bluuebunny/crossref_metadata_2025 huggingface dataset:
Ischemic Optic Neuropathy: Incidence, Clinical Profile and Long-Term Prognosis in Qatar
Authors: Qaddoura R. H. , Hamad A. I. , Al Mansouri F. A. , El Shafei M. M. , Al Mannaei F. A.
Published: February 2016

Background: Ischemic optic neuropathy (ION) is the most common optic neuropathy in patients over the age of 50 years. It has variable clinical features, prognosis and associated risk factors. As far as we know there are no published data about ION from other Arabic countries.

Objective: We describe the clinical presentation, associated risk factors and the prognosis in patients presenting to our hospital and compare our findings with USA studies.

Methods: In a hospital-based prospective study, consecutive patients with a diagnosis of ION seen between January 2001 and December 2004 were included. Detailed neuro-ophthalmic evaluation, laboratory and neuroradiological investigations were performed in all patients. The patients were followed up at the clinic for mean period of 18 months.

Results: Twenty-six patients, 21 males and 5 females (male to female ratio 4.2:1) were enrolled. Mean age was 50.3years. The incidence was calculated as 1/100,000/year. Anterior ION was the commonest type (88%). Vascular risk factors were common; e. g. diabetes mellitus (DM) (58%), hypertension (HTN) (42%), hypercholesterolemia (10%). Prevalence of disc-at-risk (small or absent physiological cup) was (16%) and of temporal arteritis was uncommon (4%). Brain MRI showed ischemic vascular changes in (29%).

Conclusion: The incidence of ION in Qatar is much less and showed male predominance when compared with data from USA. Anterior non-arteritic ION is the commonest type. Vascular risk factors were more common while prevalence of disc at-risk and temporal arteritis was less compared to USA studies while DM was higher. Therefore, controlling risk factors may reduce the incidence of ION.
Osteonecrosis Characteristics in Qatar
Authors: Sarakbi H. A. , Hammoudeh M.
Published: February 2016

Osteonecrosis (ON) is a disease with significant morbidity, it is associated with multiple diseases. The aim of this study was to find out the characteristics of ON in Qatar.

Methods: this is a retrospective study done at Hamad Medical Corporation, which is the main hospital in Qatar (Arabian Gulf) with 1300- bed capacity. Inpatients records from 1993 to 2003 with the diagnosis of ON and avascular necrosis (AVN) were reviewed. Patients’ characteristics were recorded.

Results: 40patients records were reviewed;only 38 had complete records, the other two incomplete files excluded from the study. The patients'age ranged from 9 to 69 years old, 22 males and 16 female. Twenty patients were Qataris and eighteen were non-Qatari, Time to diagnosis ranged from six days to two years. Forty-seven total joints were affected (more than one joint was affected in eight patients). The hip was the most common site involved 39/ 47 and eight were a non-hip (four knees, three ankles and one wrist). Six (15.7%) patients were on steroids. Associated diseases were as follows: five (13%) patients had sickle cell anemia, seven (18.4%) patients had trauma, four (10.5%) patients had hematological diagnosis (one leukemia, one protein C deficiency, one polycythemia vera (PCV), and one TTP. One (2.6%) had nephrotic syndrome, one had reticular sarcoma of the femur; one had Hodgkin lymphoma with radiation, one patient had polymyositis, one had rheumatoid arthritis and one had systemic lupus erythematosus with nephritis. In 12 patients (31.5%) no obvious cause were found.

Conclusions: this is the first study on ON in Qatar, there were some differences of the characteristics of our patients compared to others; notably less trauma and alcohol associations and more hematological association, this study may represent a local demographic data of ON in this region.
Chromosomal Analysis in a Sample of Iraqi Children with Down's Syndrome and Concominant Cogenital Heart Disease
Authors: Shakir D. K. , Gehani A. A.
Published: February 2016

To study the demographical pattern of Iraqi children with Down's syndrome (DS) and congenital heart disease (CHD) forty-five children with DS were examined clinically, radiologic ally and by 2D color Doppler echocardiography. In eight with CHD (six female, two male) chromosomal analysis was used to investigate the possible relationship between chromosomal patterns and the type of CHD. All had a 47,+21 chromosomal pattern. Three had atrioventricular septal defect (AVSD), three atrial septal defect (ASD) and two ventricular septal defect (VSD). Only one case had reached the Eisenmenger complex, all the others had pulmonary hypertension. In this small sample of Iraqi children with Down's syndrome there appeared no relationship between CHD type and chromosomal pattern.
Idiopathic Charcot Joint of Knee
Authors: Arun K. P. , Wozniak A. P. , Rasvey M.
Published: February 2016

A Charcot joint or neurogenic arthropathy is seen in conditions where proprioceptive afferents from the joint (ire altered or destroyed. In many cases a definite cause for developing a Charcot joint can be identified but there (ire some cases (the idiopathic variant) where the etiology remains obscure. Few have been reported. We present such a case and discuss the treatment involved.
Isolated Bilateral Cryptophthalmos
Authors: Rodriguez V. R. , El Shafei M. M. , Eguia F.
Published: February 2016

