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HLA class II profile and distribution of HLA-DRB1 and HLA-DQB1 alleles and haplotypes among Lebanese and Bahraini Arabs.

The gene frequencies of HLA class II alleles were studied in 95 healthy Lebanese Arab and 72 healthy Bahraini Arab subjects. Our aim was to establish the genetic relationship between Bahraini and Lebanese Arabs in terms of HLA class II gene and haplotype frequencies and to compare these results with frequencies for other countries with populations of Caucasian and non-Caucasian descent. Subjects were unrelated and of both sexes, and HLA-DRB1 and -DQB1 genotyping was done by the PCR sequence-specific primer technique. Comparative analysis of the HLA-DR and -DQ alleles revealed differences in the allelic distribution among Bahraini and Lebanese subjects. Analysis of the 25 HLA-DRB1 alleles that have been investigated showed that the DRB1*040101 and DRB1*110101 alleles were more frequent among Lebanese, whereas DRB1*030101 and DRB1*160101 alleles were more frequent among Bahrainis. Similarly, of the seven HLA-DQB1 alleles analyzed, the presence of DQB1*0201 was more frequent among Bahrainis, whereas DQB1*030101 was more frequent among Lebanese. The DRB1*160101-DQB1*050101 (0.1318 versus 0.0379%) and DRB1*030101-DQB1*0201 (0.1202 versus 0.0321%) haplotypes were more frequent among Bahrainis, while the DRB1*110101-DQB1*030101 (0.3142 versus 0.1198%) and DRB1*040101-DQB1*0302 (0.1416 versus 0.0278%) haplotypes were more frequent in Lebanese subjects. Furthermore, a high prevalence of the DRB1*040101-DRB1*110101-DQB1*0302-DQB1*030101 (12.63 versus 1.35%, P = 0.015) and the homozygous DRB1*110101-DRB1*110101-DQB1*030101-DQB1*030101 (7.37 versus 0.00%, P = 0.046) genotypes was seen among Lebanese, and DRB1*070101-DRB1*160101-DQB1*0201-DQB1*050101 (6.76 versus 0.00%, P = 0.034) was seen more frequently among Bahraini subjects. Our results underline significant differences between these two populations in HLA class II distribution, provide basic information for further studies of major histocompatibility complex heterogeneity among Arabic-speaking countries, and serve as a reference for further anthropological studies.

Adolescent↗

Susceptible and protective human leukocyte antigen class II alleles and haplotypes in bahraini type 2 (non-insulin-dependent) diabetes mellitus patients.

Whereas the genetic risk for type 1 diabetes is linked to human leukocyte antigen (HLA) class II genes, the HLA association in type 2 (non-insulin-dependent) diabetes is less clear. The association between HLA class II genotypes and type 2 diabetes was examined in adult Bahrainis, an Arab population with a high prevalence of type 2 diabetes. HLA-DRB1* and -DQB1* genotyping of 86 unrelated type 2 diabetes patients (age, 51.6+/-8.2 years; mean duration of diabetes, 7.7+/-7.1 years) who had a strong family history of diabetes (52 of 72 versus 0 of 89 for controls, P<0.001) and 89 healthy subjects was done by PCR-sequence-specific priming. DRB1*040101 (0.1221 versus 0.0562, P=0.019) and DRB1*070101 (0.2151 versus 0.0843, P<0.001) were positively associated, while DRB1*110101 (0.0698 versus 0.1461, P=0.014) and DRB1*160101 (0.0640 versus 0.1236, P=0.038) were negatively associated with type 2 diabetes. DRB1*040101-DQB1*0302 (0.069 versus 0.0007; P=0.004), DRB1*070101-DQB1*0201 (0.178 versus 0.0761, P=0.007), DRB1*070101-DQB1*050101 (0.125 versus 0.0310, P=0.002), and DRB1*150101-DQB1*060101 (0.0756 versus 0.0281, P=0.008) were more prevalent among patients, while DRB1*160101-DQB1*050101 (0.0702 versus 0.0349, P=0.05) was more prevalent among controls, conferring disease susceptibility or protection, respectively. In Bahrainis with type 2 diabetes, there is a significant association with select HLA class II genotypes, which were distinct from those in type 1 diabetes.

Bahrain↗

Challenges of teaching physiology in a PBL school.

