New Emirates Medical Journal - Volume 5, Issue 1, 2024

Depression is on a steady rise across the United Arab Emirates (UAE), causing much socio-economic burden to the country. Identifying patient journey gaps for depression, beginning with awareness and screening, diagnosis, and treatment to sustained remission and rehabilitation, can help design health policies with actionable solutions, mitigating the burden of the disease.

Studies in the English language between 2010 and 2021 were shortlisted using a structured search in electronic databases followed by an unstructured search using government websites and Google Scholar and anecdotal data from local professional experts. Synthesized data was subjected to weighted mean calculation, and an evidence gap map was charted.

Varying prevalence of depression (5.1%-82.2%) was reported across different settings and population sample sizes in the UAE. One study reported that 13.0% of the UAE population was aware of their depressive condition. Screening rates of depression were reported to be relatively high (34.2%-90.5%), while depression was diagnosed in 0.5%-48.5% of patients. The treatment rate was 36.1%, while adherence rates were estimated to be low at 0.3%. No evidence of control or remission of depression could be gathered.

The reviewed studies used only the Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria for diagnosing depression. The review also lacked large-scale research studies that may have limited the actual representation of the prevalence of depression across the country.

Addressing the gaps identified through evidence mapping methodology can shape a ‘model of care’ for depression. This model should aim to harmonize collaborations among the mental health stakeholders and advocate for the social reintegration of patients.

Estimate the proportion and outcomes of blood transfusion in iron deficiency anemia in a specialist maternal hospital in Dubai, United Arab Emirates (UAE).

In a cross-sectional study, data were collected from 177 pregnant inpatients and delivered outpatients with haemoglobin less than 12g/dL at the hospital in Dubai (UAE) between the 1st of February 2018 to 31st of January 2019. Sociodemographic factors were age, parity (number of birth to a live neonate or gestational age more than 24 weeks), and ethnicity. The outcome variable is blood transfusion. Different variables such as age, parity, nationality, gestational age at diagnosis, most severe haemoglobin reading, serum ferritin, haemoglobin electrophoresis, treatment, gestational age at delivery, mode of delivery, postpartum haemorrhage, neonatal birthweight, neonatal haemoglobin were tested using frequencies and means (standard deviation), chi-square and sample T-test was used.

One hundred and seventy-seven ladies had anemia, and one hundred and twenty-two (68%) had iron deficiency anemia (ferritin<30ng/dL). 52.5% (N=93) had moderate to severe anemia, and only 7.3% (N=13) received a blood transfusion. Anaemia was mostly diagnosed in the first trimester (40.7%; N=72) and second trimester (38.4%; N=68). 11 (6.2%) ladies had hemoglobinopathies such as beta-thalassemia, 138 (78%) ladies didn’t have hemoglobin electrophoresis reading. 37.9% (N=67) of vaginally delivered ladies and 4.5% (N=8) of cesarean section-delivered ladies had a postpartum hemorrhage. The majority of anemic antenatal and postnatal were Emiratis (74.6%; N=132), and a greater number fell in the middle age group between 30-39 (58.2%; N=103). The larger part had normal neonatal birthweight (76.8%; N=136) and only had a low neonatal birthweight (18.1%; N=32). 105 (59.3%) of neonates had abnormal hemoglobin readings.

This is the first study in the UAE that assess both maternal and fetal outcome due to iron deficiency anemia in pregnant ladies. The prevalence of blood transfusion increased as iron deficiency anaemia was more severe. We endorse health practitioners to regularly measure serum haemoglobin, to treat anaemia early in pregnancy to avoid the need for blood transfusion.

Phlebitis is still a common complication of peripheral venous catheters. Finding a suitable solution to prevent and reduce the incidence of this complication continues to be a challenge. Various strategies were used to reduce the incidence of phlebitis. Mostly non-pharmacological measures were taken as first preference. Intially, when patients come to any hospital for their treatment, the first is the peripherally inserted venous catheter access conducted inpatient for medication administration, fluid administration and blood transfusion in both the hospital setting and ambulatory setting. About 70% of the patients admitted to the hospital requires peripherally inserted venous catheters (PIVCs). The incidence of phlebitis is higher in patients who undergo continuous intravenous therapy.

To find out the effect of hand grip exercise in the sustaining patency of peripherally inserted venous catheters among patients in continuous intravenous therapy.

During the 8 weeks the hand grip exercise was evaluated in patients, who had undergone continuous intravenous infusion through the peripherally inserted venous catheter for at least 3 days. The measurement of data is based on the patient’s socio-demographic Performa, patency checklist, visual infusion phlebitis score and visual analogue scale. The post-test was conducted in both experimental and control groups.

Till the end of the study, 76 participants were taken. On day 3 of the hand grip exercise maximum of 24 (61.5%) PIVC were patent, whereas in control group 5 (13.5%) PIVC were able to maintain their patency. On day 5 of exercise 34 (91.9%) PIVC were replaced with a cause of phlebitis 33(89.2%) in the control group in comparison with the experimental group only 22 (56.4%) lines were replaced with the same cause of phlebitis 24 (61.5%).

Hand grip exercise is important for clients, to reduce the need for the potentially painful process of placing vascular lines and also helps to control costs by reducing the number of devices used for each client and the development of phlebitis.

Dysmenorrhea is painful menstruation and is the most common menstrual symptom affecting adolescents. Evidence suggests that worldwide prevalence can be high and can significantly affect academic performance through its impact on activity, absenteeism, and other aspects of learning.

This is a cross-sectional survey using a pre-validated questionnaire incorporating demography, menstrual history, severity, and effects on academic performance. Female students selected by non-probability sampling of Ras al Khaimah Medical and Health Sciences University were included (calculated sample size=249).

A total of 252 students participated (mean age 20.14 years). The prevalence of dysmenorrhea was 80.5%. Pain was severe for 25.1% (≥7/10 score),14.7% reported severely restricted daily activity, 66% received regular treatment, and 24(11.8%) required hospitalization during the last year due to pain. More than 50% of students missed academic sessions, 68% had trouble concentrating, 70. 4% were unable to study. 59% had an inability to complete assignments, 58% had trouble concentrating during examinations, and 8.8% missed assessments due to dysmenorrhea. The majority missed 1-2 days each month. Dysmenorrhea was a significant predictor of academic domains (AD) like reduced concentration, inability to complete assignments, missing lectures, and assessments [adjusted OR-2.25, 5.57, 4.32, 3.96] with p less than .05 in each. Moderate to severe pain was an independent predictor of all AD compared to mild pain (score less than 3) (p=.026). Moderate to severe dysmenorrhea had a significant negative impact on academic performance (p=.02).

Dysmenorrhea is a prevalent health problem among university students and has a significant negative impact on education.

Thyroid hormones play a crucial role in erythropoiesis, both directly and indirectly, with reduced secretion potentially causing anaemia—a commonly overlooked symptom of hypothyroidism. By compiling existing data, discussing recent advancements, identifying root causes, and proposing potential treatment options, this work acknowledges the complexity of the issue and aims to serve as a foundational reference for those in the early stages of research or clinical practice.

To comprehend the concept of this disease condition, a number of medical textbooks were consulted. Various search engines, such as PubMed, Google Scholar, Research Gate, Science Direct, Scopus, etc., were cited to explore the recent advancements and obtain data on the topic in question. Later, all the information and data gathered were organised into a review article.

Anemia, often referred to as the “haematological mask” of hypothyroidism, can manifest even before hypothyroidism is clinically diagnosed. Hypothyroidism must be considered as a potential cause when confronted with refractory anemia, as its treatment is pivotal for achieving comprehensive and lasting improvements in haematological parameters.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that is gradually gaining popularity. However, there is minimal scientific research exploring the clinical presentation of this highly complex disorder and the general understanding of such varying presentations by general practitioners and pediatric physicians.

This study aims to explore the patterns of referral of patients with ASD to a tertiary hospital in Dubai, United Arab Emirates, and to understand better and analyze the general knowledge of referring physicians through their impression of the patient’s clinical presentation.

