Modulation of PPAR-γ, SREBP-1c and inflammatory mediators by luteolin ameliorates ß-cell dysfunction and renal damage in a rat model of type-2 diabetes mellitus.

BACKGROUND: Natural products have been recommended as a complementary therapy for type 2 diabetes mellitus (T2DM) due to constraints of safety and tolerability of existing anti-diabetic agents. Luteolin exhibits anti-diabetic and anti-inflammatory effects. Hence, the impact of luteolin on glucose homoeostasis and organ damage was investigated in high-fat diet (HFD) and streptozotocin (STZ) induced T2DM in rats. METHODS AND RESULTS: Male Wistar rats were maintained on HFD (provided 55% energy as fat) for 10 days. Subsequently, a single dose of 40 mg/kg STZ was injected intraperitoneally on the 11th day. Seventy-two hours after STZ administration, diabetic rats with established hyperglycemia (fasting serum glucose > 200 mg/dL) were randomized into different groups having six rats each and orally administered either 0.5% hydroxy propyl cellulose or pioglitazone (10 mg/kg) or luteolin (50 mg/kg or 100 mg/kg) once daily for 28 days, while continuing HFD for respective groups. Luteolin significantly reduced hyperglycaemia, homoeostasis model assessment (HOMA) of insulin resistance (HOMA-IR) levels, and improved hypoinsulinemia and HOMA of b-cell function (HOMA-B) in a dose-dependent manner. Increased TNF-α, IL-6 and NFκB levels in diabetic rats were significantly regulated. Additionally, luteolin significantly augmented PPAR-γ expression while attenuating sterol regulatory element binding protein-1c (SREBP-1c) expression. Histopathological scrutiny validated that luteolin effectively attenuated HFD-STZ-induced injury in pancreatic ß-cells and kidneys to near normalcy. CONCLUSION: Our study showed that luteolin ameliorated hyperglycemia and improved hypoinsulinemia, ß-cell dysfunction, and renal impairment in HFD-STZ-induced diabetic rats by attenuating inflammation and dysregulated cytokine secretion through modulation of PPAR-γ, TNF-α, IL-6 and NF-kB expression and down-regulation of SREBP-1c.

Luteolin Mitigates Diabetic Dyslipidemia in Rats by Modulating ACAT-2, PPARα, SREBP-2 Proteins, and Oxidative Stress.

Diabetic dyslipidemia is a crucial link between type-2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular diseases (ASCVD). Natural biologically active substances have been advocated as complementary remedies for ASCVD and T2DM. Luteolin, a flavonoid, exhibits antioxidant, hypolipidemic, and antiatherogenic effects. Hence, we aimed to determine influence of luteolin on lipid homeostasis and hepatic damage in rats with T2DM induced by high-fat-diet (HFD) and streptozotocin (STZ). After being fed HFD for 10 days, male Wistar rats received 40 mg/kg STZ intraperitoneal injection on 11th day. Seventy-two hours later, hyperglycemic rats (fasting glucose > 200 mg/dL) were randomized into groups, and oral hydroxy-propyl-cellulose, atorvastatin (5 mg/kg), or luteolin (50 mg/kg or 100 mg/kg) administered daily, while continuing HFD for 28 days. Luteolin significantly ameliorated dyslipidemia levels and concomitantly improved atherogenic index of plasma in a dose-dependent manner. Increased levels of malondialdehyde and diminished levels of superoxide dismutase, catalase, and glutathione in HFD-STZ-diabetic rats were significantly regulated by luteolin. Luteolin significantly intensified PPARα expression while decreasing expression of acyl-coenzyme A:cholesterol acyltransferase-2 (ACAT-2) and sterol regulatory element binding protein-2 (SREBP-2) proteins. Moreover, luteolin effectively alleviated hepatic impairment in HFD-STZ-diabetic rats to near-normal control levels. The findings of the present study expound mechanisms by which luteolin mitigated diabetic dyslipidemia and alleviated hepatic impairment in HFD-STZ-diabetic rats by amelioration of oxidative stress, modulation of PPARα expression, and downregulation of ACAT-2 and SREBP-2. In conclusion, our results imply that luteolin may be efficacious in management of dyslipidemia in T2DM, and future research may be essential to substantiate our findings.

Use of mobile phone applications (apps) in preventing drug-drug interactions: A cross-sectional evaluation in a clinical setting in South India.

