Background:Septic shock is a severe form of sepsis characterized by circulatory failure and organ dysfunction, often requiring vasopressor support to maintain adequate mean arterial pressure. Norepinephrine is the recommended first-line vasopressor, but new-onset atrial fibrillation (AF) is a common complication in septic shock patients receiving vasopressors, potentially influenced by vasopressor choice. This study compares the incidence of new-onset AF and related cardiac outcomes in septic shock patients treated with norepinephrine versus phenylephrine. Objective:To compare the incidence of new-onset AF within 72 hours of vasopressor initiation in adult septic shock patients treated with norepinephrine versus phenylephrine. Methods:A retrospective observational cohort study was conducted using the TriNetX database, including adult septic shock patients without prior AF who received either norepinephrine or phenylephrine. Propensity score matching balanced baseline characteristics across cohorts. The primary outcome was incidence of new-onset AF; secondary outcomes included cardioversion events, rate control medication use, other arrhythmias, and embolic stroke incidence. Outcomes were analyzed using Cox proportional hazards models and Kaplan-Meier survival curves. Results:After matching, 138,051 patients were included in each group. New-onset AF occurred in 0.3% of norepinephrine-treated patients versus 0.01% in the phenylephrine group (OR 3.05; 95% CI: 2.55-3.65; p < 0.001). Norepinephrine use was also associated with significantly increased rates of electrical and pharmacological cardioversion, rate control medication utilization, other arrhythmias, and embolic stroke (all p < 0.001). Kaplan-Meier analysis confirmed higher AF incidence in the norepinephrine group (log-rank p < 0.001). Conclusion:In septic shock patients, norepinephrine is associated with a significantly higher risk of new-onset AF and related adverse cardiac events compared to phenylephrine. These findings suggest vasopressor choice may influence arrhythmia risk and highlight the need for prospective studies to guide optimal vasopressor selection and management strategies in this population.
Background:Superficial parotidectomy is the traditional treatment for benign parotid tumors but may be associated with facial nerve dysfunction and other morbidities. Intracapsular parotidectomy has emerged as a function-preserving alternative; however, concerns regarding oncologic safety remain. Randomized evidence comparing both techniques is limited. Therefore, this study aimed to compare their functional and oncologic outcomes. Objective:This study aimed to compare intracapsular parotidectomy and superficial parotidectomy in terms of operative efficiency, complications, facial nerve preservation, and tumor recurrence for benign parotid tumors. Methodology:This multicenter randomized controlled trial included patients with benign parotid tumors who were randomly assigned to undergo either intracapsular or superficial parotidectomy between May 2019 and May 2023, in Cairo, Egypt. Functional outcomes, postoperative complications, and recurrence rates were evaluated. Results:The mean age was 46.3 ± 9.5 years, with a range of 25-65 years. Most patients (84, 70%) were male, while 36 (30%) were female. The intracapsular parotidectomy (ICP) group demonstrated significantly reduced operative time (68.5 ± 12.3 vs. 88.3 ± 14.5 minutes; p = 0.01) and blood loss (120 ± 55.3 vs. 170 ± 50.5 ml; p = 0.001) compared to the superficial parotidectomy (SP) group. Facial nerve injury occurred exclusively in the SP group 9 (15%), including 3 (5%) cases of permanent palsy. Recurrence was observed in 1 (1.7%) ICP case and 3 (5%) SP cases, with no statistically significant difference (P > 0.05). Other complications, including seroma formation and postoperative bleeding, were similarly distributed between the two groups. Conclusion:Intracapsular parotidectomy is a safe, effective, and less invasive alternative to superficial parotidectomy for benign parotid tumors. It offers shorter operative time, reduced bleeding, and improved facial nerve preservation without compromising oncological outcomes. Careful patient selection is essential for optimal results.
