Hospital In Qatar Research Articles

Do Night Shifts Increase the Risk of Benign Paroxysmal Positional Vertigo Among Doctors and Nurses?

BackgroundNight shift work is one of the significant and most frequent reasons for circadian rhythm disruptions, resulting in the alteration of biological functions and sleep. These factors can affect the psychological and physical well-being and also negatively impact an individual’s performance at work. Sleep disturbance has been associated with increased risk of several medical conditions such as benign paroxysmal positional vertigo (BPPV), hypertension, diabetes, high cholesterol, chronic obstructive pulmonary disease, and others.ObjectiveTo determine whether the night shift increases the risk of BPPV by reviewing a 7-year retrospective data.MethodsThe cross-sectional research study was conducted at the emergency department of a tertiary care teaching hospital in Qatar. A total of 69 doctors and nurses who suffered from vertigo in a period of seven years were consented and considered for the study. We excluded 12 patients with vertigo due to causes rather than BPPV. Fifty-seven patients who were diagnosed with BPPV based on examination using the Dix–Hallpike bedside test. They were treated by particle repositioning maneuvers in the emergency department.ResultsApproximately, 93% (n = 53) of participants had posterior canal BPPV and 7% (n = 4) had lateral canal BPPV (n = 5) between 2013 and 2019. Anterior canal BPPV was not reported. Chi-square test showed that night shift was associated with a high prevalence of first BPPV episode (P ≥0.001) with less likelihood of diabetes and hypertension (P ≥0.001).ConclusionRetrospective data review indicates a possible association between night shifts and BPPV development in doctors and nurses.

Characteristics and predictors of burnout among healthcare professionals: a cross-sectional study in two tertiary hospitals

BackgroundThe pattern and impact of burnout among the medical staff are not yet well defined. However, the consequences of burnout are not limited to the healthcare providers but also may...

Impact of an antimicrobial stewardship programme on antimicrobial utilization and the prevalence of MDR Pseudomonas aeruginosa in an acute care hospital in Qatar.

BackgroundThe excessive and inappropriate use of antibiotics is universal across all healthcare facilities. In Qatar there has been a substantial increase in antimicrobial consumption coupled with a significant rise in antimicrobial resistance (AMR). Antimicrobial stewardship programmes (ASPs) have become a standard intervention for effective optimization of antimicrobial prescribing.MethodsA before–after study was conducted in Hamad General Hospital (603 bed acute care hospital): 1 year before implementation of a comprehensive ASP compared with the following 2 years. The ASP included a hospital-wide pre-authorization requirement by infectious diseases physicians for all broad-spectrum antibiotics. Prevalence of MDR Pseudomonas aeruginosa was compared with antimicrobial consumption, calculated as DDD per 1000 patient-days (DDD/1000 PD). Susceptibility was determined using broth microdilution, as per CLSI guidelines. Antibiotic use was restricted through the ASP, as defined in the hospital’s antibiotic policy.ResultsA total of 6501 clinical isolates of P. aeruginosa were collected prospectively over 3 years (2014–17). Susceptibility to certain antimicrobials improved after the ASP was implemented in August 2015. The prevalence of MDR P. aeruginosa showed a sustained decrease from 2014 (9%) to 2017 (5.46%) (P = 0.019). There was a significant 23.9% reduction in studied antimicrobial consumption following ASP implementation (P = 0.008). The yearly consumption of meropenem significantly decreased from 47.32 to 31.90 DDD/1000 PD (P = 0.012), piperacillin/tazobactam from 45.35 to 32.67 DDD/1000 PD (P < 0.001) and ciprofloxacin from 9.71 to 5.63 DDD/1000 PD (P = 0.015) (from 2014 to 2017).ConclusionsThe successful implementation of the ASP led to a significant reduction in rates of MDR P. aeruginosa, pointing towards the efficacy of the ASP in reducing AMR.

