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   2017| July-September  | Volume 7 | Issue 3  
    Online since July 10, 2017

 
 
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REVIEW ARTICLES
Ebola virus disease: Essential clinical knowledge
Mahmoud Tawfik Khalafallah, Omar Ali Aboshady, Shaban Ahmed Moawed, Menna Said Ramadan
July-September 2017, 7(3):96-102
DOI:10.4103/ajm.AJM_150_16  PMID:28791241
Since its initial outbreak in 1976, Ebola virus disease (EVD) has affected thousands of people, causing severe illness with high mortality rates. In the absence of a vaccine or effective specific treatment, as well as the lack of early diagnostic and detective methods, the EVD outbreak has generated a significant worldwide health concern. Insufficient health-care system resources, deficient infection control measures, and the shortage of appropriate personal protective equipment acted as amplifiers of the outbreak extension, especially in poorly resourced and unprepared communities. Operating on the frontlines, health-care workers must be familiar, not only with the identification of the disease, but also with the ability to protect themselves and initiate the appropriate response. This review seeks to provide essential information required to identify and manage the disease, with an emphasis on pathogenesis, transmission, diagnosis, treatment, and prevention. We conducted a literature search in MEDLINE/PubMed and Google Scholar using the following keywords: “Ebola, Ebola virus disease, Hemorrhagic Fever, Outbreak.” We included all types of publications. To augment our study, we searched the reference lists of identified reviews.
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ORIGINAL ARTICLES
To compare the efficacy of tamsulosin and alfuzosin as medical expulsive therapy for ureteric stones
Rikki Singal, Gaurav Bhatia, Amit Mittal, Samita Singal, Muzzafar Zaman
July-September 2017, 7(3):115-120
DOI:10.4103/ajm.AJM_87_16  PMID:28791244
Aims and Objectives: This study aims to evaluate the efficacy of tamsulosin and alfuzosin for the distal ureteral stone. This study assessed the spontaneous passage and expulsion of the stone. Materials and Methods: The study was conducted in the Department of Surgery at Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, from May 2013 to May 2014. A total number of 136 patients diagnosed as distal ureteric stone (US) of size <10 mm were included in this study. It was divided into two groups (I and II) out of which 36 cases were excluded. Group I received tablet tamsulosin 0.4 mg/day, and Group II received alfuzosin 10 mg/day. The efficacy of tamsulosin and alfuzosin as an adjunctive medical therapy was determined. Results: Both the drugs can be safely used for the distal USs. The stone expulsion rate was seen in 36 patients (72.0%) in Group I, and in 34 patients (68.0%) in Group II (P = 0.545). The passage of stones noticed by 32 patients in each Groups I and II (P = 1.000). The mean number of pain attacks was 2.91 ± 1.01 for Group I, and 1.8 ± 0.83 for Group II (P < 0.001 and P < 0.001). Thus, we propagate the use of alfuzosin significantly lower number of pain attacks. The drug-related side-effects were postural hypertension (four in Group I and one in Group II) and retrograde ejaculation (eight in Group I, and one in Group II). Thus, the difference was statistically significant in terms of retrograde ejaculation but insignificant for postural hypotension. Conclusion: There is no difference between both medications in term of efficacy (passing stones) for the management of distal ureteral stones. Both medications are safe and effective. In addition, alfuzosin was better tolerated than tamsulosin as it has fewer side effects.
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CASE REPORTS
The endovascular management of a 3.5-cm gastroduodenal artery aneurysm presenting with gastritis and recurrent pancreatitis
Baraa Zuhaili, Robert G Molnar, Nitin G Malhotra
July-September 2017, 7(3):130-132
DOI:10.4103/ajm.AJM_3_17  PMID:28791247
Visceral artery aneurysms (VAAs) are a rare entity. Within this subset of aneurysms, gastroduodenal artery (GDA) aneurysms represent an even more rare occurrence. We present a case report of treating GDA aneurysm on semi-elective basis followed by literature review of the clinical presentation and mainstream treatment modalities. GO is a 65-year-old male, with 6-month history of recurrent epigastric pain. He was found to have acute pancreatitis and an adjacent 3.5-cm GDA aneurysm. After conservative treatment of pancreatitis, the aneurysm was treated with coil embolization of the sac and GDA. Most VAAs are asymptomatic; GDA aneurysms tend to present clinically with epigastric pain or pancreatitis. In addition, together with pancreaticoduodenal aneurysms, GDA aneurysms warrant immediate intervention once diagnosed. Open surgical options for VAAs include aneurysm resection with or without revascularization (i.e., bypass), aneurysm ligation, or end-organ resection (i.e., splenectomy). Endovascular repair involves coil embolization with or without stent placement. While endovascular modality continues to be the first choice for stable elective VAA patients, modality of treatment for ruptured VAA or unstable patients will vary according to the patient's overall status, operator's experience, and institute capacity.
