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Batran RA, Kamel M, Bahr A, Waheb J, Khalil A, Elsokary M. Multiple sclerosis: economic burden, therapeutic advances, and future forecasts in the Middle East and North Africa region. Expert Rev Pharmacoecon Outcomes Res 2024; 24:873-882. [PMID: 38832693 DOI: 10.1080/14737167.2024.2364832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 06/03/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION Multiple sclerosis (MS) is a persistent condition characterized by immune-mediated processes in the central nervous system, affecting around 2.8 million individuals globally. While historically less prevalent in the Middle East and North Africa (MENA) region, recent trends mirror the global rise in MS. AREA COVERED The impact of MS is substantial, particularly in the MENA region, with costs per patient surpassing nominal GDP per capita in certain countries. Disease-modifying therapies aim to alleviate MS effects, but challenges persist, especially in managing progressive MS as it shifts from inflammatory to neurodegenerative phases. Limited resources in the MENA region hinder care delivery, though awareness initiatives and multidisciplinary centers are emerging. Contrary to global projections of a decline in the MS market, the MENA region is poised for growth due to increased prevalence, healthcare expenditures, and infrastructure investments. EXPERT OPINION This review underscores the urgent necessity for effective treatments, robust disease management, and early diagnosis in tackling MS's repercussions in the MENA region. Bolstering resources tailored to MS patients and elevating the quality of care stand as pivotal strategies for enhancing health outcomes in this context. Taking decisive action holds the key to enhancing the overall well-being of individuals grappling with MS.
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Affiliation(s)
- Radwa Ahmed Batran
- Medical Affairs Department, Volaris LLC, Dubai, UAE
- Clinical Pharmacy & HEOR, Cairo University Hospitals, Cairo, Egypt
| | - Mohab Kamel
- Medical Affairs Department, Volaris LLC, Dubai, UAE
| | - Ayman Bahr
- Medical Affairs Department, Volaris LLC, Jeddah, Saudi Arabia
| | - Joseph Waheb
- Medical Affairs Department, Volaris LLC, Cairo, Egypt
| | - Ahmed Khalil
- Medical Affairs Department, Volaris LLC, Dubai, UAE
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Salehi Z, Naghizadeh MM, Ezabadi SG, Ebrahimitirtashi A, Abbasi Kasbi N, Khodaie F, Aliyari S, Ashtari F, Baghbanian SM, Nabavi SM, Hosseini S, Razazian N, Shaygannejad V, Majdi-Nasab N, Harirchian MH, Bayati A, Kamali H, Hosseni Nejad Mir N, Beladi Moghadam N, Poursadeghfard M, Mozhdehipanah H, Jalali N, Nahayati MA, Faraji F, Kamyari N, Sahraian MA, Maghbooli Z, Eskandarieh S. Consanguineous marriage among familial multiple sclerosis subjects: A national registry-based study. Heliyon 2024; 10:e32946. [PMID: 38984301 PMCID: PMC11231546 DOI: 10.1016/j.heliyon.2024.e32946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/12/2024] [Accepted: 06/12/2024] [Indexed: 07/11/2024] Open
Abstract
Background The rising prevalence of familial multiple sclerosis (MS) in Iran has spurred interest in the potential impact of parental consanguinity on the risk of developing the disease. This study aims to aggregate current knowledge on parental consanguinity and its possible effect on MS risk, particularly among familial MS patients from various regions and ethnicities in Iran. The objective is to enhance the understanding of MS genetics and encourage further research in this field. Materials and methods A cross-sectional study was conducted on clinically definite familial MS (FMS) patients registered in the nationwide MS registry of Iran (NMSRI). Data were extracted and supplemented with structured telephone follow-ups to gather detailed histories of MS in relatives and the familial relationships of the patients' parents. A family penetration score was proposed. Descriptive statistics and inferential statistical tests were used to analyze the data at a significance level of 0.05, adhering to ethical guidelines. Results Out of 19,911 individuals registered in the NMSRI, 2307 FMS patients across 13 provinces were included in the final analysis. Among these, 385 (19.3 %) reported parental consanguinity, with 283 (14.2 %) having parents who were cousins and 102 (5.1 %) having parents who were distant relatives. The data showed no significant association between parental kinship and variables such as MS phenotype, number of affected relatives with MS, hospitalization rates, and expanded disability status scale score. Similarly, MS severity did not differ based on parental consanguinity (P-value >0.05). While the rate of consanguineous marriage was higher among patients with an onset age less than 18 years, there was no statistically significant difference in disease onset age based on parental consanguinity status. Conclusion Our study highlights the complexity of factors influencing MS development, including genetic and environmental components. These results highlight the need for further research to achieve a more comprehensive understanding of MS etiology.
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Affiliation(s)
- Zahra Salehi
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sajjad Ghane Ezabadi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Ebrahimitirtashi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Naghmeh Abbasi Kasbi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Faezeh Khodaie
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahram Aliyari
- Division of Applied Bioinformatics, German Cancer Research Center DKFZ Heidelberg, Heidelberg, Germany
| | - Fereshteh Ashtari
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Seyed Massood Nabavi
- Department of Regenerative Medicine, Royan Institute for Stem Cell Technology and Biology, Tehran, Iran
| | - Samaneh Hosseini
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nazanin Razazian
- Department of Neurology, School of Medicine, Imam Reza Hospital, Kermanshah University of Medical Sciences, Iran
| | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nastaran Majdi-Nasab
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Hossein Harirchian
- Department of Neurology, School of Medicine, Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Iran
| | - Asghar Bayati
- Department of Neurology, Shahrekord University of Medical Sciences and Health Services, Shahrekord, Iran
| | - Hoda Kamali
- Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Nahid Hosseni Nejad Mir
- Department of Internal Medicine, School of Medicine, Shohadaye Ashayer Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Nahid Beladi Moghadam
- Department of Neurology, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Iran
| | - Maryam Poursadeghfard
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Nazanin Jalali
- Department of Neurology, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Mohammad Ali Nahayati
- Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fardin Faraji
- Department of Neurology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Naser Kamyari
- Department of Biostatistics and Epidemiology, School of Health, Abadan University of Medical Sciences, Abadan, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zhila Maghbooli
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sharareh Eskandarieh
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Abuawad M, Ziyadeh-Isleem A, Alkaiyat A, Ziyadeh J, Afifi B, Saidi M, Sous A. Epidemiology of multiple sclerosis in West bank of Palestine. Mult Scler Relat Disord 2022; 59:103686. [DOI: 10.1016/j.msard.2022.103686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/21/2022] [Accepted: 02/11/2022] [Indexed: 02/07/2023]
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Algahtani H, Shirah B, Khafaji R, Algahtani S. Novel Heterozygous Variants in the HLA-DRB1 Gene in a Saudi Family with Early-Onset Familial Multiple Sclerosis: Therapeutic Failure and Success. Int J MS Care 2021; 24:100-103. [DOI: 10.7224/1537-2073.2020-125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Abstract
Multiple sclerosis (MS) is a chronic neurodegenerative disease that affects the central nervous system. Familial MS is arbitrarily defined as a type of MS that runs in families with one or more first- to third-degree relatives in addition to the index case affected by MS. The aim of this article is to report a unique case of familial MS from Saudi Arabia with two novel variants in the HLA-DRB1 gene that may contribute to the pathogenesis. We observed an unfavorable response to interferon therapy and successful treatment using fingolimod therapy. This observation needs further study, including whether this lack of response is really specific to interferon treatment or possibly a chance occurrence. This family work-up illustrates the importance of genetic testing in identifying variants associated with familial MS, especially if more than two members of the same family are affected. Although this genetic tool is used mainly for research purposes, it had clinical implications for our patient, including the appropriate selection of disease-modifying therapy and prognostic counseling. Further large-scale studies are needed to expand the genetic spectrum of familial MS with clinical and pharmacologic correlation.
