Comparison of intravenous paracetamol (acetaminophen) to intravenously or intramuscularly administered non-steroidal anti-inflammatory drugs (NSAIDs) or opioids for patients presenting with moderate to severe acute pain conditions to the ED: systematic review and meta-analysis.

OBJECTIVE: Paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs) and opiates/opioids, administered parenterally via intravenous or intramuscular route, are widely used to provide analgesia for patients with moderate to severe pain. This systematic review and meta-analysis evaluated the level of analgesia provided by intravenous paracetamol (IVP) alone compared with NSAIDs (intravenous or intramuscular), or opioids (intravenous) alone in adults attending the ED with acute pain. METHODS: Two authors independently searched PubMed (MEDLINE), Web of Science, Embase (OVID), Cochrane Library, SCOPUS and Google Scholar (3 March 2021-20 May 2022) for randomised trials without any language or date restriction. Clinical trials were evaluated using the Risk of Bias V.2 tool. The primary outcome was mean difference (MD) for pain reduction at 30 min (T30) post analgesia delivery. The secondary outcomes were MD in pain reduction at 60, 90 and 120 min; the need for rescue analgesia; and the occurrence of adverse events (AEs). RESULTS: Twenty-seven trials (5427 patients) were included in the systematic review and 25 trials (5006 patients) in the meta-analysis. There was no significant difference in pain reduction at T30 between the IVP group and opioids (MD -0.13, 95% CI -1.49 to 1.22) or IVP and NSAIDs (MD -0.27, 95% CI -1.0 to 1.54. There was also no difference at 60 min, IVP group versus opioid group (MD -0.09, 95% CI -2.69 to 2.52) or IVP versus NSAIDs (MD 0.51, 95% CI 0.11 to 0.91). The quality of the evidence using Grading of Recommendations, Assessments, Development and Evaluations methodology was low for MD in pain scores.The need for rescue analgesia at T30 was significantly higher in the IVP group compared with the NSAID group (risk ratio (RR): 1.50, 95% CI 1.23 to 1.83), with no difference found between the IVP group and the opioid group (RR: 1.07, 95% CI 0.67 to 1.70). AEs were 50% lower in the IVP group compared with the opioid group (RR: 0.50, 95% CI 0.40 to 0.62), whereas no difference was observed in the IVP group compared with the NSAID group (RR: 1.30, 95% CI 0.78 to 2.15). CONCLUSION: In patients presenting to the ED with a diverse range of pain conditions, IVP provides similar levels of pain relief compared with opiates/opioids or NSAIDs at T30 post administration. Patients treated with NSAIDs had lower risk of rescue analgesia, and opioids cause more AEs, suggesting NSAIDs as the first-choice analgesia and IVP as a suitable alternative. PROSPERO REGISTRATION NUMBER: CRD42021240099.

Caesarean section in Sudan: findings from nationwide household surveys on rates, trends, and geographic and sociodemographic variability.

BACKGROUND: Medically unjustifiable caesarean section (CS) deliveries have been rising rapidly in many developed countries over the last three decades. While many developing countries show rates beyond optimal levels, few poorer countries appear to have sub-optimal obstetric care in relation to essential surgeries. The objective of this study is to document the rates of CS delivery, its time trend, and geographic and sociodemographic variability in Sudan. METHODS: We utilized a number of Multiple Indicator Cluster Surveys (MICS) conducted in 2014, 2010, and 2006 to quantify CS rates per 1000 live births. We also documented absolute changes in rates over three-time points and variation in CS rates across geographic regions and areas of residence. RESULTS: Over a decade, CS rates in Sudan increased steadily from 4.3% in 2006 to 6.7% in 2010 and 9.1% in 2014. During this period, CS rates varied considerably across regions showing higher rates in the Northern region (7-25%) and lower rates in Darfur (2-3%). Urban areas experienced rapidly increasing rates (6-14%), while rural areas showed negligible changes to absolute CS rates over time (5-7%). We also found geographic regions, maternal age, maternal education, receiving antenatal care, and birth order of the child were important determinants of CS in Sudan. CONCLUSION: Sudan may be facing a double burden of problems associated with surgical interventions for childbirth. While the wealthier parts of Sudan are experiencing a rapid surge in CS, some poor parts of rural Sudan may not be getting the essential surgical intervention for birth when mandated. Urgent improvement to obstetric care and the development of appropriate public health interventions that focus on regional disparities are warranted.

Clinical manifestations associated with acute viral gastroenteritis pathogens among pediatric patients in Qatar.

