Qatar Medical Journal - Volume 2021, Issue 2

Background: Syria has suffered for nine years from a conflict that left over 11.1 million inhabitants in need of humanitarian assistance and over 80% in poverty. A ten-week-long full lockdown was enforced in Syria and successfully minimized the spread of COVID-19. This study aims to estimate the occurrence of mental health disorders after lockdown termination among the citizens of war-torn Syria.

Methods: Online questionnaires, which included demographic and war-related questions, Dimensions of Anger Reactions 5 (DAR-5) and the Depression Anxiety Stress Scale-21 (DASS-21) were distributed to different social media groups.

Results: This study recruited 1445 participants, of which 515 (35.6%) were males, the mean age was 24.8 ± 6.3 years, 38% had problematic anger, 64% had moderate to very severe depression, 42.9% had moderate to severe anxiety and 39.7% had moderate to severe stress. Increased living expenses, not being able to go out and a reduced ability to earn income and provide food were significantly associated with the psychological burden after the lockdown (p < 0.05). The association of war variables with mental disorders was weaker than the effect of the deteriorating economy. Other healthcare workers had more severe distress than doctors, who themselves were found to have less distress than the general population (p < 0.05). Anger scores were approximately equal, regardless of the type of work. Finally, shisha smoking was associated with worse mental health (p < 0.05).

Conclusion: The psychological burden of the damaged economy surpassed the direct damage due to COVID-19 and the effect of years of conflict. Urgent interventions are required, as this burden may continue for years, if not for decades. A full lockdown in countries with fragile economies may delay the spread of the virus, but it will severely damage the economy, which will lead to a deterioration of the mental health of their citizens.

Introduction: The presence of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and its associated disease, COVID-19 has had an enormous impact on the operations of the emergency department (ED), particularly the triage area. The aim of the study was to derive and validate a prediction rule that would be applicable to Qatar’s adult ED population to predict COVID-19-positive patients.

Methods: This is a retrospective study including adult patients. The data were obtained from the electronic medical records (EMR) of the Hamad Medical Corporation (HMC) for three EDs. Data from the Hamad General Hospital ED were used to derive and internally validate a prediction rule (Q-PREDICT). The Al Wakra Hospital ED and Al Khor Hospital ED data formed an external validation set consisting of the same time frame. The variables in the model included the weekly ED COVID-19-positivity rate and the following patient characteristics: region (nationality), age, acuity, cough, fever, tachypnea, hypoxemia, and hypotension. All statistical analyses were executed with Stata 16.1 (Stata Corp). The study team obtained appropriate institutional approval.

Results: The study included 45,663 adult patients who were tested for COVID-19. Out of these, 47% (n = 21461) were COVID-19 positive. The derivation-set model had very good discrimination (c = 0.855, 95% Confidence intervals (CI) 0.847–0.861). Cross-validation of the model demonstrated that the validation-set model (c = 0.857, 95% CI 0.849–0.863) retained high discrimination.

A high Q-PREDICT score ( ≥ 13) is associated with a nearly 6-fold increase in the likelihood of being COVID-19 positive (likelihood ratio 5.9, 95% CI 5.6–6.2), with a sensitivity of 84.7% (95% CI, 84.0%–85.4%). A low Q-PREDICT ( ≤ 6) is associated with a nearly 20-fold increase in the likelihood of being COVID-19 negative (likelihood ratio 19.3, 95% CI 16.7–22.1), with a specificity of 98.7% (95% CI 98.5%–98.9%).

Conclusion: The Q-PREDICT is a simple scoring system based on information readily collected from patients at the front desk of the ED and helps to predict COVID-19 status at triage. The scoring system performed well in the internal and external validation on datasets obtained from the state of Qatar.

Background: Pain management is an evolving area of expertise in Qatar. Gaps in knowledge, inadequate training for physicians and nurses, and the absence of policies/guidelines are the main barriers to effective pain management in Qatar. In addition, the use of certain pain medication, especially opioids, is highly regulated, limiting their availability in outpatient pain management. These factors are responsible for the undertreatment of pain in Qatar. This study aimed to standardize evidence-based local recommendations for pharmacological treatment of pain in Qatar.

