Al Hadā, Saudi Arabia
Al Hadā, Saudi Arabia

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Emara S.S.,Al Hada Military Hospital | Aboulwafa A.M.,Ain Shams University | Alzaylai A.A.,Al Hada Military Hospital | Farag M.M.,Ain Shams University
Burns | Year: 2013

Purpose: To evaluate the effectiveness of microalbuminuria monitoring in the management of patients with severe burns. Methods: Consecutive patients admitted to the burn unit with total body surface area burn between 20% and 50% were examined for microalbuminuria during the hospitalisation. The findings were correlated to different clinical variables usually encountered in this patient category. Results: Microalbuminuria was found in patients with inhalation injuries (100%), systemic inflammatory response syndrome (SIRS, 88.4%), burn sepsis (95.1%) and postoperatively (94.9%). Conclusion: Microalbuminuria is the only simple, non-invasive, bedside, immediate and cost-effective test to indicate for occurrence of SIRS, if the other variables were stabilised. It can be measured with every urine void or more often when a urinary catheter is inserted. This will affect our management of patients with severe burns. © 2012 Elsevier Ltd and ISBI.


Al-Jiffry B.O.,Taif University | Al-Jiffry B.O.,Al Hada Military Hospital
International Journal of Surgery Case Reports | Year: 2013

Introduction: Adult hepatoblastoma is a rare malignant liver neoplasm. Surgery is the only cure, but recurrence is common even after complete resection. No therapeutic strategy has been established. PRESENTATION OF CASE: A 22-year-old man presented with a rapidly expanding right hypochondrial mass. Pain preceded the appearance of the mass. No definitive diagnosis was established in the referring hospital. In addition, two attempts of embolization failed to reach the tumor due to its large size and vascular displacement. Clinical examination revealed a 26 cm × 23 cm mass occupying the right hypochondrium and epigastrium as far as the right iliac fossa, compressing the stomach, spleen, kidneys and liver. The preoperative diagnosis was gastrointestinal stromal tumor because it appeared to originate from the stomach. During surgery, we found a mass arising from the liver, adhering to the omentum, stomach, and left hemidiaphragm, and infiltrating the pericardium. The tumor was completely resected off the inferior vena cava and pericardium. The histopathological diagnosis was a 30 cm × 30 cm hepatoblastoma weighing 4 kg. The postoperative treatment course went smoothly until day 10, when the patient developed complications like bilateral atrial thrombi and left ventricular hypokinesia and expired on day 16. Discussion: Due to the rarity of hepatoblastoma in adults and non-specific initial symptoms, hepatoblastoma is often overlooked as a diagnosis. Early detection may lead to improved prognosis and survival. Conclusion: We report here the first case of adult hepatoblastoma in the Middle East and the largest such tumor ever reported in literature. © 2012 Surgical Associates Ltd.


Al-Jiffry B.O.,Taif University | Al-Jiffry B.O.,Al Hada Military Hospital | AlNemary Y.,Taif University | Khayat S.H.,Al Hada Military Hospital | And 2 more authors.
BMC Cancer | Year: 2013

Background: Pancreatic paragangliomas are rare tumors, with only 16 reported cases to date. One of these cases demonstrates metastasis to lymph node, while another case was functional, however, none of these cases showed malignant and large, pancreatic paraganglioma with marked invasion. Also another unique feature was the age of our patient compared to the average reported ages in published literature (42-85 years).Case presentation: A 19-year-old woman presented with a one-year history of intermittent abdominal pain. Physical examination showed a palpable mass in the right upper abdomen, but initial laboratory results were within normal ranges; tumor markers (CEA, AFP, and CA19-9) were negative. An abdominal and pelvic computed tomography (CT) scan showed a well-defined retroperitoneal para-aortic mass. The CT scan revealed that the surrounding lymph nodes were not enlarged, but the liver showed evidence of parenchymal infiltration. Intraoperatively, a large, firm tumor originating from the head of pancreas was found pushing on the caudate hepatic lobe and the inferior vena cava (IVC). The tumor was resected through a pancreaticoduodenectomy, involving segment VI of the liver and a small segment of the IVC. The blood pressure spiked (>220 mm Hg) when the tumor was manipulated during the operation. The final pathology report showed a 9-cm tumor with lymphovascular invasions; immunohistochemistry was positive for synaptophysin and chromogranin. All resection margins were negative and 1/15 lymph nodes was positive for metastasis. Post-operative recovery was unremarkable. One month after discharge, the patient was re-admitted with abdominal pain and found to have an abdominal collection at the resection site, which was drained under CT guidance. She received a therapeutic dose of I131-metaiodobenzylguanidine (MIBG). Follow-ups showed the absence of recurrence, and she has remained disease free.Conclusion: This patient was an extraordinary example of a rare tumor. Even more remarkable was that the tumor was malignant with lymph node invasion. To our knowledge, a case similar to that presented here has not been previously reported in the literature. © 2013 Al-Jiffry et al.; licensee BioMed Central Ltd.


