Browsing by Author "Ennab, Farah"

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Clinical Characteristics of Children with COVID-19 in the United Arab Emirates: Cross-sectional Multicenter Study
(2021) Ennab, Farah; ElSaban, Mariam; Khalaf, Eman; Tabatabaei, Hanieh; Hassan Khamis, Amar; Saravanan, Ketharanathan; Cremonesini, David; Popatia, Rizwana; Malik, Zainab; Ho, Samuel B; Abusamra, Rania
Background: COVID-19 has infected over 123 million people globally. The first confirmed case in the United Arab Emirates (UAE) was reported on January 29, 2020. According to studies conducted in the early epicenters of the pandemic, COVID-19 has fared mildly in the pediatric population. To date, there is a lack of published data about COVID-19 infection among children in the Arabian region. Objective: This study aims to investigate the clinical characteristics, laboratory findings, treatment, and outcomes of children with COVID-19. Methods: This cross-sectional, multicenter study included children with confirmed COVID-19 infection admitted to 3 large hospitals in Dubai, UAE, between March 1 and June 15, 2020. Serial COVID-19 polymerase chain reaction (PCR) testing data were collected, and patients’ demographics, premorbid clinical characteristics, and inpatient hospital courses were examined. Results: In all, 111 children were included in our study and represented 22 nationalities. Of these, 59 (53.2%) were boys. The mean age of the participants was 7 (SD 5.3) years. About 15.3% of children were younger than 1 year. Only 4 (3.6%) of them had pre-existing asthma, all of whom had uneventful courses. At presentation, of the 111 children, 43 (38.7%) were asymptomatic, 68 (61.2%) had mild or moderate symptoms, and none (0%) had severe illness requiring intensive care. Fever (23/111, 20.7%), cough (22/111, 19.8%), and rhinorrhea (17/111, 15.3%) were the most common presenting symptoms, and most reported symptoms resolved by day 5 of hospitalization. Most patients had no abnormality on chest x-ray. The most common laboratory abnormalities on admission included variations in neutrophil count (22/111, 24.7%), aspartate transaminase (18/111, 22.5%), alkaline phosphatase (29/111, 36.7%), and lactate dehydrogenase (31/111, 42.5%). Children were infrequently prescribed targeted medications, with only 4 (3.6%) receiving antibiotics. None of the 52 patients tested for viral coinfections were positive. COVID-19 PCR testing turned negative at a median of 10 days (IQR: 6-14) after the first positive test. Overall, there was no significant difference of time to negative PCR results between symptomatic and asymptomatic children. Conclusions: This study of COVID-19 presentations and characteristics presents a first look into the burden of COVID-19 infection in the pediatric population in the UAE. We conclude that a large percentage of children experienced no symptoms and that severe COVID-19 disease is uncommon in the UAE. Various laboratory abnormalities were observed despite clinical stability. Ongoing surveillance, contact tracing, and public health measures will be important to contain future outbreaks.
COVID-19 vaccine hesitancy: A narrative review of four South Asian countries
(2022) Ennab, Farah; Zary, Nabil; Nawaz, Faisal A.
Objectives: Vaccine hesitancy remains a global issue, especially within poverty-stricken countries where there’s an interplay of financial and nonfinancial barriers. This narrative review aims to understand attitudes and behaviors toward COVID-19 vaccination in four South Asian countries and make context-specific recommendations to vaccine program drivers and decision-makers. Methods: A search was conducted using PubMed and Science Direct, and CINHAL from January 2020 up to May 2022 restricted to the English language for terms: “Afghanistan” OR “Pakistan” OR “India” OR “Bangladesh” in combination with “COVID-19 vaccine” and other related terms. All articles were initially included, and those with relevance were included in the synthesis of this paper. Results: A narrative review was performed for this study. Our narrative review included a total of eighteen studies with a sample size (n = 223–5,237) averaging about 1,325 participants per study conducted. The studies included revealed public hesitancy to receive the COVID-19 vaccine ranging from 6.3 to 56.2% with an average of 31.63% across all eighteen studies. Several reasons were linked to this observation in these four South Asian countries, and the predominant ones included: Insufficient information provided to the general public about the side effects of the vaccines, concerns regarding vaccine safety, and skepticism of vaccine efficacy. Conclusion: Vaccine hesitancy is a global problem within the context of COVID-19, and issues regarding equity, misinformation, and poverty in South Asian countries makes it di cult to meet goals for herd immunity. Policymakers and governments should aim toward financial and non-financial incentives to drive the public toward vaccination.
