bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigating Contextual Determinants of Happiness among Seoul Residents*
Authors: Woo Changbin
Published: October 2021

This study investigated contextual determinants of happiness such as spatial, socio-economic, and socio-political factors, as well as individual determinants. Using samples from the Seoul Survey, the study applied multilevel analyses separately to the whole sample, a cohort of the upper class, and a cohort of the lower class. It demonstrated that spatial, socio-economic, and sociopolitical contexts have an impact on individual happiness; however, negative externalities caused by social comparison exist only in people in the lower social class, while those in the upper class feel happier with a higher degree of economic prosperity. Natural amenities such as green spaces and political participation (measured by voter turnout) have a positive impact on the level of happiness regardless of social status. In order to raise the general level of happiness, public policy should focus more on these contextual determinants, especially non-material determinants.
Precarious Working Youth and Pension Reform in the Republic of Korea and Italy*
Authors: Lee Sophia Seung-Yoon , Kim Yunyoung
Published: October 2021

This paper focuses on two aspects of the welfare state: the old age pension system and the labor market, where the majority of youth are working in precarious jobs. We discuss the interplay between pension funds and the increase in young atypical workers by studying the case of Italy and the Republic of Korea, closely analyzing the projected benefit level of both standard and non- standard workers among the youth population in Korea in order to assess where young workers will find themselves after retirement age and what Korea can learn from the case of Italy.
A Study on the Ex-ante Evaluation on Government R&D Programs Using Fuzzy Reasoning
Authors: Lee Yoon Been
Published: October 2021

In 2007, the Korean government officially introduced an ex-ante evaluation system, the preliminary feasibility study (PFS), for supporting the decision making process that informs R&D investment budgets, which uses economic, policy, and technological criteria to evaluate prospective R&D programs. From an analytical perspective, this kind of balanced assessment is very important in budget allocation decision making and thus the need for objective quantitative values that can lead to a conclusive judgment on the status of an R&D investment has been growing.
However, owing to measurement problems and a lack of information, PFSS as well as economic feasibility assessments, a critical subdimension of PFSS, have faced difficulties in deriving a satisfactory single assertive conclusive value. Furthermore, the emphasis on expected economic returns of the R&D investment from the perspective of long-term national strategy in PFSS seems to contradict the original intention of ex-ante evaluation system, which is supposed to take not only economic but also technological and policy dimensions into account independently.
The aim of this study is to investigate the question of independency in PFSS, especially in the assessment of economic feasibility raised by many critics. If there are some systematic connections between assessments of other dimensions of feasibility and the economic one, it becomes hard to sustain the basic assumption of the PFS, and we need to explicitly take this linkage into account in performing PFSS. To verify the existence of this connection, I propose a method to derive pseudovalues that provide an economic assessment of the R&D program from those originally derived via analyses: a method of a fuzzy reasoning approach that converts experts' judgments into systematic calculations. Furthermore, I suggest that the results generated by fuzzy reasoning can be used to complement a traditional economic analysis, since fuzzy reasoning can inform the development of a comprehensive structure for ex-ante evaluation for government programs.
Intracranial Tumors- Overview, Histological Types, Symptoms and Treatment Plans
Authors: Chaulagain Dipak , Smolanka Volodymyr , Smolanka Andriy
Published: October 2021

People, in general, are affected by a brain or intracranial tumor when abnormal cells started functioning within their brain. This paper explores mainly tumors that affect the brain. Almost every type of brain tumor might create symptoms which are based on the parts of the brain affected. In order to better understand reasons of occurrence intracranial tumors in various sections of the population, the study examined the relationship between sociodemographic variables, i.e., age, gender and marital status and the relative frequency of intracranial tumors as part of a study. Samples are collected based on the information from Uzhhorod Regional Center of Neurosurgery and Neurology in Ukraine. And factors such as age, gender and marital status has been considered to examine tumor size variation. The ratios of organ cancers in Ukrainians are evidently increasing. Besides, there has been growing trend in affected rates in both the genders of CNS cancers have been noticed in all the records. The ratio of most harmful brain tumors is comparatively in minimal ratio in East and Southeast Asia, and India. On the other hand, the highest ratio has been noted in European countries and as well United States, and Ukraine is one of those countries. The major burdens of cancer frequency in Ukraine have been noticed in the lung, breast, and prostate and brain. Of these, brain tumor rate in Ukraine had been hardly studied. The major difference in frequency in Asian and European populations implies the potential influence of genetic or environmental factors in malignant brain tumors. Continuing monitoring of tumor ratio in Ukraine is essential to comprehend how best to reduce cancer burden globally and to explain the causes of provincial variations, for example access to diagnosis methods and ecological exposures.

Key words: Intracranial tumors, symptoms, tumor incidence in Ukraine, treatment plans, survival rate of cancer in Ukraine.
Evidence-Based Diagnosis and Physiotherapy Management of Musculoskeletal Disorders of Cervical Spine
Authors: Khan Jibran Ahmed , Pandey Vipin Kumar
Published: October 2021

The main aim of this review article is to identify the evidence-based diagnosis and physiotherapy management of musculoskeletal disorder of cervical spine. Neck pain from cervical spine disorders is the most common cause of musculoskeletal disorders. Neck pain can exist alone or with the presence of upper-extremity symptoms.

