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PubMed2006

Acute bacterial meningitis in Qatar.

OBJECTIVE: To study the changes in the epidemiology, clinical and bacteriological profiles of bacterial meningitis in the era of the Haemophilus influenzae type b (Hib)vaccine and pneumococcus resistance. METHODS: This is a retrospective study of children aged <12 years admitted to the Hamad Medical Corporation, Qatar between January 1998 through December 2002 with positive cerebrospinal fluid culture. RESULTS: We described 64 patients with culture proven bacterial meningitis. In infants <3 months (n=29 [45%]), the most common organism was Group B Streptococcus (GBS) (20%). Children >3 months (n=35 [55%]); Hib (25%) and Streptococcus pneumoniae (STP) (20%) were the most common organisms before introduction of Hib vaccination. A significant drop of Hib infections were noticed after introduction of the vaccine. Fever, neck stiffness, seizure, vomiting, and bulging fontanel were the most frequent presenting features. Group B Streptococcus were sensitive to ampicillin and cefotaxime with no resistance detected. Forty percent of STP isolates were resistant to penicillin and 12% were resistant to ceftriaxone. Fifty percent of Hib were resistant to ampicillin; while none of Hib were resistant to ceftriaxone. No case of Listeria monocytogenes meningitis was diagnosed. Morbidity was 28%, and one patient expired (2%) after Klebsiella pneumoniae meningitis. Streptococcus pneumoniae was associated with the highest morbidity (62%) while Hib had zero morbidity in our patients. CONCLUSION: Bacterial meningitis is a serious illness with a significant morbidity and mortality. Haemophilus influenzae type b infection decreased which indicated an effective vaccination. As there is 12% bacterial resistance of STP reported against ceftriaxone; We recommend Cefotaxime for infants <3 months while ceftriaxone plus vancomycin as empiric therapy for older patients with community acquired bacterial meningitis. A pneumococcal vaccination may further decrease the incidence of meningitis in our community. A continuos surveillance to detect changes in the microbiology of organisms causing bacterial meningitis or their sensitivity in our community is essential to update these recommendations.

Acute Disease↗
PubMed1990

Detection of African horsesickness (AHS) in recently vaccinated horses with inactivated vaccine in Qatar.

Two 7-year old Arabian racing horses were reported to show typical AHS symptoms in Qatar and died shortly after. The horses had been vaccinated with formol inactivated vaccine approximately 10 days before the onset of the disease. Blood samples from these horses were collected and AHS virus isolated from one sample after intracerebral (i.c.) inoculation into suckling mice. The virus identity was confirmed by complement fixation test (CFT) using the virus antigen and reference type 9 of AHS virus hyperimmune serum. The serotype of the isolated virus was identified by serum neutralization test (SNT) using reference types of AHS virus. Two possibilities of the original source of this infection were suggested. The infection might be due first to the natural endemic occurrence of the virus in the country and secondly, to the presence of residual infectious virus in the inactivated vaccine.

African Horse Sickness↗
PubMed1995

Childhood asthma in Qatar.

BACKGROUND: Asthma is one of the most important causes of morbidity in childhood. Significant differences in the prevalence of asthma have been reported in children from different countries. OBJECTIVE: Our objective was to study the profile of asthmatic children in Qatar and compare it with other countries. METHODS: The study consisted of our outpatient asthmatic cases. It consists of detailed clinical questionnaires, physical examinations, and laboratory evaluations. RESULTS: Four hundred fourteen children with asthma were reviewed. The ages of the patients ranged from 7 months to 12 years with a mean of 6.15 years. There were 135 girls (32.6%) and 279 boys (67.4%). Seventy percent of patients had their first episodes within the first 2 years of life. Viral respiratory infections were the most common precipitating factor (95.17%). Fumes were incriminated as a triggering factor in 36% of patients with Bokhour representing 54% of them. The majority of cases were moderate in severity (56.52%), while 27.78% were mild and 15.7% of cases were severe. Fifty percent of patients had been hospitalized at least once. Eighty-six percent had positive family histories of allergic diseases. Absolute eosinophil counts of more than 500 cells/mm3 were found in 36.62%. Total serum IgE was elevated for age in 61.59%. Positive skin tests to significant antigens were noted in 80.4% of cases. CONCLUSIONS: Our study describes the characteristic findings of asthma in Qatari children which are similar to reports from other developing countries except that our patients were younger in age of onset and Bokhour (an Arabian Gulf incense) was an important precipitating factor. It will help to improve understanding and management of asthma.

Asthma↗
PubMedDate not supplied

Vertebral osteomyelitis in Qatar.

