Cystic fibrosis in children of the eastern Arabian peninsula : a clinical, spatial and genetic study

Aim: The aim of this thesis is to describe the process by which the inherited disease, cystic fibrosis, (CF) was recognised as an important clinical entity in the United Arab Emirates (UAE) and the Sultanate of Oman (Oman). It examines the clinical presentation of the first patients and assesses their degree of severity. Further, it describes the first studies carried out to determine the underlying CF mutations associated with the disease in the UAE and Oman. An estimate is offered of the birth frequency of the condition. Overall, the cultural, geographical and historical aspect of the societies in which the disease occurs is stressed. Methods: An initial literature search was carried out using Medline of any literature pertaining to the Arab World and CF. this was read and classified into the relevance to Arabs in general, the Middle East and then specifically the Arab (Persian) Gulf societies. Thereafter, a clinic was established at Tawam Hospital, Al Ain, UAE, for children presenting With chronic respiratory disease that could serve as a national referral centre. It was run by the Author as a service of the Paediatric Department of the UAE University Medical School. I sent a letter to every Paediatrician working in the UAE informing them of our clinic and offering our services for the diagnosis and management of chronic respiratory disease in children. This was based on the author's experience as a respiratory paediatrician in Australia and New Zealand and as the Professor of Paediatrics in the UAE. No such service then existed in the UAE. Funding was sought to establish a research programme and develop a molecular genetics laboratory in the UAE Medical School. A series of successful research applications provided the grants to commence the investigations. Once a small number of children had been identified as having CF from those referred to the respiratory clinic, the initial project was to assess and report their clinical presentation. Following this an early start was made on the identification of the mutations responsible. Once these were established an attempt was made to estimate the frequency of the condition at birth. Additional clinical studies revolved around assessing the severity of the condition that was associated with the main mutations that were identified. A clinical comparison was made with those with the mutation AF508 and the other main mutation, despite the obvious limitation of small numbers then available. Radiological assessment was made to evaluate the progression of the disease. The final aspect of the study was to assess patients from Oman and compare their findings and mutations with the neighbouring UAE. Based on information gained hypotheses are proposed regarding the spread of the gene mutation by population drift. Thesis outline: A literature review is presented in the form of a critique on the disease and a resume of the relevant aspects of the genetics of CF. Additionally, facts about the two countries' geography and history are presented. Finally, knowledge about CF mutations and population origins from other areas is presented. The second main section deals with the clinical features of the disorder as it presents in the UAE. Molecular findings are then presented and details of the common mutation found in Bedouin Arabs. Hypotheses are then presented based on the information gathered. Results: CF is not a rare disease in the Arab children of the UAE and Oman. These findings refute previous reports of CF being a rare or non-existent disease in Arabs. The condition presents with a severe clinical picture, with early colonisation of the respiratory tract with staphylococcus, haemophilus and pseudomonas organisms, even with conventional CF management practices in place. The CF mutation S549R is prevalent in Arabs of Bedouin stock, while AF508 is found in those of Baluch origin. The former may be descendants of Arabs who left southern Arabia and travelled to the Trucial Coast at the time of the destruction of the great dam at Marib. The origins of this mutation may lie in the area that corresponds to the modern Republic of Yemen. The latter groups are descendants of those who came originally from Baluchistan. It is hypothesised also that the ancestral home of the AF508 mutation may be in the geographical area now known as Baluchistan, that spans three separate modern political territories. The evidence presented supports the concept that the S549R mutation may be associated with a severe, if not the severest, clinical pattern recognised. It equates with that seen with the homozygous AF508 genotype. The absence of an additional mutation in the promoter region accounts for the different clinical pattern seen in previously described patients. Conclusions: There needs to be a major awareness of the presence of CF as a severe clinical disease in the children of the Gulf States. The clinical presentation and findings support the concept of under recognition of the disease. Climatic conditions put the children at special risk of hyponatraemia and electrolyte imbalance. The absence of surviving adults with the disease suggests premature deaths have occurred, but the high fertility rates have maintained the gene pool for this recessive disorder.

eBusiness use in the United Arab Emirates : lessons for evolving markets

Since the early 1990’s the United Arab Emirates has been actively seeking to diversify into non-oil sectors. The nation has set out to market itself as a hub for foreign and domestic companies; realizing to achieve these goals that it must provide appropriate e-business frameworks and infrastructures. While the nation itself is paving the way for other nations in the Middle East to undertake electronic business initiatives, the use of everyday e-business in the UAE appears to be somewhat stifled. An investigation into reasons for the apparent low levels of adoption of e-business by UAE inhabitants has been conducted using an autoethnographic research methodology coupled with qualitative interviews of selected stakeholders. Findings from this research may contribute to a better understanding of how e-business initiatives in specific regions need to take into account local cultural and other issues which may be irrelevant elsewhere.

