Risk and predictors of severity and mortality in patients with type 2 diabetes and COVID-19 in Dubai

BACKGROUND Globally,patients with diabetes suffer from increased disease severity and mortality due to coronavirus disease 2019(COVID-19).Old age,high body mass index(BMI),comorbidities,and complications of diabetes are recognized as major risk factors for infection severity and mortality.AIM To investigate the risk and predictors of higher severity and mortality among inhospital patients with COVID-19 and type 2 diabetes(T2D)during the first wave of the pandemic in Dubai(March–September 2020).METHODS In this cross-sectional nested case-control study,a total of 1083 patients with COVID-19 were recruited.This study included 890 men and 193 women.Of these,427 had T2D and 656 were non-diabetic.The clinical,radiographic,and laboratory data of the patients with and without T2D were compared.Independent predictors of mortality in COVID-19 non-survivors were identified in patients with and without T2D.RESULTS T2D patients with COVID-19 were older and had higher BMI than those without T2D.They had higher rates of comorbidities such as hypertension,ischemic heart disease,heart failure,and more life-threatening complications.All laboratory parameters of disease severity were significantly higher than in those without T2D.Therefore,these patients had a longer hospital stay and a significantly higher mortality rate.They died from COVID-19 at a rate three times higher than patients without.Most laboratory and radiographic severity indices in non-survivors were high in patients with and without T2D.In the univariate analysis of the predictors of mortality among all COVID-19 non-survivors,significant associations were identified with old age,increased white blood cell count,lymphopenia,and elevated serum troponin levels.In multivariate analysis,only lymphopenia was identified as an independent predictor of mortality among T2D non-survivors.CONCLUSION Patients with COVID-19 and T2D were older with higher BMI,more comorbidities,higher disease severity indices,more severe proinflammatory state with cardiac involvement,and died from COVID-19 at three times the rate of patients without T2D.The identified mortality predictors will help healthcare workers prioritize the management of patients with COVID-19.

The Impact of Behavioural Insights on Effective Prescription of Antibiotics by Doctors: A Case Study from Latifa Hospital for Women and Children, Dubai Health Authority

Introduction: Wise prescription of antibiotics is an ethical duty of physicians in view of rising antimicrobial resistance in the community, it should be balanced between the health requirements of the patients and resulting long-term antibiotics resistance. Overuse of antimicrobials is a major cause of emerging resistance to antimicrobials. There are multiple factors in the community that influence the physician’s antibiotic prescriptions. Methods: This is a systematic case-control study on antibiotics prescription for paediatric patients attending Latifa Hospital for Women and Children (LWCH), Dubai Health Authority, to know the effects of behavioral interventions on rates of inappropriate antimicrobials prescription by doctors in the Paediatric Emergency Department. Results: The results of our study showed the effectiveness of behavioral insights by peer comparison in antibiotic use among paediatricians in Latifa Hospital had a statistical significance (P = 0.0038). The rate of the prescription decreased from 41% to 21%, a difference of 20%. Conclusion: The study concluded behavioural intervention is an effective measure in reducing the improper prescription of antibiotics in the hospital setting.

Testicular oxidative stress and apoptosis status in streptozotocin-induced diabetic rats after treatment with rooibos(Aspalathus linearis),honeybush(Cyclopia intermedia),and sutherlandia(Lessertia frutescens)infusions

