New Emirates Medical Journal - Volume 5, Issue 1, 2024

Plastics have become an inevitable part of life. Healthcare workers play an ineluctable role in creating enduring solutions to plastic pollution and mitigating the impact of plastic pollution on human health and well-being.

The aim of this study was to explore the pattern of plastic consumption and the perception of the bioecological and health impact of plastic pollution among undergraduate nursing students.

A quantitative, cross-sectional survey was undertaken among 200 undergraduate nursing students recruited through a convenience sampling technique. Data were collected using a self-developed structured questionnaire and analysed using SPSS version 26. A p-value of less than 0.05 was taken as statistically significant.

The mean age of the students was found to be 20.12± 6 years. Though more than half (65.7%) of them reported using plastic products daily, 63.3% of the students reported willingness to reduce the use of plastic products. Bottled water (72.4%), followed by bags (62.4%) were the most frequent modality of plastic used. Only 47.6% of them were aware of the difference between 100% biodegradable versus recyclable plastics. The perceived impact of plastic pollution on bio-ecological environments and human health was found to be low among most (66.7% and 43.7% respectively) of the students.

Awareness regarding the direct and indirect hazards of plastic pollution and available sustainable alternatives to plastic needs to be strengthened among the study population.

Stress occurs when people are faced with challenges and feel overwhelmed. Too much stress can cause negative effects on the body. Medical students especially feel a lot of stress due to their curriculum, which affects their eating habits and, in turn, their academic performance.

This study aimed to assess the effects of academic-related and teaching and learning-related stressors on the pattern of eating habits.

A cross-sectional study was carried out among students of private medical universities in UAE. MBBS and BDS students of and above the age of eighteen were included. A standardized questionnaire (Medical Student Stressor Questionnaire) was used to collect data. SPSS version 28 was used to analyze the data.

We identified two main types of stressors: Academic Related Stressors (ARS) and Teaching and Learning Related Stressors (TLRS), resulting in high levels of stress causing them to eat more than usual or less than usual. Most students (82.6%) who ate less or much less than usual had experienced high or severe stress due to academic-related stressors of ‘strenuous task’ (P=0.007). Moreover, 81.5% of students who ate more than usual had experienced high or severe stress when they were nervous and stressed (P=0.004). When feeling “difficulties pile up” and during times when students “lacked confidence” due to teaching-related stressors, 71.7% and 66.3% of the participants experienced mild/moderate stress, respectively and ate less or much less than usual (P<0.05).

We were able to determine the effect of academic-related stressors (ARS) and teaching and learning-related stressors (TLRS) on eating habits. This has led us to discover the importance of well-developed and improved intervention programs by universities to reduce stress and promote healthy eating habits among medical students.

The incidence of renal neoplasms has been increasing globally. Immunohistochemistry aids in differentiating the subtypes of Renal Cell Carcinoma (RCC).

This study aimed to describe the demography of renal cancer in the Kingdom of Bahrain, comparing it to other regions worldwide, emphasizing the most common type of renal cancer, clinical presentation, and immunohistochemistry.

This retrospective chart review comprises 74 Bahraini patients diagnosed with Renal neoplasms (from 2009-2019) at the Bahrain Defense Force (BDF) Hospital in the Kingdom of Bahrain. Variables collected include demographics, clinical presentation from patients’ electronic records and pathology registry, surgical management, immunohistochemistry, pathological staging, grading, and prognosis. IBM SPSS Statistics, version 28.0.0.0, was used.

About 71 patients’ characteristics were analyzed; 63 had malignant neoplasms, and 8 had benign neoplasms. The mean age of patients with a malignant renal neoplasm was 56.38 (± 12.643). The most common presentation was an incidental finding (60.6% of lesions being right-sided). Clear Cell RCC was the most common malignant lesion (77.1%), and the most common stage was stage 1 (69.8%). CD10 and vimentin were 100% sensitive for Clear Cell RCC. No significant association was found between diabetes and a higher Fuhrman grade (3 or 4) (P = 0.066).

From 2009 to 2019, renal neoplasms incidence increased. The most common malignant neoplasm was clear cell RCC and among benign tumours was oncocytoma. Immunohistochemistry plays an important role in subtype determination. One recommendation would be to assess the incidence of renal neoplasms in other hospitals in Bahrain to establish more epidemiological data and compare our results with other Gulf hospitals.

Assessment of thyroid dysfunction among relatives of patients diagnosed with Hashimoto’s thyroiditis is controversial due to the lack of evidence.

