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  Most popular articles (Since February 23, 2018)

 
 
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EDITORIAL
Secondary stroke prevention offers now more choices and is critical to reduce the burden of recurrent stroke and death
Michael Brainin
January-March 2018, 11(1):1-1
DOI:10.4103/2227-2437.228868  
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STATE OF THE ART REVIEW
Prevention of stroke: Antihypertensives, cholesterol-lowering drugs, antithrombotics, anticoagulation, carotid surgery, and stenting
Michael Brainin
January-March 2018, 11(1):2-12
DOI:10.4103/2227-2437.228869  
Antihypertensive drugs are very effective in secondary stroke prevention. More important than the choice of a class of antihypertensives is to achieve the systolic and diastolic blood pressure targets (<140/90 mmHg in nondiabetics and < 130/80 mmHg in diabetics). In many cases, this requires a combination therapy and lifestyle modification. Statin therapy reduces the rate of recurrent stroke and vascular events. The target range of low-density lipoprotein is 70–100 mg/dL. Patients with transient ischemic attack (TIA) or ischemic stroke should receive antiplatelet drugs. The choices are acetylsalicylic acid (ASA 50–150 mg) or clopidogrel (75 mg). Short-term use of dual antiplatelet therapy (ASA plus clopidogrel) may be considered in patients with acute minor stroke or TIA and high risk of recurrence. Patients with a cardiac source of embolism, in particular atrial fibrillation (AF), should be treated with oral anticoagulation. Options for patients with AF include dose-adjusted warfarin (international normalized ratio 2.0–3.0), apixaban, dabigatran, edoxaban, or rivaroxaban. Patients with contraindications to use oral anticoagulation should receive ASA 100–300 mg/day. Symptomatic patients with significant stenosis of the internal carotid artery (degree of stenosis between 70% and 95%) should undergo carotid endarterectomy. Carotid artery stenting is an alternative to endarterectomy in patients who are unsuitable or at high risk for endarterectomy. Patients should receive ASA before, during, and after endarterectomy or the combination of clopidogrel (75 mg) plus ASA (75–100 mg) and after carotid stenting for 1–3 months. Symptomatic patients with intracranial stenosis or occlusions should be treated with optimal medical management, which includes antiplatelet therapy and high-dose statins (if deemed appropriate). In patients with recurrent events, angioplasty can be considered.
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REVIEW ARTICLE
Shoulder ultrasonography accuracy compared with magnetic resonance imaging in the detection of rotator cuff injuries
Mohamed Walaaeldin Elfaal
January-March 2018, 11(1):13-16
DOI:10.7707/hmj.737  
Rotator cuff injuries are common and frequently seen by orthopaedic surgeons. Accurate diagnosis of the injury is crucial for appropriate management. Imaging studies are the cornerstone of diagnosis and have great value compared with clinical assessment alone.
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ORIGINAL RESEARCH ARTICLES
Complication rates of thyroidectomy by an experienced, high-volume thyroid surgeon in a private hospital in Abu Dhabi, United Arab Emirates
Zahoor Ahmad, Ammar Kutaiman, Youssef Hassan, Peshraw Amin, Mohammad Amjad Khan
January-March 2018, 11(1):17-21
DOI:10.7707/hmj.735  
Background: Thyroidectomy is one of the most common endocrine surgical procedures; it is performed by surgeons of various specialities including general surgeons, endocrine surgeons, ear, nose and throat (ENT) surgeons and head and neck surgeons. Thyroidectomy carries a significant and immediate risk of complications, some of which can be life threating. Improved surgical techniques and surgeons experienced in thyroid surgery can significantly reduce morbidity and mortality. Objective: The objective of this prospective study was to determine the overall complication rate and demonstrate that a permanent complication rate of 0% can be achieved. Study Design and Settings: The study was carried out between January 2013 and May 2015 and involved 228 patients. All patients were assessed preoperatively by an endocrinologist and an ENT surgeon for vocal cord functions; all were operated on by the same surgeon, who had >10 years' experience and performed over 100 thyroidectomies per year. Patients were followed up at 6 months to record any complications. Data were analysed using SPSS version 13.0 (IBM, Armonk, NY, USA) and a Chi-squared test was used to calculate P values. Results: There was an overall complication rate of 16.23%; 15.8% of patients experienced transient hypocalcaemia and 0.4% experienced post-operative bleeding. There were no permanent complications, and the rate of both recurrent laryngeal nerve injury and wound infection was 0%. Conclusion: We conclude that the rate of complications of thyroidectomy can be significantly reduced and the rate of permanent complications reduced to 0% if the procedure is performed by an experienced, high-volume surgeon with a special interest in thyroid surgery.
