Qatar Medical Journal - العدد الحالي

Background: Chronic suppurative otitis media (CSOM) is a persistent middle ear infection. The tubotympanic type, which is the predominant form, mainly causes conductive hearing loss (CHL), but may result in sensorineural hearing loss (SNHL). This study aims to investigate the frequency and audiological profile of SNHL in patients with tubotympanic CSOM based on a single-center patient population.

Methods: A cross-sectional descriptive study was conducted at a tertiary otolaryngology and audiology unit, from September 2024 to January 2025. Sixty patients with unilateral tubotympanic CSOM were included, with the opposite ear serving as a control. Ethical approval and informed consent were obtained from all participants. Audiological assessments included pure-tone audiometry (PTA), tympanometry, and tuning fork tests. Patients with pre-existing SNHL, prior ear surgery, noise exposure, or other confounders were excluded. Data were analyzed using SPSS v. 28, applying non-parametric tests, with statistical significance set at P ≤ 0.05.

Results: A total of 60 patients were recruited. Twenty-five percent of patients had a disease duration of less than 5 years, 48.3% had a disease duration of 5 to 10 years, and 26.7% had a disease duration of more than 10 years. Presenting symptoms were hearing loss in 86.7%, otorrhea in 45.0%, tinnitus in 36.7%, and dizziness in 13.3%. Fifty-one patients (85%) showed CHL, while nine patients (15%) exhibited mixed hearing loss. SNHL was significantly associated with longer disease duration (P = 0.018) and larger tympanic membrane (TM) perforation (P = 0.036). Bone conduction thresholds were significantly elevated in the diseased ear (P < 0.001), with higher frequencies affected more than speech frequencies.

Conclusion: Tubotympanic CSOM is significantly associated with the development of SNHL, particularly in patients with prolonged disease duration and larger TM perforations. Periodic audiological assessments, proper management, and early intervention are recommended to prevent cochlear damage and permanent hearing loss.

Background: Cardiovascular disease (CVD) remains a major health concern in Qatar, with ischemic heart disease being the leading cause of mortality. Suboptimal cholesterol levels represent a major risk factor for CVD. Suboptimal cholesterol levels are highly prevalent among adults worldwide, including in the Middle East and North Africa region. Obesity, a major risk factor for suboptimal cholesterol, is highly prevalent in Qatar and contributes significantly to both mortality and morbidity.

Objective: To estimate the prevalence of total cholesterol (TC), low-density lipoprotein (LDL), and low high-density lipoprotein (HDL) levels in a specific population in Qatar, and to assess their associations with obesity.

Methods: Data for this cross-sectional study was derived from the Qatar Biobank, a population-based biobank that recruits Qatari nationals or long-term residents aged 18 years and above. Multivariable logistic and linear regression models were used to assess the associations between TC, LDL, HDL, and obesity levels defined by body mass index (BMI) and waist circumference (WC).

Results: Of 1,000 participants, 920 were included in the study. Approximately 37% of women had higher TC (≥ 5.18 mmol/L), 28% had higher LDL (≥ 3.4 mmol/L), and 36% had lower HDL (<1.3 mmol/L). Among men, 43% had higher TC, 41% had higher LDL, and 22% had lower HDL. HDL levels were significantly associated with higher BMI and WC in both women (adjusted odds ratio [aOR] for obese vs normal weight = 3.60, 95% CI: 1.86–6.94; aOR for higher WC vs lower WC = 2.35, 95% CI: 1.42–3.90) and men (aOR for obese vs normal weight = 3.00, 95% CI: 1.48–6.11; aOR for higher WC vs lower WC = 2.12, 95% CI: 1.27–3.55). In men, higher BMI was significantly associated with increased odds of higher TC (aOR = 2.45, 95% CI: 1.38–4.36) and LDL (aOR = 2.56, 95% CI: 1.42–4.56), while no significant associations were found in women.

Conclusion: Both women and men with higher BMI and WC had significantly lower HDL levels. Additionally, men with higher BMI were at increased risk for higher TC and LDL levels, whereas no significant associations were observed in women. Further research is needed to examine the associations between cholesterol types and metabolic syndrome components in representative populations with adequate sample sizes.

Background: Mental health disorders significantly impact individual well-being and place a substantial burden on healthcare systems worldwide. In Oman, enhancing medication adherence among patients with psychiatric disorders is crucial, as non-compliance can worsen symptoms and lead to increased hospitalizations. This study aims to identify the predictors of medication non-adherence among patients at a tertiary care facility in Oman.

