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   Table of Contents - Current issue
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July-December 2019
Volume 4 | Issue 2
Page Nos. 31-88

Online since Tuesday, July 30, 2019

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REVIEW ARTICLE  

Genotoxic burden of water pipe smoking in arabian countries: The risk in female population Highly accessed article p. 31
Dhafer Mahdi Alshayban, Faheem Hyder Pottoo, Muhammad Tariq Aftab
DOI:10.4103/ijas.ijas_6_19  
The perception that water pipe smoking (WPS) is safe mode of smoking is biased; the purpose of this study was to review literature for genotoxic effects of WPS and associated vital organ damage. The amount of nicotine, polycyclic aromatic hydrocarbons, carbon monoxide, tar, and heavy metals delineated after prolonged exposure to WPS exceeds that reported for cigarette smoking (CS). WPS is related to diverse adverse health consequences on cardiovascular, respiratory, hematological, and reproductive systems without sparing infants who are reported to born with reduced birth weight and length from exposed mothers. WPS causes significant reduction in mRNA expression levels of DNA repair genes (OGG1 and XRCC1) compared to CS and predisposes to heightened risk of developing bladder cancer, lung cancer, prostate cancer, and pancreatic cancers. Education about the harmfulness of WPS and policies to limit its use should be implemented, particularly in females (Graphical Abstract). [INLINE:1] Graphical Abstract
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ORIGINAL ARTICLES Top

Quality of care: A strong predictor of treatment compliance in hypertensives p. 39
Mariyam Khwaja, Mohd Athar Ansari, Saira Mehnaz
DOI:10.4103/ijas.ijas_8_19  
Context: Many countries have reported <25% of patients treated for hypertension achieve optimum control despite the availability of effective treatments. Poor compliance to treatment forms the main reason of uncontrolled blood pressure. Strategies for improving accessibility and affordability of drugs have an important influence on compliance particularly in poor sections of the population. Aims: This study aims (1) to determine the impact of health care and provider factors on compliance to hypertension treatment and (2) to suggest measures for the removal of the identified barriers. Settings and Design: This was community-based cross-sectional study conducted in urban and rural areas in Aligarh. Subjects and Methods: A total of 356 hypertensive patients were selected using simple random sampling. A pretested semi-structured questionnaire was used for the study. Compliance was measured by Morisky 8-item Medication Adherence Scale. Statistical Analysis Used: Analysis was done using proportions and Chi square test in SPSS (Statistical Package for the Social Sciences) software version 20.0. It was developed initially in 1968. It was acquired by IBM in 2009. The current versions (2015) are named IBM SPSS Statistics. Results: Easy accessibility and affordability of drugs were found to be significantly associated with treatment compliance. Long clinic waiting time and dissatisfaction with relation with physician were some other reported barriers to treatment compliance. Conclusions: An uninterrupted supply of medicines; sustainable financing, affordable prices, and reliable supply systems can help the poor sections of the society and improve compliance. Universal access of health-care services is another area to be emphasized, especially in the outreach areas.