Objective:To investigate the testicular oxidative stress and apoptosis status,as well as the sperm functional parameters in streptozotocin(STZ)induced diabetic rats following treatment with rooibos(Aspalathus linearis),honeybush(Cyclopia intermedia)and sutherlandia(Lessertia frutescens)infusions.Methods:Diabetes was induced by injecting fourteen-week-old adult male Wistar rats(250-300 g)with a single intraperitoneal injection of STZ(45 mg/kg body weight).Fifty rats were randomly divided into five groups:the vehicle group received 0.1 M citrate buffer,the diabetic control group received 45 mg/kg STZ,the diabetic+rooibos group received 45 mg/kg STZ+2.0%rooibos,the diabetic+honeybush group received 45 mg/kg STZ+4.0%honeybush,and the diabetic+sutherlandia group received 45 mg/kg STZ+0.2%sutherlandia.Rats were sacrificed 7 weeks after induction of diabetes mellitus.The testes and epididymides were harvested and weighed after induction.Spermatozoa were retrieved from the cauda epididymis for motility,concentration,and morphology analysis,and the testis was used for all biochemical assays.Oxidative stress was determined by measuring malondialdehyde levels,catalase,and superoxide dismutase activities,while apoptotic biomarkers were evaluated by Western blotting assays.Results:After induction of diabetes,rats in the diabetic control group,diabetic+rooibos group,diabetic+honeybush group,and diabetic+sutherlandia group presented with significantly elevated blood glucose levels as compared with the vehicle group(P<0.001).Rats in the diabetic control group had a reduction in sperm progressive motility,while rats in the diabetic+rooibos group and the diabetic+sutherlandia group displayed an increase in progressive motility as compared with the diabetic control group.The diabetic control animals showed a 40.0%decrease in sperm concentration when compared to the vehicle group,and there were no significant differences in sperm kinematic and speed parameters between the groups.In addition,the percentage of morphologically normal spermatozoa was increased by 13.0%,16.0%,and 15.0%after treatment with rooibos,honeybush,and sutherlandia,respectively and the rats in the diabetic+infusion groups also displayed an increase in superoxide dismutase activity when compared to the diabetic control group.Conclusions:Rooibos,honeybush and sutherlandia infusions may partly alleviate diabetes-induced sperm function impairment by reducing oxidative stress.

Inter-ethnic marriages and severity of coronary artery disease:A multicenter study of Arabian Gulf States

AIM To assess the association of inter-ethnic vs intra-ethnic marriage with severity of coronary artery disease(CAD) in men undergoing angiography.METHODS We conducted a prospective multicenter,multi-ethnic,cross sectional observational study at five hospitals in Saudi Arabia and the United Arab Emirates,in which we used logistic regression analysis with and without adjustment for baseline differences. RESULTS Data were collected for 1068 enrolled patients undergoing coronary angiography for clinical indications during the period of April 1^(st),2013 to March 30^(th),2014. Ethnicities of spouses were available only for male patients. Of those enrolled,687 were married men and constituted the cohort for the present analysis. Intra-ethnic marriages were reported in 70% and inter-ethnic marriages in 30%. After adjusting for baseline differences,interethnic marriage was associated with lower odds of having significant CAD [adjusted odds ratio 0.52(95%CI:0.33,0.81)] or multi-vessel disease(MVD) [adjusted odds ratio 0.57(95%CI:0.37,0.86)]. The adjusted association with left main disease showed a similar trend,but was not statistically significant [adjusted odds ratio 0.74(95%CI:0.41,1.32)]. The association between interethnic marriage and the presence of significant CAD and MVD was not modified by number of concurrent wives(P interaction > 0.05 for both).CONCLUSION Among married men undergoing coronary angiography,inter-ethnic,as compared to intra-ethnic,marriage is associated with lower odds of significant CAD and MVD.

Descriptive histomorphological evaluation of the testis and caudal epididymis following treatment with rooibos(Aspalathus linearis),honeybush(Cyclopia intermedia)and sutherlandia(Lessertia frutescens)in healthy and streptozotocin-induced diabetic rats