Hospital Discharge Strategy at a Governmental Hospital in Qatar

Preparing a patient for hospital discharge takes time, especially when complicated by medication preparation and reconciliation, patient education, and discharge summary documentation. Therefore, the healthcare managers and administrators should have tangible policies for discharging patients to avoid unnecessary readmissions linked to wasteful hospital expenditures. A single case study design was applied to investigate the varied inputs from different administrators within one setting and obtained information related to optimal patient discharge practices bounded by time and place. The hospital had six departments, the departments including pediatrics, obstetrics and gynecology, surgery, burns, medicine, and an intensive care unit. One toolkit designed to reduce readmission rates is the Re-Engineered Discharge (RED) toolkit. This strategy is an evidenced based approach with the three-fold aim of ensuring that patients understand how to care for themselves, reducing emergency visits and readmissions, and improving patient satisfaction. As for implementing RED, several specific indicators could be used depending on the context specific to the hospital. These indicators should be meaningful, credible, feasible, and timely. As a result of this study, both patient educations, planning for outpatient appointments and telephone follow-up by clerical or nursing staff were shown to have successfully reduced readmission rates for patients discharged to home. The hospital setting involved in the study introduced the admission-discharge lounge that helps, first, to accommodate patients that are already discharged in the inpatient but are not yet ready to leave the hospital for personal reasons. This prompts the process of clearing bed spaces for other admissions. Second, is by transferring the patient to the admission-discharge lounge, giving the patient and families time to support the discharge instruction education because now patients receive the instructions twice, once from the inpatient, and also from the lounge.

Hospital Discharge Strategy at a Governmental Hospital in Qatar

Preparing a patient for hospital discharge takes time, especially when complicated by medication preparation and reconciliation, patient education, and discharge summary documentation. Therefore, the healthcare managers and administrators should have tangible policies for discharging patients to avoid unnecessary readmissions linked to wasteful hospital expenditures. A single case study design was applied to investigate the varied inputs from different administrators within one setting and obtained information related to optimal patient discharge practices bounded by time and place. The hospital had six departments, the departments including pediatrics, obstetrics and gynecology, surgery, burns, medicine, and an intensive care unit. One toolkit designed to reduce readmission rates is the Re-Engineered Discharge (RED) toolkit.

Co-Morbidity between Major Depression and Schizophrenia: Prevalence and Clinical Characteristics.

The aim of this study was to explore the co-morbidity between Major Depressive Disorder (MDD) and Schizophrenia (SZ) among a large number of patients describing their clinical characteristics and rate of prevalence. A cohort-study was carried out on 396 patients affected by MDD and SZ who consecutively attended the Department of Psychiatry, Rumeilah Hospital in Qatar. We employed the World Health Organization - Composite International Diagnostic Interview (WHO-CIDI) and the Structured Clinical Interview for DSM-5 (SCID-5) for diagnoses. Patients were also grouped in MDD patients with and without co-morbid SZ (MDD vs MDD/SZ) for comparisons. A total of 396 subjects were interviewed. MDD patients with comorbid SZ (146(36.8%)) were 42.69±14.33 years old whereas MDD without SZ patients (250 (63.2%)) aged 41.59±13.59. Statistically significant differences between MDD with SZ patients and MDD without SZ patients were: higher BMI (Body Mass Index) (p=0.025), lower family income (p=0.004), higher rate of cigarette smoking (p<0.001), and higher level of consanguinity (p=0.023). Also, statistically significant differences were found in General Health Score (p=0.017), Clinical Global Impression-BD Score (p=0.042), duration of illnesses (p=0.003), and Global Assessment of Functioning (p=0.012). Rates of anxiety dimensions (e.g.: general anxiety, agoraphobia, somatisation, etc.), mood dimensions (e.g.: major depression, mania, oppositional defiant behaviour, Bipolar disorder), Attention Deficit Hyperactivity Disorder, psychotic and personality dimensions were higher among MDD with SZ patients than MDD without SZ. This study confirms that MDD with SZ is a common comorbidity especially among patients reporting higher level of consanguinity. MDD/SZ comorbidity presents unfavourable clinical characteristics and higher levels of morbidity at rating scales.

Early laboratory markers may reflect the severity of pyogenic liver abscess infection: Retrospective cohort study

