Lipoprotein-associated Phospholipase A2 Activity Contributes to the Coronary Artery Disease with Metabolic Syndrome

Background: Coronary artery disease (CAD) is an inflammatory process characterized by atherosclerosis in coronary arteries and it is a major cause of death and disability in developed countries. Lipoprotein-associated phospholipase A2 (Lp-PLA2) has been consistently associated with CAD risk factors and predictive of CVD outcomes; additionally, it is consistently higher among type 2 diabetics than nondiabetics. However, the relationships of circulating Lp-PLA2 activity with incident CAD among patients with metabolic syndrome (MetSynd) have not been examined sufficiently. Objective: The aim is to determine contribution of Lp-PLA2 to coronary artery disease (CAD) in patients with Metabolic Syndrome (MetSynd). Subjects and methods: This is a cohort prospective study based on 412 patients male and female were eligible and aged 25-75 years old patients and gave consent to participate in study. The study included socio-demographics, clinical biochemistry and the presence of co-morbid diseases. The data were analyzed using descriptive and multivariate analyses. Results: There was a significant difference between MetSynd Positive and normal subjects with respect to age groups, gender, BMI, smoking, nargile use, thyroid, COPD, CAD, hypertension, diabetic and stroke. Also, there was a significant difference between MetSynd versus normal subjects with respect to BMI, Waist Circumference, hemoglobin, HbA1c, vitamin B12, fasting blood glucose, vitamin D, calcium, creatinine, triglyceride, uric acid, ferritin, systolic BP (mm Hg) and diastolic BP (mm Hg), creatine kinase-myocardial band (CK-MB) (p=0.001); Lp-PLA2 activity, (p=0.001); HOMA-IR index,(p=0.004), insulin (p=0.001); C-reactive protein (p=0.004);White blood cell (WBC) (p=0.008); Platelet p= 0.018) Mean Plate Volume (p= 0.032); red cell distribution width (p=0.001); and vitamin D levels (p=0.018), respectively. The multivariate stepwise regression analysis indicated that Lp-PLA2 (p<0.001), BMI (kg/m2) (p<0.001), systolic BP (p<0.001), MetSynd (p=0.002), CK-MB (p=0.019), Calcium) (p= 0.023), Triglyceride (p= 0.029), Total-cholesterol (p= 0.046) were considered as risk predictors of the CAD patients after adjusting for age and gender. Conclusion: Lp-LPA2 contributes to CAD in the presence of MetSynd, as well as Lp-PLA2 could be utilized as a useful predictor in cases of CAD with MetSynd

The Driver Behaviour Questionnaire as an Accident Predictor in Cross-cultural Countries in Qatar and Turkey: Global Public Health Problem.

Background: The Manchester Driver Behaviour Questionnaire (DBQ) has been extensively used as predictor of self-reported road traffic accidents. The associations between crashes and the violation and error factors of the DBQ however, might be reporting a little bias. Aim: The current study aiming to explore the driving behaviours of Qatari’s and Turkish ethnic groups and to investigate the relationship between error, violations, and lapses of DBQ and accident involvement. Materials and Methods: The DBQ instruments has been used to measure the aggressive driving behaviours leading to road accidents. The study included a representative sample of 2050 drivers and of whom 1,511 drivers agreed to participate (73.7%). A sample of 1,511 drivers from two ethnic groups; Qatar (620), and Turkish (891) completed the driver behaviour questionnaire and background information. Results: There was a significant difference found between both the countries, Qatar and Turkish, in age group, education, occupation, marital status, car type, and seat belt use (p<0.001). The Qatari drivers scored higher on almost all items of violations, errors and lapses compared to other ethnic groups, while Turkish drivers were lower on all the items. Turkish drivers (38.9%) have been involved in more accidents compared to Qatari drivers (32.9%). In terms of cause of accidents, careless driving (31.6%) and excessive speeding (28.5%) were significantly higher among Qatari drivers (p<0.001). More than one third of the studied drivers of two ethnic groups were involved in traffic violations; Qatari (26.6%), and Turkish (33.3%). The use of DBQ permitted the differentiation between deliberate deviations from safe driving practices and errors and violation due to misjudgments or lapses in focus. Conclusion: The present study revealed driver behaviour is different in two ethnic and cultural groups and scores rated differently. Qatari drivers scored higher on most of the items of violations, errors and lapses of DBQ compared to Turkish drivers in all DBQ items. The results emphasise the importance of social, socio-economic, life-style, cultural factors, general driving style and skills, differ between both countries with the respect of traffic safety.

