Toe tourniquet syndrome

Toe tourniquet syndrome refers to external, mechanical, circumferential constriction of the toes. We report a series of 4 infants with toe tourniquet syndrome from Saudi Arabia who presented during wintertime with very similar symptoms [approximately 48 hours of inconsolable crying and irritability], similar involved region [toes], and similar constricting agent [hairs]. Immediate removal of the hair fibers was carried out in all patients, fortunately followed by fast healing with no signs of tissue necrosis. The prompt diagnosis and treatment of the condition were vital in attaining the good outcome and preventing ischemic complications

Factors associated with successful induction of labor

To evaluate the prevalence, indications, and factors associated with successful induction of labor [IOL], and maternal and neonatal outcomes. All women booked for IOL at King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia from April 2010 to March 2011 were included. The characteristics of women who had successful IOL were compared to those who delivered by cesarean section [CS]. A multivariable logistic regression analysis was performed to evaluate the factors associated with successful IOL. During the study period, 564 women had IOL. The prevalence rate of IOL was 16%. Vaginal delivery was achieved in 472 [84%] women. The most common indications for IOL were post-term pregnancy in 174 [31%], and diabetes mellitus in 131 [23.2%] of the participants. Maternal characteristics associated with risk of CS were nulliparity [odds ratio: 1.58; 95% confidence interval: 1.09-2.320; p=0.01], and high maternal body mass index [p=0.01]. Neonates of women with successful IOL had significantly higher APGAR scores [p=0.04], and more frequent pH ?7.1 at delivery [p=0.02]. There was no difference in the rate of post-partum hemorrhage, CS, or ruptured uterus between the women who had IOL, and those who went into spontaneous labor. Nulliparity and maternal weight are the main determinants of the outcome of IOL. Case selection for IOL is vital for achieving outcomes similar to spontaneous labor

Medical and surgical management of fecal incontinence after repair of high imperforate anus anomalies

To report the medical and surgical management of fecal incontinence in children after repair of high imperforate anus. Thirty-seven children with fecal incontinence post repair of high imperforate anus were recruited between January 2000 and July 2007 at Aseer General Hospital, Abha, and Alhada Military Hospital, Taif, Kingdom of Saudi Arabia. The decision for surgery [dynamic graciloplasty] was based on the degree of incontinence and failure to respond to medical treatment. Five children were operated from the start according to the input of history, examination, and investigations [incontinence score of 15-20]. The remaining 32 patients were treated medically. Those cases that failed to respond to medical treatment had alternatively biofeedback therapy. Cases that failed to respond to biofeedback therapy underwent surgery. Response to medical treatment is favorable [71%]. Biofeedback showed discouraging results [22%] Dynamic graciloplasty showed excellent outcome [100% improvement in continence on long term follow up]. Based on history, examination, and investigations, recruited cases were primarily treated medically; those who had failed the medical treatment approach had dynamic graciloplasty, which demonstrated excellent results during the 1 -7 years follow-up period

Road traffic fatalities in Qatar, Jordan and the UAE: estimates using regression analysis and the relationship with economic growth

Smeed's equation is a widely used model for prediction of traffic fatalities but has been found inadequate for use in developing countries. We applied regression analysis to time-series data on vehicles, population and traffic fatalities in the United Arab Emirates [UAE], Jordan and Qatar. The data were fitted to exponential models for fatality prediction, producing an average absolute error of 20.9% for Qatar, 10.9% for Jordan and 5.5% for the UAE. We found a strong linear relationship between gross domestic product and fatality rate

Survey of hepatitis markers among donors in the state of Qatar

A total of 78,428 blood units collected by the Blood Donor Unit, Hamad Medical Corporation, Doha, from the multinational donors of Qatar [28,622 Qatari nationals donors and 49, 806 Non-Qatari donors] in the period January 1994 to Dececember 2001 were screened for hepatitis markers. About 10, 382 units [13.2%] were discarded because of positivity for one or more hepatitis markers; 769 units [0.9%] were positive for hepatitis-B surface antigen [HBsAg], 8516 units [10.9%] were positive for hepatitis- B core antibodies [HBcAb] and 1097 units [1.39%] were positive for hepatitis C [HCV] antibodies. There was no significant difference between the rate of positivity for HBcAb and HBsAg in indigenous Qataris and Non-Qataris despite a slightly higher rate of positivity for HCV antibodies in the Non-Qatari group. An outstanding finding was the significantly high rate of positivity for HCV antibodies in Egyptian donations [11.2%], which accounted for 31.2% of all discards for the Non-Qatari group. As the Blood Donor Unit at HMC is the only blood collection center in Qatar it is assumed that the results could be representative of the country as a whole

