Utilization of Complementary and Alternative Medicine for the Management of Cardiovascular Diseases Among Adults in Ajman, United Arab Emirates.

BACKGROUND: As the general population is expanding their choices regarding healthcare, many are opting for complementary and alternative medicine (CAM) in addition to or instead of conventional modes of treatment, for the management of various health conditions. AIMS: This study investigated the utilization of CAM for the management of various cardiovascular diseases as well as its risk factors among the adult population in Ajman, UAE. MATERIALS AND METHODS: The study was conducted upon receiving approval from the Institutional Review Board (IRB). This cross-sectional study was conducted by administering an interviewer-administered questionnaire, consisting of three domains aimed at assessing the sociodemographic features and use of CAM and factors associated with the use among the respondents. A total of 414 responses were collected from adults residing in Ajman, UAE, who consented to participate in the study. A chi-square test was performed on Statistical Product and Service Solutions (SPSS) (IBM SPSS Statistics for Windows, Version 27.0, Armonk, NY) to assess the association between the use of CAM and factors. Statistical significance was set to p ≤ 0.05. RESULTS: Out of 414 participants in the study, 57% of the participants used CAM before, while 43% of the participants never used CAM. Among the CAM users, 23% used it for anxiety and stress, 7.6% utilized it for the management of hypertension, 3.3% used it for high cholesterol, 3.1% for obesity, 1.9% for chronic kidney disease, 0.9% used it for diabetes mellitus, 0.5% used it for stroke, and 0.5% used it for heart failure. CONCLUSIONS: From the results of the study, it can be concluded that the majority (57%) of the participants have used CAM before. Most of the participants utilized CAM to manage chronic conditions (81.9%).

Vaccination Rate and Incidence of COVID-19 and Case Fatality Rate (CFR): A Correlational Study Using Data From 2019 to 2021.

INTRODUCTION:  COVID-19 has infected over 300 million people and killed almost five million people worldwide. The rapid development and deployment of vaccines almost a year after the initial outbreak was poised to contain the pandemic and enable the mobilization of the people and the economy. Vaccine deployment and containment of the pandemic have been far from uniform across the world. There is a lack of a clear understanding of the correlation between the COVID-19 vaccination rates and the incidence of the COVID-19 disease and COVID-19 mortality. AIM:  The study aims to determine the correlation between the COVID-19 vaccination rate and the bi-weekly incidence rate of the COVID-19 disease to better understand the correlation between the vaccination rate and the COVID-19-related fatality in various countries. MATERIALS AND METHODS:  Data from vaccination and the case fatality rate were abstracted until September 15, 2021, and from October 15 to October 31, respectively, for the various countries categorized based on their income levels. The bi-weekly COVID-19 incidence rate per million population and the case fatality rate was analyzed using SPSS version 27 (IBM Corp., Armonk, NY), followed by frequencies and percentages. Spearman rank correlation was used to determine the relationship between the variables. RESULTS:  A total of 191 countries were included in the study. The vaccination rate ranged from 0.03% to 82.1%, CFR from 0.14% to 32.1%, and the bi-weekly incidence rate ranged from zero to 1,283 per million population. A positive correlation was observed between vaccination rate and bi-weekly incidence rate (+0.57), whereas a negative correlation was observed between vaccination rate and CFR (-0.34). The results indicate a moderate positive correlation between vaccination rate and bi-weekly incidence rate and a weak negative correlation between vaccination rate and case fatality rate. DISCUSSION AND CONCLUSION:  Our study is interesting for the observation that the bi-weekly incidence rate of COVID-19 positively correlated with the rate of vaccination. In contrast, the vaccination rate correlated negatively with the case fatality rate. Although several factors may have contributed to the increased incidence rates for COVID-19, these observations refute the myth that COVID-19 vaccination offers complete protection from reinfection, especially in the backdrop of easing pandemic containment measures by some countries. An increase in the vaccination rate is certainly a positive contributor to the decreasing case fatality observed.

Predictors of Nicotine Dependence Among Adult Male Midwakh and Cigarette Smokers.

