Epidemiological profile of stroke in Qatar: Insights from a seven-year observational study.

OBJECTIVES: Stroke prevalence is progressively increasing in developing countries due to increased vascular risk factors. This study aims to describe the epidemiology, prevalent risk factors, and outcomes of stroke in a multi-ethnic society of Qatar. MATERIALS AND METHODS: We conducted a retrospective analysis of all patients with suspected stroke admitted to stroke services between January 2014 and September 2020. RESULTS: A total of 11,892 patients were admitted during this period with suspected stroke. Of these, the diagnosis was ischemic stroke (48.8 %), transient ischemic attack (10.3 %), intracerebral hemorrhage (10.9 %), cerebral venous sinus thrombosis (1.3 %), and stroke mimics (28.6 %). The median age was 52 (43-62), with a male-female ratio of 3:1. The study population was predominantly Asian (56.8 %) and Arab (36 %). The majority of the patients were hypertensive (66.8 %), diabetic (47.9 %), and dyslipidemic (45.9 %). A history of prior stroke was observed in 11.7 %, while 0.9 % had prior transient ischemic attack. Among ischemic strokes, 31.7 % arrived within 4.5 h, 12.5 % received thrombolysis, and 4.6 % underwent thrombectomy. Median Door-to-Needle time was 51 (33-72) minutes. The average length of stay was 5.2 ± 9.0 days, with 71.5 % discharged home, 13.8 % transferred to rehabilitation, 9.3 % to other specialties, 3 % to long-term care, and 2.4 % suffered in-hospital mortality. CONCLUSION: Stroke in Qatar is characterized by a younger, expatriate-dominant cohort, with notable prevalence of ischemic and hemorrhagic stroke and a distinct risk factor profile. Further analysis of epidemiological differences among different population groups can inform targeted policies for prevention and management to reduce the burden of disease.

What adult patients prefer for reporting their pain levels, and frequency of reassessment when in the emergency department.

OBJECTIVES: This study interviewed adult patients presenting to the emergency department (ED) for various pain conditions enquiring about their preferred tool for reporting pain severity and preferred time interval between initial assessment and subsequent pain reassessments. METHODS: A prospective observational (cross-sectional) study was conducted in adult patients with acute pain in a tertiary care hospital ED setting. Patients' initial pain score was recorded using NRS (numerical rating scale) pain scale, and appropriate analgesia offered. Once the patient had been evaluated by an attending physician, a research team member interviewed the patient regarding the pain reassessment time and preferred pain assessment tool. The pain assessment tools evaluated in this study were NRS, PS (picture scale or face pain scale), VRS (verbal rating scale), and VAS (visual analogue scale). The patients were presented with the four pain assessment tools (in their primary language) through an audio-visual on an electronic tablet display. RESULTS: 200 (138 male, mean age 36.5 ± 11.17) patients participated in the study. With increasing age, pain reassessment interval increased by 0.19 min (95% CI 0.03-0.36 min). Males requested pain reassessment 6.7 min (95% CI 2.2-10.8) faster than females. In this study, the preferred interval for pain reassessment was reported as a mean of 22.8 (SD + -13.6) minutes. There was no relationship reported between time reassessment and pain severity (P = 0.22). Out of 200 subjects, irrespective of the initial pain scores, 100 preferred NRS. NRS was preferred by patients with mild to moderated pain due to the perception of being faster. However, patients with severe pain choose a non-NRS scale to prioritize accuracy. CONCLUSION: There was no influence found between the initial pain severity scores and the desired frequency of pain reassessment. However, associations were identified between the time for pain reassessment interval and age, sex, and geographical region. Patients with severe pain preferred PS or VRS while patients with mild/moderate pain preferred the NRS.

Exogenous methyl jasmonate modulates antioxidant activities and delays pericarp browning in litchi.

