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

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.

The risk of the post-operative severe atrioventricular block is high when infective endocarditis spreads to the conduction system. However, a clear surgical method to prevent post-operative severe atrioventricular block in infective endocarditis patients has not been developed.

A 39-year-old man with a persistent fever was referred to our hospital. Echocardiography showed mitral valve infective endocarditis with severe aortic regurgitation due to a congenital bicuspid aortic valve. Before the surgery, a paroxysmal atrioventricular block appeared. Intraoperative inspection revealed an aortic-root abscess with ulcerated lesions below the commissure of the noncoronary-right coronary cusps and perforation of the anterior leaflet of the mitral valve. Considering the risk of atrioventricular block, the ulcerated lesions were only cleared with saline solution. After replacing the mitral valve with a mechanical mitral valve, the interventricular fibrous body and aortic annulus were reconstructed with a bovine pericardial patch. The mechanical aortic valve was sutured to the reconstructed aortic annulus. Two years after the surgery, severe atrioventricular block did not occur.

Our method may be effective when the risk of post-operative severe atrioventricular block is high and the patient’s prognosis worsens.

Nephrogenic adenoma is an uncommon, benign, tumour-like lesion within the urothelial mucosa of the urinary tract caused by reimplantation and proliferation of the renal tubular cells that have been shed by chronic irritation of the mucosa of the urinary tract.

We report a case of the rare fibromyxoid variant of nephrogenic adenoma in the prostate urethra. To the best of our knowledge, only a few cases have been described in the literature.

This tumour can have variable morphological patterns with occasional worrisome features that can mimic carcinoma of the lower urinary tract.

Domperidone is an antiemetic and prokinetic agent that is widely used to treat nausea and vomiting, gastroparesis, and as a galactagogue.

This review article focuses on QT prolongation, torsades de pointes, severe ventricular arrhythmia, and sudden cardiac death associated with the use of domperidone or domperidone-containing products.

The online databases, such as Medline/Pubmed/PMC, Google Scholar, Science Direct, Ebsco, Scopus, Web of Science, Embase, and reference lists, were searched using keywords like Domperidone, Cardiotoxicity, QT prolongation, Cardiac arrhythmia, Torsades de pointes, Ventricular arrhythmia, and Sudden Cardiac Death, to identify published articles relevant to domperidone-associated cardiotoxicity.

Domperidone has been linked to an increased risk of QT prolongation, torsades de pointes, severe ventricular arrhythmia, and sudden cardiac death, according to a number of epidemiological studies and meta-analyses.

Domperidone can only be used to treat nausea and vomiting in patients between the ages of 12 and 60, and a maximum daily dose of 30 mg has been set by a number of regulatory bodies. The risk of severe ventricular arrhythmia and sudden cardiac death caused by domperidone should be made clear to clinicians along with the recommendations from regulatory bodies to avoid any potential complications.

More than 175,000 new cases of cancer in children are diagnosed every year worldwide.

This study aimed to investigate the recorded cancer frequency in children and adolescents in Isfahan Province, Iran.

As one of the main reasons for death among children and adolescents is reported as cancer with different prevalence worldwide, therefore, reporting the occurrence of cancers in this population is crucial.

Information from the years between 2013 to 2015 related to the Surveillance, Epidemiology, and End Results; (SEER) was collected from the Isfahan Cancer Registry. The cancer sites studied were defined according to the International Classification of Diseases and recorded by related topography codes.

Among all 30,465 registered cancers, there were 582 cases (2%) of cancer, including 57% of children and 43% of adolescents. The mean ± SD age of patients was 11.5 ± 5.9 years (Min; 1, Max 19). The top four ranked cancers were (n=264; 45%) comprised of; 1) hematopoietic and reticuloendothelial system (n= 122), 2) secondary and unspecified malignant neoplasm of lymph nodes (n=56), 3) malignant neoplasm of the brain (n=43) 4), thyroid gland (n=43). Death-reported data was associated with 32% of the total population studied. The neoplasm was reported in 174 cases, which was associated with 95% death.

This frequency source of children and adolescents cancers could be used for health strategy. The observed variations in the frequency of different cancers require continuous monitoring and investigation. Therefore, plan of health-system should focus based on greater efforts toward advanced evidence-based drug therapy in Isfahan, Iran.

Student nurses are the future healthcare providers. Safe nursing practice is crucial as they often are exposed to multiple infections, including bloodborne pathogens, during their clinical practice.

To assess the factors that influence adherence to standard precautions among nursing students and to find the association between adherence to standard precautions with their selected demographic variables.

A cross-sectional study was conducted among 103 undergraduate nursing students recruited by convenience sampling technique from a selected health sciences university. Adherence to standard precautions was assessed using a standardized questionnaire, ‘Factors Influencing Adherence to Standard Precautions Scale-Student Version’ (FIASPS-SV). Using SPSS version 23 the data were analysed with descriptive and inferential statistics. Frequency and percentage were used to describe the socio-demographic characteristics. Inferential statistics, namely the Chi-Square test, was used to find out the association between FIASPS-SV and their demographic variables. The P value less than 0.05 was taken as statistically significant.

The ‘contextual cues’ was found to be the most influencing factor [Total Mean 21.98(6.148), Range 0-28; Mean Response Range of 3.18(.32), Response Range 1-4] while the factor ‘justification’ was found to be the least influencing factor [Total Mean 7.31(6.1285), Range 0-28; Mean Response Range -1.06 (.23), Response Range 1-4] for the adherence of standard precautions among the study participants. A statistically significant association was found between age and specific factors of ‘Leadership’ & ‘Contextual cues’. Gender was found to be associated with specific factors of ‘Justification’ and ‘Contextual cues.’

The study findings showed that the overall student adherence to standard precautions was good. However, they need to improve in some areas, like wearing gloves when drawing blood or cannulation, following standard precautions when handling needles, and confronting people when they are not adhering to these precautions. The faculty should reinforce and encourage the students to implement standard precaution practices effectively at clinical settings to promote safe practice.

Phagophobia is characterized by conditioned excessive fear of swallowing or choking that is usually triggered by an incident. It usually leads to avoidance of certain types of food or, in severe forms, a complete refusal to eat solid food and/or liquids. The condition is commonly associated with physical and psychological symptoms impacting the health condition of the individual due to deprivation of essential nutrients.

A 12-year-old boy developed acute onset fear of swallowing (Phagophobia) following a dream he had of someone choking. This was exacerbated by watching an online video of a person choking. This has led to an avoidance of solid food and dependence on soft food and liquids. Fear of swallowing along with food avoidance has led to malnutrition, weight loss, and several physical complaints for which the patient was admitted under pediatric care. A course of Cognitive Behavioral Therapy (CBT) resulted in limited response and was augmented with fluoxetine. Full remission was achieved within six weeks.

A systematic review of all peer-reviewed English literature was performed for articles related to the pharmacological treatment of pediatric phagophobia (0-18 years) following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.

A total of 17 case reports were identified describing 17 children with phagophobia (females = 70%). The mean age was 9.3 and the average was between 2 and 15 years who were diagnosed with choking phobia/ phagophobia or different but equivalent diagnoses like Avoidant/Restrictive Food Intake Disorder or Post Traumatic Feeding Disorder. Different classes of medications were used in variable doses for different durations which were associated with significant improvement in eating patterns and reduction in fear and anxiety associated with eating.

Phagophobia is a serious and potentially life-threatening illness that can cause physical complications and functional impairment in the psychosocial aspect. Pharmacological treatment can be a beneficial and safe option either alone or in combination with therapeutic interventions for children presenting with phagophobia.