Qatar Medical Journal - Volume 2025, Issue 2

Simulation, in its various forms, is widely used in all stages of education, training, and assessment of healthcare students and professionals. There is, however, a lot of variation in practice regarding the way in which institutions implement simulation, and in particular how educators work with simulated participants (SPs). This short article makes a case for bringing together all of Qatar’s healthcare educators and SPs at the 2025 Qatar Simulation Symposium in order to enhance simulation-based educational practices and raise awareness of standards of best practice. It could play a significant role in improving learners’ experiences and eventually positively impact on patient care.

Background: A false division between mental and physical disorders is supported by dualism, contributing to mental health stigma. There is a widespread misconception about the prognosis and treatment options for psychiatric diseases. This is despite data supporting the effectiveness of psychiatric treatments for a variety of illnesses that have been proven by meta-analysis. In general, the efficacy of drugs used to treat physical problems and psychiatric disorders is comparable.

Methods: In this article, experts from a variety of fields—including psychiatry, primary care, and general medicine—highlight how the paradigms based on dualism play a crucial role in maintaining the myths regarding psychiatric disorders, particularly those that relate to their treatability in comparison to physical health conditions.

Results: There are numerous similarities between mental and physical problems in terms of the causes andtreatment. Healthcare, like other complex human systems, is rife with uncertainty. In actuality, the severity and treatability of both physical and mental diseases range widely. Treatment response varies from person to person. There are certain physical and mental health disorders that respond well to treatment, some that do not, and some for which there are currently no effective cures.

Conclusion: We believe that dualism, which promotes the separation of mental and physical phenomena, is the core driving force behind these misconceptions. These fallacies, in our opinion, are primarily motivated by dualism, which advocates the division of mental from physical occurrences.

Background: An unplanned intensive care admission (UIA) after elective surgery is a clinical indicator of patient safety and outcomes. Furthermore, it reflects both surgery- and anesthesia-related complications. The overall rate of UIA ranges from 0.28% to 2.2%. UIA is linked with higher rates ofmorbidity and mortality in surgical patients. Thus, understanding the factors leading to UIAs could improve the quality of patient care. In this study, we aimed to determine the rate and reasons for UIA following elective surgeries in public facilities in Qatar.

Methods: UIA was defined as an admission to the intensive care unit (ICU) within 72 hours of anesthesia that was not anticipated during the pre-anesthesia assessment phase. A multicenter audit was conducted from January 1, 2021, to December 31, 2021, across five public hospitals in Qatar. UIA was identified from the electronic preoperative and postoperative anesthetic assessment notes and intraoperative notes.

Results: Among the 2,087 ICU admissions, 42 (2.0%) were UIAs. Among the 42 patients, 57.1% were males, and the mean age was 41.83 ± 12.95 years. Most patients (64.3%) were classified as American Society of Anesthesiologists status II. The mean length of ICU stay was 2.60 ± 2.45 days. Most of the UIAs were surgery-related (54.8%), followed by anesthesia-related (26.2%) and medical-related (16.6%).

Conclusion: The rate of UIA in our study was 2%, corresponding to the wide range of incidence reported in the literature. The causes of UIA are multiple; however, our study showed that the rate of anesthesia-related UIAs was 26.2%, which is less than in most previous studies.

Background: Point-of-care ultrasonography (POCUS) has rapidly emerged as a valuable diagnostic tool in various medical conditions, including acute kidney injury (AKI) in the Western healthcare system. Its utility in the Middle East and Asian healthcare setups remains under-explored. This study aimed to assess the effectiveness of POCUS, performed by internal medicine residents (IMRs), in diagnosing hydronephrosis in AKI patients at a tertiary care training hospital in Qatar.

Methods: We conducted a pilot prospective cross-sectional study from June 2021 to September 2021, enrolling adult patients admitted with AKI in the acute medical assessment unit (AMAU) via convenience sampling. IMRs received mandatory POCUS training (including a 30-minute didactic teaching session and supervised performance of renal POCUS scans). The primary outcome was the detection of hydronephrosis, with findings compared to departmental renal ultrasound scans performed by the radiologists.

Results: Fifty patients were included, with POCUS identifying hydronephrosis in five out of nine patients with confirmed hydronephrosis via official departmental renal ultrasound, demonstrating a sensitivity of 83.3% and specificity of 93% for POCUS performed by IMRs. Hydronephrosis via bedside POCUS scans had clinically reliable positive and negative predictive values (55.6% and 98%, respectively). Cohen’s kappa was 0.7 (0.45–0.94), indicating substantial agreement. One patient whose renal POCUS was reported as normal by IMR was identified to have hydronephrosis on an official departmental renal ultrasound.

Conclusion: This study demonstrated the effectiveness of adequate training in improving the diagnostic skills of residents using POCUS for bedside detection of hydronephrosis in patients with AKI in a residency program from the Middle East. Residency programs that include POCUS training have the potential to significantly increase bedside diagnostic capabilities with improved quality of training and patient care.

Background: Obstructive sleep apnea syndrome (OSAS) significantly impacts patients’ quality of life (QOL) due to symptoms such as impaired sleep and reduced daily functioning. Barbed reposition pharyngoplasty (BRP) has emerged as a surgical intervention aimed at alleviating these symptoms. However, its effect on patients’ QOL remains underexplored.

Objectives: To evaluate the impact of BRP surgery on a patient’s QOL with OSAS.

Methods: Our study had a quasi-experimental design, which was conducted for 40 adult OSAS patients (one group) from 2015 to 2023 between men and women with inclusion criteria above 18 years old who had been diagnosed with OSAS and who had BRP surgery. We measured the impact of this surgery on patient satisfaction by correlating the subjective measures of the pre- and post-operative self-administered the Functional Outcomes of Sleep Questionnaire (FOSQ) as one of the prognostic indicators.

Results: The study included 40 participants, with ages ranging from their 30s to 60s. The mean age of the participants is 44.5 years (SD ± 9.5). Mean FOSQ scores had a significant increase (p < 0.001) in all domains (general productivity, activity level, vigilance, social outcomes, intimate) when comparing pre-operative mean scores with post-operative mean scores. No statistically significant differences were observed in mean percentage change from baseline FOSQ when compared between males and females (p > 0.05) for all domains (general productivity, activity level, vigilance, social outcomes, intimate).

Conclusion: BRP surgery seems to have a significant impact on patient satisfaction in OSAS patients as it reflects on their health-related QOL mood, social outcome, and daily activity and improves their quality of sleep.