Pericarp browning (PB) is a serious problem in harvested litchi and drastically affects consumer acceptability and marketability. Postharvest PB and subsequent decay in fruit are linked to reactive oxygen species (ROS) accumulation in tissues. Antioxidants neutralize or scavenge ROS and maintain the shelf-life of fruit, especially in non-climacteric ones such as litchi. This work was aimed to assess the effect of vacuum infiltrated methyl jasmonate (MeJA; 1 and 2 mM) on the quality of harvested litchi fruit (cv. Purbi) during ambient storage (28 °C, RH 70-75%). The exogenous MeJA infiltration (2 mM) significantly retained quality attributes of litchi fruit as evident by lowered PB, weight loss, disease occurrence, quinone, and ROS (H2O2 and O2 -) accumulation. Moreover, MeJA infiltrated fruit suppressed the activity of polyphenol oxidase and peroxidase resulting in higher anthocyanin, phenolics, antioxidant potential, phenylalanine ammonia lyase activity as well as membrane integrity throughout the storage. Control fruit showed an early quality deterioration marked by prominent PB and other biochemical degradative changes. Thus, exogenous MeJA infiltration (2 mM) could be suggested to increase the shelf life of litchi by four days under ambient conditions.

Effect of postharvest hydrogen sulphide on lignification and biochemical markers of pointed gourd.

Hydrogen sulphide (H2 S) has emerged as a gasotransmitter molecule that modulates several physiological functions in plants, specially, different biotic and abiotic stresses. Pointed gourd (PG) fruits start losing their soft texture and appealing colour within 2-3 days of harvest, resulting in poor marketability and shelf life. Here, the effect of exogenous H2 S (1 and 2 mm) application on lignification and other biochemical markers linked to ripening, shelf-life and edible quality of PG was assessed during cold (12 °C, 85-90% RH) and ambient (27 ± 2 °C, 55 ± 5% RH) storage. The synergistic effect of H2 S was recorded during simulated storage at ambient conditions. Postharvest H2 S treatment (1 mm) effectively delayed yellowing and chlorophyll loss (four-fold reduction) and maintained the phenolic content and higher antioxidant activity (36%). The H2 S-treated PG fruits had significantly lower lignification and membrane permeability i.e. 15% and 13%, respectively, than control samples. H2 S-treated fruit also maintained higher PAL and lower PPO activity. Therefore, postharvest application of H2 S (2 mm) could be effective in maintaining postharvest quality of PG fruits and extending the marketing period.

Randomized double-blinded placebo-controlled trial of hydroxychloroquine with or without azithromycin for virologic cure of non-severe Covid-19.

BACKGROUND: Hydroxychloroquine (HC) ± azithromycin (AZ) is widely used for Covid-19. The Qatar Prospective RCT of Expediting Coronavirus Tapering (Q-PROTECT) aimed to assess virologic cure rates of HC±AZ in cases of low-acuity Covid-19. METHODS: Q-PROTECT employed a prospective, placebo-controlled design with blinded randomization to three parallel arms: placebo, oral HC (600 mg daily for one week), or oral HC plus oral AZ (500 mg day one, 250 mg daily on days two through five). At enrollment, non-hospitalized participants had mild or no symptoms and were within a day of Covid-19 positivity by polymerase chain reaction (PCR). After six days, intent-to-treat (ITT) analysis of the primary endpoint of virologic cure was assessed using binomial exact 95% confidence intervals (CIs) and χ2 testing. (ClinicalTrials.gov NCT04349592, trial status closed to new participants.). FINDINGS: The study enrolled 456 participants (152 in each of three groups: HC+AZ, HC, placebo) between 13 April and 1 August 2020. HC+AZ, HC, and placebo groups had 6 (3·9%), 7 (4·6%), and 9 (5·9%) participants go off study medications before completing the medication course (p = 0·716). Day six PCR results were available for all 152 HC+AZ participants, 149/152 (98·0%) HC participants, and 147/152 (96·7%) placebo participants. Day six ITT analysis found no difference (p = 0·821) in groups' proportions achieving virologic cure: HC+AZ 16/152 (10·5%), HC 19/149 (12·8%), placebo 18/147 (12·2%). Day 14 assessment also showed no association (p = 0·072) between study group and viral cure: HC+AZ 30/149 (20·1%,), HC 42/146 (28·8%), placebo 45/143 (31·5%). There were no serious adverse events. INTERPRETATION: HC±AZ does not facilitate virologic cure in patients with mild or asymptomatic Covid-19. FUNDING: The study was supported by internal institutional funds of the Hamad Medical Corporation (government health service of the State of Qatar).

