New Emirates Medical Journal - Volume 3, Issue 2, 2022

Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) is a rare, T-cell mediated hypersensitivity reaction that develops secondary to a drug reaction. Several drugs have been associated with DRESS syndrome, most commonly carbamazepine. The mechanism is not clearly understood. It is a life-threatening condition that can present with skin rash, hematologic abnormalities, lymphadenopathy, and organ failure.

The authors report a case of 43-year-old gentleman who developed DRESS syndrome secondary to lamotrigine and was found to have EBV reactivation. Patient was managed with supportive care; topical steroids and the culprit drug were discontinued. He had full recovery almost 2 weeks following treatment. DRESS syndrome can occur 2 weeks following exposure to an offending drug in susceptible individuals.

Lamotrigine and EBV reactivation are not frequently reported in patients with DRESS syndrome. Therefore, physicians should be vigilant about this rare drug related hypersensitivity reaction in order to prevent life threatening complications.

Pituitary Stalk Interruption Syndrome is a rare midline brain anomaly involving the pituitary gland that leads to a variable degree of pituitary hypofunction with a classic neuroimaging finding of the ectopic posterior pituitary, thin or absent pituitary stalk, and anterior pituitary hypoplasia.

We present the case of a term newborn who developed encephalopathy and respiratory distress during the neonatal period and was later diagnosed with Pituitary Stalk Interruption Syndrome.

Genetic defects have been identified in 5% of cases, and at times there are associated extra pituitary malformations. In spite of being a well-described syndrome, a detailed description of its neonatal presentation and course is lacking in the literature.

Based on the adverse event reporting system, the authors observed unique occupational and pharmacological trends in central serous chorioretinopathy (CSC); despite being a common condition in the region, there are no large epidemiological studies.

The study aims to describe the clinical profile, risk factors, and co-medications of CSC in a multispecialty hospital in the UAE.

Hospital based retrospective, observational study in which all the confirmed cases of CSC (272) seen between 2010 and 2019 were included. Supplementary data were collected on follow up visits or through telephonic calls.

The male: female ratio was 17:1; low socio-economic status was (155; 73.45%), and occupations such as drivers (61; 28.9%) and outdoor laborers (59; 27.96%) were the most commonly affected. The majority (78.05%; 185) were single expatriates. Financial worries (105; 50.72%) constituted the leading cause of stress. The usage of corticosteroids (83; 30.51%), nasal decongestants (14.70%), or both (17; 6.25%) within one year was common; mostly (82; 30.14%) for rhinitis/respiratory states, though grossly under-recognized. Muscle relaxants and psychotropic medications were the other major medications used in 24 (8.82%) and 25 (9.19%) cases prior to CSC. Seven of 15 women had at least one condition that alters the endocrinal milieu: Pregnancy (3), recent child birth (1), erratic oral contraceptive intake (1), menopause with liver dysfunction (1), hormone replacement therapy for menopause and endometriosis (1), ovarian cyst and infertility (1) hypothyroidism (3), and cushing syndrome (1). Chronic/ recurrent forms were seen in 31.08%. There were too few glaucoma patients despite both CSC and glaucoma being common among our patients.

CSC in Al-Ain predominantly affected males with a specific occupational predisposition. Emotional distress, financial worries, allergic disorders, and endocrinal disorders (among females) were common. Adverse drug events were under-reported compared to the usage of steroid or decongestant users. Suspected pharmacological associations included drugs that modulated the vasomotor tone.

Beyond their vital role in blood transfusion, ABO antigens were speculated to be involved in developing various human illnesses, including infectious, neoplastic, cardiovascular, and many others. Many researchers attempted to highlight the relationship between kidney disease and ABO phenotypes. The majority of these reports showed a predominance of blood group O antigen among patients with chronic kidney disease, while few had opposed these findings. We aimed in this study to elaborate on blood group typing among our hemodialysis patients and whether it has a prognostic effect on the overall mortality.

This is an observational, cross-sectional, retrospective study among chronic adult hemodialysis patients being dialyzed at Dubai Hospital over the past six months, from Jan 2021 till June 2021. The patient's demographic characteristics (age, sex, etiology of chronic kidney disease, medical comorbidities, and blood groups) were retrieved using an electronic hospital medical record system.