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An unusual presentation of chronic lymphocytic leukemia
Dinesh Atwal, Mihir Raval, Belal Firwana, Jeanette Ramos, Appalanaidu Sasapu
July-September 2017, 7(3):133-136
DOI:10.4103/ajm.AJM_161_16  PMID:28791246
Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is a B-cell lymphocytic neoplasm with indolent clinical course. If identified early, observation is opted. Many variables lead to the initiation of treatment. Authors describe a 62-year-old male presenting with shortness of breath and found to have white cell count of 1360 × 109/L and subsequently was diagnosed with CLL/SLL. The patient received leukapheresis along with tumor lysis treatment and systemic chemotherapy with fludarabine, cyclophosphamide, and rituximab regimen. His course was complicated with deep venous thrombosis, extensive cutaneous, and sinus mucosa involvement by CLL/SLL. The patient clinically improved and on follow-up clinic visits documented normalization of his white cell counts. The case report brings up a rare presentation of CLL/SLL with such an extreme high white cell count, leukostasis symptoms and extramedullary involvement of disease and encourages providers to be vigilant of rare presentation of CLL/SLL.
  - 2,474 168
NOTICE OF RETRACTION
Retraction: Topical vasodilator response in skeletonized internal mammary artery: Is there really a difference?

July-September 2017, 7(3):137-137
DOI:10.4103/2231-0770.210055  PMID:28791249
  - 1,418 108
ORIGINAL ARTICLES
Diagnostic yield and safety of closed needle pleural biopsy in exudative pleural effusion
Govind Singh Rajawat, Supreet Batra, Rajendra Prasad Takhar, Lalit Rathi, Chand Bhandari, Manohar Lal Gupta
July-September 2017, 7(3):121-124
DOI:10.4103/ajm.AJM_112_16  PMID:28791245
Background: Closed pleural biopsy was previously considered a procedure of choice in cases of undiagnosed pleural effusion with good efficacy. Currently, the closed pleural biopsy has been replaced by thoracoscopic biopsy but not easily available in resource-limited setups. Objective: The objective of this study was to analyze the diagnostic yield and safety of closed needle pleural biopsy in exudative pleural effusion and assessment of patients' characteristics with the yield of pleural biopsy. Design: This was a cross-sectional study. Settings: This study was conducted at Institute of Respiratory Diseases, SMS Medical College, Jaipur, a tertiary care center of West India. Patients and Methods: A total of 250 cases of pleural effusion were evaluated with complete pleural fluid biochemical, microbiological, and cytological examination. Out of these 250 patients, 59 were excluded from the study as the diagnosis could be established on initial pleural fluid examination. The remaining (191) patients were considered for closed pleural biopsy with Abrams pleural biopsy needle. Main Outcome Measures: The main outcome measure was diagnostic yield in the form of confirming diagnosis. Results: Out of the 191 patients with exudative lymphocytic pleural effusion, 123 (64.40%) were diagnosed on the first pleural biopsy. Among the remaining 68 patients, 22 patients had repeat pleural biopsy with a diagnostic yield of 59.9%. The overall pleural biopsy could establish the diagnosis in 136 (71.20%) patients with pleural effusion. The most common diagnosis on pleural biopsy was malignancy followed by tuberculosis. Conclusions: Closed pleural biopsy provides diagnostic yield nearly comparative to thoracoscopy in properly selected patients of pleural effusions. In view of good yield, low cost, easy availability, and very low complication rate, it should be used routinely in all cases of undiagnosed exudative lymphocytic pleural effusion. Limitations: There was no comparison with a similar group undergoing thoracoscopic pleural biopsy.
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Etiologies and posttreatment conditions of thyrotoxic patients in Sylhet division, Bangladesh: A clinical series
Md Kayes Mahmud, Shahnaz Jalil, A HM Mahmudur Rahman, Md Mamun-Ur Rashid, Shiny Sultana, Adnan Taher, Lutful Haque, Jannatul Fardous, Kamrun Nahar
July-September 2017, 7(3):125-129
DOI:10.4103/ajm.AJM_161_16  PMID:28791246
Objective: The endeavor of the study was to analyze the posttreatment (postradioactive iodine therapy [RAI]) conditions of thyrotoxic patients in a tertiary level hospital. Materials and Methods: A retrospective study of 186 patients was conducted from 2012 to 2014 in Institute of Nuclear Medicine and Allied Sciences (INMAS), Sylhet MAG Osmani Medical College Campus. Patients' information regarding the etiologies and their disease status after getting RAI therapy was recorded. Results: In this study, 29.57% patients were male and 70.43% were female where the mean ages were 44.57 and 43.46 accordingly. The most vulnerable group was in between 41 and 50 years of age, which is 25.81%. The patients were categorized according to the etiologies as Graves' disease (GD), multinodular goiter (MNG), and single toxic nodule (STN). In primary stage, 60.22% patients had GD, 26.88% had MNG, and 12.90% had STN. After 6 months of RAI therapy, the disease status of 51.61% patients became euthyroid, 19.35% became hypothyroid, and 29.03% remained thyrotoxic. Thus, a second dose of RAI therapy was given to those patients for next 6 months. After 12 months from the beginning of the therapy of each patient, the total recovery was found to be 72.04%. However, though all the GD patients improved to either euthyroid or hypothyroid state after 6 months, on a 12-month observation, 17.86% of them regained the thyrotoxicosis due to discontinuation of the treatment. Conclusion: The findings show an overall significant recovery of thyrotoxic patients taking RAI therapy in INMAS and important points to improve the rate.