Methods: A cross-sectional study was conducted at Al Masarra Hospital involving adult patients undergoing follow-up care for documented mental disorders. The Medication Adherence Rating Scale was used to assess medication adherence, while demographic and medical history data were collected through self-report. Descriptive statistics and linear regression were used to analyze the relationship between adherence and various factors.

Results: Among the 151 participants, primarily aged between 26 and 45 years, the average medication adherence score was 5.71 (with a standard deviation of 2.45). Key predictors of non-adherence included marital status and treatment satisfaction, with unmarried individuals showing lower adherence levels. Interestingly, greater insight into one’s illness correlated with lower adherence, whereas higher treatment satisfaction was associated with better adherence.

Conclusion: Medication non-adherence remains a significant challenge among psychiatric patients in Oman, influenced by psychosocial factors such as marital status, level of insight, and treatment satisfaction. Targeted interventions that address patient insight and enhance treatment engagement are essential for improving medication adherence and clinical outcomes.

Background: Hearing loss (HL) affects approximately 3 in every 1,000 infants worldwide. However, current Early Hearing Detection and Intervention (EHDI) guidelines may not fully account for region-specific neonatal risk factors. In the Middle East, conditions such as gestational diabetes mellitus (GDM), pre-eclampsia, and consanguinity are highly prevalent but remain underexplored in HL research. This study investigates the association between these and other neonatal risk factors and HL outcomes in newborns in Qatar.

Methods: A retrospective cross-sectional review of electronic health records was conducted for 5,098 neonates born between March 2019 and March 2022 at a tertiary hospital in Qatar. After exclusions, 4,126 neonates were analyzed. Maternal and neonatal risk factors, along with newborn hearing screening outcomes, were assessed using Fisher’s exact test, Chi-square test, and logistic regression analysis.

Results: Overall, 6% of neonates failed the hearing screening (n = 248). The most common risk factors were GDM (34.5%), hyperbilirubinemia (21.0%), and gentamicin exposure (9.6%). However, GDM showed no significant association with failed screening. The strongest association was found with Down syndrome (odds ratio [OR] = 14.215; 95% confidence interval [CI]: 4.286–47.151; p < 0.001), followed by cleft lip/palate (OR = 4.371; 95% CI: 1.384–13.801; p < 0.012), and high-risk categorization (OR = 1.973; 95% CI: 1.266–3.076;p < 0.003).

Conclusion: Contrary to expectations, GDM and hyperbilirubinemia were not associated with an increased risk of HL. In contrast, Down syndrome and cleft lip/palate showed significant associations with HL risk. These findings highlight the importance of incorporating regionally relevant risk factors—such as genetic syndromes and craniofacial anomalies—into local Early Hearing Detection and Intervention (EHDI) frameworks. Contextualizing hearing screening within the Gulf region may enhance early detection and optimize care pathways.

Background: Back pain is a common musculoskeletal disorder (MSD) linked to various occupational activities. Understanding its prevalence is essential, as many healthcare workers (HCWs) are at risk of developing back pain and related conditions due to the physical demands of their job responsibilities.

Objective: To determine the prevalence and identify the predictors of back pain and other MSDs among primary HCWs in Qatar in 2023.

Methods: An analytical cross-sectional study was conducted among primary HCWs between May 2023 and June 2023. A multistage random sample (n = 654) was used to recruit participants from five healthcare centers nationwide, who were invited to complete a face-to-face survey.

Results: Among the 392 participants, 52% (n = 204) reported back pain, with 69% of these cases involving the lower back. Back pain was most common among nurses (21.6%), data entry/computer-based workers (21.1%), office administrative staff (13.2%), and receptionists (11.8%). Other musculoskeletal conditions reported among HCWs included scoliosis (32.6%), right shoulder and knee pain (37.2%), and osteoporosis affecting the neck and spine (9.3%). Logistic regression analysis identified female gender (adjusted odds ratio [AOR]: 2.057; 95% confidence interval [CI]: 1.76–4.85; p = 0.0003) and the presence of other MSDs (AOR: 4.695; 95% CI: 2.017–10.929; p = 0.000) were significant predictors of back pain.

Conclusion: This study highlights that a substantial proportion of primary HCWs employed in health centers across Qatar experience back pain, representing a serious occupational health concern. Female gender and pre-existing MSDs were identified as key predictors, underscoring the need for targeted interventions. Promoting ergonomic practices and encouraging regular physical activity are essential to reduce back pain and protect the health of HCWs.

Background: Anorectal abscesses are common surgical conditions associated with a high risk of recurrence or fistula formation. Although several studies have investigated the potential predictors, data from Saudi Arabia remain limited. This study aimed to assess the rate, timing, and predictors of recurrence or fistula formation following the primary surgical drainage of anorectal abscesses.