Methods: An expert panel of physicians from different disciplines, with experience in diagnosis and treatment of the three pain types (i.e., acute, chronic, and neuropathic), was convened for two face-to-face meetings in Doha, Qatar, on November 29, 2019, and on February 22, 2020, with subsequent virtual meetings. A literature search was performed on Medline and Google Scholar databases from inception till December 2019, and all relevant articles were selected. Based on these articles and repeated feedback from the authors, the final pain treatment protocols were developed.Results: Recommendations for the treatment of acute pain, based on pain severity, followed three approaches: acetaminophen/paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) for mild pain and moderate pain and referral to a pain specialist for severe pain. Acetaminophen/paracetamol or NSAIDs is recommended for chronic pain, and the use of opioids was strongly discouraged because of its long-term side effects. For neuropathic pain, tricyclic antidepressants or gabapentin or pregabalin or serotonin-norepinephrine reuptake inhibitors were recommended first-line agents. Non-responders must be referred to neurologists or a pain specialist.

Conclusion: The expert panel provides recommendations for the management of acute, chronic, and neuropathic pain based on international guidelines adapted to local practice and treatment availability in Qatar. More importantly, the panel has recommended taking extreme caution in the use of opioids for long-term management of chronic pain and to refer the patient to a pain specialist clinician as required.

Background: Well-performing physician reflects the success of the residency program in selecting the best candidates for training. This study aimed to evaluate the selection criteria, mainly the United States Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge (CK) results and applicants’ status as international or locally trained applicants, used by the medical education department and the internal medicine residency program in Hamad Medical Corporation in Qatar to predict the residents’ performance during their training.

Methods: A retrospective chart review was performed for three batches of graduates who started residency training in 2011, 2012, and 2013. Each group completed 4 years of training. The USMLE Step 2 CK status of the applicant, in-training exam (ITE) scores, formative evaluation scores, Arab Board written and clinical exams pass rate, and other indicators were analyzed. Statistical analysis included chi squares and independent t-test to identify associations. Multivariable analyses were conducted using logistic and linear regressions to test for adjusted associations.

Results: The study included 118 (81 international/37 locally trained applicants) internal medicine residents. The ITE score correlated positively with the USMLE Step 2 CK score (r = 0.621, r = 0.587, r = 0.576, r = 0.571, p < 0.001) over the 4 years of training and among the international compared with locally trained applicants (p < 0.001). The rate of passing part 1 and 2 written exam of the Arab Board was higher in international than in local applicants, whereas clinical Arab Board exam and formative evaluation were not associated with any criteria.

Conclusions: Higher USMLE Step 2 CK score correlated with better performance on ITE but not with other performance indicators, whereas international applicants did better in both ITE and Arab Board written exam than local applicants. These variables may provide reasonable predictors of well-performing physicians.

Background: Ventilator-associated pneumonia (VAP) is an infectious pulmonary disease that develops after 48 hours of ventilation. To date, several methods have been proposed to reduce VAP occurrence, such as the VAP prevention bundle, which involves raising the head of the bed, reducing sedation, avoiding deep vein thrombosis, and preventing peptic ulcer in the gastrointestinal system. The purpose of this study was to evaluate the role of personnel in hand washing, case airway suctioning, and systematic monitoring in the prevention of VAP.

Methods: In the current clinical trial, 129 patients hospitalized and intubated at Vali-e-Asr Hospital ICU in Arak, Iran, were included in the study and randomized to one of the three VAP prevention methods: group A, VAP prevention bundle measures; group B, group A measures plus washing of patients’ mouth with 0.12% chlorhexidine and suction of secretion every six hours; and finally group C, group B measures plus 72-hour suction package. Demographic information, VAP diagnosis, and outcome of each patient were recorded in the special checklist.

Results: The age of the patients ranged from 18 years to 93 years with a mean of 54.6 ± 21.8 years. There was no significant difference in age, sex, Clinical Pulmonary Infection Score (CPIS), and Glasgow Coma Scale (GCS) between the three groups. However, there is a significant relationship between chest X-ray (CXR) index and pneumonia in the three groups (p < 0.05). The prevalence of pneumonia is generally seen to be higher in patients who were local, diffuse, or patchy than those who had no infiltration (p < 0.05).

Conclusion: This study showed that the application of VAP prevention bundle measures, mouthwash with chlorhexidine, personnel hand washing, airway suctioning, and systematic monitoring is an efficient approach to the prevention of VAP in ICUs.

Objective: Clinical methods that are generally used to evaluate the completeness of medical abortion are not reliable. Ultrasound imaging and beta-human chorionic gonadotropin (β-hCG) measurements are used to diagnose completed medical abortion, but a precise evaluation of these two methods has shown contradictory results. The purpose of this study is to evaluate the agreement of serum β-hCG measurement and ultrasound imaging to confirm complete medical abortion.

