Qatar Medical Journal - Volume 2025, Issue 1

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.

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

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

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

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

Background: Myelomeningocele (MMC) is a severe congenital malformation of the CNS (central nervous system) that often leads to seizures due to factors such as shunt complications and hydrocephalus. This study aims to develop a machine learning model to predict the likelihood of seizures in MMC patients by analyzing various predictors.

Methods: This retrospective study involved 103 MMC patients. Factors such as demographics, MMC location, shunt history, and imaging were analyzed using the random forest classifier, the support vector classifier, and logistic regression. Model performance was assessed through bootstrap estimates, cross-validation, classification reports, and area under the curve (AUC).

Results: Of the evaluated patients, 11 experienced seizures. The key influencing factors included gestational age, sacral location, hydrocephalus, shunt history, and corpus callosum dysgenesis. Machine learning (ML) models predicted seizure risk with an accuracy of 86–92% and an AUC ranging from 0.764 to 0.865. Significant predictors were imaging findings, shunt infection history, and gestational age.

Conclusion: ML models effectively predict seizure risk in MMC patients, with certain variables showing strong associations and significant impact.

Background: Cardiovascular disease (CVD) affects 500 million people globally, with mortality over 20 million. In the UK, the financial burden is estimated to be approximately £54 billion. Consequently, Lp(a) has been incorporated as an additional biomarker for cardiovascular risk stratification. It is used as a superior marker over the traditional marker LDL-C.

Methods: This was a single-centre retrospective study conducted at Hampshire Hospital NHS Foundation Trust spanning 16 months (September 2022–January 2024). Lp(a) results were retrieved from the laboratory database and assessed for trends. The distribution of Lp(a) results was also compared with the values outlined in the HEART UK consensus statement (2019). Additionally, demographic characteristics such as age, sex, medical history, and lifestyle factors were collected. Personal details, including names, addresses, and phone numbers, were anonymised to ensure confidentiality. A total of 192 patients were included in the study. These patients were referred for a lipid panel by lipid specialists (172), GP surgeries (10), cardiologists (5), unspecified consultants (3) and endocrinologists (2). All patients were over 18 years of age. They were attending the clinic and had been screened for dyslipidaemia and high cardiovascular risk, including conditions such as familial hypercholesterolaemia, renal dysfunction, and those on antilipid therapy.

Results: The demography included 99 (52%) females and 93 (48%) males. The chronological age (mean ± SD) was 61.17 ± 13.18 for females and 53.91 ± 12.84 for males (p < 0.001). Additionally, the Lp(a) values were 126.50 ± 118.92 and 135.33 ± 99.59 (p < 0.01) for females and males, respectively. The analysed samples were categorised as normal ( ≤ 32 nmol/L) and abnormal (>32 nmol/L) concentrations of Lp(a), with normal results observed in 104 patients and abnormal results in 88 patients: Lp(a) ≤ 32 nmol/L (54%) versus >32 nmol/L (46%), p < 0.0001. According to the CVD risk groupings established by HEART UK, 54%, 12%, 18%, 15% and 1% of the patients had Lp(a) values of 12.2 ± 7.5, 52.20 ± 16.42, 147.14 ± 36.64, 291.71 ± 62.49, and 471.50 ± 28.99 nmol/L, classified as normal, minor risk, moderate risk, high risk, and very high risk, respectively.

Conclusion: This study provided evidence supporting the inclusion of Lp(a) as an extra component in lipid profile testing. Elevated levels of Lp(a) are associated with an increased risk of CVD, which may be more significant than the risk posed by LDL-C. Incorporating Lp(a) as a routine biomarker in real-world clinical practice would accurately stratify cardiovascular risk, particularly for patients with elevated Lp(a) concentrations, and could potentially be a more significant risk than LDL-C in individuals at high risk for CVD, especially for those ≥ 50 years of age.

Background: The screening of post-traumatic stress disorder (PTSD) and depression after an injury is essential for improving the patient's quality of life. The aim of this study was to assess the utility of PTSD and depression screening and the early referral to the trauma psychology service at a level 1 trauma center. We hypothesized that as the screening process becomes more established as a standard of care, compliance with screening would improve. Furthermore, early referral of trauma patients to a dedicated psychologist within the trauma care system would be beneficial.

Methods: This retrospective study involved 1,245 consecutive eligible patients who were admitted to the trauma service between September 2019 and December 2020. The Injured Trauma Survivor Screen (ITSS) and an additional criteria checklist were used for patient screening, and data were analyzed. The screening was conducted within 24 hours of the admission of trauma patients aged  ≥ 14 years, all of whom had a Glasgow Coma Scale of 15.

