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El-Menyar A, Consunji R, Abdelrahman H, Latifi R, Wahlen BM, Al-Thani H. Predictors and Time-Based Hospital Mortality in Patients with Isolated and Polytrauma Brain Injuries. World J Surg 2018; 42:1346-1357. [PMID: 29063224 DOI: 10.1007/s00268-017-4310-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide. We studied the predictors and time-based mortality in patients with isolated and polytrauma brain injuries in a rapidly developing country. We hypothesized that TBI-related 30-day mortality is decreasing over time. METHODS A retrospective analysis was conducted for all patients with moderate-to-severe TBI who were admitted directly to a level 1 trauma center between 2010 and 2014. Patient's data were analyzed and compared according to survival (survived vs. not survived), time (early death [2 days], intermediate [3-7 days] versus late [>7 days]) post-injury, and type (polytrauma vs. isolated TBI). Cox proportional hazards models were performed for the predictors of mortality. RESULTS A total of 810 patients were admitted with moderate-to-severe TBI with a median age of 27 years. Traffic-related injury was the main mechanism of TBI (65%). Isolated TBIs represented 22.6% of cases and 56% had head AIS >3. The overall mortality rate was 27%, and most of deaths occurred in the intermediate (40%) and early period (38%). The incidence of TBI was greater in patients aged 21-30 years but the mortality was proportionately higher among elderly. The average annual incidence was 8.43 per 100,000 population with an overall mortality of 2.28 per 100,000 population. Kaplan-Meier curves showed that polytrauma had greater mortality than isolated TBI. However, Cox survival analysis showed that age [Hazard ratio (HR) 1.02], scene GCS (HR 0.86),subarachnoid hemorrhage (HR 1.7), and blood transfusion amount (HR 1.03) were the predictors of mortality regardless of being polytrauma or isolated TBI after controlling for 14 relevant covariates. CONCLUSIONS The 30-day survival in patients with TBI is improving over the years in Qatar; however, the mortality remains high in the elderly males. The majority of deaths occurred within a week after the injury. Further studies are needed to assess the long-term survival in patients with moderate-to-severe TBI.
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Affiliation(s)
- Ayman El-Menyar
- Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar. .,Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
| | - Rafael Consunji
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Bianca M Wahlen
- Department of Anesthesia, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
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Al-Thani H, El-Matbouly M, Al-Sulaiti M, Asim M, Majzoub A, Tabeb A, El-Menyar A. Management and outcomes of hyperparathyroidism: a case series from a single institution over two decades. Ther Clin Risk Manag 2018; 14:1337-1345. [PMID: 30104880 PMCID: PMC6074786 DOI: 10.2147/tcrm.s160896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Hyperparathyroidism is a frequent endocrine disorder with variable clinical manifestations and outcomes. We aimed to evaluate clinical presentations, management and outcomes of hyperparathyroidism. Methods A retrospective study was conducted to include all patients presented with hyperparathyroidism between 1995 and 2014 at a single tertiary hospital with an average follow-up period of 46 months. Data were reviewed for clinical presentations, diagnostic work-up, intraoperative findings, management, and outcomes. Result We identified 161 patients with hyperparathyroidism; 69% were females and the mean age was 49.4±15 years. Patients presented mainly with musculoskeletal (65.8%), renal (37.3%), gastrointestinal tract (53.8%) and neuropsychiatric (8.8%) manifestations. At presentation, mean serum calcium and parathyroid hormone levels were elevated while mean vitamin D level was lower. Sestamibi-99mTc (MIBI) scintigraphy was done for 134 patients (83.2%) and was positive in 94 (70%). Primary hyperparathyroidism (67.7%) was the most frequent diagnosis followed by secondary (29.8%) and tertiary hyperparathyroidism (2.5%). The frequent indication for surgery was hypercalcemia (67.3%), bone disease (35.6%) and renal calculi (28.9%). The main postoperative pathology was parathyroid adenoma (63.1%) followed by hyperplasia (37.3%). Fourteen (8.9%) and 18 (11.4%) patients had persistent and recurrent hyperparathyroidism, respectively. Autotransplantation of parathyroid tissue was done in 36 cases. Conclusion Primary hyperparathyroidism is the most frequent cause of the parathyroid disease. Parathyroidectomy is the effective surgical approach in symptomatic patients. Further studies are needed to establish the association between vitamin D levels, renal disorders and persistent or recurrent hyperparathyroidism.
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Affiliation(s)
| | | | | | - Mohammad Asim
- Clinical Research, Trauma & Vascular Surgery, Hamad General Hospital, Doha, Qatar,
| | - Ahmad Majzoub
- Department of Surgery, Hamad General Hospital, Doha, Qatar
| | | | - Ayman El-Menyar
- Clinical Research, Trauma & Vascular Surgery, Hamad General Hospital, Doha, Qatar, .,Clinical Medicine, Weill Cornell Medical College, Doha, Qatar,
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153
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El-Menyar A, Muneer M, Samson D, Al-Thani H, Alobaidi A, Mussleman P, Latifi R. Correction to: Early versus late intramedullary nailing for traumatic femur fracture management: meta-analysis. J Orthop Surg Res 2018; 13:182. [PMID: 30041696 PMCID: PMC6058367 DOI: 10.1186/s13018-018-0884-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Ayman El-Menyar
- Department of Surgery Clinical Research Unit, Westchester Medical Center Health Network, Valhalla, NY, USA. .,Trauma Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar. .,Clinical Medicine, Weill Cornell Medical School, Doha, Qatar.
| | | | - David Samson
- Department of Surgery Clinical Research Unit, Westchester Medical Center Health Network, Valhalla, NY, USA
| | - Hassan Al-Thani
- Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Ahmad Alobaidi
- Department of Surgery, Orthopedic Surgery, Al Wakrah Hospital, Doha, Qatar
| | - Paul Mussleman
- Distributed eLibrary, Weill Cornell Medical School, Doha, Qatar
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center Health Network and New York Medical College, Valhalla, NY, USA
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El-Menyar A, Mekkodathil A, Al-Thani H. Diagnosis and management of gastrointestinal stromal tumors: An up-to-date literature review. J Cancer Res Ther 2018; 13:889-900. [PMID: 29237949 DOI: 10.4103/0973-1482.177499] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Gastrointestinal stromal tumors (GISTs) are rare life-threatening forms of cancer that may arise anywhere in the GI tract. Herein, we aimed to review the literature to describe the incidence, management, and outcomes of GISTs. We conducted a traditional narrative review using PubMed and EMBASE, searching for English-language publications for GISTs between January 2001 and January 2016 using keywords ""gastrointestinal" "stromal tumors." Among 4582 retrieved articles, 50 articles were relevant over the last 15 years. Several risk stratification systems exist to predict the outcomes of GISTs based on certain criteria such as the primary site of occurrence, size of the tumor, mitotic activity, staining for proliferating cells, and tumor necrosis. Risk stratification is crucial in the management and outcomes of the disease. Surgical resection remains the gold standard option of GISTs treatment. Complete resection of the tumor is the main predictor of the postoperative patient's survival. Laparoscopic resections are associated with less intraoperative blood loss, early return of bowel function, early resumption of diet, and short hospital stay. However, laparoscopy is difficult to perform in large and unfavorably placed GISTs and may result in disease progression, recurrence, and poor survival. Robot-assisted laparoscopic resections provide instruments for surgeons to perform technically demanding operations. Moreover, extensive research work including large clinical trials is ongoing to establish promising role of the adjuvant and neo-adjuvant therapy for better disease- free survival in GIST patients.
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Affiliation(s)
- Ayman El-Menyar
- Department of Surgery, Clinical Research, Trauma Surgery, Hamad General Hospital, Doha; Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Ahammed Mekkodathil
- Department of Surgery, Clinical Research, Trauma Surgery, Hamad General Hospital, Doha, Qatar
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155
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El-Menyar A, Muneer M, Samson D, Al-Thani H, Alobaidi A, Mussleman P, Latifi R. Early versus late intramedullary nailing for traumatic femur fracture management: meta-analysis. J Orthop Surg Res 2018; 13:160. [PMID: 29954434 PMCID: PMC6022515 DOI: 10.1186/s13018-018-0856-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 06/05/2018] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION There is no consensus yet on the impact of timing of femur fracture (FF) internal fixation on the patient outcomes. This meta-analysis was conducted to evaluate the contemporary data in patients with traumatic FF undergoing intramedullary nail fixation (IMN). METHODS English language literature was searched with publication limits set from 1994 to 2016 using PubMed, Scopus, MEDLINE (OVID), EMBASE (OVID), Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL). Studies included randomized controlled trials (RCTs), prospective observational or retrospective cohort studies, and case-control studies comparing early versus late femoral shaft fractures IMN fixation. Variable times were used across studies to distinguish between early and late IMN, but 24 h was the most frequently used cutoff. The quality assessment of the reviewed studies was performed with two instruments. Observational studies were assessed with the Newcastle-Ottawa Quality Assessment Scale. RCTs were assessed with the Cochrane Risk of Bias Tool. RESULTS We have searched 1151 references. Screening of titles and abstracts eliminated 1098 references. We retrieved 53 articles for full-text screening, 15 of which met study eligibility criteria. CONCLUSIONS This meta-analysis addresses the utility of IMN in patients with FF based on the current evidence; however, the modality and timing to intervene remain controversial. While we find large pooled effects in favor of early IMN, for reasons discussed, we have little confidence in the effect estimate. Moreover, the available data do not fill all the gaps in this regard; therefore, a tailored algorithm for management of FF would be of value especially in polytrauma patients.
