To our knowledge, this is the first detailed information about epilepsy in Qatar. The geographical origin of patients adds to the heterogeneity of this disorder. Neurocysticercosis should be in the etiological differential diagnosis of epilepsy in patients coming from Southeast Asian countries, despite the fact that it is not endemic to Qatar. The choice of antiepileptic drugs is influenced by the availability of individual agents in the patients' native countries but had no bearing on the final seizure outcome.
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
BackgroundThe average number of clerkship weeks required for the pediatric core rotation by the US medical schools is significantly lower than those required for internal medicine or general surgery.ObjectiveThe objective behind conducting this survey study was to explore the perceptions and expectations of medical students and pediatric physicians about the third-year pediatric clerkship.MethodsAn anonymous survey questionnaire was distributed to all general pediatric physicians at Hamad Medical Corporation and to students from Weill Cornell Medical College-Qatar.ResultsFeedback was obtained from seven attending pediatricians (100% response rate), eight academic pediatric fellow physicians (100% response rate), 36 pediatric resident physicians (60% response rate), and 36 medical students (60% response rate). Qualitative and quantitative data values were expressed as frequencies along with percentages and mean ± standard deviation and median and range. A P-value <0.05 from a 2-tailed t-test was considered to be statistically significant. Participants from both sides agreed that medical students receive <4 hours per week of teaching, clinical rounds is the best environment for teaching, adequate bedside is provided, and that there is no adequate time for both groups to get acquainted to each other. On the other hand, respondents disagreed on the following topics: almost two-thirds of medical students perceive postgraduate year 1 and 2 pediatric residents as the best teachers, compared to 29.4% of physicians; 3 weeks of inpatient pediatric clerkship is enough for learning; the inpatient pediatric environment is safe and friendly; adequate feedback is provided by physicians to students; medical students have accessibility to physicians; students are encouraged to practice evidence-based medicine; and students get adequate exposure to multi-professional teams.ConclusionAssigning devoted physicians for education, providing proper job description or definition of the roles of medical student and physician in the pediatric team, providing more consistent feedback, and extending the duration of the pediatric clerkship can diminish the gap of perceptions and expectations between pediatric physicians and medical students.
Introduction Ustekinumab (UST) is effective for induction and maintenance of remission in Crohn’s disease (CD) as demonstrated in the UNITI trials. There is paucity of data in real world experience for dose escalation with UST, particularly for perianal disease. This study examines the effectiveness and safety of dose escalation in both luminal and perianal CD at a tertiary IBD referral center. Methods A retrospective, single center cohort study was conducted at the University of Texas Southwestern Medical Center examining outcomes of UST dose escalation in CD. Dose escalation was defined as increasing frequency to every four or six weeks. The primary outcomes were improvement in perianal disease as documented by the treating clinician and a composite outcome reflecting disease response. Patients who met the composite outcome had at least one of the following: steroid-free clinical response, objective improvement in disease activity on follow up CT, MRI or endoscopy, or normalization of CRP. Secondary outcomes included IBD-related surgery and adverse events. Patients were followed up to 6 months after dose intensification. Results 38 patients underwent dose intensification. 28 patients (74%) were escalated to every 4 week dosing and 10 patients (26%) were escalated to every 6 weeks. Baseline characteristics were recorded (see Table 1). 18/38 (48%) were escalated for primary non-response. Median time from UST induction to dose escalation was 10 months (IQR 2–24 months). Following escalation, patients were followed for a medianof 4.5 months (range 1–6 months). Nearly all (92%) patients had prior exposure to anti-TNF therapies and 74% had prior exposure to an anti-integrin therapy. Pre-escalation inflammatory markers included median CRP of 9.55 mg/Land median fecal calprotectin of 340 μg/mg. Median UST trough prior to escalation was 1.3 μg/mL(IQR 0.8–2.1). Overall, half (19/38) of patients who underwent dose escalation met the primary composite outcome of disease response and 50% (12/24) of patients with active perianal disease showed evidence of improvement after escalation. 60% (6/10) of the patients on steroids at time of escalation achieved steroid-free response. 72% (8/11) of those who underwent follow-up endoscopy showed endoscopic improvement. 50% (6/12) of patients who had radiographic follow-up showed signs of improvement. 27% (9/33) had normalization of CRP after dose escalation. 8% (3/38) patients required an IBD-related surgery after dose escalation. Two patients had adverse events recorded (see table 3). Conclusion Patients who underwent UST dose escalation demonstrated improvement in perianal disease as well as steroid-free clinical, endoscopic, radiographic, and biochemical response. No increase in serious adverse events was seen in this cohort. Dose escalation is an effective option for non-responders to every 8-week dosing.
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