Library Collaboration with Medical Humanities in an American Medical College in Qatar

Sally Birch,¹* Amani Magid,² and Alan Weber³

Abstract

The medical humanities, a cross-disciplinary field of practice and research that includes medicine, literature, art, history, philosophy, and sociology, is being increasingly incorporated into medical school curricula internationally. Medical humanities courses in Writing, Literature, Medical Ethics and History can teach physicians-in-training communication skills, doctor-patient relations, and medical ethics, as well as empathy and cross-cultural understanding. In addition to providing educational breadth and variety, the medical humanities can also play a practical role in teaching critical/analytical skills. These skills are utilized in differential diagnosis and problem-based learning, as well as in developing written and oral communications. Communication skills are a required medical competency for passing medical board exams in the U.S., Canada, the UK and elsewhere. The medical library is an integral part of medical humanities training efforts. This contribution provides a case study of the Distributed eLibrary at the Weill Cornell Medical College in Qatar in Doha, and its collaboration with the Writing Program in the Premedical Program to teach and develop the medical humanities. Programs and initiatives of the DeLib library include: developing an information literacy course, course guides for specific courses, the 100 Classic Books Project, collection development of ‘doctors’ stories’ related to the practice of medicine (including medically-oriented movies and TV programs), and workshops to teach the analytical and critical thinking skills that form the basis of humanistic approaches to knowledge. This paper outlines a ‘best practices’ approach to developing the medical humanities in collaboration among the medical library, faculty and administrative stakeholders.

Keywords: Medical Humanities; Medical Libraries–Qatar; Medical Education-Humanities.

Evaluating the Relationship between Body Size and Body Shape with the Risk of Breast Cancer

Samira Ebrahimzadeh Zagami,¹ Nahid Golmakani,^1* Fatemeh Homaei Shandiz,² and Azadeh Saki³

Abstract

Objective: This study aims to determine the relationship between body size and body shape with the risk of breast cancer.

Methods: In this case control study, 480 women participated (240 women with breast cancer in case group and 240 healthy women in control group). After completing the interview form, the weight, height, waist circumference, hip circumference and breast size, were measured. The data were analyzed using statistical test by SPSS11.5.

Results: The present study showed that the mean of hip circumference were significantly different in both groups (p=0.036). The size of the breast was statistically significant between the two groups. Thyroid type, one of the body shapes, was more seen in the case group than control group (p<0.001).

Conclusion: This study revealed that the risk of breast cancer increases with increased hip circumference. In addition, the results indicate that body shape may be a useful predictor in determining the risk of breast cancer. More studies should be designed to address this subject.

Keywords: Breast cancer; Body size; Waist circumference; Waist-hip ratio.

Psychological Predictors of Intention to Deliver Vaginally through the Extended Parallel Process Model: A Mixed-Method Approach in Pregnant Iranian Women

Sepideh Hajian,^1* Mohammad Shariati,² Khadijeh Mirzaii Najmabadi,³ Masud Yunesian,⁴ and Mohammad Esmaeel Ajami⁵

Abstract

Objectives: Despite the fact that cesarean delivery does not offer significant health benefits for either mother or newborn, there has been a noticeable upward trend in elective cesarean births in Iran, over the last two decades. This study aims to examine whether knowledge, perception of health threats, efficacy, and personal beliefs act as psychological predictors towards the intention of women to have a normal vaginal delivery.

Methods: The mixed-method approach was used as quantitative and qualitative design. Simultaneously, 290 pregnant women who visited prenatal clinics participated in the study. Quantitative and qualitative data were collected using a structured questionnaire based on Witte’s Extended Parallel Process Model, and four focus groups, respectively.

Results: Women perceived lower personal risk but higher levels of efficacy. Perceived self-efficacy, severity, and response efficacy emerged as significant predictors of intention to experience vaginal birth. The participants’ insufficient knowledge and misconceptions about birth methods were prevalent. Major themes were identified and divided into negative and positive beliefs about vaginal birth.

Conclusion: This educational model is useful for understanding women’s intention to undergo a vaginal birth, especially when it is combined with a qualitative approach. Maternal care providers should acknowledge their clients’ beliefs and intended childbirth methods prior to offering medical intervention.

Keywords: Normal vaginal delivery; Extended Parallel Process Model; mixed methods.

