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The year in ramadan fasting research (2017): A narrative review
Salem A Beshyah, Issam M Hajjaji, Wanis H Ibrahim, Asma Deeb, Ashraf M El-Ghul, Khalid Bel'eed Akkari, Ashref A Tawil, Abdul Shlebak
March-April 2018, 10(2):39-53
Ramadan fasting is one of the five Pillars of Islam. While there are several exemptions from fasting, many Muslims with medical conditions still choose to fast. This may adversely affect their health if not addressed properly. Recently, there has been an increased interest in the health implications of Ramadan fasting. The authors performed a narrative, nonsystematic review of the literature including case reports, case series, and review articles indexed in PubMed and Google Scholar in a full calendar year. All records were reviewed by two coauthors at least. Studies were reviewed, summarized, and represented to provide a readily comprehensible concise account of the contributions made to research and clinical practice in 1 year (January–December 2017). The publications spanned physiological and clinical aspects and crossed conventional disciplinary lines in various languages, locations, and systems of journal access. A total of 92 and 82 were found in the PubMed and Google Scholar databases, respectively. Diabetes, hypoglycemia, insulin, and body composition were among the most relevant issues addressed this year. Discipline wise, diabetes, physiology, gastrointestinal, cardiovascular, eyes, respiratory, nephrology, neuropsychiatry, and endocrinology were most prominent. Other articles have considered professional competence, education, ethics, culture, and organization of care. Many of the research groups are based in emerging countries with Muslim-majority, but the publications are still widely distributed in internationally recognized journals. Several workers seem to have Ramadan fast at the center of their academic interest inferred from the number of publications to which they have contributed. The authors hope this review will help direct further research and should inform clinical practice guidance.
  10,466 656 15
Clinical characteristics of igG4-related disease in the United Arab Emirates: A retrospective single-center study
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
April-June 2021, 13(2):60-66
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.
  9,200 590 -
An intraoperative finding of double L5 nerve root
Abdulhamid Ben Shaban, Qayss Atiyah, Seraj Saleh Ajaj
November-December 2017, 9(6):169-171
Congenital anatomical anomalies of the lumbosacral nerve root are a rare condition. Various types of anomalies of the lumbosacral nerve roots have been described in the literature. Undiagnosed lumbosacral nerve root anomalies are at risk for iatrogenic injury, may contribute to wrong-site surgery, and contribute to continued postoperative symptoms. Here, we present the case of a 45-year-old female with discogenic back pain and L5 radiculopathy who found to have a duplicated left L5 nerve root intraoperatively.
  7,493 367 2
Rectal, axillary, and tympanic temperatures inneonates and infants with or without fever
Asma Ali Shagleb, Zinab Ashour Saad, Fauzi Abdalla Sagher
July-August 2018, 10(4):115-118
Objectives: To evaluate the agreement between temperature measured at the axilla or tympanic to rectum using standard techniques. Patients and Methods: We studied 50 neonates and 50 infants admitted to special care baby unit and Pediatric Gastroenterology Department with or without fever. Preterm, sick, malnourished neonates and uncooperative and crying infants were excluded from the study. Verbal consent from mothers was taken before the measurements. To adjust for rectal temperature, 0.55°C added to neonates and 0.65°C to infants' axillary temperature, 0.1°C to neonates, and 0.45°C to infants' tympanic membrane temperature. Results: There was a strong correlation (r) between 0.79 and 0.89 for axillary temperature with rectal temperature in neonates and infants, males and females, and for tympanic temperature with rectal in male infants. However, moderate correlation (r) was between 0.73 and 0.76 for tympanic temperature with rectal temperature in overall neonates and male and female infants. Axillary temperature missed 1% of pyrexia cases, whereas tympanic membrane measurements overestimate pyrexia in 5% of cases. Conclusion: It is safe reliable and convenient to use the axillary route for measurements of temperature in neonates and infants with or without fever.