ABSTRACT Background: Cardiotoxicity remains a major limitation in breast cancer treatment, especially with anthracyclines and radiotherapy. Early biomarkers may improve risk stratification. Methods: This retrospective cohort study included breast cancer patients treated between 2020 and 2023 with chemotherapy and/or radiotherapy. Troponin I (TPI) and N-terminal pro B-type natriuretic peptide (NT-proBNP) were measured at baseline and at three, six, 12, 18, 24, 30, and 36 months. Cardiotoxicity was defined per European Society of Cardiology (ESC) guidelines as a ≥10% drop in left ventricular ejection fraction (LVEF) to <53% or >15% relative reduction in global longitudinal strain (GLS). Receiver operating characteristic (ROC) analysis, logistic regression, and mixed-effects models assessed associations. Results: A total of 190 patients were included; 141 patients (74.2%) developed cardiotoxicity within 12 months. At six months, NT-proBNP (median: 212.6 pg/mL) and TPI (0.038 ng/mL) were significantly higher in the cardiotoxic group ( p < 0.01). ROC area under the curve (AUC) for NT-proBNP at six months was 0.83 (95% CI: 0.77–0.89); for TPI, AUC = 0.79 (95% CI: 0.73–0.86). Multivariable regression showed both biomarkers remained independent predictors of cardiotoxicity after adjustment for GLS and cumulative anthracycline dose (NT-proBNP: OR 1.78 [95% CI 1.22–2.61], p = 0.003). Conclusion: In this real-world breast cancer cohort, serial NT-proBNP and TPI monitoring, particularly at 3 and 6 months, provided meaningful early prognostic information for subsequent cardiotoxicity beyond baseline assessment alone. When integrated with echocardiographic surveillance, these biomarkers may support earlier identification of high-risk patients, more tailored cardio-oncology follow-up, and timely cardioprotective intervention, although prospective external validation is required before routine implementation.
ABSTRACT Background: Managing umbilical hernia in cirrhotic patients is complex. No prior national studies have examined the outcomes associated with treatment approaches for this demographic. Objectives: To evaluate the results of cirrhotic patients with umbilical hernia treated conservatively compared to those who underwent elective surgical hernia repair. Methodology: This is a retrospective cohort study conducted over 5 years period from January 2017 to December 2022 at King Abdulaziz Medical City and King Abdullah Specialized Children’s Hospital in Riyadh, Saudi Arabia. A comparison was conducted between those who underwent elective umbilical hernia repair and those treated conservatively. A chi-square test was used for categorical variables, while t-test and analysis of variance were used for numerical and categorical variables. Results: The study included 70 patients, out of which 54 patients initially planned for conservative treatment, and 21 eventually underwent emergent umbilical hernia repair. In the elective surgery group, 11 (68.8%) had a Child A score, whereas the emergency group had 9 patients (42.9%) with a Child B score and 10 patients (47.6%) with a Child C score ( p = 0.001). Post-operatively, 12 patients (57.1%) required intensive care unit (ICU) admissions in the emergency group compared to only 2 patients (12.5%) in the elective group ( p = 0.006). Conclusion: Expectant management of cirrhotic patients with umbilical hernia and ascites often results in a higher complication rate, frequently leading to emergency surgery, which is associated with significant morbidity. In contrast, elective hernia repair typically results in fewer complications and is therefore recommended.
Introduction:Gestational diabetes mellitus (GDM) is a common pregnancy complication associated with maternal and neonatal morbidity. Various risk factors for GDM, including pre-pregnancy body mass index (BMI) and gestational weight gain (GWG), have been described in the literature. Although both factors have been identified as important risk factors for GDM, the relative contribution of each to the development of GDM remains controversial. In this retrospective observational study, we aimed to compare the relative impact of early pregnancy BMI and GWG on the risk of developing GDM in a study from a single tertiary center. Materials and Methods:Our retrospective study analyzed data from pregnant women who were referred to our clinic between 2017 and 2024 and underwent a 75-g oral glucose tolerance test (OGTT) between the 24th and 28th weeks of gestation. Sociodemographic characteristics, plasma glucose levels at 0, 1, and 2 hours during the OGTT, maternal height and self-reported weight at the onset of pregnancy (when informed of the positive pregnancy test), and body weight at the time of the OGTT were retrieved. Results:Among the 290 pregnant women included in the study, 45 (15.5%) were diagnosed with GDM. In the multivariate logistic regression analysis, advanced maternal age (p = 0.034), a prior history of GDM (p = 0.043), excessive gestational weight gain (adjusted odds ratio [aOR] = 2.989; p = 0.042), and elevated early pregnancy BMI (aOR = 4.317; p = 0.025) were identified as independent risk factors for GDM. Conclusion:The findings of our study showed that pre-pregnancy BMI was independently associated with a higher risk for GDM compared to gestational weight gain. Additionally, advanced age and a history of GDM were independent risk factors for GDM. These results suggest that clinicians should focus on pre-pregnancy BMI assessment and gestational weight monitoring to reduce the risk of GDM.
