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   Table of Contents - Current issue
Coverpage
April-June 2021
Volume 13 | Issue 2
Page Nos. 47-100

Online since Wednesday, June 30, 2021

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EDITORIAL  

Editorial p. 47
Elmahdi A Elkhammas
DOI:10.4103/1947-489X.320328  
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COMMENTARY Top

Pharmacy curriculum in Libya: The time of a needed change p. 49
Abdalla Salem Elhwuegi
DOI:10.4103/1947-489X.320332  
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VIEW POINT Top

Adoption of a design-based research approach to improve understanding about complex educational problems p. 51
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/1947-489X.320337  
Over the past couple of decades, remarkable progress occurred in medical education research. However, most of the ongoing research did not seem to have added much to the existing literature. Thus, our understanding has not shown considerable improvement. An extensive search of all materials related to the topic was carried out in the PubMed search engine, and a total of six articles were selected based on the suitability with the current review objectives and analyzed. Design-based research targets complex educational problems in the real world, with an ultimate intention to enhance learning among the students and not justify the superiority of one teaching–learning method. In conclusion, the framework of design-based research plays a significant role in the better understanding and resolving of complex educational problems. Further, considering the encouraging results obtained in different educational problems, it is the need of the hour that all the educational researchers should adopt a design-based research approach for gaining an in-depth understanding of the local educational problems.
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REVIEW ARTICLE Top

The urgent need for diagnostic criteria and further understanding of burnout syndrome p. 54
Jeffrey King, Noof AlJneibi, Renee Houjintang King
DOI:10.4103/1947-489X.320339  
The term burnout is widely used and accepted worldwide, but its existence as a distinct clinical entity remains poorly understood and is the source of controversy within academic circles. The existence or nonexistence of burnout has significant implications for individuals, families, organizations, communities, and societies. There is an urgent need for further descriptive research to determine consensus-driven diagnostic criteria that will aid in high-quality research to guide nonpharmacologic and pharmacologic treatment and to aid in the development of individual, organizational, and societal prevention strategies. This urgency is driven by recent changes in the occupational-social contract and highlighted by the ongoing COVID-19 pandemic. To address this need, the authors performed a narrative, nonsystematic review to obtain an overview of the current body of literature regarding the symptoms, diagnosis, and treatment of burnout symptoms. A literature search was conducted in PubMed for relevant articles in English since 1974 with the following search terms: “occupational burnout,” “professional burnout,” “career burnout,” “assessment,” “inventory,” “measure,” “instrument,” “diagnosis,” “treatment,” “guideline” in different combinations. Hand searching was also performed. Retrieved records were reviewed, and the relevant studies were summarized. Burnout, whether a distinct clinical entity or an occupationally triggered manifestation of an already defined mental health condition, is an urgent public health priority. There is peril in waiting for a follow-on epidemic of its manifestations before embarking on high-quality research into diagnostic criteria, treatment, and prevention, as this takes time. However, this information is vital for individual practitioners, health-care systems, governments, and societies to meet this pressing need.
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ORIGINAL ARTICLES Top

