Qatar Medical Journal最新文献

Background: Vitamin D deficiency is a widespread global public health concern. Although it is prevalent in the Middle East, available data remain limited. This gap in research leaves important questions unanswered regarding the exact prevalence of vitamin D deficiency and its potential impact on the population health. This study aims to determine the prevalence of vitamin D status among individuals in Qatar during the SARS-COV-2 pandemic (2020), using a fully automated chemiluminescent immunoassay.

Methods: This epidemiological study included 1,000 participants selected from the Primary Health Care Corporation electronic medical record system. Random sampling was used to select the study sample, and data analysis was performed to determine prevalence by gender, age group, and patient's continent of origin. Serum levels of 25-hydroxyvitamin D [25(OH)D] were interpreted according to the guidelines of The Endocrine Society. Levels were classified as follows: vitamin D deficiency (serum 25(OH)D<20 ng/mL), vitamin D insufficiency (20-29 ng/mL), optimal levels (30-50 ng/mL), and potential toxicity (>50 ng/mL).

Results: The overall prevalence of vitamin D deficiency in Qatar was 49.8%. While there was no significant variation by gender, the prevalence varied significantly across age groups (p <0.0001) and by patients' continent of origin (p <0.0001). Deficiency rates were highest in the 10-17 years age group (63%) and lowest among individuals aged >60 years (24.7%). Additionally, the deficiency rates were highest among individuals from Asian countries (51.6%) and the Middle East and North Africa (MENA) region (49.8%), and lowest among those from America and Europe.

Conclusion: This study reveals a high prevalence of vitamin D deficiency in Qatar, affecting nearly half of the population and showing significant variations across age groups and geographical backgrounds. Individuals from Asian and MENA regions were more affected than those from America and Europe, highlighting possible lifestyle or genetic influences. These findings are intended to guide public health interventions and support global efforts to address vitamin D deficiencies.

Background: Invasive candidiasis has risen alarmingly over the last decades, with diagnosis often complicated by colonization at multiple body sites. The Candida score offers a simplified tool to help identify patients at risk of invasive candidiasis, particularly in intensive care unit (ICU) settings; however, its applicability in patients with broader characteristics remains uncertain. Moreover, research on Candida colonization and the utility of such tools in Indonesia is still limited. This study aimed to evaluate the association between clinical and laboratory characteristics and patient outcomes, while also assessing the predictive value of the Candida score in both ICU and non-ICU patients at a tertiary academic hospital in Yogyakarta, Indonesia.

Materials and methods: This is an observational retrospective cohort study. During the period of January 2019 to December 2021, recorded laboratory data and clinical characteristics of patients (ICU and non-ICU patients) whose specimens yielded Candida spp. were collected through electronic health records. The correlation of laboratory profile and clinical characteristics with the outcome was analyzed comparatively using bivariate and multivariate analysis.

Results: Ward status, length of stay, number of comorbid, history of steroids, Candida score of ≥3, and mechanical ventilation were significantly correlated with the non-survivor group. Multivariate analysis showed that intensive care status and a Candida score ≥3 were found to have the strongest and independent correlation with the non-survivor group (p ≤ 0.001; OR 11.8 [95% CI, 4.368-31.962] and p = 0.004; OR, 3.9 [95% CI, 1.562-9.065], respectively).

Conclusion: Being in the ICU and having a Candida score of ≥3 was independently correlated with poorer clinical outcomes in hospitalized patients with Candida spp. colonization.

Background: Intravenous lidocaine is used to treat acute postoperative pain by reducing discomfort, accelerating mobilization, and shortening hospitalization. This study evaluated the effects of intravenous bolus and continuous lidocaine infusion on pain intensity, fentanyl requirements, and plasma norepinephrine levels in hysterectomy surgery under spinal anesthesia.

Methods: A double-blinded randomized clinical trial was conducted on 46 patients undergoing hysterectomy with spinal anesthesia. The lidocaine group (n = 23) received a 2% lidocaine bolus (1.5 mg/kg) followed by a continuous infusion (1 mg/kg/hour) for 24 hours. The control group (n = 23) received 0.9% NaCl. Resting and moving numeric rating scale (NRS) pain scores, total fentanyl requirements, and norepinephrine levels were recorded at 4, 6, 12, and 24 hours postoperatively.