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Affiliation(s)
- Hussein Algahtani
- From the King Abdulaziz Medical City/King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia (HA)
| | - Bader Shirah
- King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia (BS)
| | - Randa Khafaji
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia (RK)
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Risk Factors Associated with Multiple Sclerosis: A Case-Control Study in Damascus, Syria. Mult Scler Int 2021; 2021:8147451. [PMID: 34123428 PMCID: PMC8189778 DOI: 10.1155/2021/8147451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/25/2021] [Accepted: 05/28/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives To assess the probable risk factors associated with Multiple sclerosis among Syrian patients in the city of Damascus. Method In a case-control study conducted from May to September 2020, 140 MS patients and 140 healthy controls were selected from two main hospitals in Damascus. Data regarding risk factors associated with MS was collected via a structured questionnaire and complementary laboratory tests. The statistical analysis was carried out by the SPSS Statistical Software Version 26. Results Factors such as smoking, family history of MS, migraine, and vitamin D deficiency were associated with a higher risk of developing MS: Smoking (OR = 2.275 95% CI (1.348-3.841) P = 0.002). Family history of MS (OR = 3.970 95% CI (1.807-8.719) P ≤ 0.001). Migraine (OR = 3.011 95% CI (1.345-6.741) P = 0.005). Vitamin D deficiency (OR = 4.778 95% CI (2.863-7.972) P ≤ 0.001). However, factors such as diabetes, hypertension, a surgical history of appendectomy, tonsillectomy, and being the first-born in a family were statistically irrelevant: Diabetes (OR = 0.652 95% CI (0.226-1.882) P = 0.426). Hypertension (OR = 1.445 95% CI (0.724-2.885) P = 0.295) Appendectomy (OR = 1.269 95% CI (0.486-3.317) P = 0.626) Tonsillectomy (OR = 1.280 95% CI (0.576-2.843) P = 0.544). First-born Child (OR = 0.933 95% CI (0.558-1.562) P = 0.793). Conclusion Our study suggests that smoking, vitamin D deficiency, family history of MS, and migraine are probable risk factors for multiple sclerosis. Therefore, engaging in outdoor activities and maintaining a healthy diet-for females in particular-is highly recommended.
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Alqadi KS, Rammal SA, Alam ME, Alshahrani AM, Baeesa SS, Kayyali HR, Babtain FA, Al-Said YA. Consanguinity in patients with mesial temporal lobe epilepsy due to hippocampal sclerosis in a Saudi population. ACTA ACUST UNITED AC 2021; 25:276-280. [PMID: 33130813 PMCID: PMC8015614 DOI: 10.17712/nsj.2020.4.20200055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Objectives: To investigate if there is an association between consanguinity and hippocampal sclerosis (HS) in the Saudi population. Methods: A retrospective case-control study was conducted by assessing the prevalence of consanguinity in patients with pathologically proven HS, who underwent epilepsy surgery at King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia, between January 2004 and December 2015. We reviewed the medical records to extract data, which included; age, gender, duration of epilepsy, history of febrile seizure, family history of epilepsy in a first or second-degree relative, and pathology reports. Results: A total of 120 patients, out of which 40 patients (65% male) having mesial temporal lobe epilepsy due to HS, and 80 controls (56% male) with cryptogenic epilepsy, were identified. Twenty-two patients (53.5%) in the HS group had a history of consanguinity. In the control group, 30 patients (37.5%) had a history of consanguinity. The odds ratio was 2.04 (95% confidence interval = 0.94 - 4.4, p = 0.052). A family history of epilepsy was found in 28% of the patients with HS and 32.5% cryptogenic epilepsy. Only 8 patients (19.5%) with HS reported a history of febrile seizure. Conclusion: Our retrospective case-control study suggests that consanguinity might increase the likelihood of developing HS.
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Affiliation(s)
- Khalid S Alqadi
- Department of Neurosciences, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia. E-mail:
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Alkhawajah NM, Hussain-Alkhateeb L, Alshamlan YA, Almohaini MO, Aleissa GA, Muayqil TA, Aljarallah S. Shared breastfeeding & other early multiple sclerosis risk factors: A case-control study. Mult Scler Relat Disord 2021; 50:102812. [PMID: 33581612 DOI: 10.1016/j.msard.2021.102812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease. Etiology is thought to be multifactorial with genetic and environmental factors interplay. Our objective in this study is to evaluate culture specific and other early life risk factors for MS. We examined the association between MS and breastfeeding including shared breastfeeding, parental consanguinity, being born abroad or living abroad during childhood, prematurity, vaccination, tonsillectomy, rank among siblings, number of siblings, number of household members (HHM) at birth, and age first time joining school. METHODS This is an age and sex matched case-control study that was conducted in Riyadh, Kingdom of Saudi Arabia (KSA). We enrolled 300 cases and 601 controls. A structured questionnaire about demographics, consanguinity and potential environmental factors was answered by participants. Data was analyzed using logistic regression adjusting for covariates occurring later in life such as waterpipe smoking and performing Hajj. RESULTS About two thirds of the cases and the controls were females. Mean age was 34.8 (9.2) for the cases and 33.6 (10.6) for the controls. We found that shared breastfeeding (OR=0.58; 95% CI, 0.35-0.96, p = 0.033), and older age first joining school (OR=0.83; 95% CI, 0.73-0.94, p = 0.005) were associated with decrease risk of MS. While longer duration of breastfeeding by biological mother (OR=1.03; 95% CI, 1.01-1.04, p = 0.001), rank among siblings of ≥6 (OR=1.69; 95% CI, 1.11-2.56, p = 0.014), and larger number of HHM at birth (OR=2.32; 95% CI, 1.64-3.28, p = 0.001) were associated with increased risk. Patients with MS were less likely to receive formula with breastfeeding than controls (OR=0.72; 95% CI, 0.51-0.99, p = 0.046). No association was found with breastfeeding by biological mother, number of siblings, prematurity, being born abroad or living abroad during childhood, vaccination, consanguinity, or tonsillectomy. CONCLUSION The findings of this case-control study add to the accumulating evidence that early life factors could modify the risk of developing MS. Among these, novel associations with shared breastfeeding and number of HHM at birth are suggested. Future studies are needed to verify the observed results.