Twenty-eight cases of vertebral osteomyelitis were diagnosed at Hamad General Hospital in Qatar between January 1988 and December 1991: 16 (57.2%) cases were tuberculous spondylitis, 6 (21.4%) Brucella spondylitis, 3 (10.7%) Staphylococcus aureus spondylitis, 2 (7.1%) Salmonella spondylitis, and 1 (3.6%) Pseudomonas cepacia spondylitis. Plain vertebral x-ray films and CT scans were abnormal in all patients. Bone and gallium scans were abnormal in 87.5% and 64% of cases respectively. Clinical manifestations, haematological and radiological investigations were not able to differentiate between the causes. Serological tests were helpful in diagnosing Brucella spondylitis. CT-guided needle biopsy was able to identify the aetiology in 90% of cases. We conclude that invasive tests are still needed to establish the microbiological diagnosis and to guide antimicrobial therapy in most cases of vertebral osteomyelitis.

Adolescent↗
PubMed1993

Kikuchi's lymphadenitis in Qatar.

The clinicopathologic features of five cases of Kikuchi's lymphadenitis (histiocytic necrotizing lymphadenitis without granulocytic infiltration) occurring in Qatar are presented. There were three females and two males aged from 18 to 36 years with a mean of 29 years. Three were Indians and two were Qataris. Cervical lymph nodes were affected in all cases while one patient also had inguinal and femoral lymph node enlargement. Three patients achieved complete remission within three months. The differential diagnosis both clinically and histologically, included malignant lymphoma, toxoplasmosis, tuberculosis, leprosy, Yersinia and viral infections. To avoid errors in diagnosis, especially that of malignant lymphoma, attention must be paid to the location of the lesion, composition of the cellular infiltrate and the typical fibrinoid type of necrosis in the background.

Adolescent↗
PubMed1998

Abdominal tuberculosis in Qatar: a clinico-radiological study.

SETTING: Hamad General Hospital, the tertiary health centre for Doha, Qatar. OBJECTIVE: The purpose of the study was to define and correlate the role of radiology with clinical and pathological findings in abdominal tuberculosis. MATERIAL AND METHODS: A total of 59 patients (47 males and 12 females) diagnosed bacteriologically and/ or histologically for abdominal tuberculosis were radiologically assessed. Evaluation was based on the analysis of plain abdominal radiographs, gastro-intestinal contrast studies (barium meal follow through and barium enema), ultrasonography and computed tomography. RESULTS: Plain abdominal radiographs performed in 38 patients were positive in 19 cases (50%). Gastrointestinal contrast examinations were positive in 27 out of 34 cases (80%). Ultrasound examinations were abnormal in 25 out of 31 cases (81%), while computed tomography, performed in 24 patients, revealed abnormal findings in 19 cases (80%). Combined radiographic and imaging procedures revealed peritoneal involvement (ascites) in 16 patients (27%), bowel involvement in 36 (61%), mass lesion in 11 (19%), lymphadenopathy in 13 (22%) and organ involvement in 13 (22%). CONCLUSION: There was no single radiological method that provided all necessary information suggestive of abdominal tuberculosis. Although unequivocal diagnosis of abdominal tuberculosis can only be made by culture and histological findings, combined computed tomography and ultrasound findings were the most important imaging tools in the diagnostic process for abdominal tuberculosis, while contrast studies helped to assess the extent of bowel disease, hence influencing decisions concerning surgery.

Adolescent↗
PubMed2000

Stillbirths in Qatar: a review of 83 cases.

To evaluate the aetiology, diagnostic procedures and current management of stillbirths in Qatar, 83 stillbirths with a birth weight of more than 500 g were studied. The validity of the cause of death was classified as certain, probable and unexplained. Frequency and descriptive statistics were used. The stillbirth rate was 8.15 per 1000. The cause of death was certain in 29%, probable in 62% and remained entirely unexplained in 9% of the cases. The major factors that might be the causes of fetal death were intrauterine growth retardation (23%), abruptio placentae (16.3%), congenital anomalies (13.3%), gestational diabetes (9.6%) and hydrops fetalis (7.2%). The cause of death was found unavoidable in 24 cases (29%). The autopsy rate was terribly low (1/80) and far away from the recommended rate of 75%. The introduction of a stillbirth programme, that includes post-mortem autopsy, in any maternity hospital, is considered crucial to reach a specific diagnosis for almost all stillbirths and to prevent fetal death in future pregnancies. However, if the patient or her family refused autopsy, a combination of patience and learned communication can pave the way to their understanding and acceptance of the procedure. Postmortem magnetic resonance imaging may be used as alternative to autopsy if it is refused.

Journal Article↗
PubMedDate not supplied

Tuberculous meningitis: a clinical and laboratory study of 20 patients in Qatar.

