Qatar Medical Journal - Volume 2012, Issue 1

In Baghdad in 931 AD Caliph Al Muqtadir learned that a patient had died as the result of a physician's error. There upon he ordered his chief physician, Sinan Ibn Thabit bin Qurrah to examine all those who practiced the art of healing. In the first year of the decree more than 860 were examined in Baghdad alone. From that time on, licensing examinations were required and administered in various places. Licensing Boards were set up under a government official called Muhtasib or inspector general. The Muhtasib also inspected weights and measures of traders and pharmacists. Pharmacists were employed as inspectors to inspect drugs and maintain quality control of drugs sold in a pharmacy or apothecary.

Qatar Medical Journal is the official periodical of the medical community in Qatar.

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.

Abstract Objective: The objective was to explore the body mass index (BMI) of women as related to the different parameters of the in vitro fertilization (IVF) procedure and outcome.

Materials and Methods: This retrospective study on 206 couples analyzed epidemiological features, characteristics of ovarian stimulation and number and quality of retrieved oocytes, as well as pregnancy outcome according to three groups of BMI values: 20>BMI, 28>BMI > 20 and BMI >28 kg/m2.

Results: The prevalence of underweight and overweight women was 15.5% and 41.3%, respectively. The mean ratio of follicle-stimulating hormone to luteinizing hormone increased significantly according to BMI. An increase in the mean number of consummated gonadotropin ampoules together with a decrease in the number of collected oocytes was observed in long stimulation protocol cycles when BMI >28 kg/m2. The same observations were made in short stimulation protocol cycles for 20 > BMI and BMI > 28 kg/m2. No significant relationship could be between clinical pregnancy and miscarriage rates and a patient status as underweight, normal weight, or overweight.

Conclusions: Both underweight and overweight have negative effects on IVF parameters and outcome leading to decreased chances of pregnancy.

Abstract Background: Convulsive status epilepticus (CSE) in childhood is a medical emergency and its epidemiology should be studied separately from adult CSE; this study reviewed pediatric cases reported in Qatar in 2008. Methods: A retrospective study for a defined pediatric age group (30 days <  age <  15 years) with SE was carried out in Qatar for 12 months and included 25 patients. Results:: Of the patients, 56% male, 44% female, 56% were younger than 2 years, and 52% had febrile status epilepticus, 76.9% of whom were boys. All who displayed prolonged seizure status (more than 45 min) had abnormal EEG and brain CT readings and required a prolonged stay in PICU; 20% had history of status epilepticus before. Conclusions:: The incidence of SE in Qatar is similar to reports around the world, and the age-specific incidence pattern is similar as well. Febrile status epilepticus is the most important cause especially in boys. Symptomatic SE has a significantly longer duration with higher risk for recurrence than idiopathic SE.

Periodontal diseases comprise a large group of predominantly infectious and/or inflammatory disorders affecting periodontal tissues. They are diagnosed by assessment of the dento-gingival area, including the the gingival sulcus depth, and the presence of bleeding with radiographic assessment of the alveolar bone. The prevalence of periodontitis (PD) is reported to be 20-50% worldwide;(1) while the aggressive form of PD is found in less than 10% of the population/2,3). Periodontitis is a chronic infectious/inflammatory disease of multi-factorial etiology(4) with a number of risk factors that are shared with other chronic inflammatory conditions; increasing age, low socio-economic conditions, stress, increased body weight, dyslipidemia, hypertension, metabolic syndrome, cigarette smoking and Diabetes mellitus.(5-6) Systemic reviews have shown a clear association between PD and coronary heart diseases (CHD) emphasizing the need to consider PD as a risk factor for CHD.