Key words: Neck Pain, Cervical Spine, Joint mobilization, Massage.
Comparison Of Concrete Using Portland Composite Cement And Ordinary Portland Cement
Authors: Ponco Vinansius , Tanijaya Jonie , Sanggaria Olan Jujun
Published: October 2021

Cement is the basic material for making concrete that can be used as a hydraulic binder. There are various types of cement including OPC and PCC cement. The problem now is that there is no technical data that can be used as a reference in determining the proportion of the mixture. Examples of cement are obtained from the same factory. namely PT. Semen Tonasa, South Sulawesi with an amount of 78.96 kg of cement for each type of cement. From the results of laboratory tests, it was found that the data on the comparison of concrete using OPC and PCC cements had different data on the of OPC cement is 3.726 Mpa and PCC cement is 3.223 Mpa and for testing the modulus of elasticity of OPC cement is 19371.316 Mpa and PCC cement is 17579.182 Mpa. The test results have met the standard for structural concrete with the same water-cement factor.
Aphidophagous Predator diversity in Kalimpong District, India
Authors:   District Entomologist, Chief Medical Officer of Health, Purba Medinipur, West Bengal, India, Debnath Manashi
Published: October 2021

Kalimpong, part of Eastern Himalaya have a diverse flora and aphid fauna. Aphidophagous predators are important natural enemies of aphids in these areas. Coccinellids, Syrphids and europterans are the important predators. These are abundant at altitude between 1400-2100 meters.
Live streaming of child sexual abuse: an analysis of offender chat logs
Authors: Napier Sarah , Teunissen Coen
Published: October 2021

Live streaming of child sexual abuse presents challenges for law enforcement and policy development. This study analysed chat logs from seven offenders who watched and directed the sexual abuse of 74 children (mostly in the Philippines) via live stream. The study found that offenders paid facilitators and victims very small amounts of money (median A$51) to view the sexual abuse of children, and used mainstream messaging and video platforms (eg Facebook) to communicate and transmit the abusive materials. Two key factors emerged from this study that present potential points for intervention and disruption: payment characteristics (such as price ranges and the use of remittance services) and messaging platforms where offenders view CSA live streaming.
Qatar Health 2021: An online conference to prepare for a mass gathering sporting event while still addressing the pandemic
Authors: Alinier Guillaume , Rizoli Sandro , Al Thani Hassan
Published: October 2021

It feels like yesterday that we wrote the editorial related to the previous issue of the Qatar Health 2020 Conference!. 2020 is clearly a year to remember globally as a challenging one and this probably contributed to time passing so rapidly, keeping everyone so busy caring for patients and conducting research. COVID-19 has had a big impact on all aspects of our lives, from the way we deliver patient care and work, to how we socialize and plan for the future in general. The past year has certainly provided an opportunity for the State of Qatar to demonstrate its resilience, its ability to rapidly adapt to new circumstances, and to find effective solutions to new problems. Although very concerned by the current pandemic, our focus needs to also concentrate on the forthcoming FIFA World Cup in 2022 and every possible health related aspects, to ensure the event is safely hosted for everyone’s enjoyment. This has been clearly reflected in the Qatar Health 2021 conference program and call for abstracts () which was organized into four parallel tracks fully hosted online for everyone’s safety. This issue of the Journal of Emergency Medicine, Trauma and Acute Care contains an extensive selection of 38 out of the 94 abstracts that have been accepted for oral or poster presentation during the conference. The abstract themes are summarized in and range from the impact of the pandemic on delivering primary care to Qatar’s preparedness to dealing with hazardous and chemical, biological, radiological and nuclear incidents. Notably 48 (51.06%) of the abstract titles contained the word COVID-19 or pandemic while only 4 abstracts (4.25%) were related to mass gatherings and sporting events. The later topics were primarily covered by multiple invited speakers with the relevant experience and proved to be the most attended conference sessions. It is worth noticing that the event attracted just over of 5,400 delegates and speakers from a total of 40 countries and has received highly positive feedback. We look forward to welcoming everyone again next year as we come closer to the FIFA World Cup 2022, with many more topics, partner organizations, and attendees.
Effective approach to manage COVID-19 challenges in Hamad General Hospital dialysis facilities
Authors: Fouda Tarek , Ibrahim Abdullah , Elgaalib Musab Ahmed , Farooqig Farrukh Ali , Ismail Aly Sahar Mohamed , Abdel Latif Akl Tabasim Ali , Diamant Michael Catli , Abdulla Aisha El Sayed , Al-Malki Hasan
Published: October 2021

Background: Hamad Medical Corporation (HMC) is providing dialysis treatment to approximately 1050 patients. COVID-19 started from China in December 2019, and the first case in Qatar was confirmed on 27th February 2020. There were challenges to provide dialysis treatment for COVID-19 positive and negative patients during the pandemic due to severe staff shortage, staff fear and psychological distress, workload, lack of dialysis slots, prolonged working hours and staff fatigue. Some staff were even deployed to COVID-19 facilities (modular dialysis services, hotel and quarantine facilities) to provide treatment. Methods:

1) A COVID-19 management committee was established

2) An on-call team was assigned to manage new cases and review dialysis slots availability.

