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   Table of Contents - Current issue
Coverpage
July-September 2021
Volume 13 | Issue 3
Page Nos. 101-153

Online since Monday, September 27, 2021

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EDITORIAL  

Life and medicine: COVID-19 and beyond p. 101
Elmahdi A Elkhammas, Salem A Beshyah
DOI:10.4103/ijmbs.ijmbs_63_21  
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REVIEW ARTICLE Top

Ramadan fasting in health and disease (2020): A narrative review p. 102
Khadija Hafidh, Khawla F Ali, Salem A Beshyah
DOI:10.4103/ijmbs.ijmbs_35_21  
The medical literature on health aspects of Ramadan fasting (RF) is widely spread in many journals of varying access, making it less readily available to those interested in the subject. We performed a nonsystematic review of the international literature from a major online database (PubMed in 1 year [2020]). The search term “Ramadan fasting” was used, and relevant literature was narrated in a concise thematic account excluding diabetes. The publications spanned fundamental, clinical, ethical, professional, cultural, and advocacy facets. The publications predictably crossed the conventional disciplinary lines and geographical locations and appeared in journals with different access systems. The contents are presented under the emerged themes depending on the retrieved literature. This year, the basic coverage included changes in physiology, nutrition during Ramadan. However, the clinical issues included a more comprehensive range such as the impact of RF on the liver and gut, and endocrine conditions such as hypothyroidism and adrenal insufficiency. Coverage also included chronic kidney disease, maternal health and fetal well-being, cardiovascular medicine, nature and function of eyes, and neurological conditions, especially epilepsy. Sports medicine and athletes' well-being received somewhat prominent coverage. Other researchers focused on documenting patients' and health-care professionals' perceptions, attitudes, and practices during Ramadan. Health aspects of RF received a sustained academic interest with a broad spectrum in 2020. This narrative provides a scoping overview to help researchers and clinicians catch up quickly with state-of-the-art science today.
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ORIGINAL ARTICLES Top

