Qatar Medical Journal最新文献

Background: Achalasia is a rare esophageal motility disorder of unknown etiology, which leads to changes in the pressure and relaxation of the lower esophageal sphincter (LES), affecting peristalsis and contraction of the esophageal body. Dysphagia can impact individuals of any age, it is frequent in the elderly. Non-specific gastrointestinal symptoms are delayed and can give false diagnoses. The aim of this study is to compare clinical presentation and pulmonary complications in younger (Group I) and elderly patients (Group II).

Methods: 108 patients with achalasia were separated into two groups-young and elderly patients. Demographic, clinical, radiological and manometric data, smoking status, and symptom score were compared between these groups.

Results: There was no significant difference in gender, duration of symptoms, body mass index (BMI), or diameter of esophagus between the two patient groups. There was a statistically significant difference between frequencies of comorbidity between groups (p = 0.009). Even though there were no differences in chest tomography scan (CT) findings and diameter, there were statistical differences in diffusion capacity (p = 0.041). Respiratory symptoms occurred in 38 (48.7%) patients in Group I and in 20 (66.7%) in Group II (p = 0.011). Cough was dominant in the younger group, but fatigue and chest pain were statistically significant and frequent in elderly group patients with achalasia. There was no significant difference in Eskardt symptom score (ESS), but there was the difference in the frequency of individual symptoms. Vomitus and regurgitation were statistically higher frequent in Group I, but dysphagia and weight loss in Group II. Subtype 1 was dominant in the younger group, and subtype 2 in a group with older patients.

Conclusion: The younger achalasia population group was found to be associated with decreased diffusion capacity, type 1 achalasia, cough, and gastrointestinal symptoms such as vomitus and regurgitation. Geriatric status was found to be associated with frequent comorbidities, subtype 2, frequent respiratory symptoms, dysphagia, and weight loss. Our findings demonstrated an association between esophageal motility abnormalities and characteristics of geriatric population.

Background: Secondary hypertension is characterized by an elevated blood pressure greater than 140/90 mmHg, which occurs as a consequence of other diseases. The common etiologies of secondary hypertension include renal parenchymal causes, endocrine disorders, and vascular pathologies like coarctation of the aorta (CoA).

Case presentation: A 20-year-old patient was admitted to our hospital as he complained of headache and palpitations since one week. On examination, the blood pressure in his right upper limb was 180/100 mmHg. The volume of the femoral and the dorsalis pedis pulses was found to be reduced bilaterally. The patient was started on antihypertensive medication labetalol 10 mg injection intravenously immediately. After clinical suspicion and a series of investigations, the patient was diagnosed with severe CoA, distal to the origin of the left subclavian artery via computed tomography (CT) aortogram. The patient was managed by coarctoplasty with stenting.

Discussion: The most striking examination findings indicative of CoA include decreased lower limb pulses and a blood pressure difference of >20 mmHg across both the lower and upper extremities. It is important to evaluate the blood pressure in both upper and lower limbs to diagnose obstructive vascular diseases.

Conclusion: The presence of multiple well-developed collaterals can often mask symptoms and delay the detection of hypertension in patients with CoA. Patients with CoA require regular follow-up to monitor left ventricular outflow tract obstruction, and patients with severe CoA should be treated interventionally to prevent complications including aortic aneurysm and dissection.The patient was managed by coarctoplasty with stenting and recovered well post-surgery.

Background: Respiratory syncytial virus (RSV) is a highly contagious pathogen known for causing respiratory tract infections, particularly among pediatric and elderly patients. Its ability to induce outbreaks in both community and hospital settings underscores its substantial health burden. This review aims to provide a comprehensive understanding of RSV, including its biological and clinical aspects.

Methods: A comprehensive review of the literature was conducted by searching PubMed, Scopus, and Web of Science databases for relevant articles. Key topics included RSV virology, epidemiology, clinical findings, diagnostic methods, management approaches, and preventive strategies.

Results: This review encompasses the taxonomy and structure of RSV, including its genome and proteins. Various strains and their dominance patterns, alongside pathogenesis mechanisms, are explored. Diagnostic techniques such as nucleic acid amplification tests are discussed for their efficacy and accessibility. Supportive care remains the primary treatment, with antiviral therapies playing a limited role. Monoclonal antibody immunization and vaccination efforts offer promising avenues for RSV prevention. The impact of the COVID-19 pandemic on RSV epidemiology is also considered, along with the oncolytic potential of RSV in cancer treatment.

Conclusion: Advancements in understanding RSV virology, epidemiology, and clinical management have paved the way for improved diagnostic and preventive strategies. However, challenges remain in ensuring widespread access to diagnostics and effective treatments, particularly in resource-limited settings. Continued research and global collaboration are essential for addressing the ongoing impact of RSV and reducing its burden on public health.

