bluuebunny/crossref_metadata_2025 huggingface dataset:
Gaucher Disease presenting with atypical skin pigmentation in an Arab patient
Authors: Hateeti Husni
Published: July 2017

Gaucher disease (GD) is the most prevalent lysosomal storage disease resulting in accumulation of glucoceramide in lysosomes of the reticuloendothelial system. There are three clinical types of GD; the most common of which is type 1. The clinical spectrum is variable with patients developing anemia, evidence of hypersplenism and pathological fractures that are due to bone involvement, nevertheless, many have a normal life span. A case of typical type 1 GD but with atypical skin pigmentation in a Palestinian patient with strong family history of skin hyperpigmintation and hypersplenism is reported
Bronchial thermoplasty in asthma: Scrutinizing the current evidence
Authors: Ibrahim Wanis
Published: July 2017

Objectives: Severe asthma accounts for 5-10% of all asthma cases and half of asthma-related costs in developed countries. Targeting smooth muscle hypertrophy and hyperplasia using bronchial thermoplasty (BT) represents a novel therapeutic approach to this disease. This review aims to critically examine and appraise the methodology and interpretation of individual clinical trials concerning the use of BT in severe asthma. It is not intended to be a systematic review or a meta-analysis. Methods: PubMed, Ovid MEDLINE, Ovid EMBASE, Google Scholar, and Scopus were searched until August, 31st 2015 for published clinical trials concerning the use of BT in asthma patients. Search titles included BT, severe asthma, BT in asthma, BT and severe asthma and effectiveness and safety of BT in asthma. Results: One published non-randomized, three randomized and three extension trials were identified. The methodology and results of each individual trial were subjected to careful examination and appraisal. A good safety profile of BT as a novel therapeutic approach of severe asthma has been confirmed in multiple clinical trials. However, there are still unanswered questions and concerns regarding the effectiveness of this procedure in severe asthma. The evidence concerning this effectiveness needs to be augmented by further well-designed sham controlled trials. Conclusion: Well-designed controlled trials using hard outcome measures such as asthma control, lung function and ability to withdraw/reduce steroid are desperately needed to confirm the effectiveness of BT in severe asthma cases. Consideration of asthma phenotypes when conducting such trials would be rewarding.
Ectopic ACTH syndrome caused by hepatic metastases from previously non-functional pancreatic neuroendocrine tumor
Authors: El Mehdawi Rafik , Elbarsha Abdulwahab , Buzaid Najat , Attia Adel , El Hemri Maisoon
Published: July 2017

Background: Pancreatic neuroendocrine tumors (NETs) are rare; representing less than 10% of all primary pancreatic tumors. The minority of these tumors are functional producing a clinical syndrome according to the hormone secreted. ACTH production by pancreatic NETs is rare and even rarer, it occurs from liver metastasis later in the course of the disease. Case Report: We report a case of a 30-year-old Libyan man who presented with Cushing's syndrome due to ectopic ACTH production from liver metastases of a pancreatic NET. The pancreatic NET was diagnosed 7 years previously when it was considered a nonfunctional at the time of diagnosis; the tumor was resected completely then. In the current presentation there was no evidence of the primary tumor but multiple liver metastases were present. Conclusions: This report highlights the fact that initially non-functional pancreatic NETs may present later with a functional hormonal syndrome either from the primary tumor itself or from its metastatic secondary tumors elsewhere.
Applicability of the world health organization's healthcare system framework: A consensus development study in Libya
Authors: Aburawi Elhadi , Ghrew Murad , Zoubeidi Taufik , Benamer Hani , Elfituri Abdulbaset , Ziglam Hisham , Aboutwerat Ali , Alagili Nabil , Sagar Samir , Aburawi Hanan , El Oakley Reida
Published: July 2017

Introduction: The World Health Organization (WHO) Health Systems Framework (HSF) with its 6 building blocks is a widely accepted tool for accurate evaluation of health systems. However, its role in the developing world has not been widely assessed yet. Methods: Six Questionnaires with 5-point Likert-scale were designed and distributed to all the attendees of Libya Health 500 (LH500) Conference, and collected just before the group discussion of Libyan health system's session. Results: There were high levels of agreement of the respondents to the questionnaires items about the 6 building blocks. The application of evidencebased medicine and equal provision of health service to all, received the highest levels of agreement. Most of the attendees agreed that health services should be paid by the health insurance system, as it has many advantages, including the peace of mind for the public. The fairness and efficiency of the workforce and the establishment of regulatory mechanisms to address the needs of the health workforce had a high level of agreement. Moreover, a functioning health technology requires an effective supply and distribution system of technology elements. The participants agreed that health information technology is important to improve healthcare services and to prevent financial and administrative corruptions. Conclusion: It is feasible to adapt the WHO-HSF to identify the needs and ways to enhance health systems in the developing world. The Libyan healthcare providers were fully aware and committed to the need for the applicability of the WHOHSF to the National Health Service in Libya.
Metformin treatment decreases mTOR mRNA level in MCF-7 breast cancer cells
Authors: Alalem Mohamed , Ray Alpana , Ray Bimal
Published: July 2017

Besides the involvement of mTOR activity in several cancer conditions, evidence exists that increased total mTOR protein level might be linked to some cancer conditions such as colorectal carcinoma. The increase in total mTOR protein level in colon cancer was found to be associated with enhanced tumor progression and poor prognosis. Total mTOR protein level is elevated in breast cancer cells compared to their nonmalignant counterparts. High mTOR protein level in breast cancer cells could be attributed to decreased mTOR protein degradation, increased mTOR protein expression, or both. Increased protein expression may involve an increase in the gene expression.

