Qatar Medical Journal - Volume 2007, Issue 1

The Miswak (Miswaak, Siwak) is a natural toothbrush made from the twigs of the Salvadora persica tree. Other tree types that are used are the arak tree, peelo tree, olive, walnut, and other trees with bitter roots. Pomegranate twigs are never used for miswak

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

Benign prostatic hyperplasia (BPH) is a chronic and complex disease involving anatomical enlargement of the gland, real urinary obstruction and non-specific lower urinary tract symptoms (LUTS). LUTS are age-related lower urinary tract symptoms that affect 30-60% of men over the age of 40 years. LUTS could be due to causes related to the prostate, bladder or the central nervous system. Because the term “LUTS” is broader, it has replaced the term “prostatism”; the term LUTS BPH is the preferred one in urological literature

Objective: In the past 20 years, breast cancer incidence in the world has a dramatic increase of 50-100%, which strongly supports the need for breast cancer prevention, and screening programs.The purpose of this study was to identify and investigate the knowledge and practice of breast self examination (BSE) with the influencing factors on the compliance of (BSE) among female nurses.

Methods: A study was conducted between January and December 2002. Female nurses (80) from Prince Rashid Military Hospital constituted the study population. The questionnaire contained items on the demographic characteristics of the respondents, knowledge of breast cancer; attitudes toward BSE and questions regarding the practice of BSE. The analysis included descriptive statistics to examine the association between BSE and medical history, knowledge of BSE and attitudes toward BSE.

Results: The results of the study indicated that 52% of the sample performs BSE. Approximately 30% of those who perform BSE said they learned information regarding BSE during their work experience. The significant relation was found between higher levels in work experience and BSE practice. Except for age, no significant relation was found between the socio-demographic factors and BSE practice. The sample showed strong belief in breast lump as a causing factor of breast cancer and had significant correlation with BSE practice.

Conclusion: Positive correlations were found between nursing work experience and their practice in BSE as working nurses. Studies like these can enhance the knowledge regarding BSE among nurses and other medical professionals.

Childhood obesity is associated with significant health problems in the age group and is also an important early risk factor for much of adult morbidity and mortality. It is a problem that is increasing. To asses the prevalence of overweight and obesity in primary school children (7-13 years of age) in Baghdad City a random sample of 5361 primary schoolchildren from different schools in Baghdad city was studied for obesity. Risk factors were assessed by a questionnaire specially prepared for this purpose then weight and height were measured for every child to obtain the BML Overweight and obesity were defined by adopting the cut-offs obtained from the WHO International Task Force on Obesity (ITOF). In this sample the prevalence of obesity was 4.1% and of overweight was 12.4%; the prevalence increasing with age in a significant linear correlation. The risk factors that significantly influenced the occurrence of obesity were gender; physical activity, parental obesity and family size. On the basis of this sample it is concluded that the prevalence of obesity in Baghdad is high compared to many other countries. This could be due to many contributing factors, the rapidly growing trend of sedentary life, incorrect nutritional education and habits, and the lack of exercise.

Assisted reproductive technology (ART), employing in vitro fertilization (IVF) techniques, has been established as the most effective form of treatment for human infertility but despite its potential ART is regarded by many as undermining some important ethical issues and advocates of medical ethics and moralists worldwide have proposed legislative measures to regulate the practice. This paper attempts to explore any possible rules and regulations as well as guidelines to control the ART practice in the Gulf Cooperative Council (GCC) countries and surveys the reported compliance. There are fifty, mostly private, IVF licensed centers/ units in the GCC countries, most of which lack proper ART legislation. Certain recommendations are presented here to form a basis for regulating the procedures and for overseeing their implementation in assisted conception units/centers.

