Qatar Medical Journal - Volume 2002, Issue 2

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.