Patients’ Adherence to Anti-Diabetic Medications in a Hospital at Ajman, UAE

Background: Anti-diabetic medications are integral for glycemic control in diabetes. Non-adherence to drugs can alter blood glucose levels, resulting in complications. Adherence to anti-diabetic medications reported by patients and the factors associated with medication adherence among adult patients with diabetes mellitus were explored. Methods: This cross-sectional study was carried out among patients with type II diabetes mellitus attending the Internal Medicine Department of a hospital in the United Arab Emirates. Consecutive patients were selected, and data regarding their medication adherence were collected using a questionnaire. Data analysis was carried out using SPSS-20. The chi-square test was performed to examine the associations between categorical variables; a two-sided P Value < 0.05 was considered significant. Results: A total of 132 patients participated in the study (63 males; 69 females). The mean age (standard deviation) of the respondents was 54 years (SD 10.2). The self-reported adherence rate to anti-diabetic drugs was 84%. The most common reason for non-adherence was forgetfulness, and the adherence rate was similar in both genders. Patients with Bachelor’s and Master’s degree reported greater adherence rate to anti-diabetic medication in comparison to the secondary school educated. Conclusion: The self-reported adherence rate to anti-diabetic medications was 84%, and forgetfulness was the most common reason for non-adherence. Future studies on strategies to improve adherence rate should be considered.

Efficacy of statins in dyslipidemia: a non interventional comparative study in a tertiary care hospital, Ajman, UAE

The reduction of serum total cholesterol and LDL-cholesterol levels varies with different statins. The objective of the present study was to compare the efficacy of Simvastatin, Atorvastatin and Rosuvastatin in the treatment of newly diagnosed dyslipidemia. A prospective, non-interventional 12-week study was conducted after approval from the Ethics Committee. A total of 70 patients with newly diagnosed dyslipidemia receiving 20mg of Simvastatin, Atorvastatin or Rosuvastatin were included. The primary efficacy measure was reduction of lipid levels from the initial baseline values at the end of 12 weeks with the respective Statins. Data was analyzed using descriptive statistics, Paired -t test, and analysis of variance [ANOVA]. Of total 70 patients, 14 patients received Simvastatin; 40 patients received Atorvastatin and 16 patients received Rosuvastatin. Demographic and baseline clinical characteristics were similar between the three groups. Significant reduction in lipid levels [total cholesterol, and LDL] was seen within the three treatment groups [p<0.01]. However, statistically significant difference in the reduction lipid levels was not observed between the three groups. We found no significant difference in the reduction of lipid levels between Simvastatin, Atorvastatin or Rosuvastatin patients with newly diagnosed dyslipidemia

Urolithiasis in male patients: a pilot study on the ethnic differences and clinical profile

The association between ethnicity, age, clinical profile, stone size with type of ureteric stones among male patients with urolithiasis was studied. Male patients above 18 years with lower ureteral stones size < 10mm attending outpatient department of Urology, GMC hospital, Ajman over a period of one year were included. Ethical approval obtained from Institutional Ethics Committee. Data was retrieved from the case record form which included socio-demographic variables [age, nationality], clinical profile [ureteric colic, duration of pain, other complaints, laboratory investigations [type of stone, stone size]. Descriptive and inferential statistics were performed with SPSS version 20 and p values < 0.05 considered significant. 185 male patients were included. Mean age was 41.5 [7.3] years, range [22-71] years. Of the total, 81[43.8%] patients were of Asian ethnicity, 81[43.8%] Arab and 23 [12.4%] were of other ethnicity. Most patients [95.1%] reported with ureteric pain. Only 49 [26.5%] had family history of stone disease with majority being first degree relation. Data on type of stone was available for 90 patients; of which, 21 were calcium oxalate monohydrate, 33-calcium oxalate dehydrate, 24-uric acid and remaining 12 other form of stones. Uric acid stone was common among Asians and calcium oxalate-dehydrate among Arab ethnicity. Among those with family history calcium oxalate monohydrate and uric acid stones were common compared to other types. Average age for different types of stone was 38.3, 41.6, 39.4 and 42.8 years respectively for calcium oxalate monohydrate, calcium oxalate dehydrate, uric acid and other types. Uric acid stones were more prevalent among Asians and calcium oxalate-dehydrate stones among the Arabs. Further studies among multiethnic population focusing on detailed dietary pattern and stone analysis can be conducted

