March Edition 2017

 IJASR Volume 5 – Issue 1, February – March 2017 Edition

All listed papers are published after full consent of respective author or co-author(s).
For any discussion on research subject or research matter, the reader should directly contact to undersigned authors.

Use of Medical Applications And Tools in Smartphones And Tablets Among King Saud University Medical Students: A Cross Sectional Study

Amr Jamal, Abdullah Almazyad, Khalid AlKhamis, Turki Alturki, Turki Alotaibi, Fahd Alshuweishi, Abdulrahman Albakr


Due to the prevalence of students using medical applications and tools in smart devices, the question arises, “What is the use of medical related applications and tools in Smartphone and tablets among medical students?”. We distributed a web-based questionnaire to 355 randomly selected medical students in King Saud University regarding use of medical apps among medical students. A total of 315 medical students participated in the study.97% owned Smartphone and 66.1%of students owned both Smartphone & tablet. We have found that the most used type of applications was web browser (96.2%). The least used type of applications was medical calculators/clinical scores system (7.7%).Concerning disease diagnosis/management and medical dictionaries type of apps we have found difference between pre-clinical students and clinical students, which turned out to be significant. Most students use the application for education purposes with higher percentage for clinical students. On the other hand the clinical use results were much higher in the clinical years’ students than the pre-clinical students.

[Download]                                                                                                       1-8


Association between obesity and eating habits among female adolescents attending middle and high schools in National Guard Compound, Riyadh

Salem Althuwaykh, Khalid Alwakeel, Abdullah Abdulmomen, Ziad Alsaadi, Aamir Omair, Mohamud S Mohamud


Background: Obesity among adolescents is at an alarming increase, and in order to achieve effective management, an association between obesity and lifestyle must be established. This study aimed to determine prevalence and association between obesity and dietary habits among female adolescents attending middle and high schools in National Guard Compound, Riyadh. Methodology: A cross-sectional study was conducted in Riyadh on female students attending National Guard middle and high schools. Ages ranged from 11 – 18 years.  A qualified nurse took anthropometric measurements which included weight, height, and waist circumference. Other data that could have an impact on weight such as TV habits and vegetable consumption were gathered by using a self-reported questionnaire. Results: 400 female students, with an average age of 14.8 ±1.2 years, were included in the study. BMI showed that 98 (25%) were overweight and 61 (15%) were obese. Eating habits revealed that 50% of normal/underweight students tend to eat breakfast on both weekend days as compared to 33% of overweight/obese students (p=0.005). Also, 102 (64%) of obese/overweight students rarely eat vegetables as compared to 119 (50%) of normal/underweight (p=0.03).  There were 22 (65%) students who were obese/overweight whose fathers were unemployed, as compared to 137 (38%) students whose fathers were employed (p=0.003). Conclusion: Obesity and overweight is high among female adolescents with an overall prevalence of 40%. In turn, we recommend implementing national prevention programs emphasizing on lifestyle modification, reduced television viewing, and avoiding unhealthy dietary habits, such as skipping breakfast on weekends and infrequent vegetable consumption.

[Download]                                                                                                    19-25


Acute Effect of Drinking Cold Hibiscus Beverage on Blood Pressure in Adult Females: A Randomized Controlled Trial

Afraa Salman, Israa Abdullah, Israa Saib, Bashaer Abdulaziz, Khulood Abdullah, Khulood Yahya, Maram Awad, Mawaddah Hassan, Wafaa Ibrahim, Wafaa Odah and Wala Saleh


Objectives: to test the acute effect of cold Hibiscus beverage on blood pressure and heart rate readings compared to both boiled Hibiscus and placebo beverages.  Methods: This double blind randomized control clinical trial was performed at Al Madinah, Saudi Arabia. Three hundred adult females aged 39.20 ± 8.71 years were randomized to receive either cold, boiled hibiscus or placebo beverages. The primary outcome measure was the acute effect of the different beverages on the systolic, diastolic blood pressure (SBP, DBP) and heart rate (HR) in both supine and erect positions within 15 and 30 minutes. Results: The 3 groups showed normal baseline blood pressure readings with significantly lower blood pressure among placebo group (p=0.022 for SBP and p=0.011 for DBP). Only in the cold Hibiscus group, the basal SBP (119.87 mmHg) dropped significantly to 114.29 mmHg after 15 minutes (p=0.00) and to 115.47 mmHg after 30 minutes (p=0.00) and the basal DBP (77.27 mmHg) dropped significantly to 74.31 mmHg after 15 minutes (p=0.00) and to 74.48 mmHg after 30 minutes (p=0.00). Comparing the effects of the three beverages, the cold Hibiscus beverage significantly lowered the SBP by 5.57±10.76 mmHg and the mean blood pressure by 3.88±7.56 mmHg after 15 minutes (p=0.00) and lowered the mean blood pressure significantly by 3.43±6.98 (p=0.007) after 30 minutes. The three beverages had similar comparable effects on HR and postural changes.  Conclusion: in adult females with normal baseline blood pressure readings cold but not boiled Hibiscus beverage lowers the blood pressure acutely and safely BUT limited to 15 minutes.