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Key Words
- Abbreviations Multiple sclerosis (MS), household members (HHM), central nervous system (CNS), Kingdom of Saudi Arabia (KSA), institutional review board (IRB), King Saud University Medical City (KSUMC), Bacillus Calmette-Guerin (BCG), odds ratios (OR), 95% confidence interval (95% CI), standard deviation (SD), Epstein-Barr virus (EBV), infectious mononucleosis (IM)
- Consanguinity
- Multiple sclerosis
- Risk factors
- Shared breastfeeding
- Vaccination
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Affiliation(s)
- Nuha M Alkhawajah
- College of Medicine, King Saud University, P.O. Box 7805, Riyadh 11472, KSA; Division of Neurology, Department of Medicine, King Saud University Medical City, P.O. Box 2925, Riyadh 11461, KSA.
| | - Laith Hussain-Alkhateeb
- Global Health, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 463, 40530 Gothenburg, Sweden.
| | - Yafa A Alshamlan
- Division of Neurology, Department of Medicine, King Saud University Medical City, P.O. Box 2925, Riyadh 11461, KSA.
| | - Mohammad Osama Almohaini
- Division of Neurology, Department of Medicine, King Saud University Medical City, P.O. Box 2925, Riyadh 11461, KSA.
| | - Ghadah A Aleissa
- College of Medicine, King Saud University, P.O. Box 7805, Riyadh 11472, KSA.
| | - Taim A Muayqil
- College of Medicine, King Saud University, P.O. Box 7805, Riyadh 11472, KSA; Division of Neurology, Department of Medicine, King Saud University Medical City, P.O. Box 2925, Riyadh 11461, KSA.
| | - Salman Aljarallah
- College of Medicine, King Saud University, P.O. Box 7805, Riyadh 11472, KSA; Division of Neurology, Department of Medicine, King Saud University Medical City, P.O. Box 2925, Riyadh 11461, KSA.
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AlJumah M, Otaibi HA, Al Towaijri G, Hassan A, Kareem A, Kalakatawi M, Alrajeh S, Al Mejally M, Algahtani H, Almubarak A, Alawi S, Qureshi S, Al Malik Y, El-Metwally A, Shami S, Ishak S, Bunyan R. Familial aggregation of multiple sclerosis: Results from the national registry of the disease in Saudi Arabia. Mult Scler J Exp Transl Clin 2020; 6:2055217320960499. [PMID: 33110617 PMCID: PMC7556172 DOI: 10.1177/2055217320960499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/05/2020] [Accepted: 08/25/2020] [Indexed: 12/30/2022] Open
Abstract
Background Multiple Sclerosis (MS) is a chronic CNS inflammatory disease commonly affecting young adults. Both genetics and environmental factors have been reported to have a role in pathophysiology of the disease. Objective This article aims to report familial nature and aspects of MS in Saudi Arabia. Method The study utilized data collected by the National Saudi MS Registry between 2015 and 2018; especially data relevant to the familial history of MS. SPSS 22 was used for all analysis and reporting. Statistical significance was set at p-value < 0.05. Results The registry included 20 hospitals and a total of 2516 patients from the different regions of Saudi Arabia with median age 32.00 (Range: 11-63) and 66.5% being female. About 12.8% of all registered patients reported a family history of MS (95%CI: 11.2-13.9). Reported parental consanguinity was significantly higher among patients with family history (FMS) (56.3%) compared to non-FMS patients (27.9%). 42.53% of FMS patients reported having siblings affected with MS (95%CI: 37.01-48.21), with more female siblings affected than males (63.4% vs 36.6% respectively). Conclusion Our Findings suggested that FMS was less prevalent than what was reported previously; however, parental consanguinity was significantly more prevalent among FMS patients than non-FMS. Our findings were in line with those reported in recent studies in the region, but lower than those reported by western countries indicating that increasing prevalence of MS in Saudi Arabia could be multifactorial and other environmental factors should be considered for understanding this recent rise in the prevalence of MS in Saudi Arabia.
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Affiliation(s)
- Mohammed AlJumah
- Neurology Department, King Fahd Medical City (KFMC), MOH, Riyadh, Saudi Arabia
| | - Hessa Al Otaibi
- Neurology Department, King Fahd General Hospital-Jeddah, Jeddah, Saudi Arabia
| | - Ghada Al Towaijri
- Neurology Department, King Fahd Medical City (KFMC), MOH, Riyadh, Saudi Arabia
| | - Ahmed Hassan
- Neurology Department, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Abid Kareem
- Neurology Department, King Fahd General Hospital-Al-Madinah, Madinah, Saudi Arabia
| | | | - Saad Alrajeh
- Neurology Department, Dr. Sulaiman Al Habib Hospital-Olaya Branch, Riyadh, Saudi Arabia
| | - Mousa Al Mejally
- Neurology Department, Heraa General Hospital, Makkah, Saudi Arabia
| | - Hussein Algahtani
- Neurology Department, King Abdul-Aziz Medical City (National Guard Health Affairs), Jeddah, Saudi Arabia
| | - Ali Almubarak
- Neurology Department, Qatif Central Hospital, Qatif, Saudi Arabia
| | - Sadaga Alawi
- Neurology Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Shireen Qureshi
- Neurology Department, Johns Hopkins Aramco Healthcare Company (JHAH), Dhahran, Saudi Arabia
| | - Yaser Al Malik
- Neurology Department, King Saud bin Abdulaziz University For Health Sciences, Riyadh, Saudi Arabia
| | - Ashraf El-Metwally
- King Saud bin Abdulaziz University For Health Sciences, Riyadh, Saudi Arabia
| | - Sahar Shami
- King Fahd Specialist Hospital (KFSH)-Dammam, Dammam, Saudi Arabia
| | - Samah Ishak
- Itkan Health Consulting, Riyadh, Saudi Arabia
| | - Reem Bunyan
- King Fahd Specialist Hospital (KFSH)-Dammam, Dammam, Saudi Arabia
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Demographic and clinical characteristics of familial and sporadic multiple sclerosis: A single center exploratory study from Abu Dhabi. J Clin Neurosci 2020; 76:145-147. [PMID: 32284288 DOI: 10.1016/j.jocn.2020.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/06/2020] [Indexed: 11/22/2022]
Abstract
Demographic and clinical characteristics of Familial Multiple Sclerosis (FMS) have not been fully investigated yet in Abu Dhabi. The aim of this single center exploratory study was to investigate demographic and clinical characteristics of FMS compared to sporadic MS (SMS) in Abu Dhabi. A chart review single center study was conducted in 98 patients with MS. Group comparisons were performed using Mann-Whitney and Chi-Square tests as appropriate. A p < 0.05 was considered statistically significant. 24.5% were patients with FMS and 83% were Emirates. No significant differences in demographic and clinical characteristics were found between patients with FMS and SMS in overall all MS patients and in the Emirati group analyzed alone. Patients with FMS did not differ in demographic and clinical characteristics compared to patients with SMS. Further prospective studies are needed to elucidate environmental and genetic risk factors contributing to FMS in the Emirati population.