Here, we investigated the possibility of increased MTOR gene expression as a potential underlying cause of the elevated total mTOR protein in breast cancer cells. Our results suggest that transcription of MTOR gene is increased in the estrogen receptor positive (ER+) MCF-7 breast cancer cells compared to other breast cell lines. DNA sequencing of the MTOR promoter identified sequence variations in MCF-7 cells, which could be potentially involved in upregulation of mTOR expression. Among these variations is a truncation of guanine thymine dinucleotide (GT) n repeat region in MCF-7 cells, which might be possibly implicated in the elevated transcription of MTOR gene in these cells. Moreover, our results revealed that metformin treatment, profoundly decreased mTOR mRNA levels in MCF-7 breast cancer cells.

In conclusion, unraveling the potential mechanisms involved in the regulation of mTOR expression in breast cancer cells could provide an avenue for optimizing the efficacy of breast cancer treatment regimens.
Immunohistochemical evaluation of positive hormone receptors and HER2 overexpression in women with breast cancer
Authors: Al-Khayat Zakarea , Baban Ahmed , Ali Botan , Al-Mufty Tamara
Published: July 2017

Background: Breast cancer has a tremendous heterogeneity in its clinical behavior. The objective of this study is to assess the positive expression of estrogen receptors (ER), progesterone receptors (PR) and HER2 overexpression in relationship to the age of patients, and certain prognostic parameters such as tumor grade, size and lymph node involvement. Patients and methods: A cross sectional case study was conducted between June 2011 and June 2014 at the pathology department of Rizgary General Hospital, Erbil, Iraq. 114 Confirmed cases of breast cancer were studied. Immunohistochemistry was used to evaluate the expression of ER, PR and HER2 status. Patients'f mean age was 48±5 (Range: 28-83) years; 57% of them were ≥50 years. Results: The expression of ER and PR was 58.8% and 49.1% respectively. HER2 overexpression (score +3) was 29.8%. Hormone receptors (ER and PR) correlated significantly with age and grade of the tumor whereas HER2 overexpression correlated significantly with grade and lymph node involvement. An inverse correlation was observed between the distribution of both ER & PR and overexpression of HER2. Conclusions: Expression of hormone receptors were evident in about half while HER2 overexpression was observed in less than one third of patients in our population. Different and common correlations were observed between ER, PR and HER2 expression and other patient and tumor characteristics. HER2 overexpression is associated with an aggressive form of breast cancer with high histological grade and negative ER status.
Second ASPED/ISPAD Diabetes postgraduate course; 12th-14th May, 2016, Abu Dhabi, United Arab Emirates
Authors: Elbarbary Nancy , DeBeaufort Carine , Deeb Asma
Published: July 2017

The second ASPED/ISPAD Diabetes postgraduate course is an intensive course initiated by the Arab Society of Paediatric Endocrinology and Diabetes (ASPED) in collaboration with the International Society of Pediatric and Adolescence Diabetes (ISPAD). The course is exclusively sponsored by Lilly, Gulf. The course was held in Abu Dhabi over 3 days. It was run by an expert group of faculty from 12 different countries. The faculty group consisted of 4 speakers from ISPAD, 13 speakers and mentors from ASPED. Candidates were selected following open competitive applications which was advertised by both ASPED and ISPAD. Strict enrolment criteria were agreed on by the ASPED/ISPAD course committee. 64 candidates (out of 142 applicants) from 12 countries were enrolled and attended the course. Course curriculum was delivered in the form of lectures, interactive sessions, case scenarios and research presentation in small group sessions. The themes of the curriculum featured; comprehensive diabetes care, diabetes registry (international and regional experience), dietary challenges, monogenic diabetes (international and regional experience), diabetes management in special circumstances (school, sick days and Ramadan fasting), diabetes complications; acute and chronic, psychology and patient empowerment, obesity and type 2 diabetes in children, novel therapeutic approaches and diabetes prevention and use of technology in diabetes management. The course ended with tasks to follow and recommendations. A task force of 7 members from 6 countries was nominated to initiate and follow up on the execution of the tasks. The main task was to start building up an ASPED diabetes registry amongst different Arab countries. Plans regarding curriculum, venue and course format for future annual courses will be implemented based on faculty and attendees feedback reports.
Education and self-management for women with polycystic ovary syndrome; a narrative review of literature
Authors: Mani Hamidreza , Khunti Kamlesh , Daly Heather , Barnett Janette , Davies Melanie
Published: July 2017

Polycystic ovary syndrome (PCOS) is the most common endocrine condition in women of reproductive age and is associated with high risk of long term metabolic and psychological conditions such as diabetes, cardiovascular disease and depression. These patients present at a young age to the health care system and seek information about their condition. A structured education program seems to be able to answer these questions. Structured education selfmanagement programs are pragmatic and cost-effective patient-centered group educations which are underpinned by learning theories and empower patients to take control of their management and reduce their associated long term risks. In this paper, we introduce structured education programs and review the evidence of education programs for women with PCOS.
The relationship between retinol-binding protein-4 and cardiometabolic risk factors in obese patients with type 2 diabetes mellitus
Authors: Idriss Naglaa , Abdel-Galeel Ahmed , Dimitry Salwa , Abdel Aal Eman
Published: July 2017

