Browsing by Author "Azar, Aida J"

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Clinical and laboratory findings of COVID-19: A systematic review and meta-analysis
(2021) Hassan Khamis, Amar; Azar, Aida J
Background/purpose: The aim of this study was to systematically review all COVID-19 publications to summarize the clinical features, assess comorbidities, prevalence, and disease outcomes. Methods: Included were all COVID-19 published studies between January 1 to July 20, 2020. The random effect model was used to calculate the pooled prevalence and corresponding 95% confidence interval (CI). Publication bias was assessed using the funnel plot for the standard error by logit event. Results: The mean age of the patients was 46.8 years (95% CI, 41.0e52.6) and males comprised 54.0% (95% CI, 51.3e56.7). Total co-morbidities prevalence was 29.5% (95% CI, 19.0e36.6), with diabetes mellitus being the most prevalent 13.8% (95% CI, 8.7e21.1), followed by hypertension 11.7% (95% CI, 5.7e22.6), and cardiovascular disease 9.7% (95% CI, 6.5e14.2). The most common clinical manifestations were fever, 82.0% (95% CI, 67.7e90.8), cough 54.3% (95% CI, 45.5e62.9), fatigue 30.2% (95% CI, 23.3e38.1), sputum 28.5% (95% CI, 21.2e37.2), sore throat 21.7% (95% CI, 14.6e31.0), and headache 11.0% (95% CI, 7.9e15.2). The most common COVID19 serious complications were RNA Anemia 98.2% (95% CI, 96.2e99.2), hospitalization 83.7% (95% CI, 76.0e89.3), bilateral pneumonia 70.9% (95% CI, 58.2e81.0); of those hospitalized 43.5% (95% CI, 24.9e64.2) were discharged. Fatality accounted for 10.5% (95% CI 6.8e16.1). Conclusion: Patients infected with COVID-19 coronavirus showed a wide range of clinical presentation with non-specific symptoms.
Design, Implementation and Evaluation of a Distance Learning Framework to Expedite Medical Education during COVID-19 pandemic: A Proof-of-Concept Study
(2021) Azar, Aida J; Hassan Khamis, Amar; Naidoo, Nerissa; Lindsbro, Marjam; Gonuguntla, Suneetha; Banerjee, Yajnavalka
Background: The COVID-19 pandemic has forced medical schools to suspend on-campus live-sessions and shift to distance-learning (DL). This precipitous shift presented medical educators with a challenge, ‘to create a “simulacrum” of the learning environment that students experience in classroom, in DL’. This requires the design of an adaptable and versatile DL-framework bearing in mind the theoretical underpinnings associated with DL. Additionally, effectiveness of such a DL-framework in content-delivery followed by its evaluation at the userlevel, and in cognitive development needs to be pursued such that medical educators can be convinced to effectively adopt the framework in a competency-based medical programme. Main: In this study, we define a DL-framework that provides a ‘simulacrum’ of classroom experience. The framework’s blueprint was designed amalgamating principles of: Garrison’s community inquiry, Siemens’ connectivism and Harasim’s online-collaborative-learning; and improved using Anderson’s DL-model. Effectiveness of the DL-framework in course delivery was demonstrated using the exemplar of fundamentals in epidemiology and biostatistics (FEB) course during COVID-19 lockdown. Virtual live-sessions integrated in the framework employed a blendedapproach informed by instructional-design strategies of Gagne and Peyton. The efficiency of the framework was evaluated using first 2 levels of Kirkpatrick’s framework. Of 60 students, 51 (85%) responded to the survey assessing perception towards DL (Kirkpatrick’s Level 1). The survey-items, validated using exploratory factor analysis, were classified into 4-categories: computer expertise; DL-flexibility; DL-usefulness; and DL-satisfaction. The overall perception for the 4 categories, highlighted respondents’ overall satisfaction with the framework. Scores for specific survey-items attested that the framework promoted collaborative-learning and student-autonomy. For, Kirkpatrick’s Level 2 that is, cognitive-development, performance in FEB’s summative-assessment of students experiencing DL was compared with students taught using traditional methods. Similar, mean-scores for both groups indicated that shift to DL didn’t have an adverse effect on students’ learning. Conclusion: In conclusion, we present here the design, implementation and evaluation of a DL-framework, which is an efficient pedagogical approach, pertinent for medical schools to adopt (elaborated using Bourdieu’s Theory of Practice) to address students’ learning trajectories during unprecedented times such as that during the COVID-19 pandemia.
