THE NEW DIAGNOSTIC CRITERIA OF AUTISM: IMPLICATIONS FOR RESEARCH AND PRACTICE IN THE MIDDLE EAST AND NORTH AFRICAN REGION

This article discusses history of autism diagnosis and provides an update of the latest diagnostic criteria. This is essential before starting any research or intervention for people with autism anywhere in the world, particularly in the Middle East and North African (MENA) region where autism diagnosis and public perception about this condition is challenging. We start by defining autism and its diagnostic criteria according to American Psychiatric Society (DSM-5 2013), including an outline of some characteristics of people with autism and some related terms e.g. the notion of a ‘triad of impairments’, ‘Autistic Spectrum Disorder’ (ASD) and its relationship with ‘learning disabilities/difficulties’. We concluded that the latest diagnostic criteria according to DSM-5 2013 is very helpful in terms of treating autism as spectrum of different abilities and allow for designing a bespoke individualised interventional approaches to help them. As far as autism in the MENA region is concerned we argue that the new diagnostic criteria if implemented will result in improving the life of people of autism and their families

Lattice-based Robust Distributed Coding Scheme for Correlated Sources

In this thesis we propose two lattice-based robust distributed source coding systems, one for two correlated sources and the other for three correlated sources. We provide a detailed performance analysis under the high resolution assumption. It is shown that, in a certain asymptotic regime, our scheme for two correlated sources achieves the information-theoretic limit of quadratic multiple description coding (MDC) when the lattice dimension goes to infinity, whereas a variant of the random coding scheme by Chen and Berger with Gaussian codes is 0.5 bits away from this limit. Our analysis also shows that, under the same asymptotic regime, when the lattice dimension goes to infinity, the proposed scheme for three correlated sources is very close to the theoretical bound for the symmetric quadratic Gaussian MDC problem with single description and all three descriptions decoders.ThesisDoctor of Philosophy (PhD

Metabolic-associated fatty liver disease: a selective review of pathogenesis, diagnostic approaches, and therapeutic strategies

BackgroundMetabolic associated fatty liver disease (MAFLD) is a novel terminology introduced in 2020 to provide a more accurate description of fatty liver disease associated with metabolic dysfunction. It replaces the outdated term nonalcoholic fatty liver disease (NAFLD) and aims to improve diagnostic criteria and tailored treatment strategies for the disease. NAFLD, the most prevalent liver disease in western industrialized nations, has been steadily increasing in prevalence and is associated with serious complications such as cirrhosis and hepatocellular carcinoma. It is also linked to insulin resistance syndrome and cardiovascular diseases. However, current studies on NAFLD have limitations in meeting necessary histological endpoints.ObjectiveThis literature review aims to consolidate recent knowledge and discoveries concerning MAFLD, integrating the diverse aspects of the disease. Specifically, it focuses on analyzing the diagnostic criteria for MAFLD, differentiating it from NAFLD and alcoholic fatty liver disease (AFLD), and exploring the epidemiology, clinical manifestations, pathogenesis, and management approaches associated with MAFLD. The review also explores the associations between MAFLD and other conditions. It discusses the heightened mortality risk associated with MAFLD and its link to chronic kidney disease (CKD), showing that MAFLD exhibits enhanced diagnostic accuracy for identifying patients with CKD compared to NAFLD. The association between MAFLD and incident/prevalent CKD is supported by cohort studies and meta-analyses.ConclusionThis literature review highlights the importance of MAFLD as a distinct terminology for fatty liver disease associated with metabolic dysfunction. The review provides insights into the diagnostic criteria, associations with CKD, and management approaches for MAFLD. Further research is needed to develop more accurate diagnostic tools for advanced fibrosis in MAFLD and to explore the underlying mechanisms linking MAFLD with other conditions. This review serves as a valuable resource for researchers and healthcare professionals seeking a comprehensive understanding of MAFLD

Transverse Myelitis Associated with Anti-Ro (SSA) Autoantibodies: A Record of Two Cases

Transverse myelitis (TM) is an inflammatory process involving a restricted area of the spinal cord. The usual dramatic presentation makes TM a medical emergency. Early detection and aggressive therapy are required in order to improve the prognosis. The association of this unique clinical phenotype and autoantibody provides circumstantial evidence that an autoimmune aetiology might be involved. We describe two cases of TM associated with anti-Ro (SSA) autoantibodies without connective tissue disease manifestations. The two patients were treated successfully with IV steroids and cyclophosphamide

Impact of polypharmacy phenogroups on different heart failure phenotypes in patients with chronic heart failure: a retrospective examination of real-world cohort