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How to reduce no-show in pain clinic? p. 45
Rabah Alharbi
DOI:10.4103/ijas.ijas_9_19  
Background: Failure to attend scheduled appointments in the outpatient clinic represents a challenge to health care. Almost quarter billion dollar was lost in the United Kingdom in 2001; Saudi Arabia has 29.5% “no-show” rates, and these findings are encouraging to explore the reasons and to implement strategies to improve attendance. Moreover, we found 0.12% reduction in no-show, 1 month after using phone call reminder associated with the application of strategies to increase attendance rate used in similar work. Context: To identify reasons of no-show and to use strategy to decrease the substantial no-show rates. Aims: This study aimed to minimize significant loss of time and money and to decrease the dissatisfaction and worsening of patient's clinical outcome. Settings and Design: The study was conducted in pain management clinic in King Abdulaziz Medical City National Guard Hospital, pain clinic, staffed by one consultant, one staff physician, one fellow and two nurses, and one patient service coordinator, responsible for answering phone calls and booking appointments; patient receives phone call 2 days prior to their scheduled appointment by obtaining their contact number from Bestcare® health information system. Data of all patients booked from the begging of August to the end of October 2017 were collected and analyzed, and no show rate was calculated by dividing the number of no show to the number of all booked appointments, showing that a mean average in 3 months of 100 visit per month, with a mean average of no show within 3 months of 0.34% no show rate. Subjects and Methods: Contact information of all patients who had been booked in the month of November 2017 were collected; we applied strategy for all phone calls. First, we identified if the patient had answered or not and if he/she has answered a welcoming and orientation statement was used (i.e., who we are and why we are calling and where is exactly our clinic and the time of the appointment). Second we have to identify that the answering is either the patient or the caregiver to avoid breaching the confidentiality. Third we identified the appointment status if the patient is attending or not, and finally. Fourth we used verbal contract to inform the patient or the caregiver that in case of failure to show-up; patient might be discharged from the clinic to decrease the waiting list which can lead to further health deterioration of other patients. Results: Total no-show has decreased from 0.34% to 0.22% within 1 month of implementation. Conclusions: Significant strategies can be applied to enhance attendance rate implemented through telephone call which led to 0.12% reduction of no-show in 1 month compared to 3 months average no-show rate.
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Patient health monitoring system based on zigbee communication protocol p. 49
Mohanad Abdulhamid, Kiprono Victor
DOI:10.4103/ijas.ijas_11_19  
This study presents a review of ZigBee communication protocol and a wireless sensor network (WSN) for monitoring patients' physiological conditions continuously using ZigBee communication protocol. The physiological conditions monitored are body temperature and pulse rate. The body temperature and pulse rate are monitored by ZigBee sensor nodes for each patient, and the output is transmitted via ZigBee communication protocol to a ZigBee base node. A peer-to-peer network topology is implemented with three ZigBee sensor nodes and a ZigBee base node. The observed physiological signals are then sent from the ZigBee base node to a remote wireless monitor hosted in a personal computer via a universal serial bus. The remote wireless monitor is made of a web server and web interface. The medical attendant can then simultaneously monitor remotely multiple patients from one patient monitoring station.
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Prevalence of hypocalcemia, its correlation with duration of phototherapy and persistence in healthy term newborns after intensive phototherapy: A prospective observational hospital-based observational study p. 57
Jehangir Allam Bhat, Sajad Ahmad Sheikh, Zubair Ahmad Wani, Roshan Ara
DOI:10.4103/ijas.ijas_2_19  
Aims and Objectives: The aim is to study the prevalence of hypocalcemia, its correlation with duration of phototherapy and its persistence in health new-borns after intensive phototherapy. Materials and Methods: A prospective hospital-based observation study was conducted on 380 newborns who received intensive phototherapy in Neonatal intensive care unit (NICU). Pre, post, and at the 10th day after phototherapy calcium levels were estimated in the study neonates. Neonates were observed for clinical manifestations of hypocalcemia during phototherapy treatment and up to 10 days after discharge from hospital. All the data were collected and analyzed for statistical significances in relevant software. Results and Observations: Prevalence of hypocalcemia in this study was 12.63%. Only two infants developed symptomatic hypocalcemia. Statistically significant (P < 0.001) decrease in calcium levels were recorded between pre- and post-phototherapy. However, there was no statistical change in calcium levels when prehototherapy and at the 10th day after phototherapy calcium levels were compared and no baby developed clinical manifestations of hypocalcemia during observation for 10 days. Thus, phototherapy-induced hypocalcemia is short lived without any long-term effect. Duration of phototherapy has negative but not significant correlation with phototherapy-induced change in calcium levels. Conclusion: To conclude, there occurs significant asymptomatic phototherapy-induced hypocalcemia, correlation of this hypocalcemia with duration of phototherapy is negative but insignificant and effect of phototherapy-induced hypocalcemia on long-term outcome of neonates is nil. Thus, calcium therapy is not required in hypocalcemia associated with phototherapy, because it is asymptomatic and recovers of its own.