Our study population constituted 224 hemodialysis patients; their mean age was 55.4 years (16-94 years), 83.6% were UAE nationals, and 59.8% were males. Diabetic nephropathy was the etiology of end-stage kidney disease in 46%. ABO blood group distribution among our study population was as follows; group O was the commonest (45%), followed by group B positive (23%) and A Positive (20.9%). Among the UAE national patients group, O+ constitutes 46.9%, followed by B+ in 24%, and A+ in 21%. Nevertheless, group O+ was still the commonest among the non-national hemodialysis patients in 37.7%, A+ in 28.8%, and B+ in 24.4%. Additionally, group O-positive was the predominant group among all diabetic dialysis patients (47%). Nine patients died during the study period of different causes; out of them, 4 patients (44.4%) had group O positive.

Blood group O was the commonest blood group among our hemodialysis patients. Additionally, it was the commonest group in all diabetic dialysis patients. More studies from Arab countries are needed to comprehend the relationship between ABO blood phenotypes and kidney disease and whether certain blood groups have any role in a patient's progression to ESKD.

Polyarteritis nodosa or PAN is a rare disease. It is diagnosed frequently in middle age patients and the elderly. Reduction in hepatitis B virus infection has been associated with a reduction in the prevalence of PAN.

We present a 78-year-old patient with extensive skin lesions, weight loss, high blood pressure (HBP), polyneuropathy, evidence of hepatitis B virus infection, and a biopsy showing vasculitis of small or medium-sized arteries. Corticosteroid and antiviral treatment were prescribed to the patient and with great results.

PAN is a necrotizing vasculitis that typically affects medium-sized vessels with occasional involvement of small vessels. It is prevalent in older male patients, mostly in patients in their 60s who have recurrent skin ulcers and high blood pressure.

Pertussis seroprotection among neonates depends on maternal antibodies before receiving their first childhood acellular pertussis (DTaP) vaccination. Therefore, childbearing women need to have adequate seroprotection, either before conception or during the antenatal period, to protect their neonates from contracting neonatal pertussis. Given the global rise in neonatal pertussis incidence, there is a need to address the importance of protection against this infection by promoting booster vaccinations among female medical students as a preventive measure for their future generation. This paper addresses a part of our study on the seroprevalence of anti-PT IgG antibodies in female medical students who are more prone to acquire infections from the patients during their clinical rotations.

A cross-sectional study was conducted for three months by recruiting female medical students of RAK Medical and Health Sciences University, Ras Al Khaimah, UAE. The antibody levels (IgG) of pertussis (anti-PT) in blood sera of the study population were quantitated by enzyme-linked immunoassay. A 60 – 125 IU/mL titer was considered the positive titer level (p-value <0.05 being statistically significant).

Among 90 ethnically different student participants (mean age of 21 years), forty-four percent (n=40) showed detectable titers of anti-PT IgG antibodies. Whereas fourteen percent of participants (n=13) had high positive titers above 125U/mL, four percent (n=3) showed positive titers ranging from 60-125IU/mL. Two percent (n=2) were in borderline with 55 - <60IU/mL and twenty three percent (n=21) were < 55IU/mL titres. The mean ± SD of IgG titers was 42 ± 74.93 IU/mL with a range of 0-267 IU/mL

Only forty-four percent had detectable titers of anti-PT IgG antibodies, among whom fourteen percent (n=13) had high positive titers indicating recent infection. The results signify a low level of seroprotection among female medical students that emphasizes the need to promote booster vaccination for the high-risk group who work in the health profession.

Hemodialysis patients are not only prone to acquire COVID-19 infection but also more likely to suffer a higher rate of morbidity and mortality. This study aims to report the incidence and mortality rate of COVID-19 infection in our hemodialysis patients and to determine risk factors.

