Delayed bile leak in a patient with grade IV blunt liver trauma: A case report and review of the literature

AbstractIntroductionDelayed bile leak following blunt liver trauma is not common.Presentation of caseWe presented a case report and literature review of delayed bile leak in a young male patient who presented with grade IV blunt liver injury following a motor vehicle collision; he was a restrained driver who hit a fixed object. Physical examination was unremarkable except for revelaed tachycardia, right upper quadrant abdominal tenderness, and open left knee fracture. A diagnosis of grade IV multiple liver lacerations with large hemo-peritoneum was made and urgent exploratory laparotomy was performed. The patient developed a biloma collection post- operatively. He underwent endoscopic retrograde cholangiopancreatography (ERCP) and common bile duct stenting. His recovery was uneventful, and he was discharged home after 1 month.DiscussionThis is a rare case with no intra or extra hepatic biliary radicle injury seen on magnetic resonance cholangiopancreatography (MRCP) and no evidence of leak by ERCP. A review of the literature to highlight the incidence of delayed bile leak revealed only few reported cases.ConclusionOur findings demonstrate the need for prompt diagnosis and treatment of delayed bile leak in blunt liver injuries. When these principles are followed, a successful outcome is possible

Digital Wellbeing for All: Expanding Inclusivity to Embrace Diversity in Socio-Emotional Status

The ubiquity of information and communication technology contributed positively in enhancing lives, mainly in increasing productivity and economic growth, while their impact on life satisfaction and wellbeing has been a hidden cost. Digital media shall empower users to maximise their digital wellbeing, i.e. healthy and regulated relationship with technology. Similar to usability, people differ in their needs to achieve and maintain their digital wellbeing. A technology design shall be inclusive in how it helps users to increase their digital wellbeing and reduce possible harm. Typical inclusivity dimensions in Human-Computer Interaction research include gender, race, physical and cognitive abilities, with the aim of making the product usable by the wider possible user set. However, another range of inclusivity dimensions becomes prominent and that is the diversity in users' socio-emotional characteristics such as susceptibility to online pressure (technical and social), resilience and others. Such characteristics can be traits, e.g. introversion, or temporal status, e.g. being in a low mood. In this position paper, we are proposing digital wellbeing as a target for an inclusive design where technology designers need to anticipate and reduce the negative impact of their products and services on the wellbeing of users through considering their diverse socio-emotional status

How the different explanation classes impact trust calibration: The case of clinical decision support systems

Machine learning has made rapid advances in safety-critical applications, such as traffic control, finance, and healthcare. With the criticality of decisions they support and the potential consequences of following their recommendations, it also became critical to provide users with explanations to interpret machine learning models in general, and black-box models in particular. However, despite the agreement on explainability as a necessity, there is little evidence on how recent advances in eXplainable Artificial Intelligence literature (XAI) can be applied in collaborative decision-making tasks, i.e., human decision-maker and an AI system working together, to contribute to the process of trust calibration effectively. This research conducts an empirical study to evaluate four XAI classes for their impact on trust calibration. We take clinical decision support systems as a case study and adopt a within-subject design followed by semi-structured interviews. We gave participants clinical scenarios and XAI interfaces as a basis for decision-making and rating tasks. Our study involved 41 medical practitioners who use clinical decision support systems frequently. We found that users perceive the contribution of explanations to trust calibration differently according to the XAI class and to whether XAI interface design fits their job constraints and scope. We revealed additional requirements on how explanations shall be instantiated and designed to help a better trust calibration. Finally, we build on our findings and present guidelines for designing XAI interfaces

Clinical Study Implications of Foot Ulceration in Hemodialysis Patients: A 5-Year Observational Study

Foot ulceration (FU) remains a serious concern for patients worldwide. We analyzed the incidence, risk factors, and outcome of FU in hemodialysis (HD) patients. A retrospective cohort study was conducted for 252 HD patients who were followed up for 5 years. Patients were categorized according to whether they developed FU or not. The FU group (17%) was older and had significantly higher incidence of nephropathy, retinopathy, peripheral (PAD), coronary artery disease (CAD), and diabetes mellitus (DM) as compared to no-FU group. FU group had higher frequency of major amputation ( = 0.001) and HD vascular access ( = 0.01). Patients with combined DM and PAD had a 10-fold increased risk of FU in comparison to those who had DM alone. Presence of PAD was the main independent predictor for development of FU in HD with an adjusted odd ratio (aOR) of 16.0 (95% CI: 4.41-62.18; = 0.001). After adjusting for age, sex, and CAD, predictors for mortality were PAD (aOR 4.3), FU (aOR 3.6), and DM (aOR 2.6). FU is common in HD patients regardless of DM. However, the presence of PAD is significantly associated with more FU and mortality in HD. HD patients need intensive foot care and warrant progressive modification of vascular risk factors

