Qatar Medical Journal最新文献

Background: Pertussis, a highly contagious disease, has made a resurgence following the easing of COVID-19 pandemic restrictions. Infants under three months old are particularly vulnerable due to their immature immune systems and lack of protective vaccination.

Methods: This study presents a case series of four infants, aged one to three months, who initially presented with nonspecific respiratory symptoms at Alkhor Hospital between January and June 2024. Subsequent diagnostic testing confirmed pertussis in all four cases. It is noteworthy that all cases involved were previously healthy infants with no underlying health conditions. Additionally, none of the mothers had received the Tdap vaccine during pregnancy.

Results: All infants required hospitalization, with one being admitted to the PICU for eight days. Ultimately, all four infants made a full recovery.

Conclusion: Pertussis remains a significant cause of morbidity and mortality in infants under three months of age. Given the potential for severe complications and the burden it places on the healthcare system during outbreaks, it is crucial to emphasize preventive measures such as maternal vaccination.

Background: Hypocalcemia is an electrolyte disorder that can be effectively corrected. However, in its severe form, it poses significant risks, including potentially fatal symptoms such as electrocardiographic changes that may lead to sudden cardiac arrest if not treated promptly.

Case presentation: We report the case of a young female patient who presented with multiple episodes of tonic posturing and altered level of consciousness. Diagnostic evaluation revealed severe hypocalcemia with hypomagnesemia, QT prolongation, and episodes of non-sustained ventricular tachycardia. The condition was managed with calcium and magnesium supplementation. Further investigations revealed a novel missense mutation in transient receptor potential melastatin 3 (TRPM3).

Discussion: Hypocalcemic seizures are rare in adults and are typically associated with severe hypocalcemia and cardiovascular instability, including ventricular dysrhythmias. The differential diagnoses in this case included primary hypoparathyroidism, Bartter syndrome type 5 (CaSR (calcium-sensing receptor) mutation), Gitelman syndrome, and claudin mutations. TRPM3 is highly expressed in kidney tissue, playing a role in the resorption of calcium and divalent ions. However, further research is needed to confirm its role in calcium homeostasis.

Conclusion: The patient was initially misdiagnosed with epilepsy for the past two years. Following a comprehensive evaluation, she was successfully treated with intravenous calcium and magnesium. On follow-up after six months, her condition showed marked improvement, characterized by better cardiac function and the absence of further seizure episodes. This case represents the first reported instance of a TRPM3 mutation affecting calcium channels, highlighting the need for further investigation into its implications for calcium metabolism.

Background: Language barriers significantly impact healthcare delivery, particularly in emergency medical services (EMS) operating in linguistically diverse environments. The demographic composition of Qatar, with its predominantly expatriate population, presents unique challenges for effective communication in pre-hospital care settings. The aim of this was to assess the opinions of personnel from the Hamad Medical Corporation Ambulance Service (HMCAS) regarding the impact of language barriers on pre-hospital emergency care.

Methods: A cross-sectional study was conducted using an anonymous survey with a five-point Likert scale among 312 frontline personnel of HMCAS. Fisher's exact and Kruskal-Wallis tests were used to compare ordinal outcomes across groups. Machine learning algorithms, including ordinal logistic regression, support vector machines (SVM), and naive Bayes, were used to develop predictive models for HMCAS staff opinions on their language learning needs.

Results: Both bivariate and multivariate analyses revealed significant differences in the frequency of experiencing communication challenges. The most influential factors identified were strong opinions on language barriers and the willingness of staff to enhance their language skills. Variables related to using family members as interpreters showed relatively low importance. The SVM model demonstrated the best predictive capability concerning staff perceptions about language learning needs, with an accuracy of 0.50 and an average area under the curve score of 0.74.

Conclusion: Language barriers significantly impact pre-hospital emergency care in Qatar. The findings highlight the need for targeted interventions, such as language training programs and mobile translation apps. These strategies could enhance communication in multicultural EMS settings, improving patient care and reducing miscommunication risks. Future research should evaluate the long-term impact of these interventions on patient outcomes.

Background: When Qatar imposed a nationwide lockdown in accordance with WHO guidelines during the first wave of the COVID-19 pandemic, dental healthcare services were disrupted, limiting services to emergencies and postponing elective procedures due to transmission risks. Teledentistry was introduced to remotely manage dental conditions and reduce hospital admissions. The present study examines patient perceptions of audio-dentistry, a form of teledentistry, in managing dental emergencies during the pandemic and explores factors influencing overall patient satisfaction.

