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VOLUME 30 | NUMBER 04 | APRIL 2013



04|2013CONTINUING MEDICAL EDUCATIONDelayed ejaculation: a management challenge Delayed ejaculation and anejaculation are probably the least understood of the male sexual dysfunctions.

MIDDLE EAST REVIEW Significance of Nutrition Assessment and Nutrition Screeningin Determining Nutrition Status and Predicting Complications Among Patients with Liver Cirrhosis

IN THE MEDICINE Summary of Antibiotic Treatments in AdultsDose regimens for common bacterial infections.

JOURNAL DIGESTS FROM REUTERS HEALTHWhooping cough immunity may wane after vaccination |Women overwhelmed by cancer treatment options |Men with big bellies likely to have weaker bones |Traffic pollution tied to autism risk: study ...and more

CME Answers for the month of FEBRUARY 2013

U-J02372 Acino_Mepha Journal Ad final.pdf 1 3/27/13 6:26 PM


Prof. AbdulrAhmAn S. Al-frAyh, MD Prof. of Pediatrics Chairman of the Saudi National

Asthma Committee Vice President of the Saudi Pediatric

Association Previous Dean of the Faculty of

Medicine, King Saud University

Prof. Mansour M. al-nozha, MD, FRCP, FACC, FESC Professor of Medicine and consultant

Cardiologist President, Taibah University, Madinah

Munawwarah, Saudi Arabia

Prof. Khaled alsaeid, MD, FAAP Dean of Students and Associate

Professor and Consultant Pediatrics and Infectious Diseases &

Rheumatology at Kuwait University. Practices Pediatrics at Mubarak

Teaching Hospital.

dr. Khalid obead bawaKid, MBBS, DCH (Ireland), DAC (UK), ABFM, JBFM, AAFP Consultant Family Medicine Medical Supervisor & Head of Trai-

ning and CME Program, Jeddah. Member of the Saudi Society of Family

Medicine and of Pediatric.

Prof. Galal lotfi, MD, MRCOG Professor Ob. & Gynecology Canal Suez

University Head department Obstetrics &

Gynecology, Suez Canal University.

dr. abdulwahab ahMed bawahab, MBBS, FACHARZT (Internal Medicine & Endocrinology) Fellow Royal Society of Medicine (UK). Member American Diabetes

Association & American Endocrine Association.

Coming next month

P&CC-Publishing and Communications Company, Ltd.7 Stasandrou Street, Nicosia, [email protected]

MODERN MEDICINE is marketed by HCP-MEPPO, Beirut, Lebanon, and printed in Lebanon and U.A.E. in order to service the respective surrounding countries. (ISSN: 0759-240X)

Copyright 2013 by P&CC-Publishing and Communications Company, Ltd., Nicosia - Cyprus. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including, photocopy, recording, or any information or retrieval system, without permission in writing from the pub-lisher. MODERN MEDICINE is a registered trademark owned by P&CC-Publishing and Communications Company, Ltd.

All the Modern Medicine editorial is selected from a pool of international editions. In order to deter-mine the physicians interest in reading any specific article, we pre-test all available editorial with a revolving random sample of doctors in the Middle East. Only articles rating more than 65% as inter-esting-to-read are cleared for publishing in Modern Medicine. Any article rating above 85% qualifies to become a CME article.

Jeddah Primary Care Cme unit

In collaboration with

Reuters Medical NewsThe latest medical news from the leader supplier.

CME - Continuing Medical EducationManaging scleroderma Challenges in primary careScleroderma is a complex and challenging connective tissue disease that may affect multiple organ systems. Most patients have a slowly progressive course and can be managed with vigilant screening, monitoring and timely intervention.

In the MedicineExcessive scalp hair thinning in a middle-aged womanIs bilateral recession and major hair loss in the central scalp region in a postmenopausal woman a case of female pattern hair loss?

Notes: The above articles are subject to change without prior notice.

All Modern Medicine are submitted to a revolving random sample of doctors in the Middle East and are rated for their interest of reading. Only articles rating over 65% are published, highest rating articles are published as CME.


ARTICLESVOLUME 30 | NUMBER 04 | April 2013




In collaboration with

Jeddah Primary Care CME unit





Summary of Antibiotic Treatments in AdultsDose regimens for common bacterial infections. Suspected menin-gococcal disease meningitis with non-blanching rash/meningococcal


Significance of Nutrition Assessment and Nutrition Screening in Determining Nutrition Status and Predicting Complications Among

Patients with Liver CirrhosisIn patients with Protein energy malnutrition (PEM), a common complication among patients with liver cirrhosis, most random-ized studies have shown a significant increase in morbidity and

mortality in relation to the severity of PEM.

