New Emirates Medical Journal - Volume 5, Issue 1, 2024

Depression is on a steady rise across the United Arab Emirates (UAE), causing much socio-economic burden to the country. Identifying patient journey gaps for depression, beginning with awareness and screening, diagnosis, and treatment to sustained remission and rehabilitation, can help design health policies with actionable solutions, mitigating the burden of the disease.

Studies in the English language between 2010 and 2021 were shortlisted using a structured search in electronic databases followed by an unstructured search using government websites and Google Scholar and anecdotal data from local professional experts. Synthesized data was subjected to weighted mean calculation, and an evidence gap map was charted.

Varying prevalence of depression (5.1%-82.2%) was reported across different settings and population sample sizes in the UAE. One study reported that 13.0% of the UAE population was aware of their depressive condition. Screening rates of depression were reported to be relatively high (34.2%-90.5%), while depression was diagnosed in 0.5%-48.5% of patients. The treatment rate was 36.1%, while adherence rates were estimated to be low at 0.3%. No evidence of control or remission of depression could be gathered.

The reviewed studies used only the Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria for diagnosing depression. The review also lacked large-scale research studies that may have limited the actual representation of the prevalence of depression across the country.

Addressing the gaps identified through evidence mapping methodology can shape a ‘model of care’ for depression. This model should aim to harmonize collaborations among the mental health stakeholders and advocate for the social reintegration of patients.

Phlebitis is still a common complication of peripheral venous catheters. Finding a suitable solution to prevent and reduce the incidence of this complication continues to be a challenge. Various strategies were used to reduce the incidence of phlebitis. Mostly non-pharmacological measures were taken as first preference. Intially, when patients come to any hospital for their treatment, the first is the peripherally inserted venous catheter access conducted inpatient for medication administration, fluid administration and blood transfusion in both the hospital setting and ambulatory setting. About 70% of the patients admitted to the hospital requires peripherally inserted venous catheters (PIVCs). The incidence of phlebitis is higher in patients who undergo continuous intravenous therapy.

To find out the effect of hand grip exercise in the sustaining patency of peripherally inserted venous catheters among patients in continuous intravenous therapy.

During the 8 weeks the hand grip exercise was evaluated in patients, who had undergone continuous intravenous infusion through the peripherally inserted venous catheter for at least 3 days. The measurement of data is based on the patient’s socio-demographic Performa, patency checklist, visual infusion phlebitis score and visual analogue scale. The post-test was conducted in both experimental and control groups.

Till the end of the study, 76 participants were taken. On day 3 of the hand grip exercise maximum of 24 (61.5%) PIVC were patent, whereas in control group 5 (13.5%) PIVC were able to maintain their patency. On day 5 of exercise 34 (91.9%) PIVC were replaced with a cause of phlebitis 33(89.2%) in the control group in comparison with the experimental group only 22 (56.4%) lines were replaced with the same cause of phlebitis 24 (61.5%).

Hand grip exercise is important for clients, to reduce the need for the potentially painful process of placing vascular lines and also helps to control costs by reducing the number of devices used for each client and the development of phlebitis.

Dysmenorrhea is painful menstruation and is the most common menstrual symptom affecting adolescents. Evidence suggests that worldwide prevalence can be high and can significantly affect academic performance through its impact on activity, absenteeism, and other aspects of learning.

This is a cross-sectional survey using a pre-validated questionnaire incorporating demography, menstrual history, severity, and effects on academic performance. Female students selected by non-probability sampling of Ras al Khaimah Medical and Health Sciences University were included (calculated sample size=249).

A total of 252 students participated (mean age 20.14 years). The prevalence of dysmenorrhea was 80.5%. Pain was severe for 25.1% (≥7/10 score),14.7% reported severely restricted daily activity, 66% received regular treatment, and 24(11.8%) required hospitalization during the last year due to pain. More than 50% of students missed academic sessions, 68% had trouble concentrating, 70. 4% were unable to study. 59% had an inability to complete assignments, 58% had trouble concentrating during examinations, and 8.8% missed assessments due to dysmenorrhea. The majority missed 1-2 days each month. Dysmenorrhea was a significant predictor of academic domains (AD) like reduced concentration, inability to complete assignments, missing lectures, and assessments [adjusted OR-2.25, 5.57, 4.32, 3.96] with p less than .05 in each. Moderate to severe pain was an independent predictor of all AD compared to mild pain (score less than 3) (p=.026). Moderate to severe dysmenorrhea had a significant negative impact on academic performance (p=.02).

