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- Volume 4, Issue 1, 2023
New Emirates Medical Journal - Volume 4, Issue 1, 2023
Volume 4, Issue 1, 2023
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A Case of Eosinophilic Cystitis treated with Mepolizumab
Authors: Saeed Alzaabi and Mohsen NasirBackgroundEosinophilic cystitis is a rare inflammatory cystitis of unknown origin. Common symptoms include urinary frequency, urgency, pain, and recurrent urinary tract infections. Currently used treatments include corticosteroids, anti-inflammatory drugs, antihistamines, and antibiotics. Here we present a case of successful treatment of eosinophilic cystitis with mepolizumab.
Case PresentationA 41-year-old female presented with urinary frequency, urgency, and suprapubic pain. She underwent multiple tests including cystoscopy and biopsy, which revealed a diagnosis of eosinophilic cystitis in 2000. She was initially managed with oral antihistamines and oral steroids. However, over the years her symptoms increased in frequency, intensity, and duration. Montelukast 10 mg daily started which did not show any improvement. In 2017 Mepolizumab 100 mg every 4 weeks started. The patient noted improvement after a few months, and she was tolerating her injections well without side effects and had no further flares of her condition.
DiscussionWe present a case of eosinophilic cystitis which was refractory to multiple treatments and responded well to mepolizumab. There are no definite guidelines for the management of EC and there is no curative treatment for this disease. Mepolizumab is an anti-IL-5 monoclonal antibody and the use of mepolizumab in the management of EC that is refractory to treatment have been reported in a few cases. The use of mepolizumab has been described in different diseases associated with eosinophilic inflammation such as severe eosinophilic asthma, eosinophilic esophagitis, eosinophilic chronic obstructive pulmonary disease, and severe nasal polyposis.
ConclusionMepolizumab can be considered a treatment option in EC cases refractory to the standard treatment. At this time, larger studies are needed to evaluate the efficacy and safety of mepolizumab in EC.
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Diagnostic and Management Challenges of Rapid Lung Metastasis of Gestational Trophoblastic Neoplasia after a Non-molar Pregnancy: A Case Report
Authors: Trilok Chand, Norbert Dreier, Urfan Ul Haq, Fady Hachem and Vikram KumarBackgroundPulmonary metastasis of pregnancy-related rare gestational trophoblastic disease is common, and a patient’s rapid clinical deterioration leads to a poor prognosis.
Case PresentationWe report a case of a non-pregnant woman with severe respiratory symptoms masquerading as pulmonary infection who was diagnosed with pulmonary metastasis of the gestational trophoblastic disease.
ConclusionThe timely diagnosis of pulmonary metastasis was the key aspect in the management of our case, and she survived and was discharged to home after a long hospitalization course.
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Acute Thrombocytopenia after Administration of Heparin and Tirofiban: Differential Diagnosis and Treatment
Authors: Thrasivoulos Konstantinou, Evangelos Sdogkos and Ioannis VogiatzisIntroductionDrug-induced thrombocytopenia (DIT) is a condition characterized by low platelet count after administration of a variety of drugs. It is most commonly seen in patients treated with heparin. Its diagnosis is complicated when more than one DIT-causing drug is co-administered. Patients with thrombocytopenia may present with minor or major hemorrhages, depending on the severity of the recess of the platelets.
Case DescriptionWe herein report an uncommon presentation of acute IIb/IIIa glycoprotein inhibitor-induced thrombocytopenia in a 50-year-old male who suffered from myocardial infarction. Serial complete blood counts revealed low platelet counts, rising after discontinuation of the administered IIb/IIIa inhibitor. Recovery was prompt, complete, and sustained with minimal costs.
ConclusionThis report highlights the importance of prompt recognition of severe thrombocytopenia caused by IIb/IIIa inhibitors, particularly tirofiban, by measuring platelet count before and after the initiation of tirofiban, as it can be resolved by the interruption of its infusion and early supportive treatment.
