Mayank Vats

Respiratory disorders in the Middle East: A review

The spectrum of pulmonary pathology in the Middle East is as versatile as its civilizations and cultures. In this review, we outline the key challenges confronting pulmonologists in the Middle East. We shed light on the diverse conditions commonly encountered in the region, from the centuries‐old illnesses of tuberculosis, to contemporary problems such as lung complications from chemical warfare. We specifically highlighted unique aspects related to respiratory illnesses in the Middle East, for example, climate factors in the desert region, cultural habits, for example, water‐pipe smoking and disorders unique to the region, such as Behçets disease. Pulmonologists are also faced with the consequences of modernization, including large immigrant population and associated social and health issues, rising incidence of obesity and sleep apnoea, and drug‐resistant tuberculosis. Tackling these health issues will require an integrated approach involving public health, primary care as well as specialist pulmonology input, taking into consideration the unique cultural and environmental factors to ensure effective management and compliance to medical care.

Prevalence of symptoms and risk of sleep apnea in Dubai, UAE

Purpose The United Arab Emirates (UAE) ranks 18th on the 2007 Forbes list of fattest countries with 68.3% of its citizens with an unhealthy weight and it is well known that weight gain and obesity are important determinants in the progression of obstructive sleep apnea syndrome (OSAS). The purpose of this study is to estimate the prevalence of symptoms and risk of OSAS in the primary health care setting in Dubai, and the relationship between obesity and sleep apnea. Methods In this prospective survey, a trained medical nurse administered the Berlin Questionnaire to a consecutive random sample of patients in the age group older than 14 years, who attended the primary health care center in Dubai Health Authority, Dubai, UAE, from September 2011 to March 2012. Based on the questionnaire answers, individuals were classified into high risk and low risk groups for OSAS. Results Based on the responses and measurement of the Berlin Questionnaire of 1214 subjects studied, 58% (n = 704) of the respondents were female, while 42% (n = 510) were male. Two-hundred-fifty-four respondents met the criteria for the high risk scoring. This gives a prevalence rate of 20.9% (out of which 22.9% of the male respondents were high risk for OSAS, while 19.5% of the females were high risk for OSAS), while the remainder of the participants were classified as low risk. The overall mean age of the high risk for OSAS female respondents was 39.95 years (standard deviation [SD] 11.73 years) and was 41.18 years (SD 14.95 years) for male respondents The highest prevalence was observed between age 51 to 60 in both genders. Seventy percent of the high risk group had a body mass index (BMI) ≥ 30 kg/m2 and nearly 75% of the low risk group had a BMI < 30 kg/m2, and the mean BMI was 32.06 kg/m2 (SD 5.67 kg/m2) for males and 33.59 kg/m2 (SD 6.44 kg/m2) for females. Conclusion In the primary health care setting, the prevalence of symptoms of OSAS among adult UAE citizens is very high, and UAE patients are at risk for OSAS and may benefit from proper evaluation for OSAS.

Environmental Exposure and Nonadherence with Medicines Directly Correlate with Exacerbations and Hospitalization for Asthma: A Population-Based Survey from UAE

Acute severe exacerbation of asthma is directly related with the uncontrolled asthma including noncompliance with the medicines and exposure to the environmental factors. To our knowledge, none of the community-based study has explored the prevalence of asthma and other factors (namely, pattern of symptoms, environmental/occupational/housing/behavioral pattern/misperception about asthma, and educational factors) contributing to the exacerbation of asthma. We also studied the nonadherence issues related to the management of asthma in the United Arab Emirates (UAE). By using European Community Respiratory Health Survey (ECRHS) questionnaires and pooled data from AIRGNE (UAE) study, we aimed to determine the above-mentioned factors in the general population by means of a cross-sectional assessment of a random sample of 1,229 participants of which 62.97% were male and 20.01% were UAE nationals, with a mean age (±SD) of 32.9 (±14.1) years. Prevalence of individual respiratory symptoms from the ECRHS questionnaire in all participants ranged from 8 to 10%, while those participants aged 20–44 years presented a lower prevalence in all symptoms (𝑃<0.05). Conclusion. Certain specific persistent environmental factor along with nonadherence to the controller medicines is a significant factor leading to uncontrolled asthma with consequent exacerbations, morbidity/mortality, and health care cost in UAE.

