Introduction: Hypertension and obesity are key risk factors for long-term complications associated with type 2 diabetes mellitus (type 2 DM). Previous studies have shown that the prevalence of hypertension and obesity is high in the United Arab of Emirates (UAE). However, none of these studies has focused on the investigation of hypertension and obesity in Emirati patients with type 2 DM. Methodology:The present study is a retrospective observational study which was conducted in Rashid Centre for Diabetes and Research (Ajman, UAE). Medical records for 510 diabetic Emirati patients were examined and 51 medical records were excluded due to incomplete or missing medical data. 459 medical records of Emirati patients with type 2 DM were filtered, examined and analyzed and the following variables were included in the investigation: anthropometric variables, diabetes type and duration, BMI, HbA1c, blood pressure and lipid profile. Results and conclusions:Findings of the present study have demonstrated that the prevalence of hypertension and obesity in Emirati patients with type 2 DM were 63% and 57%, respectively. Compared to non-hypertensive patients, hypertensive patients with type 2 DM were older and had higher levels of HbA1C and about 60% of the hypertensive patients were obese. A strong positive relationship between the systolic blood pressure, and age and diabetes duration was observed whereas the diastolic blood pressure was negatively correlated with age and diabetes duration. The prevalence of hypertension and obesity among Emirati patients with type 2 DM was significantly high. Age and diabetes duration have opposite effects on systolic and diastolic blood pressure.

Background Therapeutic drug monitoring, the measurement of serum biologic concentrations and immunogenicity, has become an important method in guiding the management of biologic therapy in patients with Crohn’s disease (CD). Ustekinumab, an inhibitor of the p40 subunit of interleukins 12 and 23, is an approved therapy for patients with CD. However, few studies have explored the relationship between serum ustekinumab drug levels and outcomes in CD. Thus, the utility of serum ustekinumab drug levels in the management of CD remains unknown. The primary objective of the study was to evaluate the association between serum ustekinumab drug levels and endoscopic remission (ER) in CD. Secondary outcomes included evaluating the association between serum ustekinumab drug levels and clinical (CR), biochemical, and histological remission (HR). Methods Adult patients with CD maintained on ustekinumab were prospectively recruited at the time of routine colonoscopy from 2019 to 2021 at the Montreal University Health Centre, Montreal, Quebec. Clinical and demographic information was obtained from chart and patient review. CD symptom severity was assessed by the Harvey-Bradshaw Index (HBI), with clinical remission defined as an HBI score less than 5. Blood samples were drawn for measurement of serum ustekinumab drug level and C-reactive protein. Stool samples for fecal calprotectin were also collected. Elevated C-reactive protein and fecal calprotectin were defined as a value greater than 5 mg/L and 200 ug/g, respectively. Endoscopic remission was evaluated by the Simplified Endoscopic Score for Crohn’s Disease (SES-CD), with ER defined by an SES-CD score less than 3. If biopsies were taken, histological outcomes were recorded. HR was defined as inactive colitis. Results 53 patients were included in the study, of which 22 (41.5%) were in ER. Median [interquartile range] ustekinumab drug levels were not associated with ER (Figure 1. ER = 5.4 mg/L [2.6–9.4 mg/L], no ER = 4.3 mg/L [2.3–9.4 mg/L]; P=0.843). There was also no association between quartiles of ustekinumab drug levels and ER (P=0.772). In addition, there was no association observed between median ustekinumab drug level and CR (CR = 4.7 mg/L [2.7–8.3 mg/L], no CR = 3.8 mg/L [2.1–9.6 mg/L]; P=0.993) or HR (HR = 6.4 mg/L [3.5–9.5 mg/L], no HR = 3.7 mg/L [2.2–8.0 mg/L]); P=0.168). There was no association observed between median ustekinumab drug level and C-reactive protein or fecal calprotectin as well (P=0.158 and 0.923, respectively). Conclusion There was no association observed between serum ustekinumab drug levels and endoscopic remission. Further studies are required to validate our findings.

A sinus of Valsalva aneurysm (SOVA) is a rare cardiac defect in which the aortic root area between the aortic annulus and the sinotubular junction is dilated. We present a case of acute liver failure (ALF) in a 21-year-old man secondary to ruptured SOVA inducing severe ischemic hepatitis. The patient presented clinically with classical ALF. The liver ultrasound reported hepatomegaly with pulsatile portal flow and dilated hepatic veins. A transthoracic echocardiogram revealed focal aneurysmal dilatation of the aortic root with flow across the aneurysm toward the right atrium and elevated right chambers pressures. The surgical repair of the non-coronary SOVA was successful, and post-operatively, liver transaminases improved, and ALF resolved. Given that ruptured SOVA can be surgically repaired, hepatologists should be aware of this diagnosis in a young patient with ALF.

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