Half of the Emirati Population Has Abnormal Red Cell Parameters: Challenges for Standards and Screening Guidelines

In populations with high prevalences of iron deficiency and thalassemia trait, many apparently healthy individuals have abnormal erythroid parameters, which may cause diagnostic problems in clinical practice. We studied the prevalence and causes of red cell parameter values outside their reference ranges in 394 healthy individuals of Bedouin Arab origin, who had complete blood counts (CBCs), hemoglobin (Hb) analyses and serum ferritin tests done. Their mean age?±?standard deviation (SD) was 24.8?±?4.9 years and 51.8% were females. Overall, 53.0% (209/394) had low Hb, MCV or MCH or high RDW. Anemia was present in 27.0% (55/204) of the women and 3.0% (6/190) of the men. Overall prevalence of MCV <80.0?fL was 45.0% (176/394) and MCH <27.0?pg was 48.0% (190/394); RDW >14.0% was found in 21.0% (43/204) of women and 7.0% (14/190) of men. Of the women, 16.0% had iron deficiency anemia (33/204) and 65.0% had ferritin values of <30.0?μg/L (133/204). The estimated prevalence of α-thalassemia (α-thal) trait in men was 32.0% (60/190) and that of β-thalassemia (β-thal) trait in both sexes was 3.0% (12/394). In conclusion, half of the healthy Emirati population have abnormal CBC values. For clinical purposes, they require reference standards for red cells that are derived from their own population. Screening of women for iron deficiency is justified due to a high prevalence of iron deficiency.     

Translation and culture adaptation of the Simplified Diabetes Knowledge Test,the Literacy Assessment for Diabetes and the Diabetes Numeracy Test

BackgroundThe ability to understand instructions on drug bottles, appointment slips and medical education brochures could be affected by patients' health literacy. Healthcare providers need to be aware of, hence, assess patients’ literacy before they develop effective educational strategies for these patients. Many validated instruments have been used to evaluate literacy of diabetic patients in the English language, only a limited number is available in Arabic.ObjectiveTo translate and culturally-adapt the Simplified Diabetes Knowledge Test (DKT), the Literacy Assessment for Diabetes (LAD), and the Diabetes Numeracy Test (DNT) for potential use in Arabic-speaking countries.MethodsA formal process based on the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines was adopted in translating and culturally adapting the three tools. An expert panel reviewed forward and backward translations of the tools. Ten diabetic patients participated in the cognitive debriefing process to evaluate the tools for clarity, simplicity, and comprehensiveness, and to assess their cultural equivalence.ResultsOnly minor changes were introduced in tools’ design, appearance, and instructions. However, issues identified during the expert panel review and cognitive debriefing led to modifying the tools resulting in item re-wording, addition, deletion or re-arrangement. Terms such as glycosylated hemoglobin, carbohydrates, and infection were adapted to cumulative sugar, starch and microbial inflammation respectively. Issues related to cultural and conceptual equivalence were resolved by replacing words such as kilo instead of pound, and supper instead of dinner, or adding diacritics to the Arabic word for “kidney”. The original 43 items of the DNT were reduced to 26, eliminating questions with the same mathematical calculations within each tool domain.ConclusionsA Culturally equivalent version of the Simplified DKT, LAD and DNT have been developed in the Arabic language available to be used in research and clinical practice in the Arabic speaking countries.     

Diet and caries experience among preschool children in Ajman,United Arab Emirates

The study investigated the association between food and drink consumption and the caries experience among young children in Ajman, United Arab Emirates. A one‐stage cluster sample was used to select children who were 5 or 6 yr of age. Clinical examinations for caries were conducted. Parents completed questionnaires seeking information on dietary habits. Principal components analysis was used to derive a summary score for the dietary variables (designated ‘snack consumption level’) and thus overcome the multicollinearity problems associated with using multiple dietary variables. Dental examination and questionnaire data were obtained for 1,036 children (79.9% participation rate). The overall mean number of decayed, missing or filled teeth (dmft) was 4.5. Snacking three or more times per day was associated with a dmft score that was almost one‐third higher than the dmft score for children who snacked only once daily. One‐third of children had a low overall snack consumption level (41% moderate and 25% high). There was a consistent dmft gradient across those categories. The severity of Early Childhood Caries (ECC) in young Ajman children is high, with dietary habits being important determinants. Cariogenic snack consumption can be represented using a summary exposure variable that appears to be valid. Young children in Ajman would benefit from health‐promotion strategies directed towards appropriate dietary practices.     

