Publications by authors named "Rajvir Singh"

218 Publications

Screening for antenatal depression and its determinants among pregnant women in Qatar: revisiting the biopsychosocial model.

BMC Pregnancy Childbirth 2021 Apr 26;21(1):330. Epub 2021 Apr 26.

Primary Health Care Corporation, Doha, Qatar.

Background: Screening for antenatal depression and its determinants is highly recommended. However, there is no consensus on a standard conceptual framework to approach pregnant women in a primary health care setting. The prevalence of antenatal depression and significant determinants are unknown in Qatar, a gap that we propose to fill.

Methods: An analytical cross-sectional study with a probability sampling technique was employed. Enrolling eight-hundred participants from primary health care centers. The screening was performed through a valid and reliable screening instrument 'Edinburgh Postpartum Depression Scale.' In addition to the proposed Comprehensive Biopsychosocial Model, participants were asked about their predisposing profile, biological risk, and other suggested modifiable variables.

Results: Twenty-one percent reported minor depressive episodes (n = 167, 20.9%) at a 95% confidence interval [18.2-23.8]. Previous use of mental health medications, fear of giving birth, concern about appearance, low perceived social support, and low resilience level showed to be associated with antenatal depression. The logistic regression analyses revealed that the Comprehensive Biopsychosocial model forecast 89% of antenatal depression predictors provided Area Under the Receiver Operating Characteristic Curve of 0.89 at a 95% confidence interval [0.85 to 0.92].

Conclusions: Antenatal depression is common among pregnant women in Qatar, and preventive interventions must target the determinants revealed. From a clinical perspective, the use of the proposed model may aid in the standardization of the screening process.
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http://dx.doi.org/10.1186/s12884-021-03793-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077962PMC
April 2021

Partitioning risk factors for embolic stroke of undetermined source using exploratory factor analysis.

Int J Stroke 2021 Apr 26:17474930211009847. Epub 2021 Apr 26.

Neuroscience Institute, Hamad General Hospital, Doha, Qatar.

Background: Embolic stroke of undetermined source (ESUS) accounts for up to 25% of strokes. Understanding risk factors associated with ESUS is important in reducing stroke burden worldwide. However, ESUS patients are younger and present with fewer traditional risk factors. Significant global variation in ESUS populations also exists making the clinical picture of this type of stroke unclear.

Methods And Results: ESUS patients were pair matched for age, sex, and ethnicity with a group of all other strokes (both  = 331). Exploratory factor analysis was applied in both groups to 14 risk and clinical factors to identify latent factors. In ESUS patients, two latent factors emerged consisting primarily of heart-related variables such as left ventricular wall motion abnormalities, reduced ejection fraction, and increased left atrial volume index, as well as aortic arch atherosclerosis. This is in comparison to the all other strokes group, which was dominated by traditional stroke risk factors.

Conclusions: Our findings support the existence of a unique pattern of risk factors specific to ESUS. We show that LVWMA and corresponding changes in left heart function are a potential source of emboli in these patients. In addition, the clustering of aortic arch atherosclerosis with left heart factors suggests a causal link. Through the application of exploratory factor analysis, this work contributes to a further understanding of stroke mechanisms in ESUS.
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http://dx.doi.org/10.1177/17474930211009847DOI Listing
April 2021

Effect of Pre-Treatment with a Combination of Fentanyl and Midazolam for Prevention of Etomidate-Induced Myoclonus.

Turk J Anaesthesiol Reanim 2021 Feb 25;49(1):11-17. Epub 2019 Nov 25.

Department of Cardiology, Cardiology Research Center, Heart Hospital, HMC, Doha, Qatar.

Objective: Pre-treatment with either fentanyl or midazolam has previously been used to prevent etomidate-induced myoclonus (EIM). The aim of the present study was to determine the effect of pre-treatment with a combination of midazolam and fentanyl in reducing the incidence and severity of EIM.

Methods: This prospective, randomised, double-blind study was conducted on 210 surgical patients allocated to three study groups. Group F patients received fentanyl 2 μg kg and 5 mL saline. Group M patients received midazolam 0.03 mg kg and 5 mL saline. Group FM patients received fentanyl 2 μg kg plus midazolam 0.03 mg kg. The study drugs were administered intravenously over 30 s. Five minutes after study drug administration, etomidate 0.3 mg kg was administered over 60 s. Patients were observed for 1 min for occurrence and severity of EIM.

Results: The incidence of EIM was 34/70 (48.6%), 55/70 (78.6%) and 11/70 (15.7%) in groups F, M and FM, respectively (p=0.001). Myoclonus of moderate or severe grade occurred in 23/70 (32.9%), 45/70 (64.3%) and 6/70 (8.6%) in groups F, M and FM, respectively (p=0.001). Patients who experienced myoclonus exhibited a significantly higher percentage change in post-induction heart rate (p=0.02), systolic blood pressure (p=0.001) and mean blood pressure (p=0.001) from pre-induction values than those who did not.

Conclusion: Pre-treatment with a combination of fentanyl and midazolam is more effective than that with fentanyl or midazolam alone in reducing the incidence and severity of EIM. Myoclonus is associated with a higher post-induction haemodynamic variation.
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http://dx.doi.org/10.5152/TJAR.2019.90248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7932701PMC
February 2021

Opt-Out Consent at Different Levels of Attitude to Organ Donation: A Household Survey in Qatar.

J Multidiscip Healthc 2021 18;14:401-410. Epub 2021 Feb 18.

Trauma & Vascular Surgery, HMC, Doha, Qatar.

Purpose: Demand for an organ transplant is surpassing the number of organ donors and hence increasing waiting lists worldwide, compelling many countries to adopt an opt-out consent system for organ donation. Opt-out is used in several European countries and has increased organ registration rate. No study on this subject has been published from the gulf region to associate sociodemographic characteristics, knowledge, attitude, beliefs, and intention domains regarding an opt-out consent for organ donation.

Materials And Methods: A household survey was conducted between October and November 2016 using a validated questionnaire. Integer codes were assigned for qualitative data to interpret results at par with quantitative data for each domain to allow data for advanced statistical analysis.

Results: Of 1044 surveyed participants, 724 (69.34%) those aged 37.7±10.4 agreed to adopting an opt-out consent system of which 231 (29.4%) were Qatari citizens and 353 (48.8%) were males. Mean levels of indices such as attitude, behavioral beliefs, and intention domains to organ donation were found higher in opt out participants. After adjusting statistical significant variables, multivariate analysis showed that attitude index was associated to opt out system (OR: 16.7, 95% C.I.:10.6-26.3, p=0.001) whereas; knowledge index (OR: 0.25, 95% C.I.: 0.07-0.83, p=0.03), behavioral beliefs (OR: 0.55, 95% C.I.: 0.35-0.86, p=0.009) and intention indices (OR: 0.42, 95% C.I.: 0.20-0.87, p=0.02) were associated with opt-in system for organ donation in Qatar. Regression model was able to discriminate (AUC: 84%, 95% C.I.:81% to 87%) for opt-out consent. Future probabilities for opt-out consent were 0.80, 0.88, 0.92,0.95,0.96,0.97,0.99 and 0.993 for 0.20, 0.30, 0.40, 0.50, 0.60, 0.70, 0.80 and 0.90 attitude levels after using 200 re-samples to make traditional multivariate regression model to realistic model for the population.

