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REVIEW ARTICLE
The year in ramadan fasting research (2017): A narrative review
Salem A Beshyah, Issam M Hajjaji, Wanis H Ibrahim, Asma Deeb, Ashraf M El-Ghul, Khalid Bel'eed Akkari, Ashref A Tawil, Abdul Shlebak
March-April 2018, 10(2):39-53
DOI:10.4103/ijmbs.ijmbs_9_18  
Ramadan fasting is one of the five Pillars of Islam. While there are several exemptions from fasting, many Muslims with medical conditions still choose to fast. This may adversely affect their health if not addressed properly. Recently, there has been an increased interest in the health implications of Ramadan fasting. The authors performed a narrative, nonsystematic review of the literature including case reports, case series, and review articles indexed in PubMed and Google Scholar in a full calendar year. All records were reviewed by two coauthors at least. Studies were reviewed, summarized, and represented to provide a readily comprehensible concise account of the contributions made to research and clinical practice in 1 year (January–December 2017). The publications spanned physiological and clinical aspects and crossed conventional disciplinary lines in various languages, locations, and systems of journal access. A total of 92 and 82 were found in the PubMed and Google Scholar databases, respectively. Diabetes, hypoglycemia, insulin, and body composition were among the most relevant issues addressed this year. Discipline wise, diabetes, physiology, gastrointestinal, cardiovascular, eyes, respiratory, nephrology, neuropsychiatry, and endocrinology were most prominent. Other articles have considered professional competence, education, ethics, culture, and organization of care. Many of the research groups are based in emerging countries with Muslim-majority, but the publications are still widely distributed in internationally recognized journals. Several workers seem to have Ramadan fast at the center of their academic interest inferred from the number of publications to which they have contributed. The authors hope this review will help direct further research and should inform clinical practice guidance.
  4,092 350 5
The dietary fat–heart disease hypothesis: An ongoing debate
Nasr Anaizi
January-February 2018, 10(1):3-8
DOI:10.4103/ijmbs.ijmbs_71_17  
The belief that the consumption of saturated fat as the primary source of daily energy needs is detrimental to heart health has held a firm grip on public consciousness for decades. It was initially based entirely on tenuous observational (correlation) studies but was later bolstered by a vast array of evidence and more direct observations from long-term randomized controlled trials and dietary intervention studies. Further support also came from the elucidation of the pathophysiology and molecular mechanisms involved in atherogenesis. However, in recent years, the association between dietary saturated fat and heart disease has come under attack based mainly on meta-analyses and large multinational studies most of which relying on questionnaires and diet recall. More recent publications have elevated the debate to a new level, leading some experts to question the evidence behind commonly accepted dietary recommendations, attracting media attention, and generating heated debates. Here, the most relevant studies will be reviewed defining the salient issues and where the proponents and opponents of the hypothesis stand.
  3,524 399 -
CASE REPORTS
An intraoperative finding of double L5 nerve root
Abdulhamid Ben Shaban, Qayss Atiyah, Seraj Saleh Ajaj
November-December 2017, 9(6):169-171
DOI:10.4103/ijmbs.ijmbs_20_17  
Congenital anatomical anomalies of the lumbosacral nerve root are a rare condition. Various types of anomalies of the lumbosacral nerve roots have been described in the literature. Undiagnosed lumbosacral nerve root anomalies are at risk for iatrogenic injury, may contribute to wrong-site surgery, and contribute to continued postoperative symptoms. Here, we present the case of a 45-year-old female with discogenic back pain and L5 radiculopathy who found to have a duplicated left L5 nerve root intraoperatively.
