Qatar Medical Journal - Volume 2002, Issue 2

We have received many requests from colleagues in Qatar and abroad to re-publish the biographies of the Muslim physicians and scientists who contributed to the development of medicine as we know it today.

He is Abu A1 Hassan Ala Addin Ali Ibn Abu A1 Hazm. One of the prominent Muslim Physicians. He was the first to describe the pulmonary circulation (minor circulation) of the blood. This was an important landmark in the understanding of the circulation, several hundreds of years before William Harvey's description. In finding that the wall between the right and the left ventricles of the heart is solid without pores, he disputed Galen's view that the blood passes directly from the right to the left side of the heart. Ibn A1 Nafis correctly stated that the blood must pass from the right ventricle to the left ventricle by way of the lungs. But the significance of this statement remained unheaded and in fact unknown by physicians in western countries. It was only in the 20th century that his work was brought to light.

Abu Ali Hassan Ibn Al Haitham was one of the most eminent physicists, whose contributions to optics and the scientific methods are outstanding. Known in the West as Alhazen, Ibn Al Haitham was born in 965 A.D. in Basrah, and was educated in Basrah and Baghdad (Iraq).

Papers considered for publication in Qatar Medical Journal are those reporting original work, review articles and case reports that are particularly relevant to medicine in the broad sense. Editorials and Review articles are by invitation.

Laparoscopic supracervical hysterectomy is a viable alternative with putative advantages over the same procedure performed via laparotomy for those individuals requiring uterine extirpation without indication for cervical removal. The laparoscopic approach to this procedure provides even lower morbidity and therefore can enhance clinical outcomes. The risk of subsequent cervical cancer, an uncommon and largely preventable occurrence, may not outweigh the benefits of supracervical hysterectomy, which should be offered as an option for selected patients. Therefore it seems likely that, in a woman with a history of regular screening with negative cytology, there will be a minimal risk of future malignant change in a cervical remnant, even this risk would be reduced to near zero if the transition zone and part or all of the endocervical cana were to be removed.

The International Guidelines 2000 Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care was the world's first international conference to produce evidence- based international resuscitation guidelines.

The presence of Helicobacter pylori (HP) was studied histologically in 574patients who underwent Oesophagogastroduodenoscopy. The most common gastroscopic findings were gastritis in 300patients (52.2%) followed by normal gastroscopy in 119 patients (20.7%), duodenal ulcer in 67 patients (11.7%), gastric ulcer in 20 patients (3.5%), duodenitis in 59patients (10.3%) and other findings in nine patients (1.6%).

Histological examination of all574patients showed that 442 (77%) with positive HP tests had different histological abnormalities. Negative tests for HP occurred in 132 patients (23%) of whom 51 (38.6%) had normal histology, 39 (29.6%) had active chronic gastritis and 42patients (31.8%) had inactive chronic gastritis.

Howell-Jolly bodies (HJB) are composed ofDNA which will apparently take the fluorescent dye used to stain the chromatin bodies of the malarial parasites (MP). While evaluating a capillary tube/fluorescent staining technique for malaria we came across this previously unreported false positive effect of HJB in ten cases, all negative microscopically for MP and not originally requested for that test All gave positive results, the degree of which correlated well with the frequency of HJB. The positivity concentrated in the upper red cell layer of the capillary tube where MP rings also concentrate.

During the month of Muslim fasting (Ramadan) many people alter their sleeping habits and stay awake most of the night In this study I looked into the effect of this alteration as well as the effect of fasting on testosterone and its circadian variation in fifty-eight (58) healthy adults. Fortysix (46) of the subjects showed alteration of the diurnal variation during the third week of fasting. Thirty-eight (38) males showed significant increase in evening testosterone level and eight (8) females showed significant decrease of morning testosterone level (P <  0.001 in both). These findings suggest that alteration in sleeping pattern during Ramadan has a significant effect on testosterone levels.

To compare the efficacy of either preoperative or postoperative peritonsillar infiltration of local anesthetic upon posttonsillectomy pain, 70patients aged 15/40 years scheduled for elective tonsillectomy under general anesthesia were divided into three groups. Six patients were excluded for failure to complete the postoperative data, two patients had post-operative bleeding and two patients developed otitis media on the second day postoperatively.

Twenty patients received peritonsillar infiltration with 0.25% bupivacaine, twenty received 0.9% saline and a third group of twenty had peritonsillar infiltration with 0.25% bupivacaine after completion of surgery but before being awakened from anesthesia. Significant changes occurred with bupivacaine infiltration in reducing pain during the first 24 hours after surgery.

