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   Table of Contents - Current issue
July-December 2020
Volume 5 | Issue 2
Page Nos. 53-98

Online since Thursday, February 25, 2021

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Oxcarbazepine as a safe therapy for the management of trigeminal neuralgia (Trileptal®): Case series and review article p. 53
Khalil Ibrahim Assiri
Oxcarbazepine is an effective antiepileptic medication. It is typically used alone or in conjunction with other drugs to treat partial seizures and is believed to be the first line for the treatment of trigeminal neuralgia, which is a sharp pain attack lasting for seconds in orofacial territories and the distribution of the trigeminal nerve and its branches. Its therapeutic effectiveness is comparable to carbamazepine, but it has better pharmacokinetic properties, is better tolerated, and has a safe profile compared to carbamazepine drug-to-drug interactions and general side effects.
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Impact of COVID-19 pandemic on acute coronary syndrome presentation and its management in saudi arabia “a local experience” p. 57
Sondos Samargandy, Abdulrahman AlQahtani, Turki Al Garni, Sami AlAsmari, Mohammed Alahmari, Bandar AlShehri, Fahmi AlKaf, Bander AlGhamdi, Abdulrahman AlMoghairi, Waleed AlHarbi, Hussein AlAmri
Background: The impact of COVID 19 pandemic on all acute coronary syndrome (ACS) presentations and its management in Saudi Arabia is still unknown. Objectives: To find furthermore in the rate of ACS presentation, including ST-segment elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina (UA) during this outbreak and its effect on the management. Materials and Methods: We conducted a retrospective analysis of consecutive patients presenting with ACS requiring cardiac catheterization in three primary percutaneous coronary intervention (PCI) capable centers from March to April 2020 compared to the same period from 2019. Results: We found a numeric downward shift of 62.2% in all ACS presentations, including ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina (UA) during the study time when compared to its equivalent period in 2019, (P = 0.329). The door-to-balloon median time in STEMIs was statistically insignificant between the two comparison groups, but more patients in 2020 had a delay in transfer with either evaluating a suspected COVID-19 case or more time to prepare the cath lab staff protected precaution (P = 0.002). We illustrated a significant delay in time to seek medical attention from onset of symptoms by patients with NSTEMI and UA in 2020, with a median of 36 h (24, 96) versus 12 h (2, 96) in 2019 (P < 0.001). Moreover, the rate of female patients with ACS cases requiring PCI yields an increase in 2020 (P < 0.001). Overall, revascularization management of ACS patients presenting before and during the pandemic showed no difference. Conclusion: ACS admissions have been reduced during the COVID-19 pandemic, with no much impact on the overall management of revascularization. Efforts should be directed to understand the underlying mechanisms of these results to improve the short and long-term outcomes of these high-risk groups in these challenging times.
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The clinical utility of red blood cells and reticulocyte-related indices for early detection of latent Iron deficiency p. 62
Husain Y Alkhaldy
Background: Iron deficiency (ID) with and without anemia is common among young women of childbearing age. Screening and early diagnosis of ID before anemia develops are relevant to manage before the symptomatic stage. Several automated red blood cell (RBC) and reticulocyte indices have been investigated to identify early ID. Objectives: To explore the clinical utility of both old (MCV, MCH, and MCHC) and new (Ret-He and IFR) indices for detecting latent ID before the symptomatic anemia stage develops. Methods: A group of female college students at high altitude southern Saudi Arabia was assessed for iron status and associated anemia. Three groups were identified, ID anemia (IDA) group, ID without anemia (i.e., latent ID), and normal group. The lab generated RBC related indices (mean corpuscular volume [MCV], mean corpuscular hemoglobin [MCH], and mean corpuscular hemoglobin concentration), And reticulocyte count and their derived indices (reticulocyte hemoglobin content [RET-He] and immature reticulocyte fraction [IRF]) were collected. The RBC and Reticulocyte indices were compared between the normal, ID and IDA groups in order to identify possible distinguishing parameters of early ID state. Descriptive analysis and significance testing were performed. Results: Ninety-two of two hundred participants (46%) were found to have a latent ID and 30 (15%) had IDA. Hemoglobin, MCV, and MCH showed progressive decrement on their values from the iron replete through iron deplete state to full-blown anemia state. Reticulocytes count and MCV/MCH were significantly lower in the latent ID group compared to the normal group. RET-He and IRF showed no statistical difference between the latent ID and normal groups. Conclusion: Latent ID, before anemia develops, is associated with significant RBC indices, MCV/MCH, changes. These changes can be used to follow-up and detect early recurrence of ID. At our setting of high altitude, Ret-He shows no clinical utility in early diagnosis of ID state. Reticulocyte count drops early before qualitative reticulocyte indices like RET-He, a finding that could be attributed to baseline high-altitude-associated erythrocytosis.
