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   Table of Contents - Current issue
Coverpage
January-March 2019
Volume 12 | Issue 1
Page Nos. 1-36

Online since Wednesday, February 27, 2019

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REVIEW ARTICLE  

Extraoesophageal reflux manifestations of gastro-oesophageal reflux disease p. 1
Berit Schneider-Stickler
DOI:10.4103/HMJ.HMJ_8_19  
Gastro-oesophageal reflux disease (GERD) is defined as a condition when the reflux of gastric content causes troublesome symptoms or complications. Gastro-oesophageal reflux is associated with numerous pathologic conditions of the upper aerodigestive tract. GERD can be subclassified into oesophageal and extraoesophageal syndromes. Extraoesophageal manifestations can be either pulmonary or otorhinolaryngological. This review provides an overview of most important extra-oesophageal reflux manifestations in GERD patients.
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ORIGINAL ARTICLES Top

Investigating the role of the histone deacetylases-inhibitor suberanilohydroxamic acid in the differentiation of stem cells into insulin secreting cells p. 10
Ibrahim Elsharkawi, Divyasree Sandeep, Ahmed El-Serafi
DOI:10.4103/HMJ.HMJ_29_18  
Introduction: The United Arab Emirates has the second incidence of diabetes in the world. The current diabetes management plans are associated with many complications and do not provide a cure. Stem cells offer hope for permanent alleviation of this health problem through the possible differentiation into insulin-secreting cells. The current methods for the differentiation do not produce homogeneous beta-cell populations. Histone deacetylation is an epigenetic silencing mechanism that can render many genes irresponsive to the induction protocols. This study aimed at investigating the effect of the histone deacetylase inhibitor suberanilohydroxamic acid (SAHA) on the production of functional beta cells, based on a mesenchymal stem cells model. Methods: MG63 cells were treated for three consecutive days with SAHA, followed by a three-steps of beta cells differentiation protocol, with media-contained retinoic acid, epidermal growth factor, nicotinamide and exendin-4 at different stages. Then, glucose-stimulated insulin secretion was conducted to assess the functional state of the differentiated cells. Results: Pretreating the cells with SAHA enhanced the insulin production and secretion in comparison to the control (PBS) and the vehicle dimethyl sulfoxide, as shown by the immunofluorescence detection of insulin and the transcription factor “PDX1”, as well as an increase in insulin secretion in the media. Gene expression analysis showed that SAHA pretreated cells had more induction of the studied markers when challenged with high glucose level. Conclusion: Such findings indicate a novel approach to enhance the ability of stem cells to differentiate into insulin-producing cells with potential therapeutic implications.
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Prevalence of opioid misuse, abuse and dependence among chronic pain patients on opioids followed in chronic pain clinic in a tertiary care hospital Riyadh, Saudi Arabia p. 15
Sameeh Al Maharbi, Abdullah Abolkhair, Hani Al Ghamdi, Mamdouh Haddara, Bjarni Valtysson, Yasser Tolba, Raghad Alaujan, Shadi Abu-Khait
DOI:10.4103/HMJ.HMJ_30_18  
Background: Opioids have proven very useful for treatment of acute pain and cancer pain, and in the developed countries, opioids are increasingly used for the treatment of chronic non-malignant pain patients as well. Treatment of chronic pain patients with opioids may have several long-term consequences; especially, addiction that has been a feared complication. Objective: The objective of the study was to estimate the prevalence of opioid misuse, abuse and dependence amongst chronic pain patients on opioids followed in chronic pain clinic. Study Design and Settings: This is a cross-sectional study that carried out in chronic pain clinic in a tertiary care hospital Riyadh, Saudi Arabia (King Faisal Specialist Hospital and Research Centre [KFSH and RC]). All chronic pain patients on opioids, apart from acute pain patients and children, were eligible