Hamad General Hospital

Abdominal aortic aneurysms (AAAs) are a serious medical condition that may culminate in internal bleeding and death. Clinicians are expected to assess the rupture risk of AAAs accurately to determine the mode and timing of intervention. In general practice, AAA diameter and growth rate are used as rupture risk indicators. However, numerous cases have been reported where relying solely on these two AAA characteristics has proven insufficient, suggesting that other biomechanical factors deserve further consideration. This paper aims to investigate the involvement of disturbed hemodynamics in AAA rupture. Twenty-two AAA cases that had progressed to the point where surgical intervention was necessitated were assessed to examine the flow dynamics around the rupture sites. Using computational fluid dynamics (CFD), four key wall shear stress (WSS)-related hemodynamic parameters were calculated for each studied case, namely the time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), endothelial cell activation potential (ECAP), and relative residence time (RRT). CFD geometries were developed exclusively using patient computed tomography images, and simulations were run with general physiological boundary conditions to demonstrate a clinically practical, low-input CFD pipeline. The study found that analyzing the spatial distribution of the WSS-related hemodynamic parameters can be a powerful approach for predicting the site of rupture in AAAs. Low TAWSS and high OSI/ECAP/RRT regions (specifically within the ranges: TAWSS 0-0.5 Pa, OSI 0.35-0.5, ECAP 1.6-2.0 Pa-1, RRT 24-30) were found to be high-risk locations for rupture. Additionally, the simultaneous analysis of all four parameters was critical for rupture risk assessment.

POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder, and skin changes) syndrome is a rare multisystem disorder caused by a monoclonal plasma cell dyscrasia, often presenting with a constellation of neuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes. Its initial manifestations frequently overlap with more common causes of chronic progressive neuropathy, such as chronic inflammatory demyelinating polyneuropathy (CIDP) and diabetic or paraproteinemic neuropathies, which can obscure the diagnosis and delay definitive treatment. We report a 45-year-old male with progressive bilateral lower-limb distal-predominant weakness and numbness over three months, in whom the clinical picture and cerebrospinal fluid findings initially supported a working diagnosis of CIDP, despite coexisting thrombocytosis, skin hyperpigmentation, and newly diagnosed diabetes mellitus. Electroneuromyography showed severe sensorimotor mixed axonal and demyelinating neuropathy, and cerebrospinal fluid analysis demonstrated albuminocytologic dissociation, further reinforcing the initial impression of CIDP and illustrating the diagnostic conflict. However, serum studies identified an IgA lambda monoclonal protein, and fluorodeoxyglucose positron emission tomography revealed a solitary, metabolically active lesion in the right femur, raising suspicion for an underlying plasma cell dyscrasia rather than isolated inflammatory neuropathy. Histopathological examination of the femoral lesion confirmed a lambda-restricted plasmacytoma with minimal bone marrow plasma cell infiltration, fulfilling the diagnostic criteria for POEMS syndrome in conjunction with polyneuropathy, monoclonal plasma cell disorder, plasmacytoma, thrombocytosis, and skin changes. This case highlights the importance of considering POEMS syndrome in patients with atypical or treatment-refractory CIDP-like presentations and systemic features, and it underscores how a stepwise, multidisciplinary diagnostic approach incorporating electrophysiology, advanced imaging, and targeted histopathology can resolve overlapping differentials and guide timely, targeted therapy

Septoplasty is a commonly performed procedure with known complications including infection, bleeding, ocular injury, septal abscess, septal perforation, and long-term sequelae; however, middle turbinate involvement is rare and sparsely described in the literature. We report the case of a 20-year-old woman with no significant medical history who underwent septoplasty with submucosal diathermy of the inferior turbinates at a private facility and subsequently presented with persistent nasal obstruction. Computed tomography demonstrated bilaterally hanging middle turbinates. The patient was managed with revision septoplasty, bilateral excision of the hanging middle turbinates with hemostasis, and repeat submucosal diathermy of the inferior turbinates, resulting in an uncomplicated postoperative course and complete symptomatic improvement. This case underscores the importance of preoperative computed tomography in revision septoplasty to delineate nasal anatomy and guide appropriate surgical management.

