Qatar Medical Journal - Current Issue

To the Editor,

We have carefully reviewed the insightful case report by Avantifiori et al. entitled “Penile Mondor’s disease after open hernia repair surgery: A case report”, which was published in the Qatar Medical Journal.¹ Their detailed exploration of penile Mondor’s disease (PMD) following inguinal hernia repair provides valuable perspectives on this rare condition.

In light of their work, we wish to present our findings from a series of cases of Mondor’s disease that occurred after axillary osmidrosis surgery. Our experience with this condition and the management strategies we used may contribute to a comparative viewpoint that enhances the broader understanding of Mondor’s disease.

Notably, in the present clinical practice, we have applied intralesional steroid injections for treating Mondor’s disease, which has not been previously reported. This treatment strategy is guided by dermatological practices for managing inflammation in conditions such as inflamed cysts or eczema.^2-3 Given the efficacy observed in our cases, it may warrant further investigation as a potential therapeutic option.

Objective: Urinary incontinence (UI) is involuntary urine leakage, mainly due to a feeling of high pressure in the abdominal part, the immediate and urgent need for micturition, or both. Neurotrophins (NTs) are a family of peptides that play a role in the regulation of nerve cells. Their effects on the lower urinary tract organs may provide a perspective to understand the development and diagnosis of UI. This study aims to investigate NT levels to understand how these molecules change in multiparous premenopausal women who suffer from stress-related UI. The study also evaluates diagnostic and distinguishing capabilities of NTs for these disorders.

Methods: In this cross-sectional case–control study, multiparous premenopausal women underwent a urodynamic examination, a stress cough test, and were evaluated with an International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Participants were divided into three groups: 29 healthy women in the control group and two patient groups consisting of 26 women diagnosed with stress urinary incontinence (SUI) and 33 women diagnosed with mixed urinary incontinence (MUI). Nerve growth factor (NGF), brain-derived neurotrophic factor, neurotrophin-3 (NT-3), and neurotrophin-4 (NT-4) levels in serum were measured by enzyme-linked immunosorbent assay. The body mass index (BMI) and ICIQ-SF scores of the patients were also calculated. The data obtained were compared between the groups. Receiver-operating characteristic analysis was performed to determine the role of NTs in diagnosing UI.

Results: The result showed that serum NGF and NT-3 levels were significantly low in both incontinence subtypes compared to the control group (p < 0.05). BMI scores and number of vaginal deliveries were higher in incontinence subtypes compared to the control group, and ICIQ-SF scores were higher in the MUI group.

Conclusion: The differences in serum NGF and NT-3 levels were observed in multiparous premenopausal patients with UI. There was a decrease in serum NGF levels in MUI patients and serum NT-3 levels in SUI patients. Although the changes in serum NGF and NT-3 levels were significant, their discriminatory potential was weak or moderate.

Background: Cancer is a significant global health challenge. One of the biggest health issues that cancer patients face is depression and anxiety. This has a significant impact on their quality of life and treatment outcomes.

Aim: The aim of this study was to investigate the frequency of depression and anxiety among cancer patients in Qatar.

Materials and methods: This study was a cross-sectional design using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scales. A total of 500 cancer patients were surveyed from the National Center for Cancer Care and Research in Doha.

Results: The study found that a significant proportion of cancer patients suffered from depression, with an average PHQ-9 score indicating mild levels of severity. Depression was commonly categorized as mild, with a smaller percentage experiencing moderate, moderate-to-severe, or severe depression. Additionally, patients were predominantly anxious, as reflected by an average GAD-7 score, with most patients experiencing mild to moderate symptoms, while a few experienced moderate or severe anxiety. These findings highlight the significant prevalence of both depression and anxiety among cancer patients, pointing to the importance of comprehensive mental health support. Moreover, patients with advanced-stage cancer, those in their 40s and 60s, those undergoing radiotherapy or hormone therapy, and female patients were found to be more susceptible to depression and anxiety.

Conclusion: Treatment of mental health issues is essential to enhancing the effectiveness of cancer treatment. Cancer patients can have a higher quality of life and better adherence to cancer treatments when mental illnesses such as depression and anxiety are identified and treated early. Furthermore, most patients reported having depression and anxiety, according to the study, which showed that these conditions were more common in Qatar than in other countries. Several demographic groups have been linked to higher rates of depression and anxiety, including women, middle-aged adults, people with stage IV cancer, and patients receiving therapies such as radiotherapy and chemotherapy.

