Qatar Medical Journal - Volume 2005, Issue 1

The modern drug store, owes its origin to the Arabs. The Moslems showed much originality as apothecaries and herbalists. They gave the sick new and wondrous medicaments: Cassia, senna, manna, arsenic, ambria, camphor, balsam and borax.

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.

In the early 1980s, patients with diabetic nephropathy (DN) had a doomed prognosis. Severe renal failure developed within five years of the onset of proteinuria.[1] The mortality was 53%, with 59% of deaths attributable to renal failure. There is no doubt that this devastating complication of diabetes has caused immeasurable human suffering and enormous healthcare costs.

The study involved 196 participants, 83 (42.3%) of which were consultants and 113 (57.7%) were General Practitioners (GP's).

Background: The way that GP's and hospital consultants or specialists interact has important implications for any health care system in which a GP is the first contact health professional person for patients and the point of access to relatively scarce and expensive hospital services, for this reason, the relationship between the two main branches of the medical profession has received a considerable amount of interest.

Objectives: To test out some professional issues on a random sample of both parties to determine their ability to work together productively.

Methods: We conducted a lickert-style survey based upon statements made in qualitative questionnaire sent to GP's and specialists working at Hamad Medical Corporation and health centers in state of Qatar. The questionnaire was modified and validated during a multistage pilot and was distributed to a stratified random sample of 196 clinicians.

Results: GP's and consultants demonstrated a good level of agreement, mutual understanding and respect (Significant difference in opinion only in four statements out of 13).

Conclusion: The ability of GP's and specialists to work together has been tested out and confirmed with acceptable significance and it may be repeated to assess the relationship which is central to an efficient and effective operation of health care delivery.

Cervical cancer is the third most common cancer worldwide and the leading cause of death from cancer amongst women in developing countries. A study in Qatar in 1997 found that the cancer of the cervix was the most common type of cancer in the female genital tract. In order to further assess the relevance of various risk factors, the records were reviewed of 100 women diagnosed with cervical cancer and intraepithelial lesions between January 2000 and October 2002. There was a highly significant association between detection of human papilloma viruses and increasing incidences of cervical intraepithelial lesions especially with low grade squamous intraepithelial lesions. Young women were more likely to have mostly low grade intraepithelial lesions whereas older women were more likely to have adenocarcinoma and there was a significant relation between parity and risk of the disease. Human papillomaviruses infections, early marriage andfrequent coitus started early in life and an increasing number of pregnancies were predisposing factors for the genesis of cancer of the cervix in Qatar. Older women do not realize that the risk of developing cervical cancer is not reduced as they age and it is important for them to continue having pap smears.

A multi-stage sampling design was used between January and May 2004 to explore the association between sociodemographic factors and consanguineous marriages in the Qatari population using a sample of 1800 Qatari females aged 15 years and above. Data on 1515 (85.8%) Qatari national families who gave their consent for the study were obtained. The socio-demographic factors considered were: husband's age, her own age, husband's and own educational levels, husband's occupationher own occupation, housing conditions, husband's parental kinship, her own parental kinship and kinship between the spouses. The rate of consanguineous marriages in the sample was found to be 54% with 95% estimated population confidence limits 52.4% to 55.6%. Consanguinity was more common for women with educated husbands (secondary or university / high) and the frequency of consanguineous marriage significantly increased when the husband's educational level was higher (p = 0.003). The results of stepwise multiple logistic regression analysis for the occurrence of consanguineous marriages showed that the wife's education, the husband's education and parents’ consanguinity status were the only significant associated variables.

Post-partum choriocarcinoma is a rare complication of pregnancy. We have analyzed a series of six consecutive patients presenting with choriocarcinoma after a fullterm non-molar pregnancy. The incidence was calculated to be 1 in 19,000 births. Five patients were managed at the Hamad Medical Corporation between 1991 and 2001. All presented with persistent primary or secondary post-partum hemorrhage. Treatment with chemotherapy was successful in all cases. Early diagnosis is important because this rare condition is potentially curable with appropriate chemotherapy.

