Saeed Abu-Eshy

Acute abdomen in pregnancy

Objective: To calculate the frequency of acute abdomen in pregnancy due to non‐obstetric causes in a Saudi population, to discuss the etiology of the high incidence, to discuss how pregnancy altered the symptomatology of acute abdomen and to evaluate the result of early surgical intervention and use of tocolytics on maternal and fetal health. Design: Retrospective analytic study of all cases of acute abdomen in pregnancy admitted between 1/1/1991 and 31/12/1993 to evaluate the result of early surgical intervention and use of tocolytics. Setting: The surgical wards of Asir Central Hospital, Abha, Saudi Arabia. Subjects: Sixty pregnant Saudi females who were admitted because of acute abdomen due to non‐obstetric causes. Results: The frequency of acute abdomen in pregnancy due to non‐obstetric causes in this population is 0.39% which is high in comparison to other studies and the etiology is multifactorial. Resemblance of early acute abdomen symptoms like nausea, vomiting to those of normal pregnancy and the anatomical displacement of abdominal organs by the pregnant uterus greatly masked the clinical picture and enhanced surgical delay awaiting definitive criteria for surgical intervention. This delay significantly increased maternal morbidity (P<0.05) and resulted in a poor fetal outcome. Those who had early surgical intervention had a better perinatal outcome (P<0.001) and decreased maternal morbidity (P<0.05). Although tocolytics were used, they proved to be ineffective, altered the maternal clinical picture and had fetal side‐effects. Conclusion: There is a higher incidence of acute abdomen in pregnancy and although pregnancy blunted the clinical picture, early surgical intervention resulted in a better perinatal outcome and decreased maternal morbidity. Tocolytics had their side effects and did not improve the fetal outcome.

Circulating levels of cytokines and soluble cytokine receptors in various T‐cell malignancies

Background. Cytokines, interleukin (IL)‐4, IL‐6, interferon‐gamma (IFN‐γ), tumor necrosis factor‐alpha (TNF‐α), soluble CD23 (sCD23), and soluble IL‐2 receptors (sIL‐2R) are mediators of inflammation and immune response. Alterations in immune status of patients with various cancers may result in release of cytokines in circulation. The authors measured the circulating levels of IL‐4, IL‐6, IFN‐γ TNF‐α, sCD23, and sIL‐2R from patients with T‐cell chronic lymphocytic leukemia (T‐CLL), T‐cell acute lymphoblastic leukemia (T‐ALL) and peripheral T‐cell lymphoma (PTCL) to determine their importance in these T‐cell disorders.

Seroprevalence of hepatitis B and C virus infections among health students and health care workers in the Najran region, southwestern Saudi Arabia: The need for national guidelines for health students

BackgroundThe objectives of the study were to study the seroprevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among health college students (HS) and health care workers (HCWs) in the Najran Region of south-western Saudi Arabia and to study the students’ knowledge of occupational exposure to blood-borne viral infections.MethodsA cross-sectional study of a representative sample of 300 HS and 300 HCWs was conducted.ResultsAn overall seroprevalence of HBV of 1.7% and 8.7% was found among HS and HCWs, respectively. Two-thirds of HS (66.7%, 200) and 23.3% (70) of HCWs lack anti-HBs and are susceptible to HBV infection. An overall seroprevalence of HCV of 0% and 0.3% was found among the HS and HCWs, respectively. The present study indicates poor knowledge among HS and moderate knowledge among HCWs regarding occupationally transmitted blood-borne diseases, safe injection practices, and standard precautions to prevent occupationally transmitted blood-borne infections.ConclusionIt is mandatory to develop a structured program to raise awareness among HS, and current health colleges’ curricula should be upgraded to address these issues early. The HS should be considered new recruits to health services in terms of their initial screening for blood-borne infections and vaccination against HBV. The development of a novel continuing medical education and pre-employment awareness program for HCWs is recommended to address the following: blood-borne diseases transmitted occupationally, standard precautions to prevent occupationally transmitted blood borne infections, and safe injection practices.

Iodine-deficiency disorders in the Aseer region, south-western Saudi Arabia: 20 years after the national survey and universal salt iodization.

OBJECTIVE To study (i) the current prevalence of iodine-deficiency disorders among schoolchildren in south-western Saudi Arabia after universal salt iodization and (ii) the iodine content of table salts and water. DESIGN Cross-sectional study on a stratified proportional allocation sample of children. Thyroid gland enlargement was assessed clinically and by ultrasound scanning. Urine, table salt and water samples were taken to measure iodine content. Settings The Aseer region, south-western Saudi Arabia. SUBJECTS Schoolchildren aged 8-10 years. RESULTS The study included 3046 schoolchildren. The total goitre rate amounted to 24·0 %. Prevalence of enlarged thyroid by ultrasound was 22·7 %. The median urinary iodine concentration of the study sample amounted to 17·0 µg/l. The iodine content of table salt ranged from 0 to 112 mg/kg; 22·5 % of the table salt samples were below the recommended iodine content (15 mg/kg) set by WHO. The total goitre rate increased significantly from 19·8 % among children using table salt with iodine content ≥15 mg/kg to reach 48·5 % among children using table salt with 0 mg iodine/kg. Analysis of water samples taken from schools showed that the majority of water samples (78·8 %) had an iodine content of 0 µg/l. CONCLUSIONS The study documented that 18 years after the national study, and after more than a decade of universal salt iodization in Saudi Arabia, the problem of iodine-deficiency disorders is still endemic in the Aseer region. Efforts should focus on fostering advocacy and communication and ensuring the availability of adequately iodized salt.