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Affiliation(s)
- Ayman El-Menyar
- Department of Surgery Clinical Research Unit, Westchester Medical Center Health Network, Valhalla, New York USA
- Trauma Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar
- Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
| | | | - David Samson
- Department of Surgery Clinical Research Unit, Westchester Medical Center Health Network, Valhalla, New York USA
| | - Hassan Al-Thani
- Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Ahmad Alobaidi
- Department of Surgery, Orthopedic Surgery, Al Wakrah Hospital, Doha, Qatar
| | - Paul Mussleman
- Distributed eLibrary, Weill Cornell Medical School, Doha, Qatar
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center Health Network and New York Medical College, Valhalla, New York USA
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156
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Afifi I, Abayazeed S, El-Menyar A, Abdelrahman H, Peralta R, Al-Thani H. Blunt liver trauma: a descriptive analysis from a level I trauma center. BMC Surg 2018; 18:42. [PMID: 29914487 PMCID: PMC6006727 DOI: 10.1186/s12893-018-0369-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 05/24/2018] [Indexed: 11/18/2022] Open
Abstract
Background We aimed to review liver injury experience in a level 1 trauma center; namely clinical presentation, grading, management approach and clinical outcomes. Methods It is a retrospective analysis to include all blunt liver injury patients who were admitted at the Level 1 trauma center over a 3-year period. Data were compared and analyzed based on the liver injury grades and management approaches. Results Blunt liver injury accounted for 38% of the total blunt abdominal trauma cases with a mean age of 31 ± 13 years. Liver injury grade II (44.7%) was most common followed by grade I (28.8%), grade III (19.1%), grade IV (7.0%) and grade V (0.4%). Blood transfusion was more frequently required in patients with grade IV (p = 0.04). Out of 257 patients with blunt liver trauma, 198 were initially treated conservatively, that was successful in 192 (97%), whereas it failed in 6 (3%) patients due to delayed bleeding from hepatic hematoma, associated splenic rupture and small bowel injury which mandate surgical intervention. Fifty-nine patients (23%) underwent emergent surgery in terms of packing, resection debridement, left lobe hepatectomy and splenectomy. Hepatic complications included biloma, pseudoaneurysm and massive liver necrosis. Subanalysis of data using the World Society of Emergency Surgery (WSES) classification revealed 19 patients were categorized as a WSES grade IV who needed surgical intervention without having an initial computerized tomography scanning. The overall mortality was 7.8% which was comparable among the conservative and operative group. Conclusions In our center, low grade liver injury in young males prevails. NOM is successful even for high graded injuries. All conservatively treated patients with high-grade liver injuries should be closely monitored for signs of failure of the non-operative management. Introducing the new WSES classification makes clear how is important the hemodynamic status of the patients despite the lesion. However, further larger prospective and multicenter studies are needed to support our findings.
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Affiliation(s)
- Ibrahim Afifi
- Department of surgery, Trauma Surgery section, Hamad General Hospital (HGH), Doha, Qatar
| | | | - Ayman El-Menyar
- Clinical Research, Trauma & Vascular Surgery, HGH, Doha, Qatar. .,Clinical Medicine, Weill Cornell Medical College, PO Box 3050, Doha, Qatar.
| | - Husham Abdelrahman
- Department of surgery, Trauma Surgery section, Hamad General Hospital (HGH), Doha, Qatar
| | - Ruben Peralta
- Department of surgery, Trauma Surgery section, Hamad General Hospital (HGH), Doha, Qatar
| | - Hassan Al-Thani
- Department of surgery, Trauma Surgery section, Hamad General Hospital (HGH), Doha, Qatar
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157
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Latifi R, Olldashi F, Dogjani A, Dasho E, Boci A, El-Menyar A. Telemedicine for Neurotrauma in Albania: Initial Results from Case Series of 146 Patients. World Neurosurg 2018; 112:e747-e753. [DOI: 10.1016/j.wneu.2018.01.146] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 10/18/2022]
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158
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Al-Thani H, El-Menyar A, Sathian B, Mekkodathil A, Thomas S, Mollazehi M, Al-Sulaiti M, Abdelrahman H. Blunt traumatic injury during pregnancy: a descriptive analysis from a level 1 trauma center. Eur J Trauma Emerg Surg 2018; 45:393-401. [DOI: 10.1007/s00068-018-0948-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 03/22/2018] [Indexed: 10/17/2022]
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159
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El-Menyar A, Sathian B, Asim M, Latifi R, Al-Thani H. Efficacy of prehospital administration of tranexamic acid in trauma patients: A meta-analysis of the randomized controlled trials. Am J Emerg Med 2018; 36:1079-1087. [PMID: 29573898 DOI: 10.1016/j.ajem.2018.03.033] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/14/2018] [Accepted: 03/14/2018] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Antifibrinolytic agent tranexamic acid (TXA) has a potential clinical benefit for in-hospital patients with severe bleeding but its effectiveness in pre-hospital settings remains unclear. We conducted a systematic review and meta-analysis to evaluate whether pre-hospital administration of TXA compared to placebo improve patients' outcomes? METHODS PubMed, MEDLINE, Cochrane Library, WHO International Clinical Trials Registry Platform, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, clinicaltrials.gov and Google scholar databases were searched for a retrospective, prospective and randomized (RCT) or quasi-RCT studies that assessed the effect of prehospital administration of TXA versus placebo on the outcomes of trauma patients with significant hemorrhage. The main outcomes of interest were 24hour 30-day mortality and in-hospital thromboembolic complications. Two authors independently abstracted the data using a data collection form. Results from different studies were pooled for the analysis, when appropriate. RESULTS Out of 92 references identified through the search, two analytical studies met the inclusion criteria. The effect of TXA on 24-hour mortality had a pooled odds ratio (OR) of 0.49 (95% CI 0.28-0.85), 30-day mortality OR of 0.86 (95% CI, 0.56-1.32), and thromboembolic events OR of 0.74 (95% CI, 0.27-2.07). CONCLUSION Prehospital TXA appears to reduce early mortality in trauma patients. The pooled analysis also shows a trend toward lower 30-day mortality and reduced risk of thromboembolic events. Additional randomized controlled clinical trials are needed to determine the significance of these trends.
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Affiliation(s)
- Ayman El-Menyar
- Department of Surgery, Trauma Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar; Clinical Medicine, Weill Cornell Medical School, Doha, Qatar.
| | - Brijesh Sathian
- Department of Surgery, Trauma Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar.
| | - Mohammed Asim
- Department of Surgery, Trauma Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar.
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center, Valhalla, NY, USA.
| | - Hassan Al-Thani
- Department of Surgery, Trauma & Vascular Surgery, Hamad General Hospital, Doha, Qatar
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El-Menyar A, Sulaiman K, Almahmeed WA, Asaad N, Albinali H, Singh R, Al Suwaidi J. UTILITY OF SHOCK INDEX IN PATIENTS PRESENTING WITH ACUTE HEART FAILURE: MULTICENTER MULTINATIONAL OBSERVATIONAL STUDY. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31524-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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161
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Singh R, Agarwal TM, Al-Thani H, Al Maslamani Y, El-Menyar A. Validation of a Survey Questionnaire on Organ Donation: An Arabic World Scenario. J Transplant 2018; 2018:9309486. [PMID: 29593894 PMCID: PMC5822804 DOI: 10.1155/2018/9309486] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 12/25/2017] [Accepted: 01/14/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To validate a questionnaire for measuring factors influencing organ donation and transplant. METHODS The constructed questionnaire was based on the theory of planned behavior by Ajzen Icek and had 45 questions including general inquiry and demographic information. Four experts on the topic, Arabic culture, and the Arabic and English languages established content validity through review. It was quantified by content validity index (CVI). Construct validity was established by principal component analysis (PCA), whereas internal consistency was checked by Cronbach's Alpha and intraclass correlation coefficient (ICC). Statistical analysis was performed by SPSS 22.0 statistical package. RESULTS Content validity in the form of S-CVI/Average and S-CVI/UA was 0.95 and 0.82, respectively, suggesting adequate relevance content of the questionnaire. Factor analysis indicated that the construct validity for each domain (knowledge, attitudes, beliefs, and intention) was 65%, 71%, 77%, and 70%, respectively. Cronbach's Alpha and ICC coefficients were 0.90, 0.67, 0.75, and 0.74 and 0.82, 0.58, 0.61, and 0.74, respectively, for the domains. CONCLUSION The questionnaire consists of 39 items on knowledge, attitudes, beliefs, and intention domains which is valid and reliable tool to use for organ donation and transplant survey.
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Affiliation(s)
- Rajvir Singh
- Cardiology Research Center, Heart Hospital, Hamad Medical Corporation (HMC), P.O. Box 3050, Doha, Qatar
| | - Tulika Mehta Agarwal
- Trauma & Vascular Surgery, Hamad Medical Corporation (HMC), P.O. Box 3050, Doha, Qatar
| | - Hassan Al-Thani
- Trauma & Vascular Surgery, Hamad Medical Corporation (HMC), P.O. Box 3050, Doha, Qatar
| | | | - Ayman El-Menyar
- Trauma & Vascular Surgery, Hamad Medical Corporation (HMC), P.O. Box 3050, Doha, Qatar
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162
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Abdelrahman H, Almadani A, El-Menyar A, Shunni A, Consunji R, Al-Thani H. Home-related falls: An underestimated mechanism of injury. J Family Community Med 2018; 25:48-51. [PMID: 29386962 PMCID: PMC5774043 DOI: 10.4103/jfcm.jfcm_148_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND: The home is a leading location for falls, but the epidemiology and outcome of falls at home (FH) have not been adequately described. Our aim was to evaluate FH, particularly in the bathroom. MATERIALS AND METHODS: We conducted a retrospective analysis of patients with a history of FH admitted to the Level I trauma center in Qatar. Patients were divided into Group 1: <60 years and Group 2: 60 year or older, and their data were analyzed and compared. RESULTS: A total of 98 patients with FH in the bathroom with a mean age of 51 ± 18 years, mostly males (73.5%) were identified over 3 years. One out of every 50 trauma patients admitted was a victim of a fall in the bathroom. Group 2 had significantly more females and sustained a single-site injury. Group 1 had more involvement of alcohol (P = 0.02) and sustained more multiple injuries (44% vs. 23%; P = 0.02). The mean Injury Severity Score and length of hospital stay was comparable among the two groups. Head, abdomen, and facial injuries were significantly higher in Group 1 whereas lower extremity injuries and mortality were significantly higher in Group 2. CONCLUSION: FH, particularly in the bathroom, is an underrecognized mechanism of injury with a unique dichotomous epidemiology based on age. This needs increased public awareness and primary prevention programs for high-risk populations.
