research-v2

Our Projects

Dementia study

Principal Investigators: 
Prof. Rayaz Malik (Professor of Medicine & Senior Consultant, WCM-Q & HMC)
Dr. Hanadi Al Hamad (Chairman of Geriatric Dept. & Senior Consultant, WCM-Q & HMC) 

Investigators
Mr. Georgios Ponirakis (Clinical Researcher)
Dr. Adnan Khan (Post Doctoral Associate in Medicine)
Dr. Anoop Sankaranarayanan (Consultant)
Dr. Marwan Ramadan (Consultant)
Dr. Shafi Khan (Consultant)
Dr. Essa AlSulaiti (Consultant)
Dr. Ahmed Elsotouhy (Radiologist)
Dr. Mani Chandran (Consultant)
Ms. Priya Vitthal Gawhale (Nurse)
Ms. Rhia Tosino (Nurse)
Dr. Maryam Alobaidi (Consultant)
Mr. Noushad Thodi (MRI In-charge)
Dr. Susan Osman (Consultant)
Dr. Navas Nadukkandiyil (Consultant)
Ms. Marwa Elorrabi (Nurse)
Dr. Ioannis Petropoulos (Post Doctoral Associate in Medicine)
Prof. Ashfaq Shuaib (Director of Neuroscience Institute) 

Early identification of dementia is important to ensure patients are offered treatment early in order to achieve a better quality of life and more independence. The objectives of this study are as follows:

To prospectively use CCM in patients attending the memory clinic to:
  1. Study its clinical potential as a dementia biomarker.
  2. Characterise corneal nerve/endothelial changes seen in patients with cognitive impairment and/or dementia.
  3. Identify corneal/endothelial changes that will assist in identifying or differentiating patients with different types of dementia (e.g. Alzheimer's versus Vascular) and different severity (mild versus moderate versus severe) of cognitive impairment and/or dementia.

Multiple sclerosis study

Principal Investigators:
Prof. Rayaz Malik (Professor of Medicine & Senior Consultant, WCM-Q & HMC)
Dr. Saadat Kamran (Consultant Neurologists at HMC)

Investigators:
Dr. Ioannis Petropoulos (Post Doctoral Associate in Medicine)
Dr. Adnan Khan (Post Doctoral Associate in Medicine)
Mr. Georgios Ponirakis (Clinical Researcher)
Dr. Naveed Akhtar (Consultant Neurologists)
Prof. Ashfaq Shuaib (Director of Neuroscience Institute)
Dr Dirk Deleu (Senior Consultant and Head of Neurology & Neurophysiology)

Multiple Sclerosis (MS) is a progressive, chronic inflammatory, neurodegenerative disease and is the leading cause of neurological disability in young adults. Magnetic Resonance Imaging (MRI) is one of the most important para-clinical and research tools available for the diagnosis and monitoring of MS worldwide. However, the correlation between MRI measures of disease activity and clinical disease progression is weak. Retinal nerve fibre loss has been associated with optic neuritis, one of the manifestations of MS

We would like to examine whether more sophisticated MRI measures of brain atrophy (shrinkage) and nerve loss in the retina as well as corneal nerve loss may give us a better idea of disease severity and progression.


ccm

Figure 1. CCM images of a patient with MS showing a reduction in corneal nerves from the centre and inferior whorl (top) with a reduction in temporal retinal nerve fibre layer (RNFL) (bottom) and marked loss of corneal nerves in the centre and inferior whorl of the same patient from the eye with optic enuritis associated with more widespread reduction in RNFL (bottom) compared to the control.


Stroke study or CORTIAS

Principal Investigators: 
Prof. Rayaz Malik (Professor of Medicine & Senior Consultant of the WCM-Q & HMC)
Dr. Atlantic D'souza (Consultant Neurologists at HMC)

Investigators
Dr. Adnan Khan (Post Doctoral Associate in Medicine)
Mr. Georgios Ponirakis (Clinical Researcher) 
Dr. Naveed Akhtar (Consultant Neurologists)
Dr. Ioannis Petropoulos (Post Doctoral Associate in Medicine)
Dr Dirk Deleu (Senior Consultant and Head of Neurology & Neurophysiology)
Dr Yahia Imam (Consultant Neurologists) 
Dr Khalid Salem (Consultant Neuroradiologist)
Dr Salim Kalynly (Consultant Radiologist – Ultrasound)


Role of CORneal Confocal Microscopy in Triaging TIA and Minor Strokes (CORTIAS) Study

The main risk factors for stroke in Qatar are hypertension (73.7%), diabetes (66.8%) and hypercholesterolemia (52.5%). To identify those patients with TIA/minor stroke who are at highest short term risk of acute ischemic stroke or disease progression using Corneal Confocal microscopy (CCM). This will be a prospective pilot proof of concept study in two cohorts of patients admitted to HMC with a diagnosis of minor ischemic stroke and TIAs. One cohort will contain patients with TIA or minor stroke (NIHSS < 4 ) and the other will be age-matched controls. We would like to show for the first time that CCM and stroke are related and if our hypothesis is correct we will be able to accurately and reproducibly predict those patients at high risk of progression to a major stroke.


