New Emirates Medical Journal - Volume 5, Issue 1, 2024

Identifying the preferred learning modalities of students is crucial for a comprehensive understanding of the content of the study, and this can be achieved by employing the VARK inventory developed by Neil D. Fleming. The preferred learning modality of students significantly influences their learning outcomes.

This study aimed to identify the preferred learning modalities among health professional students.

Using a cross-sectional survey study design, we surveyed a consecutive sample of 351 students from three health professional programs: Nursing, Medical, and Pharmacy. After obtaining institutional board approval, a standardized self-administered VARK inventory (Visual, Aural, Read/write, Kinaesthetic), version 7.8, was employed. VARK scores were computed for each respondent and sent to the publisher for interpretation and categorization of learning preferences. Data were analyzed using SPSS version 28.0 and 29.0.

The findings revealed that 35.9% of participants were between 18-20 years old and identified as unimodal learners, with 19.09% preferring kinaesthetic learning. In the bimodal and trimodal categories, 5.98% exhibited preferences for AK (Aural, Kinaesthetic) and VAK (Visual, Aural, and Kinaesthetic). Only seventy students (19.9%) preferred multimodal learning patterns. Notably, all the college students were identified as unimodal learners.

Understanding these diverse learning preferences empowers students to employ appropriate learning methods, enhancing their overall learning experience. Faculty members can leverage this data to tailor teaching styles, thereby optimizing the learning environment. Further research across different universities can contribute to broader knowledge and informed strategies that promote effective learning processes.

Nowadays, the resistance to available antibiotics could be mentioned as a global threat to public health. The aim of this preliminary study was to conduct a retrospective survey associated with the prevalence of Nosocomial Infections (NIs) and the pattern of microbial resistance in a tertiary care referral hospital (Alzahra), Isfahan, Iran.

The data between the years 2016 to 2022 were extracted from the official database of hospital NI records. The microbiological culture results, represented by non-repetitive specimens, were further analyzed for pathogens and the pattern of antibiotic resistance. Then antibiotic susceptibility testing was done using standard methods of disk diffusion or Phoenix M50. The recorded variables have been presented as mean ± standard deviation, prevalence, and percentage. Data were analyzed using SPSS version 20.

For a duration of 5.5 years, the period prevalence of NIs was recorded as 2%, with more than 50% associated with ventilator-associated events and urinary tract infections. Klebsiella pneumonia, Acinetobacter baumannii, and Staphylococcus were the main pathogens. Further study of specimens from the year 2022 (n= 898) confirmed the most isolated bacteria as Klebsiella pneumonia (n = 290, 32%), Acinetobacter baumannii (n= 206, 23%), Enterococcus (faecium-fecalis n=125, 14%), Escherichia coli (n = 116, 13%), Staphylococcus aureus (n = 95, 11%), and Pseudomonas aeruginosa (n = 66, 7%). Resistance (R%) in Isfahan versus the whole country was confirmed for Klebsiella pneumonia (third or fourth generation of cephalosporins: R = 80.9 vs. 82%), fluoroquinolones (R = 76.6 vs. 73%), beta-lactamase inhibitors (R = 75 vs. 79%), carbapenems (R = 65.7 vs. 66%), and so on, respectively.

There has been reported an increase in the proportion of isolates resistant to cephalosporins, fluoroquinolones, and others. The variety of latent pathogens resistant to frequently administered antibiotics highlights the significance of continued and homogenous antimicrobial evidence-based pharmacotherapy investigations in Isfahan, Iran. Further studies in this direction are recommended.

Sickle cell anemia (SCA) poses significant metabolic challenges in affected individuals, yet the relationship between resting metabolic rate (RMR) and disease severity remains underexplored, particularly in Sudanese pediatric populations.

The aim of this study is to investigate the RMR and its correlation with disease severity scores and treatment with hydroxyurea in Sudanese patients with sickle cell disease.

We conducted a case-control study on 100 individuals aged 3-18 years, with 50 having SCA and 50 forming the healthy control group. RMR was computed using the Harris-Benedict formula, the World Health Organization equation, and the Buchowski formula. Severity scores were determined using a SCA Scoring System.

