Qatar Medical Journal最新文献

Background: Adrenoleukodystrophy (ALD) is an intriguing disease with a heterogeneous clinico-radiological profile. Behavioral and cognitive impairments are often the initial and predominant manifestations, yet their patterns are frequently overlooked. This study aims to elaborate on the patterns of cognitive dysfunction, behavioral changes, and movement disorders in ALD to facilitate its earlier diagnosis.

Methods: In this case series, 12 cases of ALD were assessed and evaluated for cognitive, behavioral, and movement abnormalities to identify patterns of involvement.

Results: All patients were male, with an age range of 5-46 years. 75% presented with cerebral ALD (CALD), and 25% had an adrenomyeloneuropathy phenotype. Cognitive dysfunction, behavioral changes, and seizures were observed in 75%, 66.7%, and 33.3% of ALD patients. An initial posterior to anterior pattern of progression of cognitive impairment dominated by higher-order visual dysfunction and language regression was observed in 66.7% of CALD patients, while a frontal pattern was noted in 22.2% of CALD patients. While cognitive impairment typically indicated dysfunction of occipito-parieto-temporal networks, behavioral changes predominantly suggested dysfunctional fronto-temporal-subcortical connections. A novel observation was the occurrence of tics and stereotypies in 33.3% of ALD patients.

Conclusion: This study describes the patterns of cognitive, behavioral, and movement abnormalities in ALD and highlights the contributory role of dysfunctional white matter networks. Cognitive patterns predominantly reflect a posterior-to-anterior gradient of impairment of white matter connections, while behavioral markers indicate involvement of fronto-temporal-subcortical networks. Adding to this spectrum, the occurrence of tics and stereotypies is a unique observation in ALD.

Introduction: Asthma is a common noncommunicable disease with public health implications due to the rising number of cases among the pediatric population in Qatar.

Aim: The objective of the current study is to explore possible risk factors and associations in relation to pediatric asthma, allergic rhinitis, and eczema cases in Qatar.

Methods: Using the Global Asthma Network questionnaires, this study sampled 2646 children, of which 1210 were aged 6-7 years and 1436 were aged 13-14 years in addition to 3831 adult parents or guardians. The STROBE guidelines were used to ensure the reporting of this cross-sectional study. Univariate and multivariate logistic regression were used to produce the odds ratio for the various risk factors and associated factors, respectively. Multiple associations and risk factors for each of the three diseases were reported.

Results: Based on the outcome of a multivariate logistic regression, being born in Qatar was the only risk factor present across all three diseases. Being male, wheezing ever, wheezing after exercise, and having eczema were other risk factors reported for asthma. Being in the older age group, wheezing ever, and having hay fever were other risk factors reported for allergic rhinitis.

Conclusion: The study concluded that further evaluation into associated and risk factors for asthma, allergic rhinitis, and eczema is warranted in the future.

Background: Mature cystic teratomas, also known as dermoid cysts, are the most prevalent form of ovarian germ cell tumors. While they typically manifest in women of reproductive age, they can also occur in pediatric patients. These tumors are generally benign and comprise a diverse array of tissue types. However, large lesions, particularly those exceeding 10 cm in diameter, are infrequent and can present diagnostic and therapeutic challenges. Notably, elevated tumor markers, such as cancer antigen 19-9 (CA 19-9), are not commonly associated with mature cystic teratomas, rendering this case particularly unusual.

Case presentation: The clinical case involved an 8-year-old female patient who presented with an exceptionally large ovarian teratoma, measuring 13 × 12 cm. While the prepubertal presentation of such tumors is not uncommon, the remarkable size of the lesion was an extraordinary occurrence. Preoperative evaluation revealed markedly elevated levels of CA 19-9, a tumor marker, at 297 U/mL-an atypical finding for mature cystic teratomas. Imaging studies identified a complex cystic adnexal mass, indicative of a teratoma. Consequently, a laparotomy was performed, revealing an intact, benign lesion that was successfully resected via cystectomy, with preservation of the ovary. Histopathological examination confirmed the diagnosis of a mature cystic teratoma, without any evidence of malignant transformation. Notably, following the surgical intervention, the elevated CA 19-9 levels normalized, suggesting a potential association between the teratoma and the abnormal tumor marker levels.