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Influence of personal characteristics on self-concept and job satisfaction of registered nurses working in cross-cultural settings in the United Arab Emirates
Vimala Edwin
January-March 2018, 11(1):22-28
DOI:10.7707/hmj.718  
Background: Self-concept is vital for the nurses to understand about themselves and their patient in the health care setting. In order to meet the patient needs, it is important that the nurses should possess healthy self-concept that makes them more responsible and be more confident to handle the situations skillfully. Every nurse is an important member of the health care organization to provide quality patient care, their work environment and other related factors are essential to satisfy their job. Objective: The objective of the study was to determine the association of self-concept and job satisfaction of registered nurses working at cross-cultural setting. Study Design and Settings: A descriptive correlational study was conducted with 1061 registered nurses working in selected government hospitals using convenience-sampling method. The registered nurses self-concept and job satisfaction were surveyed using the standardized tool Nurses Self-Concept Questionnaire (NSCQ) and Mccloskey/Muller job satisfaction scale (MMSS). SPSS software version 20 was used to analyze the collected data to report descriptive and inferential statistics. Results: The current study identified that there is a relationship between registered nurses self-concept and job satisfaction and the correlation coefficients were statistically very highly significant (P < 0.001). The association of job satisfaction with sub component of self-concept reveals that Nurses General Self-Concept r = 0.273, P < 0.001, Care r = 0.141, P < 0.001, Staff relation r = 0.320, P < 0.001, Communication r = 0.174, P < 0.001, Knowledge r = 0.218, P < 0.001, and lower association with 'Leadership' (r = 0.063, P < 0.05). Conclusion: The results of this research demonstrated the importance of registered nurses self-concept and its effect on job satisfaction that is essential for nurses to provide effective care to the patients.
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Prevalence of diarrhoea and related risk factors among children aged under 5 years in Sana'a, Yemen
Mabrook Aidah Bin Mohanna, Naijla Al-Sonboli
January-March 2018, 11(1):29-33
DOI:10.7707/hmj.711  
Background: Diarrhoeal disease is one of the most common problems affecting children across the world. This study assessed the prevalence of diarrhoea and related risk factors among children aged <5 years. Methods and Material: A cross-sectional study was conducted over 8 months at Sam Specialized Paediatric Centre and Al-Mamoon Diagnostic Medical Centre, Yemen, involving 1570 children aged <5 years with diarrhoea. Detailed data regarding age, sex, diarrhoeal episodes, family size, education level of mother or female caregiver, breastfeeding and weight were collected. Results: Of 5400 patients seen for different causes, 1570 patients were children aged <5 years presenting with diarrhoea, giving a prevalence of 29.07%. A total of 850 children were boys and 720 were girls, with ages ranging from 6 to 60 months. There were 1325 children aged <12 months, 160 aged 1–2 years and 85 aged 3–5 years. There were 700 (44.59%) children from small families and 870 (55.41%) from large families. A total of 922 (58.73%) children were malnourished and 648 (41.27%) were not. There were 1125 (71.66%) children whose mothers or female caregivers had no or low-level formal education and 445 (28.34%) whose mothers or female caregivers had secondary or high-level education. A total of 651 (41.46%) children were breastfed, 735 (46.82%) were mixed fed and 184 (11.72%) were bottle-fed. Conclusion: The prevalence of diarrhoea in children was high; it was highest in those who were aged <12 months, from a large family, malnourished and not exclusively breastfed, and in those whose mother or female caregiver had no or low-level education. It is important to encourage family planning, a balanced diet, exclusive breastfeeding and maternal education, and to strengthen health intervention programmes, in order to reduce the incidence of diarrhoea.
