Types, Patterns and Outcomes of Personal Watercraft- Related Trauma

Background: Personal watercraft (PWC) - related injuries have increased significantly as well as its popularity.Aim: We aimed to describe types, patterns and outcomes of PWC injuries in Qatar.Subjects and Methods: A retrospective analysis was conducted to identify patients admitted and treated for PWC-related injuries between 2008 and 2014. Data included patients demographics, mechanism of injury, Glasgow coma scale, injury severity scoring, Abbreviated Injury Score, location of injuries, hospital length of stay, ventilator days and mortality. Data were analyzed by the type of PWC (Jet Ski and motorboat).Results: A total of 39 patients were identified with PWC-related injuries. The majority of cases (71.8%, 28/39) were young and aged 21 to 40 years. Twenty-six cases were injured in Jet Ski accidents and 13 sustained motorboat-related injuries. Patients injured in Jet Ski accidents were younger than those involved in motorboat accidents (mean age (SD); 25(7.6) vs 32.6(6), p=0.01). Chest injury was the most common type of injury; however, the severity of injury was highest in head trauma as compared with other body regions. The injured anatomical regions, severity of injury and outcomes were comparable in the Jet Ski and motorboat-related injuries. Two fatalities were reported; one in Jet Ski-related accident which occurred due to severe head injury and the other patient died due to drowning following motorboat accident. The small sample size in this cohort is one of the limitations, however, given the small number of Qatar population, rarity of reported PWC-related injuries and the importance of paying attention of healthcare authorities for this mechanism of injury may counteract this limitation.Conclusion: PWC-related injuries are increasing and possess potential risk of severe injuries and disabilities among young population. Strict regulation for training and operation of PWC together with public awareness is needed to improve the safety of recreational injuries.Keywords: Personal watercraft, Jet Ski, Motorboat, Sport, Injury pattern, Outcom

Emergency medical services (Ems) transportation of trauma patients by geographic locations and in-hospital outcomes: Experience from qatar

Background: Prehospital care provided by emergency medical services (EMS) plays an important role in improving patient outcomes. Globally, prehospital care varies across countries and even within the same country by the geographic location and access to medical services. We aimed to explore the prehospital trauma care and in-hospital outcomes within the urban and rural areas in the state of Qatar. Methods: A retrospective analysis was conducted utilizing data from the Qatar National Trauma Registry for trauma patients who were transported by EMS to a level 1 trauma center between 2017 and 2018. Data were analyzed and compared between urban and rural areas and among the different municipalities in which the incidents occurred. Results: Across the study duration, 1761 patients were transported by EMS. Of that, 59% were transported from an urban area and 41% from rural areas. There were significant differences in the on-scene time and total prehospital time as a function of urban and rural areas and municipalities; however, the response time across the study groups was comparable. There were no significant differences in blood transfusion, intubation, hospital length of stay, and mortality. Conclusion: Within different areas in Qatar, the EMS response time and in-hospital outcomes were comparable. This indicates that the provision of prehospital care across the country is similar. The prehospital and acute in-hospital care are accessible for everyone in the country at no cost. Understanding the differences in EMS utilization and prehospital times contributes to the policy development in terms of equitable distribution of healthcare resources

Perception of Healthcare Workers about Barriers Impacting Organ Donation in Qatar: A Focus Group Study

Objectives: To understand perception of healthcare workers about factors acting as barriers to organ donation and transplantation process in Qatar.Subjects and Methods: A phenomenological approach with the help of focus group discussions was used to fulfill the objectives of the research. Participants were healthcare workers working as volunteers in organ donation campaigns or playing a crucial role in the process of organ donation or transplantation in Qatar. They were selected purposively to participate in the discussions. Open-ended questions were asked during the audio-recorded discussions. Transcripts were coded and assessed using NVivo software. Results were analyzed based on the Theory of Planned Behavior to explore intentions shaping an individual’s donation decision.Results: Lack of awareness and information about the process of organ donation were found to be the root cause barriers for both deceased and living organ donation in Qatar whereas; family, religious and community influences, and an incongruous attitude towards organ donation are the main factors influencing organ donation registration and family consent for deceased donation.Conclusion: Improving awareness and accurate information about organ donation could play significant in increasing deceased and living organ donation in Qatar. However, factors impacting family consent, which was found to be the most prominent reason for gap between availability and utilization of organs, need to be further researched

Epidemiologic characteristics, clinical management and Public Health Implications of Coronavirus Disease 2019 (COVID-19) in Pregnancy: A Systematic Review and meta-analysis