Methods: A retrospective, cross-sectional telephone questionnaire included 352 participants who used a dental emergency hotline service during the first wave of the COVID-19 pandemic lockdown (March 29-August 31, 2020) in Qatar. A validated, closed-ended questionnaire was administered to explore participants' views on audio-dentistry. The questionnaire explored the influence of variables related to dental problems depending on the specialty required, the years of experience of the responding dentist, and teletriage management decisions on overall satisfaction with audio-dentistry.

Results: The response rate was 80.18%. Most participants expressed positive views of audio-dentistry in five domains (usefulness, interaction quality, ease of use and reliability, quality of care, satisfaction, and future use). However, approximately one-third of participants disagreed or strongly disagreed that their dental problem had improved following the call (35.3%) and viewed the lack of physical contact as a disadvantage (31.2%). Overall satisfaction was only influenced by telephone triage outcomes, with patients transferred for chairside management more likely to be satisfied (89.8%) than those managed remotely through self-care instructions and medications (80.4%) or instructions only (75.4%) (p = 0.011).

Conclusions: Audio-dentistry effectively sustained oral health services during the COVID-19 pandemic while minimizing face-to-face visits, with patients largely expressing high satisfaction in areas such as usefulness, interaction quality, ease of use, reliability, and overall care. Satisfaction was primarily influenced by call outcomes and referrals or prescription decisions rather than caller demographics or dentist experience. However, some dissatisfaction arose when immediate improvement was not achieved, particularly in conditions such as pulpitis that are challenging to manage remotely.

The post-COVID-19 syndrome may present with a range of neurological symptoms such as headaches, sleep disorders, and dizziness. The objective of this study was to examine the effectiveness of the Gam-COVID-Vac vaccine in mitigating the neurological symptoms of post-COVID-19 syndrome. The study involved 95 patients diagnosed with the neurological form of long COVID-19, who were divided into two groups according to their vaccination status. The immunological parameters of humoral immunity were evaluated by enzyme-linked immunosorbent assay (ELISA), while the parameters of cellular immunity were evaluated using flow cytometry. Administration of the vaccination resulted in a reduction in clinical symptoms of the neurological form of long COVID-19. Statistically significant differences (p = 0.035) were found in symptoms such as headaches, sleep disturbances, and dizziness, especially in central nervous system (CNS) disorders, between the groups that received the vaccination and those that did not. More than 90% of patients had elevated levels of Receptor Binding Domain (RBD) immunoglobulin G against the viral S-protein (>2,500 BAU/ml), indicating strong humoral immunity regardless of vaccination status. An increase in B-lymphocyte (CD3^-CD19⁺) counts was noted in both groups, with levels significantly higher in the group that received the vaccination (p < 0.03). Analysis of T-cell profiles and NK (natural killer) cell levels showed no changes. The study suggests that administration of Gam-COVID-Vac vaccination could reduce the occurrence of CNS symptoms in individuals with post-COVID-19 syndrome. Although certain neurological symptoms may continue, immunization has a beneficial influence on their progression. The results emphasize the crucial role of an increased humoral immune response in individuals with post-COVID-19 syndrome, but do not show significant changes in T-cell immune parameters.

Introduction: Postoperative pain management is crucial for recovery from surgery. Patient-controlled analgesia (PCA) with morphine and fentanyl are commonly used, but their comparative efficacy remains uncertain. This study aims to evaluate opioid consumption and pain control in patients receiving PCA morphine versus PCA fentanyl after colorectal surgery.

Methodology: A retrospective analysis of adult patients undergoing elective colorectal surgery was conducted. Patients were divided into two groups based on PCA morphine or PCA fentanyl use. Outcomes measured were opioid consumption in morphine equivalents, numerical pain scores expressed as Numerical Rating Scale (NRS), patient demand, and side effects within the first 48 hours postoperatively.

