Exploring the Relationship Between Diabetes and Breast Cancer in the United Arab Emirates.

Introduction This study delves into the complex interplay between diabetes and breast cancer within the United Arab Emirates (UAE), a subject of considerable global health concern. Given the increasing incidence of both diseases worldwide, this research investigates explicitly the potential influence of diabetes on the staging of breast cancer. The UAE, mirroring global trends, has experienced a surge in both conditions attributed to a blend of genetic, environmental, and lifestyle factors. The core objective of this investigation is to explore the link between diabetes and the stage at which breast cancer is diagnosed in UAE patients. Material and method To conduct this study, data were extracted from an extensive medical database consisting of anonymized records about breast cancer patients and their comorbid conditions. The research encompassed adult patients of all genders, all of whom had been definitively diagnosed with breast cancer. The data was analyzed using a suite of Python libraries, including Pandas, NumPy, SciPy, Scikit-learn, Matplotlib, and Seaborn. Descriptive and inferential statistical methods were employed, focusing on the Chi-Square test and logistic regression analysis to evaluate the relationship between diabetes and the stages of breast cancer, considering other comorbidities as well. Results The analysis included 131 breast cancer patients, predominantly female (98.47%), with an average age of 54.2 years. Among these patients, 22.14% were diabetic. The prevalence of other comorbidities, such as dyslipidemia, hypertension, and hypothyroidism, was also recorded. The Chi-Square test indicated no significant correlation between diabetes and the stages of breast cancer (χ² = 3.07, p = 0.381). Stage II was the most frequently diagnosed, irrespective of the presence or absence of diabetes. Conclusion In conclusion, this study finds no substantial link between diabetes and the stage of breast cancer diagnosis among patients in the UAE after adjusting for age and other comorbid conditions. These results underscore the need for early breast cancer detection approaches that are not exclusively dependent on the diabetic status of the patients. However, limitations such as the retrospective cohort design and the relatively small sample size highlight the necessity for further comprehensive studies. Such research would deepen the understanding of the relationship between diabetes and breast cancer and contribute to the advancement of breast cancer healthcare in the UAE.

Developing and Implementing Postoperative Pain Management Guidelines for Breast Cancer Surgery: A Leadership Perspective.

Introduction Persistent postoperative pain significantly diminishes the quality of life in breast cancer patients. Effective pain management post-surgery is critical for patient satisfaction, reducing complications, and facilitating quick recovery and hospital discharge. This study addresses the lack of patient-centered postoperative pain management guidelines for breast cancer patients. Aim The primary goal of this study was to develop tailored postoperative pain management guidelines for the local community in the United Arab Emirates, integrating these into a broader network of oncology facilities. Methods and Materials Employing a mixed-methods approach with a qualitative emphasis, the study gathered data from 10 female breast cancer patients (aged 39-65 years) with postoperative satisfaction surveys. Additionally, semi-structured interviews with six healthcare professionals involved in guideline development were conducted. Results A significant 90% of patients reported experiencing moderate-to-extreme pain post-surgery, indicating a need for improved pain management. Key factors identified included the need for enhanced nurse training and patient education on pain management preoperatively. The study team unanimously recognized the necessity for dedicated postoperative guidelines. Conclusion The study underscores the critical need for adequate postoperative pain management in breast cancer care. The findings advocate for creating multidisciplinary, evidence-based guidelines focused on patient-centered care. Furthermore, the study highlights the importance of international collaboration and continuous quality improvement measures, such as the Plan-Do-Study-Act (PDSA) cycle, for developing and refining these guidelines.

Unilateral Axillary Lymphadenopathy in Cancer Patients Post-COVID-19 Vaccination: Review and Case Series.