Utilization of complementary and alternative medicine by parents for their children: a cross sectional study in Ajman, UAE

The study aimed to determine the utilization pattern of Complementary and Alternative Medicine [CAM] by parents for their children in Ajman, UAE. This cross sectional study was carried out among parents attending Parent-Teachers meeting at schools in Ajman, UAE. Self-administered questionnaires were distributed among the parents after obtaining consent. The questionnaire included demographic characteristics of parent [Age, gender, educational qualification, nationality] and child [age, gender] and details of utilization pattern [type of CAM, route of therapy, indication]. Descriptive and inferential statistics performed using SPSS-20; p value < 0.05 considered significant. Total of 136 parents participated [Fathers 32.6%; Mothers 67.6%]. Their age ranged between 20-55 years. Asians constituted 30.4% and Arab ethnicity 53.6% of total. About 57.2% of the parents were graduates. About 31.2% parents had one child, 30.4%- two children and 38.4% had three or more children. CAM use among their children was reported by 73[53.6%] parents. It was noted that parent who used CAM for the first child 73[53.6%], also reported to use CAM in their subsequent children [2nd, 311 child-7 1[52.2%] each]. Indications for use were gastrointestinal disorders, respiratory disorders, fever, and dermatological conditions. CAM therapies used in descending frequency were herbal medicine, dietary supplements, prayer, homeopathy and massage therapy. Based on ethnic groups, utilization frequency was similar among Asians, Arabs and other groups [50%, 53%, and 59% respectively]. Similarly, utilization frequency was similar among parents with school education, graduation and post- graduation [50%, 54.4%, and 53.8% respectively]. CAM was recommended by family members in 48% of the responders. About 47% parents reported good 30% excellent results with CAM in their children. In accordance to previous reports from the Middle East, herbal medicine was the common CAM therapies in the study. Utilization of CAM by parents for their children was similar in different ethnic groups and parents with different levels of education

Parents' opinion about the use of complementary and alternative medicine for their children: a cross sectional study in Ajman, UAE

The use of Complementary and Alternative Medicine [CAM] has increased over recent years. Little is known about the parent opinion regarding the use of CAM for children. This study aimed to identify the parent opinion about the use of CAM for their children and the most important source of information on CAM. A cross sectional study was carried out over a period of 12 months, including parents attending Parent-Teachers meeting in the schools in Ajman, UAE. A self- administered validated, pilot tested questionnaire was used as a tool. Informed consent was taken from participants before enrolment in the study. Analysis was performed using the SPSS-20. Descriptive statistics and inferential statistics performed [Z test] and p values < 0.05 was considered significant. The study includs 136 parents who are most frequently females [67%], less than 40 years age [54%], Non-Arabs [65%], holding Diploma/ Bachelor or higher degree [76%], and having 2 children [61%]. Although about 79% of the parents reported that it is safe/very safe to use CAM for children [89% of CAM user vs. 28.5% of CAM non-user, z=5.1, P < 0.001], however, about 46% of them are not using CAM, and the most common reason stated was that the modern medicine is more effective [42%]. Family is the most frequent source of information for CAM [57%]. The use of CAM for other children is recommended either alone by 49% [n=66] or to be used in combination with other conventional medicine by25% [n=34] of the parents. Most of the parents reported that the use of CAM for children is safe/ very safe. However, the opinion differed significantly among the parents who used CAM for their children as compared to those who did not

Acute tonsillitis in adults: the bacteriological profile and antibiotic sensitivity pattern in Ajman, UAE