for the study. The Alcohol, Smoking and Substance Involvement Screening Test (Opioid ASSIST) screening questionnaire in Arabic was used as a screening tool for opioid misuse, abuse and dependence. Results: A total of 219 chronic pain patients participated in the study. There were 80 males (36.5%) and 139 females (63.5%). Prevalence of opioids misuse, abuse and dependence in chronic pain patients attending chronic pain clinic in KFSH and RC is 12.8%, 9.1% and 3.2%, respectively, based on opioids ASSIST questionnaire cut points. Conclusion: Opioid use disorders are common in pain clinics. They should be considered as serious complications of using opioids in managing chronic pain patients. Considering the high risk of opioid misuse, abuse and dependence amongst chronic pain patients, more screening and rehabilitation services are necessary.
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Prevalence of vestibular migraine in Dubai p. 19
Teja Deepak Dessai, Samer Sakka Amini, Faisal Asad, Helen Kutty
DOI:10.4103/HMJ.HMJ_42_18  
Introduction: A vast number of adult persons suffering from vertigo associated with migraine are reported on a daily clinical practice. However, clinical identification of VM still remains hindered in Dubai due to dearth of agreement in diagnostic criteria. Aim: The aim of this study is to determine the prevalence of VM in the general population of Dubai. Methods: A total of 218 adult persons who visited outpatient otolaryngology and rhinology clinic in a given year 2017 with a complaint of vertigo were retrospectively studied and accounted in research. Further, labelling of each person was done based on the presented symptoms. Results and Discussion: To calculate the prevalence of VM, total number of each diagnosis was counted and was further subjected to a formula to calculate prevalence. Out of the 218 persons considered in the study, 30 were diagnosed with migraine (2 persons with migraine alone and 28 persons with VM). This accounts to a prevalence of 0.9% migraine alone and 12.8% VM in a clinical setting for 1 year. Conclusion: The high prevalence of VM in a clinical setup for 1 year hints toward the need for careful diagnosis of a person.
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Knowledge and attitude of post-natal mothers in al ain medical district about hereditary blood disorders (sickle cell disease, thalassemia and glucose-6-phosphate dehydrogenase deficiency) p. 23
Faisal Abdulla AlShamsi, Falah Abdulla Al Mahmmod, Ali Hussain Al Hammadi
DOI:10.4103/HMJ.HMJ_60_18  
Background: Hereditary haemolytic anaemia has been considered as a major health problem in many countries including the United Arab Emirates (UAE), while the prevalence is not decreasing due to lack of knowledge, unorganised teamwork and services, lack of support groups and inadequate research in the fields of prevention and control. Aim and Objectives: The study aimed at assessing the knowledge and attitude of post-natal mothers in Al-Ain medical district towards common hereditary haemolytic anaemias (glucose-6-phosphate dehydrogenase [G6PD] deficiency, thalassemia and sickle cell anaemia), as a step towards decreasing the prevalence of these diseases amongst the population. Our main objective was to assess understanding of common hereditary haemolytic anaemias as well as to measure the attitude of mothers in Al Ain towards these diseases. Methods: The study was analytical cross-section survey conducted in the period from 23 August to 16 September 2003, in Al Ain Medical District, UAE, in three main hospitals: Al Ain Hospital, Tawam Hospital and Oasis Hospital. An interview-administered questionnaire was used for data collection. Data analysis was done using SPSS version 11. Results: Analysis of the study showed a significant difference amongst participants who heard about G6PD deficiency, according to different age groups, the (18–24) age group had more knowledge about G6PD deficiency when compare with other age groups (P = 0.008). Another significant difference amongst individuals who heard about G6PD deficiency, according to different educational level was as follows: 31% less than secondary school, 60.6% completed secondary school and 50% for higher