bluuebunny/crossref_metadata_2025_split huggingface dataset:
Novel Perspectives on the Hepatitis B Virus Vaccine in the Chronic Kidney Disease Population
Authors: Fabrizi Fabrizio , Martin Paul , Messa Piergiorgio 
Published: January 2016

Background The prevalence and incidence rates of hepatitis B virus (HBV) among patients undergoing maintenance dialysis in developed countries have declined over the last 2 decades thanks to the implementation of numerous infection control procedures in dialysis units, including the hepatitis B vaccine. It is well known that the immune response against HBV vaccine is unsatisfactory in the chronic kidney disease (CKD) population. The seroprotection rate after the HB vaccine schedule is low and the anti-HB titers are reduced, falling logarithmically over time. Purpose We did an extensive review of the medical literature on the mechanisms underlying the reduced response rate towards the HBV vaccine in patients with CKD. The efficacy and safety of HBV vaccines for use in the CKD population was also evaluated. Results Currently available vaccines against HBV are mostly plasma-derived or manufactured by recombinant DNA technology (yielding the S protein of the HBV envelope). The most promising strategy to enhance the immune response toward the HBV vaccine in the dialysis population is given by adjuvanted vaccines. Second-generation recombinant HB vaccines provided with a novel adjuvant (AS04, made of 3- O-4′-desacyl-monophosphoryl lipid A adsorbed on aluminum phosphate) demonstrated improved immunogenicity but a number of patients with an unsatisfactory response still occurs. Additional second-generation vaccines containing nonaluminum-based adjuvant systems such as AS02 (3- O-desacyl-4′-monophoshoryl lipid A and QS21) or 1018 (a Toll-like receptor 9 agonist) have shown higher immunogenicity and acceptable safety in the CKD population. The evidence in patients with end-stage renal disease is extremely limited on the use of third-generation vaccines, recombinant HBV vaccines expressed in mammalian cells containing S/Pre-S antigens. Conclusions The immunogenicity of HBV vaccines in patients with CKD is suboptimal but novel technologies promise to give better results in the near future.
How to Select and Develop International Law Case Studies: Lessons from
Comparative Law and Comparative Politics
Authors: Linos Katerina 
Published: February 2016

To develop international law claims, it is often critical to compare different countries’ laws. This essay explores how methods drawn from comparative law and comparative politics research can help international lawyers make comparative inquiries more simply and straightforwardly.International lawyers recognize three main sources of legal authority: treaties, custom, and general principles. Cross-national comparisons are deeply embedded in the very definitions of two of these three sources. To establish international custom, an international lawyer must show that a broad range of states consistently engage in a certain practice out of a sense of legal obligation. To establish a general principle, an international lawyer must show that it is “recognized by civilized nations”; in practice this requires that the principle be found in diverse legal families. Treaty interpretation does not necessitate cross-country comparison as a matter of definition: in theory, the text of the treaty itself could provide the requisite answers. However, in practice, international and domestic courts are typically faced with ambiguous treaty terms. To interpret them, they often turn to the jurisprudence of diverse states and to subsequent state practice, thus implicitly beginning a comparative inquiry. in sum, comparative international law is useful for identifying and applying international law, as this volume’s introduction explains.
Protocol on the Establishment of the African Monetary Fund & Statute of the African Monetary Fund
Authors: Ofodile Uche Ewelukwa 
Published: February 2016

On June 27, 2014, at the 23rd Ordinary Session of the Summit of the African Union held in Malobo, Equatorial Guinea, member states of the Africa Union adopted the Protocol on the Establishment of the African Monetary Fund (Fund).
Plan for the Fund is not new but dates back to the 1963 Charter of the Organization of African Unity (the predecessor to the Africa Union) as well as to the 1991 Abuja Treaty—the agreement that established the African Economic Community and put in place a framework for continental integration. The Constitutive Act of the African Union (Constitutive Act) adopted in 2000 also envisaged the establishment of the Fund. Annexed to the Protocol is the Statute of the African Monetary Fund (Statute). As envisioned in the Abuja Treaty, the Fund, together with continental institutions such as the Africa Investment Bank and the African Central Bank that are still in the pipeline, are critical to efforts to create a continental economic and monetary union in Africa.
Prevalence of hepatitis c virus infection among multitransfused thalassemic children in Basrah – Iraq
Authors: Al Wtaify A. S. , Hassan M. K. 
Published: February 2016

