Publications by authors named "Mahera Abdulrahman"

33 Publications

Intravenous methylprednisolone with or without tocilizumab in patients with severe COVID-19 pneumonia requiring oxygen support: A prospective comparison.

J Infect Public Health 2021 Aug 10;14(8):985-989. Epub 2021 Jun 10.

Health Regulation Sector, Dubai Health Authority, United Arab Emirates. Electronic address:

Background: Cytokine storm is a marker of severity and severe mortality in patients with coronavirus disease 2019 (COVID-19) pneumonia. Immunomodulatory treatments may reduce morbidity and mortality.

Objectives: To determine whether a 7-day course of methylprednisolone (MP) administered with and without tocilizumab improves outcomes in patients with severe COVID-19 (SARS-CoV-2) pneumonia requiring oxygen therapy, relative to historical controls.

Study Design And Method: In this randomized controlled study, patients hospitalized with severe COVID-19 at Rashid Hospital, Dubai, in June 2020 were randomized 1:1 to receive intravenous MP (40 mg twice daily for 7 days) with or without a single dose of intravenous tocilizumab (400 mg). While data from the control arm, consisting of patients administered usual care, were obtained through retrospective review of their electronic medical records. The patients in the three arms were matched by disease severity and inclusion and exclusion criteria. The primary outcomes were day 45 all-cause mortality after randomization, rate of admission to the intensive care unit (ICU), length of ICU stay, days on ventilators, and length of hospital stay.

Results: In total, 76 patients were recruited, including 23 treated with MP, 26 with MP plus tocilizumab, and 27 historical controls. The rates of admission to the ICU and invasive mechanical ventilation were lowest in patients treated with MP alone, with the rates in this group being significantly lower than the rates in the control group (p = 0.04). Time on a ventilator was lowest in the MP group (1.09 ± 3.68 days) and highest in the control group (7.93 ± 14.86 days). The number of days in the ICU was significantly lower in the MP group than in the control and MP plus tocilizumab groups (p = 0.043). One patient (4.3%) in the MP group and five (18.5%) in the control arm died within 45 days. Survival was highest in patients treated with MP alone, with the addition of tocilizumab not improving survival or any of the other outcomes significantly.

Interpretation/conclusion: In patients with severe COVID-19 pneumonia on oxygen support, administration of MP daily for 7 days had reduced mortality at 45 days and was associated with significantly lower ICU admission and ventilation rates compared with usual. Adding tocilizumab to MP did not improve any of the studied outcomes significantly.
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http://dx.doi.org/10.1016/j.jiph.2021.06.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8191304PMC
August 2021

Large variations in disease severity, death and ICU admission of 2993 patients infected with SARS-CoV-2: The potential impact of genetic vulnerability.

J Infect Public Health 2021 Jul 22;14(7):886-891. Epub 2021 Apr 22.

Health Informatics and Smart Health Department, Health Regulation Sector, Dubai Health Authority, Dubai, United Arab Emirates. Electronic address:

Background: The COVID-19 pandemic has had an immeasurable impact, affecting healthcare systems, the global economy, and society. Exploration of trends within the existing COVID-19 data may guide directions for further study and novel treatment development. As the world faces COVID-19 disease, it is essential to study its epidemiological and clinical characteristics further to better understand and aid in its detection and containment.

Methods: We aimed to study the clinical characteristics of patients infected with COVID-19 in Dubai, a multi-national Society.

Results: Our findings demonstrate that during the first wave of the COVID-19 epidemic, age, gender, and country of origin were associated with more severe cases of COVID-19, higher risk for hospitalization and death. Male individuals between 41 and 60 years of age from India had the most significant hospitalization and death predictor (p=.0001). The predictors for COVID-19 related deaths were slightly less than UAE Nationals by individuals from GCC (p=.02) that were followed closely behind by Pilipino (p=.02) and Arabs (p=.001).

Conclusion: The vulnerability of individuals to infection and in the spectrum of COVID-19 symptoms remains to be understood. There are large variations in disease severity, one component of which may be genetic variability in responding to the virus. Genomics of susceptibility to COVID-19 infection and the wide variation in clinical response to COVID-19 in patients should become active investigation areas.
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http://dx.doi.org/10.1016/j.jiph.2021.04.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8061633PMC
July 2021

Women's knowledge and awareness on menopause symptoms and its treatment options remains inadequate: a report from the United Arab Emirates.

Menopause 2021 May 10. Epub 2021 May 10.

Department of Public Health, Dubai Medical College, Dubai, United Arab Emirates University of Central Florida College of Medicine, Orlando, FL MGH Institute for Health Professions, Boston, MA Centre for Mental Health Research in association with University of Cambridge, Cambridge, UK Health Informatics and Smart Health Department, Health Regulation Sector, Dubai Health Authority, Dubai, United Arab Emirates.

Objectives: We aimed to evaluate the awareness, knowledge, and perception of middle-aged women regarding menopause and hormone therapy (HT).

Methods: This observational study was conducted on pre-, peri-, post-, and surgically menopausal women (n = 591) from January 2020 until June 2020 in Dubai. A structured questionnaire was developed based on previous literature to assess participants' knowledge and awareness of menopause and HT. The questionnaire was implemented by face-to-face interview. Factors associated with the degree of menopausal knowledge were identified.

Results: Majority (498, 82%) of participant women had fair to poor overall knowledge on menopause, did not know whom HT is used for (404, 48%), and for whom it is contradicted (455, 77%). Knowledge on menopause and HT was highly associated with better attitudes (P < 0.001 and P < 0.001, respectively).Furthermore, the greater the knowledge on menopause, the better the knowledge of HT (P < 0.001). Education was the primary factor that played a significant role in having better knowledge or attitudes. Nationality showed an association with better attitudes on menopause, with non-Arabs having better attitudes than Arabs and UAE nationals.

Conclusions: Community medicine educators and primary healthcare providers need to prepare tailored premenopausal and postmenopausal educational interventional programs for further educating women and preparing them for this phase of their lives.
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http://dx.doi.org/10.1097/GME.0000000000001783DOI Listing
May 2021

Barriers to healthcare seeking, beliefs about ovarian cancer and the role of socio-economic position. A cross-sectional multilevel study in Dubai, a multicultural society.

J Public Health Res 2021 Mar 24. Epub 2021 Mar 24.

Department of Public Health, Dubai Medical College, Dubai.

Background: Studies have shown that public awareness of ovarian cancer is weak, and women are often diagnosed at late stages when treatment is difficult.

Design And Methods: To determine the barriers for seeking early medical care and level of knowledge and awareness among women regarding ovarian cancer. A structured questionnaire was designed and adapted from the validated cancer awareness measure.