educational level (P = 0.033). Similarly, for G6PD deficiency, mothers from GCC countries were more aware of G6PD deficiency when compare with other nationals (P = 0.006). Of the total participants, 90% agreed on the importance of genetic counselling before marriage. As the best method of increasing knowledge about hereditary anaemias, media campaigns were the preferred approach having 70.6% voting for it, followed by the approach of educating schoolchildren with 43.1% approval. Conclusion: There is a lack of knowledge amongst post-natal mothers in Al Ain Medical District about common hereditary anaemias compared to a good attitude towards prevention of these disorders.
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Comparative study between haemorrhagic and ischaemic strokes in hadramout: A hospital-based study p. 29
Rasheed Mohammed Bamekhlah, Mohammed Rasheed Bamekhlah, Hussain Saeed Al-Ghazali, Abdulraheem Abdullah Bahishwan
DOI:10.4103/HMJ.HMJ_62_18  
Aim: The aim of this study was compare between haemorrhagic stroke (HS) and ischaemic stroke (IS) stroke in relation to risk factors and clinical presentation among stroke patients admitted to a tertiary teaching hospital over a 5-year period. Materials and Methods: This was a retrospective, cross-sectional, hospital-based study. We reviewed the medical files of patients admitted with the diagnosis of stroke at Ibn Sina Teaching Hospital, from January 2011 to December 2015 to compare between HS and IS patients. Results: From a total of 1678 stroke patients, IS constituted 81.2% of them and 18.8% were HS, males were 57.7% and females 42.3%. HS patients were significantly younger than IS patients, (odds ratio [OR] 0.4; 95% confidence interval [CI] 0.31–0.51, P= 0.000), and there was no significant difference in gender (males 61.6% vs. 56.8%, P = 0.12). Hypertension and smoking were significantly higher among HS than IS patients (OR 5.51; 95% CI 3.98–7.62, P < 0.0001) and (OR 1.84; 95% CI, 1.37–2.46, P= 0.003), respectively, whereas diabetes mellitus (OR, 0.75 95% CI, 0.58–0.96, P= 0.024), transient ischaemic attacks (TIA) (OR, 0.23; 95% CI 0.14–0.38, P < 0.0001), hyperlipidaemia (OR, 0.35; 95% CI 0.19–0.66, P = 0.007) and family history of stroke (OR, 0.64; 0.42–0.97, P= 0.033) were significantly higher in IS than HS patients. Sudden onset of stroke attack and impaired consciousness including coma was significantly more frequent in HS than IS patients (98.7% vs. 86.8%, P= 0.000) and (77.5% vs. 34.2%, P = 0.000), respectively. In-hospital fatality was higher among HS than IS victims (46.3% vs. 26.5%, P = 0.000). Conclusion: Younger age, hypertension and smoking were higher in HS than IS patients, and increasing age, diabetes, TIA, hyperlipidaemia and family stroke history were higher in IS patients, sex did not favour any type, HS was more presented with impaired consciousness and had a higher in-hospital fatality than IS.
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CASE REPORT Top

Simultaneous bilateral nephrectomy of hugely enlarged polycystic kidneys p. 34
Fariborz Bagheri, Senthil Kumar, Hamzeh Esmaeilpour, Mohammad Hassan, Akos Pytel
DOI:10.4103/HMJ.HMJ_36_18  
This case is the first of its kind of simultaneous bilateral nephrectomy of the largest size of autosomal dominant polycystic kidneys in the United Arab Emirates. A 57-year-old man referred to our department with abdominal pain and distension, difficulty in walking and breathing, and edema of both legs caused by hugely enlarged bilateral polycystic kidneys. He was on hemodialysis for the past 3 years. Any type of operation was refused by him. In October 2016, he was admitted to the hospital due to deterioration of his general condition and intolerable quality of life caused by severe compression to the abdominal organs. After obtaining written consent, simultaneous open bilateral nephrectomy was done successfully. Mass of both kidneys removed was 13,050 g which is, to our knowledge, the largest polycystic kidneys removed simultaneously so far. Early bilateral nephrectomy is advisable in patients with end-stage renal failure with the tendency of progressive enlargement of the kidney size.
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