This is an observational, retrospective study conducted in the dialysis unit of Dubai Hospital. Our target population was hemodialysis patients who tested positive for COVID infection (PCR assay of the nasopharyngeal swab) from 1^st April 2020 to 31^st August 2021. Our primary outcome was to study the mortality rate associated with COVID-19 infection in dialysis patients in Dubai hospital. Our secondary objectives were to study the incidence and determine risk factors for the severity of infection. Patient demographics and clinical features were collected from medical record software, i.e., EPIC. Univariate Cox regression analysis was performed to evaluate potential risk factors for mortality in our cohort.

72 out of 250 (28.8%) hemodialysis patients acquired COVID infection during the study period, the median age was 54.32 (15-93) years, and 56.94% (n=41) were male. The most common comorbid was hypertension (59.72%), while the main symptom at presentation was shortness of breath (25%). One-third of patients required a different form of oxygen therapy, and 11.11% of patients were mechanically ventilated. The mortality rate was 16.6%. High median age, ischemic heart disease, low absolute lymphocyte count, and high levels of ferritin, LDH, and procalcitonin, as well as mechanical ventilation, were statistically significant risk factors associated with mortality.

The overall outcome of COVID infection in our hemodialysis patients was better compared to the hemodialysis population from other parts of the world.

Baclofen is a centrally acting GABA B receptor agonist, widely used for the treatment of neurological diseases ranging from hiccups to multiple sclerosis. As the drug is renally excreted, intoxication can rapidly develop in those patients with a reduced glomerular filtration rate. A strong index of clinical suspicion is essential to correctly diagnose the condition.

We report a case series of patients with advanced kidney disease and baclofen-induced encephalopathy that settled with discontinuation of the drug and hemodialysis sessions.

We report this cluster of patients with baclofen toxicity to highlight the common occurrence of neurotoxicity after its use in patients with end-stage renal disease and its resolution after cessation of the drug and hemodialysis sessions.

Allergic rhinitis (AR) is a common chronic health problem in the United Arab Emirates (UAE). Achieving adequate symptom control is pivotal to successful AR management, which may be attained following a stepwise treatment algorithm. Despite the availability of several guideline recommendations for the best management of AR, morbidity remains high in patients with AR, with treatment goals being far from reach.

The objective of this consensus statement was to discuss the currently available knowledge on the treatment of AR and to provide an expert opinion on the use of MP-AzeFlu (azelastine HCl, AZE; 137 µg per spray) and INCS (fluticasone propionate, FP; 50 µg per spray) for the effective management of AR in the UAE.

A consensus meet involving 13 otorhinolaryngologists and one pulmonologist was held in Dubai, UAE, to discuss the current understanding of the treatment and management of AR.

The panel advised to start AR pharmacotherapy with antihistamines (AH), leukotriene receptor antagonist (LTRA), INCS or MP-AzeFlu based on the visual analogue scale (VAS) score. In mild intermittent AR (VAS score <5/10), AH or LTRA is recommended as first-line therapy. However, in case of VAS score ≥5/10 or persistent AR, and treatment failure with AHs alone, INCS or MP-AzeFlu is recommended, followed by reassessment for 7 days to confirm a step-up or step-down therapy. Patients non-responsive to therapy were advised to step-up with MP-AzeFlu.

The panel advocated a combination of intranasal second-generation AH and INCS in a single device (Dymista^®) as first-line therapy for the management of AR. The algorithm provided herein can be applied in most healthcare settings by following a step-up or step-down strategy based on the VAS scores for AR control in the UAE.

To determine the knowledge, attitude and practice of the use of nanoparticles amongst health care professionals for treating oral cancer patients. Also, to understand the indications and contraindications of nanoparticles in treating oral cancer patients.

A descriptive cross-sectional study was executed amongst dental surgeons practising with undergraduate and post-graduate degrees. A Google questionnaire form was developed and distributed, and 102 authentic entries were short-listed. Data obtained from the study were recorded in Microsoft Excel 2007 version, and SPSS version 18.0 was used. Calculation of statistical analysis like mean and standard deviation and analysis between variations was done using student t-tests, and the association between variables was determined using Chi-square. A value was found significant when the p-value was less than 0.05.

