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June 2020 -
Volume 18, Issue 6

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From the Editor



Original Contribution

Lean processes mapping of diabetic patient flow in primary healthcare centres in Kuwait highlights opportunities for fewer patient visits
Hisham Kelendar, Muhammad Faisal, Mohammed A Mohammed
DOI: 10.5742MEWFM.2020.93814

The Survey of primary care physicians about their comprehension of HBA1C , and their understanding of the common medical conditions that can affect the accuracy of HBA1C
Husam Al Saudi , Fazila Khattak
DOI: 10.5742MEWFM.2020.93815

Prevalence of Type 2 Diabetes in a Rural Population of AbuNakhla, Doha, Qatar
Mir Saad Hussain , Nusrat Nizamani
DOI: 10.5742MEWFM.2020.93816

Get Acquainted with the Secret "Its Duration And Not The Type Of Contact That Matters In COVID-19"
Hamzullah Khan, Mian Mohammad Naveed, Ghazan Khan, Mohammad Zahid Khan, Abu Zar, Fazli Bari
DOI: 10.5742MEWFM.2020.93817

The most desired values of high density lipoproteins in the metabolic syndrome
Mehmet Rami Helvaci, Abdulrazak Abyad, Lesley Pocock
DOI: 10.5742MEWFM.2020.93818

Population and Community Studies

Effects of Touch and Massage Care in Advanced Alzheimer Patient: A Pilot Case Report
Emi Miki
DOI: 10.5742MEWFM.2020.93819

Do tourists suffer from depression and anxiety disorders?
Yahia Mater AlKhaldi
DOI: 10.5742MEWFM.2020.93820

Identifying depression symptoms among general population living in conflict zone In Jammu And Kashmir
Anood Tariq Wani, Tafazzul Hyder Zaidi
DOI: 10.5742MEWFM.2020.93821

Knowledge, Attitude and Practice of Stethoscope Disinfection Among Health Care Providers in Karachi
Kanwal Jamal, Muhammad Waqaruddin Sheroze, Syed Tafazzul Hyder Zaidi, Rabisa Batool,
DOI: 10.5742MEWFM.2020.93822


World Perspective of Divorce in Selected Countries: A Sociological Appraisal

Mohammad Taghi Sheykhi
DOI: 10.5742MEWFM.2020.93823

Parkinson's Disease: An update on Pathophysiology, Epidemiology, Diagnosis and Management. Part 2 : Etiology and Pathophysiology
Abdulrazak Abyad
DOI: 10.5742MEWFM.2020.93824

Case Study

Anti-TNF-a drug-induced lupus: A Case Report
Abdulaziz Saad Alshahrani
DOI: 10.5742MEWFM.2020.93825

Middle East Quality Improvement Program

Chief Editor -
Abdulrazak Abyad MD, MPH, MBA, AGSF, AFCHSE


Publisher -
Lesley Pocock
medi+WORLD International

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The contents of this journal are copyright. Apart from any fair dealing for purposes of private study, research, criticism or review, as permitted under the Australian Copyright Act, no part of this program may be reproduced without the permission of the publisher.

June 2020 - Volume 18, Issue 6

From the Editor

This issue has a variety of papers from Japan, Saudi Arabia, Pakistan, Qatar, Kuwait, Turkey, Iran, Australia and Lebanon.

Kelendar H et al., used a descriptive exploratory approach in the modality of a case study through semi-structured interviews with thirteen staff involved in the care of PWT2D in four Kuwaiti primary healthcare centres. The aim is to map the flow of patients with type 2 diabetes (PWT2D) without any complications in primary care, identify potential waste and make recommendations for improvement. Staff acknowledged waste as non-standardised clinical practice, delays, waiting times and unnecessary patient visits. Four potential improvements were identified which could be consolidated into a single visit: using point of care testing, the posting of laboratory results to GP computer systems, the introduction of guidelines that standardise the practice for the patient's visit and permitting the GP to prescribe four months of medication. The authors concluded that the process map of PWT2D has highlighted waste and improvement suggestions that may reduce workload, enhance patient satisfaction, avoid unnecessary visits, enhance the timeliness of laboratory testing, improve communication between and across departments and minimise use of resources without undermining the quality of care. These suggestions need to be implemented and rigorously evaluated.

Miki, E et al., reported on the Effects of Touch and Massage Care in Advanced Alzheimer Patient. The patient was a woman in her late 80s with the most severe level of care need and dementia due to AD. Once a month during 5 months, unscented jojoba oil was applied to the patient's hands while she was seated on a wheelchair with her hands on a table, and she received 10 minutes of touch and massage care on each hand, for a total of 20 minutes. Salivary amylase activity was measured just before and immediately after every intervention session as a non-invasive indicator which reflects psychological stress. The average salivary amylase values before and after the 5 times that the patient received the touch and massage care were 185.6 KIU/L (SD = 44.5) and 112.8 KIU/L (SD = 38.3), respectively. A significant decrease was observed (P = 0.043). As for the patient's appearance during the sessions, when she was helped to move her arms onto the tabletop, her arms and legs sometimes stiffened, and she flexed them intermittently, however, the stiffening diminished after the massage began. The authors concluded that since this was a pilot case study with a single patient, the results cannot be generalized. However, the study showed that touch and massage care could provide pleasant stimulation for an advanced AD patient with verbal communication difficulties and offered the possibility of reducing physical and emotional stress; therefore, it provides important clues for the future occupational therapy intervention and care of advanced AD patients.

Al Saudi H et al., surveyed primary care physicians about their comprehension of HBA1C , and their understanding of the common medical conditions that can affect the accuracy of HBA1C. Although the test is simple and straightforward, but not, in reality health care professionals needs to be very vigilant and critical when interpreting values of HBA1C as HBA1C is affected by many other medical conditions and medications, and most of these medical conditions co -exits with Diabetes melilites or develop as a result of diabetes itself.