Screening and prediction of thyroid dysfunction among first- and second-degree relatives (FDRs and SDRs) of patients who were previously diagnosed with Hashimoto’s thyroiditis.

Three hundred and forty-six asymptomatic relatives of 97 patients diagnosed with Hashimoto’s thyroiditis were enrolled in mixed cross-sectional and prospective assessments for thyroid dysfunction over more than two years (September 2018-December 2020).

Both FDR and SDR were evaluated by thyrotropin (TSH) and thyroid ultrasound at enrollment. Individuals with abnormal TSH were thoroughly evaluated biochemically and were subsequently classified as euthyroid, subclinical, and overt thyroid dysfunction. The future reversion of enrolled individuals with normal and subclinical thyroid function to overt dysfunction was predicted by using the Thyroid Event Amsterdam (THEA) score.

Three-quarters of the participants were non-smoking married women. Thyroid dysfunction was diagnosed among 43% of the participants (n=150), of whom two-thirds (74%) were having overt dysfunction (n=111). Neither the demographic elements nor the initial thyroid function could predict the future thyroid function among those participants. Two out of ten (16%) were having autoimmune thyroid disease (AITD) as part of familial clustering (n=56). Four participants with subclinical hypothyroidism were treated accordingly due to their high THEA score despite the global lower THEA score (5.00±0.44).

Screening of asymptomatic relatives of patients diagnosed with Hashimoto's thyroiditis could help identify the familial background of thyroid diseases in 43% of FDRs and SDRs. One-third may have an underlying autoimmune basis.

Autism Spectrum Disorder (ASD) is a complex and heterogeneous neurodevelopmental disorder that is associated with functional impairments across an individual’s lifespan. The complexity and increasing global prevalence of ASD pose significant strains on healthcare systems. Early Intensive Behavioral Interventions (EIBI) are cost-effective evidence-based interventions that improve outcomes for individuals with ASD, especially when implemented in early childhood.

This study reviews the disease burden of ASD and analyzes four potential financing models for EIBI in Dubai.

A rapid literature review was conducted to synthesize the disease burden of ASD and EIBI services in Dubai. Bardach’s eightfold model for policy analysis was used to analyze four policy options for EIBI in Dubai: (1) Government financing and provision of EIBI through specialized centers, (2) Government financing of EIBI through contracting private providers, (3) Mandating insurance coverage of EIBI for children with ASD, and, lastly, (4) A mixed model that includes both mandating insurance coverage for EIBI and government provision through non-profit organizations.

EIBI services were available in Dubai but were associated with a substantial out-of-pocket (OOP) burden on families. Many young children with ASD were unable to access EIBI. Option (4) of using the mixed financing model of EIBI was optimal in the context of Dubai, based on evaluation criteria, including accessibility, cost-effectiveness, quality, and implementability, with minimal OOP burden on families.

To ease the burden on families with children suffering from ASD, the stakeholders, including the government of Dubai, should consider a mixed financial model to provide EIBI.

Operative hysteroscopy is a surgical technique for various procedures of the uterus, for example, hysteroscopic myomectomy. This has been an effective alternative to conventional hysterectomy and has produced better surgical outcomes in terms of faster recovery, less post-operative pain and better patient satisfaction.

A 49-year-old female was presented to the PAC clinic for hysteroscopic myomectomy for her dysfunctional uterine bleeding. There was no medical history of any previous medical or surgical problems. Her physical examination and routine labs did not reveal any abnormalities. She was labeled an ASA class 1 patient. Hysteroscopic myomectomy under spinal anesthesia was approved by the patient. On the day of the surgery, the patient was presented to the preoperative patient holding and was calm and comfortable. Vital parameters recorded were under normal limits. 20 G intravenous cannula was taken on her left dorsum of the wrist, and she was wheeled to the operating room. She was connected to ASA standard monitors, and her blood pressure, pulse rate, and spo2 were recorded. Spinal anesthesia was performed in a sitting position with a 27 G pencil point needle in a single attempt, and the procedure was regular. The level of anesthesia was ascertained to be till T6, and the patient was handed over to the surgical team. Surgery was started in a low lithotomy position. 65 minutes into the surgery, the patient started to complain of intra-abdominal pain, difficulty breathing, and started being restless. Blood pressure was 133/83mmhg, and SpO2 dropped from 98% to 86%. Her pulse rate was 112 beats per minute.

