Qatar Medical Journal - Volume 2025, Issue 3

Background: Pediatric emergencies require specialized prehospital care due to children’s unique medical needs. This study explored the perceptions of a Middle Eastern Ambulance Service’s paramedics regarding the impact of pediatric-related simulation-based activities on their knowledge and confidence. It also evaluated the influence of pre-simulation activities, including online materials, lectures, video-based learning, and skills workstations, on their preparedness for these simulations.

Methods: This quantitative study involved 225 paramedics who participated in a 1-day pediatric Continuous Professional Development program conducted between January and March 2022. Following the program, participants completed an online post-program survey utilizing the Simulation Effectiveness Tool-Modified (SET-M).

Results: The SET-M results showed strong agreement (>90%) regarding the effectiveness of simulation in enhancing knowledge and confidence (M = 2.9, SD = 0.24–0.32). Participants also strongly agreed (>89.3) that pre-simulation activities improved their preparedness for simulation. Skills workstations received the highest ratings (M = 2.9, SD = 0.26), while video-based learning was slightly lower (M = 2.9, SD = 0.31). The breakdown analysis of two survey statements indicated that, regardless of experience, simulation exposure, or qualifications, participants positively perceived the effectiveness of both simulation scenarios and pre-simulation activities.

Conclusion: The study highlights the paramedics’ perceived positive impact of simulation on their knowledge and confidence in managing pediatric emergencies, emphasizing the value of pre-simulation activities in enhancing their preparedness for the simulation-based activity. The findings hold practical implications for educators, curriculum designers, and paramedic practitioners in improving pediatric emergency training.

Introduction:Listeria monocytogenes is a bacterium found in raw foods and water and causes severe infections in immunocompromised, pregnant women, and the elderly. Although the incidence of listeriosis is low, it is a life-threatening disease with a case–fatality rate of 20% to 30% and numerous complications, including central nervous system (CNS) infections and maternal-fetal transmission. The purpose of this study was to determine the epidemiology, clinical features, and outcomes of listeriosis in Qatar over 10 years.

Methods: This retrospective cohort study was conducted at Hamad Medical Corporation, the main public healthcare provider in Qatar, analyzing laboratory-confirmed L. monocytogenes bloodstream infections from May 1, 2011, to November 26, 2021. The data were collected from the electronic medical records system and included demographic data, clinical features, microbiology, management, and outcome. The study was approved by the Institutional Review Board (MRC-01-21-1023). The inclusion criteria for the study were positive blood cultures and clinical signs of infection. Descriptive statistics and comparative analyses were used in the statistical analyses.

Results: The study involved 35 cases with a median age of 39 years and 77.14% female. Pregnancy-associated cases were 22.86% with high fetal morbidity, including 33.33% stillbirth and 55.56% preterm delivery. Twenty percent of the patients had clinical features of meningoencephalitis. Although the source of infection could not be determined, it is known that Listeria monocytogenes is most commonly transmitted through contaminated food products. All the isolates were sensitive to ampicillin, co-trimoxazole, and meropenem. The 30- and 90-day mortality rates were 2.86% and 14.26%, respectively, and age (60 years and above) and meningoencephalitis were independent predictors of mortality.

Conclusion: This study offers significant information about listeriosis in Qatar, characterized by a higher incidence of pregnancy-associated cases and a lower incidence of CNS involvement than in other countries. These findings also show the gaps in antimicrobial resistance surveillance and the foodborne transmission in the Middle East. Even though all mothers recovered fully, the adverse fetal outcomes stress the importance of preventive measures and enhanced food safety measures. Future research should focus on molecular characterization, source attribution, and antimicrobial resistance monitoring to enhance infection control and public health interventions, ultimately mitigating the impact of listeriosis in the region.

Background and Aim: Guillain–Barré Syndrome (GBS) is a severe neurological disorder in which the immune system attacks the peripheral nervous system, leading to acute flaccid paralysis. The conventional treatment involves intravenous immunoglobulin (IVIG), yet the efficacy of a second IVIG dose remains uncertain. This systematic review aims to evaluate the clinical outcomes of administering a second dose of IVIG in GBS patients.

Methods: The review was registered in the PROSPERO database (CRD42024557465) and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Databases including EBSCO, MEDLINE, CINAHL, and SCOPUS were searched from database inception until June 2024, using a combination of relevant keywords. Only English-language studies were included. Quality assessment was conducted using the Joanna Briggs Institute critical appraisal tools. In total, 89 abstracts were initially screened, 20 full-text articles were reviewed, and 10 studies met the inclusion criteria for final evaluation.