The objective of this study was to determine the prevalence, pattern and antibiotic sensitivity of acute tonsillitis. A descriptive study was carried out from January 2011 to December 2011 among all adult patients attending the ENT outpatient department with acute tonsillitis. The data were retrieved from the medical records using a questionnaire. Statistical analysis was carried out using SPSS. 19 version. A total of 175 patients were included. The age ranged from 18 to 70 years. The majority of the patients were Indian 49[20.6%], Emirati 35[14.7%], and Pakistani 31 [13%]. The common clinical types of tonsillitis noted were acute parenchymatous / follicular/ exudative tonsillitis and acute pharyngotonsillitis. The highest frequency of acute tonsillitis was observed in 20- 29 year age group with the commonest symptoms at presentation being sore throat and fever. The tonsils on examination were enlarged in more than half the patients and follicles seen on the congested surface of both or one tonsil in a majority of the patients included in the study. The relative frequency of presentation was high in the summer months from March to September. About one fourth of the study group reported to have had an episode of similar clinical presentation during the previous year. Among the study participants whose throat swab cultures were done, Streptococcus was the commonest species identified, a majority being alpha haemolytic streptococci, followed by streptococcus pyogenes and streptococcus pneumoniae. Most of these organisms were sensitive to third or fourth generation. Cephalosporins and Co-Amoxyclavulanic acid. The majority of patients responded to treatment with oral or parenteral antibiotics of the above group. Some organisms were multi-drug resistant, being sensitive only to piperacillin, ceftriaxone, cefotaxime and meropenem. Therapeutic guidelines for optimum clinical response to acute tonsillitis among adult patients can be developed based on the common organisms grown on throat swab and their antibiotic sensitivity pattern to reduce patient morbidity and provide cost effective treatment

Knowledge of effects of drinking alcohol and attitude towards anti-substance use campaign among school students in Ajman, UAE

Alcohol consumption is an important epidemiological problem affecting health and is on a rise among the adolescents. Knowledge about effects of alcohol consumption and attitude towards anti-substance use campaign among school students in Ajman, UAE was assessed. A population-based cross-sectional study was conducted among students in four schools in Ajman, grades IX-XII. A pre-tested, close-ended questionnaire relating to knowledge of health and social effects of alcohol and attitude towards anti-substanceuse campaign was administered to the students. Chi-square test was applied to determine association between variables using SPSS.19. 411 students between 15-17 years of age participated [Male students constituted 55.7%, mean age: 15.65 +/- 1.1 years], 375 [91.2%] students indicated alcohol consumption was harmful that. 288 [70.1%] were aware of the use alcohol among school students. Severe health-associated risk was attributed to drinking alcohol by 63%. About 334 [81.3%] responded that social problems were associated with alcohol consumption. Common social problems mentioned were problems with parents, friends, and teachers, and the other effects included poor academic performance. Female students were more aware of the reasons for initiation and health and social problems than the males [p<0.05]. Television, internet and newspaper constituted the most common source of their knowledge. About 66% had advised individuals to quit the habit; about 21.2% students had participated in anti-substance use campaigns. Media. Seminars and workshops in schools were the possible ways suggested for increasing awareness. 81% were willing to organize and participate in anti-substance use campaign in their school. High proportions of students were aware of the harmful effects of alcohol and had positive attitude towards anti-substance use campaigns that are necessary to reduce unhealthy behaviors among adolescents

Prevalence of allergies among university students in Ajman, UAE

Urbanization and globalization in UAE has resulted into drastic environmental changes and increase in the allergens present in the environment and the prevalence of allergies. Hence, this study aimed to assess the prevalence of allergies among undergraduate students of Gulf Medical University. This cross-sectional survey was carried out among undergraduate students of Gulf Medical University. A self administered questionnaire was used as research instrument for data collection. The demographic data and the allergy characteristics were collected and analyzed using SPSS version 19. descriptive and inferential statistics were performed. A total of 255 students [33.3% males and 66.7% females] were included. The commonest allergies among the students were allergic conjunctivitis [104 [40.8%]], allergic dermatitis [89[34.9%]], dust allergies [58 [22%]] and eczema in [38 [14.9%]]. A positive family history of allergies was reported by 62 [24.3%] for allergic dermatitis and 33 [12.9%] for allergic conjunctivitis. Allergies associated with pollen, food and drugs were less frequent allergy. Students with allergies reported interference with their daily activities, and academic, social and extra-curricular activities. Overall higher proportion of students had allergies especially among the African and Pakistani students. Adequate preventive strategies should be initiated to crumb this rising prevalence of allergies