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Compliance level of textual therapeutic usage of kakoli-containing formulations with ethnomedicinal survey and modern system of medicine p. 62
Gunpreet Kaur, Vikas Gupta, Sanjiv Kumar, RG Singhal, Mukesh Maithani, Parveen Bansal
DOI:10.4103/ijas.ijas_1_19  
Study Background: Roscoea purpurea (Kakoli) is a wonder plant used by Saints/Rishies since ages, however, entered the list of plants facing extinction due to enumerable reasons. Ancient texts claim very potent uses of kakoli-containing formulations, but the information is available in regional languages and hence the real usages of the plant are not well understood by scientific fraternity. Hence, it becomes important to know the real status of the mentioned therapeutic potentials as well as practiced potentials by tradomedical practitioners. Hence, the major objective of the work was to conduct the ethnomedicinal survey for intended formulations and compares it with therapeutic usage mentioned in text/modern system of medicine. Materials and Methods: A field survey was conducted in Himachal Pradesh, Punjab, Uttrakhand, and Uttar Pradesh followed by discussion with 18 shopkeepers, 24 local medical practitioners, and 4 traditional healers. The information regarding usage of these formulations were recorded and compared. Results: Results showed that usage of formulations containing kakoli was highest in Himachal Pardesh and Uttrakhand. Only few clinical studies have been done by scientists on these formulations. Conclusion: The efficacy of the remedies alluded by the respondents claimed to be exact as per the Ayurvedic textual literature. This survey provides a template for scientists for further screening and research on these formulations useful in plethora of disorders.
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Prevalence of hemolytic antibodies among blood donors in owo, Southwest Nigeria p. 69
Musa A Muhibi, Olabanke I Dada, Kolawole A Fasakin, Obiageli W Onwurah, Mulikat O Muhibi, Busira A Tijani, Zacheus A Jeremiah
DOI:10.4103/ijas.ijas_3_19  
Background: One of the dangers of blood transfusion is the introduction of lethal substance like potent hemolysins into a blood unit's or product's recipient, in a heterologous transfusion practice. The prevalence of alpha (α-) and beta (β)-hemolysins among blood donors in Owo, was investigated. Materials and Methods: A volume of 4 ml of blood samples was collected from 300 consenting Groups A, B, and O donors who had been screened and accepted as donors. About 400 μl of donor serum was added into three test tubes labeled A, B, and O. To each tube, 200 μl of 5% red cell suspension of Groups A, B, and O were added, respectively. The standard O cell suspension was used as negative control. The tubes were then incubated at 22°C–25°C for 1 h, after which all tubes were centrifuged. They were then held before a source of light, and with minimal disturbances and the supernatant was examined macroscopically for hemolysis. Results: Of 300 donors recruited, frequencies of A, B, and O groups were 20%, 26.6%, and 53.3%, respectively. Among the donors, hemolysin was present in 32, translating to 10.67% prevalence. Among the 32 donors with hemolysins, the percentage obtained for the age groups 20–25, 26–30, 31–35, and 36–40 was 43.75%, 25.0%, 18.75%, and 12.5%, respectively. The distribution of α-hemolysin, β-hemolysin, and α+β-hemolysin was 14, 6, and 6 for male, whereas female recorded 2, 4, and 0, respectively. Conclusion: The results obtained suggest that there is low prevalence of hemolysins among blood donors in Owo. Although hemolysin status is not a limiting factor in the donation of blood, it becomes one when it comes to blood units' and products' selection and transfusion into patients in the hospital. It is recommended that homologous transfusion is practiced as a priority, while hemolysin-positive units should never be considered for heterologous transfusion.
