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   Table of Contents - Current issue
Coverpage
April-June 2019
Volume 12 | Issue 2
Page Nos. 37-89

Online since Wednesday, March 27, 2019

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REVIEW ARTICLES  

Management of Alzheimer's disease p. 37
Michael Rainer, Hermann A M. Mucke
DOI:10.4103/HMJ.HMJ_10_19  
Despite a huge amount of research investiment during the past three decades there is still no cure or disease-modifying therapy of any kind for Alzheimer's disease, and only very limited progress has been made since the millenium. This review provides a perspective on how Alzheimer's disease symptoms are currently treated with pharmacological and non-pharmacological approaches, and what the evidence for each is. In the absence of new drugs, it is remarkable how well medical foods and behavioural interventions fare in comparison, although much research is still required. A true causal therapy of Alzheimer's disease will have to await the unvailing of its ultimate cause.
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Updates on the role of imaging in the assessment of crohn's disease p. 47
Mohamed Walaaeldin Elfaal
DOI:10.4103/HMJ.HMJ_41_18  
As initial studies reported that magnetic resonance imaging (MRI) was useful for the evaluation of the small intestine, this modality has become increasingly important in the diagnosis, assessment and exclusion of small bowel disease. The use of MRI for the assessment of inflammatory bowel disease is increasing, at the expense of the current primary imaging modality and computed tomography (CT) enterography. MRI has many advantages over CT, including a lack of radiation exposure, lower prevalence of adverse events, availability of dynamic information, higher resolution and better soft-tissue contrast. New MRI techniques, including diffusion-weighted imaging, spectroscopy, motility study, positron-emission tomography-MRI and molecular imaging, are currently under investigation to improve the diagnosis, follow-up and management of the disease.
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Anaesthetic challenges in complicated labour: Unruptured intracranial aneurysm p. 52
Ira Shrivastava
DOI:10.4103/HMJ.HMJ_43_18  
Intracranial aneurysms are uncommon during pregnancy. Haemodynamic stress during pregnancy is a key factor in the multifactorial pathogenesis of cerebral aneurysm, contributing to the risk of aneurysm formation, progression and rupture. Successful management requires multidisciplinary care; anaesthetists require knowledge of obstetric anaesthesia, neuro-anaesthesia and critical care. The incidence of subarachnoid haemorrhage in pregnancy is 0.01%—0.05%, with a maternal mortality rate of 11% in treated cases and a foetal mortality rate of 5% in treated cases.[1] Definitive treatment involves either open neurosurgical clipping or endovascular therapy, maintaining stable transmural pressure in the aneurysm to prevent rupture. Very few cases have been reported in the literature, and guidelines for the management of intracranial aneurysm during pregnancy and evidence-based recommendations for obstetric anaesthesia in patients with unruptured intracranial aneurysm during labour do not exist. A review of the literature reveals varying results, differing on a case-by-case basis, for the treatment of intracranial aneurysms during pregnancy and labour. Reducing risks associated with intracranial aneurysm must focus on both mother and child. This review encourages the establishment of formal guidelines for an algorithmic approach to manage the intracranial aneurysm during pregnancy and labour.
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ORIGINAL ARTICLE Top

