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Biomedical subjects

M A Moussa

Publications and source records attributed to M A Moussa.

At least 19 recordsLinked to original sources
PubMed1995

The outcome of placenta accreta in Kuwait (1981-1993).

OBJECTIVES: To study the demographic characteristics of patients with placenta accreta and to identify the clinical features, maternal and neonatal complications of this condition. METHODS: Sixteen cases of placenta accreta were identified in the Maternity Hospital of Kuwait during the period January 1981 to July 1993. Medical records were reviewed regarding past obstetric history, type of placenta, clinical presentation, maternal and fetal outcome. RESULTS: The rate of placenta accreta was found to be 98 per 1,000,000 deliveries. Emergency hysterectomy was needed in 87.5% of cases. There was one maternal death (6.25%) and three perinatal deaths (18.75%). Hemorrhage was the major presenting symptom either externally and antenatally in previa accreta or postpartum in accreta of the upper segment or internally in the same cases. The major postoperative complications were coagulopathy, urinary injury, pelvic hematoma and abscess, in addition to cardiac arrest. These complications, when considered separately, were not affected by a previous history of uterine scarring. CONCLUSIONS: Placenta accreta is a major cause of obstetric hemorrhage and has an adverse effect on maternal and neonatal outcome. It ought to be considered a possibility in patients with previous uterine scarring, placenta previa or retained placenta. It will remain a growing problem in the developing countries due to the rising incidence of previous multiple cesarean sections. Unfortunately the latter do not deter women in this part of the world from insisting upon having big families and refusing tubal ligation.

Adult↗
PubMed1995

High incidence of childhood-onset IDDM in Kuwait. Kuwait Study Group of Diabetes in Childhood.

OBJECTIVE: To determine the incidence of insulin-dependent diabetes mellitus (IDDM) in children aged 0-14 years in Kuwait, as part of the World Health Organization Multinational Collaborative Study (DIAMOND), and to determine if the incidence rates have increased. RESEARCH DESIGN AND METHODS: All cases of IDDM diagnosed before the child's 15th birthday between 1 January 1992 and 31 December 1993 were recorded. Prospective notification of all children with newly diagnosed diabetes who were admitted to hospitals and periodic review of hospital medical records provided the primary source; notification by physicians working in diabetic clinics, in which registry of all new cases is mandatory, provided the secondary source of ascertainment. RESULTS: The degree of ascertainment was 92.2%. The annual incidence of IDDM for children aged 0-14 years over the 2-year period was 15.4/100,000 (95% confidence interval, 12.4-19), with a male:female ratio of 1.2:1. The age-specific annual incidence rates for the age-groups 0-4, 5-9, and 10-14 years were 12.8, 15.1, and 18.3/100,000, respectively, with a male:female ratio of 1.45:1 in the 0- to 4-year-old age-group and an equal sex ratio in the 5- to 9- and 10- to 14-year-old age-groups. No significant difference was detected between incidence rates of IDDM in boys and girls in the three age-groups. There was no significant linear trend toward an increase in IDDM incidence rates as age advanced. Compared with a previous study by Taha et al. (Taha T, Moussa M, Rashed A, Fenech F: Diabetes mellitus in Kuwait: incidence in the first 29 years of life. Diabetologia 25:306-308, 1983), there was a nearly fourfold increase of IDDM in the age-group 0-14 years, mainly in those children < 5 years old, suggesting a rapid increase in a short period of time. CONCLUSIONS: Kuwait has the highest incidence of IDDM in children in the region, and an apparently increasing incidence has been demonstrated over the last decade.

Adolescent↗
PubMed1994

Factors associated with obesity in school children.

To investigate factors associated with the development of obesity in school children, the authors undertook a case-control study of 220 obese and 220 non-obese children aged 6 to 18 years from Al Ain, United Arab Emirates between September 1992 to May 1993 inclusive. The inclusion criterion for cases comprised children with body mass (Quetelet index) > 90th percentile of age-sex reference data of the French population. Questionnaires were used to obtain information about socioeconomic status (SES), family history of obesity, related diseases and behavioral factors (smoking, physical activity and preferred diet). Anthropometric measures (weight, height, waist and hip circumferences), systolic and diastolic blood pressure were measured. The waist/hip circumference ratio was used as an index for body fat distribution. The logistic regression analysis showed that family history of obesity, diet, physical activity and mother education were significant factors for development of obesity after adjusting for other confounding covariates. Neither smoking nor SES showed apparent relation to obesity. Both systolic and diastolic blood pressure showed stronger correlation with the fatness index, BMI, than with the fat distribution index, waist/hip ratio.