Objective:To evaluate the testis and the cauda epididymis after treating both healthy and diabetic rats with rooibos(Aspalathus linearis),honeybush(Cyclopia intermedia),and sutherlandia(Lessertia frutescens),respectively.Methods:Ninety male Wistar rats were randomly divided into nine groups(n=10 per group).Fifty rats were randomized to receive tap water,0.1 M citrate buffer,2.0%fermented rooibos,4.0%fermented honeybush,or 0.2%unfermented sutherlandia.Diabetes was induced via a single intraperitoneal injection of streptozotocin(STZ)at 45 mg/kg in 40 rats.The diabetic rats were randomized to receive tap water,2.0%fermented rooibos,4.0%fermented honeybush,or 0.2%unfermented sutherlandia.Rats were sacrificed after seven weeks of diabetic induction.Blood was collected for hormonal assay,while the testes and caudal epididymis were retrieved for histomorphological evaluations.Results:Diabetic rats treated with 2.0%fermented rooibos exhibited a significant increase in fasting plasma glucose(FPG)versus the vehicle group(P=0.002),and a 3.6%decrease compared to the diabetic control group(P>0.05).Diabetic rats treated with honeybush or sutherlandia showed 23.6%and 15.4%decrease in FPG when compared to the diabetic control group,respectively(both P>0.05).The diabetic control rats had a significant decrease in the percentage of histologically normal seminiferous tubules compared to the control group(P=0.049).There was 21.0%,14.0%,and 5.4%rise in the percentage of normal seminiferous tubules in diabetic rats receiving rooibos,honeybush or sutherlandia,respectively,compared to the diabetic control group.The infusion control groups(rooibos,honeybush and sutherlandia)showed normal seminiferous tubules,presence of spermatozoa in the epididymal lumen,and had normal overall architecture.Both testicular and epididymal morphology were altered in the diabetic control group,but these disruptions were mildly ameliorated by rooibos,honeybush,and sutherlandia.Conclusions:The detrimental effects of diabetes on the histomorphological architecture of the testis and epididymis are mildly ameliorated by the infusions(2.0%fermented rooibos,4.0%fermented honeybush,and 0.2%unfermented sutherlandia).

Utility of oral glucose tolerance test in predicting type 2 diabetes following gestational diabetes:Towards personalized care

BACKGROUND Women with gestational diabetes mellitus(GDM)are at a seven-fold higher risk of developing type 2 diabetes(T2D)within 7-10 years after childbirth,compared with those with normoglycemic pregnancy.Although raised fasting blood glucose(FBG)levels has been said to be the main significant predictor of postpartum progression to T2D,it is difficult to predict who among the women with GDM would develop T2D.Therefore,we conducted a cross-sectional retrospective study to examine the glycemic indices that can predict postnatal T2D in Emirati Arab women with a history of GDM.AIM To assess how oral glucose tolerance test(OGTT)can identify the distinct GDM pathophysiology and predict possible distinct postnatal T2D subtypes.METHODS The glycemic status of a cohort of 4603 pregnant Emirati Arab women,who delivered in 2007 at both Latifa Women and Children Hospital and at Dubai Hospital,United Arab Emirates,was assessed retrospectively,using the International Association of Diabetes and Pregnancy Study Groups(IADPSG)criteria.Of the total,1231 women were followed up and assessed in 2016.The FBG and/or the 2-h blood glucose(2hrBG)levels after a 75-g glucose load were measured to assess the prevalence of GDM and T2D,according to the IADPSG and American Diabetes Association(ADA)criteria,respectively.The receiver operating characteristic curve for the OGTT was plotted and sensitivity,specificity,and predictive values of FBG and 2hrBG for T2D were determined.RESULTS Considering both FBG and 2hrBG levels,according to the IADPSG criteria,the prevalence of GDM in pregnant Emirati women in 2007 was 1057/4603(23%),while the prevalence of pre-pregnancy T2D among them,based on ADA criteria,was 230/4603(5%).In the subset of women(n=1231)followed up in 2016,the prevalence of GDM in 2007 was 362/1231(29.6%),while the prevalence of prepregnancy T2D was 36/1231(2.9%).Of the 362 pregnant women with GDM in 2007,96/362(26.5%)developed T2D;142/362(39.2%)developed impaired fasting glucose;29/362(8.0%)developed impaired glucose tolerance,and the remaining 95/362(26.2%)had normal glycemia in 2016.The prevalence of T2D,based on ADA criteria,stemmed from the prevalence of 36/1231(2.9%)in 2007 to 141/1231(11.5%),in 2016.The positive predictive value(PPV)for FBG suggests that if a woman tested positive for GDM in 2007,the probability of developing T2D in 2016 was approximately 24%.The opposite was observed when 2hrBG was used for diagnosis.The PPV value for 2hrBG suggests that if a woman was positive for GDM in 2007 then the probability of developing T2D in 2016 was only 3%.CONCLUSION FBG and 2hrBG could predict postpartum T2D,following antenatal GDM.However,each test reflects different pathophysiology and possible T2D subtype and could be matched with a relevant T2D prevention program.