Background: Liver abscess carries significant morbidity and mortality rate due to its complications. We aimed to identify laboratory markers associated with septic shock related to pyogenic liver abscess. Methods: The study was conducted at Hamad General Hospital, a tertiary hospital in Qatar. Data were collected retrospectively. All patients diagnosed with pyogenic liver abscess between 2013 and 2017 were included. Liver abscess was diagnosed based on clinical presentation and radiological finding with or without microbiological evidence. Septic shock defined as the need of vasopressors to maintain mean arterial pressure &gt; 60 mmHg. Data has been collected on admission time. Descriptive data were presented in mean ± SD and percentages. Normally distributed data were analyzed by T-test otherwise Mann–Whitney was used.Fisher Exact test was used for categorical data. The level of significance was set at P&lt;0.05. Results: Pyogenic liver abscess has been identified in 78 patients. 89.9% were males. 48.7% of the patients were diabetic. Nine patients (11.5%) developed septic shock. Patients who developed septic shock had higher procalcitonin level (Hazard ratio [HR] 1.025, 95% CI 1.006-1.044, p0.009) but lower level of hemoglobin (HR 0.744, 95% CI 0.581-0.952, P. 0.019), protein(HR 0.867, 95% CI 0.779-0.966, p 0.009) and platelet (HR 0.994, 95% CI 0.988-1.000, p 0.035) Conclusion: Measurement of baseline procalcitonin, hemoglobin, protein, and platelet in pyogenic liver abscess may provide early information about the severity of the infection and the need for early aggressive management. However, a larger sample size is needed to achieve more statistical significance.

Left Ventricular Wall Motion Estimation by Active Polynomials for Acute Myocardial Infarction Detection

Echocardiogram (echo) is the earliest and the primary tool for identifying regional wall motion abnormalities (RWMA) in order to diagnose myocardial infarction (MI) or commonly known as heart attack. This paper proposes a novel approach, Active Polynomials, which can accurately and robustly estimate the global motion of the Left Ventricular (LV) wall from any echo in a robust and accurate way. The proposed algorithm quantifies the true wall motion occurring in LV wall segments so as to assist cardiologists diagnose early signs of an acute MI. It further enables medical experts to gain an enhanced visualization capability of echo images through color-coded segments along with their “maximum motion displacement” plots helping them to better assess wall motion and LV Ejection-Fraction (LVEF). The outputs of the method can further help echo-technicians to assess and improve the quality of the echocardiogram recording. A major contribution of this study is the first public echo database collection composed by physicians at the Hamad Medical Corporation Hospital in Qatar. The so-called HMC-QU database will serve as the benchmark for the forthcoming relevant studies. The results over HMC-QU dataset show that the proposed approach can achieve 87.94% accuracy, 92.86% sensitivity and 87.64% precision in MI detection even though the echo quality is quite poor and the temporal resolution is low.

Quality of life among caregivers of asthmatic children attending pulmonology clinics at Hamad General Hospital, Qatar

Introduction:Chronic paediatric diseases, as bronchial asthma, affect the quality of life, which can be defined as the ability to preserve personal well-being despite sickness. These diseases have a huge impact on the quality of life of both the children, their parents and or caregivers.Methodology:A cross-sectional study using convenient sampling was conducted in the paediatric pulmonology clinics at Hamad General Hospital in Qatar aiming to evaluate the quality of life among caregivers of asthmatic children. The quality of life of caregivers was assessed using the standard Paediatric Asthma Caregiver Quality of Life questionnaire. Depression and asthma control were assessed using the Beck Depression Inventory; second edition and the Paediatric Asthma Control and Communication Instrument, respectively.Results:Total number of the caregivers was 330. Majority of the asthmatic children had controlled or partially controlled asthma (47% and 44%, respectively). Most of the caregivers had either very good or good quality of life (63% and 31%, respectively). Mean quality of life score was 5.55 ± 1.14. Males, married and father caregivers had significantly higher mean quality of life. In addition, gender, getting bothered about child’s asthma, asthma control score and depression score were significant predictors of quality of life among the caregivers.Conclusion:Most of the caregivers had either very good or good quality of life. Being a female, degree of asthma control and depression were important determinants of the quality of life of the caregivers. Provision of needed support to caregivers and effective approach to controlling asthma are recommended to improve the quality of life of caregivers.

