Qatar Medical Journal最新文献

Background: During the Coronavirus disease (COVID-19) pandemic, healthcare workers globally experienced unprecedented levels of stress. However, limited research has focused specifically on paramedics. As frontline workers, paramedics were placed under immense and unprecedented pressure. This study assessed stress levels and Post-Traumatic Stress Disorder (PTSD) symptoms among paramedics in Qatar before and during the COVID-19 pandemic.

Methods: An online survey adapted from validated tools was distributed to all paramedics in Qatar employed by Hamad Medical Corporation Ambulance Service (n = 1100) between December 2020 and March 2021. Responses from volunteer participants were analyzed with data stratified by demographic factors to explore their impact on self-reported stress and PTSD levels. Stress levels were categorized into five ranges, from low to potentially dangerous.

Results: The study received 272 valid responses. Before the pandemic, paramedics reported moderate stress levels, which escalated to severe levels during the pandemic. A paired t-test revealed significant differences in average stress and PTSD symptom scores before and during the pandemic. Symptoms included intrusive memories, avoidance behaviors, hypervigilance, sleep disturbances, and emotional numbness (P < 0.05). The average total PTSD score increased significantly during the pandemic from 37.59 (±16.02) before the pandemic to 42.42 (± 17.29; P < 0.05). The proportion of paramedics reporting little to no PTSD symptoms decreased from 39.3% before to 28.3% during the pandemic. Conversely, those reporting highly severe PTSD increased from 33.1% to 44.1% (P < 0.001).

Conclusion: The study highlights a significant increase in stress levels and PTSD symptoms among paramedics in Qatar during the COVID-19 pandemic compared to the pre-pandemic period. This rise can be attributed to their role as frontline responders, which exposed them to heightened risks of infection, long shifts, and prolonged periods between leave. The findings underscore the need for targeted interventions to address stress and PTSD among paramedics, ensuring their mental and physical well-being and enabling them to continue providing effective medical care.

Background: Degenerative lumbar spinal diseases are a leading cause of disability worldwide, often requiring surgical intervention when conservative management fails. Transforaminal lumbar interbody fusion (TLIF) is a commonly employed procedure to stabilize the spine and alleviate symptoms. This systematic review and meta-analysis aimed to test the safety and efficacy of robotic-assisted minimally invasive transforaminal lumbar interbody fusion (RA MIS-TLIF) in managing degenerative lumbar spinal diseases. Our primary objective was to compare the robotic approach with the conventional open or minimally invasive approach for TLIF regarding patients' perioperative and postoperative outcomes.

Methods: PubMed, Cochrane Library, Scopus, and Embase were searched from inception until October 2023. The selection criteria included only English-language articles focused on human participants aged 18 years and older with measurable outcomes. Prospective and retrospective cohort studies were included. Relevant data regarding perioperative outcomes and postoperative pain scores were then extracted. Review Manager (RevMan) 5.4 was used for statistical analysis. No restrictions were applied regarding the surgical approach compared to the robotic approach. This review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: Twelve observational studies, including 1,385 patients, were included in our final analysis. Robotic-assisted minimally invasive lumbar interbody fusion was associated with significantly lower blood loss compared to both open (MD: -161.11 mL [95% CI, -184.89 to -137.34]) and conventional minimally invasive surgery (MD: -25.18 mL [95% CI, -64.06 to 13.70]), with an overall significant reduction (MD: -76.27 mL [95% CI, -118.65 to -33.90]). Operative time was significantly longer in robotic surgery compared to non-robotic approaches (MD: 17.61 minutes [95% CI, 4.10 to 31.11]). Hospital stay was shorter in the robotic group than in the non-robotic surgery group (MD: -0.89 days [95% CI, -1.54, -0.24]). Radiation time and dose showed no significant differences. Postoperative pain and functional outcomes, including ODI and VAS scores, showed a trend toward improvement in the robotic group but did not reach statistical significance.

Conclusion: Robotic-assisted minimally invasive TLIF shows promising results in operative time and blood loss compared to open or minimally invasive TLIF.

Background: Vitamin D deficiency is increasingly recognized as a significant public health issue, with far-reaching effects on bone health and overall well-being, especially among children and adolescents.Aim/Objectives: This cross-sectional, record-based study aimed to assess the prevalence and predictors of vitamin D deficiency in individuals under 18 years old who attended Primary Health Care Corporation (PHCC) centers in Qatar between 2018 and 2019.Methodology: Data were extracted from 48,947 electronic medical records, each containing at least one valid serum vitamin D test result. Severe deficiency was defined as serum vitamin D levels <10 ng/ml. Participants undergoing vitamin D therapy were excluded from the prevalence analysis.