Al-Jiffry B.O.,Taif University | Al-Jiffry B.O.,Al Hada Military Hospital | Elfateh A.,Al Hada Military Hospital | Chundrigar T.,Al Hada Military Hospital | And 8 more authors.
World Journal of Gastroenterology | Year: 2013

Aim: To find a non-invasive strategy for detecting choledocholithiasis before cholecystectomy, with an acceptable negative rate of endoscopic retrograde cholangiopancreatography. Methods: All patients with symptomatic gallstones were included in the study. Patients with abnormal liver functions and common bile duct abnormalities on ultrasound were referred for endoscopic retrograde cholangiopancreatography. Patients with normal ultrasound were referred to magnetic resonance cholangiopancreatography. All those who had a negative magnetic resonance or endoscopic retrograde cholangiopancreatography underwent laparoscopic cholecystectomy with intraoperative cholangiography. Results: Seventy-eight point five percent of patients had laparoscopic cholecystectomy directly with no further investigations. Twenty-one point five percent had abnormal liver function tests, of which 52.8% had normal ultrasound results. This strategy avoided unnecessary magnetic resonance cholangiopancreatography in 47.2% of patients with abnormal liver function tests with a negative endoscopic retrograde cholangiopancreatography rate of 10%. It also avoided un-necessary endoscopic retrograde cholangiopancreatography in 35.2% of patients with abnormal liver function. Conclusion: This strategy reduces the cost of the routine use of magnetic resonance cholangiopancreatography, in the diagnosis and treatment of common bile duct stones before laparoscopic cholecystectomy. © 2013 Baishideng. All rights reserved.


Al-Jiffry B.O.,Taif University | Al-Jiffry B.O.,Al Hada Military Hospital | Allam H.M.,Al Hada Military Hospital | Hatem M.,Taif University
Oncology Letters | Year: 2015

Gastrointestinal stromal tumors (GISTs) are rare, but remain the most common GI mesenchymal neoplasms. In the present study, six cases of GIST are reported, and one of these cases, a patient with esophageal GIST, is reported in-depth. Certain recent developments in the clinical therapy of GISTs are also discussed. The records of all surgically-resected GI stromal tumors treated at the Al-Hada Military Hospital between January 2007 and December 2012 were reviewed. There were six cases of surgically resected GISTs during this time period, three males and three females, with a mean age of 69.3±16.4 years. The stomach was involved in 66.7% of cases, the small intestine in 16.7% and the esophagus, which is an extremely rare site, in 16.7% of cases. The most common symptom at presentation was abdominal pain, followed by GI bleeding. The mean tumor size was 8.7±6.3 cm. Surgery was indicated by the presence of the aforementioned symptoms or a tumor size >5 cm. All tumors were completely resected with histologically negative margins. The diagnoses were established by immunohistochemistry. Four patients were classified as possessing a high-grade variant, and were administered with tyrosine kinase inhibitors (TKIs). Following a mean follow up of 31 months, no recurrence or mortality was detected. Complete surgical resection with tumor-free margins is the standard treatment for GISTs, and TKIs should be used as adjuvant therapy if the risk of progressive disease is high. © 2015, Spandidos Publications. All rights reserved.


Ezeldin T.H.,Al Hada Military Hospital
Saudi Medical Journal | Year: 2013

Objectives: To determine the impact of preoperative serum creatinine level in non-dialyzable patients on postoperative morbidity and mortality. Methods: This is a prospective study, where serum creatinine was used to give primary assessment on renal function status preoperatively. This study includes 1,033 patients, who underwent coronary artery bypass grafting, or valve(s) operations. The study took place at Al-Hada Military Hospital, Taif, Kingdom of Saudi between May 2008 and January 2012. Data were statistically analyzed using Chi square (χ2) test and multivariable logistic regression, to evaluate the postoperative morbidity and mortality risks associated with low serum creatinine levels. Results: Postoperative mortality increased with high serum creatinine level >1.8 mg/dL (p≤0.0005). Multivariable logistic regression, adjusting for potentially confounding variables demonstrated that a creatinine level of more than 1.8mg/dL was associated with increased risk of re-operation for bleeding, postoperative renal failure, prolonged ventilatory support, ICU stay, and total hospital stay. Conclusions: Perioperative serum creatinine is strongly related to post operative morbidity and mortality in open heart surgery. High serum creatinine in nondialyzable patients can predict the increased morbidity and mortality after cardiac operations.