OBJECTIVES: With the advancement in technology, many mobile phone applications (apps) are available for preventing drug-drug interactions (DDIs). As no information is available about usage of these apps, we aimed to investigate the awareness of clinicians of Saveetha Medical College and Hospital, Chennai, India, about DDI mobile apps, to assess utilization and perceptions of the apps, and to ascertain perceptions of DDIs. MATERIALS AND METHODS: A cross-sectional questionnaire-based survey was conducted to collect data from 115 clinicians through Google Forms. Pearson χ2-test was utilized to identify associations among variables. For assessing perceptions, median total and individual statement scores were compared between various groups using Wilcoxon rank-sum or Kruskal-Wallis tests. RESULTS: Only half of the respondents were aware of DDI mobile apps, with internet (75.9%) and colleagues (50%) being common sources of information about the apps. The clinicians agreed that using these apps for confirming DDIs was time saving and improved patient care. Significant differences were observed in their perceptions by qualification and specialty. The majority of the clinicians (68.7%) did not have any specific training on DDIs, seldom encountered a harmful DDI (37.4%), often asked their patients about the use of over-the-counter drugs (88.6%), and always considered DDIs as a part of their prescribing decisions (46.1%). The most common sources of information regarding DDIs were websites (52.2%) followed by reference books for DDIs (50.4%). CONCLUSION: DDI apps have tremendous potential in influencing drug safety in the future. Ensuring thorough quality control by the providers and regulatory supervision of these apps will empower this possibility while consistently improving patient safety.

Knowledge of warning signs, presenting symptoms and risk factors of coronary heart disease among the population of Dubai and Northern Emirates in UAE: a cross-sectional study.

BACKGROUND: To evaluate the level of knowledge regarding warning signs, presenting symptoms and risk factors associated with coronary heart disease (CHD) among population of Dubai and Northern Emirates in UAE. MATERIALS AND METHODS: A cross sectional survey of 1367 residents of Dubai and Northern Emirates was conducted using a self-administered questionnaire. RESULTS: Respondents were classified into two groups: Young Adult Population (YAP; 18-24 years of age) and General Population (GP; 25 years and older). Majority of participants were males (56.7%) and of South Asian (57.5%) or Middle-Eastern (30.8%) ethnicity. Regarding presenting symptoms of CHD, chest pain was identified by around 80% of population, whereas pain in the left shoulder was recognized by 61% of GP and 44% of YAP. Atypical symptoms were poorly identified. Regarding risk factors, only one-fourth population knew that males were at higher risk compared to premenopausal females. Few knew that the risk increases in females after menopause and that the risk is higher for females who smoke and use oral contraceptives. 62% knew that the survivors of a heart attack are at high risk of recurrences. Except for tobacco smoke, hypercholesterolemia and hypertension, knowledge of other risk factors was not satisfactory. Older adults and females had comparatively higher level of knowledge. CONCLUSION: Knowledge level of many of the symptoms and risk factors of CHD is unsatisfactory. There is, therefore, a need to increase the awareness in the population of UAE. The knowledge gaps identified through this study can be addressed through health campaigns to increase the awareness about warning signs, symptoms and modifiable risk factors. .

What do faculty feel about teaching in this school? assessment of medical education environment by teachers.

BACKGROUND: Faculty members are major stakeholders in curriculum delivery, and positive student learning outcomes can only be expected in an educational environment (EE) conducive to learning. EE experienced by teachers includes all conditions affecting teaching and learning activities. As the EE of teachers indirectly influences the EE of students, assessment of teachers' perceptions of EE can highlight issues affecting student learning. These perceptions can also serve as a valuable tool for identifying faculty development needs. In this study, we have used the Assessment of Medical Education Environment by Teachers (AMEET) inventory as a tool to assess medical teachers' perceptions of the EE. METHODS: The AMEET inventory was used to assess perceptions regarding various domains of EE by teachers teaching undergraduate students at the College of Medicine, Gulf Medical University, Ajman, United Arab Emirates. Median total, domain, and individual statement scores were compared between groups using Wilcoxon rank-sum test. RESULTS: Teaching-learning activities, learning atmosphere, collaborative atmosphere, and professional self-perceptions were identified as strengths of the EE while time allocated for various teaching-learning activities, preparedness of students, levels of student stress, learning atmosphere in hospital, and support system for stressed faculty members were areas necessitating improvement. The scores of faculty members teaching in basic medical sciences were found to be significantly higher than those in clinical sciences. DISCUSSION: The EE of this medical college was generally perceived as being positive by faculty although a few areas of concern were highlighted. Strengths and weaknesses of the EE from the teachers' point of view provide important feedback to curriculum planners, which can be used to improve the working environment of the faculty as well as facilitate a better direction and focus to faculty development programs being planned for the future.