Methods: We conducted a five-year retrospective cohort study at King Fahad Hospital of the University in Al Khobar, Saudi Arabia, including all patients who underwent surgical incision and drainage for a first-time anorectal abscess between January 2019 and December 2023. Demographic data, abscess characteristics, operative details, and follow-up outcomes were analyzed. Logistic regression and Cox proportional hazards models were used to identify the predictive factors.

Results: Among 302 patients, 51.7% (n = 156) developed either a recurrent abscess (12.9%, n = 39) or an index perianal fistula (38.7%, n = 117) during follow-up. The mean time to recurrence was 19.5 weeks. Complex abscesses, observed in 28.1% (n = 85) of cases, were the only independent predictor of earlier recurrence (hazard ratios [HR]: 2.391, p < 0.001). Preoperative imaging was also associated with an increased risk in logistic regression analysis. Seton placement was rare (2.6%, n = 8), despite intraoperative fistula detection in 17.9% (n = 54) of cases.

Conclusion: Recurrence and fistula formation following drainage of first-time anorectal abscesses are common and tend to occur early. Abscess complexity is a key predictor of poor outcomes, highlighting the need for structured early follow-up and risk-based surgical planning.

Background: Hypothyroidism is commonly associated with obesity. While the effects of bariatric surgery on comorbidities such as type 2 diabetes and hypertension have been well studied, there is limited information regarding its benefits in obese patients diagnosed with and receiving treatment for hypothyroidism.

This study aimed to evaluate the effects of bariatric surgery in patients with hypothyroidism, with particular focus on changes in levothyroxine (LT4) dosage and the prevalence of hypothyroidism remission post-surgery.

Methods: A retrospective study spanning seven years was conducted at the Obesity Clinic of KFMC (King Fahad Medical City—a public tertiary care center in Riyadh, Saudi Arabia), involving 163 patients with concurrent obesity and hypothyroidism who underwent bariatric surgery. Patient’s medical charts and pharmacological treatment records were reviewed. Pre- and post-operative parameters, including weight, body mass index (BMI), thyroid status, thyroid-stimulating hormone, free thyroxine, LT4 dosage, and the type of bariatric surgery performed, were recorded. Continuous variables are presented as mean±SD (standard deviation) and as percentages. Student’s t-test was used to analyze the difference between means, and data normality was assessed using the Shapiro–Wilk test.

Results: Of the 163 patients, 14 (8.6%) were male and 149 (91.4%) were female, with an overall mean pre-operative BMI of 49.30 ± 9.49 kg/m². Prior to surgery, the mean LT4 dose was 118.25 ± 59.39 mcg, which significantly decreased to 83.13 ± 57.39 mcg post-surgery (P < 0.001), reflecting a 30% reduction. Additionally, 24 patients (14.7%) experienced remission from hypothyroidism, whereas 8 patients (4.9%) showed an increase in thyroxine dosage.

Conclusion: The study demonstrated a significant reduction in LT4 doses following bariatric surgery, suggesting that obesity may contribute to hypothyroidism. Bariatric surgery may improve thyroid function, potentially reducing the need for medication. Patients with hypothyroidism undergoing bariatric surgery should have their thyroid function closely monitored every 6–12 weeks post-operatively for 1–2 years, or until their nadir weight is reached, to allow for appropriate levothyroxine dose adjustments.

Background: Nuchal translucency (NT) measurement by ultrasound is used in the first trimester as a screening tool for genetic, chromosomal, and structural anomalies. As the NT measurement increases, the risk of an underlying abnormality also rises. This study aims to evaluate the significance of increased NT measurements within a local cohort, examining their associations with adverse pregnancy outcomes and their potential role in guiding clinical interventions.

Methods: Pregnancies with first-trimester fetal NT measurements greater than 2.5 mm were included. Participants were categorized into five groups based on NT measurements: ≤3.4 mm, 3.5–4.4 mm, 4.5–5.4 mm, 5.5–6.4 mm and ≥6.5 mm. The outcomes evaluated included chromosomal anomalies confirmed by invasive testing (such as Trisomy 21), major congenital anomalies involving any major organ system, and miscarriage or termination of pregnancy before 24 weeks of gestation. Gestational age at delivery, birthweight, small-for-dates (SFD) status, and admission to the neonatal intensive care unit (NICU) were evaluated for infants born after 24 weeks of gestation without congenital anomalies.