Study of fourier transform infrared of adding metallic nanofillers on heat cure acrylic resin treated by microwave p. 57
Makarem M Abdulkareem, Amer A Taqa, Nadira A Hatim
DOI:10.4103/HMJ.HMJ_70_18  
Background: Polymethylmethacrylate (PMMA) has been the most popular material for the construction of denture bases since 1937. This is largely due to its favourable although not ideal characteristics. Aims of the study: To study the structural characterisation using Fourier transform infrared (FTIR) of adding aluminium oxide (Al2O3) and silver nanofillers on heat cure acrylic powder treated with microwave radiation and microwave-treated PMMA powder ground by micronizer. Materials and Methods: PMMA powder was treated with microwave radiation at a power level of 360 watt for ¾ h. The obtained PMMA powder was then grinded using a domestic blender group (V). The next step is particle size reduction of the microwave-treated PMMA powder using micronizer group (M). Two concentrations of Al2O3and Ag nanoparticles (NPs) were added separately into untreated PMMA powder group (P) and microwave-treated PMMA powder group (V and M) compared with the control group. The structural characterisations of all experimental groups are determined by FTIR. The samples were divided into 15 groups, one sample for each group. Results: The FTIR analysis has confirmed that the structural behaviour of both microwave and micronizer groups showed that there were no changes in the regions of the band locations for C=C and C=O when compared with the control one. The infrared spectra of all acrylic groups with (Al2O3and Ag) NPs additives showed all of the unique peaks attributed to the PMMA. These bands appeared in the same regions of the acrylic except the carbon double bond carbon (C=C) were absent in the infrared spectrometer chart. Conclusion: The FTIR test charts provide strong evidence that there are no chemical changes in all experimental groups. Except for the C=C band from the methacrylate group did not appear in samples containing NPs, which in turn indicates that the residual monomer of these groups is remarkably decreased.
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Streptozotocin-induced molecular and metabolic targets in pancreatic beta-cell toxicity p. 65
Arwa Munassar Thabet Al-Nahdi, Annie John, Haider Raza
DOI:10.4103/HMJ.HMJ_54_18  
Background/Aim: The prevalence of diabetes is on the rise globally causing excessive burden on the health systems. Pancreatic beta-cell mass destruction/neogenesis/proliferation (seen in type1diabetes) and/or malfunction (type 2 diabetes) have been implicated in the aetiology, pathology, progression as well as in responses towards therapies and disease managements. Oxidative stress and alterations in mitochondrial energy metabolism play important roles in diabetes-induced cellular complications. Several studies, including our own, have suggested that Rin-5F pancreatic beta cells are extremely susceptible to oxidative stress due to excessive production of endogenous and exogenous reactive oxygen/nitrogen species (ROS/RNS) and low antioxidant defences, particularly, associated with GSH metabolism. Our aim was to investigate the molecular mechanism of streptozotocin (STZ), a beta cell-specific antibiotic, cytotoxicity in pancreatic cells. Methods: Rin-5F cells were treated with STZ under varying conditions to study oxidative stress-related changes. Results: Our studies have suggested that treatment of Rin-5F cells with STZ, inhibits cell survival and induces cytotoxicity by altering cellular survival and apoptotic signalling and gene expressions. Increased oxidative stress with increased DNA fragmentation and oxidative protein carbonylation were seen in STZ-treated cells. We also observed that beta cells treated with high glucose (up to 25mM) exhibited enhanced cytotoxicity. Cells exposed to conditions mimicking diabetes (hyperglycaemia) were under elevated oxidative stress and showed increased apoptosis and altered redox homeostasis leading to increased cytotoxicity. N-acetyl cysteine (NAC) treatment attenuated these changes in STZ-treated cells. Conclusion: These results may have implications in understanding the mechanism of beta cell survival/death in response to potential therapeutics/managements as well as in the aetiology and pathophysiology of diabetes.
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Outcome of pregnancy among women with threatened miscarriage in Latifa Hospital-Dubai p. 72
Bedaya Amro, Salma Almahdi
DOI:10.4103/HMJ.HMJ_77_18  
Aim: The aim of this study was to investigate the outcome of pregnancy among women with threatened miscarriage, and the risk factors that can affect it and to determine the effect of bed rest and progestogen therapy on that outcome. Materials and Methods: This is a retrospective study that involved all pregnant women who attended the Early Pregnancy Assessment Unit in Latifa Hospital in Dubai with an intrauterine pregnancy and vaginal bleeding up to 14 weeks of gestation. The study was done in the period from March 2010 to March 2011. The main outcome measures included gestational age, baby weight at delivery and placental outcome. Results: A total of 129 pregnant women who met the inclusion criteria were analysed. The early foetal loss rate was 37.2%. Of the remaining, 62.8% who had continued their pregnancy, 23.4% of them had pre-term delivery and 9.9% had placental abruption. Regarding the baby outcome, 35.8% of women delivered low-birth-weight (LBW) babies (<2.5 kg). There was a statistically significant effect of increasing maternal age, increasing gravidity and increasing number of previous miscarriages on increasing the risk of miscarriage in current pregnancy (P < 0.05). No significant difference was found in using bed rest for the management of threatened miscarriage. On the other hand, using progestogen therapy significantly reduced the rate of miscarriage and the rate of LBW babies (P < 0.05). However, we found it had no significant effect on reducing pre-term delivery. Conclusions: Vaginal bleeding in early pregnancy (i.e. threatened miscarriage) is an important risk factor for adverse pregnancy outcomes, which should be taken into consideration when deciding on antenatal surveillance and counselling after a bleeding event. Overall, the results showed the positive effect of using progestogen therapy on pregnancy outcome. However, strong meta-analyses of prospective studies with good methodological quality are still needed to support its routine use in threatened miscarriage management.
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CASE REPORT Top