Prevalence and Determinants of Common Fears in Children and Their Socio-Demographic Characteristic.

Objective: Most children experience some degree of fear during their development. Excessive fears can create serious obstacles to children. The aim of this study was to identify the most common fears in a sample of children and adolescents and examine the socio-demographic correlates of fears. Materials and Methods: This cross-sectional study was conducted during the period from July 2010 to February 2012 at Public and Private Schools of the Ministry of Education and Higher Education, State of Qatar. Out of 2188 students approached, 1703 students agreed to participate in this study, with a response rate of 77.8%. The questionnaire includes socio-demographic information, academic performance, behaviour at home and various fears. Results: More than half of the children experienced fears (56.7%). Most of them were in the intermediate level, 12 – 15 years old (46.1%). Overall, reported fears were significantly more frequent in girls (62.6%) than boys (37.4%) (p<0.001). A significant difference was observed between girls and boys who experienced fears in their age group (p<0.001), education of mother (p=0.04), household income (p=0.008) and academic performance (p<0.001). The most frequent reported fears were fear of someone dying in the family (85.2%), parents getting divorced (84.5%), breaking religious law (82%), being kidnapped (78.2%), family members ill (78%) and dying (76.7%). Conclusions: The study findings revealed that fears were highly prevalent in Arab children and adolescents in Qatar. Girls reported more fears than boys. There was a significant difference observed between girls and boys in their age group and academic performance for the reported fears.

Treatment Non-Compliance of Psychiatric Patients and Associated Factors: Are Patients Satisfied from Their Psychiatrist.

Aims: The aim of the study was to determine the extent of compliance and noncompliance with treatment of psychiatric patients and examine the factors affecting compliance and non-compliance with treatment. Study Design: Hospital based prospective descriptive study. Place and Duration of Study: The study was carried out from September 2010 to May 2011 in Qatari population aged above 16 years at the Psychiatry Department of the Hamad Medical Corporation, Qatar. Methodology: The study included 628 patients aged 16-77 years who were hospitalized with psychiatric disorders and treated in the outpatient clinics of the Psychiatry department. The diagnostic classification of definite psychotic disorders was according tothe International Classification of Disease, Tenth revision (ICD-10). Results: Of the 628 patients studied, 62.4% of them were compliant with treatment and 37.6% were non-compliant. High compliance was significantly more in patients in the age group (16 - 20) years old (84.4%), retired (70.2%) and housewives (70%) (P<0.001). Social support (40.3%) was poor in non-compliant patients, whereas 50.3% of compliant patients had good social support (P<0.001). The major reasons for non-compliance were irregular attendance to clinic (55.5%; P<0.001), ignorance about side effects of medication (61.0%; P=0.001), and lack of education about medication (47.9%; P<0.001). Conclusion: Non-compliance is quite common in Qatari population like any other society. All efforts should be exerted to improve the compliance of psychiatric patients by eliminating the factors leading to non-compliance. High complaint patients were more satisfied with psychiatrist than non compliant patients. The main reasons found for compliance were lack of family support, irregular attendance to clinic, ignorance about side effects of medication, free medicine and lack of education about medication.

Schizophrenia and Its Association with Biological and Environmental Factors: A Community Based Study.

