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

Edited by: Dr. Mohammed Hammoudeh
Hamad Medical Corporation, Doha, Qatar

This Abstract was published “ American Journal of Kidney Diseases “, March 2003, Volume 41, Number 3.

Adenovirus Infection of a Renal Allograft

Muhammad Asim, Agustin Chong-Lopez, Volker Nickeleit Doha, Qatar

One month after renal transplantation, a 60-year-old man developed acute allograft dysfunction associated with gross hematuria and dysuria. Urinary cytological examination showed viral inclusion-bearing epithelial cells. A renal transplant biopsy specimen showed granulomatous interstitial nephritis, tubular necrosis, and ground glass-like intranuclear viral inclusion bodies in tubular cells caused by an adenovirus (ADV) infection. A reduction in baseline immunosuppressive therapy resulted in rapid normalization of allograft function and ultimately viral clearance. We report this case not only to illustrate an exceptional manifestation of an ADV infection in a renal allograft, but also to highlight the beneficial effect of reduction in immunosuppressive therapy on viral replication and clinical outcome.

Am J Kidney Dis 41:696-701. © 2003 by the National Kidney Foundation, Inc.

This Abstract was presented by Dr. Hanan Sherif in “European Congress of Radiology”, March 7-11 2003, Vienna, Austria.

Early Hepatic Venous Drainage From Focal Nodular Hyperplasia on Dynamic Gd-DTPA- Enhanced MR Images.

H. Sherif, S. Hirohashi, A. E. Mahfouz, B. Hamm, M. Taupitz Doha, Qatar

Purpose: To assess the pattern of venous drainage of hepatic focal nodular hyperplasia (FNH) on dynamic Gd-DTPA- enhanced MR images.

Materials and Methods: Dynamic Gd-DTPA- enhanced MR images of 49 patients with FNH were retrospectively reviewed. The images were obtained by breath-hold gradient-echo T1-weighted fast-low-angle-shot sequence (TR= 174.9 ms, TE= 4.1 ms, flip angle= 90) performed before as well as 15 s, 55 s, 2 min, 5 min, and 10 min after intravenous bolus injection of 0.1 mmol/kg body weight. The images were reviewed for the pattern of early venous drainage from the lesions, defined early appearance of the contrast agent in the hepatic vein draining the lesion before its appearance in the other hepatic veins.

Results: Early venous drainage of focal nodular hyperplasia in the hepatic vein, which drained the lesion has been observed in 5 out of 49 patients with FNH (10.2%). No enhancement could be seen in the remaining hepatic veins of the same patients at the same timepoints.

Conclusion: Early hepatic venous drainage occurs in 10.2% patients with FNH, probably reflecting the hyperdynamic circulation within the lesion

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

Black Sting Allergy: A Clinical Problem in Qatar

M.K. Khalid, M. El Tawil, A.W. Al Musleh, H.H. Al Kilani, and B.H. Al Kahlout
Doha, Qatar

Objective: To study the methods of clinical presentation of black ant sting allergy and try to estimate the extent of this problem in Qatar.

Methods: Review of patients charts who attended the A&E department of Hamad General Hospital with allergic reaction due to ant sting between 1st of January to 31st of December 1998

Results: One hundred and five patients attended the A&E department at HMC suffering from allergic reaction due to black ant stings. Most of them suffered the incident during the summer months 5.71% in June, 54% in July, 28% in August, and 12% in September. More than half of the patients (56%), came at night, 71% were female, 42% had past history of allergy to other allergens, 43% had been exposed to ant sting, and 1% had past history of asthma. Most patients presented with low grade fever, hyperventilation and tachycardia, 54.28% of the patients had shortness of breath, 36% had wheezes, 64% had no systemic allergic manifestations, 3.15% of the patients had severe anaphylaxis.

Conclusion: Blank ant sting allergy constitute a real clinical problem in Qatar and needs further attention and studies. Patients with recurrent ant sting allergy should be educated about anaphylaxis first aid and adrenalin self injection.

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

THE MEDICAL COST OF MOTOR VEHICLE COLLISIONS IN QATAR

Firas Adel Tawfiq
Doha, Qatar

Motor vehicle collisions (MVC) related trauma is a leading cause of morbidity and mortality in Qatar. In the year 2000, a total of 3394 victimsof MVC needed to be treated at Hamad General Hospital (HGH), 742 (21.9%) were admitted to surgical wards and 160 (4.7%) admissions to intensive care areas (TICU & SICU). 15 (0.4%) needed admission to the rehabilitation unit and there were 6320 rehabilitation outpatient visits. Ten (0.3%) patients required to be sent abroad for specialized treatment. Finally, there were 83 (2.5%) MVC related fatalities during that year.

