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- Volume 2006, Issue 2
Qatar Medical Journal - Volume 2006, Issue 2
Volume 2006, Issue 2
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Ibn Khaldun (Abd A1 Rahman Ibn Mohammad) (1332-1395 AD)
More LessAbd A1 Rahman Ibn Mohammad known as Ibn Khaldun, was born in 1332 AD to Yemenite Arab parents who had migrated to Tunisia from muslim Spain to escape the inspection courts that were set following the fall of Seville. In Tunisia he received his early education and while still in his teens he entered the service of the Egyptian ruler, Sultan Barquq. This he soon left for Fez in Morocco in the hope of finding a more learned environment.
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Notes For Contributors
A apers considered for publication in Qatar Medical Journal are those reporting original work, review articles and case reports that are partic
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Can the Central Sympathetic Blockade Profile be Advantageous in the Management of Patients with Metabolic Syndrome?
More LessMetabolic syndrome, the association of obesity, hypertension and hyperlipidaemia in conjunction with impaired glucose tolerance or frank diabetes, is a rising global pattern and has been subjected to a useful consensus re-definition in recent months. Its origins are fixed in changing dietary and activity patterns across the developed world but also increasingly affecting all developing economies. The obvious sequelae of this spiraling pattern are increases of atherosclerotic vascular disease and subsequent occlusive vascular events, morbidity and premature mortality for affected patients. Given its emerging importance we should consider carefully the role of the sympathetic nervous system in the overlapping management of the pathophysiology of obesity and hypertensive vascular disease; the recognition of the metabolic syndrome and its definition in practice; and whether new trial results pertinent to managing hypertension in the overweight patient with metabolic syndrome using the central imidazoline antagonist drug, moxonidine, might prompt reconsideration of this established strategy for lowering blood pressure.
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Usefulness of Cytokeratin CK7 and CK20 in the Diagnosis of Barrett's Esophagus (BE)
Authors: G. C. Ejeckam, A. Chong-Lopez, C. R. Jyothi, S. Al Kaabi and N. El DweikDiagnosis of BE is hinged on the presence of intestinal metaplasia (IM) and inflammation in the lower esophagus. However IM can occur in the cardia and lower esophagus following reflux and helicobacter infection. The special stain for demonstrating intestinal metaplasia cannot distinguish IM in BE and that in cardia or lower esophagus due to other causes(1). Quite often biopsies labeled lower esophagus by the endoscopist may in fact be from the cardia especially in cases where the gastro-esophageal junction is indistinct.
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Urinary Tract Injuries During Caesarean Section
Authors: W. Dauleh, M. Al Sakka and M. ShahataA retrospective review of obstetric urinary tract injury in Hamad Medical Corporation (HMC) from January 1994 to December 2004 identified 16 cases from 21,337 Caesarean Sections. Diagnosis of bladder injury was immediate but of uretric injury was often delayed. Although the injury rates are lower than previously reported in the literature, 0.0016%-0.94% and 0.029%-0.09% for bladder and uretric injuries respectively compared to 0.07 and 0.01 for bladder and uretric injuries in Qatar; a previous caesarean section still represents the most common predisposing factor for intra-operative bladder injury (17 cases; 0.08%) while only one such injury occurred in a primary caesarean section (0.0047%).
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Prevalence of Human T-Lymphotropic Virus (HTLV) Antibodies Among the Donor Population in the State of Qatar
Authors: Z. O. Fawzi, A. Al Malki and H. Al MutawaTo determine the prevalence of antibodies to HTLV-1 & II among the donor population in Qatar and to evaluate the relevance of continuing routine pretransfusion screening of all donations for HTLV-I& II we surveyed all the results of the screening tests performed on 124,266 donations collected in the period August 1991 to the end of January 2004. All donations were screened by ELISA based assays and all donors who tested positive were recalled for repeat ELISA testing and confirmatory testing by Western-Blot (WB). Two hundred and sixty nine donors tested positive for HTLV-I/HTLV-II antibodies by ELISA but only 81 donors could be retrieved for confirmatory testing. On repeat ELISA testing 27 donors gave negative reactions; the remaining 54 were still positive and were tested by WB. Of those, 22 were confirmed positive by WB, 20 were WB negative while the remaining 12 donors gave an indeterminate WB pattern. Only one of the 22 W-B confirmed positive was a Qatari national The remaining 21 were non-Qatari donors belonging to various nationalities.
