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   Table of Contents - Current issue
Coverpage
July-September 2019
Volume 2 | Issue 3
Page Nos. 103-181

Online since Monday, July 1, 2019

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REVIEW ARTICLES  

Using insulin clamp technique as part of the perioperative care p. 103
Mazen Hassanain
DOI:10.4103/JNSM.JNSM_45_18  
Operatively induced inflammation has been the focus of many studies to evaluate the most efficient responses and protocols to be used for its control. Insulin has been characterized with nonmetabolic properties and is used as a preoperative anti-inflammatory agent. We reviewed the published evidence in the past 10 years reporting on the use of glucose–insulin-normoglycemia therapy as a potential anti-inflammatory therapy to improve surgical outcomes about tissue trauma, with the challenges and progress attenuated so far. We also portray our experience in the use of insulin therapy on our liver resection patients as well as the significant knowledge gaps that still exist and the need for a multidisciplinary approach to bridge them.
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The incidence rate of metastasis from the primary cutaneous squamous cell carcinoma: A literature review p. 112
Badr Mohammed F. Alotaibi, Mohammed A Kilani
DOI:10.4103/JNSM.JNSM_55_18  
Background: Cutaneous squamous cell carcinomas (cSCCs) are the second highest nonmelanoma skin cancer, commonly targeting the head and neck region. Owing to its rising annual incidence, the actual rate of metastasis from the primary cSCC is needed to be investigated separately to develop more efficient management plans, hence nobly decreasing the incidence rate of metastasis overall. Materials and Methods: We conducted a literature review about the incidence rate of metastasis from the primary (or de novo) cSCC, based on two popular databases (PubMed and Cochrane), excluding different-purpose serving articles, for example, unrelated outcomes, case series, and case reports. Results: The mean incidence rate of metastasis from the primary cSCC is 10% (1.2–16.5). The least mean tumor size reportedly associated with regional and distant metastasis was 1.11 cm, and the least median thickness was 3 mm deep. Most of the metastatic tumors were of T1 stage before metastasis, and all metastases reported in the literature had more than one risk factor at a time. The mean follow-up duration was 4 years. Discussion: About half of the included literature carried a suspicion of selection bias, which threatens both their internal validity by overestimating the actual rate of metastasis and their external validity by seizing the reproducibility of the current evidence. Almost 85% of the metastasis was reported in the regional lymph nodes, while only a few cases involved distant anatomies at the time of diagnosis. This was consistent with other separate literatures. Conclusion: The mean incidence rate of metastasis from the primary cSCC tumors in our literature review is 10%, which is relatively higher than what was reported before in similar reviews. However, a large prospective study needs to be conducted to control and follow the involved prognostic factors, stratify them according to their risk factors, and minimize the risk of the previously reported bias in other reviews.
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ORIGINAL ARTICLES Top

Association of galectin-3 and hypoxia-inducible factor-1α with progression of oral squamous cell carcinoma p. 123
Nadia Attia Radi, Gihan Adel Balbola
DOI:10.4103/JNSM.JNSM_48_18  
Background: Oral squamous cell carcinoma (OSCC) represents more than 90% of all malignancies of the head and neck. Some biochemical and molecular changes in cells precede the establishment of neoplasms, and in this case, the deregulation of various proteins, such as hypoxia-inducible factor-1 and galectins-3 can strongly influence tumor progression through their effects on immunological surveillance, angiogenesis, cell migration, adhesion and cellular response to chemotherapy. Objective: In this study we investigated the association of both HIF-1α and galectin-3 in oral carcinogen. Materials and Methods: Five cases of normal oral epithelial tissues, 15 cases of severe epithelial dysplasia and 40 cases of different grades of OSCC were collected.Immunohistochemical staining for HIF-1α and galectin-3 antibodies were done for all specimens. Results: For both antibodies, statistically, the greatest mean area percent was recorded OSCC, whereas the lowest values were recorded in normal tissue. Conclusions: These results confirm that there is a dynamic regulation of galectin-3 in response to the tumor microenvironment associated hypoxia.