Dysmenorrhea is a prevalent health problem among university students and has a significant negative impact on education.

Thyroid hormones play a crucial role in erythropoiesis, both directly and indirectly, with reduced secretion potentially causing anaemia—a commonly overlooked symptom of hypothyroidism. By compiling existing data, discussing recent advancements, identifying root causes, and proposing potential treatment options, this work acknowledges the complexity of the issue and aims to serve as a foundational reference for those in the early stages of research or clinical practice.

To comprehend the concept of this disease condition, a number of medical textbooks were consulted. Various search engines, such as PubMed, Google Scholar, Research Gate, Science Direct, Scopus, etc., were cited to explore the recent advancements and obtain data on the topic in question. Later, all the information and data gathered were organised into a review article.

Anemia, often referred to as the “haematological mask” of hypothyroidism, can manifest even before hypothyroidism is clinically diagnosed. Hypothyroidism must be considered as a potential cause when confronted with refractory anemia, as its treatment is pivotal for achieving comprehensive and lasting improvements in haematological parameters.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that is gradually gaining popularity. However, there is minimal scientific research exploring the clinical presentation of this highly complex disorder and the general understanding of such varying presentations by general practitioners and pediatric physicians.

This study aims to explore the patterns of referral of patients with ASD to a tertiary hospital in Dubai, United Arab Emirates, and to understand better and analyze the general knowledge of referring physicians through their impression of the patient’s clinical presentation.

This is a retrospective descriptive study where all the data were collected electronically from past medical records and referral documents taken from Al Jalila Children's Specialty Hospital (AJCH). Patients who were referred were later assessed by the neurodevelopmental specialists using the NICE Guidelines. The data were analyzed statistically and described using different statistical tools. These results were then considered in light of the local clinician's needs for diagnostic support and the possibility of developing a national screening program for ASD.

Within a sample of 90 referrals, 69 (76.7%) were predominantly male, 73 (81.1%) were Emirati nationals, and the majority fell within the age group of 0 to 5 years old. Of the 90 referred patients, 53 (58.9%) were diagnosed with ASD by neurodevelopmental specialists using the NICE Guidelines. Physicians were keen on picking up features of speech and language deficits, hyperactivity, and inappropriate or atypical behavior. However, they seemed hesitant and required further assessment when interpreting and reporting features revolving around social communicative skills, interaction and rapport, and evaluating patients’ ideas and imagination.

Physicians practicing in the United Arab Emirates (UAE) are advised to assess the full range of clinical symptoms of ASD according to their respective categories as listed in the National Institute for Health and Care Excellence (NICE) guidelines. Furthermore, the Dubai Health Authority (DHA) has published the first edition document titled “Dubai Clinical Practice Guidelines for Autism Spectrum Disorder (ASD) in Children and Adolescents,” designed to align physician recognition and practice with the government's objectives toward all individuals with ASD. Their achievement aligns with the goals of our study as it will make the clinical recognition of ASD clinically more sound and prevent misdiagnosis. Finally, the authors hope that this study aids in developing a national screening program dedicated to general practitioners and pediatric physicians in providing a structured assessment for ASD, which in return will result in early intervention by neurodevelopmental specialists for further diagnosis and management, ultimately improving the quality of life of the patients and their families.

Adsorption and mixed agglutination reactions detect A, B, and H blood group antigens in the cells.

The study aimed to investigate the adsorbing abilities of group-specific polyclonal antibodies using erythrocytes and leukocytes to improve the quality of blood typing.