Clinical characteristics of igG4-related disease in the United Arab Emirates: A retrospective single-center study p. 60
Rajaie Namas, Mohamed Elarabi, Safa Hegazin, Abhay Joshi, Fulvio Salvo, Imad Jassim, Muriel Ghosn, Nizar Attallah, Priti Joshi, Esat Memisoglu, Waleed Hassen, Jamal Al-Saleh, Mohamed Abuzakouk
DOI:10.4103/1947-489X.320341  
Background: Demographic and clinical data of IgG4-related disease affecting solely the native population of the UAE, known as Emiratis, does not exist in the literature. Aim: To explore the demographic and clinical characteristics of IgG4-related disease in a well-defined population of Emirati patients attending Cleveland Clinic Abu Dhabi, a large tertiary center in the Middle East. Patients and Methods: The data presented is part of a retrospective cohort study, in which 15 Emirati patients with IgG4-related disease (IgG4-RD) were evaluated over 5 years from April 2015 to September 2020 at the rheumatology outpatient clinic at Cleveland Clinic Abu Dhabi. The demographic and clinical data were recorded. Descriptive statistics of the variables were applied. Results: Fifteen Emirati patients with an established diagnosis of IgG4-RD were assessed. There was a male predominance (53%) with a median age at the time of diagnosis of 47 ± 11.2 years. A 6-year lag period was noted from the initial presentation until a diagnosis of IgG4-RD was established. The most frequent comorbidities observed were hematological conditions (63%), hypertension (47%), diabetes mellitus (40%), and gastroesophageal reflux disease (40%). An elevated serum IgG4 was observed in the majority of patients at the initial presentation. Rheumatoid factor was detected in 13% and low titer of immunofluorescence antinuclear antibody in 7%. 86% of patients had a tissue biopsy with marked lymphocytic and plasmacytic infiltration being the most reported finding in 86%. Methotrexate, azathioprine, and rituximab were the most frequently prescribed disease-modifying agents. Conclusion: We report the first comprehensive analysis on a small cohort of Emirati patients with IgG4-RD. We describe disease features unique to UAE patients and demonstrate that IgG4-RD has a significant disease burden. Our results underscore the need for the IgG4-RD UAE-wide national registry to improve the quality of care of these patients.
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Cancer mortality pattern in a resource-poor country: A Case study of a teaching hospital in the southeast region of Nigeria p. 67
Chinedu O Ndukwe, Chinwe Chioma Ndukwe, Kenechi Gerald Ike, Uchechukwu Brian Eziagu
DOI:10.4103/1947-489X.320345  
Background: There are many studies on the pattern and incidence of cancer, but there are few documented works on cancer mortality (CM). Even fewer are African studies on CM that encompass all cancers and reveal the relative contributions of the various cancers to the overall burden of CM. This retrospective study was therefore performed to determine the types and patterns of cancer deaths in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Southeast, Nigeria, during the 10-year period from 2010 to 2019. Materials and Methods: Data were collected from the death data files in the mortuary unit of the department of anatomic pathology. These death data document the cause of death as issued by the attending medical/surgical/oncology teams or the pathologist that performed an autopsy on the deceased. Data collected included the deceased's age, sex, and underlying cause and date of death. Results: One thousand one hundred and sixty-six deaths (representing 10.3% of all hospital deaths) were due to cancers. There were 472 (40.5%) males and 694 (59.5%) females in the series (P < 0.001), giving a male-to-female ratio of 1:1.5. The mean age for males was 53.2 ± 22.6 years and that of females was 48.3 ± 17.9 years. A bimodal age distribution pattern of CM was noticed with peaks in the 0–10-year and 51–60-year age groups (P < 0.001). The second peak occurs a decade earlier in females (51–60 years) than in males (61–70 years). In terms of type, breast, liver, and hematological malignancies were among the top three causes of cancer deaths. Cancers of the breast, liver, hematolymphoid tissues, ovary, and cervix were the largest contributors to the cancer-associated mortality burden among females. Prostate, liver, hematological, pancreas, and colorectal malignancies were the leading cause of CM among males. Hematological malignancies resulted in the death of more children and young adults younger than 31 years. Breast and liver cancers accounted for the most cancer deaths that affected patients in the 31–60-year-old age group, while deaths due to prostate cancer predominated in those above 60 years of age. Conclusion: Cancers have remained a vital cause of mortality in our setting. Screening for premalignant lesions, early detection, and treatment of cancers are therefore keys to improving dismal outcomes.
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An assessment of pharmacy practice in Libya measured against international standards p. 74
Mohammed Mansour Ali, Amal Y Benkorah
DOI:10.4103/1947-489X.320352  
Introduction: Practicing pharmacy in Libya is still limited to the dispensing roles. However, pharmacists have started to work proactively to advance modern practices by expanding their roles in different practice settings. Objective: This study aims to evaluate the status of pharmacy practice in Libya through self-assessing competencies of hospital and community pharmacists. Materials and Methods: This is a cross-sectional online survey study of community and hospital pharmacists. The survey questionnaire was based upon the “Global Competency Framework for Pharmacists̶ and the Joint FIP/WHO guidelines on good pharmacy practice. Results: A total of 199 responses were received with 93% response rate. 47.0% were community pharmacists, 39.4% worked both in hospital and community, and 13.6% practiced exclusively in hospitals. 10% of respondents graduated in 1980–1989; 15% graduated in 1990–1999. 30% graduated in 2000–2009, and 45% graduated in the past 8 years before the study (2010–2017). The overall pharmacy competency indicators were reportedly met consistently by 45.3% of respondents, usually by 25% of responders and only sometimes or rarely by 15.9% or 13.8% of respondents, respectively. Conclusions: Pharmacy practice in Libya is more population and system-focused than being professional and patient-focused. Significant amendments in pharmacy education curricula are required to include modern teaching methods, knowledge, skills, and competencies. Continuous professional development programs are also needed for established pharmacists to modernize pharmacy practice in the country.
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EDUCATION Top

