Demographic characteristics, laboratory features and complications in 346 cases of brucellosis: A retrospective study from Qatar.

Objectives: To study the epidemiology and laboratory findings and outcomes of human brucellosis in the state of Qatar. Methods: A retrospective study involving adult patients with a definitive diagnosis of brucellosis was conducted. Results: Of the 346 patients 299 were males. The mean age was 39.62 years. 120 patients had history of drinking raw milk and 116 had a history of contact with animals. Fever (89.9%) and myalgia (56.6%) were the most common presenting symptoms observed. Raised C-reactive protein level was the most frequent laboratory finding noted. Alanine aminotransferase and aspartate aminotransferase levels were raised to three times the normal in 39.6% and 37% of patients, respectively. Blood culture was positive in 72.8% whereas Brucella immunoglobulin G antibody and immunoglobulin M antibody titer was positive in 72.5% and 73.1% patients, respectively. Approximately 21.4% had focal involvement and osteoarticular (11.6%) involvement was the most frequently observed focal form. Doxycycline with rifampicin or gentamicin was the common regimen received. Relapse was seen in 7.2% patients. Conclusion: Human brucellosis continues to be a serious health issue in Qatar predominantly affecting healthy young adult men resulting in significant morbidity. Preventive measures and community awareness particularly among high-risk groups will help in decreasing the prevalence of the disease and its aftereffects.

Infective Endocarditis Presenting as Rhabdomyolysis and Muscle Abscess: A Case Report.

Rhabdomyolysis is characterized by the degradation of skeletal muscle tissue, which releases cellular contents into circulation. This condition commonly stems from various factors, including trauma, overexertion, muscular hypoxia, infections, metabolic and electrolyte imbalances, certain medications, toxins, and genetic abnormalities. Despite this, instances of rhabdomyolysis precipitated by bacteremia of infective endocarditis remain exceedingly rare. This report describes an unusual case wherein infective endocarditis manifested as rhabdomyolysis, accompanied by a muscular abscess and acute renal failure. The patient's condition was successfully managed through hydration and targeted antibiotic therapy, leading to a favorable recovery. The case underscores the importance of vigilance for extracardiac symptoms and signs of infective endocarditis, such as rhabdomyolysis and muscular abscesses. Of particular note in this case was the discovery of an atypical causal bacterium, Streptococcus dysgalactiae, in the setting of infective endocarditis. This case highlights the broad range of potential manifestations and causal factors associated with this serious cardiac condition.

Venous Thromboembolism Among Hospitalized Patients: Incidence and Adequacy of Thromboprophylaxis - A Retrospective Study.

Purpose: We aimed to determine the incidence of venous thromboembolism among hospitalized patients in Qatar as well as to analyze the adequacy of VTE assessment and prophylaxis in hospitalized patients. Design: Retrospective observational study. Setting: Four hospitals under Hamad Medical Corporation, Qatar. Participants: Patients over the age of 18 who were hospitalized between January 2015 and December 2019 and developed venous thromboembolism during hospitalization or within a month after discharge were included. Results: During the study period, 641,994 individuals were admitted to hospitals. The inclusion criteria were satisfied by 209 of them. The mean age was 51.25 years and 54.5% were males. Hypertension and diabetes mellitus were the most common comorbidities found in the overall group. The incidence of VTE was 32.55 [95% CI 28.4, 37.3] per 100,000 admission per year [0.032%]. The annual incidence was least in 2015 (17.8 per 100,000 admissions) and highest in 2018 (44.4 per 100,000 admissions). Eighty-six subjects had DVT, and 109 had PE, whereas 14 had both. And, 67.5% of the patients developed VTE during admission while, 32.5% developed within 1 month of discharge. Moreover, 22.9% of the patients with PE developed pulmonary embolism after discharge from the hospital. VTE assessment was performed on 64.7% of the patients, and 69.7% received VTE prophylaxis in accordance with guidelines. Conclusion: Although the occurrence of VTE among hospitalized patients in Qatar is low, healthcare providers need additional education and knowledge of VTE assessment and prophylaxis to follow guidelines for all patients at the time of admission. Furthermore, risk assessment for VTE should be done for all patients at the time of discharge to decide on post-discharge prophylaxis so that incidence of VTE after discharge can be minimized. Future studies should focus on patients who developed VTE after discharge from the hospital as well as on various risk factors.

Ceftriaxone-induced hepatotoxicity in patients with common medical infections in Qatar: A retrospective study.