This is a retrospective descriptive study where all the data were collected electronically from past medical records and referral documents taken from Al Jalila Children's Specialty Hospital (AJCH). Patients who were referred were later assessed by the neurodevelopmental specialists using the NICE Guidelines. The data were analyzed statistically and described using different statistical tools. These results were then considered in light of the local clinician's needs for diagnostic support and the possibility of developing a national screening program for ASD.

Within a sample of 90 referrals, 69 (76.7%) were predominantly male, 73 (81.1%) were Emirati nationals, and the majority fell within the age group of 0 to 5 years old. Of the 90 referred patients, 53 (58.9%) were diagnosed with ASD by neurodevelopmental specialists using the NICE Guidelines. Physicians were keen on picking up features of speech and language deficits, hyperactivity, and inappropriate or atypical behavior. However, they seemed hesitant and required further assessment when interpreting and reporting features revolving around social communicative skills, interaction and rapport, and evaluating patients’ ideas and imagination.

Physicians practicing in the United Arab Emirates (UAE) are advised to assess the full range of clinical symptoms of ASD according to their respective categories as listed in the National Institute for Health and Care Excellence (NICE) guidelines. Furthermore, the Dubai Health Authority (DHA) has published the first edition document titled “Dubai Clinical Practice Guidelines for Autism Spectrum Disorder (ASD) in Children and Adolescents,” designed to align physician recognition and practice with the government's objectives toward all individuals with ASD. Their achievement aligns with the goals of our study as it will make the clinical recognition of ASD clinically more sound and prevent misdiagnosis. Finally, the authors hope that this study aids in developing a national screening program dedicated to general practitioners and pediatric physicians in providing a structured assessment for ASD, which in return will result in early intervention by neurodevelopmental specialists for further diagnosis and management, ultimately improving the quality of life of the patients and their families.

Adsorption and mixed agglutination reactions detect A, B, and H blood group antigens in the cells.

The study aimed to investigate the adsorbing abilities of group-specific polyclonal antibodies using erythrocytes and leukocytes to improve the quality of blood typing.

The adsorption was performed with group B erythrocytes and leukocytes using the usual heated citrated anti-B plasma at 4°C and 37°C. A mixed agglutination reaction revealed group B antigens on leukocytes and erythrocytes.

The highest adsorption of antibodies from usual plasma on erythrocytes was observed at 4°C at physiological conditions. Weaker adsorption was determined at pH 8.0 compared to pH 6.0 (the decrease of agglutination strength from 3+ to 2+ and 1+ accordingly).

The adsorption of polyclonal antibodies on erythrocytes at 37°C was the highest at pH 6.0 and 8.0 compared to physiological conditions (the decrease of agglutination strength from 3+ to 1+). In contrast, adsorption at 4°C appeared to be stronger at pH 6.0.

The adsorption of IgG antibodies on erythrocytes at 37°C was higher at pH 8.0.

Complete adsorption of IgG antibodies was observed on group B erythrocytes and leukocytes at 37°C and 4°C.

Adsorption of polyclonal group-specific antibodies on erythrocytes was the highest at 4°C, and adsorption of IgG antibodies was strong at 4°C and 37°C. Adsorption of leukocytes was revealed only with the use of the heated serum. IgG group-specific antibodies from the heated plasma demonstrated higher adsorbing abilities on leukocytes than IgM antibodies from plasma.

Despite the available clinical practice guidelines, many management decisions in bronchiolitis are made subjectively, resulting in variable length of stay and unplanned ICU admissions. We hypothesized that certain independent predictors would affect the length of stay (LOS) and care escalation.

To identify predictors for increased LOS and ICU admissions in acute bronchiolitis.

We conducted a retrospective descriptive cohort study involving 589 children admitted to MZH with acute bronchiolitis in 2 years. Predictors evaluated were age, gender, family history of asthma, prematurity, fever, hypoxemia, comorbidities, RSV, and medications (salbutamol, steroids, and antibiotics).

Acute bronchiolitis comprised 18.61% of Pediatric admissions and 6.2% of total hospital admissions. The mean age is 8.28±6.1(2-36 months); 83% were infants, 39.2% were girls, 15% were preterm, and 25.1% had a family history of asthma. Despite 84.2% having X-rays, significant findings were present in 21.3%. RSV positive 26.3%. The mean LOS was 3.6±1.6 (2-11 days).

Age less than 2 months(P=0.029 OR=1.8, CI1.1 - 3.3), family history of asthma (P=0.03 OR=1.8, CI1.14 - 2.9), hypoxemia on admission (P<0.001 OR=3, CI1.8 - 4.9), presence of comorbidity (P=0.012), and significant radiographic findings (P<0.002, OR=2.7, CI1.6 - 4.6) were predictors of longer LOS. Prematurity (P<0.001, OR 8.8, CI 2.7-28.4), RSV bronchiolitis (P<0.002, OR=3.02, CI=1.5 – 6.03), and hypoxemia on admission (P< 0.042 OR=4.6, CI1.1 - 14.9) qualified as independent predictors for escalated care.

RSV bronchiolitis, especially in preterm infants, may prompt a low threshold for admission and escalating the care. Evidence-based treatments, early respiratory support, and treatment of comorbidities help to achieve the optimal LOS.

The objectives of the study were to assess the prevalence of moderate to severe depressive symptoms among adults aged 18 years or older, assess the relationship between the severity of depression and selected socio-demographic, psycho-social, lifestyle, and health-related factors, and identify the determinants of moderate-to-severe depressive symptoms in the adult population of 18 years and older in the United Arab Emirates (UAE).

This was a cross-sectional study conducted in the United Arab Emirates that targeted residents above 18 years of age. A research questionnaire was developed and approved by three specialists in the field, along with the Patient Health Questionnaire-9 (PHQ9). The Chi-square test was used to assess the association between variables, and multiple logistic regression analysis was used to find the predictive risk factors for moderate to severe depressive symptoms.

The study encompassed a group of 562 participants, achieving a response rate of 97.33%. Initially, a Google Form was distributed electronically to the entire participant pool; however, 15 individuals declined to participate, resulting in a final sample size of 547 (n). Amongst the variables that showed significant prevalence of moderate to severe depressive symptoms were age (P <0.001), sex (P <0.001), marital status (P <0.001), occupation classification (P <0.001), religiosity (P <0.001), education level (P <0.001), job stress (P <0.001), domicile and residence (P <0.001), responsibility towards family (P <0.001), post-traumatic stress disorder (PTSD) (P <0.001), consumption of alcohol (P <0.001), coronavirus disease pandemic (P <0.001), employment status (P = 0.002), family size (P = 0.001), and smoking (P = 0.004). Amongst the variables, the sub-groups that showed significant predictive factors of moderate to severe depressive symptoms were the ages between 18 and 25 years old (P = 0.01), the female gender (P <0.001), and low levels of religiosity (P <0.001).

The prevalence of moderate-to-severe depressive symptoms was 48% (n=260). In our study on the prevalence of depression, we have investigated several predictive factors, including age, gender, religiosity, and a history of prior depression diagnosis. While numerous factors contribute to depression, additional research is imperative to identify and validate additional predictive factors.

Ossification of the posterior longitudinal ligament (OPLL) constitutes a significant etiology of cervical myelopathy. The most common clinical presentations are myelopathy and radiculopathy, which result from a decrease in the spinal canal's volume and the spinal cord's subsequent compression by the ossified posterior longitudinal ligament. This results in motor and sensory deficits, especially in the extremities.

A 48-year-old male presented with a complaint of neck pain that radiated to both upper limbs and was associated with numbness, tingling, and paranesthesia. He also had a history of lower back pain that radiated to the right leg, which was also associated with numbness and limited mobility to his cervical spine. Lhermitte's sign was positive. Sensory deficit to pinprick and touch was noted in the right upper limb and lower limbs. Flexion deformities of the right hand and elbow extension fingers were noted. Neuroimaging of the cervical spine showed cervical canal stenosis, OPLL, and myelopathy. Surgical management included internal fixation using plates and transpedicular screws, lateral mass fixation, and laminectomy of the third to sixth cervical vertebrae (C3-C6).