To investigate the association between C-reactive protein (CRP) with sensory symptoms and deficits and measures of small fiber damage. Adults with and without T2D underwent corneal confocal microscopy (CCM) and assessment of vibration perception threshold (VPT), DN4 symptom questionnaire, and fasting blood tests for CRP and metabolic markers. Of the 122 participants, 77 had T2D of whom 23 (29.9%) had DPN, and 45 were controls. CRP levels were significantly higher in those with T2D without and with DPN compared to controls (5.6 ± 2.9 and 5.4 ± 4.0 vs 3.8 ± 2.9 mg/L, P = 0.008 and P = 0.046, respectively), with no difference between those with and without DPN (P = 0.894). Higher CRP was independently associated with lower corneal nerve fiber density (CNFD) (β = -5.5 fibers/mm2 per 10 mg/L increase, P = 0.036), after adjusting for diabetes duration, BMI, HbA1c, and triglycerides. In the DPN group, those with positive symptoms (burning, painful cold, and electric shocks) had higher CRP levels compared to those with negative symptoms (6.5 ± 4.7 vs 3.8 ± 1.9 mg/L, P = 0.039). Elevated CRP is associated with small nerve fiber loss and positive neuropathic symptoms in T2D. These findings suggest that CRP may help identify individuals with inflammation-driven DPN who could benefit from targeted interventions.

To evaluate the long-term effects of sleeve gastrectomy (SG) on glucose excursion and hypoglycemia in persons without diabetes during the oral glucose tolerance test (OGTT). This quasi-experimental study included persons undergoing body contouring surgeries, some of whom had a history of SG, while the remaining did not have a history of SG. An OGTT (75 grams) was undertaken at four time points (before body contouring surgery, immediate postoperative, short-term, and long-term postoperative). Glucose levels were measured at six time points (fasting, 15, 30, 45, 60, and 120 min). Glucose excursion was analyzed using Tai's trapezoidal rule and Doi's weighted average glucose (dwAG). Statistical models included linear and logistic regression. The study evaluated 125 OGTTs. The SG group exhibited significantly higher rates of level 1 hypoglycemia (12.5%) compared to the non-SG group (3.2%). SG increased the odds of hypoglycemia 8-fold [OR: 8.11, (95% UI: 1.43-45.95)] compared to the non-SG group. Hypoglycemia occurred predominantly at 120 min. Logistic regression indicated no relationship of age, body fat, and gender on hypoglycemia odds. The unified measures (dwAG and Tai's area) demonstrated that glucose excursion was less after SG then with participants without bariatric surgery. SG alters the OGTT responses, leading to increased risk of late post-load hypoglycemia in participants without diabetes. Data from this study will assist with OGTT management in post-SG patients, and it is suggested that use of unified measures like dwAG may be useful.

Early identification of patients at risk for admission to the medical intensive care unit (MICU) at the time of medical admission is crucial for optimizing resource utilization and improving patient outcomes. No standardized, unified scoring system exists to predict MICU requirements for early medical admissions (EMA). This study aimed to develop and validate a predictive scoring system, the Medical Intensive Care Admission Prediction Score (MICAPS), to identify patients at high risk of transfer to the MICU based on demographic data, triage hemodynamics, and limited presentation-day laboratory data. This retrospective cross-sectional study included 11,847 adult patients admitted to medical floors via the emergency department (ED) at Hamad General Hospital, Qatar, between January 2019 and December 2019. Cerner® was used to extract relevant data. Multivariate logistic regression identified significant predictors of MICU admission, and regression coefficients were used to develop the MICAPS model. ROC curve analysis and bootstrapping methods were employed to validate the model’s performance and accuracy. Of 11,847 patients admitted to medical services, 909 (7.7%) were transferred to MICU. Significant predictors included male gender (OR: 1.41, 95% CI: 1.17-1.70), age ≤ 60 years (OR: 2.15, 95% CI: 1.72–2.68), abnormal respiratory rate (OR: 2.35, 95% CI: 1.48–3.72), oxygen saturation < 88% (OR: 1.95, 95% CI: 1.30–2.92), Glasgow Coma Scale < 9 (OR: 6.54, 95% CI: 4.91–8.71), RRT activation (OR: 3.82, 95% CI: 3.19–4.56), and abnormal laboratory values such as WBC ≥ 10 (OR: 1.29, 95% CI: 1.08–1.54) and lactate > 1.7 mmol/L (OR: 1.96, 95% CI: 1.64–2.34). MICAPS demonstrated good predictive power, with an area under the ROC curve of 0.809 (95% CI: 0.79–0.82), a sensitivity of 67.4%, a specificity of 81.3%, and a positive likelihood ratio of 3.60 at a score of ≥ 40. MICAPS is a simple-to-apply scoring system that enables the identification of patients early in their hospitalization who may require ICU care later during the hospital stay. It can support early clinical decision-making and optimize resource allocation in emergency departments, medical floors, and critical care settings. Further multicenter prospective validation is needed to assess its generalizability in the real world. Not applicable.