Short-term outcomes of trabeculectomy surgery in primary open-angle glaucoma p. 122
Samar A Bukhatwa, El-Said G Metmoah
DOI:10.4103/ijmbs.ijmbs_144_20  
Introduction: Trabeculectomy controls the intraocular pressure (IOP) and decreases the progress of open-angle glaucoma; the outcome of such procedure has not been ascertained in Libya. Objective: We report the short-term outcome of trabeculectomy in terms of IOP in primary open-angle glaucoma (POAG). Settings and Design: The medical records of the trabeculectomy patients previously diagnosed with POAG were reviewed retrospectively. Patients and Methods: Case characteristics were extracted including preoperative IOP and the IOP outcome 6 months postoperatively using Goldmann applanation tonometry. Data were presented as frequencies and mean ± standard deviation. Wilcoxon signed-ranks test was used to analyze the changes in the measurement of IOP after trabeculectomy. Results: Fifty-seven cases had trabeculectomy with a mean age of 51.6 ± 12.2 years. There was a statistically difference (P < 0.0001) in the IOP measurement pre and 6 months post trabeculectomy. 39 patients (68.4%) achieved an IOP of ≤21 mmHg 6 months after surgery without medications. IOP decreased from 33.2 ± 6.5 mmHg before surgery to 18.8 ± 5.8 mmHg after surgery. All the cases with preoperative IOP of 21–30 mmHg had a posttrabeculectomy IOP ≤ 21 mmHg (P < 0.0001). The rate of complications was low; seven eyes (12.3%) developed early postoperative complications that resolved within 2 weeks. Conclusions: This is the first report on trabeculectomy surgery in Libya. The results are encouraging with a low complication rate. This warrants further evaluationsof long term outcomes.
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Determinants of intensive care unit admission of hospitalized patients with COVID-19 in Saudi Arabia: An analytic retrospective cohort p. 127
Sulafa Alqutub, Wedad Albalawi, Nermeen Nasser Alrajhi
DOI:10.4103/ijmbs.ijmbs_48_21  
Background: In March 2020, Saudi Arabia (KSA) experienced a coronavirus disease 2019 (COVID-19) outbreak. The mitigation strategy aimed to reduce both the impact on vulnerable groups and the risk of admission to the intensive care unit (ICU). Risk factors, such as sequential organ failure, comorbidities, ventilation, and mortality, have not been described in different settings of care. Materials and Methods: A multicenter, retrospective chart review of 220 adults with COVID-19 admitted to the ICU included demographics and ICU admission factors (e.g., quick sequential organ failure assessment (qSOFA) score, ventilator status, comorbidities, days from laboratory confirmation to ICU admission, and days from hospitalization to ICU admission). Regression was utilized to identify predictors of need for mechanical ventilation (MV) and mortality in ICU patients. Results: ICU admission, COVID-19 hospital mortality, and ventilator-associated mortality rates were 26.5%, 44%, and 30.5%, respectively. The mean patients' age was 30 years. Across four cities, Jeddah patients were at the highest risk of MV (<0.001). Within the 1st day of hospitalization, without lymphocytopenia, non-Saudi patients with a qSOFA score of 2 and 3 were at the highest risk of ventilation (odds ratio [OR], 3.9; 95% confidence interval [CI], 1.72–8.66; OR, 11.4; 95% CI, 2.35–55.47; and OR, 6.1; 95% CI, 1.0–37.33, respectively). Moreover, within the same period of hospital stay, mechanically-ventilated patients with a qSOFA score of 3 who received antiviral medications were significantly at the higher risk of death (OR, 2.8.4; 95% CI, 1.44–5.64; OR, 13.1; 95% CI, 1.23–39.68; and OR, 2.2; 95% CI, 1.14–4.14, respectively). Conclusions: The 1st day of hospitalization, along with an assessment of the dyspnea status using the qSOFA score, is the window of opportunity for minimizing ICU admission risk. Neither lymphocytopenia nor comorbidities are associated with the risk of mechanical ventilation. Factors were also discussed. Reviews are needed on the indications for the use of antiviral agents, intubation, and ventilation in hospitalized patients.
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Can the immature granulocyte count have a role in the diagnosis of coronavirus 2019 disease? p. 136
Fatih Selvi, Cihan Bedel, Mustafa Korkut
DOI:10.4103/ijmbs.ijmbs_43_21  
Background: The pathophysiology of COVID-19 disease is not clearly understood; inflammation has been shown to play a major role. The immature granulocytes count (IGC) can be an indicator of inflammation. To the best of our knowledge, there is no data on the usability of IGC for the diagnosis of COVID-19. Objectives: We aim to investigate the usability of the inflammatory marker IGC in the diagnosis of COVID-19. Patients and Methods: COVID-19 patients admitted to a tertiary university hospital were included in this study, and hemogram parameters, white blood cells, hemoglobin, neutrophils, lymphocytes, and IGC were investigated. According to the real-time reverse transcriptional polymerase chain reaction, patients were categorized into two groups as COVID-19 positive and COVID-19 negative. Results: The mean value of IGC was 0.02 (0.02) for the COVID-19-positive group and 0.11 (0.04) for the COVID-19-negative group. Patients with COVID-19 positive were found to have an IGC value that is significantly lower than the other group (P < 0.001). For IGC, it was calculated at a cut-off value of 0.03 (area under the curve: 0.718; sensitivity: 66.7%; specificity: 72.3%; P < 0.001). Conclusions: The results of our study have shown that on-admission IGC level is a novel, cost-effective, and readily available biomarker with a promising predictive marker for COVID-19 patients.
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Profiles of diabetes care, control and complications in Benghazi, Libya 2020: A cross sectional study p. 142
Omar Alfalah, Imhemed Eljazwi, Najat Buzaid
DOI:10.4103/ijmbs.ijmbs_45_21  
Background: Diabetes mellitus is one of the growing health problems worldwide. Comprehensive medical evaluation, screening for complications, and proper diabetes care are crucial to improve outcome. Objectives: We aimed to study the profile of diabetes in Benghazi city and assess the changes since the last study of 2002. Patients and Methods: This study is a descriptive cross-sectional study of 504 persons with diabetes who were following at Benghazi diabetes center during June and July in 2020. Results: The age was, mean ± standard deviation; 57.8 ±12.3 years. with equal sex split. A quarter (24.8%) of participants graduated from a university/college. About half of the patients were obese (48.4%) Hypertension and dyslipidemia were found in 35.1% and 42.1%. respectively. The mean glycated hemoglobin A1c (HbA1c) was 8.3% ±1.7%. Self-monitoring of blood glucose (SMBG) was practiced by 20.2% of all patients, Less than two thirds (63.5%) of all patients had diabetes eye screening within the previous year. However, none of the participants had ever had a comprehensive feet examination. Ramadan fasting was observed by most of participants (95.4%). Conclusions: There is an improvement regarding annual eye examination, taking the medications regularly, SMBG, assessment of lipid profile, and regular follow-up with HbA1c in comparison with the practice in 2002. On the other hand, there is a decline in having comprehensive feet examination, practicing regular exercise, and diet control. The uncovered gaps in diabetes care need urgent attention.
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CASE REPORT Top

Delayed presentation of late-onset glutamic aciduria type II: A disease of infancy presenting in an adult p. 148
Abdul Karim Arida, Wala Kamel Hamed, Omar Khaddam, Hussain Alawadhi, Jozef Hertecant
DOI:10.4103/ijmbs.ijmbs_125_20  
Glutamic aciduria Type II is an uncommon inborn error of metabolism. It has a rare late-onset variant that can present in adulthood with recurrent lethargy, vomiting, metabolic acidosis, and myopathy. This is a case of a 27-year-old previously healthy gentleman who presented with complains of daily vomiting and generalized body aches that started 3 days after initiation of strenuous exercise and poor oral intake. Initially found to have high anion gap metabolic acidosis, elevated creatinine kinase levels and hypoglycaemia that improved with intravenous fluids. He later deteriorated and he was transferred to the intensive care unit for intubation and monitoring of his mental status. Labs were evident of hyperammonaemia not responding to lactulose. Further management with continuous venovenous hemodialysis (CVVHD) for ammonia clearance was required. This presentation raised the suspicion for metabolic disease and work up done was suggestive of Type II glutaric aciduria. After a long stay of 28 days in the hospital the patient recovered his mental status and was discharged home on carnitine and riboflavin. The diagnosis was confirmed with further genetic testing. He was later found to have concurrent celiac disease that was confirmed by duodenal biopsy.
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OBITUARY Top

Prof. Taher Ahmed Rizgalla p. 153
Issam Mehdi Hajjaji
DOI:10.4103/ijmbs.ijmbs_52_21  
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