Prevalence of Dysmenorrhea among Female Adolescents in Dubai: A Cross-Sectional Study

Objective: This study aimed to investigate the prevalence of dysmenorrhea among adolescents in Dubai, and its effect on their academic and athletic performance. Methods: This was a cross-sectional study conducted in ten randomly selected private and government high schools in Dubai, United Arab Emirates. Using both the English and Arabic translated version of the Women’s Health Symptom Survey Questionnaire World, data was collected from 456 female students of grades 7 - 12, aged 11 - 19 years. Results: Dysmenorrhea was a crucial problem reported by 432 (94.7%) of the participants. Of the total number, 208 (45%) participants reported experiencing severe pain during menstruation and 152 (33.4%) students reported being absent from school during every menstrual cycle. Nonsteroidal anti-inflammatory drugs (NSAIDs) were used by 147 (32.3%) students, and majority reported no or little improvement. The percentage of students who experienced menstrual pain with micturition or defecation was 43.1% and 46.7%, respectively. None of the participants reported the use of hormonal agents. Conclusion: The unexpected high number of female adolescents who reported symptoms of primary dysmenorrhea necessitating treatment, as well as subsequent school absenteeism, calls for implementation of a screening questionnaire for early detection of persistent primary dysmenorrhea. Moving from surgical to clinical diagnosis of endometriosis can contribute greatly to improving the quality of life and reproductivity of female adolescents with severe dysmenorrhea.

Emotional Distress and Metabolic Control in Diabetic Patients Attending Primary Health Care in the Eastern Province, Saudi Arabia

Background:Recognition and treatment of emotional distress,which affects 20 to 40%of outpatients with type 1 or type 2 diabetes,are important because of its association with worse diabetes self-care,poor glycemic control,increased rates of mortality and diabetes-related complications,and a rise in healthcare expenditure.However,although the symptoms of emotional distress improve in diabetic patients after psychological and pharmacological interventions,evidence of benefits in glycemic control is still uncertain.Objective:The aim of this study was to assess the metabolic control in diabetic patients with emotional distress attending primary mental care clinics(PMCC)in the Eastern Province of Saudi Arabia.Method:This study was a single group pretest-posttest design conducted on adult diabetic patients with emotional distress attending PMCC.Out of 194 attendees,62 patients who fulfilled the selection criteria were studied.Data were collected from the patients’records using a worksheet designed for the study.Metabolic parameters including BMI,BP,FBS,HbA1c and lipid profile were recorded before and after the management of emotional distress.Socio-demographic characteristics,complications related to diabetes and co-morbidities were also recorded.Paired t-test was used appropriately to compare continuous variables.A p-value of less than 0.05 was considered significant in all statistical analysis.Results:The majority of the patients had type 2 DM(98.2%)and the presence of co-morbidities was high(83.9%).A comparison of the metabolic parameters before and after management of emotional distress,showed a significant reduction in HbA1c(p=0.020)and elevation in HDL(p=0.010).No differences in BMI,BP,FBS,TC,TG or LDL were found.Conclusions:Treating emotional distress in diabetic patients is associated with an improvement in HbA1c and HDL.

Critical care practices in the world:Results of the global intensive care unit need assessment survey 2020

BACKGROUND There is variability in intensive care unit(ICU)resources and staffing worldwide.This may reflect variation in practice and outcomes across all health systems.AIM To improve research and quality improvement measures administrative leaders can create long-term strategies by understanding the nature of ICU practices on a global scale.METHODS The Global ICU Needs Assessment Research Group was formed on the basis of diversified skill sets.We aimed to survey sites regarding ICU type,availability of staffing,and adherence to critical care protocols.An international survey‘Global ICU Needs Assessment’was created using Google Forms,and this was distributed from February 17^(th),2020 till September 23^(rd),2020.The survey was shared with ICU providers in 34 countries.Various approaches to motivating healthcare providers were implemented in securing submissions,including use of emails,phone calls,social media applications,and WhatsApp^(TM).By completing this survey,providers gave their consent for research purposes.This study was deemed eligible for category-2 Institutional Review Board exempt status.RESULTS There were a total 121 adult/adult-pediatrics ICU responses from 34 countries in 76 cities.A majority of the ICUs were mixed medical-surgical[92(76%)].108(89%)were adult-only ICUs.Total 36 respondents(29.8%)were 31-40 years of age,with 79(65%)male and 41(35%)female participants.89 were consultants(74%).A total of 71(59%)respondents reported having a 24-h inhouse intensivist.A total of 87(72%)ICUs were reported to have either a 2:1 or≥2:1 patient/nurse ratio.About 44%of the ICUs were open and 76%were mixed type(medical-surgical).Protocols followed regularly by the ICUs included sepsis care(82%),ventilator-associated pneumonia(79%);nutrition(76%),deep vein thrombosis prophylaxis(84%),stress ulcer prophylaxis(84%),and glycemic control(89%).CONCLUSION Based on the findings of this international,multi-dimensional,needs-assessment survey,there is a need for increased recruitment and staffing in critical care facilities,along with improved patientto-nurse ratios.Future research is warranted in this field with focus on implementing appropriate health standards,protocols and resources for optimal efficiency in critical care worldwide.