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Histopathological Changes in the Gastric Mucosa with Long-term Use of a Percutaneous Gastrostomy Tube (PEG)
Authors: M. Derbala, N. Al Dweik, F. Pasic, S. Al Kaabi, M. T. Butt and A. LopezOf 95 randomly selected patients using a percutaneous gastrostomy tube (PEG), 20 required tube replacement at least six months after the initial placement In order to study the possible histopathological changes that might develop in the gastric mucosa with the prolonged use of PEG, gastric biopsies were taken during the replacement procedure. The overall procedure-related minor complication rate was 16.84%; the predominant complication was superficial peristomal wound infection. Other minor complications were tubal migration into the small bowel, surgical emphysema and stomal leak. Histopathological changes seen in six patients showed mild chronic nonspecific gastritis, the predominant cells being lymphocytes and plasma cells. There was no dysplasia or metaplasia. PEG is a safe method of feeding that does not predispose to significant gastric mucosal changes with long-term use. It has a low rate of morbidity even with markedly debilitated patients
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The Outcome of Pregnancies Associated with Intrauterine Contraceptive Devices
Authors: B. Ahmed, S. Ghaffari, M. Abushama, A. Gamal and A.L. AshmagIn this retrospective study we sought to determine the outcome of pregnancies associated with intrauterine contraceptive devices. Medical records of2000 women, who used IUCD, were reviewed in detail. All IUCDs were inserted either post menstrual, post delivery or post miscarriage. 1196 (60%) IUCDs were inserted by doctors and the remaining 804 (40%) by midwives. The cohort was divided to four groups on the basis of their age. There were 300, 950, 300 and 450 women in 18-22,23-27,28-32 and 33-37 years groups respectively. They were also divided to three groups on the basis of their parity with 300 Para 1 women, 1100 Para 2-4 women and 600 Para 5 or more. 37 (1.85%) unintended pregnancies occurred, including 35 intrauterine pregnancy and 2 ectopic pregnancies. 9 (3%) of these pregnancies occurred in 18-22 year group, 16 (1.68%) in 23-27 age group, 8 (2.67%) in 28-32 age group and 4 (0.89%) in 33-37 age group (Fig. 1). 19 (1.59%) of the pregnancies occurred in women whose IUCDs were inserted by medical staff and 18 (1.51%) in those whose IUCDs were inserted by midwives. The outcome of intrauterine pregnancies included 19 (51%) term pregnancies, 9 (24%) miscarriages, no septic abortions, 7 (19%) Preterm labour including 2, 26-28 weeks and 5 29-32 weeks. No puerperal sepsis or congenital abnormalities were reported (Fig. 2).
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The Time of Reactivation of Tuberculosis in Expatriates in the State of Qatar
Authors: M. Al Marri, L. Al Hail, S. Al Otaibi and N. D. Al MarriObjective: This is the first study to evaluate the time of reactivation of tuberculosis (TB) in the expatriates after the application of a screening program in 1984.
Method: Follow up analysis of expatriates who arrived in the State of Qatar in 1993. The number of expatriates, as well as the date of possible death and deportation was identified from the medical commission registry and the State of Qatar Central Statistical Organization. The rate of notification was obtained from the tuberculosis treatment unit registry.
Results: There were 32,134 applicants of which 23,842 (74.2%) were from the Indian subcontinent and Southeast Asia. The rest were from different parts of the world. Males account for 64.4% of the applicants. On arrival 669 (2.08%) applicants were found to be unfit, of which 67 (0.21%) were unfit due to tuberculosis and the rest for reasons other than tuberculosis. Active tuberculosis was found in 55 (0.17%). Tuberculosis notification rate declined from 0.17% on arrival to 0.03% in the first twelve months. This was followed by an increase to a mean of 0.05% for the next two years, then decreased to a mean of 0.025% over the next three years.