Results: Findings revealed that infants (under 1 year) and children aged 1-4 years had the lowest rates of severe deficiency at 3.8% and 3.4% respectively. The prevalence increased with age, reaching 40% among adolescents (10-17 years). Females had significantly higher rates of severe deficiency (30.4%) compared to males (15.3%).Multivariate logistic regression identified age, sex, and nationality as significant predictors. Adolescents were 17 times more likely to have a severe deficiency compared to children under 5 years. Females had a 2.4-fold increased risk, and individuals from Southern Asia had a 5.7-fold higher risk compared to other nationalities.

Conclusion: This study highlights a high prevalence of vitamin D deficiency among adolescents in Qatar, particularly among females and certain ethnic groups. To address this emerging health issue in the pediatric population, targeted interventions, such as awareness campaigns, supplementation programs, and policy-level strategies, are essential.

Hydatid disease (echinococcosis) is a zoonotic infection caused by Echinococcus species, characterized by cyst formation in various organs, most commonly the liver and lungs. While often asymptomatic in the early stages, progressive cyst growth can lead to severe complications, including organ dysfunction, secondary infections, or rupture. In this review, we aimed to assess the incidence of hydatid disease among pediatric populations across different regions. We searched PubMed, Scopus, Cochrane, and Web of Science for studies reporting the incidence of hydatid disease in children up to February 20, 2025. A random-effects meta-analysis was performed using STATA version 28. Subgroup analyses were conducted based on country, geographic region, and cyst location. Study quality was assessed using the Newcastle-Ottawa Scale. We pooled data from nine studies, yielding an overall incidence of 3.37 per 1,000 children (95% confidence interval [CI]: 0.52-8.48), with substantial heterogeneity (I ² = 99.97%). The highest incidence was reported in China (17.86 per 1,000), followed by Turkey (1.48 per 1,000) and Bulgaria (1.47 per 1,000). Lower incidence rates were reported in Iran (0.62 per 1,000) and Romania (0.12 per 1,000). Studies conducted in rural areas showed a higher incidence (14.84 per 1,000) compared to those including patients from diverse geographic regions (1.91 per 1,000). Based on the available evidence, we conclude that the incidence of hydatid cysts in children varies across countries, with the highest rates observed in China and in rural areas. Echinococcosis poses a significant threat to both public health and livestock; therefore, effective monitoring and control strategies are crucial to reduce its impact.

Background: Thyroid cancer is the most common endocrine cancer worldwide. Differentiation between benign and malignant thyroid pathology is crucial for optimum management. Immunohistochemical markers (IHC) such as galectin-1 and the trophoblast cell surface antigen 2 (TROP-2) are valuable tools in this differentiation. The study aimed to evaluate the role of immunohistochemical expression of galectin-1 and TROP-2 in differentiating benign from malignant thyroid lesions.Methodology: This retrospective observational study analyzed 136 thyroid specimens, including 50 cases of follicular nodular disease (FND), 23 follicular adenomas (FA), 37 papillary carcinomas (PTCs), and 26 follicular carcinomas (FTCs) collected from Al-Yarmouk Teaching Hospital from October 2022 to October 2024. All cases underwent IHC staining for galectin 1 and TROP-2.

Results: Galectin-1 IHC expression was significantly associated with tumor size of papillary carcinoma cases (P = 0.002). TROP-2 IHC expression was significantly associated with female gender (P = 0.0006) and tumor size in follicular carcinoma cases (P = 0.031). A highly significant difference in IHC expression between benign and malignant cases was observed for both markers (P = 0.001). TROP-2 expression was higher in malignant cases at 82% (papillary and follicular carcinoma) compared to galectin-1 (62%; P value, 0.0097).

Conclusion: Both galectin-1 and TROP-2 showed higher expression in malignant thyroid cases compared to benign lesions. TROP-2 showed higher sensitivity in detecting malignant lesions, whereas galectin-1 exhibits greater specificity. Combining both markers enhances the differentiation between benign and malignant lesions, thus providing valuable diagnostic insight.

Background: Globally, cognitive impairment has evolved as a major health and social issue. Hypertension, age, and stroke are independent risk factors for the development of cognitive impairment. Elderly individuals with hypertension are more prone to earlier cognitive decline. The risk is reduced by proper antihypertensive treatment. Various classes of antihypertensive drugs have varied protective effects on cognition, so we aimed to compare the cognitive scores of individuals taking different classes of antihypertensive drugs and correlate the blood pressure levels with their cognitive scores.

