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  Citation statistics : Table of Contents
   2017| March-April  | Volume 9 | Issue 2  
    Online since July 10, 2017

 
 
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ARTICLES
Management of diabetes during ramadan fasting: A comprehensive survey of physicians’ knowledge, attitudes, and practices
Salem A Beshyah, Muhammad Hamed Farooqi, Mohamed Farghaly, Salah Abusnana, Juma M Al Kaabi, Mahmoud M Benbarka, The MENA Endocrine Research Group
March-April 2017, 9(2):28-36
DOI:10.4103/1947-489X.210107  
Background: Physicians play a role in informing patients’ choices to fast or not and also in education and support of those diabetic patients who choose to observe the Ramadan fast. Objectives: To ascertain physicians’ knowledge, attitudes, and practices regarding practical management of diabetes during Ramadan. Subjects and Methods: A cross-sectional Internet-based survey of a convenience sample of physicians, mostly practicing in UAE, was included. The survey questionnaire was developed de novo to address the objectives of this exercise. Responses were collected completely anonymously and were summarized using descriptive statistics. We report here the responses from 236 physicians who submitted adequately completed questionnaires. Results: General management knowledge varied widely. Over 90% recognized the importance of Ramadan-focused education, 75.1% valued the importance of glycemic control at night time, and 71.2% were aware of the exemption of T1DM. 69.0% were familiar with the time of highest risk of hypoglycemia, and 62.0% knew the rulings regarding exemption of pregnant women with diabetes. There was an awareness of the advantages of DDP-IV inhibitors over sulphonylureas, but many thought that all sulphonylureas carry the same hypoglycemic risk potential. Many physicians would maintain metformin and pioglitazone in the same daily doses and use SGLT2 inhibitors carefully in certain groups. Nearly two-thirds of respondents were aware of the traditional adjustments of doses and timing of sulphonylureas. Most (>90%) of respondents recognized the importance of prompt management of hypoglycemia, the need and permission to monitor blood glucose during the day and that potential for the use of GLP1 therapy is supported by experimental evidence. About three quarters recognized the usual practice of reversing the insulin doses when premixed insulin between day and night but only thirds recognized the possible need to reduce basal insulin to avoid hypoglycemia. Attitude: Perceived level of self-confidence, 71% of the respondents stated that they are fully confident or somewhat confident in the management of diabetes during Ramadan. There was a wide variation in recognition of relevant concerns and risks associated with fasting during Ramadan in people with diabetes. Hypoglycemia was the most highly recognized risk (96%) followed by dehydration (85%). About two-thirds of respondents’ associated increased risk of hyperglycemia and diabetic ketoacidosis with fasting. Less than half of respondents recognized the increased risks in pregnancy and of thromboembolic disease. Forty- one percent of respondents followed the ADA workshop of 2005 and its updates. Its risk scale was thought to be the most practical by 34% of respondents. Risk stratification practices were stated to be undertaken consistently, often or occasionally (80%, 15%, and 5% of respondents respectively). 78% confirmed formal stratification using one of the published guidelines. Clinical management practices during the previous month of Ramadan, a total responded positively in high proportions to almost all the questions with no particular differences between the issues nor between the care settings and facilities. Younger doctors were not especially competent as their more senior colleagues. Conclusions: Physicians demonstrated variable levels of knowledge about care of patients with diabetes during Ramadan. Reported self-reported competence was not matched by actual knowledge and treatment practices. Continued education, mentoring and support schemes are needed with regular assessments before Ramadan fast on an annual basis.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  5 834 169
Cancer incidence in Western Libya: First results from Tripoli medical center
Taha Benyasaad, Firvouz Altrjoman, Nabil Enattah, Farag Eltaib, Nureddin Ashammakhi, Adam Elzagheid
March-April 2017, 9(2):37-45
DOI:10.4103/1947-489X.210108  
Background. Cancer is a major problem and monitoring of its incidence is important. Aim: To estimate cancer incidence in western Libya. Methods: Data were collected retrospectively from Tripoli Medical Center during 2008. Classification of cancer diagnosis was made according to the International Classification of Disease. Results: A total of 1051 cancer cases were found (50.1% males and 49.9% females). Age-wise, 31% were younger than 15 years, 64.6% between 15 and 64 years and 4.2% above 64 years old. In females, most common cancers were breast (23.7%), colorectal (9.4%) and uterine (8.6%). In males, they were lung (15.6%), colorectal (12.3%) and prostate (9.9%). In females there were two peaks (in age group 40-44 and in those older than 75). Conclusions: Cancer incidence in western Libya increases with age. Most common cancer in men was lung cancer and in women was breast cancer. Further larger studies are needed to confirm such findings. Public health education, including antismoking and tobacco control, as well as awareness campaigns regarding early detection of cancer are needed to reduce cancer mortality.
