Herpes zoster on the forehead masquerading as an abscess complication to look out for: a case report

Herpes zoster or shingles is caused by the reactivation of latent varicella zoster virus (VZV) infection within the sensory ganglia. Primary VZV infection results in varicella (chickenpox) usually in childhood, characterized by vesicular lesions on the face, trunk, and extremities. Although herpes zoster can occur at any age, it is mainly a disease of adults over age 50 and/or immunocompromised individuals. Complications of herpes zoster include post herpetic neuralgia, herpes zoster ophthalmic us and less commonly acute retinal necrosis, aseptic meningitis, and encephalitis. Here we present the case of a 51-year-old female patient with Herpes Zoster infection involving the dermatome on the forehead, initially misdiagnosed, to alert clinicians to create awareness and minimize misdiagnosis of other patients with similar cases. It is unusual to find patients presenting with infection involving the dermatome of the forehead.

Estimation of insulin resistance in non-diabetic normotensive Saudi adults by QUICKI, HOMA-IR and modified QUICKI: a comparative study

Identification of insulin resistance [IR] in the general population is important for developing strategies to reduce the prevalence of non-insulin-dependent diabetes mellitus [NIDDM]. We used the original and a modified version of the Quantitative Insulin Sensitivity Check Index [QUICKI, M-QUICKI], and the Homeostasis Model Assessment of Insulin Resistance [HOMA-IR] to divide non-diabetic normotensive adults into high-[HIR] and low-insulin-resistant [LIR] subgroups to investigate similarities and differences in their characteristics. Three hundred fifty-seven healthy adults aged 18-50 years were recruited randomly from health centers in Jeddah in a cross-sectional study design. Anthropometric and demographic information was taken. Insulin, glucose, lipid profile and free fatty acid were determined in fasting blood samples. M-QUICKI, HOMA-IR and QUICKI were calculated. Reported cut-off points were used to identify HIR subjects, who were then matched for age and sex to others in the study population, resulting in 3 HIR and 3 LIR subgroups. Two hundred nine subjects satisfied the selection criteria. M-QUICKI correlated significantly [P=.01] with HOMA-IR and QUICKI values. Increased adiposity was the common characteristic of the three HIR subgroups. HIR subgroups identified using M-QUICKI [97 subjects] and HOMA [25 subjects], but not QUICKI [135 subjects], had statistically different biochemical characteristics compared to corresponding LIR sub-groups. Adiposity, but not sex, is a risk factor for IR in the studied population. Further studies are needed to choose the most appropriate index for detecting IR in community-based surveys

Causes of hospitalization of pilgrims during the Hajj period of the islamic year 1423 [2003]

Approximately 2 to 3 million pilgrims perform Hajj every year. Planning for health care requires knowledge of the pattern of diseases, complications, and outcome of pilgrims who require hospitalization during the Hajj period. In a cross-sectional study we compiled data on all patients admitted to 1487 beds in four hospitals in Mena [793 beds] and three hospitals in Arafat [694 beds] from the seventh to the thirteenth day of the Hajj season of the Islamic year 1423, corresponding to 8 to 14 February 2003. Of 808 patients hospitalized, most [79%] were older than 40 years. There was no sex preponderance. A total of 575 [71.2%] patients were admitted to medical wards, 105 [13.0%] to surgical wards, and 76 [9.4%] to intensive care units. Most patients [84.8%] had one acute medical problem. Pneumonia [19.7%], ischemic heart disease [12.3%], and trauma [9.4%] were the most common admitting diagnoses. More than one third [39%] had co-morbid conditions. A total of 644 [79.7%] patients were discharged from the hospital in stable condition to continue therapy in their residential camps, 140 [17.3%] were transferred to other hospitals in Makkah for specialized services or further care, 19 [2.3%] were discharged against medical advice, and 5 [0.7%] patients died. This study provided information on the most common causes of hospitalization, pattern of diseases, and required medical services for pilgrims in Hajj. It is hoped that this data will be of help to health sector planners and officials to provide optimal and cost-effective health care services to pilgrims in Hajj

Protective effect of preconditioning on hepatic ischemia-reperfusion injury in a rat model

