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Background: Subacromial impingement syndrome (SIS) is considered the most prevailing cause of shoulder pain. Although Mulligan's technique may be useful in treating shoulder impingement, its significance in areas of range of movement (ROM), pain, and function is still debated.Objective: To systematically review and summarize the best evidence on treating subacromial impingement syndrome using mobilization with movement.Patients and Methods: Databases Cochrane Library Web search, PEDro and PubMed were searched for RCTs published in English language from inception to September 2019, updated later to 7th of July 2021. Reference lists of relevant publications were also screened. Two reviewers separately identified relevant papers based on the inclusion criteria. The identified papers by both authors were obtained in full text. To evaluate methodological quality and risk of bias, the Cochrane risk of bias tool was used. We used the random-effects model in all analyses for meta-analyses.Results: A total of 11 RCTs with a total number of 358 adults with subacromial shoulder pain were included. They examined the effect of mobilization with movement (MWM) combined with exercise with or without taping against rotator cuff strengthening, ROM exercises, isometric strengthening, shoulder joint mobilization, and sham techniques. Meta-analysis was done comparing MWM against exercise and found a significant difference in VAS and a non-significant difference in SPADI.Conclusion: Shoulder mobilization with movement combined with a supervised exercise program (ROM, and functional limitations) has a better impact on pain than exercise alone or sham in short-term with similar improvement to exercise in the long-term.

Background: Acute intestinal obstruction occurs when there is an interruption in the forward flow of intestinal contents. This interruption can occur at any point along the length of the gastrointestinal tract, and clinical symptoms often vary based on the level of obstruction. Intestinal obstruction in children can occur as a result of various causes such as, intussusception, adhesive small bowel obstruction, malrotation, and Hirschsprung’s disease. In this review paper we will go through the literatures that have been investigated to assess the various management measures and its outcomes. Objective: In this review we aimed at assessing of different management plans of gastrointestinal obstruction in different conditions like Intussusception, Congenital Duodenal Obstruction and Adhesive Small Bowel Obstruction (ASBO), and the outcomes related. Moreover, providing a reference paper analyzing all the clinical studies in this field. Methods: PubMed database was used for articles selection, and the following keys used in the Mesh ("Intestinal Obstruction/diet therapy"[Mesh] OR "Intestinal Obstruction/drug effects"[Mesh] OR "Intestinal Obstruction/ drug therapy"[Mesh] OR "Intestinal Obstruction/surgery"[Mesh] OR "Intestinal Obstruction/ therapy"[Mesh]). Results: Intussusception should be treated with hydrostatic reduction (HR) even with more than one try because this method was associated with high success rate. After successful HR, patient can be discharged from ED if there were no suspected complications. Surgical treatment is indicated mostly in cases of complications. Manual reduction was associated with significantly better post-operative outcomes and lesser time to recovery. It is advised not to maintain high threshold for resection in order to avoid post-operative recurrence or perforation. The use of Gastrografin in treating children with adhesive small bowel obstruction when the conservative management fails is safe. However, half of the patients will need surgical management after all. Conclusion: The laparoscopic approach in the management of congenital duodenal obstruction can be performed in neonates safely. It showed similar outcomes to the open approach despite the presence of high conversion rate.

Aim of the Study: was to investigate the influence of phacoemulsification on corneal endothelial cells and its injury risk factors in diabetic cataract patients and non-diabetic patients. Methods: electronic databases were searched: Scopus, EMBASE, and Google Scholer), PubMed/MEDLINE, Scopus, The Cochrane Library, and Web of Science. Econlit from 1990 to 2017. This was completed with a manual search of references of relevant papers. Risk of bias in methodology of studies was measured using the Newcastle-Ottawa Scale. Results: Observation of corneal endothelial cell density, coefficient of variation and percentage of hexagonal cells preoperatively, 1 day, 1week, 1 and 3 months postoperatively was carried out, and multiple Logistic regression analysis for risk factors of corneal endothelial cell injury was taken. Results: Out of 779 retrieved papers, 9 studies with a total of 1129 individuals were finally included (579 diabetic eyes and 550 non-diabetic eyes). For the dynamic changes between preoperative and postoperative values, significant differences were identified between the two groups in endothelial cell density (ECD) and hexagon cells (HC%) at 1 day, 1 week, 1 month, and 3 months postoperatively, in central corneal thickness (CCT) at 1 month postoperatively, and in coefficient variation (CV) at 1 week and 1 month postoperatively. However, no significant differences were observed in CCT at 1 day, 1 week and 3 months postoperatively or in CV at 1 day and 3 months postoperatively. Conclusion: it could be concluded from the current literature that aged-cataract patients with diabetes mellitus manifested poor tolerability to cataract phacoemulsification surgery in contrast to senile cataract patients.