Conclusion: The majority of the survey participants showed a good attitude but less knowledge, behavioral beliefs, and intention towards adopting an opt-out system for organ donation in Qatar.
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http://dx.doi.org/10.2147/JMDH.S285011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901440PMC
February 2021

Comparison of chest radiography and chest CT for evaluation of pediatric COVID-19 pneumonia: Does CT add diagnostic value?

Pediatr Pulmonol 2021 Feb 25. Epub 2021 Feb 25.

Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Purpose: First, to investigate the added diagnostic value of chest computed tomography (CT) for evaluating COVID-19 in symptomatic children by comparing chest CT findings with chest radiographic findings, and second, to identify the imaging signs and patterns on CT associated with COVID-19 pneumonia in children.

Materials And Methods: From March 2020 to December 2020, 56 consecutive children (33 males and 23 girls; mean age ± SD, 14.8 ± 5.0 years; range, 9 months-18 years) with mild to moderate symptom and laboratory confirmed COVID-19 (based on Centers for Disease Control criteria) underwent both chest radiography and chest CT on the same day within the first 2 days of initial presentation to the hospital. Two experienced radiologists independently evaluated chest radiographs and chest CT studies for thoracic abnormalities. The findings from chest radiography and chest CT were compared to evaluate the added diagnostic value of chest CT for affecting patient management. Interobserver agreement was measured with Cohen's κ statistics.

Results: Eleven (19.6%) of 56 patients had abnormal chest radiographic findings, including ground-glass opacity (GGO) in 5/11 (45.4%) and combined GGO and consolidation in 6/11 (54.5%). On chest CT, 26 (46.4%) of 56 patients had abnormal CT findings, including combined GGO and consolidation in 19/26 (73.1%), GGO in 6/26 (23.1%), and consolidation in 1/26 (3.8%). Chest CT detected all thoracic abnormalities seen on chest radiography in 11/26 (42.3%) cases. In 15/26 (57.7%), chest CT detected lung abnormalities that were not observed on chest radiography, which included GGO and consolidation in 9/15 (60%), GGO in 5/15 (33.3%), and consolidation in 1/15 (6.6%) cases. These additional CT findings did not affect patient management. In addition, chest CT detected radiological signs and patterns, including the halo sign, reversed halo sign, crazy paving pattern, and tree-in-bud pattern. There was almost perfect interobserver agreement between the two reviewers for detecting findings on both chest radiographs (κ, 0.89, p = .001) and chest CT (κ, 0.96, p = .001) studies.

Conclusion: Chest CT detected lung abnormalities, including GGO and/or consolidation, that were not observed on chest radiography in more than half of symptomatic pediatric patients with COVID-19 pneumonia. However, these additional CT findings did not affect patient management. Therefore, CT is not clinically indicated for the initial evaluation of mild to moderately symptomatic pediatric patients with COVID-19 pneumonia.
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http://dx.doi.org/10.1002/ppul.25313DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014659PMC
February 2021

Resistin induces cardiac fibroblast-myofibroblast differentiation through JAK/STAT3 and JNK/c-Jun signaling.

Pharmacol Res 2021 May 29;167:105414. Epub 2021 Jan 29.

Cardiovascular Research Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Diabetes, Obesity and Metabolism Institute, Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Graduate School of Biomedical Sciences, The Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA. Electronic address:

Cardiac fibrosis is characterized by excessive deposition of extracellular matrix proteins and myofibroblast differentiation. Our previous findings have implicated resistin in cardiac fibrosis; however, the molecular mechanisms underlying this process are still unclear. Here we investigated the role of resistin in fibroblast-to-myofibroblast differentiation and elucidated the pathways involved in this process. Fibroblast-to-myofibroblast transdifferentiation was induced with resistin or TGFβ1 in NIH-3T3 and adult cardiac fibroblasts. mRNA and protein expression of fibrotic markers were analyzed by qPCR and immunoblotting. Resistin-knockout mice, challenged with a high-fat diet (HFD) for 20 weeks to stimulate cardiac impairment, were analyzed for cardiac function and fibrosis using histologic and molecular methods. Cardiac fibroblasts stimulated with resistin displayed increased fibroblast-to-myofibroblast conversion, with increased levels of αSma, col1a1, Fn, Ccn2 and Mmp9, with remarkable differences in the actin network appearance. Mechanistically, resistin promotes fibroblast-to-myofibroblast transdifferentiation and fibrogenesis via JAK2/STAT3 and JNK/c-Jun signaling pathways, independent of TGFβ1. Resistin-null mice challenged with HFD showed an improvement in cardiac function and a decrease in tissue fibrosis and reduced mRNA levels of fibrogenic markers. These findings are the first to delineate the role of resistin in the process of cardiac fibroblast-to-myofibroblast differentiation via JAK/STAT3 and JNK/c-Jun pathways, potentially leading to stimulation of cardiac fibrosis.
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http://dx.doi.org/10.1016/j.phrs.2020.105414DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8085100PMC
May 2021

Adiponectin receptor 1 variants contribute to hypertrophic cardiomyopathy that can be reversed by rapamycin.

Sci Adv 2021 Jan 6;7(2). Epub 2021 Jan 6.

Cardiovascular Research Center, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.

Hypertrophic cardiomyopathy (HCM) is a heterogeneous genetic heart muscle disease characterized by hypertrophy with preserved or increased ejection fraction in the absence of secondary causes. However, recent studies have demonstrated that a substantial proportion of individuals with HCM also have comorbid diabetes mellitus (~10%). Whether genetic variants may contribute a combined phenotype of HCM and diabetes mellitus is not known. Here, using next-generation sequencing methods, we identified novel and ultrarare variants in adiponectin receptor 1 () as risk factors for HCM. Biochemical studies showed that variants dysregulate glucose and lipid metabolism and cause cardiac hypertrophy through the p38/mammalian target of rapamycin and/or extracellular signal-regulated kinase pathways. A transgenic mouse model expressing an variant displayed cardiomyopathy that recapitulated the cellular findings, and these features were rescued by rapamycin. Our results provide the first evidence that variants can cause HCM and provide new insights into regulation.
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http://dx.doi.org/10.1126/sciadv.abb3991DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787482PMC
January 2021

Intensive care outcome of left main stem disease surgery: A single center three years' experience.

World J Crit Care Med 2021 Jan 9;10(1):12-21. Epub 2021 Jan 9.

Department of Cardiothoracic Surgery, Hamad Medical Corporation, Doha 3050, DA, Qatar.

