Avicenna - Current Issue

Cysteine cathepsins are defined as lysosomal enzymes that are members of the papain family. Cysteine cathepsins (Cts) prevalently exist in whole organisms, varying from prokaryotes to mammals, and possess greatly conserved cysteine residues in their active sites. Cts are engaged in the digestion of cellular proteins, activation of zymogens, and remodeling of the extracellular matrix (ECM). Host cells are entered by SARS-CoV-2 via endocytosis. Cathepsin L and phosphatidylinositol 3-phosphate 5-kinase are crucial in endocytosis by cleaving the spike protein, which permits viral membrane fusion with the endosomal membrane and succeeds in the release of the viral genome to the host cell. Therefore, inhibition of cathepsin L may be advantageous in terms of decreasing infection caused by SARS-CoV-2. Coordinate inhibition of multiple Cts and lysosomal function by different drugs and biological agents might be of value for some purposes, such as a parasite or viral infections and antineoplastic applications. Zn²⁺ deficiency or dysregulation leads to exaggerated cysteine cathepsin activity, increasing the autoimmune/inflammatory response. For this purpose, Zn²⁺ metal can be safely combined with a drug that increases the anti-proteolytic effect of endogenous Zn²⁺, lowering the excessive activity of some CysCts. Biguanide derivative complexes with Zn²⁺ have been found to be promising inhibitors of CysCts protease reactions. Molecular docking studies of cathepsin L inhibited by the metformin-Zn+2 complex have been performed, showing two strong key interactions (Cys-25&His-163) and an extra H-bond with Asp-163 compared to cocrystallized Zn⁺² (PDB ID 4axl).

Introduction: Telemedicine is the delivery of health care services to patients distantly. During the Coronavirus Disease 2019 (COVID-19) pandemic, telemedicine has become an essential implement in delivering healthcare services worldwide. Accordingly, in March 2020, the Primary Health Care Centers (PHCCs) in Qatar has started telephone consultation follow-up appointments in Family Medicine (FM) clinics instead of conventional consultation. Given the limited data about telephone consultations in Qatar, our aim of this study is to investigate the possible impact of telemedicine on chronic disease patients’ follow-up compliance.

Methods: This study compares the compliance of adult patients with chronic diseases following-up within FM clinics in Qatar's PHCC through telephone consultations with a minimum of three telephone consultations ordered between April to November 2020, in comparison to the compliance of the same group of patients to their prior face-to-face follow-up consultations in FM clinics with a minimum of three face-to-face ordered follow up appointments between April to November 2019. A cross-sectional study will be carried out to investigate the effect of telephone consultation in PHCC on patients’ compliance with reference to conventional face-to-face consultation. Patients’ data will be received from Health Information Management in twenty-seven PHCCs in Qatar.

Conclusion: Due to the limited studies on the effectiveness of telemedicine on patient compliance in FM follow-ups within Qatar's PHCC, comparing patients’ follow-up compliance with telephone consultations to their prior face-to-face consultations would be helpful in assessing patients’ quality of care delivering within FM clinics. With telecommunication being easily accessible and time-efficient, it is believed, when used correctly, it might improve compliance and adherence to the management prescribed by the physician and follow-up appointments in Qatar's PHCC. In addition, this study will help in providing recommendations that could guide the organization on forming policies to be applied in PHCCs after the resolution of the COVID-19 pandemic.

Informed consent is an ethical and legal requirement in modern medicine. A valid consent implies that the patient can decide on treatment after receiving adequate information from his doctor. In case of incapacity and specific conditions, doctors can administer treatments without patient consent. Nonetheless, some cases are borderline, such as the patient presented in this paper who had a mild intellectual impairment and refused to undergo urgent intervention for aortic dissection. In this case, psychiatrists and cardiologists collaborated to check whether the patient could consent and decided to respect his choice. He was not operated, and the local ethical committee agreed with this decision. In Tunisia and developing countries, the paternalistic approach is still prevalent in the doctor-patient relationship. This paper highlights that ethical considerations should be universal and applied to all patients in all cultures and discusses ethical and legal aspects.