Incidence and etiology of surgical site infections in appendectomies: a 3-year prospective study

Objectives: Surgical site infections [SSIs] constitute a threat, especially in complicated appendicitis, and are commonly due to gram-negative organisms. We sought to describe the incidence of SSIs in appendectomies performed during a three-year period [January 2013 to December 2015] in a community hospital in Qatar, and compare this with external benchmarks

Methods: We conducted a longitudinal study at The Cuban Hospital, Qatar. We used the standardized surveillance criteria to define SSI developed by the Centers for Disease Control. Information about age, sex, smoking habits, diabetes mellitus status, body mass index, and the result of bacteriologic studies were collected

Results: Of a total 603 patients, 22 [3.6%] cases of SSI were reported, with an infection rate of 13.6%, 4.5%, and 1.0% in 2013, 2014, and 2015, respectively. SSIs were observed more frequently in patients with contaminated/dirty wounds [6.6%]. About 65% of isolates from the surgical site were multidrug-resistant organisms [Escherichia coli and Klebsiella spp.]

Conclusions: This study describes the incidence of SSI in appendectomy, which could be used as a benchmark for the facility improvement program. The high frequency of multidrug-resistant organisms in SSIs requires additional studies focused on evaluating the effectiveness of the current preventive practices with a particular reference to antimicrobial prophylaxis

Collaborative Intervention of Middle East Respiratory Syndrome: Rapid Response Team / 감염과화학요법

On May 20th 2015, a 68 year old man was the first to be diagnosed with Middle East Respiratory Syndrome-Corona Virus (MERS-CoV) in Korea. He travelled to Bahrain, Saudi Arabia, and Qatar for 16 days. On May 4th 2015, the patient entered Korea, with febrile sense and respiratory symptoms that appeared on May 11th. The MERS-CoV Outbreak became worse and several patients had to be admitted throughout various hospitals starting at the beginning of June. This situation led to a nationwide chaos. The Rapid Response Team (RRT) was organized after the Korean government's calling for specialists that were composed of 15 Infectious disease Doctors and 2 Infection Control professionals on the 8th of June 2015. The main purpose of the RRT were: 1) consultation to the Government controlling MERS-CoV outbreak. 2) Visit hospitals that were exposed to MERS-CoV infected patients, and to provide advice regarding infection control strategy for rehabilitating of the exposed hospitals. Since June 8th, the RRT visited more than 10 hospitals and an effective consultation was carried out. Most of the hospitals were recovering from the MERS outbreak since early July. Cooperation between the government and private sector experts was very effective. The efforts of government and private sector experts overcame the initial chaos situation. It could prevent further deterioration of the MERS outbreak.

Institutional Preparedness to Prevent Future Middle East Respiratory Syndrome Coronavirus-Like Outbreaks in Republic of Korea / 감염과화학요법

A year has passed since the Middle East respiratory syndrome (MERS) outbreak in the Republic of Korea. This 2015 outbreak led to a better understanding of healthcare infection control. The first Korean patient infected by Middle East Respiratory Syndrome Coronavirus (MERS-CoV) was diagnosed on May 20, 2015, after he returned from Qatar and Bahrain. Thereafter, 186 Korean people were infected with the MERS-CoV in a short time through human-to-human transmission. All these cases were linked to healthcare settings, and 25 (13.5 %) infected patients were healthcare workers. Phylogenetic analysis suggested that the MERS-CoV isolate found in the Korean patient was closely related to the Qatar strain, and did not harbor transmission efficiency-improving mutations. Nevertheless, with the same infecting virus strain, Korea experienced the largest MERS-CoV outbreak outside the Arabian Peninsula, primarily due to the different characteristics of population density and the healthcare system. We aimed to review the epidemiological features and existing knowledge on the Korean MERS outbreak, and suggest methods to prevent future epidemics.