  6,485 370 -
The dietary fat–heart disease hypothesis: An ongoing debate
Nasr Anaizi
January-February 2018, 10(1):3-8
The belief that the consumption of saturated fat as the primary source of daily energy needs is detrimental to heart health has held a firm grip on public consciousness for decades. It was initially based entirely on tenuous observational (correlation) studies but was later bolstered by a vast array of evidence and more direct observations from long-term randomized controlled trials and dietary intervention studies. Further support also came from the elucidation of the pathophysiology and molecular mechanisms involved in atherogenesis. However, in recent years, the association between dietary saturated fat and heart disease has come under attack based mainly on meta-analyses and large multinational studies most of which relying on questionnaires and diet recall. More recent publications have elevated the debate to a new level, leading some experts to question the evidence behind commonly accepted dietary recommendations, attracting media attention, and generating heated debates. Here, the most relevant studies will be reviewed defining the salient issues and where the proponents and opponents of the hypothesis stand.
  6,116 592 -
Prevention and management of cardiovascular disease risk factors during childhood
Elhadi H Aburawi
November-December 2017, 9(6):150-153
Coronary artery disease (CAD) or alternatively called atherosclerosis is the leading cause of death worldwide. There are multiple cardiovascular disease risk factors (CVDRFs), which are the precursors for CAD. A chronic inflammation prompted by cholesterol-rich lipoproteins and other noxious CVDRF is central in the pathogenesis of CAD. Endothelial dysfunction is the first step in the development of CAD. There are many theories in the development of the atherosclerotic process such as the hygiene theory, genetic susceptibility, and the endothelial injury. For the modification and management of CVDRF, the disturbances in lipid and glucose metabolism, hypertension, obesity, and smoking are the most important targets. The main aim of both primordial and primary preventions is to prevent the first cardiovascular event rather than preventing the further myocardial infarction. The prevention should be considered and started early in childhood and not after the first cardiac event. The primary healthcare physicians, obstetricians, neonatologists, and pediatricians need to work together on prevention of CAD early in life and as early as in fetal life.
  5,908 348 -
Fat facts: An overview of adipose tissue and lipids
Nasr H Anaizi
January-March 2019, 11(1):5-15
The term fat evokes a multitude of ideas, images, and prejudices. It encompasses the different types of adipose tissue (AT) and cellular components as well as the myriad of lipid molecules. The AT and lipid molecules throughout the body carry out scores of vital functions ranging from thermal insulation to energy homeostasis to signal transduction. A fact that is not generally appreciated is that in addition to its roles in energy balance and thermoregulation, the AT is also an integral part of both the endocrine and immune systems. Fatty acids (FAs) are the primary building blocks of most lipids. They serve as fuel, structural components, and regulatory molecules (mediators). Most of the free FAs in the body are either obtained from the diet or released by the AT (lipolysis). However, most of the short-chain FAs such as propionate and butyrate are generated in the colon by the fermentation of dietary fiber by the gut microbiota. In addition to providing fuel for the colon enterocytes, these molecules act on specific G protein-coupled receptors in the gut cells stimulating the release of glucagon-like peptide-1 and peptide YY simultaneously improving insulin sensitivity and curbing appetite. The essential FAs linoleic and α-linolenic give rise to two distinct classes of omega FAs, n-6 and n-3, respectively, and hence to more complex lipid derivatives (eicosanoids) which are involved in virtually all aspects of cellular function including immunomodulation and inflammation. These include prostacyclins, thromboxanes, leukotrienes, and epoxyeicosatrienoic acids.
  5,259 479 1
Evaluation of nutrition knowledge of professional football players
Isam Denna, Ali Elmabsout, Ashmisa Eltuhami, Shehab Alagory, Tahani Alfirjani, Fatima Barakat, Saif-Aleslam Almajouk, Mustafa Y. G Younis
January-February 2018, 10(1):21-24
Background: Adequate knowledge of nutrition is believed to influence the performance of endurance athletes. Objectives: To assess the level of nutrition knowledge among football players in Benghazi. Subjects and Methods: Following ethical approval, a cross-sectional study was conducted involving 101 football (soccer) players (25 ± 5 years of age) from seven clubs of the first and second divisions. The height (cm) and weight (kg) were recorded for each player. A questionnaire composed of three sections was filled out by each participant. It included questions concerning personal data, general nutrition, and specific knowledge concerning the appropriate foods to consume before, during, and after exercise. Results: The mean body mass index was 24 ± 2 kg/m2. Fifty-seven percent of the participants were below the university level of formal education. Furthermore, 75% reported that they never received any formal education related specifically to nutrition. In addition, 70% had no knowledge of the concept of the food pyramid, and only 18% of the players communicated with dieticians either during season or off-season. Only 22% answered correctly the questions about which foods are appropriate to consume before and after exercise. Noticeably, 81% of the participants did not correctly identify the contents of the nutrient to be consumed during exercise. Conclusions: The study revealed an alarming lack of nutrition knowledge among professional football players in Benghazi. The results highlight the need to establish specific programs for nutrition education for the players to enhance their knowledge in this critical area and positively influence their dietary habits and ultimately improve their physical performance. It is also important to emphasize the role of qualified dieticians in athletic clubs.
