Pharmacogenomic insights in psychiatric care: uncovering novel actionability, allele-specific CYP2D6 copy number variation, and phenoconversion in 15,000 patients.

Pharmacogenomic testing has emerged as an aid in clinical decision making for psychiatric providers, but more data is needed regarding its utility in clinical practice and potential impact on patient care. In this cross-sectional study, we determined the real-world prevalence of pharmacogenomic actionability in patients receiving psychiatric care. Potential actionability was based on the prevalence of CYP2C19 and CYP2D6 phenotypes, including CYP2D6 allele-specific copy number variations (CNVs). Combined actionability additionally incorporated CYP2D6 phenoconversion and the novel CYP2C-TG haplotype in patients with available medication data. Across 15,000 patients receiving clinical pharmacogenomic testing, 65% had potentially actionable CYP2D6 and CYP2C19 phenotypes, and phenotype assignment was impacted by CYP2D6 allele-specific CNVs in 2% of all patients. Of 4114 patients with medication data, 42% had CYP2D6 phenoconversion from drug interactions and 20% carried a novel CYP2C haplotype potentially altering actionability. A total of 87% had some form of potential actionability from genetic findings and/or phenoconversion. Genetic variation detected via next-generation sequencing led to phenotype reassignment in 22% of individuals overall (2% in CYP2D6 and 20% in CYP2C19). Ultimately, pharmacogenomic testing using next-generation sequencing identified potential actionability in most patients receiving psychiatric care. Early pharmacogenomic testing may provide actionable insights to aid clinicians in drug prescribing to optimize psychiatric care.

Results from the United Arab Emirates 2022 report card on physical activity for children and adolescents.

Objective: The United Arab Emirates (UAE) 2022 Report Card provides a systematic evaluation of the physical activity (PA) levels of children and adolescents in the UAE. Methods: The 2022 Report Card utilized data from 2017 to 2021 to inform 10 core PA indicators that were common to the Global Matrix 4.0. Results: One in five (19%) UAE school children achieved the recommended amount of moderate-to-vigorous PA (i.e. ≥60 min/d; Total Physical Activity Grade F). Less than 1% of school children used active transport to and from school (Active Transportation Grade F). One in four (26%) secondary school children achieved the recreational screen time recommendations (i.e. ≤2 h/d; Sedentary Behaviours Grade D-). A quarter of adults reported achieving the recommended PA level (i.e. ≥150 min of moderate-intensity PA per week, or equivalent) (Family and Peers Grade D-). All school children are taught physical education (PE) by a specialist with at least a bachelor's degree in PE; however, the duration of weekly PE classes varied between schools (School Grade A-). The UAE Government has invested significant funds and resources into developing and implementing strategies and facilities that will increase PA across the entire population (Government Grade B+). Organised Sport and Physical Activity, Active Play, Physical Fitness, and Community and Environment indicators were graded 'Incomplete' (INC) due to a lack of available data. Conclusions: Overall, PA levels remain low and sedentary behaviours remain high amongst UAE children and adolescents. The UAE Government has sustained investment in further developing PA opportunities for all children and adults which should translate to increased PA and health improvements at a population level.

Endodontic Management of a Maxillary First Molar with Taurodontia and Two Palatal Canals: A Case Report.

The present case report describes an endodontic treatment of a three-rooted maxillary first molar with taurodontia and a palatal root with two separate canals. Maxillary first molar with two palatal canals is rare since extra canals are found most in the mesiobuccal root as the second mesiobuccal canal. Clinicians should have a thorough knowledge of the root canal system and internal anatomy and be alert about the possible existence of any variation in the canal morphology because it determines the successful outcome of an endodontic treatment.

Effects of a workplace exercise intervention on cardiometabolic health: study protocol for a randomised controlled trial.