Adolescent↗
PubMed1994

Contribution of body fat and fat pattern to blood pressure level in school children.

OBJECTIVE: The study aims are investigating the effect of body fat and fat localization on blood pressure. DESIGN: Case-control study. SETTING: The study was carried out in the school health primary care. SUBJECTS: The case-control study included 220 obese and 220 non-obese children aged 7-18 years from Al Ain city, United Arab Emirates between September 1992 to May 1993 inclusive. Each group consisted of 120 males and 100 females. Two schools were randomly selected from each of the three educational stages: primary, junior and secondary. The inclusion criterion for cases comprised children with body mass index (BMI; Quetelet index), > 90th percentile of age and sex-specific reference data of the French population. Non-obese healthy controls were randomly selected from the same classes from where obese children were identified in order to ascertain that cases and controls were matched by age and sex. MEASUREMENTS: Anthropometric measures (weight, height, waist and hip circumferences), systolic and diastolic blood pressure were measured. To minimize inter-observer error, blood pressure was measured by one physician. We also collected information about other confounding social variables (family history of obesity and mother's education) and behavioural variables (preferred diet and physical activity). RESULTS: There was significant difference of systolic and diastolic blood pressure means between obese and non-obese children (P < 0.001) in both males and females. Applying the multiple linear regression analysis to fix the confounding effect of age, sex, social and behavioural factors, the fatness index, BMI, was significantly related to systolic (P < 0.0004) and diastolic (P < 0.0001); while waist-to-hip circumference ratio (WHR) was not significant (P = 0.803 in systolic and P = 0.648 in diastolic blood pressure respectively). CONCLUSIONS: Systolic and diastolic blood pressure showed a positive relationship with the fatness index BMI, but not with WHR, in both boys and girls. This is an evidence that WHR may not be a reliable indicator of body fat distribution in children.

Adipose Tissue↗
PubMed1991

Analysis of multiple-choice items.

This paper deals with scoring and analysis of multiple-choice exam questions. Data may be read by an optical mark reader scanner or from a file created by a system editor and stored in a format convenient to be analysed by a specially designed program 'MCQ'. In addition the data file created can be linked with the package SPSSx for pertinent statistical methods or SPSS Graphics for illustration of score and item distributions. The MCQ program comprises: (1) scoring; (2) item analysis: difficulty and discrimination indices; (3) testing the goodness of alternatives attached to each question. The method is applicable to multiple-choice questions with 4.5 greater than 5; true/false and combined exam questions. The method should prove useful for instructors to build up a balanced discriminant questions bank.

Computer Graphics↗
PubMed1990

Reliability of death certificate diagnoses.

Consistency between death certificates and clinical records from 5 general hospitals in Kuwait was studied for 470 deaths with the following underlying or associated causes: hypertensive (HYP), ischaemic heart diseases (IHD), cerebrovascular diseases (CVD) and diabetes mellitus (DM). Direct causes were not considered since they are of little interest analytically. Only deaths with definite or most probable ascertainment were included. One cardiologist, who was provided with the WHO criteria and relevant documents on death certification, independently reviewed the records. To test the reviewer's bias and the reliability of his judgement, an adjudication process was effected by having one senior cardiologist re-review a random subsample of 140 records. The two reviewers showed good agreement. Specific diagnoses criteria for deciding the underlying cause of death in multiple morbid conditions by the reviewer were followed. Due to possible reviewer bias, we aimed at measuring the difference between initial certifiers and the reviewer rather than measuring the diagnostic accuracy of initial certifiers in reference to the reviewer. The agreement index kappa showed poor agreement between original and revised certificates. The original certificates under-estimated CVD as an underlying cause of death by 69.2%, DM by 60%, IHD by 33.5% and HYP by 31.8% in our sample. Associated causes were also consistently under-estimated by initial certifiers as compared with the reviewer. This bias calls for basing mortality statistics in Kuwait on hospital death committees' reports rather than on initial certifier death certificates, use of multiple-causes of death instead of one underlying cause and adequate training of the medical profession on the value and process of death certification.

