Qatar Foundation Annual Research Conference Proceedings Volume 2016 Issue 1

Background

Current screening for carriers of genetic diseases in oocyte donors includes the assessment of risk of transmission of inherited diseases based on personal and family history of genetic disorders. Most assisted reproduction centers also include karyotyping, mutational screening of the CFTR gene and directed the study of fragile X premutation. Next generation sequencing (NGS) technologies of have allowed to expand genetic screening to a large number of diseases at a reasonable cost.

Objective

 • Develop a new genetic test (qCarrier) based on NGS technology for extended recessive diseases in the field of reproductive medicine screening.

 • Implementation of the carrier screening test in our oocyte donation program.

Material and Methods

The test covers 200 genes (68 in full sequence analysis and targeted screening of 132 known mutations) associated with autosomal recessive diseases 185 (AR) and 11 linked to chromosome X. The test was developed by NGS technology and allows characterization of a broad spectrum of mutations (point, indels, rearrangements and CNVs). The expanded carrier screening is performed on all candidate of oocyte donors and on the male partner of the recipient of oocytes. We discard from the oocyte donor program all candidates that are carriers of X-linked disease. The heterozygous carrier status for an autosomal recessive condition is no a reason for exclusion as a donor, but it involves the selection of a recipient whose male partner is not a carrier of disease mutations in the same gene.

Results

The validation of the test showed high sensitivity (>99%). It has made the extended carrier screening a total of 445 oocyte donor candidates and a total of 587 male partners of oocyte recipients. The implementation of the test in our OD program has identified 57% of patients/donors carriers least a pathogenic mutation.

Conclusions

 • The implementation of the test in oocyte donors program has identified a 3% allocation at high risk of disease autosomal recessive. Two percent of donor candidates to enter the oocyte donors program are carriers of pathogenic mutations linked to the X chromosome.

 • The expanded carrier screening is a useful tool to reduce the rate of newborns affected of genetic diseases in children born through oocyte donors program.

 • The implementation of the test in clinical settings requires pre and post-test genetic counseling to ensure adequate information, consent of patients and safeguard the fundamental ethical issues facing patients and oocyte donors.

Malaria is a major public health concern in north east India with the preponderance of drug resistance strains. Till recently partner drug for Artemisinin Combination Therapy was Sulphadoxine Pyrimethamine. The antifolate drug resistance has been associated with the mutations at dihydropteroate synthase (dhps) and dihydrofolatereductase (dhfr) gene. The study was aimed to investigate the antifolate drug resistance at molecular level and therapeutic efficacy in 35 patients. Three novel point mutations were found in dhps gene with 10 haplotypes along with the already reported mutations. A single haplotype having quadruple mutation was found in dhfr gene. The study reports higher degree of antifolate drug resistance as evidenced by the presence of multiple point mutations in dhps and dhfr genes. The therapeutic efficacy revealed one early treatment failure and three late clinical failure. The findings of the study recommends to stop the use of SP as partner drug in malaria treatment for NE India.

Keywords

Plasmodium falciparum, North East India, Drug resistance, therapeutic efficacy

Diabetes mellitus (DM) and cardiovascular diseases (CVD) constitute a major health care challenge worldwide. We evaluated the trends and outcome of DM in patients presenting with CVD over a 22-year period in the state of Qatar.

Methods

We performed a descriptive retrospective chart review of all admitted CVD patients, including DM from the Cardiology and Cardiovascular Surgery database at the Heart Hospital (HH) of Hamad Medical Corporation (HMC) in Qatar over a 22-year period.

Results

During the study period between the year 1991 and 2012, a total of 48,803 patients (77% males; 40.3% diabetics) were admitted to the HH, resulting in an average admissions rate of 2218 CVD patients per year. Two out of five CVD patients (40%) were known diabetics. Thus, it was estimated that 14.2 per 10,000 people of the general population in Qatar have both DM and CVD. On average each year, 895 CVD patients admitted to the HH are diabetics. The overall proportion of admissions for diabetic patients with CVD increased over the study duration. Diabetic males were 6 years younger than females. DM was more prevalent in Arabs (68 vs. 32%), but its burden showed a decreasing trend over time compared with South Asians. Diabetics presented with ST-elevation myocardial infarction (47.5 vs. 22.7%), tended to be 8 years younger compared with heart failure with DM. Over the study period, beta-blocker use increased substantially (from 10 to 71%). However, angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs) were underutilized (from 30 to 56%). There were 4.4 deaths per 100 CVD admissions, which is equivalent to 97 deaths per year. Of this, 52% had DM (2.3 deaths per 100 CVD admissions). The overall case fatality rate (CFR) of DM was 5.6%. Diabetic Asian patients died 9 years earlier than diabetic Arabs at the HH. Age-adjusted Predictors of mortality in DM patients in the HH included lack of beta-blocker use (OR 4.35), lack of ACEI/ARBs use (OR 3.58), myocardial infarction (OR 3.20), lack of aspirin use (OR 2.56), and congestive heart failure (OR 1.75) (P = 0.001 for all).

Conclusions

In Qatar, DM is still a healthcare challenge. Although the admission rate of diabetic patients is increasing at the HH, the mortality rate is decreasing. Evidence-based medication use remains far from the guideline recommendation; however, it shows a substantial improvement. Lack of evidence-based CVD medications in diabetic patients is associated with a significant increase in the mortality in the HH. Efforts should be directed toward public awareness regarding CVD risk factors and DM through education programs and efficient primary and secondary prevention strategies.

The first task of tissue engineer trying to make a scaffold of a heart valve, is to adapt some model of a heart valve to establish target geometries and properties that should be recreated in artificial scaffold. The natural way to do so is to conduct literature research and find the current scientific consensus on the topic. Here the problems start, each researcher seems to have an individual opinion about optimal geometry of valve. What makes situation more complex is that each researcher has carefully chosen arguments to explain why that particular design is better than others. Hence, the consensus is not there yet, we chosen to contribute to this discussion. The analysis of available reports enable to “cook out” 2 distinguishable and to some extent contrary hypothesis.

1st –the optimal architecture of artificial valve is an architecture of native one.

2nd-there is not such a thing as optimal architecture of a heart valve, and never will be

The first option is very tempting due to its simplicity. Of course, in most of human beings the valves work fine for entire life so let's make the same structure for the sick patient. But which one? – Literally mine or yours? Maybe we should make an average from 1000 or million healthily examples? Hypothetically, if you would need new face, would you like to have the “median” appearance or you rather would go for the most beautiful one? Let's take it further – what is an optimal design of human face, perhaps one would wish to obtain the most beautiful face possible, while others would opt for younger variant of their old one. When it comes to faces, it is easy to distinguish beautiful from average and ugly. Using our internal standards, we are doing this every day hundreds times. But valves are usually not visible, so do we need to work out the standard of “beauty” for HV. Frequently, clinicians and researchers seem to use the same face-related-internal standards to propose geometries of scaffold. “I like this more than that, because its follows better my internal visual standards of HV beauty”. But this is not the way to go. We need hard core evidence to distinguish structure that is better than the other.

The second option is more radical – each patient needs individually chosen design of the heart valve that will reflect its specific needs and conditions. This is obviously very elegant but horribly expensive solution, since an individualized scaffold not only needs to be designed but also produced only in few copies.

The consensus of both strategies is in our opinion the establishing the most “beautiful HV” but according to objective physical parameters. What additionally supports this logic is that under physiological condition the scaffold will adjust to patient by changing the geometries.

To confirm our observation and conclusion we contacted 30 prominent clinicians (n = 11) and tissue engineers (n = 19) with question: What is an optimal design of aortic heart valve? In this report we are presenting their responses and comments.

Background

The high prevalence of obesity was observed in numerous developed and developing countries. A reduce in energy expenditure due to the low physical activity level is a factor contributed to the increase in obesity. Physical inactivity is one of the ten leading risk factors for global death, and associated with the all-cause mortality. Regular physical activity lowers the risk of various types of non-communicable diseases. The prevalence of obesity is high among women in the Gaza Strip. There is a lack of studies on the pattern of physical activity among adults in the Gaza Strip.

Objective

The aim of this study was to determine the prevalence of physical activity among mothers aged 18–50 years in the Gaza Strip and its associated factors. Additionally to explore mothers' perception and practice of physical activity.

Methodology

A mixed methods design was conducted using quantitative and qualitative methods. A total of 357 mothers were recruited from the Gaza Strip using multistage sampling method from three different geographical areas, namely, Jabalia refugee camp in the north of Gaza Strip, El Remal urban area in Gaza city, and Al Qarara rural area in the south of Gaza Strip. A structured questionnaire was used for face to face interviews with mothers to obtain information on the mothers' sociodemographic, and their nutrition knowledge. The short form of the International Physical Activity Questionnaire (IPAQ) was used to assess the physical activity pattern. In this study, sitting time is used as an independent proxy measure of sedentary behavior. For qualitative component, three focus group discussions (one group in each area) were conducted involving 24 surveyed mothers to explore mothers' perceptions and practices of physical activity. Binary logistic regression analyses were applied to identify the determinants of physical activity and were adjusted in relation to various factors.

Results

The prevalence of physical inactivity was 21.6%, about 78% of mothers were classified as moderately active, while vigorous activity was not observed. Mean sitting hours was 2.74 ± 1.32 hour/day. Results revealed that, physical activity level decreased among mothers who lived in households with low income (OR: 2.30; 95%CI: 1.20–4.45; p = 0.013), and those with high nutrition knowledge were more likely to be physically inactive (OR: 1.15; 95%CI: 1.0–1.314; p = 0.040), while mothers who had low or medium education level were more active (OR: 0.31; 95%CI: 0.15–0.62; p = 0.001), or (OR: 0.47; 95%CI: 0.23–0.96; p = 0.039). There was no significant association between physical activity levels and the geographical areas. The qualitative results showed that most of the mothers believed home chores were kind of exercises and could substitute for practicing sports. The main constraints to physical activity practice attributed to the sociocultural factors due to the limited availability of exercising facilities for Palestinian women and restrictions on their freedom.

Conclusions

Results of this study are important to monitor physical activity levels among mothers in the Gaza Strip. Despite a high level of nutrition knowledge among mothers, physical inactivity prevalence is high. More attention must be given to the policy makers to improve awareness on the importance of the physical activity practice to improve the overall health status of the community. Understanding the cultural attitudes is required as it is relevant in order to implement effective community-based intervention programs to improve physical activity levels among mothers in the Gaza Strip.

Background

Crowding in hospital Emergency Departments (EDs) is a commonly observed problem in all over the world. Although the reasons and mechanisms are different, the major factors are increasing volume of patients seeking medical care in ED services, lack of inpatient beds, and care for non-urgent conditions for patients who identify the ED as their easiest and usual site of care, notwithstanding the typical treatment of patients with serious illnesses or injuries, non availability and accessibility of other medical services in the community.