Maternal Child Abuse and its Association with Maternal Anxiety in the Socio-Cultural Context of Iran

Zahra Esmaeili Douki,¹ Mohammad Reza Esmaeili,² Nazanin Vaezzadeh,¹ Reza Ali Mohammadpour,¹ Hamideh Azimi,³ Robabeh Sabbaghi,¹ Mousa Esmaeil,¹ and Zohreh Shahhosseini^1*

Abstract

Objectives: The prevalence of parental violence has been an area of major public concern. There are few available data detailing the ways parents and other caregivers discipline children, particularly in low and middle income countries. This study focuses on the prevalence of different types of maternal child abuse and its association with maternal anxiety in the socio-cultural context of Iran.

Methods: Participants in this cross-sectional study consisted of 562 mothers with the last child aged from 1 month to 12 years old who attended the Amirkola Children’s Referral Hospital in Mazandaran Province, Iran, seeking healthcare services for their children. Demographic characteristics of the mothers, their children and reactions to conflicts with children were evaluated by a validated version of Conflict Tactics Scale for Parent and Child. Also, the relationship between maternal anxiety and child abuse was assessed using the Spielberger State-Trait Anxiety Inventory. The association between variables was examined by Pearson correlation coefficient, independent t-test, one-way ANOVA, and multivariate regression.

Results: The prevalence of mother-to-child corporal punishment, severe physical abuse and very severe physical abuse were 436 (78%), 260 (46%) and 180 (32%), respectively. Verbal emotional abuse was reported by 506 (90%) participants and nonverbal emotional abuse was reported in 374 (67%) cases. A correlation was observed between child abuse and mothers’ age (p=0.02), as well as with the number of children in the family (p=0.03), and the mothers’ trait anxiety (p<0.001).

Conclusion: Overall, the assessment of maternal child abuse should be an important focus for evaluation in mothers with anxiety and vice versa, when child abuse is suspected, maternal psychological assessment should be essential.

Keywords: Anxiety; Child abuse; Maternal behavior.

Evaluation of the Sensitivity and Specificity of Immunohistochemical Markers in the Differential Diagnosis of Effusion Cytology

Zahraa Mohammed Yahya,¹ Hussam Hasson Ali,¹ and Haider Ghazi Hussein^2*

Abstract

Objective: To evaluate the sensitivity and specificity of Calretinin and Carcinoembryonic antigen as immunocytochemical markers in distinguishing mesothelial cells from metastatic adenocarcinoma cells in effusion cytology.

Methods: This study included 50 patients who presented with effusions (26 pleural and 24 peritoneal), at Al-Kadhimya Teaching Hospital who were selected according to their preliminary diagnosis from 1st December 2010 to 30th June 2011. Effusion fluids were aspirated and processed for both conventional cytological methods using Papanicolaou-stain and immunocytochemical staining with anti Calretinin and Carcinoembryonic antigen.

Results: The sensitivity of cytology for detection of malignant cells was 77%, with 100% specificity and 86% accuracy. Calretinin was observed to be a specific (100%) and sensitive (90%) marker for mesothelial cells (of benign etiology). Carcinoembryonic antigen exhibited 70% sensitivity and 100% specificity for adenocarcinoma cells. When the results of both cytology and immunocytochemistry were considered in conjunction, the sensitivity for the detection of malignancy increased to 97%, with 100% specificity and 98% accuracy.

Conclusion: Calretinin and Carcinoembryonic antigen were found to be useful markers for differentiating reactive mesothelial cells from metastatic adenocarcinoma cells in smears prepared from body fluids. Also, the combination of both cytology and immunocytochemical studies using the two markers can greatly enhance the diagnostic accuracy, sensitivity and specificity in malignant effusions.

Keywords: Calretinin; Carcinoembryonic antigen; Adenocarcinoma; Mesothelial Cells; Effusion.

The Diagnostic Efficacy of Adenosine Deaminase in Tubercular Effusion

Mohd Arif Kelam,¹ Farooq Ahmad Ganie,^2* Bashir Ahmad Shah,¹ Shabir Ahmad Ganie,³ Mohd Lateef Wani,² Nasir-U-Din Wani,² and Masaratul Gani⁴

Abstract

Objective: This study aims to evaluate the diagnostic efficacy of adenosine deaminase in tubercular effusions.

Methods: This study was conducted at the Department of General Medicine and Cardiovascular and Thoracic Surgery, SKIMS, for a period of two years between November 2008 and November 2010. A total of 57 patients presenting with pleural effusions during the two-year study period, who presented with clinical manifestations suggestive of tuberculosis (i.e., the presence of productive cough, low-grade fever, night sweats, weight loss, and chest pain, especially if these symptoms last ≥4 weeks) were included in the study. If the patients presented with less than two of these symptoms, and especially if the clinical manifestations were of <4 weeks duration, they were excluded from the study.