Background:  The novel coronavirus disease 2019 (COVID-19) outbreak, caused by the pathogenic severe acute respiratory syndrome-2 (SARS-CoV-2) virus, is exponentially spreading across the globe. Methods: The current systematic review was performed utilizing electronic databases i.e. PubMed, MEDLINE and EMBASE. We searched for the keywords "COVID-19 AND "pregnancy" between January 1st, 2020 until December 31, 2020. Results: Out of 4005 records which were identified, 36 original studies were included in this systematic review. Pooled prevalence of vertical transmission was 10%, 95% CI: 4-17%. Pooled prevalence of neonatal mortality was 7%, 95% CI: 0-21%. Conclusion: The contemporary evidence suggests that the incubation period of COVID-19 is 2-14 days, and this infection could be transmitted even from the infected asymptomatic individuals. It is found that the clinical presentation of pregnant women with COVID-19 infection is comparable with the infected non-pregnant females, and the frequent symptoms were fever, cough, myalgia, sore throat and malaise. There are some cases with severe maternal morbidity and perinatal deaths secondary to COVID-19 infection. Under these circumstances, the pregnant women should focus on maintaining personal hygiene, proper nutrition and extreme social distancing to reduce the risk of COVID-19. Therefore, a systematic data reporting for evidence base clinical assessment, management and pregnancy outcomes is essential for prevention of COVID-19 infection among pregnant women

Efficacy and safety of the second in-hospital dose of tranexamic acid after receiving the prehospital dose: double-blind randomized controlled clinical trial in a level 1 trauma center

Background: Prehospital administration of tranexamic acid (TXA) to injured patients is increasing worldwide. However, optimal TXA dose and need of a second infusion on hospital arrival remain undetermined. We investigated the efficacy and safety of the second in-hospital dose of TXA in injured patients receiving 1 g of TXA in the prehospital setting. We hypothesized that a second in-hospital dose of TXA improves survival of trauma patients. Methods: A prospective, double-blind, placebo-controlled randomized, clinical trial included adult trauma patients receiving 1 g of TXA in the prehospital settings. Patients were then blindly randomized to Group I (second 1-g TXA) and Group II (placebo) on hospital arrival. The primary outcome was 24-h (early) and 28-day (late) mortality. Secondary outcomes were thromboembolic events, blood transfusions, hospital length of stay (HLOS) and organs failure (MOF). Results: A total of 220 patients were enrolled, 110 in each group. The TXA and placebo groups had a similar early [OR 1.000 (0.062–16.192); p = 0.47] and late mortality [OR 0.476 (95% CI 0.157–1.442), p = 0.18].The cause of death (n = 15) was traumatic brain injury (TBI) in 12 patients and MOF in 3 patients. The need for blood transfusions in the first 24 h, number of transfused blood units, HLOS, thromboembolic events and multiorgan failure were comparable in the TXA and placebo groups. In seriously injured patients (injury severity score > 24), the MTP activation was higher in the placebo group (31.3% vs 11.10%, p = 0.13), whereas pulmonary embolism (6.9% vs 2.9%, p = 0.44) and late mortality (27.6% vs 14.3%, p = 0.17) were higher in the TXA group but did not reach statistical significance. Conclusion: The second TXA dose did not change the mortality rate, need for blood transfusion, thromboembolic complications, organ failure and HLOS compared to a single prehospital dose and thus its routine administration should be revisited in larger and multicenter studies. Trial registration: ClinicalTrials.gov Identifier: NCT03846973

Khat Use: History and Heart Failure

Recent reports suggest that 20 million people worldwide are regularly using khat as a stimulant, even though the habit of chewing khat is known to cause serious health issues. Historical evidence suggests khat use has existed since the 13th century in Ethiopia and the southwestern Arabian regions even before the cultivation and use of coffee. In the past three decades, its availability and use spread all over the world including the United States and Europe. Most of the consumers in the Western world are immigrant groups from Eastern Africa or the Middle East. The global transport and availability of khat has been enhanced by the development of synthetic forms of its active component. The World Health Organization considers khat a drug of abuse since it causes a range of health problems. However, it remains lawful in some countries. Khat use has long been a part of Yemeni culture and is used in virtually every social occasion. The main component of khat is cathinone, which is structurally and functionally similar to amphetamine and cocaine. Several studies have demonstrated that khat chewing has unfavorable cardiovascular effects. The effect on the myocardium could be explained by its effect on the heart rate, blood pressure, its vasomotor effect on the coronary vessels, and its amphetamine–like effects. However, its direct effect on the myocardium needs further elaboration. To date, there are few articles that contribute death among khat chewers to khat-induced heart failure. Further studies are needed to address the risk factors in khat chewers that may explain khat-induced cardiotoxicity, cardiomyopathy, and heart failure

Pediatric Traumatic Brain Injury: a 5-year descriptive study from the National Trauma Center in Qatar

