Qatar Medical Journal - Volume 2003, Issue 2

Abu Yousuf Yaqub Ibn Ishaq A1 Kindi was born at Kufa around 800 C.E. His father was an official of Haroon A1 Rashid. A1 Kindi was a contemporary of A1 Mamun, A1 Mu'tasim and A1 Mutawakkil and flourished largely at Baghdad. He vas for-mally employed by Mutawakkil as a calligrapher. On account of his philosophical views, Muta-wakkil was annoyed with him and confiscated all his books. These were, however, returned later on. He died in 873 C.E. during the reign of A1 M'utamid.

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.

Objective: To evaluate how effective was the conserva-tive treatment in managing congenital talipes equinovarus deformity.

Methods: This is a retrospective study of 25 children treated with manipulation, casting followed by percutane-ous tenotomy at the age of thee months with casting till age of walking with a follow-up between 2-5 years 25 pa-tients 18 males 7females M\F (2.6-1), 19 bilateral (15 My 4 F), 6 unilateral (3 M, 3 F) total of 44 feet.

Result: The first three months offer the skilled and knowledgeable surgeon a golden opportunity to correct the deformity by manipulation and casting. Proper manipula-tive techniques followed by the applications of well-molded plaster casts offer the best and safest correction of most clubfeet in infants. Failures of manipulative treatment usually occur when the surgeon lacks a thorough knowledge of the kinematics and pathological anatomy of the deformity.

Conclusion: CTEV can be treated by manipulation, casting and ETA in about 70% of cases with good results if managed early and by skilled orthopedic surgeon. Some feet are unpredictable and in spite of the severity of the deformity, respond well to conservative treatment.

The files were reviewed retrospectively of all patients diagnosed with spinal tuberculosis in Qatar; Arabian Gulf during 1992-1997. Qatar has a large single male immigrant labor force, mainly young Asians, and these constituted more than half of the 35 patients treated. Pain was the most common complaint at presentation. Computerised tomography (CT) and magnetic resonance imaging (MRI) were utilised to identify the lesions and these two methods, singly or in conjunction, gave better results than ordinary X-Ray. Fine needle aspiration was used for bacteriological confirmation. It is concluded that CT, MRI and fine needle aspiration enable successful medical treatment under supervision and result in an excellent cure rate.

Hyperbilirubinemia is a common problem of term and preterm neonates. Two hundred four jaundiced neonates admitted to Basrah Maternity and Childrens Hospital over a 6-month period were studied to determine the frequency of pyruvate kinase (PK) deficiency, glucose-6-phosphate dehydrogenase (G6PD) deficiency and glutathione reductase (GSSG-R) deficiency. Forty two neonates (20.5%) had PK deficiency, 68 (33.3%) G6PD deficiency and 40 (19.6%) GSSG-R deficiency. Interaction of more than one enzymopathy was found in 36 neonates (17.6%). Other hemolytic causes of jaundice were ABO incompatibility in 50 (24.5%) of neonates and Rh. incompatibility in 18 (8.8%). In 38 neonates no cause of jaundice was identified. There was a statistically significant increase in the frequency of G6PD deficiency and more than one enzymopathy with increasing severity of jaundice. The highest frequency of kenricterus was found in those with more than one enzymopathy. Red cell enzymopathies are an important cause of jaundice in Iraqi neonates and the presence of more than one enzymopathy carries a greater risk of developing severe jaundice.

Objective. To review the role of intravenous immunoglobulin (IVIG) in the prevention of recurrent miscarriage (RM). Methods. In a prospective controlled clinical tria], 40 women with a history of unexplained. RMwere treated with IVIG, according to a specific protocol and compared to another 40 women who had the same condition and treated with tender loving care and vitamins only. The birth of a child of more than 28 weeks gestation was considered a successful outcome.

Results. The overall success rate was 60% in the IVIG group compared with 52.6% in the control group (P = 0.65). The success rates for women with primary RM were 56.3% for IVIG group and 68.8% for the control group (P = 0.72). The success rates for women with secondary RM were 62.5% and 41.7% respectively (P = 0.25). None of the previous results is statistically significant.

Conclusion. Women with unexplained RM in general have a good prognosis. IVIG did not improve the prognosis significantly in the total group of patients compared with controls. However; further investigations are needed to explore whether the 21 % therapeutic benefit of IVIG in patients with secondary RM indicates that the treatment is efficient in this subset of patients.

One hundred patients with chronic sciatica were stud-ied to determine the effects upon the knee and ankle joints of both the sciatic and non-sciatic sides. The frequency of the clinical involvement of the knee and ankle joints at the sciatic side were 51% and 46% respectively, compared to 20% and 6% on the non-sciatic side (p < 0.001).

