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   Table of Contents - Current issue
Coverpage
July-September 2021
Volume 14 | Issue 3
Page Nos. 107-142

Online since Friday, October 1, 2021

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REVIEW ARTICLE  

Key catalysts for a better sleep disorders management in primary care p. 107
Ahmed Husain Ebrahim, Walaa Jasim Mahmood
DOI:10.4103/hmj.hmj_16_21  
Sleep-related disorders necessitate adequate attention in the primary health care setting, the first point of contact for patients. Hence, this paper aims to identify factors reinforcing improvement strategies for sleep disorders management in primary health care. A narrative literature review was performed by examining sleep health-related scholarly sources identified in relevant databases. Subsequently, a comprehensive overview is shaped about potential factors catalysing active primary care practitioners' (PCPs') involvement in sleep disorders management. Eight key catalysts have been identified and described concisely based on current research. These eight catalysts could serve as an aide-memoire for primary care professionals for pursuing sleep-centric practices. Further, the identified catalysts could function as a reference for developing actions related to training, sleep medicine guidelines, policymaking, and public health programs dedicated towards sleep disorders' early detection, management, and education. As an important implication of this review, researchers interested in sleep health can utilize this review's outcome for crafting and validating a questionnaire to understand the involvement of PCPs in managing sleep disorders.
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ORIGINAL ARTICLES Top

