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   Table of Contents - Current issue
Coverpage
October-December 2019
Volume 11 | Issue 4
Page Nos. 133-205

Online since Monday, December 30, 2019

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EDITORIAL  

Ibnosina Journal of Medicine and Biomedical Sciences at 11 years of age Highly accessed article p. 133
Elmahdi A Elkhammas, Salem A Beshyah
DOI:10.4103/ijmbs.ijmbs_78_19  
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VIEW POINT Top

Implication of the 2023 education commission for foreign medical graduates policy changes for medical education in developing countries p. 135
Elmahdi A Elkhammas, Salem A Beshyah, Dima K Abdelmannan
DOI:10.4103/ijmbs.ijmbs_71_19  
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COMMENTARIES Top

Sacrificing heart and air pipes for a waterpipe: A rising epidemic p. 138
Fahad Shamsi, Mahmoud I Traina
DOI:10.4103/ijmbs.ijmbs_76_19  
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The Year in Ramadan Fasting and Health: Changing Perspectives and a Slow Pace! p. 140
Abdulfattah A Lakhdar
DOI:10.4103/ijmbs.ijmbs_81_19  
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INVITED REVIEW Top

Acute and long-term effects of water pipe smoking on the respiratory system: A narrative review p. 142
Waqar Mogassabi, Sara S Hassen, Sahar A Mahadik, Reem S Mubarak, Wanis H Ibrahim
DOI:10.4103/ijmbs.ijmbs_63_19  
Tobacco use has become a global major health problem and a leading global cause of preventable death. Water pipe smoking epidemic is on the rise and is replacing cigarettes as the most popular method of tobacco use in many countries. In this narrative review, we aimed to summarize the acute and long-term effects of water pipe smoking on the respiratory system. A comprehensive literature search addressing these effects was conducted without date restrictions. Among the serious acute respiratory effects of water pipe smoking on the respiratory system that have been reported in in literature are acute eosinophilic pneumonia, acute carbon monoxide poisoning, increase in respiratory rate, transmission of infection, and acute deterioration in lung function. Among the long-term effects are the increased risk of lung cancer, chronic obstructive lung disease, asthma and asthma exacerbations, and long-term effects on lung function. The impact of water pipe smoking on the respiratory system and on human health in general deserves more attention from researchers and health policy makers.
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The Year in “Ramadan Fasting and Health” (2018): A Narrative Review p. 151
Salem A Beshyah, Amal Badi, Ashraf M El-Ghul, Ahmed Gabroun, Khaled K Dougman, Mohsen S Eledrisi
DOI:10.4103/ijmbs.ijmbs_77_19  
Introduction: There has been an increased interest in health implications of Ramadan fasting (RF). Materials and Methods: This is a narrative, nonsystematic review of the literature including all relevant full articles in English in three electronic databases (Scopus, PubMed, and Google Scholar). The search term “Ramadan fasting” was used to identify the relevant records to provide a readily comprehensible concise account of the contributions made to research and clinical practice in 1 year (2018). Results: The publications spanned basic, clinical, ethical, professional, and cultural and advocacy facets of the subject. The publications crossed the conventional disciplinary lines and geographical locations and appeared in journals with varying systems of access. Only full-text research articles in English were reviewed. Review articles, news, note items, and correspondence were not included. No formal bibliometric analysis is presented. Emerging concepts are presented under the relevant subheading depending on the available literature. Impact of RF on diabetes control, pregnancy outcome and fetal life, and sports and athletes' well-being received somewhat more prominent coverage by research work published in 2018. Renovascular disease, and risk factors, posttransplant care, and some metabolic concerns for patients with hepatic, renal, and metabolic conditions were covered too. Patterns of use of emergency services during Ramadan and features of some specific medical emergencies were examined by some workers. Most interesting perhaps was the greater focus on documenting the perception, attitudes, and practices of both patients and healthcare professions regarding deciding and acting during Ramadan. Isolated research reports addressed subjects of wide nature from body composition and energy metabolism to smoking, law, music, and history. Conclusions: The volume of scholarly work on Ramadan fasting and health remains modest. Greater improvements in both quality and quantity of research on Ramadan are needed. Most studies indicate that Ramadan fasting is safe in mild and stable medical conditions under normal circumstances. High risk individuals must be identified, evaluated and managed on individual basis. Experiences from epidemiological, observational and experimental studies reviewed in this article should inform patients' and physicians' decisions.
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ORIGINAL ARTICLES Top

