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  Citation statistics : Table of Contents
   2013| September-October  | Volume 5 | Issue 5  
    Online since July 13, 2017

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Osteoporosis and its management: Knowledge, attitudes and practices of physicians in United Arab Emirates
Salem A Beshyah, Wafa Al Mehri, Ali B Khalil
September-October 2013, 5(5):270-279
Background: Awareness among physicians is essential for early detection and timely treatment. Aim: To assess physicians' attitudes and knowledge to management of osteoporosis. Methods: A descriptive study using a questionnaire. The group studied consisted of a convenience sample of hospital and primary care physicians in the United Arab Emirates. Results: Responses were obtained from 173 physicians (49.7% female, 50.2% male). Over half were senior physicians (87) with the majority practicing in public institutions (158). The majority of the respondents thought that osteoporosis was an important clinical problem, and appreciated the fact that women in the Middle East are at an increased risk of osteoporosis. They thought that anti- osteoporosis management should be covered by national medical insurance schemes. However, more than 75% were unaware of the presence of regional guidelines on osteoporosis. Many respondents recognized the frequency and importance of vitamin D deficiency in non-skeletal health issues, though not all realized the need for higher doses in people with lower levels of sun exposure. A high proportion of respondents encouraged physical activity and cessation of smoking for all women. However, their use of medications was variable and not compatible with current guidelines. A relatively low level of knowledge was found regarding adequate dosing of several pharmacological treatments. Conclusions: Gaps in knowledge of physicians about bone health were identified. There is a need to extend medical knowledge regarding the contemporary management of osteoporosis and its risk factors.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  3 1,062 159
Significance of serum vascular endothelial growth factor in chronic liver disease and hepatocellular carcinoma: An exploratory study
Mabrouk Ghonaim, Rawhia El-Edel
September-October 2013, 5(5):288-295
Background and Objectives: Vascular endothelial growth factor (VEGF) is the most potent directly acting angiogenic growth factor that plays an important role in inducing tumor-associated angiogenesis. We evaluated the clinical significance of the circulating VEGF in patients with hepatocelluar carcinoma (HCC) and chronic liver disease (CLD). Patients and Methods: The study included 65 patients [20 with chronic viral hepatitis (CVH), 20 with liver cirrhosis (LC) and 25 with HCC] and 15 age- and gender- matched healthy subjects as controls. For each studied subject, detection of hepatitis viral markers, and assessment of liver function tests, α-fetoprotein (AFP) and VEGF were performed. Results: There was a significantly higher VEGF level in the sera of HCC patients as compared to other groups (p< 0.001). Serum VEGF level was significantly associated with portal vein tumor thrombosis (p< 0.01), but was not related to tumor size. There was no significant difference between the serum VEGF levels in either LC or CVH groups when compared to the controls. Moreover, no significant difference was detected between the different Child-Pugh classes among LC patients. Furthermore, no correlation was found between the level of serum VEGF and AFP, serum albumin, aminotransferases or prothrombin time (PT) in all the studied groups. Conclusions: Serum VEGF may be useful as a tumor marker for diagnosis of HCC and as a prognostic marker for tumor invasion. Large studies with greater numbers of patients and controls is required to support our conclusion.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  2 994 124
Efficacy of daily low dose versus intermittent isotretinoin regimens in patients with moderate acne vulgaris: A randomized-controlled trial
Nadia A El-Sherif, Azza SH Greiw, Amal M Benamer
September-October 2013, 5(5):296-302
Background: Oral isotretinoin, a vitamin A acid derivative, is the most effective treatment of severe acne. As its use is associated with many side effects, low-dose and intermittent application protocols for patients with mild or moderate acne have been reported. Aim: Our purpose was to compare the outcome of two different regimens of low dose isotretinoin; daily versus monthly doses in patients with moderate acne vulgaris. Patients and methods: A randomized controlled trial was conducted on 75 patients with moderate acne vulgaris attending outpatient clinic in the dermatology department at El-Jumhuriya hospital in Benghazi city during the period of June 2009 to June 2011. The patients were randomly assigned to two groups. Group 1 consisted of 45 patients, treated with a daily fixed dose of 20 mg of isotretinoin and group 2 consisted of 30 patients, treated with 20 mg of isotretinoin twice daily for seven days every month. Both groups were treated for a total period of four months. No topical treatments were permitted for both groups. Clinical assessment was done at 0, 4, 8, 12, and 16 weeks, which included acne lesion counts, total acne load, the assessment of severity score of acne and the side effects