A problem-based learning (PBL) curriculum was introduced at McMaster University more than three decades ago. Not many schools have adopted the system despite its distinct advantages. The present paper examines the challenges of teaching physiology in a PBL curriculum and gleans through the literature supporting PBL. It appears that one of the reasons why PBL is not becoming readily acceptable is the lack of concrete reports evaluating the curricular outcomes. The suggestion (R.E. Thomas. Med Educ. 31:320-329, 1997) to standardize and internationalize all components of validated PBL curricula is quite valid. A database needs to be generated that can be easily accessed by traditional institutions to see the rationality and easy implementation of the PBL curriculum.

Bahrain↗

Gene deletions in Arab patients with spinal muscular atrophy.

Spinal muscular atrophy is an autosomal recessive disorder characterized by degeneration of lower motor neurons. We have investigated the presence of survival motor neuron gene and neuronal apoptosis inhibitory protein gene deletions in 17 Arab and 1 Indian families with spinal muscular atrophy (15 type I and 3 type II). Homologous deletions were detected in exons 7 and 8 of the survival motor neuron gene and exon 5 of the neuronal apoptosis inhibitory protein gene in all patients with type I spinal muscular atrophy. Exon 13 of the neuronal apoptosis inhibitory protein gene was deleted in only one patient with type I spinal muscular atrophy. In two patients with type II spinal muscular atrophy, only exons 7 and 8 of the survival motor neuron gene were deleted whereas exons 5 and 13 of the neuronal apoptosis inhibitory protein gene were present. In another patient with spinal muscular atrophy type II, exons 7 and 8 of the survival motor neuron gene and exon 5 of the neuronal apoptosis inhibitory protein gene were deleted. This latter patient also had the Pierre Robin syndrome. No deletion was detected in healthy siblings or the parents. The deletions found in our patients are similar to those reported in other population groups.

Apoptosis↗

Obesity in Bahraini adults.

In this study the prevalence of obesity and the demographic factors associated with it were analysed on 290 adult Bahraini individuals, of whom 137 were males and 153 were females. The overweight and obesity prevalence rates, using the Body Mass Index (BMI) as a criterion, were 26% and 16% in males and 29% and 31% in females, respectively. The prevalence of underweight (BMI < 20) was 16.8% and 11.8% in the males and females respectively. The mean body fat percentage of females, calculated from the skinfold measurements, was 35%; the fat percentage of males was 18.6%. Bahraini women had greater fat deposition in the subscapular region than the amount reported for American women. Females and males living in urban areas had a greater tendency to be obese than those residing in rural areas. Marriage, ownership of a car as well as a large family ( > 7 members) were positively associated with obesity; unmarried women were more likely to be underweight than married women. The educational level was not associated with obesity in either the males or females. The age of adult females was not found to be associated with obesity, whereas in males the incidence of obesity was more frequent among those who were 50 years of age and above than under 50 years of age. Family monthly income was not associated with the incidence of obesity. The high prevalence of overweight and obesity in the women reported in this study and the difference in the distribution of body fat suggest that genetics may be a determinant factor of this disorder in Bahrainis but certainly social factors are also important.

Adult↗

Intravenous iron optimizes the response to recombinant human erythropoietin in cancer patients with chemotherapy-related anemia: a multicenter, open-label, randomized trial.

PURPOSE: Recombinant human erythropoietin (rHuEPO) is the standard of care for patients with chemotherapy-related anemia. Intravenous (IV) iron improves hemoglobin (Hb) response and decreases dosage requirements in patients with anemia of kidney disease, but its effect has not been studied in randomized trials in cancer patients. METHODS: This prospective, multicenter, open-label, randomized trial enrolled 157 patients with chemotherapy-related anemia (Hb <or= 105 g/L, serum ferritin <or= 450 pmol/L or <or= 675 pmol/L with transferrin saturation <or= 19%) receiving subcutaneously rHuEPO 40000 U once weekly to: (1). no-iron; (2). oral iron 325 mg twice daily; (3) iron dextran repeated 100mg IV bolus; or (4) iron dextran total dose infusion (TDI). Hb and quality of life (QOL) were measured at baseline and throughout. RESULTS: All groups showed Hb (P <.0001) increases from baseline. Mean Hb increases for both IV iron groups were greater (P <.02) than for no-iron and oral iron groups. The percentage of patients with hematopoietic responses was higher (P <.01) in both IV iron groups (each case 68%) compared with no-iron (25%) and oral iron (36%) groups. IV iron groups showed increases in energy, activity, and overall QOL from baseline, compared with a decrease in energy and activity for no-iron group and no change in activity or overall QOL for oral iron group. CONCLUSION: rHuEPO increases Hb levels and improves QOL in patients with chemotherapy-related anemia. Magnitude of Hb increase and QOL improvement is significantly greater if IV iron is added.