Is surgical intervention in acute cholecystitis in pregnancy justified

Over a three-year period 49 cases were admitted to our hospital with an acute abdomen in pregnancy due to cholecystitis. In this article we compare surgical treatment with medical treatment and consider the aetiology of the high prevalence. Out of the 49 cases admitted, 15 cases (31%) had emergency cholecystectomy within the first week and 34 cases (69%) were treated conservatively of whom 24 relapsed many times and had to be readmitted to the hospital (mean number of admissions was 4 +/- 1.4 and the mean hospital stay was 8 +/- 2.3 days) and of the remaining 10 on conservative management, three had emergency cholecystectomy and seven reached term safely. The maternal morbidity is significantly less in the surgically treated group (P < 0.0001) but the perinatal outcome failed to show any significant difference. The frequency of acute cholecystitis in pregnancy (0.33%) is high in comparison with other studies. Although tocolytics were used in 13 cases they did not improve the fetal outcome significantly and had maternal and fetal side effects. In conclusion early surgical intervention is recommended and the use of tocolytics did not improve the perinatal outcome.

Peripheral T‐cell lymphomas. Immunoregulatory cytokine (interleukin‐2, interleukin‐4, and interferon‐gamma) abnormalities and autologous mixed lymphocyte reaction

Background. Cytokines are the most important secretions of the immune system and have a wide range of immunoregulatory functions in various immune disorders and T‐cell malignancy. The authors have determined that characteristic enhanced autologous mixed lymphocyte reaction (AMLR) of the lymph node‐derived malignant T‐cells from peripheral T‐cell lymphomas is a function of the T‐cell derived cytokines interleukin (IL) 2, IL‐4, and interferon‐gamma (IFN‐τ).

Regulation of interleukin-4 production and cytokine-induced growth potential in peripheral T-cell non-Hodgkin's lymphomas

The malignant cells in tumour tissues produce cytokines/growth factors that may influence tumour growth, tumour immunogenicity and host immune response. We demonstrate that lymph node cell (LNC) purified neoplastic T cells from CD4+ peripheral T‐cell lymphoma (CD4+ PTCL) and CD8+ PTCL spontaneously, and after stimulation with anti‐CD3, secreted high amounts of interleukin‐4 (IL‐4) as compared to LNC‐purified CD4+ and CD8+ non‐malignant T cells. Furthermore, IL‐4 was observed to be the most potent cytokine that induced in vitro proliferation and growth of the malignant T cells. Moreover, malignant T‐cell‐derived IL‐4 secretion was augmented by exogeneous recombinant human interferon‐gamma (IFN‐γ) and was profoundly inhibited by IL‐2. Because IL‐4 was shown to be a locally active cytokine with a wide range of immunoregulatory properties, regulation of IL‐4 production by IFN‐γ and IL‐2 in malignant T cells may be one of the important parameters to be assessed in the design of anticancer‐specific immunotherapy. In summary, we report that malignant T cells produce IL‐4, a type 2 cytokine (Th2 cell response) that acts as a growth factor and which may play a critical role in PTCL disease mechanism.

Surgical audit: A prospective study of the morbidity and mortality of acute appendicitis.

Between March and September 1989, acute apendicitis was clinically diagnosed in 317 patients who were studied as part of a prospective surgical audit. The study was designed to determine the accuracy of diagnosis, comparison of the macroscopic appearance of the appendix at operation, and subsequent histopathology and complications associated with the morbidity and mortality of emergency appendectomy. The clinical diagnosis was correct in 278 patients (88%). Thirty-nine (12%) of the patients had a negative laparotomy. There was no mortality, and wound infection was the source of increased morbidity in 37 (12%) patients. The highest incidence of wound infection was among those who had pus in the peritoneum (20%) or had a perforated or gangrenous appendix (25%). When the macroscopic appearance of the appendix was compared with the subsequent histopathological findings, a false positive error of 7% and a false negative error of 42% was found. During appendectomy the gross appearance of the appendix must be carefully noted so that a meticulous surgical technique can be complemented by appropriate antibiotic prophylaxis against wound infection, started at the time of surgery.

Development of Medical Education in Saudi Arabia

This chapter examines in detail the provision of medical education in Saudi medical colleges, including an emphasis on the processes being enacted to ensure that the quality of medical training is of world-class standard. The Saudi medical colleges have adopted most of the current global trends in medical education, including the integrated and problem-based learning systems. Much more, however, needs to be done to strike a balance between basic scientific knowledge and professional practice.

Topical ampicillin for prophylaxis against wound infection in acute appendicitis.

A total of 249 patients, undergoing appendectomy for acute appendicitis, were prospectively randomized into two groups. Group I, comprising 132 patients, received sterile normal saline irrigation to the surgical wound at closure. Alternatively, Group II included 117 patients, who received intraoperative topical ampicillin irrigation of the wound. Both groups were comparable with regard to age, sex, duration of symptoms, and severity of appendicitis. All patients additionally received preoperative systemic gentamicin and Flagyl. Wound infection occurred in 5.3% of Group I compared to only 0.9% of Group II (P<0.05). The reduction in infection rate was significant (P<0.05) in histologically proven appendicitis. We conclude that the addition of intraoperative topical ampicillin to systemic gentamicin and Flagyl augments prophylaxis against wound infection in acute appendicitis.