The adsorption was performed with group B erythrocytes and leukocytes using the usual heated citrated anti-B plasma at 4°C and 37°C. A mixed agglutination reaction revealed group B antigens on leukocytes and erythrocytes.

The highest adsorption of antibodies from usual plasma on erythrocytes was observed at 4°C at physiological conditions. Weaker adsorption was determined at pH 8.0 compared to pH 6.0 (the decrease of agglutination strength from 3+ to 2+ and 1+ accordingly).

The adsorption of polyclonal antibodies on erythrocytes at 37°C was the highest at pH 6.0 and 8.0 compared to physiological conditions (the decrease of agglutination strength from 3+ to 1+). In contrast, adsorption at 4°C appeared to be stronger at pH 6.0.

The adsorption of IgG antibodies on erythrocytes at 37°C was higher at pH 8.0.

Complete adsorption of IgG antibodies was observed on group B erythrocytes and leukocytes at 37°C and 4°C.

Adsorption of polyclonal group-specific antibodies on erythrocytes was the highest at 4°C, and adsorption of IgG antibodies was strong at 4°C and 37°C. Adsorption of leukocytes was revealed only with the use of the heated serum. IgG group-specific antibodies from the heated plasma demonstrated higher adsorbing abilities on leukocytes than IgM antibodies from plasma.

Despite the available clinical practice guidelines, many management decisions in bronchiolitis are made subjectively, resulting in variable length of stay and unplanned ICU admissions. We hypothesized that certain independent predictors would affect the length of stay (LOS) and care escalation.

To identify predictors for increased LOS and ICU admissions in acute bronchiolitis.

We conducted a retrospective descriptive cohort study involving 589 children admitted to MZH with acute bronchiolitis in 2 years. Predictors evaluated were age, gender, family history of asthma, prematurity, fever, hypoxemia, comorbidities, RSV, and medications (salbutamol, steroids, and antibiotics).

Acute bronchiolitis comprised 18.61% of Pediatric admissions and 6.2% of total hospital admissions. The mean age is 8.28±6.1(2-36 months); 83% were infants, 39.2% were girls, 15% were preterm, and 25.1% had a family history of asthma. Despite 84.2% having X-rays, significant findings were present in 21.3%. RSV positive 26.3%. The mean LOS was 3.6±1.6 (2-11 days).

Age less than 2 months(P=0.029 OR=1.8, CI1.1 - 3.3), family history of asthma (P=0.03 OR=1.8, CI1.14 - 2.9), hypoxemia on admission (P<0.001 OR=3, CI1.8 - 4.9), presence of comorbidity (P=0.012), and significant radiographic findings (P<0.002, OR=2.7, CI1.6 - 4.6) were predictors of longer LOS. Prematurity (P<0.001, OR 8.8, CI 2.7-28.4), RSV bronchiolitis (P<0.002, OR=3.02, CI=1.5 – 6.03), and hypoxemia on admission (P< 0.042 OR=4.6, CI1.1 - 14.9) qualified as independent predictors for escalated care.

RSV bronchiolitis, especially in preterm infants, may prompt a low threshold for admission and escalating the care. Evidence-based treatments, early respiratory support, and treatment of comorbidities help to achieve the optimal LOS.

The objectives of the study were to assess the prevalence of moderate to severe depressive symptoms among adults aged 18 years or older, assess the relationship between the severity of depression and selected socio-demographic, psycho-social, lifestyle, and health-related factors, and identify the determinants of moderate-to-severe depressive symptoms in the adult population of 18 years and older in the United Arab Emirates (UAE).

This was a cross-sectional study conducted in the United Arab Emirates that targeted residents above 18 years of age. A research questionnaire was developed and approved by three specialists in the field, along with the Patient Health Questionnaire-9 (PHQ9). The Chi-square test was used to assess the association between variables, and multiple logistic regression analysis was used to find the predictive risk factors for moderate to severe depressive symptoms.

