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PURPOSE OF THE STUDY Pelvic trauma causes severe threats especially to polytraumatized patients. Not only it is in itself a possible cause for significant bleeding, but it also indicates a high risk for intra-abdominal injuries. The initial treatment of patients with pelvic trauma follows the ATLS principles of priority-oriented treatment. To examine the value of this highly standardized concept and to evaluate the effect of different patient collectives on early outcome parameters, two large collectives from Germany and Qatar were analyzed regarding injury parameters and early outcomes. MATERIAL AND METHODS Patients were recruited in Hamad General Hospital, Doha, Qatar (HGH) and BG Trauma Center Ludwigshafen, Germany (BG). All patients that were treated with a pelvic fracture between 2013 and 2016 were included in this retrospective analysis. Demographic parameters were collected as well as type of injury and the frequency of complication parameters as pneumonia, acute kidney failure, ARDS, sepsis and amount of blood transfusion. 1436 patients with pelvic fracture (645 from BG and 791 from HGH) were recruited. The mean age was 57.4 years in the BG and 33.6 years in the HGH group (p<0.000). The mean ISS was 17.81 in the BG and 15.88 in the HGH group (p=0.009). The mean pelvic AIS was 2.65 in the BG and 2.25 in the HGH group (p<0.000). RESULTS The mean frequency of complications was 9.3% in the BG and 9.9% in the HGH group (p=0.128). The mean frequency of ARDS was significantly higher in the BG group than in the HGH group (5.6% vs. 1.8%, p<0.000). The mean frequency of blood transfusion was significantly lower in the BG group than in the HGH group (28.8% vs. 39.2%, p<0.000). CONCLUSIONS Despite significant differences in the two collectives, this analysis shows comparable results regarding early outcome parameters in patients with pelvic injuries. In total, pelvic injuries are accompanied by a relatively high complication risk and need to be evaluated and treated according to priority-based algorithms. [ABSTRACT FROM AUTHOR]

Previous work on CdS–CuInSe2 (CIS) solar cells, which reported distortions of their current-voltage (J–V) curves under red illumination, is expanded in this work to include CdS–CuIn1-xGaxSe2 cells with variable Ga and CIS cells with variable CdS thickness. Different amounts of J–V distortion were observed in these cells under red light. The details are in good agreement with predictions of a photodiode model, in which a secondary barrier caused by the positive conduction-band discontinuity (spike) at the buffer–absorber interface is responsible for the current limitation. The illumination of the cell with high-energy photons lowers the barrier due to buffer photoconductivity, and thus removes the J–V distortion. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the clinical outcomes of multiple rib fracture due to blunt trauma in young patients, a 3-year retrospective study was conducted. Patients with ≥3 rib fractures were divided into two groups (group I: <45 years old and group II: ≥45 years old). Mortality, hospital stay, ventilatory support, chest tubes insertion and associated injuries were studied. Results: Of the 902 patients admitted with blunt chest trauma, 240 (27 %) met the inclusion criteria and 72.5 % patients were <45 years old. The most common causes of injury were motor vehicle crash (59 %) and fall (29 %). The Injury Severity Score (ISS) was higher in group I (16 ± 9 vs. 13 ± 6; p = 0.04). Hospital mortality was higher in group II (6 vs. 2 %; p = 0.18). Pneumothorax, haemothorax and ventilatory support were comparable. Patients in group II were more likely to undergo chest tubes insertion (26 vs. 14 %; p = 0.04), while group I had a significantly higher incidence of associated abdominal injuries (25 vs. 12 %; p = 0.03). Conclusion: Old age presenting with rib fractures is associated with higher mortality in comparison to young age; however, this difference becomes statistically insignificant in the presence of multiple rib fracture. [ABSTRACT FROM AUTHOR]

Background: Percutaneous dilatational tracheostomy (PDT) is a routine surgical procedure for critically ill patients who require prolonged ventilatory support. Methods: We conducted a retrospective cohort study of all PDTs performed at the adult Trauma Intensive Care Unit (TICU) of Hamad Medical Corporation in Doha, Qatar, from January 2009 through September 2012. For all adult patients, we analyzed the demographic characteristics, mean ventilator time before the procedure, injury severity score (ISS), complications, and outcomes. Results: Of the 1,442 trauma patients admitted to the adult TICU during our study period, 124 (8.5 %) underwent PDT using the Ciaglia Blue Rhino technique. The vast majority were male (94.3 %). The mean age was 35 ± 15.6 years; mean ventilator time before the procedure, 12 ± 3 days; and mean ISS, 24.2 ± 9.3. More than half of patients had head injury (56 %), followed by chest and abdomen (26 %) and cervical spine injuries (18 %). Early complications included difficult tube placement (0.8 %), hypoxemia (0.8 %), minor bleeding (1.6 %), and hypotension (0.8 %), but the vast majority (93 %) of patients had no complications. The procedure-related mortality rate was 0 %. Conclusion: PDT is safe and can be performed with minimal complications even in a newly established trauma center. [ABSTRACT FROM AUTHOR]