Congenital cytomegalovirus infection-related diaphragmatic dysfunction: Acase study p. 80
Yasmin A Gad, MN Khalaf, N Sujay
DOI:10.4103/HMJ.HMJ_38_18  
Congenital cytomegalovirus(CMV) infection is a common disorder that can lead to multiple developmental sequelae. This case study reports a newborn with respiratory distress syndrome(RDS) associated with diaphragmatic dysfunction due to congenital CMV infection. In newborns with unexplained RDS, CMV infection-related diaphragmatic dysfunction is a potential underlying pathological mechanism.
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Haemophagocytic lymphohistiocytosis and the challenge of early diagnosis p. 83
Hoda Mohamed Hammoda, Mahmoud Mohamed Marashi, Hesham Abdalla Mohamed Abdalla, Mahmod El Shahat Awad Makhlof, Manal Sayed Rezzek
DOI:10.4103/HMJ.HMJ_40_18  
Haemophagocytic lymphohistiocytosis (HLH) is an uncommon, life-threatening hyperinflammatory syndrome in which abnormal, ineffective energising of the immune system causes excessive activation of lymphocytes and macrophages, which can lead to hypercytokinaemia and massive tissue destruction. A high index of suspicion is necessary for early diagnosis. We report a case of HLH in a 66-year-old woman who presented with fever, pancytopenia and hepatosplenomegaly.
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Hepatolithiasis: A case report and literature review p. 86
Noor Amar, Labib Al-Ozaibi, Faisal Badri
DOI:10.4103/HMJ.HMJ_39_18  
Hepatolithiasis (HL) is defined as calculi in the biliary ducts proximal to the joining of the right and left hepatic ducts regardless of the presence of concurrent gallstones in either the gallbladder or common bile duct. Most HL cases are asymptomatic. When patients do present with symptoms, they are usually features of cholangitis. 43 year old Bengali male presented to the emergency department with signs of cholangitis and a past surgical history of recurrent cholangitis and multiple ERCPs. He was febrile with scleral icterus and right upper quadrant abdominal tenderness with a positive Murphy's sign. His labs showed and elevated white blood cell count, alkaline phosphatase, total bilirubin, and C-reactive protein. Computed tomography of the abdomen revealed multiple intrahepatic stones occluding the left hepatic biliary duct causing proximal dilation of the hepatic duct [Figure 1] and [Figure 2]. The patient was diagnosed with acute ascending cholangitis and a left hepatectomy was done. The post-operative period was uneventful. Hepatolithiasis is a rare disease found mostly in East Asia. The gold standard for its diagnosis is ERCP and PTC. The current options for treating HL include non-surgical endoscopic approaches and hepatectomy. Indications for its surgical management include presence of stones in one lobe (especially left-sided), multiple large stones that cannot be treated by other methods, complications secondary to cholangitis and suspicion of cholangiocarcinoma.
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