Results: The mean adenosine deaminase activity level in all the 57 patients was 109 U/L while the mean adenosine deaminase activity levels in pleural TB patients was 80 U/, and 64 U/L in the controls (p=0.381). Considering 40 U/L as the cut off, the results were positive in 35 out of 39 tuberculosis patients and 9 out of 18 controls. The sensitivity of adenosine deaminase for tubercular effusions worked out to be 90%, with only 50% specificity.

Conclusion: This study suggests that the estimation of adenosine deaminase activity in pleural fluid is a rapid diagnostic tool for differentiation of tubercular and non tubercular-effusions. The sensitivity and specificity of adenosine deaminase for tubercular effusions in this study was 90% and 50% respectively.

Keywords: Adenosine Deaminase (ADA); Pleural effusion; Acid fast bacillus staining (AFB staining).

The Patterns and Causes of Neonatal Mortality at a Tertiary Hospital in Oman

Mohamed Abdellatif,^1* Abeer Al Battashi,² Masood Ahmed,¹ Maria Flordeliz Bataclan,¹ Ashfaq Ahmed Khan,¹ and Abdullah Al Maniri³

Abstract

Objective: To report the patterns and causes of neonatal death from a tertiary care neonatal intensive care unit over a period of four years.

Methods: This is a retrospective cohort study where four years data (January 2006 - December 2009) of all inborn neonatal admissions and deaths were collected from the neonatal intensive care unit at Sultan Qaboos University hospital on predesigned forms. All out born admissions and deaths were excluded. The causes of neonatal death were classified using Wigglesworth's classification.

Results: The number of inborn live births during the study period was 10064 and the total number of inborn neonatal admissions was 1475. The total deaths (neonatal and post neonatal) at the neonatal intensive care unit was 73 (63 inborn and 10 out born). Among the inborn, five deaths were post neonatal deaths and hence, excluded from analysis. Among the remaining inborn neonatal deaths (n=58), 34 (59%) were males and 24 (41%) were females. The number of neonatal admissions increased over the years during the study period from 248 to 356, while the number of deaths also increased from 10 deaths in 2006, to 20 deaths in 2009. The primary causes of neonatal deaths were prematurity and its complications 52% (n=30). Lethal congenital malformations lead to 17 (29%) newborn deaths, specific diagnosis in 7 newborns (12%), and birth asphyxia in four (7%) of cases.

Conclusion: There was an increasing trend of neonatal admissions and deaths among inborn babies. Prematurity, with sepsis as its major complication and congenital malformations were the leading cause of neonatal mortality.

Keywords: Neonatal mortality; Prematurity; Oman.

Diagnosis of Adult Chronic Rhinosinusitis: Can Nasal Endoscopy Predict Intrasinus Disease?

Arif Ali Kolethekkat,^1* Roshna Rose Paul,² Mary Kurien,¹ Shyam Kumar,³ Rashid Al Abri,¹ and Kurien Thomas⁴

Abstract

Objectives: To define the role of endoscopic evaluation of middle meatus in adult patients clinically diagnosed to have chronic rhino-sinusitis and its ability to predict intra-sinus mucosal involvement as compared to CT scan.

Methods: This prospective analytical study was conducted on consecutive patients with diagnosis of chronic rhino-sinusitis who were symptomatic and fulfilled the American Academy of Otolaryngology - Head and Neck Surgery Task Force criteria. The patients were enrolled prospectively and were subjected to rigid diagnostic nasal endoscopy and classified as defined by the revised Sinus Allergy Health Partnership Task Force criteria. The patients then underwent non contrast CT sinuses on the same day. Results were analyzed as a diagnostic test evaluation using CT as a gold standard.

Results: Among the 75 study patients with symptom based chronic rhino-sinusitis, nasal endoscopy was abnormal in 65 patients (87%). Of these patients, 60/65 (92%) showed positive findings on CT scan. Ten patients had normal endoscopy, of these 6/10 (60%) had abnormal CT scan. Sensitivity and specificity of diagnostic nasal endoscopy against CT scan were 91% (95% CI: 81-97) and 44% (95% CI: 14-79), respectively. The likelihood ratio for positive nasal endoscopy to diagnose chronic rhino-sinusitis was 1.6 and the likelihood ratio to rule out chronic rhino-sinusitis when endoscopy was negative was 0.2.

