Journal of King Abdulaziz University - Medical Sciences Medical Sciences King Abdulaziz University en-US Journal of King Abdulaziz University - Medical Sciences 1319-1004 Is It Time to Consider Other Treatment Options for Opioid Use Disorder in Saudi Arabia? Ahmed Hassan Copyright (c) 2020 Ahmed N. Hassan 2020-06-30 2020-06-30 27 1 1 4 10.4197/Med.27-1.1 Radiotherapy-induced Acute Carotid Blowout Syndrome in Base of Tongue Cancer <p>Carotid blowout syndrome is an uncommon and fatal medical emergency in patients with head and neck cancer. Tumor progression, previous surgery, and radiotherapy on the head and the neck regions are some of the predisposing factors that affect its presentation. An early suspicion of a carotid blowout syndrome allows early safety measurements to prevent catastrophic events. A 71-year-old man with advanced base of tongue cancer was presented with a self- limiting oral bleeding 18 months after receiving chemoradiotherapy. Fiberoptic laryngoscopy and contrast-enhanced computed tomography revealed the presence of edema of the hypopharynx and thyroid cartilage fracture and necrosis. The patient developed acute oral hemorrhage. Surgical intervention was insufficient to achieve hemostasis. The carotid angiography revealed a common carotid artery rupture, and a covered stent was placed endovascularly. The covered stent placement was enough to stop the bleeding. However, the patient died from perioperative complications. Experience is necessary for the early detection and prevention of a carotid blowout syndrome.</p> Abdulrahman Almazrooa Copyright (c) 2020 Abdulrahman A. Almazrooa 2020-06-30 2020-06-30 27 1 75 81 10.4197/Med.27-1.10 Reversible Thyrotoxicosis Dilated Cardiomyopathy <p>Thyrotoxic cardiomyopathy is a rarely diagnosed disease in patients coming into the hospital with hyperthyroidism for the first time. The objective of this case study is to present the rare case of a patient, who was diagnosed with a thyrotoxic cardiomyopathy for the first time. A 47-year old Saudi male was presented in the King Abdulaziz Medical City in Jeddah, Saudi Arabia in March 2017, with a two-week history of progressive dyspnea, orthopnea, paroxysmal nocturnal dyspnoea, and atrial fibrillation. Following physical examinations and investigations, the diagnosis of thyrotoxicosis was performed. Initially, he was treated with Methimazole, followed by radioactive therapy, which resulted in the patient’s full recovery from cardiomyopathy through the treatment of his thyrotoxicosis.</p> <p>One of the first symptoms, the manifestation of thyrotoxicosis, is thyrotoxic dilated cardiomyopathy. In most cases, it may be completely reversible through the appropriate treatment of the thyrotoxicosis.</p> Tariq Nasser Faiza Abdulaziz Qari Ashraf Banna Aysha Tabbakh Copyright (c) 2020 Tariq Nasser, Faiza A. Qari, Ashraf Banna, and Aysha Tabbakh 2020-06-30 2020-06-30 27 1 83 88 10.4197/Med.27-1.11 A Case of Peripartum Cardiomyopathy in Saudi Arabia <p>Peripartum cardiomyopathy is a rare idiopathic condition that affects pregnant women from their last month of gestation up to five months of their postpartum period. Its symptoms are similar to those of a heart failure, which mimic the exaggerated physiological symptoms of pregnancy. In Saudi Arabia, there is only one study that, so far, reported cases of obscure peripartum cardiomyopathy. Here, we discuss a case of this rare condition. A young pregnant lady was admitted with anemia and premature contractions. Two days later, she developed an acute heart failure. Her echocardiography test confirmed a reduced left ventricular ejection fraction. The secondary causes of heart failure were then excluded. A diagnosis for peripartum cardiomyopathy was made, and the patient was treated accordingly. Peripartum cardiomyopathy in pregnant women must be considered in cases of heart failure presented during such period.