Qatar Medical Journal最新文献

Background: Familial Mediterranean fever (FMF) is an autosomal recessive disease caused by mutations in the MEFV gene and is characterized by recurrent febrile episodes of abdominal pain, chest pain, and joint involvement. We aim to study the clinical and genetic features of FMF in Moroccan children and to establish a phenotype-genotype correlation in this group of patients.

Methods: A total of 35 patients were included in this study. Genetic analysis of exon 10 of the MEFV gene was performed in 33 patients. To establish a phenotype-genotype correlation, we statistically compared clinical features between patients with and without the M694V mutation.

Results: Abdominal pain was observed in 82.9% of our patients, followed by fever (74.3%), arthralgia (85.7%), arthritis (42.8%), chest pain (34.3%), and IgA vasculitis (20%). Genetic analysis showed a predominance of the M694V mutation (62.5%), followed by A744S (11.4%) and K695R (5.7%). The presence of the M694V genotype was found to be significantly associated with a high frequency of arthralgia and arthritis. A significant association was found with an earlier age of onset in the absence of the M694V mutation.

Conclusion: Joint involvement is more common in the M694V genotype, and the genetic profile shows different results compared to neighboring countries.

Background: The introduction of the varicella vaccine has led to a significant decrease in pediatric varicella-induced invasive Streptococcus pyogenes (group A streptococcal [GAS]) infections. However, the development of a pleural empyema following a chickenpox infection is a rare complication in pediatric patients.

Case presentation: In this report, we present a 5-year-old male patient who presented to the emergency department with a deteriorating course two days after a chickenpox infection. The patient complained of high-grade documented fever, a congested throat, abdominal pain, shortness of breath, and most importantly, decreased air entry on the right side of the chest, along with the presence of crepitations. Such a deteriorated clinical picture suggested the presence of an infectious cause. The patient's physical examination and radiological imaging provided evidence for the presence of lower right-sided lobar pneumonia. On the second day of hospitalization, the patient showed worsening respiratory distress, prompting further investigations that confirmed the development of a right-sided pleural empyema through radiological imaging. Pediatric surgery consultation was requested, and 500 cc of pus was drained following the insertion of a chest tube, which was later sent for analysis. The patient's clinical picture improved significantly following this intervention. Due to the severity of his condition, the patient was transferred to the pediatric intensive care unit (PICU) for close monitoring. After one night in the PICU, during which his condition stabilized and oxygen therapy was gradually weaned off, the patient continued to improve on the general ward. Daily assessments and laboratory tests showed decreasing inflammatory markers and resolution of symptoms. Following three days of admission and confirmation of no underlying immunologic deficiency, the patient was discharged home with appropriate antibiotic therapy and follow-up instructions.

Discussion: Similar cases have been sporadically documented in pediatric literature, with notable examples involving older patients. The pathophysiology involves complex immune interactions and virulence factors of GAS, contributing to severe outcomes such as pleural effusion.

Conclusion: In this case, the 5-year-old patient experienced a severe progression from chickenpox to pleural empyema but ultimately improved following prompt medical intervention and chest tube drainage. The patient was discharged after a successful recovery, highlighting the efficacy of early recognition and treatment in managing such complications.

Background: Wars are escalating globally with devastating impacts on all aspects of life. The conflict between Ukraine and Russia began on February 24, 2022. Approximately 80,000 students of 155 nationalities were studying in Ukraine when the war started, disrupting their education and forcing many to leave the country. We aimed to determine the physical, emotional, and moral effects of the Ukrainian war on foreign medical students, as well as the secondary impacts of the war on the students due to the ongoing conflict.

Methods: The participants were non-Ukrainian medical students aged 18 years and over, studying at a medical school in Ukraine before the war started. A survey including the depression anxiety stress scales-21 (DASS-21) scale variables, a validated and reliable measure of depression, anxiety, and stress dimensions, and other questions on participants' demographics, education, and current socio-economic status was sent to all eligible students via their registered university emails and distributed using an online link.