The patient’s abdomen was examined by moving the operative drapes, and gross abdominal distention was noted. Lung auscultation revealed crepitations on the basal lobes. Immediately, distention syndrome was suspected.

The studies of agglutinating and adsorbing abilities of IgM and IgG antibodies towards the red blood cells (RBCs) and tissue cells are scarce.

The study aimed to estimate the differences in the avidity of blood group-specific IgM and IgG antibodies to RBCs and epithelial cells.

The reaction of hemagglutination, adsorption, mixed agglutination reaction and saliva inhibition test were used. Anti-B 2-54 monoclonal antibody, polyclonal citrated plasma and the heated plasma were used for investigation of IgM and IgG antibodies.

IgM antibodies showed high adsorbing ability to RBCs and epithelial cells in an alkaline medium.

On the contrary, the heated plasma containing IgG antibodies showed high adsorbing ability to RBCs and epithelial cells in the acid medium as compared to the alkaline medium. Complete adsorption of IgG antibodies was observed by epithelial cells as compared to erythrocytes.

A mixed agglutination reaction confirmed the strong binding of anti-B IgG antibodies with group B epithelial cells in an acid medium.

The binding of polyclonal IgM and IgG group-specific antibodies with red blood cells and epithelial cells depends on the opposite values of pH of the medium. IgG antibodies completely adsorb on epithelial cells contrary to IgM antibodies.

Blood group-specific IgG antibodies showed high avidity to epithelial cells as compared to red blood cells. IgG antibodies demonstrated high agglutinating ability in alkaline medium and strong adsorbing ability in acid medium contrary to IgM antibodies, demonstrating high adsorption properties in alkaline medium.

Studies conducted worldwide have found that medical students have higher levels of stress than students in other fields. Chronic stress can result in increased rates of fatigue, depression, and impairment in function. Although this phenomenon has been studied globally, there has been limited attention in our region. Therefore, the purpose of this study is to assess stress levels in medical students in Dubai and evaluate their coping strategies to highlight the importance of shedding light on the psychological well-being of this population.

A cross-sectional design was utilized for this study. The target population consisted of all medical students enrolled at a local university for the 2020-2021 academic year. The participants completed a survey that collected information on stress and coping strategies. The Perceived Stress Scale (PSS-10) and the Brief COPE inventory were utilized to gather the data.

The total of 97 individuals completed the study questionnaire. The rates of high stress levels according to the Perceived Stress Scale (PSS-10) were higher among medical students in the first to the third year (43.6%), when compared to medical students in the fourth and fifth years (7.7%). Results of the Brief COPE inventory indicated that the average score for a Problem Focused coping style among medical students fell in the medium to high range (22 out of 32).

Levels of stress are elevated among medical students. Coping responses reflect the individual’s psychological adjustment and well-being. Our study sample revealed a medium to high rate of engagement in healthy coping strategies. Future research that evaluates the psychological impact of stress in-depth and explores effective strategies to enhance coping is highly warranted.

Tertiary hyperparathyroidism (THPT) is a well-known complication of end-stage kidney disease (ESKD), resulting from a loss of functional renal tissue with subsequent alterations in calcium and phosphate metabolism. Tertiary hyperparathyroidism reflects severe parathyroid hyperplasia with autonomous excessive secretion of parathyroid hormone (PTH) that is no longer responsive to the concentration of plasma calcium and leads to abnormal bone remodelling, soft tissue calcifications, vasculopathy, and other systemic complications.

The authors, hereby, highlight varied presentations of tertiary hyperparathyroidism (THPT) by presenting 3 interesting cases, describing their clinical course and outcomes. Through sharing these experiences and insights, we hope to contribute to a better understanding of THPT and its optimal management in patients with ESKD.

THPT can have a significant impact on patient health and quality of life. Despite the widespread use of interventions, such as vitamin D analogues, calcimimetics and parathyroidectomy, THPT remains a significant clinical challenge for patients with ESKD.

Chylothorax corresponds to the incidence of chyle in the pleural space; it was described for the first time in 1633. Its most common cause is associated with iatrogenic injuries to the thoracic duct; 80% of them take place during surgeries, such as pneumonectomy or esophagectomy.

A case of an unusual cervical stab wound complication in a 23-year-old man who presented a late large volume chylothorax has been presented and discussed in this paper, as well as its management.