3) Staff performance and adherence to safety measures was monitored.

4) A hierarchy model was implemented for COVID-19.

A) Elimination:

 – Confirmed COVID-19 patients were not to receive dialysis at Ambulatory Dialysis centres.

 – Unit meetings were only held online.

B) Substitution:

   – Dialysis services were to be provided in HMC dialysis facilities, COVID-19 hospitals, and isolation/quarantine facilities (home/hotels).

– Administrators with chronic disease worked from home.

C) Engineering:

– Reduce number of chairs in tearoom and waiting area

– Rearrange offices, working spaces, and conference room to keep everyone 2 meters apart.

D) Administrative:

  – Staff, patient and family education

  – Screening by using visual triaging scale

  – Deployment of staff

  – Managing staff mental health and psychosocial well-being

Results: 76 dialysis patients and 30 dialysis staff were infected. 900 hemodialysis sessions were provided inside quarantine and isolation facilities (home, hotel, Bu-Sidra, and other locations) and Hazm Mebaireek General Hospital (HMGH) Modular Dialysis Unit from March to October 2020 (). The number of COVID-19 positive patients reduced from 39 in May 2020 to 12 in July 2020 (p = 0002) (). Conclusion: Thanks to our approach, we were able to provide a high quality and safe dialysis service for in-centre dialysis and in COVID-19 facilities and quarantine centres (home/hotels).
Impact of COVID-19 integrated physical barrier systems in prevention of other upper respiratory tract infections in occupational settings: The key lessons learned
Authors: Al-Naemi Mohamad Hamad BA , Hassanen Walid Sayed , Mohamed El Nahrawi Sherif Fawzi , Rashad Rama Abdulsalam , Atienza Arro Randall
Published: October 2021

Background: During the COVID-19 pandemic response, Qatar Gas implemented a multi-layer integrated physical barrier system in the field based on an interrelated meshwork of dimensions. It involved the utilization of fiberglass partitions, air purifiers, and dedicated transportation vehicles for suspected cases besides the traditional measures of physical distancing of at least 2 meters between employees, wearing face masks, and hand hygiene. Methods: We evaluated the impact of these measures by comparing the prevalence of upper respiratory tract infections (URTIs), other than COVID-19, compared to the same time the previous year. In addition, we compared the number of sick leave days issued in 2020 to those issued during the previous year in the same time period and after stratification of other confounding or contributing factors. Results: Mechanistic studies found that surgical masks could prevent transmission of human coronavirus and in-fluenza virus infections if worn by infected persons. The number of other URTIs were statistically significantly lower after COVID-19 prevention measures were implemented ( and ). A simultaneous significant decline in the number of sick leaves issued (51.7% decline) was observed over the same period of the decline of URTI visits (sick leave rate declined from 1.3% in 2019 to 0.77% in 2020, p value ≤  0.05) (). Conclusion: A clinically and statistically significant decline was observed in the incidence of URTI cases and the rate sick leaves between 2019 and 2020. This observation correlates with the start of the implementation of COVID-19 preventive measures. We recommend to consider continuation of the same precautionary measures as far as reasonably applicable, for critical workers in the field.
Implementation of on-call clinical pharmacy service in an emergency department during COVID 19: New initiative in Hamad General Hospital, Qatar
Authors: ElMalik Ashraf , Salemeh Rawan Khalil , Mohamed Asmaa , Anwer Shahzad , Al Bakri Mona
Published: October 2021

Background: Throughout COVID-19, complex therapeutics and medication protocols left clinicians overwhelmed by contradicting information leading to drug-related problems (DRPs) potentially leading to ineffective pharmacotherapy and drug-related morbidity and mortality. DRPs queries are time consuming, utilize numerous resources, and require skills and experience to provide accurate answers. Quick answers are paramount in the Emergency Department (ED) especially during a pandemic period. Clinical pharmacists (CP) can identify and resolve DRPs but are only available in the ED during daytime hours. We set up an out-of-office CP service for ED DRPs. This study aimed to assess the capacity of the service to capture 100% of calls received and to measure the time taken to resolve DRP queries compared to the international standard. Methods: A dedicated ED CP on-call phone line and rota until 10 pm daily was arranged by the Hamad General Hospital Pharmacy (Doha, Qatar). Data was documented in a logbook and within the Electronic Medical Records (EMR) and analysed using predefined parameters. Results: Between March-September 2020, 133 DRPs calls were received and resolved by a CP. 38% were related to drug interaction/safety (often about medications used in COVID-19 treatment protocols), adverse drug reactions, dose-adjustments, drug allergies and drug in pregnancy. 30% were about medication administration, such as infusion rates, titration, and intravenous compatibility. Those questions were mostly from nurses (). Appropriate dose selection and appropriate indication represented 21% and 11% respectively (). Caller's acceptance rate to responses provided by CP was 100%. Responses were documented in the patients’ EMR. The call-history-log showed an average duration of 4.66 minutes per call which is below the average standard of 15-30 minutes. Conclusion: The availability of clinical pharmacists to provide quick, acceptable, responses to DRPs queries is crucial given the complexity and diversity of ED patients. During COVID-19, an on-call clinical pharmacy service has proven its capability to resolve DRPs and support the clinical decision-making process in a relatively short time.
Qatar Biobank in the COVID-19 era and beyond
Authors: Fthenou Eleni , El Deeb Marwa , Al Emadi Ameena , Khayat Eiman Al , Dosari Mohamed Al , Fadalah Sheikha Al , Salau Althea , Hannigan Linda , Lobo Wilma , Frenneaux Michael , Al Khal Abdul Latif , Al Thani Asma , Afifi Nahla
Published: October 2021

