Publications by authors named "Walid El Ansari"

164 Publications

Patient-reported orofacial-dental pain severity and tele-triage decisions during COVID-19 pandemic: Does the severity of pain drive tele-triage decisions?

BMC Oral Health 2022 07 27;22(1):310. Epub 2022 Jul 27.

Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.

Background: Globally, with the COVID-19 pandemic, dental services were limited to emergency/ urgent conditions and were provided only after tele-triage referral for face-to-face management. However, no previous research explored whether the pain severity (PS) drives the tele-triage decisions. The current study examined the association between PS and tele-triage decision of whether to manage the condition remotely or refer the caller for face-to-face management.

Methods: This retrospective cross-sectional study analyzed the PS reported by hotline callers, using numerical rating scale (NRS-11), during the first wave of COVID-19 lockdown (23 March-31 August 2020) and its association with tele-triage decision controlling for age, sex, history of chronic illness, and dental discipline needed. Binomial logistic regression assessed the association between the PS (exposure) and tele-triage decision (outcome). ANOVA compared PS across tele-triage categories, dental history and tentative diagnosis.

Results: PS was significantly associated with tele-triage decisions (p < 0.05). An increase in pain score by 1 unit was associated with 1.4 times increased odds of face-face referral (95% CI: 1.26-1.54). Pediatric/ adolescent patients (9-18 years) (odds ratio (OR) = 2.07; 95% CI: 1.07-4.02), history of chronic illness (OR = 2.12; 95% CI:1.28-3.51), need for surgical specialty (OR = 1.93; 95% CI: 1.22-3.04) and orthodontic specialty (OR = 7.02; 95% CI: 3.54-13.87) were independently associated with tele-triage decision. PS was highest for the emergency triage category (8.00 ± 2.83, P < 0.0001), dental history of tooth with cavity or filling (6.65 ± 2.024, P < 0.0001), and the tentative tele-diagnosis of cellulitis (7.75 ± 2.872, P < 0.0001).

Conclusions: During COVID-19 pandemic, tele-triage decisions were significantly influenced by patient-reported PS, adjusting for a range of variables. Despite this, referral for face-to-face management was individualized and driven by the tripartite considerations of the reported pain, clinical judgement, and the high transmission characteristics of COVID-19.
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http://dx.doi.org/10.1186/s12903-022-02340-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9326137PMC
July 2022

Subacute (De Quervain's) thyroiditis presenting as painful thyroid nodule suspicious of papillary thyroid carcinoma: Case report.

Int J Surg Case Rep 2022 Jun 23;96:107329. Epub 2022 Jun 23.

Department of General Surgery, Hamad General Hospital, Doha, Qatar.

Introduction: We report a case of subacute thyroiditis (SAT) in a 29 -year-old female who presented with painful thyroid swelling.

Presentation Of Case: Patient presented with neck pain, tender neck swelling and generalized fatigue. She had no history of neck or chest radiation or compressive symptoms. Ultrasound (US) imaging reveled bilateral nodules of the thyroid gland. Lymph nodes were unremarkable. FNAC was suspicious for papillary thyroid carcinoma. The patient was discussed at the thyroid multidisciplinary meeting, and after deliberation the decision was to offer the patient the choice of repeating FNAC of the bilateral nodules in one month or to proceed with total thyroidectomy.

Discussion: Despite being aware of the possibility that the final pathology could be benign, the patient insisted on total thyroidectomy, given that her FNAC results were suspicious of papillary thyroid carcinoma, and in order to avoid recurrence of the condition and the pain. Following the patient's preference, total thyroidectomy was performed, and surgery was not straightforward as intraoperatively, there was a diffusely inflamed gland. Histopathology findings revealed benign pathology. Follow up until 1.5 years showed that the patient was satisfied, and with normal voice.

Conclusion: SAT is a painful but potentially self-limiting. In some cases, FNAC findings might be suspicious for papillary thyroid carcinoma. Treatment is mostly conservative, but if the pain is severe and the patient insists on surgery as in our case despite the possibility of the condition being of benign pathology, then surgery should be undertaken.
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http://dx.doi.org/10.1016/j.ijscr.2022.107329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9284041PMC
June 2022

Health-Promoting Behavior and Lifestyle Characteristics of Students as a Function of Sex and Academic Level.

Int J Environ Res Public Health 2022 06 20;19(12). Epub 2022 Jun 20.

Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha 3050, Qatar.

University students frequently engage in unhealthy behaviors. However, there is a lack of studies examining a wide range of their lifestyle characteristics by sex and academic level of study. This cross-sectional survey of students enrolled in BSc, MSc, or PhD programs at one university in Germany ( = 3389) assessed physical activity (PA), sedentary behavior (SB), nutrition, sleep quality, and alcohol, tobacco, and other drug (ATOD) use by sex and academic level and was conducted with EvaSys version 8.0. Chi-squared tests compared categorical variables by sex, and binary logistic regression analyses adjusted for sex with Bonferroni adjustments evaluated differences across academic level. Although 91% of students achieved the aerobic PA guidelines, only 30% achieved the muscle strengthening exercises (MSE) guidelines, and 44% had high SB. Likewise, <10% met the fruit and vegetable consumption (FVC) recommendations, >40% of students experienced impaired sleep, and >30% had hazardous alcohol consumption. Less than 20% of the sample achieved the guideline/recommendation of all three PA, MSE and SB. Some behaviors exhibited significant sex and academic level differences. The identified at-risk groups included males (lower FVC), females (eating more during stress), and BSc students (poorer nutrition/sleep quality, more ATOD use). Given the above findings, multipronged strategies are needed with an overarching focus highlighting the health-academic achievement links. Behavioral interventions and environmental policies are required to raise awareness and promote student health.
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http://dx.doi.org/10.3390/ijerph19127539DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9224493PMC
June 2022

Atypical parathyroid adenoma: Series of two consecutive cases from a tertiary care hospital in Qatar.

Int J Surg Case Rep 2022 Jun 10;96:107296. Epub 2022 Jun 10.

Department of General Surgery, Hamad General Hospital, Doha, Qatar. Electronic address:

Introduction: Atypical parathyroid adenomas (APA) are an uncommon cause of hypercalcemia and comprise a minority of parathyroid adenomas.

Presentation Of Cases: Case 1 - Egyptian male, 48 years old with history of type 2 diabetes mellitus, incidentally discovered increased serum of calcium level on routine investigation, was diagnosed as PHPT, US and MIBI scan showed large left inferior parathyroid adenoma, focused exploration and excision of the APA was undertaken, histopathology confirmed APA. Case 2 - Egyptian male, 60 years old, cardiac patient with history of diabetes, hypertension and multiple cardiac interventions, had nausea, vomiting, constipation abdominal pain, polyuria, polydipsia, and history of passing renal stones, hypercalcemia workup showed primary hyperparathyroidism (PHPT), MIBI was negative and SPECT scan suggested right inferior parathyroid adenoma, focused exploration and excision of the APA was undertaken, histopathology confirmed APA.