Novel coronavirus-19 (COVID-19) variants continue to spread worldwide with the development of highly transmissible strains. Several guidelines addressing management of cancer patients during the COVID-19 pandemic have been published, primarily based upon expert opinion. The COVID-19 pandemic has affected all aspects of breast cancer care including screening, diagnosis, treatment, and long-term follow-up. Recent reports indicate that mRNA COVID-19 vaccines can provoke lymphadenopathy in both cancer patients and healthy individuals. Unilateral axillary lymphadenopathy (UAL) post-COVID-19 vaccination is a challenging presentation for cancer patients because of the potential for misinterpretation as malignancy. The World Health Organization's target to vaccinate 70% of the world's population by mid-2023 is likely to increase the incidence of post-COVID-19 vaccination UAL. In this article, we review the published evidence regarding UAL post-COVID-19 vaccination and present diverse cases of breast cancer patients where false-positive UAL post-COVID-19 vaccination proved to be a therapeutic challenge. The United Arab Emirates (UAE) vaccination program is well ahead of other countries in the world, having accomplished the target of 100% vaccination of the population with at least one dose. Therefore, an increasing number of recently vaccinated patients are likely to present with UAL, detected by surveillance imaging, post-vaccination. We have therefore made recommendations regarding the management of cancer patients with UAL post-COVID-19 vaccination in order to avoid misdiagnosis and unnecessary imaging or invasive biopsy procedures.

Clinicopathological characteristics of gene-positive breast cancer in the United Arab Emirates.

INTRODUCTION: Breast cancer is the most prevalent cancer in the United Arab Emirates (UAE). This is the first study to provide data on predisposition of breast cancer susceptibility genes with associated clinical and pathological aspects in the UAE. MATERIAL & METHODS: A retrospective chart review for breast cancer patients undergoing genetic testing from 2016 to 2018. According to National Comprehensive Cancer Network (NCCN) guidelines genetic testing was offered. The analyzed data included; age, ethnicity, family cancer history, pathogenic variant, histopathology, stage, molecular subtype and proliferation. RESULTS: 309 patients underwent genetic testing with a positive result in 130 patients (11.9%) over a period of 36 months. In 34.6% pathogenic and likely pathogenic variants were identified. BRCA2 was the most common gene identified. The mean age was 42.9 years (±9.01). Positive family history was identified in 66 patients (50.7%). Majority had stage 1 or 2 disease (66.2%), invasive ductal carcinoma (81.5%) and hormone receptor positive cancer (45.3%). CONCLUSIONS: This is the first study in the UAE to describe the clinical and pathological characteristics of hereditary breast cancer in a mixed ethnic group with dominant Arabic population. Further genetic studies will be required in the UAE population, as the prevalence of breast cancer continues to rise.

Inhibition of urokinase plasminogen activator "uPA" activity alters ethanol consumption and conditioned place preference in mice.

Urokinase plasminogen activator, uPA, is a serine protease implicated in addiction to drugs of abuse. Using its specific inhibitor, B428, we and others have characterized the role of uPA in the rewarding properties of psychostimulants, including cocaine and amphetamine, but none have examined the role of uPA in ethanol use disorders. Therefore, in the current study, we extended our observations to the role of uPA in ethanol consumption and ethanol-induced conditioned place preference. The general aim of the present series of experiments was to investigate the effects of the administration of the B428 on voluntary alcohol intake and ethanol conditioned reward. A two-bottle choice, unlimited-access paradigm was used to compare ethanol intake between vehicle- and 3, 10, and 30 mg/kg B428-administered mice. For this purpose, the mice were presented with an ethanol solution (2.5%-20%) and water, at each concentration for 4 days, and their consumption was measured daily. Consumption of saccharin and quinine solutions was also measured. Systemic administration of B428 dose-dependently decreased ethanol intake and preference. Additionally, B428 mice did not differ from vehicle mice in their intake of graded solutions of tastants, suggesting that the uPA inhibition did not alter taste function. Also, ethanol metabolism was not affected following B428 injection. More importantly, 1.5 g/kg ethanol-induced conditioned place preference acquisition was blocked following B428 administration. Taken together, our results are the first to implicate uPA inhibition in the regulation of ethanol consumption and preference, and suggest that uPA may be considered as a possible therapeutic drug target for alcoholism and abstinence.

The histone deacetylase (HDAC) inhibitor valproic acid reduces ethanol consumption and ethanol-conditioned place preference in rats.

