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   Table of Contents - Current issue
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January-April 2017
Volume 5 | Issue 1
Page Nos. 1-87

Online since Wednesday, November 16, 2016

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EDITORIAL  

Zika virus: An emerging pathogen p. 1
Abdulaziz A Al-Quorain
DOI:10.4103/1658-631X.194246  
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REVIEW ARTICLES Top

Zika virus disease Highly accessed article p. 2
Adel I Al-Afaleq
DOI:10.4103/1658-631X.194260  
The Zika virus is an arbovirus belonging to the virus family Flaviviridae. The virus was isolated in 1947 from a rhesus monkey in the Zika Forest of Uganda. The virus causes sporadic mild human infections in Africa and later in Asia. However, by 2007 a major shift in its infection pattern was noticed and thousands of human infections were reported in the State of Yap and Federated States of Micronesia. In the last 3 years, major outbreaks have continued to occur and the virus has spread to several Pacific and American countries. These outbreaks were mostly asymptomatic; however, there were more severe clinical signs associated with the infections. Those signs included microcephaly and Guillain–Barre syndrome. It is believed that various species of mosquitoes can biologically transmit the virus. However, Aedes aegypti is most widely associated with the Zika virus. Recently, new modes of virus transmission have been reported, including mother-to-fetus, sexual, blood transfusion, animal bites, laboratory exposure and breast milk. Differential diagnosis is very important as some other arboviruses such as yellow fever virus, West Nile virus, dengue virus, and chikungunya virus have similar clinical manifestations to the Zika virus infection as well as relating serologically to some of these viruses. Established laboratory diagnostic tests to detect the Zika virus are limited, with reverse transcription polymerase chain reaction being the most widely used test. Taking into consideration the quickness of the spread of infection, size of the infected population and change of the infection severity pattern, the Zika virus infection merits collective efforts on all levels to prevent and control the disease. Limited research work and data, concurrent infection with other arboviruses, involvement of biological vectors, mass crowd events, human and trade movements and lack of vaccines are some of the challenges that we face in our efforts to prevent and control the Zika virus infection.
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Targeting cancer cells using 3-bromopyruvate for selective cancer treatment Highly accessed article p. 9
Hussam H Baghdadi
DOI:10.4103/1658-631X.194253  
Cancer treatment deserves more research efforts despite intensive conventional treatment modalities for many types of malignancies. Metastasis and resistance to chemotherapy and radiotherapy receive a lot of global research efforts. The current advances in cancer biology may improve targeting the critical metabolic differences that distinguish cancer cells from normal cells. Cancer cells are highly glycolytic for energy production, exhibit the Warburg effect, establish aggressive acidic microenvironment, maintain cancer stem cells, exhibit resistance to chemotherapy, have low antioxidant systems but different ΔΨm (delta psi, mitochondrial transmembrane potential), express P-glycoprotein for multidrug resistance, upregulate glucose transporters and monocarboxylate transporters and are under high steady-state reactive oxygen species conditions. Normal cells differ in all these aspects. Lactate produced through the Warburg effect helps cancer metastasis. Targeting glycolysis reactions for energy production in cancer cells seems promising in decreasing the proliferation and metastasis of cancer cells. 3-bromopyruvate makes use of cancer biology in treating cancer cells, cancer stem cells and preventing metastasis in human cancer as discussed in this review. Updated advances are analyzed here, which include research analysis of background, experience, readings in the field of cancer biology, oncology and biochemistry.