In the year 2000, the medical cost incurred on the health system of Qatar for treating MVC victims approximated QR 41,320,872 (US$ 11,320,787).

This cost does not include the cost of loss of working hours, loss of wages, property damage, insurance claims and long-term disabilities.

Key words: MVC, cost, A&E, EMS, Rehabilitation, and Qatar

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

Is Admission of Patients with Acute Appendicitis After Midnight Needed in Adults?

Abdulnaser Falah Howaidi, M. El Tawil, Y. Al Maslamani, H. Al Jaff, H. Al Kilani and El Fadel Hamad
Doha, Qatar

Acute appendicitis is still the most common emergency surgical condition. Approximately about 7% of the population will develop acute appendicitis in their life span. This big figure gives an idea about the huge number of patients presenting with suspected Acute appendicitis who are dealt with on a daily bases in our busy accident and emergency department. Our current hospital practice is to keep selected acute appendicitis patients who are not hot and diagnosed late in the day or after midnight under observation in the accident and emergency department overnight and to be reassessed in the morning after.

Aim of the study: To find out if delaying patients over night and observing them in A&E department will or will not have an effect on the outcome i.e. morbidity, wound infection, abscess formation, perforation.

Methodology: A prospective cohort study of the cases referred to and observed in the A&E department with suspicion of acute appendicitis and operated upon in comparison to a control group, which are admitted to the general surgical ward in less than 6 hours.

Results: Of one hundred fifteen cases collected, 9 were excluded and 105 left. 62 cases were admitted and found to be acute appendicitis, 43 cases diagnosed as nonspecific acute appendicitis and discharged either from the A&E or from the general surgical ward after further observation for 24 to 48 hours. The group with acute appendicitis where 64.52% admitted immediately ( less than 6 hours) and 35.48% after observation. There were no mortality and there was no difference in the morbidity between the 2 groups.

We conclude that putting patients under observation for selected cases is safe and a good policy to decrease load on the hospital. Also we recommend to extend the observation period up to 72 hours.

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

Injury-Related Mortality in Pediatric Population in Qatar

H. Kilani, A.W. Al Musleh, M. El Tawil, W. Abu Jalala, F. Tawfiq
Doha, Qatar

Objective: To identify the factors influencing injury related deaths among the pediatric population of Qatar and to 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 were admitted to hospital between 1st January 1996 and 31st December 1996. All charts were reviewed for demographic data, mechanism of injury, site of injury and mode of transportation.

Results are displayed in a descriptive format and statistical analysis using the chi square test was done where feasible.

Results: The total number of children was 383. There was a total of 27 deaths (7%) among these children (overall annual mortality of 16.3 per 100,000 population). The mean age of the children who died was 6 years, (range 0-12) and the highest number of deaths occurred in the age group >10 years. The majority of deaths occurred among Qatari children (59.2%), and they were mainly boys (77.8%). MVC was the most common mechanism of injury (74%), followed by falls and drowning (11% for each) and child abuse last (4%). Head injury was the most common cause of death (77.8 %). A comparison is drawn out between the children who died and the group of surviving children who were exposed to similar injuries during the same study period.

Conclusions: MVC and home injuries are the most common cause of mortality for children in our community. Serious and fatal injuries could be prevented by local and state intervention; a legislation mandating child safety policies, family and public education, and injury prevention strategies considering those mechanisms of injury are necessary, targeting the population at special risk.

Key words: Pediatric trauma, motor vehicle collisions (MVC), head injury

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

The Role of Interventional Radiology in A & E Department

Ahmed Al Muzrakchi and Wojciech Szmigielski
Doha, Qatar

nterventional Radiology (IR) is now a well-established branch of medicine and help management of a variety of conditions including cases seen in A&E Department.

For example, transcatheter embolization is employed in control of life threatening, acute conditions like haemorrhages in musculoskeletal trauma, solid intraperitoneal and retroperitoneal organs injuries, acute GIT bleedings of various aetiology (e.g. due to gastric ulcer or tumour), massive haemoptysis, and many others.

Other examples include aspiration of abscesses of abdominal organs and intraperitoneal collections, perinephric abscesses or collections of the pelvis, including periappendicular. Nephrostomy is widely used in cases of acute ureteric obstruction, cholecystostomy in acute cholecystitis or hydrops of the gall bladder, etc.

We present our experience in treating ten trauma cases during the last seven years, which presented to our A&E Department with severe bleeding related to pelvis or spine fractures. They were successfully treated by transcatheter superselective embolization of the bleeder.