Qatar Medical Journal - Volume 2003, Issue 1

Abu Muhammad Abdallah Ibn Ahmad Ibn A1 Baitar Dhiya A1 Din A1 Malaqi was one of the greatest scientists of Muslim Spain and was the greatest bota-nist and pharmacist of the Middle Ages. He was born in the Spanish city of Malaqa (Mala-ga) towards the end of the 12th century. He learned botany from Abu A1 Abbas A1 Nabati, a learned botanist, with whom he started collecting plants in and around Spain. In 1219 he left Spain on a plant-collecting ex-pedition and travelled along the northern coast of Africa as far as Asia Minor. The exact modes of his travel (whether by land or sea) are not known, but the ma-jor stations he visited include Bugia, Qastantunia (Constanti-nople), Tunis, Tripoli, Barqa and Adalia. After 1224, he entered the service of al-Kamil, the Egyptian Governor, and was appointed chief herbalist. In 1227 A1 Kamil ex-tended his domination to Damaseus, and Ibn A1 Baitar accompanied him there which provided him an opportu-nity to collect plants in Syria His researches on plants ex-tended over a vast area: including Arabia and Palestine, which he either visited or managed to collect plants from stations located there. He died in Damascus in 1248.

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.

Menorrhagia and dysfunctional uterine bleeding are com-mon indications for referral to a gynecologist. One in 20 women aged 30-49 will consult her general practitioner every year com-plaining of heavy uterine bleeding. Over 70,000 hysterecto-mies are performed annually in the UK with menorrhagia being the commonest indication. In up to 30% of these cases the uterus is anatomically normal. To these women, heavy uterine bleed-ing brings considerable stress and disruption to their social, domestic and professional lives. In the UK, the cost of primary care prescriptions for the treatment of menorrhagia was esti-mated in 1998 to be around £7 million. Gynecologists have looked at less radical but effective alternatives to hysterectomy for the treatment of heavy uterine bleeding. While the MISTLE-TOE* audit had demonstrated a pivotal role for less extreme yet successful interventions than hysterectomy for the treatment of bleeding problems, there were some setbacks. Special skills are needed to perform rollerball and diathermy loop resections of the endometrium. As well as the risk of serious intra-opera-tive complications the techniques are relatively time consum-ing to perform. In the MISTLETOE audit there were two direct deaths as a consequence of the procedure and 1.26% of patients required emergency surgery. This review looks at two new in-terventions available for clinical use, in the short term they have both proven to be successful and safe in the management of heavy uterine bleeding. Individually, they offer distinct advan-tages in the successful treatment of heavy uterine bleeding with-out the disadvantages of major surgery or medical treatment. They are both relatively easy to learn and do not require ad-vanced hysteroscopic skills. A major step forward is the suit-ability for outpatient setting.

The American Heart Association, together with representatives from the International Liaison Committee on Resuscitation (ILCOR), which is made up of leading resuscitation organizations from the Americas, Europe, Southern Africa, Australia, and New Zealand, undertook a series of evidence-based evaluations of the science of resuscitation which culminated in the publication of ’Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care’ in August 2000 tL2). Experts from non-ILCOR organizations from Asia and elsewhere also participated in drawing up the guidelines.

Management of scorpion envenomation in children is a difficult problem. The envenomation syndrome is not very well understood in humans although there has been extensive work on animal envenomation. This is an attempt to bring together the two experiences in order to produce an acceptable management protocol for envenomation in children. This protocol is based on the management of more than 2,500 cases over a period of seven years in Saudi Arabia where the mortality was about five per cent at the start and zero at the end. The management protocol adopted there in 1992 was a result of serious work on clinical data from Ministry of Health hospitals and laboratory work in the pharmacology department of the faculty of Pharmacy, King Saud University

Cryptococcal meningitis is a rare disease that can affect both immunocompetent and immunocompromised patients. A patient presenting with proximal muscle weakness was found to have cryptococcal meningitis. Nerve conduction studies (NCV) confirmed the proximal weakness as acute demyelinating polyradiculoneuropathy. During treatment the patient developed drug-related acute renal failure. He was then treated successfully with an alternative drug. A discussion of cryptococcal. meningitis and its treatment is presented.