Delayed ejaculation: a management challengeDelayed ejaculation and anejaculation are probably the least understood of the male sexual dysfunctions. However, their impact is significant because they may result in a lack of sexual fulfilment

for both the man and his partner.

For Migraine patients...


1-3 sachets/day

Effective, fast acting acute oral therapy for migraine-headache attacks.1

38% of Cmax reached within 5 minutes.2

Peak plasma values reached after 10 minutes.2


CATAFAST 50 mg powder for oral soluonImportant note: Before prescribing, please consult full prescribing informaon. Presentation: Diclofenac potassium: powder for oral soluon in sachets of 50 mg. Indicaons: Short-term treatment in the following acute condions: post-traumac pain, inammaon and swelling, e.g. due to sprains, post-operave pain, inammaon and swelling, e.g. following dental or orthopaedic surgery, painful and/or inammatory condions in gynaecology, e.g. primary dysmenorrhoea or adnexis, migraine aacks, painful syndromes of the vertebral column, non-arcular rheumasm, as an adjuvant in severe painful inammatory infecons of the ear, nose or throat. Dosage: Dose to be individually adjusted, lowest effecve dose to be given for the shortest duraon. Adults: 50 to 150 mg daily in divided doses. For dysmenorrhoea and migraine aacks: up to 200 mg daily. Adolescents aged 14 and over: 50 to 100 mg daily in divided doses. Not recommended in children and adolescents below 14 years of age. Contraindications: Acve gastric or intesnal ulcer, bleeding or perforaon; known hypersensivity to diclofenac or to any of the excipients, to aspirin or other non-steroidal an-inammatory drugs (NSAIDs); last trimester of pregnancy; severe hepac, renal or cardiac failure. Warnings/Precautions: Avoid use with other systemic NSAIDs including COX-2 inhibitors. Risk of gastrointesnal (GI) bleeding, perforaon or serious allergic reacons; to be disconnued if these condions occur. Risk of allergic reacons. May mask signs and symptoms of infecon. Cauon recommended in paents with symptoms/history of GI disease, asthma, seasonal allergic rhinis, chronic pulmonary diseases, elderly or impaired hepac funcon (including porphyria), ulcerave colis or Crohns disease. Cauon when used concomitantly with corcosteroids, ancoagulants, an-platelets agents or SSRIs. Cauon while driving or using machines. Should not be used in the rst and second trimester of pregnancy and by breast-feeding mothers. Not recommended to use in women aempng to conceive as it may impair female ferlity. Combined use with protecve agents to be considered in paents with history of ulcer, elderly, and those requiring low dose aspirin. Monitoring of liver funcon and blood counts recommended during prolonged period. Monitoring of renal funcon recommended in paents with history of hypertension, impaired cardiac or renal funcon, extracellular volume depleon, the elderly, paents treated with diurecs or drugs that impact renal funcon. Monitoring recommended in paents with defect of haemostasis. As Catafast contains a source of phenylalanine, may be harmful for paents with phenylketonuria. Beware of severe uid retenon and oedema. Interactions: Cauon with concomitant use of diurecs and anhypertensives (e.g. beta blockers, ACE inhibitors), methotrexate, other NSAIDs and corcosteroids, SSRIs. Monitoring recommended for paents receiving ancoagulants, an-platelet agents as well as blood glucose level if used concomitantly with andiabecs. Monitoring of serum lithium and digoxin levels recommended if used concomitantly. Dose of diclofenac to be reduced in paents receiving ciclosporin. Interacons with concomitant use of quinolones anbacterials, CYP2C9 inhibitors (e.g. sulnpyrazone, voriconazole). Monitoring of phenytoin plasma concentraons is recommended if used concomitantly. Adverse reactions: Common undesirable effects are: Headache, dizziness, vergo, nausea, voming, diarrhoea, dyspepsia, abdominal pain, atulence, anorexia, transaminases increased, rash. Rare undesirable effects are: Hypersensivity, anaphylacc and anaphylactoid reacons (including hypotension and shock), somnolence, asthma (including dyspnoea), gastris, gastrointesnal haemorrhage, haematemesis, melaena, diarrhoea haemorrhagic, gastrointesnal ulce