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At least 181 records · Page 10Linked to original sources

Respiratory insufficiency in a severe autosomal recessive form of muscular dystrophy.

In a large Sudanese kindred of 176 individuals, 15 children developed a brief respiratory illness in the course of a severe autosomal recessive muscular dystrophy (MD) and eight of them died. The type of MD in this kindred delineates a newly recognized entity which has been described from Sudan, Tunisia, Libya and Qatar . To assess the role of pulmonary insufficiency in the fatal outcome of this disease, pulmonary function was studied in six of the survivors. Values of lung volume were grossly abnormal and revealed a restrictive pattern. The degree of lung volume restriction varied from 50 to 76% of predicted total lung capacity (TLC) and 31-55% of predicted forced vital capacity (FVC). The high FEV1/FVC ratio (80-100%) in all patients excluded airway obstruction and the elevated ratio of residual volume (RV) to TLC (51-68%) reflected loss of inspiratory capacity. FVC showed no correlation with the degree of muscular disability and did not seem to be affected by the mild scoliosis seen in five children. These results are discussed in view of similar studies in a variety of neuromuscular disorders.

Adolescent↗

Co-isolation of Trichosporon inkin and Candida parapsilosis from a scalp white piedra case.

White piedra is a rare fungal infection of the hair shaft characterized by small, firm, irregular white-brown nodules. The infection is caused by basidiomycetous yeasts in the genus Trichosporon. We report a case of a 28-year-old female patient who acquired the infection in Qatar. In this case, the scalp was the only site affected, but infection at that site was extensive. The hair had a Saccharomyces-like yeast odor and appeared to be beaded, with light-brown nodules of varying sizes up to 2 mm long. Trichosporon sp. accompanied by Candida parapsilosis grew out along hair shafts planted in primary isolation media. Molecular identification of the Trichosporon carried out by analyzing the 26S ribosomal gene gave a 100% match with Trichosporon inkin, a major cause of pubic white piedra. The patient was treated with daily applications of ketoconazole shampoo followed by econazole shampoo and cream, and was considered clinically and mycologically cured after 2 months. Novel findings in the present case are the first identification of T. inkin as an agent of scalp white piedra, and the heavy outgrowth of C. parapsilosis from the concretions, although in the latter case it is not clear if the co-occurring yeast was etiologically contributory to the pathogenesis of the white piedra.

Adult↗

Cannabis (marijuana) contamination of United States and foreign paper currency.

It is well known that United States paper currency in general circulation is contaminated with trace amounts of illicit substances such as cocaine, heroin and marijuana. As is the case with cocaine, differentiating "background levels" of the various cannabinoid constituents of Cannabis sativa L., namely, Delta(9)-tetrahydrocannabinol (THC), cannabinol (CBN), and cannabidiol (CBD) contaminating currency found in the general circulation from currency associated with illegal drug activity is imperative if a legal nexus is to be established with the latter. We analyzed 165 randomly collected paper currency notes from 12 U.S. cities (N = 125) and 4 foreign countries (N = 40) for THC, CBD, CBN, 11-nor-9-carboxy-Delta(9)-tetrahydrocannabinol, and 11-hydroxy-Delta(9)-tetrahydrocannabinol. Uncirculated US 1 dollar notes were added as negative controls. Drug residues were washed from individual bills, extracted using a liquid-liquid extraction protocol, derivatized, and quantitated by gas chromatography-mass spectrometry by selected ion monitoring. For the US 1 dollar currency, THC was present in 1.6% (2 notes), CBN 10.31% (13 notes), CBD 1.6% (2 notes). The following concentrations were determined: 0.085 microg/bill and 0.146 microg/bill for THC; 0.014-0.774 microg/bill (mean 0.166 microg/bill) for CBN; and 0.032 microg/bill and 0.086 microg/bill for CBD. For the foreign currency (Colombia, Qatar, India, and New Zealand), THC and CBN were present in 22.5% (9 notes). The following concentration ranges were determined: THC 0.026-0.065 microg/bill (mean 0.049 microg/bill), CBN 0.061-0.197 microg/bill (mean 0.115 microg/bill). All of the positive THC and CBN were found in the New Zealand polypropylene notes. This study demonstrated that marijuana (cannabinoids) may contaminate both paper and plastic currency.

Cannabinoids↗

Chromosomal polymorphism in sand gazelles (Gazella subgutturosa marica).