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Effects of COVID-19 Pandemic on Young Individuals - A Mini Review
Authors: Rohan Rishabh Susarla, Rania Zein Eldin and Ritika CoelhoBackgroundThe COVID-19 pandemic has dominated the last two years of the life of young individuals in every aspect. Medical illness associated with COVID-19 is only one element of the detrimental impact that it has had. The psychological, educational, and social aspects of lives of young individuals have been affected with potentially far-reaching effects. The aim of this review is to determine the negative impact of COVID-19 in each of these areas and inform future practices or policies on the management of young individuals impacted by COVID-19 or future pandemics of this magnitude.
MethodsWe have collated and analyzed data available on the psychosocial, educational, and social aspects of young individuals in an attempt to understand the negative impact of COVID-19 on this group. Data was collected from an extensive Medline search of relevant articles relating to the effect of COVID-19 on individuals less than eighteen years.
ResultsOur results show that although young individuals experienced a milder form of COVID-19 in the pandemic, conditions, such as anxiety, depression, and loss of routine, have caused considerable comorbidities in this population. Young individuals have also experienced a greater rise in obesity and a higher incidence of myopia. A key finding of this review showed that children with special needs experienced a lack of continuity of care. Additionally, distant and digital learning presented challenges for children from different backgrounds. Concerns regarding wider issues, such as finance, have also directly impacted young individuals. Vaccination for COVID-19 among children has also raised important ethical issues.
ConclusionCOVID-19 has negatively impacted the psychological, physical, and emotional needs of young individuals with potentially far-reaching consequences. A combined psychosocial and clinical approach to tackling the specific needs of young individuals is essential to support the needs and management of individuals affected by the pandemic. The findings of our review recommend measures to include balancing screen time with outdoor activity and encouraging the continued education of children regarding good health practices and vaccination in particular. We hope that this will inform future practices or policies on the management of young individuals impacted by COVID-19 or future pandemics of this magnitude.
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Electronic Cigarettes Versus Tobacco Poly Use: Reduced Oxidative Stress but Similar Inflammatory Effect
BackgroundSmoking in any form is a significant risk factor for developing cardiovascular diseases, chronic obstructive pulmonary disease, lung cancer, and other oxidative damage-induced diseases. The increasing global trend of E-cigarettes has led traditional smokers to perceive them as a safer option.
ObjectivesThis study aimed to compare the levels of malondialdehyde (MDA) as a marker of oxidative damage and high-sensitivity C-reactive protein (hs-CRP) as a marker of inflammation between pure E-cigarette users and tobacco poly-users (smoking combinations of traditional products). Moreover, it also evaluated the influence of Body Mass Index, frequency, and duration of vaping/smoking on these biomarkers.
Materials and MethodsThis analytical cross-sectional pilot study included 40 males aged 18-25 (20 pure E-cigarette users and 20 tobacco poly-users). MDA and hs-CRP were estimated on serum, and SPSS-Version 28.0.1.1 was used for data analysis. Mean hs-CRP and MDA levels for the two groups were compared using the Mann-Whitney-U test.
ResultsMean level of hs-CRP between the two groups was not significantly different. However, MDA levels were lower in pure E-cigarette users than in tobacco poly-users, especially among those with normal BMI and those who vaped/smoked more frequently and for a longer duration.
ConclusionOxidative damage was lesser for pure E-cigarette users and could potentially be the less harmful option than tobacco poly-use. However, E-cigarettes are not the safest substitute for conventional smoking as it causes a similar extent of risk for inflammation-related CVD. Findings need further exploration to study the long-term effects on a larger population group to draw definitive conclusions.
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Laparoscopic Approach to a Patient with Omental Infarction: A Case Report
BackgroundOmental infarction is an entity that seldom manifests with gastrointestinal symptoms and often presents a diagnostic challenge. Due to its non-specific presentation, it is usually not included as a differential diagnosis of acute abdomen, especially in an emergency setting.