Background: The SARS-CoV-2 pandemic (COVID-19) has significantly impacted global health, with emerging evidence indicating potential long-term complications affecting various organ systems, including the musculoskeletal system, like avascular necrosis (AVN) of the femoral head. This retrospective study aims to investigate the incidence and risk factors of AVN in patients treated for COVID-19.

Methods: We conducted a cross-sectional retrospective study in the department of orthopedics at a tertiary care teaching hospital in Central India from July 2022 to December 2023. Patients presenting with new-onset hip pain and low back pain who were asymptomatic before COVID-19 with a new radiological diagnosis of AVN hip were included in the study. Data on demographics, comorbidities, steroid use, and COVID-19 management were collected and analyzed using statistical tests to identify associations between these factors and AVN incidence.

Results: A total of 86 patients met the inclusion criteria. The majority of participants were males (83.7%), predominantly within the 30–45 years (44.2%) and 15–30 years (30.2%) age groups. Bilateral AVN was observed in 62.8% of cases. A significant portion (25.6%) had a history of COVID-19, with steroid use prevalent among 30.2% of participants, with an odds ratio of 4.47 indicating strong association. Statistically significant associations were found between COVID-19 status and age distribution (p = 0.049), comorbidities (p = 0.014), symptom onset (p = 0.001), and steroid therapy history (p = 0.002).

Conclusions: This study highlights a notable incidence of AVN among COVID-19 patients, with significant correlations to steroid use and specific comorbidities. The findings underscore the importance of vigilant monitoring for AVN in post-COVID-19 patients, particularly those with a history of steroid therapy. Further research is needed to elucidate the mechanisms linking COVID-19 and AVN and to develop targeted prevention strategies.

Background: Prothymosin alpha (PTMα) is a small acidic polypeptide from the thymosin family with immune activity and protective properties against oxidative stress induced by reactive oxygen species trimethylamine-N-oxide (TMAO), produced in the liver from gut bacterial metabolite trimethylamine and associated with increased cardiovascular disease risk and higher all-cause mortality. Ischemia-modified albumin (IMA) is a significant oxidative stress biomarker, particularly in ischemia-reperfusion conditions. This study investigates PTMα, TMAO, and IMA levels in type 2 diabetes mellitus (T2DM) patients, both with and without hyperlipidemia, to explore their relationships and their potential role as biomarkers or therapeutic targets.

Method: The study received ethical approval from the Selcuk University Faculty of Medicine Hospital committee under approval number 2024/33. The study included male and female T2DM patients aged 30–60, with 30 having hyperlipidemia and the rest being non-lipemic. TMAO was performed using API 3200 LC-MS\MS while PTMα was analyzed using an ELISA kit from BT LAB, serum IMA levels were evaluated by the spectrophotometric method.

Results: Comparisons were made between those with T2DM and control groups. In the T2DM group, PTMα was significantly higher in females (p = 0.047), while TMAO and IMA showed no significant gender difference. The control group had no significant differences in PTMα, TMAO, and IMA levels. Comparisons among healthy controls, non-lipemic T2DM patients, and hyperlipidemic T2DM patients revealed significantly decreased PTMα levels with no change in IMA levels across groups. In contrast, TMAO was significantly higher in the patient group.

Conclusion: The findings of this study have potential implications for the field, suggesting that PTMα might serve as a prognostic indicator for T2DM and that reduced TMAO levels might play a role in T2DM pathogenesis, opening up new avenues for research and treatment.

Objective: We aimed to determine the radiological changes on computed tomography (CT) scans of the chest and pulmonary function abnormalities at a 1-year follow-up in intensive care unit (ICU) survivors with severe COVID-19.

Design: A 2-year prospective cohort study with an enrollment of 204 patients within 3 months after their discharge from the ICU at Hamad General Hospital, the tertiary care center in Qatar.

Main Results: The mean age of our cohort was 48.7 ± 8.6 years. CT chest was performed on a total of 135 patients at a 1-year follow-up, out of which 43 patients had a CT chest during hospital admission with COVID-19. Abnormal CT chest findings were seen in 118 (87.4%) patients at 1 year. The mean CT severity score significantly improved at 1 year (8.1 ± 6.8 vs. 19.4 ± 3.6, p < 0.001). Those with an abnormal CT chest in 1 year had a significantly lower but normal predicted forced vital capacity (91.9% ± 15.4 vs. 81.1% ± 13.7, p = 0.01), predicted total lung capacity (82.5% ± 13.9 vs. 94.3% ± 12.7, p = 0.02) and oxygen saturation after 6-minute walk test (6MWT) (97.5 ± 1.2 vs. 98.3 ± 0.651, p = 0.033). 6MWT distance was significantly shorter than the predicted distance in those with an abnormal CT (63 (62.4%) vs. 7 (77.8%), p = 0.020).

Conclusion: Patients recovering from severe COVID-19 have significant improvement but persistent radiological changes at a 1-year follow-up that correlate with several physiological parameters, but these findings are limited by the absence of pre-COVID-19 baseline imaging.

Background/Introduction: Acute myocardial infarction (AMI) affects around 3 million people annually worldwide. Typical symptoms prompt timely care, while atypical symptoms may delay diagnosis and treatment, increasing the risks of heart failure and sudden cardiac death.

Objective/Purpose: This study aimed to compare typical and atypical myocardial infarction (MI) presentations to enhance early diagnosis, treatment, and prognosis by examining clinical characteristics, chronic comorbidities, history of coronary artery disease, and smoking status at a tertiary hospital in Amman.

Methods: This purposive, descriptive, retrospective study was conducted at the coronary care unit of Al Basheer Hospital in Amman, Jordan, from July 1, 2022, to July 1, 2023. Records of patients diagnosed with MI (ICD-10 code I21) were extracted. Data were analyzed using the IBM SPSS Statistics software (version 25.0). Tests of association were adjusted at the 5% significance level.

Results: The study included 267 MI cases: 60.3% were typical, and 39.7% were atypical. No significant differences were found among age (p = 0.58) and sex (p = 1.27). Atypical MI was linked to a history of coronary artery disease (p < 0.05) and higher diabetes prevalence (p < 0.05). Recurrence rates (p = 0.41) and artery involvement, especially the left anterior descending artery, were similar between groups. Echocardiography showed identical rates of left ventricular hypertrophy in both types, with tricuspid regurgitation more common in atypical MI.

Conclusion: The study found that atypical MI was linked to higher rates of diabetes and coronary artery disease history compared to typical MI. Recurrence rates, artery involvement, and echocardiography results were similar between both types.