Background: Retinol-binding protein-4 (RBP4) is an adipocyte-secreted hormone considered to link obesity with cardiovascular complications. The oxidative stress has been implicated in the pathophysiology of obesity. We evaluated serum RBP4 and plasma total thiols (TT) in generalized obesity (GO) and abdominal obesity (AO) in relationship to classical cardiovascular risk factors. Glycated haemoglobin (HbA1c%), C-reactive protein (CRP) and lipid profile were also evaluated. Patients and Methods: Sixty obese patients were recruited [30 abdominally obese (AO) patients, (15 male and 15 female, mean (SD), 49.5 (5.5) years) were measured by waist circumference (WC > 102 cm for men or > 88 cm for women) and waist/hip ratio (WC divided by that of the hips of > 0.9 for men and > 0.85 for women)] and [30 generalized obese (GO) patients (22 male and 8 female; mean (SD); 42.5 (8) years) were measured by body mass index (BMI). [BMI ≥ 30.0-34.9 kg/m2, with normal WC] compared to 20 healthy subjects (14 males and 6 females; mean age (SD); 36.60 (5.97) years). Results: AO had significantly higher circulating RBP4 levels in comparison to GO (p< 0.05). Total thiols levels were significantly lower in AO compared to GO patients (p< 0.05). CRP significantly elevated in AO compared to GO patients (p<0.05). Total serum cholesterol, triglycerides and Hb1Ac% increased with BMI, WC and waist/hip ratio (WHR). Conclusion: The study reveals that RBP4 is autonomously related to visceral fat accumulations and cardiovascular diseases. The study also reveals the beneficial effect of TT against obesity and cardiovascular disease and the potential clinical applicability of RBP4 and total thiols in cardiovascular diseases.
Medical aspects of fitness to drive in the developing world: Time to act!
Authors: Beshyah Salem , Lakhdar Abdul
Published: July 2017

Driving of motor vehicles is a highly coordinated process involving a series of learned reflexes and carefully made conscious decisions. Many medical conditions with cognitive dysfunction, neuromuscular coordination or vision consequently affect driving safety. The medical profession, transport authorities and regulatory bodies have been interested in the medical aspects of fitness to drive. Legislations have been established in almost all developed countries. Good examples include legislations in North America, Europe and Australia. Sadly the global situation is not as promising. There is an urgent need for the rest of the world to adopt the latest evidence-based and well-tested guidelines, legislations and experiences from the developed countries in this area. Raising the awareness among the public, professionals and regulators about the importance of the issue is urgently needed.
The profile of diabetic children in Benghazi, Libya 2013
Authors: Ben Sauod Ekram , Elfasi Mohamed
Published: July 2017

Background and Objectives: Diabetes is a public health challenge and its prevalence appears to be increasing worldwide. We aimed to assess the epidemiological characteristics of diabetes mellitus in children, and to describe its effect of on health. Materials and Methods: Descriptive cross sectional study was conducted in Benghazi pediatric diabetic clinics by interviews questionnaires to the parents of the patients based on published international and national guidelines. Results: Female to male ratio was 1:1.2. History of parental consanguinity was 32.7%. Positive family history of diabetes was 48%. Glycosylated hemoglobin and random blood glucose clinic values indicated suboptimal control. No psychological support in the clinics, but nutritional education was present. Delayed growth or pubertal development reported in 38% of the children. Conclusions: Patients with T1DM do attend on fairly regular follow-up to the clinics, families share the children in healthy diet but health education does not seem adequate and formal psychological support is non-existing whereas it should have been an integral part of standard management. Metabolic control in this convenience sample was poor. There is an amble room for improvement to bring practices to the internationally and nationally accepted standards.
Experience with multidetector computed tomography changes in acute myocardiatis
Authors: Mizouni Habiba , Mghaieh Fathia , Bejar Sofiane , Ramzu Amr , Hedhli Mohamed , Mourali Sami , Mechmeche Rachid , Menif Emna
Published: July 2017

Background: Acute myocarditis can present as an ACS with elevated ST segment and elevated level of troponin mimicking myocardial infarction. Aim: To determine the potential diagnostic value of ECG-gated multidetector computed tomography (MDCT) in the setting of suspected acute myocarditis. Patients and methods: The study group consisted of 12 consecutive patients admitted for suspected acute myocarditis less than 5 days after onset of symptoms. All patients had clinical, electrocardiographic signs, and laboratory findings consistent with the diagnosis. ECGgated MDCT was performed in all patients and included a first-pass contrast-enhanced acquisition and a delayed low dose acquisition performed 5 min later without reinjection of contrast medium. 3 patients underwent cardiac MRI with injection of gadolinium. Results: The first-pass MDCT acquisition showed absence of coronary stenosis in all patients. Delayed MDCT acquisition, revealed multiple areas of sub epicardial myocardial hyperenhancement in 9 patients. This hyperhencement was confirmed in the 3 MRI examinations. Conclusion: ECG-gated MDCT could be a useful alternative non-invasive diagnostic test in the early phase of acute myocarditis, especially in the context of emergency and when MRI is unavailable.
Pituitary apoplexy in the emergency room: A prior history of pituitary adenoma may not be necessarily present!
Authors: Ibrahim Wanis
Published: July 2017

