Qatar Medical Journal - Volume 2004, Issue 1

Abu Raihan Mohammad Ibn Ahmad Al Biruni was one of the well-known figures associated with the court of King Mahmood Ghaznawi, a famous Muslim kings of the 11th century AD. Al Biruni was a versatile scholar and scientist who had equal facility in physics, metaphysics, mathemat-ics, geography and history. Born in the city of Kheva near “Ural” Turkey in 973 AD, he was a con-temporary of the well-known phy-sician Ibn Sina. He died in 1048 AD at the age of 75, after having spent 40 years in thus gathering knowledge and making his own original contributions to it.

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.

The benefits of cholesterol-lowering with statins has been established for patients with high cholesterol levels as well as for patients with prior occlusive coronary heart disease. However; substantial uncertainty has existed about the long-term benefits of these agents in certain groups, including patients with “normal” cholesterol levels pretreatment, women, the elderly, as well as those with prior occlusive non-coronary disease. The Heart Protection Study 1 was designed to resolve these uncertainties and to provide substantially more safety information of statins. We present its significance and practical implications.

The medical records of 219 epileptic patients seen over a period of eight years were reviewed to determine the incidence and causes of intractable epilepsy amongst adults in Qatar: The incidence rate of hospital admission with uncontrolled epilepsy was calculated as 25per 100,000persons. Thirty-nine patients (18%) fulfilled the criteria for IE and the incidence of IE could be approximated at 4.5 per 100,000 persons. In the native Qatari population the approximated incidence of IE would be 1 in 100,000 persons per year, while in the expatriate population the rate would be 3.5 per 100,000 persons per year. The most common type of IE was idiopathic generalized epilepsy (75%) followed by symptomatic epilepsy (19%) and temporal lobe epilepsy (6%). To calculate the crude incidence of epilepsy in Qatar, the records were reviewed of 1217patients (aged 13-85 years) visiting the outpatient department or admitted to hospital because of a newly diagnosed epilepsy during the calendar year, 1st January-31st December 2001. These figures were extrapolated to an approximation of an incidence of 174 in 100,000 persons per year.

In this era of antibiotics the incidence of brain abscess and lateral sinus thrombosis (LST) secondary to chronic suppurative otitis media (CSOM) should not be underestimated and the management still remains a clinical challenge. We review the clinical records of patients who presented with temporal lobe abscess (Case 1), cerebellar and extradural abscess (Case 2) and LST (Case 3) of otogenic origin and discuss the importance of multidisciplinary team approach in the management of these high-risk cases. We review the literature in detail and discuss the epidemiology, clinical presentation, diagnostic modalities, treatment options and controversies in the management of brain abscess and LST.

Premature rupture of the membranes (PROM) defined as a rupture of membranes before onset of labor, which is one of the most complications of pregnancy that leads to significant maternal and neonatal morbidity and mortality. These complications depend on the gestational age to which it occurred. The aim of this study is to determine diagnostic value of CRP during pregnancy complicated by PROM. Retrospective study performed at Hamad Women's Hospital in Qatar. Data collected from files in the Medical Records over a two period from 27/11/2000 to 27/11/2002. One hundred and fifty cases were chosen and divided into: Group (la) 50 patients with PROM before 37 wks. Group (lb) 50 patients with PROM after 37 wks. Group (2) 50 patients as control. Statistical analysis showed high incidence of Oligohydroamnios and polyhydramnios in the group 1 compared with control Measurement of maternal blood CRP early before 37 weekindicated significant relation between the prevalence of premature rupture of the membranes, associated oligohydramnios with the incidence of positive results of CRP. We recommend that further investigations needed to document our data and to prove the beneficial effect of the test especially before 37 week of gestations.

We retrospectively analyzed the results of263 consecutive Methacholine challenge tests (MCTs) done in our laboratory between July 2000 and June 2003, in symptomatic adult patients with no history of bronchial asthma or chronic lung disease, who presented with chronic nonproductive cough, shortness of breath (subjective dyspnea), or both. All of these patients had normal results of chest physical examination, chest radiographs and screening spirometry measurements (FEVl >80% of predicted). We considered a 20% fall in the forced expiratory volume in the first second (FEVJ as the primary outcome measure (MCT PC 20-FEV1X and a 35% fall in the specific conductance (sGaw) as the primary outcome in patients who cannot perform acceptable spirometry. Out of263 patients, 79 patients (30%) were positive for bronchial hyper-responsivenes (BHR), 20 patients (25.3%) of the positive patients had sever BHR, 18 patients (22.8%) had moderate BHR, and 41 patients (51.9%) had mild BHR.