Records of patients attending the Andrology Clinic, Hamad Medical Corporation, Qatar; over a period often years were analyzed to determine the demographic features, contributory risk factors, and best methods of treatment for erectile dysfunction (ED). Of1,245patients with ages ranging from 19-78 years (mean 49 years) 45% were Qataris. Most complained of weak erections, a few reported ejaculatory dysfunction. Diabetes mellitus was the most frequent risk factor (53%) followed by hypertension (28%), smoking (27%) and coronary artery disease (14%). Oral Sildenafil given to 310 patients gave overall satisfaction to 75 (49%) of the 152 patients in whom satisfaction could be assessed; intracorporal injection given to 413 patients resulted in overall satisfaction to 107 (68%) of 157 in whom satisfaction could be assessed; penile prosthesis implantation in 64 patients remained an effective therapeutic modality with 31 (84%) of the 37 patients in whom satisfaction could be assessed being satisfied with the results.

Conclusion: Erectile dysfunction is as common in Qatar as it is in the rest of the world. The higher incidence of diabetes mellitus in the ED. population in the region forms the major risk factor and might reflect the need for the implementation of preventive strategies.

Thirty sound human upper premolars were used to evaluate the in vitro effect of collagen removal from the acid-etched dentin surface on the penetration depth of three types of dental adhesive systems. Standardised buccal and lingual class V cavities were made and the teeth were then subdivided randomly into six groups five teeth each. Three types of dental adhesive systems were used (syntac sprint, Vivadent-Liechtenstein. Syntac single component, Vivadent-Liechtenstein. PQ1> Ultra Dent-USA). The bonds were used with and without deproteinization (10% Sodium hypochlorite for one minute). The highest mean of penetration depth (10.15 jl) was recorded in the group where the PQ1 bond was used on acid-etched and NaOCl-treated dentin. The lowest mean of penetration depth (5.77jl) was recorded where the Syntac Single Component bond was used on the acid-etched dentin surface.

Conclusion: A one minute application of 10% sodium hypochlorite on conditioned dentin significantly increases the penetration depth regardless of the type of adhesive system used. Alcohol-containing systems showed the greatest penetration.

Objective: The purpose of this study is to review the maternal and neonatal outcome in pregnant diabetic women given a trial of labor and delivered macrosomic infants (>4000 grams) and to assess the accuracy of birth weight prediction by ultrasound examination at term.

Methods: One hundred and twenty-nine charts of pregnant diabetic women were reviewed, sixty eight women were given a trial of labor and delivered macrosomic fetuses (>4000 grams), fifty of them had vaginal delivery and the other eighteen had caesarean delivery. In the other group, 61 patients delivered by elective caesarean section, for 41 of them the indication was fetal macrosomia (>4000 grams) as estimated by ultrasound examination and in the other 20, it was due to clinical estimation of big baby. Maternal and neonatal complications were reviewed in each group. Maternal complications included lacerations, hemorrhage and infection and the neonatal complications evaluated were shoulder dystocia and associated birth trauma, asphyxia, and mortality. The accuracy of ultrasound in estimating fetal weight was also evaluated.

Results: Sixty eight (52.7%) women attempted a trial of labor; 73.5% delivered vaginally and 26.5% had a caesarean delivery. All, except two, had macrosomic fetuses (>4000 grams). Only one woman, of those who delivered vaginally, had postpartum hemorrhage due to atonic uterus. The incidence of shoulder dystocia for infants weighing 4000-4499 grams was 6.3% and those infants had the same incidence (6.3%) of brachial plexus injury. There was no perinatal asphyxia or perinatal mortality among those infants who were delivered vaginally. There were no maternal complications for women who had caesarean delivery after labor (18 patients) but there was perinatal asphyxia in two infants who were treated properly without any neurological sequele. Elective caesarean delivery was performed in 47.3% of the study population. There were no neonatal complications or perinatal mortality in this group of patients and only one woman had wound infection. The sonographic prediction of fetal weight was accurate in 52.4% of the cases. The over estimation was in 50.8% of the estimated fetal weights and 49.2% of them were underestimated when compared to actual birth weights.

