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PubMed2004

Hyperimmunoglobulinemia D syndrome in an Arab child.

Hyperimmunoglobulinemia D syndrome (HIDS) is newly recognized and resembles familial Mediterranean fever (FMF). It is inherited as an autosomal recessive trait. Mutation of the gene coding for mevalonate kinase is responsible for the disease. The gene is located at chromosome 12q24. The patients initially described were of Dutch ancestry. Other cases from Turkey and Armenia were reported. The case we present is the first from Arab countries to be registered in the International HIDS Registry and to our knowledge the first to be reported.

Child↗
PubMed2006

Apolipoprotein E gene polymorphism and allele frequencies in the Lebanese population.

Apolipoprotein E (ApoE) genotypes were studied in order to determine the prevalence in the Lebanese population and compare it with other populations. DNA from 160 unrelated healthy donors from our HLA-bank was used. ApoE genotype was determined using the CardioVascular Disease (CVD) StripAssay (this assay is based on a Polymerase Chain Reaction-Reverse Hybridization technique). The prevalence of genotypes E3/3, E3/4, and E2/3 was found to be 69%, 26%, and 22%, respectively, and 0.6% for each of E2/4 and E4/4 genotypes. The Lebanese population tested showed similarities to earlier reported ApoE genotypic distributions (high E3 allele frequency) but also peculiar differences especially to some Arabic countries (total absence of E2 allele among Saudis) and other populations. This is the first report from Lebanon that will serve as a template for future investigations of the prevalence of ApoE alleles in association with various clinical entities.

Apolipoproteins E↗
PubMed2006

ApoB-100 R3500Q mutation in the Lebanese population: prevalence and historical review of the literature.

An interesting mutation affecting the Apo-B gene, R3500Q, is known to display variable geographical distribution in the world and is mostly implicated in the pathogenesis of Familial Hypercholesterolemia (FH). The aim of this study is to determine the prevalence of this mutation in the Lebanese population and compare it to the available international literature. DNA from 160 unrelated healthy donors from our HLA-bank was used and the ApoB genotype was determined using the CardioVascular Disease (CVD) StripAssay (this assay is based on a Polymerase Chain Reaction-Reverse Hybridization technique). The R3500Q mutation was not observed in the general Lebanese population. Since the mutation frequency is elevated in Central Europe and tends to decrease as one moves east and south, it disappears completely in the Mediterranean regions such as Spain, Turkey and Israel; therefore, it is rather expected to be absent in Lebanon as well. Our report adds a valuable piece of information regarding this mutation in an Arab country and paves the way for future research involving patients diagnosed with FH in order to assess the role of the R3500Q mutation in the development of this clinical entity.

Apolipoprotein B-100↗
PubMed2004

Alcohol use among university students in Lebanon: prevalence, trends and covariates. The IDRAC University Substance Use Monitoring Study (1991 and 1999).

The practical inexistence of research on alcohol use among university students in Lebanon and other Arab countries spurred us at IDRAC to initiate a university-based substance use monitoring study, so far conducted in two phases (1991 and 1999), to assess the prevalence, patterns, trends, and factors associated with the use and abuse of alcohol (and other substances). In both phases, the sample was a stratified cluster, representing 25% (N = 1850) of the student population of two major universities in Lebanon. The rates of lifetime alcohol use and problem use have increased from 1991 to 1999, the increase being higher in younger cohorts and in females. Belief in God and practice of that belief, irrespective of the students' religion, were associated with less frequent experimentation with alcohol. Although more Christians ever drank alcohol, once users, university students (irrespective of their religion) had the same rates of alcohol problem use and dependence. Several other covariates concordant with the international literature were also delineated such as students' anti-social behavior, and family and peer environment.

Adolescent↗
PubMed2004

Family history of benign thyroid disease and cancer and risk of thyroid cancer.