OPLL should be considered an integral component of the differential diagnosis when evaluating a patient with neck pain and consequent motor and sensory deficits of the extremities. OPLL with mild and/or non-progressive symptoms can be addressed with non-operative measures. Assessing preoperative neuroimaging is crucial before surgery to determine the degree of spinal cord compression and the presence of OPLL in all patients with cervical myelopathy. Surgical treatment options for posterior longitudinal ligament calcification include laminectomy and fusion, anterior decompression including transpedicular and costo-transversectomy, laminoplasty, and circumferential decompression via staged posterior and anterior approaches. Determining the most effective surgical approach for managing OPLL is still controversial, and selecting the appropriate procedure should be based on the patient's clinical presentation and level of pathological involvement.

The study of Crimean-Congo hemorrhagic fever (CCHF) worldwide is of low rate as it is an uncommon disease. The outbreak in Iraq in 2022 is high.

To study the prognosis of hemorrhagic fever patients in Thi-Qar governorate, where the highest rate of the disease is, so that we might expect the fat of the disease.

Patients and Methods: A descriptive cases series of cross-section studies that included all patients with severe or life-threatening Crimean-Congo hemorrhagic fever(CCHF) PCR-positive cases (out of the total 100) admitted and followed up in AL-Hussain Teaching Hospital in 2022. To study patients' features that indicate the prognostic factors of the disease.

All cases proved to be CCHF by PCR were 100 patients of variable severity, 14 cases were admitted to intensive care units (ICU), 13 patients died, 2 pregnant ladies were infected with CCHF unfortunately died, 16 children admitted to hospital 2 of them died and 14 cases completely cured. The most serious cases are intrapulmonary hemorrhage and neuropsychiatric presentation.

There are many clinical and laboratory prognostic markers. The riskiest clinical bad prognostic factor is the neuropsychiatric and pulmonary hemorrhage and CCHF in pregnant ladies.

Dispensing practice is the fundamental component of the rational use of drugs. Inappropriate dispensing of drugs can lead to Adverse drug reaction (ADR), Drug interaction (DI), therapeutic failure, and increased cost of treatment. In case of antibiotic misuse, it can lead to developing an extra burden of antibiotic resistance.

The objective of this study was to determine the antibiotic dispensing practice and the impact of intervention among medicine retailers of Butwal and Bhairahawa cities of Nepal.

An interventional simulated patients survey study was conducted in two cities of Nepal from 2016-2018. A scenario of fictitious cases of common cold and running nose was simulated by two trained pharmacists in two different sites. Prior to the survey, the researcher visited selected retailers to obtain consent and demography details. About two weeks after obtaining consent, simulated patients visited the retailers. The information given by the community pharmacist was memorized and recorded in data collection form after leaving the community pharmacy. The intervention study was carried out 30 days after the simulated study survey. The educational intervention was given to the test group i.e. the community medicine retailer of Butwal. The researchers also provided a booklet to the test groups. Post-intervention simulated patient survey was conducted after 3 days of the training period. Data were entered into Microsoft Excel and SPSS for analysis.

All together 64 community pharmacies were included in this study involving 32 medicine retailers from each city of Butwal and Bhairahawa. The total drugs dispensed by medicine retailers were 146 and 127 drugs in Butwal and Bhairahawa, respectively in the before-intervention studies. Similarly, about 122 and 152 drugs were dispensed by medicine retailers in Butwal and Bhairahawa after intervention studies. The average numbers of medicines dispensed by medicine retailers were 4.56±1.66 and 3.96±1.92 before intervention in the Butwal and Bhairahawa study sites. The average numbers of medicines dispensed by medicine retailers were 3.78±1.06 and 4.78±1.73 after intervention in the study sites of Butwal and Bhairahawa. None of the medicine retailers talked about either the brand or generic name and strength of antibiotic medicine to the simulated patient before and after intervention in both study sites. Similarly, medicine retailers informed about the frequency of dosage of antibiotic medicine to simulated patients before and after interventions in Butwal and Bhairahawa cities. However, there was no statistical significance (P=0.388) observed in Butwal City, whereas in Bhairahawa City, statistical significance (P=0.006) was observed.

Antibiotic dispensing without a prescription is routine. Insufficient medicine information was given to the simulated patient by the medicine retailer. Hence, we suggest meaningful implementation of policy and regular inspection to improve the situation.

The efficacy of immunization is contingent upon public acceptance. Using the behavioral theory of the Health Belief Model (HBM), this study seeks to determine intervention strategies against the most influential factor towards the acceptance of the COVID-19 vaccination program among the societies of Singkawang City.

This investigation involved a cross-sectional design. The perceived severity, susceptibility, barriers, benefits, cues to action, and self-efficacy were the independent variables. The dependent variable was the adoption of the COVID-19 vaccine by the public. Mann-Whitney, Chi-square and Multivariate tests were used to present vaccine acceptance differences, relationships and impacts of each variable towards COVID-19 vaccine acceptance.

There was a total of 461 participants in this study. For the majority of respondents (56.40%), COVID-19 vaccine acceptance among them remains modest. The difference between the low and high vaccination acceptance groups (p-value < 0.05) was revealed. Except for perceived severity, this study demonstrated that all HBM constructs had a significant relationship with vaccination acceptance (p-value < 0.05). In addition, the results of the logistic regression test indicated that the cues-to-action construct was the most influential factor in vaccine acceptance (OR= 7.156; CI, 95%= 4.107 – 12.469), followed by self-efficacy (OR=3.218; CI, 95%=1.819 – 5.694).

Thus, health policymakers should focus on cues-to-action and self-efficacy factors for developing a strategy to increase vaccine acceptance among the Indonesian population by using current study results among the Singkawang population as a model to start the persuasion techniques.

Plastics have become an inevitable part of life. Healthcare workers play an ineluctable role in creating enduring solutions to plastic pollution and mitigating the impact of plastic pollution on human health and well-being.

The aim of this study was to explore the pattern of plastic consumption and the perception of the bioecological and health impact of plastic pollution among undergraduate nursing students.

A quantitative, cross-sectional survey was undertaken among 200 undergraduate nursing students recruited through a convenience sampling technique. Data were collected using a self-developed structured questionnaire and analysed using SPSS version 26. A p-value of less than 0.05 was taken as statistically significant.

The mean age of the students was found to be 20.12± 6 years. Though more than half (65.7%) of them reported using plastic products daily, 63.3% of the students reported willingness to reduce the use of plastic products. Bottled water (72.4%), followed by bags (62.4%) were the most frequent modality of plastic used. Only 47.6% of them were aware of the difference between 100% biodegradable versus recyclable plastics. The perceived impact of plastic pollution on bio-ecological environments and human health was found to be low among most (66.7% and 43.7% respectively) of the students.

Awareness regarding the direct and indirect hazards of plastic pollution and available sustainable alternatives to plastic needs to be strengthened among the study population.

Stress occurs when people are faced with challenges and feel overwhelmed. Too much stress can cause negative effects on the body. Medical students especially feel a lot of stress due to their curriculum, which affects their eating habits and, in turn, their academic performance.

This study aimed to assess the effects of academic-related and teaching and learning-related stressors on the pattern of eating habits.

A cross-sectional study was carried out among students of private medical universities in UAE. MBBS and BDS students of and above the age of eighteen were included. A standardized questionnaire (Medical Student Stressor Questionnaire) was used to collect data. SPSS version 28 was used to analyze the data.