Middle East Respiratory Syndrome Outbreak in Korea, 2015

Since April 2012, more than 1,600 laboratory-confirmed human infections with Middle East Respiratory Syndrome Coronavirus (MERS-CoV) have been reported, occurring primarily in countries in the Arabian Peninsula; the majority in Saudi Arabia. The MERS outbreak in Korea, which began in May 2015 through the importation of a single case who had recently traveled to Bahrain, the United Arab Emirates, Saudi Arabia, and Qatar. As of November 28th, 186 secondary and tertiary cases had been reported; 38 deaths, mainly associated with underlying chronic illnesses, were reported. One case was exported to China and has been recorded as the first MERS case in China. Thirty-seven confirmed cases were associated with the index case, who was hospitalized from May 15 to May 17. Emergency room at one of the nation's largest hospitals had been affected by hospital-to-hospital and intra-hospital transmissions of MERS-CoV, resulting in an outbreak of 90 infected patients. The vast majority of 186 confirmed cases are linked to a single transmission chain associated with health facilities. The median age of patients is 55 years, with a range of 16 to 87 years. The majority (61%) of patients are men. Twenty-five (14%) of the cases involve healthcare workers. The overall median incubation period was six days, but it was four days for secondary cases and six days for tertiary cases. There has been no evidence of airborne transmission and sustained human-to-human transmission in communities. Intensified public health measures, including contact tracing, quarantine and isolation of all contacts and suspected cases, and infection prevention and control have brought the MERSCoV under control in Korea. Since 4 July no new cases have been reported.

Definition and management of the close contacts with Middle East respiratory syndrome cases: reflection and lessons in 2015 Korean outbreak

Middle East respiratory syndrome (MERS) is an emerging zoonosis caused by the novel MERS corona virus isolated in 2012. Most MERS cases have been reported from Arab countries of the Middle East, including Saudi Arabia, United Arab Emirates, Qatar, and Jordan. There have been a few imported cases in many countries, but the exception is Korea, which reported 186 confirmed cases originating from one imported case in a two-month outbreak in 2015. There are many lessons to be learned from the MERS outbreak in Korea, among them, management of contacts. The definition of "close contact" used by the Korean Centers for Disease Control and Prevention (KCDC) for MERS response was not clear and not compatible with the definition of the World Health Organization. This incorrect definition allowed the KCDC make serious mistakes in contact tracing and management in the early epidemic stage of MERS. After the rapid expansion of the outbreak, the KCDC redefined a "close contact" according to the definition of the US CDC. The total number of close contacts was 16,693 in this outbreak, and they were all forced to conduct a self-quarantine for 14 days after the last contact with a MERS patient. It was not clear whether self-quarantine of close contacts was effective to control the outbreak. Given the lack of prepared guidelines or a social support system for them, these measures for the massive number of asymptomatic contacts caused a great deal of confusion in the field A clear response guideline is needed for contact management based on robust evidence from this MERS epidemic in Korea.

The impact of the interpregnancy interval on birth weight and other pregnancy outcomes / O impacto do intervalo entre gestações no peso de recém-nascidos e outros desfechos da gravidez

To investigate the relationship between the interpregnancy interval and low birth weight and other pregnancy outcomes. METHODS: this case-control study was carried out in hospitals from January 2010 to April 2011. For cases, mothers of 1216 newborns with birth weight<2500 g were approached and 854 mothers participated (70.2 percent). For controls, mothers of 1158 newborns with >2500 g were approached and 854 mothers participated in this study (73.7 percent). Face-to-face interviews were conducted to complete the questionnaires. RESULTS: of the newborn babies with low birth weight, the risk was higher among mothers with a short interpregnancy interval (40.3 percent), whereas for infants with normal birth weight, the majority of the mothers had a longer interpregnancy interval of 24 months (44.7 percent). A short interpregnancy interval of 612 months was more common among women of <25years (49.4 percent; p<0.001) and those who were illiterate (13.1 percent; p=0.043) with a higher risk of low birth weight compared to the controls. Prenatal care during the 1st trimester was lower in women with low birth weight children (p<0.001). Normal delivery was observed less in women with a short birth interval among cases (58.7 percent) compared to controls (79 percent) (p=0.001). A J-shaped association was observed between low birth weight and the interpregnancy interval. CONCLUSIONS: a short interpregnancy interval is associated with an increased risk of low birth weight, especially in younger and illiterate women...

