"FROM QATAR TO THE WORLD" ABSTRACTS
PRESENTED AT INTERNATIONAL CONFERENCES

Edited by: Dr. A. A. Gehani and Dr. M. Hammoudeh
Hamad Medical Corporation, Doha, Qatar

This Abstract was published in the European Journal of Cancer, 37 (2001) 2010-2014

Double-blind, Placebo-controlled Cross-over Study of Oral Pilocarpine for the Prevention of Chemotherapy-induced Oral Mucositis in Adult Patients with Cancer

A. Awidi, U. Homsi, R.I. Kakail, A. Mubarak, A. Hassan, M. Kelta, P. Martinez, S. Sulaiti, A. Al Qady, A. Jamhoury, M. Daniel, C. Charles, A. Ambrose, A.S. El Aloosy

This study aimed to investigate the effect of oral pilocarpine (OP) in reducing the incidence of chemotherapy-induced oral mucositis. Thirty two adult patients completed a total of 82 courses of chemotherapy in which either OP or placebo was given pro-phylactically in a double-blind cross-over design to prevent mucositis. Mucositis was documented in 20 out of 41 courses in which patients were given placebo, whereas mucositis was documented in only six out of 41courses when patients were given OP (P<0.005). OP treatment was found to significantly reduce the mucositis score when assessed by the method of Donnelly and colleagues (Donnelly JP, Muus P, Schatttenberg A, De Witte T, Horrevorts A, De Pauw BE. Bone Marrow Transplant 1992, 9, 409-413). Using this score, all patients scored a total of 52 when they were given the placebo versus eleven when they were treated with OP (P<0.001). A similar reduction in mucositis score was noticed using the World Health Organization (WHO) mucositis score; the total patient score was 25 for the placebo-treated group versus 6 for the OP group (P<0.001). We therefore conclude that oral pilocarpine is highly effective in the prevention of oral mucositis when given prophylactically to adult patients receiving a variety of cancer chemotherapy regimens.

This Abstract was presented in “Qatar International Trauma & Emergency Medicine Conference”, April 13-16 2002, Doha, Qatar

Percutaneous Dilatational Tracheostomy in Surgical and Trauma Intensive Care Units

Abdul Hafiz Ali Ahmed & Ibrahim El Boursaly

A prospective, observational clinical study evaluated the safety of bedside percutaneous single-step dilational tracheostomy in surgical and trauma intensive care units (HMC). The procedure was done by surgical and trauma intensive care units consultants. Thirty patients were deemed suitable for procedure. The mean duration of tracheal intubation prior to tracheostomy was 10 days. The mean duration of the procedure was 10 minutes ranging between 8 to 14 minutes.

Difficulty in identifying anatomical landmarks was faced in 3 patients only and endoscopic guidance was used twice. No loss of airways occurred in any patient and cannulation was considered difficult when more than one attempt was necessary and second attempt occurred only for 3 patients. No major bleeding occurred in any patient. Temporary mild hypoxia occurred in 6 cases manifested by dropping of O2 saturation, but gradually after the end of the procedure, doing good suction and connecting the patient back to the ventilator. Neither pneumothorax nor surgical emphysema was recorded for any patient. No reported cases of infection at the side of tracheostomy and only 5 patients died from their underlying disease and the remaining were transferred from the Intensive Care Units after weaning from artificial ventilation and stabilization of their general condition.

Forceps dilatational percutaneous appeared to be a convenient bedside procedure. However, complications can occur and further studies should address late sequellae, such as tracheal stenosis.

This Abstract was presented in “First GCC Cardiovascular Conference”, January 15-17 2002, Doha, Qatar

Tuberculous Pericarditis in the State of Qatar: Seril Cases Reports and Review of Literatures

Mohammed R.H.A. Al Marri, MD, FRCPC, FCCP; Abdul Rahman Al Nabit, MD; Amr Salam, MD

