Ibrahim Al-Habdan

Ultrasonography: Can It Differentiate Between Vasoocclusive Crisis and Acute Osteomyelitis in Sickle Cell Disease?

We prospectively evaluated the results of ultrasonography in 53 patients of sickle cell disease suspected to have vasoocclusive crisis/acute hematogenous osteomyelitis. The average age was 8.4 +/- 3.40 years (range, 1-14). Twenty-six children were boys and 27 were girls. Seventeen (32%) patients had ultrasonographic changes that suggested acute osteomyelitis. The minimal white cell count was 7,200/mm3, and maximal, 9,900/mm3 (mean, 8,190/mm3) in uninfected patients and in 17 patients, the mean was 10,300/mm3 (7,200-13,600/mm3). The mean erythrocyte sedimentation rate in uninfected patients was 32 for the first hour (19-36 mm), and in infected patients, it was 43 for the first hour (35-38 mm). Pus culture was positive in all infected patients, and the infective organism was Salmonella enteriditis in eight, staphylococcal species in six (S. aureus in four and S. epidermidis in two), and Streptococcus species 1 and 2, anaerobic streptococci. All patients with vasoocclusive crisis were treated with analgesics and intravenous fluids and did not require any further treatment. In patients with acute osteomyelitis, the treatment was incision, drainage and drilling of bone, and antibiotic therapy. We conclude that ultrasonography clearly and decisively differentiated acute osteomyelitis from vasoocclusive crisis in patients with sickle cell disease.

Bone mineral density measurements of distal radius in Saudi Arabian females.

A survey using Gammadensit x-ray bone mineralometer was conducted on 150 Saudi Arabian postmenopausal (PM) females and on another group of 150 females of menstruating age of around 30 years as the group with peak bone mass (PBM). The minimum age in the PM group was 44 years and maximum was 71 years (mean 54.08 years), SD +/- 7.02, whereas for the PBM group, the mean age was 29.15 years (range 24 to 33). The bone mineral density (BMD) for the PM group was 0.310 g/cm(2) minimum and the maximum ws 0.546 g/cm(2) (mean 0.440 g/cm(2)). In the PBM group, the mean BMD was 0.660 g/cm(2). Compared to Western females, the PM group BMD was 21% lower and the Saudi PBM group was 29% higher than in Western females of the same age and sex. The BMD of rural Saudi females was 0.479 g/cm(2) as compared to 0.359 g/cm(2) in the urban population. In females who had borne more than 10 children, the BMD was 0.483 g/cm(2), and was 0.354 g/cm(2) in females who had fewer than five children. There was no statistical significance in rural versus urban and </= 5 versus >/= 10 children (P value was <0.18 and <0.13). This study concludes that BMD of the PM Saudi females is lower than that of the Western females of the same age, making them more osteoporotic with a higher risk of osteoporotic-related fractures.

An epidemiological analysis of the incidence of osteoporosis and osteoporosis-related fractures among the Saudi Arabian population.

BACKGROUND AND OBJECTIVES Osteoporosis is common in Saudi Arabia and the burden of management in an aging population will increase in coming decades. There is still no national policy nor consensus on screening for this silent disease. The objective of this analysis was to determine from the published data the prevalence of osteopenia and osteoporosis in Saudi Arabians, the prevalence of secondary osteoporosis, and the prevalence of osteoporosis-related fractures (ORF). We also sought to determine the best age to begin and best modality for screening. METHODS Data Sources were MEDLINE (1966 to May 2011), EMBASE (1991 to May 2011), the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (1952 to May 2011), and the Science Citation Index (1966 to May 2011), published data from the Saudi Medical Journal (1985–2011) and Annals of Saudi Medicine (1985–2011). We selected English-language articles with at least 100 Saudi individuals. Two authors independently reviewed articles and abstracted data. RESULTS The authors identified 36 potentially relevant articles, of which 24 met the inclusion criteria. Of 5160 healthy women 50 to 79 years of age (mean, SD: 56.8 [2.7]), 36.6% (6.6%) were osteopenic and 34.0% (8.5%) were osteoporotic. In three studies on males (n=822), the prevalence of osteopenia was 46.3% and osteoporosis 30.7%. Males had a significantly higher frequency of osteopenia in comparison to females (P=<.001 95% CI<−0.0333), The mean age of the patients with secondary osteoporosis was 37.4 (13.5, 18–57) years, with the osteoporosis in 46.4% and osteopenia in 34.1%. In 5 studies of ORF, the incidence of vertebral fractures was between 20%–24%. CONCLUSION The currently available literature on Saudi Arabian population suggests that the ideal age for screening for low bone mass among the Saudi population should be earlier (55 years) than the ≥65 years in Western countries. Both quatitative ultrasound and dual-energy x-ray absorptiometry could be used for screening. The relatively small number of studies on Saudi Arabians and the different machines used for diagnosis limited the authors ability make conclusions with surety.