Materials and Methods: This study was conducted on pregnant women who had been referred to our center for medical abortion from 2015 to 2017. All cases occurred in the first trimester of pregnancy. They obtained one or two doses of vaginal misoprostol for medical abortion. Success rate of medical abortion was measured by both transvaginal ultrasound imaging and consecutive serum β-hCG measurements two to four weeks after initial treatment.

Results: Among the 275 women who completed the study, complete medical abortion was confirmed by serum β-hCG in 231 women (84.3%) and transvaginal ultrasound imaging in 195 women (70.8%) after two weeks. All remaining cases completed the medical abortion after an additional two weeks, confirmed by both transvaginal ultrasound imaging and serum β-hCG. The sensitivity, specificity, positive, and negative predictive values of β-hCG were 95.2%, 86.7%, 84%, and 70%, respectively; and these values for transvaginal ultrasound imaging were 68.5% 64.5%,77%, and 30.%, respectively, for the diagnosis of completed medical abortion.

Conclusion: Serum β-hCG measurement is as effective as transvaginal ultrasound imaging to confirm successful medical abortion in early pregnancy.

Background: Clinical data on Coronavirus Disease 2019 (COVID-19) in solid organ transplant (SOT) recipients are limited. We herein report the initial clinical experience with COVID-19 in SOT recipients in Qatar.

Methods: All SOT recipients with laboratory-confirmed COVID-19 up to May 23, 2020 were included. Demographic and clinical data were extracted retrospectively from the hospital’s electronic health records. Categorical data are presented as frequency and percentages, while continuous variables are summarized as medians and ranges.

Results: Twenty-four SOT recipients with COVID-19 were identified (kidney 16, liver 6, heart 1, and liver and kidney 1). Organ transplantation preceded COVID-19 by a median of 60 months (range 1.7–184). The median age was 57 years (range 24–72), and 9 (37.5%) transplant recipients were females. Five (21%) asymptomatic patients were diagnosed through proactive screening. For the rest, fever (15/19) and cough (13/19) were the most frequent presenting symptoms. Five (20.8%) patients required invasive mechanical ventilation in the intensive care unit (ICU). Eleven (46%) patients developed acute kidney injury, including three in association with drug-drug interactions involving investigational COVID-19 therapies. Maintenance immunosuppressive therapy was modified in 18 (75%) patients, but systemic corticosteroids were not discontinued in any. After a median follow-up of 226 days (26–272), 20 (83.3%) patients had been discharged home, 2 (8.3%) were still hospitalized, 1 (4.2%) was still in the ICU, and 1 (4.2%) had died.

Conclusions: Our results suggest that asymptomatic COVID-19 is possible in SOT recipients and that overall outcomes are not uniformly worse than those in the general population. The results require confirmation in large, international cohorts.

We report two cases of Qatari children with cystic fibrosis (CF) from different families presenting the homozygous CFTR 1521_1523delCTT (p. Phe508del) mutation with classic CF phenotypes. This gene mutation is considered the second CF mutation identified in Qatar. Herein, we review the frequency and distribution of this mutation in Arab countries.

Introduction: Sleep is necessary for maintaining adequate health and well-being. However, several behavioral and environmental factors, known as sleep hygiene, could affect sleep quality, contributing to the development of insomnia. Instruments to measure sleep hygiene such as the sleep hygiene index (SHI) have been developed, but only a few are available in the Arabic language. Therefore, this study was designed to translate and culturally adapt the SHI from English to Arabic. Methods: The SHI was translated from English to Arabic using the forward–backward translation method recommended by the International Society for Pharmacoeconomics and Outcomes Research guidelines. Nine Arabic-speaking individuals of diverse educational and cultural backgrounds reviewed the Arabic SHI. The internal consistency reliability of the items contained in the Arabic SHI was determined. Results: The SHI was successfully translated and culturally adapted into the Arabic language. Minimal changes in the wording of some questions were required to ensure the cultural adaptability of the instrument. The Arabic version of the SHI was found to be simple, clear, and brief as reported by the participants during cognitive debriefing. The Arabic SHI has moderate internal consistency reliability with a Cronbach's alpha of 0.589. Conclusion: The Arabic SHI is a brief and easy-to-understand instrument for assessing sleep hygiene practices and behavior in Arabic-speaking population. Further assessment of the psychometric properties of the Arabic SHI is necessary to ensure the validity of this instrument in different populations.