Conclusion: Nasal endoscopy is a valid and objective diagnostic tool in the work up of patients with symptomatic chronic rhino-sinusitis. When clinical suspicion is low (<50%) and endoscopy is negative, the probability of rhino-sinusitis is very low (<17%) and there is no need to perform a CT scan to reconfirm this finding routinely. Endoscopy alone is able to diagnose chronic rhino-sinusitis in >90% of patients when clinical suspicion is high (88%) as defined in this study by AAO-HNS Task Force criteria. Negative endoscopy, however, does not totally exclude the sinus disease in patients fulfilling task force criteria. CT scan may be needed on follow-up if there is clinical suspicion in 10% of these patients who are negative on endoscopy if symptoms persists. It is thus possible to reduce the number of CT scans if patients are carefully selected based on clinical criteria and endoscopy is done initially as part of their evaluation.

Keywords: Chronic; Sinusitis; Endoscopy; CT scan; Sensitivity; Specificity; Likelihood ratio.

Characteristics and Prognosis of Adult Acute Myeloid Leukemia with Internal Tandem Duplication in the FLT3 Gene

Adhra Al-Mawali,^1* David Gillis,² and Ian Lewis³

Abstract

Objectives: Constitutive activation of the fms-like tyrosine kinase 3 (FLT3) receptor by internal tandem duplication (ITD) of the juxtamembrane region has been described in patients with acute myeloid leukemia. FLT3/ITDs are present in about 20-30% of all acute myeloid leukemia cases. It has been shown that the mutation is correlated with worse prognosis. However, none of the previous studies investigated which FAB subtype is associated with higher percentage of FLT3/ITD, thus the reason for undertaking the current study.

Methods: The prevalence and the potential prognostic impact of FLT3 mutations in 39 acute myeloid leukemia patients were analyzed by genomic polymerase chain reaction. Twelve samples with FLT3/ITDs and 27 acute myeloid leukemia samples without the mutations were compared with respect to clinical prognosis and FAB subtype. Results were correlated with cytogenetic data and the clinical response.

Results: FLT3/ITD mutations were found in 31% of patients. FLT3/ITD was associated with similar clinical characteristics and was more prevalent in patients with normal karyotype (83%). Interestingly, half of the FLT3/ITD aberrations were found in patients with FAB M1 (50%), and fewer were found in patients with FAB M2 (8%), M4 (8%), and M5 (8%). Although less frequent in patients with cytogenetic aberrations, FLT3/ITDs were found in 17% of patients with t(15;17). Although the study was powered to 80%, patients with FLT3/ITD mutation did not show shorter complete remission duration or a higher relapse rate.

Conclusion: The data confirm that FLT3/ITD mutations represent a common alteration in adult acute myeloid leukemia, mainly with normal karyotype (83%) and de novo acute myeloid leukemia (75%), as compared to secondary acute myeloid leukemia (25%) (p<0.001). It also showed that half of the M1-FAB subtype is FLT3/ITD positive. Therefore, FLT3/ITD is a therapeutic target, and thus inhibition of FLT3 tyrosine kinase activity may provide a new approach in the treatment of leukemia carrying these mutations.

Keywords: Acute Myeloid Leukemia; M1; FLT3 gene; Tandem duplication; Prognosis.

Solid Pseudopapillary Neoplasm of the Pancreas: A Case Report with Review of the Diagnostic Dilemmas and Tumor Behavior

Ritu Lakhtakia,¹* Khalifa Al-Wahaibi,² Khawaja F. Zahid,³ Kamran A. Malik,² and Ikram A. Burney³

Abstract

Solid pseudopapillary neoplasm of the pancreas is a rare tumor of the pancreas often detected initially on imaging. Of uncertain histogenesis, it has a low-grade malignant potential with excellent post-surgical curative rates and rare metastasis. Despite advances in imaging, pseudocysts and other cystic neoplasms feature in the differential diagnosis. Pathological and/or cytological evaluation remains the gold standard in reaching a definitive diagnosis. On morphology alone, other primary pancreatic tumors and metastatic tumors pose a diagnostic challenge. Recent advances in immunohistochemical characterization have made the histopathologic diagnosis more specific and, in turn, shed light on the likely histogenesis of this rare tumor. We report a case of solid pseudopapillary neoplasm of the pancreas that was suspected on radiology and diagnosed intraoperatively on imprint cytology guiding definitive surgery. The diagnostic dilemmas are reviewed.

