Qatar Medical Journal - Volume 2015, Issue 2

Background: Research on the attitudes of Saudi adults towards consanguinity is scarce. The study aimed to explore the attitudes towards consanguinity and its associations with socio-demographic characteristics in a sample of Saudi adults. Methods: A cross-sectional study was conducted using a self-administered questionnaire. A total of 386 outpatient waiting-area attendees at King Abdul-Aziz Medical City-Riyadh were included. Participants were asked about their socio-demographic characteristics, attitude towards consanguinity and the reasons behind this. Results: The positive attitude towards consanguinity among the study respondents was 48.1% with 95% confidence interval (42.91–53.33%). Social and traditional culture (59.9%) were found to be the predominant reasons for favoring consanguinity in Saudi Arabia. Evidence against a positive attitude towards consanguinity was noted in respondents who received medical information about consanguinity versus those who had not received medical information (42.3% vs. 57%, p-value = 0.008). According to the multivariate logistic model, the odds of a positive attitude towards consanguinity were 2 times higher for males (adjusted odds ratio [aOR]: 2.2; 95% CI: 1.147, 4.290) and 4.1 times higher in respondents in consanguineous marriages (aOR: 4.1; 95% CI: 2.350, 7.156). The odds of a positive attitude towards consanguinity were 50% less in respondents who received health information on consanguinity compared to those who had not received health information about consanguinity (aOR: 0.50; 95% CI: 0.253, 0.863). Conclusion: One in every two Saudi adults favors consanguinity however, Saudi men and women differ in their attitudes towards consanguinity. Receiving health information on consanguinity was associated with a negative attitude towards this practice.

Osteoporosis is a disease that affects the bones. It leads to increased risk of fractures as a result of decreased bone mineral density. The goal of this study was to assess the general perception of osteoporosis as well as knowledge of lifestyle, risk factors, and preventive measures among patients in Qatar. The study was conducted between September 2013 and September 2014. The study subjects (n = 93) were patients diagnosed with osteoporosis who attended the Outpatient Rheumatology Clinic at Hamad General Hospital in Doha, Qatar. The results showed that those with a university or graduate degree had a significantly higher level of knowledge about osteoporosis (p = 0.009) than those with less education. Among those in our study, knowledge related to osteoporosis was principally obtained through media sources such as television and radio (39%). In conclusion, osteoporosis patients in Qatar need a better understanding of the disease. Identifying thought patterns related to the perception of osteoporosis and treatment might assist in building a foundation for management modalities and effective preventive strategies for the disease in Qatar.

Background: Sickle cell anemia (SCA) is an inherited blood disease with known complications as a result of certain pathophysiological dysfunctions. It has been suggested that an increase in oxidative stress contributes to the incidence of these changes. Objectives: This study investigated the oxidant/antioxidant status of patients with SCA, and evaluated the effect of SCA on antioxidant enzymes and their cofactors. Methods: The study included 42 patients with SCA (in steady state), and a control group of 50 age-matched individuals without SCA. Serum malondialdehyde (MDA), copper, zinc, ferritin and iron levels, red blood cell (RBC) superoxide dismutase (SOD) and catalase levels were measured for the SCA and control groups. Results: Significantly lower levels of antioxidant enzymes (RBC SOD and catalase) and higher serum MDA levels (biomarker of oxidative stress) were found in SCA patients compared to the control group (all p < 0.001). Increased levels of serum ferritin, iron and copper and decreased zinc concentrations were also found in the SCA patients compared to the control group (all p < 0.001). In the SCA group, there were significant negative correlations between MDA levels and RBC SOD, RBC catalase, and serum zinc levels (p < 0.01), while a significant positive correlation between MDA with serum copper and iron levels (p < 0.01) was observed. Conclusion: SCA is associated with alterations in markers of oxidative stress including an increased MDA level, decreased antioxidant enzyme levels, and altered levels of enzyme cofactors (zinc, copper, and iron). This suggests that these antioxidant enzymes could be used as effective therapeutic targets for the treatment of this disease and supplementation of patients with substances with antioxidant properties may reduce the complications of this disease.

Primary headache disorders account for the majority of the cases of headache. Nevertheless, the primary objective of a physician, when encountered with a patient with headache is to rule out a secondary cause the headache. This entails a search for specific associated red-flag symptoms or signs that may indicate a serious condition, as well as a heightened suspicion of and evaluation for a don't miss diagnosis.

