Total antioxidant status and microalbuminuria in type-2 diabetics attending GMC Hospital Ajman, United Arab Emirates

United Arab Emirates [UAE] has a high prevalence of Diabetes mellitus. While inflammation and oxidative stress are thought to play important roles in the pathogenesis of diabetes mellitus, the role of the antioxidant system still remains unclear. To determine the total antioxidant status in type-2 diabetic patients with and without microalbuminuria. Type-2 diabetics, aged 25-65 years, without history of cardiovascular or renal disease, attending GMC Hospital Ajman, UAE were included in this study. Medical history, height, weight were taken and biochemical investigations performed on venous blood samples. Urine albumin-to-creatinine ratio [ACR] was also measured. Data was entered into SPSS 19 software and analyzed using Pearson's and t-test for correlation and significance respectively. 82 type-2 diabetics included in the study. 76.8% were male and 73.2% were of middle-east ethnicity. Average age was 47 +/- 9.1 years. 79.2% were overweight. 58% had hypertension, 68.3% dyslipidemia and 53.6% family history of diabetes. Microalbuminuria [ACR 30-299 microg/mg], found in 17 diabetics, correlated weakly [r=0.32] but significantly [p < 0.05] with duration of diabetes. Serum total antioxidant status of diabetic patients [1.14 +/- 0.4 mmol/l] was significantly lower [p < 0.05] than in normal volunteers [1.35 +/- 0.08 mmol/l]. No difference was found between males and females. Diabetics with microalbuminuria had a higher total antioxidant status [1.24 +/- 0.62 mmol/l] than those without microalbuminuria [1.1 +/- 0.37 mmol/l]. However this difference was not found significant after adjusting for serum uric acid levels which were significantly higher [p < 0.01] in patients with microalbuminunia [5.98 +/- 1.71 mg/dl] compared to those without microalbuminuria [4.98 +/- 0.94]. Type-2 diabetics had significantly lower total antioxidant status compared to normal adults. Prevalence of microalbuminuria was 20.7% highlighting the need for screening all diabetics. Total antioxidant status in diabetics with microalbuminuria was found to be slightly higher probably due to the higher uric acid levels

Attitude and perceptions of GMU interns towards nutrition and nutrition education

Rise in lifestyle-related diseases including Diabetes and Cardiovascular disease has resulted in more physicians treating and advising patients regarding nutrition and beneficial nutritional modifications. To assess attitude to nutrition counseling and perceptions regarding nutrition knowledge, proficiency and nutrition education among GMU interns in various hospitals in the UAE. A questionnaire was developed with items spanning five domains including 'Attitude to nutrition counseling [10 items]', 'Perceptions regarding nutrition knowledge [10 items]', 'Perceptions regarding competencies in nutrition related areas [15 items]', 'Behavior with respect to nutrition [5 items]', 'Perceptions regarding nutrition education in the undergraduate medical curriculum [6 items] and Demographics [6 items]. Responses were on a likert-like scale from strongly disagree to strongly agree [1-5]. The questionnaire was validated by medical education faculty, physicians and nutritionists. Pilot testing was carried out on 3 medical graduates. Data collection from GMU interns in various hospitals is in progress. Preliminary analysis from 22 Interns shows very positive attitude and behaviour towards nutrition in health care. 'Nutrition counseling should be part of routine care by all physicians, regardless of specialty', 'I encourage patients to ask diet related questions', 'Physicians can have an effect on a patient's dietary behavior if they take the time to discuss the problem' [median score 4] and Nutrition counseling is not an effective use of my professional time [median score 2] suggest nutrition counseling is considered important. Regarding knowledge, all items received good scores except 'potential harmful interactions between medications and food/herbal supplements'. They feel confident regarding many nutrition-related competencies but are unsure of 'assessing fluid requirements based on activity and health'. However regarding nutrition education, interns feel much more nutrition education is needed during both basic medical sciences and clinical clerkships. Nutrition education relevant to personal health and well-being is also required [median score 4]

Knowledge of cardiovascular disease risk factors among the non-medical staff of a medical university in UAE

