Saudi medical journal (SAUDI MED J)

Publications in this journal

• Article: Effects of dexmedetomidine on succinylcholine-induced myalgia in the early postoperative period.

  Nalan Celebi, Ozgur Canbay, Hemra Cil, Asli Ayaz
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  ABSTRACT: To determine the effects of dexmedetomidine on the incidence of fasciculation and myalgia, and to evaluate changes in creatine kinase levels due to succinylcholine administration. Sixty patients undergoing direct laryngoscopy were enrolled in this study carried out in the Department of Anesthesiology and Reanimation, Hacettepe University, Ankara, Turkey between January and March 2010. Patients were allocated blindly to 3 anesthesiologists. In the dexmedetomidine group (group D) (n=30), dexmedetomidine 1ug/kg was administered intravenously over 10 minutes before the intubation. In the control group (group C) (n=30), the same volume of normal saline was administered. Laryngoscopy was performed one minute after administration of succinylcholine. Dexmedetomidine infusion was continued until the end of surgery. Fasciculation and myalgia at the postoperative thirtieth minute, and creatine kinase levels before the induction of anesthesia and at the postoperative 24th hour, and adequacy of relaxation for intubation were recorded. The severity and incidence of fasciculation were better in group D than group C (p=0.025). Intubating conditions were better in the dexmedetomidine group (p=0.011). At the thirtieth minute, the incidence and severity of myalgia were significantly higher in group C (p=0.014). Postoperative creatine kinase levels increased significantly compared with their base-line levels in both groups (p=0.022 in group D and p=0.017 in group C). Creatine kinase level elevation was higher in group C (p=0.03). Dexmedetomidine infusion before and after succinylcholine administration may be useful in diminishing the incidence of succinylcholine-induced myalgia in the early postoperative period. Routine use of dexmedetomidine cannot be recommended, but further research is needed with a larger number of patients.
  Saudi medical journal 04/2013; 34(4):369-73.
• Article: Glaucoma after open globe injury at a tertiary care university hospital in Central Saudi Arabia. Cumulative incidence and risk factors.

  Essam A Osman, Nawaf Al-Fawaz, Abdulla G Al-Otaibi, Samir M Al-Mansouri, Ahmed Mousa, Hani S Al-Mezaine
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  ABSTRACT: To investigate the incidence and risk factors of glaucoma after open globe injury (OGI). The medical records of all patients admitted with the diagnosis of OGI at the Department of Ophthalmology, King Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia and had undergone primary repair from January 1996 to December 2011 were retrospectively reviewed. For the 15-year study period, 775 patients who underwent repair of an OGI were identified. The overall risk of post-traumatic glaucoma was 5.3% (41/775) with a mean +/- SD follow-up period of 12+/-6.5 months. Univariate analysis revealed that Zone II injury (p=0.027), penetrating ocular injury (p=0.0008), lens injury (p=0.011), vitreous hemorrhage (p=0.002), and presence of intraocular foreign body (p<0.0001) were significantly associated with glaucoma. Age of more than 18 years was critical (p=0.054). Following logistic regression, penetrating ocular injury (p=0.019), lens injury (p=0.002), and vitreous hemorrhage were significant (p=0.037). Glaucoma after OGI is not uncommon. Zone II injury, penetrating ocular injury, lens injury, presence of vitreous hemorrhage, and presence of an intraocular foreign body were significant risk factors for developing post-traumatic glaucoma.
  Saudi medical journal 04/2013; 34(4):374-8.
• Article: Aspirin induced leukocytoclastic vasculitis, lower gastrointestinal hemorrhage and acute renal failure (mimicking systemic vasculitis).

  Fahdah A Alokaily, Mushabab Alghamdi, Ahmad S Almalki, Hussa Alhussaini
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  ABSTRACT: This is a case of a 60-year-old gentleman who presented with an extensive cutaneous vasculitic rash (leukocytoclastic) with lower gastrointestinal bleeding following a small dose of aspirin (81 mg). The aspirin was stopped immediately. Three weeks later, he had acute renal failure, which was initially thought to be secondary to systemic vasculitis, but proved to be acute renal tubular necrosis as a delayed reaction to aspirin.
  Saudi medical journal 04/2013; 34(4):420-3.
• Article: Atomic force microscopy and tridimensional topography analysis of human enamel after resinous infiltration and storage in water.

