Qatar Medical Journal - Volume 2012, Issue 2

Objective: To determine the prevalence of eclampsia in Qatar, the associated maternal and perinatal outcomes for the period from January 1991 to December 2009 and to define any possible preventive measures to this potentially fatal complication. Methods: A retrospective case review was performed of all women with eclampsia admitted to the Women's Hospital and Obstetrics and Gynecology department at Al Khor Hospital for the period from January 1991 to December 2009. Details were collected by reviewing the files of the patients from the medical records. Data were analyzed by either X² analysis or the unpaired student “t” test as appropriate. Results: During the period of the study there were 224,809 births. Seventy women developed eclampsia (0.31/1000 deliveries), 44.3% of them were antepartum, 31.4% postpartum and 24.3% intrapartum eclampsia. 34.3% of patients presented with fits, 38.5% presented with pre-eclampsia (PE) and 20% presented with severe pre eclampsia; 18.5% were mild PE and another 27.2% were admitted with different complaints. Symptoms of impending eclampsia were seen in 22.9% of the PE patients. Thirty percent had no antenatal care (ANC). Antihypertensive therapy was given to 72% of cases. Antiepileptic therapy was administered to 48% of cases and 58.5% received magnesium sulfate. Eclampsia was associated with increased rate of cesarean section (CS) (64.2%). There was one maternal death, and the rate of major maternal complications was 20%. The perinatal mortality rate was 12.8%. Conclusion: The incidence of eclampsia in Qatar is 0.31 per 1000 deliveries. Although rare, this condition is associated with increased maternal morbidity and perinatal mortality. However our result is lower than reported worldwide. Improvement of obstetric care by having high index of suspicion even with apparently low risk patients, using magnesium sulfate prophylaxis for all cases of severe pre-eclampsia, in addition to community based approach to improve community health, education and prenatal care, all can be effective measures for the decrease incidence of this fatal condition although eclampsia cannot be entirely prevented.

Objective: This is the first paper to evaluate the potency of the tuberculin skin test (TST) results in confirmed pulmonary tuberculosis in the developing country. Method: Data was collected retrospectively from the tuberculosis (TB) treatment unit during the period from 1998 to 2004. All charts diagnosed as active tuberculosis based on positive sputum smear or culture with documented TST were reviewed. The standard TST was done by injecting o.1 ml of 5 international units subcutaneous RT 23 purified protein derivative (PPD) on volar surface of the right arm. Results: There were 306 patients with confirmed active pulmonary tuberculosis, of which 58% were smear positive and 42% were smear negative but culture positive. Expatriates accounted for 81% (247) and male for 74% (225) of the patients. The mean TST was 18.5 mm with standard deviation of 7.54 mm. TST was less than 5 mm in 8.2% (25), 5–10 mm in 1.6% (5), 10–15 mm in 11.1% (34) and more than 15 mm in 79.1% (242). False negative (reaction less than 10 mm) was significantly higher in Qatar nationals (17% vs 8% in expatriates) and those with associated diseases (16.3% vs 7% without associated diseases). Conclusion: Although 9.8% of confirmed pulmonary tuberculosis had false negative TST, it remains a potent aide for epidemiological and diagnostic purposes and periodic assessment of this is highly recommended. In our community with BCG vaccination a reaction more than 10 mm should be considered positive.

The incidence of post caesarean wound infection and independent risk factors associated with wound infection were retrospectively studied at a tertiary care hospital.

A retrospective case controlled study of 107 patients with wound infection after lower segment caesarean section (LSCS) was undertaken between January 1998 and December 2007. The control group comprised of 340 patients selected randomly from among those who had LSCS during the study period with no wound infection. Chart reviews of patients with wound infection were identified using the definitions from the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance Systems. Comparisons for categorical variables were performed using the X² or Fisher exact test. Continuous variables were compared using the 2-tailed Student t test. P < 0.05 was considered significant. Logistic regression determined the independent risk factors.

