Qatar Medical Journal - الأعداد السابقة

Background: Bronchial asthma affects about 20% of Qatar’s population. The impact of asthma on COVID-19 outcomes is controversial. The aim of this study was to explore the impact of asthma on COVID-19 outcomes and the predictors of COVID-19-related morbidity and mortality in a cohort of asthma patients infected by COVID-19.

Methods: This is a retrospective cohort study of adult patients with asthma infected with COVID-19, who were recruited from Hamad Medical Corporation (HMC), the main healthcare system in Qatar. Patients were matched to a control group of non-asthmatic COVID-19 patients (1:2) based on sex, age, and other comorbidities.

Results: Between March and August 2020, 616 patients with asthma met the inclusion criteria. The need for hospitalization among patients with asthma was independently associated with older age (adjusted odds ratio [aOR] for 10 years, 1.32; 95% confidence interval [CI], 1.13–1.54; p = 0.001) and hypertension (aOR, 2.4; 95% CI, 1.43–3.93; p = 0.001) but not with the use of inhaled corticosteroids (ICS), long-acting beta2 agonists, montelukast, or tiotropium. Patients with asthma required less hospitalization for COVID-19 than non-asthmatic patients (28.2% vs. 37.3%, respectively; aOR, 0.59; 95% CI, 0.77–0.90; p < 0.001). However, admission to the intensive care unit (ICU) was comparable between both groups (3.3% vs. 2.2%; aOR, 1.64; 95% CI, 0.78–3.43; p = 0.193).

No difference in mortality rate was observed between the two groups.

Conclusions: In Qatar, adult patients with asthma do not appear to be at higher risk of COVID-19-related hospitalization or ICU admission compared to the general adult COVID-19-infected population. Older age and hypertension were the only significant predictors of COVID-19-related hospitalization among patients with asthma. Further larger studies are required to confirm such an association.

We describe the case of a 44-year-old gentleman with hypertension and asthma presenting to the emergency department after noticing right upper-extremity weakness upon awakening. Brain imaging did not reveal a stroke. Initial neurological examination pointed to cervical myelopathy with radiculopathy as well as possible underlying length-dependent peripheral neuropathy as there was right arm strength of 4/5 and there were brisker (3+) reflexes all over except at the right biceps reflex and both ankle reflexes. Cervical spine magnetic resonance imaging (MRI) showed myelomalacia at the C2 level and an os odontoideum (OO). Os odontoideum is a chronic condition that occurs due to the failure of the center of ossification of the dens to fuse with the body of C2. By the next day after a few hours of sustaining a fall, weakness progressed to quadriparesis, without a sensory level on examination, followed by urinary retention. This situation was attributed to a possible cervical cord contusion due to the fall in the presence of OO, with other possibilities being spinal cord hemorrhage, infarct and transverse myelitis. However, repeat scanning of the cervical spine (MRI) did not reveal any acute cord changes. The initial examination for common causes of peripheral neuropathy did not reveal any findings. Finally, the diagnosis of Guillain–Barré syndrome (GBS) was considered, and treatment was initiated with intravenous immunoglobulin. Cerebrospinal fluid analysis was normal. The diagnosis was confirmed using electromyography. Our patient’s initial presentation of monoparesis and progression in an asymmetric descending manner was unusual for GBS. His initial presentation mimicked a stroke, and the later progression masqueraded as cervical myelopathy secondary to a chronic cervical cord lesion. The presence of a cervical cord lesion (upper motor neuron) concealed the expected areflexia in GBS. The presence of OO on spine imaging, absence of expected areflexia in GBS, and progression to paraparesis after the fall sidetracked the direction of the initial investigation and led to a relative delay in diagnosis. Nonetheless, appraising the diagnostic data in the clinical context led to an appropriate diagnosis. We emphasize the importance of reconciling the available clinical and diagnostic information to reach the correct diagnosis.

Background: Primary care-based studies examining the prevalence of anxiety symptoms severity and associated factors among older adults during the COVID-19 pandemic are scarce. The study aims to determine the prevalence of general anxiety symptoms severity and associated sociodemographic and physical health characteristics, including SARS-CoV-2 infection history, among older adults in primary care in Qatar during the COVID-19 pandemic.