Pituitary apoplexy is a rare but life-threatening medical emergency that results from either a sudden hemorrhage or infarction in a pituitary tumor. Unrecognized pituitary apoplexy can lead to serious hormonal and neuro-ophthalmic complications and even death. A major challenge in the diagnosis of pituitary apoplexy is that majority of such patients don't have a prior diagnosis of pituitary adenoma. Emergency magnetic resonance imaging of the pituitary gland is the diagnostic tool of choice for this condition. This may not be readily available in many emergency rooms. A previously healthy patient who presented with sudden severe headache and confusion and was found to have pituitary apoplexy is described and a focused review of the condition is given with emphasis on early recognition and complications of this condition
Homocysteine and hematological indices in hemodialysis patients
Authors: Yassin Maged , Lubbad Abdel Monem , Abu Taha Ahmed , Saadallah Nabil
Published: July 2017

Objectives: To explore the relationship between homocysteine and various hematological indices in hemodialysis patients. Patients and Methods: This casecontrol study comprised 60 hemodialysis patients and 60 healthy controls matched for gender and age. Hemodialysis duration was 3.2±2.9 year at frequency of 2.6±0.6/week. Hypertension and diabetes were the most common selfreported disorders among the hemodialysis patients. Results: Serum homocysteine was significantly higher in hemodialysis patients than in controls (50.8±9.7 vs. 13.1±3.7 μmol/l, P=0.000). White blood cell (WBC) and platelet (PLT) counts were significantly higher in hemodialysis patients than in controls [(7.18±2.37 ×109/L and 266.3±111.9 ×109/L vs 5.95±1.37 ×109/L and 222.0±54.1 ×109/L) with P=0.017 and P=0.045, respectively]. In contrast, red blood cell (RBC), hemoglobin, and hematocrit were significantly lower in hemodialysis patients (3.1±0.5 ×1012/L, 8.9±1.5 gm/dl and 26.3±4.6%) than in controls (4.0±0.4 ×1012/L, 12.8±1.6 gm/dl and 45.0±4.6%) with P=0.000. Prothrombin time (PT) and international normalized ratio (INR) were significantly higher in hemodialysis patients compared to controls (16±3 sec and 1±0 vs. 14±0 sec and 1.0±0.1, P=0.000), whereas activated partial thromboplastin time (APTT) was significantly decreased in hemodialysis patients (25±5 vs 33±2 sec, P=0.000). Homocysteine correlated directly with WBC count (r=0.338, P=0.008) and PLT count (r=0.369, P=0.000) whereas inverse correlations were found between homocysteine and RBC count (r=- 0.648, P=0.000), hemoglobin (r=-0.733, P=0.000) and hematocrit (r=-0.836, P=0.000). In addition, homocysteine showed direct correlations with PT (r=0.564, P=0.000) and INR (r=0.657, P=0.000) and inverse correlation with APTT (r=-0.690, P=0.000). Conclusion: Serum homocysteine was significantly higher in hemodialysis patients compared to controls. Homocysteine correlated directly with WBC count, PLT count, PT and INR, and inversely with RBC count, hemoglobin, hematocrit and APTT.
Vancomycin creep and daptomycin minimum inhibitory concentration in methicillin-resistant staphylococcus aureus
Authors: Nandakumar Ashwaty , Kumar Anil , Dinesh Kavitha , Karim Shamsul
Published: July 2017

Objective: To determine the in vitro activity of daptomycin and vancomycin against 50 strains of methicillin-resistant Staphylococcus aureus (MRSA) isolated from blood and pus specimens. Material and methods: Fifty consecutive MRSA were isolated from pus (n=25) and blood (n=25) were included in the study. Oxacillin susceptibility was determined by cefoxitin disc diffusion, green colored colonies on chromogenic media. Susceptibility testing for 18 antimicrobial agents was determined by a disc diffusion method. The minimum inhibitory concentration (MIC) of daptomycin and vancomycin was determined by the Etest as recommended by the Clinical and Laboratory Standards Institute (CLSI). Results: Antibiotic susceptibility pattern of the MRSA isolates showed that 38% were multi-drug resistant overall and 52% in blood and 24% in pus isolates when expressed separately. The MIC50 and MIC90 of daptomycin were 0.08 and 0.09 mg/L and of vancomycin were 1.2 mg/L and 1.3 mg/L, respectively. Ten percent of the isolates had vancomycin MIC of 2 mg/L which is the upper limit of CLSI breakpoint for sensitive isolates. None of the isolates showed intermediate susceptibility or resistance to vancomycin or daptomycin. Conclusion: Creeping MIC of vancomycin is a matter of concern and MIC of 1.5–2 mg/L of vancomycin in MRSA increases the risk of development of complicated bacteraemia. MIC's of vancomycin should be reported for all S. aureus isolates and should be used to guide treatment. Otherwise, daptomycin can be considered as an alternative antibiotic for therapy of MRSA infections in India.
Experience with nasotracheal intubation: Description of the procedure and outcomes
Authors: Sadaqa Wael , Abujaber Dina
Published: July 2017

