Qatar Medical Journal最新文献

Background: Cryptosporidium is a common pathogenic parasite known to cause diarrhea in humans and animals, particularly in young children living in poor conditions. Although diarrheal disease is usually mild in immunocompetent individuals, it may progress into a life-threatening complication among the immunocompromised. Due to insensitive conventional diagnostic methods, the identification of Cryptosporidium can be inaccurate and challenging. The present study aimed to investigate the prevalence of cryptosporidiosis infection in Qatar by comparing four different diagnostic methods for detecting Cryptosporidium in human stool samples.

Methods: From January 2018 to December 2019, stool samples from patients with various gastrointestinal symptoms were collected at the microbiology laboratory at Hamad General Hospital in Qatar for parasitic detection. The stool samples were tested using four diagnostic methods: routine microscopy, immunochromatography (ICT), multiplex polymerase chain reaction (PCR), and modified Kinyoun's acid-fast stain (MKS).

Results: In the evaluation of the four different detection methods, 36 (18%) out of 205 stool samples tested positive for Cryptosporidium, with detection rates of 18%, 15%, 7%, and 6% using PCR, ICT, MKS, and routine microscopy, respectively.

Conclusion: The superior sensitivity of PCR and ICT supports their integration into routine diagnostics to improve the detection and public health surveillance of cryptosporidiosis in Qatar.

Background: Emergence delirium (ED) in pediatric patients can result in bodily harms, maladaptive changes, and longer post-anesthesia care unit (PACU) stays. The incidence of ED varies in pediatric patients depending on various factors such as age, type of anesthesia, type of surgery, pain, and the choice of diagnostic tools. Various pharmacological and non-pharmacological methods have been used to reduce its incidence postoperatively. This study aims to investigate the role of a fixed dose of intravenous dexmedetomidine in preventing ED in pediatric patients.

Methods: Approval from the institutional ethical committee was obtained for this randomized controlled trial. Inclusion criteria included pediatric patients aged between 2 and 12 years, with ASA scores ranging from 1 to 3, who were scheduled to undergo general anesthesia for a surgical procedure. The intervention group received 20 ml of 0.2 mcg/kg dexmedetomidine intravenously over a period of 20 minutes before the end of the operation. In contrast, the control group received 20 ml of 0.9% saline. The primary outcome measure of this study was the incidence of ED in the PACU. All data collected during the study were entered and analyzed using the SPSS 22.0 statistical package program.

Results: A total of 66 patients were included in the study. All baseline characteristics of both groups were similar. The incidence of ED in the control group was 42% (14/33), whereas it was 15% (5/33) in the dexmedetomidine group (p = 0.014).

Conclusion: The use of 0.2 mcg/kg intravenous dexmedetomidine reduces the incidence of ED in patients undergoing general anesthesia with sevoflurane.

Objective: This study aims to evaluate the outcomes of surgical treatment in adult and pediatric patients with post-corrosive gastric outlet obstruction (GOO) in Yemen.

Patients and methods: A prospective observational study was conducted at Al-Thawra Modern General Hospital (TMGH), from January 1, 2019 to January 31, 2023. The study involved 77 patients, comprising both adults and children, who were admitted for surgical treatment of post-corrosive GOO. Data were collected from medical records, patient interviews, and follow-up visits.

Results: Among the 77 patients, 77% (n = 59) were pediatric patients and 23% (n = 18) were adults. The mean age of the cohort was 10.6 years, with an average age of 4.12 years for pediatric patients and 30.8 years for adults. The primary cause of post-corrosive GOO was the accidental ingestion of acidic substances, accounting for 97% of cases. Common symptoms at presentation included vomiting, early satiety, and weight loss. Definitive surgery was performed in one stage in 95% of patients, with Heineke-Mikulicz pyloroplasty being the most common procedure (82%) in pediatric cases, whereas gastrojejunostomy was mainly used in adults (67%). Postoperative complications occurred in 22% of patients, with vomiting, wound infection, and aspiration pneumonia being the most common. Anastomotic restriction was observed in two pediatric patients who required reoperation. The overall mortality rate was 1.3%, with one pediatric patient having succumbed. Notably, improvements in GOO symptoms were observed in 96% of patients. Pediatric patients had a longer median hospital stay (6.5 days) than adult patients (6 days).

Conclusion: Corrosive injuries, particularly in the pediatric population, pose a significant issue in Yemen due to the unsafe storage of sulfuric acid. It is recommended to conduct early surgical interventions within 4 weeks after ingestion to prevent weight loss and to reduce prolonged hospitalization. Further research and interventions are needed to prevent such injuries, improve public awareness, and regulate the sale and storage of corrosive substances.

Background: Dysfunctions in thyroid hormones induce various effects on hematopoiesis such as anemia, changes in red blood cells (RBC) and platelet counts, as well as changes in hematological indices. The aim of the present study was to assess the association between thyroid hormone levels and hematological indices among women with thyroid dysfunction who were attending an outpatient clinic in Mosul, Iraq.

