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   Table of Contents - Current issue
April-June 2020
Volume 12 | Issue 2
Page Nos. 77-142

Online since Saturday, June 27, 2020

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COVID-19 pandemic: A tsunami in medical practice and research Highly accessed article p. 77
Salem A Beshyah, Issam M Hajjaji, Elmahdi A Elkhammas
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Persistent Müllerian duct syndrome: A challenge in diagnosis and treatment p. 80
Francesco Chiancone
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Myocardial injury in coronavirus disease 2019 (COVID-19) Patients Highly accessed article p. 82
Elhadi H Aburawi, Ahmed R Alsuwaidi
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Coronavirus disease 2019 (COVID-19) and neurological manifestations: A potential neuroinvasive pathogen p. 85
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
Coronavirus disease 2019 (COVID-19) was first described in December 2019 in Wuhan, China, and rapidly widespread and became a global concern. In this outbreak, a new beta coronavirus from the order Nidovirales, which has a positive sense and single-stranded RNA genome, was identified. Herein, we would like to highlight the neurological complications of the COVID-19 and the neuroinvasive potential of this virus. It is worthy of mentioning that COVID-19 mainly causes acute respiratory distress syndrome, which is one of the most common causes of death. However, the latest studies demonstrated that, in severe cases, neurological manifestations can occur.
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A rational approach to the evaluation and management of patients with hyperprolactinemia Highly accessed article p. 90
Khaled M Aldahmani, Mussa H AlMalki, Salem A Beshyah
Prolactin has multiple biological functions. Hyperprolactinemia is a common condition in clinical practice both in women and men. It has multiple etiologies and may present with variable symptoms to different health-care providers. Therefore, a rational and systematic approach is paramount when evaluating patients with hyperprolactinemia to arrive at the correct diagnosis and institute the appropriate therapy. We here review the etiology, clinical presentation, and differential diagnosis of hyperprolactinemia and present a practical plan for further evaluation and management. It is most essential to establish the diagnosis and need for the treatment of patients with micro- and macro-prolactinomas and identify when only observation may be warranted. The biological, medical, and social contexts have to be considered to make the appropriate management decisions on an individual basis.
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The individualization of care for people with diabetes during ramadan fasting: A narrative review p. 98
Bachar O Afandi, Salem A Beshyah, Mohamed M Hassanein, Abdul Jabbar, Aly B Khalil
Management of Muslim people with diabetes who choose to observe the fasting during the holy month Ramadan may become a complicated situation in which neither physicians nor patients have straightforward solutions. While most patients with diabetes fast Ramadan safely, some patients do face potentially life-threatening complications, including hypoglycemia, hyperglycemia, dehydration, and ketoacidosis. Several professional recommendations categorize patients with diabetes as very high/high, moderate, or low-risk groups. This classification was based principally on the type of disease, the status of metabolic control, type of treatment, and modified by the presence of other comorbidities and circumstantial factors. Ramadan clinical recommendations for individuals with diabetes are mainly based on expert opinions with limited, yet growing, scientific evidence, and research. On occasions, they do not take account of many important variables that require a personalized approach. In this narrative perspective, we discuss the individualized management of people with diabetes during Ramadan fasting taking into consideration the hours of fasting during the day, weather, resources, personal patterns of dieting, sleeping and exercise, previous fasting experience, and, most importantly, patient preferences among many other factors. This narration is aimed to encourage physicians to think out of the box and provide an individually-tailored recommendation on whether to fast and how best to modify management plans if fast was deemed safe.
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Low back pain among healthcare personnel in Saudi Arabia: A systematic review p. 108
Alexander Woodman, Mohammed Homan, Asim Niaz, Lamiaa Al-Jamea, Mahmood Akhtar, Mohammed Sager
Background: Low back pain (LBP) is a complex condition with several determinants contributing to its occurrence. LBP is defined as pain that persists for 12 weeks or longer. The prevalence of work-related LBP among health-care personnel in Saudi Arabia affects both the healthcare personnel and the quality of patient care. Aim: The aim of this study was to review the epidemiology of LBP among the healthcare personnel in Saudi Arabia and wellness programs aimed at decreasing the rate of LBP. Methods: A systematic literature search was conducted using relevant keywords to search for studies conducted in Saudi Arabia regarding LBP among healthcare personnel. After selecting the inclusion criteria and epidemiological measures of LBP for the current research as well as obtaining full texts for the study, a total of 13 articles were used. Results: Thirteen studies were included in the current systematic review. Nurses and dentists were among the most vulnerable groups, constantly experiencing LBP due to long working hours, standing, as well as stress. Physical and occupational therapists and surgeons were experiencing LBP and generalized myalgia due to the work stress caused by the overcommitment at work and a high number of treated patients. Emergency medical services personnel reported a very high prevalence of musculoskeletal disorders. Based on the results of the reviewed studies, most of the participants experienced the prevalence of the LBP within the last 12 months. Conclusion: LBP has multifactorial risks, etiology, and increased evidence and prevalence among healthcare personnel in Saudi Arabia. The results show that there is good reason to conduct an in-depth study of available best practice interventions aimed at preventing LBP among healthcare personnel. Future studies in Saudi Arabia should focus on creating workplace wellness programs and on assessing risk factors as well as preventing LBP.