Discussion: APA are an uncommon cause of hypercalcemia and are responsible for a minority of parathyroid adenomas. Combined US and MIBI and SPECT scans can detect APA. Focused exploration and excision of the APA under general anaesthesia can completely remove the APA.

Conclusion: Awareness of the physician and a high index of suspicion to symptoms or signs that could reflect an underlying PHPT is essential. Yearly biochemical and neck US follow up are required to detect any risk of recurrence or malignancy in the long term.
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http://dx.doi.org/10.1016/j.ijscr.2022.107296DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9233270PMC
June 2022

Preoperative Prediction of Body Mass Index of Patients with Type 2 Diabetes at 1 Year After Laparoscopic Sleeve Gastrectomy: Cross-Sectional Study.

Metab Syndr Relat Disord 2022 Aug 3;20(6):360-366. Epub 2022 May 3.

Department of Bariatric Surgery/Bariatric Medicine, Hamad Medical Corporation, Doha, Qatar.

Very few models predict weight loss among type 2 diabetes mellitus (T2D) patients after laparoscopic sleeve gastrectomy (LSG). This retrospective study undertook such a task. We identified all patients >18 years old with T2D who underwent primary LSG at our institution and had complete data. The training set comprised 107 patients operated upon during the period April 2011 to June 2014; the validation set comprised 134 patients operated upon during the successive chronological period, July 2014 to December 2015. Sex, age, presurgery BMI, T2D duration, number of T2D medications, insulin use, hypertension, and dyslipidemia were utilized as independent predictors of 1-year BMI. We employed regression analysis, and assessed the goodness of fit and "Residuals versus Fits" plot. Paired sample -tests compared the observed and predicted BMI at 1 year. The model comprised preoperative BMI ( = 0.757,  = 0.026) + age ( = 0.142,  < 0.0001) with adjusted of 0.581 ( < 0.0001), and goodness of fit showed an unbiased model with accurate prediction. The equation was: BMI value 1 year after LSG = 1.777 + 0.614 × presurgery BMI (kg/m) +0.106 × age (years). For validation, the equation exhibited an adjusted 0.550 ( < 0.0001), and the goodness of fit indicated an unbiased model. The BMI predicted by the model fell within -3.78 BMI points to +2.42 points of the observed 1-year BMI. Pairwise difference between the mean 1-year observed and predicted BMI was not significant (-0.41 kg/m,  = 0.225). This predictive model estimates the BMI 1 year after LSG. The model comprises preoperative BMI and age. It allows the forecast of patients' BMI after surgery, hence setting realistic expectations which are critical for patient satisfaction after bariatric surgery. An attainable target motivates the patient to achieve it.
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http://dx.doi.org/10.1089/met.2021.0153DOI Listing
August 2022

Is tele-diagnosis of dental conditions reliable during COVID-19 pandemic? Agreement between tentative diagnosis via synchronous audioconferencing and definitive clinical diagnosis.

J Dent 2022 07 26;122:104144. Epub 2022 Apr 26.

Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar; College of Medicine, Qatar University, Doha, Qatar; Weill Cornell Medicine, Qatar, Doha, Qatar; School of Health and Education, University of Skovde, Skovde, Sweden. Electronic address:

Objectives: To assess the reliability of synchronous audioconferencing teledentistry (TD) in making tentative diagnosis compared to definitive clinical face-to-face (CFTF) diagnosis; and whether agreement was influenced by dentist's experience, caller-patient relationship, and time of call.

Methods: All patients calling the TD hotline during COVID-19 pandemic, triaged as emergency/ urgent and referred for CFTF care were included (N=191). Hotline dentists triaged the calls, made tentative audio-dentistry (AD) diagnosis, while dentists at point of referral made the definitive CFTF diagnosis. Cohen's weighted kappa (κ) assessed the extent of agreement between AD vs CFTF diagnosis.

Results: There was significantly very good pair-wise agreement (κ = 0.853, P < 0.0001) between AD and CFTF diagnosis. AD diagnosis of pulpitis and periodontitis exhibited the most frequent disagreements. Tele-dentists with ≥ 20 years' experience exhibited the highest level of agreement (κ =0.872, P < 0.0001). There was perfect agreement when mothers mediated the call (κ = 1, P < 0.0001), and very good agreement for calls received between 7 am-2 pm (κ = 0.880, P < 0.0001) compared to calls received between 2-10 pm (κ = 0.793, P < 0.0001).

Conclusions: Remote tentative diagnosis using AD is safe and reliable. Reliability was generally very good but varied by dentist's experience, caller-patient relationship, and time of call.

Clinical Significance: The findings suggest that using AD in the home environment is safe and reliable, deploying providers with variable years of experience. The findings have generalizability potential to a variety of similar circumstances, healthcare settings and epi/pandemic situations.
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http://dx.doi.org/10.1016/j.jdent.2022.104144DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9040478PMC
July 2022

Grooved vs smooth ureteric stent before extracorporeal shockwave lithotripsy: Single-blind randomised clinical trial.

Arab J Urol 2022 7;20(1):41-48. Epub 2021 Dec 7.

Department of Surgery, Urology Section, Hamad Medical Corporation, Doha, Qatar.

Objective: No study compared the grooved stent to the widely used standard smooth (non-grooved) stent in humans. We compared stone clearance, complications, and patient tolerance of the grooved stent vs standard JJ stent.

Patients And Methods: Single-blinded randomised trial among patients planned for pre-extracorporeal shockwave lithotripsy (ESWL) stenting. Adult patients with unilateral ureteric/renal stones planned for ESWL were randomly assigned to receive (Percuflex) smooth ureteric stent or (Visiostar) grooved lithotripsy stent and blinded to the stent type. We collected and compared the baseline data and outcomes (stone-free rate, complications, and stent-related symptoms) of both patient groups.

Results: A total of 96 adults were included (48 per arm). There were no significant differences between the groups at baseline in terms of demographics, body mass index, comorbidities, renal function, number of ESWL sessions, and stone characteristics, including pre-ESWL stone volume (mean [SD] smooth 310.2 [301.6] vs grooved 270.7 [278.6] mm3, P = 0.5). Stone clearance was statistically insignificant between the groups, although clinically relevant (smooth stent 70.8% vs grooved stent 81.2%, P = 0.2). Grooved-stent patients reported comparable urinary symptoms score ( 0.05) and operative complications ( 0.6), but significantly more urinary tract infections (UTIs) not requiring hospitalisation ( 0.003).

