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   Table of Contents - Current issue
October-December 2020
Volume 12 | Issue 4
Page Nos. 235-328

Online since Thursday, December 31, 2020

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Goodbye 2020! p. 235
Elmahdi A Elkhammas, Salem Arifi Beshyah
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Characterizing lung cancer in Libya: A stepping stone toward a better lung cancer care in the country p. 237
Wanis H Ibrahim, Tasleem Raza
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Ramadan fasting in health and disease (2019): A narrative review p. 240
Khawla F Ali, Sara A Abdulla, Amal Badi, Khadija Hafidh, Salem Arifi Beshyah
Introduction: Literature on the health aspects of Ramadan fasting (RF) is widespread in many journals, making it less readily available to those interested in the subject. Materials and Methods: This is a narrative, nonsystematic review of international literature from two major online databases (viz., Scopus and PubMed) in 1 year (2019). The search term “RF” was used, and relevant literature was narrated in a concise thematic account excluding diabetes. Results: The publications spanned the fundamental, clinical, ethical, professional, cultural, and advocacy facets of the subject. The publications crossed the conventional disciplinary lines and geographical locations and appeared in journals with different access systems. The content is presented under relevant themes depending on the available literature. Basic coverage included changes in physiology, nutrition, and metabolism during Ramadan. Clinical aspects such as the impact of RF on kidney function, pregnancy outcome, fetal life, structure and function of eyes, and athletes' well-being received comparatively prominent coverage by researchers in 2019. Gut, liver, skin, skeleton, and blood were also covered. Other workers focused on documenting the perception, attitudes, and practices of both patients and health-care professionals during Ramadan. Conclusions: The health aspects of RF received sustained academic interest with a wide spectrum in 2019. We provided a scoping overview to help researchers and clinicians catch up quickly with the state-of-the-art today.
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Mental health of health-care workers during the COVID-19 pandemic p. 258
Walaa Mogassabi, Waqar Mogassabi, Maram Saliba, Rana M Emam, Wanis H Ibrahim
Besides its effects on physical health, the coronavirus disease 2019 (COVID-19) pandemic has resulted in adverse consequences on mental health of health-care workers. Several factors such as safety concerns and fear of infecting self or family members, social isolation measures, strict infection control procedures, lack of protective measures, exhaustion due to increased duration of working, and seeing patients die or colleagues infected can contribute to the development of mental health problems in health-care workers during the current COVID-19 pandemic. Some health-care staff including nurses, advanced practice providers, frontline health-care workers, and health-care workers who have children are more vulnerable to these mental health problems. Prevention of infection and staff burnout in health-care workers, provision of a timely mental health care, and social support are among the most important measures to provide a mental health care for health-care workers during the current COVID-19 pandemic.
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An analysis of gut dysbiosis in obesity, diabetes, and chronic gut conditions Highly accessed article p. 264
Ahmed Haleem, Sama Anvari, Aisha Nazli, Mohamed Sager, Mahmood Akhtar
Introduction: Gut dysbiosis is an imbalance in the microbial communities of the intestine and has been associated with numerous chronic diseases. Objectives: We aimed to compare gut dysbiosis within and across various disease states (Crohn's disease [CD], colorectal cancer [CRC], irritable bowel syndrome [IBS], and type 2 diabetes mellitus [T2DM], and obesity). Materials and Methods: Assessing comparative studies which examined levels of bacterial phyla in cases and controls. PubMed and Web of Science were searched to identify relevant studies, in which human fecal samples were used to analyze microbial flora. Results: Twenty-one studies were included, which met inclusion and exclusion criteria. Three studies were included assessing IBS, which found a decrease in Bacteroidetes in the IBS population, but inconsistent findings for other phyla. Six studies were included assessing obesity, and no consistent patterns emerged. Five studies were included examining T2DM, which found a consistent decrease in the Firmicutes/Bacteroidetes ratio in cases as compared to controls. No patterns were found for other phyla. Three studies were included examining CD, and five examining CRC. Conclusions: No consistent patterns were found for either of these diseases. While some patterns were found in bacterial phyla distribution, there were few commonalities, even in same-system disorders. However, uncovering underlying dysbiosis patterns shows great promise in furthering the understanding of disease pathogenesis and the potential for new therapeutic and diagnostic interventions. Further systematic reviews and well-controlled studies are warranted.