Results: The review included 10 studies with 94 patients across all included studies (31 female, 63 male). This review includes two clinical trials, six case studies, and two case report series, conducted across Europe and Asia. The studies evaluated the clinical outcomes of a second IVIG dose in GBS patients in various healthcare settings, such as emergency rooms, medical departments, and intensive care units. Most of these studies reported significant clinical improvements in motor symptoms and successful weaning from mechanical ventilation following the administration of a second IVIG dose. Eighty percent of the studies included patients on mechanical ventilation, with a standard IVIG dose of 0.4 g/kg reported in 60% of studies. Half of the studies administered the second IVIG dose 2 weeks after the first. Seventy percent of the studies reported clinical motor improvement following the second IVIG dose, with half indicating successful weaning from mechanical ventilation. Evaluation methods varied, with cerebrospinal fluid protein testing (60%) and nerve conduction studies (50%) being the most common. A smaller proportion of studies assessed GMI/GDIA antibodies, immunoglobulin G (IgG) levels, or conducted electrophysiological studies. The findings demonstrate the potential effectiveness of a second IVIG dose in improving motor outcomes and reducing ventilator dependency in GBS patients.

Conclusion: The findings suggest that a second dose of IVIG may enhance clinical outcomes in GBS patients, particularly in improving motor functions and facilitating weaning from mechanical ventilation. However, further prospective randomized trials are essential to validate these results and improve treatment protocols.

Introduction: Simulation-based education (SBE) is an effective teaching method in nursing education that integrates theoretical knowledge with practical application. It provides nursing students with a safe and controlled environment where they can apply their knowledge, develop essential clinical skills, and make critical decisions - without compromising patient safety.

Nursing learners possess varying levels of experience, ranging from novice to expert, as outlined in Benner’s “Novice to Expert” theory. This variation in expertise necessitates the design of simulation experiences that are tailored to accommodate these diverse levels of competence. This practical guide presents evidence-informed strategies to support simulation facilitators in tailoring their facilitation approaches for nurses ranging from novice to expert.

Methods: A narrative conceptual review approach was employed to examine the literature on facilitation in SBE. Key theoretical perspectives, including “Novice to Expert” theory and adaptive approaches, were used to frame the discussion. The review synthesized findings from existing studies and frameworks to develop this practical guide, which supports the use of tailored simulation facilitation strategies in nursing education.

Results: Tailoring facilitation strategies based on learners’ developmental stages enhances learner engagement, performance, and learning outcomes. Novice learners benefit from structured guidance, close supervision, and stepwise instruction. In contrast, proficient and expert learners require facilitation approaches that promote autonomy, critical thinking, and complex decision-making. This guide emphasizes the importance of adjusting simulation facilitation strategy, feedback style, and simulation complexity to meet learners’ needs. Additionally, adherence to established simulation standards supports consistency and effectiveness of facilitation across different learner levels.

Conclusion: Simulation facilitators play an important role in customizing learning experiences based on nursing learners’ level of expertise. Applying Benner’s Novice to Expert theory enables facilitators to provide appropriate support, which enhances the educational outcomes of simulations. Future efforts should focus on faculty development and institutional support to ensure facilitators are prepared to deliver adaptive, learner-centered simulation experiences.

Introduction:Cyberlindnera fabianii is an uncommon opportunistic yeast increasingly recognized as a cause of invasive fungal infections, particularly in immunocompromised patients and those with indwelling medical devices. Clinical experience remains limited, with most published cases involving neonates or adults with significant comorbidities.

Case Presentation: We report a case of C. fabianii fungemia in a 26-year-old man with end-stage renal disease on maintenance hemodialysis via a long-term tunneled catheter. The patient presented with fever following dialysis and was found to have leukocytosis and elevated inflammatory markers. Blood cultures from both peripheral and catheter sites grew yeast after 48 hours. Empiric antibacterial therapy was initiated, and the hemodialysis catheter was removed. Antifungal treatment with anidulafungin was started, leading to clinical improvement. Species identification was achieved using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), which revealed C. fabianii. Antifungal susceptibility testing demonstrated low minimum inhibitory concentrations (MICs) for echinocandins and variable susceptibility to azoles. The patient completed a 14-day course of anidulafungin with full recovery.

Discussion: This case underscores the importance of accurate identification of rare yeasts such as C. fabianii, which may be misidentified as other less pathogenic species. MALDI-TOF MS and molecular diagnostics are critical tools for early detection. Due to its potential for azole resistance and biofilm formation, echinocandins appear to be an effective treatment option. Prompt catheter removal and appropriate antifungal therapy were pivotal to the patient’s successful outcome.

