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This study aimed to evaluate the development of healthcare teamwork during and after the collaboration tabletop exercises, through observation and interview methods. Integration and maturity theoretical models were employed to explain the collaborative challenges in teams that may suffer from unequally distributed power, hierarchies, and fragmentation. Using three-level collaboration tabletop exercises and the Command and control, Safety, Communication, Assessment, Treatment, Triage, Transport (CSCATTT) instrument, 100 healthcare workers were observed during each step in the implementation of the CSCATTT instrument using two simulated scenarios. The results show a lack of integration and team maturity among participants in the first scenario, leading to the delayed start of the activity, task distribution, and decision making. These shortcomings were improved in the second scenario. In-depth interviews with 20 participants in the second phase of the study revealed improved knowledge and practical skills, self-confidence, and ability in team building within trans-professional groups in the second scenario, which in concordance with the integration theory, was due to the attempts made in the first scenario. Additionally, there was an improvement in the team’s maturity, which in concordance with the maturity theory, was due to the knowledge and practical skills during scenario plays. These results indicate the importance of continuous tabletop training, and the use of CSCATTT as a collaborative instrument, to promote the development of collaboration and to test the concept of preparedness.

This is the first time that a local preliminary document on gender differences in CVDs has been initiated in Pakistan. International forum has been highlighting significant gender and ethnicity in CVDs. So different countries from world took the initiative to develop their local guideline or clinical scientific statements on gender differences with different socio-cultural and educational background for their own countries. GRFW in collaboration with Scientific Council of Women with Heart Disease PCS Pakistan floated this idea to develop a local guideline in various aspects CVDs for our own women population. In this regard different topics were assigned to different groups including mostly female cardiologists, senior gynecologists/obstetricians and radiologist from all over Pakistan. Primary objectives of this write up on Cardiac Imaging in Women is to provide a local clinical practice guideline for the assessment and management of CVD that will improve and standardize the physicians’ decision making for Pakistani women population. In the setting of growing awareness of providing personalized precision medicine, addressing sex differences in CVD is a key goal. The intention is to inform cardiologists, non-cardiologist physicians’, general practitioners, and, obstetrician/gynecologists about the reasonable use and understanding of technologies to help in proper approach to their treating women with HDs and when to send them for cardiac specialist diagnostic center. As we could not find our own local data on cardiac imaging to report at present, most recommendations on cardiac imaging used has been taken from international literatures (which we have found feasible, readily available, and some cost effective approach in our money constraint society which can be followed in our population) and also which were published within the past decade were given priority. In this document, we discuss the role of using different cardiac imaging modalities, with a focus on diseases which are unique/or occur more in women. So, five women specific topics more commonly seen in our population were selected currently, which are (stable/unstable angina and ACS, MINOCA), non-ischemic CMP, HD during pregnancy, cardio-oncology, and connective tissue diseases (CTD). In these topics we have tried to used our own local incidences and prevalence of these diseases in our community/internationally on gender basis and have highlighted the availability/limitations of cardiac imaging in our society. The updated recommendations in women have been taken from international guidelines. Graphs and tables layout has been taken from abroad literatures and made some few changes according to its use in our population. You will find this a preliminary review document which will be simple to read, have updated approach in evaluating the diagnosis of HD in women easily. For current cost effectiveness issues for our population will be taken up by PCS to Health ministries of Pakistan for its making it easily availability with cheap cost so to benefit our female (very neglected and ill informed) with CVD population.

The effect of different concentration of crude oil had been examined upon Oscillatoria splendida, it was depended upon measuring Growth as optical density, Chlorophyll, Phycocyanin and Protein concentration as an Physiological activities indicator of crude oil effects on Oscillatoria splendida, in addition to morphological changes. The growth optical density in the control sample in the day 30 was (0. 34), while it was (0.148) & (0.08) at 0.25% & 0.5% of crude oil respectively, 41% of chlorophyll concentration has been reduced under effect of 0.25% of crude oil, and reduction 63% of chlorophyll concentration with treatment 0.5%. Protein was reduced 45% at 0.25%, and 82% at 0.5% of crude oil. It was observed reduction growth, chlorophyll, phycocyanin as well as the protein concentration to a minimum under the influence of crude oil treatment 1% and 2% respectively. As well as the absorption spectrum infrared by FTIR show there were absence of methyl group CH3 at (2950 cm-1), (2870 cm-1) and other bundle such as (2300) cm-1, (1500) cm-1, and this is could due to consumed by this species. With appearance a new compounds at 2400 cm-1 and 800 cm-1. Morphologically Observed that the cells within the filament appearance clearly.

ان مشكلة التنمر الاداري لدى رؤساء الأقسام، تعد مشكلة خطيرة على الجامعات، كما انها تتميز بكونها من المشاكل التي يصعب تحديدها وتقييمها بدقة، وهذا ما يستدعي على الجهات ذات العلاقة الوقوف على معرفة أسباب التنمر الاداري في مكان العمل وعلاقته بأداء أعضاء الهيئة التدريسية. فالتنمر الاداري تعد ظاهرة سلبية تؤرق أعضاء الهيئة التدريسية في الجامعات نتيجة ميل أصحاب السلطة الى اتباع مجموعة من الممارسات والأساليب العدائية في بيئة العمل، مما يؤثر سلبا على أداء أعضاء الهيئة التدريسية. ان التنمر الاداري يكثر لدى المرؤوسين من ذوي الأنماط الشخصية الانفعالية الاستبدادية الذين يجبرون موظفيهم على ممارسة الإذعان الفـوري للأوامـر، ولكنهم لا يهتمـون بتوضـيح الأسـباب مـن وراء ذلـك، وفي حالة لم ينفذ موظفيهم اوامرهم بـدون تسـاؤلات، فانهم يلجؤون الى ممارسة التهديدات بدلا من تفويض السلطات ويســعون الــى الســيطرة المحكمــة علــى أي موقــف والرقابــة عليــهم بحــرص شـديد. لذا جاء هذا البحث ليحقق الهدفين الاتيين: 1-التنمر الإداري لدى رؤساء الأقسام العلمية من وجهة نظر تدريسي الجامعة. 2-دلالة الفروق في التنمر الإداري لدى رؤساء الأقسام العلمية من وجهة نظر تدريسي الجامعة تبعا لمتغيري: ا-النوع: (ذكور – اناث). ب-التخصص: (علمي -انساني). ولأجل التوصل الى هدفا البحث قام الباحث ببناء مقياس للتنمر الإداري لدى رؤساء الأقسام العلمية على عينة بلغت (300) تدريسي وتدريسية من أساتذة الجامعة المستنصرية، وبعد استخراج معاملات الصدق والثبات للمقياس، وكذلك استخراج البيانات الخاصة بإجاباتهم، أظهرت نتائج البحث ما يلي: 1-ان رؤساء الاقسام العلمية يعانون من مستوى مرتفع من التنمر الاداري. 2-ليس هنالك تأثير للنوع والتخصص في ارتفاع مستوى التنمر الاداري لدى رؤساء الاقسام العلمية.

The effect of different concentration of Kerosene had been examined upon Oscillatoria splendida, The optical density had been depended as measure for growth as well as chlorophyll a concentration, Phycocyanin pigment and protein concentration as an indicator of Kerosene effects, in addition to morphological changes. The optical density of growth in the control sample was (0.34), while it was (0.23) at 0.25% of kerosene concentration, It is noted slowing growth with high concentration of kerosene treatment, at 0.5% peak of growth was (0.08), and resisted the influence of the Kerosene transactions 1% and 2%, but with low growth values. concentration of chlorophyll pigment under effect of 0.25% was (0.32) mg /ml, for as low as (0.165) mg /ml at 0.5% of kerosene, Chlorophyll concentrations have fallen to the minimum under the influence of transactions 1% and 2%. Protein concentration was (0.215, 0.86) mg/ml under the influence of kerosene transactions 0.25% and 0.5% respectively, In spite of the doubling kerosene concentration to 1% and 2%, but the values of the protein did not reduced Completely. Some morphological changes were observed under the effect of kerosene such as yellowing of cells colors with a slight increase in the length of the cells. As well as the absorption spectrum infrared by FTIR show that the Oscillatoria splendida consume many of bundle such as (2870) cm-1 and (2950) cm-1, also the disappearance 2300) cm -1, 1500 cm -1, with the appearance a new bundle at (800) cm-1 Attributed to the introduction of a new compound not found in control sample.

