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 that is rich with papers from the region. A paper from Eygpt looked into Anthracycline versus Non- anthracycline Induction Regimens in Patients with De Novo Acute Myeloid Leukemia. A total of 90 AML patients were enrolled in the study; they were retrospectively recruited from AML patients who were admitted at South Egypt Cancer Institute (SECI) from 2000-2010. Demographic, clinical, hematologic and data concerning treatment and therapeutic response were collected from hospital records of patients. Results: Analysis of the collected data showed lower median age of the study participants compared to other studies, FAB M2, M3, M4, followed by M1 were the commonest FAB subtypes among the study patients. Survival analysis showed longer overall survival (OS) and progression free survival (PFS) in those treated with anthracycline induction regimens compared with the non-anthracycline treated group. Also, higher incidence of relapse was observed in the non-anthracycline group. Conclusion: Anthracycline based induction regimens are still more effective than non-anthracycline regimens for treatment of AML, however the search for safer drugs than anthracyclines is still mandatory.

A paper from Turkey looked at the role of white coat hypertension (WCH) is unknown in metabolic syndrome. The study was performed in Internal Medicine Polyclinic. The study included 1.068 patients (628 females). Prevalence of excess weight increased from the third (28.7%) up to the seventh decades (87.0%), gradually (p<0.05 nearly in all steps), and then decreased in the eight decade of life (78.5%, p<0.05). The most significant increase was detected during the passage from the third to the fourth decades (28.7% versus 63.6%, p<0.001) parallel to the smoking. On the other hand, hypertension (HT), type 2 diabetes mellitus (DM), and coronary heart disease (CHD) always increased without any decrease by decades (p<0.05 nearly in all steps) indicating their irreversible properties. The authors concluded that probably metabolic syndrome is an accelerated atherosclerotic process all over the body. WCH may be an initial sign of the accelerated atherosclerotic process that can be detected easily.

A case report from Jordan report on Diffuse peritoneal deciduosis in pregnancy. The authors stressed that Deciduosis or ectopic decidua is the presence of group of decidual cells outside the endometrium . Walker was the first to define the condition in 1887(1).In pregnancy, the occurrence of ectopic deciduas was observed in ovaries, uterus and tubes, while localization in peritoneum was rare. The authors are reporting a case of ectopic deciduas in a 27-year -old lady who was asymptomatic during the course of her pregnancy, presented with preterm labour pain, underwent caesarean section due to Triplet pregnancy . The lesions were discovered accidentally, they were nodular covering most of the peritoneum and there was omental cake, biopsies were taken to differentiate it from malignant conditions. Histopathological diagnosis confirmed deciduosis.

A paper from Oman looked at the Diagnosis of Porphyria after sternotomy for severe calcific coronary artery disease through a case. Acute intermittent porphyria (AIP) is an autosomal disorder marked by a deficiency of the enzyme, the hydroxymethylbilane synthase which is part of the heme biosynthesis. It is manifested clinically by multi-system involvement. Our patient does have chronic ischemic heart disease needed surgical revascularization, his sternotomy incision revealed the classical blackish discoloration of the bone marrow, which guided us for his work up and diagnosis

Another topic that was dealt with from Jordan was Heterotropic pregnancy is a condition in which pregnancy occurs synchronously intrauterine and extrauterine . The estimated incidence following spontaneous conception is below 1/30,000. The authors report a case of a 20 years old woman, nulliparous, who presented to the emergency department with acute abdominal pain post ovulation induction with human menopausal gonadotrophins and intrauterine insemination. Examination revealed acute surgical abdomen. Ultra-sonographic examination showed viable triplet intrauterine gestation of 10 weeks and presence of right complex adnexial mass. Laparotomy done and patient found to have right tubal ectopic pregnancy that was managed by salpingostomy. Though the incidence of heterotropic pregnancy is low following spontaneous pregnancy but a high index of suspicion must be considered in any patient with intrauterine pregnancy who presented with abdominal pain and adnexal mass and particularly if conception occurs after artificial reproductive techniques. This approach would avoid maternal morbidity and mortality.

One more retrospective observational study from South Jordan has been carried out over a four-year period between 1st January 2012 & 31st December 2015. The medical records of all patients who underwent instrumental deliveries were reviewed & analyzed. During this four-year period 238 successful instrumental deliveries were performed out of 9767 deliveries with a rate of 2.56%. The commonest instrument used was vacuum (202/240) and 36 patients were delivered by forceps. The indications were; presumed fetal distress (132), prolonged 2nd stage of labor (85) and maternal exhaustion (21). Maternal complications reported were postpartum hemorrhage (18) and different degrees of genital tract tears (28). Fetal complications registered consisted of 34 cases of which (11) were cases of Erbs palsy, (12) were cases admitted to NICU for observation & one case was diagnosed with cereberal palsy. The authors concluded that their study showed a lower rate of operative vaginal delivery in comparison to the international figures. This may be attributed to the lack of epidural anesthesia; which increases the incidence of instrumental deliveries, in addition to the simple experience of the attending residents who fear of possible complications of applying these instruments and the potential subsequent litigations. The complications reported in our study were expected in assisted vaginal deliveries and mimic those mentioned in the literature.