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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  
  398 125 -
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.
  390 90 -
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.
  304 71 -
ORIGINAL RESEARCH ARTICLES
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.
  296 68 -
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.
  284 76 -
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.
  215 40 -
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.
  134 31 -
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.
  114 26 -
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.
  112 21 -
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]
  37 12 -
STATE-OF-THE-ART REVIEW
Children and sport – how hard should children be trained?
Kyle C Pierce, Michael H Stone
January-March 2017, 10(1):19-38
DOI:10.7707/hmj.730  
The participation of children and early and late adolescents in resistance training activities, including training for sport, appears to continually be on the rise. The involvement of youth in the sport of weightlifting and the use of weightlifting methods as part of training for sport performance also appears to be growing. The increased acceptance of these activities is evidenced by the number of both lay and scientific articles, specialized magazines and publications devoted to the different types of resistance training. It is also indicated by simple observation of fitness centres and sports training facilities. The use of resistance training appears to be growing in popularity despite poorly supported position statements, anecdotal reports and speculation concerning the potential for injury. Children and adolescents participating in resistance training programs can make noticeable increases in strength and power as well as physiological parameters associated with both health and sport performance. Although the number of children and adolescents (aged 8–18 years) involved in some form of resistance training is increasing and evidenced-based reviews that support these activities have been published, controversy still exists. There are still those who insist that training with free weights, particularly the sport of weightlifting, should not take place until a person is fully developed, even though there is not much objective evidence to support such a position. More recently published scientific data support the notion that properly supervised resistance training programs can improve sport performance, reduce injury potential and enhance healthy facets of children and early and late adolescents.
[ABSTRACT]   Full text not available  [PDF]
  25 13 -
ORIGINAL RESEARCH ARTICLES
Acid neutralization capacity and cost-effectiveness of antacids sold in various retail pharmacies in the United Arab Emirates
Shery Jacob, Annie Shirwaikar, Shijna Anoop, Reham Khaled, Mariyam Imtiaz, Anroop Nair
April-June 2016, 9(2):137-146
DOI:10.7707/hmj.452  
The objective of this research was to determine the acid neutralization capacity (ANC) at 37°C ± 2°C (as per United States Pharmacopeia 30 and the National Formulary 25) of antacid preparations sold in various retail pharmacies in the United Arab Emirates. Another important objective was to quantify the sodium and calorific content of antacids, as well as overall monthly consumption, and cost of therapy of different antacids from different manufacturers. The tablet and liquid antacids fall into four statistically different ANC groups. Three of the tablet antacids have an ANC similar to that of liquid antacid medications described as being in the high-ANC class. Of the five liquid antacids tested, only two were found to have a high ANC between four production lots at 5% level of significance. The ANC of the most effective liquid antacid was twice that of the lowest. However, this variation in capacity for neutralization is not observed in the product description of antacid brands. A standard dose is one to two teaspoons: one teaspoon will neutralize 20.2–35.92 mEq and two teaspoons will neutralize 40.44–71.84 mEq depending on the antacid selected. It is apparent from the results of quantification that maximum ANC combined with a minimum dosage volume–weight ratio is achieved by antacids from the high- or intermediate/high-ANC group. Consumption of these categories of antacids is beneficial as they contain less sodium and fewer calories and they are less expensive for pharmacists and/or the public. The monthly cost of daily high-dose therapy is much lower for high-ANC tablet antacids than for low-ANC tablet antacids. In conclusion, if antacids are to be used optimally, it is imperative that the ANC is specified on the product label.