The study conducted at Center for the Early Detection of Breast Tumors at Medical City’s oncology teaching hospital carried 90 patients who participated in this study. The research was carried out between February 15, 2021, and July 20, 2021. The diagnosis was made by the consultant medical team using the triple assessment technique, which includes physical breast examination, ultrasonography, mammography, and fine needle aspiration cytology. Women patients clasified into 3 groups (benign tumor, control and malignant tumor) benign B (34 women) divided in/to two sub groups such as (benign premenopausal age B1 (17) and benign postmenopausal age B2 (17) and malignant M (34), malignant premenopausal age M1 (17) and malignant postmenopausal age M2 (17), and control group C includes (11) premenopausal age C1 and (11) C2. An ELISA approach was used to measure the level of soluble PDL, PD L1, and CD8 expression in serum. PD1 shows significant increase (p ≤ 0.05) in pre- and post-menopausal malignant groups M5, M6 when compared with C1, C2, B1, B2. PDL-1 levels were non-significant (p ≥ 0.05) in pre and postmenopausal control and benign groups (C1, C2, B1 and B2) while they were increased significantly (p ≤ 0.05) in M1, M2 in comparison with B2,C1,C2, B1. CD8 in the M1 increased significantly (p ≤ 0.05) when compere with group1, group 2, group bening1, group benign 2 and malignant 2. Conclusions from the current study that the values of PD1and PDL1in pre and postmenopausal malignant women breast cancer showed an increase compere with the other groups, the levels of CD8+ increase in the premenopausal malignant breast cancer women in comparison with other groups.

Elevated levels of circulating estrogens and androgens are linked to higher breast cancer risk among postmenopausal women; however, little is known about hormone levels within the breast. Hormone concentrations within the breast may not be reflected in the blood and are likely important contributors to breast carcinogenesis. The present study investigated the sex hormone (Estrogen, progesterone, Prolactin and testosterone). Female patients are divided into three groups (Benign, malignant and control). Benign (B)(34 patients) is divided into sub-groups including Benign premenopausal stage (B1)(17 patients) Benign postmenopausal stage (B2) (17 patients) and Malignant (M)(34 patients), Malignant premenopausal stage (M1) (17patients) and Malignant postmenopausal stage (M2)(17patients), and control group (C) include (11) premenopausal stage (C1) and (11) postmenopausal stage (C2). The expression level of soluble sex hormone (Estrogen, progesterone, Prolactin and testosterone) in serum was determined by an ELISA. Technique. The patients attended the Center for Early Detection of Breast Tumor at an oncology teaching hospital in Medical City. The study was conducted on 15/February (2021) to 20/July (2021). The values of Estrogen hormone in premenopausal malignant M1 (34.76 ±4.26 pg/ml) decreased significantly (P≤0.05) in comparison with C1, but it was non-significant in comparison with C2 and B1. M2 (64.28 ±4.17 pg/ml) shows a non-significant increase compared with C1, but it increased significantly with C2, B2 and M1. The values of progesterone hormone B1(12.75 ±3.34ng/ml) and B2( 13.06 ±2.98 ng/ml) was non-significant(P≤0.05) in comparison with C1 (8.17 ±2.87 ng/ml) and C2(6.28 ±2.87 ng/ml).M1 (14.30 ±4.29 ng/ml) and M2 (15.76 ±4.34 ng/ml) show non-significant difference in comparison with C1,C2,B1and B2. The values of Prolactin hormone in the M1(32.07±3.56(µIU/ml)) and M2(29.42±3.16) show non-significant difference(p>0.05) with C1,C2,B1 and B2.levelsTestosterone hormone show a significant in M1(1.462 ±0.11(ng/ml)) increased (p

Breast cancer is one of frequent cancer that affects millions of people worldwide. Delayed diagnosis of these cancers has raised mortality and morbidity. Cancer biomarkers have tremendously increased the efficacy of treatment and the effectiveness of detection. This study aimed to investigate some biomarkers, including EGF, HER2, CA15-3, and Acid phosphatase, associated with early breast cancer (BC) diagnosis in Iraqi women. Carried on 90 Samples, the patients attended the Center for Early Detection of Breast Tumor at an oncology teaching hospital in Medical City. The study was conducted between 15/February (2021) and 20/July (2021). The consultant medical personnel made the diagnosis based on a Triple Assessment Technique, including physical breast examination, ultrasonography, with or without mammography and fine needle aspiration cytology. Female patients were divided into three groups (Benign, malignant and control). Benign B(34 patients) was split into subgroups, including. Benign premenopausal group B1(17 patients) Benign post-menopausal group B2(17patients) and malignant M(34 patients), malignant premenopausal group M1(17 patients) and malignant post-menopausal group M2(17 patients), and control group C include (11) premenopausal stage C1and (11) post-menopausal group C2. The value of EGF in Malignant cancer M1 (179.80 ±19.07) and M2(130.59 ±18.59)shows a highly significant (P≤0>05) increase in comparison with benign cancer and B2 and healthy control C1and C2 groups, respectively but B1 and B2 shows high significant (P≤0>05)decrease in comparison with C1 and C2 respectively. The values of HER2 show in B2(1.377±0.10); M1(11.76±0.10), and M2(11.79±0.09) increased significantly(P≤0.05) in comparison with C1, C2, B1 respectively. The values of CA-15-3 in M1 and M2 increase significantly(P≤0.05) compared with C1, C2, B1, and B2. The values of acid phosphatase in pre-and post-menopausal males in M1 and M2 increased significantly (p

Soil microbes perform a multitude of essential biological functions, including organic matter decomposition, nutrient cycling, and soil structure preservation. Qatar is one of the most hostile and fragile arid environments on earth and is expected to face a disproportionate impact of climate change in the coming years.

In this paper, the reliability of two nondestructive corrosion detection methods, Half-Cell Potential (HCP) and Electrical Resistivity (ER), was evaluated, considering the Weight Loss (WL) as the reference method. The specimens prepared for this work were placed in Al-Nasiriya Power Station where subjected to three different exposure conditions. They were high relative humidity, high temperature T and laboratory setting R. The concrete mixes included four chloride contents, 0 %, 1.5 %, 3 % and 4 % by weight of cement to generate multiple corrosion degrees. The results showed that exposure to high temperatures has slightly increased the corrosion activity of the T specimens. While the exposure to high relative humidity has clearly increased the corrosion probability of the RH specimens, comparing with the reference R specimens. However, for such environmental conditions, it was found that the reliabilities of the HCP and the ER techniques still questionable and need further investigation.

