Qatar Medical Journal - Volume 2014, Issue 1

Late cancellations of scheduled elective surgery limit the ability of the surgical care service to achieve its goals. Attributes of these cancellations differ between hospitals and regions. The rate of late cancellations of elective surgery conducted in Hamad General Hospital, Doha, Qatar was found to be 13.14% which is similar to rates reported in hospitals elsewhere in the world; although elective surgery is performed six days a week from 7:00 am to 10:00 pm in our hospital. Simple and systematic analysis of these attributes typically provides limited solutions to the cancellation problem. Alternatively, the application of the theory of constraints with its five focusing steps, which analyze the system in its totality, is more likely to provide a better solution to the cancellation problem. To find the constraint, as a first focusing step, we carried out a retrospective and descriptive study using a quantitative approach combined with the Pareto Principle to find the main causes of cancellations, followed by a qualitative approach to find the main and ultimate underlying cause which pointed to the bed crisis. The remaining four focusing steps provided workable and effective solutions to reduce the cancellation rate of elective surgery.

Epidermoid cysts, true dermoid cysts and teratoid cysts compose the spectrum of cystic teratomas, which are defined as neoplasms whose tissue are derivatives of more than one germ layer, foreign to that part of the body from which the tumor arises. Epidermoid cysts of the floor of the mouth are rare lesions and are much less common than dermoid cysts in the head and neck. This case reports a 43-year-old male patient who presented with a longstanding midline swelling in the submental region. Initial imaging was done using ultrasound followed by computed tomography (CT) scan. Biopsy was taken and revealed a cyst wall lined with epidermal squamous epithelium along with areas of focal ulceration suggesting chronic inflammatory changes of the wall of the epidermoid cyst.

There are characteristic and even pathognomonic imaging features of epidermoid cysts at the floor of the mouth in ultrasound and CT scan. Imaging has an important role in the surgical management plan according to the size and location of the cyst in relation to geniohyoid and mylohyoid muscles.

Background: Screening for colon cancer aims at early detection and prompt treatment of the disease. Prior knowledge of the disease will contribute to increased participation. However, barriers to performing screening are not known. Methods: A survey using a questionnaire was presented to patients attending the Outpatient Department of a tertiary hospital in the Western Region of Saudi Arabia, to evaluate the background knowledge of colon cancer screening, the diagnostic methods used for that purpose, and the barriers that may resist the implementation of screening. Results: Six hundred and nineteen questionnaires were distributed. Completed questionnaires that were included in the final analysis numbered 321 (51.9%). Age and gender had no statistically significant association with increased awareness of screening options (p = 0.526 and p = 0.2). However, education played a significant role (p = 0.045). Among the group that agreed to undergo screening, there were 55.3% who were willing to undergo colonoscopy or sigmoidoscopy. Contrary to that, among the group that did not agree to undergo screening, 77.4% of them would undergo radiological screening using barium enema and/or a computed tomography (CT) scan of the abdomen. Conclusion: There is a deficiency of knowledge of colorectal cancer (CRC) screening influenced by an individual's level of education, yet unrelated to age or gender. The endoscopic modality was usually chosen by individuals who were aware of CRC screening. However, the fear of undergoing this investigation, for the same reason, would likely make them decide to choose less invasive testing, using barium enema or a CT of the abdomen.

الوعي العام بفحوصات الكشف عن سرطان القولون بين عامة السكان دراسة من المنطقة الغربية في المملكة السعودية العربية

الملخص

الأهداف: يهدف الكشف المبكر عن سرطان القولون إلى التعرف على المرض وعلاجه مبكرًا. وتسهم المعرفة المسبقة بالمرض في تحسين المشاركة في الفحص وزيادة فاعليته. ولكن العوائق التي تمنع مشاركة الناس في الفحص المبكر غير معلومة.

