Does the circadian pattern for acute cardiac events presentation vary with fasting?

BACKGROUND

Over one billion Muslims fast worldwide during the month of Ramadan. The impact of fasting on circadian presentation with acute cardiac events is unknown.

AIM

To determine if fasting has any effect on the circadian presentation of acute cardiac events.

SETTING AND DESIGN

A prospective study in a general hospital.

MATERIALS AND METHODS

Patients with acute coronary events were divided into two groups based on the history of fasting. Information about age, gender, cardiovascular risk factor profiles and outcome was collected. The relationship of time of presentation of initial symptoms with fasting was evaluated using Student's t-test, Mann-Whitney U-test and chi2 analysis.

RESULTS

Of the 1019 patients hospitalized during the study period, 162 were fasting. Although, fasting patients were more likely to present to the emergency department in the time periods 5-6 AM (10.5% vs 6.3%) and 11 PM (11.1% vs 7.1%) and were less likely to present in the time periods 1-2 PM (3.7% vs 7.2%) and 5-6 PM (3.7% vs 7.0%); these differences were not statistically significant. Fasting patients were less likely to have their symptoms start between 5 and 8 AM (11.1% vs 19.4%) and more likely to have symptoms between 5 and 6 PM (11.1% vs 6.0%) and 3 and 4 AM (11.1% vs 6.9%). These differences for time of initial symptoms were statistically significant (P=0.002).

CONCLUSION

Exogenous factors associated with fasting, namely, the changes in food intake and/or sleep timings, affect the circadian rhythm and influence the timing of presentation of acute coronary events.

Is hypertension a predictor for heart failure? A cross cultural comparison over a 10-year period

This was a retrospective cohort study to assess the effect of hypertension (HTN) among Qatari and Asian patients admitted to the Hamad General Hospital in Qatar with heart failure (HF) and to identify risk factors that contribute to the development of HF in HTN patients in the State of Qatar. A total of 20,856 patients were treated during the 10-year period; 8446 were Qataris and 60% were male. Among the total Qatari patients admitted with HF (n=2342), 52.4% had HTN. The incidence of HTN was slightly higher in males than in females (50.4 vs. 49.6%; p<0.001). Significantly more HTN patients had diabetes mellitus (DM) (p<0.001) and hypercholesterolemia (p<0.001). There was also a significant difference between Qatari and Asian HTN patients in respect of their age (p<0.001) and gender (p<0.001). Qatari hypertensive patients were more likely to have DM (p<0.001). HTN and DM were the most common risk factors for HF.

Thrombolytic therapy use for acute myocardial infarction and outcome in Qatar

OBJECTIVE

Data on the outcome of patients treated with thrombolytic therapy in the Arab world is scarce. The main objective of this study is to study the 7-day morbidity and mortality rate and the rate of use of thrombolytic therapy in patients presenting with acute myocardial infarction treated with thrombolytic therapy in the Middle East.

METHODS

We conducted a retrospective analysis of prospectively collected data for all patients who were admitted to Coronary Care Unit in Cardiology Department in Hamad Medical during the period (1991-2001). Patients were divided into two groups in relation to ethnicity whether they received thrombolysis or not. In each group, the number of patients, age at the time of admission, gender, cardiovascular risk profile, therapy and outcome in regard of in-hospital complication and 7-day death as primary end point were analyzed.