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CASE REPORTS
Neonatal bilateral chylothorax treated by octreotide
Mahmoud Ahmed, Atef Hamed Alshafei, Anwar Khan, Ahmed Gouda
January-March 2018, 11(1):34-36
DOI:10.7707/hmj.721  
Chylothorax is a type of abnormal leak and accumulation of lymphatic fluid in the pleural space. Although clinically rare, chylothorax is the most common cause of pleural effusion in neonates and is usually idiopathic in nature. Chylothorax causes significant respiratory problems as well as nutritional and immunological issues. Patients unresponsive to medical management usually require surgical intervention such as pleurodesis. We report the case of a full-term infant with an idiopathic bilateral chylothorax who was treated with octreotide (a long-acting somatostatin analogue) after failure of conservative nutritional management. The infant responded well and tolerated the medication without complications.
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Rare complications of severe mucositis and psychosis with levetiracetam in an emirati child with acute lymphoblastic leukaemia
Anjan Madasu, Asim Rana, Hani Humad, Saleh Banat, Abdulrahman Al Jassmi
January-March 2018, 11(1):40-41
DOI:10.7707/hmj.741  
We report on a 10-year-old Emirati child with T-cell acute lymphoblastic leukaemia who developed severe mucositis and psychosis while taking levetiracetam. The child was diagnosed with T-cell acute lymphoblastic leukaemia on 9 May 2014 and was started on chemotherapy in accordance with the ALL-BFM 95 protocol. During induction chemotherapy, he developed seizures thought to be due to posterior reversible encephalopathy syndrome, and after neurology consultation, he was started on levetiracetam. He developed severe mucositis and psychosis while on levetiracetam, which was resolved by discontinuing treatment with this medication. Levetiracetam has been used to treat seizures in children with cancer because of its low reported side effects and compatibility with chemotherapy. Severe mucositis and psychosis are two serious complications associated with levetiracetam. This is the first reported case in the literature of an Emirati child with leukaemia developing severe mucositis and psychosis when taking levetiracetam.
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Internal supravesical hernia
Ahmad Kamal, Osama Alzoabi, Ali Salem, Faisal Badri, Alya Al-Mazrouei
January-March 2018, 11(1):37-39
DOI:10.7707/hmj.719  
Internal supravesical hernia is a rare condition with unclear presentation features. If an obstructed hernia is suspected, computerised tomography (CT) can aid diagnosis; some cases are diagnosed at exploratory laparotomy. We report the case of a 72-year-old man who presented with an irreducible left inguinal hernia and an associated supravesical hernia. The diagnosis was suspected during CT and exploratory laparotomy was performed. With early diagnosis and management, supravesical hernias can have an excellent prognosis.
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ORIGINAL RESEARCH ARTICLES
Extending the opening hours of family medicine clinics will reduce load on emergency departments – effects on the early detection of limb fractures
Aisha Yousuf, Darine H Saad, Nada N A Mulla, Amna Hassan
October-December 2017, 10(4):237-243
DOI:10.7707/hmj.690  
Patients with serious and non-serious limb complaints are diverted to emergency departments (EDs) at night, when regular clinics are closed. This study was conducted to identify the impact of extending the opening hours of family medicine (FM) clinics on the detection of limb fractures in patients with limb complaints, which could be a measure of expected patient influx in EDs. A cross-sectional comparative study was conducted in a health centre in Dubai, United Arab Emirates. Patients with limb complaints were categorized by attendance during regular hours (7:30–21:30 hours) and extended hours (21:30–7:30 hours). Rates of fracture positivity, patients handled by the FM clinic and patients referred by the FM clinic to other departments were analysed. SPSS Statistics version 24 (IBM Corporation, Armonk, NY, USA) was used for analysis; chi-squared tests were used to determine association and P-values <0.05 were considered significant. A total of 736 patients with limb complaints were studied: 81.79% (602) attended the FM clinic during regular hours and 18.21% (134) attended during extended hours. The total number of fracture-positive patients was 108. Fracture positivity was more frequent during extended hours: 23 of 134 (17.16%) patients were fracture positive during extended hours and 85 of 602 (14.11%) patients were fracture positive during regular hours. Only 30 of 134 (22.38%) patients were referred to the ED or another department during extended hours, whereas 150 of 602 (24.91%) patients were referred to the ED or another department during regular hours. Referral of fracture-positive patients was not affected by time of attendance (P>;0.05). More fracture-positive patients and fewer referrals during extended hours indicates the significance of extending clinic opening hours; extending the opening hours of this clinic to 24 hours indirectly reduced ED crowding.
