New Emirates Medical Journal - Current Issue

To evaluate the suitability of commercially available glucometers in the UAE in terms of accurate and reliable blood glucose measurements.

Portable glucometers are employed for measuring blood glucose levels, offering distinct advantages such as providing instant results and being user-friendly when compared to laboratory reference analyzers. However, certain molecules, such as those found in medications, can interfere with the accuracy of glucometer readings.

To evaluate the precision and interference in the presence of maltose and vitamin C of three glucometers commercially available in the UAE.

We utilized plasma samples to conduct two types of experiments: a precision experiment and an interference experiment. We compared the precision of three glucometer brands available in the United Arab Emirates [Accu-Chek Instant^TM, One Touch Select Plus Flex^TM, and Trister GlucoScan^TM] in the presence or not of various interfering molecules, such as Maltose and Ascorbic Acid (Vitamin C).

Accu-Chek Instant^TM demonstrated the highest precision among the glucometers tested, with a coefficient of variation of less than 5% for all measured glucose values. In contrast, OneTouch Select Plus Flex^TM and Trister Glucoscan^TM exhibited higher variability in precision, with coefficients of variation of 11.4% and 11%, respectively. Accu-Chek Instant^TM consistently performed well in terms of bias and precision in the presence of interferences, and does not display glucose readings above 50mg/dL of Vitamin C. Notably, Ascorbic acid induced a greater bias compared to Maltose for all three glucometers.

The performance of the glucometer is affected by its testing methodology. Accu-Chek Instant^TM shows improved precision and is able to detect the presence of Vitamin C. When it comes to Maltose interference, it results in a higher bias change but lower variability, which can be addressed by applying a correction factor.

Mobile health interventions showcase effectiveness for improving treatment adherence among Latent TB Infection (LTBI) patients. However, there is a paucity of evidence regarding their acceptability and usability. This study aimed to assess the initial acceptability and usability of a mobile health application that has been designed to ensure treatment adherence in LTBI patients.

A descriptive study was conducted to assess the acceptability and usability of a mobile health application, “My Treatment Friend”. A total of 82 LTBI patients were selected, and access to the application was given to them. This application provides support to LTBI patients in reporting daily medication and side effects. The basic demographic characteristics of the participants were collected through a Google form-based questionnaire. The acceptability and usability of the application were assessed using the likert scale questionnaire and SUS tool, with samples of n=44 and n=20 participants, respectively.

LTBI patients found the mobile application acceptable and feasible, with an SUS score of 73, which comes under Grade B as per the SUS score sheet. The majority believed that the app was very simple to use and easy to understand. However, there is a requirement to add more features that can enhance the acceptability and usability of the application.

The study showed the importance and usefulness of mobile applications to assist LTBI patients in finishing their prescribed treatment courses of action. Additionally, it highlights how crucial it is to build future applications using user-centered design. User-centered design may play an important role in designing mobile applications and ensuring effective engagement and satisfaction among users.

A significant risk factor for cardiovascular disease, hypertension, affects more than a billion people globally. Numerous non-pharmacological methods work well to lower blood pressure. The objective of this study was to assess the short-term effect of green tea supplementation on blood pressure among people with hypertension.

This community-based randomized controlled trial was conducted among people with hypertension recruited using a purposive sampling technique from the village of Lakhnaur, Mohali, Punjab, India. Sixty patients were randomly assigned to receive either supplementation with green tea beverage (one cup/day) or no intervention. The primary outcome measure was systolic and diastolic blood pressure. Blood pressure was measured at the baseline and 15 days after the intervention using a standard calibrated digital sphygmomanometer.

Post-intervention, the decrease in the mean systolic blood pressure was significantly greater (p <0.01) in the experimental group (129.83±6.497) than in the control group (135.0±6.433).

Green tea supplementation significantly lowered the systolic blood pressure among study participants. Green tea may be included as part of a lifestyle intervention to manage and control systolic blood pressure in hypertensive patients.

BFUHS/2K22/p-TH/12888 8/12/22.

The coverage of immunization amongst adults in India remains low; a lack of nationally endorsed guidelines and implementation policies is a contributing factor. There is a paucity of tools available to assess knowledge, attitude, and practices (KAP) regarding adult immunization. Hence, we attempted to develop a KAP questionnaire to evaluate the existing expertise regarding adult immunization among medicine and infectious diseases resident doctors in an apex medical institute in India.

A two-stage scheme for the development and validation of the questionnaire was followed. The first step involved an exhaustive literature review, focused group discussion, and in-depth interviews. The prepared draft was reviewed by experts in the field of infectious diseases and adult immunization across the domains of necessity, relevance, and clarity. ‘Item-level content validity indices’ (I-CVI) and ‘Scale-level content validity indices’ (S-CVI) were then calculated. Brennan and Prediger's AC (Agreement Coefficient) and Gwet’s AC (Agreement Coefficient) were used to establish inter-rater agreement on the obtained expert reviews.