Keywords: Solid pseudopapillary neoplasm (SPN); Pancreas; Beta-catenin; E-cadherin.

A Case of Metatropic Dysplasia: Operative Treatment of Severe Kyphoscoliosis and Limb Deformities

Hae Ryong Song,¹ Shivam Sinha,^2* Sang Heon Song,¹ and Seung Woo Suh¹

Abstract

Metatropic dysplasia is a rare but severe spondyloepimetaphyseal dysplasia characterized by long trunk and short extremities. The exact incidence is not known; however, 81 cases have been reported in the literature till now. Due to progressive kyphoscoliosis, there is a reversal of proportions in childhood (shortening of trunk with relative long extremities). The diagnostic radiographic findings include marked platyspondyly (wafer-thin vertebral bodies), widened metaphyses (dumbbell-shaped tubular bones) and small epiphysis and a specific pelvic shape. The severe kyphoscoliosis is relentless and resistant to conservative treatment with bracing. Operative treatment is controversial due to the recurrence of deformity despite aggressive correction. We, herein report a case of this rare dysplasia and its follow-up after corrective surgery for spine and limb deformity. The excellent correction and good functional pulmonary status at 6-year follow-up has never been previously reported.

Keywords: Kyphoscoliosis; Metatropic dysplasia; Deformity correction.

Patients with Black Hip and Black Knee Due to Ochronotic Arthropathy: Case Report and Review of Literature

Mehmet Ali Acar,^1* Ömer Faruk Erkocak,¹ Bahattin Kerem Aydin,¹ Egemen Altan,¹ Hakan Şenaran,¹ and Nuh Mehmet Elmadağ²

Abstract

Ochronotic arthropathy is a manifestation of longstanding alkaptonuria. With increasing age, an accumulation of pigment deposits of homogentisic acid in the joint cartilage results in ochronotic osteoarthritis. We present a case of a 62-year-old female who underwent staged left uncemented total hip and right cemented total knee arthroplasty for osteoarthritis secondary to ochronosis.

Keywords: Ochronosis; Total hip arthroplasty; Total knee arthroplasty; Osteoarthritis.

Case Report and Literature Review of Very Echogenic Amniotic Fluid at Term and Its Clinical Significance

Genevieve Tam¹ and Tamima Al-Dughaishi^2*

Abstract 

The presence of echogenic amniotic fluid on sonography is uncommon and its clinical significance is not well appreciated. Very echogenic amniotic fluid has been attributed to meconium, blood, or vernix caseosa. Two cases of patients with echogenic amniotic fluid at term are presented here. In the first case, the patient’s management was altered as the finding of echogenic amniotic fluid was interpreted to be thick meconium. The second case was induced for post-datism and the amniotic fluid was found clear during labour. Since the first reported cases of meconium with echogenic amniotic fluid on sonography by Benacerraf et al. (1984), larger studies have consistently shown that echogenicity is not predictive of meconium. As with our cases, meconium was suspected in both patients with dense echogenic amniotic fluid. Labor was induced in the first case to avoid fetal distress and asphyxia with increasing gestation. Meconium was not present in either of our cases and both the babies were healthy. 

Keywords: Prenatal ultrasound; Echogenic amniotic fluid; Thick meconium; vernix; Term-pregnancy. 

Low Voltage Electric Injury induced Atrial Fibrillation as a Presenting Feature of Wolff-Parkinson-White Syndrome: A Case Report

Imran Hafeez,* Mohd Maqbool Sohail, Ajaz Lone, Amit Gupta, Khurshid Iqbal, Khursheed Aslam, Mohd. S. Alai, and Shamim Iqbal

Abstract

Electric injury can cause a variety of cardiac arrhythmias. Atrial fibrillation as a result of such injury is very rare. We present a case of a young asymptomatic patient who developed acute atrial fibrillation with antegrade conduction over the atrioventricular bypass tract and very high ventricular rate after accidental low voltage electric injury, which was reverted successfully by DC shock.

Keywords: Atrial fibrillation; Pre-excitation; Electric injury.