[Download]                                                                                                    26-34


A Case Report of the Natural Course of Eosinophilic Angiocentric Fibrosis of the Nasal Septum

Abdullah H. Alnemari1, Manyer G. Almutari, Moyasr Krami, abdulaziz Aldakil, Hatim Q. Al-Maghraby, Abdulrahman Alqin


We present the case of a 47-year-old female patient with eosinophilic angiocentric fibrosis (EAF): a rare, benign, fibroinflammatory condition of uncertain etiology in the sinonasal cavity. Her autoimmune profile was normal, and she had a history of adult-onset atopic asthma and atopic dermatitis. Histological and magnetic resonance imaging findings were typical for EAF. The patient was not treated with surgery, and there was no significant worsening of the condition over a 5-year follow up. There have been no recorded cases of malignant changes or mortality related to EAF. Additionally, surgical treatment typically results in recurrence, and EAF has been observed to stabilize over time. Therefore, we conclude that based on the natural course of the disease, surgical treatment should be re-evaluated as the first-choice treatment of this rare condition.

[Download]                                                                                                    35-39


Knowledge and Attitude of Blood, Organ and Stem Cells Donation Among AlAhssa Population

Ayesha A. AlAbdulqader, Amal M. AlMulhim, Faiy F. AlMulhim, Hanan H. Alshaikh Almubarak

Abstract: Background and Objectives: Many lifesaving medical procedures involve blood transfusion and wouldn’t be possible without a reliable blood supply, as well as organ donation and stem cells transplant which are tow surviving procedures that can increase life expectancy of end-stage or chronically ill patients. But donor numbers are lacking in AlAhssa. The main objective of this study was to measure the level of knowledge regarding blood donation, organ donation and stem cells transplant in AlAhssa population, find out positive and negative attitude, identify the obstacles and suggest some motivational factors. Methods: A cross sectional study conducted in AlAhssa during October 2015. Total of 1017 participants answered questionnaire consist of 3 sections to assess the knowledge, attitudes towards blood donation, organ donation, and stem cells awareness. Data analysis was done using IBM SPSS. Results: In the assessment of blood donation awareness 20.6% of the participants were blood donors, 95.9 % of participants are welling to donate in the future. Regarding organ donation 1.4% of participants reported history of organ donation or receiving an organ. Only 18.1 % participants show positive attitude, in addition there was significant differences in the attitude between people of medical or Para-medical specialties and non-medical specialties. Regarding stem cells 25.8% had never heard of stem cells before. Conclusion & recommendations: We found a positive attitude toward blood donation but more knowledge is needed to increase the donation rate. The main reason identified was not having the time. Regarding organ donation and stem cell transplant there was poor knowledge and attitude in both of them. 54.3% of participants had never thought or consider organ donation probably due to misconceptions, poor knowledge. Therefore, we suggest that various educational programs should be implemented to improve the knowledge and encourage a more positive attitude.

[Download]                                                                                                     40-53


Knowledge, Practice, and Attitudes Regarding Hookah (Water Pipe) Smoking among College Students Studying Health Sciences in Riyadh, Saudi Arabia

Fahad Allohidan, Ahmed K. Alanazi, Mohammed K. Azzahrani, Mishaal R. Alrashoud


Objectives: The aims of this study were to estimate the current prevalence and characteristics of hookah smoking among college students in Riyadh, Saudi Arabia, and to assess students’ knowledge, attitudes, and beliefs regarding hookah use. Methods: A cross-sectional, questionnaire-based study was conducted at King Saud bin Abdul-Aziz University for Health Sciences (KSAU-HS) in Riyadh. The study included representative samples from all of the colleges of KSAU-HS.  Results: Of 354 participants, 266 (75.1%) had never tried smoking hookah and only 88 (24.9%) students had smoked hookah during their lifetime. Students who had used hookah included 55 (63%) males and 33 (38%) females. When assessing beliefs and attitudes, we found that 157 (44.4%) believed hookah use to be more socially acceptable than cigarette smoking. Most of the hookah smokers (88.6%) reported that at least one of their five closest friends have ever smoked hookah, whereas only 11.4 reported that none of their closest friends had smoked hookah. Most students strongly agree with the banning of hookah and cigarette smoking by minors and in public areas. Conclusion: Hookah smoking has become a challenging health concern and is spreading among college students. Students who have used hookah have a higher number of closest friends currently smoking hookah than do non-smoking students, indicating a strong influence of friends on the decision to try hookah. Greater efforts must be put toward educating college students on the risks of hookah smoking to prevent its popularity from growing.