Results: The recognition level of ovarian cancer symptoms among women in this study varied from 12-51%, and the most alarming ones, back pain, eating difficulties, and persistent abdominal pain, were missed by most of the surveyed women. The most recognized ovarian cancer risk factors were never being pregnant, having a history of infertility, and going through menopause, while the least recognized was having personal or family history of breast cancer. Non-UAE nationals' women with higher educational levels had better knowledge of ovarian cancer compared to their peers.

Conclusions: A change or implementation model is highly recommended in order to improve women's awareness of ovarian cancer symptoms. Strengthening education among women with regards to risk factors, early symptoms, and the need to seek early medical help should help to increase ovarian cancer awareness and reduce a delay in the diagnosis.
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http://dx.doi.org/10.4081/jphr.2021.2073DOI Listing
March 2021

A review of gestational diabetes mellitus management, risk factors, maternal and neonatal outcomes in two major maternity hospitals in the United Arab Emirates: A report from Dubai.

J Neonatal Perinatal Med 2020 ;13(4):555-562

University of Central Florida College of Medicine, Orlando, FL USA.

Objectives: This study was conducted in order to explore and analyze the status of gestational diabetes (GDM) amongst pregnant women in Dubai, United Arab Emirates (UAE); a country with high prevalence of diabetes. We aimed to describe GDM-associated risk factors and clinical outcomes of pregnant women and their neonates. Our objective was to contribute to the broader literature on reproductive health disparities and to inform efforts to improve GDM care at our region.

Methods: Chart review of case records were used to collect data on both maternal and neonatal parameters and outcomes during the specified study period from two main maternity hospitals in Dubai.

Results: UAE national women with GDM were more prone to be obese or overweight compared to non-UAE women (p < 0.0001, and p < 0.0001 respectively). In addition, UAE national women with GDM had higher history of GDM in previous pregnancies (p < 0.0001) and more family history of diabetes (p < 0.0001).The neonate admission into NICU was significantly associated with cesarean section (p < 0.0001), twins (p < 0.0001), preeclampsia (p = 0.02), receiving MgSO4 (p = 0.02), birth weight less than 2500 g (p < 0.0001), low Apgar scores (p < 0.0001), baby with congenital anomaly (p < 0.0001), and neonatal hypoglycemia (p < 0.0001).

Conclusions: Our results demonstrate that pregnant women with GDM who are UAE nationals and have higher parity need to be under special attention during their pregnancy in order to improve both maternal and neonatal outcomes.
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http://dx.doi.org/10.3233/NPM-200410DOI Listing
January 2020

Association between knowledge, awareness, and practice of patients with type 2 diabetes with socio-economic status, adherence to medication and disease complications.

Diabetes Res Clin Pract 2020 May 4;163:108124. Epub 2020 Apr 4.

Centre for Mental Health Research in association with University of Cambridge, Cambridge, UK; University of Central Florida College of Medicine, Orlando, FL USA; MGH Institute for Health Professions, Boston, MA, USA.

Aims: Diabetes is a self-managed condition; knowledge, attitudes, and practices about the condition can influence the overall treatment outcomes and complications of the disease. The aim of this study was to assess the knowledge, attitude, and practice toward diabetes among T2DM patients in the UAE, a highly prevalent country with diabetes.

Methods: We used the revised Michigan Diabetes Knowledge Scale on T2DM patients. The awareness on diabetes was then assessed based on socio-demographic characteristics, illness perceptions, medication adherence, diabetic self-care, and T2DM complications.

Results: Overall assessment of T2DM patients on their knowledge, and attitude toward their diabetes were good in the majority of participants (544, 76%; 570, 76% respectively). However, adherence to diabetic self-care practices was fair in the mainstream (437, 57%). The compliance to medication (527, 70%) and eye care practice (475, 63%), were quite high; yet regular checking blood sugar at home 330 (44%) and the foot care practice 336 (45%) were not satisfying.

Conclusion: Our results demonstrate that the intensive education service being given and time the physician spends with the T2DM patients is highly associated with better practice and outcome of the disease. There is a need for the establishment of better DM education programs in PHC clinics and the development of more campaigns and enlightening programs, both for health care providers and public on T2DM self-care, complications, and nature of the disease. We suggest that new policies be established with a focus on increasing community awareness of diabetes and preventive measures in UAE.
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http://dx.doi.org/10.1016/j.diabres.2020.108124DOI Listing
May 2020

Perceived Academic and Psychological Stress among Adolescents in United Arab Emirates: Role of gender, age, depression, and high expectation of parents.

Psychiatr Danub 2019 Sep;31(Suppl 3):331-337

Department of Public Health, Dubai Medical College, Dubai, United Arab Emirates.

Introduction: Academic learning is the most important source of stress among young students worldwide and appears to be quite severe in eastern countries. We aimed to examine the relationship between academic stress and depression among adolescents.

Methods: A cross-sectional study was conducted among adolescents in United Arab Emirates using the Perceived Stress Scale - 14 (PSS-14) and Educational Stress Scale (ESS) for Adolescents (English and Arabic versions).

Results: The overall PSS was high in 186 (20%) of the respondents, and moderate in 695 (76%). A multiple regression model of predictors of the PSS showed statistically significant correlations between the total PSS-14 scores and age (p<0.0004), gender (p<0.0001), and grade (p<0.001). A multiple regression model of the PSS-14 questionnaire as predictors of the ESSA revealed that Four variables on PSS-14 were statistically significant predictors of the ESSA: history of depression (p<0.0001), content with academic achievement (p<0.0001), high academic expectation of parents (p<0.003), and a believe capable of meeting parental expectations (p<0.0001).

Conclusions: Adolescents with severe academic stress need to be identified early. We suggest that an interdisciplinary team in the schools including student advisors and counselors be developed to further address stressors. In addition, students should be taught different stress management techniques such as cognitive behavioral skills to improve their ability to cope with school demands. The identification of stressors may lead to strategies that might address the quality of teaching and mental health evaluation among adolescents.
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September 2019

Pattern and determinants of contraceptive usage among women of reproductive age in the United Arab Emirates.

J Family Med Prim Care 2019 Jun;8(6):1931-1940

Bedfordshire Centre for Mental Health Research in Association with University of Cambridge, Cambridge, UK.

Introduction: Women in the UAE and Muslim countries are a largely understudied population with significant disparities in knowledge to most basic health concerns and family planning. Our objective was to identify UAE contraceptive knowledge similarities and variances to other world regions, and to inform efforts to improve contraceptive care at Arab world and Muslim countries.

Methods: Structured questionnaire consisting of socio-demographic characteristics, knowledge, beliefs and attitudes related to contraception methods.