Background: Left main coronary artery (LMCA) supplies more than 80% of the left ventricle, and significant disease of this artery carries a high mortality unless intervened surgically. However, the influence of coronary artery bypass grafting (CABG) surgery on patients with LMCA disease on morbidity intensive care unit (ICU) outcomes needs to be explored. However, the impact of CABG surgery on the morbidity of the ICU population with LMCA disease is worth exploring.

Aim: To determine whether LMCA disease is a definitive risk factor of prolonged ICU stay as a primary outcome and early morbidity within the ICU stay as secondary outcome.

Methods: Retrospective descriptive study with purposive sampling analyzing 399 patients who underwent isolated urgent or elective CABG. Patients were divided into 2 groups; those with LMCA disease as group 1 (75 patients) and those without LMCA disease as group 2 (324 patients). We correlated ICU outcome parameters including ICU length of stay, post-operative atrial fibrillation, acute kidney injury, re-exploration, perioperative myocardial infarction, post-operative bleeding in both groups.

Results: Patients with LMCA disease had a significantly higher prevalence of diabetes (43.3% 29%, = 0.001). However, we did not find a statistically significant difference with regards to ICU stay, or other morbidity and mortality outcome measures.

Conclusion: Post-operative performance of Patients with LMCA disease who underwent CABG were comparable to those without LMCA involvement. Diabetes was more prevalent in patients with LMCA disease. These findings may help in guiding decision making for future practice and stratifying the patients' care.
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http://dx.doi.org/10.5492/wjccm.v10.i1.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805253PMC
January 2021

Optimal dose and duration of enteral erythromycin as a prokinetic: A surgical intensive care experience.

Qatar Med J 2020 12;2020(3):36. Epub 2021 Jan 12.

Communicable Disease Center, Hamad Medical Corporation, Doha, Qatar.

Background: Enteral feeding has various advantages over parenteral feeding in critically ill patients. Acutely ill patients are at risk of developing enteral feeding intolerance. Prokinetic medications improve gastrointestinal mobility and enteral feed migration and absorption. Among the available prokinetic agents, erythromycin is the most potent. Erythromycin is used in different dosages and durations with variable efficacy. Intravenous erythromycin has an early and high rate of tachyphylaxis; hence, enteral route is preferred. Recently, the combination of prokinetic medications has been increasingly used because they accelerate the prokinetic action and decrease the adverse effects.

Aim: This study aimed to determine the optimal effective prokinetic dose and duration of administering enteral erythromycin in combination with metoclopramide in critically ill patients.

Patients And Methods: This study has a prospective observation design. After obtaining permission from the medical research center of the institution, all patients in the surgical and trauma intensive care unit having enteral feed intolerance and those who were already on metoclopramide for 24 hour (h) were enrolled in the study. Patients' demographic data, diagnosis, surgical intervention, disease severity scores, erythromycin dose, duration of administration, any adverse effects, factors affecting erythromycin response, and outcome were recorded. All patients received 125 mg syrup erythromycin twice daily through a nasogastric tube (NGT). The NGT was clamped for 2 h, and half amount of previous enteral feeds was resumed. If the patient did not tolerate the feeds, the erythromycin dose was increased every 24 h in the increment of 250, 500, and 1000 mg (Figure 1). Statistical significance was considered at <  0.05. A total of 313 patients were enrolled in the study. Majority of the patients were male, and the mean age was 45 years.

Results: Majority (48.2%) of the patients (96) with feed intolerance were post laparotomy. Ninety percent (284) of the patients responded to prokinetic erythromycin therapy, and 54% received lower dose (125 mg twice daily). In addition, 14% had diarrhea, and none of these patients tested positive for toxin or multidrug resistance bacteria. The mean duration of erythromycin therapy was 4.98 days. The most effective prokinetic dose of erythromycin was 125 mg twice daily ( = 0.001). Erythromycin was significantly effective in patients with multiple organ dysfunction and shock ( = 0.001). Patients with high disease severity index and multiple organ dysfunction had significantly higher mortality ( < 0.05). Patients not responding to erythromycin therapy also had a significant higher mortality ( = 0.001).

Conclusion: Post-laparotomy patients had high enteral feed intolerance. Enteral erythromycin in combination with metoclopramide was effective in low dose and was required for short duration. Patients who did not tolerate feeds despite increasing dose of erythromycin had higher mortality.
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http://dx.doi.org/10.5339/qmj.2020.36DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802089PMC
January 2021

Characteristics and Comparison of 32 COVID-19 and Non-COVID-19 Ischemic Strokes and Historical Stroke Patients.

J Stroke Cerebrovasc Dis 2021 Jan 2;30(1):105435. Epub 2020 Nov 2.

Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. Electronic address:

Objectives: The presence of COVID-19 infection may increase the risk of thrombotic events including ischemic strokes. Whilst a number of recent reports suggest that COVID-19 associated stroke tends to be severe, there is limited data on the effects of COVID-19 in prospective registries.

Material And Methods: To determine how COVID-19 infection may affect cerebrovascular disease, we evaluated the ischemic stroke sub-types, clinical course and outcomes prior to and during the pandemic in Qatar. The Hamad General Hospital (HGH) stroke database was interrogated for stroke admissions during the last 4 months of 2019 and January-May 2020.

Results: In Qatar the number of confirmed cases of COVID-19 increased from only 2 in February to 779 in March, 12,628 in April and 45,501 in May. Stroke admissions to HGH declined marginally from an average of 97/month for six pre-COVID months to 72/month in March-May. There were 32 strokes that were positive for COVID-19. When compared to non-COVID-19 stroke during the three months of the pandemic, COVID-19 patients were younger with significantly lower rates of hypertension, diabetes and dyslipidemia. COVID-19 positive patients had more cortical strokes (34.4% vs 5.6%; p = 0.001), severe disease (NIHSS >10: 34.4% vs 16.7%; p = 0.001) prolonged hospitalization and fewer with good recovery (mRS 0-2: 28.1% vs 51.9%; p = 0.001).

Conclusions: When compared to six pre-COVID-19 months, the number of ischemic stroke admissions during the three months of the pandemic declined marginally. COVID-19 positive patients were more likely to have a large cortical stroke with severe symptoms and poor outcome.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.105435DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605738PMC
January 2021

Small Intestinal Diverticulosis: A Rare Cause of Intestinal Perforation Revisited.

Case Rep Surg 2020 21;2020:8891521. Epub 2020 Oct 21.