Objective

To identify the factors related to patients unscheduled revisit in ED, to find out average length of stay in different priority patients and to identify the reason for more than 6 hours stay in ED.

Methods

The alkhor hospital has 110 bed capacities in the north part of Qatar with an annual ED patient volume of 158000.

A prospective study conducted during two months periods from 15/09/2014 to 14/11/2014 in ED. The census sample of patients who had revisit within 72 hours of discharge from the ED was recruited in the Study. CERNER system utilized to collect all revisit patients data including demographic and first visit information. Two experts from ED consultants reviewed the data independently. Further data include average length of stay and reason for more than 6 hours stays in ED were collected by the research team and all the data was analyzed by the author. The factors were categorized in to four types includes: physician related: missed diagnosis, not prescribed medications, treatment error/ patient related: perception of not improved/illness related: complications of disease process, prognosis of disease process/system related: not availability of health care, not availability of health center locally.

Results

During study period 24933 patients visited in ED, 849 were revisited within 72 hours of their discharge which accounts 3.4%. 165 were excluded from the study which includes LWBS,DAMA and absconded patients. The characteristic of revisited patients, more likely young adults between 20–40 years of age (59.79%). Mostly males (78.94%) expatriate (69.73%) 30.27% patient had three visit in ED while 69.73% twice visited. The most of the patients (538) were self-reported in ED during their second visit. The vast majority of patients (542) agreed that they received discharge instructions.

Physician related Factors includes: this includes missed diagnosis (1.6%), adverse drug reaction ((1.3%) and discharged without home medication (8.4%)

Patient related: The 60.26% (331) of the patients perceived that they were not improved with initial treatment. However, among these patients only 8 were admitted in Alkhor hospital and one transferred to another health care facility for expert management. The vast majority of the patients 97.2% patients were discharge from the ED.

Illness related: This was the most common reason for revisit in ED, 52.9% (362) return with same complaints while 21.3% (146) with related complaints in which 97.6% patients were discharged and 1.3% (7) admitted in hospital 22.8% (156) patients reported in ED with new complaint.

System related: The 23.49% revisited patient's living in Alkhor or nearby area, with their primary health center facility 70 km away from their residential area. 30% patients have no health center facility for further follow up. This cause high financial burden for low income workers

During the study period 718 patients found stayed more than 6 hours in ED, which accounts 2.87% of the total ED patients, mean age of 35.43 years. Most of the patients were males (93.3%). The vast majority of patients were priority 3 and 4 which accounts 26.6% and 63.6 % respectively. The mean times for triage and physician assessment were 2.538 hours and 2.571 hrs accordingly and length of stay in ED was 8.365 hrs. The top 5 reasons for delay the patient in ED was waited for assessment by physician (26.3%), waiting for reassessment by physician (20.2%) observation (11.3%) waited for triage by nurse (8.6%) and repeat lab works (8.2%).

The revisited patients distributed unequally in the three shift duty hours. The morning (7 am–15 pm) and evening (15 pm–23 pm) shifts received the highest proportion 43.12% (295) and 38.45(263) compared to night shift (23 pm–7 am) 15.05% (103). Whereas on daily basis of revisited patients maintained almost equal distribution.

In general the average length of stay of priority 2 patients was 2 hours 14 mts, priority 3 was 2 hrs 17 mts where as priority 4 and 5 was 2 hrs 27 mts and 1 hour 54 mts respectively

Conclusion

The patients decision to revisit in ED is complex, it include several factors like poor quality of service, missed diagnosis, financial factors, disease process etc. From our study we found majority of revisit due to illness or system related factors like their perception of disease progress, lack of local health center facility for workers, financial burden etc. Effective educational program and initiation of tele nursing service for discharged patients can avoid unnecessary ED visits.

Background

ITP (Immune thrombocytopenic purpura) is the most common bleeding disorder in childhood. It is usually a self-limiting disorder, and most patients recover spontaneously without serious complication. The clinical features of ITP have remained unchanged over the past few decades but there have been many recent changes in management strategies as evidenced by the new international guidelines on the management of childhood ITP. We wanted to study our pediatric inpatient population in Qatar who were admitted with acute ITP over the last 5 years for their presenting features and the management strategies adopted by our pediatricians, most of the these decisions in our institution are in conjunction with the pediatric hematology team. This study would also serve as baseline data, which could be used to compare changes in trends of management in the future.

Methods

This was designed as a retrospective descriptive study. We included previously healthy, newly diagnosed ITP, aged 0 to 14 years, admitted to the pediatric inpatient unit, in Hamad General Hospital, Doha, Qatar from January 2008 to January 2014. Patients with a pre-existing chronic medical illness, including hematological conditions and those that were later diagnosed to have conditions other than ITP, were excluded. Data was collected from the patient's medical records using a specially designed data collection sheet that was used to gather the all the relevant patient related details including demographics, presenting signs and symptoms, investigations, treatment and outcome. The study was approved by the Medical Research Center at Hamad Medical Corporation.

Results

80 patients fulfilled the inclusion criteria with a male to female ratio of 1.1: 1. (38.3%) of the patients were in the 2–5 year age group, which reflects the peak incidence of ITP in children as per literature, (13.8%) of the patients were below the age of 12 months and (16.3 %) were above the age of 10.(34.3%) of the patients were Qatari Nationals, while the rest of them were expatriates residing in Qatar.

(40.5%) reported flu-like symptoms before the presentation of the illness. Most of the parents (>80%) denied any history of known hematological disease in their families.

The platelet counts at admission to the pediatric ward were as follows: (80%) of patients had a platelet count f 20,000 or less, (11.3%) from 21,000 to 35,000, while the rest of the patients had platelet counts between 36,000 to 100,000. The most common clinical features reported were spontaneous sub-cutaneous bruising in (77.5%) of patients, followed by oral mucosal petechial rash in (38.8%), fever in (28.8%), epistaxis in (16.3%), gum bleeding in (7.5%). 3 patients needed observation in the pediatrics intensive care unit due to life threatening bleeding, one of whom had intracranial bleeding.

The treatment modalities used in our patient population were as follows: Intravenous immunoglobulin (IVIG) alone in (86.3%), a combination of IVIG and steroids in (6.3%) and steroids alone (1.1%). Only 5 patients (6.3%) were managed by observation alone, 4 of these patients had platelet counts above 20,000 and none had any significant bleeding clinically. The most common IVIG dosing used was 1 gram/kg/day for 2 days. (28.7%) of our study population was prescribed a second dose of IVIG by their treating physician. The vast majority (74.3%) did not experience any adverse reaction after IVIG treatment. However, (10.8%) had fever, (8%) had vomiting and headache. 2 patients were clinically suspected of aseptic meningitis, post IVIG therapy, based on the treating physician's assessment. In terms of the length of stay in hospital, majority of the children (83.8%) were hospitalized for 1 to 5 days.

At follow up, (66%) children had recovered with normal platelet counts within 1 year from the date of diagnosis, while (34%) had progressed to chronic ITP, which is defined as the persistent thrombocytopenia, lasting beyond 1 year.

Conclusion

Our study showed that the clinical features of Acute ITP in Qatar were similar to those reported from various parts of the world. However, the percentage of chronic ITP was higher in our study population than that quoted in literature. Management decisions in our center, like in many centers around the world, were often based on the physician's clinical judgement, rather than the current established international guidelines.

Antibody Directed Enzyme Prodrug Therapy (ADEPT) is a technique used in cancer treatment, which convert a prodrug to a powerful cytotoxic drug only in the vicinity of the tumor. The technique relies on a bacterial enzyme, glucarpidase (former name: carboxypeptidase G2, CPG2). Also the glucarpidase is a very effective enzyme for detoxification of methotrexate, (MTX) which serves as an important component of various chemotherapeutic regimens for the treatment of cancer patients.

Repeated cycles of ADEPT and the use of wild type glucarpidase in detoxification are essential but are hampered by the human antibody response to the enzyme. Additionally, glucarpidase has a relatively slow action in detoxification.

The aim of the work is to provide solutions to overcome the pitfalls of the techniques through the application of different strategies.

In our work we successfully isolated new glucarpidase produces from soils. We cloned and overexpressed the novel gene in E.coli. The new recombinant glucarpidase has been characterized. We also produce different variants of our new gene using different strategies. These variants will be investigated to isolate glucarpidase with higher activity and glucarpidase which avoid the immune system.

Background

Electronic Medical Records (EMRs) hold diverse clinical information about large populations. When this information is coupled with genetic data, it has the potential to make unprecedented associations between genes and diseases. The incorporation of these discoveries into healthcare practice offers the hope to improve healthcare through personalized treatments. The Qatar National Genome project aims to achieve this vision by building a warehouse of genome sequencing information linked to de-identified EMR data. The warehouse should facilitate accessibility to research data, but also protect patients’ privacy and confidentiality by employing responsible data de-identification and data sharing mechanisms.

This abstract discusses the privacy and governance challenges encountered during the construction and deployment of the data warehouse. To simplify the presentation, we divide the data management lifecycle into four stages and discuss the challenges at each stage separately: 1) Initial data collection, 2) data storage, 3) data sharing (utilization) and 4) Dissemination of research findings to the community.

Data collection

The data for the Qatari genome project is sought from the community. Thus it is important to consult with the population to establish the basic principles for data collection and research oversight. To achieve that, a community engagement model should be defined. The model should establish:

1. An advocating technique for advertising the project to the community and raising the number of individuals who are aware of the project. The technique should strive to reach different elements within the society, provide clear dissemination of risks and benefits and establish methods for recurrent evaluation of the community attitudes and understanding of the Project.

2. A recruitment strategy for establishing the enrollment criteria and enrollment process:

 a. The enrollment criteria defines the basis for enrollment (should it be disease based or volunteer based) and the acceptable age for volunteers, and

 b. The enrollment process defines the scope of subjects’ consent (opt in/out or informed consent) and warrants a clear boundary between research and clinical practice.

3. The extent of institutional review board (IRB) and community oversight, given the potential impact of the project on the community, an oversight for the program by the community and the IRB should be discussed and established. The scope includes oversight on data repositories, oversight on research studies as well as oversight on any changes to the protocol (data use agreements, communications, etc.)

Data storage

Foundational documents in modern research ethics stress the importance of reducing harm to participants and maximizing benefits to the society. Re-identification of participants’ identity is one form of harm that can be involuntarily or deliberately inflicted. Personal information derived from EMR records and/or genomic data can be used against the participants to limit insurance coverage, to guide employment decisions, or to apply social stigma. To minimize the risk of harm, the research platform should store de-identified clinical and biobank data while retaining the link between both data sources (the de-identified EMR data and the biobank data). This can be achieved by applying the following two operations:

1. The first operation (known as pseudonymization) identifies a stable and unique identifier(s) (such as Qatari IDs) that is included in both data sources and replaces it with a unique random ID (or pseudonym).

