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   2016| September-October  | Volume 8 | Issue 5  
    Online since July 11, 2017

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Health systems: A review of the concept, global challenges and reforms
Mohamed M B El-Fallah
September-October 2016, 8(5):134-148
The study of health systems (HSs) is an important but confusing field. Its unclear boundaries, overlap, and multiple interpretations of terms require conceptual clarification. In light of the available evidence, Firstly, it is very important to realize that the current HSs thinking addresses individual parts rather than the whole HS. Secondly, it fails to recognize that concentrating on the performance of one part of the HS may have damaging effects on the whole HS. Thirdly, current HSs thinking fails to address the views, interests and influence of human resources for health involved in the implementation of reform, and how people and communities are expected to benefit from it. Fourthly, it does not take into account the different meanings, perceptions, cultural values and beliefs that may influence the very different institutions and structures belonging to a HS and working towards the same goals. Fifthly, the structural parts of HSs are designed to work in a stable environment, rather than addressing the ever changing context. Finally, HSs thinking does not provide a structural response to cope with the variety of healthcare stakeholders. The way HSs are currently understood may contribute to their weak performance. The current understanding is fundamentally functionalist, because the practice has focused on the definition of the structure, units and functions at different levels of recursion. The analysis of the literature demonstrates that most existing HSs are underpinned by functionalist approaches. This review provides a conceptual framework for many of the studies that focuses on specific situations and localities and explores what other approaches and methodologies can offer, in order to develop a framework for a given HS, which is more relevant in theory and practice than the other functionalist frameworks that may have been adopted previously. This framework will hopefully also narrow the gap between HSs goals and performance.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
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Kallmann syndrome with short stature and pituitary hypoplasia
Salwa Baki, Raja El Latifi, Ghizlane El Mghari, Nawal El Ansari
September-October 2016, 8(5):188-192
Kallmann syndrome (KS) is a rare disease in which hypogonadotropic hypogonadism and anosmia co-exist. In KS, the gonadotropic deficiency is isolated, the other pituitary hormones, especially the growth hormone, are preserved. We report the case of a 17 year old male having a sporadic case of KS associated with growth retardation. The diagnosis was based on hormonal workup and specific features on the MRI. The pituitary gland was hypoplastic. The patient was diagnosed to have Kallmann's syndrome with short stature associated to pituitary hypoplasia. To the best of our knowledge, this is the first case to be described in the literature combining KS, short stature and hypoplastic pituitary gland.
[ABSTRACT]   Full text not available  [PDF]
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Effect of the muslims' ablution practice on nasal colonization of staphylococcus aureus
Mabrouk Mahmoud Ghonaim, Rawhia Hassan El-Edel
September-October 2016, 8(5):149-154
Background: The human nose contains many different types of bacteria including Staphylococcus aureus (S. aureus). It is possible to get rid of this pathogen using many topical antiseptics or antibiotics. However, good washing using clean water may be valuable to decrease colonization by this organism. Objectives: This study determined the effect of daily repeated nasal washing in the ablution process performed by Muslims before every prayer on the presence and density of S. aureus nasal colonization. Material and methods: Two groups of volunteers were selected from the students and staff who were selected from Taif University, Saudi Arabia and Menoufia University, Egypt. The first group included 200 subjects who are practicing ablution and prayer and the second group included 100 subjects who do not do ritual ablutions. Personal data were collected and swabs were obtained from inside of the nostrils from all volunteers. Swabs were obtained from worshipers before, directly after, and 2-hours after ablution. Cultures were performed on suitable media and identification of S. aureus was performed according to the standard bacteriological methods. Results: The rate of colonization by S. aureus was 62% among non-worshipers and 38% among worshipers before ablution with a non- significant difference. Among worshipers, the rate of isolation of S. aureus just before ablution was 38% and significantly reduced to 20% directly after ablution (p<0.01). It rises to 32% 2-hours after ablution. The microbial density of S. aureus was significantly (p<0.001) lower among worshipers than nonworshipers. Conclusion: Nasal washing in ablution can reduce S. aureus nasal colonization. It can be a simple, easy and effective way to reduce colonization by this organism and thereby decrease the occurrence of serious staphylococcal diseases.