In a population-based study of 313 case-control pairs in Kuwait, we evaluated whether a family history of benign thyroid disease (BTD) and thyroid or other cancers was associated with an increased risk of thyroid cancer, the second most common neoplasm among women in this and several other Arab countries in the Gulf region. Family history of BTD was reported by 78 (24.9%) cases and 40 (12.8%) controls in 132 and 57 relatives, respectively. There was an approximately 2-fold increased risk of thyroid cancer in individuals who had a mother (Odds Ratio (OR)=2.3; 95% Confidence Intervals (95% CI): 1.1-5.1), sister(s) (OR=2.6; 95% CI: 1.3-5.3) or aunt(s) (OR=2.1; 95% CI: 0.9-5.3) with BTD; there was also a significant trend in increasing risk with an increasing number of affected female relatives (P<0.0001). Stratification by age at diagnosis of the case showed that individuals aged </= 35 years, who had an affected first- or second/third-degree relative(s), had an approximately 3-fold increased risk of the cancer. Family history of thyroid cancer was reported by 9 (2.9%) cases in 13 relatives (11 females, 2 males) and by 3 controls in 3 relatives (all females) (OR=3.0; 95% CI: 0.8-11.1). The OR for all hormone-related cancers combined was 1.5 (95% CI: 0.8-2.6). There was no clear association with family history of breast or any other common cancer. Our data suggest that a family history of BTD is associated with an increased risk of thyroid cancer, and point to the role of familial susceptibility to BTD and thyroid cancer in the Kuwaiti population.

Adolescent↗
PubMed2006

Prevalence and risk factors of disk-related sciatica in an urban population in Tunisia.

BACKGROUND: Disk-related sciatica (DRS) creates a public health burden because of its high incidence and considerable socioeconomic costs. We are not aware of previous epidemiological studies of the prevalence and risk factors of DRS in Tunisia or other Arab countries, and few studies have addressed these issues elsewhere. OBJECTIVES: To determine the prevalence and incidence of DRS in Monastir, Tunisia; to look for risk factors; and to evaluate socioeconomic costs. METHODS: Data on a cross-section of 5000 individuals aged 15 years or older living in Monastir were collected by interviewers using a previously developed 51-item questionnaire. RESULTS: The study participation rate was 87.6%. The annual prevalence of DRS was 2.21% and the incidence was 1.44%. Among the patients with DRS, 94.8% received healthcare interventions, 64% had plain radiographs taken, and 45.4% underwent computed tomography of the lumbar spine. Sick leaves were given to 77.7% of patients, and mean sick leave duration was 9 weeks. A change in job was required in 5.5% of cases. Factors associated with DRS included male gender (P<0.001), obesity (P<0.0001), smoking (P<0.0001), a history of low back problems (P<0.0001), anxiety and depression (P<0.0001), a job requiring prolonged standing and bending forward (P<0.03), heavy manual labor (P<0.005), heavy lifting (P<0.0001), and exposure to vibrations (P<0.0001). CONCLUSION: The prevalence of DRS in Monastir is 2.2%. We identified a number of patient- and occupation-related risk factors. The high socioeconomic cost should encourage preventive measures.

Adolescent↗
PubMed2005

Bone density measured by dual energy X-ray absorptiometry in Qatari women.

