An analytic study of the trends in perinatal and neonatal mortality rates in the State of Qatar over a 30-year period (1977 to 2007): a comparative study with regional and developed countries

OBJECTIVE

This study was designed to analyze the trends and differences in perinatal and neonatal mortality rates in the State of Qatar over a period of 30 years (1977 to 2007), to examine the causes of neonatal deaths and compare them with some regional Gulf states and developed world countries.

STUDY DESIGN

This is a retrospective study conducted in the Women's Hospital, Hamad Medical Corporation, State of Qatar from 1977 to 2007.

METHOD

The study included all perinatal and neonatal deaths for the period 1977 to 2007, which were monitored through registers of the Neonatal Intensive Care Unit (NICU), Women's hospital. Cause of death was determined using information from hospital records, including discharge certificates. There is a national database in the Department of Preventive Medicine that records all deaths through death certificates. The missing information for the early years was collected from this database. All causes of deaths were classified in accordance with criteria based on the International Classification of Disease tenth revision (ICD-10).

RESULT

There was a notable peak in neonatal (14.1), early neonatal (12.5) and perinatal (24.7) mortality rates in 1977. There was a second peak in neonatal (12.1) and late neonatal (7.5) mortality rates in 2000. Over a period of three decades (1977 to 2007), there was a significant decline in mortality rates (P<0.0001). By 2007, the neonatal mortality rate had decreased from 14.1 to 5.1; the early neonatal mortality rate had a dramatic fall from 12.5 to 2.3; and perinatal mortality came down from 24.7 to 10.3. There was no notable reduction in the late neonatal mortality rate in 2007 (2.8) compared with that in 1980 (3.0). The still-birth (8), neonatal (5), early neonatal (2.3) and perinatal (10.3) mortality rates in Qatar were very close to the rates found in developed countries, but lower than the rates in Bahrain and Saudi Arabia. Similar to developed countries, prematurity was the leading cause of neonatal death in Qatar (42.6%), followed by congenital anomalies (28%).

CONCLUSION

This study revealed that there was a sharp significant decline in neonatal and perinatal mortality rates during the study period in Qatar. The stillbirth, neonatal and perinatal mortality rates in Qatar are comparable with those in some of the developed countries and were lower than those in some of the Gulf countries. The proportion of underweight live births was found constant during the study period. Prematurity was the leading cause of neonatal death, followed by congenital anomalies.

The impact of air pollution on hospital admission for respiratory and cardiovascular diseases in an oil-rich country

OBJECTIVES

Aim of this study was to evaluate the impact of air pollution on hospital admissions for respiratory and cardiovascular diseases in an oil rich developing country, State of Qatar.

METHODS

A prospective cohort population based study was conducted at different stations of Qatar during the period (2002-2005) for recording the concentration of air pollutants daily for sulphur dioxide (SO2), nitric oxide (NO), nitrogen dioxide (NO2), carbon monoxide (CO), ozone (O3) and particulate matter (PM10). Hospital admission data were collected from the inpatient discharge database of the Medical Records Department, Hamad General Hospital.

RESULTS

An average of 5.36 admissions from ischemic heart diseases was counted daily in all the population which was even higher than the respiratory diseases (3.4/day). Minimum temperature was inversely correlated with all pollutants except for O3 and SO2.

CONCLUSION

There was an association between increasing air pollutant levels and patients admitted for respiratory and cardiovascular diseases.

Hepatitis B and C viral infections in chronic liver disease: a population based study in Qatar

We investigated the incidence of hepatitis B (HBV) and C (HCV) virus infection among patients with liver disease in Qatar from 2000 to 2005. The grading and staging of HBV and HCV cases were obtained from pathology reports at the principal reference laboratory for Qatar. Of the 915 liver patients studied, 29.4% had HCV and 2.5% had HBV. The incidence of HBV and HCV infection was greater in non-Qataris than Qatari nationals and in males than females, especially for HCV. Most cases were uncomplicated (89.0%) and had no inflammation (76.4%). The incidence of HCV has been increasing in liver patients in recent years up to a rate of 481 per 1000 patients with liver disease in 2005.