The presented case demonstrates a rare complication after a cervical stab wound. The management of chylothorax can involve non-operative management, non-operative intervention, or operative management depending on the symptoms and duration. Usually, surgical interventions are required after two weeks of clinical treatment. The differential diagnosis in a post-trauma acute onset ventilatory manifestation is mandatory to rule out pulmonary embolism.

Traumatic chylothorax is a rare event; however, its morbidity and mortality rates can be catastrophic when it is not diagnosed early and when the treatment is not established based on a proper flowchart. Thus, dietary and drug-based clinical measures, interventional radiology, videothoracoscopy, and thoracotomy for thoracic duct ligation are valid therapeutic options for the proper management of these cases.

Autoimmune thyroid disease (AITD) is a serious and treatable disease that could be associated with other autoimmune disorders. It is a common cause of hypothyroidism in adult females. The diagnosis is established by detecting serum antithyroid antibodies. The disease slowly progresses, and the treatment includes thyroid hormone replacement in cases of hypothyroidism.

The aim of this study is to investigate the clinical presentation, laboratory findings, and comorbidity factors involved in autoimmune thyroid disease among Emirati citizens in the UAE.

Medical records from Advanced Cure Diagnostic Centers were reviewed in a retrospective study over the period of four years from 2018 to 2022. The patients population included those who attended the Endocrinology Unit and others seen by the rest of the medical staff. Patients were considered to have AITD if they tested positive for thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb), or both. The data collected was evaluated using descriptive analysis to provide a basic summary of the patients sample and dataset. Unpaired t-test was used to compare the mean value of elevated autoantibodies in males and females.

Of the 366 Emirati nationals who were tested for autoimmune thyroiditis, 220 (60%) had an abnormal result for TPOAb and/or TgAb. Among the 220 patients who had an abnormal result for TPOAb and/or TgAb, 188 (85.5%) were females, and 100 patients (45.5%) were in the age group between 31 and 40 years. 42% were in a euthyroid state and 42% presented with hypothyroidism. Only 7% presented with hyperthyroidism, 5% with subclinical hypothyroidism, and 2% with subclinical hyperthyroidism. An analysis of the comorbidity factors revealed 142 (65%) patients with obesity, 82 (37%) with a family history of thyroid disease, 77 (35%) with hyperlipidemia, 14 (6%) with hypertension, and 11 (5%) with diabetes.

This is the first publication intended to address AITD in Emirati citizens. Our findings concur with the international data regarding the prevalence among middle-aged females. Eighty-four percent of the positive patients either presented with no abnormality of their thyroid gland function or with hypothyroidism. With the alarming increase of obesity in the UAE, we found it to be the single most important and preventable comorbidity factor present in 65% of the studied population. This is followed by a family history of first-degree relatives with thyroid disease in 37% of the participants, due to the high rate of consanguineous marriages in the UAE.

In the past several years, acupuncture has been used more often to manage pain, either in conjunction with other therapies or as a complementary treatment. Evidence also points to a rise in physiotherapists’ interest in acupuncture.

The goal of performing a cross-sectional survey was to identify the characteristics of physiotherapists who use acupuncture in their relevant practice and also to explore what views participants had regarding the inclusion of acupuncture in the physiotherapy curriculum.

A quantitative cross-sectional survey methodology was used in the investigation. Through pilot studies and expert input, an online survey was developed and validated. The South African Society of Physiotherapy (SASP), the Physiotherapy Association of South Africa (PASA), and the Emirates Physiotherapy Society (EPS) used email and social media to distribute the questionnaire to physiotherapists in order to gather data. These countries were specifically chosen based on language and researcher familiarity with the organizations. One hundred eighty-one physiotherapists who were members of the appropriate professional associations in South Africa and the United Arab Emirates were included in the study as a convenient sample. Active physiotherapists who have treated patients within the previous six months and consented to take the survey were eligible to participate. The study had no exclusion criteria.

The survey had varied results, although most respondents recognized the value of acupuncture in the practice of physiotherapy. However, the majority of participants did not think that physiotherapy alone is ineffective. Overall, the survey results showed that some respondents preferred postgraduate acupuncture education over including acupuncture in undergraduate education. Notably, despite the majority of physiotherapists having bachelor’s degrees, the survey data showed that many of them possessed practical experience in acupuncture.

Antibody titres against several infections are hypothesized to be protective against COVID-19 due to cross-immunity. The study intends to assess the relationship between historical data of measles, rubella, pertussis antibody titres and the occurrence of self-reported COVID-19.