[ABSTRACT]   Full text not available  [PDF]
  28 7 -
REVIEW FOR THE SHEIKH HAMDAN BIN RASHID AL MAKTOUM AWARD FOR MEDICAL SCIENCES
Discovery of first-in-class therapeutics – venlafaxine (Effexor®), desvenlafaxine (Pristiq®), temsirolimus (Toresil®), ILS-920 and gemtuzumab ozogamicin (Mylotarg®)
Magid Abou-Gharbia
September-December 2014, 7(3):317-331
DOI:10.7707/hmj.346  
The pharmaceutical industry today is experiencing unprecedented difficulty and faces enormous challenges, which include the industry's declining efficiencies, patent expirations for key drugs, fierce price competition from generic drugs, mergers and acquisitions, high regulatory hurdles, declining innovation and the industry's perceived tarnished image. Pharma has embarked on a range of initiatives to address these challenges, maintain its commitment to innovation and continue its mission to alleviate human suffering through the discovery of new medicines. This review covers the following themes: (1) drug discovery – highlighting process, targets, approach and current pharmaceutical platforms (small molecules, biologics and vaccines); (2) today's realities – highlighting current challenges facing the pharmaceutical industry, especially the innovation gap, and Pharma's commitment to innovation; (3) commitment to innovation and success stories focusing on selected examples of first-in-class therapeutics, such as the serotonin–noradrenaline reuptake inhibitor antidepressants venlafaxine (Effexor®, Pfizer, Surrey, UK) and desvenlafaxine (Pristiq®, Pfizer, Surrey, UK), immunophilin mammalian target of rapamycin modulator temsirolimus (Toresil®, Pfizer, Surrey, UK), the neuroprotectant ILS-920 for stroke therapy and the first conjugate anticancer drug gemtuzumab ozogamicin (Mylotarg®, Pfizer, Surrey, UK). Although many high drug discovery hurdles remain, the future holds great promise. The search continues for major breakthrough therapies that address unmet medical needs, such as disease-halting drugs for the treatment of Alzheimer's disease, drugs to eradicate hepatitis C and acquired immune deficiency syndrome, and drugs to attack resistant cancers, treat strokes and alleviate cardiovascular disease.
[ABSTRACT]   Full text not available  [PDF]
  32 3 -
CASE REPORTS
Treatment of peripherally inserted central catheter line-associated thrombus in a preterm neonate with low-molecular-weight heparin
Mahmoud G Ahmed, Muzammil Hafeez, Anwar Khan, Ahmed M AlKamali, Fadhil H Ghayb, Anjan Madasu
January-March 2017, 10(1):75-80
DOI:10.7707/hmj.635  
Thrombus formation is a known complication of the use of peripherally inserted central catheter (PICC) lines. The thrombus can be asymptomatic or compromise limb or organ function. Symptomatic thrombi need to be treated. The treatment options include the use of unfractionated heparin or low-molecular-weight heparin (LMWH). We present a case of a PICC line-associated thrombus that resolved after treatment with LMWH.
[ABSTRACT]   Full text not available  [PDF]
  21 11 -
ORIGINAL RESEARCH ARTICLES
Well-preserved ventricular myocyte shortening in Goto–Kakizaki type 2 diabetic rats
EM Gaber, P Jayaprakash, MA Qureshi, M Oz, FC Howarth
May-August 2014, 7(2):211-217
DOI:10.7707/hmj.v7i2.311  
The global prevalence of type 2 diabetes mellitus (T2DM) is rising at a spectacular rate and the prevalence of T2DM in the United Arab Emirates is among the highest in the world. Risk factors for diabetes mellitus include obesity, sedentary lifestyle, unhealthy eating habits, family history of diabetes mellitus, genetics, increasing age, high blood pressure and high cholesterol. A variety of diastolic and systolic dysfunctions have been reported in the hearts of type 2 diabetic patients and the severity of abnormalities is partly dependent on the patient's age and the duration of diabetes mellitus. The Goto–Kakizaki (GK) rat is a genetic model of T2DM and its general characteristics include fasting hyperglycaemia, impaired insulin secretion and insulin resistance. In the GK rat heart, there are a variety of dysfunctions including decreased heart rate, decreased ejection fraction (mainly due to loss of left ventricular longitudinal contraction) and prolonged shortening and/or relaxation in ventricular myocytes. Widespread consumption of sugar-sweetened beverages has been linked to higher incidence of obesity and T2DM. Ventricular myocyte shortening and Ca2+ transport in GK type 2 diabetic rats that were fed a sucrose-enriched diet have been investigated. GK and control rats received either water or water enriched with increasing concentrations of sucrose (100–400 mmol/l) for a period of 6 months. Ventricular myocyte shortening and intracellular Ca2+ were measured by video edge detection and fluorescence photometry, respectively. Resting cell length, time to peak (TPK) shortening, time to half-relaxation of shortening and amplitude of shortening were not significantly altered in ventricular myocytes from GK/sucrose compared with GK rats and control/sucrose compared with control rats. TPK Ca2+ transient was prolonged in myocytes from GK/sucrose compared with GK and control/sucrose rats and amplitude of the Ca2+ transient was increased in myocytes from GK/sucrose compared with control rats. Myofilament sensitivity to Ca2+ was unaltered in myocytes from GK/sucrose and control/sucrose compared with GK and control rats. In conclusion, ventricular myocyte shortening was well preserved despite some alterations in Ca2+ transport in GK rats receiving a sucrose-enriched diet.