Results: The median NT measurement among the 290 women in the study was 3.7 mm, ranging from 2.9 mm (25th centile) to 7.4 mm (75th centile). Overall, 43.5% of the participants were in the lowest NT category, while 15.9% were in the highest category. Maternal age, body mass index, and nationality were comparable between the groups. The odds of chromosomal anomalies increased with higher NT measurements, with odds ratio (OR) ranging from 2.50 to 4.02 (p < 0.05), compared to the lowest NT group. Similarly, the odds of major congenital anomalies (OR: 2.20–4.20; p < 0.05), multiple anomalies (OR: 5.61–8.19 in the highest three categories; p < 0.005), and miscarriages (OR: 5.04–14.9 in the highest three categories; p < 0.001) all increased with rising NT measurements. The odds of most chromosomal anomalies increased with NT, except for Trisomy 21, which was similar across the groups. Participants in the two lowest NT groups had 12.7- and 7.5-fold higher odds (both p < 0.001) of achieving a pregnancy beyond 24 weeks without anomalies compared to those in the highest NT group. Among pregnancies resulting in viable non-anomalous deliveries, there were no significant differences in the gestational age at delivery, birthweight, incidence of SFD, or NICU admission.

Conclusion: Adverse outcomes, including chromosomal and congenital anomalies, increased with higher NT measurements, with a significant difference observed beyond 3.4 mm. These findings highlight the importance of early NT screening and targeted interventions to improve perinatal outcomes.

Background: Type 2 diabetes mellitus (T2DM) requires significant patient involvement, with health literacy playing a crucial role in patients’ ability to navigate their care. Qatar has one of the highest T2DM prevalence rates globally, yet research on health literacy in this population remains limited. The purpose of this study was to evaluate health literacy levels and predictors among Type 2 diabetes patients in Qatar.

Methods: An analytical cross-sectional study was conducted, targeting patients diagnosed with type 2 diabetes. A total of 450 patients were randomly sampled, and data were collected through structured interviews using the European Health Literacy Survey Questionnaire - short version (HLS-EU-Q16) to measure health literacy. In addition to determining the prevalence of different health literacy levels, associations between health literacy and patient characteristics were examined using bivariate analysis. A regression model was employed to identify independent predictors of health literacy.

Results: Of the 450 participants, 57.8% were male with a mean age of 51.6 years. 62.4 % demonstrated sufficient health literacy, 31.8 % problematic, and 5.8 % inadequate levels. Health literacy was significantly associated with participants’ age, education, occupation, income, living situation, diabetes duration, treatment, and complications (P < 0.05). Multivariable analysis showed that primary (adjusted odds ratio (AOR), 0.080; P < 0.001), no formal (AOR, 0.162; P = 0.008) and secondary education (AOR, 0.266; P = 0.001) each reduced the odds of higher literacy versus university education, while living with family (AOR, 2.843; P = 0.030) and being managed with oral medications alone (AOR, 3.230; P = 0.004) or no medication (AOR, 11.196; P = 0.038) increased the odds.

Conclusion: Although a high proportion of patients had sufficient health literacy, many still struggled with problematic or inadequate levels, especially those with lower education or complex insulin regimens. Routine health literacy assessment and targeted, culturally appropriate education for high-risk groups should be embedded in diabetes services and national strategies.

Background: The dental home is essential for maintaining proper oral health in children. This study explores parents’ perspectives on using social media to find a dental home for their preschool-aged children.

Methods: A cross-sectional study was conducted using a questionnaire administered to parents visiting Sidra Medicine, the only tertiary pediatric center in the State of Qatar.

Results: A total of 384 questionnaires were completed by parents and caregivers, resulting in a 94% response rate. The majority of participating parents (66.9%) were male, with over 30 years of age accounting for 45.8%, and about half of them were college graduates. After learning about the concept of a dental home for preschool children, 73% of parents expressed interest. Nearly all participants were active on social media, and about 60.2% preferred to receive oral health messages through these platforms, while 10.9% were unsure. Furthermore, almost 60% believed that social media could influence their decision to seek a dental home, and 77.6% agreed that social media would be an effective way to promote proper oral hygiene. Facebook and Instagram were the two major platforms where our participants preferred to receive information regarding dental health. Importantly, three-quarters of the participants felt that primary care physicians or their representatives should use social media to send reminders about dental home care. Statistical analysis was performed to examine associations between parental age, gender, and educational status in relation to their perceptions of using social media to find a dental home for their children, but the results did not reveal any statistically significant correlations.

Conclusion: Social media can be a valuable tool for disseminating information and promoting the concept of a dental home for preschool children. In addition to social media, pediatricians can play a crucial role in advocating for the idea of a dental home for children.

