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   Table of Contents - Current issue
Coverpage
April-June 2017
Volume 7 | Issue 2
Page Nos. 35-80

Online since Tuesday, April 4, 2017

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REVIEW ARTICLES  

Do not resuscitate, brain death, and organ transplantation: Islamic perspective Highly accessed article p. 35
Hassan Chamsi-Pasha, Mohammed Ali Albar
DOI:10.4103/2231-0770.203608  
Muslim patients and families are often reluctant to discuss and accept fatal diagnoses and prognoses. In many instances, aggressive therapy is requested by a patient's family, prolonging the life of the patient at all costs. Islamic law permits the withdrawal of futile treatment, including life support, from terminally ill patients allowing death to take its natural course. “Do not resuscitate” is permitted in Islamic law in certain situations. Debate continues about the certainty of brain death criteria within Islamic scholars. Although brain death is accepted as true death by the majority of Muslim scholars and medical organizations, the consensus in the Muslim world is not unanimous, and some scholars still accept death only by cardiopulmonary criteria. Organ transplantation has been accepted in Islamic countries (with some resistance from some jurists). Many fatwas (decrees) of Islamic Jurisprudence Councils have been issued and allowed organs to be donated from living competent adult donor; and from deceased (cadavers), provided that they have agreed to donate or their families have agreed to donate after their death (usually these are brain-dead cases). A clear and well-defined policy from the ministry of health regarding do not resuscitate, brain death, and other end-of-life issues is urgently needed for all hospitals and health providers in most (if not all) Muslim and Arab countries.
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Are these results trustworthy? A guide for reading the medical literature p. 46
Fares Alahdab, Allison Morrow, Mouaz Alsawas, M Hassan Murad
DOI:10.4103/2231-0770.203611  
Physicians practicing evidence-based medicine need to be able to appraise a new study and determine whether the results warrant sufficient certainty to the level that they can be applied to patient care. Without such appraisal, misleading results can be incorporated into patient care, which can lead to inefficient, costly, and possibly harmful care. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach offers a modern framework that can be applied to evaluate the trustworthiness of evidence. In this guide, we present a simplified approach based on GRADE; in which we call on readers of the medical literature to pay attention to six domains before making an overall judgment about the trustworthiness of results and before applying the evidence to patient care.
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ORIGINAL ARTICLES Top

Black widow spider bites experience from tertiary care center in Saudi Arabia p. 51
Ali Al Bshabshe, Musa Alfaifi, Ahmed Fouad Alsayed
DOI:10.4103/2231-0770.203606  
Introduction: Black widow spiders are one of the most poisonous species to humans; there are more than 30 species of widow spiders in the globe but good thing that not all of them are dangerous. Some of these spiders produce toxic venoms, which cause broad spectrum of clinical manifestations including skin lesions, neurotoxicity, cardiac toxicity and death in some occasions. In Saudi Arabia there were no much reports of black widow spider bites apart from the case series by BUCUR and his group in ALBAHA region. Settings: In 2 years period a total of 8 patients were presented to the emergency departments diagnosed to have black widow spider bites based on description by the patients. Results: 100 % of the cohort were males, aged between 25-58 years. The time between bite and presentation to emergency room was one hour in average (30 min to 4 hours). 75% occured during summer season. All of them 100% had one bite only and reported the bite to be at nighttime in 75% of the times. The average pain score at presentation was 4 /10.100% of the bites were in the lower extremities and almost all progressed to have lower back pain. Three patients had gastrointestinal tract manifestation in form of abdominal cramps and nausea. One had bilateral ptosis, none of them had cardiac or pulmonary complications. The outcome was excellent in all patients and the average of hospital stay was 2.5 days (1-5).
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Efficacy of a multi-component psychosocial intervention program for caregivers of persons living with neurocognitive disorders, Alexandria, Egypt: A randomized controlled trial p. 54
Zeinab Nazeeh Shata, Marwa R Amin, Heba M El-Kady, Mervat W Abu-Nazel
DOI:10.4103/2231-0770.203610  
Background: Unlike other chronic diseases, dementia caregiving is associated with enormous psychological burden, which stresses the need for caregivers-directed psychosocial interventions. Aim: This randomized controlled trial (RCT) was conducted to evaluate the short-term efficacy of a multi-component psychosocial intervention program for informal caregivers of persons with neurocognitive disorders in Alexandria, Egypt. Methods: Informal caregivers (120) were randomly assigned into intervention and control groups. The intervention group (60) participated in a multi-component program of 8 sessions, including psycho-education, group cognitive-behavioral therapy, and group social support. Program primary outcomes were assessed after program termination (post-1), and three months later (post-2). Measured outcomes included caregivers' knowledge, depression and anxiety symptoms, and perceived burden. Results: Caregivers' depression, anxiety, and perceived burden demonstrated significant drop at post-1, and post-2 compared to the control group (P< 0.001). The intervention group showed significant negative absolute change on depression, anxiety, and perceived burden measures, while on the dementia-related knowledge measure, a significant positive absolute change was found at post-1, and post-2 (P< 0.001), in comparison to controls. All outcome measures recorded a large effect size; the highest was for knowledge (partial eta2 = 0.98), and the least was for perceived burden (partial eta2 = 0.71). Conclusion: A multi-component psychosocial intervention for caregivers of persons with neurocognitive disorders demonstrated a short-term efficacy in reducing their burden, depression, and anxiety, as well as improving caregivers' knowledge. However, further research is needed to investigate long-term efficacy of the intervention.
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BRIEF REPORT Top