Aims: The aim of this study was to examine the proportion of probable schizophrenia in Arab population visiting primary health care centers and investigate its associated biologic and environmental factors. Study Design: Cross sectional study. Place and Duration of Study: Primary Health Care (PHC) centres, Supreme Council of Health, Qatar, between January 2009 to December 2010. Subjects: Of 1491 Arab patients approached, 1148 patients agreed to participate in the study (77%). Methods: The study was based on a face to face interview with a designed questionnaire including socio-demographic, biologic and environmental factors. A diagnostic screening questionnaire which consisted of 6 questions about the symptoms of schizophrenic disorders was used for the diagnosis of schizophrenia. Results: Of the studied subjects, 11.7% of them were diagnosed with schizophrenia. A significant association was observed between schizophrenic and non-schizophrenic patients in terms of age group (p=0.048), BMI (p=0.019), gender (p=0.027), ethnicity (p=0.008), marital status (p=0.001), occupation (p<0.001), household income (p<0.001) and place of residence (p=0.039). Obstetric complications were significantly higher in schizophrenic patients with a higher frequency of pregnancy stress (31.3%; p<0.001) and diabetes (20.1%; p=0.008). Among the obstetric complications, Rhesus incompatibility (OR 2.74; 95% CI (1.16-6.47); P=0.021) and pregnancy stress (OR 2.51; 95% CI (1.60-3.94); P<0.001) were the major predictors for the development of schizophrenia. Delivery complications of asphyxia (17.9%; p=0.003), uterine atony (10.4%; p=0.028) and emergency caesarean section (17.2%; p=0.024) were significantly higher in mothers of the patients. Urban upbringing (OR 1.60; 95% CI (1.02 - 2.50); P<0.037) and social isolation (OR 1.72; 95% CI (1.06-2.74); P<0.027) were the main significant environmental risk factors for schizophrenia. Conclusion: An increasing schizophrenia risk with obstetric complications was observed in the study sample. Rhesus incompatibility and pregnancy stress were the main predictors for schizophrenia.

Psychological distress among postpartum mothers of preterm infants and associated factors: a neglected public health problem

Objective: The aim of the present study was to determine the prevalence of psychological distress, depression, anxiety, and stress among postpartum Arab mothers of preterm or low birth weight (LBW) infants and to identify maternal characteristics that can predict psychological distress among mothers of preterm infants. Methods: A hospital-based study was conducted. A representative sample of 2,091 postpartum mothers was surveyed and 1,659 women (79.3%) gave their consent to participate in the study. The study was based on a face-to-face interview with a designed questionnaire covering sociodemographic characteristics, anthropometric measures, medical history, and maternal characteristics. Depression, anxiety, and stress were measured using the Depression Anxiety Stress Scale (DASS-21). Results: In the study sample, 10.2% of the postpartum mothers had preterm/LBW infants. Depression (29.4 vs. 17.3%) and anxiety (26.5 vs. 11.6%) were significantly more common among mothers of preterm births compared to mothers of full term infants (p < 0.001). The risk of depression in mothers of preterm/LBW infants was two times the risk in mothers of full term infants, while the risk of anxiety was 2.7 times in mothers of preterm/LBW infants than in mothers of full term infants. Young mothers and those who had less than secondary education (42.0 vs. 21.7%; p = 0.007) and lower monthly household income (72.0 vs. 53.3%; p = 0.024) were more depressed and anxious after the preterm birth when compared with mothers of full term infants. Psychological distress was higher in mothers with history of preterm birth (30.0 vs. 21.7%) and delivery complications (52.0 vs. 33.3%). Conclusions: We found a greater risk of depression and anxiety in mothers of preterm births than in mothers of full term infants. Our analysis revealed that depressed and anxious women of preterm infants were younger, less educated, had a lower body weight and low household income ...

The impact of the interpregnancy interval on birth weight and other pregnancy outcomes / O impacto do intervalo entre gestações no peso de recém-nascidos e outros desfechos da gravidez

To investigate the relationship between the interpregnancy interval and low birth weight and other pregnancy outcomes. METHODS: this case-control study was carried out in hospitals from January 2010 to April 2011. For cases, mothers of 1216 newborns with birth weight<2500 g were approached and 854 mothers participated (70.2 percent). For controls, mothers of 1158 newborns with >2500 g were approached and 854 mothers participated in this study (73.7 percent). Face-to-face interviews were conducted to complete the questionnaires. RESULTS: of the newborn babies with low birth weight, the risk was higher among mothers with a short interpregnancy interval (40.3 percent), whereas for infants with normal birth weight, the majority of the mothers had a longer interpregnancy interval of 24 months (44.7 percent). A short interpregnancy interval of 612 months was more common among women of <25years (49.4 percent; p<0.001) and those who were illiterate (13.1 percent; p=0.043) with a higher risk of low birth weight compared to the controls. Prenatal care during the 1st trimester was lower in women with low birth weight children (p<0.001). Normal delivery was observed less in women with a short birth interval among cases (58.7 percent) compared to controls (79 percent) (p=0.001). A J-shaped association was observed between low birth weight and the interpregnancy interval. CONCLUSIONS: a short interpregnancy interval is associated with an increased risk of low birth weight, especially in younger and illiterate women...