The most frequent knee and/or ankle joint manifesta-tions on the sciatic side were recurrent pain and tender-ness although these symptoms may be confused with the points of valliex and secondary pain loci. Painful exten-sion, giving way of the knee joint and recurrent twist of the foot seem significant in identifying affectedjoints together with functional limitations and swelling of the knee. Age, gender; duration and affected side seem to have some im-pact on the development of these symptoms.

It is concluded that chronic sciatica may predispose the knee and ankle joints to different insults in the context of muscle weakness, changed biomechanics and neurologi-cal abnormalities, resulting in the above problems.

The reference range for Haemoglobin A2 (HbA2) by the microcolumn technique is not well defined. Various textbooks and inserts give different reference ranges. This leads to confusion in interpretation. Normal Saudi individuals were checked by the method, excluding all disease in them that can affect HbA2 level. The reference range obtained was 2.0-2.7 (mean+SD). This new range will decrease remarkably the overlap between normal, alpha thalassemia trait and beta thalassemia trait individuals.

Also>, and in spite of the claim by the manufacturer to the contrary, it was shown that presence of sickle haemoglobin, places the assay of Hb A2 significantly outside the normal range> using a column that is supposed to be just for the purpose of accurate assay of Hb A2 in presence of HbS. The range in sickle trait patients was shown to be 2.5-3.4 (mean+SD).

This retrospective study evaluated the effectiveness and safety of laparoscopic adjustable gastric banding as a means of treatment of morbid obesity in Qatar.

Methods: Seventy-one patients (59 females; mean age 32 years, range 18 to 60) underwent laparoscopic adjust-able gastric banding for morbid obesity. Their mean weight was 134.6 Kg (range 90 to 200) and mean preoperative body mass index was 49.8 Kg/m2 (range 36.5 to 70).

Results: All patients were followed-up for a mean du-ration of 8.6 months (average 1 to 27). The mean excess weight loss was 27% (range 0 to 84). The operation time showed a marked reduction with a mean duration of 149 minutes in the first ten cases reaching to a mean of 81 minutes in the last ten cases. The commonest early com-plication was chest infection seen in 3 patients (4.1%). Late complications were seen in 5 cases (6.9%) most commonly related to swallowing. One case developed band infection severe enough to necessitate removal of the band. There was no operative related mortality.

Conclusion: Laparoscopic adjustable gastric banding is relatively an effective means for control of morbid obe-sity with a low rate of complications.

Intensive follow-up of cancer of the colon and rectumincludes colonoscopy 1 year after curative resection and is the current practice in Calgary. There is much debate in the literature as to the value of this intensive follow-up,including 2 prospective randomized controlled trials showing no benefit. The purpose of this study was to assess the benefit of 1-year follow-up colonoscopy by documenting the findings at the time of the procedure. One hundred and four (104) charts were randomly selected and reviewed. All had undergone peri-operative colonoscopy, resection for curative intent and follow-up colonoscopy approximately 1 year post-op. There were 16 (15%) abnormal findings at the time of follow-up colonoscopy. In 10, the colon had notbeen “cleared” peri-operatively and the polyps identified were anticipated and removed. In 6 (6%) there were newfindings not previously documented: 3 hyperplastic polyps; 2 small ( < 0.75 cm) adenomatous polyps and 1 anastomotic recurrence of a rectal cancer. The recurrent cancer was within reach of a rigid sigmoidoscope and the polyps can be considered not clinically significant. This review of our experience with surveillance colonoscopy 1 year after curative resection for cancer of the colon and rectum supports the previously published data from 2 randomized controlled trials showing no benefit.

Using the World Health Organization (WHO) visual acuity classification protocol, a national simple descrip-tive study for determination of the causes and severity of sight loss amongst 90 children studying in Al Noor Insti-tute for blinds in Qatar was done between September 2001-September 2002. Of 90 patients with complete ophthalmic examinations, 65 (72%) of them had an inherited or con-genital cause and only 25(28%) had an acquired cause. The main causes were bilateral congenital microphthalmia, Homocystinuria with lens subluxation or dislocations, ac-quired retinal disease such as Retinopathy of prematurity. Congenital cataract, retinitis Pigmentosa, Optic atrophy and congenital Glaucoma in descending order.

Conclusion: The principal causes of blindness amongst children in Qatar were inherited and/or congenital, most probably due to consanguineous marriages. The outline for childhood blindness is similar in Arab gulf countries in comparison to distant countries such as India, Czech Re-

FNA has emerged as a powerful and accurate diagnostic tool for breast carcinomas. In the experienced hands false positive and false negative diagnosis have been reduced to a minimum. It has also been recognized that besides diagnosis, several other important clinical prognostic information can be obtained from FNA material. These include estrogen and progesterone recep-tor assay, proliferative fraction and oncogene products. These are achieved by subjecting the FNA material to immunoperoxidase methods, ploidy analysis an'd S phase frac-tion on flow cytometry. Lately cytological grading of breast cancer has been added to these investigations 1.2.3.4.5 Since histology is the gold standard in the diagnosis of breast cancer, and since the FNA obviously may not sample enough breast volume, the question is why bother with cytological grading of breast cancer? Why don't we wait and do the grading on histol-ogy where several sections would be examined and thereby cover any kind of variations in the tumor? On the other hand histo-logical grading of breast carcinoma assesses mainly nuclei mor-phology and architectural configurations.