BACKGROUND: Acute gastroenteritis (AGE) remains a significant cause of diarrhea that affects children worldwide. It is usually caused by viral agents, including rotavirus (RV), norovirus (NoV), adenovirus (AdV), astrovirus (AstV), and sapovirus (SaV), and the disease severity varies accordingly. Here, we report the association of clinical severity among AGE-infected pediatrics caused by a single viral pathogen, coinfection (viral-viral), mixed infection (viral-bacterial), and AGE-negative samples. METHODS: A total of 901 pediatric patients were admitted with AGE to the Pediatric Emergency Center of Hamad Medical Corporation in Qatar from June 2016 to June 2018. The age of the subjects ranged between 3 months and 14 years (median of 16 months). Virus antigens detection was performed by using Film Array Gastrointestinal (GI) Panel kit. AGE severity was assessed using the Vesikari Clinical Severity Scoring System. Multivariable multinomial logistic regression was used to model the five AGE viral agents' likelihood in relation to severity versus co-infection, mixed infection, and AGE-negative samples. RESULTS: AGE was most common in pediatrics aged 1-3 years (median age = 1.25 years) and more frequent in males than females, with a ratio of 1:0.8. About 19.2% of the infections were caused by NoV, followed by RV (18.2%), AdV (6.5%), SaV (2.3%), and AstV (1.8%). The majority of viral agents were detected higher in mixed infection (32.1%) than coinfection (4.9%). Based on the Vesikari score system, severe clinical illness was recorded among pediatrics infected with RV (82.2%) and NoV (75.7%). Further on multivariable analysis, compared to testing negative, the odds of detecting RV was three times significantly higher in children with severe symptoms relative to those with moderate (adjusted-odds ratio [a-OR] = 3.10; 95% confidence interval [CI] = 1.82-5.28). Similar results were observed when considering RV relative to co-infection and mixed infection (a-OR = 2.59; 95% CI = 1.23-5.48 and a-OR = 2.06; 1.28-3.30, respectively). About one-third of the study sample were Qatari children with AGE (33%), whereas 35% and 32% were pediatrics from the Middle East and North Africa region, excluding Qatari and nonregions. CONCLUSION: This study underlines the association of disease severity among AGE-infected pediatrics in Qatar. The overall Vesikari median score was significantly high, followed by more frequent hospitalization among RV-infected pediatrics compared to others. There was no reduction in the disease severity among RV-infected regardless of the vaccine dose.

Prevalence and trends of transfusion transmissible infections among blood donors in the State of Qatar, 2013-2017.

BACKGROUND: Millions of lives around the world are being saved annually through blood transfusion. However, blood transfusion is among the essential vehicles for transmitting infections. The overall prevalence of Transfusion Transmissible Infections among blood donors differs around the world, reflecting the variation in the prevalence of these infections. This study aims to assess the prevalence and trends of Transfusion Transmissible Infections among blood donors in Qatar. METHODS: This is a cross-sectional study utilizing donation records of 5 years from January 2013 to December 2017. We included in the study results for all screening and confirmatory tests for Hepatitis B Virus, Hepatitis C Virus, Human T-lymphotropic Virus-I/II, Syphilis and Malaria. RESULTS: Among the 190,509 donations received at the donation centre during the study period, about 91% of donations were received from males and 9% from females. The overall positivity rate for all tests was 1.87, 2.23, 1.78, 2.31, 2.67% for the years 2013 through 2017, with an increasing yearly trend by 6% each year. The overall positivity rates for Hepatitis C Virus, Human T-lymphotropic Virus-I/II, Hepatitis B Virus, Syphilis and Malaria (2013-2017) were 0.60, 0.18, 0.30, 0.43 and 0.20%, respectively. CONCLUSION: The overall positivity rate of all tests combined for the Transfusion Transmissible Infections demonstrated a gradually increasing trend from 2013 to 2017. However, the trend for each infection (Hepatitis C Virus, Hepatitis B Virus, Syphilis and Malaria) was fluctuating except for Human T-lymphotropic Virus-I/II, which was increasing. Supporting the development of effective prevention and control strategies requires further comprehensive investigations for better estimation of the burden of these infections.

The differential effects of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on seizure frequency in patients with drug-resistant epilepsy - A randomized, double-blind, placebo-controlled trial.