Abnormalities, Drug-Induced↗

Structured problem-related anatomy demonstrations: making order of random teaching events.

BACKGROUND: A standardized learning activity called "Structured Problem-Related Anatomy Demonstrations" was recently implemented. This activity is intended to be a substitute to the need-based instruction method in which students schedule appointments in small groups or individually with faculty to discuss issues and difficulties related to anatomy the students have encountered during their tutorial discussions and self-study learning. DESCRIPTION: Students in a given year were divided into 2 groups. Each group was further divided into 4 small groups (n = 10) who rotated through 4 "stations." A faculty member who demonstrated a specific aspect of anatomy related to the weekly health problem staffed each of the stations. EVALUATION: The effect of the new method of instruction on students' performance in end-of-unit examinations was not statistically significant. A 5-point scale questionnaire seeking the perceptions of 3rd- and 4th-year medical students (n = 176), who had experience with both methods, was used. The means +/- standard deviation of students' responses to items related to organization was 3.61 +/- 0.55, to knowledge was 4.29 +/- 0.73, to integration was 3.91 +/- 0.73, and to skills was 3.84 +/- 0.83. The vast majority of students expressed their overall support for continuing the new system (4.54 +/- 0.58). CONCLUSIONS: The new method increased students' satisfaction and confidence while maintaining their level of performance in final assessments. Faculty have more control over their schedules and can devote more quality time to teaching and research.

Anatomy↗

Relations of some sociocultural variables and attitudes and motivations of young Arab students learning English as a second language.

This paper examined a number of variables pertaining to the sociocultural outlooks of 412 young Arab students learning English as a foreign language and the relation of their attitudes and motivations prior to their learning of the language. Analysis indicated clearly that certain variables appeared to be correlated with their attitudes and motivations more than others. Most of the students had maids in their homes, and the presence of a maid was associated with most of the psycholinguistic variables tested. Their previous learning experience of the language was positively correlated as was their knowledge of English stories. Having some sort of English games had the highest correlations (.25 to .41). Potential pedagogical implications of these results were discussed.

Arabs↗

Assessing prescription writing skills of pre-clerkship medical students in a problem-based learning curriculum.

OBJECTIVE: To audit the acquisition of prescribing skills of pre-clerkship medical students in a problem-based learning (PBL) curriculum that incorporates a prescribing program. MATERIAL AND METHODS: Student performance in pharmacotherapy stations included in six out of eight end-of-unit-objective structured practical examinations (OSPE) was evaluated using a rating checklist. RESULTS: Prescription writing skills of 539 students (66.2% female and 33.8% male) were appraised. With the exception of refill element, the other physician-related components including prescriber's identity, date of prescription order, patient's identity, the symbol Rx "Take Thou", and prescriber's signature were written by 96.1% of the students (95% confidence interval (CI) 94.1 - 97.5). However, the drug-related components such as the appropriateness of drug(s) selected, strength, dosage form, quantity to be dispensed and directions for use were written satisfactorily by 50.2% of the students (95% CI 46.0 - 54.4). With respect to prescribing skills, the mean total score of Year 4 students did not significantly differ from that of Year 2 (69.4 (CI 65.7 - 73.1) vs. 66.3 (CI 62.7 to 69.9); p = 0.237). However, the mean scores of individual drug-related components such as appropriateness of drug(s) selected, dosage form, and direction for use were significantly higher in Year 4 than that of Year 2 students (p < 0.05). Of 381 rationally prescribed drugs, 81.1% were written with generic names. CONCLUSION: This study revealed that the students acquire prescribing skills to a limited extent during the pre-clerkship phase in a PBL program. Prescribing errors and deficits were found to be mainly associated with drug-related components. Further training and assessment of prescribing skills during the clerkship and internship period are needed to achieve mastery of this skill as a terminal competency of graduating physicians.

Bahrain↗