Introduction: Ischemia and reperfusion [I/R] injury is a common complex inflammatory phenomenon encountered in medical practices. The initial site of abnormality in ischemia has recently emphasized on the cellular mitochondria. The damage is dramatically magnified by large number of events, such as oxygen free radical formation, release of iron storage, damage of the microvasculature of [I/R] organs, inflammatory cytokines, complement activation and neutrophil infiltration of the site of injury

Aim of the Work: To determine which is more injurious to liver tissue, ischemia or reperfusion? and to investigate the protective effect of ascorbic acid, DDB* and Silymarin preconditioning on [l/R] injury in a rat model

Materials and Methods: eighty rats were exposed to different periods of [l/R] injury with total time of 60 minutes, They were divided equally into 4 groups. One of them was used as a control group while the others were exposed to 10; 20 and 30 minutes ischemia respectively. Each group was subdivided into 4 subgroups which were preconditioned with either no medication, Ascorbic acid, DDB or Silymarin respectively. Blood samples were taken twice, after the periods of ischemia and reperfusion where serum levels of malondialdehyde [MDA], ALT, AST and LDH were determined. Liver biopsy also, was taken twice, after ischemia and after reperfusion, for histopathological study

Results: The pathological results showed that [I/R] injury was time related. In short periods of ischemia [10 min and 20 min] the pathological changes improved during the reperfusion periods while in longer duration of ischemia [30 min] the pathological changes were irreversible and even worsen during the reperfusion period. Preconditioning with Ascorbic acid, DDB and Silymarin minimize the pathological changes in all periods of ischemia when compared with the corresponding non-treated groups. The best results were detected with Ascorbic acid subgroup then DDB. The laboratory results showed that serum levels of MDA. ALT, AST and LDH were greater in the post reperfusion samples than that of the post-ischemic samples and were time-related. Preconditioning decreased the serum levels of MDA, ALT. AST and LDH in all groups after exposure to [I/R] as compared with non-treated group, but not to the significant level. The best results were detected with Ascorbic acid subgroup then DDB

Conclusion: The reperfusion plays the main rule in hepatic [I/R] injury. Preconditioning with Ascorbic acid, DDB or Silymarin attenuated the hepatic [I/H] injury. However, Ascorbic acid showed the best results, then DDB while Silymarin was the last. *DDB. Chinese herbal therapy used as a hepato-protective

Significance of serum hyaluronic acid in assessment of chronic liver diseases and hepatocellular carcinoma

Introduction: Hyaluronic acid [HA] is produced mainly in fibroblasts specially in synovial tissue, and part of the produced HA enters the general circulation via the lymphatic system and is rapidly cleared and degraded almost exclusively in the liver, by a very efficient and specific receptor mechanism in sinusoidal endothelial cells [SEC]. The serum level of HA increases if its production is increased [inflammation of synovial membranes] or its clearance is decreased [impaired liver function]

Aim of the work: To determine the value of serum level of Hyaluronic acid in assessment of chronic liver diseases and Hepatocellular carcinoma

Patients and Methods: This study included 90 patients, divided into 3 groups: - Group 1: 60 patients had chronic liver diseases with various etiology with no malignancy. -Group 2: 20 patients had HCC. -Group 3: 10 patients with no liver disease as a control group. The group of chronic liver disease was subdivided into 3 subgroups, according to Child-Pugh [CP] classification, [A, B, and C]. Serum Hyaluronic acid [HA] was determined for all the studied cases at the time of examination and once more for HCC group, 2 weeks after surgical resection or tumor ablation

Results: Serum[S]. hyaluronic acid was significantly higher in the group of chronic liver disease and its subgroups [Child-Pugh A, B and C subgroups] than in the control group. There was direct proportion between the serum level of HA and the severity of the chronic liver disease. Pre-operatively, the serum level of HA in HCC cases was increased significantly, as compared to the control group. Postoperatively, the s. level of HA was decreased but insignificantly

Conclusion: The serum Hyaluronic acid [HA] concentration reflects the extent of liver fibrosis and severity of cirrhosis. HA could be used as a non-invasive marker for assessment of chronic liver disease, where its serum level was seen to correlate positively with the advancement of the liver disease. Its value in HCC cases was insignificant, where it has no diagnostic or prognostic value, and the serum level of HA in these cases reflects the underlying liver disease

