http://www.saudiannals.net/currentissue.asp Table of Contents:Ann Saudi Med 2010 - 30(4) Annals of Saudi Medicine Medknow Publications0256-4947 Suhad M Bahijri Eman M Alissa Daad H Akbar Tawfik M Ghabrah Original Article Annals of Saudi Medicine 2010 30(4):257-264doi:10.4103/0256-4947.65252 Annals of Saudi Medicine 10.4103/0256-4947.65252 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=257;epage=264;aulast=Bahijri http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=257;epage=264;aulast=Bahijri304 257 264 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=257;epage=264;aulast=Bahijri Suhad M Bahijri, Eman M Alissa, Daad H Akbar, Tawfik M Ghabrah

Annals of Saudi Medicine 2010 30(4):257-264

Background and Objectives :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. Subjects and Methods : 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. Results : 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. Conclusion : 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.]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=257;epage=264;aulast=Bahijri Mohammed N Barakat Randa M Youssef Jawad A Al-Lawati Original Article Annals of Saudi Medicine 2010 30(4):265-270doi:10.4103/0256-4947.65253 Annals of Saudi Medicine 10.4103/0256-4947.65253 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=265;epage=270;aulast=Barakat http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=265;epage=270;aulast=Barakat304 265 270 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=265;epage=270;aulast=Barakat Mohammed N Barakat, Randa M Youssef, Jawad A Al-Lawati

Annals of Saudi Medicine 2010 30(4):265-270

Background and Objectives :Oman provides comprehensive care for the detection and management of diabetes during pregnancy with the goal of reducing or eliminating adverse outcomes for mothers and newborns. We assessed the outcome of pregnancies complicated with diabetes as compared to healthy controls. Subjects and Methods :A 1-year retrospective review of registry records was conducted on pregnant women with gestational diabetes mellitus (GDM) and pre-gestational diabetes mellitus (PGDM). Of the 5394 women registered, 225 had GDM and 56 had PGDM. Fourteen cases of GDM and 2 cases of PGDM were excluded. For each patient recruited, the next healthy control of the same age and parity was selected. Results : Nearly 80% of diabetic women achieved good glycemic control (hemoglobin A1c <7%). Adjusted for hypertension and body mass index, the risk of macrosomia was three times higher among women with GDM (OR=3.03, 95% CI=1.36-6.75) and up to seven times higher among those with PGDM (OR=7.20, 95% CI=2.30-22.61). A significantly higher risk of cesarean delivery was observed among women with GDM (OR=2.70, 95% CI=1.17-4.03) and PGDM (OR=4.39, 95% CI=1.68-11.49). Admission to the special care baby unit was higher among infants born to mothers with PGDM (OR=5.70, 95% CI=2.40-13.51) and GDM (OR=2.85, 95% CI=1.68-4.83). Conclusion : The findings indicate that many of the unfavorable pregnancy outcomes of diabetes for women and infants have not been brought under control despite the comprehensive care provided. Further studies are recommended to evaluate the system of care provided to pregnant women and to identify gaps in achieving the goals of the St. Vincent Declaration.]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=265;epage=270;aulast=Barakat Hissa Moammar George Cheriyan Revi Mathew Nouriya Al-Sannaa Original Article Annals of Saudi Medicine 2010 30(4):271-277doi:10.4103/0256-4947.65254 Annals of Saudi Medicine 10.4103/0256-4947.65254 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=271;epage=277;aulast=Moammar http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=271;epage=277;aulast=Moammar304 271 277 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=271;epage=277;aulast=Moammar Hissa Moammar, George Cheriyan, Revi Mathew, Nouriya Al-Sannaa