Efficacy of EZStep in the management of plantar fasciitis: a prospective, randomized study.

Plantar fasciitis is one of the most common causes of heel pain. Despite extensive efforts foot surgeons continue to debate the best modality of treatment. Analgesics, shoe inserts, stretching exercises, steroid injection, night splints, and extracorporeal shock wave therapy have proved effective in one group but fail in others. This study evaluated the efficacy of EZStep, a new foot brace for the management of plantar fasciitis. A total of 198 patients were randomized in 2 groups; group 1 (study group) received nonsteroidal anti-inflammatory drugs (NSAIDs; 4-6 weeks) and EZStep whereas group 2 (control group) received either NSAID and physiotherapy alone (2A) or NSAID, physiotherapy, and local steroid injection (2B). None of the patients received over-the-counter insoles or strapping of plantar arch to avoid any bias in randomization. Evaluations included measurement of weight and height, visual analog scale (VAS) for pain, and Short-Form McGill Pain Questionnaire (SFMPQ). After 8 weeks, patients were reevaluated, and assessment for the VAS and SFMPQ with treatment outcome was performed. Patients with VAS scores ≤3 were considered as excellent, ≥4 as good, and ≥7 as poor. The posttreatment evaluation showed that VAS scores were in the range from 2.97 ± 1.06 to 7.64 ± 2.9 (2A), P = .001, 95% confidence interval (CI) <−4.104; for 2B P = .001, CI <−2.44, and SFMPQ was 21.7 ± 4.5 and 69.2 ± 5.8 (group 2A; P = .001, 95% CI <−46.44). Compared with group 2B the SFMPQ was 66.5 ± 4.3 (P = .001, 95% CI <−30.720). In group 1 as per VAS, 86 (73.5%) were evaluated as excellent, 15 (12.8%) as good, and 16 (13.6%) as poor. Our study shows that the regular use of EZStep with short course of NSAIDs (4-6 weeks) was effective in ameliorating symptoms in more than 85% of patients suffering from plantar fasciitis.

