Qatar Medical Journal最新文献

Introduction: Malignant otitis externa (MOE) is an aggressive infection of the external auditory canal and the underlying bony structures of the skull base. Predominantly caused by Pseudomonas, the treatment has shifted from surgical to medical, with antimicrobial therapy being primary, although surgical intervention may still be required. This review aims to provide global prevalence and mortality data on MOE to help institutions establish treatment benchmarks.

Methods: A systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Searches were completed in Scopus and PubMed Databases for articles on MOE mortality published between 1994 and 2022. Publications included data on MOE, mortality, and all genders.

Results: A total of 22 studies involving 9,633 patients diagnosed with MOE were analyzed. The gender distribution was nearly equal, with 4,819 (50.1%) males and 4,814 (49.9%) females. The patients' ages ranged from 18 to 90 years, with a mean age of 70.3 years. The pooled period prevalence of mortality due to MOE was estimated to be 18% (95% confidence interval: 6-30%), highlighting a significant mortality risk in patients with this condition. Heterogeneity across the studies was high (I² = 99%, p < 0.001). Additionally, the prevalence of comorbidities was significant: 57.1% of patients were diabetic, 51% had hypertension, and other notable comorbidities included chronic pulmonary diseases (12.2%), liver disease (7.2%), and malignancies (3.4%). The most common microbiological cause was Pseudomonas aeruginosa (30%), followed by Staphylococcus aureus (10%). Surgical interventions were performed in 3.7% of cases, and cranial nerve involvement was reported in 9% of patients, primarily affecting the facial nerve (91%). Morbidity related to MOE was found to be 15.2%, and sepsis was a complication in 0.5% of cases. The results underscore the importance of addressing both comorbidities and mortality risks in managing MOE patients.

Conclusion: This review highlights a significant global mortality rate of 18% in patients with MOE, with comorbidities like diabetes and hypertension contributing to worse outcomes. Despite current treatment advancements, mortality and morbidity remain substantial, stressing the need for early diagnosis, targeted interventions, and improved management strategies to enhance patient survival and outcomes.

Background: Pleural diseases are common and often require drainage, with the growing use of small-bore chest drains (SBCDs) instead of larger tubes. This review aimed to examine the failure rate and complications associated with SBCD use in different pleural pathologies.

Methods: A literature search (PubMed, SCOPUS, and Google Scholar) was performed on the complications associated with SBCDs to treat pleural diseases. This review analyzed patient demographics, indications, outcomes, failure rate, and complications associated with the use of SBCDs. The systematic review was conducted using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines.

Results: Thirty studies were included in this review with 4,973 patients. The indications for insertions of SBCDs were pleural effusion at 48.4%, pneumothorax at 30.1%, empyema or parapneumonic effusion at 11.4%, hemothorax at 6.5%, and other indications at 3.6%. The overall failure rate to achieve satisfactory drainage was 19.4%. Significant complications included iatrogenic pneumothorax at 11.9%, major hemorrhage at 1.0%, local bleeding at 0.7%, infection at 1.2%, and iatrogenic organ injury at 0.9%. Other insertional complications included tube dislodgement at 5.9%, tube blockage at 5.4%, tube kinking at 3.7%, misplacement at 3.3%, and subcutaneous hematoma at 0.5%. Most of the data published revolves around hemodynamically stable patients with SBCD insertions and is, thus, deficient regarding hemodynamically unstable patients.

Conclusion: Despite carrying notable failure rates and complications, small-bore catheters remain an acceptable option for managing selected pleural diseases.

Background: Diabetic striatopathy (DS) typically presents with hemichoreoballism and contralateral striatal lesions on neuroimaging. However, cases of unilateral movement disorders with predominant ipsilateral striatal lesions are rare.

Case presentation: We present a case of DS in a 62-year-old woman from rural India with poorly controlled diabetes mellitus who developed acute-onset right hemichoreoballism. Neuroimaging revealed a predominantly right-sided striatal lesion, illustrating a clinicoradiological discordance-a mismatch between the clinical symptoms and radiological findings. Despite achieving tight glycemic control and administering neuroleptic medications, the involuntary movements demonstrated only partial improvement. Neurological changes persisted on the ipsilateral side of the affected limbs even after 1 year of follow-up. Notably, perioral dyskinesias developed during subsequent follow-up visits.