The study encompassed a group of 562 participants, achieving a response rate of 97.33%. Initially, a Google Form was distributed electronically to the entire participant pool; however, 15 individuals declined to participate, resulting in a final sample size of 547 (n). Amongst the variables that showed significant prevalence of moderate to severe depressive symptoms were age (P <0.001), sex (P <0.001), marital status (P <0.001), occupation classification (P <0.001), religiosity (P <0.001), education level (P <0.001), job stress (P <0.001), domicile and residence (P <0.001), responsibility towards family (P <0.001), post-traumatic stress disorder (PTSD) (P <0.001), consumption of alcohol (P <0.001), coronavirus disease pandemic (P <0.001), employment status (P = 0.002), family size (P = 0.001), and smoking (P = 0.004). Amongst the variables, the sub-groups that showed significant predictive factors of moderate to severe depressive symptoms were the ages between 18 and 25 years old (P = 0.01), the female gender (P <0.001), and low levels of religiosity (P <0.001).

The prevalence of moderate-to-severe depressive symptoms was 48% (n=260). In our study on the prevalence of depression, we have investigated several predictive factors, including age, gender, religiosity, and a history of prior depression diagnosis. While numerous factors contribute to depression, additional research is imperative to identify and validate additional predictive factors.

Ossification of the posterior longitudinal ligament (OPLL) constitutes a significant etiology of cervical myelopathy. The most common clinical presentations are myelopathy and radiculopathy, which result from a decrease in the spinal canal's volume and the spinal cord's subsequent compression by the ossified posterior longitudinal ligament. This results in motor and sensory deficits, especially in the extremities.

A 48-year-old male presented with a complaint of neck pain that radiated to both upper limbs and was associated with numbness, tingling, and paranesthesia. He also had a history of lower back pain that radiated to the right leg, which was also associated with numbness and limited mobility to his cervical spine. Lhermitte's sign was positive. Sensory deficit to pinprick and touch was noted in the right upper limb and lower limbs. Flexion deformities of the right hand and elbow extension fingers were noted. Neuroimaging of the cervical spine showed cervical canal stenosis, OPLL, and myelopathy. Surgical management included internal fixation using plates and transpedicular screws, lateral mass fixation, and laminectomy of the third to sixth cervical vertebrae (C3-C6).

OPLL should be considered an integral component of the differential diagnosis when evaluating a patient with neck pain and consequent motor and sensory deficits of the extremities. OPLL with mild and/or non-progressive symptoms can be addressed with non-operative measures. Assessing preoperative neuroimaging is crucial before surgery to determine the degree of spinal cord compression and the presence of OPLL in all patients with cervical myelopathy. Surgical treatment options for posterior longitudinal ligament calcification include laminectomy and fusion, anterior decompression including transpedicular and costo-transversectomy, laminoplasty, and circumferential decompression via staged posterior and anterior approaches. Determining the most effective surgical approach for managing OPLL is still controversial, and selecting the appropriate procedure should be based on the patient's clinical presentation and level of pathological involvement.

Dispensing practice is the fundamental component of the rational use of drugs. Inappropriate dispensing of drugs can lead to Adverse drug reaction (ADR), Drug interaction (DI), therapeutic failure, and increased cost of treatment. In case of antibiotic misuse, it can lead to developing an extra burden of antibiotic resistance.

The objective of this study was to determine the antibiotic dispensing practice and the impact of intervention among medicine retailers of Butwal and Bhairahawa cities of Nepal.

An interventional simulated patients survey study was conducted in two cities of Nepal from 2016-2018. A scenario of fictitious cases of common cold and running nose was simulated by two trained pharmacists in two different sites. Prior to the survey, the researcher visited selected retailers to obtain consent and demography details. About two weeks after obtaining consent, simulated patients visited the retailers. The information given by the community pharmacist was memorized and recorded in data collection form after leaving the community pharmacy. The intervention study was carried out 30 days after the simulated study survey. The educational intervention was given to the test group i.e. the community medicine retailer of Butwal. The researchers also provided a booklet to the test groups. Post-intervention simulated patient survey was conducted after 3 days of the training period. Data were entered into Microsoft Excel and SPSS for analysis.