Development and validation of the AMEET inventory: An instrument measuring medical faculty members' perceptions of their educational environment.

We developed, through a three-round modified Delphi technique, an inventory [Assessment of Medical Education Environment by Teachers (AMEET)] to assess viewpoints of medical faculty on educational environment experienced by teachers. In Round 1, 16 members from international settings graded (0-3) and modified an initial list of statements, or suggested new statements for inclusion. In Round 2, the new statements were graded and previous responses reconsidered. Subsequently, statements with median scores ≤1 were excluded. The questionnaire was compiled following reconsideration of responses to new statements in Round 3. A pilot test enabled assessment of the validity and reliability of the instrument. The panel members modified and graded the initial 50 statements of the preliminary inventory and suggested five new statements. The new statements were graded, responses to previous 50 statements were reconsidered, and three statements with median scores <1 were removed following Round 2. On review of the 52 statements by panel, two statements (each with agreement of <75%) were deleted. The final 50-item inventory comprising six domains was piloted with 62 faculty. Cronbach's alpha of 0.94 was obtained. The AMEET inventory is valid, highly reliable and practically useful to assess medical faculty members' perceptions of educational environment.

A systematic review of self-medication practices among adolescents.

The purpose was to systematically review the global trends and factors influencing self-medication (SM) among adolescents. Databases (Medline/Pubmed, Ingenta, Cochrane Library, EMBASE, CINAHL, Proquest, Scopus, and Google Scholar) were searched for peer-reviewed research published between January 2000 and December 2013 on SM among adolescents aged 13-18 years. Articles were scrutinized for country of origin, sample size, recall period, prevalence rates and associations, influencing factors, medicines used, self-medicated health complaints, sources of drug information, recommendation and procurement, knowledge about medicines, and adverse drug reactions. One hundred and sixty-three publications met the inclusion criteria. SM prevalence ranged from 2% to 92% in different countries. The most frequently self-medicated over-the-counter and prescription-only medicines were analgesics and antibiotics, respectively. Headache, allergies, and fever were the most common self-medicated health complaints reported. Misuse of both over-the-counter and prescription-only medicines reflected a risky trend. Female gender, older age, maternal education, and familial practices were associated with SM among adolescents. The primary sources of drug information, recommendation, and procurement included pharmacists, parents, and friends. High-risk practices such as diversion of prescription medicines and utilization of previous prescriptions were also reported. Most studies revealed gaps in drug knowledge, although adolescents self-rated it as satisfactory. However, few adverse drug reactions were reported, probably because of lack of awareness about the potential harmful effects of medicines. Recommendations for "responsible SM" have been made to minimize the adverse effects of SM. Understanding the links between various factors promoting SM can be helpful in deriving strategies aimed at reducing drug-related health risks among adolescents. Moreover, these will aid in creating awareness among adolescents about the potential risks of using drugs without proper information and consultation. Studies need to be designed to assess the changing trend and identify new correlates of self-medication practices among adolescents, which pose fresh challenges to monitor the menace.

Does curricular change improve faculty perceptions of student experiences with the educational environment? A preliminary study in an institution undergoing curricular change.

PURPOSE: College of Medicine, Gulf Medical University, United Arab Emirates, underwent a major curriculum change from a discipline-based to an organ system-based integrated curriculum. However, it was not known how the faculty perceived the changes in the educational environment as experienced by the students. In this context, we aimed to compare the faculty perceptions of the student experiences in the discipline-based curriculum with those in the organ system-based integrated curriculum. METHODS: The Dundee Ready Education Environment Measure (DREEM) questionnaire was modified to assess faculty perceptions of the student experiences, pilot-tested, and administered to all faculty members (n=28) involved in the discipline-based curriculum (FDC) in January 2009. In the subsequent year, data were collected from the same faculty involved in the new integrated curriculum (FIC). Collected data were transferred to Predictive Analytics Software version 18. Total, domain, and individual statement scores were assessed with the Wilcoxon signed rank test. Percentage agreement, disagreement, and uncertainty were assessed by the McNemar's test for proportion. RESULTS: The mean total DREEM score was significantly higher (P<0.001) for FIC (139/200) as compared to FDC (119/200). The FIC perceived significantly more positive student experiences with the educational environment as indicated by the domain scores and statement scores. The differences in proportions of agreement between FIC and FDC also reinforced that the FIC perceived more positive student experiences with the educational environment. CONCLUSION: The study showed that the faculty perceived the organ system-based integrated curriculum as providing a better educational environment for the students than the discipline based curriculum.