Results: The findings of the study showed that the integration of the new screening tool into a standard of care requires a significant amount of time. Screening compliance increased from 84% to 100% throughout the duration of the study. Notably, there was a 10% gap in the referral of patients identified through the ITSS tool, with 64% referrals based on the symptom checklist.

Conclusions: The current screening methods used as a standard of care show good utility value in identifying trauma patients predisposed to developing PTSD or depression, warranting their continued use. Facilitating direct referrals to trauma psychology service by attending staff, including nurses, could help bridge the gap in patient identification and referral. However, further research is warranted to validate this process.

Background: Pertussis, a highly contagious disease, has made a resurgence following the easing of COVID-19 pandemic restrictions. Infants under three months old are particularly vulnerable due to their immature immune systems and lack of protective vaccination.

Methods: This study presents a case series of four infants, aged one to three months, who initially presented with nonspecific respiratory symptoms at Alkhor Hospital between January and June 2024. Subsequent diagnostic testing confirmed pertussis in all four cases. It is noteworthy that all cases involved were previously healthy infants with no underlying health conditions. Additionally, none of the mothers had received the Tdap vaccine during pregnancy.

Results: All infants required hospitalization, with one being admitted to the PICU for eight days. Ultimately, all four infants made a full recovery.

Conclusion: Pertussis remains a significant cause of morbidity and mortality in infants under three months of age. Given the potential for severe complications and the burden it places on the healthcare system during outbreaks, it is crucial to emphasize preventive measures such as maternal vaccination.

Background: Language barriers significantly impact healthcare delivery, particularly in emergency medical services (EMS) operating in linguistically diverse environments. The demographic composition of Qatar, with its predominantly expatriate population, presents unique challenges for effective communication in pre-hospital care settings. The aim of this was to assess the opinions of personnel from the Hamad Medical Corporation Ambulance Service (HMCAS) regarding the impact of language barriers on pre-hospital emergency care.

Methods: A cross-sectional study was conducted using an anonymous survey with a five-point Likert scale among 312 frontline personnel of HMCAS. Fisher's exact and Kruskal–Wallis tests were used to compare ordinal outcomes across groups. Machine learning algorithms, including ordinal logistic regression, support vector machines (SVM), and naive Bayes, were used to develop predictive models for HMCAS staff opinions on their language learning needs.

Results: Both bivariate and multivariate analyses revealed significant differences in the frequency of experiencing communication challenges. The most influential factors identified were strong opinions on language barriers and the willingness of staff to enhance their language skills. Variables related to using family members as interpreters showed relatively low importance. The SVM model demonstrated the best predictive capability concerning staff perceptions about language learning needs, with an accuracy of 0.50 and an average area under the curve score of 0.74.

Conclusion: Language barriers significantly impact pre-hospital emergency care in Qatar. The findings highlight the need for targeted interventions, such as language training programs and mobile translation apps. These strategies could enhance communication in multicultural EMS settings, improving patient care and reducing miscommunication risks. Future research should evaluate the long-term impact of these interventions on patient outcomes.

Objective: The aim of this systematic review and meta-analysis was to compare the outcomes of cemented collared composite beam (CB) and collarless taper slip (TS) femoral stems in total hip arthroplasty (THA).

Methods: Four databases were searched from inception to August 2023 for original studies that compared the outcomes of cemented CB and TS femoral stems following THA. The primary outcome was aseptic loosening, and the secondary outcomes were periprosthetic fractures, instability, dislocation, revision, survivorship, and periprosthetic joint infection (PJI). This review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

Results: A total of 11 studies with 730,769 hips were included, with a mean follow-up period of 8.48 ± 6.07 years and average MINORS (Methodological Index for Non-Randomized Studies) score of 17.36 ± 1.86. There was a statistically significant difference in aseptic loosening (OR 0.28, 95% CI 0.19–0.43, p < 0.001) and PJI rate (OR 0.61, 95% CI 0.53–0.71, p < 0.001) between the CB and TS groups in favor of the latter. However, periprosthetic fracture, revision rate, survivorship, instability, and dislocation were similar in both groups (p  =  NS).

Conclusion: This study showed a significantly higher aseptic loosening and PJI in the CB group compared to the TS stem type. However, other outcomes were comparable. Due to confounding effects, these results must be interpreted in context.