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   2017| September-October  | Volume 9 | Issue 5  
    Online since September 4, 2017

 
 
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ORIGINAL ARTICLES
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
DOI:10.4103/ijmbs.ijmbs_10_17  
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.
  3,397 259 -
EDITORIAL
Predatory publishing: A wake-up call for editors and authors in the Middle East and Africa
Salem A Beshyah
September-October 2017, 9(5):123-125
DOI:10.4103/ijmbs.ijmbs_26_17  
  2,986 389 5
ORIGINAL ARTICLES
End-stage renal disease in children on maintenance dialysis in Benghazi, Libya
Ekram A Barakat Ben Sauod, Ahmed Awad Aklifa
September-October 2017, 9(5):128-131
DOI:10.4103/ijmbs.ijmbs_13_17  
Background: End-stage renal disease (ESRD) is a major cause of morbidity and mortality worldwide. Understanding the risk factors of ESRD can help identify preventive strategies and is critical for planning interventions to minimize the disease morbidity and mortality. Objectives: The aim is to identify the demographic and clinical characteristics and risk factors that contribute to ESRD 2005–2016. Settings: The dialysis unit of Benghazi Pediatric Hospital, Benghazi, Libya. Patients and Methods: This is a descriptive case series of all children with ESRD on maintenance dialysis (hemodialysis or peritoneal dialysis) between January 2006 and June 2016. Data were collected from patients' charts and the statistics department of the hospital. Demographic information, the age of onset, duration, and type of dialysis, likely etiology (if documented), complications and comorbidities were all documented and outcome including the cause of death. Results: The mean age of onset of ESRD was 8.5 years; nearly 41% of patients started dialysis at 6–10 years. The majority of patients (72%) resided locally. Male to female ratio was 1.5:1. Consanguinity of parents and family history of renal disease were reported by 12% and 16% of patients, respectively. More than half of patients (51.3%) had had no complications from dialysis. The most common known cause of ESRD was glomerulopathy (18.4%); including glomerulonephritis and nephrotic syndrome. Congenital and hereditary disorders involved 17.1% of cases. These were obstructive uropathy in 9.2% of the patients. The cause was not known in a large proportion (52.6%). Nearly 80% of the patients were alive during the study. Encephlophay (10.5%) and sepsis (6.5%) are the most common causes of death. Conclusions: The clinical profiles, causes, and outcome of ESRD in a specialized center in Benghazi were documented. The study is limited by the high proportion of unknown etiology. Full documentation of underlying etiology is a good clinical practice that should produce better epidemiological studies.
  2,650 276 -
Bronchoalveolar lavage: General utilization and correlation between special stains and microbiologic cultures at a major pediatric institution
Geok Chin Tan, Sura M Al-Rawabdeh, Amy L Leber, Samir B Kahwash
September-October 2017, 9(5):132-135
DOI:10.4103/ijmbs.ijmbs_22_17  
Background: Bronchoalveolar lavage (BAL) is a widely used method in the evaluation of lung pathology in adults and children. The main indications in children include confirming suspected infection/inflammation, aspiration pneumonia, and periodic evaluation of lungs in cystic fibrosis patients. Materials and Methods: We reviewed a total of 308 consecutive reports from pediatric BAL specimens as a part of quality assurance project aiming to compare morphologic findings of cytological examination with microbiology testing and evaluate impact of reported data at different stages of sample testing process. Results and Conclusions: We summarized our findings below and found that in most cases of infections, definitive clinical decisions were taken only after microbiologic culture results were available as compared to morphologic findings.
  2,424 271 -
CASE REPORTS
Recurrent thyrotoxicosis of extrathyroidal origin due to struma ovarii: A case report and review
Soad Imhmed R Alkhumsi, Salah E Gerryo, Saleh Hdia, Salem Edra, Yonis Zaidi, Abdulati Khalil
September-October 2017, 9(5):140-143
DOI:10.4103/ijmbs.ijmbs_7_17  
Struma ovarii (SO) is a recognized, albeit infrequent, cause of ectopic thyroid hormone secretion. Due to its rarity, only a few cases had been reported with fairly detailed information on thyroid function test (TFT) results. Furthermore, data are limited in the extent of local spread, surgical approach, and postoperative management. A 41-year-old woman from Libya presented with tremor, nervousness, weight loss, heat intolerance, and palpitation. She had also complained of lower abdominal pain and delayed periods. Two years earlier, she was diagnosed with hyperthyroidism, treated with a 12-month course of antithyroid medications resulting in full resolution of symptoms. Her TFTs revealed elevated serum triiodothyronine, thyroxine (T4), free T4, and low thyroid-stimulating hormone (TSH). Pelvic ultrasonography showed a left ovarian cystic mass and a suspicious of ectopic pregnancy was suggested. Abdominal surgical exploration with left salpingo-oophorectomy was performed. Gross and microscopic examinations confirmed the diagnosis of SO. Four weeks later, TFTs were repeated and revealed a high level of serum TSH, and low total T4 and free T4 levels. L-thyroxine replacement was started. In conclusion, Determination of the cause of thyrotoxicosis is essential for proper management. If clinical data and initial investigations are not consistent with common causes of hyperthyroidism, whole-body radioactive iodine scan should be considered. The definitive treatment for patients with SO is surgical resection via laparoscopic approach.
  2,147 201 -
Thyrotoxic graves' disease-induced by interferon-ribavirin therapy in a patient with amiodarone-induced hypothyroidism on thyroxine replacement
Adela Elamami Absat
September-October 2017, 9(5):144-146
DOI:10.4103/ijmbs.ijmbs_35_17  
An unusual type of drug-induced thyroid dysfunction is described. Thyrotoxicosis was seen in association with the use of interferon therapy despite prior established amiodarone-induced hypothyroidism. A 63-year-old female patient with a history of hypertension, high-grade ventricular arrhythmia on sotalol 80 mg daily was diagnosed to have amiodarone-induced hypothyroidism previously. She has been receiving thyroxine replacement therapy for 4 years. During the second cycle of interferon for hepatitis C virus relapse. She developed autonomous thyrotoxicosis. Her anti-thyroid peroxidase antibody was persistently negative before, during, and after either amiodarone or interferon while anti-thyroid stimulating hormone receptor antibody titer. Thyroid Tc-99m scan showed a high uptake during interferon therapy. To the best of the author's knowledge, this is the first report of a case of long-term hypothyroidism-induced by amiodarone therapy evolving into thyrotoxic Graves' disease-induced by interferon/ribavirin combination therapy in Libya reflecting an interaction of drugs and the background autoimmune disease.
  1,874 177 -
COMMENTARY
Organ preservation can do more
Nureddin Ashammakhi, Elmahdi A Elkhammas, Adam Elzagheid
September-October 2017, 9(5):126-127
DOI:10.4103/ijmbs.ijmbs_21_17  
  1,738 181 -