  3,584 193 -
REVIEW ARTICLE
Fat facts: An overview of adipose tissue and lipids
Nasr H Anaizi
January-March 2019, 11(1):5-15
DOI:10.4103/ijmbs.ijmbs_6_19  
The term fat evokes a multitude of ideas, images, and prejudices. It encompasses the different types of adipose tissue (AT) and cellular components as well as the myriad of lipid molecules. The AT and lipid molecules throughout the body carry out scores of vital functions ranging from thermal insulation to energy homeostasis to signal transduction. A fact that is not generally appreciated is that in addition to its roles in energy balance and thermoregulation, the AT is also an integral part of both the endocrine and immune systems. Fatty acids (FAs) are the primary building blocks of most lipids. They serve as fuel, structural components, and regulatory molecules (mediators). Most of the free FAs in the body are either obtained from the diet or released by the AT (lipolysis). However, most of the short-chain FAs such as propionate and butyrate are generated in the colon by the fermentation of dietary fiber by the gut microbiota. In addition to providing fuel for the colon enterocytes, these molecules act on specific G protein-coupled receptors in the gut cells stimulating the release of glucagon-like peptide-1 and peptide YY simultaneously improving insulin sensitivity and curbing appetite. The essential FAs linoleic and α-linolenic give rise to two distinct classes of omega FAs, n-6 and n-3, respectively, and hence to more complex lipid derivatives (eicosanoids) which are involved in virtually all aspects of cellular function including immunomodulation and inflammation. These include prostacyclins, thromboxanes, leukotrienes, and epoxyeicosatrienoic acids.
  2,070 279 -
ORIGINAL ARTICLES
Evaluation of nutrition knowledge of professional football players
Isam Denna, Ali Elmabsout, Ashmisa Eltuhami, Shehab Alagory, Tahani Alfirjani, Fatima Barakat, Saif-Aleslam Almajouk, Mustafa Y. G Younis
January-February 2018, 10(1):21-24
DOI:10.4103/ijmbs.ijmbs_34_17  
Background: Adequate knowledge of nutrition is believed to influence the performance of endurance athletes. Objectives: To assess the level of nutrition knowledge among football players in Benghazi. Subjects and Methods: Following ethical approval, a cross-sectional study was conducted involving 101 football (soccer) players (25 ± 5 years of age) from seven clubs of the first and second divisions. The height (cm) and weight (kg) were recorded for each player. A questionnaire composed of three sections was filled out by each participant. It included questions concerning personal data, general nutrition, and specific knowledge concerning the appropriate foods to consume before, during, and after exercise. Results: The mean body mass index was 24 ± 2 kg/m2. Fifty-seven percent of the participants were below the university level of formal education. Furthermore, 75% reported that they never received any formal education related specifically to nutrition. In addition, 70% had no knowledge of the concept of the food pyramid, and only 18% of the players communicated with dieticians either during season or off-season. Only 22% answered correctly the questions about which foods are appropriate to consume before and after exercise. Noticeably, 81% of the participants did not correctly identify the contents of the nutrient to be consumed during exercise. Conclusions: The study revealed an alarming lack of nutrition knowledge among professional football players in Benghazi. The results highlight the need to establish specific programs for nutrition education for the players to enhance their knowledge in this critical area and positively influence their dietary habits and ultimately improve their physical performance. It is also important to emphasize the role of qualified dieticians in athletic clubs.
  1,945 238 -
EDITORIAL
Fake academia and bogus conferences are on the rise in the middle east: Time to act
Salem A Beshyah
November-December 2017, 9(6):147-149
DOI:10.4103/ijmbs.ijmbs_61_17  
  1,902 237 1
ORIGINAL ARTICLES
Rectal, axillary, and tympanic temperatures inneonates and infants with or without fever
Asma Ali Shagleb, Zinab Ashour Saad, Fauzi Abdalla Sagher
July-August 2018, 10(4):115-118
DOI:10.4103/ijmbs.ijmbs_26_18  
Objectives: To evaluate the agreement between temperature measured at the axilla or tympanic to rectum using standard techniques. Patients and Methods: We studied 50 neonates and 50 infants admitted to special care baby unit and Pediatric Gastroenterology Department with or without fever. Preterm, sick, malnourished neonates and uncooperative and crying infants were excluded from the study. Verbal consent from mothers was taken before the measurements. To adjust for rectal temperature, 0.55°C added to neonates and 0.65°C to infants' axillary temperature, 0.1°C to neonates, and 0.45°C to infants' tympanic membrane temperature. Results: There was a strong correlation (r) between 0.79 and 0.89 for axillary temperature with rectal temperature in neonates and infants, males and females, and for tympanic temperature with rectal in male infants. However, moderate correlation (r) was between 0.73 and 0.76 for tympanic temperature with rectal temperature in overall neonates and male and female infants. Axillary temperature missed 1% of pyrexia cases, whereas tympanic membrane measurements overestimate pyrexia in 5% of cases. Conclusion: It is safe reliable and convenient to use the axillary route for measurements of temperature in neonates and infants with or without fever.