From diagnosticians to “triageologists:” The transformation of modern physicians through the lens of a pathologist! p. 82
Samir Kahwash
DOI:10.4103/1947-489X.320355  
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PRACTICE POINT Top

Let's sit down and talk: The art of breaking bad news p. 84
Ali M Ghellai, Kafia M Elhafi, Maram A Ghellai, Mamoon A Ghellai
DOI:10.4103/1947-489X.320358  
Physicians often are uncomfortable when communicating bad or difficult news. In the absence of much effective training, many doctors find that breaking bad news is one of the most difficult, demanding, and stressful tasks. A significantly negative relationship can form between the patient and their medical staff if poor communication is used. Most patients want the truth, but how bad news is delivered can substantially influence a patient's emotions, satisfaction, subsequent psychological adjustments, and attitudes toward treatment. Moreover, values in certain cultures can become barriers that can limit or pressure a physician in ethically approaching the patient. Disclosing bad news is a complex communicational task that requires time, compassion, and empathy. Although breaking bad news will never be easy, communicating well is a skill that can be learned. The SPIKES protocol provides a simple and easily learnable strategy for communicating bad news.
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CASE REPORT Top

Steroid-Induced acute psychosis in an 8-year-old child with inflammatory bowel disease p. 91
Om-Elkhair I Elbanoni, Adel I Altawaty
DOI:10.4103/1947-489X.320362  
We present a case of an 8-year-old male child diagnosed with Crohn's disease, and he experienced a steroid-induced psychosis during induction of remission with corticosteroid therapy. This study aims to report a steroid-induced psychosis in the pediatric age group and add this case to the limited number of reported pediatric patients who developed a steroid-induced psychosis with a focused review of the literature.
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CONFERENCE HIGHLIGHTS Top

Highlights of the Ninth Diabetes and Ramadan International Alliance conference (mena-zone virtual), January 21–22, 2021 p. 95
Salem A Beshyah, Khadija Hafidh
DOI:10.4103/1947-489X.320366  
The 9th “Ramadan and Diabetes” international alliance annual conference was held over 2 days (January 21–22, 2021) virtually due to health restrictions imposed by the COVID-19 pandemic. The program included several sessions covering various aspects of Ramadan fasting from physiology, nutrition, pharmacotherapies, mental well-being, and bioethical considerations. A good proportion of the conference was used to highlight the 2021 edition of the International Diabetes Federation-diabetes and Ramadan (DaR) recommendations on diabetes management during Ramadan. The proposed new risk stratification tool for objectively assessing patient's risk was discussed. Results of the DAR global survey of the impact of COVID-19 on fasting practices were reported during the event. Results of a couple of recent trials were presented during the conference. The conference closed by a thoughtful review of the grading of evidence and a futuristic vision of future research directions. The present report provides a concise overview of the conference to help those who did not have the opportunity to attend the live event.
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