Design, Implementation, and Evaluation of a Distance Learning Framework to Adapt to the Changing Landscape of Anatomy Instruction in Medical Education During COVID-19 Pandemic: A Proof-of-Concept Study
(2021) Naidoo, Nerissa; Azar, Aida J; Hassan Khamis, Amar; Gholami, Mandana; Lindsbro, Marjam; Alsheikh-Ali, Alawi; Banerjee, Yajnavalka
Abstract: This study presents the design of a DL-framework to deliver anatomy teaching that provides a microfiche of the onsite anatomy learning experience during the mandated COVID-19 lockdown. First, using nominal-group technique, we identified the DL learning theories to be employed in blueprinting the DL-framework. Effectiveness of the designed DL-framework in anatomy teaching was demonstrated using the exemplar of the Headand Neck (H&N) course during COVID-19 lockdown, in the pre-clerkship curriculum at our medical school. The dissemination of the DL-framework in the anatomy course was informed by the Analyse, Design, Develop, Implement, and Evaluate (ADDIE) model. The efficiency of the DL-framework was evaluated using the first two levels of Kirkpatrick’s model. Versatility of the DL-framework was demonstrated by aligning its precepts with individual domains of key learning outcomes framework. The framework’s blueprint was designed amalgamating principles of: Garrison’s community inquiry, Siemens’ connectivism and Harasim’s online-collaborative-learning; and improved using Anderson’s DL-model. Following the implementation of the DL-framework in the H&N course informed by ADDIE, the framework’s efficiency was evaluated. In total, 70% students responded to the survey assessing perception toward DL (Kirkpatrick’s Level: 1). Descriptive analysis of the survey results showed that the DL-framework was positively received by students and attested that students had an enriched learning experience, which promoted collaborative-learning and student-autonomy. For, Kirkpatrick’s Level: 2 i.e., cognitive development, we compared the summative assessment performance in the H&N course across three cohort of students. The results show that the scores of the cohort, which experienced the course entirely through DL modality was statistically higher (P < 0.01) than both the other cohorts, indicating that shift to DL did not have an adverse effect on students’ learning. Using Bourdieu’s Theory of Practice, we showed that the DL-framework is an efficient pedagogical approach, pertinent formedical schools to adopt; and is versatile as it attests to the key domains of students’ learning outcomes in the different learning outcomes framework. To our knowledge this is the first-study of its kind where a rationale and theory-guided approach has been availed not only to blueprint a DL framework, but also to implement it in the MBBS curriculum.
In death there is life: perceptions of the university community regarding body donation for educational purposes in the United Arab Emirates
(2021) Naidoo, Nerissa; Al-Sharif, Ghadah A; Khan, Raeesa; Azar, Aida J; Omar, Amar
Abstract: Human body dissection is the traditional instructional method for anatomy education worldwide, providing a kinaesthetic learning experience that is often challenging to achieve with other teaching techniques. However, due to lack of body donation programs in Middle Eastern medical schools, dead bodies are imported from abroad. Since literature suggests that the body shortage is influenced by reluctance to donate one's body, this study aimed to determine the perceptions of faculty, staff, and students regarding body donation for educational purposes at a new Dubai-based medical school. An online dually translated questionnaire was administered to the target population (322), of which 150 participants representative of faculty, staff, and students, responded. Although 111 (74.0 %) of participants considered body donation to be appropriate for educational and research purposes, only 44 (29.3 %) of participants expressed willingness to donate their bodies. Reluctance to donate 106 (70.7 %) appeared to be mostly influenced by religion, psychological barrier, and familial reasons. The emergence of four themes (i.e., resource, barrier, humanitarian, and awareness) and the identification of a potential donor group within the group that was willing to donate provided insight into the level of awareness within the university community. Furthermore, such findings may assist to establish future body donation programs and strategize recruitment approaches, especially when there is an ensuing dearth of anatomical donations.