Results: The use of effective contraception methods was associated with higher educational levels of UAE national women who desired to conceive. These women had knowledge of contraception that was associated with an identified impact of their spouse on their choice of contraception. Religion plays an essential role in knowledge on the risk of contraception and safe type of contraceptive methods in the UAE. Statistically significant predictors of having knowledge on different methods of contraception were nationality, < 0.002; education level, < 0.03; number of marriages < 0.002; monthly income, < 0.04; and the number of children, < 0.015.

Conclusions: Our results demonstrate that higher education and communication of the benefits and risks of different types of contraceptive methods are needed to improve the use of contraception in the UAE population. We recommend additional training in this area for healthcare providers. The involvement of the spouse in the mutual understanding of contraception and its choice coupled with third party insurance coverage may decrease knowledge and utilization gaps further assisting in providing a best contraceptive method.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_390_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6618233PMC
June 2019

Prevalence of Undiagnosed Depression in Patients With Type 2 Diabetes.

Front Endocrinol (Lausanne) 2019 3;10:259. Epub 2019 May 3.

Dubai Health Authority, Dubai, United Arab Emirates.

Type 2 Diabetes Mellitus (T2DM) is the most prevalent type of diabetes among adults and constitutes around 90% of all cases. Substantial evidence demonstrates that depression in the context of diabetes is associated with a wide range of adverse consequences such as reduced adherence to the prescribed treatment regimen, lower quality of life, higher fasting glucose and HbA1c levels, and higher health expenditures. This study was conducted to assess the depression among T2DM patients attending diabetic clinics, primary healthcare centers (PHC), Dubai Health Authority (DHA). Depressive symptoms were assessed by using both Arabic and English version of the Beck Depression Inventory. Out of 1,050 diabetic patients approached, 559 were within our inclusion criteria and agreed to participate in this study (Response rate of 53%). The mainstream of the participants had T2DM for <10 years (393, 70%), were under oral hypoglycemic treatment only (479, 86%), and had good medication adherence (526, 94%). The overall depression prevalence using a cutoff of 16 was 17%. When we assessed the level of depression amongst participants in association with their sociodemographic and clinical characteristics, there was a significant difference between age groups ( < 0.00001); gender ( < 0.0001); nationality ( < 0.00001); educational level ( < 0.00001); and employment status ( < 0.0001). The type of clinic in which the T2DM patients were attending (e.g., diabetes mini-clinic vs. General Family Clinic) was also significantly associated with depression ( < 0.0001). Our results demonstrate that the intensive service being given in a diabetes mini-clinic compared to routine PHC clinics appears to benefit the psychological aspects of T2DM patients in the UAE population resulting in a lower incidence of depression than commonly seen in a diabetic population. We have identified a need for the establishment of these mini-clinics in each PHC clinics; and the development of campaigns and educational programs, both for health care providers and the public to decrease depression in T2DM patients in this region.
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http://dx.doi.org/10.3389/fendo.2019.00259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6509230PMC
May 2019

Implementing Resident Research Program to Enhance Physicians Research in the United Arab Emirates.

Int J Appl Basic Med Res 2019 Apr-Jun;9(2):75-79

Department of Neurology, Carrick Institute, Cape Canaveral, FL, USA.

Objectives: The Dubai Residency Training Program (DRTP) commenced in the year 1993; then, a "Residency Research Program (RRP)" has implemented from 2011 to promote research among young physicians. This study was conducted by the Dubai Health Authority to review the RRP to assess its effectiveness in meeting original objectives and generating desired outcomes.

Methods: Source documents such as the chronicles of the DRTP, communication between the stakeholders, resident feedback, research director, and program director reports were accessed and retrospectively reviewed.

Results: Seven research workshops and ten advanced statistics courses were held. Ten scholarships were provided to the residents for "Introduction to Clinical Research Training" held by Harvard Medical School. Of 370 residents, a total of 156 residents submitted their research proposal, of which 128 residents presented their thesis. Nineteen residents presented their research on international conferences, 12 published their study, and 9 got award locally.

Conclusions: Efforts are focused on improving the quality of the research projects, as well as getting residents involved in research that leads eventually to publication. Research is a major component of DRTP; nevertheless, it is challenging for residents to conduct research successfully because of some barriers inherent in residency training. This experience was the first in the United Arab Emirates, and we believe that this paper will contribute to the integrating research in residency programs by the educators and academics in across countries within the region.
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http://dx.doi.org/10.4103/ijabmr.IJABMR_183_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6477951PMC
May 2019

Exploring Obstetrical Interventions and Stratified Cesarean Section Rates Using the Robson Classification in Tertiary Care Hospitals in the United Arab Emirates.

Rev Bras Ginecol Obstet 2019 Mar 14;41(3):147-154. Epub 2019 Mar 14.

Bedfordshire Centre for Mental Health Research in association with University of Cambridge, Cambridge, United Kingdom.

Objective:  The objective of the present study was to explore obstetric management in relation to clinical, maternal and child health outcomes by using the Robson classification system.

Methods:  Data was collected from obstetrics registries in tertiary care hospitals in Dubai, United Arab Emirates (UAE).

Results:  The analysis of > 5,400 deliveries (60% of all the deliveries in 2016) in major maternity hospitals in Dubai showed that groups 5, 8 and 9 of Robson's classification were the largest contributors to the overall cesarean section (CS) rate and accounted for 30% of the total CS rate. The results indicate that labor was spontaneous in 2,221 (45%) of the women and was augmented or induced in almost 1,634 cases (33%). The birth indication rate was of 64% for normal vaginal delivery, of 24% for emergency CS, and of 9% for elective CS. The rate of vaginal birth after cesarean was 261 (6%), the rate of external cephalic version was 28 (0.7%), and the rate of induction was 1,168 (21.4%). The prevalence of the overall Cesarean section was 33%; with majority (53.5%) of it being repeated Cesarean section.

Conclusion:  The CS rate in the United Arab Emirates (UAE) is higher than the global average rate and than the average rate in Asia, which highlights the need for more education of pregnant women and of their physicians in order to promote vaginal birth. A proper planning is needed to reduce the number of CSs in nulliparous women in order to prevent repeated CSs in the future. Monitoring both CS rates and outcomes is essential to ensure that policies, practices, and actions for the optimization of the utilization of CS lead to improved maternal and infant outcomes.
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http://dx.doi.org/10.1055/s-0038-1676524DOI Listing
March 2019

Burnout and depression among medical residents in the United Arab Emirates: A Multicenter study.