  1,896 168 -
Low awareness about breast self-examination and risk factors of breast cancer in Benghazi, Libya
FatmaYousuf M Ziuo, Ahmed Ahmed Twoier, Tahani Ragab Huria, Fayek Salah El-Khewisky
March-April 2018, 10(2):54-59
DOI:10.4103/ijmbs.ijmbs_16_17  
Background: Breast cancer is the most common cancer in women in the Eastern Mediterranean region and the leading cause of cancer mortality worldwide. Objectives: The study aimed to ascertain the level of awareness about the breast self-examination (BSE) and early detection of breast cancer and risks of breast cancer in the women of Benghazi, the second capital city of Libya. Subjects and Methods: A community-based survey was carried out in Benghazi to assess the knowledge, attitude, and practice of women at Benghazi about BSE and risk and protective factors of breast cancer. Cluster sampling technique was used. 30 clusters were selected during the year 2013. Results: Three thousand women were targeted; 2601 women were interviewed. Their mean age was 36.4 ± 10.9 years; more than half of them were married. The respondents' knowledge about BSE was poor with less than half of them (48.1%) having ever heard about BSE. Less than one-fifth of them (16.9%) knew what is BSE and less than one-quarter (25.7%) had satisfactory knowledge about the recommended frequency of BSE. About 39.0% of the respondents knew how to perform BSE, less than one-quarter of them (22.5%) knew when to start it. However, about three quarters (74.4%) of women considered BSE practice very important based on information from television programs as their source of knowledge (23.8). Less than half (43%) thought that high-fat diet and 42% stated that that physical inactivity are recognized risk factors for developing breast cancer. Conclusions: There is a poor knowledge about BSE and about risk and protective factors of breast cancer even among educated women in Benghazi. Primary prevention and early detection awareness should be the first step for prevention of breast cancer in Benghazi, Libya.
  1,769 235 -
COMMENTARY
Platelet genesis: Unraveling an incredible journey!
Abdul A Shlebak
July-August 2017, 9(4):101-102
DOI:10.4103/ijmbs.ijmbs_6_17  
  1,815 154 -
IN MEMORIAM
Mansour Al Mabrouk Ali Ben Halim (1937–2018)
Elhadi H Aburawi
July-August 2018, 10(4):145-145
DOI:10.4103/ijmbs.ijmbs_43_18  
  1,718 81 -
REVIEW ARTICLE
Prevention and management of cardiovascular disease risk factors during childhood
Elhadi H Aburawi
November-December 2017, 9(6):150-153
DOI:10.4103/ijmbs.ijmbs_40_17  
Coronary artery disease (CAD) or alternatively called atherosclerosis is the leading cause of death worldwide. There are multiple cardiovascular disease risk factors (CVDRFs), which are the precursors for CAD. A chronic inflammation prompted by cholesterol-rich lipoproteins and other noxious CVDRF is central in the pathogenesis of CAD. Endothelial dysfunction is the first step in the development of CAD. There are many theories in the development of the atherosclerotic process such as the hygiene theory, genetic susceptibility, and the endothelial injury. For the modification and management of CVDRF, the disturbances in lipid and glucose metabolism, hypertension, obesity, and smoking are the most important targets. The main aim of both primordial and primary preventions is to prevent the first cardiovascular event rather than preventing the further myocardial infarction. The prevention should be considered and started early in childhood and not after the first cardiac event. The primary healthcare physicians, obstetricians, neonatologists, and pediatricians need to work together on prevention of CAD early in life and as early as in fetal life.
