Drug-resistant tuberculosis: an experience from Qatar.

This study was conducted to evaluate the characteristics, treatment outcome and risk factors associated with 223 drug-resistant tuberculosis (DR-TB) cases in the State of Qatar. A descriptive records-based retrospective study was conducted on patients registered at Communicable Disease Centre (CDC), Qatar to all consecutive microbiologically confirmed tuberculosis cases for the period January 2010 - March 2015. Demographic, clinical data, drug-resistance pattern of isolated mycobacteria and treatment outcome was assessed for the patient who completed their treatment in Qatar. Of 3301 patients with positive M. tuberculosis culture were analyzed; 223 (6.7%) were resistant to at least one drug. The overall prevalence of multi-d rug resistant TB (MDR-TB) was 1.2% (n = 38) of patients. A former resident of Indian sub contents was the most common demographic characteristic observed (64.1%). The outcome of treatment was assessed for 85 resistant cases with follow-up after completion of treatment. Cure and relapse rates were 97.6%, and 2.4%, respectively. Drug-resistant TB in Qatar is influenced by migration where the patients were probably infected. Rapid sputum sampling performed in the early stages of the disease, patient isolation, and drug-susceptibility testing should be the standard of care.

It is all about patients' stories: Case-based learning in residents' education.

Background: Problem-based learning (PBL) is an inquiry-based learning strategy which is learner centered and facilitates group discussion and critical thinking. Case-based learning (CBL), which is a more guided approach of PBL, enables students to learn within the context of patients and formulate their knowledge around patients' scenarios. Midweek (MW) activity is an important educational activity in the internal medicine residency program (IMRP). CBL has shown many benefits in postgraduate education. The aim of our study was to describe the implementation of a teaching resident's management of acute medical conditions encountered during their call utilizing the CBL format and to evaluate resident satisfaction with the new teaching style. Methods: This study describes the implementation of CBL in residents' education at the IMRP. CBL was introduced in five of the 10 acute medical sessions taught in the noon activity. A mixed-method study was employed using both a structured questionnaire and a focus group to compare the two methods to evaluate the residents' satisfaction and perception of knowledge acquisition. Results: The focus group discussion showed that sessions conducted in CBL format were more engaging, interactive, and resulted in better knowledge acquisition through sharing and peer-to-peer teaching than the traditional lecture format. Thirty-nine out of 83 (47%) residents ranging from PGY2 to PGY4 responded to the survey. Overall satisfaction with CBL was good. Sixty-four percent preferred it over the lecture format; 87% found that they did improve their knowledge; 84% agreed that they were excellent and more interactive. Seventy-nine percent stated that they would like to have this type of teaching in the MW activity sessions. Conclusion: Based on the present study, we conclude that incorporation of CBL resulted in more engagement, interaction, peer-to-peer education, and overall residents' satisfaction. The key elements for a successful implementation of this format are both instructors' and residents' orientation and careful selection of the case scenarios (problems) that trigger the learning process. Incorporation of various teaching strategies in residents' education is mandatory to enhance learning and create excellent educational experiences.

Medical thoracoscopy for exudative pleural effusion: an eight-year experience from a country with a young population.

BACKGROUND: With the exception of areas with high prevalence of tuberculosis, medical thoracoscopy is becoming the diagnostic modality of choice for exudative pleural effusions. The aims of this study were to determine the diagnostic yield and safety of medical thoracoscopy for exudative pleural effusions and ascertain the etiology of such effusions in Qatar. METHODS: This is a retrospective-descriptive study of 407 patients who underwent diagnostic medical thoracoscopy for exudative pleural effusions from January, 2008 till December, 2015 at the only tertiary referral center performing this procedure in Qatar. RESULTS: Tuberculosis was the most common etiology of exudative pleural effusions in Qatar accounting for 84.5% of all causes. Around 85% of patients were young males (mean age of 33 ± 12.1 years). The diagnostic yield of medical thoracoscopy for tuberculous pleural effusion was 91.4%. Malignant pleural effusions accounted for 5.2% of cases. Minor bleeding occurred in 1.2% of cases with no procedure-related mortality observed. CONCLUSION: Medical thoracoscopy is a very safe procedure. Tuberculous pleuritis is by far the most common etiology of exudative pleural effusions in Qatar. Closed needle biopsy is a worth consideration as an initial safe, easy and low-cost diagnostic modality for exudative pleural effusions in this country.

Primary Pituitary Tuberculosis Revisited.