Incidence of adhesive small bowel obstruction and outcome of management Highly accessed article p. 112
Maahroo Makhdoom, Shahroo Makhdoom, Hadiel Kaiyasah, Labib Al Ozaibi
DOI:10.4103/hmj.hmj_69_20  
Background: Small bowel obstruction (SBO) is a common surgical condition that leads to emergency admission. Adhesions are the single most common cause for SBO, accounting for 60% of cases. The occurrence of adhesive SBO (ASBO) is higher following specific surgeries including colorectal, high gynaecological and paediatric surgeries. Initially, all patients are treated conservatively, but in case they fail to improve, surgical management is considered. Aim & Objectives: The objective of the study is to assess the number of patients admitted at Rashid Hospital with ASBO and the outcomes of their management. Materials and Methods: A retrospective study was conducted on patients who were admitted with ASBO from April 2017 until December 2019. A total of number of 85 patients who met the inclusion criteria were enrolled in the study. Those with underlying inflammatory bowel disease, abdominal tuberculosis and small bowel tumours were excluded. The outcomes of non-operative management (NOM) in terms of success rate, length of hospital stay and surgical intervention were assessed. Result: A total of 303 records were reviewed, of which 85 met the inclusion criteria (50 males and 35 females). The most common type of previous abdominal surgeries includes lower gastrointestinal (38.8%) and gynaecological surgeries (12.9%). Seventy-eight patients who underwent NOM had a success rate of 77.6% (n = 59) with a mean length of stay (LOS) of 3.5 days. Seventeen patients (22.4%) needed surgical intervention after a mean of 3.5 days. These patients were found to have intra-abdominal bands in 52.9% of the cases (P = 0.191). During the time period set for the study, the recurrence rate of patients who had successful NOM versus those who needed surgical intervention was 12% and 35.3%, respectively (P = 0.061). Sixty per cent of these recurrent cases were treated non-operatively on the second admission to the hospital whereas 40% required surgical intervention. Conclusion: NOM for ASBO has a shorter LOS and a lower recurrence rate as compared to those who required surgical management.
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Pediatric out of hospital cardiac arrest p. 115
Saad Essa Alqahtani, Ahmed Saleh Alhajeri, Ayman Adel Ahmed, Sahar Yousef Mashal
DOI:10.4103/hmj.hmj_76_20  
Background: Cardiac arrest is one of the leading causes of death globally. Aim & Objectives: This study aims to investigate and identify the characteristics of pediatric out of hospital cardiac arrest (POHCA) patients who were attended to and treated by National Ambulance. It is important to understand the characteristics of the patients to improve the implementation of chain of survival and to increase the survival rate. Materials & Methods: This is a 2-year prospective, descriptive, cohort study of POHCA group between January 2018 and December 2019. Data for this study were collected using a structured electronic questionnaire for all out of hospital cardiac arrest patients under 18 years old. Results: A total of 73 POHCA cases were attended by National Ambulance during this 1-year study with a higher percentage being that of infants (59%). In this group, it was found that the percentage of male pediatrics (68%) is higher than females. More than half the total cases (53%) were witnessed by bystanders, 27.3% received bystander cardiopulmonary resuscitation (CPR), and 1% had automated external defibrillator applied on them prior to ambulance arrival. In this population, more than half of cardiac arrest cases occurred in their places of residence (53%). Non-traumatic cardiac arrest was the highest in this group (62%) while traumatic cardiac arrest was found at 22% and drawing cases were 14% of cardiac arrest in this group of patients. The highest percentage of the cardiac arrest patients had nonshockable rhythms (93%). Return of spontaneous circulation at the scene was 4.1%, and all of the cardiac arrests were witnessed and had bystander CPR. Conclusion: This 2-year study emphasised the importance of understanding the characteristics of POHCA. Inculcate a sense of community engagement in public through implementing Good Samaritan Law in UAE. Development and implementation of first aid training for both parents and caregivers were suggested to ensure proper implementation of chain of survival in UAE. Developing legislations for caregivers or babysitters who is taking care of child to receive first aid training and accredited CPR license as a precondition to work as a caregiver or a babysitter. Further linkage between pre-hospital and hospitals data is essential to conduct proper researches to improve chain of survival and reduce pediatric out of hospital cardiac arrest morbidity and mortality.
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First experience with hysterosalpingo-foam sonography (HyFoSy) for office tubal patency testing in Dubai hospital p. 120
Tazeen Makhdoom, L Khalid, N Hubaishi
DOI:10.4103/hmj.hmj_100_20  
Background: The present study was conducted to describe the first experience with hysterosalpingo-foam sonography (HyFoSy) as a routine office procedure to check for tubal patency in infertility clinic of Dubai Hospital. Materials and Methods: A retrospective, observational study was conducted. Hundred patients with subfertility and low risk of tubal pathology were examined. A non-toxic HyFoSy foam containing hydroxymethyl cellulose and glycerol was applied through the cervical applicator for contrast sonography. Tubal patency was determined by transvaginal ultrasound by demonstrating echogenic dispersion of foam in Fallopian tubes and or in the peritoneal cavity. Only in cases where patency could not be demonstrated, hystosalpingogram/laparoscopy was performed as a control. Inclusion Criteria: All patients who underwent HyFoSy in infertility clinic in Dubai hospital were included in the study. Exclusion Criteria: Any patient with active tubal disease such as pelvic inflammatory disease, endometriosis and previous ectopic pregnancy were excluded from the study. Results: One hundred patients were observed in the study. HyFoSy was successful in 97 patients (97%) and was failed in three patients (3%). Bilateral patency was seen in 72 patients (74%), bilateral blockage was seen in six cases (6.1%), delayed spill was seen in five patients (5%) and hydrosalpinx was found in 1 patient (1%). Antibiotics were given to 97 patients (100%). Out of the 97 patients who successfully underwent HyFoSy, 17 conceived within 6 months after the procedure. Conclusion: HyFoSy is a successful procedure to demonstrate tubal patency as the first step office procedure.
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Salivary enzymes and oxidant-antioxidant parameters as biomarkers of head and neck cancer: Correlation between blood and saliva p. 124
Arnadi Ramachandrayya Shivashankara, Paul Simon, Saira Pais, Sucharitha Suresh, Thomas George, Manjeshwar Shrinath Baliga
DOI:10.4103/hmj.hmj_5_21  
Background: Studies with saliva are of immense advantage as the process of it collection from humans is a noninvasive method and can be repeated with least compliance problems. In this study, the levels of lactate dehydrogenase (LDH), amylase, reduced glutathione (GSH), glutathione S-transferase (GST), protein-bound sialic acid (PBSA), lipid peroxidation (LPO) and total antioxidant capacity (TAC) were analysed in the blood and saliva samples of head and neck cancer (HNC) patients and compared it with age-matched healthy controls (N = 30) to explore the usefulness of the parameters as an endpoint biomarkers. Materials and Methods: HNC patients visiting hospital for treatment (n = 31) were the participants of the study; age- and sex-matched healthy controls were included. Levels of LDH, amylase, PBSA, LPO (as malondialdehyde), GSH, GST and TAC were analysed in whole, unstimulated saliva samples. Results: The levels of LDH, amylase, PBSA and LPO were significantly higher, and levels of GSH, GST and TAC were significantly lower in blood and saliva of HNC patients when compared to healthy controls (P < 0.001). There was statistically significant correlation between blood and saliva with regard to the levels of amylase and GSH (P < 0.001). Conclusions: This study demonstrated significant changes in the biochemical parameters of blood and saliva in HNC patients and correlation of salivary GSH and amylase with corresponding levels of blood. Salivary biochemical parameters could serve as sensitive and convenient biomarkers of HNC.
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CASE REPORTS Top

