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1.  Arabo-Farsi anatomy figures 
Annals of Saudi Medicine  2009;29(1):62.
PMCID: PMC2813607  PMID: 19139626
2.  Notices 
Annals of Saudi Medicine  2009;29(6):489.
PMCID: PMC2881442
7.  A prospective, randomized clinical trial comparing bipolar plasma kinetic resection of the prostate versus conventional monopolar transurethral resection of the prostate in the treatment of benign prostatic hyperplasia 
Annals of Saudi Medicine  2009;29(6):429-432.
For treatment of benign prostatic hyperplasia (BPH), Plasma Kinetic loop Resection of the Prostate (PKRP) is an alternative to conventional monopolar transurethral resection of prostate (TURP). We compared outcomes with the two treatments in a randomized trial.
Over a one-year period, we randomly assigned patients with an indication for surgery for BPH and who met inclusion criteria to treatment with either PKRP or TURP. We measured prostate volume by transrectal ultrasound, relief of bladder outlet obstruction, operative time, decline in serum sodium and hemoglobin, weight of resected prostatic chips, duration of catheterization and hospital stay. Patients were evaluated one month after discharge for obstructive symptoms. Complications were also recorded.
Of 102 patients enrolled, 51 underwent PKRP and 51 underwent TURP. Relief of obstructive symptoms and mean operative time showed no statistically significant difference. The PKRP group had a smaller decline in hemoglobin than the TURP group (0.6 g/dL vs 1.8 g/dL, P=.01), a lower reduction in serum sodium levels (1.03 mmol/L vs 5.01 mmol/L, P=.01), a shorter catheterization time (37.2 hours versus 57.7 hours, P=.03) and a shorter hospital stay (1.5 days versus 2.6 days, P=.02). One patient in the bipolar PKRP group needed recatheterization versus four patients in the TURP group.
PKRP reduces morbidity with an outcome similar to conventional monopolar TURP in the treatment of BPH.
PMCID: PMC2881428  PMID: 19847078
8.  Infective endocarditis at a hospital in Saudi Arabia: epidemiology, bacterial pathogens and outcome 
Annals of Saudi Medicine  2009;29(6):433-436.
Data on infective endocarditis prevalence, epidemiology and etiology from Saudi Arabia and the Gulf region are sparse. We undertook this study to describe the pattern and the causative agents of endocarditis at a hospital in Saudi Arabia.
We conducted a retrospective analysis of all reported endocarditis cases at the Dhahran Health Center from January 1995 to December 2008.
Of the 83 cases of endocarditis, 54 (65%) were definite endocarditis and the remaining 29 (35%) were possible endocarditis based on the Duke criteria. Patients with definite endocarditis included 39 males and 15 females (ratio of 2.6:1) with a mean age (SD) of 59.7 (18.2) years. Of the definite endocarditis cases, native valve endocarditis occurred in 44 (81.5%) cases of and prosthetic valve endocarditis was observed in 10 (18.5%). The most commonly involved valves were mitral (n=24; 44.4%) and aortic (n=20; 39.2%). The most common organisms were S aureus (n=23; 42.6%), Enterococcus faecalis (n=12; 22.2%) and viridans streptococci (n=9; 16.7%). Surgical intervention was required in 17 (31.4%) cases and the in-hospital mortality rate was 29.4% (n=15). Of all the patients, 3 (5.5%) had embolic stroke as a complication.
Native valve endocarditis is the predominant type of endocarditis. The patients were older adults and the most common organisms were S aureus, E faecalis and viridans streptococci.
PMCID: PMC2881429  PMID: 19847079
9.  Performance of body mass index in predicting diabetes and hypertension in the Eastern Province of Saudi Arabia 
Annals of Saudi Medicine  2009;29(6):437-445.
Body mass index (BMI) is the most widely used measure to define obesity and predict its complications, such as diabetes and hypertension, but its accuracy and usefulness in Saudi subjects is unknown. This study aimed to assess the validity of standard BMI cut-point values in the Saudi population.
