Qatar Medical Journal最新文献

Background: Traumatic injuries to the extrahepatic bile ducts are rare, with an incidence of 0.4%-0.6% in cholecystectomy procedures among adults, particularly following the introduction of laparoscopic cholecystectomy. Among these, the presence of foreign bodies within the biliary tree is exceptionally rare, with obstructive jaundice caused by a bullet lodged in the common hepatic duct being particularly uncommon. This case report aims to share the diagnostic process and the challenges in managing such a rare condition.

Case presentation: A 41-year-old female with a 13-year history of an accidental gunshot wound, which required an emergency laparotomy, presented to our hospital with symptoms of cholangitis. Endoscopic retrograde cholangiopancreatography was performed, revealing a bullet that caused significant dilation of the proximal bile duct. Exploratory laparoscopy, cholecystectomy, and intraoperative cholangiography confirmed the presence of the bullet. The procedure included a choledochotomy and removal of the bullet, followed by primary closure of the common bile duct using interrupted 4-0 Prolene sutures. The patient was discharged on the 11th postoperative day, and follow-up revealed complete resolution of symptoms and normal liver function.

Discussion: This case underscores the rarity and complexity of managing extrahepatic bile duct injuries caused by foreign bodies. The delayed presentation of symptoms and the unique diagnostic challenges highlight the necessity for meticulous imaging. The successful surgical intervention in this case highlights the importance of individualized treatment strategies implemented by a multidisciplinary team.

Conclusion: Managing traumatic injuries to the extrahepatic bile ducts requires careful consideration due to their rarity and complexity. The challenges in diagnosis and treatment underscore the necessity of a multidisciplinary approach.

Background: A false division between mental and physical disorders is supported by dualism, contributing to mental health stigma. There is a widespread misconception about the prognosis and treatment options for psychiatric diseases. This is despite data supporting the effectiveness of psychiatric treatments for a variety of illnesses that have been proven by meta-analysis. In general, the efficacy of drugs used to treat physical problems and psychiatric disorders is comparable. Methods: In this article, experts from a variety of fields-including psychiatry, primary care, and general medicine-highlight how the paradigms based on dualism play a crucial role in maintaining the myths regarding psychiatric disorders, particularly those that relate to their treatability in comparison to physical health conditions. Results: There are numerous similarities between mental and physical problems in terms of the causes andtreatment. Healthcare, like other complex human systems, is rife with uncertainty. In actuality, the severity and treatability of both physical and mental diseases range widely. Treatment response varies from person to person. There are certain physical and mental health disorders that respond well to treatment, some that do not, and some for which there are currently no effective cures. Conclusion: We believe that dualism, which promotes the separation of mental and physical phenomena, is the core driving force behind these misconceptions. These fallacies, in our opinion, are primarily motivated by dualism, which advocates the division of mental from physical occurrences.

Background/introduction: Acute myocardial infarction (AMI) affects around 3 million people annually worldwide. Typical symptoms prompt timely care, while atypical symptoms may delay diagnosis and treatment, increasing the risks of heart failure and sudden cardiac death.

Objective/purpose: This study aimed to compare typical and atypical myocardial infarction (MI) presentations to enhance early diagnosis, treatment, and prognosis by examining clinical characteristics, chronic comorbidities, history of coronary artery disease, and smoking status at a tertiary hospital in Amman.

Methods: This purposive, descriptive, retrospective study was conducted at the coronary care unit of Al Basheer Hospital in Amman, Jordan, from July 1, 2022, to July 1, 2023. Records of patients diagnosed with MI (ICD-10 code I21) were extracted. Data were analyzed using the IBM SPSS Statistics software (version 25.0). Tests of association were adjusted at the 5% significance level.

Results: The study included 267 MI cases: 60.3% were typical, and 39.7% were atypical. No significant differences were found among age (p = 0.58) and sex (p = 1.27). Atypical MI was linked to a history of coronary artery disease (p < 0.05) and higher diabetes prevalence (p < 0.05). Recurrence rates (p = 0.41) and artery involvement, especially the left anterior descending artery, were similar between groups. Echocardiography showed identical rates of left ventricular hypertrophy in both types, with tricuspid regurgitation more common in atypical MI.

Conclusion: The study found that atypical MI was linked to higher rates of diabetes and coronary artery disease history compared to typical MI. Recurrence rates, artery involvement, and echocardiography results were similar between both types.

Background: Tinea pedis, commonly known as athlete's foot, is a fungal infection of the feet, particularly affecting the space between toes, and it is easy to treat. While it is prevalent worldwide, limited data exist on its prevalence in Qatar. This study aims to determine the prevalence of tinea pedis and identify its associated risk factors among adults in the primary healthcare settings in Qatar.

Methods: A cross-sectional study analyzed electronic medical records (EMRs) of adults aged ≥18 years who registered with the Primary Health Care Corporation (PHCC) between July 2018 and June 2023. A total of 1,002,594 EMRs were studied, and statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 28. We obtained approval with reference number BUHOOTH-D-23-00039 to conduct this study from the Institutional Review Board (IRB) at PHCC.