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Trends, and tumor characteristics of lung cancer and malignant pleural mesothelioma in the East of Libya p. 272
Wail A Eldukali, Khaled Elmahdi Omran, Raouf Azzuz
Background: Lung cancer is the most common cancer worldwide and the leading cancer killer. Lung cancer is classified histologically into two types; small-cell lung cancer and nonsmall-cell lung cancer (NSCLC) (squamous cell carcinoma, adenocarcinoma (AC), large cell carcinoma [LCC]). Malignant pleural mesothelioma is a rare thoracic tumor. We aimed to provide comprehensive epidemiological data about lung cancer in the eastern part of Libya. Patients and Methods: A retrospective medical records review of lung cancer patients attending the oncology department of Benghazi Medical Center from January 1, 2006 to December 31, 2015. Results: There were 684 lung cancer cases out of 7725 total registered cancer cases (8.85%), 627 were male (91.7%, median age 63.5), and 57 females (8.3%, median age 64). NSCLC was the dominant histology 78.5%, SCLC 11%, and malignant mesothelioma 2.5%. NSCLC subtypes were AC (35.1%), squamous carcinoma (25.7%), LCC (4.6%), and not otherwise specified (12.6%). Only 30.6% of cases were diagnosed in Libya, the most commonly used diagnostic modalities were bronchoscopic biopsy 46.6%, and computed tomography guided biopsy 17.4%. Only 18 cases were tested for epidermal growth factor receptor sensitizing mutations and anaplastic lymphoma kinase rearrangement fusion. Stage IV was the most common initial stage for NSCLC 60%, malignant mesothelioma 47.1%, and 74.7% of SCLC presented with extensive disease. Only 42.9% of males and 5.3% of female lung cancer patients were smokers. Conclusions: Lung cancer is a major health burden in Libya, and it is increasing in incidence; this epidemiological study tries to put this problem into public health and clinical perspective.
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Impact of COVID-19 on educational and academic activities of health-care professionals: An international survey of doctors, dentists and nurses. p. 280
Hussain Alsaffar, Haider Al-Saffar, Khadija Ali, Fahad Aljaser, Amar Mahdi, Manar Muhammad, Salwa Alaidarous, Najwa Rbiai, Iyad Ahmed, Foued Abdelaziz, Asma Deeb
Introduction: The COVID-19 pandemic has affected the whole world in different levels from numerous aspects. This deadly, highly contagious viral infection has led to lockdown in many cities across the world; significantly disrupting previously planned educational activities. Objectives: We aim to evaluate the impact of the COVID-19 pandemic on the educational and academic activities of the health care professionals practicing in different countries. Subjects and Methods: A cross-sectional survey was conducted using a link to an online questionnaire which was sent to doctors, dentists and nurses working in several countries using WhatsApp medical groups. The questionnaire consisted of eight questions related to the impact of COVID-19 on educational and academic activities of the health care professionals (HCPs). Results: 898 responses received from doctors (66.5%), nurses (21%) and dentist (12.5%), working in 36 countries. 66.6% of respondents think their academic activities are less than what it was before the pandemic. However, 63% of participants have attended more webinars and 58% have completed more on-line courses and e-learning sessions during the pandemic. Conclusions: COVID-19 pandemic negatively impacted the academic activities of HCPs. However, COVID-19 health crisis created an opportunity for enriching the educational activities through e-learning, online courses, and webinars. This experience should be utilized in the future, with more online material available.
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Predictors of dental general anesthesia receipt among children attending a tertiary hospital in Saudi Arabia p. 288
Mostafa A Abolfotouh, Ghaida A Alhumaidan, Bashaer Y Almalki, Alanoud H Alhasson, Ibraheem Bushnak, Abdallah Adlan
Aim: Children are normally treated in a dental chair, despite that some may have their treatment done under dental general anesthesia (DGA). Factors affecting the decision on DGA include the quality and quantity of treatment needed and child's age and cooperation. This study aimed to estimate the prevalence of DGA among children with dental caries and to identify the associated factors in a tertiary care setting in Saudi Arabia. Methods: A cross-sectional study of 400 children with dental caries was conducted. Data were collected from the patients' records including demographic, behavioral, and clinical information, diagnosis using caries indexes (Decayed, Missing, Filled Teeth/decayed filled teeth [dft]), and number of DGA and its indications. Logistic regression analysis was applied to identify the predictors of DGA, and significance was considered at P ≤ 0.05. Results: The study included 400 children; 55% of them were below the age of 6 years, with a mean age of 6.4 ± 2.3 years. About one-half of children were males (51.7%) and unhealthy (48.2%). The majority were of negative behavior (70.7%) and noncomplaint to dental appointments (70.3%). More than three-fourth of children (78.5%) experienced one or more DGA. GA use was significantly associated with gender (χ2 = 4.30, P < 0.04), age (t = 12.37, P < 0.0001), health status (χ2 = 16.02, P < 0.0001), dft index (z = 11.44, P < 0.0001), child behavior (χ2 = 48.54, P < 0.0001), age at the first dental visit (t = 11.73, P < 0.0001), number of dental treatment visits (z = 11.14, P < 0.0001) and dental preventive visits (z = 7.21, P < 0.0001) before the index dental visit, and compliance with dental appointments (χ2 = 39.50, P < 0.001). However, after adjusting for confounders, using the logistic regression analysis, DGA use was predicted by unhealthy children (odds ratio [OR] = 27.35, P = 0.002), those with a negative behavior (OR = 18.28, P = 0.003), and those with higher dft index (OR = 1.68, P < 0.001). Conclusions: Noncooperation, general health status, and dental caries level (dft) were the main factors for the decision of DGA. High caries-risk children must be the target for behavioral management to minimize their need for treatment under DGA. Post-DGA appointment to guide the child back to normal dental care is recommended.