  Nadia M Taher
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  ABSTRACT: To evaluate the effect of water storage on surface roughness (Ra) of human enamel after treatment with resin infiltrant and fissure sealant, by utilizing atomic force microscopy (AFM) and microtomography. This study was conducted after registration and ethical approval clarification at the College of Dentistry Research Center, King Saud University, Riyadh, Kingdom of Saudi Arabia between January 2011 and August 2011. Thirty enamel surface specimens were prepared from caries-free human premolar teeth. Specimens were divided into 3 groups: Group I, was the control; Group II, a resin infiltrant (Icon) was applied on the enamel surfaces; and Group III, the teeth were treated with fissure sealant (SealRite). All specimens were stored in distilled water for 6 months and then, subjected to AFM Veeco CP11 1.2 analysis. A few specimens were scanned by skyscan-1072-x-ray microtomography. The Ra mean readings were recorded and statistical analysis was performed with the Statistical Package for Social Sciences Version 16 at the significance level of p<0.05. No significant differences in the mean Ra were recorded among the 3 groups, (Group I = 0.21+/-0.057), (Group II = 0.23+/-0.075), and (Group III = 0.20+/-0.039) at p=0.747. The AFM images of enamel surface show thin and inhomogeneous Icon resin in Group II, meanwhile, the SealRite in Group III showed a homogeneous layer in all specimens. The microtomography supported the findings of the AFM images. The persistence of the SealRite in all specimens revealed its low solubility in water and its protective effect on enamel surface.
  Saudi medical journal 04/2013; 34(4):408-14.
• Article: Serum vitamins A and E deficiencies in patients with inflammatory bowel disease.

  Javad Hashemi, Jahanbakhsh Asadi, Taghi Amiriani, Sima Besharat, Gholam R Roshandel, Hamid R Joshaghani
  Saudi medical journal 04/2013; 34(4):432-4.
• Article: Causes of uveitis in a tertiary center in Western Saudi Arabia.

  Shaik Hm Nizamuddin, Ahmed M Bawazeer
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  ABSTRACT: To analyze the causes of uveitis and compare our results with national and international published studies. This is a retrospective review of medical records of patients who attend the uveitic clinic of Magrabi Eye and Ear Hospital in Jeddah, Kingdom of Saudi Arabia from January 1999 to December 2011. We encountered 823 eyes of 587 uveitis patients (male: 319 [54%] and female: 268 [46%]). Native Saudi patients constituted 52% of our total population, expatriate Arabs 23%, and Afro-Asians 23%. Average age at presentation was 34.8+/-12.83 (range 5-70) years. Unilateral presentation was noted in 351 (60%) and bilateral in 236 (40%) patients. Idiopathic anterior uveitis was the most common diagnosis (n=268, 45.7%). Anterior uveitis was the most common anatomical diagnosis (n=335, 57.1%) followed by panuveitis (n=151, 25.7%), posterior uveitis (n=51, 8.7%) and intermediate uveitis (n=50, 8.5%). There were 50 patients (8.5%) of Behcet`s disease, 48 patients (8.2%) of Vogt-Koyanagi-Harada disease (VKH) and 35 cases (6%) of toxoplasmosis. The most common cause of anatomic diagnosis was anterior uveitis. Behcet`s disease was the most common identifiable cause of uveitis followed by VKH. The most common cause of infectious uveitis was toxoplasmosis. Idiopathic anterior uveitis was the most common uveitic entity.
  Saudi medical journal 04/2013; 34(4):379-87.
• Article: Depression in patients with colorectal cancer.

  Mohammad G Sehlo, Mahmoud S Al Ahwal
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  ABSTRACT: Patients with colorectal cancer (CRC) experience psychological stress due to the diagnosis and the physical and social changes brought on by the illness, increasing the risk of depressive disorder. Depression causes tremendous disability and adds to the suffering that patients must already endure. It is known to alter immune and endocrine functions that affect vulnerability to CRC, its course over time, and its response to treatment. We review the prevalence of depressive symptoms and disorders worldwide and in the Kingdom of Saudi Arabia (KSA), focusing on patients with medical illness and those with CRC, in particular. We examine how often depression is diagnosed, how it is treated, and its likely course over time, and review the effects of depression on functional disability, longevity, and immune functions. Finally, we discuss research needs and make recommendations on highest priority research studies to advance our understanding of depressive disorder in CRC patients in KSA.
  Saudi medical journal 04/2013; 34(4):341-7.
• Article: New method for evaluation of cervical vertebral maturation based on angular measurements.