Recent evidence suggests that epigenetic mechanisms such as chromatin modification (specifically histone acetylation) may play a crucial role in the development of addictive behavior. However, little is known about the role of epigenetic modifications in the rewarding properties of ethanol. In the current study, we studied the effects of systemic injection of the histone deacetylase (HDAC) inhibitor, valproic acid (VPA) on ethanol consumption and ethanol-elicited conditioned place preference (CPP). The effect of VPA (300 mg/kg) on voluntary ethanol intake and preference was assessed using continuous two-bottle choice procedure with escalating concentrations of alcohol (2.5-20% v/v escalating over 4 weeks). Taste sensitivity was studies using saccharin (sweet; 0.03% and 0.06%) and quinine (bitter; 20 µM and 40 µM) tastants solutions. Ethanol conditioned reward was investigated using an unbiased CPP model. Blood ethanol concentration (BEC) was also measured. Compared to vehicle, VPA-injected rats displayed significantly lower preference and consumption of ethanol in a two-bottle choice paradigm, with no significant difference observed with saccharin and quinine. More importantly, 0.5 g/kg ethanol-induced-CPP acquisition was blocked following VPA administration. Finally, vehicle- and VPA-treated mice had similar BECs. Taken together, our results implicated HDAC inhibition in the behavioral and reinforcement-related effects of alcohol and raise the question of whether specific drugs that target HDAC could potentially help to tackle alcoholism in humans.

The cannabinoid receptor 2 agonist, ß-caryophyllene, reduced voluntary alcohol intake and attenuated ethanol-induced place preference and sensitivity in mice.

Several recent studies have suggested that brain CB2 cannabinoid receptors play a major role in alcohol reward. In fact, the implication of cannabinoid neurotransmission in the reinforcing effects of ethanol (EtOH) is becoming increasingly evident. The CB2 receptor agonist, ß-caryophyllene (BCP) was used to investigate the role of the CB2 receptors in mediating alcohol intake and ethanol-induced conditioned place preference (EtOH-CPP) and sensitivity in mice. The effect of BCP on alcohol intake was evaluated using the standard two-bottle choice drinking method. The mice were presented with increasing EtOH concentrations and its consumption was measured daily. Consumption of saccharin and quinine solutions was measured following the EtOH preference tests. Finally, the effect of BCP on alcohol reward and sensitivity was tested using an unbiased EtOH-CPP and loss of righting-reflex (LORR) procedures, respectively. BCP dose-dependently decreased alcohol consumption and preference. Additionally, BCP-injected mice did not show any difference from vehicle mice in total fluid intake in a 24-hour paradigm nor in their intake of graded concentrations of saccharin or quinine, suggesting that the CB2 receptor activation did not alter taste function. More importantly, BCP inhibited EtOH-CPP acquisition and exacerbated LORR duration. Interestingly, these effects were abrogated when mice were pre-injected with a selective CB2 receptor antagonist, AM630. Overall, the CB2 receptor system appears to be involved in alcohol dependence and sensitivity and may represent a potential pharmacological target for the treatment of alcoholism.

ß-Caryophyllene, a CB2 receptor agonist produces multiple behavioral changes relevant to anxiety and depression in mice.

Recent evidence suggests that the cannabinoid receptor subtype 2 (CB2) is implicated in anxiety and depression disorders, although few systematic studies in laboratory animals have been reported. The aim of the current experiments was to test the effects of the CB2 receptor potent-selective agonist ß-caryophyllene (BCP) in animals subjected to models of anxiolytic- and antidepressant-like effects. Therefore effects of BCP (50mg/kg) on anxiety were assessed using the elevated plus maze (EPM), open field (OF), and marble burying test (MBT). However for depression, the novelty-suppressed feeding (NSF), tail suspension test (TST), and forced swim tests (FST) were used. Results indicated that adult mice receiving BCP showed amelioration of all the parameters observed in the EPM test. Also, BCP significantly increased the time spent in the center of the arena without altering the general motor activity in the OF test. This dose was also able to decrease the number of buried marbles and time spent digging in the MBT, suggesting an anti-compulsive-like effect. In addition, the systemic administration of BCP reduced immobility time in the TST and the FST. Finally, BCP treatment decreased feeding latency in the NSF test. Most importantly, pre-administration of the CB2 receptor antagonist AM630, fully abrogated the anxiolytic and the anti-depressant effects of BCP. Taken together, these preclinical results suggest that CB2 receptors may provide alternative therapeutic targets for the treatment of anxiety and depression. The possibility that BCP may ameliorate the symptoms of these mood disorders offers exciting prospects for future studies.

Muslim women's physician preference: beyond obstetrics and gynecology.

