Ibrahim Mahmoud

Satisfaction with emergency department service among non‐English‐speaking background patients

The present study aims to investigate non‐English‐speaking background (NESB) patients satisfaction with hospital ED service and compare it with that of English‐speaking background (ESB) patients.

Language and utilisation of emergency care in Queensland

To compare access and utilisation of EDs in Queensland public hospitals between people who speak only English at home and those who speak another language at home.

The FTO rs9939609 “A” allele is associated with impaired fasting glucose and insulin resistance in Emirati population

BACKGROUNDnFat mass and obesity-associated protein gene variants have shown diverse influence on body weight and metabolism across different populations. Overweight, obesity and metabolic syndrome are multifactorial major health problems in the UAE and worldwide. Insulin resistance represents the link between overweight and development of metabolic syndrome and type 2 diabetes mellitus. We investigated two (FTO) variants in Emirati population, in relation to insulin resistance and different parameters of metabolic syndrome.nnnMETHODSnWe recruited 259 Emiratis through the UAE National Diabetes and Lifestyle Project. Ethical approval was obtained. Besides basic data collection, venous blood samples were collected. Fasting blood glucose, Lipid profile, and insulin levels were measured. Genotyping for (FTO) rs9939609 (A>T) and rs9930506 (G>A) were performed using real time-PCR. Insulin resistance were identified using HOMA2-IR calculation; with a cut-off point of 1.4 for female and 1.18 for male subjects.nnnRESULTSnThe study included 259 Emiratis (age range 30-53u202fyears, mean 41.76u202fyears, 54.4% females), 24.5% are diabetic and 30.8% are hypertensive, with body mass index of 28.4u202f±u202f5.9 and 28.7u202f±u202f5.7u202fkg/m2 in female and male subjects, respectively. Homozygous A of rs9939609 showed significantly higher fasting glucose compared to other genotypes (pu202f=u202f0.04) with a trend of higher insulin level and HOMA-2IR. The A/A diabetic patients (nu202f=u202f13) showed significantly higher insulin levels compared to other genotypes. G allele of rs9930506 showed a trend of higher fasting glucose and HOMA-2IR, but lower insulin level and HbA1c. No association of genotypes was detected with other components of metabolic syndrome.nnnCONCLUSIONnThere is an association of FTO rs9939609 A/A genotype and impaired fasting glucose and insulin resistance. Homozygous A genotype diabetic patients may be more vulnerable to blood glucose fluctuation. Focused genotyping can help the health care providers to identify high risk groups of both normal population and diabetic patients to intervene accordingly.

Community-acquired urinary tract infections due to extended-spectrum β -lactamase-producing organisms in United Arab Emirates

BACKGROUNDnThe epidemiology of extended-spectrum β-lactamase (ESBL)-producing bacteria is fast evolving with increasing global trend towards community-acquired infections. Limited information available about ESBLs therapy outcomes and control strategies, especially in the Middle Eastern countries.nnnMETHODSnWe studied 399 ESBL-producing Escherichia coli and Klebsiella pneumoniae isolates from urinary tract infections (UTIs) occurred between 2014 and 2016 in University Hospital Sharjah. We included 124 ESBL-negative E. coli and K. pneumoniae isolates from UTIs as controls. Pearson Chi squares test and independent t-test were used to compare difference between ESBL positives and negatives. Multivariate logistic regression analysis was also performed.nnnRESULTSnApproximately 75% of the E. coli and K. pneumoniae isolates causing UTIs were community-acquired. We found that recurrent UTIs, old age, and catheterization among other risk factors for community-acquired ESBL-positive UTIs. Majority of these ESBL-positive isolates were resistant to antibiotics such as ciprofloxacin (74%) and trimethoprim-sulphamethoxazole (73%) that are commonly used for treatment of community-acquired urinary tract infections.nnnCONCLUSIONSnESBL-producing E. coli and K. pneumoniae have become major etiological pathogens of community-acquired UTIs in the United Arab Emirates. Healthcare providers should implement better infection control strategies and careful use of antimicrobials especially in out-patient and community settings.

Group OSCE (GOSCE) as a formative clinical assessment tool for pre-clerkship medical students at the University of Sharjah

Objectives Continuous formative assessment with appropriate feedback is the pillar of effective clinical teaching and learning. Group Objective Structured Clinical Examination (GOSCE) has been reported as a resource-effective method of formative assessment. The present study aims to describe the development and evaluation of GOSCE as a formative assessment for pre-clerkship medical students. Methods At the University of Sharjah, GOSCE was introduced to medical students in Years 1, 2, and 3. The GOSCE was conducted as a formative assessment in which groups of 4–5 students were observed while they performed various clinical skills, followed by structured feedback from clinical tutors and peers. GOSCE was evaluated both quantitatively and qualitatively and appropriate statistical analysis was applied to evaluate their responses. Results A total of 232 students who attended the GOSCE responded to the questionnaires. Most of the students and clinical tutors preferred formative GOSCE over individual feedback. Both students and clinical tutors valued the experience as it helped students to identify gaps and to share knowledge and skills among group members. Conclusion This study found that formative GOSCE provided a valuable and feasible educational opportunity for students to receive feedback about their clinical skills.