Methods: A cross-sectional study was conducted using a random sample of older adults aged 60 years and above (n = 337) from all primary health care centers (n = 28) of Qatar’s Primary Health Care Corporation. Participants were interviewed via telephone by family physicians between June and August 2020. General anxiety symptoms severity was assessed using the Generalized Anxiety Disorder 7-item Scale (GAD-7). Descriptive statistics and ordinal regression were used to analyse the data.

Results: The mean age of participants was 65 years (ranging from 60 to 89 years), standard deviation = 4.8. About 49.0% and 32.0% of participants were females and of Qatari nationality, respectively. The prevalence of minimal, mild, moderate, and severe general anxiety symptoms was 82.5%, 13.9%, 3.0%, and 0.6%, respectively. Around 33.5%, 63.5%, and 3.0% of participants had unknown, negative, or positive SARS-CoV-2 infection histories, respectively. Females had greater odds of higher levels of anxiety symptoms severity (odds ratio (OR) 2.34; 95% confidence interval (CI) 1.22, 4.50; p = 0.011). As compared to participants with unknown SARS-CoV-2 infection status, those with a negative and positive SARS-CoV-2 infection history had increased odds of higher levels of general anxiety symptoms severity by 2.48 (95% CI 1.17, 5.24; p = 0.017) and 7.21 (95% CI 1.67, 31.25; p = 0.008), respectively. Age, marital status, living arrangements, nationality, and the number of medical conditions had no statistically significant associations with general anxiety symptoms severity.

Conclusions: Most older adults experience minimal to mild anxiety symptoms during the COVID-19 pandemic. Female gender and confirmed or suspected SARS-CoV-2 infection history are independent predictors of more severe anxiety symptoms among older adults.

Lymphangiomas are congenital malformations of the lymphatic system, mostly well-circumscribed and cystic. Although many theories were proposed to explain etiology, it is still controversial. Most of these lesions are found in the cervicofacial region, while the scalp is considered a scarce location, with only a few reported cases in the literature. Herein, we report a case of scalp lymphangioma in a 33-year-old male, which unexpectedly and significantly progressed in size over one year. The MRI scan characteristics were unique compared to the literature description of the lymphangioma, as it appeared hypointense in both T1WI and T2WI with inhomogeneous contrast enhancement, eventually consistent with lymphangioma on histopathology. The patient underwent surgical excision of the mass without any recurrence over a follow-up period of 1 year.

Background: SARS-CoV-2 in children with cystic fibrosis (CF) has been reported to cause mild illness without pre-existing severe lung disease. This review described the clinical presentation and course of COVID-19 infection in children with CF in Qatar.

Methods: The pediatric CF registry of 51 patients in Qatar was reviewed for COVID-19 cases from February 2020 to February 2022. Demographics, vaccination status, symptoms, and course were reviewed. Data were expressed as median, range, frequencies, and percentages.

Results: The study included eight patients with CF below 18 years of age infected with COVID-19. The incidence of COVID-19 in children with CF was 15.7%. The median age was 11 (2-18) years. Half of the cohort were males. Seven patients were pancreatic sufficient (I1234V mutation), and one was pancreatic insufficient (3129del4 mutation). The median baseline FEV1 was 91 (78-107%) predicted. None had received CFTR modulators or undergone a lung transplant. Three patients were vaccinated before their infections. Two of them were asymptomatic. Six patients (75%) had a cough and flu-like symptoms. Three patients had a fever. Two patients were hospitalized due to pulmonary exacerbation; both had mild CF-lung disease. None required respiratory support.

Conclusion: We report a favorable outcome of COVID-19 infection in children with CF, similar to published international studies. Our findings are attributable to the community-dominant milder CFTR mutation, precautionary measures, and causative COVID-19 strain. More longitudinal data are needed to study these factors as potential protective mechanisms.