of the treatment. Patients were followed for six months after stopping treatment. Results: Fifty five patients with moderate acne vulgaris completed the study. Group 1 consisted of 32 patients with equal proportion of females and males; their mean age and standard deviation (SD) was 20.2±4.1 years. Group 2 consisted of 23 patients; 52.2% were females and 47.8% were males, their mean age and SD was 20±3.4 years. No statistically significant difference was observed according to the age and gender among both groups. Acne scores in each group were significantly lower at the end of treatment period. The mean decrease in the inflammatory and non-inflammatory lesion counts was more and earlier in group 1 compared to group 2, this difference was statistically insignificant. Both treatment regimens were well tolerated; cheilitis was the most frequent side-effect seen in 81.3% and 69.6% of patients in group 1 and group 2 respectively. However, there was no statistically significant differences among both groups regarding the frequency and severity of the side effects. The total cumulative dose was significantly higher in group 1 as compared to group 2 (P=0.000). During the follow- up period there was no statistically significant difference between both groups in relapse rate which has been seen in 7 (21.9%) patients in group 1 and 9 (39.1%) patients in group 2. Conclusion: Both isotretinoin regimens were safe and effective treatment for moderate acne vulgaris, however, intermittent sotretinoin regimen may be a cost- effective alternative.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  2 1,037 99
Microbiology of periodontitis in diabetic patients in Oran, Algeria
Amel Yacoubi
September-October 2013, 5(5):280-287
Background: Poorly controlled diabetes increases the risk of periodontitis. The link between diabetes and periodontal disease is increasingly recognized and that diabetics are more susceptible to periodontal disease. Material and methods: Cultures of sub-gingival plaque from 62 subjects suffering from aggressive periodontitis (37 patients with diabetes and 25 control cases) and 136 patients with chronic periodontitis (92 with diabetes and 44 control cases) were done on selective and nonselective media. The bacterial isolates were identified by conventional biochemical tests. Results: In aggressive periodontitis, Actinomyces israelii was present in patients with diabetes only while Actinomyces naeslundii was positive in the control group only. The rates of Eubacterium nodatum, Capnocytophaga spp, Peptostreptococcus anaerobius, and Eikenella corrodens. Actinobacillus actinomycetemcomitans were remarkably present in diabetic patients. Culture of Prevotella intermedia, Eubacterium spp and Campylobacter spp were more remarkable in control patients with aggressive periodontitis. On the other hand, in chronic periodontitis, Eikenella corrodens, Aggregatibacter aphrophilus, and Eubacterium were more noticeable in patients with diabetes. Conclusions: Periodontal pathogens are distinctly different in patients with diabetes from those without diabetes. The differences are evident in both aggressive and chronic periodontitis. These different microbiological characteristics are relevant in both dental and general medical practices.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  1 1,030 97
Intra-abdominal collection caused by fish bone migration
Abdulfattah Shaban, I Jaluta, R Abdulgader, A Burawais, Adnan F Bisheya, Abdusalam Aboghrara, A Abosauod, A Hamid
September-October 2013, 5(5):303-306
A 45-year-old Libyan male presented to the gastroenterology outpatient clinic with non-specific abdominal pain. After the initial diagnostic investigative imaging, he proceeded to undergo laparotomy in which a large mass was found adjacent to jejunum. The surgery confirmed the preoperative diagnosis of an intra-abdominal collection caused by extra- intestinal fishbone migration reported by ultrasonography and CT of the abdomen.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  1 949 102
Novel oral anticoagulants: A new era in anti-thrombotic therapy
Abdul Shlebak
September-October 2013, 5(5):247-253
For over half-a-century vitamin K antagonists (VKAs) served our patients well as effective anticoagulants, several novel oral anticoagulants (NOACs) have emerged and are now available as a suitable alternative for stroke prevention, venous thromboembolism prevention and treatment and to reduce vascular events in acute coronary syndrome. Compared to VKAs, the novel agents have several advantages including an improved efficacy/safety ratio, a faster onset of action, shorter plasma half-life, few drug or food interactions, and no requirement for regular monitoring. Although very promising in many regards their proper use will require new approaches in many daily aspects with dose adjustments may be required for patients with severe renal impairment or in the setting of drug interactions. The lack of specific antidote makes reversing their effect during bleeding or for emergency surgery particularly a major challenge. This article provides a focused overview on their current status.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  1 972 106
Cardiac risk factors and psychosocial variables in coronary artery disease: A case-control study of the younger population of United Arab Emirates
