International Research Journal of Medicine and Medical Sciences

91-93

Authors: Zahra Mozaheb

Ocular involvement in patients with hematologic malignancies especially Non-Hodgkin Lymphoma (NHL) remains frequently unrecognized and in consequence not adequately treated. Ocular involvement in different subtypes of Non-Hodgkin’s lymphoma is more common than Hodgkin's lymphoma, including predominantly diffuse large B-cell lymphoma (DLBCL), mucosa-associated lymphoid tissue (MALT) lymphoma and T-cell lymphoma. In this report, we present a patient with marginal zone B cell lymphoma that was diagnosed and treated with R-CHOP. He had relapse after three years and treated with R-Bendamustine and again achieved complete remission. He presented with redness of eyes about 2 years later, on July 2017. At first he was treated for conjunctivitis, but subsequently orbital mass was reported in MRI which biopsy from his conjunctive showed low grade lymphoma infiltration in conjunctiva. He did not have response with chemotherapy R-Bendamustin, but he achieved complete response with radiotherapy. Hematologic malignancies with eye involvement may cause permanent damage of visual acuity and its timely recognition and treatment can prevent unnecessary visual loss.

101-106

Authors: Tahani O. Alkahtani, H. I. Almohammad, Halima Hawesa, Arwa H. Alhulwah and Hind D. Qasem

Osteoporosis is a bone density associated disease that causes fading of the bone structure and function, which thereby makes the bone fragile. This fragile bone can be easily fractured as a result of mechanical forces, or events that would otherwise not cause a fracture if the bones were healthy. Most previous studies have been conducted on postmenopausal females. The few studies that have been conducted on a Saudi population have primarily focused on risk factors for osteoporosis in women > 60 years of age or who are postmenopausal. This study aimed to evaluate younger, premenopausal Saudi females, <59 years old to investigate the impact of Body mass index (BMI) on bone mineral density (BMD) using a quantitative ultrasound (QUS) machine. Cross-sectional observational study of 100 Saudi women aged 19 to 58 years. Body mass index (BMI) was calculated from each participant’s weight in kilograms divided by the square of her height in meters (kg/m2). The DMS PEGASUS SMART Bone Densitometer, Mauguio, France, was used for portable quantitative ultrasound (QUS) with a Caucasian ethnicity setting and measurement of the right calcaneus bone. The mean age of the participants was 29.62 year (SD ± 10.25), range (19 to 58 years). A total of 5% exhibited evidence of osteoporosis and 64% had normal broadband ultrasound attenuation (BUA). The average BMI was 24.7268 kg/m² and average SOS was 1,390.28 m/s. Spearman’s rho showed weak negative correlation between BMI and SOS (p = 0.001≤ 0.05 and r= -.331) and fairly positive correlation between BUA and SOS (p = .000 ≤ 0.05 and r = .463). Furthermore, none of the participants in the low and normal BMI category showed evidence of osteoporosis. A total of 6.9% of the participants in the overweight BMI category showed evidence of osteoporosis, and 17.6% of those in the obese BMI category had evidence of osteoporosis. In conclusion, low and high BMI were positively correlated with low BMD regardless of age. A BMD screening test using QUS should be considered as primary screening for BMD in pre- and postmenopausal females with low or high BMI, to prevent future development of osteoporosis. QUS should be used for primary screening because it is, portable, fast, efficient, user friendly, widely available and uses non-ionizing radiation.

113-119

Authors: Syed M. Hasnain, Alanoud A. AlQassim, Halima A. Alsini, Abdulrahman S. Al-Frayh, Futwan A. Almohanna, Mohamed M. Shoukri and Sultan T. Al-Sedairy

Allergic diseases such as bronchial asthma and allergic rhinitis have increased in the pediatric and adults populations in Saudi Arabia. Apart from traditional lifestyle, the hot temperatures force families to spend more time indoors, resulting in high probability of individuals’ exposure with the indoor allergy sensitizers. In order to evaluate their impact in the allergic population, a nationwide study of various allergy and asthma sensitizers was conducted simultaneously in several cities of Saudi Arabia including coastal and non-coastal regions, during 2015-2016. A total of 560 house dust samples (HDS) from 164 allergic patients and 396 control homes were collected in sterile ziploc bags, by vacuuming from seven regions. Samples were sieved, extracted in PBS-Ph8 and analyzed by ELISA using seven different antibodies from Indoor Biotechnologies (Cardiff-UK). The targeted allergens included Dermatophagoides pteronyssinus (Der p1), Dermatophagoides farinae (Der f1), Blattella germanica (Bla g1, Bla g2), Felis domesticus (Fel d1), Rattus norvegicus (Rat n1) and Blomia tropicalis (Blo t5). Chi-square test and odd ratio to test the association between patients and controls as well as detection rate in coastal and non-coastal cities were conducted. The analyses of data between patients and controls as well as coastal verses non-coastal regions revealed quantitative variations in their threshold values. Der p1, Der f1 and Blo t5, the three house dust mites (HDM) antigens were higher in the coastal regions compared to non-coastal. While the other allergens viz. Bla g1, Bla g2, Fel d1 and Rat n1, exhibit an opposite trend. Significant levels for Bla g1 in Makkah (p < 0.0001) and Riyadh (p < 0.0006), Rat n1 (p < 0.0001) and Blo t5 (p < 0.0038) for Riyadh were obtained. The results are expected to help physicians, allergists and hospitals in selection of appropriate diagnostic test panels and may further help in therapeutic and preventive approaches on a regional basis.