We identified two main types of stressors: Academic Related Stressors (ARS) and Teaching and Learning Related Stressors (TLRS), resulting in high levels of stress causing them to eat more than usual or less than usual. Most students (82.6%) who ate less or much less than usual had experienced high or severe stress due to academic-related stressors of ‘strenuous task’ (P=0.007). Moreover, 81.5% of students who ate more than usual had experienced high or severe stress when they were nervous and stressed (P=0.004). When feeling “difficulties pile up” and during times when students “lacked confidence” due to teaching-related stressors, 71.7% and 66.3% of the participants experienced mild/moderate stress, respectively and ate less or much less than usual (P<0.05).

We were able to determine the effect of academic-related stressors (ARS) and teaching and learning-related stressors (TLRS) on eating habits. This has led us to discover the importance of well-developed and improved intervention programs by universities to reduce stress and promote healthy eating habits among medical students.

The incidence of renal neoplasms has been increasing globally. Immunohistochemistry aids in differentiating the subtypes of Renal Cell Carcinoma (RCC).

This study aimed to describe the demography of renal cancer in the Kingdom of Bahrain, comparing it to other regions worldwide, emphasizing the most common type of renal cancer, clinical presentation, and immunohistochemistry.

This retrospective chart review comprises 74 Bahraini patients diagnosed with Renal neoplasms (from 2009-2019) at the Bahrain Defense Force (BDF) Hospital in the Kingdom of Bahrain. Variables collected include demographics, clinical presentation from patients’ electronic records and pathology registry, surgical management, immunohistochemistry, pathological staging, grading, and prognosis. IBM SPSS Statistics, version 28.0.0.0, was used.

About 71 patients’ characteristics were analyzed; 63 had malignant neoplasms, and 8 had benign neoplasms. The mean age of patients with a malignant renal neoplasm was 56.38 (± 12.643). The most common presentation was an incidental finding (60.6% of lesions being right-sided). Clear Cell RCC was the most common malignant lesion (77.1%), and the most common stage was stage 1 (69.8%). CD10 and vimentin were 100% sensitive for Clear Cell RCC. No significant association was found between diabetes and a higher Fuhrman grade (3 or 4) (P = 0.066).

From 2009 to 2019, renal neoplasms incidence increased. The most common malignant neoplasm was clear cell RCC and among benign tumours was oncocytoma. Immunohistochemistry plays an important role in subtype determination. One recommendation would be to assess the incidence of renal neoplasms in other hospitals in Bahrain to establish more epidemiological data and compare our results with other Gulf hospitals.

Assessment of thyroid dysfunction among relatives of patients diagnosed with Hashimoto’s thyroiditis is controversial due to the lack of evidence.

Screening and prediction of thyroid dysfunction among first- and second-degree relatives (FDRs and SDRs) of patients who were previously diagnosed with Hashimoto’s thyroiditis.

Three hundred and forty-six asymptomatic relatives of 97 patients diagnosed with Hashimoto’s thyroiditis were enrolled in mixed cross-sectional and prospective assessments for thyroid dysfunction over more than two years (September 2018-December 2020).

Both FDR and SDR were evaluated by thyrotropin (TSH) and thyroid ultrasound at enrollment. Individuals with abnormal TSH were thoroughly evaluated biochemically and were subsequently classified as euthyroid, subclinical, and overt thyroid dysfunction. The future reversion of enrolled individuals with normal and subclinical thyroid function to overt dysfunction was predicted by using the Thyroid Event Amsterdam (THEA) score.

Three-quarters of the participants were non-smoking married women. Thyroid dysfunction was diagnosed among 43% of the participants (n=150), of whom two-thirds (74%) were having overt dysfunction (n=111). Neither the demographic elements nor the initial thyroid function could predict the future thyroid function among those participants. Two out of ten (16%) were having autoimmune thyroid disease (AITD) as part of familial clustering (n=56). Four participants with subclinical hypothyroidism were treated accordingly due to their high THEA score despite the global lower THEA score (5.00±0.44).

Screening of asymptomatic relatives of patients diagnosed with Hashimoto's thyroiditis could help identify the familial background of thyroid diseases in 43% of FDRs and SDRs. One-third may have an underlying autoimmune basis.

Autism Spectrum Disorder (ASD) is a complex and heterogeneous neurodevelopmental disorder that is associated with functional impairments across an individual’s lifespan. The complexity and increasing global prevalence of ASD pose significant strains on healthcare systems. Early Intensive Behavioral Interventions (EIBI) are cost-effective evidence-based interventions that improve outcomes for individuals with ASD, especially when implemented in early childhood.

This study reviews the disease burden of ASD and analyzes four potential financing models for EIBI in Dubai.

A rapid literature review was conducted to synthesize the disease burden of ASD and EIBI services in Dubai. Bardach’s eightfold model for policy analysis was used to analyze four policy options for EIBI in Dubai: (1) Government financing and provision of EIBI through specialized centers, (2) Government financing of EIBI through contracting private providers, (3) Mandating insurance coverage of EIBI for children with ASD, and, lastly, (4) A mixed model that includes both mandating insurance coverage for EIBI and government provision through non-profit organizations.

EIBI services were available in Dubai but were associated with a substantial out-of-pocket (OOP) burden on families. Many young children with ASD were unable to access EIBI. Option (4) of using the mixed financing model of EIBI was optimal in the context of Dubai, based on evaluation criteria, including accessibility, cost-effectiveness, quality, and implementability, with minimal OOP burden on families.

To ease the burden on families with children suffering from ASD, the stakeholders, including the government of Dubai, should consider a mixed financial model to provide EIBI.

Operative hysteroscopy is a surgical technique for various procedures of the uterus, for example, hysteroscopic myomectomy. This has been an effective alternative to conventional hysterectomy and has produced better surgical outcomes in terms of faster recovery, less post-operative pain and better patient satisfaction.

A 49-year-old female was presented to the PAC clinic for hysteroscopic myomectomy for her dysfunctional uterine bleeding. There was no medical history of any previous medical or surgical problems. Her physical examination and routine labs did not reveal any abnormalities. She was labeled an ASA class 1 patient. Hysteroscopic myomectomy under spinal anesthesia was approved by the patient. On the day of the surgery, the patient was presented to the preoperative patient holding and was calm and comfortable. Vital parameters recorded were under normal limits. 20 G intravenous cannula was taken on her left dorsum of the wrist, and she was wheeled to the operating room. She was connected to ASA standard monitors, and her blood pressure, pulse rate, and spo2 were recorded. Spinal anesthesia was performed in a sitting position with a 27 G pencil point needle in a single attempt, and the procedure was regular. The level of anesthesia was ascertained to be till T6, and the patient was handed over to the surgical team. Surgery was started in a low lithotomy position. 65 minutes into the surgery, the patient started to complain of intra-abdominal pain, difficulty breathing, and started being restless. Blood pressure was 133/83mmhg, and SpO2 dropped from 98% to 86%. Her pulse rate was 112 beats per minute.

The patient’s abdomen was examined by moving the operative drapes, and gross abdominal distention was noted. Lung auscultation revealed crepitations on the basal lobes. Immediately, distention syndrome was suspected.

The studies of agglutinating and adsorbing abilities of IgM and IgG antibodies towards the red blood cells (RBCs) and tissue cells are scarce.

The study aimed to estimate the differences in the avidity of blood group-specific IgM and IgG antibodies to RBCs and epithelial cells.

The reaction of hemagglutination, adsorption, mixed agglutination reaction and saliva inhibition test were used. Anti-B 2-54 monoclonal antibody, polyclonal citrated plasma and the heated plasma were used for investigation of IgM and IgG antibodies.

IgM antibodies showed high adsorbing ability to RBCs and epithelial cells in an alkaline medium.

On the contrary, the heated plasma containing IgG antibodies showed high adsorbing ability to RBCs and epithelial cells in the acid medium as compared to the alkaline medium. Complete adsorption of IgG antibodies was observed by epithelial cells as compared to erythrocytes.

A mixed agglutination reaction confirmed the strong binding of anti-B IgG antibodies with group B epithelial cells in an acid medium.