2. The second removes all uniquely identifying information (such as names, record number, and emails) from the structured data and masks all unique identifiers from the unstructured data (such as doctors’ notes). To perform this step properly, we need to determine the uniquely identifying information proper to the Qatari setting. Due to the relatively small population size in Qatar, some regular attributes might prove to be very informative. For example an age of 87 or above and certain professions, such as lawyer, might uniquely identify a participant.

Multiple aspects need to be considered when designing the pseudonymization operation, these include:

1. Ensuring that each subject is assigned the same random ID (pseudonym) across the different data sources. This consistency will ensure that data belonging to a particular subject will be mapped to one record.

2. The pseudonymization process could be reversible or not. Reversible systems allow reverting back to the identity of the subjects through a process called de-pseudonymization. They are used when communication with patients is a foreseen possibility.

3. In case communication with participants is forecasted, then a secure de-pseudonymization mechanism should be specified. The mechanism should define (i) the cases for which re-identification can occur, (ii) the bodies that can initiate re-identification requests, (iii) those that rule and regulate these requests, and (iv) the actual re-identification mechanism.

Data sharing

After the removal of uniquely identifying information, the resulting data is said to be de-identified -but not anonymized. Access to (non-anonymized) biomedical data collected in Qatar is governed by the QSCH “guidelines, regulations and policies for research involving human subjects”. So a critical part in defining a data access protocol is to:

1. Identify and understand data access procedures and requirements set by QSCH, and

2. Identify and understand data access desires of the Qatari community (through surveys, meetings with community representatives, etc.)

3. And finally deploy the gathered policies and requirements along with the collected consents into the design of the data-access platform.

Note that access to the research data platform has to be provided to all research institutes within Qatar. Such as researchers from Hamad Medical Corporation, Qatar Biomedical Research Institute, Qatar Computational Research Institute, Weil Cornell Medical College in Qatar, Qatar University, Hamad bin Khalifa University, Sidra Medical and Research Center and other research institutions. Moreover, the data warehouse is viewed as a platform for worldwide collaborative research projects. With such massive mandate, a principal feature is to have the capacity to foster timely research and discoveries. Data application processes and approvals should be smooth and should not delay project initiation significantly. This cannot be realized using traditional “IRB-based” data-sharing systems. Thus, there will, eventually be a need to (fully or partially) automate the data access process. In other words, we need to design a system to automatically match data access requests with access decisions. In general, access decisions could be provided at multiple access levels. For example in some cases, the requested data could be exported to the investigator premises while in other cases, secure remote access can be imposed. In general, the granted access levels should counter the risk posed by data requests. For example, a request for highly sensitive data (such as HIV data) from an investigator affiliated with a well-established Qatari research institute is inherently less risky than a request for the same dataset by an investigator affiliated with an institution outside Qatar, thus, the second request should receive more access limitations than the first.

Dissemination of findings

Prior work demonstrated that in order to affirm the value of research participation and contribute to public education, it is important to have a mechanism for disseminating research findings to the public. This will keep the community aware of how their participation is facilitating research and improving knowledge in the biomedical field.

The mechanism should also tackle the issue of disseminating specific research findings to specific participants. One of the main challenges in that regard is to define when a finding is considered scientifically valid and when it is considered valuable information for the recipient.

Introduction

Replacement of damaged tissue is nowadays an aim of tissue engineering. This technique involves the use of porous or fibrous structures – the so-called scaffolds – that support the colonization with the desired cell type and which are degraded after fulfilling their temporary supporting function. Basic requirements for the prevailing materials used in this field are nontoxicity, low immunogenicity and cell-adhesiveness. Furthermore blood-contacting devices should exhibit low thrombogenicity.

The biopolymer silk, mainly consisiting of the protein silk fibroin, matches some of these criteria but bare silk does not facilitate cellular adhesion and growth and unfortunately the material is prone to platelet attachment.

In our approach, the chemical surface immobilization of a cell adhesive peptide of silk samples reduces thrombocyte adhesion to a large extent while simultaneously promotes specific adhesion and colonization by endothelial cells (ECs).

The specific interaction of the modification was further demonstrated by fibroblast cell culture.

Materials & Methods

The EC specific adhesive peptide Arg-Glu-Asp-Val (REDV) derived from the extra cellular matrix protein fibronectin was used in our experiments. The peptide was chemically immobilized onto silk fabric scaffold by using hexamethylene diisocyanate (HMDI) as an activator for the substrate. Subsequent hydrolysis of pending isocyanate moieties yielded in primary amino functionalities. REDV was subsequently conjugated directly using a short chain amino-reactive crosslinker or via a bifunctional polyethylene glycol (PEG) spacer. Additionally, silk was modified with amino-functional PEG only. Modified as well as untreated specimens were subjected to cell culture using ECs and fibroblasts. In addition samples were challenged with platelet rich plasma in order to evaluate thrombocyte adhesion. Potential changes in material bulk properties and morphology were checked by scanning electron microscopy, gel permeation chromatography and mechanical testing.

Results & Discussion

Coverage of silk fabric with ECs was greatly promoted through REDV-modification by a factor of 17 (directly coupled peptide) and a factor of 20 (PEG-mediated coupling) respectively after 2 weeks growth in comparison to cell colonization of untreated material. Substrate modification also inhibited initial (24 h) fibroblast adhesion. Thrombocyte attachment was strongly reduced 5-fold as a result of PEG-modification, independent of an additionally conjugated peptide. Mechanical (tensile testing) as well as morphological properties (SEM) were not significantly altered by the chemical treatment. The initial activation of silk showed no detectable influence on the composition (GPC).

Conclusion

Taken together, the feasibility of improving the biological performance of silk, an established biomaterial, was shown. We where able to show that the chemical modification left the basic material properties largely unaffected. These findings may contribute to novel tissue engineering approaches that facilitate the endothelialization of cardiovascular implants such as vascular grafts and heart valves.

Figure 1: Covalent immobilization of the REDV peptide – either directly coupled or PEG-mediated – renders silk an excellent substrate for endothelialization. In addition the presence of PEG alone inhibits the attachment of platelets to a large extend.

Background

Studies show that diabetics are in high risk for complications, hospitalization, and death from uncontrollability.

Good Glycemic control is an important part of preventive services for diabetic complications. One of the most important treatment options for Diabetic patient is insulin therapy, however there is evidence of poor physician knowledge about types and modalities of insulin therapy. Lack of knowledge will increase the likelihood of medication errors; contribute to poor glycemic control in diabetic patient and increased morbidity and mortality

- Our aim is to improve Insulin therapy related knowledge in type 2 DM Among Physicians in West-bay health center by 20% above baseline by January 2013 and To raise the awareness of that problem among our physicians.

Subjects, Materials & Methods

- The project began on November 2012 with baseline Questionnaire survey as pilot for our study. Followed by This Pre-intervention insulin knowledge Questionnaire conducted to Identify deficient areas in the insulin-Related knowledge with the results showed Mean Percentage of incorrect answers is 62%.

- For more on which brainstorming session was done to identify the root causes of such problem, and depicted using the fish bone diagram.

- A survey questionnaire was designated to assess the main causes of the problem and distributed to nurses and physicians working in NCD clinics.

Prioritization of Reasons of insufficient insulin therapy knowledge demonstrated in Paretto chart.

According to analysis we found three main causes of the problem:

1. a – No Training Program for physicians.

2. No specific form or Ineffective Auditing

3. Less Exposure to Patient with T2DM.

- Our intervention was in the form of:

1- Training program: conducted on December 2012 and it is include a PowerPoint presentation, problems solving cases, and group discussion about insulin types and Pharmacokinetics, concerns about insulin therapy, initiation, titration, and monitoring of insulin therapy, and insulin regimens in PHC setting.

2- Post intervention insulin knowledge Questionnaire: distributed after conducting training program.

- Two audits done retrospectively before intervention & one done after to show average percentage of improvement in knowledge to assess effect of intervention.

- All data was demonstrated using run chart.

Results

Improvement of insulin therapy-related knowledge reflected by mean percentage of correct answers in pre & post questionnaire conducting before and after training program. showed mean correct answers improved from 38% to 78 % in physician in West Bay H.C.

Conclusions

The results of the pre and post questionnaire analyses clearly showed an improvement in the level of insulin therapy knowledge among physicians.

The study indicates the areas that need to be addressed with greater emphasis.

The post test analysis shows that the training program has been successful in significantly improving knowledge of insulin therapy that may help to improve patient safety in PHC.

Next Steps

Share results with training and development dept.

Expansion of insulin therapy training program to include All PHC to transfer the knowledge.

Continue process of education (twice annually).

To analyses the segmented data to see where the improvement can be happen.

The novel Schiff bases I HAMTTSC (2-Acetyl-4-methylthiazole thiosemicarbazone), II HAPTSC(2-Acetylpyrazine thiosemicarbazone) and their complexes with Pt(II) and Pd(II): 1 [Pt(AMTTSC)Cl], 2 [Pt(AMTTSC)2], 3 [Pd(AMTTSC)Cl], 4 [Pd(AMTTSC)2], 5 [Pt(APTSC)Cl], 6 [Pt(APTSC)2], 7 [Pd(APTSC)Cl], and 8 [Pd(APTSC)2] have been synthesized, and characterized by elemental analysis and spectroscopic studies. The crystal structure of the Schiff bases I, II, and the complex 1 [Pt(AMTTSC)Cl], have been solved by single-crystal X-ray diffraction. The electronic, IR, UV/Vis, and NMR spectroscopic data of I and II and their complexes are reported. The in vitro antitumor activity of the Schiff bases and 1, 2, 4, 5 and 6 complexes against two different human tumor cell lines (HT-29 and HuTu-80) reveals that the complexes are more cytotoxic than their corresponding ligands with IC50 values at the range of 0.1–10 μM. These compounds can therefore be considered as agents with potential antitumor activity.

Molecular structure of 1 [Pt(AMTTSC)Cl]

Introduction

Thiosemicarbazones (TSCNs) are very promising molecules in coordination chemistry because of their pharmacological properties of both ligands and complexes, (1–3) which include notably their antiparasital, (4) antibacterial (5, 6) and antitumor activities (7) depending on the parent aldehyde and ketone and, of course, metal ion. The thiosemicarbazone ligand usually coordinates with a metal through the imine nitrogen and the sulphur atom forming a five-membered ring chelate. Since cis-platin emerged as the most important antitumor drug (8), thousands of metal complexes have been synthesized and characterized in order to study the effect of the metal, the attached group on the structural and kinetic properties involved in the biological activity. (9) However significant problems are still extant, including side effects, toxicity, cancer specificity and acquired resistance. Consequently the development of new compounds outside the usual coordination sphere or of different structural properties is the challenge to cancer research.

