Factors associated with knowledge and practice of optimal breastfeeding among mothers in Dubai.

Although breastfeeding has been the primary source of nutrition for infants, many women do not choose to practise breastfeeding due to lack of knowledge, inability to do so or personal choices. This study aimed at determining the breastfeeding practices and examining the sociodemographic factors associated with optimal breastfeeding among mothers attending child welfare clinic at Dubai Health Authority. A structured questionnaire was designed consisting of sociodemographic data, knowledge, attitude and practice towards breastfeeding. The main reasons for not breastfeeding the baby within 30 min after delivery were having had a caesarean section, followed by separation of the baby from the mother. We found better practice among homemakers, non-United Arab Emirates (UAE) and married women, those with less monthly income, and those with standard delivery. There is a need for better education on optimal breastfeeding, especially in UAE national pregnant women, who have had caesarean sections, or having babies admitted in the intensive care unit.

Digital Health Technology for Remote Care in Primary Care During the COVID-19 Pandemic: Experience from Dubai.

Introduction: We aimed to provide an insight on the feasibility and impact of telemedicine use among primary health care (PHC) providers and on nonurgent health care delivery during the coronavirus disease 2019 (COVID-19) outbreak in the United Arab Emirates (UAE). Methods: This observational study was conducted using telemedicine data from Dubai Health Authority from January 2020 to July 2021. Results: Of 123,944 individuals who booked an appointment for the telemedicine service, 106,408 (86%) showed up. Most patients were 19-59 years old, UAE nationals, female, and having government insurance. The telemedicine care volume grew from 188 visits in January 2020 to 11,757 in April 2020. The most common diagnosis was general health consultation (55,672; 52%), followed by COVID-19-related consultation (18,523; 17%) and laboratory test requests (11,064; 10%). Around 4,997 (5%) telemedicine consultations were for a medication refill. A multiple linear regression model predicting the types of diagnosis-related telemedicine needs by age and the interaction of gender and nationality was statistically significant for dermatology (p = 0.0000), respiratory (p = 0.0000), and cardiovascular (p = 0.0000) diseases. Conclusions: Virtual care services in PHC clinics have been highly successful in meeting the needs of patients during the COVID-19 pandemic. Telemedicine has enabled clinicians to continue providing care to patients while maintaining the necessary public health measures adopted in the fight against COVID-19. However, will the switch to telemedicine be sustainable in the long term and what will be the level and degree of telemedicine adoption beyond COVID-19? This requires more studies to explore how the PHC organizations will provide further support and guidance on the suitability of telemedicine in various circumstances and clinical conditions.

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

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.

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

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

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.

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

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.

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

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.

Adoption of Electronic Medical Records in Healthcare Facilities in the Emirate of Dubai.

OBJECTIVES: This paper aimed to assess the adoption of electronic medical records (EMRs) in healthcare facilities in Dubai, the largest city in the United Arab Emirates (UAE) and a location where extensive healthcare services are provided. It explored the challenges, milestones, and accomplishments associated with this process. METHODS: A situation analysis was conducted by contacting 2,089 healthcare facilities in Dubai to determine whether they had implemented EMR in their medical practices and to identify the challenges they faced during this process. Additionally, the Electronic Medical Record Adoption Model (EMRAM) was utilized to measure the maturity level of hospitals in terms of EMR adoption. The EMRAM stages were rated on a scale from 0 to 7, with 0 representing the least mature stage and 7 the most mature. RESULTS: By September 2023, all hospitals (100%, n = 54) and 75% of private clinics (n = 1,460) in Dubai had implemented EMRs. Several challenges were identified, including the absence of EMRs within the healthcare facility, having an EMR with a low EMRAM score, or the lack of a unified interoperability standard. Additionally, the absence of a clear licensing program for EMR vendors, whether standalone or cloud-based, was among the other challenges noted. CONCLUSIONS: EMR implementation in healthcare facilities in Dubai is at a mature stage. However, further efforts are required at both the decision-making and technical levels. We believe that our experience can benefit other countries in the region in implementing EMRs and using EMRAM to assess their health information systems.

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

Compound heterozygosity for Hb D-Punjab [ß121(GH4)Glu→Gln, GAA>CAA] /ß-thalassemia (ß-thal) must be carefully differentiated from homozygous Hb D-Punjab in premarital screening. This is essential when the partner is a carrier of ß-thal trait. The case of a baby born affected with ß-thal major (ß-TM), from a marriage between a mother with ß-thal trait and a father with Hb D-Punjab/ß-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 ß-thal carrier.

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

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: ß-thalassemia (ß-thal), 4.56% (n = 293); Hb S [ß6(A3)Glu→Val, GAG>GTG; HBB: c.20A>T], 2.9% (n = 186); Hb D-Punjab [ß121(GH4)Glu→Gln, GAA>CAA; HBB: c.364G>C], 0.78% (n = 50); Hb Lepore (뫧 hybrid gene) with an undetermined molecular genotype, 0.17% (n = 11); Hb E [ß26(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-ß-thal also occurred at a rate of 0.016% (n = 1) each; and 0.87% (n = 56) subjects were suspected of carrying silent ß-thal. The prevalence of ß-thal trait was consistent with the prevalence published by others in the region. Silent ß-thal is challenging for screening programs, and is expected to arise in populations with a high prevalence of ß-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 ß-thal major (ß-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 ß-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.

Knowledge, Attitudes, and Willingness regarding Organ Donation in a Muslim Country: A Report from the United Arab Emirates.