Double or single gloves : Which is safer in pediatric orthopedic surgery

Background and Aim: Surgical gloves should form an efficient barrier between surgeons and patients to prevent cross infection. Single gloves (SGs) have long been reported unsafe, and usage of double gloves (DGs) is still not universal. No study has reported the usage of DGs in pediatric orthopedic operations. The aim of this study was to assess the efficacy of DGs versus SGs in prevention of body fluid contact between patients and surgeons during pediatric orthopedic surgery. Methodology: After 150 pediatric orthopedic operations, DGs and SGs were collected and tested for perforations. Gloves were tested for size, site, and number of perforations among principal surgeons, assistant surgeons, and scrub nurses. Gloves were not changed during long surgical procedures and were changed only if perforations were identified and recorded. The DGs used were Maxitex Duplex, powder-free indicator gloves and the SGs were of Gammex-Ansell. One hundred unused gloves of each group were tested as controls. Medical records of the patients were reviewed for age, sex, type of operation, duration of operation, and any postoperative wound infection. The data were entered in database and analyzed using SPSS package. The data were compared between double and SGs using t test with a level of statistical significance at P less than 0.05. Results: Five hundred twenty-six DGs and 316 SGs were tested. Forty-three perforations were detected in DGs (8.1%). Outer gloves were breached in 7.8% and inner in 0.3% as compared with SGs in which 28 (8.7%) were perforated. In DGs, 4% had multiple perforations compared with 11.9% in SGs. There was a statistical significance (P < 0.001) when the perforations of inner gloves were compared with the SGs. None of the inner perforations were recognized during surgery, but the outer gloves of the DGs were recognized in 71% as compared with 9% in SGs (P < 0.001). The majority of perforations were seen in the nondominant hand in surgeons and assistants hands, whereas scrub nurses had 85% of perforations in the dominant hand. The index finger was the site of perforations in DGs (53.4%; SGs, 43%). The inner gloves were breached only when the outer glove was found to be perforated. The duration of surgery had a direct impact on the number of perforations. There were no perforations in DGs in less than 60 minutes as compared with 3 (10.7%) in SGs. Between 60 and 120 minutes, the perforations in the DGs were 11, and in SGs, 21. During the study period, 4 patients had surgical site infection. Three were superficial and one deep-seated infection. In 3 patients with infection, the gloves were found to be perforated, and 1 patient with infection had no perforations in the gloves. Conclusion: Our study confirms that DGs are safer than SGs during pediatric orthopedic operations. In the event of nonavailability of DGs, SGs should be changed on an hourly basis during long procedures. Lastly, there exists a relationship between surgical site infection and glove perforations.

Glove perforation in pediatric orthopedic practice.

A prospective study was conducted to assess the glove perforation rate during 100 consecutive pediatric orthopedic operations. Eight hundred fifty-four gloves were tested for perforations. The overall glove perforation rate was 8.43%. Assistant surgeons had a rate of 45.8%, surgeons 33.4%, and scrub nurses 20.8%. More perforations were noticed on the left glove; the thumb and index finger were the most common sites of perforation. The duration of surgery was significantly related to the perforation rate. Two patients had postoperative wound infections and the gloves of surgeons and assistant surgeons were found to be perforated. Every attempt needs to be made to reduce the risk of glove perforation.

The role of growth factor Sadat-Habdan mesenchymal stimulating peptide in healing of burn wounds.

BackgroundBurns occur in everyday life and cause morbidity and mortality due to delayed healing. Many agents were tried to accelerate healing of burns. The aim of this study was to assess for the first time Sadat-Habdan mesenchymal stimulating peptide (SHMSP) known angiogenesis factor in healing of experimentally created burns in rats. MethodsForty male rats weighing (200–250 g) were randomly divided into 2 groups of 20 each. Under general anesthesia, reproducible, deep, partial-thickness, thermal burn injury was created by 1-cm2 aluminum template on the dorsal aspect of the body of each animal by heating the template at 80°C for 10 seconds. Alternate rats were assigned to 1 of the 2 groups to minimize the difference of timing of the burn. Sadat-Habdan mesenchymal stimulating peptide 10 mg was applied on daily burn area, covered with a nonabsorbent dressing. All animals were kept in similar standard laboratory conditions. Its application continued 14 days as described by the inventors, and burned areas were photographed. On day 15, blood was collected from the animals for serum albumin levels, and the animals were killed, then the entire burn areas were excised for biopsy for general morphology and histopathology. ResultsThere were no deaths among groups. The majority of the animals showed good to excellent healing compared with the control group. Clinical pictures revealed better healing in the SHMSP-treated group. Quantitative and qualitative analyses of images revealed significant contraction of burned areas. Image analysis showed that improved healing in the form of exaggerated fibroplasia in 19 of 20 in the study group and 11 of 20 in the control group. Regeneration of the panniculous muscle layer was observed in 19 of 20 of the study group and 5 of 20 of the control group. The mean vessel index in the study group was 53.18 ± 4.74 mm2 and in the control group 23.7 ± 6.37 mm2 (P < 0.001; confidence interval, 25.88–33.04), whereas the mean of vessel area density was 24.76 ± 7.35 versus 8.68 ± 4.04 mm2 (P < 0.001; confidence interval, 12.28–19.88) in the control group. Histopathologic analysis by hematoxylin-eosin stain, CD31, and factor VIII stains showed significant angiogenesis in the quantity and quality of the new blood vessels in the study group compared with the control group. ConclusionsSadat-Habdan mesenchymal stimulating peptide has potential of early healing of experimentally produced burns in rats. Healing was effective and better in the study group compared with the control group, in qualitative and quantitative measures.

