Qatar Medical Journal - Volume 2013, Issue 1

Examinations at the Faculty of Medicine of Mu'tah University are based on a single best answer multiple-choice questions (MCQs) format. However, the reliability of this examination format has not been determined. Objective: Using an examination of obstetrics and gynaecology as a model, this study aims to analyze the difficulty (facility) index, the discriminatory power and reliability of the examination format. Materials, Subjects and Methods: A prospective study on the psychometric performance was carried out for an undergraduate examination in obstetrics and gynaecology. The performance of the items was measured in terms of facility, discrimination and reliability. Two statistical tests were used to estimate the reliability of the exam: The Kuder-Richardson Formula 20 (KR-20) and the Cronbach alpha test. Results: The items scored well in facility with a significant portion (26%) achieving a positive point biserial of over 0.3 and a Cronbach alpha score of 0.947. However, 23% of the items had a negative point biserial and the Kuder-Richardson 20 (KR20) score was only 0.599. Conclusion: In order to improve the reliability of examinations, we recommend removing the items with negative point biserials and increasing the total number of items.

A fifty-two years old male presenting with a history of abdominal pain of six months duration was found on investigation to have a large non-functioning adrenal mass. Adrenal myelolipoma was diagnosed preoperatively and surgical resection was carried out. Only a small number of cases of giant adrenal myelolipoma (>3500 grams) have been reported. A brief review of literature is done.

Metabolic syndrome is a cluster of metabolic abnormalities that increases the risk of cardiovascular disease and type 2 diabetes. Total human energy expenditure is divided into three major components; resting metabolic rate, thermic effect of food, and activity thermogenesis which is divided into exercise and non exercise activity thermogenesis (NEAT). In this study, NEAT was used as a lifestyle intervention on subjects with metabolic syndrome. 200 eligible patients from the Diabetes and Endocrinology Department at Hamad Medical Hospital in Doha, Qatar were assigned to an intervention (n = 100) or control (n = 100) group and followed for one year. The intervention group was advised to practice NEAT enhancing activities, while the control group was not advised about NEAT. Measurements of waist circumference, weight, BMI, blood pressure, glucose and lipid profile were assessed at baseline, six months and 1 year.

After 1 year 52 intervention and 55 control subjects completed the study. The results revealed no statistically significant differences in metabolic syndrome components between the two randomized groups. The amount of recommended NEAT activity appears to have been too small to influence study outcomes. Future studies in similar populations may need to consider the high dropout rate, and use of incentives or other interventions to increase compliance and retention.

Background: Hospitals play a crucial role in providing communities with essential medical care during times of disasters. The emergency department is the most vital component of hospitals' inpatient business. In Iraq, at present, there are many casualties that cause a burden of work and the need for structural assessment, equipment updating and evaluation of process. Objective: To examine the current pragmatic functioning of the existing set-up of services of in-hospital emergency departments within some general hospitals in Baghdad and Mosul in order to establish a mechanism for future evaluation for the health services in our community. Methods: A cross-sectional study was employed to evaluate the structure, process and function of six major hospitals with emergency units: four major hospitals in Baghdad and two in Mosul. Results: The six surveyed emergency units are distinct units within general hospitals that serve (collectively) one quarter of the total population. More than one third of these units feature observation unit beds, laboratory services, imaging facilities, pharmacies with safe storage, and ambulatory entrance. Operation room was found only in one hospital's reception and waiting area. Consultation/track area, cubicles for infection control, and discrete tutorial rooms were not available. Patient assessment was performed (although without adequate privacy). The emergency specialist, family medicine specialist and interested general practitioner exist in one-third of the surveyed units. Psychiatrist, physiotherapists, occupational therapists, and social work links are not available. The shortage in medication, urgent vaccines and vital facilities is an obvious problem. Conclusions: Our emergency unit's level and standards of care are underdeveloped. The inconsistent process and inappropriate environments need to be reconstructed. The lack of drugs, commodities, communication infrastructure, audit and training all require effective build up.

Hydatid disease is an important zoonotic disease with a worldwide distribution. In the Middle East, as well as in some other parts of the world, it has always been a serious economic and public health problem. The disease is endemic and enzootic in Iraq. In Iraq, the disease is caused by Echinococcus granulosus but a multilocular hydatid cyst of E. multilocularis has been recovered from the liver of a woman in Erbil, North Iraq. This paper documents the second case of hydatid disease caused by E. multilocularis, this time reported in Basrah, Southern Iraq.