Synthesis of the ligands

The ligands 2-Acetyl-4-methylthiazole thiosemicarbazone and 2-acetylpyrazine thiosemicarbazone, were prepared according to the literature (10).

Synthesis of Complexes Pt (AMTTSC)Cl Complex

A solution of K2PtCl4 (0.208 g, 0.5 mmol) in methanol, was added dropwise to a stirred solution of HAMTTSC (0.5 mmol) in 20 mL of methanol. The solution was refluxed for 2 hours and stirred for 24 hours at room temperature. The dark red precipitate was collected by filtration and dried in vacuo. Crystals suitable for X-Ray diffraction were obtained through slow evaporation of the DMF solvent.

Solid, yield: 70.59%, m.p. 236–237°C. Anal. Calc. For Pt(C7H9N4S2)Cl (443.84 g/mol): C, 18.94%; H, 2.04%; N, 12.62%. Found: C, 18.74%; H, 2.18%; N, 12.85%. I.R. (solid state, cm^− 1): ν(NH2) 3395, 3267; ν(C = N) 1520.38; ν(C = S) 873.31; ν(N-N)1065.89. 1H-N.M.R (DMSO-d6): δ 2.21, 2.41 (s, 6H, 2CH3), 7.75 (s, 1H); 8.07(b, 2H, NH2).). 13C-N.M.R. (DMSO-d6): δ 13.93, 16.39 (2CH3); 148.59,-154.62(3C ring); 171.92 (HC = N); 183.20 (C = S). Electronic spectra (λmax nm): 270, 391, 531.

Pt (AMTTSC) 2 Complex

A solution of K2PtCl4 (0.208 g, 0.5 mmol) in methanol, was added dropwise to a stirred solution of HAMTTSC (1.0 mmol) in 30 mL of methanol. The solution was refluxed for 2 hours and stirred for 24 hours at room temperature. The pinkish red precipitate was collected by filtration and dried in vacuo.

Solid, yield: 74.36%, m.p. dec.>245°C.Anal. Calc. For Pt(C7H9N4S2)2 (621.69 g/mol): C, 27.05%; H, 2.92%; N, 18.02%. Found: C, 27.01%; H, 3.028%; N, 18.97%. IR (solid state, cm^–1): ν(NH2) 3354.48, 3265.78; ν(C = N) 1535.94; ν(C = S) 873.25; ν(N-N) 1075.01. 1H-N.M.R (DMSO-d6): δ 2.21, 2.39 (s, 6H,2CH3), 7.74, 7.34(s, 1H); 8.07 (b, 2H, NH2); 8.51, (b, 2H, NH2). 13C-N.M.R. (DMSO-d6): δ 13.51, 16.39 &13.91, 16.76 (4CH3); 144.02-152.49 &148.57-154.64 (3C ring); 166.07&171.93 (HC = N); 183.22 (C = S). Electronic spectra (λmax nm): 270, 363, 389, 53.

Pd (AMTTSC)Cl Complex

A solution of K2PdCl4 (0.163 g, 0.5 mmol) in methanol, was added dropwise to a stirred solution of HAMTTSC (0.5 mmol) in 20 mL of methanol. The solution was refluxed for 2 hours and stirred for 14 hours at room temperature. The orange precipitate was collected by filtration, washed with ethanol and ether, and dried in vacuo.

Solid, yield: 92.39%. m.p. 236–237°C. Anal. Calc. For Pd(C7H9N4S2)Cl (355.18 g/mol): C, 23.67%; H, 2.55%; N, 15.77%. Found: C, 22.94%; H, 2.68%; N, 15.09%. IR (solid state, cm^− 1): ν(NH2) 3426.47, 3304.62; ν(C = N) 1552.37; ν(C = S) 867.85; ν(N-N) 1118.21. 1H-N.M.R. (DMSO-d6): δ 2.25, (s, 6H, 2CH3), 7.64 (s, 1H); 7.93 (d, 2H, NH2).13C-N.M.R. (DMSO-d6): δ 13.83, 16.36 (2CH3); 145.69, 147.79–154.36(3C ring); 169.58 (HC = N); 180.71 (C = S). Electronic spectra (λmax nm): 274, 313, 386,493.

Pd(AMTTSC)2 Complex

A solution of Pd(acac)2 (0.152 g, 0.5 mmol) in CH2Cl2/ CH3OH (30 mL, 2:1 v/v) was added dropwise to a stirred solution of HAMTTSC (1.0 mmol) in 30 mL of methanol. The solution was refluxed for 2 hours and stirred for 24 hours at room temperature. The red precipitate was collected by filtration, washed with ethanol and ether, and dried in vacuo.

Solid, yield: 79.54%. m.p. dec.>174°C. Anal. Calc. For Pd(C7H9N4S2)2, (533.03 g/mol): C, 31.55%; H, 3.4%; N, 21.02%. Found: C, 30.77%; H, 3.62%; N, 19.84%. IR (solid state, cm^− 1): ν(NH2) 3308.98, 3257.77; ν(C = N) 1557.07; ν(C = S) 871.65; ν(N-N)1080.62. 1H-N.M.R. (DMSO-d6): δ 1.46, 1.62 (s, 6H, 2CH3), 7.04 (s, 1H); 8.04, 6.74 (d, 2H, NH2). 13C-N.M.R. (DMSO-d6): δ 13.66, 16.18 (2CH3); 147.49, 152.70& 148.44, 155.45 (3C ring); 169.62&171.19 (HC = N);, 182.38 (C = S). Electronic spectra (λmax nm): 289, 348, 448.

Conclusion

New potential anti-cancer Pt (II) and Pd(II) complexes were synthesized through the reaction of the heterocyclic thiosemicarbazone ligands with Pt (II) and Pd (II) ions in 1:1 and 1:2 ratios reactions.

The structures of the synthesized compounds were elucidated on the bases of spectroscopic data (IR. 1H and 13C N.M.R, UV-VIS and XRD).

As the experimental results show, the synthesized Schiff bases reacts with Pt(II) ion in different modes of bonding, they react as tridentate through the mercaptide sulfur ion, the azomethine nitrogen atom and the nitrogen of the ring.

All ligand and complexes tested show a concentration dependent reduction of cell proliferation. The test results show that the change of the ligand metal ratio has significant effects on the antiproliferative activities of the platinum(II) complexes. In general, it was found that complexes were more active than the corresponding ligand. The complex with the formula PtLCl was found to be slightly more active than the complexes with formula PtL2 against HT-29 and HuTu cancer cells line.

References

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(2) Kovala-Demertzi D., Varadinova T., Genova P., Souza P., and Demertzis M. A., “Platinum(II) and palladium(II) complexes of pyridine-2-carbaldehyde thiosemicarbazone as alternative antiherpes simplex virus agents, Bioinorganic Chem. and App, (2007), 56165, 2007.

(3) Scovill, J.P. Klayman D.L., Franchino C.F., Acetylpyridine Thiosemicarbazones Complexes with Transition Metals as Antimalarial and Antileukemic Agents. J. Med. Chem., (1982); 25, 1261.

(4) Duffy K. J., Shaw A. N., Delmore E., Dillon S. B., Erickson-Miller C., Giampa L., Huang Y., Keenan R. M., Lamb P., Liu N., Miller S. G., Price A. T., Rosen J., Simth H., Wiggal K. J., Zhang L, Luengo J. I., J. Med. Chem., (2002), 45, 3573.

(5) Agarwal R. K., Singh L., and Sharma D. K., Synthesis, spectral, and biological properties of copper(II) complexes of thiosemicarbazones of Schiff bases derived from 4-aminoantipyrine and aromatic aldehydes, Bioinorg. Chem. and Appl., (2006), 59509, 2006.

(6) Pandey O. P., Sengupta S. K., Mishra M. K., and Tripathi C. M., Synthesis, spectral and antibacterial studies of binuclear titanium(IV)/zirconium(IV) complexes of piperazine dithiosemicarbazones, Bioinorg. Chem. and Appl, (2003), 1., 1, 35.

(7) Quiroga A. G., Pérez J. M., López-Solera I., et al., Novel tetranuclear orthometalated complexes of Pd(II) and Pt(II) derived from p isopropylbenzaldehyde thiosemicarbazone with cytotoxic activity in cis-DDP resistant tumor cell lines. Interaction of these complexes with DNA, J. of Med. Chem, (1998), 41, 9, 1399.

(8) Smith J. E., Talbot D. C., Ber. J. Cancer, (1991), 65, 787.

(9) Hacker M. P., Khokar A. R., Brown D. B., McCormack J. J., Krakoff J. M., Cancer Res, (1985), 45, 4748.

(10) De Lima G.M., Neto J.L., Beraldo H., Seibald H.G.L, Duncalf D.J.,J.of Molec.Struc.(2001), 604, 287.

Pulmonary tuberculosis (PTB) is a common worldwide infection and a medical and social problem causing high mortality and morbidity, especially in developing countries. An expert system for diagnosis of this disease was designed based on expert's knowledge for providing decision support platform to assist fresh graduator (inexperienced) physicians, and other healthcare practitioners to arrive the final diagnosis of TB more quickly and efficie ntly especially in rural areas. Information about pulmonary tuberculosis and its symptoms and treatment from doctor who are specializing in the diagnosis and treatment of tuberculosis were collected.

The system was built using C sharp language and artificial intelligence based expert system in coordinated manner help in the diagnosis of tuberculosis disease and assistance in giving the necessary treatment In addition to giving advice to patients.

Background and Objectives

Renal cell carcinoma is the most common and lethal form of all renal cancers, and accounts for 4.1% of all cancer cases in Qatar. Mutations to Von-Hippel Lindeau (VHL) gene in renal cells activates hypoxia inducible factor-1 alpha (HIF-1α) response pathway, and contributes to increased proliferation and progression to renal cell carcinoma. Hence, chemotherapeutic modalities available to treat renal cell carcinoma are targeted toward modulation of the VHL-HIF response pathway. Annonacin, a potent cytotoxic mono-tetrahydrofuran acetogenin found in Annonaceae plants, has been demonstrated to exert anticancer activity against breast cancer; however, its therapeutic potential against renal cell carcinoma is yet to be determined. Hence the objective of this study is to investigate anti-neoplastic potential of annonacin in renal carcinoma cells.

Methods

We investigated the effect of annonacin - at concentrations ranging from 0.5 to 2 μM – on cell viability (using MTT assay and Alamar blue assay), and the protein expression of markers of HIF signaling pathway (HIF-1α), mTOR pathway (Thr-389 phosphorylation of p70S6 kinase), cell cycle progression (p21 levels), and apoptosis (caspase-3 expression) in CaKi-2 cells, a human renal carcinoma cell line. The cells were treated with annonacin for 24 or 48 hours and assessed for the aforementioned parameters.

