Antibody Response to SARS-CoV-2: A Cohort Study in Qatar's Primary Care Settings.

BACKGROUND: Globally, countries are rolling out Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) quarantine policies and vaccination programs. Research studies are needed in helping understand the likelihood of acquired immunity to reinfection and identify priority groups for vaccination to inform them. This study aimed to assess period prevalence and longitudinal changes in antibody levels after SARS-CoV-2 infection in Qatari primary care settings. METHODS: A cohort study design with 2 data collection phases was undertaken-Phase 1 (conducted in July 2020) and Phase 2 (conducted in October 2020). A stratified random sampling technique by age, gender and nationality was utilized to identify the study sample. The total sample size required for the study was estimated to be 2102. Participants were invited to an appointment where they were administered a questionnaire and provided samples for polymerase chain reaction and Immunoglobulin G immunoassay tests. RESULTS: A total of 943 individuals participated in both Phase 1 and Phase 2. In this cohort, seroprevalence of SARS-CoV-2 was found to be 12% (N = 113) in Phase 1 and 17.2% (N = 162) in Phase 2. Of the 113 participants who were seropositive in Phase 1, 38.1% (CI 29.5-47.2%, N = 43) had a reduction, 54.9% (CI 45.7-63.8%, N = 62) had no change, and 7.1% (CI 3.4-12.9%, N = 8) had an increase in IgG titer in Phase 2. All (N = 18) participants aged 10 to 17 years retained their antibodies. The proportion of men who retained their antibodies was slightly higher compared to women-92.5% (N = 74) and 87.9% (N = 29) respectively. Similarly, symptomatic individuals (97.8%; N = 45) had a higher antibody retention compared with asymptomatic individuals (86.4%; N = 57). CONCLUSIONS: This study provides preliminary information on the longitudinal changes in antibody levels after SARS-CoV-2 infection. These findings will help inform quarantine policies and vaccination programs.

Primary health care physicians' perspective on COVID-19 pandemic management in Qatar: a web-based survey.

OBJECTIVES: To assess primary care physicians' satisfaction towards COVID-19 pandemic management in Qatar and to identify the associated factors with their satisfaction. DESIGN: A cross-sectional web-based survey conducted from 1 June to 30 July 2020. SETTING: All the 27 public primary healthcare centres in Qatar. PARTICIPANTS: 294 primary care physicians working in the publicly run primary healthcare corporation in Qatar. PRIMARY OUTCOME MEASURES: Overall satisfaction towards COVID-19 management in Qatar and satisfaction towards each aspect of this management including COVID-19 clinical practice guidelines, psychological support, team dynamics, work safety as well as institutional and governmental regulations. RESULTS: 294 primary care physicians participated in the survey with a response rate of 65%. Overall satisfaction of physicians towards COVID-19 19 management at Primary Health Care Corporation was 77%. The highest satisfaction was towards institutional and governmental support while it was the lowest towards the corporation case definition and management of COVID-19 guidelines. Female physicians were less satisfied with psychological support in comparison to males (64.1% and 51% respectively, p=0.049). Overall satisfaction towards case definition and management of COVID-19 guidelines were strongly correlated with their clarity, updating these guidelines in due time and applicability of the guidelines (r=0.759 P<0.001; r=0.701 P<0.001; r=0.698 P<0.001) respectively, while satisfaction towards work safety was strongly correlated with availability and quality of Personal Protective Equipment provided (r=0.83 P<0.001 and r=0.811 P<0.001 respectively). CONCLUSION: Most primary care physicians in Qatar who responded to the survey were satisfied with the COVID-19 guidelines developed rapidly in response to this pandemic. Availability and quality of PPE were a particular concern. The clinicians who were less satisfied were younger and female.

Diabetes, hypertension and dyslipidemia medication prescribing in Qatari primary care settings: a retrospective analysis of electronic medical records.

