Qatar Medical Journal - Volume 2024, Issue 4

Background: The COVID-19 pandemic triggered a rapid shift to telehealth and reshaped healthcare delivery worldwide. In Qatar, telehealth has emerged as a critical tool for ensuring uninterrupted care while minimizing the spread of viruses. However, its long-term efficacy, particularly in mental health services, is still poorly understood. The aim of this study was to address this gap by evaluating the post-pandemic impact of telehealth on the accessibility of mental health services in Qatar.

Methods: We conducted a comparative analysis of no-show rates over a four-month period before the initiation of telepsychiatry and telepsychology (March to June 2019) and corresponding periods in 2020, 2021, and 2022. The analysis considered visit types (new visit and follow-up visit) in various psychiatric (child and adolescent, adult, geriatric, forensic, and intellectual disability) and psychological outpatient clinics before and after the implementation of telehealth services.

Results: Among both new and follow-up cases, there was a significant reduction (p < 0.0001) in the collective proportion of no-show rates following the introduction of telehealth compared to the rates recorded before the implementation. Exceptions to this trend were appointments in child and adolescent mental health service psychology and forensic psychiatric services.

Conclusion: Telehealth has proven instrumental in improving access to mental health services in Qatar post-pandemic. Its integration shows the potential for reducing no-show rates and enhancing continuity of care. These findings are important for healthcare policy-making and practice in Qatar and provide valuable insights into the global discourse on the evolving role of telehealth.

Background: Leishmaniasis is an emerging tropical infectious disease in Qatar. It is caused by the protozoan parasite of the Leishmania genus, which is endemic in many regions of the world, including the Middle East. In Qatar, there is limited data about this disease, which is hindering the efficient planning and implementation of disease prevention and control measures. Therefore, to address this knowledge gap, we conducted a retrospective study to gather information on the prevalence, clinical characteristics, as well as outcomes of leishmaniasis treatment. The primary objective of this study is to provide a comprehensive analysis of leishmaniasis cases in Qatar over seven years (2016–2022). The findings of this study offer valuable insights that can guide the development of a national registry and treatment program for leishmaniasis in Qatar.

Methods: Using a retrospective cross-sectional study design, clinical and epidemiological data of all documented cases of leishmaniasis in Qatar between 2016 and 2022 were collected from electronic medical records at Hamad Medical Corporation (HMC).

Results: A total of sixty-eight cases of leishmaniasis were detected in Qatar between 2016 and 2022. Males were predominant (69.12%) with a median age of 33 years. Our study revealed a higher incidence of leishmaniasis among individuals of Syrian nationality, followed by Pakistani and Sudanese, thus promoting further investigation into the underlying factors contributing to this health disparity. Our findings revealed important epidemiological trends, highlighted key clinical characteristics, identified risk factors associated with susceptibility to leishmaniasis, and reported treatment outcomes.

Conclusion: This retrospective study presents the first comprehensive analysis of leishmaniasis in Qatar, shedding light on the epidemiology, clinical characteristics, and treatment outcomes of the disease. The data generated from this study can serve as a guide for authorities in establishing a national registry and treatment program for leishmaniasis in Qatar. Implementing these measures will contribute to the effective management and control of leishmaniasis, ultimately improving patient outcomes and public health in the country.

Background: Achalasia is a rare esophageal motility disorder of unknown etiology, which leads to changes in the pressure and relaxation of the lower esophageal sphincter (LES), affecting peristalsis and contraction of the esophageal body. Dysphagia can impact individuals of any age, it is frequent in the elderly. Non-specific gastrointestinal symptoms are delayed and can give false diagnoses. The aim of this study is to compare clinical presentation and pulmonary complications in younger (Group I) and elderly patients (Group II).

Methods: 108 patients with achalasia were separated into two groups—young and elderly patients. Demographic, clinical, radiological and manometric data, smoking status, and symptom score were compared between these groups.