Introduction: Individuals with serious mental illness (SMI) experience premature death, likely due to increased rates of obesity and cardiovascular disease (CVD). This study was conducted to estimate the CVD risk in a cohort of individuals with SMI receiving outpatient psychiatric services in Qatar and to assess contributory CVD risk factors.

Methods: This is a retrospective review of the electronic medical records of a cohort of outpatients with SMI attending a mental health clinic in Doha, Qatar. The CVD risk was estimated using two risk prediction tools: the American Heart Association and the American College of Cardiology (AHA/ACC) risk calculator and the World Health Organization/International Society of Hypertension (WHO/ISH) CVD risk prediction charts for the Eastern Mediterranean region. Descriptive and inferential statistics were used to analyze the demographic and clinical data. Data were analyzed using Statistical Package for the Social Sciences.

Results: Of the 346 eligible patients, 28% (n = 97) had obtainable data for the estimation of their CVD risk using both tools. Approximately one-third of the cohort (33%) were classified as high risk using the AHA/ACC risk calculator, and 13.3% were classified as intermediate to high risk using the WHO/ISH CVD risk prediction charts. Based on the AHA/ACC risk scores, among those with a high CVD risk, almost two-thirds had CVD modifiable risk factors (i.e., smoking, diabetes, dyslipidemia, and hypertension). No statistically significant difference in the CVD risk estimates was observed among individuals with a body mass index of more or lower than 30 kg/m² (p = 0.815).

Conclusion: Based on the AHA/ACC risk calculator, approximately one-third of the study cohort had high CVD risk estimates. The WHO/ISH CVD risk prediction charts appeared to underestimate CVD risk, particularly for those identified as high risk using the AHA/ACC risk calculator. A closer alliance between psychiatrists and primary healthcare professionals to control modifiable cardiovascular risk factors among patients with SMI is necessary.

Introduction: In late 2019, a novel strain of coronavirus, discovered in the city of Wuhan, China, was found to cause a disease later named coronavirus disease 2019, or COVID-19. In January 2020, COVID-19 first reached the Gulf region. Afterwards, the disease spread rapidly across the countries of the Gulf and the number of COVID-19 cases rose significantly. Now, more than a year later, there are only a limited number of studies regarding COVID-19 and its behavior in this region. In this article, we aim to assess the mortality caused by the disease in the Gulf region by calculating the Case Fatality Rates (CFR) for all of the Gulf Cooperation countries and comparing the results with those of Europe.

Methods: Data was obtained from the official statistics of the World Health Organization (WHO) from January to May 2020. From the data, the CFR was calculated for every Gulf and European country included in the study. Following the calculation, the results were compared and analyzed. To make our comparison more accurate, we added the total number of COVID-19 tests per 1000 population and the Health Access and Quality index for each individual country.

Results: CFRs in the Gulf region to May 12, 2020 were: United Arab Emirates (1.06%), Kuwait (0.69%), Saudi Arabia (0.62%), Oman (0.45%), Bahrain (0.15%), and Qatar (0.06%). Within Europe over the same time period, 10 countries had CFRs above 10%, with the majority above 3%.

Conclusions: Compared to Europe, the COVID-19 mortality rate in the Gulf region has been much lower. The difference in age groups between the Gulf region and Europe may be the most important factor, mainly due to a younger population and a smaller elderly demographic in the Gulf region. Although age is a strong factor for the lower CFR in the Gulf, other factors must also be considered. These include the number of COVID-19 tests conducted per population, different country capabilities, and varying criteria for reporting COVID-19 deaths(Table–1)(Table–2).

Background: The central nervous system is an unusual location of sarcoidosis, which commonly affects the cranial nerves, meninges, hypothalamus, and pituitary gland. Involvement of the pineal region is extremely rare. This systematic review focused on the diagnosis and management of pineal region sarcoidosis, dorsal mesencephalon, and periaqueductal region.

Objectives: This study aimed to discuss diagnostic modalities and best management tools of the aforementioned pathology.