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Affiliation(s)
- Husham Abdelrahman
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ammar Almadani
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Clinical Research Unit, Section of Trauma Surgery, Hamad General Hospital and Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
| | - Adam Shunni
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Rafael Consunji
- Department of Surgery, Injury Prevention, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
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Wahlen BM, El-Menyar A, Peralta R, Al-Thani H. World Academic Council of Emergency Medicine Experience Document: Implementation of Point-of-Care Thromboelastography at an Academic Emergency and Trauma Center. J Emerg Trauma Shock 2018; 11:265-270. [PMID: 30568368 PMCID: PMC6262651 DOI: 10.4103/jets.jets_134_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: We aimed to discuss the initial experience of the implementation of point-of-care thromboelastography (POC-TEG) at the Level 1 Trauma Center of an academic health institution in Qatar. Materials and Methods: A TEG protocol was developed and tailored to our hospital requirements and patient population, after an exhausting review of the literature and international published protocols, including a synthesis of a preexisting TEG protocol from our heart hospital. To successfully achieve the incorporation of point-of-care testing (POCT) in our clinical practice, a multidisciplinary organizational and education approach is required. The education and training of the physicians in this POCT modality during the first 3 months period has been described in detail. Results: A TEG protocol has been developed and implemented according to hospital standards. Ten physicians from the department of trauma surgery have been trained over a 3-month period to perform the daily quality control as well as the patient samples in order to provide a 24/7 service. In patients with major trauma, brain injury, bleeding, sepsis, and coagulopathy are the most important determinants of the clinical course and outcomes. Viscoelastic whole-blood assays have already proved their values in cardiac as well as liver surgery. Therefore, this POCT-directed approach would be considered as a part of the goal-directed management in severe polytrauma patients. Conclusions: Our experience shows that implementation of POC-TEG program is feasible and it is a promising tool in the management of major trauma patients with a potential compromised coagulation. However, further prospective research projects and well-trained personnel still warranted.
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Affiliation(s)
- Bianca M Wahlen
- Department of Anesthesia and Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Trauma and Vascular Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar.,Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Ruben Peralta
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
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164
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Al-Thani H, Jabbour G, El-Menyar A, Abdelrahman H, Peralta R, Zarour A. Descriptive Analysis of Right and Left-sided Traumatic Diaphragmatic Injuries; Case Series from a Single Institution. Bull Emerg Trauma 2018; 6:16-25. [PMID: 29379805 DOI: 10.29252/beat-060103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Hassan Al-Thani
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Gaby Jabbour
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Husham Abdelrahman
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Ruben Peralta
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Ahmad Zarour
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Doha, Qatar
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Mahmood S, Mahmood O, El-Menyar A, Asim M, Al-Thani H. Predisposing factors, clinical assessment, management and outcomes of agitation in the trauma intensive care unit. World J Emerg Med 2018; 9:105-112. [PMID: 29576822 DOI: 10.5847/wjem.j.1920-8642.2018.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Agitation occurs frequently among critically ill patients admitted to the intensive care unit (ICU). We aimed to evaluate the frequency, predisposing factors and outcomes of agitation in trauma ICU. METHODS A retrospective analysis was conducted to include patients who were admitted to the trauma ICU between April 2014 and March 2015. Data included patient's demographics, initial vitals, associated injuries, Ramsey Sedation Scale, Glasgow Coma Scale, head injury lesions, use of sedatives and analgesics, head interventions, ventilator days, and ICU length of stay. Patients were divided into two groups based on the agitation status. RESULTS A total of 102 intubated patients were enrolled; of which 46 (45%) experienced agitation. Patients in the agitation group were 7 years younger, had significantly lower GCS and sustained higher frequency of head injuries (P<0.05). Patients who developed agitation were more likely to be prescribed propofol alone or in combination with midazolam and to have frequent ICP catheter insertion, longer ventilatory days and higher incidence of pneumonia (P<0.05). On multivariate analysis, use of propofol alone (OR=4.97; 95% CI=1.35-18.27), subarachnoid hemorrhage (OR=5.11; 95% CI=1.38-18.91) and ICP catheter insertion for severe head injury (OR=4.23; 95% CI=1.16-15.35) were independent predictors for agitation (P<0.01). CONCLUSION Agitation is a frequent problem in trauma ICU and is mainly related to the type of sedation and poor outcomes in terms of prolonged mechanical ventilation and development of nosocomial pneumonia. Therefore, understanding the main predictors of agitation facilitates early risk-stratification and development of better therapeutic strategies in trauma patients.
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Affiliation(s)
- Saeed Mahmood
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | | | - Ayman El-Menyar
- Clinical Research, Trauma Surgery Section, Department of Surgery, HGH, Doha, Qatar.,Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
| | - Mohammad Asim
- Clinical Research, Trauma Surgery Section, Department of Surgery, HGH, Doha, Qatar
| | - Hassan Al-Thani
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar
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Arumugam SK, Mudali I, Strandvik G, El-Menyar A, Al-Hassani A, Al-Thani H. Risk factors for ventilator-associated pneumonia in trauma patients: A descriptive analysis. World J Emerg Med 2018; 9:203-210. [PMID: 29796145 DOI: 10.5847/wjem.j.1920-8642.2018.03.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We sought to evaluate the risk factors for developing ventilator-associated pneumonia (VAP) and whether the location of intubation posed a risk in trauma patients. METHODS Data were retrospectively reviewed for adult trauma patients requiring intubation for > 48 hours, admitted between 2010 and 2013. Patients' demographics, clinical presentations and outcomes were compared according to intubation location (prehospital intubation [PHI] vs. trauma room [TRI]) and presence vs. absence of VAP. Multivariate regression analysis was performed to identify predictors of VAP. RESULTS Of 471 intubated patients, 332 patients met the inclusion criteria (124 had PHI and 208 had TRI) with a mean age of 30.7±14.8 years. PHI group had lower GCS (P=0.001), respiratory rate (P=0.001), and higher frequency of head (P=0.02) and chest injuries (P=0.04). The rate of VAP in PHI group was comparable to the TRI group (P=0.60). Patients who developed VAP were 6 years older, had significantly lower GCS and higher ISS, head AIS, and higher rates of polytrauma. The overall mortality was 7.5%, and was not associated with intubation location or pneumonia rates. In the early-VAP group, gram-positive pathogens were more common, while gram-negative microorganisms were more frequently encountered in the late VAP group. Logistic regression analysis and modeling showed that the impact of the location of intubation in predicting the risk of VAP appeared only when chest injury was included in the models. CONCLUSION In trauma, the risk of developing VAP is multifactorial. However, the location of intubation and presence of chest injury could play an important role.
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Affiliation(s)
| | - Insolvisagan Mudali
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Gustav Strandvik
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar.,Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Ammar Al-Hassani
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Doha, Qatar
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El-Menyar A, Consunji R, Mekkodathil A, Peralta R, Al-Thani H. Alcohol Screening in a National Referral Hospital: An Observational Study from Qatar. Med Sci Monit 2017; 23:6082-6088. [PMID: 29275423 PMCID: PMC5749138 DOI: 10.12659/msm.905201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Alcohol consumption is a high-risk factor for several medical disorders and traffic accidents and poses a burden on outpatient clinics and emergency units. We aimed to assess the pattern of alcohol screening among patients in a multicultural setting in a national referral hospital in an Arab Middle-Eastern country. Material/Methods A retrospective analysis was conducted for patients who were screened with blood alcohol concentration (BAC) in the Emergency Department (ED) in the period from January 2009 to December 2012. BAC positive and negative patients were compared, and BAC positive patients were classified into mmol/L (Group 1: BAC 0.1–10.8 (less intoxicated); Group 2: BAC 10.9–21.7 (intoxicated), and Group 3: >21.7 mmol/L (intoxicated at CNS depression level). Results A total of 9417 patient visits were screened for BAC during the study period (an average of 4.87 per 1000 ED visits); 38% of these tested positive. Most screened persons were males (97%) with a mean age of 37.5±11.6 years. There was a steady increase in BAC screening initially (3.18 per 1000 ED visits in 2009 and 7.47 in 2012). However, the proportion of BAC-positives per total screened decreased steadily over the years, from 50% in 2008 to 33% in 2012. There were more BAC positives (92% vs. 81%, p<0.05) in patients seeking medical vs. non-medical assessment. Among BAC positives, Group 3 patients had higher HLOS (p=0.001), but the ICU-LOS was comparable. Conclusions Despite the absence of a clinical protocol for alcohol screening, this study shows that alcohol consumption has a serious impact in ED visits and hospitalizations, even in a country that partially prohibits alcohol drinking. Implementing a protocol for the screening of alcohol misuse among select hospitalized patients should be considered in the ED.
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Affiliation(s)
- Ayman El-Menyar
- Clinical Research, Trauma Surgery, Hamad General Hospital, Doha, Qatar.,Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Rafael Consunji
- Injury Prevention, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | | | - Ruben Peralta
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
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168
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El-Menyar A, Consunji R, Al-Thani H, Mekkodathil A, Jabbour G, Alyafei KA. Pediatric Traumatic Brain Injury: a 5-year descriptive study from the National Trauma Center in Qatar. World J Emerg Surg 2017; 12:48. [PMID: 29151847 PMCID: PMC5678808 DOI: 10.1186/s13017-017-0159-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/26/2017] [Indexed: 11/10/2022] Open
Abstract
Background The epidemiologic characteristics and outcomes of pediatric traumatic brain injury (pTBI) have not been adequately documented from the rapidly developing countries in the Arab Middle East. We aimed to describe the hospital-based epidemiologic characteristics, injury mechanisms, clinical presentation, and outcomes of pTBI and analyze key characteristics and determinant of pTBI that could help to make recommendations for policies to improve their care. Methods We conducted a retrospective observational study in a level 1 trauma center (2010-2014) for all pTBI patients. Data were analyzed and compared according to different patient age groups. Results Out of 945 traumatic brain injury patients, 167 (17.7%) were ≤ 18 years old with a mean age of 10.6 ± 5.9 and 81% were males. The rate of pTBI varied from 5 to 14 cases per 100,000 children per year. The most affected group was teenagers (15-18 years; 40%) followed by infants/toddlers (≤ 4 years; 23%). Motor vehicle crash (MVC; 47.3%) was the most frequent mechanism of injury followed by falls (21.6%). MVC accounted for a high proportion of pTBI among teenagers (77.3%) and adolescents (10-14 years; 48.3%). Fall was a common cause of pTBI for infants/toddlers (51.3%) and 5-9 years old group (30.3%). The proportion of brain contusion was significantly higher in adolescents (61.5%) and teenagers (58.6%). Teenagers had higher mean Injury Severity Scoring of 24.2 ± 9.8 and lower median (range) Glasgow Coma Scale of 3 (3-15) (P = 0.001 for all). The median ventilatory days and intensive care unit and hospital length of stay were significantly prolonged in the teenage group. Also, pTBI in teenage group showed higher association with pneumonia (46.4%) and sepsis (17.3%) than other age groups (P = 0.01). The overall mortality rate was 13% (n = 22); 11 died within the first 24 h, 7 died between the second and seventh day and 4 died one week post-admission. Among MVC victims, a decreasing trend of case fatality rate (CFR) was observed with age; teenagers had the highest CFR (85.7) followed by adolescents (75.0), young children (33.3), and infants/toddlers (12.5). Conclusions This local experience to describe the burden of pTBI could be a basis to adopt and form an efficient, tailored strategy for safety in the pediatric population.