Methods: This case-control study was conducted at Al-Wafa Specialist Centre for Diabetes and Endocrine Diseases from April to July 2024. A total of 300 women participated in this study (100 with hypothyroidism, 100 with hyperthyroidism, and 100 with normal thyroid function serving as controls). The hematological indices of the three groups were analyzed and compared. Blood indices were analyzed using the Mythic-18 hematology analyzer. Ethical approval was obtained before data collection, and written consent was obtained from all participants.

Results: All RBC indices [hemoglobin (Hb), RBC count, hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC)] were significantly lower in patients with hypothyroidism compared to those in the control group (p ≤ 0.05), except for red blood cell distribution width (RDW), which was significantly higher in patients with hypothyroidism (p = 0.000).White blood cell count was significantly lower in patient with hypothyroidism compared to those in the control group (p = 0.000). In contrast, no statistically significant differences were observed in any blood indices in patients with hyperthyroidism compared to the control group. A statistically significant negative correlation was identified between thyroid-stimulating hormone and Hb, RBC count, HCT, MCV, MCH, alongside a statistically significant positive correlation with RDW.

Conclusion: The dysfunction of thyroid hormones has an impact on blood indices. Anemia is frequently observed in patients with thyroid dysfunction, especially in cases of hypothyroidism. Variations in blood indices may indicate underlying thyroid disorders. Therefore, it is imperative not to disregard the assessment of thyroid hormones in cases of unexplained anemia or unaccounted changes in blood indices.

Background: Fecaloma is a mass of hardened feces impacted in the rectum and sigmoid. When the colonic mucosal wall and vasculature are compressed, stercoral colitis, a rare type of inflammatory colitis, may occur. Despite being connected to psychiatric patients and antipsychotic medications in the literature, fecaloma remains a significant, yet often overlooked, cause of morbidity and mortality in this population.

Case presentation: A 43-year-old patient with schizophrenia being treated with aripiprazole and benztropine lost follow-up and eventually presented to the emergency department with a giant fecaloma and associated stercoral colitis. She was managed with oral and rectal laxatives and supportive therapy. Additionally, aripiprazole was discontinued.

Discussion: Antipsychotics have been associated with constipation, fecaloma, and stercoral colitis due to their anticholinergic properties. Benztropine, an antimuscarinic drug commonly used in psychiatric patients to alleviate extrapyramidal symptoms, may further decrease gastrointestinal mobility. Fecaloma and associated stercoral colitis are often diagnosed via imaging, typically a computed tomography scan of the abdomen. Management depends on the severity and generally ranges from conservative treatment to surgical options.

Conclusion: This case describes a schizophrenic patient undergoing treatment with aripiprazole and benztropine who presented with constipation and was diagnosed with a giant fecaloma complicated by stercoral colitis. The patient was managed successfully with aggressive laxatives and discontinuation of aripiprazole. Early recognition and prompt management of fecaloma are essential to mitigate associated complications. In addition, it is important to recognize risk factors for constipation and regularly review home medications, such as antipsychotics, that may cause constipation as a side effect.

Background: During the coronavirus pandemic, many people looked for information on COVID-19 through social, official, and traditional media sources. This caustic situation resulted in panic among the public, leading to many false news, conspiracy theories, and magical cures being spread among the public at an alarming rate. Controversial theories about the validity of vaccination and non-adoption of disease control resulted in a slow disease control rate and adverse impacts on global health and the economy. Recent studies have shown that health information could safely guard mental health during the COVID-19 pandemic. To adopt a disease control strategy, it is essential to identify the public confidence in information sources and the most efficient media to disseminate intervention messages to the public. The main objectives of this study were to identify from 12 alternative information sources the most utilized COVID-19 source of information, the most trusted information source, and the factors associated with high trust in a given source.

Methods: A cross-sectional online survey with 442 participants aged 18 years and above was conducted to assess public views and preferences on sources of information for COVID-19. Data was analyzed using descriptive statistics, correlation, and logistic regression analyses. Bloom's scale, composite score preference, and chi-squared test were determined for result evaluation purposes.

Results and conclusion: The study findings suggest that the Ministry of Public Health is a widely trusted information source that offers a potentially effective tool for shaping, designing, and disseminating information messages to shape public attitudes toward control of COVID-19 and enhancement of preventive actions. By offering insight into the pattern of COVID-19 information sources and its associated factors among the public in Qatar, the study formulated a set of recommendations for health decision-makers to set packages to help manage and control the spread of coronavirus.

Introduction: The burden of stroke is increasing in Qatar, similar to many other countries in the world. The prevalence of stroke risk factors plays an important role in the burden of stroke in Qatar.

Objective: This study aims to assess the stroke knowledge, recognition, prevention, and medication adherence among high-risk patients.

Methods: This was a cross-sectional study involving high-risk patients admitted to the inpatient medical unit through a paper-based survey using four adopted scales Stroke knowledge test, Stroke Recognition Questionnaire, stroke prevention awareness, and Medication Adherence Rating Scale tool. Two hundred ninety-nine completed responses from the participants were used for analysis.