  Adel M Alhadlaq, Eman I Al-Shayea
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  ABSTRACT: To investigate the validity of a new approach to assess the cervical vertebral maturation based on angular measurements of the lower border concavity of cervical vertebral bodies. Hand-wrist and lateral cephalometric radiographs of 197 male subjects with age range of 10-15 years attending the orthodontic clinic at King Saud University, Riyadh, Kingdom of Saudi Arabia were utilized. The study was carried out between September 2009 and May 2011. The study sample was divided into 6 groups (group 1: 10 years to group 6: 15 years) based on the chronological age of the subject. The skeletal age of the subjects was determined using Greulich and Pyle's standard radiographic atlas, and skeletal maturation was assessed by Fishman's skeletal maturity indicators. The cervical vertebral maturation (CVM) of subjects was determined using angular measurements of the second, third, and fourth cervical vertebral bodies. The validity of the newly developed method was assessed by examining the correlation between CVM stages determined by the angular measurements and the skeletal maturation level as determined by the standard hand-wrist methods. A significant correlation (r=0.94) was found between the angular CVM stages and the skeletal age determined by Greulich and Pyle's atlas from hand-wrist radiographs. Also, a high correlation (r=0.94) was found between the angular CVM stages and the Fishman's hand-wrist skeletal maturity indicators. The new angular measurement approach to determine CVM is valid and has the potential to be applied in assessing skeletal maturity level in growing male children.
  Saudi medical journal 04/2013; 34(4):388-94.
• Article: Analysis of factors related to patient peritoneal dialysis drop out rates.

  Yang Lin, Zhang Minghua, Zhong Wenqi, Liu Xiaojiao
  Saudi medical journal 04/2013; 34(4):428-31.
• Article: Reduced systemic inflammatory mediators after treatment of chronic gingivitis.

  Ahmed S Alzahrani, Nabil F Bissada, Richard J Jurevic, Sena Narendran, Imad E Nouneh, Mohammad S Al-Zahrani
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  ABSTRACT: To assess the changes in the level of C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-alpha) in gingival crevicular fluid (GCF) after treatment of chronic gingivitis in systemically healthy individuals. This is a clinical trial conducted at Case Western Reserve University, Cleveland, Ohio, United States of America from February to December 2011. A total of 41 systemically healthy subjects were assigned to 2 groups according to the severity of gingival inflammation. Group I consisted of 18 subjects who had mild gingival inflammation; and group II consisted of 23 with more severe gingival inflammation. Periodontal assessment consisted of gingival index (GI), probing depths (PD), and GCF volume. Four to six weeks after prophylaxis and oral hygiene instruction, the same measurements were repeated. The level of CRP and TNF-alpha in the GCF was determined using enzyme-linked immunosorbent assays. A statistically significant reduction in the mean CRP and TNF-alpha levels after the treatment was found in the severe, but not in the mild gingivitis group. Both groups showed a statistically significant reduction in GI, PD, and periotron readings after the treatment. Treatment of severe chronic gingivitis reduces the levels of CRP and TNF-alpha in GCF of otherwise systemically healthy individuals, which could have an impact on preventing or controlling future or existing systemic disease conditions.
  Saudi medical journal 04/2013; 34(4):415-9.
• Article: Oral rehabilitation of a case of Papillon-Lefevre syndrome with dental implants.