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

Jejunoileal diverticulosis (JID) is a rare and nonspecific symptomatic disease. It is usually an acquired condition associated with false diverticula and integrated with colonic diverticulosis which can be diagnosed incidentally or later with complications. A sixty-nine-year-old male presented with sudden onset generalized abdominal pain. Computed tomography (CT) imaging was suggestive of ileal diverticulitis with localized perforation. The patient was treated conservatively with IV fluids and antibiotics and kept nil per orem for three days and discharged after symptoms subsided. The patient returned with a similar presentation but with a greater intensity. CT with oral contrast revealed evidence of distal ileal perforation. The terminal ileum was resected, and a double barrel ileostomy was created. Six months later, the stoma was reversed after resecting 50 cm of proximal terminal ileum which included all diverticula. The patient had a smooth postoperative recovery. Small bowel diverticulitis is generally managed conservatively unless the patient's clinical condition mandates urgent exploration. This report may add knowledge and lead to a change in clinical practice.
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http://dx.doi.org/10.1155/2020/8891521DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7596452PMC
October 2020

Generalized and pregnancy-related anxiety prevalence and predictors among pregnant women attending primary health care in Qatar, 2018-2019.

Heliyon 2020 Oct 23;6(10):e05264. Epub 2020 Oct 23.

Primary Health Care Corporation, Doha, Qatar.

Background: Cumulative evidence suggests that early identification of anxiety in pregnancy is important, given that antenatal anxiety has been linked to morbid outcomes in expecting mothers and their offspring. However, the burden of antenatal anxiety is not yet known in Qatar. This research aims to measure the prevalence and determinants of generalized and pregnancy-related anxiety among pregnant women.

Methods: Eight hundred pregnant women completed a structured interview and self-administrated questionnaires after being selected through probability sampling from nine primary healthcare centers distributed across Qatar. We subjected the data to Binary and Multiple Logistic Regression Analysis. Furthermore, we conducted a Confirmatory Factor Analysis for the utilized scales.

Results: Out of eight hundred participants, 26.5% reported high pregnancy-related anxiety, while 16.4% had a generalized anxiety disorder. A high level of perceived social support and resilience was shown to mitigate generalized and pregnancy-related anxiety. However, we revealed that different determinants influence the two types of anxiety.

Limitations: There is no recognized optimal cut-off point to distinguish 'high risk' in pregnancy-related anxiety scales.

Conclusions: Pregnancy-related anxiety is more prevalent than generalized anxiety among pregnant women in Qatar, indicating that stakeholders must include screening for pregnancy-related anxiety in Qatar's clinical guidelines. Tailored interventional studies could focus on increasing resilience and social support to decrease the burden of antenatal anxiety.
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http://dx.doi.org/10.1016/j.heliyon.2020.e05264DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7586091PMC
October 2020

Post-trauma transmesocolic hernia: a case report.

J Surg Case Rep 2020 Oct 21;2020(10):rjaa417. Epub 2020 Oct 21.

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

The prevalence of transmesocolic hernias, a subtype of internal hernias (IHs), is generally low. Its clinical consequences, including strangulation, ischemia and even death, however, necessitate awareness. IHs are classified as congenital or acquired as resulting from surgery, trauma or intraperitoneal inflammation. This is a case of a 37-year-old male victim of a motor vehicle collision 1 month prior to the index admission. The trauma-related injuries were managed conservatively and then discharged home. The patient was re-admitted with a 2-day history of epigastric pain, vomiting and abdominal distension. A diagnosis of small bowel obstruction due to a transmesocolic hernia was made on CT and emergency laparotomy performed. The post-operative course was unremarkable. It is vital to consider transmesocolic hernias in trauma patients presenting with a picture of bowel obstruction even in the absence of prior surgery.
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http://dx.doi.org/10.1093/jscr/rjaa417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7575331PMC
October 2020

A Unique Case of Low-Grade Mucinous Neoplasm in Stump Appendectomy.

Case Rep Surg 2020 14;2020:8850403. Epub 2020 Sep 14.

Department of Acute Care Surgery, Hamad Medical Corporation, Doha, Qatar.

Background: We describe a case of a young male with a history of appendectomy one year ago, who developed symptoms of stump appendicitis, and after removing this stump, histopathology showed low grade neoplasm. . Stump appendicitis is an uncommon complication after appendectomy and may lead to serious complications. Management of low-grade appendiceal mucinous neoplasm (LAMN) is controversial, and we discuss the importance of the case.

Conclusion: The case of young male post stump appendectomy with histopathology showing LAMN in the stump of the appendix, which to our knowledge, is the first in the medical literature and, discuss the stump appendicitis and incomplete appendectomy concerning malignancy, mucinous neoplasm, and adenocarcinoma.
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http://dx.doi.org/10.1155/2020/8850403DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7512081PMC
September 2020

Clinical presentation and outcomes of peripartum cardiomyopathy in the Middle East: a cohort from seven Arab countries.

ESC Heart Fail 2020 Sep 23. Epub 2020 Sep 23.

Adult Cardiology, Hamad Medical Corporation, Hamad Medical city, Rayan Street, Doha, 3050, Qatar.

Aims: Published data on the clinical presentation of peripartum cardiomyopathy (PPCM) are very limited particularly from the Middle East. The aim of this study was to examine the clinical presentation, management, and outcomes of patients with PPCM using data from a large multicentre heart failure (HF) registry from the Middle East.

Methods And Results: From February to November 2012, a total of 5005 consecutive patients with HF were enrolled from 47 hospitals in 7 Middle East countries. From this cohort, patients with PPCM were identified and included in this study. Clinical features, in-hospital, and 12 months outcomes were examined. During the study period, 64 patients with PPCM were enrolled with a mean age of 32.5 ± 5.8 years. Family history was identified in 11 patients (17.2%) and hypertension in 7 patients (10.9%). The predominant presenting symptom was dyspnoea New York Heart Association class IV in 51.6%, class III in 31.3%, and class II in 17.2%. Basal lung crepitations and peripheral oedema were the predominant signs on clinical examination (98.2% and 84.4%, respectively). Most patients received evidence-based HF therapies. Inotropic support and mechanical ventilation were required in 16% and 5% of patients, respectively. There was one in-hospital death (1.6%), and after 1 year of follow-up, nine patients were rehospitalized with HF (15%), and one patient died (1.6%).

Conclusions: A high index of suspicion of PPCM is required to make the diagnosis especially in the presence of family history of HF or cardiomyopathy. Further studies are warranted on the genetic basis of PPCM.
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http://dx.doi.org/10.1002/ehf2.13030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7754996PMC
September 2020

One-pot three component synthesis of substituted dihydropyrimidinones using fruit juices as biocatalyst and their biological studies.

PLoS One 2020 15;15(9):e0238092. Epub 2020 Sep 15.

Department of Chemistry, Chaudhary Charan Singh Haryana Agricultural University, Hisar, India.