Results: Statistically significant differences in resting pain NRS were observed at the 4th, 6th, 12th, and 24th hours (0.52 ± 0.51 vs. 1.52 ± 0.51, 0.61 ± 0.58 vs. 1.52 ± 0.51, 0.52 ± 0.51 vs. 1.74 ± 0.81, and 0.52 ± 0.51 vs. 1.52 ± 0.51, respectively; p < 0.001). The reduction in pain score on the moving NRS in the lidocaine group was significantly greater at 6 hours (2.22 ± 0.79 vs. 2.91 ± 1.04; p = 0.001) and 12 hours (2.26 ± 0.75 vs. 2.57 ± 1.12; p < 0.001) postoperatively compared to the control group. Total fentanyl requirements were significantly lower in the lidocaine group (103.04 ± 33.63 mcg vs. 421.74 ± 74.32 mcg; p < 0.001). Plasma norepinephrine changes differed significantly at T6-T0 (-0.66 ± 1.81 pg/mL vs. 1.98 ± 1.69 pg/mL; p < 0.001) and T24-T0 (-1.74 ± 1.94 pg/mL vs. 1.53 ± 1.12 pg/mL; p < 0.001). No side effects were observed.

Conclusion: Intravenous bolus and continuous lidocaine infusion reduced postoperative pain intensity, fentanyl requirements, and norepinephrine levels without significant side effects.

Background: Thyroglobulin has been identified as a marker for thyroid cancer monitoring. However, researchers have proposed and employed it as a biomarker to assess iodine-dependent thyroid dysfunction during pregnancy. Pregnancy is a hyperdynamic state that significantly strains the mother's iodine stores due to the demands of the foetus. This study combined thyroglobulin and thyroid function tests to see their impact on identifying more patients who are at risk for thyroid disorders in pregnancy. The aim of the study was to determine thyroglobulin as an adjunct biomarker in thyroid function assessment in pregnancy.

Methods: Participants were across five centers, and the study was conducted over a period of 9 months (June 2019-February 2020). The study comprised a cohort of 250 pregnant women who were attending their antenatal clinic visits. These participants were selected randomly using a table of random numbers. Blood samples were taken and analyzed using immunoassay techniques. The data were analyzed using Statistical Package for Social Sciences (SPSS), version 21 (IBM, Chicago, IL).

Results: Thyroid-stimulating hormone (TSH) assay only identified 35 (14%) participants, whereas the combination of the TSH and Tg assays identified 50 (20%) participants. Thyroglobulin and free thyroxine measurements revealed the presence of hyperthyroidism in 15 (9.6%) and hypothyroidism in 8 (3.2%). Using both TSH and thyroglobulin, we identified 54 (21.6%) participants as having thyroid dysfunction, with a higher prevalence of 40 (16%) hypothyroid participants compared to 14 (5.6%) hyperthyroid participants.

Conclusion: Thyroglobulin is valuable during pregnancy, with the ability to reflect iodine status as a sensitive marker in identifying early thyroid dysfunction.

Background: Celiac disease (CD) is a chronic immune-mediated disorder of the digestive system triggered by gluten ingestion among genetically predisposed individuals. It is a chronic disease that causes malnutrition, but it is a non-fatal condition. A significant proportion of cases remain undiagnosed due to asymptomatic or nonspecific presentations, contributing to delayed diagnosis and long-term complications. CD is not a contraindication for blood donation. This study aims to determine the seroprevalence of CD antibodies and the prevalence of biopsy-proven CD among blood donors.

Methods: A cross-sectional study was conducted on 1,497 blood donors (≥18 years) at Hamad Medical Corporation, Doha, Qatar, between 2018 and 2022. Serum anti-tissue transglutaminase IgA (anti-tTG IgA) and anti-endomysial IgA (anti-EM IgA) antibodies were measured in enrolled blood donors. Individuals with positive results for either antibody underwent esophagogastroduodenoscopy (EGD) with duodenal biopsies to confirm the diagnosis.

Results: Serological testing revealed a seroprevalence of 0.8% (95% CI, 0.4%-1.4%) for anti-tTG IgA, with 83.3% of these individuals also being positive for anti-EM IgA. All seropositive individuals were male. Of 12 seropositive individuals, 4 (33%) consented to EGD and duodenal biopsy. Histological findings confirmed CD in two cases (50% of seropositive individuals who consented to biopsy). Both confirmed cases exhibited Marsh grade 2 changes.

Conclusion: The seroprevalence of CD antibodies among healthy blood donors was 0.8%, and biopsy-proven CD was 50% among seropositive individuals who consented to EGD. These findings highlight the presence of undiagnosed CD in this population, predominantly in males, and underscore the need for further community-based studies to assess the true prevalence and clinical implications of CD.

