Qatar Medical Journal - Volume 2010, Issue 2

Abdullah Muhammad Ibn Jabir Ibn Sinan Al Battani Al Harrani was born around 858 CE in Harran, and according to one account, in Battan, a State of Harran. Battani was first educated by his father Jabir Ibn San'an Al Battani, who was also a well-known scientist. He then moved to Raqqa, situated on the bank of the Euphrates, where he received advanced education and later on flourished as a scholar. At the beginning of the 9th century, he migrated to Samarra, where he worked until the end of his life in 929 CE. He was of Sabian origin, but was himself a Muslim.

Qatar Medical Journal is the official periodical of the medical community in Qatar.

Papers considered for publication in Qatar Medical Journal are those reporting original work, review articles and case reports that are particularly relevant to medicine in the broad sense. Editorials and Review articles are by invitation.

With the ultimate goal of improving medical care for diabetes, a study of four Primary Healthcare Centers (PHC) surveyed the composition of PHC population, completeness of patient data, changes in biochemical variables two years before and after establishing specialized diabetic clinics. Patients with diabetes of less than four years duration were excluded from the study. Most (71.7%) of 403 patients with Type II diabetes were aged 40-59 years. Diabetes regulation (HbA1 C), lipid levels (total cholesterol), systolic blood pressure and creatinine improved significantly after inclusion in the specialized diabetic clinic demonstrating that the introduction of systematic care for diabetic patients was effective and lead to an improvement in the recorded process measures and outcome criteria.

Using a modified standard questionnaire a crosssectional study was conducted between October and December 2006 to assess knowledge, attitude and practices towards food safety measures among 43 randomly selected food service staff at Hamad Medical Corporation (HMC), Qatar. Knowledge, attitude and practice of food service staff towards food safety was 91.9 %, 86% and 89.7 % respectively. Many (95.3%) recognized the importance of salmonella contamination but fewer (20.9%) were aware of the significance of Hepatitis A. In general the attitudes (86%) and practices (89.7%) of the staff towards clean and safe food preparation were adequate but the basic knowledge and understanding of the reasons for the necessary practices were inadequate (91.9%). Continuous training in health education, food safety and hygiene is required for all staff involved in hospital food services.

To define the demographic, clinical and laboratory features, methods of diagnosis and outcome, in patients with meningococcal meningitis in Qatar, records were reviewed retrospectively to 25 patients (21 male, 4 female; mean age 24 years) treated for meningococcal meningitis at the Hamad Medical Corporation (HMC) between 1992 and 2008). Most (88%) were expatriates. The most common presenting symptoms were fever, vomiting, headache and altered consciousness. Neck stiffness and impaired level of consciousness were the most common signs. Elevated WBC, elevated protein and low glucose in CSF were present in 95.6%, 84% and 80% of cases respectively. Positive CSF Grainstain showing gram negative diplococci and culture growing N. meningitidis in CSF and blood were seen in 64%, 44% and 72.7% of cases respectively. The most common serotypes were Groups A and W 13 5 accounting for 50% and 25% respectively. 15.8% of isolates were intermediately resistant to penicillin, while all were sensitive to ceftriaxone. One patient (4%) died and 24 (96%) survived. Six of those who survived developed neurologic sequelae. Meningococcal meningitis remains uncommon in Qatar but the incidence has increased markedly recently especially among expatriates. Because the clinical features of the disease are non-specific, a high index of suspicion is essential for early diagnosis. Empirical treatment with ceftriaxone in a patient with suspected meningococcal meningitis seems prudent to avoid an unfavorable outcome.

Despite the emergence of therapeutic advances, the morbidity and mortality still occur in the obstetric patients, although intensive care utilization by obstetric and gynecological patient, are still rare compared to the general population. Majority of obstetric patients needed the intensive care therapy compared to gynecological patients. The aim of our study was to know the indications for the intensive care admission by obstetric and gynecological patients, length of stay and outcome of these patients.

Methods: We retrospectively reviewed the medical records of all obstetric and gynecological patients admitted to our Surgical and Trauma Intensive Care Units (SICU and TICU) from February 1995 to March 2005. Indication for admission, nationality, age, and length of stay in ICU, severity of disease and outcome of these patients were recorded. Data analyzed with SPSS program.

Results: A total of 182 patients were admitted to the SICU of the Hamad Medical Corporation in Doha, Qatar, from the Women's Hospital. 159 (87%) patients were obstetric patients and 23 (13%) patients gynecological patients, 126 (69.6%) patients were admitted post Lower Segment Caesarean Section (LSCS). The most common indication for admission was 73 (39.3%) patients obstetric hemorrhage and Disseminated Intravascular Coagulation (DIC), and then 44 (25.3%) patients of hypertensive disorder of pregnancy. The major anesthesia related indication was scoline apnea, 21 (11.6%). Total three obstetric patients died, two due to severe sepsis and multi-organ failure and one due to cerebral sinus thrombosis, giving mortality rate of 1.66%.