To determine the oral health status of 15-yearold. Qatari students, 527 (216 males, 311 females) were selected randomly from five regions of Qatar to be examined according to World Health Organization standards using the standardized simplified version of Community Periodontal Index (CPI) to evaluate the severity and prevalence of periodontal diseases. The oral health status was recorded by the simplified oral hygiene index (OHI-S) and teeth status was recorded using index decayed, missing, filled teeth (DMFT). One-third of the students (36.33%) with a mean sextant of (2.18) presented with completely healthy periodontal tissues; the highest prevalence of periodontal status was related to bleeding (39.73%) with a mean sextant of (2.38); the prevalence of calculus was 20.26% (1.21). Dental caries was high, more than 60% of teeth examined were found to be decayed. Male students showed more decay than females (74.15%, 64.8% respectively). More males (33.33%) failed to brush their teeth than females (11.89%). While 41 % of girls brushed their teeth more than once daily only 22.22% of the boys claimed to brush more than once a day. Most students needed motivation and instruction in oral hygiene; one-third required removal of calculus. Deep scaling and complex periodontal treatment was needed for 60% of the teeth examined were decayed only 0.21 sextants per subject. To achieve the WHO goals greater effort must be directed towards the implementation of effective preventive programs in Qatar.

A cross-sectional stratified cluster sample of 4291 children (2187 boys and 2104 girls) aged 6 to18 years attending primary public schools in Qatar was used to determine the prevalence of underweight, overweight and obesity among primary school children in Qatar using BMI as an indicator. Structured questionnaires were used to obtain socio-demographic data. Anthropometric measures were taken by trained nurse. The study revealed a high prevalence of underweight and obesity among Qatari children, with both conditions implicating adverse short and long-term health effects. The prevalence of underweight (BMI <  5% of CDC standard for ageand sex) was 14.6%, overweight (BMI 85% to 95%) was 11.6% and obesity (BMI > 95%) was 14.7% (95% confidence level). The prevalence of overweight and obesity was higher in girls (28.7%) than boys (24%) but was similar in Qatari (26.4%) and non-Qatari children (26.2%). The prevalence of both underweight (15.6%) and obesity (15.8%) were considerably higher in Qatari children.

To estimate the potential risk of malignancy in endometrial polyps and to investigate the possible clinical risk factors. Clinical, sonographic, hysteroscopic and pathological data were reviewed of 337 women with pathologically confirmed endometrial polyps diagnosed in Qatar between 2000 and 2010. The polyps were benign in 95.6% of cases, pre-malignant in 2.3%, and malignant in 2.1 % of cases. Advanced age, menopausal status and vaginal bleeding were strongly associated with atypical hyperplasia and cancer. There appeared to be no association between the risk of malignancy and other clinical risk factors.

Conclusions: There is a small risk of malignancy in endometrial polyps, mainly in post-menopausal patients of advanced age with symptomatic vaginal bleeding. In these circumstances, endometrial polyps should be managed aggressively as potential cancer and removalfor histology is mandatory.

Superior vena cava syndrome and constrictive pericarditis are rare complications of intrapericardial hematoma. We herein report a young patient presenting with a mass attached to the heart causing pressure on the right atrium and superior vena cava, and leading to superior vena cava syndrome and constrictive pericarditis. The exact pathogenesis was not determined but possibly was related to pericardiocentesis 29 years prior to presentation. Diagnosis was established at surgery and confirmed by histopathology. Resolution was partial because complete resection was not possible due to adherence of the mass to the right ventricular wall.

A study was carried out to investigate the status of p53 proteins and their relation to the occurrence of TEL-AML-1 translocation in children with acute lymphoblastic leukemia (ALL) attending the oncology unit at Basrah maternity and children hospital during the period from May 2009 to April 2010. A total of 100 blood samples were collected from 40 newly diagnosed ALL cases, and 60 healthy children served as controls. Anti-p53 antibody was detected by an enzyme-linked immunosorbent assay (ELISA), and TEL-AML-1 fusion gene was determined by reversetranscriptase polymerase reaction (RT-PCR) on RNA extracted from fresh blood samples. The overall proportion of anti-p53 was 20% in the leukemic patients, whereas none of the healthy control group showed anti-p53 positivity. This difference was statistically significant (P < 0.05). According to the French-American-British (FAB) classification, 75% of the anti-p53 positive cases were classified as L2 stage ALL. There was a significant difference (P < 0.05) between standard and high-risk groups of ALL patients in the frequency of anti-p53: 40% of high-risk group members had anti-p53 compared to 8% in the standard risk patients. There was no association (P>0.05) between TEL-AML-1 translocation and anti-p53. None of the standard risk patients with positive TEL-AML-1 fusion gene displayed the anti-p53 while 33.3% of TEL-AML-1 positive with high risk displayed the antip53 antibody.