A Retrospective Review of Anti-Diabetic Regimens in Geriatric Emirati Patientswith Type 2 Diabetes and Its Relation to Glycemic Control: A Dubai HospitalOutpatient Clinic Experience

Geriatric population is a special subset of adult population with different needs as there are physiological changes that occur with aging, that lead to a decline in patient’s overall performance functional disabilities and, cognitive impairment, We reviewed the various anti diabetic regimes in Emirati geriatric patients with type 2 diabetes following outpatient medical clinics. In a view to find optimum anti-diabetic regime which is more suitable and acceptable to the patients with minimum side effects. We believe that patients following in government hospitals would be a true representation of whole subset of Emirati geriatric population and hence any results obtained could be a reflection of entire Emirati geriatric population. Medical records of 350 Emirati type 2 diabetic patients age above 65 were reviewed. HBAIC at the clinic visit was noted and they were retrospectively followed up as to see which anti diabetic regime these patients were on for the preceding 3 months. Patients were divided accordingly into 4 groups namely. a) Those on oral hypoglycemic, b) oral hypoglycemic plus basal insulin, c) premix insulin and d) basal insulin bolus. Mean HBAIC was compared amongst the various age groups. Conclusion 350 patients were following medical clinics, 16 patients were excluded. Out of the remaining 334 patients 224 were females and 110 were males. Patients were divided into 2 groups according to age. Patients less than 70 years of age were 121 (36.2%) and patients greater than 70 years of age were 213 (63.8%). Patients in both these age groups had uncontrolled blood sugars. HBAIC 8.1% vs. HBAIC 7.76% in patients less than 70 year’s vs. patients greater than 70 years age). In higher age groups HBAIC was better controlled as compared to lesser age groups reflecting better care of elderly in the Emirati society. Most patients were on oral hypoglycemic as compared to insulin (60.5% vs. 21.6%). Both males and females were better controlled on oral medication as compared to insulin (HBAIC 7.58% males and HBAIC 7.69% in females on oral medications). Sulfonyl urea and metformin being the most popular oral medications used. Only 21.6% were on insulin reflecting increase needle phobia in the elderly age groups.

Joint statement for the diagnosis, management, and prevention of chronic obstructive pulmonary disease for Gulf Cooperation Council countries and Middle East–North Africa region, 2017

Smoking and subsequent development of COPD is an ever-increasing epidemic in Arabian Gulf and Middle East countries, with no signs of decline. The important fact to be highlighted is that this COPD epidemic of increasing incidence and prevalence is mostly unrecognized by patients, due to the common attribution of symptoms to “smoker’s cough”, and the underdiagnosis and undertreatment by physicians because the common signs and symptoms masquerade as asthma. Consequently, there are long-term adverse effects of missing the diagnosis. The purpose of this review article is to focus upon the status of COPD in Arabian Gulf and Middle East countries, stressing the increasing burden of smoking and COPD, to emphasize the specific factors leading to rise in prevalence of COPD, to bring to light the underdiagnosis and undermanagement of COPD, and to treat COPD in conformity with standard guidelines with local and regional modifications. This review ends with suggestions and recommendations to the health department to formulate policies and to generate awareness among the general public about the side effects of smoking and consequences of COPD.

Obesity and Sleep-Related Breathing Disorders in Middle East and UAE

A pandemic of obesity is sweeping all across the globe and the Middle East region also does not remain untouched by this prevailing pandemic. In fact, as per WHO report, Kuwait has the second highest obesity prevalence followed closely by other Middle East (ME) countries, namely, Qatar, Saudi Arabia, and United Arab Emirates (UAE). Apart from direct medical, psychological, and quality of life related adverse effects of obesity, many indirect medical comorbidities, namely, obstructive sleep apnea (OSA), obesity hypoventilation syndrome (OHS), diabetes mellitus (DM), hypertension (HTN), and metabolic syndrome, imposes a significant health burden on the individual and community with consequent morbidity and mortality. The purpose of this review is to shed light on the very high prevalence of obesity, undiagnosed sleep apnea, and other obesity related disorders with discussion of the contributing factors specific to the region including the fair insight into the current status of sleep medicine services in Middle East and UAE despite huge number of patients having undiagnosed sleep disorders. We will also suggest to control this epidemic of obesity and OSA so that the corrective measure could be taken at health ministry level to help people of this region to fight against obesity and related disorders, primarily OSA.