A total of 84 Gazella subgutturosa from three captive populations (two in Saudi Arabia, one in Qatar) were karyotyped. The number of chromosomes is 33, 32, or 31 for the males and 32, 31, or 30 for the females because of the X-autosome translocation that is common in the genus and a centric fusion between the two pairs of acrocentric chromosomes. The G- and R-banded karyotypes of gazelles translocated show that this fusion is the same as that previously reported for gazelles from Jordan. The precise origin of these populations is not known, but in every case the first animals are said to come from the wild in Saudi Arabia. This chromosomal translocation appears to be a populational polymorphism and not the result of hybridization between two different subspecies of G. subgutturosa.

Animals↗

Microbiological identification in cystic fibrosis patients with CFTR I1234V mutation.

Recurrent and chronic bacterial pulmonary infection is the major cause of morbidity and mortality in cystic fibrosis (CF). Over 6 months, 72 sputa or oropharyngeal samples were examined from 36 Arab Bedouin CF patients attending Hamad General Hospital, Doha, Qatar. More than 100 pathogens were isolated, mostly Haemophilus influenzae, Staphylococcus aureus and Pseudomonas aeruginosa. Unusual pathogens included Stenotrophomonas maltophilia, Acaligenes xylosoxidans and Mycobacterium abscessus. It is concluded that microbiological biodiversity in the lower airways of CF patients continues to be underestimated and that CF patients harbouring mucoid strains of P. aeruginosa are at a higher risk of acquiring more unusual organisms and probably have a worse prognosis.

Adolescent↗

Traditional intravaginal practices and the heterosexual transmission of disease: a review.

OBJECTIVE: To review reports on the use and effects of traditional intravaginal substances and practices. METHOD: The medical and social science literature of the past 50 years regarding use and effects of traditional intravaginal substances and practices is reviewed. RESULTS: Traditional intravaginal practices have been described in 11 countries of sub-Saharan Africa, and also in Qatar, Indonesia, Thailand, Haiti, the Dominican Republic, and the United States. Women's reasons for the practices include personal hygiene, disease prevention or treatment, and enhancement of sexual experience. Few studies document damage to the vaginal epithelium or changes in vaginal flora due to these practices. No prospective studies link these practices to disease transmission. CONCLUSION: The determination of how these practices affect disease transmission will require precise definition of independent variables, which is difficult because of the diversity of the practices. It is appropriate to search for intervening variables; specifically, the effects on the vaginal pH, flora, and epithelium.

Administration, Intravaginal↗

Hemoglobin D-beta (0) thalassemia. A case report and family study.

Findings are presented on a Pakistani family in Doha, Qatar with hemoglobin D-Los Angeles (alpha 2 beta 3 121 (glutamine----glycine) and thalassemia trait. The propositus, a child, has hemoglobin D-beta(0) thalassemia, and suffers from moderately severe hemolytic anemia. The father has beta-thalassemia trait, and the mother is heterozygous for hemoglobin D-Los Angeles. This, the eighth confirmed case in the medical literature, is reported to emphasize its clinical manifestations and genetic basis.

Hemoglobins, Abnormal↗

Severe autosomal recessive muscular dystrophy in an extended Sudanese kindred.

The clinical manifestations, biochemical, electrocardiographic, histological and histochemical features of a severe autosomal recessive muscular dystrophy (MD)--as seen in 15 members of a large Sudanese kindred, both male and female--are reported and discussed. The age of onset ranged from three to five years, the pattern of muscular weakness was similar to that of Duchenne MD and pseudohypertrophy was a remarkable feature. Both sexes became completely dependent by 16 years, and died at or before 20 years of age. The clinical picture in this family and the histological features are compared with those of Duchenne MD and with cases reported from Tunisia, Qatar and Libya. Certain clinical and histological features distinguish all of these types from each other and from the milder autosomal recessive MD of childhood which is more usual in the United Kingdom, Europe, Australia and North America.

Adolescent↗

Clinical and molecular pathological features of severe childhood autosomal recessive muscular dystrophy in Saudi Arabia.

The clinical, biochemical and histochemical features of 14 patients (nine females and five males) with severe childhood autosomal recessive muscular dystrophy (SCARMD) seen at a tertiary hospital in Riyadh from 1982 to 1993 are described. Onset was at 3 to 9 (median 3) years and four of five children aged > 12 years lost ambulation. Five of the eight pairs of parents were closely consanguineous. The mean creatine kinase was 20 times the upper normal limit. Histochemistry of muscle showed dystrophic features in all cases, and dystrophin was positive in all cases examined (N = 6). Three patients (two girls and a boy) were deficient in adhalin, the 50-kDa dystorphin-associated glycoprotein. A boy aged 13 years had rapidly progressing disease. Another boy of the same age (from a family characterized by early onset and slower progression) had normal dystrophin and adhalin. The clinical features conformed with previous observations from Sudan, North Africa and Qatar in the Arabian Peninsula. The disease is common in Saudi Arabia and seems to be more prevalent than Duchenne muscular dystrophy.