The mean age for the control group (9.52 ± 4.35 y) was similar to that of the SCA group, whether receiving or not receiving hydroxyl-urea (9.44 ± 4.164 and 9.68 ± 4.534, respectively (p=0.980). The resting metabolic rate (RMR) in the case group was significantly lower compared to the control group when using the Harris-Benedict and WHO equations (p = 0.004 and 0.001, respectively). A notable difference in RMR was observed between the case group (using the Buchowski formula) and the control group (using the Harris-Benedict equation) (p = 0.006), but not with the WHO equation (p = 0.054). Treatment with hydroxyl-urea was significantly associated with low severity scores among the SCA patients (p< 0.001).

The elevated RMR levels among Sudanese SCA patients compared to healthy subjects can be shown when calculated with the Buchowski formula but not with the other standard equations designed for healthy individuals.

Non-resolving pneumonia after antibiotic treatment is encountered on quite a few occasions in clinical practice and is estimated to account for approximately 15 percent of inpatient pulmonary consultations and 8 percent of bronchoscopies. This is more frequently seen in intensive care/ ventilated patient-associated pneumonia compared to community-acquired pneumonia. Treatment failures are mostly due to infectious causes, and only 20% of the cases are due to noninfectious causes.

We present here an interesting case of non-resolving pneumonia. Our patient was a 58-year-old Middle Eastern descendant male who presented with a cough with excessive mucoid sputum for 6 months. Chest radiology showed patchy consolidation in the right lower lobe, which gradually progressed to multilobar consolidation over several months despite treatment with antibiotic antifungal and steroids. Extensive evaluation was done with laboratory microbiological studies and bronchoscopy, but it was negative for tuberculosis and malignancy. So, the patient underwent an open lung biopsy. Histopathology and immunohistochemical staining were suggestive of adenocarcinoma of the lung, predominant lepidic pattern, with papillary, acinar patterns, and foci of invasion.

This case is interesting because of its unique clinical presentation with bronchorrhea and progressive pneumonia. Also, it reveals the role of surgical lung biopsy in navigating cases of difficult non-resolving pneumonia.

In the year 2009, Remdesivir or Veklury was discovered by Gilead Sciences for the management of hepatitis C, Ebola and Marburg virus disease through injection into a vein and then a few years later, 22nd Oct 2020 (United States), the drug was recommended for the management of COVID-19 under a provisional guideline.

The aim of this systematic review was to address pharmacotherapy approaches associated with the efficacy and side effects of remdesivir for the treatment of viral infections.

This is a focused, in-depth consequent guide approach and literature search, with a methodical assessment associated with the terms “Remdesivir,” “ Remdesivir Bioavailability,” “Remdesivir and Disease,” “ Remdesivir and COVID-19” that was done through Pubmed, Scopus, and Web of Science from their inception to 29 Oct 2023.

101 studies included in silico, in-vivo, and in-vitro experiments to test remdesivir therapeutic efficacy were selected based on the current, knowledgeable, and high-quality topics of manuscripts. Regarding efficacy, in addition to COVID-19, remdesivir shows therapeutic efficacy in other virus infections, such as hepatitis C, Ebola, and Marburg. In patients with COVID-19, remdesivir shortens the time to recovery, lowering progression to mechanical ventilation and decreasing hospital resources. Combination with dexamethasone in selected patients who need minimal conventional oxygen but are at high risk of severe COVID-19 was reported beneficial. Combination with chloroquine or hydroxychloroquine may cause a decrease in the antiviral activity of remdesivir, but dexamatason reported minimal or no reduction in drug exposure. However, synergistic effects were reported in combination with favipiravir, but methotrexate toxicity needs to be evaluated. Significant improvement in 'patients' conditions was reported in combination with methylprednisolone pulse therapy. Infusion-related reactions such as nausea, elevated liver enzymes, sweating, and hypotension are the most common side effects.

Different studies showed that with remdesivir pharmacotherapy, in addition to significant improvement in the recovery rate in those with COVID-19, the risk of adverse effects was significantly lower than in the control groups. To verify efficacy and side effects, besides attentive consideration of kidney and liver function, further evidence-based pharmacotherapy studies of remdesivir seem advantageous.

Although most cases of choriocarcinoma are of gestational origin, rare cases of extrauterine origin (such as pulmonary) have been reported, which have a poor prognosis.

