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From the
Editor
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Chief Editor:
A. Abyad
MD, MPH, AGSF, AFCHSE
Email: aabyad@cyberia.net.lb
This issue of the journal has a number of research
papers from the region. A paper from Saudi Arabia
evaluates the sensitivity of urine dipstick
analysis as a screening test in predicting UTI
in symptomatic adults in the primary care setting.
Urinary tract infection (UTI) is a common clinical
problem in the primary care. Urine dipstick
analysis is a quick, cheap and a widely used
test to predict UTI in clinically suspected
patients. A total of 420 culture-positive urine
samples from patients with symptomatic UTI,
and had dipstick urinalysis in a primary care
center were the subjects of this study. The
sensitivity of urine dipstick nitrites (NT),
leukocyte esterase (LE) and blood was calculated
and compared with positive culture samples either
individually or in combination. The sensitivity
of dipstick NT alone was the lowest of all tests
(20.7%), while LE alone was little higher than
NT (31.42%), whereas dipstick blood test when
considered alone was the highest sensitive (61.9%).
On combination, NT and/or LE were marginally
higher than either test alone (41.2%), while
NT and/or blood were (64.5%).The highest sensitivity
of dipstick is obtained when all the three parameters
are considered together (81.4%). The authors
concluded that Dipstick NT, LE, and blood are
poor screening tests when used individually.
Dipstick sensitivity significantly increases,
and it could be considered a good screening
test to predict UTI in symptomatic adults in
the setting of primary care when its three components
are considered together. However, negative dipstick
analysis should not rule out UTI in symptomatic
adults, and urine culture is necessary for accurate
diagnosis.
Intussusception. The authors stressed that
Intussusception is a rare potential adverse
effect of oral rotavirus vaccination, estimated
to occur in approximately 1 in 100,000 vaccine
recipients. The patient is a six-months old
boy presented with vomiting for 3 days, colicky
abdominal pain, and did not pass stool for one
day prior the admission. No seizure, no cough,
no jaundice, no skin/joint/ bone complications.
History of similar condition 2 months ago at
age of 4 months (one week following his scheduled
vaccination which contains Rota vaccine). Physical
examination; lethargic, afebrile with stable
vital signs, abdomen was soft lax and not distended
and no palpable mass. Per rectal (PR) examination
was blood stained. He was diagnosed with intussusception.
Laparotomy resection of 6 CM of terminal ileum
15CM away from ileocaecal valve with appendectomy.
The authors concluded that although the reported
vaccine-induced intussusception every now and
then , The overall risk benefit balance of vaccines
remains positive So World Health Organization
(WHO) and the Australian Technical Advisory
Group on Immunization (ATAGI) have recommended
the continued use of rotavirus vaccine for infants
as it reduce annual hospital admissions in children
under 5 years due to rotavirus gastroenteritis.
A paper from Turkey looked at Accelerated atherosclerosis
and digital clubbing in sickle cell diseases.
The authors stressed that Sickle cell diseases
(SCDs) are chronic destructive processes mainly
on the capillary endothelium. We tried to understand
significance of digital clubbing in severity
of SCDs. All patients with SCDs were taken into
the study. The study included 397 patients (193
females). There were 36 cases (9.0%) with digital
clubbing. Male ratio was significantly higher
in the digital clubbing group (66.6% versus
49.8%, p<0.05). The mean white blood cell
counts of peripheric blood were similar in both
groups (p<0.05). On the other hand, the mean
hematocrit value and platelet count of peripheric
blood were lower in the digital clubbing group,
significantly (p= 0.001 and p= 0.012, respectively).
Beside that, prevalence of leg ulcers, pulmonary
hypertension, chronic obstructive pulmonary
disease, coronary heart disease, cirrhosis,
and stroke were significantly higher in the
digital clubbing group (p<0.01 for all).
There were 25 mortalities during the period,
and 13 of them were males. The authors concluded
that SCDs are chronic destructive processes
on endothelium particularly at the capillary
level, and terminate with accelerated atherosclerosis
induced end-organ failures in early years of
life. Probably digital clubbing is one of the
terminal consequences of the SCDs indicating
significantly shortened survival in such patients.
A Cross sectional study from Dubai and Saudi
Arabia assessed the components of self monitoring
blood glucose among patients with type 2 diabetes
attending primary health care service and its
relation to glycemic control. One hundred and
seventy eight (178; male 72, female 106) were
randomly selected from our diabetic registry.
All selected patients were having type 2 diabetes.
Data was collected through designed questionnaire.
The three components of the glucose self monitoring
system was assessed. One hundred and seventy
eight - 178; (40.04% male vs 59.56% female).
Eighty eight (88 subjects) were illiterate (49.4%)
and most of them were female (38.9% male vs
56.6% female). In the male group only 77.7%
had glucometers while In female group only 52.8%
had glucometers (P value <0.0001). in male
group only 61.1% know how to operate the SMBG
while only 39.6% of female group can do (P value
<0.00001).In male group only 33.3% stated
that they knew the targets of glucose monitoring
while it was 68.8% in female group (P value
<0.00001) . Only 55.5% of male subjects had
the three components of proper home glucose
self monitoring while 56.1% (P value 0.036).
The authors concluded that Lack of proper structured
education presented by educators and illiteracy
may explain the bad glycemic control in our
study sample. Further large studies were recommended
A double blind study from Lebanon examined
the efficacy and safety intramuscular vitamin
B12 (Tricortin 1000) in the treatment of low
back pain in patients with mechanical lumbago.
A total of 120 patients aged between 18 and
65 years with lumbago or sciatic neuritis of
mechanical origin without need for surgical
procedures were enrolled. Patients had to present
with a proven medical history for back pain
(lasting from 6 months to 5 years). Both treatment
groups experienced a sharp decrease in pain
and disability. However, comparison between
groups at the end of the treatment period showed
a statistically significant difference in favour
of the active treatment). In addition the use
of paracetamol proved significantly higher in
the placebo group than in the active treatment
(p < 0.0001). The author concluded that the
efficacy and safety of parenteral Vitamin B12
in alleviating low back pain and related disability
and in decreasing the consumption of paracetamol
was confirmed in patients with no signs of nutritional
deficiency.
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