[ABSTRACT]   Full text not available  [PDF]
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STATE-OF-THE-ART REVIEW
Multiple sclerosis – an overview on epidemiology, pathogenesis and diagnosis
Fritz Leutmezer
October-December 2017, 10(4):205-211
DOI:10.7707/hmj.811  
This overview will address the epidemiology, main risk factors and clinical course of multiple sclerosis (MS). The clinical as well as pathophysiological features of both relapsing–remitting and progressive MS will be discussed. Furthermore, an overview of diagnostic criteria will be given, supplemented by a differential diagnostic work-up for the clinician.
[ABSTRACT]   Full text not available  [PDF]
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CASE REPORTS
Superior mesenteric artery syndrome – a rare diagnosis for common upper gastrointestinal symptoms
Ammar MH Shehadeh, Mohammed Samir Mokhtar Hamed Elwan, Hazem Mohamed Mostafa Elfar
October-December 2017, 10(4):245-249
DOI:10.7707/hmj.616  
Superior mesenteric artery (SMA) syndrome is a rare acquired vascular compression disorder in which acute angulation of the SMA results in compression of the third part of the duodenum, leading to intestinal obstruction. This is typically caused by an angle of 6–25° between the abdominal aorta and the SMA, in comparison with the normal range of 38–56°, as a result of a lack of retroperitoneal visceral fat (mesenteric fat). In addition, the aortomesenteric distance is 2–8 mm as opposed to the typical 10–20 mm. Here we report the case of an 11-year-old girl who presented with frequent attacks of non-specific abdominal pain over a few years, who had been treated symptomatically without a clear diagnosis. However, in the last admission, she presented to our hospital with symptoms of subacute small bowel obstruction including bilious vomiting and epigastric pain that prompted extensive investigations including multislice abdominal computerized tomography with oral and intravenous contrast. This scan confirmed the diagnosis of SMA syndrome.
[ABSTRACT]   Full text not available  [PDF]
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Severe aortic coarctation incidentally discovered in a young university student
Hazem Almeselmani, Mahmoud Alsoufi, Mohammed Samir Elwan, Amer Albawab, Mohamed Elfadel Musa
October-December 2017, 10(4):265-268
DOI:10.7707/hmj.680  
Coarctation of the aorta is a narrowing of the descending aorta, resulting in left ventricular overload, arterial hypertension and cardiovascular and neurological complications. It is frequently diagnosed in infancy and childhood; first-time presentation in adults is rare. The classic symptom is arterial hypertension; most patients are asymptomatic unless hypertension is present. We report the case of a 19-year-old woman who presented with a headache, tiredness and arterial hypertension. Clinical examination revealed that blood pressure was significantly lower in the lower extremities than in the upper extremities and radiofemoral delay (delayed femoral pulses). Severe aortic coarctation was confirmed by computerized tomography aortography; echocardiography was inconclusive. The lesion was successfully treated with balloon dilatation and mesh stent placement.
[ABSTRACT]   Full text not available  [PDF]
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Localized leishmaniasis of the pharyngeal mucosa in the United Arab Emirates
Muhammad Sami Jabbr, Azizullah Jaffar, Jamal Kassouma, Hussain Talib Salman
October-December 2017, 10(4):251-256
DOI:10.7707/hmj.641  
We present a case of mucosal leishmaniasis located in the pharynx and possibly the maxillary sinus in a healthy 51-year-old man. The only manifestations of leishmaniasis disease in the described case were dysphagia, voice changes and a longstanding painless pharyngeal mass. Thorough clinical examination and investigations were carried out and treatment was provided in the form of amphotericin B, piperacillin/tazobactam and linezolid. A review of the literature on this subject has been undertaken.
[ABSTRACT]   Full text not available  [PDF]
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EDITORIAL
Why sports medicine?