OBJECTIVES: The omega-3 (n-3) fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are known to play an important role in maintenance and modulation of neuronal functions. There is evidence that omega-3 fatty acids may have anticonvulsant effects. The effect of DHA and EPA on seizure rate in patients with drug-resistant epilepsy (DRE) was investigated. METHODS: A double-blind, randomized, placebo-controlled clinical trial included ninety-nine (n = 99) subjects with DRE, aged 5-16 years (n = 85) and 17-45 years (n = 14). After randomization, subjects were given two, four, or six capsules per day of DHA (417.8 mg DHA and 50.8 mg EPA/capsule, n = 33), EPA (385.6 mg EPA and 81.2 mg DHA/capsule, n = 33), or placebo (high oleic acid sunflower oil, n = 33) for one year. The primary endpoint was the effect of treatment on rate of seizure. Random-effects negative binomial regression models were fitted to model the patients' total count of seizures per month. The treatment effects on seizure incidence rate ratio (IRR) were tested after controlling for the covariate effects of gender, age, rate of seizure per week at enrollment, type of seizure, and number of antiepileptic drug (AED) combinations used at enrollment. RESULTS: Fifty-nine subjects (n = 59) completed the study (59.6%). The average number of seizures per month were 9.7 ±â€¯1.2 in the EPA group, 11.7 ±â€¯1.5 in the DHA group, and 16.6 ±â€¯1.5 in the placebo group. Age, gender, and seizure-type adjusted seizure IRRs of the EPA and DHA groups compared with the placebo group were 0.61 (CI = 0.42-0.88, p = 0.008, 42% reduction) and 0.67 (CI = 0.46-1.0, p = 0.04, 39% reduction), respectively. There was no difference in IRR between the EPA and DHA groups (p = 0.56). Both treatment groups had a significantly higher number of seizure-free days compared with the placebo group (p < 0.05). SIGNIFICANCE: This study demonstrates that EPA and DHA are effective in reducing seizure frequency in patients with DRE.

Sickle cell disease in western Sudan: genetic epidemiology and predictors of knowledge attitude and practices.

OBJECTIVE: To investigate the epidemiology of sickle cell disease (SCD) and determinants of knowledge, attitudes and practices (KAP) towards SCD in western Kordofan State, Sudan. METHODS: A community-based, descriptive, cross-sectional study was conducted in three towns. Three hundred and seventy-two households were polled, and blood samples for haemoglobin phenotyping were collected from 1116 individuals. Sociodemographic, socio-economic and KAP data were collected using investigator-administered questionnaires. Descriptive, frequency distribution and multiple regression analyses were performed. RESULTS: About 50.9% of the study population were Misseriya tribes. Consanguineous marriages were reported by 67.5% of the households. The highest percentage of homozygous SCD was 2.8% among children under 5 years of age. About 24.9% were carriers of HbS allele (HbAS). HbS allele frequency was highest in children aged 5-11 years (18.3%, CI: 13.7-22.9%) and lowest in males >15 years old (12.0%, CI: 6.1-17.9%). The average HbS frequency across all age groups was 14.5% (95% CI: 12.2-16.8%). The most frequent ß-globin gene cluster haplotype was the Cameroon (30.8%), followed by the Benin (21.8%), the Senegal (12.8%) and the Bantu (2.2%) haplotypes. About 17.0% of all-cause child deaths were due to SCD. The estimated change in log odds of having the SS genotype per year increase in age was (-) 0.0058 (95% CI -0.0359, 0.0242). This represents a non-statistically significant 2.9% increase in 5-year mortality for individuals with the SS genotype relative to those with AS and AA genotypes. About 46.9% of the households had poor knowledge, 26.1% had satisfactory knowledge, and 26.9% had good knowledge about sickle cell disease. Mothers' and fathers' educational levels were significant predictors of good knowledge about SCD (P < 0.05). About 48.0% had a satisfactory attitude towards sickle cell disease while 30.7% had poor attitude and only 21.3 showed good attitudes. Poor knowledge about SCD and low socio-economic status were the strongest positive predictors of poor attitude and practices towards SCD (P < 0.01). CONCLUSIONS: Sickle cell disease is a major health problem in West Kordofan, Sudan. Knowledge, attitude and practices towards the disease are not satisfactory. The development of public health programs is highly recommended to control and manage SCD in western parts of Sudan.

Associations between perceived occupational stressors and symptoms severity of depression, anxiety and stress among academic faculty: First cross-sectional study from Qatar.