[ABSTRACT]   Full text not available  [PDF]
  27 5 -
REVIEW ARTICLE
Brucellosis associated with kidney injury and any form of nephropathy – a review of the literature
Anthony Kodzo-Grey Venyo
July-September 2016, 9(3):251-264
DOI:10.7707/hmj.447  
Systemic brucellosis may be associated with acute kidney injury (AKI), haemolytic–uraemic syndrome, nephrotic syndrome or various types of nephropathy. Presentation depends on the type of renal disease the patient develops. A diagnosis of brucellosis as a cause of nephropathy would require the following: isolation of Brucella in blood culture; positive serological test for brucellosis; renal biopsy evidence of the type of nephropathy; culture of Brucella from perinephric abscess or renal abscess aspirate; culture of Brucella from nephrectomy specimen; and finding a specific type of nephropathy during histological examination. Ultrasonographic and computerized tomographic findings are not specific for brucellosis; however, the scans may show an abnormal area in the kidney from which renal biopsies can be taken for pathological examination and culturing, and if there is an abscess it can be aspirated for culture. A high index of suspicion is required to diagnose the disease. The most commonly used antibiotic regimen for the treatment for brucellosis is doxycycline 100mg twice a day for 45 days in combination with streptomycin 1g/day for 15 days. The main alternative treatment is doxycycline 100mg twice a day for 45 days in combination with rifampicin 15mg/kg/day (600–900mg) for 45 days. Experience suggests that streptomycin may be replaced by gentamicin 5mg/kg/day for 7–10 days. The optimal treatment for neonates and children under 8 years old with acute brucellosis has not yet been determined but there is some experience with trimethoprim/sulfamethoxazole (cotrimoxazole) in combination with an aminoglycoside (streptomycin, gentamicin) or rifampicin. In general, other combinations of antibiotics have also been used to treat brucellosis. In cases of kidney injury and dehydration, in addition to antibiotic treatment, rehydration and clinical monitoring is required, as is monitoring urine output, repeated urinalysis and repeated serum biochemical tests for renal function estimation to assess the patient's progress. Most renal complications due to brucellosis resolve/improve after combined antibiotic treatment and rehydration, which is also most often associated with return of normal renal function or improvement in renal function. However, relapses can occur, and careful patient follow-up is required to further assess the patient clinically by regularly repeating urinalysis, renal function tests, liver function tests and full blood count and coagulation tests, as well as repeating blood and urine cultures and Brucella serology tests. Patients should be educated to avoid contact with and ingestion of unpasteurized dairy products. Pasteurization of all dairy products should be advised, encouraged and monitored. Veterinary surgeons in endemic areas should be informed and assist when a new diagnosis is made in order to help identify and treat or kill affected animals harbouring Brucella.
[ABSTRACT]   Full text not available  [PDF]
  23 9 -
ORIGINAL RESEARCH ARTICLES
Sensitization of murine macrophages and human hepatoma cells to lipopolysaccharide-induced oxidative and nitrosative stress by aspirin
Haider Raza, Annie John, Jasmin Shafarin
May-August 2014, 7(2):219-228
DOI:10.7707/hmj.v7i2.316  
Bacterial endotoxin lipopolysaccharide (LPS) induces the production of inflammatory cytokines and reactive oxygen species (ROS) under in vivo and in vitro conditions. Acetylsalicylic acid (ASA, aspirin) is one of the most commonly used anti-inflammatory drugs. Our aim was to study the mechanism of aspirin action in the presence of LPS in murine macrophages and human hepatoma cells. We investigated the effects of LPS with a subtoxic concentration of ASA, alone and in conjunction, on oxidative and nitrosative stress using the mouse macrophage cell line J774.2 and human hepatoma HepG2 cells. Apoptosis was measured by flow cytometric analysis. LPS alone markedly induced nitric oxide (NO) production in macrophage cells and moderately in HepG2 cells. When ASA was added to LPS-treated macrophage cells, the increase in NO production was significantly higher than that induced by LPS or ASA alone. However, treatment of HepG2 cells with LPS or ASA alone or in combination exhibited moderate effects on NO production. Similarly, production of ROS after treatment with LPS and ASA was also higher in macrophages than in HepG2 cells. The combination of LPS and ASA also markedly increased the rate of lipid peroxidation in both cell lines. The activity of aconitase, an oxidative stress-sensitive mitochondrial matrix enzyme, was also markedly inhibited in J774.2 cells compared with HepG2 cells. Furthermore, treatment of cells with LPS alone or in combination with ASA also resulted in higher apoptotic cell death in macrophages. These results suggest that macrophages are more sensitive to LPS and that LPS and ASA treatments synergistically increase oxidative and nitrosative stress in these cells.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  27 4 2