Case PresentationWe present the case of a 38-year-old overweight female, seen in the emergency department, with a complaint of sudden onset of worsening epigastric abdominal pain for four days. The pain became more localized at the right iliac fossa two days before the admission. A physical examination revealed severe right iliac fossa tenderness and positive rebound tenderness.
A computed tomography of the abdomen was done and showed a localized area of mesenteric fat stranding in the right lumbar region reaching up to the inferior border of the right lobe of the liver with adjacent peritoneal fold thickening, likely suggesting inflammatory etiology. However, the appendix was visualized normally with a mild enhancement of the distal part suggesting secondary mild acute appendicitis.
A decision for diagnostic laparoscopy was made, where we found a 4x4 cm infarcted greater omental segment, which was excised and sent for histopathology.
ConclusionIdiopathic omental infarction is a rare cause of acute abdomen in adults and needs to be considered as a potential differential diagnosis, especially if the clinical finding does not correspond with common conditions, like acute appendicitis.
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Anesthetic Management of a Child with Adrenocortical Virilizing Tumour Excision
Authors: Sonal Khatavkar, Chhaya Suryawanshi, Shahbaz Haroon and Deepali PatilIntroductionA multidisciplinary team that includes an endocrinologist, radiologist, anesthesiologist, and surgeon is a prerequisite for adrenal gland surgeries. The prime indications for adrenal gland surgery can include both hormonal and non-hormonal secreting tumors. Adrenal hormone secreting tumors usually present to the anesthesiologist with a unique set of challenges that require a good preoperative evaluation and hemodynamic control, corrections of all electrolytes and metabolic imbalances, a carefully planned anesthetic strategy, detailed knowledge about the specific diseases, maintaining of postoperative adrenal function, and finally a good collaboration with other involved colleagues. This review will mainly focus on endocrine issues and anesthetic management during the resection of a hormone secreting adrenal gland tumor.
Case PresentationThis is a case report of a 1.5-year-old boy weighing 13.5 kg who was admitted to our hospital with complaints of an increase in height and weight more than appropriate for age, macroglossia, facial oedema, abnormally enlarged genitals and development of pubic hair for 6 months. On examination along with signs of precocious puberty, he had presented raised blood pressure for which he was started on medication.
ResultsOn ultrasonography, a 6*4 cm mass was seen in the right supra renal fossa which was confirmed on the CECT scan. He underwent surgery for the excision of the tumor mass under general anesthesia with a regional blockade (epidural). The histopathological report of the tumor specimen revealed Adrenocortical Carcinoma. The child required post-operative steroid treatment and subsequently was started on chemotherapy as well.
ConclusionThe perioperative medical management of active Adreno Cortical Carcinomas is complex enough, but anesthesia causes even more substantial changes in physiology. Treatment with steroids helps to maintain hemodynamics to a great extent.
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Standardized Criterion of Presepsin Reference Interval for Accurate and Early Diagnosis of Sepsis
Authors: Faraz Hassan Mirza, Faraz Ahmed Baig, Serajuddaula Syed, Ashok Kumar and Moazzam Ali ShahidBackgroundPresepsin is a soluble analog of CD14, recently validated as a new biomarker for sepsis. Different cut-off levels of Presepsin for the diagnosis of sepsis have been proposed however, the optimum threshold for early clinical discrimination of sepsis from non-infectious conditions remains unknown.
ObjectiveThis work was undertaken to define the reference interval of Presepsin for Sepsis according to the CLSI C28-A3c approved guideline.
MethodsReference individuals (N=72) receiving in-patient care at ICU for sepsis and complications were selected for the study. Presepsin concentrations were measured by enzyme-linked immunosorbent assay. Reference limits were calculated using the non-parametric robust method.
ResultsOverall, the reference range for Presepsin in sepsis patients was 24.2 -872.2 pg/mL (90% confidence interval). Peak values for males were relatively higher than for females and the presepsin concentrations were influenced by age.