Conclusion:C. fabianii should be considered in patients with fungemia and risk factors for invasive candidiasis, especially when initial identification is inconclusive. Awareness of this emerging pathogen and its management is essential to ensure timely intervention and improve clinical outcomes.

Introduction: Systemic lupus erythematosus (SLE) and Sjögren’s syndrome (SS) are chronic autoimmune diseases that can coexist, complicating the diagnostic process due to overlapping clinical and serological features. Hypergammaglobulinemia, often associated with these conditions, can mimic hematological malignancies, posing a significant diagnostic challenge.

Case Presentation: We report a case of a 57-year-old woman presenting with progressive fatigue, dry cough, and vasculitic rashes for several weeks. Initial laboratory results revealed pancytopenia, hypergammaglobulinemia, and elevated inflammatory markers (erythrocyte sedimentation rate (ESR) >100 mm/hr, C-reactive protein (CRP) 137.7 mg/L), raising suspicion for multiple myeloma. However, protein electrophoresis (which showed polyclonal rather than monoclonal globulinemia) and bone marrow biopsy excluded malignancy. Further autoimmune screening confirmed coexisting SLE and SS, with positive ANA (≥1:1280), anti-dsDNA, anti-Ro, and anti-La antibodies. Polyclonal hypergammaglobulinemia was attributed to these autoimmune conditions. The patient responded well to azathioprine and hydroxychloroquine, with significant clinical and biochemical improvement.

Discussion: This case highlights the importance of distinguishing polyclonal hypergammaglobulinemia due to autoimmune diseases from monoclonal gammopathies such as multiple myeloma. Early autoimmune screening and multidisciplinary collaboration were essential in achieving an accurate diagnosis and appropriate management.

Conclusion: Polyclonal hypergammaglobulinemia in the presence of elevated inflammatory markers warrants a thorough differential diagnosis to distinguish autoimmune conditions from hematological malignancies. This case underscores the critical role of comprehensive autoimmune screening in guiding timely and accurate diagnosis.

Background: Recurrent uncomplicated urinary tract infections (UTIs) in healthy females pose a significant challenge to both patients and healthcare professionals, due to the need for repeated antibiotic treatments and the recurrence of symptoms and suffering. This case report suggests a potentially simple approach to treating recurrent uncomplicated UTI in a healthy, sexually active female, which, if validated, may eliminate the need for frequent antibiotic courses and long-term prophylactic use, potentially leading to a complete cure.

Case presentation: A 35-year-old healthy, sexually active Middle Eastern female was diagnosed with a recurrent uncomplicated UTI. The patient received multiple courses of culture-guided antibiotics, including ertapenem, for over a period of two years. The patient inadvertently recovered from the disease after she and her family received mebendazole treatment, following the diagnosis of a pinworm infestation in her five-year-old child. All patients’ symptoms resolved, with no recurrence of urinary tract infections or need for antibiotics during the two-year follow-up period after mebendazole administration. The patient remained sexually active throughout the follow-up period without any lifestyle modifications.

Discussion: Recurrent urinary tract infections (rUTIs) in healthy females remain a significant medical challenge as there is no established hypothesis to explain why some women are more susceptible to rUTIs than others. While pinworm (Enterobius vermicularis) is a well-recognized parasite, research has primarily focused on its effect on children – with few studies investigating its impact on the adult population. This may be attributed to the fact that pinworm infections in adults are mostly self-limiting and asymptomatic. However, some case reports have documented complications arising from pinworm.

Conclusion: This case raises the question of whether empirical treatment with mebendazole should be considered for recurrent uncomplicated UTIs in sexually active, healthy females – alongside standard antibiotic therapy. Identifying pinworm infection in healthy adult females with rUTIs could provide valuable insights, particularly if an association between the two is confirmed.

Introduction: The eustachian valve (EV) is a remnant of the right sinus venosus valve. It remains different in size and shape without much impact on adult life. In 5% to 10% of all endocarditis, are seen in the right side of the heart is involved, which is rare compared to the left side of the heart. Bacteremia, central venous catheter, heart implants, and drug abuse increase the risk of EV vegetation and right heart endocarditis. We are reporting a case of EV endocarditis in patients with Fournier’s gangrene and septic shock.

Case Presentation: A 45-year-old male patient was admitted into the surgical intensive care unit with Fournier’s gangrene, septic shock, and acute kidney injury (AKI). The patient was managed by invasive ventilation, noradrenaline, vasopressin, and renal replacement therapy. He developed Escherichia coli bacteremia and candidemia. We added meropenem and antifungal to the therapy. The transthoracic echocardiography showed EV vegetation and thread-like vegetation in the right coronary sinus, which was confirmed with transesophageal echocardiography. With aggressive therapies, the patient recovered from septic shock, organ dysfunction and was successfully liberated from invasive ventilation. The patient was discharged home on day 27. The antibiotics and antifungal were continued for 6 weeks. Two weeks after discharge, the follow-up echocardiogram was normal, and he was doing well.