INTRODUCTION: The worldwide rising levels of physical inactivity especially in the United Arab Emirates (UAE) and the Eastern Mediterranean region are alarming. The UAE reports one of the highest rates of non-communicable disease mortality and insufficient physical activity (PA) is a major underlying cause. Therefore, action is required to reduce physical inactivity using evidence-based strategies. This study aimed to evaluate the efficacy of a worksite exercise intervention on cardiometabolic health in the UAE. METHODS AND ANALYSIS: This is a protocol for a pragmatic parallel randomised controlled trial with a 1:1 allocation ratio to the intervention group and delayed intervention group. A total of 150 participants will be recruited from a semigovernment telecommunications company in Dubai (UAE) after meeting the eligibility criteria. The intervention group will receive 2 hours of exercise per week during working hours for 12 weeks (maximum 1 hour/day). The intervention group will be assigned to attend personal trainer sessions in the workplace gym throughout the intervention period. After the intervention is completed, the delayed intervention group will also receive 2 hours of exercise time per week from working hours for 4 weeks. The main outcome measure is the change in the cardiometabolic risk components, that is, systolic or diastolic blood pressure, waist circumference, glycated haemoglobin, fasting plasma glucose, low-density lipoprotein cholesterol from baseline to the end of the intervention. The secondary outcome is to examine whether the workplace exercise intervention improves PA levels 4 weeks postintervention. ETHICS AND DISSEMINATION: The study has been approved by the Dubai Scientific Research Ethics Committee (DSREC-SR-08/2019_02). The results will be disseminated as follows: at various national and international scientific conferences; as part of a PhD thesis in Public Health at the College of Medicine and Health Sciences, UAE University; and in a manuscript submitted to a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT04403789.

Tribulus terrestris: preliminary study of its diuretic and contractile effects and comparison with Zea mays.

OBJECTIVES: Tribulus terrestris L. (Zygophyllaceae) which is called Al-Gutub (in Iraqi dialect) or Quti;ba (in classical Arabic medicine), and Zea mays were both used alone or in combination by Iraqi herbalists to propel urinary stones. We studied the aqueous extract of the leaves and fruits of T. terrestris and the hair of Z. mays, to determine their diuretic activity and the contractile effect of T. terrestris. METHODS: The aqueous extract was filtered and the solvent was evaporated to produce a dry crude extract. The dry extract was then dissolved in physiological saline to make the required concentrations. Wistar male rats were used for the diuresis test and strips of isolated Guinea pig ileum were used for the contractility test. RESULTS: The aqueous extract of T. terrestris, in oral dose of 5g/kg elicited a positive diuresis, which was slightly more than that of furosemide. Z. mays aqueous extract did not result in significant diuresis when given alone in oral dose of 5g/kg, while combination of Z. mays and T. terrestris extracts produced the same extent of diuresis as that produced by T. terrestris alone. Na(+), K(+) and Cl(+) concentrations in the urine had also much increased. In addition to its diuretic activity T. terrestris had evoked a contractile activity on Guinea pig ileum. CONCLUSION: T. terrestris has long been used empirically to propel urinary stones. The diuretic and contractile effects of T. terrestris indicate that it has the potential of propelling urinary stones and merits further pharmacological studies.

Surgically treated transitional cell carcinomas of the bladder. The role of radical surgery.

OBJECTIVE: To assess the treatment outcome and differentiate between the individual behavior of the tumor stages that were studied (Ta, T1, and T2a) with special reference to T2a tumors. METHODS: This study was carried out at Al-Rasheed Military Hospital, Baghdad, Iraq, during a 12 year period. Fifty-six patients with Ta, T1, and T2a (superficial invasion of muscularis propria) transitional cell carcinomas of the bladder, have been retrospectively analyzed. They were treated surgically with either transurethral of the bladder tumor (N=45) or radical surgery (N=11). Tumors with frequent recurrences or mulifocal or extending to the ureter or vesical outlet were treated with radical surgery. No adjuvant intraveiscal chemotherapy or bacillus calmette-guerin therapy was practiced. RESULTS: All Ta tumors were controlled by transurethral of the bladder tumor treatment. Seventy-five percent of T1 tumors were controlled by transurethral of the bladder treatment and 25% qualified for radical surgery according to our criteria. Sixty percent of T2a tumors were controlled by transurethral of the bladder treatment and 40% warranted radical surgery. No stage progression occurred in Ta and T1 lesions, but 27% of T2a lesions (superficial invasion of muscularis propria) progressed to T2b (deep invasion of muscularis propria). All grade 2a lesions of all stages under study were controlled by transurethral of the bladder treatment. Of 6 patients with T2a grades 2b and 3 tumors, 5 patients (83%) qualified for radical surgery. No distant metastasis occurred during the observation period, which ranged from 4 months to 12 years (mean 51 months). Seventy-five percent of all patients, 78% of the transurethral of the bladder treatment group and 64% of the radical surgery group are alive and free of disease for 5 years or more. CONCLUSION: Radical surgery is indicated for T1 and T2a bladder carcinomas if they were multifocal, or extending to the ureter or the vesical outlet or frequently recurring within the first year, specially if they were T1 tumors of grade 3 or T2a tumors of grades 2b and 3. Transurethral resection is justifiable for grades 1 and 2a, low risk T2a tumors.