  Abdullah Al Farraj Aldosari
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  ABSTRACT: Papillon-Lefevre syndrome (PLS) is a rare autosomal recessive disorder characterized by diffuse palmoplantar keratoderma and precocious aggressively progressing periodontitis, leading to the premature loss of deciduous and permanent teeth. Full mouth rehabilitation with implant supported fixed prosthesis provides numerous advantages over the conventional denture in terms of esthetics, function, longevity of the prosthesis, and patient satisfaction. We report a case of PLS in a 19-year-old female who underwent extraction of all the teeth followed by full mouth rehabilitation with implant supported fixed prostheses. A one-year follow up of the case showed functionally and esthetically stable dental implant with no signs of infection or bone loss.
  Saudi medical journal 04/2013; 34(4):424-7.
• Article: The course of the marginal mandibular branch of the facial nerve in adult cadavers. An anatomic study.

  Ugur Karapinar, Cenk Kilic, Bilal Cetin, Omer Saglam, Engin Dursun, Muzaffer Durmus
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  ABSTRACT: To observe the course of the marginal mandibular branch of the facial nerve (MMBFN) and its relation to the inferior border of the mandible and facial vessels. This cadaveric study was conducted at the Department of Anatomy, Gulhane Military Medical Academy, Ankara, Turkey from April to September 2012. The 44 facial halves of 22 adult cadavers were dissected under a stereomicroscope. The nerve was found to be presented by one branch (36.4%), and 2 branches (63.6%). The distance of the nerve from the inferior border of the mandible varied from 13.06-40.08 mm, with an average distance of 21.91 mm. There were communications with buccal branch only in 2 specimens (4.6%). All the branches of the marginal mandibular branch ran laterally to the facial artery in 43 (97.7%) of the 44 specimens. In one specimen, the 2 marginal mandibular branches ran between the facial artery and vein. The MMBFN can occasionally be damaged during surgeries confined to the submandibular region due to its location and anatomical variant. The most common pattern of MMBFN was nerve with 2 branches. The maximum distance between the MMBFN and the mandible was 40.08 mm. This anatomical knowledge may be useful to surgeons of the head and neck in planning incisions and procedures in the submandibular region.
  Saudi medical journal 04/2013; 34(4):364-8.
• Article: Prevalence of obesity among military personnel in Saudi Arabia and associated risk factors.

  Ghalib Bin Horaib, Hesham I Al-Khashan, Adel M Mishriky, Mohei A Selim, Noura Alnowaiser, Abdulaziz A Binsaeed, Ahmed D Alawad, Abdulrahman K Al-Asmari, Khalid Alqumaizi
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  ABSTRACT: To measure the prevalence of obesity among military personnel in the Kingdom of Saudi Arabia (KSA), and to identify its risk factors. This nationwide cross-sectional study covered all 5 military regions of KSA. It included a multistage stratified random sample of 10,500 active military personnel. The World Health Organization STEP wise approach to chronic disease risk factor surveillance (STEPS) was used in the design of the data collection tool. The project lasted from January 2009 to February 2011. The response rate was 97.4%; 40.9% of the participants were overweight, 29% obese, and 42.4% had central obesity. Multivariate analysis revealed age, education years, and family history of diabetes or hypertension as statistically significant positive predictors of body mass index, while higher military rank, smoking, eating fruits more than twice per week, and heavy physical activities were negative predictors. Obesity is a major health problem among military personnel in this survey especially among soldiers, and is associated with unhealthy dietary and physical activity habits. Prompt action must be taken by the military medical services department in terms of intervention programs primarily directed to soldiers and overweight personnel to control obesity and mitigate its consequences. Review of the anthropometric standards for recruitment, continuation, and promotion in military service is recommended.
  Saudi medical journal 04/2013; 34(4):401-7.
• Article: Role of vitamins E and C in mitigating hypoxia- and exhaustive exercise-induced aberrant stem cell factor expression and impaired reproductive function in male Wistar rats.