Conclusions: Although statistically insignificant, the grooved stent exhibited higher stone clearance compared to the smooth stent, with similar complication rates excpet that patients with grooved stents reported more UTIs. A re-visit to the size of the outer diameter of the grooved stent could enhance its stone clearance properties, and further development of its coating material could lead to better patient satisfaction.
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http://dx.doi.org/10.1080/2090598X.2021.2004502DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8881060PMC
December 2021

What you see might not be what you get: Analysis of 15 prospective cases of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP).

Int J Surg Case Rep 2022 Feb 5;91:106751. Epub 2022 Jan 5.

Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.

Introduction: Noninvasive follicular thyroid neoplasm with papillary-like nuclear (NIFTP) is a new entity. No previous study reported prospective cases, outlining using many quantitative and qualitative variables.

Methods: Retrospective analysis of all (15) prospective NIFTP cases diagnosed between 2017 and 2021 at our institution. Statistical quantitative analysis outlined demographic, history, ultrasound, histopathology and treatment characteristics. Qualitative analysis examined the cases, with details provided on three cases to highlight the different possible presentations and configurations.

Results: Mean age was 41.5 ± 9.91 years, 73.3% were females, and mean BMI was 29.49 ± 5.74 kg/m. About 87% patients were symptomatic; 86.6% had neck swelling. Ultrasound (US) showed multiple nodules in 71.4% of cases. Fine-needle aspiration cytology (FNAC) showed that follicular lesion of undetermined significance (42.8%) was most common, followed by benign nodule (21.3%). Using the Bethesda System for Reporting Thyroid Cytopathology, 7 cases were category III, 3 category IV, 3 category II, and 1 category I. 60% of patients underwent total thyroidectomy. All cases were diagnosed postoperatively, 2 patients had additional papillary microcarcinoma. In 3 cases, the NIFTP site in the histopathology of resected specimen was different than the US-recommended site of the FNAC.

Conclusion: We found discrepancies in the site and diagnosis of the preoperative US recommendation for the FNAC vs the postoperative histopathology of the specimen. These suggest that NIFTP might be incidentally and postoperatively diagnosed, irrespective of US or FNAC findings, hence its 'true' incidence might remain underestimated. As NIFTP cases higher BMI, Future research could predict preoperative diagnosis of NIFTP and explore associations with BMI.
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http://dx.doi.org/10.1016/j.ijscr.2021.106751DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8858746PMC
February 2022

Effectiveness and Safety of Liraglutide in Managing Inadequate Weight Loss and Weight Regain after Primary and Revisional Bariatric Surgery: Anthropometric and Cardiometabolic Outcomes.

Obes Surg 2022 04 20;32(4):1005-1015. Epub 2022 Jan 20.

Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, 3050, Doha, Qatar.

Background: No study appraised the effectiveness and safety of liraglutide in managing inadequate weight loss or weight regain (IWL/ WR) after primary versus revisional bariatric surgery (BS).

Methods: Retrospective study of all eligible adults who completed liraglutide 3 mg therapy for IWL/WR after primary or revisional BS at our institution between May 2016 and June 2019 (N = 145; 119 primary, 82%; 26 revisional, 18%). Changes in anthropometric and cardiometabolic parameters were assessed before the start of liraglutide and at 6 and 12 months after treatment.

Results: The mean age was 43.32 ± 10.49 years, and 83% were females. Patients received liraglutide at a mean of 54.10 ± 31.75 months after their BS, for WR (74.3%) or IWL (25.6%). Liraglutide significantly reduced weight and BMI among primary and revisional patients (P < 0.0001 for all) and was equally effective in these reductions for both groups. Primary patients achieved total weight loss percentage (TWL%) of 5.97% and 6.93% at 6 and 12 months. Additionally, 52.3% and 60% of the patients lost ≥ 5% of their total weight (TW) at 6 and 12 months after primary BS. Revisional patients achieved TWL% of 6.41% and 4.99% at 6 and 12 months, and 60% and 48% of patients lost ≥ 5% TW at the two time points. Liraglutide did not improve cardiometabolic outcome for primary patients; for revisional patients, only the systolic blood pressure decreased after treatment. Liraglutide was well tolerated, and the most common side effect was nausea.

Conclusions: Liraglutide is useful as an adjunct weight loss medication for patients achieving unsatisfactory outcomes with BS.
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http://dx.doi.org/10.1007/s11695-021-05884-yDOI Listing
April 2022

Multiple nutritional deficiencies among adolescents undergoing bariatric surgery: who is at risk?

Surg Obes Relat Dis 2022 Mar 11;18(3):413-424. Epub 2021 Nov 11.

Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar; College of Medicine, Qatar University, Doha, Qatar; Weill Cornell Medicine-Qatar, Doha, Qatar; School of Health and Education, University of Skovde, Skovde, Sweden. Electronic address:

Background: Nutritional deficiencies among adolescents undergoing bariatric surgery (BS) have not been evaluated a in relation to patient's sex.

Objectives: We compared the preoperative nutritional profile of adolescents characterized by sex and single versus multiple deficiencies.

Setting: University hospital.

Methods: Cross-sectional retrospective chart review of 415 eligible adolescents who underwent primary BS between 2011 and 2020. Data included preoperative demographic, anthropometric information as well as three sets of nutritional variables: anemia-related, calcium-related, and other nutritional variables.

Results: The sample comprised 247 males (59.5%) with a mean age of 15.89 ± 1.03 years and a mean body mass index (BMI) of 47.80 ± 6.57 kg/m. Most common deficiencies were vitamin D (92.3%), albumin (51.8%), anemia (15.9%), zinc (11.1%), and vitamin B (8%); 21.7% had hyperparathyroidism. Females exhibited a significantly higher prevalence of low hemoglobin, low hematocrit, and iron deficiency. Multiple deficiencies were present among 97.6%, 73.2%, 23.6%, 15%, and 12.6% of adolescents, who had vitamin D, albumin, hemoglobin, zinc, and vitamin B deficiencies, respectively. Univariate analysis revealed that adolescents with a BMI of ≥50 kg/m were 1.24 times more likely to have multiple deficiencies (P = .004). Using multivariate log-binomial regression, BMI of ≥50 kg/m was a significant predictor of multiple nutritional deficiencies (P = .005, adjusted risk ratio = 1.23, 95% CI 1.06-1.42). Age and sex were not independent predictors of multiple nutritional deficiencies.

Conclusion: To our knowledge, this study is the first to appraise single and multiple nutritional deficiencies in adolescents undergoing BS by sex. Multiple deficiencies were common. Females are at higher risk of anemia-related deficiencies. A BMI of ≥50 kg/m independently and significantly predicted multiple nutritional deficiencies. Correction before and monitoring after surgery are important.
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http://dx.doi.org/10.1016/j.soard.2021.10.024DOI Listing
March 2022

Nutritional Deficiencies Among Adolescents Before and After Sleeve Gastrectomy: First Study with 9-Year Follow-up.