Takayasu's arteritis is a rare inflammatory arteriopathy that affects predominantly young females and segmentally involves the aorta and its major branches. Infectious, hereditary, and autoimmune causes of Takayasu's arteritis have all been suggested; yet there is no consensus regarding its cause.

A 37 year-old Asian man with an infection of the upper respiratory tract experienced sudden visual changes suggestive of acute multifocal posterior placoid pigment epitheliopathy (AMPPPE). Extensive examination showed this to be serpiginous choroidopathy that was treated successfully with a single subtenon injection methylprednisolone. It is suggested that this method of treatment needs further investigation and evaluation.

Traumatic intrusion of permanent teeth is rare, as with many things in dentistry often treatment has been empiri-cal in nature. This article will review the available research data as well as present a case study showing successful treatment of an eight year-old Qatari who sustained such an injury.

An Egyptian infant with the common CFTR mutation N1303K in exon 21 developed alkalosis, electrolyte disturbance and pancreas insufficiency. The need is emphasized to consider the possibility of cystic fibrosis (CF) in the Arab world. The frequency of N1303K mutation in the Middle East and its distribution are both reviewed.

This is retrospective study of breast cancer in Qatar during period 1999-2002, using cancer registry data A total 214 patients were diagnosed with breast cancer; with incidence of5/10,000 of population per year; account-ing for 13.3% of new cancer cases and 29.9% of all female cancer. Male breast cancer is rare accounting for 3.2% of total number. Qatari patients were 23% and non-Qatari patients were 36.2%. The disease more common in ages between 46-55years old accounting for 64% of total breast cancer; patients usually presented beyond or equal to Stage II and with distant metastasis in 7% of cases, patients com-monly present with invasive ductal carcinoma and histo-logical Grade 2 & 3, it has been noticed that were decrease in incidence of Stage III & IV and decrease in Stage I & II which reflect improvement in patient awareness of this problem.

G6PD deficiency is the most common enzyme deficiency disease worldwide, affecting 10% of the world's population. It is an X linked recessive disease therefore it affects males more than females (females are usually carriers of the disease).

The delivery system of oxygen in the human body consist of lungs and CVS, which it depends by it self on the:

1. 1 Amount of O2 entering the lung.
2. 2 Adequacy of pulmonary gas exchange.
3. 3 Blood flow to the tissue: witch depends on the degree of the constriction of the vascular bed in the tissue, and on the cardiac output.
4. 4 Capacity of blood to carry O2: which depends on the amount of dissolved O2, amount of Hb in the blood, and affinity of Hb for O2

This study aimed to investigate the effect of oral pilocarpine (OP) in reducing the incidence of chemotherapy-induced oral mucositis. Thirty two adult patients completed a total of 82 courses of chemotherapy in which either OP or placebo was given pro-phylactically in a double-blind cross-over design to prevent mucositis. Mucositis was documented in 20 out of 41 courses in which patients were given placebo, whereas mucositis was documented in only six out of 41 courses when patients were given OP (P<0.005). OP treatment was found to significantly reduce the mucositis score when assessed by the method of Donnelly and colleagues (Donnelly JP, Muus P, Schatttenberg A, De Witte T, Horrevorts A, De Pauw BE. Bone Marrow Transplant 1992, 9,409–413). Using this score, all patients scored a total of 52 when they were given the placebo versus eleven when they were treated with OP (P<0.001). A similar reduction in mucositis score was noticed using the World Health Organization (WHO) mucositis score; the total patient score was 25 for the placebo-treated group versus 6 for the OP group (P<0.001). We therefore conclude that oral pilocarpine is highly effective in the prevention of oral mucositis when given prophylactically to adult patients receiving a variety of cancer chemotherapy regimens.

Background: It has been suggested that an oxidative mechanism is involved with the impaired endothelium-dependent vasodilatation that occurs after a high-fat meal.

Hypothesis: The study was undertaken to evaluate the effect of a single oral dose of vitamin C (2g) on postprandially impaired endothelium dependent vasodilatation in patients with coronary heart disease (CHD).

Methods: This study included 74 patients with CHD and 50 subjects without CHD with risk factors. The two groups were divided into two subgroups that did or did not receive 2g of vitamin C (CHD/VitC and CHD/control, n=37; non-CHD/VitC and non-CHD/control, n=25) after a high-fat meal (800 calories, 50g fat). Serum levels of triglyceride, total cholesterol, low-density lipoprotein cholesterol, and high-density liporotein cholesterol in the fasting state and at 2,4,5 and 7 h after the high-fat meal were measured. Endothelial function was assessed in the brachial artery by high-resolution ultrasound at baseline and at 4h postprandially.