We report a male, Qatari infant, born in September 2001 at Hamad Medical Corporation (Doha, Qatar) with bilateral, asymmetric cryptophthalmos. Parents presented first degree familial consanguinity, but negative for ocular abnormalities. General physical examination was unremarkable. Ocular exam showed incomplete variety in the right eye and complete on the left eye. Partially exposed right eye exhibited total corneal opacity. The left eye B Scan Ocular Ultrasound depicted anterior megalophthalmos and enlargement of globe's axial length. CT Scan revealed anterior chamber dysgenesis in the right eye, with normal posterior segment. Cryptophthalmos is a very rare inherited condition, mainly when it appears as an isolated case and not syndromic. To our knowledge, this is the first isolated non syndromic cryptopthalmos case reported in Qatar and in the Gulf countries.
Recent Advances in the Diagnosis of Benign Prostatic Hyperplasia
Authors: Al Ansari A. , Al Remaihi K. , Younis N.
Published: February 2016

Benign prostatic hyperplasia (BPH) is a chronic and complex disease involving anatomical enlargement of the gland, real urinary obstruction and non-specific lower urinary tract symptoms (LUTS). LUTS are age-related lower urinary tract symptoms that affect 30-60% of men over the age of 40 years. LUTS could be due to causes related to the prostate, bladder or the central nervous system. Because the term “LUTS” is broader, it has replaced the term “prostatism”; the term LUTS BPH is the preferred one in urological literature
The Spectrum of Breast Diseases in Qatar: A pathological study of 1336 cases over 10 years
Authors: Al Bozom I. A.
Published: February 2016

The incidence and pattern of breast diseases are well studied in the West and to a lesser extent in neighboring Arab countries but rarely in the State of Qatar. In an attempt to delineate the spectrum of breast diseases of women living in Qatar, records were reviewed and analyzed of breast lesions from 1336 women received by the Department of Laboratory Medicine and Pathology, Hamad Hospital, from 1992 until May 2002. This enabled comparisons with data from other countries in the region and with western countries. Fibroadenoma was the most common lesion encountered (34%), followed by infiltrating ductal carcinoma (22.7%), Fibrocystic changes (15.2%), and Mastitis and Abscess (8.8%). The mean age for infiltrating ductal carcinoma was 45.4 years compared to 54 years in Western countries. Statistical results were similar to neighboring Arab countries but different from Western countries (i.e. early presentation of carcinoma, and more cases attributed to lactation and pregnancy probably related to the high fertility amongst women in Qatar). The spectrum of breast diseases in Qatar shows little difference compared to neighboring Arab countries but differs from western countries in that, although breast carcinoma is the most common carcinoma affecting women residing in Qatar, its incidence is far less than in the west and it is most prevalent in a younger age group.
Regional Necrotizing Fasciitis and its Outcome
Authors: Shaikh N. , Rasheed A. , Al Faki A. , Husham A. R. , Kattern M. A. , Al Shafie S. , Ahmed A. H.
Published: February 2016

Necrotizing fasciitis, a devastating progressive destructive infection of subcutaneous tissue and fascia, is a surgical emergency with a high mortality and morbidity. To analyze the location of necrotizing fasciitis, mode of presentation, microbiological characteristics, comorbid conditions, morbidty and mortality, records were reviewed retrospectively of all ninety-five patients admitted with necrotizing fasciitis to the surgical intensive care unit of Hamad General Hospital between January 1995 and February 2005. Fifteen patients died (15.1%). All patients had leucocytosis and fever on admission with a mean SOFA score varying from 8 to 10.3 according to the type of necrotizing fasciitis involved (Type 1 or 2) and the regions affected. All received aggressive fluid replacement therapy and all underwent debridement at least twice. The most common comorbid condition was Diabetes mellitus. Type 1 necrotizing fasciitis was common in gluteal, cervical and perineal regions; Type 2 was common in chest, axilla, leg and foot regions. Necrotizing fasciitis of the chest, axilla and gluteal regions had the highest mortality while necrotizing fasciitis of the perineum and genitalia had the lowest mortality.
Maternal Intrapartum Antibiotic Use and Severity of Neonatal Infection in Qatar: A hospital-based cohort study
Authors: Lutfi S. A. , Salameh K. M. , Al Rifai H. A. , El Shafie E.
Published: February 2016

To study the effect of intrapartum antibiotics on neonatal mortality and morbidity for infants with cultureproven neonatal sepsis the records were reviewed of all live born infants with culture positive neonatal septicemia admitted to the Neonatal Intensive Care Unit (NICU), Women's Hospital, Qatar between January 1st 2004 and April 30th 2005. Of 113 infants with culture-proven septicemia, 59 had received intrapartum antibiotics. Using univariate analysis, infants whose mothers had received intrapartum antibiotics were less likely to survive the septic episode (OR 0.09,95% CL 0.11-0.75, p = 0.009) and more likely to have severe septicemia (OR 4.38, 95% CI 1.74-11.02, p = 0.01) but gestational age adjusted estimates of survival and severe sepsis showed no difference between study and comparison groups. Being retrospective the study had certain limitations in variables but there is no clear evidence that intrapartum use of antibiotics plays a direct role in increasing mortality in septicemic infants.
Epidemiology of Genito-Urinary Tumors in Qatar (From a paper read in the 2nd Congress of Qatar Cancer Society
Authors: Al Khadi S. , Al Ansari A. , Younes N. , Al Said S.
Published: February 2016

A retrospective review of genito-urinary tumors examined histopathologically in Qatar during the period 1998-2004 showed bladder cancer to be the most common followed by prostate, renal, testicularrenal pelvis and urethral tumours in order of decreasing prevalence. The apparent increasing annual prevalence of some tumors is discussed and the findings are compared with those reported from neighbouring countries and in literature from the West.
Assessment of Initiation Time of Thrombolytic Therapy in Patients with ST-Segment Elevation Myocardial Infarction in Hamad General Hospital
Authors: Al Nuaimi S. A. , Al Chetachi W. F. , Gehani A. A.
Published: February 2016