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Possible immunochemical pattern of anti-HCV, HBeAg, HBsAg HBeAb, and HIV-1 p24 in newly infected Mycobacterium pulmonary tuberculosis patients p. 130
Mathew Folaranmi Olaniyan, Ruth Aderibigbe, Temitayo Afolabi
DOI:10.4103/JNSM.JNSM_66_18  
Background: Viral biomarkers in pulmonary tuberculosis (PTB) could be a primary or secondary viral infection to PTB which may depressed immunity or make the patient susceptible to the secondary infection. Aim and Objective: This work was, therefore, designed to determine frequency of anti-hepatitis C virus (HCV), hepatitis B envelope antigen (HBeAg), hepatitis B surface antigen (HBsAg), hepatitis B envelope antibody (HBeAb), and human immunodeficiency virus (HIV)-1 p24 in newly infected Mycobacterium PTB patients. Materials and Methods: Sixty newly infected Mycobacterium tuberculosis patients were recruited from the medical outpatient Department of Baptist Medical center, Saki-Nigeria. The patients were classified into females (30) and males (30) aged 38–79 years. M. tuberculosis was determined in the patients through fluorescence immunoassay, cultivation of sputum sample on Löwentein–Jensen medium, and radiological chest X-ray report. Anti-HCV, HBeAg, HBsAg HBeAb, and HIV-1 p24 were determined in the patients by immunochromatography and ELISA methods. Results: The viral immunochemical pattern obtained in the newly infected PTB patients showed a frequency of: 5% (3) (males - 3.3% [2] and females - 1.67% [1]) anti-HCV; 3.3% (2) (all males - 3.3% [2]) HIV-1 - p24; 15% (9) (males - 3 [5%] and females - 6 [10%]) HBsAg; 9 (15%) (males - 5% [3] and females - 10% [6]) HBeAg; 18.33% (11) (males - 6.7% [4] and females - 11.67% [7]) hepatitis B envelope (HBe) antibody; 3.33% (2) (males - 1.67%[1] and females - 1.67% [1]) HBeAg + HBsAg + HIV-1 - p24. Conclusion: This work revealed evidence of anti-HCV; HIV-1 - p24; HBsAg; HBeAg; and HBe antibody and HBeAg + HBsAg + HIV-1 - p24 in newly infected pulmonary M. tuberculosis-infected patients. Routine evaluation of viral biomarkers in PTB patients is necessary for effective management.
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Pharmacognostic standardization and physicochemical evaluation of Caesalpinia crista L. root for quality control assessment p. 135
Pooja Upadhyay, Bhuwan Chandra Joshi, Ankush Sundriyal, Minky Mukhija
DOI:10.4103/JNSM.JNSM_61_18  
Background: Caesalpinia crista Linn. (Caesalpiniaceae) have been used widely as ethnomedicinal practices and traditional medicine for its medicinal values. Conventionally, the plant was used for the treatment of bladder stone, fever, leucorrhea, as a tonic for rheumatism and backache; there is no published data on standardization of the plant for its authenticity, quality, and purity. Aim: The present study was to scientifically establish a pharmacognostic profile of C. crista root as per standard procedures. Materials and Methods: The investigation deals with comprehensive pharmacognostical parameters were carried out by organoleptic, microscopic characters, physicochemical, and phytochemical studies. Results: The present study provides the general organoleptic, microscopic characteristics of the root. Physicochemical studies revealed total ash (9.20 ± 0.17), acid insoluble ash (1.25 ± 0.11), water-soluble ash (3.1 ± 0.05), alcohol-soluble extractive (11.54 ± 0.46), and water-soluble extractive (12.66 ± 0.24), respectively. Preliminary phytochemical screening of root revealed the presence of carbohydrates, proteins, alkaloids, triterpenoids, glycosides, flavonoids, tannins, diterpenes, glycosides, and saponins. Conclusion: These studies will provide referential information for the correct taxonomical identification, standardization, and establishing monograph of C. crista.