Double trouble: COVID-19 vaccine misinformation amidst conflict in Ukraine
(2022-08) Ennab, Farah; Nawaz, Faisal A.
Abstract: The repercussions of the COVID-19 pandemic have presented valuable insights into new public health challenges which were once difficult to recognize. At the core of this strenuous public health emergency, lies a dire urgency to prioritize effective therapeutic interventions - namely vaccines, surveillance programs, and public awareness measures. Particularly in the midst of a digital era fueled by misinformation and ongoing conflicts [1]. On the 24th of February earlier this year, Ukraine was embattled by recurrent conflicts with Russia, its neighboring country; exacerbating the number of people potentially affected by this humanitarian crisis and causing profound destruction to medical institutions which encompass the cornerstone of treatment for many patients affected with COVID-19 [2]. Additionally, there have been increasing concerns of a significant decline in COVID-19 testing since the beginning of this conflict, suggesting that undetected transmission is occurring at a much higher rate than previously reported.
Implications of social media misinformation on COVID-19 vaccine confidence among pregnant women in Africa
(2022) Ennab, Farah; Khan, Abdul Rahman; Nawaz, Faisal A.
Abstract: It has been over a year since the World Health Organization (WHO) declared the outbreak of COVID-19 as a Public Health Emergency of International Concern and subsequently a global pandemic. The world has experienced a lot of uncertainty since then as we all get used to this new ‘normal’ with social distancing measures, lockdowns, the emergence of new variants, and an array of hope with the development of vaccines. Having an abstract understanding of vaccine delivery, public perceptions of vaccines, and promoting acceptance of vaccines are critical to tackling the pandemic. The advent of the pandemic has led to the emergence of an ‘infodemic’ or rampant misinformation surrounding the virus, treatment, and vaccines. This poses a critical threat to global health as it has the potential to lead to a public health crisis by exacerbating disease spread and overwhelming healthcare systems. This ‘infodemic’ has led to rising vaccine hesitancy which is of paramount concern with the WHO even identifying it as one of the ten main threats to Global health almost 2 years before the approval of COVID-19 vaccines. Pregnant African women are one of the most vulnerable population groups in a region with an already burdened healthcare system. Currently, there isn’t ample research in the literature that explores vaccine hesitancy in this subpopulation and the impact of social media misinformation surrounding it. The aim of this paper is to highlight the implications of this ‘infodemic’ on the pregnant African population and suggest key recommendations for improved healthcare strategies.
Monkeypox Outbreaks in 2022: Battling Another "Pandemic" of Misinformation
(2022-07) Ennab, Farah; Nawaz, Faisal A
Abstract: Monkeypox is a virus that was formerly recognized as a rare zoonotic disease but has been noted as an emerging disease of concern where there are significant gaps in knowledge. In 2022, Monkeypox outbreaks are being concurrently reported in numerous non-endemic geographical areas, thus instigating a global wave of public health concern amid calls for urgent action from international authorities. As of the 8th of June 2022, about 1,285 laboratory-confirmed cases were detected in 28 regions across Africa, the Americas, and the European Region [1]. This virus is more commonly reported in West and Central Africa, where previous self-limiting outbreaks have had a mortality rate ranging between 1% and 15% [2]. However, the alarming surge of cases in 2022 with obvious multicountry community transmission is raising the alarm bells for monkeypox as a potential future global threat with unprecedented ramifications.