J Family Med Prim Care 2018 Mar-Apr;7(2):435-441

Bedfordshire Centre for Mental Health Research in Association with University of Cambridge, Cambridge, UK

Introduction: Persistent imbalance between work demands and resources seems to be a crucial contributor to the development of burnout among medical professionals. Yet, it seems that Middle East is lacking studies analyzing psychological well-being's of medical residents. Hence, we aimed to conduct a nationwide study to understand and address burnout and depression in medical residents in the UAE.

Methods: A multicenter, cross-sectional study was designed to evaluate professional burnout and depression among medical residents to address the gap.

Results: Our results indicate that 75.5% (216/286) of UAE medical residents had moderate-to-high emotional exhaustion (EE), 84% (249/298) had high depersonalization (DP), and 74% (216/291) had a low sense of personal accomplishment. In aggregate, 70% (212/302) of medical residents were considered to be experiencing at least one symptom of burnout based on a high EE score or a high DP score. Depression ranging from 6% to 22%, depending on the specialty was also noted. Noticeably, 83% (40/48) of medical residents who had high scores for depression also reported burnout.

Conclusions: This study shows that burnout and depression are high among medical residents in UAE. There is a crucial need to address burnout through effective interventions at both the individual and institutional levels. Professional counseling services for residents will certainly be a step forward to manage resident burnout provided the social stigma associated with counseling can be eliminated with awareness. The work hour regulations suggested by the Accreditation Council for Graduate Medical Education partly provides a solution to improve patient safety and care quality. There is an urge to reconfigure the approach to medical training for the well-being of the next generation of physicians in the Arab world.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_199_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060937PMC
August 2018

Evolution of family medicine residency training program in Dubai Health Authority: A 24-year review, challenges, and outcomes.

J Family Med Prim Care 2018 Mar-Apr;7(2):425-429

Department of Primary Health Care, Dubai Health Authority, Dubai, UAE.

Introduction: It is well known that family medicine (FM) is a cornerstone for developing a community-based health-care system, and training family physicians is critical for the society. In Middle East, only 5%-10% of physicians, nurses, and health technicians are citizens. This demands more efforts toward having national FM practitioners in the country. The development of FM residency training program through the past two decades in Dubai has played a crucial rule in this aspect.

Methods: The primary purpose of this study is to review the status of FM specialty training in the Emirates of Dubai throughout the past two decades.

Results: The FM residency training program started since 1993 and had intake of 230 residents till 2017; out of which, 200 (87%) were female and 211 (92%) were the United Arab Emirates national. From 176 residents who are supposed to be graduated by 2017, 162 (92%) completed 4-year training, 132 (75%) has got the Arab Board certificate, and 116 (66%) qualified by the Membership of the Royal College of General Practitioners (MRCGP) international.

Conclusion: The present study revealed that despite all challenges, the well-structured FM program enabled the graduates to reach high clinical, administrative, leadership, and academic positions such as consultant (40), chief executive officer (1), chief advisor for primary care (1), director (9), head of sections (9), head/deputy head of primary health center (55), head of academic affair center (1), chair of MRCGP international (1), program director of FM (4), MRCGP convener (6), MRCGP coordinator (6), and MRCGP examiner (42). However, the program is still lacking certification by an international accreditation body. This will help in reaching a better balance between education and clinical duties for all trainers and faculty; and will positively advocate support for an environment conducive to learning for residents as well as faculty members.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_183_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060948PMC
August 2018

Evolution of the Dubai health authority's residency training program: A 25-year review, challenges and outcomes.

J Family Med Prim Care 2018 Mar-Apr;7(2):319-323

Royal Centre for Defense Medicine, ICT Centre, Birmingham, UK.

Background: The Dubai Residency Training Program (DRTP) is a structured postgraduate educational training program started on 1992 to improve healthcare in the United Arab Emirates (UAE) through education and training; align doctors' training in the UAE with internationally recognized standards; deliver educational best practice; and achieve a balance between clinical service delivery and continuing professional development. The aim of this paper is to review the experiences, challenges and outcomes of the DRTP over the last 25 years.

Methods: All documentation relating to the DRTP was reviewed and reevaluated.

Results: The DRTP has become a very solid foundation; yet, one of the major challenges we are facing is containing the balance between the health service and education. Another challenge is that our capacity for training is limited, in spite of demand, we are not yet able to open all specialties needed in the UAE. Finally, there is a mandate to separate the educational body from service to better govern the education.

Conclusions: The time has come, however, for the UAE to have its own medical specialty board. This would further support high quality, comprehensive specialty training to deliver the bespoke workforce required by the Dubai Health Authority. The concept of structured training where the resident knows what, when, and how to learn the required knowledge and skills is already established, and the UAE has the required numbers of highly trained professionals to form the board. Nevertheless, we should neither be complacent nor underestimate the challenges that remain to deliver the UAE specialty board.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_359_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060933PMC
August 2018

The Treatment of Autism Spectrum Disorder With Auditory Neurofeedback: A Randomized Placebo Controlled Trial Using the Mente Autism Device.

Front Neurol 2018 5;9:537. Epub 2018 Jul 5.

Bioengineering, Carrick Institute, Cape Canaveral, FL, United States.

Children affected by autism spectrum disorder (ASD) often have impairment of social interaction and demonstrate difficulty with emotional communication, display of posture and facial expression, with recognized relationships between postural control mechanisms and cognitive functions. Beside standard biomedical interventions and psychopharmacological treatments, there is increasing interest in the use of alternative non-invasive treatments such as neurofeedback (NFB) that could potentially modulate brain activity resulting in behavioral modification. Eighty-three ASD subjects were randomized to an Active group receiving NFB using the Mente device and a Control group using a Sham device. Both groups used the device each morning for 45 minutes over a 12 week home based trial without any other clinical interventions. Pre and Post standard ASD questionnaires, qEEG and posturography were used to measure the effectiveness of the treatment. Thirty-four subjects (17 Active and 17 Control) completed the study. Statistically and substantively significant changes were found in several outcome measures for subjects that received the treatment. Similar changes were not detected in the Control group. Our results show that a short 12 week course of NFB using the Mente Autism device can lead to significant changes in brain activity (qEEG), sensorimotor behavior (posturography), and behavior (standardized questionnaires) in ASD children.
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http://dx.doi.org/10.3389/fneur.2018.00537DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6041407PMC
July 2018

Emergency peripartum hysterectomy in the Dubai health system: A fifteen year experience.

Turk J Obstet Gynecol 2018 Mar 28;15(1):1-7. Epub 2018 Mar 28.

Bedfordshire Centre for Mental Health Research in Association with University of Cambridge, Department of Neurology and Senior Research, Cambridge, United Kingdom.

