The Effects of Distance, Time, and Nonspatial Factors on Hemodialysis Access in Qatar.

Background A long distance and time spent traveling to a hemodialysis (HD) center and other factors, such as comorbidities, can significantly impact HD patient compliance, satisfaction, and cost. Uncertainty about HD-dependent patients' geographical location may lead to inappropriate distribution of HD centers. The present study investigates travel time, distance, and nonspatial factors affecting HD center accessibility within a 30-km radius in the State of Qatar. Materials and methods The study included all HD-dependent patients residing in Qatar between March 1, 2020, and December 31, 2021. There were 921 patients dialyzed in six HD centers across Qatar. Our methodology incorporated descriptive and analytical cross-sectional designs to accurately identify the shortest routes and quickest travel times. We used two applications (Maptive {Vancouver, WA: BatchGeo LLC} and Google Maps {Mountain View, CA: Google LLC}) and marked a driving distance of 30 km as the main assessment scale and measurement standard, allowing optimum spatial accessibility determination. Results On average, patients traveled approximately 19±4.2 km, requiring almost 17.6±3.4 minutes to reach the assigned HD center three times per week. Based on geographic-spatial accessibility analysis, patients living in Umm Salal drove 31.4±3.5 km in 32.4±4.7 minutes, Al Daayen patients drove 30.2 km in 25.3 minutes, and others even drove more than 70 km to access HD sessions. Approximately 37.8% of Qatar's municipalities had no HD centers within their boundaries, but nearly 47% of HD-dependent patients lived in those municipalities. Additionally, some municipalities had HD centers; however, their general population density was less than 100 inhabitants/km2, and they had relatively few patients requiring regular HD. We noted a statistically significant correlation between the patients' residences and the locations of HD centers, whether they were located within or outside municipalities. Also, nonspatial factors may have affected the likelihood of reaching a hemodialysis center within a 30-km distance, including two or more comorbid conditions, having HD for at least five years, living in a municipality with more than 1,000 inhabitants/km2, being female, and attending dialysis centers that are more than 30 km away. Conclusion Although the available HD centers were sufficient for the present number of patients requiring HD, HD center locations did not match the patients' distribution, leading to difficulties for some patients. Understanding the impact of this geographic mismatch, population density, and other spatial factors helps significantly improve patient care and satisfaction at minimal cost. Furthermore, considering all these factors is crucial when planning new centers to achieve higher satisfaction and compliance as well as better health care.

Epidemiologic and Clinical Patterns of Malignant Lymphoma in Qatar 2013-2017: A population-based Cohort Study.

BACKGROUND: Lymphoma, encompassing common non-Hodgkin lymphoma (NHL) and less common Hodgkin lymphoma (HL), represents significant hematological malignancies. Advancements in treatment modalities have reshaped survival rates, particularly in NHL. This complexity results in varying outcomes, some requiring extended observation periods and multiple chemotherapy treatments. OBJECTIVE: The primary objective is to explore and compare the overall survival (OS) of HL and NHL at 1, 3, and 5-year follow-ups among adult lymphoma patients in Qatar during January 2013 - December 2017. Further objectives encompass comparing the most prevalent histological types, clinical and epidemiological traits of HL and NHL, as well as secondary aims of assessing clinical features, treatment, response, disease-free survival, and overall survival. METHODS: A retrospective, descriptive study of consecutive cases was conducted at Qatar's NCCCR between 2013 and 2017. Inclusion criteria involved patients ≥18 years old, of any gender and clinical stage at diagnosis, who received chemotherapy and had known outcomes. Descriptive statistics were applied, and survival analysis utilized Kaplan-Meier curves. STATA version 13.0 facilitated data analysis. RESULTS: Between 2013-2017, 414 individuals in Qatar were diagnosed with lymphoma. The median age at diagnosis was 49 years (IQR 36-95 years; p<0.001) across all patients. Males exhibited a higher likelihood of developing HL and NHL, comprising 74% and 70% of cases respectively, though this difference was statistically insignificant (p=0.45). Among NHL-B subtypes, mature B-cell neoplasms (60%) predominated, while Lymphocyte-rich subtype (49%) was prominent in HL cases. With a median follow-up of 17.3 months, OS rates at 1, 3, and 5 years were 99%, 82%, and 64% respectively for all lymphoma patients. Subtype stratification revealed trends in 3-year follow-up OS (94% versus 82%) for HL and NHL, with 5-year OS of 67% and 60% respectively. HL demonstrated higher OS throughout the study period compared to NHL (p<0.001), though median OS remained unreached. CONCLUSIONS: Diffuse large B-cell lymphoma emerged as the most prevalent subtype among lymphomas in Qatar. Generally, HL exhibited superior survival rates, at 67% compared to 60% for NHL. Minor deflation in survival rates, particularly for HL, might be attributed to Qatar's immigration patterns.

