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Updates on the Epidemiology Pathophysiology and Management of Uraemic Pruritus محمد سعود السعيدان

Pruritus is a very common chronic and frustrating symptom that considerably affects the quality of life of patients with end-stage renal disease. The current review examined the updates in the epidemiology, pathophysiology, and management of uraemic pruritus. Recently, there has been reduction in the prevalence of urameic pruritus. With few exceptions, there have been no significant differences in the prevalence of uraemic pruritus by age, gender, and type of dialysis. However, pre-dialysis prevalence was lower than during dialysis prevalence. In recent years, new pathophysiologic hypotheses (immune and opioid) have been postulated and other hypotheses have been undermined (serotonin). There have been several anti-pruritic therapies examined among hemodialysis patients, including efficient dialysis, topical medications, systemic medications, physical and alternative treatments, and surgical treatments. However, none is considered the drug of choice or exclusively efficient in all patients. Several new medications have been examined in the last decade. However, for many of these medications, the evidence is still insufficient for their recommendations.

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Academic Satisfaction among Traditional and Problem Based Learning Medical Students. A comparative study. Saudi Medical Journal 2013; 34(11): 1179-1188. A. Albarrak, R. Mohammed, Mohammed F. Abalhassan, N. Almutairi. MOHAMMED FAHAD ABALHASSAN
OBJECTIVE:

To evaluate the academic satisfaction and importance among traditional learning (TL) and problem based learning (PBL) medical students, and to further evaluate the areas of concern in the academic education from the student's point of view.

METHODS:

A cross sectional study was conducted at the College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia from May to June 2012. The survey questionnaires were self-administered and consisted of mainly 6 sections: teaching, learning, supervision, course organization, information technology (IT) facilities, and development of skills.

RESULTS:

A total of 92 TL (males: 66 [71.7%]; females: 26 [28.3%]), and 108 PBL (males: 84 [77.8%]; females: 24 [22.1%]), with a mean age of 21.3 /- 1.3 (TL), and 20.7 /- 1.0 (PBL) were included in the study. The overall satisfaction rate was higher in the PBL students when compared with TL students in: teaching (84.7%/60.3%); learning (81.4%/64.5%); supervision (80%/51.5%); course organization (69.3%/46.9%); IT facilities (74.0%/58.9%); and development of skills (79.1%/53.9%). There was statistical significance difference in academic satisfaction comparing both groups of students (p</=0.001). The overall importance rating was almost similar in both TL and PBL of students, and found no significance in comparing importance rating.

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Efficacy and Safety Study of Adalimumab in Treatment of Hidradenitis Suppurativa عثمان صالح أباحسين

This study is to evaluate the safety of adalimumab and to determine how well it works in the treatment of adults with moderate to severe hidradenitis suppurativa (HS).

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BILATERAL PATELLAR TENDON RUPTURE نايف عبدالله آل نويهض
BILATERAL PATELLAR TENDON RUPTURE� Homod AlGashim1 , Hassan AlMoallem2 , Naif AlShahrani3 , Abdullah Aljuid1 Salman Bin Abdulaziz University, Alkarj, Saudi Arabia Prince Sultan Medical Military City, Riyadh, Saudi Arabia. 2 King Khalid University  Hospital, Riyadh, Saudi Arabia

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The Interpretation of Long-term Trials of Biologic Treatments for Psoriasis سلمان عبدالله بن دايل
Abstract

Psoriasis is a chronic disease requiring long-term therapy, which makes finding treatments with favourable long-term safety and efficacy profiles crucial. The goal of this review is to provide the background needed to evaluate properly long-term studies of biologic treatments for psoriasis. Firstly, important elements of design and analysis strategies are described. Secondly, data from published trials of biologic therapies for psoriasis are reviewed in light of the design and analysis choices implemented in the studies. Published reports of clinical trials of biologic treatments (adalimumab, alefacept, etanercept, infliximab or ustekinumab) that lasted 33 weeks or longer and included efficacy results and statistical analysis were reviewed. Study designs and statistical analyses were evaluated and summarized, emphasizing patient follow-up methods and handling of missing data. Various trial designs and data handling methods are used in long-term studies of biologic psoriasis treatments. Responder analyses in long-term trials can be conducted in responder enrichment, re-treated nonresponder or intent-to-treat trials. Missing data can be handled in four ways, including, from most to least conservative, nonresponder imputation, last-observation-carried-forward, as-observed analysis and anytime analysis. Long-term clinical trials have shown that adalimumab, alefacept, etanercept, infliximab and ustekinumab are efficacious for psoriasis treatment; however, without common standards for these trials, direct comparisons of these agents are difficult. Understanding differences in trial design and data handling is essential to make informed treatment decisions.

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Portal hypertension secondary to splenic arteriovenous fistula بدر عبدالله ..
Portal hypertension is a common condition in association with  chronic liver disease; however, it is rarely caused by vascular shunting from splenic arteriovenous fistula (SAVF). We are presenting a case of non-cirrhotic portal hypertension due to SAVF. This condition is usually seen in multiparity women; however, other causes like trauma or mycotic infection are reported in the literatures with equal gender prevalence. Most of the patients present  with gastric and esophageal varices, splenomegaly or upper abdominal pain. Clinical history and examination are the first step for diagnosis followed by ultrasound or contrast enhanced computer tomography. Splenic arteriovenous fistula must be then confirmed by selective celiac or splenic arteriography which is the  gold standard tool. The condition is treatable either  surgical ligation or intra-arterial embolization. Due to less invasive procedure, the later one is more  favorable in unstable patients. Both procedures have been reported to be equally successful in managing SAVF. ...
Peripheral primitive neuroectodermal tumor of the pleura in a 41-year-old female بدر عبدالله ..