BACKGROUND: Mental health concerns among university faculty are on the rise, with reports of anxiety, depression, and occupational stress, impacting the higher education community. In Qatar, an assessment of faculty mental health has not been previously realized. The objectives of the current study were twofold: Firstly, to evaluate the extent of perceived occupational stress, depression, anxiety, and stress, and secondly, to assess the association among these mental health parameters. METHODS: A cross-sectional study was conducted among faculty using an online, self-administered, anonymous, voluntary survey. All faculty were included by sending the survey to their institutional emails. In addition to faculty demographics and general health status, the survey measured perceived stress due to academic job roles using the Faculty Stress Index (FSI) with its five distinct domains, and assessed faculty mental health using the Depression, Anxiety, and Stress Scale-21 items (DASS-21). Modified Poisson regression with robust variance was used to assess how FSI influences levels of depression, anxiety, and stress. RESULTS: A total of 112 faculty responded to the survey. The highest faculty self-perceptions of mental health conditions were for anxiety (63% at least moderate), followed by depression (30% at least moderate), and least for stress (26% at least moderate). The overall mean FSI score was 48.8 ± 29.4; time constraint and rewards and recognition domains scored highest (18.5 ± 11.4 and 13.3 ± 9.3 respectively) while the departmental influence domain scored least (4.8 ± 4.4). Increased risk of at least moderate levels of self-perceived depression and stress were significantly associated with higher FSI score (p˂0.001). Increased risk of at least moderate levels of depression were less likely among faculty aged 50 years and above (p = 0.034), while increased risk of at least moderate levels of anxiety were more likely among faculty from humanities colleges (p = 0.027). CONCLUSIONS: This is the first investigation of university faculty mental health in Qatar, indicating multifactorial perceived occupational stress, associated with higher perceived severity of mental health conditions. These baseline results establish links between specific occupational stressors for faculty and their mental well-being. As such, assessment of mental health conditions, controlling occupational stress, and developing tailored mental health interventions for faculty, are strategic to implement and foster well-being of academics. Further research into mental health of faculty and designing effective interventions that consider their specific stressors and associated factors are warranted.

Effectiveness of two and three doses of COVID-19 mRNA vaccines against infection, symptoms, and severity in the pre-omicron era: A time-dependent gradient.

BACKGROUND: Vaccines were developed and deployed to combat severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This study aimed to characterize patterns in the protection provided by the BNT162b2 and mRNA-1273 mRNA vaccines against a spectrum of SARS-CoV-2 infection symptoms and severities. METHODS: A national, matched, test-negative, case-control study was conducted in Qatar between January 1 and December 18, 2021, utilizing a sample of 238,896 PCR-positive tests and 6,533,739 PCR-negative tests. Vaccine effectiveness was estimated against asymptomatic, symptomatic, severe coronavirus disease 2019 (COVID-19), critical COVID-19, and fatal COVID-19 infections. Data sources included Qatar's national databases for COVID-19 laboratory testing, vaccination, hospitalization, and death. RESULTS: Effectiveness of two-dose BNT162b2 vaccination was 75.6% (95% CI: 73.6-77.5) against asymptomatic infection and 76.5% (95% CI: 75.1-77.9) against symptomatic infection. Effectiveness against each of severe, critical, and fatal COVID-19 infections surpassed 90%. Immediately after the second dose, all categories-namely, asymptomatic, symptomatic, severe, critical, and fatal COVID-19-exhibited similarly high effectiveness. However, from 181 to 270 days post-second dose, effectiveness against asymptomatic and symptomatic infections declined to below 40%, while effectiveness against each of severe, critical, and fatal COVID-19 infections remained consistently high. However, estimates against fatal COVID-19 often had wide 95% confidence intervals. Analogous patterns were observed in three-dose BNT162b2 vaccination and two- and three-dose mRNA-1273 vaccination. Sensitivity analyses confirmed the results. CONCLUSION: A gradient in vaccine effectiveness exists and is linked to the symptoms and severity of infection, providing higher protection against more symptomatic and severe cases. This gradient intensifies over time as vaccine immunity wanes after the last vaccine dose. These patterns appear consistent irrespective of the vaccine type or whether the vaccination involves the primary series or a booster.

Removal of user fees for caesareans and under-fives in northern Sudan: a review of policy implementation and effectiveness.

In 2008, the Government of Sudan launched a policy of free curative care for under-fives and caesareans. This paper presents the findings of a review of this policy, on the basis of research conducted in five focal states of northern Sudan in 2010. Policy implementation was assessed using four research tools: key informant interviews, exit interviews, a facility survey, and analysis of facility finances and the cost of the package of care. The findings point to important weaknesses in implementation, such as unclear specification of the exact target group and package of care and inadequate funding. Despite this, service utilisation appears to have responded, at least in the short term. The findings also highlight the urgent need for improved access to basic health care and financial protection against health care costs in northern Sudan (for those with and without national health insurance membership). This review contributes to the growing literature on the selective removal of user fees for priority services. It indicates the range of challenges to effective implementation (strategic, financial and organisational). Some of these are particular to Sudan, but many are shared, and indicate important lessons for improving access to and quality of care for women and children in Africa.

Trends in 'cure' fraction from colorectal cancer by age and tumour stage between 1975 and 2000, using population-based data, Osaka, Japan.