Procalcitonin and other inflammatory markers in patients with sepsis and septic shock: A single-center experience

Objective: The objective of the study was to compare the diagnostic value of serum procalcitonin (PCT), C-reactive protein (CRP), lactic acid, and white blood cells (WBC) as markers of sepsis in critically ill patients in the main tertiary hospital in Qatar. Materials and Methods: The PCT levels and other inflammatory markers (CRP, lactic acid, and WBC) were retrospectively reviewed in 137 consecutive adult patients with a suspected diagnosis of sepsis who admitted to the Internal Medicine inpatient service (i.e., Medical Wards and Medical Intensive Care Unit) at Hamad General Hospital, Qatar. The serum PCT was measured by chemiluminescence immunoassay and the results were compared with commonly used inflammatory markers between the patients with and without proven sepsis. Results: A significantly higher PCT level was observed among patients with severe sepsis and septic shock compared to those without sepsis (19.34 ± 50 and 25.91 ± 61.3 vs. 4.72 ± 10, respectively; P = 0.011). No significant differences were found in CRP and WBC between these groups. Nonsurvivors of both septic and nonseptic groups had a mean PCT level of 22.48 ± 8.26 significantly higher than that measured in survivors of both the groups (P = 0.01), a difference not evident in other inflammatory parameters. Conclusions: PCT is a highly efficient inflammatory laboratory parameter for the diagnosis of severe sepsis and septic shock, but WBC and CRP levels were of little value. PCT value assists in the diagnosis of septic shock, hence supporting appropriate disposition of patients. The levels of PCT also have prognostic implications with regard to mortality suggesting intensification of antibiotic therapy and supportive measures including appropriate family counseling.

Fetal Outcomes among Hypertensive Pregnant Women at a Tertiary Maternity Hospital in Qatar, 2015-2017: A Case-Control Study

According to population data, hypertensive disorders in pregnancy affect around 10% of pregnant women. They can be preexisting hypertension in 1%, preeclampsia in around 2% and 6 % pregnancy induced hypertension (hypertension without proteinuria). Preexisting hypertension, defined as a diastolic blood pressure > 90mmHg and/or a systolic > BP of 140mmHg, is associated with increased risk of perinatal and maternal complications.

630. Clinical and Molecular Characteristics of Carbapenem-Resistant Enterobacteriaceae in Qatar: A Retrospective and Prospective Observational Study

BackgroundThere are limited data describing carbapenem-resistant Enterobacteriaceae (CRE) from the Arabian Gulf region. Our aims were to describe the clinical, microbiological and molecular characteristics of CRE infections and to characterize the gene displaying resistance to carbapenem.MethodsRetrospective and prospective review of clinical, microbiological and molecular characteristics of CRE isolated between April 2015 and November 2017 at 7 tertiary hospitals in Qatar. Susceptibility testing was performed and interpreted according to Clinical Laboratory Standards Institute methodology and breakpoints. Carbapenemase genes were identified using PCR. Whole-genome sequencing followed by bioinformatics analysis was performed on a subset of samples for accurate detection of resistant genes. SPSS V.21.0 was used for all statistical analyses.ResultsA total of 144 nonrepeating CRE strains were recovered from 137 individuals over the study period, of which 35 (24.3%) represented colonization. Klebsiella spp. (98, 68.1%) and E. coli (38, 26.4%) were the most predominant. The most prevalent carbapenemases were NDM (69, 47.9%), OXA-48 (36, 25.0%), and KPC (15, 10.4%). Sixteen (11.1%) strains possessed multiple carbapenemase genes but none were detected in 37 (25.7%) strains. Genomic analysis also detected the presence of NDM-7, NDM-5, NDM1, VIM4, and OXA48-like carbapenemase genes among 34 clinical samples. The majority of the strains were susceptible to tigecycline (124, 86.1%), fosfomycin (122, 84.7%) and amikacin (102, 70.8%). There were 109 CRE infections involving the urinary tract (40, 36.7%), bloodstream (31, 28.4%), and respiratory tract (17, 15.6%). Fifty-seven (52.3%) were males and the median age was 57 years (range 3–97). Baseline comorbidities included diabetes (57, 52.3%), chronic kidney disease (27, 24.8%), and cancer (27, 24.8%) (Table 1). Within the 30 days preceding CRE infection, 38 (34.9%) had received carbapenem therapy, 65 (59.6%) had undergone invasive procedures and 33 (30.3%) had had surgery. All-cause 30-day mortality was 29.4%. The only variable independently associated with mortality was baseline SAPS Score (Table 2).ConclusionNDM and OXA-48 are the predominant carbapenemases in Qatar. CRE infections are associated with high overall mortality. Disclosures All authors: No reported disclosures.