Time Spent on Medical Round Activities, Distance Walked, and Time-Motion in the General Medicine Department at Hamad General Hospital in Qatar.

Background The daily morning round is a routine activity performed by medical teams. During the morning round, updates on the patient's clinical condition, new laboratory results, and other test results are reviewed and discussed between team members, the patient, and at times the family. Completing these tasks takes time. The design of the patient location differs between hospitals, and significant distance between patients can considerably affect round times. This study assesses physicians' time spent on clinical activities, the distance traveled, and the time they spend walking between patients during daily morning rounds to identify better reorganization methods to reduce wasted time. Methodology The survey was self-administered and had no intervention needing ethical approval. The research team's leader engaged two observers (a general practitioner from another department and a general internal medicine department case manager) to collect the data. The general practitioner was a medical graduate doctor, while the bed manager was not a medical college graduate. They observed 10 rounds over 10 non-consecutive days from July 1 to July 30, 2022. They recorded daily activities during the daily morning round, including time spent with patients, family conversations, bedside education, medication, social issues, and the time and distance required to move from patient to patient and from one location to location. The informal conversations about age, work history, and other small talk were recorded and converted into quantitative data. In each round, records were given to a statistician for rechecking. Subsequently, the records were imported into a Microsoft Excel spreadsheet for further statistical analysis. For continuous variables, the data were summarized as mean, median, and standard deviation. For categorical variables, the data were summarized as counts or proportions. Results On average, the duration of the daily morning round was 161.7 ± 17.3 minutes. The average number of patients seen by the general internal medicine round team was 14. The median patient encounter time per patient was 14 minutes (11-19 minutes), with an average of 12 minutes. An average of 8.6 employees participated in the 10-day rounds. The physician spent 41.2% of the time in direct contact with the patient during the morning round, 11.4% in maintaining electronic medical records, and 18.20% in bedside teaching. Additionally, 7.1% of the round time was spent because of interruptions by clinical and non-clinical staff other than team members or family members who were not in the room. Furthermore, a team member walked an average of 763 ± 54.5 m (667-872 m) per round, costing 35.7 minutes (22.1%) of the total round time. Conclusions The daily morning round time was significantly longer compared with the reported round times. Relocating patient beds to a common location reduced the rounding time by 22.30%. Disruption, teaching, and medical instruction must also be considered and shortened to reduce the morning round time.

The Pros and Cons of Use of Handheld Electronic Devices During Ward Rounds and the Impact of the COVID-19 Pandemic.

Purpose: The exponential use of handheld electronic devices (HEDs) among healthcare providers has shown the potential to enhance clinical workflows and improve patient care. However, the challenges and risks of carrying these devices during ward rounds and their impact on postgraduate trainees' (PGTs') training in general and more specifically during the COVID-19 pandemic need to be explored. Methods: A cross-sectional mixed-methods online survey was conducted to evaluate the perceptions of trainees and faculty at Accreditation Council for Graduate Medical Education International accredited residency and fellowships programs in Qatar on the use of HEDs on clinical workflow, trainees' education, and the impact of the COVID-19 pandemic. One hundred and fifty-eight participants were enrolled in the study (87 postgraduate trainees and 71 faculty). Exploratory data analysis and descriptive statistics were performed using STATA version 12 and thematic analysis of 301 qualitative responses to the survey open-ended questions using Atlas. ti qualitative software, version 9.4.0. Results: Almost all PGTs, 83 (95.4%), and faculty 43 (62.3%) use HEDs during ward rounds. Accessibility of patient information by PGTs 73 (94.8%) and faculty 46 (84.4%) and work efficiency were the main perceived benefits. Hindering communication between team members, disruption of interaction with patients, increased risk of infection and breach of patient confidentiality were among the challenges associated with their use. Carrying devices reduced the frequency of hand hygiene practices and physical examinations of patients by trainees. The COVID-19 pandemic led to a decrease in the use of HEDs by both faculty [38(64%)] and PGTs [42(60%)]. Conclusion: HEDs' use is valued by both faculty and PGTs in enhancing workflow, trainees' education, patient experience, and patient care during the COVID-19 pandemic. Graduate medical education leaders should adopt measures to monitor their use during ward rounds as they can negatively impact trainees' education, reduce interaction with patients, increase the risk of infection, and breach patient confidentiality.