Obes Surg 2022 02 13;32(2):284-294. Epub 2021 Nov 13.

Department of Surgery, Hamad General Hospital, 3050, Doha, Qatar.

Background: Globally, only two studies appraised the long-term nutritional status of adolescents after laparoscopic sleeve gastrectomy (LSG).

Methods: Retrospective chart review of all adolescents aged ≤ 18 years who underwent LSG with ≥ 5 years follow-up and had no subsequent revisional surgery (N = 146). We assessed 15 nutritional parameters preoperatively and at 1, 3, 5, 7, and 9 years post surgery.

Results: Mean age was 16.51 ± 1.29 years, 51% were males. We identified three patterns: 1) Significant worsening of preoperative deficiencies: 4.7% and 0.8% of the sample exhibited zinc and vitamin B12 deficiencies, worsening to 20.8% and 12.8% at 1 year, respectively. Likewise, 0.7% of the sample had low total protein, worsening to 8.3% at year 3. A total of 32.4% of females had preoperative low hemoglobin worsening to 57.9% at year 5. 2) Significant improvement: the percentage of males with preoperative low hemoglobin (5.6%) was reduced to 4.1% and 5.1% at years 1 and 3, respectively. 3) Persistent deficiency: all (100%) of adolescents had preoperative vitamin D deficiency that persisted through years 3 and 9 at 90.5% and 100%, respectively. The most common complications were food intolerance (51%), vomiting (47.5%), gastritis/ esophagitis (35.7%), and gastroesophageal reflux disease (20.3%). We observed one case of Wernicke's encephalopathy. Across the 9 years, 15.4% of the adolescents underwent intra-abdominal surgeries where 12.6% had cholecystectomy and one patient had appendectomy.

Conclusion: Adolescents had several preoperative nutritional deficiencies, most of which worsened or persisted on the long term. This is the first study among adolescents to assess such deficiencies beyond 5 years.
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http://dx.doi.org/10.1007/s11695-021-05767-2DOI Listing
February 2022

First case of chronic cell leukemia discovered incidentally in extra-saccular inguinal lymph node during laparoscopic bilateral inguinal hernia repair. Case report and literature review.

Int J Surg Case Rep 2021 Nov 2;88:106558. Epub 2021 Nov 2.

Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar; College of Medicine, Qatar University, Doha, Qatar; Weill Cornell Medicine-Qatar, Doha, Qatar; School of Health and Education, University of Skovde, Skovde, Sweden. Electronic address:

Introduction: Chronic cell leukemia discovered incidentally in extra-saccular inguinal lymph node during laparoscopic bilateral inguinal hernia repair is extremely rare.

Presentation Of Case: 62-year-old Romanian male presented at the outpatient general surgery clinic in April 2019 complaining of bilateral inguinal swelling that gradually increased in size mainly on right side and was diagnosed with bilateral inguinal hernia. During the laparoscopic repair of the hernia, a large lymph node in the left femoral canal was incidentally observed. Histopathologic, immunohistochemical, and flowcytometric evaluation of the excised specimen confirmed chronic lymphocytic leukemia/small lymphocytic lymphoma.

Discussion: Whole body CT showed supra and infra-diaphragmatic lymphadenopathy, and few small subsolid pulmonary nodules, possibly metastatic. Splenomegaly and pancreatomegaly were also noted, suggesting lymphomatoid infiltration.

Conclusion: There is need for cautious inspection and meticulous palpation of the inguinal area for any lymphadenopathy during routine inguinal hernia repair.
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http://dx.doi.org/10.1016/j.ijscr.2021.106558DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8581364PMC
November 2021

Physical activity and mental health. Is achieving the physical activity guidelines associated with less depressive symptoms among undergraduates at the University of Turku, Finland?

Cent Eur J Public Health 2021 Sep;29(3):201-208

Department of Epidemiology and Biostatistics, King Fahad Specialist Hospital, Dammam, Saudi Arabia.

Objectives: Virtually no previous research assessed physical activity (PA) of university students in Finland, and their associations with depressive symptoms, whilst simultaneously controlling for potential confounders.

Methods: Students at the University of Turku (1,177) completed an online health and wellbeing questionnaire that assessed depressive symptoms (22 items), as well as their achievement of the guidelines of four forms of low, moderate, vigorous, and muscle strengthening PA (LPA, MPA, VPA, MSPA, respectively). We explored the associations of depressive symptoms with these PA forms, accounting for socio-demographic and health confounders (age, gender, year of study, marital status, accommodation during semesters, self-rated health).

Results: Achievement of PA guidelines was generally low for these young adult Finnish undergraduates. Bivariate relationships (no controlling for confounders) between depressive symptoms and four forms of PA guidelines achievement showed that in males, good/very good/excellent self-rated health, and achievement of the MSPA guidelines were significantly negatively associated with depressive symptoms. Conversely, low PA was significantly positively associated with depressive symptoms. Multiple regression (controlling for confounders) showed that achievement of the MSPA guidelines was independently significantly negatively associated with depressive symptoms; and whilst achievement of the MPA and VPA guidelines was negatively associated with depressive symptoms, the relationships did not reach statistical significance. Likewise, low PA was positively associated with depressive symptoms, but the relationships were again not statistically significant.

Conclusion: Universities would benefit from multipronged strategies and approaches employing effective interventions aimed at improving students' general awareness of their health and promoting more physically active lifestyles among students.
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http://dx.doi.org/10.21101/cejph.a6813DOI Listing
September 2021

Choroidal metastasis as initial presentation of aggressive medullary thyroid carcinoma with widespread mediastinal, brain, pituitary, bone, lung, and liver metastasis: Case report and literature review.

Int J Surg Case Rep 2021 Oct 16;87:106419. Epub 2021 Sep 16.

Department of General Surgery, Hamad General Hospital, Doha, Qatar.

Introduction: Medullary thyroid carcinoma (MTC) is a neuroendocrine tumor that originates from the parafollicular C cells of the thyroid gland. MTC can be due to sporadic or hereditary causes due to gain of function germ line mutations in the RET proto-oncogene. MTC presenting as ocular symptoms due to choroidal mass is rare with bad prognosis.

Presentation Of Case: A 38-year-old Sudanese male presented to Hamad General Hospital, complaining of sudden painless decrease of vision of the right eye of 3 weeks duration. After investigations using imaging methods, the patient was discovered to have metastatic MTC that presented as choroidal mass and metastasized to his lung, bone, brain, pituitary, liver and mediastinum.