Conclusion: The first 5years of arrival still a high risk for reactivation ofTB in the expatriates even though they have normal screening test on arrival. It is possible to improve this control of TB among high prevalence expatriates by application of preventive health care measures such as Mantoux skin testing, preventive therapy, and / or BCG vaccination for those aged under 30.
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Histiocytic Necrotizing Lymphadenitis (Kikuchi-Fujimoto Disease): A study of 14 cases from Qatar
Authors: H. Al Soub, I. Al Bosom, Y. El Deeb, M. Al Maslamani and J. Al KHuwaiterTo define the demographic, clinical and laboratory features, and outcome of patients with Kikuchi-Fujimoto disease in Qatar and to compare it with those reported by others, fourteen cases of Kikuchi-Fujimoto disease seen at Hamad Medical Corporation between 1995 and 2004 were reviewed retrospectively. Unusually there was an unexplained male predominance amongst the ten males and four females even amongst the Qatari nationals who comprised 57% of the cases. All had lymphadenopathy, mostly cervical, and less commonly fever; anorexia, chills, weight loss, hepatomegaly, and skin rash. The diagnosis was made by lymph node biopsy, with no indication of any etiologic agent All patients survived although symptomatic treatment with non-steroidal anti-inflammatory drugs and steroids was required in five patients. There was recurrence in two patients. It seems that Kikuchi-Fujimoto disease is rare in Qatar although the incidence might be increasing possibly due to greater awareness amongst clinicians. The clinical features are similar to those reported by others but certain diagnosis requires lymph node biopsy. The outcome is good.
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Assessment of Knowledge and Practice of Primary Health Care Physicians Regarding Bronchial Asthma in Qatar
Authors: S. Flamerzi, A. Abdulmajeed, M. Abdulmalek and S. Al MarriIntroduction: Previous studies from other countries that have investigated the level of knowledge of bronchial asthma and competence of primary care physicians in management issues concluded that there is a substantial variation among general practitioners in both their knowledge and management practices. There is no such study conducted in Qatar; therefore, we have conducted assessment for PHC physicians for further educational interventions that improve their quality of care for asthmatic patients.
Subjects and Methods: It is a cross sectional observational study. Our target population was the PHC physicians working in PHC centers affiliated to Hamad Medical Corporation in Qatar. Of the 21 centers present in Qatar; we selected 3 urban and 3 rural centers randomly. The total number of physicians who attended the evaluation setting was 55 (30 urban and 25 rural physicians). The evaluation format was of three groups of questions to collect data for evaluation of knowledge and practice. Previously validated 30 MCQ questions were used to evaluate knowledge and 2 written problems were used to evaluate the practice. 50% and 60% were the cut of point to pass the evaluation for knowledge and practice respectively. Epi-Info statistical package was usedfor data entry and statistical analysis.
Results: the percentage of physicians who passed the knowledge evaluation was 44% of the total number ofphysicians while 37% only of them passed the practice assessment. Age (p = 0.04), nationality (p = 0.003), specialty (p = 0.00), last certificate (p = 0.00), and No of years since graduation (p = 0.00) were significant variables in passing the knowledge test while age (p = 0.018), specialty (p = 0.00), and last certificate (p = 0.00) were significant variables in passing practice test. Regarding source of information about asthma, 96.7% of urban physicians reported that their main source is conferences and meetings while 84% of rural physicians using textbooks as their main source of information (p = 0.02). 80% of urban physicians versus 48% of rural doctors felt that they need more knowledge and training in asthma diagnosis and management (p = 0.00) while 73.3% of urban physicians recommended more CME seminars to improve their asthma practice and 64% of rural physicians recommended standard guidelines (p = 0.04).
Conclusion: this study addresses areas of weakness that might be a stimulus to design a tailored educational interventions in order to improve the PHC physician's knowledge and practice of asthma.
