bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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.
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.
Clinical and thoracic radiography features determine patient outcome in young and middle age adults with COVID-19
Authors: Frias Alexander Sosa , Vergara Santos Aimara de la C 
Published: October 2021

Background: The new coronavirus disease 2019 (COVID-19) emerged in Wuhan, China, in December 2019. Researchers described COVID-19 mortality risk factors as being elderly, male, having comorbidities, and in some ethnicities. Some authors validated the use of first chest x-ray (CXR) severity scores (CSE) as an independent indicator of poor outcomes with COVID-19. Our objective was to evaluate the clinical and CXR findings as predictors of poor outcomes (death, needing intubation, Intensive Care Unit (ICU) admission) in patients with COVID-19. Methods: We performed a retrospective study of case-controls using a sample size of 60 patients admitted with the diagnosis of COVID-19 during the period of July-August 2020 to the Cuban Hospital in Qatar, as determined with the free online OpenEpi software (https://www.openepi.com/SampleSize/SSCC.htm). We defined cases as patients with a complication like death, needing intubation, ICU admission, or organ failure, and controls as patients who did not demonstrate the described complications. The dependent variables used were patient evolution divided into poor outcome or good outcome. The independent variables used were age, history of diabetes mellitus type II, and high blood pressure (HBP), CSE, and white blood count (WBC). The bivariate analysis was performed using the Chi-Square test or Fisher exact test. Multivariate analysis was done using binary logistic regression (IBM SPSS software 25). The results are expressed in Odds Ratio with p-value < 0.05 defined as statistically significant. Results: The bivariate analysis showed being older, having a history of HBP, diabetes, abnormal WBC, and high CSE were linked to poor outcome (p < 0.05) (). The multivariate analysis defined WBC and CSE with independent influence over the patient evolution (). Conclusion: We demonstrated that the value of WBC and CSE are predictors of poor outcome in patients with COVID-19. WBC increases the possibility of the described complications in COVID-19 patients 68,634 times and CSE 12,201 times.
Effective continuing interprofessional healthcare education to improve sepsis care in a tertiary children and women’s hospital in the State of Qatar “Culture of think sepsis”
Authors: Kiat-Floro Joy , Ashour Rasha A. , Janahi Mohammad , Labib Ahmed 
Published: October 2021

Background: Sepsis is a medical emergency and a global economic and health burden. It is one of the leading causes of death worldwide with 1 death every 2.8 seconds and represents 20% of all deaths worldwide.
Sidra Medicine, the only pediatric tertiary care centre in the State of Qatar, in collaboration with Qatar’s Ministry of Public Health, Hamad Medical Corporation (HMC), and Hamad Healthcare Improvement Institute (HHQI) share the national goal of reducing mortality due to sepsis and septic shock through an increase in healthcare provider compliance to the sepsis six bundle of care from 0% to 95% by the end of 2022. Methods: A multifaceted, interdisciplinary, comprehensive education and training program was designed and provided to healthcare practitioners across Sidra and comprised:
• Pre-implementation education
• Multidisciplinary education sessions and workshops
• Train-the-trainer nurse educator workshop
• Bedside interdisciplinary simulation-based education
• Sepsis case discussions during morning reports, academic activities, grand rounds, and morbidity and mortality meetings
• Annual Qatar National Sepsis Symposium
• September Sepsis-Awareness Month
• Pediatric and women sepsis e-learning module
• National Patient Safety Collaborative (NPSC) training sessions and storyboards in collaboration with the Institute for Healthcare Improvement (IHI) and HHQI
In addition, sepsis pathway posters, think-sepsis booklets and pocket cards, antibiotic preparation and administration cards, and family education materials in Arabic and English were produced and utilized. Results: Improved sepsis awareness and education was observed. 95% of providers successfully completed the e-learning module (). Compliance to the sepsis six bundle of care subsequently reached 81%. Sepsis mortality rate was 1.8% in the first two quarters of 2020 which is well below international mortality rates. Conclusion: Since 2018, Sidra Medicine embraced sepsis education and care through a national evidence-based sepsis guideline for early recognition and treatment which is positively reflected in low sepsis mortality rates for 2020.
Cybersecurity for next generation healthcare in Qatar
Authors: Zubair Mohammad , Unal Devrim , Al-Ali Abdulla , Reimann Thomas , Alinier Guillaume 
Published: October 2021

Background: IoMT (Internet of Medical Things) devices (often referred to IoMT domain) have the potential to quickly diagnose and monitor patients outside the hospital by transmitting information through the cloud domain using wireless communication to remotely located medical professionals (user domain). shows the proposed IoMT framework designed to improve the privacy and security of the healthcare infrastructure. Methods: The framework consists of four modules:
1. Intrusion Detection System (IDS) using deep learning (DL) to identify bluetooth-based Denial-of-Service (DoS)-attacks on IoMT devices and is deployed on edge-computing to secure communication between IoMT and edge.
2. IDS is backed up with identity-based cryptography to encrypt the data and communication path.
3. Besides the identity-management system (to authenticate users), it is modeled with aliveness detection using face authentication techniques at the edge to guarantee the confidentiality, integrity, and availability (CIA) of the framework.
4. At the cloud level, another IDS using MUSE (Merged-Hierarchical-Deep-Learning-System-with-Layer-Reuse) is proposed to protect the system against Man-In-The-Middle attacks, while the data is transferred between IoMT-EDGE-CLOUD. Results: These four modules are developed independently by precisely analyzing dependencies. The performance of IDS in terms of precision is 99% and for the identity-management system, the time required to encrypt and decrypt 256-bit key is 66 milliseconds and 220 milliseconds respectively. The true positive rate is 90.1%, which suggests real-time detection and authentication rate. IDS (2) using MUSE (12-layer) the accuracy is >95%, and it consumes 15.7% to 27.63% less time to train than the smaller four-layer model. Conclusion: Our designed models suit edge devices and cloud-based cybersecurity systems and support the fast diagnosis and care required by critically ill patients in the community.