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Family relations of living-related kidney donors in Tripoli, Libya p. 295
Jamila Salem Elamouri, Nada Bulgasem Fawaris
Introduction: Despite efforts to increase community awareness of kidney donation and transplantation, there remains a huge gap between the number of kidneys needed and those available. Objectives: We aimed to document the types of relationship between donors and recipients of kidney transplants in a previously unexamined community. Patients and Methods: This was a descriptive retrospective study of 454 living-related kidney transplant patients registered during 2019 in the posttransplant clinic at the National Centre for Organ Transplantation, Tripoli, Libya. Demographic data and the type of relationship between recipients and donors were studied. Results: There was a male donor predominance (67.4%), with a male-to-female ratio of 2: 1. The mean age of the donors was 34.2 ± 10.27 years. The sibling constituted the majority (62.2%) of donors, with brother predominance. They were followed by off-spring donors (17.6%), with a predominance of sons and parents (12.4%), with mothers acting as donors more than fathers. Donation from spouses was relatively infrequent (3.5%). Conclusions: The study revealed that brothers are the most common donor and all donors more commonly donate to male recipients, except mothers who donate more commonly to female recipients. This may be reflective of the sociocultural factors. More social awareness is needed regarding organ donation, especially among females, to increase their contribution in donation.
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Predisposing factors and health-care utilization in liver transplant recipients with takotsubo cardiomyopathy: A national analysis p. 300
Kishan Patel, Salman K Bhatti, Sylvester M Black, Kyle Porter, James Hanje, Khalid Mumtaz
Aims and Objectives: Takotsubo cardiomyopathy (TCMP) is an acquired cardiomyopathy associated with physical, emotional, and surgical stress. Current literature on TCMP in liver transplant recipients (LTRs) is limited to case reports and case series. Methods: The Nationwide Readmission Database was utilized to identify all adults with an index admission for LT between 2010 and 2014 who developed TCMP. The prevalence of TCMP at the LT admission or readmission within the calendar year was examined. Predictors of development and health-care utilization of patients with and without TCMP in LTR were compared. Multivariable regression analysis was performed. Results: The prevalence of TCMP in LTRs was found to be 0.5% (141/28,067). Most of these patients developed early TCMP on the index admission for LT (n = 115; 82%). Older (57.5 ± 1.3 vs. 55.1 ± 0.3 years, P < 0.001) females (adjusted odds ratio [aOR]: 2.27; confidence interval [CI]: 1.20–4.27; P = 0.01) with ≥4 Elixhauser comorbidity (aOR: 2.36; CI: 1.15–4.83; P = 0.02) were predisposed to develop TCMP in LTRs. LT at a medium-sized center (aOR: 0.17; CI: 0.03–0.88) has a protective effect on the development of TCMP. Increased health-care utilization in the form of mechanical ventilation, hemodialysis, vasopressors, and intra-aortic balloon pumps is observed in patients with TCMP. This resulted in increased length of stay and cost in patients with TCMP. Moreover, increased mortality was seen in patients who developed TCMP within the same calendar year. Conclusion: This is the first report showing the prevalence of TCMP in LTRs to be 0.5%. Older females with increased comorbidity are predisposed to TCMP. Patients who developed TCMP necessitate a higher acuity of medical care and cause an increased health-care burden and ultimately experience an increase in mortality.
