bluuebunny/crossref_metadata_2025 huggingface dataset:
Exocrine drainage of the transplanted pancreas: A review
Authors: Beal Eliza , El-Hinnawi Ashraf , Whitson Bryan , Elkhammas Elmahdi , Henry Mitchell , Black Sylvester
Published: July 2017

Pancreas transplant is an important treatment option for insulin dependent diabetic patients as it may result in physiologic euglycemia. Improvements in surgical technique, graft preservation, immunosuppression, diagnosis and management of rejection, and management of post-transplant complications have led to improved patient survival.

There are several technical variables to consider when performing a pancreas transplant. One is the type of exocrine drainage to be used. The most common types of exocrine drainage are enteric or bladder drainage. Gastric- exocrine drainage has also been recently introduced. The most commonly cited complications associated with bladder drainage include metabolic complications, urologic complications and the need for enteric conversion.

Many complications related to bladder drainage can be managed non-operatively with Foley catheter drainage. For those complications that cannot be managed in this manner, enteric conversion is an option. Complications associated with enteric drainage include anastomotic leak and intra-abdominal abscess, although at rates lower than cited in the early literature on the topic. Bladder drainage of exocrine secretions and enteric drainage of exocrine secretions, or a staged procedure with bladder drainage followed by indicated or elective enteric conversion are reasonable options for drainage of the exocrine secretions of the pancreas. Gastric-exocrine drainage is a promising therapy deserving of future exploration.
Medical management of diabetes during ramadan fasting: Are physicians ready for the job?
Authors: Beshyah Salem , Farooqi Muhammad , Chentli Farida , Raza Syed , Chadli Asma , Benbarka Mahmoud , Sherif Ibrahim ,   The MENA Endocrine Research Group
Published: July 2017

Introduction: Fasting during Ramadan is obligatory for all adult Muslims. Physicians have a pivotal role in educating and supporting patients regarding safe fasting. A few studies addressed the Ramadan specific knowledge of medical practitioners and how well equipped they are to be engaged in efficiently providing care to people with diabetes. Objectives: We aimed to appraise the knowledge, attitudes, and practices of medical practitioners regarding management of people with diabetes during Ramadan. Materials and methods: The databases of PubMed and Google Scholar were searched using the relevant key search terms. All identified publications were reviewed. Challenges, concerns, and opportunities were identified, and proposals were made to bridge gaps in perceptions and practices. Emerging concepts: Many of the reports are either small or lacked depth. There is a remarkable degree of inconsistency in the levels of knowledge, attitudes, and practices among physicians between regions and within the same country. Lack of ethnic-competency was observed in some studies from the west. The current level of preRamadan educational activities remains patchy, inconsistent and too often mostly “ceremonial” as part of pre-Ramadan festivities organized by pharmaceutical companies. Recommendations: The call for improvement and harmonization is timely to translate guidelines into clinical practice. To this end, a widely-shared curriculum of an evidence-based syllabus is strongly recommended as the core education for physicians and other health care professions. These should be delivered by consortia of highly motivated clinicians and academics, organized by professional societies and patient advocacy bodies, accredited by national authorities and unconditionally supported by the pharmaceutical industry.
Trichomonas vaginalis infection in women with type 2 diabetes mellitus and vaginal discharge in Benghazi, Libya
Authors: Younis Eman , Elamami Adela
Published: July 2017

Background: There is a wide variation in the prevalence of Trichomonas vaginalis in Libyan women. There are no data on prevalence in Libya women with diabetes, a known risk factor for increased genital infection. Objective: We wished to ascertain the prevalence of Trichomonas vaginalis infection in diabetic women with vaginal discharge in Benghazi, Libya. Patients and Methods: A cross-sectional study was performed at one specialized polyclinic between November 2011 and December 2013. One hundred and ten pregnant and non-pregnant diabetic women aged 17-52 years who complain of vaginal discharge were interviewed and high vaginal swabs were taken and tested with wet mount and culture to detect Trichomonas vaginalis, candida and bacteria. Random blood glucose levels and VDRL tests were also done for all patients. Results: 27 out of 110 vaginal swabs (24.5%) were positive for Trichomonas vaginalis. The age of the patient, color and smell of the vaginal discharge significantly concurred with the Trichomonas vaginalis infection status. Highest rate of infection (50%) was observed in diabetic women over 40 years of age. Non-pregnant diabetic women had a slightly higher prevalence (27.7%) than pregnant diabetic women (22.2%). Eighteen of all vaginal discharge (16.4%) were positive for Candida albicans. Bacterial vaginosis was mostly due to Staphylococcus spp (100%). Additionally, 4 patients (3.6%) had a positive VDRL test. Conclusion: Nearly quarter of women with type 2 diabetes mellitus presenting with vaginal discharge in Benghazi had Trichomonas vaginalis infection. This is markedly higher than previously reported rates in the general female population of the city.
Effect of the muslims' ablution practice on nasal colonization of staphylococcus aureus
Authors: Ghonaim Mabrouk , El-Edel Rawhia
Published: July 2017

