Il MIOT (Myocardial Iron Overload in Thalassemia ...

Vol. 10 - n. 1 - Gennaio-Aprile 2012 ISSN 2035-0678

Indexed in EMBASE/Compendex/Geobase/SCOPUS

Le striae distensae o “smagliature” (I parte) Periodico quadrimestrale - Poste Italiane S.p.A. - Spedizione in abbonamento postale - D.L. 353/2003 (conv. in L. 27/02/2004 n. 46) - Art. 1, comma 1 DCB Milano

Vincenzo De Sanctis

ORGANO UFFICIALE

ESPERIENZA SUL CAMPO Il pediatra tra Narciso e Peter Pan Maria Giuliano, Costantino Apicella, Vincenzo Bianco, Riccardo Amoroso, Marialuisa D’Arco, Paola Ecuba

FRONT LINE Come l’adolescente vive la casa. La sindrome del “nido” vuoto Fabio Franchini, Stefania Pisano

MAGAM NOTES Declaration of Catanzaro 2010-2011

The adolescent in the Arabic culture Ashraf T. Soliman, Ahmed Elawwa, Aml Sabt

Il MIOT (Myocardial Iron Overload in Thalassemia) network nella diagnosi e nel follow-up del paziente talassemico Alessia Pepe

Rivista Italiana di Medicina dell’Adolescenza - Volume 10, n. 1, 2012 MAGAM NOTES

The adolescent in the Arabic culture

MAGAM NOTES

Section Editor: Bernadette Fiscina, New York

Ashraf T. Soliman, Ahmed Elawwa, Aml Sabt Department of Pediatrics, Hamad Medical Center, Doha, Qata.

Summary

The current “youth bulge” in the population of Arab countries creates bigger demands for educational and healthcare services which should be anticipated and planned. The prevalence of emotional and behavioural disorders is increasing in the Arab adolescent, and rates are comparable to international data. Adolescent health problems especially noted in this area include the high prevalence of overweight/obesity, and vitamin D and iron deficiencies, which necessitate appropriately planned national policies in order to combat them. Concerns are raised about the lack and/or deficiency of specific adolescent medical care and the inability of specialist child and adolescent mental health services to meet these growing need and demands. Key words: adolescent care, Arabic countries.

Introduction The Arab world consists of 25 Arabic-speaking countries stretching from the Atlantic Ocean in the west to the Arabian Sea in the east, and from the Mediterranean Sea in the north to the Horn of Africa and the Indian Ocean in the southeast, straddling North Africa and Western Asia. It has a combined population of 358 million people (Figure 1) (1). In 2005 the number of young Arab persons totaled 66.2 million, of which 33.8 million were males and 32.4 million females. The proportion of young people in the total population of Arab countries is the highest since 1950, accounting for 20.62% of the overall Arab population. In 2005, this proportion was almost equal to that of Africa, and is the highest in the world (Figure 2) (2). There are economic disparities between oil-rich and oil-poor countries, which, particularly in the more sparsely populated states of the Arabian Gulf and Libya, trigger extensive labor immigration. Four Arab Gulf states, Saudi Arabia, the UAE, Kuwait, and Qatar, are among the top ten oil or gas exporters worldwide. Algeria, Libya, Iraq, Bahrain, Egypt, Tunisia, and Sudan all have smaller but significant reserves (1, 3). Despite the economic disparities, the authoritative parenting pattern is still common in most of the Arab countries. The current “youth bulge” in the populations of

Arab countries is intimately linked to the demographic evolution of the region in the last few decades. Large numbers of youth might be seen as a burden on the economy because of bigger demands for educational and healthcare services, in addition to

Figure 1. Arab Countries.

21


decent job opportunities. This increases fiscal risk in already heavily indebted Arab countries (4). Young people in the Arab region today face challenges in the areas of education, health, unemployment, and gender equality (5).