It is concluded that preoperative and postoperative blocking of nociceptive impulses reduces postoperative pain but causes no reduction in the intake of analgesics. It is further suggested that the timing of peritonsillar infiltration with bupivacaine is not of clinical importance and does not affect the quality of postoperative analgesia in a patient undergoing tonsillectomy.

A hundred patients presenting with dyspepsia and/or symptoms suggesting parasitosis/candidiasis were subjected to oesophago-gastroduodenoscopy (OGD) in the Endoscopy Unit of Basrah Teaching Hospital Duodenal ulcers were found in 23% of them. Duodenal aspirate and stool samples were taken and examined microscopically for parasitosis and candidiasis. Examination of duodenal aspirates revealed the presence of Giardia lamblia in 15% of the cases, B. hominis in 5%, C. parvum in 4% and Candida spp. in 16%; the respective figures for those microorganisms in stool samples were 8%, 12%y 2% and 7%. There was no characteristic pH level of the duodenal aspirate in relation to parasitosis, candidiasis or endoscopic findings.

A retrospective study was used in the Fertility Clinic of the Department of Obstetrics & Gynecology, Tawam Hospital, Al Ain, Abu Dhabi, United Arab Emirates to determine the outcome of IVF/ICSI cycles complicated by OHSS.

Materials & Methods: In the period between January 1994 and August 2000, 3174 IVF/ICSI cycles were performed and 2918 cycles had reached embryo transfer, 564 women achieved pregnancy (19.33%). 92 women (3.15%) developed moderate-severe OHSS and were hospitalized and their medical and IVF records were reviewed. Supportive management whilst waiting for the condition to resolve spontaneously together with follow-up by ultrasound scan and blood tests was applied to all patients included in the study. Pregnancy test was performed 17 days after ovum pick-up.

Results: Ninety-two women developed moderate-severe OHSS, 37 women of them had a clinical pregnancy (40.2%). 51.4% were singletons and 48.6% were multiple pregnancies; including 13 sets of twins, 4 sets of triplets and one set of quadruplets. The miscarriage rate was 32.4% and the spontaneous fetal reduction rate was 16.6%. 25 women continued pregnancy (67.6%); eleven women had preterm delivery (44%), low birth weight rate was 44% and take home baby rate was 59.4%. The Cesarean section rate was 24%. Pregnancy-induced hypertension rate was only 8% and gestational diabetes 4%. There were no cases of ectopic pregnancy or placental abruption.

Conclusion: The pregnancy rate and the rate of multiple pregnancy, miscarriage, prematurity, low birth weight and Cesarean section rate are significantly higher than those reported previously for pregnancies conceived with the use of assisted reproductive techniques without the development of OHSS. The incidence of other obstetric complications such as pregnancy-induced hypertension, gestational diabetes, abruptio placentae and ectopic pregnancy are not significantly different.

To determine the prevalence of obesity amongst pregnant women in Qatar and to compare pregnancy complications and perinatal outcome among obese and non-obese women, a retrospective controlled study was conducted at the Women's Hospital, Doha, during the period from 1st January to the end of June 2001. We compared 75 obese and 75 non-obese women matched for age and parity.

Maternal demografic variables included maternal age, parity, race and body mass index. The antepartum variables were gestational diabetes, pregnancy-induced hypertension (PIH), abruptio placentae and intrauterine growth restriction. Intrapartum variables were preterm labor; mode of delivery and meconium in labor. Neonatal variables included low birth weight, macrosomia, low Apgar score, stillbirth and admission to the Neonatal Intensive Care Unit (NICU).

Compared to non-obese women, obese pregnant women had significantly adverse perinatal outcomes including gestational diabetes (34.7% vs. 12%, P < 0.001), PIH (16% vs. 2.7%, P = 0.012), macrosomia (20% vs. 6.7%, P = 0.031), cesarean section (29.3% vs. 13.3%, P = 0.038) and admission to NICU (17.3 vs. 5.3%, p = 0.039). Other adverse outcomes were higher in the obese group but the differences were not statistically significant.

Obesity in pregnancy appears to be an independent risk factor for adverse perinatal outcome. Maternal obesity may be one of the most important preventable risk factors for perinatal morbidity and mortality.

Bleeding from a bladder tumor is a common presentation. Most bleeding can be managed conservatively but on certain occasions bleeding can be severe and hard to control. Sixteen patients who were presented with severe intractable bleeding secondary to bladder tumors and failed conservative management, underwent embolization of branches of the hypogastric arteries to control bleeding. Effective control of bleeding was achieved in 15 patients (94%).