Implementation of pressure ulcer prevention and management in elderly patients: a retrospective study in tertiary care hospital in Qatar

Objective Preventing pressure ulcers is an essential part of patient care and it is important to be aware of the best way to prevent it. Hence, the present study aims to look for the demographics, clinical characteristics, and risk factors in patients with and without pressure ulcer among elderly patients. Methods A retrospective longitudinal study was conducted in elderly (above 65 years) patients from a period of October 2014 to October 2015 in the medical ward under acute Geriatric care at Hamad General Hospital in Qatar. Results Overall, a total of 90 patients were included with an average age of 79 ± SD 11.3 years of which 45 patients developed pressure ulcer. There was male (64.4%) preponderance in the study population. Most common comorbidity was hypertension (77.8%). Anemia correction (91%), high protein diet supplementation (1.5 g/kg body wt.) (100%), and 2 h repositioning (100%) were implemented for majority of the pressure ulcer patients as preventive intervention. Conclusions From the study finding, it is observed that, anemia correction, high protein diet supplementation and 2 h repositioning are the best practices for the management of pressure ulcer. Hence, these best practices are recommended for the early prevention of pressure ulcer among elderly.

Catheter ablation in highly symptomatic Brugada patients: a Dutch case series.

In the past few years, promising results were described in targeting the arrhythmogenic substrate of the epicardial right ventricular outflow tract (RVOT) region in patients with Brugada syndrome (BrS). In this report, we describe our experience with endo- and epicardial substrate mapping and ablation in a series of highly symptomatic BrS patients. This case series consists of seven patients with clinical BrS diagnosis who underwent catheter ablation in two Dutch hospitals (Isala hospital Zwolle; and Amsterdam University Medical Centre, location AMC, Amsterdam) and Hamad Heart Hospital in Qatar between 2013 and 2017. All patients had an ICD and recurrent ventricular arrhythmia (VA) episodes. All patients underwent endo-and epicardial mapping of the RVOT region. Elimination of all abnormal potentials and disappearance of BrS ECG pattern during the ablation procedure was the aimed endpoint. The study group consisted of seven patients with mean age 45.6 ± 16.9years. Five patients had SCN5A mutations. One patient was excluded from analysis, since ablation could not be performed due to a very large low-voltage area and was later diagnosed with arrhythmogenic right ventricular cardiomyopathy, associated with an SCN5A mutation. One patient underwent both endo- and epicardial ablation to eliminate VA. During a mean follow-up of 3.6 ± 1.5years, 5/6 patients remained VA free with two patients continuing quinidine. In patients with BrS and drug-refractory VA, ablation of the arrhythmogenic substrate in the RVOT region was associated with excellent long-term VA-free survival. The majority of these highly symptomatic BrS patients had an SCN5A mutation and also low-voltage areas epicardially.

Cross-Validation of the Arabic Mini International Neuropsychiatric Interview, Module K, for Diagnosis of Schizophrenia and the Arabic Positive and Negative Syndrome Scale

The Mini International Neuropsychiatric Interview, version 6, module K (MINI6-Mod-K) is a diagnostic tool to confirm schizophrenia; whereas the Positive and Negative Syndrome Scale in Schizophrenia (PANSS) is a scale to assess psychotic symptoms severity. The objective of this study was to cross-validate the diagnostic questions (categorical) from the Arabic MINI6-Mod-K with the corresponding items’ scores (dimensional) from Arabic PANSS. Arab subjects (N = 101) were recruited from the Psychiatry Hospital in Qatar. MINI6-Mod-K was used to confirm schizophrenia diagnosis, and PANSS was administered to assess psychopathology by an independent rater. The most common symptoms according to MINI6-Mod-K were the delusions and hallucinations but the PANSS items scores ≥2.5 captured more positive responses on all the diagnostic features of schizophrenia. The cut-off PANSS scores that significantly distinguished between the presence or absence of schizophrenia features on MINI6-Mod-K were mostly between 2.5 and 3.5. Multivariate linear regression showed that negative symptoms and disorganized/catatonic behaviors independently contributed to the PANSS score on positive symptoms subscale. However, none of the symptom questions in the MINI6-Mod-K were significant predictors of the PANSS negative score. Our results showed that there is very good cross-validation between the diagnostic questions of Arabic MINI6-Mod-K and the corresponding positive cut-off scores in Arabic PANSS.

Etiology and outcome of hemoptysis in Qatar, a high-resource country with a large expatriate population: A retrospective study.

