Is More Nutrition Education Needed in the Undergraduate Medical Curriculum? : Perceptions of graduates from a medical university in the United Arab Emirates

Objectives: The rise in lifestyle diseases has resulted in primary physicians advising more patients on the benefits of nutritional modifications. However, nutrition education has remained more or less unchanged in the undergraduate medical curriculum. This study aimed to assess the perceptions of medical graduates regarding nutrition education in their undergraduate curriculum. Methods: A total of 125 medical graduates from the Gulf Medical University in Ajman, United Arab Emirates, were invited to participate in an anonymous online survey from May to October 2012. The validated pilot-tested questionnaire was designed to assess perceptions regarding nutrition education in the undergraduate medical curriculum. Results:A total of 65 medical graduates responded to the survey, of which 55% were female. Of the respondents, 32% were general physicians and 68% were specialists in various disciplines. Nutrition education was perceived to be very important by 80% of the respondents; however, 78.5% felt that they had not received adequate instruction in this field during their undergraduate medical curriculum. The major areas of deficit identified were in the categories of clinical nutrition, nutrition in primary care and evidence-based nutrition. Conclusion: In this study, Gulf Medical University graduates perceived a need for more nutrition-related instruction in their undergraduate medical curriculum. The areas of deficit identified in this study could help in future curricular improvements.Keywords:

The future physicians of United Arab Emirates: how do they self-medicate?

Background: Health professions have been a predictive factor for self-medication (SM). SM practices of medical students, the future practitioners will have a bearing on their impending professional practice. The aims were to identify prevalence and practice of SM among the medical students of Gulf Medical University (GMU), United Arab Emirates and to assess the associating factors.Methods: The study was planned as a cross-sectional descriptive survey among 247 medical students of GMU. Students from 1st to 5th year were included in the study. Data were analyzed using SPSS version 19. Associations were tested with Chi-square test.Results: SM with both over-the-counter medications and prescription-only medicines was practiced by 65% of students. The prevalence of SM was associated with the year of study and age. The most common sources of drugs were private pharmacies and stocks at home. The students mostly relied on themselves and parents for drug selection. The self-reliance significantly increased with year of study. Common indications for SM were headache and flu symptoms and correspondingly, analgesics and antipyretics were frequently used. A high prevalence of misuse of antibiotics was also reported. SM was 2.9 times higher (95% CI=1.502-5.620) among students belonging to families practicing SM.Conclusion: The study revealed a fairly high rate of prevalence of SM among the medical students of GMU, which was associated with age and year of study. There is a need to emphasize responsible SM practices among the medical students by accentuating rational drug use in the curricula

Diabetes Mellitus-Related Knowledge among University Students in Ajman, United Arab Emirates

The aim of this study was to assess diabetes mellitus (DM)-related knowledge and practices among university students enrolled in non-health care related professional courses in the United Arab Emirates. Methods: A pre-tested questionnaire assessing the knowledge of DM was administered to the above-mentioned students. Data collected were transferred to PASW Statistics (Chicago, IL, USA, Version 18) and analysed. Results: Data on 168 university students (47 males and 121 females) were included in the analysis. Of the participants, 25% were overweight or obese and only 27% exercised regularly. Regarding their knowledge of DM, 70% knew that it is characterised by high blood sugar levels and identified family history as a major risk factor. Surprisingly, only just over half could link obesity and physical inactivity as risk factors for developing DM, or could identify an excessive feeling of thirst, frequent urination, and weight loss as symptoms. Knowledge of the complications of diabetes, including gangrene, loss of sensation in limbs, oral and dental complications, recurrent infections, and risk for cardiovascular disease got a moderate response. Knowledge of diabetes was found to be higher in females compared to males. No significant differences were observed in the health behaviour of participants with or without a family history of DM. Conclusion: Our study revealed that in spite of exposure to various sources of information, the participants’ level of DM-related knowledge was not adequate. We recommend the engagement of health professionals in educational settings in order to enhance health-related knowledge and inculcate healthy lifestyle practices in students.