Discussion: This report delineates the surgical management and clinical course of an exceptionally large ovarian teratoma in a pediatric patient with abnormal preoperative tumor markers. Despite atypical features, the excellent prognosis following fertility-sparing resection underscores the significance of conservative treatment in young females.

Conclusion: This case highlights the occurrence of a large mature cystic teratoma with elevated CA-19-9 in a pediatric patient with no complications such as torsion, rupture, or malignancy. The elevation in CA-19-9 likely relates directly to the teratoma itself. A conservative, fertility-sparing surgical approach proved effective, emphasizing the importance of careful preoperative evaluation and management in similar cases.

Background: The incidence of hepatic abnormalities has been notably higher following the coronavirus disease 2019 (COVID-19) infection, attributed to the virus's entry into cells via angiotensin-converting enzyme 2 (ACE2) surface expression. The gastrointestinal tract's significant ACE2 expression, alongside a lesser degree in the biliary epithelium, has been implicated in gastrointestinal symptoms and liver injury.

Purpose: The aim of this study was to determine whether specific ultrasonographic findings in the liver correlate with acute increases in liver function tests (LFTs) among hospitalized patients.

Methods: A retrospective analysis was conducted on hospitalized COVID-19 patients at Hazem Mebaireek General Hospital in Qatar, from March 1, 2020, to June 30, 2020. The study focused on patients who experienced acute increases in LFTs, excluding those with chronic liver disease. Ultrasound imaging and patient records were reviewed to gather data.

Results: Out of 223 ultrasound studies of COVID-19 patients, 158 met the inclusion criteria. The majority were male, with a mean age of 47.76 ± 13.76 years. Ultrasound results showed 43.7% normal liver parenchyma, while 56.3% exhibited nonspecific abnormalities such as diffuse liver hyperechogenicity (39.2%), enlargement with diffuse hyperechogenicity (12.7%), and other findings (4.4%). The biliary tree was predominantly normal (96.2%), with 3.8% showing abnormalities, including intrahepatic (2.5%) and extrahepatic (1.3%) dilatation. Gallbladder evaluations were normal in 60.1% of cases, with 39.9% showing abnormalities like stones (6.3%), stones with sludge (13.3%), polyps (6.3%), wall thickening (1.9%), and other conditions (12%). A significant correlation was found between abnormal liver parenchyma findings and elevated levels of bilirubin (total and direct) and alkaline phosphatase, with p-values < 0.05. Only aspartate aminotransferase levels showed a significant correlation with biliary tree abnormalities.

Conclusion: The most common ultrasonographic finding associated with acute increases in LFTs among hospitalized COVID-19 patients was diffuse liver hyperechogenicity, with or without enlargement. These findings suggest a nonspecific yet significant association with liver function anomalies in the context of COVID-19.

Background: Perioperative stroke, defined as a stroke occurring within 30 days post-surgery, typically emerges within the first week. The incidence of perioperative stroke among adults undergoing non-cardiac and non-neurological surgeries ranges from 0.1% to 1% after a surgical intervention. Mortality rates following perioperative stroke surge, reaching up to eight times higher than controls, with approximately one in four cases resulting in death. Fortunately, various strategies are available to potentially prevent perioperative strokes. However, the vast amount of data poses challenges for physicians in memorization and recall for clinical use. This study aims to summarize essential perioperative stroke prevention strategies and determine an effective mnemonic for their memorization and recall.

Method: The initial search in PubMed focused solely on review articles published within the last 10 years. It utilized the keywords "perioperative stroke" and "prevention."

Results: An initial search found 39 articles, with two suitable for review. Using data from selected review articles, further searches were conducted on Google Scholar and PubMed for articles from 2000 to 2024, identifying 30 additional suitable references. From these 32 articles, the author developed a mnemonic, "DAANISH," to aid in remembering strategies for preventing perioperative stroke.