The elevation of reperfusion therapy for acute STsegment elevation myocardial infarction are time-related and there are decreasing benefits with increasing delays to therapy. To determine whether the time interval between a patient's arrival at the emergency department of Hamad General Hospital, Qatar and initiation of thrombolytic therapy in the coronary care unit (door-to-needle time) is within the 30 minutes recommended by American College of Cardiology!American Heart Association guidelines, the medical records were reviewed of 213 patients with STsegment elevation myocardial infarction who were admitted through the Emergency Department to receive thrombolysis in the Coronary Care Unit in the twelve months May 2006-April 2007. Medians were calculated for door-to-needle and painto-needle times and intermediate points. The median painto-needle and pain-to-door times were 211 and 143 minutes respectively, both increasing significantly with the age of the patient and were shorter in men than in women. The median door-to-needle time was 60 minutes with 11.7% of the sample having a door-to-needle time within the recommended 30 minutes. It is concluded that the need for transferring such patients from the emergency department to the coronary care unit of the hospital before the administration of thrombolysis incurs inevitable delays that can be minimized by administering thrombolysis in the emergency department.
A Study of Dementia in Home Care Patients in Qatar with the Psychosocial Burden on Caregivers
Authors: Al Sulaiti E. M. , Abdelnour S. , Ramadan M.
Published: February 2016

Dementia is characterized by progressive deterioration of cognitive functions. It places a burden on caregivers and on society,and has been established as one of the major challenges of the present time. A retrospective study of 350 home care patients in Qatar found 50 with dementia for which it assessed various risk factors, co-morbities and the psychosocial burden on the care givers. It was found that the two major types of dementia, Alzheimer's disease and Vascular dementia had equal occurrence amongst home care patients in Qatar, with hypertension and atherosclerosis being the major contributing factors; a family history of dementia played only a minor role. Depression was the main co-morbidity in the patients. The care givers, mostly female, showed no significant psychosocial burden.
Clinical Pattern of Cirrhotic Ascities in the State of Qatar
Authors: Khan Y. F. , Abbas M. T. , El Mudathir M. , Errayes M. , El Hiday A. H.
Published: February 2016

Ascites is a common important feature of chronic liver disease and to determine the extent, causes, clinical presentation and nature of cirrhotic ascites in Qatar a descriptive, prospective study was made of 48 males and 14 females with cirrhotic ascites and a mean age of 562 “12.6 years admitted to the Medical Department, Hamad General Hospital between January 2004 and January 2005. Twenty six were Qatari, the remainder being of various nationalities. The most common cause of cirrhotic ascites was chronic alcoholism, found in 29 (46.8%) patients. Uncomplicated liver cirrhosis was found in 40 (64.5%) patients, complicated liver cirrhosis in 22 (35.5%) patients. At admission, encephalopathy, GI bleeding, and fever were found to be significantly associated with complicated cirrhotic ascites. Results of the study suggest that cirrhotic ascites is common in the State of Qatar with the most common causes being chronic alcoholism followed by chronic viral hepatitis C and B. It is suggested that efforts are needed to prevent and treat these two conditions.
Rhinosporidiosis in Qatar: A Case Report and Literature Review
Authors: Abdulkader F. I. , Al Sulaiti M. , Al Saey H. , Ganesan S. , Al Qahtani A. , Al Shaikhly A.
Published: February 2016

Rhinosporidiosis is a chronic granulomatous inflammatory disease characterised by polypoid lesions of the mucus membranes. The disease is endemic in India but very rare in the Middle East. We report the clinical presentation, management, and histopathology of the first case of rhinosporidiosis in Qatar and review the literature.
Clinical Quiz 1 MICU Pearl: Young lady referred from Women's Hospital to Medical ICU because of abdominal pain, fever and hypotension
Authors: Kamha A. , Alzeer H.
Published: February 2016

Young lady referee from women's hospital to Medical Intensive Care Unit because of abdominal pain, fever (Temperature 39°C) and hypotension. She was pregnant 20 weeks on top of intrauterine device (IUD) and was evaluated as intrauterine fetal death. The diagnosis was septic shock due to intra-abdominal infection. Looking for the source of infection, CT abdomen and pelvis was done (Figs. 1 and 2).
Clinical Quiz 2 A Young Male with Fever and Abdominal Chest X-Ray
Authors: El Hiday A. H. , Al Maslamani M. , Errayes M. M.
Published: February 2016

A 28- year old male from Nepal presented with history of fever, right-sided chest pain for the last four weeks. During admission some investigations were carried out.
Selected Abstracts From Other Journals
Authors: Gehani A. A. , Hammoudeh M.
Published: February 2016

Background: We aimed to investigate whether the addition of nonsteroidal anti-inflammatory drugs or spinal manipulative therapy, or both, would result in faster recovery for patients with acute low back pain receiving recommended first-line care.
Frequency of Dissociative Disorder Among Psychiatric Outpatients in Saudi Arabia: A Replication Study
Authors: Abdel Hafeiz H. B. , Abumadini M. S.
Published: February 2016