Coexistent left ventricular clot and self-contained pericardial haematoma: An unusual combination found in a patient post inferior ST-elevation myocardial infarction p. 129
Rommana Mehdi, Ali Raza Rajani, Salah Roqia
DOI:10.4103/hmj.hmj_80_20  
The discovery of a left ventricular (LV) thrombus in combination with a pericardial haematoma is a rare occurrence secondary to a complicated myocardial infarction (MI). A 53-year-old male was brought to our emergency in an unresponsive state with unstable haemodynamics. Electrocardiogram showed inferior and right ventricular ST-elevation MI. The patient underwent primary percutaneous coronary intervention of the right coronary and right posterior descending arteries. Echocardiography revealed a mobile clot in the LV apex, secondary to subacute myocardial rupture, and a self-contained pericardial haematoma. Therapeutic subcutaneous enoxaparin was commenced for the LV clot. Changes in the size of the haematoma and LV clot were monitored through serial echocardiographies. The patient underwent an uneventful course where there was gradual dissolution of the clot and resolution of the haematoma. This case illustrates the clinical dilemma of administering anticoagulation for LV clot in the presence of a self-sealed haematoma that could have otherwise resulted in cardiac tamponade and LV wall rupture.
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The result of stopping carbimazole p. 133
Omar Yousef Al-Assaf, Hend AlSaidi
DOI:10.4103/hmj.hmj_91_20  
Electrolyte imbalances are a known cause of electrocardiography (ECG) change. We report an ECG change of a known hyperthyroidism patient who stopped his medications. In addition, we discuss the ECG findings and the physiological disturbance that occur.
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A rare primary presentation of crohn's disease: Enterocutaneous fistula with abdominal abscess p. 135
Yazan Ghazi Al Shaikh, Sabah Taha Zaki, Lutfi Rami Kawaf Kalla
DOI:10.4103/hmj.hmj_99_20  
Crohn's disease (CD) is defined as a chronic gastrointestinal tract inflammatory disease which most commonly affects the distal ileum. It might present with a wide range of unspecific symptoms such as diarrhoea, abdominal pain and anorectal pathologies. In this article, we report the case of a 57-year-old man who presented solely with an abdominal abscess associated with low-grade fever. Radiological studies revealed an enterocutaneous fistula and severely inflamed small bowel loops, which were all managed surgically. The patient was stable post-operatively, and final laboratory results confirmed the diagnosis of CD and he was treated accordingly.
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Thromboprophylaxis causing spontaneous bleeds in COVID patients p. 138
Samreen Kidwai, Heena Anuff, Ali Salem, Labib Al-Ozaibi
DOI:10.4103/hmj.hmj_20_21  
COVID-19 is an ongoing pandemic that was identified in December 2019 in Wuhan, China. Patients admitted to the hospital with COVID-19 present with many coagulation abnormalities, precipitating a hypercoagulable state which exposes them to thrombosis for which they receive thromboprophylaxis therapy with enoxaparin. Over the course of this therapy, some patients develop spontaneous bleeding episodes in different regions of the body of varying degrees and sometimes require radiological angioembolisation to control the bleed. This case series sheds light on three patients who were admitted in Rashid Hospital, Dubai, UAE, with COVID-19 and developed spontaneous bleeds. Amongst the three patients, two of them developed retroperitoneal bleed and one patient developed a chest wall haematoma. One of them underwent radiological intervention (angioembolisation), while the other two underwent conservative management and were monitored for haemodynamic changes. There are limited studies demonstrating the correlation between high dose of enoxaparin and bleeding episodes amongst COVID-19 patients. However, we advise the need for further guidelines and data to advocate the relation between enoxaparin and bleeding episodes.
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LETTER TO THE EDITOR Top

Clinicolaboratory and treatment profile of dengue in children: Observations from a tertiary care hospital p. 142
Mahmood Dhahir Al-Mendalawi
DOI:10.4103/hmj.hmj_14_21  
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