Background:Antimicrobial resistance (AMR) is a critical global health threat. Local, real-time epidemiological data are the cornerstone of effective antimicrobial stewardship. This study aimed to establish a 2024 baseline for AMR patterns at a major tertiary care center in Qatar to directly guide empirical therapy and stewardship interventions. Methods:We conducted a retrospective, cross-sectional analysis of 1,656 positive bacterial cultures from blood, urine, and wound samples collected from 1,218 patients between January 1 and December 31, 2024. Antibiotic susceptibility testing was interpreted per European Committee on Antimicrobial Susceptibility Testing (EUCAST) 2024 guidelines. Statistical analysis utilized descriptive statistics and Chi-square tests. Results:The most common pathogens were Escherichia coli (30.0%), Staphylococcus aureus (25.0%), and Pseudomonas aeruginosa (15.0%). High resistance rates were observed, with E. coli exhibiting resistance to ceftriaxone (45.0%, 95% CI 40.5-49.5) and ciprofloxacin (50.0%, 95% CI 45.5-54.5). Methicillin-resistant S. aureus (MRSA) prevalence was 30.0% (95% CI 25.6-34.7). Carbapenem-resistant Klebsiella pneumoniae (CRKP) accounted for 5.5% (95% CI 4.4-6.7) of all isolates. Multidrug-resistant organisms (MDROs) were identified in 35.0% (95% CI 32.7-37.3) of samples, with a significantly higher prevalence in intensive care units (ICUs) (45.0%) compared to other wards (p < 0.001). Conclusion:This study documents a high burden of AMR, dominated by Gram-negative pathogens in critical care settings. These findings necessitate a multi-pronged response, including the revision of empirical antibiotic guidelines, enhanced stewardship focused on high-risk agents, and intensified infection control in ICUs. Integrating molecular epidemiology into future prospective surveillance is essential to combat this escalating crisis.
Background:Spontaneous splenic rupture (SSR) is an uncommon life-threatening complication of chronic myeloid leukemia (CML); however, it rarely occurs as the initial presentation of the disease. A contrast-enhanced computed tomography (CT) scan is the preferred method for confirming the diagnosis. The definitive treatment is radical splenectomy. Case Presentation:We report the case of a 37-year-old previously healthy man who presented to the Emergency Department with severe, vague abdominal pain and nausea of one day's duration. On physical examination, he had epigastric tenderness and palpable splenomegaly, while his vital signs were within the normal limits. Contrast-enhanced CT revealed massive splenomegaly and splenic rupture with active bleeding. Subsequently, the patient became hemodynamically unstable and required an urgent total splenectomy. Molecular cytogenetic tests showed abnormalities consistent with CML. The patient's condition gradually improved, and he was discharged home on the 10th postoperative day. Discussion:SSR typically occurs in patients with preexisting hematologic disorders or constitutional symptoms. This case is unique because the patient, who had no history of trauma, constitutional symptoms, or a known hematologic disorder, presented with massive splenomegaly and extremely elevated leukocytosis and was found to have undiagnosed CML. The patient's massive splenomegaly and abrupt splenic rupture highlight that SSR can occur even in the absence of classic B symptoms, posing significant diagnostic and management challenges. Timely multidisciplinary intervention is crucial, and thorough post-splenectomy care is essential. Conclusion:SSR as the initial manifestation of CML is an uncommon and unexpected clinical presentation. This case demonstrates that extreme leukocytosis and massive splenomegaly can precipitate splenic rupture in the absence of prodromal symptoms. Timely surgical intervention, comprehensive post-splenectomy care, and the prompt initiation of targeted therapy are indispensable for achieving optimal clinical outcomes, as demonstrated in our patient.