An Evaluation of Healthcare Safety Culture Among Healthcare Professionals in Secondary and Tertiary Public Hospitals in the Middle East Region.

Background and aim The provision of quality healthcare is initiated by a culture of patient safety. Understanding the patient safety culture (PSC) is a critical concept for all healthcare workers. We conducted this study to evaluate the PSC understanding among the Hamad Medical Corporation (HMC) staff members. Furthermore, to establish a local (HMC) reference point for providing quality health care based on a culture of patient safety. Method A Hospital Patient Safety Culture Survey (HSOPSC) was presented to our health system employees to assess their perceptions and understandings of PSC. The survey was self-administered. STATA Package version 12.0 culture software was used to analyze these data in terms of descriptive, correlational, and multivariate ordinal regression. Results This study targeted to survey 6,538 employees in HMC facilities, but only 5,583 responded, resulting in a percentage response rate of 85.4%. Ten facilities achieved 100% participation, and other HMC facilities had response rates ranging from 71.2% to 97.5%. Approximately 88.0% of the responders had direct patient contact. The HSOPSC survey resulted in an overall positive response rate of 62.4%. The dimensions with the highest positive response score were "teamwork within the Unit" followed by "organizational learning/continuous improvement" and "management support for patient safety" with a mean percent positive response (PPR) of 83.1%, 82.0%, and 79.2%, respectively. Conversely, there are three dimensions with the lowest positive response score, including "communication openness," "staffing," and "nonpunitive response to errors," with a mean PPR of 46.6%, 40.1%, and 27.7%, respectively. ANOVA and the student t-test revealed that men (64.3% ± 8.1%), employees with 11-15 years of experience in their specialty (65.8% ± 6.5%), and general hospital type (64.4% ±7.2%), were all significantly associated with differences in the overall perceptions of PSC. According to the study results, there was a moderate correlation between perceptions of PSC at the hospital and the following: Teamwork Across Units (RS= 0.43; p < 0.05), and Frequency of Events Reported (RS= 0.40; p < 0.05.). A regression analysis found that men, workers under 40 years of age, professionals with no direct contact with patients, employees with 11-15 years of experience in their specialty, intensive care staff, and general hospital staff were all significant predictors of overall favorable perceptions of the PSC. Conclusion PSC's understanding of HMC staff is moderate. Furthermore, this is the first study conducted for PSC understanding by the HMC staff in Qatar State. It is eligible to be considered a backbone and reference for new research projects about PSC in Qatari health facilities, if not worldwide.

Time-Series Forecasting of Hemodialysis Population in the State of Qatar by 2030.