Objective: To determine the incidence, demographic data, risk factors, indications, outcome and complications of emergency peripartum hysterectomy (EPH) performed in two major tertiary care hospitals in Dubai, and to compare the results with the literature.

Materials And Methods: The records of all women who underwent EPH from January 2000 to December 2015 in two major tertiary care hospitals in Dubai were accessed and reviewed. Maternal characteristics, hysterectomy indications, outcomes, and postoperative complications were recorded using descriptive statistics to describe the cohort.

Results: There were 79 EPH out of 168.293 deliveries, a rate of 0.47/1000 deliveries. The most common indications for hysterectomy were abnormal placentation (previa and/or accreta) and uterine atony. The majority of hysterectomies were subtotal (70%). The complications were dominated by massive transfusion, urinary tract injuries, one case of maternal death, and one case of neonatal death.

Conclusion: The main indication for EPH was abnormal placentation in scarred uterus and uterine atony. The major method of prevention of EPH is to assess women's risks and to reduce the number of cesarean section deliveries, by limiting the rate of primary cesareans. This is challenging in the United Arab Emirates (UAE) where the culture is for high gravidity and high parity. Recommendations to act to reduce primary and repeated cesareans should be included on the national agenda in UAE.
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http://dx.doi.org/10.4274/tjod.55492DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5894529PMC
March 2018

Limited Understanding of Pap Smear Testing among Women, a Barrier to Cervical Cancer Screening in the United Arab Emirates

Asian Pac J Cancer Prev 2017 Dec 29;18(12):3379-3387. Epub 2017 Dec 29.

Primary Health Care Sector, Dubai Health Authority, Dubai, United Arab Emirates. Email:

Global data indicate that cervical cancer is the fourth most common cancer among women worldwide. Important factors that affect interventions for early diagnosis of cervical cancer include social beliefs and values and poor knowledge. These may contribute to women’s participation in screening for cervical cancer and have a significant impact on decisions to take preventive action. The present study was conducted with 599 women in the UAE between September 2016 and March 2017. A cross-sectional survey was conducted to determine knowledge about cervical cancer and screening, demographic characteristics and perceived barriers. Knowledge about the Pap smear test was limited, and awareness that they should undergo the Pap smear test every three years even with an initial negative/normal Pap smear result was abysmal. In spite of the positive attitude of the women towards the Pap smear test, almost 80% of the women surveyed had no knowledge of precancerous lesions. Having higher income (21/29, 72%, p=0.027) and more miscarriages were associated with better practice of Pap smears (19/26, 73%, p=0.010). Knowledge levels were significantly higher (66.3±22.2,) that values for attitude (60.5±20.9, p= 0.03, 95% CI {0.22-11.3}, Chi-square 4.38) and practice (53.7 24.1, p= 0.001, 95% CI {6.9-18.1}, Chi-square 19.7). A well-designed health education programme on cervical cancer and benefits of screening should increase the awareness among women in UAE. One point to stress is that better communication with health professionals and improvement of access to health care services should increase the rate of cervical cancer screening.
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http://dx.doi.org/10.22034/APJCP.2017.18.12.3379DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5980898PMC
December 2017

Predictors of Postpartum Depression in Dubai, a Rapidly Growing Multicultural Society in the United Arab Emirates.

Psychiatr Danub 2017 Sep;29(Suppl 3):313-322

Dubai Medical College, Dubai, United Arab Emirates.

Background: Postpartum depression (PPD) is a significant public health problem adversely affecting mothers, their newborns, and other members of the family. Although PPD is common and potentially dangerous, only a minority of the cases are identified in primary health care settings during routine care, and the majority of depressed mothers in the community lies unrecognized and therefore untreated.

Subjects And Methods: In this study, a total of 1500 mothers were approached randomly, 808 accepted to participate, and 504 were within the inclusion criteria (women who had a birth of a singleton full-term healthy infant, had an uncomplicated pregnancy, and were within their one week to six months postpartum). The participants completed the Edinburgh Postnatal Depression Scale.

Results: A total of 168 women had an EPDS score ≥10, yielding a crude prevalence rate of 33%. The prevalence of suicidal ideation was 14 out of 504 (3%), among which 11 (79%) had EPDS score of ≥10. We fitted multiple linear regression models to evaluate the predictors of variables measured on the EPDS scale. This model was statistically significant p<0.0001 in predicting the total EPDS score. Women's employment status, baby's birth weight, stressful life event and marital conflict were statistically significant predictors.

Conclusions: The findings of this study are anticipated to entail the government and policy makers in the region to pay more attention to the apparently high prevalence of unrevealed PPD in the community. It is crucial to enhance screening mechanisms for early detection, providing interventions to manage symptoms, and at the same time mandating local guidelines to address the PPD pathology as a high priority for the UAE population.
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September 2017

Professionalism among multicultural medical students in the United Arab Emirates.

Med Educ Online 2017 ;22(1):1372669

d Bedfordshire Centre for Mental Health Research , University of Cambridge , Cambridge , UK.

Background: Moral competencies and ethical practices of medical professionals are among the desired outcomes of academic training. Unfortunately, academic dishonesty and misconduct are reported from medical colleges across the world. This study investigates the level of academic dishonesty/misconduct among multicultural medical students.

Objective: The aim of this study is to investigate the level of academic dishonesty/misconduct among multicultural medical students.

Design: Validated and customized version of Dundee Polyprofessionalism Inventory-1 detailing lapses of professionalism in undergraduate health professions education was used to determine the perceived prevalence and self-reported lapses of academic integrity in this study.

Results: This study shows that the majority (458/554, 83%) of medical students have admitted to acts of academic dishonesty mentioned in the questionnaire. Approximately 42% (231/554) of the students have given proxy for attendance and 71% of them considered this as an offense. Similarly, 12% (66/554) have copied from the record books of others, and 86% (477/554) have considered it unethical. In addition, 5% (28/554) of the students revealed forging a teacher's signature in their record or logbooks, with 16% (91/554) of them reporting that they have seen others forge signatures.

Conclusion: This is the first multi-center, multi-cultural and multi-ethnic study involving a large number of participants that addresses academic professionalism among medical students in the Middle East. Certainly, the paucity of data limits definitive conclusions about the best approach to prevent academic misconduct in the UAE medical schools. Yet, the results of our study are anticipated not only to benefit the UAE but also to find application in the Arab world, with similar medical school programs, values, culture and tradition.
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http://dx.doi.org/10.1080/10872981.2017.1372669DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5653941PMC
April 2018

Randomized Controlled Study of a Remote Flipped Classroom Neuro-otology Curriculum.

Front Neurol 2017 24;8:349. Epub 2017 Jul 24.

Health Professions Education, MGH Institute of Health Professions, Boston, MA, United States.