The overall wound infection rate in the study was 4.2% among 2 541 lower transverse CS. The independent risk factors identified for wound infection were, obesity, duration of labor >12 hours, and no antenatal care. Patients' age and parity, diabetes mellitus, premature rupture of membranes (PROM) >8 hours and elective vs. emergency surgery was not found to be significantly associated with wound infection. Conclusion: The independent risk factors could be incorporated into the policies for surveillance and prevention of wound infection. Antibiotic prophylaxis may be utilized in high risk patients such as PROM, obese patients and prolonged labor.

Objective: To analyze the association between maternal ethnicity and gestational age with the incidence of low birth weight and intrauterine growth restriction. Study Design: Prospective, analytic study Methods: The study was conducted between March 14th and April 4th 2011 in Women's Hospital HMC. The data was ascertained from the delivery register of labor ward on daily basis using predesigned, structured questionnaire. Data was stratified according to the maternal ethnicity groups and gestational age at birth (term and preterm). Results: The total deliveries during the study period were 890; 35.5% Qatari (n 316) and 64.5% non-Qatari (n 574). The incidence of LBW was 12.36% (n 110). The difference of LBW incidence between Qatari (13.6% n 43) and non-Qatari (11.67% n 67) groups was non significant (RR 1.17, 95% CI 0.82-1.67, p = 0.401). The same was between non-Qatari sub groups (p < 0.05). The incidence of IUGR was 6% (n 54; 49.09% of LBW). The incidence of IUGR between Qatari (5.7% n 18) and non-Qatari (6.27% n 36) groups was significant (RR 0.45, 95% CI 0.3-0.6 p>0.05).

The incidence of LBW was 7.85% (n 60) in term babies and 39.68% (n 50) in preterm babies. The incidence if IUGR was 3.79% (n 29) in term babies and 19.84% (n 25) in preterm babies. Preterm babies had a five times higher risk of both being LBW (RR 5.05; 95%CI 3.65-6.99; p < 0.001) and IUGR (RR 5.23; 95% CI 3.17-8.62; p < 0.001). Conclusion: The incidence of low birth weight is independent of maternal ethnicity in Qatar. However, the incidence of IUGR is significantly higher among the non-Qatari population. The relative risk of being LBW or IUGR is five times higher in preterm babies. Further in depth studies are indicated.

An antigen of high sensitivity and 97.5% specificity prepared from hydatid cyst fluid was used in an ELISA test for a sero-epidemiological survey in areas of Basra, Iraq. The calculated predictive values for positive and negative cases were 3.5% and 96.4% respectively.

Background: Women-headed families tend to be the most marginalized and poverty prone in any given community. One in 10 Iraqi households is headed by woman according to International Organization for Migration, though their assessments suggest that this ratio rises to 1 in 8 in displaced families. Objective: To draw attention to the exposure and vulnerability of women headed families to key medical and social problems. Methods: This cross – sectional study was conducted from March through February 2011. Eleven non-governmental organizations (NGOs) were chosen to be the pool of data collection, in addition to 50 primary, intermediate, and secondary schools for girls. The actual participants were 720 with a response rate of (97%). Women headed families participated in the study were distributed in different areas of Baghdad and the districts around. Results: Hypertension is the leading disease (20%) followed by arthritis (9.6%), heart disease (7.6%), and diabetes mellitus (5.2%), the least was tuberculosis (0.1%). On the other hand, the number of sons and daughters with chronic disease was 159 (6.4%). Respiratory system disease is at the top of the list at a rate of (20.6 per 1000) while the gastrointestinal disease is at the bottom at a rate of (1.6 per 1000). 7.8% of the studied household-heading women were exposed to violence that was either verbal (75%) or physical (25%), the source was the woman's parents (42.9%), husband's family (34%), neighbors (8.9%), and others (14.3%). The percentage of problematic sons (17.9%) who show different types of behavior, (30.2%) of them not obeying their mothers, (21%) hit their brothers, (9.3%) insulting the mother, (2.3%) have problems with neighbors.