Background and objective: The majority of thyroid cancer patients have a good prognosis. Even in advanced disease, the radioactive iodine (RAI) response improves the prognosis. However, RAI refractoriness poses a significant challenge for these patients. The objective of the study was to assess the expression of SCL5A5 as a potential marker for predicting future resistance to radioiodine treatment.

Materials and methods: Radioactive iodine-refractory papillary thyroid carcinoma (RAIR-PTC) and iodine-sensitive papillary thyroid carcinoma (PTC) were included in the study. Demographic and clinicopathological data were retrospectively analyzed. RNA samples were converted to cDNA. Gene expression reactions were performed using synthesized solute carrier family 5 member 5 (SLC5A5) and glyceraldehyde-3-phosphate dehydrogenase (GADPH) primer samples.

Results: Of the patients, 51 (61.4%) had iodine-sensitive PTC and 32 (38.5%) were RAIR-PTC. Patients were followed up for 8 ± 6.4 years. The mean age at diagnosis was higher in the RAIR-PTC group (56.56 ± 15.22 years vs. 46.82 ± 12.43 years, p = 0.002). The PTC group had higher SLC5A5 gene expression than RAIR-PTC. In addition, no statistically significant correlation was observed between basal thyroglobulin levels and tumor standardized uptake value-maximum (SUV-max) on fluorodeoxyglucose positron emission tomography (p = 0.304).

Conclusion: SLC5A5 gene expression is reduced in radioactive iodine-refractory thyroid carcinoma. Furthermore, the decreased expression status of the SLC5A5 gene before preablative iodine treatment may serve as a predictive indicator of future resistance to RAI therapy.

The post-COVID-19 syndrome may present with a range of neurological symptoms such as headaches, sleep disorders, and dizziness. The objective of this study was to examine the effectiveness of the Gam-COVID-Vac vaccine in mitigating the neurological symptoms of post-COVID-19 syndrome. The study involved 95 patients diagnosed with the neurological form of long COVID-19, who were divided into two groups according to their vaccination status. The immunological parameters of humoral immunity were evaluated by enzyme-linked immunosorbent assay (ELISA), while the parameters of cellular immunity were evaluated using flow cytometry. Administration of the vaccination resulted in a reduction in clinical symptoms of the neurological form of long COVID-19. Statistically significant differences (p = 0.035) were found in symptoms such as headaches, sleep disturbances, and dizziness, especially in central nervous system (CNS) disorders, between the groups that received the vaccination and those that did not. More than 90% of patients had elevated levels of Receptor Binding Domain (RBD) immunoglobulin G against the viral S-protein (>2,500 BAU/ml), indicating strong humoral immunity regardless of vaccination status. An increase in B-lymphocyte (CD3^-CD19⁺) counts was noted in both groups, with levels significantly higher in the group that received the vaccination (p < 0.03). Analysis of T-cell profiles and NK (natural killer) cell levels showed no changes. The study suggests that administration of Gam-COVID-Vac vaccination could reduce the occurrence of CNS symptoms in individuals with post-COVID-19 syndrome. Although certain neurological symptoms may continue, immunization has a beneficial influence on their progression. The results emphasize the crucial role of an increased humoral immune response in individuals with post-COVID-19 syndrome, but do not show significant changes in T-cell immune parameters.

Introduction: Postoperative pain management is crucial for recovery from surgery. Patient-controlled analgesia (PCA) with morphine and fentanyl are commonly used, but their comparative efficacy remains uncertain. This study aims to evaluate opioid consumption and pain control in patients receiving PCA morphine versus PCA fentanyl after colorectal surgery.

Methodology: A retrospective analysis of adult patients undergoing elective colorectal surgery was conducted. Patients were divided into two groups based on PCA morphine or PCA fentanyl use. Outcomes measured were opioid consumption in morphine equivalents, numerical pain scores expressed as Numerical Rating Scale (NRS), patient demand, and side effects within the first 48 hours postoperatively.

Results: Of 370 patients screened, 152 met the inclusion criteria. No significant differences were found in total opioid consumption (median: 38 vs. 28.5 mg, p = 0.095), patient demand (median: 46.5 vs. 35, p = 0.156), or NRS (median: 4 vs. 3.5, p = 0.348). Side effects were comparable between groups. Subgroup analysis revealed higher opioid consumption and demand in females taking fentanyl compared to morphine. Age was negatively correlated with pain-related outcomes, and smokers showed higher opioid consumption and higher pain scores.