Background: The human nose contains many different types of bacteria including Staphylococcus aureus (S. aureus). It is possible to get rid of this pathogen using many topical antiseptics or antibiotics. However, good washing using clean water may be valuable to decrease colonization by this organism. Objectives: This study determined the effect of daily repeated nasal washing in the ablution process performed by Muslims before every prayer on the presence and density of S. aureus nasal colonization. Material and methods: Two groups of volunteers were selected from the students and staff who were selected from Taif University, Saudi Arabia and Menoufia University, Egypt. The first group included 200 subjects who are practicing ablution and prayer and the second group included 100 subjects who do not do ritual ablutions. Personal data were collected and swabs were obtained from inside of the nostrils from all volunteers. Swabs were obtained from worshipers before, directly after, and 2-hours after ablution. Cultures were performed on suitable media and identification of S. aureus was performed according to the standard bacteriological methods. Results: The rate of colonization by S. aureus was 62% among non-worshipers and 38% among worshipers before ablution with a non- significant difference. Among worshipers, the rate of isolation of S. aureus just before ablution was 38% and significantly reduced to 20% directly after ablution (p< 0.01). It rises to 32% 2-hours after ablution. The microbial density of S. aureus was significantly (p< 0.001) lower among worshipers than nonworshipers. Conclusion: Nasal washing in ablution can reduce S. aureus nasal colonization. It can be a simple, easy and effective way to reduce colonization by this organism and thereby decrease the occurrence of serious staphylococcal diseases.
Free communications of the third qatar internal medicine conference; 6-8 October 2016; Doha, Qatar
Authors: El Zouki Abdel-Naser , Zahid Mohammed
Published: July 2017

These are the abstracts of the free communications of the Third Qatar Internal Medicine Conference held on 6th-8th October 2016 in Doha, Qatar. The program of the conference had different types of sessions include plenary lectures, mini-symposia, clinical debates, 12 workshops in different aspects of Internal Medicine, and a preconference post-graduate course on “Best Practice in Internal Medicine”, were conducted by invited panel of international, regional and local experts. The conference was endorsed by the American College of Physicians, Society of Hospital Medicine-USA, Mediterranean Association for Study of Liver Disease, and Mediterranean Task Force for Cancer Control. It was also supported by the Royal college of Physicians of London. In addition to the plenary sessions, free communications selected from submitted abstracts were presented as oral communications or posters. These reflected regional disease profiles, patterns of clinical practice and locally conducted clinical and basic research. The focus of this abstract book is to disseminate specifically free communications as this is the unique feature of the conference. We hope by doing this, we expand the message of the congress to those who could not make it to the live events.
Abstracts of the fourth clinical congress of the gulf chapter of the American association of clinical endocrinologists; 3-5 November 2016; Dubai, UAE. II. free communications
Authors: Alsayed Nasreen , Al Kaabi Juma , Al-Ozairi Ebaa , Al Mahfouz Abdel , Lamki Mohamed
Published: July 2017

These are the advance abstracts of the free communications accepted for presentation at the fourth clinical congress of the Gulf Chapter of the American Association of Clinical Endocrinologists to be held on 3rd- 5th of November 2016. One of the main objective of the congress is to give an opportunity to share results of clinical and basic research relating specifically to clinical practice of diabetes care and clinical endocrinology in the region.
We present the abstracts of the free communications as submitted by the authors after minimal restyling and editing to suit the publication requirements of the journal. Reflecting mostly the regional epidemiology and clinical practice in diabetes care and endocrinology, were selected for presentations as either oral or poster presentations. By publishing the proceedings of our fourth annual congress in this open access journal, we hope to extend the benefit to those who could not make it to the live presentations and give a safe home for all the abstracts for future reference. Thus making them permanently available to facilitate regional and international networking and collaboration between clinicians and academics of shared interests
Physiological responses during moderate exercise in thermo-neutral and hot environment for normal weight
Authors: Doukman Khaled , Sproule John
Published: July 2017

Background: Recent research has shown that climatic stress has the ability to cause changes in exercise performance. The purpose of this study was to investigate whether the current exercise prescription guidelines remain appropriate or should be modified, given rise of summer temperatures in the United Kingdom, and to what effect the prescription guidelines had on individuals with different body weights. Subjects and Methods: Twenty healthy normal weight adult males with a body mass index (BMI) 23±1.9, and waist to hip ratio (WHR) 0.89±0.04, age 24±1.4 year were randomly assigned to either cycling for 30 min in a climate chamber at either at 18°C (thermo-neutral) or 30°C (hot environment) (T18, T30), with 24-h between trials. The third trial was performed at 30°C with an adjusted workload (T30a) to determine whether workload adjustment was necessary in order to reduce HR to approximately that of T18 levels 24-h after the second trial. Heart rate (HR), RPE, VO2, CHO and fat utilization; energy expenditure in calorie KCAL (kcal.min-1) and RER were determined. Results: HR at T30 was significantly higher than the HR at T18 and at T30a. Carbohydrate (CHO) and fat utilization; energy expenditure in calorie KCAL (kcal.min-1) and Respiratory Exchange Ration (RER) HR at T30a dropped to a level close to the HR level of T18. No statistical differences were found for KCAL, VO2, RER, CHO and fat between the three trials. Conclusion: Exercising moderately for 30min in a hot environment of 30°C, compared to 18°C, raises the HR and the RPE for normal weight men. Adjusting workload is not required to reduce HR whilst exercising moderately in 30°C.
Attitude towards insulin therapy among patients with type 2 diabetes in Tripoli, Libya
Authors: Sabei Laila , Sammud Mohamed
Published: July 2017

