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This study demonstrates the development of alloying process and identifies the different alloys patterns used in Jezirah during the third millennium B.C. and examines if there was any relation between alloys patterns and the types of objects to be manufactured. To achieve these goals, findings of published studies that have analysed copper-based alloys chemically have been assembled and re-evaluated. In this multi-disciplinary paper, archaeometallurgical and archaeometric, 1279 copper-based alloys objects, from Jezirah, Mesopotamia and South-eastern Anatolian sites, were studied. Results of compositional analyses show that alloying process development in Jezirah during the third millennium B.C. was non-linear as was the case in the Mesopotamian and Anatolian schema. Three major types of different compositional patterns of copper-based alloys during the third millennium B.C. were used. At the beginning of third millennium B.C. arsenical copper alloys with arsenic content ≥ 4% were used alongside tin-bronze alloys with tin concentration from ≥ 2 to ≤ 5%. By the middle of the third millennium B.C., tin-bronze with tin content from ≥ 2 to ≥ 10%, arsenical copper alloys with arsenic content ≤ 2.5% and arsenical bronze with low tin and varied arsenic concentrations were diffused.

Background Actinomyces species are Gram-positive anaerobic branching bacilli which are commensal of oropharynx, urogenital and gastrointestinal tracts that is associated with infrequent chronic granulomatous diseases including cervicofacial, intrabdominal and genital infections. Actinomyces Blood Stream Infections (BSIs) are usually rare but becoming more frequent with advanced modern diagnostic techniques. The presented study aims to evaluate the spectrum and clinical relevance of Actinomyces BSI at Hamad Medical Corporation (HMC), Qatar. Methods A retrospective observational study was conducted for all reported Actinomyces species BSI at HMC between January 2016 to November 2020. Isolates were identified using modern automated BD PhoenixTM and MALDI-TOF microbiological methods. Results Over the five years study period, 37 episodes of Actinomyces BSIs were recorded the majority of which identified as Actinomyces odontolyticus (40.5 %, 15/37). The mean age was 32 years (range 1 month – 81 years), 62.2 % were females (23/37), 64.8 % had chronic medical conditions while 78.4 % developed fever as presenting illness. Out of the total cases, cultures were considered significant in only 48.6 % of cases (18/37), in which primary source of infection was oropharyngeal (10) followed by genitourinary (4), gastrointestinal (2) and 2 infected diabetic foot. However, 86.5 % (32/37) received antimicrobial therapy mainly as βlactam antibiotics or cephalosporins ranging between 3 days to 6 months. Antimicrobial therapy was given for a short duration in 87.5% (28/32) of cases for less than 14 days with no long-term complications while only four cases received prolonged therapy. The remaining Five patients did not receive any antibiotics as the cultures were considered contaminants by the primary provider. Conclusion Actinomyces species blood stream infection is becoming more frequent with advanced diagnostic techniques affecting all age groups. Females and patients with chronic comorbidities are more commonly affected while A. odontolyticus is the predominant isolated species. Almost half of the cases were not clinically relevant, but most cases received short courses of antimicrobial therapy with no long-term complications. Disclosures All Authors: No reported disclosures.

Euglycemic diabetic ketoacidosis (EDKA) is a well-known complication of sodium-glucose co-transporter 2 inhibitors, and many cases with variable onset following the initiation of these agents are reported before, with a median onset of approximately 2 wk. This letter discusses a 45-year-old lady who initially presented with ischemic stroke but developed EDKA 4 d after starting empagliflozin, a rare occurrence. The patient had severe metabolic acidosis that necessitated admission into the intensive care unit. Prompt discontinuation of empagliflozin and DKA management resulted in clinical recovery.