All together 64 community pharmacies were included in this study involving 32 medicine retailers from each city of Butwal and Bhairahawa. The total drugs dispensed by medicine retailers were 146 and 127 drugs in Butwal and Bhairahawa, respectively in the before-intervention studies. Similarly, about 122 and 152 drugs were dispensed by medicine retailers in Butwal and Bhairahawa after intervention studies. The average numbers of medicines dispensed by medicine retailers were 4.56±1.66 and 3.96±1.92 before intervention in the Butwal and Bhairahawa study sites. The average numbers of medicines dispensed by medicine retailers were 3.78±1.06 and 4.78±1.73 after intervention in the study sites of Butwal and Bhairahawa. None of the medicine retailers talked about either the brand or generic name and strength of antibiotic medicine to the simulated patient before and after intervention in both study sites. Similarly, medicine retailers informed about the frequency of dosage of antibiotic medicine to simulated patients before and after interventions in Butwal and Bhairahawa cities. However, there was no statistical significance (P=0.388) observed in Butwal City, whereas in Bhairahawa City, statistical significance (P=0.006) was observed.

Antibiotic dispensing without a prescription is routine. Insufficient medicine information was given to the simulated patient by the medicine retailer. Hence, we suggest meaningful implementation of policy and regular inspection to improve the situation.

The efficacy of immunization is contingent upon public acceptance. Using the behavioral theory of the Health Belief Model (HBM), this study seeks to determine intervention strategies against the most influential factor towards the acceptance of the COVID-19 vaccination program among the societies of Singkawang City.

This investigation involved a cross-sectional design. The perceived severity, susceptibility, barriers, benefits, cues to action, and self-efficacy were the independent variables. The dependent variable was the adoption of the COVID-19 vaccine by the public. Mann-Whitney, Chi-square and Multivariate tests were used to present vaccine acceptance differences, relationships and impacts of each variable towards COVID-19 vaccine acceptance.

There was a total of 461 participants in this study. For the majority of respondents (56.40%), COVID-19 vaccine acceptance among them remains modest. The difference between the low and high vaccination acceptance groups (p-value < 0.05) was revealed. Except for perceived severity, this study demonstrated that all HBM constructs had a significant relationship with vaccination acceptance (p-value < 0.05). In addition, the results of the logistic regression test indicated that the cues-to-action construct was the most influential factor in vaccine acceptance (OR= 7.156; CI, 95%= 4.107 – 12.469), followed by self-efficacy (OR=3.218; CI, 95%=1.819 – 5.694).

Thus, health policymakers should focus on cues-to-action and self-efficacy factors for developing a strategy to increase vaccine acceptance among the Indonesian population by using current study results among the Singkawang population as a model to start the persuasion techniques.

Stress occurs when people are faced with challenges and feel overwhelmed. Too much stress can cause negative effects on the body. Medical students especially feel a lot of stress due to their curriculum, which affects their eating habits and, in turn, their academic performance.

This study aimed to assess the effects of academic-related and teaching and learning-related stressors on the pattern of eating habits.

A cross-sectional study was carried out among students of private medical universities in UAE. MBBS and BDS students of and above the age of eighteen were included. A standardized questionnaire (Medical Student Stressor Questionnaire) was used to collect data. SPSS version 28 was used to analyze the data.

We identified two main types of stressors: Academic Related Stressors (ARS) and Teaching and Learning Related Stressors (TLRS), resulting in high levels of stress causing them to eat more than usual or less than usual. Most students (82.6%) who ate less or much less than usual had experienced high or severe stress due to academic-related stressors of ‘strenuous task’ (P=0.007). Moreover, 81.5% of students who ate more than usual had experienced high or severe stress when they were nervous and stressed (P=0.004). When feeling “difficulties pile up” and during times when students “lacked confidence” due to teaching-related stressors, 71.7% and 66.3% of the participants experienced mild/moderate stress, respectively and ate less or much less than usual (P<0.05).

We were able to determine the effect of academic-related stressors (ARS) and teaching and learning-related stressors (TLRS) on eating habits. This has led us to discover the importance of well-developed and improved intervention programs by universities to reduce stress and promote healthy eating habits among medical students.