We present a case of a high-school student whose first manifestation of systemic lupus erythematosus (SLE) was a headache due to cerebral venous and sinus thrombosis, initially misdiagnosed as tension-headache and ‘ophthalmoplegic migraine’ (now known as ‘recurrent painful ophthalmoplegic neuropathy’). The patient made a complete neurological and radiological recovery after systemic anticoagulation and treatment of SLE. An analysis of the clinical errors and cognitive biases leading to delayed referral to hospital is presented. We highlight the fact that adherence to the fundamental principles of clinical medicine and enhancement of cognitive awareness is required to reduce diagnostic errors.

Background: Multivessel cervical dissection with cortical sparing is exceptional in clinical practice. Case presentation: A 55-year-old man presented with acute-onset neck pain with associated sudden onset right-sided hemiparesis and dysphasia after chiropractic manipulation for chronic neck pain. Results and Discussion: Magnetic resonance imaging revealed bilateral internal carotid artery dissection and left extracranial vertebral artery dissection with bilateral anterior cerebral artery territory infarctions and large cortical-sparing left middle cerebral artery infarction. This suggests the presence of functionally patent and interconnecting leptomeningeal anastomoses between cerebral arteries, which may provide sufficient blood flow to salvage penumbral regions when a supplying artery is occluded. Conclusion: Chiropractic cervical manipulation can result in catastrophic vascular lesions preventable if these practices are limited to highly specialized personnel under very specific situations.

Introduction: Filariasis is an endemic disease with worldwide distribution in tropical and subtropical regions. It is uncommon in Qatar. The conventional diagnostic procedure is the demonstration of microfilaria in blood smears. Even with its high incidence, it is unusual to detect microfilaria in fine needle aspiration cytology (FNAC) smears. Although the ‘filarial dance sign’ is rarely documented, it remains a classical ultrasonographic sign in lymphatic filariasis. Case presentation: We present a case of a 38-year-old male patient with fever, chills, shortness of breath and a tender warm swelling on his right thigh. Ultrasound of the thigh lesion showed the classical filarial dance sign. Subsequently FNAC from the lesion documented microfilaria in spite of absent peripheral blood eosinophilia and microfilaria. The patient underwent an incision and drainage of the thigh lesion and was treated with ivermectin and diethylcarbamazine. He was subsequently admitted to the medical ward and discharged home after two weeks in a stable condition. Conclusion: This case report illustrates the importance of diagnostic tools like ultrasound and FNAC along with a high index of clinical suspicion while evaluating patients presenting with unusual signs and symptoms. We would like to highlight the rarity of filarial presentation in a nonendemic country like Qatar. This case is unique since microfilaria was demonstrated in the pus aspirated from the thigh abscess and showed the filarial dance sign by ultrasound along with involvement of the pleura and pericardium.

Background: The exacerbation of chronic obstructive pulmonary disease (COPD) is a major factor for the high mortality associated with the disease. There is a paucity in the lung-specific biomarkers which diagnose these exacerbations. Surfactant protein D (SP-D) is a promising biomarker in predicting clinical outcomes for patients with COPD, is lung-specific and can be detected in serum. However, the profile in which serum concentrations of SP-D change during acute exacerbation is still unclear. This study aims to estimate and compare the concentrations of serum SP-D in patients with stable disease and during the exacerbation. Methods: A cross-sectional study was conducted which composed of apparently healthy individuals (n = 28), which included 14 smokers and 14 nonsmokers, patients with stable COPD (n = 28), and patients experiencing acute exacerbations (n = 28). Pulmonary functions were performed for all groups. Serum SP-D concentrations were measured using enzyme-linked immunosorbent assay (ELISA). These concentrations were compared by analysis of variance. Results: Serum SP-D levels were significantly elevated in patients with acute exacerbations (508.733 ± 102.813 ng/ml) compared to patients with stable COPD (337.916 ± 86.265 ng/ml) and healthy subjects (177.313 ± 46.998 ng/ml; p <  0.001). Serum SP-D levels correlated inversely with lung function parameters including FEV1%pred, FVC%pred and FEV1/FVC. Conclusion: Serum SP-D levels are raised early on during acute exacerbations of COPD, which could be a potential early diagnostic biomarker for COPD exacerbations.

We describe an elderly gentleman with end stage renal disease on haemodialysis who presented with ophthalmic zoster infection and was discharged on oral acyclovir. He presented again a few days later with confusion and expressive dysphasia. Differential diagnosis was mainly between varicella-zoster virus (VZV) associated encephalitis versus acyclovir toxicity. Cerebrospinal fluid analysis confirmed the diagnosis of VZV associated encephalitis and the patient was treated with intravenous acyclovir and steroids with full recovery back to pre-admission neurological status.