Background: The Family Medicine Specialty was endorsed to fulfill the needs of qualified Primary Health Care providers. Family Medicine Postgraduate Training in Egypt had started in the universities under the umbrella of Medical Colleges in the form of postgraduate trainings and degrees.Objectives: This paper aimed to identify the strengths and weaknesses of the different clinical rotations in Family Medicine in relation to the learning outcomes and to assess trainees' satisfaction.Methods: A mixed research exploratory study was conducted among 48 postgraduate family physicians’ candidates in their final year of training from two purposively selected universities (Cairo University and El Menoufia University) during 2019.Results: The attitude of the physicians towards their clinical education experience differs significantly between the Internal Medicine & Pediatrics. About 72% of participants were from Cairo University and 28% from Menoufia. Internal Medicine training was the best perceived among trained physicians. More than (71%) of the physicians believed they understood the common clinical cases.Conclusions: These findings can be useful for the policy makers to emphasize the importance of raising awareness among staff member regarding family practice and to implement the suggested recommendations and deal with obstacles to improve the Family Medicine training in order to provide effective and efficient primary care services.

Background: The Scaphoid bone is the tmost commonly fractured carpal bone. Proper clinical examination and radiological imaging is essential for early diagnosis and management. The management of scaphoid fractures varies from cast immobilization to open reduction and internal fixation. This paper explores the outcome of using headless cannulated screws in minimally displaced scaphoid fractures. Objective: Aim of this study is to assess the functional and clinical outcome of using cannulated headless screws in management of acute scaphoid fractures. Methods: A prospective study held between February 2019 and January 2020, where eighteen patients included with acute scaphoid fractures of Herbert B1, B2 and B3 classification. Fixation was done using both volar and dorsal percutaneous technique. Patients were evaluated postoperatively clinically using modified Mayo wrist score (MMWS). Results: Of mean age 34.5±8.37 years, the majority were with excellent final outcome (83.3%), good (5.6%), fair one case (5.6%) and only one poor (5.6%) and mean time of union was 9.66±1.9 months. Conclusion: All active young individuals with acute non-displaced or minimally displaced scaphoid fractures should be offered percutaneous internal fixation, for the sake of earlier gain of motion of the wrist, earlier time to union, quicker return to activity of daily living, and a lower complication rate.

Background: Inborn errors of metabolism (IEM) are disorders in which there is a block at some point in the normal metabolic pathway caused by a genetic defect of a specific enzyme. Diagnosis is important not only for treatment and prognostication but also for genetic counseling and antenatal diagnosis in subsequent pregnancies. Objective: The present study aimed to find out the relative frequency of inborn errors of metabolism among infants with unapparent cause of failure to thrive (FTT). Patients and Methods: This study was cross-sectional prospective study, which was conducted during the period from 2017 to August 2019. It included 58 cases with non-apparent cause of failure to thrive admitted at Pediatric Department, Faculty of Medicine, Zagazig University. All studied cases were subjected to: EMS (extended metabolic screen) using filter paper by Tandem Mass Spectrometry. Urinary organic acids analysis was performed. Results: In this study, frequency of inborn errors of metabolism (IEM) among the studied unapparent causes of FTT cases was 8.6%. Types of IEM diseases among the studied cases were one case for each of biotinidase enzyme deficiency (1.7%), methyl malonic acidemia (1.7%), mitochondrial disease (1.7%), organic acidemia (1.7%) and phenylketonuria (1.7%). There was statistically significant increase in complains of vomiting and diarrhea among cases with inborn errors of metabolism than those without inborn errors of metabolism. Conclusion: There was high frequency of inborn errors of metabolism (IEM) among FTT without apparent cause. Frequency of hypoglycemia, positive ketone in urine, high anion gap and high serum ammonia were significantly more frequent among cases with inborn errors of metabolism than those without inborn errors of metabolism.

Background: The food safety is one of the top priorities in the protection of public health. Pesticide residue has environmental and human health impact so, studding the behavior and dissipation of pesticides on foods is necessary. Objectives: This paper aimed to study the dissipation kinetics of pymetrozine to assess its effect in the ecosystem of tomato field, to expose residual dissipation behavior. Materials and methods: In a tomato-field ecosystem, tomato samples were collected after pymetrozine application in different time intervals 0, 1, 3, 5, and 7 days. The dissipation kinetics and residual behavior of insecticide were analyzed based on a QuEChERS method and quantified by high-performance liquid chromatography combined with photodiode array detection (HPLC-DAD). Results: The average recovery from tomatoes was 90.75% (88.5 - 93%), and 85 - 87.5% from soil. The coefficient variation of the method (CV %) was less than 7% in tomatoes, and less than 12%. in soil, ranged from 1.27% to 4.77% for repeatability. The low detection limit (LOD) and limit of quantitation (LOQ) of pymetrozine were determined to be 0.01 and 0.03 mg/kg, respectively. The dissipation kinetics of pymetrozine residue was C = 1.504 e−0.528t in tomato and C= 11.82 e−0.4082t in soil, in addition, residues half-lives were 1.31, and 2 days, respectively. The pre-harvest interval (PHI) of pymetrozine on tomatoes was 3 days. The recommended dosage could be considered a safe dosage for humans. Conclusion: This study would contribute to provide information on safe and proper use of the pesticide.