Investigating the evolution of undergraduate medical students perception and performance in relation to an innovative curriculum-based research module: A convergent mixed methods study launching the 8A-Model
(2023) Otaki, Farah; Alhashmi, Deena; Hassan Khamis, Amar; Azar, Aida J
Abstract: Background: Embedding into undergraduate medical programs experiential research curricula, based on holistic theories of education which emphasize participation in the social world, remains uncommon. The purpose of this study was to investigate the journey of undergraduate medical students in relation to an innovative compulsory curriculum-based research module, which has a prominent experiential learning component. Methods: A convergent mixed methods study design was adapted to develop a systemic understanding of the experience of the undergraduate medical students throughout the respective research module. As such, the students’ perception of the experience was qualitatively explored using thematic analysis (n = 15). In parallel, the students’ performance data were quantitatively analyzed using multi-repeated ANOVA (n = 158). The findings from both types of analyses (i.e., qualitative and quantitative study components) were then mapped onto each using joint display analysis. Findings: The exploration generated four themes that correspond to sequential steps that the students go through to effectively integrate the scientific research method. These themes include: 1- Attend-Acquire, 2- Accumulate-Assimilate, 3- Apply-Appreciate, and 4-Articulate-Affect. Quantitatively, two distinct clusters of mean Grade Point Average were revealed (p p<0.01). Joint display analysis enabled integrating the qualitative and quantitative findings, generating the 8A-Model. Conclusion: The evidence-driven 8A-Model, generated by this study, highlights that medical students’ understanding of the true value of research seems to increase as they progress in the module. They begin expressing appreciation of the significance of the experience when they start implementing what they are learning as part of their own research studies. It is recommended for such a research module, with a firm experiential learning component, to be integral to undergraduate medical programs. This is expected to improve the future physicians’ research competences, and in turn add value in terms of quality of care and patient outcomes.
Kawasaki disease in children from Dubai, United Arab Emirates (2012-2020): a single-centre retrospective clinical case series
(2022-11) Sait, Ruzaina; Azar, Aida J; Loney, Tom
Abstract: Kawasaki disease (KD) is most common among East Asian children. There is a lack of data from Middle Eastern countries. We conducted a retrospective study of 27 paediatric patients with KD in Dubai, United Arab Emirates, 2012–2020. The majority of the patients were male, Asian, aged 1–5 years and presented with typical (complete) KD. Timely high-dose intravenous immunoglobulins were administered to 18 patients. Twelve patients did not develop any cardiac complications, 12 had a coronary artery aneurysm and 2 patients developed serious cardiac complications . No patient experienced non-cardiac complications or died. Paediatric patients with KD in Dubai were similar to those from other countries.
A novel 6D-approach to radically transform undergraduate medical education: preliminary reflections from MBRU
(2018-12) Banerjee, Yajnavalka; Azar, Aida J; Tuffnell, Christopher; Bayoumi, Riad; Davis, David A
Background: Designers of undergraduate medical education (UME) need to address the exponentially expanding volume and variability of scientific knowledge, where by didactic teaching techniques need to be augmented by innovative student - centric pedagogical strategies and implementation of milieus, where information, communication and technology-enabled tools are seamlessly integrated, and lifelong information gathering, assimilation, integration and implementation is the ultimate goal. In UME, the basic sciences provide a solid scaffold allowing students to develop their personal critical decisional framework as well as define the understanding of normal human physiology, pivotal for the identification, categorization and management of pathophysiology. However, most medical schools confine themselves to“stagnant curricula”, with the implementation of traditional “teacher centered” pedagogical techniques in the dissemination of the courses pertaining to basic sciences in UME. Method: To tackle the above paucity, we present a novel“6D-Approach”for the dissemination of concepts in basic sciences through mentored journal-clubs. The approach is informed by a teaching principle derived from Constructivism. The technique in which the 6D-approach can be implemented in UME, is shown using an example from a first-year course of Molecular Biology and Principles of Genetics at our medical school. A reflection on the impact of 6D-Approach for students as well as instructors is also presented. Result: The 6D-approach was positively received by the students and the formal feedback for the course: Molecular Biology and Principles of Genetics, where the approach was repeatedly employed, indicated that students expressed satisfaction with the teaching strategies employed in the course, with ~ 89% of the students in the cohort strongly agreeing with the highest grading score “extremely satisfied”. Further, the approach through the use of mentored journal clubs encourages retention of knowledge, critical thinking, metacognition, collaboration and leadership skills in addition to self-evaluation and peer feedback. Conclusion: Hence, through the 6D-Approach, our attempt is to initiate, advance and facilitate critical thinking,problem-solving and self-learning in UME, demonstrated by graduating accomplished, competent and safe medical practitioners.