BACKGROUND: There are few statistics on dialysis-dependent individuals with end-stage kidney disease (ESKD) in Qatar. Having access to this information can aid in better understanding the dialysis development model, aiding higher-level services in future planning. In order to give data for creating preventive efforts, we thus propose a time-series with a definitive endogenous model to predict ESKD patients requiring dialysis. METHODS: In this study, we used four mathematical equations linear, exponential, logarithmic decimal, and polynomial regression, to make predictions using historical data from 2012 to 2021. These equations were evaluated based on time-series analysis, and their prediction performance was assessed using the mean absolute percentage error (MAPE), coefficient of determination (R2), and mean absolute deviation (MAD). Because it remained largely steady for the population at risk of ESKD in this investigation, we did not consider the population growth factor to be changeable. (FIFA World Cup 2022 preparation workforce associated growth was in healthy and young workers that did not influence ESKD prevalence). RESULT: The polynomial has a high R2 of 0.99 and is consequently the best match for the prevalence dialysis data, according to numerical findings. Thus, the MAPE is 2.28, and the MAD is 9.87%, revealing a small prediction error with good accuracy and variability. The polynomial algorithm is the simplest and best-calculated projection model, according to these results. The number of dialysis patients in Qatar is anticipated to increase to 1037 (95% CI, 974-1126) in 2022, 1245 (95% CI, 911-1518) in 2025, and 1611 (95% CI, 1378-1954) in 2030, with a 5.67% average yearly percentage change between 2022 and 2030. CONCLUSION: Our research offers straightforward and precise mathematical models for predicting the number of patients in Qatar who will require dialysis in the future. We discovered that the polynomial technique outperformed other methods. Future planning for the need for dialysis services can benefit from this forecasting.

IgA nephropathy pathogenesis and therapy: Review & updates.

BACKGROUND: IgA nephropathy (IgAN) is the most frequent type of primary glomerulonephritis since the first type was described more than four decades ago. It is the prevalent cause of primary glomerular disease that causes end-stage renal disease. In most patients with IgAN, hematuria is the most common reported symptom, particularly in those with a preceding upper respiratory tract infection. Although the pathogenesis of IgAN is usually multifactorial, autoimmune complex formation and inflammatory processes are the most widely recognized pathogenic mechanisms. Multiple approaches have been trialed as a therapy for IgAN, including tonsillectomy, steroids, other immune-suppressive therapy in different regimens, and kidney transplantation. AIM AND METHOD: PubMed, Google, Google Scholar, Scopus, and EMBASE were searched by the authors using different texts, keywords, and phrases. A non-systemic clinical review is intended to review the available data and clinical updates about the possible mechanism(s) of IgAN pathogenesis and treatments. CONCLUSION: IgAN has a heterogeneous pattern worldwide, making it difficult to understand its pathogenesis and treatment. Proteinuria is the best guide to follow up on the IgAN progression and treatment response. Steroids are the cornerstone of IgAN therapy; however, other immune-suppressive and immune-modulative agents are used with a variable response rate. Kidney transplantation is highly advisable for IgAN patients, although the recurrence rate is high. Finally, IgAN management requires collaborative work between patients and their treating physicians for safe long-term outcomes.

Scenarios to Improve the Patient Experience Time in a Tertiary Academic Hospital Using Simulation.

Background Shortening the patient experience time (PET) in the emergency department (ED) improves patient quality and satisfaction and reduces mortality and morbidity. Worldwide, the PET target in the ED is ≤ 6 hours; however, the PET awaiting admission to inpatient Medicine at Hamad General Hospital (HGH) in the Qatar State, through ED is currently 15.3±6.4 (mean ± SD) hours. Aim Identify solutions to reduce the PET duration at HGH-ED to the international target. Method A cohort study was done using the Discrete-event simulation (DES) model, utilizing a commercial simulation software package (Process Model Inc., Utah, version 5.2.0). One-year data, January 1, 2019 - December 30, 2019, was analyzed and found to follow seven subprocesses. The duration of each subprocess was recorded, and the average time was calculated. A computer simulation scheme was developed for all the subprocesses of the actual PET duration. The simulated PET was validated, and scenarios were proposed and assessed for each subprocess separately and in combination, A constructed simulatory design using an iterative process involving a construction model. This model starts with the logical organization of submitted tasks based on their cycle times. A subject-matter expert interview was conducted to determine the appropriateness and frequency of actions. The duration of each activity in the considered process was defined using a triangular distribution. Results The actual PET duration for the Medical Department was 15.3±6.4 (mean + SD) hours. The three most prolonged PET subprocess durations were in the referral to internal medicine, the decision to admit, and finding a free bed; these represent 17.9%, 53.8%, and 16.7% of the PET, respectively. Adding two physicians to each shift, which shortens the subprocess of the decision to admit, reduced the PET duration by 27.5%. Moreover, creating a new admitting team (unit) that takes care of new patients admitted to the ED reduced PET duration by another 12.5%. Combining these two scenarios reduced the average PET duration to only 10.2±0.5 hours. In addition to these scenarios, the PET can be further decreased to six hours by increasing the number of inpatient beds. Conclusions The simulated scenarios indicated that restructuring the medical teams, adding two physicians to each shift, and creating an admissions team dedicated to the ED would reduce the total PET duration to 10.2 hours, Furthermore, PET's further reduction to six hours is predictable by increasing the bed number.

