BLOOD PRESSURE MANAGEMENT AND FACTORS AFFECTING ADHERENCE TO ANTIHYPERTENSIVE MEDICATIONS IN THE UNITED ARAB EMIRATES

Hypertension is a significant public health problem worldwide and is a major modifiable risk factor for cardiovascular disease. The dynamics of guidelines-recommended blood pressure (BP) control and adherence to antihypertensive medications in incident hypertensives remain unclear. This dissertation aims to assess guidelines-recommended BP management, adherence to antihypertensive medications, and factors associated with poor BP control among newly diagnosed hypertensive patients in the UAE. A retrospective chart review of 5308 newly treated hypertensives across the emirate of Abu Dhabi, UAE, in 2017 was conducted. These patients were diagnosed by the treating physician according to ambulatory (ABPM), or home-based BP monitoring (HBPM) was considered. After collecting data regarding basic details and BP measurements, patients were followed up for six months. Changes in the BP, adherence to antihypertensive treatment within the first six months of treatment initiation, and factors associated with achieving target BP and medication adherence were assessed. Patients who did not reach BP targets despite taking three or more antihypertensive medications were defined as treatment-resistant hypertension (TRH). The mean BP was 133.9 ± 72.9 mmHg at baseline and 132.7 ± 72.5 mmHg at six months. Among the sample, only 31.7% of the patients aged ≤40 years, 37.5% with a body-mass index (BMI) of ≥ 25 kg/m2, 45.4% smokers, and 37.5% patients with diabetes reached the BP target (\u3c130/80 mmHg). Patients with lower BMI and those treated in secondary care settings were more likely to achieve BP targets. The overall adherence to antihypertensive treatment was 42%. Male gender, secondary care settings, and diabetes were associated with adherence. Among 189 patients using three or more antihypertensive medications, only 34% (n =64) were adherent to the treatment, and only 13.7% (n =26) reached the BP target. The prevalence of TRH was 20.1%. To the best of our knowledge, this is the first work in the UAE to investigate longitudinal BP control and medication adherence in a large community cohort of patients with incident hypertension. The findings provide contemporary evidence on guidelines-recommended BP management and adherence to treatment among newly treated hypertensive patients. BP control and adherence to antihypertensive therapy were suboptimal in the UAE. Moreover, TRH in this population is relatively very high and requires urgent public health attention

Anisotropic Particles Strengthen Granular Pillars under Compression

We probe the effects of particle shape on the global and local behavior of a two-dimensional granular pillar, acting as a proxy for a disordered solid, under uniaxial compression. This geometry allows for direct measurement of global material response, as well as tracking of all individual particle trajectories. In general, drawing connections between local structure and local dynamics can be challenging in amorphous materials due to lower precision of atomic positions, so this study aims to elucidate such connections. We vary local interactions by using three different particle shapes: discrete circular grains (monomers), pairs of grains bonded together (dimers), and groups of three bonded in a triangle (trimers). We find that dimers substantially strengthen the pillar and the degree of this effect is determined by orientational order in the initial condition. In addition, while the three particle shapes form void regions at distinct rates, we find that anisotropies in the local amorphous structure remain robust through the definition of a metric that quantifies packing anisotropy. Finally, we highlight connections between local deformation rates and local structure.Comment: 15 pages, 15 figure

INAPPROPRIATE MEDICATION USE IN THE ELDERLY POPULATION ATTENDING GONDAR UNIVERSITY HOSPITAL: A PRELIMINARY ASSESSMENT

Objective: To assess the prevalence and associated factors of potentially inappropriate medications (PIMs) use in the elderly population attending Gondar University Hospital (GUH). Methods: A two years (2011-2012) retrospective cross sectional analysis was conducted in Gondar University Hospital (GUH). Elderly patients, aged ≥65 years treated with prescription drugs were included in the study. Updated Beers criteria (2012 version) independent of diagnosis was employed to determine the appropriateness of each medication prescribed and SPSS (version16.0) was used for data analysis. P-value < 0.05 was considered as significant association indicator between the variables. Results: A total sample of 1252 patients were used in the study, of whom 347(27.72%) were received at least one potentially inappropriate medication. The mean age of the participants was 71.15 ± 6.18. The most commonly used medications were immediate release nifedipine (53.89%), diclofenac (22.19%), ibuprofen (7.78%) and indomethacin (5.19%). PIM use and our variables were not associated with the prevalence of PIM use among the elderly. Conclusion: PIMs prescriptions for elderly population attending GUH are common with no association with any of our demographic or any other variables we set, which implies to work on improving the availability of updated medical information and knowledge for prescribers and to involve in careful monitoring and optimal use of drug regimens of elderly patients attending GUH