Background: Acne is a widespread and complex skin disease among developed nations, affecting nearly all young adults between the ages of 15 to 17 years. It is a chronic inflammatory skin disorder resulting in psychological stress. Historically, the relationship between diet and acne is controversial. As a result, significant studies have been done to evaluate this relationship. Assessment of these literatures will help to provide better outcomes for the patients. Objective:This study aims to: 1- Measuring effect of diet and nutritional substances in the management and prevention of acne vulgaris. 2- Providing a reference paper analyzing all the clinical studies in this field. 3- Analyzing the last progression has been reached. Methods: PubMed database was used for articles selection. We included all relevant articles to our review with the following topics (("Acne Vulgaris/diet therapy"[Mesh]) AND ("Acne Vulgaris/prevention and control"[Mesh])) AND ("Acne Vulgaris/therapy"[Mesh]). We excluded other articles which are not related to this field. The data will be extracted according to specific form in which it is going to be reviewed by group members to assess the dietary effect of nutritional substance on acne vulgaris. Conclusion: We concluded that there are studies that showed promising results among patients and proved that associations do exist.Nevertheless, further studies with bigger sample and better protocols are needed to establish a concrete evidence-based relationship.

Background: Breast cancer (BC) is the most common type of malignancy in women around the world. In Saudi Arabia, a total of 6,922 female BC cases were recorded in the Saudi Cancer Registry during the period from 2001-2008. Eastern province has the highest prevalence rate in Saudi Arabia at 26.6 per 100,000 women, followed by Riyadh 20.5 then other regions. Materials and Methods: Cross sectional study, was carried out on random, adult females 18 years old or more in eastern province, Saudi Arabia. They were approached to participate in a questionnaire about BC. The questionnaire (either paper or online), consent forms were taken. Data were analyzed by demographic criteria, including age, gender, marital status, and level of education, to determine if there are any difference between them. Statistical analysis: Data were analyzed using Statistical Package for Social Sciences version 23 (SPSSv23). Results: In total, 555 participants completed the survey. Most of them believed that screening should begin before the onset of the symptoms (63%). less than one third of participants believed in early menarche, late menopause, and nulliparous. Their answers were varied according to their education levels. Even though, there were some misconceptions with high educated people. Conclusion: Although higher education and older individuals tended to answer questions correctly more than others, there is a need to improve the knowledge about the BC and its screening guidelines to encourage them to go through these tests. A national education program in Saudi Arabia is recommended to improve BC knowledge.

Background: In performing an MRI examination the patient may feel anxious due to the nature of the MRI scan as the patient would be inserted into the narrow bore of the MRI scanner and would be asked to be immobile during the examination period for approximately 20 to 90 minutes depending on the scan type. Patient feeling anxious may also be evoked by several causes and consequently may develop into anxiety reactions by the patient either before, during, or after the scan. Aim: This paper aim to study the issues surrounding the anxiety in patients undergoing MRI examinations by identifying the prominent causes, outlining the possible effects of anxiety, discussing the main potential methods for alleviating patient's anxiety. Materials and methods: This review is conducted by using a comprehensive search of PubMed, Google Scholar, and Elsevier, August 1993, through March 2018. The following search terms were used: causes of anxiety in MRI, claustrophobia and MRI, effects of anxiety in MRI, alleviation of anxiety in MRI patient. Conclusion: Patient's anxiety can pose problems that may impede the process of the MRI examination. Patient's anxiety may have adverse effects on both patient and the healthcare institution as it can cause financial losses for the healthcare institutions. However, sedation techniques, acoustic noise reduction, and adequate patient preparation for the MRI scan are possible methods that can alleviate patient's anxiety.

Background: Significant research papers have been published to assess the relation between rapid weight loss and the development of cholelithiasis, and the risk factors behind it. Assessment of cholelithiasis development after rapid weight loss as a result in most of bariatric surgery will help in reducing the admission rate to hospitals because of colic pain, and the complication related to stones formation. Objective: This study aimed at measuring the association of rapid weight loss with the development of gallbladder stones and identifying the role of prophylactic cholecystectomy. Methods: PubMed database was used for articles selection. All relevant articles to our review with the following topics: Bariatric Surgery, Gallbladder stones, bariatric surgery complication were included. We excluded other articles which are not related to this field. The data were extracted according to specific form in which it is going to be reviewed by group members to assess the relation between bariatric surgery and the development of stones, and weight loss as well as the benefits of prophylactic cholecystectomy against gallbladder stones. Conclusion: Bariatric surgery can lead to gallstone formation because of the rapid excess weight loss. Small percentage may become symptomatic and rarely cholecystectomy becomes needed during the first year of the bariatric surgery. So, it is not evidently recommended to be done as prophylaxis. However, Prophylactic medicinal therapy (Ursodeoxycholic acid) in the first 6 months can be used instead.

Background: Poor ovarian response to stimulation in IVF cycles is a challenging and frustrating condition for both clinician and patient, due to its poor prognosis in terms of pregnancies and live births. Although in the literature a large number of papers have been published in which many stimulation protocols suggested should be considered as the best for these women, however, no conclusive results have been reached. Aim of the Work: To evaluate ICSI outcome in patient at risk of poor responder using mild ovarian stimulation protocol versus short gonadotropins releasing hormone agonist protocol. Patients and Methods: This randomized controlled study was conducted on one hundred patients, complaining of infertility at risk of poor responders, patients with at least two of the criteria specific for poor responders at assisted reproductive technology unit, international Islamic center for population studies and research, Alazhar University, Cairo, Egypt, between august 2016 and august 2017. Results: Statistically significant differences were found in the Endometrial thickness, E2 at day of HCG, No. of dominant follicles at day of HCG, Number of retrieved oocyte, fertilization rate, Embryo number, Number of transferred embryos, Pregnancy rate and cost p-value 0.029, 0.036, 0.007, 0.027, 0.048, 0.019, 0.046, 0.044 ,0.001 respectively. Conclusion: ICSI outcome was evaluated in patients at risk of poor responders using short Gonadotropin releasing hormone agonist versus mild ovarian stimulation protocol (clomiphene citrate); showing that short Gonadotropin releasing hormone agonist should be preferred in these patients.