197 681 adults participated in a cross-sectional study to detect diabetes and hypertension in the Saudi Eastern province in 2004/2005, with blood pressure, fasting blood sugar, height and weight measurements taken. Sensitivities, specificities, areas under the curves, predictive values, likelihood ratios, false positive, false negatives and total misclassification ratios were calculated for various BMI values determined from receiver operating characteristic (ROC) curves. The significance of the association between risk factors and BMI was assessed using regression analysis.
For the definition of overweight, ROC curve analysis suggested optimal BMI cut-offs of 28.50 to 29.50 in men and 30.50 to 31.50 in women, but the levels of sensitivity and specificity were too low to be of clinical value and the overall misclassification was unacceptably high across all the selected BMI values (>0.80). The relationship between BMI and the presence of diabetes and/or hypertension was not improved when a BMI of 25 was used. Using regression analyses, the odds ratios for hypertension and/or diabetes increased significantly from BMI values as low as 21-23 with no improvement in the diagnostic performance of BMI at these cutoffs.
In Saudi population, there is an increased risk of diabetes and hypertension relative to BMI, starting at a BMI as low as 21 but overall there is no cutoff BMI level with high predictive value for the development of these chronic diseases, including the WHO definition of obesity at BMI of 30.
PMCID: PMC2881430  PMID: 19847080
10.  Inferior vena caval filters: 5 years of experience in a tertiary care center 
Annals of Saudi Medicine  2009;29(6):446-449.
Interruption of the Inferior Vena Cava (IVC) is recommended in certain cases to prevent Pulmonary Embolism (PE). Reported data on the efficacy and rate of complications vary considerably.
We conducted a retrospective analysis of patients who had a temporary or permanent IVC filter inserted at our institution during the past 5 years.
Seventy-seven of 225 patients (34%) with Venous Thrombosis (VT) had an IVC filter inserted. Deep vein thrombosis and PE were the most common causes for anticoagulation. Bleeding was the reason for IVC filter insertion in 48 (62%). The only complication found was the breaking of a temporary filter during removal related to the procedure. However, 3 patients (out of 10) had a recurrence of VT after prolonged discontinuation of anticoagulation.
Our criteria for indication of IVC filter insertion are in line with current standard of care. The immediate and delayed complications caused by IVC filter insertion was low. Active bleeding was the most common indication for filter insertion, whereas inherited thrombophilia was relatively common.
PMCID: PMC2881431  PMID: 19847081
11.  Renal biopsy in patients with type 2 diabetes mellitus: indications and nature of the lesions 
Annals of Saudi Medicine  2009;29(6):450-453.
The prevalence of non diabetic renal disease (NDRD) among patients with type 2 diabetes mellitus varies widely depending on the selection criteria and the populations being studied. The aim of this study was to evaluate the renal biopsies performed on type 2 diabetic patients for suspicion of NDRD and to correlate the pathological with the clinical and laboratory findings.
We selected and reviewed biopsies performed on type 2 diabetics for clinically suspected NDRD from January 2006 to December 2008 at a single hospital. Clinical and laboratory data were analyzed in relation to the histopathology findings. Patients were grouped into either group I with isolated DGS or group II with NDRD on top of DGS.
Thirty-one biopsies were performed on type 2 diabetic patients; Seventeen patients (54.8%) were males. Mean age was 50.68 (11.29) years. The mean duration of diabetes was 9.33 (3.6) years. Renal biopsy showed that among the studied group 14 patients (45.2%) showed NDRD on top of DGS. Crescentic glomerulonephritis was the commonest finding seen in 3 cases (21.4% of group II cases) followed by acute tubulointerstitial nephritis and hypertensive changes each was seen in 2 cases (14.4%). Other findings included IgA nephropathy, primary focal segmental glomerulosclerosis, rhabdomyolysis, membranoproliferative glomerulonephritis each of them was seen in one case (7.1%). Group I had a significantly higher level of proteinuria 4.97 (2.08) gm/24 hrs urine than group II 2.72 (1.09) gm/24 hrs urine (P=.003). There was no significant difference between the two groups in age, duration of diabetes, gender, presence of hypertension, hematuria, serum creatinine or glomerular filtration rate.