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ORIGINAL ARTICLES Top

Medical students' opinion toward the application of complementary and alternative medicine in healthcare p. 20
Syed Meraj Ahmed, Mohammed A Al-Mansour, Elsadig Y Mohamed, Khalid A Medani, Sawsan M Abdalla, Waqas S Mahmoud
DOI:10.4103/1658-631X.194255  
Context: An accelerated approach to popularize complementary and alternative medicine (CAM) in healthcare services has led to the need to assess medical students' knowledge of CAM. Furthermore, their attitude toward its efficacy and usage will determine its growing popularity in healthcare. Another key idea is to integrate CAM with conventional medical teaching to make it a part of the mainstream medical curriculum. The objectives were to assess the medical students' perceptions about integrating CAM with conventional medicine and to assess the attitude of prescribing different CAM modalities to patients presenting with a particular disease or health disorder. Settings and Design: This is a descriptive, institutional based study conducted on undergraduate 3rd year medical students. Materials and Methods: Data were collected by a structured and pretested questionnaire to be filled in by the participants in the presence of the investigator. Statistical data were entered in SPSS software, and descriptive analysis was conducted. Results: Most of the students (74%) agreed that conventional and CAM therapy can be integrated to achieve a better health care outcome. Forty-eight percent of the participants were positive that knowledge of CAM is important since many patients still prefer this option, particularly for chronic illnesses. Conclusions: The students were receptive to the introduction of a new treatment method in their curriculum, which although unconventional, presents an alternative and traditional form of treatment even if it does not have major backing from the scientific community. The participants felt that more knowledge is required to make an informed opinion about its usefulness to the community as a whole.
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Hospital prevalence of retinopathy in patients with newly-diagnosed type 2 diabetes p. 26
Waseem M AL-Zamil
DOI:10.4103/1658-631X.194248  
Aims: To determine the period prevalence of diabetic retinopathy (DR) and the associated factors in patients with newly-diagnosed Type 2 diabetes mellitus (T2DM). Subjects and Methods: In this prospective study, all newly-diagnosed T2DM patients who attended the ophthalmology clinic at King Fahad Hospital of the University between January 2012 and January 2015, were examined for DR. After pupillary dilation, the ophthalmic fundus was examined by a retina consultant using slit-lamp indirect ophthalmoscopy. Risk factors such as gender, age, hypertension, nephropathy, the level of glycated hemoglobin (Hb), microalbuminuria, and hyperlipidemia were evaluated for possible association with DR at the time of diagnosis. Results: The study included 112 newly-diagnosed T2DM patients. DR was present in seven patients (6.25%) with a mean age of 53.4 ± 6.4 years, four of whom were females (57%). Nonproliferative DR was present in all patients with DR, two patients (28.6%) presented with bilateral clinically significant macular edema requiring laser photocoagulation treatment and intravitreal anti-vascular endothelial growth factor therapy. In the study cohort, elevated hemoglobin A1C levels (HbA1C) were detected in 55 patients (49.1%), microalbuminuria in 28 (25.0%), hypertension in 31 (27.6%), hyperlipidemia in 65 (58.0%) and obesity in 43 (38.1%). At the time of T2DM diagnosis, uncontrolled HbA1C levels were significantly associated with the presence of retinopathy (P = 0.045); however, no statistical significance was observed for the remaining risk factors. Conclusion: The frequency of retinopathy in newly-diagnosed T2DM patients was similar to previous reports. Vision-threatening maculopathy was present in two of seven patients, requiring further intervention. Therefore, early screening is strongly recommended for all newly-diagnosed T2DM patients. Prospective studies with a large sample size are needed to verify the risk factors for these patients.
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Nurses' attitude towards patients with mental illness in a general hospital in Kuwait p. 31
Anwar Al-Awadhi, Farid Atawneh, M. Ziad Y Alalyan, Altaf Ahmad Shahid, Sulaiman Al-Alkhadhari, Muhammad Ajmal Zahid
DOI:10.4103/1658-631X.194249  
Introduction: Stigma and discrimination have been reported to cause unnecessary delay in mentally-ill patients seeking help, which adversely affects a patient's outcome. The attitude of health care professionals has been described as being, even more, negative than that of the general public, which worsens the prognosis for patients with a mental illness. Aims: The aim of this study was to describe the attitude of nurses toward mentally-ill patients in a general hospital. Methods: All the nurses in the hospital were administered a 40-item Community Attitudes Toward the Mentally-Ill (CAMI) questionnaire which determines whether the mentally-ill are viewed as “inferior;” deserve “sympathy;” perceived as a “threat” to society or “acceptable” if residing in community dwellings. The analysis of variance was performed to determine association of the four subscales with the individual characteristics, including age, gender, education, qualification type, position held, contact and contact type. Results: Out of a total of 990 nurses, 308 (31%) completed the CAMI questionnaire. The mean scores for the authoritarian (2.85), benevolent (3.66), social restrictiveness (2.97) and community mental health ideology (3.48) subscales reflected a negative attitude of nurses toward mentally-ill patients. The direct or indirect utilization of the mental health facilities resulted in significantly higher authoritarian and lower benevolence scores, indicating a positive attitude change in this group of nurses. Conclusion: Despite the small size and selective nature of the sample, the nurses' negative attitude toward the mentally-ill patients provides useful baseline data for further large-scale studies and underscores the need for psychoeducation of different health care professionals, including nurses.