The natural history of asymptomatic adult moyamoya disease (MMD) is unclear, and the benefit of treatment remains controversial. This study aimed to investigate the natural history of asymptomatic MMD in a North American cohort and to evaluate risk factors associated with and the effects of treatment on disease progression.Medical records from 3 institutions of consecutive adult patients with MMD diagnosed between 1984 and 2018 were retrospectively reviewed. Patients with unilateral or bilateral asymptomatic MMD were evaluated for subsequent development of infarction or hemorrhage. Multivariate Cox proportional hazards regression assessed risk factors associated with infarction or hemorrhage, adjusting for age, sex, race, initial Suzuki grade, hypertension, hyperlipidemia, diabetes, obesity, presence of aneurysms, smoking status, aspirin, and statin use at diagnosis.We identified 106 hemispheres with asymptomatic MMD in 97 patients with mean 5.1 years (interquartile range, 1.0-7.9 years) of follow-up. Of 106 hemispheres, 59 were treated medically, and 47 were treated with revascularization with direct or indirect bypasses. The medical and surgical cohorts had a 1.9% and 1.3% annual rate of radiographic infarction or hemorrhage per hemisphere, respectively. Cox regression for radiographic events, including early postoperative events, showed no significant difference between the treatment groups (adjusted hazard ratio 0.34 [95% confidence interval 0.05-2.5]).We found an overall 1.7% annual rate of radiographic infarction or hemorrhage in asymptomatic MMD hemispheres. Although we did not find a benefit to surgical treatment within the study period, asymptomatic patients with expected long-term survival may benefit from surgery given the sustained long-term benefits after surgery despite an initial postoperative risk.

Vertebrate cells have evolved an elaborate multi-tiered intracellular surveillance system linked to downstream antimicrobial effectors to defend themselves from pathogens. This cellular self-defense system is referred to as cell-autonomous immunity. A wide array of cell-autonomous mechanisms operates to control intracellular pathogens including protozoa such as Toxoplasma gondii. Cell-autonomous immunity consists of antimicrobial defenses that are constitutively active in cells and those that are inducible typically in response to host cell activation. The IFN family of cytokines is an important stimulator of inducible cell-autonomous immunity. There are several hundred interferon-stimulated genes (ISGs); many of them have known roles in inducible cell-autonomous immune mechanisms. The importance of IFN-γ activation of cell-autonomous immunity is evidenced by the fact that many intracellular pathogens have evolved a diversity of molecular mechanisms to inhibit activation of infected cells through the JAK-STAT pathway in response to IFN-γ. The goal of this review is to provide a broad framework for understanding the elaborate system of cell-autonomous immunity that acts as a first line of defense between a host and intracellular parasites.

ObjectivesCOVID-19 presents a risk for delays to stroke treatment. We examined how COVID-19 affected stroke response times.MethodsA literature search was conducted to identify articles covering stroke during COVID-19 that included time metrics data pre- and post-pandemic. For each outcome, pooled relative change from baseline and 95% CI were calculated using random-effects models. Heterogeneity was explored through subgroup analyses comparing comprehensive stroke centers (CSCs) to non-CSCs.Results38 included studies reported on 6109 patients during COVID-19 and 14 637 patients during the pre-COVID period. Pooled increases of 20.9% (95% CI 5.8% to 36.1%) in last-known-well (LKW) to arrival times, 1.2% (−2.9% to 5.3%) in door-to-imaging (DTI), 0.8% (–2.9% to 4.5%) in door-to-needle (DTN), 2.8% (−5.0% to 10.6%) in door-to-groin (DTG), and 19.7% (11.1% to 28.2%) in door-to-reperfusion (DTR) times were observed during COVID-19. At CSCs, LKW increased by 24.0% (−0.3% to 48.2%), DTI increased by 1.6% (−3.0% to 6.1%), DTN increased by 3.6% (1.2% to 6.0%), DTG increased by 4.6% (−5.9% to 15.1%), and DTR increased by 21.2% (12.3% to 30.1%). At non-CSCs, LKW increased by 12.4% (−1.0% to 25.7%), DTI increased by 0.2% (−2.0% to 2.4%), DTN decreased by −4.6% (−11.9% to 2.7%), DTG decreased by −0.6% (−8.3% to 7.1%), and DTR increased by 0.5% (−31.0% to 32.0%). The increases during COVID-19 in LKW (p=0.01) and DTR (p=0.00) were statistically significant, as was the difference in DTN delays between CSCs and non-CSCs (p=0.04).ConclusionsFactors during COVID-19 resulted in significantly delayed LKW and DTR, and mild delays in DTI, DTN, and DTG. CSCs experience more pronounced delays than non-CSCs.

Seizures are the second most common presenting symptom of cerebral arteriovenous malformations (AVMs). Evidence supporting different treatment modalities is continuously evolving and it remains unclear which modality offers better seizure outcomes.To compare various interventional treatment modalities (i.e., microsurgery, radiosurgery, endovascular embolization, or multimodality treatment), regarding outcomes in AVM-associated epilepsy.PubMed, Embase, and Web of Science were searched on December 31, 2020 for studies that evaluated outcomes in patients with AVM-associated epilepsy after undergoing different treatment modalities. Pooled analysis was performed using a random-effects model and stratified by different modalities.Forty-nine studies including 2668 patients were included. Interventional management was associated with a 56.0% probability of seizure freedom and a 73.0% probability of seizure improvement. The probability of discontinuing antiepileptic drugs was estimated at 38.0%. The stratified analysis showed that microsurgery was associated with a higher probability of seizure freedom and seizure improvement than was radiosurgery, endovascular, or multimodality treatment. The probability of antiepileptic drug cessation was also higher after microsurgery compared with radiation therapy; however, only clinical but not statistical significance could be inferred because of the lack of comparative analyses.Interventional management of AVM-related epilepsy was associated with seizure freedom and seizure improvement in 56% and 73% of cases. Microsurgery seemed to be associated with a higher incidence of seizure freedom and seizure improvement than did other modalities. Future well-designed comparative studies are needed to draw definitive conclusions regarding each modality.

Parkia speciosa is frequently consumed as a raw salad due to the notion that the plant exhibits numerous pharmacological activities that could benefit health particularly among Asians. This study was aimed to investigate the cytotoxicity and acute oral toxicity consequences of Parkia speciosa seeds extract against 4T1 mouse mammary cancer cells on C57BL/6 female mice. The antiproliferative effect of aqueous and ethanolic extracts was studied using the in-vitro antiproliferative assay, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Meanwhile, for acute toxicity study, twenty female mice were categorized into 5 groups, each with three aqueous extract treatment groups: 50 mg/kg, 300 mg/kg, 2000 mg/kg, meanwhile one vehicle group (treated with sterile distilled water), and one control group (no treatment given). Changes in behavioural signs, mortality rate, relative body weight, haematology, serum biochemistry, and organ histological evaluation were observed. Based on the MTT assay, the aqueous extract of Parkia speciosa was weakly active (IC50 = 312.5 ± 1.20 ug/ml) against 4T1 mammary cancer cells. In the acute study, no mortality, behavioural and physical changes were observed in any of the mice groups throughout the 14-day experiment. The haematological and serum biochemistry results of the treated and control groups showed no alteration. The kidney and liver were histopathologically evaluated and found to have normal organ architectures. Analyzed results could conclude that aqueous extract of Parkia speciosa has weakly active against cancer cells but has no deleterious effects on C57BL/6 mice given at high doses up to 2000 mg/kg.

Background A double-chambered left ventricle (DCLV) is an extremely rare congenital malformation. The exact prevalence of DCLV is not known, although studies have reported prevalence of 0.04–0.42%. This abnormality is characterized by the sub-division of left ventricle into two chambers, the main left ventricular chamber (MLVC) and the accessory chamber (AC) by a septum or muscle band. Case presentation We are reporting two cases of DCLV, one in an adult male and an infant, who were referred for undergoing cardiac magnetic resonance (CMR) imaging. The adult patient was asymptomatic, whereas the infant had the diagnosis of left ventricular aneurysm on fetal echocardiography. On CMR, we confirmed the diagnosis of DCLV in both patients, as well as moderate aortic insufficiency in the adult patient. Both patients were lost to follow-up. Conclusions The double-chambered left ventricle (DCLV) is commonly detected in infancy or childhood. Although echocardiography can help detect double-chambered ventricles, MRI provides a better knowledge of this problem and can also be used to diagnose other related heart disorders.