Hyponatremia and SARS-CoV-2 infection: A narrative review.

A novel rapid spreading and changing virus called SARS-CoV-2 appeared in Wuhan city in December 2019. It was announced by the World Health Organization (WHO) as a pandemic disease in March 2020. It commonly presents with respiratory symptoms; however, it may be asymptomatic. Electrolyte abnormalities are not uncommon features of SARS-CoV-2 infection. Hyponatremia is one of these electrolyte disturbances among SARS-CoV-2 patients, and it may produce symptoms such as weakness and seizure as the initial presenting symptoms. The underlying mechanism(s) of hyponatremia due to SARS-CoV-2 infection is (are) not established. The aim of this review is to evaluate the possible mechanism of hyponatremia in patients with COVID-19. Understanding and categorizing the hyponatremia in these patients will lead to better treatment and correction of the hyponatremia. A review of the literature between December 2019 and March 2022 was conducted searching for the possible reported mechanism(s) of hyponatremia in SARS-CoV-2. Although SIADH is the commonly reported cause of hyponatremia in SARS-CoV-2 infection, other causes such as diarrhea, vomiting, and kidney salt loss must be considered before SIADH.

Chest X-ray Findings and Hyponatremia in COVID-19 Pneumonia Patients.

BACKGROUND: The World Health Organization declared the coronavirus disease-2019 (COVID-19) a pandemic in December 2019. COVID-19 can affect most organs of the body but predominantly affects the lungs. Chest infection is associated with hyponatremia primarily due to inappropriate ectopic secretion of antidiuretic hormone. We conducted a six-month retrospective observational study to evaluate the relationship between chest X-ray (CXR) radiological findings and serum sodium levels. Our secondary goal was to assess the relationship between CXR findings and patient outcomes. AIM OF THE STUDY: To assess the relationship between the initial CXR findings, hyponatremia severity, and outcome in COVID-19 infected patients. MATERIALS AND METHODS: We conducted a retrospective review of CXR findings of COVID-19 patients aged > 18 years. The patients were healthy and had no history of hyponatremia before COVID-19 infection. All recruited patients were admitted to one of four hospitals in Qatar (Hazm Mebaireek General Hospital, Communicable Disease Center, and all affiliated quarantine centers managed under the Communicable Disease Centre, Mesaieed Hospital, and Ras Laffan Hospital) between March and June 2020. We excluded patients with factors that contributed to hyponatremia. Three score grades were established to describe the CXR findings. Patients were divided into three groups by the principal researcher according to their serum sodium levels. A radiologist evaluated the CXR findings with the patient and group information obscured. The principal researcher collected the X-ray scores for analysis with the serum sodium levels. We used SPSS for Windows, Version 15.0. (SPSS Inc., Chicago, IL, USA) and STATA Package Version 12.0 (StataCorp, College Station, TX, USA) to analyze the data. A p-value ≤  0.05 was considered significant. RESULTS: A total of 414 CXR patients with COVID-19 were recruited; 275 patients had hyponatremia and 139 had normal sodium levels and were used as the control group. Patients with normal serum sodium and hyponatremia were classified into three categories based on the CXR findings. Grade 0 (95), Grade 1 (43), and Grade 2 (137) hyponatremic patients were reported. The mean sodium levels were 133.6, 131.3, and 127.2 mmol/L for Grades 0, 1, and 2, respectively (p < 0.001). More than 95% of the patients who developed hyponatremia were >30 years. Moderate and severe hyponatremia was more prevalent in patients with Grade 1 or Grade 2 CXR findings and were >30 years. CONCLUSION: Serum sodium levels in COVID-19 patients correlated well with the severity of the CXR findings observed at the early disease stage. Furthermore, simple CXR scores can be used to identify COVID-19 patients at a higher risk of hyponatremia, length of hospital stay, medical care support type, and mortality.