Annals of Saudi Medicine 2010 30(4):271-277

Background and Objectives :Individual inborn errors of metabolism (IEM) are rare disorders, but may not be that uncommon in our patient population. We report the incidence of IEM in a defined cohort of births at the Saudi Aramco medical facilities in the Eastern Province of Saudi Arabia over 25 years. Methods : The records of all patients diagnosed with IEM from 1 January 1983 to 31 December 2008 were reviewed and categorized according to accumulated or deficient metabolites into small-molecule disorders (aminoacidemia, organic acidopathies [OA], urea cycle defects, fatty acid oxidation, and carbohydrate metabolic disorders) and other disorders, including glycogen and lysosomal storage disorders (LSDs), and organelle disorders. Results : During the study period, 165 530 Saudi Arabian infants were born at Saudi Aramco and 248 were diagnosed with an IEM, corresponding to a cumulative incidence of 150 cases per 100 000 live births. Small-molecule disorders were diagnosed in 134/248 patients (54%). OA were the most common (48/248 patients; 19%), and methylmalonic aciduria was the most frequently observed OA (13/48 patients; 27%). LSDs were diagnosed in 74/248 patients (30%), and mucopolysaccharidosis was the most frequently observed LSD (28/74; 38%). Conclusion : We believe that our data underestimate the true incidence of IEM in the region. Regional and national newborn screening programs will provide a better estimation of the incidence of IEM. We recommend a centralized newborn screening program that employs tandem mass spectrometry.]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=271;epage=277;aulast=Moammar Ahmed M Mohamadin Fawzia A Habib Abdulrahman A Al-Saggaf Original Article Annals of Saudi Medicine 2010 30(4):278-283doi:10.4103/0256-4947.65255 Annals of Saudi Medicine 10.4103/0256-4947.65255 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=278;epage=283;aulast=Mohamadin http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=278;epage=283;aulast=Mohamadin304 278 283 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=278;epage=283;aulast=Mohamadin Ahmed M Mohamadin, Fawzia A Habib, Abdulrahman A Al-Saggaf

Annals of Saudi Medicine 2010 30(4):278-283

Background and Objectives :Polycystic ovary syndrome (PCOS) is a disorder characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovaries. Little is known about cardiovascular risk factors in patients with PCOS. We investigated plasma markers of cardiovascular disease in Saudi women with PCOS, with an emphasis on asymmetric dimethylarginine (ADMA) and total homocysteine (tHcy). Patients and Methods : Fifty Saudi women with PCOS diagnosed by the Rotterdam criteria (mean age [SD] 30.2 [3.0] years) and 40 controls without PCOS (mean age 29.3 [2.5] years) had measyrements taken of clinical, metabolic, and hormonal parameters, including plasma ADMA, tHcy, lipoprotein (a) ([Lp(a)], and serum high sensitivity C-reactive protein (hs-CRP), nitric oxid, and fibrinogen. Insulin resistance was calculated by the homeostasis model assessment (HOMA-IR). Results : Women with PCOS had significantly higher fasting insulin, HOMA-IR, and luteinizing hormone (LH) levels than healthy controls (P<.001). Lipid profile, free androgen index (FAI), ADMA, tHcy, hsCRP, and Lp(a) were significantly higher in women with PCOS compared with healthy controls (P<.001). The women with PCOS had significantly lower nitric oxide and high-density lipoprotein cholesterol (HDL-C) levels compared with healthy controls (P<.001). Conclusion : Our study revealed that Saudi women with PCOS had a significantly different levels of plasma markers of cardiovascular disease compared with normal controls. Therefore, clinicians who manage women with PCOS should follow up on these markers to reduce the risk of cardiovascular disease.]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=278;epage=283;aulast=Mohamadin Shaikha Al Arrayed Amani Al Hajeri Original Article Annals of Saudi Medicine 2010 30(4):284-288doi:10.4103/0256-4947.65256 Annals of Saudi Medicine 10.4103/0256-4947.65256 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=284;epage=288;aulast=Al http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=284;epage=288;aulast=Al304 284 288 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=284;epage=288;aulast=Al Shaikha Al Arrayed, Amani Al Hajeri

