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Background : Mental Disorders, particularly Depression, are recognised as one of the biggest burden of disease worldwide. Two of the top three burdens of disease in Qatar are mental health related. Yet, this is scarcity of lifetime prevalence data available to understand the impact in this country. Aim : This study uses the WHO Composite International Diagnostic Interview (WHO-CIDI), to measure the lifetime prevalence of the most presenting mental disorders in the adult Qatari population, aged 18-65, and examine their symptom patterns and co-morbidity. Design : This is a cross sectional study conducted during the period from April 2010 to October 2011. Setting : Five Primary Health Care (PHC) Centres distributed around the country. Subjects : A total of 1,500 Qatari subjects aged 18 to 65 years were approached; 1,063 (70.8%) gave consent and participated in this study. Methods : Four field supervisors from Qatar were trained and certified as trainers by IDRAAC, the education and training centre responsible for the Arabic translation and validation of CIDI. Variations in Arabic dialect were reported to IDRAAC for verification and approval. In line with the World Health Organization (WHO) World Mental Health (WMH) Survey Initiative, a nationally representative psychiatric epidemiological survey was carried out in Qatar. Prevalence and severity of ICD-10 disorders were assessed with the WHO Composite International Diagnostic Interview (CIDI, Version 3.0). Results : Of the studied 1063 subjects, 50.1% were males and 49.9% were females. Most of the respondents were in the age group 18-34 years (46.1%), followed by 35-49 years (34.1%), then 50-65 years (19.8%). The most common ICD-10 disorders were specific generalized anxiety disorders (20.4)%, and major depression (19.1%), with a higher prevalence in women. 20.6% of the sample had chronic physical conditions. There were high levels of statistically significant differences between age groups and gender regarding Generalized Anxiety Disorders, Social phobia, specific phobia, major depression, and personality disorders screen. Women performed significantly worse as assessed by the 30 day functioning screen (p < 0.001). Conclusion : The findings of this study in lifetime prevalence of mental disorders in Qatar are comparable with international figures. Women were more likely than men to have mental illness. Overall, Generalized Anxiety Disorders; Social phobia, specific phobia, major depression, and personality disorders were the commonest disorders.

Insulin resistance and beta cell dysfunction are core defects in type 2 diabetes (T2DM). Impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) are intermediate states in the transition in glucose tolerance from normal to T2DM, both of which are associated with increased conversion rate to T2DM. Understanding the metabolic abnormalities that lead to the development of IFG and IGT will help develop strategies to prevent the development of T2DM. in the present study, we have examined the metabolic abnormalities responsible for the development of IFG and IGT in Arab individuals. 43 subjects with NGT (n=17), isolated IFG (N=17) and isolated IGT (n=9) received 75-gram OGTT and plasma glucose, insulin and C-peptide concentrations were measured at baseline and every 15 minutes for 3 hours after the glucose drink. Insulin secretion was measured with the incremental area under the plasma insulin and C-peptide concentration curves and insulin sensitivity was measured with the Matsuda Index. Beta cell function was measured with the Disposition Index as the product of insulin secretion and insulin sensitivity indices. IGT subjects manifested severe insulin resistance compared to IFG and NGT subjects. The Matsuda Index was 3.7±0.4, 7.2±1.0 and 8.4±1.1, respectively (p

Metabolic syndrome is a cluster of metabolic abnormalities that increases the risk of cardiovascular disease and type 2 diabetes. Total human energy expenditure is divided into three major components; resting metabolic rate, thermic effect of food, and activity thermogenesis which is divided into exercise and non exercise activity thermogenesis (NEAT). In this study, NEAT was used as a lifestyle intervention on subjects with metabolic syndrome. 200 eligible patients from the Diabetes and Endocrinology Department at Hamad Medical Hospital in Doha, Qatar were assigned to an intervention (n = 100) or control (n = 100) group and followed for one year. The intervention group was advised to practice NEAT enhancing activities, while the control group was not advised about NEAT. Measurements of waist circumference, weight, BMI, blood pressure, glucose and lipid profile were assessed at baseline, six months and 1 year. After 1 year 52 intervention and 55 control subjects completed the study. The results revealed no statistically significant differences in metabolic syndrome components between the two randomized groups. The amount of recommended NEAT activity appears to have been too small to influence study outcomes. Future studies in similar populations may need to consider the high dropout rate, and use of incentives or other interventions to increase compliance and retention.