Background: Maxillofacial surgical procedures often require nasotracheal intubation as an alternative method for achieving general anesthesia. The procedure for intubation involves achieving neuromuscular blockade followed by passing the endotracheal tube (ETT) into the trachea. Objectives: Our hypothesis was that the nasopharyngeal passage of the endotracheal tube can be facilitated by the finger of a sterile glove acting as a pathfinder. Patients and Methods: We performed a randomized controlled trial with blinded assessment of nasopharyngeal bleeding and contamination of the tip of the endotracheal tube. After the induction of anesthesia, the tip of the ETT was inserted into the finger of a sterile glove before the ETT was inserted into the more patent nostril. In the control group (n=40), the gloves finger was retrieved before nasopharyngeal passage was attempted with an endotracheal tube (inner diameter: 7.0 mm). In the intervention group (n=40), the finger of a sterile glove was kept in position. The tip of the endotracheal tube is inserted into the gloves finger. Subsequently, the endotracheal tube was advanced under visual control to the oropharynx when the gloves finger was removed and intubation completed. Results: The pathfinder technique reduced the incidence (p<0.001), and severity (p = 0.001) of bleeding, decreased tube contamination with blood and mucus (p< 0.001), and diminished postoperative nasal pain (p=0.035). Conclusion: Our study results suggest that nasopharyngeal passage of the endotracheal tube can be facilitated by (a sterile gloves finger) acting as a pathfinder.
Uric acid in chronic heart failure; correlation with prognostic markers
Authors: Ehmouda Fathia , Elbrasai Hamid , Elneihoum Ali
Published: July 2017

Background: Chronic heart failure (CHF) is a leading cause of both morbidity and mortality worldwide. The pathophysiologic understanding of chronic heart failure (CHF) has shifted from a mere hemodynamic disorder to a much more complex approach including changes and imbalances in neurohormonal, immune, and metabolic functions. Hyperuricemia is a constant finding in CHF. Aim: To estimate the level of uric acid (UA) in patients with CHF, and to explore the possible relationship with established prognostic markers in these patients. Patients and Methods: Ninety-five patients with CHF were studied. Detailed clinical assessment, ECG, laboratory investigations and echocardiography were performed for all patients. Serum UA level >7.0 mg/dl was considered high. Results: The age range of patients was 28-85 years (median age 67). Of this group, 54 were males. The duration of the disease ranged from 113 years. In addition, 56% of patients were diabetic, 64% were hypertensive, and 74% had ischemic heart disease. 41 patients were class III New York Heart Association (NYHA) functional calcification, whereas 34 patients and 12 patients were in class II & IV respectively. The following diagnostic information was obtained: 1) blood pressure readings were 60 -123mmHg (mean=87.9±14.4). 2) atrial fibrillation (AF) was noted in 36 patients (38%) 3) left ventricular ejection fraction (EF%) was 13-68% (mean=37.9±20.1) 4) blood urea ranged from 13-197 mg/dl (mean=64.7±42.6) 5) serum creatinine was 0.4-5.5mg/dl (mean=1.4±0.9) 6) serum sodium was 119-148 (mean=134.2±5.9) 7) Elevated serum uric acid levels were found in 73% of our patients. We found a significant inverse correlation between serum uric acid level and mean arterial blood pressure (r = -0.42, p = 0.019) and with left ventricular ejection fraction (EF%) (r = -0.31, p = 0.003). We also demonstrated a direct correlation between serum UA and blood urea (r= +0.21, p= .042), serum Cr (r= +0.21, p= 0.051) and age (r=+0.37, p= 0.034). No significant differences were noted in serum UA level in different (NYHA) functional subgroups. Conclusions: High serum UA was observed in 73% of patients with CHF. The observed significant correlation between UA level and some established prognostic markers in these patients may indicate that serum UA could provide additional prognostic information in this population. We propose that such a simple marker that can be measured anywhere at a low cost to help identify high-risk patients with CHF.
Ectodermal dysplasia: Features and dental management
Authors: Bahjat Roqaya , Herwis Khadiga , Musrati Ahmed
Published: July 2017

The current case report presents a rare clinical case of ectodermal dysplasia for a three years old Libyan child. The child's parents were concerned about the missing dentition for their child at his age, and his malnutrition as consequence of the inability to eat healthy food. Clinical and radiographic examinations were carried to confirm the diagnosis and to make the proper treatment plan. A prosthodontic treatment offered to the child and he kept under observation.
The morphologic identification of common organisms that may look alike in the general pathology practice: A brief review
Authors: Boué Jenna , Kahwash Basil , Kirby Sean , Kahwash Samir
Published: July 2017

Surgical Pathologists often rely on morphologic features in identifying organisms in their general practice. The aim of this paper is to provide a brief practical and illustrated reference, comparing the morphologic features of organisms commonly encountered in the general practice of pathology. This comparison will focus on pairs of organisms that may look alike, resulting in diagnostic difficulties. These paired look–alike organisms include: Histoplasma Capsulatum versus Pneumocystis, Falciparum Malaria versus Babesia Microti, Pseudohyphae (of Candida) versus True Fungal Hyphae (of Aspergillus), Septate Hyphae (as in Aspergillus) versus Aseptate Hyphae (as in Mucor), Fungal Hyphae versus Artifact, and Antibiotic-Altered Bacteria versus Other organisms. Key distinguishing morphologic features are compared to help avoid diagnostic pitfalls.
Type D personality and coronary artery disease: Exploring their relationship in younger population of United Arab Emirates
Authors: Namavar Azimeh , Haque Amber
Published: July 2017

