Dubai Medical Journal

Prevalence of Adherence to Anti-hyperlipidemia Medication Among Adults in the Gulf Cooperation Council: A Narrative Scoping Review

Hajra H. Amoodi — 2024-12-27

Introduction: Hyperlipidemia, a silent asymptomatic disease, contributes significantly to cardiovascular disease (CVD) mortality and morbidity in the Gulf Cooperation Council (GCC) region. One of the facets of preventing CVD endpoint is medication adherence to lipid-lowering drugs (LLDs). Accordingly, this scoping review aims to explore the adherence to anti-hyperlipidemia medications among adults in the Arabian Gulf region.

Methods: Based on the Preferred Reporting Items for Systematic Reviews and Meta- Analyses guidelines, a literature search was conducted in Scopus, PubMed, Web of Science, and Google Scholar to screen for articles published from 2013 to 2023 reporting adherence or compliance to LLDs among adults aged 18 years or above with or without any co-morbidities in the GCC region. The quality of the paper was assessed using the AXIS checklist.

Discussion: The search yielded 139 articles, six meeting our inclusion criteria, all of which were cross-sectional. The researchers utilized varied measuring tools, resulting in heterogeneous results: good adherence in two studies, low adherence in three, and indefinite results in one. Younger age, polypharmacy, and female gender were the variables associated with higher drug noncompliance in one or more studies.

Conclusion: There is a research gap on anti-hyperlipidemia medication adherence in the Arabian Gulf region which calls for further research, especially higher evidence studies as no attempts have been made beyond the cross-sectional design. Public health implications of the results may include awareness interventions and cliniciandriven strategies to improve patient compliance.

Navigating Telemedicine in the Middle Eastern Countries: A Scoping Review

Alanood Abdulla Saeed Rabeea Alnaqbi — 2024-12-27

Introduction: The COVID-19 pandemic has highlighted the urgent need for innovative healthcare solutions to address rapid population growth and healthcare service disparities, especially in resource-constrained settings. Telemedicine, which enables remote patient-provider communication and care, offers great potential to improve accessibility, efficiency, and quality of healthcare delivery. However, its development in Middle Eastern (ME) countries has been relatively slow and insufficiently monitored. This scoping review summarizes recent telemedicine implementations and their associated challenges in ME countries while offering recommendations for policymakers.

Methods: A search of Pubmed, Scopus, and Web of Science for articles published between January 2019 and August 2023 yielded 437 publications, of which 34 were included for data analysis. Study data were categorized using country of origin, study design, data collection methods, study subjects, telemedicine interventions, and major findings.

Results: The key insights highlight the need for integrating innovative technologies into healthcare systems, increasing public awareness and education on telemedicine, diversifying research to address regional priorities, and fostering interdisciplinary collaboration to accelerate telemedicine adoption.

Conclusion: In conclusion, while telemedicine has made significant progress in ME countries, ongoing challenges must be addressed to ensure equitable and effective healthcare delivery for all.

Resident Pediatrician’s Knowledge and Practice Toward Infantile Colic: A Cross-Sectional Survey

Ghassan Yousif Ahmed — 2024-12-27

Background: Although infantile colic is believed to be a benign and self-limiting condition, it can cause anxiety in both caregivers and infants. Thus, this study aimed to ascertain what pediatric residents know and do regarding this condition.

Methods: A cross-sectional facility-based survey was carried out on 113 pediatric residents enrolled in the 4th-year pediatric residence training program. The researchers developed a structured, pretested, and validated questionnaire to gather the data. SPSS version 25 was used for the data analysis. The qualitative data are expressed as frequencies (N) and percentages (%). The quantitative data are expressed as ranges, means, standard deviations, medians, and interquartile ranges (IQRs).

Results: The respondent’s mean age was 30.32 ± 3.04 years. Less than half of the participants can identify the clinical criteria for diagnosing infantile colic. Although 97 (85.8%) of the residents suspected infantile colic when examining infants screaming or irritable for no obvious reason, 83 (73.4%) believed that additional laboratory testing was required to confirm the diagnosis. Although 111 (98.2%) of the residents agreed that parent education on the condition’s benign and self-limiting nature is the cornerstone of treatment, most were unsure about alternative treatment approaches. The majority of residents do not always give medications and/or remedies, nor do they promote nonpharmacological treatments for colic. If the infants do not improve with conservative or medical therapy and their parents return them, 64 (56.6%) of the residents will undertake a medical assessment, while 50 (44.2%) would request more investigations. In addition, 70 (61.9%) will continue to provide parental counseling and comfort.