Between November 1998 and May 1999 a prospective study for HCV antibodies was conducted on 200 patients (113 males and 87 females), with B-thalassemia major and sickle cell-thalassemia, who were attending the thalassemia center at Basrah Maternity and Children Hospital. Their ages ranged from 1-18 years with a mean age of 9 years.
Nineteen patients (9.5%) were found to have antibodies in comparison to only one (0.5%) amongst the 200 children of a control group. The risk of exposure to HCV was higher than for HBs antigen and HIV amongst the same patients.
Anti-HCV seropositivity was significantly higher amongst patients with B-thalassemia major than patients with sickle cell-thalassemia and patients older than 10 years.
The study showed also that anti-HCV seropositivity was directly related to the frequency of blood transfusion and there were significant elevations of serum bilirubin and aminotransferase levels amongst seropositive thalassemic patients compared to seronegative patients.
The Pattern and Severity of Primary Glaucoma in Qatar
Authors: Al Mansouri F. 
Published: February 2016

Purpose: To describe the pattern of both types of pri-mary glaucoma in Qatari adult patients and to outline the main problem related to its management.
Material and Methods: A random sample of Qatari patients with primary glaucoma either open angle or angle closure glaucoma in whom the diagnosis was made after the age of 30 years was studied over the last 2 years (1997-1998) by standard questionnaire as regards their personal and medical profile, and assessed ophthalmologically both subjectively and objectively.
Results: 195 patients were studied, of whom 29.7% had angle closure glaucoma. Early presentation was clearly shown in both type of glaucoma. Legal blindness was present in significant proportion of patients.
Comment: Glaucoma in Qatari patients presents at an early age, with substantial loss of visual function at presentation. Poor compliance is an obstacle for manage-ment in both types of glaucomas. The need for an educa-tional campaign and a program for early detection is highly advised.
“From Qatar to the World” Abstracts Presented at International Conferences
Authors: Hammoudeh Mohammed 
Published: February 2016

Objective: To identify the incidence of ocular injury in Qatar from January 1999 to December 2000 and the related factors.
Methods: Retrospective study of all patients who suffered ocular injury requiring hospitalization during the mentioned period. Data was collected from medical records and the statistical analysis done using SPSS 7.5.
Results: The type of ocular injury and the effect on the Visual Acuity were determined, as well as the incidence relationship to age, gender and occupation. The main causative agents are outlined and the surgical procedures done and sequels reported.
Conclusions: This study provides data about the risk factors and visual outcomes of ocular trauma in Qatar, allowing recommendations that could decrease its incidence in the future.
Fetal Echocardiography Service in Qatar: Establishment, Challenges and Outcome
Authors: Ahmed B. , El Sisi A. , Khenyab N. , Saleh N. , Al Mansoori Z. , Gendi S. , El Said H. , Numan M. 
Published: February 2016

A prospective observational study at the newly estab-lished Fetal Medicine Unit, Hamad Hospital, Qatar; evalu-ated the impact of the service on the detection rate of criti-cal congenital heart defects, patterns of referral and sub-sequent yield for structural congenital heart disease in a population with a significant proportion of high risk fac-tors.
Of 391 pregnant females examined between January 2003 and December 2004, 58 (14.8%) had fetal cardiac abnormalities of which 23 (5.8% of total referrals) had major structural malformations of the heart. Cases of fetal congenital heart disease had further evaluation us-ing real time three-dimensional echocardiography (RT3DE) which is new equipment in the paediatric cardi-ology department. All cases with cardiac defects whether minor or major had follow up fetal echocardiography. Neonatal echocardiography confirmed the diagnosis in all cases with major defects (100% specificity). False positive cases that were found to be normal post natal were 1% of the total cases referred (12% of cases with congenital mal-formation). False negative cases were 1% and all had a small ventricular septal defect (VSD) except for one Down's syndrome with a very large VSD.
Three patients needed urgent Caesarean section (CS) deliveries, one with complete heart block (HB) and two with supraventricular tachycardia (SVT). One patient traveled abroad as the fetus had left isomerism and major cardiac defects and complete HB. Fifteen newborns had to receive prostaglandin based on the fetal diagnosis before being seen by paediatric cardiologists. There was no termination of pregnancy due to major cardiac defects even in cases of HLHS.
The preliminary results of this clinic are very satisfac-tory and have affected favorably the outcome of the new-borns with congenital heart defects. It is hoped that the results of this study will encourage more referrals to the FMU.
Acute Pancreatic Nine Years of Surgical ICU Experience
Authors: Shaikh N. , Kettern M. A. , Louon A. , Ahmed A. H. A. 
Published: February 2016