Qatar Biobank Studies

Principal Investigator:
Prof. Rayaz Malik (Professor of Medicine & Senior Consultant, WCM-Q & HMC)

Investigators:
Mr. Georgios Ponirakis (Clinical Researcher)
Dr. Adnan Khan (Post Doctoral Associate in Medicine)
Dr. Ioannis Petropoulos (Post Doctoral Associate in Medicine)
Dr. Nahla Afifi (Scientific and Education Manager)
Prof. Ashfaq Shuaib (Director of Neuroscience Institute) 

Visual impairment in the form of low vision and blindness is a common disability affecting an estimated 160 million people worldwide. The exact prevalence and incidence of ophthalmic disorders in Qatar are currently unknown. The eye, due to its unique and easily accessible structure allows the systematic study of vascular disease. The size, shape and branching pattern of retinal vessels may offer a snapshot of an individual's cardiovascular health. In the past decade novel imaging biomarkers have emerged and have shown potential to act as surrogate endpoints of systemic disease such as Parkinson's and Alzheimer's disease, diabetic neuropathy, hypertension, stroke and other neurological and vascular disorders. Screening harmonisation with current clinical protocols for ophthalmic disease could provide unique diagnostic and prognostic information for the individual and the Qatari population as a whole. Findings from the QBB could be used to establish a universal screening strategy to identify these sight-threatening diseases early to enable intervention and limit progression

Corneal Confocal Microscopy in Qatar BioBank participants

The current QBB screening protocol lacks a measurement for neuronal damage. And yet peripheral and central neurological diseases are highly prevalent in the general population, especially as a consequence of metabolic abnormalities, particularly prediabetes and diabetes. Given our expertise in the use of CCM as a diagnostic test for peripheral and central neurological complications we aim to:
  • Implement CCM screening in the current QBB protocol to identify the prevalence of peripheral neuropathy in the Qatari population, particularly given the high prevalence of obesity, prediabetes and diabetes.
  • Identify novel associations and risk factors for neuropathy in Qatar.
  • Utilize the detailed phenotyping of QBB participants to gain better understanding about disease mechanisms, investigate the genome-wide associations with neuropathy and discover novel clinical associations between corneal nerve damage and systemic disease.
  • Study the temporal relationship between retinopathy and neuropathy using highly sensitive methods.
  • Create a novel, world-class neuropathy screening service for patients in Qatar.
  • Create a clinical care paradigm whereby physicians and scientists will work collaboratively and translate research findings into clinical care to improve population health

biobank


Diabetic Neuropathy

Principal Investigator:
Prof. Rayaz Malik (Professor of Medicine & Senior Consultant of the WCM-Q)

Investigators
Mr. Georgios Ponirakis (Clinical Researcher)
Dr. Tarik Elhadd (Endocrinologist)
Ms Subitha Chinnaiyan (Nurse in Diabetic Foot clinic)
Dr. Khaled Ali E Ashawesh (Endocrinologist)
Dr Khaled Mansur O Dukhan (Endocrinologist)
Dr Stephen Frederick Beer (Endocrinologist)
Dr. Abdul Hakeem Hamza (Endocrinologist)
Dr. Mohammed Ali (Endocrinologist)
Dr Sanaulla Sheik (Endocrinologist)
Dr. Mohamed Shaheen Annodiyil (Endocrinologist)
Dr. Mohamed Elnaggar (Endocrinologist)
Dr. Mohamed Ghallab (Endocrinologist)
Dr. Adnan Khan (Post Doctoral Associate in Medicine)
Dr. Ioannis Petropoulos (Post Doctoral Associate in Medicine)

The current screening health system in Qatar lacks a measurement for neuropathy in people with diabetes in the primary and secondary care. Yet the consequences of neuropathy in the form of foot ulceration and amputation are highly prevalent in the Qatari population with diabetes. This underlines the need to perform a community-based study to identify the prevalence of asymptomatic DPN and painful DPN and high risk diabetic foot in Qatar. We anticipate the results of this study will identify the scope of the problem and help develop public health strategies for prevention of DPN in Qatar.


CCM as a biomarker

Evaluation of CCM as a surrogate endpoint for the identification and prediction of diabetic neuropathy (NIH-DP3 multinational study).Principal Investigators:

Prof. Rayaz Malik (Professor of Medicine & Senior Consultant, WCM-Q & HMC) 
Professor Bruce Perkins (Toronto General Research Institute, Canada)
Professor Nathan Efron (Queensland University of Technology in Brisbane, Australia) 

Diabetic neuropathy is a significant clinical problem that currently has no effective therapy, and in advanced cases, it is a major cause of morbidity and mortality worldwide. The accurate detection, characterization and quantification of this condition are important to define at risk patients, anticipate deterioration, monitor progression and assess new therapies. There is thus a fundamental need to establish an objective marker that can accurately predict onset and assess progression or regression of neuropathy. We have robust data to support the thesis that the measurement of corneal nerve morphology parameters using in-vivo corneal confocal microscopy (CCM) represents an accurate ocular biomarker of diabetic neuropathy in patients with type 1 and type 2 diabetes. Importantly, this procedure could be harmonized with the annual eye examination for retinopathy, a part of current clinical practice. Results of our pooled, multinational longitudinal datasets will unequivocally determine the role of CCM as a method to determine future risk of neuropathy allowing clinicians to risk stratify their patients. It will also pave the way for evaluating putative interventions in clinical trials. Ultimately, CCM has the potential to serve as a broadly applicable means for disease identification and prognosis in clinical practice and may prove to be a valid biomarker for use in the clinical trials designed to identify disease-modifying interventions. We will study 516 (363 without DPN and 151 with DPN) subjects with T1DM and 524 subjects with T2DM (241 without DPN and 283 with DPN) at baseline. Further analyses will be performed in identical fashion to the baseline, except that case status will be determined according to longitudinal incident DPN. We assume a 70% follow-up rate (30% attrition) and as such, we anticipate including T1D Derivation (n=128), T1D Validation (n=128) and a T2D Derivation (n=84) and T2D Validation (n=84) sets.