A 57-item KAP questionnaire was developed and was reviewed by a total of 11 experts. The questionnaire had satisfactory I-CVI (>0.6 for all the items) and S-CVI Ave (>0.9 for each of the domains). The questionnaire had a strong inter-rater agreement as assessed by both Brennan and Prediger AC (> 0.6, p<0.001) and Gwet’s AC (>0.8, p<0.001).

The developed tool was scientifically validated following a staged process. We propose that this questionnaire can hence be used to evaluate the knowledge, attitude, and practices regarding adult immunization amongst medical practitioners across medical colleges and hospitals in India. This may be instrumental in developing programmatic interventions and major policy changes to enhance the practice of adult immunization amongst healthcare providers.

This study aimed to evaluate the effect of ameliorated insulin injection site rotation on the incidence of Lipohypertrophy (LH) and glycemic control in patients with diabetes.

A quasi-experimental design involving a pretest-posttest with a control group was utilized at the medical outpatients’ clinic of Sohag University Hospital. The participants were divided into two groups (30 in the study group and 30 in the control group). Two instruments were utilized to collect the data, i.e., a sociodemographic and clinical data sheet and a lipohypertrophy assessment sheet.

The majority have been found to suffer from type I DM with an insulin injection duration from one to less than 6 months. A significant reduction has been noticed in the lipohypertrophy incidence and grade during the 6-month assessment compared to the pre-intervention assessment.

A marked reduction in the incidence of LH and improved glycemic control have been noted in the study group, indicating the clinical significance of the anti-clockwise insulin site rotation technique.

Overweight and obesity are growing problems worldwide, along with a decrease in physical activity. This trend is also seen in the United Arab Emirates, including insufficient exercise among university students. This study aimed to evaluate the physical activity level, weight categories, and fat distribution among female college students and determine the correlations and associations between these factors and demographic factors.

A cross-sectional study was conducted among 204 female undergraduate health profession students recruited through a convenience sampling technique. Data were collected using anthropometric measurements and a self-administered International Physical Activity Questionnaire (IPAQ). The relationships between weight categories (Body Mass Index, BMI), fat distribution (Waist-to-Hip Ratio, WHR), and levels of physical activity, as well as the relationship between BMI and WHR, were analyzed using the PSPP statistical program.

The mean age of the students was 20.5 ± 1.9 years, with an average BMI of 25.4 ± 6.6 kg/m². About 60.3% of the students were moderately active. Physical activity levels were significantly associated with BMI categories (P= 0.008). BMI and WHR categories were also significantly associated (P= 0.012). There was a strong association between students' perceived physical activity levels and their actual activity, as measured by the IPAQ short form (P= 0.001). No significant relationships were found between physical activity, anthropometrics, and demographic characteristics.

Female college students demonstrated moderate levels of physical activity, and a negative correlation was detected between their physical activity levels and weight categories. None of the studied demographics showed a correlation or association.

Normal circadian blood pressure response includes a nocturnal fall in BP by 10 to 20% of the average daytime BP. Many diseases, including diabetes mellitus, alter these normal circadian BP changes. DM, through its long-term microvascular and macrovascular complications, such as autonomic neuropathy, affects BP dipping patterns by decreasing dipping (non-dipper), exaggerating dipping (nocturnal hypotension), or causing an actual increase in BP (reverse dipping). These altered dipping patterns are likely to be more common in those with long-standing hyperglycemia, poor glycemic control, and concurrent renal dysfunction. Abnormal dipping patterns (non-dipping and reverse dipping) are associated with increased target organ damage and cardiovascular risk among diabetic patients. The BP variation and dipping patterns are best studied using ambulatory blood pressure monitoring. This study has compared BP dipping patterns in patients with T2DM and healthy controls and evaluated their correlation with the duration of diabetes, glycemic status, and renal status by employing Ambulatory Blood Pressure Monitoring (ABPM).

50 patients with T2DM for more than 5 years have been compared with 50 normal subjects (controls) for alteration in the circadian BP pattern and its relationship with the patients’ duration of diabetes, glycemic status, and renal status.

This study has revealed statistically significant findings concerning abnormal dipping patterns (non-dipping and reverse dipping) between diabetic and non-diabetic patients (56% vs. 24%, p-value=0.001), between the duration of diabetes for more than 10 years and 5-10 years (77.8% vs. 43.8%, P=0.02), between higher HbA1c of more than 9% and 7-9% (34.5% vs. 4.8%, P=0.0001), between patients with proteinuria and those without proteinuria (p=0.045), and between patients with microalbuminuria and those with no microalbuminuria (87.5% vs. 41.2%, p=0.002).