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Malaria Cases Presenting at Hamad General Hospital in Doha-Qatar 2000-2002
By F. Y. KhanImported malaria is increasing in nonendemic countries, including the State of Qatar, mainly as a result of the influx of immigrant workers. A retrospective chart review of 153 malaria cases identified at Hamad General Hospital during 2000-2602 is used to emphasise the scale of the problem especially the need to create greater public awareness that travellers to malarious areas must take suitable precautions including appropriate chemoprophylaxis.
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Rapid Identification of Streptococcal Pharyngitis
Authors: B. H. Shaheen and A. T. HamdanAcute pharyngitis is one commonest reasons for patients to visit the family physician, 80-90% of cases are caused by viruses particularly adenovirus. The most important bacterial cause is group A streptococcus, which is responsible for about 15% of all cases. Because of the time required to confirm the presence of group A streptococci using throat cultures many commercial antigen detection tests for the rapid identification of group A streptococci directly from throat swabs have been developed utilizing the latex agglutination principle and a result is available within 5 minutes.
Objective: The purpose of this study was to determine the value of using rapid detection procedure (Reveal color strep A test, Murex) for group A streptococci directly from throat swabs.
Material and Method: Data from 200 patients with sore throat attending one of the Public Medical Centers in Amman over 6 month period May 1998-January 1999. Both throat swabs and cultures were taken and throat swabs were subjected using (Reveal color strep A test) for rapid detection. The culture results were interpreted and reported by microbiologist. Data were analyzed by calculating the number of positives and negatives for both swabs and cultures, the specificity, sensitivity and predictive value were determined.
Results: The usefulness of latex test was as follows: Sensitivity 87%, Specificity 98.2%, Predictive value positive 90%, and Predictive value negative 97.6%.
Conclusion: Using tests for the rapid identification may help in establishing a policy for sore throat management in general practice by avoiding unnecessary cultures and antibiotic prescription
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Morel-Lavalle Syndrome
Authors: T. Al Hetmi, A. Hammouda and A. MakkiClosed degloving injury is a severe traumatic separation of the skin and subcutaneous tissue from the underlying fascia first described by Mor el-lav alle in the mid∼19th century. He observed the phenomenon in the lower limb of a woman after tangential trauma with separation of the fatty layers. Sporadic cases have been reported in the literature since. We report a case referred for plastic surgery for cosmetic reasons
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Pregnancy Outcome in Liver Transplant Recipients: First case from Qatar
Authors: B. Badereldeen Ahmed, S. F. Abdelaziz and T. S. Al InziThe number of pregnancies following organ transplantation is increasing due to better patient and graft survival We describe the pregnancy course, complications and outcome in patient with liver transplant and spleenovenal shunt for the first time in the history of the Women's Hospital in Doha, Qatar. Following successful liver transplantation, menstrual cycle returns to normal in a few months and pregnancy may be ensued{ l). We report the management and outcome of the pregnancy of a 22-year old female with orthotopic liver transplant and spleenovenal shunt with regard to safety to the mother; the fetus and transplanted graft. The pregnancy was terminated at 29 weeks of gestation by caesarean section because of severe Pre-eclampsia and fetal distress. Both mother and baby did well.
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Unusual Presentation of Peripheral T-Cell Lymphoma
Authors: K. I. Rasul, A. M. Amer, U. Al Homsi and N. MoradMature or peripheral T cell lymphomas (PTCL) are uncommon in most parts of the world and account for only 10-15% of all non-Hodgkin's lymphomas (NHLs). They usually occur in middle-aged to elderly patients, 68% presenting with features characterized by a disseminated disease, with systemic symptoms in nearly half of them (45%), bone marrow (BM) involvement in a quarter (25.8%), and extranodal disease in a third (37%). We report for the first time a patient with a lesion on the glans penis, an unusual site.
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Pancytopenia Due to Hemophagocytic Lymphohistiocytosis in a Patient with Acute Brucellosis
Authors: A. M. Al Ani, S. Bujassom, Z. Fawzi and A. YousifA Bangladeshi male patient with a culture positive Brucellosis had severe pancytopenia andfever. Patient was found to have Hemophagocytosis. He had uneventful recovery after treatment of Brucellosis. Discussion of the case and its treatment is presented
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