The study was conducted as an online cross-sectional survey which was compared with historical data of antibody titers. The university female students who had participated in our previous study evaluating seroprevalence of measles, rubella and pertussis antibody titres were contacted online for the survey. The online questionnaire was sent to collect details on COVID-19 occurrence among all the participants. The measles, rubella and pertussis titers of all participants were correlated with the present questionnaire data. All volunteers participated in the survey after online informed consent.

Among the 52 responders to the questionnaire, 18 participants had been reported to be suffering from COVID-related symptoms and 12 were reported to have confirmed RT-PCR positive for COVID-19. The unpaired “t” test comparing antibody titres of measles, rubella and pertussis between COVID-19 RT PCR positive and RT PCR negative subjects did not show statistical significance.

There was no statistical difference between antibody titers of measles, rubella and pertussis among self-reported COVID-19 RT PCR positive and RT PCR negative university female students.

This study aimed to investigate the validity of the mean platelet volume (MPV) alone and MPV combined with the revised Clinical Risk Index for Babies (CRIB II) score to predict neonatal mortality in preterm infants.

This retrospective observational study performed between May 2018 and June 2021 included preterm neonates (gestational age 23–32 weeks) admitted to a tertiary neonatal intensive care unit (NICU) within 12 hours of birth, who were followed up until death or discharge. MPV was recorded at admission and within 72 hours before death or discharge. The CRIB II score variables were assessed within 12 hours of birth, and the area under the receiver operating characteristic curve (AUC) was calculated for the MPV and CRIB II scores to predict neonatal mortality.

We investigated 404 newborns, of whom 28 (6.9%) died. The mean neonatal gestational age was 28.6±2.8 weeks. The MPV was significantly higher in non-survivors than in survivors (p=0.001). The AUC for the MPV and the CRIB II score was 0.68 (95% CI: 0.55–0.80) and 0.85 (95% CI: 0.79–0.91), respectively. The AUC for the MPV combined with the CRIB II score was 0.91 (95% CI 0.87–0.95). The difference in MPV at birth between survivors and non-survivors was statistically non-significant.

MPV was found to be a poorer predictor of neonatal mortality than the CRIB II score; however, MPV combined with the CRIB II score demonstrated significantly improved predictive ability for preterm infant mortality risk.

Pregnancy is rare in women with end-stage renal disease (ESRD). However, this scenario has changed in recent years with considerable improvement and successful outcomes in pregnant women with end-stage renal disease on dialysis. The understanding of the principles related to pregnant dialysis patients, combined with a multidisciplinary approach to case management, has resulted in many success stories, and today, pregnancy for young women with ESRD is more plausible and far safer than ever before.

However, these pregnancies carry a high-risk status for both the mother and fetus, with increased rates of maternal and fetal complications.

We present a series of three women who conceived while on dialysis and delivered successfully. These women were managed with increasing dialysis frequency and developing a clinical protocol early on, with a multidisciplinary approach and close collaboration with obstetricians. Our case series is unique as one of the women had three successful deliveries while on dialysis, and one of them had a positive outcome with twin pregnancies while on dialysis.

Successful outcomes in these high-risk pregnancies while on dialysis suggest that with meticulous care and multidisciplinary approach, conception and successful deliveries are plausible in women who receive dialysis.

Hydralazine has been used in the treatment of hypertension and heart failure for a long time. It has been associated with the development of Vasculitis and Drug induced lupus. This is a male patient in his sixties who was admitted at the hospital and prescribed hydralazine. He developed Hydralazine-induced lupus with Pancytopenia and renal failure. This case report has been written to raise awareness about the hydralazine side effects.

This case report describes a 68-year-old male, transferred to our hospital for rehabilitation. He was tracheostomized. He is hypertensive with a history of CVA. BP was elevated during the admission. He has no family history of immunological diseases or any allergies. 6 months after hydralazine, the patient started to have a purpuric rash over the lower limbs and an elevated renal profile. Only Direct Coomb’s test was positive. He had hematuria and pancytopenia also. He was started on steroids and he became edematous. On March 2021, the hydralazine was stopped and the patient's blood tests improved, the rash disappeared and hematuria stopped. Unfortunately, he got fungemia and septicemia with pneumonia. He became hypotensive and anuric. The patient kept deteriorating and passed away.

Hydralazine is not a first line choice for the treatment of hypertension. Common side effects include tachycardia and headache. It can also cause drug-induced lupus.

Hydralazine has been used in the treatment of hypertension and heart failure for a long time. It has been associated with the development of Vasculitis and Drug induced lupus.