[ABSTRACT]   Full text not available  [PDF]
  - 768 113
PRACTICE POINT
Getting boarded and beyond; a personalized guide for international medical graduates
Ala-Eddin Samir Sagar, Majdi Al Dliw
March-April 2017, 9(2):46-49
DOI:10.4103/1947-489X.210109  
For some international medical graduates (IMGs), becom- ing an American Board of Medicine Diplomate (ABIM) may sound extremely hard or perhaps impossible. Those who think this way forget the obvious fact that almost 25 percent of the medical workforce in the United States started exactly like them as international medical graduates. It may also come to everyone’s surprise that the number of non-US citizens IMGs continues to grow, and has been the highest ever last year based on the latest National Resi- dency Matching Program Report. Moreover, the match rate for non-U.S. citizen IMGs continues to grow to reach 50.5% in 2016, up from 49.4% in 2015. In this paper, we reflect on our own journey from being in- ternational medical graduates preparing for the United States Medical Licensing Exams (USMLEs) to American board certified physicians and will take you a step further through the initial steps of fellowship. We hope this will help guide other IMG’s to make their dream, one day, come true.
[ABSTRACT]   Full text not available  [PDF]
  - 726 86
REVIEW
Clinical impact of omega-3 consumption on the management of chronic heart failure
Marwan Mohammad, Mahmoud Houmsse
March-April 2017, 9(2):21-27
DOI:10.4103/1947-489X.210106  
Interest in omega-3 has grown dramatically since the observation that Eskimos have a high level of omega-3 due to high fish consumption that was associated with a low incidence of myocardial infarction. This was thought to be related to its antithrombotic effect due to inhibition of platelet aggregation. Subsequently, several studies indicated a potential beneficial impact of omega-3 in the treatment and prevention of cardiovascular disease including chronic heart failure (CHF) especially in patients with reduced ejection fraction. Despite the progress in the medical and device management of CHF, a significant number of patients with this clinical syndrome do not respond to current therapy. In addition, CHF remains a condition of a high morbidity, hospitalization and mortality. Therefore, clinicians got interested in exploring any potential benefit in the care of patients with CHF. Potential benefits of omega-3 in the management of CHF patients have been evaluated and showed possible positive effect on the progression of CHF through several mechanisms. These include the improvement of endothelial function, reduction of vascular tone, reduction of platelet aggregability, and improvement of myocardial function. This review article cites data from several experiments pertaining to the benefits of omega-3 in patients with CHF. The aim is to review the mechanisms, potential benefits, and possible therapeutic implications of omega-3 in patients with CHF. Results show that there is a significant difference in patients who intake omega-3 versus those who do not. This article is proof that there are other methods to treating CHF than what is prescribed in modern medicine.
[ABSTRACT]   Full text not available  [PDF]
  - 709 97
VIEW POINT
Fast and efficient science communication
Nureddin Ashammakhi, Adam Elzagheid, Mansour Elbabour
March-April 2017, 9(2):50-51
DOI:10.4103/1947-489X.210110  
Full text not available  [PDF]
  - 451 95