Introduction:Type 1 diabetes mellitus (T1DM) and celiac disease (CD) represent two frequently recognized and interrelated autoimmune disorders. Despite the well-documented coexistence of T1DM and CD, the exact etiology behind this association remains unclear. Methods:A retrospective study analyzed handwritten medical files of 109 children and adolescents diagnosed with T1DM documented between the years 2004 and 2022 in the Pediatric Unit of Mustapha Bacha University Hospital, Algiers, Algeria. Data were collected, including age, sex, age at diagnosis of both T1DM and CD, the mean annual Glycated Hemoglobin ( HbA1c) levels, celiac serology, and histopathological results. Comparisons between the CD-negative and CD-positive groups were performed using the Mann-Whitney U test. Results:The mean age was 9.99 ± 4.05 years, and the age at diagnosis of T1DM was 6.33 ± 3.45 years. HbA1c was 8.47 ± 1.42%, equivalent to 69.1 ± 15.5 mmol/mol. Celiac serology was positive in 21 patients (19.3%), including 11 patients with a confirmed CD (57.89%), with a mean age at CD diagnosis of 5.82 ± 2.82 years. The Mann-Whitney U test revealed a significant difference in the age at diagnosis of T1DM (P = 0.027). Logistic regression analysis showed that age at T1DM diagnosis was significantly associated with the risk of developing CD, with a 21.4% decrease in risk per additional year of age (odds ratio = 0.786 [95% CI, 0.627-0.986]; P = 0.038). Conclusion:In this retrospective cohort, younger age at T1DM diagnosis was associated with a higher risk of CD, supporting intensified screening in children diagnosed at younger ages. Prospective studies are warranted to confirm these clinical implications.
Introduction:Coronavirus disease 2019 (COVID-19) is increasingly recognized as a multisystem disorder with potential endocrine sequelae. Emerging reports suggest that adrenal insufficiency (AI) may occur in patients with COVID-19 without preexisting adrenal disease, but the clinical spectrum and strength of evidence remain unclear. To systematically review the literature on new-onset AI associated with COVID-19 in patients without prior adrenal disorders, focusing on clinical presentation, diagnostic approaches, and underlying mechanisms. Methods:A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. PubMed/MEDLINE, Scopus, and Web of Science were searched from inception to December 28, 2025. Eligible studies included observational studies, case reports, and case series reporting AI in COVID-19 patients without known adrenal disease. Risk of bias was assessed using the Newcastle-Ottawa Scale and Joanna Briggs Institute tools. Given the heterogeneity, a qualitative synthesis was conducted. Results:Nine primary studies (two observational studies and seven case reports) were included. Four narrative reviews were used solely for contextual discussion. Cases involved adults and children and occurred during acute infection or the post-COVID period. Most reports described biochemically confirmed central AI, while fewer reported primary AI due to adrenal infarction, hemorrhage, or autoimmune adrenalitis. Some presentations based mainly on steroid responsiveness were interpreted as probable critical illness-related corticosteroid insufficiency. Diagnostic thresholds and the use of ACTH stimulation testing varied. Most patients improved with glucocorticoid replacement. Conclusion:New-onset AI has been reported in temporal association with COVID-19 and may represent an infrequently reported but clinically significant endocrine manifestation. Prospective studies with standardized hormonal assessment are needed to clarify incidence, mechanisms, and screening strategies. Registration:The review was registered with PROSPERO under registration number CRD420251275141.
Background:Orbital traumatic neuromas are rare lesions that can mimic common orbital pathologies, such as dermoid cysts, particularly in the superonasal region. Case Presentation:A 17-year-old female presented with a long-standing, slowly enlarging superonasal orbital mass that had initially been diagnosed as a dermoid cyst. Computed tomography revealed a well-defined, non-enhancing extraconal lesion measuring approximately 3.1×1.5×1.3 cm with associated bone remodeling. Surgical excision revealed a solid, vascular lesion complicated by retrobulbar hemorrhage, which was promptly managed. Histopathological examination confirmed a traumatic neuroma. Conclusion:Traumatic neuroma can mimic a dermoid cyst and should be considered when intraoperative findings are atypical. Definitive diagnosis relies on histopathological examination.
Background:Qatar residents undertake substantial outbound travel, often to destinations with risks of malaria, yellow fever, and enteric infections; however, many travelers remain unaware of preventable health risks or how to access pre-travel care. Local data show high vaccination needs and a rising incidence of imported malaria among non-immunized residents, highlighting a missed opportunity for earlier intervention at the point of booking. Methods:A narrative synthesis of peer-reviewed travel medicine literature and Qatar-specific epidemiological data was combined with stakeholder and service mapping to identify gaps in current information pathways and define the core features of a digital prompt aligned with national public health services. Results:Global evidence shows that many international travelers experience travel-related illness, while data from Qatar indicate frequent travel to high-risk destinations and substantial vaccination needs. Current airline and government websites provide only static information and lack contextual prompts, clear next steps, and direct referral pathways. We propose a smart, bilingual travel-health pop-up, triggered only for flagged destinations, that briefly summarizes key infectious disease risks in Arabic and English and directs users to locally aligned World Health Organization/Centers for Disease Control and Prevention (WHO/CDC)-based guidance and national travel and vaccination clinics. Conclusion:This low-friction, privacy-preserving pop-up could help convert awareness into timely pre-travel consultation in Qatar and serve as a scalable, low-cost complement to existing education channels. A multi-stakeholder pilot study is recommended to assess its feasibility, impact, and scalability.