Background: As a consequence of unintentional injury or trauma, children may develop permanent disabilities such as limb amputations or disfigurement; and in severe cases these injuries can lead to death or severe neurological disabilities. The aim of this study was to identify the most frequently reported type of unintentional injury sustained by children in Saudi Arabia, as well as the most common locations in which such injuries take place. This paper will also examine the long-term consequences of children’s unintentional injuries on their parents and the different types of care that are needed post-injury Methodology: This research was carried out in the form of a cross-sectional survey that was intended to be used as an evaluation tool during the first ‘Childhood Safety Campaign’ in Riyadh, Saudi Arabia. The campaign was conducted over 4 days (14 - 17 March 2017) and provided parents with free childhood safety educational resources. The campaign also aimed to capture the personal experiences of families using pre-designed electronic surveys that were completed both before and after attending the campaign. Data was subsequently analyzed using SPSS® version 21.0 basic descriptive software. Results: Out of the 374 parents who were surveyed, 32% (N=122) reported that at least one child of theirs had sustained an injury of some sort in the 12 months preceding the campaign. The most common type of unintentional injuries that were reported were falls (50.9%), whilst the most common location for the occurrence of such injuries was at home (66%). Parents also reported that, as a consequence of the injuries, most children endured a contusion/abrasion (28.7%). The families that took part in this survey also reported that most of the medical care needed as a consequence of injury took place in the Emergency Department. However, hospitalization was needed in (2.3%) of cases. Conclusion: Accidental injuries are most commonly reported by the parents of children in Saudi Arabia, Incidentally, the majority of these accidents occur at home and can be easily treated in the ER Department. Occasionally, however, certain serious types of injury toke place thereby requiring hospitalization. By raising awareness of these types of preventable injuries via the use of educational awareness campaigns, the risks posed to vulnerable young children may be greatly reduced.

Aim of the study: was to investigate the effectiveness of Percutaneous Needle Aspiration in comparison to continuous catheter drainage in the treatment of hepatic abscesses. Methods: A review of the scientific literature (From 1980 to October 2017) MEDLINE, EMBASE, SCOPUS, Current Contents, Cochrane Library, and Clinicaltrials.gov were searched to identify randomized controlled trials that investigated thoroughly the Percutaneous Needle Aspiration Versus Catheter Drainage in the treating of hepatic abscess and clearly met the inclusion criteria and the study primary endpoints (success rate, total resolution and mortality). Identification of papers and data extraction were performed by independent researchers. Results: the search yielded six eligible RCTs covering 348 patients. The meta-analysis showed that outcomes in patients treated with PCD were superior to those in patients treated with PNA in terms of success rate (RR: 0.79, 95% CI=0.64–0.97; P = 0.04), days to achieve a 50% reduction in abscess cavity size (SMD: −1.076, 95% CI 0.63–1.51; P < 0.00001) and overall clinical improvement (SMD: 0.71, 95% CI 0.35–1.09; P =0.0001). On the other hand, no significant difference was notable in the duration of hospitalization (SMD: −0.15, 95% CI −2.03 to 1.72, P = 0.84) or procedure-related complications (RR: 0.48, 95% CI 0.13–2.58; P = 0.39). Conclusion: The results of the present meta-analysis and systematic review indicated that PCD and PNA can be less safe and less invasive methods for the treatment of hepatic abscesses yet PCD is suggested to be more advantageous and superior to PNA.

Background: Cardiovascular disease (CVD) is a cluster of diseases that involve heart and blood vessels (10). They also include coronary heart disease (CHD), coronary artery disease (CAD), and acute coronary syndrome (ACS). This paper aimed at measuring the quality of life after coronary artery bypass graft procedure and determine the factors that affect the quality of life. Methods: Data was collected via a structured close-ended questionnaire in which 100 (male and female, aged 40-60) were questioned. Patients were chosen after underwent CABG surgery 2 to5 years. Results: Carried out as good 36% for their general heath and 24% very good. The activities indicated that there was a significant difference between males and females. Moreover, female participants were significantly different from male (P. value