Annals of Saudi Medicine 2010 30(4):284-288

Background and Objectives : Previous studies that have assessed patient awareness of the management of sickle cell disease (SCD) indicated a lack of awareness of the disease and possibly a need for more public education. Therefore, we measured public awareness in Bahrain of SCD. Methods : The study was conducted from December 2006 to February 2007. A questionnaire was distributed among 2000 persons selected from among the general public. The participants had face-to-face interviews with either a health professional or a trained interviewer. Results : Most (93%) had heard of SCD and 89% knew that it can be diagnosed by a blood test, but 51% did not know the prevalence of SCD in Bahrain. Eighty-four percent recognized it as a hereditary disorder and 72% said that it can skip generations. Females showed better knowledge than males and married persons seems to know more about SCD than unmarried ones. Conclusion : There is a good level of knowledge about SCD among the public, though some of the respondents were confused about the difference between the carrier state of a disease and the disease itself. There is wide acceptance and appreciation of the SCD prevention campaigns being conducted in Bahrain, such as the premarital service and the student screening program.]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=284;epage=288;aulast=Al Mahmoud A Moawad Habib Bassil Mona Elsherif Abeer Ibrahim Moustafa Elnaggar Jameela Edathodu Abdulaziz Alharthi Muneerah Albugami Ahmed Sabry Mohammed Shoukri Ibtisam Bakhsh Ulrike Laudon Original Article Annals of Saudi Medicine 2010 30(4):289-294doi:10.4103/0256-4947.65259 Annals of Saudi Medicine 10.4103/0256-4947.65259 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=289;epage=294;aulast=Moawad http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=289;epage=294;aulast=Moawad304 289 294 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=289;epage=294;aulast=Moawad Mahmoud A Moawad, Habib Bassil, Mona Elsherif, Abeer Ibrahim, Moustafa Elnaggar, Jameela Edathodu, Abdulaziz Alharthi, Muneerah Albugami, Ahmed Sabry, Mohammed Shoukri, Ibtisam Bakhsh, Ulrike Laudon

Annals of Saudi Medicine 2010 30(4):289-294

Background and Objectives : Fever of unknown origin (FUO) is mainly secondary to infectious, neoplastic or inflammatory diseases. To increase the body of knowledge on this diagnosis in the region, we collected information on all patients admitted to our institution with FUO in a 13-year period. Methods : We conducted a retrospective chart review of all immunocompetent males and females aged 13 years and older admitted between January 1995 and June 2008 who fulfilled the criteria for FUO. Data collection included demographics, laboratory investigations, imaging studies, procedures and discharge diagnoses. For true FUO, we recorded the duration of follow-up and the outcome. Results : The 98 patients who met the criteria included 44 males and 54 females with a mean (SD) age of 41.3 (18.5) years and range of 14 to 85 years. The most frequent diagnostic etiology was infectious in 32 (32.7%). Seventeen (17.3%) patients were undiagnosed or had true FUO. Of 9 patients followed up, 8 recovered and 1 expired. The mean duration of follow-up was 20.6 months (range, 0-168 months). Conclusion : Infectious diseases, especially TB, continue to be the leading etiology of FUO in our area. Our data did not identify any predictor of certain FUO diagnoses except for older age and neoplastic etiology. True FUO patients generally did well. Reporting local experience is important in guiding clinicians about the epidemiologic patterns of FUO in their regions.]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=289;epage=294;aulast=Moawad Hadeel Faras Nahed Al Ateeqi Lee Tidmarsh Review Annals of Saudi Medicine 2010 30(4):295-300doi:10.4103/0256-4947.65261 Annals of Saudi Medicine 10.4103/0256-4947.65261 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=295;epage=300;aulast=Faras http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=295;epage=300;aulast=Faras304 295 300 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=295;epage=300;aulast=Faras Hadeel Faras, Nahed Al Ateeqi, Lee Tidmarsh