Bilateral congenital choanal atresia (CCA) in newbornscarries significant morbidity and mortality. Many surgical approaches have been described for its correction but none of the approaches have proved superior in preventing postoperative granulation tissue and restenosis. Recently, topical Mitomycin C (MMC) has been used intraoperatively to prevent the formation of granulation tissue and restenosis in choanal atresia repair. We report a series of three consecutive patients who underwent bilateral CCA repair and received topical MMC intraoperatively. We have used topical MMC in CCA repair for the first time in Qatar and report the outcome of these patients. Case 1 was a preterm child (29 gestational weeks) who underwent transnasal repair. Case 2 had CHARGE association and case 3 had no other anomalies, both of whom underwent transpalatal repair. In case 1, we had used topical MMC \ during revision surgery with improved outcome. In cases 2 and 3, topical MMC was applied during primary repair and in addition both received a second application selectively at the margins of the choanae 6 weeks after stent removal. Case 3 needed further dilatation of the choanae four months after second application of topical MMC. None of our patients developed any local or systemic side effects. To our knowledge, bilateral CCA repair in a 29 weeks gestational age child has not been reported in the literature. Our study suggests that topical MMC may be a useful adjunctive therapy in choanal atresia repair.

The medical records were reviewed of 124 patients (108 males, 16 females) with Behget disease attending the King Hussein Medical Center and Prince Rashed Bin Al-Hasan Military Hospital, Jordan, between January 1996 and June 2001. The clinical pattern, manifestations and clinical course in Jordanian patients were compared with those in other countries of the region. There was some variation in the frequency of lesions in the sample compared to these other countries but it was concluded that the “Silk Road Disease” does pass through Jordan without having any specific features.

The objective of this study was to explore the prevailing complications of diabetes mellitus and to explore some of the associated factors among Qatari patients previously diagnosed as having diabetes mellitus. A random sample of Qatari diabetic patients attending outpatient clinics (8 am to 12 pm) attached to Hamad General Hospital, between May 2001-2002 were included in the study. The total sample was 225, 74 males, and 151 females. The results revealed that retinopathy was the most prevailing complication (43.6%), followed by nephropathy (40.9%), hypertension (36.9%), neuropathy (28.9%), hyperlipidemia (26.7%), coronary heart disease (18.7%), foot ulcer (4.4%), and thyroid problems (3.6%). A significant association between development of hypertension and high body mass index (BMI) was found. Neuropathy and thyroid problems were significantly higher in females. (56.9%) of the patients were obese (BMI >30 kg/m2), and 28.9% were overweight (BMI 25-29.9). Two thirds of the patients had positive family history of the disease, and females who had diabetic fathers were significantly higher than males.

Objective: Hydrocephalus is a common condition seen in the neurosurgical practice that usually requires insertion of a cerebrospinal fluid (CSF) shunt. It is commonly seen in our country for possible several reasons; some of them are the prohibition of abortion and increased consanguinity marriages. In this study, the authors retrospectively analyzed 124 hydrocephalic patients operated upon at our institute for three years period. Our aim is to verify the extent of the problem in our community, addressed some facts and to improve our services.

Methods: Between January 1999 and December 2001, 124 patients with hydrocephalus underwent CSF shunt operations (insertions and revisions) at King Fahd Hospital of the University were retrospectively analyzed to assess the etiology, clinical presentation, management and outcome.

Results: In this study, 124patients were analyzed. 244 operations were performed. 96patients (72.4%) had congenital hydrocephalus, 24 patients (20%) had associated cranial anomalies, 32 patients (25%), their parents were relatives. 70 patients (56%) had noticeable mental retardation. Shunt malfunction reported in 71 patients (57%) and the infection rate was 8% (10 patients).

Conclusion: The higher incidence of hydrocephalus between Saudi population possibly due to consanguinity marriages and prohibition of abortion. Premarital counseling and people orientation about this problem might help to reduce the number of cases. Shunt infection and malfunction are still the main complications of shunting. There is possibility of reducing the complication's rate if a special protocol is advocated and strictly followed.

Intestinal obstruction is common surgical emergency, ileosigmoid knot is a rare cause of intestinal obstruction (a loop of ileum and sigmoid colon twisted around each other in a knot). This knot is common in Negro people. About 150 cases recorded in literatures, but we recorded a more six cases in Basrah General Teaching Hospital in the last 10 years.