Al-Jiffry B.O.,Taif University | Al-Jiffry B.O.,Al Hada Military Hospital | Al-Malki O.,Taif University
World Journal of Surgical Oncology | Year: 2013

We describe the treatment of a 46-year-old Saudi man with advanced stage liver metastatic neuroendocrine rectal cancer. The patient presented with a large liver lesion and rectal bleeding. He was cachectic, with a firm tender mass 20 mm above the anal verge. Computed tomography (CT) showed a mass 9.5 × 13 cm in size in the right hemi-liver, abutting the middle hepatic vein. The patient refused treatment, and consulted another hospital. After 3 months, he presented with the same symptoms in addition to delirium. Colonoscopy showed an ulcerating anorectal mass, from which a biopsy was taken. Repeat CT showed an increase in the size of the liver lesion to 17 cm and no change in the pelvis. The final histopathology report identified anaplastic small cell carcinoma. The patient underwent extended right liver resection followed by abdominoperineal resection, then 13 cycles of chemotherapy and monthly somatostatin injections. At the most recent follow-up, the patient had been disease-free for 48 months. Surgical resection (R0) of the primary and secondary tumor, followed by platinum-based chemotherapy can result in good survival in cases of small cell carcinoma with large liver metastasis, irrespective of whether the primary or secondary tumor is resected first. © 2013 Al-Jiffry and Al-Malki; licensee BioMed Central Ltd.


Mbanya J.C.,University of Yaounde I | Mbanya J.C.,Endocrinology and Metabolic Diseases Unit at the Hospital Central in Yaounde | Al-Sifri S.,Al Hada Military Hospital | Abdel-Rahim A.,Alexandria University | Satman I.,Istanbul University
Diabetes Research and Clinical Practice | Year: 2015

Aim: Hypoglycemia can be a concern for patients with type 2 diabetes when fasting during Ramadan. In this analysis, we assessed the incidence of symptomatic hypoglycemic events in fasting patients treated with gliclazide or dipeptidyl peptidase-4 (DPP-4) inhibitors. Methods: A systematic literature review was performed to identify randomized clinical trials comparing the efficacy and safety of gliclazide with DPP-4 inhibitors when treating adults with type 2 diabetes fasting during Ramadan. The primary endpoint of all included studies was the incidence of symptomatic hypoglycemic events. Results: The pooled analysis included three randomized trials. There was no evidence of heterogeneity between the studies (I2=0%). There was no significant difference in the incidence of symptomatic hypoglycemic events in patients fasting during Ramadan treated with either a DPP-4 inhibitor or gliclazide (5.6% versus 7.2%, risk ratio 1.12, 95% CI 0.73-1.73, p=0.61). Conclusion: Patients treated with either gliclazide or DPP-4 inhibitors while fasting during Ramadan have similarly low risks of experiencing symptomatic hypoglycemia. Gliclazide is an effective oral antidiabetic that may be suitable for the management of patients with type 2 diabetes during Ramadan. Individualized Ramadan-focused advice and evening intake of treatment may improve the management of patients with diabetes during Ramadan. © 2015 Elsevier Ireland Ltd.


PubMed | University of Yaounde I, Istanbul University, Alexandria University and Al Hada Military Hospital
Type: Journal Article | Journal: Diabetes research and clinical practice | Year: 2015

Hypoglycemia can be a concern for patients with type 2 diabetes when fasting during Ramadan. In this analysis, we assessed the incidence of symptomatic hypoglycemic events in fasting patients treated with gliclazide or dipeptidyl peptidase-4 (DPP-4) inhibitors.A systematic literature review was performed to identify randomized clinical trials comparing the efficacy and safety of gliclazide with DPP-4 inhibitors when treating adults with type 2 diabetes fasting during Ramadan. The primary endpoint of all included studies was the incidence of symptomatic hypoglycemic events.The pooled analysis included three randomized trials. There was no evidence of heterogeneity between the studies (I(2)=0%). There was no significant difference in the incidence of symptomatic hypoglycemic events in patients fasting during Ramadan treated with either a DPP-4 inhibitor or gliclazide (5.6% versus 7.2%, risk ratio 1.12, 95% CI 0.73-1.73, p=0.61).Patients treated with either gliclazide or DPP-4 inhibitors while fasting during Ramadan have similarly low risks of experiencing symptomatic hypoglycemia. Gliclazide is an effective oral antidiabetic that may be suitable for the management of patients with type 2 diabetes during Ramadan. Individualized Ramadan-focused advice and evening intake of treatment may improve the management of patients with diabetes during Ramadan.


PubMed | King Saud University and Al Hada Military Hospital
Type: Journal Article | Journal: JPMA. The Journal of the Pakistan Medical Association | Year: 2016

The metabolic physiology during pregnancy is unique in the life of women. This change is a normal physiological adaptation to better accommodate the foetal growth and provides adequate blood, nutrition and oxygen. The metabolic changes prepare the mother\s body for pregnancy, childbirth and lactation. Early gestational period is considered as an anabolic phase, in which female body stores nutrients, enhance insulin sensitivity to encounter the maternal and feto-placental demands of late gestation and lactation. However, late gestational period is better named as a catabolic phase with reduced insulin sensitivity. The placenta plays a role as a sensor between mother and foetus physiology and acclimatizes the needs of the foetus to adequate growth and development. During pregnancy the female body changes its physiological and homeostatic mechanisms to meet the physiological needs of the foetus. However, if the maternal metabolic physiology during pregnancy is disturbed, it can cause hormonal imbalance, fat accumulation, decreased insulin sensitivity, increased insulin resistance and even gestational diabetes mellitus.

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