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Investigation of the pharmacognostical, phytochemical, and antioxidant studies of various fractions of Dichrostachys cinerea root p. 141
Rajesh Bolleddu, Sama Venkatesh, MM Rao, Rachamalla Shyamsunder
DOI:10.4103/JNSM.JNSM_56_18  
Aim: The objective of this study was to analyze the pharmacognostical, phytochemical and antioxidant studies of aqueous ethanolic extract, petroleum ether, chloroform, ethyl acetate and butanol fractions of Dichrostachys cinerea root (Veerataru). Materials and Methods: The pharmacognostical studies on D. cinerea root including parameters such as powder microscopy, extractive values, ash values, and fluorescence and the phytochemical studies are established. The aqueous ethanolic extract and all the fractions were screened against few free radicals, such as diphenylpicrylhydrazyl radical, hydroxyl radical, nitric oxide radical and superoxide anion radical. Results: Powder microscopy revealed the presence of lignified crystal fibers, stone cells, and prism-shaped crystals. All the fractions were rich in steroids, flavonoids, phenolic compounds, and carbohydrates. High level of total phenolic content (158 mg gallic acid equivalent/g) and flavonoids (32 mg rutin equivalent/g) was observed in ethyl acetate fraction. Conclusions: It is concluded that the ethyl acetate fraction followed by butanol fraction of D. cinerea root has strong antioxidant potential. Further study is required for the isolation of bioactive component, which may serve as a potent natural antioxidant.
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Bacterial etiology and antimicrobial sensitivity patterns of ear infections at King Abdulaziz University Hospital, Jeddah, Saudi Arabia p. 147
Firas Addas, Mohammed Algethami, Nabeel Mahmalji, Shadi Zakai, Talal Alkhatib
DOI:10.4103/JNSM.JNSM_42_18  
Objective: This study aimed to provide recent data about the causative organisms of ear infection and their antibiotic sensitivity at King Abdulaziz University Hospital. Materials and Methods: This retrospective study involved 160 patients with ear infection collected between March 2010 and February 2016. Ear swabs were investigated by conventional microbiology methods including cultures and biochemical reactions for identification of microorganisms and antibiotic sensitivity tests. Results: Out of total number of cases, 120 (75%) cases were infected by bacteria and 25 (15.6%) were infected by yeast cells. The majority of patients (n = 61, 38.1%) were of the children and young age group (0–17 years). Most of the patients were diagnosed with chronic suppurative otitis media (OM) (n = 73, 45.6%), followed by OM (n = 48, 30.0%), and otitis externa (n = 39, 24.4%). We also found that the most common pathogens cause ear infection were Pseudomonas aeruginosa, Staphylococcus aureus, and yeast cells. Conclusion: Ear infections are known as a mild disease and are usually treated with empiric therapy, and as our study revealed the most common causative agents of ear infections and their patterns of sensitivity and resistance, this will help in the proper selection of empiric therapy and prevention of the emergence of resistant strains.
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The effect of alternating shifts on the quality of life and career satisfaction of emergency physicians in Saudi Arabia: A survey study p. 153
Najla S Ewain, Anas A Khan
DOI:10.4103/JNSM.JNSM_57_18  
Background: The Department of Emergency Medicine (EM) provides critical medical care to patients at all times. Providing medical care, especially at night, has led physicians to work in alternating shifts. Objective: The objective of this study was to determine the effect of alternating shifts on the quality of life and career satisfaction among emergency physicians (EP). Design: This was a multicenter, observational, cross-sectional study. Settings: EM departments of major government and private hospitals in Saudi Arabia. Methods: An e-survey-based study using a structured questionnaire was conducted on 234 board-certified EP in 2017. Data were analyzed using the Statistical Package for the Social Sciences software. Results: Most EM physicians (59.4%) were either satisfied or very satisfied in their career, with a majority (39.7%) admitting that shift alternations influenced their job satisfaction. While 52.6% of the physicians denied that shift alternations caused them to think about leaving EM, about 15% admitted that it is a major factor. Approximately, 40.6% of participating physicians believed that shift alternations moderately impacted their social and family life. About 88.1% of physicians believed that one or more medical conditions are primarily caused or aggravated by shift alternations; only 11.9% reported no direct impact on their health. Female physicians; singles; physicians with children, evening shifts, and higher number of shifts; and physicians with less years of experience reported less satisfaction. Physicians with equal distribution of shift times, older age, and more nonclinical hours or with part-time jobs showed more satisfaction. Conclusions: EM physicians report a moderate-to-major negative impact on their social, family, and healthy life due to the constant alternation of shifts. However, the effect did not cause them to think about leaving EM and most of them had high career satisfaction.