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Affiliation(s)
- Ayman El-Menyar
- Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar.,Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
| | - Rafael Consunji
- Hamad Injury Prevention Program, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | | | | | - Gaby Jabbour
- Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - Khalid A Alyafei
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
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169
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Dogjani A, Gjata A, Latifi R, Zago M, Celiku E, Draçini X, Haxhirexha K, Beqiri A, Diaconescu B, El-Menyar A, Lafranco D, Alimoğlu O, Dika - Haxhirexha F, Uranues S, Eryılmaz M, Vassiliu P, Dibra A, Dajti A, Lenjani B, Kaci M, Zatriqi S, Mustafa A, Petrela E, Gradica F, Nikollari L, Degjoni R, Vaso A, Alimehmeti R, Veliu S, Domi R, Xhumari A, Zylbeari L, Kacani A, Zaimi E, Boci B, Bardhoshi E, Semini G, Shehi D, Jonuzi E, Selmani E, Sokoli S, T Hoxha F, Basho J, Galiqi G, Bizhga G, Ibrahimi A, Mustaqe P, Zikaj G, Fezollari L, Osmanaj S, Duni A, Vellku F, Puca E, Marku V, Brataj S, Demko V, Demiraj Z, Rroji A, Tocilla B, Binjaku L, Bendo H, Blloshmi A. ACTES 2017 - Abstracts Book; The 1st Albanian Congress of Trauma and Emergency Surgery. AJTES 2017. [DOI: 10.32391/ajtes.v1i1.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
ASTES has organized an attractive scientific program, in partnership with the Surgical and Medical Societies of our country. In addition, we have prepared several special lectures by national and international speakers.The “Frederic Shiroka” lecture will be given by Professor Flamur Tartari, a distinguished surgeon who hasbeen the chief of general surgery service over the years as the father of Albanian modern surgery. He willdeliver his lecture titled “A lifetime with surgical patients”.The pre-conference course for medical personnel (BLS & D) will be available a day before the conference.Finally, we would like to thank all members of the organizing and scientific committees for their hard work in the past few months to ensure that every aspect of the conference is smooth and with the highest standards.Without their hard work and dedication, this conference would not have been possible. Let us express specialthanks to all speakers, particularly to our distinguished international faculty who honored us with theirpresence.
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170
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Alani M, Mahmood S, El-Menyar A, Atique S, Al-Thani H, Peralta R. An unusual case of transpelvic impalement injury: A case-report. Int J Surg Case Rep 2017; 41:26-29. [PMID: 29031173 PMCID: PMC5645491 DOI: 10.1016/j.ijscr.2017.08.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 08/16/2017] [Accepted: 08/16/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Impalement injury is a rare type of mechanical injury following forceful insertion of projecting object into the body. Careful planning for removal of the impaling object is essential to decrease the blood loss and preserve the function of the injured organ. PRESENTATION OF CASE A 27 year-old male fell from 4m height over a U shaped projecting up metallic bar. The bar penetrated the left side of the pelvis and traversed through the left iliac bone causing a comminuted fracture in the supra-acetabular region extending to the left psoas muscle, injuring the viscera and causing fracture of the right femur. Exploratory laparotomy was performed and the metallic bar was pulled out from the sigmoid colon through the inlet of the injury. Intramedullary nailing was performed for femur fracture. The patient developed infection (Methicillin-sensitive Staphylococcus aureus and Escherichia coli) during the post-operative course that was successfully managed with antibiotic therapy. Finally the patient was sent home after a week in a good health condition. DISCUSSION Two surgical teams worked in sequence to fix the injuries starting with the trauma team followed by the orthopedic surgeons. CONCLUSION Impalement injury is a serious injury that needs a multidisciplinary team with a coordinated approach to achieve a favorable outcome.
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Affiliation(s)
- Mushrek Alani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Saeed Mahmood
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar; Clinical Research, Trauma Section, Hamad General Hospital, Doha, Qatar.
| | - Sajid Atique
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ruben Peralta
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
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171
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Al-Ashry H, Abuzaid A, Asim M, El-Menyar A. Microcirculation Alteration and Biomarker Dilemma in Early Septic Shock Diagnosis and Treatment. Curr Vasc Pharmacol 2017; 14:330-44. [PMID: 26916399 DOI: 10.2174/1570161114666160226145732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 02/07/2016] [Accepted: 02/13/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Septic shock is represented by severe hemodynamic changes which are manifested with failure of organ systems and high mortality. Early diagnosis together with timely and appropriate treatment is important to attain better outcome. OBJECTIVES We reviewed the diagnostic approach of septic shock in relation to the microcirculatory abnormalities, novel biomarkers, monitoring, interventions, and therapy. METHODS A narrative literature review was carried out using PubMed, MEDLINE and Google scholar search engines. RESULTS Septic shock is characterized by extensive microcirculatory alterations. These changes are diverse in nature and lead to inconsistency of response to various interventions. The severity of these abnormalities correlates with the patient prognosis. The pathophysiology of septic shock is highly complex which requires better understanding of disease progression and risk-stratification based on potential sepsis biomarkers such as lactic acid, procalcitonin, C-reactive protein, cytokines, and novel molecular markers. The newly identified candidate biomarkers include soluble Triggering Receptor Expressed on myeloid cells-1, presepsin, soluble urokinase-type Plasminogen Receptor and pro-adrenomedullin, but their clinical utilities still need to be validated by large prospective clinical trials. A number of promising therapies for the management of severe sepsis and septic shock has been proposed with potential implications. CONCLUSION It is crucial to improve microvascular perfusion through targeted interventions using patient-centred approach. Moreover, systems biology approach could play a promising role in understanding the immune complexity, characterization of gene expression patterns, and recognition of novel therapeutic targets which could be used as clinical decision making tool in the future.
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Affiliation(s)
| | | | | | - Ayman El-Menyar
- A Clinical Medicine Weill Cornell Medical College &: Clinical Research, Trauma Surgery, Hamad General Hospital, Doha, Qatar.
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172
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El-Menyar A, Al-Thani H, Latifi R, Savino JA. Brain-Heart Link: The Role of High Sensitive Troponin T in Traumatic Brain Injury. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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173
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Abstract
We aimed to investigate the association between obesity and deep venous thrombosis (DVT) in a country with a high prevalence of obesity. This is a retrospective cohort study of patients who presented with DVT between 2008 and 2012. Data were analyzed and compared based on body mass index (BMI), and patients were classified into normal (<25), overweight (≥25 to <30), obese I (30 to <35), obese II (35 to <40), and obese III (≥40). Among 662 patients with DVT, 28% were overweight and 49% were obese. The mean age was 50.3 (16.5) years, and 51% were females. Diabetes mellitus and prior venous thromboembolism were significantly higher among obese patients. History of malignancy was more common in nonobese patients. Protein S and antithrombin III deficiency and hyperhomocysteinemia were more prevalent among morbid obese patients. Also, obese patients had higher incidence of thrombosis in the distal veins ( P = .03). Warfarin use and long-term therapy were more frequent in obese than nonobese. Postthrombotic syndrome was comparable in obese and nonobese groups. Recurrent DVT was higher in obese I ( P < .01), whereas mortality rates were greater in nonobese groups ( P = .001). Malignancy, diabetes mellitus, and common femoral vein involvement were predictors of mortality, whereas BMI ≥30 was the predictor of survival. Cox regression models showed that after adjusting for age, sex, pulmonary embolism, and duration of warfarin treatment, BMI ≥40 had better survival (hazard ratio: 0.177, 95% confidence interval: 0.045-0.691, P = .013). There is a significant association between obesity and DVT. Obese patients have characteristic risk factors and better survival. This obesity paradox needs further studies to assess its clinical and pharmacotherapeutic implications.
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Affiliation(s)
- Ayman El-Menyar
- 1 Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar.,2 Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Mohammad Asim
- 1 Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- 3 Trauma and vascular Surgery Section, Department of Surgery, Hamad General Hospital, Doha, Qatar
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174
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Abstract
Imminent upper airway obstruction due to life-threatening tracheal stenosis of any cause is challenging. A 77-year-old woman, with a history of temporal tracheostomy for prolonged mechanical ventilation, presented with life-threatening tracheal stenosis to the emergency department. After failed intubation with a 5.0 mm internal diameter endotracheal tube, the patient was ventilated via a tube exchanger using Ventrain. Ventrain is a manual ventilation device that, in addition to oxygen supply during inspiration, initiates expiration by actively removing gas from the lungs by suction. Despite the nearly obstructed airway the patient was adequately ventilated with 'permissive' hypercarbia of 50 mm Hg and Saturation of peripheral Oxygen (SpO2) 95%-98% until surgical re-tracheostomy was performed. The haemodynamic stability of the patient indicated that the active expiration prevented intrapulmonary pressure build-up by air trapping and subsequent barotrauma and/or haemodynamic deterioration, which may well be observed during traditional jet ventilation especially in case of a completely obstructed airway.