Background:Lipoid proteinosis (LP) is a rare autosomal recessive disorder caused by mutations in the extracellular matrix protein 1 (ECM1) gene. Reporting index cases is important for enhancing clinical recognition and understanding phenotypic variability. Case presentation:A 36-year-old woman presented with bilateral pruritic eyelid papules and long-standing hoarseness. Clinical examination revealed moniliform blepharosis, oral cobblestone plaques, and a broad tongue. Neuroimaging showed symmetrical calcifications in the medial temporal lobes. Fiberoptic laryngoscopy demonstrated an infantile larynx, an uncommon finding in LP. A positive family history and parental consanguinity supported the diagnosis. The patient declined genetic testing and neurological treatment despite experiencing a seizure episode and mood disturbances. Topical and systemic corticosteroids were ineffective. She continues ophthalmology follow-up but has discontinued dermatological and genetic care. Conclusion:This case highlights the classic features of LP, a potentially novel laryngeal finding, and emphasizes the need for early diagnosis and multidisciplinary management to address neurological and psychosocial complications.
Background:Tuberculosis (TB) remained the deadliest infectious disease in 2023, with 8.2 million newly diagnosed cases-the highest number recorded since 1995. In Qatar, the estimated TB incidence was 37 per 100,000 population in 2024. This review aimed to identify gaps in TB research conducted in Qatar and inform future research priorities. Methods:PubMed, Scopus, Web of Science, and the Cochrane Library were systematically searched using relevant Medical Subject Headings (MeSH) terms and keywords. Peer-reviewed original research articles on TB with data from Qatar published between 1993 and 2022 were included, while reviews and editorials were excluded. Results:Thirty-six studies met the inclusion criteria. Most were retrospective observational studies focusing on extrapulmonary TB and used nonprobability purposive sampling. The most common research theme was clinical and diagnostic research. Conclusion:Key research gaps include the evaluation of TB treatment, the epidemiology of drug-resistant TB, and delays in TB diagnosis. The absence of studies on pediatric TB highlights the need to prioritize this population. Strengthening TB research in Qatar will require dedicated funding and a focus on underexplored and high-priority areas.
Objectives:Nonspecific abdominal pain (NSAP) is a frequent emergency presentation characterized by diagnostic uncertainty, recurrent healthcare utilization, and variable imaging strategies. We aimed to evaluate long-term diagnostic trajectories, recurrence patterns, mortality, direct hospital costs, and the diagnostic yield of abdominal imaging (computed tomography abdomen and pelvis [CTAP] and ultrasound [USS]) in a large UK cohort. Methods:We conducted a retrospective observational study of 1171 patients presenting with NSAP to a UK district general hospital over 10 years, with a 2-year follow-up. Data included demographics, investigations, recurrence, diagnostic progression, mortality, and direct hospital costs. Predictors of recurrence were assessed using multivariable logistic regression. Results:The mean age was 46.3 years, and 62% were female. At 2 years of follow-up, 71.2% remained without a confirmed diagnosis, and 33.4% experienced recurrence of NSAP. Recurrence was significantly higher among patients who ultimately received a diagnosis (53.1%) compared with those who remained undiagnosed (25.4%; P < 0.001). Prior similar abdominal pain was the strongest independent predictor of recurrence (adjusted odds ratio, 4.0 [95% CI, 3.1-5.3]; P < 0.001). CTAP was performed in 390 patients; reports were available for 347 (89.0%), of which 39.8% were abnormal. CTAP led to further clinical actions in 34.9% and contributed to a confirmed diagnosis in 34.6%. USS was performed in 354 patients; reports were available for 297 (83.9%), of which 9.8% were abnormal. USS led to further clinical actions in 5.6% and contributed to a confirmed diagnosis in 5.4%.Two-year mortality was 8.7%, with malignancy accounting for 12.5% of confirmed diagnoses and 24.5% of recorded causes of death. Recurrence-related direct hospital costs totaled approximately £469,955 over 2 years. Conclusion:NSAP is associated with high diagnostic uncertainty, frequent recurrence, and substantial resource use. CTAP demonstrates meaningful diagnostic yield and commonly contributes to actionable management and diagnostic clarification, supporting structured pathways with targeted imaging and follow-up, while recognizing limitations of retrospective electronic health record capture.
