Molecular Subtyping of Blastocystis from Diverse Animals in the United Arab Emirates

The contribution of Blastocystis from non-human hosts to zoonotic transmission is only partly known. The objective of this study was to determine the distribution of Blastocystis genetic subtypes in different animal species in United Arab Emirates. A total of 114 stool samples were tested using PCR of the small subunit (SSU) rRNA gene and sequence analysis. Twenty-three Blastocystis-positive samples were identified. The following detection rates were observed: cattle, 22.7%; sheep, 63.6%; rabbits, 33.3%; rodents, 37.5%; reptiles, 21.2%. Four subtypes were identified in this study; ST4, ST10, ST14, and ST17; ST10 was isolated from sheep and cattle, corroborating previous data indicating that these are natural hosts for this subtype. Cases of mixed subtype colonization were also detected. Conspicuously, we found ST14 in rabbits. The discovery of ST17 in a squirrel indicates a novel host for this subtype. Furthermore, the discovery of ST4 in rodents suggests that these may serve as reservoir for human Blastocystis ST4 colonization. Six tortoises and one iguana were positive for Blastocystis. In conclusion, this is the first report of Blastocystis infection in various animals in the UAE. Apart from ST4, no potentially zoonotic subtypes were detected.

Prevalence, Characteristics, and In-Hospital Outcomes of Metabolic Syndrome among Patients with Acute Coronary Syndrome in the United Arab Emirates

Objective:

To evaluate clinical profiles, management and in-hospital outcomes of acute coronary syndrome (ACS) patients with metabolic syndrome (MetS) in the United Arab Emirates (UAE).

Methods:

MetS was defined according to the criteria for its diagnosis by the International Diabetes Federation (IDF) and the American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI). Participants were admitted to various hospitals in the UAE with a diagnosis of ACS in 2007 as part of the Gulf Registry of Acute Coronary Events (Gulf RACE) project. We compared baseline characteristics, treatment patterns, and in-hospital outcomes stratified by MetS status.

Results:

Of 1259 patients with ACS in the UAE (mean age: 52 ± 11 years, 88.8% males), the majority (n = 851, 67.6%) had MetS. MetS patients were more frequently males (86.4 vs 13.6%; P < 0.001). They were more obese (waist circumference and BMI, P < 0.001) as compared with non-MetS patients. MetS was more frequently associated with hypertension (51.1 vs 37.7%; P < 0.001) and diabetes mellitus (45.6 vs 24.3%; P < 0.001). After multivariate adjustment, certain MetS criteria rather than MetS itself were associated with higher in-hospital mortality and heart failure. Paradoxically, hypertension was associated with lower in-hospital mortality.

Conclusions:

Prevalence of MetS among patients with ACS in our study population was high. Certain MetS criteria were associated with higher in-hospital mortality and heart failure.

A prospective study on the use of warfarin in the United arab emirates

OBJECTIVES

The aims of this study were to evaluate adherence of patients and medical staff to warfarin guidelines and assess clinical outcome and predictors of treatment failure.

METHODS

This cross-sectional survey involved out- and in-patient subjects receiving warfarin. Patient attentiveness, compliance, co-morbidities, complications, and international normalized ratio (INR) as well as adherence of medical staff to established warfarin treatment guidelines were recorded.

RESULTS

One-hundred-sixty patients were recruited (mean ± SD age = 54 ± 1.3 years; 46% males; 77% overweight/obese). Indications for warfarin were atrial fibrillation (35%), deep vein thrombosis (28%), prosthetic heart valve (20%) and stroke or dilated cardiomyopathy (12%). "Warfarin booklets" were made available to 25% of the patients, and ~80% of the recipients reported inadequate understanding of its content. INR was strictly monitored in 23% of the patients; ~70% never received Information Leaflets; ~88% were unaware of warning labels; and ~58% were unaware that over-thecounter medications may affect warfarin. Therapeutic INR (2.9 ± 0.2; 76 days) was achieved in 73%; 20% had high INR (3.7 ± 0.1; 18.6 days) and 7% had low INR (1.6 ± 0.1; 16.7 days). Of the patients with high INR, 2.5% had major bleeding events. Of the patients with low INR, 5% had thromboembolic events. Poor compliance and co-morbidities were associated with adverse events (p=0.01).

CONCLUSIONS

Attentiveness and adherence to warfarin treatment and monitoring guidelines are suboptimal among patients and medical staff. Novel strategies are necessary to alert patients, pharmacists and physicians on the seriousness of warfarin treatment failure.