The primary goal of this study was to investigate the relationship between type D personality and coronary artery disease (CAD) in the United Arab Emirates (UAE) using a case-control study design. The sample for casecontrol study consisted of 90 CAD patients recruited from a local hospital who underwent catheterization due to a heart attack and 90 non-cardiac controls matched with respect to age, gender, and ethnicity. Participants were administered DS14 and CAD assessment. Results indicated that there is no significant difference in the proportion of type D personality among the two groups (Chi2=0.28, p=0.87). However, heredity, smoking, hypertension, diabetes, body mass index, and sedentary lifestyle were found to be significantly associated with CAD (p<0.05). Possible reasons for no relation between type D and CAD are discussed and recommendations given for future studies on local and non-Western populations.
Clinical and microbiological profile of cryptococcosis in a tertiary care hospital in South India
Authors: Kumar V , Babu Rachna , Venkatachalam Anil
Published: July 2017

Objectives: We aimed to 1) estimate the prevalence of cryptococcal infections among clinically suspected cases of chronic meningitis in a tertiary care center, 2) evaluate the clinical, radiological, microbiological features and 3) assess outcome of these patients. Materials and Methods: Medical records of 756 patients investigated for meningitis and any case which was positive for cryptococcus by culture or antigen detection, from January 2006 to December 2012 were abstracted using a standardized abstraction form. The patients' demographic data, underlying diseases, clinical manifestations, radiological findings, laboratory data, and disease outcomes were retrospectively analyzed. Blood and cerebrospinal fluid specimens were processed by standard microbiological procedures. Results: The proportion of probable cryptococcal meningitis was only 2.4% with male preponderance who were predominantly non-HIV patients. No risk factors could be documented in 16.6% (3/18) cases. India ink was found to be positive in 76.9%, CSF culture in 86.6% (13/15), blood culture in 56.25%, and latex agglutination in 100%. Half the cases were confirmed cryptococcal meningitis while 16.6% had only cryptococcal septicemia. No case of pulmonary and cutaneous cryptococcosis were seen. Conclusion: We underline the need to rule out cryptococcal infection in non-HIV patients and patients with previous history of tuberculosis, as we have documented a higher mortality in this group.
Reporting of cancer-related fatigue in palliative care journals
Authors: Kumar Senthil , Prasad Krishna
Published: July 2017

Introduction: Cancer-related fatigue (CRF) is a highly prevalent symptom in patients with cancer. Palliative care clinical practice depends upon an evidence-based decisionmaking process. We performed a quantitative analysis of research publications in palliative Care journals for their reporting of CRF. Settings and Design: Systematic review of palliative cares journals. Materials and Methods: Twelve palliative care journals were searched for articles with ‘cancer’ in title and ‘fatigue’ in title/abstract of the articles published from 2006-2010. The reporting rates of all journals were compared. The selected articles were categorized into assessment and treatment, and subsequently grouped into original and review articles. The original articles were sub-grouped into qualitative and quantitative studies, and the review articles were grouped into narrative and systematic reviews. Each subgroup in the original articles category was further classified according to study designs. Descriptive analysis using frequencies and percentiles was used. Results: The overall reporting rate among all journals was 1.04% (38/3634), and Am J Hosp Palliat Care (AJHPC) had highest reporting rate of 1.98% (9/454), followed by Palliat Med (PM) with 1.85% (10/538), and Indian J Palliative Care (IJPC) with 1.69% (1/59). Conclusions: The overall reporting rate for CRF articles in palliative care journals was very low and there were very few randomized clinical trials and systematic reviews found. The study findings indicate a lack of adequate evidence base for CRF.
Early days of health service in Abu Dhabi, United Arab Emirates: A personal perspective
Authors: Kazi Nazir
Published: July 2017

In this article, the author presents a personal first hand experiences of having spent over 20 years practicing surgery in Abu Dhabi. He recalls being recruited amongst the first few doctors to start the services in Abu Dhabi. He practiced general surgery with its widest possible sence to include orthopedics, urology and even newurosurgery. Of course trauma surgery was central theme including camel's bites. Memories of the early days of the postgraduate education and holding the primary examination of the syrgical Fellowship examinations. Many anecdotes of professional,and social encounters with colleagues, VIP's, and patients were recalled with great love and affection. These give an value added insight into the first two decades of life the Gulf reagion at the dawn of its development.
Influence of hypo-osmolality and induced seizures on blood brain barrier permeability and brain concentrations of trace elements in rats
Authors: Hassan Asmaa , Abedelhaffez Azza
Published: July 2017