Biomaterials in Traumatic Brain Injury: Perspectives and Challenges

Traumatic brain injury (TBI) is a leading cause of mortality and long-term impairment globally. TBI has a dynamic pathology, encompassing a variety of metabolic and molecular events that occur in two phases: primary and secondary. A forceful external blow to the brain initiates the primary phase, followed by a secondary phase that involves the release of calcium ions (Ca2+) and the initiation of a cascade of inflammatory processes, including mitochondrial dysfunction, a rise in oxidative stress, activation of glial cells, and damage to the blood–brain barrier (BBB), resulting in paracellular leakage. Currently, there are no FDA-approved drugs for TBI, but existing approaches rely on delivering micro- and macromolecular treatments, which are constrained by the BBB, poor retention, off-target toxicity, and the complex pathology of TBI. Therefore, there is a demand for innovative and alternative therapeutics with effective delivery tactics for the diagnosis and treatment of TBI. Tissue engineering, which includes the use of biomaterials, is one such alternative approach. Biomaterials, such as hydrogels, including self-assembling peptides and electrospun nanofibers, can be used alone or in combination with neuronal stem cells to induce neurite outgrowth, the differentiation of human neural stem cells, and nerve gap bridging in TBI. This review examines the inclusion of biomaterials as potential treatments for TBI, including their types, synthesis, and mechanisms of action. This review also discusses the challenges faced by the use of biomaterials in TBI, including the development of biodegradable, biocompatible, and mechanically flexible biomaterials and, if combined with stem cells, the survival rate of the transplanted stem cells. A better understanding of the mechanisms and drawbacks of these novel therapeutic approaches will help to guide the design of future TBI therapies

The replacement of five consecutive amino acids in the cyt1a protein of bacillus thuringiensis enhances its cytotoxic activity against lung epithelial cancer cells

Cyt1A protein is a cytolytic protein encoded by the cyt gene of Bacillus thuringiensis subsp. israelensis (Bti) as part of the parasporal crystal proteins produced during the sporulation. Cyt1A protein is unique compared to the other endotoxins present in these parasporal crystals. Unlike ?-endotoxins, Cyt1A protein does not require receptors to bind to the target cell and activate the toxicity. It has the ability to affect a broad range of cell types and organisms, due to this characteristic. Cyt1A has been recognized to not only target the insect cells directly, but also recruit other endotoxins by acting as receptors. Due to these mode of actions, Cyt1A has been studied for its cytolytic activity against human cancer cell lines, although not extensively. In this study, we report a novel Cyt1A protein produced by a Bti strain QBT229 isolated from Qatar. When tested for its cytotoxicity against lung cancer cells, this local strain showed considerably higher activity compared to that of the reference Bti and other strains tested. The possible reasons for such enhanced activity were explored at the gene and protein levels. It was evidenced that five consecutive amino acid replacements in the ?8 sheet of the Cyt1A protein enhanced the cytotoxicity against the lung epithelial cancer cells. Such novel Cyt1A protein with high cytotoxicity against lung cancer cells has been characterized and reported through this study. -2018 by the authors. Licensee MDPI, Basel, Switzerland.Scopu

Investigating the individual interests of undergraduate students in STEM disciplines

Despite massive investments in the education sector to empower youth in Qatar, a vital concern remains to retain students in science, technology, engineering, and mathematics (STEM) disciplines at the undergraduate level. Even though the country is committed to fostering a knowledge-based society, the low interest of undergraduates in STEM disciplines remains a vital challenge. To investigate this, the current study uses a survey methodology to investigate the perspectives of 172 undergraduate students to understand quantitatively the factors that influence their individual interests in STEM disciplines. Non-parametric significance tests and binary logistic regressions were employed to quantitatively measure the direct factors and predictors that affect students’ individual interests. Findings indicated that aspects like students’ reason/motivation to join STEM, their interaction with faculty, the habit of skipping classes, the difficulty faced in the curriculum, and their parents’ highest educational qualification have an association with individual interests. Also, it was found that demographics such as age group, ethnicity, undergraduate discipline, undergraduate year, parent’s employment status, and mother’s highest educational qualification do not contribute to significant differences in students’ individual interests. These conclusions provide important implications for educationists and policymakers to devise constructive reforms to enhance undergraduate students’ individual interests, thereby improving their persistence in STEM