BACKGROUND: Over the past 10 years, osteoporosis has emerged as a major public health problem. It is characterized by low bone mass with micro architectural deterioration of bone tissue resulting in increase bone fragility and susceptibility to fractures. Bone mineral density measurements are widely used to diagnose osteoporosis and to assess its severity. Commercial dual-energy X-rays absorptiometry (DXA) scanners used to determine bone mineral density (BMD) contains reference data for different populations. AIM: The aim of this study was to determine reference values for Qatari female population and to compare them with values from western and other Arab countries. METHODS: A cross-sectional study of 574 Qatari women aged between 20 and 69 years was carried out using DXA scan to establish reference values of bone mineral density. Measurements were taken at the lumbar spine and proximal femur. The data were compared with normative taken by Caucasians, Kuwaiti, Lebanese and Saudi women over five decades of age. RESULTS: Our results showed that the Qatari subjects showed the expected decline in BMD at spinal sites with age after peaking at 30-39 years age group, and for femoral site at 40-49 years. The BMD values of the spine of Qatari women were lower than Caucasian and Kuwaiti women but higher than the Lebanese and similar to Saudi women. The BMD values of the total femur were higher in Qatari females than Caucasians, Kuwaitis, Lebanese and Saudis in the age group of 40-59, but lower in the age group 60-69 years. Of the 147 studied Qatari women in the age group (50-69) years, the T-score was normal (>-1 S.D.) in 79 subjects (53.7%), in the osteopenic range (-1 to -2.5 S.D.) in 51 subjects (34.7%) and in the osteoporotic range (<-2.5 S.D.) in 17 subjects (11.6%). CONCLUSION: BMD value of Qatari females are lower than Caucasians and Kuwaitis at the spine, and at the total femur in the age group 60-69 years, but higher values of total femur in the age group 40-59 years. Osteoporosis is common among menopausal Qatari women and should be considered a matter of public concern.

Absorptiometry, Photon↗
PubMed2004

Traffic safety assessment and development of predictive models for accidents on rural roads in Egypt.

This paper starts by presenting a conceptualization of indicators, criteria and accidents' causes that can be used to describe traffic safety. The paper provides an assessment of traffic safety conditions for rural roads in Egypt. This is done through a three-step procedure. First, deaths per million vehicle kilometers are obtained and compared for Egypt, three other Arab countries and six of the G-7 countries. Egypt stands as having a significantly high rate of deaths per 100 million vehicle kilometers. This is followed by compiling available traffic and accident data for five main rural roads in Egypt over a 10-year period (1990-1999). These are used to compute and compare 13 traffic safety indicators for these roads. The third step for assessing traffic safety for rural roads in Egypt is concerned with presenting a detailed analysis of accident causes. The paper moves on to develop a number of statistical models that can be used in the prediction of the expected number of accidents, injuries, fatalities and casualties on the rural roads in Egypt. Time series data of traffic and accidents, over a 10 years period for the considered roads, is utilized in the calibration of these predictive models. Several functional forms are explored and tested in the calibration process. Before proceeding to the development of these models three ANOVA statistical tests are conducted to establish whether there are any significant differences in the data used for models' calibration as a result of differences among the considered five roads.

Accident Prevention↗
PubMed2002

Socio-demographic correlates of psychiatric morbidity among low-income women in Aleppo, Syria.

Interest in mental morbidity as an important component of health is increasing worldwide. Women generally suffer more than men from common mental disorders, and discrimination against women adds to their mental sufferings. Studies looking into the socio-demographic correlates of women's mental morbidity are lacking in most Arab countries. In this study we wanted to determine the spread and socio-demographic correlates of mental distress among low-income women in Aleppo, Syria. A sample of 412 women was recruited from 8 randomly selected primary care centers in Aleppo. Response rate was 97.2%, mean age of participants 28 + 8.4 years, where married women constituted 87.9%. A special questionnaire was prepared for the study purpose, utilizing the SRQ-20 non-psychotic items and questions about background information considered relevant to the mental health of women in the studied population. Interviews were conducted in an anonymous one-to-one fashion. The prevalence of psychiatric distress in our sample was 55.6%. Predictors of women's mental health in the logistic regression analysis were; physical abuse, women's education, polygamy, residence, age and age of marriage. Among these predictors, women's illiteracy, polygamy and physical abuse were the strongest determinants of mental distress leading to the worse outcomes. Our data show that mental distress is common in the studied population and that it is strongly associated with few, possibly modifiable, factors.

Adolescent↗
PubMed1985

What's new in hepatitis delta virus?