Factors associated with self-medication among expatriate high school students: a cross-sectional survey in United Arab Emirates

The study aimed to assess factors associated with self-medication (SM) among expatriate high school students of United Arab Emirates using a validated questionnaire. Most common reasons for self-medication in 324 participating students were: presence of mild illness and previous experiences. High risk practices like altering the dose, discontinuation of medication and self-medication without adult guidance were observed. The likelihood of SM was 4.9 times (95%C.I.: 2.0-12.2) in students not utilizing private healthcare services than those who were utilizing these services. Increased efforts are needed to prevent the risks of self-medication in adolescents through healthcare education for both parents and adolescents

The bitter side of epigenetics: variability and resistance to chemotherapy

One of the major obstacles to the development of effective new cancer treatments and the main factor for the increasing number of clinical trial failures appears to be the paucity of accurate, reproducible and robust drug resistance testing methods. Most research assessing the resistance of cancers to chemotherapy has concentrated on genetic-based molecular mechanisms, while the role of epigenetics in drug resistance has been generally overlooked. This is rather surprising given that an increasing body of evidence pointing to the fact that epigenetic mechanism alterations appear to play a pivotal role in cancer initiation, progression and development of chemoresistance. This resulted in a series of clinical trials involving epi-drug as single treatment or combined with cancer conventional drugs. In this review, we provided the main mechanisms by which the epigenetic regulators control the resistance to cancer drugs

Arginine deprivation alters microglial polarity and synergizes with radiation to eradicate non-arginine-auxotrophic glioblastoma tumors

New approaches for the management of glioblastoma (GBM) are an urgent and unmet clinical need. Here, we illustrate that the efficacy of radiotherapy for GBM is strikingly potentiated by concomitant therapy with the arginine-depleting agent ADI-PEG20 in a non-arginine-auxotrophic cellular background (argininosuccinate synthetase 1 positive). Moreover, this combination led to durable and complete radiological and pathological response, with extended disease-free survival in an orthotopic immune-competent model of GBM, with no significant toxicity. ADI-PEG20 not only enhanced the cellular sensitivity of argininosuccinate synthetase 1–positive GBM to ionizing radiation by elevated production of nitric oxide (˙NO) and hence generation of cytotoxic peroxynitrites, but also promoted glioma-associated macrophage/microglial infiltration into tumors and turned their classical antiinflammatory (protumor) phenotype into a proinflammatory (antitumor) phenotype. Our results provide an effective, well-tolerated, and simple strategy to improve GBM treatment that merits consideration for early evaluation in clinical trials.Fondo de Desarrollo Regional (FEDER). Programa Operativo Epiro 2014-2020National Strategic Reference Frameworks de la Unión Europea. NSRF 2014-2020-5033092Ministerio de Ciencia, Innovación y Universidades de España y fondos FEDER. RTI2018-098645-B-100Consejería de Economía y Conocimiento de la Junta de Andalucía y fondos FEDER. P18- RT-1372Universidad de Sevilla. US-126480

A Phase I Study of Pegylated Arginine Deiminase (Pegargiminase), Cisplatin, and Pemetrexed in Argininosuccinate Synthetase 1-Deficient Recurrent High-grade Glioma.

PURPOSE: Patients with recurrent high-grade gliomas (HGG) are usually managed with alkylating chemotherapy ± bevacizumab. However, prognosis remains very poor. Preclinically, we showed that HGGs are a target for arginine depletion with pegargiminase (ADI-PEG20) due to epimutations of argininosuccinate synthetase (ASS1) and/or argininosuccinate lyase (ASL). Moreover, ADI-PEG20 disrupts pyrimidine pools in ASS1-deficient HGGs, thereby impacting sensitivity to the antifolate, pemetrexed. PATIENTS AND METHODS: We expanded a phase I trial of ADI-PEG20 with pemetrexed and cisplatin (ADIPEMCIS) to patients with ASS1-deficient recurrent HGGs (NCT02029690). Patients were enrolled (01/16-06/17) to receive weekly ADI-PEG20 36 mg/m2 intramuscularly plus pemetrexed 500 mg/m2 and cisplatin 75 mg/m2 intravenously once every 3 weeks for up to 6 cycles. Patients with disease control were allowed ADI-PEG20 maintenance. The primary endpoints were safety, tolerability, and preliminary estimates of efficacy. RESULTS: Ten ASS1-deficient heavily pretreated patients were treated with ADIPEMCIS therapy. Treatment was well tolerated with the majority of adverse events being Common Terminology Criteria for Adverse Events v4.03 grade 1-2. The best overall response was stable disease in 8 patients (80%). Plasma arginine was suppressed significantly below baseline with a reciprocal increase in citrulline during the sampling period. The anti-ADI-PEG20 antibody titer rose during the first 4 weeks of treatment before reaching a plateau. Median progression-free survival (PFS) was 5.2 months (95% confidence interval (CI), 2.5-20.8) and overall survival was 6.3 months (95% CI, 1.8-9.7). CONCLUSIONS: In this recurrent HGG study, ADIPEMCIS was well tolerated and compares favorably to historical controls. Additional trials of ADI-PEG20 in HGG are planned