Genetic Influence in Developmental Dysplasia of the Hip in Saudi Arabian Children Due to GDF5 Polymorphism

Developmental dysplasia of the hip (DDH) is quite common among Saudi Arabian babies. With an objective to assess the presence of SNP rs143383 and the alleles in the GDF5 gene among patients with DDH, parents, and unaffected siblings, we undertook this case-controlled study. We collected and analyzed for a functional single nucleotide polymorphism (SNP) in the 5′-untranslated region of the GDF5 gene (rs143383), 473 blood samples, (100 patients, 200 parents, 73 siblings and 100 healthy controls. We determined the association between the patients’ genotype and their fathers’, mothers’ and siblings’ genotype through Chi-square analysis. The majority of those screened possessed the TC genotype, and 61.8% of patients and their fathers had the TT genotype. There was no association between patients’ and fathers’ genotype, P value < 0.332, 95% CI (0.328–0.346), and between patients’ and mothers’, P < 0.006, 95% CI (0.004–0.007). When considering DDH patients’ and the control group’s genotypes, the odds ratios of TT versus other combined (0.641 > 1) and CC versus other combined (0.474 < 1) revealed that the TT genotype has higher risk of developing DDH compared with the CC genotype. The 95 percent confidence interval of TT versus other combined and CC versus other combined is 0.932–2.891 and 0.208–1.078, respectively. For patients’ and fathers’ genotypes, the odds ratios of TT versus other combined (1.275 > 1) and CC versus other combined (0.815 < 1) indicate that the TT genotype has higher risk of exhibiting DDH compared to the CC genotype. For patients’ and siblings’ genotypes, the odds ratios of TT versus other combined (1.669) and CC versus other combined (1.048) specify that the TT genotype possesses higher risk of developing DDH compared with the CC genotype. Our study shows that there exists a relationship between GDF5 (SNP rs143383) and DDH in our population. Second, we found for the first time that the genotype TT and the T allele were overly expressed in the patients and the fathers. More studies on the confirmation of this genetic marker for DDH are called for.

Topical Application of Sadat-Habdan Mesenchymal Stimulating Peptide (SHMSP) Accelerates Wound Healing in Diabetic Rabbits

Objective. Diminished wound healing is a common problem in diabetic patients due to diminished angiogenesis. SHMSP was found to promote angiogenesis. The present study was carried out to examine the effect of this peptide in healing of wounds in diabetic rabbits. Materials and Methods. Twenty male New Zealand rabbits were used in this study. Diabetes mellitus was induced and the rabbits were randomly divided into two equal groups: control group and peptide group. A-full thickness punch biopsy was made to create a wound of about 10 mm on the right ears of all rabbits. Every day, the wound was cleaned with saline in control groups. In the peptide group, 15 mg of SHMSP was applied after cleaning. On day 15th, all animals were sacrificed, and the wounds were excised with a rim of 5 mm of normal surrounding tissue. Histo-pathological assessment of wound healing, inflammatory cell infiltration, blood vessel proliferation, and collagen deposition was performed. Results. There were no deaths among the groups. There was significant increase in wound healing, blood vessel proliferation and collagen deposition, and significant decrease in inflammatory cell infiltration in the peptide group compared to the control group. Conclusion. Topical application of SHMSP improves wound healing in diabetic rabbits.

Fire during arthroscopy - an unusual complication

We report a case of fire during routine arthroscopy. This is an unusual but potentially disastrous complication. Recommendations are presented for preventing such an event.