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   2018| November-December  | Volume 10 | Issue 6  
    Online since December 10, 2018

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Modulation of Parkinson's disease by the gut microbiota
Ali Eshaghpour, Mohammed M. Abu Hassan, Mohamed Sager, Yasser Ad'Dabbagh, Mahmood Akhtar
November-December 2018, 10(6):184-192
The gut microbiota consists of thousands of microbial species sharing a symbiotic relationship with the human host. These microorganisms have a well-defined role in maintaining optimal function through various avenues including metabolism and immunomodulation. A literature search was accomplished using Google Scholar, MEDLINE, PubMed, and relevant articles were nonsystematically reviewed. In states of dysregulation termed dysbiosis, the gut microbiota may play a role and can lead to various pathologies. Interestingly, pathological states are not entirely limited to the gut and have the potential to affect other systems. Notably, dysbiosis has been linked to several neurological pathologies, including Parkinson's disease (PD). Hallmarks of Parkinson's include buildup of Lewy bodies mediated by α-synucleinopathies, aggregation of misfolded proteins, and mitochondrial dysfunction, resulting in various motor and gastrointestinal dysfunctions. The gut microbiota is implicated in contributing to this pathology through communication via the gut–brain axis. While there have been preliminary findings indicating the potential for a causal role of the gut microbiota in PD, further research is required before making solid conclusions.
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Predictors of relapse in graves' hyperthyroidism after treatment with antithyroid drugs
Sami A Lawgaly, Houda Abou Kallousa, Salaheldin Gerryo
November-December 2018, 10(6):205-208
Background: Choice of the treatment for patients with Graves' hyperthyroidism depends on local preference, the higher recurrence risk, comorbidities, and the patient's preferences. About half of the patients relapse after a course of a standard antithyroid drug (ATD) therapy for Graves' disease. Objectives: The objective of this study was to determine the clinical and biochemical features of Graves' hyperthyroidism that can predict the relapse of the disease after a standard course of ATD therapy. Patients and Methods: We conducted a retrospective 6-month study of 79 patients with Graves' hyperthyroidism who were treated with ATD (carbimazole) therapy for 12–18 months and went into remission for at least 1 year after ATD withdrawal. Results: The relapse rate in Graves' hyperthyroidism after 1 year in remission was 40.5%; patients with younger age (<40 years) and with severe biochemical disease correlated significantly with relapse. Gender, presence of a palpable goiter, orbitopathy, and smoking habits were not significant predictors of relapse, perhaps because of the small sample size. Conclusions: Forty percent of Graves' hyperthyroidism relapsed after 1 year of remission. Younger age and severe biochemical disease at diagnosis predicted relapse.
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Biomarkers of oxidative stress and antioxidant defense in patients with type 1 diabetes mellitus
Rabia Alghazeer, Nadia Alghazir, Nuri Awayn, Obiyda Ahtiwesh, Sana Elgahmasi
November-December 2018, 10(6):198-204
Background: Oxidative stress has become the focus of interest in most biomedical disciplines and many types of clinical research. Increasing evidence from research on several diseases shows that oxidative stress is associated with the pathogenesis of diabetes and many other diseases. Objectives: We aimed to investigate the status of oxidative stress and antioxidant enzymes related parameters in type 1 diabetes mellitus (T1DM) patients. Patients and Methods: A total of 110 patients (70 patients newly diagnosed diabetic and 40 healthy) were studied by evaluating the level of lipid peroxidation (malondialdehyde [MDA]), nitric oxide (NO), fasting blood sugar (FBS), and glycated hemoglobin (HbA1c). Antioxidant enzymes, including superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx), were also evaluated. Results: The FBS and HbA1c levels were significantly higher in diabetic patients compared to those of healthy participants. Higher levels of MDA and NO were observed in the diabetic group compared to those in the healthy participants. A significant decrease was observed in serum SOD, CAT, and GPx activities in the serum of T1DM patients by 16.7%, 72.8%, and 15.3%, respectively (P < 0.05), as compared with their activities in the controls. On the basis of sex, both male and female patients showed a significant reduction in antioxidant levels as compared to their respective controls. Conclusions: These results indicated that oxidative status and antioxidant levels were affected in T1DM. The results suggested that the biomarkers such as the plasma levels of lipid peroxidation and antioxidants in early diagnosed diabetics can be used to monitor the developing complications of the diabetes.