Cardiovascular diseases [CVD], a group of disorders of heart and blood vessels [Coronary Heart Diseases; CHD and stroke], are the most common causes of premature morbidity and mortality worldwide. To study the level of knowledge about CVD risk factors and prevention among non-medical staff of Gulf Medical University. A cross - sectional questionnaire - based survey was used to collect data from 77 participants. Questions enquiring about the definitions of CHD and stroke [closed ended statements]; steps to be taken to reduce the risk of getting CHD/stroke [Open ended sections] and identification of factors that increase risk of CVD [from a list] formed parts of the questionnaire. Majority of the participants were South Asians, educated males [74%]. Around 76.6% and 57.1% knew definitions of CHD and stroke respectively. Exercise [76.6% and 45.5%], healthy food habits [68.8% and 35.1%] and smoking cessation [28.6% and 20.8%] were indicated as steps to be taken to reduce the risk of CHD and stroke respectively. From the listed factors, high blood cholesterol [87%], high blood pressure [84.4%], family history [75.3%], obesity/ overweight [65.7%], and diabetes mellitus [58.4%] were identified as factors that increase the risk for CVD. Very few participants identified male gender [30%] and South Asian ethnicity [18.2%] as risk factors. Though 84.4% identified tobacco smoking as a risk factor of CVD, only half of them knew that regular exposure to second-hand smoke can also lead to CVD. Moreover, few [36.4%] knew about high risk in females who smoke and use oral contraceptives and that the risk increases after menopause [23.4%]. The knowledge about CVD risk factors and prevention among the participants is high which may have been influenced by their working environment. However, it is far from [deal as they belong to a high risk ethnic population

Pattern of urinary albumin excretion in non-diabetic first-degree relatives of type 2 Diabetes Mellitus patients

To determine the pattern of urinary albumin excretion among non-diabetic first-degree relatives of patients with Type 2 DM residing in United Arab Emirates and to relate it to the socio-demographic profile and family history of chronic diseases. non-diabetic first-degree relatives of patients with Type 2 DM attending the Gulf Medical College Hospital [GMCH] or employed in the GMU/ GMCH were invited to participate in the study. None of the participants had any known renal disorder. Data was collected using a pilot-tested, interviewer-administered questionnaire. Albumin/Creatinine ratio [ACR] was measured in urine. Data was analyzed using PASW 19.0 software. Among the 231 participatns, 66.3% were male. 53.7% of the participants were in the 26-35 year age group. Forty [17.3%] had ACR higher than 10mg/g, of whom 10 had > 30mg/g. ACR was >15mg/ g in 9.9% of males and 18% of females. An increasing trend was seen with age. The percentage of participants having ACR 15-30 mg/ g was 6.2, 8.1, 11.4, 27.3 in 10 mg/g, two reported a family history of kidney disorder, three stroke and seven CVD. Among the non-diabetic first-degree relatives of Type 2 DM patients, urinary albumin excretion level was higher among females and in the older age group

Awareness and practices regarding diabetes among the educated Indian population residing in UAE

To assess the knowledge and practices regarding diabetes among college educated Indians, settled and living in UAE. Study subjects were young parents of a reputed Indian school in Sharjah. Survey was conducted using a pre-tested questionnaire and respondents were required to answer questions focusing on the knowledge of risk factors, symptoms and complication of diabetes and lifestyle practices. PASW18 software was used for statistical analysis. Out of 350 college educated adults contacted, 219 returned the completely filled questionnaire. Very high prevalence of family history of diabetes [49%], hypertension [43%] and cardiovascular disorders [29%] was observed among the respondents. Regarding the knowledge on risk factors for diabetes, physical inactivity, family history, obesity and high consumption of sweets were correctly identified by 82%, 81%, 77% and 64% of respondents. Only 56% identified age 45 and 46% identified delivering baby of more than 4 Kg as risk factors. Excessive feeling of thirst and urination was identified as symptoms by 77% and 83%, whereas weight loss and excessive eating was marked by only 68% and 56.5% respectively. Regarding the knowledge on complications, eye and kidney related problems were well identified [83% and 78.5%]. Loss of sensation in arms and legs and joint pain, recurrent infection, limb decay and dental problems were identified as complications by 58%, 57.5%, 56% and 51% respectively. 64% knew that diabetes is a risk factor for CVD. Increasing the physical activity was perceived by most respondents [92%] as a beneficial behavioral change.52% of respondents felt that they could delay or prevent diabetes. As expected, educated Indians in UAE are well informed about diabetes, but definitely major gaps exist even in their knowledge, emphasizing the need for measures to increase awareness. Steps must be taken to promote physical activity

