Over-prescription of short-acting ß2-agonists and asthma management in the Gulf region: a multicountry observational study.

BACKGROUND: The overuse of short-acting ß2-agonists (SABA) is associated with poor asthma control. However, data on SABA use in the Gulf region are limited. Herein, we describe SABA prescription practices and clinical outcomes in patients with asthma from the Gulf cohort of the SABA use IN Asthma (SABINA) III study. METHODS: In this cross-sectional study conducted at 16 sites across Kuwait, Oman, and the United Arab Emirates, eligible patients (aged ≥ 12 years) with asthma were classified based on investigator-defined disease severity guided by the 2017 Global Initiative for Asthma report and by practice type, i.e., respiratory specialist or primary care physician. Data on demographics, disease characteristics, and prescribed asthma treatments, including SABA, in the 12 months prior to a single, prospective, study visit were transcribed onto electronic case report forms (eCRFs). All analyses were descriptive in nature. Continuous variables were summarized by the number of non-missing values, given as mean (standard deviation [SD]) and median (range). Categorical variables were summarized by frequency counts and percentages. RESULTS: This study analyzed data from 301 patients with asthma, 54.5% of whom were treated by respiratory specialists. Most patients were female (61.8%), with a mean age of 43.9 years, and 84.4% were classified with moderate-to-severe disease, with a mean (SD) asthma duration of 14.8 (10.8) years. Asthma was partly controlled or uncontrolled in 51.2% of patients, with 41.9% experiencing ≥ 1 severe exacerbation in the 12 months preceding their study visit. Overall, 58.5% of patients were prescribed ≥ 3 SABA canisters, 19.3% were prescribed ≥ 10 canisters, and 13.3% purchased SABA over-the-counter (OTC) in the 12 months before the study visit. Most patients who purchased OTC SABA (92.5%) also received SABA prescriptions. Inhaled corticosteroid/long-acting ß2-agonist combinations and oral corticosteroid bursts were prescribed to 87.7% and 22.6% of patients, respectively. CONCLUSIONS: SABA over-prescription was highly prevalent in the Gulf region, compounded by purchases of nonprescription SABA and suboptimal asthma-related outcomes. Increased awareness among policymakers and healthcare practitioners is needed to ensure implementation of current, evidence-based, treatment recommendations to optimize asthma management in this region. TRIAL REGISTRATION: NCT03857178 (ClinicalTrials.gov).

Continued smoking exacerbates but cessation ameliorates progression of early type 2 diabetic nephropathy.

PURPOSE: We tested the hypothesis that continued cigarette smoking exacerbates and its cessation ameliorates progression of the early nephropathy of type 2 diabetes mellitus (DM2) from microalbuminuria to macroalbuminuria. METHODS: We recruited 91 DM2 subjects with microalbuminuria, 39 nonsmokers and 52 smokers. Smokers underwent smoking cessation intervention with 11 of the 52 smokers quitting, yielding 3 groups: nonsmokers (NS, n = 39), continued smokers (S, n = 41), and quitting smokers (Quit, n = 11), all on angiotensin converting enzyme inhibition (ACEI), treated toward recommended BP and glycemic targets, and followed prospectively for 5 years. Subjects had yearly measurements of estimated glomerular filtration rate (eGFR) and albumin (mg)-to-creatinine (g) ratios (alb/cr) in spot morning urines. Comparison of changes in characteristics was done using analysis of variance, with all pair wise multiple comparison procedure at alpha = 0.05. RESULTS: Although average urine alb/cr was not different among groups at recruitment, 7 of the 41 S (17%) but none of the 50 NS or Quit progressed to macroalbuminuria (P < 0.003). eGFR decline rate was faster in S (-1.79 +/- 0.35 mL/min/yr) than in NS or Quit (-1.30 +/- 0.43 and -1.54 +/- 0.37 mL/min/yr, respectively, P < 0.001). Multivariate analysis revealed smoking to be the only measured baseline factor that influenced eGFR decline rate (P < 0.041). CONCLUSION: Smoking exacerbates progression of early to advanced DM2 nephropathy and its cessation is an effective kidney-protective intervention in the early nephropathy of DM2.

Does Physical Self-Concept Mediate the Relationship between Motor Abilities and Physical Activity in Adolescents and Young Adults?

The purpose of this study is to examine the reciprocal relationship between motor abilities and physical activity and the mediation effects of physical self-concept in this relationship using longitudinal data. We expect that the effects of motor abilities on physical activity are rather indirect via physical self-concept and that the effects of physical activity on motor abilities are rather direct without involvement of the motor ability self-concept. Data was obtained from the Motorik-Modul (MoMo) Longitudinal Study in which 335 boys and 363 girls aged 11-17 years old at Baseline were examined twice in a period of six years. Physical activity was assessed by the MoMo Physical Activity Questionnaire for adolescents, physical self-concept by Physical Self-Description Questionnaire and motor abilities by MoMo Motor Test which comprised of the dimensions strength, endurance, coordination and flexibility. Multiple regression analyses were used to analyse the direct and indirect effects. The results of the multiple regression analyses show that the effects of motor abilities on physical activity were only indirect for the dimensions strength, coordination, and flexibility. For the dimension endurance, neither direct nor indirect effects were significant. In the opposite direction, the effects of physical activity on motor abilities were partially mediated by the self-concept of strength. For the dimensions endurance, coordination and flexibility, only indirect were significant. The results of this study support the assumption that the relationship between motor abilities and physical activity is mediated by physical self-concept in both directions. Physical self-concept seems to be an important determinant of adolescents´ physical activity.

Comparative study of Y-split recession versus bilateral medial rectus recession for surgical management of infantile esotropia.

AIM: This prospective study compares the results of bilateral medial rectus recession versus (vs) Y-split recession of medial recti techniques for surgical management of essential infantile esotropia. PATIENTS AND METHODS: Thirty patients were included in this study and had preoperative infantile esotropia with large angles (ie, >30 prism diopters [PD]). Patients were divided into Group A, which underwent bilateral medial rectus (BMR) recession and Group B, which underwent bilateral Y-split recession of medial recti muscles. All patients were subjected to complete ophthalmologic examination and met the criteria for inclusion in this study. The degrees of BMR recessions performed ranged from 6.0-7.5 mm. All operations were performed under general anesthesia. Follow-up visits were conducted at 1 and 2 weeks, and 1, 3, and 6 months postoperatively. Rates of reoperation for residual esotropia and consecutive exotropia were determined. RESULTS: The patients' preoperative angles of deviation ranged from 30-80 PD. Group A consumed 57% less operative time than Group B. Immediately postoperatively, the Y-splitting technique showed satisfactory results (ie, orthotropic or residual angles ≤15 PD) in 73% of patients vs 67% only for the BMR recession patients. By the end of six months of follow up; 13% of the BMR technique patients vs 27% of the Y-splitting technique patients showed negative change of PD but without reoperation. CONCLUSION: Our results suggest that, although the Y-splitting technique is more difficult and time consuming, both procedures are effective and have shown comparable results for the correction of horizontal deviation ≤70 PD.