Introduction and importance Retroperitoneal fibrosis (RPF) is a rare disease characterized by the replacement of normal tissue with fibrosis and inflammation. We present the case of a 40-years-old gentleman with RPF whose presenting complaints were bilateral flank pain and weight loss and was found to have IgG4 related disease. To the best of our knowledge, IgG4-related disease with isolated retroperitoneal involvement is a very rare occurrence. Case presentation The diagnosis of IgG4-Related retroperitoneal fibrosis was made based on clinical, radiological and histopathological criteria. Imaging revealed isolated retroperitoneal involvement and the patient was started on oral steroids with a good clinical response after ten days. Repeated imaging months later showed significant regression in the fibrosis. Clinical discussion RPF can occur due to many etiologies and is categorized to idiopathic and secondary. Factors associated with secondary RPF include medications, autoimmune disease, malignancy and IgG4 related disease. Almost all the reported cases of IgG4 related disease had evidence of multifocal involvement such as the pancreas, aorta and kidneys. Our patient was diagnosed with isolated RPF due to IgG4 disease. He met all the suggested diagnostic criteria, was started on oral steroids and had an excellent clinical outcome. Conclusion IgG4 related disease can present with isolated retroperitoneal fibrosis without involvement of other organ systems. The diagnosis should be based on specific criteria. Treatment with corticosteroids can lead to remission both clinically and radiographically., Highlights • Retroperitoneal fibrosis can present in a variety of clinical pictures. • IgG4 related disease can present with isolated retroperitoneal fibrosis. • It is diagnosed based on clinical, radiological and pathological criteria. • Treatment with corticosteroids can lead to clinical and radiological remission.

Human immune deficiency virus (HIV) infection remains a major health problem since discovery of the virus in 1981. Globally, since introduction of antiretroviral therapy, AIDS-related mortality was reduced by 47% since 2010. Also, HIV-related opportunistic infections (OIs) became less common, especially with use of prophylaxis to prevent such infections. In this study, we aim to assess the incidence of HIV infection and related OIs in Qatar for 17-year period, and to assess the spectrum of these infections, risk factors and treatment outcomes.This is a retrospective cohort study for all HIV infected patients registered in the state of Qatar from 2000 to 2016. Incidence of HIV infection and related opportunistic illness was calculated per 100,000 population. Demographic and Clinical characteristic were compared between two groups of patients with and without opportunistic illness.of 167 cases with HIV infection 54 (32.3%) had opportunistic illness. The average incidence rate of HIV infection over 17 years is 0.69 per 100,000 population, and the incidence rate for opportunistic illness is 0.27 per 100,000 population. The most common opportunistic illness is pneumocystis jirovecii pneumonia (PCP) which constituted 25% of cases, followed by cytomegalovirus (CMV) retinitis 7.2%, Tuberculosis 5.4%, Toxoplasmosis 4.2% and, less than 2% for each of Kaposi sarcoma, lymphoma and cryptococcal infection.The outcome of treatment of cases with opportunistic illness showed cure rates of 59.3%, one year relapse rates of 8.76% and overall, 90-day mortality of 3.7% however, 33.4% of patients left the country before completion of therapy.Most of our patients in both groups were of young age, majority males, and almost half of them were Qatari. The CD4 count, CD4%, CD4/CD8 ratio and viral load were statistically significant risk factors in cases with opportunistic illness with a p value 0.05, however presence of comorbidities was lower in patients with opportunistic illness P value of 0.032.Qatar has a low prevalence rate for HIV infection and related opportunistic illness. Early diagnosis and use of antiretroviral therapy are important measures to decrease the rate of opportunistic illness.

