Abdishakur Abdulle

Favorable Changes in Lipid Profile: The Effects of Fasting after Ramadan

Aims We assessed the effect of fasting during Ramadan on blood pressure (BP), body weight, plasma lipid, and lipoprotein variables among healthy normal individuals. Methods 102 (68% male) multi-ethnic volunteers; mean age ± SD (38.7±10.5 years) were randomly recruited in Al-Ain, United Arab Emirates (UAE), to be investigated before Ramadan, one day after the end of Ramadan, and four weeks after Ramadan. Anthropometric, demographic, fasting plasma total cholesterol (TC), triglyceride (TG), and high density lipoprotein–cholesterol (HDL-C) were measured by standard methods, and Low density lipoprotein-cholesterol (LDL-C) was calculated using Friedewald’s formula. Results 65 subjects completed the study. We found significant and beneficial changes in systolic blood pressure (SBP), body weight, waist circumference (WC), TG, HDL-C and LDL-C, at the end of Ramadan, but not in TC. Further, there was a progressive and significant increase and decrease in HDL-C and LDL-C levels, respectively, four weeks after Ramadan. Conclusions We observed significant improvements in HDL-C, and LDL-C levels even after four weeks post Ramadan. Ramadan-like fasting may be considered for more effective lipid and lipoprotein control.

Under- treatment and under diagnosis of hypertension: a serious problem in the United Arab Emirates

BackgroundHypertension, notably untreated or uncontrolled, is a major risk factor for cardiovascular diseases (CVD) morbidity and mortality. In countries in transition, little is known about the epidemiology of hypertension, and its biochemical correlates. This study was carried out in Al Ain, United Arab Emirates, to characterize self-reported (SR) normotensives and hypertensives in terms of actual hypertension status, demographic variables, CVD risk factors, treatment, and sequalae.MethodsA sample, stratified by SR hypertensive status, of 349 SR hypertensives (Mean age ± SD; 50.8 ± 9.2 yrs; Male: 226) and 640 SR normotensives (42.9 ± 9.3 yrs, Male: 444) among nationals and expatriates was used. Hypertensives and normotensive subjects were recruited from various outpatient clinics and government organizations in Al-Ain city, United Arab Emirates (UAE) respectively. Anthropometric and demographic variables were measured by conventional methods.ResultsBoth under-diagnosis of hypertension (33%) and under-treatment (76%) were common. Characteristics of undiagnosed hypertensives were intermediate between normotensives and SR hypertensives. Under-diagnosis of hypertension was more common among foreigners than among nationals. Risk factors for CVD were more prevalent among SR hypertensives. Obesity, lack of exercise and smoking were found as major risk factors for CVD among hypertensives in this population.ConclusionHypertension, even severe, is commonly under-diagnosed and under-treated in the UAE. Preventive strategies, better diagnosis and proper treatment compliance should be emphasized to reduce incidence of CVD in this population.

Parental weight perceptions: a cause for concern in the prevention and management of childhood obesity in the United Arab Emirates.

Parental participation is a key factor in the prevention and management of childhood obesity, thus parental recognition of weight problems is essential. We estimated parental perceptions and their determinants in the Emirati population. We invited 1541 students (grade 1–12; 50% boys) and their parents, but only 1440 (6–19 years) and their parents consented. Of these, 945 Emirati nationals provided data for analysis. Anthropometric and demographic variables were measured by standard methods. CDC BMI percentile charts for age and sex were used to classify children’s weight. Parental perception of their children’s weight status (underweight, normal, and overweight/obese) was recorded. Logistic regression analyses were used to identify independent predictors of parental perceptions of children’s weight status. Of all parents, 33.8% misclassified their children’s’ weight status; underestimating (27.4%) or overestimating (6.3%). Misclassification was highest among parents of overweight/obese children (63.5%) and underweight (55.1%) children. More importantly, parental perceptions of their children being overweight or obese, among truly overweight/obese children, i.e. correct identification of an overweight/obese child as such, were associated with the true child’s BMI percentile (CDC) with an OR of 1.313 (95% CI: 1.209–1.425; p<0.001) per percentile point, but not age, parental education, household income, and child’s sex. We conclude that the majority of parents of overweight/obese children either overestimated or, more commonly, underestimated children’s weight status. Predictors of accurate parental perception, in this population, include the true children’s BMI, but not age, household income, and sex. Thus, parents having an incorrect perception of their child’s weight status may ignore otherwise appropriate health messages.