Results: A total of 99 students were included in the study. 52 (52.5%) of the students were female and 49 (49.5%) were between the ages of 23 and 24 years old. Participants reported high levels of depression (86.9%) and anxiety (82.8%), with significant percentages experiencing extreme levels: 40.4% for depression and 55.6% for anxiety. Additionally, 74.7% reported feeling stressed, with 18.2% indicating extreme stress. Reasons for leaving Ukraine included safety concerns (67.7%), seeking a more secure educational environment (63.6%), the impact of the ongoing war and conflict on their future (56.6%), and the loss of educational opportunities (28.3%).

Conclusion: It is not easy to predict how the war in Ukraine will affect the education of international students in the near future. This uncertainty situation may explain students' depression, anxiety, and stress. As a result, it is necessary to design effective strategies to maintain the training of health professionals during wartime. Research should be conducted on how to rebuild health education systems after the wartime crises stabilize, both for students who are citizens of the country exposed to war and for foreign students who went to that country to receive education, and solutions for this should be put forward.

Introduction: The inclusion of artificial intelligence (AI) in the healthcare sector has transformed medical practices by introducing innovative techniques for medical education, diagnosis, and treatment strategies. In medical education, the potential of AI to enhance learning and assessment methods is being increasingly recognized. This study aims to evaluate the performance of OpenAI's Chat Generative Pre-Trained Transformer (ChatGPT) in emergency medicine (EM) residency examinations in Qatar and compare it with the performance of resident physicians.

Methods: A retrospective descriptive study with a mixed-methods design was conducted in August 2023. EM residents' examination scores were collected and compared with the performance of ChatGPT on the same examinations. The examinations consisted of multiple-choice questions (MCQs) from the same faculty responsible for Qatari Board EM examinations. ChatGPT's performance on these examinations was analyzed and compared with residents across various postgraduate years (PGY).

Results: The study included 238 emergency department residents from PGY1 to PGY4 and compared their performances with ChatGPT. ChatGPT scored consistently higher than resident groups in all examination categories. However, a notable decline in passing rates was observed among senior residents, indicating a potential misalignment between examination performance and practical competencies. Another likely reason can be the impact of the COVID-19 pandemic on their learning experience, knowledge acquisition, and consolidation.

Conclusion: ChatGPT demonstrated significant proficiency in the theoretical knowledge of EM, outperforming resident physicians in examination settings. This finding suggests the potential of AI as a supplementary tool in medical education.

Background: The Ponseti method for clubfoot treatment is a non-surgical treatment with a successful outcome. However, many children are not able to complete Ponseti treatment due to various barriers and are termed dropout children. This study aimed to find out the factors responsible for dropout from clubfoot treatment in Peshawar, Pakistan.

Methods: The study was conducted in the Clubfoot Department of a tertiary care hospital. Clinical and demographic information like age, casting phase, bracing phase, and clubfoot types, i.e., idiopathic, syndromic, or neurogenic, were extracted from the hospital database, while for dropout factors, a semi-structured questionnaire was used. Descriptive statistics were applied to demographic data, assessments, and semi-structured questionnaires for parents. The association of dropout rates with age, gender, and unilaterally/bilaterally clubfoot was analyzed through chi-square tests.

Results: Between December 2017 and December 2022, a total of 1,150 babies were treated with the Ponseti method in the Clubfoot Department. Of 1,150 patients, 197 (17.1%) patients dropped out of the treatment. Twenty-four (12.1%) patients of this dropout were from the casting phase, and 173 (87.9%) patients were from the bracing phase. Age was found to be a significant factor affecting dropout from the Ponseti method. No significant association was found between the patient's dropout and gender or between dropout and unilaterally/bilaterally clubfoot.

Conclusion: The Ponseti method improves clubfoot treatment but faces high dropout rates due to barriers like lack of family support and transport issues. Clinics addressed this by offering family support, transportation aid, telemedicine, community outreach, financial aid, peer support, and extended hours, reducing dropout rates and enhancing outcomes.

Introduction: Neonatal sepsis (NS) is a major healthcare burden in Gulf Cooperation Council (GCC) countries, with a prevalence higher than the global average. Microbial drug resistance has major implications for mortality and morbidity from NS.