Results: The 41-50-year-old age group was most represented (33.11%) with a median age of 49 years. The male-female ratio was approximately 3:1 and 30.10% of the participants held a graduate degree or higher.The majority of the patients (41.47%) are obese (BMI > 30) and overweight (31.10%). The mean stroke knowledge was 38.01 ± 15.78, while the recognition and prevention domains had mean scores of 67.85 ± 10.85 and 77.55 ± 27.63 respectively. The medication adherence group has a statistically significant association with stroke recognition and prevention domains with a mean score of 72.14 ± 12.34 (p = 0.000) and 88.87 ± 24.75 (p = 0.000) respectively.

Conclusion: Participants' awareness regarding stroke knowledge was low compared to recognition and preventive measures. Stroke awareness positively correlates with medication adherence among high-risk patients admitted to the inpatient unit.

Background: Despite substantial clinical evidence and recommendations from international societies supporting the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) for managing patients with type-2 diabetes (T2D) and chronic kidney disease (CKD), their adoption has remained limited. To address this, the nephrology quality improvement (QI) team at Hamad Medical Corporation (HMC), Qatar, implemented a key performance indicator (KPI) program in March 2022, aiming to ensure that at least 80% of eligible T2D-CKD patients at HMC were receiving SGLT2i by December 31, 2023.

Methods: The use of SGLT2i and angiotensin-converting enzyme inhibitor (ACEi) or angiotensin II receptor blocker (ARB) in T2D-CKD patients attending nephrology clinics at HMC hospitals were assessed through retrospective surveys using a cluster-based sampling approach. Nephrology physicians were then updated on the results of these retrospective surveys as well as evidence from the SGLT2i trial and guidelines. The aims, objectives, and targets of the KPI program were clearly defined. Three additional surveys were conducted at 6-month intervals. A multifaceted QI intervention approach-combining audit, feedback, leadership engagement, and peer consultation-was implemented to drive improvement.

Results: Retrospective surveys conducted in November 2021 and February 2022 revealed that 38% and 44% of eligible T2D-CKD patients were receiving SGLT2i therapy, compared to 98% and 99% for ACEi/ARB. Four months after implementing the KPI program, the July 2022 survey revealed no change in SGLT2i use (41%), while ACEi/ARB prescription rates remained near 100%. Following QI interventions in November 2022, the February 2023 survey revealed a significant increase in SGLT2i use, rising to 88%, with SGLT2i initiation in naive patients increasing from 34% to 61%. The final survey conducted in August 2023 showed that 84% of patients were receiving SGLT2i therapy.

Conclusion: Our KPI program boosted SGLT2i prescription rates for eligible T2D-CKD patients in nephrology clinics, resulting in a 47% rise from 41% to 88%. It overcame prescription inertia and accelerated the guideline adoption by combining real-time feedback, leadership engagement, and peer discussions. The sharp rise in new prescriptions following November 2022 feedback underscores its direct influence on behavior modification rather than a broader trend.

Background: Papillary thyroid carcinoma (PTC) accounts for 90% of thyroid malignancies, with lymph node metastasis being a critical prognostic factor. However, the mechanisms driving metastasis remain unclear. This study investigated the role of E-cadherin and zinc finger E-box-binding homeobox 1 in cancer progression among Iraqi PTC patients.

Methods: The expression levels of E-cadherin and zinc finger E-box-binding homeobox 1 were analyzed in 50 Iraqi patients diagnosed with PTC without lymph node metastases, evaluated between January 2015 and December 2021. The Pearson correlation coefficient between these markers and the risk of lymph node metastasis, as well as their relationship to tumor grade and stage, was calculated. The area under the receiver operating characteristic (ROC) curve for both markers was performed. The Medical Ethics Committee of the Iraqi Ministry of Higher Education and Scientific Research (Reference No. 14) approved the study.

Results: This study examined 50 PTC cases, revealing significant associations between E-cadherin and zinc finger E-box-binding homeobox 1 expression and lymph node metastasis, clinical stage, and tumor grade. Zinc finger E-box-binding homeobox 1 expression was higher in metastatic cases (92% vs. 16%), while E-cadherin was lower (24% vs. 84%). Zinc finger E-box-binding homeobox 1 positively correlated with lymph node metastasis (r = 0.68), stage (r = 0.72), and grade (r = 0.56), whereas E-cadherin showed negative correlations (r = -0.60, -0.59, and -0.52, respectively). ROC analysis showed areas under the curve of 0.88 zinc finger E-box-binding homeobox 1 and 0.82 (E-cadherin), suggesting their potential as biomarkers for metastasis prediction.

Conclusions: The study concluded that E-cadherin and zinc finger E-box-binding homeobox 1 are key predictors of lymph node metastasis, tumor grade, and stage in PTC. Monitoring these markers could enhance clinical decision-making and patient management.