Results

hour annonacin treatment caused a significant and dose-dependent decrease in the viability of CaKi-2 cells, i.e., 42% in 0.5 μM, 36% in 1 μM and 29% in 2 μM annonacin treatment groups as compared to control set at 100%. This was further confirmed by Alamar blue assay, which revealed a significant decrease in the viability of CaKi-2 cells upon treatment with annonacin for 48 h. The expression of HIF-1α was reduced by 68% at 24 h in CaKi-2 cells treated with 2 μM annonacin. In addition, the expression of p21 (a key molecule that inhibits transition of cells from G1 to S phase in cell cycle) was induced by 1.34-fold in 0.5 μM annonacin-treated cells indicating an arrest in G1 phase of cell cycle. This was further confirmed through cell cycle analysis using Tali cytometer, in which annonacin treated groups (0.5 μM and 1 μM) showed cell cycle arrest at G1 phase, i.e., 57% of cells in G1 phase with 0.5 μM annonacin treated vs. 7% of cells in G1 phase in control group. In addition, a dose-dependent decrease in the phosphorylation of p70S6 kinase (a downstream target of mTOR) was observed with annonacin treatment at both 24 and 48 h end-points. This suggests that treatment of annonacin has possibly led to the inhibition of mTOR, in addition to suppression of HIF-1α activation, and underscores the cross-talk between HIF pathway and mTOR signaling pathway in renal cell carcinoma.

Conclusions

Our findings demonstrate that annonacin treatment (at concentrations ranging from 0.5 to 2 μM) inhibits HIF-1α and mTOR activation and causes cell cycle arrest at G1 phase and induces apoptosis in renal cell carcinoma. These findings indicate that annonacin exerts anti-cancer effects via modulation of HIF and mTOR signaling pathways, resulting in alterations in the cell cycle and activation of apoptosis in renal cell carcinoma. In conclusion, our study for the first time unveils the therapeutic potential of annonacin to inhibit the progression of renal cell carcinoma. Further studies in vivo are required to establish its efficacy to treat patients with renal cell carcinoma.

Funding Source

This study is supported by an intramural grant (#QUUG-CPH-CPH-14/15/7) funded by the Office of Academic Research, Qatar University, Doha, Qatar.

Purpose

Pulmonary arterial hypertension (PAH) is a devastating cardiovascular disease of the pulmonary vasculature that remains poorly understood. Despite a number of available FDA approved drugs, survival remains low, reaching an estimated 5-year survival as low as 27%. This severe disease is characterized by dysfunction and eventual failure of the right ventricle (RV) of the heart. The main focus of therapeutic strategies thus far has been to target the pathways of pulmonary vascular remodeling that lead to the hypertensive phenotype. It is not known however, if there is an added therapeutic benefit in targeting the RV directly. Prostacyclin analogues are among the most widely used therapies for PAH. However, it is unknown whether they confer protection exclusively via attenuating pulmonary vascular remodeling and constriction or if RV myocardio-specific mechanisms are also involved. Moreover, their use in severe models of PAH has not been adequately tested. Insight into these two major unknowns could not only blaze the trail of new effective therapies for PAH to improve survival, but would also open new avenues for targeting other major forms of heart failure. To address gaps in knowledge of the underlying responses to prostacyclin, the analogue treprostinil was used in a pre-clinical rat Sugen-hypoxia (SuHx) model of angioproliferative severe PAH that closely resembles the human disease.

Methods

Male Sprague-Dawley rats (300g) were implanted with ALZET osmotic pumps containing vehicle or treprostinil (900 ng/kg/min), injected concurrently with a bolus of Sugen (SU5416; 20 mg/Kg) and exposed to 3 wk hypoxia (10% O2) followed by 3 wk normoxia (21% O2). RV function was assessed using pressure-volume loops measured using an admittance catheter and hypertrophy assessed by Fulton Index (FI; RV/LV+Septum wet weight).

Results

Treprostinil significantly reduced SuHx-associated RV hypertrophy and rise in systolic pressure (FI: 0.26 ± 0.02, 0.58 ± 0.04 & 0.37 ± 0.05, P

Background

As a conventional type of communication, health education usually face several barriers that make its outcome fall short. Among many, lack of interest, distraction, and rejection are well documented barriers to engaging audience in a communication process leading to behavioral change. Despite the novel corona virus which was responsible for the Middle East Respiratory Syndrome (MERS-CoV) created public concerns, it, on the other hand, paved the road to effective health education via raising receivers’ attention. With the aim to highlight the context and factors attributed to educate the public during epidemics, this study documented how the outbreak of MERS-CoV offered valuable opportunities to communicate critical educational messages on the recommended preventive behaviors and practices.

Methods

In this retrospective study, we documented the timeline of MERS-CoV key events in Qatar, along with the disseminated health education messages that were captured by the print media during the period Sep 2012 through Nov 2013.

Results

The media documented that one of the first two reported cases worldwide was a Qatari national. A significant turn of the public's risk perception about MERS-CoV took place when studies documented that camels are thought to play critical role in the virus transmission to humans. Six months after the identification of the first case, this relationship was confirmed when it was declared that the MERS-CoV was isolated from camels in Qatar, provided that raising camels is a social norm and an embedded cultural practice in the country and across the region. Nevertheless, MERS-CoV cases and deaths continued to be reported.

Out of 153 news stories reported on MERS-CoV, 12 major developments either reporting confirmed cases or deaths were identified in Qatar. Two Press conferences, sixteen press releases, and two interviews were counted, all from competent authorities. As the novel virus captured the media attention, all aspects of the new virus were extensively reported, ranging from the basic information about the virus traits, the clinical signs and symptoms, treatment outcome of cases, to the ongoing researches, epidemiological findings of the most vulnerable persons, the zoonotic nature of the disease, and the recommended course of action. The public pressing demand for updates and information drove the media interest to arrange talk shows and interviews with the high health officials to give firsthand accounts about the virus and the prevention and control efforts.

While fresh MERS-CoV cases were reported from The Kingdom of Saudi Arabia, fears were growing that Hajj season may allow for a large scale spread of the virus. The publicized health education messages at that time called upon the most-at-risk group to postpone going to Hajj and Umrah, be assessed for medical fitness, get vaccinated against seasonal flu, and avoid the crowded and badly ventilated areas. This group involved elderly and patients with chronic illnesses or impaired immunity. Afterwards, frequent hand washing and drinking pasteurized camel milk or consuming well-cooked camel meat was advised along with minimizing close contact with symptomatic persons.

Discussion

The timeline of MERS-CoV events along with the communication activities in response to them gave a strong indication about the correlation between the media interest and public concern of a particular subject in hand, and the opportunities created by this momentum to communicate key information and recommended course of action by the competent authorities to satisfy the public's needs on the other hand.

Three main factors influenced how MERS-CoV was perceived in Qatar: its unfamiliarity, the epidemiological link to camels, and the way media had portrayed it. Like any other exotic risk, MERS-CoV's acknowledged unfamiliarity even to health officials seduced the media to fill the uncertainty vacuum by persistently focusing on the similarities with the deadly SARS epidemic that erupted in 2002, thereby allowing for scary scenarios to seed in the public's imagination. It was then announced that a kind of relationship had been established between the infected persons and camels before a Qatari scientific team declared that the life MERS CoV was isolated from an infected camel. The immediate result of this perceived risk was heightened public attention and interest. However, the repeatedly announced symptoms of suspected cases allowed for better identification and induced voluntary reporting of cases to healthcare facilities.

Substantial proportion of the communication process usually devoted to achieve the preparatory steps of seizing the audiences’ attention besides making sure that the content matters to them. Whereas the public need for information was being satisfied through news releases and press conferences, health education messages constituted a prime ingredient of the communication content.

Despite of the denial and stigma linked to the unfamiliar disease, the communicated health messages had a tangible influence on giving the target audience the information necessary to take decisions on the personal and community level. According to records of the medical Hajj committee, response to the pre-travel medical assessment and vaccination was remarkable. Patients complied with the isolation requirements. Nevertheless, Information, Education, and Communication (IEC) materials were not prepared prior to the press conferences, indicating missed opportunities.

After all, no significant rejection to the recommended course of action was identified.

Study limitations

As this study was based on reviewing the content of print media, other types of mass media were excluded. Moreover, it was important to determine the extent to which the target communities relied on official press releases and press conferences to gain information related to MERS-CoV.

Conclusion

Couple of factors contributed to the successful engaging of the target communities to adopt the recommended course of action: the perceived risk of the novel virus which made the public highly attentive, the timing of the health education messages that usually coincided with the critical disease developments, and the assignment of credible well-known resource officials from the competent authorities. As the public uptake of behaviors recommended by trusted authorities tends to be very high during epidemics, efforts should be made on designing health education messages to be injected within media products like press conferences and press releases during early preparedness phases.

Introduction

Urinary tract infection (UTI) is one of the most common pediatric infections. UTI may be associated with bacteremia and even meningitis in small babies, warranting full septic work up including a cerebrospinal fluid (CSF), especially in infants below the age of 60 days. Literature regarding the co-existence of meningitis in infants diagnosed with UTI is conflicting. It is critical to be able to correctly identify and treat any co-existing meningitis, as both the choice and duration of antibiotic used for UTI, is often insufficient to effectively treat meningitis.

Objective

The primary objective of this study was to determine the rate of co-existing bacterial meningitis in infants below the age of 60 days with a diagnosed urinary tract infection (UTI) and to determine if age, sex and prematurity and bacteremia were risk factors.

Method

A retrospective observational study was conducted at Hamad General Hospital, a tertiary medical institution in the State of Qatar. Patients under the age of 2 months hospitalized with a first episode of UTI from January 1, 2008 to December 31, 2013 were included in the study. UTI was defined as urine culture growing a single organism, with a colony count of greater than 103, where in the urine sample was obtained by either catheterization or supra-pubic aspiration. Infants with pre-exisiting clinical conditions like spina bifida or meningomyelocele and those diagnosed with congenital renal anamolies, were excluded from the study because of their higher likelihood of developing UTI. Infants with a questionable diagnosis of UTI (not in accordance with American Academy of Pediatrics definition of UTI) were also excluded.The study was approved by the Medical Research Center at Hamad Medical Corporation.

Results

113 patients met the inclusion criteria. 51 patients (44.3%) were neonates (0?28 days old) and 64 patients (55.7%) were between the age group of 29 to 60 days. 43.5% of the infants were male, and most (86.1%) were term. All 113 patients had culture proven UTI. The commonest pathogens causing UTI were Escherichia coli (38%), Klebsiella pneumoniae (15%), Enterococcus faecalis (13%), Group B Streptococcus sp(7%), and Citrobacter (6%). As per the routine practice in our institution, blood culture was ordered in all but one patient. Among these 112 patients, 3 (2.6%) had bacteremia. All 3 patients were Term female babies, 2 of them were neonates and 1 was between 29 to 60 days of age. Of the three pts who had a positive blood culture, CSF study was done in two babies, which was negative and 1 patient's family refused CSF study. A cerebrospinal tap was done in 78 patients i.e. 69% of the sudy population. None of these patients had a postive CSF culture. Physicians were more likely to order a CSF study in babies who were neonates (80% had a CSF study, as opposed to 60.3% of babies in the 29 to 60 day age group).