Conclusion: The findings of this study highlight the need for substantial efforts to improve resident’s knowledge and practice of infantile colic management. Such research findings are critical for allocating resources, planning, and implementing successful healthcare initiatives and policies.

Exploring Monkeypox: An In-depth Examination of Its History, Current Status, and Prospects

Sonam Yadav — 2024-12-27

Introduction: Neglected infectious infections have become more prevalent in recent decades. One example is the monkeypox virus (MPV), genus Orthopoxvirus, capable of spreading between animals and humans. Human monkeypox (MPX) outbreaks have occurred in numerous countries, posing an escalating threat to global health.

Methods: Relevant articles were gathered till July 2024 on the MPV using a variety of pertinent information sources, including Elsevier, Science Direct, PubMed, ACS articles, SciFinder, Wiley, and Google Scholar. BioRender was used for creating scientific images on MPV and chemical structures of antivirals were created by using ChemDraw software. Clinical studies information related to MPV was taken from the clinicaltrials.gov website. This review was conducted succeeding PRISMA guidelines to encapsulate the literature accessible on the adopted review topic.

Discussion: It is essential to comprehend the variables influencing the MPV’s spread to ensure preparedness for healthcare, and to develop protection against possible threats. The field of MPX emergence has expanded, with a significant increase in infectivity and notable changes in epidemiology in recent years. Collaborative efforts in sharing resources and data globally are essential to facilitate the study of viruses and develop effective countermeasures. To mitigate the serious consequences of new outbreaks and their spread, it is imperative to enhance our understanding of this infection, particularly focusing on prevention strategies, clinical courses, and epidemiology.

Conclusion: This article offers a concise review of literature spanning from historical accounts to the latest advancements in knowledge regarding the epidemiology, etiology, transmission, clinical characteristics, available treatments, and vaccines for human MPV infection. It consolidates data on the most recent developments in the prevention as well as management of human MPX, providing a detailed overview for reference.

Malignant Infantile Osteopetrosis: A Rare Genetic Disorder

Aya Mohammed Alsabbah — 2024-12-27

Introduction: Osteopetrosis is a clinical syndrome characterized by impairment in the production or function of osteoclasts, leading to bone condensation. Symptoms and their onset depend on the disease’s hereditary pattern.

Case Report: We report a 6-month-old female with dysmorphic features, failure to thrive, lymphadenopathy, hepatosplenomegaly, anemia, and thrombocytopenia. Born term by emergency lower cesarean section due to fetal distress, she was admitted into the neonatal intensive care unit (NICU) for 22 days. Complete blood count (CBC) showed hemoglobin (Hb) 13.6 g/dL, white blood cell (WBC) 14.3 × 10⁹/L, platelet 30 × 10⁹/L, manual 35 x 10⁹/L. At the age of 6 weeks, she was seen in a hematology clinic for thrombocytopenia where she was admitted for bone marrow aspiration. The sample was inadequate, and no megakaryocytes were seen. A skeletal survey was done, it showed evidence of diffuse osteosclerosis overlying the bones, mainly long bones of the upper and lower limbs as well as the metacarpals, metatarsals, and phalangeal bones of both hands and feet. Congenital osteopetrosis was suspected, thus parents opted for second medical advice in Germany where a molecular genetic test confirmed the diagnosis.

Discussion: The patient presented with a wide range of symptoms, the diagnosis of osteopetrosis depends on skeletal radiology and is confirmed by the genetic test. Currently, hematopoietic stem cell transplantation (HSCT) is the only therapeutic intervention available causing it to be the sole opportunity for recovery; however, it cannot be used in all types of osteopetrosis.

Conclusion: The approach to such cases must be comprehensive and must be done by a multidisciplinary team to address and manage the existing symptoms and complications.