The impact of air pollution on hospital admission for respiratory and cardiovascular diseases in an oil and gas-rich country

OBJECTIVES

Aim of this study was to evaluate the impact of air pollution on hospital admissions for respiratory and cardiovascular diseases in an oil rich developing country, State of Qatar.

METHODS

A prospective cohort population based study was conducted at different stations of Qatar during the period (2002-2005) for recording the concentration of air pollutants daily for sulphur dioxide (SO2), nitric oxide (NO), nitrogen dioxide (NO2), carbon monoxide (CO), ozone (O3) and particulate matter (PM10). Hospital admission data were collected from the inpatient discharge database of the Medical Records Department, Hamad General Hospital.

RESULTS

An average of 5.36 admissions from ischemic heart diseases was counted daily in all the population which was even higher than the respiratory diseases (3.4/day). Minimum temperature was inversely correlated with all pollutants except for O3 and SO2.

CONCLUSION

There was an association between increasing air pollutant levels and patients admitted for respiratory and cardiovascular diseases.

Size at birth in a rapidly developing economy: intrauterine growth pattern of UAE infants

BACKGROUND

Despite rapid economic growth and the recognition of intrauterine growth pattern as an important indicator of neonatal morbidity and mortality, the size at birth relative to gestation for UAE (United Arab Emirates) live births has not been investigated.

AIM

The present study evaluated the intrauterine growth pattern of UAE infants and compared the data with the currently used reference standard.

SUBJECTS AND METHODS

A total of 2497 singleton hospital live births to UAE mothers without pregnancy complications were studied. Anthropometric measurements and gestational age assessment of each infant were carried out according to standard procedures. The LMS computer program was used to construct perentile curves.

RESULTS

The mean birth weight, length and head circumference of 1113 male term infants were 3298 g, 50.6 cm and 34.5 cm, respectively, and the same parameters for 1118 female term infants were 3201 g, 49.9 cm and 34.0 cm, respectively. These growth parameters were higher in males than females. Mean birth weight data were similar to those reported previously from a study from an economically developed community. The 10th percentile values were higher than in the currently used reference chart.

CONCLUSION

Data on size at birth for UAE infants indicate that continuing use of the current reference chart may underestimate the prevalence of fetal growth failure in the population. Data from larger numbers of very preterm infants are needed to generate percentiles charts for very preterm infants.

High prevalence of vitamin D deficiency in young children in a highly sunny humid country: a global health problem

AIM

Several studies indicate a high prevalence of vitamin D deficiency among young populations. Information about the vitamin D status in young adult populations from the Middle East is scarce. The vitamin D status can be expected to be influenced by highly different factors between various countries in Europe, the Middle East and Asia. The aim of this study was to determine the prevalence of vitamin D deficiency in young Qatari children below 16 years of age.

METHODS

A cross-sectional study carried out among children below 16 years of age who visited the Primary Health Care Centers (PHCs). The survey was conducted over a period from August 2007 to March 2008. Qatari nationals, male and female, aged below 16 years. A random sample of 650 children who visited the PHC Centers was approached and parents of 458 children expressed their consent to participate in this study, corresponding to a response rate of 70.5%. Face-to-face interviews were based on a questionnaire that included variables such as socio-demographic information, life style, family history and feeding patterns during infancy, and clinical information as well as laboratory investigations for biochemical assessment of vitamin D status.

RESULTS

Of the total number of 458 children surveyed, 228 (49.8%) were males and 230 (50.2%) females. The prevalence of vitamin D deficiency among the studied Qatari children was (68.8%), mostly in the age group (11-16) years (61.6%). There was a significant difference between vitamin D deficient and normal children as compared to their age (P=0.013). Vitamin D deficiency was more common among girls (51.4%) than boys (48.6%). Exposure to sunlight was limited in both groups; but even lower in vitamin D deficient children (57.5%) than in normal children (70.6%). The duration of time spent outside was again low in both groups but significantly lower in vitamin D deficient children (23.5 minutes) compared to normal children (28.4 minutes). Low duration of time spent outdoors, breast feeding less than 6 months, a family history of diabetes mellitus and physical activity were significant predictors for vitamin D deficiency in Qatari children. Rickets, fractures, gastroenteritis and delayed milestones were all significantly higher in vitamin D deficient children.