BACKGROUND: Globally, non-communicable diseases (NCDs) are recognised as a leading cause of morbidity and mortality. Medications and medicines optimisation play an important role in the management of modifiable physiological risk factors and NCDs. The importance of lifestyle interventions in prevention of modifiable risk factors is also well established. The aim of this paper was to describe the quantity of type 2 diabetes mellitus (T2DM), hypertension and dyslipidaemia prescribing in Qatari primary care settings. Its findings will provide necessary information to inform pharmaceutical policy and practice. METHODS: The study was undertaken in Qatar's publicly funded primary health care centres. Data sources for this study comprised electronic medical records. The Anatomical Therapeutic Chemical (ATC) drug classification system was used to classify the medications prescribed. The number and proportion of medications by age, sex, nationality and diagnosis (T2DM, hypertension and dyslipidaemia) were reported. RESULTS: A total 81,569 individuals were included (18-29 years 2.4%; 30-39 years 11.7%; 40-49 years 25.4%; 50-59 years 31.9% and ≥ 60 years 28.6%). 55.6% participants were male. On average 10.2 medications were prescribed per person and 2.3 medications were included in each prescription. T2DM medications were most prescribed (N = 361,87780,799; 43.2%) followed by hypertension (N = 303,086; 36.2%) and dyslipidaemia (N = 172,163; 20.5%). Of the total medications prescribed, 72% (N = 605,488) were prescribed in individuals aged 50 years and above. Men were prescribed 62% (N = 515,043) medications while women were prescribed 38% (N = 322,083) medications. Southern Asians (N = 330,338; 39%) were prescribed most medication followed by Qataris (N = 181,328; 22%) and Northern African (N = 145,577; 17%). CONCLUSIONS: In Qatar's primary care settings, average medications prescribed per patients were found to be higher compared to other populations. While medications were actively prescribed for the 3 conditions, the study found variations by medication type, age, gender and nationality. Rational guidelines for the utilisation of medications need to be established with the support of real-world evidence.

Prognostic significance of E-Cadherin, ß-Catenin and cyclin D1 in oral squamous cell carcinoma: a tissue microarray study.

OBJECTIVE: To study the prognostic significance of E-cadherin, ß-catenin, and cyclin D1 expression in oral squamous cell carcinoma. SUBJECTS AND METHODS: The study included 65 subjects with histologically confirmed squamous cell carcinoma. TMA blocks were prepared for immunohistochemical quantification of the expression of the three markers using IHC profiler and Immune ratio plugin of Image J. RESULTS: E-cadherin expression was significantly correlated with histological grades and the metastasis status (p<0.05), whereas ß-catenin expression was significantly correlated with smoking and tumor recurrence (P<0.05). Cyclin D1 expression was significantly correlated with depth of invasion and tumor recurrence. (p<0.05). Advanced tumor stage and depth of tumor invasion increases the risk of recurrence or death by 2.5 times (OR= 2.53 and 0.84 respectively). CONCLUSION: High expression of ß-Catenin and Cyclin D1 are significantly correlated with tumor recurrence and old age. Depth of invasion, low histological grade and old age were a significant predictor for the risk of having tumor recurrence and cancer related death.

Epidemiology of SARS-CoV2 in Qatar's primary care population aged 10 years and above.