Discussion: This report highlights the clinical and neuroradiological discordance observed in DS. The potential underlying mechanisms contributing to this paradox are explored and discussed.

Conclusion: The clinical and radiological discordance in DS is a frequent yet under-reported phenomenon. However, the actual mechanistic underpinnings need to be addressed by advanced functional and structural neuroimaging.

Simulation, in its various forms, is widely used in all stages of education, training, and assessment of healthcare students and professionals. There is, however, a lot of variation in practice regarding the way in which institutions implement simulation, and in particular how educators work with simulated participants (SPs). This short article makes a case for bringing together all of Qatar's healthcare educators and SPs at the 2025 Qatar Simulation Symposium in order to enhance simulation-based educational practices and raise awareness of standards of best practice. It could play a significant role in improving learners' experiences and eventually positively impact on patient care.

Background: Cerebral venous sinus thrombosis (CVST) is an uncommon yet critical complication, especially when arising from heparin-induced thrombocytopenia (HIT). In patients with preexisting conditions such as myasthenia gravis (MG), this correlation adds further complexity to clinical management and outcomes.

Case presentation: We report a unique case of CVST induced by HIT in a patient with an established diagnosis of MG. Following plasma exchange therapy, which included heparin administration, the patient developed symptoms indicative of CVST. Diagnostic imaging confirmed thrombosis in the cerebral venous sinuses. Management involved the immediate discontinuation of heparin and the initiation of fondaparinux, leading to effective anticoagulation and clinical improvement.

Discussion: This case illustrates the rare intersection of CVST and HIT within the context of MG, underscoring the potential risks associated with heparin therapy in vulnerable patient populations. Early recognition of the signs is essential, as these conditions, in combination, demand prompt and specialized interventions to prevent serious complications.

Conclusion: The successful management of this complex case demonstrates the importance of heightened awareness and proactive strategies in patients with MG undergoing heparin therapy. This report advocates for careful monitoring and tailored treatment to mitigate risks in similarly complex clinical scenarios.

Background: Lung cancer is a leading cause of cancer-related mortality globally, often presenting with diverse and challenging manifestations. This case report discusses an unusual presentation of epidermal growth factor receptor (EGFR)-mutated non-small-cell lung cancer (NSCLC) initially mimicking tuberculosis (TB), complicated by pituitary involvement.

Case presentation: A 30-year-old female presented with respiratory symptoms and systemic complaints, initially suggestive of miliary TB. Further investigations revealed metastatic lung adenocarcinoma with pituitary metastasis, causing diabetes insipidus, hyperprolactinemia, adrenal insufficiency, and hypothyroidism. Treatment with targeted therapy involving osimertinib resulted in clinical improvement.

Conclusion: This case underscores the diagnostic challenges posed by atypical presentations of lung cancer, which can masquerade as infectious diseases like TB. The presence of pituitary metastasis further complicates the clinical picture, emphasizing the importance of considering rare metastatic sites in the differential diagnosis of lung adenocarcinoma. Timely recognition and appropriate management are crucial for optimizing outcomes in such complex cases, highlighting the need for a multidisciplinary approach in oncological and endocrine care.

Introduction: Venous thromboembolism (VTE) following anterior cruciate ligament (ACL) arthroscopic reconstructions is reported to occur at a rate of 0.5%-2.2%, with very few studies investigating the use of thromboprophylaxis. This study aims to investigate the incidence of VTE post ACL reconstruction surgery while proposing a thromboprophylaxis regimen.

Methods: A single-center retrospective cross-sectional observational study was conducted over 8 years and 8 months. The primary outcome was the incidence of symptomatic VTE up to 12 weeks post-operatively. Secondary outcome measures were the rate of major bleeding incidents, wound infections, and delayed wound healing. Enoxaparin 40 mg subcutaneously once daily and thromboembolic deterrent stockings were given to all patients for 14 days post-operatively. Total anesthetic time, total surgical time, and tourniquet time were also recorded. Only patients who underwent arthroscopic ACL reconstruction were included, with all conservatively managed patients being excluded.