Obesity and female infertility
(2023) Ennab, Farah; Atiomo, William
Abstract: Infertility is a significant global health issue, with a negative impact on people's wellbeing and human rights. Despite the longstanding association between obesity and infertility, there remains uncertainty, about the precise mechanisms underpinning this association and best management strategies. In this article, we aimed to address these uncertainties by reviewing the recent literature, and focusing on studies which evaluated live birth rates. We found that just over half of the studies, investigating the relationship between preconception maternal weight and live birth rates found an inverse correlation. There was, however, insufficient evidence, that preconception maternal lifestyle or pharmacological interventions in obese women with infertility, resulted in improved live birth rates. The implications for clinical practice and future research are highlighted. For example, the need to consider some flexibility in applying strict preconception body mass index targets, limiting access to fertility treatment, and a need for large clinical trials of new pharmacological options and bariatric surgery.
Polycystic Ovarian Syndrome (PCOS): Does the Challenge End at Conception?
(2022) Mirza, Fadi G.; Ennab, Farah; Hassan Khamis, Amar; Atiomo, William
Abstract: Polycystic ovary syndrome (PCOS) is a prevalent condition that not only has the potential to impede conception but also represents the most common endocrine dysfunction in fertile women. It is considered a heterogeneous and multifaceted disorder, with multiple reproductive and metabolic phenotypes which differently affect the early- and long-term syndrome’s risks. Undoubtedly, the impact of PCOS on infertility has attracted most of the attention of healthcare providers and investigators. However, there is growing evidence that even after conception is achieved, PCOS predisposes the parturient to several adverse pregnancy outcomes including a high risk of pregnancy-induced hypertension, spontaneous abortion, gestational diabetes, preeclampsia, and preterm birth, which increase the risks of stillbirth and neonatal death. Fetal growth abnormalities may also be more common, but the relationship is less well defined. This narrative review aims to summarize current knowledge regarding these conditions as they interplay with PCOS and concludes that although there appears to be an increase in these complications during the pregnancy of women with PCOS, there is a need for further research to clarify the possible confounding impact of obesity. Implications for clinical practice and future research are outlined.
A potential rise of breast cancer risk in the UAE post-COVID-19 lockdown: A call for action
(2022) Ennab, Farah; Nawaz, Faisal A.
Introduction: Coronavirus disease 2019 (COVID-19) was first detected in late December of 2019 with early reports of pneumonia-like symptoms from Wuhan, China. This outbreak has quickly caused major healthcare havoc, with the World Health Organization (WHO) recognizing it as a public health emergency of international concern and subsequently declaring it a global pandemic on March 11th, 2020 [1]. The first confirmed case in the United Arab Emirates (UAE) was reported on January 29th, 2020. As of April 6th, 2022, the current total case count has reached over 800,000 infections with a total of 2300 coronavirus-related deaths [2,3]. The UAE government took early and effective approaches, which all successfully played a crucial part in controlling the rate of infection [4]. Unfortunately, however, even with the implementation of these measures, the strain on the healthcare facilities necessitated the cessation of elective procedures and created gaps in many routine screening appointments for women seeking early detection of breast cancer. This delay in vital screening amidst the COVID-19 pandemic as reported by relevant clinical studies is thought to be responsible for the concerning spike in late-stage breast cancer cases across the country today [5]. The sudden reprioritization of care had a profound impact on oncological services, with a noticeable reduction in routine breast cancer screening programs such as mammograms and ultrasounds [6]. Additionally, there have been numerous reports of an increasing number of late-stage breast cancer diagnoses as an unintended effect of the pandemic’s early lockdowns and medical restrictions as described by early reports from global trends [7,8]. Oncology experts worldwide are expressing their fears over this new phenomenon known as the “Tsunami of Cancer”, where there will be an expected upscale in cancer diagnoses on a global level [9]. To date, there has been a lack of published papers in this context in the UAE. The aim of this commentary article is to highlight the implications surrounding breast cancer screening in the UAE and provide recommendations.