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Prevalence of gallbladder cancer in patients with cholecystectomy in Saudi Arabia, cross-sectional study p. 74
Mohammad Bukhetan Alharbi
DOI:10.4103/ijas.ijas_4_19  
Background: Gallbladder cancer, well despite the fact that it is rare, it is the most common malignancy of the biliary tree. However, preoperative abilities to diagnose the disease are still limited. Thus, variability in prevalence globally is obvious. Materials and Methods: Cross-sectional study was done to assess the prevalence of surgically removed gallbladder from February 2007 to August 2018 which was collected from 1085 patients in a community hospital in Gurayat Hospital, situated along the northern border. Results: The prevalence of gallbladder cancer was 0.2%. The mean age was 38.4 years. 96 (8.9%) patients were with acute cholecystitis, 107 (9.9%) with acute on chronic cholecystitis, 10 (0.9%) with gangrenous cholecystitis, and 872 (80.3%) patients with chronic cholecystitis. Conclusion: The prevalence of gallbladder cancer which is discovered at cholecystectomy is rare in Saudi Arabia.
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Severe alopecia areata: Analysis of treatment outcome p. 78
Thamer Mubki, Rasha Zainalabidin
DOI:10.4103/ijas.ijas_13_19  
Problem Statement: Data on treatment options in severe alopecia areata (AA) are limited. All available therapies are currently off-label. Choosing the best therapy could be challenging. Materials and Methods: Medical records of a cohort of 55 patients with severe AA, involving >40% of scalp, including totalis and universalis who were started on topical or systemic therapy, were reviewed for efficacy and safety data. Response to therapy was evaluated using changes in the validated Severity of Alopecia Tool (SALT). SALT50 was defined as 50% regrowth and was regarded as a treatment success. Results: Thirty-two patients met the study inclusion criteria. Mean treatment duration was 11.4 months. 78% of patients had AA for >1 year. 41% had AA totalis/universalis. 53% achieved SAL50 using the described treatments. However, only 38% of AA totalis/universalis achieved SALT 50 as compared to 62% of patchy type (P = 0.148). SALT50 was achieved in 27% of patients using anthralin, 30% with diphenylcyclopropenone acetate, 28% with intralesional steroid injection, and 56% using tofacitinib. 55% of patients who used minoxidil 5% achieved SALT50 compared to only 40% of those who did not use it (P = 0.026). Conclusions: Treatment of severe AA is possible. More than 50% of cases may respond to therapy. AA totalis/universalis may, however, respond less favorably than the patchy type. Tofacitinib, and possibly other Janus kinase inhibitors, is very promising therapies for severe cases. Minoxidil 5% solution was significantly associated with better response to therapies in severe AA cases.
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CASE REPORT Top

A novel homozygous point mutation and deletion in exon 3 of growth hormone receptor causes laron syndrome: A case study p. 83
Mosleh Jabari
DOI:10.4103/ijas.ijas_5_19  
Laron syndrome is mainly an autosomal recessive disorder that is caused by the body's inability to utilize the growth hormone (GH) secreted by the pituitary gland. As the name suggests, GH is an important hormone that regulates the overall growth of the body throughout the lifetime of an individual. GH exerts its effect on binding to the GH receptors (GHRs), which thereby initiate a signaling cascade resulting in the production of insulin-like growth factors (IGFs). Clinically, individuals with Laron syndrome harbor mutations in the gene encoding GHR, which results in normal to high serum GH levels, negligible or no IGF1 production, low levels of GH binding proteins, hypoglycemia, and high insulin sensitivity. Physically, these individuals have short physical stature (dwarfism), obesity, hypogonadism (in males), protruding forehead and saddle nose, blue sclera, and high-pitched voice (in females). GHR mutations that cause the various anomalies associated with Laron syndrome generally occur within introns, exons, or splice sites. Here, we report for the first time, a combination of a homozygous point mutation (Cys119Phe) and a deletion within exon 3 in a 3-year-old boy from Saudi Arabia who was evaluated as having Laron syndrome. The boy is currently being treated with IGF1 therapy.
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