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Canibaño B, Deleu D, Mesraoua B, Melikyan G, Ibrahim F, Hanssens Y. Pregnancy-related issues in women with multiple sclerosis: an evidence-based review with practical recommendations. J Drug Assess 2020; 9:20-36. [PMID: 32128285 PMCID: PMC7034025 DOI: 10.1080/21556660.2020.1721507] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 01/21/2020] [Indexed: 12/18/2022] Open
Abstract
Objective: To review the current evidence regarding pregnancy-related issues in multiple sclerosis (MS) and to provide recommendations specific for each of them. Research design and methods: A systematic review was performed based on a comprehensive literature search. Results: MS has no effect on fertility, pregnancy or fetal outcomes, and pregnancies do not affect the long-term disease course and accumulation of disability. There is a potential risk for relapse after use of gonadotropin-releasing hormone agonists during assisted reproduction techniques. At short-term, pregnancy leads to a reduction of relapses during the third trimester, followed by an increased risk of relapses during the first three months postpartum. Pregnancies in MS are not per se high risk pregnancies, and MS does not influence the mode of delivery or anesthesia unless in the presence of significant disability. MRI is not contraindicated during pregnancy; however, gadolinium contrast media should be avoided whenever possible. It is safe to use pulse dose methylprednisolone infusions to manage acute disabling relapses during pregnancy and breastfeeding. However, its use during the first trimester of pregnancy is still controversial. Women with MS should be encouraged to breastfeed with a possible favorable effect of exclusive breastfeeding. Disease-modifying drugs can be classified according to their potential for pregnancy-associated risk and impact on fetal outcome. Interferon beta (IFNβ) and glatiramer acetate (GA) may be continued until pregnancy is confirmed and, after consideration of the individual risk-benefit if continued, during pregnancy. The benefit of continuing natalizumab during the entire pregnancy may outweigh the risk of recurring disease activity, particularly in women with highly active MS. GA and IFNβ are considered safe during breastfeeding. The use of natalizumab during pregnancy or lactation requires monitoring of the newborn. Conclusions: This review provides current evidence and recommendations for counseling and management of women with MS preconception, during pregnancy and postpartum.
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Affiliation(s)
- Beatriz Canibaño
- Department of Neurology, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Dirk Deleu
- Department of Neurology, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Boulenouar Mesraoua
- Department of Neurology, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Gayane Melikyan
- Department of Neurology, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Faiza Ibrahim
- Department of Neurology, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Yolande Hanssens
- Clinical Services Unit, Pharmacy, Hamad Medical Corporation, Doha, Qatar
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Khoury SJ, Tintore M. Multiple sclerosis in the Middle East and North Africa region. Mult Scler J Exp Transl Clin 2020; 6:2055217319895540. [PMID: 35145729 PMCID: PMC8822444 DOI: 10.1177/2055217319895540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Samia J Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center American University of Beirut, Lebanon
| | - Mar Tintore
- Cemcat Neurology/Neuroimmunology Department, Hospital Universitari Vall d'Hebron, Spain
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Bhinder MA, Sadia H, Mahmood N, Qasim M, Hussain Z, Rashid MM, Zahoor MY, Bhatti R, Shehzad W, Waryah AM, Jahan S. Consanguinity: A blessing or menace at population level? Ann Hum Genet 2019; 83:214-219. [PMID: 30891741 DOI: 10.1111/ahg.12308] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 02/15/2019] [Accepted: 03/01/2019] [Indexed: 12/18/2022]
Abstract
Consanguinity has highly complex and multifaceted aspects with sociocultural as well as biological debates on its pros and cons. The biological upshot of consanguinity includes the increased homozygosity, which results in manifold increased risk of genetic disorders at family and population levels. On the other hand, in addition to social, cultural, political, and economic benefits, consanguineous marriages have biological advantages at the population level. The consequence of consanguineous marriages is an upsurge in the number of homozygous diseased individuals with fewer chances of mating and reduced chances of survival, therefore evolutionarily confining the transmission of disease alleles to future generations and encouraging its elimination from a population. Protective effects of consanguinity have also been observed in a few diseases in different populations. Although attractive for many reasons, nonconsanguineous marriages will cause risk alleles to spread throughout the population, making most individuals carriers, and ultimately will resume the production of recessive diseases in subsequent generations. Although consanguinity, from an evolutionary point of view, is beneficial at the population level, it increases the risk of diseases in the very next generation. Presently, there is no treatment for most of the genetic disorders; we cannot opt for consanguinity for long-term benefits. Nonconsanguineous marriages are a better strategy by which we may delay disease manifestation for some generations until science offers a viable solution.
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Affiliation(s)
- Munir Ahmad Bhinder
- Department of Human Genetics & Molecular Biology, University of Health Sciences, Lahore, 54600, Pakistan
| | - Haleema Sadia
- Balochistan University of Information Technology, Engineering and Management Sciences, Takatu Campus, Quetta, Pakistan
| | - Nasir Mahmood
- University of Health Sciences, Lahore, 54600, Pakistan
| | - Muhammad Qasim
- Department of Bioinformatics and Biotechnology, Govt. College University, Faisalabad, Pakistan
| | - Zawar Hussain
- Department of Zoology, University of Education, Lahore, Pakistan
| | - Muhammad Mudassar Rashid
- Department of Human Genetics & Molecular Biology, University of Health Sciences, Lahore, 54600, Pakistan
| | - Muhammad Yasir Zahoor
- Institute of Biochemistry & Biotechnology, University of Veterinary & Animal Sciences, Lahore, Pakistan
| | - Rashid Bhatti
- National Centre of Excellence in Molecular Biology, Lahore, Pakistan
| | - Wasim Shehzad
- Institute of Biochemistry & Biotechnology, University of Veterinary & Animal Sciences, Lahore, Pakistan
| | - Ali Muhammad Waryah
- Molecular Biology & Genetics Department, Medical Research Center, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
| | - Shah Jahan
- University of Health Sciences, Lahore, 54600, Pakistan
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Halawani AT, Zeidan ZA, Kareem AM, Alharthi AA, Almalki HA. Sociodemographic, environmental and lifestyle risk factors for multiple sclerosis development in the Western region of Saudi Arabia. A matched case control study. Saudi Med J 2018; 39:808-814. [PMID: 30106419 PMCID: PMC6194980 DOI: 10.15537/smj.2018.8.22864] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objectives: To examine the association of exposure to sociodemographic, environmental, and lifestyle risk factors during adolescence with the development of multiple sclerosis (MS). Methods: We conducted a case-control study between October 2017 and January 2018 at King Fahd General Hospital (KFH) in Madinah, Saudi Arabia. Data were collected by direct physician-subject interviews. We utilized a questionnaire modified from the environmental risk factors in multiple sclerosis questionnaire (EnvIMS-Q). Chi-square tests were used to examine associations of selected risk factors with the development of MS, a p-value of <0.05 was considered significant. Results: A total of 80 cases and 160 controls were enrolled into the study. Smoking during adolescence significantly increased the risk of MS, with an adjusted odds ratio (AOR) of 4.165, and a 95% confidence interval (CI) of 1.449-11.974. Large body size, assessed using a figure rating scale, also increased the risk of MS (AOR=8.970, 95% CI=1.032-77.983), as well as a history of measles infection (AOR=3.758, 95% CI=1.455-9.706). Furthermore, exposure to sunlight during the weekend for more than 4 hours/day decreased the risk of MS (AOR=0.063, 95% CI=0.006-0.654), so did the consumption of fish for more than once per week (AOR=0.206, 95% CI=0.055-0.773). Conclusion: The risk of developing MS is significantly increased by exposure during adolescence to smoking, a history of measles infection, and large body size (obesity).