Immune thrombocytopenic purpura (UP) is a common pediatric hematologic disorder. Bone marrow aspiration (BMA) is often performed in children with acute ITP to rule out leukemia, aplastic anemia or other hematologic diseases. However, whether BMA is needed in children with typical and hematological features of acute ITP has been questioned. To determine whether BMA is indicated in acute childhood ITP, samples were examined from 122 patients with the provisional diagnosis of acute ITP attending Hevi Pediatric Teaching Hospital, Duhok/North of Iraq between August 2006 and July 2010. Typical acute ITP was defined as an appearance of well being, no hepatosplenomegaly, no lymphadenopathy, normal Hb, WBC, neutrophil count and peripheral blood smear except for thrombocytopenia. A platelet count of 50 x109/L or lower was the cut-off level. No diagnoses of leukemia or aplastic anemia were revealed in the 122 (100%) children with typical hematologic features of ITP and it was concluded that routine BMA is not needed for children with typical features of acute ITP.

Work-related injuries constitute a large sector of patients seen at Al Khor Hospital's Emergency Department. The aim of this study is to describe the characteristics, frequency and mechanism of work-related injuries presenting to the emergency department. Patients of all ages with work-related injuries presenting to the Emergency Department at Al Khor Hospital at any time, from May to November 2009, were included in the study. Domestic injuries were excluded from the study. Character of the patients and injuries were described. The study included 903 patients. The mean age was 32.73 years (standard deviation 8.565). Most patients were construction workers, 346 (39.1%), and mechanical workers, 262 (29.6%). The types of non-fatal work related injury were: hands injuries, 329 (36.4%), contusions, 239 (26.5%) and cuts, 205 (22.7%). The main mechanisms of injury involved heavy objects falling on patients, 191 (21.2%). Wearing personal protective gear was reported in 546 (60.5%) patients, and having training to use it was reported in 510 (56.5%) cases. Wearing protective equipment was lower in mechanical workers (62.6%) and construction workers (57.4%) who had the higher percentage of work related injuries (29.6% and 39.1 % respectively), [E1] P value < 0.001. There was a positive correlation between the level of education and wearing protective equipment (P value 0.002). Our findings affirm that safety precaution and proper training on how to use the personal protective equipment is needed from companies in industrial areas to reduce the incidence of work related injury.

Pulmonary sequestration is a rare congenital malformation of the lower respiratory tract characterized by a non-functioning mass of lung tissue that is not communicating with the normal tracheo-bronchial tree and receives its vascular supply from a systemic artery. We report the first case of intrapulmonary sequestration in Qatar, of a 22 year-old Qatari male who presented with recurrent chest infection. This case study includes a literature review.

Pai Syndrome was first described in 1987 as a constellation of three developmental anomalies: i) complete median cleft palate, ii) cutaneous polyps and iii) midline lipomas of the central nervous system.(1) Since then, eighteen cases have been reported by Pai et al,(1) Preece et al,(2) Morgan and Evans,(3) Rudnikschoneborn and Zerres,(4) Mishima et al,(5) Al Mazrou et al,(6) Coban et al,(7), Szeto et al,(8) Guion-Almeida et al,(9) and Castori et al,(10) Vaccarella et al,(11) Chousta et al,(12) and Ochoa et al(13) To our knowledge, this is the first case of Pai Syndrome to be reported in Qatar and the second case in a patient of Arabian descent. The aim of this paper is to describe the clinical presentation of a variant of Pai Syndrome including a novel ocular finding.

