The Journal of Middle East and North Africa Sciences

6-18

Authors: Tayo Toriola; Zaiya Waseem; Bhaktawar Nader; Deepika Gudapati; Samrah I. Siddiqui; Safeera Khan

Type Two Diabetes Mellitus (T2DM), formerly known as adult-onset diabetes, is a disease caused by impaired pancreatic insulin production and the ineffective use of insulin (insulin resistance) in the liver and periphery. It is believed that today, up to 5000 children are being diagnosed with Type Two Diabetes Mellitus per year, with the incidence of T2DM tripling between the ages of 10-14 and 15-18, especially among racial minorities. A high-yield symptom for those suffering from T2DM is weight gain, however, T2DM can also be linked to other co-morbidities including hypertension, dyslipidaemia, diabetic retinopathy, nephropathy, and neuropathy. This is why the American Diabetes Association introduced bariatric surgery as a form of diabetic treatment in 2009. Since its approval, bariatric surgical procedures such as Gastric Banding (GB), Roux-en-Y Gastric Bypass (RYGB), Biliopancreatic Diversion (BPD), and Sleeve Gastrectomy (SG) have elicited several positive results in adult patients. However, its use on children has been put into question due to safety concerns. For that reason, we searched databases such as PubMed, ScienceDirect, Cochrane Library, Embase, and Google Scholar to conduct a systematic review containing 34528 patients from 20 different studies to determine the effectiveness of bariatric surgery as a treatment option for obese pediatric patients with Type Two Diabetes Mellitus. For this systematic review, we only included patients <18 years of age with a BMI >35 along with papers that measured their patients' change in Body Mass Index (BMI), estimated weight loss (EWL), or total weight loss (TWL). Upon completion of the investigation, it was concluded that bariatric surgery is an effective treatment for obese adolescents with Type Two Diabetes Mellitus.

14-23

Authors: Kerolos N. Youssef; Aafreen Khan; Christine M. Zakhary; Hiam Rushdi; Jaafar A. Hamdan; Mohammed A. Abdalla; Safeera Khan

Diabetes mellitus (DM) and hepatocellular carcinoma (HCC) are very challenging health conditions. Although the relation between them is not completely understood, many factors contribute to this relation, including hyperinsulinemia, inflammatory reactions, and other co modifiers as obesity. This study is designed to detect the role of metformin in preventing HCC in patients with DM compared to other anti-diabetic medications. We have screened the articles systemically in three databases such as PubMed, PubMed Central (PMC), and Medical Literature Analysis and Retrieval System Online(MEDLINE), using specific keywords and Medical Subject Heading (MeSH) terms for related published articles. Moreover, we have used Google Scholar, International Diabetes Federation (IDF), and American Diabetes Association (ADA). We have applied our inclusion/ exclusion criteria, and we have also applied the quality check assessment using Cochrane bias assessment, AMSTAR checklist, SANRA checklist, and New-Castle Ottawa tool. In the end, we reviewed ten studies that were strictly reviewed and analyzed. Based on our study, we reported that the major factor in the development of HCC in patients with DM is the duration, especially more than ten years. We concluded that the risk of development of HCC is directly proportional to the longer duration of DM. Our results show that metformin plays an important role in preventing HCC in patients with DM by decreasing insulin resistance. In contrast, the use of Insulin and drugs that promote insulin secretion is associated with increased incidence of HCC.

9-14

Authors: Viral Patel; Shereen Henin; Anoud S. Al kaabi; Mohammed Y. Rashid; Anupa Gnawali; Asfa Noor; Alejandrina Cuello-Ramírez; Jihan A. Mostafa