Conclusion

Our study demonstrated that in the 78 patients with culture proven UTI, who had a CSF study, none of the patients had co-existing bacterial meningitis. Our results are reflective of several other studies which also show a low risk of meningitis in patients with UTI. We tried to overcome some of the limitations of these studies by maintaining very strict criteria for diagnosing UTI. CSF study is a part of the septic work up in neonates. In contrast for patients between the age group of 29 to 60 days, more selective approach to lumbar puncture is warranted.

Background: Many health organizations are always highlighting the importance of health promotion, and disease prevention, due to the high incidence of chronic diseases that are spread worldwide and increasing continuously. One of the most prevalent chronic diseases is diabetes mellitus (DM). Many studies conducted in developed countries proved that lifestyle changes in patients resulted in a reduction in the prevalence of diabetes, and that there's a link between DM, and behavioral, clinical, and economical outcomes. Furthermore there was an affiliation between knowledge, attitude, and practice (KAP), and DM. Even though self-management of type 2 diabetes is necessary in order to improve quality of life, many patients still have a problem with being able to self-manage diabetes. Many models and interventions were tested to enhance self-management but none were successful so far. Self-management is a socio-behavioral problem, and the use of a model such as the transtheoretical model (TTM) could improve it. TTM is one of the most commonly used behavioral models. It was first introduced in the 1980s by Prochaska and DiClemente to explain how people change their behavior, but not why they change. It is a model of choice that focuses on the decision making capabilities of individuals. This model is different to alternative approaches to health promotion in that its primarily focus is not on social and biological behavioural influences. It is a psychological health promotion model about the intention of change. It is a model of choice that focuses on the decision making capabilities of individuals. It first uses the baseline information, with an aim to alter self-efficacy, cues, or other psychosocial factors using five TTM principles: Precontemplation, Contemplation, Preparation, Action, and Maintenance. Objective: The objective of this study is to collect enough evidence using a systematic review in order to assess the use of TTM in improving self-management activities in type 2 diabetic patients. Self-management activities include following a healthier diet, exercising more regularly, and an enhanced medication adherence. Methods: The systematic review was conducted between February and May 2015. PubMed (n = 83), Medline (n = 126), Science direct (n = 985), and Cochrane (n = 62) were the databases searched with predefined terms relating to TTM interventions for type 2 diabetic patients. A second extensive search was conducted using google, and google scholar (n = 2) to retrieve articles relevant to the research. The search strategy aimed to identify articles in which the Transtheoretical model had been applied and which had been published in English between 2000 and March 2015. In order to ensure that all potentially relevant articles had been identified, the search terms included “Transtheoretical model”, “Sociobehavioral”, “social changes”, “diabetes”, and “self-management”. All study designs were included and no limits were set to articles comparing the behavioral model to other approaches. The methods used for this review followed the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The systematic search was conducted in March 2015. The initial search of the above strategy yielded 1,153 articles. These articles were reviewed by the primary author for relevance to the aims of the review. Retained articles were then assessed for relevance to the aims based on the title and the abstract using the inclusion criteria. Articles identified as potential for inclusion were then retrieved. Each step during the selection process was conducted by two researchers, and in case of disagreement, consensus would be reached with the aid of a third researcher. Results: There was consensus in the review team that the 10 papers met the inclusion criteria. The 10 studies included were published between 2003 and 2011, and were conducted in the US (n = 6), Canada (n = 1), Trinidad and Tobago (n = 1), Scotland (n = 1), and one was unspecified. In all 10 studies, the majority of participants at baseline were at the Precontemplation/Contemplation or Preparation stage, and after the TTM intervention the majority of patients were at the Action or Maintenance stage. Four studies did not specify which stage had the highest number of participants at baseline and post TTM intervention. In one study, the highest number of participants was at the preparation stage (39.1%) at baseline, and after the TTM intervention the highest number of patients was in the action phase (45.7%) indicating an advancement through the stages of change. Moreover, in 4 studies most of the patients at baseline were in the pre-action stage, but at follow-up after the TTM interventions most of the participants moved to the action or maintenance stage. In one study, the greatest number of participants was at the action/maintenance stage pre- and post- the TTM intervention. All studies demonstrated some positive outcomes self-management due to implementing TTM. Four studies reported a significant reduction in glycosylated hemoglobin (HbA1c), 5 studies reported improvements in diet after TTM, and Participants exercised more in 2 studies. In one study there was progress towards reaching participants’ goals whether it's better adherence, diet, or more exercise. However, using the TTM had no change on medication use in any of the studies included. Moreover, Different study designs were used in all studies. 2 studies were pre-test/post-test. In addition, there were 3 Randomized controlled trials (1 was an RCT, 1 was a randomized split plot design where there was a group receiving the usual care and another receiving the intervention, and another study was a cohort randomized controlled prospective trial). One study was a quasi-experimental study. Three studies were reviews; one was a preliminary study which is an economic evaluation of a theoretical cohort of patients. The other one was a study describing how resources and supports for self-management (RSSM) and strategies of the transtheoretical model intersect to produce a comprehensive approach resulting in cutting-edge diabetes Program, and the last review was determining the impact of TTM in changing the unhealthy dietary habits of type 2 diabetic patients. Moreover, one article followed a cross sectional study design which consisted of questionnaires. Conclusion: Ten articles using TTM to self-manage type 2 diabetes were identified and critically reviewed. The narrative findings from this systematic review provide evidence that TTM interventions are effective in promoting exercise, and encouraging participants to pursue a healthier diet. However, the effect of TTM on medication adherence has not been clearly identified yet, and it should be studied in future research.

Introduction: Doha city has a high feral cat population that is estimated to outnumber its human inhabitants by 2-3:1 with a total population of 2-3 million cats according to Qatar Cat Control Unit (QCCU). Doha had a significant rodent problem for decades as in many cities throughout the world. It was difficult to control this huge rodent number. Therefore, cats were introduced in the 1960s, but without any consideration of the possible knock-on effects to human health. Introduced cats have colonized and reproduce rapidly around food and water resources in both urban and rural areas. It is known that cats are natural host for a wide range of helminths and protozoa. Since there were no plans to eliminate cats after they have been introduced to the country, the density of cats increased in an uncontrollable manner. This high cat population has an obvious risk for human and different diseases such as toxoplasmosis would be expected. Hospital records show that human toxoplasmosis is quite widespread in the city, with up to 35% of women of childbearing age being reported to be seropositive, and 41% of the elderly persons of both sexes in the population. These findings highlight the role cats might be playing in the transmission of protozoa in the society. Cats are also hosts to other closely related species of intestinal protozoa. For example, cats can harbour Isospora spp., Cryptosporidum felis, Giardia intestinalis and Blastocystis spp. Given the high density of cats in the city, it is clearly important to assess the prevalence of protozoal infections among these animals as a first step towards achieving a better understanding of their role in the transmission of human infectious disease of feline origin eventually. Objectives: Since Doha has a high feral cat population, there is a need to understand the role of cats as vectors of human protozoal infections. Our preliminary data indicate that Blastocystis spp. and Toxoplasma gondii is highly prevalent among the residents of Doha. In this project, it was proposed to estimate the prevalence of gastrointestinal protozoa including Giardia intestinalis, Cryptosporedium parvum and Blastocystis hominis in the feral cat population in Doha. A total of 264 fecal samples will be collected from feral cat population from different geographical locations of Doha. Advanced technologies will be used including DNA extraction, RT-PCR and sequencing to provide an accurate assessment of the prevalence. Methodology Study area and Population: Fresh stool samples were collected from cats in different areas in Qatar. In this study, 37 areas were divided into two geographical regions: outside Doha and inside Doha based on occupation of people. Cats were trapped during the winter (November–April) and the summer (May–October) seasons of 2015. Traps were prepared with fish heads or canned cat food. Cats were retrieved from traps and assessed for sterilization status. Pregnant, lactating female cats and cats estimated to be less than 6 months old were immediately released. Cats older than 6 months were eligible for the study. In order to prevent any repetition and re-sampling of cats already and treated earlier, cat's ear will be tagged with a small metal tag. All project ethical approvals were obtained before the beginning of the project. Samples Collection Fresh stool samples were collected from sterilized cats during the period from February–September 2015 and stored at -20 °C by veterinary laboratory of stray cat control unit in Ministry of environment (department of animal resources). A total of 264 samples were processed in order to achieve the aim of this project. Samples were collected in sterile containers labeled with site, where the cat is found, gender and date of collection. The samples were kept and transported on ice and frozen directly after the sample collected. Fecal Examination In order to extract the DNA of the enteric pathogens samples were warmed at 4 °C and approximately 200 mg of the stool sample were used for examination. QIagen miniamp stool kit was used to extract DNA from the sample following manufacturer's instructions with minor modifications. Lyses buffer ASL was added and mixed with each stool sample. Since cat stool is hard to break, tissue rupture machine was used to ensure the homogenization of the sample and increase DNA recovery. This is followed by vortexing the samples and incubating them at 95 °C for 10 minutes to insure complete lysis. After lysis, samples were centrifuged for 10 minutes at 4500 rpm in order to separate and pellet the stool particles. After that, supernatant were placed in new microcentrifuge tubes. Using InhibitEx binding reagent DNA-degrading substances and PCR-inhibitors were separated and removed from the sample. The DNA InhibitEx matrix was centrifugated twice at 14,000 rpm for 3 minutes to pellet the stool and any impurities. 15 μL of proteinase K, 200 μL of the supernatant and 200 μL of the buffer AL were all added to new microcentrifuge and incubated at 70 °C for 10 minutes. Proteinase K is used to digest protein and remove contamination and inactivates nucleases which degrade the DNA during the purification process. However, in order to make proteinase K work high temperature is needed to denature proteins. Therefore, samples are incubated at 70 °C for 10 minutes. Supernatant part containing DNA was then transferred to a Qiagen Minispin column. Two different washing buffers with optimized pH and salt concentration were added to eliminate the digested proteins and any other impurities. Samples were centrifuged at 14,000 rpm before the addition of each buffer. Finally using AE buffer the DNA was eluted. DNA concentration was measured using Nanodrop (Thermo Fisher Scientific, USA). Primers and Probes Using primer designing software, the primer and probe sets used for detecting parasitic pathogens were designed based on data available in National Center for Biotechnology Information (NCBI) databases. Targeted genes were chosen based on published data and studies describing their sequences, uniqueness, and conservation. Real-time PCR Samples were analyzed by uniplex real-time PCR using Applied Biosystems Cycler 7500. Protocols were finalized after adjustment of the respective concentrations of primers, probes and the evaluation of several cycling protocols. A proposed protocol based on available literature was a starting point. Two different fluorescence reporter dyes were used in Real-time PCR. SYBR Green was used for Blastocystis hominis and TaqMan for other targeted parasites. For both fluorescence reporter dyes amplification reactions were performed in a total 20 μL volume in each well with 17.5 μL master mix and 2.5 μL DNA template. For each plate prepared positive controls consisted of internal controls provided by Hamad Medical Corporation (HMC). Both positive and negative controls were run for each sample. Sample PCR results were compared with both controls and analyzed using 7500 software v2.3. Results: A total of 264 of stray cat samples were trapped for examination of enteric parasite. The samples were classified according to their gender, area and season. Table (1) summarized the frequency of the cat population examined. Three protozoal parasites (Giardia intestinalis, Cryptosporidium parvum and Blastocystis hominis) were examined using real-time PCR. According to PCR results obtained previously, Giardia intestinalis was the only protozoa positively detected. Table (2) shows the prevalence of examined protozoa in cat samples. Figure 1 and Fig. 2 show the interaction between Giardia intestinalis infection and other independent variables (gender, season and area). Table 1. Number of stray cats examined by season, gender and study site from Qatar during 2015 Season Winter Summer Male Female Male Female Site N N N N Outside Doha 44 (16.67%) 39 (14.77%) 25 (9.47%) 23 (8.71%) Inside Doha 34 (12.88%) 20 (7.58%) 37 (14.01%) 42 (15.91%) Total 78 59 62 65 *N, number of samples; the number in brackets indicates the percentage of prevalence. Table 2. Number of subjects in each category and the prevalence (%) of the three species of protozoa by gender, season and area Number of subjects Giardia intestinalis Cryptosporidium parvum Blastocystis hominis Gender Male 140 5 0 0 Female 124 7.2 0 0 P 0.443 (NS) NS NS Season Winter 137 6.5 0 0 Summer 127 5.5 0 0 P 0.719 (NS) NS NS Area Outside Doha 131 5.34 0 0 Inside Doha 133 6.77 0 0 P 0.628 (NS) NS NS *NS: not significant **The highest prevalence in each category is in bold italics for emphasis. Benefits to Qatar This study will provide important data for the public healthcare, which they can exploit to determine the role feral cat might be playing in zoonotic diseases in Doha. The training in research methodologies will also foster the interest in research the undergraduate students have and therefore add to the pool of qualified researchers in Qatar.

