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Zaqout A, Daghfal J, Munir W, Abdelmajid A, Albayat SS, Abukhattab M, Al-Maslamani MA. Clinical manifestations and outcome of Mpox infection in Qatar: An observational study during the 2022 outbreak. J Infect Public Health 2023; 16:1802-1805. [PMID: 37741014 DOI: 10.1016/j.jiph.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 08/29/2023] [Accepted: 09/03/2023] [Indexed: 09/25/2023] Open
Abstract
Mpox emerged in May 2022 as a global outbreak, mostly in hitherto non-endemic countries. To describe the epidemiological and clinical characteristics of mpox in Qatar, data were retrospectively retrieved for all laboratory-confirmed mpox cases diagnosed in Qatar between May and November 2022. Twelve cases were identified; of which 10 were males, and the median age was 33.5 years (IQR 24.5-37.5). Recent sexual exposure was reported in 9 patients, 6 of which were outside Qatar. Seven individuals reported exclusive heterosexual contact. Pleomorphic skin lesions were present in all cases, with anogenital involvement in 11. Fever (7/12) and lymphadenopathy (4/12) were relatively common. All cases were HIV-negative. The majority of cases had an uncomplicated and self-limiting clinical illness. In conclusion, the majority of early mpox infections in Qatar were purportedly acquired through heterosexual contact, primarily among middle-aged men. The clinical course was mostly uneventful. In the absence of active case finding and the mild and self-limiting nature of the clinical illness, undetected community transmission cannot be ruled out.
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Affiliation(s)
- Ahmed Zaqout
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar; Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Joanne Daghfal
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar.
| | - Waqar Munir
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar; Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Alaaeldin Abdelmajid
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar; Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Soha S Albayat
- Department of Public Health, Ministry of Public Health, Doha, Qatar.
| | - Mohammed Abukhattab
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar; Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Muna A Al-Maslamani
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar; Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.
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Elmekaty EZI, Maklad A, Abouelhassan R, Munir W, Ibrahim MIM, Nair A, Alibrahim R, Iqbal F, Al Bishawi A, Abdelmajid A, Aboukamar M, Hadi HA, Khattab MA, Al Soub H, Al Maslamani M. Evaluation of anakinra in the management of patients with COVID-19 infection: A randomized clinical trial. Front Microbiol 2023; 14:1098703. [PMID: 36778864 PMCID: PMC9910697 DOI: 10.3389/fmicb.2023.1098703] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023] Open
Abstract
Background The global COVID-19 pandemic led to substantial clinical and economic outcomes with catastrophic consequences. While the majority of cases has mild to moderate disease, minority of patients progress into severe disease secondary to the stimulation of the immune response. The hyperinflammatory state contributes towards progression into multi-organ failure which necessitates suppressive therapy with variable outcomes. This study aims to explore the safety and efficacy of anakinra in COVID-19 patients with severe disease leading to cytokine release syndromes. Methods In this open-label, multi-center, randomized clinical trial, patients with confirmed COVID-19 infection with evidence of respiratory distress and signs of cytokine release syndrome were randomized in 1:1 ratio to receive either standard of care (SOC) or anakinra (100 mg subcutaneously every 12 h for 3 days then 100 mg subcutaneously once daily for 4 days) in addition to SOC. The primary outcome was treatment success at day 14 as defined by the WHO clinical progression score of ≤3. Primary analysis was based upon intention-to-treat population, with value of p of <0.05. Results Out 327 patients screened for eligibility, 80 patients were recruited for the study. The mean age was 49.9 years (SD = 11.7), with male predominance at 82.5% (n = 66). The primary outcome was not statistically different (87.5% (n = 35) in anakinra group vs. 92.5% (n = 37) in SOC group, p = 0.712; OR = 1.762 (95%CI: 0.39-7.93). The majority of reported adverse events were mild in severity and not related to the study treatment. Elevated aspartate aminotransferase was the only significant adverse event which was not associated with discontinuation of therapy. Conclusion In patients with severe COVID-19 infection, the addition of anakinra to SOC treatment was safe but was not associated with significant improvement according to the WHO clinical progression scale. Further studies are warranted to explore patients' subgroups characteristics that might benefit from administered therapy. Clinical Trial Registration Trial registration at ClinicalTrials.gov, identifier: NCT04643678.
