Seroprevalence of SARS-CoV-2 infection among blue-collar workers in United Arab Emirates.

Background: This is one of the first studies exploring immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among blue-collar workers in Abu Dhabi. Aims: This study estimated the seroprevalence of SARS-CoV-2 infection among workers living in a closed setting using qualitative analysis of the total SARS CoV-2 antibody immune response. Methods: We conducted this monocentric, prospective, observational study in a labour compound for a cohort of workers between 28 March and 6 July 2020. We tested for SARS-CoV-2 (nasopharyngeal) (RT-PCR) and anti-SARS-CoV-2 T-Ab. Results: Out of a total of 1600 workers, 1206 (75.0%) participated in the study - all were males, median age 35 years (19-63 years). We found 51% of the participants to be positive for SARS-CoV-2; the 49.0% who tested negative were considered as contacts. Anti-SARS-CoV-2 T-Ab was detected among 864 participants, showing an overall point prevalence of 71.6%. A relatively higher response was found among cases (89.0%) than among contacts (53.2%). Conclusion: This study highlights the need to prioritize public health interventions in closed settings where disease transmission is higher due to greater overall exposure. A high seroprevalence of anti-SARS-CoV-2 T-Ab was found among the residents. A serial quantitative study applying time series and regression models is recommended to further evaluate the sustainability of the immune response among this and similar population groups.

Gulf Asthma Diagnosis and Management in Adults: Expert Review and Recommendations.

The prevalence and incidence of asthma are increasing globally because of genetic and environmental influences. Prevalence of asthma in the Gulf has been reported to range from 4.7% to 32.0% and has a substantial economic burden. In this paper, we summarize current asthma management guidance for adults, present insights, and recommendations by key opinion leaders (KOLs) in the Gulf region, and key performance indicators for guiding clinical practice for asthma diagnosis, management, and treatment in the Gulf. While it is recommended that the Global Initiative for Asthma (GINA) guidelines should be followed wherever possible for the management of asthma, KOLs in the Gulf region have presented additional recommendations based on regional challenges and insights. There is a need for better diagnosis using objective testing, increased efforts in tackling the burden of comorbidities in the region, and greater provision of the necessary tools for phenotyping severe asthma. Furthermore, there is a need for greater education for physicians regarding asthma treatment, including the importance of inhaled-corticosteroid-containing controller medication. Regionally, there is also a need for specialist asthma clinics and asthma educators, which would serve to educate physicians and their patients as well as to improve the management of patients. Finally, the use of asthma registries, digital devices, and electronic templates would be of benefit in the management of asthma patients in the region.

Integration of a Patient-Centered Medical Home Into Ambulatory Health Care Services Centers in Abu Dhabi.

This study describes the transformation of Abu Dhabi Ambulatory Healthcare Services into patient-centered medical homes (PCMH) in 3 pilot sites by applying the National Commission for Quality Assurance (NCQA) PCMH standards. The intervention was system redesign, population management, team building, and optimizing electronic medical records toward patient-centered care. The pilot centers outperformed non-pilot centers in clinical key performance indicators. Based on the NCQA 2011 PCMH criteria, the pilot achieved 84% compared with 42% at the start of the project. In conclusion this study shed light on a firm path to operationalizing PCMH to enhance the quality and access to care.

Prevalence of neutropenia in children by nationality.

BACKGROUND: A high prevalence of neutropenia has been reported in several ethnic groups amongst whom many healthy individuals with low neutrophil counts undergo unnecessary investigations. This study aims to ascertain the prevalence of neutropenia (NP) in a large cohort of children from North African, Middle Eastern, and Asian countries residing in the United Arab Emirates. METHODS: Neutrophil counts of 26,542 children (one day to six years of age) from 86 countries were analyzed. The subjects were enrolled in the Well-Child-Care program of Ambulatory Health Services of Emirate of Abu Dhabi, United Arab Emirates. NP was defined as a neutrophil count <1.5 × 10(9)/L and severe NP <0.5 × 10(9)/L. RESULTS: The neutrophil counts reached a nadir in the fourth week of life and changed slightly from the age of six-months to six-years. The frequency of NP was (from West-to-East): North African Arabs 15.4 %, Green Crescent Arabs 9.8 %, Peninsular Arabs 10.9 %, Iranians 3.1 %, Afghanis 2.5 %, Pakistanis 5.6 %, Indians 10.2 %, and Filipinos 7.3 %. The frequency of severe NP in North African Arabs (Sudanese) was 2.8 %, Green Crescent and Peninsular Arabs ≤1 %, Indians 1.5 %, and Filipinos 1.8 %. In 12,703 Emirati children, the frequency of NP was 10.6 % similar to their adult counterparts. CONCLUSION: The prevalence of childhood NP varied considerably by geoethnicity. Measures to prevent the inappropriate investigations of healthy children with benign neutropenia are proposed.