Polio in Syria: Problem still not solved p. 64
Ahmad Al-Moujahed, Fares Alahdab, Heba Abolaban, Leo Beletsky
DOI:10.4103/ajm.AJM_173_16  
The reappearance of polio in Syria in mid-2013, 18 years after it was eliminated from the country, manifests the public health catastrophe brought on by the civil war. Among the lessons learned, this outbreak emphasizes the importance of increasing the international financial and logistical support for vaccine and immunization efforts, especially in countries suffering from conflicts. The lack of access to polio accredited laboratory or outright lack of laboratories in settings of conflict should be recognized allowing international surveillance to be strengthened by supplementing the laboratory definition with the clinical definition. In addition, it illustrates the imperative for the United Nations (UN) agencies involved in global health to be able to operate independently from governments during conflicts in order to provide adequate and efficient medical and humanitarian relief for civilians. Proper communicable disease surveillance and control, delivery of vaccinations, and other pivotal healthcare services to these areas require independence from governments and all military actors involved. Moreover, it shows the necessity to adequately support and fund the front-line nongovernmental organizations (NGOs) that are implementing the delivery of medical and humanitarian aid in Syria.
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CASE REPORTS Top

Drug-induced hypersensitivity reaction: A case of simultaneous thyroiditis and fulminant type 1 diabetes p. 67
Michael Marchese, Matthew Leinung, Hassan Shawa
DOI:10.4103/ajm.AJM_124_16  
A 43-year-old incarcerated man with AIDS was hospitalized for 30 pounds weight loss and diffuse pruritic rash. Three months prior, he was started on dapsone for Pneumocystis jiroveci pneumonia prevention. Biochemical evaluation was remarkable for eosinophilia, thrombocytopenia, acute renal insufficiency, transaminitis, thyrotoxicosis, and significant hyperglycemia (450 mg/dl; nl, 65–99). His hemoglobin A1c level was 5.9% (nl, 4.1–5.6). Thyroid-stimulating immunoglobulin, glutamic acid decarboxylase, and islet cell autoantibodies were within the normal range. He was found to have acute interstitial nephritis based on renal biopsy. He was diagnosed with hypersensitivity reaction due to dapsone. The patient was managed with a tapering dose of corticosteroid, beta-blocker, and multiple daily injections of insulin. The symptoms and biochemical disturbances including thyrotoxicosis resolved within a few weeks. Insulin requirements decreased but diabetes did not resolve with hemoglobin A1c of 6.1% a year after hospitalization. To our knowledge, this is the first case of hypersensitivity reaction due to dapsone causing simultaneous fulminant type 1 diabetes and thyroiditis.
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Isolated palatal weakness without optic neuritis as the presenting manifestation of multiple sclerosis and its diagnostic dilemma with acute disseminated encephalomyelitis in a young boy p. 71
Virti D Shah, Sumeet Prakash Mirgh, Nirmal Surya
DOI:10.4103/ajm.AJM_91_16  
We present a case of a young boy who at initial presentation was diagnosed as acute disseminated encephalomyelitis (ADEM) but subsequently on follow-up was diagnosed as multiple sclerosis (MS). Differentiating ADEM from MS in their first presentation can be tricky as the features may not be typical of anyone. The importance lies in the close follow-up of these patients.
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Donor-transmitted melanoma after limbal stem cell transplantation p. 75
Anas Alsara, Muhammad Rafi
DOI:10.4103/2231-0770.203609  
Limbal Stem Cells are a unique cell line located at the corneal limbus. They are responsible for regenerating and restoring corneal epithelial layers. Limbal stem cell transplantation is a promising technique that has been used to treat several hereditary and acquired corneal diseases. Cornea tissue lack vascularity. Hence, there were no special restrictions on collecting ocular tissues from donors with a diagnosis of metastatic melanoma. We are reporting a case of a patient who developed an ocular melanoma after she had limbal stem cell transplantation from a donor with history of melanoma. After this case, Eye Bank Association of America updated the donor criteria to exclude donors with any history of melanoma.
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LETTERS TO THE EDITOR Top

Hyperthyroidism and noncompaction p. 78
Josef Finsterer, Claudia Stöllberger
DOI:10.4103/ajm.AJM_184_16  
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Left ventricular noncompaction cardiomyopathy p. 79
Amer Hawatmeh, Habib Habib, Fayez Shamoon
DOI:10.4103/ajm.AJM_27_17  
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