Investigar a relação entre o intervalo entre gestações e o baixo peso de recém-nascidos e outras conseqüências da gestação. MÉTODOS: este estudo caso-controle foi realizado em hospitais entre janeiro de 2010 e abril de 2011. Dentre as mães dos 1216 recém-nascidos com peso <2500 g, 854 (70,2 por cento) aceitaram participar do estudo de caso. No grupo controle, dentre as mães dos 1158 recém-nascidos com peso > 2500 g, participaram 854(73,7 por cento). Para completar os questionários, foram conduzidas entrevistas face a face. RESULTADOS: dos recém-nascidos com baixo peso, o fator de risco foi mais alto entre as mães com curto intervalo intergestacional (40,3 por cento), enquanto para recém-nascidos com peso normal a maioria das mães tinham uma boa margem de intervalo intergestacional de 24 meses (44,7 por cento). Curtos intervalo intergestacional (6 a 12 meses) foi mais comum entre mulheres de <25 anos (49,4 por cento; p<0,001) e analfabetas (13,1 por cento; p=0,043), com mais alto risco de baixo peso quando comparado aos controle. Cuidados pre-natais durante o primeiro trimestre foi menor nas mulheres com crianças de baixo peso (p<0,001). Menos partos normais foi observado em mulheres com curtos intervalos de nascimento para os casos (58,7 por cento) comparados aos controles (79 por cento) (p=0,001). Uma associação não monotônica tipo função J, foi observada entre o baixo peso e intervalo intergestacional. CONCLUSÕES: um curto intervalo entre gestações é associado a um risco maior de nascerem bebês de baixo peso, principalmente entre mulheres mais jovens e analfabetas...

Exclusive breast feeding and prevention of diarrheal diseases: a study in Qatar / Aleitamento materno exclusivo na prevenção de doenças diarréicas: um estudo realizado no Qatar

OBJECTIVE: to explore the relationships between breast feeding and diarrhea and to assess the effect of exclusive breast feeding (EBF) on reducing the risk of diarrhea in Qatar. METHODS: this is a cross sectional survey carried out at the Well baby clinics and Pediatric clinics in the 11 Primary Health Care Centers and Hamad General Hospital, Hamad Medical Corporation, in Qatar. A multistage sampling design was used and a representative sample of 1500 Qatari infants and preschool children with an age range of 0-3 years and mothers agedbetween 18 to 47 years were surveyed during the period from October 2006 to September 2008 in Qatar. Out of the 1500 mothers, 1278 agreed to participate in this study, with a response rate of 85.2 percent. Questionnaires were administered to women who were attending Primary Health Care (PHC) Centers for child immunization. Data about the child gathered included date of birth, gender, birth order, consanguinity, socio-economic conditions, age of mother, level of education of mother, occupation, mode of breast feeding, sterilization of bottle and incident of diarrhea during the interview. Univariate statistical methods were performed for statistical analysis. RESULTS: of the 1278 infants studied, more than half (59.3 percent) were exclusively breastfed, and the mean duration was11.4 (SD=6.7). The risk for presenting diarrhea was higher in formula fed (48.7 percent) and partiallybreastfed children (37.3 percent) when compared to EBF(32.5 percent). CONCLUSION: EBF plays an important role in reducing the incidence and severity of infantile diarrhea.

OBJETIVOS: investigar a relação entre a amamentação e a diarréia e avaliar o efeito do aleitamento maternao exclusivo (AME) na redução do risco de diarréia noQatar. MÉTODOS: um estudo transversal realizado nos Well Baby Clinics and Pediatric Clinics dos 11 centros de atenção básica do Hamad General Hospital, Hamad Medical Corporation, no Qatar. Um desenho amostral de múltiplos estágios foi empregado com uma amostra representativa de 1500 recémnascidos e crianças de idade pré-escolar catarianos entre outubro de 2006 esetembro de 2008 no Qatar. Entre as 1500 mães, 1278 aceitaram participar neste estudo, uma taxa de resposta de 85,2 por cento. Os questionários foram aplicados a mulheres atendidas pelos centros de atenção básica para imunização infantil. Dados colecionados sobre as crianças incluíram data de nascimento, gênero, ordem de nascimento, consanguinidade, condições socioeconômicas, idade maternal, escolaridade maternal, ocupação maternal, método de amamentação, esterilização dos biberões, e incidência de diarréia durante a entrevista. Métodos univariados e foram utilizados para realizar a análise estatística. RESULTADOS: dos 1278 recém-nascidos estudados, mais que metade (59.3 por cento) foram exclusivamente amamentados e a duração média foi de 11,4 (DP=6,7). O risco de apresentar a diarréia foi mais alto nas crianças aleitadas com fórmulas (48.7 por cento) e nas que foram parcialmente amamentadas (37.3 por cento) em comparação com a AME(32.5 por cento). CONCLUSÕES: o AME desempenha um papel importante na redução da incidência e da gravidade da diarréia infantil.