</p> Abeer Kawthar Copyright (c) 2020 Abeer M. Kawthar 2020-06-30 2020-06-30 27 1 89 94 10.4197/Med.27-1.12 Fatigue Testing of a Titanium Tapered Rod versus Two Rods Connected by a Parallel Connector across the Cervicothoracic Junction: A Biomechanical Study <p>This study compares the fatigue failure of a tapered titanium-rod construct against two connected titanium rods (domino construct) across the cervicothoracic junction. All testing was carried out in a simulated flexion-extension plane. The 3.5-mm/6.0-mm tapered titanium rod and the 3.5-mm titanium rod, connected to a 6.0-mm titanium rod with a connector, were compared for their fatigue failures. Six specimens of each construct were tested in a cantilever displacement control method using 6 different amplitudes. Each specimen was cycled to failure or to 2.5 million cycles (run out) at 10 Hz. Failure was defined as rod fracture. The domino construct reached the test limit of 2.5 million cycles at± 0.45 mm (72 N) but failed in all the other tested amplitudes. The tapered rod construct reached the test run out limit of 2.5 million cycles at higher amplitudes than the domino construct at ± 0.9 mm and failed in all the other tested amplitudes. The study showed that the tapered-rod construct across the cervicothoracic junction is more fatigue resistant than the domino construct.</p> Ammar Qutub Fahad Abduljabbar Anas Nooh Lorne Beckman Lauren Bould Thomas Steffen Peter Jarzem Copyright (c) 2020 Ammar Qutub, Fahad Abduljabbar, Anas Nooh, Lorne Beckman, Lauren Bould, Thomas Steffen,, Peter Jarzem 2020-06-30 2020-06-30 27 1 5 11 10.4197/Med.27-1.2 Evaluation of the Pediatric Neurogenic Bladder Dysfunction of the Patients in the King Abdulaziz University Hospital, Jeddah, Saudi Arabia <p>A neurogenic bladder results from conditions that affect either the central or peripheral nervous system. This study reviewed all the pediatric neurogenic patients in the King Abdulaziz University Hospital from 2008 to 2018, using their medical records and histories. The patients’ ages were between one month and 16 years during their first diagnosis. Patients with more than 50% missing data were excluded. A total of 678 patients were diagnosed with neurogenic bladder during the study period. But only the data of 212 patients were processed for statistical analysis. The patients’ median age was 9 years. The causes of neurogenic bladder in these patients were 1) spina bifida in 110 patients (51.8% of the sample population), 2) non- neurogenic neurogenic bladder (Hinman syndrome) in 40 (18.8%) cases, 3) bilateral hydronephrosis in 72 (33.9%) patients, and 4) urine incontinence, which was the main complain in 132 (62%) patients. Sixty-four (30%) patients had urine retention and were dependent on catheter. Spina bifida was the main cause of neurogenic bladder in this study group. Upper tract status of the patients during their presentation had affected the complication rates and the decisions to administer surgical intervention.</p> Waad Banjar Anfal Jar Roba Ashor Mai Ahmed Banakhar Copyright (c) 2020 Waad F. Banjar, Anfal A. Jar, Roba M. Ashor, Mai A. Banakhar 2020-06-30 2020-06-30 27 1 13 17 10.4197/Med.27-1.3 Epidemiological Study of Ulcerative Colitis: A Single-Center Experience in the Western Region of Saudi Arabia <p>This retrospective chart review was conducted at the King Abdulaziz University Hospital and covered the data for the period 2010–2019. The clinical data included the presenting symptoms, extraintestinal symptoms, time elapsed from the onset of the symptoms to the confirmed diagnosis of ulcerative colitis, and endoscopic severity. A total of 413 patients with a confirmed diagnosis of ulcerative colitis were included. Approximately 94.3% (n = 299) of the patients were presented with diarrhea, with 86.9% of the cases had bloody stools, and 64.5% reported lower abdominal pain. About 4.8% of the patients (n = 18) lost &gt;10% of their body weight within six months. Extraintestinal manifestations were documented in 127 (30.8%) patients, including the most common manifestations, such as aphthous ulcers (n = 41, 9.9%), large joint arthralgia/arthritis (n = 34, 8.2%), and erythema nodosum (n = 25, 6.0%). Based on the Montreal classification, 76 (18.5%) patients had ulcerative proctitis, 211 (51.0%) had left-sided ulcerative colitis, and 126 (30.5%) had extensive or pancolitis. The clinical presentation of ulcerative colitis is variable, resulting in the delay of their diagnoses. Research and clinical efforts should be directed to facilitate the conduct of early diagnosis.