BackgroundPolypharmacy is a rising morbidity amongst patients with chronic heart failure (CHF), with reported prevalence ranging from 70% to 85%. While polypharmacy is essential for managing comorbid conditions, its exact impact on heart failure outcomes is still emerging. This study aims to examine the effects of different polypharmacy phenogroups on mortality and intensive care unit (ICU) admissions across various heart failure phenotypes.MethodsWe conducted a retrospective cross-sectional study involving 4,902 patients with chronic heart failure treated at Hamad Medical Corporation, Doha, Qatar, between January 2018 and January 2022. Patients were classified into three polypharmacy groups: no polypharmacy (0–4 medications), major polypharmacy (five to eight medications), and excessive polypharmacy (≥9 medications). Heart failure phenotypes were categorized based on ejection fraction (EF): reduced EF (HFrEF, <40%), mildly reduced EF (HFmrEF, 40%–49%), and preserved EF (HFpEF, ≥50%). The primary outcome was all-cause mortality, with secondary outcomes including intensive care unit (ICU) admissions.ResultsA cohort of 4,902 patients with chronic heart failure, with a mean age of 61.47 years (SD 15.99), was analyzed. Among them, 51.7% had heart failure with reduced ejection fraction (HFrEF), 16.2% had mildly reduced ejection fraction (HFmrEF), and 32% had preserved ejection fraction (HFpEF). Major polypharmacy due to guideline-directed medical therapy (GDMT), was associated with a significant improvement in survival. In patients with HFpEF, the hazard ratio (HR) for all-cause mortality was 0.62 (95% CI: 0.52-0.75, p < 0.001), while for HFmrEF, it was 0.70 (95% CI: 0.59-0.85, p = 0.001). Conversely, excessive polypharmacy involving non-heart failure medications, was linked to increased ICU admissions (odds ratio [OR]: 1.34, 95% CI: 1.10-1.62, p = 0.02). Cox proportional hazards models demonstrated that excessive polypharmacy was associated with a hazard ratio of 0.11 (95% CI: 0.05-0.23, p < 0.001) for all-cause mortality when the medications were primarily heart failure-specific.ConclusionIn patients with chronic Heart failure, guideline directed polypharmacy was associated with improved survival, particularly in HFpEF and HFmrEF phenotypes. However, non-heart failure-related polypharmacy is associated with worse outcomes including ICU admissions, necessitating need for targeted interventions for this group of patients

What is polypharmacy in people living with HIV/AIDS? A systematic review.

Polypharmacy in people living with HIV/AIDS (PLWHA) is a rising morbidity that exacts hefty economic burden on health budgets in addition to other adverse clinical outcomes. Despite recent advances, uncertainty remains around its exact definition in PLWHA. In this systematic review and Meta-analysis, we explored relevant databases (PUBMED, EMBASE, CROI) for studies evaluating polypharmacy in PLWHA from January 2000 to August 2021 to ascertain the exact numerical threshold that defines this morbidity. Two independent reviewers extracted and reviewed relevant variables for analyses. The review included a total of 31 studies involving n = 53,347 participants with a mean age of 49.5 (SD ± 17.0) years. There was a total of 36 definitions, with 93.5% defining polypharmacy as the concomitant use of 5 or more medications. We found significant variation in the numerical definition of polypharmacy, with studies reporting it as "minor" (N = 3); "major" (N = 29); "severe" (N = 2); "excessive" (N = 1); and "higher" (N = 1). Most studies did not incorporate a duration (84%) in their definition and excluded ART medications (67.7%). A plurality of studies in PLWHA have established that polypharmacy in this cohort of patients is the intake of ≥ 5 medications (including both ART and non-ART). To standardize the approach to addressing this rising morbidity, we recommend incorporation of this definition into national and international PLWHA treatment guidelines

Kikuchi–Fujimoto Disease: Review of 11 Cases Diagnosed Over 10 Years at a Tertiary Care Hospital in Doha, Qatar

Introduction: Kikuchi-Fujimoto (KF) disease is a rare and self-limiting disorder of unknown aetiology characterized by cervical lymphadenopathy (CLN) and fever. The pathophysiology remains unclear and may be triggered by an infectious agent leading to a self-limiting autoimmune process. There are no confirmatory laboratory tests and lymph node biopsy is required to differentiate KF disease from other serious conditions. Materials and methods: We report 11 cases of KF disease diagnosed at Hamad General Hospital, Qatar, between 2006 to 2016. The diagnosis is based on clinical presentation, investigations and histopathological examination of lymph nodes. Results: All patients had painful neck swelling (average duration of 2.9 weeks) and 10 had fever (average duration of 3.2 weeks). Five patients developed mild leucopenia which resolved completely. HIV and tuberculosis (TB) screening including sputum for AFB, a PPD skin test and chest x-ray was done for all patients and came back negative. Autoimmune screening was done for all patients and excluded any rheumatological disease. Ultrasound and CT of the neck confirmed cervical lymphadenopathy. Except for hepatomegaly in one patient, CT scans of the chest and abdomen were negative for any lymphadenopathy or organomegaly (performed in seven patients). Diagnosis was confirmed on lymph node excision biopsy. Histopathological examination showed findings consistent with the diagnosis of histiocytic necrotizing lymphadenitis (KF disease).Conclusion: KF disease should be kept in mind for patients presenting with fever and CLN. Lymphoma, TB and autoimmune diseases like systemic lupus erythematosus should be excluded in such patients