  1,589 186 -
ORIGINAL ARTICLES
Biochemical, physiological and body composition changes in patients with type 2 diabetes during Ramadan fasting
Haifa Sfar, Senda Sellami, Fatma Boukhayatia, Khadija Ben Naceur, Faika Ben Mami
November-December 2017, 9(6):164-168
DOI:10.4103/ijmbs.ijmbs_59_17  
Context: During the month of Ramadan, healthy Muslims must fast from dawn until sunset. However, religious rulings dispense the sick from this duty. During the fast, diabetic patients, are predisposed because of their disease, to an increased risk of hypoglycemia, loss of diabetes control, dehydration especially in summer and thromboembolic complications. Objectives: In order to better categorize the indications for the fasting of the month of Ramadan by people with type 2 diabetes mellitus (T2DM), we studied the effects of fasting on clinical; and biological parameters, dietary behavior, and physical activity. Subjects and Methods: We conducted an observational, descriptive, comparative study of patients with T2DM and 16 age- and sex-matched controls. Results: The average age of patients was 52 ± 4 years, and the mean duration of diabetes was 7 ± 4 years. The fasting did not seem to affect the anthropometric parameters and the glycemic control. For the lipid profile, fasting significantly increased high-density lipoprotein-cholesterol (P = 0.004), total cholesterol (P = 0.001) and triglycerides (P = 0.04). Dietary intake decreased from 54% before Ramadan to 47% in Ramadan (P = 0.001), and the intake of lipids increased from 27% to 37% during Ramadan (P = 0.001), in particular, the intake of polyunsaturated fatty acids, which doubled between the two periods (P = 0.009). Physical activity also showed a significant increase in patients and controls combined, essentially represented by the prayer of Tarawih. Conclusions: The Ramadan fast is well tolerated by T2DM patients, treated by diet or oral antidiabetic medications. They can stay free from serious complications, through regular medical support and self-monitoring. However, it is necessary for patients allowed to fast by their physician, to ensure a proper nutrition and obtain diabetes education.
  1,581 178 -
Five-Year experience with pyeloplasty using intubated and nonintubated techniques
Abdalla M Etabbal, Younis M El Bashari, Hussam H Bakar
November-December 2017, 9(6):154-158
DOI:10.4103/ijmbs.ijmbs_15_17  
Background: Ureteropelvic junction obstruction (UPJO) is an obstruction of urine flow from the renal pelvis to the ureter. This condition can be caused by congenital and acquired due to intrinsic or extrinsic factors. UPJO due to acquired conditions such as secondary to inflammation, passage stones, or ureteric folds is less common. In case of suspected UPJO, the critical decision to be made depends on the correlation between the radiologic findings and the physiologic picture. There have been recent and serious trials to perform the surgical repair of UPJO without intubation, with reservation of double J (DJ) stents and nephrostomy tubes for complex cases. The Aim of Study: The aim of the study was a comparison of the time of drain removal, hospital stay, complications, and the end result of surgery in intubated and nonintubated UPJO repair. Patients and Methods: A retrospective case serious study performed in Urological Departments at Benghazi Medical Center and Al-Hawari Urology Center by reviewing 51 files of consecutive patients of UPJO admitted to the department of urology from May 2010 to 2015. All patients were diagnosed using different diagnostic tools. Forty-three cases underwent reconstructive surgeries as follows: 41 (95.3%) patients underwent Anderson-Hynes-dismembered (A-H-D) pyeloplasties and 2 (4.7%) patients underwent VY Foley pyeloplasties. Out of 41 cases underwent A-H-D pyeloplasties, there were six cases underwent concomitant pyelolithotomy. Results: The time of removal percutaneous perinephric tube drain was 7th to 9th postoperative days and 7.9 ± 0.5 days. The postoperative hospital stay for all cases range from 7 days to 10 days and the mean was 8.0 ± 0.8 days. Conclusions: Despite both intubated and nonintubated techniques of UPJO repair are comparable regarding the hospital stay postoperative complication, the tubeless surgical repair of UPJO is more suitable for children and superior to the intubated technique regarding the cost of DJ stent and nephrectomy tube.