Background: During the COVID-19 outbreak, Qatar Biobank (QBB) adapted its services to collect, process, and store high-quality data and specimens. This transformation period brought opportunities, risks, and challenges. Methods: QBB holds College of American Pathologists (CAP) accreditation and International Organization for Standardization (ISO) certification for Quality Management (9001:2105) and Information Security Management Systems (27001: 2013). These standards helped to effectively convert its operations to facilitate the COVID-19 national project. The COVID-19 Biorepository is a National Disease-based study aiming to collect adequate health information and biological samples from Qatar residents infected by SARS-CoV-2 virus to enable evidence-based research towards the discovery and development of novel healthcare interventions and to facilitate research projects related to the COVID-19 pandemic. QBB IT Department used open-source Onyx (ObiBa) software to newly develop a COVID-19 electronic system and interface for various clinical devices and Laboratory Information Management System. QBB operational services were adapted to accommodate the COVID-19 project by providing training to the personnel (n = 20; i.e. nurses, research assistants etc.) and developing work instructions (n>5) for the participants’ recruitment process, data and specimen collection in the different hospitals. A COVID-19 portal was also developed by QBB to facilitate data access for researchers from Qatar and worldwide. Results: Within 5 weeks QBB transformed to accommodate a disease/virus-based biorepository. At an operational level, multi-adjustments were implemented. QBB IT department developed an electronic system for the data collection and specimen traceability. Clinically trained staff were transferred to different healthcare facilities to recruit COVID-19 positive patients. QBB laboratory designed special collection kits. QBB Medical Review Office and Scientific and Education departments managed the recruitment process, set up of the study and provided training to the staff. The Communications and Participants Recruitment Department transformed its operations to fit the needs of the COVID-19 initiative. The Research Access Office designed the COVID-19 access portal and supported the project through purchasing of personal protective equipment and other administrative tasks. Conclusion: It is now time to consider lessons learned, as many countries have been affected by this pandemic, and to understand that biobanks are an asset for a country and there is a need to integrate them into a new standard with their sustainability in mind. Qatar Biobank is a good showcase of how a biobank can successfully assist in the collection of important data related to different health crises such as the COVID-19 pandemic.
Improving clinical outcomes for type 2 diabetes patients using teleconsultations during the COVID-19 pandemic
Authors: Al-Abdulla Samya Ahmad , Mansaray Mariama
Published: October 2021

Background: Diabetic patients are at significant risk of serious complications and higher mortality rates if they contract COVID-19. Primary Health Care Corporation (PHCC) in Qatar launched a Diabetes Teleconsultation Clinic to proactively support high risk diabetic patients with a hemoglobin A1c (HbA1C) superior or equal to 8 mg/dL and without a primary health care encounter in the last 2-12 months, in an attempt to support this high risk population and still provide continuity of care. Methods/Case presentation: Patients meeting the criteria were proactively contacted and received a teleconsultation call from a family medicine physician. During the call, family physicians and patients reviewed individual management plans, and if agreed and required changes, the patient management plans were adjusted and monitored. Patients were additionally supported by a wider team of professionals via teleconsultations, including dieticians, health educators and primary care psychology and psychiatry services. A paired sample T-Test () was conducted to compare the HbA1c mean levels for patients before and after joining the PHCC Diabetes Management Teleconsultation Clinic, after a 4-month period. Results/Findings/Recommendations: There was a statistically significant difference in the results of mean HbA1c levels for patients before joining the Diabetes Management Teleconsultation Clinic and after the intervention. Of the 384 patients analysed, the average HbA1c level before the intervention was 9.49 mg/dL, and after the intervention the average was 8.83 mg/dL (p < 0.001). Conclusion: The use of teleconsultations, remote multidisciplinary team support, and collaborative patient management plans has had a positive impact on the health outcomes of 384 high-risk diabetic patients within primary care. This inclusive model of care will be replicated to support more patients as a preventative and supportive intervention not only during the COVID-19 pandemic but in the long term.
Challenges faced during COVID-19 outbreak investigation in Qatar: From the investigators’ perspective
Authors: Ahmed Abrar , Jaffrey Syed Shariq , Fatima Farhat , Elnour Fatimah Ahmed , Mohamed Abuzaid Marwa Saleh , Abu Baker Abd Farag Elmoubasher , Ahmed Shazia Nadeem N. , Al-Romaihi Hamad Eid
Published: October 2021