Psychological health and sources of stress in first year undergraduate students at Gulf medical university, Ajman

Gulf Medical University, Ajman [GMU], is an international university where students from different parts of the world, cultures and educational backgrounds study together. First year students have to adjust to both a new learning environment and to a new culture during their training in GMU, and this can be stressful. Our objective was to assess the psychological health of our first year students using a validated tool and to study the various causes of psychological distress. A questionnaire based survey was carried out during January 2011 among 125 first year students registered in various programs for the academic year 2010-2011 at GMU. Psychological health was assessed using the 12-item General Health Questionnaire [GHQ12]. A 22-item questionnaire was used to identify the sources of stress. 116 students participated giving a response rate of 92.8%. The overall prevalence of psychological morbidity was found to be 33.6% among the first year undergraduate students at GMU, using a GHQ cutoff of 4/5. The prevalence of psychological morbidity was higher in female students [37%] compared to males [31%] and higher in students who had a language of instruction other than English in high school [41%] compared to those who had studied in English [31%]. Students in the medicine [MBBS] program were found to have the most psychological morbidity followed by those in Physiotherapy, Dentistry and Pharmacy programs. Worries regarding future and high parental expectations were major causes of stress for most students. Total stress scores and academics-related domain scores were significantly associated with psychological morbidity. Psychological morbidity is seen in 1 in 3 students in the first year in the Gulf Medical University, Ajman, UAE. Important sources of stress are worries regarding the future and high parental expectations. Psychological morbidity was significantly associated with academic causes of stress and family problems

Subclinical hypothyroidism in patients attending GMC hospital and its association with lipid disorders - a preliminary study

Subclinical hypothyroidism is a state characterized by mild elevations in Thyroid Stimulating Hormone [TSH] in patients without known thyroid disease. Clinical importance and therapy for subclinical hypothyroidism are subjects of both debate and research. To study the lipid disorders in patients with subclinical hypothyroidism referred from the Department of Internal Medicine, GMC Hospital and Research Centre, Ajman, UAE. Subjects referred to the laboratory for thyroid profiles between January and December 2009 were divided into three groups; Euthyroid [EUT], Subclinical Hypothyroid [SCH] and Overt Hypothyroid [OVH] based on TSH values 4 /= 10 mIU/ mL respectively. patients with diabetes, cardiovascular disease, dyslipidemia or on treatment for thyroid disorders were excluded. Serum lipid profiles of the subjects were investigated. PASW 18 software was used for analysis. One way ANOVA and Duncan multiple comparison tests were used to find the significance. of the 1234 subjects studied, 953 were females [77%] and 281 males [23%]. Mean age for the female subjects was 33+/- 10 years and for the male subjects 38 +/- 11 years. 95.5% were in the 19-59 year age group. 77 subjects [6.2%] were found to be SCH. Mean +/- SD total Cholesterol values were 223 +/- 33, 225 +/- 28, 253 +/- 35, LDL cholesterol values were 120 +/- 22, 130 +/- 21, 123 +/- 17 and Triglyceride levels were 99 +/- 21, 90 +/- 14, 130 +/- 45 mg/dl in the EUT, SCH and the OVH groups respectively. While there was no significant difference between the EUT and SCH group in the total Cholesterol and Triglyceride values, they were significantly different from the OVH group [p<0.05]. There were no differences in LDL cholesterol between the groups or lipid parameters between the genders. 6.2% of the patients referred were found to be SCH. There were no significant differences between the lipid parameters of EUT and SCH patients. OVH patients showed significantly higher total cholesterol and triglyceride levels in blood