Background: In patients with type 2 diabetes mellitus (T2DM), failure to control of blood glucose with lifestyle modifications and oral hypoglycemic agents (OHA) leads to insulin therapy. Objectives: We aimed to 1) find out the prevalence of psychological insulin resistance among patients with T2DM and 2) explore the factors affecting and reasons behind their attitude towards insulin use. Patients and methods: In a cross sectional study, 1703 Libyan patients with T2DM on oral hypoglycemic agents (OHA) were studied. They were recruited from outpatient clinics of two hospitals and 5 primary health care centers in Tripoli, Libya over a period of six months. They were asked to complete a self-administered questionnaire. Results: From the total number of 1703 participants, 1611 (94.6%) reported unwillingness to accept insulin therapy should it be prescribed to them. Hesitant patients reported more concerns about possible side effects that may develop from errors in insulin dose than acceptors (73.1% vs 46.7% respectively). 25.6% of the reluctant patients perceived that insulin may cause blindness. Concerns about painful injection of insulin and occurrence of hypoglycemia were expressed by 48.4% and 66.2% of the unwilling group respectively. Conclusion: Psychological insulin resistance is a common obstacle to initiation of insulin therapy in Libyan patients with T2DM. There is an urgent need for enhanced patient education to change the attitude of the patients towards insulin therapy.
Eosinophilic esophagitis: A brief review
Authors: Kahwash Basil , Prasad Vinay
Published: July 2017

Eosinophilic esophagitis (EoE) is an emerging disease. It is defined as a chronic hypersensitivity disease characterized by localized inflammation of the esophagus. Here we present a focused summary of current medical understanding of the disease, including the diagnostic criteria, management approaches and future directions of research.
Pulmonary manifestations of adult polycystic kidney disease: Case report and literature review
Authors: Ibrahim Wanis , Rasoul Fatema
Published: July 2017

Adult polycystic kidney disease (ADPKD) is an autosomal dominant condition that can be associated with several extrarenal manifestations including hepatic and pancreatic cysts, cardiac valve abnormalities, intracranial aneurysms, diverticulosis, and abdominal wall hernias. Pulmonary manifestations of ADPKD are scarcely described in literature. Only a couple of retrospective reports have described increased prevalence of radiographic bronchiectasis in patients with ADPKD. In this paper, we describe a young man with bronchiectasis as the sole presentation who was incidentally discovered to have ADPKD. A point of strength in this report is that other causes of bronchiectasis have been excluded by detailed history and extensive laboratory investigations.
Cefoxitin mannitol salt agar for selective isolation of methicilin-resistant staphylococcus aureus
Authors: Ahmed Mohamed , Elramalli Asma , Amri Samira , Abouzeed Yousef
Published: July 2017

Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial infection that causes problems in screening testing. Cefoxitin is potent selective antibiotic agent widely recommended for the detection of MRSA. The aim is to evaluate the optimum concentration of cefoxitin incorporated into mannitol salt agar (MSA) needed to select and detect MRSA. A total of 99 MRSA isolates were tested against 4 different concentrations of cefoxitin mannitol salt agar (MSC) of: 2 μg/ml (MSC-2), 4 μg/ml (MSC-4), 6 μg/ml (MSC-6) and 8 μg/ml (MSC-8). The susceptibility of MSCs were respectively as follows: 53.5%, 53.5%, 74% and 78%. Accurate and effective laboratory screening of MRSA is an important measure control of MRSA.
False track as an unexpected complication of therapeutic endoscopic retrograde cholangio pancreatography
Authors: Ibrahim Abeer , Alrobayaan Abdulrhman , Alhassan Ibrahim , Al Garni Abdullah , Elsiesy Hussein
Published: July 2017

A 65 years old female had an ERCP whilst being managed for obstructive jaundice in her local hospital. Misplacement of the stents during cannulation occured. The stents created false track retroperitoneally. They remained silent and were not removed after being palpated during laparotomy due to the high risk relationships to important structures and to the poor prognosis of the patient condition.
Renin angiotensin aldosterone system in the cardiovascular continuum: An overview of the trial evidence and clinical practice
Authors: Zuberi Beyla , Aijazi Ishma , Bashier Alaaeldin , Abdelgadir Elamin , Mirza Hina , Mathew Manoj , Abuelkeir Sona
Published: July 2017

The renin angiotensin aldosterone system (RAAS) inhibitors represent an invaluable class of drugs in the management of various stages of the cardiovascular disease continuum. Both angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have unique pharmacodynamics properties. These enable them to block the RAAS system at multiple levels. The ARBs inhibit RAAS in a mechanistically distinct fashion when compared to the ACEIs. Whereas ACEIs decrease the synthesis of angiotensin II, ARBs selectively and competitively bind to the AT1 receptors hence preventing there activation by angiotensin II. The differential effects of these two groups of drugs, resulted in them playing different roles in primary and secondary cardiovascular protection. It is suggested that ACEIs tend to be more “cardioprotective” whereas ARBs may be more “cerebral-protective”.