Objectives: Midwakh is a popular form of smoking in the Middle East. This study aimed to assess the predictors of nicotine dependence among cigarette or midwakh smokers in the United Arab Emirates (UAE). Methods: This cross-sectional study was conducted from September to December 2015 in Ajman, UAE. A convenience sampling strategy was implemented to recruit adult male smokers aged ≥18 years who exclusively smoked either cigarettes or midwakh. A validated self-administered questionnaire was used to collect data from the participants, with nicotine dependence assessed using the Modified Fagerström Test for Nicotine Dependence. In addition, the levels of salivary cotinine and exhaled breath carbon monoxide (CO) were measured. Results: Of the 88 adult male smokers included in the study, 40 (45.5%) were cigarette smokers and 48 (54.5%) smoked midwakh. The majority of participants were 26-35 years of age (48.9%), followed by 18-25 years (30.7%) and >35 years (20.5%). Midwakh use was associated with more than a three-fold increase in the risk of moderate-to-high nicotine dependence compared to cigarette smoking. Moreover, for each unit increase in CO level, there was a 10% increase in the risk of nicotine dependency. There was also a significant association between nicotine dependence level and depth of inhalation (P = 0.023). Conclusion: Type of smoking and CO level were found to be significant predictors of nicotine dependence among adult male smokers. In particular, greater dependency was observed among midwakh smokers than cigarette smokers.

Case fatality rates of COVID-19 across the globe: are the current draconian measures justified?

Aim: The current study assessed the case fatality rate (CFR) across different income level countries of the world, and the virulence pattern of COVID-19, against the backdrop of panic and uncertainty faced by many governments, who are trying to impose draconian containment measures to control the outbreak. Subjects and Methods: Data on confirmed cases and number of deaths due to coronavirus infection were retrieved from the WHO as on 30 March 2020, and examined for the various income level countries, per the World Bank criteria. The CFR was calculated country-wise and estimated for the various groups such as low, lower-middle, upper-middle, and high-income, and the data was analyzed. Results: The overall CFR for the high income countries was 5.0%, compared with a CFR of 2.8% for low-income countries. The upper-middle-income countries showed a CFR of 4.3%, while the lower-middle-income countries stood at 3.7%. The results from our study predict that the maximum CFR in high-income countries will be contained at approximately 5% (95% CI). The CFR for the low, lower-middle, and upper-middle-income countries will range between 2.8 and 4.3% (95% CI). Conclusion: COVID-19, irrespective of its transmissibility, produces a lower CFR compared with that of SARS-Cov and MERS-Cov, although COVID-19 has infected eight times more countries than MERS-Cov and SARS-Cov, and caused a higher number of deaths. The nation-wide lockdown measures to prevent the spread of the virus may be reconsidered, given the hardships for the population and their impact on the economic system.

Dentists' perception of health-risk associated with cigarettes and alternative tobacco products: A descriptive study.

Cigarettes and alternative tobacco products cause various oral health issues ranging from minor tooth decay/gum-diseases to oral cancer. According to the Centre for Disease Control (CDC), over 40% of adult cigarette smokers have untreated tooth decay which later leads to severe oral health problems. The present study intended to assess the impact of dentists' perceived risk of smoking tobacco products on their attitude and practice toward tobacco cessation advice. It was a cross-sectional study to collect data on the perception of dentists who are smokers, regarding smoking-related health risks. Dentists' attitude was measured using a questionnaire with a 5-point rating scale and a practice list of items with a 3-point rating scale. Descriptive/inferential techniques were applied, and a significance level was fixed at 5%. Among the 31 tobacco users, 80.6% of dentists perceived severe risk with cigarette use as compared to alternative tobacco products (71%). Positive attitude and good practice were observed among those who perceived severe risk; however, no statistical significance was observed (p-value >0.05). Young dentists, males, Arab nationals, highly educated and specialists had a positive attitude toward smoking cessation activities. Among the smokers, dentists recognize their role and responsibility very seriously in building a smoke-free community, but their risk perception and good attitude did not positively reflect on their clinical practice in smoking cessation programs. Though the dentists had a better perception and attitude towards smoking cessation, their clinical practice in offering advising sessions is inversely related to their perception/attitude.

Salivary cotinine concentration and carbon monoxide levels in young adults smoking midwakh in comparison with cigarette smokers.

OBJECTIVES: To estimate and compare the salivary cotinine levels using a semiquantitative method, called NicAlert, between three groups: non-smokers, daily smokers of cigarettes and daily smokers of midwakh, and to compare the carbon monoxide (CO) levels among these groups. MATERIALS AND METHODS: A total of 159 adult male volunteers aged 20 and above were included, with 54 current cigarette smokers, 52 current midwakh smokers and 53 non-smokers. Estimate of breath carbon monoxide and salivary cotinine were collected, as well as sociodemographic characteristics and details of smoking habits and second-hand smoke exposure among participants. Institutional review board approval was obtained and data were analysed using SPSS V.21 with the Kruskal-Wallis test used to obtain differences in the distribution. RESULTS: There was no significant difference in the median breath CO and salivary cotinine levels between cigarette and midwakh smokers. Levels of breath CO were significantly higher in cigarette and midwakh smokers as compared with non-smokers (19.5, 17.5 and 6.0, respectively, p<0.05); the same relationship was observed for cotinine levels among cigarette and midwakh smokers as compared with non-smokers (4.0, 3.0 and 0.0, respectively, p≤0.05). Additionally, the values of both salivary cotinine and breath CO increased with the frequency of tobacco use. CONCLUSION: These are the first data that we are aware of that demonstrate that in terms of at least two key biomarkers of tobacco use, there are comparable levels of exposure between cigarettes and midwakh users, demonstrating a need for intensified attention to the use of midwakh.