Investigar a relação entre o intervalo entre gestações e o baixo peso de recém-nascidos e outras conseqüências da gestação. MÉTODOS: este estudo caso-controle foi realizado em hospitais entre janeiro de 2010 e abril de 2011. Dentre as mães dos 1216 recém-nascidos com peso <2500 g, 854 (70,2 por cento) aceitaram participar do estudo de caso. No grupo controle, dentre as mães dos 1158 recém-nascidos com peso > 2500 g, participaram 854(73,7 por cento). Para completar os questionários, foram conduzidas entrevistas face a face. RESULTADOS: dos recém-nascidos com baixo peso, o fator de risco foi mais alto entre as mães com curto intervalo intergestacional (40,3 por cento), enquanto para recém-nascidos com peso normal a maioria das mães tinham uma boa margem de intervalo intergestacional de 24 meses (44,7 por cento). Curtos intervalo intergestacional (6 a 12 meses) foi mais comum entre mulheres de <25 anos (49,4 por cento; p<0,001) e analfabetas (13,1 por cento; p=0,043), com mais alto risco de baixo peso quando comparado aos controle. Cuidados pre-natais durante o primeiro trimestre foi menor nas mulheres com crianças de baixo peso (p<0,001). Menos partos normais foi observado em mulheres com curtos intervalos de nascimento para os casos (58,7 por cento) comparados aos controles (79 por cento) (p=0,001). Uma associação não monotônica tipo função J, foi observada entre o baixo peso e intervalo intergestacional. CONCLUSÕES: um curto intervalo entre gestações é associado a um risco maior de nascerem bebês de baixo peso, principalmente entre mulheres mais jovens e analfabetas...

Exclusive breast feeding and prevention of diarrheal diseases: a study in Qatar / Aleitamento materno exclusivo na prevenção de doenças diarréicas: um estudo realizado no Qatar

OBJECTIVE: to explore the relationships between breast feeding and diarrhea and to assess the effect of exclusive breast feeding (EBF) on reducing the risk of diarrhea in Qatar. METHODS: this is a cross sectional survey carried out at the Well baby clinics and Pediatric clinics in the 11 Primary Health Care Centers and Hamad General Hospital, Hamad Medical Corporation, in Qatar. A multistage sampling design was used and a representative sample of 1500 Qatari infants and preschool children with an age range of 0-3 years and mothers agedbetween 18 to 47 years were surveyed during the period from October 2006 to September 2008 in Qatar. Out of the 1500 mothers, 1278 agreed to participate in this study, with a response rate of 85.2 percent. Questionnaires were administered to women who were attending Primary Health Care (PHC) Centers for child immunization. Data about the child gathered included date of birth, gender, birth order, consanguinity, socio-economic conditions, age of mother, level of education of mother, occupation, mode of breast feeding, sterilization of bottle and incident of diarrhea during the interview. Univariate statistical methods were performed for statistical analysis. RESULTS: of the 1278 infants studied, more than half (59.3 percent) were exclusively breastfed, and the mean duration was11.4 (SD=6.7). The risk for presenting diarrhea was higher in formula fed (48.7 percent) and partiallybreastfed children (37.3 percent) when compared to EBF(32.5 percent). CONCLUSION: EBF plays an important role in reducing the incidence and severity of infantile diarrhea.