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Doctors' attitude and engagement in research: A survey from two emerging regions p. 307
Salem A Beshyah, Khawla F Ali, Huda E I Mustafa, Issam M Hajjaji, Khadija Hafidh, Dima K Abdelmannan
Background: Research is an essential component in the advancement of medicine. Evidence indicates that developing regions have low research productivity and contribution to the international literature. It is unclear if physicians' attitudes and perceptions of research could be contributory. Objectives: This study examined the attitudes to research, perceived barriers to research, and experiences of prior participation in research projects among physicians from the Middle East and Africa. Subjects and Methods: A cross-sectional electronic survey was developed based on the published literature to address these questions and was E-mailed to a large sample of practising clinicians and academics. Results: A total of 283 responses received, 61.1% were men with a mean age of 48 years. Responses originated from 23 countries. The majority were from the Middle East (79.2%), whereas 29.9% were from African countries. Over half of physicians (51.1%) held high-level speciality qualifications and were senior clinicians or academics (50.9%). Regarding engagement in research, 41.3% were interested in research but not involved at the time of the survey, 38.5% were involved but not formally employed in a research role, 12.7% had formal research roles, and 7.4% were not interested in research. Majority conducting research held lead-investigator roles (44.2%) followed by co-investigator roles in 37.9% of respondents. Most of the research work was self-initiated original research (42.6%) followed by clinical case series (35.7%). Main motivators to conduct research were contributing to the practice and improving patients' care. Main deterrents to research were lack (41.7% of respondents) and/or difficulty in acquiring research funding (50.2%), in addition to the lack of research-protected time (40.5%). Conclusions: The majority of physicians interested and/or involved in research are not formally employed in a research role. The facilitators seem to stem from personal interest and professional recognition, whereas barriers result from lack of time, support, and expertise.
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Nephrocalcinosis in genetically proved dopa-responsive dystonia due to sepiapterin reductase deficiency in a Libyan Girl p. 315
Samira A Etarhuni, Adel M Zeglam, Awatef S Elbouaishi, Abdulbast Mahdi Sharfddin
Dopa-responsive dystonia (DRD) encompasses clinically and genetically heterogeneous disorders that typically manifest as limb-onset, diurnally fluctuating dystonia and exhibit a robust and sustained response levodopa treatment. GCH1 gene mutations are the most frequent cause of DRD. Mutations in the TH or SPR gene less often cause this condition. The index case is a 12-year-old young girl presented to the pediatric neurology clinic at the age of 8 years with tiptoes walking and deterioration of her gait. She is the product of first-degree consanguineous marriage with insignificant history. The index case has two sisters, one of whom suffers from learning difficulties, epilepsy, and bilateral nephrocalcinosis. Her two uncles had severe axonal polyneuropathy and died in their forties of unknown cause. Her magnetic resonance imaging of the brain demonstrated agenesis of the corpus callosum. Renal ultrasound studies showed bilateral nephrocalcinosis. Genetic DNA evaluation (whole-exome sequencing) identified the heterozygous variant c.207C>G,p. (Asp69Glu) in the SPR gene (OMIM: 182125), which leads to an amino acid exchange. Nine out of ten bioinformatic in silica programs predict a pathogenic effect for this variant. Treatment with levodopa\ benserazide 4:1 (Madopar) has not made any changes to the girl's condition.
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Direct gunshot wound to the testicular artery: A rare case report p. 320
Francesco Chiancone, Marco Fabiano, Nunzio Alberto Langella, Simone Sannino, Paolo Fedelini
Gunshot wounds (GSWs) to male genitalia are rare. They have mainly been described in the military and urban trauma settings, such as in sports activities or violent interactions. Male genitalia can be injured in an isolated way or in association with other genitourinary traumatism. GSWs can also determine vascular injuries which can be life-threatening. We report a rare case of direct GSW of the testicular artery and a scrotal hematoma without a primary injury of the testis. We present the case of a 29-year-old man with a direct GSW to the testicular artery. The patient underwent a surgical left inguinal exploration and orchiectomy. Intraoperative findings showed an actively bleeding from the left testicular artery at the level of the superficial inguinal ring. Dartos fascia and tunica vaginalis were thickened and testis was ischemic but not directly injured by GSW. After the surgery, cessation of bleeding and clinical stabilization occurred. The patient was discharged after 5 days. The pathology report showed an extensive ischemic infarction, heavy infiltration by acute inflammatory cells, excessive tissue edema, and congested blood vessels. Surgical exploration should be performed in all cases except for the most insignificant and superficial wound. All patients with a GSW to the external genitalia should be evaluated with an index of suspicion for other associated lesions. In this context, fertility and sexuality can be negatively impacted. Moreover, people with violence-related disabilities manifest a complex array of psychosocial and relational problems.
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Introduction to clinical research training - Dubai.(March-September 2020) p. 323
Huda E I Mustafa, Walaa A Kamel
It is well known that there is a great need for research training programs in the scientific community of the MENA region. The increasing number of clinical trials conducted in the region mandates that all involved personnel undergo the necessary training to work on increasingly complex studies, ensuring adequate quality in clinical trials and adherence to international guidelines. The Introduction to Clinical Research Training program ICRT conducted in Dubai by Harvard Medical School is considered one of the leading clinical research training programs in the region with great benefits and adjustable limitations.
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Oligomannate and aducanumab: Novel drugs for alzheimer disease p. 327
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
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