Prevalence of Polypharmacy and Risks of Potentially Inappropriate Medication Use in the Older Population in a Developing Country : A Systematic Review and Meta-Analysis

Research work of Assoc. Prof. D. Fialová has been supported by the project INOMED No. CZ.02.1.01/0.0/0.0/18_069/0010046, by the European Union’s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement no 764632, PROGRESS Q42 program (KSKF-2 scientific group), and SVV 260417Peer reviewedPublisher PD

Impact of Body Mass Index on the Development of Inflammatory Bowel Disease:A Systematic Review and Dose-Response Analysis of 15.6 Million Participants

Background: A growing trove of literature describes the effect of malnutrition and underweight on the incidence of inflammatory bowel disease (IBD). However, evidence regarding the association between underweight or obesity and IBD is limited. The study aimed to assess the association of body mass index (BMI) with a risk of IBD (Crohn’s disease (CD) and ulcerative colitis (U.C.)) incidence. Methods: We systematically searched PubMed/Medline, Cochrane, Web of Science, and Scopus for observational studies assessing the association between BMI and IBD that were published up to 30 June 2020. We estimated pooled hazard ratios (HR) with corresponding 95% confidence intervals (CI). Random effect dose-response meta-analysis was performed using the variance weighted least-squares regression (VWLS) models to identify non-linear associations. Results: A total of ten studies involving 15.6 million individuals and 23,371 cases of IBD were included. Overall, obesity was associated with an increased IBD risk (HR: 1.20, 95% CI: 1.08–1.34, I2 = 0%). Compared to normal weight, underweight (BMI < 18.5 kg/m2) and obesity (BMI ≥ 30 kg/m2) were associated with a higher risk of CD, and there was no difference in the risk of U.C. among those with BMI < 18.5 kg/m2 and BMI ≥ 30 kg/m2. There was a significant non-linear association between being underweight and obesity and the risk of development of CD (Coef1 = −0.0902, p1 < 0.001 Coef2 = 0.0713, p2 < 0.001). Conclusions: Obesity increases the risk of IBD development. Underweight and obesity are independently associated with an increased risk of CD, yet there is no evident association between BMI and the risk of U.C. Further studies are needed to clarify the underlying mechanism for these findings, particularly in CD

Knowledge and attitude towards HIV/AIDS in India:A systematic review and meta-analysis of 47 studies from 2010-2020

Background: Several studies assessed the level of knowledge and general public behavior on human immunodeficiency virus/acquired immuno-deficiency syndrome (HIV/AIDS) in India. However, comprehensive scrutiny of literature is essential for any decision-making process. Our objective was to perform a systematic review and meta-analysis to examine the level of knowledge and attitude towards HIV/AIDS in India. Methods: A systematic search using Medical Subject Headings (MeSH) and free terms was conducted in PubMed/Medline, Scopus, Embase, and Google Scholar databases to investigate the level of knowledge and attitude of HIV/AIDS in India population. Cross-sectional studies published in English from January 2010 to November 2020 were included. The identified articles were screened in multiple levels of title, abstract and full-text and final studies that met the inclusion criteria were retrieved and included in the study. The methodological quality was assessed using the Joanna Briggs Institute’s checklist for cross-sectional studies. Estimates with corresponding 95% confidence intervals (CIs) for each domain were pooled to examine the level of knowledge and attitude towards HIV/AIDS in India. Results: A total of 47 studies (n= 307 501) were identified, and 43 studies were included in the meta-analysis. The overall level of knowledge about HIV/AIDS was 75% (95% CI: 69-80%; I2 = 99.8%), and a higher level of knowledge was observed among female sex workers (FSWs) 89% (95% CI: 77-100%, I2 = 99.5%) than students (77%, 95% CI: 67-87%, I2 = 99.6%) and the general population (70%, 95% CI: 62-79%, I2 = 99.2%), respectively. However, HIV/AIDS attitude was suboptimal (60%, 95% CI: 51-69%, I2 = 99.2%). Students (58%, 95% CI: 38-77%, I2 = 99.7%), people living with HIV/AIDS (57%, 95% CI: 44-71%, I2 = 92.7%), the general population (71%, 95% CI: 62-80%, I2 = 94.5%), and healthcare workers (HCWs) (74%, 95% CI: 63-84%, I2 = 0.0%) had a positive attitude towards HIV/AIDS. The methodological quality of included studies was "moderate" according to Joanna Briggs Institute’s checklist. Funnel plots are asymmetry and the Egger’s regression test and Begg’s rank test identified risk of publication bias. Conclusion: The level of knowledge was 75%, and 40% had a negative attitude. This information would help formulate appropriate policies by various departments, ministries and educational institutions to incorporate in their training, capacity building and advocacy programs. Improving the knowledge and changing the attitudes among the Indian population remains crucial for the success of India’s HIV/AIDS response