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Objectives: To validate and recalibrate the CURB-65 and pneumonia severity index (PSI) in predicting 30-day mortality and critical care intervention (CCI) in a multiethnic population with COVID-19, along with evaluating both models in predicting CCI. Methods: Retrospective data was collected for 1181 patients admitted to the largest hospital in Qatar with COVID-19 pneumonia. The area under the curve (AUC), calibration curves, and other metrics were bootstrapped to examine the performance of the models. Variables constituting the CURB-65 and PSI scores underwent further analysis using the Least Absolute Shrinkage and Selection Operator (LASSO) along with logistic regression to develop a model predicting CCI. Complex machine learning models were built for comparative analysis. Results: The PSI performed better than CURB-65 in predicting 30-day mortality (AUC 0.83, 0.78 respectively), while CURB-65 outperformed PSI in predicting CCI (AUC 0.78, 0.70 respectively). The modified PSI/CURB-65 model (respiratory rate, oxygen saturation, hematocrit, age, sodium, and glucose) predicting CCI had excellent accuracy (AUC 0.823) and good calibration. Conclusions: Our study recalibrated, externally validated the PSI and CURB-65 for predicting 30-day mortality and CCI, and developed a model for predicting CCI. Our tool can potentially guide clinicians in Qatar to stratify patients with COVID-19 pneumonia.

The management of sinister cutaneous lesions including malignant melanoma in the clinically frail patient tends to present clinicians with a professional and ethical dilemma on the optimal but yet least invasive management option. We present a case of an 80-year-old female with numerous co-morbidities, presenting with metastatic melanoma, in which electrochemotherapy (ECT) was successfully used to manage her debilitating symptoms of intractable bleeding. Level of evidence: Level V, therapeutic study.

Background β-thalassemia major is a hereditary disorder of hemoglobin (Hb) that results in defective Hb synthesis, leading to severe chronic anemia. The mainstay of its treatment is lifelong regular packed red cell transfusions associated with iron-chelating therapy. Globally, there is a gap between blood donation and the actual needs of the patients who depend on transfusion. Patients with β-thalassemia major are no exception and have limited access to regular and safe blood transfusions. This study aimed to assess the gap between the demand and supply of blood for transfusion-dependent patients with β-thalassemia major treated at the Hereditary Blood Diseases Center, Al Ahsa, Eastern Saudi Arabia. Methodology This was a retrospective, cross-sectional study conducted at the Hereditary Blood Disease Center, Al Ahsa, Saudi Arabia, including patient data from January 2017 to December 2019. We used Excel 365 from Microsoft Office 2016, version 1706. Results A total of 158 patients were on chronic transfusion. Of the total patients, 65% were adults, while the remaining 35% comprised the pediatric population. The total number of units requested and received during the three-year period was 14,509 and 9,530, respectively, indicating a gap of 4,979 (34%) units. The age of most of the units received was more than 14 days: 36% of those in 2017, 49.9% in 2018, and 61.5% in 2019. Rare blood groups and alloimmunization accounted for

Importance Obesity is associated with increased prevalence of gastroesophageal reflux disease (GERD); with recent reports suggesting improvement in GERD symptoms and weight loss following bariatric surgical intervention. However, the exact impact of the type of bariatric surgery on the evolution of GERD symptoms have remained unexamined. Objective To characterize the exact evolution of GERD symptoms, post bariatric surgery.Data sources We systematically searched electronic databases (PubMed, EMBASE, Web of Science, and the Cochrane Library from inception to December 2018) for eligible studies that satisfy pre-specified inclusion criteria. Study selection We included clinical trials of all designs (prospective and retrospective) that reported on GERD outcomes following Laparoscopic Sleeve Gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB).Data extraction and synthesis Two independent reviewers extracted relevant data based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Data were pooled using a random-effects model.Main outcomes Symptomatic improvement in GERD symptoms following bariatric surgery Results A total of 39 studies were analyzed and a robust-error meta-regression model was used to conduct a Dose-Response Meta-Analysis (DRMA) synthesizing data on 39 studies that reported GERD outcomes after bariatric surgery. Out of 43,994 patients who underwent either LSG (N = 9,547 patients) or LRYGB (N = 34,447 patients), 32.4% experienced improvement in symptoms (95% CI 20.62 to 45.45); The DRMA demonstrated a window period of two years for sustained improvement after which symptoms began to recur in those that were asymptomatic. Conclusion and relevance Bariatric surgery may improve GERD symptoms in obese patients who underwent LSG, however, the most favorable effect is likely to be found after Roux-en-Y gastric bypass surgery. The effects were not sustained and returned to baseline within 4 years.