Results: There was no significant difference in gender, duration of symptoms, body mass index (BMI), or diameter of esophagus between the two patient groups. There was a statistically significant difference between frequencies of comorbidity between groups (p = 0.009). Even though there were no differences in chest tomography scan (CT) findings and diameter, there were statistical differences in diffusion capacity (p = 0.041). Respiratory symptoms occurred in 38 (48.7%) patients in Group I and in 20 (66.7%) in Group II (p = 0.011). Cough was dominant in the younger group, but fatigue and chest pain were statistically significant and frequent in elderly group patients with achalasia. There was no significant difference in Eskardt symptom score (ESS), but there was the difference in the frequency of individual symptoms. Vomitus and regurgitation were statistically higher frequent in Group I, but dysphagia and weight loss in Group II. Subtype 1 was dominant in the younger group, and subtype 2 in a group with older patients.

Conclusion: The younger achalasia population group was found to be associated with decreased diffusion capacity, type 1 achalasia, cough, and gastrointestinal symptoms such as vomitus and regurgitation. Geriatric status was found to be associated with frequent comorbidities, subtype 2, frequent respiratory symptoms, dysphagia, and weight loss. Our findings demonstrated an association between esophageal motility abnormalities and characteristics of geriatric population.

Background: Secondary hypertension is characterized by an elevated blood pressure greater than 140/90 mmHg, which occurs as a consequence of other diseases. The common etiologies of secondary hypertension include renal parenchymal causes, endocrine disorders, and vascular pathologies like coarctation of the aorta (CoA).

Case presentation: A 20-year-old patient was admitted to our hospital as he complained of headache and palpitations since one week. On examination, the blood pressure in his right upper limb was 180/100 mmHg. The volume of the femoral and the dorsalis pedis pulses was found to be reduced bilaterally. The patient was started on antihypertensive medication labetalol 10 mg injection intravenously immediately. After clinical suspicion and a series of investigations, the patient was diagnosed with severe CoA, distal to the origin of the left subclavian artery via computed tomography (CT) aortogram. The patient was managed by coarctoplasty with stenting.

Discussion: The most striking examination findings indicative of CoA include decreased lower limb pulses and a blood pressure difference of >20 mmHg across both the lower and upper extremities. It is important to evaluate the blood pressure in both upper and lower limbs to diagnose obstructive vascular diseases.

Conclusion: The presence of multiple well-developed collaterals can often mask symptoms and delay the detection of hypertension in patients with CoA. Patients with CoA require regular follow-up to monitor left ventricular outflow tract obstruction, and patients with severe CoA should be treated interventionally to prevent complications including aortic aneurysm and dissection.

The patient was managed by coarctoplasty with stenting and recovered well post-surgery.

Mycobacterium tuberculosis (TB) disease is a major global health problem affecting 10.6 million people worldwide, and India alone contributes 28% to this burden. Pancreatic TB is considered an extremely rare entity which closely mimics pancreatic carcinoma. However, while 87% of the total globally notified TB cases are from 30 high-burden countries mostly from Asia, about 45% of pancreatic TB cases are from developed countries. This suggests that the identified cases of pancreatic TB in developing counties are just the tip of iceberg, and many cases either remain undetected or wrongly diagnosed. The majority of the patients with pancreatic TB undergo extensive evaluation and frequently undergo major abdominal surgeries since pancreatic carcinoma is often considered as the most probable diagnosis before TB. Here, 2 cases of pancreatic TB managed separately at two different centers are described. Both cases presented with significant unintentional weight loss and poor glycemic control which is an unusual presentation for pancreatic TB. Imaging showed pancreatic mass lesions, and initially pancreatic carcinoma was considered by the treating physicians. Chromogranin A in both patients and tumor markers done in one of the patients were negative. Both the patients underwent Ga-68 DOTANOC PET/CT scan, and one of the patients even showed multiple DOTANOC avid lesions. Owing to contradictory biochemical and imaging findings, biopsy of the pancreatic mass was done which clinched the diagnosis of pancreatic TB. On starting standard anti-tubercular therapy (ATT), both patients showed clinical and radiological recovery with a significant regain of glycemic control. The clinical features, appropriate investigation including imaging and tissue biopsy, and treatment options are described in the article for better understanding of the disease. This may guide clinicians in early detection of pancreatic TB with least invasive diagnostic procedures.

