Hassan Al Thani

Polyvascular Disease in Patients Presenting with Acute Coronary Syndrome: Its Predictors and Outcomes

We evaluated prevalence and clinical outcome of polyvascular disease (PolyVD) in patients presenting with acute coronary syndrome (ACS). Data for 7689 consecutive ACS patients were collected from the 2nd Gulf Registry of Acute Coronary Events between October 2008 and June 2009. Patients were divided into 2 groups (ACS with versus without PolyVD). All-cause mortality was assessed at 1 and 12 months. Patients with PolyVD were older and more likely to have cardiovascular risk factors. On presentation, those patients were more likely to have atypical angina, high resting heart rate, high Killip class, and GRACE risk scoring. They were less likely to receive evidence-based therapies. Diabetes mellitus, renal failure, and hypertension were independent predictors for presence of PolyVD. PolyVD was associated with worse in-hospital outcomes (except for major bleedings) and all-cause mortality even after adjusting for baseline covariates. Great efforts should be directed toward primary and secondary preventive measures.

Prevalence, Predictors, and Impact of Peripheral Arterial Disease in Hemodialysis Patients A Cohort Study With a 3-year Follow-Up

We evaluated the prevalence, predictors, and outcome of peripheral arterial disease (PAD) among hemodialysis (HD) patients (n = 252) in a prospective study (3-year follow-up) conducted in Qatar. Those with PAD (n = 97; 38.5%) were older and more likely to be males and to have diabetes mellitus, prior coronary artery disease (CAD), or cerebrovascular disease. Diabetic retinopathy was an independent predictor of PAD (adjusted odds ratio: 2.7; P = .004). Women had a higher mortality. Three-year all-cause mortality was high in the PAD group (adjusted hazard ratios [HRs] 2.92; 95% confidence interval [CI] 1.55-5.51). Other predictors of mortality were age (HR 1.06; 95% CI 1.04-1.10), number of vascular access (HR 2.3; 95% CI 1.04-5.01), and prior CAD (HR 1.8; 95% CI 1.05-3.49). Prevalence of PAD was high among HD patients. Early detection of PAD as well as diabetic retinopathy is of value in identifying an even higher risk population among HD patients.

Diabetic retinopathy: a new predictor in patients on regular hemodialysis

Abstract Background: Data evaluating the presence and impact of diabetic retinopathy (DR) in patients on regular hemodialysis (HD) are scarce. Objective: To assess prevalence and outcomes of DR in HD patients. Methods: Data were collected from 252 consecutive HD-dependent patients who underwent eye examination for detection of DR in 2007. Patients were divided into two groups (DR vs. no-DR) and followed up for 3 years. Demographic and clinical profiles were analyzed and compared. Multivariate logistic regression was used to find out the predictors of DR, morbidity and mortality. Results: DR was diagnosed in 113 patients (45%). In comparison to no-DR, DR patients were older and more likely to have high prevalence of dyslipidemia, coronary artery disease and cerebrovascular accidents. Duration of DM was longer in DR patients (p = 0.02). There was significant correlation between DR and nephropathy (r = 0.38; p = 0.001) and PAD (r = 0.27; p = 0.001). Hemoglobin A1c, serum calcium and total cholesterol were higher while serum albumin and phosphorus were lower in DR in comparison to no-DR group. The rates of renal transplant, coronary artery disease and cerebrovascular accidents were comparable in the two groups. Peripheral arterial disease (PAD) was associated with 4-fold increase in the presence of DR (Adjusted OR 3.9; p = 0.009). DR was independent predictor for PAD (adjusted OR 2.2; p = 0.01). Age-sex adjusted DR was independent predictor of 3-year mortality (OR 2.04; p = 0.03). Limitations: The main issue with a cross-sectional study such as this, is differentiating cause and effect from simple association. Also, the current study did not specify the severity of DR. Conclusion: Prevalence of DR is high among HD patients and associated with high mortality. DR is an independent predictor for PAD and not for transplantation. Early detection of DR is highly recommended among HD population for risk-stratification and counseling. Further randomized controlled studies are needed to support our finding.

Pedestrians: the daily underestimated victims on the road

Traffic-related pedestrian injuries (TRPI) are vulnerable to road users. In this study, we aimed to evaluate the demographic pattern of injury and outcome of TRPI. Patients with TRPI admitted between November 2007 and March 2010 to the only level 1 trauma centre in Qatar were included. A retrospective analysis was based on medical records and Emergency Medical Services run sheets. The spreadsheet included demographic data and pre-hospital transport, service admissions and injuries by system and mortality. Of 4077 patients who were admitted, 420 (10.3%) had TRPI. The mode of transportation included ambulances (91%), private vehicles (6%) and helicopters (3%). The direct dispositions were trauma intensive care units (38%), surgical wards (42%) and operating rooms (17%). Patients were classified according to Injury Severity Score (1–8 in 28%, 9–15 in 25%, 16–24 in 20% and 25–75 in 17% cases). Multisystem injuries were most characteristic. Of 804 injures, injury of extremities was predominant followed by head, thorax and abdomen. The overall mortality was 8%. Pedestrian injuries are a significant cause of serious trauma in Qatar. Motor vehicle/pedestrian interface contributes to this ongoing public health problem. Reducing pedestrian trauma requires recognition of the problem and implementing programmes to mitigate these largely preventable injuries.

Abdominal Wall Reconstruction in Patients with an Open Abdomen and Enterocutaneous Fistulas: A Nine-Step Treatment Strategy

Enterocutaneous fistulas (ECFs) are serious postoperative complications; less commonly, they result from an inflammatory or oncologic process. No matter what the cause, the consequences can be devastating. The surgeon should have a clear strategy for how to manage ECFs. Particularly when they are associated with an open abdomen or with a large abdominal wall defect requiring complex abdominal wall reconstruction, ECFs lead to a high rate of complications, of failure of the operative intervention, and of mortality. The management of ECFs (whether alone or combined with an abdominal wall defect or an open abdomen) requires a multidisciplinary approach.