Background: Mechanically ventilated patients experience many stressors related to their physiological conditions, treatments, and the Intensive Care Unit (ICU) environment itself. As patients are recovered from the respiratory problems, they can be weaned from mechanical ventilation (MV). Weaning represents a major challenge in critically ill patients' management. Weaning from MV imposes more stress on the patients as it leads to feeling of helplessness. Excessive and inappropriate use of sedatives can result in cardiovascular instability, prolongation of MV and ventilator associated pneumonia. Critical care nurses have an important role in alleviating stress manifestations and helping patients’ holistic healing. Non-pharmacological approach is recommended to be used prior to or in conjunction with sedatives use. Listening to Holy Quran Recitation (HQR) is a kind of spiritual support for Muslim patients. Spiritual care has been recommended as it can affect patient’s comfort. Accordingly, spiritual support strategies including HQR have been recently proposed to achieve better outcomes of critically ill patients which is the aim of the current study. Methods: A quasi experimental research design was used in this study. Physiological and psychological parameters were measured before and after HQR in the study group. Results: All differences between physiological and psychological parameters of the study group before and after HQR were statistically significant (P= 0.00). All differences between initial and the final measurement values of physiological and psychological parameters of the control group were statistically not significant. The mean values of heart rate, respiratory rate, mean arterial blood pressure, and shortness of breath of the study group after HQR were lower than that in the control group. Conclusion: HQR is an effective non-pharmacological strategy to improve vital signs, SpO2, shortness of breath and anxiety level for mechanically ventilated Muslim patients undergoing weaning. In addition, it can increase spontaneous breathing trial (SBT) duration for patients undergoing weaning from MV.

Water-pipe (WP) smoking is the most common method of tobacco consumption in the Middle-East and is rapidly spreading on a global scale. Although, water-pipe smoking is linked to various diseases, such as emphysema and various types of cancers, its effect on testosterone levels has yet to be investigated. This study explores the effect of water-pipe smoking on serum testosterone levels in males in Qatar. In this cross-sectional sample within a cohort study, we retrieved data for a total of 1000 male volunteers from the Qatar BioBank (QBB) project. A self-reported questionnaire was used to determine the water-pipe smoking status of participants. Moreover, participants were stratified based on the frequency of smoking. Total testosterone and sex hormone binding globulin (SHBG) were measured clinically, whereas free testosterone and bioavailable testosterone were calculated using Vermeulen's equation. Hormone values of 541 males (277 water-pipe smokers and 264 non-smokers) were compared using multiple regression analysis based on water-pipe smoking status after adjusting for confounding factors. No statistically significant difference was observed between WP smokers and non-water-pipe smokers in the likelihood of having lower or higher total testosterone, after adjustment for confounding factors. Similar results were found in free testosterone, bioavailable testosterone, and sex hormone binding globulin (all p>0.05). When compared with the reference group, both light and heavy water-pipe smokers had a similar likelihood of circulating low total testosterone levels (OR=0.83, 95% CI: 0.46-1.49; and OR=0.80, 95% CI: 0.43-1.49; respectively). Our results reveal, for the first time, that there is no significant change in total testosterone, free testosterone, bioavailable testosterone and sex hormone binding globulin in waterpipe smokers compared to non-water-pipe smokers. Therefore, we believe that further studies are needed to confirm the effect of water-pipe smoking on testosterone in different populations. This work was supported by the College of Medicine of Qatar University and grant QUST-2-CMED-2018-1 from Qatar University.

Background: Efforts have been made to define professionalism across the professions, yet little attention has been paid to the concept in mental health services, where patients’ needs differ to that in other healthcare specialties. Aims: To derive a definition of professionalism for mental health services using the existing literature. Method: A rapid, systematic review was conducted to identify empirical and non-empirical records that described professionalism in a mental health service context from 2006 to 2017. Studies were synthesised narratively using thematic analysis. Results: Seventy records were included in the review. Professionalism was described on two levels; at a societal level, a dynamic social contract between professions and society, and; at an individual level, having intrapersonal, interpersonal, and working professionalism. Utilising emerging themes, an operationalised definition of professionalism, suitable for a mental health service context was derived. Conclusions: Within mental health services, emphasis is placed on the interpersonal aspects of practice such as communication skills, maintaining boundaries and humanity. Themes relating to the vulnerability of patients and the challenge of supporting autonomy and choice whilst maintaining safety and acting in a client’s best interest are also evident. ‘Practical wisdom’ and a flexible approach to working are needed to manage these challenging situations.