Background: Globally, cognitive impairment has evolved as a major health and social issue. Hypertension, age, and stroke are independent risk factors for the development of cognitive impairment. Elderly individuals with hypertension are more prone to earlier cognitive decline. The risk is reduced by proper antihypertensive treatment. Various classes of antihypertensive drugs have varied protective effects on cognition, so we aimed to compare the cognitive scores of individuals taking different classes of antihypertensive drugs and correlate the blood pressure levels with their cognitive scores.

Methods: Known hypertensive individuals belonging to the age group of 35 to 60 years participated in this single-center cross-sectional study conducted in a tertiary care center in southern India. Individuals with any chronic systemic illness or any history of pre-existing cognitive impairment were excluded from the study. After taking a detailed history on hypertension and drug history, the patient’s cognition was assessed using the Montreal Cognitive Assessment (MoCA) test. Out of a total score of 30, greater than or equal to 26 is considered normal. The hypertensive individuals were divided into three groups, namely those who were taking Angiotensin Receptor Blockers (ARBs), Calcium Channel Blockers (CCBs), and other antihypertensive drugs, and their cognitive scores were compared.

Results: Two hundred and forty-nine known hypertensive individuals participated in the study, of whom 43% were found to be males. Patients on ARBs (25.1 ± 3) had higher cognitive scores compared to CCBs (22.6 ± 3.8) and other antihypertensive drugs (24.3 ± 3.8). When the cognitive scores were correlated with mean arterial pressure, it showed a negative association was shown (P-value, 0.45). When grouped individually and analyzed using an independent t-test, patients who have been hypertensive for more than 5 years and who were on irregular treatment showed lower cognitive scores, which is statistically significant.

Conclusion: Our study showed a strong association between hypertension and cognitive function decline, and also the ARBs’ protective effect over other classes of antihypertensive drugs. The pharmacodynamics of different classes of antihypertensive drugs should be taken into account to support the cognitive health of hypertensive individuals.

Background: Drug-drug interactions (DDIs) can lead to adverse events or altered drug effectiveness, and polypharmacy increases the likelihood of DDIs. This study aimed to explore the prevalence of clinically significant DDIs among patients with mental health problems who are prescribed psychotropic medications.

Methodology: This was a retrospective observational study that included patients who had visited the Outpatient Mental Health Pharmacy at Mental Health Services (MHS) in Qatar for medication dispensing. The study covered all individuals over 2 months, totaling 1586 patients. The list of medications was cross-referenced with Lexicomp^® to identify potential DDIs. Then, each identified DDI was assessed for risk rating, severity, and reliability rating. Descriptive analysis was applied first. The Shapiro-Wilk test for normality, the chi-square test, the Mann-Whitney U test, and binary logistic regression were conducted as appropriate.

Results: Of the 1586 files reviewed, 49% of the patients did not experience any DDIs, while the remaining 51% (n = 807) had at least one potential interaction. Among these, 44% had no comorbidities aside from their psychiatric condition. Anxiety disorders (25.65%) and schizophrenia (23.9%) emerged as the most common diagnoses. Patients were found to be taking an average of 4.69 ± 3.36 medications, with 2.23 ± 0.96 of these being psychotropic drugs. On average, each patient experienced 3.15 potential psychotropic DDIs. The majority of the interactions belonged to Category C (86%; n = 2192), followed by Category D (7.8%; n = 200). The total number of medications was the only statistically significant predictor of having potential “Intervention Required/High-Risk Drug Interactions” (P < 0.001).

Conclusions: The study provided valuable insight into the prevalence of potential DDIs among patients prescribed psychotropic medications in Qatar. Notably, the analysis highlighted significant interactions, particularly those associated with severe outcomes, like Torsades de Pointes and anticholinergic intoxication. These findings underscore the need for targeted strategies to mitigate adverse effects and enhance patient safety in clinical practice.

Background: Gram-negative bacteremia (GNB) causes substantial morbidity, mortality, prolonged hospitalization, and readmissions worldwide. Standard practice recommends initial intravenous (IV) antibiotics, but many clinically stable patients now complete therapy through outpatient parenteral antimicrobial therapy (OPAT), which may improve antimicrobial stewardship and reduce costs. This study aims to compare clinical and economic outcomes of inpatient versus OPAT-managed GNB.

Methods: We conducted a retrospective observational cohort study of all adults with GNB treated at a 320-bed general hospital from July 2021 to July 2022. We excluded patients younger than 18 years, blood culture contaminants, and patients with Gram-positive or mixed infections. Patients were assigned to four final treatment pathways: inpatient IV only, hospital-based OPAT IV room (OPAT-IV), home-based IV therapy (Home-IV), or early oral switch. Primary outcomes were 30-day mortality and bacteremia recurrence; secondary outcomes were length of stay and treatment cost.