Background: Postoperative pulmonary complications (PPC) include any complication that affects the respiratory system after anesthesia and surgery and are a significant cause of postoperative mortality and morbidity.

Objectives: To describe the risk factors for immediate postoperative pulmonary complications after appendectomy under general anesthesia and to determine if rapid sequence induction decreases the risk.

Design and Setting: A retrospective analysis of perioperative medical records of patients who underwent appendectomy under general anesthesia over a year, from January 1^st, 2014, to December 31^st, 2014, at Hamad General Hospital, Doha, Qatar, was done.

Results: Of the 1005 patients who met the inclusion criteria, 27 (3.7%) had PPC. The incidence of PPC had a significant positive association with diabetes mellitus (DM), bronchial asthma (BA), number of intubation attempts, laparoscopic approach, and longer surgeries (>2 h). Hypertension, recent or ongoing upper respiratory tract infections, and smoking were not associated with an increased risk of PPC. Non-rapid sequence intubation (RSI) was not associated with an increased risk of PPC compared with RSI.

Conclusions: The incidence of immediate PPC in ASA 1 and 2 appendectomy patients aged between 15 and 50 is significant. There is an increased risk among asthmatics, diabetics, and those with difficult airways. The RSI technique does not offer protection.

Background and Aims: As part of the COVID-19 control strategy, a growing number of vaccine portfolios evolved and got fast-tracked through regulatory agencies, with a limited examination of their efficacy and safety in vulnerable populations, such as patients with chronic conditions and immunocompromised states. Patients with chronic liver disease (CLD), and cohorts post liver transplant (LT) in particular, were underrepresented in the determinant trials of vaccine development, hence the paucity of data on their efficacy and safety in published literature. This systematic review aims to examine the available evidence and ascertain the effectiveness and safety of Covid-19 vaccination in patients with CLD and those with LT.

Methods: A systematic review of PubMed (Medline), Google Scholar, Cochrane Library, and ScienceDirect from inception until 1^st March 2022 was conducted. We included observational studies and assessed vaccine efficacy regarding seroconversion or immunological rate, whereas serious or significant adverse effects have been considered safety outcomes when reported.

Results: Studies comprised 45275 patients, performed in 11 different countries. Seroconversion or immunological rate after Covid-19 vaccination was mostly the primary endpoint, whereas other endpoints like covid-19 related adverse effects were also reported. Twenty-four of the final analyzed studies are prospective cohort studies, while four are retrospective cohort studies. Twenty-one studies included patients who underwent LT and received the Covid vaccine; nine included patients who had CLD due to various etiologies. The median age range of all included patients varied from 43–69 years. All patients with LT who received at least two doses of Covid vaccine had a seroconversion rate of around 60%. Patients with CLD had a seroconversion rate of about 92% post two doses of Covid vaccination. The average seroconversion rate in post-transplant recipients was around 45% after two doses of the significant Covid vaccines: Pfizer, AstraZeneca, Moderna, and Jansen. Only two studies have reported a higher seroconversion rate of 75% and 73% after the third dose of Covid vaccine. No significant adverse effects were reported in all studies; the most commonly reported negative effect was local injection site pain.

Conclusion: The present systematic review, comprising real-world observational data studies, concludes that Covid-19 vaccination was associated with 92% and 60% seroconversion rates in patients with CLD and LT, respectively. No significant side effects were reported in all studies. This finding helps to resolve the uncertainty associated with Covid-19 vaccination in this cohort of patients.

The ovary’s Torsion is the adnexa’s total or partial rotation around its vascular axis or pedicle. Complete torsion causes venous and lymphatic blockade leading to stasis, venous congestion, hemorrhage, and necrosis. If neglected, it may result in permanent loss of the affected ovary. Ovarian torsion is one of the most critical gynecological surgical emergencies. Therefore, it requires urgent surgical intervention. It is mainly diagnosed by clinical examination and ultrasound. Ovarian torsion is primarily seen in the first trimester of pregnancy.^1,2 Infertility treatment is a significant risk factor due to ovarian stimulation. We present a case of acute abdominal pain who came to the emergency department of Al Ahli Hospital, diagnosed as right adnexal torsion with viable intrauterine pregnancy at six weeks. Laparoscopic oophorectomy was done by removing the corpus luteum cyst, which supports early pregnancy. Despite its disposal, the pregnancy continued because the hormonal therapy started in doses higher than recommended for threatened abortion.³ Eventually, she gave birth to a healthy baby boy at 35 weeks.