OBJECTIVES: To determine the factors associated with a poor final visual outcome following a non-perforating traumatic hyphema. METHODS: The in-patient records of all traumatic hyphema patients admitted to the Department of Ophthalmology of the Hamad Medical Centre (HMC) in Doha, Qatar, were retrospectively reviewed for a four-year period from January 2004 to March 2008. One hundred and seventeen patients who did not meet the exclusion criteria were divided into two groups based on their final visual outcome post-treatment. Group 1 (good outcome) consisted of 100 patients with a visual acuity (VA) of 6/18 or better and group 2 (worse outcome) consisted of 17 patients with a VA of less than 6/18. The two groups were compared to determine the factors associated with a poor final visual outcome. RESULTS: Group 2 patients had an 82.3% incidence of complications after a traumatic hyphema compared with a 21% incidence in group 1. Of these complications, secondary glaucoma and rebleeding were significantly associated with a worse final visual outcome. Trauma from projectiles or blows did not differ significantly in their effect on the final visual outcome, although blow injuries had a greater impact on the final visual outcome. Posterior segment injuries were associated with a worse visual outcome. CONCLUSION: It was concluded that secondary glaucoma, rebleeding, and posterior segment injuries are factors associated with a poor final visual outcome.

Background and Objectives: Neonatal mortality, a component of United Nations Millennium Development Goal 4 (MDG-4) (two thirds reduction in childhood mortality by 2015), has been a focus of all global health improvement strategies and plans of action since 1990. Our study aims to prospectively ascertain Qatar's neonatal mortality rate (NMR) during 2011, analyze trends between 1975 and 2011, and compare with recent data from high income countries. Methods: A PEARL study (perinatal neonatal outcomes research study in the Arabian Gulf), a joint collaborative research project between Hamad Medical Corporation (HMC), Qatar and University of Gloucestershire, United Kingdom, is Qatar's prospective national perinatal epidemiologic study funded by Qatar National Research Fund. The study quantifies maternal, neonatal and perinatal mortality, morbidities and their correlates by establishing a national neonatal perinatal registry for Qatar called Q-Peri-Reg. Data on live births and neonatal mortality was collected from all public and private maternity facilities in Qatar during 2011 and compared with historical neonatal mortality data (1975-2011) ascertained from the database of maternity and neonatal units of the Women's Hospital and annual reports of HMC. Inter-country comparisons were made using World Health statistics 2011 and the European perinatal health report 2008. Results: Total live births during the study period were 20,583 and neonatal deaths 102. NMR was 4.9, early neonatal mortality rate (ENMR) 2.7, late neonatal mortality rate (LNMR) 2.2 and corrected neonatal mortality rate (cNMR) 3.26. Between 1975 and 2011, relative risk of NMR decreased by 87% (RR 0.13, 95% CI 0.10-0.18, p

Background and Objectives: Perinatal mortality, a combination of stillbirths and early neonatal mortality (day 0-6 of life), is a very strong indicator to assess healthcare during the perinatal period. Our study aims to prospectively determine Qatar's perinatal mortality rate (PMR) during 2011, analyze trends from 1990 to 2011 and compare the findings with recent data from selected high income countries. Methods: A PEARL study (perinatal neonatal outcomes research study in the Arabian Gulf), a joint collaborative research project between Hamad Medical Corporation, Qatar and the University of Gloucestershire, United Kingdom, is a prospective national perinatal epidemiologic study funded by Qatar National Research Fund. The study aims at quantifying maternal, neonatal and perinatal mortality, morbidities and their correlates by establishing a national neonatal perinatal registry for Qatar called Q-Peri-Reg. The data on live births, stillbirths and early neonatal mortality were collected from all public and private maternity units in Qatar during 2011 and compared with Qatar's historic perinatal mortality data (1990-2010) ascertained from maternity and neonatal unit databases of the Women's Hospital and annual reports of HMC. We used ICD-10 definitions both for reporting and comparison with selected high income countries (data from World Health Statistics 2011 and European Perinatal Health Report 2008). Results: The total births during the study period were 20,725 (live births 20,583 and 142 stillbirths) and perinatal deaths 198 (fetal deaths 142 and early neonatal deaths 56) giving a PMR of 9.55, ENMR 2.7 and SBR of 6.85 for reporting and 4.76 for international comparison. The trend of risk ratio (RR) between 1990 and 2011 was significantly down (p= 0.016). This significant improvement in PMR (RR 0.72, 95% CI 0.58-0.89, p= 0.002) since 1990 (13.2) was more marked in ENMR (p