Background: Patients and physicians are considered primary customers of laboratory services. Therefore, assessing customer satisfaction with laboratory services is an essential indicator in improving the quality of laboratory services. Objectives: This study measures the level of satisfaction of physicians and patients who avail of the clinical laboratory and phlebotomy services, respectively, at the outpatient department (OPD) in King Abdullah Medical City (KAMC), to evaluate the possible issues and carry out corrective actions. Methods: A cross-sectional survey to evaluate the level of satisfaction using a modified patient and physician questionnaires, the patients were randomly selected and interviewed in phlebotomy areas at the outpatient and chemotherapy clinics. A paper-based questionnaire was distributed to all physicians all available physicians in KAMC who were regularly requiring laboratory investigations. The collected data were coded, entered, and checked for outliers or missing data and analyzed using the SPSS statistical package version 21. Results: A total of 435 patients were interviewed and their mean satisfaction was 4.51±0.32 out of 5. Respondents were satisfied with the Availability of laboratory tests. However, they were dissatisfied with Explanation of the phlebotomy cautions by the phlebotomist (75.4%). Twenty eight percent of physicians (132) participated, their mean satisfaction rate was 3.6±0.7 out of 5. The greatest satisfaction rate was related to critical results notification and the communication with laboratory personnel. Physicians were most dissatisfied with both specimen delivery process and incorrect test results. Conclusion: Both customers were satisfied with the laboratory service provided for them. Factors as "Explanation of the phlebotomy process by phlebotomist" and "specimen collection and delivery process" received lowest satisfaction score for patients and physicians respectively. Therefore, improving them is required to meet the needs of the customers and gain their satisfaction regarding the service.

Background: neonatal hyperbilirubinemia is a common condition in the first few days of life (1) and it can be divided into: pathological and physiological and indirect (unconjugated) and direct (conjugated) hyperbilirubinemia. Objective: This paper aimed to evaluate the effect of different types of phototherapy on serum calcium of both preterm and full-term infants with indirect hyperbilirubinemia, in either supine or prone position. Methods: data were taken from 100 newborns candidate by divided them into two groups. Blue and white light phototherapy were equally used for different infants of both groups. Results: the results showed that 31% developed hypocalcemia, 20% preterm and 11% full term infants. 38% developed hypocalcemia, where among infants who received prophylactic phototherapy 24% developed hypocalcemia. 60% of infants who received extensive phototherapy developed hypocalcemia, where 27.7% of infants who managed with single phototherapy developed hypocalcemia. Seventeen of the infants who managed in prone position and 14 infants of those who received phototherapy in supine position developed hypocalcemia. Conclusion: all in all, 19 infants developed hypocalcemia under blue light and 12 received white light phototherapy. Phototherapy induced hypocalcemia in both full term and premature infants. In addition to the common practice of monitoring the total serum bilirubin and PCV in all newborns on phototherapy, it is important to monitor the total serum calcium on daily base.

Background: Earlier studies have recommended that asthmatic patients regularly have comorbid depression; nonetheless, temporal associations remain uncertain. Objectives: To determine whether depression predicts asthma and, on the other hand, whether asthma expects depression. Methods: A literature search was conducted without language restrictions using Pubmed, Embase, Cochrane and PsycINFO for studies published before April, 2017. Papers referenced by the obtained articles were correspondingly reviewed. Only comparative prospective studies with reported risk estimates of the association between depression and asthma were included. In order to examine whether one of these conditions was predictive of the other, studies were excluded if enrolled participants had pre-existing depression or asthma. A random effects model was used to calculate the pooled risk estimates for two outcomes: depression predicting asthma and asthma predicting depression. Results: Seven citations, derived from 8 cohort studies, met our inclusion criteria. Of these, six studies reported that depression predicted incident adult-onset asthma, including 83,684 participants and 2,334 incident cases followed for 8 to 20 years. Conversely, two studies reported that asthma predicted incident depression. These studies involved 25,566 participants and 2,655 incident cases followed for 10 and 20 years, respectively. The pooled adjusted relative risks (RRs) of acquiring asthma associated with baseline depression were 1.43 (95% CI, 1.28–1.61) (P

Background: Cervical cancer is the third most common malignancy in women worldwide, and it remains a leading cause of cancer-related death for women in developing countries Aim and objectives: the aim of the paper is to assess and increase the awareness toward cancer cervix, early detection and prevention of risk factors among Saudi males and females. Materials and Methods: a cross-sectional descriptive study was carried out among 740 Saudi males and females above the age of 16 years. The participants were randomly enrolled in this study. Results: the participants 446 (60.3%) females and 294 (39.7%) males were included in the study. Majority of the participants (n= 547, 73.9%) have heard about cervical cancer but most of them didn’t know that it is a preventable disease (n= 359, 48.5%). We found that; only 17.6% of the study group has heard about HPV Vaccine. It could be attributed to low level of knowledge about the virus itself, since only 19.9% of the population knew about the virus. Conclusion: there is a great need to increase the educational standards of the society and improve the information and knowledge about this important disease to reduce the number of patients as well as raising the health status of the populations.

Objective: This review to show the degree of patient satisfaction and length of stay after laparoscopic appendectomy or open appendectomy. Moreover, the degree of appendicitis was considered either acute appendicitis or perforated appendicitis which can result in complications like sepsis, peritonitis and gangrene. Data sources: (PubMed, Google Scholar) have been searched for papers that addressed patient satisfaction and length of stay after appendectomy, preoperative appendicitis status and the operation used for appendectomy were considered during searching. Results: It was obvious that patient who have undergone laparoscopic appendectomy were more satisfied and had short length of stay after the operation neither than patients who have undergone open appendectomy who were less satisfied and had longer length of stay. Also, it was clear that patient with acute appendicitis were more satisfied with short length of stay neither than patients with perforated appendicitis who were less satisfied with longer length of stay