We present one such rare case involving a 35-year-old female patient who initially presented to the emergency department with hemothorax and was found to have primary lung choriocarcinoma after multiple biopsies. The patient was properly managed and discharged in a healthy condition. However, she subsequently returned to the hospital with an intracranial haemorrhage and, unfortunately, passed away despite all efforts.

Due to the life-threatening initial presentations of primary pulmonary choriocarcinoma, it is essential to conduct an intensive work-up and maintain close observation when a patient initially presents with such symptoms. Early diagnosis is crucial to initiate appropriate treatment and prevent further complications. Therefore, we aimed to discuss and establish an emergency medicine department-based diagnostic pathway to contribute to the early diagnosis of this deadly malignancy.

Dermatoglyphics is the study of dermal ridge configuration on the skin of the fingers and palms, which can be used to diagnose chromosomal disorders and individual identification. Stress is characterized by feeling overwhelmed with mental or emotional pressure and evokes a biological response when any intrinsic or extrinsic stimulus is applied. Stress can cause acute effects and disorders that can trigger structural changes like atrophy and decrement in weight in different brain parts with long-term effects on the nervous system.

In this cross-sectional study, fingerprints of 150 participants of Gulf Medical University with an equal number of students and faculty/ staff were obtained by fingerprint scanner. Participants were classified into low, moderate, and high-stress levels by questionnaire. Collected data were statistically analyzed to find any association between dermatoglyphics and perceived stress levels.

Radial Loop was found to have the highest frequency as a percentage in all three groups. Plain whorl was the pattern with the second-highest percentage of occurrences. A notable observation was the lack of plain arch and low frequency of accidental whorl in the high-stress group.

The findings contribute to our understanding of the potential of dermatoglyphics as an indicator of perceived stress, opening up avenues for further research in utilizing these patterns as a non-invasive tool for assessing stress levels.

The association between visceral obesity and insulin resistance establishes an alternative risk for the onset of type 2 diabetes mellitus. The infiltration of macrophages in the visceral fatty tissue and the unreliable generation of adipokines are associated with mechanisms directing the progress of insulin resistance.

The objective of the study was to observe the relationship between visceral fat-associated adipokines and biochemical variables in central obese type 2 diabetic patients.

This study included 100 central obese subjects (both genders) aged 30-60 years newly diagnosed with type 2 diabetes mellitus. Out of the 100 participants, 73 were male and 27 were female. Serum adipokines were analyzed using an enzyme-linked immunosorbent assay. Biochemical parameters were assessed using the Cobas^® 6000 analyzer, while HbA1c levels were determined through high-performance liquid chromatography.

The results showed a significant relationship (p < 0.05) between the adipokines and HbA1c, fasting, and postprandial blood glucose levels. The results indicated a significant association (p < 0.05) between the adipokines and lipid profile with varying degrees in central obese type 2 diabetic subjects.

The relationship between visceral fat-associated adipokines and metabolic variables may influence the metabolic pathways in central obese type 2 diabetic patients. The adipokines are strong predictors for the intensification of diabetic risk and can be used as a diagnostic tool for risk assessment in the central obese population.

It is known that attitudes towards the elderly are an important variable affecting healthcare services. Considering the increasing trends of the population over 65 years in countries, it is important to determine the attitudes of future healthcare workers towards the elderly and to prepare them to serve in the health sector with activities that will lead to positive changes. In this direction, it is important to determine the effect of personality traits of prospective healthcare workers on their attitudes toward the elderly.

The research was conducted using the “relational survey model”. The study was conducted with 581 prospective healthcare workers. Personal Information Form, Eysenck Personality Questionnaire, and Kogan's Scale of Attitudes towards the Elderly were used as data collection tools. Data were obtained and analyzed using the online data collection method.

According to the results of the study, it was found that the attitudes of students who were healthcare candidates for older adults were generally positive (= 63.46±13.42). While there was a positive yet moderate and statistically significant correlation between attitudes towards the elderly and scores on the Extraversion subscale (r= 0.634, p<0.01) and a negative yet moderate and statistically significant correlation with scores on the Neuroticism (r= -0.568, p<0.01) and Psychoticism (r= -0.602, p<0.01) subscales. The personality traits extraversion, neuroticism, and psychoticism explained 58.6% of the attitude towards the elderly. According to the regression results, extraversion (β= 0.358; p<0.001) positively affected attitudes towards the elderly, whereas neuroticism (β= -0.310; p<0.001) and psychoticism (β= -0.307; p<0.001) negatively affected attitudes towards the elderly.