RESULTS

Of the total 5388 patients admitted with acute myocardial infarction during the 10-year period, 66.3% (3567) with STE MI were found, 61.4% (2190) of them received thrombolytic therapy while 38.6% (1377) were not eligible for thrombolytic therapy. The remaining 33.7% (1821) were admitted with non-STE MI. In consideration of ethnic variation, patients with STE MI eligible for thrombolytic therapy, 29.6% (1598) were Qataris and 70.4% (3792) were non-Qataris. Thrombolytic therapy was administered to 25.9% (414) of Qatari patients and 51.3% (1947) of non-Qataris. The mortality rate of Qatari patients who received thrombolytic therapy was 9.2% (38) vs. 19.5% (231) who did not receive thrombolytic therapy (p<0.001). In non-Qatari patients, the mortality rate was 5.2% (102) for those who received thrombolytic therapy, while it was 8.6% (159) for those with no thrombolytic therapy (p<0.001). When compared to male patients, female patients with thrombolytic therapy had higher mortality rates (in both Qataris and non-Qataris) (20.5% vs. 6.1%; p value<0.001 and 16.1% vs. 9.4%; p<0.001, respectively), there were no significant differences between the ethnic groups in regard to in-hospital complications. Patients treated with thrombolytic therapy had lower incidence of in-hospital complication regarding acute heart failure, post-myocardial angina, heart block and arrhythmia. Thrombolytic therapy reduced mortality rate in acute myocardial infarction by 69%. Logistic regression analysis had shown that arrhythmia, acute heart failure, heart block, cardiogenic shock, diabetes mellitus and stroke were independent predictors of increased mortality. Thrombolysis was used in 61.4%, which is still underutilized when compared to a few available studies in the Gulf area, and to other studies in the developed world.

CONCLUSION

In the current study, use of thrombolysis in acute myocardial infarction was associated with significant decrease in in-hospital mortality and morbidity. Mortality rate was higher in the Qatari nationals when compared to non-Qataris. Reperfusion therapy may be underutilized in the developing world. Increased use of reperfusion therapy would result in reduced mortality rate. Global measures to encourage the use of reperfusion therapy including patients' education, and strategies to improve the health care system are needed.

Safety of vaginal birth after cesarean delivery

OBJECTIVE

To compare the outcomes of labor induction in women with a history of 1 cesarean section (CS) who undergo trial of labor.

METHODS

A prospective observational study of 702 pregnant women who had 1 previous CS was conducted at Women's Hospital, Hamad Medical Corporation, Doha, Qatar, between April 2003 and April 2004. Those with no history of vaginal delivery were assigned to one group and those with a history of vaginal delivery were assigned to another group, and the latter group was then divided into 2 subgroups according to the results of trial of labor.

RESULTS

Of these 702 women with a history of 1 CS, 62.4% also had a history of vaginal delivery. After trial of labor, vaginal delivery occurred more often among women with no history of vaginal delivery (64.8%). Moreover, trial of labor resulted in a vaginal delivery more often in women who were delivered only once and by CS (87.7%) than in women who also had a history of vaginal delivery (79.2%).

CONCLUSION

These findings indicate that women who have had a CS should strongly consider natural delivery for subsequent pregnancies.

Correlation between hypertension and income distribution among United Arab Emirates population

To determine the correlation between hypertension and income distribution among United Arab Emirates (UAE) population. Case-control study matched for age, sex, nationality and education. The survey included 500 hypertensive adults aged 20-65 years ascertained from Primay Health Care (PHC) Clinics along with a randomly selected sample of 500 control subjects from the community. Face-to-face interviews were done where data were gathered on socio-demographic-economic status (SES) and lifestyle habits. Hypertension was defined according to WHO criteria as having Systolic Blood Pressure (SBP) > or = 140 mm Hg and/or Diastolic Blood Pressure (DBP) > or = 90 mm Hg and/or being on antihypertensive treatment. The survey was carried out in urban and semi-urban PHC Clinics. A total of 818 subjects were included in this study from a sample of 1000; 409 cases and 409 controls. There were 422 males and 396 females in this study, with 255 UAE nationals and 438 expatriates. Hypertension was found to be significantly higher among the low income group (35.2% vs. 24.9% controls, p = 0.002; while mean SBP in the low income group was 130.2 +/- 17.6 vs. 128.0 +/- 17.4 controls, p = 0.022). Among males, smoking and alcohol consumption were higher among the group with low income level but only smoking showed significant difference (p value = 0.016). Activity level was higher among the low income groups. This study supports the importance of socio-economic factors as an income distribution effect on life-style habits and hypertension.