15-24 year olds ranges from less than 1% in Jordan to 50% in Yemen. Literacy rates for young women are quite high in most Arab countries, with the exceptions of Yemen, Comoros, Mauritania and Morocco. Secondary school enrollment rates in the Middle East North Africa (MENA) region remain lower than in Latin America and East Asia (2). Figure 2. In 2004, overall secondary school Population pyramid, Arab countries, 2005. enrollment rates below 50 per cent could still be found in Djibouti, Mauritania, Sudan, Comoros, Iraq, Morocco and Yemen. However, female secondary enrollment in MENA increased dramatically from 1970 (15%) to 2004 (63%). Nonetheless, these rates remain lower in 2004 than overall enrollment, and remain close to 18 per cent in Djibouti and Mauritania (2). As for tertiary education, enrollment rates in the MENA region are well below those found in Latin America and East Asia, with less than 19 per cent average enrollment rate in universities. Few financial returns to higher education coupled with uncertain labor market outcomes are the main factors underlying the low enrollment in universities across the Arab world (2).

Demography and marriage patterns

Health and reproductive health

Over the past decade, Arab societies experienced a significant decline in early marriage among women, which caused adolescent and overall fertility rates to fall. Forty percent of women aged 15 to 19 were married in Kuwait and Libya in the early 1970s, but these figures had dropped by the mid-1990s to 5% and 1%, respectively. In the UAE the percentage of women ages 15 to 19 who were married dropped from 57% in 1975 to 8% by 1995. The decrease in early marriage and adolescent fertility is beneficial as young mothers may not have sufficient knowledge of safe medical practices and are entirely dependent on their usually older husbands for access to healthcare and other services.

Publicly available data on youth-related health issues such as reproductive health, sexually transmitted diseases and other risks are lacking for Arab adolescents. This is evidence of the reluctance most Arab societies have in openly addressing their young persons’ health needs. High adolescent mortality rates were recorded in Iraq, Mauritania, Djibouti, Sudan, Egypt and Yemen. Young females have, on the average, lower mortality rates than young males (2, 6).

Arab adolescents and education

Reproductive health general knowledge

The Arab region is slowly advancing towards full literacy among young people. In 2004, the regional average rate of literacy for youth was 89.9% for males and 80.1% for females. More than one third of young people remain illiterate in some Arab countries (Djibouti, Mauritania, Somalia, Sudan, and Yemen). Illiteracy for

An inventory of KAP studies (highly focused evaluations that measure changes in human knowledge, attitudes and practices http://files.dnr.state.mn.us/assistance/grants/community/6kap_su mmary.pdf) in the Middle East North Africa (MENA) region, covering Algeria, Bahrain, Egypt, Iraq, Jordan, Lebanon, Morocco,

22


Gender equality

Oman, Syria, and Tunisia, published by UNFPA in 2004, showed that knowledge of reproductive system anatomy and physiology is low in most countries. Knowledge of at least one modern contraceptive is generally high. Knowledge (heard of) of HIV/AIDS is generally high but that of other STIs is generally low. Knowledge of transmission of HIV/AIDS by sexual contact is high but of other modes of transmission is quite low. The main source of knowledge seems to be the mass media, specifically TV, but the preferred sources of knowledge are parents and health professionals. Overall, Arab youth feel they are not susceptible to HIV infection. Most of the data on behavior across countries is related to age at marriage, number of children, and use of contraception when married. Results overall indicate the presence of a knowledge and information gap (2, 7). In Egypt, a youth reproductive health study (n = 1660 adolescents) with subjects between 14 and 24 years of age (55% females, 80% single, 20% married) (Table 1) showed a relative lack of knowledge of certain kinds of family planning methods, especially condoms, and a relative lack of knowledge of STDs other than AIDS and lack of knowledge about STD prevention (Table 1) (8).

