Qatar Medical Journal最新文献

Malaria continues to pose a significant public health challenge in Africa, where 95% of global malaria cases and deaths occur in Sub-Saharan Africa (SSA). Cerebral malaria (CM) is a fatal type of severe malaria primarily caused by Plasmodium falciparum species and disproportionately affects children under five years. Despite ongoing control efforts, CM persists as one of the most prevalent presentations of severe malaria with surprisingly high prevalences even in regions with lower endemicity and transmission rates. This commentary presents an updated compilation of key CM-related public health challenges, including delayed presentation of cases and a lack of diagnostic tools in resource-limited African communities, leading to misdiagnosis. Further challenges include insufficient provision of anti-malarial drugs and inaccessibility in rural and remote areas, coupled with emerging resistance to the gold-standard therapy (artemisinin combination therapy). CM carries a high risk of long-term neurological complications and is seen in almost half of the survivors. These complications severely impair their daily quality of life and extend to social and financial challenges. CM survivors also suffer from the lack of appropriate health services such as continuous rehabilitation, medical care, and psychological support. Despite its burden, interventional research in CM management remains insufficient, particularly regarding short- and long-term neurological complications. Local African governments have occupied the backseat for the length of this continental health crisis. It is crucial for them to occupy a proactive role in supporting healthcare infrastructure and delivering high-quality health services. Intragovernmental collaborations and establishing a regional health network within Africa can ensure realistic and accurate surveillance data tracking. From this, strategic healthcare planning, control measures, and source allocation could be better observed and tailored to the needs of different African subpopulations.

Background: Obesity and type 2 diabetes mellitus (T2DM) are modern-day pandemics that have a significant impact on global healthcare. The glucagon-like peptide-1 receptor agonist (GLP1-RA) semaglutide is a novel treatment for both tbl2DM and obesity, but can be associated with an increased risk of venous thromboembolism. Case presentation: This case report describes a 59-year-old woman with tbl2DM who received semaglutide to manage glycemic levels, and also experienced the additional benefit of weight reduction. Within six months of initiating GLP1-RA, the patient experienced low back pain associated with nausea and poor oral intake. She had no known risk factors for venous thromboembolism or thrombophilia and had no history of significant illness in her family. Her physical examination revealed no significant findings. Only mild leukocytosis and neutrophilia were noted. She underwent an abdominal computed tomography scan, which revealed intrahepatic portal vein thrombosis without evidence of liver cirrhosis or abdominal malignancy. Her symptoms improved with oral anticoagulation (rivaroxaban). The result of thrombophilia examination was negative for inherited or acquired thrombophilia, except for a Janus kinase 2 mutation, which may increase the risk of thrombosis. Conclusions: The use of GLP1-RA is increasing due to the growing desire for weight loss medications. Therefore, it is important that physicians better understand the possible risks of thrombosis before initiating GLP1-RA treatment.

Introduction: Pulmonary barotrauma in coronavirus disease-2019 (COVID-19) acute respiratory distress syndrome (ARDS) carries high risk of mortality. While various studies have reported increased mortality, few have assessed the contributing factors for the occurrence of this complication. This study aimed at exploring the contributing factors for barotrauma in COVID-19 ARDS.

Methodology: In this retrospective study, patients aged ≥18 years with laboratory confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by reverse transcriptase polymerase chain reaction (RT-PCR) from a nasopharyngeal swab and having severe or critical COVID-19 disease requiring Intensive Care Unit (ICU) admission according to the World Health Organisation (WHO) criteria for disease severity in COVID-19 disease admitted at forty-bedded ICUs at a tertiary care research hospital in North India from April 1, 2020, to March 31, 2022 were included.

Results: Of 825 patients admitted to COVID ICU, 40 developed pulmonary barotrauma, with a mortality rate of 85%. The mean ± SD PaO₂/FiO₂ was 96.76 ± 27.78 mmHg. Thirty-nine patients received steroids, 37 developed secondary bacterial infection of the lower respiratory tract with one or more organisms. Acinetobacter baumannii (n = 15), Klebsiella pneumoniae (n = 10), and Pseudomonas aeruginosa (n = 8) were the commonest isolates. Ten patients developed pneumomediastinum, of which 6 patients had subcutaneous emphysema along with pneumomediastinum, and 2 patients developed isolated subcutaneous emphysema. The remaining 28 patients developed pneumothorax.The mean (±SD) for static respiratory system compliance (Crs) for patients on mechanical ventilation on the day of barotrauma was 19.3 (±10.5) mL/cmH₂O.