Pegylated interferon-alpha 2b-ribavirin combination in Egyptian patients with genotype 4 chronic hepatitis

Egypt has a high prevalence rate of hepatitis C (HCV) infection and as much as 90% is genotype 4. Response to interferon (IFN) varies with viral genotype and degree of fibrosis. Genotype 4 is poorly sensitive to standard IFN and IFN-ribavirin combination. We evaluated pegylated interferon (PEG-IFN)-alpha2b in our patients. Sixty-one patients with compensated chronic HCV genotype 4 were enrolled in two groups: group A (31 patients) received IFN-alpha2b 3 MU three times per week and group B (30 patients) received 1.5 mug/kg PEG-IFN-alpha2b once weekly. Ribavirin was added to each regimen in a dose of 800-1200 mg based on body weight. Patients were followed up for 24 weeks to assess the sustained response (SR). End-of-treatment response (ETR) was achieved in 11 of 31 patients (35.48%) in group A, and 13 of 30 patients (43.33%) in group B (P < 0.05). Only eight patients in group A and 10 in group (B) achieved a sustained virological response (25.8 and 33.3%, respectively) (P < 0.05). By computing ETR, SR or relapse and pretreatment baseline data (pretreatment, viral load, alanine transaminases, necroinflammatory and hepatic fibrosis), both inter- and intragroup, no significant correlations could be detected. In terms of safety and tolerability, PEG-IFN-alpha2b and IFN-alpha2b were comparable. In spite of mild insignificant increase in ETR and SR with the pegylated form, the poor response of genotype 4 in Egypt (genotype 4a) to different forms of IFNs may be related to an intrinsic resistance to the direct antiviral effect of IFN.

Public Knowledge and Attitudes Toward Organ Donation and Transplantation: A Cross-Cultural Study

OBJECTIVE

The aim of this study was to determine the knowledge, attitudes, awareness, and determinants of organ donation and transplantation in a Qatari population.

DESIGN

This is a cross-sectional study to determine the knowledge and attitude toward organ donation in a Peninsula Arabian Gulf country.

SETTING

The setting was Primary Health Care (PHC) Centers and community-based study in Qatar.

SUBJECTS

A multistage sampling design was used in a representative sample of 1600 Qataris and non-Qataris, including males and females of at least 17 years of age, from October 2003 to May 2004. In this study a 1305 (81.5%) subjects participated, each giving consent for the study.

MEASUREMENTS

Participants completed a questionnaire assessing their knowledge, attitudes, and awareness for organ donation.

RESULTS

Of 1305 samples, 637 (48.8%) males and 668 females (51.2%) living in urban and semiurban areas agreed to participate and complete the questionnaire. Of these, 762 (58.4%) were Qataris. There was a significant difference between Qataris and non-Qataris with respect to their age, educational level, monthly income, and occupation. In this study, 31.6% of Qataris and 29.8% of non-Qataris had no idea about the organ donation; 37.8% of Qataris and 32.8% of non-Qataris were willing to donate their organs. The majority of subjects preferred donating organs to their close relatives and friends. However, 83.8% of the studied subjects did not agree with an incentive-based approach for donating organs.

CONCLUSION

This study showed that people should not be blamed for not being willing to participate in organ donation, but the health system and health education providers are responsible. A more effective approach should be tried regarding health education.

Prevalence, awareness and determinants of health care-seeking behaviour for urinary incontinence in Qatari women: a neglected problem?

OBJECTIVES

The aim of this study was to determine the prevalence, awareness and determinants of urinary incontinence (UI) among Qatari women and the sociodemographic factors involved in their health care-seeking behaviour.

DESIGN

A cross-sectional study was used to determine the symptoms of UI experienced by Arabian Gulf women.

SETTING

Primary Health Care (PHC) Centres and community-based study in Qatar.

SUBJECTS

A multistage sampling design was used and a representative sample of 1000 Qatari women aged 45 years and above were included from January to June 2003.

MEASUREMENTS

Participants completed a questionnaire assessing UI in the previous 12 months and health care-seeking behavior for urinary symptoms.