Results: A total of 155 patients were identified, and none had a symptomatic VTE up to 12 weeks post-operatively. None of the patients experienced delayed wound healing, wound infections, or major bleeding incidences up to 12 weeks post-operatively. Average total anesthetic time was 145 (±24.8) minutes, average total surgical time was 122 (±25.3) minutes, and average Tourniquet time was 82.1 (±23.8) minutes.

Conclusion: We demonstrated a 0% rate of clinically symptomatic VTE without complications such as delayed wound healing or major bleeding incidents. This is the only study proposing a combined regimen of both chemical and mechanical thromboprophylaxis after ACL reconstruction. Further research involving larger groups would be required to assess the effectiveness of this approach and to compare the effectiveness of mechanical and chemical thromboprophylaxis after ACL reconstruction.

Background: Chronic granulomatous disease (CGD) is a primary immunodeficiency due to alterations in the oxidative metabolism of phagocytic cells. This condition is characterized by serious and recurrent infections caused by pyogenic bacteria, particularly Staphylococcus aureus, and fungal pathogens such as Aspergillus. These infections are associated with granuloma formation and inflammatory manifestations.The aim of our study was to report the clinical characteristics, microbiological aspects and outcomes, and prognosis of a cohort comprising 42 Moroccan patients suffering from CGD.

Methods: A total of 42 patients were diagnosed for family history, consanguinity, and both clinical and laboratory findings.The diagnosis was confirmed by assessing neutrophil oxidative burst activity, using either the nitroblue tetrazolium (NBT) test or the dihydrorhodamine (DHR) test.

Results: The cohort comprised children from 34 different families, including 12 siblings. The age of onset ranged from 4 days to 13 years, with the diagnosis being established between the ages of 25 days and 13 years. The predominant clinical manifestations were skin infections, lymphadenopathy, pneumonia, BCGitis, liver abscess, pulmonary aspergillosis, and inflammatory colitis. The most frequently isolated germs were Aspergillus, Serratia, and Staphylococcus. Among the total of 42 patients, 17 fatalities occurred, with aspergillosis being identified as the primary cause of their deaths.

Conclusions: In this study, the clinical characteristics and isolated microorganisms correspond to the pathogens known to be important in CGD. Lung infections represent the most prevalent complication and significantly contribute to high mortality rates, particularly in the case of Aspergillus pneumonia, which is known for its tendency to disseminate. Additionally, BCGitis has been frequently observed in countries where the BCG (Bacille Calmette-Guérin) vaccination is routinely administered. Enterocolitis emerges as the most common inflammatory complication in clinical settings. Unfortunately, CGD remains largely unknown in Morocco, highlighting the urgent need to raise awareness among doctors. This increased awareness could facilitate early diagnosis and improve patient prognosis.

Background: The artery of Percheron (AOP) stroke is a rare cause of bilateral thalamic strokes, which may or may not involve the midbrain. Existing literature has identified four anatomical variants of thalamic blood supply, with AOP being the IIB variant that arises as a solitary arterial trunk from either posterior communicating artery. The clinical manifestations of AOP strokes are diverse, with no specific localizing signs. Typically, patients present with symptoms such as amnesia, gaze palsy, and hypersomnolence. The predominant underlying etiology is often cardioembolic, requiring management strategies that are tailored to the source of emboli with anticoagulation/antiplatelets.

Clinical presentation: We report a case involving a 72-year-old female patient with AOP stroke characterized by a sudden loss of vision, followed by a decreased level of consciousness. Magnetic resonance imaging revealed bilateral thalamic infarcts sparing the midbrain. CTA (computed tomography angiography) revealed a filling defect at the origin of the Percheron artery arising from the left P1 segment. The patient was treated with intravenous thrombolysis. The stroke workup was unremarkable, with a normal thrombophilia workup, a transthoracic echo, and no arrhythmias detected on a prolonged Holter monitor. The patient was treated with aspirin, atorvastatin, and intensive physical and cognitive therapy. On follow-up, she regained her consciousness but exhibited residual impaired vertical eye movements and right-sided dysmetria.

Conclusions: AOP stroke is a radiological diagnosis with no specific localizing neurological signs. A high index of suspicion is essential for timely diagnosis and management, as bilateral thalamic involvement can arise from a wide range of metabolic, infectious, and other vascular etiologies that could delay optimal management.