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   Table of Contents - Current issue
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July-September 2018
Volume 11 | Issue 3
Page Nos. 91-141

Online since Monday, September 24, 2018

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REVIEW ARTICLES  

Vascular anomalies p. 91
Julia Roka, Kurosh Paya
DOI:10.4103/HMJ.HMJ_51_18  
Vascular anomalies are rare congenital anomalies partly belonging to the Orphan diseaeses. Due to the intensive collaboration of the ISSVA a common categorization based upon histopathological attributes could be established. We present a short overview of the classification, manifestations and the diagnostic and therapeutical options.
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Paediatric urology: Emerging challenges p. 94
Felix Naegele, Josef Oswald
DOI:10.4103/HMJ.HMJ_59_18  
Medical advancements in paediatric urology are moving at a rapid pace, understanding natural history in congenital malformation of the urinary tract in infancy has changed our diagnostic as well therapeutic approach. Additionally more efficient diagnostic options have evolved our therapeutic in particular surgical approach toward minimally invasive options in children. Interdisciplinary teamwork are the needs of the moment applies above all to children with complex congenital malformations such as disorders of sexual development, urethral valves, cloacal extrophy or complex congenital deformities of the upper urinary tract. This short summary give insights into the current diagnostic discussion as well minimal invasive concepts of most important disease patterns in paediatric urology.
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Current concepts in the management of anorectal malformations p. 100
Carlos A Reck-Burneo
DOI:10.4103/HMJ.HMJ_66_18  
Anorectal malformations (ARMs) occur in approximately 1 of every 5000 newborns and management still differs widely among practitioners. In this review, we adress some of the current accepted concepts in management. Missmanagement can have devastating consequences such as faecal incontinence, urinary incontinence and sexual disfunction. We briefly review common pecularities of the most common cases the and initial management oft he newborn. In this article I intend to present a brief overview without going into details but hopefully will motivate interest and further reading. Further the recommendation is made that case referal to a centre with a high volume load provides the highest benefits fort he patient in the form of better prognosis and long term management.
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Prevalence and risk factors of cardiovascular disease in the United Arab Emirates p. 105
Hira Abdul Razzak, Alya Harbi, Wael Shelpai, Ahmad Qawas
DOI:10.4103/HMJ.HMJ_37_18  
Noncommunicable diseases are a cause of great concern in developing countries, particularly cardiovascular disease (CVD). CVD is most commonly attributable to risk factors such as obesity, high-blood pressure (BP), lack of physical activity and smoking. This study aims to summarize previous research on the prevalence and risk factors of CVD in the United Arab Emirates (UAE). Search engines and databases such as PubMed, Scopus and Science Direct, as well as several local journals, were utilised to identify relevant literature. Inclusion was limited to studies published between 2007 and 2016 in the English language and conducted with UAE participants (citizens and/or expatriates). Twenty-one relevant studies were found, including cross-sectional studies (n = 11), population-based studies (n = 3), literature reviews (n = 2) and a case–control study (n = 1). Estimates of the prevalence of CVD are considerably high, although there is insufficient information available on prevalence in the UAE as a whole. Primary determinants of CVD include obesity, smoking and diabetes mellitus. The prevalence of risk factors associated with CVD has increased in the UAE and will continue to increase, as made clear by the reviewed studies and as predicted by projections and future estimates. Some risk factors can be controlled, treated and prevented. Further attention should be given to developing preventative and curative strategies in order to reduce BP, increase physical activity, improve dietary habits and reduce smoking.
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ORIGINAL ARTICLES Top