Methods: ScienceDirect, PubMed, and Google Scholar databases were searched for English or French articles about sarcoidosis of the pineal region, dorsal mesencephalon, and periaqueductal region. The clinical case of a patient managed at our department that we believe is directly relevant to this review is also presented. Patients’ demographics, clinical presentations, presence of hydrocephalus, other sarcoidosis locations in the central nervous system, and medical treatment were collected. Surgical management, surgical approach, and outcomes and complications of each procedure were also obtained. This study was conducted in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

Results: Fifteen cases were examined. The study sample consisted of nine (60%) male and six (40%) female, and the mean age was 32 years. Eight (53%) patients had hydrocephalus, and the predominant clinical presentations were signs of increasing intracranial pressure (headaches, vomiting, and papilledema). Six (40%) patients had diplopia, and convergence–retraction nystagmus was noted in three (20%) patients. Argyll Robertson sign was present in one patient and suspected in another patient (13%). Medical treatment consisted mainly of steroids (93% of cases). Open surgery on the pineal region was performed in five patients, and four of them reported to have serious complications (such as ophthalmoplegia, hemianopsia, hemiparesis, bilateral third cranial nerve paresis, and cerebellar syndrome). Endoscopic management was performed in two patients without complications.

Conclusion: To treat hydrocephalus, brain imaging is mandatory in patients with sarcoidosis if intracranial hypertension is suspected. In pineal region sarcoidosis, management of hydrocephalus is the priority, followed by medical treatment of the lesion. Open surgery of any approach presents a high risk of complications; thus, an endoscopic approach is the preferred management, as it treats hydrocephalus and makes biopsy possible with minimal risk.

Similar to several viruses, coronaviruses can affect the eye and cause conjunctivitis. In addition to ocular involvement, it causes systemic manifestations, mainly respiratory symptoms. However, conjunctivitis as the only sign and symptom of coronavirus disease 2019 (COVID-19) is a rare presentation. We present a case of a 20-year-old male patient who presented with conjunctivitis for 3 days and diagnosed on the same day with COVID-19 without other manifestations. Conjunctivitis affected both eyes and resolved over 2 weeks with artificial tears only and without any ocular complications.

Conjunctivitis can be the only sign and symptom of COVID-19 in some patients. Therefore, healthcare providers, particularly ophthalmologists, should take precautions when dealing with patients presenting with conjunctivitis amid the COVID-19 pandemic.

Objective: Alzheimer's disease (AD) is characterised by progressive cognitive decline due to neurodegeneration. Over activation of the hypothalamic–pituitary–adrenal axis, oxidative stress and inflammation potentially damage the neuronal system, affecting cognition.

Aim: This study aimed to assess the relationship between serum cortisol, Interleukin-6 (IL-6) and homocysteine (Hcy) levels in AD.

Methods: Case-Control observational study consisting of 71 patients with AD and 70 healthy controls above 60 years of age. Serum samples were analysed for cortisol, IL-6 and Hcy levels using chemiluminescence immunoassay (Immulite 1000) technique. Cognitive functions were measured using the Mini-Mental State Examination (MMSE) Score. AD subjects were categorised based on the modified Kuppuswamy socioeconomic status scale. Statistical evaluation was conducted using SPSS Statistics software. Group data were analysed using a two-tailed Student's t-test, analysis of variance (ANOVA), the Mann–Whitney U test and Pearson's correlation test.

Results: Serum cortisol, IL-6 and Hcy levels were significantly increased (p < 0.01) in AD (cortisol: 19.69 ± 8.96 ug/dl; IL-6: 10.27 ± 2.76 pg/ml; Hcy: 23.29 ± 3.81 μmol/l), as compared with the controls (cortisol: 13.37 ± 5.59 ug/dl; IL-6: 3.37 ± 0.79 pg/ml; Hcy: 8.25 ± 2.36 μmol/l). MMSE scores in AD were negatively correlated with cortisol, IL-6 and Hcy levels.

Conclusions: Serum cortisol, IL-6 and Hcy levels are independent biomarkers for AD progression. Hypercortisolaemia, hyperhomocysteinemia and inflammation play important roles in AD-related cognitive dysfunction and are interlinked.

Introduction: Central obesity appears to play a major role in the pathogenesis of metabolic disorders in polycystic ovary syndrome. Insulin resistance and carbohydrate disorders are associated with dysfunctional secretion of various adipokines by the adipose tissue.

Objectives: This study aimed to evaluate leptin, apelin, and visfatin against a background of carbohydrate metabolism parameters in patients diagnosed de novo with polycystic ovary syndrome (PCOS).