Introduction: Venous thromboembolism (VTE) following anterior cruciate ligament (ACL) arthroscopic reconstructions is reported to occur at a rate of 0.5%–2.2%, with very few studies investigating the use of thromboprophylaxis. This study aims to investigate the incidence of VTE post ACL reconstruction surgery while proposing a thromboprophylaxis regimen.

Methods: A single-center retrospective cross-sectional observational study was conducted over 8 years and 8 months. The primary outcome was the incidence of symptomatic VTE up to 12 weeks post-operatively. Secondary outcome measures were the rate of major bleeding incidents, wound infections, and delayed wound healing. Enoxaparin 40 mg subcutaneously once daily and thromboembolic deterrent stockings were given to all patients for 14 days post-operatively. Total anesthetic time, total surgical time, and tourniquet time were also recorded. Only patients who underwent arthroscopic ACL reconstruction were included, with all conservatively managed patients being excluded.

Results: A total of 155 patients were identified, and none had a symptomatic VTE up to 12 weeks post-operatively. None of the patients experienced delayed wound healing, wound infections, or major bleeding incidences up to 12 weeks post-operatively. Average total anesthetic time was 145 (±24.8) minutes, average total surgical time was 122 (±25.3) minutes, and average Tourniquet time was 82.1 (±23.8) minutes.

Conclusion: We demonstrated a 0% rate of clinically symptomatic VTE without complications such as delayed wound healing or major bleeding incidents. This is the only study proposing a combined regimen of both chemical and mechanical thromboprophylaxis after ACL reconstruction. Further research involving larger groups would be required to assess the effectiveness of this approach and to compare the effectiveness of mechanical and chemical thromboprophylaxis after ACL reconstruction.

Background: In March 2020, the World Health Organization declared COVID-19 a global pandemic. Healthcare organizations across the world introduced various measures to restrict the spread of the disease, with an increasing reliance on telephonic consultations as a key measure to limit exposure to COVID-19 in hospital facilities. This study assesses the impact of restrictive measures on gynecological emergency services by comparing services before the COVID-19 pandemic with services during the first and second waves of the pandemic (COVID-19 Peak 1 and COVID-19 Peak 2).

Method: This was a retrospective single-center cross-sectional study comparing the first 50 women attending the emergency department (ED) of the Women’s Wellness and Research Center in Qatar with a gynecological complaint during three distinct periods. The peak of the first COVID-19 wave from June 2020 was considered COVID-19 Peak 1, and the peak of the second wave from April 2021 was COVID-19 Peak 2. The control group included 50 women who attended the ED during non-COVID-19 times. Early pregnancy complications (miscarriage and ectopic pregnancy) were compared between the three periods to determine the impact of the COVID-19 restrictions on the clinical presentation, subsequent management, and any patient safety issues arising out of this in terms of complications.

Results: Data from 50 patients were analyzed during each study period (total = 150). There were no statistically significant differences in age, nationality, and parity between the three groups. The gestational age at diagnosis of ectopic pregnancy or miscarriage was significantly higher, 12.4 ± 4.0 weeks during COVID-19 Peak 1 compared to 10.9 ± 3.6 in pre-COVID-19 and 9.7 ± 3.9 in COVID-19 Peak 2 (p = 0.002). The length of hospital stays (median ± interquartile range) for women with the diagnosis of miscarriage was significantly shorter during COVID-19 Peak 1(1 ± 2 days) compared to pre-COVID-19 (2 ± 1.5) and COVID-19 Peak 2 (1 ± 2), with p < 0.001. There was no difference in patient demographics, symptoms at presentation, type of management, and timing of surgical management.

Conclusion: The COVID-19 restrictions led to a major shift in the way healthcare was delivered, with increased use of telephone consultations and prompt early discharge from the hospital. Although we did not record safety issues or adverse outcomes, we found a delay in gestational age at presentation and diagnosis, which has the potential to lead to adverse outcomes. The COVID-19 pandemic has further highlighted the importance of telemedicine in healthcare practice.

Background: Pulmonary fibrosis is characterized by excessive matrix formation, which destroys typical lung architecture and increases the chances of comorbidity. It is essential to look into potential serum indicators for the early identification of individuals who may develop such severe fibrotic consequences since there is currently no specific marker for the early diagnosis of post-COVID-19 pulmonary fibrosis. The study is aimed at examining potential serum markers that could be used for early detection of pulmonary fibrosis in patients with COVID-19.

Methods: It is a cross-sectional retrospective observational study that included male (n = 26) and female (n = 10) patients who were confirmed positive for COVID-19 using the Reverse transcription polymerase chain reaction (RTPCR) test. Various hematological parameters, such as platelet count, white blood cell count (WBC count), platelet-to-lymphocyte ratio (PLR), white blood cell count to mean platelet volume ratio (WMR), red cell distribution width (RDW), plateletcrit (PCT), mean platelet volume (MPV), platelet distribution width (PDW), serum ferritin level, and CT severity scores (CT-SSs) were recorded. The association between hematological parameters, serum ferritin level, and CT-SS was assessed by the Pearson correlation test using the GraphPad Prism software (version 10). p < 0.05 was considered statistically significant.

Results: The descriptive analysis revealed no significant correlation between platelet count (r = 0.1610, p = 0.3483), WBC count (r = −0.1381, p = 0.4217), PLR (r = 0.2262, p = 0.1847), WMR (r = −0.1093, p = 0.5258), RDW (r = 0.05982, p = 0.7289), PCT (r = −0.059, p = 0.752), MPV (r = 0.046, p = 0.788), and PDW (r = −0.06, p = 0.699) with CT-SS. However, a significant positive correlation was observed between CT-SS and serum ferritin levels in COVID-19 patients (r = 0.5452, p = 0.0006).

Conclusions: As there was a significant positive correlation between serum ferritin level and CT-SS, the serum ferritin level could be considered as a simple and cost-effective biomarker for predicting the development of lung fibrosis in long COVID-19 conditions after controlling the confounders.

Background: Papillary thyroid carcinoma (PTC) accounts for 90% of thyroid malignancies, with lymph node metastasis being a critical prognostic factor. However, the mechanisms driving metastasis remain unclear. This study investigated the role of E-cadherin and zinc finger E-box-binding homeobox 1 in cancer progression among Iraqi PTC patients.