[ABSTRACT]   Full text not available  [PDF]
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Free communications of the third qatar internal medicine conference; 6-8 October 2016; Doha, Qatar
Abdel-Naser El Zouki, Mohammed Zahid
September-October 2016, 8(5):219-258
These are the abstracts of the free communications of the Third Qatar Internal Medicine Conference held on 6th-8th October 2016 in Doha, Qatar. The program of the conference had different types of sessions include plenary lectures, mini-symposia, clinical debates, 12 workshops in different aspects of Internal Medicine, and a preconference post-graduate course on “Best Practice in Internal Medicine”, were conducted by invited panel of international, regional and local experts. The conference was endorsed by the American College of Physicians, Society of Hospital Medicine-USA, Mediterranean Association for Study of Liver Disease, and Mediterranean Task Force for Cancer Control. It was also supported by the Royal college of Physicians of London. In addition to the plenary sessions, free communications selected from submitted abstracts were presented as oral communications or posters. These reflected regional disease profiles, patterns of clinical practice and locally conducted clinical and basic research. The focus of this abstract book is to disseminate specifically free communications as this is the unique feature of the conference. We hope by doing this, we expand the message of the congress to those who could not make it to the live events.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
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Vitamin D deficiency among adults attending primary health care centers in Abu Dhabi, United Arab Emirates
Khuloud Al Hammadi, Shamma Al Maamari, Kawthar Al Marzouqi, Arwa Al Senani, Abdulla Al Mazrouei, Nwanneka Ofiaeli, Ibtihal Darwish
September-October 2016, 8(5):155-159
Background: Deficiency of vitamin D is very common. It has been recognized as a pandemic worldwide.Although itfs sunny throughout the year, it is more common in the Middle East and Gulf region. Objectives: The goal of this study is to ascertain the prevalence of vitamin D deficiency in adults aged 21 to 60 years of age and to explore its relationship to different variables. Patients and Methods: A cross sectional study of 370 adults, aged 21-60 years,was conducted. A random selection of individuals was done from six primary health care clinics in the city of Abu Dhabi, United Arab Emirates, in the year of 2012.Serum levels of 25-hydroxy vitamin D, demographic data, body mass index, presence or absence of diabetes mellitus, hypertension, dyslipidemia, chronic kidney disease and inflammatory bowel disease were the variables of interest.The cutoff values for vitamin D were defined as follows: deficient (<50nmol/L), insufficient (50-75 nmol/L) and normal (. 75 nmol/L). Results: 237 (64%) of subjects were vitamin D deficient, 98 (26.5%) were vitamin D insufficient and only 35 (9.5%) were vitamin D sufficient. Vitamin D deficiency was more frequent in females than males [181(65.6%)vs. 56(59.6%)]. Higher prevalence of vitamin D deficiency was particularly noted in the age group 21-30 years (73.6%). No statistically significant relationships were noted between deficiency of vitamin D and ethnicity, diabetes mellitus, hypertension, dyslipidemia, chronic kidney disease and inflammatory bowel disease. Conclusions: Deficiency and insufficiency of vitamin D are very common among adults attending primary health care centers. It is more common in females and younger age groups. No other statistically significant relationships were noted.
[ABSTRACT]   Full text not available  [PDF]
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Pharmacists' management of diabetes during ramadan fasting
Muhammad Adnan, Asif Khaliq, Muhammad Fahad, Syed Abdullah Hussaini, Shahid Karim
September-October 2016, 8(5):160-167
Background: Proper management of diabetes requires a set of preventive and therapeutics measures that include proper diet, regular exercise, monitoring of blood glucose and insulin administration however, significant counseling and education of patients are required to be provided by pharmacists if patients are fasting. Objectives: This study investigated pharmacists' knowledge and practices towards diabetes management during the month of Ramadan. Methods: A cross sectional pre-validated questionnaire-based study was carried out among pharmacists practicing in hospital settings and pharmaceutical industry pharmacists. Data were collected from June 2015 to November 2015. The questionnaire covered: a) demographics, b) knowledge of diabetic risk factors and c) knowledge of blood glucose levelssuch as normal, diagnostic, target levels require during fasting and during complications. Results: 288 pharmacists participated in the study; 69.1% were practicing pharmacists and 30.9% were industrial pharmacists. The majority qualified as Pharm D (70.5%) and most respondents (85.5%) have experience ranging between 1 to 5 years. A significant difference has been found between practicing pharmacists and industrial pharmacists regarding knowledge of diabetes risk factors, complications, normal and target blood glucose levels. The mean knowledge score for industrial pharmacist was higher than hospital and clinical pharmacists [9.5 (3.4) versus 6.8 (2.7); p<0.05]. Conclusion: The barriers that hinder the role of pharmacists in Pakistan should be addressed especially for practicing pharmacists. Initiation of education and training programs related to diabetic care for practicing pharmacists is required on urgent basis. Pre-Ramadan training is essential to enable pharmacists to counsel fasting diabetic patients effectively.