The binding of polyclonal IgM and IgG group-specific antibodies with red blood cells and epithelial cells depends on the opposite values of pH of the medium. IgG antibodies completely adsorb on epithelial cells contrary to IgM antibodies.

Blood group-specific IgG antibodies showed high avidity to epithelial cells as compared to red blood cells. IgG antibodies demonstrated high agglutinating ability in alkaline medium and strong adsorbing ability in acid medium contrary to IgM antibodies, demonstrating high adsorption properties in alkaline medium.

Studies conducted worldwide have found that medical students have higher levels of stress than students in other fields. Chronic stress can result in increased rates of fatigue, depression, and impairment in function. Although this phenomenon has been studied globally, there has been limited attention in our region. Therefore, the purpose of this study is to assess stress levels in medical students in Dubai and evaluate their coping strategies to highlight the importance of shedding light on the psychological well-being of this population.

A cross-sectional design was utilized for this study. The target population consisted of all medical students enrolled at a local university for the 2020-2021 academic year. The participants completed a survey that collected information on stress and coping strategies. The Perceived Stress Scale (PSS-10) and the Brief COPE inventory were utilized to gather the data.

The total of 97 individuals completed the study questionnaire. The rates of high stress levels according to the Perceived Stress Scale (PSS-10) were higher among medical students in the first to the third year (43.6%), when compared to medical students in the fourth and fifth years (7.7%). Results of the Brief COPE inventory indicated that the average score for a Problem Focused coping style among medical students fell in the medium to high range (22 out of 32).

Levels of stress are elevated among medical students. Coping responses reflect the individual’s psychological adjustment and well-being. Our study sample revealed a medium to high rate of engagement in healthy coping strategies. Future research that evaluates the psychological impact of stress in-depth and explores effective strategies to enhance coping is highly warranted.

Tertiary hyperparathyroidism (THPT) is a well-known complication of end-stage kidney disease (ESKD), resulting from a loss of functional renal tissue with subsequent alterations in calcium and phosphate metabolism. Tertiary hyperparathyroidism reflects severe parathyroid hyperplasia with autonomous excessive secretion of parathyroid hormone (PTH) that is no longer responsive to the concentration of plasma calcium and leads to abnormal bone remodelling, soft tissue calcifications, vasculopathy, and other systemic complications.

The authors, hereby, highlight varied presentations of tertiary hyperparathyroidism (THPT) by presenting 3 interesting cases, describing their clinical course and outcomes. Through sharing these experiences and insights, we hope to contribute to a better understanding of THPT and its optimal management in patients with ESKD.

THPT can have a significant impact on patient health and quality of life. Despite the widespread use of interventions, such as vitamin D analogues, calcimimetics and parathyroidectomy, THPT remains a significant clinical challenge for patients with ESKD.

Chylothorax corresponds to the incidence of chyle in the pleural space; it was described for the first time in 1633. Its most common cause is associated with iatrogenic injuries to the thoracic duct; 80% of them take place during surgeries, such as pneumonectomy or esophagectomy.

A case of an unusual cervical stab wound complication in a 23-year-old man who presented a late large volume chylothorax has been presented and discussed in this paper, as well as its management.

The presented case demonstrates a rare complication after a cervical stab wound. The management of chylothorax can involve non-operative management, non-operative intervention, or operative management depending on the symptoms and duration. Usually, surgical interventions are required after two weeks of clinical treatment. The differential diagnosis in a post-trauma acute onset ventilatory manifestation is mandatory to rule out pulmonary embolism.

Traumatic chylothorax is a rare event; however, its morbidity and mortality rates can be catastrophic when it is not diagnosed early and when the treatment is not established based on a proper flowchart. Thus, dietary and drug-based clinical measures, interventional radiology, videothoracoscopy, and thoracotomy for thoracic duct ligation are valid therapeutic options for the proper management of these cases.

Autoimmune thyroid disease (AITD) is a serious and treatable disease that could be associated with other autoimmune disorders. It is a common cause of hypothyroidism in adult females. The diagnosis is established by detecting serum antithyroid antibodies. The disease slowly progresses, and the treatment includes thyroid hormone replacement in cases of hypothyroidism.

The aim of this study is to investigate the clinical presentation, laboratory findings, and comorbidity factors involved in autoimmune thyroid disease among Emirati citizens in the UAE.

Medical records from Advanced Cure Diagnostic Centers were reviewed in a retrospective study over the period of four years from 2018 to 2022. The patients population included those who attended the Endocrinology Unit and others seen by the rest of the medical staff. Patients were considered to have AITD if they tested positive for thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb), or both. The data collected was evaluated using descriptive analysis to provide a basic summary of the patients sample and dataset. Unpaired t-test was used to compare the mean value of elevated autoantibodies in males and females.

Of the 366 Emirati nationals who were tested for autoimmune thyroiditis, 220 (60%) had an abnormal result for TPOAb and/or TgAb. Among the 220 patients who had an abnormal result for TPOAb and/or TgAb, 188 (85.5%) were females, and 100 patients (45.5%) were in the age group between 31 and 40 years. 42% were in a euthyroid state and 42% presented with hypothyroidism. Only 7% presented with hyperthyroidism, 5% with subclinical hypothyroidism, and 2% with subclinical hyperthyroidism. An analysis of the comorbidity factors revealed 142 (65%) patients with obesity, 82 (37%) with a family history of thyroid disease, 77 (35%) with hyperlipidemia, 14 (6%) with hypertension, and 11 (5%) with diabetes.

This is the first publication intended to address AITD in Emirati citizens. Our findings concur with the international data regarding the prevalence among middle-aged females. Eighty-four percent of the positive patients either presented with no abnormality of their thyroid gland function or with hypothyroidism. With the alarming increase of obesity in the UAE, we found it to be the single most important and preventable comorbidity factor present in 65% of the studied population. This is followed by a family history of first-degree relatives with thyroid disease in 37% of the participants, due to the high rate of consanguineous marriages in the UAE.

In the past several years, acupuncture has been used more often to manage pain, either in conjunction with other therapies or as a complementary treatment. Evidence also points to a rise in physiotherapists’ interest in acupuncture.

The goal of performing a cross-sectional survey was to identify the characteristics of physiotherapists who use acupuncture in their relevant practice and also to explore what views participants had regarding the inclusion of acupuncture in the physiotherapy curriculum.

A quantitative cross-sectional survey methodology was used in the investigation. Through pilot studies and expert input, an online survey was developed and validated. The South African Society of Physiotherapy (SASP), the Physiotherapy Association of South Africa (PASA), and the Emirates Physiotherapy Society (EPS) used email and social media to distribute the questionnaire to physiotherapists in order to gather data. These countries were specifically chosen based on language and researcher familiarity with the organizations. One hundred eighty-one physiotherapists who were members of the appropriate professional associations in South Africa and the United Arab Emirates were included in the study as a convenient sample. Active physiotherapists who have treated patients within the previous six months and consented to take the survey were eligible to participate. The study had no exclusion criteria.

The survey had varied results, although most respondents recognized the value of acupuncture in the practice of physiotherapy. However, the majority of participants did not think that physiotherapy alone is ineffective. Overall, the survey results showed that some respondents preferred postgraduate acupuncture education over including acupuncture in undergraduate education. Notably, despite the majority of physiotherapists having bachelor’s degrees, the survey data showed that many of them possessed practical experience in acupuncture.

Antibody titres against several infections are hypothesized to be protective against COVID-19 due to cross-immunity. The study intends to assess the relationship between historical data of measles, rubella, pertussis antibody titres and the occurrence of self-reported COVID-19.

The study was conducted as an online cross-sectional survey which was compared with historical data of antibody titers. The university female students who had participated in our previous study evaluating seroprevalence of measles, rubella and pertussis antibody titres were contacted online for the survey. The online questionnaire was sent to collect details on COVID-19 occurrence among all the participants. The measles, rubella and pertussis titers of all participants were correlated with the present questionnaire data. All volunteers participated in the survey after online informed consent.