Seven years of clinical and laboratory research have provided us with a rather good knowledge of the infectious agent that causes hepatitis delta. This agent is a small RNA containing virus (hepatitis delta virus), which is functionally incomplete and needs the help of hepatitis B virus for infection and replication. It is unique also in respect to its RNA, which is smaller than the RNA of every other known RNA virus, but larger than the RNA of the viroids of higher plants. Animal experiments as well as clinical studies showed that hepatitis delta virus infection can be transmitted either simultaneously with hepatitis B, leading to a clinical picture which usually resembles that of hepatitis B alone, or as superinfection of a chronic HBsAg-carrier. The latter often leads to severe, and sometimes fatal, acute hepatitis, followed by chronic liver disease in as many as 30-40% of cases. The hepatitis delta virus is distributed world-wide, showing a high endemicity in Italy and some Arab countries, but also in certain risk groups such as intravenous drug addicts and haemophilics. Further epidemiological studies will probably reveal other foci where the hepatitis delta virus is endemic; especially in Africa, areas of high endemicity of hepatitis delta virus are suspected. Extensive research on delta agent is continuing: further clinical studies, using the highly sensitive method of DNA-RNA-hybridization for the detection of hepatitis delta virus RNA, will tell us more about the role of this virus in acute and chronic hepatitis, and future biochemical and biological research may be expected to increase our insight into the still enigmatic cooperation of the hepatitis delta virus and hepatitis B viruses.

Animals↗
PubMed1999

Salvadora persica L.: hypolipidemic activity on experimental hypercholesterolemia in rat.

Stems of Salvadora persica are widely used as tooth cleaning sticks in Arabic countries and decoctions show hypocholesterolemic properties. The effects of prolonged administration of a lyophilized stem decoction of Salvadora persica were evaluated in diet-induced rat hypercholesterolemia. The preparation was administered for 15 and 30 days (by gavage at a dose of 500 mg/kg in an aqueous vehicle in a volume of 0.5 ml/100 g b.w.). Cholesterol, HDL, LDL and triglyceride plasma levels were assayed. The results showed that the S. persica decoction significantly lowered cholesterol and LDL plasma levels in rats, proving to be more active at 30 days of treatment. The systemic administration of Triton results in a rise in plasma cholesterol and triglyceride levels. The results obtained show that S. persica decoction was inactive at 18 hr after treatment, whereas at 27 hr, it was able to reduce cholesterol and LDL plasma levels. In all experiments HDL and triglycerides were unchanged.

Africa↗
PubMed2006

Current prevalence of hepatitis delta virus (HDV) infection and the range of HDV genotypes in Lebanon.

Recently the prevalence of hepatitis B virus (HBV) genotypes and the association between these genotypes and the clinical status of HBV-infected patients were recently investigated in the Lebanese population. The aim of the additional study reported here was to determine the current prevalence of hepatitis delta virus (HDV) infection and the range of HDV genotypes in this Lebanese population. Two hundred and fifty-eight HBsAg-positive patients (107 asymptomatic blood donors, 92 with chronic hepatitis, 24 with cirrhosis, 15 with hepatocellular carcinoma, 20 patients on haemodialysis) from ten medical centers in Lebanon were tested for antibody to hepatitis D virus (anti-HDV). Those testing positive were analysed further for HDV-RNA and for genotyping by reverse transcriptase-polymerase chain reaction (RT-PCR) and restriction fragment length polymorphism (RFLP). Three samples (1.2%) were anti-HDV positive and out of these, only one was HDV-RNA positive (0.6%) and was analysed as HDV genotype I. Our results point to a low endemicity of HDV in the Lebanese population which is in sharp contrast to data reported from Lebanon 20 years ago and to the situation in neighbouring Arab and non-Arab countries in the Mediterranean region. HDV genotype I seems to be the predominant genotype in Lebanon and the Middle East.

Adult↗
PubMed2001

Cumulative impact of early maternal marital age during the childbearing period.