Mike S Irani
January-March 2017, 10(1):1-2
DOI:10.7707/hmj.728  
Full text not available  [PDF]
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ORIGINAL RESEARCH ARTICLES
Serum interleukin 8 level is linked to the inflammatory and cardiometabolic indicators in survivors of breast cancer
Marwan Salih Mohammad Al-Nimer, Zhian Mahmood Ibrahim Dezayee
July-September 2017, 10(3):163-167
DOI:10.7707/hmj.676  
Serum interleukin 8 (IL-8) levels have been shown to increase in post-relapse survivors of breast cancer, and its levels are linked with a poor prognosis and progression of breast tumours. This study aims to assess serum IL-8 levels and the components of metabolic syndrome in breast cancer survivors, taking into consideration their menopausal status. This observational study was carried in Nanakali Hospital in Erbil, Kurdistan. A total of 120 women with a history of breast cancer were enrolled and divided into premenopausal (group I, n = 30) and postmenopausal (group II, n = 90) groups. Cardiometabolic determinants including body mass index, blood pressure, fasting serum lipids and lipoproteins were measured. Markers that related to breast cancer, including high-sensitivity C-reactive protein (hs-CRP) and IL-8, were determined. Group II patients had significantly higher levels of atherogenic lipids than group I patients. The mean levels of hs-CRP and IL-8 were significantly higher in group II {3.040 mg/l [standard deviation (SD) ± 0.762] and 424.7 pg/ml (SD ±87.3 pg/ml), respectively} than in group I [2.435 mg/l (SD ±0.891) and 354.6 pg/ml (SD ±109.4), respectively] patients. We conclude that postmenopausal women with breast cancer are at a significant risk of dyslipidaemia and have higher levels of inflammatory and pro-tumorigenic factors than premenopausal women.
[ABSTRACT]   Full text not available  [PDF]
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Efficacy of anterior column reconstruction in tuberculosis of the cervical spine with stand-alone titanium cage without anterior plating
Qazi Muhammad Amin, Ashfaq Ahmed, Muhammad Imran, Farrukh Bashir, Atiq Uz Zaman, Shahzad Javed, Amer Aziz
July-September 2017, 10(3):169-172
DOI:10.7707/hmj.727  
Tuberculosis (TB) is a common disease, especially in underdeveloped countries. TB of the vertebral column constitutes nearly 50% of all lesions of osteoarticular TB. The most common site for the disease is the peridiscal region. The primary treatment option is usually anti-TB chemotherapy, but in some patients with severe pain and neural involvement, instability and a large abscess, surgery is recommended. To our knowledge there are no publications describing the use of a stand-alone titanium cage and bone graft without anterior plating in the treatment of tuberculous spondylitis (TBS). The aim of this study is to evaluate the efficacy of stand-alone titanium mesh cages in TB of the cervical spine. A retrospective study of 47 patients with cervical TBS was carried out at Ghurki Trust Teaching Hospital, Lahore, Pakistan, of whom 61.6% were aged 3–35 years and 28.4% were aged 36–70 years. Twenty-six were male and 21 were female. Preoperative spinal function was categorized as Frankel grade E in 26 patients, Frankel grade D in four patients, Frankel grade C in 10 patients, Frankel grade B in two patients and Frankel grade A in five patients. Following surgery, one patient categorized as Frankel grade A remained the same while the remaining four improved to grade C at follow-up. The rest of the patients improved to grade E at the 2-year follow-up. The mean preoperative Cobb angle was 39.06° [standard deviation (SD) 10.92°], which improved to –5.51° (SD 77°) (P < 0.05). When comparing the visual analogue scores, there was also a statistically significant difference in pain improvement. All patients underwent single-stage radical debridement, decompression and instrumentation. Anterior column reconstruction was performed in all patients using a stand-alone titanium cage. The use of titanium cages effectively corrects sagittal deformity in the TB-affected spine with no donor site morbidity.