A prospective study of dissociative disorders was compared with a study 20 years before. During the study period all new dissociative outpatients of King Fahd Hospital of the University, Al Khobar, Saudi Arabia were included. In accordance with the concept of decreasing incidence of dissociative disorders over the years, there was a significant decrease in the frequency of dissociative disorders between the two studies. Fits and dyspnea significantly dominated the clinical presentation, while other symptoms were rare. The dominant age was below 30 and the female-male ratio was 3.2:1, similar to that reported worldwide. Dissociative disorder seems to breed true over the years but the pattern remains unique to the ambient culture.
Index Finger Pollicisation for a Congenital Thumb Hypoplasia and Aplasia-Surgical Techniques
Authors: Al Hetmi T. , Gilbert A.
Published: February 2016

Thumb hypoplasia and aplasia are disabling congenital deformities and in the more severe cases (Grades IV and V) the only possibility is pollicisation Some Grade III hypoplasia cases are more severe with absence of the trapezio-metacarpal joint and most of the first metacarpal These cases are best treated by amputation and pollicisation. The authors describe in detail pollicisation of the index and its pitfalls.
Awareness, Knowledge, and Attitudes of the General Public Towards Hepatitis C in Port Said City, Egypt (2005)
Authors: Salama R. E.
Published: February 2016

Hepatitis C is a major and increasing health problem in Egypt. To assess the awareness, knowledge, and attitudes of the general public towards Hepatitis C a KAP crosssectional study was conducted in Port Said between May and November 2005 on 395 randomly selected individuals over 18 years of age. A structured questionnaire collected data for the assessment ofpersonal characteristics, general knowledge about Hepatitis C, awareness about Hepatitis C transmission and ways of its prevention, and the society's attitudes towards Hepatitis C. Approximately 95% of the study population had heard about Hepatitis C but only half were certain that it was a public health problem. Many had incorrect perceptions about transmission, prevention and vaccination. There is an obvious need for public education in which government and health educators can play an important and effective role.
Prolactin-Producing Adenoma. Clinical Presentation in Adult Sudanese Patients
Authors: Idris M. N. , Zibair M. A. , Salama H. A. , Ibrahim E. A. , Mirgani M. , Osman R. R. , Abadalatif M. , Sokrab T. O.
Published: February 2016

Objectives: To describe the clinical features of prolactin-producing pituitary adenoma (prolactinoma) in adult patients.

Methods: In a prospective hospital-based study, adult patients with prolactinoma presenting to the National Center for Neurological diseases and the National Center for cancer in Khartoum, Sudan were enrolled in the period from January 2001 to February 2005. The diagnosis was based on finding a pituitary adenoma on cranial MRI and an associated elevated blood prolactin level above 200 pig/L. The size of the adenoma was classified as either microadenoma ( < 10 mm without sellar enlargement or extrasellar extension) ormacroadema (>10 mm). The hormone profile done on each patient included blood level of prolactinand other pituitary trophic hormones, free triiodothyronine and free thyroxine hormones.

Results: Sixteen (14 females and 2 males) were identified as having a prolactinoma. The female to male ratio was 7:1. Their mean age was 24 ± 5.1 years. The prolactinoma was macroadenoma in 9 cases and microademoma in 7. Galactorrhea, amenorrhea and infertility (primary or secondary) were the commonest presenting symptom followed by headache. Affection of the visual pathway, either as bitemporal hemianopia (41.2%) or optic atrophy (11.8%), was the major neurological deficit. The mean prolactin level in macroadenoma was 2053 ± 442.6 jig/L and in microadenoma was 853.6 ± 77.8 jig/L.

Conclusions: Our prolactinoma patients, when reaching the appropriate medical attention, are more likely having an expanded macroadeoma that is compromising the visual pathway. Early recognition and referral to specialized clinics is necessary and that should have a favorable prognostic implication.
Use of Insulin Pump in Children with Type I Diabetes Mellitus: Effect on Glycemic Control and Body Mass Indices (BMI)
Authors: Al Hemaidi N. , Wagdi M. , Al Ali M. , Soliman A. , Al Zyoud M.
Published: February 2016

To assess the effect of an insulin pump on the glycemic control as well as the body mass index (BMI) of children with type 1 diabetes mellitus (DM1), 23 patients under the age of 18 years were monitored for one year or more. HbAlc concentration decreased from 9.36+/- 2.02% to 8.54+/-1.149%. The BMI increased significantly from 17.12+/- 2.236 to 20.4+1- 2.93. No hypoglycemia was reported in any of the patients after using the pump. Three incidences of diabetic-ketoacidosis (DKA) were reported due to two pump malfunctions and one patient error. All except two wanted to continue with the pump because of the desirable flexibility of their lifestyle including activity and meal times.
Neurocysticercosis Presenting with Psychiatric Manifestations
Authors: Garieballa S. S. , Hakam A. M.
Published: February 2016

Cysticercosis is the most common heliminth infection of the human central nervous system Epilepsy is the most common presentation and occurs in 50-85% of patients. Psychiatric manifestations in a form of depressive disorders, cognitive decline and psychosis have been reported frequently(2). A19-year-old Nepalese male presented with severe headache, seizures, fears and anxiety for one week. A CT scan of the brain showed small calcified lesion in the right deep temporal white matter without perifocal edema. This was considered suggestive of a healed inflammatory granuloma-neurocysticercus cyst. Treatment with a combination of albendazole dexamethazone, ranitidine, phenytoin, lorazepam and hydroxyzine resulted in a rapid recovery.
Oral and Dermatologic Findings in Two siblings with Papillon-Lefevre Syndrome: Review of the Literature
Authors: Yacoub A.A. , Hattab F.N.
Published: February 2016