Impact of COVID-19 upon changes in emergency room visits with chest pain of possible cardiac origin.

OBJECTIVES: A decrease in Emergency Department (ED) visits for cardiac conditions has recently been reported from the US and Western Europe due to the COVID-19 pandemic. The data are still scant, and the correlation between cardiac symptoms and confirmed diagnoses are not available. There are no reports on changes in ED volumes at a national level, or from countries in the Asia-Middle Eastern region. We report data from national referral centers for tertiary care and cardiac care centers in Qatar, which see > 80% of cardiac emergencies in the country. RESULTS: We analyzed 102,033 ED visits in the COVID-19-era (March-April 2020 and 2019) and determined the proportion presenting for cardiac symptoms and their confirmed diagnoses. We observed a 16-37% decline in ED volumes overall, with a 25-50% decline in patients presenting with cardiac symptoms in March and April 2020 compared with March and April 2019. Among those presenting with cardiac symptoms, we observed a 24-43% decline in cardiac diagnoses in March and April 2020 compared with March and April 2019.

Volume and Acuity of Emergency Department Visits Prior To and After COVID-19.

BACKGROUND: There are scant data regarding the change in volume and acuity of patients presenting to emergency departments (EDs) after Coronavirus Disease 2019 (COVID-19), compared with the pre-COVID-19 era. OBJECTIVE: To determine ED volumes and triage acuity prior to and after COVID-19. METHODS: We determined the volume of patients presenting to four large EDs affiliated with general, cardiac, cancer, and obstetrics hospitals, and the acuity of presenting illness (using the Canadian Triage Acuity Scale [CTAS]) for March and April 2020 and compared them with the same months in 2019 and January 2020. Together, these facilities see over 80% of the ED visits in Qatar. The first COVID-19 patient in Qatar was diagnosed on February 29, 2020. RESULTS: A total of 192,157 ED visits were recorded during the study period. There was a 20-43% overall drop in number of ED visits, with significant variability across hospitals. The Heart Hospital experienced the sharpest decline (33-89%), and the National Center for Cancer Care and Research experienced the least decline in volumes. The decline was observed across all CTAS levels, with the largest decline observed in individuals presenting with CTAS 1 and 2 (26-69% decline month by month). No increase in overall number of deaths or crude mortality rate was observed in the COVID-19 era, according to national statistics. CONCLUSIONS: Sharp declines in ED visits and the triage acuity seen in both general and specialty hospitals raise the concern that severely ill patients may not be seeking timely care, and a surge may be expected once current restrictions on movement are lifted.

Impact of COVID-19 Upon Changes in Emergency Room Visits with Chest Pain of Possible Cardiac Origin

BackgroundA decrease in Emergency Department (ED) visits for cardiac conditions has recently been reported from the US and Western Europe due to the COVID-19 pandemic. The data are still scant, and the correlation between cardiac symptoms and confirmed diagnoses are not available. There are no reports on changes in ED volumes at a national level, or from countries in the Asia-Middle Eastern region. MethodsWe report data from national referral centers for tertiary care and cardiac care centers in Qatar, which see >80% of cardiac emergencies in the country. ResultsWe analyzed 102,033 ED visits in the COVID-era (March-April 2020 and 2019) and determined the proportion presenting for cardiac symptoms and their confirmed diagnoses. We observed a 16-37% decline in ED volumes overall, with a 25-50% decline in patients presenting with cardiac symptoms in March-April 2020 compared with March-April 2019. Among those presenting with cardiac symptoms, we observed a 24-43% decline in cardiac diagnoses. ConclusionsA sharp decline in patients presenting with cardiac symptoms was observed in the COVID-era. A post-COVID surge in patients with these conditions may be anticipated and preparations should be made to address it.