In this review article, we will attempt to enhance understanding of the role of RAAS blockers in most appropriate selection of ACEIs and ARBs according to their attributes and the needs of the clinical situation. We will initially described the role of RAAS activation in the pathophysiology of common cardiovascular disease processes. This will be followed by a review of the major clinical trials of different ACEIs and ARBs in the primary prevention and secondary prevention of cardiovascular diseases.

In conclusion, the effects of ACEIs across a wide spectrum of cardiovascular diseases remain indisputable. However, ARBs showed a superior effect to ACEIs with regard to stroke, but their efficacy in certain major clinical end points seems limited.
Ramadan fasting in children with epilepsy: An exploratory study
Authors: Fathalla Waseem
Published: July 2017

Objective: To observe seizure occurrence during the month of Ramadan among fasting Muslim children with epilepsy who are on treatment with antiepileptic drugs (AEDs). Methods: Prospective observational study of pediatric patients with epilepsy intending to fast in Ramadan of the year 2011 and 2012. Patients identified through pediatric neurology clinic visits in the 3 months prior to Ramadan were asked whether they plan to fast Ramadan or not. They were counseled on medication compliance, medication rescheduling, seizure precautions, and management of breakthrough seizures. Patients were advised against fasting if their epilepsy was not controlled. The outcome was assessed by verbal report on their follow up visit after Ramadan. Results: 20 patients (13 males, 7 females, with age range of 7-14 years, median age 10 years) with 19 reported patient fasting cycles were identified (2 patients fasted on both years, 3 patients did not fast). There were only 2 reported seizures in 19 patient fasting cycles. All patients reported compliance with the medication schedule as directed in the pre-Ramadan visit. There were no reported adverse effects to the new schedule of medication administration. Conclusions: Fasting Ramadan in children with epilepsy appears to be feasible with proper physician guidance and patient compliance. Anticipatory guidance is essential in caring for children with epilepsy who intend to participate in religious based activities that may potentially modify their risk for seizures.
Characteristics and outcome of primary hyperoxaluria type 1 patients in Jenin district, Palestine
Authors: Abumwais Jamal
Published: July 2017

Background: Primary hyperoxaluria (PH) type 1 is a rare inherited metabolic disorder leading to urolithiasis, nephrocalcinosis and most often end-stage renal disease (ESRD). PH type 1 is the most common and the most severe form of primary hyperoxalurias worldwide. In the developing world, patients with PH type 1 usually have a poor prognosis and short survival time. Objectives: We aimed to document the characteristics and outcome of PH type 1 patients in Jenin district, Palestine being the type commonly seen here. Patients and Methods: 18 patients were diagnosed with primary hyperoxaluria type 1 in Jenin District (Palestine) between 2005 and 2012. A review of the patients' charts was performed and the following parameters were recorded: sex, age, age at first symptoms, age at ESRD (onset of dialysis), history of conservative treatment, history of parental consanguinity, family history of the disease, and outcome or current status. Some data were obtained directly from physicians and nurses of the kidney unit and/or from patients' families. Results: Seven patients were males and 11 were females. Mean age at diagnosis was 3.12 years while the median was 0.42 year (range: 3 months - 20 years). All the patients were from one tribe and the rate of parental consanguinity was 100%. Regarding patients' outcome, 7 children died before initiation of hemodialysis (6 of them during infancy and one at 8 years of age), 2 patients died from complications of liver or combined liver-kidney transplantation procedures, 2 patients died while on hemodialysis, 5 patients were still on conservative treatment at last follow-up, and 2 patients remained on hemodialysis. There was an important heterogeneity in symptoms, age at first symptoms, and age at ESRD. Conclusion: The high mortality rate among our patients compared to that found in the literature, may be due to the severity of the disease, shortage of some medical facilities such as absence of pediatric hemodialysis, preemptive liver or combined liver-kidney transplantation operations in Palestine.
Inflammation versus oxidative stress in pathophysiology of alzheimer's disease in rat model
Authors: Ahmed Omyma , Thabet Hayam , Mohamed Aml
Published: July 2017

Background: Alzheimer's disease (AD) is a highly debilitating neurodegenerative disorder characterized by cognitive dysfunction. Inflammation and oxidative stress are thought to play major roles in the pathophysiology. Which one has the principle role is unclear. Objectives: The role of brain growth factors, cytokines and oxidative biomarkers in cognitive dysfunction induced by Aluminium chloride (AlCl3) in rats with application of an anti-inflammatory (Cilostazol) and an antioxidant (N-acetyl cysteine, NAC) were investigated to clarify the predominant pathophysiological mechanism involved. Methods: Alzheimer's model group was given AlCl3 (100 mg/kg) orally for six weeks. Alzheimer's model + NAC, and Alzheimer's model + Cilostazol groups were given (NAC) and Cilostazol respectively one hour before AlCl3 for the same duration. Results: Anti-inflammatory or antioxidant interventions significantly improved memory retention, which was evaluated by Morris Water Maze, passive avoidance task, and eight-arm radial maze. This improvement was consistent with histological recovery and was mediated by reduction AlCl3 concentration in the brain hippocampus and frontal cortex, interference with the cholinergic dysfunction, as well as prevention of oxidative damage. In addition, anti-inflammatory agents can modulate superiorly the inflammatory response via reduction of the levels of inflammatory cytokines and adjustment of the levels of brain–derived neurotrophic factors and transforming growth factor B. Conclusions: These finding support the principal role of inflammation in pathophysiology of AD and suggests the potential therapeutic application of anti-inflammatory agents for this condition.
Unexplained hyperglycemia in a patient on insulin pump therapy; transient insulin failure?
Authors: Kolesnikova Irina , Afandi Bachar
Published: July 2017