Conclusion: Patients with COVID-19 ARDS developing pulmonary barotrauma have a high associated mortality, and secondary bacterial infection, lung fragility, patient-ventilator asynchrony, as well as low respiratory system compliance, may contribute to lung injury, predisposing to barotrauma.

Background and purpose: Recent studies have highlighted the clinical characteristics and incidence of post-COVID-19 stroke conditions. Comparing the function and overall prognosis of stroke patients and post-COVID-19 stroke patients is an intriguing idea. Therefore, the aim of this study was to examine and compare the functional outcomes between the two groups from an occupational therapy perspective. Methods: Forty patients admitted to a rehabilitation facility were included, 20 of whom were diagnosed with post-COVID-19 stroke and 20 with non-COVID-19 stroke (ischemic and hemorrhagic). The study was a mixed design consisting of both prospective and retrospective data collection. Existing data from electronic medical records were used for the retrospective dataset. The retrospective dataset only consisted of data from post-COVID-19 stroke patients. The prospective dataset consisted of data from non-COVID-19 stroke patients. Data were collected at the time of admission and at discharge. Outcome measures included the functional independence measure (FIM), the Action Research Arm Test (ARAT), the post-COVID-19 functional status (PCFS) scale, the Borg rating of perceived exertion, and the mini-mental state examination (MMSE). Results: Both the post-COVID-19 stroke and non-COVID stroke groups showed significant differences before and after rehabilitation (NIHSS (National Institutes of Health Stroke Scale): p = 0.014, 0.000, FIM: p = 0.000, 0.000, MMSE: p = 0.015, 0.000, ARAT: p = 0.000, 0.000, respectively). However, the mean difference in the non-COVID-19 stroke group was higher than that in the post-COVID-19 stroke group, particularly in MMSE, FIM, and NIHSS scores (NIHSS: 2.8 ± 0.4, 0.9 ± 0.04, FIM: 34.8 ± 5.03, 32.95 ± 0.81, MMSE: 5.05 ± 3.5, 0.7 ± 1.17, ARAT: 1 ± 0.062, 1.2 ± 0.47, respectively). It was also found that in the post-COVID-19 stroke group, age had a positive influence on NIHSS (p = 0.022) and FIM (p = 0.047), and impaired side affected the NIHSS scores (p = 0.007). In the non-COVID-19 stroke group, significant correlations were found between the NIHSS and FIM scores (r = -0.445, p = 0.050) and the NIHSS and ARAT scores (r = -0.529, p = 0.017). Conclusion: Higher mean differences in the non-COVID-19 stroke group than in the post-COVID-19 group could be due to additional COVID-19 complications in the stroke condition itself. Overall functional gain was observed in both groups due to the effective rehabilitation. Therefore, rehabilitation is critical for functional optimization in such vulnerable populations. There is an urgent need to consider post-pandemic rehabilitation aspects.

Objectives: The aim of this study was to investigate the potential cardiac side effects associated with Pfizer/BioNTech and Sinopharm vaccines. Methods: A total of 200 healthy volunteers were enrolled after receiving two doses of Pfizer/BioNTech or Sinopharm vaccine 21 days apart. In addition, 100 healthy, unvaccinated individuals were included as a control group. Cardiac biomarkers such as cardiac troponin-I (cTnI), creatinine kinase-myocardial band (CK-MB), and myoglobin (MYO) were measured 4 days after receiving the second dose of vaccine. In addition, the SARS-CoV-2 neutralizing antibody levels of all participants were also determined. Results: Post-vaccination findings in both vaccinated groups were comparable. There was no statistically significant difference in cTnI, MYO, and CK-MB levels between the Pfizer/BioNTech and Sinopharm vaccine groups. Furthermore, our results showed that the levels of SARS-CoV-2 neutralizing antibodies stimulated by the Pfizer-BioNTech vaccine were significantly higher (171.19, p < 0.001) compared to the Sinopharm vaccine (70.14). Owing to the successful efficacy of the vaccine and based on the available data, COVID-19 vaccines remain the best option to eliminate the pandemic and its complications. Conclusion: Our study shows that both Pfizer-BioNTech and Sinopharm vaccines are safe for the heart in the short term, with no significant changes in cardiac biomarkers observed four days after vaccination. The findings suggest that these vaccines are effective and do not pose an immediate risk to cardiovascular health within the observed time frame. However, further research is required to assess the long-term cardiac safety profiles of these vaccines.