As the average life expectancy is gradually increasing, more elderly patients are seen in neurosurgical clinics but those aged 80 years or more pose significant medical and ethical dilemmas for neurosurgeons. A retrospective study of eleven patients assessed the post-operative short term outcome in very old patients with benign brain tumors. Six had total surgical excision and five had partial resection. The outcome was good for six, unchanged in one and four died. Post-operative intracranial complications were not tolerated and resulted in a poor outcome in this age group. However; it is suggested that carefully selected patients over the age of 80 years with symptomatic benign brain tumors can be considered for surgical intervention.

Objective: To study the obstetric performance and neonatal outcome of patients of extreme multiparity, Para 10 and more, compared to control group of Para 2 to 4.

Study Design: It is a retrospective comparative study. Data were collected from Medical Records ofpatients during the period from January-December 2000. The total number of deliveries during that period was 10,999. 240 patients records were reviewed, 120 records in each group.

Result: The incidence of great-grand multiparity was 1.09%. The incidence of lack of perinatal care among great grand multipara was statistically significant. However; there are no differences in the perinatal morbidity and mortality; also there was no difference in the rate of instrumental delivery and mal-presentation in the two groups. The duration of pregnancy is similar in the two groups. There was no difference in incidence of antepartum hemorrhage, rate of caesarean section rate. However; the only statically significant difference in the two groups was the increased incidence of large babies (macrosomia).

Conclusion: This study showed that extreme grand multiparity carry the added risk of macrosomia (> 4000mg), this was not reflected on any adverse perinatal outcome. However, the number of patients in this study is limited and it is difficult to draw firm conclusion.

To study the antimicrobial resistance pattern of aerobic Gram-negative bacilli isolated from patients in intensive care units in Hamad Medical Corporation, 108 non-duplicate isolates from 60 patients with nosocomial infections were determined by Vitek machine. The minimal inhibitory concentration of 14 antimicrobials was determined by E-test and results were interpreted according to the National Committee for Clinical Laboratory Standards guidelines. The most common species was Pseudomonas aeruginosa High levels of resistance were seen to second and third generation cephalosporins, piperacillin, fi-lactam Ji-lactamase inhibitors combinations, and gentamicin. The most active agents were amikacin, meropenem and imipenem (resistance 19%, 19%, 20% respectively). We conclude that second and third generation cephalosporins, piperacillin, fi-lactam/fi-lactamase inhibitors combinations and gentamicin are not suitable drugs for empirical monotherapy for aerobic Gram-negative infections in intensive care units in Qatar.

The purpose of this study is to formulate guidelines for proper surgical management ofphyllodes tumours. It is a disease often misdiagnosed by the pathologist and undertreated by surgeons. We have retrospectively studied 12 patients with histologically proven cystosarcoma phyllodes (CSP). There were 4 benign and 8 malignant lesions, with an incidence of 33.33% vs 66.66% respectively. The treatment was surgical in all patients. The extent of surgery ranged from wide local excision to Modified Radical Mastectomy (MRM). One patient with malignant CSP developed lung metastases (12.5%) and three had recurrences (37.5%). The exact recurrence rate can't be calculated because 5 patients lost follow-up. The results of this study indicates that local excision is safe for benign CSP and all patients with malignant CSP should be treated by mastectomy since there is a high recurrence rate with local excision (37.5 %).

One of the critical decisions during the preparative assessment of a patient who will have a breast reconstruction is whether a flap transfer will he necessary to supplement the anterior chest wall tissue. In our practice the material of choice for breast reconstruction is autologous tissue. The latissimus dorsi muscle flap (LDMF) is the most commonly used autogenous tissue flap for breast reconstruction. Few reports exist fro its use in oncologic breast surgery. The authors present 115 patients who underwent LDMF reconstruction to correct volume and contour abnormalities. This retrospective study demonstrates a method of breast reconstruction used LDMF as delayed reconstruction. This methods was used for patients who were diagnosed as having Stage 0, Stage 1 or Stage 2 breast cancer. This study covers a period of 12 years.