Drug knowledge of expatriate adolescents in the United Arab Emirates and their attitudes towards self-medication.

BACKGROUND: Adolescents have limited knowledge about medicines and their potential adverse effects. In this context, we aimed to investigate the basic knowledge of medicines, any differences in knowledge related to practice of self-medication (SM), attitudes towards SM and sources of information about medicines among expatriate adolescents in the United Arab Emirates (UAE). METHODS: A cross-sectional survey was conducted among 324 students from four schools in the UAE using a self-administered questionnaire. Data were analyzed using SPSS version 19. RESULTS: The sample of multi-ethnic students, with ages ranging from 14 to 19 years, was almost equally distributed between the genders. A total of 289 students reported to be self-medicating. More than 60% of adolescents had responded incorrectly to eight questions related to knowledge about medicines. There were no significant differences between mean scores for drug knowledge (maximum score=22) of self-medicating adolescents (12.1±4.32; SMAs) and those not practicing SM (12±4.53; NSMAs). Self-assessment of drug knowledge was perceived as good by 33% and satisfactory by 34% of SMAs. The majority of adolescents (87%) believed that SM was acceptable and reported being aware of its advantages and disadvantages. Parents and pharmacists were common sources of information about medicines. CONCLUSION: The participants showed a positive inclination towards SM. The SMAs and NSMAs had similar knowledge about medicines. However, gaps in knowledge may lead to drug misuse and toxicity. Healthcare providers, pharmacists, educators and parents should be actively involved in health education strategies for rational use of medicines among adolescents in the UAE.

Self-medication and related health complaints among expatriate high school students in the United Arab Emirates.

BACKGROUND: Self-medication, often without adult guidance, has been reported to be a common practice during adolescence. Similar to other preventable health-risk behaviors initiated in early adolescence, it has become a cause for concern universally. OBJECTIVE: This study examines the prevalence of self-medication with both prescribed and non-prescribed (OTC) medications, related health complaints, sources of drugs, and sources of drug recommendation, and gender differences related to self-medication among expatriate high school students in the United Arab Emirates (UAE). METHODS: A cross-sectional survey was conducted among 324 expatriate students through a validated, self-administered questionnaire and data was analyzed using SPSS 19 version. Means and proportions were calculated and Pearson Chi-square test of significance was used to analyze association among variables. RESULTS: Majority of the participating students, almost equally distributed by gender, was aged 16 to 17 years. The period prevalence rate of self-medication with prescribed and OTC medications were 89.2%, which did not vary with age, gender, ethnicity or parents' educational level. The most common sources of drug and drug recommendation were community pharmacies and parents respectively. Headache and fever were the common self-medicated conditions and consequently, analgesics and antipyretics were most commonly used both in the previous two weeks and the previous year prior to the survey. A high prevalence of self-medication with antibiotics (53%) and sedative/hypnotics (27%) was also observed. A female excess emerged for certain health complaints and use of medicines except for the use of anti-allergic and herbal/homeopathic drugs. CONCLUSIONS: This is the first study to explore self-medication practices among high school students in UAE and provides baseline data critical in creating awareness about the risks and benefits of self-medication. Health care providers, educators and parents should be actively involved in health education strategies for inculcating responsible self-medication practices in the adolescent population of UAE.

Do faculty in Southern Indian medical colleges support animal use in postgraduate education more than in undergraduate education?