[Download]                                                                                                   54-65


The Common Types of Congenital Heart Disease in Down Syndrome Patients at King Abdul-Aziz Medical City-Jeddah

Rahaf Waggass, Ahmed Kashi, Hassan Alshehri, Adeeb Munshi, Omar Alhusaini, Waleed Mohammad Alshehri.


Background: Down syndrome (DS) is a type of mental retardation caused by extra genetic material on chromosome 21. Congenital heart defects (CHD) are the common abnormality in this syndrome. This study is to determine the frequency of congenital heart defects (CHD) in Down syndrome (DS) patients at King Abdul-Aziz Medical city-Jeddah (KAMC-JD) and to characterize the types of CHD. Methods: A retrospective chart review study of 178 Down syndrome patients born in or referred to (KAMC-JD) between January 2000 and January 2014 was conducted. For all patients, the diagnosis of Down syndrome was confirmed by karyotyping. DS patients with no echocardiography results were excluded. Results: a total of 178 DS patients were included in our study. CHD were detected in 110 patients (61.8%) while the echocardiography was normal in 68 patients (38.2), out of those 110 patients, 62 patients (56.4%) were male and 48 patients (43,6%) were female. Seventy-four patients (67.3%) had isolated CHD, while combined CHD were detected in thirty-six patients (32.7%). For both sexes, the most common detected lesions, either isolated or combined, were the atrial septal defect (ASD) in 71/110 (64.5%), ventricular septal defect (VSD) in 39/110 (35.5%), and patent ductus arteriosus (PDA) in 25/110 (22.7%). On the other hand, atrioventricular septal defect (AVSD) in 16/110 (14.5%), and tetralogy of Fallot (TOF) in 2/110 (1.8%) were the least common lesions.  Conclusion: The frequency of CHD in our study was higher than the international studies and most of the national studies. The most common CHD detected in our study (ASD) was different than other lesions in international and domestic studies

[Download]                                                                                                     66-71


The Prevalence of Depression and Anxiety among Medical Students in Comparison with Non-Medical Students: A Cross-Sectional Study in Taibah University, Al Madinah Al Munawwarah, Saudi Arabia, 2016

Wala’a Al Raddadi, Jawaher N. Aljabri, Mohammed A. Kareem, Abdullah M. Alattas,  Mohammed J Alkhalawi

Abstract: Background: Depression and anxiety have been observed as a common issue among medical students. Medical students are often exposed to several stressors, thus making them more prone to depression than other students from different disciplines. This  study  aimed  to  measure and compare the prevalence of depression and anxiety among medical students and non-medical students, Madinah, Saudi Arabia. Methods: A cross-sectional study was carried out in Taibah University, Al Madinah Al Munawwarah, Saudi Arabia. The participants, who were both males and females, were composed of 238 final-year medical  and computer science students. A simple stratified sample was used for sampling, and ethical approval was issued by Taibah University IRB committee. Data were collected using an electronic questionnaire written in Arabic. The questionnaire was categorized into three parts: demographic questions, Beck Depression Inventory II (BDI-II), and Penn State Worry Questionnaire (PSWQ). Results:  For the sample distribution, 44% was Medical student, and 56% was Computer Science students. Findings showed that of these percentage, 33% of medical students suffered moderately from depression, and only 4% of them underwent severe depression. On the other hand, results indicated that among the computer science students, 53% and 7% of them had higher rate of moderate depression and severe depression respectively. Computer science students 23% are also more susceptible to high anxiety than are medical students 14%. The significance relation between depression and specialty (p= 0.001) was found, including the non-significance relation between anxiety and specialty (p= 0.077). Conclusion and Recommendation: Most medical students were not depressed, but they suffered moderately from anxiety. Moreover, both depression and anxiety were more prevalent among computer science students than among medical students.

[Download]                                                                                                     72-80


Measuring the Percentage of Consanguinity in Sickle Cell Patients and Its Effect on the Prognosis of the Diseas

Hassan Mohammed Barnawi, Hammam Naji Albeshr, Raed Fuad Abuazzah,  Abdulhalim Bakr Hafizallah, Abdulrhman Ahmed Ghunaim,  Waheed Ahmed Turkistani.