BACKGROUND: There is an urgent need to elucidate the epidemiology of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) and characterize its potential impact. Investing in characterising the SARS-CoV2 will help plan and improve the response to the pandemic. Furthermore, it will help identify the most efficient ways of managing the pandemic, avoiding public health policies and interventions that may be unduly restrictive of normal activity or unnecessarily costly. This paper describes the design and reports findings of a population based epidemiological study undertaken to characterise SARS-CoV2 in Qatar using limited resources in a timely manner. METHODS: Asymptomatic individuals ≥10 years registered with Qatar's publicly funded primary health provider were eligible. A stratified random sampling technique was utilized to identify the study sample. Participants were invited to an appointment where they completed a questionnaire and provided samples for polymerase chain reaction and Immunoglobulin M and G immunoassay tests. Data collected were analyzed to calculate point and period prevalence by sociodemographic, lifestyle and clinical characteristics. RESULTS: Of 18,918 individuals invited for the study, 2084 participated (response rate 10.8%). The overall point prevalence and period prevalence were estimated to be 1.6% (95% CI 1.1-2.2) and 14.6% (95% CI 13.1-16.2) respectively. Period prevalence of SARS-CoV2 infection was not considerably different across age groups (9.7-19.8%). It was higher in males compared to females (16.2 and 12.7% respectively). A significant variation was observed by nationality (7.1 to 22.2%) and municipalities (6.9-35.3%). CONCLUSIONS: The study provides an example of a methodologically robust approach that can be undertaken in a timely manner with limited resources. It reports much-needed epidemiological data about the spread of SARS-CoV2. Given the low prevalence rates, majority of the population in Qatar remains susceptible. Enhanced surveillance must continue to be in place, particularly due to the large number of asymptomatic cases observed. Robust contact tracing and social distancing measures are key to prevent future outbreaks.

COVID-19 Surveillance in the Primary Health Care Population of Qatar: Experience of Prioritizing Timeliness Over Representativeness When Sampling the Population.

SARS-CoV2 a new emerging Corona Virus Disease in humans, which called for containment measures by many countries. The current paper aims to discuss the impact of two different sampling methodologies when executing a drive through COVID-19 survey on the quality of estimated disease burden measures. Secondary data analysis of a pilot cross-sectional survey targeting Qatar's primary health care registered population was done. Two groups with different sampling methods were compared for estimating COVID-19 point prevalence using molecular testing for nasopharyngeal swabs. The first group is a stratified random sample non-proportional to size (N = 260). A total of 16 population strata based on age group, gender, and nationality were sampled. The second group is the Open invitation group (N = 841). The results showed that the two groups were obviously and significantly different in age and nationality. Besides, reporting of COVID-19 symptoms was more frequent in the open invitation group (28.2%) than the random sample (16.2%). The open invitation group overestimated the symptomatic COVID-19 prevalence rate by more than four times, while it overestimated the asymptomatic COVID-19 cases by a small margin. The overall prevalence rate of active COVID-19 cases in the open invitation sample (13.3%) was almost double that of the random sample (6.9%). Furthermore, using population sampling weights reduced the prevalence rate to 0.8%. The lesson learned here is that it is wise to consider the magnitude of bias introduced in a surveillance system when relying on convenient sampling approaches in response to time constraints.

Estimating point prevalence of COVID-19 in Qatar's primary care registered population: an RT-PCR drive-through study protocol.

BACKGROUND: The first COVID-19 cases in Qatar were reported on 29 February 2020. As the epidemic progresses, essential epidemiological information is needed to facilitate monitoring of COVID-19 in the population and plan the pandemic response in Qatar. AIM: The primary aim of this cross-sectional study is to estimate the point prevalence of COVID-19 in Qatar's primary care registered population. DESIGN & SETTING: A cross-sectional study design will be utilised. One publicly funded health centre from each of three geographical regions in Qatar will be identified as a study location and set up to facilitate a drive-through for the study. METHOD: Primary Health Care Corporation (PHCC) is publicly funded and the largest primary care provider in Qatar. The study will include randomly selected individuals from the full list of PHCC's registered population on its electronic medical records system. The sample selection will be done using a proportional to size sampling technique stratified by age, sex, and nationality representative of the overall PHCC-registered population. Considering the total population registered in PHCC, a sample of 2080 is proposed. A questionnaire will be administered to collect sociodemographic information, and nasal and throat swab samples will be taken. Data will be analysed to report overall symptomatic and asymptomatic point prevalence of COVID-19. CONCLUSION: This study, with the help of a randomly selected representative sample from Qatar's primary care registered population, will provide results that can be applied to the entire population. This study design will closely represent a real-world scenario of the outbreak and is likely to provide important data to guide COVID-19 pandemic planning and response in Qatar.

Inter-personal versus content: assessment of communication skills in Iraqi physicians.