ConclusionProposed reference interval could assist in accurate and early diagnosis of sepsis which would eventually improve the outcome in patients of all age groups.
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A Review of the Novel Antidiabetic Medications: Efficacy, Safety and Innovation
IntroductionType 2 diabetes is a chronic health condition affecting hundreds of millions of people. Type 2 diabetes has traditionally been combated with a combination of lifestyle modification, insulin therapy and pharmacological agents, including sulfonylureas, biguanides, thiazolidinediones and alpha-glucosidase inhibitors. Type 2 diabetes is associated with an increased risk of cardiovascular disease and the development of diabetic kidney disease. Although sulfonylureas are low-cost drugs and widely prescribed, they have been shown in recent cardiovascular outcome trials to present a high risk of hypoglycemia, which in turn increases the risk of negative cardiovascular outcomes. Metformin, a biguanide that is the most commonly-prescribed antidiabetic agent worldwide, is contraindicated in patients with risk factors for lactic acidosis, including heart failure and chronic kidney disease.
ObjectivesThe last decade has seen significant advances in the development of novel antidiabetic agents shown to possess both reno- and cardioprotective qualities. This article aims to review the available literature and recent studies demonstrating the efficacy and safety of these agents individually, as well as exploring areas of future development in the field.
MethodsThe reporting of this review is based on the 2020 PRISMA statement. A literature search for all papers related to antidiabetic medication was conducted using reliable sources such PubMed and Google Scholar Databases, including a recent meta-analysis of renal and cardiovascular outcome trials.
ConclusionA critical analysis of clinical trials on type 2 diabetes and the two most severe comorbidities in cardiovascular and chronic kidney diseases may help cardiologists, urologists and diabetes specialists to adapt their therapeutic approaches to individual patients. Data related to antidiabetic effects of agents of natural origin accompanied by their Cardioprotective and renoprotective capacity testify benefits of these compounds as novel therapeutic agents.
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Gut Microbiome and Insomnia: A Mini-Review
More LessBackgroundThe gut microbiome (microorganisms present in our gut) has emerged as an important determinative factor in a variety of diseases and health conditions. One new area in which the role of the gut microbiome is of intense interest is its role in various neurological manifestations, including insomnia, the most common sleep disorder. In this mini-review, we aim to highlight the latest research developments concerning the association between the gut microbiome and insomnia and summarize gut-brain interaction for a better understanding of the role of microbiota in insomnia.
MethodsOur search results included publications written in English from the year 2010 up to the year 2022. We used Pubmed, Google Scholar, and ScienceDirect to search for original articles pertaining to the relationship between the gut microbiome and insomnia using the following search terms: “Gut-brain Axis and Insomnia,” “Brain and Gut Microbiome,” ” Gut-brain Homeostasis”, and “Circadian Rhythm and Gut Microbiome”. Relevant articles from the reference list were reviewed in order to collect additional information.
ResultsStudies have shown that the microbiome-gut-brain axis is thus associated with the development of insomnia. The gut microbiome can have an important role in the development of insomnia. On the other hand, insomnia can also modulate the gut microbiome. However, scientific work in this field is limited as relevant scientific research is at the initial state.
ConclusionBacteria present in the gut send signals to the brain via the vagus nerve by stimulating the afferent neurons of the enteric nervous system and influencing sleep quality and stress reactivity of the hypothalamic-pituitary-adrenal axis. The gut microbiome also communicates with the nervous system via the neuroendocrine pathway through various metabolic products. Insomnia also influences the structure and function of the gut microbiome.
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Reversible Complete Heart Block in a Pregnant Woman Responding to Steroids: A rare Case Report
BackgroundComplete heart block (CHB) is the total absence of conduction from atria to ventricles with an escape rhythm most commonly arising from the AVN or His bundle. CHB in pregnancy is very rare, and most reported cases are due to congenital variety, where the pre-existing CHB from birth is either detected incidentally or presented with symptoms during pregnancy. Pregnancy is associated with various physiological changes, such as a pro-inflammatory, hypercoagulable state with possible oedema of the heart's conduction system, which may rarely give rise to CHB. There are no clear guidelines to manage CHB complicating pregnancy.
