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Strongyloides hyper-infection causing life-threatening gastrointestinal bleeding

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World Journal of Gastroenterology 2006年第39期12卷 6401-6404页

作者： Lajos Csermely Hassan Jaafar Jorgen Kristensen Antonio Castella Waldemar Gorka Ahmed Ali Chebli Fawaz Trab Hussain Alizadeh Béla Hunyady County hospital Zalaegerszeg Hungary tawam hospital Al-Ain Abu Dhabi United Arab Emirates First Department of Medicine University of Pécs Hungary Correspondence to: Professor Béla Hunyady MD PhD DSc

A 55-year old male patient was diagnosed with strongy- loides hyper-infection with stool analysis and intestinal biopsy shortly after his chemotherapy for myeloma. He was commenced on albendazole anthelmintic therapy. After initiation of the treatment he suffered life- threatening gastrointestinal (GI) bleeding. Repeated endoscopies showed diffuse multi-focal intestinal bleeding. The patient required huge amounts of red blood cells and plasma transfusions and correction of haemostasis with recombinant activated factor Ⅶ. Abdominal aorto-angiography showed numerous micro- aneurysms (‘berry aneurysms’) in the superior and inferior mesenteric arteries’ territories. While the biopsy taken prior to the treatment with albendazole did not show evidence of vasculitis, the biopsy taken after initiation of therapy revealed leukoclastic aggregations around the vessels. These findings suggest that, in addition to direct destruction of the mucosa, vasculitis could be an important additive factor causing the massive GI bleeding during the anthelmintic treatment. This might result from substances released by the worms that have been killed with anthelmintic therapy. Current guidelines advise steroids to be tapered and stopped in case of systematic parasitic infections as they might reduce immunity and precipitate parasitic hyper-infection. In our opinion, steroid therapy might be of value in the management of strongyloides hyper- infection related vasculitis, in addition to the anthelmintic treatment. Indeed, steroid therapy of vasculitis with other means of supportive care resulted in cessation of the bleeding and recovery of the patient.

关键词： Myeloma Immunosuppression Strongyloides stercoralis Exudative enteropathy Gastrointestinal bleeding Vasculitis

Before the Jury Is out on Cinacalcet’s Cardiovascular Effects in Hemodialysis Patients: Is Troponin a Missing Link?

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Open Journal of Nephrology 2014年第1期4卷 47-53页

作者： Samra Abouchacra Ahmed Chaaban Mohammad Budruddin Fares Chedid Mohamad Hakim Mohamad Ahmed Nicole Gebran Farida Marzouki Muhy Eddin Hassan Faiz Al Abbacheyi Department of Medicine Tawam Hospital Abu Dhabi UAE Department of Pediatrics Tawam Hospital Abu Dhabi UAE Department of Pharmacology Tawam Hospital Abu Dhabi UAE SEHA Dialysis Services Tawam Hospital Abu Dhabi UAE

Raised levels of the cardiac biomarker, Troponin I, are frequently encountered in hemodialysis patients and appear to be prognostic indicators for cardiovascular risk. Though evidence suggests that control of secondary hyperparathyroidism may reduce cardiac endpoints, the effect of the calcimimetic agent, cinacalcet, remains controversial. This retrospective study aimed at evaluating troponin levels in hemodialysis patients with severe secondary hyper parathyroidism (SHPT) who are on cinacalcet vs controls on conventional treatment. In addition, clinical outcomes including all-cause, cardiovascular morbidity and mortality were compared among both groups. A decline in Troponin I levels was observed in the cinacalcet group, this however was not translated clinically into improved survival. In fact, all-cause and cardiac mortality was similar in the two groups. Conversely, comparison of the incidence of cardiovascular events revealed lower rates in the cinacalcet group including cardiac, cerebral and peripheral vascular complications. Given some of our study limitations, further long-term, placebo-controlled trials are necessary to definitively establish the effect of cinacalet on cardiac biomarkers and ultimately its impact on clinical outcomes.

关键词： Calcimimetics Secondary Hyperparathyroidism Parathyroid Hormone Cinacalcet Chronic Kidney Disease Cardio Vascular Disease End Stage Renal Disease Troponin I C-Reactive Protein Parathyroidectomy Acute Coronary Syndrome Peripheral Vascular Disease Atherogenesis Myocardial Infraction

Enablers and barriers of implementing shared governance in nursing departments:a case study from the United Arab Emirates

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Frontiers of Nursing 2024年第4期11卷 415-426页

作者： Siboj Kurup Anne Paula Manalastas Jayzafer Ciruelas Nursing Department Tawam HospitalAl AinUAE

Objective:The literature provides evidence about the positive impact of shared governance implementation in nursing departments and units,as well as on several aspects of nursing practice,including nurse empowerment,engagement,well-being,job satisfaction,retention,and positive outcomes in direct patient ***,many nursing departments of United Arab Emirates(UAE)hospitals have implemented shared governance in their ***,the success of implementation varies among these ***,the study aimed to explore the progress of shared governance implementation in hospitals,identify the enablers and inhibitors of implementing the model,and produce a recommendation to help the nursing departments of hospitals to overcome challenges and accelerate the implementation ***:The study used an inductive,qualitative case-study research method and semi-structured in-depth interviews with a purposive sample of 15 nurses working in various units in a tertiary hospital in *** authors used a thematic data analysis approach to find the ***:The results identified immediate manager understanding and support as a significant enabler and lack of senior management support,nurses'attitudes and behaviors,and time as the main *** study highlights that nurses are positive and enthusiastic about improving the current situation of shared governance by providing several suggestions and ***:The study highlights that senior nursing managers should re-evaluate shared governance implementation and modify the strategies accordingly.