Acute viral hepatitis in Egyptian pregnant women; natural history

Seventy-three pregnant women with acute hepatitis were selected for this study. All cases were subjected to history taking, obstetric status, clinical and abdominal ultrasonography examinations. Out of these cases, 61 patients agreed to participate in this study. The commonest symptoms and signs were jaundice, urine darkness, anorexia, abdominal pain, fever, diarrhea, hepatomegaly and splenomegaly. Fulminant hepatitis was found in seven cases. Serum bilirubin and transaminases were about 3-5 fold above the normal level. Two deaths, three were still birth and five premature labor were the mean complications and the normal labor was 82.2%. A benign clinical course was given in 88.7% and the mortality rate was 3.2%. There was no specific clinical course indicated to a specific virus infection. Pregnancy did not aggravate the course of acute viral hepatitis, but the viral hepatitis could complicate the pregnancy course

prevalence of asymptomatic gallbladder stones in patients with diabetes mellitus

To study the prevalence of asymptomatic gallstones in patients with diabetes mellitus [DM] and to determine the risk factors for the occurrence of asymptomatic gallstones among diabetics. In a cross-sectional study design, 511 patients [294 with DM and 217 without DM] were ultrasonically screened for the presence or absence of asymptomatic gallbladder stones and information on risk factors was obtained. The prevalence of asymptomatic gallstones among patients with diabetes mellitus was 11.9% compared to 3.2% among non-diabetics [p<0.001]. Among diabetics increasing age and female gender were found to be risk factors for developing gallbladder stones. Diabetes mellitus per se is a risk factor for the development of gallbladder stones in Saudi patients

Thyroid cancer in the Eastern region of Saudi Arabia a population-based study [1987-1988]

No population-based data on thyroid cancer exist in Saudi Arabia. This is the first population-based study describing thyroid cancer incidence in the Eastern Region. Population-based data on cancer during 1987 and 1988 was obtained from all health facilities in the eastern region. Population census for 1988 was made available. Data on cancer death were obtained from death registries. Data on thyroid cancer were expressed in terms of: relative frequency rate, crude incidence rate, age specific incidence rate, age standardized incidence rate adjusted to the standard world population, and relative age standardized incidence rate. Sixty-seven cases of thyroid cancer were registered in 1987 and 1988. Relative frequency rate of thyroid cancer among Saudi females, 7.1%, was significantly higher than among Saudi males, 1.3%. Mean age of Saudi females in years, 40.1, was significantly lower than that of Saudi males, 61.1. Age standardized incidence rate/100,000 population per year in Saudi females, 5.6, was significantly higher than that in Saudi males, 1.8, and occupied the 23rd highest rank on the international scale. Saudi males and females relative age standardized incidence rates occupied, respectively, the eleventh and sixth highest ranks on the international scale. Thyroid cancer in the Eastern Region of Saudi Arabia has a high relative frequency rate, age standardized incidence rate and relative age standardized incidence rate, particularly for females

Cancer in the eastern region of Saudi Arabia: a population-based study [1987-1988]

This study presents the findings of the first population-based tumor registry in the Eastern region [ER]. Data on all cancer sites, in 1987 and 1988, were captured from all health facilities in the ER. A regional population census was obtained from regional health authorities. Cancer deaths obtained from death registries. Age-specific rate, crude incidence rate [CIR], age-standardized incidence rate [ASR] and relative age-standardized incidence rate [%ASR] were compared with available population-based data from 137 tumor registries. 1559 primary cancer cases were captured. The CIR and ASR/100, 000/year for cancer among Saudi males were respectively 59.8 and 125.7. The corresponding rates Saudi females were 43.6% and 95.5. These rates rank very low on the international scale. Cancer sites with the highest%ASR among Saudi males were lung, lymphomas, leukemias, urinary bladder and tumors of uncertain primary. For Saudi females, these sites were breast, leukemias, tumors of brain and nervous system, thyroid and tumors of unceration primary. Lung cancer was the leading cause of death from cancer among Saudi males. The first regional population-based cancer registry in Saudi Arabia was established in 1987. The overall cancer ASR in the ER is low. The leading cancer sites with the highest%ASR are in Saudi males and breast in Saudi females