Results: We identified 125 patients (mean age, 56 years; 51.2% female). Most isolates originated from urinary (54.4%) or intra-abdominal (23%) sources. Pan-sensitive organisms accounted for 57.6% of cases; extended-spectrum β-lactamase producers, 35.2%; and multidrug-resistant organisms, 7.2%. Thirty-seven patients (29.6%) completed IV therapy as inpatients, 16 (12.8%) in OPAT-IV, 13 (10.4%) in Home-IV, and 59 (47%) were discharged on oral antibiotics. Nine deaths (24.3%) occurred in the inpatient group and one (7.7%) in Home-IV; no deaths occurred in OPAT-IV or oral-therapy groups. Readmissions within 90 days were uncommon (≤7.7% across groups). Mean antibiotic durations were 13.0 days (inpatient), 11.3 days (OPAT-IV), 10.6 days (Home-IV), and 7.7 days (oral). OPAT pathways shortened hospital stays and reduced drug and bed-day costs.

Conclusion: OPAT provided safe, effective treatment for selected patients with GNB, lowering mortality, shortening length of stay, and reducing costs compared with continued inpatient care. Careful patient selection and early IV-to-oral transition can maximize these benefits while maintaining favorable clinical outcomes.

Introduction: Cognitive health, crucial for the independence and quality of life in older adults, is influenced by various factors, including nutritional status, which is increasingly recognized for its importance. Folate (vitamin B9) and cobalamin (vitamin B12) are essential for neurological health. Despite most studies offering broad global insights, this research addresses the knowledge gap regarding the relationship between folate and cobalamin levels and cognitive memory performance in a cognitively healthy aging adult. The primary objective of this study is to examine the relationship between memory performance and blood levels of folate and cobalamin, as well as to identify the determinants of memory performance, in adults in Qatar.

Methods: We conducted a cross-sectional analysis of the data obtained from Qatar Biobank. This study assessed cognitive performance using the Cambridge Neuropsychological Test Automated Battery and measured blood concentrations of folate and cobalamin. Additionally, we examined demographic, lifestyle, behavioral, and disease-related factors as determinants of memory performance. We used multivariable linear regression to identify associations between Paired Associated Learning First Attempt Memory (PALFAMS) and vitamin levels.

Results: Six hundred and thirty-six individuals aged 40 years and older were included in this study. The z-scores for blood levels of folate and cobalamin were each found to be positively associated with the PALFAMS (β, 0.17 [95% CI, −0.188 to 0.538]; P = 0.334 and β, 0.19 [95% CI, −0.15 to 0.53]; P = 0.28, respectively), after adjustment for covariates. Older age and being male were found to have negative associations with PALFAMS (β, −0.10 [95% CI, −0.18 to −0.02]; P = 0.011 and β, −0.98 [95% CI, −1.91 to −0.05]; P = 0.040, respectively), whereas a higher level of education and the use of supplements showed positive associations with memory function (β, 3.76 [95% CI, 2.38 to 5.14]; P < 0.001 and β, 0.76 [95% CI, 0.02 to 1.50]; P = 0.044), after adjustment for covariates.

Conclusion: Since the associations between blood levels of folate and cobalamin and memory performance were not statistically significant, these results underscore the need for more comprehensive studies to explore the complex relationships between nutrition and memory performance, ultimately guiding more effective strategies for the prevention and management of memory impairment.

Introduction: Empyema, characterized by the accumulation of pus in the pleural space, poses a significant medical challenge with diverse complications. This study aims to provide a comprehensive overview of the epidemiology, microbiological spectrum, management strategies, and outcomes of empyema patients in Qatar.

Methods: We conducted a comprehensive review of electronic medical records from all hospitals affiliated with Hamad Medical Corporation, the national healthcare system of Qatar, for patients aged 18 years and older diagnosed with empyema between January 1, 2015, and December 31, 2019.

Results: Seventy-five empyema cases were reviewed, predominantly male (89.3%) with a mean age of 44 years. Common comorbidities included diabetes mellitus (30.7%) and a history of malignancy (20%). Pleural fluid was universally exudative, with turbidity in (55.4%) and blood staining in (16.9%). Streptococcus (38.7%) and Gram-negative bacteria (29.3%) were the predominant pathogens. All patients received antibiotics, with chest tube insertion as the primary intervention in 74.6%. Video-Assisted Thoracoscopic Surgery (VATS) was performed in 24% and medical thoracoscopy in 1.3%. The mortality rate was significant at 18.6%. Univariate and multivariate analyses indicated that a prior history of pneumonia (P = 0.004), pleural effusion/empyema (P = 0.024), and malignancy (P < 0.036) were significant predictors of mortality.