Many practitioners have been using nanoparticles prepared by using nanobiotechnology for the last 2-4 years. About 92.9% of participants were well conversant with nanoparticles in treating oral cancer patients, out of which 88% are willing to specify therapeutic medicaments prepared using nano-biotechnology for oral cancer patients. About 94.9% of the dentists accepted the fact that nanomedicine can also be used in combination therapy for treating patients, and 98% stated that the use of nanotechnology for diagnosing as well as treating patients will not only be advantageous but will also be the new face of cancer management shortly.

Lack of awareness, increased tobacco consumption, and late diagnosis are the prime concerns regarding increased oral cancer cases and decreased prognosis. Nanoparticles having a small particulate size will be able to detect the changes on the surface and the cellular levels and inside the cells. Similarly, in the case of therapeutic use, nanoparticles are highly efficient in delivering drugs to systemic circulation by reducing the drug’s immunogenicity by releasing the drug in an environmentally responsive dose, thus lowering the frequency of administration and systemic toxicity.

Differences in free beta HCG and PAPP-A values, which are among the biochemical parameters in the double screening test, are frequently used for pregnancy follow-up, allowing aneuploidy and triploidy risk to be determined. In recent studies, it is suggested that the modified hemogram indices have gained importance as a marker in the prognosis of diseases.

In this study, we aimed to determine the hematological parameters, which are routinely applied in the first trimester of pregnancy, have any value in predicting the risk increase in the double screening test and in early diagnosis.

Pregnant women who conceived spontaneously and had double screening tests were included in the study. CBC results that were studied together with the first trimester screening test were reported. The patients were divided into two groups according to the results of the screening test as the combined risk ratio.

The mean age was found to be significantly higher in the high-risk group than in the low-risk group. Monocyte, % M and WBC values were significantly lower in the high-risk group (0,483±0,140, 5,58±1,44 and 8,75±2,12, respectively). There was no significant difference in NLR and PLR values compared between the groups. MPV values were lower and PAPP-A, PAPP-A MoM values were significantly lower in high-risk group compared to the low-risk group.

The findings support low Monocyte, % M and WBC values as a potential marker for the identification of high risk pregnancy in otherwise healthy pregnant women. The results indicate that CBC parameters commonly used in pregnancy can be used to predict the prognosis.

Hernias containing the appendix are well-known entities that preferentially affect the groin. The presence of an appendix within a Spigelian hernia, a rare ventral hernia that presents with nonspecific symptoms and location, adds significantly to the complexity and rarity of its diagnosis. Further, only 18 such cases were reported and published in the literature. We report a case of Spigelian hernia and appendicitis within the hernial sac to highlight the diagnostic challenges associated with this type of hernia.

In her late 30s, a female who underwent laparoscopic surgery for a uterine fibroid two and a half years back presented with right lower quadrant abdominal pain for two days. This followed abdominal pain on exertion for the previous nine months. On examination, there was tenderness, guarding, and a positive cough impulse in the right lower quadrant of the abdomen. Her body mass index was 37.53 kg/m². A contrast-enhanced computed tomography imaging of the abdomen reported a right iliac fossa incisional hernia with omental congestion necessitating an emergency laparoscopic surgery. At surgery, a Spigelian hernia was found at least 5 cm away from the port site scar of the previous surgery. The hernia contained an inflamed appendix. Thus, a diagnosis of Spigelian hernia and appendicitis within the hernial sac was made. A laparoscopic reduction and repair of the Spigelian hernia and a laparoscopic appendectomy were performed.

Whereas Spigelian hernias are considerably rare, the presence of an appendix within a Spigelian hernia sac is a more infrequent occurrence. Although the imaging modalities are often inconclusive, careful interpretation of the computed tomography imaging findings may reveal the pathology preoperatively.

Enteric fever is a common infection found in many developing countries around the world, which often has life-threatening complications if not treated promptly. One of the rarest complications of enteric fever is a splenic abscess.

Our case is that of a 32-year-old male, admitted with febrile illness, diagnosed with typhoid fever (enteric fever) with rare complication- multiple splenic abscesses, after his travel to an endemic area, which was effectively treated with antibiotics under an inpatient setting.

Early diagnosis with imaging modalities such as computed tomography can lead to better treatment approaches. Splenic abscesses are often treated with antibiotics or conservative treatment; however, non-responsive cases may require splenectomy.