Background: Case investigation and surveillance is a key step in managing any epidemic. This report aimed to identify the main challenges faced by COVID-19 case investigators in Qatar and to suggest possible solutions to improve the case investigation process in managing future pandemics. Methods: Purposive sampling was used to select 40 COVID-19 case investigators posted at the Ministry of Public Health, Qatar. Interviewees were from diverse educational and cultural backgrounds and had been investigating COVID-19 cases for more than 6 months, at the time of interview. Face-to-face semi-structured interviews were done to collect data which was anonymized before analyzing for the purpose of this qualitative study. Results: The most common concern faced in conducting case investigations was language barrier, given the multinational and diverse diasporas Qatar is host to. Authenticity of the investigation was a matter of suspicion for many patients; whereas the majority of the investigators opined that multiple calls received from different healthcare departments asking for information overwhelmed many patients. Laborers/migrant workers often did not divulge information due to fear of repercussions from their supervisors. Social stigma associated with COVID-19 caused reluctance to reveal the index case and close contacts. Information regarding social gatherings attended and public places visited was often concealed (). Cultural differences as well hindered smooth investigation in a few cases. Rising case load at times put restraints on improved coordination between different health departments and structured guidance for investigators about the pandemic response system, which could help to deliver appropriate health services more efficiently. Comprehensive orientation in using the Electronic Surveillance database could also improve the efficacy of epidemiological analysis for improved public health outcomes. Conclusion: Addressing these challenges will help the public health team in Qatar to increase preparedness and efficiency in managing potential future outbreaks, especially in view of upcoming mass gathering events such as the FIFA 2022 World Cup.
The implementation of a pediatric early warning system in the Sidra Pediatric Emergency Department, Qatar
Authors: Abdul Razak Sheik , Goldsworthy Lisa , Cullen Carmel , Adusumilli Sudhakar , Al Ansari Khalid , Powell Colin
Published: October 2021

Background: Establishing a paediatric early warning system in a paediatric Emergency Department (ED) is a complex process and more so with the COVID-19 pandemic. PUMA (PEWS Utilisation & Morality Avoidance) is a qualitative system assessment survey tool which assesses the strengths and weaknesses of the patient care safety processes and systems within a department. This model draws together evidence from two theoretically informed systematic reviews. Methods: The Sidra Medicine ED Quality group surveyed online 200 staff from the department of physicians/nursing team focussing on processes of monitoring patients and documentation, communication amongst the team and with parents, staff empowerment, situational awareness, escalation processes and response to the deteriorating child in the three broad domains of Detect, Prepare, and Act, with a further seven smaller domains (monitor, record, interpret, review, prepare, escalate, and evaluate) (). Survey analysis enabled to review current practice, identify areas that are working well and areas for improvement. Results and implications: The online survey helped achieve a 85% return rate and identify seven areas for improvement in the system. The spider diagram () illustrates the areas of strength and weakness in the seven domains with respect to Detect, Prepare, and Act. We collaborated with the Cerner team, created an automatic documentation of vital signs from triage and treatment areas to the patient’s Electronic Medical Record by associating patient’s cardiac monitors to reduce manual errors and for the timely monitoring of vital signs. A one-day “Back to Basics Training” refresher course for the nursing team was conducted. A senior nurse, as a watcher in the triage and treatment area, identified children at high risk of deterioration. A Pediatric ED Situational Awareness Tool (PEDSAT) was developed locally and is in trial to help manage sick children effectively. Conclusion: PUMA, a novel system assessment tool, empowered our ED to tailor a quality program with an aim to deliver effective and efficient patient care.
Community acquired pneumonia (CAP): Epidemiology, clinical presentation, management and outcomes in infants and children presenting to Al Wakra Pediatric Emergency Department (PED)
Authors: Abdelgadir Ibtihal S , Almawashi Haider , Elgharbawy Fawzia M , Alghazali Abdo M , Ponce Kryzl D , Mendoza Jaymie B. , Mawlood Bashdar R , Powell Colin
Published: October 2021

Background: Community acquired pneumonia (CAP) is defined clinically as the presence of signs and symptoms of pneumonia in a previously healthy child due to an infection that has been acquired outside the hospital. There is no previous data available from children in Qatar on CAP. Objectives: To evaluate the incidence, clinical features, management, outcomes and, complications in infants and children presenting to Al Wakra Hospital, Qatar with CAP. Methods: This is a prospective, observational, non-interventional study that assessed all children aged 3 months to 14 years, during a period of 12 months, from November 2017 to November 2018. Results: The incidence of CAP was found to be 2.8 per 1000 of all patients presenting to Al Wakra Pediatric Emergency Department Qatar (328 of 116,761patients). The majority of cases were children 1-5 years (58.2%) (). Fifty-one percent and 61.3% of children admitted to inpatient wards had dyspnoea and tachypnea respectively. This is to be compared to 88.5% and 96.2% of patients respectively admitted to the Pediatric Intensive Care Unit (PICU) with dyspnoea and with tachypnea. C-reactive protein (CRP) more than 50 mg/L was noted in 48.2% of patients admitted to inpatient wards and 26.7% of patients admitted to PICU (). Oral amoxicillin was prescribed for 1.5% of patients, amoxicillin/clavulanic acid for 18% of patients, a further 18% had cefuroxime, and 29% had clarithromycin. Intravenous (IV) cefuroxime was the most used IV medication (29.6% of all patients). Nearly 50% of patients were admitted to inpatient wards, with 7.9% transferred to PICU, and only 39.3% discharged home without admission. Conclusion: Community acquired pneumonia represents 0.28% of all studied patients. More than 60% of the patients with CAP were admitted either to inpatient wards or to PICU.
Community-onset ESBL– producing enterobacteriaceae urinary tract infection in pediatric patients: Retrospective case control study
Authors: Aly Soliman , Homosy Ahmed Al
Published: October 2021