Introduction Water-pipe (WP) smoking is the most widespread tobacco use in the Middle-East, and is rapidly spreading globally. Meanwhile, changes in testosterone levels have been linked to various diseases including type 2 diabetes and erectile dysfunction. This investigation addresses an important gap in the outcome of WP smoking on testosterone levels. Aim To explore the outcome of WP smoke on serum levels of total testosterone (TT), free testosterone (FT), bioavailable testosterone (bioT) and sex hormone-binding globulin (SHBG) among men in Qatar. Methods This is a cross-sectional cohort study based on data gathered from a total of 1000 volunteer men from Qatar BioBank (QBB). To determine the WP and Cigarette smoking status, a self-reported questionnaire was used. TT and SHBG were measured clinically, whereas FT and BioT were calculated using Vermeulen’s equation. Hormone values were compared using multiple regression analysis based on WP smoking status after adjusting for appropriate confounding factors. Results Once exclusion criteria were applied, 541 males (277 WP smokers and 264 non-smokers) were included in the analysis. After adjustment for cofounding factors, no statistical significant difference was observed in TT, FT, SHBG, and BioT between WP smokers and non-smokers (all p > 0.05). Furthermore, Similar results were found in non-adjusted regression model, while only age was shown to significantly affect androgens level (P= 0.014). Conclusions In this study we report, for the first time, that there was no significant change in TT, FT, BioT and SHBG in WP smokers when compared to non-WP smokers. Funding This study was supported by a Qatar University Student Grant.

We investigated whether spinalized animals can produce inspiratory rhythm. We recorded spinal inspiratory phrenic (PNA) and cranial inspiratory hypoglossal (HNA) nerve activity in the perfused brainstem preparation of rat. Complete transverse transections were performed at 1.5 (pyramidal decussation) or 2 mm (first cervical spinal segment) caudal to obex. Excitatory drive was enhanced by either extracellular potassium, hypercapnia or by stimulating arterial chemoreceptors. Caudal transections immediately eliminated descending network drive for PNA, while the cranial inspiratory HNA remained unaffected. After transection, PNA bursting remained sporadic even during enhanced excitatory drive. This implies, cervical spinal circuits lack intrinsic rhythmogenic capacity. Rostral transections also abolished PNA immediately. However, HNA also progressively lost its amplitude and rhythm. Chemoreceptor activation only triggered tonic, non-rhythmic HNA. Thus the integrity of ponto-medullary circuitry was maintained. Our results suggest that an area overlapping the caudal nucleus retroambiguus provides critical ascending input to the ponto-medullary respiratory network for inspiratory rhythm generation.

The past few years have seen rapid advances in the understanding and management of foetal disease. The development of high-resolution and three-dimensional/four-dimensional ultrasound and the ability to analyse foetal DNA in the maternal blood have proved to be exciting innovations. In-utero foetal therapy is, however, still limited by the complications of preterm labour and premature rupture of membranes and the further development of endoscopic procedures is dependent on improvements in the management of these complications. Moreover, application of foetal therapy in clinical practice has been restrained by insufficient evidence to support its efficacy as a treatment.

The immunity profile against H5N1 highly pathogenic avian influenza (HPAI) in the commercial poultry value chain network in Egypt was modeled with the use of different vaccination scenarios. The model estimated the vaccination coverage, the protective seroconversion level, and the duration of immunity for each node of the network and vaccination scenario. Partial budget analysis was used to compare the benefit-cost of the different vaccination scenarios. The model predicted that targeting day-old chick avian influenza (AI) vaccination in industrial and large hatcheries would increase immunity levels in the overall poultry population in Egypt and especially in small commercial poultry farms (from 60%). This strategy was shown to be more efficient than the current strategy of using inactivated vaccines. Improving HPAI control in the commercial poultry sector in Egypt would have a positive impact to improve disease control.

BACKGROUND Several methods have been proposed for rapid detection of drug resistance of Mycobacterium tuberculosis (M. tuberculosis). High resolution melting (HRM) curve analysis has been developed for accurate and simultaneous detection of resistance of M. tuberculosis isolates to rifampicin (RIF) and isoniazid (INH). Other techniques include the resazurin microtiter assay (REMA) which is one of the new colorimetric phenotypic methods. The present study evaluated the HRM curve analysis and REMA assay in comparison to the proportional method (PM) for rapid identification of multidrug resistant (MDR) M. tuberculosis isolates. METHODS Thirty M. tuberculosis clinical isolates of known resistance phenotypes were used. An HRM curve was generated for each isolate to scan for mutations in the rpoB and katG genes to detect RIF and INH resistance, respectively. The REMA colorimetric assay was also evaluated using the same isolates. The results of both techniques were compared to the gold standard proportional method. RESULTS The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the REMA assay for RIF and INH susceptibility testing were 100%. The HRM curve assay results for RIF susceptibility testing were 92.3%, 100%, 100%, 94.4%, and 96.7%, respectively, and for INH they were 85%, 100%, 100%, 76.9%, and 90%, respectively. CONCLUSIONS REMA is a rapid non-conventional and inexpensive method and may serve as a replacement for the proportion method in resource limited settings, while the PPV and NPV of the HRM curve make this assay an ideal screening method for the TB laboratory.