Pharmacy and medical students' attitudes and perspectives on social media usage and e-professionalism in United Arab Emirates.

BACKGROUND: It is imperative to establish how students view and present themselves on social media and to assess level of awareness regarding the implications of their social media presence, e-professionalism, and accountability. The study objectives were to: 1) Determine the social media usage levels among medical and pharmacy students in the United Arab Emirates (UAE); 2) Characterize the students' views and perceptions, including their awareness of e-professionalism; and 3) Compare the responses in behavior between the two groups. METHODOLOGY: A cross-sectional study was performed on 575 undergraduate students from two study disciplines, pharmacy (n = 325) and medicine (n = 250). Minor revisions were made to previously validated assessment tools and pilot tested. The study sample included students from five different universities across the country. RESULTS: In comparison to medical students, pharmacy students were observed to use social media more for learning purposes (χ2 = 6.8, P < .05). However, medical students' opinions reflected more strongly on the context of accountability and e-professionalism (χ2 = 15.8, P < .05). A considerable proportion (89%) of students felt it was discriminatory for prospective employers to use their social media profile information for investigative purposes while hiring. One-third of respondents reported sharing information that they would not want their employers to view, and 67.1% reported the same for information relevant to patients. CONCLUSION: The research findings converge to address the need for educators and administrators in the UAE to develop guidelines concerning its safe use and proactively integrate e-professionalism into their respective curriculum.

Rosuvastatin-related rhabdomyolysis causing severe proximal paraparesis and acute kidney injury.

We describe the case of a 76-year-old man who presented with bilateral lower limb weakness associated with decreased urine output. His initial blood results showed acute kidney injury (AKI) stage 3 with substantially raised serum creatine kinase concentration of 37 950 IU/L (normal range <171 U/L). He had been on high-dose rosuvastatin for 4 years with a recent brand change occurring 1 week prior to onset of symptoms. There was no history of pre-existing neuromuscular disease. Statin-related rhabdomyolysis was suspected and rosuvastatin was withheld. His muscle strength gradually improved. He required haemodialysis for 10 weeks. He was discharged home after a complicated course of hospitalisation. His renal function improved and he became dialysis-independent; however, he was left with residual chronic kidney disease.

Nasopharyngeal airway aspiration: An uncommon cause of sudden respiratory distress in hospitalized patients.

An elderly, bed ridden patient with a history of stroke was admitted for management of aspiration pneumonia. Two days after insertion of a nasopharyngeal airway, sudden respiratory distress prompted further investigations which led to the eventual diagnosis and removal of the nasopharyngeal airway that had been aspirated. The device was removed under conscious sedation with fiber optic bronchoscopy.

Triple trouble: A case of traumatic cervical spinal cord injury in a patient with ossification of posterior longitudinal ligament and disc prolapse.

We describe the case of a trauma patient who presented to our emergency department with signs and symptoms suggestive of cervical cord injury. The patient had an underlying ossification of the posterior longitudinal ligament with multiple cervical disc prolapses from C3 to C7. The presence of these two factors increased the impact of the traumatic cervical cord injury. The patient underwent spinal decompression via laminectomy. Unfortunately, his neurological status did not show any significant improvement after the surgery. Our aim is to highlight the association between ossification of the posterior longitudinal ligament and spinal cord injury in trauma patients.

Ackerman syndrome: a rare cause of arthritis with dermatitis.

We present a case of a middle-aged woman who presented with acute onset of non-erosive oligoarthritis and cutaneous lesions. Her laboratory work up revealed mild anaemia with positive antinuclear antibody. Her skin biopsy confirmed the presence of interstitial granulomatous dermatitis. She was treated with a successful trial of non-steroidal anti-inflammatory agents. Interstitial granulomatous dermatitis with arthritis (IGDA), or Ackerman syndrome, is an under-recognised cause of arthritis with dermatitis. This is primarily due to the varied clinical presentation of the skin lesions and the non-specific laboratory findings. Our aim is to highlight the pivotal role of skin biopsy as part of the diagnostic assessment of patients who present with arthritis and concomitant skin lesions.

Acute peripheral polyneuropathy with multiorgan failure: a diagnostic dilemma.

We describe the case of a young man who presented with abdominal pain, vomiting and acute symmetric peripheral polyneuropathy. He was noted to have high anion gap metabolic acidosis with high lactate levels and persistently high arterial and venous pO2 values. The cerebrospinal fluid was acellular with a high protein and the nerve conduction study was consistent with axonal sensorimotor neuropathy. His clinical condition deteriorated rapidly despite full supportive care and he subsequently died of multiorgan failure. An extensive workup for various infectious, autoimmune and other possible aetiologies was carried out to identify the underlying cause for his fulminant illness. All diagnostic workup was non-conclusive except for a significantly elevated serum aluminium level. We have discussed the possibility of aluminium phosphide poisoning in view of the clinical presentation.

Unreported neurological complications of Gemella bergeriae infective endocarditis.

We report the first case of native aortic and mitral valve endocarditis due to Gemella bergeriae from the Middle East in a young patient with rheumatic heart disease. Our case illustrates a fulminant course of infection with G. bergeriae endocarditis that was complicated by embolic stroke, as well as intracerebral and subarachnoid haemorrhage secondary to rupture of a mycotic aneurysm in the right middle cerebral artery. This case highlights the dire, unreported neurological complications of infective endocarditis due to a rare causative organism-G. bergeriae.

Pneumothorax as a presentation of perforated duodenal ulcer.