Case PresentationAn asymptomatic 27-year-old lady with G2P1L1, 39 weeks of gestation with breech presentation, was referred for delivery given the low maternal heart rate of 40 bpm. Per abdominal examination revealed a term size uterus with active contractions and a fetal heart rate of 140bpm. An ECG revealed a CHB with an escape rate of 40 bpm. Other routine investigations were normal, with negative serological evaluation for hepatitis B, C, and HIV. ANA and Anti-Ro ⁄ SSA antibodies. She underwent an emergency LSCS under spinal anaesthesia with a backup temporary pacemaker (TPM). She received a short course of empirical steroid therapy for three days as there were no obvious secondary causes for CHB, which reverted to sinus rhythm after 48 hours.
DiscussionCHB complicating pregnancy with or without symptoms may require definitive therapy in the form of permanent pacemaker implantation. However, the insertion of a TPM for managing pregnancy is controversial as opinion in the literature is divided. There are no reports of CHB occurring in pregnancy without congenital or other known acquired causes. In the reported case, the CHB reverted to sinus rhythm with a short course of IV steroid therapy without any subsequent need for a PPM implantation.
ConclusionCongenital CHB remains the most common cause of rarely seen CHB complicating pregnancy. Through the conduction system oedema and inflammation, physiological changes in gestation may rarely cause CHB during pregnancy. In the absence of congenital CHB and other demonstrable acquired causes, a short course of steroid therapy may reverse the CHB avoiding PPM implantation as shown in the reported case.
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A Retrospective Single Centre Analysis of the Incidence of Hospital Admission for Acute Coronary Syndrome During the COVID-19 Pandemic
BackgroundThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a pandemic due to ‘coronavirus disease 2019’ (COVID-19) that has led to millions of deaths. This may have resulted in a change in the rate of admissions for other potentially life-threatening conditions such as acute coronary syndromes (ACS). Therefore, we investigated the incidence of ACS admissions during the current pandemic and compared it to a similar period the year before.
MethodsThis was a retrospective analysis of all patients admitted to a tertiary cardiology centre with ACS between February 2019 and the end of April 2019 (pre-COVID) that was compared with admissions between the same three months in 2020 (post-COVID). The main outcomes of interest were to evaluate any potential reduction of ACS admissions during the pandemic or change in mortality. In addition, we evaluated the rate of patients proceeding to coronary angiography (CAG).
ResultsDuring the post-COVID period, only 200 patients were admitted with ACS as compared to 331 patients during the pre-COVID period (39.6% reduction; 95% confidence interval (CI): 34% - 44%; p<0.01). A reduction in the percentage of patients proceeding to CAG was also noted (253 patients during the pre-COVID period compared to only 134 patients in the post-COVID period (76.4% vs 67.0%; p = 0.02)) but no associated reduction of primary percutaneous coronary intervention was noted. No increase in in-hospital mortality was noted between the pre-COVID and post-COVID groups (1.5% vs 1% respectively; p = 0.62).
ConclusionThere was a significant reduction in admissions for ACS in the post-COVID period compared to a similar period prior. There was also a reduction in the overall invasive management of ACS, with less CAG performed but no associated reduction in the rate of PPCI. The in-hospital mortality rate was similar in the two groups.
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Hernia Surgical Treatment; Multi-options and Paucity of Statistical Conformation for the Preferred Surgical Option
Authors: Basheer Abdullah Marzoog and Kostin Sergey VladimirovichBackgroundHernia is a common pathology around the globe and is reported more frequently particularly inguinal hernia.