Journal Monitor

Journals reviewed in this article:
Journal of the American Academy of Child and Adolescent Psychiatry (1997, 1998) , p.36
Journal of Abnormal Child Psychology (1998) , p.37
Child Care Health and Development (1997) , p.37
Families, Systems and Health (1997) , p.39
Child Development (1997) , p.39     

氯沙坦配合加味六味地黄汤对老年糖尿病肾病早期尿微量白蛋白排泄率的影响

目的：探讨氯沙坦配合加味六味地黄汤对老年糖尿病肾病(DN)早期尿微量白蛋白排泄率(UAE)的影响。方法：62例随机分为治疗组和对照组，治疗组31例用氟沙坦、加味六味地黄汤；对照组31例用哌唑嗪。两组均用糖适平、维生素E、潘生丁。观察24hUAE、肾小球滤过率(GFR)、平均动脉压(MAP)的变化。结果：治疗组极显地减少老年DN的UAE．并明显优于对照组(P=0.000)。治疗组使肾小球高滤过恢复正常，并优于对照组(P=0．000)。两组治疗后MAP均降至正常。结论：氯沙坦配合加味六味地黄汤显减少老年DN的UAE。     

A Novel Resorbable Embolization Microsphere for Transient Uterine Artery Occlusion: A Comparative Study with Trisacryl-Gelatin Microspheres in the Sheep Model

PurposeTo evaluate angiographic recanalization, inflammatory reaction, and uterine damage after sheep uterine artery embolization (UAE) with a novel calibrated resorbable embolization microsphere (REM) and compare the results with control nonresorbable microspheres.Materials and MethodsSix hormonally artificially cycled sheep underwent bilateral UAE until stasis with either REM or trisacryl-gelatin microspheres (TGMS). At 7 days, control angiograms were obtained to assess the residual vascularization at arterial and parenchymal phases. The animals were then sacrificed for analysis of the presence of microspheres, inflammatory foreign body reaction, and surface areas of uterine damage.ResultsMean volume of microspheres injected per uterine artery (UA) or per animal did not differ between groups. At day 7, the flow was normal for six of six UAs that received embolization with REM versus only three of six UAs with TGMS (P = .0455, χ² test). Uterine parenchymography showed no defects in six UAs in the REM group versus five defects in six UAs in the TGMS group (P = .0060, χ² test). No REM or residual fragments of microspheres were observed on histologic analysis. TGMS were observed in tissues and accompanied by a mild inflammatory response. Necrosis rates were not significantly different between the two products, either in endometrium (REM 23.5% ± 28.8% [median 8.1%] vs TGMS 21.8% ± 23.7% [median 14.6%]) or in myometrium (REM 8.2% ± 22.7% [median 0.0%] vs TGMS 8.8% ± 20.8% [median 0.9%]). Endometrium alteration rate was lower with REM than with TGMS (39.7% ± 25.7% [median 34%] vs 60.6% ± 27.1% [median 71%]; P = .0060, Mann-Whitney test). Myometrium alteration rates were not significantly different between REM (45.7% ± 37.1% [median 63.0%]) and TGMS (37.8% ± 34.0% [median 19.1%]).ConclusionsAt 1 week after sheep UAE with REM, the recanalization was complete, the microspheres were completely degraded, and there was no remnant inflammatory response.     

Reproductive outcomes of cesarean scar pregnancies pretreated with methotrexate and uterine artery embolization prior to curettage

ObjectiveTo evaluate the reproductive outcomes of cesarean scar pregnancy (CSP) pretreated with methotrexate (MTX) and uterine artery embolization (UAE) prior to curettage.Materials and methodsThe medical records of patients with CSP who were pretreated with MTX and UAE prior to curettage in our institute from January 2013 to December 2015 were collected and retrospectively reviewed.ResultsA total of 53 patients were eligible for further analysis. Consecutive systemic MTX or a single dose of MTX was administered in 31 or 15 patients, respectively. The UAE procedure was uneventful, and no side effects occurred. The duration of the curettage operation was 21.4 ± 10.4 min, and the volume of blood loss was 23.5 ± 61.6 ml. The serum β-HCG level returned to normal 36.1 ± 10.1 days after the date of initial MTX administration. Eight of 10 patients with a desire to have children became pregnant naturally. Two (25%) patients developed recurrent CSP during the first trimester. One patient underwent emergency cesarean delivery and hysterectomy due to placental implantation and sudden massive hemorrhage during delivery. A total of 6 live newborns were delivered.ConclusionPretreatment with MTX and UAE prior to curettage is safe and effective for the management of CSP. The reproductive outcomes are encouraging.