[ABSTRACT]   Full text not available  [PDF]
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Glucose homeostasis during ramadan fasting: First case series illustrated by flash glucose monitoring and ambulatory glucose profiling
Salem A Beshyah, Marcil Haddad, Marwa Kahwatiah
September-October 2016, 8(5):176-187
Background: The impact of fasting during the month of Ramadan, practiced by adult Muslims, on glucose homeostasis has attracted much attention recently with view to understanding the metabolic price of fasting and to help plan rational management. The flash glucose monitoring (FGM) expressed as ambulatory glucose profiles (AGP) provides a minimally invasive yet comprehensive insight into blood glucose (BG) changes in relationship to various physiological and behavioral factors. Objectives: To investigate the BG homeostasis during Ramadan fasting in a group of individuals with different states of glucose tolerance. Methods: Eight individuals who were fasting during Ramadan were studied by FGM using the Abbott's FreeStyle® Libre system. They included individuals with normal glucose tolerance during pregnancy (1), prediabetes (2), postbariatric hypoglycemia (1) and type 2 diabetes mellitus (4). Results: In the normal pregnancy AGP's fluctuated minimally around meals with some asymptomatic low BG readings on prolonged fasting. In those with prediabetes, most of the daytime BG were within normal but there was a minimal post-prandial rises and some asymptomatic lower readings on prolonged fasting too. In the case of the patient with history of post-bariatric hypoglycemia, daytime fasting periods had perfectly stable normal BG. However, marked early postprandial hyperglycemia occurred in the evening followed by a short-lived symptomatic hypoglycemia. In the 4 patients with diabetes, AGP showed high glucose exposure, wide variation and marked instability after both traditional meals of dawn time (Suhor) and sunset (Iftar) particularly in the later. A variably slow downward trend throughout the day was observed. The differences in the AGP's reflected both biological and behavioral differences between patients within the general picture. AGP's before, during and after Ramadan in 3 patients revealed distinctly-different profiles reflecting the Middle Eastern meal pattern, Ramadan meal pattern and Eid feasting respectively. For patients these findings were discussed with them and used to plan glycemic management. Conclusions: This is the first comprehensive demonstration of glucose changes during Ramadan fasting using AGP. The visually illustrated data give insights into glucoses homeostasis in diabetes and related disorders throughout whole day of Ramadan. This may help inform therapeutic decisions on individual basis and help plan future studies.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
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Second ASPED/ISPAD Diabetes postgraduate course; 12th-14th May, 2016, Abu Dhabi, United Arab Emirates
Nancy Elbarbary, Carine DeBeaufort, Asma Deeb
September-October 2016, 8(5):195-218
The second ASPED/ISPAD Diabetes postgraduate course is an intensive course initiated by the Arab Society of Paediatric Endocrinology and Diabetes (ASPED) in collaboration with the International Society of Pediatric and Adolescence Diabetes (ISPAD). The course is exclusively sponsored by Lilly, Gulf. The course was held in Abu Dhabi over 3 days. It was run by an expert group of faculty from 12 different countries. The faculty group consisted of 4 speakers from ISPAD, 13 speakers and mentors from ASPED. Candidates were selected following open competitive applications which was advertised by both ASPED and ISPAD. Strict enrolment criteria were agreed on by the ASPED/ISPAD course committee. 64 candidates (out of 142 applicants) from 12 countries were enrolled and attended the course. Course curriculum was delivered in the form of lectures, interactive sessions, case scenarios and research presentation in small group sessions. The themes of the curriculum featured; comprehensive diabetes care, diabetes registry (international and regional experience), dietary challenges, monogenic diabetes (international and regional experience), diabetes management in special circumstances (school, sick days and Ramadan fasting), diabetes complications; acute and chronic, psychology and patient empowerment, obesity and type 2 diabetes in children, novel therapeutic approaches and diabetes prevention and use of technology in diabetes management. The course ended with tasks to follow and recommendations. A task force of 7 members from 6 countries was nominated to initiate and follow up on the execution of the tasks. The main task was to start building up an ASPED diabetes registry amongst different Arab countries. Plans regarding curriculum, venue and course format for future annual courses will be implemented based on faculty and attendees feedback reports.
[ABSTRACT]   Full text not available  [PDF]
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Immunohistochemical evaluation of positive hormone receptors and HER2 overexpression in women with breast cancer
Zakarea AY Al-Khayat, Ahmed A Baban, Botan A Ali, Tamara AE Al-Mufty
September-October 2016, 8(5):168-175
Background: Breast cancer has a tremendous heterogeneity in its clinical behavior. The objective of this study is to assess the positive expression of estrogen receptors (ER), progesterone receptors (PR) and HER2 overexpression in relationship to the age of patients, and certain prognostic parameters such as tumor grade, size and lymph node involvement. Patients and methods: A cross sectional case study was conducted between June 2011 and June 2014 at the pathology department of Rizgary General Hospital, Erbil, Iraq. 114 Confirmed cases of breast cancer were studied. Immunohistochemistry was used to evaluate the expression of ER, PR and HER2 status. Patientsf mean age was 48±5 (Range: 28-83) years; 57% of them were ≥50 years. Results: The expression of ER and PR was 58.8% and 49.1% respectively. HER2 overexpression (score +3) was 29.8%. Hormone receptors (ER and PR) correlated significantly with age and grade of the tumor whereas HER2 overexpression correlated significantly with grade and lymph node involvement. An inverse correlation was observed between the distribution of both ER & PR and overexpression of HER2. Conclusions: Expression of hormone receptors were evident in about half while HER2 overexpression was observed in less than one third of patients in our population. Different and common correlations were observed between ER, PR and HER2 expression and other patient and tumor characteristics. HER2 overexpression is associated with an aggressive form of breast cancer with high histological grade and negative ER status.
[ABSTRACT]   Full text not available  [PDF]
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EKG quiz: “Confusion EKG!”
Yousef Darrat, Khalid Abozguia, Fathi Idris Ali
September-October 2016, 8(5):193-194
Full text not available  [PDF]
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