Prevalence of pre-eclampsia in women in the Middle East: a scoping review
(2024-08) Hegazy, Ayatullah; Eid, Farida Abdelrehim; Ennab, Farah; Atiomo, William; Azar, Aida Joseph
Abstract Hypertensive disorders of pregnancy are the second most common cause of maternal deaths worldwide. Metabolic syndrome is recognized as one of the risk factors for pre-eclampsia. A recent study revealed a high prevalence of metabolic syndrome in the United Arab Emirates (UAE), particularly amongst Emirati women compared with global estimates. This finding raises the possibility that the prevalence of pre-eclampsia in the region may also be higher as research is increasingly demonstrating an association between pre-eclampsia and metabolic syndrome. We therefore conducted this scoping review of the literature to investigate the nature and extent of studies evaluating the prevalence of pre-eclampsia within the Middle East region to enable subsequent comparison of these findings with the global burden of pre-eclampsia, objectively identify gaps in the literature and inform the design of future studies to address these gaps. PubMed and Scopus were used to extract studies published over the last 20 years (2003-2023). The search terms used included ("Pre-eclampsia" AND "Prevalence") OR ("Hypertension in pregnancy" AND "Prevalence") OR ("Pregnancy" AND "Pre-eclampsia") OR ("Pre-eclampsia" AND "Epidemiology"). We limited our studies to those from the Middle East (ME). A total of 556 relevant articles were identified following which 11 were shortlisted for review. There were four studies from Iran, two from Saudi Arabia, two from Qatar, one from Jordan, and one from Bahrain. The remaining study included 29 countries from Africa, Asia, Latin America, and the Middle East of which data from Jordan, Lebanon, the Occupied Palestinian Territory, and Qatar were included. There were four retrospective, two cross-sectional, and two cohort studies, one prospective study, one meta-analysis, and one descriptive-analytical study. The prevalence of pre-eclampsia in the studies ranged from 0.17 to 5%. We did not find any study investigating the prevalence of pre-eclampsia in the United Arab Emirates. Based on our findings, we conclude that there is a significant scarcity of research in this area, especially within the Middle East, and notably an absence of studies specifically pertaining to the UAE. Consequently, we assert that there is a pressing requirement for additional research to evaluate the prevalence of pre-eclampsia in the region.
The psychological aftermath of an emerging infection affecting pregnant women: is monkeypox to blame?
(2022-12) Ennab, Farah; Al Sharif, Ghadah A
Introduction: As the world grapples with life changed by the repercussions of the COVID-19 pandemic, emerging infections with consequential public health threats continue to be invariably reported in various regions of the world. A clear example is the most recent global monkeypox outbreak which was declared a “Public Health Emergency of International Concern” (PHEIC) by the World Health Organization (WHO) on July 23rd, 2022 (World Health Organization 2022). To date, this unprecedented outbreak has resulted in 60,799 laboratory-confirmed cases from over 95 non-endemic countries, and although viral genomic surveillance has observed several monkeypox strains, few deaths have been documented thus far (CDC 2022). Despite the favorable clinical outcomes of this disease, epidemiological data suggest that community-sustained transmission of monkeypox infections has the potential to adversely affect high-risk populations, especially immunocompromised individuals and particularly pregnant women (Vouga et al. 2022). This concern is eminently presented by available clinical evidence surrounding monkeypox in pregnancy which supports the likelihood of increased obstetric complications such as intrauterine fetal demise, increased risk of congenital infections, preterm birth, miscarriage, and ominous maternal reactions (Dashraath et al. 2022). The heightened risk of vertical transmission of this virus coupled with a notable absence of case-specific and national management guidelines is negatively impacting the psychological state of pregnant women worldwide (Medscape 2022). This recent public health emergency calls for a unified action plan toward better understanding the mental health consequences of another future global crisis. Intensified efforts are especially important as maternal mental health research is a valuable yet understudied aspect of public health research.
Rise of monkeypox: Lessons from COVID-19 pandemic to mitigate global health crises
(2022) Ennab, Farah; Nawaz, Faisal A.