When Emirati (Muslim) women (n = 218) were asked about their preferred physician (in terms of gender, religion, and nationality) for three personal clinical scenarios, a female was almost exclusively preferred for the gynecological (96.8%) and "stomach" (94.5%) scenarios, while ±46% of the women also preferred a female physician for the facial allergy scenario. Only 17% considered physician gender important for the prepubertal child scenario. Just over half of the women preferred a Muslim physician for personal examinations (vs. 37.6% for the child). Being less educated and having a lower literacy level were significant predictors of preferred physician religion for some personal scenarios, whereas a higher education level was a significant predictor for physician gender not mattering for the facial allergy scenario. Muslim women's preference for same gender physicians, and to a lesser extent religion, has implications for health care services beyond obstetrics and gynecology.

Endoplasmic reticulum quality control is involved in the mechanism of endoglin-mediated hereditary haemorrhagic telangiectasia.

Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant genetic condition affecting the vascular system and is characterised by epistaxis, arteriovenous malformations and mucocutaneous and gastrointestinal telangiectases. This disorder affects approximately 1 in 8,000 people worldwide. Significant morbidity is associated with this condition in affected individuals, and anaemia can be a consequence of repeated haemorrhages from telangiectasia in the gut and nose. In the majority of the cases reported, the condition is caused by mutations in either ACVRL1 or endoglin genes, which encode components of the TGF-beta signalling pathway. Numerous missense mutations in endoglin have been reported as causative defects for HHT but the exact underlying cellular mechanisms caused by these mutations have not been fully established despite data supporting a role for the endoplasmic reticulum (ER) quality control machinery. For this reason, we examined the subcellular trafficking of twenty-five endoglin disease-causing missense mutations. The mutant proteins were expressed in HeLa and HEK293 cell lines, and their subcellular localizations were established by confocal fluorescence microscopy alongside the analysis of their N-glycosylation profiles. ER quality control was found to be responsible in eight (L32R, V49F, C53R, V125D, A160D, P165L, I271N and A308D) out of eleven mutants located on the orphan extracellular domain in addition to two (C363Y and C382W) out of thirteen mutants in the Zona Pellucida (ZP) domain. In addition, a single intracellular domain missense mutant was examined and found to traffic predominantly to the plasma membrane. These findings support the notion of the involvement of the ER's quality control in the mechanism of a significant number, but not all, missense endoglin mutants found in HHT type 1 patients. Other mechanisms including loss of interactions with signalling partners as well as adverse effects on functional residues are likely to be the cause of the mutant proteins' loss of function.

Muslim women and medical students in the clinical encounter.

CONTEXT: Increasingly, male medical students report being refused by female patients, particularly in obstetrics and gynaecology, which is impacting on recruitment into the discipline. However, little has been documented in terms of Muslim patients and medical students in the clinical consultation. METHODS: Female Emirati nationals (n = 218) attending out-patient clinics at a public hospital in Al Ain, United Arab Emirates (UAE), were interviewed by medical students. Participants were provided with four hypothetical clinical scenarios (three personal, one concerning a pre-pubertal child) and asked whether they would allow male and female students to be present at a consultation, take a history or perform an examination. They were also canvassed about their past experiences with medical students and their social responsibility to contribute towards the training of Emirati doctors. RESULTS: Significant differences were recorded in terms of female versus male student involvement for all activities (P < 0.05-0.0005). For gynaecological and abdominal problems, patients would generally refuse male students. More than 50% of interviewees would not allow a male student to examine their face. Students of either gender could, however, examine their 8-year-old child. Although 47% of the women had had previous clinical encounters with students, in only 58% of consultations had the attending doctor asked their permission. Despite this, the women had generally felt comfortable, although satisfaction decreased with increasing age (P = 0.088). Almost 90% of the women believed that Emiratis had a social responsibility to contribute towards the training of Emirati doctors, but this decreased with increasing income (P = 0.004). CONCLUSIONS: As many medical students will encounter Muslim patients during their training, they need to be sensitive to religious and cultural issues, particularly for personal examinations. In contexts where most patients are Muslim, alternative options (e.g. manikins, international rotations) may be required for male students. In the UAE, patient education may improve history-taking opportunities but will probably not transcend religious and cultural beliefs without intervention from religious leaders.