The Renin Angiotensin System (RAS) mediates bifunctional growth regulation in melanoma and is a novel target for therapeutic intervention

Despite emergence of new systemic therapies, metastatic melanoma remains a challenging and often fatal form of skin cancer. The renin–angiotensin system (RAS) is a major physiological regulatory pathway controlling salt–water equilibrium, intravascular volume and blood pressure. Biological effects of the RAS are mediated by the vasoactive hormone angiotensin II (AngII) via two receptor subtypes, AT1R (encoded by AGTR1) and AT2R (encoded by AGTR2). We report decreasing expression and increasing CpG island methylation of AGTR1 in metastatic versus primary melanoma and detection in serum of methylated genomic DNA from the AGTR1 CpG island in metastatic melanoma implying that AGTR1 encodes a tumour suppressor function in melanoma. Consistent with this hypothesis, antagonism of AT1R using losartan or shRNA-mediated knockdown in melanoma cell lines expressing AGTR1 resulted in acquisition of the ability to proliferate in serum-free conditions. Conversely, ectopic expression of AGTR1 in cell lines lacking endogenous expression inhibits proliferation irrespective of the presence of AngII implying a ligand-independent suppressor function for AT1R. Treatment of melanoma cell lines expressing endogenous AT2R with either AngII or the AT2R-selective agonist Y6AII induces proliferation in serum-free conditions whereas the AT2R-specific antagonists PD123319 and EMA401 inhibit melanoma growth and angiogenesis and potentiate inhibitors of BRAF and MEK in cells with BRAF V600 mutations. Our results demonstrate that the RAS has both oncogenic and tumour suppressor functions in melanoma. Pharmacological inhibition of AT2R may provide therapeutic opportunities in melanomas expressing this receptor and AGTR1 CpG island methylation in serum may serve as a novel biomarker of metastatic melanoma

The collagen prolyl hydroxylases are bifunctional growth regulators in melanoma

Appropriate post-translational processing of collagen requires prolyl hydroxylation, catalyzed by the prolyl 3- (C-P3H) and prolyl 4- (C-P4H) hydroxylases is essential for normal cell function. Here we have investigated the expression, transcriptional regulation and function of the C-P3H and C-P4H families in melanoma. We show that the CP3H family exemplified by Leprel1 and Leprel2 are subject to methylation-dependent transcriptional silencing in primary and metastatic melanoma consistent with a tumour suppressor function. In contrast, although there is transcriptional silencing of P4HA3 in a sub-set of melanomas, the CP4H family members P4HA1, P4HA2 and P4HA3 are often over-expressed in melanoma, expression being prognostic of worse clinical outcomes. Consistent with tumour suppressor function, ectopic expression of Leprel1 and Leprel2 inhibits melanoma proliferation, whereas P4HA2 and P4HA3 increase proliferation and particularly invasiveness of melanoma cells. Pharmacological inhibition with multiple selective C-P4H inhibitors reduces proliferation and inhibits invasiveness of melanoma cells. Together, our data identify the C-P3H and C-P4H families as potentially important regulators of melanoma growth and invasiveness and suggest that selective inhibition of C-P4H is an attractive strategy to reduce the invasive properties of melanoma cells