SCD is one of the major health problems in Saudi Arabia, specially in Southern, Western and Eastern areas where the gene frequency of this disease is quite prevalent. Many studies were carried out in these areas. There is a lack of studies of the effect of consanguinity on disease outcome and prognosis. we did this study in western area in Almadinah Almunawarah. We determined the effect of consanguinity on the disease by three factors. These factors are (Blood Transfusion, First complain, and complications). In this study, we carried out a retrograde analysis of patients’ files, and found that 44% of the patients were products of consanguineous marriages. But the research concluded that there was no clear increase in complications caused by the state of consanguinity of the patient’s parents, although patients on consanguineous parents have had slightly more incidences of vaso-oclusive crisis.

[Download]                                                                                                    81-89



Abdulaziz Almehrej, Ayman Almozaini, Abdulaziz jaber Aldoseri, Abdulla Yousif Alkhaja, Abdulrhman Abdulla Alsulaiti, Ahmed Maher , Ali Mohammed Alsada, Faisal Mohammed Shoaib


In our study we are going to see the effect of smoking and some other important risk factors on the prevalence of hypertension in kingdom of Bahrain in 2012, also to identify the prevalence of smoking among hypertensive patients and to study the relationship between several risk factors like gender, age, marietal status, smoking, food, diseases, treatment, gender and Hypertension. Cigarette smoking is a powerful cardiovascular risk factor and smoking cessation is the single most effective lifestyle measure for the prevention of a large number of cardiovascular diseases. Impairment of endothelial function, arterial stiffness, inflammation, lipid modification as well as an alteration of antithrombotic and prothrombotic factors are smoking-related major determinants of initiation, and acceleration of the atherothrombotic process, leading to cardiovascular events. Cigarette smoking acutely exerts an hypertensive effect, mainly through the stimulation of the sympathetic nervous system. As concern the impact of chronic smoking on blood pressure, available data do not put clearly in evidence a direct causal relationship between these two cardiovascular risk factors, a concept supported by the evidence that no lower blood pressure values have been observed after chronic smoking cessation. Nevertheless, smoking, affecting arterial stiffness and wave reflection might have greater detrimental effect on central blood pressure, which is more closely related to target organ damage than brachial blood pressure. Hypertensive smokers are more likely to develop severe forms of hypertension, including malignant and renovascular hypertension, an effect likely due to an accelerated atherosclerosis [16]. The association between hypertension and socioeconomic status was complex and differed between men and women. Among men, those with lower educational and occupational status but who were rich were more likely to be hypertensive. More women with lower occupational and economic status were hypertensive. Study was conducted in department of medicine, SUNY Health science center, New York, USA and found that increase in Age is associated with a significant increase in the prevalence of hypertension and especially of systolic hypertension after age 60. The study showed that  increase obesity in age between 30 -50 yrs , is associated with significant increase in diastolic blood pressure , and trend is also seen in African-Americans who are heavier than whites , it is found out that increase of age is associated with atherosclerotic renovascular hypertension , renal insufficiency and primary hypothyroidism. Previous studies have linked lack of exercise to hypertension development in middle age and young adults.

[Download]                                                                                                  90-104


Electrocoagulation (with Iron electrodes) as a pre-treatment part of brackish groundwater desalination system

Shereen Adnan Kabarty


TH (total hardness) and pH reduction is an essential pretreatment step in water desalination plant (thermal or membrane especially RO), in order to minimize precipitation of salts, and reduce operation/maintenance costs. This research studies the effect of using electrocoagulation technique as brackish groundwater pretreatment, to improve water quality by reducing (TH, pH, electrical conductivity), considering TH as a basic studied parameter. Among four metallic electrode types (aluminum, chromium, stainless steel, iron), Iron has the best performance for TH removal, it has been demonstrated that 8 iron electrodes with: monopolar system, (4A) current intensity, (40min) retention time, (3h) later sedimentation time, can slightly reduce  conductivity, while achieve 75% TH removal rate, and pH reduction more than 2.4 degree without any acidic addition (so we could eliminate the traditional acidification step prior to RO membrane since the preferred  pH is about 5.5 to 6.5), resulting in less secondary pollution, with electrical consumption about 4.4 Kw.h/m3.