Conclusion: Streptococci were identified as the predominant pathogen in empyema cases in Qatar, with Diabetes Mellitus being the most common comorbidity. Early antibiotic therapy and chest tube insertion were key to effective management, often reducing the need for surgical interventions. Despite this, mortality remains a significant concern.

Background: During the Coronavirus disease (COVID-19) pandemic, healthcare workers globally experienced unprecedented levels of stress. However, limited research has focused specifically on paramedics. As frontline workers, paramedics were placed under immense and unprecedented pressure. This study assessed stress levels and Post-Traumatic Stress Disorder (PTSD) symptoms among paramedics in Qatar before and during the COVID-19 pandemic.

Methods: An online survey adapted from validated tools was distributed to all paramedics in Qatar employed by Hamad Medical Corporation Ambulance Service (n = 1100) between December 2020 and March 2021. Responses from volunteer participants were analyzed with data stratified by demographic factors to explore their impact on self-reported stress and PTSD levels. Stress levels were categorized into five ranges, from low to potentially dangerous.

Results: The study received 272 valid responses. Before the pandemic, paramedics reported moderate stress levels, which escalated to severe levels during the pandemic. A paired t-test revealed significant differences in average stress and PTSD symptom scores before and during the pandemic. Symptoms included intrusive memories, avoidance behaviors, hypervigilance, sleep disturbances, and emotional numbness (P < 0.05). The average total PTSD score increased significantly during the pandemic from 37.59 (±16.02) before the pandemic to 42.42 (± 17.29; P < 0.05). The proportion of paramedics reporting little to no PTSD symptoms decreased from 39.3% before to 28.3% during the pandemic. Conversely, those reporting highly severe PTSD increased from 33.1% to 44.1% (P < 0.001).

Conclusion: The study highlights a significant increase in stress levels and PTSD symptoms among paramedics in Qatar during the COVID-19 pandemic compared to the pre-pandemic period. This rise can be attributed to their role as frontline responders, which exposed them to heightened risks of infection, long shifts, and prolonged periods between leave. The findings underscore the need for targeted interventions to address stress and PTSD among paramedics, ensuring their mental and physical well-being and enabling them to continue providing effective medical care.

Background: Vitamin D deficiency is increasingly recognized as a significant public health issue, with far-reaching effects on bone health and overall well-being, especially among children and adolescents.

Aim/Objectives: This cross-sectional, record-based study aimed to assess the prevalence and predictors of vitamin D deficiency in individuals under 18 years old who attended Primary Health Care Corporation (PHCC) centers in Qatar between 2018 and 2019.

Methodology: Data were extracted from 48,947 electronic medical records, each containing at least one valid serum vitamin D test result. Severe deficiency was defined as serum vitamin D levels <10 ng/ml. Participants undergoing vitamin D therapy were excluded from the prevalence analysis.

Results: Findings revealed that infants (under 1 year) and children aged 1–4 years had the lowest rates of severe deficiency at 3.8% and 3.4% respectively. The prevalence increased with age, reaching 40% among adolescents (10–17 years). Females had significantly higher rates of severe deficiency (30.4%) compared to males (15.3%).

Multivariate logistic regression identified age, sex, and nationality as significant predictors. Adolescents were 17 times more likely to have a severe deficiency compared to children under 5 years. Females had a 2.4-fold increased risk, and individuals from Southern Asia had a 5.7-fold higher risk compared to other nationalities.

Conclusion: This study highlights a high prevalence of vitamin D deficiency among adolescents in Qatar, particularly among females and certain ethnic groups. To address this emerging health issue in the pediatric population, targeted interventions, such as awareness campaigns, supplementation programs, and policy-level strategies, are essential.

Background: Thyroid cancer is the most common endocrine cancer worldwide. Differentiation between benign and malignant thyroid pathology is crucial for optimum management. Immunohistochemical markers (IHC) such as galectin-1 and the trophoblast cell surface antigen 2 (TROP-2) are valuable tools in this differentiation. The study aimed to evaluate the role of immunohistochemical expression of galectin-1 and TROP-2 in differentiating benign from malignant thyroid lesions.

Methodology: This retrospective observational study analyzed 136 thyroid specimens, including 50 cases of follicular nodular disease (FND), 23 follicular adenomas (FA), 37 papillary carcinomas (PTCs), and 26 follicular carcinomas (FTCs) collected from Al-Yarmouk Teaching Hospital from October 2022 to October 2024. All cases underwent IHC staining for galectin 1 and TROP-2.