Common cold is a viral infection of the upper respiratory tract that brings discomfort to people for few days to few weeks. Although, seasonal common cold is widespread during wintertime, the disease can be contracted all year round. Initially common cold was believed to be link to exposure to cold air because of its widespread during that period; the disease has been categorized as infectious disease there after (William and Sheldon, 2009). Common cold can bring about serious economic hardship or downfall to workforce because it often results in absenteeism from work or school (Babak et al., 2009). The disease is the most commonly encountered infectious disease in human and most frequent illness managed by general practitioner. It was reported that about 25 million people visit doctors yearly in the USA alone with common cold (Heikkinen and Jarvinen, 2003). Common cold can be caused by a variety of virus that depends on a number of factors such season and age, with rhinoviruses been the most common cause of common cold. Heikkinen and Jarvinen, 2003 provide extensive literature on common cold that include causes, epidemiology, clinical diagnosis, treatment and prevention. The effect of weather conditions is very crucial in infectious disease modeling. Social network contacts are vital when seeking to understand and predict the spread of infectious diseases inhuman populations. The transmission of infectious disease has been linked to social contact behavior (Willem et al., 2012, Wallinga et al., 2006) and animal contacts (Kifle et al., 2015, Jones et al., 2008). The frequency of infection may depend on the number of social and animal contacts. The spread of infectious disease can be control through understanding the dynamics of social contact behavior and animal contact. It is reported that adults get the illness two to three times in a year while children are infected five to seven times a year (Babak Amra et al., 2009, Heikkinen and Jarvinen, 2003) The objectives of this project are: a) To explore the dynamics of transmission of the common cold between different age groups. b) To investigate the effect of social contact patterns on the disease incidence. c) To estimate the effects of other associated risk factors such climatic and environmental variables. d) To investigate the effect of socioeconomic background such as family size, education, contact type and so on. To explore the influence of animal ownership on the frequency of the infectiousness. Conceptual Framework and data collection This study will look at the relationship between common cold and climatic changes with the effects of social contact through the development of flexible predictor statistical models. We shall combine flexible statistical models for network data to study these relationships. The data sets will be collected by the undergraduate students over a period of 3-4 months within Qatar through the use of surveys. The social network contact survey which includes the illness status and some demographic variables will be conducted within and outside Qatar University. Recruited participants will cut across different age groups, nationality and gender. An adapted version of the social contact survey POLYMOD (Improving Public Health Policy in Europe through the Modelling and Economic Evaluation of Interventions for the Control of Infectious Diseases) will be used for contact diaries. The participants will be asked if they could be contact again via email or telephone (in a month or so) for completion of the second diary. Firstly, they will be asked to answer few demographic questions such as, the number of family member, age, gender, country and educational attainment. Secondly, for each participant, the daily number of social contacts will be recorded as well as contact type. Participants will be asked if they engaged in a direct conversation with someone else at most three meters away or touched someone else (e.g. shaking hands or kisses on the chick), this was considered as a “physical” contact, even if not a word was spoken. In additional to social network contact, participants will be asked about their interaction with animal. Ownership of animal which is defined as having at least one live animal in the household in which the participant was spending the majority of his/her time. Animals with be categorized into four classes: pets (cat, dog, fish), livestock (horse, sheep, camel, cow), poultry (chicken, turkey, pigeon) and “other”. And lastly, each participant will be asked about his/her illness status will be asked (such as onset date and severity). The climatic data sets that will be used are mean daily temperature, humidity and dust aerosol. The collection of the daily climatic data will commence at least a weeks before the survey. Few weeks later (between 2-4 weeks), participants will be contacted again via email or telephone with similar follow-up questionnaire for the second social contact diary. Modeling techniques Logistic regression is a technique used for making predictions when the dependent variable is a dichotomy, and the independent variables are continuous and/or discrete. For analysis of social network data (clustered), random effect term will be added to the regression model to account for the correlation in the data. The resulting model is a mixed model including the usual fixed effects for the regressors plus the random effects in the predictor. Development of generalized linear mixed models (GLMM) for dichotomous data has been an active area of statistical research. Several approaches, usually adopting a logistic or probit regression model and various methods for incorporating and estimating the influence of the random effects, have been developed. The mixed-effects logistic regression model is a common choice for analysis of correlated dichotomous data and is arguably the most popular GLMM.

References

Babak A, Hamid S, Shahin S, Mohammad G. (2006) Prevalence of the Common Cold Symptoms and Associated Risk Factors in a Large Population Study. Tanaffos 5(3): 13-17.

Heikkinen T, Jarvinen A. (2003) The common cold. The Lancet, 361 (9351): 51-59.

Jones K, Patel N, Levy M, Storeygard A, Balk D, Gittleman J, et al. (2008) Global trends in emerging infectious diseases. Nature 451: 990-993. doi: 10.1038/nature06536 PMID: 18288193.

Kifle YW, Goeyvaerts N, Van Kerckhove K, Willem L, Faes C, Leirs H, et al. (2015) Animal Ownership and Touching Enrich the Context of Social Contacts Relevant to the Spread of Human Infectious Diseases. PLoS ONE 10(7): doi:10.1371/ journal.pone.0133461.

Wallinga J, Teunis P, Kretzschmar M. (2006) Using data on social contacts to estimate age-specific transmission parameters for respiratory-spread infectious agents. American Journal of Epidemiology 164: 936-944.

Willem L, Van Kerckhove K, Chao DL, Hens N, Beutels P. (2012) A Nice Day for an Infection? Weather Conditions and Social Contact Patterns Relevant to Influenza Transmission. PLoS ONE 7(11): doi:10.1371/journal.pone.0048695.

Low-density polyethylene (LDPE) represents polymer having good chemical and physical characteristics for which it is widely used in many applications, such as biomedical and food packaging industry. This polymer excels by good transparency, flexibility, low weight and cost which makes it suitable material compared to non-polymer packaging materials. However, its hydrophobicity cause many limitations for antimicrobial activity which can result in absence of some characteristics required in food packaging applications. For that purpose, some researches have done experiments to modify the polymer surface to increase the surface free energy (hydrophilicity). This can be done by introducing some polar functional groups into the LDPE surface which will permit an increment of its surface free energy and so its wettability or adhesion without any disruption in its bulk properties [1]. One of the most preferable modification techniques is known as non-thermal radio-frequency discharge plasma, and it is preferred technique due to the ability to modify only thin surface layer leading to noticable improvement of the surface properties [2].Moreover, it represents environmentally friendly technique since it does not require the use of any hazardous chemicals or dangerous radiations and therefore non-thermal plasma is highly recommended for food packaging applications [1]. In addition, the surface modification of LDPE can lead to the enhancement of the antimicrobial activity, which was the main purpose of this research. Food packaging materials requires preventing any growth of bacteria, fungal, or any other microbial organisms for health and food safety. Some approved preservatives are commonly used directly in foods to preserve them form microorganisms growth and spoilage. Nowadays, some innovative ways are applied to graft acrylic acid on polymers surfaces [3] for biomedical applications to create an effective layer for an immobilization of antibacterial agents and this results in bacteria prevention on the LDPE surface. In this research, we focused on grafting of sorbic acid as one of the most commonly used preservatives in food and beverage for being safe, and effective in bacteria inhibition (whether pathogenic strains or spoilage kinds), molds, and yeasts [4]. It is also used in cosmetic industries since it has good compatibility with skin and it is easily usable [5]. For the potential enhancement of the antimicrobial efficiency, chitosan representing antimicrobial agent was used for the immobilization on sorbic acid created layer. Chitosan (a derivative of chitin polysaccharide) was chosen as a natural occurring antimicrobial agent (from crabs shrimps, and other sea shells [5]) that has strong and effective antimicrobial activity along with its nontoxicity, biofunctionality, biodegradability, and biocompatibility [6]. In this study, the LDPE surface was modified by several modification steps. The first step involved the modification of the LDPE surface by non-thermal radio-frequency discharge plasma as a radical graft initiator for the subsequently polymerization of sorbic acid containing double bonds. In the next step, grafting of sorbic acid was carried out immediately after plasma treatment allowing the interaction of plasma created radicals on LDPE surface with sorbic acid. Final step was focused on the immobilization of chitosan on grafted sorbic acid platform. Each modification step was analyzed by different analytical techniques and methods to obtain detailed information about the modification process. The surface parameters changes after modification of the LDPE surface, such as surface free energy (contact angles measurements), graft yield (gravimetric measurements) surface morphology (scanning electron microscopy and atomic force microscopy) and chemistry (Fourier transform infrared spectroscopy with attenuated total reflectance) were obtained allowing understanding the modification process.