Introduction: Systemic lupus erythematosus (SLE) and Sjögren's syndrome (SS) are chronic autoimmune diseases that can coexist, complicating the diagnostic process due to overlapping clinical and serological features. Hypergammaglobulinemia, often associated with these conditions, can mimic hematological malignancies, posing a significant diagnostic challenge.

Case presentation: We report a case of a 57-year-old woman presenting with progressive fatigue, dry cough, and vasculitic rashes for several weeks. Initial laboratory results revealed pancytopenia, hypergammaglobulinemia, and elevated inflammatory markers (erythrocyte sedimentation rate (ESR) >100 mm/hr, C-reactive protein (CRP) 137.7 mg/L), raising suspicion for multiple myeloma. However, protein electrophoresis (which showed polyclonal rather than monoclonal globulinemia) and bone marrow biopsy excluded malignancy. Further autoimmune screening confirmed coexisting SLE and SS, with positive ANA (≥1:1280), anti-dsDNA, anti-Ro, and anti-La antibodies. Polyclonal hypergammaglobulinemia was attributed to these autoimmune conditions. The patient responded well to azathioprine and hydroxychloroquine, with significant clinical and biochemical improvement.

Discussion: This case highlights the importance of distinguishing polyclonal hypergammaglobulinemia due to autoimmune diseases from monoclonal gammopathies such as multiple myeloma. Early autoimmune screening and multidisciplinary collaboration were essential in achieving an accurate diagnosis and appropriate management.

Conclusion: Polyclonal hypergammaglobulinemia in the presence of elevated inflammatory markers warrants a thorough differential diagnosis to distinguish autoimmune conditions from hematological malignancies. This case underscores the critical role of comprehensive autoimmune screening in guiding timely and accurate diagnosis.

Objectives: This study aimed to evaluate the effectiveness and short-term outcomes of primary nasal intermittent positive pressure ventilation (NIPPV) in extremely preterm (EP) infants with respiratory distress syndrome (RDS).

Methods: A retrospective case-control study was conducted at the Women's Wellness and Research Center in Qatar, from January 2017 to December 2019. Primary NIPPV success was defined as the absence of surfactant administration or mechanical ventilation within the first 72 hours of life.

Results: Of 367 infants requiring respiratory support at birth, 69 were managed with primary NIPPV. Among them, 62.3% succeeded (NIPPV-S) and 37.7% failed (NIPPV-F). Birth weights (956 g vs. 937 g) and gestational ages (26.3 weeks vs. 26.2 weeks) were similar between groups. NIPPV-S babies had more vaginal deliveries (48.8% vs. 19.2%, p = 0.014), higher arterial pH levels (7.36 vs. 7.29, p < 0.001), lower initial FiO₂ (27.8% vs. 35.3%, p < 0.001), and less severe RDS (2.5% vs. 28.6%, p = 0.006). They also received caffeine earlier (2.6 hours vs. 4.3 hours, p = 0.042) and were more often in room air at day 28 (34.9% vs. 8.2%, p = 0.016). In the NIPPV-F group, 65% were intubated within 12 hours. NIPPV-S infants also had lower rates of brain injury (14.6% vs. 45.8%, p = 0.006) and bronchopulmonary dysplasia (BPD) (18.6% vs. 41.7%, p = 0.041), with a trend towards reduced death or severe BPD (2.3% vs. 15.4%, p = 0.063). Multivariate analysis identified admission FiO₂ less than 0.4, vaginal delivery, and normal fetal Doppler as significant predictors of NIPPV success.

Conclusions: Among EP infants managed with primary NIPPV, success within the first 72 hours was associated with lower initial FiO₂, vaginal delivery, and normal fetal Doppler findings. EP infants who succeeded on NIPPV had less severe RDS and better outcomes, including lower rates of brain injury and BPD. Early identification of infants likely to succeed may improve clinical outcomes.

Background: The physiological changes during Ramadan in people with type 2 diabetes (T2D) are not well described in the literature. However, advances in technology have created new frontiers to understand these changes. This study aims to understand the impact of Ramadan fasting on blood glucose excursion, vital signs, and physical activities in people with T2D who are on three or more antidiabetic medications.

Methods: This prospective observational study was conducted at Hamad General Hospital, National Diabetes Centre, between February 1, 2020 and May 30, 2020 (covering three months before and including the month of Ramadan). We included people with T2D who were on three or more antidiabetic medications. Medications were adjusted during Ramadan based on international guidelines. Flash glucose monitoring and Fitbit devices were used to monitor glucose levels and physical activity. The primary outcomes were changes in time in range (TIR), time above range (TAR), and time below range (TBR) before and during Ramadan.