124-131

Authors: Pérez-Alvarado C. M., Vargas-Madrazo E., Montes-Villaseñor E., Valdez-Betanzos A., Aranda G. E. and Hernández-Aguilar M. E.

Integrative Medicine is a growing branch of medicine which integrates the best aspects of conventional (allopathic) and complementary and alternative medicines. This kind of medicine recognizes that the mechanistic, fragmentary and linear view of science, i.e. reductionism, has many limitations, particularly in biological and medical sciences. Moreover, Integrative Medicine provides a particular care to each patient, orienting its practices towards healing and emphasizing the therapeutic relationship. Its principles harmonize with the proposals of Systemic Biology which acknowledges the complexity, integrality and holistic nature of living beings. Based on the aforementioned postulates integrate our Five-Spheres Model for patient care.

56-59

Authors: Daniel Zewdneh Solomon, Natae Fekadu and Yocabel Gorfu

Parasitic twining, also known as heteropagus is an asymmetric twinning of conjoined identical or monozygotic twins where the tissues of a severely defective twin (the parasite) are dependent on the cardiovascular system of the other twin (autosite) for survival. The condition only occurs when an undeveloped or underdeveloped twin is attached to parts of the body of the twin that develops and is delivered. The estimated incidence is approximately 1 per 1 million live births. To date, only a few isolated case reports are published in the literature of this rare congenital anomaly. Here, we report a case of this rare entity in a neonate referred to our teaching hospital.

67-78

Authors: Ali Dezhgir, Tayebe Talebzadeh, Iman Alsadat Hosseini, Donya Altafi, Hamed Hojatian, Rashed Mehrfard, Sahel Towfigh Rafiei, Marjan Moradi Fard, Zeinab Shabani, Morteza Taghizadeh, Massoud Houshmand, Soudeh Soleymani Mashhadi, Navid Rahimian, Arvin Haghighatfard and Soha Sadeghi

Azathioprine therapy was recently used to treat dermatologic conditions such as Alopecia areata (AA). Previous reports showed that Thiopurine S-methyltransferase (TPMT) activities in human red blood cell are associated with a polymorphism in this gene. Therefore, patients carrying mutant allele of TPMT may show severe myelosuppression when they are treated with standard doses of Azathioprine drugs. This study aimed to evaluate the TPMT gene amongst Alopecia areata patients and healthy adult in Iranian populations. TPMT gene polymorphisms were investigated in 1285 Iranian healthy adult blood donors and 632 patients with Alopecia Areata Universalis (AU). Tetra Arms PCR, Real-Time PCR and Sequencing were used to evaluate the presence of allele-specific polymorphisms of TPMT gene (TPMT *2(c.238 GC,), TPMT *3A (c.460 GA and c.719 AG), TPMT *3B (c.460 GA), and TPMT *3C (c.719 AG). Results were shown that the TPMT*2 allele is associated with a low enzymatic activity that was detected in 22.51% (863 in 1917) of Iranian individuals. Heterozygous genotypes were in 827 (43.14%) subjects (232 AA and 595 healthy), and homozygous genotypes were in 18 (0.94%) individuals (3 AA and 15 healthy). The normal allele (wild-type) was found in 55.92% of the studied individuals (20.70% AA and 35.21% healthy). According to a higher frequency of TPMT polymorphism in Iranian population in comparison with other population, determination of TPMT genotype in may have the clinical benefit to thiopurine dosage selection and treat patients as well.

85-90

Authors: Olfat A. Salem, Anoud Kaabi, Bodoor Al shehri and Reem Sufyani

The primary aim of this investigation was to explore the effects of stress management programs on stress levels in nursing students studying in Saudi nursing college. Stress management training help the nurse to cope up with professional challenges, in retaining workforce and assist in solving the issue of shortage of registered nurses. This research project is a quasi-experimental study and sample size for this study was 16 students selected by using random sampling method. The researcher developed a questionnaire to measure the effectiveness of the stress management program regarding the students' stress levels. Results revealed nursing students who did not attend the interventional program reported an increase in the level of stress index level. Nurses who have attended the stress management sessions showed changes in their stress levels, although the minimization in stress was detected at a minute level. The study did not deliver a definitive outcome of the effectiveness of stress management program in improving coping abilities among nursing students. The outcome of this study though has not been clear, it still holds some valuable implications for future endeavors in stress management scenario.