Malaria continues to pose a significant public health challenge in Africa, where 95% of global malaria cases and deaths occur in Sub-Saharan Africa (SSA). Cerebral malaria (CM) is a fatal type of severe malaria primarily caused by Plasmodium falciparum species and disproportionately affects children under five years. Despite ongoing control efforts, CM persists as one of the most prevalent presentations of severe malaria with surprisingly high prevalences even in regions with lower endemicity and transmission rates. This commentary presents an updated compilation of key CM-related public health challenges, including delayed presentation of cases and a lack of diagnostic tools in resource-limited African communities, leading to misdiagnosis. Further challenges include insufficient provision of anti-malarial drugs and inaccessibility in rural and remote areas, coupled with emerging resistance to the gold-standard therapy (artemisinin combination therapy). CM carries a high risk of long-term neurological complications and is seen in almost half of the survivors. These complications severely impair their daily quality of life and extend to social and financial challenges. CM survivors also suffer from the lack of appropriate health services such as continuous rehabilitation, medical care, and psychological support. Despite its burden, interventional research in CM management remains insufficient, particularly regarding short- and long-term neurological complications. Local African governments have occupied the backseat for the length of this continental health crisis. It is crucial for them to occupy a proactive role in supporting healthcare infrastructure and delivering high-quality health services. Intragovernmental collaborations and establishing a regional health network within Africa can ensure realistic and accurate surveillance data tracking. From this, strategic healthcare planning, control measures, and source allocation could be better observed and tailored to the needs of different African subpopulations.

Background: Respiratory syncytial virus (RSV) is a highly contagious pathogen known for causing respiratory tract infections, particularly among pediatric and elderly patients. Its ability to induce outbreaks in both community and hospital settings underscores its substantial health burden. This review aims to provide a comprehensive understanding of RSV, including its biological and clinical aspects.

Methods: A comprehensive review of the literature was conducted by searching PubMed, Scopus, and Web of Science databases for relevant articles. Key topics included RSV virology, epidemiology, clinical findings, diagnostic methods, management approaches, and preventive strategies.

Results: This review encompasses the taxonomy and structure of RSV, including its genome and proteins. Various strains and their dominance patterns, alongside pathogenesis mechanisms, are explored. Diagnostic techniques such as nucleic acid amplification tests are discussed for their efficacy and accessibility. Supportive care remains the primary treatment, with antiviral therapies playing a limited role. Monoclonal antibody immunization and vaccination efforts offer promising avenues for RSV prevention. The impact of the COVID-19 pandemic on RSV epidemiology is also considered, along with the oncolytic potential of RSV in cancer treatment.

Conclusion: Advancements in understanding RSV virology, epidemiology, and clinical management have paved the way for improved diagnostic and preventive strategies. However, challenges remain in ensuring widespread access to diagnostics and effective treatments, particularly in resource-limited settings. Continued research and global collaboration are essential for addressing the ongoing impact of RSV and reducing its burden on public health.

Background: Hearing loss (HL) is a major public health problem that is significant for mental health and physical conditions. HL may be a potentially modifiable risk factor for poorer mental health outcomes. The study aimed to explore the association between HL, social isolation, anxiety, and depression.

Methods: A cross-sectional study was conducted on a sample of consecutive patients aged 50 years or older (n = 226) from February 2023 to August 2023. We used regression models to assess the association between HL and the odds of social isolation, anxiety, and depression.

Results: There are more female participants with HL (58.7% vs. 41.3%) than male individuals with HL. HL was found to have a statistically significant association with smoking (p = 0.001), and HL showed significant associations with anxiety and depression (p = 0.008 and p = 0.011, respectively). A significant association was also observed between HL and social isolation (p = 0.016). HL was associated with diabetes mellitus (p = 0.006) and hypertension (p = 0.008). Participants with HL were more likely to have depression (OR = 2.16; 95% CI: 1.05–4.44), social isolation (OR = 2.87; 95% CI: 1.44–5.70), and anxiety (OR = 2.62; 95% CI: 1.21–5.67) compared to participants in the no hearing loss (No-HL) group.

