INTRODUCTION Renewed interest in whole blood (WB) resuscitation in civilians has emerged following its military use. There is a paucity of data on its role in civilians where balanced component therapy (CT) resuscitation is the standard of care. The aim of this study was to assess nationwide outcomes of using WB as an adjunct to CT versus CT alone in resuscitating civilian trauma patients. METHODS We analyzed the (2015–2016) Trauma Quality Improvement Program. We included adult (age, ≥18 years) trauma patients presenting with hemorrhagic shock and requiring at least 1 U of packed red blood cells (pRBCs) within 4 hours. Patients were stratified into WB-CT versus CT only. Primary outcomes were 24-hour and in-hospital mortality. Secondary outcomes were hospital length of stay and major complications. Hierarchical logistic regression was performed to account for clustering effect within hospitals and adjusting for patient- and hospital-level potential confounding factors. RESULTS A total of 8,494 patients were identified, of which 280 received WB-CT (WB, 1 [1–1]; pRBC, 16 [10–23]; FFP, 9 [6–16]; platelets, 3 [2–5]) and 8,214 received CT only (pRBC, 15 [10–24]; FFP, 10 [6–16]; platelets, 2 [1–4]). Mean ± SD age was 34 ± 16 years, 79% were male, Injury Severity Score was 33 (24–43), and 63% had penetrating injuries. Patients who received WB-CT had a lower 24-hour mortality (17% vs. 25%; p = 0.002), in-hospital mortality (29% vs. 40%; p < 0.001), major complications (29% vs. 41%; p < 0.001), and a shorter length of stay (9 [7–12] vs. 15 [10–21]; p = 0.011). On regression analysis, WB was independently associated with reduced 24-hour mortality (odds ratio [OR], 0.78 [0.59–0.89]; p = 0.006), in-hospital mortality (OR, 0.88 [0.81–0.90]; p = 0.011), and major complications (OR, 0.92 [0.87–0.96]; p = 0.013). CONCLUSION The use of WB as an adjunct to CT is associated with improved outcomes in resuscitation of severely injured civilian trauma patients. Further studies are required to evaluate the role of adding WB to massive transfusion protocols. LEVEL OF EVIDENCE Therapeutic, level IV.

BACKGROUND:Whole blood (WB) has shown promise in pediatric trauma resuscitation following its prominent role in the resuscitation of adult trauma patients. Although WB in children has been shown to be feasible, its effectiveness has yet to be explored. The aim of this study was to examine the outcomes of WB transfusion as an adjunct to component therapy (CT) compared with CT only as early resuscitation for pediatric trauma patients. METHODS:Children aged 1 to 17 years, who were transfused within 4 hours of presentation, were identified in the Trauma Quality Improvement Program 2017 database. Patients were stratified into those receiving WB-CT versus CT alone. Propensity score matching in a 1:2 ratio was performed based on patient demographics, injury characteristics, hemorrhage control interventions, and trauma center level. The primary outcome measure was patient transfusion requirement. Secondary outcome measures were mortality, hospital length of stay, ventilation days, and major complications. RESULTS: A total of 135 children receiving WB-CTwere matched to 270 patients receiving CT only. Mean (SD) age was 12 (5) years, 66% were male, and the median Injury Severity Score was 32 (range, 20-43). A total of 51% of patients were in shock, 34% had penetrating injuries, and 41% required surgical intervention for hemorrhage control. Total blood products transfused were significantly decreased in children receiving WB, both at 4 hours (35 [22-73] vs. 48 [33-95] mL/kg; p = 0.013) and 24 hours (39 [24-97] vs. 53 [36-119] mL/kg; p < 0.001). Mortality rate at 24 hours (19.3% vs. 21.9%; p = 0.546) and in-hospital mortality (31.1% vs. 34.4%; p = 0.502) were not different. Similarly, no difference in hospital length of stay and rates of major complications was found. Patients in the WB group required significantly less ventilation days (2 [2-6] vs. 3 [2-8] days; p = 0.021). CONCLUSION:Using WB as an adjunct to CT was associated with decreased transfusion requirements and ventilation days in pediatric trauma patients.

ObjectivesThe current study aimed to validate and determine the psychometric properties of the Arabic versions of the Beck Depression Inventory-II (BDI-II) and the Edinburgh Postnatal Depression Scale (EPDS) in Qatar.DesignA cross-sectional study design was employed.SettingAntenatal care (ANC) clinics at nine primary healthcare centres.ParticipantsPregnant women (n=128) aged 15–46 years in different trimesters of pregnancy, attending the ANC clinics as well as capable of reading and writing in the Arabic language.ResultsA total of 128 participants were enrolled. On conducting the receiver operating characteristic (ROC) analysis, the EPDS showed a larger area under the curve at 0.951 than the BDI-II tool (0.912). Using Youden’s index, a score>13 on the EPDS (87% sensitivity, 90% specificity) and>19 on the BDI-II (96% sensitivity, 73% specificity) allowed for the greatest division between depressed and non-depressed participants.ConclusionTo address the under-recognition of antenatal depression, physicians at primary healthcare centres in Qatar should be encouraged to utilise the EPDS to screen pregnant women seeking ANC services.

No abstract

Aging is the process of growing older at cellular, organ, or whole body level throughout the life span. Furthermore, the term “demographic transition” refers to a shift in fertility and mortality rates leading to changes in population growth rates, and age distribution. Thus, as people globally live longer, increasing levels of chronic illness as well as diminished wellbeing are nominated to become major global health challenges. Subsequently, the global population of elderly is projected to further increase and reach 1.4 billion by 2030 and 2.1 billion by 2050. Moreover, ageing has important implications on social security, the economy, the organization and delivery of health care, caregiver availability and constraints, society, and policies. Thus, it is pertinent to establish comprehensive elderly-friendly health care with further focus on preventive action to maintain a healthy ageing process.