[Download]                                                                                                105-117


Post Burn Injury Face Transplantation

Ahmad Abdulrazaq Nahhas


Facial transplantation has emerged in recent years as a promising treatment option for patients with severe facial burns especially to those who are suffering crushing injuries and result in various physical and psychosocial effects. Structures affected, for example, the nose and teeth might get twisted because of irregular outside strengths brought about by contractures. Genuine inconveniences, for example, impediment amblyopia and microstomia must be expected and desperately tended to deflect lasting results, though other reconstructive techniques can be postponed until scar development happens. Reconstruct complex facial injuries is still a challenge regardless of the development of microsurgical techniques. The reconstructive options for conditions such as facial burns are very limited. But it’s very important since it might be a surgical intercession with the possibility to lessen the psychiatric suffering connected with individuals suffering burns injuries. This study comes to evaluate and discuss the success and safety of face reconstruction transplantation after burn accidents. To do this we have conducted systemic review search for similar previous studies mainly in Medline (PubMed), the studies were included which are concerning Facial transplantation after burn injuries.

[Download]                                                                                                 118-122


Attitudes, knowledge and behavior of parents regarding safety child occupant travel in Bahrain

Aamer Meshari Alghamlas, Turki Suliman Alkhuliwi, Mazen Jezaa Alotabi, Abdulkarim Mohammed Aljassem, Hamzah Fehaid Alanazi, Saleh Alharbi


Objective: The aim of this study is to investigate parents’ attitudes, knowledge and behaviors regarding safe child occupant travel in Bahrain and to evaluate the risk factors associated with safe child occupant. Design: Crosssectional Study. Setting: The City Center Mall in Bahrain  Method: A questionnaire exploring attitudes, knowledge and behaviors regarding general road safety, as well as safe child occupant travel in particular, was completed by 187 participants. Data were collected over a two months period; September and October 2013. Result: The majority of participants in the current study were male and relatively well-educated. Participants in the current study were more likely to be: male and married. Responses to the questionnaire revealed that 64.7% of the parents studied agreed that children must travel in a specially fitted capsule. However, only 27.8% of the parents were using the child restraints for their children. Using Seat belt did not show any significant association with respondents’ age(pvalue =0.73), gender(p-value =0.41), nationality(p-value =0.40), level of education(p-value =0.06), or number of children(p-value =0.59). The results showed that there was no significant  association  between type of restraint used for Children and  respondents’ age(p-value =0.10), gender (p-value =0.12) and  nationality(p-value =0.95). However, there was significant  association  with the  level of education (p-value =0.02) and  number of children (p˂.001). Conclusion: the findings of this study revealed that attitudes, knowledge and behaviors regarding general road safety were fairly acceptable. However, measures for safe child occupant travel and the use of a specially fitted capsule for children were not frequently implemented. These findings suggest that it is important to educate parents about the importance of child restraint principles and process for appropriate use. These findings should be taken seriously for those who are responsible in the government, health care and media to reach an acceptable degree of awareness and knowledge.

[Download]                                                                                               123-148


Knowledge and Attitude of Stroke Among Saudi Population in Riyadh, Kingdom of Saudi Arabia

Muteb Khadran AlOtaibi, Fawaz Fahad AlOtaibi, Yara Osama AlKhodair, Eiman Mohammed Falatah, Haneen Ali AlMutairi


Background: A stroke occurs when the blood supply to the brain is either interrupted or reduced. When this occurs, the brain does not get enough oxygen or nutrients which cause brain cells to die 2. In 2009, stroke was proclaimed as the underlying cause of death in 128,842 persons in the US, resulting in the rate of 38.9 deaths per 100,000 population.There are two broad types of stroke: ischemic and hemorrhagi 4. The risk factors for stroke are categorized into two principal subdivisions of risk factors:  First;  The Modifiable Risk factors, which are known to be adjustable with effort and proper knowledge, e.g., smoking and obesity. The other subtype is The Non-modifiable Risk Factors, such as age and positive family history. Aims: To measure the knowledge and attitude of stroke among Riyadh city population, along with determining their source of information and the reliability of these sources. Methods: The study is a  cross-sectional study carried on by a questionnaire to all Saudi population living in Riyadh city, who successfully fulfill the inclusion and exclusion criteria a total number of 304 participants contributed to this study. Results: Knowledge about stroke: Respondents were asked whether they comprehend stroke as medical disease/emergency or not. Of the respondents, 198 (65.1%) answered by yes and 106 (34.9) answered by no. Nature of stroke and its leading cause: Respondents were asked whether they think stroke is infectious disease or not. Of the respondents, 2 (0.7%) answered yes, and 277 (91.1%) answered no, while 25 answered by “don’t know.”Awareness of stroke: Respondents were asked whether they studied about stroke or not or if they’ve encountered this medical condition by anyway. Of the respondents, 104 (34.2%) answered by yes and 200 (65.8%) answered by no. Discussion: This community-based study shows the level of public knowledge and perception about stroke. Of 304 respondents, 227 (74.7%)  knew clearly the most common stroke cause, and they have chosen “hypertension” as the primary risk factor for of stroke. Awareness of stroke especially causes, and symptoms remain the most critical approach to substantially reducing the morbidity and mortality of stroke. In a review prepared by Gorelick 21, he discovered that lifelong controlling risk factors best achieved during pre-adolescence or adolescence, and that managing requires deep awareness and continuous vital role for the society. Unfortunately, the respondents of this study responded with minimum education levels have no adequate knowledge about the symptoms of stroke nor the leading cause of stroke.Conclusion: The study suggests that cultural and educational strategies are essential to improve knowledge about stroke in Riyadh community 1 .Considerable efforts should be planned to increase awareness about stroke especially with low income and low-educated population.