Qatar is a peninsular country with predominantly hot and humid weather, with 88% of the total population being immigrants. As such, it leaves the country liable to the introduction and dissemination of vector-borne diseases, in part due to the presence of native arthropod vectors. Qatar's weather is expected to become warmer with the changing climatic conditions across the globe. Environmental factors such as humidity and temperature contribute to the breeding and distribution of different types of mosquito species in a given region. If proper and timely precautions are not taken, a high rate of particular mosquito species can result in the transmission of various vector-borne diseases. In this study, we analyzed the environmental impact on the probability of occurrence of different mosquito species collected from several different sites in Qatar. The Naive Bayes model was used to calculate the posterior probability for various mosquito species. Further, the resulting Naive Bayes predictions were used to define the favorable environmental circumstances for identified mosquito species. The findings of this study will help in the planning and implementation of an active surveillance system and preventive measures to curb the spread of mosquitoes in Qatar.

This paper deals with reinforced concrete beams strengthened by CFRP in flexure. The debonding between CFRP and the surface of the beam is the main problem. Many researchers around the world have made extensive efforts to study the phenomenon of debonding for efficient applications. Based on these efforts and different related field applications, code previsions and various models have been proposed for predicting debonding failure. Two code previsions and three typical models are presented in the current study. ACI-440.2R 17, CNR-DT 200 R1/2013, Said and Wu, Lu et al., and Teng et al. have been used to estimate the flexural strength of RC beams strengthened by CFRP with and without grooves. Test results of eleven flexural beams strengthened by CFRP sheet/laminate using externally bonded reinforcement (EBR) and externally bonded reinforcement on grooves (EBROG) methods were used in the current paper. The performance and accuracy of each model were evaluated based on these test results. Most of the prediction models that used in this study give a closer prediction of the flexural strength of beams strengthened by EBR compared to that of the beams strengthened by EBROG. Finally, the prediction results of CNR-DT 200 R1/2013 were the most accurate and approval with test results compared with other models in the current study

Vector-borne diseases (VBDs) have re-emerged worldwide due to urbanisation, increase in travel and climate change, becoming a major and serious threat to global public health. In Qatar, the concern has recently risen because of the attribution of the soccer 2022 FIFA World Cup Qatar™, which necessitates fulfilling requirements in terms of prevention and preparedness for disease transmission, including VBDs. This review presents a general overview about current status of vectors and VBDs in Qatar and addresses key challenges and future prospects of control programmes and strategies. It is based on a vector control situation analysis and needs assessment performed during an expert mission in Qatar, November 2017, organised by the WHO Eastern Mediterranean Regional Office and achieved in collaboration with the Ministry of Public Health of Qatar and other local stakeholders. The situation of vectors and VBDs of public health importance in Qatar was analysed based on a systematic literature review by December 31, 2019. The literature reveals that no locally transmitted VBD cases have been recorded in Qatar, but cases were recorded among expatriate workers and travellers who returned from an endemic country. However, data on VBD cases remain scarce except for malaria. The presence of native arthropod vectors is under-recorded to date. A compilation of literature data revealed reports of 30 vector species, including 20 mosquitoes, 2 fleas, 1 louse, 1 fly, and 6 ticks. Overall, Qatar benefits currently from a good surveillance of some VBDs (malaria) and has some capacities in vector control, but no national plan exists, and vector surveillance is in its infancy. In Qatar, clear needs exist in capacity in epidemiology and vector entomology, as well as on the organisational level, and a number of measures are suggested to mitigate and improve VBD risk assessment and management. There is an urgent need to define sustainable solutions for VBD control, management and prevention, and a number of recommendations are suggested.

This study measured the impact of virtual three-level collaboration (3LC) exercises on participants’ perceived levels of collaboration, learning, and utility (CLU) at hospitals in the southern region of Saudi Arabia. Our 3LC exercise is a tabletop training tool used to facilitate disaster education and document CLU. This model enables the practitioner to acquire new knowledge and promotes active learning. An English version of the CLU scale, the validated Swedish survey tool, was applied to 100 healthcare managers or leaders in various positions at both the operational and tactical levels after conducting the 3LC exercises. The response rate was 100%, although not all questions were answered in some cases. The results show that most participants strongly agreed that the exercises focused on collaboration (r2 = 0.767) and that they had acquired new knowledge during the exercises. There was a statistically significant association between participation in the collaboration exercises and perceived learning (r2 = 0.793), as well as between perceived learning and utility (r2 = 0.811). The collaboration exercises enhance the perceived effects of CLU. They also improve the ability of participants to adapt situational strategies to achieve a safer society. Although exercises were conducted virtually, they were well received by the participants and achieved a value M = 4.4 CLU score, which opens up new dimensions in collaboration simulation exercises.

The externally bonded reinforcement on grooves (EBROG) method is increasingly recognized as an alternative strengthening method that can overcome the debonding problem. This study aims to experimentally investigate the effectiveness of EBROG as compared to the conventional externally bonded reinforcement (EBR) method in strengthening reinforced concrete (RC) beams. Twelve RC beams have been tested under four point load bending. One of these beams has been designated as a reference beam, seven beams have been strengthened with carbon fiber reinforced polymer (CFRP) sheets, and four beams have been strengthened with CFRP laminates using EBROG or EBR methods. The effect of CFRP type, number of layers, as well as the type of strengthening methods on the flexural performance have been also investigated. The load, deflection, stiffness, and failure modes were recorded and discussed intensively. Overall, test results indicated that the flexural strength and stiffness of the strengthened specimens using EBR or EBROG methods increased compared to the control beam, where the increase in the load carrying capacity of beams strengthened using the EBR method ranged between 24.8 and 48.2% and by the EBROG method ranged between 31.7 and 76.7% of the control beam. The most interesting result obtained is that the failure mode of beams has been changed from debonding of CFRP material to rupture of CFRP in some samples strengthened by EBROG, which demonstrates the superior behavior of this strengthening technique as compared to the traditional strengthening using EBR.

Objective Spontaneous subarachnoid hemorrhage is often due to rupture of an intracranial aneurysm, but some patients present with no identifiable source. Increased incidence of nonaneurysmal subarachnoid hemorrhage (naSAH) has been reported over time. Methods We performed a retrospective analysis of naSAH from 2008−2017 to determine the rate of naSAH change over time and its association with cannabis use. Univariable and multivariable regression analyses were performed to study the trend over time, radiographic patterns of hemorrhage, and clinical outcome at the time of discharge. In addition, we compared the rate of naSAH with the rate of aneurysmal SAH (aSAH) to adjust for changes in hospital volume and prevalence/reporting of cannabis use in the population over time. Results A total of 86 naSAH and 328 aSAH patients were identified, with an increase in naSAH over time compared with aSAH (P = 0.0034). Increased cannabis use was associated with naSAH (odds ratio [OR] 2.1, 95% confidence interval 1.1, 4.1, P = 0.035) but not aSAH over time. Cannabis use was also associated with different subarachnoid hemorrhage patterns (P = 0.0065) in naSAH. Multivariable analysis demonstrated good neurologic outcome after naSAH to be inversely associated with cocaine use (OR 0.008 [0.002−0.4]), ventriculostomy placement (OR 0.004 [0.03−0.50]), and anticoagulant use (OR 0.016 [0.003−0.54]) but not with cannabis use. Conclusions As cannabis use becomes more prevalent with legalization, it is important to further investigate this association with spontaneous SAH.