RESULTS

Of 1000 women living in urban and semiurban areas who were asked, 798 (79.8%), representing the study sample, agreed to participate and completed the questionnaire. Of these, 164 (20.6%) were found to have UI. Overall, the reason for not seeking medical attention was mainly embarrassment (40.6%) at having to speak with doctor. Of the total study sample, 562 subjects (70.4%) believed that UI was abnormal and worth reporting to a doctor. Coping mechanisms among incontinent women included frequent washing (58.3%) and wearing a protective perennial pad (42.4%), changing underwear frequently (41.3%), decreasing fluid intake (19.8%) and stopping all work (4.9%). Sufferers were most troubled by their inability to pray (64%) and their marital relationship (47%), limitation of their social activities (20%), difficulty in doing housework (14%) and inconvenience during shopping (13%). Most (71.9%) of the incontinent subjects were self-conscious, ashamed of themselves and troubled by guilt (P < 0.001); 56% found it most embarrassing to discuss UI with their husbands. The majority of women (51.9%) believed child birth to be the major cause of UI, followed by ageing (49.5%), menopause (34.2%) and paralysis (25.3%). Most of the subjects (62.3%) believe that UI can cause infection, some (20.5%) believe that it can cause skin allergy and very few think that it can cause cancer or other disorders.

CONCLUSIONS

Our findings indicate that although UI is relatively common in the community, it is underreported by Qatari women because of social and cultural attitudes and-most importantly-lack of information. This findings suggest that strategies to promote care-seeking for incontinence must be developed and employed in the community.

Pet ownership: its effect on allergy and respiratory symptoms

BACKGROUND

Studies have shown that pets are very important sensitizing agents in patients with asthma. Respiratory disorders such as asthma and allergic rhinitis are common in the State of Qatar.

OBJECTIVE

The aim of the present study was to determine whether exposure to pets and domestic animals plays a significant role in the development of asthma and allergic rhinitis among Qatari population.

DESIGN

A hospital-based prospective descriptive study conducted.

SETTING

Allergy Laboratory at the Hamad General Hospital and Hamad Medical Corporation, State of Qatar.

PATIENTS

Adult patients over 12 years of age diagnosed with bronchial asthma and/or allergic rhintis who were referred for allergy skin prick test. 1106 adult patients recruited with respiratory diseases of suspected allergic origin who attended Allergy Clinic at the Hamad General Hospital, during three years from January 2001 to April 2003. Total of 1106 whom 607 were females (54.9 %) and 499 were males (45.1%) and their mean was age 30 years (12-48).

METHODS

Skin Prick Test (SPT) was performed on 1106 patients for common allergens whom the blood sample was taken for measuring total IgE concentration.

RESULTS

There were 1106 patients studied and 496 patients (44.9%) had positive and 610 (55.1%) had negative skin prick tests. Out of 1106 patients, 311 patients (28.1%) had asthma; 503 patients had allergic rhinitis (45.5%) and 87 patients (7.8%) had skin allerg. Three hundred and forty (340/1106=30.7%) of the 1006 subjects studied had at least one animal at home, and the remaining 69.3% had never had pets in the home. A further 12% reported having had pets in the past, but not anymore. Cats (26.7%), goats (15%) and birds (14.7%), animals were the most common present within the house and was the most frequently seen pet types when compared to other pet types. The risk of having asthma (RR: 1.29; 95% CI: 1.07-1.55; p=0.008), allergic rhinitis (RR: 1.48; 95% CI: 1.24-1.77; p<0.0001) and eczema (RR: 3.56; 95% CI:1.24-1.77; p<0.0001) was significantly higher in subjects with animals than in patients without.

CONCLUSION

In the present study, the prevalence of asthma, rhinitis, and skin allergy was significantly more common in families with animals than in those without.