Material and methods: The study group consisted of 40 patients with PCOS (mean age, 29 years) diagnosed in accordance with the American Society for Reproductive Medicine criteria from 2003. The control group consisted of 37 clinically healthy women (mean age, 26 years). All controls had regular menses and no clinical or biochemical signs of hyperandrogenism. Concentrations of leptin, apelin, visfatin, and insulin were measured by immunoenzymatic methods. Glucose concentrations were determined using spectrophotometry.

Results: Significantly higher concentrations of leptin, insulin, homeostatic model assessment for insulin resistance (HOMA-IR) index, and the immunoreactive insulin (IRI)/glucose index were found in the PCOS group than in the control group. Notably, the concentration of apelin was over five times lower in the PCOS group than in the control group. In patients with PCOS, a positive correlation was found between the concentrations of insulin and leptin and concentrations of leptin and IRI/glucose. Patients of the PCOS group with body mass index (BMI) ≥  25 had significantly higher values of leptin, insulin, HOMA-IR index, and IRI/glucose index than patients of the PCOS group with normal BMI. In the PCOS group, a positive correlation was found between BMI and leptin concentration (r = 0.7176; p < 0.0001) and carbohydrate metabolism, such as insulin (r = 0.5524; p = 0.0003), glucose (r = 0.3843; p = 0.0157), HOMA-IR (r = 0.5895; p < 0.0001), and IRI/glucose (r = 0.3872; p = 0.0163). These findings were not observed in the control group.

Conclusions: (1) Increased leptin concentration observed in women diagnosed de novo with PCOS as well as positive correlations between leptin and HOMA-IR, and IRI/glucose and BMI may indicate a potential role of leptin in the reduction of tissue sensitivity to insulin. (2) Significantly lower apelin concentration in the PCOS group (>5 fold) than in the control group, associated with a concomitant increase in leptin, may also contribute to carbohydrate metabolism disorders occurring in the course of PCOS.

Background: A needlestick injury (NSI) is a serious occupational hazard among healthcare personnel (HCP), as it can cause transmission of blood-borne pathogens such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). This study aimed to determine the frequency and distribution of reported NSIs, associated factors, use of post-exposure prophylaxis (PEP), and percentage of seroconversion among HCP in a major tertiary care hospital in Qatar.

Methods: This retrospective study analyzed NSIs among HCP reported in Hamad Medical Corporation facilities in Doha between May 01, 2017, and May 01, 2018. A surveillance follow-up period of 6 months commenced after the 1-year study period.

Results: A total of 130 NSIs were reported during the study period, with an overall incidence of eight injuries per 1000 HCP. The mean age was 34.6 ± 7.9 years. Among the reported cases, the proportion of female HCP (n = 72, 55.4%) was greater than that of male HCP (n = 58, 44.6%). Of 130 NSIs, 79 (60.8%) occurred in nurses, followed by 35 (26.9%) cases in doctors and 16 (12.3%) in other HCP. The total healthcare population comprised 49.6% of nurses and 18% of doctors. NSIs occurred in 10.1 per 1000 nurses and in 12.4 per 1000 doctors. Exposures mainly occurred in the operating theater, 35 (31.5%); inpatient wards, 24 (21.6%); and emergency department, 20 (18%). Common modes of injury were after use or before disposal of the device in 44 (44.4%) cases and during surgical interventions in 35 (35.4%) cases. Hollow-bore needles (64/98, 65.3%) were the most common devices involved. Source serology was documented in 71 (54.6%) cases of which 52 (73.2%) were normal, 9 (12.7%) were abnormal, and 10 (14.1%) were incomplete. Among the exposed HCP, 124 (95.4%) had adequate immunity to HBV. PEP for HBV was indicated in 6 (4.6%) and received by 4 (3.1%) HCP. NSI cases were followed up for 6 months post-exposure, and during this surveillance period, no seroconversion to HBV, HCV, or HIV was detected.

Conclusion: NSIs are common among HCP. In this study, most of the exposed HCP had adequate immunity to HBV. There was no hepatitis B, hepatitis C, or HIV transmission among the study cohort. Adherence to proper needle/sharps disposal techniques and safe practices during procedures will help prevent NSIs.

Background: Alcohol consumption is a major cause of acute and chronic health conditions associated with comorbidities and traumatic injuries, despite its partial prohibition in some countries. Moreover, alcohol-related hospital admissions increase the burden on the healthcare system. More than 80% of the population in Qatar comprises expatriates. This study aimed to analyze the demographics and clinical characteristics of subjects with alcohol-related emergency department (ED) visits/hospitalization with respect to different age groups in a single tertiary hospital in Qatar.