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Assessment of quality of life, functional capacity, and disability in patients with vestibular disorders: A cross-sectional study p. 67
Sarah Alshehri
Background: The Vestibular Disorders Activities of Daily Living Scale (VADL) is a valid and reliable scale designed to assess the activity component in people with vestibular disorders. It is a self-evaluation scale and has been adapted into French, Brazilian Portuguese, Arabic, and Persian. Objectives: In this study, we assessed the internal consistency, intrarater reliability, and concurrent validity of the Arabic version of the VADL scale (VADL-A) in patients with vestibular disorders. Methodology: A total of 50 patients with vestibular disorders completed the VADL-A, the Dizziness Handicap Inventory (DHI), and the Activities-Specific Balance Confidence (ABC) scales during a visit to their health-care provider. On the following day, they filled out the VADL-A scale again. The obtained data were used to assess the psychometric properties of the scale. Results: The internal consistency of the scale was excellent, with a Cronbach's alpha of 0.977. The intrarater reliability was also compelling, with an intraclass correlation coefficient of 0.94. The concurrent validity was obtained by comparing the VADL-A with the DHI and ABC scales and was found to be moderate, with r values of 0.52 (P = 0.003) and -0.65 (P < 0.001), respectively. Conclusion: The results of our study proved the VADL-A to be a reliable and valid scale for assessing activity-related problems in patients with vestibular disorders.
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Serum osteocalcin levels in saudi females with type 2 diabetes mellitus in Al Madinah Al Munawarah p. 71
Walaa Mohammedsaeed, Lobnah Saber
Background: Osteocalcin (OC), a bone-derived protein hormone, regulates glucose and fat metabolism. In Saudi population, the relationship between serum OC levels and Type 2 diabetes mellitus (DM) is limited. The association of OC with cardiovascular disease (CVD) is also not clear. Objectives: We performed a case–control study to explore the relationship between OC and Type 2 DM and CVD among Saudi females in Almadinah. Materials and Methods: A case–control study was conducted between January 2017 and January 2019 for 50 female patients with Type 2 DM attending Prince Abdelaziz Ben Maged Ben Abdelaziz Diabetic Center in Almadinah enrolled as research subjects. Fifty Type 2 DM female patients, aged about 30–55 years, and 50 age-matched healthy female control subjects were enrolled in our study. After overnight fasting, total OC, glucose, glycated hemoglobin (HbA1c), and lipid profile were analyzed to determine association of OC with glucose intolerance and lipid profile. Data processing was performed using GraphPad Prism 7 (GraphPad Software, CA, USA). Results: There was a significant elevation in the frequency of low OC levels in Type 2 DM patients compared with controls (P < 0.001). Fasting serum glucose varied inversely with the OC tertials (P = 0.049). However, no statistically significant difference was noted in HbA1c or lipid levels with the OC tertials. The Atherogenic Index of Plasma (AIP = Log10 [TG/HDL]) was 36% among Type 2 DM patients, indicating higher cardiovascular risk, while 26% had intermediate risk, with increased frequency of low OC levels in patients with high and intermediate cardiovascular risk compared to low-risk patients group (P = 0.047). Conclusions: Low serum OC level was associated with impaired glucose metabolism and increased cardiovascular risk in Type 2 diabetes.
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Estimating reference dose measurements during common computed tomographic procedures p. 76
Hussain M Almohiy, E Elshiekh, Mohammed S Alqahani, Khalid I Hussein, Madshush M Alshahrani, Mohammed Saad
Background: Medical X-rays are the largest man-made source of public exposure to ionizing radiation. In CT examination, the probability of radiation-induced cancer is more than other x-ray examinations. Objective: The aim of this research is to estimate the reference dose values for some common procedures (head and abdomen) and compare the findings with those of a previous research. Methods: Dose measurements were taken from the scanner readings, and using the periphery of the PMMA phantom, the body phantom and head were found to be about 32 cm and 16 cm in diameter, respectively. The volume computed tomography (CT) dose index (CTDIvol) carefully chosen in the small phantom was used as a benchmark for a CT head, and the measure in large phantom was utilized as a benchmark for body CT. The results of the average estimated CTDIvol for the head-and-abdomen scans in the emergency department of a large hospital and large diagnostic clinic scanner were compared with international reference dose levels. Results: In this study, the average values of CTDIvol were 53.02 mGy and 16.95 mGy for the head and abdomen, respectively. The dose for the head phantom, 53.02 mGy, was perceived to be inferior in differentiation with international diagnostic reference level (DRL) doses. The estimated dose for the abdomen scan was elevated in comparison with 2004 European DRLs by 13%, but it was lower than the DRL for ACR by 32%. Conclusion: The results presented here will assist by collectively providing a fixed reference point for determining reference doses for CT examinations.