AimsTo identify the surgery of choice for the treatment of hernias by evaluating the required postoperative hospitalization time, as no other complications have been reported according to data from Mordovian Republic hospital.
Material and MethodsA retrospective cohort study involved 790 patients for the period 2017-2022 treated surgically for various types of hernia; inguinal hernia, umbilical hernia, spontaneously reduced strangulated post-operative ventral hernia, incarcerated post-operative ventral hernia, and hernia of the Lina Alba. The T-test was used for statistical analysis, and a one-way ANOVA test and Pearson correlation test were conducted using the Statistica program.
ResultsThe hospitalization period after Liechtenstein surgery is statistically less than Postemsky surgery (mean 6.88 days, 7.43 days, respectively, t value -2.29593, p<0.02) and laparoscopic surgery (mean 6.88 days, 8.19072 days, respectively, t value 4,206817, p<0,000031). At the same time, laparoscopic surgery has a shorter post-operative hospitalization than Postemsky surgery (t value -2.19326, p<0.02). According to the surgical approach, the patient’s post-operative hospitalization days differ (mean days: min. days; max. days, 7.50192: 0.00; 30.00). According to Postemsky (M ± m; 7.43262, ±0.167012), according to Martynov (M ± m; 8.37500, ±0.113440), according to Liechtenstein (M ± m; 6.88153, ±0.146845), according to Mayo (M ± m; 7.51282, ±0.280156), according to Bassini (M ± m; 8.77778, ± 2.379179), laparoscopically (M ± m; 8.19072, ± 0.268434), according to Sapezhko (M ± m; 8.25000, ± 1.380074), and another type of surgery (M ± m; 11.40000, ± 2.501999). Women (mean 8.525114 days) were hospitalized longer than men (mean 7.065371 days), t value 5.871044, p< 0.001. A statistically significant correlation has been found between age and postoperative hospitalization time (Pearson Rank Order Correlations r=0.215561, p <0.05).
ConclusionThe study shows that the Lichtenstein surgery is the surgery of choice in terms of hospitalization time after the surgery. Straight association between sex and age with postoperative hospitalization days.
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Examining the Extension of the Technology Acceptance Model (TAM) in Electronic Medical Records Among Community Pharmacists in Malaysia
More LessBackgroundElectronic medical records (EMR) have been proven to reduce medical errors in drug distribution. However, EMR adoption is still relatively low among Malaysian community pharmacists.
ObjectivesAs a result, this study aims to see how community pharmacists in Malaysia use the EMR system. The factors influencing the community pharmacist's intent in adopting EMR will also be determined.
MethodsThe Technology Acceptance Model (TAM) and Extended TAM were utilized in this study to determine Malaysian community pharmacists' main intention for using EMR. The information was gathered by surveying 144 community pharmacists nationwide. The data was analyzed using SPSS and Smart PLS software.
ResultsThe study found a positively significant relationship between Perceived Usefulness (PU) and Behavioural Intention to Use (BIU).
ConclusionThis study shows critical factors influencing the intention to use EMR among Malaysian community pharmacists. Hopefully, this study will better understand the importance of EMR in the healthcare industry.
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Duchenne Muscular Dystrophy Management and Treatment Access Challenges: Case Report
More LessIntroductionDuchenne muscular dystrophy (DMD) is a rare neuromuscular disease that causes muscle weakness with respiratory and cardiac complications. International DMD standard of care guidelines exist, but their implementation and DMD treatment access in the Middle East have historically been challenging. This report highlights sub-optimal management of DMD in the Middle East together with recommendations for best practice, and the first reported use of ataluren, a mutation-specific treatment for nonsense mutation DMD (nmDMD), in this region.