Hyperglycemia may occur with no apparent medical, dietary, insulin delivery or pump failure reasons. We herein present a case of persistent hyperglycemia secondary to transient insulin failure in a 24 year old lady with type 1 diabetes mellitus who is being treated with continuous subcutaneous insulin infusion.
Type 1 diabetes presenting after bariatric surgery: A medical paradox leading to a delayed diagnosis and diabetic ketoacidosis
Authors: Hafidh Khadija , Abbas Saira
Published: July 2017

The relationship between type 2 diabetes and obesity is well established;however obesity at onset of type 1 diabetes is fairly uncommon. We present a19 year old man who was diagnosed with type 1 diabetes after considerable weight loss following bariatric surgery. This unexpected medical paradox may have led to the delayed recognition of the type of diabetes resulting in decompensation into diabetic ketoacoidosis.
Physical activity: The need of a physician's prescription
Authors: Harrabi Imed , Al Ghamdi Saad
Published: July 2017

Healthcare providers are uniquely positioned to influence the sedentary epidemic trend by prescribing physical activity more frequently and more precisely. Specific written exercise prescriptions can increase patient compliance substantially. Methodical physical activity counseling, even for a short duration, will at least to some degree increase the weekly physical activity of previously sedentary patients. Frequency, intensity, timing and type are the key elements of physical activity prescription.
Call for multinational studies of the epidemiology of congenital heart disease in the Arab world
Authors: Aburawi Elhadi
Published: July 2017

Congenital Heart Disease (CHD) is the commonest congenital anomaly worldwide representing nearly one third of all congenital malformations presenting in the neonatal period. Arabs have a high fertility rates and they are liable to have more children with congenital defects including CHD. High rates of consanguineous marriages may increase rates of congenital and genetic anomalies. No reliable statistics exist and assumption that the incidence of congenital defects in the Arab world being greater than the rest of the world is only anecdotal. It is therefore crucial and timely to have a multinational and multicenter study of the incidence of CHD in the Arab world. Creation of cross the Arab world multinational congenital cardiac defects registry program and stratification is essential prerequisite to develop good pediatric cardiac services. Over the last two decades, some Arab countries have already started their pediatric cardiac programs. The author call upon other countries to follow suit and learn from their experiences.
Phytochemical screening, acute toxicity and analgesic properties of aqueous extract of flueggea virosa's root in rats
Authors: Ezeonwumelu JOC , Matuki E , Ajayi A , Okoruwa A , Tanayen J , Adiukwu C , Goji ADT , Dare S , Okonkwo C , Byarugaba F
Published: July 2017

Introduction: Flueggea virosa (Roxb. ex Willd.) belongs to the family of Euphorbiaceae and grows wild in tropical Africa and most parts of the world; but can also be domesticated. Different parts of the plant have been claimed to have many folkloric usages for treatment of diverse ailments. Therefore, the aqueous extract of the Flueggea virosa's root was investigated to ascertain its total yield, phytochemical components, acute toxicity and analgesic activity in groups of Wistar rats. Materials and Methods: Extraction was by the locally employed decoction method. Phytochemical screening was done by standard methods. Acute toxicity was evaluated by the modified Lorke's method in one phase and analgesic activity was tested using Tail-Flick and Formalin models using rats. Results: The percentage yield of the extract was 9.1%. Tannins, saponins, terpenoids, steroids, cardiac glycosides, and reducing sugars were evident. Acute toxicity tests indicated that it is generally safe; with piloerection observed at high doses only. The extract showed a statistically significant (p<0.05), dose-dependent inhibition of pain in formalin test and some level of nonstatistically significant and non-dose dependent pain reduction in tail-flick test at 100-400mg/kg of body weight given orally. Conclusion: Flueggea virosa root produces modest yield of extract and possesses potent phytochemicals, some measure of acute safety and significant analgesic properties.
Serum adiponectin level in children with nephrotic syndrome in relation to right ventricular functions and metabolic profiles
Authors: Hassan Asmaa , Metwalley Kotb
Published: July 2017