Cognitive and autonomic dysfunction measures in normal controls, white coat and borderline hypertension

BackgroundWhite coat hypertension (WCHT) is a significant clinical condition with haemodynamic differences and presence of functional changes. We aim to compare cognitive and autonomic dysfunction variables (heart rate variability) between subjects with normal blood pressure (controls), WCHT, and borderline hypertension (BLH).MethodsWe performed a cross-sectional study in a cohort of 69 subjects (mean age ± SD; 38.2 ±10.8 years) comprising comparable number of normal controls, WCHT, and BLH. We measured clinic and 24-hour ambulatory blood pressure monitoring (ABPM), cognitive function parameters, and heart rate variability (HRV). All subjects underwent 24-hour ambulatory electrocardiography monitoring which was analyzed for HRV measurements. We performed a routine echocardiography (ECHO) for all subjects.ResultsMultiple comparison between the three groups revealed significant (p < 0.04) differences in mean day-time ABPM (systolic and diastolic). In the state anxiety inventory (SAI), both subjects with WCHT and BLH had significantly (p < 0.006) higher anxiety levels than the control group. In memory tasks WCHT subjects scored significantly (p < 0.004) lower in comparison with the other two groups. WCHT significantly (p < 0.001) performed less in memory tests, whereas BLH subjects had significantly (p < 0.001) lower reaction time. We found a significant (p < 0.05) difference in the 24-hour RMSSD and SDNN between the three groups. There was significant correlation between 24-hour RMSSD and computer CANTAB scores. The Echocardiography assessment revealed no significant differences in LV mass indices and diastolic function.ConclusionsWCHT and BLH subjects showed lower cognitive performance and higher levels of anxiety when compared to controls. Autonomic function reflected by HRV indices was lower in WCHT and BLH in contrast to control, though not significantly. Our results suggest that WCHT may not be a benign condition as it may contribute to the overall risk for cardiovascular disease and LV damage. Longitudinal studies of patients with WCHT should clarify the transient, persistent or the progressive nature of this condition.

Association between homocysteine and endothelial dysfunction markers in stroke disease

Abstract Background: Evidence shows that there is an increase in concentrations of markers of endothelial dysfunction immediately following acute ischaemic stroke. Several studies suggest that endothelial dysfunction may be partly caused by oxidation related to the effects of raised total plasma homocysteine. Objective: The aim of this study was to measure changes in total plasma homocysteine and markers of endothelial dysfunction in stroke disease within a known period of time post infarct. Subjects and methods: We studied 40 acute ischaemic stroke patients (mean age ± SD, 50.2 ± 9.5 years) and 42 hospitalised non-stroke patients (mean age, 44.3 ± 14.9 years). Fasting venous blood was obtained within 24 h, 3 days and 7 days after the stroke onset and hospitalisation for non-stroke patients for measurements of total plasma homocysteine, markers of endothelial dysfunction including intracellular adhesion molecule (i-CAM), vascular cell adhesion molecule-1 (v-CAM) and leukocyte adhesion molecule-1 (E-selectin) and C-reactive proteins (CRPs). Results: We found no significant differences in baseline total plasma homocysteine, E-selectin, v-CAM, vitamin B12, and folate concentrations between ischaemic stroke patients and non-stroke controls. i-CAM concentrations were significantly higher and CRPs non-significantly lower at baseline in stroke patients compared with controls. Although all endothelial dysfunction markers increased significantly during the study period, the rise in E-selectin levels was less than that seen in i-CAM, and v-CAM. Total plasma homocysteine concentrations showed positive correlations with creatinine (r = 0.537; P < 0.02), and inverse correlations with both vitamin B12 (r = –0.560; P < 0.001) and folate (r = –0.469; P < 0.002); however, there were no significant correlations between total plasma homocysteine or B-vitamins and markers of endothelial dysfunction in ischaemic stroke patients or controls. Conclusions: We found evidence of an increase in markers of endothelial dysfunction following acute ischaemic stroke but this had no relationship with total plasma homocysteine concentrations.