35-40

Authors: Sussan U. Arinze-Onyia, Edmund O. Ndibuagu and Ignatius I. Ozor

The risk for hospital-acquired infections (HAIs) is high among nurses. This study is aimed at assessing nurses’ knowledge and use of standard precautions (SP) in a tertiary health institution in Enugu, southeast Nigeria. The study was descriptive cross-sectional among nurses at University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State. A pre-tested questionnaire was used and analysis was done using SPSS version 17. There were 290 respondents, most of them were females (91.7%), married (65.9%) and between the ages of 20 and 59 years. Almost 98% have heard of SP, 77.2% could define it while about 80% knew the indications and could identify most components of SP. Only 43.8% knew about respiratory hygiene. Over 90% agreed that SP is useful in protecting against hospital infections and that employers should provide SP training for their workers. Decontamination of hands was 100% prior to an aseptic procedure and 97.9% before leaving patient’s care area. Gloves were the most commonly used PPE (55.2%) while irregular access was the major reason for non-consistent use of PPEs (64.6%). Over 70% of respondents discard needles without recapping. The nurses who work in the ICU ranked highest in exposure to patients’ serum (100%) and use of PPEs (88.9%). Those who were trained on SP (68.6%) and PPE (69%) were more likely to use PPEs. In conclusion, knowledge and attitude to SP were good but the practice is suboptimal. Regular training and supply of required materials for SP are indicated.

47-49

Authors: Tarig Fadelelmoula

Students’ class attendance and engagement plays an important role in contemporary higher education. The present study aimed to investigate the compliance of Respiratory Care students to attendance regulations and the relationship between mandatory class attendance and final exam performance in four Respiratory Care courses. Attendance was measured by the overall lecture attendance percent, throughout the course. Students’ performance was assessed by the final exam mark obtained. No statistically significant differences in student attendance between the different courses were found; although attendance was lower in cardiopulmonary anatomy and physiology course compared with the other 3 courses. Statistically significant differences in performance were present between the four courses. Positive correlation was found between attendance and final exam performance in all courses together, but the relationship between the variables was not statistically significant. Correlation between attendance and final exam results for each separate course was also examined and found to be positive, but also lacked statistical significance. Students’ compliance with the student regulations and the overall attendance is excellent. Class attendance got a positive impact on students’ academic performance. This suggests that lecture attendance is critical for learning, but a larger study is required to adjust for other factors like, English language proficiency student CGPA (cumulative average grade point) and gender and to minimize the effect of the small sample size used in this pilot study.

1-9

Authors: Varsha Arjandas, Fatema Salem Al Ameri, Mehmood Chaudhry and Rasha Buhumaid

Point of care ultrasound (POCUS) performed at bedsides is an invaluable tool and is used to evaluate clinical manifestations, to facilitate accurate diagnosis, and to assist procedures in emergency and critical care. This study aimed to characterize the current practice of emergency physician-performed POCUS in UAE Emergency Departments. An online survey of all government emergency departments in the UAE was conducted from January 2016 to August 2016 in order to determine how POCUS was used. A 20-question survey, including Emergency department demographics, ownership of ultrasound (US) equipment, and frequency of POCUS performance in general and by examination type, credentialing patterns, quality assurance methods, and billing patterns was conducted. Overall, 70% of respondents reported lack of training as the greatest barrier for the use of POCUS. Other shortcomings included not owning equipment, concerns regarding liability, not beneficial financially, and adequate coverage by other specialists. In conclusion, the study identified an underutilization of POCUS in UAE government Emergency Departments, with only a quarter of them performing POCUS regularly. Most of the respondents stated that attending a training course is the minimal requirement for the physicians to perform POCUS. Recent educational and training advancements might help to overcome this barrier.

18-34

Authors: Hala El-Wakil, Eman Khalil, Dalia Maharem, El-Said Mahena and Mohamed Hasab

Lupus nephritis (LN) affects up to 60% of patients with systemic lupus erythematosus (SLE), either as the initial manifestation or during the disease course. Moreover, LN has a negative impact on survival of SLE patients. Accordingly, it is mandatory to identify specific and feasible markers able to guide clinicians towards the adequate therapeutic option in LN patients. The aim of this work was to evaluate the predictive value of renal resistance index (RRI), measured by Doppler Sonography in comparison with disease activity score, serologic and biopsy parameters in patients with LN. This study was carried out on forty three SLE patients, they were categorized into two groups: Group I included thirty three patients with LN and Group II included ten patients without LN and Group III included ten healthy subjects of matched age and sex as control group. All were subjected to history taking, clinical examination, assessment of disease activity by SLEDAI, laboratory investigations including FBG, blood urea, serum creatinine, serum albumin, CBC, ESR, CRP, complete urine analysis, 24 hour urine protein, eGFR, serum ANA, anti ds-DNA titre, C3, C4 and renal Doppler with measurement of RRI. Renal biopsy was done for those with LN. The mean value of RRI was statistically significantly higher in group I than that of group II and group III. Out of 33 cases of LN cases, 6 patients had RRI of 0.7 and above giving a percentage of 18.18%. LN patients with RRI higher than 0.7 had statistically significant higher age, mean serum creatinine and blood urea levels and a lower eGFR, higher chronicity index of renal biopsy. RRI is of clinical significance in predicting the chronicity index of renal biopsy which is a major determinant of renal outcome so it is useful as non invasive technique to evaluate chronicity in patients with LN, therefore justifying aggressive immune suppression but further follow-up studies are needed to evaluate its role in predicting response to treatment.