Discussion: In terms of investigations, serum levels of calcitonin have superior diagnostic accuracy. Our patient undertook diagnostic imaging including ultrasonography, fine needle aspiration and computerized tomography (CT) scan and/or MRI imaging. He undertook total thyroidectomy and left neck dissection followed by stereotactic radiosurgery for the right orbit and pituitary. He then received systemic anti-RET therapy (Selpercatinib). At 5 months follow up there was dramatic drop in CEA from 888 μg/L to 164 μg/L, and calcitonin from >585.2 pmol/L to 354 pmol/L.

Conclusion: Choroidal metastasis as initial presentation of MTC is extremely rare and challenging to diagnose. Surgeons need a high index of suspicion when ocular symptoms accompany a neck mass or thyroid-related symptoms. MTC has a progressive course with involvement of blood vessels and neck lymph nodes. Choroidal metastasis of MTC is challenging to manage.
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http://dx.doi.org/10.1016/j.ijscr.2021.106419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8488480PMC
October 2021

Water clear cell ectopic non-iatrogenic giant parathyroid adenoma in sternohyoid muscle with thyroid nodule and asymptomatic hypercalcemia due to primary hyperparathyroidism: Case report and literature review.

Int J Surg Case Rep 2021 Sep 10;86:106295. Epub 2021 Aug 10.

Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.

Background: Ectopic parathyroid gland is not uncommon, and is associated with primary hyperparathyroidism. Giant parathyroid adenoma (PA) and concurrent presence of enlarged thyroid nodule increases the probability of ectopic location. The combination of a giant PA that is ectopic (within the strap muscle) in the neck is very rare, especially in cases with no previous surgery. The rare histopathological findings of the current case, water clear cell parathyroid adenoma (WCCPA), could explain the patient's presentation, since it has low endocrine function.

Case Presentation: A 56-year-old Qatari female on routine visit to primary health care physician for hypertension, was incidentally discovered to be hypercalcemic and was referred to the emergency department of our institution. Neck ultrasound showed a thyroid nodule on the left side, but Tc-sestamibi scintigraphy identified a left PA. FNAC of the thyroid nodule showed that it was a colloid nodule. She underwent left hemithyroidectomy and excision of left PA. Intraoperatively, the PA was giant and in the sternohyoid muscle. Intraoperative monitoring of intact PTH (IOiPTH) confirmed successful excision.

Discussion: Ectopic giant parathyroid adenoma is rare especially with the intramuscular location in sternohyoid muscle in the neck without previous neck surgeries. The presence of thyroid nodule could be a precipitating factor for migration of the PA. Preoperative assessment with the radiological image is crucial for diagnosis but sometimes fail to localized the PA.

Conclusion: Giant asymptomatic PA with long standing low function before hyperfunctioning should raise the suspicion of WCCPA. If diagnosis is confirmed, metastasis from a clear cell renal cell carcinoma should be ruled out.
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http://dx.doi.org/10.1016/j.ijscr.2021.106295DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8397889PMC
September 2021

First case of huge classic papillary thyroid cancer rupturing spontaneously leading to ischemic necrosis, perforation and inflammation of overlying skin: Case report and review of the literature.

Int J Surg Case Rep 2021 Aug 29;85:106136. Epub 2021 Jun 29.

Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.

Introduction: Papillary thyroid cancer (PTC) is the commonest form of well-differentiated endocrine carcinoma. It is categorized into indolent and aggressive, where the indolent subtypes (classic, follicular) rarely demonstrate aggressive behavior. We present a classic PTC presenting with a rapidly growing huge anterior neck mass that subsequently spontaneously ruptured subcutaneously resulting in ischemia, necrosis, and perforation of overlying skin leading to inflammation.

Presentation Of Case: A 37-year-old female with no comorbidities presented to our emergency department with a neck swelling of 2 years duration that rapidly enlarged one week prior to presentation. Though the mass initially appeared of inflammatory nature, the tumor was a PTC, and she underwent total thyroidectomy with selective right side neck dissection and debridement of necrotic skin. The gross specimen revealed a fragmented non-intact right thyroid lobe mass causing pressure ischemia, necrosis and perforation of the skin. Histopathology showed a 9 × 9 × 5 cm classic PTC staged as pT3b N1b. Postoperative course was uneventful, she was discharged by the eighth postoperative day, and then she received a high dose of radioactive iodine ablation (RAI).

Discussion: Classic PTC is usually of a smaller size and a relatively benign course compared to other PTC subtypes and thyroid cancers. It is indolent with favorable prognosis. Although it is associated with increased risk of lymph node metastases at the time of diagnosis, it is slow growing with high survival rates approaching 95%.

Conclusion: Despite that classic PTC progresses slowly, it should still be suspected in neck swellings presenting with rapid and aggressive behavior. Prompt and systematic assessment is required with surgical intervention and radioactive iodine ablation therapy.
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http://dx.doi.org/10.1016/j.ijscr.2021.106136DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8313845PMC
August 2021

Multi-Substance Use Behaviors: Prevalence and Correlates of Alcohol, Tobacco and Other Drug (ATOD) Use among University Students in Finland.

Int J Environ Res Public Health 2021 06 14;18(12). Epub 2021 Jun 14.

Department of Epidemiology and Biostatistics, King Fahad Specialist Hospital, Dammam 31444, Saudi Arabia.

Virtually no studies appraised the co-use of alcohol, tobacco, and other drug (ATOD) among Finn undergraduates. We assessed the associations between sociodemographic, health, academic, policy, and lifestyle characteristics (independent variables); and individual, multiple and increasing ATOD use (dependent variables) using regression analyses. Data were collected by online questionnaire at the University of Turku, Finland (1177 students). Roughly 22% of the sample smoked, 21% ever used illicit drug/s, 41% were high frequency drinkers, and 31.4%, 16.3%, and 6.7% reported 1, 2, or 3 ATOD behaviors respectively. Individual ATOD use was significantly positively associated with the use of the other two substances [adjusted odds ratio (Adj OR range 1.893-3.311)]. Multiple ATOD use was negatively associated with being single ( = 0.021) or agreeing with total smoking or alcohol ban policy on campus ( < 0.0001 for each); but positively associated with not living with parents ( = 0.004). Increasing ATOD behaviors were significantly less likely among those agreeing with total smoking or alcohol ban policy on campus ( range 0.024 to <0.0001). Demographics significant to either individual, multiple, or increasing ATOD use included males, being single, not living with their parents during semesters, and to some extent, religiosity. Age, depressive symptoms, perceived stress, self-rated health, health awareness, income sufficiency, and academic variables were not associated with individual, multiple, or increasing ATOD use. Education and prevention efforts need to reinforce abstinence from ATOD, highlight their harmful outcomes, and target risk groups highlighted above. University strategies should be part of the wider country-wide successful ATOD control policies.
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http://dx.doi.org/10.3390/ijerph18126426DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8296251PMC
June 2021

Third reported case of rare necrolytic migratory erythema associated with bacteraemia due to severe zinc deficiency after revisional Roux-En-Y gastric bypass: case report and literature review.