Background: Hemoptysis is an alarming symptom in clinical practice. We reviewed ten years of experience with hemoptysis in a tertiary hospital in Qatar to identify hemoptysis etiologies, patient characteristics, and associated factors. Methods: Hemoptysis was defined based on severity as mild ( < 50 ml or streaks of blood), moderate (50–150 ml) and massive (>150 ml) in the 24 hours before admission. Hemodynamically unstable is considered when systolic BP < 100 mmHg,tachycardia with HR>110/min, tachypnea with RR>22/min, or SpO2 < 92% on room air. Results: A total of 102 patients (41 females and 61 males) with 133 episodes of hemoptysis were identified in this study. Among the hemoptysis patients with co-morbidities, 19 patients had hypertension, 17 patients had cardiovascular disease, and 66 patients with other co-morbidities. COPD patients had a significant (p < 0.02) association with hemoptysis. Chest X-ray was used in most patients and other modalities like CT scan and bronchoscopies were used less frequently. Pneumonia (12.8%), bronchiectasis (11.8%) and cardiovascular disorders (11.8%) are the primary causes of hemoptysis. Malignancy was less frequent (7.8%), and bronchogenic carcinoma was uncommon (2%). There were 24 (23.5 %) no identified causes of hemoptysis. The overall mortality was 9.8% in this study. Conclusions: Population demographics played a significant role in the severity of hemoptysis and prognosis. Most patients had benign etiologies, lower severity of hemoptysis and good prognosis. Differences in the etiology, initial severity, and prognosis of patients with hemoptysis were found significantly different when compared with those reported in previous studies.

Knowledge and Practice of Emergency Physicians Regarding Food-borne Disease Surveillance at Hamad General Hospital in Qatar.

IntroductionAccording to the World Health Organization (WHO), foodborne diseases (FBD’s) have become a global health issue. In Qatar, foodborne diseases are among the top ten events reported to the Ministry of Public Health. Efforts to enhance FBD surveillance cannot succeed without involving the emergency department (ED), which is typically the first point of contact for the FBD victims with the healthcare system. Therefore, we aimed to explore the knowledge and practices of emergency physicians regarding stool sample collection as part of FBD surveillance efforts in Qatar.MethodsA cross-sectional study was conducted at the ED of Hamad General Hospital (HGH) between July 22 and September 12 of 2018. The enrolled participants were invited to participate in an online survey at the “QSurvey” platform. The data was analyzed using Microsoft Excel (Version 2016). Descriptive statistics such as frequency tables, proportions, and percentages were applied as appropriate.ResultsA total of 65 responses (response rate: 29.27%) were received within the duration of the study. Most participants were specialists (45%), graduated between 2000 and 2013 (64%), and worked for one year or more at HGH-Hamad Medical Corporation (95%). Regarding their knowledge of FBD surveillance, most participants (80%) reported that a stool culture is a necessary laboratory investigation for patients with acute bloody diarrhea and fever. Also, a large percentage of physicians identified salmonella (75%), Clostridium difficile (70%), and E.coli O157:H7 (70%) as pathogens of nationally notifiable diseases. Regarding the respondents’ practice towards FBD surveillance, almost three-quarters of the physicians (72%) who encountered a patient with acute diarrhea did not order a stool culture. Subsequently, about two-thirds (62%) of the participants who requested a stool culture reported not following up on the results of such request. Regarding the history taken from patients with acute diarrhea, a large percentage of respondents reported asking about the patient’s travel history (100%), presence of any sick contacts (93.6%), and presence of any associated symptoms (abdominal pain, fever, bloody stool) as well as other details.ConclusionThe current research identified several gaps regarding the knowledge and practice of emergency physicians towards the surveillance of foodborne disease. Such results serve as a basis for future research and intervention strategies to augment surveillance activities related to food-borne diseases in the State of Qatar.

Gallbladder cancer: 7-Year experience from Qatar.