Conclusions: Caution should be taken in the use of sonographic estimations of fetal weight to guide obstetric decisions concerning labor and delivery. Special consideration should be given to diabetic patients having fetuses with estimatedfetal weights between 4000 and 4500 grams. Flexibility in the management of these patients is best, taking in consideration their previous obstetric performance and if the estimated fetal weight is closer to 4500grams than to 4000 grams, it is perhaps, better to proceed to a primary caesarean delivery.

Background: Ischemic optic neuropathy (ION) is the most common optic neuropathy in patients over the age of 50 years. It has variable clinical features, prognosis and associated risk factors. As far as we know there are no published data about ION from other Arabic countries.

Objective: We describe the clinical presentation, associated risk factors and the prognosis in patients presenting to our hospital and compare our findings with USA studies.

Methods: In a hospital-based prospective study, consecutive patients with a diagnosis of ION seen between January 2001 and December 2004 were included. Detailed neuro-ophthalmic evaluation, laboratory and neuroradiological investigations were performed in all patients. The patients were followed up at the clinic for mean period of 18 months.

Results: Twenty-six patients, 21 males and 5 females (male to female ratio 4.2:1) were enrolled. Mean age was 50.3years. The incidence was calculated as 1/100,000/year. Anterior ION was the commonest type (88%). Vascular risk factors were common; e. g. diabetes mellitus (DM) (58%), hypertension (HTN) (42%), hypercholesterolemia (10%). Prevalence of disc-at-risk (small or absent physiological cup) was (16%) and of temporal arteritis was uncommon (4%). Brain MRI showed ischemic vascular changes in (29%).

Conclusion: The incidence of ION in Qatar is much less and showed male predominance when compared with data from USA. Anterior non-arteritic ION is the commonest type. Vascular risk factors were more common while prevalence of disc at-risk and temporal arteritis was less compared to USA studies while DM was higher. Therefore, controlling risk factors may reduce the incidence of ION.

Background: this work aims at determining the efficacy of modified CHOP combination in which Vinorelbine (Navelbine) replaces Vincristine for the treatment of aggressive Non-Hodgkin's Lymphomas (NHL).

Patients and methods: This open label pilot study included 19 patients with aggressive NHL and one patient with low grade NHL who were treated with the new combination which we abbreviated as P-CAN (Prednisolone 100 mg/day PO day 1-5, Cyclophosphamide 750 mg/m2 i.v day 1, Adriamycin (Doxorubicin) 60 mg/m2 i.v day 1, Navelbine (Vinorelbine) 30 mg/m2 i.v day). The patients1 were 13 males and 6 females, mean age 50 years (34-65), performance state 0-2, International Prognostic Index (IPI) 0-3. Seven patients Stage I, one patient Stage II, eight patients Stage III and 3 patients in Stage IV. 14 patients with nodal disease and five patients with extra-nodal disease. They received total of 97 cycles of the chemotherapy (3-7 cycles).

Results: 18 out of 19 patients achieved complete response (CR). In one patient the response could not be assessed, one patient progressed while on treatment. Toxicity was mainly hematological. The 3 years overall survival (OS) and disease free survival (DFS) was 83%.

Conclusion: P-CAN is an effective, well tolerated combination in chemo-naive aggressive NHL. The addition of Vinorelbine to steroid, Adriamycin, and Cyclophosphamide seems improve the response. Further larger trials are needed to study this combination and its impact on longer overall survival.