Annals of Saudi Medicine 2010 30(4):295-300

Pervasive developmental disorders are a group of neurodevelopmental disorders characterized by impairments in communication, reciprocal social interaction and restricted repetitive behaviors or interests. The term autism spectrum disorders (ASD) has been used to describe their variable presentation. Although the cause of these disorders is not yet known, studies strongly suggest a genetic basis with a complex mode of inheritance. More research is needed to explore environmental factors that could be contributing to the cause of these disorders. The occurrence of ASD has been increasing worldwide, with the most recent prevalence studies indicating that they are present in 6 per 1000 children. The objectives of this article are to provide physicians with relevant information needed to identify and refer children presenting with symptoms suggestive of ASDs to specialized centers early, and to make them feel comfortable in dealing with public concerns regarding controversial issues about the etiology and management of these disorders.]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=295;epage=300;aulast=Faras Ahmet Celik Vedat Davutoglu Kemal Sarica Sakip Erturhan Orhan Ozer Ibrahim Sari Mustafa Yilmaz Yasemin Baltaci Murat Akcay Behcet Al Murat Yuce Necat Yilmaz Brief Report Annals of Saudi Medicine 2010 30(4):301-305doi:10.4103/0256-4947.65264 Annals of Saudi Medicine 10.4103/0256-4947.65264 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=301;epage=305;aulast=Celik http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=301;epage=305;aulast=Celik304 301 305 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=301;epage=305;aulast=Celik Ahmet Celik, Vedat Davutoglu, Kemal Sarica, Sakip Erturhan, Orhan Ozer, Ibrahim Sari, Mustafa Yilmaz, Yasemin Baltaci, Murat Akcay, Behcet Al, Murat Yuce, Necat Yilmaz

Annals of Saudi Medicine 2010 30(4):301-305

Background and Objectives : Mitral annular calcification (MAC) is associated with osteoporosis and there is evidence of reduced bone mineral density (BMD) in patients with renal stone formation (RSF). Therefore, we designed this study to test if RSF was associated with MAC and if this association could be linked to bone resorption. Methods : Fifty-nine patients (mean age, 41.5 years) with RSF and 40 healthy subjects (mean age, 44.2 years) underwent screening for MAC and BMD, and measuurements were taken of serum and urine electrolytes, parathyroid hormone, alkaline phosphatase and urine dypyridoline. Results : MAC was diagnosed in 11 (18%) patients with RSF compared with 1 (2.5%) control (P=.01). Urine phosphorus, magnesium, sodium, potassium and chloride levels were lower (P<.001, P=.02, P<.001, P<.001 and P<.001, respectively), but serum alkaline phosphatase, calcium and potassium levels were higher (P=.008, P=.007 and P=.001, respectively) in patients with RSF versus those without RSF. None of these abnormalities were found in patients or subjects with MAC. Urine pyridoline levels were higher and T-scores were more negative (more osteopenic) in patients and subjects with MAC than in those without MAC (P=.01 and P=.004, respectively). In a multivariate analysis, only T-scores and urine dipyridoline level were predictive of MAC (P=.03 and P=.04, respectively). Conclusions : Screening for MAC and bone resorption markers in patients with RSF demonstrated a high incidence of MAC in these patients. The presence of MAC in patients with RSF was associated with bone resorption markers. This seemingly complex interrelationship between RSF, MAC and bone loss needs to be clarified in further studies.]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=301;epage=305;aulast=Celik Hind M Alkatan Khalid M Al-Arfaj Azza Maktabi Brief Report Annals of Saudi Medicine 2010 30(4):306-312doi:10.4103/0256-4947.65265 Annals of Saudi Medicine 10.4103/0256-4947.65265 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=306;epage=312;aulast=Alkatan http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=306;epage=312;aulast=Alkatan304 306 312 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=306;epage=312;aulast=Alkatan Hind M Alkatan, Khalid M Al-Arfaj, Azza Maktabi