  Fahaid H Al-Hashem
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  ABSTRACT: To evaluate and compare the potential role of vitamins E and C in protecting against acute swimming induced reproductive function damage at different altitudes. The study was carried between October and November 2010. A total of 36 adult male Wistar rats weighing 250+/-5 g, and aged 8 weeks were used in this study, which was carried at the Physiology laboratory of King Khalid University in Abha City (high altitude area [HA]), and at the College of Science, King Saud University in Riyadh city (low altitude area [LA]), Kingdom of Saudi Arabia. The rats of each area were divided into 3 groups (n=6 each): control, acute exercise stress, and vitamins E and C pretreated stress. At the end of the study, oxidative stress, reproductive function, histopathology, and expression of stem cell factor (CSF) were examined in all rats. Living under HA conditions decreased expression of SCF, sperm count, and serum levels of reproductive hormones, and significantly increased testicle tissue oxidative stress and lipid peroxidation. Exhaustive exercise-induced stress at both altitudes resulted in similar results with more deteriorating effects in rats of HA compared with LA. Supplementation of vitamins E and C prior to stress induction at both altitudes prevented all these structural and functional aberrations from happening. High altitude or strenuous exercise, or both, may impair male reproductive function, while vitamins E and C in combination potentially mitigate these adverse effects.
  Saudi medical journal 04/2013; 34(4):354-63.
• Article: High C reactive protein associated with increased pulse wave velocity among urban men with metabolic syndrome in Malaysia.

  Amilia Aminuddin, Zaiton Zakaria, Ahmad F Fuad, Jaarin Kamsiah, Faizah Othman, Srijit Das, Yusof Kamisah, Haji S Qodriyah, Zakiah Jubri, Noranita M Nordin, Wan Z Ngah
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  ABSTRACT: To determine the association between carotid femoral pulse wave velocity (PWVCF); augmentation index (AI); and high-sensitivity C reactive protein (hs-CRP) with metabolic syndrome (MetS), and to determine the influence of ethnicity on PWVCF and AI, and the association between high hs-CRP and increased PWV, and AI in MetS. A cross-sectional study was conducted at Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia from September 2009 to September 2011. Three hundred and eighty men (Chinese and Malays) were recruited from the study. The PWVCF and AI were measured by Vicorder (SMT Medical, Wuerzburg, Germany). The hs-CRP level was also determined. We defined MetS using the International Diabetes Federation (IDF) and harmonized criteria. Malays had higher AI compared to the Malaysian Chinese. Patients with MetS had higher PWVCF (IDF criteria: 8.5 [8.3-8.7] versus 8.2 [8.0-8.4] m/s, p=0.03; harmonized criteria: 8.5 [8.4-8.7] versus 8.2 [8.0-8.4] m/s, p=0.007) and hs-CRP (IDF criteria: 0.9+/-2.0 versus 0.4+/-1.1 mg/L, p=0.0007; harmonized criteria: 0.8+/-1.9 versus 0.4+/-1.1 mg/L, p=0.002) compared to non-MetS. In subjects with MetS, those with high hs-CRP (>3mg/L) had higher PWVCF. Augmentation index values were significantly higher in Malays compared with Malaysian Chinese. Metabolic syndrome was associated with increased PWVCF and hs-CRP. Patients with MetS and high hs-CRP were associated with higher PWVCF. The measurement of hs-CRP reflects the degree of subclinical vascular damage in MetS.
  Saudi medical journal 03/2013; 34(3):266-75.
• Article: A novel approach to manage patients with compromised airway. Videoscopic assisted retromolar intubation.

  Abdulaziz M Boker
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  ABSTRACT: Aids to difficult airway management are essential for safe practice of anesthesia particularly for high-risk patients. This case series described a novel approach of combined use of complementing tools (videolaryngeoscopic assisted retromolar intubation) to enhance airway management of a subset of various high-risk patients with extremely difficult airway. It also addressed the rational for the combination of such approaches as well as the advantages and disadvantages of this technique. In all of the 4 patients, the use of the combined approach resulted in a successful intubation without the need for surgical airway. This technique showed many advantages making it possible to use in cases with life threatening airway obstruction.
  Saudi medical journal 03/2013; 34(3):308-12.
• Article: New sources for insulin-producing cells.

  Hussain R Al-Turaifi
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  ABSTRACT: Cellular replacement offers the potential of a `cure` for type 1 diabetes mellitus. Shortage of suitable donors limits widespread implementation of this approach. Recent research has been focused on potential new sources of beta-cells including embryonic and adult stem cells, and other organs cells. The contribution of beta-cell replication to new islet formation, in addition to the potential for transdifferentiation of pancreatic acini and ductal cells in adult human pancreas is not clear. The existence of true stem cells within pancreas remains contentious issue. In this review, we summarized the possible sources of new insulin-secreting cells.
  Saudi medical journal 03/2013; 34(3):232-9.