DeepSeek is a recently launched large language model (LLM), whereas GPT-4o is an advanced ChatGPT version whose electrocardiography (ECG) interpretation capabilities have been previously studied. However, DeepSeek's performance in this domain remains unexplored. This study aims to evaluate DeepSeek's accuracy in ECG interpretation and compare it with GPT-4o, emergency medicine specialists, and cardiologists. A secondary aim is to assess any performance changes in GPT-4o over one year. Between February 9 and March 1, 2025, 40 ECG images (20 daily routine, 20 more challenging) from the book 150 ECG Cases were evaluated by both GPT-4o and DeepSeek, each model tested 13 times. The accuracy of their responses was compared with previously collected answers from 12 cardiologists and 12 emergency medicine specialists. GPT-4o's 2025 performance was compared to its 2024 results on identical ECGs. GPT-4o outperformed DeepSeek with higher median correct answers on daily routine (14 vs. 12), more challenging (13 vs. 10), and total ECGs (27 vs. 22) with statistically significant differences (p=0.048, p<0.001, p<0.001). A moderate agreement was observed between the responses provided by GPT-4o (p<0.001, Fleiss Kappa=0.473), while a substantial agreement was observed in the responses provided by DeepSeek (p<0.001, Fleiss Kappa=0.712). No significant year-over-year improvement was observed in GPT-4o's performance. This first evaluation of DeepSeek in ECG interpretation reveals its performance is lower than that of GPT-4o and human experts. While GPT-4o demonstrates greater accuracy, both models fall short of expert-level performance, underscoring the need for caution and further validation before clinical integration.

Systemic lupus erythematosus (SLE) is a complex autoimmune disease with heterogeneous clinical presentations influenced by ethnicity, geography, and healthcare practices. This audit evaluated adherence to key quality indicators for SLE management at Hamad General Hospital (HGH), a major public tertiary care center in Doha, Qatar, in line with international standards. A retrospective cross-sectional audit was conducted between March and July 2024 involving 61 patients with SLE attending the rheumatology clinic at HGH. This audit assessed adherence to four selected key quality indicators: hydroxychloroquine (HCQ) use, annual proteinuria screening, annual ophthalmologic screening for HCQ-related retinopathy, and medication reconciliation documentation during the most recent clinic visit. All patients were initiated on HCQ, with 11.5% discontinuing it due to adverse effects. Annual proteinuria screening was completed in 95% of patients. Ophthalmologic screening for HCQ-related retinopathy was documented in 65%, and medication reconciliation was completed in 72% of cases. The cohort represented a total of 21 nationalities, including Qataris who accounted for 31%-a proportion higher than their estimated 11.6% representation in Qatar's national population. While adherence to HCQ initiation and renal monitoring met international benchmarks, ophthalmologic screening and medication reconciliation rates were suboptimal and required improvement. Targeted system-level and educational interventions are planned to enhance adherence to these standards. Re-audit following implementation will be essential to assess progress and to sustain the quality of care.