Eat Weight Disord 2022 Apr 1;27(3):1235-1241. Epub 2021 Jun 1.

Department of Bariatric Surgery/Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar.

Introduction: Obesity is a risk factor for zinc deficiency. After bariatric surgery, non-compliance to diet/vitamin supplements, surgical complications leading to vomiting/diarrhea, poor follow-up and malabsorption can precipitate or exacerbate pre-existing zinc deficiency.

Case Report: We report a patient with rare necrolytic migratory erythema associated with bacteraemia due to severe zinc deficiency after revisional Roux-en-Y gastric bypass (following primary laparoscopic sleeve gastrectomy).

Conclusion: Bariatric teams should screen patients before bariatric surgery for nutritional deficiencies and continue surveillance of their nutritional status after surgery. They should maintain a high index of suspicion for zinc deficiency in patients with skin rash after bariatric surgery.

Level Of Evidence: Level V, case report.
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http://dx.doi.org/10.1007/s40519-021-01154-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8964611PMC
April 2022

Second ever reported case of central cause of unilateral foot drop due to cervical disc herniation: Case report and review of literature.

Int J Surg Case Rep 2021 Jun 29;83:105928. Epub 2021 Apr 29.

Department of Orthopedic Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.

Background: Foot drop is defined as a weakness in the ankle and foot dorsiflexors. A disruption of the neural pathway starting from the motor prefrontal cortex and ending in the peroneal nerve can lead to foot drop. Foot drop due to lower motor neuron injury is well documented. However, foot drop due to a central cause of cervical disc prolapse is very rare.

Case Presentation: A 55-year-old male presenting with neck pain, right and left arms radicular pain and numbness, and unilateral right foot drop following cervical disc prolapse. The patient presented with upper motor neuron lesion signs. MRI showed cervical disc prolapse at two levels, confirming central cause of foot drop. The patient underwent anterior cervical decompression and fusion surgery.

Discussion: Following decompression and fusion of involved cervical spine disc pathology, the patient had complete recovery of his right foot drop.

Conclusions: Central causes, although rare, should be considered in the differential diagnosis of foot drop. Causes could be due to the compression effect of the cortico-spinal tract of the cervical spinal cord. Satisfactory results can be achieved upon correcting the causative lesion.
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http://dx.doi.org/10.1016/j.ijscr.2021.105928DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8141523PMC
June 2021

Durability of Cardiometabolic Outcomes Among Adolescents After Sleeve Gastrectomy: First Study with 9-Year Follow-up.

Obes Surg 2021 07 10;31(7):2869-2877. Epub 2021 Apr 10.

Department of Surgery, Hamad General Hospital, 3050, Doha, Qatar.

Background: Long-term durability of weight loss and comorbidity resolution beyond 7 years after laparoscopic sleeve gastrectomy (LSG) among adolescents is completely lacking.

Methods: Retrospective review of adolescents aged ≤ 18 years who underwent primary LSG at our institution between 2011 and 2015 (N = 146). We assessed anthropometric and cardiometabolic outcomes at 1, 3, 5, 7, and 9 years.

Results: Follow-up rates were 57.53%, 82.87%, 85.24%, 83.92%, and 83.33% at the five time points. The preoperative mean body mass index (BMI) (45.60 ± 6.50 kg/m) decreased at year 1 (30.04 ± 4.96 kg/m, P=0.001) and was maintained up to 9 years (30.20 ± 3.92 kg/m, P = 0.001). Remission rates were triglycerides, 100% (11/11) at 5 years, and 100% (1/1) at 9 years; high density lipoprotein, 89.4% (17/19) at 5 years, and 100% (3/3) at 7 years; low density lipoprotein, 71.4% (11/14) and 100% (3/3) at 5 and 7 years; total cholesterol, 70% (7/10) at 5 years, and 100% (2/2) at 9 years; uric acid, 100% (3/3) at 5 years. Remission of liver enzymes was 84.6-100% (22/26-2/2) at 5-9 years. Prediabetes remission was 87.5% (14/16 and 7/8) at 5 and 7 years and 100% (3/3) at year 9. Type 2 diabetes complete remission was 50% (3/6, 1/2) at years 5 and 7, with all cases resolved at 9 years. The only case of hypertension completely resolved.

Conclusions: LSG achieved substantial weight loss and remission of cardiometabolic risk factors that were sustained on the long term. This is the first study among adolescents to assess such outcomes beyond 7 years.
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http://dx.doi.org/10.1007/s11695-021-05364-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8175305PMC
July 2021

Prevalence and predictors of smoking, quit attempts and total smoking ban at the University of Turku, Finland.

Cent Eur J Public Health 2021 Mar;29(1):45-55

Department of Epidemiology and Biostatistics, King Fahad Specialist Hospital, Dammam, Saudi Arabia.

Objectives: The current study employed socio-demographic, health and lifestyle, and academic variables to assess the prevalence and independent predictors of daily smoking, attempts to quit smoking, and agreement with total smoking ban at university.

Methods: Students at the University of Turku (1,177) completed an online questionnaire that assessed socio-demographic, health and lifestyle, and academic characteristics, and three smoking variables (smoking, attempts to quit, agreement with total smoking ban at university). Bivariate relationships and multiple logistic regression assessed relationships between student characteristics and the three smoking variables before and after controlling for all other variables.

Results: Slightly < 80% of students never smoked, 16% were occasional, and about 6% were daily smokers, and about 40% had attempted to quit. Nearly half the sample agreed to total smoking ban at university. Physical activity, consuming alcohol, illicit drug/s use and daily smoking were significant independent predictors across > 1 of the three smoking variables. Age, health awareness, importance of achieving good grades, academic performance compared to peers, study burden, and mother's educational level were significant independent predictors of one of the three variables examined.

Conclusion: Universities need to assess smoking, with specific focus on the modifiable independent predictors that were associated with > 1 the variables examined, to encourage physical activity and pay attention to reduce alcohol consumption and illicit drug/s and daily smoking, whilst targeting at-risk students. University strategies should be part of the wider country-wide effective tobacco control policies.
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http://dx.doi.org/10.21101/cejph.a6576DOI Listing
March 2021

Epidemiology, histopathology, clinical outcomes and survival of 50 cases of appendiceal mucinous neoplasms: Retrospective cross-sectional single academic tertiary care hospital experience.

Ann Med Surg (Lond) 2021 Apr 6;64:102199. Epub 2021 Mar 6.

Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.