The present study showed that crescentic glomerulonephritis is the commonest NDRD among diabetic patients. A higher level of proteinuria was reported among those with NDRD superimposed on DGS. So, Renal biopsy should be performed in diabetics when the clinical scenario is atypical.
PMCID: PMC2881432  PMID: 19847082
12.  Clinical characteristics and computed tomography findings in Arab patients diagnosed with pulmonary sarcoidosis 
Annals of Saudi Medicine  2009;29(6):454-459.
Sarcoidosis is prevalent worldwide with significant heterogeneity across different ethnic groups. We aimed To describe the clinical characteristics and computed tomography findings among Arab patients with pulmonary sarcoidosis.
A retrospective study of patient demographics, symptoms, co-morbid illness, sarcoidosis stage, treatment, pulmonary function and CT results.
Of 104 patients, most (77%) were 40 years of age or older at diagnosis, and females in this category (≥40 years) significantly outnumbered male patients (69/104 (66.3%) vs. 35/104 (33.7%), P=.003). The most common complaints were dyspnea (76%), cough (72.1%) and weight loss (32.7%). The majority of patients displayed impairment in lung function parameters at presentation. However, significant impairment in forced vital capacity, percentage predicted (FVC%) (<50%) was present in only 17% of patients. The most frequent CT finding was mediastinal lymph node enlargement in 49 patients (73.1%). Parenchymal abnormalities indicating lung fibrosis were noted in 31 patients (46.3%), and traction bronchiectasis was the most common (35.8%) fibrotic pattern detected on CT scans.
At presentation, clinical manifestations of sarcoidosis among this sample of Arab patients were similar to reports from other nations. Further studies are needed to explore the effects of race and ethnicity on disease severity in the Middle East.
PMCID: PMC2881433  PMID: 19847083
13.  Management of end-stage heart failure: a perspective on the Arab Gulf states 
Annals of Saudi Medicine  2009;29(6):460-466.
The ever expanding epidemic of end-stage heart failure represents one of the greatest challenges of modern cardiovascular medicine. With medical treatments hampered by significant limitations, physicians caring for patients with advanced heart disease have turned to cardiac transplantation and durable mechanical circulatory assist devices as definitive therapies. These advanced therapeutic modalities are not widely available outside the United States and Europe, but nevertheless offer enormous potential for patients in the Arab Gulf suffering from end-stage heart failure. This review will discuss the management of end-stage heart failure in the Gulf States, with an emphasis on therapies best utilized within a framework of regional cooperation and coordination.
PMCID: PMC2881434  PMID: 19847084
14.  The prevalence and diagnostic performance of anti-cyclic citrullinated peptide antibody in rheumatoid arthritis: the predictive and discriminative ability of serum antibody level in recognizing rheumatoid arthritis 
Annals of Saudi Medicine  2009;29(6):467-470.
The utility of anticyclic citrullinated peptide (anti-CCP) antibody in the diagnosis of rheumatoid arthritis (RA) varies across different studies. We determined the diagnostic performance and predictive ability of anti-CCP for RA.
We studied 201 patients with RA and compared them with 208 non-RA patients as controls. RA patients included in the study fulfilled the American College of Rheumatology revised criteria and patients with other diseases as well as those with undifferentiated arthritis (UIA) were used as controls. Anti-CCP was measured by enzyme-linked immunosorbent assay (ELISA) and rheumatoid factor (RF) by the agglutination method. The optimal cutoff value and diagnostic accuracy were determined using receiver operating characteristics (ROC) curve and area under the curve (AUC).The sensitivity and specificity were determined by comparison of RA patients with non-RA controls.