Annals of Saudi Medicine 2010 30(4):306-312

Background and Objective : Conjunctival nevi are benign lesions with wide variation in clinical and histopathological features. The differentiation between benign nevi and other pigmented lesions is essential. The aim of our study was to identify the distribution of the histopathologic types of conjunctival nevi among the Saudi population and to provide the basic knowledge needed for proper clinical diagnosis. Patients and Methods : This retrospective study of surgically excised benign conjunctival nevi was conducted at a tertiary care eye hospital from 1995 to 2006. Clinical data was collected from medical records and the histopathologic features reviewed by a single pathologist. Results : A total 105 conjunctival nevi were included from 104 consecutive patients (mean age, 26 years, 54 males and 50 females). The anatomical location was the bulbar conjunctiva in 83%, juxtalimbal in 12%, caruncle in 4% and palpebral in 1%. The lesion was removed for cosmetic reasons in 38% while 8% of the lesions were removed to rule out malignancy. The compound nevus was the commonest (72%) in all age groups, followed by subepithelial nevus (24%) and finally junctional nevus (3%). Conclusions : The distribution of the histopathologic types of this tumor in our population matches the pattern in other areas of the world with the compound nevus being the commonest lesion. However, fewer lesions among our patients are removed to rule out malignancy.]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=306;epage=312;aulast=Alkatan Ali M Somily Case Report Annals of Saudi Medicine 2010 30(4):313-316doi:10.4103/0256-4947.65267 Annals of Saudi Medicine 10.4103/0256-4947.65267 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=313;epage=316;aulast=Somily http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=313;epage=316;aulast=Somily304 313 316 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=313;epage=316;aulast=Somily Ali M Somily

Annals of Saudi Medicine 2010 30(4):313-316

Recent reports indicate that nalidixic acid susceptibility correlates well with the clinical outcome of patients with Salmonella Typhi infection treated with quinolones. We report a case of enteric fever caused by S Typhi in which the isolate was resistant to nalidixic acid, but showed in vitro susceptibility to ciprofloxacin. Following treatment with ciprofloxacin, the clinical outcome was not satisfactory and the patient had a relapse. However, after using a higher dose of ciprofloxacin, the patient was cured. We recommend that all Salmonella systemic infections resistant to nalidixic acid with in vitro but decreased susceptibility to fluoroquinolones be treated with other antibiotics like third-generation cephalosporins or azithromycin. These patients should be closely followed up and observed for further relapse.]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=313;epage=316;aulast=Somily Turgut Piskin Cemalettin Aydin Bora Barut Abuzer Dirican Cuneyt Kayaalp Case Report Annals of Saudi Medicine 2010 30(4):317-320doi:10.4103/0256-4947.65268 Annals of Saudi Medicine 10.4103/0256-4947.65268 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=317;epage=320;aulast=Piskin http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=317;epage=320;aulast=Piskin304 317 320 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=317;epage=320;aulast=Piskin Turgut Piskin, Cemalettin Aydin, Bora Barut, Abuzer Dirican, Cuneyt Kayaalp

Annals of Saudi Medicine 2010 30(4):317-320

Reduction of giant hernia contents into the abdominal cavity may cause intraoperative and postoperative problems such as abdominal compartment syndrome. Preoperative progressive pneumoperitoneum expands the abdominal cavity, increases the patient's tolerability to operation, and can diminish intraoperative and postoperative complications. Preoperative progressive pneumoperitoneum is recommended for giant ventral hernias, but rarely for giant inguinal hernias. We present two giant inguinal hernia patients who were prepared for hernia repair with preoperative progressive pneumoperitoneum and then treated successfully by graft hernioplasty. We observed that abdominal expansion correlated with the inflated volume and pressure during the first four days of pneumperitoneum. Although insufflated gas volume can be different among patients, we observed that the duration of insufflation may be the same for similar patients.]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=317;epage=320;aulast=Piskin Bashir A Laway Mohammad S Alai Tariq Gojwari Mohd A Ganie Abdul H Zargar Case Report Annals of Saudi Medicine 2010 30(4):321-324doi:10.4103/0256-4947.65269 Annals of Saudi Medicine 10.4103/0256-4947.65269 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=321;epage=324;aulast=Laway http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=321;epage=324;aulast=Laway304 321 324 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=321;epage=324;aulast=Laway Bashir A Laway, Mohammad S Alai, Tariq Gojwari, Mohd A Ganie, Abdul H Zargar