Background: Appendicular neoplasms are rare, most commonly as carcinoids followed by appendicular mucinous neoplasms (AMN). To date, there remains controversy regarding the best treatment of AMN and factors affecting its prognosis.

Method: Retrospective chart review of patients operated for appendicular pathology (January 2011-December 2018, follow up to December 2020) at our institution. For all AMN patients, data included pre-operative clinical presentation, and operative/post-operative findings.

Results: 12454 patients underwent appendectomy, of whom 50 (0.4%) had AMN histopathologically (mean age = 47.2). Most patients had laparoscopic appendectomy as primary surgery. Low grade AMN was the most common subtype (n = 41, 82%), and pseudomyxoma peritonei (PMP) was found in 8 (16%) patients. Based on histopathology and margin involvement, the 50 patients were categorized into 3 prognostic categories of recurrence risk (no risk, 24 patients; low risk, 8; high recurrence risk, 18 patients). Disease-free survival (DFS) was lowest for high recurrence risk group (P < 0.001). Eleven (22%) patients had AMN involving resection margin, of whom 3 had no completion surgery and had no recurrence. Higher tumor markers were associated with lower DFS, however it was not statistically significant.

Conclusion: AMNs are rare but serious due to the risk of PMP. Laparoscopic approach for AMN may be feasible. Prognostic categories were significantly inversely correlated with recurrence risk; hence useful in predicting prognosis. Contrary to previous proposals, AMNs with acellular mucin at margin or local acellular mucin spillage may not require secondary surgery, especially if the patient is in low recurrence risk group. Tumor markers may predict risk of recurrence.
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http://dx.doi.org/10.1016/j.amsu.2021.102199DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010208PMC
April 2021

Weight Regain and Insufficient Weight Loss After Bariatric Surgery: Definitions, Prevalence, Mechanisms, Predictors, Prevention and Management Strategies, and Knowledge Gaps-a Scoping Review.

Obes Surg 2021 04 8;31(4):1755-1766. Epub 2021 Feb 8.

Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, Doha, 3050, Qatar.

Some patients experience weight regain (WR) or insufficient weight loss (IWL) after bariatric surgery (BS). We undertook a scoping review of WR and IWL after BS. We searched electronic databases for studies addressing the definitions, prevalence, mechanisms, clinical significance, preoperative predictors, and preventive and treatment approaches including behavioral, pharmacological, and surgical management strategies of WR and IWL. Many definitions exist for WR, less so for IWL, resulting in inconsistencies in the reported prevalence of these two conditions. Mechanisms and preoperative predictors contributing to WR are complex and multifactorial. A range of the current knowledge gaps are identified and questions that need to be addressed are outlined. Therefore, there is an urgent need to address these knowledge gaps for a better evidence base that would guide patient counseling, selection, and lead to improved outcomes.
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http://dx.doi.org/10.1007/s11695-020-05160-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8012333PMC
April 2021

Ossifying fibromyxoid tumor in the lower extremity mimicking a sebaceous cyst. Case report and literature review.

Int J Surg Case Rep 2021 Feb 2;79:37-43. Epub 2021 Jan 2.

Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.

Introduction: Ossifying fibromyxoid tumor (OFMT) is an uncommon soft tissue neoplasm, with malignant potential and unclear histogenesis. OFMT exhibits a spectrum of histopathologic features including benign (typical), atypical and malignant subtypes. To the best of our knowledge, about 300 cases have been reported worldwide. We present the first reported case from Qatar.

Presentation Of Case: A 36-year old Egyptian male, with no comorbidities was admitted electively as a day case for excision of left thigh suspected sebaceous cyst under local anesthesia. History, physical examination and soft tissue ultrasound imaging were unremarkable. Intraoperatively, the patient was found to have a hard-calcified mass adhering to the surrounding fascia which was excised en bloc. The histopathology result was of ossifying fibromyxoid tumor. The post-operative course along with 40 months follow-up were uneventful in terms of surgical complications and recurrence.

Discussion: OFMT has marked features in terms of cytology. Though it is difficult to diagnose preoperatively, it should be considered in tumors involving soft tissue that demonstrate prominent ossification and calcification.

Conclusion: OFMT is a rare soft tissue neoplasm, and should be considered as a differential diagnosis in any subcutaneous swelling with a bony component. All OFMT patients should undergo a long course of follow-up to rule out and assess any recurrence or metastasis in the malignant variants.
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http://dx.doi.org/10.1016/j.ijscr.2020.12.086DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7811059PMC
February 2021

Giant mammary hamartoma in a middle aged female. Case report and review of literature of the last 15 years.

Int J Surg Case Rep 2021 Jan 2;78:145-150. Epub 2020 Dec 2.

Department of Breast Surgery, Hamad Medical Corporation, Doha, Qatar.

Background: Mammary hamartoma is a benign rare tumour occurring in both sexes, with size range mostly between 2-4 cm. Giant breast hamartoma (GMH) is very rare and can reach unexpected sizes in women.

Presentation Of The Case: A 26 year old Egyptian female presented with left breast lump since 3 years, gradually increasing in size, with no other associated complaints. No family history of breast cancer, she did not smoke or consume alcohol, and had no past medical history. Examination revealed a large soft freely mobile mass (12 × 9 cm) in the lower outer quadrant of the left breast at the 3-6 o'clock position. There were no palpable axillary lymph nodes in both sides. Nipples and right breast were normal.

Discussion: The diagnosis of GMH can be made by examination and imaging only. The specific features that appear in mammogram and ultrasound can be used to reduce the need for core biopsy in hamartoma. Wide local excision is curative. We include a review of the literature of cases of GMH > 10 cm published during the last 15 years.

Conclusion: A non-invasive mammogram and ultrasound provide sufficient evidence of the tumour, hence core biopsy might not be critically required. However, if a breast hamartoma is still clinically suspected but with inconclusive or unequivocal mammographic and ultrasonographic features or if there is suspicion of dysplasia, then invasive core biopsy is justified. Recurrence is low and prognosis is good.
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http://dx.doi.org/10.1016/j.ijscr.2020.11.139DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7770458PMC
January 2021

First bilateral non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) co-occurring with bilateral papillary thyroid microcarcinoma. Case report and literature review.

Int J Surg Case Rep 2021 Jan 2;78:411-416. Epub 2020 Dec 2.

Department of General Surgery, Hamad General Hospital, Doha, Qatar.

Introduction: Non-invasive follicular thyroid neoplasm with papillary-like features (NIFTP) is a recently characterized lesion with very low malignant potential. This has allowed for less aggressive management of this tumor subtype. Papillary thyroid carcinoma (PTC) has malignant potential and requires different considerations in management.