The relative share of women in tertiary education is below 10% in Morocco, Sudan, Mauritania, Djibouti, Comoros and Yemen, while other Arab countries have also low female tertiary education enrollment. The young female labor force participation is below 30% in most Arab countries, with the exception of Somalia, Mauritania, Djibouti, Comoros and Syria; these mostly rural countries still have an agrarian economic structure which induces women to work at an early age. In Egypt 25.8% of females aged 15-24 are not in the labor force and not in school, and as many as 35.6% of young women in Jordan are in a similar state. These proportions are compared to the male rates of 12.2 and 3 per cent in Egypt and Jordan, respectively (2, 10).

Parenting styles and mental health of Arab adolescents The Psychological State Scale, Multigenerational Interconnectedness Scale, and the Parental Authority Questionnaire were administered to 2,893 Arab adolescents in eight Arab societies. Authoritative parenting was associated with a higher level of connectedness with the family and better mental health of adolescents. A higher level of adolescent-family connectedness is associated with better mental health of adolescents (11).

Table 1. Reproductive health knowledge in Egyptian adolescents. Illiterate

15%

University degree

9%

Ideal age of marriage

21.5 y for females 25 y for males

Married before 18 years

15%

95% knew about

Family planning

77% knew about

Use of contraceptive pills

53% knew about

Injectable contraceptives

92% knew about

IUD

Smoking and tobacco (The Global Youth Tobacco Survey) The GYTS, a school-based survey that collects data from students aged 13-15 years, gave information on tobacco use in 21 of 22 countries in the region. Most data focus on cigarette smoking. Generally about 20% of 13-15 year-olds in the region (in any country) are current users of any tobacco product. Lebanon is an outlier (60% smoke cigarettes). Data about other forms of tobacco use, especially arghile, are still missing. Egyptian male adolescents (n = 1930 students) showed a prevalence of ever-smoking of 34%, smoking within the last 30 days of 16%, current smoking of 8% and susceptibility to smoking, 51%. Female prevalence of ever-smoking was 16%, 30-day smoking was 7%, current smoking was 4% and susceptibility to smoking was 26%. Smoking causes 90% of the lung cancer cases in Egypt, and tobacco-related cancers as a percentage of all cancers are on the rise. In Qatar, of adolescents aged 13-15 years, 16.6% were current tobacco users in 2004. Current use of any tobacco product was found in 20.2% (boys = 25.9% and girls = 14.9%). In Algeria, 24% of adolescents aged 15-29 consumed tobacco at least once in their lives (42.3% of males and only 0.3% of females). The average age for starting to smoke is 16.3 yrs. Around 36% of males consume between one and two packs per week (12-15).

Those using contraceptives Use IUD

67%

Use injectable contraceptives

14%

Use oral contraceptives

19%

Unemployment One out of three young persons in the labor force in the Arab world is unemployed, with female unemployment almost 10 per cent higher than for males. The Gulf countries have the lowest youth unemployment rates, mostly due to the recent economic boom following rising oil revenues. Youth unemployment rates as high as 43.4 per cent and 39.8 per cent are found in Algeria and Palestine, respectively. Young females’ unemployment rates are almost double those of males in Saudi Arabia, Qatar, Jordan and Egypt (2, 9).

23


Table 3.

Alcohol and other Drugs

Comparison of overweight prevalence in Arab Countries (From: http://www.cdc.gov/GSHS/results/index.htm accessed Sept. 30th 2006).

Data about alcohol use is found for only three countries (Lebanon, Saudi Arabia, and Syria). It appears to be low (~5%) in Saudi Arabia and Syria, but high (40%) in Lebanon. Data about drug use was only obtained from two countries: Lebanon (10% ever use) and Saudi Arabia (6% ever use) (14, 16).

