Hussein M. Al-Freihi

Stroke in a Tertiary Hospital in Saudi Arabia: A Study of 372 Cases

Epidemiological studies have shown a consistent downward trend in the incidence and mortality of stroke in industrialized communities. There are however no reports on the pattern of stroke in Saudi nationals and expatriates in Saudi Arabia. The types and etiologies in 372 subjects (262 Saudis, 110 non-Saudis) are described. Males outnumbered females in the ratios of 2.2:1 and 8.2:1 for Saudis and non-Saudis, respectively. The frequency of stroke increased steadily with age until the 7th decade in Saudis but dropped sharply after the 6th in expatriates. The frequency of stroke types in Saudis was ischemic (61%), hemorrhagic (17%) and unspecified (22%) as against 46, 47, and 7% respectively in non-Saudis. Intracerebral hemorrhage was more frequent than subarachnoid hemorrhage (SAH) and was encountered more often in Saudis than in non-Saudis; SAH was 3 times more common in expatriates than in Saudis. The major predisposing factors for stroke were hypertension, diabetes mellitus, and cardiac disorders. Abnormal hemoglobinopathies, especially sickle cell anemia, were rare. The differences observed in the age and sex distribution and in the stroke pattern between Saudi nationals and expatriates most likely reflect the demographic structure existing in Saudi Arabia.

Community survey of neurological disorders in Saudi Arabia: Results of the pilot study in Agrabiah.

A pilot study of the Agrabiah area in Al-Khobar was undertaken to field test study methodologies and identify possible limitations and constraints to a planned community survey for neurological disorders in the Eastern Province of Saudi Arabia. The survey used a pre-tested questionnaire administered by trained personnel to all subjects living within 50 blocks randomly selected from the 198 inhabited ones in the area. Subjects with abnormal responses on screening were then evaluated by neurologists using specific guidelines and criteria to establish the diagnosis of neurological disease. One thousand four hundred and eighty-five subjects (98.3% of all eligible subjects) were screened: 227 (15%) had abnormal responses. Of the 202 subsequently evaluated by neurologists, 178 had definite neurological disease. The overall crude prevalence rate (PR) per 1000 population for neurological morbidity was 120.5 (95% confidence limits [CL] 103.5 to 136.5). Headache syndromes (PR 99.7, CL 83 to 114.7) were common. The other common disorders were seizures (PR 10.2, CL 5.1 to 15.3), peripheral nerve disorders (PR 2.7), and stroke (PR 2.0). Mental retardation and cerebral palsy were the main pediatric problems with PRs of 1.4 and 0.7 respectively. Our results show that a community survey for neurological disorders is feasible in Saudi Arabia and the modified questionnaire was a good screening instrument (sensitivity 94.7%, specificity 96.8%). However, the findings on the pattern and prevalence of neurological disorders need to be viewed with caution, particularly against the background of the scope of the study and the small number of subjects assessed. Cultural practices, local time and social events, and climatic conditions significantly affected community participation and the coverage achieved by the study. These factors should be considered when planning community surveys in Saudi Arabia and other environments with similar sociocultural settings.

Prevalence of hepatitis B surface antigenemia among patients with schistosoma mansoni.

This case-control study was designed to determine the prevalence of persistent hepatitis B surface antigenemia (HBsAG) among patients with schistosoma mansoni and to rationalize their vaccination against hepatitis B virus (HBV) infection. Seventy consecutive patients with a confirmed diagnosis of schistosoma mansoni were matched for age, sex, nationality, and residence (for Saudis only) with 70 healthy controls. Despite identical mean ages, sex, and nationality distribution, 18 schistosomiasis patients (26%) had positive HBsAg as compared with only three of the controls (4%). The odd ratio for HBsAg antigenemia among patients as compared to controls was 7.73 (95% confidence interval (CI) = 2-35.01, P = 0.0004. Neither sex nor nationality had any influence on the positive rate for HBsAg found in schistosomiasis patients. Patients with schistosomiasis and a concomitant positive HBsAg had significantly more derangement of their hepatic enzymes (14 out of 18; 78%) as compared with those without this viral serological marker (22 out of 52; 42%) (odd ratio - 4.77; 95% CI=1.22-20.11; P = 0.009). I have concluded that patients with schistosoma mansoni are exposed to a higher risk of acquiring HBV infection and that concomitant schistosomiasis and HBV infection has a deleterious effect on hepatic enzymes as well as other liver functions. Prospective evaluation of the preventive role of HBV vaccine among these patients is warranted.

Acute Myocardial Infarction in the Eastern Province of Saudi Arabia: Retrospective Analysis of 264 Patients

The medical records of all patients (N = 264) admitted to King Fahd Hospital with a confirmed diagnosis of acute myocardial infarction (AMI) between January 1982 and December 1987 were retrospectiv...

Evolution of the Undergraduate Curriculum at the College of Medicine, King Faisal University

The curriculum of the College of Medicine, King Faisal University, Dammam, has been subjected to vigorous and continuous evaluation since the establishment of the College in 1975. As a result, the ...

Deliberate Self-Harm in the Eastern Region of Saudi Arabia: A Hospital-Based Study

ABSTRACT This study comprises all Saudi cases of deliberate self-harm who were admitted to a university teaching hospital in the Eastern Province of the Kingdom of Saudi Arabia between 1 January 19...

COMPARISON OF INTRAVENOUS FAMOTIDINE AND RANITIDINE IN SUPPRESSING GASTRIC ACID SECRETION IN CRITICALLY ILL PATIENTS

Abstract Histamine 2 (H 2 )-receptor antagonists are administered to raise gastric pH levels and have been found to reduce the risk of stress ulceration and gastrointestinal bleeding in patients admitted to intensive care units. This study compared the efficacy of famotidine to ranitidine in raising gastric pH above 4.00 in critically ill patients. Thirty-two patients were randomly assigned to receive intravenous bolus doses of either famotidine 20 mg every 12 hours (n = 16) or ranitidine 50 mg every 8 hours (n = 16) for a minimum of 3 days and a maximum of 7 days, depending on when the nasogastric tube was removed from the patient. Gastric fluid was aspirated before the start of treatment (baseline) and six times during each 24-hour period; pH was measured using a pH meter. Baseline pH (mean ± SD) was 1.87 ± 0.42 for the famotidine group and 1.71 ± 0.31 for the ranitidine group ( P > 0.05). Famotidine elevated gastric pH to higher levels than ranitidine, reaching statistical significance ( P

Psychiatric Aspects of Diabetes Mellitus

We studied the psychiatric morbidity in 47 insulin-dependent diabetic patients who attended the Diabetic Clinic at King Fahd Hospital of the University, Al-Khobar, in eastern Saudi Arabia. Clinical...

Comparative Study of Students’ Performance at Premedical, Preclinical, and Clinical Levels in a Medical School

ABSTRACT A retrospective analysis was carried out to evaluate the performance of 942, 995, and 1911 examinees in chemistry, general pathology, and internal medicine, respectively, over a 6-year per...