Background and objective:Osteoporosis poses significant risks to skeletal health and dental treatment outcomes. This study evaluated the diagnostic potential of cone beam computed tomography (CBCT) voxel values and radiomorphometric analysis in identifying low bone mineral density (BMD), exploring their correlation with calcaneal quantitative ultrasound (QUS) and serum biomarkers. Methods:A cross-sectional study was conducted on 86 participants aged over 40 years. QUS of the calcaneus was utilized to classify subjects into normal or osteopenic/osteoporosis groups. CBCT-derived voxel values (cortical and cancellous) and radiomorphometric indices were recorded alongside serum calcium and 25(OH) vitamin D levels. Statistical analyses included Pearson's/Spearman's correlations and t-tests to compare groups. Results:Participants with normal QUS T-scores exhibited significantly higher CBCT cortical (855.63 ± 71.38) and cancellous (439.90 ± 85.61) voxel values compared to osteoporotic individuals (P < 0.001). Strong positive correlations were found between QUS T-scores and CBCT voxel values (r = 0.766 for cortical; r = 0.789 for cancellous), as well as with serum vitamin D (P < 0.001). Serum calcium showed a weaker but significant correlation. CBCT-derived radiomorphometric indices did not significantly correlate with QUS T-scores. However, a strong negative correlation was observed between the qualitative computed tomography cortical index (CTCI) grading and QUS T-score (P < 0.001). Interpretation and Conclusion:CBCT voxel values and CTCI strongly correlate with QUS measurements and vitamin D levels, offering superior diagnostic utility compared to standard morphometric indices. These metrics may serve as effective adjunctive tools for opportunistic osteoporosis screening in dental settings, facilitating early diagnosis and risk management.
This narrative review examines the evolution, organization, and performance of emergency medicine (EM) services in Qatar within a nationally coordinated healthcare system. Qatar operates a highly centralized public healthcare model serving approximately 2.9 million residents through a single national health region, which includes 31 primary healthcare centers and multiple secondary and tertiary hospitals, encompassing both teaching and non-teaching institutions. Emergency departments manage a wide spectrum of acute presentations, most commonly trauma, cardiovascular emergencies, respiratory illnesses, and undifferentiated medical conditions. The review explores key aspects of workforce development, including structured training pathways, residency programs, and interprofessional education initiatives, placing Qatar's experience within a broader global context. International literature indicates that challenges related to workforce sustainability, trainee well-being, retention, and standardization of education are widely shared across health systems, highlighting the universal relevance of these issues. Qatar's nationally coordinated approach to emergency care delivery, residency training, clinical governance, and quality improvement has strengthened workforce capacity, enhanced clinical performance, and improved system resilience. The transformation from a fragmented, generalist-driven service to a cohesive, specialty-led network demonstrates how coordinated planning, structured education, and infrastructure investment can achieve international standards of emergency care. By synthesizing these developments, this review provides insights and transferable lessons for other nations seeking to establish robust, high-quality EM services, illustrating the impact of systematic, evidence-based approaches on both patient care and health system performance.