  5,153 456 -
A role for nurses during echocardiography procedure in ethnically sensitive settings
Elhadi H Aburawi, Ekhlass T Mohammad
April-June 2019, 11(2):90-92
Echocardiography is the main procedure for diagnosis in both acquired and congenital heart diseases (CHD). In pediatric cardiology, the surgeons accept more than 80% of children with CHD for surgery just based on echocardiography investigation. The role of nurses before, during, and after the procedure is well known since 1982. Their role is becoming more and more challenging with the development of technology and easier manipulation during echocardiography procedure. In this practice point, we are highlighting a new role for female cardiac nurses in the outpatient clinical setting. This new nurse's role is to handle the probe during the echocardiography procedure for the adolescent girls by a female nurse.
  5,059 156 -
Logistic regression analysis to predict mortality risk in COVID-19 patients from routine hematologic parameters
Sudhir Bhandari, Ajit Singh Shaktawat, Amit Tak, Bhoopendra Patel, Jyotsna Shukla, Sanjay Singhal, Kapil Gupta, Jitendra Gupta, Shivankan Kakkar, Amitabh Dube
April-June 2020, 12(2):123-129
Background: The triage of coronavirus-19 patients into various strata based on some prognostic indicator might prove a utilitarian strategy in the management of epidemic. The goal of health-care facilities is optimization of the use of medical resources. The present study aimed to develop a predictor model of mortality risk from routine hematologic parameters. Patients and Methods: In this retrospective case–control study, seventy survivors (n = 47) and nonsurvivors (n = 23) were enrolled who were laboratory-confirmed coronavirus disease 2019 (COVID-19) cases from SMS Medical College, Jaipur (Rajasthan, India). The clinical and routine blood profile of the survivors and nonsurvivors was recorded. A logistic regression model was fitted with step-wise method to the above dataset with dependent variable such as survivor or nonsurvivor and independent variables such as age, sex, symptoms, random blood glucose, and complete blood count. The best model was selected on the basis of Akaike information criterion. Results: It was observed that differential neutrophil count (%) and random blood sugar (RBS in mg/dL) are the statistically significant regressors (P < 0.05). The performance metrics of the model with 5-fold cross-validation showed area under the receiver operating characteristic curve, sensitivity, specificity, and validation accuracy to be 0.95, 90%, 92%, and 70%, respectively. The cutoff probability comes out at 0.30 for the outcome (nonsurvivor as success). Conclusion: The study concludes that differential neutrophil count and RBS levels can be used as early screening tools of mortality risk in COVID-19 patients and they assist in further patient management.
  4,675 519 -
Fake academia and bogus conferences are on the rise in the middle east: Time to act
Salem A Beshyah
November-December 2017, 9(6):147-149
  4,750 411 3
A bibliometric analysis of the international medical literature on predatory publishing
Anas S Beshyah, Momna Basher, Salem A Beshyah
January-March 2020, 12(1):23-32
Introduction: Predatory journals threaten the quality, honesty, and credibility of published scholarly work. This study aimed to provide a quantitative overview of the issues of predatory publishing and journals in international literature. Materials and Methods: We searched the Scopus database for “predatory journalism and publishing” in the abstract, keywords, and title between 2012 and 2018. The Scopus tools were used online for calculations, and VOSviewer was used to construct the visualization maps. Documents were analyzed for bibliographic and citation characteristics such as publication years, languages, countries or regions, journals, articles, and authors. Results: Four hundred and eleven articles were retrieved; 31.3% were “open access;” 46.0% were original research articles. Medical journals were of varying impact. Authors from the USA and affiliated institutions were the most dominant. One author has a clearly evident dedication to the subject being the first to coin the term “predatory” journals. Visualization maps showed sparse associations between most prolific authors, journals, and institutions. Conclusions: This study is the first bibliometric analysis of the threat of predatory journalism to medical research. Increasing anxiety is evident with an uncoordinated strive to fight it. The study represents a starting point to identify and quantify the gaps in the field. It should help pinpoint possible directions and potential collaborations for future action.