Anorexia-Bulimia A representative stratified random sample of 495 adolescent girls in the UAE completed the Eating Attitudes Test (EAT-40). One hundred and sixteen girls (23.4%) scored above the recommended values on EAT. Half of those were found to have a propensity for anorexic behavior, while 2% met the criteria for the full clinical syndrome (Table 2) (17, 18). In Oman, 33% of Omani teenagers (29.4% females and 36.4% males) showed a propensity for anorexic-like behavior. On the Bulimic Investigatory Test, 12.3% of Omani teenagers showed a propensity for binge eating or bulimia (13.7% females and 10.9% males). In contrast, barely 2% of Omani adults showed either the presence of or a severe behavior disorder regarding food (19).

Dietary behavior

Lebanon 2005

Jordan 2004

Oman 2005

UAE 2005

Percent of students who are overweight

2.7

3.5

NR

11.8

Percent of students at risk for becoming overweight

15.7

13.9

NR

21.3

Violence (Global School-based Student Health Survey) (GSHS) There is a notable prevalence of violence (Table 4) and mental health issues such as sense of isolation and suicidal ideation (Table 5) among adolescents in school in some countries (23, 24). Table 4. Comparison of violence prevalence among adolescents in Arab countries (From: http://www.cdc.gov/GSHS/results/index.htm accessed Sept. 30th 2006).

Violence

Table 2. Prevalence of eating disorders in Arab female adolescents. Country

Abnormality

Females

UAE (495)

Abnormal eating attitude

23.4%

UAE

Bulimia/ Nervosa

2%

Egypt

Abnormal eating attitude

11.4%

Egypt

Bulimia/ Nervosa

1.2%

Jordan

Abnormal eating attitude Bulimia/ Nervos

12.5 1%

Lebanon 2005

Jordan 2004

Oman 2005

UAE 2005

Percent of students who were physically attacked one or more times in the last 12 months

40.5

NR

38.6

31.9

Percent of students who were in a physical fight one or more times in the last 12 months

45.9

46.6

41.6

43.2

Percent of students who were bullied on one or more days during past 30 days

33.9

46.4

36.0

20.9

Table 5. Comparison of student mental health data in Arab Countries (From: http://www.cdc.gov/GSHS/results/index.htm accessed Sept. 30th 2006).

Obesity, Vitamin D and iron deficiency

Mental health issue

Obesity seems to be a particular problem in the Arab Gulf States (GCC) (Saudi Arabia, Qatar, Bahrain, and UAE). In various samples 25-30% are overweight or obese (Table 3). In these countries the prevalence of type II diabetes mellitus and the metabolic syndrome are exceptionally high (around 25%) (20). Vitamin D and iron deficiency appear to be two major adolescent health problems in different Arab countries (21, 22).

24

Lebanon 2005

Jordan 2004

UAE 2005

Percent of students who felt lonely most of the time or always in last 12 months

12.0

15.8

14.4

Percent of students who seriously considered suicide

15.8

15.1

12.7

Percent of students who have no close friends

3.2

4.9

6.2


Attention-deficit hyperactivity disorders (ADHD)

1979, and 3 per 100,000 in 2005 . Sixty percent of those who attempted suicide were between 15-24 years of age. Recent (2009) data collected from Alexandria, Egypt, showed that 30% of the 1621 high-school adolescents sampled experienced a strong death wish in the year before the study. However, for many reasons, the problem of adolescent suicide is still neglected in the Middle East (33).

ADHD rates in Arab populations were similar to those in other cultures. In a sample of 1,541 adolescent students in Qatar, 14.1% of boys and 4.4% of girls (9.4% total) scored above the cutoff for ADHD symptoms. Students who have a higher score for ADHD symptoms have poorer school performance than those with lower scores (p= .003) (23, 24) In Oman, 1500 adolescent students were screened for ADHD, and 7.8% of the sample exhibited hyperactivity. This was strongly associated with indices of conduct disorder, poor school performance, and behavioral disorders (such as aggression, stealing, and lying). These data are comparable to those reported in US children aged 8 to 15 years where 8.7% meet DSM-IV criteria for ADHD (25-27).