Introduction: Diagnostic reference levels (DRL) of procedures involving ionizing radiation are important tools for optimizing radiation doses delivered to patients and to identify cases where the levels of dose are unusually high. This is very important for pediatric patients undergoing fluoroscopic examinations, as these examinations can be associated with a high radiation dose. Material and Methods: Pediatrics fluoroscopic studies performed at Maternity and Children Hospitals in Makah city was conducted on 140 patient Children ranging in age from (1 to 14 years) analyzed to determine range, mean, 75th percentiles of Dose–Area Product (DAP) undergoing X-ray Fluoroscopy examination to evaluate the diagnostic and measure Total Effective dose (msv), and Total Entrance Dose (mGy.cm2). This data is automatically collected from DF by the structured sent by the imaging network’s to the software (DICOM, RIS, HIS, and Dose watch. Results: were obtained Result Comparing the dose (DAP, and ESR) with the (NPDD-IAEA-ICRP) depend on range or median, all radiation doses for pediatric are within the limit. Conclusion: Diagnostic reference levels are recommended as an optimization tool for radiation dose assessment in medical imaging procedures involving the utilization of radiation. So can be divided the optimization for reducing doses to exposure setting and exposure protocol.

Background and ObjectivesWhile somatic mutations have been well-studied in cancer, their roles in other complex traits are much less understood. Our goal is to identify somatic variants that may contribute to the formation of saccular cerebral aneurysms.MethodsWe performed whole-exome sequencing on aneurysm tissues and paired peripheral blood. RNA sequencing and the CRISPR/Cas9 system were then used to perform functional validation of our results.ResultsSomatic variants involved in supervillin (SVIL) or its regulation were found in 17% of aneurysm tissues. In the presence of a mutation in theSVILgene, the expression level of SVIL was downregulated in the aneurysm tissue compared with normal control vessels. Downstream signaling pathways that were induced by knockdown ofSVILvia the CRISPR/Cas9 system in vascular smooth muscle cells (vSMCs) were determined by evaluating changes in gene expression and protein kinase phosphorylation. We found thatSVILregulated the phenotypic modulation of vSMCs to the synthetic phenotype via Krüppel-like factor 4 and platelet-derived growth factor and affected cell migration of vSMCs via the RhoA/ROCK pathway.DiscussionWe propose that somatic variants form a novel mechanism for the development of cerebral aneurysms. Specifically, somatic variants inSVILresult in the phenotypic modulation of vSMCs, which increases the susceptibility to aneurysm formation. This finding suggests a new avenue for the therapeutic intervention and prevention of cerebral aneurysms.

BackgroundSaudi Arabia has made extensive efforts to manage disasters using unique national approaches; however, challenges and obstacles concerning disaster health handling persist. The nation has a reactive strategy to disaster management with a need for increased involvement of health professionals in disaster management and improvement of healthcare facilities emergency preparedness including competency-based education training.ObjectiveA comprehensive and consistent approach of disaster education programs for short and intermediate training of health professionals involved in disaster responses in Saudi Arabia is still not evident. Therefore, it is vital to explore and map the current state of the disaster education framework in Saudi Arabia.MethodsThe Joanna Briggs Institute approach for scoping reviews was used to assess research articles and preprints between January 2000 and September 2021 from Saudi Digital Library; PubMed, CINAHL, and Google Scholar. Five experts identified key aspects of the disaster education approach and eligibility criteria to facilitate identification of relevant articles.ResultsOnly five articles met the specified criteria and described two short and three intermediate courses on disaster health management in Saudi Arabia. All courses involved competency-specific training aimed at basic or foundational level and involved a range of activities and learning types. None had refresher courses within 12 months.ConclusionThe review highlights the obvious scarcity of short and intermediate term evidence-based disaster health programs in Saudi Arabia. Adoption of the education framework proposed by the authors based on international frameworks could improve the quality and consistency of the disaster education curriculum in Saudi Arabia.

Background In adults with ischemic moyamoya disease (MMD), the efficacy of direct vs indirect revascularization procedures remains a matter of debate. Objective To investigate the outcomes of ischemic MMD in a North American cohort treated by direct and indirect revascularizations. Methods We retrospectively reviewed medical records of adult patients with MMD with ischemic presentation from 1984 to 2018 at the Brigham and Women's Hospital and Massachusetts General Hospital who underwent either direct or indirect bypasses. Early postoperative events and outcome at more than 6 mo postoperatively were evaluated using multivariable logistic regression analyses. Multivariable Cox proportional hazards regression analyses were used to evaluate delayed ischemic and hemorrhagic events. Analyses were performed per hemisphere. Results A total of 95 patients with MMD and 127 hemispheres were included in this study. A total of 3.5% and 8.6% of patients had early surgical complications in the direct and indirect bypass cohorts, respectively (P = .24). Hemispheres with direct bypasses had fewer long-term ischemic and hemorrhagic events at latest follow-up (adjusted hazard ratio [HR] 0.19, 95% confidence interval [CI] 0.058-0.63, P = .007; median follow-up 4.5 [interquartile range, IQR 1-8] yr). There was no difference between the direct and indirect bypass groups when the endpoint was limited to infarction and hemorrhage only (P = .12). There was no difference in outcome (modified Rankin Scale [mRS] ≥ 3) between the 2 cohorts (P = .92). Conclusion There was no difference in early postoperative events, long-term infarction or hemorrhage, or clinical outcome between direct and indirect revascularization. However, there was a significant decrease in all ischemic and hemorrhagic events combined in direct revascularizations compared to indirect revascularizations.

Objective To evaluate cardiovascular outcomes in patients with normal nuclear myocardial perfusion imaging, but ischaemic electrocardiogram changes during pharmacological or exercise stress tests. Methods The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of patients who underwent either pharmacological or exercise stress myocardial perfusion scan and had a normal scan with ischaemic electrocardiogram changes between January 2013 and December 2014. All cardiac events, including angina, myocardial infarction, heart failure, coronary revascularisation and cardiac death, as well as non-cardiac deaths were noted. Data was analysed using STATA 14.2. Results Of the 2770 patients whose data was initially checked, 296(10.6%) developed ischaemic electrocardiogram changes during the stress test but had normal myocardial perfusion scan. Of them, 181(61%) patients were male, and the overall mean age was 62±15 years. Follow-up data was available for 280(94.5%) of these patients, with a mean follow-up of 48±7 months. Of these patients, 8(2.8%) died, and 1(0.3%) of them died due to inferior wall myocardial infarction. Myocardial infarction was found in 2(0.7%) patients, and 1(0.3%) patient was hospitalised with heart failure. Also, 12(4.3%) patients underwent revascularization for stable angina, 9(3.2%) underwent percutaneous transluminal coronary angioplasty, and 3(1.07%) needed coronary artery bypass grafting. Conclusions Ischaemic electrocardiographic changes during stress testing in patients with normal myocardial perfusion scan were not associated with adverse outcomes, and the risk of cardiovascular events was relatively low for an intermediate follow-up period.

BackgroundCatheter retention and difficulty in retrieval have been observed during embolization of brain arteriovenous malformations (bAVMs) with the Onyx liquid embolic system (Onyx). The Apollo Onyx delivery microcatheter (Apollo) is a single lumen catheter designed for controlled delivery of Onyx into the neurovasculature, with a detachable distal tip to aid catheter retrieval. This study evaluates the safety of the Apollo for delivery of Onyx during embolization of bAVMs.MethodsThis was a prospective, non-randomized, single-arm, multicenter, post-market study of patients with a bAVM who underwent Onyx embolization with the Apollo between May 2015 and February 2018. The primary endpoint was any catheter-related adverse event (AE) at 30 days, such as unintentional tip detachment or malfunction with clinical sequelae, or retained catheter. Procedure-related AEs (untoward medical occurrence, disease, injury, or clinical signs) and serious AEs (life threatening illness or injury, permanent physiological impairment, hospitalization, or requiring intervention) were also recorded.ResultsA total of 112 patients were enrolled (mean age 44.1±17.6 years, 56.3% men), and 201 Apollo devices were used in 142 embolization procedures. The mean Spetzler–Martin grade was 2.38. The primary endpoint was not observed (0/112, 0%). The catheter tip detached during 83 (58.5%) procedures, of which 2 (2.4%) were unintentional and did not result in clinical sequelae. At 30 days, procedure related AEs occurred in 26 (23.2%) patients, and procedure-related serious AEs in 12 (10.7%). At 12 months, there were 3 (2.7%) mortalities, including 2 (1.8%) neurological deaths, none of which were device-related.ConclusionThis study demonstrates the safety of Apollo for Onyx embolization of bAVMs.Clinical trial registrationCNCT02378883.