New and facile one-pot three component approach for the synthesis of substituted dihydropyrimidinones derivatives (4a-4h) from reaction of equimolar substituted aldehydes (1a-1h), methyl acetoacetate (2a) and urea (3a) in presence of nature derived catalyst viz. Cocos nucifera L. juice, Solanum lycopersicum L. juice and Citrus limetta juice, commonly known as coconut juice, tomato juice and musambi juice respectively, at room temperature has been carried out. All synthesized compounds were evaluated for in vitro herbicidal activity against Raphanus sativus L. (Radish seeds). The compounds (4a-4h) were also screened for their antifungal activity against Rhizoctonia solani and Colletotrichum gloeosporioides by poisoned food techniques method. Antibacterial activity was also studied against Erwinia cartovora and Xanthomonas citri by inhibition zone method. From activity data, it was found that compounds 4g and 4d were most active against Raphanus sativus L. (root) and Raphanus sativus L. (shoot) respectively. Compounds 4f and 4c was found most active against Rhizoctonia solani and Colletotrichum gloeosporioides fungus respectively at highest concentration. Compound 4g has shown maximum inhibition zone i.e. 1.00-5.50 mm against Erwinia cartovora at 2000 μg/mL concentration. Maximum Xanthomonas citrii growth was inhibited by compounds 4f showing inhibition zone 4.00-12.00 mm at highest concentration. Short reaction time, high yields, mild reaction condition and simple work-up are some merits of present methodology.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238092PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7491738PMC
October 2020

Left Heart Factors in Embolic Stroke of Undetermined Source in a Multiethnic Asian and North African Cohort.

J Am Heart Assoc 2020 08 29;9(15):e016534. Epub 2020 Jul 29.

Neuroscience Institute Hamad General Hospital Doha Qatar.

Background Cardiac features diverge in Asians; however, it is not known how these differences relate to embolic stroke of unknown source (ESUS) in Southeast Asian and Eastern Mediterranean regions. Methods and Results A retrospective analysis of prospectively collected acute ischemic stroke data from 2014 to 2018 was performed. Stroke subtypes were noncardioembolic stroke (large-vessel and small-vessel disease; n=1348), cardioembolic stroke (n=532), and ESUS (n=656). Subtypes were compared by demographic, clinical, and echocardiographic factors. In multivariate logistic regression, patients with ESUS in comparison with noncardioembolic stroke were twice as likely to have left ventricular diastolic dysfunction (=0.001), 3 times the odds of global hypokinesia (=0.001), and >7 times the odds of left ventricular wall motion abnormalities (=0.001). In the second model comparing ESUS with cardioembolic stroke, patients with ESUS were 3 times more likely to have left ventricular wall motion abnormalities (=0.001) and 1.5 times more likely to have left ventricular diastolic dysfunction grade I (=0.009), and 3 times more likely to have left ventricular diastolic dysfunction grades II and III (=0.009), whereas age (=0.001) and left atrial volume index (=0.004) showed an inverse relation with ESUS. ESUS in patients ≥61 years old had higher levels of traditional risk factors such as coronary artery disease, but the coronary artery disease was not significantly different in ESUS age groups (=0.80) despite higher left ventricular wall motion abnormalities (=0.001). Conclusions Patients with ESUS and noncardioembolic stroke were younger than patients with cardioembolic stroke. While a third of the patients with ESUS >45 years old had coronary artery disease, it was unrecognized or underreported in the older ESUS age group (61 years old). In patients with ESUS from Southeast Asia and Eastern Mediterranean regions, left ventricular wall motion abnormalities and left ventricular diastolic dysfunction were related to ESUS.
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http://dx.doi.org/10.1161/JAHA.120.016534DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7792276PMC
August 2020

Beliefs and Intention to Organ Donation: A Household Survey.

Int J Appl Basic Med Res 2020 Apr-Jun;10(2):122-127. Epub 2020 Apr 2.

Cardiology Research Center, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.

Background: Organ transplantation is considered as the last therapeutic option for the treatment for end-stage organ failure. However, the gap between the demand and supply of transplantable organs is still wide. Extensive researches have been conducted to understand this gap, and many countries have introduced Opt-out laws and have started targeted awareness programs. We aimed to assess, among the household residents, the normative behavior and beliefs and its correlation to intentions toward becoming organ donors.

Subjects And Methods: A household survey with the resident population of Qatar was conducted from October 2016 to November 2016. A sample of 1044 individuals aged 18 and above, residing in eight municipalities within the country, was selected using a two-stage systematic random sampling method to understand the relationship between organ donation intentions and behavioral, normative, and control beliefs. Independent female enumerators collected data on electronic tablets and exported to SPSS for data analysis.

Results: Data from 930/1044 (89%) individuals responded to the intention-related questions were taken for final analysis. Multivariate analysis brought out that behavioral beliefs (standardized beta coefficient = 0.25, = 6.5, = 0.001) and normative beliefs (standardized beta coefficient = 0.32, = 8.4, = 0.001) were significant contributors to intention to donate organs whereas control beliefs (standardized beta coefficient = -0.07, = -2.3, = 0.02) were negatively associated to organ donation intention.

Conclusions: Findings indicate that behavioral and normative beliefs play a very important role in contributing to the intention of the individual toward organ donation.
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http://dx.doi.org/10.4103/ijabmr.IJABMR_108_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7289197PMC
April 2020

Beliefs and Intention to Organ Donation: A Household Survey.

Int J Appl Basic Med Res 2020 Apr-Jun;10(2):122-127. Epub 2020 Apr 2.

Cardiology Research Center, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.

Background: Organ transplantation is considered as the last therapeutic option for the treatment for end-stage organ failure. However, the gap between the demand and supply of transplantable organs is still wide. Extensive researches have been conducted to understand this gap, and many countries have introduced Opt-out laws and have started targeted awareness programs. We aimed to assess, among the household residents, the normative behavior and beliefs and its correlation to intentions toward becoming organ donors.

Subjects And Methods: A household survey with the resident population of Qatar was conducted from October 2016 to November 2016. A sample of 1044 individuals aged 18 and above, residing in eight municipalities within the country, was selected using a two-stage systematic random sampling method to understand the relationship between organ donation intentions and behavioral, normative, and control beliefs. Independent female enumerators collected data on electronic tablets and exported to SPSS for data analysis.

Results: Data from 930/1044 (89%) individuals responded to the intention-related questions were taken for final analysis. Multivariate analysis brought out that behavioral beliefs (standardized beta coefficient = 0.25, = 6.5, = 0.001) and normative beliefs (standardized beta coefficient = 0.32, = 8.4, = 0.001) were significant contributors to intention to donate organs whereas control beliefs (standardized beta coefficient = -0.07, = -2.3, = 0.02) were negatively associated to organ donation intention.

Conclusions: Findings indicate that behavioral and normative beliefs play a very important role in contributing to the intention of the individual toward organ donation.
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http://dx.doi.org/10.4103/ijabmr.IJABMR_108_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7289197PMC
April 2020

Views and experiences of decision-makers on organisational safety culture and medication errors.

Int J Clin Pract 2020 Sep 15;74(9):e13560. Epub 2020 Jun 15.

Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar.

Background: In 2017, the World Health Organization published "Medication Without Harm, WHO Global Patient Safety Challenge," to reduce patient harm caused by unsafe medication use practices. While the five objectives emphasise the need to create a framework for action, engaging key stakeholders and others, most published research has focused on the perspectives of health professionals. The aim was to explore the views and experiences of decision-makers in Qatar on organisational safety culture, medication errors and error reporting.