  1,588 140 -
EDITORIAL
Predatory publishing: A wake-up call for editors and authors in the Middle East and Africa
Salem A Beshyah
September-October 2017, 9(5):123-125
DOI:10.4103/ijmbs.ijmbs_26_17  
  1,466 255 2
SPECIAL COMMUNICATIONS
The rules and realities of authorship in biomedical journals: A cautionary tale for aspiring researchers
Salem A Beshyah, Wanis H Ibrahim, Elhadi H Aburawi, Elmahdi A Elkhammas
September-October 2018, 10(5):149-157
DOI:10.4103/ijmbs.ijmbs_62_18  
Medical research and publications are not only important for scientific development but also vital for the professional advancement and individual academic progress. Ranking is extremely important for appointments and leadership roles. Authorship is central to the credit and responsibility in medical research and appropriate assignment of authorship carries ethical, legal as well as intellectual implications. Despite being globally established for many years, deviation from the “International Committee of Medical Journal Editors (ICMJE)” criteria for authorship is still seen in varying orders of magnitude and in different shapes and forms. In this communication, we revisit the latest ICMJE criteria for authorship, highlight the increasingly recognized forms of potential of authorship misconduct (intentional or unintentional) and reflect on some emerging concepts and practices in authorship attribution. The target readers are primarily young and aspiring researchers who may err due to lack of experience but also veterans who may turn complacent for political reasons.
  1,505 195 1
ORIGINAL ARTICLES
Knowledge, attitude, and practice of parents regarding Vitamin A supplementation to children in Benghazi, Libya
Lubna Jamal Abdulmalek, Fatma Saleh Benkhaial
September-October 2018, 10(5):174-177
DOI:10.4103/ijmbs.ijmbs_49_18  
Background: According to the World Health Organization, Vitamin A deficiency can cause immune system depression in about 130 million preschool children and 7 million pregnant women mostly in developing countries and cause mortality risk up to 20%–30%. Objectives: We aimed to evaluate the knowledge, attitude, and practice of parents in Benghazi regarding the Vitamin A campaign. Subjects and Methods: A cross-sectional descriptive study of 1390 parents attending maternal and child health clinics and pediatric clinics at six main polyclinics, in Benghazi in April and May 2018. Results: Most of the parents were younger than 40 years (71%). Mothers constitute 68% of the study population and 52% of the children were male. Half of the parents had higher education. Only 40% of the parents were having good knowledge about the benefits and food sources of Vitamin A. The coverage rate of Vitamin A supplementation among under-five children in the study was 66%. The main reason for not giving their children Vitamin A supplementation in this study was the lack of awareness of the campaign during the previous year. However, 88% of the interviewed parents had a positive attitude of regiving Vitamin A to their children in the next campaign. Conclusions: The overall knowledge level of Vitamin A among the parents was relatively low; hence, more efforts are needed to promote awareness about Vitamin A supplementation.
  1,498 162 -
Are oral hypoglycemic agents suitable as the first-line treatment for newly diagnosed type 2 diabetes in patients with severe hyperglycemia?