Papillon-Lefevre syndrome (PLS), first described in 1924, is a rare autosomal recessive disorder characterized by early onset palmoplanter hyperkeratosis and severe generalized destructive periodontitis leading to premature loss of both primary and permanent dentitions. PLS usually manifest itself between the ages of six months to four years, coinciding with the eruption of primary teeth. The proband becomes completely edentulous by the age of 15.
Retained Surgical Instrument in the Abdomen: Presenting as a strangulated obstruction of small bowel
Authors: Tawfik G.H.
Published: February 2016

A patient who needed surgery for a strangulated obstruction of small bowel was found to have a pair of artery forceps in the peritoneal cavity following surgery for repair of an abdominal wall hernia twelve months before. The six-inch metallic forceps fractured easily on initial manipulation directly after retrieval. This case demonstrates the easy retention of a small surgical instrument in the abdomen, with the rare and serious complication of bowel strangulation, and the sequel of corrosion of a metallic foreign body in a human.
Clinical Quiz: Pyoderma Gangerenosum
Authors: Yassin M. , El Ayoubi H. , Al Hijji I. , Abboudi K. , Yassin R.T. , Negm Eldin R.H.
Published: February 2016

52 year old Indian female patient with no significant past medical history presented with a skin lesion started since three weeks associated with fever for three days CBC showed pancytopenia investigations (bone marrow) revealed a very severe Aplastic anemia.
“From Qatar to the World” Abstracts Presented at International Conferences or Published in Medical Journals
Authors: Gehani A.A. , Hammoudeh M.
Published: February 2016

The dentofacial structures are some of the most frequently injured parts of the body by traumatic injuries which can occur as a result of sports, motor vehicle accidents or altercations. Injuries can range from minor dental injuries to facial lacerations to fracture of one or more of the facial bones.
Pseudomonas Aeruginosa in Cystic Fibrosis Patients with CFTR 11234V in a Large Kindred Family
Authors: Abdul Wahab A. , Abu Shahin A.
Published: February 2016

To describe the characteristics of Pseudomonas aeruginosa (P. aeruginosa) in cystic fibrosis (CF) patients with CFTR 11234V in a large kindred family in Qatar, medical and laboratory records were reviewed of 46 patients of CF with CFTR 11234V from 25 families arising from a single large Arab kindred tribe who attended the CF clinic between May 2002 and June 2008. Thirty eight CF patients, who were negative for P. aeruginosa at first lower respiratory culture, were enrolled in the study. The diagnosis of CF was confirmed by sweat test and molecular genetic study. Trypticase soy agar with 5% sheep blood, McConkey agar, oxidative-fermentative polymyxin B-bacitracin lactose agar, Hemophilus isolation agar and mannitol salt agar were used as selective media for the isolation of important CF respiratory pathogens. The prevalence of (P. aeruginosa) in lower respiratory cultures from 46 patients was 60.9%. Twenty (52.6%) of 38 CF patients with CFTR 11 234V acquired P\ aeruginosa with no seasonal variation. Positive siblings with P. aeruginosa were found in 70% indicating cross-infection within the family. The median (range) age at first detection of P. aeruginosa was 12.5 (1–19) years. There was no significant difference between males and females in acquisition of P. aeruginosa. P\ aeruginosa of mucoid phenotype was detected in 11 (55%) of 20 with additional organisms, 5. aureusbe'mg the second isolated organism in nine (81.8%) of the 11. Conclusion: A larger prospective study in a cohort of CF patients with CFTR 11234V in the Arabian Gulf region is required to determine the risk factors for acquisition of P. aeruginosa with early aggressive antipseudomonal therapy.
Does Delay in Diagnosing Acute Appendicitis Affect the Outcome?
Authors: Kanbour A. , Al Alawia A. , Al Den A.S. , Bener A. , Khallid M.
Published: February 2016

Acute appendicitis is the most common surgical case met in an emergency department. Immediate surgery results in the confirmation of diagnosis and control of sepsis. To determine whether the delay in operating upon patients with acute appendicitis will affect the outcome or the stage of the disease, and if the clinical parameters give an indication of the severity of the disease medical records were reviewed retrospectively of 373 appendectomized patients above 14 years of age who were diagnosed with appendicitis in the emergency department of Hamad General Hospital, State of Qatar, between June and September 2007; 341 were diagnosed as acute appendicitis. Patients were classified according to the pre-operative and histopathological findings into four grades; A1: inflamed appendix, A2: gangrenous appendix, A3: perforated appendix, A4: pus +/- mass formation. Complications increased with the duration of the pre-hospital delay. The length of stay in hospital correlated significantly with the grade of diagnosis. The presence of fever, no change in bowel habit, and rigidity correlated well with advanced pathology, the complications increasing with greater delay. We conclude that delayed appendectomy is unsafe since it is associated with an increase in pathological grading as well as increasing the morbidity and the length of stay in hospital.
Mucous Cysts Formation: A rare complication of Rhinoplasty
Authors: Kaldari S. , Al Thalatheni M.
Published: February 2016

Mucous cysts formation following a rhinoplasty is a rare complication and typically presents late. Only one case has been reported in our department. The cysts seem to arise from mucosal remnants left in the subcutaneous layer and must be distinguished from other complications causing post-operative swelling of the nose, such as foreign body, paraffinoma (rare nowadays) and bony or cartilaginous fragments. We describe a case of dorsal mucous cysts following rhinoplasty, provide a quick review of the relevant literature and discuss the surgical removal of this unusual lesion.
Allergic Reaction to Bismuth-lodoform-Paraffin Paste (BIPP) Following Ear Surgery
Authors: Al Hail A. , Al Qahtani A.
Published: February 2016