Background: A quarter of trauma-related deaths are attributable to traumatic chest injury (TCI). Objective: To outline the pattern and outcome of TCI in a rapidly developing country among different age groups. Methods: We conducted a retrospective observational study for patients who sustained TCI and admitted between January 2008 and December 2010 to the Level I trauma center at Hamad General Hospital in Qatar. Patients were classified and analyzed in four age groups (group 1 ≤18, group 2 between 19-44, group 3 45-59, and group 4 >60 years). Multivariate regression analysis was performed for predictors of mortality. Results: Of 5,118 cases admitted to the Section of Trauma Surgery, 1,355 (26.5 %) had TCI (12, 67, 16, and 5 % in groups 1-4, respectively), which was due to blunt trauma in 96 % of cases. The overall mean age was 33 ± 15 years and males comprised 94 % of cases. Children (≤18 years of age) had more traffic-related injury, intubation, high Injury Severity Score (ISS) (19 ± 12), and associated head and liver injuries in comparison to the other groups. The overall mortality rate was 13 % (24, 11, 12, and 16 % in groups 1-4, respectively). The death rate was higher in pedestrians, followed by motor vehicle crashes (MVCs) and fall-related injuries (24 vs. 13 vs. 7 %, respectively, p = 0.001). The highest mortality occurred within the first day ( n = 115, 65 %). In comparison to old age, children were more likely to die early (on the first day) and the adult group died mostly within the first week of hospitalization. Independent predictors for mortality included associated head injury [odds ratio (OR) 2.3, 95 % confidence interval (CI) 1.48-3.62), ISS (OR 1.11, 95 % CI 1.09-1.13), and age (OR 0.37, 95 % CI 0.22-0.62). Conclusion: TCI is an alarming problem in Qatar, with a bimodal mortality curve. The highest mortality peak occurred in children, followed by old age. However, young males are the most exposed population. Regulatory efforts and strict enforcement of traffic laws would likely reduce morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: Enteral nutrition (EN) is a widely used, standard-of-care technique for nutrition support in critically ill and trauma patients. Objective: To review the current techniques of gastrointestinal tract access for EN. Methods: For this traditional narrative review, we accessed English-language articles and abstracts published from January 1988 through October 2012, using three research engines (MEDLINE, Scopus, and EMBASE) and the following key terms: 'enteral nutrition,' 'critically ill,' and 'gut access.' We excluded outdated abstracts. Results: For our nearly 25-year search period, 44 articles matched all three terms. The most common gut access techniques included nasoenteric tube placement (nasogastric, nasoduodenal, or nasojejunal), as well as a percutaneous endoscopic gastrostomy (PEG). Other open or laparoscopic techniques, such as a jejunostomy or a gastrojejunostomy, were also used. Early EN continues to be preferred whenever feasible. In addition, evidence is mounting that EN during the early phase of critical illness or trauma trophic feeding has an outcome comparable to that of full-strength formulas. Most patients tolerate EN through the stomach, so postpyloric tube feeding is not needed initially. Conclusion: In critically ill and trauma patients, early EN through the stomach should be instituted whenever feasible. Other approaches can be used according to patient needs, available expertise, and institutional guidelines. More research is needed in order to ensure the safe use of surgical tubes in the open abdomen. [ABSTRACT FROM AUTHOR]