Objective:The aim of our study was to determine the related clinical factors affecting the outcome of occlusion treatment for Strabismic Amblyopia in Qatari children.Design:This is a retrospective descriptive study.Subjects and Methods: The study included 38 Qatari children with strabismic amblyopia who were treated with occlusion therapy. The survey was conducted among the Qatari children below 12 years of age during a 10 year period from 1992-2002. During this study period, 23 girls and 15 boys were treated for strabismic amblyopia.Results:A total of 38 Qatari children were treated during the 10 year period. Of these children, 39.5% were males and 60.5% females. After the treatment, it is found that their final visual acuity improved. 73.7% achieved 6/9 or more and 26.3% achieved less than 6/9. The initial visual acuity, the presence of anisometropia and compliance were found to be related to the outcome of amblyopia treatment. The age at the start of treatment was found unrelated to the outcome. It was further discovered that most vision loss from amblyopia can be reversed with the correct intervention.Conclusion:The results of the present study indicated that the main factors affecting the treatment of strabismic amblyopia are initial visual acuity, presence of anisometropia and compliance.

Traumatic brain injuries (TBI) are important public health problem resulting in short-term or permanent disability and death. To determine the extent and outcome of severe TBI amongst children in Qatar medical records were reviewed retrospectively of all cases of severe TBI in children aged 14 years or less who attended the Children Rehabilitation Unit, Hamad General Hospital, Qatar, between January 2002 to December 2008. The severity of TBI was assessed by the Glasgow Coma Scale (GCS). Of 65 children with severe TBI, most were male (73.8 %) and 91 % were older than five years of age. The leading causes of injury were road traffic accident (84.6%) and falls (10.8%). Other causes included trauma by ceiling fan blades (4.6%), sports and recreation injuries. Early sequelae included spasticity (43.1 %) and posttraumatic epilepsy (33.8%); both were significantly associated with the increased severity and need for intracranial surgery. Almost a quarter of the children had communication disorders, 17 (26.2 %) had poor cognition, 16 (24.6%) had hemiplegia and 12 (18.5 %) had abnormal behaviour. Twelve (18.5%) children died within the first month of admission to hospital. It is clear that severe TBI results in significant morbidity and mortality among children in Qatar and special efforts are needed to reduce the causes especially motor vehicle crashes and injuries. Rehabilitation programs are also needed to limit the extent of long-term complications associated with TBI.

Acute appendicitis is the most common surgical case met in an emergency department. Immediate surgery results in the confirmation of diagnosis and control of sepsis. To determine whether the delay in operating upon patients with acute appendicitis will affect the outcome or the stage of the disease, and if the clinical parameters give an indication of the severity of the disease medical records were reviewed retrospectively of 373 appendectomized patients above 14 years of age who were diagnosed with appendicitis in the emergency department of Hamad General Hospital, State of Qatar, between June and September 2007; 341 were diagnosed as acute appendicitis. Patients were classified according to the pre-operative and histopathological findings into four grades; A1: inflamed appendix, A2: gangrenous appendix, A3: perforated appendix, A4: pus +/- mass formation. Complications increased with the duration of the pre-hospital delay. The length of stay in hospital correlated significantly with the grade of diagnosis. The presence of fever, no change in bowel habit, and rigidity correlated well with advanced pathology, the complications increasing with greater delay. We conclude that delayed appendectomy is unsafe since it is associated with an increase in pathological grading as well as increasing the morbidity and the length of stay in hospital.

To determine whether morbid obesity increased morbidity in abdominoplasty 200 mostly female patients (100 patients morbidly obese and 100 overweight and obese) were studied but showed no statistically significant difference in the complication rate between the two categories nor between them and the international rate of complication of dermolipectomy in non-obese patients although co-morbid diseases did increase the risk of complications. It is concluded that morbid obesity should not preclude abdominoplasty, that patients do benefit, especially obese patients who are unable to lose weight following dieting or even gastric banding. surgery.

Objectives: The objective of the study was to determine prevalent pneumococcal serotypes causing infections in different age groups, their susceptibility to fi-lactams and macrolides and whether these serotypes are covered by the conjugated pneumococcal vaccines. Methods: Streptococcus pneumonia strains isolated from different patients at Hamad Medical Corporation, Microbiology Laboratory between September 1999 and July 2000 were sent to Statum Serum Institute in Denmark for serotyping. The strains were tested for their susceptibility to penicillin, ceftriaxone and erythromycin by Vitek 2 machine (bioMerieux, France) at Hamad Medical Corporation, Microbiology Laboratory. Results: Predominant serotypes in children Conclusion: The 7-valent and 9-valent vaccines offer similar coverage of serotypes in children less than 2 years while the 11-valent vaccines offers 55% coverage. This difference is not statistically significant. Resistance to penicillin was high which leaves ceftriaxone as the drug of choice for empirical treatment of invasive pneumococcal diseases.