Bismuth Iodoform Paraffin Paste (BIPP) impregnated ribbon gauze is one of the most commonly used packs after external and middle ear surgery. Allergic reaction to BIPP is rare. We report two cases of hypersensitive BIPP reaction following tympanoplasty surgery. To our knowledge no such cases have been reported previously in Qatar. We reviewed the literature and discuss the management and its prevention.
Job Satisfaction and Stress Level of Primary Health Caregivers at Primary Health Centers in Qatar
Authors: Al Khalaf J.H. , Singh R. , Malallah M. , Al Jak E.A.
Published: February 2016

Job satisfaction of Primary Health Caregivers is critical for the improvement of health systems. A cross-sectional study was conducted by means of a questionnaire to evaluate the job satisfaction and stress in 323 Primary Health Caregivers in Qatar, of whom 176 (54%) Physicians/General Practitioners responded. Similar numbers of males (85; 48%) and females (91; 52%) replied; most were non-Qatari, aged 30–45 years, married with children. The overall job satisfaction and stress were both below average. There were no significant differences in overall job satisfaction for nationality, sex, marital status and number of children, but female Qatari health caregivers were stressed more than their counterparts. There was a negative correlation between job satisfaction and stress level (r = − 0.29, p = 0.01). Qatari physicians were less satisfied with their salaries and the variety in their work and stress was greater in Qatari Health Caregivers than Non-Qatari counterparts.
Measles Outbreak in Qatar 2007
Authors: Ibrahim K. , Al Gibali O. , Sakran M. , Al Ansari K.
Published: February 2016

To analyze the epidemiological and clinical characteristic of a measles outbreak in Qatar in 2007, the records of 21 2 confirmed cases of measles were analyzed retrospectively, confirmation being based on clinical suspicion of the disease with a positive measles IgM (170 cases) and /or exposure to a laboratory confirmed measles case during the infectious period (42 cases; epidemiologic link). Eighty five percent of the cases occurred between April and July. Seventeen percent were in infants <  1 year of age, 47% in children between 1-5 years of age, 24% in school age children < 10 year of age and 1 2% in children >10 years old. Vaccinations were up to date in 60% of cases, second dose missed in 30% and no vaccination in 10% because of travel outside the country, concurrent illness, or lack of transportation. Thirty one percent of the cases required admission, with a mean hospital stay of four days. Cases were reported predominantly in Pakistani and Qatari patients, living mainly in three areas within the capital, Abu Hammour, Al Rayyan, and Al Mamuora.

Conclusion: Status of vaccination in Qatar needs careful analysis and the vaccination schedule should be reviewed. Early administration of vaccine, increasing community awareness, a well-coordinated school-based immunization program and immunization campaigns are required to prevent future outbreaks.
Comparison Between the Antioxidant Level of Uremic Patients Before and After Hemodialysis (Hd) and Vitamin E Therapy: Prospective cohort study
Authors: Al Youzbaki W.B. , Thanoon I.A/J. , Mustafa K.N. , Al Hayali R.Y.
Published: February 2016

A prospective cohort study of 18 males aged 19–45 years with chronic renal failure attending the Ibn Sina Teaching Hospital, Mosul for Hemodialysis (HD) between March 2007 and March 2008 assessed the oxidative stress, antioxidant status, serum urea and serum creatinine before and after hemodialysis and following subsequent supplementation with oral Vitamin E. Blood samples collected before starting hemodialysis, after three weeks of twice-weekly dialysis, and then after three weeks of oral vitamin E (400 i.u/day) showed significant decreases of total antioxidant status (TAS) after HD but a significant increase of TAS after Vitamin E therapy; a non-significant increase of lipid peroxidation indicator (serum malondialdehyde; MDA) after HD alone but a significant decrease of MDA after Vitamin E therapy; a highly significant decrease of serum urea after HD and a highly significant increase of serum urea after Vitamin E therapy; a highly significant decrease of serum creatinine after HD and a highly significant increase of serum creatinine after Vitamin E therapy; a highly significant decrease of serum uric acid after HD and a highly significant increase of serum uric acid after Vitamin E therapy. There were non-significant correlations between TAS and MDA, uric acid, serum urea and serum creatinine after HD and after Vitamin E therapy. It is concluded that in patients with chronic renal failure oxidative stress is further exacerbated, as shown by decreased TAS and increased MDA although serum uric acid is not the sole contributor. Vitamin E supplementation in such patients after HD does not enhance renal function but it decreases the oxidative stress by decreasing MDA and enhancing antioxidant body status by increasing significantly TAS and serum uric acid.
Screening for Blood Lead Levels in Basrah, Southern Iraq
Authors: Al Naama L.M. , Hassan M.K. , Hehdi J.K. , Al Sadoon I.O.
Published: February 2016