Obstructive sleep apnea (OSA) is a common disorder for which obesity is a major risk factor. It has been suggested that the circumference of the neck (NC) is more predictive of OS A than general obesity assessed by the Body Mass Index (BMI). In the National Tertiary Center for Sleep Study, Hamad Medical Corporation, Qatar; 187 patients were studied to evaluate the usefulness of NC and BMI in diagnosing OSA and in selecting patients for overnight polysomnography (PSG). Eighty patients (42.8%), 69 males and 11 females with higher mean age, had evidence of significant OSA (RDI > 15 events/h sleep). OSA was found more in the non-Qatari (n = 57, 553%) than the Qatari's (n = 23, 27.4%). NC mean levels were more in OSA group (41.51 ± 3.12) than non OSA group (39.57 ± 4.35) but, classifying obese as BMI = 30, there was no significant difference in the BMI of apneic and non-apneic groups. The study suggest that OSA is more common in males and NC correlates well in predicting OSA compared to generalized obesity/BMI has no clinical relevance in diagnosing OSA.

Osteonecrosis (ON) is a disease with significant morbidity, it is associated with multiple diseases. The aim of this study was to find out the characteristics of ON in Qatar.

Methods: this is a retrospective study done at Hamad Medical Corporation, which is the main hospital in Qatar (Arabian Gulf) with 1300- bed capacity. Inpatients records from 1993 to 2003 with the diagnosis of ON and avascular necrosis (AVN) were reviewed. Patients’ characteristics were recorded.

Results: 40patients records were reviewed;only 38 had complete records, the other two incomplete files excluded from the study. The patients'age ranged from 9 to 69 years old, 22 males and 16 female. Twenty patients were Qataris and eighteen were non-Qatari, Time to diagnosis ranged from six days to two years. Forty-seven total joints were affected (more than one joint was affected in eight patients). The hip was the most common site involved 39/ 47 and eight were a non-hip (four knees, three ankles and one wrist). Six (15.7%) patients were on steroids. Associated diseases were as follows: five (13%) patients had sickle cell anemia, seven (18.4%) patients had trauma, four (10.5%) patients had hematological diagnosis (one leukemia, one protein C deficiency, one polycythemia vera (PCV), and one TTP. One (2.6%) had nephrotic syndrome, one had reticular sarcoma of the femur; one had Hodgkin lymphoma with radiation, one patient had polymyositis, one had rheumatoid arthritis and one had systemic lupus erythematosus with nephritis. In 12 patients (31.5%) no obvious cause were found.

Conclusions: this is the first study on ON in Qatar, there were some differences of the characteristics of our patients compared to others; notably less trauma and alcohol associations and more hematological association, this study may represent a local demographic data of ON in this region.

To study the demographical pattern of Iraqi children with Down's syndrome (DS) and congenital heart disease (CHD) forty-five children with DS were examined clinically, radiologic ally and by 2D color Doppler echocardiography. In eight with CHD (six female, two male) chromosomal analysis was used to investigate the possible relationship between chromosomal patterns and the type of CHD. All had a 47,+21 chromosomal pattern. Three had atrioventricular septal defect (AVSD), three atrial septal defect (ASD) and two ventricular septal defect (VSD). Only one case had reached the Eisenmenger complex, all the others had pulmonary hypertension. In this small sample of Iraqi children with Down's syndrome there appeared no relationship between CHD type and chromosomal pattern.

A Charcot joint or neurogenic arthropathy is seen in conditions where proprioceptive afferents from the joint (ire altered or destroyed. In many cases a definite cause for developing a Charcot joint can be identified but there (ire some cases (the idiopathic variant) where the etiology remains obscure. Few have been reported. We present such a case and discuss the treatment involved.

A child with a left non-palpable testis underwent surgery for an incarcerated right inguinal hernia. During the operation a left crossed ectopic testis was found at the internal ring and was brought down into the left hemiscrotum through a suprapubic tunnel. The literature is reviewed and this approach of orchidopexy of crossed testis is discussed.

Congenital anomalies of the liver are rare. Agenesis of the right lobe of liver is a rare anomaly with 43 cases reported so far in the English literature. Hypoplasia and agenesis occur more on left side. Agenesis of right lobe of liver is presented in this case report. Role of multislice computed tomography is highlighted in diagnosis. A brief literature review is made along with discussions on differential diagnosis.