Results: Galectin-1 IHC expression was significantly associated with tumor size of papillary carcinoma cases (P = 0.002). TROP-2 IHC expression was significantly associated with female gender (P = 0.0006) and tumor size in follicular carcinoma cases (P = 0.031). A highly significant difference in IHC expression between benign and malignant cases was observed for both markers (P = 0.001). TROP-2 expression was higher in malignant cases at 82% (papillary and follicular carcinoma) compared to galectin-1 (62%; P value, 0.0097).

Conclusion: Both galectin-1 and TROP-2 showed higher expression in malignant thyroid cases compared to benign lesions. TROP-2 showed higher sensitivity in detecting malignant lesions, whereas galectin-1 exhibits greater specificity. Combining both markers enhances the differentiation between benign and malignant lesions, thus providing valuable diagnostic insight.

Background: Degenerative lumbar spinal diseases are a leading cause of disability worldwide, often requiring surgical intervention when conservative management fails. Transforaminal lumbar interbody fusion (TLIF) is a commonly employed procedure to stabilize the spine and alleviate symptoms. This systematic review and meta-analysis aimed to test the safety and efficacy of robotic-assisted minimally invasive transforaminal lumbar interbody fusion (RA MIS-TLIF) in managing degenerative lumbar spinal diseases. Our primary objective was to compare the robotic approach with the conventional open or minimally invasive approach for TLIF regarding patients’ perioperative and postoperative outcomes.

Methods: PubMed, Cochrane Library, Scopus, and Embase were searched from inception until October 2023. The selection criteria included only English-language articles focused on human participants aged 18 years and older with measurable outcomes. Prospective and retrospective cohort studies were included. Relevant data regarding perioperative outcomes and postoperative pain scores were then extracted. Review Manager (RevMan) 5.4 was used for statistical analysis. No restrictions were applied regarding the surgical approach compared to the robotic approach. This review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: Twelve observational studies, including 1,385 patients, were included in our final analysis. Robotic-assisted minimally invasive lumbar interbody fusion was associated with significantly lower blood loss compared to both open (MD: −161.11 mL [95% CI, −184.89 to −137.34]) and conventional minimally invasive surgery (MD: −25.18 mL [95% CI, −64.06 to 13.70]), with an overall significant reduction (MD: −76.27 mL [95% CI, −118.65 to −33.90]). Operative time was significantly longer in robotic surgery compared to non-robotic approaches (MD: 17.61 minutes [95% CI, 4.10 to 31.11]). Hospital stay was shorter in the robotic group than in the non-robotic surgery group (MD: −0.89 days [95% CI, −1.54, −0.24]). Radiation time and dose showed no significant differences. Postoperative pain and functional outcomes, including ODI and VAS scores, showed a trend toward improvement in the robotic group but did not reach statistical significance.

Conclusion: Robotic-assisted minimally invasive TLIF shows promising results in operative time and blood loss compared to open or minimally invasive TLIF.

Hydatid disease (echinococcosis) is a zoonotic infection caused by Echinococcus species, characterized by cyst formation in various organs, most commonly the liver and lungs. While often asymptomatic in the early stages, progressive cyst growth can lead to severe complications, including organ dysfunction, secondary infections, or rupture. In this review, we aimed to assess the incidence of hydatid disease among pediatric populations across different regions. We searched PubMed, Scopus, Cochrane, and Web of Science for studies reporting the incidence of hydatid disease in children up to February 20, 2025. A random-effects meta-analysis was performed using STATA version 28. Subgroup analyses were conducted based on country, geographic region, and cyst location. Study quality was assessed using the Newcastle–Ottawa Scale. We pooled data from nine studies, yielding an overall incidence of 3.37 per 1,000 children (95% confidence interval [CI]: 0.52–8.48), with substantial heterogeneity (I² = 99.97%). The highest incidence was reported in China (17.86 per 1,000), followed by Turkey (1.48 per 1,000) and Bulgaria (1.47 per 1,000). Lower incidence rates were reported in Iran (0.62 per 1,000) and Romania (0.12 per 1,000). Studies conducted in rural areas showed a higher incidence (14.84 per 1,000) compared to those including patients from diverse geographic regions (1.91 per 1,000). Based on the available evidence, we conclude that the incidence of hydatid cysts in children varies across countries, with the highest rates observed in China and in rural areas. Echinococcosis poses a significant threat to both public health and livestock; therefore, effective monitoring and control strategies are crucial to reduce its impact.