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How to write an effective clinical document?
Ali M Ghellai, Kafia M Elhafi, Mamoon A Ghellai
November-December 2018, 10(6):209-214
Medical records are the most important practice tools used by doctors in their daily practice, regardless of specialty. The rule of thumb is “If it is not documented, it does not exist.” Deficiencies in the clinical documentation have been directly linked to increased incidence of adverse events and medical errors with resulting patient injury. Doctors are required to keep accurate and comprehensive medical records that will stand alone without their interpretation. An excellent medical record should be clear, concise, complete, accurate, and current factual record of clinical care. That must be recorded in a legible chronological and a confidential way while avoiding duplications and abbreviations. Written communication is vital to patients' quality of care, and thus this paper is dedicated to the basic written communication skills and concepts that are foundational to all healthcare professionals. In this practice point, we provide standardized templates for most common written documentation by physicians.
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Expanding the research on gut microbiota in health and disease
Dima K Abdelmannan, Muhammad Hamed Farooqi, Nureddin Ashammakhi, Salem A Beshyah
November-December 2018, 10(6):181-183
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Inter-grader agreement in the diabetic retinopathy screening program in Palestine
Riyad George Banayot
November-December 2018, 10(6):193-197
Aims: This audit aims to assess the quality and accuracy of primary graders in the diabetic retinopathy screening program in the occupied Palestinian territories. Subjects and Methods: A retrospective audit of 198 image sets from eight fully trained primary graders in the diabetic retinopathy screening program in the occupied Palestinian territories was performed. An expert grader regraded all images and audited their quality. The interobserver agreement between primary graders and the expert grader and the corresponding Kappa coefficient were determined for overall grading, referable, nonreferable disease, and ungradable disease. The audit standard was set at 80% for interobserver agreement with a Kappa coefficient of 0.7. Results: The interobserver agreement was 80% or better for overall outcome, referable, and nonreferable disease. The Kappa coefficient was 0.70 (substantial) for the overall grading results, 0.72 (substantial) for referable disease, 0.86 (almost perfect) for nonreferable disease, and was 0.21 (fair) for ungradable disease. About 82% of pictures showed two positions, and 75% of pictures showed good and adequate quality. Conclusions: The audit demonstrates an adequate level of quality and accuracy for primary grading in the diabetic retinopathy screening program in the occupied Palestinian territories.
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Ectopic parathyroid adenoma in the carotid sheath
Maisoon El Hemri, Abdulwahab M Elbarsha, Rafik R Elmehdawi
November-December 2018, 10(6):215-217
Parathyroid adenomas can be found in various ectopic positions including the carotid sheath. We report a 52-year-old Libyan woman who presented with neck mass and a fragility fracture. Her serum Calcium was elevated (14.3 mg/dl), as well as her parathyroid hormone (1202 pg/ml). Technetium-99m-sestamibi scan showed a large localized parathyroid adenoma at the upper lateral left aspect of the neck just below the left submandibular gland. The patient underwent surgical resection, and the histopathology confirmed the diagnosis of parathyroid adenoma. The rarity of the ectopic parathyroid adenoma in the carotid sheath led to a delayed diagnosis of this case. Therefore, ectopic parathyroid adenoma should be considered in the differential diagnosis of masses that arise from the carotid sheath.
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Kamal Abdulaziz Suliman Al-Shoumer (1961-2018)
Thamer Alessa, Ebaa Al-Ozairi, Salem A Beshyah
November-December 2018, 10(6):218-218
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