Use of Cardiovascular Disease Secondary Prevention Medications in Four Middle East Countries in a Community Setting.

Background: Evidence-based International clinical practice guidelines, universally recommend secondary prevention medications for those with previous cardiovascular disease (CVD). There is limited data on the community use of these medications in the Middle East (ME). Objectives: This study assesses the use and predictors of evidence based secondary prevention medications in individuals with a history of CVD [coronary heart disease (CHD) or stroke]. Methods: Between 2005 and 2015, we enrolled 11,228 individuals aged between 35-70 years from 52 urban and 35 rural communities from four ME countries, United Arab Emirates (n = 1499), Kingdom of Saudi Arabia (n = 2046), Occupied Palestinian Territory (n = 1668) and Islamic Republic of Iran (n = 6013). With standardized questionnaires, we report estimates of medication use in those with CVD at national level and the independent predictors of their utilization through a multivariable analysis model. Results: Of the total ME cohort, 614 (5.5%) had CVD, of which 115 (1.0%) had stroke, 523 (4.7%) had CHD and 24 (0.2%) had both. The mean age of those with CVD was 56.6 ± 8.8 years and 269 (43.8%) were female. Overall, only 23.5% of those with CVD reported using three or more proven secondary prevention medications, and a substantial proportion (stroke 27.8%, CHD 25.8%) did not take any of these medications. In a fully adjusted analysis, increasing age, female gender, higher education, higher wealth in individual household, residence in a higher income country as well as being obese, hypertensive or diabetic were independent predictors of medication use. Conclusion: The use of secondary prevention medication is low in ME and has not reached the modest recommended WHO target of 50% use of 3 or more medications. Independent factors of higher use were, better socioeconomic status (household wealth, country wealth and education) and better contact and accessibility to health care (increasing age, female gender, obesity, diabetes and hypertension).

Laparoscopic Repair of Colorectal Perforations Induced by Compressed Air Pressure: A Case Report.

A compressed air nozzle has the potential to result in lethal injuries when handled inappropriately. Owing to the rarity of colorectal perforations due to barotrauma, no clear pathway to managing them has been established. We report an incident of a 33-year-old male patient who presented with tension pneumoperitoneum due to rectosigmoid perforations after being subjected to transanal compressed air insult. An emergency laparoscopic exploration with primary repair of the rectal perforation and Hartmann procedure were performed resulting in a smooth postoperative course. We hereby conclude that laparoscopy is a safe and effective approach associated with faster recovery and fewer adverse events.

Parenting children with autism spectrum disorder in the United Arab Emirates: Exploring perceptions towards using the picture exchange communication system to enhance the development of children with autism spectrum disorder.

BACKGROUND: Autism spectrum disorder (ASD) is an interplay between biological, social and environmental factors that impact the development of individuals. However, core characteristics are social, communication and behaviour challenges that restrict children's participation in society. Consequently, there are discussions regarding the need for society to develop interventions that are geared towards promoting the participation of children with ASD in societies. While the Picture Exchange Communication System (PECS) helps lessen the biological characteristics of children with ASD, its impact has rarely been explored in non-western societies, such as the United Arab Emirates (UAE). OBJECTIVES: The instant study's purpose was to explore parents' perceptions of the effectiveness of the PECS on the communicative, social and academic developments of children with ASD in UAE. METHOD: The Perception Towards Picture Exchange Communication Scale (PTPECS) was developed to collect data from the participants. The newly developed tool was piloted and validated before being implemented. The participants included 73 caregivers of children with ASD in the UAE. RESULTS: The following non-parametric tests were conducted: Mann-Whitney U test, Kruskal-Wallis test, and spearman rho. The results revealed that the parents were generally positive about employing the PECS to support the development of their children with ASD. There was also a positive association between using the PECS and improving communication, learning and social skills in children with ASD. CONCLUSION: It is imperative that educators and policymakers envisage parents as equal partners in providing rehabilitation services to children with ASD. Various implications, such as the need for continual engagement and empowering parents of children with ASD, are discussed.

Cellular Respiration in Thymic Fragments from Mice.