Since the 1960s, Japan has experienced a striking increase in the incidence of colorectal cancer, now the second most common cancer in the country. Meanwhile, the management of colorectal cancer has changed dramatically with the implementation of, for example, screening, endoscopy and adjuvant chemotherapy. It is therefore of interest to monitor the long-term trends in population 'cure' in Japan. We analysed 33 885 colorectal cancer cases diagnosed between 1975 and 2000 in Osaka. We applied the multivariable mixture cure model to estimate cure fraction and median survival time (MST) for 'uncured' patients, by sex, age, stage, period at diagnosis and subsite. For colon cancer, the cure fraction increased by about 25%, while MST for the uncured was prolonged from 8 to 12 months. The cure fraction was 5% higher in men than in women, while MST was similar in both. The cure fraction also increased for localized and regional tumours. For rectal cancer, the cure fraction increased by about 25-30%, but remained lower than for colon cancer. From the late 1970s, the cure fraction for colorectal cancer increased dramatically due to better management of detection and care for colorectal cancer. This improvement was obtained at the cost of shorter MST for uncured patients.

A survey of oral health in a Sudanese population.

BACKGROUND: We aimed to assess the oral health status and risk factors for dental caries and periodontal disease among Sudanese adults resident in Khartoum State. To date, this information was not available to health policy planners in Sudan. METHODS: A descriptive population-based survey of Sudanese adults aged ≥ 16 years was conducted. After stratified sampling, 1,888 adult patients from public dental hospitals and dental health centres scattered across Khartoum State, including different ethnic groups present in Sudan, were examined in 2009-10. Data were collected using patient interviews and clinical examinations. Dental status was recorded using the DMFT index, community periodontal index (CPI), and a validated tooth wear index. RESULTS: Caries prevalence was high, with 87.7% of teeth examined having untreated decay. Periodontal disease increased in extent and severity with age. For 25.8% of adults, tooth wear was mild; 8.7% had moderate and 1% severe toothwear. Multivariate analysis revealed that decay was less prevalent in older age groups but more prevalent in southern tribes and frequent problem based attenders; western tribes and people with dry mouths who presented with less than18 sound, untreated natural teeth (SUNT). Older age groups were more likely to present with tooth wear; increasing age and gender were associated with having periodontal pocketing ≥ 4 mm. CONCLUSIONS: The prevalence of untreated caries and periodontal disease was high in this population. There appear to be some barriers to restorative dental care, with frequent use of dental extractions to treat caries and limited use of restorative dentistry. Implementation of population-based strategies tailored to the circumstances of Sudanese population is important to improve oral health status in Sudan.

Frailty Predicts Adverse Outcomes in Older Patients Undergoing Transcatheter Aortic Valve Replacement (TAVR): From the National Inpatient Sample.

OBJECTIVE: We aimed to study the impact of frailty on the outcome of transcatheter aortic valve replacement (TAVR) procedures. METHODS: The National Inpatient Sample (NIS) database was queried for all patients aged ≥65 years who underwent a TAVR procedure during the years 2016-2017. Frailty was measured using a previously validated Hospital Frailty Risk Score (HFRS) scoring system. The score is ICD-10 code based; thus, it can be calculated from an administrative database. Study outcomes were in-hospital all-cause mortality, peri-procedural complications, length of stay, and total cost. Outcomes were modeled using logistic regression for binary outcomes and generalized linear regression for continuous outcomes. RESULTS: There were 84,750 patients included in the study. These patients were divided into low-risk (61,050), intermediate-risk (22,955), and high-risk (744), based on average frailty index scores of 2, 7, and 16.8, respectively. On multivariable analysis, the HFRS correlated with increased odds for mortality with an adjusted odd ratio (a-OR) of 1.25 (95% CI: 1.22-1.29, p < 0.001), myocardial infarction [a-OR 1.10 (95% CI: 1.07-1.13, p < 0.001)], pericardiocentesis [a-OR 1.16 (95% CI: 1.12-1.20, p < 0.001)], pacemaker insertion [a-OR 1.06 (95% CI: 1.04-1.08, p < 0.001)], blood transfusion [a-OR 1.14 (95% CI: 1.11-1.16, p < 0.001)], vascular complications [a-OR 1.05 (95% CI: 1.00-1.09, p = 0.03)], longer length of stay [a-MR 1.10 (95% CI: 1.10-1.11, p < 0.001)] and higher cost [a-MR: 1.04 (95% CI: 1.03-1.04, p < 0.001)]. CONCLUSION: The HFRS can be utilized in the risk stratification of older patients undergoing TAVR.

Assessing left ventricular systolic function by emergency physician using point of care echocardiography compared to expert: systematic review and meta-analysis.