Results: Of 370 patients screened, 152 met the inclusion criteria. No significant differences were found in total opioid consumption (median: 38 vs. 28.5 mg, p = 0.095), patient demand (median: 46.5 vs. 35, p = 0.156), or NRS (median: 4 vs. 3.5, p = 0.348). Side effects were comparable between groups. Subgroup analysis revealed higher opioid consumption and demand in females taking fentanyl compared to morphine. Age was negatively correlated with pain-related outcomes, and smokers showed higher opioid consumption and higher pain scores.

Conclusions: PCA morphine and fentanyl provide similar postoperative pain relief in colorectal surgery patients, with no significant differences in opioid consumption or side effects. Female patients may respond better to morphine, and age and smoking status significantly influence pain management outcomes. Further prospective studies are recommended to better define these findings and inform postoperative pain strategies.

Background: This review provides a comprehensive and current overview of the clinical outcomes associated with the use of OviTex reinforced tissue matrix (RTM) in hernia repair. Methods: We conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our search included research publications related to clinical outcomes involving the use of OviTex RTM in hernia repair up to August 2023. We extensively examined and extracted relevant data from databases such as Embase, PubMed, and Scopus. The meta-analysis included comparisons related to body mass index (BMI) in hernia treatment, primary abdominal wall hernias treated with OviTex, and other relevant factors. The quality of the included studies was assessed using the MINORS (Methodological Index for Non-Randomized Studies) scale. Our systematic review protocol was registered with PROSPERO (International Prospective Register of Systematic Reviews) under registration number CRD42023456009. Results: A total of 9 observational studies involving 990 patients from three countries (USA, Netherlands, and Germany) were included in our study. Pooled results show that the risk of the OviTex group was lower than that of the comparison group (pooled risk ratio (RR) = 0.84; 95% confidence interval (CI): 0.67-1.05; Z = -1.514; p = 0.13). The prevalence rate of primary abdominal wall hernia among the included studies ranged from a minimum of 43% (95% CI: 30-58) to a maximum of 81% (95% CI: 64-91%), the risk was not significantly higher in the comparison group compared with the OviTex group (pooled RR = 1.11; 95% CI: 0.29-4.30; Z = 0.155; p = 0.877), the prevalence of laparoscopic surgery was 12% (95% CI: 6-19%), the BMI was favorable in the comparison group but was not statistically significant (mean difference = 25; 95% CI: -0.02, 0.52; p = 0.073). Conclusion: OviTex RTM has shown promising outcomes in abdominal wall reconstruction and hernia repair. However, it is crucial to conduct further research and clinical studies to confirm these findings and unlock the capabilities of OviTex across different medical scenarios.

Objective: Urinary incontinence (UI) is involuntary urine leakage, mainly due to a feeling of high pressure in the abdominal part, the immediate and urgent need for micturition, or both. Neurotrophins (NTs) are a family of peptides that play a role in the regulation of nerve cells. Their effects on the lower urinary tract organs may provide a perspective to understand the development and diagnosis of UI. This study aims to investigate NT levels to understand how these molecules change in multiparous premenopausal women who suffer from stress-related UI. The study also evaluates diagnostic and distinguishing capabilities of NTs for these disorders.

Methods: In this cross-sectional case-control study, multiparous premenopausal women underwent a urodynamic examination, a stress cough test, and were evaluated with an International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Participants were divided into three groups: 29 healthy women in the control group and two patient groups consisting of 26 women diagnosed with stress urinary incontinence (SUI) and 33 women diagnosed with mixed urinary incontinence (MUI). Nerve growth factor (NGF), brain-derived neurotrophic factor, neurotrophin-3 (NT-3), and neurotrophin-4 (NT-4) levels in serum were measured by enzyme-linked immunosorbent assay. The body mass index (BMI) and ICIQ-SF scores of the patients were also calculated. The data obtained were compared between the groups. Receiver-operating characteristic analysis was performed to determine the role of NTs in diagnosing UI.

Results: The result showed that serum NGF and NT-3 levels were significantly low in both incontinence subtypes compared to the control group (p < 0.05). BMI scores and number of vaginal deliveries were higher in incontinence subtypes compared to the control group, and ICIQ-SF scores were higher in the MUI group.

Conclusion: The differences in serum NGF and NT-3 levels were observed in multiparous premenopausal patients with UI. There was a decrease in serum NGF levels in MUI patients and serum NT-3 levels in SUI patients. Although the changes in serum NGF and NT-3 levels were significant, their discriminatory potential was weak or moderate.