A 63-year old Yemeni male, known case of endstage renal disease (ESRD), hypertension and diabetes mellitus, underwent craniotomy and endoscopic removal of an intraventricular mass. Peri-operatively he was started on cefazolin, a normal diet and regular hemodialysis without heparin. The international normalising ratio (INR) increased rapidly, reaching 4.2 on day five but responded equally rapidly to parenteral Vitamin K and withdrawal of cefazolin. Cefazolin is an antibiotic commonly used in clinical practice because of its long half-life, narrow spectrum and its ability for dose adjustment in renal failure patients. We review the literature, discuss the risk factors of its use and suggest possible mechanisms causing the prolonged coagulation.

Tuberculous Tenosynovitis of the hand usually presents late because of its non-specific nature that starts insidiously and becomes indolent. Although most of the tuberculous tenosynovitis reported has been the primary focus of the disease, tuberculous tenosynovitis of the hand can be the presenting feature of multiple foci skeletal tuberculosis. In this case series we report three cases of tuberculous tenosynovitis with three different presentations; the definitive diagnosis being made by biopsy and tissue culture. Combined early surgical intervention and chemotherapy was the definitive treatment although the courses of treatment and outcomes differed.

Ischemic Optic Neuropathy (ION) is a rare complication of interferon (IFN) during treatment of Hepatitis C virus (HCV) with all reported cases occurring within three months of the start of therapy. We report a case of a late bilateral sequential ischemic optic neuropathy after 36 weeks of pegylated-interferon therapy. In contrast to previous reports, we recommend a regular ophthalmological follow-up throughout the whole course of interferon therapy.

Heparin-induced thrombocytopenia (HIT) is a rare clinico-pathological abnormality. It is characterized by the development of thrombocytopenia, resulting from heparin administration, which leads to a decrease in platelet count by 50%, or to less than 1 0 0 x 1 0 3 M within 5 to 14 days. HIT causes increased morbidity and mortality, thus it is of vital importance that acute care physicians, surgeons and intensivist should be aware of this clinical entity. We report a case of heparin-induced thrombocytopenia and review of its management, including alternatives to heparin therapy.

Tubercular Dactylitis is a rare extra-pulmonary presentation in adults with more than 85% of cases presenting children below 6 years old.

Relapse prevention with antipsychotic drugs compared with placebo in patients with schizophrenia has not been sufficiently addressed by previous systematic reviews. We aimed to assess the association between such drugs and various outcomes in patients with schizophrenia to resolve controversial issues.

Background: Ocular trauma is a significant problem in pediatric patients. Also, leads to visual loss throughout the world there are no data of pediatric ocular trauma in Arabian Gulf Countries in the current literature.

Aim: To study the epidemiology, mechanism, causes and outcome of serious ocular trauma requiring hospital admission, in children below 16 years of age.

Study design: A retrospective cohort study. Subjects: All pediatric patients (up to 16 years of age) presenting with ocular injuries to a tertiary care pediatric ophthalmology and Pediatric Accident Emergency Department January 1, 2005 to December 30,2009.

The Editorial Board would like to express sincere thanks to all the reviewers who have cooperated in making this endeavor such a great success. We appreciate the feedback from them, the valuable contributions that they have made. We hope for their continued support.

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Hamad Medical Corporation (HMC) and Cerner® have signed a landmark agreement to digitize the entire public health system of Qatar, including all HMC hospitals and Primary Health Care Centers (PHCs). Acting as a prime contractor and CIS integrator, Cerner will deliver cutting edge health IT solutions from Cerner and third party suppliers that will bring the HMC Hospital Information Management into the 21 st century. This is Cerner's first project in the region to digitize an entire country's public health system on a single computing platform.