High Blood Pressure and Its Association with Body Weight among Children and Adolescents in the United Arab Emirates

Objectives To estimate the prevalence of high blood pressure (BP) and its relationship with obesity among children and adolescents. Methodology/Principal Findings In this cross-sectional population (Emirati) representative study, we invited a random sample of 1600 students (grades 1–12) attending 23 out of all 246 schools in the Emirate of Abu Dhabi, United Arab Emirates. But analysis was restricted to Emirati nationals aged 6–17 years. We measured BP, height, weight, waist circumferences (WC), and calculated body mass index (BMI) by standard methods. BP levels ≥90th percentile but <95th percentile and ≥ 95th for age, sex, and height (CDC percentiles) were classified as pre-hypertension (pre-HTN) and hypertension (HTN), respectively. Associations between BP, age, BMI, WC, and sex, were investigated by (multiple) linear regression methods. A total of 999 (47% girls) students provided complete results. The prevalence of pre-HTN was 10.5% and 11.4% and the prevalence of HTN was 15.4% and 17.8% among boys and girls, respectively. The prevalence of systolic/diastolic HTN was 14.4%/2.5% and 14.8/7.4% among boys and girls, respectively. BMI CDC percentile was positively correlated with WC percentile (r = 0.734, p<0.01), and both systolic (r = 0.34, p<0.001) and diastolic (r = 0.21, p<0.001) standardized BP. WC percentile was less strongly correlated with standardized SBP (r = 0.255, p<0.01) and DBP (r = 0.175, p<0.01) than BMI. Conclusions/Significance The prevalence of elevated BP, notably systolic was significantly high among the Emirati children and adolescents in Abu Dhabi. High BP was strongly related to body weight, and appears more strongly associated with BMI than WC. Further studies are required to investigate the impact of childhood obesity on HTN.

Terrestrial Snakebites in the South East of the Arabian Peninsula: Patient Characteristics, Clinical Presentations, and Management

Background To describe the characteristics, clinical presentations, management and complications of snakebites in the border region between Al-Ain, United Arab Emirates (UAE) and Buraimi, Sultanate of Oman. Methodology/Principal Findings We carried out a retrospective review of medical records to study snakebite cases over four-year duration at three tertiary hospitals. Overall, 64 snakebite cases were studied with median hospitalization of 2 (interquartile range [IQR] 1–4) days. The majority of cases were male (87.5%), and most (61%) of the incidents occurred during summer months. The bite sites were predominantly (95%) to the feet and hands. Main clinical features included pain, local swelling, and coagulopathy, blistering and skin peeling. Overall, there were no deaths, but few major complications occurred; extensive skin peeling (n = 5, 8%), multi-organ failure (n = 1, 1.5%), and compartment syndrome (n = 1, 1.5%). Polyvalent anti snake venom (ASV), analgesia, tetanus toxoid, intravenous fluids, and antibiotics such as ampicillin, cloxacillin, and cephalosporins were commonly instituted as part of treatment protocols in the three hospitals. Conclusion The overwhelming majority of bites occurred during summer months, and envenomations were more common in, relatively, young male farmers, but with no serious clinical complications. Prevention and treatment strategies should include increasing public awareness, developing management guidelines, and manufacturing specific ASV for a wide spectrum of the local venomous snakes.