Context: Medical Education can be delivered in the traditional classroom or novel technology including an online classroom.

Objective: To test the hypothesis that learning in an online classroom would result in similar outcomes as learning in the traditional classroom when using a flipped classroom pedagogy.

Design: Randomized controlled trial. A total of 274 subjects enrolled in a Neuro-otology training program for non-Neuro-otologists of 25 h held over a 3-day period. Subjects were randomized into a "control" group attending a traditional classroom and a "trial" group of equal numbers participating in an online synchronous Internet streaming classroom using the Adobe Connect e-learning platform.

Interventions: Subjects were randomized into a "control" group attending a traditional classroom and a "treatment" group of equal numbers participating in an online synchronous Internet streaming classroom.

Main Outcome Measures: Pre- and post-multiple choice examinations of VOR, Movement, Head Turns, Head Tremor, Neurodegeneration, Inferior Olivary Complex, Collateral Projections, Eye Movement Training, Visual Saccades, Head Saccades, Visual Impairment, Walking Speed, Neuroprotection, Autophagy, Hyperkinetic Movement, Eye and Head Stability, Oscilllatory Head Movements, Gaze Stability, Leaky Neural Integrator, Cervical Dystonia, INC and Head Tilts, Visual Pursuits, Optokinetic Stimulation, and Vestibular Rehabilitation.

Methods: All candidates took a pretest examination of the subject material. The 2-9 h and 1-8 h sessions over three consecutive days were given live in the classroom and synchronously in the online classroom using the Adobe Connect e-learning platform. Subjects randomized to the online classroom attended the lectures in a location of their choice and viewed the sessions live on the Internet. A posttest examination was given to all candidates after completion of the course. Two sample unpaired tests with equal variances were calculated for all pretests and posttests for all groups including gender differences.

Results: All 274 subjects demonstrated statistically significant learning by comparison of their pre- and posttest scores. There were no statistically significant differences in the test scores between the two groups of 137 subjects each (0.8%, 95% CI 85.45917-86.67952;  = 0.9195). A total of 101 males in the traditional classroom arm had statistically significant lower scores than 72 females (0.8%, 95% CI 84.65716-86.53096;  = 0.0377) but not in the online arm (0.8%, 95% CI 85.46172-87.23135;  = 0.2176) with a moderate effect size (Cohen's  = -0.407).

Conclusion: The use of a synchronous online classroom in neuro-otology clinical training has demonstrated similar outcomes to the traditional classroom. The online classroom is a low cost and effective complement to medical specialty training in Neuro-Otology. The significant difference in outcomes between males and females who attended the traditional classroom suggests that women may do better than males in this learning environment, although the effect size is moderate.

Clinical Trial Registration: Clinicaltrials.gov, identifier NCT03079349.
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http://dx.doi.org/10.3389/fneur.2017.00349DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5523077PMC
July 2017

Analysis of blood donor pre-donation deferral in Dubai: characteristics and reasons.

J Blood Med 2017 25;8:55-60. Epub 2017 May 25.

Dubai Health Authority, Dubai, UAE.

Background: To ensure an adequate and safe blood supply, it is crucial to select suitable donors according to stringent eligibility criteria. Understanding the reasons for donor deferral can help in planning more efficient recruitment strategies and evaluating donor selection criteria. This study aims to define donor pre-donation deferral rates, causes of deferral, and characteristics of deferred donors in Dubai.

Materials And Methods: This retrospective study was conducted on all donors who presented for allogeneic blood donation between January 1, 2010, until June 30, 2013, in Dubai Blood Donation Centre, accredited by the American Association of Blood Banks. The donation and deferral data were analyzed to determine the demographic characteristics of accepted and deferred donors, and frequency analyses were also conducted.

Results: Among 142,431 individuals presenting during the study period, 114,827 (80.6%) were accepted for donation, and 27,604 (19.4%) were deferred. The overall proportion of deferrals was higher among individuals less than 21 years old (35%, <0.000), females (44% were deferred compared to 15% of males, <0.0001), and first-time donors (22% were deferred vs 14% of repeat donors, <0.0001). The main causes for a temporary deferral were low hemoglobin and high blood pressure.

Discussion: The deferral rate among blood donors in Dubai is relatively high compared to the internationally reported rates. This rate was higher among first-time donors and females, with low hemoglobin as the major factor leading to a temporary deferral of donors. Strategies to mitigate deferral and improve blood donor retention are urged in Dubai to avoid additional stress on the blood supply.
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http://dx.doi.org/10.2147/JBM.S135191DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5449161PMC
May 2017

Overall Assessment of Human Research and Ethics Committees in the United Arab Emirates.

J Empir Res Hum Res Ethics 2017 04 20;12(2):71-78. Epub 2017 Mar 20.

2 Department of Academic Affairs Medical Affairs, Tawam, Johns Hopkins Medicine International and College of Medicine, UAE University, Al Ain, UAE.

Growing demand for human health research in the United Arab Emirates (UAE) has prompted the need to develop a robust research ethics oversight. Examination of the structure, function, and practices of the human research ethics committees (HRECs), followed by evaluation of standards for measuring research output, was conducted. Results indicate that among the HRECs, 90% followed International Council for Harmonization-Good Clinical Practice guidelines, 66.6% have been in operation for more than 5 years, 95% reviewed proposals within 8 weeks, and 56% reviewed for scientific merit apart from ethics. However, systems to recognize accomplishments of researchers, funding transparency, and adverse event reporting were deployed in less than 30% of all HRECs. Research was incorporated into the vision and mission statements of many (65%) organizations. Research publications, collaborations, and recognitions were used to measure research output and report key performance indicators. In spite, resources to generate research output such as dedicated budget (20%), support staff (20%), and continuous training and mentoring program for medical residents (15%) and HREC members (25%) were somehow lacking. HREC structure and operations in the UAE are similar to other regions of the world. Systems to conduct research and report outcomes are defined in the UAE. Regulatory legislation and allocation of resources to support the clinical research enterprise will not only help to meet growing demand for clinical trials but also transform the quality of patient care in the UAE. It is anticipated that the results of this study will benefit investigators, regulators, pharmaceutical sponsors, and the policy makers in the region.
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http://dx.doi.org/10.1177/1556264617697522DOI Listing
April 2017

Specialty preferences and motivating factors: A national survey on medical students from five uae medical schools.

Educ Health (Abingdon) 2016 Sep-Dec;29(3):231-243

Department of Hematology, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.

Background: Workforce planning is critical for being able to deliver appropriate health service and thus is relevant to medical education. It is, therefore, important to understand medical students' future specialty choices and the factors that influence them. This study was conducted to identify, explore, and analyze the factors influencing specialty preferences among medical students of the United Arab Emirates (UAE).