CONCLUSIONS

The present study revealed that the prevalence of vitamin D deficiency is high in Qatari children and more common in Qatari girls. In the young population in Qatar, vitamin D deficiency appears to result from a combination of limitations in sunlight exposure and a low oral intake of vitamin D.

The Prevalence of Attention Deficit Hyperactivity Symptoms in School Children: A Highly Consanguineous Community

Objective:

The objective of the present study was to find the prevalence of attention deficit hyperactivity (ADH) symptoms in a highly consanguineous community.

Design:

A cross sectional study was conducted during October 2006 - January 2007.

Subjects and methods:

A total of 2500 primary school students, aged 6-12 years were randomly selected from the government primary schools and 1869 students (74.8%) gave consent to participate in this study.

Results:

Of the students surveyed, 50.7% were boys and 49.3% girls. The data revealed that 158 boys [16.7%; 95%CI (14.4-19.2] and 50 girls [5.4%;95%CI (4.1-7.1)] scored above the cut-off (≥15) for ADH symptoms, thus giving an overall prevalence of [11.1%; 95%CI (9.7-12.6)]. The Children who had higher score for ADH symptoms were in the age group 6-9 years. Children who had higher score for ADH symptoms had school performance poorer than those with lower scores (P=0.002). 200 children (96.2%) with ADH were disobedient, 60.6% noisy and hyperactive, 36.5% very cranky, 37.5% troublesome and 37.9% nervous. The logistic regression identified in our study that socio-economic condition, number of children, school performance and poor relationship between parents were the main contributors for ADH. This shows that the consanguinity has no impact on ADH children.

Conclusion:

The study revealed that ADH symptoms are found to be a common problem among the school children in Qatar. A significant difference was found between children with and without ADHD for their behaviour.

Prevalence of Overweight, Obesity, and Associated Psychological Problems in Qatari’s Female Population

Background:

Dissatisfaction with body weight and the use of unhealthy weight reduction practices have been reported among adolescents.

Objective:

The aim of the present study was to examine the severity of dieting and its association with obesity, body satisfaction and psychological problems in female adolescents.

Subjects:

A representative sample of 800 girls aged 14-19 years were approached during the period October to December 2004 and 566 girls gave consent and participated in the study, thus giving a response rate of 70.8%.

Methods:

Self-reports were obtained from 566 teenage girls using the Adolescent Dieting Scale (ADS) and the Self-Reporting Questionnaire (SRQ-20) for psychopathology.

Results:

The prevalence of overweight and obesity for female adolescents were 13.4% vs 1.8%;-; 39.9% were intermediate dieters, and 8.3% were extreme dieters. Dieting was not associated with age but was significantly associated with body mass index (BMI) (p=0.045). Extreme dieting was strongly associated with peer perception of respondent's figure (p< 0.001) and self perception of figure (p=0.016). Additionally, in adult Qatari population overweight and obesity for males were (34.4% vs 34.6%) and for females were (33.0% vs 45.3%). This is significantly higher than adolescent girls. (p< 0.01). The SRQ score was significantly highest in the extreme dieters group (p=0.005). The extreme dieters get most of their education (or information?) about dieting from school(14.0%) and TV(43.6%).

Conclusion:

The present study revealed strong evidence for the association between frequent dieting and overweight, body image dissatisfaction and psychological problems among adolescent females.

Prevalence and Impact of Diabetes Mellitus in Patients With Acute Myocardial Infarction: A 10-year Experience

Background: Diabetes mellitus is associated with a higher incidence of acute myocardial infarction. Objective: To study the prevalence and outcome of patients with diabetes among patients with acute myocardial infarction. Methods: Retrospectively, patients who presented with acute myocardial infarction in a 10-year period were identified from the coronary care unit database. Results: A total of 1598 Qatari patients were admitted with acute myocardial infarction, 863 (54%) of them had diabetes mellitus (females 68.5% vs males 48.3%; P < .001). In-hospital mortality rate was non-significantly higher in diabetic patients (18% vs 15% P = .15). Aspirin (odds ratio 2.39, 95% confidence interval 1.96-2.90, P = .003] and β-blocker use (odds ratio 1.75, 95% CI 1.21-2.52, P = .0001) were independently associated with reduced mortality risk. Conclusions: The prevalence of diabetes mellitus among patients with acute myocardial infarction in a geographically defined population in the developing world is high with a trend for poor outcomes. However, mortality was not significantly higher in diabetes mellitus than non-diabetes mellitus patients.