INTRODUCTION: Ceftriaxone, a third-generation cephalosporin, is frequently used for the treatment of various bacterial infections as a broad-spectrum antibiotic for many decades. Although ceftriaxone is a well-tolerated drug in most cases, it can lead to serious liver injury, which can be a real challenge to the treating physician. Given the potentially serious adverse effects that can vary from mild biochemical abnormalities to complete liver failure, we intend to assess the spectrum of liver injury based on biochemical criteria for patients treated with ceftriaxone for common bacterial infections in Qatar. OBJECTIVES: This study aimed to explore the incidence of ceftriaxone-induced liver injury at Hazm Mebaireek General Hospital, Qatar, and to evaluate the relationship of the ceftriaxone dose, if any, with liver dysfunction. METHODS: This retrospective study included hospitalized adult patients treated with ceftriaxone at our hospital from January 2019 to December 2019 and analyzed demographic and clinical data obtained from electronic medical records. This study determined the incidence of liver injury (primary outcome) in patients treated with ceftriaxone (2 g/day) for ≥ 2 consecutive days by reviewing liver function test results until the day of discharge and at the first outpatient follow-up. RESULTS: The final data analysis included a total of 634 patients admitted and treated with ceftriaxone from January 2019 to December 2019.In the multivariate analysis with propensity score adjustment, ceftriaxone was independently associated with liver injury, especially when combined with other agents utilizing hepatic metabolism. CONCLUSIONS: Ceftriaxone was associated with a significantly higher incidence of liver injury (19.7%) when used along with other medications that are metabolized in the liver, as found in the present study compared with other similar studies (approximately 2.9%-13.9%). Furthermore, the incidence was too high to be ignored in clinical practice.

Convalescent plasma for the treatment of patients with severe coronavirus disease 2019: A preliminary report.

BACKGROUND: The role of convalescent plasma therapy for patients with coronavirus disease 2019 (COVID-19) is unclear. METHODS: We retrospectively compared outcomes in a cohort of critical COVID-19 patients who received standard care (SC Group) and those who, in addition, received convalescent plasma (CP Group). RESULTS: In total, 40 patients were included in each group. The median patient age was 53.5 years (interquartile range [IQR] 42-60.5), and the majority of patients required invasive ventilation (69, 86.2%). Plasma was harvested from donors after a median of 37 days (IQR 31-46) from the first positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) result and 26 days (IQR 21-32) after documented viral clearance; it was administered after a median of 10 days (IQR 9-10) from the onset of symptoms and 2.5 days (IQR 2-4) from admission to intensive care unit. The primary endpoint of improvement in respiratory support status within 28 days was achieved in 26 patients (65%) in the SC Group and 31 patients (77.5%) in the CP Group (p = .32). The 28-day all-cause mortality (12.5% vs. 2.5%; p = .22) and viral clearance (65% vs. 55%; p = .49) were not significantly different between the two groups. Convalescent plasma was not significantly associated with the primary endpoint (adjusted hazard ratio 0.87; 95% confidence interval 0.51-1.49; p = .62). Adverse events were balanced between the two study groups. CONCLUSION: In severe COVID-19, convalescent plasma therapy was not associated with clinical benefits. Randomized trials are required to confirm our findings.

Diagnostic Performance of Point-of-Care Troponin I and Laboratory Troponin T in Patients Presenting to the ED with Chest Pain: A Comparative Study.

BACKGROUND: Chest pain is a common symptom in patients visiting the emergency department (ED). Diagnosing acute coronary syndrome is a challenging task for emergency physicians. Evaluation of chest pain depends on clinical symptoms and signs, ECG, and cardiac enzymes. Here, we aimed to compare the diagnostic performance of the point-of-care troponin I assay with laboratory HsTnT assay in patients presenting to the ED with chest pain. METHODS: A prospective study was done at the ED of Alkhor Hospital, Hamad Medical Corporation, between March 2016 and December 2016. Patients more than 18 years old who presented to the ED with chest pain were enrolled. Patients with renal failure, initial ECG showing ST-elevation MI, or arrhythmias, and hemodynamically unstable patients were excluded. A blood sample was collected at 0 and 3 hours post-admission for POC TnI and laboratory HsTnT assay. The sensitivity, specificity, PPV, NPV, and AUC were determined and compared. RESULTS: Out of 313 patients enrolled, ten were excluded. At 0 hour, the POC TnI assay had a lower sensitivity (72.5% versus 97.5%) and had almost equal specificity (99.24% versus 93.2%) when compared to lab HsTnT assay. At 3 hours post-admission, the sensitivity increased to 95% versus 100%, and specificity was 100% versus 94.3% when compared to lab HsTnT. The POC TnI assay had a higher PPV than HsTnT, whereas both assays showed a high NPV at 0 and 3 hours. CONCLUSION: Although the diagnostic performance of POC TnI was lower than that of Lab HsTnT at 0 hour, at 3 hours post-admission, the diagnostic performance was almost equal to that of HsTnT. Hence we conclude that chest pain in patients with a negative POC TnI at 3 hours post-admission is unlikely to be due to NSTEMI.