Objective: To synthesize data regarding the patterns of causative bacteria of NS in the GCC and their antimicrobial susceptibility profiles.

Methods: Following the exploration of four electronic databases, i.e., EBSCOhost, ProQuest, PubMed/MEDLINE, and ScienceDirect, eligible studies were identified (i.e., published between 2013 and 2023 and reported bacterial profile and/or antimicrobial susceptibility patterns). The outcomes included the pooled prevalence of bacteria and their susceptibility patterns. Proportion meta-analysis was performed for each outcome of interest.

Results: Fifteen studies were eligible (total positive cases = 2,473). Coagulase-negative Staphylococci (CoNS) (28.1%) were the most common gram-positive causative pathogen, followed by group B Streptococcus (GBS) (16.2%) and Staphylococcus aureus (9.9%); for gram-negative, Escherichia coli (12.7%) and Klebsiella species (11.4%) were most common. The susceptibility rates of these bacteria to first-line antibiotics were high; gram-positive bacteria had the highest susceptibility to ampicillin (72.8-98%), and gram-negative bacteria was most susceptible to amikacin (94.6-98%). Additionally, both gram-positive (67-77%) and negative (87-93%) bacteria exhibited high susceptibility to gentamicin.

Conclusion: The most common pathogens among NS patients were gram-positive. The pathogens, irrespective of stain test, were susceptible to the current antibiotic therapy. We recommend the judicious use of empirical antibiotic therapy to prevent the growing risk of antimicrobial resistance.

Background: Proton pump inhibitors (PPIs) are commonly prescribed to hospitalized patients, but many of these prescriptions may not be based on evidence-based indications. It's important to understand that inappropriate prescribing of PPIs can lead to unnecessary medications and financial burdens. Unfortunately, there are not many recent studies exploring how often PPIs are prescribed and if they are being prescribed appropriately.

Objective: The study aimed to assess the appropriateness of PPIs use among hospitalized patients. It evaluated the indications for PPIs use and determined whether the use of PPIs in hospitalized patients is justified or not.

Setting: The study was conducted at Hamad General Hospital, a tertiary academic healthcare center in the state of Qatar.

Methods: A retrospective observational study with 201 subjects, was conducted in general internal medicine wards at a tertiary hospital. Physician documentation and inpatient and outpatient medication prescriptions were analyzed for PPIs exposure.

Main outcome measures: The appropriateness of exposure to PPIs is determined based on international recommendations.

Results: Of 533 hospitalized patients who were not critically ill, 201 (37.7%) were prescribed PPIs. The study found that 65.2% of the patients had no valid indication for PPIs exposure. Furthermore, 18% of patients were inappropriately prescribed stress ulcer prophylaxis with PPIs even though they had a low risk for the development of ulcer disease. After discharge, 82.6% of patients were prescribed PPIs, with the most common indication (43%) being gastrointestinal ulcer prophylaxis.

Conclusion: This study sheds light on the issue of overutilization of PPIs, specifically in non-critically ill hospitalized patients. It highlights the unnecessary continuation of PPI prescriptions at discharge and emphasizes the importance of physicians reevaluating PPI prescriptions periodically to ensure they are still necessary and discontinuing them when possible to avoid unwanted consequences.

Introduction: Preeclampsia and eclampsia are hypertensive disorders of pregnancy associated with significant maternal and fetal morbidity and mortality. Posterior reversible encephalopathy syndrome (PRES) is a neurological complication observed in these conditions, yet its impact on fetomaternal outcomes remains underexplored. The aim of this study is to investigate the association between PRES and fetomaternal outcomes in women with preeclampsia and eclampsia.

Methods: This prospective cohort study enrolled 64 singleton pregnant women beyond 20 weeks of gestation with preeclampsia and eclampsia having neurological symptoms. Participants underwent clinical evaluation and radiological assessment, including non-contrast computed tomography (NCCT) and magnetic resonance imaging (MRI). Maternal outcomes, including high dependency unit (HDU)/intensive care unit (ICU) stay, intubation, mode of delivery and maternal mortality. Fetal outcomes, i.e., stillbirth, prematurity, and neonatal intensive care unit (NICU) stay, were recorded. Statistical analysis was performed to compare outcomes between PRES and non-PRES groups.