Results: We included 18 patients with T2D, of whom 13 were males (72.2%). The mean age was 51.2 years (SD 7.4), the mean HBA1c was 7.8% (SD 1.0), and the mean duration of T2D was 12.5 years (SD 3.1). There were no significant changes in TIR, TAR, and TBR before and after Ramadan. There was no statistically significant difference in the TIR, TAR, and TBR during fasting hours and after iftar. However, the ambulatory glucose profile shows a reduction in glucose levels during fasting hours, reaching a nadir just before iftar, followed by a prolonged period of hyperglycemia post iftar. Physical activity levels decreased during fasting hours but increased approximately one hour before iftar. Multilinear regression analysis showed a positive correlation between engaging in vigorous physical activity and the TBR during fasting hours [β-coefficient (95% CI): 0.26 (0.07-0.45), p < 0.05].

Conclusion: Our findings show no significant changes in the overall glucose profile, except for prolonged post-iftar hyperglycemia. Intensive physical activity during fasting hours can increase the risk of hypoglycemia. This studyhighlights the need for further in-depth research to better understand the impact of lifestyle changes on blood glucose excursion during Ramadan.

Background: Ambulance collisions pose a significant occupational risk to personnel, patients, and the public. Despite ongoing efforts to improve safety measures, the complex nature of emergency response operations continues to pose challenges in reducing collision risks.

Objective: This study investigates the role of the dedicated Vehicle Collisions Review Panel at Hamad Medical Corporation Ambulance Service (HMCAS) in identifying, understanding, and managing risks associated with ambulance collisions.

Methods: A retrospective quantitative analysis of HMCAS ambulance collision records from 2023 was conducted using descriptive and bivariate analyses, along with supervised and unsupervised machine learning (ML) techniques - including multinomial logistic regression (MLR), decision tree (DT) analysis, association rule mining (ARM), and time series forecasting - to uncover hidden patterns, predictive insights, and future projections.

Results: A total of 131 ambulance collisions were analyzed. The majority of incidents involved emergency urban ambulances. MLR and DT achieved prediction accuracies of 41% and 35%, respectively. ARM revealed significant association between daytime incidents, normal road conditions, and the absence of patient involvement. Time series forecasting predicted a gradual increase followed by stabilization in collision incidents.

Conclusion: This study highlights the crucial role of a dedicated collision review panel in managing and mitigating ambulance collision risks. ML techniques provided evidence-based support for decision-making. Future research is needed to evaluate the long-term impacts of targeted training programs and safety protocols.

Background: Herpes zoster (HZ) is a secondary viral infection that results from the reactivation of latent varicella zoster virus, characterized by dermatological manifestations and neurological sequelae. The incidence of HZ increases with age and is higher among immunocompromised individuals. While the global literature extensively documents HZ disease and its impact, there is a paucity of data in regional studies. Despite the availability of vaccines, HZ poses a public health challenge, especially in regions with limited healthcare access, underscoring the need for better surveillance and management strategies globally, regionally, and nationally.The study aims to estimate the incidence of HZ among attendees of primary healthcare facilities in the Kingdom of Bahrain, analyze the demographic distribution of patients based on age, sex, and risk factors, and gain insights into the clinical presentation and the most common complications within the local society.

Methods: This study used a retrospective cross-sectional design, targeting all patients who visited governmental healthcare facilities and were reported to have been diagnosed with HZ in 2021, according to electronic medical records. Patients were contacted via phone to collect specific information related to the episodes they experienced, while additional information was retrieved from electronic health records (EHR). Informed consent was obtained from all participants. During the calls, five patients declined to provide details about the episodes; their decision was respected, and only the information available in their EHR was used. All collected data were systematically recorded in an Excel spreadsheet for analysis.

Results: The total incidence of HZ was 59.09 per 100,000 population. The median age was 42.8 ±19 years, with a higher prevalence observed in males (53.4%). Of the study participants 79.1% were Bahrainis, 22.3% had diabetes, and 3% had other comorbidities. The most frequently reported clinical manifestations were rash (79.9%) and pain (15.8%). The trunk (30.5%), back (19.5%), and abdomen (13.9%) were the most commonly reported locations affected by HZ. Antiviral treatment was administered to 65.2% of the patients. The most commonly reported complications included post-herpetic neuralgia (6.7%) and cellulitis (4.4%).

Conclusion: Individuals in older age groups exhibit a significantly higher likelihood of developing HZ infection along with the associated post-infection complications. This finding aligns with those from other studies. It is recommended to implement interventions aimed at reducing both the incidence and morbidity of HZ, particularly targeting those at higher risk.