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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This is the last issue this year of the journal.
The issue has papers from various countries in
the region dealing with various topics. In addition
with this issue we are Introducing the Middle
East Primary Care Quality Improvement program
(MEQUIP). See www.mejfm/MEQUIP/index.htm
A paper from Yemen attempt to
describe epidemiological and clinical features
of cutaneous leishmana cases. It was a retrospective
descriptive records review of all patients with
cutaneous leishmaniasis diagnosed at the Seiyun
general hospital from January to December 2013.
A total of 122 patients were diagnosed with cutaneous
leishmaniasis. The age of patients ranged between
1 to 62 years and the mean age is 26.5 ±
18.1 years. Most of the patients 56(45.9%) were
of age group less than 20 years. The most common
type of lesions were nodulo-ulcerated 52(42.7%)
followed by nodular 45(36.9%). The distribution
of sex, in which males and females of age group
less than 20 years, were predominant 38 (31.1%)
and 18 (14.8%) respectively. The authors concluded
that that Wadi Hadramout is an endemic region
of leishmaniasis and our findings will be of great
interest to the public health authorities in Hadramout.
A paper from Turkey investigated
the possibility that t Digital clubbing may be
a pioneer sign of cirrhosis in sickle cell patients.
All patients with SCDs were taken into the study.
The study included 397 patients (193 females and
204 males). There were 36 patients (9.0%) with
digital clubbing. The male ratio was significantly
higher in the digital clubbing group (66.6% versus
49.8%, p<0.05). The author concluded that SCDs
are chronic catastrophic processes on endothelium
particularly at the capillary level, and terminate
with accelerated atherosclerosis induced end-organ
failures in early years of life. Digital clubbing
may show an advanced disease and be a pioneer
sign of cirrhosis in such patients.
A paper from Iraq was designed
to compare the effectiveness of different angiotensin
inhibitors; direct rennin inhibitor (Aliskiren),
angiotensin-converting enzyme inhibitors (Ramipril)
and angiotensin II receptor blocker (Irbesartan)
in prevention and treatment of nephropathy in
a group of rat diabetic nephropathy in rats. Diabetic
nephropathic rats showed a significant increase
in blood glucose level, blood pressure, heart
rate, serum urea, serum creatinine, in addition
to deteriorating renal functions including (urine
flow, glomerular filtration rate, Na+ and K+ excretion
rate, albumin and creatinine in the urine). The
administration of (Ramipril, Irbesartan, and Aliskiren)
caused a significant reduction in blood pressure,
blood glucose, serum urea, Na+ and K+ excretion
rate, with a significant improvement in urine
flow and glomerular filtration rate. All three
drugs induced a significant elevation in serum
K+ concentration. The authors concluded that administration
of different angiotensin inhibitors (ramipril,
irbesartan, & aliskiren) could slow the progression
of nephropathy in alloxan induced diabetic rats.
Both ramipril and irbesartan have the same renoprotective
effects for most parameters.
A review paper form Lebanon looked at obesity
Management in Primary Health Care. The author
stressed that Obesity is a key public health problem
across the world. Easy solutions are unlikely,
given the complex interaction between the abundant
availability of energy dense food, the ever decreasing
demand for energy expenditure in the modern world.
This review paper address the issues of overweight
and obesity in primary health care.
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