Among the 52 responders to the questionnaire, 18 participants had been reported to be suffering from COVID-related symptoms and 12 were reported to have confirmed RT-PCR positive for COVID-19. The unpaired “t” test comparing antibody titres of measles, rubella and pertussis between COVID-19 RT PCR positive and RT PCR negative subjects did not show statistical significance.

There was no statistical difference between antibody titers of measles, rubella and pertussis among self-reported COVID-19 RT PCR positive and RT PCR negative university female students.

This study aimed to investigate the validity of the mean platelet volume (MPV) alone and MPV combined with the revised Clinical Risk Index for Babies (CRIB II) score to predict neonatal mortality in preterm infants.

This retrospective observational study performed between May 2018 and June 2021 included preterm neonates (gestational age 23–32 weeks) admitted to a tertiary neonatal intensive care unit (NICU) within 12 hours of birth, who were followed up until death or discharge. MPV was recorded at admission and within 72 hours before death or discharge. The CRIB II score variables were assessed within 12 hours of birth, and the area under the receiver operating characteristic curve (AUC) was calculated for the MPV and CRIB II scores to predict neonatal mortality.

We investigated 404 newborns, of whom 28 (6.9%) died. The mean neonatal gestational age was 28.6±2.8 weeks. The MPV was significantly higher in non-survivors than in survivors (p=0.001). The AUC for the MPV and the CRIB II score was 0.68 (95% CI: 0.55–0.80) and 0.85 (95% CI: 0.79–0.91), respectively. The AUC for the MPV combined with the CRIB II score was 0.91 (95% CI 0.87–0.95). The difference in MPV at birth between survivors and non-survivors was statistically non-significant.

MPV was found to be a poorer predictor of neonatal mortality than the CRIB II score; however, MPV combined with the CRIB II score demonstrated significantly improved predictive ability for preterm infant mortality risk.

Pregnancy is rare in women with end-stage renal disease (ESRD). However, this scenario has changed in recent years with considerable improvement and successful outcomes in pregnant women with end-stage renal disease on dialysis. The understanding of the principles related to pregnant dialysis patients, combined with a multidisciplinary approach to case management, has resulted in many success stories, and today, pregnancy for young women with ESRD is more plausible and far safer than ever before.

However, these pregnancies carry a high-risk status for both the mother and fetus, with increased rates of maternal and fetal complications.

We present a series of three women who conceived while on dialysis and delivered successfully. These women were managed with increasing dialysis frequency and developing a clinical protocol early on, with a multidisciplinary approach and close collaboration with obstetricians. Our case series is unique as one of the women had three successful deliveries while on dialysis, and one of them had a positive outcome with twin pregnancies while on dialysis.

Successful outcomes in these high-risk pregnancies while on dialysis suggest that with meticulous care and multidisciplinary approach, conception and successful deliveries are plausible in women who receive dialysis.

Hydralazine has been used in the treatment of hypertension and heart failure for a long time. It has been associated with the development of Vasculitis and Drug induced lupus. This is a male patient in his sixties who was admitted at the hospital and prescribed hydralazine. He developed Hydralazine-induced lupus with Pancytopenia and renal failure. This case report has been written to raise awareness about the hydralazine side effects.

This case report describes a 68-year-old male, transferred to our hospital for rehabilitation. He was tracheostomized. He is hypertensive with a history of CVA. BP was elevated during the admission. He has no family history of immunological diseases or any allergies. 6 months after hydralazine, the patient started to have a purpuric rash over the lower limbs and an elevated renal profile. Only Direct Coomb’s test was positive. He had hematuria and pancytopenia also. He was started on steroids and he became edematous. On March 2021, the hydralazine was stopped and the patient's blood tests improved, the rash disappeared and hematuria stopped. Unfortunately, he got fungemia and septicemia with pneumonia. He became hypotensive and anuric. The patient kept deteriorating and passed away.

Hydralazine is not a first line choice for the treatment of hypertension. Common side effects include tachycardia and headache. It can also cause drug-induced lupus.

Hydralazine has been used in the treatment of hypertension and heart failure for a long time. It has been associated with the development of Vasculitis and Drug induced lupus.

Disseminated intravascular coagulation (DIC) is a known complication of malignancy. Drug-induced DIC is also reported. Sunitinib is a tyrosine kinase inhibitor approved as an oral targeted therapy in the treatment of different cancers. Here we present a case study of disseminated intravascular coagulation following the administration of Sunitinib after COVID-19 infection in a patient diagnosed with metastatic neuroendocrine tumor of the lung.

A 35-year-old male patient with a known metastatic lung neuroendocrine tumor (NET) who was treated with Sunitinib for many years with partial response and tolerating the treatment well-developed recurrent DIC on Sunitinib after COVID-19 infection.

COVID-19 infection is reported to be associated with endothelial injury and inflammation. Vascular endothelial growth factor (VEGF) receptors have a role in the protection and modulation of endothelium. Sunitinib is a multikinase inhibitor with anti- VEGF effect. It is possible that endothelial injury after COVID-19 may have triggered recurrent DIC in this patient who had previously tolerated the same drug without problems.

DIC may be underreported especially with antineoplastics having anti-VEGF effects. Potential risk, interaction, and association with COVID-19 infection in the Era of the pandemic are unclear but warrants further research, and drug-induced DIC should be considered in the differential diagnosis of such cases.

The prevalence of dyslipidemia in the United Arab Emirates (UAE) can be as high as 72.5%. Patients with dyslipidemia usually present with other metabolic risk factors, increasing their risk of acute cardiovascular diseases (CVD). Despite these alarming findings, local data regarding management practices in the UAE are lacking. The current report gathered the perspectives of experts from the UAE regarding the burden and current practices in managing dyslipidemia, as well as the current unmet needs and treatment gaps.

The present perspective is based on a consensus meeting that gathered the insights of six consultant cardiologists. All experts were affiliated with academic institutions representing the UAE's different geographical areas.

Data regarding the prevalence of dyslipidemia in the UAE and its associated ethnic differences are lacking. It is suggested that there needs to be more adherence to international recommendations for screening lipid profiles in primary care centers, which may lead to underestimating the burden of dyslipidemia. As CVD presents at a younger age in the UAE, screening for lipid profile at 35 is recommended, regardless of CVD risk. The panel emphasized that most dyslipidemia patients in the UAE are categorized as high or very high-risk groups for CVD; however, current risk assessment tools have not been validated in the UAE population and may not be tailored to the Middle Eastern and Asian populations. International guidelines have recommended the high-intensity statins-ezetimibe combination for high and very high-risk patients; the experts stated that the high-intensity statins-ezetimibe combination could be initiated in high-risk groups in the UAE. Several barriers to effectively controlling dyslipidemia in the UAE have been identified, including non-adherence, limited awareness about screening and management recommendations, and physician inertia toward achieving the recommended therapeutic goals.

With the digitalization of health care, nurses are required to possess adequate eHealth competence.

This study aimed to explore the perceived confidence in eHealth concepts and willingness for training among nursing students.

A cross-sectional survey was conducted among 572 undergraduate nursing students recruited by convenience sampling technique from two selected nursing colleges in Southern and Northern India. A structured questionnaire was used to collect data. The data was analysed using SPSS. A p-value of less than 0.05 was taken as statistically significant.

A total of 572 students completed the survey. The age of the participants ranged from 18 to 28 years, with a mean of 20.7 (SD 2.0) years. Most of the students (92.5%) used smartphones as their source of internet. More than half (66.1%) of the students were confident in various eHealth concepts. Those who were not confident in a particular eHealth concept were more willing to learn the same concept than those who were confident.

The study recommends preparing future nurses having knowledge of various eHealth concepts using curricular and co-curricular activities to increase their confidence and enable them to work effectively in the era of digital transformation of health care.

This qualitative study explored parental perceptions of autism spectrum disorder (ASD) services in the United Arab Emirates (UAE).