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Public knowledge and awareness about food–drug interactions in the northern border region, Saudi Arabia p. 82
Nasser Salem Alqahtani
Background: Food–drug interactions (FDIs) are underreported which could be due to a variety of factors such as lack of food history, follow-ups, or unawareness. Objective: The present study intended to investigate the degree of existing knowledge and awareness of FDIs among the Saudi people. Methodology: This is a cross-sectional study conducted in the Northern Border Region, Arar city of Saudi, among a random convenient sample of 223 people. Voluntary participants filled a predesigned self-administered questionnaire comprising 22 close-ended questions and 1 open-ended question. Data were collected for a duration of 2 months and descriptive analysis was performed to obtain frequencies of responses. Results: The overall response rate was 89% with a larger number of females and 79% belonging to the 20–30 age group. Of the study population, only 6% reported having experienced such FDIs at least once in their lifetime. Almost 97% believe that they should read the label of any drug before consuming it. More than half of the participants (52%) agreed that acidic foods and beverages such as tomato sauce, tea, coffee, and citrus juices affect drug absorption and may cause food/drug interaction. About 62% believe that alcohol and drugs should never be clubbed. Conclusion: It is hereby shown that FDIs' awareness and knowledge were poor among the Saudi population. This, however, can be addressed as a high proportion of respondents had a positive attitude toward reading the drug label before use.
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Eosinophilic gastroenteritis presenting as persistent abdominal pain and ascites: A case report p. 86
Mohammed Attieh S. Alzahrani
Eosinophilic gastroenteritis (EGE) is a rare benign inflammatory disease affecting the infant and adult population. It presents by eosinophilic infiltration of the intestinal tract wall including the stomach, small intestines, and rarely the colon. EGE is divided into three subtypes depending on the layers and extent of bowel involved (mucosal, muscular, and serosal). Accurate diagnosis is still considered a challenge to professionals because of the protean manifestations; it needs a combination of clinical, laboratory, radiological, and histological workup. We report here a case of a 35-year-old male with a 3-month history of abdominal pain and distension. On examination, we found mild-to-moderate ascites and peripheral eosinophilia with markedly elevated eosinophils (85%). The imaging studies showed bowel wall thickening involving the entire small bowel and mild duodenitis. The diagnosis was confirmed by duodenal biopsy. The patient was managed with steroids (prednisolone 40 mg) and had an excellent response to the treatment. There is no single laboratory test or procedure to diagnose EGE; it requires a combination of laboratory, radiologic, and endoscopic findings. This report will guide decision-making for the initial phase of treatment and maintenance therapy in a more consistent way.
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Prolonged type 1 diabetes honeymoon period: Case report and review of the literature p. 90
Moeber Mohammed Mahzari
The clinical and biochemical variables of a patient with unusual and relatively long? type 1 diabetes (T1DM) remission are reported. The case is followed by literature review of interventions with a positive impact on T1DM remission. The patient has clinical and biochemical phenotype consistent with T1DM. He refused to take treatment for diabetes. He has been using Trigonella foenum-graecum as the only treatment for diabetes. The patient has not developed diabetic ketoacidosis until the time of this report (34 months after his initial diagnosis), which is unusual for patients with T1DM. The positive effect of Trigonella foenum-graecum on T1DM remission in this patient is not ascertained but possible. Relevant literature of studies and case reports of similar prolonged T1DM remission reviewed and summarized. There is a clear need to continue exploring interventions in prospective studies to induce and prolong T1DM remission.
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Fabrication of a silicone partial nasal prosthesis p. 95
Nasser Mohammad Alqahtani
Fabricating a partial extraoral prosthesis is challenging, especially partial nasal prosthesis. An extraoral prosthesis can be successful when patients can socialize without fear of being noticed with an abnormal facial defect. Homogeneity, subtle textures, and color match are essential to fabricate successful extraoral prosthesis. In this case report, a 69-year-old Caucasian female patient presented with a partial nasal defect. A silicone partial nasal prosthesis was fabricated to replicate the missing structures.
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