Background: Urinary tract infection (UTI) is a common childhood disease with a prevalence of 7.8% that can lead to serious complications including renal scarring. Approximately 80% of UTIs in children are caused by Escherichia coli that are unfortunately accompanied by an increased prevalence of extended-spectrum beta-lactamases (ESBL) - producing strains. This study tries to determine the incidence of ESBL-producing Enterobacteriaceae (PE) UTIs among the pediatric population in Qatar, and predict the relation between multiple antibiotics exposure, antibiotic prophylaxis, recurrent UTIs, prior hospitalizations, prior urinary tract abnormalities as risk factors, and the development of ESBL-PE UTI in the same population. Methods: This is a retrospective case control and cross-sectional study conducted over a period of one year from January 2018 to January 2019. The inclusion criteria were infants and children from 0 month to 14 years old diagnosed with community-onset of urinary tract infection however, exclusion criteria were immunocompromised or cancer patients. Case group was defined as patients who developed ESBL-PE UTI (n = 135), while the control group were patients who developed sensitive Enterobacteriaceae UTI (n = 219). Results: 406 patients were included, 33% of them had ESBL-PE UTI () and 51 were excluded (infection caused by another organism) (). Regarding antibiotics exposure during the preceding 6 months, 28% of the case group patients were prescribed multiple courses of antibiotics versus 10% in the control group. 21% within the case group patients received antibiotic prophylaxis versus 6% in the control group. Furthermore, 21% of case group patients were diagnosed with urinary tract anomalies versus 4.5% in the control group, however no significant statistical difference regarding UTI recurrence was found (p>0.05). 17% of case group patients were hospitalized previously versus 7% in the control group (). Conclusion: The study found that ESBL-PE UTI incidence among pediatric patients was high. Repeated exposure to antibiotics courses, antibiotic prophylaxis, previous hospitalization, and prior UT anomalies may have an impact on this resistance rate.
Ruptured liver abscess mimicking perforated viscus
Authors: Thayyil Noushad , Khan Zohaer S , Mullaveettil Shaheed , Cordero Maria Jennifer
Published: October 2021

Background: Liver abscesses are common in the Emergency Department. A cross-sectional study conducted in Qatar showed pyogenic liver abscesses were more common than amebic abscesses. Spontaneous rupture of pyogenic liver abscess is a rare entity with serious complications. A rupture resulting in peritonitis requires urgent surgical intervention whereas localized abscesses are managed with surgical or image-guided percutaneous drainage in addition to appropriate antibiotics. We report a case of spontaneous rupture of liver abscess presented to our Emergency Department that mimicked perforated hollow viscus. Methods/Case presentation: A 58-year-old male patient presented with fever, generalized weakness, anorexia, and abdominal discomfort for 2 weeks. The patient had a history of Type 2 diabetes mellitus and taking oral hypoglycemics. His initial vital signs revealed a temperature of 38.2°C, heart rate of 104 beats per minute, blood pressure of 150/74 mmHg, respiratory rate of 26 breaths per minute, oxygen saturation of 96% on room air. He appeared sick and dehydrated. Pertinent findings on abdominal examination were epigastric and right upper quadrant tenderness. The laboratory report showed leucocytosis and elevated transaminase. A chest X-ray was ordered and revealed air under the diaphragm ().

Point of care ultrasound showed a right liver lobe hypoechoic lesion with internal echoes and surrounding free fluid ().

A computed tomography of the abdomen showed a large hepatic lesion (11.5 x 8.5 x 9 cm), subcapsular in location, containing gas with dependent fluid, suggesting a gas-forming hepatic abscess, with the possibility of rupture and pneumoperitoneum. Results/Findings/Recommendations: The patient was admitted and underwent ultrasound guided drainage of the abscess. His blood and pus culture showed Klebsiella pneumonia and he received Ceftriaxone and Metronidazole intravenously (IV) for 14 days. He was discharged after 15 days with a favorable outcome. Conclusion: To the best of our knowledge, spontaneous liver abscess rupture resulting in pneumoperitoneum is rare. Chest X-ray findings may mimic perforated hollow viscus.
Vascular calcification: “The silent killer” in the hemodialysis population in Qatar
Authors: Saqar Al Ali Fadwa , Fouda Tarek , Jamil Al Omari Anees , Yahya Mohamed , Mohamed Ismail Aly Sahar , Ali Farooqi Farrukh , Ibrahim Omar Ala , Alsaid Ahmad Abeer , Yeihya Nermeen Galal , Ibrahim Abdullah
Published: October 2021