Incidence and outcome of subarachnoid haemorrhage in the general and emergency department populations in Queensland from 2010 to 2014

To determine: (i) incidence and outcome of subarachnoid haemorrhage (SAH) in the general population; and (ii) proportions of SAH in both the general ED population and in ED patients presenting with headache.

Statin-induced myopathy SLCO1B1 521T > C is associated with prediabetes, high body mass index and normal lipid profile in Emirati population

BACKGROUNDnStatin-induced myopathy has been linked to the C allele of a single nucleotide polymorphism (SNP) (rs4149056) of SLCO1B1 gene. This effect is more significant, but not restricted to simvastatin. Many studies have included European, American, African and Southeast Asian ancestries, but few were carried out on Middle Eastern population.nnnAIMnTo detect the prevalence of SLCO1B1 rs4149056 (521Tu202f>u202fC) in Emirati population.nnnMETHODnWe recruited 282 Emiratis through the UAE National Diabetes and Lifestyle Project. Ethical approval was obtained before the study starts. Besides basic data collection, venous blood samples were collected. Fasting blood glucose, Lipid profile, and insulin levels were measured. Genotyping for rs4149056 (521Tu202f>u202fC) was tested in triplicates through Real Time-PCR using TaqMan® Drug Metabolism Genotyping Assay. rs2306283 (388Au202f>u202fG) was analyzed for comparison. In addition, presence of minor alleles of both SNPs define stronger association with statin-induced myopathy.nnnRESULTSnThe study included 282 individuals, 52.8% were males with median age of 39.5u202fyears. 10% had Diabetes Mellitus and 23% were hypertensive. Median of body mass index (BMI) was 27.68u202fkg/m2 in males and 28.38u202fkg/m2 in females. One-hundred ninety-seven (69.9%) showed abnormal lipid profile (either increased LDL-cholesterol or triglycerides or both). For rs4149056, C allele was present in 21.3% (2.8% homozygous C and 18.4% heterozygous CT). Although homozygous C genotype prevalence was low, compared with Caucasians (4%) and Africans (0%), C allele was associated with a trend of having higher BMI and abnormal lipid profile. C allele subjects were all pre-diabetics with mean glycated hemoglobin above 6%. Mean BMI in CC, CT, and TT genotypes was 30.91u202f±u202f4.4, 29.48u202f±u202f4.2, 27.96u202f±u202f5.5u202fkg/m2 respectively, with lack of such a trend observed with the different genotypes of the rs2306283 (used for comparison). Abnormal lipid profile was observed in 7/8(87.5%), 38/52(73.1%) and 152/222(70%) of the CC, CT, and TT genotypes respectively.nnnCONCLUSIONnThere is lower prevalence of statin-induced myopathy-linked C allele of rs4149056 in SLCO1B1 gene in Emirati population, compared to Caucasians and Africans. However, there is a trend of higher glycosylated hemoglobin and BMI associated with normal lipid profile in patients having this allele.

Diabetes risk score in the United Arab Emirates: a screening tool for the early detection of type 2 diabetes mellitus

Objective The objective of this study was to develop a simple non-invasive risk score, specific to the United Arab Emirates (UAE) citizens, to identify individuals at increased risk of having undiagnosed type 2 diabetes mellitus. Research design and methods A retrospective analysis of the UAE National Diabetes and Lifestyle data was conducted. The data included demographic and anthropometric measurements, and fasting blood glucose. Univariate analyses were used to identify the risk factors for diabetes. The risk score was developed for UAE citizens using a stepwise forward regression model. Results A total of 872 UAE citizens were studied. The overall prevalence of diabetes in the UAE adult citizens in the Northern Emirates was 25.1%. The significant risk factors identified for diabetes were age (≥35u2009years), a family history of diabetes mellitus, hypertension, body mass index ≥30.0u2009and waist-to-hip ratio ≥0.90u2009for males and ≥0.85u2009for females. The performance of the model was moderate in terms of sensitivity (75.4%, 95% CI 68.3 to 81.7) and specificity (70%, 95%u2009CI 65.8 to 73.9). The area under the receiver-operator characteristic curve was 0.82 (95% CI 0.78 to 0.86). Conclusions A simple, non-invasive risk score model was developed to help to identify those at high risk of having diabetes among UAE citizens. This score could contribute to the efficient and less expensive earlier detection of diabetes in this high-risk population.