Compared to normal subjects, most patients with T2DM had an abnormal BP dipping pattern. The duration of DM, poor glycemic control, and renal dysfunction (proteinuria and microalbuminuria) were positively correlated with nocturnal BP dipping pattern abnormalities.

An adverse drug reaction is defined as “an appreciably harmful or unpleasant reaction, resulting from an intervention related to the use of a medicinal product, which warrants prevention or specific treatment, alteration of the dosage regimen, or withdrawal of the product, as it predicts hazard from future administration.”

Currently used to report such responses, the International Classification of Diseases will soon incorporate WHO's Adverse Reaction Terminology. A medication's bad effects can fall into one of six types, each having its own mnemonic: withdrawal, therapeutic failure, dose-and time-related, non-dose-related, weird, increased withdrawal, and withdrawal overall (time-related). Factors such as timing, illness pattern, investigation findings, and retesting the medicine could be useful in pinpointing the reason for a suspected adverse drug reaction. Management includes treating the effects of the medication specifically as well as, if feasible, stopping it altogether.

Reporting suspected adverse medication reactions is important. Monitoring techniques are able to identify responses and establish connections. There is many software that is used to report and monitor adverse drug reaction responses. Various Pharmacovigilance companies use AI technology to utilize this method to record signals, communicate, and solve new issues in order to limit or avoid harm because of large data size.

The study sought to quantify the frequency and categorize the types of prescribing errors occurring in outpatient settings while evaluating the efficacy of pharmacist interventions in mitigating such errors.

This study was a cross-sectional, retrospective interventional study conducted over a one-year period from September 1, 2017, to August 31, 2018, at the outpatient departments of one government and one private tertiary care hospital in Hyderabad, Pakistan. A total of 2,552 outpatient prescriptions were randomly collected and evaluated by the researchers to identify prescribing errors, using the British National Formulary (BNF) as a reference guide. The study rigorously adhered to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines, ensuring comprehensive reporting, transparency in methodology, analysis, and interpretation of the observational research findings.

The collected data were analyzed using chi-square tests in SPSS version 25 to assess statistical significance. Among the 2,552 outpatient prescriptions examined, 12,501 (40.4%) prescribing errors were identified. The error rate was higher in the government hospital (6,672; 42.8%) compared to the private hospital (5,829; 38.0%). The most prevalent errors occurred during the subscription stage (2,302; 45.1%), with 1,245 (48.1%) and 1,057 (42.0%) errors in the government and private hospitals, respectively. This was followed by errors in the inscription (3,447; 45.0%), superscription (5,156; 40.4%), and transcription (1,596; 31.3%) stages. Common interventions during the subscription stage addressed incomplete patient information (age, weight, etc.), missing consultant signatures, and stamps. For the inscription stage, frequent interventions involved incorrect drug doses and strengths.Typical interventions for the subscription and inscription stages included adding missing therapy durations and usage instructions, respectively. Pharmacist interventions were accepted at a higher rate in private hospitals (3,669; 62.9%) compared to government hospitals (3,675; 55.1%), with a total of 7,344 (58.7%) interventions accepted.

The study revealed a high prevalence of prescribing errors across all stages of the outpatient prescription process, with the subscription stage being the most error-prone. The findings highlight the critical role of pharmacist-led prescription interventions in mitigating prescribing errors, thereby enhancing prescribing practices, optimizing therapeutic outcomes, and safeguarding patient safety.

Type 2 diabetes is a heterogeneous disease characterized by high blood glucose levels. Its prevalence is increasing as a result of lifestyle, related genes expression, and insufficient insulin signaling. The activation or inhibition of some proteins in the insulin signaling pathway play a vital role in glucose uptake into the cells and in maintaining serum glucose homeostasis. Phosphoinositide-3-kinase (PI3K), 3-phosphoinositide-dependent protein kinase-1 (PDK1), Protein kinase B [PKB, also known as the serine and threonine kinase (AKT)], and Rac family small GTPase 1 (RAC1) are key proteins that play important roles in the liberation of Glucose Transported-4 (GLUT4) vesicle, and consequently the uptake of glucose in response to the insulin signal of hyperglycemia.

In this study, we have focused on the route of targeting insulin signaling proteins for decreasing insulin resistance by targeting the four proteins, PI3K, PDK1, AKT, and RAC1, using in silico studies.