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Affiliation(s)
| | - Hassan Al-Thani
- Department of Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ayman El-Menyar
- Department of Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
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175
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Mahmood I, El-Menyar A, Younis B, Ahmed K, Nabir S, Ahmed MN, Al-Yahri O, Mahmood S, Consunji R, Al-Thani H. Clinical Significance and Prognostic Implications of Quantifying Pulmonary Contusion Volume in Patients with Blunt Chest Trauma. Med Sci Monit 2017; 23:3641-3648. [PMID: 28746303 PMCID: PMC5541976 DOI: 10.12659/msm.902197] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Pulmonary contusion (PC) is the most frequent blunt chest injury which could be used to identify patients at high-risk of clinical deterioration. We aimed to investigate the clinical correlation between PC volume and outcome in patients with blunt chest trauma (BCT). Material/Methods BCT patients with PC were identified retrospectively from the prospectively collected trauma registry database over a 2-year period. Contusion volume was measured and expressed as percentage of total lung (CTCV) volume using three-dimensional reconstruction of thoracic CT images on admission. Data included patients’ demographics, mechanism of injury (MOI) and injury severity, associated injuries, CTCV, mechanical ventilation, complications, and mortality. Results A total of 226 BCT patients were identified to have PC with a mean age of 35.2 years. Motor vehicle crash (54.4%) and falls (16.4%) were the most frequent MOIs. Bilateral PC (61.5%) was more prevalent than right-sided (19.5%) and left-sided PC (19%). CTCV had a significant positive correlation with ISS; whereas, age and PaO2/FiO2 ratio showed a negative correlation (p<0.05 for all). The median CTCV was significantly higher in patients who developed in-hospital complications (p=0.02). A CTCV >20% was associated with increasedrisk of acute respiratory distress syndrome (ARDS), blood transfusion and prolonged mechanical ventilation. However, multiple linear regression analysis showed that CTCV alone was not an independent predictor of in-hospital outcomes. Presence of chest infection, CTCV, and Injury Severity Scores were predictors of ARDS. Conclusions Quantifying pulmonary contusion volume could allow identification of patients at high-risk of ARDS. CTCV has a significant correlation with injury severity in patients with BCT. Further prospective studies are needed to address the validity of CTCV in the patients care.
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Affiliation(s)
- Ismail Mahmood
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Trauma Surgery, Clinical Research, Hamad Medical Corporation, Doha, Qatar.,Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Basil Younis
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - Khalid Ahmed
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - Syed Nabir
- Department of Radiology, Hamad General Hospital, Doha, Qatar
| | | | - Omer Al-Yahri
- Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Saeed Mahmood
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - Rafael Consunji
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
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176
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Abdelaal A, El Ansari W, Al-Bozom I, Khawar M, Shahid F, Aleter A, Abunuwar MR, El-Menyar A. Frequency, characteristics and outcomes of appendicular neuroendocrine tumors: A cross-sectional study from an academic tertiary care hospital. Ann Med Surg (Lond) 2017; 21:20-24. [PMID: 28761642 PMCID: PMC5524220 DOI: 10.1016/j.amsu.2017.07.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/16/2017] [Accepted: 07/17/2017] [Indexed: 12/28/2022] Open
Abstract
Background Appendicular neuroendocrine tumors (NET, Carcinoid tumors) of the appendix are rare and mostly diagnosed incidentally on the post-operative histopathological examination. NET are usually associated with good 5-year survival rates. We aimed to assess our experience for the diagnosis and management of NET over 11 years. Method It is a retrospective chart review of all clinically suspected patients with acute appendicitis who underwent emergent appendectomy with intention to treat between January 2004–December 2014, and were clinically followed up until 2016. Results During the study period, a total of 13641 patients underwent emergency appendectomy, of which 32 were histologically confirmed NET. The mean age of the NET cases was 25.3 ± 7.9 years; 78% were males and all were clinically presented with acute appendicitis. The mean leucocyte was 15 ± 14 × 109 per Liter, and mean tumor size was 4.86 ± 3.18 (ranged 1.5–13) mm. The median length of hospital stay was 4 (2–15) days. One patient had right hemicolectomy; diagnosed with right colonic cancer with NET being an incidental finding as part of histopathological assessment. Another patient required a second stage procedure; he was diagnosed as goblet cell carcinoid with positive margin. None of the patients died 30-day postoperatively and all of them survived on clinical follow-up that ranged between 2 and 13 years. Conclusion Carcinoid tumors of the appendix are rare and typically diagnosed incidentally. Detailed examination of routine appendectomy specimens is the key for diagnosis. Simple appendectomy suffices for tumors <2 cm for adequate clearance. Appendicular carcinoid tumors are associated with good long-term outcomes.
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Affiliation(s)
| | | | - Issam Al-Bozom
- Departments of Pathology, Hamad General Hospital, Doha, Qatar
| | - Mahwish Khawar
- Departments of Surgery, Hamad General Hospital, Doha, Qatar
| | - Fakhar Shahid
- Departments of Surgery, Hamad General Hospital, Doha, Qatar
| | - Ammar Aleter
- Departments of Surgery, Hamad General Hospital, Doha, Qatar
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177
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Jabbour G, Al-Hassani A, El-Menyar A, Abdelrahman H, Peralta R, Ellabib M, Al-Jogol H, Asim M, Al-Thani H. Clinical and Radiological Presentations and Management of Blunt Splenic Trauma: A Single Tertiary Hospital Experience. Med Sci Monit 2017; 23:3383-3392. [PMID: 28700540 PMCID: PMC5519223 DOI: 10.12659/msm.902438] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Splenic injury is the leading cause of major bleeding after blunt abdominal trauma. We examined the clinical and radiological presentations, management, and outcome of blunt splenic injuries (BSI) in our institution. Material/Methods A retrospective study of BSI patients between 2011 and 2014 was conducted. We analyzed and compared management and outcome of different splenic injury grades in trauma patients. Results A total of 191 BSI patients were identified with a mean (SD) age of 26.9 years (13.1); 164 (85.9%) were males. Traffic-related accident was the main mechanism of injury. Splenic contusion and hematoma (77.2%) was the most frequent finding on initial computerized tomography (CT) scans, followed by shattered spleen (11.1%), blush (11.1%), and devascularization (0.6%). Repeated CT scan revealed 3 patients with pseudoaneurysm who underwent angioembolization. Nearly a quarter of patients were managed surgically. Non-operative management failed in 1 patient who underwent splenectomy. Patients with grade V injury presented with higher mean ISS and abdominal AIS, required frequent blood transfusion, and were more likely to be FAST-positive (p=0.001). The majority of low-grade (I–III) splenic injuries were treated conservatively, while patients with high-grade (IV and V) BSI frequently required splenectomy (p=0.001). Adults were more likely to have grade I, II, and V BSI, blood transfusion, and prolonged ICU stay as compared to pediatric BSI patients. The overall mortality rate was 7.9%, which is mainly association with traumatic brain injury and hemorrhagic shock; half of the deaths occurred within the first day after injury. Conclusions Most BSI patients had grade I–III injuries that were successfully treated non-operatively, with a low failure rate. The severity of injury and presence of associated lesions should be carefully considered in developing the management plan. Thorough clinical assessment and CT scan evaluation are crucial for appropriate management of BSI.
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Affiliation(s)
- Gaby Jabbour
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | | | - Ayman El-Menyar
- Department of Surgery, Trauma Surgery, Clinical Research, Hamad Medical Corporation, Doha, Qatar.,Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | | | - Ruben Peralta
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | | | - Hisham Al-Jogol
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Asim
- Department of Surgery, Trauma Surgery, Clinical Research, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
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178
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Mahmood S, El-Menyar A, Shabana A, Mahmood I, Asim M, Abdelrahman H, Al-Thani H. Bispectral index as a predictor of unsalvageable traumatic brain injury. Brain Inj 2017; 31:1382-1386. [DOI: 10.1080/02699052.2017.1330966] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Saeed Mahmood
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma Surgery Section, Department of Surgery, HGH, Doha, Qatar
- Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
| | - Amr Shabana
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Ismail Mahmood
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Mohammad Asim
- Clinical Research, Trauma Surgery Section, Department of Surgery, HGH, Doha, Qatar
| | - Husham Abdelrahman
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Hassan Al-Thani
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar
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179
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Khalid A, Abdelrahman H, Ali SM, Latif EA, Al-Thani H, El-Menyar A. Dieulafoy's Lesion of the Anal Canal: A Rare Cause of Lower Gastrointestinal Bleeding. Am J Case Rep 2017. [PMID: 28623248 PMCID: PMC5482380 DOI: 10.12659/ajcr.903735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Dieulafoy's lesion of the anal canal is an uncommon cause of lower gastrointestinal bleeding due to rupture of a submucosal artery. This could be an under-recognized cause of hemorrhagic shock in rare cases. CASE REPORT We present 2 cases admitted with bleeding per rectum and hemorrhagic shock, and both were diagnosed as Dieulafoy's lesion of the anal canal on sigmoidoscopy. One case was treated surgically and the second was managed endoscopically. CONCLUSIONS Dieulafoy's lesion of the anal canal can be a source of massive lower gastrointestinal bleeding. Initial anoscopy or sigmoidoscopy might miss such a lesion. Proper visualization helps not only the diagnosis, but also the provision of therapeutic intervention in the same setting.
