Search

Objective: The present study aimed to evaluate the clinical benefits and drawbacks of administering ECMO/ECLS therapies to drug-intoxicated patients.Methods: From inception until April 30, 2024, an extensive search was performed on four main databases:PubMed, Web of Science, Cochrane Library, and EMBASE. There was no restriction on the search period. Onlythe studies that reported survival to hospital discharge rates, adverse events, and the utilization of ECMO/ECLSin the treatment of intoxicated patients were included. On the other hand, articles that did not report adverseevents or hospital discharge rates as outcomes, as well as studies published in languages other than English,were excluded. The evaluated outcomes were the rate of survival to hospital discharge rate and the incidenceof adverse events associated with ECMO therapy. The Newcastle Ottawa scale was employed to appraise eachstudy to determine its methodological quality. The Comprehensive Meta-Analysis (CMA) software (version3.0) for statistical analysis was used, with the random effects model (due to high heterogeneity among thestudies) and a 95% confidence interval.Results: From a total search of 2216 search results, only 10 studies were included. The pooled analysis from10 studies indicated that ECMO therapies among drug-overdosed/poisoned patients were associated witha significant survival to hospital discharge rate of 65.6% ([95% CI: 51.5%-77.4%], p=0.030). However, theoutcomes were highly heterogeneous (I2=83.47%), which could be attributed to the use of several medicinesby different studies. In contrast, ECMO therapies among drug-overdosed patients were associated with asignificant incidence rate of adverse events of 23.1% ([95% CI: 12.3%-39.2%], p=0.002). However, the pooledanalysis had a significant heterogeneity (I2=70.27%).Conclusion: Despite various health complications, extracorporeal membrane treatment enhanced survival tohospital discharge with good neurological outcomes. Hence, it was a viable, effective, and feasible alternativefor managing drug-induced intoxication in patients.

BackgroundPosterior cerebral circulation ischemic stroke (PCS) comprises up to 25% of all strokes. It is characterized by variable presentation, leading to misdiagnosis and morbidity and mortality. We aim to describe PCS in large multiethnic cohorts.MethodsA retrospective review of a large national stroke database from its inception on the 1st of January 2014 till 31 December 2020. Incidence per 100,000 adult population/year, demographics, clinical features, stroke location, and outcomes were retrieved. We divided the cohort into patients from MENA (Middle East and North Africa) and others.ResultsIn total, 1,571 patients were identified. The incidence of PCS was observed to be rising and ranged from 6.3 to 13.2/100,000 adult population over the study period. Men were 82.4% of the total. The mean age was 54.9 ± 12.7 years (median 54 years, IQR 46, 63). MENA patients comprised 616 (39.2%) while others were 954 (60.7%); of these, the majority (80.5%) were from South Asia. Vascular risk factors were prevalent with 1,230 (78.3%) having hypertension, 970 (61.7%) with diabetes, and 872 (55.5%) having dyslipidemia. Weakness (944, 58.8%), dizziness (801, 50.5%), and slurred speech (584, 36.2%) were the most commonly presenting symptoms. The mean National Institute of Health Stroke Score (NIHSS) score was 3.8 ± 4.6 (median 3, IQR 1, 5). The overall most frequent stroke location was the distal location (568, 36.2%). The non-MENA cohort was younger, less vascularly burdened, and had more frequent proximal stroke location (p

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.

Abstract Background Non-invasive measures that can accurately estimate cardiac output may help identify volume-responsive patients. This study seeks to compare two non-invasive measures (corrected carotid flow time and carotid blood flow) and their correlations with invasive reference measurements of cardiac output. Consenting adult patients (n = 51) at Massachusetts General Hospital cardiac catheterization laboratory undergoing right heart catheterization between February and April 2016 were included. Carotid ultrasound images were obtained concurrently with cardiac output measurements, obtained by the thermodilution method in the absence of severe tricuspid regurgitation and by the Fick oxygen method otherwise. Corrected carotid flow time was calculated as systole time/√cycle time. Carotid blood flow was calculated as π × (carotid diameter)2/4 × velocity time integral × heart rate. Measurements were obtained using a single carotid waveform and an average of three carotid waveforms for both measures. Results Single waveform measurements of corrected flow time did not correlate with cardiac output (ρ = 0.25, 95% CI −0.03 to 0.49, p = 0.08), but an average of three waveforms correlated significantly, although weakly (ρ = 0.29, 95% CI 0.02–0.53, p = 0.046). Carotid blood flow measurements correlated moderately with cardiac output regardless of if single waveform or an average of three waveforms were used: ρ = 0.44, 95% CI 0.18–0.63, p = 0.004, and ρ = 0.41, 95% CI 0.16–0.62, p = 0.004, respectively. Conclusions Carotid blood flow may be a better marker of cardiac output and less subject to measurements issues than corrected carotid flow time.

Background: One of the traditional approaches for knowledge transfer in medical education is through face-to-face (F2F) teaching. We aimed to evaluate the acquisition of knowledge about point-of-care ultrasound (POCUS) and learner’s satisfaction with the flipped classroom (FC) teaching approach. Methods: This was a prospective, mixed-method, crossover study and included 29 emergency medicine (EM) residents in current training program. Over a period of three months, each resident was exposed to F2F and FC teaching models in a crossover manner. There was a multiple-choice questions (MCQ) test before and after each educational intervention (F2F & FC). Two months after each educational intervention a final MCQ test was administered to assess the retention of knowledge between the two approaches. After each educational approach feedback was sought from a selected group of residents concerning the acceptability of the two educational approaches through a semi structured interview. Results: A total of 29 EM residents participated in this study. The numbers of residents by year of post-graduation training were seven (24.14%) PGY-1, eight (27.59%) PGY-2, six (20.69%) PGY-3, and eight (27.59%) PGY-4. The baseline mean score was 15.82 using MCQs test mean scores. For the face-to-face teaching model, the difference between pre and post-intervention scores was 2.7 (95% CI 2.1 to 3.3, p=0.001); whereas, for the flipped classroom teaching model, the difference was 3.93 (95% CI 3.2 to 4.5, p= 0.001). At two months post-intervention, for face-to-face teaching model, the MCQ assessment showed an increase of 1.7 (95% CI 1.1 to 2.2, p= 0.001) mean scores when compared to the pre-intervention mean scores; whereas, for the flipped classroom model this difference was significantly higher, recorded as 4.48 (95% CI 3.7 to 5.1, p= 0.001). Finally, the difference between mean scores for F2F and FC teaching models was 2.75 (95% CI 1.87 to 3.64, p=0.001) at two months post-intervention. Overall, the participants expressed a preference for the FC teaching methodology. Conclusion: Both F2F and FC teaching methods resulted in significant and sustained improvements in POCUS knowledge base. The FC teaching method accomplished higher test scores than the F2F teaching method both at the end of the teaching and after two months of completing the educational program.