Table 6. WHO Suicide rates per 100,000 by country and sex, 2009.

Depression In Egypt, 2043 adolescents were screened for depression, using CDI Scores in junior and senior high schools. In adolescent males, 16% in junior high and 17.5% in senior high schools showed depression, whereas 13.5% and 15% of females in junior and senior high schools, respectively, were depressed. In Oman (n = 552 school adolescents), 10.5% of adolescent boys and 7.5% of adolescent girls had depression. In the entire sample, a history of physical abuse during childhood and personal history of organic illness were correlates of depression. For girls, age, relationship with parents and current cigarette smoking were related. In Sudan the estimated prevalence of major depressive disorder for the population was 4.2%, yet 11% of the adolescent girls reported severe depression. These findings suggest a high rate of adolescent depression, and considering the fact that none of the girls who were identified with major depression reported to the health system, a surveillance system is recommended to identify depression among adolescent girls (28-30). The relationship between depression and anxiety among undergraduate students was studied in 4230 males and 4938 females ages 18-25 years in 18 Arab countries. Findings indicate that depression is positively significantly correlated with anxiety (median= 0.66, p < 0.01) (29).

Male

Female

Egypt

0.1

0.0

Bahrain

4.9

0.5

Syria

0.2

0.0

France

25.5

9.0

Italy

9.9

2.8

Germany

17.9

6.0

Kuwait

2.5

1.4

USA

17.7

4.5

Conclusions The current “youth bulge” in the population of Arab countries creates bigger demands for educational and healthcare services which should be anticipated and planned. Prevalence of emotional and behavioural disorders is increasing in the Arab adolescent, and rates of many of these disorders are comparable to international data. Particularly recognized adolescent health problems in this area include the high prevalence of overweight/obesity, and vitamin D and iron deficiencies, which necessitate appropriately planned national policies to combat them. Concerns are raised about the lack and/or deficiency of specific adolescent medical care and the inability of specialist child and adolescent mental health services to meet these growing need and demands.

References

Suicide

1. http://www.arabic-studies.com/english/learn_arabic/arabworld.asp

The sparse literature indicates a low incidence of suicide in various Arab countries. A review of research from Israel shows that the rate of suicide in the Arab population of children and adolescents is also low, but an increase has been observed over the past decade. However, it is still much lower than in the Israeli population (31-33). In Egypt (Cairo), the attempted suicide rate was reported to be 2.8 per 100,000 in 1959, 3.8 per 100,000 in

2. Chaaban J. ESCWA Expert Group Meeting. Amman, 26 February 2007. 3. Hobbs JJ, Salter CL. World regional geography, 6th ed. Belmont (CA): Brooks/Cole; 2009, Chapter 7. 4. The demographic profile of the Arab countries. United Nations, 090508. E/ESCWA/SDD/2009/Technical Paper 9, 26 November 2009. 5. Rashad H, Osman M, Roudi-Fahimi F. Marriage in the Arab world. Population Reference Bureau (PRB) 2005; 1-7.

25


6. Panama, CA. Healthcare for people of different ethnicities. In: Tseng W-S, Streltzer J, eds. Cultural competence in health care. New York: Springer US; 2007.

comparison of western and non-western countries. Med Gen Med. 2004; 6(3):49. 19. Al-Adawi S, Burke D, Al-Bahlani S et al. Presence and severity of anorexia and bulimia among male and female Omani and nonOmani adolescents. J Am Acad Child Adolesc Psychiatry 2002; 41:1124-1130.

7. International Bank for Reconstruction and Development /The World Bank. Preventing HIV/AIDS in the Middle East and North Africa: a window of opportunity to act. Washington, DC; 2005. www.worldbank.org.

20. www.scribd.com/doc/326077/World-Population-Datasheet-2007

8. Qayed MH. Egypt: KAP study on reproductive health among adolescents and youth in Assiut Governorate, Egypt. Summary of final report prepared for the women’s studies project. Family Health International: The Research Management Unit of The National Population Council. Cairo, Egypt; June 1998.