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Affiliation(s)
- Eman Zeyad I. Elmekaty
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar,*Correspondence: Eman Zeyad I. Elmekaty,
| | - Aya Maklad
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | | | - Waqar Munir
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Arun Nair
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - Rim Alibrahim
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - Fatima Iqbal
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad Al Bishawi
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Mohamed Aboukamar
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - Hamad Abdel Hadi
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Hussam Al Soub
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - Muna Al Maslamani
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
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Abdelmajid A, Osman W, Musa H, Elhiday H, Munir W, Al.Maslamani MA, Elmekaty EZ. Remdesivir therapy causing bradycardia in COVID-19 patients: Two case reports. IDCases 2021; 26:e01254. [PMID: 34401329 PMCID: PMC8359645 DOI: 10.1016/j.idcr.2021.e01254] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 11/18/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has been an enormous public health challenge. The pursuit for an effective therapy led to the use of the antiviral drug Remdesivir for hospitalized patients with severe COVID-19 pneumonia. We reported two cases of patients with severe COVID-19 pneumonia and worsening oxygen requirements. Both patients developed sinus bradycardia following the initiation of Remdesivir therapy and reverted after stopping it. One of the patients developed QTc interval prolongation and required intensive care unit admission. The proposed mechanism for Remdesivir-induced bradycardia and cardiac toxicity could be due to the intrinsic electrophysiological properties and the effect on the AV node; yet, further large observational studies are warranted for better understanding and correlation of Remdesivir with cardiac adverse events. Till then, healthcare providers need to be alert of this potential adverse event and to monitor their COVID-19 patients closely while on Remdesivir therapy.
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Affiliation(s)
- Alaaeldin Abdelmajid
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Wala Osman
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - Huda Musa
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - Hisham Elhiday
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Waqar Munir
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Muna A. Al.Maslamani
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Eman Zeyad Elmekaty
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
- Correspondence to: Dr. Eman Zeyad Ibrahim Elmekaty, BSc (Pharm), PharmD, SIDP/ASCP. Clinical Pharmacy Department - Infectious Disease. Communicable Disease Center at Hamad Medical Corporation (HMC). Box 3050 Doha, Qatar.
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Yousaf Z, Munir W, Hammamy RAM. Use of SGLT-2 inhibitor in COVID-19: A cautionary tale. MedComm (Beijing) 2021; 2:114-116. [PMID: 33821255 PMCID: PMC8013199 DOI: 10.1002/mco2.45] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 01/05/2023] Open
Affiliation(s)
- Zohaib Yousaf
- Department of Medicine Hazm Mebaireek General Hospital Hamad Medical Corporation Qatar
| | - Waqar Munir
- Department of Medicine Hazm Mebaireek General Hospital Hamad Medical Corporation Qatar