Conclusion: Implementing this mnemonic may help reduce the risk of perioperative stroke and improve patient outcomes. Future research is needed to confirm its effectiveness.

Background: Blunt trauma is a physical injury to a part of the body, mainly caused by road accidents, direct blows, attacks, sports injuries, and falls in elderly people. Spinal fractures are observed only in a small percentage of injured patients. Accordingly, the present study was conducted on collected data between 2018 and 2022 to determine the frequency of spinal fractures in blunt trauma in Iran while also considering the mechanism of injury as a secondary outcome of interest.

Methods: In this retrospective study, blunt trauma patients with spinal fractures, regardless of age were included by the census sampling method. Data were obtained from the National Trauma Registry of Iran. Means and standard deviations were used for continuous variables, and the chi-square test was used to assess the relationship between the variables.

Results: Among 25,986 cases of all-cause trauma patients, 1,167 cases (4.5%) of blunt trauma and spinal fracture were included in the study. Gender, the severity of injury, and the cause of trauma showed a significant difference among different age groups (p < 0.05). Significant differences were found in the injury mechanisms across various spine regions (p < 0.05). The majority of patients (68.2%) had lumbar spinal fractures. Road traffic collisions were the most common cause of spinal cord injuries, accounting for 58.3% of cases, followed by falls (36.1%). The injury severity score was higher in younger patients (under 18 years old), with a mean of 4.4 ± 3.5, and in patients with cervical injuries. The majority of injuries occurred in the lumbar area (68.2%), followed by the thoracic area. Furthermore, notable variations existed in Emergency Room (ER) stay duration, overall hospitalization, Intensive Care Unit (ICU) stay duration, and injury severity levels, all influenced by the spinal regions (p < 0.05). Distinctively, ICU stay durations and ER stay duration showed significant differences, particularly in relation to injuries in the lumbar and thoracic regions (p < 0.05).

Conclusion: According to the results of the present study, trauma is more severe, and cervical injuries are more common in young people, which is a critical finding that underscores the need for targeted interventions to mitigate the severity of trauma in this age group. Additionally, the majority of cervical injuries occurred in young people, which is a particularly concerning finding given the potential for long-term disability and impact on quality of life. Our findings suggest that strategies to reduce cervical injuries, such as speed control, seat belt use, and phone-free driving, are crucial interventions for mitigating the severity of trauma and promoting patient outcomes in young people.

Background: Thyroid cancer (TC) is becoming more prevalent in Saudi Arabia, currently ranking among the top three cancers affecting women. Despite its rising prevalence, there has been limited assessment of the factors influencing the survival rate (SR) among the Saudi population over an extended period. Therefore, this study aims to address this critical gap in knowledge by identifying the factors affecting the SR of TC, comparing the SR with previous studies, and exploring potential areas for improving the SR of patients.

Methods: A retrospective study analyzed secondary data from patients diagnosed with TC, as recorded in the King Abdulaziz Medical City Cancer Registry in Riyadh, Saudi Arabia, over 10 years from 2009 to 2018.

Results: Of the total 665 TC cases, the mean age at diagnosis was 46.2 years (±SD 16), and most patients were women (78.5%), with the majority being under 50 years old. The most common type of cancer was papillary thyroid carcinoma, comprising 88.6% of all TCs. Over half of the cases were localized to one of the lobes of the thyroid gland, with almost equal frequency between the two lobes. The 5-year SR of localized papillary thyroid carcinoma reached 96.5%, in contrast to the extremely low SR of anaplastic thyroid carcinoma, where most patients died within a few months of the diagnosis. Factors such as morphology, tumor extension, male gender, and age at diagnosis significantly impacted patient survival, as analyzed by the Kaplan-Meier test (p < 0.001). Compared to other types of cancer, those with anaplastic thyroid carcinoma had a lower SR.