BackgroundGallbladder cancer (GC) is a relatively rare disease. To date, there are no studies describing the epidemiology of this disease in Qatar.ObjectiveTo study the epidemiology of Gallbladder Cancer in Qatar.MethodsA retrospective analysis of the cases of GC in Hamad General Hospital in Qatar from 2009 to 2016.ResultsThirty-five patients presented with GC during the study period, 10 females (28.6%) and 25 males (71.4%). Fourteen patients (40%) were diagnosed incidentally after laparoscopic cholecystectomy, 16 (48.6%) were diagnosed pathologically, and 4 (11.4%) were diagnosed radiologically. The median age at diagnosis was 54 years (31–78). 74.3% of the disease occurred in patients less than 60 years old. Metastatic disease was discovered in 25 patients (71.4%) versus no metastasis in 10 patients (28.6%). The most common sites for metastasis were the liver (42.9%), peritoneum (25.7%), and lymph nodes (25.7%). Curative central hepatic resection was done in 8 patients (22.9%). Pathology showed adenocarcinoma in 27 patients (77.1%), neuroendocrine tumor in 3 patients (8.6%) and high-grade dysplasia in 1 patient (2.9%). No histopathology was available for 4 patients (11.4%). Twenty-eight patients (80.0%) had regular follow up, with 22 (62.9%) still alive. Six patients (17.1%) died during follow up with survival after diagnosis ranging from 42 days to 6.8 years.ConclusionsIn Qatar, due to the unique demographics, GC is more common in males and younger age groups. Most of the patients present late with metastasis, but curative resection is associated with long-term survival.

Torsemide versus furosemide after acute decompensated heart failure: a retrospective observational study

BackgroundLoop diuretics are recommended by clinical practice guidelines to treat volume overload in acute decompensated heart failure (ADHF). The effectiveness of switching furosemide to torsemide versus optimizing the furosemide dose following ADHF has not yet been evaluated.MethodsThis retrospective observational study aimed to assess the impact of switching furosemide to torsemide versus optimizing the furosemide dose after ADHF on HF-related hospitalization within 1 month and 6 months of discharge. The study included patients previously on furosemide admitted with ADHF to the Heart Hospital in Qatar between January 1, 2016 and June 30, 2017. The study included 2 groups: (1) patients discharged on torsemide; and (2) patients discharged on an optimized furosemide dose. Cox proportional hazard regression analysis was used to determine the association between diuretic use and hospitalization.ResultsOf the 232 patients included, 45 received torsemide and 187 received an optimized furosemide dose upon discharge. The majority of patients included were males (54%) with a mean age of 67 ± 12 years, and presented with HF with reduced ejection fraction (57%) and had a history of coronary artery disease (68%). The 1-month and 6-month HF-related hospitalization did not differ between the torsemide and optimized furosemide groups (aHR = 0.72; 95% CI 0.23–2.3, p = 0.57; aHR = 0.94, 95% CI 0.45–1.8, p = 0.87), respectively.ConclusionSwitching furosemide to torsemide after ADHF was not associated with reduced HF-related hospitalization compared to receiving an optimized furosemide dose. Larger prospective clinical trials are needed to confirm the findings of this study.

Assessment of PULP score in predicting 30-day perforated duodenal ulcer morbidity, and comparison of its performance with Boey and ASA, a retrospective study.

Background/aim: Scores commonly employed to risk stratify perforated peptic ulcer patients include ASA (American Society of Anesthesiologists), Boey and peptic ulcer perforation score (PULP). However, few studies assessed and compared the accuracy indices of these three scores in predicting post PPU repair 30-day morbidity. We assessed accuracy indices of PULP, and compared them to Boey and ASA in predicting post perforated duodenal (PDU) ulcer repair 30-day morbidity.MethodsRetrospective chart review of all PDU patients (perforated duodenal ulcers only) at the largest two hospitals in Qatar (N = 152). Data included demographic, clinical, laboratory, operative, and post repair 30-day morbidity. Area under the Curve (AUC), sensitivity and specificity were computed for each of the 3 scores. Multivariate logistic regression assessed the accuracy indices of each score.ResultsAll patients were males (M age 37.41 years). Post PDU repair 30-day morbidity was 10.5% (16 morbidities). Older age, higher ASA (≥3), Boey (≥1) or PULP (≥8) scores, shock on admission and preoperative comorbidities; and conversely, lower hemoglobin and albumin were all positively significantly associated with higher post PDU 30-day morbidity. PULP displayed the largest AUC (72%), and was the only score to significantly predict 30-day morbidity. The current study is the first to report the sensitivity and specificity of these three scores for post PDU repair 30-day morbidity; and first to assess accuracy indices for PULP in predicting post PDU repair 30-day morbidity.ConclusionPULP score had the largest AUC and was the only score to significantly predict post PDU repair 30-day morbidity.