Conclusions: PCA morphine and fentanyl provide similar postoperative pain relief in colorectal surgery patients, with no significant differences in opioid consumption or side effects. Female patients may respond better to morphine, and age and smoking status significantly influence pain management outcomes. Further prospective studies are recommended to better define these findings and inform postoperative pain strategies.

Background: Mirizzi syndrome (MS) is a rare condition in which the common bile duct or hepatic duct is blocked by impacted gallstones. It can cause symptoms such as cholecystitis, including abdominal pain, nausea, and vomiting. Although diagnosis is challenging, imaging techniques such as ultrasonography and CT scans are helpful. The gold standard for diagnosis is ERCP (Endoscopic Retrograde Cholangiopancreatography). Surgical management is the primary treatment, with laparotomy preferred over laparoscopic procedures.

Methodology: This prospective study was conducted over a period of five years at a tertiary care hospital in Pakistan. A total of 72 patients, aged 21–70 years (mean age 44.81 years), with symptomatic cholelithiasis were included. All patients underwent ultrasonography and, in selected cases, MRCP (Magnetic Resonance Cholangiopancreatography) and ERCP were performed preoperatively. MS was detected preoperatively in 19.4% of cases and intraoperatively in the remaining cases. Data were analyzed using SPSS version 28.

Results: Of the 72 patients, 75% were female. Most patients (69.4%) presented with the right hypochondrium pain, while 16.7% presented with pain and jaundice. Preoperative liver function tests were abnormal in 44.4% of patients. Imaging techniques used included ultrasound (100% of patients), MRCP (22.2%), and ERCP (8.3%). Laparoscopic cholecystectomy was completed in 63.8% of patients, with a conversion rate to open surgery of 30.55%. Two patients required open cholecystectomy with hepaticojejunostomy due to gallstone ileus. The MS types identified were type I (50%), type II (25%), type III (19.4%), type IV (2.77%), and type V (2.77%).

Conclusion: MS is a rare and challenging condition to diagnose. Although imaging techniques are helpful, ERCP remains the gold standard. Surgical management, particularly laparoscopic cholecystectomy, is effective but requires careful implementation by experienced surgeons to avoid complications. In complex cases, laparotomy remains a necessary option.

Introduction: Reproductive technologies are used more widely today than ever before. This increase in the use of assisted reproductive technology (ART) is directly related to sociodemographic conditions that result in delayed childbirth among age groups with lower fertility. Infertility affects 17% of married couples, and in some countries 6% of children are born with in vitro fertilization (IVF). In this context, the aspect of the influence of reproductive technologies on hormonal indicators of offspring in relation to anthropometric data remains insufficiently examined. The purpose of this cohort study is to compare the hormonal panel and anthropometric data of ART-conceived children with the corresponding data of children conceived naturally.

Methodology: Biochemical tests are used to determine the amount of free triiodothyronine (T3) and total thyroxine (T4), somatotropin, insulin, insulin-like growth factor, glucose, potassium, and sodium cations in blood samples from the experimental and control groups.

Results: The results indicate that the use of assisted reproductive technologies neither altered the endocrine panel of the thyroid gland, nor affected other biochemical parameters. Variations in technologies – classical IVF, fresh or frozen embryo transfer, intracytoplasmic sperm injection – also did not affect the quantitative value of the above indicators. Artificial insemination also had no effect on puberty (in both boys and girls). Children born naturally had a greater body weight (3,453 vs 3,160 g, p < 0.001) and height (53 vs 51 cm, p = 0.002). ART children had significantly higher median free T3 levels (3.65 vs 3.48 mU/L, p = 0.002) and potassium levels (4.8 vs 4.7 mmol/L, p = 0.013), although within the reference ranges. Glucose levels were also higher in ART children (median 4.45 vs 4.29 mg/dl, p = 0.01).

Conclusion: Several relationships between biochemical and anthropometric indicators were identified: the correlation between body weight and blood levels of insulin-like growth factor was statistically significant, positive, and weak. The T3 level in the experimental group was found to be statistically significant and directly proportional to body height, and insulin content was inversely proportional to body weight. The data obtained make it possible to verify the safety of using a different range of reproductive technologies.