Redistribution of Doctors and Decentralization of Clinics Improved Utilization of Services, Demand, and Capacity of Hamad Medical Corporation's Staff Clinic.

BACKGROUND:  The Staff Medical Clinic (SMC) of the Hamad Medical Corporation (HMC) serves the staff members who require healthcare services, but in a crowded environment, the SMC can only meet 75% of that demand. Overcrowding reduces productivity and service quality and increases waiting time. Furthermore, overcrowding in healthcare facilities decreases the experience and satisfaction of patients and healthcare providers. AIM: The main objective of this study was to use simulation modeling to evaluate interventions that could improve SMC waiting time and efficiency. METHOD:  Eighteen months of data on SMC patient flow, staffing, and clinical sessions were collected (January 2018 to June 2019). The patient's journey through the SMC was modeled as a series of processes with assigned durations defined mathematically using the appropriate probability distribution. A simulation flow model was developed considering the locations of the staff and nearby main hospital facilities. An intervention was proposed and evaluated through a simulation. The intervention involved redistributing 25% of the SMC staff into three main satellite clinics located at the facilities where most of the SMC patients came.  Results: The proposed intervention decreased crowding by 37%, reduced staffing requirements by 28%, and increased the number of patient slots by 22%, resulting in a net increase in the number of patients served by an average of 1250 monthly, without the need for hiring new additional staffing. CONCLUSION:  Redistribution of the available medical staff to three new satellite clinics reduces workload pressure at all sites and increases clinic capacity without additional costs.

Clinical, Radiological, and Outcome Characteristics of Acute Pulmonary Embolism: A 5-year Experience from an Academic Tertiary Center.

BACKGROUND: Acute pulmonary embolism (PE) is a common and potentially life-threatening condition. This comprehensive study from a Gulf Cooperation Council (GCC) country aimed to evaluate the clinical, radiological, and outcome characteristics associated with acute PE. METHODS: This retrospective observational study analyzed data of patients with confirmed acute PE who were admitted to the largest academic tertiary center in the State of Qatar from January 1, 2014, to December 31, 2018. Data on the clinical presentation, radiologic, and echocardiographic findings, as well as outcomes were collected. RESULTS: A total of 436 patients were diagnosed with acute PE during the study period (male, 53%). Approximately 56% of the patients were < 50 years old at presentation, with a median age of 47 years. In approximately 69% of cases, the PE occurred outside the hospital. The main associated comorbidities were obesity (34.6%), hypertension (29.4%), and diabetes (25%). Immobilization (25.9%) and recent surgery (20.6%) were the most common risk factors. The most frequent presenting symptom was dyspnea (39.5%), and the most frequent signs were tachycardia (49.8%) and tachypnea (45%). Cardiac arrest was the initial presentation in 2.2% of cases. Chest X-ray findings were normal in 41%. On computed tomography pulmonary angiography (CTPA), 41.3% of the patients had segmental PE, 37.1% had central PE, and 64.1% had bilateral PE. The main electrocardiographic (ECG) abnormality was sinus tachycardia (98%). In patients who underwent echocardiography, right ventricular (RV) enlargement was the main echocardiographic finding (36.4%). Low-, intermediate-, and high-risk PE constituted 49.8%, 31.4%, and 18.8% of the cases, respectively. Thrombolysis was prescribed in 8.3% of the total and 24.4% of the high-risk PE cases. Complications of PE and its treatment (from admission up to 6 months post-discharge) included minor bleeding (14%), major bleeding (5%), PE recurrence (4.8%), and chronic thromboembolic pulmonary hypertension (CTEPH) (5%). A total of 15 (3.4%) patients died from PE. CONCLUSIONS: Acute PE can manifest with complex and variable clinical and radiological syndromes. Striking findings in this study are the younger age of acute PE occurrence and the low PE-related mortality rate.

Effectiveness of Messenger RNA Vaccines against SARS-CoV-2 Infection in Hemodialysis Patients: A Case-Control Study.