Early marriage of girls, close to age of menarche, is a widespread practice in Arab countries. Knowledge on the cumulative effect of early maternal marriage on maternal and infant health during the childbearing period is insufficient. The objectives of this study were to estimate the prevalence of early maternal marriage in Jeddah, identify its relation with other maternal risk factors, and investigate the cumulative impact of early maternal marriage on subsequent maternal health and pregnancy outcomes throughout the reproductive period. Data were collected from six randomly selected primary health care units in Jeddah City. Married women with an infant < or = 12 completed months of age were interviewed and information on sociodemographic characteristics, maternal health and previous pregnancy outcomes were collected. Early marriage of girls before the age of 16 years accounted for 26.5% of the study population and was reported by a third of mothers currently below the age of 20 years. Illiterate mothers, housewives, multiparae, smokers and those married to a relative reported the highest proportion of marriages before their sixteenth birthday. Those who married before the age of 16 were at about double the risk of developing chronic diseases and experiencing miscarriage, stillbirths and infant deaths. These results suggest that early maternal marriage still exists in our community and is intimately related to other maternal risk factors. Maternal marriage < 16 years appears to be fraught with insecurities for the mother and infant throughout the whole length of the childbearing period and not merely the first pregnancy. Thus, even if culture norms claim early marriage of girls, it should be discouraged before the age of 16 years. Moreover, it is recommended that future research on maternal and infant health considers the cumulative effect of the various risk factors during the whole reproductive period and not only a single pregnancy outcome.

Adolescent↗
PubMed2002

Further evidence for the rising incidence of childhood Type 1 diabetes in Kuwait.

AIMS: To provide age-gender standardized incidence rate, temporal trend and seasonal variation of Type 1 diabetes in Kuwaiti children aged < or = 14 years. METHODS: Data were prospectively collected over a period of 6 years (1992-1997) according to the DiaMond Project protocol using the capture-recapture method of ascertainment. RESULTS: Data ascertainment varied between 90% and 96%. The incidence rate of Type 1 diabetes was 20.1 per 100,000 children 0-14 years (95% confidence interval (CI) 18.0-22.1); age-standardized incidence rate 20.9 (95% CI 18.8-23.0). The incidence rate among boys, 21.1 per 100,000 (95% CI 18.1-24.1) was slightly higher than that among girls, 19.0 per 100,000 (95% CI 16.1-21.8). The age-standardized incidence rate was 21.9 (95% CI 18.9-24.8) in boys, and 19.9 (95 CI 17.1-22.8) in girls. Incidence rates increased with age in both sexes (boys chi(2) for linear trend = 13.5, P < 0.001; and for girls chi(2) = 27.8, P < 0.0001). There was a significant trend towards increase in overall incidence during the 6-year period (chi(2) = 6.210, P = 0.013), and in age group 5-9 (chi(2) = 10.8, P = 0.001). Seasonality was demonstrated overall, in boys and girls (P < 0.001). CONCLUSION: The incidence of Type 1 diabetes in Kuwait is high compared with the neighbouring Arab countries, and it appears to be increasing as in many European populations.

Adolescent↗
PubMed2001

Hypopigmentation after non-permanent henna tattoo.

A young girl presented with a hypopigmentation in the shape of the sun. During a holiday in Egypt 3 months before a non-permanent henna tattoo had been applied on her right upper arm. Three to 4 days later there was a severe cutaneous reaction followed by massive swelling of the arm. The lesion took 6 weeks to subside. Patch testing revealed positive reactions to para-phenylenediamine (PPD) but not to henna or any other standard allergen. Especially in Arabic countries PPD is a common additive in natural henna preparations to enhance the weak colouring properties of the natural henna dye. We conclude that henna preparations may contain 'hidden' allergens, such as PPD, which can provoke severe cutaneous reaction without any cosensitization to the henna dye itself.

Child↗
PubMed2002

Serum leptin concentrations in children with type 1 diabetes mellitus: relationship to body mass index, insulin dose, and glycemic control.