Conclusions: This study shows that HL is consistently associated with poorer mental health symptoms and poor social isolation. Although additional evidence is necessary, it is plausible that addressing HL would alter this trajectory.

Background: Obese patients are at increased risk of postoperative respiratory complications because of sedatives and opioids. The erector spinae block is a novel regional block that has been used in different surgeries. It offers an easier approach and a better safety profile. This study aimed to assess the role of erector spinae plane block (ESPB) in reducing postoperative pain scores and opioid consumption in patients undergoing sleeve gastrostomies.

Methods: Institutional committee approval was obtained for this randomized controlled trial. Inclusion criteria included patients aged between 18 and 65 years with American Society of Anesthesiologists (ASA) scores 1–3 who were scheduled to undergo laparoscopic sleeve gastrectomy under general anesthesia. Simple randomization using sealed opaque envelopes was used to allocate study patients to either of the two groups. The intervention group received erector spinae block using 0.2% ropivacaine just after induction of anesthesia while the control group did not receive a block. Primary outcome variables were pain scores during the first 24 hours after surgery.

Results: A total of 60 patients were included in the study. There was no significant difference in the baseline characteristics between two groups. Numerical rating scale (NRS) pain scores in the postoperative period were lower in the ESPB group but there was no statistical significance. Intraoperative remifentanil consumption was statistically lower in the ESPB group compared to the control group (P < 0.01). ESPB also reduced 24-hour opioid consumption (P = 0.002). There was no statistical difference in the incidence of adverse events between the two groups.

Conclusion: The use of ESPB in laparoscopic sleeve gastrectomy patients is associated with a significant reduction in intraoperative and 24-hour postoperative opioid consumption.

Trial registration ID

The trial was registered with Clinicaltrials.gov as trial ID-NCT04368195.

Introduction: Preeclampsia and eclampsia are hypertensive disorders of pregnancy associated with significant maternal and fetal morbidity and mortality. Posterior reversible encephalopathy syndrome (PRES) is a neurological complication observed in these conditions, yet its impact on fetomaternal outcomes remains underexplored. The aim of this study is to investigate the association between PRES and fetomaternal outcomes in women with preeclampsia and eclampsia.

Methods: This prospective cohort study enrolled 64 singleton pregnant women beyond 20 weeks of gestation with preeclampsia and eclampsia having neurological symptoms. Participants underwent clinical evaluation and radiological assessment, including non-contrast computed tomography (NCCT) and magnetic resonance imaging (MRI). Maternal outcomes, including high dependency unit (HDU)/intensive care unit (ICU) stay, intubation, mode of delivery and maternal mortality. Fetal outcomes, i.e., stillbirth, prematurity, and neonatal intensive care unit (NICU) stay, were recorded. Statistical analysis was performed to compare outcomes between PRES and non-PRES groups.

Results: The majority (92.18%) of participants were unscheduled and (56.2%) were primigravida. PRES was diagnosed in 62.5% of cases, predominantly associated with antepartum eclampsia (47.5%). Neurological symptoms such as headache (85.9%) and blurring of vision (68.8%) were common in PRES cases. Cesarean section rate was significantly higher in PRES group (75%), along with adverse outcomes including increased HDU/ICU stay, intubation, postpartum haemorrhage (PPH), abruption, maternal mortality, stillbirth, prematurity, fetal growth restriction (FGR), meconium-stained liquor (MSL), and NICU stay, which were observed significantly higher in women with PRES (p < 0.001) and low Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) scores (p < 0.05). However, no significant association was observed between PRES and early neonatal death (ENND).

Conclusion: PRES is associated with adverse fetomaternal outcomes in women with preeclampsia/eclampsia, including higher cesarean section rate and increased maternal and neonatal morbidity. Early recognition and management of PRES are crucial for improving outcomes in these high-risk pregnancies. Further research with larger sample sizes is warranted to validate these findings and explore potential interventions.