Introduction: The emergence and spread of infectious diseases with pandemic potential has occurred regularly throughout history. HIV/AIDS, bubonic plague, smallpox, and influenza are some of the highest-profile examples. The COVID-19 outbreak was declared a pandemic on March 11, 2020, by the World Health Organization (WHO). Alongside other measures such as restrictions on population mixing and the use of face masks, COVID-19 vaccination has been arguably the most effective intervention in reducing deaths and severe COVID-19 disease. As of May 23, 2022, almost 12 billion vaccine doses have been administered globally [1]. Monkeypox is a rare viral zoonotic disease caused by the monkeypox virus. This virus has 2 strains, the West African and the Congo Basin clades [2]. On May 13, 2022, the WHO reported several cases of monkeypox virus infections, across three of its regions: namely Africa, the Americas, and the European Region. As of the June 8, 2022, about 1285 laboratory-confirmed cases were detected in 28 regions [3]. This rare viral disease commonly endemic in West and Central Africa has now been detected in more than 11 non-African countries such as the United Kingdom (UK) and the United States of America. Health authorities in the United Kingdom established a special task force to coordinate the extensive contact tracing of people who had contact with the confirmed cases. In addition, vaccination has been offered to higher-risk contacts [4]. The SARS-CoV-2 virus is typically spread by respiratory aerosols or droplets. Monkeypox can be transmitted via respiratory aerosols, but transmission can be via contact with lesions, bodily fluids, and contaminated materials such as bedding and towels. The basic reproduction number for monkeypox appears to be much lower than COVID19, hence transmission should be slower than has been observed from COVID-19 outbreaks [5]. Some patients may display clinical features including the classical skin rashes and listers, along with symptoms such as headache, fever, swollen lymph nodes, muscle and body aches, back pain, and exhaustion. The West African strain is the type of monkeypox virus responsible for the 2022 outbreak, and this strain appears to cause less severe disease compared to the Congo Basin strain, with a case fatality rate of 3.6% compared to 10.6% for the Congo Basin strain [6]. The pandemic response to COVID-19 has provided significant new knowledge, some of which could be adapted and applied to the 2022 Monkeypox outbreak, minimizing its spread and reducing the global impact.
Spindle cell lipoma of the tongue: First case report from the Gulf region and review of the literature
(2023) AlShehabi, Nagam; Ennab, Farah
Introduction: Lipomas are prevalent benign soft tissue neoplasms of mesenchymal origin that develop in up to 20% of cases in the head and neck area. Oral lipoma is considered to account for 1% to 4% of all benign mouth lesions. Pleomorphic lipoma, angiolipoma, chondrolipoma, fibrolipoma, and spindle cell lipoma (SCL) are all histologic variations. Enzinger and Harvey were the first to report the SCL variant in 1975; morphologically, this variant has mature adipose tissue with bland spindle cells, myxoid stroma, ropey collagen bundles, and dispersed mast cells.
A successful management of left-sided posterior congenital diaphragmatic hernia of the jejunum, ileum, colon and left kidney: a case report
(2022-10) Al-Abdullah, Zainab; Duvuru, Ruthwik; Nawaz, Faisal A; Ennab, Farah
Abstract: Congenital diaphragmatic hernia (CDH) is a rare developmental anomaly in which abdominal contents herniate into the thoracic cavity due to underdevelopment of the diaphragm, possibly leading to pulmonary hypoplasia. Whereas surgery is not the first priority in treatment, it must be performed within a window of 2 weeks and after hemodynamic stability has been achieved. The patient described in this case report had a CDH of the jejunum, ileum, colon and left kidney diagnosed in a boy of South Asian origin who presented with tachypnea in the third hour of life. Imaging studies conducted included chest X-ray, chest ultrasound including echocardiogram, and abdominal and pelvic ultrasound. Treatment and management were successful despite complications. Future research on CDH is warranted in the populations in the Middle East, and local guidelines must be generated in order to improve diagnosis, treatment and prognosis.