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Ali M, Howady F, Munir W, Karim H, Al-Suwaidi Z, Al-Maslamani M, Alkhal A, Elmaki N, Ziglam H. Drug-resistant tuberculosis: an experience from Qatar. Libyan J Med 2020; 15:1744351. [PMID: 32238120 PMCID: PMC7170354 DOI: 10.1080/19932820.2020.1744351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 01/22/2020] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Maisa Ali
- Department of Infectious Disease, Communicable Diseases Centre, Hamad Medical Corporation, Doha, Qatar
| | - Faraj Howady
- Department of Infectious Disease, Communicable Diseases Centre, Hamad Medical Corporation, Doha, Qatar
| | - Waqar Munir
- Department of Infectious Disease, Communicable Diseases Centre, Hamad Medical Corporation, Doha, Qatar
| | - Hanfa Karim
- Department of Infectious Disease, Communicable Diseases Centre, Hamad Medical Corporation, Doha, Qatar
| | - Zubaida Al-Suwaidi
- National Tuberculosis Reference Laboratory, Hamad Medical Corporation, Doha, Qatar
| | - Muna Al-Maslamani
- Department of Infectious Disease, Communicable Diseases Centre, Hamad Medical Corporation, Doha, Qatar
| | - Abdullatif Alkhal
- Department of Infectious Disease, Communicable Diseases Centre, Hamad Medical Corporation, Doha, Qatar
| | - Nada Elmaki
- Department of Infectious Disease, Communicable Diseases Centre, Hamad Medical Corporation, Doha, Qatar
| | - Hisham Ziglam
- Department of Infectious Disease, Communicable Diseases Centre, Hamad Medical Corporation, Doha, Qatar
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Sharma R, Sardar S, Arshad AM, Ata F, Zara S, Munir W. A Patient with Asymptomatic SARS-CoV-2 Infection Who Presented 86 Days Later with COVID-19 Pneumonia Possibly Due to Reinfection with SARS-CoV-2. Am J Case Rep 2020; 21:e927154. [PMID: 33257644 PMCID: PMC7718490 DOI: 10.12659/ajcr.927154] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/20/2020] [Accepted: 09/30/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has radically changed the world, and promising vaccine trials are currently underway. The immune responses in asymptomatic and symptomatic individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are still under investigation, and data are evolving. While it is known that humoral and cell-mediated immune responses against SARS-CoV-2 are elicited, it is uncertain whether these responses protect against reinfection or that they provide definitive evidence of viral clearance. Very few cases have been reported in the literature regarding reinfection with SARS-CoV-2. CASE REPORT We present a case of a middle-aged man with asymptomatic SARS-CoV-2 infection who later developed mild symptomatic COVID-19 after a period of 3 months. The source of reinfection was likely from the community, which had a soaring burden of infection with the highest number of COVID-19 cases per million in the world at that time. The patient had 2 negative COVID-19 polymerase chain reaction (PCR) tests 2 weeks after the initial infection. During the second infection, a nasopharyngeal reverse-transcription PCR test and tests for the presence of COVID-19 immunoglobulin (Ig)M and IgG antibodies were all positive. CONCLUSIONS Reinfection with SARS-CoV-2 is a strong possibility. This case raises concerns that asymptomatic infections may not provide long-term protective immunity to all patients, which could make them susceptible to reinfection. Possible explanations for reinfection include an interval decrease in protective antibodies titers after SARS-CoV-2 infection that may be more prevalent in patients who had an asymptomatic infection. Other possibilities include viral reactivation after a prolonged carriage of the virus or delayed immune response.