Assessing left ventricular systolic function (LVSF) by echocardiography assists in the diagnosis and management of a diverse range of patients presenting to the emergency department (ED). We evaluated the agreement between ED-based clinician sonographers and apriori-defined expert sonographers. We conducted a systematic review and meta-analysis based on Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. We searched Medline, EMBASE, Cochrane, ClinicalTrials.gov, TRIP and Google Scholar for eligible studies from inception to February 2021. Risk of bias was evaluated using Quality Assessment Tool for Diagnostic Accuracy Studies-2 tool. The level of agreement between clinician and expert sonographers was measured using kappa, sensitivity, specificity, positive and negative likelihood ratio statistics using random-effects models. Twelve studies were included (1131 patients, 1229 scans and 159 clinician sonographers). Significant heterogeneity was identified in patient selection, methods of assessment of LVSF, reference standards and statistical methods for assessing agreement. The overall quality of studies was low, with most being small, single centre convenience samples. A meta-analysis including seven studies (786 scans) where visual estimation method was used by clinician sonographers demonstrated simple Kappa of 0.68 [95% confidence interval (CI), 0.57-0.79], and sensitivity, specificity, positive and negative likelihood ratio of 89% (95% CI, 80-94%), 85% (95% CI, 80-89%), 5.98 (95% CI, 4.13-8.68) and 0.13 (95% CI, 0.06-0.24), respectively, between clinician sonographer and expert sonographer for normal/abnormal LVSF. The weighted kappa for five studies (429 scans) was 0.70 (95% CI, 0.61-0.80) for normal/reduced/severely reduced LVSF. There is substantial agreement between ED-based clinician sonographers and expert sonographers for assessing LVSF using visual estimation and ranking it as normal/reduced, or normal/reduced/severely reduced, in patients presenting to ED.

Comparing Levels of Metabolic Predictors of Coronary Heart Disease between Healthy Lean and Overweight Females.

Screening for the metabolomic signature of coronary heart disease (CHD) before disease onset could help in early diagnosis and potentially disease prevention. In this study, the levels of 17 CHD metabolic biomarkers in apparently healthy overweight females were compared to lean counterparts, and their associations with conventional clinical risk factors were determined. Clinical and metabolic data from 200 apparently healthy non-obese Qatari females were collected from Qatar Biobank (discovery cohort). Logistic regression was used to assess the association between body mass index (BMI) groups and 17 CHD metabolic biomarkers, and receiver operating characteristic (ROC) analysis was used to evaluate the prognostic value of CHD metabolic biomarkers in overweight. Stepwise linear regression was performed to identify the classical risk factors associated with CHD metabolites differentiating the two BMI groups. Validation of the association of CHD metabolic biomarkers with BMI groups was performed in 107 subjects (replication cohort). Out of the tested CHD metabolic biomarkers, five were significantly different between lean and overweight females in the discovery cohort (AUC = 0.73). Among these, the association of mannose, asparagine, and linoleate with BMI groups was confirmed in the replication cohort (AUC = 0.97). Significant correlations between predictors of CHD in overweight healthy women and classical risk factors were observed, including serum levels of cholesterol, testosterone, triiodothyronine, thyroxine, creatinine, albumin, bilirubin, glucose, c-peptide, uric acid, calcium and chloride. Apparently, healthy overweight females exhibit significantly different levels of specific CHD metabolites compared to their lean counterparts, offering a prognostic potential with preventative value.

Impact of Atrial Fibrillation on Hospitalization Outcomes of Heart Failure in Patients ≥ 60 Years with Implantable Cardioverter Defibrillator.

The impact of atrial fibrillation (AF) on the hospitalization outcomes in patients ≥ 60 years of age with implantable cardioverter defibrillators (ICD) is not well studied. We queried the National Inpatient Sample database for all patients aged ≥ 60 who had a history of ICD placement, and were admitted with a primary diagnosis of heart failure (HF) during the years 2016-2017. Patients were stratified into 2 groups based on their history of AF. The primary outcome of the study was all-cause in-hospital mortality. Secondary outcomes included cardiogenic shock, myocardial infarction (MI), ventricular fibrillation (VF), stroke and acute kidney injury (AKI). The association between different age strata and outcomes was investigated. The hospitalization outcomes were modeled using logistic regression. A total of 178,045 patients were included, of whom 56.2% had AF. AF correlated with increased mortality (A-OR 1.22 (95% CI: 1.06-1.4), p=0.005), cardiogenic shock (A-OR 1.21 (95%CI: 1.08-1.36), p<0.001), AKI (A-OR 1.12 (95%CI: 1.06-1.17), p<0.001 and lower risk for MI (A-OR 0.79 (95% CI: 0.68-0.9), p<0.001. There was no correlation between AF and risk for VF or stroke. A significant correlation between AF and higher risk for mortality, cardiogenic shock and AKI was demonstrated in ages ≤ 75, ≤ 75, and ≤ 80 years, respectively. In contrast, a significant correlation between AF and lower risk for MI is only demonstrated at age > 70 years. We conclude that AF is an independent predictor for increased all-cause in-hospital mortality and cardiogenic shock. Such risk is influenced by age.