Background: Folate is a naturally occurring B vitamin, is needed in the brain for the synthesis of norepinephrine, serotonin, and dopamine. Thus, previous researches suggested that folate levels play an important role in the etiology and course of depression. However, the literature has been inconsistent regarding differences in folate level between individuals with and without depression. The present meta-analysis synthesized the results of previous studies to examine whether individuals with depression had lower levels of folate than individuals without depression. Aim of the Study: to assess the relationship between Depression and Folate deficiency. Methods: A review of the scientific literature (PubMed Search 1994 to 2017) Pubmed, Embase and CENTRAL were searched to identify randomized controlled trials that investigated The Correlation between Depression and Folate Deficiency as the primary outcome. Identification of papers and data extraction was performed by two independent researchers. We searched for relevant trials in the Cochrane Library, MEDLINE (from 1946), Embase (from 1974), the Transfusion Evidence Library (from 1980), and ongoing trial databases; all searches current to October 2017. Results: 8 studies were included enrolling 173000 participants; 1813 patients with depression and 15487 control subjects. Pooling of all estimates showed a significant correlation between folate status and depression (OR pooled unadjusted = 1.41; 95% CI 1.19 to 1.82), (OR pooled adjusted = 1.39; 95% CI 1.04 to 1.76). Conclusion: Low folate and B12 serum levels seem to be associated with depression Folate has been linked to depression and there is a strong body of evidence suggesting the introduction of folate supplement in the prevention and treatment of depression at the population and individual levels.

Background: headaches account for 10% of all consultations with the general practitioner, and the third leading cause of emergency department visits. The current prevalence of headache can go from 7.4% to 22.7% and may be associated with much comorbidity, and can cause significant disabilities in an individual’s quality of life. Methodology: in this paper we carried out a systematic review on 32 observational (nonrandomized) studies using PUBMED. Aim: our aim in the study is to evaluate the prevalence, associated risk factors, pathogenesis, management, and the effect on quality of life caused due to chronic headaches. Conclusion: chronic headache adds to a huge burden in overall health care system, and a very frequent general practice visit. Treatment of this type of headache is very challenging due to its chronicity as well as its risk of conversion into medication onset headache. More researches that can promise better quality of life for individuals that suffer from chronic daily headache must be done.

Infection with herpes simplex is a standout amongst the most well-sexually transmitted infections. As the infection is common in women of reproductive age it may be contracted and transmitted to the fetus amid pregnancy and the new-born. Herpes simplex virus is a significant cause of neonatal infection, which could lead to death or long-term disabilities. Infrequently in the uterus, as it happens frequently during the transmission delivery. The most serious danger of transmission to the fetus and the new-born happens in case of an early maternal infection contracted in the second half of pregnancy. The danger of transmission of maternal-fetal-neonatal herpes simplex could be diminished by applying a treatment with antiviral medicines or depending on a caesarean section in some particular cases. The aim of this paper is to provide recommendations on the management of herpes simplex infections in pregnancy and approaches to decrease perinatal transmission of herpes simplex virus.

Background: Scientific evidence has been accumulated about the health benefits of physical activity and exercise on the health of adults in the last decades. However, few studies attempted to study the physical activity profile among adults in Saudi Arabia. Thus, this study aimed to identify the physical activity profile among patients who attend family medicine clinics in Jeddah city, Saudi Arabia. Methods: The cross-sectional design with 382 patients attended family medicine clinics in King Faisal residential city clinics and King Khalid residential city clinics were surveyed using a validated structured questionnaire. The short form of IPAQ questionnaire, which was used in this study, consists of 7 items questioning physical activity, in addition to questions about time spent (minutes per day and days per week) and intensity of physical activity (moderate or vigorous). The data collected in the paper forms of questionnaire then coded and introduced into computers, and then they analyzed using the Statistical Analysis System (SAS), Version 9. Results: In the study participants, only 12.6% reported that they were highly active, 28.5% were moderately active, 17.85% lightly active, and 41.1% were inactive. A highly significant difference (P

Background: urinary tract infections (UTI) are one of the most common types of bacterial infection in patients with diabetes mellitus (DM). There are certain aspects to diabetes that makes it a risk factor for getting urinary tract infection and additionally, diabetes may also predispose to certain complications. Methodology: in this paper we aim to carry out a systematic review on observational (nonrandomized) studies on PUBMED. Aim: to evaluate the prevalence, pathogenesis, diagnosis, management and complications of UTI in patients with DM. Conclusion: the proper management of UTI in diabetics is crucial, as prompt diagnosis and correct use of antibiotics is vital for treatment. Future research in this regard will hopefully decrease the burden of UTI in diabetic patients.

In spite of being rare, fat embolism syndrome is considered a fatal complication after bone fracture and orthopedic procedures. It was suggested that early immobilization might reduce the incidence of fat embolism syndrome. However, no enough data are available to justify this finding. Objectives: The aim of this review is to determine the incidence of fat embolism among patients who had long fracture fixation. Methods: A systematic review of Medline and Cochrane library was conducted on their database. This search yielded 34 papers, 13 of which were related. Results: The incidence of fat embolism syndrome after long fracture fixation ranged from 2.7% and 11%. More specifically, the incidence among long bone fracture patients who were operated early (within the first 24 hours after injury) ranged from zero% in some studies (16,19) to 1.8% in others. As regards late operation, after 24 hour of bone fracture, the incidence of fat embolism syndrome (FES) ranged from 3.5% to 10.4. Conclusions: The incidence of fat embolism in post long fracture fixation is very low. Several research works indicate that early fixation significantly reduce the incidence of FES compared to late fixation.