Presentation Of Case: A 33-year-old woman presented to our Thyroid Surgery Clinic with a left neck swelling slowly enlarging over 4 years, and recent right-sided neck pain. Neck ultrasound and fine needle aspiration for cytology found bilateral thyroid nodules, labelled as 'follicular lesion of undetermined significance' (FLUS). Final pathology report after total thyroidectomy identified four distinct tumors: bilateral NIFTP lesions and bilateral papillary microcarcinomas.

Discussion: Management of NIFTP comprises partial or total thyroidectomy without further intervention. Management of PTC is the same but with the possible addition of radioactive ablation due to the increased malignant potential. This is the first report of bilateral NIFTP lesions and bilateral papillary microcarcinomas co-occurring together in the same patient, so management was challenging. The decision was made to give the patient low dose radioactive iodine ablation and continue monitoring. Ultrasound of the neck follow up 6 months later showed no residual thyroid tissue or local recurrence.

Conclusion: Although rare, NIFTP can co-occur with PTC. Bilateral NIFTP with bilateral PTC is extremely rare. Surgeons and pathologists need to be aware of this rare entity that can co-occur in both thyroid lobes. Total thyroidectomy is the definitive treatment. Post-surgery surveillance is important and follow up needs to be watchful for any recurrence or metastasis.
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http://dx.doi.org/10.1016/j.ijscr.2020.11.159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7814091PMC
January 2021

Right ectopic paraesophageal parathyroid adenoma with refractory hypercalcemia in pregnancy: A case report and review of the literature.

Int J Surg Case Rep 2020 28;77:229-234. Epub 2020 Oct 28.

Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.

Introduction: Ectopic parathyroid adenoma is rare during pregnancy but poses multiple challenges in treatment. It presents as primary hyperparathyroidism which leads to symptoms and complications of hypercalcemia in both the mother and fetus.

Presentation Of Case: A 38-year-old Sudanese female presented with diffuse bone pain and polyuria. Laboratory investigations revealed elevated serum calcium and parathyroid hormone. Ultrasound of the neck did not show any abnormal lesion, however 99mTc-sestamibi scan showed a right sided parathyroid adenoma, and an earlier CT scan showed the adenoma to be in an ectopic paraesophageal position. Focused surgical neck exploration was done, and the ectopic parathyroid adenoma was excised.

Discussion: Preoperative localization of the ectopic parathyroid adenoma allows for a focused surgical procedure. Ultrasound is the safest during pregnancy, but 99mTc-sestamibi and CT scan may be necessary if ultrasound or initial bilateral neck exploration do not detect any adenoma. Mild elevations in maternal serum calcium can have detrimental effects on the fetus which suggests that a surgical approach may be necessary in the majority of cases.

Conclusions: Ectopic parathyroid adenoma is rare during pregnancy and is detrimental to both the mother and fetus. Preoperative localization allows for a focused surgery which is a definitive treatment and can safely be performed during the 2nd trimester of pregnancy.
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http://dx.doi.org/10.1016/j.ijscr.2020.10.093DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7689332PMC
October 2020

Parental perceptions of child's healthy diet: Evidence from a rapidly developing country.

J Family Med Prim Care 2020 Sep 30;9(9):4949-4955. Epub 2020 Sep 30.

Department of Pediatrics, Section of Academic General Pediatrics, Sidra Medicine, Doha, Qatar.

Background: There are no studies in Qatar or in the Middle East to investigate parental perception of healthy diet in childhood.

Purpose: To investigate parental perception of childhood healthy diet in the State of Qatar.

Methods: Cross-sectional prospective study at Hamad Medical Corporation, State of Qatar. Parents of children <14 years old were invited to complete a questionnaire.

Results: A total of 398 parents agreed to participate, while 22 parents refused (response rate 94%). About 80% of parents were between 20 and 39 years of age, and 77% were females. Around 230 (58%) parents had ≥1 housemaid to help with housework, including food preparation. Whilst 151 children (37%) fell into the overweight and obese category, only 68 parents (17%) perceived that their child was in this category. Less than half the participants ( = 179, 45%) stated that childhood weight should be monitored prior to 5 years of age, while around 35% stated the same, but for children ages 5-14 years. Most participants ( = 324, 81%) agreed that parental eating habits could influence childhood weight. In terms of food preparation at home, mothers cooked almost 50% of the times, housemaids 30%, followed by grandmothers (16.6%), and fathers (3.4%). When asked about the frequency of school meals being prepared at home, 237 parents (60%) prepared their children's lunch box only 1-2 times per week. Moreover, 63% of parents chose the quality of food based on nutritional values, while 44% and 35% chose it based on safety and taste, respectively. When queried about whether the child's pediatrician or the primary care physician counsel families regarding childhood healthy diet, 187 families (47%) had not received counseling by their children's health care providers. Most families agreed that healthy diets lead to better school performance ( = 372, 94%) and better physical activity quality ( = 379, 96%). Compared to families living in the rural areas, parents living in the capital Doha had better insights that healthy diets result in better in school performance ( = 0.032).

Conclusion: Parental perception is an important target for public health interventions. Within the current sample, families were aware of the positive impact of healthy diet on overall wellbeing. Qatar is a well-resourced country and it would be cost effective to train and professionally develop pediatricians and primary care physicians to be more proactive in tackling childhood obesity.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_1252_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7652186PMC
September 2020

Epidemiology and pathology of oral squamous cell carcinoma in a multi-ethnic population: Retrospective study of 154 cases over 7 years in Qatar.

Ann Med Surg (Lond) 2020 Dec 20;60:195-200. Epub 2020 Oct 20.

Department of laboratory medicine and pathology, Hamad Medical Corporation, Doha, Qatar.

Background: Oral cancer (OC) is a neoplastic process of the oral cavity that has high mortality and significant effects on patients' aesthetics. The majority of OC is oral squamous cell carcinoma (OSCC) and resection remains the most frequent treatment. Recurrence is the main cause of tumor-related mortality.

Material And Methods: A retrospective review of patients' charts at Hamad Medical Corporation examined 154 adults who were diagnosed as OSCC and referred to the national head and neck cancer multi-disciplinary team meetings between 2012 and 2018. The data extracted was demographic, pathologic and clinical. All patients with oral cavity tumors other than squamous cell carcinoma were excluded.

Results: Males comprised the majority of the sample, mean age was 46.93 years. Tongue was the most common location. The majority of the patients were diagnosed at early stages, and a small subset of patients had histologically-proven local recurrence.

Conclusion: The young male predominance of OSCC patients in Qatar is unprecedented worldwide. Most patients were non-Qataris, mainly from South Asia. Loss of follow-up was a challenge in assessing the long-term outcomes of OSCC. Our findings suggest the need for a more vigilant surveillance approach to oral lesions particularly in male South-Asian patients, as well as improving the follow-up strategies.
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http://dx.doi.org/10.1016/j.amsu.2020.10.029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7610004PMC
December 2020
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