The anti-CCP test was positive in 164 patients with RA for a sensitivity of 81.6%, specificity of 87.5%, and overall accuracy of 84.6%. The respective values for RF were 75.6%, 86.5% and 84.4%. The anti-CCP test discriminated RA from non-RA patients with high accuracy (AUC=0.889 [0.017] 95% CI, 0.856-0.952, P=.001), and predicted progression of UIA to RA with moderate accuracy (AUC=0.733 [0.069], 95% CI 0.60-0.87, P<.006) at a sensitivity of 75% and a specificity of 68.1%. Among 60 UIA patients, in 16 (26.7%) who differentiated to RA, the mean (standard deviation) for anti-CCP was significantly higher than in 24 (40%) patients who progressed to non-RA (134.8 [172] vs 46 [86] U/mL, P<.01).
These findings indicate that anti-CCP yields higher sensitivity and overall accuracy, but slightly greater specificity than RF for diagnosis of RA. Anti-CCP positivity, particularly a higher level of serum antibody in patients with UIA, may be a predictor of subsequent RA.
PMCID: PMC2881435  PMID: 19847085
15.  Diffuse idiopathic hyperplasia of the sternocleidomastoid muscle in a child 
Annals of Saudi Medicine  2009;29(6):471-473.
Unilateral diffuse or localized enlargement of the sternocleidomastoid muscle (SCM) is an event commonly seen in infancy, and is popularly known as ‘sternocleidomastoid tumor’. The condition, which usually spontaneously resolves with or without physiotherapy, is due to a hematoma following a difficult labor. The muscle regains its elasticity and complete function. In some infants it resolves with fibromatous changes in the muscle leading to shortening, fibrosis and finally culminating in torticollis. We describe a case of idiopathic diffuse enlargement of unilateral SCM in a 12-year-old child without any functional compromise or torticollis. The histopathological and clinical characteristics differentiating it from more commonly described sternocleidomastoid tumor or fibromatosis coli are described. We believe this is the first case report of idiopathic hyperplasia of SCM.
PMCID: PMC2881436  PMID: 19847086
16.  Hepatic vasculitis mimicking liver abscesses in a patient with systemic lupus erythematosus 
Annals of Saudi Medicine  2009;29(6):474-477.
Clinical and radiological liver diseases are uncommon in patients with systemic lupus erythematosus (SLE). We report a 29-year-old female with SLE who presented with right upper quadrant abdominal pain, thrombocytopenia, elevated liver enzymes and multiple hypodense lesions in the liver on a computed tomography (CT) study that mimicked multiple liver abscesses. A liver biopsy showed mild chronic inflammation. Culture results were negative. With steroid therapy the patient improved clinically, the platelet count returned to the normal range and the multiple liver lesions disappeared radiologicaly. This patient represents a rare case of SLE that had hepatic vasculitis mimicking multiple liver abscesses.
PMCID: PMC2881437  PMID: 19847087
17.  Lymphoepithelioma-like carcinoma of the urinary bladder: report of a rare case 
Annals of Saudi Medicine  2009;29(6):478-481.
Lymphoepithelioma-like carcinoma (LELC) is a rare malignant neoplasm in the urinary bladder, which can histologically mimic lymphoma, poorly differentiated invasive transitional cell carcinoma or poorly differentiated squamous cell carcinoma with a lymphoplasmacytic background. A urinary bladder tumor was identified in a 65-year-old man suffering from hematuria for several weeks. Transurethral biopsy revealed an undifferentiated tumor with prominent lymphocytes and plasma cell infiltration. Immunohistochemical evaluation showed positive staining for cytokeratin and epithelial membrane antigen. Subsequent radical cystectomy showed pure LELC. We present the case to highlight the significance of recognizing this unusual bladder tumor and discuss the important differential diagnosis, treatment options and prognosis.
PMCID: PMC2881438  PMID: 19847088
18.  Poland-Mobius syndrome in an infant girl 
Annals of Saudi Medicine  2009;29(6):482-484.