Adolescent↗

Rehabilitation of schizophrenics by the extended family.

Patterns of care by extended and nuclear families for their patients were studied in relation to 540 Arab schizophrenic outpatients in Qatar. The extended family differs from the nuclear family not only in its larger size but also in the greater emotional commitment of its members to each other's well being. The extended family is more tolerant of patients' minor behavioural abnormalities and temporary protective withdrawals. It is more helpful in the supervision of patients' medication and their social adjustment and leisure-time occupation. Being more traditionally oriented, the extended family helps patients to understand their illness experiences in terms of cultural belief systems once they lose the components that cannot be contained in these systems. Extended family members are less likely than nuclear family members to tax the patients' emotional resources and limited repertoire of social skills.

Adult↗

Occurrence of valvar heart disease in acute rheumatic fever without evident carditis: colour-flow Doppler identification.

OBJECTIVE: To determine the frequency of occurrence of mitral and aortic valvar regurgitation in rheumatic children in whom there was no evidence of carditis acutely or at an earlier attack. DESIGN: Colour flow Doppler imaging was used in a non-randomised study of sequentially admitted children who met the criteria for acute rheumatic fever without clinically evident carditis and patients in whom the disease was quiescent after a previous attack of rheumatic fever. Two separate control groups were used for comparison of the echocardiographic findings, and a group of patients with confirmed rheumatic carditis was included for comparison of acute phase and antistreptococcal reactants. SETTING: A general hospital with the only paediatric inpatient department in Qatar. PATIENTS: From November 1988 to October 1990, 11 children were studied during the acute rheumatic period. In seven additional children the disease was quiescent when they were studied 18 to 36 months after a documented episode of acute rheumatic fever in which there was no evidence of carditis. The control patients were all studied during the same period. MAIN OUTCOME MEASURE: Detection of mitral and aortic regurgitation in patients without clinical evidence of rheumatic carditis in the acute or quiescent stages of the disease. RESULTS: Mitral or mitral and aortic regurgitation was found in 10 of the 11 children studied in the acute rheumatic period. None had a murmur or other evidence of carditis. In all the cases studied the valvar insufficiency was mild. Four of the children studied late in the quiescent period had either aortic or mitral insufficiency by colour flow Doppler evaluation; two children who had previously had valvar insufficiency no longer showed this, and one child without positive findings in the acute phase remained without insufficiency. None of the non-rheumatic control subjects showed mitral or aortic regurgitation. CONCLUSIONS: Colour flow Doppler imaging is a useful method of identifying subclinical mitral and aortic valvar disease at all stages of rheumatic fever when carditis cannot be otherwise detected and is a valuable addition to current diagnostic criteria.

Acute Disease↗

Psychosocial profile of the parasuicidal patient in Kuwait.

A consecutive sample of 92 parasuicides aged 14-44 years (mean age +/- standard deviation, 22.9 +/- 5.6) was seen during the period December 1984-November 1985 at Kuwait's main teaching general hospital (catchment area 449000 population). Self-poisoning accounted for 85.9%. Their sociodemographic characteristics were consistent with contemporary trends of parasuicidal behaviour reported in other countries. The structure of the Kuwaiti population is quite special. The majority (58.3%) are expatriates mostly males at the working age group while the minority (41.7%) are Kuwaiti nationals. Family discord was the dominant antecedent life event in Kuwaitis. On the other hand, non-Kuwaiti Arabs and non-Arab expatriates reported an excess of work-related problems as precipitating factors. Non-Arab females resorted to more violent methods than other females. Acute situational distress was the most common diagnosis while depression was present in about 25% of the total sample. The attitudes of family members of the parasuicidal patients were discussed in the light of the socio-cultural perspective. Attention to possible preventive measures is suggested. Parasuicide (Kreitman et al 1970) is a topic which has stimulated considerable research in recent years. A wealth of information has become available on the subject and its patterns in different cultures and various countries (WHO 1974). In the "Arab World" a few studies have dealt with parasuicide. El-Islam (1974) studied the characteristics of hospital referred parasuicide in Qatar and indicated that intergenerational conflict was the commonest precipitating life event.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Policies and practices related to information system adoption in hospitals owned by Ministries of Health in the Arab Gulf.