Method: Qualitative, semi-structured interviews were conducted with healthcare decision-makers (policy-makers, professional leaders and managers, lead educators and trainers) in Qatar. Participants were recruited via purposive and snowball sampling, continued to the point of data saturation. The interview schedule focused on: error causation and error prevention; engendering a safety culture; and initiatives to encourage error reporting. Interviews were digitally recorded, transcribed and independently analysed by two researchers using the Framework Approach.

Results: From the 21 interviews conducted, key themes were the need to: promote trust within the organisation through articulating a fair blame culture; eliminate management, professional and cultural hierarchies; focus on team building, open communication and feedback; promote professional development; and scale-up successful initiatives. There was recognition that the current medication error reporting processes and systems were suboptimal, with suggested enhancements in themes of promoting a fair blame culture and open communication.

Conclusion: These positive and negative aspects of organisational culture can inform the development of theory-based interventions to promote patient safety. Central to these will be the further development and sustainment of a "fair" blame culture in Qatar and beyond.
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http://dx.doi.org/10.1111/ijcp.13560DOI Listing
September 2020

Sex-Specific Differences in Short-Term and Long-Term Outcomes in Acute Stroke Patients from Qatar.

Eur Neurol 2020 20;83(2):154-161. Epub 2020 May 20.

Department of Medicine, University of Alberta, Edmonton, Alberta, Canada,

Background: Sex differences may determine presentation, utility of treatment, rehabilitation, and occurrences of major adverse cardiovascular events (MACEs) in acute stroke (AS).

Objective: The purpose of the study was to evaluate the short-term prognosis and long-term outcomes in MACEs in Qatari nationals admitted with AS.

Methods: All AS patients admitted between January 2014 and February 2019 were included. We evaluated the preadmission modified Rankin scale (mRS) score, etiology and severity of symptoms, complications, and functional recovery at discharge and 90 days. MACEs were recorded for 5 years.

Results: There were 891 admissions for AS (mean age 64.0 ± 14.2 years) (male, n = 519 [mean age ± SD 62.9 ± 14.1 years]; female, n = 372 [mean age ± SD 65.6 ± 14.2 years] p = 0.005). There were no differences in the preadmission mRS and severity of symptoms as measured on National Institute of Stroke Scale. At discharge, the outcome was better (mRS 0-2) in men (57.8 vs. 46.0%), p = 0.0001. This difference persisted at the 90-day follow-up (mRS 0-2, male 69.4% vs. female 53.2%, p = 0.0001). At the 90-day follow-up, more women died (total deaths 70; women 38 [10.2%] versus men 32 [6.2%], p = 0.03). MACEs occurred in 25.6% (133/519) males and 30.9% (115/372) females over the 5-year follow-up period (odds ratio 0.77, 95% confidence interval 0.57-1.0, p = 0.83).

Conclusions: Female patients have a poor short-term outcome following an AS when corrected for age and comorbidities. While our study cannot explain the reasons for the discrepancies, higher poststroke depression and social isolation in women may be important contributory factors, and requires further studies are required to confirm these findings.
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http://dx.doi.org/10.1159/000507193DOI Listing
December 2020

Prevalence of socio-demographic and behavioral factors about organ donation in Qatar: A household survey.

Qatar Med J 2020 16;2020(1). Epub 2020 Mar 16.

Trauma & Vascular Surgery, HMC, Doha, Qatar, Post Box: 3050.

A single organ and tissue donor can serve and save eight-fold lives, but availability of organ donors is scarce, posing a grim situation for end-stage organ failure worldwide. Knowledge, attitudes, behaviors, and beliefs toward organ donation can help policymakers develop strategies to address the challenges facing organ donation and transplantation in Qatar. To assess sociodemographic characteristics, knowledge, attitudes, beliefs and intentions regarding organ donation in the household population of Qatar. A prospective observational household survey was conducted between October and November 2016 in Qatar using a validated questionnaire. One thousand forty-four individuals aged 18 and older residing in eight municipalities in the country were enrolled in the survey. Average age was 38 ± 11 years. There were 27.4% Qatari citizens and 72.6% nonQatari residents in the survey. 48.9% of the total (1044) were males. Knowledge [46% (95% C.I.: 45% - 47%)], attitude [70% (95% C.I.: 66%-74%)], behavioral beliefs [42% (95% C.I.: 39%-50%)], normative beliefs [29% (95% C.I.: 28%-30%)], control beliefs [-27% (95% C.I.: - 24% to - 30%)] and intentions towards organ donation [29% (95% C.I.: 27%-31%)] were observed in the study. Factor analyses were able to explain 70%, 72%, 70%, and 74% variations in knowledge, attitude, beliefs, and intentions domains respectively showing adequacy of construct of the domains for organ donation. Most of the survey participants showed good attitude but less intention towards organ donation.
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http://dx.doi.org/10.5339/qmj.2020.5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074447PMC
March 2020

Clinical Presentations and Outcomes in Patients Presenting With Acute Cardiac Events and Right Bundle Branch Block.

Angiology 2020 Mar 6;71(3):256-262. Epub 2019 Dec 6.

Cardiology Department, Al-Ahli Hospital, Doha, Qatar.

We conducted a retrospective analysis of 50 974 patients admitted with acute cardiac events with and without right bundle branch block (RBBB) over 23 years. Compared to non-RBBB, patients with RBBB (n = 386; 0.8%) were 3 years older ( = .001), more likely to present with breathlessness rather than chest pain ( = .001), and had more diabetes mellitus ( = .001). Patients with RBBB had significantly higher cardiac enzymes ( = .001); however, there were no significant differences in the presentation with ST-segment elevation myocardial infarction (24.6% vs 22.2%), non-ST-segment elevation myocardial infarction (23.7% vs 22.4%), and unstable angina (51.7% vs 55.4%). Patients with RBBB were more likely to have congestive heart failure (CHF; 9.6% vs 3.2%, = .001), cardiogenic shock (10.6% vs 1.7%, = .001), and ventricular tachyarrhythmias (7.3% vs 2.2%, = .001). Left ventricular ejection fraction and hospital length of stay were comparable between the groups. All-cause mortality was 5 times greater in patients with RBBB (21% vs 4.2%, = .001). Right bundle branch block was independent predictor of mortality (adjusted odd ratio 5.14; 95% confidence interval: 3.90-6.70). Subanalysis comparing normal QRS, RBBB, and left BBB showed that RBBB was associated with the worst outcomes except for CHF. Although RBBB presents in only about 1% of patients with cardiac disease, it was found to be an independent predictor of hospital mortality.
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http://dx.doi.org/10.1177/0003319719892159DOI Listing
March 2020

A Teaching Intervention Increases the Performance of Handheld Ultrasound Devices for Assessment of Left Ventricular Ejection Fraction.

Heart Views 2019 Oct-Dec;20(4):133-138. Epub 2019 Nov 14.

Non-Invasive Cardiology, Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.

