Background: Cigarette smoking is one of the major preventable causes of death and diseases in Qatar. The study objective was to test the effect of a structured smoking cessation program delivered by trained pharmacists on smoking cessation rates in Qatar. Methods: A prospective randomized controlled trial was conducted in eight ambulatory pharmacies in Qatar. Eligible participants were smokers 18 years and older who smoked one or more cigarettes daily for 7 days, were motivated to quit, able to communicate in Arabic or English, and attend the program sessions. Intervention group participants met with the pharmacists four times at 2 to 4 week intervals. Participants in the control group received unstructured brief smoking cessation counseling. The primary study outcome was self-reported continuous abstinence at 12 months. Analysis was made utilizing data from only those who responded and also using intent-to-treat principle. A multinomial logistic regression model was fitted to assess the predictors of smoking at 12 months. Analysis was conducted using IBM-SPSS® version 23 and STATA® version 12. Results: A total of 314 smokers were randomized into two groups: intervention (n = 167) and control (n = 147). Smoking cessation rates were higher in the intervention group at 12 months; however this difference was not statistically significant (23.9% vs. 16.9% p = 0.257). Similar results were observed but with smaller differences in the intent to treat analysis (12.6% vs. 9.5%, p = 0.391). Nevertheless, the daily number of cigarettes smoked for those who relapsed was significantly lower (by 4.7 and 5.6 cigarettes at 3 and 6 months respectively) in the intervention group as compared to the control group (p = 0.041 and p = 0.018 respectively). At 12 months, the difference was 3. 2 cigarettes in favor of the intervention group but was not statistically significant (p = 0.246). Years of smoking and daily number of cigarettes were the only predictors of smoking as opposed to quitting at 12 months (p = 0.005; p = 0.027 respectively).

RationaleEpilepsy is one of the most prevalent neurologic conditions. It is estimated to affect 70 million people worldwide. Epilepsy is an important cause of disability and mortality. It is associated with social stigma and significant economic costs. Although epilepsy is a disease with a worldwide distribution, its prevalence varies between different countries. Very little is known about the epidemiology of epilepsy in Qatar. Qatar's population is a mixture of native citizens and immigrants. We aim at describing the features of epilepsy in Qatar as such information is virtually lacking from the current literature.MethodsA database was created in 2014 to summarize information retrospectively collected on patients with epilepsy seen through the national health system (HMC) adult neurology clinic. For each subject, in addition to the typical demographic variables, we identified the age at onset, seizure types, epilepsy syndrome, etiology, treatment and outcome. Brain imaging and EEG results were also tabulated. All these variables were analyzed using the statistical package for social science (IBM-SPSS, version 20).ResultsOf 504 patients included in the database, 467 with sufficient information were analyzed. Sixty percent were men. The mean age at the last clinic visit was 35. Native Qataris represented 38.5%, Asian subjects 33%, and Middle Eastern/North African (MENA) origin accounted for 25% of the studied population. Generalized tonic-clonic seizures were the most common seizure type, noted in 89% of subjects. Epilepsy was classified as focal in 65.5% of the cases, and generalized in 23%. EEGs were abnormal in 55.5 %, showing epileptiform discharges in 49% of subjects. Imaging studies revealed epileptogenic pathologies in 40% of reports. Common causes of epilepsy were: vascular (11%), hippocampal sclerosis (8%), infectious (6%) and trauma (6%). Sixty six percent of patients were receiving a single antiepileptic drug, and 53% were seizure free at the last follow-up. Overall, the most commonly prescribed drug was Leviteracetam (41%) followed by Valproic Acid (25%) and Carbamazepine (22%). On current therapy, 54% of patients were seizure-free, 41% had a partial response and five percent were refractory. When the patients were divided by geographical background, some differences were noted. Remote infections caused the epilepsy in 15% of Asian patients (with neurocysticercosis accounting for 10%), but only in 1% of Qatari and 3% of MENA subjects (with no reported neurocysticercosis) (p