Background: Proton pump inhibitors (PPIs) are commonly prescribed to hospitalized patients, but many of these prescriptions may not be based on evidence-based indications. It’s important to understand that inappropriate prescribing of PPIs can lead to unnecessary medications and financial burdens. Unfortunately, there are not many recent studies exploring how often PPIs are prescribed and if they are being prescribed appropriately.

Objective: The study aimed to assess the appropriateness of PPIs use among hospitalized patients. It evaluated the indications for PPIs use and determined whether the use of PPIs in hospitalized patients is justified or not.

Setting: The study was conducted at Hamad General Hospital, a tertiary academic healthcare center in the state of Qatar.

Methods: A retrospective observational study with 201 subjects, was conducted in general internal medicine wards at a tertiary hospital. Physician documentation and inpatient and outpatient medication prescriptions were analyzed for PPIs exposure.

Main outcome measures: The appropriateness of exposure to PPIs is determined based on international recommendations.

Results: Of 533 hospitalized patients who were not critically ill, 201 (37.7%) were prescribed PPIs. The study found that 65.2% of the patients had no valid indication for PPIs exposure. Furthermore, 18% of patients were inappropriately prescribed stress ulcer prophylaxis with PPIs even though they had a low risk for the development of ulcer disease. After discharge, 82.6% of patients were prescribed PPIs, with the most common indication (43%) being gastrointestinal ulcer prophylaxis.

Conclusion: This study sheds light on the issue of overutilization of PPIs, specifically in non-critically ill hospitalized patients. It highlights the unnecessary continuation of PPI prescriptions at discharge and emphasizes the importance of physicians reevaluating PPI prescriptions periodically to ensure they are still necessary and discontinuing them when possible to avoid unwanted consequences.

Introduction: The inclusion of artificial intelligence (AI) in the healthcare sector has transformed medical practices by introducing innovative techniques for medical education, diagnosis, and treatment strategies. In medical education, the potential of AI to enhance learning and assessment methods is being increasingly recognized. This study aims to evaluate the performance of OpenAI’s Chat Generative Pre-Trained Transformer (ChatGPT) in emergency medicine (EM) residency examinations in Qatar and compare it with the performance of resident physicians.

Methods: A retrospective descriptive study with a mixed-methods design was conducted in August 2023. EM residents’ examination scores were collected and compared with the performance of ChatGPT on the same examinations. The examinations consisted of multiple-choice questions (MCQs) from the same faculty responsible for Qatari Board EM examinations. ChatGPT’s performance on these examinations was analyzed and compared with residents across various postgraduate years (PGY).

Results: The study included 238 emergency department residents from PGY1 to PGY4 and compared their performances with ChatGPT. ChatGPT scored consistently higher than resident groups in all examination categories. However, a notable decline in passing rates was observed among senior residents, indicating a potential misalignment between examination performance and practical competencies. Another likely reason can be the impact of the COVID-19 pandemic on their learning experience, knowledge acquisition, and consolidation.

Conclusion: ChatGPT demonstrated significant proficiency in the theoretical knowledge of EM, outperforming resident physicians in examination settings. This finding suggests the potential of AI as a supplementary tool in medical education.

Introduction: Neonatal sepsis (NS) is a major healthcare burden in Gulf Cooperation Council (GCC) countries, with a prevalence higher than the global average. Microbial drug resistance has major implications for mortality and morbidity from NS.

Objective: To synthesize data regarding the patterns of causative bacteria of NS in the GCC and their antimicrobial susceptibility profiles.

Methods: Following the exploration of four electronic databases, i.e., EBSCOhost, ProQuest, PubMed/MEDLINE, and ScienceDirect, eligible studies were identified (i.e., published between 2013 and 2023 and reported bacterial profile and/or antimicrobial susceptibility patterns). The outcomes included the pooled prevalence of bacteria and their susceptibility patterns. Proportion meta-analysis was performed for each outcome of interest.