Background: The COVID-19 pandemic triggered a rapid shift to telehealth and reshaped healthcare delivery worldwide. In Qatar, telehealth has emerged as a critical tool for ensuring uninterrupted care while minimizing the spread of viruses. However, its long-term efficacy, particularly in mental health services, is still poorly understood. The aim of this study was to address this gap by evaluating the post-pandemic impact of telehealth on the accessibility of mental health services in Qatar. Methods: We conducted a comparative analysis of no-show rates over a four-month period before the initiation of telepsychiatry and telepsychology (March to June 2019) and corresponding periods in 2020, 2021, and 2022. The analysis considered visit types (new visit and follow-up visit) in various psychiatric (child and adolescent, adult, geriatric, forensic, and intellectual disability) and psychological outpatient clinics before and after the implementation of telehealth services. Results: Among both new and follow-up cases, there was a significant reduction (p < 0.0001) in the collective proportion of no-show rates following the introduction of telehealth compared to the rates recorded before the implementation. Exceptions to this trend were appointments in child and adolescent mental health service psychology and forensic psychiatric services. Conclusion: Telehealth has proven instrumental in improving access to mental health services in Qatar post-pandemic. Its integration shows the potential for reducing no-show rates and enhancing continuity of care. These findings are important for healthcare policy-making and practice in Qatar and provide valuable insights into the global discourse on the evolving role of telehealth.

Background: The World Health Organization (WHO) considers health to be a fundamental human right. Health is a resource that enables people to lead productive lives on an individual, social, and economic level. In Qatar, there are a limited number of studies addressing the health-promoting lifestyle behaviors of healthcare employees. Aim: The aim of this study was to compare the health-promoting lifestyle of at-risk and non-risk groups of employees working in Hamad Medical Corporation (HMC), the largest secondary and tertiary healthcare provider in the State of Qatar. Methods: This was a cross-sectional comparative research study of all categories of healthcare employees working in HMC facilities. Participants with a body mass index (BMI) >30 kg/m², smokers, or those with pre-existing non-communicable diseases (NCDs) were classified as the at-risk group, and individuals without any of these factors were classified as the non-risk group. Data were collected through an online survey using an adopted scale, Adolescent Health Promotion Short Form (AHP-SF), after approval by the Institutional Review Board (IRB) of HMC. Results: The age of the participants ranged from 22 to 69 years and the majority of them were female (64.07%). Most of the respondents were overweight or obese, accounting for 42.99% and 26.68% of the sample, respectively. Interestingly, 87.64% of the participants were non-smokers and approximately 70% had no chronic diseases. The overall AHP-SF score was 60.01/84 ± 12.32, with the highest score from the "life appreciation" subscale (12.68/16 ± 2.84) and the lowest score from the "exercise" subdomain (7.05/12 ± 2.93). Five subdomains - nutrition, social support, health responsibility, exercise, and stress management - of the AHP-SF scale showed no significant statistical differences between at-risk and non-risk groups. However, the "life appreciation" scale showed significant statistical differences between the at-risk (12.91/16 ± 2.69, p = 0.04) and non-risk (12.42/16 ± 2.98) groups. The AHP-SF scores varied significantly across the participants' regions of origin, with Americans having the highest score (63.93/84 ± 10.67, p = 0.03) compared to other regions. Conclusions: Healthcare employees moderately practice health-promoting lifestyle behaviors. The lowest scores were in the exercise subdomain, suggesting that more interventions are required to improve these behaviors. Healthcare organizations are ideal settings to implement comprehensive workplace wellness programs and awareness campaigns that can motivate employees to take greater responsibility for their own health and influence the wider community to adopt health-promoting lifestyle behaviors.

Background: Leishmaniasis is an emerging tropical infectious disease in Qatar. It is caused by the protozoan parasite of the Leishmania genus, which is endemic in many regions of the world, including the Middle East. In Qatar, there is limited data about this disease, which is hindering the efficient planning and implementation of disease prevention and control measures. Therefore, to address this knowledge gap, we conducted a retrospective study to gather information on the prevalence, clinical characteristics, as well as outcomes of leishmaniasis treatment. The primary objective of this study is to provide a comprehensive analysis of leishmaniasis cases in Qatar over seven years (2016-2022). The findings of this study offer valuable insights that can guide the development of a national registry and treatment program for leishmaniasis in Qatar.