Some risk factors for hypertension in the United Arab Emirates

A case-control study evaluated the relationship between hypertension and socioeconomic and lifestyle factors in Al-Ain city. The survey included 426 hypertensive adults aged 20-65 years attending urban and semi-urban clinics and a randomly selected sample of 436 normotensive controls. Hypertension among cases was higher for men, age 40-49 years, non-UAE nationals, urban living, currently married, having children, illiterate, administrative/professional job, living in traditional house and low income. There were significant differences between cases and controls with regard to obesity, raised cholesterol level, low physical activity and family history of heart disease, kidney disease or diabetes. Multivariate logistic regression analysis revealed that obesity, medium/high income, history of diabetes, low physical activity and having 3+ children were significantly associated with hypertension

Does hospitalization for congestive heart failure occur more frequently in Ramadan: a population-based study (1991–2001)

OBJECTIVE

Over one billion Muslims fast worldwide during the month of Ramadan. Fasting during Ramadan is essentially a radical change in lifestyle for the period of one lunar month, so it is important to see the response of congestive heart failure patients to this change. Our objective in this study is to investigate whether Ramadan fasting has any effect on the number of hospitalization for congestive heart failure (CHF) in a geographically defined population.

METHODS

We conducted a retrospective review of clinical data study on all Qatari patients in Qatar for a period of 10 years (January 1991 through December 2001) who were hospitalized with heart failure. Patients were divided according to the time of presentation in relation to the month of Ramadan, 1 month before, during and 1 month after Ramadan. The number of hospitalization for CHF in various time periods was analyzed. The age of presentation, gender, cardiovascular risk factor profiles (smoking status, hypertension, hypercholesterolemia, diabetes, pre-existing coronary heart disease) and outcome were analyzed.

RESULTS

Of the 20,856 patients treated during the 10-year period, 8446 of them were Qataris with 5095 males and 3351 females. Overall, 2160 Qatari patients were hospitalized for CHF and their mean age and standard deviation was 64.2 +/- 11.5 years, 52.4% were hypertensives, 18.5% had hypercholestrolemia, 17.7% were current smokers and 56.5% were diabetics. The overall mortality was 9.7%. The number of hospitalization for CHF was not significantly different in Ramadan (208 cases) when compared to a month before Ramadan (182 cases) and a month after Ramadan (198 cases); p > 0.37). There was no significant difference found in the baseline clinical characteristics or mortality (11.5%, 7.7% and 9.6%, respectively; p > 0.43) in patients presenting in various time periods.

CONCLUSION

This population-based study demonstrates that no significant difference was found in number of hospitalization for CHF while fasting in Ramadan when compared to the non-fasting months.

The effect of hypertension as a predictor of risk for congestive heart failure patients over a 10-year period in a newly developed country

AIMS

Cardiovascular disease is the leading cause of mortality and morbidity in the western world and has reached epidemic proportions. The incidence of congestive heart failure (CHD) and hypertension is also rising rapidly in many of the affluent Arab nations and cardiovascular diseases continue to be a leading cause of morbidity and mortality among adult Qataris and Asians residing in Qatar.

OBJECTIVE

The objective of this study is to assess the effect of hypertension among patients admitted to hospital in Qatar with CHD and to identify risk factors that contribute to the development of CHD in hypertensive subjects.

DESIGN

This is a retrospective cohort study.

SETTING

Hamad General Hospital, Hamad Medical Corporation.

SUBJECTS

All patients who were hospitalized with CHD with or without hypertension in the Hamad General Hospital, State of Qatar, from 1991 to 2001.

METHODS

The diagnostic classification of definite CHD was made in accordance with criteria based on the International Classification of Disease, ninth revision (ICD-9].

RESULT

A total of 20,856 patients were treated during the 10-year period; 8446 were Qataris. Among them, 60% were males and 40% females. Among the total patients (3713) hospitalized with CHD, 1744 (46.9%) had hypertension. Furthermore, the incidence of hypertension was slightly higher in males than in females (56.4 vs 43.6%). A statistically significant difference was found between hypertensive and non-hypertensive cases with diabetes mellitus and angina. Hypertensive subjects were more likely to have diabetes (p < 0.001) and angina (p < 0.030). The mortality rate of CHD patients with hypertension was higher among Qataris than among non-Qataris (p < 0.038).

CONCLUSION

Hypertension was the most common risk factor for CHD; it contributed a large proportion of heart failure cases in this population-based sample. Preventive strategies directed toward earlier detection of elevated blood pressure and its control are likely to offer the greatest promise for reducing the incidence of CHD and its associated mortality.