Adolescent↗
PubMed1990

Term infant asphyxia in Kuwait.

In the developing nation of Kuwait, we undertook a case-control study of 43 consecutively born, asphyxiated, term infants. The asphyxia incidence of 9.4/1000 was only slightly higher than that in more developed countries. Severe morbidity occurred in 1.1/1000, and mortality in 1.1/1000. We found significant associations between asphyxia and primiparity, maternal hypertension, consanguinity, increased length of labour, and instrumental deliveries. Maternal age, socio-economic class, maternal illnesses other than diabetes, and breech delivery did not seem to play a role. The fact that the chosen method of delivery failed for a number of the asphyxiated patients, necessitating emergency Caesarian section, suggests that obstetric factors may need closer analysis.

Apgar Score↗
PubMed1990

Planning the size of clinical trials with allowance for patient noncompliance.

Various approaches are considered for adjustment of clinical trial size for patient noncompliance. Such approaches either model the effect of noncompliance through comparison of two survival distributions or two simple proportions. Models that allow for variation of noncompliance and event rates between time intervals are also considered. The approach that models the noncompliance adjustment on the basis of survival functions is conservative and hence requires larger sample size. The model to be selected for noncompliance adjustment depends upon available estimates of noncompliance and event rate patterns.

Clinical Trials as Topic↗
PubMed1989

Exact, conditional, and predictive power in planning clinical trials.

It is shown how the predictive power, which takes account of prior clinical opinion about treatment differences, can be extended to group sequential designs based on a range rather than point of equivalence. It is found that such design when averaged over the whole prior distribution seems to be most conservative in terms of probability of firm conclusion followed by the nonzero null hypothesis design. Planning a trial based on calculations of the "exact" power or zero null hypothesis design may result in a practically unacceptable probability of firm conclusion.

Clinical Trials as Topic↗
PubMed1989

Vitamin-D-deficiency rickets in Kuwait: the prevalence of a preventable disease.

Two hundred and fifty children with clinical, biochemical and radiological evidence of vitamin-D-deficiency rickets were studied over a period of 5 years. Their ages ranged from 1 month to 2 years. Breastfed infants formed 63% of total cases. Intramuscular therapy with vitamin D in a dose of 600,000 IU, deep intramuscular, proved to be safe and effective. In contrast, oral vitamin D did not provide such satisfactory results, presumably owing to poor patient/parental compliance. This report reveals that vitamin-D-deficieny rickets is common in Kuwait in spite of abundant sunlight all through the year because children are wrapped up and kept indoors. Insufficient intake of vitamin D is another important factor in the pathogenesis of vitamin-D-deficiency rickets in Kuwait.

Child, Preschool↗
PubMed1989

The profile of parasucide repeaters in Kuwait.

A one-year cohort of 92 parasuicides was followed up at 6 monthly intervals for a period of 2 years since their index parasuicide to study the outcome and evaluate the level of social readjustment. One male patient died of suicide (1.1%) and 18 (19.6%) individuals repeated parasuicide using self-poisoning. The rate of repeated parasuicidal behaviour in this investigation was considerably higher than that reported in comparable studies from developing countries but similar to that from a number of western European cities. The data indicated that the probability of further episodes of parasuicidal behaviour increased in the few months after the index episode. Although the repeaters and non-repeaters were essentially similar in most of their sociodemographic characteristics, the former were a distinctive group in many respects. The factors found to be significantly associated with subsequent parasuicide included self-poisoning by prescribed drugs at the index parasuicide, previous parasuicidal behaviour prior to the index, occupational status of a housewife, past history of depression and/or dependence and precipitating life events in the family environment. Contrary to our hypothesized theory, none of the types of attitudes received by the patients from their family members at the index parasuicide related to outcome. The global level of social readjustment of non-repeaters was about three times higher than that of repeaters of parasuicide. The implications of these findings for future policy making were discussed with respect to prevention of parasuicide.

Adult↗
PubMed1989

Efficacy of zona-free hamster egg sperm penetration assay as a predictor of in vitro fertilization.