Objectives: The aim of this study was to investigate the quality of life (QOL) in people with epilepsy (PWE) living in Khartoum State, Northern Sudan. The region offers a model of urban and suburban communities in developing countries. Methods: A cross-sectional study was carried out in the neurology clinic of Khartoum State Hospital and Omer Ibn Alkhatab Health Center in the suburb of Khartoum State. We interviewed PWE living in the city, the suburbs and adjacent villages. Our subjects were known to have been on antiepileptic drugs (AED) for at least 6 months. The impact of epilepsy on the QOL was assessed in the clinic using a 23-item questionnaire with graded scales and check-lists to explored demographic characteristics, seizure control, adverse effects of antiepileptic medication, physical harm, social and psychological impact and stigmatization. Results: Fifty-two females and 48 males between the ages of 10 and 80 years were interviewed. Sixty percent of participants were between 20 and 39 years of age. While on AED treatment, 63% developed at least one seizure at any given time, 49% in the past 6 months and 27% in the past week. Twenty six percent experienced one or more side effect of AEDs. A significant number of respondents admitted that epilepsy had a negative impact on several aspects of their daily life activities, education and social functioning. Of individuals eligible for work, 17% were unemployed or had their job terminated because of epilepsy. Relationships with spouses were affected in 20 % of cases. Fifteen percent felt stigmatized by their illness. None of the participants had received any formal health education or counseling about epilepsy. Conclusion: Epilepsy has a significant impact on several aspects of QOL, particularly physical injury and socioeconomic functioning affecting PWE living in Khartoum State. Poor seizure control, a risk factor for impaired QOL, was common. The overall perceptions of QOL and self satisfaction as stated by our PWE was more favorable when compared to those in developed countries and the Gulf. Nevertheless, this could be more reflective of social circumstances and better seizure control, health education and counseling for PWE and their families is still encouraged and recommended.

It is the first prospective study about anaesthesia related postoperative complications conducted in Hamad General Hospital. Total 1128 adult patients admitted to the Post Anaesthesia Care Unit (PACU) during a period of three months were surveyed for anaesthesia related complications. Documented complications were found in 48 patients i.e. 4.25% of patients' population. The types of complications were related to the respiratory system, cardiovascular system, nausea/vomiting and body temperature in this descending order. Most of the complications happened to healthy ASA I and II patients. Factors that play major role in determining the immediate postoperative complications were the ASA status, the level of anaesthesia seniority attending the patient, the urgency and the nature of procedure. We tried to find other factors that may influence complications in addition, discussed below.

A rare case of malignant transformation of uterine leiomyoma is reported. A 54 year old lady, nulliparous and 2 years postmenopausal presented to gynecology clinic with a pelvi – abdominal mass and ultrasound scan suggestive of multiple uterine fibroid. Total abdominal hysterectomy performed. Histopathology report showed leiomyosarcomative changes from benign leiomyoma within the huge mass.

Therapeutic hypothermia (protective hypothermia) has been known to have beneficial effects since ancient times but interest was renewed after two land mark publication a decade ago. The survival as well as quality of life of post cardiac arrest patients depends on neurological outcome. Mild induced hypothermia is recommended for improving the neurological status of these patients. All acute care physician, nurses and emergency medical services personals should be aware of this approach. We report a case of post cardiac arrest that displayed improved neurological status with mild therapeutic hypothermia. Case: A young, female patient experienced perioperative cardiac arrest. Immediate resuscitation lead to return of spontaneous circulation in six minutes. Her post resuscitation Glasgow Coma score (GCS) was five. We induced therapeutic hypothermia—the patient required sedation and a chemical muscle relaxant. After 24 h we began slow rewarming. On day four, her GCS improved to 14, and she was extubated on day 6. She had mild cognitive disorder but was functionally independent. She was transferred to the ward on day 11 and subsequently discharged home. Conclusion: Mild induced therapeutic hypothermia improves neurological status of post cardiac arrest patients; however, it had adverse effect of increased risk for infection, arrhythmia and electrolyte disorders.

Idiopathic lumbosacral plexitis (LSP) or non-diabetic lumbosacral radiculoplexus neuropathy (LRPN) is a rare monophasic immune-mediated disorder. The disease is characterized by multiple lumbosacral root and nerve involvement in the absence of trauma, mass lesion or elevated blood sugar. We report a 60-year-old man presenting with a 4-day history of acute-onset sharp left hip pain radiating down his leg associated with numbness over the lateral dorsum of his left foot. MRI of the lumbosacral plexus revealed gadolinium enhancement of mainly L5 on the left. A dramatic response to oral steroids was observed.