Some risk factors for hypertension in the United Arab Emirates

A case-control study evaluated the relationship between hypertension and socioeconomic and lifestyle factors in Al-Ain city. The survey included 426 hypertensive adults aged 20-65 years attending urban and semi-urban clinics and a randomly selected sample of 436 normotensive controls. Hypertension among cases was higher for men, age 40-49 years, non-UAE nationals, urban living, currently married, having children, illiterate, administrative/professional job, living in traditional house and low income. There were significant differences between cases and controls with regard to obesity, raised cholesterol level, low physical activity and family history of heart disease, kidney disease or diabetes. Multivariate logistic regression analysis revealed that obesity, medium/high income, history of diabetes, low physical activity and having 3+ children were significantly associated with hypertension.

Methacholine Challenge Test in the Diagnosis of Airway Hyperresponsiveness in the State of Qatar

We retrospectively analyzed the results of263 consecutive Methacholine challenge tests (MCTs) done in our laboratory between July 2000 and June 2003, in symptomatic adult patients with no history of bronchial asthma or chronic lung disease, who presented with chronic nonproductive cough, shortness of breath (subjective dyspnea), or both. All of these patients had normal results of chest physical examination, chest radiographs and screening spirometry measurements (FEVl >80% of predicted). We considered a 20% fall in the forced expiratory volume in the first second (FEVJ as the primary outcome measure (MCT PC 20-FEV1X and a 35% fall in the specific conductance (sGaw) as the primary outcome in patients who cannot perform acceptable spirometry. Out of263 patients, 79 patients (30%) were positive for bronchial hyper-responsivenes (BHR), 20 patients (25.3%) of the positive patients had sever BHR, 18 patients (22.8%) had moderate BHR, and 41 patients (51.9%) had mild BHR.

Epidemiology of prostate cancer in United Arab Emirates

OBJECTIVE

To evaluate the magnitude of prostate cancer in the United Arab Emirates (UAE).

DESIGN

A descriptive retrospective study.

SETTING

Tawam and Al-Ain Teaching Hospitals, Al-Ain Medical District, UAE.

SUBJECTS

Analysis based on patient admissions into the main referral teaching hospital, categorizing age, nationality groups and type of cancer. All prostate cancer patients, diagnosed and treated at Tawam and Al-Ain Hospitals during the period from 1982 to 2000, are included in the study and consisted of 84 subjects.

RESULTS

The study series consisted of 84 patients with the ages ranging from 38 to 81 years with a median age of 56 years and a mean and standard deviation of 56.5 +/- 12.5 years. The study revealed that majority of the patients (n = 33, 39.2%) were diagnosed between 51 to 60 years of age. The majority of our patients were UAE nationals (44.0%), followed by patients from neighboring countries i.e. Oman, Yemen, Syria, Jordan and Egypt (40.5%). The initial pathological diagnosis was confirmed mainly by Trucut Needle Biopsy in the majority of patients (n = 48, 57%), TURP (n = 15, 18%), Open Prostatectomy (n = 4, 5%) and others i.e. lymph node, bone marrow, and pleural biopsies and high PSA (n = 17, 20%). The majority of our patients (77.7%) presented with an advanced disease and received hormonal treatment while 16.6% received radical radiotherapy and 5.5% had radical prostatectomy. According to our analysis the annual incidence of prostate cancer is 4.5/100,000 male population.

CONCLUSION

The prevalence of prostatic carcinoma in the UAE, like other Arabian Gulf and Asian countries, is very low compared to Western Countries despite the high intake of calories and consumption of animal fat. However, genetics and environmental factors believed to be involved in the complex etiology of prostate cancer in UAE are not clear yet, and awaiting investigation.

Modified carpal box technique in the diagnosis of suspected scaphoid fractures

PURPOSE

To establish and test the clinical efficacy of a new diagnostic algorithm with the extensive utilization of modified carpal box radiography (mX-CB) in the detection of scaphoid fractures.

MATERIAL AND METHODS

Initial and early follow-up radiographic evaluation of 146 suspected scaphoid fractures were carried out by mX-CB. Patients with unconfirmed diagnosis were referred to CT. Patients were followed for 1 year after injury. Sensitivity, specificity and interobserver agreement of reading mX-CB images were determined statistically.