Methods: Known hypertensive individuals belonging to the age group of 35 to 60 years participated in this single-center cross-sectional study conducted in a tertiary care center in southern India. Individuals with any chronic systemic illness or any history of pre-existing cognitive impairment were excluded from the study. After taking a detailed history on hypertension and drug history, the patient's cognition was assessed using the Montreal Cognitive Assessment (MoCA) test. Out of a total score of 30, greater than or equal to 26 is considered normal. The hypertensive individuals were divided into three groups, namely those who were taking Angiotensin Receptor Blockers (ARBs), Calcium Channel Blockers (CCBs), and other antihypertensive drugs, and their cognitive scores were compared.

Results: Two hundred and forty-nine known hypertensive individuals participated in the study, of whom 43% were found to be males. Patients on ARBs (25.1 ± 3) had higher cognitive scores compared to CCBs (22.6 ± 3.8) and other antihypertensive drugs (24.3 ± 3.8). When the cognitive scores were correlated with mean arterial pressure, it showed a negative association was shown (P-value, 0.45). When grouped individually and analyzed using an independent t-test, patients who have been hypertensive for more than 5 years and who were on irregular treatment showed lower cognitive scores, which is statistically significant.

Conclusion: Our study showed a strong association between hypertension and cognitive function decline, and also the ARBs' protective effect over other classes of antihypertensive drugs. The pharmacodynamics of different classes of antihypertensive drugs should be taken into account to support the cognitive health of hypertensive individuals.

Introduction: Cognitive health, crucial for the independence and quality of life in older adults, is influenced by various factors, including nutritional status, which is increasingly recognized for its importance. Folate (vitamin B9) and cobalamin (vitamin B12) are essential for neurological health. Despite most studies offering broad global insights, this research addresses the knowledge gap regarding the relationship between folate and cobalamin levels and cognitive memory performance in a cognitively healthy aging adult. The primary objective of this study is to examine the relationship between memory performance and blood levels of folate and cobalamin, as well as to identify the determinants of memory performance, in adults in Qatar.

Methods: We conducted a cross-sectional analysis of the data obtained from Qatar Biobank. This study assessed cognitive performance using the Cambridge Neuropsychological Test Automated Battery and measured blood concentrations of folate and cobalamin. Additionally, we examined demographic, lifestyle, behavioral, and disease-related factors as determinants of memory performance. We used multivariable linear regression to identify associations between Paired Associated Learning First Attempt Memory (PALFAMS) and vitamin levels.

Results: Six hundred and thirty-six individuals aged 40 years and older were included in this study. The z-scores for blood levels of folate and cobalamin were each found to be positively associated with the PALFAMS (β, 0.17 [95% CI, -0.188 to 0.538]; P = 0.334 and β, 0.19 [95% CI, -0.15 to 0.53]; P = 0.28, respectively), after adjustment for covariates. Older age and being male were found to have negative associations with PALFAMS (β, -0.10 [95% CI, -0.18 to -0.02]; P = 0.011 and β, -0.98 [95% CI, -1.91 to -0.05]; P = 0.040, respectively), whereas a higher level of education and the use of supplements showed positive associations with memory function (β, 3.76 [95% CI, 2.38 to 5.14]; P < 0.001 and β, 0.76 [95% CI, 0.02 to 1.50]; P = 0.044), after adjustment for covariates.

Conclusion: Since the associations between blood levels of folate and cobalamin and memory performance were not statistically significant, these results underscore the need for more comprehensive studies to explore the complex relationships between nutrition and memory performance, ultimately guiding more effective strategies for the prevention and management of memory impairment.

Background: Gram-negative bacteremia (GNB) causes substantial morbidity, mortality, prolonged hospitalization, and readmissions worldwide. Standard practice recommends initial intravenous (IV) antibiotics, but many clinically stable patients now complete therapy through outpatient parenteral antimicrobial therapy (OPAT), which may improve antimicrobial stewardship and reduce costs. This study aims to compare clinical and economic outcomes of inpatient versus OPAT-managed GNB.

Methods: We conducted a retrospective observational cohort study of all adults with GNB treated at a 320-bed general hospital from July 2021 to July 2022. We excluded patients younger than 18 years, blood culture contaminants, and patients with Gram-positive or mixed infections. Patients were assigned to four final treatment pathways: inpatient IV only, hospital-based OPAT IV room (OPAT-IV), home-based IV therapy (Home-IV), or early oral switch. Primary outcomes were 30-day mortality and bacteremia recurrence; secondary outcomes were length of stay and treatment cost.