In this review we present our experience in the management of intractable bleeding from bladder tumors by percutanous emobolization in respect of technical success, technique and complications

To assess the diagnostic value of fiberoptic bronchoscopy (FOB) in patients with abnormal chest radiographs suggestive of pulmonary tuberculosis (PTB) but with negative sputum smears for acid fast bacilli (AFB), a retrospective study was made of all such cases referred to the Pulmonary Diseases Service at Hamad Medical Corporation between July 1997 and June 2000. It included patients unable to produce any sputum sample. From 193 FOB procedures, active pulmonary tuberculosis was diagnosed in 58 patients (30 %). The diagnosis was confirmed either by finding acid fast bacilli in a smear or by culture of bronchial washings or bronchoalveolar lavage (BAL), or by demonstrating caseating granulomata on transbronchial or endobronchial biopsy. In 19 of58 (33%) positive cases, the diagnosis was rapidly established by demonstrating AFB in smears of bronchial aspirate or by positive histopathology. It is concluded that FOB is still the gold-standard procedure in the diagnosis of pulmonary tuberculosis in those patients in whom the diagnosis cannot be established by sputum examination, thus allowing early diagnosis in a significant proportion of them. The results are in agreement with similar studies.

Current treatment regimens with either long-term interferon (IFN) monotherapy or interferon-ribavirin combination achieve a sustained response of 6-21%. To improve the efficacy of IFN several strategies have been devised, including the use of higher doses of IFN, prolonged courses or pegylated IFN. Some recent reports have suggested that daily administration of IFN in the early phase of therapy (induction dose) may be more efficacious than the classic thrice-weekly regimen. There is no available data about the combination of induction dose regimen of IFN and ribavirin.

Our objective was to evaluate prospectively the efficacy and safety of a 5mu IFN induction dose in combination with ribavirin in HCV patients. End treatment response (ETR) was 36.7% of the 30 patients included in the study, while 81.1% ofresponders could remain viral negative for one year after discontinuation of treatment (sustained response). Though responders had higher pretreatment levels of viraemia and ALT, it was still without statistical signficance. Also, there was no statistical histological difference between both groups. There was a significant correlation between response rate and post induction viraemia level (p < 0.05) but no similar relation to post-induction ALT level. We conclude that induction dose regimen seems to have no effect on ETR but may improve sustained response. Also, post-induction viral load level is a good predictor for both ET and sustained responses.

This report describes a diabetic Yemeni male with pancreatic exocrine insufficiency and calcification. Persistent diarrhea and weight loss led to further investigation and a diagnosis of celiac disease with an excellent response to a gluten free diet

Objective: To measure the incidence and risk factors of eclampsia, establish how often it is preceded by preeclampsia, detect the clinical characteristics of women developing eclampsia, document the morbidity associated with eclampsia, determine the maternal case fatality rate and review the clinical features and management of this condition.

Method: A retrospective review of all cases of eclampsia which were managed in the Women's Hospital in the State of Qatar in the period between January 1991 to December 2000. Details were collected by reviewing the files of the patients from the medical record. Data were analyzed by either x2 analysis or the unpaired student “t” test as appropriate.

Result: Thirty nine cases of eclampsia were notified. The incidence of eclampsia in Qatar was 4.1 /10,000 maternities. Fourteen women (36%) had no antenatal care (ANC). However most convulsions occurred despite ANC (64%) and within one week of the woman's last visit to a doctor (58%). Thirty nine percent of the first seizures occurred in hospital, of which 23% developed before both proteinuria and hypertension had been developed. Twenty three percent of eclampsia occurred postpartum (PP), 51% antepartum (AP), and the remainder (26%) intrapartum (IP). There was no maternal fatality in Qatar but 23% of all women had at least one major complication. The rate of still birth (SB) andfirst week neonatal death (NND) was 76.2/1000 and 83.6/1000 respectively and the perinatal mortality rate (PNMR) was 153.8/1000. Preterm eclampsia was more common than term eclampsia (74% V 26%). Preterm eclampsia occurred more commonly AP (66%) and was associated with more maternal complications (26%) and fetuses that were small for gestational age (34%) as well as with higher rates of SB (10%) and first week NNDs (14%).

Conclusion: Eclampsia occurs in nearly one in 4000 maternities in Qatar and is associated with high incidence of maternal and neonatal morbidity and mortality. Antepartum onset carries greater risks and preterm eclampsia is particularly dangerous to both mother and fetus.