The management of blunt splenic injury in adults: The trauma centre experience in Dubai p. 112
Osama Alozaibi, Ali Salem, Rufaida Satti, Hadiel Kaiyasah, Faisal Badri, Alya Al Mazrouei
DOI:10.4103/HMJ.HMJ_46_18  
Introduction: The spleen is the most frequently injured solid organ during blunt abdominal trauma. The treatment strategy for managing splenic insults came under review as doctors were increasingly concerned about post-splenectomy sepsis. Nonoperative management (NOM) of blunt splenic injuries (BSIs) became the standard of care for most of the cases where patients are haemodynamically stable, irrespective of injury grade. Methodology: This is a retrospective study where all adult patients with blunt abdominal injuries treated at level-1 trauma centre in Dubai, between January 2011 and October 2013, were reviewed. Data regarding demographics, pre-operative management, intraoperative findings, blood transfusions requirements and length of hospital stay were collected from patients' files. SPSS (version 20, IBM) was used for data analysis. Results: During the study, 153 patients were enrolled. Nearly 82% of patients with splenic injury were between 13 and 44 years of age. Only 12 patients had an isolated splenic injury. Of 153 patients, 106 were managed conservatively; only 6/106 failed the conservative treatment and got operated. Of 6 patients, 2 were operated due to bowel perforation and the rest 4 patients underwent splenectomy due to hemodynamic instability and drop in haemoglobin. Among the living group, 25/30 patients with Grade I injury and 45/50 patients with Grade II injury were managed conservatively. Conclusion: NOM of BSI was successful in 62.1% in our study which is consistent with other studies. Careful selection of patient and resource availability should be taken into consideration while adopting NOM approach.
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Prevalence and characteristics of supernumerary teeth in patients from Ras Al Khaimah: A retrospective study from a Teaching Dental Hospital in the UAE p. 116
Fatema Almuheiri, Carolina Duarte
DOI:10.4103/HMJ.HMJ_20_18  
Context: Supernumerary teeth are teeth that exceed the normal dental formula. They have variable characteristics and may cause a number of clinical complications. In the Middle East, a prevalence of 0.3%–2.14% has been observed; however, the number of studies of this condition is limited in the region. Aims: This study aimed to examine the prevalence and characteristics of supernumerary teeth in patients from Ras Al Khaimah with consideration of demographic variations. Setting and Design: The study was performed at RAK College of Dental Sciences Dental Clinic. The radiographic database from two consecutive years was used as study sample. Subjects and Methods: A total of 2925 panoramic radiographs were analyzed to identify supernumerary teeth, and demographic-clinical data were extracted from patient files. Statistical Analysis: Data were analyzed using nonparametric tests. P ≤ 0.05 was considered statistically significant. Results: A prevalence of 0.75% was observed. Affected patients were predominantly South Asian males. The teeth were mostly supplemental, para-premolars, and impacted with low incidence of distomolars and no difference in occurrence in the maxilla or mandible. Occurrence of multiple supernumerary teeth was low and restricted to one jaw. Conclusions: This study suggests that one of every 133 patients will have impacted supernumerary teeth that can be expected in the premolar area of the maxilla/mandible, which should be considered when planning community oral health diagnosis and dental treatment strategies.
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Examination of gendered differences in the advertising of cosmetic surgery procedures in the United Arab Emirates p. 120
Zahir Vally
DOI:10.4103/HMJ.HMJ_15_18  
Background: The number of cosmetic surgery procedures has steadily increased, in the United States (US) as well as on a global scale. Research reports that the majority of surgical procedures are performed on women, despite societal changes that have precipitated increased interest from potential male consumers. Much less is known about cosmetic surgery practices outside of the US. Objectives: This study investigated the differential targeting of cosmetic surgery advertising directed towards male and female patients. Methods: An exploratory review of publicly available online information was conducted. A systematic search strategy was employed to find cosmetic surgery practice websites operating in the United Arab Emirates. Website content was examined to determine the procedures performed, whether services were specifically targeted at male patients and the gender of the images contained on the website. Results: The content of 34 websites was accessed and examined; 90 surgeons who were predominantly male (75%), some of whom had trained in the US (21%) and were primarily working from metropolitan cities formed the sample. The majority of practices did not specifically target male patients, 82% did not have a male services section, only 18% displayed images of male patients or models, but more than half of the practices performed gynaecomastia. Conclusions: It appears that despite socio-cultural and attitudinal changes in this region of the world towards cosmetic surgery, many practices continue to ignore male consumers in their online advertising efforts.
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Is hypoglycaemia in acute ill children presenting to emergency department investigated properly? p. 124
Suha Hadi, Noura Al Hassani, Manar Abushkhaeidem, Aisha Al Khaaldi, Abeer Khayat
DOI:10.4103/HMJ.HMJ_2_18  
Background: Infants and children presenting to the emergency department with hypoglycemia are a diagnostic emergency and require urgent treatment. We hypothesize that pediatric patients who present with hypoglycemia associated with other acute illnesses are not being investigated properly for the hypoglycemia etiology. Methods: The medical records of all pediatric patients with the diagnosis of hypoglycemia, blood glucose level of <3mmol/L (54mg/dl) and not known to have metabolic or endocrine illness, who presented to the emergency department at Tawam Hospital from Jan 2012 until December 2014, were retrospectively reviewed. Patient's demographic data had been collected in addition to associated diagnosis, hypoglycemic related symptoms, glucocheck, serum glucose, urine ketones, workup and management. Data were analyzed using Excel 2010. Results: Among 514 subjects reviewed, 197 were included. 52% were male and 81% were less than five years of age. The most common associated diagnosis was acute gastroenteritis (AGE), 152 (77%). 46 (23%) had associated hypoglycemic related symptoms, although nonspecific. None of the subjects had specific investigations for hypoglycemia at time of presentation. 16 (8%) were identified as high risk for having pathologic cause for hypoglycemia, however 4 (25%) referred for metabolic and/or endocrinology services. Urine was checked only in 50 (25%) subjects, 45 (90%) of them tested positive for ketones. Conclusion: Evidence based clinical practice guidelines are needed in managing children with hypoglycemia associated with acute illness who are not known to have metabolic or endocrine diseases. In addition, parent's education on proper care of children with AGE is required to prevent hypoglycemia.
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CASE REPORTS Top