OBJETIVOS: investigar a relação entre a amamentação e a diarréia e avaliar o efeito do aleitamento maternao exclusivo (AME) na redução do risco de diarréia noQatar. MÉTODOS: um estudo transversal realizado nos Well Baby Clinics and Pediatric Clinics dos 11 centros de atenção básica do Hamad General Hospital, Hamad Medical Corporation, no Qatar. Um desenho amostral de múltiplos estágios foi empregado com uma amostra representativa de 1500 recémnascidos e crianças de idade pré-escolar catarianos entre outubro de 2006 esetembro de 2008 no Qatar. Entre as 1500 mães, 1278 aceitaram participar neste estudo, uma taxa de resposta de 85,2 por cento. Os questionários foram aplicados a mulheres atendidas pelos centros de atenção básica para imunização infantil. Dados colecionados sobre as crianças incluíram data de nascimento, gênero, ordem de nascimento, consanguinidade, condições socioeconômicas, idade maternal, escolaridade maternal, ocupação maternal, método de amamentação, esterilização dos biberões, e incidência de diarréia durante a entrevista. Métodos univariados e foram utilizados para realizar a análise estatística. RESULTADOS: dos 1278 recém-nascidos estudados, mais que metade (59.3 por cento) foram exclusivamente amamentados e a duração média foi de 11,4 (DP=6,7). O risco de apresentar a diarréia foi mais alto nas crianças aleitadas com fórmulas (48.7 por cento) e nas que foram parcialmente amamentadas (37.3 por cento) em comparação com a AME(32.5 por cento). CONCLUSÕES: o AME desempenha um papel importante na redução da incidência e da gravidade da diarréia infantil.

Púrpura trombocitopênica idiopática na infância: estudo de base populacional no Catar / Idiopathic thrombocytopenic purpura in childhood: a population-based study in Qatar

OBJETIVO: Definir o padrão da púrpura trombocitopênica idiopática (PTI) (aguda/crônica), e descrever seus sintomas e características clínicas em crianças com menos de 14 anos de idade em uma sociedade árabe recentemente desenvolvida. MÉTODOS: Este estudo descritivo retrospectivo foi realizado no Departamento de Pediatria do Hospital Geral de Hamad, Hamad Medical Corporation, Catar. Foram incluídas neste estudo 50 crianças com idade inferior a 14 anos e diagnóstico de PTI durante o período de 2000 a 2005. RESULTADOS: Das crianças estudadas (50), 62 por cento foram diagnosticadas com PTI aguda e 38 por cento com PTI crônica. A PTI aguda foi mais prevalente em meninos (64,5 por cento) em comparação com meninas (35,5 por cento), enquanto que a PTI crônica apresentou uma distribuição quase igual em meninos (57,9 por cento) e meninas (42,1 por cento). História de infecção viral foi comum em casos de PTI tanto aguda (71 por cento) quanto crônica (63,2 por cento); 68 por cento das crianças com PTI apresentaram contagem de plaquetas abaixo de 20x10(9)/L ao diagnóstico. A maioria das crianças estudadas (74 por cento) foi tratada com imunoglobulina intravenosa. CONCLUSÕES: O estudo revelou uma alta incidência de PTI entre as crianças no Catar. As descobertas do estudo são semelhantes às de outros relatos internacionais.

OBJECTIVE: To find the pattern of idiopathic thrombocytopenic purpura (ITP) (acute/chronic) and to describe presenting features and clinical characteristics of the disease in children below 14 years of age in a newly developed Arabian society. METHODS: This retrospective, descriptive study was carried out at the Pediatric Department of the Hamad General Hospital, Hamad Medical Corporation, Qatar. A total of 50 children below 14 years of age who were diagnosed with ITP during the period 2000-2005 were included. RESULTS: Among the studied children (50), 62 percent were diagnosed with acute ITP and 38 percent with chronic ITP. Acute ITP was more prevalent in boys (64.5 percent) when compared with girls (35.5 percent), whereas for chronic ITP, nearly an equal distribution was found in boys (57.9 percent) and girls (42.1 percent). Preceding viral infection was common in both acute (71 percent) and chronic (63.2 percent) ITP cases; 68 percent of the children with ITP showed a platelet count below 20x10(9)/L at the time of presentation. Most of the studied children were treated with intravenous immunoglobulin (74 percent). CONCLUSIONS: The study revealed a high incidence of ITP among children in Qatar. The study findings are in line with other international reports.

