Objectives To validate and recalibrate the CURB-65 and pneumonia severity index (PSI) in predicting 30-day mortality and critical care intervention (CCI) in a multiethnic population with COVID-19, along with evaluating both models in predicting CCI. Methods Retrospective data was collected for 1181 patients admitted to the largest hospital in Qatar with COVID-19 pneumonia. The area under the curve (AUC), calibration curves, and other metrics were bootstrapped to examine the performance of the models. Variables constituting the CURB-65 and PSI scores underwent further analysis using the Least Absolute Shrinkage and Selection Operator (LASSO) along with logistic regression to develop a model predicting CCI. Complex machine learning models were built for comparative analysis. Results The PSI performed better than CURB-65 in predicting 30-day mortality (AUC 0.83, 0.78 respectively), while CURB-65 outperformed PSI in predicting CCI (AUC 0.78, 0.70 respectively). The modified PSI/CURB-65 model (respiratory rate, oxygen saturation, hematocrit, age, sodium, and glucose) predicting CCI had excellent accuracy (AUC 0.823) and good calibration. Conclusions Our study recalibrated, externally validated the PSI and CURB-65 for predicting 30-day mortality and CCI, and developed a model for predicting CCI. Our tool can potentially guide clinicians in Qatar to stratify patients with COVID-19 pneumonia.

Diabetes mellitus (DM) has become a worldwide public health burden and a significant cause of motility and morbidity. The most common type of diabetes is type 2 diabetes, which is estimated to have a prevalence of one in every ten adults living with diabetes in the United States. The risk factors for type 2 diabetes are obesity and being overweight. Therefore, the primary strategy used to manage type 2 diabetes is weight loss. Different measures, such as dietary therapies and physical training, have been used to manage type 2 diabetes through weight and glycemic control. The dietary therapies used to manage type 2 diabetes are ketogenic and low-carbohydrate diets. Despite studies showing that both ketogenic and low-carbohydrate diets significantly impact weight and glycemic control, the difference between the two diets has not been fully established. Therefore, this systematic review has demonstrated and compared the effectiveness of ketogenic and low-carbohydrate diets on glycemic and weight control. The literature search was conducted on five electronic databases, PubMed, ScienceDirect, Embase, Web of Science, and Google Scholar, from 2000 to 2022. Specified keywords related to the ketogenic diet (KD), low carbohydrates, and type 2 diabetes were used to search for relevant and original articles. The identified articles were analyzed using the eligibility criteria before they were included in the study. The eligibility criteria yielded 15 studies that were included in this systematic review. The results obtained by conducting a meta-analysis showed that low-carbohydrates had a greater reduction in the HbA1c than other diets (standardized mean difference [SMD]: -0.27%; 95% CI; -0.60%, 0.07%: P = 0.008, I2 = 66%). Similarly, a significant decrease in HbA1c percentage was recorded in patients that consumed KDs compared to those who consumed the control diets (SMD: -1.45%; 95% CI; -2.73%, -0.17%: P < 0.00001). The results also show that the KD significantly impacts weight loss than control diets. The results show that the KD is more effective in reducing glycated haemoglobin and body weight (BW) than a low-carbohydrate diet. Therefore, we can summarize that the KD is a more effective dietary therapy. However, there is a need to balance the weight loss and glycemic control benefits obtained from the KD with the increased cardiovascular risks for patients with type 2 diabetes.

Introduction: Point of care ultrasound (POCUS) has been a part of emergency medicine (EM) training for almost two decades. EM training program has a very broad and rigorous POCUS curricula which, in several cases, does not translate to routine application in clinical settings. This study therefore sought to compare the indications, utilization, barriers, and preferred POCUS educational method in a large Middle Eastern academic EM. Methodology: A validated questionnaire was emailed to 50 EM faculties between April and May 2019. Volunteer faculty members partook in a semi-structured interview to better understand the indications, current use, barriers, and preferred learning method. Responses were anonymous, and data were analyzed with descriptive statistics. Results: This was a mixed design study. 30/50 (60%) of faculty responded to the survey, with a mean age of 39.2 years and a mean number of years in practice, 13.1. 55% (n=28) completed POCUS training in less than five years, while 45% completed more than five years ago and 5% never completed it. Forty percent of EM physicians were trained in Africa, while 55% were qualified in Asia and 5% completed their training in Europe. The indications and frequently performed procedures were consistent with the previous research. The common barrier reported was lack of time, lack of credentialing, lack of quality assurance, and national guidelines. The majority of the faculty preferred a blended learning approach for POCUS. Conclusion: POCUS perceived barriers to its full use include time constraints, lack of national guidelines, and credentialing (awarding POCUS qualifications) of the faculty. Blended learning appears to be the preferred approach towards acquiring the knowledge and skills of POCUS.