Case PresentationThe management of two patients in the United Arab Emirates diagnosed with nmDMD is described. Under multidisciplinary care, both patients were treated with corticosteroids as per international DMD standard of care guidelines. Although both patients presented with typical DMD signs/symptoms, one received a genetic diagnosis and treatment relatively late owing to low awareness of the early signs and symptoms of DMD among physicians in the region; delayed genetic diagnosis of DMD hinders early initiation of mutation-specific treatments such as ataluren. Moreover, this patient demonstrated low adherence to the treatment plan, potentially resulting from low DMD awareness and poor understanding of the benefit-risk of corticosteroids in the patient’s family. In contrast, the other patient was genetically diagnosed early at 25 months, was administered ataluren whilst ambulatory, and demonstrated high adherence to the management plan. Limited expertise in performing motor function assessments and complications with medical insurance for ataluren in the region created additional obstacles in the management of both patients.
ConclusionsThe contrasting experiences of these patients highlight the high variability of diagnosis and management of DMD in the Middle East. There is a need in the region to boost disease education for both public and professional communities, establish local DMD networks and guidelines, and improve access to treatments to improve the quality of care that patients with DMD receive.
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Pharmacological Treatment of Children and Adolescents Diagnosed with Attention-deficit/hyperactivity Disorder at Mental Health Services in Qatar: A Retrospective Study
Authors: Oraib Abdallah, Nour Isleem, Rania Abu-Kuhail, Sali El Hoseny, Yassin Eltorki and Noriya Al KhuzaeiBackgroundAttention-deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders affecting children. The consequences of ADHD could seriously impact the patient’s life, and thus parental training, behavioral therapies, and pharmacological interventions are the main therapeutic options applied. This study was conducted to explore the trends of prescribing pharmacological medications used in ADHD and identify the reasons for discontinuation of such medications.
MethodologyA retrospective chart review for patients diagnosed with ADHD at Child and Adolescent Mental Health Services (CAMHS) in Qatar from January 2019 to December 2019 was carried out. Patients less than 18 years old, diagnosed with ADHD as per the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and were on pharmacological treatment for ADHD were suitable to be included. Patients who were not on anti-ADHD medications were excluded from the study.
ResultsNinety-two patients were eligible to be included in the study. Autism Spectrum Disorder (ASD) was found to be the most coexisting condition in addition to ADHD in 16.3%. Methylphenidate was the most prescribed medication (68.5%), followed by atomoxetine (30.4%). None of the participants were found on modafinil, guanfacine, bupropion, or benzodiazepines, and none exceeded the maximum licensed dose of either methylphenidate or atomoxetine. Half (50%) of the sample on atomoxetine discontinued treatment compared to 14.2% in the methylphenidate group.
ConclusionThe clinical practice of prescribing pharmacological options for ADHD was thoroughly in alignment with international guidelines. The effects of long-term use of these psychotropics in this particular group of patients on their neurobiological, behavioral, and physical health should be studied further.
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Perinatal Outcome in Pregnant Women with Heart Disease
Authors: DR Noopur R. Kedia, DR Mohit Kejariwal and Malay JhancyWith improved technology and better access to health care, the number of pregnant women with heart diseases is increasing. Due to various physiological changes in pregnancy, women with heart diseases are at increased risk of both maternal and fetal complications. Thus, pregnancy with heart disease is considered a high-risk pregnancy. In the near future, the burden on the healthcare system will increase and we will be required to answer various questions about the different outcomes possible and their management. If women are made aware of the various risks associated with their pregnancies, they can make informed life choices. This can only be achieved if more objective data is offered to her [1]. In this article, we review the available data on the observed perinatal outcomes in mothers with heart disease, their management, and what lacunas need to be filled, so as to be able to provide better care. Relevant articles were referred and data was summed. We concluded that in the majority of studies, the odds for adverse neonatal outcomes like preterm birth, low birth weight, stillbirth, low Apgar score and admissions to neonatal intensive care unit were higher among pregnant women with heart disease as compared to women with no heart disease.