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Demographic characteristics and clinical manifestations of systemic sclerosis in Benghazi, Libya Highly accessed article p. 118
Fathi M Elbraky, Imhamed A Amailaf, Khaled D Alsaeiti
Background: Systemic sclerosis (SSc) is a rare, heterogeneous autoimmune disease characterized by skin fibrosis, vasculopathy, and internal organ involvement. This study aims to determine the frequency of clinical manifestations of SSc among Libyan patients in Benghazi. Patients and Methods: Thirty patients (28 females) attended the Rheumatology Clinic at Benghazi Medical Center between January 2016 and December 2019. They were diagnosed to have SSc according to American College of Rheumatology/European League Against Rheumatism 2013 revised classification criteria and were classified into diffuse cutaneous systemic sclerosis (dcSSc) and localized systemic sclerosis (lcSSc) disease subsets. Results: We reviewed the data of the 30 patients, including 28 (93.3%) females and 2 (6.7%) males (female: male ratio 14:1); the mean age at diagnosis was 40.5 ± 21.5 years (17–62 years). Twenty-four (80%) patients were diagnosed as dcSSc, whereas 6 (20%) were diagnosed as lcSSc. On diagnosis, patients with dcSSc were comparatively younger than those with lcSSc. The frequency of musculoskeletal manifestations and organ involvement was more frequent among patients with dcSSc (P = 0.001). All the thirty patients had rheumatoid factor and anti-nuclear antibody positivity. Anti-Scl-70 was only positive in the dcSSC subset in all patients of dcSSc only, whereas anti-centromere Ab was positive in all patients of lcSSc only. Conclusions: This is the first study to assess the clinical manifestations of SSc in the Libyan population. Our disease cohort showed similarity to what was published in other cohorts with regard to the age at the time of diagnosis, gender, and autoimmune profile.
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Logistic regression analysis to predict mortality risk in COVID-19 patients from routine hematologic parameters p. 123
Sudhir Bhandari, Ajit Singh Shaktawat, Amit Tak, Bhoopendra Patel, Jyotsna Shukla, Sanjay Singhal, Kapil Gupta, Jitendra Gupta, Shivankan Kakkar, Amitabh Dube
Background: The triage of coronavirus-19 patients into various strata based on some prognostic indicator might prove a utilitarian strategy in the management of epidemic. The goal of health-care facilities is optimization of the use of medical resources. The present study aimed to develop a predictor model of mortality risk from routine hematologic parameters. Patients and Methods: In this retrospective case–control study, seventy survivors (n = 47) and nonsurvivors (n = 23) were enrolled who were laboratory-confirmed coronavirus disease 2019 (COVID-19) cases from SMS Medical College, Jaipur (Rajasthan, India). The clinical and routine blood profile of the survivors and nonsurvivors was recorded. A logistic regression model was fitted with step-wise method to the above dataset with dependent variable such as survivor or nonsurvivor and independent variables such as age, sex, symptoms, random blood glucose, and complete blood count. The best model was selected on the basis of Akaike information criterion. Results: It was observed that differential neutrophil count (%) and random blood sugar (RBS in mg/dL) are the statistically significant regressors (P < 0.05). The performance metrics of the model with 5-fold cross-validation showed area under the receiver operating characteristic curve, sensitivity, specificity, and validation accuracy to be 0.95, 90%, 92%, and 70%, respectively. The cutoff probability comes out at 0.30 for the outcome (nonsurvivor as success). Conclusion: The study concludes that differential neutrophil count and RBS levels can be used as early screening tools of mortality risk in COVID-19 patients and they assist in further patient management.
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Persistence of Müllerian derivatives in an adult male p. 130
Souha Elabd, Mussa Hussain Almalki
Persistent Müllerian duct syndrome (PMDS) is a rare congenital abnormality that leads to male disorders of sexual development (DSD) due to the persistence of Müllerian duct derivatives in otherwise normally virilized male patients with a normal karyotype. It is usually diagnosed in the early years of life at the time of surgery for cryptorchidism or repair of an inguinal hernia. Cases of affected adult males have been reported as well. We report a rare case of PMDS in a middle-aged (47-year-old) infertile male who was referred to the endocrine clinic for the evaluation of primary infertility. A high index of suspicion needs to diagnose such conditions as early treatment is necessary to preserve fertility and to reduce the occurrence of neoplastic transformation in remnant Müllerian structures.
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An unusual cause of multiple foot ulcers in a patient with type 2 diabetes p. 134
Akrem Y M Elmalti, Targ Elgzyri, Shiby Varghese, Mamoun Mukhtar
Diabetes is the most common cause of nontraumatic lower limb amputation. The majority of those amputations are preceded by an ulcer, usually as a result of peripheral neuropathy, peripheral vascular disease, or a combination of both. Regular foot examination and multi-disciplinary team approach are supported by evidence as tools to reduce foot ulceration. A cause for foot ulceration is not always evident, but presumed trauma or burn are usually thought. We are presenting a rather unusual case of a 70-year-old patient with long-standing diabetes and peripheral sensory neuropathy who first presented with bilateral superficial foot ulcers. On follow-up visits, further new superficial multiple ulcers were discovered and a possibility of rat bite was raised which he and his family denied. His daughter later confirmed the sighting of rodent biting his flesh. Rodent bites causing foot ulcers are rare; however, the clinician's vigilance is key for the early detection and treatment.
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Neuroanatomy of cavernous sinus and sellar region: Clinico-anatomical correlation p. 137
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
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Dental health and epilepsy: Important but too often ignored p. 139
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
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Maternal and fetal outcomes in patients with systemic lupus erythematosus p. 141
Mahmood Dhahir Al-Mendalawi
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Maternal and fetal outcomes in patients with systemic lupus erythematosus - Authors' response p. 142
Abdelnasir M Ahmed, Salem A Ibkhatra, Khaled D Alsaeiti, Fathi M Elbraky
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