Tobacco cessation: attitude and practice of dentists in Northern United Arab Emirates.

BACKGROUND: Tobacco use has profound health consequences globally. Dentists with positive attitudes towards tobacco cessation counselling show minimal involvement in practice. AIMS: To assess the attitude and practice of dentists in the Northern United Arab Emirates towards tobacco cessation advice. METHODS: An interviewer-administered, questionnaire-based study was conducted among 250 dentists practicing in the Northern Emirates in 2015. Statistical analysis was performed with the χ2 test and multivariate analysis. RESULTS: Around 88% of dentists exhibited good attitudes but only 37% had good practice of providing tobacco cessation advice to their patients. Nationality, level of education, total duration of practice and personal use of tobacco were significantly associated with attitude towards tobacco cessation. Nonusers of tobacco showed an odds ratio of 3.12 (95% confidence interval: 1.18-8.20) towards good attitude. CONCLUSIONS: Most of the surveyed dentists had a good attitude towards provision of tobacco cessation advice, but comparatively suboptimal practice was observed. We recommend providing training to the dentists on the methods and techniques of tobacco cessation.

Predictors of Colorectal Cancer Knowledge among Adults in the United Arab Emirates

Objective: To assess knowledge regarding colorectal cancer (CRC) and to identify its predictors in the UAE. Materials and Methods: A cross sectional study was conducted among subjects ≥ 50 years-old, using a validated self-administered questionnaire. Awareness of CRC risk factors, warning signs/symptoms (S/S), and screening methods was evaluated with a level of knowledge score for various areas. Low (poor) knowledge was defined as a score below the corresponding average value. The Chi-square test and logistic regression were used in the statistical analysis. Results: The percentage of respondents who had poor knowledge score concerning risk factors, warning S/S and screening were 81.7%, 84.7% and 94.1% respectively. Male and lower education level subjects had significantly higher probability of low knowledge related to risk factors and warning S/S. Also respondents without a family history of CRC or personal history of polyps had a significantly higher probability of low knowledge concerning warning S/S compared to those who had a positive history. Significantly higher probability of low knowledge concerning screening methods was noted among non-Arabs and subjects with a lower education level. Conclusion: Most of the respondents had poor knowledge. Gender, education level, family and personal history and ethnicity were found to be significant predictors of CRC knowledge.

Contraceptive Utilisation Among Mothers of Reproductive Age in Ajman, United Arab Emirates.

OBJECTIVES: This study aimed to determine contraceptive utilisation among mothers aged 18-49 years old in Ajman, United Arab Emirates (UAE). METHODS: This cross-sectional study was carried out from May to November 2013. A total of 400 participants were recruited from two primary healthcare centres and one private hospital in Ajman. An interviewer-administered validated questionnaire was used for data collection. RESULTS: The frequency of previous and current contraceptive use was 68.0% and 61.8%, respectively. Expatriates more frequently used contraceptives in comparison to Emiratis (77.3% versus 54.3%, respectively). Contraceptive use increased significantly with age (75.5% among >35-year-olds versus 57.3% among ≤25-year-olds; P <0.050) and education level (83.3% among postgraduates versus 60.0% among those with primary education; P <0.050). In addition, contraceptive use was significantly higher among those living in a nuclear family system (P <0.050). A univariate analysis indicated significant associations between contraceptive use and age, nationality, education level, type of family system, employment sector, parity, knowledge of birth control measures and source of birth control information (P <0.050 each). However, no significant associations were found via multivariate analysis. CONCLUSION: Healthcare practitioners can play a pivotal role in providing contraceptive advice which could lead to an improvement in contraceptive utilisation. Efforts are recommended to raise awareness regarding newer forms of contraceptives among mothers of reproductive age in the UAE.

Evolution of technology in teaching: Blackboard and beyond in Medical Education.