Abstract Background The epidemiologic characteristics and outcomes of pediatric traumatic brain injury (pTBI) have not been adequately documented from the rapidly developing countries in the Arab Middle East. We aimed to describe the hospital-based epidemiologic characteristics, injury mechanisms, clinical presentation, and outcomes of pTBI and analyze key characteristics and determinant of pTBI that could help to make recommendations for policies to improve their care. Methods We conducted a retrospective observational study in a level 1 trauma center (2010–2014) for all pTBI patients. Data were analyzed and compared according to different patient age groups. Results Out of 945 traumatic brain injury patients, 167 (17.7%) were ≤ 18 years old with a mean age of 10.6 ± 5.9 and 81% were males. The rate of pTBI varied from 5 to 14 cases per 100,000 children per year. The most affected group was teenagers (15–18 years; 40%) followed by infants/toddlers (≤ 4 years; 23%). Motor vehicle crash (MVC; 47.3%) was the most frequent mechanism of injury followed by falls (21.6%). MVC accounted for a high proportion of pTBI among teenagers (77.3%) and adolescents (10–14 years; 48.3%). Fall was a common cause of pTBI for infants/toddlers (51.3%) and 5–9 years old group (30.3%). The proportion of brain contusion was significantly higher in adolescents (61.5%) and teenagers (58.6%). Teenagers had higher mean Injury Severity Scoring of 24.2 ± 9.8 and lower median (range) Glasgow Coma Scale of 3 (3–15) (P = 0.001 for all). The median ventilatory days and intensive care unit and hospital length of stay were significantly prolonged in the teenage group. Also, pTBI in teenage group showed higher association with pneumonia (46.4%) and sepsis (17.3%) than other age groups (P = 0.01). The overall mortality rate was 13% (n = 22); 11 died within the first 24 h, 7 died between the second and seventh day and 4 died one week post-admission. Among MVC victims, a decreasing trend of case fatality rate (CFR) was observed with age; teenagers had the highest CFR (85.7) followed by adolescents (75.0), young children (33.3), and infants/toddlers (12.5). Conclusions This local experience to describe the burden of pTBI could be a basis to adopt and form an efficient, tailored strategy for safety in the pediatric population

Review of Existing Scoring Systems For Massive Blood Transfusion in Trauma Patients: Where Do We Stand?

BACKGROUND: Uncontrolled bleeding is the main cause of the potential preventable death in trauma patients. Accordingly, we reviewed all the existing scores for massive transfusion posttraumatic hemorrhage and summarized their characteristics, thus making it easier for the reader to have a global view of these scores - how they were created, their accuracy and to which population they apply. METHODS: A narrative review with a systematic search method to retrieve the journal articles on the predictive scores or models for massive transfusion was carried out. A literature search using PubMed, SCOPUS and Google scholar was performed using relevant keywords in different combinations. The keywords used were massive transfusion , score , model , trauma and hemorrhage in different combinations. The search was limited for full-text articles published in English language, human species and for the duration from 01 January, 1998 to 30 November, 2018. RESULTS: The database search yielded 295 articles. The search was then restricted to the inclusion criteria which retrieved 241 articles. Duplicates were removed and full-texts were assessed for the eligibility to include in the review which resulted in inclusion of 24 articles. These articles identified 24 scoring systems including modified or revised scores. Different models and scores for identifying patients requiring massive transfusion in military and civilian settings have been described. Many of these scorings were complex with difficult calculation, while some were simple and easy to remember. CONCLUSIONS: The current prevailing practice that is best described as institutional or provider centered should be supplemented with score based protocol with auditing and monitoring tools to refine it. This review summarizes the current scoring models in predicting the need for MT in civilian and military trauma. Several questions remain open; i.e., do we need to develop new score, merge scores, modify scores or adopt existing score for certain trauma setting

Knowledge and Willingness for Organ Donation in the Middle Eastern Region: A Meta-analysis

Medical advancements over the past decades brought organ transplantation as a definitive therapy for different end-stage organ failure. However, non-availability of organs required for transplantation is a major challenge worldwide. We aimed to determine the knowledge and willingness to donate organs in various populations and settings in the Middle Eastern region. Literature searches were conducted on PubMed, MEDLINE, Cochrane, and Google scholar electronic databases. Different combinations of search terms such as “organ donation”; “knowledge”, “awareness”; “beliefs”, “willingness”; and “attitude” along with the country names were used. Additional searches using reference lists of studies and review articles were conducted. Data were extracted using standardized excel form and pilot tested. Three authors independently abstracted the data using a data collection form. Results from different studies were pooled for the analysis when appropriate. The search yielded 1806 articles; 1000 duplicates and review articles were excluded, and a further 792 articles not relevant were excluded. Finally, 14 original studies met the inclusion criteria. Total pooled sample size for assessing knowledge was 6697 and for willingness was 8714. Pooled overall knowledge regarding organ donation was 69% with a 95% CI [64.5, 73.5]. Pooled overall willingness to donate organ was 49.8% with a 95% CI [41.3, 58.4]. Knowledge about organ donation and willingness to donate organs varies in different population and settings in the Middle East. These in fact are linked to multiple social factors ultimately leads to ‘consent’ for donating organs by a potential donor. Family’s influence; religious, traditional and spiritual beliefs; and status of ethnic, minority, and immigrant populace are the important determinants of the decision for organ donation. Understandings on social determinants in organ donation remain crucial and should be addressed while developing policies and organizational developments.Other Information Published in: Journal of Religion and Health License: https://creativecommons.org/licenses/by/4.0See article on publisher's website: http://dx.doi.org/10.1007/s10943-019-00883-x</p