We report a male, Qatari infant, born in September 2001 at Hamad Medical Corporation (Doha, Qatar) with bilateral, asymmetric cryptophthalmos. Parents presented first degree familial consanguinity, but negative for ocular abnormalities. General physical examination was unremarkable. Ocular exam showed incomplete variety in the right eye and complete on the left eye. Partially exposed right eye exhibited total corneal opacity. The left eye B Scan Ocular Ultrasound depicted anterior megalophthalmos and enlargement of globe's axial length. CT Scan revealed anterior chamber dysgenesis in the right eye, with normal posterior segment. Cryptophthalmos is a very rare inherited condition, mainly when it appears as an isolated case and not syndromic. To our knowledge, this is the first isolated non syndromic cryptopthalmos case reported in Qatar and in the Gulf countries.

Recently it has been found that many critically ill patients develop secondary neuromuscular disorders following admission to intensive care units (ICU). One of these is critical illness polyneuropathy (CIP), a widespread symmetrical disorder affecting the peripheral nervous system and often associated with sepsis and multi-organ dysfunction. Two percent of all intensive care patients and as many as 80% of septic patients develop critical illness polyneuropathy which leads to a considerably increased risk of in-hospital mortality. The exact etiology of the condition is not known but various risk factors, differential diagnosis, treatment, management and prognosis are discussed in this report of ci woman who, following caesarian section, developed CIP, septic shock, multi-organ failure and subsequently died.

A 56-year-old male presented with a history of right loin pain of two months duration. Physical examination showed a firm non-tender mass in the left upper quadrant. Blood and urinary investigations including serum Cortisol and urinary cathecholamines were normal. CT scan showed an oval, welldefined, heterogeneous mass measuring 14-10 cm. in the region of the left suprarenal gland (Fig. 1). There was no evidence of infiltration into the surrounding tissue. In view of the size and supra-renal location of the mass it was decided to remove the retroperitoneal tumor and the ipsilateral adrenal gland through a left thoraco-abdominal incision to permit adequate exposure and vascular control.

The patient was admitted to Medical ICU because of severe shortness of breath and fever. The patient is known case of renal transplant using immunosuppressant medications. Deep endotracheal tube aspirate reported as, Gram's stain showed delicate, filamentous, branching gram positive rods. Acid-fast staining showed partially acid fast filamentous branching rods.

Epilepsy is one of the commonest neurological disorders with increasing incidence over the last few decades.

As with many neurological disorders, the incidence of the disease is slightly higher in females than males and certain measures or precautions have to be addressed by the treating Physician(s) when treating females with epilepsy as failure to do so my involve medico-legal implications.

Aim: To assess the exocrine pancreatic function among cystic fibrosis patients with cystic fibrosis trans-membrane conductance regulator (CFTR) 11234V mutation. METHODS: Cross-sectional study of 40 cystic fibrosis patients with homozygous CFTR 11234V mutation belonging to a large Arab kindred family and 25 healthy subjects as a control group over a period of 12 mo. Assessment of their exocrine pancreatic function was performed by measuring faecal elastase-1 (FE1) concentration with a commercial ELISA kit using polyclonal antibodies (BioServ Diagnostics) in CF patients compared to healthy subjects. The results were compared with those obtained from a second laboratory using another commercial ELISA (ScheBo; Biotech, Germany) that uses two monoclonal antibodies against different specific epitopes of human pancreatic elastase. RESULTS: All CF patients with CFTR 11234V mutation had normal levels of faecal elastase 1. No significant difference was found between the two methods for the CF groups or between the CF patients with and without pancreatic enzyme replacement.

Contex: In assessing the patient with headache, clinicians are often faced with 2 important questions: Is this headache a migraine? Does this patient require neuroimaging? The diagnosis of migraine can direct therapy, and information obtained from the history and physical examination is used by physicians to determine which patients require neuroimaging.