Background: Hirsutism is a common endocrine problem with high prevalence in Iraqi women. Polycystic ovarian syndrome and idiopathic hirsutism (IH) are the most common etiology of this disorder. There is a clear association between insulin resistance and polycystic ovarian syndrome. However, there is insufficient data on the relationship between insulin resistance and IH. Aim: The aim of this study was to determine whether Iraqi women with IH have insulin resistance. Methods: The study included two groups: 60 Iraqi women with IH and 60 women without hirsutism as a control group. A physical examination, a medical history, and the patient's age and BMI were collected. Blood samples were collected for hormone analysis, including insulin, follicle-stimulating hormone, luteinizing hormone, prolactin, dehydroepiandrosterone sulfate, 17-hydroxyprogesterone, and free testosterone. To evaluate insulin resistance in both groups, the homeostasis model assessment-insulin resistance (HOMA-IR) and the quantitative insulin sensitivity check index (QUICKI) were used in addition to the Matsuda index. Results: Basal insulin was higher in the IH group (9.5 ± 0.2 mIU/L) than in the control group (4.8 ± 3.7 mIU/L), with a p value of < 0.0001. HOMA-IR was higher in the IH group (2.3 ± 4.1 μU mg), while in the control group, it was (0.8 ± 1.2 μU mg), with a p value of 0.007. There was a significant difference in the QUICKI, which was lower in the IH group (0.31 ± 0.2 μU^-1/mg) than in the control group (0.45 ± 0.1 μU^-1/mg), with a p value of < 0.0001. The insulin sensitivity index (Matsuda) was significantly lower in the IH group (3.1 ± 0.4) than in the control group (7.8 ± 1.3), with a p value of < 0.0001. Conclusion: According to the results of this study, Iraqi women with IH have insulin resistance and higher basal insulin levels.

Introduction: Self-injury (SI) behavior represents a significant mental health concern that is prevalent among children and adolescents. The aim of this study was to examine the rates and types of suicidal and non-suicidal SI among post-traumatic stress disorder (PTSD) cases of sexual abuse victims and compare them with a major depressive disorder (MDD) group and a healthy control group. Methods: This retrospective study focused on patients seeking treatment in the Ankara Yildirim Beyazit University Yenimahalle Education and Research Hospital Child and Adolescent Psychiatry Department between 2018 and 2021 in Ankara, Turkey. The study included patients diagnosed with PTSD and MDD following sexual abuse in the PTSD group and assessed standardized scales such as the child depression inventory, screen for child anxiety related emotional disorders, and clinical global impression. Results: The study included 46 cases in the PTSD-MDD group, 60 in the MDD group, and 47 in the control group. The PTSD-MDD group had significantly higher levels of SI (p < 0.05). The predominant form of SI in this group was self-cutting. Moreover, those with sexual abuse were four times more likely to attempt suicide (OR = 4.1), and the non-suicidal self-injury (NSSI) group was 12 times more likely to attempt suicide (OR = 12.7). Conclusion: These findings highlight the increased risk of self-harm and suicidal behavior in individuals diagnosed with PTSD-MDD who have been sexually abused, particularly highlighting the significant impact of NSSI and its association with increased suicide risk.

Purpose: The aim of this study was to investigate the possibility of including miRNA-371 and miRNA-143 in the early detection and diagnosis of the extent of the metabolic syndrome (MetS) in obese patients by measuring the expression of miRNA-143 and miRNA-371 in metabolically and pre-metabolically obese individuals and comparing the results with metabolically healthy obese controls. In addition, the study aimed to assess the correlation between the two types of miRNA and the criteria of MetS. Methods: The expression levels of miRNA-143 and miRNA-371 were determined using quantitative real-time polymerase chain reaction (PCR) for 135 obese patients who were divided into the following three different categories based on metabolic criteria: 1) metabolic syndrome obese (MetS) group, 2) pre-metabolic syndrome obese (PreMetS) group, and 3) metabolically healthy obese (MHO) group. Results: The results indicated a significant association of miRNA-143 and miRNA-371 with the MetS group compared with the PreMetS and MHO groups. As a result, the correlation analysis for these miRNAs revealed a large association with the results of the analysis for various factors, especially with regard to fasting glucose and lipid profiles in the MetS group. Conclusion: There was an association between obesity and MetS. This study was able to establish the role of miRNA-371 and miRNA-143 molecules in metabolically obese individuals. Therefore, by tracking the regulatory pathway of these molecules and expanding the understanding of the process of regulation and interference with the various metabolic pathways, this study could provide a deeper analysis and understanding of the MetS in obesity and the molecular causes leading to it.

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.