Peripheral primitive neuroectodermal tumor (pPNET) is a rare, very aggressive neoplasm that belongs to a small round cell tumor, and most often arises from the chest wall. Here, we report a female case with proven pPNET who was treated in our institution. She presented with a history of left side chest pain, cough, and significant weight loss. Contrast enhanced CT imaging of the chest showed multiple left pleural-based enhancing masses with left diaphragmatic involvement. She underwent chemotherapy followed by tumor debulking through thoracotomy. However, she died of rapid growth from recurrent local tumors 3 months thereafter. 

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مؤشرات أمراض المناعة الذاتية وأمراض الغدة الدرقية بين مرضى البهاق نايف سالم الشهراني

The precise pathogenesis remains not fully understood. However, it is thought to involve an autoimmune process directed against melanocytes. Thyroid disorders and autoimmune thyroid diseases have been shown in some reports to be associated with vitiligo. Additionally, there is limited and conflicting data examining the association of antinuclear antibodies (ANA) with vitiligo.

METHODS: We conducted a cross-sectional study among 50 vitiligo patients diagnosed according to established clinical criteria at King Khalid University Hospital, Riyadh from January 2008 through December 2010.� Blood samples were obtained from the study participants and were tested for antinuclear antibodies (ANA), thyroid stimulating hormone (TSH) and free thyroxin hormone (T4).

RESULTS: Males represented 62% and the mean age was 28.2�11.0 years. A total of 20 (41.7%) had positive ANA values (titer ≥1:40). The mean TSH level was 2.69�2.17 �IU/mL. The mean free T4 level was 16.40�2.74 pmol/L and all patients were in the normal range (10.3-25.8 pmol/L). There were no statistically significant associations between ANA and age, gender, extent of skin lesion, face inclusion, and free thyroxin levels. On the other hand, positive ANA level had significant association with TSH level (p=0.041). With exception of ANA, TSH level had no statistically significant associations with the above variables.

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معدل انتشار متلازمة الأمعاء المتهيجة بين طلاب الطب بجامعة سلمان بن عبد العزيز سمير حامد الغامدي

المقدمة: متلازمة الأمعاء المتهيجة تعد من أكثر الاضرابات الهضمية انتشارا و تتميز بأعراض غير نوعية مثل ألام البطن و تناوب عادات الاخراج و ذلك من دون وجود سبب عضوي معروف للمرض. معدل انتشاره يتباين في مختلف المجتمعات و سببه مازال خفي و غير محدد و لكن يرجح و جود عدة عوامل مسببه له.

الأهداف: تحديد معدل انتشار و العوامل المرتبطة و تأثير متلازمة الأمعاء المتهيجة بين طلاب الطب بجامعة سلمان بن العزيز.

طرق البحث: تم اجراء دراسة مقطعية بين نوفمبر و ديسمبر، 2013 بين طلاب الطب الذكور المسجلين بجامعة سلمان بن عبد العزيز للعام الدراسي 1434-1435 هـ. تم دعوة كل طلاب الطب الذكور من المرحلة الثانية الي المرحلة السادسة للمشاركة في البحث و ذلك بتعبئة استبانة. تم استخدام استبانة مؤكد صدقها و ثباتها و موثوق فيها لجمع البيانات. تم تشخيص متلازمة الأمعاء المتهيجة بناء علي خصائص رومان 3.

النتائج: كان معدل انتشار متلازمة الأمعاء المتهيجة 21%. و بصفة عامة تميزت الأعراض بوجود اسهال في 34.3% من الحالات و امساك في 20% منهم و أعراض متبادلة في 45.7% من الحالات. الطلاب الذين يعانون من مشاكل صحية مزمنة كانوا ثلاث مرات أكثر عرضة للاصابة بمتلازمة الأمعاء المتهيجة من الذين لا يعانون منها(معدل خطورة=2.93). الذين يعانون من التوتر كانوا 2.63 مرة أكثر من غيرهم عرضة للاصابة بمتلازمة الأمعاء المتهيجة و الذين يعانون من حساسية زائدة للغذاء كانوا أكثر عرضة للاصابة بمتلازمة الأمعاء المتهيجة من غيرهم (معدل خطورة=3.29). متلازمة الأمعاء المتهيجة غير مرتبطة بالتحصيل الأكاديمي للطلاب.

الخلاصة:متلازمة الأمعاء المتهيجة منتشرة بين طلاب الطب لذا يوصي باجراء مسوحات بينهم لها و للمشاكل النفسية...

اضطرابات هرمون تنشيط الغدة الدرقية بين مرضى البهاق محمد سعود السعيدان
مقدمة البحث: مرض البهاق هو الاضطراب الأكثر شيوعا ذو الصلة بصبغة الجلد. وقد تم الربط بين مرض البهاق و كلا من اضطرابات الغدة الدرقية وأمراض الغدة الدرقية الناتجة عن اضطراب المناعة الذاتية. وهناك عدد من التقارير الدولية التى تقدر معدل انتشار اضطرابات هرمون تنشيط الغدة الدرقية بين مرضى البهاق. ومع ذلك، فلا وجود لمثل هذه الدراسات في المملكة العربية السعودية ...
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