RESULTS

No non-union or avascular necrosis was seen at 1 year after the injury. 90% of the fractures were diagnosed by mX-CB, only 6.8% of the patients needed referral to CT. Sensitivity of mX-CB at initial presentation was 81.6%. Interobserver agreement was very high among evaluators of mX-CB images.

CONCLUSION

Extensive utilization of mX-CB as primary and early follow-up investigation resulted in high initial diagnostic accuracy and low referral rate to a more expensive diagnostic modality.

Epilepsy in children with cerebral palsy

OBJECTIVES

To study the occurrence, associated factors, nature and prognosis of seizures in children with cerebral palsy (CP).

DESIGN

A prospective, descriptive, hospital-based, case-control study.

SETTING

Tertiary level University Teaching Hospitals in the Al Ain Medical District, United Arab Emirates.

PATIENTS

Fifty-six children with CP and seizures seen in the neurodevelopmental clinics at Al Ain and Tawam University Hospitals during the period of 1997-1999 were studied (group 1). Two control groups of 35 children with CP without seizures (group 2) and 50 children with seizures but no CP (group 3) were also studied.

RESULTS

Spastic tetraplegia was the commonest type of CP associated with seizures whereas spastic diplegia was the commonest variety of CP in group 2. Most children with CP had an early onset of seizures within the first year of life as against those without CP. The children in group 1 had a higher incidence of neonatal seizures (42.9% vs. 29.4% in group 2 and 0% in group 3), presence of significant developmental delay (98.2% vs. 20.0% in group 3), occurrence of significant abnormalities on brain imaging (94.6% vs. 19.6% in group 3) and a need for use of more than 1 antiepileptic drug (66.1% vs. 30.0% in group 3). Over half of children in the study group presented with generalized tonic clonic seizures; the electroencephalogram (EEG) showed focal epileptic discharges with or without secondary generalization in 39.3%. The overall outcome of seizures in children with CP was poor needing prolonged course of anticonvulsant medications, polytherapy and higher incidence of refractory seizures and admissions for status epilepticus compared to the control group.

CONCLUSIONS

Cerebral palsy is associated with a higher incidence of seizure disorders, which, in a majority, has its onset in the neonatal period; brain imaging showed abnormal pathology in most affected children, which possibly accounts for the tendency to more refractory seizures in these children.

Professional Advice and the Utilization of Non-Steroidal Anti-Inflammatory Drugs at Community Pharmacies in the United Arab Emirates

The present study examined the pattern of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in relation to the source of advice. Ten community pharmacies in the United Arab Emirates were randomly selected and patients visiting these sites were interviewed using a standard questionnaire. The interview covered “source of advice,” “name of medicine,” “type of disease,” “duration of disease,” and “knowledge of adverse effects and drug interactions.” After a month the patients were contacted. On average 22.7% of prescriptions contained NSAIDs and 17.5% of visits were for these drugs. Advice from physicians was given to 33.3%, from pharmacists 32.5%, from friends 18.8%, and 15.4% depended on themselves. Other medicines were taken by 14.5% and 12% suffered from gastrointestinal upsets. Paracetamol followed by ibuprofen and diclofenac were the most frequently utilized agents. Headache, fever, and musculoskeletal pain were the common complaints. A month later, 50.7% of the patients continued taking their medications. This study revealed an association between the source of advice and knowledge of side effects. It is argued that, although self-care is important, professional advice in its support is essential since unsupervised self-medication exposes the patient to harmful consequences.

An analysis of skin prick test reactions in asthmatics in a hot climate and desert environment

BACKGROUND

Studies have shown that allergens are very important sensitizing agents in patients with asthma. Respiratory disorders such as asthma and allergic rhinitis are common in the United Arab Emirates, (UAE).

OBJECTIVES

The aim of this study was to investigate the relationship between allergen specific IgE antibodies and skin test reactivity in patients with asthma in hot climate and desert Arabian country.

DESIGN

A hospital-based prospective study conducted.

SETTING

Tawam Teaching Hospital, Al-Ain, UAE.