Methods: The expression levels of E-cadherin and zinc finger E-box-binding homeobox 1 were analyzed in 50 Iraqi patients diagnosed with PTC without lymph node metastases, evaluated between January 2015 and December 2021. The Pearson correlation coefficient between these markers and the risk of lymph node metastasis, as well as their relationship to tumor grade and stage, was calculated. The area under the receiver operating characteristic (ROC) curve for both markers was performed. The Medical Ethics Committee of the Iraqi Ministry of Higher Education and Scientific Research (Reference No. 14) approved the study.

Results: This study examined 50 PTC cases, revealing significant associations between E-cadherin and zinc finger E-box-binding homeobox 1 expression and lymph node metastasis, clinical stage, and tumor grade. Zinc finger E-box-binding homeobox 1 expression was higher in metastatic cases (92% vs. 16%), while E-cadherin was lower (24% vs. 84%). Zinc finger E-box-binding homeobox 1 positively correlated with lymph node metastasis (r = 0.68), stage (r = 0.72), and grade (r = 0.56), whereas E-cadherin showed negative correlations (r = −0.60, −0.59, and −0.52, respectively). ROC analysis showed areas under the curve of 0.88 zinc finger E-box-binding homeobox 1 and 0.82 (E-cadherin), suggesting their potential as biomarkers for metastasis prediction.

Conclusions: The study concluded that E-cadherin and zinc finger E-box-binding homeobox 1 are key predictors of lymph node metastasis, tumor grade, and stage in PTC. Monitoring these markers could enhance clinical decision-making and patient management.

Background: Tinea pedis, commonly known as athlete’s foot, is a fungal infection of the feet, particularly affecting the space between toes, and it is easy to treat. While it is prevalent worldwide, limited data exist on its prevalence in Qatar. This study aims to determine the prevalence of tinea pedis and identify its associated risk factors among adults in the primary healthcare settings in Qatar.

Methods: A cross-sectional study analyzed electronic medical records (EMRs) of adults aged ≥18 years who registered with the Primary Health Care Corporation (PHCC) between July 2018 and June 2023. A total of 1,002,594 EMRs were studied, and statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 28. We obtained approval with reference number BUHOOTH-D-23-00039 to conduct this study from the Institutional Review Board (IRB) at PHCC.

Results: The overall prevalence of tinea pedis was 1.8%. The risk of tinea pedis increased significantly with age, being 25.1 times higher among individuals aged 70 years or older compared to younger adults (18–29 years). Males were 1.6 times more likely to be affected than females. North Africans had a 3.9 times increased risk. Obesity was a major risk factor, with morbidly obese individuals being 15.1 times more likely to develop tinea pedis than underweight individuals. Diabetics had a 7.1-fold increased risk compared to non-diabetics. HbA1c% values of <7, 7.0–7.9, and ≥8 were considered as recommended control, less-stringent control, and poor control of diabetes mellitus, respectively. Poor control of diabetes elevated the risk by 20% compared to recommended control. All associations were statistically significant.

Conclusion: Tinea pedis is a significant health issue in Qatar, particularly among older adults, males, obese individuals, diabetics, and those with poorly controlled diabetes. These findings can increase awareness among local physicians about the need to screen high-risk groups and promote prevention of modifiable risk factors through targeted interventions and patient education.

Background: During the coronavirus pandemic, many people looked for information on COVID-19 through social, official, and traditional media sources. This caustic situation resulted in panic among the public, leading to many false news, conspiracy theories, and magical cures being spread among the public at an alarming rate. Controversial theories about the validity of vaccination and non-adoption of disease control resulted in a slow disease control rate and adverse impacts on global health and the economy. Recent studies have shown that health information could safely guard mental health during the COVID-19 pandemic. To adopt a disease control strategy, it is essential to identify the public confidence in information sources and the most efficient media to disseminate intervention messages to the public. The main objectives of this study were to identify from 12 alternative information sources the most utilized COVID-19 source of information, the most trusted information source, and the factors associated with high trust in a given source.

Methods: A cross-sectional online survey with 442 participants aged 18 years and above was conducted to assess public views and preferences on sources of information for COVID-19. Data was analyzed using descriptive statistics, correlation, and logistic regression analyses. Bloom’s scale, composite score preference, and chi-squared test were determined for result evaluation purposes.

Results and Conclusion: The study findings suggest that the Ministry of Public Health is a widely trusted information source that offers a potentially effective tool for shaping, designing, and disseminating information messages to shape public attitudes toward control of COVID-19 and enhancement of preventive actions. By offering insight into the pattern of COVID-19 information sources and its associated factors among the public in Qatar, the study formulated a set of recommendations for health decision-makers to set packages to help manage and control the spread of coronavirus.

Introduction: Diabetes is a major public health concern that affects millions of individuals worldwide, and given the increasing prevalence of this disease, there is a critical need to better understand its pathophysiology, which could lead to improved management strategies to mitigate its effects on society. The aim of this study was to investigate the vascular anatomy of the pancreas and classify the arterial variations of pancreatic blood flow, as well as to determine the correlation between these variations and the occurrence of diabetes and metabolic syndrome (MS).

Methods: This study used multidetector computed tomography (MDCT) angiography to assess the vascular anatomy of the pancreas in a total of 100 participants. The variations were classified based on the origin and course of the pancreatic arteries, and the imaging data were recorded and analyzed.

Results: The study identified three major types of arterial variations. The dorsal pancreatic artery (DPA) was observed to arise from the splenic artery (SPA), common hepatic artery (CHA), and superior mesenteric artery (SMA). The prevalence of arterial variations in the observed population (single-center study) in this research was found to be different from that reported in previous studies conducted on other populations. Specifically, the study found a higher incidence of DPA variations arising from the SPA (in 73% of the participants). The origin from the SMA was seen in 24% of patients and from the CHA in 3% of patients. The length, width, and other characteristics of the pancreatic arteries were also carefully documented. The study also found no significant correlation between arterial variations and the presence of diabetes mellitus or MS. One of the variations was found to display minor constriction but was not significant enough to be considered pathological.

Conclusion: The study revealed the utility of MDCT imaging as a reliable tool for studying pancreatic arterial blood flow. This study contributed to the existing body of knowledge about the vascular anatomy of the pancreas and provided valuable insights for future research in this area.

Introduction: The burden of stroke is increasing in Qatar, similar to many other countries in the world. The prevalence of stroke risk factors plays an important role in the burden of stroke in Qatar.

Objective: This study aims to assess the stroke knowledge, recognition, prevention, and medication adherence among high-risk patients.