Epidemiology and referral patterns of patients with chronic kidney disease in the Emirate of Abu Dhabi.

According to estimates, the dialysis prevalence in Abu Dhabi is around 370 per million population. The annual growth is 12-15% and the dialysis population is likely to double in the next five years. Most patients present to dialysis as an emergency and only 2.7% have an arteriovenous fistula at the first dialysis. The prevalence of chronic kidney disease (CKD) in the Emirate is undefined. A study of the epidemiology of CKD and referral patterns was undertaken. SEHA, the Abu Dhabi Health Service delivery company, has a unified computer system containing all measurements made in its laboratories. This study considered all serum creatinine measurements performed between 1 September 2011 and 31 October 2012 from outpatient departments or emergency rooms. The estimated glomerular filtration rate (eGRF) was calculated using the Modification of Diet in Renal Disease formula (the Schwartz formula was used for children). We identified 331,360 samples from 212,314 individuals. The mean serum creatinine was 61 ± 48 µmol/L in females (59 ± 43 µmol/L in Emiratis, 63 ± 54 µmol/L in expatriates) and 87 ± 69 µmol/L in males (80 ± 59 µmol/L in Emiratis, 92 ± 74 µmol/L in expatriates). Among Emiratis, 4.6% of males and 2.8% of females had an eGFR between CKD 3 and 5. Among expatriates, 4.2% of males and 3.2% of females had an eGFR between CKD 3 and 5. On average, eight months elapsed before a patient with CKD 3, and three months for a patient in CKD 5, to attend the nephrology clinic. This study has defined the prevalence of CKD within Abu Dhabi and demonstrated the need to improve identification and referral of CKD patients. Possible solutions include campaigns to increase public and physician awareness of CKD.

The use of an interferon-gamma release assay to screen for pediatric latent tuberculosis infection in the eastern region of the Emirate of Abu Dhabi.

OBJECTIVES: Intense migration to the United Arab Emirates from tuberculosis (TB) high-endemic areas presents a particular risk to the population. Screening for latent tuberculosis infection (LTBI) usually involves risk assessment, the tuberculin skin test (TST), and interferon-gamma release assay (IGRA). This study investigated the use of an IGRA to screen for LTBI and compared its performance with a risk assessment questionnaire. METHODS: This prospective cross-sectional study was conducted at seven Ambulatory Healthcare Services facilities in Abu Dhabi. Participants (88% Emiratis) were pediatric patients presenting for routine care. The QuantiFERON-TB Gold In-Tube test was performed and the parents completed a questionnaire assessing TB risk factors. RESULTS: Six-hundred and ninety-nine subjects (median age 8.7 years, interquartile range 9.2 years) were enrolled; 669 (96%) agreed to testing. Four patients had a positive IGRA; one had previously been treated for TB, resulting in three patients with LTBI. The estimated LTBI prevalence was 0.45% (95% confidence interval 0.09-1.3). A household contact from a TB high-endemic area was reported in 44%, travel to a TB high-endemic area in 10%, and contact with someone with a chronic cough in 7%, a TB case in 3%, a TST-positive case in 2%, and an IGRA-positive case in 2%. Fifty percent of participants had at least one risk factor. The risk assessment did not predict a positive IGRA. CONCLUSIONS: The questionnaire yielded a risk of TB exposure of 50%, however the LTBI prevalence, as defined by the IGRA, was low (0.45%).