  4,650 304 3
Biochemical, physiological and body composition changes in patients with type 2 diabetes during Ramadan fasting
Haifa Sfar, Senda Sellami, Fatma Boukhayatia, Khadija Ben Naceur, Faika Ben Mami
November-December 2017, 9(6):164-168
Context: During the month of Ramadan, healthy Muslims must fast from dawn until sunset. However, religious rulings dispense the sick from this duty. During the fast, diabetic patients, are predisposed because of their disease, to an increased risk of hypoglycemia, loss of diabetes control, dehydration especially in summer and thromboembolic complications. Objectives: In order to better categorize the indications for the fasting of the month of Ramadan by people with type 2 diabetes mellitus (T2DM), we studied the effects of fasting on clinical; and biological parameters, dietary behavior, and physical activity. Subjects and Methods: We conducted an observational, descriptive, comparative study of patients with T2DM and 16 age- and sex-matched controls. Results: The average age of patients was 52 ± 4 years, and the mean duration of diabetes was 7 ± 4 years. The fasting did not seem to affect the anthropometric parameters and the glycemic control. For the lipid profile, fasting significantly increased high-density lipoprotein-cholesterol (P = 0.004), total cholesterol (P = 0.001) and triglycerides (P = 0.04). Dietary intake decreased from 54% before Ramadan to 47% in Ramadan (P = 0.001), and the intake of lipids increased from 27% to 37% during Ramadan (P = 0.001), in particular, the intake of polyunsaturated fatty acids, which doubled between the two periods (P = 0.009). Physical activity also showed a significant increase in patients and controls combined, essentially represented by the prayer of Tarawih. Conclusions: The Ramadan fast is well tolerated by T2DM patients, treated by diet or oral antidiabetic medications. They can stay free from serious complications, through regular medical support and self-monitoring. However, it is necessary for patients allowed to fast by their physician, to ensure a proper nutrition and obtain diabetes education.
  4,557 353 5
Five-Year experience with pyeloplasty using intubated and nonintubated techniques
Abdalla M Etabbal, Younis M El Bashari, Hussam H Bakar
November-December 2017, 9(6):154-158
Background: Ureteropelvic junction obstruction (UPJO) is an obstruction of urine flow from the renal pelvis to the ureter. This condition can be caused by congenital and acquired due to intrinsic or extrinsic factors. UPJO due to acquired conditions such as secondary to inflammation, passage stones, or ureteric folds is less common. In case of suspected UPJO, the critical decision to be made depends on the correlation between the radiologic findings and the physiologic picture. There have been recent and serious trials to perform the surgical repair of UPJO without intubation, with reservation of double J (DJ) stents and nephrostomy tubes for complex cases. The Aim of Study: The aim of the study was a comparison of the time of drain removal, hospital stay, complications, and the end result of surgery in intubated and nonintubated UPJO repair. Patients and Methods: A retrospective case serious study performed in Urological Departments at Benghazi Medical Center and Al-Hawari Urology Center by reviewing 51 files of consecutive patients of UPJO admitted to the department of urology from May 2010 to 2015. All patients were diagnosed using different diagnostic tools. Forty-three cases underwent reconstructive surgeries as follows: 41 (95.3%) patients underwent Anderson-Hynes-dismembered (A-H-D) pyeloplasties and 2 (4.7%) patients underwent VY Foley pyeloplasties. Out of 41 cases underwent A-H-D pyeloplasties, there were six cases underwent concomitant pyelolithotomy. Results: The time of removal percutaneous perinephric tube drain was 7th to 9th postoperative days and 7.9 ± 0.5 days. The postoperative hospital stay for all cases range from 7 days to 10 days and the mean was 8.0 ± 0.8 days. Conclusions: Despite both intubated and nonintubated techniques of UPJO repair are comparable regarding the hospital stay postoperative complication, the tubeless surgical repair of UPJO is more suitable for children and superior to the intubated technique regarding the cost of DJ stent and nephrectomy tube.