Annals of Saudi Medicine 2010 30(4):321-324

Cardiac abnormalities in patients with Sheehan syndrome are uncommon. A case of Sheehan syndrome with dilated cardiomyopathy is presented in whom hormone replacement with levothyroxine and prednisolone resulted in complete recovery of cardiomyopathy. A 25-year-old woman presented with lactation failure, secondary amenorrhea, features of hypothyroidism and a hypocortisol state following severe postpartum hemorrhage after her last child birth. She also had smear positive pulmonary tuberculosis. After starting antitubercular treatment, she developed shock, suggestive of hypocortisol crisis. Hormonal investigations revealed evidence of panhypopitutarism and magnetic resonance imaging revealed partial empty sella. Meanwhile echocardiography revealed evidence of dilated cardiomyopathy (DCM). The patient was given replacement therapy in the form of glucocorticoids and levothyroxine in addition to antitubercular treatment. She improved and on follow-up over a period of 7 months, the DCM completely reversed. To our knowledge this is the first report of reversible DCM in a patient with Sheehan syndrome.]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=321;epage=324;aulast=Laway Hussein A Algahtani Abduljaleel P Abdu Imad M Khojah Ali M Al-Khathaami Case Report Annals of Saudi Medicine 2010 30(4):325-328doi:10.4103/0256-4947.65266 Annals of Saudi Medicine 10.4103/0256-4947.65266 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=325;epage=328;aulast=Algahtani http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=325;epage=328;aulast=Algahtani304 325 328 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=325;epage=328;aulast=Algahtani Hussein A Algahtani, Abduljaleel P Abdu, Imad M Khojah, Ali M Al-Khathaami

Annals of Saudi Medicine 2010 30(4):325-328

Scurvy has become rare in modern societies, but should be considered in malnourished persons, alcoholics, and in infants on unsupplemented milk diets who present with musculoskeletal pain or a bleeding tendency. The diagnosis of scurvy can be challenging because of the rare incidence and vague and nonspecific early symptoms. We report here a case of scurvy in a young boy who presented with an inability to walk and severe musculoskeletal pain. The diagnosis was established based on his clinical picture, radiological appearance, and low serum level of vitamin C. The patient responded well to vitamin C supplementation with full resolution of his symptoms. He regained his ability to walk and his family was happy and satisfied with the outcome of treatment. Although the incidence of scurvy has become low in Saudi Arabia, it can still occur and early recognition is important because of the excellent prognosis.]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=325;epage=328;aulast=Algahtani Kenneth L Mattox Letter Annals of Saudi Medicine 2010 30(4):329-329doi:10.4103/0256-4947.65258 Annals of Saudi Medicine 10.4103/0256-4947.65258 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=329;epage=329;aulast=Mattox http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=329;epage=329;aulast=Mattox304 329 329 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=329;epage=329;aulast=Mattox Kenneth L Mattox

Annals of Saudi Medicine 2010 30(4):329-329

]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=329;epage=329;aulast=Mattox Jayadevan Sreedharan Letter Annals of Saudi Medicine 2010 30(4):330-330doi:10.4103/0256-4947.65260 Annals of Saudi Medicine 10.4103/0256-4947.65260 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=330;epage=330;aulast=Sreedharan http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=330;epage=330;aulast=Sreedharan304 330 330 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=330;epage=330;aulast=Sreedharan Jayadevan Sreedharan

Annals of Saudi Medicine 2010 30(4):330-330

]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=330;epage=330;aulast=Sreedharan Attia Z Taha Letter Annals of Saudi Medicine 2010 30(4):330-330Annals of Saudi Medicine http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=330;epage=330;aulast=Taha http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=330;epage=330;aulast=Taha304 330 330 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=330;epage=330;aulast=Taha Attia Z Taha

Annals of Saudi Medicine 2010 30(4):330-330

]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=330;epage=330;aulast=Taha Ismail Erden Letter Annals of Saudi Medicine 2010 30(4):331-331doi:10.4103/0256-4947.65263 Annals of Saudi Medicine 10.4103/0256-4947.65263 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=331;epage=331;aulast=Erden http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=331;epage=331;aulast=Erden304 331 331 http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=331;epage=331;aulast=Erden Ismail Erden

Annals of Saudi Medicine 2010 30(4):331-331

]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=4;spage=331;epage=331;aulast=Erden