Given the important role of healthcare professionals in improving the care and quality of life of the elderly, it is necessary to develop strategies to improve the attitudes of future healthcare professionals towards the elderly. Consideration of personality traits in determining these strategies may contribute to the development of effective and personalized approaches.

The relationship between ECG changes in dilated nonischemic cardiomyopathy and ejection fraction (EF) is complex and poorly understood. Thus, this study aimed to identify the most common patterns of ECG associated with dilated nonischemic cardiomyopathy and their relationship to EF.

A retrospective cross-sectional study was conducted between 2019 and 2022, including 100 consecutive patients with nonischemic dilated cardiomyopathy. ECG data were rate, axis, left (LBBB) and right bundle branch block (RBBB), first-degree heart block, premature ventricular contractions, depth of S wave in leads V1 and V2, length of R wave in leads V2 and V6, the ratio of R/S in the lead V4, left ventricular hypertrophy (LVH), maximum R wave length in leads I, II, and III, poor R wave progression, ST-segment elevation, and T wave inversion.

The most common ECG pattern associated with cardiomyopathy was T-wave inversion (47%). The EF was 23.9± 8.87% in patients with LBBB and 25.5± 8.07% in patients without LBBB (P= 0.361). In patients with T-wave inversion, the EF was 23.4± 8.21%, and it was 26.28± 8.35% in patients without T-wave inversion (P= 0.086). In patients with LVH, the EF was 23.89± 7.84%, and it was 25.5± 8.66% in patients without LVH (P= 0.354). A negative nonsignificant correlation existed between SV1, SV2, RV2, RV6, R/S V4, and maximum R in I, II, III, and EF.

The study showed that T-wave inversion was the most common pattern associated with dilated nonischemic cardiomyopathy. The study provided insight into the negative correlation between EF and SV1, SV2, RV2, RV6, R/S V4, and maximum R in I, II, and III, although it did not reach a significant level.

Acceptance of COVID-19 vaccination of medical personnel reduces the spread of infection the research aimed to evaluate healthcare professionals' attitudes toward vaccination by the health belief model.

A quantitative, cross-sectional research design was used for the study.

Most medical personnel agreed to get the COVID-19 vaccination (84%; n=384). Medical workers over 45 (90%) showed more readiness for vaccination. The main pushbacks against the vaccination included the development of a vaccine in a short period (n=56; 73.7%), fear of side effects (n=49; 64.5%), lack of reliable information about vaccination (n=35; 46.1%), negative information spread by the media (n=26, 34.2%). Recommendations by healthcare workers (63.9%), health authorities (73.1), media (70%), large number of people being vaccinated (72.6%), and provision of trustworthy information (71.3%) facilitate vaccination.

The high rate of COVID-19 vaccination among medical personnel shows that they have a high risk perception of infection. Among Health Belief Model components, cues to actions were most important in willingness to carry out vaccination. Recommendations of the WHO and scientists significantly influence the willingness to carry out vaccination. The regulatory responsibilities of the state and the public's trust in it play a crucial role in raising the population's awareness about the vaccine.

The study investigated the relationship between Determining the Factors Related to Maternal-Fetal Attachment in Pregnant Mothers with Maternal-Fetal Attachment.

Demographic policies in Iran emphasize population, fertility, and maternal health. Maternal-fetal attachment (MFA) is a term used to describe conditions that help the mother cope with the physiological changes during pregnancy. MFA contributes significantly to the future health of mother and child. Thus, it is essential to identify the nature of maternal-fetal attachment during pregnancy, when women need to prepare for and adapt to childbirth. The present study was conducted to determine the factors related to maternal-fetal attachment in pregnant mothers of Arak City.

The study investigated the relationship between obstetric-demographic factors, emotional intelligence, marital satisfaction, and domestic violence with maternal-fetal attachment.