A comparison of plasma leptin levels in obese and lean individuals in the United Arab Emirates

Abstract Objective: The main objective of this study was to evaluate blood leptin as a marker of obesity and correlate it with anthropometric measurements. Patients and Methods: There were 70 healthy obese and 35 lean individuals. Fasting plasma leptin was determined by radioimmunoassay in both study groups. The vital signs, body weight and height were taken, and the skinfold thickness was measured over the triceps muscle and in the subscapular region. Results: The median leptin level in the obese was significantly higher than that of the lean controls (38 Vs 5.6 ng/ml, p Conclusions: The systolic blood pressure, fasting blood leptin and sugar are higher in obese than lean individuals. Leptin is also higher in females than males and it correlates well with anthropometric measurements. However, it is not a perfect estimate of obesity, as 23 out of the 70 patients studied had normal leptin levels.

Prevalence and Determinants of Peripheral Neuropathy in Patients with Type 2 Diabetes Attending a Tertiary Care Center in the United Arab Emirates

Objective: This study was designed to estimate prevalence and identify relevant determinants of peripheral neuropathy in patients >18 years old with type 2 diabetes mellitus of at least 12 months. Methods: Adults with type 2 diabetes mellitus (394 patients, age = 57 ± 12 yr, 67% females, duration of diabetes = 10.9 ± 7.9 yr) were randomly selected from the Diabetes Center at Tawam Hospital (Al Ain City, United Arab Emirates). The Michigan Neuropathy Screening Instrument (MNSI) history and sign scores were used to assess neuropathy. Stepwise logistic regression analysis was used to assess independent predictors of peripheral neuropathy on the Michigan score. Results: Prevalence of peripheral neuropathy was 10.4% based on the MNSI-history score of ≥7 and 25.6% based on the MNSI-sign score of ≥ 3. Logistic regression analysis revealed that HbA1c [OR=3.41, 95% CI; 1.15– 10.16] and physical activity [OR=4.99, 95% CI; 2.21–11.29] were significant predictors of the MNSI-history score. Age [OR=1.06, 95% CI; 1.03–1.09], height [OR=1.06, 95% CI; 1.02–1.10], systolic blood pressure [OR=1.03, 95% CI; 1.01–1.06] and duration of diabetes [OR=1.08, 95% CI; 1.04–1.13] were significant predictors of the MNSI-sign score. Conclusion: Peripheral neuropathy was common in the studied diabetic patients and was associated with modifiable risk factors, such as glycemic control, blood pressure control and physical activity.

A Clinical Audit on Diabetes Care in Patients with Type 2 Diabetes in Al- Ain, United Arab Emirates

Objectives: To implement a prospective interventional clinical audit to evaluate the current clinical practice and the effect of standard interventions on the management of type 2 diabetes (T2DM). Methods: 254 patients with T2DM where recruited in a specialized diabetes care center in Al-Ain, UAE. The diabetes care components were audited before (baseline) and after (3 and 6 months) implementation of Institute of Clinical System Improvement (ICSI) guidelines. Data was compared against international guidelines to achieve target goals of normoglycemia, blood pressure (BP), and low density lipoprotein-cholesterol (LDL-C). We measured changes in mean scores of patient satisfaction level regarding diabetes care at similar intervals, by validated Patient Satisfaction Questionnaire (PSQ-18). Results: We observed a significant reduction in fasting blood glucose (FBG; mean± SD; 9.3 ± 0.03 vs 7.4 ± 0.3mmol/l; P=0.03), and HbA1c (8.7 ± 0.02 vs 8.1 ± 0.02 %; P=0.04) levels after 6 months compared with baseline. Patients who achieved target FBG and HbA1c levels improved significantly (45.7 vs 81.1%; P=0.03), and (40.1 vs 73.6%; P=0.04), respectively. The LDL-C levels improved, though this was not statistically significant. Patients achieving target of BP control improved significantly (SBP 142±7.6 and DBP 95±6.2 vs SBP 136±8.2 and DBP 87±5.8 mmHg;P=0.05). Conclusions: The results of this interventional audit were generally positive and emphasized the feasibility of improving the current clinical practice. Our individualized approach has helped us to achieve a better target in glycemic and BP control as well as patient satisfaction. Further research is needed to understand the long-term impact of our structured approach to improve the quality of T2DM care in the UAE.