Conclusion: Intensive care therapy required by gynecological and obstetric patient is less than the general population. The commonest indication for admission was obstetric hemorrhage, DIC, and hypertensive disorders of pregnancy. The mortality was due to septic shock with multi-organ failure, and cerebral venous sinus thrombosis.

To enhance the quality of patient care, Hamad Medical Corporation (HMC) has previously adopted guidelines for the management of community-acquired pneumonia (CAP) based upon the PSI model. We audited retrospectively the management of CAP inpatients admitted to Hamad General Hospital from 1 January until 31 June, 2008 with the objective of establishing whether these HMC guidelines were being implemented appropriately. Sixty-nine patients with CAP were admitted during the study period. Guidelines for the assessment of disease severity at presentation were not followed in all patients. Appropriate antibiotic therapy was instituted in 52 (75.4%) cases. Ten patients died (14.5%). The rate of use of a severity assessment score to stratify patients with CAP based on recognized guidelines was zero and the death rate of 14.5% might reflect that noncompliance.

To analyze the epidemiological and clinical characteristic of a measles outbreak in Qatar in 2007, the records of 21 2 confirmed cases of measles were analyzed retrospectively, confirmation being based on clinical suspicion of the disease with a positive measles IgM (170 cases) and /or exposure to a laboratory confirmed measles case during the infectious period (42 cases; epidemiologic link). Eighty five percent of the cases occurred between April and July. Seventeen percent were in infants <  1 year of age, 47% in children between 1-5 years of age, 24% in school age children < 10 year of age and 1 2% in children >10 years old. Vaccinations were up to date in 60% of cases, second dose missed in 30% and no vaccination in 10% because of travel outside the country, concurrent illness, or lack of transportation. Thirty one percent of the cases required admission, with a mean hospital stay of four days. Cases were reported predominantly in Pakistani and Qatari patients, living mainly in three areas within the capital, Abu Hammour, Al Rayyan, and Al Mamuora.

Conclusion: Status of vaccination in Qatar needs careful analysis and the vaccination schedule should be reviewed. Early administration of vaccine, increasing community awareness, a well-coordinated school-based immunization program and immunization campaigns are required to prevent future outbreaks.

A prospective cohort study of 18 males aged 19–45 years with chronic renal failure attending the Ibn Sina Teaching Hospital, Mosul for Hemodialysis (HD) between March 2007 and March 2008 assessed the oxidative stress, antioxidant status, serum urea and serum creatinine before and after hemodialysis and following subsequent supplementation with oral Vitamin E. Blood samples collected before starting hemodialysis, after three weeks of twice-weekly dialysis, and then after three weeks of oral vitamin E (400 i.u/day) showed significant decreases of total antioxidant status (TAS) after HD but a significant increase of TAS after Vitamin E therapy; a non-significant increase of lipid peroxidation indicator (serum malondialdehyde; MDA) after HD alone but a significant decrease of MDA after Vitamin E therapy; a highly significant decrease of serum urea after HD and a highly significant increase of serum urea after Vitamin E therapy; a highly significant decrease of serum creatinine after HD and a highly significant increase of serum creatinine after Vitamin E therapy; a highly significant decrease of serum uric acid after HD and a highly significant increase of serum uric acid after Vitamin E therapy. There were non-significant correlations between TAS and MDA, uric acid, serum urea and serum creatinine after HD and after Vitamin E therapy. It is concluded that in patients with chronic renal failure oxidative stress is further exacerbated, as shown by decreased TAS and increased MDA although serum uric acid is not the sole contributor. Vitamin E supplementation in such patients after HD does not enhance renal function but it decreases the oxidative stress by decreasing MDA and enhancing antioxidant body status by increasing significantly TAS and serum uric acid.

Background: Cigarette smoking is universally acknowledged to be a health hazard. Primary care physicians have several important responsibilities, being role models, information providers, and identifiers/modifiers of risk behaviors, and researchers. They are often able to influence the behavior of their own patients as well as the society as a whole in the prevention of illness and promotion of well-being. This can be accomplished by both serving as personal role models and actively promoting healthy behavior among their patients. Doctors who smoke may have a problem in achieving these two objectives, especially when trying to convince their own patients to quit smoking. The purpose of this study was to identify smoking prevalence among primary care physicians in Doha, Qatar, and to explore how the smoking behaviors of physicians, their perceived ability to influence patient smoking behavior, and their knowledge about health outcomes related to smoking can influence their interaction with patients.

Methods: A cross-sectional, self-administered, anonymous survey was conducted in November through December 2007, among 12 primary healthcare centers in Doha. Analyses were based on responses from 151 physicians, representing an 83.8% response rate.