[ABSTRACT]   Full text not available  [PDF]
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Factors influencing the use of complementary and alternative medicine for musculoskeletal disorders in the United Arab Emirates
Sharfaa Ahmed, Faryal Shaikh, Salihu M Lawal, Fredrick Ogugua, Khaleifah Al-Hafeiti, Saif Saeed Al-Hafri, Rizwana B Shaikh
January-March 2015, 8(1):137-144
DOI:10.7707/hmj.371  
The objective was to estimate the prevalence of and reasons for using complementary and alternative medicine (CAM) for various musculoskeletal conditions and to determine the most common musculoskeletal problems for which CAM is used. A cross-sectional study was conducted using 305 subjects, which included the doctors and staff members of Gulf Medical University and Gulf Medical Hospital, 20 years of age and over. Data were analysed using the SPSS program. Of the subjects documented, 51.1% admitted that they used alternative medicine, of which 30.1% used it alongside conventional medicine. Most subjects interviewed used Ayurveda (34%) and the most common use of CAM was to relieve general aches and pains (46.8%). A total of 30.2% of CAM users stated that 'conventional medicine was not effective', 23% of them felt that CAM 'relieves stress' and 22.6% felt that it could reduce the severity of the condition. Painkillers were the most common conventional medicine used alongside alternative medicine (48.2%). No significant difference was found between the effectiveness of CAM alone and CAM with conventional medicine. More than half the participants were making increasing use of CAM. Hospitals can provide CAM alongside conventional medicine in the UAE
[ABSTRACT]   Full text not available  [PDF]
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REVIEW ARTICLE
Micropapillary variant of urothelial carcinoma – a review of the literature
Anthony Kodzo-Grey Venyo
January-April 2014, 7(1):56-69
DOI:10.7707/hmj.v7i1.258  
The micropapillary variant of urothelial carcinoma is one of the variants of urothelial carcinoma that was added to the World Health Organization (WHO) classification in 2004. This variant of urothelial carcinoma is uncommon and, therefore, a number of practitioners have not yet encountered the tumour in their clinical practice. In view of this, the diagnostic features and the biological behaviour of this tumour are not well known by practitioners. This review documents the diagnostic features, management and outcome of the micropapillary variant of urothelial carcinoma. Various internet search engines were used to identify literature on the micropapillary variant of urothelial carcinoma, including case reports and case series, which formed the basis of the literature review. At least 500 cases of the micropapillary variant of urothelial carcinoma have been reported since it was first described in 1994. The gross morphology is variable and there are no special features to differentiate this variant from other variants or from conventional urothelial carcinoma. The micropapillary variant may be sessile, papillary, ulcerative or polypoid or may manifest as an infiltrative mass of variable size, ranging from microscopic to > 10 cm. The microscopic features of this variant of urothelial carcinoma exhibit an architecture that is reminiscent of the papillary configuration of ovarian papillary serous tumours. The nuclei of the micropapillary variant cells are commonly of high grade and show reverse polarity to the external surface of the tumour nests. A minority of the tumour-containing spaces represent actual lymphovascular invasion, which is supported by their characteristic immunohistochemical staining with endothelial markers. Lymphovascular invasion can be found in most cases of the invasive micropapillary variant of urothelial carcinoma if the specimens are adequately sampled, but a majority of the tumour-containing lacunae do not have endothelial lining and, therefore, do not represent true lymphovascular invasion. Psammoma bodies, which are common in ovarian papillary serous tumours, are rare in the micropapillary variant of urothelial carcinoma, and most of these tumours exhibit deep muscle invasion. Urine cytology exhibits papillary/spheroid clusters of tumour cells that have a high nuclear grade. The micropapillary variant of urothelial carcinoma is a rare and aggressive variant and may be under-reported as some pathologists may not be aware of its diagnostic features. Reports so far would indicate that this variant is associated with poor prognosis and adjuvant chemotherapy may have a questionable efficacy. Because of the rarity of this variant of urothelial carcinoma, there is no consensus opinion regarding the optimal treatment. Therefore, there is a need for urologists and oncologists throughout the world to report cases of the micropapillary variant of urothelial carcinoma so that the biological behaviour of the tumour can be ascertained. There is also a need for multicentre trials of treatment of this variant of urothelial carcinoma so that lessons can be learnt regarding the biological behaviour of the tumour and a consensus opinion can be established regarding the best treatment modality for such an apparently aggressive tumour.
[ABSTRACT]   Full text not available  [PDF]
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Tarlov cyst – an uncommon cause of back pain
Mohamed Walaaeldin Elfaal, Mohamed Samir
July-September 2017, 10(3):201-204
DOI:10.7707/hmj.695  
Tarlov cysts, also known as perineural or sacral nerve root cysts, are cerebrospinal fluid-filled dilatations of the nerve root sheath most commonly found at the sacral spine, near the dorsal root ganglion. The cysts are relatively rare and usually asymptomatic, but some can exert pressure on the nerve root, causing perineal pain/discomfort or lower back pain or sphincter/sexual dysfunction. Tarlov (perineural) cysts of the nerve roots were first described in 1938.
