whole genome will undoubtedly shift the balance in focus from common variants to more rare variations impacting common diseases. Moreover, the combined power of GWASs, sequencing, pathway analysis, and functional data to study common disease shall only be limited by our ability to comprehend.
The continuous glucose monitoring system (CGMS) in patients with beta-thalassemia major
(2013) Yousef, Abdullah; Aldilaijan, Abdulmohsin; Khamis, Ammar; AlMaghlouth, NoufAlbaker, Waleed
Blood transfusion-dependent beta Thalassemia Major (BTM) patients are at risk of hemosiderosis. Hemosiderosis of pancreas results in impaired glucose homeostasis tolerance and diabetes mellitus (DM). Since glycosylated hemoglobin has limited role in patients with hemoglobinopathies, this study was conducted as a first attempt worldwide to understand glucose homeostasis and evaluate efficacy of Continuous Glucose Monitoring (CGM) system as a diagnostic tool of abnormal glucose homeostasis in these patients. Materials and Methods: A case series study of six non-diabetic, transfusion-dependent beta-thalassemia patients aged 9-13-year-old. Clinical and laboratory data were collected on admission for their monthly transfusion. Patients were connected to CGM systems for one day. Findings: Using CGM and based on American Diabetes Association guidelines, three patients were found to have abnormal glucose levels of diabetic range. The other three showed impaired glucose tolerance. Among all patients, glycosylated hemoglobin (HbA1C) readings have an inverse relationship to CGM and calibration readings. Conclusion: CGM could be a promising tool for evaluating BTM patients. Larger studies are recommended.
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.
Dyspnea in an elderly male
(2013) Bella, AbdelhaleemHadhiah, Kawthar
An encouraging start
(2013) Al-Quorain, AbdulazizBella, Hassan
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.
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.
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.
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.
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.
Is hyperleptinemia a risk factor for hypertension
(2013) Afzal, NasirRafique, Nazish
Major risk factors of hypertension (HTN) including obesity, insulin resistance, renal pathology, increased sympathetic nerve activity (SNA) and vascular inflammation are associated with hyperleptinemia. Therefore hyperleptinemia may act as a mediator of blood pressure, linking body fat mass with changes in insulin action, sympathetic neuronal outflow and renal pathology. bjective: The objective of our study was to explore the relationship between hyperleptinemia and HTN in Pakistani population. Materials and Methods: It was a case control study of 6 months duration, carried out at Shifa College of Medicine and Shifa International Hospital, Islamabad. One hundred and four male subjects, 52 with HTN and 52 without HTN were included in this study. Leptin levels were measured by enzyme-linked immunosorbent assay (ELISA) technique. The relationship of leptin (LEP), body mass index (BMI), fasting blood sugar (FBS) and cholesterol levels with blood pressure were assessed. Results: Patients with HTN versus patients without HTN had a higher body mass index (28.0 ± 0.12 to 24.11 ± 0.27 kg/m ² ), FBS (169.20 ± 7.34 to 127.50 ± 2.30 mg/dl), total cholesterol (160 ± 3.72 to 158 ± 2.71 mg/dl) and LEP (53.40 ± 5.32 to 21.65±3.50 ng/ml) levels. In univariate analysis, obesity, hyperglycemia and hyperleptinemia (with P values of 0.000, 0.001, 0.000, respectively), whereas in multivariate analysis, hyperglycemia and hyperleptinemia (with P values of 0.006 and 0.001, respectively) were risk factors for HTN. Our study also showed that hyperleptinemia is an independent risk factor for HTN. Conclusions: We observed a strong positive relationship between hyperleptinemia and hypertension, thereby indicating that increased leptin levels could be considered as a risk factor for HTN and cardiovascular disease. Further studies are needed to probe the underlying pathophysiological mechanisms responsible for hyperleptinemia in HTN.
Journal Impact Factor
(2013) Bella, Hassan
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.
King Abdullah Bin Abdulaziz Arabic health encyclopedia (www.kaahe.org): A reliable source for health information in Arabic in the internet
(2013) Alsughayr, Abdulrhman
Launching the Official Scientific Journal of the University of Dammam
(2013) Al-Rubaish, Abdullah
Molecular classification of breast cancer: An overview with emphasis on ethnic variations and future perspectives
(2013) Ahmed, Ayesha; Al-Tamimi, DalalShawarby, Mohamed
Morphologically identical breast cancers can display divergent clinical outcomes and responses to therapy. This can predominantly be attributed to molecular class differences that exist amongst histologically similar cancer types. Consequently, molecular classification can be more powerful than histopathology as a predictive factor for the different treatments. This article reviews the molecular classification of breast cancer and emphasizes that ethnic variations may exist in molecular class prevalence patterns. It also highlights key insights into the currently defined molecular classes as provided by ongoing research on primary breast cancers using recent state-of-the-art technology. Such research is revealing that significant molecular heterogeneity may exist within the molecular classes themselves. More diverse ethnic variations may also be unraveled. The results of ongoing and upcoming research may provide more precise prognostic and predictive information about breast cancer and perhaps a breakthrough step toward "personaliziation" of breast cancer treatment. Forty-one relevant articles (2000-2012) extracted through PubMed and Google advanced searches and at our institute's library were utilized to prepare the article, along with results of published and ongoing research by the authors.
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.

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