Background: The lungs of particularly newborn are fragile and can be easily damaged. With injury, scarring may follow which is translated into difficult breathing and increased oxygen needs, a condition called bronchopulmonary dysplasia (BPD) or Chronic Lung Disease (CLD). Since inflammation plays an important role in the pathogenesis of CLD, corticosteroids, especially dexamethasone, have been extensively used to avert or treat CLD. Thus, several studies suggest that systemic corticosteroids decrease the duration of ventilator dependence. Aim of the Study: investigate the beneficial and harmful effects of the use of steroid in the prevention and treatment of BPD. Methods: A systematic review and meta-analysis of observational studies and randomized controlled trials was conducted. A review of the scientific literature. Pubmed, Embase and Central were searched to identify randomized controlled trials that investigated postnatal corticosteroids treatment for BPD were the primary endpoints. Identification of papers and data extraction were performed by two independent researchers. We searched for relevant trials in the Cochrane Library, MEDLINE (from 1955), Embase (from 1970), the Transfusion Evidence Library (from 1980), and ongoing trial databases; all searches current to September 2017.Results: The search yielded seven RCTs which enrolled a total of 1862 participants eligible for inclusion in the present review. There were significant beneficial outcomes such as lower rates of failure to extubate and decreased risks of chronic lung disease at both 28 days (RR 0.84, 95% CI 0.83 to 0.87) and 36 weeks' postmenstrual age (RR 0.77, 95% CI 0.72 to 0.84), death or chronic lung disease at 28 days (RR 0.9, 95% CI 0.85 to 0.96) and 36 weeks' postmenstrual age (RR 0.91, 95% CI 0.87 to 0.96). Nevertheless, there were no significant differences in the rates of neonatal mortality (RR= 1.06, 95% CI 0.93, 1.26), periventricular leukomalacia (RR 1.16, 95% CI 0.9 to 1.46), necrotizing enterocolitis or pulmonary haemorrhage (RR 1.21, 95% CI 0.83 to 1.62). In contrast, gastrointestinal bleeding (RR 2.13, 95% CI 1.41 to 2.84) and intestinal perforation (RR 1.77, 95% CI 1.46 to 2.1) were imperative adverse effects. Moreover, many adverse neurological effects were found at follow-up examinations, including developmental delay (RR 1.72, 95% CI 1.4 to 2.05) and cerebral palsy (RR 1.56, 95% CI 1.03 to 2.1). Additionally, the rates of the combined outcomes of death or cerebral palsy (1.92, 95% CI 1.18 to 2.67), or of death or major neurosensory disability (RR 1.25, 95% CI 0.98 to 1.53), were not significantly increased. In subgroup analyses by type of corticosteroid, most of the advantageous and disadvantageous effects were related chiefly to dexamethasone whilst hydrocortisone had slight effect on any of the outcomes except for an increase in intestinal perforation and a borderline reduction in patent ductus arteriosus. The overall risk for bias was low as all were RCTs using robust methods. Conclusion: despite the fact that early corticosteroid treatment can have beneficial outcome for BPD management through facilitation of extubation and decreasing the risk of chronic lung disease and patent ductus arteriosus, it ,on the other hand, results in short-term adverse effects including gastrointestinal bleeding, intestinal perforation, hyperglycaemia, hypertension, hypertrophic cardiomyopathy and growth failure. Clinicians should carefully assess the risks of a short course of glucocorticoid therapy to mitigate BPD for premature neonates such that an individualized decision should be made in conjunction with the infant's parents.

Background: There is a wide range of anatomical variations affecting the nose, paranasal sinuses (PNS) best diagnosed by Computed Tomography (CT). These variations may cause impairment of mucociliary drainage of the PNS resulting in sinusitis. Objectives: In this paper, the aim is to study the relationship of the anatomical variations of the lateral nasal wall, nasal septum and paranasal sinuses with the occurrence of chronic rhinosinusitis. Methods: The study included two groups of patients, the first has chronic rhinosinusitis while the second was without chronic rhinosinusitis. Anatomical variations of nose and paranasal sinuses which are nasal septal variations, concha bullosa, agger nasi cells, haller cells, paradoxical middle turbinatesand uncinate process variations were detected in both groups to investigate the relation between the anatomical variations and chronic rhinosinusitis. Results: A case control study was done which showed that there a significant statistical relation between nasal septal deviation and chronic rhinosinusitis. Conclusion: There was a significant relation between nasal septal deviation and chronic rhinosinusitis.