Prevalence and determinants of fecal incontinence in premenopausal women in an Arabian community

OBJECTIVES

The aim of this study was to determine the prevalence, awareness and determinants of fecal incontinence among Qatari women.

METHOD

In the cross-sectional community-based study in primary health-care centers, using a multistage sampling design, a representative sample of randomly selected 776 Qatari women aged from 40 to 48 years were approached from January to August 2007; only 596 women, with a response rate of 76.8%, gave consent and were included in the analysis. Participants completed a questionnaire assessing fecal incontinence in the previous 12 months and health care-seeking behavior for fecal symptoms. Fecal incontinence, determined by self-report, was categorized by frequency. Females reported the level of bother of fecal incontinence and their general quality of life. Potential risk factors were assessed by self-report, interview, physical examination, and record review.

RESULTS

Of the studied Qatari women, 62 (10.4%) were found to have fecal incontinence. There was a significant difference between fecal incontinent and continent groups with regard to menopause (p < 0.0001), surgical repair of genital prolapse (p < 0.0001) and constipation (p < 0.0001). Only 31 incontinent patients (50%) had sought medical advice. Of the fecal incontinent women, 77.4% felt embarrassment in consulting a doctor and 77.4% believed their condition was worth reporting to a doctor. Aging (51.6%) was the major cause of fecal incontinence in women, followed by childbirth (40.3%), then menopause (25.8%) and lastly paralysis (14.5%). Most of the sufferers were troubled by their inability to pray (64.5%). Their relationship with their husband (41.9%) was the significant consequence for fecal incontinent Qatari women (p = 0.02); 37.1% isolated themselves from social activities and going out to shop.

CONCLUSIONS

The study findings revealed that fecal incontinence is a common symptom among women in the community. There was a correlation between fecal incontinence and menopause. Overall, most of the fecal incontinent women reported that fecal incontinence significantly affected quality of life and only half of the studied women had consulted a physician for the symptom.

Does Morbid Obesity Increase Morbidity in Abdominoplasty?

To determine whether morbid obesity increased morbidity in abdominoplasty 200 mostly female patients (100 patients morbidly obese and 100 overweight and obese) were studied but showed no statistically significant difference in the complication rate between the two categories nor between them and the international rate of complication of dermolipectomy in non-obese patients although co-morbid diseases did increase the risk of complications. It is concluded that morbid obesity should not preclude abdominoplasty, that patients do benefit, especially obese patients who are unable to lose weight following dieting or even gastric banding. surgery.

Does prolonged breastfeeding reduce the risk for childhood leukemia and lymphomas?

AIM

Prolonged breastfeeding was shown to reduce the risk of childhood acute leukemia. The aim of the study was to investigate the protective effect of longer breastfeeding on the risk of lymphoid malignancies in children and its dependent socio-economic factors.

METHODS

The study group comprised of 169 patients with acute lymphocytic leukemia (ALL), Hodgkin's (HL) and non-Hodgkin's lymphoma (NHL), age =or<15 years, and 169 healthy controls, matched to patients by age and sex. Mothers of all study subjects provided information via telephone about the history of breastfeeding and parameters seen as proxies for viral infection.

RESULTS

The mean age+/-SD of cases was 5.44+/- 3.29 years and of control subjects 5.51+/-3.62 years. The male/female ratio was 1.73. Overall, the mean number of months of breastfeeding in the male patients and controls was 9.1 (95% confidence interval [CI] 7.9-10.4) and 12.1 (95% CI 11.0-13.4), respectively (P<0.001), and in the female patients and controls 8.4 (95% CI 6.9-10.1) and 11.5 (95% CI 10.0-13.0), respectively (P<0.01). In 103 ALL patients, a shorter period of breastfeeding (0-6 months duration), was associated with increased odds ratio (OR) for males (OR=3.1, 95% CI 1.4-6.8) and females (OR=2.2, 95% CI 0.8-6.32) as compared to breastfeeding longer than 6 months. In 103 ALL patients, 32 HL and 34 NHL patients, there were no statistically significant differences in the duration of breastfeeding between the male and female patients and their respective controls. In multivariate analysis, statistically significant risk factors for the development of childhood lymphoid malignancy were: a shorter duration of breastfeeding, lower age and level of education of mother and higher income, larger size of accommodation and birth order in the family.