Bloodstream infections (BSIs) caused by multidrug-resistant (MDR)-Pseudomonas aeruginosa are associated with poor clinical outcomes, at least partly due to delayed appropriate antimicrobial therapy. The characteristics of MDR-P. aeruginosa bloodstream isolates have not been evaluated in Qatar. Our study aimed to examine in vitro susceptibility, clinical and molecular characteristics, and mechanisms of resistance of MDR-P. aeruginosa bloodstream isolates from Qatar. We included all MDR-P. aeruginosa isolated from blood cultures taken between October 2014 and September 2017. Blood cultures were processed using BD BACTEC™ FX automated system. BD Phoenix™ was used for identification, Liofilchem® MIC Test Strips for MIC determination. Whole-genome sequencing was performed using the Illumina-HiSeq-2000. Out of 362 P. aeruginosa bloodstream isolates, 16 (4.4%) were MDR. The median patient age was 55 years (range 43–81) and all patients presented with septic shock. Most patients received meropenem (12/16) and/or colistin (10/16). Clinical response was achieved in eight patients, and five patients died within 30-days. MDR-P. aeruginosa isolates belonged to 13 different sequence types. All isolates were non-susceptible to cefepime and ciprofloxacin. The most active agents were colistin (16/16) and aztreonam (10/16). Seven isolates produced blaVIM, and four possessed genes encoding extended-spectrum β-lactamases. Aminoglycoside modifying enzymes were present in 15/16, transferable qnr-mediated quinolone resistance gene was detected in 3/16, and the novel ciprofloxacin modifying enzyme CrpP-encoding gene in one isolate. MDR-P. aeruginosa BSIs are relatively uncommon in Qatar but are highly resistant, harbour multiple resistance genes, and are commonly associated with unfavourable clinical outcomes. Colistin was the only agent with consistent activity against the study isolates.Key messagesMDR-P. aeruginosa constituted P. aeruginosa blood isolates over three years.Typical risk factors for MDR infections were highly prevalent in the study population and overall clinical outcomes are consistent with those previously reported.Colistin was the only agent with consistent antibacterial activity against the study isolates. MDR-P. aeruginosa constituted P. aeruginosa blood isolates over three years. Typical risk factors for MDR infections were highly prevalent in the study population and overall clinical outcomes are consistent with those previously reported. Colistin was the only agent with consistent antibacterial activity against the study isolates.

Background Hemorrhagic vascular lesions in the posterior cerebral circulation such as ruptured aneurysms and dissections can be challenging to treat. Flow diversion has become an important off-label option, but few studies have analyzed the safety of these devices in this setting. Using an international, multicenter cohort, we reviewed posterior circulation subarachnoid hemorrhage (SAH) patients treated with the Pipeline Embolization Device (PED) in the acute setting and assessed the incidence of Takotsubo cardiomyopathy (TCM). Methods Eleven neurovascular centers were queried to identify cases of posterior circulation aneurysms or dissections treated with the PED in the acute setting of SAH. Among those, 5 centers had cases that matched the inclusion criteria. The following variables were evaluated: demographics, the location and morphology of the aneurysm, the clinical presentation, the specific form of treatment, complications including the development of TCM, antiplatelet medication regimen, and follow-up time. Results A total of 23 patients were treated with PED after posterior circulation SAH, and 13% of these developed TCM. The lesions were the result of hemorrhagic intracranial dissection (8 patients), ruptured pseudoaneurysm (3), ruptured saccular aneurysm (7), blister aneurysm (4), and fusiform aneurysm (1). Ninety-one percent of patients had complete or near-complete aneurysm occlusion on follow-up imaging. Five patients died in the perioperative period; 16/18 survivors had a favorable outcome. Conclusions We describe an unexpectedly high incidence of TCM after the placement of PEDs in patients with posterior circulation SAH in our large case series. Further studies will be needed to elucidate possible causes.

Numerous extensive efforts have been done to acquire the applicable green corrosion inhibitors in order to decrease the corrosion rate of the materials. The corrosion inhibition of mild steel is vital for technology due to the increased industrial applications of these materials. In this report, the inhibitive action of Cymbopogon Citratus on the marine corrosion of mild steel was evaluated. The inhibition efficiency was calculated using weight loss measurement method, electrochemical measurement and inhibitor mechanism analysis. It was found that, Cymbopogon Citratus exhibited a very good performance as a green corrosion inhibitor for mild steel corrosion in seawater. All the experimental methods used for this project show that the presence of Cymbopogon Citratus in the seawater significantly decreases the corrosion rates and further decreasing the corrosion rates as the concentration of Cymbopogon Citratus increases. To sum it up, the inhibition efficiency increases with an increase in Cymbopogon Citratus concentration.

Nondestructive evaluation (NDE) technologies are increasingly being used for the condition assessment of existing structures. In order to ensure best funding allocations and most effective maintenance and repair activities, the reliability of NDE technologies for a particular application needs to be carefully assessed to determine the margin of error (MOE) of NDE data. This research aims to investigate the utilization of “Wilcoxon-Mann-Whitney (WMW) Statistics” for the reliability assessment of NDE technologies. The reliability of three of the most widely used NDE technologies for the detection of subsurface cracking in concrete was assessed using WMW analysis. The NDE technologies assessed were: Impact Echo (IE), Infrared Thermography (IRT), and Ground Penetrating Radar (GPR). Two in-service bridge decks and two full-scale fabricated deck slabs were nondestructively tested to provide suitable data for analysis. The in-service bridge decks contained areas of mild and severe subsurface cracking as determined from previous testing performed by the Missouri Department of Transportation (MoDOT). The fabricated decks, on the other hand, contained areas of synthetic cracking of different sizes and depths. The reliability indices determined from WMW analysis for the three NDE technologies discussed in this manuscript are exactly equivalent to the indices determined previously by the same authors using Receiver Operating Characteristics (ROC) analysis. Results of WMW analysis, by the way, indicated that IE and IRT technologies were more reliable than GPR for the detection of concrete subsurface cracking. The final WMW indices of IE and IRT data were much higher than the corresponding indices of GPR data for both the in-service bridge decks and the fabricated slabs. The interesting equivalence between WMW and ROC analyses may encourage other researchers to utilize the former method in order to investigate the reliability of other NDE technologies in other applications. The findings of this research may also assist decision-makers considering the use of these NDE technologies in order to form decisions regarding maintenance and repair needs for bridges.