Púrpura trombocitopênica idiopática na infância: estudo de base populacional no Catar / Idiopathic thrombocytopenic purpura in childhood: a population-based study in Qatar

OBJETIVO: Definir o padrão da púrpura trombocitopênica idiopática (PTI) (aguda/crônica), e descrever seus sintomas e características clínicas em crianças com menos de 14 anos de idade em uma sociedade árabe recentemente desenvolvida. MÉTODOS: Este estudo descritivo retrospectivo foi realizado no Departamento de Pediatria do Hospital Geral de Hamad, Hamad Medical Corporation, Catar. Foram incluídas neste estudo 50 crianças com idade inferior a 14 anos e diagnóstico de PTI durante o período de 2000 a 2005. RESULTADOS: Das crianças estudadas (50), 62 por cento foram diagnosticadas com PTI aguda e 38 por cento com PTI crônica. A PTI aguda foi mais prevalente em meninos (64,5 por cento) em comparação com meninas (35,5 por cento), enquanto que a PTI crônica apresentou uma distribuição quase igual em meninos (57,9 por cento) e meninas (42,1 por cento). História de infecção viral foi comum em casos de PTI tanto aguda (71 por cento) quanto crônica (63,2 por cento); 68 por cento das crianças com PTI apresentaram contagem de plaquetas abaixo de 20x10(9)/L ao diagnóstico. A maioria das crianças estudadas (74 por cento) foi tratada com imunoglobulina intravenosa. CONCLUSÕES: O estudo revelou uma alta incidência de PTI entre as crianças no Catar. As descobertas do estudo são semelhantes às de outros relatos internacionais.

OBJECTIVE: To find the pattern of idiopathic thrombocytopenic purpura (ITP) (acute/chronic) and to describe presenting features and clinical characteristics of the disease in children below 14 years of age in a newly developed Arabian society. METHODS: This retrospective, descriptive study was carried out at the Pediatric Department of the Hamad General Hospital, Hamad Medical Corporation, Qatar. A total of 50 children below 14 years of age who were diagnosed with ITP during the period 2000-2005 were included. RESULTS: Among the studied children (50), 62 percent were diagnosed with acute ITP and 38 percent with chronic ITP. Acute ITP was more prevalent in boys (64.5 percent) when compared with girls (35.5 percent), whereas for chronic ITP, nearly an equal distribution was found in boys (57.9 percent) and girls (42.1 percent). Preceding viral infection was common in both acute (71 percent) and chronic (63.2 percent) ITP cases; 68 percent of the children with ITP showed a platelet count below 20x10(9)/L at the time of presentation. Most of the studied children were treated with intravenous immunoglobulin (74 percent). CONCLUSIONS: The study revealed a high incidence of ITP among children in Qatar. The study findings are in line with other international reports.

Patterns of cancer incidence among the population of Qatar: a worldwide comparative study.

BACKGROUND: Cancer is a major public health problem all over the world. Monitoring the evolution of the cancer burden in the State of Qatar is of great value but has never been explored in depth. AIMS: The aim of the study was to determine the incidence patterns of cancer cases, assess trends during the period 1991 - 2006 and make comparisons with other countries. METHODS: This was a retrospective cohort study based on the Cancer disease registry of Al Amal Cancer hospital, State of Qatar, from 1991 - 2006. All Qataris and non-Qataris, males and females, who were diagnosed with any type of cancer were included in this study. The diagnostic classification of definite cancer cases was made according to the International Classification of Disease 10th revision (ICD-10). RESULTS: A total of 5,825 cancer cases were registered in Qatar during the period 1991 - 2006 with 56.7% in males and 43.3% in females, 35.6% in Qataris and 64.4% in non-Qataris. Incidence rates per 100,000 population showed that lung (5.9), lymph node (5.9), bone marrow (4.1) and connective tissue (3.9) were the top major cancers in men. In women, breast (30.1), genital organs (9), lymph node (6.8), rectum (6.1) and thyroid (5.7) cancers were the leading cancers. There was a sharp rise in the total number of cancer cases during the period 2002-2006 of 57.1% compared to the period 1991-1996. The incidence rate of cancer cases increased with increasing age in all cancer types except for breast cancer in women above 65 years old. During the study period, the five most common cancers among women were different from those in men. The incidence rate per 100,000 population of all cancer types in Qatar (63.1) was remarkably lower than the other Middle East countries and the UK. CONCLUSIONS: Cancer is an important public health problem in Qatar, with increase in incidence with age. Incidence rates of all cancers were higher across all age groups of women compared to men. Lung cancer was the most frequent cancer diagnosed in men and breast cancer in women. More epidemiological studies are now required to elucidate the patterns of cancer and related risk factors.