الطريقة: أجريت استبانة للمرضى في قسم العيادات الخارجية بأحد المستشفيات المرجعية في المنطقة الغربية من المملكة العربية السعودية لتقييم معلوماتهم العامة حول الفحص المبكر عن سرطان القولون، وطرق التشخيص المستخدمة لهذا الغرض, وكذلك معرفة العوائق التي قد تمنعهم من المشاركة فيه. النتائج: وزعت 619 استبانة, ولم يتضمن التحليل النهائي سوى الاستبانات المكتملة بشكل يتوافق مع متطلبات البحث وعددها 312 (51,9%). لم يكن للعمر أو الجنس أي دلالة إحصائية مرتبطة بزيادة الوعي (p = 0.526 وp = 0.2)، وذلك بعكس المستوى التعليمي الذي أظهر ارتباطًا وثيقًا بزيادة الوعي والاهتمام بإجراء الفحص المبكر للقولون (p = 0.045). اتضح أنه من بين المجموعة التي وافقت على المشاركة في إجراء الفحص، أبدى 55,3 % استعدادهم لإجراء منظار القولون أو المستقيم. بينما أظهرت النتائج أن 77,4 % من المجموعة التي رفضت المشاركة في الفحص، يفضلون إجراء الفحص الإشعاعي باستخدام حقنة الباريوم و/أو التصوير المقطعي للبطن كوسيلة للفحص المبكر. خاتمة: يوجد نقص في الوعي والمعرفة العامة بفكرة الفحص المبكر لسرطان القولون والمستقيم، ويرتبط ذلك بالمستوى التعليمي ولكن لا صلة له بعاملي العمر أو الجنس. المعرفة المسبقة بالفحص المبكر ترتبط إيجابًا باختيار التنظير كوسيلة للفحص، إلا أن الخوف من الخضوع لذلك الفحص، رغم المعرفة المسبقة به، قد يجعل المرضى يختارون وسائل أقل توسعًا، مثل حقنة الباريوم أو التصوير المقطعي للبطن.

Background: We conducted a retrospective cohort study to evaluate the clinical manifestations, laboratory findings, complications and treatment of brucellosis in the State of Qatar. Methods: The medical records of patients in Hamad Medical Corporation, Doha, Qatar were reviewed from January 2000 to December 2006. History, various socio-demographic features, clinical and biochemical parameters, therapeutic features, and complications were retrospectively collected from the patient database. Results: Around three quarters of the study population were males. History of raw milk consumption and animal contact were seen in 41.7% and 12.5% respectively. The main presenting features of our cohort were fever, chills and sweating (93.1%, 62.5% and 58.3% respectively). Positive antibody titre (>1:160) was detected in 95.8% and positive blood culture was reported in 63.9% of the cohort. Splenomegaly was observed in 19.4%, hepatomegaly in 15.3% and lymphadenopathy in 9.7% of the cases. Approximately half of our patients were treated with a combination of doxycycline and streptomycine and nearly one quarter received doxycycline and rifampicine combination therapy. Conclusions: Brucellosis is an important public health problem worldwide. It is associated with significant morbidity and mortality. It may affect any organ system and can present with a variety of clinical features. Diagnosis of brucellosis requires serological tests with or without blood culture. Treatment with at least two antibiotics for six weeks or more appears to be effective.

Background: The aim of this work was to analyse the past trends of biomedical and cancer publications from Qatar listed on PubMed for the years 2000–2012. These findings were then compared with the corresponding global number of publications. Methods: PubMed was searched for cancer publications, clinical trials, publications on humans or other species. Searching for “Qatar*” in the “Affiliation” field yielded the lowest number of publications; searching for “Qatar*” in the “Affiliation” or in “Title/Abstract” yielded a moderate number of results and searching for “Qatar*” in the “Affiliation” or “Title/Abstract” or “Text Word” fields yielded the highest number of publications. The annual percentage change (APC) from one year to the next was calculated for the population and each type of publication. Information on the population of Qatar was gathered from the website of Qatar Statistics Authority to determine the correlation of papers published per 1000 population. Results: The number of publications retrieved from PubMed was not particularly different for each variation of search carried out. However, the most representative number of publications was retrieved upon searching for “Qatar*” in the “Affiliation” or in “Title/Abstract” fields. Between the years 2000 and 2012, the total number of biomedical publications from Qatar increased 24 times with an average APC of 33.4%, which was found to be more than the APC of the population in Qatar which averaged at 9%. The number of biomedical publications per 1000 population increased from 0.02 in 2000 to 0.15% in 2012. Most publications retrieved were humans studies and occasionally were for other animal species. Cancer publications in Qatar represented 16.9% of the total publications and the number of cancer publications per 1000 population increased from 0% in 2000 to 0.02% in 2012. Publications classified as clinical trials represented 4.6% of Qatar biomedical publications. Publication of cancer clinical trials were very rare (0.4%). Conclusions: Despite the obvious increase in Qatar biomedical and cancer publications in PubMed, the absolute numbers were relatively small. While strategies are in place, leaders of Qatar biomedical research need to consider increasing cancer research and clinical trials to meet the country's needs. Linking research output to researchers, research facilities and research funding is needed.