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Affiliation(s)
- Ahmed Khalid
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Syed Muhammad Ali
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ejaz Ahmed Latif
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Trauma Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar.,Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
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180
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El-Menyar A, Abdelrahman H, Al-Hassani A, Peralta R, AbdelAziz H, Latifi R, Al-Thani H. Single Versus Multiple Solid Organ Injuries Following Blunt Abdominal Trauma. World J Surg 2017; 41:2689-2696. [DOI: 10.1007/s00268-017-4087-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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181
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Asim M, Al-Thani H, El-Menyar A. Recurrent Deep Vein Thrombosis After the First Venous Thromboembolism Event: A Single-Institution Experience. Med Sci Monit 2017; 23:2391-2399. [PMID: 28527240 PMCID: PMC5446976 DOI: 10.12659/msm.901924] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We investigated the frequency, clinical presentation, risk factors, and outcome after the first deep vein thrombosis (DVT) event. MATERIAL AND METHODS A retrospective study was conducted for patients with DVT between 2008 and 2012 with a 1-year follow-up. Patients were divided into 2 groups: single vs. recurrent DVT (RDVT). RESULTS Of the 6420 patients screened for DVT, 662 (10.3%) had DVT. RDVT constituted 22% of cases. A single event was more frequent in left lower limb DVT (p=0.01), while RDVT cases had more bilateral DVT (p=0.01). Recurrent pulmonary embolism (PE) and comorbidities were significantly higher in the RDVT group (P<0.05). Protein C, protein S, and anti-thrombin III deficiency were higher in patients with RDVT (P<0.05). Post-thrombotic syndrome was significantly higher among RDVT cases (p=0.01). In addition, obesity, abnormal coagulation, and prior history of PE and bilateral DVT were found to be independent predictors of RDVT. The PE rate was greater with RDVT than those with single events (22% vs. 9%, p=0.001); however, during follow-up and after adjustment for age and sex, this effect was statistically insignificant (adjusted HR 1.23, 95% CI 0.43-3.57, p=0.68). The age- and sex-adjusted mortality rate was higher in patients with single events with a HR 2.3; 95%CI 1.18-4.54 (p=0.01); however, this effect disappeared after adjusting for the duration of warfarin therapy (p=0.22). CONCLUSIONS Patients with RDVT are common and have characteristic features that required more attention and further evaluation. These findings should help identifying high-risk patients and set effective preventive measures for RDVT that may revise the duration of warfarin therapy.
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Affiliation(s)
- Mohammad Asim
- Department of Surgery, Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Department of Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar.,Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.,Cardiology Unit, Internal Medicine, Ahmed Maher Teaching Hospital, Cairo, Egypt
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182
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Latifi R, Samson D, Haider A, Azim A, Iftikhar H, Joseph B, Tilley E, Con J, Gashi S, El-Menyar A. Risk-adjusted adverse outcomes in complex abdominal wall hernia repair with biologic mesh: A case series of 140 patients. Int J Surg 2017; 43:26-32. [PMID: 28526657 DOI: 10.1016/j.ijsu.2017.05.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 04/17/2017] [Accepted: 05/14/2017] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Biologic mesh is preferred for repair of complex abdominal wall hernias (CAWHs) in patients at high risk of wound infection. We aimed to identify predictors of adverse outcomes after complex abdominal wall hernia repair (CAWR) using biologic mesh with different placement techniques and under different surgical settings. METHODS A retrospective case series study was conducted on all patients who underwent CAWR with biologic mesh between 2010 and 2015 at a tertiary medical center. RESULTS the study population included 140 patients with a mean age of 54 ± 14 years and a median follow up period 8.8 months. Mesh size ranged from 50 to 1225 cm2. Ninety percent of patients had undergone previous surgery. Type of surgery was classified as elective in 50.7%, urgent in 24.3% and emergent in 25.0% and a porcine mesh was implanted in 82.9%. The most common mesh placement technique was underlay (70.7%), followed by onlay (16.4%) and bridge (12.9%). Complications included wound complications (30.7%), reoperation (25.9%), hernia recurrence (20.7%), and mesh removal (10.0%). Thirty-two patients (23.0%) were admitted to the ICU and the mean hospital length of stay was 10.8 ± 17.5 days. Age-sex adjusted predictors of recurrence were COPD (OR 4.2; 95%CI 1.003-17.867) and urgent surgery (OR 10.5; 95%CI 1.856-59.469), whereas for reoperation, mesh size (OR 6.8; 95%CI 1.344-34.495) and urgent surgery (OR 5.2; 95%CI 1.353-19.723) were the predictors. CONCLUSIONS Using biologic mesh, one-quarter and one-fifth of CAWR patients are complicated with reoperation or recurrence, respectively. The operation settings and comorbidity may play a role in these outcomes regardless of the mesh placement techniques.
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Affiliation(s)
- Rifat Latifi
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY, USA; Department of Surgery, The University of Arizona, Tucson, AZ, USA.
| | - David Samson
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Ansab Haider
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Asad Azim
- Department of Surgery, The University of Arizona, Tucson, AZ, USA
| | - Hajira Iftikhar
- Department of Surgery, The University of Arizona, Tucson, AZ, USA
| | - Bellal Joseph
- Department of Surgery, The University of Arizona, Tucson, AZ, USA
| | - Elizabeth Tilley
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Jorge Con
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Saranda Gashi
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Ayman El-Menyar
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
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183
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Al-Thani H, El-Menyar A, Pillay Y, Mollazehi M, Mekkodathil A, Consunji R. Hospital Mortality Based on the Mode of Emergency Medical Services Transportation. Air Med J 2017; 36:188-192. [PMID: 28739241 DOI: 10.1016/j.amj.2017.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/04/2017] [Accepted: 03/24/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE We assessed the presentations and outcomes of trauma patients transported by helicopter emergency medical services (HEMS) versus ground emergency medical services (GEMS). METHODS A retrospective analysis of trauma registry data at a level I trauma center was conducted for patients transported by GEMS and HEMS between 2011 and 2013. Data were analyzed and categorized based on the mode of transportation. RESULTS A total of 4,596 trauma patients were admitted to the hospital with a mean age of 31 ± 15 years. Injured patients were transported to the trauma center by GEMS (93.3%) and HEMS (6.7%). The common mechanisms of injury were motor vehicle crash (37%) and falls (25%). Compared with GEMS, patients transported by HEMS were characterized by having a greater injury severity, more proportion of traumatic brain injury, on-scene intubation, and a 2.5-fold higher mortality. However, the impact of mode of transportation on the hospital mortality among severely injured patients has disappeared after adjusting for potential confounders. CONCLUSION Patients transported by HEMS may have different characteristic features and outcomes when compared with GEMS. However, further work is needed to identify the subgroups of trauma patients who clearly benefit from the use of HEMS.
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Affiliation(s)
- Hassan Al-Thani
- Trauma Surgery Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
| | - Yugan Pillay
- EMS Services, Hamad General Hospital, Doha, Qatar
| | - Monira Mollazehi
- Trauma Surgery Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ahammed Mekkodathil
- Clinical Research, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Rafael Consunji
- Injury Prevention, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
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184
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Irfan FB, Consunji R, El-Menyar A, George P, Peralta R, Al-Thani H, Thomas SH, Alinier G, Shuaib A, Al-Suwaidi J, Singh R, Castren M, Cameron PA, Djarv T. Cardiopulmonary resuscitation of out-of-hospital traumatic cardiac arrest in Qatar: A nationwide population-based study. Int J Cardiol 2017; 240:438-443. [PMID: 28395982 DOI: 10.1016/j.ijcard.2017.03.134] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/28/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Traumatic cardiac arrest studies have reported improved survival rates recently, ranging from 1.7-7.5%. This population-based nationwide study aims to describe the epidemiology, interventions and outcomes, and determine predictors of survival from out-of-hospital traumatic cardiac arrest (OHTCA) in Qatar. METHODS An observational retrospective population-based study was conducted on OHTCA patients in Qatar, from January 2010 to December 2015. Traumatic cardiac arrest was redefined to include out-of-hospital traumatic cardiac arrest (OHTCA) and in-hospital traumatic cardiac arrest (IHTCA). RESULTS A total of 410 OHTCA patients were included in the 6-year study period. The mean annual crude incidence rate of OHTCA was 4.0 per 100,000 population, in Qatar. OHTCA mostly occurred in males with a median age of 33. There was a preponderance of blunt injuries (94.3%) and head injuries (66.3%). Overall, the survival rate was 2.4%. Shockable rhythm, prehospital external hemorrhage control, in-hospital blood transfusion, and surgery were associated with higher odds of survival. Adrenaline (Epinephrine) lowered the odds of survival. CONCLUSION The incidence of OHTCA was less than expected, with a low rate of survival. Thoracotomy was not associated with improved survival while Adrenaline administration lowered survival in OHTCA patients with majority blunt injuries. Interventions to enable early prehospital control of hemorrhage, blood transfusion, thoracostomy and surgery improved survival.
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Affiliation(s)
- Furqan B Irfan
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83 Stockholm, Sweden; Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
| | - Rafael Consunji
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
| | - Ayman El-Menyar
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
| | - Pooja George
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
| | - Ruben Peralta
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
| | - Hassan Al-Thani
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
| | - Stephen Hodges Thomas
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
| | - Guillaume Alinier
- Hamad Medical Corporation Ambulance Service, Medical City, Doha, Qatar; School of Health and Social Work, Paramedic Division, University of Hertfordshire, Hatfield AL10 9AB, HERTS, UK.
| | - Ashfaq Shuaib
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Jassim Al-Suwaidi
- Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
| | - Rajvir Singh
- Cardiology Research, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
| | - Maaret Castren
- Helsinki University, Department of Emergency Medicine and Services, Helsinki University Hospital, Haartmaninkatu 4, 00029 HUS, Finland.
| | - Peter A Cameron
- The Alfred Hospital, Emergency and Trauma Centre, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, VIC 3004, Australia.
| | - Therese Djarv
- Department of Medicine Solna, 171 00, Karolinska Institutet, Sweden.