Conclusion: The SR of TC patients is predicted by factors such as their age, morphological type, and the presence of distant metastasis.

Background: Functional adrenal tumors may contribute to poor hypertension control and electrolyte abnormalities, thus increasing the risk of cardiovascular mortality. Currently, laparoscopic adrenalectomy is an effective surgical option that contributes to improved treatment outcomes as compared to open surgery. The purpose of this study was to evaluate the outcomes of laparoscopic adrenalectomy performed by a general surgeon at a low-volume center and to identify clinicopathological risk factors for postoperative persistent hypertension.

Methods: A retrospective study of patients with functional adrenal tumors who underwent laparoscopic adrenalectomy at Srinakharinwirot University, Thailand, between 2014 and 2022. Clinicopathologic and postoperative data were examined.

Results: This study included twenty-five patients; the indications for laparoscopic adrenalectomy included primary aldosteronism in 19 (76%), pheochromocytoma in 4 (16%), and Cushing's syndrome in 2 (8%). The average time of surgery was 103.5 ± 19.7 min, and intraoperative complications occurred in three patients (12%), with one patient requiring conversion to open surgery (4%). The postoperative systolic (125 ± 15 vs. 158 ± 18 mmHg; p < 0.001) and diastolic (78.5 ± 6.7 vs. 95.3 ± 10 mmHg; p = 0.013) blood pressure significantly decreased compared to prior surgery, but only 19 patients (76%) achieved a cure for hypertension. Multivariate analysis revealed that the patient's physical status, as classified by the American Society of Anesthesiologists (odds ratio (OR) = 0.66, 95% confidence interval (CI) 0.43-1.32, p = 0.001), and the need for at least three antihypertensive medicines (OR = 0.7, 95% CI 0.36-1.2, p = 0.002), were independent predictive factors of persistent hypertension after surgery.

Conclusion: Laparoscopic adrenalectomy is a safe and effective surgical treatment for functional adrenal tumors, even when performed in a low-volume center. According to the American Society of Anesthesiologists' physical categorization, the patient's physical condition and the necessity for at least three antihypertensive medications are predictors of postoperative hypertension.

Trial registration: The study was registered with the Thai Clinical Registry Trials: TCTR20230707007.

Background: Cervical cancer remains a global health challenge, claiming the lives of millions annually and having a significant impact on Gulf Cooperation Council (GCC) countries. Human papillomavirus (HPV), the primary causative agent, plays a central role, with regional variations in prevalence.¹ The process from HPV infection to neoplastic changes takes 5-25 years to occur, hence, knowing its prevalence in our community is vital.².

Methods: PubMed and SCOPUS were searched to identify articles related to cervical and anogenital HPV prevalence and genotypes in Qatar, Kuwait, Bahrain, Oman, the United Arab Emirates (UAE), and the Kingdom of Saudi Arabia (KSA) published between 2017 and 2024.

Results: A total of 19 articles were included in this review. Eight studies were from KSA, four were from Kuwait, three were from the UAE, one was from Qatar, Oman, and Bahrain, and one presented data collectively from the KSA, UAE, Qatar, and Bahrain. The prevalence of HPV ranged between 4.7% and 77% in studies from the KSA, between 15% and 54.3% in studies from Kuwait, between 14.7% and 88% in studies from the UAE, was 8.1% and 31.3% in the two studies from Qatar, and was 17.8% and 20% in the studies from Oman and Bahrain, respectively. HPV 16 was the most prevalent high-risk genotype found in studies conducted in the KSA, UAE, Kuwait, and Qatar. In Oman, HPV 82 predominated. In Bahrain, the majority had other non-HPV 16/18/45 genotypes. In the UAE and Kuwait, HPV 11 was the predominant low-risk type, followed by HPV 6. In Qatar, HPV 81 was the most common low-risk type, followed by HPV 11. In Oman, HPV 54 was the most common low-risk type, followed by HPV 42.

Conclusion: There are no studies with data on HPV prevalence and genotypes among women who have been vaccinated against HPV in GCC countries.