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Affiliation(s)
- Abdulrahman T Halawani
- Saudi Board of Preventive Medicine, Ministry of Health, Madinah, Kingdom of Saudi Arabia. E-mail.
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Al Wutayd O, Mohamed AG, Saeedi J, Al Otaibi H, Al Jumah M. Environmental exposures and the risk of multiple sclerosis in Saudi Arabia. BMC Neurol 2018; 18:86. [PMID: 29914402 PMCID: PMC6006694 DOI: 10.1186/s12883-018-1090-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 06/13/2018] [Indexed: 11/15/2022] Open
Abstract
Background Multiple sclerosis (MS) is the most common non-traumatic condition that leads to disability among young individuals. It is associated with demyelination, inflammation, and neurodegeneration within the central nervous system. Information on risk factors of multiple sclerosis is crucial for the prevention and control of the disease. The aim of this study was to determine risk factors of MS among adults in Saudi Arabia. Methods A matched multicenter case-control study, including 307 MS patients and 307 healthy controls, was conducted in MS clinics and wards in 3 main cities of Saudi Arabia. Age, gender, and hospital were matched. Information on demographics, family history of MS, past medical and family history, sun exposure at different age periods, tobacco use, diet, consanguinity, and coffee consumption was obtained from self-administered questionnaires. ORs and 95% confidence intervals (CIs) were calculated. A conditional logistic regression model was used to control for potential confounding factors. Results The conditional logistic regression adjusted for age and gender showed that being the first child in the family (Adjusted Odds Ratio (AOR) 1.68, 95% CI: 1.03–2.74), having a family history of MS (AOR 5.83, 95% CI: 2.83–12), eating fast food ≥5 times weekly (AOR 2.05, 95% CI: 1.03–4.08), and having had measles (AOR 3.77, 95% CI: 2.05–6.96), were independently associated with an increased risk of MS. In contrast, eating ≥5 servings of fruit per week (AOR 0.25, 95% CI: 0.16–0.38), drinking coffee daily (AOR 0.46, 95% CI: 0.31–0.68), and having a high level of sun exposure at the primary school level and university level (AOR 0.57, 95% CI: 0.38–0.85 and AOR 0.48, 95% CI: 0.30–0.76, respectively) were independently associated with a decreased risk of MS. Conclusions Our study suggested that high levels of sun exposure during primary school and university, consumption of fruits and drinking coffee protect against MS. In contrast, eating fast food was associated with an increased risk of the disease. Encouraging outdoor activity and healthy diets in school, especially for females, is highly recommended. Electronic supplementary material The online version of this article (10.1186/s12883-018-1090-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Osama Al Wutayd
- Unaizah College of Medicine, Qassim University, Qassim, Saudi Arabia.,Unaizah College of Medicine and Medical Sciences - Qassim University, Unaizah, Qassim, Saudi Arabia
| | | | - Jameelah Saeedi
- Princess Norah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Hessa Al Otaibi
- King Fahad General Hospital, Ministry of Health, Jedda, Saudi Arabia
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Increasing prevalence of familial recurrence of multiple sclerosis in Iran: a population based study of Tehran registry 1999-2015. BMC Neurol 2018; 18:15. [PMID: 29415659 PMCID: PMC5804012 DOI: 10.1186/s12883-018-1019-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 01/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tehran is the capital of Iran with an increasing multiple sclerosis (MS) prevalence. A retrospective population-based study was conducted to evaluate the trends of MS prevalence in Tehran. METHODS A population-based survey was conducted for the period 1999 to 2015, based on Iranian MS Society (IMSS) registry system of Tehran, the capital city of Iran. Point regression analysis was applied on MS trend data to find annual percent change (APC). The logistic regression analysis was used to estimate the odds ratio (OR) for individual variables in order to assess factors associating with familial recurrence of MS. P values < 0.05 were considered significant. RESULTS MS prevalence has significantly increased during the study period from 1999 to 2015 (56.22 per 100,000). Total point prevalence of MS was 115.94 per 100,000 persons in 2015 compared to general population. Positive family history of MS was observed among 12.4% of patients. The strongest association amongst first-degree relatives was found in siblings, p value ≤ 0.001. CONCLUSION MS prevalence is rising in Tehran and this city is one of the regions with highest MS prevalence in Asia. In this sample, the largest proportion of relatives with MS were found among first-degree relatives, particularly siblings. Familial recurrence correlated with relative type.
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Harirchian MH, Fatehi F, Sarraf P, Honarvar NM, Bitarafan S. Worldwide prevalence of familial multiple sclerosis: A systematic review and meta-analysis. Mult Scler Relat Disord 2017; 20:43-47. [PMID: 29291483 DOI: 10.1016/j.msard.2017.12.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/18/2017] [Accepted: 12/21/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Several studies have suggested that the existence of a history of multiple sclerosis (MS) in family, is one of the predisposing factors for MS. Based on our knowledge, the review and estimation of the prevalence of familial multiple sclerosis (FMS) in the world has not been reported up to now. This study is a systematic review and a meta-analysis of FMS prevalence in the world. METHODS Two researchers searched "epidemiology" or "prevalence" or "incidence" and "familial multiple sclerosis" as relevant keywords in international databases such as PubMed, web of science and Scopus up to 2016. MedCalc Version 15.8 was used to estimate the pooled prevalence of FMS. (PROSPERO ID = CRD42016033016) RESULTS: From the 184 total articles found from 1954 to 2016, we pooled and analyzed the data of 17 final eligible studies, according to the inclusion criteria. The prevalence of FMS was estimated as 12.6% within a total sample size of 14,619 MS patients in the world as of 95% confidence interval (CI: 9.6-15.9). CONCLUSION We detected significant heterogeneity from Hungary to Saskatchewan for FMS prevalence that was not latitude and ethnicity dependent. This highlighted the accumulation effects of genetic and environment on FMS prevalence. Pooled prevalence of FMS in MS population was calculated 12.6% by random effect in the world.
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Affiliation(s)
- Mohammad Hossein Harirchian
- Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Fatehi
- Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Payam Sarraf
- Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Niyaz Mohammadzadeh Honarvar
- Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran; Cellular and Molecular Nutrition Department, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sama Bitarafan
- Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Akdemir N, Terzi M, Arslan N, Onar M. Prevalence of Multiple Sclerosis in the Middle Black Sea Region of Turkey and Demographic Characteristics of Patients. Noro Psikiyatr Ars 2017; 54:11-14. [PMID: 28566952 DOI: 10.5152/npa.2016.12451] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 10/31/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Multiple sclerosis (MS), a demyelinating disease of the central nervous system, is increasing in prevalence worldwide. Other than small-scale studies, there is a scarcity of data on the prevalence of MS in Turkey. The present study aimed to elucidate the prevalence of MS in the Middle Black Sea Region and the demographic characteristics of patients. METHODS Patients living in the Middle Black Sea Region and who were diagnosed with MS were included. The study was designed based hospital of Turkey. RESULTS A total of 1,787 patients were interviewed, and a diagnosis of MS was confirmed in 1,584. The prevalence of MS was found to be 43.2/100,000 in the Middle Black Sea Region; this was calculated based on the total population and number of patients in the provinces and districts in this region. The mean age at the disease onset was 29.39±7.6 years. Among the patients, 1,299 (81.9%) had relapsing-remitting MS, 74 had secondary progressive MS, 77 had relapsing-progressive MS, 47 had primary progressive MS, and 87 had clinically isolated syndrome. CONCLUSION The Middle Black Sea Region was found to have a high risk for the prevalence of MS. This study is the most comprehensive epidemiologic study having the largest geographical distribution on the prevalence of MS in Turkey.