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Emergency Medicine Residents as Teachers: A Survey Pertaining to the Perceptions toward Teaching by Such Residents p. 164
Yasser Abdulkarem Alaska, Mohammad Hazem Alghofili, Mohammed Dhafer Al-Shehri, Hesham Hazem Alghofili, Arthur Isnani, Mohammad Saud Arafat
DOI:10.4103/JNSM.JNSM_71_18  
Background and Aim: There is a current trend for emergency medicine (EM) residents to adopt the role of educators within their given institution. Incidentally, such educational roles have become a part of residency training programs in many training hospitals worldwide. The current study was conducted in order to determine the perceptions of EM residents regarding their role as a teacher. Methods: A validated survey questionnaire was distributed online via Google Forms to all EM residents in six major governmental hospitals in Riyadh, Saudi Arabia. Results: A total of 76 EM residents responded to the survey. Almost 89.5% of these residents (n = 68) did not possess any previous formal training in teaching. Incidentally, 36 (47.4%) residents claimed that their institution required them to undertake a teaching role. Interestingly, a significant portion of residents (76.3%) loved to share their clinical experiences with their students. Conversely, although the majority of the residents (76.3%) felt rewarded on account of their teaching, 28.9% reported feeling stressed when they taught undergraduate medical students. Conclusion: EM residents seemed to embrace their role as teachers and deemed teaching to be a noble part of their job. It would seem, however, that, although residents gain certain benefits from teaching both academically and psychologically, there is a clear need for more in-depth formal training in teaching modalities. The amount of clinical and teaching workload should be balanced to minimize further stress among resident tutors.
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The efforts of health-care professionals in preparing their families for situations requiring first aid p. 171
Sahar Khalid, Anas Khan, Adel Altamimi, Osama Samarkandi
DOI:10.4103/JNSM.JNSM_64_18  
Objective: The aim of the study is to assess the efforts of health-care professionals (HCPs) in preparing their families for situations requiring first aid (FA). We hypothesized that if HCPs are genuinely committed and convinced of the importance of FA, then they will be more likely to share this belief and knowledge and act in a way that will positively affect their family members, social surroundings, and consequently, the community. Materials and Methods: This was a cross-sectional survey conducted in Saudi Arabia from December 2017 to January 2018. The calculated sample size was 384. An online form was uploaded on Twitter to allow any willing HCP to participate. HCPs who responded to the survey were included in the study. Exclusion criteria were being a non-HCP or a HCP from outside of Saudi Arabia. Results: Among 655 participants, 352 (53.7%) taught family members at least one of the FA maneuvers in a detailed manner, including cardiopulmonary resuscitation, seizure or choking management, and control of excessive bleeding. Participants were more inclined to have a positive attitude toward teaching FA if their family members had witnessed a situation, in which a FA intervention was required (250 [38.2%]; P < 0.001). Majority (479, 73.1%) of the participants knew that 70% of out-of-hospital cardiac arrests happen at homes and were significantly more likely to have a positive attitude (P < 0.001). Conclusion: The majority of HCPs have made and contributed to preparing their families for situations requiring FA.
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CLINICO-PATHOLOGICAL PEARLS Top

Extensive unilateral bronchiectasis in a child with 6q22.31 duplication syndrome p. 176
Hatim Hesham Bannani, Ahlam Abdulbari Mazi
DOI:10.4103/JNSM.JNSM_76_18  
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Ewing's sarcoma of the sinonasal tract: A histopathologically challenging case p. 179
Bader Mohammed Alim, Ahmed Saleh Alsaleh, Hanadi Abdulrazaq Fatani, Saad Abdulrazaq Alsaleh
DOI:10.4103/JNSM.JNSM_82_18  
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