Disseminated intravascular coagulation (DIC) is a known complication of malignancy. Drug-induced DIC is also reported. Sunitinib is a tyrosine kinase inhibitor approved as an oral targeted therapy in the treatment of different cancers. Here we present a case study of disseminated intravascular coagulation following the administration of Sunitinib after COVID-19 infection in a patient diagnosed with metastatic neuroendocrine tumor of the lung.

A 35-year-old male patient with a known metastatic lung neuroendocrine tumor (NET) who was treated with Sunitinib for many years with partial response and tolerating the treatment well-developed recurrent DIC on Sunitinib after COVID-19 infection.

COVID-19 infection is reported to be associated with endothelial injury and inflammation. Vascular endothelial growth factor (VEGF) receptors have a role in the protection and modulation of endothelium. Sunitinib is a multikinase inhibitor with anti- VEGF effect. It is possible that endothelial injury after COVID-19 may have triggered recurrent DIC in this patient who had previously tolerated the same drug without problems.

DIC may be underreported especially with antineoplastics having anti-VEGF effects. Potential risk, interaction, and association with COVID-19 infection in the Era of the pandemic are unclear but warrants further research, and drug-induced DIC should be considered in the differential diagnosis of such cases.

The prevalence of dyslipidemia in the United Arab Emirates (UAE) can be as high as 72.5%. Patients with dyslipidemia usually present with other metabolic risk factors, increasing their risk of acute cardiovascular diseases (CVD). Despite these alarming findings, local data regarding management practices in the UAE are lacking. The current report gathered the perspectives of experts from the UAE regarding the burden and current practices in managing dyslipidemia, as well as the current unmet needs and treatment gaps.

The present perspective is based on a consensus meeting that gathered the insights of six consultant cardiologists. All experts were affiliated with academic institutions representing the UAE's different geographical areas.

Data regarding the prevalence of dyslipidemia in the UAE and its associated ethnic differences are lacking. It is suggested that there needs to be more adherence to international recommendations for screening lipid profiles in primary care centers, which may lead to underestimating the burden of dyslipidemia. As CVD presents at a younger age in the UAE, screening for lipid profile at 35 is recommended, regardless of CVD risk. The panel emphasized that most dyslipidemia patients in the UAE are categorized as high or very high-risk groups for CVD; however, current risk assessment tools have not been validated in the UAE population and may not be tailored to the Middle Eastern and Asian populations. International guidelines have recommended the high-intensity statins-ezetimibe combination for high and very high-risk patients; the experts stated that the high-intensity statins-ezetimibe combination could be initiated in high-risk groups in the UAE. Several barriers to effectively controlling dyslipidemia in the UAE have been identified, including non-adherence, limited awareness about screening and management recommendations, and physician inertia toward achieving the recommended therapeutic goals.

With the digitalization of health care, nurses are required to possess adequate eHealth competence.

This study aimed to explore the perceived confidence in eHealth concepts and willingness for training among nursing students.

A cross-sectional survey was conducted among 572 undergraduate nursing students recruited by convenience sampling technique from two selected nursing colleges in Southern and Northern India. A structured questionnaire was used to collect data. The data was analysed using SPSS. A p-value of less than 0.05 was taken as statistically significant.

A total of 572 students completed the survey. The age of the participants ranged from 18 to 28 years, with a mean of 20.7 (SD 2.0) years. Most of the students (92.5%) used smartphones as their source of internet. More than half (66.1%) of the students were confident in various eHealth concepts. Those who were not confident in a particular eHealth concept were more willing to learn the same concept than those who were confident.

The study recommends preparing future nurses having knowledge of various eHealth concepts using curricular and co-curricular activities to increase their confidence and enable them to work effectively in the era of digital transformation of health care.

This qualitative study explored parental perceptions of autism spectrum disorder (ASD) services in the United Arab Emirates (UAE).

Forty-one parents of children with ASD participated in five focus groups to explore their experiences with ASD services in the UAE. These moderated focus groups were recorded, transcribed, coded, and analyzed using thematic analysis.

The following primary themes and subthemes were identified: (a) lack of awareness and support, (b) challenges in accessibility and affordability, (c) inconsistent quality of therapeutic services, and (d) Lack of educational inclusion and support.

Findings of this study support the need for creating a comprehensive system of care for ASD that is coordinated, is person centered, and promotes continuity of care that improves the outcomes for those “navigating” the often-fragmented system of ASD in the UAE.