  4,589 279 -
Low awareness about breast self-examination and risk factors of breast cancer in Benghazi, Libya
FatmaYousuf M Ziuo, Ahmed Ahmed Twoier, Tahani Ragab Huria, Fayek Salah El-Khewisky
March-April 2018, 10(2):54-59
Background: Breast cancer is the most common cancer in women in the Eastern Mediterranean region and the leading cause of cancer mortality worldwide. Objectives: The study aimed to ascertain the level of awareness about the breast self-examination (BSE) and early detection of breast cancer and risks of breast cancer in the women of Benghazi, the second capital city of Libya. Subjects and Methods: A community-based survey was carried out in Benghazi to assess the knowledge, attitude, and practice of women at Benghazi about BSE and risk and protective factors of breast cancer. Cluster sampling technique was used. 30 clusters were selected during the year 2013. Results: Three thousand women were targeted; 2601 women were interviewed. Their mean age was 36.4 ± 10.9 years; more than half of them were married. The respondents' knowledge about BSE was poor with less than half of them (48.1%) having ever heard about BSE. Less than one-fifth of them (16.9%) knew what is BSE and less than one-quarter (25.7%) had satisfactory knowledge about the recommended frequency of BSE. About 39.0% of the respondents knew how to perform BSE, less than one-quarter of them (22.5%) knew when to start it. However, about three quarters (74.4%) of women considered BSE practice very important based on information from television programs as their source of knowledge (23.8). Less than half (43%) thought that high-fat diet and 42% stated that that physical inactivity are recognized risk factors for developing breast cancer. Conclusions: There is a poor knowledge about BSE and about risk and protective factors of breast cancer even among educated women in Benghazi. Primary prevention and early detection awareness should be the first step for prevention of breast cancer in Benghazi, Libya.
  4,439 417 1
Knowledge, attitude, and practice of parents regarding Vitamin A supplementation to children in Benghazi, Libya
Lubna Jamal Abdulmalek, Fatma Saleh Benkhaial
September-October 2018, 10(5):174-177
Background: According to the World Health Organization, Vitamin A deficiency can cause immune system depression in about 130 million preschool children and 7 million pregnant women mostly in developing countries and cause mortality risk up to 20%–30%. Objectives: We aimed to evaluate the knowledge, attitude, and practice of parents in Benghazi regarding the Vitamin A campaign. Subjects and Methods: A cross-sectional descriptive study of 1390 parents attending maternal and child health clinics and pediatric clinics at six main polyclinics, in Benghazi in April and May 2018. Results: Most of the parents were younger than 40 years (71%). Mothers constitute 68% of the study population and 52% of the children were male. Half of the parents had higher education. Only 40% of the parents were having good knowledge about the benefits and food sources of Vitamin A. The coverage rate of Vitamin A supplementation among under-five children in the study was 66%. The main reason for not giving their children Vitamin A supplementation in this study was the lack of awareness of the campaign during the previous year. However, 88% of the interviewed parents had a positive attitude of regiving Vitamin A to their children in the next campaign. Conclusions: The overall knowledge level of Vitamin A among the parents was relatively low; hence, more efforts are needed to promote awareness about Vitamin A supplementation.
  4,456 400 2
A rational approach to the evaluation and management of patients with hyperprolactinemia
Khaled M Aldahmani, Mussa H AlMalki, Salem A Beshyah
April-June 2020, 12(2):90-97
Prolactin has multiple biological functions. Hyperprolactinemia is a common condition in clinical practice both in women and men. It has multiple etiologies and may present with variable symptoms to different health-care providers. Therefore, a rational and systematic approach is paramount when evaluating patients with hyperprolactinemia to arrive at the correct diagnosis and institute the appropriate therapy. We here review the etiology, clinical presentation, and differential diagnosis of hyperprolactinemia and present a practical plan for further evaluation and management. It is most essential to establish the diagnosis and need for the treatment of patients with micro- and macro-prolactinomas and identify when only observation may be warranted. The biological, medical, and social contexts have to be considered to make the appropriate management decisions on an individual basis.