Effects of tobacco use and attitude towards anti-tobacco activities: a cross-sectional study among school students in Ajman, United Arab Emirates

Use of tobacco begins early in childhood and builds up to lifelong habit. The present study determined the knowledge of school students regarding the effects of tobacco and attitude towards anti-tobacco activities. This cross-sectional study was carried out at four schools [Grades IX to XII] in Ajman. A self-administered questionnaire was used focusing on the knowledge regarding tobacco use among adolescents, reasons for initiation, associated health risk, and social problems; previous participation and willingness to participate in anti-tobacco activities. Descriptive and inferential analysis was performed using SPSS 19. 229 male and 182 female students [mean age: 15.6+1.1 years] participated. Grade XII, XI, X, IX students constituted 31.4%, 29.4%, 29.7%, and 9.5% respectively. 328 [79.8%] were aware of the use of cigarettes, shisha, midwakh, chewing and sniffing tobacco among adolescents. About 75% indicated the possible reasons for initiation: to blend with friends, elevate mood, and to deal with family problems [Females more than males p<0.05]. More than 80% were aware of associated health risk and social problems [Females more than males p<0.05]. The social problems stated were problems with family, peer and teachers. As regards the level of health risk, 66.9%, 52.8%, 48.7%, felt that severe risk is associated with cigarette smoking, chewing tobacco, and smoking midwakh respectively. The source of their knowledge included television, internet and newspaper. About 66.2% had advised individuals to quit tobacco; 21.2% participated in anti-tobacco activities. Suggested measures to increase awareness were through media, seminars, workshops and student groups in schools. More than 75% were willing to participate in anti-tobacco activities, and 63.5% interested to give talks on the effects of tobacco. The students possessed positive attitude towards anti-tobacco activities and had knowledge of the health and social effects of tobacco. Active participation of adolescents in anti-tobacco activities can help to root out the problem of tobacco use among adolescents

Antimicrobial prescribing pattern in acute tonsillitis: a hospital based study in Ajman, United Arab Emirtaes

The objective of the present study was to determine the antimicrobial prescription pattern in patients with acute tonsillitis. A cross sectional study was carried out among all the patients attending the ENT outpatient department with acute tonsillitis from January 2011 to December 2011. The data were retrieved from the medical records using a questionnaire. Statistical analysis was carried out using SPSS. 19. A total of 238 patients were included in the study [Males 138; females 100]. The majority of the patients were Indians [49 [20.6%]], Emiratis [35 [14.7%]], and Pakistanis [31 [13%]]. The common types of tonsillitis noted were acute parenchymatous tonsillitis, acute follicular tonsillitis and acute pharyngotonsillitis. Of the total, seven [2.9%] patients had self medicated themselves prior to the hospital visit. About 96% of the total drugs were prescribed by brand name. The median number of drugs prescribed was four [range 1-7]. Eighty eight percent of the prescriptions contained antimicrobial agents, which was the most commonly prescribed group of drugs, followed by analgesics and antipyretics. Amoxicillin/Clavulanic acid [24.8%] and Ceftriaxone [12.2%] were the most commonly prescribed antimicrobials. About 23.7% of the patients on Amoxicillin/Clavulanic acid had received the drug as intravenous injection. Culture and sensitivity tests were carried out in 106 [44.5%] of the cases. Antimicrobials were changed/ added on after the culture and sensitivity test in 25 patients. No pattern was noticed with regard to the change in AMA; however Cefuroxime was the most frequently added AMA based on the sensitivity report. Therapeutic guidelines based on the current sensitivity pattern can be developed to optimize the use of antimicrobial agents and provide cost effective treatment