Human infection with Histoplasma capsulatum is largely asymptomatic but disseminated disease is fatal if left untreated. We report a case of bilateral adrenal enlargement due to disseminated histoplasmosis in a Bangladeshi male who was successfully treated.

Laparascopic splenectomy is one of the advanced surgical procedures with indications gradually increasing in hematological diseases. This is a review of five cases operated upon over two years. All were female patients, three with ITP and two with thalassemia. In one with gall bladder stones, laparascopic cholecystectomy was done with splenectomy. The mean operative time was 3 hours and 30 minutes. No case was converted to open technique. There were no intra-operative or post-operative complications with optimum patient response over the six month follow up; no steroids were required for the ITP patients and no more blood transfusions for the thalassemia patients.

Non-epithelial tumors of the bladder of mesenchymal origin are very rare, comprising 1% or less of all bladder tumors(l), 50% of which are sarcomas of one type or another, and are generally classified as leiomyosarcomas, rhabdomyosarcomas and carcinosarcomas. Leiomyosarcomas arise from the muscularis mucosae and invade the lamina propria towards the outer muscular wall.

Pyomyositis is a bacterial infection affecting the large muscle groups and is usually accompanied by abscess formation; the term “tropical myositis” being an alternative as it is more common in the tropical regions, and has become an increasingly recognized entity in temperate climates. Normally skeletal muscle is resistant to metastatic infections but it seems likely that more than one specific factor can remove this barrier. The most common organism being Staphylococcus aureus found in about 90% of the cases, while Streptococcal spp. are next in frequency. Other bacterial species have been incriminated; fungal infection can also cause local destruction and abscess formation, while viral infection (notably Coxsackie viruses) may result in acute rhabdomyolysis. The spread is hematogenous except in those cases in which there is direct extension, as from osteomyelitis, and the muscles commonly affected are the glutei, quadriceps, shoulder and axial. The abscess forms deep inside such muscles.

Tuberculous liver abscesses are rare and are usuallyassociated with disease involving other organs. In 1952 Leader made an extensive review of the world literature and documented 80 cases of hepatic tuberculosis with large abscesses or nodules. In most of these cases tuberculosis was present elsewhere in the body. An isolated tuberculous liver abscess is very rare and only 20 cases have been reported in the English language literature to date. Diagnosis is often delayed or missed because of nonspecific symptomatology and the rare occurrence. We describe a case of an isolated tuberculous liver abscess in an immunocompetent patient.

The use of the stomach for bladder enlargement and replacement has been known since Sinaiko's work in a canine model. Mitchell et al later showed that the use of the stomach for bladder replacement and enlargement had many advantages especially in situations of acute acid loading and azotaemia. The advantages of using the stomach included protection against hyperchloraemic acidosis (due to net excretion of chloride), reduced mucus production and decreased urine infection rate, plus the elastic properties of the stomach. We report the use of part of the stomach as a continent urinary reservoir to replace a missing urinary bladder and we discuss the advantages and disadvantages of using the stomach in the urinary tract

Objective: To identify the incidence of ocular injury in Qatar from January 1999 to December 2000 and the related factors.

Methods: Retrospective study of all patients who suffered ocular injury requiring hospitalization during the mentioned period. Data was collected from medical records and the statistical analysis done using SPSS 7.5.

Results: The type of ocular injury and the effect on the Visual Acuity were determined, as well as the incidence relationship to age, gender and occupation. The main causative agents are outlined and the surgical procedures done and sequels reported.

Conclusions: This study provides data about the risk factors and visual outcomes of ocular trauma in Qatar, allowing recommendations that could decrease its incidence in the future.

Objective: To define forces of youth soccer ball heading (headers) and determine whether heading causes retinal hemorrhage.

Setting: Regional Children's Hospital, youth soccer camp.

Patients: Male and female soccer players, 13 to 16 years old, who regularly head soccer balls.

Measurements: Dilated retinal examination, after 2-week header diary, and accelerometer measurement of heading a lofted soccer ball.

Results: Twenty-one youth soccer players, averaging 79 headers in the prior 2 weeks, and 3 players who did not submit header diaries lacked retinal hemorrhage. Thirty control subjects also lacked retinal hemorrhage. Seven subjects heading the ball experienced linear cranial accelerations of 3.7±1.3g. Rotational accelerations were negligible.

Conclusions: Headers, not associated with globe impact, are unlikely to cause retinal hemorrhage. Correctly executed headers did not cause significant rotational acceleration of the head, but incorrectly executed headers might.