PATIENTS

327 adult patients recruited with respiratory, dermatologic and ophthalmologic diseases of suspected allergic origin who attended Tawam Teaching Hospital of Faculty of Medicine, Al Ain, UAE, during three years from 1996 to 1998.

METHODS

Skin Prick Test (SPT) and radioallegosorbent tests (RAST) were performed on 327 patients for common allergens. The blood sample was taken for measuring specific IgE concentration.

RESULTS

There were 327 UAE patients of whom 117 (35.8%) were males and 210 (64.2%) were females. The population sample had a higher prevalence of diagnosed asthma among females (48.1%) than in males (36.7%). Skin prick testing showed that 244 patients (74.6%) had positive results, and 83 patients (25.4%) were found to be skin test negative. 44% had a positive family history of asthma. The twelve most common reactions in the United Arab Emirates were: Mesquite (45.5%), Grass Mix (40.7%). Cottonwood (33.1%), Bermuda Grass (31.3%), Kochi (25.8%), Acacia (25.6%), Alfalfa (22.9%), Chenopodium (19.6%), Date palm (13.8%), Cockroach (14.7%), house dust (11.9) and Dust mite (9.5%). Total IgE level (> 100 kU/l) was strongly associated with history of wheeze (p = 0.019), asthma (p = 0.01) and allergic rhinitis (p < 0.0001), atopy (p < 0.0001) and the presence of specific IgE antibodies to grass pollen (p < 0.0001), mite (p = 0.008) and cockroaches (p = 0.025).

CONCLUSION

The present study revealed that hypersensitivity to pollens, house dust, dust mite and cockroach was common. The family history, environment, and airborne allergens are identified to be risk factors for asthma and other allergic diseases in Arabian Gulf Countries.

Prevalence of Helicobacter pylori infection among low socio-economic workers

Epidemiological studies have shown that the prevalence of Helicobacter pylori infection in a community and occupational health are closely related to lifestyle and socio-economic status. There is little information on H. pylori profile in industrial workers in the literature. The aim of this study was to investigate the prevalence rate of H. pylori profiles among low socio-economic workers in the United Arab Emirates (UAE). This study was undertaken by determining IgG H. pylori antibody profiles among industrial exposed and referent workers, sera. Presence of anti-H. pylori antibodies in the frozen stored sera was determined by ELISA. Also, data on dietary and lifestyle were obtained. The result was considered positive if IgG anti-H. pylori antibody titers was > 300. People with seropositive levels of IgG antibodies to H. pylori were assumed to be infected with H. pylori. Most of the industrial workers lived in less modern accommodation, were less educated, ate their vegetable products unwashed and did not have drinking water facilities, when compared to referents. H. pylori serology by IgG was positive in 167 industrial workers (78.4%) and 137 in referent workers (64.3%) respectively, (p < 0.002). The sensitivity and specificity of the IgG serology assay were 94.5%, and 97.2% respectively. There was statistically significant difference between the exposed industrial and non-exposed control groups in respect of their H. pylori profiles.

Can't lung cancer patients detoxify procarcinogens?

BACKGROUND

Glutathione S-transferase mu (GST mu) enzyme detoxifies carcinogens in tobacco smoke. We assessed the clinical usefulness of serum assay of GSTm in determining the risk for lung cancer.

MATERIALS AND METHODS

Fifty-nine patients with primary lung cancer and 32 control cases were enrolled. GSTm detection was performed by the method ELISA.

RESULTS

GSTm enzyme positivity rate of the patient group (39%) was significantly lower than the control group (59.4%) (p < 0.05). The GSTm positivity rates were 28.6% for the non-smoker patients with a cancer history of relatives, 31.6% for the smoker patients with the cancer history of relatives, 14.6% for the non-smoker patients with the lung cancer history of relatives and 16.7% for the smoker patients with the lung cancer history of relatives.

CONCLUSIONS

We concluded that if the people lacking GSTm are smokers and have a cancer and/or lung cancer history among their relatives, they would challenge a greater risk of lung cancer than the individuals having GST mu isoenzyme.