Patterns of cancer incidence among the population of Qatar: a worldwide comparative study.

BACKGROUND: Cancer is a major public health problem all over the world. Monitoring the evolution of the cancer burden in the State of Qatar is of great value but has never been explored in depth. AIMS: The aim of the study was to determine the incidence patterns of cancer cases, assess trends during the period 1991 - 2006 and make comparisons with other countries. METHODS: This was a retrospective cohort study based on the Cancer disease registry of Al Amal Cancer hospital, State of Qatar, from 1991 - 2006. All Qataris and non-Qataris, males and females, who were diagnosed with any type of cancer were included in this study. The diagnostic classification of definite cancer cases was made according to the International Classification of Disease 10th revision (ICD-10). RESULTS: A total of 5,825 cancer cases were registered in Qatar during the period 1991 - 2006 with 56.7% in males and 43.3% in females, 35.6% in Qataris and 64.4% in non-Qataris. Incidence rates per 100,000 population showed that lung (5.9), lymph node (5.9), bone marrow (4.1) and connective tissue (3.9) were the top major cancers in men. In women, breast (30.1), genital organs (9), lymph node (6.8), rectum (6.1) and thyroid (5.7) cancers were the leading cancers. There was a sharp rise in the total number of cancer cases during the period 2002-2006 of 57.1% compared to the period 1991-1996. The incidence rate of cancer cases increased with increasing age in all cancer types except for breast cancer in women above 65 years old. During the study period, the five most common cancers among women were different from those in men. The incidence rate per 100,000 population of all cancer types in Qatar (63.1) was remarkably lower than the other Middle East countries and the UK. CONCLUSIONS: Cancer is an important public health problem in Qatar, with increase in incidence with age. Incidence rates of all cancers were higher across all age groups of women compared to men. Lung cancer was the most frequent cancer diagnosed in men and breast cancer in women. More epidemiological studies are now required to elucidate the patterns of cancer and related risk factors.

Growth patterns of Qatari school children and adolescents aged 6-18 years.

The study was conducted to analyze the patterns of growth in height and weight and the prevalence of over-weight among Qatari school children aged 6-18 years. Weights and heights of a cross-sectional sample of Qatari school children were measured. These children were selected randomly, in equal proportions of age and gender, from different schools from urban and semi-urban districts. Appropriate statistical procedures were performed to produce smooth percentile curves for boys and girls using a two-stage approach. Initial curve smoothing for selected major percentiles was accomplished by various paramet-ric and non-parametric procedures. In the second stage, a normalization procedure was used for creating z-scores that closely matched the smooth percentile curves. The height and weight results were compared with the international reference values of National Center for Health Statistics/Centers for Disease Control and Prevention (NCHS/CDC). The prevalence of over-weight was calculated using the new International Obesity Task Force (IOTF) reference. Of 7442 Qatari children studied, 50.3% were male and 49.7%' female. The mean values for height, weight, and body mass index (BMI) increased with the age for both boys and girls until the age of 18 years, except BMI, which stabilized at the age of 16-18 years at around 22.6 for boys and at 21.6 for girls. The growth patterns of the Qatari children, aged 6-18 years, appeared to be comparable with those of the NCHS/CDC reference. The weight-for-age centile curves of the Qatari boys tended to be superior to those of the NCHS/CDC reference until the age of 15 years, less so those of the Qatari girls. In contrast, the height-for-age centile curves of the Qatari children tended to deviate in a negative sense from the NCHS/CDC reference curves, for boys and girls from age around 11 years and 13 years respectively. The deviation of the smoothed median height-for-age curves from the reference in adolescence could most likely be attributed to a later maturation among the Qatari children. The prevalence of under-weight, over-weight, and obesity for the Qatari children was quite below the CDC and IOTF rates, except for girls aged 6-9 years. More males than females were over-weight or obese according to either the local, the CDC, or the IOTF reference, and the prevalence increased with age. A good percentage of the Qatari children was at risk of being over-weight, which needs more attention because the development of obesity results in different types of diseases associated with changes in body composition.