CONCLUSION

The current study confirmed that a longer duration of breastfeeding has protective effect against ALL and HL. Additional factors found to be associated with an elevated risk of lymphoid malignancy were low age and low education of mother. All these factors can be related to an increased risk of early childhood infections.

Role of breast feeding in primary prevention of asthma and allergic diseases in a traditional society

BACKGROUND

The fact that breastfeeding may protect against allergic diseases remains controversial, with hardly any reports from developing countries. Prolonged breastfeeding was shown to reduce the risk of allergic and respiratory diseases.

AIM

The aim of this study was to assess the relationship between breastfeeding and the development of childhood asthma and allergic diseases in Qatari children at age 0-5 years. Additionally, this study investigated the effect of prolonged breastfeeding on the allergic diseases in a developing country.

DESIGN

This is a cross sectional survey.

SETTING

Well baby clinics and Pediatric clinics in the 11 Primary Health Care Centers and Hamad General Hospital, Hamad Medical Corporation, State of Qatar.

SUBJECTS

A multistage sampling design was used and a representative sample of 1500 Qatari infants and pre-school children with age range of 0-5 years and mothers aged between 18 to 47 years were surveyed during the period from October 2006 to September 2007 in Qatar. Out of the 1500 mothers of children, 1278 mothers agreed to participate in this study with the response rate of 85.2%.

METHODS

A confidential, anonymous questionnaire was completed by the selected subjects assessing breastfeeding and allergic diseases. Questionnaires were administered to women who were attending Primary Health Centers for child immunization. Questionnaire included allergic rhinitis, wheezing, eczema, and additional questions included mode and duration of breastfeeding, tobacco smoke exposure, number of siblings, family income, level of maternal education, parental history of allergies. Univariate and multivariate statistical methods were performed for statistical analysis.

RESULTS

More than half of the infants (59.3%) were exclusively breastfed, followed by infants with partial breastfeeding (28.3%) and artificial fed (12.4%). There was a significant difference found across these three categories of infants in terms of their age groups, smoking status of father, socio-economic status and parental consanguinity. Asthma (15.6%), wheezing (12.7%), allergic rhinitis (22.6%), and eczema (19.4%) were less frequent in exclusive breast fed children, compared to infants with partial breast feeding and formula milk. Ear infection (P = 0.0001) and eczema (P = 0.007) were found significant in infants with the history of maternal atopy, while asthma (P = 0.0001) and allergic rhinitis (P = 0.015) were found significant in infants with the history of paternal atopy. The main factors associated with mode of feeding were mothers having first baby, asthmatic mother and parental history of allergic rhinitis. The risk of allergic diseases, eczema, wheeze and ear infection in particular, were lower in children with prolonged breast feeding (>6 months) than in those with short-term breast feeding duration (<6 months).

CONCLUSION

The current study indicates that exclusive breast-feeding prevents development of allergic diseases in children. The main factors associated with breastfeeding for allergic diseases were being the first baby, maternal history of asthma, and parental history of allergic rhinitis. The study findings opens a big avenue for interventional role of breastfeeding. Therefore, we recommend breastfeeding is as one possible way to reduce the risk of onset asthma and allergic diseases in developing countries.

Streptococcus Pneumonia Serotypes in Newly Developed State of Qatar: Consideration for Conjugate Vaccine

Objectives: The objective of the study was to determine prevalent pneumococcal serotypes causing infections in different age groups, their susceptibility to fi-lactams and macrolides and whether these serotypes are covered by the conjugated pneumococcal vaccines.

Methods: Streptococcus pneumonia strains isolated from different patients at Hamad Medical Corporation, Microbiology Laboratory between September 1999 and July 2000 were sent to Statum Serum Institute in Denmark for serotyping. The strains were tested for their susceptibility to penicillin, ceftriaxone and erythromycin by Vitek 2 machine (bioMerieux, France) at Hamad Medical Corporation, Microbiology Laboratory.