[Download]                                                                                                 149-157


Medical students perception of factors disrupt their concentration during lectures at King Saud University, Saudi Arabia

Ashry Gad Mohamed,Hussam Zaid Alorabi, Hamad Sulaiman Aljutaili,  Mohammed Aljarbou, Hossam Hassan Alshehri, Ibrahim Mohammed Alqasir, Saud Khalid Alsaloum, Nawaf Aljarboa, Saleh Alfallay , Mohammed eid alqahtani , Mohammed Alsayyar and Abdullah Alrumaih


Objectives:To determine the factors perceived by male medical students  disrupting their concentration during lectures . Methods: Cross sectional design has been used .The study included first, second and third year’s medical students in KSU. A self administered questionnaire was used to collect data.It was designed of four sections including the characteristics of the student, lecturer, lecture hall and student demographics. Results: Of 369 , 80 % completed the questionnaires. Students believed that lack of  sleep(89.9%) ,side talks of the students (85.9%),  Long lecture (87.9%), sickness (87.6%) and lecturer’s poor knowledge (86.9%) reduce their concentration.Enthusiatic lecturer motivates students attention and concentration (74.8%).Conclusion:Students perceived  lack of enough sleep as a factor led to concentration disruption and the enthusiastic lecturer as enhancing one.

[Download]                                                                                                158-164


Trends of opioid consumption for cancer patients during the last week of their life in a tertiary care center

Abdullah Alqarni, Saleh Alghsoon, Abdullah Alawlah, Nayef Alhinti, Abdulmalik Aljulaihm, Yousef H. AlOlah


Background: Pain is considered one of the most distressing symptoms for patients, the inadequate pain management remains a public health problem. Aims: The goal of this study was to describe the doses of opioids administered in the last week of life for adult cancer patients and to examine its associated factors. Methods: This is a retrospective cross-sectional study. Opioids administration and demographic data were extracted from clinical records of 64 stage four cancer patients admitted and died in Palliative Care Department at King Abdulaziz Medical City (KAMC) in Riyadh for one year. Opioids orders on day -7 and day -1 before death were reviewed (day 0 is the day of death). Results: Of 64 patients, 46 received opioids of different types. The average dose equivalent to PO morphine on day -7 was 49.14mg and on day -1 was 39.37mg. IV morphine was the most prescribed opioid on day -7 (28 patients) and on day -1 (33 patients). 33 out of the 64 patients received other analgesics. Conclusions: Our results suggest that Opioids for end stage cancer patients are under prescribed at KAMC in comparison to the USA.

[Download]                                                                                                165-170


Role of Vitamin D in Female Sickle Cell Anemia Patients in Saudi Arabia

Ruqayah Meshikhes, May Alotaibi


Background & Objectives: Sickle-Cell Disease (SCD) patients make up around 20% of Saudi Arabia population. Several studies showed an association between vitamin D deficiency (VDD) and chronic pain crisis as well as reports of improved pain symptoms and decreased analgesic use with vitamin D supplementation. The current study was aimed to improve quality of life in patients with Sickle-Cell Anemia (SCA), determining the role of vitamin D in improve VDD symptoms among SCA patients in Saudi Arabia. Methods: Seventy-five female SCA respondents vary aged between (16 and more than 30 years). Thirtysix respondents were SCT and thirty-nine respondents were SCA and positive and negative for VDD were enrolled to interviewing and self-administered close-format questionnaire. Results: The level of daily life activities with patients who taking VD supplements are various. In young SCA female group (16-20 years old) was low (% of patients who are taking VD 50%~ % of patients who felt in low daily life activity 50%), in group (21-25 years old) was also low (35.71%~50%), in group (2630 years old) was significant low (75%~100%), and in group (more than 30 years old) was low too (57.14%~57.14%). Conclusion: Patients with Sickle Cell Anemia have increased risk of VDD. In this study, VDD is related to decrease daily life activity and increase the chronic pain of SCD female patients. More physicians’ awareness needed to realize the role of VD in long-term relieving rather than temporary relief.

