From
the Editor
In this issue various papers
from the Region and from Nepal discussed pertinent
issues to primary health care. A retrospective,
non-controlled, observational study was conducted
in the Princess Haya Military Hospital, Royal
Medical Services of Jordan between August 2018
and April 2019. The objective of the study was
to assess the incidence of posterior capsule
rupture, the visual outcome, and complications
associated with clear corneal phacoemulsification
surgery under topical anesthesia and intracameral
lidocaine. Four hundreds files of patients who
underwent clear corneal phacoemulsification
surgery under topical anesthesia and intracameral
lidocaine during the study period were considered
for the research. 216 (54%) patients were males
and 184 (46%) patients were females. Three eyes
of three patients (0.75%) developed ruptured
posterior capsule. The average unaided and best
corrected visual acuity in decimal significantly
improved (p < 0.01). Only Thirty-three (8.25%)
patients developed minor complications. The
authors concluded that Phacoemulsification surgery
under topical anesthesia and intracameral lidocaine
is a safe procedure and is not associated with
sight-threatening complications, it does not
increase the risk of posterior capsule rupture,
and significantly improves the unaided and best
corrected visual acuity.
In Abu Dhabi a descriptive cross-sectional study
was conducted during 2016-2017 using a self-administered
questionnaire. The study targeted both UAE nationals
and non-nationals attending seven clinics that
are located in the Abu Dhabi region. The study
aimed to assess the knowledge, attitudes, and
practice of CAM among people living in the Abu
Dhabi region. Most of the participants were
UAE nationals (75%). Thirty-seven percent of
the respondents reported that to have chronic
disease. The proportions of respondents who
had good, fair, and poor knowledge were 28.4%,
68.6%, and 3%, respectively. Higher education
was associated with better knowledge (P = 0.044).
The sources of CAM knowledge differed according
to certain population characteristics. Educated
people used the internet as a source of knowledge,
whereas patients with chronic diseases obtained
their knowledge primarily from health care providers
(P = 0.02, 0.039, respectively). Ninety-five
percent of the study group used CAM. The most
common practices involved the use of herbs (53.6%),
dietary supplements (44.7%), and honey products;
the least common practices were chiropractice
(9.9%) and cautery (8.6%). The authors concluded
that the use of CAM is increasing in Abu Dhabi
region. The results showed fair knowledge in
most of the participants, and neutral attitudes
toward CAM. Most of our respondents did not
discuss CAM with their primary physicians; however,
80% preferred discussing it with their doctors.
The most common practices were the use of herbs,
dietary supplements, and honey products. Primary
care physicians need to raise awareness about
the benefits and risks of CAM use among the
population, which can be achieved by patient
education regarding evidence-based CAM practices.
A paper from Nepal assessed the communication
practice of physicians when interacting with
patients. A total of 169 interactions were observed.
Mean total score of observed behavior of communication
skill and practice ranged from poor to satisfactory
across category and showed statistically significant
variations. The ANOVA test between groups is
strongly significant (p=0.000). More than three-forth
(78.11%) have given insufficient time (less
than 6 minutes) for consultation. Average interaction
time was 5.26 (SD 2.31) minutes. The mean consultation
time of Interns & Medical Officers is least
(4.36; SD 1.79). Almost half seniors, one third
juniors and 5.8% Interns & Medical Officers
have given sufficient time for consultation.
The study has revealed that history taking skill
and practice is dearth mainly lower level physicians
(medical officers/Interns and Junior faculties).
The consultation time given by physicians was
also insufficient. Thus, hospital authorities
should give attention to improve communication
skills of physicians.
A paper from Iraq look at a novel case series
of Munchausen Syndrome by Proxy Victim. A 35
years old lady, a mother of two daughters (married
18 years old and 3 years old) and a son of (17)
years. She was known to have social and marital
problems and diagnosed as case of depression
and on multiple antidepressants and attempted
suicide for several times. She is using her
6-year-old daughter and her 3-year-grandson
for visiting doctors 4-5 times a week. The reasons
for doctor visiting are different like urinary
tract infection, otitis media, gastroenteritis,
respiratory infections, different kinds of traumas
and etc. The authors concluded that Munchausen
syndrome by proxy is a complex type of abuse,
usually misdiagnosed and under-diagnosed, and
its sequelae have a significant impact.
Helvaci MR et al tried to understand the safest
value of plasma triglycerides according to the
some components of the metabolic syndrome. They
studied 457 cases (266 females and 191 males),
totally. The mean ages of the groups, body mass
index (BMI), and low density lipoproteins increased
just up to the plasma triglycerides value of
200 mg/dL, significantly (p<0.05 for all).
On the other hand, the mean fasting plasma glucose
and prevalence of smoking, white coat hypertension,
hypertension, diabetes mellitus, and chronic
obstructive pulmonary disease increased parallel
to the plasma triglycerides values from the
first towards the fourth groups, gradually.
The authors concluded that plasma triglycerides
may actually be some acute phase reactants indicating
disseminated endothelial damage, inflammation,
fibrosis, and accelerated atherosclerosis with
eventual end-organ insufficiencies all over
the body. There may be highly significant relationships
between plasma triglycerides values and aging,
BMI, and smoking. Interestingly, the greatest
number of deteriorations of the components of
the metabolic syndrome was observed just above
the plasma triglycerides value of 100 mg/dL.
Chief Editor:
A. Abyad
MD, MPH, AGSF, AFCHSE
Email: aabyad@cyberia.net.lb
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