Cutaneous adverse drug reactions in a tertiary healthcare centre in Ajman, United Arab Emirates

To study the various clinical patterns of cutaneous adverse drug reactions [ADRs] and to identify the causative drugs. A cross-sectional hospital based study was carried out with patients reporting with cutaneous ADRs to the Department of Dermatology at GMC Hospital, Ajman, U. A. E., between 2010 and 2012. Medical records of the patients were used to obtain demographic, diagnostic and ADR-related information. The data were subjected to detailed statistical analysis using SPSS. 19 software. A total of 43 patients were included [46.5% males and 53.5%females] in the study. The mean age of the patients was 30.07+.-13.63 years. The majority of the patients were from the Middle East, followed by Asian countries. The commonest cutaneous ADRs seen were maculo-papular rash [48.8%], Erythroderma [18.6%], urticaria [11.7%] and Fixed drug eruption [11.7%]. The drugs most responsible for the various cutaneous ADR were antimicrobials in 11[48.8%] and NSAIDs in 14 [32.5%] cases. Carbamazepine and Ciprofloxacin were responsible for two cases [6%] of life-threatening Stevens Johnson syndrome. Mean reaction timewas 5.63 +/- 0.5 days. Reactions were mild [46.7%], moderate [40%] and severe [13.3%]. Based on the WHO Causality assessment of ADRs, 34 [80%] cases were probable in nature; 8 [27%] possible and 1 [3%] case uncertain. A total of 5 [11.6%] cases had past history of ADRs. Three patients [9%] had secondary bacterial infection over ADR lesions and required antimicrobial treatment. The clinical pattern of ADRs and the drugs causing cutaneous ADRs was largely similar to that observed in other countries

Nasobronchial allergies among university students in Ajman, United Arab Emirates

The prevalence of wheezing and allergies among the population in Arab countries are on a rise due to urbanization that resulted in substantial environmental changes. The prevalence of respiratory symptoms is about 14% among school children but data on adolescent groups in the Gulf region are lacking. Hence, this study aimed to assess the prevalence of wheezing and bronchial asthma among undergraduate students of Gulf Medical University. A cross-sectional study was conducted among undergraduate students of Gulf Medical University using a self-administered questionnaire for data collection. The demographic data, the wheezing and bronchial asthma characteristics and family history were collected and analyzed using SPSS version 19. Of the total of 255 students that were included, 120 [47%] had allergic rhinitis and 31 [12.2%] bronchial asthma. A total of 71 [27.8%] had symptoms of wheezing [females were 66% and males 34%; African [24%] and Pakistani [22.5%] nationals]. Of the 71 students, 41 [57.7%] students experienced 1-3 episodes during the previous year, 13 [18.3%] and had episodes limiting their speech. Exercise-induced wheezing was experienced by 62 [24.3%] participants. The wheezing episodes were most frequent in January and March. A positive family history of wheezing was reported by 29[40.8%] of the students. 40.8% students reported that wheezing interfered with their daily and extra-curricular activities. Bronchial asthma and allergic rhinitis had a positive association with family history [p<0.05]. Allergic rhinitis was frequent among Pakistani, African and Emirati nationals. Symptoms of asthma and allergic rhinitis had significantly affected the quality of life of the students. Strong family history was also noted for allergic rhinitis and bronchial asthma. Asthma was associated with a high rate of allergic rhinitis symptoms. The prevalence of asthma in this study is within the reported prevalence ranges from UAE and many other parts of the world

Qualitative insights into the nurses' knowledge and experience of polypharmacy in Ajman, UAE