Background: The relationship between acne vulgaris and lipid profiles has been the subject of limited research across diverse populations, yielding conflicting results. The aim of this study was to determine whether there are any significant differences in lipid profile and selected apolipoproteins between two groups: adolescents and young adults with acne vulgaris and an age- and sex-matched control group. Additionally, the study aimed to identify indicators associated with severe acne vulgaris.

Methods: The cross-sectional study involved 100 adolescent and young adult patients (50 adolescents aged 11–18 years and 50 young adults aged 19–26 years) who were visitors to the Dermatology Unit of Azadi Teaching Hospital in Duhok City, Kurdistan Region of Iraq, diagnosed with acne vulgaris. These patients were compared with a control group of 90 healthy individuals who were matched for age, sex, and BMI (body mass index). Measurements included lipid profile, apolipoprotein A (Apo A), apolipoprotein B, and lipase. The Ethics Committee of the Directorate of Health of Duhok City Governate approved the study (reference number: 15092021-9-3). Data were statistically analyzed using SPSS software (version 26.0 for Windows), and the p value ≤ 0.05 was considered statistically significant.

Results: The results showed an increase in total cholesterol, triglycerides, HDL-C (high-density lipoprotein cholesterol), non-HDL-C, and Apo A in the acne vulgaris group compared with the control group (157.5 ± 36, 125.4 ± 50.5, 40.9 ± 10.9, 114.6 ± 41, and 189.5 ± 26 versus 129 ± 22.5, 98.1 ± 49.9, 33.4 ± 8.1, 95.6 ± 32.1 and 179.6 ± 22.4, respectively), all with p values of ≤ 0.05. The regression model showed that an increase in one unit of cholesterol resulted in a 4% increase in the odds of acne vulgaris (p < 0.001). The severity of acne vulgaris was associated with age (mild (17.9 ± 2.7), moderate (18.09 ± 2.8), severe (20 ± 2.7), p < 0.05) and with a decrease in Apo A levels compared with the mild group (179.2 ± 25.5 and 200 ± 25.9, respectively, p < 0.05). There was a significant increase in non-HDL-C levels in young adult patients compared with adolescent patients (125.8 ± 40.3 versus 103.5 ± 39.9, p = 0.01).

Conclusions: High cholesterol is a feature of adolescent and young adult patients with acne vulgaris. Older patients tend to have more severe forms of acne, which are significantly associated with elevated non-HDL-C levels. Decreased Apo A levels have also been identified as an additional indicator of severe cases of acne vulgaris.

Background: Ventriculoperitoneal shunt (VPS) placement treats hydrocephalus by draining excess cerebrospinal fluid (CSF). Despite advances, infections remain a common complication, resulting in significant morbidity and mortality. Infection rates range from 7.2 to 18%, with common pathogens being Staphylococcus epidermidis and Staphylococcus aureus. Risk factors include young age, postoperative CSF leakage, prolonged surgery, and previous infections. The aim of this study was to describe the prevalence of CSF shunt infections at King Abdullah University Hospital (KAUH), assess infection rates in pediatric and adult patients, and report causative microorganisms.

Methods: A retrospective analysis was conducted on all patients with CSF shunt-related infections in our hospital (KAUH) over the last 17 years (2005–2023). The patients’ demographics, laboratory results, and details of causative microorganisms were collected.

Results: Of the 579 patients who underwent CSF shunting at KAUH in Jordan, 59 (10.1%) had a positive CSF culture for shunt infection. The majority of the patients were children (83.1%) with a median age of 9 months and a higher proportion of male patients (57.6%). Most of the infections were due to congenital anomalies (74.6%). The median time to infection was 13 days, with 13.5% experiencing recurrent infections. Recurrent infection rates were found to be significantly higher in pediatric patients (p = 0.00007). The most common pathogens were Acinetobacter baumannii (47.5%) and Staphylococcus species (40.7%). Analysis by age group showed a significant association between age and Acinetobacter baumannii infections (p = 0.008).

Conclusion: The study provided demographic and microbiological data on VPS infections, with Acinetobacter baumannii being the most common causative organism. Treatment of these infections remains challenging, highlighting the need for more comparative research on different treatment options.