TEACHING AND LEARNING: the passing of knowledge from one generation to another - has been in existence from the earliest times of human civilization. It began in 1801, with a large piece of slate hung on the wall in a school in Scotland to provide information to a large audience at one time. In the US by mid-19th century, every class room had a blackboard to teach students. The modern version of the blackboard is either green or brown board. This was introduced in late 1960s. The whiteboards came into use during the late 1980s. Projected aids have been used since 1420. The various devices used are the epidiascope, slide projector, overhead projector for transparencies and the micro projector. An instrument to project images from a horizontal surface onto a vertical screen was invented in the 1870s. By the 1960s, transparencies were in use in classrooms. The 'Hyalotype', a transparent image of a photograph using actual black and white photographs on a glass slide that could be projected was invented in 1851. By 1916, the German company Agfa started producing colored lantern slides. The first version of PowerPoint was released by Microsoft in the year 1990. Cell phones, palmtops, and handheld computers; tablets, laptops, and media players are included under mobile learning devices. With the evolution of technology, students achieved competence and interested in interactive learning. The education industry has moved from distance learning to e-learning and finally to m-learning as knowledge expanded exponentially and the demand escalated. While using teaching aids with advanced technology, we must not forget the lessons from the past, striking a balance between embracing new methods of teaching and learning while upholding the timeless principles of education. The newer educational technology can be part of a comprehensive system for lifelong education. CONCLUSION: Use of technology in education has come a long way since the earliest times of human civilization. While embarking on aids with advanced technology, we need to take full cognizance of the lessons from the past, striking a balance between embracing new methods of teaching and learning while holding on to the timeless principles of education. Thus, the newer educational technology can be effective tools of teaching and learning in this rapidly changing technological world and be part of a comprehensive system for lifelong education. ACKNOWLEDGEMENTS: The authors wish to acknowledge Prof. Raja Bandaranayake for his valuable suggestions and editing this manuscript.

Dietary and Lifestyle Factors Associated with Dyspepsia among Pre-clinical Medical Students in Ajman, United Arab Emirates.

INTRODUCTION: Dyspepsia is a common gastrointestinal diseases worldwide with a prevalence ranging from 7 to 40%. Dyspepsia, more commonly known as heartburn or indigestion, is defined as one or more of the following symptoms: postprandial fullness, early satiation (the inability to finish a normal size meal), or epigastric pain or burning for at least 3 months in the past year. Dyspepsia has been studied extensively, but little is known of factors associated with dyspepsia among medical students. OBJECTIVES: The purpose of this study was to analyze the prevalence of dyspepsia and to evaluate the association between lifestyle and dietary factors associated with dyspepsia among pre-clinical medical students in Ajman, United Arab Emirates. METHODS: A cross-sectional survey study was conducted among pre-clinical medical students at Gulf Medical University, Ajman and collected basic demographic data, dyspepsia prevalence, dietary factors, and lifestyle factors. Data was analyzed using Microsoft Excel and SPSS software. Descriptive statistics were used to summarize the participant characteristics. Chi-square tests were used to test the association between dietary and lifestyle factors and dyspepsia. Logistic regression was used to measure the association of predictors (dietary and lifestyle factors) on the odds of having dyspepsia, independently. Multinomial logistic regression was used to examine the full association of predictors on the odds of having dyspepsia. RESULTS: The resulting sample was 176 pre-clinical medical students, with a mean age of 20.67 ± 2.57 years. A total of 77 (43.8%) respondents reported having dyspepsia while 99 (56.2%) did not. There was a significant association between smoking and dyspepsia (p<0.05), as well as a marginally significant association between inadequate sleep and dyspepsia (p<0.10). There was no significant association with alcohol or analgesic use on dyspesia. Dietary habits showed no association with dyspepsia. CONCLUSION: Dyspepsia was reported by 43.8% of the repondents. These findings emphasize the importance of improving lifestyle and dietary factors associated with dyspepsia and raising awareness of reducing risk factors associated with dyspepsia. Further studies are needed on dyspepsia in a larger cohort of students in order to fully understand the complexity of this problem and be able to generalize the findings to other cohorts.

Incidence of Type 2 Diabetes Mellitus among Emirati Residents in Ajman, United Arab Emirates.