Acute pancreatitis has a variety of presentations from self-limiting abdominal pain to development of local and systemic complications resulting in sepsis, multi-organ dysfunction, extended intensive care stay and death. Very good quality of life in survivors justifies an optimal therapy in an intensive care setup. The records of 91 patients with acute pancreatitis were reviewed retrospectively. There was a significant difference (p < 0.001) between those with edematous pancreatitis and those with necrotic pancreati-tis as regards the length of ICU stay and severity scores: Ranson and SOFA (Sepsis-related Organ Failure Assess-ment). The most common cause of pancreatitis was biliary (70.3%) followed by hyperlipidemia (12.1%), post ERCP (5.5%), trauma (4.4%), idiopathic (6.6%) and in one case, ascariasis. Common associated diseases were hypertension (33%) and diabetes mellitus (25.3%). Six patients with necrotic pancreatitis died. It is concluded that acute pancreatitis treated in an in-tensive care unit has a favorable outcome and that a com-bination of Ranson and SOFA scores with CT index helps in establishing the prognosis.
Ultrasound Prediction of Fetal Macrosomia in Diabetic Women and its Effect on the Route of Delivery and the Outcome of Pregnancy
Authors: Seyam Y. S. , Ahmad Riad E. H. , Elzain S , Saleh N. 
Published: February 2016

Objective: The purpose of this study is to review the maternal and neonatal outcome in pregnant diabetic women given a trial of labor and delivered macrosomic infants (>4000 grams) and to assess the accuracy of birth weight prediction by ultrasound examination at term.
Methods: One hundred and twenty-nine charts of pregnant diabetic women were reviewed, sixty eight women were given a trial of labor and delivered macrosomic fetuses (>4000 grams), fifty of them had vaginal delivery and the other eighteen had caesarean delivery. In the other group, 61 patients delivered by elective caesarean section, for 41 of them the indication was fetal macrosomia (>4000 grams) as estimated by ultrasound examination and in the other 20, it was due to clinical estimation of big baby. Maternal and neonatal complications were reviewed in each group. Maternal complications included lacerations, hemorrhage and infection and the neonatal complications evaluated were shoulder dystocia and associated birth trauma, asphyxia, and mortality. The accuracy of ultrasound in estimating fetal weight was also evaluated.
Results: Sixty eight (52.7%) women attempted a trial of labor; 73.5% delivered vaginally and 26.5% had a caesarean delivery. All, except two, had macrosomic fetuses (>4000 grams). Only one woman, of those who delivered vaginally, had postpartum hemorrhage due to atonic uterus. The incidence of shoulder dystocia for infants weighing 4000-4499 grams was 6.3% and those infants had the same incidence (6.3%) of brachial plexus injury. There was no perinatal asphyxia or perinatal mortality among those infants who were delivered vaginally. There were no maternal complications for women who had caesarean delivery after labor (18 patients) but there was perinatal asphyxia in two infants who were treated properly without any neurological sequele. Elective caesarean delivery was performed in 47.3% of the study population. There were no neonatal complications or perinatal mortality in this group of patients and only one woman had wound infection. The sonographic prediction of fetal weight was accurate in 52.4% of the cases. The over estimation was in 50.8% of the estimated fetal weights and 49.2% of them were underestimated when compared to actual birth weights.
Conclusions: Caution should be taken in the use of sonographic estimations of fetal weight to guide obstetric decisions concerning labor and delivery. Special consideration should be given to diabetic patients having fetuses with estimatedfetal weights between 4000 and 4500 grams. Flexibility in the management of these patients is best, taking in consideration their previous obstetric performance and if the estimated fetal weight is closer to 4500grams than to 4000 grams, it is perhaps, better to proceed to a primary caesarean delivery.
The Role of Anti-Phospholipid Auto Antibodies Syndrome in Cerebrovascular Diseases
Authors: Ali H. Y. M. , Abdullah Z. A. 
Published: February 2016