Myocardial perfusion imaging (MPI) with single-photon emission computed tomography (SPECT) is confounded by the extracardiac artefacts cause by hepatobiliary clearance of the radiotracers. Various techniques have been evaluated to lessen those artefacts. In this study, we endeavoured to determine the effect of carbonated water in reducing such infracardiac artefact so to improve MPI image quality, sensitivity and specificity. A total of 1000 patients were prospectively enrolled and randomised into two equal groups as A and B. Group A were given 250 ml of carbonated beverages and Group B were given 250 ml plain water immediately after radiotracer injection. Images were evaluated qualitatively and quantitatively for the interfering extracardiac artefacts. The qualitative analysis favoured carbonated water in reducing the interfering intestinal activity during rest as well as stress (p = 0.005 and p

Object The breadth and complexity of neurovascular pathologies treated with endovascular neurosurgery has expanded dramatically in recent years. Many aneurysms remain difficult to treat safely. Transcirculation (contralateral and/or retrograde) approaches through the circle of Willis are useful alternatives for treating challenging lesions endovascularly. Here, we present a series of patients treated with unconventional transcirculation techniques. Methods A total of six patients were treated: four patients with five aneurysms, one patient with an MCA stroke, and one patient with a meningioma requiring preoperative embolization were initially thought not to be amenable to endovascular treatment. The decision was made to treat these patients with transcirculation approaches. All patients were treated by one interventionist. One aneurysm was located in the cavernous internal carotid artery (ICA), one in the vertebral artery, two in the paraclinoid ICA, and one in a cerebellar AVM feeder vessel were treated. Results Five of six patients (83%) made a full neurologic recovery. Three aneurysms were treated to complete occlusion, one aneurysm was left with small residual neck filling, and one aneurysm was not able to be treated. One patient underwent mechanical thrombectomy of a middle cerebral artery (MCA) embolus and MCA filling was restored after treatment. One patient underwent complete embolization of the deep vascular supply of a meningioma. Conclusions Although many neurovascular pathologies remain unsuitable for endovascular treatment, transcirculation approaches can allow for safe, successful treatment of challenging lesions in select patients.

BackgroundFlow diversion is a common endovascular treatment for cerebral aneurysms, but studies comparing different types of flow diverters are scarce.ObjectiveTo perform a propensity score matched cohort study comparing the Pipeline Embolization Device (PED) and Flow Redirection Intraluminal Device (FRED) for posterior circulation aneurysms.MethodsConsecutive aneurysms of the posterior circulation treated at 25 neurovascular centers with either PED or FRED were collected. Propensity score matching was used to control for age, duration of follow-up imaging, adjunctive coiling, and aneurysm location, size, and morphology; previously ruptured aneurysms were excluded. The two devices were compared for the following outcomes: procedural complications, aneurysm occlusion, and functional outcome.ResultsA total of 375 aneurysms of the posterior circulation were treated in 369 patients. The PED was used in 285 (77.2%) and FRED in 84 (22.8%) procedures. Aneurysms treated with the PED were more commonly fusiform and larger than those treated with FRED. To account for these important differences, propensity score matching was performed resulting in 33 PED and FRED unruptured aneurysm pairs. No differences were found in occlusion status and neurologic thromboembolic or hemorrhagic complications between the two devices. The proportion of patients with favorable functional outcome was higher with FRED (100% vs 87.9%, p=0.04).ConclusionComparative analysis of PED and FRED for the treatment of unruptured posterior circulation aneurysms did not identify significant differences in aneurysm occlusion or neurologic complications. Variations in functional outcomes warrant additional investigations.

Background: Muscle Dysmorphia (MD) is a subtype of body dysmorphic disorder (BDD) and is currently classified under anxiety disorders (subheading: Obsessive-compulsive disorder) in DSM 5. MD is hypothesized to affect the self-esteem and social outlook of the younger generation. MD shows a higher rate in males and may influence their self-confidence rendering them more prone towards using steroids, supplementary proteins and other drugs to alter their physical outlooks as shown in previous studies. This problem has been on the rise lately due to revolutionary advancement in the media and film industry and the abrupt changes about the standards of physical good looks and body shapes. With the lack of studies done in our population, our study will be helpful to consider the prevalence of the disease in our setting and increase awareness in the general public and clinicians. We hope to help clinicians/ therapists find better options in managing the disease. Materials: We performed a cross-sectional study with a sample size of 246 medical school students in Karachi to collect data through self-administered questionnaires. We used the DSM 5 criteria for the diagnosis of BDD and additional questions on the presence of MD. Nutritional habits, exercise routines, use of supplements and drugs were also obtained for exploratory analysis. Results: Our study predicted the prevalence of MD to be 25%. Other main findings included statistical significant associations between MD and the thoughts and practice of steroid use for muscularity. Conclusion: MD is an underdiagnosed and often unrecognized disease that we believe has significant consequences for the young male population. Further work is needed on this in our part of the world. Our research, we believe, can be a stepping stone for further studies that would incorporate wider populations.

Background: A high level of knowledge practice among female health care workers regarding risk factors for breast cancer and screening methods is important in increasing awareness in the general population. Objective: To assess the knowledge and practice of female health care workers in Najran about breast cancer and their behavior in relation to breast screening methods. Methods: This cross-sectional study was conducted using an interviewer administered questionnaire-based survey method at a Maternity and Children’s Hospital, primary health care centers and King Khalid Hospital at Najran City, Saudi Arabia. The study was conducted from April 2019 to June 2019. A total of 493 participants were included. Data were collected, coded, and entered into a statistical software program (IBM SPSS version 25) for statistical analysis. Result: Among the 493 participants, 17% had good knowledge about the risk factors for breast cancer, while 37% had moderate knowledge and 46% had poor knowledge. Knowledge and attitudes regarding methods of screening for breast cancer was poor in 57.2% of the participants, moderate in 36.5% and only 6.3% had good awareness. In terms of barriers to screening, 47.3%, 50.5% and 27.2% were unaware of mammograms, clinical breast examinations and self-examination, respectively. Among the participants, 42.0% obtained relevant information from symposia, workshops and social media. Conclusion: The level of knowledge and attitudes among female health care workers regarding risk factors of breast screening is low. Urgent intervention by the health care system in Saudi Arabia is required to increase the awareness of breast cancer screening among health care workers.

Background: Breast diseases cover several conditions. The majority of breast diseases are noncancerous. Some of these lesions are clinically unremarkable, which needed minimal intervention. However, some symptoms may be of clinical value and attract the attention of both the patient and the attending physician, especially when they become persistent. The study aimed to assess the prevalence, pattern, types, and clinical profile of breast diseases among females in the South-western region, during the period from 2018-2020. Methods: A retrospective record-based descriptive approach was used through reviewing medical records of all cases with breast disease attended King Khalid Hospital during the period from January 2018 to January 2020. Data extracted throng pre-structured questionnaire. Results: The study included 211 cases whose ages ranged from 18 to 58 years old with a mean age of 28.9 ± 12.8 years. Breast mass was the most recorded complaint (95.1%) followed with breast pain (32%), skin changes. Benign findings based on the final pathology report were recorded for more than two thirds of the cases, with the most common finding were fibroadenoma. Excisional biopsy and modified radical mastectomy were the most reported surgical interventions. Conclusions: In conclusion, the study revealed that the majority of the cases had benign breast disease (BBD), where fibroadenoma was the most frequent.

Cardiac amyloidosis is a rare disease which is under diagnosed in this region. This study was aimed to assess the clinical presentation, cardiac magnetic resonance (CMR) imaging findings and prognosis of patients with cardiac amyloidosis in Pakistani population presenting to a tertiary care setting. A total of eight patients were included with the confirmed diagnosis of cardiac amyloidosis on CMR, after reviewing the CMR data of Aga Khan University Hospital from January 2011 to August 2019. Mean age was 51±11.5 years with the majority (75%) being male. All patients presented with heart failure. Suboptimal myocardial nulling on late gadolinium images was the most common finding on CMR. Late gadolinium enhancement was diffuse transmural in 5 patients (62.5%) and diffuse sub-endocardial in 3 patients (37.5%). On a mean follow up of 14±10 months, 3 patients (37.5%) died while 7 patients (87.5%) had hospital admissions due to heart failure.

