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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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This is the second issue this
year of the journal that includes research papers,
a review from Saudi Arabia and an Educational
overview of Ano rectal conditions for general
practitioners and surgery students.
Alnefaie, Z et al looked at the
prognosis, complications and quality of life after
fibrinolysis versus PCI Post MI. The authors stressed
that Management of acute MI is carried out through
adopted a reperfusion strategy either pharmacological
(intravenous fibrinolysis) or mechanical (primary
percutaneous coronary intervention (PCI)) to re-open
the occluded coronary artery. Many literature
studies have compared the efficacy, the complications,
and the long-term outcome of both the intravenous
fibrinolysis and primary PCI. Despite the superiority
and overgrowing popularity of primary PCI in management
of acute MI, fibrinolysis is still widely utilized.
Many factors play a role in choice of the reperfusion
strategy to be adopted particularly the time from
the symptom onset, the time required for preparing
for PCI, and patient co-morbidities e.g. risk
for bleeding. Primary PCI is generally more efficacious
in achieving reperfusion. It is safer with lower
mortality rates, and it is associated with lower
risk to develop restenosis, re-infarction, heart
failure, shock cerebrovascular stroke, or intracerebral
haemorrhage. However, the less availability and
the variable outcomes with operator experience
are the main disadvantages that make PCI not feasible
at many situations.
Helvaci,M, R et al stressed that
Pulmonary hypertension (PHT) is common in sickle
cell diseases (SCDs). All patients with SCDs were
included. The study included 434 patients (212
females). Transfused units of red blood cell (RBC)
(48.1 versus 28.5, p=0.000), chronic obstructive
pulmonary disease (COPD) (25.2% versus 7.0%, p<0.001),
ileus (7.2% versus 1.4%, p<0.001), cirrhosis
(8.1% versus 1.8%, p<0.001), leg ulcers (19.8%
versus 7.0%, p<0.001), digital clubbing (14.8%
versus 6.6%, p<0.001), coronary heart disease
(CHD) (18.0% versus 13.2%, p<0.05), chronic
renal disease (CRD) (9.9% versus 6.1%, p<0.05),
and stroke (12.1% versus 7.5%, p<0.05) were
also higher in males. There were 31 mortality
cases (17 males) with similar mean ages in males
and females (30.2 versus 33.3 years, respectively,
p>0.05). Mean ages of COPD (33.6 years), PHT
(34.0 years), leg ulcers (35.3 years), digital
clubbing (35.4 years), CHD (35.7 years), deep
venous thrombosis and/or varices and/or telangiectasias
(37.0 years), cirrhosis (37.0 years), CRD (39.4
years), and benign prostatic hyperplasia (41.5
years) were higher. The authors concluded that
SCDs are severe inflammatory processes on vascular
endothelium particularly at capillary level, since
capillary system is the main distributor of hardened
RBCs into tissues. Although various arterial and
venous involvement mechanisms, capillary endothelial
damage, inflammation, edema, and fibrosis induced
hypoxia may be the major underlying cause of PHT
in SCDs.
Helvaci,M, R et al tried to understand
whether or not there is a lower prevalence of
systemic lupus erythematosus (SLE) due to an immunosuppression
in the sickle cell diseases (SCDs). All patients
with the SCDs and age and sex-matched controls
were studied. The study included 428 patients
with the SCDs (220 males) and 433 controls (223
males). Although SLE was diagnosed in 6.0% of
the control cases (24 females and two males),
this ratio was only 0.4% (one female and one male)
in the SCDs patients (p<0.001). On the other
hand, transfused units of red blood cells in their
lives (47.6 versus 28.4, p=0.000), chronic obstructive
pulmonary disease (25.4% versus 7.2%, p<0.001),
ileus (7.2% versus 1.4%, p<0.001), cirrhosis
(7.2% versus 1.9%, p<0.001), leg ulcers (20.0%
versus 7.2%, p<0.001), digital clubbing (14.0%
versus 6.2%, p<0.001), coronary artery disease
(18.1% versus 12.9%, p<0.05), chronic renal
disease (10.4% versus 6.2%, p<0.05), and stroke
(12.2% versus 7.6%, p<0.05) were all higher
in males with SCDs. SCDs are severe and continuous
inflammatory processes on vascular endothelium,
particularly at the capillary level, and terminate
with end-organ failures in early years of life.
Beside that, SCDs may cause moderate to severe
immunosuppression by several mechanisms that may
be the cause of lower prevalence of SLE in the
SCDs.
Maurie Brygel, General
Surgeon and Academic, provides an educational
overview of Clinical Assessment and Risk Management
for Ano-rectal patients, with a focus on detecting
cancers and avoiding Adverse Events during and
after surgical procedures. A full range of ano-rectal
conditions are reviewed.
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