Use of IV immunoglobulin in a case with neonatal enterovirus sepsis p. 127
Mahmoud Galal Ahmed, Muzammil Hafeez, Anwar Khan, Mostafa Abdul Rauf El Bolkini, Niyas Parammal Ambadi
DOI:10.4103/HMJ.HMJ_23_18  
Enterovirus (EV) infection in the newborn period can present with non-specific symptoms or with serious and fatal complications. Mortality is essentially 100% with EV sepsis. Here, we present a case of EV sepsis, diagnosed with a positive polymerase chain reaction for EV, who recovered completely after treatment with intravenous immunoglobulin.
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Botryoid rhabdomyosarcoma in mastoid and middle ear in a 4-year-old boy: A rare case report p. 130
Abdelgalil Ali Ragab, Mouhannad Mahmoud Abdulber Fakoury, Jamal Kassouma, Kamal Moustafa, Fateh Al Mohamad Al Salem
DOI:10.4103/HMJ.HMJ_6_18  
A 4-year-old boy presented with the left ear discharge and polyp of the external canal. The patient was treated as a case of chronic ear infection with mastoidectomy done twice and polypectomy done three times and histopathology came as non-specific inflammation, then as botryoid rhabdomyosarcoma. The patient underwent bone marrow biopsy and confirmation of the diagnosis done. The patient received chemotherapy and doing well. The case discussed because it is rare and because rhabdomyosarcoma rarely presented as external canal polyp and to highlight the presentation of serious malignant problems may mimic the benign diseases.
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CASE REPORT Top

A rare case report of right hepatic lobe herniation through an incisional anterolateral abdominal wall hernia following an open choledochotomy with a concise literature review p. 134
Schauki Mahmoud, Amjad Soltany
DOI:10.4103/HMJ.HMJ_16_18  
Hepatic herniation through an incisional anterolateral abdominal wall hernia is an extremely rare condition. Here, we are reporting a case of hepatic herniation through the anterolateral abdominal wall which had been managed conservatively in a 75-year-old female patient. In addition, we are presenting a brief summary of all previously indexed reported cases to help other surgeons in managing similar rare cases the optimal way.
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One-stage surgical repair of heart disease and pectus excavatum in marfan syndrome strategy about the first case performed in the UAE p. 138
Olivier Jegaden, Salah Ashafy, Andres Obeso
DOI:10.4103/HMJ.HMJ_48_18  
The association of pectus excavatum and cardiac anomalies in patients with Marfan syndrome is not exceptional. The surgical treatment is always challenging. The first case performed in the UAE of a complex surgery in a one-stage procedure with simultaneous complex cardiac valve repair(valve-sparing aortic root replacement associated with mitral valve repair) and pectus deformity correction is reported. An update of the surgical strategy is proposed.
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