Twenty cases of tuberculous meningitis were diagnosed at the Hamad Medical Corporation between 1990 and 1995. Most of the patients (90%) were expatriates. The most common presenting features were fever, headache, neck stiffness and altered mental status. Five patients were in stage 1 disease at the time of presentation, 11 in stage 2, and four in stage 3. Examination of cerebrospinal fluid showed at least one abnormal finding in all patients, and culture grew Mycobacterium tuberculosis in 50%. A positive tuberculin skin test in 50% of patients, abnormal chest X-ray in 35%, abnormal CT scan or MRI showing tuberculoma or hydrocephalus in 55%, and positive sputum culture for M. tuberculosis in 15% helped establish the diagnosis. All the patients were treated with antituberculous drugs and steroids. Seventeen (85%) survived, three with severe neurological sequelae; three (15%) died. Poor outcome was associated with advanced stage of disease at presentation and high CSF protein. Tuberculous meningitis continues to be an important disease in Qatar, especially in expatriates, and should be considered in the differential diagnosis in any patient presenting with fever and change in sensorium.

Adolescent↗
PubMed1987

Qatar.

Explore the source record for details and available documents.

Asia↗
PubMed1993

Myocardial infarction in Qatar: the first 2515 patients.

The data registry of all patients admitted between 1982 and 1990 to the Coronary Care Unit at Hamad General Hospital with the diagnosis of documented acute myocardial infarction is reviewed. We report a total of 2,515 patients (86.6% men and 13.4% women) with a mean age of 51 years (range 18-99). Of these, 62% were smokers, 29% had diabetes, and 20% had hypertension. The hospital mortality rate was 10%. The most significant factors associated with higher mortality were older age, female gender, and anteroseptal infarction. The age of 23% of the patients was 40 years or younger. Comparison between these younger patients (Group I) and those over 40 years (Group II) demonstrated that Group I had lower mortality (3.6%) than Group II (12%) (p < 0.001). Group I patients were predominantly men (96.8%), of Asian nationalities (71%), and usually smokers (78%). The observation that myocardial infarction occurs frequently in young Asian men needs further evaluation to identify specific risk factors.

Adult↗
PubMed1992

Pre- and neonatal hydrocephalus in the Middle East: experience in Qatar.

In a retrospective study, all cases of hydrocephalus diagnosed antenatally or within the first 10 days of life during the period 1986-1989 were reviewed. Thirty-four cases were diagnosed antenatally and 31 after delivery. Among the last, 13 were hemorrhagic. In 17 cases a meningomyelocele was present. In 12 cases other malformations outside the nervous system were observed. This represents an incidence of 157/100,000 live births for hydrocephalus and 41/100,000 for meningomyelocele. All cases were compared against a control group that had normal antenatal ultrasound findings at the same time (35 cases), and against a second control group consisting of 53 women with five or more normal pregnancies at the time, and all normal babies. The differences are evaluated and their significance and implications for the future discussed.

Adult↗
PubMed2002

Allergic Aspergillus flavus rhinosinusitis: a case report from Qatar.

Fungal involvement in rhinosinusitis is classified into four major forms: allergic, mycetoma, chronic invasive (indolent) and acute invasive (fulminant). It can become life threatening if not diagnosed and treated properly. The preliminary diagnosis is usually made by nasal endoscopy and computed tomography (CT) imaging, but tissue biopsy and culture are of vital importance in confirming the disease and in planning treatment. We present a case of allergic fungal rhinosinusitis (AFS) caused by Aspergillus flavus. The clinical manifestation of the disease was the presence of an extensive left nasal polyp. An allergic workup revealed systemic eosinophilia (11.7%), high serum IgE levels (1,201 IU/ml) and a positive skin test for Aspergillus. CT scan showed a total opacification and expansion of the left nasal cavity and sinuses, with a secondary inflammatory reaction on the right side. There was no bony erosion beyond the sinus walls. The patient was operated on using an endoscopic approach (polypectomy and ethmoidectomy), where an abundant amount of allergic fungal mucin and dark crusts were found filling the sinuses. Fungal hyphae were evident in histopathological sections of the removed mucin. Culture of the debris resulted in the growth of Aspergillus flavus. The patient received a full course of systemic and topical steroids. The serum IgE level had dropped to 353 IU/ml and the peripheral eosinophil count to normal (1.38%) by the 10th postoperative month. Surgical debridement and corticosteroids may keep the disease quiescent for a long time.

Aged↗
PubMed2005

Thrombolytic therapy use for acute myocardial infarction and outcome in Qatar.

