Predictors of adherence to antihypertensive medication in northern United Arab Emirates.

This study aimed to assess the predictors of non-adherence to antihypertensive medications in northern United Arab Emirates. In a cross-sectional, multicentre study in Ajman Emirate, 250 patients with hypertension were randomly selected from outpatient clinics. Participants answered an interview questionnaire about sociodemographic and clinical data and completed the Morisky medication adherence scale. Non-adherence to antihypertensive medication was reported by 45.6% of patients. Sociodemographic predictors of non-adherence were sex and number of children. Therapy-related predictors of adherence were hospital admissions, number and cost of medications, medication perceived effectiveness and use of traditional remedies. Patient-related predictors of non-adherence were forgetfulness, method of identifying medication and poor awareness of hypertension complications. Health-care-related predictors were regular follow up at clinics, education and counselling, frequency of changing medication by physicians and awareness of physicians' instructions.

Tuberculous lymphadenitis: skin delayed-type hypersensitivity reaction and cellular immune responses.

BACKGROUND: Tuberculous lymphadenitis (TL) is the commonest form of extra-pulmonary tuberculosis in tropical countries. OBJECTIVE: This study aimed to characterize in vivo and in vitro cellular immune responses to Mycobacterium PPD in TL patients as markers of disease and healing. METHODS: Following informed consent, 36 TL patients, 40 patients with pulmonary tuberculosis (TB) and 20 apparently healthy individuals were enrolled when they met specific selection criteria. The tuberculin skin test (TST) and peripheral blood mono-nuclear cells (PBMCs) culture were conducted using PPD. The cytokines were measured using commercial kits. RESULTS: The mean TST was 24.6 ±8.0 mm for TL patients. The TST was variable in pulmonary TB patients and healthy individuals. It was reactive in a third of pulmonary TB patients with a mean of 20 ±3.0 mm and reactive in half of the healthy individuals with a mean of 12.6 ±3.2 mm. Pre and post-treatment interferon gamma (IFN-g) mean levels were 498.6 ±905.8 pg/ml and 710.0 ±844.6 pg/ml respectively (p=0.0001) for TL patients, while IL-10 mean levels were 93.0 ±136.0 pg/ml and 32.4 ±31.7 pg/ml respectively (p= 0.0001). TST-reactive Pulmonary TB patients had significantly higher IFN-g (851 ±234.4 pg/ml) compared to TBLNT patients (p = 0.0001), while pulmonary TB patients had significantly lower IL-10 compared to TBLNT patients (p=0.0001). Apparently healthy individuals had significantly lower IFN-g and IL-10 levels compared to TBLNT and pulmonary TB patients (p=0.003). CONCLUSION: Strong TST reactivity, high IFN-g and IL-10 levels are good surrogate markers of active TBLNT, while increasing IFN-g levels and decreasing IL-10 levels mark healing. Tuberculosis Skin Test reactivity although a good diagnostic marker does not disappear with treatment.

A randomised, controlled, double-blind, cross-over pilot study assessing the effects of spironolactone, losartan and their combination on heart rate variability and QT dispersion in patients with chronic heart failure.

BACKGROUND AND OBJECTIVE: The blocking of aldosterone or angiotensin II receptors improves mortality in patients with chronic heart failure. We explored whether combining losartan and spironolactone would have any added benefit on the known surrogate of mortality by using heart rate variability (HRV) and QT dispersion as our endpoints. METHODS: We designed a three-phase, consecutive, randomised, controlled, double-blind, cross-over pilot study to assess the effects of losartan alone (50 mg/day), spironolactone (25 mg/day) with angiotensin converting enzyme (ACE) inhibitor and, finally, losartan with spironolactone, on HRV and QT dispersion. We enrolled eight patients (aged 47 to 72 years, mean = 63.7 years), with New York Heart Association (NYHA) class II-III heart failure and ejection fraction (EF) < 35%, in the study at a university-affiliated hospital in Dundee, Scotland. Digital 24-hour Holter recordings were analysed for time-domain HRV and the 12-lead ECG was optically scanned and digitised for analysis of QT dispersion. Evaluations were done at baseline, and at six, 12 and 18 weeks from baseline. RESULTS: Losartan and spironolactone showed statistically significant, favourable effects on HRV, QT dispersion and mean heart rate (p < 0.05). CONCLUSION: The data showed that in these patients with heart failure, the addition of spironolactone to an ACE inhibitor, or the use of losartan on its own, or the combination of losartan plus spironolactone induced a favourable sympathovagal balance. The drugs significantly improved HRV indices and QT dispersion further, and the combination appeared to be safe. However, no significant differences were seen between the effects of each of these regimes on HRV and QT dispersion.

Lethality of suicide methods.

OBJECTIVES: To (a) quantify the lethality of suicide methods used in Australia in the period 1 July 1993 to 30 June 2003, (b) examine method-specific case fatality by age and sex, and (c) identify changes in case fatality during the study period. METHODS: Two sources of data on episodes of self-harm in Australia were used, mortality and hospital separation data. Double counting of cases recorded in both sources was controlled by omitting fatal hospital cases from estimates of episodes of self-harm. RESULTS: Overall case fatality was 12%. For each suicide method, case fatality was higher in males and older age groups. Firearms were the most lethal suicide means (90%) followed by hanging (83%). Rates of suicide involving firearms declined over time, and those involving hanging rose. Case fatality for firearm cases changed little over time, but declined for self-harm by hanging/suffocation, poisoning, sharp objects, and crashing a motor vehicle. CONCLUSIONS: This study (Australia) and two others (USA) show differences in method-specific lethality by gender and age. This study adds the finding of changes in lethality over time. Understanding of suicidality in populations, on which prevention efforts depend, requires explanation of these findings.