This is a discussion paper based on the findings from a study of the factors affecting the adoption of computer-based hospital information systems (CBHIS) in the Arabian Gulf. The study involved on-site visits to hospitals in Bahrain, Kingdom of Saudi Arabia, Kuwait, Qatar and the United Arab Emirates as well as visits to ministries of health in these countries. The focus of this paper is on the adoption of CBHIS by ministry of health (MOH) hospitals, in specific, because of the main role that ministries of health play as providers of health care in the Region. Prior to describing CBHIS adoption practices, an overview of the Region in terms of its economic development and its health care delivery systems is presented. Next, the research setting along with the major findings are briefly described followed by a discussion of the advantages and disadvantages of centralized CBHIS adoptions. Finally, management guidelines related to the adoption of CBHIS by multi-hospital institutions are proposed.

Decision Making, Organizational↗

Fever and acquired torticollis in hospitalized children.

Acute torticollis due to non-traumatic atlanto-axial subluxation (AAS) is often seen in children presenting with inflammatory conditions of the upper respiratory tract and the neck. Grisel's syndrome is the eponym given to this condition. These patients may present earlier in the disease process without evident subluxation. Thus, early recognition of the condition with prompt commencement of appropriate conservative treatment could halt the progression into Grisel's syndrome. The purpose of this study is to address the importance of early recognition of inflammatory torticollis that can be treated successfully by conservative methods. A retrospective review was made of the case files and radiological investigations of 13 children with fever and torticollis who were treated in the neurosurgery unit of Hamad General Hospital in Qatar, over a two-year period from July 1996 to July 1998. The children were aged between three and 12 years with a male to female ratio of 3:1. All patients arrived at the hospital within 48 hours of onset of torticollis and almost all had manifestations of upper respiratory tract or head and neck infections. Radiological examination by cervical spine X-rays, computerized tomography (CT) or magnetic resonance images (MRI) revealed that only three cases out of 13 had AAS. All patients underwent conservative treatment that included rest, neck collar, simple analgesics and antibiotics, where appropriate. A muscle relaxant was used in nine cases and Halter traction was applied to the three with AAS. All patients responded well to treatment and none required surgical intervention for AAS. We conclude that the majority of children presenting acutely with inflammatory torticollis have rotational deformity only without AAS. Progression to the latter, i.e. Grisel's syndrome, may be aborted should the diagnosis be made early and conservative treatment initiated in time. On the other hand, delay in diagnosis would deprive these children an opportunity of receiving effective conservative treatment.

Acute Disease↗

Improving oral medicine administration in patients with swallowing problems and feeding tubes.

BACKGROUND: Correct administration of oral medicines in patients with swallowing problems and feeding tubes remains a challenge. OBJECTIVE: To improve drug administration in patients with swallowing problems and feeding tubes in a 1600 bed tertiary referral center in the State of Qatar. METHODS: A questionnaire was used to evaluate the knowledge and practice of nursing staff from 6 different intensive care units (ICU). Questions assessed the respondents' knowledge of the purpose of controlled-release (CR) preparations, codes used for CR medication, the consequences of crushing these preparations, and their interactions with enteral feeds and feeding tubes. Based on the results of the questionnaire, a 2 day training program was conducted for a core group of 34 staff nurses from all units (ICU and non-ICU) and 3 nursing instructors. Following the principle of "training the trainers," the core group and the nursing instructors would widen the scope of education by running programs in the future. Lecture sessions for pharmacy staff and a monitoring tool to evaluate the practice were also developed. RESULTS: Overall knowledge of CR codes increased from 0% to 40%, correct crushing of solid preparations from 35% to 90%, and knowledge of possible interactions with the enteral feed or feeding tubes from 51% to 88%. Correct administration of medication in patients with feeding tubes improved from 32% to 83%. The quality and value of the 2 day training course received a mean score of 96%. CONCLUSIONS: While most nurses were aware of the purpose of CR formulations, little was known about the different codes used by drug companies and the consequences of crushing these preparations. Interactions with enteral feeds and feeding tubes were mostly overlooked. A 2 day training course followed by continuous in-service training, a lecture to pharmacy staff, and provision of supportive educational material greatly improved the overall medicine administration process in patients with swallowing problems and feeding tubes.

Administration, Oral↗

Serological survey for bovine bacterial and viral pathogens in captive Arabian oryx (Oryx leucoryx Pallas, 1776).