Background: Adiponectin (ADPN), a protein hormone (cytokine), is exclusively expressed on and secreted from adipocytes. It is a particularly interesting compound because it may have a protective influence on the cardiovascular system. Objective: This study was designed to evaluate serum ADPN level, right ventricular functions and metabolic profiles among children with nephrotic syndrome (NS) and asses the correlations between ADPN as a protective hormone and each of right ventricular functions and metabolic profiles. Patients and Methods: A total of 47 children (28 boys; 19 girls) with steroid-responsive nephrotic syndrome (SRNS) were studied. They included two groups: Group A: included 25 children with SRNS in relapse. Group B: included 22 children with SRNS in remission for periods ranging from 3-9 months. A control group included 28 children with matched age and sex. Methods: Serum level of ADPN was estimated by ELISA and nitric oxide (NO) by chemical detection. In addition to total cholesterol, triglycerides, high-density lipoprotein (HDL), low density lipoprotein (LDL), total protein, and albumin by Enzymatic Colorimetric kits. Also, 24-hour urine samples were collected for detection of proteinuria. Electrocardiogram (ECG) and echocardiography measuring right ventricular wall functions were done. Results: Serum levels of ADPN and NO were significantly higher in children with SRNS in relapse in comparison with children with SRNS in remission or control group. Children with SRNS in relapse showed significantly higher levels of total cholesterol, triglycerides, LDL and proteinuria while significantly lower levels of total protein, albumin and HDL as compared with SRNS in remission or control group. Echocardiographic findings revealed that a significant decrease in right ventricular ejection fraction (RVEF %) and significant increase in right ventricular end diastolic diameter (RVEDD), right ventricular peak pressure (RVPP) and pulmonary artery pressure (PAP) were found in cases with SRNS in relapse in comparison to cases with SRNS in remission and control hypertrophy in relapsed cases. Finally, in children with SRNS in relapse it was found that serum ADPN level was significantly positively correlated with each of serum NO, total cholesterol, triglycerides, LDL, proteinuria, RVEDD, RVPP and PAP, while significantly negatively correlated with serum total protein, albumin and RVEF%.

Conclusion: During relapse of SRNS, serum ADPN level is higher than its level in SRNS in remission. This higher level may represent a physiologic response to the altered metabolic profiles and right ventricular strain so as to minimize cardiovascular complications.
Stillborn twins at 26 weeks of gestation
Authors: Kahwash Basil , Kahwash Samir
Published: July 2017

A 42 year-old woman with a twin pregnancy presented at 26 weeks of gestation with vaginal bleeding. There was no fetal movement detected and delivery was induced. Photograph of the stillborn twins is presented and a question on the most likely diagnosis is posed. An answer and a short explanation are provided.
Anesthesiologist-surgeon conflicts at the workplace: An exploratory single-center study from Egypt
Authors: El-Masry Ragaa , Shams Tarek , Al-Wadani Hamed
Published: July 2017

Background: Professional relationships, in particular between anesthesiologists and surgeons, have been identified as a major source of conflict at the work place. Aims: We explored some of the perceived causes of conflict between the surgeons and anesthesiologists in a single center in Egypt. Method: A cross-sectional study of 67 anesthesiologists and 50 surgeons at Mansoura University Hospital, Mansoura, Egypt was conducted between March and June 2011. A self-reported questionnaire explored 4 domains including 24 items covering causes of conflict. Results: There was a highly significant difference between the number of anesthesiologists and surgeons who considered the working relationships between them as disturbed (76.6% vs. 13.3%, p <0.001 respectively). The most powerful significant predictors of conflicts between surgeons and anesthesiologists were: patient pressure on surgeons, lack of regard to anesthesiologists' instructions, patients' unawareness of the role of anesthesiologists, poor information about patients, decision about the urgency of operations, lack of departmental coordination regarding surgical priorities, lack of an out-patient anesthesia clinic and finally shortage of work facilities. Conclusions: We identified some causes that were perceived by participants to trigger conflicts between them. Attention to these issues may help bring about more harmony between surgeons and anesthesiologists at the work place.
Left ventricle posterior wall aneurysms with calcified thrombus in the aneurysmal area
Authors: Tekin Gulacan , Tekin Yusuf , Erbay Ali , Turhan Hasan
Published: July 2017

Aneurysms can be seen as complications of myocardial infarctions. They are generally located in the apical and anterior segments but left ventricular inferoposterior wall aneurysms are rare. After a myocardial infarction, left ventricular aneurysms can cause symptomatic intractable ventricular arrhythmias. We report a rare case of a left ventricular posterior wall aneurysm containing a calcified thrombus that caused ventricular tachycardia.
New frontiers in the management of patients with chronic kidney disease
Authors: El Essawy Abdel , Beshyah Salem
Published: July 2017

New Frontiers in the management of patients with chronic kidney diseases was a the third in a series of one day symposium held in the Medical College of Ras Al-Khaimah University of Medicine and Health Sciences on the 16th of March 2013 to mark the world Kidney Day. Local, regional and international experts considered various diagnostic and management challenges in the areas of chronic kidney disease covering such wide spectrum of subjects ranging from pre-diabetes, diabetes kidney disease, glomerulonephritis, arterial hypertension and management of hypertension in patients with chronic kidney disease to mesenchymal stem cell therapy, pancreatic transplantation and gene polymorphism profiling in clinical practice. The concise abstracts of all the presentations are presented here to extend the benefit from the meeting to all those who did not attend the live event.
Upper trapezius activation during upper limb neural tension test-1 in karate players
Authors: Mathew Jince , Kunal Thakur , Meena Sadhana , Chawla Jasmine , Sethu Lakshman
Published: July 2017