21. Bener A, Al-Ali M, Hoffmann GF. Vitamin D deficiency in healthy children in a sunny country: associated factors. Int J Food Sci Nutr 2009; 60(Suppl 5):60-70. 22. El-Hazmi MA, Warsy AS. The pattern for common anemia among Saudi children. J Trop Pediatr 1999; 45:221-225.

9. Economic and social commission for Western Asia (ESCWA). Developments in the situation of Arab women health, education, employment, political representation. e/escwa/ecw/2007/Brochure 1, 22 February 2007

23. WHO. Global School-based Student Health Survey (GSHS), Lebanon, Ministry of Public Health, 2005. http://www.cdc.gov/GSHS/results/index.htm 24. Farah LG, Fayyad JA, Eapen V, et al. ADHD in the Arab world: a review of epidemiologic studies (EJ859147). J Atten Disord 2009; 13:211-222.

10. Chaaban J. Job creation in the Arab economies: navigating through difficult waters. United Nations Development Programme. Regional Bureau for Arab States. Arab Human Development Report Paper Series, March 2010.

25. Bener A, Al Qahtani R, Abdelaal I. The prevalence of ADHD among primary school children in an Arabian society. J Atten Disord 2006; 10:77-82.

11. Dwairy M, Achoui M, Abouserie R, Farah A. Epidemiological studies on adolescent disorders in the Arab world. J Cross-Cultural Psychol 2006; 37:262-272.

26. Afifi M, Al Riyami A, Morsi M et al. Depressive symptoms among high school adolescents in Oman. East Mediterr Health J 2006;12:19-30.

12. Afifi Soweid R, Nehlawi M. Youth and health in the Arab region. Faculty of Health Sciences, American University of Beirut. Presented at the ESCWA EGM, Amman, 2007 February 26-27.

27. Froehlich TE, Lanphear BP, Epstein JN et al. Prevalence, recognition, and treatment of attention-deficit/hyperactivity disorder in a national sample of US children. Arch Pediatr Adolesc Med 2007; 161:857-864

13. El-Awa F, Warren CW, Jones NR. Changes in tobacco use among 13–15-year-olds between 1999 and 2007: findings from the Eastern Mediterranean Region. Eastern Mediterr Health J 2010; 16(3):266-273.

28. Afifi M. Depression, aggression and suicide ideation among adolescents in Alexandria, Egypt. Neuroscience Journal 2004; 9:447-453.

14. Global Tobacco Surveillance System Collaborating Group. Global Tobacco Surveillance system (GTSS): purpose, production, and potential. J School Health 2005; 75(1):15-24.

29. Al Ansari, Bader M. Relationship between depression and anxiety among undergraduate students in eighteen Arab countries: a crosscultural study. Social Behavior and Personality 2005; 33(5):503-512.

15. Dous NM. Report on the results of the global youth tobacco survey in Egypt. CDC, 2003. http://www.cdc.gov/tobacco/global/gyts/reports/egypt01.htm

30. Shaaban KM, Baashar TA. A community study of depression in adolescent girls: prevalence and its relation to age. Med Princ Pract 2003; 12:256-259.

16. Islam SM, Johnson CA. Influence of known psychosocial smoking risk factors on Egyptian adolescents' cigarette smoking behavior. Health Promotion Int 2005; 20:135-145.

31. Morad M, Merrick E, Schwarz A et al. A review of suicide behavior among Arab adolescents. Sci World J 2005; 26:674-679. 32. Nachman R, Yanai O, Goldin L et al. Suicide in Israel: 1985–1997. J Psych Neurosci 2002; 27:423-428.

17. Eapen V, Mabrouk AA, Bin-Othman S. Disordered eating attitudes and symptomatology among adolescent girls in the United Arab Emirates. Eat Behav 2006; 7:53-60.