  4,200 392 -
Efficacy of Vitamin D3 versus Vitamin D2 in deficient and insufficient patients: An open-label, randomized controlled trial
Bina Nasim, Hana Mohammed Zuhair Al Sughaiyer, Samia Murad Abdul Rahman, Rubina F B. Inamdar, Razan Chakaki, Suha Abuhatab
April-June 2019, 11(2):57-61
Background: Vitamin D deficiency is very common worldwide but highly prevalent in the Gulf region. The clinical manifestations of Vitamin D deficiency vary depending on the severity and duration of the deficiency. Effective treatment should correct the vitamin D levels and improve other metabolic markers. Objectives: We aimed to (1) compare the efficacy of Vitamin D3 and Vitamin D2 in terms of raising serum 25(OH) total Vitamin D levels, (2) evaluate the time of its attainment, and (3) demonstrate the effect of replacement with either preparation on serum markers of bone or calcium metabolism. Patients and Methods: We conducted a randomized controlled study involving 250 adults with Vitamin D deficiency or insufficiency, assigned into 1:1 ratio to receive weekly capsules of either 50,000 IU of D2 or 50,000 IU of D3 for up to 12 weeks. Serum total Vitamin D level, calcium, phosphorus, alkaline phosphatase, and parathyroid hormone (PTH) levels were measured at 0, 8, and 12 weeks. Analysis of variance and nonparametric test Kruskal–Wallis were used for the comparison of quantitative values and the Chi-square test for comparison of categorical variables. Results: After 8 weeks of treatment, the improvement in Vitamin D level was greater for patients in the D3 group (mean = 18.74, standard error [SE] = 1.08) than that for D2 group (mean = 5.88, SE = 0.65), F (1, 240) = 113.840; P < 0.0005. Similarly after 12 weeks, the improvement in Vitamin D levels was greater for those in the D3 group (mean = 20.76, SE = 1.14) than that for the D2 group (mean = 7.93, SE = 0.79), F (1, 224) = 90.78; P < 0.0005. At 12 weeks, serum calcium, phosphorus, alkaline phosphatase, and PTH levels were not significantly different between the D3 and D2 treatment groups. Conclusions: Vitamin D3 is more efficacious and faster in increasing the level of total Vitamin D than Vitamin D2. However, no significant differences were evident on calcium, phosphorus, alkaline phosphatase, or PTH levels between groups.
  4,228 311 -
Rate, Timing, and Severity of hypoglycemia in adolescents with Type 1 diabetes during ramadan fasting: A study with freestyle libre flash glucose monitoring system
Bachar Afandi, Walid Kaplan, Lina Majd, Sana Roubi
January-February 2018, 10(1):9-11
Objectives: The objective of this study is to assess the frequency, timing, and severity of hypoglycemia in adolescents with type 1 diabetes mellitus (T1DM) during fasting the month of Ramadan. Patients and Methods: Twenty-five adolescents with T1DM who fasted Ramadan were monitored using the FreeStyle Libre® flash glucose monitoring (FGM) system. Percentage and total duration of hypoglycemia were extracted from the FGM downloads, and the differences were compared between different times of the day and night according to the eating pattern in Ramadan. Results: Mean age was 16 ± 3 years and mean glycated hemoglobin was 8.6 ± 1.2%, mean glucose level was 200 ± 84 mg/dl (11.1 ± 4.7 mmol/L), and the overall time spent in hypoglycemia was 5.7% ±3.0%. The average daily time spent in hypoglycemia was 1.39 h per patient. The incidence of hypoglycemia was 0% from 19:00 to 23:00 pm and 69% from 11:00 to 19:00. Analysis of hypoglycemia revealed that 65% were between 61 and 70 mg/dl and 8% lower than 50 mg/dl. Conclusions: Hypoglycemia is typically encountered during the hours preceding Iftar time indicating an over-effect of basal insulin. Basal insulin reduction is necessary to minimize the risk of hypoglycemia
  3,910 368 11
The rules and realities of authorship in biomedical journals: A cautionary tale for aspiring researchers
Salem A Beshyah, Wanis H Ibrahim, Elhadi H Aburawi, Elmahdi A Elkhammas
September-October 2018, 10(5):149-157
Medical research and publications are not only important for scientific development but also vital for the professional advancement and individual academic progress. Ranking is extremely important for appointments and leadership roles. Authorship is central to the credit and responsibility in medical research and appropriate assignment of authorship carries ethical, legal as well as intellectual implications. Despite being globally established for many years, deviation from the “International Committee of Medical Journal Editors (ICMJE)” criteria for authorship is still seen in varying orders of magnitude and in different shapes and forms. In this communication, we revisit the latest ICMJE criteria for authorship, highlight the increasingly recognized forms of potential of authorship misconduct (intentional or unintentional) and reflect on some emerging concepts and practices in authorship attribution. The target readers are primarily young and aspiring researchers who may err due to lack of experience but also veterans who may turn complacent for political reasons.
