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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 first issue this year with papers from Jordan,
Yemen, Lebanon , Turkey and Australia.
Haddad R.M et al; did a prospective
observational study of 150 patients, diagnosed
to have bronchial asthma, and who were followed
up in pulmonary clinic in King Hussein Medical
Center (KHMC), between January 2016 and January
2018. The aim is find out the rates of poor inhaler
technique in patients diagnosed to have bronchial
asthma visiting the pulmonary clinic in King Hussein
Medical Center (KHMC). The effect of poor inhaler
technique on asthma control will be assessed as
well. Of the 150 patients enrolled in our study,
95 patients (63.3%) were males. The mean(±SD)
age was 46.0±6.8 years. The ages ranged
between (21-64) years. Poor inhaler technique
was observed in 78 patients (52%). The most common
cause of poor inhaler technique in these patients
was the lack of education about asthma medication
use, which was seen in 64 patients (82%), followed
by lack of education about the importance of regular
and correct inhaler use on the control of asthma,
which was seen in 14 patients (18%). Patients
with poor inhaler technique were found to have
poor asthma control, with 57 (73%) patients having
uncontrolled asthma, 18 patients (23%) having
partially controlled asthma, and only 3 patients
(4%) having controlled asthma. The authors concluded
poor inhaler use in patients with bronchial asthma
was found to be significant in our study, with
more than half the patients showing improper technique.
Proper education about the use of asthma medications
should be done to ensure the proper use of inhalers.
Patients with poor inhaler technique were found
to have poor asthma control; a fact that emphasizes
the importance of proper inhaler use in asthma
patients.
A paper from Yemen sought the
correlation between systolic myocardial velocity
(Sm) obtained by Tissue Doppler imaging (TDI)
and left ventricular ejection fraction (LVEF)
measured by conventional Simpson’s method
in patients with heart failure. This study involved
85 patients with heart failure whose LVEF <
50% (mean age 58 (11) years), LV EF measured by
conventional Simpson’s method correlating
with average Sm measured at septal, lateral, anterior
and inferior side of mitral annulus by tissue
Doppler echocardiography.
The mean age of the 85 patients
in the study was 58.48(11) years, 11(12.9 %) female;
74(87.1%) male. The mean LVEF was 33.53 (9.94).
A significant correlation was detected between systolic
mitral annulus velocity Sm and LV ejection fraction
EF (R: 0.609, p: 0.000). LV mean Sm obtained by
TDI is a parameter that is easily obtained and practical,
can be used to evaluate LV systolic function in
patients with HF. The authors concluded that the
assessment of average systolic myocardial velocity
(Sm) could be used as an alternative to LVEF. This
approach may be useful especially when the image
quality is poor and maintain high accuracy in prediction
LV systolic dysfunction.
Helvaci M.R et al; tried to understand
significance of high density lipoproteins (HDL)
in metabolic syndrome. Patients with plasma HDL
values lower than 50 mg/dL were collected into
the first and 50 mg/dL and higher into the second
groups. There were 183 patients in the first and
73 patients in the second groups. Although the
male ratio (49.7 versus 16.4%, p<0.001), smoking
(32.7 versus 17.8%, p<0.01), plasma triglycerides
values (162.7 versus 134.5 mg/dL, p= 0.005), and
chronic obstructive pulmonary disease (COPD) (16.9
versus 10.9%, p<0.05) decreased, the mean age
(45.6 versus 51.8 years, p= 0.002), body mass
index (BMI) (26.8 versus 29.3 kg/m2, p= 0.013),
fasting plasma glucose (FPG) (110.8 versus 134.1
mg/dL, p= 0.02), low density lipoproteins (LDL)
(119.6 versus 135.3 mg/dL, p<0.001), white
coat hypertension (WCH) (26.2 versus 36.9%, p<0.05),
hypertension (HT) (13.6 versus 28.7%, p<0.001),
and diabetes mellitus (DM) (15.3 versus 23.2%,
p<0.05) increased by the increased plasma HDL
values (40.4 versus 58.2 mg/dL, p<0.000), significantly.
Whereas coronary heart disease did not change,
probably due to effects of smoking on the first
and aging and excess weight on the second groups.
The authors concluded that the decreased male
ratio, smoking, plasma triglycerides values, and
COPD, the mean age, BMI, FPG, LDL, WCH, HT, and
DM increased by the increased plasma HDL values.
So HDL may act in similar direction with LDL in
the metabolic syndrome.
Helvaci M.R et al; tried to understand
whether or not low density lipoproteins (LDL)
may actually be some negative acute phase proteins
(APP) in the plasma. Patients with plasma triglycerides
values lower than 100 mg/dL were collected into
the first, lower than 150 mg/dL into the second,
lower than 200 mg/dL into the third, and 200 mg/dL
and higher into the fourth groups, respectively.
They studied 457 cases (266 females and 191 males),
totally. The male ratio, mean age, body mass index
(BMI), fasting plasma glucose (FPG) and prevalences
of smoking, white coat hypertension (WCH), hypertension
(HT), diabetes mellitus (DM), and chronic obstructive
pulmonary disease (COPD) increased parallel to
the increased plasma triglycerides values from
the first towards the fourth groups, continuously
(p<0.05 nearly in all steps). Whereas the mean
LDL values increased just up to the plasma triglycerides
value of 200 mg/dL and then decreased, significantly
(140.9 versus 128.2 mg/dL, p= 0.009). The authors
concluded increased plasma triglycerides values
may be one of the most significant parameters
of the metabolic syndrome that is characterized
with disseminated endothelial damage, inflammation,
fibrosis, accelerated atherosclerosis, end-organ
insufficiencies, early aging, and premature death.
Although the continuously increased male ratio,
mean age, BMI, FPG, smoking, WCH, HT, DM, and
COPD, parallel to the increased plasma triglycerides
values, the mean LDL values increased just up
to the plasma triglycerides values of 200 mg/dL
and then decreased, significantly. The significant
decrease can be explained by the hypothesis that
LDL may actually be some negative APP in the plasma.
Ebtisam, E from Libya, looked
at the Kambo Ritual. Those who practice it claim
it is a source of vitality and health but is it
an addictive substance with a short term euphoria.
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