Results: Predominant serotypes in children <  2 years were: 6A, 6B, 9V, 11 A, 14,19A, 19F and 23 F, predominant serotypes in children between 2-7years were: 3, 6B, 15B, 19A, 19F and 23F, while predominant serotypes in adults were: 3, 8, 9V, 14,15B, 20 and 22F. In children less than 2 years, the 7-valent and 9-valent conjugate vaccines covered 52% of serotypes. 33% of strains were moderately resistant to penicillin, 27% showed high-level resistance to penicillin, 30% resistant to erythromycin and 2% resistant to ceftrixone.

Conclusion: The 7-valent and 9-valent vaccines offer similar coverage of serotypes in children less than 2 years while the 11-valent vaccines offers 55% coverage. This difference is not statistically significant. Resistance to penicillin was high which leaves ceftriaxone as the drug of choice for empirical treatment of invasive pneumococcal diseases.

Montelukast treatment in children with moderately severe atopic dermatitis

BACKGROUND

Moderately severe atopic dermatitis makes up nearly one-fifth of children with atopic dermatitis.

OBJECTIVE

To determine the clinical and laboratory effects of montelukast in moderately severe atopic dermatitis.

METHODS

Randomized, double-blind, placebo-controlled, crossover trial with washout period, conducted from May 2002 to February 2006. The study involved 25 patients, 2-16 years old with dermatitis. Patients received oral montelukast (9 patients, Group B) or placebo (16 patients, Group A) in phase 1, and were crossed over to placebo or montelukast, respectively, for phase 2. Patients included if > 10% of skin was involved and failed response to 2 week conventional treatment. Itching, sleep disturbance, frequency of use of oral antihistamines & topical steroids, severity scores were serially assessed. In addition, eosinophil and serum IgE were serially collected.

RESULTS

Most of patients were 6-10 years of age. Both groups had comparable gender distribution. The patients in Group B were more likely to have a history of bronchial asthma (55.6%) or allergic rhinitis (33.3%) than patients in Group A, but were less likely to have a positive history of atopy. While on montelukast, there was a reduction of mean score for itching in phase 2, for sleep disturbance in phase 2, for antihistamines in phase 1, for extent-of-disease in phase 1 and 2, and for severity score in phase 2 and blood eosinophil & IgE in phase 2.

CONCLUSION

Montelukast reduces itching, sleep disturbance, disease extent and severity, blood eosinophil count and serum IgE.

Implementation of extended neonatal screening and a metabolic unit in the State of Qatar: developing and optimizing strategies in cooperation with the Neonatal Screening Center in Heidelberg

Qatar is a country in the Gulf area and member of the Gulf Cooperation Council states. The country is populated by original Qatari tribes that amount to about 200,000 people and about 600,000 expatriates mainly from Arabic and Asian countries. Inbreeding over centuries and high rates of consanguinity in the Qatari population and in some groups of expatriates, in addition to large family sizes and rapid population growth, have contributed to a high frequency of autosomal recessive disorders. In December 2003 Hamad Medical Corporation in Doha and the University Children's Hospital of Heidelberg, Germany, started an extended state-wide neonatal screening programme for metabolic and endocrine disorders, with the laboratory situated in Heidelberg, Germany. All aspects of the screening process had to be adapted to the unique situation of the laboratory being 6000 km from the birthplace of the neonates. Within 32 months, samples of 25,214 neonates were screened. In 28 cases an endocrine or metabolic diagnosis was identified (incidence 1:901, in Germany 1:1728). In particular, a variety of monogenic metabolic diseases were prevalent, with 19 patients detected giving an incidence of metabolic diseases of 1:1327 (Germany 1:2517). Each euro spent on the screening programme saved more than 25 euros in health and social costs. The programme revealed a high incidence of treatable inborn metabolic diseases in the population of Qatar. A reliable screening for classical homocystinuria showing a unique incidence of >1:3000 and for sickle cell disease has now been added.

Treatment of hepatitis C virus genotype 4 with peginterferon alfa-2a: Impact of bilharziasis and fibrosis stage

AIM: To evaluate pegylated interferon alpha2a (PegIFN-α2a) in Egyptian patients with HCV genotype 4, and the impact of pretreatment viral load, co-existent bilharziasis and histological liver changes on response rate.