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Reliability of sonographic estimation of fetal weight: A study of three tertiary hospitals in Nigeria p. 38
Cletus Uche Eze, Christopher Chukwuemeka Ohagwu, Livinus Chibuzo Abonyi, Nicholas Kayode Irurhe, Zachaeus Ayo Ibitoye
DOI:10.4103/1658-631X.194256  
Context: There is a dearth of sonologists in Nigeria, yet sonographic estimation of actual birth weight (ABW) is important in antenatal care. Aim: To determine the reliability of estimated fetal weight (EFW) by sonographers and sonologists in Lagos Nigeria. Settings and Design: In the cross-sectional study, a convenience sample of 663 healthy women with singleton pregnancy at term was selected. Ethical approval for the study design and consent of participants were obtained. Subjects and Methods: Three sonographers and three sonologists used a single ultrasound scanner with Hadlock-3 algorithm to measure biparietal diameter, abdominal circumference, and femur length in three centers while three midwives used a single neonatal weighing scale to measure ABW. Statistical Analysis Used: Medical® statistical software version 12.5 was used to analyze data. Descriptive and inferential statistics, as well as Bland/Altman plots were used to determine reliability of EFWs. Results were tested for statistical significance at P ≤ 0.05. Results: Majority (76.2%) of babies had normal weight while mean EFW and ABW were 3.50 ± 0.10 kg and 3.45 ± 0.12 kg, respectively and the difference between them is not statistically significant (P > 0.05). For sonographers and sonologists in each center, mean error and coefficient of variation were very small while Pearson's correlation coefficient as well as intra- and interclass correlation coefficients was very high. Conclusion: Independent estimation of ABW by sonographers in Lagos metropolis was very reliable. Sonography was also highly reliable in predicting macrosomia.
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Risk factors of post-hemithyroidectomy hypothyroidism p. 45
Alhanoof K Al-Shalhoub, Saleh Al-Dhahri
DOI:10.4103/1658-631X.194243  
Introduction: Hemithyroidectomy is one of the most frequently performed procedures often associated with complications, among which hypothyroidism is the most common. However, the risk factors for post hemithyroidectomy hypothyroidism are still unclear. Objectives: To assess the incidence, risk factors and time taken to develop hypothyroidism after hemithyroidectomy. Methods: A retrospective chart review of patients who underwent hemithyroidectomy between 2004 and 2012 in two different hospitals was performed. Patients were analyzed for age, gender, weight, height, body mass index (BMI), previous medical history and histological findings. The incidence of post hemithyroidectomy hypothyroidism was determined based on the thyroid stimulating hormone levels during the postoperative period. Results: From a total of 213 patients, 83 met our inclusion criteria; 67 (80.7%) were women and 16 (19.3%) were men. Thirty-seven (45%) patients developed biochemical hypothyroidism postoperatively whereas 46 patients remained euthyroid (55%). The time taken to develop hypothyroidism was variable. Twenty-four (61.5%) of 37 patients developed hypothyroidism within the first 3 months postoperatively. There were no significant differences in gender, age, BMI, history of diabetes mellitus, the presence of thyroiditis in histopathological examination and postoperative pathologies between the postoperative hypothyroid and euthyroid groups. Conclusions: Our results showed a high overall incidence of hypothyroidism following hemithyroidectomy (45%). As the majority of the patients in the hypothyroid group (70.3%) developed hypothyroidism within the first 6 months of post surgery, frequent thyroid function testing in the first 6 months, may help in initiating the treatment before the patient becomes symptomatic. We demonstrated that there are no predictive risk factors for post hemithyroidectomy hypothyroidism.