A prospective study over six months (from 1 July to 31 December 2002) measured the level of blood lead in individuals attending Primary Health Centers in the center District of Basrah Governorate. Six hundred and two individuals were selected randomly from those attending seventeen Primary Health Centers in the center of Basrah. Their ages ranged from 9-79 years. Of 602, Twenty six, 15 years of age or younger had mean blood lead levels (BLL) of 12.62+3.85 ug/ dl, those older than 15 years had levels of 11.20+3.4 ug /dl (p < 0.05). Males of different age groups showed a statistically significantly higher BLL compared to females (13.25+3.25 and 10.10+2.96 ug/ dl respectively), p <  0.0001. The center of Basrah was divided into 11 main areas; there was a statistically significant difference in BLL among individuals living in different areas, ranging from 7.26+2.81 |jg/ dl to 12.76+3.63 ug/dl. Individuals with higher education and smokers showed higher BLL (12.10+3.54 ug/dl, 13.81+3.57 ug/dl respectively) compared to those of lower education and non-smokers (11.11+3.23 ug/ dl, 10.93+3.26 ug/dl respectively), the differences were statistically significant. The sources of drinking water and frequency and amount of milk consumed/ week did not show a significant correlation with BLL. History of lead exposure (occupational) was statistically significantly associated with BLL (15.3+4.85 ug/ dl) for those exposed to higher concentration of lead compared to others (11.1 2+3.3 ug/dl), p < 0.0001. Amongst females using kohl (25.6%), the mean BLL was significantly higher (13.91+4.42 ug/dl), compared to non-users (9.88+2.68 ug/dl), p < 0.0001. No significant difference was observed among those exposed to paints. As adequate data on BLL in our country do not exist, especially for children, and as the number of children in this study was small, further studies are warranted to recognize the extent and risk factors for lead poisoning in children.
Fentanyl Transdermal Therapy System (TTS-Patch) for Post-Traumatic Blunt Chest Injury
Authors: Ezzat A. , Kahlout B. , Al Hassani A. , Hassan R. , Tawfik M.O.
Published: February 2016

Proper post-extubation pain control in traumatic blunt chest injury represents a challenge to provide adequate analgesia for proper lung inflation and to prevent re-intubation. In this case, the average opioid (Remifentanil) infusion drip in a traumatic blunt chest injury patient in the 48 hours prior to extubation was calculated and converted to the equivalent analgesic one of the Fentanyl Transdermal Therapeutic System (Fentanyl TTS Patch). The analgesic gap before the onset of action for the applied fentanyl patch was covered by frequent injections of tramadol. Evaluation of the Fentanyl TTS effect through the post-extubation period was carried out by measuring the analgesic effect on a visual analogue scale, the alertness status by simple sedation score, while the respiratory performance was followed by the negative inspiratory force. The outcome in this case showed that Fentanyl Patch is a reliable, favorable, safe and non-invasive method that produces a good analgesic effect and positive impaction on the post-extubation course of respiratory performance with a satisfactory outcome and no side effects.
Hydatid Cyst Causing Femoral Artery Embolism arid Ischemic Syndrome of a Lower Limb
Authors: Arifi M.
Published: February 2016

An intracardiac hydatid cyst is a rare but potentially very serious complication of hydatid disease as the rupture of the cyst may lead to embolisation of the femoral artery. We report the case of a 29-year-old man who was admitted with the diagnosis of arterial occlusion of the left leg. During surgery, a large hydatid cyst causing femoral artery occlusion was found and excised. This case emphasizes that, in endemic countries, primary vascular echinococcosis should be considered in the differential diagnosis of arterial occlusion.
Abnormal Presentation of Neurofibromatosis: Review of the Literature
Authors: Atalla H.H. , Al Hetmi T. , Makki A.S. , Al sharkawy M.
Published: February 2016

Multiple Neurofibromatosis (NF) is a disease of great interest because of the familial nature of the disease, the complexity of its morphology, the progressive character of its course and the numerous complications that may develop during its evolution. The authors present a late presentation of a genital NF type 1 affecting the penis and the right lower limb of a young adult.
Thoracic Ectopic Kidney in a 86 Year Old Male with Multiple Co-morbidities
Authors: Kanbour A. , Hussain S.A.
Published: February 2016

Thoracic ectopic kidney is a rare congenital anomaly that is often missed. We report a case of diaphragmatic hernia associated with a left thoracic ectopic kidney and bowel herniation into the left hemithorax. Radiological studies including chest radiology and computed tomography confirmed the diagnosis.
The “All-Fours” Maneuver for the Management of Shoulder Dystocia
Authors: Al Saqqa M , Khaiyon N.
Published: February 2016

The “all fours” maneuver for managing shoulder dystocia appears to be a rapid, safe and effective technique in women in labor with this problem. We report a case of shoulder dystocia managed successfully with complete vaginal delivery and no injury to mother and newborn after using the “all fours” maneuver. A brief literature review includes descriptions of other maneuvers for the problem of shoulder dystocia.
Rhinoscleroma of the Larynx: First case report in the State of Qatar
Authors: Al Alousi F.H , Al Soub H , Al Baker B
Published: February 2016

Rhinoscleroma is a chronic slowly progressive inflammatory condition of the upper airways mostly caused by infection with Klebsiella pneumoniae subspecies rhinoscleromatis and less frequently subspecies ozaenae. The disease is uncommon in developed countries but it still exists in Africa and South America. The disease usually takes a chronic course and diagnosis, which might be delayed, depends on the isolation of the organism from the tissue and the characteristic histopathologic features. We report here a case of rhinoscleroma of the upper airways that presented as a laryngeal mass in a young Egyptian man living in Qatar. The methods of diagnosis and treatment are discussed and the relevant literature reviewed.
Outcome of Occlusion Treatment for Strabismic Amblyopia in Children Below 12 Years Old Age
Authors: Mahdi Al , Bener A
Published: February 2016

AbstractObjective:The aim of our study was to determine the related clinical factors affecting the outcome of occlusion treatment for Strabismic Amblyopia in Qatari children.

