Samer Hammoudeh

Validity and Reliability of the Arabic Version of the Positive and Negative Syndrome Scale

Background: The Positive and Negative Syndrome Scale (PANSS) is widely used for patients with schizophrenia. This scale is reliable and valid. The PANSS was translated and validated in several languages. Objective: The aim of this study was to translate and validate the PANSS in the Arab population. Subjects and Methods: The PANSS was translated into formal Arabic language using the back-translation method. 101 Arab patients with schizophrenia and 98 Arabs with no diagnosis of any mental disorder were recruited. The Arabic version of the Mini International Neuropsychiatric Interview (MINI-6) was used as a diagnostic tool to confirm the diagnosis of schizophrenia or rule out any diagnosis for the healthy control group. Reliability of the scale was assessed by calculating internal consistency, interrater reliability and test-retest reliability. Construct validity was assessed using the Arabic version of the MINI-6. PANSS total scores were correlated with the Clinical Global Impression-Severity scale. Results: Our findings showed that the internal consistency was good (0.92). Scores on the PANSS of the patients were much higher than those of the healthy controls. The PANSS showed good interrater reliability and test-retest reliability (0.92 and 0.75, respectively). In comparison with the MINI-6, the PANSS showed good sensitivity and specificity, which implies good construct validity of this version. Conclusion: In conclusion, the Arabic version of the PANSS is a reliable and valid instrument for the assessment of patients with schizophrenia in the Arab population.

The effect of non-exercise activity thermogenesis on subjects with metabolic syndrome – a proof of concept study in Qatar

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

Prevalence and Association of Periodontal Disease among Rheumatoid Arthritis Patients in Qatar: A Cross Sectional Study

Objective: The goal of this study was to examine the prevalence of periodontal disease among rheumatoid arthritis patients in Qatar, along with investigating the association between the two diseases. Methods: A total of 92 participants (43 cases with rheumatoid arthritis and 49 controls without rheumatoid arthritis) were recruited from the outpatient rheumatology clinic at Hamad Medical Corporation in Doha, Qatar. The ACR/EULAR 2010 for the diagnosis criteria for rheumatoid arthritis were used to diagnose participants. Results: The overall prevalence of periodontal disease was 73.9% (95% CI: 64.2 to 82.1). The percentage of periodontal disease was observed to be higher among the rheumatoid arthritis group compared to the nonrheumatoid arthritis group (76.7% vs 71.4%; p=0.562). Patients older than 50 years of age were significantly associated with an increased risk for periodontal disease [unadjusted OR=4.11; 95% CI (1.42, 11.43); p=0.009]. Having rheumatoid arthritis [unadjusted OR=1.32; 95% CI (0.52, 3.38); p=0.563], females [unadjusted OR=1.55; 95% CI (0.51, 4.74); p=0.437], rheumatoid disease duration more than 10 years [unadjusted OR= 1.33; 95% CI (0.32, 5.59); p=0.684], and body mass index of less than 30 [unadjusted OR=1.17; 95% CI (0.46, 3.01); p=0.740] were positively associated with an increased risk for periodontal disease. Conclusions: This is the first study to assess periodontal disease among rheumatoid arthritis patients in Qatar. Future work might need to involve a larger, more representative sample.

Rheumatic manifestations of inflammatory bowel diseases: A study from the Middle East

Objective To examine the prevalence of rheumatic manifestations among patients with inflammatory bowel disease (IBD). Methods This prospective study enrolled patients with IBD in whom the diagnosis and extent of IBD were confirmed by colonoscopy and histopathology. Patients were interviewed and examined by a rheumatologist. A complete rheumatological examination, X-rays of the lumbosacral and sacroiliac joints and HLA-B27 blood tests were performed. Results A total of 127 adult patients were recruited: 46 (36.2%) with Crohn’s disease (CD) and 81 (63.8%) with ulcerative colitis (UC). Rheumatic manifestations of any type were present in 57.5% (73 of 127 patients) with no significant differences between CD and UC. Peripheral manifestations were present in 43.3% (55 of 127 patients), four patients (3.1%) had axial arthritis alone and 14 patients (11.0%) had both types. Among those with peripheral manifestations, five patients (7.2%) had type 1 arthritis (pauciarticular) and one patient (1.4%) had type 2 arthritis (polyarticular). A higher proportion of patients with CD had axial manifestations with or without peripheral manifestations (eight of 46; 17.4%) compared with patients with UC (10 of 81; 12.3%), but no difference was observed in patients with peripheral manifestations alone. Conclusions Rheumatic manifestations in patients with IBD in Qatar are more prevalent than in other regions of the world. Peripheral manifestations were more prevalent than axial.