Mobius syndrome is a rare condition of unclear origin, characterized by a unilateral or bilateral congenital facial weakness with impairment of ocular abduction, which is frequently associated with limb anomalies. Poland described a condition in which there was unilateral absence of pectoralis major muscle and ipsilateral syndactyly. The combination of Poland-Mobius syndrome is rare, with an estimated prevalence 1:500 000. We describe a case of Poland-Mobius syndrome in association with congenital bilateral vocal fold immobility. To our knowldge, this is the first report of such an association between Poland-Mobius syndrome and congenital bilateral vocal fold immobility.
PMCID: PMC2881439  PMID: 19847089
19.  Uncommon osseous involvement in multisystemic sarcoidosis 
Annals of Saudi Medicine  2009;29(6):485-486.
PMCID: PMC2881440  PMID: 19847090
21.  The need for hospital-based neonatal palliative care programs in Saudi Arabia 
Annals of Saudi Medicine  2009;29(5):337-341.
The terms palliative care, supportive care, and comfort care are used to describe individualized care that can provide a dying person the best quality of life until the end. The term “end-of-life care” is also used in a general sense to refer to all aspects of care of a patient with a potentially fatal condition. While the concept of palliative care is not new, it has only recently been applied to the neonatal population. To the best of our knowledge, none of the neonatal intensive care units (NICUs) in Saudi Arabia have adopted a neonatal program for palliative care. We believe the main reason is lack of knowledge of such programs and the fear of being accused of being heartless and cruel by providing comfort care for dying babies. Comfort care begins with the diagnosis of a life-threatening/terminal condition, and continues throughout the course of illness regardless of the outcome. In this perspective, our aim is to introduce these programs for caregivers in the NICUs in Saudi Arabia. For this purpose, we have reviewed the current recommendations in establishing neonatal palliative care programs and discussed some of the social and religious aspects pertaining to this issue.
PMCID: PMC2860398  PMID: 19700889
22.  Regional variations in the growth of Saudi children and adolescents 
Annals of Saudi Medicine  2009;29(5):348-356.
No previous study has provided a detailed description of regional variations of growth within the various regions of Saudi Arabia. Thus, we sought to demonstrate differences in growth of children and adolescents in different regions.
The 2005 Saudi reference was based on a cross-sectional representative sample of the Saudi population of healthy children and adolescents from birth to 18 years of age. Body measurements of the length, stature, weight, head circumference and calculation of the BMI were performed according to standard recommendations. Percentile construction and smoothing were performed using the LMS (lambda, mu and sigma) methodology, followed by transformation of all individual measurements into standard deviation scores. Factors such as weight for age, height for age, weight for height, and head circumference for children from birth to 3 years, stature for age, head circumference and body mass index for children between 2-18 years of age were assessed. Subsequently, variations in growth between the three main regions in the north, southwest, and center of Saudi Arabia were calculated, with the Bonferroni: method used to assess the significance of differences between regions.
There were significant differences in growth between regions that varied according to age, gender, growth parameter and region. The highest variation was found between children and adolescents of the southwestern region and those of the other two regions The regression lines for all growth parameters in children <3 years of age were significantly different from one region to another reaching – 0.65 standard deviation scores for the southwestern regions (P=.001). However, the difference between the northern and central regions were not significant for the head circumference and for weight for length. For older children and adolescents a significant difference was found in all parameters except between the northern and central regions in BMI in girls and head circumference in boys. Finally, the difference in head circumference of girls between southwestern and northern regions was not significant. Such variation affected all growth parameters for both boys and girls.
Regional variations in growth need to be taken into consideration when assessing the growth of Saudi children and adolescents.
PMCID: PMC2860399  PMID: 19700891
23.  Pediatric retinal detachment in the Eastern Province of Saudi Arabia: experience of a tertiary care hospital 
Annals of Saudi Medicine  2009;29(5):361-364.