Background. Stroke is a condition of quickly developing clinical signs of focal or global neurological disruption lasting for over twenty-four hours with no visible reason besides a vascular origin. Different risk factors are included for stroke development, like hyperlipidemia, hypertension, diabetes, and smoking. The current study was conducted to determine serum uric acid in acute ischemic stroke patients and evaluate its relationship with stroke severity. Method. An Analytical, Non-interventional Prospective study was conducted among 50 cases of acute ischemic stroke admitted in the medicine ward at Sadhana Kutir Hospital, Kim, India, over six months from August 2020 to January 2021. All patients who presented within twenty-four hours of the onset of stroke and who gave consent were included. Fifty normal healthy individuals are included as controls. Serum uric acid levels, along with other blood routine tests, were done. The GCS score measured stroke severity. Results. The mean age group in cases was 62.39±11.61 and in control was 60.18±14.72. In cases, mean blood uric acid was 5.41±1.26 and in control was 4.82±1.26; this difference was statistically significant at a p-value of 0.021. There was no correlation between the severity of stroke and serum uric acid levels. (p valve-0.2488). Conclusion. This study concludes that serum uric acid can be utilized as neurotic biomarkers in acute ischemic stroke patients. But stroke severity can not be predicted by its level.

26-30

Authors: Asim Chatterjee; Madhuvanti Mukherjee; Priyanka Gupta; Sandali Devireddy

Introduction. In India, the fragmented and heavily under-sourced diversion of resources towards the COVID-19 Pandemic has heavily limited the workings of non-COVID-related health services. Several factors, including the suspension of transport facilities, the shutdown of private facilities, conversion of public-health facilities into COVID-19 treatment centers, and the diversion of medical professionals towards COVID-19 emergency-response have lengthened these restrictions. This has gendered implications for low-income women and girls. A lack of structured social security and healthcare-provision systems obligates these persons to assume the primary caretaker role in their households. Aims. This paper aims to outline the evidence for the lived experiences of low-income Indian women as they strive to balance their paid-work and unpaid-caretaker-obligations during the COVID-19 Pandemic. On a macro level, our work aims to assess the extent to which women’s health, economic, and social empowerment can be achieved through existing programs and policies. Methods. Our findings were drawn from qualitative research conducted in urban and peri-urban regions of Jaipur and Lucknow. A mixed-methods approach was used, combining online surveys with semi-structured interviews and participatory exercises to generate high-quality data. All girls and young women selected for participation were between the ages of 15-24. Results. Interviewees described their caretaking experience as physically and emotionally depleting. As substitute providers of care, they felt unprepared and unfit to administer health procedures. Although many felt that they “needed” to earn some sort of income, their paid work options were few and poorly paid. As a result, most participants could only fulfill their domestic caretaking responsibilities in the most basic capacity. Analysis of participants’ survey reports revealed that women had little knowledge of the COVID-19 pandemic and its consequences on their lives. Conclusions. The strengthening of social security measures is of the utmost importance. In the future, policy should take into consideration the costs of womens’ caregiving responsibilities on themselves, their children, and their families. A gendered approach to the political economy must be adopted.

5-11

Authors: Reema Aslam; Maria Jamil; Aanal Patel; Safeera Khan

Congenital Diaphragmatic Hernia (CDH) is a rare birth defect in which the diaphragm fails to close during prenatal development, which causes the intestinal contents to herniate into the chest from the abdominal cavity causing lung hypoplasia and persistent pulmonary hypertension of the newborn (PPHN). Extracorporeal membrane oxygenation (ECMO) is a rescue therapy for infants having CDH on whom the conventional ventilation strategies fail. Our systematic review aimed to evaluate the outcomes of Extracorporeal Membrane Oxygenation (ECMO) use on infants with Congenital Diaphragmatic Hernia (CDH). We used PubMed, Embase, Web of Science and Google Scholars databases for our data collection, and articles from 2010-2021 were analyzed and included as part of this research. We included studies in the English language conducted on human infants. We excluded studies conducted before 2010, studies on animals, languages other than English, or studies conducted on the adult population from our research. We identified a total of 3650 studies from the databases. After removing duplicates, screening titles, applying inclusion-exclusion criteria, and assessing the papers' quality, we were left with nine articles. Six out of these nine articles were retrospective cohort studies, and three were literature reviews. We extracted data manually from these studies. ECMO's role in managing CDH in infants is controversial as some studies show improvements in infants' survival rate. In contrast, other studies mention that the risks involved in ECMO use outweigh the benefits, and we should only use it in those infants who are severely affected. Due to inadequate data, we require additional research to determine whether the use of ECMO is favorable or should it be discouraged.