Results: We identified 125 patients (mean age, 56 years; 51.2% female). Most isolates originated from urinary (54.4%) or intra-abdominal (23%) sources. Pan-sensitive organisms accounted for 57.6% of cases; extended-spectrum β-lactamase producers, 35.2%; and multidrug-resistant organisms, 7.2%. Thirty-seven patients (29.6%) completed IV therapy as inpatients, 16 (12.8%) in OPAT-IV, 13 (10.4%) in Home-IV, and 59 (47%) were discharged on oral antibiotics. Nine deaths (24.3%) occurred in the inpatient group and one (7.7%) in Home-IV; no deaths occurred in OPAT-IV or oral-therapy groups. Readmissions within 90 days were uncommon (≤7.7% across groups). Mean antibiotic durations were 13.0 days (inpatient), 11.3 days (OPAT-IV), 10.6 days (Home-IV), and 7.7 days (oral). OPAT pathways shortened hospital stays and reduced drug and bed-day costs.

Conclusion: OPAT provided safe, effective treatment for selected patients with GNB, lowering mortality, shortening length of stay, and reducing costs compared with continued inpatient care. Careful patient selection and early IV-to-oral transition can maximize these benefits while maintaining favorable clinical outcomes.

Introduction: Empyema, characterized by the accumulation of pus in the pleural space, poses a significant medical challenge with diverse complications. This study aims to provide a comprehensive overview of the epidemiology, microbiological spectrum, management strategies, and outcomes of empyema patients in Qatar.

Methods: We conducted a comprehensive review of electronic medical records from all hospitals affiliated with Hamad Medical Corporation, the national healthcare system of Qatar, for patients aged 18 years and older diagnosed with empyema between January 1, 2015, and December 31, 2019.

Results: Seventy-five empyema cases were reviewed, predominantly male (89.3%) with a mean age of 44 years. Common comorbidities included diabetes mellitus (30.7%) and a history of malignancy (20%). Pleural fluid was universally exudative, with turbidity in (55.4%) and blood staining in (16.9%). Streptococcus (38.7%) and Gram-negative bacteria (29.3%) were the predominant pathogens. All patients received antibiotics, with chest tube insertion as the primary intervention in 74.6%. Video-Assisted Thoracoscopic Surgery (VATS) was performed in 24% and medical thoracoscopy in 1.3%. The mortality rate was significant at 18.6%. Univariate and multivariate analyses indicated that a prior history of pneumonia (P = 0.004), pleural effusion/empyema (P = 0.024), and malignancy (P < 0.036) were significant predictors of mortality.

Conclusion: Streptococci were identified as the predominant pathogen in empyema cases in Qatar, with Diabetes Mellitus being the most common comorbidity. Early antibiotic therapy and chest tube insertion were key to effective management, often reducing the need for surgical interventions. Despite this, mortality remains a significant concern.

Background: Drug-drug interactions (DDIs) can lead to adverse events or altered drug effectiveness, and polypharmacy increases the likelihood of DDIs. This study aimed to explore the prevalence of clinically significant DDIs among patients with mental health problems who are prescribed psychotropic medications.

Methodology: This was a retrospective observational study that included patients who had visited the Outpatient Mental Health Pharmacy at Mental Health Services (MHS) in Qatar for medication dispensing. The study covered all individuals over 2 months, totaling 1586 patients. The list of medications was cross-referenced with Lexicomp^® to identify potential DDIs. Then, each identified DDI was assessed for risk rating, severity, and reliability rating. Descriptive analysis was applied first. The Shapiro-Wilk test for normality, the chi-square test, the Mann-Whitney U test, and binary logistic regression were conducted as appropriate.

Results: Of the 1586 files reviewed, 49% of the patients did not experience any DDIs, while the remaining 51% (n = 807) had at least one potential interaction. Among these, 44% had no comorbidities aside from their psychiatric condition. Anxiety disorders (25.65%) and schizophrenia (23.9%) emerged as the most common diagnoses. Patients were found to be taking an average of 4.69 ± 3.36 medications, with 2.23 ± 0.96 of these being psychotropic drugs. On average, each patient experienced 3.15 potential psychotropic DDIs. The majority of the interactions belonged to Category C (86%; n = 2192), followed by Category D (7.8%; n = 200). The total number of medications was the only statistically significant predictor of having potential "Intervention Required/High-Risk Drug Interactions" (P < 0.001).

Conclusions: The study provided valuable insight into the prevalence of potential DDIs among patients prescribed psychotropic medications in Qatar. Notably, the analysis highlighted significant interactions, particularly those associated with severe outcomes, like Torsades de Pointes and anticholinergic intoxication. These findings underscore the need for targeted strategies to mitigate adverse effects and enhance patient safety in clinical practice.