Forty-one parents of children with ASD participated in five focus groups to explore their experiences with ASD services in the UAE. These moderated focus groups were recorded, transcribed, coded, and analyzed using thematic analysis.

The following primary themes and subthemes were identified: (a) lack of awareness and support, (b) challenges in accessibility and affordability, (c) inconsistent quality of therapeutic services, and (d) Lack of educational inclusion and support.

Findings of this study support the need for creating a comprehensive system of care for ASD that is coordinated, is person centered, and promotes continuity of care that improves the outcomes for those “navigating” the often-fragmented system of ASD in the UAE.

Sphingomonas paucimobilis is an emerging opportunistic pathogen associated with hospital and community-acquired infections. Infection is the most common cause of morbidity and mortality in burn patients.

We present a case of a 29-year-old lady who sustained severe burn injuries after a gas explosion at home. She was admitted to the United Arab Emirates (UAE) National Burns Unit and required several episodes of surgical debridement. She developed S. paucimobilis bloodstream infection whilst being treated with Piperacillin-tazobactam. She was subsequently treated with Meropenem for a total of 7 days after removing the source of infection, an infected central line. The S. paucimobilis isolate showed intermediate resistance to Piperacillin-tazobactam.

Numerous case reports indicate high morbidity in patients with life-threatening S. paucimobilis infections, immunocompromised patients, and patients with underlying medical comorbidity; however, this is the first reported case from the UAE.

Trauma is a leading cause of death around the world, and patients who suffer traumatic brain injuries (TBI) have a worse prognosis and are at a higher probability of death compared to other trauma patients. The sheer burden of TBI on personal, social, and economic aspects of life is daunting. However, the available updated literature for UAE documenting the characteristics of TBI comprehensively is lacking. Hence, this study was conducted to understand the extent of TBI in order to encourage new policies and regulations, enhance existing programs or start new initiatives to reduce associated morbidities and mortalities.

Our study involved a sample of 998 entries extracted from the Abu-Dhabi trauma registry between December 2018 and December 2020. Patients with TBI who died on arrival or were hospitalized for more than 24 hours were included in the study.

Among our patient population, a substantial 80% were males aged 40 years or younger. Head trauma predominantly resulted from two leading causes: motor vehicle accidents and falls from heights. The majority of patients had relatively short hospital stays, with most spending 10 days or less receiving care. Of note, approximately 5% of patients developed a disability following their injury, while the mortality rate within our sample was recorded at 6%.

Most TBIs are preventable through targeted public education and awareness programs where the target population is educated and aware of the safety precautions while driving, biking, doing blue-collar jobs, or hiking. Enforcing rules for traffic and labor safety also has another major preventative rule.

Polyfibromatosis is a rare syndrome characterized by benign fibrous proliferation in different locations. It can be divided into two major categories: superficial and deep. Palmar fibromatosis (Dupuytren's contracture) in variable combinations with plantar fibromatosis (Ledderhose's disease), penile fibromatosis (Peyronie's disease), knuckle pads, and keloids are part of the spectrum seen in polyfibromatosis. There is a rare association of polyfibromatosis with keloids and erosive arthritis. Only four reported cases of polyfibromatosis with erosive arthritis and/or osteolysis have been described in the literature. In this report, we present one such case and review the existing literature on this rare syndrome. We also highlight the possibility of underlying genetic disorders in our patient, such as mucopolysaccharidosis with musculoskeletal manifestation, due to certain dysmorphic features and optic atrophy.

The patient was a 23-year-old female with palmar and plantar fibromatosis accompanied by erosive arthritis. In addition, the patient had facial dysmorphic features, optic atrophy, and nystagmus. Extensive investigations were conducted, and no evidence of inflammatory rheumatic disease was found. The Patient exhibited features consistent with polyfibromatosis.

A rare association between polyfibromatosis and erosive arthropathy with osteolysis has been demonstrated in literature through four case reports spanning from 1979 to 2018. The presence of dysmorphic facial features and ocular complications suggests a possible genetic or metabolic etiology, such as mucopolysaccharidosis.

This patient presents a diagnostic and therapeutic challenge. It is important to recognise the non-inflammatory etiology in order to avoid unnecessary treatment with anti-rheumatic drugs.

White-coat hypertension is commonly observed in subjects presenting with elevated office blood pressure measurements. Although white-coat hypertension does not require medication long-term, studies have observed progression to sustained hypertension in about 30% of individuals. Left ventricular diastolic abnormalities have been described in some individuals with white-coat hypertension and early hypertension.

The present study is a prospective study of follow-up of individuals with white-coat hypertension and the correlation of left ventricular diastolic parameters as determinants of the development of sustained hypertension.

Individuals diagnosed to have white-coat hypertension based on elevated office blood pressure measurements and normal ambulatory blood pressure measurements were included in the study and were evaluated by echocardiography for left ventricular diastolic function and filling pressures (E/A ratio, E wave deceleration time, E/E’ ratio). They were followed up for 1-year to assess for the development of sustained hypertension and to correlate with the initial echocardiographic parameters.

A total number of 32 individuals with white coat hypertension were followed up for 1 year period. Moreover, 25 (78.12%) subjects remained to be normotensive and 7 (21.88%) subjects developed sustained hypertension. There was no significant correlation between E/A, and E wave deceleration time in all the subjects. E/E’ ratio had a positive correlation (R-value 0.77) in subjects who developed sustained hypertension over a 1-year follow-up.

Echocardiographic evaluation of left ventricular filling pressure by E/E’ ratio can be considered as an early predictor for the development of sustained hypertension in white-coat hypertension in a long-term follow-up.

Cardiovascular disease (CVD) remains the leading cause of death worldwide despite the coexistence of the current COVID-19 pandemic. Current emergency management involves revascularization of the coronary arteries.

Retrospectively evaluate the association between the used number of shunts and postoperative complications.

Several complications are reported after coronary artery bypass graft (CABG) surgery, such as postoperative arrhythmia and postoperative stroke. However, the risk factors for the development remain not elaborated.

A retrospective cohort study involved 290 patients for the period 2017-2021 treated surgically for ischemic heart disease. The surgery includes shunts of the internal thoracic arteries with the post-occlusion coronary arteries. The number of shunts is varied depending on the size and number of occluded arteries. According to the number of shunts, the patient may be operated on with artificial circulation (CPB; cardiopulmonary bypass), or without a working heart (OFF pump; without artificial circulation. For statistical analysis, T-test, one-way ANOVA test, X2 test, COX proportional hazards, and Pearson correlation test were used by using the Statistica program.

The most frequently reported complication is postoperative hydrothorax, in 28 (11.20%) patients. Patients with post-CABG LV aneurysm had a longer CPB time and aortic cross-clamp time, t-value -5.58113, p < 0.000000; t-value -4.72802, p < 0.000004, respectively. Patients with postoperative hydrothorax with low BMI and longer CPB and Aortic cross-clamp time, t-value of-2.33929, p <0.020021; t-value 3.83233, P < 0.000157; t-value 2.71109, p < 0.007119, respectively. Subsequently, post-operative hydrothorax increases the intensive care unit (ICU) and total hospitalization days, t-value 5.80811, p < 0.000000; t-value 7.37431, p < 0.000000, respectively. Patients who have preoperative progressive angina have a higher number of complications, t-value of 2.108504, p < 0.035866. Post-myocardial infarction patients with myocardial sclerosis (PMIMS) have a higher number of complications, t value of 2.516784, p < 0.012396. A direct correlation between the number of complications and age/CPB time/ aortic cross-clamp time/ICU hospitalization days/total hospitalization days, r= 0.138565, 0.204061, 0.162078, 0.487048, 0.408381; respectively.

Postoperative complication rate associated with the pre-existence of progressive angina and PMIMS. Elderly people undergoing CABG are at higher risk of psychosis, arrhythmia, longer total and ICU hospitalization days, and stroke. Advanced age, longed CPB time, prolonged aortic cross-clamp time, long ICU hospitalisation, and long total hospitalization days are risks of more frequent post-CABG complications.