The present cross-sectional study was conducted on 177 pregnant mothers with a gestational age of 37-40 who were referred to health centers in Arak, Iran, for pregnancy care in 2022. Five questionnaires, including an obstetric-demographic questionnaire, Cranley's Standard Mother-Fetal Attachment Scale, Schutte Self-Report Emotional Intelligence Test, ENRICH marital satisfaction scale, and HITS domestic violence questionnaire, were used to measure the factors related to maternal-fetal attachment. Data were analyzed using SPSS21 software and descriptive and analytical statistics, including frequency distribution, Pearson correlation, t-test, Chi-square, Analysis of variance (ANOVA), and Multiple Logistic Regression model.

The mean of age women and age of husbands was 29.07± 5.88 years and 32.93± 5.28 years, respectively. The mean maternal-fetal attachment score was 88.12± 15.76. The mean of the emotional intelligence, the marital satisfaction and, the domestic violence was 4.71± 2.81, 121.88± 17.30, 37.86± 7.25, 6.54± 3.35, respectively. The interval between the current and the previous pregnancy had a range of 1-7 years and a mean of 4.71± 2.8 years.

There was a positive significant correlation between the maternal-fetal attachment score and the interval between the current and the previous pregnancy (r=0.22, p=0.02),

There was a positive significant correlation between the maternal-fetal attachment score and the emotional intelligence (r=0.31, p=0.001) the marital satisfaction (r=0.25, P=0.001). There was a negative significant correlation between the maternal-fetal attachment score and the domestic violence (r=-0.26, p=0.001

Identifying attachment-related factors helps the health staff carry out the necessary training and preventive measures to increase maternal-fetal attachment, especially in high-risk parents who need more care.

Aphasia, also known as language impairment, is a condition that affects the ability to express and understand language, as well as the ability to communicate. Crossed Aphasia in Dextral (CAD) is defined as aphasia after a right hemispheric stroke. Usually, aphasia is caused by a left-sided stroke in right-handed individuals. The prevalence of crossed aphasia in right-handed individuals is 0.38% to 3%. CAD is diagnosed when the following factors are present: aphasia, right-handed patient, no family h/o left-handedness, the structural integrity of the left hemisphere, and absence of brain damage in childhood. Another entity, Global Aphasia Without Hemiparesis (GAWH), is a rare stroke syndrome presenting with global aphasia without any weakness and occurs in the lesion of the left-sided peri-sylvian region.

A 56-year-old female with a known case of severe mitral stenosis with chronic AF on warfarin and not on regular medications was brought to our hospital as she had not communicated for the past day. On initial examination, the patient was conscious, globally aphasic, with left facial lag and no weakness of limbs. Her initial Computed Tomography (CT) brain scan was normal. She was not thrombolysed as she was out of the window. Brain Magnetic Resonance Imaging (MRI) showed right frontal, temporal, and parietal infarct in middle cerebral artery territory. She was treated conservatively with full-dose anticoagulation and, upon discharge, was started on oral anticoagulants. At the time of discharge, the patient was able to understand a few commands and was having echolalia with non-fluent speech. She was reviewed again at 3 months, and she had a full recovery of her speech.

CAD is a rare stroke syndrome with low prevalence. Even though all subtypes of aphasic syndromes are seen in CAD, Broca's aphasia is the common subtype, and men are affected commonly. Most patients also present with apraxia and visuospatial neglect. Our patient had all the criteria for the diagnosis of CAD and also had GAWH and showed rapid recovery. The cause of the disease in this patient was considered to be two different lesions involving language areas due to an embolism in her heart.

This case has been presented for its rarity due to the occurrence of both CAD and GAWH in the same patient in a right-sided infarct.

The WHO Emergency Committee advocates preventive strategies for COVID-19 management, emphasising vaccines as highly effective but acknowledging their limitations. Chloroquine and hydroxychloroquine, initially effective against COVID-19, were discontinued due to severe side effects. Further clinical trials are imperative to establish the safety and efficacy of new antiviral agents, some of which may have harmful effects on human development.

The shortcomings of various conventional treatments have prompted urgent efforts to discover safe, natural compounds that may be useful in combating COVID-19. This study aims to review research that has investigated the potential of traditional phytotherapies used by different populations for the prevention and symptomatic treatment of COVID-19 infection.

This paper reviewed scientific studies published through searching on search engines such as PubMed, Scopus, Google Scholar, ScienceDirect and Elsevier from May until October 2023.