Methods: A multiyear, multicenter survey of medical student career choice was conducted with all five UAE medical schools. The questionnaire consisted of five sections. Chi-squared tests, regression analysis, and stepwise logistic regression were performed.

Results: The overall response rate was 46% (956/2079). Factors that students reported to be extremely important when considering their future career preferences were intellectual satisfaction (87%), work-life balance (71%), having the required talent (70%), and having a stable and secure future (69%). The majority of students (60%) preferred internal medicine, surgery, emergency medicine, or family Medicine. The most common reason given for choosing a particular specialty was personal interest (21%), followed by flexibility of working hours (17%).

Discussion: The data show that a variety of factors inspires medical students in the UAE in their choice of a future medical specialty. These factors can be used by health policymakers, university mentors, and directors of residency training programs to motivate students to choose specialties that are scarce in the UAE and therefore better serve the health-care system and the national community.
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http://dx.doi.org/10.4103/1357-6283.204225DOI Listing
September 2017

Challenges Facing Medical Residents' Satisfaction in the Middle East: A Report From United Arab Emirates.

Teach Learn Med 2015 ;27(4):387-94

d Carrick Institute for Graduate Studies , Cape Canaveral , Florida , USA.

Unlabelled: PHENOMENON: Medical residents' satisfaction with the quality of training for medical residency training specialists is one of the core measures of training program success. It will also therefore contribute to the integrity of healthcare in the long run. Yet there is a paucity of research describing medical residents' satisfaction in the Middle East, and there are no published studies that measure the satisfaction of medical residents trained within the United Arab Emirates (UAE). This makes it difficult to develop a quality residency training program that might meet the needs of both physicians and society.

Approach: The authors designed a questionnaire to assess medical residents' satisfaction with the Dubai residency training program in order to identify insufficiencies in the training, clinical, and educational aspects. The survey was a self-report questionnaire composed of different subscales covering sociodemographic and educational/academic profile of the residents along with their overall satisfaction of their training, curriculum, work environment, peer teamwork, and their personal opinion on their medical career.

Findings: Respondents showed a substantial level of satisfaction with the residency training. The vast majority of residents (80%, N = 88) believe that their residency program curriculum and rotation was "good," "very good," or "excellent." Areas of dissatisfaction included salary, excessive paperwork during rotations, and harassment. INSIGHTS: This is the first report that studies the satisfaction of medical residents in all specialties in Dubai, UAE. Our findings provide preliminary evidence on the efficiency of different modifications applied to the residency program in UAE. To our knowledge, there has not been any previous study in the Middle East that has analyzed this aspect of medical residents from different specialties. The authors believe that this report can be used as a baseline to monitor the effectiveness of interventions applied in the future toward improving residency training programs in this region.
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http://dx.doi.org/10.1080/10401334.2015.1077125DOI Listing
August 2016

The multiple mini-interview for selecting medical residents: first experience in the Middle East region.

Med Teach 2014 Aug 7;36(8):703-9. Epub 2014 May 7.

Dubai Health Authority, United Arab Emirates .

Introduction: Numerous studies have shown that multiple mini-interviews (MMI) provides a standard, fair, and more reliable method for assessing applicants. This article presents the first MMI experience for selection of medical residents in the Middle East culture and an Arab country.

Methods: In 2012, we started using the MMI in interviewing applicants to the residency program of Dubai Health Authority. This interview process consisted of eight, eight-minute structured interview scenarios. Applicants rotated through the stations, each with its own interviewer and scenario. They read the scenario and were requested to discuss the issues with the interviewers. Sociodemographic and station assessment data provided for each applicant were analyzed to determine whether the MMI was a reliable assessment of the non-clinical attributes in the present setting of an Arab country.

Results: One hundred and eighty-seven candidates from 27 different countries were interviewed for Dubai Residency Training Program using MMI. They were graduates of 5 medical universities within United Arab Emirates (UAE) and 60 different universities outside UAE. With this applicant's pool, a MMI with eight stations, produced absolute and relative reliability of 0.8 and 0.81, respectively. The person × station interaction contributed 63% of the variance components, the person contributed 34% of the variance components, and the station contributed 2% of the variance components.

Discussion: The MMI has been used in numerous universities in English speaking countries. The MMI evaluates non-clinical attributes and this study provides further evidence for its reliability but in a different country and culture. The MMI offers a fair and more reliable assessment of applicants to medical residency programs. The present data show that this assessment technique applied in a non-western country and Arab culture still produced reliable results.
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http://dx.doi.org/10.3109/0142159X.2014.907875DOI Listing
August 2014

Hemoglobinopathy carrier prevalence in the United Arab Emirates: first analysis of the Dubai Health Authority premarital screening program results.

Hemoglobin 2013 7;37(4):359-68. Epub 2013 May 7.

Dubai Thalassemia Center, Dubai Health Authority, Dubai, United Arab Emirates.

The aim of this study was to determine the prevalence of hemoglobinopathy carriers in United Arab Emirates (UAE) nationals subjected to mandatory premarital screening in Dubai over a 4-year period. Data from UAE nationals who underwent premarital screening by the Dubai Health Authority between January 2007 and December 2010 were collected and analyzed. Premarital screening in Dubai is based on complete blood counts (CBC) and hemoglobin (Hb) high performance liquid chromatography (HPLC). Among the 6,420 UAE nationals screened, 8.5% (n = 545) were suspected to be carriers. The following carrier frequencies were observed: β-thalassemia (β-thal), 4.56% (n = 293); Hb S [β6(A3)Glu→Val, GAG>GTG; HBB: c.20A>T], 2.9% (n = 186); Hb D-Punjab [β121(GH4)Glu→Gln, GAA>CAA; HBB: c.364G>C], 0.78% (n = 50); Hb Lepore (δβ hybrid gene) with an undetermined molecular genotype, 0.17% (n = 11); Hb E [β26(B8)Glu→Lys, GAG>AAG; HBB: c.79G>A], 0.03% (n = 2); and hereditary persistence of fetal Hb (HPFH), 0.016% (n = 1). Hb E-Hb S and Hb E-β-thal also occurred at a rate of 0.016% (n = 1) each; and 0.87% (n = 56) subjects were suspected of carrying silent β-thal. The prevalence of β-thal trait was consistent with the prevalence published by others in the region. Silent β-thal is challenging for screening programs, and is expected to arise in populations with a high prevalence of β-thal carriers. The prevalence of Hb S trait observed in this study was lower than that in other reports for the region. New cases of β-thal major (β-TM) still arise because many fertile couples got married before the screening programs were implemented, and pregnancy termination is not widely practiced in the UAE due to religious restraints. Moreover, some couples choose not to have prenatal diagnosis (PND) or pre implantation genetic diagnosis (PGD), even if they are aware of their risk status. The prevalence of β-thal trait in the UAE is high. This justifies efforts to control the disease by holding regular community awareness and screening programs, performing premarital screening and genetic counseling, and making PND and PGD available to couples who request it.
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http://dx.doi.org/10.3109/03630269.2013.791627DOI Listing
January 2014

Misdiagnosis of Hb D-Punjab/β-thalassemia is a potential pitfall in hemoglobinopathy screening programs: a case report.