The number of complications is not associated with the dead and alive status of patients or with the number of shunts.

Regenerative therapies to rejuvenate the heart have a significant appeal for researchers. Preliminary findings from pre-clinical studies suggest that bone marrow cells may have reparative and regenerative effects on heart muscles, creating a ripe area for research. Many generations of stem cells used in pre-clinical and early clinical studies have shown promising but variable results.

The current review article discusses the dilemmas in applying stem cell therapy to cardiovascular diseases and possible strategies to make it feasible.

The field of regenerative therapies continued to progress with second-generation cells, third-generation cells, combination cell therapy, and the use of cell products alone. Research showed promising positive results in multiple randomized phases 1, 2, and 3 clinical trials in addition to numerous meta-analyses. The gaps in knowledge included stem-cell sources, their delivery routes, dosing, types of cells, and the indicated cardiac conditions.

The results from the latest randomized clinical trials, namely the Dream-HF, showed improved left ventricle function, symptoms, and overall survival. Studied patient populations include post-myocardial infarction (MI), ischemic/non-ischemic cardiomyopathy, intractable/microvascular angina, and cardiac surgery for congenital and valvular heart disease. The phase 3 DREAM-HF trial did not meet the primary heart failure endpoint of reducing hospital admission. Still, it showed a clinically significant reduction in major adverse cardiovascular events (MACE), including recurrent MI and stroke, by 60%. A 60% reduction in cardiovascular mortality and a 79% reduction in cardiovascular mortality in patients with evidence of inflammation (high CRP). The latter finding suggests a more anti-inflammatory effect. This effect was much higher than that observed in the PARADIGM-HF trial, which showed a 20% relative risk reduction in cardiovascular mortality. By combining the results of the DREAM-HF trial with MSC-HF, ixCELL-DCM, CONCERT-HF, and REGENERATE-DCM, the potential for clinical applications of cell therapy is promising.

There is a promising role for cell therapy in the management of cardiovascular diseases. Results of trials in the setting of heart failure are more encouraging in both ischemic and non-ischemic cardiomyopathy. This is in contrast with acute myocardial infarction, where the results have been variable. Amongst all the various cell types tested MSCs show the most significant promise for treating HF.

This study examines the effect of expressing emotions on the psychological well-being of individuals who have musculoskeletal disorders.

This descriptive study was conducted with 111 individuals suffering from musculoskeletal diseases who were undergoing treatment in a university hospital in a metropolitan city in Turkey. Personal information forms, the Emotion Expression Scale, and Psychological Well-Being Scale were utilized in the research questionnaire.

A significant positive relationship was detected between expressing emotions and psychological well-being scores, and it was determined that expressing emotions positively influenced psychological well-being. Emotion expression accounted for 15.8 percent of psychological well-being (F=21.668, p<0.001). It was also unearthed that there was a significant difference between the groups according to the variables of level of education, gender, marital status, family structure, personal history, and whether there was a history of illness in the family. The model explained 34.7% of the variance in psychological well-being (F=12.708, p<0.001). In order of importance, expressing closeness (β=0.470; p<0.001), a higher education level (β=0.249; p<0.05), and expressing negative emotion (β=0.178, p<0.05) variables positively predict psychological well-being. However, single marital status (β=-0.239, p<0.05) predicts psychological well-being negatively.

It has been observed that expressing emotions in musculoskeletal disorders contributes, albeit limited, to the level of psychological well-being. Accordingly, it is believed that encouraging individuals with musculoskeletal diseases to communicate their feelings with others or to express their feelings in various ways, providing supportive and reliable environments, and conducting therapeutic studies to increase their behaviors to express their feelings will contribute to patient care

The optimal treatment for the End- Stage Renal Disease(ESRD) is called kidney transplantation, which can typically improve quality of life and patient survival.

The aim of this investigation was to evaluate clinical and demographic data of kidney transplantation in a main tertiary hospital in Isfahan/Iran.

The published articles confirmed that a successful kidney transplant reduces mortality. Consequently, for further challenges associated with the causes and outcomes, preliminary studies are crucial in a large population of kidney transplant.

From the database of hospital and transplant surgery notebook, the features such as, age, duration of surgery, the number of kidney donors (living person or brain death), and predisposing factors for ESRD were extracted and analyzed.

A total of 688 kidney transplant recipients comprised of males (n= 473M) and females (n= 215) were considered for further analysis. Recipients received kidneys from 482 living and 206 cadaver donors. The mean age of donors versus recipients was 30.4 versus 43.7 years (p≤0.05) respectively. Operation time in the recipients of living versus cadaver donors was 3.7 versus 4 hours. Operation time from 5.5 (the year 2007) reached 3.7 hours (the year 2019). The number of cadaver donors was 3 (the year 2009) which reached at 19 (the year 2019).

In Isfahan, Iran, more than 50% of the population studied needed kidney transplantation around the age of 45 years, and the number of transplanted men was 2.2 times higher than the females. The mean duration of the operation was significantly reduced, and the number of brain death donors steadily increased. Further, remodelling and analyzing the data obtained from this initial investigation could facilitate resourceful decisions regarding practical aspects of kidney transplantation outcome.

A recently published article confirmed that in 2019, around 523 million people suffered from cardiovascular disease (including 18.6 million deaths) worldwide. Losartan, a drug, was patented 35 years ago and approved for medical use in the United States in 1995 (28 years ago). As an effective treatment for hypertension, losartan blocks the interaction of angiotensin II with its receptor by inhibiting the renin-angiotensin system.

This article aims to review the available literature and recent studies demonstrating the efficacy, safety, mechanism of action and drug-drug interactions of losartan in cardiovascular disease.

This is a focused literature review with the keywords relevant to the terms performed in PubMed, Scopus and Web of Science through May 28, 2023, according to the PRISMA guidelines. Based on the PICO standard format, fifty-two relevant in-depth consequent guide approaches and evidence-based choices were selected associated with a knowledgeable collection of current, high-quality manuscripts.

After oral administration, time to reach maximum concentration is about 1-2 hours. With a 78% binding to protein, it has a bioavailability of 25-35%. Losartan is not removed by hemodialysis. For the full effect to occur, it may take up to 6 weeks. The drug is mainly prescribed for patients with high blood pressure, diabetic nephropathy, hypertension and left ventricular hypertrophy. The publication reported higher drug exposures and adverse reactions in women than men with antihypertensive medications. Losartan could improve changes in gut microbiota that might be associated with hypertension. In the high-risk group of renal transplant recipients with arterial hypertension, research reported well-controlled blood pressure with losartan monotherapy.

In addition to the major losartan interactions with captopril, enalapril, lisinopril, and lithium, there are moderate interactions with aspirin, pregabalin, alprazolam, amitriptyline, baclofen, betamethasone, buspirone. Muscle cramps, respiratory infection, cough, hyperkalemia, anemia and stuffy nose are the main reported side effects. As polypharmacy could hide pharmacokinetics interaction due to cytochrome P450, therefore, the combination of losartan with drugs such as phenobarbital, rifampin or fluconazole needs vigilant attention regarding therapeutic drug monitoring.

Echinococcosis is a zoonotic infection that is characterised clinically by the development of hydatid cysts in different organs, mainly the liver and lungs. Cardiac involvement is rare but can lead to serious and fatal complications.

We report a rare challenging case of multiple, extensive cardiac and pulmonary Echinococcal cysts that were treated by successful single-stage surgical resection via median sternotomy without additional thoracic incisions.

This article highlights the rare presentation of multiple, extensive cardiac and pulmonary Echinococcal cysts and how to overcome diagnostic challenges in the era of modern diagnostic imaging. Surgical removal remains the mainstay treatment, and a single-stage surgical approach is feasible in capable centres. Perioperative chemotherapy with Albendazole and the intraoperative use of scolicidal agents improved immediate surgical outcomes, although long-term effects could not be established in this case due to loss of follow-up.