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Affiliation(s)
- Neslihan Akdemir
- Department of Neurology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Murat Terzi
- Department of Neurology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Nilden Arslan
- Department of Public Health, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Musa Onar
- Department of Neurology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
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Deleu D, Mesraoua B, El Khider H, Canibano B, Melikyan G, Al Hail H, Mhjob N, Bhagat A, Ibrahim F, Hanssens Y. Optimization and stratification of multiple sclerosis treatment in fast developing economic countries: a perspective from Qatar. Curr Med Res Opin 2017; 33:439-458. [PMID: 27892723 DOI: 10.1080/03007995.2016.1261818] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The introduction of disease-modifying therapies (DMTs) - with varying degrees of efficacy for reducing annual relapse rate and disability progression - has considerably transformed the therapeutic landscape of relapsing-remitting multiple sclerosis (RRMS). We aim to develop rational evidence-based treatment recommendations and algorithms for the management of clinically isolated syndrome (CIS) and RRMS that conform to the healthcare system in a fast-developing economic country such as Qatar. RESEARCH DESIGN AND METHODS We conducted a systematic review using a comprehensive search of MEDLINE, PubMed, and Cochrane Database of Systematic Reviews (1 January 1990 through 30 September 2016). Additional searches of the American Academy of Neurology and European Committee for Treatment and Research in Multiple Sclerosis abstracts from 2012 through 2016 were performed, in addition to searches of the Food and Drug Administration and European Medicines Agency websites to obtain relevant safety information on these DMTs. RESULTS For each of the DMTs, the mode of action, efficacy, safety and tolerability are briefly discussed. To facilitate the interpretation, the efficacy data of the pivotal phase III trials are expressed by their most clinically useful measure of therapeutic efficacy, the number needed to treat (NNT). In addition, an overview of head-to-head trials in RRMS is provided as well as a summary of the several different RRMS management strategies (lateral switching, escalation, induction, maintenance and combination therapy) and the potential role of each DMT. Finally, algorithms were developed for CIS, active and highly active or rapidly evolving RRMS and subsequent breakthrough disease or suboptimal treatment response while on DMTs. The benefit-to-risk profiles of the DMTs, taking into account patient preference, allowed the provision of rational and safe patient-tailored treatment algorithms. CONCLUSIONS Recommendations and algorithms for the management of CIS and RRMS have been developed relevant to the healthcare system of this fast-developing economic country.
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Affiliation(s)
- Dirk Deleu
- a Department of Neurology , Neuroscience Institute, Hamad Medical Corporation , Doha , State of Qatar
| | - Boulenouar Mesraoua
- a Department of Neurology , Neuroscience Institute, Hamad Medical Corporation , Doha , State of Qatar
| | - Hisham El Khider
- a Department of Neurology , Neuroscience Institute, Hamad Medical Corporation , Doha , State of Qatar
| | - Beatriz Canibano
- a Department of Neurology , Neuroscience Institute, Hamad Medical Corporation , Doha , State of Qatar
| | - Gayane Melikyan
- a Department of Neurology , Neuroscience Institute, Hamad Medical Corporation , Doha , State of Qatar
| | - Hassan Al Hail
- a Department of Neurology , Neuroscience Institute, Hamad Medical Corporation , Doha , State of Qatar
| | - Noha Mhjob
- a Department of Neurology , Neuroscience Institute, Hamad Medical Corporation , Doha , State of Qatar
| | - Anjushri Bhagat
- a Department of Neurology , Neuroscience Institute, Hamad Medical Corporation , Doha , State of Qatar
| | - Faiza Ibrahim
- a Department of Neurology , Neuroscience Institute, Hamad Medical Corporation , Doha , State of Qatar
| | - Yolande Hanssens
- b Department of Clinical Services Unit , Pharmacy, Hamad Medical Corporation , Doha , State of Qatar
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Maghzi H, Shaygannejad V, Minagar A, Hassanzadeh A, Maghzi AH. Consanguinity and multiple sclerosis susceptibility: A case control study. Mult Scler Relat Disord 2016; 10:179-180. [PMID: 27919486 DOI: 10.1016/j.msard.2016.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 09/13/2016] [Accepted: 09/30/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Several lines of evidence point towards the importance of genetic risk factors in the susceptibility to multiple sclerosis (MS). We aimed to compare the rates of consanguineous marriages between first cousins among parents of MS patients and a healthy unrelated control group. METHOD This study is a cross-sectional hospital registry based study, which was performed by analyzing the clinical records of patients registered with the Kashani hospital database, and also a control group of randomly selected healthy individuals. RESULT MS patients were significantly less an offspring of a consanguineous union than the control group (MS patients=26.1%, vs Control=32.7%, p=0.03; OR=0.730 95%CI: 0.55-0.97) CONCLUSION: Offspring of consanguineous unions seems to have a lower risk of MS compared to offspring of unrelated parents. This may have implications for inheritance mode of protective alleles in MS.
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Affiliation(s)
- Helia Maghzi
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Shaygannejad
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Minagar
- Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Akbar Hassanzadeh
- Department of Epidemiology and Biostatistics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir-Hadi Maghzi
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Mazdeh M, Khazaei M, Hashemi-Firouzi N, Ghiasian M. Frequency of Multiple Sclerosis (MS) Among Relatives of MS Patients in Hamadan Society, Iran. ACTA ACUST UNITED AC 2016. [DOI: 10.17795/ajnpp-38613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Al-Shammri SN, Hanna MG, Chattopadhyay A, Akanji AO. Sociocultural and Demographic Risk Factors for the Development of Multiple Sclerosis in Kuwait: A Case - Control Study. PLoS One 2015; 10:e0132106. [PMID: 26132203 PMCID: PMC4488528 DOI: 10.1371/journal.pone.0132106] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 05/17/2015] [Indexed: 01/19/2023] Open
Abstract
Introduction Immunological, genetic and environmental factors are believed to play important roles in the pathogenesis of Multiple Sclerosis (MS). There have been many studies on risk factors for MS but these have been mainly in Caucasian populations; robust studies in Arab populations remain relatively uncommon. This study therefore aimed to identify behavioral, socio-cultural, and demographic factors associated with development of MS in Kuwait, a high income Arab country, currently undergoing a demographic transition. Subjects and methods In this case- control study, 195 Kuwaiti MS patients and 146 healthy age and sex-matched controls were recruited. Both groups of subjects were interviewed using a structured questionnaire, in relation to anthropometric, socio-cultural and demographic data, residence during the 1990/91 Gulf War and current and past medical history, including medications. We also clinically evaluated, and retrospectively reviewed medical records of patients to derive appropriate clinical information, including associated chronic medical illness requiring long-term treatment. Results On multiple logistic regression analysis after adjustment for potential confounders including age, gender and BMI, in all the subjects, a positive associations prevail with presence of MS and some sociocultural and demographic factors, which included non-Bedouin ethnicity (AOR 2, 95% CI 1.0-3.9, p 0.049), positive family history of MS (AOR 10.6, 95% CI 3.0-36.9), p < 0.001), and low daily sunlight exposure of < 15min/day (AOR 5.3, 95% CI 2.7-10.5 p < 0.001). In addition, while 41.8% of MS patients indicated at least one comorbidity, only 26.8% of the controls reported any associated physical illness, with the suggestion that presence of certain comorbidities might increase MS risk (AOR 2.4, 95% CI 1.3-4.7, p < 0.001). Other risk variables such as smoking status and mode of routine outdoor dressing were not significant in all the MS subjects taken as a whole, but demonstrated variably positive associations in the MS subgroup classified as those with established disease and those who were newly diagnosed and drug naïve. Conclusions This study suggests that a positive family history of MS and presence of certain comorbidities appeared to be associated with an increased risk of developing MS. In contrast, relatively increased amount of daily sunlight exposure and Bedouin ethnicity appear to somewhat be protective. It is speculated that the relationship of sunlight exposure with MS might be due to vitamin D availability, and is deserving of further study.
