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From the Editor
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Ahmad Husari
Editor, Middle-East
Journal of Internal Medicine
Director, American University of Beirut Sleep
Disorders Center
Director, American University of Beirut outpatient
clinical care services
Assistant Professor
Division of Pulmonary and Critical Care Medicine
American University of Beirut Medical Center
Beirut Lebanon
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In this issue of the journal a number of issues
are discussed including hypertension, sickle cell
anemia, use of vitamin B12 and splenomegaly.
A paper from Pakistan attempts to assess the effectiveness
of an interventional program to improve hypertension
management through strengthening of the health
care delivery system. A pilot study was conducted
from February to December 2014 in two off-site
Family Medicine clinics of the Aga Khan Hospital
Karachi, Pakistan. Patients aged > 40 years,
with known hypertension were included. At the
intervention site, Family Physicians were trained;
individual and group education sessions were conducted
for catchment population, while usual care was
provided at the control site. Referral system
between primary, secondary and tertiary levels
of care was strengthened. Data was entered and
analyzed in SPSS version 19. T-test for independent
sample was used for comparison between intervention
and control groups. 118 patients were recruited
but 90 patients (44 intervention, 46 control group)
were included in the final analysis. Mean age
of patients in the intervention group was 50.5+
8.7 years in comparison to 52.0 +8.3 years in
the control group. A statistically significant
mean difference was observed in systolic BP control
in the intervention group (140.2 + 14.6 mm Hg)
after a follow-up of six months. There was a significant
difference in the mean scores of satisfaction
levels between intervention (3.9 + 0.2) and control
groups (3.7 + 0.2, P=0.003). Post intervention,
55% of patients in the intervention group and
39% in the control group were taking antihypertensive
medications regularly. The authors concluded that
intervention at primary care level along with
strengthening of the health care delivery system
should be undertaken to better manage hypertension.
A paper from Turkey looked at whether in sickle
cell diseases Acute chest syndrome has a chronic
inflammatory background. All patients with the
SCDs were taken into the study. The study included
411 patients (199 females). As one of the significant
endpoints of SCDs, patients with chronic obstructive
pulmonary disease (COPD) and without were collected
into two groups. There were 60 patients (14.5%)
with COPD. Mean age (33.0 versus 29.5 years, P=0.005)
and male ratio (80.0% versus 46.7%, P<0.001)
were higher in the COPD group. Smoking (36.6%
versus 9.9%, P<0.001) and alcohol (3.3% versus
0.8%, P<0.05) were also higher among the COPD
cases. Transfused red blood cell units in their
lives (69.1 versus 32.9, P=0.001), priapism (10.0%
versus 1.9%, P<0.001), leg ulcers (26.6% versus
11.6%, P<0.001), digital clubbing (25.0% versus
7.1%, P<0.001), coronary heart disease (26.6%
versus 13.1%, P<0.01), chronic renal disease
(16.6% versus 7.1%, P<0.01), and stroke (20.0%
versus 7.9%, P<0.001) were all higher among
the COPD cases, too. Interestingly, against the
higher rates of above problems in the COPD group,
incidence of ACS was even lower among them, nonsignificantly
(1.6% versus 3.9%, P>0.05). The authors concluded
that SCDs cause severe chronic endothelial damage
particularly at the capillary level, and terminate
with accelerated atherosclerosis induced end-organ
failures in early years of life. Probably ACS
is a sudden onset event without any chronic inflammatory
background in the SCDs.
A paper from Egypt looked
at clinical and hematologic significance of Splenomegaly
in Patients with Sideropenic Anemias. A prospective
study was conducted on 83 patients with SAs and
25 normal sex and age matched healthy controls.
Patients' demographic, clinical and hematologic
data were collected through thorough history and
clinical examination. Splenomegaly was assessed
with clinical examination of the study subjects
and was graded with Hackett's clinical grading,
then confirmed with ultrasonographic examination.
Patients were treated as per the published guidelines
for treatment of SAs. Those with splenomegaly
were subjected to a strict follow up plan. Analysis
of the collected data showed that splenomegaly
is of robust clinical and hematologic significance
in patients with SAs.
A paper from Lebanon looked at the use of Use
of Vitamin B12 in Management of pain. Methylcobalamin
(MeCbl), the activated form of vitamin B12, has
been used to manage some nutritional diseases
and other diseases in the clinic, including Alzheimer's
disease and rheumatoid arthritis. As an adjuvant,
it effects neuronal protection by fostering regeneration
of injured nerves and alienating glutamate-induced
neurotoxicity. Recently several studies revealed
that MeCbl may have conceivable analgesic effects
in experimental and clinical studies. It can reduce
pain behaviors in diabetic neuropathy, low back
pain and neuralgia. MeCbl ameliorates nerve conduction,
stimulates the regeneration of injured nerves,
and inhibits ectopic spontaneous discharges of
injured primary sensory neurons.
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