Background: The prevalence and severity of cancer pain in the outpatient palliative care (PC) setting have not been explored previously in Saudi Arabia (SA). Exploration of this basic information may help in evaluating pain severity in patients new to PC as compared to those with previous PC exposure. Objective: This paper aims to determine the prevalence and severity of cancer pain among new and follow-up patients attending a PC outpatient clinic. Methods: In a PC outpatient setting in a major tertiary hospital in SA, we interviewed adult patients with cancer during their attendance to the clinic. Patients were requested to score the severity of their pain on a 0 to 10 numerical scale. Results: A total of 124 patients were interviewed, of whom 73 (59%) were females. The majority of patients (82.3%) had metastatic disease. The most common cancers were breast (27.4%) and head and neck (15.3%). The majority of patients (85.5%) reported pain, with a median intensity score of 5 and a mean of 4.6. Of those who reported pain, 54 (51%) scored above 4. The mean pain score did not differ between groups of patients according to various characteristics such as age, sex, performance status, type of cancer or encounter type. Conclusion: Pain is a prevalent symptom in new and follow-up cancer patients seen in a PC outpatient setting in SA. Further research on a larger scale is needed to evaluate the magnitude of the problem more comprehensively with emphasis on detailed pain assessment and exploration of the adopted management approaches.

Enteric fever is a systemic illness with varying presentation. It is an important infectious disease in developing countries and also in industrialized countries where many migrants reside. Enteric fever can result in complications in different organ systems and delay in identification and prompt treatment can be fatal. The important gastrointestinal complications of enteric fever include hepatitis, intestinal ulcers, bleeding and bowel perforation. We report three relatively uncommon complications of enteric fever in Qatar, a non-endemic country, ileal ulcer presenting with hematochezia; duodenal ulcer with polyserositis, cholestatic hepatitis and bone marrow suppression; enteric fever related peritonitis.

Public health surveillance systems should be evaluated periodically, and should involve an assessment of system attributes. Objective: Evaluate hospital-based surveillance of communicable diseases using the elements of timeliness and data quality. Method: Descriptive study was conducted of communicable diseases reported at The Cuban Hospital, Qatar during January 2012 to December 2013. The completeness of notifications were assessed for contact number, address, place of work, and date of symptom onset. Time between the symptoms onset and physician notification, time between physician and Supreme Council of Health notification and time between physician notification and lab confirmation were calculated for each case. Analysis: Percentage of cases with documented essential information and 95% confidence interval (CI) were determined. Mean and standard deviation (SD) of time were calculated. Results: 1065 patients were reported, 75% were male, 80% non-qataries and 91.5% were group 1 (high priority) diseases. Symptom onset date was documented in 91.5% (95% CI, 89.8; 93.2) of cases; contact number in 84.7% (82.5;86.8), with lower frequencies for address (68.1%, 65.3;70.9) and place of work (60.5%, 57.5;63.4). Diagnostic time for tuberculosis was 61.7 days (SD 93.0), acute hepatitis 18.5 days (SD 17.6), typhoid fever 17.0 days (SD 11.6 days), other diseases of sexual transmission 300.2 days, chronic hepatitis 165 days and AIDS 154.5 days. The time of notification to the Supreme Council of Health for group 1 diseases was 1.2 days (SD 1.4). Conclusion: Our results show that the quality of essential data and timeliness is not sufficient to meet the needs of the health system. Additional studies should focus on the evaluation of time delay for diagnosis of high priority diseases.

Isolated sphenoid sinus lesions are an uncommon entity and present with non-specific symptoms. In this case report, the patient presented with a history of headaches for a duration of one month without sinonasal symptoms. A computed tomography scan showed a soft tissue mass occupying the sphenoid sinus. An endoscopic biopsy revealed fungal infection. Endoscopic wide sphenoidotomy with excision of the sphenoid sinus lesion was then performed however, the microbiological examination post-surgery did not show any fungal elements. Instead, Citrobacter species was implicated to be the cause of infection.

Disseminated herpes simplex virus (HSV) infection during pregnancy is a rare, but potentially fatal condition. We present a case where prompt treatment with intravenous acyclovir resulted in a successful outcome for both mother and baby.