Predicting hypertension using machine learning: Findings from Qatar Biobank Study.

BACKGROUND AND OBJECTIVE: Hypertension, a global burden, is associated with several risk factors and can be treated by lifestyle modifications and medications. Prediction and early diagnosis is important to prevent related health complications. The objective is to construct and compare predictive models to identify individuals at high risk of developing hypertension without the need of invasive clinical procedures. METHODS: This is a cross-sectional study using 987 records of Qataris and long-term residents aged 18+ years from Qatar Biobank. Percentages were used to summarize data and chi-square tests to assess associations. Predictive models of hypertension were constructed and compared using three supervised machine learning algorithms: decision tree, random forest, and logistics regression using 5-fold cross-validation. The performance of algorithms was assessed using accuracy, positive predictive value (PPV), sensitivity, F-measure, and area under the receiver operating characteristic curve (AUC). Stata and Weka were used for analysis. RESULTS: Age, gender, education level, employment, tobacco use, physical activity, adequate consumption of fruits and vegetables, abdominal obesity, history of diabetes, history of high cholesterol, and mother's history high blood pressure were important predictors of hypertension. All algorithms showed more or less similar performances: Random forest (accuracy = 82.1%, PPV = 81.4%, sensitivity = 82.1%), logistic regression (accuracy = 81.1%, PPV = 80.1%, sensitivity = 81.1%) and decision tree (accuracy = 82.1%, PPV = 81.2%, sensitivity = 82.1%. In terms of AUC, compared to logistic regression, while random forest performed similarly, decision tree had a significantly lower discrimination ability (p-value<0.05) with AUC's equal to 85.0, 86.9, and 79.9, respectively. CONCLUSIONS: Machine learning provides the chance of having a rapid predictive model using non-invasive predictors to screen for hypertension. Future research should consider improving the predictive accuracy of models in larger general populations, including more important predictors and using a variety of algorithms.

Early feeding practices and associated factors in Sudan: a cross-sectional analysis from multiple Indicator cluster survey.

BACKGROUND: In efforts to reduce neonatal mortality, the World Health Organization (WHO) has included breastfeeding among its recommended packages of interventions. Early initiation of breastfeeding and avoidance of prelacteal feeding are key contributors to optimal feeding practices. This study aims to assess the prevalence and associated factors of early breastfeeding practices in Sudan. METHODS: This study utilises the cross-sectional nationally-representative Sudan Multiple Indicator Cluster Survey (MICS) conducted in 2014. The sample includes women who had a live birth in the two years before the survey and their self-report on early breastfeeding practices, namely early initiation and prelacteal feeding. Percentages of these early breastfeeding practices indicators were estimated accounting for the complex survey design. Multivariable logistic regression analyses were used to examine the factors associated with these outcomes. RESULTS: Of 5622 mothers, 69% initiated breastfeeding within one hour of birth, 72% avoided prelacteal feeding in the first three days after birth, and 51% met the criteria for both (i.e. practised optimal early feeding practice). Optimal early feeding varied across regions of Sudan. Birth by caesarean section (Adjusted Odds Ratio [AOR] 0.34; 95% CI 0.25, 0.47) and at a health facility (AOR 0.75; 95% CI 0.60, 0.94) were negatively associated with optimal early feeding practice. Mothers with secondary education (AOR 1.62; 95% CI 1.30, 2.02), those who desired their pregnancy at the time (AOR 1.31; 95% CI 1.08, 1.60), those who were assisted by a skilled birth attendant at birth (AOR 1.48; 95% CI 1.19, 1.83), and those who gave birth to female infants (AOR 1.16; 95% CI 1.02, 1.33) had higher odds of use optimal early feeding practice. Similarly, the odds of optimal early feeding increased with parity and maternal age. CONCLUSIONS: Only half of Sudanese mothers practised optimal early feeding practice, with important differences between regions in the country. Early feeding practices in Sudan are associated with various maternal, child and community level factors. The findings suggest the need to develop breastfeeding promotion programs with consideration of regional variations and healthcare system interventions.

Relation of Age to Survival in Patients with Obstructive Sleep Apnea who Develop an Acute Coronary Event (from the National Inpatient Sample).