A 9 years retrospective study, from January 1992 to December 2000, at the Hamad General Hospital in the state of Qatar pointed out 21 tuberculous pericarditis among the 97 pericarditis. The Qatar nationals accounted for 23.4% and Indian subcontinent accounted for 47.6%. The sex-ratio was 0.64 and the mean age was 36.8 years (Std D +/-7.1). Hospitalization was justified by dyspnea (2 cases), thoracic pin (6 cases), lower limbs edema (1 case). Moreover, electrocardiography showed microvoltage in 18 cases and thoracic radiography showed heart enlargement (8 cases). Although 15 cases had an associated pleural effusion, only 2 patients had a pulmonary image suggestive of tuberculosis. Tuberculous pericarditis has been proved by the following examinations: Pericardium puncture (18 cases), pericardium and pleural biopsy (11 and 10 cases respectively), search of alcohol-acid-fast bacilli in sputum: 2 cases (1 smear positive, 1 culture positive). Histologic proof has been obtained 4 times out of 11 pericardial biopsies and out of 10 pleural biopsies. Bacteriological proof has been obtained 9 times by pathological samples cultivation: twice from 20 sputum, 5 times from 11 pericardial biopsies, twice from 10 pleural biopsies. The patients have been put under antitubercuous treatment associated with prednisone. 16 patients have been declared cured at the end of the treatment, 1 left the country and 4 were lost out of sight. Tuberculous pericarditis has become rare in developed countries but it is still challenging in Qatar. In spite of the antituberculous treatment associated with corticoids, prognosis is severe (evolution towards pericardial constriction and death).

This Abstract was presented in “First GCC Cardiovascular Conference”, January 15-17 2002, Doha, Qatar

Thrombolytic Therapy in Smokers Compared to Diabetics: A Clinical and Angiographic Study of 1320 Patients with Acute Myocardial Infarction

Gehani A.A., Al Suwaidi J., Tamimi O., Hajar H.A.

Smokers (SM) and Diabetics (DM) responses to thrombolytic therapy (Tx) are often reported separately. In the present study, the clinical and angiographic profile of 1340 consecutive patients with AMI who were either Smokers (SM, N=930) or Diabetics (DM, N=410) are compared. IV Streptokinase (1.5 x 106 IU) was given to 503 of SM (62.6%) AND 103 OF dm (25.2%).

Overall, in-hospital mortality was higher in DM (17.6% Vs 3.9% in SM, p<0.05). Tx had a greater impact on mortality in SM (1.8% with Tx Vs 6.3% without Tx, a 71% reduction) compared to DM (11.6% with Tx Vs 17.7% without Tx, a 38% reduction). Angiography was performed on 753 SM (84%) and 220 DM (65%). In the Tx group, SM had higher coronary patency than DM (86.3% Vs 80.5% respectively, p<0.01). The reverse was true in those who did not receive Tx (78% patency in SM Vs 84% in DM, p <p<0.05).

DM had a lower Ejection Fraction (EF) than SM (51+14.8 Vs 54+12.4, respectively, p<0.05). More importantly, severe LV dysfunction (EF<40%) was commoner in DM (21% Vs only 11.3% in SM, p<0.001). These finding were consistent even when correcting for difference in age (58+11 yrs in DM Vs 46+9 in SM), gender (70% males in DM Vs 98% in SM) and peak CPK (1500+1776 in DM Vs 2327+2620 in SM) using multiple linear regression analysis.

Conclusions:

1- Smokers appear to derive a greater benefit from thrombolytic therapy than diabetics.

2- As compared to smoking, Diabetes has a stronger negative effect on survival and LV function even in patients receiving thrombolysis.

This Abstract was presented in “Qatar International Trauma & Emergency Medicine Conference”, April 13-16 2002, Doha, Qatar

Outcome of Out of Hospital Cardiac Arrest in Qatar

Firas Adil Tawfiq Al Rawi, Muayad K. Khalid, Abdul Wahab Al Musleh, Mohammed El Tawil

Out of hospital cardiac arrest remains one of the common causes of death outside hospital. This study looks at all the out of hospital, non-traumatic, adult cardiac arrests that presented to the Accident & Emergency Department of Hamad General Hospital, Doha – Qatar, during the period between 1st June 1999 and 31st May 2000. In total, there were 132 patients included in this study. Of these, 44 (33.3%) had a return of a spontaneous circulation after being resuscitated in the A&E and were admitted to CCU. However, only 11 patients (8.3%) survived to discharge without complications. Another 5 patients (3.8%) survived but with irreversible brain damage.

Several related factors are also considered, including patient’s demographic data, mode of transport to hospital, transport time, effect of pre-hospital interventions, rhythm on arrival to hospital and associated and co-morbid conditions.

The most important determinants of outcome were found to be the mode of transport (better outcome for patients brought in by family), heart rhythm on arrival and patient’s age.

We stress on the importance of educating the public to recognize potential, pre-arrest conditions and to call for help as early a possible.