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]
  21 10 -
CASE REPORTS
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]
  22 8 -
ORIGINAL RESEARCH ARTICLES
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]
  24 6 -
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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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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HISTORICAL REVIEW
The lifework of Erich Saling – the father of perinatal medicine
Monika Drager, Asim Kurjak
September-December 2012, 5(3):193-198
DOI:10.7707/hmj.v5i3.179  
Aim. To present the lifework of Prof. Dr. med. Dr. h. c. mult. Erich Saling, obstetrician and perinatologist, with regard to his impact on the history and development of perinatal medicine. Methods. Discussion of some of Erich Saling's most important scientific contributions as well as his contributions to the development of perinatal medicine as a new field of medicine by founding societies and journals, organizing congresses, etc. Results. Fetal blood analysis, performed by Erich Saling in 1960 (and published in 1961), was the first direct approach to the human fetus that could already be used in routine clinical practice. Erich Saling also developed amnioscopy and made several other important contributions, most of them aiming to reduce the infant mortality and morbidity rate and the number of preterm births. In addition to his scientific contributions, Erich Saling played an important role in the development of perinatal medicine by founding the very first national and international scientific associations – in 1967 he founded the German Society of Perinatal Medicine and in 1968 he founded the European Association of Perinatal Medicine. He also organized the first scientific congresses – in 1967 the first national congress and in 1968 the first European Congress of Perinatal Medicine that was held in Berlin – and was involved in the organization of many scientific meetings. Erich Saling also published the first book concerning the infant within obstetrics and founded the very first journal in this field, entitled Journal of Perinatal Medicine. Conclusion. Erich Saling can truly be regarded as one of the main pioneers of perinatal medicine.
[ABSTRACT]   Full text not available  [PDF]
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CASE REPORTS
Oral lymphangioma of the alveolar ridge – a report of a rare case
Faysal Ugurlu, Alper Kaya, Emine Tuna Akdogan, Vakur Olgac, Aysegul Sipahi
July-September 2016, 9(3):247-250
DOI:10.7707/hmj.605  
Lymphangiomas are benign hamartomatous lesions of the lymphatic vessels, which are commonly seen in the head and neck region. The most frequent locations of oral lymphangiomas are the dorsum of the tongue, followed by the palate, buccal mucosa, gingiva and lips. The various treatment options are surgical excision, radiation therapy, cryotherapy, electrocautery, sclerotherapy, steroid administration, embolization, ligation, laser surgery using neodymium-doped yttrium aluminium garnet, carbon dioxide and radiofrequency tissue ablation. We report a rare case of an oral lymphangioma affecting the posterior alveolar ridge of the maxilla. The 51-year-old male patient was referred to our clinic because of a diffuse, 2×3cm, blue–purple lesion in the right posterior alveolar ridge. The lesion was removed completely, together with adjacent healthy tissue. Histopathological examination confirmed the lesion as a lymphangioma.
[ABSTRACT]   Full text not available  [PDF]
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EDUCATIONAL REVIEW
The gut–brain axis – a new key to understand mind–body connection
Fahad Basheer, Shabnam P Samath, Fahim Basheer
April-June 2017, 10(2):143-144
DOI:10.7707/hmj.685  
The gut has been considered a digestive organ until the recent discovery of the gut–brain axis. The gut–brain axis is a connection through which the gut microbes are able to influence and control the emotions as well as the cognition of an individual through neuroimmunoendocrinological pathways. This article puts forth some of the well-established discoveries of the gut–brain axis, explaining the mechanism of action on how gut microbes modulate the formation of the enteric nervous system and the production of neurohormones and chemokines to alter the cognitive performance of the brain and the emotional balance of an individual through neural, immune and endocrine pathways. Moreover, this bidirectional axis acts as a new key to understand the mind–body connection in the future.
[ABSTRACT]   Full text not available  [PDF]
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