Results: The overall prevalence of tinea pedis was 1.8%. The risk of tinea pedis increased significantly with age, being 25.1 times higher among individuals aged 70 years or older compared to younger adults (18-29 years). Males were 1.6 times more likely to be affected than females. North Africans had a 3.9 times increased risk. Obesity was a major risk factor, with morbidly obese individuals being 15.1 times more likely to develop tinea pedis than underweight individuals. Diabetics had a 7.1-fold increased risk compared to non-diabetics. HbA1c% values of <7, 7.0-7.9, and ≥8 were considered as recommended control, less-stringent control, and poor control of diabetes mellitus, respectively. Poor control of diabetes elevated the risk by 20% compared to recommended control. All associations were statistically significant.

Conclusion: Tinea pedis is a significant health issue in Qatar, particularly among older adults, males, obese individuals, diabetics, and those with poorly controlled diabetes. These findings can increase awareness among local physicians about the need to screen high-risk groups and promote prevention of modifiable risk factors through targeted interventions and patient education.

Background: Re-expansion pulmonary edema (REPE) is traditionally associated with the resolution of pneumothorax or pleural effusion. Its occurrence after routine cardiopulmonary bypass (CPB) in cardiac surgery is rare. The incidence of REPE after treatment of pneumothorax or pleural effusion is less than 1%, but it carries a mortality rate of up to 20%.

Case presentation: We present a case of REPE in a 64-year-old male undergoing elective coronary artery bypass grafting. Despite an uneventful surgery and standard perioperative management, the patient developed REPE, manifested with increased airway pressures, blood-tinged secretions, and compromised oxygenation post-CPB. Immediate intervention comprising mechanical ventilation adjustments, diuretics, and vasopressor support was initiated to facilitate recovery. The pulmonary edema resolved within 24 hours after the surgery, and the patient was transferred to the surgical high-dependency unit (HDU) on the third postoperative day.

Discussion: This case reports a rare occurrence of REPE following routine CPB and highlights the multifactorial pathogenesis involving reperfusion injury and altered pulmonary physiology. Possible mechanisms include reperfusion injury from free radicals, cytokine release, and increased vascular permeability. The management of REPE requires prompt recognition and treatment and involves diuretics, ventilatory adjustments, and hemodynamic monitoring.

Conclusion: REPE, though rare post-CPB, requires a high index of suspicion and prompt management to prevent adverse outcomes.

Background: Surgical intervention remains the primary treatment for localized renal tumors and masses, with partial nephrectomy (PN) and radical nephrectomy (RN) being the two most frequently employed procedures. The choice between these approaches is often influenced by factors such as tumor size, location, histology, and patient comorbidities. However, the decision between PN and RN remains a subject of ongoing debate, particularly as emerging evidence suggests varying outcomes based on the stage and type of renal tumors. This meta-analysis evaluates the association between renal tumor stage and subtype with the outcomes of PN and RN, focusing on renal function, cancer-specific survival, and postoperative complications.

Method: An exhaustive search was conducted across PubMed, Scopus, and Embase databases, covering the literature from their inception up to March 2023, in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Original studies comparing PN to RN in the management of renal tumors at various stages were meticulously screened, adhering to stringent inclusion and exclusion criteria. This protocol was registered on PROSPERO (CRD42023455985).

Result: Overall, 38 cohort studies were included, with a total of 144,608 patients diagnosed with renal cancer who underwent nephrectomy, 71,582 who underwent PN, and 72,671 who underwent RN. The data revealed a significant difference in cancer-specific survival between PN and RN, which was higher in the RN group (pooled HR: 1.17; 95% CI = 1.01-1.35) p < 0.001. The postoperative renal function of patients who underwent RN was worse than that of patients who underwent PN (pooled RR: 4.22; 95% CI: 1.45, 12.27, p < 0.00001). The relative risk of papillary renal cell carcinoma (RCC) was lower in patients who underwent RN as compared to PN (the pooled RR, 1.32; 95% CI = 1.02, 1.72, p < 0.001), while the relative risk of RCC collecting duct subtype was significantly lower patients who underwent PN as compared to RN (the pooled RR, 0.44 (95% CI = 0.29, 0.67) p = 0.97. Additionally, the pooled risk for patients with a Charlson Comorbidity Index score of ≥2 was lower in the PN group compared to the RN group.

Conclusion: Across various tumor stages, RN demonstrates superior cancer-specific survival, and a lower incidence of postoperative complications compared to PN. However, PN is associated with more favorable renal function preservation. These findings, in conjunction with individual patient characteristics, should be meticulously evaluated to inform the selection of the most appropriate surgical approach and guide patient counseling.