Background: Manual examinations and subsequent manual therapy became the mainstream options for treatment of mechanical musculoskeletal disorders. Neurodynamics deals with the mechanics and pathomechanics of the nervous system as it moves relative to its adjacent tissues. Objectives: We determined upper trapezius activity during upper limb neural tension test-1 (ULTT-1) in asymptomatic National level Karate players of Madhya Pradesh State of India and correlated its activity with sensory responses during neural test. Subjects and Methods: Fifty national-level karate players (26 males) aged 20 to 25 years (mean age 22.0±1.4 SD) with no history of musculoskeletal or neurological injury were studied. Sensory response intensity was recorded on visual analogue scale (VAS). Electromyography (EMG) activity of upper trapezius muscle was recorded from the muscle belly. Results: All subjects showed ‘positive’ sensory responses on VAS with the mean value of 6.5±1.1 and EMG activity in upper trapezius muscle with mean of 93±19 microvolts. They all had “positive” sensory responses during upper limb tension test-1. They were described mainly as stretch, pain, pull and, tightness. Majority of the sensory responses was reported during the stages of wrist and elbow extension and all subjects showed increased EMG activity in upper trapezius muscle during ULTT-1, which correlated directly with the perceived sensory response. Conclusion: Upper trapezius muscle activity is evident during ULTT-1 which is directly correlated with the perceived intensity of sensory responses during the test. Sensory responses to ULTT 1 can be elicited in a large proportion of asymptomatic active young players.
Perceived stress and burnout among medical students during the clinical period of their education
Authors: El-Masry Ragaa , Ghreiz Seba , Helal Randah , Audeh Ahmed , Shams Tarek
Published: July 2017

Background: Transition from pre-clinical to clinical training has been identified as a crucial stage of medical education regarding student stress. When entering the clinical environs, students may become more prone to burnout. Aims: This study aimed to determine the prevalence, sources and predictors of high stress levels and burnout among medical students at King Faisal University, Saudi Arabia, during the clinical phase of medical education. Subjects and Methods: A cross-sectional survey of medical students in years four through six at Al-Ahsa Medical College during the academic year 2011-12 was performed. All 324 regular course attendants were invited to participate in the study and 233 participated (response rate of 71.9%). A self-reported questionnaire was used which covered three categories, including 18 sources of stress. Short Perceived Stress Scale and Emotional Exhaustion Subscale of Maslach Burnout Inventory were used to measure stress and burnout. Result: Sixth year students were more likely to cite relationship, hospital, and professional issues as stressors. Top stressors cited by final year students were concern about the future, defective clinical practice skills, fear of harming patients, and high parental expectations. Whereas first year students cited stressors such as transportation problems to hospital, fear of infection, and time limitations for training. The prevalence of emotional exhaustion and high levels of perceived stress was 76.8 and 71.7% respectively. Year of study was the only single independent risk factor for burnout and high levels of stress among students of clinical years. Conclusions: Clinical phase of medical education is a necessary area of intervention in order to provide an improved transition between pre-clinical and clinical periods. In addition, adoption of a new curriculum that integrates pre-clinical and clinical training of students from an early stage of education may reduce the stress.
Phytochemical screening, antibacterial and cytotoxic activity of different fractions of xylocarpus mekongensis bark
Authors: Ahmed Arif , Labu Zubair , Dey Shubhra , Hira Arpona , Howlader Mohamed , Hossain Mohamed , Roy Jimuty
Published: July 2017

Background: In Bangladesh, the tree Xylocarpus mekongensis (Lamk.) M. Roem. is used as the traditional medicine for the treatment of a number of ailments. Objectives: The present study was undertaken for antibacterial activity and cytotoxicity study of the methanol, ethyl acetate and chloroform extract of X. mekongensis bark. Materials and methods: Antimicrobial activity has been investigated against Vibrio cholera, Shigella flexneri, Shigella boydii, Salmonella typhi, Salmonella paratyphi and Staphylococcus aureus by disc diffusion and broth macro- dilution assay. For cytotoxicity test, methanol, acetate and chloroform extract of bark of X. mekongensis were subjected to brine shrimp lethality bioassay. Results: The zone of inhibition has been observed with almost all bacteria with some exceptions. Minimum inhibitory concentrations (MIC) of the extracts were found to be significant. The LC50 values of these three extracts were found to be 1280, 320 and 320 μg/ml, respectively. Conclusions: Findings of the study justify the use of the plant in traditional medicine and suggests further investigation.
Regulating healthcare professions in Libya: A viewpoint
Authors: Mahmud Salaheddin , Ali Fathi , Salhin Amna , Mohamed Fellani , Elkhammas Elmahdi ,   For the Libyan Healthcare Society-USA
Published: July 2017

Regulating the licensing and practice of healthcare professions is an essential first step for reforming the Libyan healthcare system. In this article, we identify the overarching principles that should guide any efforts targeted at reforming the regulation of healthcare professions in Libya, and to summarize the perspective of the Libyan Healthcare Society-USA (LHS-USA) on these issues. Our aim is not to advocate for the adoption of a specific regulatory model. Instead, we hope to stimulate debate about the principles of professional regulation, and over the process needed to develop consensus on the final shape of the Libyan regulatory model.
Metformin, the remarkable and unique antidiabetic agent
Authors: Lakhdar Abdulfattah
Published: July 2017