A young man presented with a sudden onset of severe abdominal pain and vomiting. He also had shortness of breath with right-sided pleuritic chest pain. On examination he was found to have a rigid and diffusely tender abdomen. Auscultation of the chest revealed reduced air entry into the right lung. An erect chest X-ray confirmed the presence of pneumoperitoneum and a right-sided pneumothorax. He underwent placement of a right intercostal drain followed by urgent laparotomy. The intraoperative findings were consistent with a small duodenal perforation, which was managed by a simple omental patch closure. His postoperative course was uneventful. Pneumothorax is a rare complication of perforated duodenal ulcer and should be kept in mind while assessing patients who present with abdominal pain and dyspnoea. We have discussed various possibilities that should be considered in patients who present with a concomitant pneumothorax and pneumoperitoneum.

Not your typical torticollis: a case of atlantoaxial rotatory subluxation.

A 9-year-old boy was pushed while carrying a heavy backpack. He had no fall or direct trauma to his neck. After a few hours from the incident, he presented with neck pain and torticollis. However, somewhat atypical for torticollis, he was not able to rotate his face to the neutral position. There were no neurological deficits. Concerned by his inability to rotate his neck, the clinician suggested CT of the upper cervical spine, which demonstrated rotary subluxation of the atlantoaxial junction. The patient was taken to the operating theatre. Reduction was performed under general anaesthesia. He did well and was back to school in the following days.

A young patient with recurrent respiratory tract infection and anasarca.

A young man with a history of recurrent respiratory tract infections for the past 8 years presented with generalised anasarca. He was found to have advanced renal disease (stage 4) and a profound proteinuria of 82.9 g/day. Further workup revealed the presence of advanced bronchiectatic changes in the lungs. Rectal biopsy showed the characteristic pattern of amyloid deposition. A diagnosis of systemic amyloidosis secondary to bronchiectasis was made. To the best of our knowledge no other cases of bronchiectasis-associated renal amyloid disease with such marked proteinuria have been reported in the literature. Our patient had a relatively short duration between the onset of his symptoms related to underlying bronchiectasis and his clinical presentation of renal amyloidosis. He had an aggressive course of disease and unfortunately died at a very young age.

A 'medical' diagnosis in the trauma clinic.

A previously healthy 27-year-old Nepalese man presented with a history of direct low-impact direct trauma to the left leg. An x-ray was performed in a private hospital and he was referred to our emergency department for the management of a possible foreign body in the left leg. X-ray of the left leg showed a single, small, 'cigar-shaped' calcified lesion in the posterior aspect of the left leg. There was an inconsistency between the injury and x-ray finding. As the patient originated from a region endemic in Taenia solium, a clinical suspicion for cysticercosis was raised. The patient was then sent for a skeletal survey which subsequently confirmed our diagnosis.

Brucella endocarditis: an occupational hazard!

A young man presented with a 2-month history of fever and malaise. Cardiac auscultation revealed the presence of a diastolic murmur. Subsequently, a cardiac echocardiogram was done, which showed a large vegetation adherent to an anterior mitral leaflet. The blood culture was positive for Brucella species. The patient was given antibiotic therapy for brucellosis and referred for surgery. Brucella endocarditis is one of the rarest, yet most notorious complications of this infection. This condition requires a high degree of clinical suspicion in order to facilitate prompt diagnosis and treatment.

Blunt traumatic internal carotid artery dissection with delayed stroke in a young skydiver.

We describe a case of a 33-year-old skydiver who presented to the emergency department after a traumatic landing following a parachuting episode. He initially presented with right knee pain secondary to a tibial plateau fracture. There were no neurological symptoms or signs at the initial assessment. While he was still in the emergency department, he suddenly developed headache and left-sided hemiplegia. An urgent work-up showed right middle cerebral artery thrombosis with right internal carotid thrombosis and dissection. We have discussed some possible mechanism of injury in skydiving that may have predisposed to the occurrence of cervical dissection in our patient.

An unexpected diagnosis in a dyspnoeic patient with primary Sjogren syndrome.

We describe a case of a 50-year-old lady with newly diagnosed primary Sjogren syndrome who presented with severe pulmonary artery hypertension and pericardial effusion. She was managed by immunosuppressive agents and a combination of standard therapy for pulmonary hypertension. Our patient had a clinically significant involvement of cardio-pulmonary system that is atypical of this disease. Prompt recognition and management of this condition are extremely crucial as untreated cases carry a grave prognosis. However, the ideal treatment strategy is yet to be defined for this condition.

Transient cortical blindness as a manifestation of solitary cysticercus granuloma.

Neurocysticercosis is recognised as a significant cause of neurological morbidity in endemic regions. The wide range of pleomorphic and non-specific neurological manifestations of neurocysticercosis must be kept in mind by physicians, as the disease has shown resurgence in developed countries. When an atypical presentation of an unusual tropical disease occurs in non-endemic regions, the diagnosis is often missed. We describe a case of a 4-year-old girl who presented with a history of transient bilateral loss of vision with headache and vomiting. Brain MRI revealed the presence of a single cysticercus granuloma in the occipital lobe. A diagnosis of symptomatic occipital lobe seizure secondary to neurocysticercosis was made. She was given a course of albendazole. There was no recurrence of symptoms at 3 years follow-up. Occipital seizures that are associated with ictal amaurosis closely mimic basilar migraine. Such cases benefit from neuroimaging in order to rule out the underlying structural causes.