The specter of polypharmacy is an ever increasing problem. Nurses play a functional role in assisting patients to understand the dangers of polypharmacy. Nurses' knowledge and their experience of polypharmacy in their nursing practice are determined in the study. Nurses working in Gulf Medical College Hospital and Research Centre, Ajman, United Arab Emirates participated in this cross-sectional study during March to May 2011. A self-administered structured questionnaire was used to obtain data. Chi-square test was performed to find the association between sociodemographic characteristics and the variables under study using PSAW software. A total of 105 nurses [92 female; 13 male] participated. The definition of polypharmacy was correctly identified by only 45.7% nurses. Elderly was identified as the most common age group in whom polypharmacy is practiced. 66.7% of the nurses acknowledge their non-awareness of rational and irrational polypharmacy. Non-awareness of rationality of polypharmacy was similar between genders and all three groups of clinical experience. The common reasons given for practice of polypharmacy included use of multiple drugs to manage multiple disease conditions. 66% identified the elderly population as the common age group exposed to polypharmacy, while 22.9% nurses opined that it is common in all age groups. Working knowledge of rational polypharmacy is essential among the nursing community to reduce the practice of polypharmacy

Progeroid syndrome of De Barsy with hypocalcemic seizures: a case report and review of literature

De Barsy et al first reported a rare cutaneo-oculo-cerebral malformation syndrome, now commonly referred as 'progerioid syndrome of de Barsy'. It is the constellation of progeria-like appearance, cutis laxa, intrauterine growth retardation, cornea clouding and hypotonia. We report a case of Debarsy syndrome in a neonate presented at birth with typical clinical features with hypocalcemic seizures. There are no previous reports among those of Afghani origin and this also is the first case reported from United Arab Emirates. There have been no reported cases of hypocalcemic seizures

Nurses opinion on the negative attributes of polypharmacy in patient safety, in Ajman, UAE

The negative attributes of polypharmacy should be known by nurses while reviewing and administering medications. We studied the nurses' opinion on the negative attributes of polypharmacy. Nurses working in a tertiary care teaching hospital participated in this cross-sectional study, conducted over 3 months, by responding to a self-administered questionnaire. Chi-square test was used to analyze association between socio-demographic characteristics and items in the study. A value of p<0.05 was considered statistically significant. Increased drug interactions scored the highest [98.1%], followed by increased adverse drug effects [81.9%] among the negative effects of polypharmacy. No difference was observed in the opinions between male and female nurses or among nurses of varying duration of nursing experience. Nurses with 5-10 years of experience opined increase in non-compliance to prescribed medication regimen and increase in financial burden also as negative attributes. There is a lacuna in the knowledge about ill effects of polypharmacy among nurses, which can be filled in by Continuing educational programs and workshops

Reporting of adverse drug reactions: a study among clinicians

Adverse drug reactions [ADRs] are an important public health problem. Serious ADRs lead to morbidity and mortality and considerable economic burden on the society and healthcare systems. Only 6-10% of all ADRs are reported. Spontaneous reporting of ADRs enhances detection of serious, unexpected and unusual ADRs. Health care professionals play an integral role in the success of the safety surveillance of drugs. This study aimed to investigate knowledge, practice and factors affecting ADR reporting among clinicians. A cross sectional study was carried out among all the clinicians of Gulf Medical College Hospital and Research Centre [GMCHRC] irrespective of their gender, specialization and experience. A validated self-administered questionnaire was used to assess the knowledge, practice and factors influencing ADR reporting. The questionnaire was distributed among clinicians during their duty hours, who were given adequate time to fill in the forms. The filled in self-administered questionnaire was returned by only 42 clinicians. The 42 clinicians included in the study comprised more than 50% males, had a mean age 36 +/- 8 years and represented a multi-ethnic population of varying clinical experience. The most frequent ADR the clinicians had come across was rashes. The commonly implicated drugs were antibiotics and analgesics. With regard to ADR reporting, the majority of the clinicians correctly identified which of the ADRs had to be reported and the individuals who can report ADRs. Very few clinicians had reported ADRs to the Pharmacovigilance Centre. The common factor discouraging reporting of ADR was that most clinicians did not know how to report ADRs [71%]. A majority of the clinicians were willing to undergo training on this aspect. The study revealed the existence of under-reporting of ADRs, but also the willingness of clinicians to be trained in ADR reporting and thus contributing to the Pharmacovigilance program