The preventive and anti-COVID-19 attributes of Traditional Chinese Medicine, Ayurvedic formulations and African medicinal plants have been substantiated in research. In Nepal, recommendations endorse the utilisation of medicinal plants for herbal teas and homemade sanitizers. Zingiber officinale, Curcuma longa L. and Curcuma xanthorriza Roxb., along with Camellia sinensis are crucial Indonesian medicinal plants with potential for treating COVID-19. Z. officinale was predominantly chosen for relieving coughs and sore throats associated with COVID-19 in Saudi Arabia.

The immunomodulatory properties of medicinal plants, which may prove useful in combating COVID-19, have been verified via elevation of the level of peripheral WBCs, IgM, IgG; inhibition of leukotrienes and prostaglandins, maintenance of the integrity of intestinal mucosal barrier and regulation of HMGB1. The antiviral effects of herbs, including the inhibition of viral DNA and RNA replication, down-regulation of oxidative stress, and the impediment of SARS-CoV-2 access to vascular endothelial cells, suggest their potential to facilitate earlier recovery from COVID-19 infection.

Advancing scientific research in phytotherapy promises the possibility of novel approaches for effectively managing future infectious diseases and pandemics.

Vancomycin, used to treat severe gram-positive infections, can induce acute kidney injury. Some evidence introduced Interleukin-18 (IL-18) as an inflammatory mediator of ischemic damage to many organs and urinary IL-18 as a diagnostic biomarker of acute tubular necrosis.

The current study aimed to evaluate the urinary level of IL-18 after vancomycin therapy.

This cross-sectional study was conducted on patients under treatment with vancomycin selected from those referred to Dr. Sheikh Hospital, Mashhad, Iran, from 2018-2019. Urinary IL-18 was measured based on nanograms per milliliter using a human IL-18 enzyme-linked immunosorbent assay kit about this cytokine before vancomycin administration and then two days later. All the analyses were performed in SPSS software (version 25), and a P-value less than 0.05 was considered statistically significant.

A total of 36 patients with a mean age of 40.06±36.67 months were included in the study. The mean scores of IL-18 before and after taking vancomycin were 1453.00±555.01 and 1713.00±660.98, respectively. The IL-18 was significantly lower before vancomycin consumption than the level reported after 48 h (P<0.05).

The present study highlighted a higher level of urinary IL-18 after vancomycin treatment, which may indicate kidney injuries. Therefore, it may be considered a potential biomarker of acute tubular necrosis in patients under vancomycin therapy.

Over the last half-century, the treatment and management of autoimmune rheumatic diseases have progressively improved, particularly with the contribution of immunobiological or biological therapies known as disease-modifying antirheumatic drugs. Although these agents have been generally efficient in the management of rheumatoid arthritis (RA), some patients experience limited efficacy and non-responsiveness to treatment. In addition, they may cause adverse clinical effects, further aggravating the disease.

Despite advancements in biological therapies, significant clinical needs persist. This review aims to discuss novel treatments, guiding future guidelines and drug discoveries for rheumatoid arthritis.

This review follows the 2020 PRISMA statement, utilising PubMed and Google Scholar for literature search and emphasizing recent meta-analyses on the safety and efficacy of targeted immunobiological medications.

Small molecule inhibitors, whether utilised independently or in conjunction with Methotrexate, have been shown to contribute to effective disease management and have the potential for better adherence to the American College of Rheumatology criteria. Tocilizumab therapy demonstrates a significant reduction in disease activity and improves rates of disease remission when combined with Methotrexate. Investigations of mesenchymal stromal cell therapies have had promising outcomes, improving both cartilage quality (as evaluated by Macroscopic Cartilage Repair Assessment) and joint tenderness and swelling in clinical joint counts. Intra-articular administration of tolerogenic dendritic cells has displayed a capacity to alleviate pain, as measured by Visual Analog Scale scores, and enhance the Disease Activity Score across 28 joints. Resveratrol capsules supplemented with allopathic therapy show potential in reducing TNF-α and interleukin-6 serum levels.

More investigations and their analysis will improve patient outcomes and reduce adverse effects and the costs involved in developing and obtaining immunobiological drugs. Moreover, assessing the safety and efficacy of anti-RA properties of the bioactive compounds could offer less toxic and more cost-effective natural treatment options.