Diabetes-related knowledge among university students

To assess the diabetes-related knowledge among the university students attending non-healthcare related professional courses. Study subjects were students enrolled in non-healthcare related professional courses in a reputed university in Ajman. A pre-tested questionnaire, assessing the knowledge of risk factors, symptoms and complications of diabetes and lifestyle practices, was administered and analyzed. 182 subjects [53 males and 129 females] of 23 nationalities, age group of < 24 years, participated in the study. Of the subjects, 11.2% were current smokers, 26% were overweight and obese, 8% were known diabetic, 14% were hypertensive and 11% had hypercholesterolemia. Only 29% of these university students exercised regularly. 37% thought that they have very good health. Regarding their general knowledge on diabetes mellitus [DM], 70% knew that it is a condition characterized by high blood sugar level, and identified family history as a major risk factor. Surprisingly, only 53% could link obesity and physical inactivity as risk factors for development of DM. Excessive feeling of thirst, urination and weight loss were identified as symptoms by approximately 55% of them. Knowledge on complications including loss of sensation and decaying limbs, oral and dental complications, recurrent infections and CVD risk were poorly identified. Only 55% thought that onset of diabetes can be delayed. Our results show surprisingly high health-related issues among the young adults studied. This study also highlights the poor level of knowledge related to diabetes among university students considering the availability of various sources of information to the modern day youth

Male infertility and its association with metabolic syndrome and hypogonadism

Hormonal profile alteration is seen in men with metabolic syndrome. Obese men have elevated levels of estrone and estradiol and there is also an attenuation of the pulse amplitude of luteinizing hormone [LH] which leads to a reduction of testicular production of testosterone. This study was conducted to assess the sperm morphology, prevalence of metabolic syndrome and association between gonadal hormones and parameters of metabolic syndrome among men diagnosed with infertility. Out of 434 men referred to the laboratory of Gulf Medical College Hospital and Research Centre, Ajman, UAE, 184 were diagnosed as infertile based on seminal parameters. Prevalence of metabolic syndrome and gonadal hormonal level among these infertile men were also studied. Data were analyzed with PASW 18 software and student t-test used for the significance. Mean age of the men referred for seminal analysis was 33 +/- 7.2 years. Forty two percent of the men were found to be infertile based on seminal parameters. Majority had total forward progression abnormality followed by abnormalities of head, tail and neck. Prevalence of metabolic syndrome among these men was found to be 19%. FSH and LH levels were significantly lower and prolactin levels were significantly higher [p<0.01] in men with metabolic syndrome. Estradiol and total testosterone levels showed no difference. High prevalence of metabolic syndrome was found among men diagnosed with infertility. Significant hypogonadism was found associated with metabolic syndrome among these men

Does the curricular change at Gulf medical college, United Arab Emirates improve the faculty perceptions of student experiences with the educational environment?

Gulf Medical College, United Arab Emirates, underwent a major curriculum change from a discipline-based to an organ system-based integrated curriculum. However, it was not known how the faculty perceived the educational environment as experienced by the students in the new curriculum. In this context, the present study compared faculty perceptions of the student experiences in the discipline-based curriculum with those in the organ systems-based integrated curriculum. The Dundee Ready Education Environment Measure [DREEM] questionnaire was modified, pilot-tested and administered to all faculty members [n=28] involved in the discipline-based curriculum [FDC]. In the subsequent year, data were collected from the same faculty involved in the integrated curriculum [FIC]. The data collected were transferred to PASW-18. Global, domain and individual item scores were assessed with Wilcoxon Signed Rank test. Percentage agreement, disagreement and uncertainty were assessed by z test for proportion. The total DREEM score was significantly higher [p<0.001] for FIC [139/200] as compared to FDC [119/200]. FIC perceived significantly more positive student experiences with the educational environment as indicated by the domain scores and item scores. The differences in proportions of agreement between FIC and FDC also reinforced that the FIC perceived more positive student experiences with the educational environment. The study showed that the faculty perceived the organ systems-based integrated curriculum was providing a better educational environment for the students than the discipline based curriculum

Comparison of the psychological health of first and second year undergraduate students in GMU: identification of stressors and coping strategies adopted

