The perception of harmful or near harmful threats is expressed and recognized by a feeling of extreme discomfort that is pain. Starting with simple reflex circuits such as contraction or flight to avoid further harm in primitive organisms, evolution provided higher organisms with a complex structure of receptors, transmitters, hormones and nervous systems in order to not only detect harmful or near harmful threat, but also to discriminate quality and intensity of a threatful event as well as to learn how to avoid further exposure and how to behave in order to allow healing and recovery after getting injured. The variety of receptors and transmitters as well as the transmitting inter-neuronal networks are extremely complex and are still not completely elucidated. What is already known of this“nociceptive networks” on the other hand, allows better understanding of the progress and treatment of pathological pain states. By analyzing structure - action relation a variety of new drugs such as receptor agonists and antagonists as well as ion-channel blockers primarily not designed for pain treatment have been proven to be useful in the control of complex pain syndromes. A better understanding of the mechanisms involved in perception and transmission of nociceptive inputs as well as peripheral and central downregulating feedback may help to create individualize analgesic treatment regimens for complicated pain syndromes.

Chronic obstructive pulmonary disease (COPD) is a debilitating and complex disease with an underlying pathology such as asthma. We set out to systematically review existing published research on the prevalence and risk factor of COPD conducted in the United Arab Emirates (UAE). We performed a systematic search in PubMed and Scopus to identify relevant articles. Search limits using the Medical Subject Headings terms were restricted to studies conducted between 2007 and 2016, mainly focussing on the UAE population (both citizens and expatriates). The review yielded eight studies about the 'prevalence and risk factors' of COPD in the UAE, including cross-sectional studies (n = 6), observational population-based study (n = 1) and a prospective, multi-centre, multinational study (n = 1). The COPD prevalence in the studies reviewed ranged from 3.7% to 5.3%. Smoking, male gender, outdoor and indoor air quality, for example, purposely smelling gasoline fumes or car exhaust were the most frequently observed COPD risk factors. COPD is not only a major health concern for health-care bodies but it is also a leading contributor of disability and reduced quality of life in communities worldwide. The study suggests that COPD requires regular follow-up, education and holistic care. Medication compliance with precise focus on using the correct inhaler method is recommended. Longitudinal studies in the future are needed to investigate the determinants and prognosis of this condition.

Aims: The aims of this study were to explore the effect of delayed presentation to a rheumatologist on the clinical outcomes in patients with early rheumatoid arthritis (RA) after 2 years of follow-up and to determine the predictors of failure to achieve therapeutic targets in those patients. Methods: It is a retrospective study; patients were recruited from Dubai Arthritis Registry (DAR). All patients with symptoms of RA <6months, who attended early arthritis clinic and subsequently completed a follow-up of 2 years in the general rheumatology clinic, were included in the study. We extracted clinical and demographic data from DAR. Results: We have enrolled 78 patients with ERA. Their median age was 49 years (interquartile range [IQR]: 34–52) years, 88.5% were female and 5.2% were current or past smokers. The median delay between symptom onset and seeing a rheumatologist was 34 (IQR: 13–71) days. About 75.4% achieved clinical targets at 24 months of follow-up. Seventy per cent had a good response, 14% had a moderate response and 16% had no response. The proportion of non-responder was higher in the delayed group than those who presented early after the onset of symptoms (odds ratio = 2.6, 95% confidence interval: 1.2–5.9 and P = 0.02). Female gender, Anti-Citrullinated Protein Antibodies (ACPA) positive and Disease Activity Score 28 (DAS28) at baseline are independent predictors of achieving clinical targets after 2-year follow-up. Conclusion: Delayed presentation to rheumatologist adversely affects the clinical outcomes in patients with early RA. Indeed, female gender, DAS28 at baseline and ACPA positivity remain independent predictors of achieving clinical outcomes in patients with ERA.

Introduction: Propofol belongs to one of the commonly used intravenous (IV)-inducing anaesthetic agents. However, at least 70% of the patients experience pain on propofol injection. To reduce pain, various methods were tried. A randomised, double-blinded comparative study was done by us. Materials and Methods: A total of 180 patients belonging to American Society of Anesthesiologists Grade 1 and 2, who were for elective or emergency surgery, were randomly divided into three groups. All surgeries were under general anaesthesia. Group 1 was administered 2 ml of 2% IV lignocaine, Group 2 was administered IV ondansetron 2 mg and Group 3 was administered IV ondansetron 4 mg. One-fourth of the total dosage was injected over 5 s, and pain was assessed in the patients during injection of propofol by verbal rating scale. Results: The intensity and incidence of pain were comparatively less with lignocaine and ondansetron 4 mg overall. Even though there was better relief of pain with lignocaine, ondansetron 4 mg along with venous occlusion also reduced propofol injection pain. Conclusion: Ondansetron also can be used as an alternative in relief of pain on propofol injection just like lignocaine.