The CT scan is a determining imaging study in the diagnosis and treatment of head trauma; however, its indiscriminate application can have serious consequences for patients and the health system. More than 45% of CT scans of the head requested for minor head injuries in the paediatric age group in the emergency department were not correctly indicated according to international guidelines. The root of such a high percentage was misinformation and lack of knowledge about the ideal parameters for requesting a CT scan for minor head injuries. To achieve this, survey-based interventions and educational programmes were conducted to improve understanding of international guidelines and access to this information, which was the most important parameter during this project. A decreasing rate of CT scans for paediatric minor head injuries was demonstrated at the rate of 17%, achieving a reduction by more than 47% after the implementation of the interventions. Besides, misinformation and documentation deficits improved by more than 30%. Quality improvement methods decreased misinformation and improved access to information, which reduced errors in the indication of CT scans of the head in the paediatric age group and increased efficiency of patient care.

Acute pancreatitis (AP) is characterized by abdominal pain and elevated levels of pancreatic enzymes in the serum. Pain is the hallmark of this condition, and as a presenting symptom, is localized in the epigastrium in at least 60% of patients having the mild or severe form of the disease. Thus, the differential diagnosis may be difficult in some cases due in part to the fact that the disease may mimic other diseases, and in particular, acute coronary syndrome. We present the case of a patient who presented to our facility with epigastric pain, normal electrocardiogram (ECG), elevated high-sensitive troponin-T and elevated lipase, and amylase. Laboratory investigations and ultrasonography confirmed AP, with further serial ECGs being within the normal limits and normal echocardiography. The patient underwent laparoscopic cholecystectomy and intraoperative cholangiogram. Postoperative diagnosis confirmed biliary pancreatitis with chronic cholecystitis.

Background:Cardiogenic shock (CS) is an acute complex condition leading to morbidity and mortality.Vasoactive medications such as vasopressors and inotropes are considered the cornerstone of pharmacological treatment of CS to improve end-organ perfusion by increasing cardiac output and blood pressure, thus preventing multiorgan failure. Objective:A critical review was conducted to analyse the currently available randomized studies of vasoactive agents in CS to determine the indications of each agent and to critically appraise the methodological quality of the studies. Methods:PubMed database search was conducted to identify randomized controlled trials on vasoactive therapy in CS. After study selection, the internal validity of the selected studies was critically appraised using the three-item Jadad scale. Results:Nine studies randomized 2,388 patients with a mean age ranged between 62 and 69 years, were identified. Seven of studies investigated CS in the setting of acute myocardial infarction. The studies evaluated the comparisons of norepinephrine (NE) versus dopamine, epinephrine versus NE, levosimendan versus dobutamine, enoximone or placebo, and nitric A c c e p t e d M a n u s c r i p t oxide synthase inhibitors versus placebo. The mean Jadad score of the nine studies was 3.33, with only three studies of a score of 5. Conclusions:The evidence from the studies of vasoactive agents in CS carries uncertainties. The methodological quality between the studies is variable due to the inherent difficulties to conduct a study in CS. Vasopressors and inotropes continue to have a fundamental role given the lack of pharmacological alternatives.

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We report a case of fulminant liver failure in a patient with acute active hepatitis B infection who was found to have COVID-19 without lung involvement. A 24-year-old male was brought by ambulance service to Hamad General Hospital, Emergency Department (ED), in Doha on April 8, 2020, with chief complaints of fever and cough for 3 days. Upon initial evaluation, the patient was febrile (39.4°C), jaundiced, and disoriented regarding time, place, and person, with an unremarkable past medical history. Initial blood tests showed severely elevated urea, creatinine, transaminases, and ammonium in addition to an impaired coagulation profile consistent with fulminant liver failure. A swab was taken for COVID-19 PCR testing and found to be positive. Serological tests revealed hepatitis B surface antigen positivity and other serology indicating acute hepatitis B. Initial X-ray and repeat chest X-rays did not show lung infiltrates. On the 6th day after admission, the patient developed fixed dilated pupils, with brain edema on CT; cardiac arrest occurred on the 10th day after admission, and the patient died. Although it is still largely unclear, HBV0-activated sudden-onset strong cytotoxic T lymphocyte response and enhanced viral replication and/or retention of the viral capsid in infected hepatocytes may cause the pathogenesis of FH. These pathophysiological events cause extensive hepatocyte apoptosis and necrosis, which results in deadly severe liver failure. Our findings support that the liver damage occurring in COVID-19 is caused by an impaired innate immune system rather than by direct cell damage caused by SARS-CoV-2. We think that more consideration should be given to the presence of acute hepatitis B, especially in COVID-19 patients.