AFM-compatible microfluidic platform for affinity- based capture and nanomechanical characterization of circulating tumor cells

Circulating tumor cells(CTCs)carried by the patient’s bloodstream are known to lead to the metastatic spread of cancer.It is becoming increasingly clear that an understanding of the nanomechanical characteristics of CTCs,such as elasticity and adhesiveness,represents advancements in tracking and monitoring cancer progression and metastasis.In the present work,we describe a combined microfluidic–atomic force microscopy(AFM)platform that uses antibody–antigen capture to routinely isolate and nanomechanically characterize CTCs present in blood samples from prostate cancer patients.We introduce the reversible assembly of a microfluidic device and apply refined and robust chemistry to covalently bond antibodies onto its glass substrate with high density and the desired orientation.As a result,we show that the device can efficiently capture CTCs from patients with localized and metastatic prostate cancer through anti-EpCAM,anti-PSA,and anti-PSMA antibodies,and it is suitable for AFM measurements of captured intact CTCs.When nanomechanically characterized,CTCs originating from metastatic cancer demonstrate decreased elasticity and increased deformability compared to those originating from localized cancer.While the average adhesion of CTCs to the AFM tip surface remained the same in both the groups,there were fewer multiple adhesion events in metastatic CTCs than there were in their counterparts.The developed platform is simple,robust,and reliable and can be useful in the diagnosis and prognosis of prostate cancer as well as other forms of cancer.

Human leukocyte antigen B polymorphism and association between HLA-B27 and endoplasmic reticulum aminopeptidase 1 rs30187 SNP in patients with ankylosing spondylitis in Bangladesh

Objectives:To determine the association of Human leukocyte antigen B(HLA‑B)alleles with ankylosing spondylitis and the allelic association of HLAB27 with endoplasmic reticulum aminopeptidase 1(ERAP1)single-nucleotide polymorphism(SNP)rs30187 in patients with ankylosing spondylitis(AS).Methods:We studied 48 consecutively enrolled well-defined AS patients and 48 healthy controls recruited from the outpatient clinic of the rheumatology department of Bangabandhu Sheikh Mujib Medical University(BSMMU),Dhaka,Bangladesh.To genotype HLA-B alleles from peripheral blood DNA,we designed sequence-specific primers for polymerase chain reaction.Sanger's sequencing method was used to detect the ERAP1 rs30187 SNP.The HLA-B allele distributions were compared between cases and controls.To infer an allelic association between HLA-B27 and ERAP1,allele distributions from both loci were compared using cross-tabulations.Chi-squared test or Fisher's exact test was used to quantify the association,and their strength of association was tested by odds ratio(OR)with 95%confidence interval(CI).Results:The frequency of HLA-B27 was found to be higher in AS patients(60.4%)than in healthy controls(8.3%).HLA-B27 allele had an OR of 16.8(95%CI=5.2–54.4)for the development of AS.Overall,4%of AS patients had both HLA-B27 and HLA-B40.No significant association was found between ERAP1 rs30187 SNP and HLA-B27 in patients with AS(OR=1.7,95%CI=0.5–5.6).Conclusions:HLA-B27 was significantly associated with AS in patients in Bangladesh.However,no association between ERAP1 rs30187 SNP and HLA-B27 was observed.