Between 5th July and 22nd September 1999, forty-three patients were bronchoscoped of whom forty-one had samples sent for Microbiology i.e., eighty-two specimens (forty one broncho-alveolar lavage (BAL) and forty one bronchial wash(BW)). Of the eighty-two specimens, forty (from twenty patients) grew Burkholderia cepacia with or without other pathogens. None of the patients showed evidence of infection. Sputum cultures from all patients before bronchoscopy and during the episode of infection did not grow B. cepacia. “Savlon” (chlorhexidine and cetrimide; Schering-Plough), used for cleaning bronchoscopes was found to be contaminated with B. cepacia and acted as a source of contamination of the environment, bronchoscopes and samples of patients, leading to a pseudooutbreak.

Several reports indicate that haemoglobinopathies and thalassemias are the most common genetic abnormalities in the population of the Arabian- Peninsula. However the exact frequencies of these abnormalities among the Qatari population has not yet been determined. We surveyed the results of all hemoglobin-electrophoresis performed in Hematology laboratory at Hamad Hospital over a period of 78 months (Jan.1994- June.2000) together with the results of all other relevant tests to highlight the distribution of these disorders among the Qatari patients seen at Hamad Hospital.

The size of the group analyzed was 3275 of whom 1702 were Qatari and 1573 were non-Qatari residents of different nationalities. The survey of Qatari results revealed that 30.43% of all Qatari patients tested carry fi-thalassemia (minor, intermedia or major), 12.28% carry oc-thalassemia (minor or intermedia) while 0.53% were labeled as having Hereditary Persistence of Fetal Hemoglobin (HPFH). fithalassemia is the most common type of thalassemic disorders seen in the Qatari patients, accounting for 71.25% of all thalassemias encountered in this group.

Out of Qatari patients tested 16.33% were found to carry a structurally abnormal hemoglobin variant of one type or another. Sickle cell hemoglobin (Hb-s) is the most common structural hemoglobin variant detected where it is found in 14.63% of those tested and constituting about 83.97% of all structural hemoglobin variants detected. Hb.D was found in 1.41% of those tested and constituted 12.42% of all structural hemoglobin variants detected in this group. Other structurally abnormal hemoglobin variants such as Hb. E and Hb. C were less common. As expected, almost all possible combinations between different types of structural hemoglobin variants and different types of thalassemias could be identified.

Considering the fact that the hematology laboratory at Hamad Hospital is the only laboratory in the State of Qatarthat performs hemoglobin- electrophoresis we hope that this study will reflect for the first time a reasonable idea about the prevalence of thalassemia and other types of hemoglobinopathies among the indigenous Qatari population and help to provide a comprehensive baseline information for any proper future epidemiological studies to establish the exact frequencies of these genetic disorders among Qatari nationals and for any future molecularbased studies for elucidation of the molecular basis of these disorders in this population.

A retrospective study of patients diagnosed with pyogenic arthritis at Hamad Medical Corporation over the fiveyear period January 1st 1996 to December 312000 showed that only 24 patients out of 63 fulfilled the criteria for bacterial arthritis. Staph. aureus was the main organism isolated from the synovial fluid (72%). The mean duration between the onset of symptoms and admission was 11 days. Nearly half the patients (45%) were under 12 years of age. Earlier diagnosis and treatment gives a better outcome.

Upper gastrointestinal bleeding is a common problem and is an important cause of morbidity and mortality. Between June 1999 to May 2000 eight hundred and sixty patients were admitted to the Medical Intensive Care Unit, Hamad Medical Corporation, 102 of whom (11.8%) were admitted with a diagnosis of upper gastrointestinal bleeding. The most common nationality was Qatari (42.2%) and the most common age group was between 50-60years old (28.4%). The most frequent cause of bleeding was peptic ulcer disease (50 patients) followed by variceal bleeding. Our results are compatible with other reports.

In a single blind study of 20 ASA 1 patients undergoing rhinoplastic surgery under controlled hypotensive anesthesia in Rumailah Hospital, Qatar, on reaching the steady state of anesthesia the mean arterial blood pressure (MAP) was adjusted to the lower accepted limit (40-50 mm.Hg) using esmolol infusion. The MAP and bispectral index (BIS) were continuously recorded together with all essential monitoring perioperatively. A significant correlation was observed between the MAP and BIS at mean blood pressure below 45 mm.Hg.

Conclusion: BIS is a multivariant derived EEG device designed to monitor the state of consciousness under different hypnotic agents and could be a useful monitor during hypotensive anesthesia.