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Student and faculty perception of objective structured clinical examination: A teaching hospital experience p. 49
Abir H Alsaid, Mona Al-Sheikh
DOI:10.4103/1658-631X.194250  
Introduction: The primary objective of this study was to explore student and faculty perception of the objective structured clinical examination (OSCE) to assess the clinical competence of 5th year medical students. Methods: Two validated tools were used to survey students' and faculty perception of the OSCE as an assessment tool. The questionnaires were self-administered and handed to the students immediately after the OSCE was conducted. Subjects were 29 female students who had completed their 3-week Internal Medicine rotation and 15 faculty members who had participated in evaluating the students. The response rate was 100%. The OSCE comprised of 21 active stations involving skills like history taking standardized patients were used, physical examination, and data interpretation for which real patients were used. Results: Majority of students, 63.2% indicated that the OSCE assessed their skills fairly. This was also true for 80% thought the OSCE was a fair method of assessing students' skills as well as a better assessment tool than the traditional long/short case exams. Conclusion: The OSCE was positively perceived by 5th year medical students and faculty members as a tool that can fairly assess students' clinical skills.
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Evaluation of cathodic antigen urine tests for diagnosis of schistosoma mansoni infection in Sudan p. 56
Mutamad A Amin, Abdelhafeiz M Elsadig, Hussam A Osman
DOI:10.4103/1658-631X.194257  
Background: Kato–Katz is the preferred method for the detection of Schistosoma mansoni eggs in stool. However, the sensitivity of this method is low and affected by day-to-day variation in egg excretion. Cathodic antigen urine tests have been proven to be sensitive for the diagnosis of S. mansoni infection in limited studies. Aim: To evaluate the accuracy and sensitivity of cathodic antigen urine tests for the diagnosis of S. mansoni infection. Setting and Design: This study was conducted in the Gezira Irrigation Scheme in the Gezira State, Sudan. Both S. mansoni and Schistosoma haematobium are endemic in the Gezira State. Kab-Algidad Village situated in Al Kamleen locality was selected for the study. This is a school-based, cross-sectional, comparative study. Subjects and Methods: Female school children, aged between 11 and 14 years who consented to participate, were enrolled in the study. Stool samples were examined using Kato–Katz technique and sodium dodecyl sulfate (SDS) digestion method. Urine samples were tested using the circulating cathodic antigen assays for the diagnosis of S. mansoni, and by centrifugation for S. haematobium. Statistical Analysis Used: Data were analyzed using the Scientific Package for Social Sciences version 15. Results: Cathodic antigen urine tests showed similar sensitivity to SDS and higher sensitivity compared to six Kato–Katz (reference diagnostic test). Conclusion: Cathodic antigen urine tests is a useful tool for mapping S. mansoni and may be used to evaluate the interruption of transmission.
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CASE REPORTS Top

Isolated skeletal muscle metastasis and hypercalcemia in non-small cell lung carcinoma p. 62
Javvid Muzamil Dandroo, Naveed Mohsin, Shabir Ahmed Rather
DOI:10.4103/1658-631X.194245  
Lung cancer is the most common malignancy throughout the world. Non-small cell lung carcinoma is the most common type and squamous cell type is the most common in India. Patients mostly present with chest related symptoms and signs. Isolated skeletal muscle metastasis (ISMM) is rarely seen. We describe a patient who presented with ISMM and hypercalcemia without any pulmonary symptoms.
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Adult intussusception p. 65
Ahmad Abdulrahman Almaghrabi, Aiman Saleh Sirag Alddin, Abdulrahman Khalid Alzamzami, Mohamed Elamin Salih
DOI:10.4103/1658-631X.194254  
Adult intussusception is rare. We report the case of an elderly female patient with an ileocecal intussusception who underwent resection and ileocolic anastomosis. The histology revealed chronic inflammation of the ileum and cecum and there was no evidence of malignancy. There was no evidence of malignancy. The appendix showed fibrous obliteration of the lumen.