Design:This is a retrospective descriptive study.

Subjects and Methods: The study included 38 Qatari children with strabismic amblyopia who were treated with occlusion therapy. The survey was conducted among the Qatari children below 12 years of age during a 10 year period from 1992-2002. During this study period, 23 girls and 15 boys were treated for strabismic amblyopia.

Results:A total of 38 Qatari children were treated during the 10 year period. Of these children, 39.5% were males and 60.5% females. After the treatment, it is found that their final visual acuity improved. 73.7% achieved 6/9 or more and 26.3% achieved less than 6/9. The initial visual acuity, the presence of anisometropia and compliance were found to be related to the outcome of amblyopia treatment. The age at the start of treatment was found unrelated to the outcome. It was further discovered that most vision loss from amblyopia can be reversed with the correct intervention.

Conclusion:The results of the present study indicated that the main factors affecting the treatment of strabismic amblyopia are initial visual acuity, presence of anisometropia and compliance.
Growth Response to Growth Hormone (GH) Therapy in Children with and without GH Deficiency
Authors: Al Zyoud M. , Wegdee M. , Al Ali M. , Soliman A. , Al Humeedi N. , Al Khalaf F.
Published: February 2016

The diagnosis of growth hormone deficiency (GHD) needs consideration of both clinical and biological aspects such as auxological data, GH provocative tests and active metabolites of GH including IGF-I and IGFBP-3. In children with GHD, recombinant human GH (rhGH) replacement therapy has been used worldwide with minimal serious side effects. This study aimed to report the results of an investigations for GHD, to describe the growth responses to rhGH in deficient children compared to those without GH deficiency, to evaluate the relationship between clinical and biochemical responses, and to describe the experience of diagnosis and treatment with rhGH at Hamad General Hospital, the main hospital in Qatar where most short children are referred for further investigation. The clinical records of 116 short children were reviewed retrospectively. Forty-six failed the clonidine test and 42 of these also failed the glucagon test and were confirmed with GHD. These and 16 children without GDH were treated with rhGH (25 gg/kg/ day) and were evaluated in terms of growth response, HtSDS, changes of IGF-I concentration and the relationship between these parameters. Treatment with GH of short children with GHD does produce a satisfactory growth response but the HtSDS gain was significantly higher in those with GHD compared to children without GHD. Measurement of IGF-I was found not to be a useful diagnostic test in GHD.
Neuro-lmages of Patients with Infantile Spasm
Authors: Alshami R. , Bessisso M. , El Said M.F. , Venktraman B.
Published: February 2016

With the intention of assessing the neuro-imaging, clarifying the percentages of symptomatic, idiopathic and cryptogenic cases and identifying the underlying causes, records were reviewed retrospectively of 30 children with infantile spasm admitted to Hamad Medical Corporation, Doha, Qatar. Twenty-three patients were symptomatic, four idiopathic and three cryptogenic. Brain CT and MRI scans of 13 cases detected similar neuro-imaging findings in nine cases while MRI provided more information in another four cases. Three patients had normal neuro-images despite persistently abnormal EEGs. We conclude that MRI scans are superior to CT scans in detecting areas of cortical dysgenesis, disorders of neuronal migration, or disorders of myelination although more advanced studies are required for patients with persistently abnormal EEGs but normal MRIs.
Levonorgestrel-Releasing Intrauterine System (LNG-IUS) as a Therapy for Endometrial Carcinoma
Authors: Al Mulla N. , Al Ansari A. , Falamarzi M. , Emad M.
Published: February 2016

In our study we present two cases that have been diagnosed as stage I endometrial carcinoma where a Levonorgestrel intrauterine releasing system (LNG-IUS) referred to as Mirena was used as a primary treatment because the standard surgical treatment was deemed to carry an unacceptable risk of death. Histopathology report after therapy showed complete regression of endometrial cancer.
Percutaneous Treatment of a Large Celiac Artery Aneurysm Using a Stent Graft
Authors: Arifi M.
Published: February 2016

Celiac trunk aneurysm is a rare finding. Most patients are symptomatic at the time of diagnosis but occasionally such aneurysms are detected incidentally during diagnostic imaging for other diseases. Since the anomaly was first described in 1745(1) fewer than 180 cases have been reported in the international medical literature.(2) Atherosclerotic aneurysms of the celiac artery (CAAs) comprise approximately 4–6% of all visceral aneurysms.(3–4) Early surgical intervention has reduced the rupture rate to 7% in recent years.(5) Early recognition and intervention are crucial because the operative mortality rate associated with ruptured celiac artery aneurysms is around 40%.(6) There are no absolute size criteria associated with significant rates of CAA rupture, but 2 cm appears to warrant intervention in most series.(7–8) Surgical reconstruction, surgical ligation, intraluminal embolization, thrombin injection and endovascular grafting have all been reported with success/9”11) We present a case of a 6.9 cm symptomatic celiac artery aneurysm treated successfully with endovascular stenting.
Classic Kaposi's Sarcoma: A Case Report and Literature Review
Authors: AI Hammadi N.M. , Perkins G. , Rasul K. , Wannenmacher M.
Published: February 2016

Kaposi's Sarcoma (KS) is a rare multifocal spindle cell tumor with four epidemiologic variants: classic KS, African endemic KS, AIDS related KS, and immunosuppressant therapy related KS. Classic KS remains a rare but challenging disease because of its protracted, indolent course. The authors describe a case recently observed in our clinic, emphasizing the clinical management of the disease.