Uterine artery embolisation has been introduced recently as an alternative treatment for fibroids. The purpose of this study was to evaluate the initial results of uterine artery embolisation in the treatment of symptomatic muterine leiomyomata in HMC and review the data from the literature.

On the basis of clinical and ultrasonographic examinations, four women aged between 35 to 44 years with severe fibroid-related menorrhagia were referred for uterine artery embolisation. In allfour cases bilateral embolisation of the uterine arteries was carried out using particles of polyvinyl alcohol (Ivalon, 500-750jum) under local anaesthesia and fluoroscopy I digital subtraction angiography control. Complete occlusion of the arteries supplying the fibroids was achieved resulting in restoration of normal menstrual bleeding. Three patients did not develop any complications, except short post-embolisation discomfort lasting only a few hours. In one case with large fibroids, a post-embolisation syndrome (abdominal pain, sweating, vomiting and increased blood pressure) lasting 48 hours was observed. All the patients expressed satisfaction with the treatment.

Data from the literature indicate that uterine artery embolisation has gained wide acceptance in the treatment of symptomatic uterine fibroids, particularly in patients wishing to avoid total hysterectomy or blood transfusion, although hysteroscopic resection, myolysis and laparoscopic myomectomy remain alternative methods of treatment.

In order to review our experience with prostaglandin-E2 for the induction of labour and to evaluate its safety and outcomesa retrospective study was carried out at the Women's Hospital, Hamad Medical Corporation, over a six-month period. Three hundred and thirty four patients (7% of total deliveries) were induced by PGE2 (Dinoprostone), including 105 (30%) nulliparae and 229 (70%) multiparae. Patients with a history of one previous lower segment caesarean section were also included. Post date pregnancy and diabetes were the most common indications for induction.

There were significant differences in the two groups regarding the number of doses and the mean total dose of PGE2 used. The need for syntocinon augmentation was more in the nulliparae (41% vs 22%). Failed induction occurred only in nulliparae. The rate of caesarean section in induced labour remained significantly low compared with a spontaneous labour (11.6% vs 10.7%). The caesarean section rate was higher in the nulliparae (16.0% vs 9.6%) but this was not statistically significant. The caesarean section rate was higher when Bishop score 0-4 (76% vs 24%). Only two of the babies in the study group had an Apgar score less than 7 at 5 minutes. There was one caesarean hysterectomy because of postpartum hemorrhage associated with the PGE2 induction.

Conclusion: The calculated induction rate with PGE2 was 7% of total deliveries. Induction of labour with PGE2 in a grandmultiparae and previous caesarean section is relatively safe but further multicentre studies are needed to confirm our findings.

A young patient with a ventricular septal defect presentedwith Streptococcus pneumoniae pneumonia complicatedby endocarditis. The presentation was acute withhigh fever; hypotension, leukocytosis, and renal impairment The organism was penicillin sensitive. Treatment with ampicillin for four weeks produced a successful outcome. Endocarditis due to Streptococcus pneumoniae has become rare in recent years and the association with a ventricular septal defect has not been reported before. Pertinent literature is reviewed.

Spinal subpial lipoma is a rare entity and comprises only 0.9% of spinal cord tumours(l\ It arises from premature dysfunction of the cutaneous ectoderm during neural tube formation(2). We present a case of a 44-year-old male who presented with the symptoms attributed to this lesion, together with pathology, neuroimaging characteristics and management strategies

A seven-year-old girl presented with recurrent left renal pain, generalized weakness and lack of energy. Ultrasound scanning showed bilateral pelvic kidneys. Intravenous urography (IVU) demonstrated bilateral floating kidneys. Nuclear scintigraphy performed in both the upright and recumbent positions showed slight impairment of drainage in the upright position on both sides.

Diffuse sclerosing variant of Papillary Thyroid Carcinoma(DSPC) is an unusual type of Papillary Carcinoma that occurs in young patients. Clinically it can be mistaken for Hashimoto's Thyroiditis as it often presents as a diffuse firm thyroid swelling 3*. It is important to recognize this variant as the patients invariably have lymph node metastasis at the time of diagnosis.Contrary to the previous reports of a poor prognosis of this variant when compared to the classical papillary carcinoma, recent reports indicate a good prognosis(2,3). We report a case of DSPC occurring in a young boy.