Prevalence, pattern, and attitudes of smoking among libyan diabetic males: A clinic-based study p. 171
Hawa Juma El-Shareif
DOI:10.4103/ijmbs.ijmbs_37_19  
Introduction: Smoking is a major avoidable cardiovascular risk factor and is a cause of premature death worldwide. Objectives: To study the prevalence, pattern, and awareness of health hazards of smoking among Libyan diabetic male patients in Tripoli Medical Center, Tripoli, Libya. Patients and Methods: A cross-sectional, clinic-based study using a predesigned questionnaire, the participants were interviewed by the author. The interview covered personal data, and questions about their smoking status, and their awareness of smoking hazards. Results: The overall prevalence of current smoking was 26.4% and past smoking 40.3%. The mean age was 50.8 ± 14.4 years (range 18–75 years). The mean age at which smoking started was 18.6 ± 5.3 years; all current smokers were cigarette smokers. Main reason for quitting smoking was related to health issues while social and religious considerations were the main reasons for never smoking. Conclusions: The prevalence of smoking among Libyan diabetic patients was high; this calls for incorporating smoking cessation services within the diabetes care clinics.
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Procalcitonin and other inflammatory markers in patients with sepsis and septic shock: A single-center experience p. 176
Saibu George, Merlin Thomas, Sumaira Rafiqui, Muna Al Maslamani, Abdel-Naser Elzouki
DOI:10.4103/ijmbs.ijmbs_64_19  
Objective: The objective of the study was to compare the diagnostic value of serum procalcitonin (PCT), C-reactive protein (CRP), lactic acid, and white blood cells (WBC) as markers of sepsis in critically ill patients in the main tertiary hospital in Qatar. Materials and Methods: The PCT levels and other inflammatory markers (CRP, lactic acid, and WBC) were retrospectively reviewed in 137 consecutive adult patients with a suspected diagnosis of sepsis who admitted to the Internal Medicine inpatient service (i.e., Medical Wards and Medical Intensive Care Unit) at Hamad General Hospital, Qatar. The serum PCT was measured by chemiluminescence immunoassay and the results were compared with commonly used inflammatory markers between the patients with and without proven sepsis. Results: A significantly higher PCT level was observed among patients with severe sepsis and septic shock compared to those without sepsis (19.34 ± 50 and 25.91 ± 61.3 vs. 4.72 ± 10, respectively; P = 0.011). No significant differences were found in CRP and WBC between these groups. Nonsurvivors of both septic and nonseptic groups had a mean PCT level of 22.48 ± 8.26 significantly higher than that measured in survivors of both the groups (P = 0.01), a difference not evident in other inflammatory parameters. Conclusions: PCT is a highly efficient inflammatory laboratory parameter for the diagnosis of severe sepsis and septic shock, but WBC and CRP levels were of little value. PCT value assists in the diagnosis of septic shock, hence supporting appropriate disposition of patients. The levels of PCT also have prognostic implications with regard to mortality suggesting intensification of antibiotic therapy and supportive measures including appropriate family counseling.
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Macular thickness in healthy Libyan adults measured by optical coherence tomography p. 181
Samar A Bukhatwa, Sabah S Eldressi, Naeima M Elzlitni
DOI:10.4103/ijmbs.ijmbs_75_19  
Objectives: Management of various macular diseases depends on macular thickness which is measured quantitatively by optical coherence tomography. Studies have reported variations in the macular thickness by race and gender. The aim of this study was to determine the normal macular thickness measurements in healthy eyes of Libyans. Subjects and Methods: This study was conducted at the Ophthalmology Outpatient Department at Alkeish polyclinic in the period between January and December 2018. This study included 243 healthy eyes of 131 Libyan adults of both genders who underwent a complete ophthalmic examination including spectral domain optical coherence tomography to measure the macular thickness at the nine areas corresponding to Early Treatment Diabetes Retinopathy Study map (ETDRS). Results: The mean age of the study population was 48.3 ± 16.6 years (ranged between 21 and 79 years), the thickness in the foveola/center point of macula (CPT) was 192 ± 22.4 μm, the central foveal thickness was 230.3 ± 18.3 μm, and the average thickness was 270.1 ± 9.4 μm. Males were having more thickness than females. Conclusions: Foveola's thickness (CPT) in Libyan adults measured by spectral domain optical coherence tomography is thinner than that of previously published studies. Moreover, the central foveal thickness is less than that of many other studies and males have more thickness than females in all the areas of ETDRS map, which indicates that gender must be taken into consideration while interpreting macular retinal thickness data.
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CASE REPORTS Top