Discussion: Eustachian valve endocarditis is rare, and should be treated with appropriate, culture- and sensitivity-guided antibiotics and or antifungal therapy for 6 weeks. The outcome of EV vegetations of endocarditis is good. The reported mortality is up to 17%. The independent risk factors associated with mortality are AKI, the Charlson comorbidity index, congestive heart failure, larger vegetation, and central nervous system involvement.

Conclusion: The presence of larger EV, along with E. coli (ESBL) bacteremia and fungemia, increases the risk of right-sided endocarditis, which is rarely reported. Our patient was diagnosed early, received appropriate antimicrobial treatment for a sufficient duration, resulting in a better outcome. A high index of suspicion, along with early diagnosis and culture-guided 6-week antimicrobial therapy, will improve the patient’s outcomes.

Objectives: This study aimed to evaluate the effectiveness and short-term outcomes of primary nasal intermittent positive pressure ventilation (NIPPV) in extremely preterm (EP) infants with respiratory distress syndrome (RDS).

Methods: A retrospective case–control study was conducted at the Women’s Wellness and Research Center in Qatar, from January 2017 to December 2019. Primary NIPPV success was defined as the absence of surfactant administration or mechanical ventilation within the first 72 hours of life.

Results: Of 367 infants requiring respiratory support at birth, 69 were managed with primary NIPPV. Among them, 62.3% succeeded (NIPPV-S) and 37.7% failed (NIPPV-F). Birth weights (956 g vs. 937 g) and gestational ages (26.3 weeks vs. 26.2 weeks) were similar between groups. NIPPV-S babies had more vaginal deliveries (48.8% vs. 19.2%, p = 0.014), higher arterial pH levels (7.36 vs. 7.29, p < 0.001), lower initial FiO2 (27.8% vs. 35.3%, p < 0.001), and less severe RDS (2.5% vs. 28.6%, p = 0.006). They also received caffeine earlier (2.6 hours vs. 4.3 hours, p = 0.042) and were more often in room air at day 28 (34.9% vs. 8.2%, p = 0.016). In the NIPPV-F group, 65% were intubated within 12 hours. NIPPV-S infants also had lower rates of brain injury (14.6% vs. 45.8%, p = 0.006) and bronchopulmonary dysplasia (BPD) (18.6% vs. 41.7%, p = 0.041), with a trend towards reduced death or severe BPD (2.3% vs. 15.4%, p = 0.063). Multivariate analysis identified admission FiO2 less than 0.4, vaginal delivery, and normal fetal Doppler as significant predictors of NIPPV success.

Conclusions: Among EP infants managed with primary NIPPV, success within the first 72 hours was associated with lower initial FiO2, vaginal delivery, and normal fetal Doppler findings. EP infants who succeeded on NIPPV had less severe RDS and better outcomes, including lower rates of brain injury and BPD. Early identification of infants likely to succeed may improve clinical outcomes.

Background: Emergence delirium (ED) in pediatric patients can result in bodily harms, maladaptive changes, and longer post-anesthesia care unit (PACU) stays. The incidence of ED varies in pediatric patients depending on various factors such as age, type of anesthesia, type of surgery, pain, and the choice of diagnostic tools. Various pharmacological and non-pharmacological methods have been used to reduce its incidence postoperatively. This study aims to investigate the role of a fixed dose of intravenous dexmedetomidine in preventing ED in pediatric patients.

Methods: Approval from the institutional ethical committee was obtained for this randomized controlled trial. Inclusion criteria included pediatric patients aged between 2 and 12 years, with ASA scores ranging from 1 to 3, who were scheduled to undergo general anesthesia for a surgical procedure. The intervention group received 20 ml of 0.2 mcg/kg dexmedetomidine intravenously over a period of 20 minutes before the end of the operation. In contrast, the control group received 20 ml of 0.9% saline. The primary outcome measure of this study was the incidence of ED in the PACU. All data collected during the study were entered and analyzed using the SPSS 22.0 statistical package program.

Results: A total of 66 patients were included in the study. All baseline characteristics of both groups were similar. The incidence of ED in the control group was 42% (14/33), whereas it was 15% (5/33) in the dexmedetomidine group (p = 0.014).

Conclusion: The use of 0.2 mcg/kg intravenous dexmedetomidine reduces the incidence of ED in patients undergoing general anesthesia with sevoflurane.