Al-Jalah Hospital

In Qatar, hormonal contraceptives are available over the counter in community pharmacies. However, improper use, particularly by women with specific health conditions, can result in adverse events. Community pharmacists (CPs) play a role in counseling women and assessing eligibility for contraceptives. This study evaluated the knowledge, attitudes, and practices of CPs in Qatar regarding hormonal contraceptives through a survey conducted from August to December 2021. Of 377 respondents, 136 completed the questionnaire (response rate: 35.3 percent). The mean knowledge score was 3.01, reflecting poor to moderate knowledge. The score fell between 3 and 4, with a maximum score of 6. CPs mostly counseled patients about contraceptives' names, instructions on administration, and when to start (82.2 percent, 90.2 percent, and 90 percent respectively). About 40 percent of CPs agreed that their religious beliefs do not affect recommendations about contraceptives. Lack of private rooms (57 percent), and limited counseling time (55.1 percent) were identified as counseling barriers. The study concluded that CPs had poor to moderate knowledge but positive attitudes and fair to good counseling practices, suggesting a need for educational programs and interventions to overcome barriers.

ABSTRACT Background Biologic and targeted‐synthetic disease‐modifying antirheumatic drugs (b/tsDMARDs), are pivotal in the management of autoimmune‐inflammatory disorders, acting by suppressing pathological immune activation. Because of associated immune dysfunction, opportunistic or serious infections (SIs), and latent disease reactivation is frequently reported. This study aimed to investigate the epidemiology, risk factors, and outcomes of SIs in patients treated with b/tsDMARDs in Qatar. Methods A retrospective cohort study was conducted at Hamad Medical Corporation, including all the patients treated with one of 10 b/tsDMARDs, between January 2017 and July 2021. Besides descriptive statistics, the Chi‐square test and Kaplan–Meyer survival analysis were used for statistical analysis. Results Out of 1092 patients, 86 (7.9%) had SIs, with an incidence rate of 39.4 per 1000 patient years. Mean duration of onset was 10.8 months post‐initiation of therapy. Younger age groups (18–52 years) were predominantly affected. A significant association was observed between the primary diagnosis (rheumatological followed by gastrointestinal, neurological, and dermatological disorders) and the occurrence of SIs (χ² = 9.512, p < 0.050). Adalimumab and infliximab had a higher risk of SIs compared to other b/tsDMARDs. There was no significant difference between TNF‐inhibitors and others. Ocrelizumab was significantly associated with incidence of COVID‐19 SIs (χ² = 16.84, p = 0.0000408), and etanercept with Staphylococcus aureus SIs (χ² = 17.51, p = 0.0000285). Predominant infection sites were skin–soft tissue and respiratory tract. Most of the SIs were secondary to either bacteria (43%) or viruses (17.4%). The mean duration of hospitalization was 9 days, and 7% of patients required critical care, with no recorded 90‐day mortality. Conclusions Patients with inflammatory conditions managed with b/tsDMARDs are at significant risk of SIs, which necessitate appropriate patient selection weighing benefits and risks, as well as careful long‐term management that include patient education and relevant preventive therapy.

This case report presents a rare instance of massive scrotal and abdominal subcutaneous emphysema resulting from self-injection of heroin. A 50-year-old incarcerated male exhibited painless scrotal swelling with extensive crepitus but no signs of infection or systemic toxicity. Imaging confirmed subcutaneous gas accumulation without visceral perforation or necrotizing fasciitis. Surgical exploration ruled out purulence or tissue necrosis, and the patient later admitted to intrascrotal heroin injections. The discussion underscores the importance of considering self-induced causes in diagnosing scrotal emphysema, particularly in high-risk populations. Early imaging, surgical evaluation, and psychiatric involvement are essential for optimal management.

Background: In obese patients receiving intravenous (IV) acyclovir, conflicting data exist regarding the risk of acute kidney injury (AKI) with different weight-based dosing strategies: total body weight (TBW), adjusted body weight (AdjBW), and ideal body weight (IBW). Objective: We aimed to compare the safety of the 3 dosing strategies in obese patients. Methods: A retrospective cohort study including obese patients who received IV acyclovir during their inpatient admissions. Patients were categorized into TBW, AdjBW, or IBW groups based on the received doses. The primary outcome was the incidence of AKI. Other outcomes included the need for renal replacement therapy (RRT), neurotoxicity, length of stay (LOS), and in-hospital mortality. Results: A total of 339 patients were included: 196 patients in TBW group, 86 patients in AdjBW group, and 57 patients in IBW group. The AKI developed in 17.3%, 11.6%, and 7% of TBW, AdjBW and IBW groups, respectively. After adjustment for confounders, reduced dosing (AdjBW or IBW) was associated with fewer AKI compared with TBW dosing (adjusted odds ratio (aOR) [95% CI] = 0.39 [0.19, 0.82]). Compared with TBW, IBW was associated with fewer AKI (aOR [95% CI] = 0.27 [0.08, 0.85]), but AdjBW was not (aOR [95% CI] = 0.48 [0.21, 1.09]). Median LOS was numerically longer with IBW but was not significantly different from other groups. The need for RRT, neurotoxicity, and mortality did not differ between groups. Conclusion and Relevance: In obese patients, either AdjBW or IBW dosing of IV acyclovir appears to be safer than TBW. The IBW dosing had the lowest odds of AKI among the 3 dosing strategies.