Background: Primary Sjogren's Syndrom(SS) is an autoimmune disease with diverse clinical presentation. This study was conducted to describe the clinical and immunological picture of SS in patients seen in the main hospital in Qatar.

Methods: We reviewed all the medical records of patients seen at Hamad medical corporation between 1997 and 2002 who met the classification criteria for primary SS. Eighteen patient met these criteria.

Results: Female to male ratio were 9:1. The average age at the time of diagnosis was 40.6 (range from 24-61) with a period of 2.3 years before the diagnosis was established. Dry eyes and/or dry mouth were the presenting symptoms in 66%. Parotid swelling alone or with other symptoms were the presenting symptoms in 17%..Renal tubular acidosis were seen in 17% and fatigue in 44%. Shirmer test was positive in 85% and lip biopsy in 80% of patients in whom the tests were done.Anti-SS-A/Ro were positive in 71% and Anti-SS-B/La were positive in 50%.

Conclusion: Our results are almost similar to other studies in the west.

Extraskeletal ossification may occur in muscle and other soft tissue, The phenomenon may be classified as follows: (1) progressive Myositis ossificans, (2) traumatic localized Myositis ossificans, and (3) nontraumatic localized Myositis ossificans. The literature suggests that 75% of the localized forms occur as a result of trauma. We report a case of non traumatic myositis ossificans which involved the hypothenar region of the hand.

Pathological fractures in primary hyperparthyroidsm are usually seen in the late stages of the disease. It is extremely rare to see such fractures in asymptomatic hyperparathyroidsm. We present such a case and discuss the diagnostic difficulties and problems in treatment.

A rare case of splenic abscess due to salmonella infection in a teen-age non-Qatari male was treated unsuccessfully by antibiotic therapy and percutaneous drainage. The patient recovered uneventfully after the spleen was removed laparoscopically.

Pulmonary pneumatocele is an unusual complication of bacteria Pneumonia in the neonatal period. They usually develop during the recovery phase, and generally resolve spontaneously within seeks to months [1], We present a premature newborn that developed a large pneumatocele secondary to staphylococcus aureus pneumonia that was treated successfully with a test tube inserted into the pneumatocele. This resulted in complete resolution of the pneumatocele in four days.

An old lady with mitral regurgitation, and chronic atrial fibrillation, who was maintained on amiodarone 200 mg daily for five years, presented with fever and confusion due to septicemia and hepatic encephalopathy. Her chest radiograph and chest CT scan showed interstitial infiltrates. Histopathology of transbronchial biopsies suggested amiodarone-induced lung toxicity. The amiodarone was discontinued and the patient showed some improvement. The case, the presentation and the diagnosis are discussed.

In this article(1), the authors reviewed an interesting topic of which all Radiologists and Surgeons need to be aware. The pathology of the condition was well reviewed as well as the clinical presentation and the management in the four cases presented.

This abstract was presented in 1st Gulf Scientific Dental Meeting inAl Khobar, Saudi Arabia, 30th September, 2004.

Context: There is a paucity of effective, well-tolerated drugs available for migraine prophylaxis.

Objective: To determine whether treatment with the angiotensin II receptor blocker candesartan is effective as a migraine-prophylactic drug.

Design and Setting: Randomized, double-blind, placebo-controlled crossover study performed in a Norwegian neurological outpatient clinic from January 2001 to February 2002.

Patient: Sixty patients aged 18 to 65 years with 2 to 6 migraine attacks per month were recruited mainly from newspaper advertisements.

Interventions: A placebo run-in period of 4 weeks was followed by two 12-week treatment periods separated by 4 weeks of placebo washout. Thirty patients were randomly assigned to receive one 16-mg candesartan cilexetil tablet daily in the first treatment period followed by 1 placebo tablet daily in the second period. The remaining 30 received placebo followed by candesartan.