Amber Haque, Gohar Jamil, Azimeh Namawar
September-October 2013, 5(5):261-269
Various psychosocial factors are known to contribute to the development of coronary artery diseases (CAD). However, most of these studies are done in the West and little is known about the contribution of such variables in the younger population of the Arabian Gulf region. Objectives: This study investigated the association of various physical and psychological variables with the development of coronary artery disease among young adults (<45 years old) in the United Arab Emirates. Patients and Methods: A case-control study was conducted with 90 CAD patients who underwent catherization due to heart attack and 90 control subjects selected within public setting during 2011-2012. Patient demographics, personality types, emotional intelligence and stress handling skills were also studied. Results: Eighty eight percent of the CAD patients were expatriates [88% South Asian, 20% Middle Eastern and 1% South East Asian]. Ninety five percent were men and 71% were in their 30s. Ninety two percent came from low socio-economic backgrounds; only 12 % had above high school education and 92% were classified as nonprofessional workers. Majority were married. Patients were more likely to have family history of CAD, diabetes, hypertension, and smoking when compared to controls. Diabetes, hypertension, smoking, and sedentary lifestyle were significantly more frequent among patients. type A personality was more in CAD patients than controls (61% vs 36%; p=<0.01). Patients and controls were significantly different in terms of emotional self-management (p<0.001). All control subjects were classified as emotionally unhealthy whereas 64% of patients were reported being in this category. Only 27% of patients indicated themselves as type D, which did not significantly differ from 29% of the control subjects. There was no significant difference between the two groups in stress handling abilities. Conclusions: This study revealed new findings on the prevalence of psychosocial variables in CAD in this region. Of interest that personality type D, stress handling abilities, and emotional intelligence were not significantly evident as cardiac risk factors in this population. More culturally sensitive measurements are needed to elucidate these findings further.
[ABSTRACT]   Full text not available  [PDF]
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Late diagnosis of primary hyperoxaluria type 1 despite recurrent kidney stones and positive family history
Qasem Jamal Abumwais
September-October 2013, 5(5):307-309
Primary hyperoxaluria type 1 (PH1) is the most common form of primary hyperoxalurias. It results in increased synthesis and subsequent urinary excretion of the metabolic end product oxalate and the deposition of insoluble calcium oxalate in the kidney and urinary tract. Individuals with PH1 are at high risk for recurrent nephrolithiasis, nephrocalcinosis, and end-stage renal disease (ESRD). A 13 years-old female presented with fatigue, headache, nausea, vomiting, anorexia, renal colic. Initial clinical and laboratory investigations revealed ESRD and the patient was initiated on hemodialysis. Family history of PH1 and a history of recurrent kidney stones for 4 years was elicited. Subsequently, PH1 was confirmed by, physical examination, medical history, family history, laboratory tests, ultrasound imaging, X- ray, CT scanning and renal biopsy. As this disease is no longer rare in Jenin District of Palestine where this patient was seen, delayed diagnosis can not be justified. In conclusion, early diagnosis and effective treatment of PH1 in areas with high prevalence, such as the Jenin District of Palestine, is warranted as it may delay the progression towards ESRD or systemic oxalosis.
[ABSTRACT]   Full text not available  [PDF]
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Regional organ Assessment and Repair Centers (ARCs)
Sylvester M Black, Bryan A Whitson
September-October 2013, 5(5):243-246
Full text not available  [PDF]
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Management of venous thrombo-embolism: From leeches to novel oral anticoagulants
Noura Ghalib Ali, Bisher Oscar Mustafa
September-October 2013, 5(5):254-260
Venous thromboembolism (VTE) is one of the three major cardiovascular causes of death, but the history of venous thrombosis in miniature illustrates the development of medicine itself. Anticoagulation therapy has a long history. It started with leeches and passed through heparin, warfarin and low molecular weight heparin (LMWH). The development of the novel oral anticoagulants (NOACs) has marked the beginning of a new era in the treatment of VTE. Dabigatran, Rivaroxaban and Apixaban has been approved for different indications of anticoagulation which include non valvualr atrial fibrillation, venous thromboembolism prophylaxis and treatment. Use of these agents requires expertise in managing the dose and their adjustment in special cases like renal insufficiency as these agents carry risk of bleeding and proper antidote is still being developed. Knowledge of NOACs is essential for all medical personal as these agents are the future of the anticoagulation and they are set to replace warfarin and LMWH on the long term.
[ABSTRACT]   Full text not available  [PDF]
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