Introduction: Secondary capsular opacification is prevalent in children after cataract surgery, but for its treatment in children, few options exist. Poor cooperation precludes the use of neodymium yttrium-aluminium-garnet (Nd: YAG) capsulotomy in children. Surgery in the form of membranectomy is mostly resorted to, in case of a thick visually significant posterior capsular opacification (PCO). However, in case of thin PCO in the visual axis, Nd: YAG capsulotomy could act as a non-invasive alternative. Materials and Methods: Medical records of patients aged 1–16 years who underwent YAG capsulotomy under general anaesthesia between January 2007 and December 2016 were reviewed. Here, we present a case series of 18 eyes that underwent Nd: YAG capsulotomy under general anaesthesia at our centre. Eighteen eyes of 14 patients had undergone the laser procedure. All the patients were administered general anaesthesia in the laser room, and the procedure was performed in the sitting position on the slit-lamp laser delivery system. Results: The mean age at primary surgery for cataract was 2.15 ± 2.4 years. Of the 18 eyes, 1 (5.5%) was a traumatic cataract, all others being congenital cataracts. The mean age at Nd: YAG laser capsulotomy was 4.05 ± 2.38 years. The mean pre-procedural visual acuity was 0.654 ± 0.278 logMAR units and post-procedural visual acuity was significantly better at 0.502 ± 0.55 logMAR units, with P = 0.009. Conclusion: This, to our knowledge, is the largest reported series on patients who have undergone Nd: YAG laser capsulotomy under general anaesthesia. Although controversy exists on the positioning of patients during the procedure under general anaesthesia, we have successfully done 14 patients in the sitting position with no anaesthesia-related complications. Nd: YAG laser capsulotomy could be considered as a non-invasive alternative to membranectomy for PCO in children.

Context: Stress produces physical and mental effects that can affect student academic performance, social interactions and overall quality of life. Identification and treatment of stressed individuals are necessary during clinical training. Aims: The purpose of this study was to assess and correlate the perceived stress levels and work load observed in dental students. Subjects and Methods: Students were assessed using the Perceived Stress Scale and Effort-Reward Imbalance questionnaires to evaluate the level of general stress and academic-related work load/satisfaction, respectively. Data was collected before, during and after examinations in students from the third to fifth year of the BDS programme. Results: The perceived stress was correlated primarily with student's effort and commitment, and increased with academic progression. Changes in blood pressure or body temperature did not correlate with stress in a consistent manner. Perceived stress was significantly higher during examination periods while the effort-reward index was higher in students before or after examinations. Few students were classified as being stressed or dissatisfied significantly more than what was considered normal for their peers. Conclusions: Stress experienced by dentistry students may be greatly influenced by their effort and commitment. The level of stress experienced may not be severe enough to produce a physical response that may affect overall health; however, some students may experience periods of stress or dissatisfaction that are significantly higher than the norm and may be at risk of burnout. The stress scores and effort-reward indexes had a tendency to increase with academic progression and with demanding academic periods.

Background: Despite evidence for its efficacy, the use of repetitive transcranial magnetic stimulation (rTMS) to treat major depressive disorder (MDD) remains limited in the Middle East and North Africa. The following study evaluated the efficacy of this therapy on patients diagnosed with MDD attending the Outpatient Clinic at the American Center for Psychiatry and Neurology in Abu Dhabi, United Arab Emirates. Methods: Thirty-three patients with treatment-resistant MDD were treated with rTMS according to the Food and Drug Administration (FDA)-approved protocol. The patients received five treatment sessions per week over a period of 4–6 weeks, and they completed the Patient Health Questionnaire (PHQ-9) before and after the treatment course. Results: We observed a 58% response rate to treatment, with a 30% remission rate of depressive symptoms, consistent with previous studies. Limitations: Our results do not reflect long-term efficacy of rTMS, as post-therapy scores were obtained immediately after treatment. Although significant, the reduction in PHQ-9 scores cannot be generalised due to the relatively small sample size. Future studies could look into specific characteristics of patients for better profiling of rTMS candidates. Conclusion: An FDA-approved protocol involving five weekly sessions of rTMS over the dorsolateral prefrontal cortex was effective in treating MDD. Our secondary finding of lower acceptability rate among patients may indicate the need for shortened treatment duration and comprehensive insurance plans providing coverage for rTMS therapy.

Dengue fever is rare in the United Arab Emirates; the disease can get imported by individuals travelling from endemic areas. Dengue maculopathy is a common cause of visual disturbance, and optical coherence tomography plays a valuable tool in its diagnosis. Dengue-related maculopathy can lead to persistent central or paracentral scotoma in the absence of any other clinical ocular signs. Herein, we report a case of young British female who developed ocular complications of dengue fever following a recent travel to South Asian country.

Kikuchi-Fujimoto disease (KFD) is a rare benign disorder which presents with inflammatory enlargement of the cervical lymph nodes of unknown aetiology. It is more common in young females. Its clinical presentation is quite similar to other infective, malignant and immunological disorders. We report the case of a 25-year-old female with symmetrical polyarthritis along with lymphadenopathy. Arthritis as a presenting feature is quite unusual in KFD which made this case quite challenging and difficult to diagnose.