Backgrounds: We studied the changes in blood-brain barrier (BBB) permeability and brain trace elements concentration in acute hypo-osmolality and pentylenetetrazol (PTZ)-induced seizures model in rats. Furthermore, the effect of acute hypo-osmolality on seizure activity (patterns) in the PTZ model, the correlation between seizure severity score (SS score) and changes of both of BBB permeability and brain trace elements concentration in rats were also studied. Materials and Methods: Four groups (18 animals /group) of adult male albino rats were included. The animal groups are: (1) Control group: received only a vehicle. (2) Hypo-osmolar group: received warm distilled water (DW). (3) Seizure group: injected with PTZ i.p. (4) Hypo-osmolar + seizure group: first injected with DW and then PTZ. During the next 30 minutes, the animals were observed for seizure activity. For evaluation of BBB permeability changes, serum S100B protein and Evan Blue (EB) dye content of brain tissue were evaluated. Additionally macroscopic and microscopic examinations of brain tissue were completed. Trace elements, magnesium (Mg), zinc (Zn), copper (Cu) and iron (Fe), concentration in brain tissue were estimated. Results: There were significant increase of EB content of brain tissue, and serum S100ß in hypo-osmolar, seizure and hypo-osmolar + seizure groups, as compared with control animals. These parameters were significantly increased in the hypo-osmolar + seizure group when compared with either hypo-osmolar or seizure groups. These results were confirmed by macroscopic examination of brain tissue. Trace elements concentration of brain tissue, Mg, Zn, Cu and Fe, were significantly decreased in hypo-osmolar, seizure and hypo-osmolar + seizure groups in comparison with control animals. Histological examination of sections from the hilar region of dentate gyrus of the hippocampus revealed degenerative changes in the three groups of animals in comparison with control animals. Morphometric analysis showed a significant decrease in the number of cells in the hilar region of dentate gyrus in the three groups of animals in comparison with controls. Seizure activity significantly increased in hypo-osmolar + seizure as compared to seizure group. The correlation analysis revealed that significant −ve correlations were found between SS score and trace elements concentration, while significant +ve correlations were observed between SS score, and each of EB content and serum S100ß protein in seizure and hypo-osmolar + seizure groups. Conclusion: Our study demonstrated that, hypo-osmolality and PTZ-induced seizures could result in increased BBB permeability with a decrease of brain trace elements concentration. This could play a vital role in the pathophysiology of epileptic seizures. In addition, hypo-osmolality can enhance neuronal excitability and severity of seizures in the PTZ-induced model in rats.
Intravenous furosemide and human albumin for treatment of cirrhotic ascites: Useful or harmful?
Authors: Abubakor Faisal , Fallatah Hind , Akbar Hisham
Published: July 2017

Background: About half of cirrhotic patients develop ascites. Large volume paracentesis or trans internal jugular portosystemic shunt are alternatives in patients with refractory ascites. Intravenous (IV) loop diuretics are not routinely recommended for the treatment of cirrhotic ascites. We audited our experience with the use of IV furosemide and IV human albumin for the treatment of cirrhotic ascites that did not respond to oral diuretics and salt restriction. We also assessed the treatment side effects and patient's outcomes. Patients and Methods: Study subjects were selected from patients who were admitted for management of moderate or massive cirrhotic ascites refractory to oral diuretics and salt restriction. Patients' characteristics were documented. Renal function and electrolytes were measured on admission and daily thereafter. All patients were treated with IV furo-semide at 40-60 mg TID, human albumin at 100ml of 20% (20gm) per day and spironolactone at 150-400 mg daily. We recorded complications and mortality during these admissions. Results: Fifty admission episodes for 28 patients were evaluated. The mean age was 58 ± 5 years. In 32 admissions, the ascites responded to the treatment regimen and Large volume paracentesis (LVP) was not required. The mean serum creatinine was 132 ± 17 μmol/l. High urine sodium was an indicator of response, with a mean of 71±14 mmol/l. Mild renal impairment was the most common complication (53.3%). The mean duration of hospital stay was 9.2 ± 2.3 days. Seven patients died from sepsis and hepatorenal syndrome type 1. Conclusions: Closely monitored use of IV furosemide with human albumin for treatment of cirrhotic ascites is effective and superior to oral diuretics, and it may reduce the need for LVP.
Osteolysis of the hips in a patient with long term rheumatoid arthritis
Authors: Namas Rajaie , Sagar Harpreet , Bachuwa Ghassan , Vasey Frank
Published: July 2017

Case presentation: A fifty four year old African American female with history of rheumatoid arthritis (RA) presented to the emergency room with signs and symptoms of community acquired pneumonia. Patient was diagnosed with RA 30 years ago and was treated initially with non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids and gold injections for 3 months since then she didn't receive any disease modifying anti rheumatic drugs (DMARD) or corticosteroids. On examination, she was wheelchair bound with multiple joint deformities: ulnar deviation, swan neck deformities, without any signs of active synovitis. Rheumatoid nodules were absent. She had severe limitation of passive and active movement of the hip joints bilaterally. Images of the pelvis showed resporption of the femoral (1). Marked subchondral sclerosis was noted in the acetabulum. CT scan of the pelvis was done to rule out subcapital femoral neck fracture. It demonstrated advanced degenerative changes in both hip joints with partial resorption of both femoral heads worse on the left, no fracture was noted. Conclusion: Osteolysis is a complication of long term untreated RA that is rarely seen in adults with RA and is more common in JRA.
Pathogenesis of psoriasis: Comparison of natural killer cells, interleukin-18, intercellular adhesion molecule-1, interleukin-2-receptoralpha and sCD44 status in patients and controls
Authors: Ghonaim Mabrouk , El-Edel Rawhia , Abo-Salem Osama , Basha Mohammed
Published: July 2017