Prevalence of human T-lymphotropic virus [HTLV] antibodies among the donor population in the state of Qatar

To determine the prevalence of antibodies to HTLV-1 and II among the donor population in Qatar and to evaluate the relevance of continuing routine pretransfusion screening of all donations for HTLV-I and 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

Drainge of pancreatic pseudocysts. the importance of cyst wall biopsy in the recent era

While open internal drainage has been the standard treatment for pancreatic pseudocysts, less invasive techniques which pay little attention to cyst wall biopsy, are becoming popular. The aim of this study is to report on our experience in draining pancreatic pseudocysts and probe the necessity or otherwise of obtaining a wall biopsy at drainage. Operation theatre registry, operation log books and medical records at Aseer Central Hospital, Abha, Kingdom of Saudi Arabia, were reviewed to retrieve the clinical details of patients with pancreatic pseudocyst who required a drainage procedure in a 13 years period from August 1989 to November 2002. Sixteen patients were identified. Cyst wall biopsy was obtained in 10 cases, in 8 of them the diagnosis was confirmed, while a true cyst was found in the remaining 2 excluding them from further analysis. In the remaining 14 cases [8 males, 6 females, mean age 38 years, range 4-60], pain was the main presenting feature. Open internal drainage was offered to 12 cases while one patient received external drainage under ultrasound guidance and the other received open external drainage. The type of operation was cystogastrostomy in 9 patients and cystojejunostomy in 3 patients. The recurrence rate after internal drainage was 16.7%, while after external drainage was 100%. There was no mortality in this series. A procedure-related complication occurred in 3 [21.4%] patients. The mortality, morbidity and recurrence rates in this series are compared favorably with other reports. The final diagnosis of a presumed pancreatic pseudocyst should rest on the histopathologic examination of the cyst wall

Improved screening of donor's blood for malaria: a qatari experience

Malaria is one of the most widespread infections globally and is undoubtedly responsible for the majority of all cases of transfusion-transmitted disease in the world. Qatar is free from endemic malaria. However, cases are seen with the large expatriate workforce imported from malarious areas. These constitute a significant percent of the blood donors'pool [34%]. Over a 27-month period, among 5845 volunteers tested for malaria, 21 were deferred [0.36%] showing positive result when screened by the Giemsa-stained thick smear technique, with 2 undiagnosed cases that led to transfusion-transmitted malaria. Since then and for the last 21 months, the Falciparum-Spot immunofluo-rescence [IF] test was implemented in an attempt to ensure accurate screening. Among 6367 donors tested, 274 [4.3%] were deferred. Careful questioning about donor travel history, expansion of deferral policy and the use of a more sensitive screening test have all resulted in increasing layers of safety where no transfusion-transmitted malaria was reported in the last 21 months. These measures were necessary to regain the trust of the public in the safety and stewardship of the blood supply

Undescended testes: do we need to fix them earlier?

Patients with undescended testes [UDT] may present with acute testicular torsion or incarcerated hernia requiring immediate surgical intervention. The exact incidence of these two complications among cases of UDT is not known. The aim of this study was to investigate the frequency of such conditions in our series of undescended testes, and to evaluate whether early intervention in undescended testes could eliminate such problems. All the data of patients with undescended testes admitted for surgery in Aseer Central Hospital, Abha Saudi Arabia, over a 6-year period were reviewed. In two hundred and ninety patients, 18 presented acutely with torsion of the undescended testicle in the inguinal canal [n=11] or incarcerated inguinal hernias [n=7]. The data of these 18 patients were looked up for patient characteristics. Methods of diagnosis, preoperative preparation, operative findings, operative interventions, histopathological results and outcome were all analyzed. Ten out of 18 patients [55.5%] were less than six months. Nine out of eleven patients with testicular torsion required orchiectomy. The other two underwent orchiopexy, which ended up with atrophy. All patients with incarcerated hernia had simultaneous hernia repair and orchiopexy; of which, three atrophied. Acute testicular torsion and hernia incarceration in cases of cryptorchidism may be more prevalent than initially thought. Orchiopexy, as early as 3 months of age, may reduce the incidence of such problems. 'Therefore, earlier intervention in undescended testes [between 3-6 months] is recommended

Abdominal twin foetuses-in-foetu in an infant: Case report and review of literature

We present a case of intra-abdominal twin foetuses-in-foetu in the left upper retroperitoneal space attached uniquely to the pancreas in a 5-month-old male infant. Antenatal ultrasonography demonstrated the presence of the mass. Although a bony component was present in the mass; the plain x-ray abdomen was not helpful in the diagnosis and abdominal computed tomography was the main diagnostic tool. Diagnosis was only confirmed at laparotomy