Qatar Medical Journal - Volume 2010, Issue 2

Epithelial myoepithelial carcinomas (EMC) are rare carcinomas of the salivary glands. We report here the 6th case of this tumor which arises at the nasal cavity. In case of any histopathological report shows up a pleomorphic adenoma in an unusual site, we highly recommended the use of immunohistochemistry assay as an important tool for the diagnosis of this tumor.

An intracardiac hydatid cyst is a rare but potentially very serious complication of hydatid disease as the rupture of the cyst may lead to embolisation of the femoral artery. We report the case of a 29-year-old man who was admitted with the diagnosis of arterial occlusion of the left leg. During surgery, a large hydatid cyst causing femoral artery occlusion was found and excised. This case emphasizes that, in endemic countries, primary vascular echinococcosis should be considered in the differential diagnosis of arterial occlusion.

Nasogastric tubes are used in all specialties of medical practice. In critically ill patients, these feeding tubes provide enteral nutrition, which maintains enteric mucosal integrity as well as the immune system of the body, less risk of sepsis and decrease in length of intensive care stay. The insertion of nasogastric tube (NGT) is being considered as a simple blind bedside procedure but this procedure is not free of complications and can be fatal as these tubes can be malpositioned into the respiratory tract or central nervous system. Critically ill patients with endotracheal and tracheostomy tube are at particular risk for malpositioning of the nasogastric tubes due to loss of protective reflexes. Here we report three cases, two intubated and one patient with tracheostomy, in whom the enteral feeding tube was malpositioned into the respiratory system, detected early and a new one inserted in correct position, confirmed by x-ray. The aim of this report is to increase awareness about malpositioning of gastric feeding tubes, proper confirmation of their positioning, risk factors for malpositioning and its prevention.

A 45 years old man reports recurrent episodes of marked lip and hand swelling; without urticaria or puritus occurring during surgical procedure for lymph nodes biopsy. He was diagnosed with lymphoma six months ago. He has had three episodes of severe, campy abdominal pain and bloating lasting up to 24–36 hours on the past year. No family history of Angioedema. Work up showed: CBC, chemistry and IgE were normal. C4 was 35 mg/dL (normal 50–100 mg/dl) C1 esterase inhibitor (C1 -INH) level: 18 mg/dL (normal 18–50 mg/dl), low C1 -INH function (less than 50% of normal) and low C1 q (less than 30% of normal)

Aim: The purpose of this study was to evaluate adherence to national guidelines on the non-pharmacologic (ablative) treatment of atrial fibrillation (AF).

Methods and Results: This prospective, observational, transversal study enrolled 1256 consecutive inpatients and outpatients referred to 43 Cardiology Departments between 1 and 31 October 2008 for the management of AF as a primary diagnosis. A rhythm-control strategy (cardioversion, antiarrhythmic medication, pace-maker implantation, substrate ablation, alone or in combination) was prescribed in 865 (69%) of the patients and a rate-control strategy [drugs, atrioventricular junction ablation and pace-maker implantation (Ablate and Pace) in 285 (23%). Specifically, substrate catheter ablation was indicated by the attending cardiologist in 187 (14.9%) patients and Ablate and Pace in 29 (2.3%). According to guideline indications, substrate catheter ablation would have been indicated in 183 (14.6%) patients, but only 105 (57%) of these were correctly identified by the attending cardiologist (K statistics for agreement for indications 0.49). Atrioventricular junction ablation and pace-maker implantation would have been indicated in 108 (8.6%) patients, but only 29 (27%) of these were correctly identified by the attending cardiologist (K statistics for agreement for indications 0.06).

Conclusion: About a quarter of patients referred to cardiology departments for AF management have potential indications for non-pharmacological treatment according to the guidelines. Substrate catheter ablation was offered by the attending cardiologist in a percentage similar to that expected, but concordance with guideline indications was moderate. Atrioventricular junction ablation and pace-maker implantation was largely underused.

The objective of this study was to analyze the factors predicting length of stay in a stroke patient rehabilitation unit at Hamad Medical Corporation (HMC) in Qatar. The medical rehabilitation data of 100 stroke patients discharged from a 15-bed inpatient rehabilitation unit (IPRU) were collected retrospectively from medical records during the period from September 2004 to April 2007. A questionnaire was developed, and variables included in the study were age of the patient, length of stay in acute care (LOSa), length of stay in rehabilitation (LOSr), functional independence measure on admission and discharge (FIMa and FIMd), modified disability scale, and modified mobility scale. Patients were grouped by impairments defined by cause as ischemic or hemorrhagic stroke, and right or left body side deficit. A significant negative correlation was observed between LOSr and FIMa (r = -0.44, p = 0.00), and positive correlation between LOSr and LOSa (r = 0.37, p = 0.00). There was no correlation between LOSr and FIMd (r = -0.03, p = 0.76). We observed that low admission FIMa and FIMd were related to extended LOS in both acute and IPRU. Multivariate regression analysis was performed by taking age, LOSa, cause of hemorrhage or ischemia, and FIMa as independent variables, and LOSr as dependent variable. The model could explain only 26% variation for LOSr. This study supports the hypothesis of an association between LOSr, LOSa, and FIMa. Further research is needed to confirm the results of this and other similar studies.