Background Achieving a low DAS28 (disease activity score) of less than 3.2, is a common treatment goal for Rheumatoid Arthritis (RA). In clinics however, despite efforts, some patients still fail to reach treatment goals due to various barriers. Given the relatively high average disease activity level in the UAE with an average DAS28 of 4.3 (1), better understanding the barriers that exist in local clinics may yield novel information regarding how to better treat RA in the future. Objectives This study aims to better understand the factors that affect low disease activity (DAS28<3.2, LDA) and barriers in the UAE and propose a future course of action in order to improve the treatment of RA within the region. Methods Data was collected through chart reviews of 182 consecutive RA patients who were seen in a private clinic in Dubai over a 2-month period. Demographic/treatment data and DAS28 scores were collected. Patients were separated into a LDA group and a group comprised of moderate (DAS28 >3.2 and <5.1) and high disease activity (DAS 28 >5.1) (MHDA). We then examined variables that may be associated with LDA and re-examined the MHDA group for barriers such as irreversible joint damage, inability to pay for treatment, resistant disease, patient driven preferences, safety concerns and comorbidities. Results While 97 (53%) of the 182 patients had achieved the treatment target of DAS 28 <3.2, 21 (11.50%) had high disease activity and 64 (35%) had moderate disease activity. No substantial difference was found in delay to diagnosis, past methotrexate use, or rheumatoid factor or anti-CCP status between the LDA and MHDA group (Table 1). However, a significantly larger portion of LDA patients had been previously treated with sulfasalazine, SSA, (36 in LDA vs 14 in MHDA, P0.002) or were presently on biological treatments (24 vs 9, P0.013). For the 85 MHDA patients, 40 (22% of 182) exhibited resistant disease with 25 (13.7% of 182) failing their current first tier disease modifying anti-rheumatic drug (DMARD) treatment or combinations and 15 (8.2% of 182) failing current anti-TNF or biologic treatment. Notably 16 of the 25 failing DMARD treatment (40%) did not change treatment plans due to insufficient insurance. Other notable barriers were patient driven preferences (20%), non-inflammatory musculoskeletal pain (9%), and safety concerns (7%). Conclusions Over half the patients achieved the DAS28 LDA target. Factors that significantly influenced LDA were prior SSA use and current biological therapy. Among those who did not achieve target (MHDA), the most prominent barriers included resistant disease (47%) and patient driven preferences (20%). Reasons listed for resistant disease and patient-driven preference were primarily socio-economic with 40% of the resistant disease group unable to afford biological drugs and 59% of the patient-driven preference group discontinuing or refusing DMARDs against professional advice. Going forward, better educating patients on the proper use of anti-rheumatic drugs could help r...

Background Variations exist in the prescription of non-biologic and biologic DMARDS for patients with Rheumatoid Arthritis (RA).Low and middle income countries use Methotrexate (MTX) and Biologics less frequently compared to high-income countries.These variations are attributed to provider and patient preferences, practice settings, and country's GDP1. Objectives To examine the prevalence of prescription of MTX & Anti-TNF drugs for RA treatment in some Arab States. Methods The Genetics of Rheumatoid Arthritis in some Arab States (GRAAS) is a multinational study designed to study the genetics & clinical characteristics of Arab RA patients from Jordan, Kingdom of Saudi Arabia (KSA),Lebanon, Qatar and the United Arab Emirates (UAE).Inclusion criteria are age≥18, Arab ancestry & diagnosis of RA based on ACR criteria.Data collected includes demographics,ancestry, disease duration, comorbidities,and the use of DMARDS.To assess prescribing patterns,we analyzed the prevalence of ever use of MTX and available anti-TNF (Infliximab,Etanercept and Adalimumab)in each of the countries.Because of difference in countries per Capita GDP,the countries were divided into two regions:Levant (Jordan and Lebanon) and Gulf (KSA and Qatar).Analysis using mean, standard deviation,t test,frequency and Chi square were used as appropriate.Adjusted analysis was done using logistic regression. Results 470 patients were included in the study.Mean age is 49±13.0 years.Female to male ratio is 5:1.Mean disease duration is 10.2±8.74 years. 