Methods: This was a cross-sectional study involving high-risk patients admitted to the inpatient medical unit through a paper-based survey using four adopted scales Stroke knowledge test, Stroke Recognition Questionnaire, stroke prevention awareness, and Medication Adherence Rating Scale tool. Two hundred ninety-nine completed responses from the participants were used for analysis.

Results: The 41–50-year-old age group was most represented (33.11%) with a median age of 49 years. The male-female ratio was approximately 3:1 and 30.10% of the participants held a graduate degree or higher.The majority of the patients (41.47%) are obese (BMI > 30) and overweight (31.10%). The mean stroke knowledge was 38.01 ± 15.78, while the recognition and prevention domains had mean scores of 67.85 ± 10.85 and 77.55 ± 27.63 respectively. The medication adherence group has a statistically significant association with stroke recognition and prevention domains with a mean score of 72.14 ± 12.34 (p = 0.000) and 88.87 ± 24.75 (p = 0.000) respectively.

Conclusion: Participants’ awareness regarding stroke knowledge was low compared to recognition and preventive measures. Stroke awareness positively correlates with medication adherence among high-risk patients admitted to the inpatient unit.

Background: Despite substantial clinical evidence and recommendations from international societies supporting the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) for managing patients with type-2 diabetes (T2D) and chronic kidney disease (CKD), their adoption has remained limited. To address this, the nephrology quality improvement (QI) team at Hamad Medical Corporation (HMC), Qatar, implemented a key performance indicator (KPI) program in March 2022, aiming to ensure that at least 80% of eligible T2D-CKD patients at HMC were receiving SGLT2i by December 31, 2023.

Methods: The use of SGLT2i and angiotensin-converting enzyme inhibitor (ACEi) or angiotensin II receptor blocker (ARB) in T2D-CKD patients attending nephrology clinics at HMC hospitals were assessed through retrospective surveys using a cluster-based sampling approach. Nephrology physicians were then updated on the results of these retrospective surveys as well as evidence from the SGLT2i trial and guidelines. The aims, objectives, and targets of the KPI program were clearly defined. Three additional surveys were conducted at 6-month intervals. A multifaceted QI intervention approach—combining audit, feedback, leadership engagement, and peer consultation—was implemented to drive improvement.

Results: Retrospective surveys conducted in November 2021 and February 2022 revealed that 38% and 44% of eligible T2D-CKD patients were receiving SGLT2i therapy, compared to 98% and 99% for ACEi/ARB. Four months after implementing the KPI program, the July 2022 survey revealed no change in SGLT2i use (41%), while ACEi/ARB prescription rates remained near 100%. Following QI interventions in November 2022, the February 2023 survey revealed a significant increase in SGLT2i use, rising to 88%, with SGLT2i initiation in naive patients increasing from 34% to 61%. The final survey conducted in August 2023 showed that 84% of patients were receiving SGLT2i therapy.

Conclusion: Our KPI program boosted SGLT2i prescription rates for eligible T2D-CKD patients in nephrology clinics, resulting in a 47% rise from 41% to 88%. It overcame prescription inertia and accelerated the guideline adoption by combining real-time feedback, leadership engagement, and peer discussions. The sharp rise in new prescriptions following November 2022 feedback underscores its direct influence on behavior modification rather than a broader trend.

Background: This umbrella review aims to synthesize evidence from previously conducted meta-analyses and review articles to assess the effects of bempedoic acid on lipid profile and cardiovascular events.

Methods: While adhering to the Preferred Reporting Items for Overviews of Reviews guidelines, PubMed, Google Scholar, Web of Science, and Scopus were searched from the database inception to June 2024 to identify relevant articles. The outcomes were total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-HDL cholesterol, triglyceride (TAG), apolipoprotein B (APOB), high-sensitivity CRP (hs-CRP), major cardiovascular events (MACE), cardiovascular mortality, and myocardial infarction (MI). A corrected covered area (CCA) assessment was performed to determine overlap among reviews. Each included review was assessed for its quality and rigor via the AMSTAR-2 tool.

Results: From 18,297 articles identified during the literature search, 18 meta-analyses were included. A significant overlap was noted across studies with a corrected cover area of 44.4%. Bempedoic acid’s effects on cardiovascular outcomes and lipid levels have been extensively studied. For cardiovascular mortality, the evidence is mixed: Goyal et al.²¹ reported a risk ratio (RR) of 0.81 (95% CI 0.61–1.08) suggesting a potential benefit, while other studies, such as De Filippo et al.²⁶ and Zhang et al.²⁴, indicate no significant association. In terms of MACE, 11 reviews show a consistent trend toward reduced risk, with RRs between 0.75 and 0.88. Bempedoic acid also appears to significantly reduce the risk of MI, with RRs and odds ratios (ORs) around 0.76. Evidence on unstable angina suggests a lower risk, although some studies do not reach statistical significance. For coronary revascularization, the data show a reduced risk, with RRs ranging from 0.74 to 0.82. Studies on coronary non-revascularization also indicate a significant risk reduction with RRs and ORs of 0.41. Regarding lipid levels, bempedoic acid consistently reduces LDL cholesterol (mean differences [MDs] from −17.5% to −33.91%), total cholesterol (MDs from −12.69% to −34.41%), and non-HDL cholesterol (MDs from −12.3% to −23.27%). The effects on HDL cholesterol are less consistent (MDs from −1.29% to −5.18%), and triglyceride levels show variable results (MDs from −8.35% to +5.23%).

Conclusion: Our findings show that bempedoic acid significantly reduces the risk of MACE, nonfatal MI, coronary and noncoronary revascularization, and hospitalizations for unstable angina. While results on cardiovascular mortality are mixed, suggesting a need for further study, bempedoic acid proves to be an effective treatment for improving lipid profiles and reducing cardiovascular events, especially in patients who cannot tolerate statins. It presents a valuable option for cardiovascular risk management, potentially enhancing patient outcomes and quality of life. Further research is needed to assess its long-term benefits and broader applicability.

Background: Monkeypox (Mpox) was identified as a virus endemic to Central and Western Africa. Since 2022, the virus has gained global attention due to increasing cases in non-endemic countries among patients having no link to travel to endemic areas. The virus is primarily transmitted through animal-to-human contact but has increasingly spread via human-to-human transmission. A comprehensive understanding of the epidemiology of Mpox in the Middle East and North Africa (MENA) region is essential for effective disease prevention, diagnosis, surveillance, and control.