This study was undertaken to investigate whether obstructive sleep apnea (OSA) produces a survival advantage in acute coronary syndrome (ACS), and to evaluate the mechanism of any benefit, including the impact of age and other risk factors. The National Inpatient Sample was queried for all patients who were admitted for ACS during the years 2013 to 2014. The primary outcomes were all-cause in-hospital mortality and cardiogenic shock (CS). Multivariable logistic regression was used for analysis. A total of 1,080,340 patients with ACS were included, 63,255 patients had OSA. The majority of patients were males (60.3%) and of Caucasian race (75%). The mean age was 67 years (SEM: 0.1). Despite a higher burden of risk factors and older age, OSA patients had a lower risk for mortality and cardiogenic shock adjusted OR 0.68 (95%CI 0.61-0.75), p <0.001 and 0.81 (95%CI: 0.74 to 0.89), p <0.001 respectively. Age was an important effect modifier. Survival advantage and lower risk for CS arises at the age above 55 and become more apparent with increasing age. In conclusion, despite a higher CV risk profile, and older age, OSA produces a survival benefit in ACS. Age is a significant modifier of risk in OSA patients with ACS. Ischemic preconditioning might explain these results.

National Trends of Outcomes in Transcatheter Aortic Valve Replacement (TAVR) Through Transapical Versus Endovascular Approach: From the National Inpatient Sample (NIS).

BACKGROUND: To evaluate the trends in complication rates following transcatheter aortic valve replacement (TAVR) procedures according to the type of vascular approach (endovascular vs. transapical) in a large US population sample. METHODS: The National Inpatient Sample (NIS) was queried for all patients diagnosed with aortic stenosis who underwent a TAVR procedure in the United States during the years 2012-2016. Outcomes assessed were peri-procedural mortality, cardiac, and non-cardiac complications. Hospitalization outcomes were modeled using logistic regression for binary outcomes and generalized linear models for continuous outcomes. RESULTS: There were 97,320 endovascular-TAVR patients and 11,140 transapical-TAVR patients. The mean age was 80.8 years (standard error of the mean: ± 0.1). Most patients were males (53.7%) and Caucasian (87.1%). On multivariate analysis, after adjusting for age, gender, comorbidities, as well as hospital factors, patients with the transapical approach had a higher risk for mortality and adverse outcomes. Among the endovascular-TAVR group, national trends showed a diminishing incidence of procedural mortality (incidence rate ratio [IRR] 0.77; 95% CI: 0.72-0.84, p < 0.001), stroke (IRR 0.80; 95% CI: 0.73-0.87, p < 0.001), and all secondary outcomes, but no significant change in myocardial infarction. In contrast, most transapical-TAVR related procedural complications remained unchanged over time, except for a significant decrease in stroke, acute respiratory failure and need for pacemaker insertion. CONCLUSION: National trends show a steady increase in the number of endovascular-TAVR procedures with a concurrent decrease in procedural complications.

Public practices on antibiotic use: A cross-sectional study among Qatar University students and their family members.

BACKGROUND: Antimicrobial resistance (AMR) is a serious public health problem and a global concern. The inappropriate use of antibiotics has been identified by the World Health Organization as a major risk factor for AMR. METHODS: The purpose of this research study is to assess the prevalence of inappropriate antibiotic use among Qatar University students and their family members, detect sociodemographic factors associated with inappropriate use, evaluate the knowledge and attitude towards antibiotic use, and assess respondents' opinions on healthcare providers' antibiotic prescription practices. Participants (N = 596) completed a self-administered questionnaire. Descriptive analysis, the Pearson chi-squared test, and multivariate logistic regression analyses were performed. RESULTS: The major inappropriate antibiotic use practices followed by the respondents were using antibiotics without prescription (82%), not completing the antibiotic course (45%), and obtaining antibiotics from the pharmacy without prescription (23%). The chi-square test results showed that age (p = 0.031) and nationality (p = 0.041) were associated with using antibiotics without prescription. In addition, respondents less than 21 years of age (p<0.001), who had only a secondary education (p = 0.007), and who lived in one of the large and crowded cities in Qatar (p = 0.011) had higher odds of stopping the antibiotic before completing the course. Our study also revealed that almost 60% of the respondents had inadequate knowledge and a negative attitude towards antibiotic use. Nationality and municipality were the independent factors associated with having appropriate knowledge of antibiotic use. Univariate logistic regression analyses in our study demonstrated that older (>26 years), married and university-graduated participants were more likely to have a positive attitude towards antibiotic use than others. Respondents also reported that neither doctors nor pharmacists were providing adequate patient education about appropriate antibiotic use. The Socio-Ecological Model was applied to interpret the findings and frame implications. CONCLUSION: The findings shed light on various factors shaping antibiotic use practices and provide evidence to design multilevel behavioral interventions to improve public practices of antibiotic use.