Anatomical variations of nasal structures in chronic rhinosinusitis as detected by computed tomography scan

Background: there is a wide range of anatomical variations affecting the nose, paranasal sinuses [PNS] best diagnosed by Computed Tomography [CT]. These variations may cause impairment of mucociliary drainage of the PNS resulting in sinusitis

Objectives: in this paper, the aim is to study the relationship of the anatomical variations of the lateral nasal wall, nasal septum and paranasal sinuses with the occurrence of chronic rhinosinusitis

Methods: the study included two groups of patients; the first has chronic rhinosinusitis while the second was without chronic rhinosinusitis. Anatomical variations of nose and paranasal sinuses which are nasal septal variations, concha bullosa, agger nasi cells, haller cells, paradoxical middle turbinatesand uncinate process variations were detected in both groups to investigate the relation between the anatomical variations and chronic rhinosinusitis

Results: a case control study was done which showed that there a significant statistical relation between nasal septal deviation and chronic rhinosinusitis

Conclusion: there was a significant relation between nasal septal deviation and chronic rhinosinusitis

Adolescent physical and psychological health: ethico-legal considerations

The health problems of adolescents [aged 13-19 years] are discussed from the perspective of the five purposes of the Law, maqasid al shari'at. The purpose of protecting diin, maqsad hifdh al ddiin, is related to adolescent identity crises, role ambiguity and marginalizing spirituality. The purpose of protecting life, maqsad hifdh al nafs, is related to protecting and promoting the physical health of adolescents. This purpose is also related to the limited competence of adolescents in making medical decisions, because of their immature brains. The purpose of protecting progeny, maqsad hifdh al nasl, is related to the sexual and reproductive health of adolescents. The purpose of protecting the mind, maqsad hifdh al 'aql, is related to adolescent problems of depression, suicide, para-suicide, addiction [nicotine, alcohol and drugs] and juvenile delinquency. The paper suggests practical social engineering measures for dealing with adolescent problems, consisting of cognitive approaches, faith [iman] therapy, early marriage with contraception, living in an extended family for psychological support and enhancing esteem

Overview of medical student assessment: why, what, who, and how

The paper discusses various issues related to assessment in the context of the Arab world and focusing on 2 forms of assessment: multiple choice questions [MCQs] and objective structured clinical examinations [OSCEs]. The appropriate assessment system is determined by the content and method of teaching as well as the expected knowledge and skills of the final product, the health professional. Assessment motivates students to study hard. It is also used to make decisions on promotion of students. A good assessment system cannot be imported; it must be home grown taking into consideration the cultural, linguistic, and educational background of the students. Centralized assessment not under the immediate control of teachers in contact with the students is appropriate for standardized examinations like the United States Medical Licensure Examination [USMLE] but is associated with many challenges in internal examinations within the teaching institution: complicated logistics, marginalization of the teachers, and the injustice of treating un-equals as equals. Assessment covers the two components of medicine: the science and the art The MCQ format assesses knowledge and its applications. The OSCE format assesses practical skills. Writing good MCQ items takes a lot of effort and time to review but is easy to administer and score. The OSCE based on simulated patients [SP] has ably replaced the traditional long and short clinical cases but penalizes the advanced candidate who asks the SP questions off the script. I propose using SPs who actually had personal experience of the condition being tested. I also propose some items in the OSCE that are of critical knowledge for professionals and which should have higher scores assigned to them. Students should be failed in the whole examination if they do not know some of these critical items

Health insurance and the ethical issue of equity

Health insurance planned and implemented according to the shari'at is considered a form of mutual self-help, takafulijtimae. The purpose of protecting life, maqsadhifdh al nafs, makes equitable access to the basic and necessary health services a basic right of every citizen to be fulfilled by the family, the community and the state in that order of increasing responsibility. Health services beyond the basic necessary ones are considered a privilege; they fall under the categories of needs, haajiyaat; complements, mukammilaat, and embellishments, tahsinaat, that can be provided to each according to economic ability. Health insurance helps reduce disparities in health care among various socio-economic groups but does also introduce new ones. This paper reviews empirical experiences of various aspects of health insurance from the perspectives of purposes of theshari'at and as they relate to the major ethical issue of equity. The issues reviewed are: access, coverage, type of care, quality of care, utilization of services and type of insurance. The paper reaches two conclusions: [a] health insurance improves access to health care but does not always assure equity, [b] private insurance is generally more effective but has objectionable aspects from the Islamic Law perspective. The paper recommends adopting some of the free market tools of private insurance to increase quality and efficiency of government or cooperative community insurance but making sure that the objections of jurists to commercial insurance are eliminated.

Ethics and etiquette of human research

Medical research is a form of ijtihad inspired by the teaching of the prophet that there is a cure for every disease that must be searched for. The Islamic ethical theory on research is based on the 5 purposes of the Law, maqasid al shari'at [religion, life, progeny, the mind, and wealth]. If any of the five is at risk permission is given to undertake human experiments that Would otherwise be legally prohibited. Therapeutic research fulfills the purpose of protecting health and life. Infertility research fulfils the purpose of protecting progeny. Psychiatric research fulfills the purpose of protecting the mind: The search for cheaper treatments fulfills the purpose of protecting wealth. The 5 principles of the Law, qawa 'id al shari 'at. resolve conflicts between and among the maqasid. Under the principle of intention, qa'idat al qasd, research is judged by its underlying and not expressed intentions. Under the principle of certainty, qa'idat al yaqeen, research on new treatment modalities is permitted if there are doubts about existing modalities. Under the principle of injury, qa 'idat aldharar, research is allowed if benefit expected from the experimental therapy outweighs the potential risks. The principle of custom, qa'idat al 'aadat, is used to define stamdards of good clinical practice [GCP] as what the majority of reasonable physicians consider as reasonable.Under the doctrine of istishaab, an existing treatment is continued until there is evidence to the contrary. Under the doctrine of istihsaan a physician can ignore results of a new experiment because of some inclination in his mind based on clinical intuition. Under the doctrine of istislaah medical research can be carried out in the public interest although it causes inconvenience to individuals.Informed consent by a legally competent research subject is mandatory for research. Informed consent is based on the principle of intention. Of all thepersons involved in research, the research subject who consents has the purest intentions because he is at risk. Others involved in the research may have selfish motives that are not in the best interests of the research subject. Informed consent does not legalize risky non-therapeutic research with no potential benefit. It is illegal to force participation, of the weak [prisoners, children, the ignorant, mentally incapacitated, and the poor] in research even if they sign informed consent forms.Findings of research should be widely disseminated either by teaching or by publication for universal benefit. Islam enjoins dissemination of knowledge and prohibits hiding or monopolizing knowledge