  3,808 375 5
Paradoxical Vitamin D deficiency in a sunny country: A narrative review of the literature from the United Arab Emirates (1992–2018)
Salem A Beshyah, Khadija Hafidh, Dima K Abdelmannan, Abdul Jabbar, Wafic S Wafa, Aly B Khalil
July-September 2019, 11(3):97-108
Deficiency of Vitamin D is a global problem related to lack of sunlight exposure and reduced dietary intake. Vitamin D deficiency (VDD) affects mainly skeletal structure and function but has a number of recognized nonskeletal effects that have wide ramifications. It sounds ironic that low serum Vitamin D levels are widely documented in a sunny country like the United Arab Emirates (UAE). The study objective was to review the literature on VDD in the UAE. This is a narrative nonsystematic review of the literature on the epidemiological and clinical aspects of Vitamin D status in the UAE based on PubMed search using two search terms “Vitamin D” and “Emirates.” We discuss the various themes that emerged as follows: epidemiology and disease burden of VDD in the UAE population in general and in specific groups (adults, children, females, and pregnant and nursing mothers); awareness of dietary intake, climate, genetics, and metabolic factors affecting serum Vitamin D levels; and the overview of current clinical management guidelines, interventional trials, and clinical practices. VDD is a widely documented health problem in the UAE population as a whole and in several special groups. This may have serious skeletal and nonskeletal health implications.
  3,834 301 3
Are oral hypoglycemic agents suitable as the first-line treatment for newly diagnosed type 2 diabetes in patients with severe hyperglycemia?
Abbas Ali Mansour, Ali Hussein Ali Alhamza, Ibrahim Abbood Zaboon
September-October 2017, 9(5):136-139
Objectives: To investigate if starting oral antihyperglycemic agent was enough to achieve the target glycated hemoglobin (HbA1c) in patients with newly diagnosed type 2 diabetes mellitus (T2DM), despite severe hyperglycemia, with or without symptoms. Patients and Methods: This was a retrospective patient data analysis for patients with newly diagnosed T2DM during January to December 2013. At baseline and after 3 months, HbA1c was measured. All patients started a diet and lifestyle changes in addition to oral hypoglycemic agents. Results: The enrolled patients were 764 in number. Of them, 331 (42.9%) achieved the target HbA1c <7% by oral hypoglycemic agents after 3 months, regardless of the treatment used. Multivariable logistic regression analysis showed that only presenting fasting plasma glucose <150 mg (odds ratio [OR] 2.193, 95% confidence interval [CI] 1.297–3.709) and drug treatment (OR 1.320, 95% CI 1.100–1.585) were the independent variables associated with achieving the glycemic target. Conclusions: Using antihyperglycemic agents as the first line for new T2DM, 42.9% patients can achieve target glycemic control. Even those with gross glycemic abnormalities, more than 60%, can achieve target glycemic control using diet, lifestyle change, and metformin. Prospective trials are needed to confirm such findings.