Although obesity is a frequent feature of type 2 diabetes mellitus (DM), many patients with type 1 DM are prone to high body mass index (BMI). We measured serum leptin concentrations in a cohort of children (n = 55) with type 1 diabetes mellitus (DM), as well as their anthropometric parameters including BMI, skin fold thickness at multiple sites, and midarm circumference. Glycemic control was assessed by blood glucose (BG) monitoring before meals, and measurement of glycated hemoglobin (HbA1c) and insulin dose/kg/d was recorded. Dietary evaluation and assessment of caloric intake (kg/d) was performed by an expert dietitian. In the newly diagnosed children (n = 10) before initiation of insulin therapy, circulating leptin concentration was significantly lower (1.1 +/- 0.8 ng/dL) versus 5 days after insulin therapy (1.45 +/- 0.7 ng/dL). The decreased leptin level appears to be related to insulinopenia in these patients. In 45 children with type 1 DM on conventional therapy (2 doses of insulin mixture (NPH and regular) subcutaneous (SC) before breakfast and dinner for more than 2 years), serum leptin concentration was significantly higher (2.15 +/- 1 ng/dL) compared with age-matched normal children (1.3 +/- 1 ng/dL). Diabetic children were further divided into 2 groups according to their HbA1c level: group 1 with HbA1C less than 7.5% (less than 2 SD above the mean for normal population) (n = 29) and group 2 with HbA1c greater than 7.5%. (greater than 2 SD above the mean for normal population) (n = 16). Patients with a higher HbA1c level (group 2) had a higher leptin concentration (2.3 +/- 0.8 ng/dL), higher BMI (17.8 +/- 1.7), and were receiving higher insulin dose/kg (0.92 +/- 0.2 U/kg/d) compared with group 1 (lower HbA1c) (1.78 +/- 0.8 ng/dL, 16.7 +/- 1.5, and 0.59 +/- 0.2 U/kg/d, respectively). Group 2 patients had a higher incidence of late morning hypoglycemia (9/29) versus group 1 patients (2/16). Analysis of dietary intake showed that patients with a higher HbA1c (group 2) consumed more calories (73.5 +/- 10.5 kcal/kg/d) versus patients with lower HbA1c (64.2 +/- 8.7 kcal/kg/d). These findings pointed to the unphysiologic nature of injecting a mixture of insulin twice daily. To cover the relatively big lunch meal (40% to 50% of the total caloric intake in the Arab countries) and prevent afternoon hyperglycemia, there is a great tendency to increase NPH dose before breakfast. This, in turn, induces late-morning hypoglycemia and increases appetite and food intake at that time. Multiple regression analysis showed that circulating leptin concentrations (the dependent variable) were best correlated with the mean skinfold thickness (SFT), BMI, and caloric intake/kg/d (together they explained 65% of the variability in leptin concentrations). It appears that oversubstitution by insulin and increased food intake stimulate fat synthesis and subsequently BMI. Increased appetite and BMI contribute to increased leptin secretion and explains the higher leptin levels in undercontrolled diabetic children (higher circulating HbA1c concentrations) who were oversubstituted by insulin.

Blood Glucose↗
PubMed1997

Menarcheal age of school girls in the city of Jeddah, Saudia Arabia.

In 1995 a survey was conducted in four schools in the city of Jeddah to determine the age of menarche in this population. Nine hundred and twenty-nine girls were studied. The mean age at menarche was 15.1 years, and this was later than most other Arabic countries and most Western countries, Social class was found to influence age at menarche, but the differences in relation to family size did not reach statistical significance. The reason for differences between population is discussed.

Journal Article↗
PubMed1986

Malignant neoplasms in Jordanian children.

Three hundred and seventy-three cases of malignant disease in children were diagnosed in Jordan during the 5-year period 1975-79. Lymphomas (28.7%) were the most frequently encountered tumours, followed by leukaemias (19.6%) and brain tumours (16.1%). One third of the children with lymphoma had Hodgkin's disease. Burkitt's lymphoma accounted for another one third, and lymphocytic lymphoma the remaining third. Abdominal involvement was frequently encountered in children with non-Hodgkin's lymphoma. Our data are similar to those reported from the neighbouring Arab countries, Iraq, Saudi Arabia, Kuwait and Egypt, and contrast with the data available from developed countries in which leukaemias and brain tumours are more frequent than lymphomas.

Adolescent↗