In the current issue of this Journal, Fiad and colleagues thoughtfully reviewed in detail the role of metformin in current clinical practice and highlighted the additional effects of metformin independent of the glycemic action of the drug. The review is comprehensive, up to date and is extensively supported by the literature. Metformin remains the first drug of choice in patients diagnosed with type 2 diabetes. Its vascular protection actions are particularly interesting though not yet fully understood. Its antineoplastic actions are very exciting. The authors clarify the issues of gastrointestinal side effects and renal limitations of its use and give practical ways of minimizing the potential loss of benefit to all treated patients.
Management of venous thrombo-embolism: From leeches to novel oral anticoagulants
Authors: Ali Noura , Mustafa Bisher
Published: July 2017

Venous thromboembolism (VTE) is one of the three major cardiovascular causes of death, but the history of venous thrombosis in miniature illustrates the development of medicine itself. Anticoagulation therapy has a long history. It started with leeches and passed through heparin, warfarin and low molecular weight heparin (LMWH). The development of the novel oral anticoagulants (NOACs) has marked the beginning of a new era in the treatment of VTE. Dabigatran, Rivaroxaban and Apixaban has been approved for different indications of anticoagulation which include non valvualr atrial fibrillation, venous thromboembolism prophylaxis and treatment. Use of these agents requires expertise in managing the dose and their adjustment in special cases like renal insufficiency as these agents carry risk of bleeding and proper antidote is still being developed. Knowledge of NOACs is essential for all medical personal as these agents are the future of the anticoagulation and they are set to replace warfarin and LMWH on the long term.
Osteoporosis and its management: Knowledge, attitudes and practices of physicians in United Arab Emirates
Authors: Beshyah Salem , Al Mehri Wafa , Khalil Ali
Published: July 2017

Background: Awareness among physicians is essential for early detection and timely treatment. Aim: To assess physicians' attitudes and knowledge to management of osteoporosis. Methods: A descriptive study using a questionnaire. The group studied consisted of a convenience sample of hospital and primary care physicians in the United Arab Emirates. Results: Responses were obtained from 173 physicians (49.7% female, 50.2% male). Over half were senior physicians (87) with the majority practicing in public institutions (158). The majority of the respondents thought that osteoporosis was an important clinical problem, and appreciated the fact that women in the Middle East are at an increased risk of osteoporosis. They thought that anti- osteoporosis management should be covered by national medical insurance schemes. However, more than 75% were unaware of the presence of regional guidelines on osteoporosis. Many respondents recognized the frequency and importance of vitamin D deficiency in non-skeletal health issues, though not all realized the need for higher doses in people with lower levels of sun exposure. A high proportion of respondents encouraged physical activity and cessation of smoking for all women. However, their use of medications was variable and not compatible with current guidelines. A relatively low level of knowledge was found regarding adequate dosing of several pharmacological treatments. Conclusions: Gaps in knowledge of physicians about bone health were identified. There is a need to extend medical knowledge regarding the contemporary management of osteoporosis and its risk factors.
Efficacy of daily low dose versus intermittent isotretinoin regimens in patients with moderate acne vulgaris: A randomized-controlled trial
Authors: El-Sherif Nadia , Greiw Azza , Benamer Amal
Published: July 2017

Background: Oral isotretinoin, a vitamin A acid derivative, is the most effective treatment of severe acne. As its use is associated with many side effects, low-dose and intermittent application protocols for patients with mild or moderate acne have been reported. Aim: Our purpose was to compare the outcome of two different regimens of low dose isotretinoin; daily versus monthly doses in patients with moderate acne vulgaris. Patients and methods: A randomized controlled trial was conducted on 75 patients with moderate acne vulgaris attending outpatient clinic in the dermatology department at El-Jumhuriya hospital in Benghazi city during the period of June 2009 to June 2011. The patients were randomly assigned to two groups. Group 1 consisted of 45 patients, treated with a daily fixed dose of 20 mg of isotretinoin and group 2 consisted of 30 patients, treated with 20 mg of isotretinoin twice daily for seven days every month. Both groups were treated for a total period of four months. No topical treatments were permitted for both groups. Clinical assessment was done at 0, 4, 8, 12, and 16 weeks, which included acne lesion counts, total acne load, the assessment of severity score of acne and the side effects of the treatment. Patients were followed for six months after stopping treatment. Results: Fifty five patients with moderate acne vulgaris completed the study. Group 1 consisted of 32 patients with equal proportion of females and males; their mean age and standard deviation (SD) was 20.2±4.1 years. Group 2 consisted of 23 patients; 52.2% were females and 47.8% were males, their mean age and SD was 20±3.4 years. No statistically significant difference was observed according to the age and gender among both groups. Acne scores in each group were significantly lower at the end of treatment period. The mean decrease in the inflammatory and non-inflammatory lesion counts was more and earlier in group 1 compared to group 2, this difference was statistically insignificant. Both treatment regimens were well tolerated; cheilitis was the most frequent side-effect seen in 81.3% and 69.6% of patients in group 1 and group 2 respectively. However, there was no statistically significant differences among both groups regarding the frequency and severity of the side effects. The total cumulative dose was significantly higher in group 1 as compared to group 2 (P=0.000). During the follow- up period there was no statistically significant difference between both groups in relapse rate which has been seen in 7 (21.9%) patients in group 1 and 9 (39.1%) patients in group 2. Conclusion: Both isotretinoin regimens were safe and effective treatment for moderate acne vulgaris, however, intermittent sotretinoin regimen may be a cost- effective alternative.