Qatar Medical Journal - الأعداد السابقة

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.