Background:Abdominoplasty, although classified as a clean elective procedure, carries a meaningful risk of surgical site infection (SSI), with reported SSI rates varying depending on patient factors and procedural complexity. Objective:To describe SSI incidence and associated risk factors after abdominoplasty at a Qatari tertiary facility, and to assess compliance with prophylaxis practices, antibiotic consumption, and costs. Methods:Retrospective cohort of all abdominoplasties at The Cuban Hospital, from January 1, 2022, to July 31, 2025 (N = 323). Data included demographics, comorbidities, perioperative glucose monitoring, procedure characteristics, and antibiotic use (prophylactic and therapeutic). The cohort comprised both simple abdominoplasties and combined procedures performed with additional interventions such as liposuction or hernia repair. SSI rates were analyzed using relative risk, 95% confidence intervals, and statistical tests with significance at P < 0.05. Results:A total of 323 patients underwent abdominoplasty with a mean age of 40.5 years (SD, 9.8; range, 19-63 years). The majority were female (276 patients, 85.4%), and 13.9% (45 patients) had a history of diabetes mellitus. Overall SSI incidence was 5.3% (17/323), highest in 2025 (8/112; 7.1%). Combined abdominoplasty had a higher SSI rate than simple procedures (10.4% [5/48] vs. 4.4% [12/275]; RR, 2.36 [95% CI, 0.88-6.35]). SSI was more frequent with diabetes (11.1% [5/45] vs. 4.3% [12/278]), overweight/obesity (7.3% [12/151]/4.3% [5/112] vs. 0% [0/42]), and higher postoperative glucose (mean: 7.97, standard deviation: 1.99; P = 0.04). Adherence to antibiotic prophylaxis was high for timing/selection/dose, but discontinuation beyond 24 hours and 7-day discharge prescriptions were common. Antibiotic consumption and costs were higher in SSI cases (355.9 vs. 280.5 DDD/100; 2807.6 vs. 2180 QR/100; P = 0.45; P = 0.72). Conclusion:SSI incidence after abdominoplasty was modest but increased with combined procedures and poorer postoperative glycemic control. Strengthening perioperative glucose protocols and enforcing 24-hour prophylaxis limits may reduce SSI and unnecessary antimicrobial use and costs.
Background:Safe perioperative transfer of patients with potential spinal cord injury (SCI) is essential to prevent secondary neurological damage. Targeted training of operating room nurses (ORNs) is critical for ensuring adherence to best-practice transfer techniques. Objectives:To determine the effect of a scenario-based training intervention on knowledge and self-reported practices of ORNs regarding safe perioperative transfer of patients with potential SCI. Methods:This survey-based pre- and post-intervention study was conducted at Hamad General Hospital, Doha, Qatar, between January and March 2024. A structured self-administered questionnaire was administered to ORNs before and after a targeted training intervention. Variables included preferred transfer device, number of staff required, leadership during transfer, hand positioning, and command sequence. Descriptive statistics and McNemar's test were used for analysis. Results:A total of 138 ORNs participated (mean age, 37.6 ± 6.2 years; 68% female). Use of plastic boards increased from 88% (n = 122) to 93% (n = 128) post-intervention (P < 0.05). Compliance with the recommended four-person log-roll team improved from 67% (n = 92) to 79% (n = 109). Reliance on anesthetists for transfer leadership increased from 41% to 58%, while inappropriate reliance on other staff decreased from 33% to 28%. Conclusion:A targeted scenario-based training intervention significantly improved ORNs' knowledge and self-reported adherence to safe perioperative transfer practices for patients with potential SCI.
Background:Metabolically-dysfunction-associated steatotic liver disease (MASLD) is highly prevalent in populations with metabolic risk factors, and the liver fibrosis stage is the main determinant of long-term outcomes. The Fibrosis-4 (FIB-4) index is widely recommended as a first-line noninvasive test for fibrosis risk stratification; however, its diagnostic performance may vary across populations. Objective:To evaluate the diagnostic performance of the FIB-4 index for detecting advanced liver fibrosis in Qatari residents with MASLD, using liver biopsy as the primary reference standard and FibroScan as a secondary comparator. Methodology:This retrospective, cross-sectional diagnostic accuracy study included adults with MASLD evaluated at Hamad Medical Corporation in Qatar between January 2023 and December 2024. FIB-4 was calculated from routine laboratory parameters, and fibrosis was staged using the METAVIR (Meta-Analysis of Histological Data in Viral Hepatitis) scoring system. It is a histological scoring system used to grade necroinflammatory activity (A0-A3) and stage liver fibrosis (F0-F4). Advanced fibrosis was defined as METAVIR stage ≥F3. Diagnostic performance metrics and the area under the receiver operating characteristic curve (AUROC) were calculated at established cut-offs. Results:A total of 117 patients were included; 74 patients (63.2%) underwent liver biopsy, and 91 patients (77.7%) underwent FibroScan assessment. Advanced fibrosis was present in 21 patients (17.9%) on biopsy. At a FIB-4 cut-off of 1.3, sensitivity and specificity for detecting advanced fibrosis were 66.7% and 67.9%, respectively, compared with liver biopsy, with an overall accuracy of 67.6% and a negative predictive value of 83.7%. The AUROC for FIB-4 was 0.76. Conclusion:FIB-4 can be used as a first-line, accountable screening tool, followed by another confirmatory tool in high-risk patients.