关键词： nursing nurses participatory leadership shared governance UAE

Renal Allograft Thrombosis in the Early Post Transplant Period

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Open Journal of Nephrology 2013年第3期3卷 148-151页

作者： M. Budruddin Issa Al Salmi R. Shilpa Nephrology Department Royal Hospital Muscat Oman Nephrology Department Tawam Hospital Al Ain UAE

Renal allograft thrombosis involving either the renal artery or the veins is a well known entity in clinical practice. This complication of the renal transplant surgery is more common in the early part of the post transplant period and it is usually associated with acute antibody mediated rejection. This more commonly occurs in the paediatric renal transplant and also seems to have some relation to the duration of peritoneal dialysis pretransplant. However, the occurrence of graft thrombosis in isolation without clinical or histological graft rejection is not rare. We encountered a patient in whom the renal allograft thrombosis occurred after 6 weeks of commercial renal transplantation without any histological evidence of rejection.

关键词： Allograft Thrombosis Immunosuppression Cyclosporine OKT3 Hemodialysis Renogram Rejection and Pyelonephritis

Alarming Presentation of a Seemingly Common Condition in a Patient with Renal Impairment

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Open Journal of Nephrology 2013年第4期3卷 181-183页

作者： Mohammad Budruddin Muhammad Yasir Khalil Issa Al Salmi Ramaiah Shilpa Nephrology Department Royal Hospital Muscat Oman Nephrology Department Tawam Hospital Al Ain UAE

We received a 23-year-old male, working in the Army for 18 months, with advanced renal impairment, haemoptysis and hyperkalemia. An impression of the pulmonary renal syndrome was made and he was managed aggressively with haemodialysis, plasma exchange and pulsing with methyl prednisolone. His condition improved, but the renal functions did not. The vasculitic workup including Extractable Nuclear Antigen (ENA) and Anti-Neutrophil Cytoplasmic Antibody (ANCA) which were sent on admission came out to be negative. As he apparently responded to the initial management protocol, he was subjected to renal biopsy which did not reveal any vasculitis but was consistent for end-stage renal disease. Subsequently he was subjected to lung biopsy which also was not supportive for vasculitis. However, we concluded that the initial pointers for Wegener’s granulomatosis were misleading. The haemoptysis entirely subsided as the congestion improved. He was maintained on Haemodialysis three times per week schedule and discharged to the peripheral health care facility.

关键词： Haemoptysis Renal Impairment Pulmonary Renal Syndrome Haemodialysis ENA ANCA Vasculitis Pulmonary Oedema

Metabolic bone disease in the preterm infant: Current state and future directions

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World Journal of Methodology 2015年第3期5卷 115-121页

作者： Moghis Ur Rehman Hassib Narchi Department of Pediatrics Tawam Hospital Department of Pediatrics College of Medicine and Health Sciences United Arab Emirates University

Neonatal osteopenia is an important area of interest for neonatologists due to continuing increased survival of preterm infants. It can occur in high-risk infants such as preterm infants, infants on long-term diuretics or corticosteroids, and those with neuromuscular disorders. Complications such as rickets, pathological fractures, impaired respiratory function and poor growth in childhood can develop and may be the first clinical evidence of the condition. It is important for neonatologists managing such high-risk patients to regularly monitor biochemical markers for evidence of abnormal bone turnover and inadequate mineral intake in order to detect the early phases of impaired bone mineralization. Dual-energy X-ray absorptiometry has become an increasingly used research tool for assessing bone mineral density in children and neonates, but more studies are still needed before it can be used as a useful clinical tool. Prevention and early detection of osteopenia are key to the successful management of this condition and oral phosphate supplements should be started as soon as is feasible.

关键词： Premature Osteopenia Bone metabolism Calcium Alkaline phosphatase Phosphorus Nutrition

Significance of platelet count in children admitted with bronchiolitis

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World Journal of Clinical Pediatrics 2017年第2期6卷 118-123页

作者： Amar Al Shibli Najla Alkuwaiti May Hamie Dima Abukhater Muhammad B Noureddin Abdulla Amri Salwa Al Kaabi Aysha Al Kaabi Mariam Harbi Hassib Narchi Department of Pediatrics Tawam Hospital Department of Pediatrics College of Medicine and Health SciencesUnited Arab Emirates University