Tests for antibodies to bovine bacterial and viral pathogens were conducted on 239 sera from 128 Arabian oryx (Oryx leucoryx) from seven locations (Taif, Riyadh and Mahazat as Said, Saudi Arabia; San Diego, United States of America [USA]; Shaumari, Jordan; Qatar; and Bahrain). No antibodies to Pasteurella multocida type E or epizootic haemorrhagic disease 1 virus were found. Antibodies to Brucella abortus, P. multocida type B, P. multocida type D, lumpy skin disease virus and Akabane virus were detected in 2, 1, 5, 2 and 1 animals, respectively. Evidence of P. multocida type A, Coxiella burnetti, Chlamydia psittaci and parainfluenza 3 virus was found in 3 herds (prevalence in the main herd [n = 78]: 8%), 3 herds (8%), 6 herds (7%) and 5 herds (15%), respectively. Evidence of antibodies against bluetongue virus was found in five oryx from the USA and in one oryx from the Taif herd. Antibody vaccinal titres against rinderpest virus (and the virus of peste des petits ruminants, due to cross-reactions) were found in almost all the herds. This is the first report of antibodies against B. abortus, C. burnetti, C. psittaci, parainfluenza 3 virus and Akabane virus in the genus Oryx.

Animals↗

Transdermal 17β-Estradiol for the Treatment of COVID-19: Protocol of an Early Terminated Phase 2 Randomized Controlled Trial.

BACKGROUND: Early epidemiological studies suggested that pre- and postmenopausal women receiving estrogen therapy were less likely to develop severe disease or die from COVID-19 infection. Potential mechanisms include estrogen-mediated immunomodulation and 17β-estradiol-induced downregulation of angiotensin-converting enzyme type 2 (ACE2), the cellular receptor for SARS-CoV-2. OBJECTIVE: This study aimed to evaluate the feasibility, safety, and preliminary efficacy of transdermal 17β-estradiol as an adjunctive treatment for COVID-19 in men and postmenopausal women. METHODS: We designed and conducted a randomized controlled trial comparing 17β-estradiol transdermal gel plus standard care with standard care alone in adults with confirmed COVID-19. Initial ethics and funding approvals were obtained in March 2021. Owing to changes in the epidemiology of COVID-19 in Qatar and revisions to national quarantine policies, protocol amendments were required before recruitment commenced in February 2022. The treatment duration was reduced from 10 to 7 days due to changes in national quarantine guidelines. Recruitment and follow-up were conducted between February 2022 and June 2022. RESULTS: Recruitment was substantially lower than anticipated because widespread COVID-19 vaccination, declining disease severity, and revised national quarantine policies markedly reduced the number of eligible hospitalized patients. Consequently, the planned sample size was not achieved, and the study was terminated in June 2022. A total of 29 men with mild COVID-19 were enrolled, with 44.8% (n=13) randomized to standard care and 55.2% (n=16) to transdermal 17β-estradiol plus standard care. The intervention was well tolerated, with no adverse safety signals or thromboembolic events reported. CONCLUSIONS: Although the study was underpowered to assess efficacy because recruitment targets were not achieved, it showed that transdermal 17β-estradiol was well tolerated, with no major safety concerns among enrolled participants. The experience also provided important operational lessons for conducting clinical trials during rapidly evolving pandemics. Adequately powered studies are required to determine whether transdermal estrogen has therapeutic potential against COVID-19, other ACE2-mediated coronavirus infections, or potentially other severe viral illnesses.

Humans↗

Erythrocyte sedimentation rate in childhood tuberculosis: is it still worthwhile?

OBJECTIVE: To evaluate the utility of the erythrocyte sedimentation rate (ESR) in the diagnosis of childhood tuberculosis. DESIGN: Data were collected retrospectively from the Qatar National Tuberculosis (TB) Registry for children (birth to 14 years of age) from 1983 to 1996. The diagnosis of active tuberculosis was based on positive sputum cultures (or histology) or an abnormal chest radiograph that responded to anti-tuberculosis chemotherapy. RESULTS: Of 144 childhood TB patients, 68 (47%) had an ESR documented at the time of diagnosis. Twenty-two children (33%) had a normal ESR (<10 mm/hour) and 46 children (67%) had an elevated ESR (> or =10 mm/hour) at the time of diagnosis. Culture positive and symptomatic children had significantly higher ESR values than culture negative and asymptomatic children, respectively, at the time of diagnosis. There was no significant difference in ESR values for children with extrapulmonary versus pulmonary disease, and likewise no significant correlation between either age or size of tuberculin skin test reactivity and ESR values. CONCLUSION: Although an elevated ESR may be expected in children with tuberculosis, this study found that one-third of children with TB had a normal ESR at the time of diagnosis, and consequently there would seem to be little value in using ESR as a diagnostic test for childhood tuberculosis.

Adolescent↗