Abbas Ali Mansour, Ali Hussein Ali Alhamza, Ibrahim Abbood Zaboon
September-October 2017, 9(5):136-139
DOI:10.4103/ijmbs.ijmbs_10_17  
Objectives: To investigate if starting oral antihyperglycemic agent was enough to achieve the target glycated hemoglobin (HbA1c) in patients with newly diagnosed type 2 diabetes mellitus (T2DM), despite severe hyperglycemia, with or without symptoms. Patients and Methods: This was a retrospective patient data analysis for patients with newly diagnosed T2DM during January to December 2013. At baseline and after 3 months, HbA1c was measured. All patients started a diet and lifestyle changes in addition to oral hypoglycemic agents. Results: The enrolled patients were 764 in number. Of them, 331 (42.9%) achieved the target HbA1c <7% by oral hypoglycemic agents after 3 months, regardless of the treatment used. Multivariable logistic regression analysis showed that only presenting fasting plasma glucose <150 mg (odds ratio [OR] 2.193, 95% confidence interval [CI] 1.297–3.709) and drug treatment (OR 1.320, 95% CI 1.100–1.585) were the independent variables associated with achieving the glycemic target. Conclusions: Using antihyperglycemic agents as the first line for new T2DM, 42.9% patients can achieve target glycemic control. Even those with gross glycemic abnormalities, more than 60%, can achieve target glycemic control using diet, lifestyle change, and metformin. Prospective trials are needed to confirm such findings.
  1,508 139 -
Rate, Timing, and Severity of hypoglycemia in adolescents with Type 1 diabetes during ramadan fasting: A study with freestyle libre flash glucose monitoring system
Bachar Afandi, Walid Kaplan, Lina Majd, Sana Roubi
January-February 2018, 10(1):9-11
DOI:10.4103/ijmbs.ijmbs_73_17  
Objectives: The objective of this study is to assess the frequency, timing, and severity of hypoglycemia in adolescents with type 1 diabetes mellitus (T1DM) during fasting the month of Ramadan. Patients and Methods: Twenty-five adolescents with T1DM who fasted Ramadan were monitored using the FreeStyle Libre® flash glucose monitoring (FGM) system. Percentage and total duration of hypoglycemia were extracted from the FGM downloads, and the differences were compared between different times of the day and night according to the eating pattern in Ramadan. Results: Mean age was 16 ± 3 years and mean glycated hemoglobin was 8.6 ± 1.2%, mean glucose level was 200 ± 84 mg/dl (11.1 ± 4.7 mmol/L), and the overall time spent in hypoglycemia was 5.7% ±3.0%. The average daily time spent in hypoglycemia was 1.39 h per patient. The incidence of hypoglycemia was 0% from 19:00 to 23:00 pm and 69% from 11:00 to 19:00. Analysis of hypoglycemia revealed that 65% were between 61 and 70 mg/dl and 8% lower than 50 mg/dl. Conclusions: Hypoglycemia is typically encountered during the hours preceding Iftar time indicating an over-effect of basal insulin. Basal insulin reduction is necessary to minimize the risk of hypoglycemia
  1,418 197 2
High prevalence of dyslipidemia irrespective of obesity in the cape coast metropolis of Ghana
Samuel Acquah, Benjamin Ackon Eghan, Johnson Nyarko Boampong
July-August 2017, 9(4):103-110
DOI:10.4103/ijmbs.ijmbs_4_17  
Objective: To investigate the relationship between obesity, insulin resistance, and lipid profile in type 2 diabetes patients and nondiabetic controls in the Cape Coast Metropolis of Ghana. Patients and Methods: Levels of fasting blood glucose (FBG), glycosylated hemoglobin, lipid profile, insulin resistance, and β-cell function were measured in 115 diabetes patients and 115 age-matched nondiabetic controls. In addition, body weight, height, waist circumference (WC), hip circumference, and blood pressure were measured. Body mass index and waist-to-hip ratio were calculated. Results: Apart from diabetes patients with normal weight who exhibited higher (P < 0.05) FBG but lower systolic blood pressure than their overweight/obese counterparts, levels of all the other metabolites were comparable between the two weight groups in both diabetics and nondiabetic controls. Diabetic patients with systolic hypertension had higher (P < 0.05) low-density lipoprotein (LDL) and WC but nondiabetic hypertensives had lower (P < 0.05) FBG than their respective normotensives. In people with diabetes, dyslipidemia of total cholesterol (CHOL), LDL, and triglyceride were more prevalent in overweight/obese and systolic hypertensives. In controls, prevalence dyslipidemia of total and LDL CHOLs was higher in normal weight and hypertensives than their respective overweight/obese and normotensive counterparts. Conclusion: Nondiabetic respondents with normal weight may be at higher risk of cardiovascular disease through dyslipidemia than their overweight/obese counterpart. This metabolic paradox requires further investigations in the Ghanaian population.