Objectives: The aims of the study are to determine the role of anti-phospholipid autoantibodies (APLAs) among patients with stroke and/or transient ischaemic attacks (TIAs), to identify the types and effective isotype of some important APLAs which are lupus anticoagulant (LA), anticardiolipin (aCL), anti∼fi2 glycoprotein I dependent (afi2-GPI), and anti-phosphatidyl serine (aPS). Also, to find out any concomitant effect of non-APLAparameters not specific to antiphospholipid syndrome (APS).
Subjects and Methods: This study was carried out on 50 patients attending mainly the Teaching and General Hospitals in Mosul, Duhok, and Erbil Cities, Iraq during the period between 1st March 2004 and 1st March 2005. The studied cases were under 50 years of age, and had no recognizable risk factors. The activated partial thromboplastin time (APTT) was used for LA estimation and ELISA assay was used to test for IgG& IgM isotypes ofaCL, aJ32-GPI, and aPS. The ANA, RF, VDRL, CRP, and C4 complement were tested by different immuoserological methods. The thrombocytopenic (TP) status was diagnosed by estimation of platelets counts.
Results: The strokes and!or TIAs related to APS were diagnosed in 22/50 (44%) of patients and a significant correlation was reported among patients with IgG plus IgM aCL (p < 0.05), IgG afi2-GPI (p < 0.05), and IgG aPS (p < 0.05). In APLAs positive patients, raised CRP concentrations were reported in 36.4%, TP status in 22.7%, ANA in 22.7%, RF positive in 13.6%, and low C4 levels in l3.6%. Finally,the FP-VDRL test was found in 50 % of APLAs positive cases.
Conclusions: The aCL, afi2- GPI, and aPS antibodies were shown to play a significant role in the development of stroke and!or TIAs among the studied cases.
Critical Care of Gynecological and Obstetric Patients: A decade of surgical intensive care experience
Authors: Khawaga S. , Ei Sayed N. , Shaikh N. , Mustafa G. , Kettern M.A. , Hafiz A. 
Published: February 2016

Despite the emergence of therapeutic advances, the morbidity and mortality still occur in the obstetric patients, although intensive care utilization by obstetric and gynecological patient, are still rare compared to the general population. Majority of obstetric patients needed the intensive care therapy compared to gynecological patients. The aim of our study was to know the indications for the intensive care admission by obstetric and gynecological patients, length of stay and outcome of these patients.
Methods: We retrospectively reviewed the medical records of all obstetric and gynecological patients admitted to our Surgical and Trauma Intensive Care Units (SICU and TICU) from February 1995 to March 2005. Indication for admission, nationality, age, and length of stay in ICU, severity of disease and outcome of these patients were recorded. Data analyzed with SPSS program.
Results: A total of 182 patients were admitted to the SICU of the Hamad Medical Corporation in Doha, Qatar, from the Women's Hospital. 159 (87%) patients were obstetric patients and 23 (13%) patients gynecological patients, 126 (69.6%) patients were admitted post Lower Segment Caesarean Section (LSCS). The most common indication for admission was 73 (39.3%) patients obstetric hemorrhage and Disseminated Intravascular Coagulation (DIC), and then 44 (25.3%) patients of hypertensive disorder of pregnancy. The major anesthesia related indication was scoline apnea, 21 (11.6%). Total three obstetric patients died, two due to severe sepsis and multi-organ failure and one due to cerebral sinus thrombosis, giving mortality rate of 1.66%.
Conclusion: Intensive care therapy required by gynecological and obstetric patient is less than the general population. The commonest indication for admission was obstetric hemorrhage, DIC, and hypertensive disorders of pregnancy. The mortality was due to septic shock with multi-organ failure, and cerebral venous sinus thrombosis.
Treatment of Refractory Diffuse Diabetic Macular Edema with Intravitreal Bevacizumab
Authors: El Shafei M.M , Pai A , Al Hashimi M , Warid F , Farouk M 
Published: February 2016