In this research we did a cross sectional study among family physicians working in primary health care corporation Doha, Qatar to see the awareness and understanding of the different medical conditions that can affect the accuracy of HBA1C levels and to see if the physicians are aware of any alternative bio marker other than HBA1C,that is reliable in conditions in which HBA1C could not be accurately used.

Hussain & Nizamani conducted a cross sectional study, gathering total number of patients registered with T2DM at AbuNakhla health center, Doha, Qatar. The study aims at looking at the prevalence of T2DM in a small rural population of AbuNakhla, Doha, Qatar with age and gender distribution. The results showed high disease burden in local population of AbuNakhla. Around 51% patients with T2DM are under the age of 50 years, out of which 10% are under the age of 35 years. Also, the number of females with T2DM is quite high under the age of 35 years. Around 49% patients are above the age of 50 years. The authors concluded that there is a high diabetes prevalence in AbunAkhla, Doha Qatar. Prevalence is higher in younger age group i.e under 50 years with a rapid rise in prevalence in age group 36 to 50 years for both males and females.

Dr AlKhaldi Y. M did a cross sectional study to explore the prevalence of depression and anxiety among tourists in Asser region, KSA. The mean age of the participants was 31±12.5 years, women represented 56%, and 53% were married. More than one two-third (61%) complained of physical symptoms, i.e. chronic headache (14%), chronic joint pain (12%), IBS (10%), and chronic back pain (9%). More than two-thirds had depression (68.9%), ( 59.5%) have GAD, while both disorders affect ( 28.4%). Mild depression affects(30.4%), moderate depression (19.8%), while severe depression reported among (18.7%). Moderate to severe anxiety were more in women (30.3%) compared to men (20.9%) with a significant difference (p-value = 0.018).

Dr. Jamal, et al, conducted a cross sectional study, conducted among medical students, trainee and resident doctors of Jinnah Sindh Medical University and Jinnah Postgraduate Medical Centre respectively from July 2019 to December 2019. The aim was to assess the knowledge, attitude and practices regarding stethoscope disinfection among students, trainee and residents doctors at Jinnah Postgraduate Medical Center. Their study concluded that there is a lack of practice by medical providers to disinfect their stethoscope in spite of considering stethoscope as potential vector for nosocomial infection. Therefore measures should be taken to elevate practice of stethoscope disinfection to reduce the nosocomial infection effectively.

Alshahrani A.S, reported a rare presentation of ATIL with hepatitis for a woman who has Crohn's disease and was treated with infliximab for 9 months. She had clinical and biochemical improvement after discontinuation of infliximab and starting steroid therapy. The authors concluded that treatment with Infliximab may cause a lupus-like syndrome, which can be reversed upon its discontinuation.

Khan, H., et ., attempted to quantitatively analyze the impact of type of contact and duration of contact with infectivity of novel corona virus. They analyzed 378 suspects/cases to prove our null hypothesis. Relevant information's were recorded on a predesigned proforma prepared in accordance with the objective of the study in SPSS. History of contact with positive COVID-19 patients was contributing in 35/41(85.36%) confirmed cases. We observed that 25/41(60.97%) of the positive cases had a contact history > 5 days. The authors concluded that it is the duration of contact and not the type of contact that has a statistically significant correlation and a higher probability of exposure to COVID-19.

Wani, & Zaidi conducted a study in Jammu And Kashmir examined the prevalence of posttraumatic stress disorder (PTSD) symptoms, depression, and coping mechanisms among the adult civilian population in Indian Kashmir. The Everstine Trauma Response Index-Adapted, the Beck Depression Inventory, and the Coping Resources Inventory were used to assess the three domains. Independent-sample t tests were used between the directly and indirectly traumatized groups to explore each of the five hypotheses of this study. The results showed significant differences for all of the hypotheses. The implications of the study are discussed and recommendations given to address the mental health situation of the victims.

Helvaci et al., reports the most desired values of high density lipoproteins in the metabolic syndromee tried to understand the most desired values of high density lipoproteins (HDL). Patients with plasma HDL values lower than 40 mg/dL were collected into the first, lower than 46 mg/dL into the second, lower than 50 mg/dL into the third, and 50 mg/dL and higher into the fourth groups, respectively. The authors concluded that the highest mean age, female ratio, BMI, FPG, WCH, HT, and DM parallel to the highest HDL and LDL, and the highest CHD in contrast to the lowest HDL and LDL values may show initially positive but eventually negative acute phase proteins functions of HDL and LDL. Due to the lowest mean age, female ratio, BMI, FPG, WCH, DM, and CHD, the most desired values of HDL may be between 40 and 46 mg/dL in the plasma.

Sheykhi, M.T., investigates the quality and quantity of divorce event taking place all over the world more than any time before. While divorce is an stigma in one society, it is a regular norm in the other. Divorce is being facilitated all over the world due to modernization and industrialization in process, and the outcome of social change. Sociologists must be quite vigilant to the phenomenon which is breaking families and creating social problems of all sorts. However, it is the sociology that can judge and assess the demerits of divorce. Many of the apparent social issues emerging such as drug abuse, child labor, criminal behaviors and many more, are somehow or the other associated with divorce. Method of research used in the present article is of qualitative type, and the article eventually concludes that the outcome of divorce is widely different in sociological terms affecting both parties of parents as well as children to a greater extent.

The second part of the review on Parkinson's disease discussed the etiology and pathophysiology of the disease. Parkinson's disease is a common neurodegenerative disorder which involves the loss of nigral dopaminergic neurons in particular. The cause is uncertain but there is growing evidence that this could be due to a combination of ecological and hereditary factors.

Chief Editor:
A. Abyad