  1,428 167 -
CASE REPORTS
Symptomatic neurocutaneous melanosis with unusual benign course: A case report and review
Baker Mustafa Ayyash, Waseem Mahmoud Fathalla
January-February 2018, 10(1):28-31
DOI:10.4103/ijmbs.ijmbs_53_17  
Neurocutaneous melanosis (NCM) is a rare, congenital, noninherited neurocutaneous syndrome characterized by the presence of “multiple or large congenital nevi” with central nervous system melanocytic deposits. Majority of cases are asymptomatic. Symptomatic cases present with hydrocephalus and signs and symptoms of increased intracranial pressure. The latter is associated with poor prognosis. We herein report an asymptomatic patient with giant congenital melanocytic nevi. He had a screening magnetic resonance imaging study at the age of 2 months that showed T1 hyperintensities in the region of amygdala of both temporal lobes. He was asymptomatic until the age of 4 years when he presented with seizure activity. A diagnosis of NCM was made. He was discharged on emergency antiepileptic medication. On regular follow-up, he remained seizure free for 1 year after the first episode of seizure. Unlike other cases reported in literature, this, to the best of our knowledge, is the first report of nonprogressive symptomatic NCM.
  1,452 137 -
ORIGINAL ARTICLES
Characteristics of diabetic foot disease and risk factors in Benghazi, Libya
Najat Buzaid, Fatma Nagem
September-October 2018, 10(5):165-168
DOI:10.4103/ijmbs.ijmbs_39_18  
Introduction: Diabetic foot ulcer and amputation are associated with an increased incidence of morbidity and mortality. Diabetic foot ulcer can be prevented by screening for risk factors and proper interventions. Objectives: We aimed to determine the risk of diabetic foot ulcer and amputation among patients with type 2 diabetes at Benghazi Medical Center diabetic clinic. Patients and Methods: A cross-sectional study of diabetic foot status and risk factors in diabetic patients attending a specialist diabetes clinic in Benghazi, Libya. Results: Eighty-seven (84.5%) patients wear inappropriate shoes, 37 (35.9%) had Tinea pedis, 26 (25.2%) had foot deformity, 13 (12.6%) patients had bilateral hallux valgus deformity, 8 (7.8%) patients had clawing of feet, 2 (1.9%) patients had Charcot joint, and one patient (0.97%) had amputated toes. Dorsalis pedis and posterior tibial arteries pulsations were not palpable in six (5.8%) patients, there was a loss of protective sensation among 20 (19.4%) patients, vibration sense was absent in 15 (14.6%) patients, and joint position sense was lost in five (4.9%) patients. According to Scottish Intercollegiate Guideline Network system, 59 (57.3%) patients were in the low-risk category, 18 (17.5%) were in the moderate-risk, 22 (21.4%) were in the high-risk, and 4 (3.9%) were in the active disease categories. Conclusions: We conclude that the prevalence of diabetic foot risk factors is high among the studied group.