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Affiliation(s)
- Suhail N. Al-Shammri
- Neurology Unit, Mubarak Al Kabir Hospital, Ministry of Health, Jabriya, Kuwait
- Division of Neurology, Department of Medicine, Faculty of Medicine, Jabriya, Kuwait University, Kuwait
- * E-mail:
| | - Magdy G. Hanna
- Neurology Unit, Mubarak Al Kabir Hospital, Ministry of Health, Jabriya, Kuwait
| | - Arpita Chattopadhyay
- Division of Neurology, Department of Medicine, Faculty of Medicine, Jabriya, Kuwait University, Kuwait
| | - Abayomi O. Akanji
- Department of Medical Sciences, Frank H. Netter, MD, School of Medicine, Quinnipiac University, Hamden, Connecticut, United States of America
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Binzer S, Imrell K, Binzer M, Kyvik KO, Hillert J, Stenager E. High inbreeding in the Faroe Islands does not appear to constitute a risk factor for multiple sclerosis. Mult Scler 2014; 21:996-1002. [DOI: 10.1177/1352458514557305] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 10/06/2014] [Indexed: 11/16/2022]
Abstract
Background: Large population-based genome-wide association studies have identified several multiple sclerosis (MS) genetic risk variants, but the existing missing heritability warrants different strategies. Isolated populations offer an alternative way of searching for rare genetic variants and evaluating the possible role of consanguinity in the development of MS. Studies of consanguinity and MS risk have yielded conflicting results. Objectives: In this study we investigated the role of consanguinity on MS risk in the relatively isolated Faroe Islands, which have a presumed high level of inbreeding. Methods: A total of 29 cases and 28 matched controls were genotyped and assessed for inbreeding coefficients, number of runs of homozygosity (ROH) at different lengths and observed number of homozygotes as measures of relatedness. Parametric and non-parametric statistical models were applied. Results: Both cases and controls exhibited considerable relatedness demonstrated by very high inbreeding coefficients, large number of observed homozygotes and many long ROH. However, apart from the number of ROH ≥ 2.5 mega base pairs, no significant differences between the two groups were observed. Conclusions: Overall, no significant difference between cases and controls were found, indicating that consanguinity in itself does not appear to be an important risk factor for MS in the population of the Faroe Islands.
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Affiliation(s)
- S Binzer
- Institute of Regional Health Services Research, University of Southern Denmark, Denmark/MS Clinic of Southern Jutland (Sønderborg, Esbjerg, Vejle), Department of Neurology, Denmark/Torshavn National Hospital, Torshavn, Faroe Islands Odense Patient data explorative network (OPEN)
| | - K Imrell
- Karolinska Institute, Clinical Neuroscience, Division of Neurology, Department of Clinical Neuroscience, Sweden
| | - M Binzer
- Institute of Regional Health Services Research, University of Southern Denmark, Denmark
| | - K. O Kyvik
- Institute of Regional Health Services Research, University of Southern Denmark, Denmark/Odense Patient data Explorative Network (OPEN), Odense University Hospital, Denmark
| | - J Hillert
- Karolinska Institute, Clinical Neuroscience, Division of Neurology, Department of Clinical Neuroscience, Sweden
| | - E Stenager
- Institute of Regional Health Services Research, University of Southern Denmark, Denmark/MS Clinic of Southern Jutland (Sønderborg, Esbjerg, Vejle), Department of Neurology, Denmark
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Warsy AS, Al-Jaser MH, Albdass A, Al-Daihan S, Alanazi M. Is consanguinity prevalence decreasing in Saudis?: A study in two generations. Afr Health Sci 2014; 14:314-21. [PMID: 25320579 PMCID: PMC4196414 DOI: 10.4314/ahs.v14i2.5] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Saudi population is unique in that there is a strong preference for cousin marriages in the general population. We studied the prevalence of consanguinity in educated Saudi females and compared the results with the results obtained in their parents, to access if a generation difference in which extensive educational activities have prevailed to inform the people of the influence of cousin marriages on health, has made any difference in prevalence of consanguineous marriages. METHOD A total of 600 Saudi women (421 university students and 179 women attending outpatients' clinics) were interviewed about their own and their parents' consanguinity. RESULTS The total consanguinity (first and second cousins) was 29.7% in the parents. Consanguinity was significantly higher among the daughters than the parents, where 37.9% of the 293 married women had consanguineous marriages. The prevalence of consanguinity was studied in different age groups, though no significant pattern was observed. A strong correlation was found between consanguinity of parents and their daughters; consanguinity was highest (52.3%) in the daughters of parents who were themselves consanguineous. CONCLUSION The results did not reveal any decrease in the prevalence of consanguinity over a generation. This shows that the tradition of marrying within the family is a preferred practice, despite the awareness that certain genetic disorders occur at a higher frequency in cousin marriages. There is a need at the primary health care level to inform the public of the consequences of this common practice.
