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   Table of Contents - Current issue
July-September 2019
Volume 11 | Issue 3
Page Nos. 95-131

Online since Monday, October 21, 2019

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Vitamin D Deficiency: Beyond Sunshine! p. 95
Hussein F Saadi, Juma M Alkaabi
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Paradoxical Vitamin D deficiency in a sunny country: A narrative review of the literature from the United Arab Emirates (1992–2018) p. 97
Salem A Beshyah, Khadija Hafidh, Dima K Abdelmannan, Abdul Jabbar, Wafic S Wafa, Aly B Khalil
Deficiency of Vitamin D is a global problem related to lack of sunlight exposure and reduced dietary intake. Vitamin D deficiency (VDD) affects mainly skeletal structure and function but has a number of recognized nonskeletal effects that have wide ramifications. It sounds ironic that low serum Vitamin D levels are widely documented in a sunny country like the United Arab Emirates (UAE). The study objective was to review the literature on VDD in the UAE. This is a narrative nonsystematic review of the literature on the epidemiological and clinical aspects of Vitamin D status in the UAE based on PubMed search using two search terms “Vitamin D” and “Emirates.” We discuss the various themes that emerged as follows: epidemiology and disease burden of VDD in the UAE population in general and in specific groups (adults, children, females, and pregnant and nursing mothers); awareness of dietary intake, climate, genetics, and metabolic factors affecting serum Vitamin D levels; and the overview of current clinical management guidelines, interventional trials, and clinical practices. VDD is a widely documented health problem in the UAE population as a whole and in several special groups. This may have serious skeletal and nonskeletal health implications.
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Empower parents and enable breastfeeding: Role of employers p. 109
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
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Prevalence of multi-drug-resistant tuberculosis among human immunodeficiency virus and nonhuman immunodeficiency virus-positive pulmonary tuberculosis patients of two referral hospitals in Southeast Nigeria p. 111
Chinenye Esther Okoro, Stellamaris Ojiuzor Ibhawaegbele, Charles Ikechukwu Ezema, Uchechukwu Anthonia Ezeugwu, Chukwuma Paulinus Igweagu, Ogechukwu Calista Dozie-Nwakile
Introduction: Multidrug-resistant tuberculosis (MDR-TB) is a type of TB that is resistant to the two most effective first-line drugs: rifampicin and isoniazid and it remains a major public health threat, particularly in developing countries. Objectives: To assess the MDR-TB prevalence among human immunodeficiency virus (HIV) and nonHIV positive pulmonary TB patients of two referral hospitals in southeast Nigeria. Materials and Methods: Sputum specimens of individuals presenting with a cough of >2 weeks duration were screened by Ziehl–Neelsen technique for the presence of acid-fast bacilli (AFB). Results: A total of 103 subjects with AFB-positive sputum samples were recruited from the two referral hospitals and HIV-1/2 antibodies were screened using serial algorithm method. The positive sputum samples were subjected to Xpert MTB/RIF assay (GeneXpert®, Cepheid, USA) and cultured on the Lowenstein–Jensen medium for 42 days at 37°C. Drug susceptibility testing was done on the isolates using the nitrate reduction assay. Eighty-three (80.6%) of the isolates were obtained from culture after suspected colonies were subjected to morphological, biochemical, and immunological tests and of the 83 (80.6%) samples analyzed using Xpert MTB/RIF assay 45 (67.2%) were rifampicin-resistant. The prevalence of culture-positive TB was higher in the HIV-negative sub-population (82.02%) when compared with the HIV-positive participants (71.40%). The rate of MDR-TB was high among HIV-positive patients though not statistically significant. HIV positive patients showed prevalence of (66.70%), whereas HIV-negative patients had (42.60%). Conclusions: The World Health Organization estimated that 26% of patients with TB infection in Nigeria are HIV-positive and the alarming evidence of MDR-TB prevalence in this study calls for close monitoring of the prevalence of drug resistance, especially in HIV-infected population.
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Trends in skin fungal infection in Tripoli, Libya, during 2007–2015 p. 116
Ahmed Atia, Abdulsalam Ashour, Najla Elyounsi
Background: Skin infection is common worldwide and continues to rise. This study was undertaken to determine the trends in skin fungal infection in patients attending a tertiary hospital. Methods: A total of 253 patients, suspected of superficial and cutaneous skin infections, referred to the Medical Mycology Laboratory of Berustta-Milad Hospital, Libya, were included from attendees over the past 8 years (January 2007–December 2015). Specimens were attained from clinically atypical skin lesions, hair or nail samples of infected patients through scraping. Dermatophyte isolates were identified by studying macroscopic and microscopic characteristics of their colonies. Results: Of 253 samples, fungi were detected in 179 (70.8%) by potassium hydroxide, of which 70 (39.1%) samples were Aspergillus infection followed by 55 (30.7%) samples which were culture positive of Trichophyton spp., 33 (18.4%) samples were isolates of Candida, and 21 (11.8%) due to other opportunistic fungi. Patients with the age group of 17–28 years were more affected. Conclusion: Skin fungal infections are common there is a need to increase the awareness of risk factors contributing to skin fungal infections. Further larger and more detailed epidemiological studies of fungus-induced dermatophytosis which have public health implication are needed.
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Coccoid Helicobacter pylori: An uncommon form of a common pathogen p. 120
Heidi Reinhard, Mary Ann Jarad, Vanessa Ladd, Samir B Kahwash
Microscopic recognition remains a major component of diagnosing specific infectious agents or, at the minimum, an important first step in initiating a workup to confirm a specific infectious etiology. However, organisms are known to adapt in response to treatment, not only by developing resistance mechanisms but also undergoing major morphologic changes in some cases. Such morphologic adaptation can make them drastically different and hence difficult to recognize or characterize by an unwary examiner. The purpose of this article is to highlight a rare and unusual form of Helicobacter pylori referred to as coccoid H. pylori.
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Takayasu's arteritis in a Libyan female p. 124
Hawa Juma El-Shareif
Takayasu's arteritis (TA) is a large-vessel vasculitis that involves the aorta and its major branches. Renal arteries are frequently involved, usually with renovascular hypertension. The prevalence of TA in Arabs is low. A study of the epidemiological and clinical features of TA in Arabs included 197 identified patients between 1995 and 2012 and none of them was Libyan. We report a 61-year-old Libyan woman in whom TA manifested with hypokalemia and arterial hypertension. Previous ultrasound showed renal size asymmetry raised the possibility of renal artery stenosis. The diagnosis of TA was confirmed by magnetic resonance angiography, which showed a thickened abdominal aortic wall, occlusions of the left renal artery and left common iliac artery, stenosis of the right common iliac artery, and stenosis of both subclavian arteries. TA is rarely encountered in Arabs. However, the disease must be considered in patients who present with renovascular hypertension, in a context of other autoimmune disorders.
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En bloc kidney transplant from pediatric donor to an adult p. 128
Navdeep Singh, Elmahdi A Elkhammas, Amer Rajab
The use of pediatric kidney donors is not a common practice. Transplant physicians and surgeons are concerned with technical issues as well as inadequate nephrons mass. We reported a case of en bloc kidney transplant from a pediatric donor to serve as a teaching case. The donor is a 3-year-old infant who died as a result of influenza. Due to the age and size discrepancy with an adult, it was decided to transplant the kidneys en bloc into an adult with successful outcome. En bloc technique renders the kidneys transplantable which would have been otherwise discarded and theoretically protect against hyperfiltration injury. Small pediatric donors are excellent resources and should be considered for donation whenever option is available.
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Insulin Pump for Paediatrics p. 131
Hussain Alsaffar
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