BACKGROUND: Diabetes mellitus (DM), particularly type-2 is a major public health concern worldwide. Not much information is available with regard to the incidence of DM in United Arab Emirates (UAE). This study aimed at determining the incidence rate of diabetes mellitus among Emirati population in Ajman, UAE. This is a retrospective cohort study. METHODS: This study was conducted in all primary health care centers and Shaikh Khalifa and GMC Hospitals, Ajman, UAE where the Emirati population primarily go for diagnosis and treatment. The incident cases of diabetes mellitus were collected during the period 2010 January to December. RESULTS: A total of 158 cases newly detected in 2010, 54 were among non-Emiratis and one was type-1 diabetes. Eliminating these, the remaining 101 were included in the analysis. The age of the patients ranged from 23 years to 78 years; 35 (34.7%) males and 66 (65.3%) were females. The overall incidence observed was 4.8/1,000 person-years (PY) with a female predominance of 6.3/1,000 PY against incidence among males of 3.3/1,000 PY. With regard to age specific incidence rate among males, it increases with age till 60 years and then showed a decreasing trend. Among females also the same trend was observed but not as similar to males. CONCLUSION: The highest incidence rate was observed in the 55-59 age group among males, 23.4/1,000 PY and females, 32.4/1,000 PY. Among males the incidence rate was much less compared to females in-the age groups older than 59 years.

Cigarette Alternatives: Are they Safe?

In spite of limited data regarding the safety or effectiveness of electronic cigarette introduced into the market as a healthier alternative to tobacco smoking, its popularity has increased enormously. E-cigarettes have penetrated the market rapidly owing to the elaborate marketing network and attractive marketing strategies. Stated advantages include the claim that they help quit smoking and produce less exposure than conventional smoking. The list of disadvantages is even more elaborate. While the majority of the studies supporting health claims and efficacy for quitting smoking are not scientifically sound, they are also challenged by studies providing contradictory results. Owing to the limited evidence on the potential advantages and disadvantages of e-cigarettes, the debate on their safety continues.

Use of antihypertensive medications in patients with type -2 diabetes in Ajman, UAE.

Optimal reduction in blood pressure with antihypertensive agents helps to prevent microvascular and macrovascular complications of diabetes. The objective of the study was to evaluate the current utilization pattern of antihypertensive medications among patients with diabetes and coexistent hypertension as per the JNC seventh report guidelines. A Cross-sectional survey was conducted among patients with diabetes attending outpatient department of Internal Medicine at a hospital at Ajman. Medical records of patients were used to obtain diagnostic, demographic and drug use information. Univariate analysis was performed using Chi-square and t- test followed by logistic regression to compute independent predictors. Of 132 patients with diabetes, uncomplicated hypertension (HTN) was coexistent in 81% (107/132) of patients. Males constituted 49.5% (53/107) of the total. Mean (SD) age of patients with HTN was 55.1(10.1) years higher than those without HTN 49.6 (9.9) years (P<0.01). Higher number of patients with HTN had duration of diabetes<5 years than those>5 years (P=0.04). While adjusting the significant factors, only duration of diabetes was statistically significant (adjusted OR=1.06; CI 95% (1.003-1.116) P= 0.03 among patients with HTN. 63.6% (68/107) prescriptions contained one drug antihypertensive drug, 27.1 % (29/107) two drugs and 7.4% (8/107) no anti-hypertensive drug were prescribed. Angiotensin converting enzyme inhibitors/ Angiotensin receptor blockers (ACEI/ARBs) followed by diuretics were commonly prescribed drugs. ARBs with diuretics were the most frequent two drug combinations. The antihypertensive utilization pattern was similar in both gender and age groups. Results represent the current prescribing trend for anti-hypertensive agents among patients with diabetes that is in accordance with JNC-7 recommendations.

Knowledge of and attitudes towards HIV/AIDS: a survey among dental students in Ajman, UAE.

AIM: Encounters between dentists and patients with HIV/AIDS are bound to rise due to increased prevalence and emerging new treatments. This study assessed dental students' knowledge about transmission and oral manifestations of HIV/AIDS, and their attitudes towards patients regarding obligations to treat. METHODS: Out of 109 students in 4 years of a 6-year dental undergraduate program, 106 responded to a questionnaire on knowledge of and attitudes towards HIV/AIDS. Knowledge and attitude scores were analyzed with Kruskal-Wallis one-way anova and the gender differences with the Wilcoxon signed-rank test. RESULTS: The median score for students' overall knowledge was 39.5 (67%; maximum possible 59). The median knowledge scores for males and females were 38 and 40 respectively, although the difference was not statistically significant. The knowledge levels in Year 4 (42.5 ± 4.7), Year 3 (44 ± 6.5), and Year 2 (42 ± 5.8), were similar but significantly higher than in Year 1 (33 ± 7.9; P < 0.01). The median attitude score was 14 out of 24, with no significant differences within genders and years of study. Although the level of knowledge of the senior students was higher than that of the first years, the negative attitudes remained largely unchanged. CONCLUSIONS: Appropriate educational programs may alter the misconceptions and the negative attitudes.