Hospital Admission Rates, Length of Stay and In-hospital Mortality for Common Acute Care Conditions in COVID-19 vs. Pre-COVID-19 Era

BackgroundImpact of COVID-19 upon acute care admission rates and patterns are unknown. We sought to determine the change in rates and types of admissions to tertiary and specialty care hospitals in the COVID-19 era compared with pre-COVID-19 era. MethodsAcute care admissions to the largest tertiary care referral hospital, designated national referral centers for cardiac, cancer and maternity hospital in the State of Qatar during March 2020 (COVID-19 era) and January 2020 and March 2019 (pre-COVID-19 era) were compared. We calculated total admissions, and admissions for eight specific acute care conditions, in-hospital mortality rate and length of stay at each hospital. ResultsA total of 18,889 hospital admissions were recorded. A sharp decline ranging from 9%-75% was observed in overall admissions. A decline in both elective and non-elective surgeries was observed. A decline of 9%-58% was observed in admissions for acute appendicitis, acute coronary syndrome, stroke, bone fractures, cancer and live births, while an increase in admissions due to respiratory tract infections was observed. Overall length of stay was shorter in the COVID-19 period possibly suggesting lesser overall disease severity, with no significant change in in-hospital mortality. Unadjusted mortality rate for Qatar showed marginal increase in the COVID-19 period. ConclusionsWe observed a sharp decline in acute care hospital admissions, with a significant decline in admissions due to seven out of eight acute care conditions. This decline was associated with a shorter length of stay, but not associated with a change in in-hospital mortality rate.

Browning metabolism and quality of fresh-cut drumstick (Moringa oleifera) as influenced by acidulant treatments.

Though fresh-cut products save our time, but they are very much prone to enzymatic browning that drastically affects product's quality and marketability. Drumstick pods are considered as super food due to high nutritional contents. However, the fresh-cut pods are prone to brown discoloration. The enzyme activities promote the softening and cut-surface browning of pods, thus deteriorates their texture, decreases consumer appeal and shortens the shelf life. So, we aimed to assess the effect of citric (1%) and ascorbic (1%) acid treatments on quality attributes of fresh-cut drumsticks at 3-d interval during storage (5 ± 1 °C). In general there was an increase in lignin and quinone contents, while phenolic content was decreased during storage. However, samples subjected to ascorbic acid dip had higher phenolic content, lower rate of lignin formation, and reduced membrane permeability. Enzyme activities (polyphenol oxidase and peroxidase) were found to increase during storage, however, samples treated with ascorbic acid showed lower activities than that of the control and citric acid treated samples. The reduced enzyme activities resulted in the reduced browning incidence and maintained the quality. Therefore, postharvest dip of fresh-cut drumstick in to ascorbic acid (1%) could be suggested to increase the shelf life with reduced browning during low temperature storage.

Genome Sequence and Phylogeny of a Bean Yellow Mosaic Virus Isolate Obtained from a 14-Year-Old Australian Lentil Sample.

Using RNA strand-specific sequencing followed by de novo assembly, a Bean yellow mosaic virus (BYMV) genome was obtained from a lentil sample (Aus14BY) collected in Victoria, Australia, in 2005. When compared with 51 BYMV genomes, it closely resembled the Western Australian isolate PN83A (Lupinus angustifolius), with 98.4% nucleotide identity.

A Wearable Soft Haptic Communicator Based on Dielectric Elastomer Actuators.