METHODS: A total of 73 naïve patients (61 with history of bilharziasis) with compensated chronic HCV genotype 4 were enrolled into: group A (38 patients) who received 180 mg PegIFN-alpha2a subcutaneously once weekly for a year and group B (35 patients) received IFN alpha-2a 3 MU 3 times weekly. Ribavirin was added to each regimen at a dose of 1200 mg. Patients were followed for 72 wk and sustained response was assessed.

RESULTS: Significant improvement in both end of treatment response (ETR) (P < 0.002) and sustained response (SR) (P < 0.05) was noted with pegylated interferon, where ETR was achieved in 29 (76.3%) and 14 patients (40%) in both groups respectively, and 25 patients in group A (65.8%) and 9 (25.7%) in group B could retain negative viraemia by the end of follow up period. Sustained virological response (SVR) showed a significant negative correlation with age and positive correlation with pretreatment inflammation in patients receiving PegIFN. Viral clearance after 3 mo of therapy was associated with high incidence of ETR and SR (P < 0.001), but without significant difference between both forms of interferon. Significant improvement in response was achieved in patients with high grade fibrosis (grade 3 and 4) with PegIFN-α2a, where SR was seen in 5 out of 13 patients in group A, but none in group B. There was no significant difference in response between bilharzial and non-bilharzial patients in both groups. In terms of safety and tolerability, neutropenia was the predominant side effect; both drugs were comparable.

CONCLUSION: PegIFN-α2a combined with ribavirin results in improvement in sustained response in HCV genotype 4, irrespective of history of bilharzial infestation.

Vitamin D Defficiency in Rheumatology Clinic Practice in Qatar

In order to assess the prevalence ofvitamin-D deficiency in patients attending the rheumatology outpatient clinic at Hamad Medical Corporation, Qatar; 360 consecutive pa-tients (97% female) were tested for fasting levels of 25-hydroxyvitamin D, parathyroid hormone, calciumphos-phorus, albumin and alkaline phosphatase. Two hundred and three patients (56%) showed vitamin D levels below 20 ng/ml. From the results obtained it is concluded that lev-els of serum calcium, phosphorus, and alkaline phos-phatase are of limited value in predicting vitamin-D sta-tus. The difficulty of skin synthesis in heavily-robed women is discussed and it is concluded that hypovitaminosis D is frequent in such women and that routine assays of vitamin D and parathyroid hormone and vitamin D supplementa-tion would be beneficial.

Prevalence of overweight, obesity, and associated psychological problems in Qatari's female population

Dissatisfaction with body weight and the use of unhealthy weight reduction practices have been reported among adolescents. It is important to conduct rigorous studies using large representative samples of female adolescents to assess accurately the frequency of dieting, overweight and eating disorders and accompanying attitudes. The aim of the present study was to examine the severity of dieting and its association with obesity, body satisfaction and psychological problems in female adolescents. A representative sample of 800 girls aged 14-19 years were approached during the period of October to December 2004, and 566 girls gave consent and participated in the study, thus giving a response rate of 70.8%. Self-reports were obtained from 566 teenage girls using the Adolescent Dieting Scale and the Self-Reporting Questionnaire (SRQ-20) for psychopathology. Subjects were classified into three categories: acceptable weight (BMI < 25 kg m(-2)); overweight (BMI 25-29.9 kg m(-2)); and obese (BMI > 30 kg m(-2)). The prevalence of overweight and obesity for female adolescents were 13.4% vs. 1.8%; 39.9% were intermediate dieters, and 8.3% were extreme dieters. Dieting was not associated with age but was significantly associated with body mass index (BMI) (P = 0.045). Extreme dieting was strongly associated with peer perception of respondent's figure (P < 0.001) and self-perception of figure (P = 0.016). Additionally, in adult Qatari population overweight and obesity for males were (34.4% vs. 34.6%) and for females were (33.0% vs. 45.3%). This is significantly higher than adolescent girls. (P < 0.01). The SRQ score was significantly highest in the extreme dieters group (P = 0.005). The extreme dieters get most of their education about dieting from school (14.0%) and TV (43.6%). The present study revealed strong evidence for the association between frequent dieting and overweight, body image dissatisfaction and psychological problems among adolescent females.

Is there any effect of Ramadan fasting on stroke incidence?