Introduction Guillain-Barré syndrome (GBS) is an immune-mediated peripheral neuropathy that was reported following meningococcus, polio, influenza and rabies vaccines. However, an association with the COVID-19 vaccine is yet to be established. Presentation of case We present the case of an elderly gentleman with no history of SARS-CoV-2 infection or any recent viral or bacterial illnesses who presented with GBS 20 days after the second dose of COVID-19 vaccination. The diagnosis was established based on physical examination, magnetic resonance imaging (MRI) of the spine, cerebrospinal fluid (CSF) analysis and electromyography (EMG). Discussion Due to the occurrence of GBS after certain types of infections, molecular mimicry has become widely acceptable as the underlying pathophysiology. The reported cases of GBS following vaccination further supported this theory, however proving a causal relationship between vaccines and GBS on the molecular level remains a challenge. Conclusions To the best of our knowledge this is the first reported case in the state of Qatar. It is important to mention that more research is needed to establish an association between COVID-19 vaccine and GBS. In our opinion, the benefits of COIVID-19 vaccine largely outweigh its risks., Highlights • COVID-19 vaccines and their adverse events are an emerging topic in medicine. • GBS was reported following influenza, hepatitis A and COVID-19 vaccines. • It is an immune-mediated peripheral neuropathy triggered by molecular mimicry. • More research is needed to confirm an association with COVID-19 vaccine.

COVID-19 complications present a huge burden on healthcare systems and warrant a predictive risk model for disease severity of SARS-CoV-2 infection to enable early intervention, prospective decision-making and triaging of patients. We profiled plasma proteins from COVID-19 patients (severe n=50, and mild n=50) and controls (n=50) using function- and pathway-based panels developed with the highly specific proximity extension assays. Several biological pathways were specific for patients with severe complications. Based on these dysregulated profiles, we propose candidate FDA-approved drugs that target multiple upregulated proteins to treat severe complications. In addition, the set of differentially expressed plasma proteins in severe disease contained a robust 46-protein signature, the COVID-19 molecular severity score, which predicts the risk of severe complications. We cross-validated this molecular severity score in an independent cohort and found it useful within three days after hospital admission to predict COVID-19 severity and outcomes. Associated with the molecular severity score, we identified a set of clinical parameters available at admission, that act as a clinical risk score for complications. The molecular and clinical risk scores described in our study may be prognostic tools for severe COVID-19 disease and help alleviate the pressure on healthcare systems during infection peaks.

COVID-19 complications still present a huge burden on healthcare systems and warrant predictive risk models to triage patients and inform early intervention. Here, we profile 893 plasma proteins from 50 severe and 50 mild-moderate COVID-19 patients, and 50 healthy controls, and show that 375 proteins are differentially expressed in the plasma of severe COVID-19 patients. These differentially expressed plasma proteins are implicated in the pathogenesis of COVID-19 and present targets for candidate drugs to prevent or treat severe complications. Based on the plasma proteomics and clinical lab tests, we also report a 12-plasma protein signature and a model of seven routine clinical tests that validate in an independent cohort as early risk predictors of COVID-19 severity and patient survival. The risk predictors and candidate drugs described in our study can be used and developed for personalized management of SARS-CoV-2 infected patients.

Highlights • Hydatidosis is an endemic infection and can involve a variety of organ systems. • The mediastinum is one of the rarest locations of hydatidosis. • It can occur primarily or secondarily to intrathoracic and intraabdominal Echinococcus. • Surgical treatment remains very crucial in the management of these cases. • The exact mechanism by which primary mediastinal hydatidosis occurs remains a debatable subject., Mediastinal involvement of hydatidosis is rare even in endemic areas. Isolated mediastinal without lung or liver involvement is even less commonly reported. We present the case of a young gentleman who was diagnosed with primary mediastinal hydatidosis based on clinical, radiological and pathological criteria. He underwent successful resection of the lesion by VATS (Video-assisted thoracoscopic surgery) preceded by two weeks of medical treatment with albendazole and had an excellent outcome. To the best of our knowledge, this is the first reported case in the state of Qatar.

Snakebites occur worldwide with varying frequency. Outcomes associated with snakebite are varied and depend on the type of snake and the general health of the patient. We report a case of snakebite by Cerastes cerastes or desert horned viper. Consumptive coagulopathy and cardiotoxicity with electrocardiographic changes complicated the clinical course of the patient. To the best of our knowledge, this is the first reported case in the state of Qatar.