Undergraduate students in health-related professions can be under considerable stress. Assessing the psychological health of the students, stressors and coping strategies adopted can help to plan appropriate interventions. To assess the prevalence of psychological morbidity among the first and second year undergraduate students at GMU, identify the causes of stress and the coping strategies adopted by them. A questionnaire-based survey was carried out among 238 first and second year students in GMU in January 2011. Psychological health was assessed using the 12 item General Health Questionnaire. A 22-item questionnaire was used to identify stressors and the Brief Cope inventory was used to study coping strategies. Response rate was 89%. Prevalence of psychological morbidity was 34% and 32% in the first year and second year respectively. Stress score was found to be significantly associated with psychological morbidity. Major causes of stress for first and second year students were 'worries regarding future' and 'high parental expectations'. Other causes were 'lack of recreation', frequency of examinations' and anxiety. Major coping strategies adopted were praying, planning and emotional support. One in three students in the first two years of undergraduate studies at GMU has psychological morbidity. Causes of stress are very similar between the first and second year students. Worries about the future and high parental expectations are major causes along with academic concerns. Anxiety and sleep problems are also common. Stress scores were significantly associated with psychological morbidity. In the first year, academics-related stress and in the second year psychological and health-related stresses were associated with psychological morbidity. Though the majority of the students are using positive coping strategies, a significant number have given up coping, are blaming themselves, or venting their negative feelings

Plasma homocysteine and other biochemical parameters in gestational Diabetes Mellitus

Gestational Diabetes Mellitus [GDM] is characterized by glucose intolerance that is first diagnosed during pregnancy. Insulin resistance is the hallmark of gestational diabetes, little is known about the other metabolic changes taking place. Plasma homocysteine [Hcy] levels have been reported associated with cardiovascular disease and osteoporosis. Elevated Hcy levels are associated with pregnancy complications and adverse pregnancy outcomes. The objective of the present study was to compare plasma levels of Homocysteine and other biochemical parameters in women diagnosed with GDM attending Gulf Medical College Hospital with that in normal pregnant women. Prospective study of pregnant women GDM [N = 26] was confirmed by the oral glucose tolerance test. Normal pregnant women served as control group [N = 36]. Fasting plasma Glucose [mg/dL] level and Body mass index [kg/m[2]] of the GDM group was significantly higher compared to the control group. serum total cholesterol level was found to be significantly higher [P<0.00] in GDM [230.77 +/- 27.21 mg /dL] compared to contral [181.53 +/- 17.09]. Serum Triacylglycerol, Uric acid and Creatinine were also significantly elevated [P < 0.001] in the GDM group compared to control even though all values lay within the normal reference ranges. Hcy level in GDM was significantly higher [19.073 +/- 3.61 micro mol/L] compared to controls [8.322 +/- 1.94], P<0.001. Homocysteine, Cholesterol, Triacylglycerol, Uric acid and Creatinine levels were significantly elevated in GDM compared to normal pregnant women. Hcy correlated strongly with the fasting glucose levels [Pearson correlation, r = 0.9]

Biochemical parameters in women with polycystic ovary syndrome

Polycystic ovary syndrome [PCOS] is a common endocrine disorder affecting 5 -10% of women and is the major cause of anovulatory infertility. Prevalence varies among populations based on genetic and environmental factors. Etiology of PCOS remains unknown but Hyperandrogenism and Insulin resistance have both been associated with PCOS. The objective of the present study was to measure plasma levels of Homocysteine and other biochemical parameters in women diagnosed with PCOS attending Gulf Medical College Hospital [GMCH], Ajman. Young women between 18 and 35 years of age, diagnosed with PCOS [N =37], not on any treatment, attending GMCH were included in the study. Biochemical parameters were measured using standard procedures. Laboratory normal reference ranges were used for comparison. 54% of the women with PCOS were overweight or obese according to the BMI and 51% had a waist circumference >88cm. Fasting and postprandial Glucose and Insulin levels and HOMA-IR were within the normal reference ranges indicating that no Insulin resistance was seen in these women. 40% of the women had a serum total Cholesterol level above 200 mg/dL. LDL Cholesterol was above and HDL cholesterol lower than the desirable value. Serum Triacylglycerol was within the normal reference range. Serum Testosterone, Estradiol, Prolactin TSH and plasma Homocysteine were found to be within the normal reference ranges. Homocysteine levels correlated with Testosterone, total Cholesterol and LDL cholesterol levels. Body mass index was high in 54% of the women. No Insulin resistance was seen in these patients. Hormone levels and Homocysteine were within the normal reference ranges. Dyslipidemia was observed. These findings differ from reports in literature where Insulin resistance, Hyperandrogenism and high Homocysteine levels have been associated with PCOS