Hemoglobin 2013 20;37(2):119-23. Epub 2013 Feb 20.

Dubai Thalassemia Centre, Dubai Health Authority, Dubai, United Arab Emirates.

Compound heterozygosity for Hb D-Punjab [β121(GH4)Glu→Gln, GAA>CAA] /β-thalassemia (β-thal) must be carefully differentiated from homozygous Hb D-Punjab in premarital screening. This is essential when the partner is a carrier of β-thal trait. The case of a baby born affected with β-thal major (β-TM), from a marriage between a mother with β-thal trait and a father with Hb D-Punjab/β-thal, is presented. The father had been misdiagnozed as homozygous Hb D-Punjab during premarital screening, even though the screening program utilized complete blood counts and high performance liquid chromatography (HPLC). The factors that may have contributed to this midsiagnosis are presented and discussed. It is recommended that cases of Hb D-Punjab, or any other hemoglobin (Hb) variant appearing as homozygous, are carefully evaluated if microcytic hypochromic parameters not associated with α-thal are present. In all cases of suspected hemizygosis, molecular analysis should always be performed, and in particular if one partner is a β-thal carrier.
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http://dx.doi.org/10.3109/03630269.2013.769174DOI Listing
September 2013

Enhanced interpretation of newborn screening results without analyte cutoff values.

Genet Med 2012 Jul 16;14(7):648-55. Epub 2012 Feb 16.

Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA.

Purpose: To improve quality of newborn screening by tandem mass spectrometry with a novel approach made possible by the collaboration of 154 laboratories in 49 countries.

Methods: A database of 767,464 results from 12,721 cases affected with 60 conditions was used to build multivariate pattern recognition software that generates tools integrating multiple clinically significant results into a single score. This score is determined by the overlap between normal and disease ranges, penetration within the disease range, differences between conditions, and weighted correction factors.

Results: Ninety tools target either a single condition or the differential diagnosis between multiple conditions. Scores are expressed as the percentile rank among all cases with the same condition and are compared to interpretation guidelines. Retrospective evaluation of past cases suggests that these tools could have avoided at least half of 279 false-positive outcomes caused by carrier status for fatty-acid oxidation disorders and could have prevented 88% of known false-negative events.

Conclusion: Application of this computational approach to raw data is independent from single analyte cutoff values. In Minnesota, the tools have been a major contributing factor to the sustained achievement of a false-positive rate below 0.1% and a positive predictive value above 60%.
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http://dx.doi.org/10.1038/gim.2012.2DOI Listing
July 2012

Trends in prevalence, incidence, and residual risk of major transfusion-transmissible viral infections in United Arab Emirates blood donors: impact of individual-donation nucleic acid testing, 2004 through 2009.

Transfusion 2012 Nov 13;52(11):2300-9. Epub 2012 Jun 13.

Dubai Blood Donation Centre, Dubai Health Authority, Dubai, UAE.

Background: United Arab Emirates (UAE) has a heterogeneous population consisting of more than 160 nationalities and 85% of the population being non-UAE. In 2007, Dubai Blood Donation Centre (DBDC), the major local supplier of blood in the UAE, introduced six-minipool nucleic acid test (NAT) for hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV), which in 2008 upgraded to individual-donation (ID)-NAT. The aim of this study was to analyze the efficacy of the donor screening program in the UAE and evaluate the impact of NAT on the yield and residual risk of transfusion-transmissible viral infections (TTVIs).

Study Design And Methods: A total of 169,781 blood donations collected at DBDC between 2004 and 2009 were screened for TTVIs. During the period 2008 through 2009, a total of 59,283 donations were tested with both ID-NAT and serologic assays. The incidence, prevalence, and residual risk for each viral agent were estimated and analyzed.

Results: The individual prevalences of HBV, HCV, and HIV per 100,000 donation were 234.4, 110, and 4, respectively. Calculated residual risk per million donations for HBV was decreased from 1.41 in pre-NAT period to 0.92 in post-NAT period. These figures were decreased for HCV and HIV from 1.73 and 0.39 to 0 and 0.32, respectively.

Conclusion: Incidence rates and estimated residual risk indicate that the current risk of TTVIs attributable to blood donation is relatively low in the UAE. The study recommends the parallel use of both serology and ID-NAT TTVIs screening in blood donations and suggests the exclusion of antibody to hepatitis B core antigen-positive donations as this can eliminate the potential infectivity of these units with marginal effects on the blood stock in UAE.
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http://dx.doi.org/10.1111/j.1537-2995.2012.03740.xDOI Listing
November 2012

Clinical validation of cutoff target ranges in newborn screening of metabolic disorders by tandem mass spectrometry: a worldwide collaborative project.

Genet Med 2011 Mar;13(3):230-54

Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

Purpose: To achieve clinical validation of cutoff values for newborn screening by tandem mass spectrometry through a worldwide collaborative effort.

Methods: Cumulative percentiles of amino acids and acylcarnitines in dried blood spots of approximately 25–30 million normal newborns and 10,742 deidentified true positive cases are compared to assign clinical significance, which is achieved when the median of a disorder range is, and usually markedly outside, either the 99th or the 1st percentile of the normal population. The cutoff target ranges of analytes and ratios are then defined as the interval between selected percentiles of the two populations. When overlaps occur, adjustments are made to maximize sensitivity and specificity taking all available factors into consideration.

Results: As of December 1, 2010, 130 sites in 45 countries have uploaded a total of 25,114 percentile data points, 565,232 analyte results of true positive cases with 64 conditions, and 5,341 cutoff values. The average rate of submission of true positive cases between December 1, 2008, and December 1, 2010, was 5.1 cases/day. This cumulative evidence generated 91 high and 23 low cutoff target ranges. The overall proportion of cutoff values within the respective target range was 42% (2,269/5,341).

Conclusion: An unprecedented level of cooperation and collaboration has allowed the objective definition of cutoff target ranges for 114 markers to be applied to newborn screening of rare metabolic disorders.
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http://dx.doi.org/10.1097/GIM.0b013e31820d5e67DOI Listing
March 2011
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