Dielectric elastomer actuators exhibit an unusual combination of large displacements, moderate bandwidth, low power consumption, and mechanical impedance comparable with human skin, making them attractive for haptic devices. In this article, we propose a wearable haptic communication device based on a two-by-two array of dielectric elastomer linear actuators. We briefly describe the architecture of the actuators and their mechanical and electrical integration into a wearable armband. We then characterize the actuators' force, displacement, and thermal properties in a bench-top configuration. We also report on the power and drive circuit design. Finally, we perform a set of preliminary perception evaluations on participants using our haptic device, including detection threshold tests and identification tests for locations and directions on the forearm. Human testing with individual actuators demonstrates that the broadband actuation can be easily perceived on the forearm, providing the basis for both the development of a wearable actuator array and its use in more extensive perception evaluation as described herein.

Coding-Complete Sequences of Barley Virus G Isolates from Australia, Obtained from a 34-Year-Old and a 1-Year-Old Sample.

Coding-complete sequences of two barley virus G isolates from Australia were obtained from a 34-year-old oat sample (isolate Aus8) and a 1-year-old barley sample (isolate Aus17N). The Aus8 and Aus17N isolates share 96.3% nucleotide identity with each other and 95.7 to 95.8% nucleotide identity with the South Korean isolate Uiseong.

Metagenomic Analysis Reveals a Nearly Complete Genome Sequence of Alfalfa Mosaic Virus from a Field Pea in Australia.

Here, we report the first nearly complete genome sequence of Alfalfa mosaic virus (AMV) obtained from a symptomatic field pea sample (Aus295) in Australia. Its genome RNA1 and RNA2 segments resembled those of the Argentinian isolate Manfredi, with 99.4% and 96.7% nucleotide (nt) identity, respectively; its RNA3 segment resembled that of Chinese isolate AMV-Gyn, with 99.6% nt identity.

Test performance of point-of-care ultrasound for gastric content.

OBJECTIVE: We sought to determine test performance characteristics of emergency physician ultrasound for the identification of gastric contents. METHODS: Subjects were randomized to fast for at least 10 h or to consume food and water. A sonologist blinded to the patient's status performed an ultrasound of the stomach 10 min after randomization and oral intake, if applicable. The sonologist recorded their interpretation of the study using three sonographic windows. Subsequently 2 emergency physicians reviewed images of each study and provided an interpretation of the examination. Test performance characteristics and inter-rater agreement were calculated. RESULTS: 45 gastric ultrasounds were performed. The sonologist had excellent sensitivity (92%; 95% CI 73%-99%) and specificity (85%; 95% CI 62%-92%). Expert review demonstrated excellent sensitivity but lower specificity. Inter-rater agreement was very good (κ = 0.64, 95%CI 0.5-0.78). CONCLUSION: Emergency physician sonologists were sensitive but less specific at detecting stomach contents using gastric ultrasound.

Efficacy of steroidal vs non-steroidal agents in oral lichen planus: a randomised, open-label study.

OBJECTIVE: This study compared the therapeutic efficacy of steroidal and non-steroidal agents for treating oral lichen planus. METHODS: Forty patients with clinical and/or histologically proven oral lichen planus were randomly placed into four groups and treated with topical triamcinolone, oral dapsone, topical tacrolimus or topical retinoid for three months. Pre- and post-treatment symptoms and signs were scored for each patient. RESULTS: Patients in all treatment groups showed significant clinical improvement after three months (p 0.05) and for topical retinoid vs topical tacrolimus (p > 0.05). CONCLUSION: Non-steroidal drugs such as dapsone, tacrolimus and retinoid are as efficacious as steroidal drugs for treating oral lichen planus, and avoid the side effects associated with steroids.

Deterministic Integration of Out-of-Plane Sensor Arrays for Flexible Electronic Applications.

A design strategy for fully flexible electrode arrays with out-of-plane through polymer vias (TPVs) for monolithic 3D integration of sensor readout circuitry is presented. The TPVs are formed using copper embedded in thin polyimide structure for support. The copper interconnects offer a stable impedance frequency response from DC to 100 kHz (Z ≈ 20 Ω, θ ≈ 0°).