Copyright law in the United Arab Emirates in the digital age

This article gives an overview of copyright law in the United Arab Emirates (UAE) and critically evaluates its operation in the digital era, providing suggestions for reform.

Water quality of two semi-closed areas in the United Arab Emirates Coast along the Arabian Gulf:a comparative study

A comparative study was carried out between the two biggest creeks along the Arabian Gulf coast of the United Arab Emirates to evaluate impacts of sewage and industrial effluents on their hydrochemical characteristics. Surface and bottom water samples were collected from Abu Dhabi and Dubai creeks during the period from October 1994 to September 1995. The hydrochemical parameters studied were: temperature (21.10-34.00°C), salinity (37.37-47.09%), transparency (0.50-10.0 m), pH (7.97-8.83), dissolved oxygen (1.78-13.93 mg/l) and nutrients ammonia (ND- 13.12,ug-at N/1), nitrite (ND-6.66 ,ug-at N/1), nitrate (ND- 41.18 ,ug-at N/1), phosphate (ND- 13.06 ,ug-at P/1), silicate (0.68-32.50 ,ug-at Si/1), total phosphorus (0.26- 21.48 ,ug-at P/1), and total silicon (0.95- 40.32 ,ug-at Si/1). The present study indicates clearly that seawater of Abu-Dhabi Creek was warmer (28.l2°C) than Dubai (27.56°C) resulting in a higher rate of evaporation. Owing to more evaporation, salinity levels showed higher levels at Abu Dhabi (43.33%) compared to Dubai (39.03%) seawater. The study also revealed higher secchi disc readings at Abu Dhabi Creek (4.68 m) as compared to Dubai Creek (2.60 m) suggesting more transparency at Abu Dhabi Creek. Whereas, seawater of Dubai exhibited higher levels of pH (1.03 times), and dissolved oxygen (1.05 times) than Abu Dhabi seawater due to an increase in productivity. Meantime, seawater of Dubai showed higher tendency to accumulate ammonia (8.22 times), nitrite (10.93 times), nitrate (5.85 times), phosphate (10.64 times), silicate (1.60 times), total phosphorus (3.19 times), and total silicon (1.54 times) compared to Abu Dhabi seawater due to the enrichment of seawater at Dubai with domestic sewage waters which has distinctly elevated the levels of the nutrient salts particularly in inner-most parts of the creek leading to eutrophication signs. The changes occurred in the receiving creek water of Dubai as a result of waste-water disposal that have also reflected on the atomic ratios of nit: Effect of pollution rogen: phosphorus: silicon.

Nutrient salts in the United Arab Emirates waters (the Arabian Gulf and the Gulf of Oman)

This paper deals with the levels and distributions of nutrient salts in the United Arab Emirates waters. Water samples were collected bimonthly during 1994-1995 from the marine environment of the United Arab Emirates, which extends more than 800km along the Arabian Gulf and the Gulf of Oman. Concentrations of ammonium, nitrite, nitrate, phosphate, silicate, as well as total concentrations of total dissolved nitrogen, phosphorus, and silicon in the area were scattered in the ranges: (ND-6.32; mean: 0.84 µg-at N/l), ND-3.02; mean: 0.42 µg-at N/l), (ND-10.88; mean: 1.18 µg-at N/1), (ND-4.22; mean: 0.62 µg-at P/l), (1.14-28.80; mean: 6.52 µg-at Si/l), (1.52-39.58; mean: 12.28 µg-at N/l), (0.40-4.98; mean: 1.07 µg-at P/l), and (2.77-44.74; mean: 13.02 Si/l) respectively. Of inorganic nitrogen species, ammonium was the highest in the Arabian Gulf waters and nitrate was the highest at the Gulf of Oman. The dissolved inorganic nitrogen total species, phosphate and silicate amounted to 16.4, 47.6, 56.5% respectively, of the concentrations of nitrogen, phosphorus and silicon in the Arabian Gulf and 22.6, 64.4, 44.9% respectively, in the Gulf of Oman, indicating that more than 80% of nitrogen was present in organic forms. Distributions of nutrient in the two regions were higher in the summer season and lower in the winter season due to the oxidation of organic materials. Regional distributions revealed higher values for nitrite (1.3 times), nitrate (2.8 times), phosphate (2.2 times), total dissolved nitrogen (1.3 times), total dissolved phosphorus (1.6 times), and total dissolved silicon (1.3 times) in the Gulf of Oman compared to the Arabian Gulf, indicating more oligotrophic conditions at the Arabian Gulf Whereas no distinct patterns of distribution were observed in the Arabian Gulf waters, an increase in the seaward direction was measured at the Gulf of Oman. Vertical distributions indicated a general increase with depth in the two regions. The mean ratios for total concentrations of phosphorus, nitrogen, and silicon in the Arabian Gulf (1: 11.6: 12.6) and the Gulf of Oman (1: 10.1: 11.8) were lower than the Redfield ratio.