Background: this work aims at determining the efficacy of modified CHOP combination in which Vinorelbine (Navelbine) replaces Vincristine for the treatment of aggressive Non-Hodgkin's Lymphomas (NHL). Patients and methods: This open label pilot study included 19 patients with aggressive NHL and one patient with low grade NHL who were treated with the new combination which we abbreviated as P-CAN (Prednisolone 100 mg/day PO day 1-5, Cyclophosphamide 750 mg/m2 i.v day 1, Adriamycin (Doxorubicin) 60 mg/m2 i.v day 1, Navelbine (Vinorelbine) 30 mg/m2 i.v day). The patients1 were 13 males and 6 females, mean age 50 years (34-65), performance state 0-2, International Prognostic Index (IPI) 0-3. Seven patients Stage I, one patient Stage II, eight patients Stage III and 3 patients in Stage IV. 14 patients with nodal disease and five patients with extra-nodal disease. They received total of 97 cycles of the chemotherapy (3-7 cycles). Results: 18 out of 19 patients achieved complete response (CR). In one patient the response could not be assessed, one patient progressed while on treatment. Toxicity was mainly hematological. The 3 years overall survival (OS) and disease free survival (DFS) was 83%. Conclusion: P-CAN is an effective, well tolerated combination in chemo-naive aggressive NHL. The addition of Vinorelbine to steroid, Adriamycin, and Cyclophosphamide seems improve the response. Further larger trials are needed to study this combination and its impact on longer overall survival.

In order to assess the prevalence ofvitamin-D deficiency in patients attending the rheumatology outpatient clinic at Hamad Medical Corporation, Qatar; 360 consecutive pa-tients (97% female) were tested for fasting levels of 25-hydroxyvitamin D, parathyroid hormone, calciumphos-phorus, albumin and alkaline phosphatase. Two hundred and three patients (56%) showed vitamin D levels below 20 ng/ml. From the results obtained it is concluded that lev-els of serum calcium, phosphorus, and alkaline phos-phatase are of limited value in predicting vitamin-D sta-tus. The difficulty of skin synthesis in heavily-robed women is discussed and it is concluded that hypovitaminosis D is frequent in such women and that routine assays of vitamin D and parathyroid hormone and vitamin D supplementa-tion would be beneficial.

We retrospectively analyzed the results of263 consecutive Methacholine challenge tests (MCTs) done in our laboratory between July 2000 and June 2003, in symptomatic adult patients with no history of bronchial asthma or chronic lung disease, who presented with chronic nonproductive cough, shortness of breath (subjective dyspnea), or both. All of these patients had normal results of chest physical examination, chest radiographs and screening spirometry measurements (FEVl >80% of predicted). We considered a 20% fall in the forced expiratory volume in the first second (FEVJ as the primary outcome measure (MCT PC 20-FEV1X and a 35% fall in the specific conductance (sGaw) as the primary outcome in patients who cannot perform acceptable spirometry. Out of263 patients, 79 patients (30%) were positive for bronchial hyper-responsivenes (BHR), 20 patients (25.3%) of the positive patients had sever BHR, 18 patients (22.8%) had moderate BHR, and 41 patients (51.9%) had mild BHR.

Background: Traumatic brain injuries (TBIs) remain as an important public health problem in most developed and developing countries and may also result in temporary or permanent disability. Objective: The aim of this study was to determine the incidence pattern of the burden of severe TBIs among young children in Qatar and to suggest practical prevention policies that can be implemented in Qatar. Methods: The study was conducted among children aged 14 years or less at the Children Rehabilitation Unit, Paediatric Department, Hamad General Hospital. Severity of TBI was assessed by Glasgow Coma Scale (GCS). Results: This study based on 65 children suffering from severe traumatic brain injury from January 2002 to December 2008, 12 of them died within the first month of admission in paediatric intensive care unit. The predominant gender was male (73.8 %), non-Qatari form 50.8%. In our study predominant mechanisms of injury were road traffic accident (84.6%), then falls (10.8%), other causes like head ...