Patients with end-stage kidney disease (ESKD) are at increased risk for SARS-CoV-2 infection and its complications compared with the general population. Several studies evaluated the effectiveness of COVID-19 vaccines in the dialysis population but showed mixed results. The aim of this study was to determine the effectiveness of COVID-19 mRNA vaccines against confirmed SARS-CoV-2 infection in hemodialysis (HD) patients in the State of Qatar. We included all adult ESKD patients on chronic HD who had at least one SARS-CoV-2 PCR test done after the introduction of the COVID-19 mRNA vaccines on 24 December 2020. Vaccinated patients who were only tested before receiving any dose of their COVID-19 vaccine or within 14 days after receiving the first vaccine dose were excluded from the study. We used a test-negative case−control design to determine the effectiveness of the COVID-19 vaccination. Sixty-eight patients had positive SARS-CoV-2 PCR tests (cases), while 714 patients had negative tests (controls). Ninety-one percent of patients received the COVID-19 mRNA vaccine. Compared with the controls, the cases were more likely to be older (62 ± 14 vs. 57 ± 15, p = 0.02), on dialysis for more than one year (84% vs. 72%, p = 0.03), unvaccinated (46% vs. 5%, p < 0.0001), and symptomatic (54% vs. 21%, p < 0.0001). The effectiveness of receiving two doses of COVID-19 mRNA vaccines against confirmed SARS-CoV-2 infection was 94.7% (95% CI: 89.9−97.2) in our HD population. The findings of this study support the importance of using the COVID-19 mRNA vaccine in chronic HD patients to prevent SARS-CoV-2 infection in such a high-risk population.

Featuring Trends in the Epidemiology of Lung Cancer Following the Publication of the National Cancer Strategy in Qatar.

OBJECTIVES: Qatar has witnessed significant reforms in its health care system, including the care of cancer patients. In 2011, the National Cancer Strategy was released with the aim to deliver a high standard of care to cancer patients across the country. We sought to investigate the featuring trends in the epidemiological and clinical characteristics of lung cancer in Qatar following the publication of the National Cancer Strategy. METHODS: We conducted a retrospective cohort study documenting the epidemiological and clinical characteristics of primary lung cancer cases in Qatar diagnosed from 1 January 2011 to 31 December 2018. RESULTS: The overall age-standardized incidence rate was 8.7 per 100 000 persons (11.6 per 100 000 and 5.4 per 100 000 persons for males and females, respectively). The one, three, and five-year overall survival rates were 67.0%, 48.0%, and 28.0%, respectively. The three-year overall survival rates for stages I, II, III, and IV were 97.0%, 78.0%, 52.0%, and 31.0%, respectively. The three-year survival rates for males and females were 43.0% and 64.0%, respectively (p = 0.029), for Qatari and non-Qatari nationals were 42.0% and 49.0%, respectively (p = 0.252), and for smokers and non-smokers were 39.0% and 69.0%, respectively (p ≤ 0.001). The overall age-standardized mortality rate was 5.5 per 100 000 persons. Adenocarcinoma was the most common histologic type. CONCLUSIONS: Despite the low overall lung cancer incidence rate in Qatar, there is a rise in the incidence among females when compared to previous studies. Qatar has favorable five-year lung cancer survival rates compared to many developed and neighboring countries. Policymakers in the country should consider the changing patterns in lung cancer incidence when planning future preventive strategies.

Knowledge, Attitude and Practice of Physicians Regarding Screening of Colorectal Cancer in Qatar: A Cross-Sectional Survey.