BackgroundTo analyse the clinical characteristics of COVID-19 with acute ischaemic stroke (AIS) and identify factors predicting functional outcome.MethodsMulticentre retrospective cohort study of COVID-19 patients with AIS who presented to 30 stroke centres in the USA and Canada between 14 March and 30 August 2020. The primary endpoint was poor functional outcome, defined as a modified Rankin Scale (mRS) of 5 or 6 at discharge. Secondary endpoints include favourable outcome (mRS ≤2) and mortality at discharge, ordinal mRS (shift analysis), symptomatic intracranial haemorrhage (sICH) and occurrence of in-hospital complications.ResultsA total of 216 COVID-19 patients with AIS were included. 68.1% (147/216) were older than 60 years, while 31.9% (69/216) were younger. Median [IQR] National Institutes of Health Stroke Scale (NIHSS) at presentation was 12.5 (15.8), and 44.2% (87/197) presented with large vessel occlusion (LVO). Approximately 51.3% (98/191) of the patients had poor outcomes with an observed mortality rate of 39.1% (81/207). Age >60 years (aOR: 5.11, 95% CI 2.08 to 12.56, pConclusionThere is relationship between COVID-19-associated AIS and severe disability or death. We identified several factors which predict worse outcomes, and these outcomes were more frequent compared to global averages. We found that elevated neutrophil-to-lymphocyte ratio, rather than D-Dimer, predicted both morbidity and mortality.

Myocarditis is largely underdiagnosed due to subclinical symptoms and non-availability of diagnostic techniques necessitating high index of suspicion and early disease identification. This study aimed to assess the clinical presentation, cardiac magnetic resonance (CMR) imaging findings and prognosis of these patients. After reviewing the CMR data of Aga Khan University Hospital from January 2011 to December 2019, a total of 24 patients were included in the study with the confirmed diagnosis of myocarditis on CMR. Mean age was 33.4±15 years with the majority (58%) being male. Dyspnoea was the commonest symptom seen in 15(62%) cases followed by chest pain in 13 (54%). On echocardiogram, 15 (62.5%) cases showed LV dysfunction. Common CMR findings were late gadolinium enhancement in 18 (75%) and bright T2 signals in 11 (45%) patients. With a mean follow-up of 3.6±2 years, one patient died of non-cardiac cause. Nine out of 14 patients (for whom repeat echocardiogram was done) had resolution of LV dysfunction suggesting favourable prognosis.

Objectives: Antimicrobial resistance (AMR) is a global priority with significant clinical and economic consequences. Multidrug-resistant (MDR) Pseudomonas aeruginosa is one of the major pathogens associated with significant morbidity and mortality. In healthcare settings, the evaluation of prevalence, microbiological characteristics, as well as mechanisms of resistance is of paramount importance to overcome associated challenges. Methods: Consecutive clinical specimens of P. aeruginosa were collected prospectively from 5 acute-care and specialized hospitals between October 2014 and September 2017, including microbiological, clinical characteristics and outcomes. Identification and antimicrobial susceptibility test were performed using the BD Phoenix identification and susceptibility testing system, matrix-assisted laser desorption ionization–time-of-flight mass spectrometry (MALDI-TOF MS), and minimum inhibitory concentration (MIC) test strips. Overall, 78 selected MDR P. aeruginosa isolates were processed for whole-genome sequencing (WGS). Results: The overall prevalence of MDR P. aeruginosa isolates was 5.9% (525 of 8,892) and showed a decreasing trend; 95% of cases were hospital acquired and 44.8% were from respiratory samples. MDR P. aeruginosa demonstrated >86% resistance to cefepime, ciprofloxacin, meropenem, and piperacillin-tazobactam but 97.5% susceptibility to colistin. WGS revealed 29 different sequence types: 20.5% ST235, 10.3% ST357, 7.7% ST389, and 7.7% ST1284. ST233 was associated with bloodstream infections and increased 30-day mortality. All ST389 isolates were obtained from patients with cystic fibrosis. Encoded exotoxin genes were detected in 96.2% of isolates. Conclusions: MDR P. aeruginosa isolated from clinical specimens from Qatar has significant resistance to most agents, with a decreasing trend that should be explored further. Genomic analysis revealed the dominance of 5 main clonal clusters associated with mortality and bloodstream infections. Microbiological and genomic monitoring of MDR P. aeruginosa has enhanced our understanding of AMR in Qatar.

Antimicrobial resistance (AMR) is a global priority with significant clinical and economic consequences. Multidrug-resistant (MDR)Consecutive clinical specimens ofThe overall prevalence of MDRMDR

Background Bloodstream infections (BSIs) caused by multidrug-resistant (MDR)-Pseudomonas aeruginosa are associated with poor clinical outcomes, at least partly due to delayed appropriate antimicrobial therapy. The characteristics of MDR-P. aeruginosa bloodstream isolates have not been evaluated in Qatar. Our study aimed to examine in vitro susceptibility, clinical and molecular characteristics, and mechanisms of resistance of MDR-P. aeruginosa bloodstream isolates from Qatar. Materials and methods We included all MDR-P. aeruginosa isolated from blood cultures taken between October 2014 and September 2017. Blood cultures were processed using BD BACTEC™ FX automated system. BD Phoenix™ was used for identification, Liofilchem® MIC Test Strips for MIC determination. Whole-genome sequencing was performed using the Illumina-HiSeq-2000. Results Out of 362 P. aeruginosa bloodstream isolates, 16 (4.4%) were MDR. The median patient age was 55 years (range 43–81) and all patients presented with septic shock. Most patients received meropenem (12/16) and/or colistin (10/16). Clinical response was achieved in eight patients, and five patients died within 30-days. MDR-P. aeruginosa isolates belonged to 13 different sequence types. All isolates were non-susceptible to cefepime and ciprofloxacin. The most active agents were colistin (16/16) and aztreonam (10/16). Seven isolates produced blaVIM, and four possessed genes encoding extended-spectrum β-lactamases. Aminoglycoside modifying enzymes were present in 15/16, transferable qnr-mediated quinolone resistance gene was detected in 3/16, and the novel ciprofloxacin modifying enzyme CrpP-encoding gene in one isolate. Conclusion MDR-P. aeruginosa BSIs are relatively uncommon in Qatar but are highly resistant, harbour multiple resistance genes, and are commonly associated with unfavourable clinical outcomes. Colistin was the only agent with consistent activity against the study isolates.Key messagesMDR-P. aeruginosa constituted

Introduction: Human papillomaviruses (HPVs), Epstein-Barr virus (EBV), and mouse mammary tumor virus-like virus (MMTV-like virus) can be present and contribute to breast cancer development and progression. However, the role of these oncoviruses and their crosstalk in breast cancer is still unclear. Methods: We explored the co-presence of high-risk HPVs, EBV, and MMTV-like virus in 74 breast cancer samples from Qatar using PCR. Results: We found the presence of HPV and EBV in 65% and 49% of our cancer sample cohorts; 47% of the samples are positive for both oncoviruses. The MMTV-like virus alone was detected in 15% of the samples with no significant association with clinicopathological features. The three oncoviruses were co-present in 14% of the cases; no significant association was noted between the co-presence of these viruses and the clinicopathological features. Conclusion: Despite the presence of the oncoviruses, additional studies are necessary to understand their interactions in human breast carcinogenesis.

Constrictive pericarditis is a rare disease with a difficult diagnosis. Cardiac magnetic resonance (CMR) imaging data of Aga Khan University Hospital, from January 2011 to March 2020 was retrospectively reviewed and patients with the diagnosis of constrictive pericarditis were included. A total of 22 patients were included with the mean age of 46 + 16 years and majority (77%, n=17) being male. The most common findings on transthoracic echo were significant respiratory variation in mitral and tricuspid inflow velocities (91%, n=20) and septal annular e’>9 (86%, n=19). Most common finding on CMR was respiratory septal shift in 100% (n=22) followed by septal bounce in 95% (n=21), and thickened pericardium in 82% (n=18). Nearly two-third patients (n=15) were considered for pericardiectomy but it was deferred in 5 patients due to high surgical risk. Ten patients underwent pericardiectomy with no mortality on a mean follow up of 4 + 2 years. Continuous...