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Omphalocele, exstrophy of bladder, imperforate anus and spinal defect complex with genital anomalies in a late preterm infant p. 67
Faisal Othman Al-Qurashi, Thammer Saad Al-Hareky, Hussah Mohammed Al-Buainain
DOI:10.4103/1658-631X.194258  
Omphalocele, exstrophy of the bladder, imperforate anus and spinal defect (OEIS) complex is a rare congenital multisystemic malformation representing unique anomalies. It was first reported in 1978 through a series of cases with an abnormality of body wall development. We are reporting a case of an infant of 36 weeks gestation, with a family history of consanguinity and oral contraceptive pill intake that was discontinued when the mother was 1-month pregnant. The neonatal examination revealed findings that were consistent with OEIS complex along with the presence of genital anomalies. The infant required multi-staged surgical intervention. We conclude that this case report might illustrate some of the possible risk factors and variability of OEIS complex.
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Polyglandular autoimmune syndrome iii with hypoglycemia and association with empty sella and hypopituitarism p. 71
Samia Abdulla Bokhari, Patan Murthuza Khan, Khalid Al Jabri, Mohammed Galal
DOI:10.4103/1658-631X.194251  
A 25-year-old Saudi female with a known case of autoimmune thyroiditis presented to the Emergency Room in stuporous condition. A blood test revealed a blood sugar level of 1.7 mmols/l (30.6 mg/dl). The patient was resuscitated with intravenous glucose. Further evaluations of the patient revealed celiac disease and idiopathic thrombocytopenia with preexisting autoimmune thyroiditis (polyglandular autoimmune syndrome III [PAS III]). The severe hypoglycemia, coupled with 6 years of infertility evaluation, revealed a rare association of empty sella syndrome with hypopituitarism {PAS II}.
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Primary umbilical endometriosis: Case report with literature review p. 74
Sara A Al-Quorain, Tariq A Al-Yahya
DOI:10.4103/1658-631X.194259  
Villars nodule, also known as umbilical endometriosis, is a rare umbilical disorder, usually affecting women of child bearing age. Endometriosis is a functional endometrial tissue found outside the uterine cavity, which affects the umbilicus in 0.5–1% of all extragenital sites. Correct diagnosis is challenging and commonly missed, but once a diagnosis has been made, the recommended management is surgical excision. We are reporting a case of primary umbilical endometriosis in a 31-year-old nulliparous patient, who presented with an umbilical mass of one year duration. Histopathology confirmed the diagnosis of endometriosis and the mass was widely excised.
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Furuncular myiasis in a child: A case report and literature review p. 77
Alaa Al Juaid, Waheed Al Zahrani
DOI:10.4103/1658-631X.194244  
Myiasis is an ectoparasitic infestation of tissue. Most cases of furuncular myiasis in Saudi Arabia are acquired from the Southern region of Saudi Arabia, including the Al Baha and Asir regions. Some authors consider these areas to be part of the Afro-tropical zoogeographical belt where infection is most likely to occur. Some studies have reported posttrauma myiasis in oral cavities in children. However, myiasis is rarely reported in children who do not suffer from skin erosion or trauma. We are reporting the case of a young, otherwise healthy girl who visited Al Taif, in the Western region of Saudi Arabia, who acquired an accidental infestation of fly larvae. To the best of our knowledge, this is the first report of indigenously acquired myiasis outside the Southern region of Saudi Arabia. This is significant in the epidemiology of this parasite, which appears to have expanded from the Southern to the Western region of Saudi Arabia.
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LETTERS TO THE EDITOR Top

Hypoglycemia in a child with tramadol poisoning p. 80
Mahmood Dhahir Al-Mendalawi
DOI:10.4103/1658-631X.194241  
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Author's reply p. 81
Ibrahim Aliyu, Fatime Kyari, Zainab Ibrahim
DOI:10.4103/1658-631X.194242  
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Why is it a diagnostic dilemma to diagnose female genital tuberculosis: A pathologist's viewpoint p. 82
Seema Dayal
DOI:10.4103/1658-631X.194252  
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IMAGE QUIZ Top

Unusual cause of dysphagia p. 83
Yasser M Aljehani, Yasser El-Ghoneimy
DOI:10.4103/1658-631X.194247  
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