OBJECTIVES: The current study sought to evaluate the communication skills of Iraqi physicians from a patient perspective, differentiating between "interpersonal" and "content" components of communication. In the past century, the doctor-patient relationship has changed considerably, shifting from a paternalistic, physician-dominated approach to a more dynamic and patient-centered. In such a context, effective communication skills have become even more crucial for good medical practice and most accreditation organizations urge medical schools to teach and evaluate communication skills. METHODS: A cross-sectional study was conducted at Baghdad Teaching Hospital's three major departments (Surgery, Medicine, Obs/ Gyne). The final sample included 270 participants. A factor analysis was performed and generated two dimensions ("interpersonal" and "content"). Statistical differences between the groups and between the two dimensions of the questionnaire were analysed through t-tests and ANOVA. In addition, a multiple linear regression model was used to study the effect of some variables on the dependent variable "communication". RESULTS: The study showed a significant difference between "interpersonal" and "content" communication, with patients reporting higher satisfaction for the former. Reported satisfaction rates varied amongst the three departments with the Surgery specialty scoring significantly lower than the Medicine and the Obs/Gyne department. The duration of care under the current physician, a higher rank of specialty and the settings (inpatients versus outpatients) were positively and significantly associated with a higher quality of communication skills. CONCLUSIONS: These findings have significant implications for training institutions.

Salivary microRNA 155, 146a/b and 203: A pilot study for potentially non-invasive diagnostic biomarkers of periodontitis and diabetes mellitus.

Dysregulated expression of MicroRNAs (miRNAs) plays substantial role in the initiation and progression of both diabetes and periodontitis. The aim of the present study was to validate four miRNAs in saliva as potential predictive biomarkers of periodontal disease among patients with and without diabetes mellitus (DM). MiRNAs were extracted from the saliva of 24 adult subjects with DM and 29 healthy controls. Each group was subdivided into periodontally healthy or having periodontitis. In silico analysis identified 4 miRNAs (miRNA 155, 146 a/b and 203) as immune modulators. The expression of miRNAs-146a/b, 155, and 203 was tested using quantitative PCR. The expression levels in the study groups were compared to explore the effect of diabetes on periodontal status and vice versa. In our cohort, the four miRNAs expression were higher in patients with periodontitis and/or diabetes. miRNA-155 was the most reliable predictors of periodontitis among non-diabetics with an optimum cut-off value of < 8.97 with accuracy = 82.6%. MiRNA 146a, on the other hand, was the only reliable predictor of periodontitis among subjects with diabetes with optimum cut-off value of ≥11.04 with accuracy = 86.1%. The results of the present study concluded that MiRNA-146a and miRNA155 in saliva provide reliable, non-invasive, diagnostic and prognostic biomarkers that can be used to monitor periodontal health status among diabetic and non-diabetic patients.

Prevalence of metabolic syndrome in primary health settings in Qatar: a cross sectional study.

BACKGROUND: In Qatar, prevalence of metabolic components is significantly higher compared to other countries. It is therefore urgent to understand the prevalence of metabolic syndrome (MetS) with the goal of identifying etiologic factors in Qatar. This study was undertaken to estimate the prevalence of MetS, by age, gender and nationality within primary care settings in Qatar. In addition, it determined the independent effects of risk factors on the prevalence of MetS. METHODS: A cross-sectional study design was used. Data for individuals aged ≥18 and who visited a publicly funded primary health centre in Qatar during 2017 were extracted from electronic medical records and analysed. RESULTS: The findings showed that the prevalence of individual MetS components ranged between 48.5-60.3%. Overall prevalence of MetS was 48.8% (N = 62,492) in the study population. Prevalence of MetS increased with age. 50.3% of the population within the 40-49 year age group had MetS. In this age band, individuals were 5.1 times more likely of having MetS compared to the 18-29 year age group. MetS was slightly more prevalent in men (56 .7%) compared to women (42.5%). However, men were 1.33 times more likely of having MetS compared to women. The prevalence of MetS ranged between 20.6 - 60% across nationalities. It was most prevalent in Southern Asians (60%), followed by Northern Africans (50.7%) and Western Asians (excluding Qatar) (46.8%). Prevalence of MetS in Qataris was 43%. Southern Asians, Northern African and Western Asians were 1.73, 1.38 and 1.17 more likely to have MetS compared to Qataris. CONCLUSIONS: The study provides essential epidemiological information required by decision makers. Although not nationally representative, this study is suggestive of a higher prevalence of MetS among a younger population, men and in Southern Asian, Northern African and Western Asian nationalities. Prevention, treatment and control of MetS is a public health problem in Qatar. More studies are needed to establish which public health interventions are likely to be effective in Qatar.