Results: The majority (92.18%) of participants were unscheduled and (56.2%) were primigravida. PRES was diagnosed in 62.5% of cases, predominantly associated with antepartum eclampsia (47.5%). Neurological symptoms such as headache (85.9%) and blurring of vision (68.8%) were common in PRES cases. Cesarean section rate was significantly higher in PRES group (75%), along with adverse outcomes including increased HDU/ICU stay, intubation, postpartum haemorrhage (PPH), abruption, maternal mortality, stillbirth, prematurity, fetal growth restriction (FGR), meconium-stained liquor (MSL), and NICU stay, which were observed significantly higher in women with PRES (p < 0.001) and low Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) scores (p < 0.05). However, no significant association was observed between PRES and early neonatal death (ENND).

Conclusion: PRES is associated with adverse fetomaternal outcomes in women with preeclampsia/eclampsia, including higher cesarean section rate and increased maternal and neonatal morbidity. Early recognition and management of PRES are crucial for improving outcomes in these high-risk pregnancies. Further research with larger sample sizes is warranted to validate these findings and explore potential interventions.

Introduction: Very important person (VIP) syndrome, or recommended patient syndrome (RPS), is a phenomenon in healthcare where well-intentioned efforts to enhance care inadvertently result in harm. Celebrities, physicians, and political leaders often receive preferential treatment, leading to potentially unnecessary interventions. This review delves into its causes, manifestations, consequences, real-life instances, prevention, and management, considering the shifting paradigm of recent advances in the medical field.

Methods: We conducted a qualitative and critical review by searching databases such as PubMed, Scopus, and Google Scholar, as well as online news outlets, exploring available data and literature, including journal articles and news articles published at any time on VIP syndrome.

Results: Twenty articles were found relevant and analyzed. Manifestations of VIP syndrome range from over- to under-treatment, disrupting established healthcare systems. Consequences encompass increased costs, heightened risks, and diminished satisfaction for patients and healthcare teams. Real-life instances, exemplified by Michael Jackson's case, highlight unintended complications. Prevention strategies advocate transparent resource allocation and adherence to established guidelines. A written VIP patient management plan, involving the hospital's command center, security, and press spokesperson, is crucial. Proposed directives underscore the importance of valuing medical skills, teamwork, effective communication, and resisting external pressures.

Conclusion: This short communication underscores the necessity of systematically addressing VIP syndrome to ensure fair, ethical, and optimal healthcare delivery. By addressing this issue in an organized way, healthcare providers can work towards treating all patients equally, following ethical guidelines, and providing the best possible care to everyone, regardless of their status or influence. Future research should focus on developing standardized protocols for managing VIP patients, incorporating ethical considerations and evidence-based practices.

Background: Hearing loss (HL) is a major public health problem that is significant for mental health and physical conditions. HL may be a potentially modifiable risk factor for poorer mental health outcomes. The study aimed to explore the association between HL, social isolation, anxiety, and depression.

Methods: A cross-sectional study was conducted on a sample of consecutive patients aged 50 years or older (n = 226) from February 2023 to August 2023. We used regression models to assess the association between HL and the odds of social isolation, anxiety, and depression.

Results: There are more female participants with HL (58.7% vs. 41.3%) than male individuals with HL. HL was found to have a statistically significant association with smoking (p = 0.001), and HL showed significant associations with anxiety and depression (p = 0.008 and p = 0.011, respectively). A significant association was also observed between HL and social isolation (p = 0.016). HL was associated with diabetes mellitus (p = 0.006) and hypertension (p = 0.008). Participants with HL were more likely to have depression (OR = 2.16; 95% CI: 1.05-4.44), social isolation (OR = 2.87; 95% CI: 1.44-5.70), and anxiety (OR = 2.62; 95% CI: 1.21-5.67) compared to participants in the no hearing loss (No-HL) group.

Conclusions: This study shows that HL is consistently associated with poorer mental health symptoms and poor social isolation. Although additional evidence is necessary, it is plausible that addressing HL would alter this trajectory.