Methods: Using a retrospective cross-sectional study design, clinical and epidemiological data of all documented cases of leishmaniasis in Qatar between 2016 and 2022 were collected from electronic medical records at Hamad Medical Corporation (HMC).

Results: A total of sixty-eight cases of leishmaniasis were detected in Qatar between 2016 and 2022. Males were predominant (69.12%) with a median age of 33 years. Our study revealed a higher incidence of leishmaniasis among individuals of Syrian nationality, followed by Pakistani and Sudanese, thus promoting further investigation into the underlying factors contributing to this health disparity. Our findings revealed important epidemiological trends, highlighted key clinical characteristics, identified risk factors associated with susceptibility to leishmaniasis, and reported treatment outcomes.

Conclusion: This retrospective study presents the first comprehensive analysis of leishmaniasis in Qatar, shedding light on the epidemiology, clinical characteristics, and treatment outcomes of the disease. The data generated from this study can serve as a guide for authorities in establishing a national registry and treatment program for leishmaniasis in Qatar. Implementing these measures will contribute to the effective management and control of leishmaniasis, ultimately improving patient outcomes and public health in the country.

Background: Obese patients are at increased risk of postoperative respiratory complications because of sedatives and opioids. The erector spinae block is a novel regional block that has been used in different surgeries. It offers an easier approach and a better safety profile. This study aimed to assess the role of erector spinae plane block (ESPB) in reducing postoperative pain scores and opioid consumption in patients undergoing sleeve gastrostomies.

Methods: Institutional committee approval was obtained for this randomized controlled trial. Inclusion criteria included patients aged between 18 and 65 years with American Society of Anesthesiologists (ASA) scores 1-3 who were scheduled to undergo laparoscopic sleeve gastrectomy under general anesthesia. Simple randomization using sealed opaque envelopes was used to allocate study patients to either of the two groups. The intervention group received erector spinae block using 0.2% ropivacaine just after induction of anesthesia while the control group did not receive a block. Primary outcome variables were pain scores during the first 24 hours after surgery.

Results: A total of 60 patients were included in the study. There was no significant difference in the baseline characteristics between two groups. Numerical rating scale (NRS) pain scores in the postoperative period were lower in the ESPB group but there was no statistical significance. Intraoperative remifentanil consumption was statistically lower in the ESPB group compared to the control group (P < 0.01). ESPB also reduced 24-hour opioid consumption (P = 0.002). There was no statistical difference in the incidence of adverse events between the two groups.

Conclusion: The use of ESPB in laparoscopic sleeve gastrectomy patients is associated with a significant reduction in intraoperative and 24-hour postoperative opioid consumption.

Trial registration id: The trial was registered with Clinicaltrials.gov as trial ID-NCT04368195.

Introduction: Motor vehicle accidents (MVAs) are a leading cause of mortality and morbidity worldwide. There is limited literature on the injuries resulting from desert off-road driving accidents. This study aims to delineate the attributes of desert MVA and associated injuries as observed in Qatar.

Methods: This is a Qatar-based retrospective descriptive multicenter study from electronic medical records (EMRs) between 2016 and 2022. Patients were evaluated based on demographic characteristics, type of injury and vehicle involved, injury locations, injury severity, treatments applied, length of hospital stay, number and outcome of surgeries, disability on discharge, and mortality.

Results: Findings reveal a rising trend in accidents from October to March, peaking between 4:00 p.m. and 8:00 p.m. The patients were predominantly male under 40 years of age, not adhering to personal protective measures, and accidents often involved all-terrain vehicles (ATVs) and sport utility vehicles (SUVs). Blunt trauma emerged as the primary injury type, with orthopedic injuries being the most frequent. Most patients did not undergo surgery and had an average hospital stay of 2.9 days. A 1.5% mortality rate and 6.7% disability rate were observed.

Conclusion: This study fills a critical gap in understanding desert traffic accidents in a Gulf Cooperation Council country. This study underscores the need for targeted interventions and public awareness campaigns tailored to the unique challenges of desert driving.