Results: Fifteen studies were eligible (total positive cases = 2,473). Coagulase-negative Staphylococci (CoNS) (28.1%) were the most common gram-positive causative pathogen, followed by group B Streptococcus (GBS) (16.2%) and Staphylococcus aureus (9.9%); for gram-negative, Escherichia coli (12.7%) and Klebsiella species (11.4%) were most common. The susceptibility rates of these bacteria to first-line antibiotics were high; gram-positive bacteria had the highest susceptibility to ampicillin (72.8–98%), and gram-negative bacteria was most susceptible to amikacin (94.6–98%). Additionally, both gram-positive (67–77%) and negative (87–93%) bacteria exhibited high susceptibility to gentamicin.

Conclusion: The most common pathogens among NS patients were gram-positive. The pathogens, irrespective of stain test, were susceptible to the current antibiotic therapy. We recommend the judicious use of empirical antibiotic therapy to prevent the growing risk of antimicrobial resistance.

Background: The Ponseti method for clubfoot treatment is a non-surgical treatment with a successful outcome. However, many children are not able to complete Ponseti treatment due to various barriers and are termed dropout children. This study aimed to find out the factors responsible for dropout from clubfoot treatment in Peshawar, Pakistan.

Methods: The study was conducted in the Clubfoot Department of a tertiary care hospital. Clinical and demographic information like age, casting phase, bracing phase, and clubfoot types, i.e., idiopathic, syndromic, or neurogenic, were extracted from the hospital database, while for dropout factors, a semi-structured questionnaire was used. Descriptive statistics were applied to demographic data, assessments, and semi-structured questionnaires for parents. The association of dropout rates with age, gender, and unilaterally/bilaterally clubfoot was analyzed through chi-square tests.

Results: Between December 2017 and December 2022, a total of 1,150 babies were treated with the Ponseti method in the Clubfoot Department. Of 1,150 patients, 197 (17.1%) patients dropped out of the treatment. Twenty-four (12.1%) patients of this dropout were from the casting phase, and 173 (87.9%) patients were from the bracing phase. Age was found to be a significant factor affecting dropout from the Ponseti method. No significant association was found between the patient’s dropout and gender or between dropout and unilaterally/bilaterally clubfoot.

Conclusion: The Ponseti method improves clubfoot treatment but faces high dropout rates due to barriers like lack of family support and transport issues. Clinics addressed this by offering family support, transportation aid, telemedicine, community outreach, financial aid, peer support, and extended hours, reducing dropout rates and enhancing outcomes.

Introduction: Pulmonary barotrauma in coronavirus disease-2019 (COVID-19) acute respiratory distress syndrome (ARDS) carries high risk of mortality. While various studies have reported increased mortality, few have assessed the contributing factors for the occurrence of this complication. This study aimed at exploring the contributing factors for barotrauma in COVID-19 ARDS.

Methodology: In this retrospective study, patients aged ≥18 years with laboratory confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by reverse transcriptase polymerase chain reaction (RT-PCR) from a nasopharyngeal swab and having severe or critical COVID-19 disease requiring Intensive Care Unit (ICU) admission according to the World Health Organisation (WHO) criteria for disease severity in COVID-19 disease admitted at forty-bedded ICUs at a tertiary care research hospital in North India from April 1, 2020, to March 31, 2022 were included.

Results: Of 825 patients admitted to COVID ICU, 40 developed pulmonary barotrauma, with a mortality rate of 85%. The mean ± SD PaO2/FiO2 was 96.76 ± 27.78 mmHg. Thirty-nine patients received steroids, 37 developed secondary bacterial infection of the lower respiratory tract with one or more organisms. Acinetobacter baumannii (n = 15), Klebsiella pneumoniae (n = 10), and Pseudomonas aeruginosa (n = 8) were the commonest isolates. Ten patients developed pneumomediastinum, of which 6 patients had subcutaneous emphysema along with pneumomediastinum, and 2 patients developed isolated subcutaneous emphysema. The remaining 28 patients developed pneumothorax.

The mean (±SD) for static respiratory system compliance (Crs) for patients on mechanical ventilation on the day of barotrauma was 19.3 (±10.5) mL/cmH2O.

Conclusion: Patients with COVID-19 ARDS developing pulmonary barotrauma have a high associated mortality, and secondary bacterial infection, lung fragility, patient-ventilator asynchrony, as well as low respiratory system compliance, may contribute to lung injury, predisposing to barotrauma.