Background: Few studies have demonstrated the utility of a teaching program for evaluation of left ventricular ejection fraction (LVEF) of echocardiographic images acquired with high-end machines. No study to date explored the value of similar programs when a handheld ultrasound device is used. The aim of this study was to determine whether a teaching intervention could improve the accuracy and the reliability of LVEF visual assessment of echocardiographic images acquired with HUD.

Materials And Methods: Twenty echocardiograms acquired with a hand-held ultrasound device with a spectrum of LVEF were presented to 26 participants with varying experience in echocardiography (range 2-12 years) for single-point LVEF visual estimates. After this baseline assessment, participants underwent three training sessions which included analysis of the individual baseline results and review and interpretation of additional 60 cases from the same platform. After 2 months, 20 new echocardiograms were presented to the same 26 participants for visual LVEF assessment. For each participant, the visual LVEF for each case was compared with the reference LVEF (quantitative measurements by experts), and a difference of > ±5% was considered a misclassification.

Results: The misclassification rate was 61% preintervention and decreased to 41% after intervention ( < 0.0001). The mean absolute differences in LVEF between visual estimates and reference before and after intervention for all readers were -7.9 ± 9.6 and -1.2 ± 7.8, respectively ( < 0.0001). Inter-rater repeatability analysis was performed using the intraclass correlation coefficient. The intraclass correlation coefficient for inter-rater reliability was fair preintervention (0.65, 95% confidence interval [CI] 0.59 0.71) and good after intervention (0.80, 95% CI 0.73 0.87), and there were no differences when categorized according to the level of experience.

Conclusions: A teaching intervention can improve the accuracy and the reliability in the visual LVEF assessment of images acquired with handheld ultrasound device.
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http://dx.doi.org/10.4103/HEARTVIEWS.HEARTVIEWS_91_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6881875PMC
November 2019

Demystifying Smoker's Paradox: A Propensity Score-Weighted Analysis in Patients Hospitalized With Acute Heart Failure.

J Am Heart Assoc 2019 12 29;8(23):e013056. Epub 2019 Nov 29.

College of Medicine QU Health Qatar University Doha Qatar.

Background Smoker's paradox has been observed with several vascular disorders, yet there are limited data in patients with acute heart failure (HF). We examined the effects of smoking in patients with acute HF using data from a large multicenter registry. The objective was to determine if the design and analytic approach could explain the smoker's paradox in acute HF mortality. Methods and Results The data were sourced from the acute HF registry (Gulf CARE [Gulf Acute Heart Failure Registry]), a multicenter registry that recruited patients over 10 months admitted with a diagnosis of acute HF from 47 hospitals in 7 Middle Eastern countries. The association between smoking and mortality (in hospital) was examined using covariate adjustment, making use of mortality risk factors. A parallel analysis was performed using covariate balancing through propensity scores. Of 5005 patients hospitalized with acute HF, 1103 (22%) were current smokers. The in-hospital mortality rates were significantly lower in current smoker's before (odds ratio, 0.71; 95% CI, 0.52-0.96) and more so after (odds ratio, 0.47; 95% CI, 0.31-0.70) covariate adjustment. With the propensity score-derived covariate balance, the smoking effect became much less certain (odds ratio, 0.63; 95% CI, 0.36-1.11). Conclusions The current study illustrates the fact that the smoker's paradox is likely to be a result of residual confounding as covariate adjustment may not resolve this if there are many competing prognostic confounders. In this situation, propensity score methods for covariate balancing seem preferable. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01467973.
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http://dx.doi.org/10.1161/JAHA.119.013056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912958PMC
December 2019

Embolic Pattern of Stroke Associated with Cardiac Wall Motion Abnormalities; Narrowing the Embolic Stroke of Undetermined Source Category.

J Stroke Cerebrovasc Dis 2020 Feb 20;29(2):104509. Epub 2019 Nov 20.

Heart Hospital, Hamad General Hospital, Doha Qatar.

Background: There is ambiguity regarding the role of left ventricle wall motion abnormalities (LVWMAs) as a potential cardioembolic source in patients, who satisfy embolic stroke of undetermined source (ESUS) criteria.

Methods And Results: We analyzed prospectively collected data in 345 acute stroke patients, 185 (53.6%) stroke with atrial fibrillation (SwAF), and 160 (46.4%) stroke with LVWMA. LVWMA were younger (P = .003), had significantly higher frequency of stroke risk factors and lower ejection fraction (P < .001). No significant difference was found between the stroke pattern in SwAF and LVWMA except focal cortical, cortical-subcortical lesions were more frequent in LVWMA (P = .002). Mean wall motion score index (WMSI) was 1.523 (range 1.05-2.71) without any correlation between the severity of WMSI and multiple strokes (P = .976). In subgroup analyses vertical basal WMSI (P = .030) and vertical mid cavity WMSI (P = .010) was significantly related to branch arterial stroke. LVWMA 94 (65%) patients were on antiplatelet/anticoagulation compared to 47 (52.4%) with atrial fibrillation (AF), with no significant difference in stroke recurrence during 4 years follow-up (P = .15).

Conclusions: Patients with LVWMA who satisfy ESUS criteria, have stroke pattern on diffusion-weighted magnetic resonance imaging and risk of stroke recurrence similar to AF-related stroke despite being on appropriate antiplatelet medications. Further studies with anticoagulation therapy may be required in this group of patients to improve the high risk of recurrent stroke.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2019.104509DOI Listing
February 2020

Dengue hepatitis with acute liver failure: Clinical, biochemical, histopathological characteristics and predictors of outcome.

J Gastroenterol Hepatol 2020 Jul 14;35(7):1223-1228. Epub 2020 Jan 14.

Acute Care Surgery, HGH, Hamad Medical Corporation, Doha, Qatar.

Background: Hepatitis infection from non-hepatotropic viruses such as dengue virus (DENV) is increasing worldwide. There is increasing recognition of the changing epidemiology and atypical presentations of DENV infection including acute liver failure (ALF). There is paucity of data regarding incidence, disease characteristics, and markers of prognosis in patients who develop DENV-related ALF.

Methods: We aimed to study the incidence, clinical features, laboratory characteristics, and determinants of outcome in patients of DENV presenting with ALF. We reviewed all patients with DENV infection and focused on DENV-related ALF from 2014 to 2017. Diagnosis of DENV and ALF was confirmed by serological tests and standard criteria, respectively.

Results: Thirty-six patients (20 men, mean age 32.3) developed ALF among 10 108 patients with DENV infection (0.35%). Twenty-one patients died (58.3%). Although bilirubin, aspartate and alanine aminotransferase, and international normalized ratio were markedly elevated in all patients with DENV ALF, there was no statistically significant difference between survivors and non-survivors. Lactate levels, pH at admission, and model for end-stage liver disease (MELD) score were the only predictors of mortality. Lactate levels were significantly higher in non-survivors (11.5 ± 4.2 mmol/L) than survivors (6.3 ± 3.6 mmol/L) (P < 0.001). MELD score in non-survivors (26.7 ± 10.2) was significantly higher than in survivors (20 ± 7.2) (P = 0.039). Receiver operator characteristic curve showed lactate or pH to be a superior prognostic marker than MELD with an area under the curve of 0.80, 0.79, and 0.70, respectively.