[Download]                                                                                                172-182


Gender Differences in Medical Students’ Interest in Obstetrics/Gynecology

Meshal R. Alotaibi, Saad S. Albogami, Zeyad S. Alamari, Shar Alahmari1, Mohammad A. Alanazi


Objectives: The aim of this study is to explore the perceptions and interest of final year Saudi medical students in Obstetrics and Gynecology specialty. Methods: A survey based cross-sectional study was made of 140 final year medical students at King Saud bin Abdulaziz University for Health Science, Riyadh. Results:The results generally show that male and female students had different perceptions of and interests in obstetrics and gynecology. For female students, their choice of specialty was found to be more influenced by malpractice concerns and the opportunity to deal with female patients than male students (α = .01 level). On the other hand, for male students, their choice of specialty was found to be more influenced by the prospect of establishing private practice and opportunity to earn high income than female students (α = 0.05 level).Conclusion: The study has provided important insight into Saudi male students’ perception of as well as interest in obstetrics and gynecology. Their decision was most likely influenced by social acceptance, working hours and income.

[Download]                                                                                                183-187  


Cervical Rheumatoid Nodule Mimicking a Lymph Nod

Abdulrahman A. Khormi, Lama A. Al-Hmaly, Abdulrahman Alarfaj


Rheumatoid nodules are subcutaneous nodules >5mm in diameter, that occur in approximately 30 percent of patients with rheumatoid arthritis (RA). Common sites include areas of pressure or repetitive irritation such as the buttocks, sacral prominences, fingers, the extensor surfaces of the forearm or the occipital region. We herein we report a case of rheumatoid nodule occurring in the right side of the neck at anterior triangle. This occurrence has not been reported before.

[Download]                                                                                                 188-191  


Severe mitral valve stenosis post mitral valve repair, treated with balloon valvoplasty, a case report


Abstract: Symptomatic severe mitral regurgitation, initially treated with complex mitral valve repair, complicated by severe mitral stenosis, which resulted in severe hypoxia and lung failure that required extracorporeal membrane oxygenation. He was diagnosed with severe mitral stenosis and finally treated with a successful mitral valve balloon valvoplasty as the final solution and best solution.

[Download]                                                                                                 192-197   


Autism Knowledge among the public in Saudis Arabi

Yousef Almana , Ahmed Alghamdi , Laila AL-Ayadhi


Autism is defined as a neurodevelopmental syndrome that starts early in life and manifests as an unusual behaviors of negligence, independence, isolationism, and constant repetition that believed to be held by a defect in special areas of the brain that assembles what is known as “the social brain”. The disease is found to be highly heritable, with strong genetic association evidence. The aim of this study is to measure the Saudis general knowledge of ASD, the causes, the treatment, and their attitude toward it in order to determine the level and significance of the educational interventions needed to raise the awareness of the Saudi society about the disease and the proper ways to deal with it.

[Download]                                                                                                 198-206  


Influence of Lifestyle and Socio-demographic Factors on Adult Hypertensive Patients Held in King Khalid university hospital in Riyadh, Saudi Arabia

Sulaiman Alshammari, Othman M. Almazyed, Abdulaziz A.Alshoweir, Saud H. Alhelal, Nawaf AbuHamra, Abdullah A. Alsouaan and Nawaf Aljarboa


Background: Hypertension is a public health concern in Saudi Arabia. A recent study done in Saudi Arabia showed that the prevalence of hypertension among adults reach up to 30%. Limited patients’ awareness about the effects of lifestyle on hypertension, lack of effective outreach to general people and lack of routine measurement of blood pressure on health care facilities being the most important factors hindering the control of hypertension. Therefore, we conducted this study to assess the lifestyle and socio-demographic factors in hypertensive patients. Methods: A Quantitative-cross sectional study was held in primary health care clinics in King Khalid University Hospital, Riyadh. A sample of 150 was taken randomly from hypertensive patients above 18 years old. The data were collected using predesigned questionnaire and an interview with illiterate patients. The measurements were taken from patients’ medical records, and the analysis was done using SPSS software. Results: the data of 150 patients who were surveyed was analyzed. The age of 130 (86.7%) of the participants was above 45 years old. 138 (92%) of participants were either overweight or obese. The study illustrates that there is no significant association between any of the hypothesized factors (age, gender, BMI, residency, education, occupation, being smoker, exercise) and being controlled or uncontrolled with a p value more than 0.1. Majority of the patient were aware of hypertension complications with eye complication being the least one identified by only 51 (34%) of participants. More than 76 (49%) of participants had diabetes mellitus. Family history is crucial as 100 (67%) of participants had first degree relative with the disease. Conclusion: We conclude that the principle factors in controlling hypertension are taking medications and awareness of the complications rather than age, gender, exercise, smoking, lifestyle, socio-demographic factors.