Retropharyngeal soft-tissue mass with multiple cranial neuropathies p. 185
Anwaar M Bennour, Anas Abdelmaola Dughman, Asmaa Elkhashmee
DOI:10.4103/ijmbs.ijmbs_45_19  
Retropharyngeal lesions have different spectrum of presentations. We herein present a case with step-wise progression of ambiguous symptoms and signs of polycraniopathy, caused by a soft-tissue mass in the retropharyngeal space extending into the cavernous sinus, as detected by magnetic resonance imaging. Initially, he was presented with hemifacial pain and lately progress rapidly to involve all cranial nerves; 3rd through 12th cranial nerves. The differential diagnosis was malignant tumor or aggressive infectious mass, which were excluded by histopathological examination. The diagnosis of inflammatory pseudotumor was a diagnosis of exclusion and decided based on a combination of clinical profile, blood test, radiological, and histopathological results.
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Hepatitis A-associated cholestasis and aplastic anemia p. 188
Amal Salem Elarabi, Zinab Ashour Saad, Fauzi Abdalla Sagher
DOI:10.4103/ijmbs.ijmbs_53_19  
Hepatitis A virus (HAV) infection in children is typically an acute, self-limited illness associated with general, nonspecific symptoms. Prolonged cholestasis is a rare atypical form of HAV infection that is characterized by serum bilirubin levels higher than 10 mg/dl for more than 12 weeks. Aplastic anemia is another very rare complication of HAV. We report the case of an 11-year-old male with blood group O Rh positive who developed cholestasis followed by aplastic anemia postfulminant HAV infection. Liver function tests rapidly responded to a short course of steroid treatment. The patient had a sickle cell trait and a variant of ABCB11 gene. There was no history of traditional herbal treatment, but we noticed several cautery marks. Immunosuppressive medication was started for aplastic anemia, and he is listed for urgent bone marrow transplant. This is the first reported case of prolonged cholestasis followed by aplastic anemia complicating fulminant HAV infection in a Libyan adolescent.
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“Neurodevelopmental disorder with microcephaly, epilepsy, and brain atrophy” with a novel mutation p. 192
Waseem Mahmoud Fathalla, Farah Hussein Salman
DOI:10.4103/ijmbs.ijmbs_61_19  
“Neurodevelopmental disorder with microcephaly, epilepsy, and brain atrophy” is a newly described disorder related to homozygous mutations in TRAPPC6B gene. Although nonspecific, the features of this disorder appear to have a characteristic course of postnatal progressive microcephaly that should raise the suspicion of this disorder. To the best of our knowledge, only eight cases were published in the literature. Here, we report a new case with a novel mutation and compare the clinical findings to the published cases. This case was not picked up by whole-exome sequencing but rather by whole-genome sequencing, emphasizing the importance of pursuing an etiological diagnosis in patients with otherwise unexplained progressive neurological disorders.
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CONFERENCE HIGHLIGHTS Top

Gulf X-linked hypophosphatemia preceptorship: July 4–6, 2019, Bicêtre Paris sud hospital, Paris, France p. 196
Hussain Alsaffar, Salem A Beshyah
DOI:10.4103/ijmbs.ijmbs_69_19  
X-linked hypophosphatemia (XLH) is an inherited disorder characterized by low levels of phosphate in the blood. Phosphate levels are low because phosphate is abnormally processed in the kidneys, which causes urinary phosphate wasting and leads to rickets in the young patients and osteomalacia in adults in addition to several other complications thereof. A 3-day conference was hosted by the Rare Diseases Unit of the Bicetre Paris Sud Hospital on July 4–6, 2019. Presentations covered the subject in a comprehensive manner spanning physiology, clinical presentations, disease burden, and the latest in the management of the XLH and its musculoskeletal, neurosurgical, obstetric, and other complications in both children and adults. Several illustrative and challenging cases were presented and discussed. The authors attended the event and would like to present a personal perspective to highlight the proceeding of the conference to extend the benefit to others who did not attend it.
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LETTER TO EDITOR Top

Neurological Manifestations in Takayasu Arteritis: An Overview p. 204
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
DOI:10.4103/ijmbs.ijmbs_65_19  
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