PURPOSE: The aim of this study was to evaluate the rate of internal medicine residents' and faculties' (specialists and consultants) compliance to colorectal cancer screening in Hamad Medical Corporation (Doha, Qatar) and to identify barriers as well as facilitators that will assist in drawing up changes that would enhance physician-related cancer screening. METHODS: A cross-sectional web-based survey was distributed among internal medicine physicians at three component hospitals of Hamad Medical Corporation (HMC); focusing on knowledge and practice of colorectal cancer screening, its barriers and facilitators. Chi-square and t-test statistics were used to draw conclusions where appropriate. RESULTS: The response rate for the survey was 91% and over 75% of the survey respondents were post-graduate trainees. The majority (90.6%) of the physicians (n=144) mentioned that they would recommend colorectal cancer screening for their asymptomatic patients, though trainees tend to choose the correct modality of screening compared to the consultants, 86.21% vs 40.74%. Only 43.4% of the survey participants always to usually recommend screening to their patients in their clinics while only 29.4% do so for their inpatients. Even though there was no statistically significant difference among the frequency of outpatient colorectal cancer screening among trainees, specialists or consultants (p=0.628), there was a clear increase in the reported referrals as the training years or the years of experience increases (p=0.049 for trainees and p=0.009 for faculty). Unclear pathway was reported as the main obstacle to outpatient cancer screening by 30.2% (n= 48) and 54% (n=87) pointed out that an easy and clear pathway for cancer screening would facilitate the same. CONCLUSION: While the attitude towards colorectal cancer screening is positive, the actual practice of recommendation is sub-optimal. Further initiatives are required to facilitate awareness and compliance to colorectal cancer screening.

Incidence and clinical outcome of Cryptococcosis in a nation with advanced HIV surveillance program.

BACKGROUND: Cryptococcosis is a major opportunistic invasive mycosis that mostly affects immunocompromised patients. METHODS: This was an observational study of all culture-confirmed cases of cryptococcosis conducted in the State of Qatar from January 2005 to December 2016. Cryptococcus fungi were identified using Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS). RESULTS: Fourteen culture-confirmed cases of cryptococcosis were identified during the study period. Four patients had a Human Immunodeficiency Virus (HIV) infection with low CD4 count and five were receiving immunosuppressant medications. The rest of the patients were apparently immuno-competent. The central nervous system was the most common site of infection (57%) followed by bloodstream infection (36%) and pneumonia (14%). One patient had a cryptococcal scrotal infection. Twelve isolates were Cryptococcus neoformans and 2 were Cryptococcus laurentii. All isolates were within the wild type ECV values to amphotericin B and fluconazole. Only 2 patients with bloodstream infection (HIV negative) died. The rest were cured of the infection. CONCLUSION: Cryptococcosis is a rare fungal disease in the State of Qatar, mostly diagnosed in Asian immigrants. The central nervous system is the most common site of infection. The presence of the fungus in the blood carries a high mortality.

Cancer genetics program: Follow-up on clinical genetics and genomic medicine in Qatar.

This article presents an overview of the cancer genetics program in Qatar. In addition to summarizing clinical, research, educational, and other aspects, data related to testing outcomes (over the course of approximately 5.5 years) are presented.

Epidemiology and clinical outcomes of viral central nervous system infections.

BACKGROUND: Central nervous system (CNS) viral infections are an important cause of morbidity and mortality. No data are available regarding their epidemiology in Qatar. DESIGN: We retrospectively evaluated all cerebrospinal fluid findings from January 2011-March 2015 at Hamad Medical Corporation. Those with abnormal CSF finding were included in our study. We excluded those with missing medical records, no clinical evidence of viral CNS infection, or proven bacterial, fungal or tuberculosis CNS infection. CNS clinical findings were classified as meningitis, encephalitis or myelitis. RESULTS: Among 7690 patients with available CSF results, 550 cases met the inclusion criteria (meningitis 74.7%; encephalitis 25%; myelitis 0.4%). Two-thirds (65%) were male and 50% were between 16-60 years old. Viral etiology was confirmed in 38% (enterovirus, 44.3%; Epstein-Barr virus, 31%; varicella zoster virus, 12.4%). The estimated incidence was 6.4 per 100,000 population. Two persons died and the rest were discharged to home. Among those with confirmed viral etiology, 83.8% received ceftriaxone (mean duration 7.3±5.2 days), 38% received vancomycin (mean duration 2.7±5.4 days) and 38% received at least one other antibiotic. Intravenous acyclovir was continued for more than 48h in patients with confirmed negative viral etiology (mean duration 5±5.6 days). CONCLUSION: Viral etiology is not uncommon among those evaluated for CNS infection in Qatar. Clinical outcomes are excellent in this group of patients. Antibiotics and acyclovir are overly used even when a viral etiology is confirmed. There is a need for clinician education regarding etiology and treatment of viral CNS infections.