Successful Closed Manipulation of Simple Lateral Dislocation of the Elbow Joint: A Case Report

Bahadir Gokcen,¹ Selahattin Ozyurek,^2* Aziz Atik,³ Ali Kemal Sivrioglu,⁴ Erkan Kaya,⁵ and  Kenan Keklikci⁶

Abstract

The elbow is the second most commonly dislocated joint in adults. Simple lateral dislocation of the elbow joint is a rare traumatic injury, and successful closed reduction is difficult and even rarer. Our proposition is to report this rare case of traumatic simple lateral dislocation treated with closed reduction under sedation emphasizing the use of this simple technique initially in order to avoid possible complications with general anesthesia and surgery.

Keywords: Elbow; Lateral dislocation; Successful closed reduction.

Spontaneous Tumor Lysis Syndrome in Childhood T cell Acute Lymphoblastic Leukemia

Rashmi Ranjan Das,¹ Smeeta Gajendra,² Sameer Bakshi,³ Rachna Seth,⁴ and Rajive Kumar²

Abstract

We report two cases that presented with unexplained acute renal failure and hyperuricemia and were subsequently diagnosed with T-cell acute lymphoblastic leukemia. The patients improved with conservative therapy without the need for dialysis. Case 1 is the youngest case of acute lymphoblastic leukemia with spontaneous tumor lysis syndrome reported to date, and Case 2 presented with spontaneous tumor lysis syndrome without hyperleukocytosis.

Keywords: Acute leukemia; Hyperuricemia; Dialysis; Child; Tumor lysis.

Computer Literacy Improvement Needs: Physicians' Self Assessment in the Makkah Region

Hani Abdulsattar Shaker¹ and Mian Usman Farooq^2*

Abstract

Objective: A confidential inquiry by the Directorate General of health affairs, Makkah region, Saudi Arabia, found physicians were resistant to enter patient-related information in the electronic medical records system at different hospitals. This study aims to highlight their computer literacy needs.

Methods: This cross-sectional survey was conducted on physicians using a structured questionnaire bearing nine questions/stems with dichotomous answers, (i.e., yes/no) that was distributed among physicians at six different Ministry of Health hospitals in the Makkah Region, Saudi Arabia, between May and August 2009. The results for future needs in computer skills were categorized as "none" if the rate of answer "yes" to any stem was 0-25%, "little" if 26-50%, "some" if 51-75% and "substantial" if >75% rated "yes".

Results: The response rate of 82% of determined sample size (n = 451) was attained. Computer literacy improvement elements (CLIE), i.e., "word processing software skills (MS Word)", "presentation software skills (Power Point)", "internet search skills", "medical database search skills", "spreadsheet software skills (Excel)" and "advanced e-mail management skills" were in "substantial" need of improvement among the majority of settings and categories. All other computer literacy improvement elements were in "some" need of improvement.

Conclusion: The overall outcome of this study indicates that physicians need further computer literacy improvements.

Keywords: Computer literacy; Computerized medical record; Cross sectional survey; Electronic medical records system (EMRS).

Validation of the Arabic Version of the Epworth Sleepiness Scale in Oman

Mohammed Al-Abri,¹* Ahlam Al-Hamhami,¹ Hamida Al-Nabhani,¹ and Ibrahim Al-Zakwani²

Abstract

Objectives: The Epworth sleepiness scale is a self-administered eight-item questionnaire that was developed as a tool to measure subjective sleepiness in adults. The validity of the Epworth sleepiness scale has been validated and tested in different populations and ethnic groups. However, it has yet to be validated or tested in an Omani or other Arabic speaking population. Thus, the aim of this study is to test the validity and reproducibility of the Epworth sleepiness scale in an Omani population.

Methods: Subjects were recruited from the general population and were asked to participate in the study. The study enrolled 97 Omani volunteers and was conducted between May and October 2008. An Arabic version of the original English questionnaire was used. The study was approved by the Research and Ethics committee of the institution. Lin’s concordance correlation coefficient along with Bland-Altman plots were used to test the agreement between the Arabic and English versions of the Epworth sleepiness scale.

Results: The study included a total of 37 males (38%) and 60 females (62%) with age ranging between 18-75 years. Concordance correlation results revealed a substantial concordance (RhoC) of 0.914, but one that does not approach 1 (95% CI: 0.881, 0.947). This results from both lack of perfect correlation (Pearson’s r=0.914) and bias (C_b = 1.000). The Bland and Altman’s limits-of-agreement measured at 0.000 (95% CI: -2.684, 2.684), indicating insignificant average departure from agreement between the two versions of the Epworth sleepiness scale.

Conclusion: The results indicate agreement between the two versions of ESS (English and the Arabic).

Keywords: Sleepiness; Arabic ESS; Bland Altman.