Methods: It is a retrospective observational study of adult patients who visited the ED at Hamad General Hospital between January 2013 and March 2015 and were screened positive for alcohol use. Collected data included sociodemographic characteristics, blood alcohol concentration (BAC), pattern of admission, previous medical history, laboratory investigations, treatment, hospital course, and mortality. Data were compared with respect to the distribution of age groups such as < 25, 25–34, 35–44, 45–54, and >55 years.

Results: In total, 1506 consecutively admitted patients screened positive for alcohol use were included in the study; the majority of them were males (95.6%), non-Qatari nationals (71.1%), and aged 35–44 years (30.9%). The age groups 35–44 years and 45–54 years showed the highest median BAC ([0.24 interquartile range (IQR: 0.14–0.33)] and [0.24 (IQR: 0.13–0.33)], respectively) as compared to the other age groups (P = 0.001). The pattern of hospital admission, sociodemographic status, presence of comorbidities, laboratory investigations, and mortality showed specific age-related distribution. Particularly, young adults were more likely to have a previous ED visit due to trauma, whereas older patients’ previous hospital admissions were mostly related to various underlying comorbidities.

Conclusion: This study highlighted the patterns of age and clinico-epidemiological status of patients with alcohol-attributable hospital admissions. Our study showed that alcohol consumption was higher among the working-age group. Further studies are needed to investigate changes in the alcohol consumption patterns that may help plan for allocation of health resources and prevention of alcohol-related problems.

Tuberculosis (TB) is a bacterial infection with multisystem presentations. Involvement of the central nervous system (CNS) is considered the most lethal form among all types. In addition to possible fatality, CNS TB has serious neurological sequelae. These morbidity issues along with diagnostic challenges doubles the clinical burden. In recent years, there have been improvements in diagnostic sensitivity and specificity due to advances in technology. Herein, we report an atypical case of a patient with TB who presented to our department and discuss the flow of the diagnostic workup.

Background: Metastases to the pituitary gland are extremely rare with an incidence rate reported from an autopsy series of 1.8%–12%, and only 20% was diagnosed clinically. Tumors that commonly metastasize are breast and lung tumors.

Case series: We present a series of five cases, including four female patients and one male patient with metastatic cancer. Two women had metastatic small lung cancer and presented with diabetes insipidus (DI). Two women had metastatic breast cancer, of which one presented with DI and the other with panhypopituitarism. The male patient had bronchogenic adenocarcinoma and presented with DI.

Conclusion: Our case series confirmed earlier reports that DI is the most common presentation of metastases to the pituitary gland.

Background: Data on the effect of metformin on serum vitamin B12 (VitB12) level in patients with type 2 diabetes mellitus (T2DM) in Qatar are limited; therefore, we aimed to assess the prevalence of VitB12 deficiency and its related factors among patients with T2DM treated with metformin at Hamad General Hospital in Doha, Qatar, from January 1, 2017, to December 31, 2017.

Methods: This cross-sectional analytical study involved patients with T2DM aged ≥ 18 years who used metformin for at least 3 months. The serum VitB12 was quantified on a chemiluminescent enzyme immunoassay analyzer using Cobas e 801 module, Roche, and VitB12 deficiency was defined as serum VitB12 level of ≤ 145 pmol/L. All data were obtained from the patients’ electronic medical records.

Results: The study recruited 3124 eligible patients with T2DM. The overall prevalence of metformin-associated VitB12 deficiency was 30.7% [95% confidence of interval, 0.290–0.323]. A significant difference exists in the median VitB12 levels between the VitB12-normal and VitB12-deficient groups [129 vs. 286; p < 0.001]. Compared with the VitB12-normal group, the VitB12-deficient group had higher mean body mass index (BMI) (p < 0.001) and consumed higher doses of metformin (p = 0.001). They also more often used sulfonylurea (p = 0.004), dipeptidyl peptidase-4 inhibitor (p < 0.001), thiazolidinediones (p < 0.001), glucagon-like peptide 1 [GLP-1] receptor agonists (p < 0.001), alpha-glucosidase inhibitor (p < 0.001), and H2 blocker/proton pump inhibitors [PPI] (p < 0.001) than the VitB12-normal group. Moreover, the VitB12-normal group consumed more calcium supplements (p < 0.001) than the VitB12-deficient group. In the multivariate analysis, independent risk factors for metformin-associated VitB12 deficiency in patients with T2DM include high daily dose of metformin >2000 mg, male gender, high BMI, smoking, sulfonylurea, dipeptidyl peptidase-4 inhibitor, H2 blockers/PPI, low fasting blood glucose, and low hemoglobin.