Because no previous studies have addressed the issue, we describe clinical characteristics and surgical outcome of patients with rhegmatogenous retinal detachment (RRD) in a pediatric population of the Eastern province of Saudi Arabia.
We conducted a retrospective review of all consecutive cases of pediatric RRD (0-18 years) patients presenting at Dhahran Eye Specialist Hospital, a tertiary care hospital, in the Eastern Province of Saudi Arabia over a period of 3 years.
Twenty patients were included in the study, accounting for 9.4% of all retinal detachment surgery cases performed over a period of 3 years (January 2006 to December 2008). The median age was 11.0 years, (range, birth to 18 years). Trauma, (45%) myopia/vitreoretinal degeneration (10%) and prior ocular surgery (25%) were significant risk factors for RRD. Proliferative vitreoretinopathy (PVR) more than grade C was present in 14/20 (70%) of cases. Most patients (15/20, 75%) were treated with pars plana vitrectomy and placement of an encircling buckle, while silicone oil or gas was used as tamponade in 13/20 (65%) patients. Surgery was successful in 17/20 (85%) cases in achieving retinal re-attachment. Visual acuity improved significantly following surgery (Mean preop 2.146 LogMAR, Mean postop 1.497 LogMAR) (P=.014). Longer duration of RRD (P=.007) and macular involvement (P=.05) were associated with worse anatomical outcomes following surgery.
Pediatric RRD in the Eastern province is often associated with predisposing pathology. Surgery is successful in achieving anatomical reattachment of the retina in a majority of cases with improvement of visual acuity.
PMCID: PMC2860400  PMID: 19700893
24.  Surgical resident satisfaction with the current surgical training program in the Riyadh area 
Annals of Saudi Medicine  2009;29(5):388-392.
The satisfaction of surgical residents with their training programs plays an important role in dictating its output. This survey was conducted to explore the satisfaction of surgical residents with their training programs in the Riyadh area.
A survey questionnaire was distributed in four major hospitals to explore the view of surgical residents regarding their training programs. Frequency tables were generated for each question in the survey.
About 78 survey forms were distributed and 52 were retrieved (67%). About 45% of residents had a comprehensive orientation on admission to the program, but only 20% felt it was helpful. Only 40% of residents felt that their trainers were committed to training and that the consultants who were trained abroad were more committed than those trained locally (62% vs 36%, P=.01). Only 15% felt the residents themselves had enough bedside teaching or operative experience. Seventy-eight percent of the residents felt that current training does not meet their expectations. However, 85% felt that training abroad was better than local training, and 60% felt it should be mandatory. While 90% felt that training programs should be unified nationally and controlled by one organization, only 6% felt that the current governing body was capable of monitoring the training. Moreover, only 28% felt that current reviews of programs by the governing body are effective.
These results show that surgical residents are generally dissatisfied with current training programs. The study suggests that there are significant weaknesses in the current programs and the governing body may be ineffective in monitoring the programs. We feel that a national review of surgical training programs is warranted in view of these results.
PMCID: PMC2860401  PMID: 19700898
25.  Strongyloides stercoralis hyperinfection after corticosteroid therapy: a report of two cases 
Annals of Saudi Medicine  2009;29(5):397-401.
Two cases of Strongyloides stercoralis hyperinfection are described. Both patients were expatriates from the Indian subcontinent, and reported the use of corticosteroids. The first patient presented with severe pulmonary disease that necessitated respiratory support, followed by acute abdomen and intestinal obstruction and he succumbed to these diseases. The second patient also presented with acute pulmonary disease, which responded to antihelmintic treatment and supportive care; however, he died later due to his primary disease. The clinical features of S stercoralis hyperinfection are nonspecific; therefore, a high index of suspicion is required for early diagnosis and to start appropriate therapy. Because of the seriousness of the disease and the associated high mortality we suggest screening for S stercoralis in patients from endemic areas who will be taking immunosuppressive therapy.
PMCID: PMC2860402  PMID: 19700900

Results 1-25 (105)