Comparative Evaluation of Lung Contusion Assessment Using Ultrasound and Computed Tomography Scan in the First 24 Hours of Intensive Care Unit Admission

Reza Alizadeh Kashani — 2024-12-27

Introduction: Lung contusion is a common condition often resulting from blunt trauma, and it is connected with substantial health complications and risk of death; therefore, timely diagnosis and treatment are essential. Ultrasonography is a valuable technique that significantly improves medical care, offering time efficiency and lifesaving benefits. This study aimed to evaluate lung contusion by comparing the use of ultrasound and computed tomography (CT) scan during the initial 24 hr of intensive care unit (ICU) hospitalization.

Methods: Eighty patients with blunt chest trauma were enrolled in this study. Each patient underwent both chest CT scan and lung ultrasound examinations. Lung ultrasound was performed in 6 anatomical regions on each lung (anterior-superior, anteriorinferior, lateral-superior, lateral-inferior, posterior-superior, and posterior-inferior). Lung contusion was identified by observing localized pulmonary effusion along with disrupting the lung parenchyma. To evaluate the extent of lung damage, the ratio of partial pressure of oxygen in arterial blood to the fraction of inspired oxygen concentration (PaO2/FiO2 ratio) was utilized, while the extent of lung involvement was classified using the blunt pulmonary contusion score (BPC-18 score).

Results: In this study, lung ultrasonography demonstrated a sensitivity of 93.6% for detecting lung contusions, with a specificity of 94.1%, positive predictive value (PPV) of 98.3%, negative predictive value (NPV) of 80%, and overall accuracy of 93.7%. Specifically, for the right lung, these measures were 90.9%, 96%, 98%, 82.7%, and 92.5%, respectively. For the left lung, the corresponding values were 88%, 96.6%, 97.7%, 82.8%, and 91.2%. The receiver operating characteristics (ROC) curve assessed the sensitivity and specificity of ultrasound in diagnosing lung contusions within the first 24 hr of ICU admission. The area under the curve (AUC) for this assessment was 0.939, indicating high diagnostic accuracy.

Conclusion: While CT remains the standard for evaluating lung contusions, its accessibility may be limited due to various circumstances, especially during hemodynamic instability. In these situations, ultrasound is highly valuable in diagnosing lung contusions with exceptional sensitivity, specificity, and diagnostic accuracy. Chest ultrasound emerges as an essential, noninvasive, and safe diagnostic tool at the bedside in the ICU for detecting lung contusions.

Concomitant Discovery of Systemic Lupus and Multiple Myeloma: Is It a Coincidence?

Sara Anibar — 2024-12-27

Introduction: It has been suggested that patients with autoimmune diseases are more likely to develop other malignancies. However, the association between lupus and multiple myeloma (MM) is still not much described in the literature.

Case Report: We report the observation of a 46-year-old female patient, in premenopause, in whom the diagnosis of systemic lupus was retained (SLICC criteria 7) with cutaneous, joint, hematological, immunological, and renal involvement. The discovery of MM was suspected due to a peak in gamma globulins on plasma protein electrophoresis and confirmed by myelogram. The outcome was fatal due to septic shock before starting any immunosuppression.

Discussion and Conclusion: In this literature review, 15 cases are reported on the occurrence of MM years after the diagnosis of lupus, only two cases were like our observation with a concomitant diagnosis of the 2 diseases. The management is still not codified; hence the prognosis of this association remains reserved, encouraging early detection of malignant plasma cell proliferation.

Dubai Clinical Practice Guidelines for Autism Spectrum Disorder (ASD) in Children and Adolescents (from Birth to 18 Years of Age)

Ammar Albanna — 2024-12-27

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by impairments in social interaction and communication, along with restricted interests and repetitive behaviors. It is a lifelong condition that can profoundly impact the individual, their family, and the community. Given that the etiology of ASD is multifactorial, and the rise in ASD prevalence internationally, establishing evidencebased clinical guidelines is critical. The UAE offers a range of services for children and adolescents with ASD with the aim to improve the quality of services within a comprehensive system of care. The Dubai Clinical Practice Guidelines for Autism Spectrum Disorder (ASD) in Children and Adolescents (from Birth to 18 Years of Age), Version 1 aims to provide clinical guidance to healthcare professionals involved in managing ASD based on the best available local and international evidence. ASD management approaches are ranked in these guidelines based on their strength and availability of empirical evidence to support them. The clinical guidelines shall be read in conjunction with any new empirical evidence that arises after 2021.