Background: Calcification is an abnormal deposition of calcium salts in vascular tissue, including valves, blood vessels, and the heart, which is highly prevalent in End Stage Renal Disease (ESRD) patients. Vascular calcification is an independent and important risk factor for cardiovascular events in hemodialysis patients and investigators have demonstrated that the extent and histo-anatomic type of vascular calcification are predictors of subsequent vascular mortality. Cardiovascular mortality risk is elevated 5-10-fold in ESRD patients compared to the general population. As we recognized the importance of early detection and delaying the complication of calcification, this study was initiated in March 2020 among 650 haemodialysis patients in Hamad General Hospital in Qatar. Methods: The haemodialysis multidisciplinary team identified patients with vascular calcification. Data was collected on available imaging study which included echocardiography, X-rays, and computed tomography (CT) to detect any kind of vascular calcification (e.g. valvular, calcified vessels). Our management protocol was updated to decrease the calcium load and active vitamin D. Abnormal serum calcium management was initiated to monitor and delay the progression of vascular calcification through interventions which included dietary control, medication, and dialysate bath. Results: We were able to screen 86% of dialysis patients (n = 559). Following the interventions, the percentage of patients with a calcium level of 2.1-2.55 mmol/l increased by 5 percentage points from 83% in March 2020 to 88% in September 2020 (p value =  0.004). Phosphorus level was maintained in the range of 0.81-1.8 mmol/l for 82% of patients () and parathyroid hormone (PTH) level in the range 150-400 pg/ml for 72% of patients (). Conclusion: We implemented a successful screening program for vascular calcification in dialysis patients combined with specific interventions. Reduced hypercalcemia episodes can delay vascular calcification. Serum calcium level was improved and maintained within the target range (2.1 - 2.55 mmol/l) for a larger number of patients.
Coronavirus disease 2019 in solid organ transplant recipients in a setting of proactive screening and contact tracing
Authors: Alattar Rand A. , Shaar Shahd H. , Othman Muftah , Abu Jarir Sulieman H. , Hashim Samar M. , Iqbal Fatima , Rustom Fatima , Almaslamani Muna A. , Omrani Ali S.
Published: October 2021

Background: As of 26 June 2020, the global number of infections caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), had reached 11 million, with more than 500 thousand associated deaths. Limited clinical information about COVID-19 on solid organ transplant (SOT) are available so far. We herein report our preliminary experience with COVID-19 in SOT recipients in the first few weeks of the outbreak in Qatar. Method: All SOT recipients with laboratory-confirmed COVID-19 up to 23 May 2020 were included. Baseline characteristics, antivirals and immunosuppressive management, complications, and outcomes were retrospectively extracted from the electronic health system. Categorical data are summarized as frequency and percentages, while continuous variables are presented as medians and ranges. Results: Twenty-four SOT patients with COVID-19 were included in this report (kidney: 16, liver: 6, heart: 1, and combined liver and kidney: 1). The median age was 57 years (range 24–72). Thanks to proactive screening, five (21%) asymptomatic cases were diagnosed (). Among the other 19 symptomatic patients, fever (15/19) and cough (13/19) were the most frequent presenting symptoms (). All patients were hospitalized; 5 (21%) required invasive mechanical ventilation in the intensive care unit (ICU) ( ). Eleven (46%) patients developed acute kidney injury as a complication, including 3 in association with drug-drug interactions involving investigational COVID-19 therapies (). Maintenance of immunosuppressive therapy was changed in 18 (75%) patients, but systemic corticosteroids were not withdrawn in any. After a median follow up of 43 days (26–89), 18 (75%) patients had been discharged home, 3 (12.3%) were still hospitalized, 2 (8.3%) were still in ICU, and 1 (4.2%) had died ().

Conclusion: Although higher mortality rates were observed in other reports, our results suggest that asymptomatic COVID-19 is possible in SOT recipients and that overall outcomes are not consistently worse than other immunocompetent patients. The results require validation in larger cohorts.
Acute unilateral decrease in vision on initial presentation of an adolescent female in the emergency department
Authors: Lynn Balmores Leal Joanna , Thayyil Noushad , Dalloul Anas S.R.
Published: October 2021