Results: The prevalence of smoking was 23.1% among primary care physicians, 1 5.8% of them were current smokers and 7.3% were ex-smokers. Smoking prevalence was significantly higher in men than women (12.9% vs.1.5 % regular smokers). Almost two thirds of smokers started smoking before reaching 20 years of age. Among smokers, 28.6% had previously smoked in the presence of patients and 40% of them felt ready to quit smoking within the next six months. Finally, physicians who smoke are less likely to ask their patients about their smoking behavior or believe their example is likely to influence their patients.

Conclusion: Smoking prevalence is considerably high among physicians in the 1 2 primary healthcare centers in Doha, and a large percentage of physician smoke in the presence of their patients. Physicians' smoking behavior and attitude to smoking influences whether they counsel patients regarding smoking. These results indicate a need to educate physicians in Qatar about their potential for influencing patients to not start or quit smoking. There is a need for health education campaign not only for the general population but also for healthcare workers.

A prospective study over six months (from 1 July to 31 December 2002) measured the level of blood lead in individuals attending Primary Health Centers in the center District of Basrah Governorate. Six hundred and two individuals were selected randomly from those attending seventeen Primary Health Centers in the center of Basrah. Their ages ranged from 9-79 years. Of 602, Twenty six, 15 years of age or younger had mean blood lead levels (BLL) of 12.62+3.85 ug/ dl, those older than 15 years had levels of 11.20+3.4 ug /dl (p < 0.05). Males of different age groups showed a statistically significantly higher BLL compared to females (13.25+3.25 and 10.10+2.96 ug/ dl respectively), p <  0.0001. The center of Basrah was divided into 11 main areas; there was a statistically significant difference in BLL among individuals living in different areas, ranging from 7.26+2.81 |jg/ dl to 12.76+3.63 ug/dl. Individuals with higher education and smokers showed higher BLL (12.10+3.54 ug/dl, 13.81+3.57 ug/dl respectively) compared to those of lower education and non-smokers (11.11+3.23 ug/ dl, 10.93+3.26 ug/dl respectively), the differences were statistically significant. The sources of drinking water and frequency and amount of milk consumed/ week did not show a significant correlation with BLL. History of lead exposure (occupational) was statistically significantly associated with BLL (15.3+4.85 ug/ dl) for those exposed to higher concentration of lead compared to others (11.1 2+3.3 ug/dl), p < 0.0001. Amongst females using kohl (25.6%), the mean BLL was significantly higher (13.91+4.42 ug/dl), compared to non-users (9.88+2.68 ug/dl), p < 0.0001. No significant difference was observed among those exposed to paints. As adequate data on BLL in our country do not exist, especially for children, and as the number of children in this study was small, further studies are warranted to recognize the extent and risk factors for lead poisoning in children.

Apexification is the standard procedure for the management of immature non-vital teeth. This report presents a case of a traumatic injury to a maxillary central incisor that lead to total pulp necrosis and a large periapical lesion. Calcium hydroxide apexification was used successfully in the treatment of this case.

Evaluation of the visual fields is an integral part of diagnosing and following-up any patient with suspected glaucoma. If any progressive loss in the visual field is noted the treatment plan may need alteration to suit the clinical circumstances but if the follow-up visual field changes are atypical then other ocular or systemic pathologies need to be excluded before changing the glaucoma management plan. We present an unusual case of brain metastasis from a lung carcinoma that masqueraded as progressive glaucoma in a patient previously diagnosed as primary open angle glaucoma.

Proper post-extubation pain control in traumatic blunt chest injury represents a challenge to provide adequate analgesia for proper lung inflation and to prevent re-intubation. In this case, the average opioid (Remifentanil) infusion drip in a traumatic blunt chest injury patient in the 48 hours prior to extubation was calculated and converted to the equivalent analgesic one of the Fentanyl Transdermal Therapeutic System (Fentanyl TTS Patch). The analgesic gap before the onset of action for the applied fentanyl patch was covered by frequent injections of tramadol. Evaluation of the Fentanyl TTS effect through the post-extubation period was carried out by measuring the analgesic effect on a visual analogue scale, the alertness status by simple sedation score, while the respiratory performance was followed by the negative inspiratory force. The outcome in this case showed that Fentanyl Patch is a reliable, favorable, safe and non-invasive method that produces a good analgesic effect and positive impaction on the post-extubation course of respiratory performance with a satisfactory outcome and no side effects.

Myelin sheath tumors are neurogenic tumors which include schwannoma, neurofibroma, neurofibromatosis and neurogenic sarcoma. They are most commonly present during middle age and 90% are benign. It has been reported that, they are twice as common in women as in men, but there are few reports of neurogenic tumors in the biliary tract and fewer than 10 cases of schwannoma of the extrabiliary tract.

Mesenteric cysts are uncommon and mesenteric chylous cysts are extremely rare. The most common presenting symptoms are abdominal pain and abdominal distention. We report two cases of mesenteric chylous cyst in a young man and a young woman. Pre-operative, intra-operative and histological findings are discussed.