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185
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El-Menyar A, Asim M, Mudali IN, Mekkodathil A, Latifi R, Al-Thani H. The laboratory risk indicator for necrotizing fasciitis (LRINEC) scoring: the diagnostic and potential prognostic role. Scand J Trauma Resusc Emerg Med 2017; 25:28. [PMID: 28270166 PMCID: PMC5341454 DOI: 10.1186/s13049-017-0359-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 02/06/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Necrotizing fasciitis (NF) is a devastating soft tissue infection associated with potentially poor outcomes. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score has been introduced as a diagnostic tool for NF. We aimed to evaluate the prognostic value of LRINEC scoring in NF patients. METHODS A retrospective analysis was conducted for patients who were admitted with NF between 2000 and 2013. Based on LRINEC points, patients were classified into (Group 1: LRINEC < 6 and Group 2: LRINEC ≥ 6). The 2 groups were analyzed and compared. Primary outcomes were hospital length of stay, septic shock and hospital death. RESULTS A total of 294 NF cases were identified with a mean age 50.9 ± 15 years. When compared to Group1, patients in Group 2 were 5 years older (p = 0.009), more likely to have diabetes mellitus (61 vs 41%, p < 0.001), Pseudomonas aeruginosa infection (p = 0.004), greater Sequential Organ Failure Assessment (SOFA) score (11.5 ± 3 vs 8 ± 2, p = 0.001), and prolonged intensive care (median 7 vs 5 days) and hospital length of stay (22 vs 11 days, p = 0.001). Septic shock (37 vs. 15%, p = 0.001) and mortality (28.8 vs. 15.0%, p = 0.005) were also significantly higher in Group 2 patients. Using Receiver operating curve, cutoff LRINEC point for mortality was 8.5 with area under the curve of 0.64. Pearson correlation analysis showed a significant correlation between LRINEC and SOFA scorings (r = 0.51, p < 0.002). DISCUSSION Early diagnosis, simplified risk stratification and on-time management are vital to achieve better outcomes in patients with NF. CONCLUSIONS Beside its diagnostic role, LRINEC scoring could predict worse hospital outcomes in patients with NF and simply identify the high-risk patients. However, further prospective studies are needed to support this finding.
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Affiliation(s)
- Ayman El-Menyar
- Clinical Medicine, Weill Cornell Medical School, Doha, Qatar. .,Clinical Research, Trauma Surgery, Hamad General Hospital (HGH), Doha, Qatar. .,Weill Cornell medical college, Clinical Research, Trauma Surgery, Hamad General Hospital, Doha, Qatar.
| | - Mohammad Asim
- Clinical Research, Trauma Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | | | - Ahammed Mekkodathil
- Clinical Research, Trauma Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Rifat Latifi
- Department of Surgery, Westchester Health, Valhalla, NY, USA
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186
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Al-Thani H, El-Menyar A, Al-Thani N, Asim M, Hussein A, Sadek A, Sharaf A, Fares A. Characteristics, Management, and Outcomes of Surgically Treated Arteriovenous Fistula Aneurysm in Patients on Regular Hemodialysis. Ann Vasc Surg 2017; 41:46-55. [PMID: 28238919 DOI: 10.1016/j.avsg.2016.08.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/19/2016] [Accepted: 08/13/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND To investigate the clinical characteristics, surgical interventions, and outcomes of arteriovenous fistula (AVF) aneurysms, we retrospectively analyzed patients on regular hemodialysis (HD). METHODS We conducted a cohort study of all patients with HD access who presented with AVF aneurysms and underwent operative procedures over a 11-year period. Patients' demographics, comorbidities, vascular access characteristics, management of aneurysms, complications, and outcomes were analyzed. RESULTS Of the 700 end-stage renal failure patients, 530 patients were maintained on HD (130 through PermCath and 400 through AV access in terms of AVF and arteriovenous graft). We identified 129 patients who developed AV aneurysms, and 40 of them required surgical interventions (24 men and 16 women) with a mean age of 58 ± 14.6 years. The 40 patients who developed AVF aneurysms underwent 43 surgical interventions. The majority of aneurysms were presented with thinning and ulceration (82.5%) of the overlying skin. Thirty-four patients had true aneurysms and 6 had pseudoaneurysms. The aneurysmal AVF comprised 26 brachiocephalic fistulas, 9 radiocephalic fistulas, 3 brachial artery grafts, 1 ulnar-basilic fistula, and 1 Fem-Fem graft at presentation. Patients were treated mainly with ligation (13; 32.5%), excision and repair with graft interposition (15; 37.5%) or vein interposition (11; 27.5%), and end-to-end AVF (1; 2.5%). The median follow-up postsurgery duration was 53 months (range 1-192) and the median duration from fistula creation to the surgical intervention was 52 months (range 4-182). On follow-up, 34 patients continued on HD, while 5 underwent renal transplantation and 1 shifted to peritoneal dialysis. The overall all-cause mortality rate was 37.5% and the leading causes of mortality were sepsis/pneumonia (60%), myocardial infarction, and heart failure (40%). CONCLUSIONS In HD patients, the rate of AVF aneurysmal formation is high with a significant rate of morbidity and mortality. Therefore, timely and appropriate evaluation and surgical intervention are crucial.
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Affiliation(s)
- Hassan Al-Thani
- Department of Surgery, Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Internal Medicine, Weill Cornell Medical College, Doha, Qatar; Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar.
| | - Noora Al-Thani
- Department of Internal Medicine, Hamad General Hospital, Doha, Qatar
| | - Mohammad Asim
- Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Ahmed Hussein
- Department of Surgery, Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Ahmed Sadek
- Department of Surgery, Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Ahmed Sharaf
- Department of Surgery, Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Amr Fares
- Department of Surgery, Vascular Surgery, Hamad General Hospital, Doha, Qatar
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187
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Al-Aieb A, Peralta R, Ellabib M, El-Menyar A, Al-Thani H. Traumatic tension pneumocephalus: Two case reports. Int J Surg Case Rep 2017; 31:145-149. [PMID: 28152490 PMCID: PMC5288330 DOI: 10.1016/j.ijscr.2017.01.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/16/2017] [Accepted: 01/16/2017] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Traumatic pneumocephalus rarely evolves into tension pneumocephalus. It can be devastating if not recognized and treated promptly. CASE PRESENTATION We presented two cases of post-traumatic tension pneumocephalus. A 30- year old male pedestrian hit by a car presented with right frontal bone fracture extending to right frontal sinuses. He developed pneumocephalus involving all ventricles and subdural space and extending down to foramen magnum with tight basal cistern. The patient was managed conservatively. During the hospital course, he developed cerebrospinal fluid leak from the facial fractures and meningitis. After complete recovery, the patient was discharged home in a good health condition. The second case was a 43- year old lady driver who involved in a motor vehicle crash and presented with comminuted fracture of the right frontal bone, right parietal extra-axial hemorrhage. She developed pnemocephalus involving the bilateral frontal lobes, mainly on the left side with extension to the left lateral ventricle. Pneumocephalus was also noted in the pre-pontine cistern. The patient had rhinorrhea during the hospital course. The patient underwent wound debridement, intracranial pressure monitoring, and repair of her globe and advancement flap for right facial injury. CONCLUSIONS These are two rare cases with posttraumatic tension pneumocephalus treated conservatively with a favorable outcome. Early diagnosis of tension pneumocephalus is a crucial step to facilitate early recovery; however, the associated injuries need attention as they could influence the hospital course.
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Affiliation(s)
- Abubaker Al-Aieb
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ruben Peralta
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Mohammad Ellabib
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Trauma Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
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Abstract
Introduction Little is known about the anatomic variation and its implication in patients with lower limb deep venous thrombosis (DVT). We studied the clinical presentation, site of thrombosis and risk factors based on the anatomic distribution of lower limb DVT. Methods A retrospective analysis of clinically suspected DVT cases was conducted between 2008 and 2012. DVT was categorized by the location of the thrombosed segment and limb involved. The DVT anatomic segments were assessed according to left-to-right ratio, predisposing factors and clinical presentations. Results A total of 637 patients with DVT were included with a mean age of 50 ± 17 years (51%; females). The most frequently thrombosed segments were popliteal, posterior tibial and profunda femoris veins. DVT was more common at the left side, with a left-to-right ratio of 1.5:1. Bilateral DVT cases (38.5%) had more prior history of DVT as compared to left- (20.3%) and right-sided DVTs (22.6%); p = 0.01. Bilateral DVT was complicated more with post-thrombotic syndrome (leg ulcer) ( p = 0.02). The rates of pulmonary embolism (25%) and mortality (23.1%) were significantly higher for bilateral DVT in comparison to left- and right-sided DVT. Abnormal coagulation profile was significantly associated with posterior tibial DVT (81% vs. 71.4%; p = 0.01) as compared to patients with normal coagulation profile. Conclusion Lower limb DVTs are more common at the left side; however, patients with bilateral DVT have higher frequency of recurrence, post-thrombotic syndrome, pulmonary embolism and mortality. The anatomic segments of DVT show specific distribution depending on the predisposing factors. These findings could improve our understanding of the pathophysiology and management of DVT patients.
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Affiliation(s)
- Ayman El-Menyar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
- Clinical Research, Trauma Surgery, Hamad General Hospital, Doha, Qatar
- Cardiology Unit, Internal Medicine, Ahmed Maher Teaching Hospital, Cairo, Egypt
| | - Mohammad Asim
- Clinical Research, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Gaby Jabbour
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma & Vascular Surgery, Hamad General Hospital, Doha, Qatar
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189
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Abstract
Delirium is characterized by impaired cognition with nonspecific manifestations. In critically ill patients, it may develop secondary to multiple precipitating or predisposing causes. Although it can be a transient and reversible syndrome, its occurrence in Intensive Care Unit (ICU) patients may be associated with long-term cognitive dysfunction. This condition is often under-recognized by treating physicians, leading to inappropriate management. For appropriate management of delirium, early identification and risk factor assessment are key factors. Multidisciplinary collaboration and standardized care can enhance the recognition of delirium. Interdisciplinary team working, together with updated guideline implementation, demonstrates proven success in minimizing delirium in the ICU. Moreover, should the use of physical restraint be necessary to prevent harm among mechanically ventilated patients, ethical clinical practice methodology must be employed. This traditional narrative review aims to address the presentation, risk factors, management, and ethical considerations in the management of delirium in ICU settings.