Oral Manifestations of Systemic Lupus Erythematosus Patients in Qatar: A Pilot Study

Objective The purpose of this pilot study was to assess the prevalence of oral manifestations among systemic lupus erythematosus (SLE) patients in Qatar, in order to warrant future studies that would investigate each one of these manifestations with detail and further scrutiny. Methods Study procedures took place between November 2014 and April 2016. All patients visiting the outpatient rheumatology clinics at Hamad General Hospital, Doha, Qatar, were asked to join. The American College of Rheumatology (ACR) 1997 criteria of SLE were used. The patients were examined initially by a rheumatologist and were later scheduled for an appointment with a dentist at the same institution. A total of 77 patients were recruited for the study. Results Prevalence rates for the different oral manifestations ranged from 2.4% for soft palate ulcers, cheilitis, and oral candida to 88.1% for the presence of cavitation. Gingivitis, periodontal disease, cavities, and missing teeth were observed in more than 50% of the sample. The prevalence of periodontal disease and missing teeth was higher among those with an SLE duration > 8 years. On the contrary, the prevalence of gingivitis and cavities was higher among those with an SLE duration ≤ 8 years. Conclusion This study found high rates of gingivitis, periodontal disease, cavities, and missing teeth among SLE patients in Qatar. It is recommended that healthcare providers of such patients monitor the presence of any oral manifestations in order to arrange for early treatment and prevention efforts. Future prospective longitudinal studies with adequate sample size and power are needed in order to ascertain any causation factors or common etiology pathways.

Validation of the Five-Factor Model of the Arabic Version of the Positive and Negative Syndrome Scale in Schizophrenia

Background: The Positive and Negative Syndrome Scale (PANSS) is a widely used assessment for patients with schizophrenia across clinical and research settings. This scale allows the classification of the psychotic symptoms to better understand the psychopathology in patients with schizophrenia. There are no available data on the different components of psychopathology in Arab patients with schizophrenia. Objectives: This study examined the factor structure of the validated Arabic version of the PANSS in a sample of Arab patients with schizophrenia. Methods: The Arabic version of the PANSS was administered to 101 patients with schizophrenia, and principal component analysis (PCA) was carried out after the cross-cultural adaptation and validation of this version. Results: This sample had more males (66.3%) than females (33.7%) with a mean age of 35.03 years (SD = 9.99). PCA showed that 28 items loaded on 5 components: cognitive, negative, excited, depressed and positive. These factors explained 63.19% of variance. The 2 remaining items, grandiosity and somatic concerns, did not load well on any of these components. Conclusion: Our results support the common 5-dimension PANSS model shown in other cultures with different languages. Nevertheless, there were minor differences, which could reflect cultural or semantic differences.

Advanced glycation end products among patients maintained on antipsychotics

The aim of this study was to measure advanced glycation end products (AGEs) among participants maintained on antipsychotics using the AGE Reader and to compare them with controls from the general population. Participants maintained on antipsychotics for at least 6 months were recruited from the Psychiatry Department at Rumailah Hospital, Doha, Qatar. Healthy controls were recruited from the primary healthcare centers in Doha, Qatar. AGEs of a total of 86 participants (48 patients and 38 controls) were recorded. Among the group maintained on antipsychotics, women, smokers, and Arabs had significantly higher AGEs levels compared with men, nonsmokers, and non-Arabs, respectively (P<0.05). The levels of AGEs were higher among the group of patients maintained on antipsychotics in comparison to controls; however, the difference did not reach statistical significance. This is the first study to examine AGEs in patients maintained on antipsychotics. Our findings showed that such patients do not differ significantly from controls comparing AGEs levels. Future investigations might need to consider recruiting a larger sample size using a prospective design.

Validation of the Arabic Version of Calgary Depression Scale for Schizophrenia.

Background Patients with schizophrenia commonly show both depressive and negative symptoms that can differentially affect the prognosis and course of treatment. The Calgary Depression Scale for Schizophrenia (CDSS) was designed to distinguish between depression and negative symptoms in patients with schizophrenia. The purpose of this study is to validate an Arabic version of the CDSS among patients with schizophrenia. Methods The diagnosis of schizophrenia was confirmed using the Arabic Mini International Neuropsychiatric Interview 6 (MINI 6). A standardized translation back-translation process was adopted. One rater administered the Arabic CDSS to subjects with schizophrenia as well as to a control group who should not have any psychiatric disorder except for depression. Another rater, blinded to the results administered the already validated Arabic version of Beck Depression Inventory-II (BDI-II). Results We recruited 102 patients and 102 controls subjects. The CDSS showed good internal consistency in the active group (Cronbach’s alpha = 0.82). The Intraclass Coefficient correlations (ICC) for the inter-rater reliability (n = 21) was 0.90, p<0.05 and test-retest reliability (n = 19) was 0.85, p<0.001. When compared to the BDI-II, the cutoff score of 5 on the Arabic CDSS showed reasonable sensitivity and specificity of 72.75% and 67.95% respectively. Conclusions The psychometric properties of the Arabic version of CDSS demonstrate that it is a valid tool to assess the depressive symptoms in the Arab patients with schizophrenia.

An assessment of patients’ knowledge of osteoporosis in Qatar: A pilot study

Osteoporosis is a disease that affects the bones. It leads to increased risk of fractures as a result of decreased bone mineral density. The goal of this study was to assess the general perception of osteoporosis as well as knowledge of lifestyle, risk factors, and preventive measures among patients in Qatar. The study was conducted between September 2013 and September 2014. The study subjects (n = 93) were patients diagnosed with osteoporosis who attended the Outpatient Rheumatology Clinic at Hamad General Hospital in Doha, Qatar. The results showed that those with a university or graduate degree had a significantly higher level of knowledge about osteoporosis (p = 0.009) than those with less education. Among those in our study, knowledge related to osteoporosis was principally obtained through media sources such as television and radio (39%). In conclusion, osteoporosis patients in Qatar need a better understanding of the disease. Identifying thought patterns related to the perception of osteoporosis and treatment might assist in building a foundation for management modalities and effective preventive strategies for the disease in Qatar.