52.3% of the patients were positive for both ACPA and RF. Patients from the Gulf were more likely to be seropositivethan patients from the Levant (57% vs 44% p=0.009) and significantly less likely to be seroengative (14%vs. 28% p<0.01).Methotrexate was the most commonly prescribed DMARD (87.0%). Anti-TNF drugs were prescribed in 31.2%. Patients from the Levant were less likely to receive MTX and anti-TNF as compared to patients from the Gulf (Table).After adjusting for age, gender, seropositivity&disease duration, patients from the Gulf are more likely to have received any anti-TNF (OR=3.78). Frequency of prescription of methotrexate and anti-TNF drugs across sites Differences in prescription across regions Medication Jordan KSA Lebanon Qatar Levant Gulf p N=130 N=96 N=80 N=162 N=210 N=258 Methotrexate 76.2% 97.9% 86.6% 89.5% 80.2% 92.6% <0.001 At least one anti-TNF 11.5% 51.0% 23.8% 38.9% 16.2% 43.4% <0.001 Conclusions Patterns of prescription of MTX & Anti-TNF for RA patients vary among Arab countries.Countries in the Gulf have prescription frequency for MTX similar to rates from developed countries, but high frequency of prescription of Anti-TNF in excess of what is reported from the developed countries. In depth analysis of patients level of disease activity,physician practice patterns and site,& health insurance type is needed to understand these variations. References Putrik et al.,Inequities in access to biologic and synthetic DMARDs across 46 European countries, Ann Rheu...

Background Genetic and ancestral risk factors underlying Rheumatoid Arthritis (RA) susceptibility in Arab populations are largely unknown.Elucidating these factors provide insights for the practice of precision medicine in Arab populations. Objectives 1)Examine population structure in Arab RA cases/controls,2)test for association of ancestral principal components with RA risk,and 3)test if inbreeding,relatedness and markers of RA severity differ between individuals from the Gulf (G) vs.the Levant (L). Methods The study Genetics of Rheumatoid Arthritis in some Arab States examines the genetics & clinical features of Arab RA patients from Jordan,KSA,Lebanon, Qatar & the UAE.To date,604 cases & 444 controls enrolled.In a pilot of a GWAS targeted for 500 cases/controls,DNA from 163 subjects from Jordan,Qatar & the UAE was genotyped using the Illumina Human Core Exome Array.PC analysis was performed in Eigenstrat.Identity-by-state clustering,pair-wise identity-by-descent and the inbreeding coefficient based on observed vs.expected homozygous genotypes were calculated using Plink.T-tests were done to assess difference in inbreeding & relatedness between cases of G and L ancestry.Association between 10 PC of ancestry & RA status & between self-reported ancestry & seropositivity were assessed using logistic regression adjusting for age and gender. Results After quality control,genotype data were available for 93 cases and 59 controls for 539,346 SNPs.PC analysis including reference panels from the HapMap2 populations revealed proximity to the CEU European population,with most G and L subjects in a line from the European to the Yoruban African population & greater heterogeneity observed in G samples.Pair-wise identity by state distance-based clustering identified one primary Arab population group comprising all individuals.PC3, the principal component that clearly separated subjects from the Levant from those from the Gulf, was associated with RA (p=0.038),suggesting that subjects with G ancestry captured by this PC might be at greater RA risk. The Arab population showed more inbreeding than outbred populations,but no significant difference in the inbreeding coefficient was found between L and G populations. While overall,the study population was not highly related, cases from the Levant showed greater inter-relatedness than cases from the Gulf (p=0.011).After adjusting for age and gender, more patients with G ancestry compared to L ancestry reported either ACPA or RF positivity (p=0.021). Conclusions An Arab RA case-control sample with Gulf and Levant sub-components clusters as one population proximal to European populations and exhibits subtle population structure.The sub-population of G ancestry is more genetically diverse than the L sub-population, and may contain genetic variation that contributes to increased risk of RA, and seropositivity.Imminent GWAS should clarify if risk alleles for RA in European populations contribute to disease risk and/or severity in some Arab groups. Acknowledgements The study i...