INTRODUCTION

Over one billion Muslims fast worldwide during the month of Ramadan. Fasting during Ramadan is a radical change in lifestyle for the period of a lunar month. The objective of this study was to investigate whether Ramadan fasting has any effect on the incidence of stroke and its outcome in a geographically-defined population.

METHODS

We retrospectively reviewed a 13-year stroke database and studied the data on Muslim patients who were hospitalised with stroke over a 13-year period from January 1991 to December 2003. Patients were divided according to the time of presentation in relation to the month of Ramadan, one month before, during, and one month after Ramadan. The number of hospitalisations for stroke in various time periods was analysed. The age of presentation, gender, cardiovascular risk factor profiles (smoking status, hypertension, hypercholesterolaemia, diabetes mellitus, and pre-existing cardiovascular disease) were analysed. We also studied the trends of in-hospital mortality, morbidity and acute medical care provided.

RESULTS

Overall, 335 Muslim patients were hospitalised for stroke. Their mean age and standard deviation were 56.99 and 13.9 years, respectively. The number of hospitalisations for stroke was not significantly different in the month of Ramadan (29 cases), when compared to the month before Ramadan (30 cases) and the month after Ramadan (29 cases). Risk factors included for stroke were not significantly different in Ramadan when compared to the month before and after Ramadan. These associated diseases were hypertension, diabetes mellitus, hypercholesterolaemia, acute myocardial infarction, and congestive heart failure.

CONCLUSION

This study demonstrated that no significant difference was found in the number of hospitalisations for stroke while fasting during the month of Ramadan when compared to the non-fasting months.

Does hospitalization for asthma and allergic diseases occur more frequently in Ramadan fasting: a population based study (2000-2004)

OBJECTIVE

Over one billion Muslims fast worldwide during the month of Ramadan. Fasting during Ramadan is a radical change in life style for the period of a lunar month. Our objective in this study was to investigate whether Ramadan fasting has any effect on the incidence of asthma and to assess whether Ramadan Fasting affected normal lung function values.

DESIGN

This is a hospital-based cohort study.

SETTING

Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar.

PATIENTS

We prospectively reviewed 1590 asthmatic Muslim patients who were hospitalized with asthma over a four year period from January 2000 to December 2004. Patients were divided according to the time of presentation in relation to the month of Ramadan, one month before, during and one month after Ramadan.

METHODS

Pulmonary function tests were performed on an electronic spirometer (Compact Vitalograph, Buckingham, U.K.). Performance of the spirometric test and data collection were according to as described by the American Thoracic Society.

RESULTS

There were 1590 patients studied. Among them, 901 were males (56.7%) and 689 were females (43.3%). Their mean age was 30 years (15-60). All patients expressed clinical allergy, 454 patients (28.6%) had asthma and rhinitis, 513 patients (32.3%) had allergic rhinitis, 300 patients (18.9%) had asthma alone and 10.6% had other allergic conditions. The ventilatory capacity of lung function parameters mean did not show any statistically significant differences between a period of pre-Ramadan, during Ramadan and after Ramadan concerning FVC, FEV1, FEF(25-75) FEV1/FVC, and PEF values.

CONCLUSION

This study demonstrated that no significant difference was found in number of hospitalization and the mean spirometric values for asthma while fasting during the month of Ramadan when compared to the non-fasting months.

Frequency of peptic ulcer disease during and after Ramadan in a United Arab Emirates hospital

We aimed to study the effect of Ramadan fasting on the occurrence of peptic ulcer disease and its complications in patients presenting to the Accident and Emergency Department at Al-Ain hospital, United Arab Emirates (UAE). We retrospectively reviewed patient records over the 10-year period, 1992 to 2002. Of 470 patients treated for peptic ulcer disease, 215 were seen during Ramadan and 255 in the month after Ramadan. The frequency of peptic ulcer disease was higher after Ramadan than during Ramadan but this was not statistically significant. Peptic ulcer disease occurred more frequently in the age group 30-49 years. Peptic ulcer perforation occurred more frequently after Ramadan but the difference was not significant. Regression analysis identified the following variables as predictors of peptic ulcer disease: anorexia, pain, hypertension, smoking, epigastric pain, diabetes and family history.