  - 2,045 132
An online academic writing and publishing skills course: Help Syrians find their voice
Ammar Sabouni, Abdelkader Chaar, Yamama Bdaiwi, Abdulrahman Masrani, Heba Abolaban, Fares Alahdab, Belal Firwana, Ahmad Al-Moujahed
July-September 2017, 7(3):103-109
DOI:10.4103/ajm.AJM_204_16  PMID:28791242
Purpose: A group of Arab-American physicians and researchers in the United States organized a blended online course in academic writing and publishing in medicine targeting medical students and physicians in war-torn Syria. This was an effort to address one of the reasons behind the poor quantity and quality of scientific research papers in Syria and the Arab region. In this paper, we report on the design, conduct, and outcome of this course and attempt to evaluate its effectiveness. Methods: The educational intervention was a 2-month blended online course. We administered a questionnaire to assess satisfaction and self-reported improvement in knowledge, confidence, and skills of academic writing and publishing. Results: The course succeeded in reaching more than 2588 physicians and medical students from the region; 159 of them completed most of the course. Eighty-three percent of the participants felt that they were confident enough to write an academic paper after the course and 95% felt the learning objectives were achieved with an average student satisfaction of 8.4 out of 10. Conclusion: Physicians in Syria and neighboring countries are in need of training to become an active part of the global scientific community and to document and communicate the crisis their countries are going through from a medical perspective. Low-cost online educational initiatives help respond, at least partially, to those needs.
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An overview of the health status of Syrian refugee children in a tertiary hospital in Turkey
Ibrahim Hakan Bucak, Habip Almis, Samet Benli, Mehmet Turgut
July-September 2017, 7(3):110-114
DOI:10.4103/ajm.AJM_17_17  PMID:28791243
Objective: Migration is a problem affecting all family members, but particularly children. Child refugees are the highest risk group for the health systems of receiving countries. We investigated the health of 104 Syrian child refugees presenting to a tertiary hospital in Turkey. Settings and Design: A retrospective study was conducted in the pediatric clinic. Materials and Methods: The medical files of Syrian refugee children (0–18 years) presenting to Adiyaman University Hospital, Pediatric Clinic between 01 and 30 November 2015, were investigated. Demographic data, body measurements, and laboratory results obtained from patients' medical records were evaluated. Results: Mean age of patients was 53.5 ± 49.6 (2–198) months; 63 were male and 41 were female. Seventy-two patients (69.2%) were under 5 years of age. Weight in 20 patients (19.2%), height in 33 (31.7%), head circumference in 2 (1.9%), and body mass index in 7 (6.7%) were below the third percentile. All patients with body weight below the third percentile had chronic malnutrition. Anemia was present in 35 (50%) of the 70 patients for whom complete blood count data were available. Conclusion: Health workers involved with Syrian refugee children must consider the two preventable conditions; malnutrition and anemia.
  - 2,689 268
REVIEW ARTICLES
Muslim patients in Ramadan: A review for primary care physicians
Heba Abolaban, Ahmad Al-Moujahed
July-September 2017, 7(3):81-87
DOI:10.4103/ajm.AJM_76_17  PMID:28791239
Fasting Ramadan, in which Muslims abstain from specific habits and behaviors from dawn to sunset, is one of the five Pillars of Islam. While there are several exemptions from fasting, many Muslim patients with acute or chronic medical conditions still choose to fast, which may adversely affect their health if not addressed properly. Some patients may not be well educated about the effects of some medical treatments and procedures on the validity of their fast, which can unnecessarily lead to suboptimal management of their conditions or treatment nonadherence. Since spirituality, religiosity, and personal beliefs affect patients' health behaviors and adherence to treatments, health-care providers need to learn how fasting Ramadan can affect the health of their Muslim patients, especially those with chronic medical conditions, and how to help them achieve safe fasting. This article aims to provide an overview of the main topics that primary care physicians may need to know in order to improve their cultural competence when caring for their fasting Muslim patients.
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Critical arrhythmia in postoperative cardiac children: Recognition and management
Mohamed Salim Kabbani, Hayan Al Taweel, Nasib Kabbani, Saleh Al Ghamdi
July-September 2017, 7(3):88-95
DOI:10.4103/ajm.AJM_14_17  PMID:28791240
Arrhythmias after pediatric cardiac surgery are common and can be life-threatening. They occur intraoperatively or may appear shortly after surgery during postoperative care. They require early management and specific intervention. In this review, we describe important critical arrhythmias that are encountered during postoperative management of children undergoing cardiac surgery. We review the diagnosis, management, and explain the role of epicardial electrocardiogram in diagnosing certain types of postoperative rhythm abnormalities seen during early period after pediatric cardiac surgery.
  - 3,969 603
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