Acknowledgement

The authors gratefully acknowledge use of the services and facilities of the Center for Advanced Materials (CAM) and Central Laboratory Unit of Qatar University, Qatar.

References

[1] S.K. Pankaj, C. Bueno-Ferrer, N.N. Misra, V. Milosavljević, C.P. O'Donnell, P. Bourke, et al., Applications of cold plasma technology in food packaging, Trends Food Sci. Technol. 35 (2014) 5-17. doi:10.1016/j.tifs.2013.10.009.

[2] T.D. Martins, R.A. Bataglioli, T.B. Taketa, F.D.C. Vasconcellos, M.M. Beppu, Surface modification of polyelectrolyte multilayers by high radio frequency air plasma treatment, Appl. Surf. Sci. 329 (2015) 287-291. doi:10.1016/j.apsusc.2014.12.010.

[3] A. Popelka, I. Novák, M. Lehocký, I. Junkar, M. Mozetič, A. Kleinová, et al., A new route for chitosan immobilization onto polyethylene surface., Carbohydr. Polym. 90 (2012) 1501-8. doi:10.1016/j.carbpol.2012.07.021.

[4] S.S. Sumner, J.E. Marcy, The Effect of Sorbic Acid on The Survival of Staphylococcus aureus on Shredded Cheddar and Mozzarella Cheese By Alison K. Roberts Thesis submitted to the Faculty of Virginia Polytechnic Institute and State in partial fulfillment of the requirements for t, (n.d.). http://scholar.lib.vt.edu/theses/available/etd-03102003-151240/unrestricted/ALISONTHESIS.pdf.

[5] F. Devlieghere, A. Vermeulen, J. Debevere, Chitosan: antimicrobial activity, interactions with food components and applicability as a coating on fruit and vegetables, Food Microbiol. 21 (2004) 703-714. doi:10.1016/j.fm.2004.02.008.

[6] M. Aider, Chitosan application for active bio-based films production and potential in the food industry: Review, LWT-Food Sci. Technol. 43 (2010) 837-842. doi:10.1016/j.lwt.2010.01.021.

Around the world as well as in Qatar, breast cancer is characterized among the highest rates of mortalities that are cancer related. Alarmingly, statistics have shown that the incidence of breast cancer is slightly higher in Qatari women than other Arab countries in the region. This evidence suggests the importance of focusing research on understanding and treatment of breast cancer in Qatar. Current treatment options for breast cancer includes; chemotherapy, surgery, and radiotherapy. Chemotherapy and radiotherapy are associated with undesired side effects; thus, many people tend to look for alternative treatments. Herbal treatments have been used as an alternative to traditional cancer therapies in recent years. Several studies have shown that herbs contain bioactive compounds, including flavonoids, steroids, as well as others, which exert anti-oxidative, anti-proliferative, and anti-inflammatory properties. One of the most commonly used herbs in the Arabian Gulf region is Origanum syriacum. It is known to have anti-oxidative effect. Unfortunately, studies are extremely limited in terms of understanding its anti-carcinogenic effect. Therefore, this study was carried out to determine the effect of O. syriacum aqueous extract (OSE) on an aggressive type of breast cancer (MDA-MB-231) cells. O. syriacum extract was prepared by dissolving the ground dried leaves in water and then drying it using a rotarvapor. Viability of MDA-MB-231 cells in the presence or absence of increasing concentration of OSE was examined by MTT assay. The flow cytometry was used to test the cell cycle progression in the presence of OSE. Moreover, the migratory capacity of MDA-MB-231 cells was determined by Boyden chamber and scratch assay. The invasiveness of MDA-MB-231 in the absence and presence of OSE was investigated using the Matrigel coated wells. Furthermore, adherence of MDA-MB-231 cells to fibronectin was tested with and without OSE. The oxidative stress of the different concentrations of OSE against MDA-MB-231 was determined using ROS-glo assay. Finally, western blot analysis was performed to test the metastatic ability (occludin expression) as well as autophagy marker (LC3A/B expression). The results indicated that OSE decreased the proliferation of MDA-MB-231 cells in a time and a concentration dependent manner. The highest anti-proliferative effects of OSE were observed at concentrations of 0.8 mg/ml and above after 24, 48 and 72 hrs of exposure. Furthermore, OSE arrested cells in G1 phase of cell cycle. Also, migratory capacity of MDA-MB-231 cells declined in the presence of OSE at a concentration of 1.2 mg/ml. Moreover, OSE inhibited the adhesive property along with the invasiveness of aggressive breast cancer cell line. Supporting the above results, an increase in occludin expression was observed in cells treated with OSE indicating that O. syriacum extract has an anti-metastatic capacity. Additionally, the production of ROS as well as the expression of LC3A/B proteins increased in MDA-MB-231 cells treated with OSE at concentration of 1.2 mg/ml. Our results demonstrate that Origanum syriacum may have a potential to be used as a supplemental therapy for patients suffering from malignant breast cancer. Further insight into understanding molecular mechanisms and safety of OSE using in vivo studies should be carried out to fully understand its activity at the molecular level and determine its safe use in the treatment/prevention of breast cancer.

Obesity is a major public health problem which adversely impacts mortality and quality of life, also it is associated with significantly increased risk of more than 20 chronic diseases and health conditions [Thiese et al., 2015]. According to the World Health Organization, the prevalence of obesity has nearly doubled within the last 30 years, which has led to an impressive estimate of 402 million obese people worldwide. The etiology of obesity is complex and encompasses a wide range of genetic, physiological, behavioral, cultural, social and environmental factors. Before the appearance of online social media, factors associated with obesity could only be measured in the real-world. However, with social environments moving online, the escalating number of interactions in online communities has created a great opportunity to study huge amount of user-generated content that comprises various topics related to obesity. These topics include people's experiences, recommendations and feedback about certain medications, medical procedures, diets or exercises, and emotional support in the form of encouragement, sympathy, and success stories. Analyzing and exploring these topics can give health practitioners various insights into community dynamics, such as the effects of online social support on community members and the profile of influential members, as well as provide important information to design effective online health intervention strategies [Bennett and Glasgow, 2009]. Online communities can be used to understand and promote health behavior as well as disseminate health innovations. But still little is known about how these communities can help enhance health conditions, such as weight loss. Advantages of online communities include access to many peers with the same health concerns, convenient communication spanning geographic distances, and anonymity (if desired) for discussion of sensitive issues [Hwang et al., 2010]. In this study, we are interested in answering the research question of whether it is possible to use online user generated content to predict success or failure of weight loss and weight maintenance. Concretely, this work investigates if there is a relation between online users behavior and the likelihood of them losing weight in an online Reddit weight loss community, namely “loseit”. Data collected include posts, comments and other metadata (i.e., timestamp, user name, number of upvotes) from August 2010 to November 2014.

In total, we obtained 70, 949 posts and 922, 245 comments. These data were generated by 107,886 unique users. The community encourages users to post their weight and progress along time, sharing experiences. Our aim is to show that social media can be exploited to help health practitioners to understand obesity dynamics, delivering more personalized treatments and improving patient-centered care. In this direction, our findings aid health practitioners to design early warning systems or effective online health interventions strategies that can be incorporated into social media platforms and lead to more effective treatment. These systems may provide great benefit to patients, for example, by integrating recommendation systems that can help users make important decisions, such as choosing the right type of diet or exercise for their obesity condition. We believe that exploring novel approaches to understand and address obesity is crucial to realize Qatar's National Vision 2030 of a healthy population.

Background: Objective structured clinical examinations (OSCEs) are considered the most psychometrically robust form of clinical skills assessment in the health professions. In 2014, the College of Pharmacy at Qatar University (CoP-QU) piloted the first cumulative OSCE for graduating students in collaboration with the Supreme Council of Health and the University of Toronto. Since then, interest has grown in measuring the psychometric properties of this examination to ensure adequate reliability, validity and defensibility. Objectives: This study aimed to evaluate the psychometric properties of the OSCE conducted in 2015 at the CoP-QU. A secondary objective of this study was to identify quality improvement opportunities for design, implementation, and evaluation of the OSCE. Methods: The psychometric analysis occurred as follows: We calculated cut scores and pass rates of the 10 stations being used in the OSCE assessment using borderline regression method. Predictive validity of undergraduate courses grades with OSCE grades were calculated using correlation and regression statistics. Concurrent validity of similar cumulative exams were evaluated using Pearson correlation. Risk of bias was calculated using Spearman correlation between assessors' analytical (checklist sheet of required tasks to be performed in a station) and global (the score of whole performance including communication skills on a scale from 1 to 5) scoring. Content validity was assessed quantitatively using 18 student-feedback forms and qualitatively through focus groups with OSCE participants and contributors (total of 5 assessors, 3 students, 3 administrators, 3 standardized patients). Interrater reliability was assessed using intra-class correlation coefficients (ICCs). Construct validity was evaluated by comparing interrater reliability between the first and second OSCE cycles. Cronbach's alpha was used to determine internal consistency of students' performance in all stations in terms of global and total scores. Correlation statistics were conducted at α level < 0.05. Results: Out of 50% allocated for global score and 50% for analytical score per station, and based on the cut scores calculated for every station, average pass rate per analytical checklist grades in all stations was 70.4%, while average pass rate calculated for total scores in all stations was 79.2%. Four courses simulating professional skills of OSCE, two adapted undergraduate formative OSCEs, and a Medicinal Chemistry course, the control, correlated with the OSCE grades as follow, 0.72 (P < 0.01), 0.47 (P < 0.05), 0.43 (P>0.05), 0.65 (P < 0.01), 0.78 (P < 0.01), 0.61 (P < 0.01), and 0.36 (P>0.05) respectively. OSCE grades can be moderately predicted by Professional skills course grades (52.3%) and its practical assessment (61.2%). Average correlation between analytical and global grades for all assessors was 0.52. A total of 90% of the stations were deemed to reflect practice, according to student perceptions. The average ICC of analytical checklists scores, global scores, and total scores were 0.88 (0.71-0.95), 0.61 (0.19-0.82), and 0.75 (0.45-0.88) respectively. Cronbach's alpha of students' performance in global scores across stations was 0.87, and 0.93 in terms of total scores. Conclusion: The cumulative OSCE conducted in 2015 showed acceptable validity and reliability as a high stakes examination and therefore is suitable to be implemented as a mandatory core curriculum component for student pharmacist assessment in Qatar.