Introduction: Motor vehicle accidents (MVAs) are a leading cause of mortality and morbidity worldwide. There is limited literature on the injuries resulting from desert off-road driving accidents. This study aims to delineate the attributes of desert MVA and associated injuries as observed in Qatar.

Methods: This is a Qatar-based retrospective descriptive multicenter study from electronic medical records (EMRs) between 2016 and 2022. Patients were evaluated based on demographic characteristics, type of injury and vehicle involved, injury locations, injury severity, treatments applied, length of hospital stay, number and outcome of surgeries, disability on discharge, and mortality.

Results: Findings reveal a rising trend in accidents from October to March, peaking between 4:00 p.m. and 8:00 p.m. The patients were predominantly male under 40 years of age, not adhering to personal protective measures, and accidents often involved all-terrain vehicles (ATVs) and sport utility vehicles (SUVs). Blunt trauma emerged as the primary injury type, with orthopedic injuries being the most frequent. Most patients did not undergo surgery and had an average hospital stay of 2.9 days. A 1.5% mortality rate and 6.7% disability rate were observed.

Conclusion: This study fills a critical gap in understanding desert traffic accidents in a Gulf Cooperation Council country. This study underscores the need for targeted interventions and public awareness campaigns tailored to the unique challenges of desert driving.

Background: Wars are escalating globally with devastating impacts on all aspects of life. The conflict between Ukraine and Russia began on February 24, 2022. Approximately 80,000 students of 155 nationalities were studying in Ukraine when the war started, disrupting their education and forcing many to leave the country. We aimed to determine the physical, emotional, and moral effects of the Ukrainian war on foreign medical students, as well as the secondary impacts of the war on the students due to the ongoing conflict.

Methods: The participants were non-Ukrainian medical students aged 18 years and over, studying at a medical school in Ukraine before the war started. A survey including the depression anxiety stress scales-21 (DASS-21) scale variables, a validated and reliable measure of depression, anxiety, and stress dimensions, and other questions on participants’ demographics, education, and current socio-economic status was sent to all eligible students via their registered university emails and distributed using an online link.

Results: A total of 99 students were included in the study. 52 (52.5%) of the students were female and 49 (49.5%) were between the ages of 23 and 24 years old. Participants reported high levels of depression (86.9%) and anxiety (82.8%), with significant percentages experiencing extreme levels: 40.4% for depression and 55.6% for anxiety. Additionally, 74.7% reported feeling stressed, with 18.2% indicating extreme stress. Reasons for leaving Ukraine included safety concerns (67.7%), seeking a more secure educational environment (63.6%), the impact of the ongoing war and conflict on their future (56.6%), and the loss of educational opportunities (28.3%).

Conclusion: It is not easy to predict how the war in Ukraine will affect the education of international students in the near future. This uncertainty situation may explain students’ depression, anxiety, and stress. As a result, it is necessary to design effective strategies to maintain the training of health professionals during wartime. Research should be conducted on how to rebuild health education systems after the wartime crises stabilize, both for students who are citizens of the country exposed to war and for foreign students who went to that country to receive education, and solutions for this should be put forward.

Background: The introduction of the varicella vaccine has led to a significant decrease in pediatric varicella-induced invasive Streptococcus pyogenes (group A streptococcal [GAS]) infections. However, the development of a pleural empyema following a chickenpox infection is a rare complication in pediatric patients.

Case presentation: In this report, we present a 5-year-old male patient who presented to the emergency department with a deteriorating course two days after a chickenpox infection. The patient complained of high-grade documented fever, a congested throat, abdominal pain, shortness of breath, and most importantly, decreased air entry on the right side of the chest, along with the presence of crepitations. Such a deteriorated clinical picture suggested the presence of an infectious cause. The patient’s physical examination and radiological imaging provided evidence for the presence of lower right-sided lobar pneumonia. On the second day of hospitalization, the patient showed worsening respiratory distress, prompting further investigations that confirmed the development of a right-sided pleural empyema through radiological imaging. Pediatric surgery consultation was requested, and 500 cc of pus was drained following the insertion of a chest tube, which was later sent for analysis. The patient’s clinical picture improved significantly following this intervention. Due to the severity of his condition, the patient was transferred to the pediatric intensive care unit (PICU) for close monitoring. After one night in the PICU, during which his condition stabilized and oxygen therapy was gradually weaned off, the patient continued to improve on the general ward. Daily assessments and laboratory tests showed decreasing inflammatory markers and resolution of symptoms. Following three days of admission and confirmation of no underlying immunologic deficiency, the patient was discharged home with appropriate antibiotic therapy and follow-up instructions.