Methods: This review investigates historical data and recent global and regional epidemiological trends of Mpox. The review discusses the clinical features, public health challenges, and preventive measures relevant to the MENA region using updated data from World Health Organization (WHO) reports, national health statistics, and additional relevant resources.

Results: Mpox cases significantly spread globally during the 2022–2024 period. The MENA region has a relatively low number of documented cases, with 857 confirmed cases by August 2024. Saudi Arabia and the United Arab Emirates (UAE) reported the highest case numbers, reflecting effective surveillance and case detection. However, new cases of Mpox were announced in September 2024 in Morocco and Jordan following the WHO’s declaration of Mpox as a public health emergency of international concern.

Conclusion: The current number of cases in the MENA region could be underestimated due to underreporting, stigmatization, limited resources, and ongoing conflicts in several countries. It is essential to prioritize the containment of the outbreak, exploring all possible strategies to protect vulnerable communities.

Introduction: Malignant otitis externa (MOE) is an aggressive infection of the external auditory canal and the underlying bony structures of the skull base. Predominantly caused by Pseudomonas, the treatment has shifted from surgical to medical, with antimicrobial therapy being primary, although surgical intervention may still be required. This review aims to provide global prevalence and mortality data on MOE to help institutions establish treatment benchmarks.

Methods: A systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Searches were completed in Scopus and PubMed Databases for articles on MOE mortality published between 1994 and 2022. Publications included data on MOE, mortality, and all genders.

Results: A total of 22 studies involving 9,633 patients diagnosed with MOE were analyzed. The gender distribution was nearly equal, with 4,819 (50.1%) males and 4,814 (49.9%) females. The patients’ ages ranged from 18 to 90 years, with a mean age of 70.3 years. The pooled period prevalence of mortality due to MOE was estimated to be 18% (95% confidence interval: 6–30%), highlighting a significant mortality risk in patients with this condition. Heterogeneity across the studies was high (I² = 99%, p < 0.001). Additionally, the prevalence of comorbidities was significant: 57.1% of patients were diabetic, 51% had hypertension, and other notable comorbidities included chronic pulmonary diseases (12.2%), liver disease (7.2%), and malignancies (3.4%). The most common microbiological cause was Pseudomonas aeruginosa (30%), followed by Staphylococcus aureus (10%). Surgical interventions were performed in 3.7% of cases, and cranial nerve involvement was reported in 9% of patients, primarily affecting the facial nerve (91%). Morbidity related to MOE was found to be 15.2%, and sepsis was a complication in 0.5% of cases. The results underscore the importance of addressing both comorbidities and mortality risks in managing MOE patients.

Conclusion: This review highlights a significant global mortality rate of 18% in patients with MOE, with comorbidities like diabetes and hypertension contributing to worse outcomes. Despite current treatment advancements, mortality and morbidity remain substantial, stressing the need for early diagnosis, targeted interventions, and improved management strategies to enhance patient survival and outcomes.

Background: Surgical intervention remains the primary treatment for localized renal tumors and masses, with partial nephrectomy (PN) and radical nephrectomy (RN) being the two most frequently employed procedures. The choice between these approaches is often influenced by factors such as tumor size, location, histology, and patient comorbidities. However, the decision between PN and RN remains a subject of ongoing debate, particularly as emerging evidence suggests varying outcomes based on the stage and type of renal tumors. This meta-analysis evaluates the association between renal tumor stage and subtype with the outcomes of PN and RN, focusing on renal function, cancer-specific survival, and postoperative complications.

Method: An exhaustive search was conducted across PubMed, Scopus, and Embase databases, covering the literature from their inception up to March 2023, in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Original studies comparing PN to RN in the management of renal tumors at various stages were meticulously screened, adhering to stringent inclusion and exclusion criteria. This protocol was registered on PROSPERO (CRD42023455985).

Result: Overall, 38 cohort studies were included, with a total of 144,608 patients diagnosed with renal cancer who underwent nephrectomy, 71,582 who underwent PN, and 72,671 who underwent RN. The data revealed a significant difference in cancer-specific survival between PN and RN, which was higher in the RN group (pooled HR: 1.17; 95% CI = 1.01–1.35) p < 0.001. The postoperative renal function of patients who underwent RN was worse than that of patients who underwent PN (pooled RR: 4.22; 95% CI: 1.45, 12.27, p < 0.00001). The relative risk of papillary renal cell carcinoma (RCC) was lower in patients who underwent RN as compared to PN (the pooled RR, 1.32; 95% CI = 1.02, 1.72, p < 0.001), while the relative risk of RCC collecting duct subtype was significantly lower patients who underwent PN as compared to RN (the pooled RR, 0.44 (95% CI = 0.29, 0.67) p = 0.97. Additionally, the pooled risk for patients with a Charlson Comorbidity Index score of ≥2 was lower in the PN group compared to the RN group.

Conclusion: Across various tumor stages, RN demonstrates superior cancer-specific survival, and a lower incidence of postoperative complications compared to PN. However, PN is associated with more favorable renal function preservation. These findings, in conjunction with individual patient characteristics, should be meticulously evaluated to inform the selection of the most appropriate surgical approach and guide patient counseling.

Background: Pleural diseases are common and often require drainage, with the growing use of small-bore chest drains (SBCDs) instead of larger tubes. This review aimed to examine the failure rate and complications associated with SBCD use in different pleural pathologies.

Methods: A literature search (PubMed, SCOPUS, and Google Scholar) was performed on the complications associated with SBCDs to treat pleural diseases. This review analyzed patient demographics, indications, outcomes, failure rate, and complications associated with the use of SBCDs. The systematic review was conducted using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines.

Results: Thirty studies were included in this review with 4,973 patients. The indications for insertions of SBCDs were pleural effusion at 48.4%, pneumothorax at 30.1%, empyema or parapneumonic effusion at 11.4%, hemothorax at 6.5%, and other indications at 3.6%. The overall failure rate to achieve satisfactory drainage was 19.4%. Significant complications included iatrogenic pneumothorax at 11.9%, major hemorrhage at 1.0%, local bleeding at 0.7%, infection at 1.2%, and iatrogenic organ injury at 0.9%. Other insertional complications included tube dislodgement at 5.9%, tube blockage at 5.4%, tube kinking at 3.7%, misplacement at 3.3%, and subcutaneous hematoma at 0.5%. Most of the data published revolves around hemodynamically stable patients with SBCD insertions and is, thus, deficient regarding hemodynamically unstable patients.

Conclusion: Despite carrying notable failure rates and complications, small-bore catheters remain an acceptable option for managing selected pleural diseases.