[ABSTRACT]   Full text not available  [PDF]
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STATE-OF-THE-ART REVIEW
Immunomodulatory treatments for relapsing–remitting multiple sclerosis
Fritz Leutmezer
October-December 2017, 10(4):213-226
DOI:10.7707/hmj.806  
Multiple sclerosis (MS) is an autoimmune disease of the central nervous system that encompasses both neuroinflammatory and prominent neurodegenerative aspects. A significant proportion of MS patients will develop neurological disability over time and, until recently, licensed drugs could not satisfactorily halt this process. However, in recent years, MS treatment has entered a phase of rapid progress. Several new drugs with significantly improved efficacy have entered the therapeutic field, and several others are currently undergoing phase III clinical trials. In this review, the efficacy data and safety and tolerability issues of currently licensed drugs for relapsing–remitting MS will be summarized, including a short update on new drugs currently undergoing late-stage clinical trials.
[ABSTRACT]   Full text not available  [PDF]
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Upcoming therapeutic options for progressive multiple sclerosis
Fritz Leutmezer
October-December 2017, 10(4):227-236
DOI:10.7707/hmj.809  
Although a wide range of therapeutic options are available for relapsing–remitting multiple sclerosis (MS), the therapeutic landscape for progressive forms of the disease is highly unsatisfactory. Therefore, the identification of effective therapies for progressive MS (PMS) is a highly relevant challenge for the global MS medical community. To achieve this, a better understanding of the mechanisms involved in PMS is required through novel clinical trial designs, new drug repurposing strategies and new methods of collaboration in identifying effective therapies. In this review, we discuss the first compounds already available for PMS as well as other therapies currently undergoing phase II and III clinical trials.
[ABSTRACT]   Full text not available  [PDF]
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Diagnosis of gastro-oesophageal reflux disease and its associated conditions
Ivan Kristo, Sebastian F Schoppmann
July-September 2017, 10(3):147-153
DOI:10.7707/hmj.768  
As the prevalence of gastro-oesophageal reflux disease (GORD) continues to rise, diagnostic modalities are crucial to differentiate GORD from related and overlapping conditions such as Barrett's oesophagus (BO), eosinophilic oesophagitis (EO) and jackhammer oesophagus (JO). Patient medical history and symptom assessment are critical in the diagnosis of GORD, and endoscopy should be utilized when patients present with alarming symptoms or are unresponsive to proton pump inhibitors. Ambulatory pH monitoring is the modality with the highest sensitivity and specificity; it is particularly helpful in unclear cases and during preoperative testing. BO is a consequence of GORD and a well-known preneoplastic condition; endoscopic evaluation is required. EO and JO are important overlapping conditions that should be differentiated when diagnosing GORD; JO is typically diagnosed using high-resolution manometry whereas EO is typically diagnosed by measuring rates of infiltrating eosinophils.
[ABSTRACT]   Full text not available  [PDF]
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Appetite regulation and physical activity – an energy balance perspective
Catherine Gibbons, John Blundell
January-March 2015, 8(1):33-52
DOI:10.7707/hmj.431  
In addressing the topic of appetite regulation, energy balance and physical activity, there are many reasons why it is appropriate to consider these issues conjointly in relation to the phenomenon of obesity. Firstly, it is widely recognized that obesity arises from a mismatch between energy taken in and energy expended, although this is not a simple matter of calculating the algebraic sum of two numbers. Secondly, recent evidence has revealed that appetite control (responsible for energy intake) is closely related to the energy requirements of the body, in contrast to the conventional approach of appetite emerging from the regulation of body fat (lipostatic hypothesis). Thirdly, physical activity is obviously implicated in energy balance and therefore connected to both energy intake (appetite control) and the control of body tissue stores (obesity). Finally, for the management of obesity, increasing physical activity (moving more) and decreasing dietary intake (eating less) are two of the major principles in the medical and public health arenas. This review will deal with research and theory relating to human obesity, with the objective of providing a synthesis relevant to understanding the predicament that this phenomenon is causing. One major reason for addressing the problem in this way is because, in recent years, it has become apparent that the observed increase in obesity, worldwide, is associated with an overconsumption of food (a problem related to appetite control) and a sedentary lifestyle (a problem related to physical activity), and the relationship between the two (an issue related to energy balance). Accordingly, investigations in this area should provide insights into how to deal with overconsumption and with sedentariness for the management of obesity. This review is about energy intake and energy expenditure and how they influence the human capacity to live healthily in a modern world.
[ABSTRACT]   Full text not available  [PDF]
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ABSTRACTS
The microbiome revolution – how can we translate the science into clinical practice?
Eamonn MM Quigley
October-December 2016, 9(4):293-296
DOI:10.7707/hmj.688  
Full text not available  [PDF]
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