Discussion: Similar cases have been sporadically documented in pediatric literature, with notable examples involving older patients. The pathophysiology involves complex immune interactions and virulence factors of GAS, contributing to severe outcomes such as pleural effusion.

Conclusion: In this case, the 5-year-old patient experienced a severe progression from chickenpox to pleural empyema but ultimately improved following prompt medical intervention and chest tube drainage. The patient was discharged after a successful recovery, highlighting the efficacy of early recognition and treatment in managing such complications.

Introduction: Very important person (VIP) syndrome, or recommended patient syndrome (RPS), is a phenomenon in healthcare where well-intentioned efforts to enhance care inadvertently result in harm. Celebrities, physicians, and political leaders often receive preferential treatment, leading to potentially unnecessary interventions. This review delves into its causes, manifestations, consequences, real-life instances, prevention, and management, considering the shifting paradigm of recent advances in the medical field.

Methods: We conducted a qualitative and critical review by searching databases such as PubMed, Scopus, and Google Scholar, as well as online news outlets, exploring available data and literature, including journal articles and news articles published at any time on VIP syndrome.

Results: Twenty articles were found relevant and analyzed. Manifestations of VIP syndrome range from over- to under-treatment, disrupting established healthcare systems. Consequences encompass increased costs, heightened risks, and diminished satisfaction for patients and healthcare teams. Real-life instances, exemplified by Michael Jackson’s case, highlight unintended complications. Prevention strategies advocate transparent resource allocation and adherence to established guidelines. A written VIP patient management plan, involving the hospital’s command center, security, and press spokesperson, is crucial. Proposed directives underscore the importance of valuing medical skills, teamwork, effective communication, and resisting external pressures.

Conclusion: This short communication underscores the necessity of systematically addressing VIP syndrome to ensure fair, ethical, and optimal healthcare delivery. By addressing this issue in an organized way, healthcare providers can work towards treating all patients equally, following ethical guidelines, and providing the best possible care to everyone, regardless of their status or influence. Future research should focus on developing standardized protocols for managing VIP patients, incorporating ethical considerations and evidence-based practices.

Introduction: Self-injury (SI) behavior represents a significant mental health concern that is prevalent among children and adolescents. The aim of this study was to examine the rates and types of suicidal and non-suicidal SI among post-traumatic stress disorder (PTSD) cases of sexual abuse victims and compare them with a major depressive disorder (MDD) group and a healthy control group.

Methods: This retrospective study focused on patients seeking treatment in the Ankara Yildirim Beyazit University Yenimahalle Education and Research Hospital Child and Adolescent Psychiatry Department between 2018 and 2021 in Ankara, Turkey. The study included patients diagnosed with PTSD and MDD following sexual abuse in the PTSD group and assessed standardized scales such as the child depression inventory, screen for child anxiety related emotional disorders, and clinical global impression.

Results: The study included 46 cases in the PTSD–MDD group, 60 in the MDD group, and 47 in the control group. The PTSD–MDD group had significantly higher levels of SI (p < 0.05). The predominant form of SI in this group was self-cutting. Moreover, those with sexual abuse were four times more likely to attempt suicide (OR = 4.1), and the non-suicidal self-injury (NSSI) group was 12 times more likely to attempt suicide (OR = 12.7).

Conclusion: These findings highlight the increased risk of self-harm and suicidal behavior in individuals diagnosed with PTSD–MDD who have been sexually abused, particularly highlighting the significant impact of NSSI and its association with increased suicide risk.