Background: The increasing use of thoracic computed tomography (CT) in trauma patients has led to the recognition of intrapleural blood and air that are not initially evident on admission plain chest X-ray, defining the presence of occult hemopneumothorax. The clinical significance of occult hemopneumothorax, specifically the role of the tube thoracostomy, is not clearly defined. Objective: To identify those patients with occult hemopneumothorax who can be safely managed without chest tube insertion. Design: Prospective observational study. Methods: During the recent 24 month period ending July 2010, comprehensive data on trauma patients with occult hemopneumothorax were recorded to determine whether tube thoracostomy was needed and, if not, to define the consequences of nondrainage. Pneumothorax and hemothorax were quantified by computed tomography (CT) measurement. Data included demographics, injury mechanism and severity, chest injuries, need for mechanical ventilation, indications for tube thoracostomy, hospital length of stay, complications and outcome. Results: There were 73 patients with hemopenumothorax identified on CT scan in our trauma registry. Tube thoracostomy was successfully avoided in 60 patients (83 %). Indications for chest tube placement in 13 (17 %) of patients included X-ray evidence of hemothorax progression (10), respiratory compromise with oxygen desaturation (2). Mechanical ventilation was required in 19 patients, five of them required chest tube insertion, and six developed ventilator associated pneumonia, while there were no cases of empyema. There was one death due to severe head injury. Conclusions: Occult hemopneumothorax can be successfully managed without tube thoracostomy in most cases. Patients with a high ISS score, need for mechanical ventilation, and CT-detected blood collection measuring >1.5 cm increased the likelihood of need for tube thoracostomy. The size of the pneumothorax did not appear to be significant in determining the need for tube thoracostomy. [ABSTRACT FROM AUTHOR]

Abstract Background: Data evaluating the presence and impact of diabetic retinopathy (DR) in patients on regular hemodialysis (HD) are scarce. Objective: To assess prevalence and outcomes of DR in HD patients. Methods: Data were collected from 252 consecutive HD-dependent patients who underwent eye examination for detection of DR in 2007. Patients were divided into two groups (DR vs. no-DR) and followed up for 3 years. Demographic and clinical profiles were analyzed and compared. Multivariate logistic regression was used to find out the predictors of DR, morbidity and mortality. Results: DR was diagnosed in 113 patients (45%). In comparison to no-DR, DR patients were older and more likely to have high prevalence of dyslipidemia, coronary artery disease and cerebrovascular accidents. Duration of DM was longer in DR patients (p = 0.02). There was significant correlation between DR and nephropathy (r = 0.38; p = 0.001) and PAD (r = 0.27; p = 0.001). Hemoglobin A1c, serum calcium and total cholesterol were higher while serum albumin and phosphorus were lower in DR in comparison to no-DR group. The rates of renal transplant, coronary artery disease and cerebrovascular accidents were comparable in the two groups. Peripheral arterial disease (PAD) was associated with 4-fold increase in the presence of DR (Adjusted OR 3.9; p = 0.009). DR was independent predictor for PAD (adjusted OR 2.2; p = 0.01). Age-sex adjusted DR was independent predictor of 3-year mortality (OR 2.04; p = 0.03). Limitations: The main issue with a cross-sectional study such as this, is differentiating cause and effect from simple association. Also, the current study did not specify the severity of DR. Conclusion: Prevalence of DR is high among HD patients and associated with high mortality. DR is an independent predictor for PAD and not for transplantation. Early detection of DR is highly recommended among HD population for risk-stratification and counseling. Further randomized controlled studies are needed to support our finding. [ABSTRACT FROM AUTHOR]

Spectroscopic ellipsometry measurements of CuInSe2 (CIS) and CuIn0.8Ga0.2Se2 (CIGS) reveal that there are important differences in electronic properties between stoichiometric CIS (CIGS) and Cu-poor CIS (CIGS). We find a reduction in the absorption strength in the spectral region of 1–3 eV. This reduction can be explained in terms of the Cu 3d density of states. Cu-poor CIS (CIGS) materials show an increase in band gap due to the reduction in repulsion between Cu 3d and Se 4p states. The experimental results have important implications for the function of polycrystalline optoelectronic devices. [ABSTRACT FROM AUTHOR]

The built-in electrical potential of Cu(In,Ga)Se[sub 2] (CIGS) solar cells was measured quantitatively and resolved spatially using scanning Kelvin probe microscopy. Profiles of the electrical potential along cross sections of the device demonstrate that the p-n junction is a buried homojunction, and the p/n boundary is located 30-80 nm from the CIGS/CdS interface in the CIGS film. The built-in electric field terminates at the CIGS/CdS interface, indicating that the CdS and ZnO layers of the device structure are inactive for the collection of photoexcited carriers. [ABSTRACT FROM AUTHOR]

A correction to the article "Gastrointestinal tract access for enteral nutrition in critically ill and trauma patients: indications, techniques, and complications" that was published in the May 15, 2013 issue is presented.