Adrenal insufficiency (AI) comprises a group of rare diseases, including primary AI, secondary AI, and congenital adrenal hyperplasia. [1,2] Glucocorticoid (GC) replacement is the cornerstone therapy in the management of AI, intended to prevent life-threatening complications related to AI and improve the well-being and quality of life in patients with AI.Adrenal crisis is a grave complication of AI, occurring even in subjects on regular GC replacement. The incidence of adrenal crisis is estimated at 5-10 per 100 patient-years, with a mortality of 0.5 per 100 patient-years. [3] The primary trigger identified for the development of adrenal crisis is a delay in increased GC dose in cases of infection. [4,5] Patient education is essential to gain the skills needed to prevent acute impairment of their AI disorder. [6,7] Furthermore, previous findings suggest that the treating physicians are the patients' primary source of information regarding AI (89%). Professional healthcare workers are essential for sharing knowledge and advice regarding the various aspects of managing the disease. [8] However, a debate exists on whether physicians' knowledge regarding AI is sufficient, in part due to the rareness of this endocrine disorder. [9][10][11][12] Significant barriers to diagnosis and management of AI were identified in some developing regions of the world with indicators of tiered healthcare that may expose deficiencies in management. [13,14] Therefore, we aimed to examine AI management's current knowledge and perceptions among a sample of physicians from the Middle East and North Africa (MENA) region and in various specialties. Our long-term goal is to identify critical deficiencies in AI Introduction: Treatment of adrenal insufficiency (AI) requires correct lifelong use of glucocorticoids (GCs) with early dose adjustments to cover the increased demand in stress to avoid life-threatening emergencies. Objectives: We determine the current specific knowledge of physicians in a convenience sample on the pathophysiological and clinical aspects of AI in the two regions of North Africa and the Middle East. Materials and Methods: Participants (n = 96) were invited to complete an electronic questionnaire with various possible answers on the subject of multiple-choice questions covering physiology, pharmacology, and clinical management and define respondents' professional profiles. Results: The present study suggests that in the investigated settings, physicians' knowledge of physiology and pharmacology GCs, medical replacement strategies in AI, and prevention of adrenal crisis may be insufficient. Great knowledge gaps were demonstrated. Conclusions: There is a need for continuous structured education and training on AI in both general medical and endocrine forums.
Scientific journals are published by commercial, no-profit, or society publishers. Most of these publishers and journals are based on the West, with the resulting gap between North and South in research work and literature productivity. This situation has resulted in a falsely perceived doubt about the value and validity of the submissions to international journals from developing regions. However, a recent increase in scientific productivity resulting from some countries' investments made into research was associated with developing many emerging national or regional journals. These journals aim to overcome barriers facing authors from producing regions to get their scholarly work published. They also aim to increase the research capacity and foster a culture of South-South collaboration. However, emerging journals face many challenges including a lack of recognition on their grounds. In this personal paper, the challenges facing emerging journals are highlighted, and the proposed urgent need for “positive discrimination” for emerging journals by regional academia is argued.
The 9th “Ramadan and Diabetes” international alliance annual conference was held over 2 days (January 21–22, 2021) virtually due to health restrictions imposed by the COVID-19 pandemic. The program included several sessions covering various aspects of Ramadan fasting from physiology, nutrition, pharmacotherapies, mental well-being, and bioethical considerations. A good proportion of the conference was used to highlight the 2021 edition of the International Diabetes Federation-diabetes and Ramadan (DaR) recommendations on diabetes management during Ramadan. The proposed new risk stratification tool for objectively assessing patient's risk was discussed. Results of the DAR global survey of the impact of COVID-19 on fasting practices were reported during the event. Results of a couple of recent trials were presented during the conference. The conference closed by a thoughtful review of the grading of evidence and a futuristic vision of future research directions. The present report provides a concise overview of the conference to help those who did not have the opportunity to attend the live event.
Background: Recent guidelines in the management of papillary thyroid microcarcinoma (PTMC) recommend limiting surgery. However, trends in the characteristics and management of PTMC from the Middle East and North Africa region is lacking. Objectives: To determine the clinical features, management strategy, and outcomes of PTMC in a large tertiary care center in the United Arab Emirates (UAE). Patients and Methods: This retrospective study included all patients diagnosed with PTMC (i.e., size ≤10 mm) at Tawam Hospital, Al Ain, UAE, between 2008 and 2019. Tumor histopathology, management strategy, and outcomes were the primary analyzed variables. Results: A total of 213 patients with PTMC met the inclusion criteria, of which 83.6% were women and 58.7% were Emiratis. The majority had the classical tumor subtype (76.1%) and tumor of size 5–10 mm (71.4%). Multifocal disease was present in 41.1% and lymph node metastasis (LNM) in 16.6% of the patients. According to the 2015 American Thyroid Association categorization, the majority (93.9%) had a low-risk disease, and all except one patient had Stage 1 disease. Total thyroidectomy was performed in 91.1% of the patients, and 47.9% received radioiodine (RAI) therapy. None of the patients were under active surveillance strategy. RAI treatment was used more often in patients with non-incidental tumors, larger tumor size, multifocal disease, positive LNM, tumors in the intermediate/high ATA category, and those who underwent total thyroidectomy or neck dissection (for all, P < 0.05). After a median follow-up of 32.4 months, about 73% had an excellent response to dynamic risk stratification assessment, and only one patient had disease recurrence. Conclusions: The majority of the patients had low-risk PTMC, yet most patients underwent total thyroidectomy, and almost 50% were treated with RAI ablation. Further studies are needed to determine if these trends are also present regionally and to explore reasons for not adopting a less aggressive approach in this indolent tumor.
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