In India, animal experiments play an integral role in both undergraduate medical education (UGME) and postgraduate medical education (PGME) in the discipline of Pharmacology. Therefore, we aimed to compare the perceptions of pharmacology faculty members in southern India with regard to the use of animal experiments and alternatives in UGME and in PGME. We also determined the association between these perceptions and the socio-demographic characteristics of the participants. Pharmacology faculty members in 15 medical colleges located in southern India answered a 27-statement, 5-domain questionnaire with a total score of 108. The means of the total, domain and statement scores were analysed by the Wilcoxon signed-rank test. The mean total score obtained for faculty members (n = 52) was significantly higher (p < 0.001) for PGME (61.2/108) than that for UGME (51.9/108). Significant differences were observed in the mean total and in the domain scores for PGME when compared to UGME in all of the socio-demographic groups, except for male faculty members and those without an MD or doctoral degree. The mean individual statement scores also indicated that there is more support for animal use in PGME. Overall, it was apparent that pharmacology faculty members in southern Indian medical colleges support animal use in PGME more than in UGME. Increased awareness is required among faculty members concerning alternatives to animal experiments in medical education, especially in PGME.

Diabetes Mellitus-Related Knowledge among University Students in Ajman, United Arab Emirates.

OBJECTIVES: The aim of this study was to assess diabetes mellitus (DM)-related knowledge and practices among university students enrolled in non-health care related professional courses in the United Arab Emirates. METHODS: A pre-tested questionnaire assessing the knowledge of DM was administered to the above-mentioned students. Data collected were transferred to PASW Statistics (Chicago, IL, USA, Version 18) and analysed. RESULTS: Data on 168 university students (47 males and 121 females) were included in the analysis. Of the participants, 25% were overweight or obese and only 27% exercised regularly. Regarding their knowledge of DM, 70% knew that it is characterised by high blood sugar levels and identified family history as a major risk factor. Surprisingly, only just over half could link obesity and physical inactivity as risk factors for developing DM, or could identify an excessive feeling of thirst, frequent urination, and weight loss as symptoms. Knowledge of the complications of diabetes, including gangrene, loss of sensation in limbs, oral and dental complications, recurrent infections, and risk for cardiovascular disease got a moderate response. Knowledge of diabetes was found to be higher in females compared to males. No significant differences were observed in the health behaviour of participants with or without a family history of DM. CONCLUSION: Our study revealed that in spite of exposure to various sources of information, the participants' level of DM-related knowledge was not adequate. We recommend the engagement of health professionals in educational settings in order to enhance health-related knowledge and inculcate healthy lifestyle practices in students.

Students' perceptions of educational environment in a medical school experiencing curricular transition in United Arab Emirates.

BACKGROUND: Gulf Medical College, UAE, underwent a major curriculum change from a discipline-based to an organ-based integrated curriculum. AIM: To compare students' perception of the educational environment in the discipline-based curriculum with that in the integrated curriculum. METHODS: Data was collected from second-year students (Group 1) in the discipline-based curriculum and in the subsequent year from second year students in the integrated curriculum (Group 2). The instrument used was Dundee Ready Education Environment Measure (DREEM). Scores were compared using Wilcoxon Rank Sum test. Data from second, third and fourth year students in the discipline-based curriculum were used to determine the total DREEM score for the school. RESULTS: The total DREEM score was significantly higher (p < 0.001) for Group 2 (135/200) when compared to Group 1(116/200). Both groups unanimously perceived a positive educational environment. Although Group 2 showed significantly more satisfaction, they perceived an over-emphasis of factual learning and a problem of cheating. Total DREEM score for the school was 120/200. CONCLUSION: This study shows that the organ system-based integrated curriculum is perceived to provide better educational environment than the discipline-based curriculum. However, areas like curriculum load and assessment strategies still require further fine tuning.

Willingness to spare animals in undergraduate medical education in Southern India: a preliminary questionnaire-based investigation.

Animal experiments continue to play an integral role in Indian undergraduate medical education, even though alternatives are becoming increasingly available. In this context, this study aimed to assess the perceptions of pharmacology faculty members from medical colleges in southern India regarding the use of animals and alternatives in experimental pharmacology, and to determine the association between these perceptions and the socio-demographic characteristics of the participants. Data were collected from 59 faculty members of 15 medical colleges in southern India. The response rate was 84.3%. A 30-statement, five-domain questionnaire was used, with a global score of 120. The mean ± SD global score was 60.9 ± 17.3. Significant differences were observed in domain scores and individual statement scores with respect to the extent of teaching experience. There were no statistically significant differences in perceptions with respect to age, gender or educational qualifications. All the participating colleges were conducting at least 3-8 animal experiments per year on the rabbit, rat, mouse and frog/toad. The pharmacology faculty members in the southern India medical colleges included in the study (especially the more experienced teachers) supported animal use in undergraduate medical education, in spite of being aware of the drawbacks of animal experiments and the availability of alternatives.