Pharmaceutical care of patients with gestational diabetes mellitus.

RATIONALE, AIMS AND OBJECTIVE: To investigate whether the introduction of a programme of optimising drug treatment, intensive education and self-monitoring of patients diagnosed with gestational diabetes mellitus (GDM) at an early stage (<20 gestational weeks), will improve management outcomes as determined by objective measures of patient knowledge about diabetes, glycaemia control, maternal/neonatal complications, and health-related quality of life. METHODS: The study was a randomized, controlled, longitudinal, prospective clinical trial performed at Al-Ain Hospital, Al-Ain, United Arab Emirates. Over an 18-month period, patients diagnosed with GDM were recruited and were randomly assigned to either an intervention or a control group, in a ratio of 3:2. Intervention patients received a structured pharmaceutical care service (including education and introduction of intensive self-monitoring) while control patients received traditional services. Patients were followed up from time of recruitment until 6 months postnatally at scheduled outpatient clinics. A range of clinical and humanistic outcome measures, including maternal and neonatal complications, were used to assess the impact of the intervention. RESULTS: A total of 165 patients (99 intervention, 66 control) completed the study. The intervention patients exhibited a range of benefits from the provision of the programme when compared with control group patients. Statistically significant (P < 0.05) improvements were shown in the intervention group for knowledge of diabetes, health-related quality of life (as determined by the SF36), control of plasma glucose and HbA(1c), maternal complications [e.g. decreased incidence of pre-eclampsia (5.1% vs. 16.7%), eclampsia (1.0% vs. 7.6%), episodes of severe hyperglycaemia (3.0% vs. 19.7%) and need for Caesarean section (7.1% vs. 18.2%)], and neonatal complications [e.g. decreased incidence of neonatal hypoglycaemia (2.0% vs. 10.6%), respiratory distress at birth (4.0% vs. 15.2%), hyperbilirubinaemia (1.0% vs. 12.1%) and large for gestational age (9.0% vs. 22.7%)]. CONCLUSION: The research provides clear evidence that provision of pharmaceutical care adds value to the management of GDM as exemplified by improved maternal and neonatal outcomes.

A Randomised; Controlled; Double-Blind;Cross-over Pilot Study Assessing the Effects of Spironolactone; losartan and their Combination on Heart Rate Variability and QT Dispersion in Patients with Chronic heart Failure : Cardiovascular Topic

Background and objective : The blocking of aldosterone or angiotensin II receptors improves mortality in patients with chronic heart failure. We explored whether combining losartan and spironolactone would have any added benefit on the known surrogate of mortality by using heart rate variability (HRV) and QT dispersion as our endpoints. Methods : We designed a three-phase; consecutive; randomised; controlled; double-blind; cross-over pilot study to assess the effects of losartan alone (50 mg / day); spironolactone (25 mg / day) with angiotensin converting enzyme (ACE) inhibitor and; finally; losartan with spironolactone; on HRV and QT dispersion. We enrolled eight patients (aged 47 to 72 years; mean = 63.7 years); with New York Heart Association (NYHA) class II-III heart failure and ejection fraction (EF) 35; in the study at a university-affiliated hospital in Dundee; Scotland. Digital 24-hour Holter recordings were analysed for time-domain HRV and the 12-lead ECG was optically scanned and digitised for analysis of QT dispersion. Evaluations were done at baseline; and at six; 12 and 18 weeks from baseline. Results : Losartan and spironolactone showed statistically significant; favourable effects on HRV; QT dispersion and mean heart rate (p 0.05). Conclusion : The data showed that in these patients with heart failure; the addition of spironolactone to an ACE inhibitor; or the use of losartan on its own; or the combination of losartan plus spironolactone induced a favourable sympathovagal balance. The drugs significantly improved HRV indices and QT dispersion further; and the combination appeared to be safe. However; no significant differences were seen between the effects of each of these regimes on HRV and QT dispersion

Haematogenous dissemination of tuberculous lymphadenitis.

OBJECTIVE: To determine whether Mycobacterium tuberculosis infection spreads through the blood to different lymph-node groups in patients with tuberculous lymphadenitis. DESIGN: Prospective analytical study. SETTING: The patients were recruited, managed and followed at the lymphodenopathy clinic, Central Police Hospital, Burr, Khartoum, Sudan. SUBJECTS: Fifty two sequential patients were enrolled. Thirty patients with FNAC diagnosis of tuberculous lymphadenitis and positive PCR for M. tuberculosis complex had a mean age of 26.9 +/- 11.2 years and similar male, female affection. Nine patients with FNAC tuberculous lymphadenitis, but negative PCR had a slightly higher mean age (32.6 +/- 18.2 years) with similar male: female proportions. Patients with reactive lymphadenopathy (9/52) were older than patients with tuberculous lymphadenitis with a mean age of 45 +/- 24.6 years. RESULTS: None of the patients were positive for HIV or had clinical or radiological evidence of pulmonary tuberculosis. M. tuberculosis DNA was detected in the blood samples of 30/39 (77%) patients with tuberculous lymphadenitis, but in none of the cases with reactive or malignant lymphadenopathy. The presence of M. tuberculosis DNA correlated strongly to multiple lymph-node involvement [OR (odds ratio) = 96.7, 95% confidence interval (CI) 9.0 - 1,039] and to caseating-granulomatous and predominantly necrotic cytomorphological categories [OR = 70, 95% confidence interval (CI) 7.0 - 703]. CONCLUSION: M. tuberculosis most probably disseminates through the blood from one node group to the other in patients with tuberculous lymphadenitis.