Background: The incidence of stroke in the Middle East is high, given its relatively young population. Smoking is a well-recognized risk factor for ischaemic stroke, and its high regional prevalence may partly account for this increased stroke risk. This research aims to determine whether young male South Asian migrants in Qatar were adversely affected by stroke depending on their smoking status.

Methods: Data from the ongoing international prospective BRAINS study was analysed. Male South Asian migrants to Qatar with a history of ischaemic stroke were recruited. Multivariate regression analysis was used to estimate the effects of comorbidities, such as BMI, hypertension, diabetes, hypercholesterolemia, alcohol consumption, and ischemic heart disease, on the association of age of stroke onset and smoking status.

Results: We identified 778 (mean age 49.5±10.2) migrant male workers of South Asian descent with ischaemic stroke in Qatar, of which 41.3% of the sample were current smokers. Compared to non-smokers, current smokers suffered a stroke 2.03 years earlier (95%CI: 0.60–3.46, P=0.005). Multivariate regression analysis demonstrated that only current smoking status was associated with an earlier age of stroke onset (β=2.03, SE=0.74, P=0.006).

Conclusion: Smoking is associated with at least a two-year earlier onset of ischaemic stroke in male South Asian migrants to the Middle East. Our study has important implications for the public health management of migrants in host countries.

Introduction: Pregnant women are considered a high-risk group for COVID-19 due to their increased vulnerability to viral infections. The impact of COVID-19 on pregnant women is not well understood, and there is a need for data on managing severe COVID-19 in pregnant patients. This retrospective descriptive cohort study described the characteristics, hospital stay, interventions, and outcomes of pregnant patients admitted to the intensive care units (ICUs) with severe COVID-19 pneumonia in Qatar.

Methods: Data were collected from medical records and chart reviews of pregnant women admitted to Hamad Medical Corporation (HMC) with COVID-19 pneumonia from March 01, 2020, to July 31, 2021. The inclusion criteria encompassed pregnant women with a positive polymerase chain reaction (PCR) antigen test or radiological changes at admission, requiring respiratory support, and hospitalized for more than 24 hours.

Results: A total of 43 pregnant women were included in this study. Most patients were admitted during the first wave of the pandemic, with a median gestational age of 212 days [interquartile range 178–242 days] at presentation. The most common respiratory support methods were high-flow nasal cannula, non-invasive positive pressure ventilation, and invasive positive pressure ventilation. Convalescent plasma therapy was administered to 58% of patients, and tocilizumab was used in 28%. Renal replacement therapy was required by 4.6% of patients and 7% required extracorporeal membrane oxygenation.

Conclusion: This study provides valuable insights into the impact of COVID-19 on pregnant patients admitted to the ICUs in Qatar. The results suggest that pregnant patients with COVID-19 pneumonia require close monitoring and appropriate interventions to minimize adverse outcomes for both mother and fetus. The data may contribute to future guidelines and management strategies for severe COVID-19 in pregnant patients.

De novo Aspergillus infections of the appendicular skeleton are rare. A 72-year-old female presented with pain and deformity in her left lower limb and an inability to bear weight that had persisted for the last six months. A femur biopsy confirmed the diagnosis of extensive Aspergillus osteomyelitis, and the patient was treated with amphotericin B and oral voriconazole. The patient died of COVID-19 after 2.5 months of treatment. A diagnosis of Aspergillus osteomyelitis may be delayed because of its varied clinical presentation. To the best of our knowledge, this is the first known case of de novo neglected and extensive (multisite, multibone) Aspergillus osteomyelitis in an immunocompetent patient. This case highlights the importance of awareness in patients and treating physicians of this rare infection and its early diagnosis to prevent extensive spread.