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Affiliation(s)
- Suresh Arumugam
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar; Deaprtment of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Ammar Al-Hassani
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Gustav Strandvik
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Mohammad Asim
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Ahammed Mekkodithal
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Insolvisagan Mudali
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
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190
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Mohammed S, Aljundi AHS, Kasem M, Alhashemi M, El-Menyar A. Anticoagulation control among patients with nonvalvular atrial fibrillation: A single tertiary cardiac center experience. J Adv Pharm Technol Res 2017; 8:14-18. [PMID: 28217549 PMCID: PMC5288964 DOI: 10.4103/2231-4040.197370] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
There is a limited knowledge about the predictors of anticoagulation control in patients with nonvalvular atrial fibrillation (NVAF). Furthermore, few reports addressed the role of time in therapeutic range (TTR) that could reflect the safety and efficacy of anticoagulation therapy. We aimed to assess factors that affect the quality of anticoagulation therapy utilizing TTR in patients with NVAF. A retrospective observational study was conducted for patients with NVAF who were maintained on warfarin >6 months at a tertiary cardiac care hospital. Patients were categorized according to the TTR status (≥65% vs. <65%). A total of 241 eligible patients were identified. A high-quality anticoagulation based on TTR values ≥65% was found in 157 (65.1%) patients; the remaining (34.9%) patients represented the low-quality anticoagulation group (TTR <65%). Demographics and clinical characteristics were comparable in the two TTR groups. Both groups were comparable in terms of warfarin dose and medications use. When compared to patients with high-quality anticoagulation, patients in the low-quality anticoagulation group were more likely to seek outpatient warfarin clinic visits more frequently (22.3 ± 5.5 vs. 18 ± 4.4, P = 0.001) and to have higher rate of polypharmacy (57.1% vs. 42%, P = 0.03). Of note, patients in both groups had similar major bleeding events (P = 0.41). After adjusting for age and sex, polypharmacy use was a predictor of poor coagulation control (odds ratio = 1.89, 95% confidence interval: 1.03–3.33; P = 0.03). In NVAF patients, TTR is generally high in our cohort. Patients with polypharmacy and frequent clinic visits have lower TTR. High-quality oral anticoagulation could be achieved through optimizing TTR without a significant risk of major bleeding.
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Affiliation(s)
- Shaban Mohammed
- Department of Clinical Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Amer H S Aljundi
- Department of Clinical Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Kasem
- Department of Clinical Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Alhashemi
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ayman El-Menyar
- Department of Clinical Medicine, Weill Cornel Medical College, Doha, Qatar; Department of Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar
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191
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El-Menyar A, Asim M, Latifi R, Al-Thani H. Research in Emergency and Critical Care Settings: Debates, Obstacles and Solutions. Sci Eng Ethics 2016; 22:1605-1626. [PMID: 26602908 DOI: 10.1007/s11948-015-9730-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 11/17/2015] [Indexed: 06/05/2023]
Abstract
Research is an integral part of evidence-based practice in the emergency department and critical care unit that improves patient management. It is important to understand the need and major obstacles for conducting research in emergency settings. Herein, we review the literature for the obligations, ethics and major implications of emergency research and the associated limiting factors influencing research activities in critical care and emergency settings. We reviewed research engines such as PubMed, MEDLINE, and EMBASE for the last two decades using the key words "emergency department", "critical care", "research", "consent", and "ethics" as the search terms. Research within emergency settings is slow or non-existent due to time and financial constraints as well as the lack of a research tradition. There are several barriers to conducting research studies in emergency situations such as who, what, when, and how to obtain patient consent. The emergency environment is highly pressurized, emotional, and overburdened. The time taken for research is a particular risk that could delay the desired immediate interventions. Ethical issues abound, particularly relating to informed consent. Research in emergency settings is still in its infancy. Thus, there is a strong need for extensive research in the emergency setting through community awareness, resource management, ethics, collaborations, capacity building, and the development of a research interest for the improvement of patient care and outcomes. We need to establish a well-structured plan to assess and track the decision-making capacity, consider a multistep enrolment and consent strategy, and develop an integrated approach for recruitment into studies.
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Affiliation(s)
- Ayman El-Menyar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
- Clinical Research, Trauma Surgery Section, Hamad General Hospital, PO Box 3050, Doha, Qatar.
- Cardiology Unit, Internal Medicine, Ahmed Maher Teaching Hospital, Cairo, Egypt.
| | - Mohammad Asim
- Clinical Research, Trauma Surgery Section, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | - Rifat Latifi
- Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Hassan Al-Thani
- Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
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192
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Al-Thani H, El-Menyar A, Asim M. Recurrent Deep Vein Thrombosis after the First Venous Thromboembolism: Clinical Presentation, Risk Factors, and Management. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.08.538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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193
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El-Menyar A, Sulaiman K, AlSadawi A, AlSheikh-Ali AA, AlMahameed W, Bazargani N, AlMotarreb A, Amin H, Asaad N, Al Habib K, Ridha M, Al-Jarallah M, Al-Thani H, AlFaleh H, Singh R, Panduranga P, Al Suwaidi J. Implications of a History of Syncope in Patients Hospitalized With Heart Failure. Angiology 2016; 68:196-206. [PMID: 27255265 DOI: 10.1177/0003319716647320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We assessed the frequency and implications of a history of syncope of up to 1 year prior to hospitalization with acute heart failure (AHF) between February and November 2012. Data were collected for 5005 patients hospitalized with AHF and analyzed and compared according to the absence/presence of a history of syncope (group 1 vs group 2). Prior syncope among patients with heart failure was 5.3%. Age, gender, hypertension, atrial fibrillation, bundle branch block, left ventricular ejection fraction (LVEF), and obstructed coronary vessels were comparable in the 2 groups. Group 2 patients were more likely to smoke or have diabetes mellitus, stroke, and cardiac arrest. Group 2 patients frequently required aggressive treatment and had more worse in-hospital and 1-year outcomes compared to group 1. After adjustment for age, sex, ethnicity, and LVEF, multivariate regression analysis showed that history of syncope predicted in-hospital mortality (odds ratio: 2.61; 95% confidence interval: 1.707-4.002). History of syncope during the year prior to the index admission with AHF is a marker of worse outcomes regardless of patient age and LVEF. Further studies are required to confirm this observation and its clinical implications.
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Affiliation(s)
- Ayman El-Menyar
- 1 Clinical Medicine, Weill Cornel Medical College, Doha, Qatar.,2 Clinical Research, Hamad General Hospital, Doha, Qatar
| | | | - Ali AlSadawi
- 4 Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Alawi A AlSheikh-Ali
- 5 Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Wael AlMahameed
- 6 Cardiology, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Nooshin Bazargani
- 7 Department of Cardiology, Dubai Hospital, Dubai, United Arab Emirates
| | - Ahmed AlMotarreb
- 8 Department of Cardiology, Faculty of Medicine, Sana'a University, Sana'a, Yemen
| | - Haitham Amin
- 9 Department of Cardiology, Mohammed Bin Khalifa Cardiac Center, Manamah, Bahrain
| | - Nidal Asaad
- 4 Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Khalid Al Habib
- 10 Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Mustafa Ridha
- 11 Department of Cardiology, Adan Hospital, Hadiya, Kuwait
| | | | | | - Husam AlFaleh
- 10 Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Rajvir Singh
- 4 Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Jassim Al Suwaidi
- 4 Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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194
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Al-Thani H, El-Menyar A, Pillay Y, Mollazehi M, Mekkodathil A, Consunji R. 786 In-hospital mortality based on the mode of EMS transportation in high-income developing middle Eastern Country. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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195
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Awadalla M, Tallon L, Peralta R, El-Menyar A, Al-Thani H, Consunji R. 868 The disproportionate risk of young drivers for road traffic injury and fatality in Qatar: evidence for policy. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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196
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Consunji R, Mehmood A, Irfan F, Abdelhamid R, Peralta R, El-Menyar A, Allen KA, Malik S, Al-Thani H, Hyder A. 916 A five-year time trend analysis of road traffic injuries [RTIS] and deaths among infants and toddlers in Qatar. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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197
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Mehmood A, Consunji R, Peralta R, Abdelhamid R, El-Menyar A, Allen KA, Malik S, Thomas S, Al-Thani H, Hyder A. 992 Time trends in work-related injuries in qatar: an analysis of hospital trauma registry data. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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198
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Consunji R, Mehmood A, Irfan F, Abdelhamid R, Peralta R, El-Menyar A, Allen KA, Malik S, Al-Thani H, Hyder A. 770 An evaluation of the utility of various data sources for occupational injury surveillance. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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199
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El-Menyar A, Al-Thani H, Consunji R. 631 Implications of alcohol screening in patients with head trauma of different mechanisms on injury. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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200
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Jabbour G, El-Menyar A, Peralta R, Shaikh N, Abdelrahman H, Mudali IN, Ellabib M, Al-Thani H. Pattern and predictors of mortality in necrotizing fasciitis patients in a single tertiary hospital. World J Emerg Surg 2016; 11:40. [PMID: 27508002 PMCID: PMC4977757 DOI: 10.1186/s13017-016-0097-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/02/2016] [Indexed: 12/18/2022] Open
Abstract
Background Necrotizing fasciitis (NF) is a fatal aggressive infectious disease. We aimed to assess the major contributing factors of mortality in NF patients. Methods A retrospective study was conducted at a single surgical intensive care unit between 2000 and 2013. Patients were categorized into 2 groups based on their in-hospital outcome (survivors versus non-survivors). Results During a14-year period, 331 NF patients were admitted with a mean age of 50.8 ± 15.4 years and 74 % of them were males Non-survivors (26 %) were 14.5 years older (p = 0.001) and had lower frequency of pain (p = 0.01) and fever (p = 0.001) than survivors (74 %) at hospital presentation. Diabetes mellitus, hypertension, and coronary artery disease were more prevalent among non-survivors (p = 0.001). The 2 groups were comparable for the site of infection; except for sacral region that was more involved in non-survivors (p = 0.005). On admission, non-survivors had lower hemoglobin levels (p = 0.001), platelet count (p = 0.02), blood glucose levels (p = 0.07) and had higher serum creatinine (p = 0.001). Non-survivors had greater median LRINEC (Laboratory Risk Indicator for NECrotizing fasciitis score) and Sequential Organ Failure Assessment (SOFA) scores (p = 0.001). Polybacterial and monobacterial gram negative infections were more evident in non-survivors group. Monobacterial pseudomonas (p = 0.01) and proteus infections (p = 0.005) were reported more among non-survivors. The overall mortality was 26 % and the major causes of death were bacteremia, septic shock and multiorgan failure. Multivariate analysis showed that age and SOFA score were independent predictors of mortality in the entire study population. Conclusion The mortality rate is quite high as one quarter of NF patients died during hospitalization. The present study highlights the clinical and laboratory characteristics and predictors of mortality in NF patients.
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Affiliation(s)
- Gaby Jabbour
- Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma Surgery, Hamad General Hospital, Doha, Qatar ; Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
| | - Ruben Peralta
- Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
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