Lung cancer in the eastern region of Saudi Arabia: a population-based study

There are no population-based studies on cancer in Saudi Arabia, where lung cancer is readily emerging as a common cancer-related death. This work is aimed at describing the incidence of lung cancer in the population of the Eastern Region of Saudi Arabia. A population-based tumor registry was established in 1987. Data on all cancer sites were captured from all 22 hospitals in the Eastern Region. The population census for 1988 was derived from a door-to-door survey. Relative frequency rates were used to compare our data with nationally reported data derived from hospital-based registries. Crude incidence rates, age-specific incidence rates, age-standardized rates adjusted to the world standard population, and relative age-standardized rates were used for international comparisons. A total of 107 cases of primary lung cancer were registered in 1987 and 1988. Saudis constituted 80% of these cases. The observed overall relative frequency rate of 6.9% was the highest in Saudi Arabia. Similarly, the relative frequency rates among males of all nationalities [9.8%], Saudi males [10.7%], and Saudi males registered from the Dhahran Health Center [15%] were higher than those reported in other regions in Saudi Arabia. The relative frequency rate among Saudi females registered from the Dhahran Health Center [7.3%] was significantly higher than that from other regions in Saudi Arabia. Among Saudi males, lung cancer was the leading cause of cancer death [25.6%], and the second cause [9.7%] among Saudi females in the Eastern Region. The crude incidence rate of lung cancer per 100,000 population per year was 6.5 for Saudi males and 1.3 for Saudi females. The age-standardized rates per 100,000 population per year were 16.5 for Saudi males and 4.0 for Saudi females. Among Saudi males, cancer of the lung was the leading cause of morbidity and mortality from cancer of all sites. The relative frequency rate of lung cancer has increased among cancer patients from Saudi ARAMCO's Dhahran Health Center during the past 40 years. This is attributed to an increased number of tobacco smokers and increased environmental pollutants from industry and gasoline-driven vehicles. The crude incidence rate and age-standardized rate of lung cancer in the Eastern Region are very low compared with those reported from developed countries. This can be explained by the young Saudi population in the eastern region and the relatively recent history of cigarette smoking and industrialization in Saudi Arabia. A plea is made for a smoke-free society and a cleaner environment to prevent the incoming creeping epidemic of lung cancer

Health profile of Balhareth Area in Taif region

To describe demographic, socio-economic, environmental factors and general health status of one of the rural and semi-urban areas around Taif city at the western province of the Kingdom. Methodology: A cross sectional multipurpose survey for 2 weeks composed of household and school surveys using questionnaires, anthropometric measurements and physical and dental examinations. 340 houses and 14 schools were surveyed. A higher percentage of young age population was found. Findings indicated a high illiteracy rate especially among females. Environmental status of the area was not optimum with a need for better services. Maternal data indicated a high fertility rate with high rate of unattended deliveries. Breast feeding was a common practice and children pattern of feeding was satisfactory. School survey revealed a lower weight and height compared to NCHS population and a high rate of dental caries. The area was not underprivileged and did not show specific endemic disease pattern. Improvements in the areas of sanitation, female education and school dental education is recommended based on the findings

Standards of forced spirometric tests in normal Saudi males aged 12-16 years

The accurate assessment of various lung functions is basic to the care of children, adolescents and adults exposed to occupational lung hazards, or having asthma. What is required is the availability of standards of normal lung function measurements for those being evaluated. Subjects and Methods: Measurements of commonly performed spirometric lung function tests were evaluated in 404 healthy Saudi children and young adults aged 12-26 years. Data for FVC, FEV 1.0, PEFR, V max50% and V max25% and other flow rate indices support the need for ethnically specific standards of normal and Recommendations: The present study provides normal values for PEFR/FVC and V max50 /FVC and other lung function flow rates. Prediction equations are provided for calculating the standard norm of spirometric tests for the first time in Saudi children and young adults

Treatment of lead poisoning by S-adenosyl-L-methionine

Lead poisoning remains a major public health problem. It induces many biochemical and histopathological changes that affect many organs. The effect of S-Adenosyl-L-Methionine [SAMe] administration on the management of lead toxicity was investigated. Rats with either acute or chronic lead intoxication were treated with S.C. injection of SAMe [30 mg/kg body weight] daily over a period of 2 days. The beneficial effects of SAMe were evaluated by a comparison between the treated and non-treated animals using different biochemical and histopathological paramenters. Results obtained from both acute and chronic poisoning were in similar pattern