Vitamin D status among adults (18-65 years old) attending primary healthcare centres in Qatar: a cross-sectional analysis of the Electronic Medical Records for the year 2017.

OBJECTIVES: To investigate the prevalence of vitamin D deficiency among individuals attending primary healthcare facilities in Qatar and to assess the association between vitamin D deficiency and some medical conditions in persons aged 18-65 years old. SETTING: The study was undertaken in publicly funded primary healthcare services in the State of Qatar. PARTICIPANTS: A total of 102 342 participants aged between 18 and 65 years old with a valid serum vitamin D test result during the year 2017. OUTCOME MEASURES: Serum level <10 ng/mL (<25 nmol/L) was defined as severe vitamin D deficiency, a serum level of <20 ng/mL (<50 nmol/L) was defined as vitamin D deficiency and a serum level <30 ng/mL (<75 nmol/L) defined as vitamin D insufficiency. RESULTS: The prevalence rate of severe vitamin D deficiency was 14.1% among study participants with no history of vitamin D replacement therapy in the previous months. The prevalence rate of vitamin D deficiency was as high as 71.4% and that of vitamin D insufficiency was up to 92.7%. None of the five chronic conditions explored in the study (diabetes, hypertension, asthma, stroke and cardiovascular disease) had an obvious association with severe vitamin D deficiency status in a bivariate analysis. However, multivariate modelling showed that (adjusting for age, gender, body mass index and nationality and each of the included chronic conditions) hypertension, cardiovascular diseases and stroke placed an individual at a higher risk of having an associated severe vitamin D deficiency status. CONCLUSION: Although not comprehensive and nationally representative, this study is suggestive of a higher prevalence of vitamin D deficiency among young adults, females, Qatari nationality and those with higher body mass index. Multivariate modelling showed that hypertension, cardiovascular diseases and stroke were associated with a higher risk of severe vitamin D deficiency status.

Concha bullosa, nasal septal deviation, and their impacts on maxillary sinus volume among Emirati people: A cone-beam computed tomography study.

PURPOSE: To determine the prevalence of concha bullosa (CB) and nasal septal deviation (NSD) and their impact on maxillary sinus volume (MSV). MATERIALS AND METHODS: Cone-beam computed tomographic (CBCT) images of 106 Emirati people were used in this study. The direction and angle of septal deviation were calculated. The presence of CB, which could be unilateral, contralateral, or bilateral in relation to the direction of NSD, was also recorded. MSV was measured using reconstructed Digital Imaging and Communication in Medicine images on Dolphin 3D imaging software version 11.8 premium (Dolphin Imaging, Chatsworth, CA, USA). P values <0.05 were considered to indicate statistical significance. RESULTS: CB was detected in 37.7% of the sample; 20.7% of the sample showed single unilateral CB and 16.6% had single bilateral CB. NSD was seen in 74.5% of the sample. In the participants with CB, 45.5% showed mild deviation, 34.4% showed moderate deviation, and only 12.5% showed severe septal deviation. CB, but not NSD, was associated with significantly higher MSV on the affected side (P=0.001). CONCLUSION: Although NSD was observed in more than two-thirds of the sample and CB was present in more than one-third of the sample, only CB had a significant impact on MSV.

Occupational noise-induced hearing loss among dental professionals.