To analyze the short term visual acuity and anatomic response after a single dose of off-label intravitreal injection of bevacizumab in diffuse diabetic macular edema (DME) not responding to conventionallaser photocoagulation.
Patients arid Methods: Prospective analysis of consecutive case series of 45 eyes of 38 patients with refractory diffuse DME who had one intra-vitreal injection of 1.25 mg of bevacizumab (Avastin) and followed up for 3 months. All patients passed at least six months since their last laser treatment before inclusion in the study. Patients underwent best corrected visual acuity determination, intraocular pressure measurement, stereoscopic biomicroscopy of the macula and measurement of the retinal thickness by optical coherence tomography (OCT) at base line and follow up visits.
Results: At 1 month post-injection, visual acuity improved by 1 line in 7 eyes, unchanged from the preinjection levels in 24 eyes and deteriorated in 14 eyes. At 3 months post injection, visual acuity improved in 18 eyes, it remained unchanged in 13 eyes and deteriorated in 14 eyes. The mean logMAR visual acuities were 0.60 (SD ± 0.34), 0.64 (SD ± 0.31) and 0.61 (SD ± 0.32) at pre-injection, at 1 month post-injection and at 3 months post-injection respectively; but this mean decrease in vision was statistically not significant (P value = 0.099). The foveal thickness on optical coherence tomography had decreased in 27 eyes and it increased in 18 eyes at 1 month post-injection. At 3 months following injection, foveal thickness was reduced in 34 eyes, but was increased in 11 eyes. The mean foveal thicknesses were 444.95 u (SD ± 127.36), 394.95 u (SD ± 138.03) and 378.32 u (SD ± 11 2.01) at pre-injection, 1 month post-injection and 3 months post-injection respectively. This decrease in the foveal thickness was statistically significant (P value < 0.001).
Conclusions: Intravitreal bevacizumab is effective in patients with diffuse DME which is refractory to treatment with conventional macular laser photocoagulation. Key words: bevacizumab, intravitreal, diffuse diabetic macular edema
Quality Care of Patients with Diabetes Mellitus in the Diabetic Clinic at Al Wakra Healthcare Center, Qatar
Authors: Nazar R , Al Ansari Y , Abdulmajeed A 
Published: February 2016

Introduction: Diabetes mellitus is a chronic illness that requires continuous medical care. Patient health education and self-management aim to prevent acute complications and to reduce the risk of long-term complications. Care of diabetic patients is a complex process and requires many issues beyond glycemic control. This study is conducted to assess quality of care of diabetic patients in the diabetic clinic at Al Wakra Healthcare Center and to determine some factors that may affect the quality of this care.
Methodology: This is a descriptive, cross-sectional study. The target population was all diabetic patients (Type 2) that meet the inclusion criteria and registered at the center. Two checklists assessed the structure of diabetic care; the first checklist is for the essential items of care (thirteen items) and the second one is for the less essential items (ten items). The indicators of the process of diabetic care was assessed by a scoring system that depends on ten items for standard diabetic care by the primary care physicians in the past year. Assessment of the outcome was done according to an international quality assurance protocol and it includes: the degree of diabetic control, obesity, smoking among the diabetic patients and control of blood pressure. We added HbA1c to this list. Another questionnaire was designed to determine factors that may affect quality of diabetic care-related to patient's knowledge and attitude and it is divided into 4 sections: personal data, patient knowledge about diabetes, patient attitude toward care and clinical and biochemical assessments. A pilot study was carried out to test the questionnaires. Epi-info. Six statistical package was used for data entry and statistical analysis. Chi square or Fisher exact tests were used to test the significance, and P value < 0.05 was considered significant.
Results: The study showed that diabetic care at Primary Healthcare Centers (PHC) in Qatar represented by Al Wakra Primary Healthcare Center is better when compared to the care in other studies in different countries. 86.7% of physicians show that most of the structure items are good to fair except for the absence of chiropodist and identification cards for diabetic patients. Assessment of the process of care showed that there is good to fair recording in 91.75% of cases; foot examination is not recorded in most of cases; and fundus examination is not recorded in 31.7%. The outcome indicators showed that patient knowledge about diabetes is poor in 35% of cases, uncontrolled FBS in 75.6% of cases, uncontrolled HbA1 c in 57.8%; obesity in 63.5% and control of blood pressure is not achieved in 49% of cases.
Conclusion: Diabetic Clinic at Al Wakra Primary Healthcare Center provides good care for diabetic patients in terms of structure, process and outcome; however, more efforts are needed for refining these services.