Background: Optic neuritis is an acute demyelinating inflammation of the optic nerve that leads to acute loss of vision and eye pain worsened with eye movement. It is a relatively rare condition in the pediatric population. Pediatric optic neuritis usually arises following a viral illness. It can present as an initial feature of a systemic demyelinating disease such as multiple sclerosis or neuromyelitis optica, but can also occur as an isolated syndrome. We report a classic presentation of optic neuritis presented to our Emergency Department in Doha, Qatar. Case presentation: A 16-year-old female adolescent, of Asian descent, with no past medical history, presented with acute decrease in vision in her left eye associated with eye pain and mild headache for the past week. There were no other associated symptoms. Vital signs, systemic and neurologic examinations were normal. Pertinent ophthalmologic findings on her left eye examination were as follows: visual acuity: counting fingers at 3 meters aided, color vision 0/15; normal intra-ocular pressure, slight ptosis; sluggish pupil with relative afferent pupillary defect and funduscopy () showing hyperemic optic disc with blurring of the nasal margin, normal macula and retinal vessels. Laboratory reports were unremarkable. Head computed tomography (CT) scan showed asymmetric thickening of the left optic nerve with subtle surrounding fat stranding (). Brain and spinal cord magnetic resonance imaging (MRI) showed left optic nerve increased signal and thickness in the proximal segment and contrast enhancement in the optic nerve and optic nerve sheet (). Lumbar puncture was done. Cerebrospinal fluid (CSF) analysis and culture showed unremarkable results. The patient was admitted with a working diagnosis of optic neuritis for further investigations. Conclusion: The patient fully recovered after receiving steroid treatment for 5 days and was discharged subsequently. Optic neuritis can be seen among young patients, often female, with classic presentation of acute loss of vision and eye pain. It can be the primary manifestation of a chronic demyelinating process.
Impact of expanding the clinical pharmacy service in the emergency department at Hamad General Hospital, a tertiary hospital in Qatar: A cross-sectional audit
Authors: Salameh Rawan , Ezzeldin Asma , El-Malik Ashraf , Musameh Ibtisam , Nazzal Sara , Chatila Rama , Mohammed Maaz , Ananzeh Abdullah , Alsaleh Hamzeh , Al-Bitar Omar , Hamdan Naser , Al-Bakri Muna
Published: October 2021

Background: The emergency department (ED) is a complex environment presenting unique challenges for high-risk populations such as critically ill patients who often require the use of high-risk medications. One study suggests that clinical pharmacists (CPs) may improve the fulfillment of safety goals for the ED patient as per the Joint International Commission. Some published reports have asserted that ED-based CPs would have the potential to increase patient safety. In our hospital, the number of CPs covering the ED increased from 2 to 9 starting from November 2019. Methods: This is a retrospective audit covering the period from January 1st 2019 till October 25th 2020 at Hamad General Hospital (HGH) in Doha, Qatar, to determine the impact of increasing the number of CPs covering the ED on the number of identified, solved, and documented drug related problems (DRPs) on the electronic medical records of ED patients. The interventions retrieved from pharmacy reports were analyzed and evaluated in terms of numbers by classification and percentages by the investigators. Results: A total number of 8,946 interventions covering 6,284 patients were carried out in 2020 compared with 1,515 interventions covering 1,001 patients in 2019 () which represents a 6-fold increment by increasing the CPs from 2 to 9. Even the detection of adverse drug reactions increased by 1.5 times with only 38 documented in 2019 compared to 64 in 2020. Classifications and quantities of interventions were also analyzed in detail (). Conclusion: This audit demonstrates that pharmaceutical intervention can positively contribute to the identification and resolution of DRPs. The benefit of CP involvement in patient care was observed based on the number of interventions that occurred. Studies are needed to assess the impact of those interventions on patients’ outcomes and cost effectiveness.
Hazardous materials and CBRN incidents: Fundamentals of pre-hospital readiness in the State of Qatar
Authors: Farhat Hassan , Gangaram Padarath , Castle Nicholas , Chaker Khenissi Mohamed , Bounouh Sonia , Pullian Naveen , Khnissi Mohamed , Gargouri Imed , Khadhraoui Moncef , Laughton James , Alinier Guillaume
Published: October 2021

Background: Hazardous Materials and Chemical/Biological/Radiological/Nuclear (HazMat-CBRN) incidents represent a serious threat to the population and the environment. They require a pre-hospital medical response system well equipped and supported with logistics and clinicians with appropriate knowledge and skills to prevent exposure and mitigate risks. Our aim is to determine if the Hamad Medical Corporation Ambulance Service (HMCAS) fulfils the pre-hospital readiness requirements for such incidents. Methods: This cross-sectional study was performed in HMCAS. An online survey assessed staff behaviour and knowledge in relation to HazMat-CBRN incidents. Responses were obtained on health risks and pre-hospital medical management of related threats in Qatar. Based on the results, a training module “HazMat Incident Management” was prepared with pre-/post-activity assessments. The results were explored using a multivariate linear regression and non-parametric Wilcoxon test for paired samples. Specialized Emergency Management (SEM) staff opinion about this training was assessed through an online survey. Both surveys’ validity and reliability tests were conducted. Ishikawa cause and effects diagram was built for the identification of the factors leading to a pre-hospital successful response to HazMat-CBRN incidents. Results: HMCAS has the proper logistics and plans to manage potential HazMat-CBRN incidents. The knowledge survey demonstrated that the pre-hospital medical staff information about this topic needs reinforcement. The multivariate linear regression ()and non-parametric Wilcoxon test () demonstrated that this was obtained thanks to the implemented training module. The course satisfaction survey showed not only a big interest in this activity but also staff recommended more related topics. Earlier-RSDAT (Recognition, Safety, Decontamination, Antidot, Transport) is a tool proposed as a response acronym to build a successful risk-based response for HazMat CBRN incidents in pre-hospital setting. Conclusion: HMCAS fulfills the readiness requirements for safe and effective response to potential HazMat-CBRN incidents in Qatar. The RSDAT response matrix might help in mitigating pre-hospital response risks.