Background: Interleukin-18 (IL-18), soluble interleukin-2 receptor-alpha (sIL-2Rα), soluble intercellular adhesion molecule-1 (sICAM-1), soluble CD44 (sCD44) may have a role in psoriasis. Objectives: We aimed to investigate the role of these cytokines, adhesion molecules and soluble receptors in this disease. Patients and Methods: Seventy psoriasis patients and 20 healthy controls were included in this study. Severity of the disease was determined by estimation of psoriasis area severity index (PASI). Serum levels of IL-18, sIL-2Rα, sICAM-1 and sCD44 were determined by enzyme immunoassay. Enumeration of circulating NK cells was performed by flow cytometry. Results: Psoriasis patients had significantly (P<0.001) higher levels of IL-18, sIL-2Rα and sICAM-1 and significantly (P<0.01) lower percentages of NK cells (CD56+, CD56+CD3- and CD56+CD3+) as compared to controls. There were no significant differences in the levels of sCD44. IL-18 was significantly (P<0.01) higher among patients with severe as compared to mild and moderate psoriasis. Levels of sIL-2Rα and sICAM-1 were significantly (P<0.05) higher among patients with severe as compared to mild psoriasis. The percentage of NK-cells and the level of sCD44 were non-significantly related to severity of the disease. There were significant (P<0.01) positive correlations between serum levels of IL-18, sIL- 2Rα and sICAM-1. There were also positive correlations (P<0.05) between PASI score and IL-18 and sICAM-1 levels. Conclusion: Increased IL-18 and sICAM-1 levels and their correlation with severity of psoriasis suggest that IL-18 may lead to increased Th1 response and up-regulation of ICAM-1 on monocytes culminating in increased cell infiltration and keratinocyte proliferation. IL-18 and sICAM-1 may serve as useful markers of psoriasis severity and targeting of both cytokines may be useful in treatment of the disease.
The role of angiogenic biomarkers in gastrointestinal cancer
Authors: El-Deek Sahar , Idriss Naglaa , Hana Randa , Abdou Madleen , Maksemose Doaa , Zakhary Madeha
Published: July 2017

Background: Angiogenesis is a key issue in the carcinogenesis progression. Gastrointestinal tract (GIT) cancer is a multi-stage disease, multifaceted, concerning convention of different signaling cascades. Abnormal angiogenesis have been related to pathogenesis of tumor. Objectives: We hypothesized inter-relationships between indices of angiogenesis biomarkers across the spectrum of GIT cancer and its relation to the pathogenesis and prognosis of the diseases. We also evaluated the consequence of estimating these indices in untimely tumor recognition. Methods: Forty patients were studied and divided into two groups: Group 1 (n=30) with GIT cancer and group 2 (n=10) with benign lesion. The cancer group subdivided into patients with gastric cancer (n= 12) and patients with colorectal cancer (n=18). 20 healthy controls (C) were involved in the study. Serum levels of all biochemical indices were estimated. Results: Significantly high serum levels of studied angiogenic biomarkers were detected in patients with GIT cancer compared to C and benign group (p<0.000l and p<0.001 for each respectively). Their levels being significantly higher in late stage of the disease versus early stage and in patients with high tumor burden versus patients with low tumor burden with the exception of Cathpsin-B and HA that showing no significant difference. Positive Significant correlations was present between all indices in cancer groups (p<0.001). Also, there was significant positive correlations between these biomarkers and stage of the tumor (p<0.01). Conclusions: There was a gradation in angiogenesis biomarkers in patients with GIT cancer which related to stage and size of the tumors. This may reflect the relative roles of these biomarkers in the biology of GIT cancer. Their estimation may have implications for our understanding of the pathphysiology of tumor, play a novel beneficial roles in early tumor detection and targeted tumor therapy by using antangiogenic therapy
Atypical pheochromcytoma: Haemorrhagic cyst and abdominal pain in a normotensive patient
Authors: Kunjumohammed Fathima
Published: July 2017

Pheochromocytomas are catecholamine-secreting tumors. They show a considerable variation in clinical presentation ranging from adrenal incidentaloma in a normotensive individual to a patient in hypertensive crisis or with cerebrovascular or cardiac decompensation. We report here a case of fifty years old Omani female patient was referred to the endocrine clinic from a regional hospital, for further investigation of a an incidental left adrenal cyst that was detected on US abdomen being performed for evaluation of abdominal pain. Pheochromocytoma was eventually confirmed and an abdominal CT showed a large haemorrhagic cyst. The course and management is described and a focused review of the pitfalls of diagnosis and management is provided.
Intra-abdominal collection caused by fish bone migration
Authors: Shaban Abdulfattah , Jaluta I , Abdulgader R , Burawais A , Bisheya Adnan , Aboghrara Abdusalam , Abosauod A , Hamid A
Published: July 2017

A 45-year-old Libyan male presented to the gastroenterology outpatient clinic with non-specific abdominal pain. After the initial diagnostic investigative imaging, he proceeded to undergo laparotomy in which a large mass was found adjacent to jejunum. The surgery confirmed the preoperative diagnosis of an intra-abdominal collection caused by extra- intestinal fishbone migration reported by ultrasonography and CT of the abdomen.
Mucinous cystadenocarcinoma in chronic anorectal fistula: Clinical and MRI characteristics
Authors: Amar Nagat , Sawed Mustafa , Alforjany Ali , Alhousainy Almabrouk
Published: July 2017

A 54 years old Libyan man presented with a long history of perineal mass, induration and passage of pus and purulent secretion; sometimes mixed with blood. It became increasingly painful over a short period of a few days prior to presentation. He had had a fistula-in-ano for ten years treated surgically 8 years previously. His past medical history included type 1 diabetes mellitus. He underwent digital rectal examination under anesthesia which disclosed edematous external skin tags, with induration of the posterior margin of the anal canal, multiple biopsies and scrapings of the fistulous track were taken. Histological examination revealed mucinous adenocarcinoma. Colonoscopy was done and showed no abnormality. Clinical and MRI characteristics are illustrated and discussed.