In Islamic countries, many religious scholars have allowed organ transplantation. However, ethical judgments on organ transplantation are disputable and unpredictable. Therefore, opinions about organ transplantation depend on personal beliefs, as well as religious faith, cultural convictions, and sociocultural factors, which deserve discussion and study. The objective of this study was to assess the knowledge of and attitudes toward organ donation in a multicultural society such as Dubai. A questionnaire was designed by a multidisciplinary team through a review of the literature. Participants were approached from October 2018 until September 2019. Our study showed a poor general knowledge of organ donation overall (447, 66%) and low awareness of the organ donation laws and regulations in the United Arab Emirates (UAE) (376, 55%). Most respondents mentioned that they were not willing to register to be an organ donor (393, 58%); nevertheless, they would accept an organ donation (347, 51%), even from a recently deceased person if required (376, 55%). The UAE faces scarcity among plenty as far as organ donation is concerned. Our study identified several consistent themes regarding barriers to organ donation among people in the UAE. The ever-increasing demand for organs can only be met by a multidisciplinary approach to educate the public and health-care providers further.

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.

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.

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

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 25­30 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.

The Pupillary Light Reflex as a Biomarker of Concussion.

The size of our pupils changes continuously in response to variations in ambient light levels, a process known as the pupillary light reflex (PLR). The PLR is not a simple reflex as its function is modulated by cognitive brain function and any long-term changes in brain function secondary to injury should cause a change in the parameters of the PLR. We performed a retrospective clinical review of the PLR of our patients using the BrightLamp Reflex iPhone app. The PLR variables of latency, maximum pupil diameter (MaxPD), minimum pupil diameter (MinPD), maximum constriction velocity (MCV), and the 75% recovery time (75% PRT) were associated with significant differences between subjects who had suffered a concussion and those that had not. There were also significant differences in PLR metrics over the life span and between genders and those subjects with and without symptoms. The differences in PLR metrics are modulated not only by concussion history but also by gender and whether or not the person has symptoms associated with a head injury. A concussive injury to the brain is associated with changes in the PLR that persist over the life span, representing biomarkers that might be used in clinical diagnosis, treatment, and decision making.

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.

BACKGROUND: Studies have shown that public awareness of ovarian cancer is weak, and women are often diagnosed at late stages when treatment is difficult. This study aimed to determine the barriers for seeking early medical care and level of knowledge and awareness among women regarding ovarian cancer. DESIGN AND METHODS: 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.

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

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.

Pregnant women's perceptions of physical activity: Adaptation of the pregnancy physical activity questionnaire in Dubai, a multicultural society.

BACKGROUND: There are major health benefits of physical activity (PA) during pregnancy, yet there is scant data about a woman's knowledge and understanding of these benefits globally. DESIGN AND METHODS: We aimed to evaluate the knowledge, attitude, and practice of pregnant women in the United Arab Emirates concerning exercise.   We wanted to investigate why some women exercise while others do not exercise during pregnancy. We used a cross-sectional study using a paper-based questionnaire involving pregnant women at antenatal clinics in the Dubai health Authority. The Modified form of Pregnancy Physical Activity Questionnaire (PPAQ) was adapted in both Arabic and English and used in this study. RESULTS:  Women aging 25-35 that had a higher educational level, were employed, having 1 or 2 previous pregnancies, and having better knowledge on the benefits of Physical Activity (PA) during pregnancy had better exercise profiles. CONCLUSIONS: Our results demonstrate that the majority of the women that participated in our study were shown to have low PA during pregnancy. Better education and communication of the benefits of PA during pregnancy are needed to improve exercise among pregnant women in the UAE population. We found that improved education of women specific to PA with involvement of a healthcare provider were associated with an increase in PA during pregnancy.

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

Population awareness of cardiovascular disease risk factors and health care seeking behavior in the UAE.

OBJECTIVES: We aimed to determine the awareness, knowledge, and attitude of people residing in Dubai, United Arab Emirates, regarding cardiovascular disease (CVD) risk factors. Our aim was to further identify prospects to increase awareness of modifiable CVD risk factors and influence behavior. METHODS: This observational study was conducted in Dubai: a global city in the United Arab Emirates. Participants were selected using simple randomization approach in primary health care centers, and a questionnaire was implemented based on literature review. RESULTS: Out of 1020 individuals approached, 738 agreed to participate in the study (response rate of 72%).The majority of participants surveyed had good knowledge and attitude toward CVD (528, 71.5% and 445, 60% respectively); yet, poor/fair practice related to CVD risk factors (553, 75%). Predictive Margins of Knowledge Scores were significant for age (p<.01), academic level (p<.0001), and nationality (p<.0001) (Table 5). Participants aging 40-49, non-UAE subjects, and university/Postgraduate academic level scored better on the knowledge. Demographics predictor for practice score was highly significant for age (p=.0001) and BMI (p=.0001). Those aging ≥50 and obese participants scored higher on practice toward CVD risk factors. Knowledge score was significant predictor of practice and attitude toward CVD risk factors (p=.0001, p<.0001). CONCLUSIONS: Although more than half of the current study participants had high knowledge and attitude toward CVD, their behaviors were not satisfactory. It is necessary to establish more effective educational interventions intended to promote positive health behaviors. Public health providers need to explain to the public that knowledge and proper actions regarding the reduction of risk factors are associated with reduced CVD and mortality.

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

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.