Background: Pulmonary fibrosis is characterized by excessive matrix formation, which destroys typical lung architecture and increases the chances of comorbidity. It is essential to look into potential serum indicators for the early identification of individuals who may develop such severe fibrotic consequences since there is currently no specific marker for the early diagnosis of post-COVID-19 pulmonary fibrosis. The study is aimed at examining potential serum markers that could be used for early detection of pulmonary fibrosis in patients with COVID-19.

Methods: It is a cross-sectional retrospective observational study that included male (n = 26) and female (n = 10) patients who were confirmed positive for COVID-19 using the Reverse transcription polymerase chain reaction (RTPCR) test. Various hematological parameters, such as platelet count, white blood cell count (WBC count), platelet-to-lymphocyte ratio (PLR), white blood cell count to mean platelet volume ratio (WMR), red cell distribution width (RDW), plateletcrit (PCT), mean platelet volume (MPV), platelet distribution width (PDW), serum ferritin level, and CT severity scores (CT-SSs) were recorded. The association between hematological parameters, serum ferritin level, and CT-SS was assessed by the Pearson correlation test using the GraphPad Prism software (version 10). p < 0.05 was considered statistically significant.

Results: The descriptive analysis revealed no significant correlation between platelet count (r = 0.1610, p = 0.3483), WBC count (r = -0.1381, p = 0.4217), PLR (r = 0.2262, p = 0.1847), WMR (r = -0.1093, p = 0.5258), RDW (r = 0.05982, p = 0.7289), PCT (r = -0.059, p = 0.752), MPV (r = 0.046, p = 0.788), and PDW (r = -0.06, p = 0.699) with CT-SS. However, a significant positive correlation was observed between CT-SS and serum ferritin levels in COVID-19 patients (r = 0.5452, p = 0.0006).

Conclusions: As there was a significant positive correlation between serum ferritin level and CT-SS, the serum ferritin level could be considered as a simple and cost-effective biomarker for predicting the development of lung fibrosis in long COVID-19 conditions after controlling the confounders.

Background: Obstructive sleep apnea syndrome (OSAS) significantly impacts patients' quality of life (QOL) due to symptoms such as impaired sleep and reduced daily functioning. Barbed reposition pharyngoplasty (BRP) has emerged as a surgical intervention aimed at alleviating these symptoms. However, its effect on patients' QOL remains underexplored.

Objectives: To evaluate the impact of BRP surgery on a patient's QOL with OSAS.

Methods: Our study had a quasi-experimental design, which was conducted for 40 adult OSAS patients (one group) from 2015 to 2023 between men and women with inclusion criteria above 18 years old who had been diagnosed with OSAS and who had BRP surgery. We measured the impact of this surgery on patient satisfaction by correlating the subjective measures of the pre- and post-operative self-administered the Functional Outcomes of Sleep Questionnaire (FOSQ) as one of the prognostic indicators.

Results: The study included 40 participants, with ages ranging from their 30s to 60s. The mean age of the participants is 44.5 years (SD ± 9.5). Mean FOSQ scores had a significant increase (p < 0.001) in all domains (general productivity, activity level, vigilance, social outcomes, intimate) when comparing pre-operative mean scores with post-operative mean scores. No statistically significant differences were observed in mean percentage change from baseline FOSQ when compared between males and females (p > 0.05) for all domains (general productivity, activity level, vigilance, social outcomes, intimate).

Conclusion: BRP surgery seems to have a significant impact on patient satisfaction in OSAS patients as it reflects on their health-related QOL mood, social outcome, and daily activity and improves their quality of sleep.

Introduction: Diabetes is a major public health concern that affects millions of individuals worldwide, and given the increasing prevalence of this disease, there is a critical need to better understand its pathophysiology, which could lead to improved management strategies to mitigate its effects on society. The aim of this study was to investigate the vascular anatomy of the pancreas and classify the arterial variations of pancreatic blood flow, as well as to determine the correlation between these variations and the occurrence of diabetes and metabolic syndrome (MS).

Methods: This study used multidetector computed tomography (MDCT) angiography to assess the vascular anatomy of the pancreas in a total of 100 participants. The variations were classified based on the origin and course of the pancreatic arteries, and the imaging data were recorded and analyzed.

Results: The study identified three major types of arterial variations. The dorsal pancreatic artery (DPA) was observed to arise from the splenic artery (SPA), common hepatic artery (CHA), and superior mesenteric artery (SMA). The prevalence of arterial variations in the observed population (single-center study) in this research was found to be different from that reported in previous studies conducted on other populations. Specifically, the study found a higher incidence of DPA variations arising from the SPA (in 73% of the participants). The origin from the SMA was seen in 24% of patients and from the CHA in 3% of patients. The length, width, and other characteristics of the pancreatic arteries were also carefully documented. The study also found no significant correlation between arterial variations and the presence of diabetes mellitus or MS. One of the variations was found to display minor constriction but was not significant enough to be considered pathological.

Conclusion: The study revealed the utility of MDCT imaging as a reliable tool for studying pancreatic arterial blood flow. This study contributed to the existing body of knowledge about the vascular anatomy of the pancreas and provided valuable insights for future research in this area.