Blood samples were collected from 30 women with age ranged from 27–70 years after 3 cycles of chemotherapy. Sera were used for IgA, IgG, IgM, C3, C4, IL-6 and TNF-α estimation. After 3 cycles of chemotherapy, all the immunological parameters reduced except TNF-α. Patients who developed disease reoccurrence after chemotherapy exhibit a significantly higher IgA, C3, IL-6 and TNF-α levels after 3 cycles of chemotherapy than patients who did not (p < 0.05). Therefore, serum IgA, C3, IL-6 and TNF-α can be used as predictors for breast cancer reoccurrence.

Background and objectives: Vitamin D deficiency is very common in pregnant women. Deficiencies have been prevalent even in studies where over 90% of the women took prenatal vitamins. The current guidelines for vitamin D intake during pregnancy of 200–400 IU has little scientific support and has been recently challenged. We conducted this study to determine the prevalence of vitamin D deficiency among pregnant women and to evaluate the effectiveness and level of weekly oral 50,000 IU of vitamin D supplementation for the mother and the newborn. Setting and design: Prospective study at Hamad Medical Corporation outpatient unit and delivery room. Patients and Methods: Ninety seven pregnant women were recruited in their first trimester between December 2007 and March 2010. Weekly oral vitamin D (50,000 IU) were prescribed after an initial testing for serum level of 25-hydroxyvitamin D, parathyroid hormone, calcium, phosphorus, total protein and albumin. Other multivitamins supplementations were allowed during pregnancy. The same tests were repeated at each trimester. Umbilical cords vitamin D levels were determined at birth. Results: Out of 97 patients, 8 patients dropped out from the study for several reasons, and 19 patients had pregnancy loss. Data were available for 97 women in the first trimester, 78 women in the second trimester and 61 women in the third trimester. The mean level of vitamin D level in the first trimester and prior to starting vitamin D supplementation was 17.15 ng/ml, 29.08 ng/ml in the second trimester, 27.3 ng/ml in third trimester and 22.36 ng/ml in newborns. There were no toxic levels of vitamin D in any of the women at the second or third trimesters or in the newborns. The mean levels of vitamin D in the second and third trimester were not significantly different in those women who were taking multivitamin supplementation and those who were not. Conclusion: Weekly doses of 50,000 vitamin D during pregnancy maintains acceptable vitamin D level during pregnancy and the newborn's vitamin D level correlates with the mother's levels.

Giant cell tumor of the bone (GCTOB) is a relatively uncommon tumor of the bone. It is characterized by the presence of multinucleated giant cells. Giant-cell tumor of the bone accounts for 4-5% of primary bone tumors and ∼20% of benign bone tumors. Giant cell tumors of the hand are rare, accounting for only 2–4% of all giant cell tumors.

Giant cell tumor (GCT) of the bones of the hand has some special features as compared to GCT at other sites. Because of the aggressive nature of this lesion, adequate assessment of the treatment method is required.

The aim is to eradicate the disease but preserve as much hand function as possible. Methods of treatment include curettage with or without bone grafts, local resection possibly combined with reconstruction using homologous or autologous bone, amputation, and resection of one or more rays.

Background: Tracheal stenosis is more frequent as a result of wide-spread use of endotracheal intubation and tracheostomy. Resection and tracheal reconstruction remain the treatment of choice in benign tracheal stenosis. Objectives: To report our experience in Basra and to identify the result of anastomosis after tracheal resection and management of those patients preoperatively and postoperatively. Methodology: A descriptive study of sixteen patients (aged 11–28 years, 10 male and 6 female) with tracheal stenosis who underwent tracheal resection and reconstruction in Basrah thoracic unit (Basra teaching hospital) from January 2008 to January 2011. Results: The result was excellent in 62.5%, good in 25%, and satisfactory in 12.5%. Postoperative complication occurred in 25% and treated successfully with no mortality. Follow-up was every 3 months for an average of 3.6 years. Conclusion: Resection and tracheal reconstruction is the treatment of choice in benign tracheal stenosis and achieved excellent results in management of the patients.