OBJECTIVE: Data on the outcome of patients treated with thrombolytic therapy in the Arab world is scarce. The main objective of this study is to study the 7-day morbidity and mortality rate and the rate of use of thrombolytic therapy in patients presenting with acute myocardial infarction treated with thrombolytic therapy in the Middle East. METHODS: We conducted a retrospective analysis of prospectively collected data for all patients who were admitted to Coronary Care Unit in Cardiology Department in Hamad Medical during the period (1991-2001). Patients were divided into two groups in relation to ethnicity whether they received thrombolysis or not. In each group, the number of patients, age at the time of admission, gender, cardiovascular risk profile, therapy and outcome in regard of in-hospital complication and 7-day death as primary end point were analyzed. RESULTS: Of the total 5388 patients admitted with acute myocardial infarction during the 10-year period, 66.3% (3567) with STE MI were found, 61.4% (2190) of them received thrombolytic therapy while 38.6% (1377) were not eligible for thrombolytic therapy. The remaining 33.7% (1821) were admitted with non-STE MI. In consideration of ethnic variation, patients with STE MI eligible for thrombolytic therapy, 29.6% (1598) were Qataris and 70.4% (3792) were non-Qataris. Thrombolytic therapy was administered to 25.9% (414) of Qatari patients and 51.3% (1947) of non-Qataris. The mortality rate of Qatari patients who received thrombolytic therapy was 9.2% (38) vs. 19.5% (231) who did not receive thrombolytic therapy (p<0.001). In non-Qatari patients, the mortality rate was 5.2% (102) for those who received thrombolytic therapy, while it was 8.6% (159) for those with no thrombolytic therapy (p<0.001). When compared to male patients, female patients with thrombolytic therapy had higher mortality rates (in both Qataris and non-Qataris) (20.5% vs. 6.1%; p value<0.001 and 16.1% vs. 9.4%; p<0.001, respectively), there were no significant differences between the ethnic groups in regard to in-hospital complications. Patients treated with thrombolytic therapy had lower incidence of in-hospital complication regarding acute heart failure, post-myocardial angina, heart block and arrhythmia. Thrombolytic therapy reduced mortality rate in acute myocardial infarction by 69%. Logistic regression analysis had shown that arrhythmia, acute heart failure, heart block, cardiogenic shock, diabetes mellitus and stroke were independent predictors of increased mortality. Thrombolysis was used in 61.4%, which is still underutilized when compared to a few available studies in the Gulf area, and to other studies in the developed world. CONCLUSION: In the current study, use of thrombolysis in acute myocardial infarction was associated with significant decrease in in-hospital mortality and morbidity. Mortality rate was higher in the Qatari nationals when compared to non-Qataris. Reperfusion therapy may be underutilized in the developing world. Increased use of reperfusion therapy would result in reduced mortality rate. Global measures to encourage the use of reperfusion therapy including patients' education, and strategies to improve the health care system are needed.

Adult↗
PubMed1997

Fatty acid composition of twelve algae from the coastal zones of Qatar.

Fatty acid compositions of twelve algal species from two different classes were determined. Three Chlorophyta species (Acetabularia calyculus, Cladophora sericoides and Dictyosphaeria cavernosa) and nine Phaeophyta species (Colpomenia sinuosa, Cystoseria trinodis, Dictyota cervicornis, Hormophysa triquetra, Padina gymnospora, Sargassum binderi, S. boveanum, S. denticulatum and S. heteromorpha) were investigated. Thirty-four fatty acids were identified. Myristic, palmitic, oleic, linoleic, eicosodienic and lignoceric acids were predominant in all examined algal species. Branched saturated fatty acids were also found in all investigated species except Cladophora sericoides.

Chlorophyta↗
PubMed1992

Intussusception in children under 2 years of age in the State of Qatar : analysis of 67 cases.

Intussusception is one of the leading causes of bowel obstruction in early infancy and childhood. From 1984-1989, 67 patients under 2 years of age with intussusception were diagnosed and treated in our institution. There were 48 boys and 19 girls ranging in age from 2 months to 2 years with a mean of 7.4 months. Presenting symptoms and signs included abdominal pain (96%), vomiting (93%), rectal bleeding (60%) and a palpable mass (67%). Symptoms and signs were present for less than 24 hours in about 80% of cases. Most of the intussusceptions were of the ileocolic type (75%). The overall success rate of hydrostatic barium enema reduction was 49%. The highest rate of reduction by enema was among patients between 9 and 16 months of age (83%). The success rate of barium enema reduction was negligible after 24 hours of cardinal symptoms. Five children underwent surgical exploration without contrast studies because of delayed presentation and signs of an acute abdomen. A pathological lead point was found in only four cases, the commonest being Meckel's diverticulum. The average length of hospitalization was 2.57 days after barium enema reduction and 7.55 days after surgical reduction. There were no deaths. There was no case of perforation during enema reduction. Three children had recurrence within 3 months of initial presentation. The best outcome is associated with early diagnosis and barium enema reduction, or selected surgical intervention when indicated.

Barium Sulfate↗