This Abstract was presented in “Qatar International Trauma & Emergency Medicine Conference”, April 13-16 2002, Doha, Qatar

Respective Analysis of 537 Patients with Maxillofacial Trauma in Qatar

Malaka Al Kaabi

A total of 537 patients with maxillofacial fractures treated between 1996 and 2001 were retrospectively analyzed. The age and sex of patients, cause and type of injuries are presented. The male/female ratio was 6.2:1 and the largest subgroup of patients was between 21 and 30 years of age and the least involved are those who are between 1 and 10 year of age (11%). The most common cause of injury was road traffic accidents (55%). Other common causes included, in descending order, fall (25%), Industrial injuries (9%), assault (6%) and sport injuries (5%). Soft tissue injuries are the most common encountered type of injury (29%), followed by isolated mandibular fractures (21%), midface with mandibular fractures (20%), isolated midfae fractures (18%) and isolated dentoalveolar factures (12%).

This Abstract was presented in “Qatar International Trauma & Emergency Medicine Conference”, April 13-16 2002, Doha, Qatar.

Childhood Injuries in Qatar

Mohammed El Tawil & Hani Al Kilani

Objectives:

To identify the common causes of injuries among the pediatric population of Qatar and suggest possible prevention strategies. Design: Hospital based retrospective chart review.

Materials and Methods:

Retrospective chart review of children under the age of 14 years who visited the emergency department at Hamad General Hospital with acute injury and admitted to the Hospital between 1st January 1996 and 31st December 1996. All charts were reviewed for age, sex, nationality, place and mechanism of injury; body area injured mode of transportation, and length of stay in the Hospital and at the Intensive Care Unit.

Result:

The total number of children was 383, the mean age of children was 6.5 years (range 0 – 14), 62.7% (n=240) were male. Falls were the most common mechanism of injury (71%). Head injury was the most common body area injured and was the main cause of hospital admission (57%). The mortality rate was 7% and an annual mortality was 16.3 per 100,000 population.

Conclusion:

Motor vehicle collisions and home injuries were the commonest cause of morbidity and mortality for children population in our community. Serious and fatal injuries could be prevented by local and state intervention; a new legislation mandating child safety policies, family and public education, and injury prevention strategies considering those mechanisms of injury are necessary.

This Abstract was presented in “Qatar International Trauma & Emergency Medicine Conference”, April 13-16 2002, Doha, Qatar

Calcaneal Fracture – Should They Be Fixed? Study of more than 200 cases.

M. Al Khayarin, J. Stehlik, J. Stulik, M. Rysavy

In the past, careful neglect was the only treatment philosophy. Bell was probably the first to treat the os calcis fracture by open reduction. Later, numerous treatment concepts were developed. With advent of computed tomography, we are able to better understand the pattern of these fractures.

The treatment prioities are an anatomic reconstruction of the entire calcaneus including articular surfaces height, alignment and length. In the first author hospital, no operative management is considered only in cases of extra articular or undisplaced os calcis fractures, and in patients with contraindication for surgery. Radiographic prerequisites for surgery of calcaneal fractures are lateral and axial radiographs and a two plane {axial and coronal} CT scan. Lateral radiograph of the uninjured side in helpful.

From 1994 to 2001, 261 patients with 302 calcaneal fractures were treated, 213 patients with 248 fractures by semi open reduction and percutaneous fixation with use of a small portal and minimal hardware, 48 patients with 54 fractures were treated conservatively.

There were 188 males and 33 females with mean age 44.8 years. For long term results study 160 patients with 187 fractures were available for a minimum of 2 years follow-up evaluation, with mean follow-up of 43.4 months, 134 males and 26 females, with mean age 44.3 years.

Results were evaluated using the Creighton-Nebraska Health Foundation score. The average value of the score was 83.9 points. Excellent result occurred in 27 patients good in 89, fair in 24 and poor in 20 patients. Seventy four % of the patients were able to return to work in their former professional capacity.

In HGH, same protocol of semi open reduction and K wire fixation is used for patients with Sanders type IV fractures and patients with any contraindication for open surgery. Selected patients with types Sanders II and III fractures and soft tissue conditions that have no increased risk of complications are treated by open reduction and plate fixation through Extended Lateral Approach.

In our opinion, conservative treatment should be considered only in case of extra articular fractures and in cases where there is a clear contraindication for surgery.