Incorporating HACCP into national food control systems - Analyzing progress in the United Arab Emirates

Today governments and other parties involved in food control are under constant pressure to find more efficient and effective mechanisms to carry out their mandates for food control. This has led to international recognition of the importance of the HACCP system as a food control tool and guidance on the role of government agencies in the application of such a system has been developed. Based on this international guidance, four main elements identified as key activities have been used in this study to evaluate the progress of HACCP implementation in the UAE. The internal Strengths and Weaknesses, as well as the external Opportunities and Threats that the government is facing towards the implementation of a HACCP-based food control system have been identified. The analysis shows that the government’s dedicated role has been an essential driving force to encourage the implementation of a HACCP-based food control system. Some areas of difficulty, including the dependence on high levels of food imports, are highlighted.

A new roadmap to life: media, culture, and modernity in the United Arab Emirates

Critical to the vision of a new United Arab Emirates is an educated, skilled workforce that fuels the intelligent growth needed in a knowledge-based economy. As the country begins developing its version of that economy, the mediated, transparent environment fundamental to this process will carry with it new visions of (and possibilities for) living life. If peaceful change is to be achieved, a transitional generation faces the conundrum of adapting the best that modernity can offer while retaining the best of tradition. As have others, this study suggests two things: that (1) media literacy, growing in part from education, is correlated with urbanization and a changing infrastructure, and that (2) media in all its forms is inseparable from the outcome of this drive to modernization.

Middle East respiratory syndrome coronavirus antibody reactors among camels in Dubai, United Arab Emirates, in 2005

We tested, using a low starting dilution, sequential serum samples from dromedary camels, sheep and horses collected in Dubai from February/April to October of 2005 and from dromedary camels for export/import testing between Canada and USA in 2000-2001. Using a standard Middle East respiratory syndrome coronavirus (MERS-CoV) neutralization test, serial sera from three sheep and three horses were all negative while sera from 9 of 11 dromedary camels from Dubai were positive for antibodies supported by similar results in a MERS-CoV recombinant partial spike protein antibody ELISA. The two negative Dubai camels were both dromedary calves and remained negative over the 5 months studied. The six dromedary samples from USA and Canada were negative in both tests. These results support the recent findings that infection with MERS-CoV or a closely related virus is not a new occurrence in camels in the Middle East. Therefore, interactions of MERS-CoV at the human-animal interface may have been ongoing for several, perhaps many, years and by inference, a widespread pandemic may be less likely unless significant evolution of the virus allow accelerated infection and spread potential in the human population.

Atlas of cancer mortality in the United Arab Emirates aided by application of geographic information system methods

The aim of this study was to determine cancer mortality rates for the United Arab Emirates (UAE) and to create an atlas of cancer mortality for the UAE. This atlas is the first of its kind in the Gulf country and the Middle East. Death certificates were reviewed for a period from January 1, 1990 to December 31, 1999 and cancer deaths were identified. Cancer mortality cases were verified by comparing with medical records. Age-adjusted cancer mortality rates were calculated by gender, emirate/medical district and nationality (UAE nationals and overall UAE population). Individual rates for each emirate were compared to the overall rate of the corresponding population for the same cancer site and gender. Age-adjusted rates were mapped using MapInfo software. High rates for liver, lung and stomach cancer were observed in Abu Dhabi, Dubai and the northern emirates, respectively. Rates for UAE nationals were greater compared to the overall UAE population. Several factors were suggested that may account for high rates of specific cancers observed in certain emirates. It is hoped that this atlas will provide leads that will guide further epidemiologic and public health activities aimed at preventing cancer. ^

Patterns of prescribing and utilization of asthma medications in a tertiary hospital in Dubai, United Arab Emirates

Purpose: To assess the prescribing patterns of asthma medications in a hospital in Dubai, United Arab Emirates (UAE) with regard to the demographic pattern of the population. Methods: One hundred fifty four patients, 83 male and 71 female, were randomly selected from the outpatient respiratory diseases clinic of a tertiary hospital in Dubai, UAE over a 3-month period. Patients were asked to complete a structured questionnaire and data were analyzed using STATA 12 software. Results: Most of the patients were within the age range of 0 – 10 years. About 86 % of the patients were overweight. Half of the patients were non-smokers while 51 % of them had a family history of asthma. About 54 % of the patients received multiple drug therapy of which two-drug combinations were widely prescribed (31 %). The most utilized drug classes were short acting β-agonists (42 %), xanthine drugs (16 %), leukotriene modifiers (14 %) and oral and intravenous corticosteroids (13 %). Statistical significant differences among the age groups (F = 2.33, p = 0.0275) were found. Conclusion: Primary prevention to reduce the level of exposure to common risk factors for asthma would be a vital step to control the disease. More resources should be channeled into educating physicians and patients on rational drug utilization to improve the quality of patients’ care.