Background: Telehealth system is defined as the use of electronic information and telecommunication technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration. The main aim of this study is to assess difficulties and limitations in hospitals that have healthcare system in Jeddah ,Saudi Arabia from applied new techniques such as Telehealth and if they have tendency to use this technique or not . This study also aims to determine the association between increase in quality of healthcare system and new techniques applied such as Telehealth system by literatures reviews. Methods: A cross-sectional study was conducted in 114 medical providers who worked at hospitals in Jeddah, Saudi Arabia. The medical providers were interviewed using paper-based questionnaire as well as electric-based questionnaire, data collected and analyzed by using SPSS. Results: Interested participants in technology were high by 59%, participants actually interested to implement advanced Telehealth Technologies by percent of 84%, and respectively that factor of lack of awareness were a major factor by 90%, factor of this technique may take a new health care system and it may being a time consuming and take a lot of money and training 71%, this previous percentage and frequency also present factor of resistance in both medical social and community. 63% saw that it is hard to get someone qualified as well as 62% saw that there is a lack of human resources in hospitals and misusing factor took a percent of 50%, some of participants saw that There is no strong need for this technique and he is think it is not important or it is not differ from face to face visit by percent of 40%. Conclusion: There are a high acceptance of new technique in hospitals and regardless of demographic information there is a high interest in technology, we determine most factors that may limit implementation of this technique and these factors may give us a general look about challenges of implementing the other techniques too, if we can determine the problems then we can resolve them to achieve high quality healthcare systems in our hospitals.

Beta-Thalassemia being particularly prevalent in the Mediterranean region. Thalassemia syndromes are common in Saudi Arabia: the Beta-Thalassemia genes occur with variable frequency in different regions of Saudi Arabia and both B+ and Bo thalassemia have been reported. Over the last few years, a great deal of information regarding the clinical, molecular and management of these disorders has accumulated in the literature. This paper summarizes some of the recent studies on the subject along with experience and attempt to clarify the importance of early detection and treatment β- Thalassemia in children.

Background:Asthma, being a chronic inflammatory disease requires not only medical treatment but also complimentary healthcare, self-management strategies and interventions for the appropriate management and possible prevention of attack as well as reduction of school absences and days of restricted activity and decrease emergency room utilization. Methods:Randomized clinical trial (RCT) data reviewed for outcomes and processes associated with asthma educational and behavioral interventions provided by different types of health professionals. Thestudy group has synthesized studies that identified barriers and interventions to improve asthma symptoms and management in children through searching in MEDLINE,Cochrane EMBASE, TOXLine and CINAHL considering papers starting from 1999. Results:Physician-led interventions were most successful for outcomes related to the use of health care. Multidisciplinary teams were best in achieving symptom reduction and quality of life. Lay persons were best in achieving self-management/self-efficacy outcomes. Components most frequently employed in successful programs are skills to improve patient–clinician communication and education to enhance patient self-management. Fifty percent of interventions achieved reduction in the use of health care and one-third in symptom control. A combination approach including self-management and patient–clinician communication involving multidisciplinary team members may have the greatest effect on most outcomes. Conclusion: strong evidences suggest that the development of self-management and clinician–patient communication skills are essentially required and considered as critical factors for Asthma patients particularly children symptoms alleviation and outcomes improvement in the long term. This can be achieved by appropriate self-care, awareness programs through effectiveeducational and behavioral intervention which are crucial components associated with success across outcomes and providers.

Background: over the last two decades, only few dermatology research papers have been published in Saudi Arabia provided the small number of experts -in this field -enlisted in higher education institutions. Hence a compelling need to review the recent publications and define the current prevalence, status and interventions needed. Objective: To present an overview of the common dermatological diseases, particularly eczema and dermatitis, in Saudi community as well as their effects and ways to mitigate them. Methods: Review of Randomized Controlled Trials (RCTs) researches conducted and published in Saudi Arabia. Results: Empirical findings revealed that Acne, Eczema and Psoriasis are the most common dermatological disorders among the Saudi community while Atopic Dermatitis was the most common mostly affecting children. In the meantime, Vitiligo emerged to be the most rampant pigmentary ailment, also viral warts appeared predominant covering up to 12% of the patients in the subject. On the other hand, dermatophytoses occurred commonly among the fungal conditions, while psoriasis arose as the most recurrent papulosquamous condition. Conclusion: The prevalence of dermatological disorders in Saudi Arabia is rather high with the issue being overlooked and deprioritized in favor of graver pathological conditions despite the significant social, psychological and quality of life impact on the patients. Thus, we recommended that proper education and awareness campaigns on skin diseases should be provided at all academic and social levels as one way of prevention and alleviation of skin diseased in Saudi Arabia.

Background: young females in Egypt still face a number of challenges regarding their reproductive health (RH) despite efforts to enhance it. Importance of young women’s reproductive choices arises from the concept that early childbearing can impair their health and their productive participation in community. Aim: the paper aimed to explore the key determinant of the contraceptive (CC) use amongst young married females in Egypt using the 2008 and 2014 Egypt Demographic and Health Survey (EDHS) with a comprehensive look at the CC use changes occurred in the study period 2008-2014. Subjects and Methods: data from the 2008 and 2014 EDHS were secondary analyzed. Variables were selected to assess their effect on CC use. Multivariable regression analyses were performed. Odds ratio was computed. Results: overall contraceptive prevalence (CP) decreased from 53.7% in 2008 to 51.2% in 2014. Traditional methods were responsible for this decrease. Younger age, being from rural Upper Egypt, husband desire for more children, no visit to health facility were the most important risk factors for not using any CC method among Egyptian young married females in 2008. Added to these factors; low women autonomy, no exposure to family planning message, in the poster and women justifying husband violence in 2014. However, region lost its significance as a determinant in 2014. Conclusions: our results discovered the determinants that modulate the CC use behavior among Egyptian young married females.