BACKGROUND Primary pituitary tuberculosis (in absence of other organ involvement and constitutional symptoms) is an extremely rare disease with total reported cases in the literature fewer than a hundred. Misdiagnosis as pituitary adenoma is common and late diagnosis can result in a permanent endocrine dysfunction and/or long-term neurologic sequelae. CASE REPORT We report on the case of a middle-aged woman who presented with severe headache and left third cranial nerve palsy. Magnetic resonance imaging (MRI) revealed a large pituitary tumor invading the left cavernous sinus. The case was initially misdiagnosed as pituitary adenoma. A pituitary biopsy was performed and was suggestive of pituitary tuberculosis. Extensive radiologic investigations did not reveal any evidence of other organ involvement by tuberculosis. She was successfully treated with anti-tuberculous medications. CONCLUSIONS In areas with a high pre-test probability of tuberculosis, pituitary tuberculosis should be included in the differential diagnosis of pituitary tumors in order to avoid unnecessary surgical interventions. Besides being the first histologically-proven primary pituitary tuberculosis case reported from Qatar, the current case is unique in that extensive radiologic investigations did not reveal any evidence of other systemic or pulmonary tuberculosis.

The burden of adult asthma in a high GDP per capita country: the QASMA study.

BACKGROUND: Asthma is a major health problem worldwide. Suboptimal asthma care and poor asthma control are common even in developed countries. Qatar has the highest gross domestic product per capita in the world and high per capita health expenditure. No prior study has assessed the burden of adult asthma in this country. OBJECTIVES: To assess asthma control, patients' level of education about asthma, and level of asthma care in a country with the highest gross domestic product per capita in the world. METHODS: A face-to-face, cross-sectional study of 520 adults with physician-diagnosed asthma conducted in various health care facilities in Qatar. RESULTS: Thirty-three percent, 41%, and 26% of patients had uncontrolled, controlled, and partly controlled asthma, respectively. Only 4.9% of patients had previously received a written asthma management plan, 3.5% had a flow meter at home, and 37.2% had a spirometry performed in the previous 5 years. In addition, 42.9% misunderstood the role of reliever and controller medications. Inhaler technique was incorrect in 47% of these patients. There was a significant association between the type of physician practice and level of asthma control, with worst control being at the general practice level. Moreover, 57.3% of patients had at least 1 asthma-related visit to the emergency department in 1 year and 18.7% had more than 3 visits. CONCLUSION: The very high gross domestic product per capita in Qatar and the high health expenditure per capita do not seem to have led to better asthma care and control. A comprehensive national asthma service improvement program is much needed.

Neurological manifestation of recreational fatal and near-fatal diethylene glycol poisonings: case series and review of literature.

Diethylene glycol is a common industrial solvent which is responsible for accidental and epidemic poisoning as early as the 1930s. Due to the unavailability and unaffordability of ethanol, people in Qatar among the low income group are consuming household chemicals, some of which contain diethylene glycol, for recreational purposes.The history of ingestion is usually not volunteered and the initial clinical presentation is usually nonspecific, making it difficult to diagnose from the clinical presentation. Moreover, the biochemical profile varies with time, making the diagnosis more difficult. The neurological course and toxicity is less well characterized than its renal counterpart. Moreover, reports in the literature of such recreational poisoning is lacking particularly in the region.Three cases of recreational diethylene glycol poisoning seen in Hamad General Hospital, Doha, Qatar from 2009 to 2012 are detailed here.These illustrate the clinical course with emphasis on the neurological sequelae that include encephalopathy and multiple cranial and peripheral neuropathies with fatal and near-fatal outcomes. Neuroimaging in 2 were initially normal, but follow-up imaging showed brain atrophy. The third patient's neuroimaging showed diffuse brain edema with evidence of transtentorial herniation. Nerve conduction studies were performed in 2 of the 3 cases and showed evidence of mixed sensorimotor neuropathy. The outcomes were death in 1 and severe neurological morbidity and disability in 2 cases.Diethylene glycol is a dangerous substance when ingested and can result in mortality and severe morbidity, particularly from the renal and neurological manifestations. Whereas the mechanism of damage is less well known, the damage is likely dose related. The typical clinical pattern of evolution of the poisoning in the absence of cost-effective ways to detect it in the serum can help clinicians in making the diagnosis.Neurological manifestations may include encephalopathy and multiple cranial and peripheral neuropathies with subsequent brain atrophy. Public awareness of the danger of such recreational use should be raised.