Background: Mad honey is a unique type of honey that is contaminated with grayanotoxins. The consumption of this honey might cause poisoning, which manifests as a wide range of signs and symptoms. We report a patient with mad honey disease who presented to our Emergency Department (ED). This is the first case report of mad honey disease in Qatar.

Case presentation: A 39-year-old male Nepalese patient presented to our ED, who complained of dizziness and feeling unwell for approximately 2 hours. He was found to be hypotensive and bradycardic. The patient responded to the supportive management provided, but a few hours later, he developed hypotension, bradycardia, and first-degree atrioventricular block. Mad honey intoxication was confirmed based on the dietary history and onset of symptoms after honey consumption. Atropine and supportive treatments were continued until the patient stabilized.

Discussion: Mad honey contains grayanotoxins, which are a group of neurotoxins produced mainly by species of the Rhododendron genus within the Ericaceae family. Grayanotoxins exert their toxic effects through binding to sodium channels in cell membranes and muscarinic M2 receptors in the vagus nerve. Although mad honey poisoning is usually a benign condition, significant morbidity has been reported.

Conclusion: Although mad honey disease is rarely encountered in the Middle East, it is not unlikely to occur. Obtaining an appropriate medical and dietary history with timely recognition of the signs and symptoms of grayanotoxin poisoning could substantially improve the initiation of supportive management and minimize morbidity.

Background: Fecaloma is a mass of hardened feces impacted in the rectum and sigmoid. When the colonic mucosal wall and vasculature are compressed, stercoral colitis, a rare type of inflammatory colitis, may occur. Despite being connected to psychiatric patients and antipsychotic medications in the literature, fecaloma remains a significant, yet often overlooked, cause of morbidity and mortality in this population.

Case Presentation: A 43-year-old patient with schizophrenia being treated with aripiprazole and benztropine lost follow-up and eventually presented to the emergency department with a giant fecaloma and associated stercoral colitis. She was managed with oral and rectal laxatives and supportive therapy. Additionally, aripiprazole was discontinued.

Discussion: Antipsychotics have been associated with constipation, fecaloma, and stercoral colitis due to their anticholinergic properties. Benztropine, an antimuscarinic drug commonly used in psychiatric patients to alleviate extrapyramidal symptoms, may further decrease gastrointestinal mobility. Fecaloma and associated stercoral colitis are often diagnosed via imaging, typically a computed tomography scan of the abdomen. Management depends on the severity and generally ranges from conservative treatment to surgical options.

Conclusion: This case describes a schizophrenic patient undergoing treatment with aripiprazole and benztropine who presented with constipation and was diagnosed with a giant fecaloma complicated by stercoral colitis. The patient was managed successfully with aggressive laxatives and discontinuation of aripiprazole. Early recognition and prompt management of fecaloma are essential to mitigate associated complications. In addition, it is important to recognize risk factors for constipation and regularly review home medications, such as antipsychotics, that may cause constipation as a side effect.

Background: Cerebral venous sinus thrombosis (CVST) is an uncommon yet critical complication, especially when arising from heparin-induced thrombocytopenia (HIT). In patients with preexisting conditions such as myasthenia gravis (MG), this correlation adds further complexity to clinical management and outcomes.

Case presentation: We report a unique case of CVST induced by HIT in a patient with an established diagnosis of MG. Following plasma exchange therapy, which included heparin administration, the patient developed symptoms indicative of CVST. Diagnostic imaging confirmed thrombosis in the cerebral venous sinuses. Management involved the immediate discontinuation of heparin and the initiation of fondaparinux, leading to effective anticoagulation and clinical improvement.

Discussion: This case illustrates the rare intersection of CVST and HIT within the context of MG, underscoring the potential risks associated with heparin therapy in vulnerable patient populations. Early recognition of the signs is essential, as these conditions, in combination, demand prompt and specialized interventions to prevent serious complications.

Conclusion: The successful management of this complex case demonstrates the importance of heightened awareness and proactive strategies in patients with MG undergoing heparin therapy. This report advocates for careful monitoring and tailored treatment to mitigate risks in similarly complex clinical scenarios.

Background: Diabetic striatopathy (DS) typically presents with hemichoreoballism and contralateral striatal lesions on neuroimaging. However, cases of unilateral movement disorders with predominant ipsilateral striatal lesions are rare.

Case presentation: We present a case of DS in a 62-year-old woman from rural India with poorly controlled diabetes mellitus who developed acute-onset right hemichoreoballism. Neuroimaging revealed a predominantly right-sided striatal lesion, illustrating a clinicoradiological discordance—a mismatch between the clinical symptoms and radiological findings. Despite achieving tight glycemic control and administering neuroleptic medications, the involuntary movements demonstrated only partial improvement. Neurological changes persisted on the ipsilateral side of the affected limbs even after 1 year of follow-up. Notably, perioral dyskinesias developed during subsequent follow-up visits.

Discussion: This report highlights the clinical and neuroradiological discordance observed in DS. The potential underlying mechanisms contributing to this paradox are explored and discussed.

Conclusion: The clinical and radiological discordance in DS is a frequent yet under-reported phenomenon. However, the actual mechanistic underpinnings need to be addressed by advanced functional and structural neuroimaging.

Background: Re-expansion pulmonary edema (REPE) is traditionally associated with the resolution of pneumothorax or pleural effusion. Its occurrence after routine cardiopulmonary bypass (CPB) in cardiac surgery is rare. The incidence of REPE after treatment of pneumothorax or pleural effusion is less than 1%, but it carries a mortality rate of up to 20%.

Case Presentation: We present a case of REPE in a 64-year-old male undergoing elective coronary artery bypass grafting. Despite an uneventful surgery and standard perioperative management, the patient developed REPE, manifested with increased airway pressures, blood-tinged secretions, and compromised oxygenation post-CPB. Immediate intervention comprising mechanical ventilation adjustments, diuretics, and vasopressor support was initiated to facilitate recovery. The pulmonary edema resolved within 24 hours after the surgery, and the patient was transferred to the surgical high-dependency unit (HDU) on the third postoperative day.

Discussion: This case reports a rare occurrence of REPE following routine CPB and highlights the multifactorial pathogenesis involving reperfusion injury and altered pulmonary physiology. Possible mechanisms include reperfusion injury from free radicals, cytokine release, and increased vascular permeability. The management of REPE requires prompt recognition and treatment and involves diuretics, ventilatory adjustments, and hemodynamic monitoring.