AIM To determine the true prevalence of thrombocytosis in children less than 2 years of age with bronchiolitis,its association with risk factors,disease severity and thromboembolic *** A retrospective observational medical chart review of 305 infants aged two years or less hospitalized for *** outcomes included disease severity,duration of hospital stay,admission to pediatric intensive care unit,or *** also included complications of thrombocytosis,including thromboembolic complications such as cerebrovascular accident,acute coronary syndrome,deep venous thrombosis,pulmonary embolus,mesenteric thrombosis and arterial thrombosis and also hemorrhagic complications such as bleeding(spontaneous hemorrhage in the skin,mucous membranes,gastrointestinal,respiratory,or genitourinary tracts).RESULTS The median age was 4.7 mo and 179 were males(59%).Respiratory syncytial virus was isolated in 268(84%),adenovirus in 23(7%) and influenza virus A or B in 13(4%).Thrombocytosis(platelet count > 500 × 109/L) occurred in 88(29%;95%CI:24%-34%),more commonly in younger infants with the platelet count declining with *** was no significant association with the duration of illness,temperature on admission,white blood cell count,serum C-reactive protein concentration,length of hospital stay or admission to the intensive care *** death,thrombotic or hemorrhagic events *** Thrombocytosis is common in children under two years of age admitted with *** is not associated with disease severity or thromboembolic complications.

关键词： hospitalization Bronchiolitis Platelet count Thrombocytosis Infant Virus diseases

Bartter and Gitelman syndromes:Spectrum of clinical manifestations caused by different mutations

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World Journal of Methodology 2015年第2期5卷 55-61页

作者： Amar Al Shibli Hassib Narchi Department of Pediatrics Tawam Hospital Department of Pediatrics College of Medicine and Health SciencesUnited Arab Emirates University

Bartter and Gitelman syndromes(BS and GS) are inherited disorders resulting in defects in renal tubularhandling of sodium,potassium and *** considered as genotypic and phenotypic heterogeneous diseases,recent evidence suggests that they constitute a spectrum of disease caused by different genetic mutations with the molecular defects of chloride reabsorption originating at different sites of the nephron in each *** they share some characteristic metabolic abnormalities such as hypokalemia,metabolic alkalosis,hyperplasia of the juxtaglomerular apparatus with hyperreninemia,hyperaldosteronism,the clinical and laboratory manifestations may not always allow distinction between *** tests,measuring the changes in urinary fractional excretion of chloride from baseline after administration of either hydrochlorothiazide or furosemide show very little change(< 2.3%) in the fractional excretion of chloride from baseline in GS when compared with BS,except when BS is associated with KCNJ1 mutations where a good response to both diuretics *** diuretic test is not recommended for infants or young children with suspected BS because of a higher risk of volume depletion in such *** symptoms and biochemical markers of GS and classic form of BS(type III) may overlap and thus genetic analysis may specify the real cause of ***,although genetic analysis is available,its use remains limited because of limited availability,large gene dimensions,lack of hot-spot mutations,heavy workup time and costs ***,considerable overlap exists between the different genotypes and *** BS and GS usually have distinct presentations and are associated with specific gene mutations,there remains considerable overlap between their phenotypes and ***,they are better described as a spectrum of clinical manifestations caused by different gene mutations.

关键词： Gitelman syndrome Bartter syndrome Potassium Chloride Magnesium Metabolic alkalosis Genetics

Psychiatric Complications of Obesity and Its Treatment: A Brief Review

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Open Journal of Psychiatry 2019年第4期9卷 267-280页

作者： Ghanem Al Hassani Amir A. Mufaddel Al Ain hospital Al Ain UAE Department of Internal Medicine Division of Psychiatry Tawam Hospital Al Ain UAE.

Obesity—defined as a body mass index (BMI) of 30 kg/m2 or more—is associated with a wide range of medical and psychiatric complications. Physical co-morbidities include: insulin resistance, type 2 diabetes mellitus, dyslipidemia, asthma, hypertension, coronary heart disease, osteoarthritis of the knee and polycystic ovary syndrome. Mental health problems are particularly more common among individuals presenting for treatment of obesity than those in the community. They have higher rates of depression, anxiety, increased substance abuse and an increased prevalence in eating disorders. It has been estimated that up to 60% of extremely obese individuals have been suffering from an Axis I psychiatric disorder;most commonly mood and anxiety disorders. Obstructive sleep apnea (OSA) can occur with obesity and can also lead to sleep disorders and psychiatric complications. Up to 40% of patients with sleep apnea were found to have affective disorder or alcohol abuse. Weight loss medications and surgery may add to the problem of psychological complications of obesity. For example, in 2008, rimonabant development was discontinued by manufacturer as it has been associated with an increased risk of adverse psychiatric events including suicidal ideation and suicidal behavior. On the other hand, the prevalence of obesity is also high among patents with psychiatric illness, which can be caused by the effects of psychotropic medications which can lead to increased appetite, weight gain, sedation and psychomotor retardation. Obesity is reported in more than 60% of patients with schizophrenia and bipolar disorder. Food intake is regulated by several neurotransmitters, peptides and amino acids. Antipsychotics which block dopamine D2 receptors increase appetite and result in significant weight gain, while drugs that increase brain dopamine concentration are anorexigenic.

关键词： Obesity Psychiatric Complications Anxiety Depression Mood Disorder Sleep Apnea Bariatric Surgery Antipsychotics