The efficacy of the zona-free hamster egg sperm penetration assay (SPA) as a predictor of in vitro fertilization (IVF) is studied. Indications for IVF were tubal factors in 35 couples and male factors in 24 couples. The diagnostic characteristics of SPA in reference to IVF for the whole group (n = 59) were reasonably reliable. Sensitivity was 74%, specificity was 84%, and diagnostic accuracy was 81%. However in patients with male factors, SPA was less reliable in terms of sensitivity (70%), specificity (57%), and diagnostic accuracy (63%), than in patients with tubal factors where the indicators were 80%, 97%, and 94%, respectively. Semen from patients with male infertility shared notable variations in terms of sperm density and motility which may account for the low SPA predictivity. SPA seems to be a useful screening test for prediction of IVF outcome. However other semen variables should be considered before interpretation, especially in male infertility where the diagnostic accuracy is low.

Animals↗
PubMed1988

Plasma dopamine beta-hydroxylase: rapid diagnostic test for recurrent hereditary polyserositis.

The diagnosis of recurrent hereditary polyserositis (RHP; also known as familial Mediterranean fever) remains one of exclusion since there has been no specific diagnostic laboratory test. A previous study suggested that the disorder is related to abnormal catecholamine metabolism. Plasma dopamine beta-hydroxylase (DBH) activity was assayed spectrophotometrically in 91 RHP patients and 162 controls. The activity was significantly higher in untreated symptom-free patients and in patients with acute attacks, than in controls (mean [SEM] 155.8 [14.1] vs 43.3 [1.9] mumol/min/1 p less than 0.0001). Colchicine treatment reduced DBH activity to control levels. The test showed a high diagnostic accuracy and specificity for RHP, whether the patient was symptom-free or having an acute attack. Moreover, it is easy to carry out.

Adult↗
PubMed1988

Planning the size of survival time clinical trials with allowance for stratification.

Approximate allocation designs for comparing two survival distributions are considered and compared with the exact solution. The influence of incorporating covariates by stratification, accrual and follow-up duration on trial size and power is investigated. The Bernstein and Lagakos design is suited for exponential survival due to its generality and allowance for stratification while the Freedman design is convenient for distribution-free survival in view of its simplicity. With other specifications fixed, the saving in sample size becomes minimal as the accrual period or post-accrual follow-up time units expand above three. Required sample size also increases dramatically when the number of strata exceeds three.

Clinical Trials as Topic↗
PubMed1988

Postpartum glycated hemoglobin A1c and glucose tolerance test in mothers of large babies.

An attempt to study macrosomia and carbohydrate metabolism was made by determination of glycated hemoglobin A1c and by the oral glucose tolerance test (OGTT) in early puerperium. We studied 76 women who gave birth to large babies greater than or equal to 4.5 kg, 74 women whose babies were 3-4 kg as controls, and 36 type II diabetics. The median of HbA1c concentration in the diabetics (8.06%) was significantly higher than in the controls (6.49%), and the large babies' mothers (6.48%), P less than 0.001. No significant difference was found between HbA1c or glucose intolerance in mothers of large babies and mothers with average size babies. HbA1c showed an association with glucose levels in the diabetics and controls, P less than 0.001, but not in the large baby group. Mothers of large babies were as old and obese as the diabetics. We speculate that the relationship of postpartum GTT, HbA1c and gestational diabetes is unwarranted.

Adult↗
PubMed1988

Sperm chromatin heterogeneity as an infertility factor.

Semen samples from husbands with a history of unexplained infertility (n = 33), of women with habitual abortion (n = 36), or normal fertile donors (n = 20) were subjected to conventional semen analysis (SA), Acridine orange test (AOT), and zona-free hamster egg penetration test (HEPT). The three tests operate independently. The most discriminatory test was AOT (p = 0.0001) followed by HEPT (p = 0.019). The frequency of sperm chromatin heterogeneity as detected by AOT red fluorescence was highest in habitual abortion (39.4%), followed by unexplained infertility (16.4%), and, last, donors (9.4%). However the percentage of penetration was highest in habitual abortion (50.7%), followed by donors (43.1%), and least in unexplained infertility (33.9%). Conventional semen parameters (sperm density, motility, abnormality, and vitality) were the least to discriminate between the three groups. The presence of abnormal sperm chromatin may lead to infertility as a result of early pregnancy loss.

Acridine Orange↗