Conclusion: Dengue hepatitis progressed to ALF in 0.35%. Development of ALF was associated with a high mortality (> 50%). Lactate level, pH, and MELD score at admission were significant determinants of outcome.
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http://dx.doi.org/10.1111/jgh.14927DOI Listing
July 2020

The FASILA Score: A Novel Bio-Clinical Score to Predict Massive Blood Transfusion in Patients with Abdominal Trauma.

World J Surg 2020 04;44(4):1126-1136

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

Background: Early identification of patients who may need massive blood transfusion remains a major challenge in trauma care. This study proposed a novel and easy-to-calculate prediction score using clinical and point of care laboratory findings in patients with abdominal trauma (AT).

Methods: Patients with AT admitted to a trauma center in Qatar between 2014 and 2017 were retrospectively analyzed. The FASILA score was proposed and calculated using focused assessment with sonography in trauma (0 = negative, 1 = positive), Shock Index (SI) (0 = 0.50-0.69, 1 = 0.70-0.79, 2 = 0.80-0.89, and 3 ≥ 0.90), and initial serum lactate (0 ≤ 2.0, 1 = 2.0-4.0, and 2 ≥ 4.0 mmol/l). Outcome variables included mortality, laparotomy, and massive blood transfusion (MT). FASILA was compared to other prediction scores using receiver operating characteristics and areas under the curves. Bootstrap procedure was employed for internal validation.

Results: In 1199 patients with a mean age of 31 ± 13.5 years, MT, MT protocol (MTP) activation, exploratory laparotomy (ExLap), and hospital mortality were related linearly with the FASILA score, Injury Severity Score, and total length of hospital stay. Initial hemoglobin, Revised Trauma Score (RTS), and Trauma Injury Severity Score (TRISS) were inversely proportional. FASILA scores correlated significantly with the Assessment of Blood Consumption (ABC) (r = 0.65), Revised Assessment of Bleeding and Transfusion (RABT) (r = 0.63), SI (r = 0.72), RTS (r = - 0.34), and Glasgow Coma Scale (r = - 0.32) and outperformed other predictive systems (RABT, ABC, and SI) in predicting MT, MTP, ExLap, and mortality.

Conclusions: The novel FASILA score performs well in patients with abdominal trauma and offers advantages over other scores.
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http://dx.doi.org/10.1007/s00268-019-05289-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223809PMC
April 2020

Wilson Disease Presenting With Acute on Chronic Liver Failure: A Single-Center Experience of Outcome and Predictors of Mortality in 68 Patients.

J Clin Exp Hepatol 2019 Sep-Oct;9(5):569-573. Epub 2019 Feb 18.

Hamad Medical Center, Doha, Qatar.

Background And Aims: Acute on chronic liver failure (ACLF) is an emerging entity whose unique pathogenesis, presentation, and outcome are different from those with decompensated cirrhosis. Patients with Wilson disease (WD) often present with ACLF. The outcome in this setting and predictors of mortality have not been well delineated. We describe the clinical features, laboratory characteristics, and prognostic factors in patients with WD with ACLF. We compared the outcome in those without criteria for ACLF.

Patients And Methods: We analyzed the admission characteristics of 68 patients with WD presenting with features of ACLF among a cohort of WD patients from 1997 to 2017. WD was diagnosed as per European association for the study of the liver (EASL)/Leipzig criteria and ACLF by the Asia-Pacific Association of Study of Liver and World Gastroenterology Organization consensus criteria. Factors associated with mortality were analyzed by univariate followed by multivariate analysis and receiver operating characteristic curve.

Results: Of the 272 patients with WD, 68 fulfilled criteria for ACLF. The mean age was 14.4 years (Range 5-42 years). Males constituted 38/68 (56%). Acute viral or drug induced hepatitis as precipitating factors was seen in 11.7%. Forty-nine patients (49/67; 73%) died including 30/32 (93.8%) with encephalopathy and 45/62 (72.6%) with ascites. Prognostic factors on univariate analysis significant for mortality included encephalopathy, international normalized ratio, white blood cell count and model for end-stage liver disease (MELD) score. On multivariate analysis, only encephalopathy was significant with 82% accuracy in differentiating survivors versus non-survivors. Post mortem liver biopsy in 21 patients and explant biopsy in 2 patients showed features of cirrhosis in all.

Conclusions: WD with ACLF is associated with a high mortality Precipitating factors such as viral and drug-induced hepatitis was seen in 11.7% patients. Liver histology in patients subjected to biopsy showed cirrhosis in all. Only encephalopathy is a prognostic marker of non-survival with an accuracy of 82%.
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http://dx.doi.org/10.1016/j.jceh.2019.02.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823726PMC
February 2019

Precipitating Factors for Hospitalization with Heart Failure: Prevalence and Clinical Impact Observations from the Gulf CARE (Gulf aCute heArt failuRe rEgistry).

Med Princ Pract 2020 16;29(3):270-278. Epub 2019 Sep 16.

Adult Cardiology, Hamad Medical Corporation, Doha, Qatar.

Objective: Despite the expanding burden of heart failure (HF) worldwide, data on HF precipitating factors (PFs) in developing countries, particularly the Middle East, are very limited. We examined PFs in patients hospitalized with acute HF in a prospective multicenter HF registry from 7 countries in the Middle East.

Method: Data were derived from the Gulf CARE (Gulf aCute heArt failuRe rEgistry) for a prospective, multinational, multicenter study of consecutive patients hospitalized with HF in 47 hospitals in 7 Middle Eastern countries between February 2012 and November 2012. PFs were determined by the treating physician from a predefined list at the time of hospitalization.

Results: The study included 5,005 patients hospitalized with acute HF, 2,276 of whom (45.5%) were hospitalized with acute new-onset HF (NOHF) and 2,729 of whom (54.5%) had acute decompensated chronic HF (DCHF). PFs were identified in 4,319 patients (86.3%). The most common PF in the NOHF group was acute coronary syndromes (ACS) (39.2%). In the DCHF group, it was noncompliance with medications (27.8%). Overall, noncompliance with medications was associated with a lower inhospital mortality (OR 0.47; 95% CI 0.28-0.80; p = 0.005) but a higher 1-year mortality (OR 1.43; 95% CI 1.1-1.85; p = 0.007). ACS was associated with higher inhospital mortality (OR 1.84; 95% CI 1.26-2.68; p = 0.002) and higher 1-year mortality (OR 1.62; 95% CI 1.27-2.06; p = 0.001).

Conclusion: Preventive and therapeutic interventions specifically directed at noncompliance with medications and ACS are warranted in our region.
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http://dx.doi.org/10.1159/000503334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7315136PMC
September 2019