OBJECTIVE: The purpose of this study was to determine whether the persistent high-frequency noise produced by dental equipment could cause hearing impairment among the dental professionals in the United Arab Emirates (UAE). METHOD AND MATERIALS: This cross-sectional study was conducted to evaluate the hearing capacity of 90 randomly selected dental practitioners from different specialties working in the UAE. The participants were approached in their workplace and their hearing capacity was evaluated using the pure tone audiometer. RESULTS: Twenty dental practitioners suffered from hearing impairment, which constitutes 22.2% of the studied sample. At high frequencies, left ears were more affected than right ears, but this was not statistically significant. There was a direct relationship between working hours per week and the hearing capacity, but this did not reach a statistically significant level. The lowest hearing capacity was detected in males at a significantly lower value compared to females. CONCLUSIONS: Positive correlation was found between years of experience and reduced hearing capacity among dental practitioners. In addition, males had a significantly higher median count of severely affected hearing frequencies compared to females. Online pure tone audiometric testing is an easy, cost-effective tool that can be used to self-assess the hearing capacity of dental professionals, and it is recommended to perform this test annually.

Why People Apply to Medical School in Iraq?

BACKGROUND: The motivations behind why people choose to study medicine in Iraqi medical schools are unknown. Such information could help school pupils to make more informed career decisions and assist medical schools in enhancing the student selection process. AIMS: To investigate why people choose to study medicine in Iraq. SUBJECTS AND METHODS: The first-year students admitted on the academic year 2015-2016 to Baghdad College of Medicine, University of Baghdad, were invited to complete a structured questionnaire, which was administered through the college electronic education portal. The data were analyzed using IBM SPSS version 21 software. RESULTS: A total of 152 (50% response rate) students responded. Women constituted 69.1% of respondents. Most students (61.8%) had made their choice by themselves without family pressure. The most frequent reasons that affected this choice were "humanitarian reasons and a wish to provide help to others" as well as "childhood dream," "positive community appraisal of doctors," and "ready availability of work for physicians." About three-quarters (73.6%) of the students made some inquiry about medical school before making their choice, and the people asked were most frequently a medical student or a doctor. Information provided by the consulted parties was regarded as satisfactory by 64.2% of the surveyed students, had a positive value in 47.2%, and affected their decision in 34.9%. The highest proportion (42.2%) of the study sample was thinking about studying medicine since primary school. In addition, students with personal preference made their choice at a significantly younger age. CONCLUSIONS: Reasons to apply for medical schools in Iraq are similar to those in many countries. Most of the students who inquired about studying medicine had not contacted the medical school itself.

Impaired trafficking of the very low density lipoprotein receptor caused by missense mutations associated with dysequilibrium syndrome.

Dysequilibrium syndrome (DES, OMIM 224050) is a genetically heterogeneous condition that combines autosomal recessive non-progressive cerebellar ataxia with mental retardation. The subclass dysequilibrium syndrome type 1 (CAMRQ1) has been attributed to mutations in the VLDLR gene encoding the very low density lipoprotein receptor (VLDLR). This receptor is involved in the Reelin signaling pathway that guides neuronal migration in the cerebral cortex and cerebellum. Three missense mutations (c.1459G>T; p.D487Y, c.1561G>C; p.D521H and c.2117G>T; p.C706F) have been previously identified in VLDLR gene in patients with DES. However, the functional implications of those mutations are not known and therefore we undertook detailed functional analysis to elucidate the cellular mechanisms underlying their pathogenicity. The mutations have been generated by site-directed mutagenesis and then expressed in cultured cell lines. Confocal microscopy and biochemical analysis have been employed to examine the subcellular localization and functional activities of the mutated proteins relative to wild type. Our results indicate that the three missense mutations lead to defective intracellular trafficking and ER retention of the mutant VLDLR protein. This trafficking impairment prevents the mutants from reaching the plasma membrane and binding exogenous Reelin, the initiating event in Reelin signaling. Collectively, our results provide evidence that ER quality control is involved in the functional inactivation and underlying pathogenicity of these DES-associated mutations in the VLDLR.