Introduction: Pregnant women are considered a high-risk group for COVID-19 infection/pneumonia as they are known to be more vulnerable to viral infections. They require close monitoring and appropriate timely intervention to minimize the impact on both the mother and the fetus. Although the more prevalent Omicron variant led to fewer severe infections and fewer intensive care unit (ICU) admissions globally during the third wave, the effect on pregnant women and pregnancy outcomes was unknown. The vaccination campaign was thoroughly established by the third wave of the pandemic in Qatar. This retrospective descriptive cohort study investigates the characteristics, hospital stay, interventions, vaccination status, and fetal and maternal outcomes of patients admitted to the ICU with severe COVID-19 pneumonia during each of the three COVID-19 waves in Qatar.

Methods: The inclusion criteria were all pregnant patients with a positive polymerase chain reaction antigen test result and/or defined radiological changes at the time of admission that subsequently required admission to the ICU for 24 hours or more. Data were collected from the medical records and chart reviews of patients admitted to Hamad Medical Corporation with COVID-19 pneumonia from March 1, 2020 to February 28, 2022.

Results: The study included a total of 54 pregnant women. In contrast, during the third wave, the number of patients admitted to the ICU was significantly less than in the first wave. The mean gestational age at presentation for each of the three waves was 213.5, 212, and 245 days, respectively. No pregnant women were vaccinated during the first two waves. However, during the third wave, 90.9% of patients admitted to the ICU were vaccinated. The average length of stay in hospital was (mean ± standard deviation) 22.0 ± 27.6, 15.5 ± 7.8, and 5.0 ± 6.3 days for each of the waves, respectively, and the average length of ICU stay was 13.4 ± 20.9, 6.3 ± 5.5, and 3 ± 2.5 days, respectively. The most common chest X-ray finding on admission was bilateral infiltrates. During the third wave, only one patient required a high-flow nasal cannula. As the severity of the disease increased, the patients received more invasive respiratory support and had a higher likelihood of a preterm delivery. Vaccination status correlated with a significantly higher birth weight (mean weight 3.14 kg). However, it was not associated with better maternal outcome.

Conclusion: This extension study of the COVID-19 patients admitted to the ICU in Qatar during all three waves suggests that those admitted to the ICU with COVID-19 pneumonia are more likely to require close monitoring and appropriate interventions to minimize adverse outcomes for both the mother and the fetus. Our data may suggest that vaccination in these patients may contribute to reducing the use of respiratory support modalities for those admitted to the ICU and shortening the length of hospital stay. Overall, there was no statistical significance between vaccination and maternal outcome.

Background: When Qatar imposed a nationwide lockdown in accordance with WHO guidelines during the first wave of the COVID-19 pandemic, dental healthcare services were disrupted, limiting services to emergencies and postponing elective procedures due to transmission risks. Teledentistry was introduced to remotely manage dental conditions and reduce hospital admissions. The present study examines patient perceptions of audio-dentistry, a form of teledentistry, in managing dental emergencies during the pandemic and explores factors influencing overall patient satisfaction.

Methods: A retrospective, cross-sectional telephone questionnaire included 352 participants who used a dental emergency hotline service during the first wave of the COVID-19 pandemic lockdown (March 29–August 31, 2020) in Qatar. A validated, closed-ended questionnaire was administered to explore participants’ views on audio-dentistry. The questionnaire explored the influence of variables related to dental problems depending on the specialty required, the years of experience of the responding dentist, and teletriage management decisions on overall satisfaction with audio-dentistry.

Results: The response rate was 80.18%. Most participants expressed positive views of audio-dentistry in five domains (usefulness, interaction quality, ease of use and reliability, quality of care, satisfaction, and future use). However, approximately one-third of participants disagreed or strongly disagreed that their dental problem had improved following the call (35.3%) and viewed the lack of physical contact as a disadvantage (31.2%). Overall satisfaction was only influenced by telephone triage outcomes, with patients transferred for chairside management more likely to be satisfied (89.8%) than those managed remotely through self-care instructions and medications (80.4%) or instructions only (75.4%) (p = 0.011).

Conclusions: Audio-dentistry effectively sustained oral health services during the COVID-19 pandemic while minimizing face-to-face visits, with patients largely expressing high satisfaction in areas such as usefulness, interaction quality, ease of use, reliability, and overall care. Satisfaction was primarily influenced by call outcomes and referrals or prescription decisions rather than caller demographics or dentist experience. However, some dissatisfaction arose when immediate improvement was not achieved, particularly in conditions such as pulpitis that are challenging to manage remotely.