Conclusion: REPE, though rare post-CPB, requires a high index of suspicion and prompt management to prevent adverse outcomes.

Background: Traumatic injuries to the extrahepatic bile ducts are rare, with an incidence of 0.4%–0.6% in cholecystectomy procedures among adults, particularly following the introduction of laparoscopic cholecystectomy. Among these, the presence of foreign bodies within the biliary tree is exceptionally rare, with obstructive jaundice caused by a bullet lodged in the common hepatic duct being particularly uncommon. This case report aims to share the diagnostic process and the challenges in managing such a rare condition.

Case Presentation: A 41-year-old female with a 13-year history of an accidental gunshot wound, which required an emergency laparotomy, presented to our hospital with symptoms of cholangitis. Endoscopic retrograde cholangiopancreatography was performed, revealing a bullet that caused significant dilation of the proximal bile duct. Exploratory laparoscopy, cholecystectomy, and intraoperative cholangiography confirmed the presence of the bullet. The procedure included a choledochotomy and removal of the bullet, followed by primary closure of the common bile duct using interrupted 4-0 Prolene sutures. The patient was discharged on the 11th postoperative day, and follow-up revealed complete resolution of symptoms and normal liver function.

Discussion: This case underscores the rarity and complexity of managing extrahepatic bile duct injuries caused by foreign bodies. The delayed presentation of symptoms and the unique diagnostic challenges highlight the necessity for meticulous imaging. The successful surgical intervention in this case highlights the importance of individualized treatment strategies implemented by a multidisciplinary team.

Conclusion: Managing traumatic injuries to the extrahepatic bile ducts requires careful consideration due to their rarity and complexity. The challenges in diagnosis and treatment underscore the necessity of a multidisciplinary approach.

Background: A complete heart block (CHB) entails the total loss of atrioventricular conduction and the failure to transmit any supraventricular impulses to the ventricles. To date, there have been no reports of CHB following the injection of intravenous contrast dye for computerized tomography.

Case Presentation: This case study details a patient who experienced a CHB and a syncopal episode after receiving intravenous contrast for a chest computed tomography (CT) scan. The patient was treated successfully for the anaphylactic reaction with steroids and intravenous fluid, and the heart rate improved with atropine and transcutaneous pacing.

Discussion: Contrast agents can affect cardiac conduction and endothelial integrity through their ionic strength, osmolality, and the release of histamine. These factors, combined with localized ischemia and adenosine release, may disrupt ion flow, potentially leading to transient or permanent atrioventricular block.

Conclusion: Anaphylactic reactions to CT contrast agents can lead to life-threatening cardiovascular complications, as exemplified in this case. Timely recognition and management of anaphylaxis, along with close cardiac monitoring, are crucial in such situations. Clinicians should be vigilant regarding the potential for severe cardiac manifestations in susceptible patients experiencing contrast-induced anaphylactic reactions, and they should take appropriate measures to ensure optimal care and recovery.

Background: Lung cancer is a leading cause of cancer-related mortality globally, often presenting with diverse and challenging manifestations. This case report discusses an unusual presentation of epidermal growth factor receptor (EGFR)-mutated non-small-cell lung cancer (NSCLC) initially mimicking tuberculosis (TB), complicated by pituitary involvement.

Case Presentation: A 30-year-old female presented with respiratory symptoms and systemic complaints, initially suggestive of miliary TB. Further investigations revealed metastatic lung adenocarcinoma with pituitary metastasis, causing diabetes insipidus, hyperprolactinemia, adrenal insufficiency, and hypothyroidism. Treatment with targeted therapy involving osimertinib resulted in clinical improvement.

Conclusion: This case underscores the diagnostic challenges posed by atypical presentations of lung cancer, which can masquerade as infectious diseases like TB. The presence of pituitary metastasis further complicates the clinical picture, emphasizing the importance of considering rare metastatic sites in the differential diagnosis of lung adenocarcinoma. Timely recognition and appropriate management are crucial for optimizing outcomes in such complex cases, highlighting the need for a multidisciplinary approach in oncological and endocrine care.

Introduction: Systemic lupus erythematosus (SLE) is a systemic autoimmune disease characterized by a dysregulated immune response against self-antigen, leading to multi-organ involvement. Myositis, as an initial manifestation of SLE, is a rare clinical entity, particularly in newly diagnosed patients.

Case Presentation: A 27-year-old male presented with massive head and neck swelling, initially suspected to be superior vena cava syndrome (SVCS). Other symptoms included non-scarring alopecia, prolonged fever, oral ulcers, a history of hyperpigmented skin lesions, and progressive lower extremity weakness with edema. Hematological findings revealed persistent pancytopenia (anemia, leukopenia, and thrombocytopenia). Laboratory investigations demonstrated elevated muscle injury markers, including aspartate aminotransferase predominance and elevated creatine kinase. Immunological analysis showed a negative antinuclear antibody by indirect immunofluorescence, high anti-dsDNA titers, and normal complement levels. Bone marrow biopsy revealed trilineage dysplasia with macrophage activation, suggesting underlying hematologic involvement. Contrast-enhanced head and neck computed tomography ruled out SVCS, showing only diffuse muscle and subcutaneous edema. Based on the constellation of clinical, hematological, and imaging findings, the patient was diagnosed with myositis-associated SLE. The therapeutic approach included total plasma exchange (TPE), high-dose corticosteroid pulse therapy, and immunosuppressive induction therapy. Within 1 month of hospitalization, the patient demonstrated significant clinical and laboratory improvement and was subsequently transitioned to maintenance therapy with hydroxychloroquine (200 mg once daily), methylprednisolone (8 mg daily in a tapering regimen), and mycophenolate mofetil (500 mg twice daily). The patient achieved a lupus low disease activity state at follow-up.

Discussion: This case represents a unique presentation of head and neck myositis in a newly diagnosed SLE patient, a manifestation not previously described in the literature. While orbital myositis in SLE has been reported, extensive myositis involving the head and neck as an initial SLE manifestation remains undocumented. Combining TPE, high-dose corticosteroids, and immunosuppressants was critical in disease control. Early recognition and aggressive immunomodulatory therapy are essential in managing such rare and severe SLE presentations.

Conclusion: This case highlights an uncommon initial manifestation of SLE, emphasizing the importance of early clinical suspicion, comprehensive immunological and hematological evaluation, and prompt intervention. A multimodal therapeutic approach, including steroid pulse therapy, induction immunosuppression, and TPE, can lead to favorable clinical outcomes in severe and atypical SLE presentations.