BACKGROUND: This report aims to detail the use of the phosphorescence oxygen analyzer for in vitro investigation of thymic responses to pharmaceutical agents, in particular immunosuppressants and immunomodulators. Sirolimus (a highly specific inhibitor of the 'molecular target of rapamycin', mTOR) and ozanimod (an agonist of the sphingosine 1-phosphate receptor, recently approved for treatment of multiple sclerosis and ulcerative colitis) are used for this purpose. METHODS: Thymic fragments from mice were placed in glass vials containing phosphate-buffered saline, bovine albumin, and Pd(II) meso-tetra (sulfophenyl) tetrabenzoporphyrin. The vials were sealed from air, and the cellular oxygen consumption was monitored as function of time. RESULTS: The decline of dissolved oxygen concentration with time (d[O2]/dt) was linear; thus, its rate (thymocyte respiration) was expressed as µM O2 min-1. Cyanide inhibited respiration, confirming the oxygen consumption was in cytochrome oxidase. In age-matched mice, the rate of thymocyte respiration (mean ± SD, in µM O2 min-1 mg-1) was 0.046 ± 0.011 (median = 0.043, range = 0.028 to 0.062, n = 10). In thymic fragments from littermates, this rate was inhibited in the presence of sirolimus (16% lower) or ozanimod (29% lower). CONCLUSIONS: Thymocyte respiration can serve as a surrogate biomarker for studying the mode-of-action and the cytotoxicity of immunotoxins and immunosuppressants.

Comparative Study of the Perspectives on the Impact of a Culturally Responsive Picture Exchange Communication System for Children With Autism Spectrum Disorder in the United Arab Emirates.

Background: The Picture Exchange Communication System (PECS) is a widely accepted way to develop the communication skills of children with developmental disabilities such as autism spectrum disorder (ASD). However, the efficacy of PECS has been largely studied in Western societies and little research is available regarding its role in the development of children with ASD in a non-Western cultural context. The purpose of this study was to compare the parent and the practitioner perceptions of the use of PECS for children with ASD in the United Arab Emirates. Method: A new scale made up of three subscales was used to collect the data from the parents and the practitioners who were either related to or working with a cohort of children with ASD. The data were analyzed using Statistical Package for the Social Sciences (SPSS) and subjected to the computation of means, t-tests, analysis of variance (ANOVA), binary logistical regression, and two-way factorial ANOVA. Results: The results showed uncertainty or neutrality among the parents and the practitioners toward the use of PECS. Variables such as age, years of experience using PECS, and gender were noted to influence perceptions of PECS. Conclusion: The need for policymakers to consider developing regular training for parents and practitioners on the use of PECS and other implications are discussed.

Risk Factors for SARS-CoV-2 Infection Severity in Abu Dhabi.

BACKGROUND: Prediction models are essential for informing screening, assessing prognosis, and examining options for treatment. This study aimed to assess the risk of SARS-CoV-2 infection severity in the Abu Dhabi population. METHODS: This is a mixed retrospective cohort study and case-control study to explore the associated factors of receiving treatment in the community, being hospitalized, or requiring complex hospital care among patients with a diagnosis of SARS-CoV-2. Of 641 patients included, 266 were hospitalized; 135 were hospitalized and either died or required complex care, i.e., required ICU admission, intubation, or oxygen and 131 did not develop severe disease requiring complex care. The third group ("controls") were 375 patients who were not hospitalized. Logistic regression analyses were used to study predictors of disease severity. RESULTS: Among hospitalized patients older age and low oxygen saturation at admission were the consistent and strongest predictors of an adverse outcome. Risk factors for the death in addition to age and low oxygen saturation were elevated white blood count and low reported physical activity. Chronic kidney disease and diabetes were also associated with more severe disease in logistic regression. The mortality rate among those with less than 30 min per week of physical activity was 4.9%, while the mortality rate was 0.35% for those with physical activity > 30 min at least once a week. The interval from the onset of symptoms to admission and mortality was found to have a significant inverse relationship, with worse survival for shorter intervals. CONCLUSION: Oxygen saturation is an important measure that should be introduced at screening sites and used in the risk assessment of patients with SARS-CoV-2. In addition, an older age was a consistent factor in all adverse outcomes, and other factors, such as low physical activity, elevated WBC, CKD, and DM, were also identified as risk factors.