</p> Yousef Qari Copyright (c) 2020 Yousef A. Qari 2020-06-30 2020-06-30 27 1 19 26 10.4197/Med.27-1.4 The Prevalences, Risk Factors, and Lengths of Hospital Stay of Patients with Suspected Lower Limb Deep Venous Thrombosis in the King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia <p>The prediction of risks and the predisposing factors that lead to the formation of blood clots, using appropriate clinical examination is crucial to the treatment of thrombosis. It is important to estimate the length of hospital stays of those clinically suspected of thrombosis. This study evaluated the prevalence of lower-limb deep venous thrombosis and its associated risk factors to predict the lengths of hospital stays of the patients. The 1,201 medical records of patients, aged 16 to 98 years, were collected from the King Abdulaziz University Hospital from January 2013 to December 2015. Their thrombosis were evaluated using a doppler ultrasound and a sonographic assessment. The results of the study revealed the prevalence of thrombosis among 18.9% of the elderly patients, 14.5% in patients with diabetes mellitus, 13.3% in those with hypertension, 17.8% in bed-ridden patients, 12.2% in patients with ischemic heart disease, 20.5% in patients with breast cancer, 5.1% in pregnant women, and 10% in obese patients. No deep venous thrombosis was reported in patients with history of heart failure. Having breast cancer and being old were the major risk factors that were identified among the patients with lower limb deep venous thrombosis.</p> Ahmed H. Abduljabbar Rani G. Ahmad Basem H. Bahakeem Yahea Alzahrani Nadia Batawil Khaled Bahubaishi Roaa N. Filfilan Mohammad A. Wazzan Copyright (c) 2020 Ahmed H. Abduljabbar, Rani G. Ahmad, Basem H. Bahakeem, Yahea A. Alzahrani, Nadia A. Batawil, Khaled M. Bahubaishi, Roaa N. Filfilan, and Mohammad A. Wazzan 2020-06-30 2020-06-30 27 1 27 35 10.4197/Med.27-1.5 Risk Factors and Incidence of Venous Thromboembolism after Total Knee Replacement <p>Patients undergoing total knee arthroplasty can be at risk in developing venous thromboembolism. The etiology of venous thromboembolism after a total knee arthroplasty is multifactorial. The aim of this study is to present the risk factors and the incidence of venous thromboembolism among the 276 patients, who underwent a total of 348 knee arthroplasty treatments in the King Abdulaziz University Hospital. Three hundred (86.2%) patients had undergone unilateral total knee arthroplasty. Only 48 (13.8%) patients had simultaneous bilateral total knee arthroplasty. Their mean length of stays was 11.02 days. venous thromboembolism was present in eight patients (2.3%), either with symptomatic deep vein thrombosis (1.4%) or with pulmonary embolism (1.1%). One hundred twenty-five (35.9%) patients had diabetes, and six of them had developed venous thromboembolism (<em>P</em>-value: 0.020). The mean post-op mobilization (4.63 ± 3.5 days) was higher in cases with venous thromboembolism (<em>P</em>-value: 0.045). Factors, such as the patients’ age, history of venous thromboembolism, gender, history of cerebrovascular, obesity, operation time, and use of preoperative venous thromboembolism prophylaxis, showed no statistical significance with the incidence of venous thromboembolism in them. The result of our study are comparable to those reported in literature. <em>Diabetes mellitus </em>and delayed postoperative mobilization were the significant risk factors to the incidence of venous thromboembolism.</p> Lutf Abumunaser Amre Hamdi Ahmed Sonbol Copyright (c) 2020 Lutf A. Abumunaser, Amre S. Hamdi, and Ahmed M. Sonbol 2020-06-30 2020-06-30 27 1 37 43 10.4197/Med.27-1.6 Comparison between the Safety and Effectiveness of Al-Hijama (Cupping) and the Conventional Medical Therapy as Treatment for Sinusitis (II) <p>Sinusitis has severe negative effects on the quality of life and on work productivity. Cupping (Al-Hijama in Arabic) is a historical, yet a successful, method of treatment for many health problems, and it is now an international evidence-based medical treatment. This study compared the effectiveness and the safety of the cupping therapy as an adjuvant or alternative to pharmacological therapy, based on clinical examinations and their corresponding laboratory results. A randomized and controlled clinical trial