33. Afifi M. Adolescent suicide in the Middle East: ostrich head in sand. Bull World Health Org 2006; 84:840.

18. Makino M, Tsuboi K, Dennerstein L. Prevalence of eating disorders: a

Corrispondenza:

Ashraf T. Soliman MD, PhD, FRCP Professor of Pediatrics and Endocrinology

Hamad Medical Center Doha, P.O. Box 3050, Qatar Tel.: +974-5983874 E-mail: [email protected]

26

THALASSEMIA INTERNATIONAL FEDERATION

Hamad Medical Corporation

“School for Growth Disorders and Endocrine Complications in Thalassaemia” Intensive Course promoted by the International Endocrine Complications in Thalassaemia Network (I-CET) 1st Announcement Doha, September 6th-8th 2012 Topics of Educational program Growth, Puberty, Thyroid, Parathyroid Glucose homeostasis, Case reports

Speakers and Moderators Vincenzo de Sanctis (Italy), Ashraf Soliman (Qatar), Ahmed Elawwa (Qatar), Mohamed Yassin (Qatar), Said Bedair (Qatar), Mohamed El Kholy (Egypt), Heba Hassan El Sedfy (Egypt), Michael Angastiniotis (Cyprus), Nicos Skordis (Cyprus), Androulla Eleftheriou (Cyprus), Christos Kattamis (Greece)

Director of School Ashraf Soliman (Doha) I-CET Coordinator and Scientific Advisor of School: Vincenzo de Sanctis (Italy)

Preliminary Program 1st day: (6 hours) Introduction - Hematology/Endocrinology Link – The role of TIF and I-CET in supporting formation (CME) and research in TM (A. Eleftheriou, V. De Sanctis) – Conventional general management of thalassaemia (C. Kattamis, M. Angastiniotis) – Gene therapy and induction of fetal haemoglobin production (M. Yassin) – Histology findings (V. De Sanctis) – Mechanisms of iron accumulation and Assessment of iron overload (A. Soliman-S. Bedair) – Chelation therapy (M. Yassin) – Endocrine complications in TH and effects of iron chelation therapy (V. De Sanctis) – Compliance to chelation therapy (A. Eleftheriou) – Social and Ethical aspects (M. Angastiniotis) – Case reports – Participants meet Thalassemic patients and families 2nd day: (6 hours) Basic-General Endocrine – Highlight on anthropometry: an introduction to growth assessment (M. El Kholy) – Growth assessment and Funcional tests (A. Soliman) – Bone age assessment (V. De Sanctis/S. Bedair) – Puberty: clinical and lab assessment (H. El Sedfy) – Assessment of fertility in males and females (N. Skordis) – Assessment and interpretation of bone densitometry (H. El Sedfy/N. Skordis) – Case reports – Participants meet Qatar and I-CET Doctors

3rd day (6 hours) Clinical-Endocrinopathies in TM – Growth disorders in TM, cases with growth disorders (A. Soliman) – Bone diseases in TM (H. El Sedfy) – Puberty disorders in TM, cases with pubertal disorders (A. Soliman/A. Elawwa) – Fertility issues (N. Skordis) – Hypothyroidism and hypoparathyroidism in TM: from the diagnosis to treatment (V. De Sanctis) – Adrenal disorders in TM, how to manage (M. El Kholy) – Diabetes and impaired glucose tolerance, how to manage (N. Skordis) – MCQ Questions for attendants Certificates

CME

Hamad Medical Corporation (HMC) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education (CME) for physicians. Application format (in capital) Name of Applicant: Date of Birth: Sex: Home Address: Work Address: Telephone number: Mobile number: E-mail: Fax number: Passaport no.: Degree (please state nature of degree e.g. MD/PhD): Present position: Date: Signature:

Deadline for the subscription: July 2012 For further information: please contact by email

[email protected]