Does the circadian pattern for acute cardiac events presentation vary with fasting?

BACKGROUND: Over one billion Muslims fast worldwide during the month of Ramadan. The impact of fasting on circadian presentation with acute cardiac events is unknown. AIM: To determine if fasting has any effect on the circadian presentation of acute cardiac events. SETTING AND DESIGN: A prospective study in a general hospital. MATERIALS AND METHODS: Patients with acute coronary events were divided into two groups based on the history of fasting. Information about age, gender, cardiovascular risk factor profiles and outcome was collected. The relationship of time of presentation of initial symptoms with fasting was evaluated using Student's t-test, Mann-Whitney U-test and chi2 analysis. RESULTS: Of the 1019 patients hospitalized during the study period, 162 were fasting. Although, fasting patients were more likely to present to the emergency department in the time periods 5-6 AM (10.5% vs 6.3%) and 11 PM (11.1% vs 7.1%) and were less likely to present in the time periods 1-2 PM (3.7% vs 7.2%) and 5-6 PM (3.7% vs 7.0%); these differences were not statistically significant. Fasting patients were less likely to have their symptoms start between 5 and 8 AM (11.1% vs 19.4%) and more likely to have symptoms between 5 and 6 PM (11.1% vs 6.0%) and 3 and 4 AM (11.1% vs 6.9%). These differences for time of initial symptoms were statistically significant (P=0.002). CONCLUSION: Exogenous factors associated with fasting, namely, the changes in food intake and/or sleep timings, affect the circadian rhythm and influence the timing of presentation of acute coronary events.

Growth patterns of Qatari school children and adolescents aged 6-18 years.

The study was conducted to analyze the patterns of growth in height and weight and the prevalence of over-weight among Qatari school children aged 6-18 years. Weights and heights of a cross-sectional sample of Qatari school children were measured. These children were selected randomly, in equal proportions of age and gender, from different schools from urban and semi-urban districts. Appropriate statistical procedures were performed to produce smooth percentile curves for boys and girls using a two-stage approach. Initial curve smoothing for selected major percentiles was accomplished by various paramet-ric and non-parametric procedures. In the second stage, a normalization procedure was used for creating z-scores that closely matched the smooth percentile curves. The height and weight results were compared with the international reference values of National Center for Health Statistics/Centers for Disease Control and Prevention (NCHS/CDC). The prevalence of over-weight was calculated using the new International Obesity Task Force (IOTF) reference. Of 7442 Qatari children studied, 50.3% were male and 49.7%' female. The mean values for height, weight, and body mass index (BMI) increased with the age for both boys and girls until the age of 18 years, except BMI, which stabilized at the age of 16-18 years at around 22.6 for boys and at 21.6 for girls. The growth patterns of the Qatari children, aged 6-18 years, appeared to be comparable with those of the NCHS/CDC reference. The weight-for-age centile curves of the Qatari boys tended to be superior to those of the NCHS/CDC reference until the age of 15 years, less so those of the Qatari girls. In contrast, the height-for-age centile curves of the Qatari children tended to deviate in a negative sense from the NCHS/CDC reference curves, for boys and girls from age around 11 years and 13 years respectively. The deviation of the smoothed median height-for-age curves from the reference in adolescence could most likely be attributed to a later maturation among the Qatari children. The prevalence of under-weight, over-weight, and obesity for the Qatari children was quite below the CDC and IOTF rates, except for girls aged 6-9 years. More males than females were over-weight or obese according to either the local, the CDC, or the IOTF reference, and the prevalence increased with age. A good percentage of the Qatari children was at risk of being over-weight, which needs more attention because the development of obesity results in different types of diseases associated with changes in body composition.