  3,807 275 -
Prevalence and risk factors of diabetic peripheral neuropathy in patients with Type 2 diabetes mellitus
Abdulwahab Elbarsha, Mohamed A. I. Hamedh, Muftah Elsaeiti
January-March 2019, 11(1):25-28
Background: Diabetic peripheral neuropathy (DPN) is common among people with diabetes and can result in foot ulceration and amputation. Objective: The objective of the study is to estimate the prevalence and risk factors of DPN among patients with Type 2 diabetes mellitus (T2DM) at a diabetes clinic in Benghazi Medical Center (BMC), Benghazi, Libya. Patients and Methods: Three hundred and sixty-seven patients with T2DM (127 [34.6%] males and 240 [65.4%] females) were included in this cross-sectional study. The patients aged ≥18 years, and they attended the outpatient diabetes clinics at BMC from May 2015 to October 2016, for routine follow-up. Patients with T1DM, gestational diabetes, and latent autoimmune diabetes in adults were excluded. Data including gender, age, type of DM, duration of DM, history of smoking, history of hypertension, weight, height, glycosylated hemoglobin (HbA1c), total cholesterol, triglyceride, low-density lipoprotein, high-density lipoprotein, creatinine, and urea were obtained by a prepared pro forma. Peripheral neuropathy was diagnosed in the presence of numbness, paresthesia, 10-g monofilament examination, and loss of vibration and joint position sensations. The relationship between DPN and its risk factors, in addition to independent predictors of DPN, was explored using multiple forward stepwise logistic regression and presented as an odds ratio (OR) and 95% confidence interval (CI). Results: The prevalence of DPN was 30.5% in the studied group. A statistical significant association found between DPN and age (P = 0.014), duration of DM (P < 0.001), macrovascular complications of DM (P < 0.001), diabetic retinopathy (P = 0.001), diabetic nephropathy (P < 0.001), poor glycemic control (high HbA1c) (P < 0.001), hypertension (P = 0.011), uncontrolled blood pressure (≥140/90 mmHg) (P = 0.007), and insulin treatment (P < 0.001). Multiple forward stepwise logistic regression analyses revealed two independent risk factors influencing DPN: diabetic nephropathy (OR = 1.976, 95% CI: 1.289–3.027) (P = 0.009) and insulin treatment (OR = 3.430, 95% CI: 2.021–5.821), (P < 0.001). Conclusions: The overall prevalence rate of DPN in this study was 30.5% among patients with T2DM. It increases with the presence of diabetic nephropathy and insulin treatment.
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High prevalence of dyslipidemia irrespective of obesity in the cape coast metropolis of Ghana
Samuel Acquah, Benjamin Ackon Eghan, Johnson Nyarko Boampong
July-August 2017, 9(4):103-110
Objective: To investigate the relationship between obesity, insulin resistance, and lipid profile in type 2 diabetes patients and nondiabetic controls in the Cape Coast Metropolis of Ghana. Patients and Methods: Levels of fasting blood glucose (FBG), glycosylated hemoglobin, lipid profile, insulin resistance, and β-cell function were measured in 115 diabetes patients and 115 age-matched nondiabetic controls. In addition, body weight, height, waist circumference (WC), hip circumference, and blood pressure were measured. Body mass index and waist-to-hip ratio were calculated. Results: Apart from diabetes patients with normal weight who exhibited higher (P < 0.05) FBG but lower systolic blood pressure than their overweight/obese counterparts, levels of all the other metabolites were comparable between the two weight groups in both diabetics and nondiabetic controls. Diabetic patients with systolic hypertension had higher (P < 0.05) low-density lipoprotein (LDL) and WC but nondiabetic hypertensives had lower (P < 0.05) FBG than their respective normotensives. In people with diabetes, dyslipidemia of total cholesterol (CHOL), LDL, and triglyceride were more prevalent in overweight/obese and systolic hypertensives. In controls, prevalence dyslipidemia of total and LDL CHOLs was higher in normal weight and hypertensives than their respective overweight/obese and normotensive counterparts. Conclusion: Nondiabetic respondents with normal weight may be at higher risk of cardiovascular disease through dyslipidemia than their overweight/obese counterpart. This metabolic paradox requires further investigations in the Ghanaian population.
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Mansour Al Mabrouk Ali Ben Halim (1937–2018)
Elhadi H Aburawi
July-August 2018, 10(4):145-145
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