Study protocol for a pilot randomized, double-blind, placebo-controlled trial to investigate the anti-inflammatory effects of Frondanol in adults with inflammatory bowel disease
(2022-12) Ghelani, Hardik; Adrian, Thomas E; Ho, Samuel B; Akhras, Jamil; Azar, Aida J; Jan, Reem Kais
Introduction: Inflammatory bowel disease (IBD), consisting of Crohn's disease and ulcerative colitis, is a debilitating condition with a rising incidence globally over recent years. Frondanol, a widely available nutraceutical extract of the edible sea cucumber Cucumaria frondosa has been reported to possess potent anti-inflammatory effects, likely mediated by the inhibition of 5-lipoxygenase and 12-lipoxygenase pathways, whilst showing no signs of toxicity. The potent anti-inflammatory effects of Frondanol in a mouse model of IBD provide encouragement for investigating its effects in human IBD patients. Here we describe the study protocol of a pilot randomized, double-blinded, placebo-controlled trial of Frondanol in patients with mild to moderate IBD who are on standard therapy. Material and methods: One hundred patients will be randomized (1:1) to receive Frondanol or placebo as an adjunct to their standard therapy for the period of six months. Blood and stool samples will be obtained during routine visits at baseline, and after three months and six months of treatment, and tissue samples from colon biopsies will be obtained during clinically indicated colonoscopies at baseline and after six months of treatment. The levels of inflammatory markers will be compared in serum and tissue samples between patients treated with Frondanol and those treated with placebo, and findings will be correlated with clinical and histological parameters. Discussion: If proven beneficial, treatment with Frondanol may increase the likelihood of patients remaining in remission and potentially provide an effective, natural and safe addition/alternative for treatment-naive patients in the future.(Clinical trial registration number: NCT05194007).
Use of convalescent plasma in pregnant women with early stage COVID-19 infection in a tertiary care hospital in Dubai, February to March 2021: a case series study
(2022) Azar, Aida J; Hassan Khamis, Amar
Background: The use of COVID-19 convalescent plasma (CCP) for the treatment of SARS-CoV-2 infection in pregnancy is intriguing in view of its safety profle in pregnancy and historical precedence of the use of plasma for other viral illnesses. This study aimed to evaluate the use of CCP in pregnant women with early COVID-19 infection. Methods: This is a retrospective case series study. We have included seven pregnant women admitted with early COVID-19 infection to a tertiary care hospital, Latifa Maternity Hospital in Dubai, United Arab Emirates between 12 February and 04 March 2021 and who consented to receive COVID-19 convalescent plasma as part of their treatment plan. Main outcomes measured were clinical and radiological features, laboratory tests, WHO clinical progression scale pre and post treatment, and maternal, fetal outcomes. COVID-19 clinical severity was classifed according to the NIH guidelines for criteria of SARS-CoV-2. For the radiological features, a modifed chest X-ray scoring system was used where each lung was divided into 6 zones (3 on each side upper, middle, and lower). Opacities were classifed into reticular, ground glass, patchy and dense consolidations patterns. Results: Seven pregnant women with early COVID-19 were enrolled in this study, their mean age was 28 years (SD 3.6). Four had comorbidities: 2 with diabetes, 1 with asthma, and 1 was obese. Five patients were admitted with a WHO clinical progression score of 4 (hospitalized; with no oxygen therapy) and 2 with a score of 5 (hospitalized; oxygen by mask/nasal prongs). Upon follow up on day 10, 6 patients had a WHO score of 1 or 2 (asymptomatic/mild symptoms) indicating clinical recovery. Adverse reactions were reported in 2 patients, one reported a mild skin rash, and another developed transfusion related circulatory overload. All patients were discharged alive. Conclusion: CCP seems to be a promising modality of treating COVID-19 infected pregnant women. However, further studies are needed to ascertain the efficacy of CCP in preventing progressive disease in the management of COVID-19 infection in pregnant women.