  1,336 181 -
COMMENTARIES
Ushering in the era of circulatory otologic biomarkers
Kourosh Parham
March-April 2018, 10(2):37-38
DOI:10.4103/ijmbs.ijmbs_18_18  
  1,339 155 -
ORIGINAL ARTICLES
Well-being of residents in training programs of Abu Dhabi health services
Bushra Al Ghailani, Mouza Ali Al Nuaimi, Asma Al Mazrouei, Eiman Al Shehhi, Maha Al Fahim, Ebtihal Darwish
May-June 2018, 10(3):77-82
DOI:10.4103/ijmbs.ijmbs_12_18  
Background: Residency is a stressful period adversely affecting the health and lifestyle of resident physicians. In September 2001, the American Council of Graduate Medical Education released requirements that limit resident working hours in an effort to decrease resident fatigue. Aims: We aimed to measure the prevalence of stress, burnout, and depression among residents working in Abu Dhabi Health Services and to determine the percentage of residents with a healthy lifestyle and to compare the well-being of residents from different specialties. Setting and Design: A cross-sectional survey was conducted in the year 2016 among resident doctors in Abu Dhabi. The study population comprised 458 residents representing 20 training programs at six institutions. Subjects and Methods: All the residents were provided self-administered questionnaires. Results: Response rate was 81%. The prevalence of perceived stress among residents was 86.4%. Stress was significantly associated with workload (P < 0.01) and night shifts (P < 0.001) among residents from most specialties. Regarding burnout, 65.7% of the residents felt emotionally exhausted and 50.8% felt depressed at some point during their residency. Furthermore, 58.8% of the residents with chronic diseases had an uncontrolled disease status. Conclusion: Majority of the residents of Abu Dhabi Health Services experienced high rates of burnout, depression, and stress along with poor lifestyle and uncontrolled status of chronic diseases.
  1,344 135 1
COMMENTARIES
Research and ramadan fasting: Not too much of a good thing!
Aly B Khalil, Abdulfattah A Lakhdar, Mahmoud M Benbarka, Ibrahim H Sherif
March-April 2018, 10(2):35-36
DOI:10.4103/ijmbs.ijmbs_15_18  
  1,302 168 5
ORIGINAL ARTICLES
End-stage renal disease in children on maintenance dialysis in Benghazi, Libya
Ekram A Barakat Ben Sauod, Ahmed Awad Aklifa
September-October 2017, 9(5):128-131
DOI:10.4103/ijmbs.ijmbs_13_17  
Background: End-stage renal disease (ESRD) is a major cause of morbidity and mortality worldwide. Understanding the risk factors of ESRD can help identify preventive strategies and is critical for planning interventions to minimize the disease morbidity and mortality. Objectives: The aim is to identify the demographic and clinical characteristics and risk factors that contribute to ESRD 2005–2016. Settings: The dialysis unit of Benghazi Pediatric Hospital, Benghazi, Libya. Patients and Methods: This is a descriptive case series of all children with ESRD on maintenance dialysis (hemodialysis or peritoneal dialysis) between January 2006 and June 2016. Data were collected from patients' charts and the statistics department of the hospital. Demographic information, the age of onset, duration, and type of dialysis, likely etiology (if documented), complications and comorbidities were all documented and outcome including the cause of death. Results: The mean age of onset of ESRD was 8.5 years; nearly 41% of patients started dialysis at 6–10 years. The majority of patients (72%) resided locally. Male to female ratio was 1.5:1. Consanguinity of parents and family history of renal disease were reported by 12% and 16% of patients, respectively. More than half of patients (51.3%) had had no complications from dialysis. The most common known cause of ESRD was glomerulopathy (18.4%); including glomerulonephritis and nephrotic syndrome. Congenital and hereditary disorders involved 17.1% of cases. These were obstructive uropathy in 9.2% of the patients. The cause was not known in a large proportion (52.6%). Nearly 80% of the patients were alive during the study. Encephlophay (10.5%) and sepsis (6.5%) are the most common causes of death. Conclusions: The clinical profiles, causes, and outcome of ESRD in a specialized center in Benghazi were documented. The study is limited by the high proportion of unknown etiology. Full documentation of underlying etiology is a good clinical practice that should produce better epidemiological studies.
  1,301 164 -