was conducted in the Prophetic Medicine Research Cupping Clinic of the King Abdulaziz University Hospital in Jeddah, Saudi Arabia, by recruiting 60 patients, who were suffering from chronic or recurrent acute sinusitis. The patients were divided into three groups: 1) those who had undergone Al-Hijama with drug therapy; 2) those who had Al-Hijama plus a salt nasal solution and an analgesic, when needed; and 3) those who were regularly treated with ordinary medicine. The groups were re-examined after three months of treatment. The results showed significant differences on the effects of cupping, based on the results of the clinical and the laboratory analyses (Eosinophil). Al-Hijama therapy was found to be effective, simple, affordable, acceptable, and safe, when used correctly.</p> Eman A. Ghazy Saad M. Al Muhayawi Samiha A. Mourad Copyright (c) 2020 Eman A. Ghazy, Saad M. Al Muhayawi, and Samiha A. Mourad 2020-06-30 2020-06-30 27 1 45 54 10.4197/Med.27-1.7 The Effect of Intravenous Contrast Agents on Renal Functions in Children and Adolescents in the King Abdulaziz University Hospital, Jeddah <p>Computerized tomography scanning is a diagnostic imaging tool that can be enhanced through the use of contrast agents. However, this process has been found to promote adverse effects, particularly those on the renal function. This study assessed the effects of intravenous iodine-based contrast agents on the kidney function in children and adolescents in the King Abdulaziz University Hospital in Jeddah, Saudi Arabia. It included 112 participants with hospital records, aged 15 years old and younger, who underwent chest or abdomen tomography scans between January 2018 and January 2019. The participants were made up of 46.4% females and 53.6% males, with a median age of 5.5 years. Majority (87.5%) of them possessed various comorbidities. This study found out that the glomerular filtration rate before and after the administration of intravenous contrast was not affected by a specific disease category, or even with no known comorbidities. However, future studies in this area should be conducted to cover more centers and regions of Saudi Arabia, but with the use of the recently identified biomarkers of AKI, such as the acute kidney injury, such as the neutrophil gelatinase-associated lipocalin and the kidney injury molecule-1, in order to match specific independent factors, such as age groups, gender, and variable comorbidities.</p> Rani G. Ahmad Fatemah Albugmi Shahad Aleiidi Rahaf Almoallim Duaa Ahmed Basalem Nashwah Waleed Helabi Copyright (c) 2020 Rani G. Ahmad, Fatemah M. Albugmi, Shahad A. Aleiidi, Rahaf M. Almoallim, Duaa A. Basalem, and Nashwah W. Helabi 2020-06-30 2020-06-30 27 1 55 61 10.4197/Med.27-1.8 Knowledge and Attitude of Female Teachers Towards Emergency Management of Traumatic Dental Injuries in Jeddah City: A Cross-Sectional Study <p>Teachers are the primary contact point, when an incident occurs in school. Traumatic dental injuries had been frequently reported among school children. The purpose of this study was to assess the attitudes and knowledge of female teachers in Jeddah City in the management of emergency traumatic dental injuries and the referrals of cases to dental clinics within a limited time. In this cross- sectional study, a questionnaire was used to collect information from 503 female teachers from schools that were randomly selected. The survey focused on the general demographic characteristics, attitudes, and knowledge among the school teachers, in addition to their preferred strategies for the management of dental emergencies. These findings revealed that 64% of the teachers had positive attitudes about dental emergency management in school, while only 37% of them had sufficient knowledge about these emergencies. There was no significant association between the attitudes of the participant their knowledge. Despite these positive attitudes displayed by the teachers, there is a significant lack of knowledge among them about the management of dental emergencies, in particular, about tooth avulsion.</p> Ola Jamal Balkhair Haneen Al-Maghrabi Rania Baakdah Copyright (c) 2020 Ola J. Balkhair, Haneen A. Al-Maghrabi, and Rania A. Baakdah 2020-06-30 2020-06-30 27 1 63 73 10.4197/Med.27-1.9