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The Use of Cyanoacrylate Tissue Adhesive to Seal Descemet’s Membrane Perforation During Deep Anterior Lamellar Keratoplasty: Report of Complications

Ibtihaj N. Bifari, Huda Al-Dhaheri, Awad Al-Qarni, Mosa AlHarbi

Abstract: Purpose: Descment’s membrane (DM) micro-perforation is a common intra-operative complication during lamellar keratoplasty. Cyano-acrylate based glue has been used widely in ophthalmic surgery. It is rapidly polymerize on the surface of any tissue in the presence of water or weak bases. However the mass in situ created by the glue can cause localized inflammation with secondary vascularization, but no clear reports in the literature for such complication after application over micro-perforation during DALK. Methods: Retrospective observational case report of two cases developed severe corneal vascularization, one with associated inflammation and melting. Conclusion: Cyano-acrylate glue application is an interesting method to seal up Descemet’s membrane perforation during DALK especially in small size perforations but the risk of inducing severe corneal vascularization and melting should be considered in individual cases.

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Impact of Principals’ Recognition on Retention of Secondary

School Teachers’ in Homa Bay County of Kenya

Lazarus Millan Okello, Manson Sichari, Florence Odera

Abstract: The present study investigated the impact of principals’ recognition on retention of secondary school teachers’ in Homa Bay County of Kenya.The study adopted an ex-post facto research design.For a population of one thousand eight hundred and one  (1801) teachers, according to the table, three hundred and twenty (320) teachers were recommended to be appropriate and for a population of 295 principals, one hundred and sixty-nine (169) were appropriate.The researcher interviewed eighteen (18) principals picked from the six sub-counties including the two purposefully picked national schools in Homa Bay County. This study used questionnaires and interview schedule as the instrument of data collection. The researcher developed questionnaires and interview schedule to collect the data. Two sets of questionnaires were used; one for the school principals and another for the teachers.To enhance validity of the instrument, a pilot study was conducted in twenty selected schools in the neighboring Migori County. This involved the ten principals and two teachers from each school.In this study, internal consistency reliability of the instruments was obtained by computing Cronbach’s alpha

(a) using SPSS and a Cronbach’s alpha of a = .793 was reported. Both descriptive and inferential statistics were used in data analysis. The study reported that there was a significant plausible positive correlation between the two variables [r = .604, n = 422, p<.05], with more teacher recognition by the principal associated with high teacher retention rate. The study recommended that the School principals should avoid the use of autocratic style of leadership in the management of schools as it does not allow teachers to give off their best and discourages teachers from working with principals who displays this kind of leadership behavior.


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Influence of School Environmental Characteristics on

Retention of Secondary School Teachers in Homa Bay CountKenya

Lazarus Millan Okello, Manson Sichari, Florence Odera

Abstract: The present study investigated the influence of school environmental characteristics on retention of secondary schoolteachers in Homa Bay County of Kenya.The study adopted an ex-post facto research design.For a population of one thousand eight hundred and one  (1801) teachers, according to Krejcie and Morgan (1970 )table of specification, three hundred and twenty (320) teachers were recommended to be appropriate and for a population of295 principals, one hundred and sixty-nine

(169) were appropriate.This study used questionnaires as the instrument of data collection. Two sets of questionnaires were used; one for the school principals and another for the teachers.To enhance validity of the instrument, a pilot study was conducted in twenty selected schools in the neighboring Migori County. This involved the ten principals and two teachers from each school.In this study, internal consistency reliability of the instruments was obtained by computing Cronbach’s alpha (a) using SPSS and a Cronbach’s Alpha of a= .705 was reported.Both descriptive and inferential statistics were used in data analysis.The findings indicated that there was a significant fairly moderate, positive correlation between the two variables [r= .463, n=422, p<.05], with high levels of conducive school environment associated with high teacher retention rate.The study recommends that the Teachers Service Commission should develop a strict policy governing teachers transfers that incorporates a term limit of 5-6 years.

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