Peripheral Arterial Disease in Patients Presenting with Acute Coronary Syndrome in Six Middle Eastern Countries

To describe prevalence and impact of peripheral arterial disease (PAD) in patients with acute coronary syndrome (ACS), data were collected over 5 months from 6 Middle Eastern countries. Patients were divided into 2 groups (with and without PAD). Out of 6705 consecutive ACS patients, PAD was reported in 177 patients. In comparison to non-PAD, PAD patients were older and more likely to have cardiovascular risk factors. They were more likely to have high Killip class, high GRACE risk score, and non-ST elevation ACS (NSTEACS) at presentation. Thrombolytics, antiplatelet use, and coronary intervention were comparable in both groups. When presented with ST-elevation myocardial infarction (STEMI), patients with PAD had worse outcomes, while in NSTEACS; PAD was associated with higher rate of heart failure in comparison to non-PAD patients. In diabetics, PAD was associated with 2-fold increase in mortality when compared to non-PAD (P = 0.028). After adjustment, PAD was associated with high mortality in STEMI (adjusted OR 2.6; 95% CI 1.23–5.65, P = 0.01). Prevalence of PAD in ACS in the Gulf region is low. Patients with PAD and ACS constitute a high risk group and require more attention. PAD in patients with STEMI is an independent predictor of in-hospital death

Do research experience programs promote capacity building in Qatar: Investigating the trend and participation differences

Research Experience programs (REPs) inspire students to pursue advanced degrees and shape their research career paths. Government and commercial organizations sponsor REPs to promote the capacity building of the country. In Qatar, the national youth is reported to show concerning participation in Science, Technology, Engineering, and Mathematics (STEM) disciplines at the K-12 level. However, none of the studies investigate these participation trends at the undergraduate level, especially in scientific research, which is deemed necessary for building a knowledge-based economy in Qatar. Therefore, to bridge this gap, the current study uses a quantitative approach to analyze the REP in Qatar through the participation data of 2455 undergraduate students. For this, statistical measures, including descriptive analysis, independent samples t-test, and Pearson's correlation analysis were used. Results indicated concerning trends in national student participation rate, implying underlying issues restricting their representation in undergraduate research activities. Also, statistically significant differences were found in student participation rates among students' gender and ethnic distributions. While female students demonstrated higher participation rates than males, national students showed lower participation than the non-nationals. Moreover, this low participation of national students suffered more drastically in STEM disciplines. Therefore, these findings determine the outlook for stakeholders and academic institutions in making meaningful educational decisions and envision synchronizing REPs at the university level, gauging measures to bolster the adjacent funding agencies and government organizations. Furthermore, being the first research addressing REPs in the Middle East region, this study has the potential to support educators in neighboring and other developing nations where STEM education is especially significant for human capacity building

Workplace-Related Traumatic Injuries: Insights from a Rapidly Developing Middle Eastern Country

Traumatic workplace-related injuries (WRIs) carry a substantial negative impact on the public health worldwide. We aimed to study the incidence and outcomes of WRIs in Qatar. We conducted occupational injury surveillance for all WRI patients between 2010 and 2012. A total of 5152 patients were admitted to the level 1 trauma unit in Qatar, of which 1496 (29%) sustained WRI with a mean age of 34.3±10.3. Fall from height (FFH) (51%) followed by being struck by heavy objects (FHO) (18%) and motor vehicle crashes (MVC) (17%) was the commonest mechanism of injury (MOI). WRI patients were mainly laborers involved in industrial work (43%), transportation (18%), installation/repair (12%), carpentry (9%), and housekeeping (3%). Use of protective device was not observed in 64% of cases. The mean ISS was 11.7±8.9, median ICU stay was 3 days (1–64), and total hospital stay was 6 days (1–192). The overall case fatality was 3.7%. Although the incidence of WRI in Qatar is quite substantial, its mortality rate is relatively low in comparison to other countries of similar socioeconomic status. Prolonged hospital stay and treatment exert a significant socioeconomic burden on the nation’s and families’ resources. Focused and efficient injury prevention strategies are mandatory to prevent future WRI