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Affiliation(s)
- Rohit Sharma
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Sundus Sardar
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Fateen Ata
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Sabeen Zara
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Waqar Munir
- Department of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar
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Alhassan SM, Iqbal P, Fikrey L, Mohamed Ibrahim MI, Qamar MS, Chaponda M, Munir W. Post COVID 19 acute acalculous cholecystitis raising the possibility of underlying dysregulated immune response, a case report. Ann Med Surg (Lond) 2020; 60:434-437. [PMID: 33224493 PMCID: PMC7664478 DOI: 10.1016/j.amsu.2020.11.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/07/2020] [Accepted: 11/07/2020] [Indexed: 02/07/2023] Open
Abstract
Introduction Novel Coronavirus disease 2019 or COVID-19 has rapidly spread throughout the world and has become an unprecedented pandemic. It has a vast spectrum of clinical presentations and can affect various organs. Rarely, it has been reported to cause acalculous cholecystitis in a non ICU setting patient. Case presentation Here we report a rare association of COVID 19 with acalculous cholecystitis in a 40 years old healthy woman. She developed fever, malaise, generalized body weakness, and right hypochondrial pain after fourteen days of COVID 19 infection, raising the possibility of Post COVID dysregulated immune response resulting in acalculous cholecystitis. She was managed conservatively with broad spectrum antibiotics. Discussion Acalculous cholecystitis primarily occurs due to the gall bladder's hypomotility and most commonly seen in critically ill patients such as severe burns, mechanically ventilated patients, and prolonged parenteral nutrition. The management depends upon treating the underlying pathology and, in some severe cases, may need surgical intervention as well. Up to our knowledge, COVID 19, causing acalculous cholecystitis, is a rare association described only in a few critically ill patients but not in young, healthy patients. It can be attributed to the body's dysregulated immunological response against the virus resulting in systemic inflammation. Conclusion Currently, there is are no clear guidelines for managing acute cholecystitis in COVID-19 patients. It depends on the patient's clinical state and disease severity. We aim to highlight the importance of early diagnosis and management in such clinical scenarios to avoid fatal complications.
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Affiliation(s)
| | | | | | | | | | - Masautso Chaponda
- Hamad Medical Corporation, Doha, Qatar.,Communicable Disease Center, Doha, Qatar
| | - Waqar Munir
- Hamad Medical Corporation, Doha, Qatar.,Communicable Disease Center, Doha, Qatar
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Shams A, Ata F, Mushtaq K, Munir W, Yousaf Z. Coronary thrombosis in a young male with COVID-19. IDCases 2020; 21:e00923. [PMID: 32754426 PMCID: PMC7381412 DOI: 10.1016/j.idcr.2020.e00923] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 02/06/2023] Open
Abstract
COVID-19 can present with a broad clinical spectrum of cardiac manifestations. The procoagulant state in COVID-19 can independently increase the risk of coronary thrombosis in otherwise healthy patients. COVID-19 patients who develop typical chest pain should be investigated for acute myocardial infarction.
COVID-19 predominantly presents with respiratory symptoms, but other presentations are reported, including cardiac manifestations and thromboembolism. We present a healthy young gentleman with COVID-19 pneumonia, who developed acute ST-segment elevation myocardial infarction (STEMI) due to coronary thrombosis. He was managed successfully by primary percutaneous coronary intervention (PPCI).
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Affiliation(s)
- Abdullah Shams
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Fateen Ata
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Kamran Mushtaq
- Department of Gastroenterology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Waqar Munir
- Department of Infectious Disease, Communicable Disease Center, Hamad Medical Corporation, Doha, Qatar
| | - Zohaib Yousaf
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Abstract
Hyponatremia is one of the most frequently observed electrolyte abnormalities in coronavirus disease 2019 (COVID-19). Literature describes syndrome of inappropriate anti diuretic hormone (SIADH) as the mechanism of hyponatremia in COVID-19 requiring fluid restriction for management. However, it is important to rule out other etiologies of hyponatremia in such cases keeping in mind the effect of an alternate etiology on patient management and outcome. We present a case of hypovolemic hyponatremia in a patient with COVID-19, which unlike SIADH, required fluid replacement early in the disease course for its correction. A 52-year-old Filipino gentleman presented with a three-week history of diarrhea and symptomatic hyponatremia. There was no history of fever or respiratory symptoms. Physical examination revealed a dehydrated and confused middle-aged gentleman. Labs revealed lymphopenia, thrombocytopenia, and severe hyponatremia (108 mmol/L). Blood cultures and stool workup were negative. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nasopharyngeal swab was positive. Hyponatremia workup excluded SIADH. The patient had hypovolemic hyponatremia due to gastrointestinal (GI) losses and was managed with saline infusion for correction of hyponatremia with improvement in his clinical status. Hyponatremia in COVID-19 is not only secondary to SIADH but can also be due to other etiologies. Hypovolemic hyponatremia should be distinguished from SIADH as these conditions employ different management strategies, and early diagnosis and management of hypovolemic hyponatremia affects morbidity and mortality.