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A Cross-sectional Study to Associate BMI with Pressure Pain Threshold and Pain Tolerance Among Healthy Young Individuals
Authors: Rihab Sayed Sufiyan, Lin Jawish, Sarah Ait Tayeb, Aisha Bachir, Ramya Rathan and Miral Nagy F. SalamaBackgroundAlthough pain is common for everyone, it is a subjective sensation influenced by different variables. One factor that influences pain threshold and perception is body mass index (BMI). This study investigates the connection between BMI and pain by assessing the pressure pain threshold and tolerance on the median and ulnar nerves in the palms.
MethodsThe PPT and PT of 120 participants were measured with a digital pressure algometer (FPIX50; Wagner Instruments). Measurement sessions consisted of consecutive PPT and PT readings on the thenar and hypothenar eminence of the dominant and non-dominant hand. In addition, the PPT and PT were compared between BMI, thenar and hypothenar, dominant and non-dominant hand, and sexes.
ResultsThe results have shown that the PPT and PT increased with BMI. However, only three out of the eight readings were significant (p = <0.05). When comparing the thenar and hypothenar, the results revealed significantly higher PPT and PT levels in the hypothenar (p = < 0.001). The results comparing the PPT and PT between the dominant and non-dominant hand revealed a significantly higher PPT in the non-dominant hand reflected across the thenar and hypothenar (t= -6.197, p= <0.01) (t= -2.550, p= 0.012), respectively. In addition, males had higher PPT and PT values (p = <0.05).
ConclusionThe results suggest that individuals with higher BMI can tolerate more pain. They also indicate that the hypothenar eminence could withstand higher pain levels than the thenar eminence. In addition, our assessment also revealed a higher pain threshold observed in participants' non-dominant hands, but the same could not be deduced for the pressure pain tolerance. Furthermore, the results have shown that males could tolerate more pain than females.
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Adaptive and Compensatory Mechanisms of the Cardiovascular System and Disease Risk Factors in Young Males and Females
More LessBackgroundCardiovascular disease (CVD) is increasing dramatically in young people and is the leading cause of death worldwide.
AimsThis study aimed to evaluate differences in the adaptive and compensatory mechanisms of the cardiovascular system (CVS) in young men and women to determine the most significant risk factors and assess the stability of the non-invasive method used in the early detection of CVD risk factors in young people.
ObjectivesCurrently, early evaluation of CVD risk factors is possible only through invasive methods, such as the Framingham risk score and the SCORE chart. Therefore, the development of a more flexible and non-invasive method is crucial in large populations.
MethodsA cohort cross-sectional investigation examined 173 volunteers, divided into two groups according to gender (n1 female=83, n2 male=90), and their heart rate, blood pressure (SBP/DBP), height, weight, and waist and hip circumference were non-invasively measured. Then, the potential adaptation value (R.M. Baevsky et al., 1987), Martinet test (MT), body mass index (BMI), and waist/hip ratio were calculated. Moreover, we collected information on lifestyle risk factors, including tobacco smoking, alcohol consumption, factors related to unhealthy diet, lack of physical activity, sleep deprivation, and anxiety, through special in-person interviews using paper/online questionnaires. The T-test and the x2 tests were applied for statistical analysis.
ResultsImpaired/pathological cardiovascular adaptation was observed in 11.54% of the female group and 46.07% of the male group. In the female group, cardiovascular recovery abnormalities were observed in the SBP, DBP, and HR MT in 20.59%, 16.18%, and 44.12%, respectively, whereas in the male group, 32.50%, 21.25% and 36.25%, respectively. Despite gender, these deviations were accompanied by the prevalence of sympathetic influences in the regulation of CVS functions in 72.73% of the first group and 69.66% of the second group. BMI was violated in 47.19% of males and 29.49% of females. The test results were identical to that in the invasive methods of assessment of CVD risk factors.
ConclusionAbnormalities in cardiovascular adaptation mechanisms in young women are less pronounced. Gender-dependent risk factors have high yields, such as obesity, low physical activity, and hypertension, which are more pronounced in men. The usability of the test requires further investigation on a larger sample.
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