Docking experiments, using AutoDock algorithms, were performed to predict the activity of eight recently purified derivatives of Gundelia tournefortii (GT) and Ocimum basilicum (4-hydroxybenzoic acid, beta-amyrin, beta-sitosterol, chlorogenic acid, lupeol, lupeol-trifluoroacetate, myo-inositol, and stigmasterol) on the insulin signaling proteins. The SwissADME website was used to predict ADMEtox properties for the eight derivatives of the above-mentioned medicinal plants.

Most of the Gundelia tournefortii and Ocimum basilicum derivatives have shown variable levels of activation, mainly on the PDK1 and AKT pathways, and to a much lesser extent on the PI3K and RAC1 pathways.

The results have indicated that Gundelia tournefortii and Ocimum basilicum derivatives can be potent anti-diabetic drugs, namely in targeting PDK1 and AKT pathways.

Valvular heart diseases are some of the most common causes of cardiovascular morbidity and mortality worldwide. The mitral valve is estimated to be the cause of 15% of deaths in heart valve disease. Mitral valve dysfunction can be treated with a variety of operative options, one of which is mitral valve replacement. Although it is less desirable than repair, in some situations, it is the only viable option. Thus, we conducted this systematic review to help guide future risk assessment for mitral valve replacement patients and help in the construction of pre-operative risk assessment tools.

This is a systematic review of original articles discussing the topic of predictors of mortality for patients undergoing mitral valve replacement surgery. A systematic search was conducted via independent researchers across a number of databases, starting with PubMed databases utilizing its MeSH database, followed by a complementary search through Google Scholar.

In total, 27 original articles were included in a collective cohort of 145005 patients. Older age was the most commonly cited variable as a mortality predictor, followed by decreased left ventricular ejection fraction. EuroSCORE is a well-known scoring system that predicts in-hospital mortality following major cardiac surgeries. It was found that it overestimated mortality greatly, while another study found that the revised EuroSCORE II system was a better predictor of mortality. Overall, we note that both versions usually overestimate mortality.

There seems to be an overall agreement over several factors, including older age, decreased ejection fraction, and the expertise of the surgeon and the institution on being clear predictors of postoperative mortality. There is also an obvious need for new tools to better predict mortality rates preoperatively, as the currently used scores often result in greatly inaccurate predictions.

A lack of proper anti-malarial medication use can lead to drug resistance, failed therapy, and even death. It is unclear how widespread the use of fake anti-malarial medications is in India. Better malaria treatment and the execution of regulatory initiatives to improve anti-malarial drug quality necessitate regional research into the quality of available anti-malarial pharmaceuticals. This study aimed to look into the quality of anti-malarial drugs in regions of India where malaria is common. Conclusions about the prevalence of substandard anti-malarial medications in Indian communities can be drawn from the findings.

Samples of anti-malarial pills were bought from stores in five different Indian areas. One hundred and fifty anti-malarial drug samples were gathered. Using a GPHF minilab lab kit, the quality of the following samples was determined: chloroquine (n=50), artemether lumefantrine (n=50), artesunate sulphadoxine-pyrimethamine (n=14), and primaquine (n=31).

This research confirmed that 98% of the tablets disintegrated properly in a minilab disintegration test. As a result, when compared to both the full set of standards and 80% of the samples, 99% of the samples passed the preliminary qualitative TLC test. Only 4% of samples (those with insufficient amounts of the active medicinal component) failed the quantitative HPLC test.

Anti-malarial medicine counterfeiting has been found to be quite uncommon in India compared to other countries. However, further research is needed, such as post-marketing surveillance, to ensure that effective anti-malarials are distributed to the public.

The normal anatomy of the coronary arteries consists of the right coronary artery and the left main coronary artery, which originate from the right and left sinuses of Valsalva in the aortic root separately. In general, congenital anomalies of the coronary artery are uncommon in adults. The ectopic origin of a coronary artery from the pulmonary trunk is part of a group of infrequent coronary artery anomalies. The Anomalous origin of the Right Coronary Artery from the Pulmonary Artery (ARCAPA) is thought to be an extremely rare congenital coronary artery anomaly. Most of our knowledge and experience about this congenital coronary malformation is derived from published case reports and series.

We have, herein, reported the case of a 68-year-old male who was discovered to have ARCAPA after he presented to our center with chest pain. The patient underwent multiple invasive and non-invasive diagnostic imaging modalities, including an echocardiogram, a coronary angiogram, a multislice-gated coronary computed tomographic angiogram, and stress perfusion cardiovascular magnetic resonance imaging. The clinical decision was to continue with conservative non-surgical management along with close follow-up.

The ARCAPA anomaly is considered to be one of the rare congenital coronary artery variances that can be discovered in late adulthood as a patient may remain asymptomatic for many decades.