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Affiliation(s)
- Adeel A Khan
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
| | - Fateen Ata
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
| | - Waqar Munir
- Infectious Disease, Hamad Medical Corporation, Doha, QAT
| | - Zohaib Yousaf
- Internal Medicine, Hamad Medical Corporation, Doha, QAT.,Clinical Research, Dresden International University, Dresden, DEU
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Ali M, Alhowady F, Munir W, Almaslamani M, Alkhal A, Alswaidi Z, Ziglam H. 800. Drug-Resistant TB: An Experience From Qatar. Open Forum Infect Dis 2018; 5. [PMCID: PMC6253567 DOI: 10.1093/ofid/ofy210.807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Methods Results Conclusion Disclosures
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Affiliation(s)
- Maisa Ali
- Infectious Disease, Hamad Medical Corporation, Doha, Qatar
| | | | | | | | | | | | - Hisham Ziglam
- Infectious Disease, Hamad Medical Corporation, Doha, Qatar
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Jadoon NA, Shahzad MA, Munir W, Bashir I. Sociodemographic, clinical and lifestyle factors associated with psychiatric illness among individuals with diabetes. Int J Diabetes Dev Ctries 2012. [DOI: 10.1007/s13410-012-0076-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Jadoon NA, Munir W, Shahzad MA, Choudhry ZS. Assessment of depression and anxiety in adult cancer outpatients: a cross-sectional study. BMC Cancer 2010; 10:594. [PMID: 21034465 PMCID: PMC2988751 DOI: 10.1186/1471-2407-10-594] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Accepted: 10/29/2010] [Indexed: 01/06/2023] Open
Abstract
Background The prevalence of anxiety and depressive disorders in cancer patients and its associated factors in Pakistan is not known. There is a need to develop an evidence base to help introduce interventions as untreated depression and anxiety can lead to significant morbidity. We assessed the prevalence of depression and anxiety among adult outpatients with and without cancer as well as the effect of various demographic, clinical and behavioral factors on levels of depression and anxiety in cancer patients. Methods This cross-sectional study was carried out in outpatient departments of Multan Institute of Nuclear Medicine and Radiotherapy and Nishtar Medical College Hospital, Multan. Aga Khan University Anxiety and Depression Scale (AKUADS) was used to define the presence of depression and anxiety in study participants. The sample consisted of 150 diagnosed cancer patients and 268 participants without cancer (control group). Results The mean age of cancer patients was 40.85 years (SD = 16.46) and median illness duration was 5.5 months, while the mean age of the control group was 39.58 years (SD = 11.74). Overall, 66.0% of the cancer patients were found to have depression and anxiety using a cutoff score of 20 on AKUADS. Among the control group, 109 subjects (40.7%) had depression and anxiety. Cancer patients were significantly more likely to suffer from distress compared to the control group (OR = 2.83, 95% CI = 1.89-4.25, P = 0.0001). Performing logistic regression analysis showed that age up to 40 years significantly influenced the prevalence of depression and anxiety in cancer patients. There was no statistically significant difference between gender, marital status, locality, education, income, occupation, physical activity, smoking, cancer site, illness duration and mode of treatment, surgery related to cancer and presence of depression and anxiety. Cancers highly associated with depression and anxiety were gastrointestinal malignancies, chest tumors and breast cancer. Conclusions This study highlights high prevalence rates of depression and anxiety in cancer patients. Younger age was associated with a higher likelihood of meeting criteria for psychological morbidity. The findings support screening patients for symptoms of depression and anxiety as part of standard cancer care and referring those at a higher risk of developing psychological morbidity for appropriate care.
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Affiliation(s)
- Nauman A Jadoon
- Department of Medicine, Nishtar Medical College Hospital, Multan, Pakistan.
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