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- Assistant Professor, Weill Cornell Medicine-Qatar [1]
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Science of quality improvement – from vision to reality: Experience from a leading academic healthcare center in Qatar
Quality improvement and patient safety are cornerstones to the delivery of effective patient care. The introduction of a quality improvement curriculum for medical students and trainee physicians can have a significant effect on their understanding of the science of improvement and its role in improving the quality of healthcare delivery and patient safety. The article describes the development and implementation of a quality improvement curriculum for trainee physicians in the department of internal medicine at a tertiary care center in Qatar through online training courses workshops didactic activities and trainee-led quality improvement projects.
Demographics, clinical characteristics, and recurrence rate of patients with primary spontaneous pneumothorax at a tertiary care center in Qatar
Introduction: Primary spontaneous pneumothorax (PSP) is a common medical emergency. Its treatment includes simple observation needle thoracentesis pleural catheter video-assisted thoracoscopy (VATS) and open surgery. We aimed to establish the demographic clinical characteristics and 12-month recurrence rate of patients with PSP in four hospitals of the Hamad Medical Corporation Qatar.
Materials and methods: We conducted a retrospective analysis of patients >14 years old who were admitted with PSP from January 1 2017 to December 31 2019. The patients were followed up for 12 months for the recurrence of PSP.
Results: Out of 246 patients enrolled in this study 223 (90.7%) were males and 23 (9.3%) were females. Their mean age was 29.1 ± 9.59 years and their mean body mass index (BMI) was 21.7 ± 4.22 kg/m2. Of these 123 (51.2%) patients were smokers. Chest pain was the most common presenting complaint (82.5%). A total of 59 (23.98%) patients had a small pneumothorax whereas 187 (76.01%) patients had a large pneumothorax.
Among the patients with small pneumothorax 16 (28.33%) were managed through observation alone 2 (3.33%) required needle aspiration 15 (25%) required pleural catheter insertion and 26 (44.06%) underwent surgical intervention for management. Out of 187 patients with large pneumothorax 16 (8.6%) were managed through observation 7 (3.76%) required needle aspiration 73 (38.1%) required pleural catheter insertion and 91 (48.6%) underwent surgery.
During the 12-month follow-up 58 patients were lost to follow-up and 5 patients (5/188; 2.66%) presented with a recurrence of PSP. Out of 108 patients who underwent VATS 2 (1.85%) had a recurrence of PSP.
Conclusion: PSP is more common in males than in females with a tendency for younger age onset. The recurrence rate of PSP in our study was 2.66%. Furthermore the recurrence rate in our patients who underwent VATS was 1.85%. Prospective studies are warranted to compare the success rates of different treatment interventions.
Enigma of categorizing COVID-19-related lung parenchymal diseases and management experience with follow-up outcomes in Qatar: a case series
Coronavirus disease 2019 (COVID-19) has become one of the worst global pandemics in recent history. Post-COVID-19 interstitial lung disease is a significant concern in COVID-19 survivors. It is a disabling clinical condition for patients and a burden on the healthcare system. With time and subsequent waves of COVID-19 globally the post-COVID-19 sequelae of lung diseases can be debilitating. We report cases of three patients with persistent hypoxia post-COVID-19 raising concerns for interstitial lung disease in Qatar. In this report we shared our experience of the patient's clinical course complications and outcomes with post-COVID-19 sequelae of lung parenchymal disease. Patients were followed up during and after treatment until recovery or discharge from the hospital.
Back pain as an initial feature of advanced gastric cancer mimicking multiple myeloma: A case report and literature review
Background: Back pain is a rare initial presentation of gastric cancer. Isolated back pain with red flags in middle-aged patients might indicate multiple myeloma. However it is rarely present in advanced gastric adenocarcinoma; hence data are limited to case reports only. For a timely diagnosis of the underlying malignancy endoscopy should be considered if the initial workup for this backache is unrevealing.
Case Presentation: We present a 34-year-old previously healthy gentleman with severe unremitting backache. He was ultimately diagnosed with gastric adenocarcinoma stage IV and received palliative treatment. The manuscript also reviewed relevant literature.
Conclusion: In rare cases gastric malignancy can initially present as back pain with lytic bone lesions mimicking multiple myeloma. Endoscopy early in the course of investigations may help reduce associated morbidities. Further more extensive studies are required to understand better the clinical characteristics demographics and management of such patients.
Efficacy and safety of rituximab as second-line therapy in immune thrombocytopenic purpura based on ethnicity: A descriptive study among the Arabic population
Background: Rituximab is used as second-line therapy in patients with immune thrombocytopenic purpura (ITP) who do not respond to first-line management. The response rate for Rituximab is variable in different populations ranging from 30% to 90%. The adverse effects of rituximab in patients with ITP range from infusion site reactions to the reactivation of hepatitis B virus and progressive multifocal leukoencephalopathy and interpopulation variation.
Methods: We conducted a single-center retrospective study in Qatar's National Center for Cancer Care & Research. The study included patients with chronic refractory ITP who received rituximab as second-line therapy. Descriptive and summary statistics were used to describe the sociodemographic parameters of the study cohort.
Results: Of the 41 patients with chronic ITP 26 were Arabs 12 were Asians and 3 were of other ethnicities. Rituximab was associated with an overall response rate of 80.4%. Arabic patients had the highest clinical response (84.6%) among the ethnicities with the lowest adverse effects (11.5%). Asians had a response rate of 66.6% and adverse effects were seen in 16.7% of the patients.
Conclusions: In chronic refractory ITP rituximab appears to have a better clinical response in the Arabic population with minimal toxicity than in other ethnicities.