Conclusion: This study showed a high prevalence of VitB12 deficiency in patients with T2DM taking metformin and a significant negative correlation between the daily dose of metformin and serum VitB12 level. Therefore, regular screening for serum VitB12 is necessary in patients with T2DM on metformin treatment, especially those who have the abovementioned risk factors.

Introduction: Endoscopic ultrasound (EUS) elastography is another technique that measures the stiffness of tissue and adds more diagnostic value to EUS.

Objective: This study aimed to assess the ability of qualitative and quantitative EUS elastography in differentiating malignant from benign solid pancreatic masses.

Methods: This 2-year cross-sectional study enrolled 80 patients with solid pancreatic masses in the department of endoscopy in Alassad University Hospital who underwent conventional and elastography-assisted EUS and then followed for pathology through EUS-guided or CT-guided biopsy or surgery.

Results: Qualitative elastography using a 5-point scoring system was able to recognize malignant pathology (obtained by EUS-guided biopsy, CT-guided biopsy, or surgery) with a sensitivity, specificity, and accuracy rates of 100%, 28.6%, and 81.3%, respectively. A quantitative method using hue histogram had a sensitivity of 71.2%–86.4% and specificity of 71.4%–81% with the best accuracy for histogram mean ratio (area under the curve, 0.867).

Conclusion: EUS elastography is a simple and good alternative method in differentiating malignant from benign pancreatic solid masses.

Background: Spontaneous pneumothorax/pneumomediastinum is an uncommon complication of coronavirus disease 2019 (COVID-19). Herein, we describe the clinical spectrum and outcomes of COVID-19-associated pneumothorax/pneumomediastinum in critical care settings.

Materials and methods: We hereby present a case series of 12 patients who tested positive for COVID-19 and developed air leak injuries in critical care settings in a tertiary care center in Northern India. Infection with severe acute respiratory syndrome coronavirus-2 was confirmed by nasal/oropharyngeal swab testing using real-time reverse-transcription polymerase chain reaction test. The clinical spectrum and outcomes of these patients were assessed. Each case has been presented as a brief synopsis.

Results: The onset of pneumothorax/pneumomediastinum varied from 11 to 28 days after the occurrence of initial symptoms and caused worsening of respiratory parameters in most patients. Of the 12 patients, eight were males who developed air leak injuries. One patient was a current smoker, and three patients had underlying lung disorders. Two patients with spontaneous breathing were managed conservatively. All intubated patients who developed air leak injuries died (100% mortality rate).

Conclusion: Pneumothorax/pneumomediastinum is a rare and life-threatening complication in mechanically ventilated patients with COVID-19. Further research is needed to understand the pathophysiology behind the development of air leak injuries in patients with COVID-19.

Background: Atherosclerotic cardiovascular disease (ASCVD) is a common disease in the State of Qatar and results in considerable morbidity, impairment of quality of life and mortality. The American College of Cardiology/American Heart Association Pooled Cohort Equations (PCE) is currently used in Qatar to identify those at high risk of ASCVD. However, it is unclear if this is the optimal ASCVD risk prediction model for use in Qatar's ethnically diverse population.

Aims: This systematic review aimed to identify, assess the methodological quality of and compare the properties of established ASCVD risk prediction models for the Qatari population.

Methods: Two reviewers performed head-to-head comparisons of established ASCVD risk calculators systematically. Studies were independently screened according to predefined eligibility criteria and critically appraised using Prediction Model Risk Of Bias Assessment Tool. Data were descriptively summarized and narratively synthesized with reporting of key statistical properties of the models.

Results: We identified 20,487 studies, of which 41 studies met our eligibility criteria. We identified 16 unique risk prediction models. Overall, 50% (n = 8) of the risk prediction models were judged to be at low risk of bias. Only 13% of the studies (n = 2) were judged at low risk of bias for applicability, namely, PREDICT and QRISK3.Only the PREDICT risk calculator scored low risk in both domains.

Conclusions: There is no existing ASCVD risk calculator particularly well suited for use in Qatar's ethnically diverse population. Of the available models, PREDICT and QRISK3 appear most appropriate because of their inclusion of ethnicity. In the absence of a locally derived ASCVD for Qatar, there is merit in a formal head-to-head comparison between PCE, which is currently in use, and PREDICT and QRISK3.