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Affiliation(s)
- Arjumand Sultan Warsy
- Department of Biochemistry, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - May Hamad Al-Jaser
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Abeer Albdass
- Department of Biochemistry, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Sooad Al-Daihan
- Department of Biochemistry, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Alanazi
- Department of Biochemistry, College of Science, King Saud University, Riyadh, Saudi Arabia
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Al Tahan AM, Alsharoqi I, Bohlega SA, Dahdaleh M, Daif A, Deleu D, Esmat K, Giampaolo D, Freedman MS, Gwilt M, Hosny H, Inshasi JS, Aljumah M, Khalifa A, Pakdaman H, Szólics M, Yamout BI, Sahraian MA, Zakaria MF. Characteristics of multiple sclerosis in the Middle East with special reference to the applicability of international guidelines to the region. Int J Neurosci 2013; 124:635-41. [DOI: 10.3109/00207454.2013.865620] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bohlega S, Inshasi J, Al Tahan AR, Madani AB, Qahtani H, Rieckmann P. Multiple sclerosis in the Arabian Gulf countries: a consensus statement. J Neurol 2013; 260:2959-63. [PMID: 23504049 PMCID: PMC3843364 DOI: 10.1007/s00415-013-6876-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 02/12/2013] [Accepted: 02/14/2013] [Indexed: 12/01/2022]
Abstract
The epidemiology of multiple sclerosis (MS) is rapidly changing in many parts of the world. Based on the Kurtzke classification, the Arabian Gulf Region is located in a low-risk zone for MS; however, recent studies suggest a moderate-to-high prevalence nearby (31-55 MS per 10,0000 individuals), with an increase in incidence in recent years. The relapsing-remitting disease course ratio is 2.5:1 versus the primary progressive type. In a geographic area that was previously associated with low prevalence; the recent high prevalence and fast rising incidence of MS in the gulf countries, encouraged the neurologists of this region to meet in a consensus panel, in order to share our latest findings in terms of MS epidemiology and consent on MS management in the Arabian Gulf. Therefore 20 key opinion leader neurologists and MS experts representing various countries of the Arabian Gulf have met in Dubai on the 2 and 3 February 2012, they shared their latest epidemiological findings, discussed recent MS aspects in the region, and consented on MS management relevantly to this geographic area.
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Affiliation(s)
- Saeed Bohlega
- King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia,
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Alroughani R, Ahmed SF, Behbehani R, Khan R, Thussu A, Alexander KJ, Ashkanani A, Nagarajan V, Al-Hashel J. Increasing prevalence and incidence rates of multiple sclerosis in Kuwait. Mult Scler 2013; 20:543-7. [DOI: 10.1177/1352458513504328] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background: Kuwait was considered as low to intermediate risk area for MS. Objectives: To determine the prevalence and incidence rates of MS among Kuwaiti nationals based on 2011 population census. Methods: This cross-sectional study was conducted between October 2010 and April 2013 using the newly developed national MS registry in Kuwait. Patients with a diagnosis of MS according to 2010 revised McDonald criteria were identified. The crude, age- and sex-specific prevalence and incidence rates among Kuwaiti patients were calculated. Results: 1176 MS patients were identified of which 927 (78.8%) were Kuwaitis and 249 (21.2%) were expatriates. Among Kuwaiti patients, female to male ratio was 1.8:1 with a mean age of 35.40 ± 10.99 years. The prevalence rate of MS was 85.05 per 100,000 persons (95% CI: 82.80 – 87.04). There was a peak in prevalence among patients aged 30–39 years. The incidence of MS was 6.88 per 100,000 persons (95% CI 5.52–8.55). Between 2003 and 2011, the incidence increased 3.22 and 2.54 times in women and men respectively. Conclusion: Kuwait is considered a high-risk area for MS. The significant increase in prevalence and incidence rates may represent a true increase despite the improvement in case ascertainment and case definition.
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Affiliation(s)
- R Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Kuwait
- Neurology Clinic, Department of Medicine, Dasman Diabetes Institute, Kuwait
| | - SF Ahmed
- Department of Neurology, Ibn Sina Hospital, Kuwait
- Department of Neurology and Psychiatry, Al-Minia Hospital, Egypt
| | - R Behbehani
- Neurology Clinic, Department of Medicine, Dasman Diabetes Institute, Kuwait
- Department of Ophthalmology, Al-Bahar Eye Center, Kuwait
| | - R Khan
- Department of Neurology, Ibn Sina Hospital, Kuwait
| | - A Thussu
- Division of Neurology, Department of Medicine, Amiri Hospital, Kuwait
- Neurology Clinic, Department of Medicine, Dasman Diabetes Institute, Kuwait
| | - KJ Alexander
- Department of Neurology, Ibn Sina Hospital, Kuwait
| | - A Ashkanani
- Division of Neurology, Department of Medicine, Amiri Hospital, Kuwait
| | - V Nagarajan
- Department of Neurology, Ibn Sina Hospital, Kuwait
| | - J Al-Hashel
- Department of Neurology, Ibn Sina Hospital, Kuwait
- Department of Medicine, Kuwait University, Kuwait
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Deleu D, Mir D, Al Tabouki A, Mesraoua R, Mesraoua B, Akhtar N, Al Hail H, D'souza A, Melikyan G, Imam YZB, Osman Y, Elalamy O, Sokrab T, Kamran S, Ruiz Miyares F, Ibrahim F. Prevalence, demographics and clinical characteristics of multiple sclerosis in Qatar. Mult Scler 2012; 19:816-9. [PMID: 22968545 DOI: 10.1177/1352458512459291] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
No published epidemiologic data on multiple sclerosis (MS) in Qatar exist. Our objectives were to determine the prevalence, demographics and clinical characteristics of MS in the Middle Eastern country of Qatar. We analyzed data for Qatari MS patients fulfilling the McDonald diagnostic criteria. A total of 154 patients fulfilled the inclusion criteria. On 31 April 2010, the crude prevalence of MS in Qatar was 64.57 per 100,000 inhabitants (95% CI: 58.31-70.37). The female-to-male ratio was 1.33:1. A positive family history was found in 10.4% of included MS patients. We conclude that Qatar is now a medium-to-high risk area for MS, with some important differences in clinical characteristics as compared to other countries in the region.
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Affiliation(s)
- Dirk Deleu
- Department of Neurology (Medicine), Hamad Medical Corporation, Doha, Qatar.
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Al Jumah M, Al Balwi M, Hussein M, Kojan S, Al Khathaami A, Al Fawaz M, Al Muzaini B, Jawhary A, Al Abdulkareem I. Association of SNPs rs6498169 and rs10984447 with multiple sclerosis in Saudi patients: a model of the usefulness of familial aggregates in identifying genetic linkage in a multifactorial disease. Mult Scler 2012; 18:1395-400. [PMID: 22492128 DOI: 10.1177/1352458512440832] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Genome-Wide association studies (GWAS) showed an association between subset of single-nucleotide polymorphism (SNPs) and multiple sclerosis. Our study aims to study this association in Saudi familial multiple sclerosis patients. METHODS Four subject groups were used in this study: sporadic MS (MS patients without family history), FMS (MS patients who have at least one family member diagnosed with MS), related controls (relatives of FMS patients who appear to be free of the disease) and independent controls (healthy volunteers). Subjects were genotyped for 15 SNPs. The variation in the genotype distribution was analyzed across study groups by using logistic regression. RESULTS 342 subjects were included. 99 were in the sporadic MS group, 22 were FMS, 89 were related control, and 132 were independent control. SNPS rs3135388, rs7577363, rs1321172, rs6897932, rs6498169, rs12487066, and rs4763655were associated with MS when MS and independent control groups were compared. Same SNPS were identified but with stronger association when the FMS and independent control groups were compared. Finally, when the patients and the controls were selected from a much more homogenous genetic pool from which it would be expected that only SNPs highly linked to MS would persist, only two SNPs rs6498169[OR 4.26, CI (1.17 - 15.51)];, and rs10984447 [OR 13.63, CI(1.54, 120.83) ][were associated with MS. CONCLUSIONS Our results suggest that using a more homogenous genetic pool of cases and controls could help to identify the most significant MS-associated SNPs. Our finding is in agreement with other studies including larger sample size and more diverse populations.
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Affiliation(s)
- M Al Jumah
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
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