Ruben Peralta
Hamad Medical Corporation, Surgery, Department Member
- Universidad Nacional Pedro Henriquez Urena, Medical School, Department Memberadd
- Surgery, Trauma Surgery, Emergency Surgery, Critical Care Medicine, Wound care, Abdominal Wall Reconstruction, and 15 moreINTENSIVE CARE, Trauma Studies, Polytraumatic Injury, Global Health, Radiology Diagnostic, Post graduate medical education, Academic surgery, Medical Education & Training, Simulation in Medical Education, Surgical Education, Migrant Health, work-related injuries(WRIs), Injury Prevention, Violence and Injury Prevention, and Complex abdominal wall reconstruction, center of excellenceedit
- Prof. Ruben Peralta, MD, FACS, FCCM, FCCP. Co-Founder Casa Rubén Foundation Deputy Trauma Medical Director Professor ... moreProf. Ruben Peralta, MD, FACS, FCCM, FCCP.
Co-Founder Casa Rubén Foundation
Deputy Trauma Medical Director
Professor & Director Trauma, Emergency & Surgical Critical Care Fellowship Programedit
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Traumatic pulmonary herniation involves the protrusion of lung parenchyma beyond the normal borders of the thoracic cage through a defect in the musculoskeletal wall. Anesthetic management involves airway protection, lung isolation, and... more
Traumatic pulmonary herniation involves the protrusion of lung parenchyma beyond the normal borders of the thoracic cage through a defect in the musculoskeletal wall. Anesthetic management involves airway protection, lung isolation, and avoidance of distension of the herniated segment. We report the successful anesthetic management during surgical management of pulmonary herniation.
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Mortality for young children in motor vehicle crashes in Qatar was highest in those who were unrestrained1. Anecdotal reports have attributed low car seat use to their expense and unavailability prompting car seat giveaway programs, but... more
Mortality for young children in motor vehicle crashes in Qatar was highest in those who were unrestrained1. Anecdotal reports have attributed low car seat use to their expense and unavailability prompting car seat giveaway programs, but an assessment of the local car seat market has not been conducted previously. This study will report the results of a rapid market survey (RMS) to understand the availability, characteristics and the cost of child restraints and make recommendations for future child restraint policies and legislation in Qatar. This RMS was conducted as part of the Young Kids in Safe Seats Project funded by the Qatar Foundation. The survey involved locating all retail outlets that sell child restraints in Qatar and collecting standard data on each restraint system: brand, model no. age/weight limits, compliance with standards, availability and language of owner's manual. The RMS showed a sufficient number and variety of car seat models [83] available at 19 retail outlets with a wide affordability range [$46 - $810]. All of the car seats complied with the European standard. Only 2% showed a date of manufacture or expiry. A user manual was available in only 71% of seats and in a variety of different languages, but only 36% in the native language of Arabic. This RMS demonstrates the availability and variety of child restraint systems in Qatar. Unavailability and expense cannot be cited as barriers to their use and the market is prepared for legislation requiring car seats for children in Qatar. Areas for improvement include: requiring user manuals for all seats, especially in Arabic, that all car seats comply with globally accepted safety standards, especially expiry/manufacturing dates, given the harsh local climate, and encouraging more variety in the local markets. References: Consunji RJ, Peralta R, Al-Thani H and Latifi R. A focused approach to the road safety of young children in Qatar. Oral Presentation. 2nd Annual Child Health Research Day. Sick Kids International/Hamad Medical Corporation Partnership. 28 January 2012. Doha, Qatar.
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In a report by the WHO Eastern Mediterranean Region(1), the non-use of child restraints for children was identified as a key risk factor that can be addressed by the adoption and enforcement of legislation that will increase their use.... more
In a report by the WHO Eastern Mediterranean Region(1), the non-use of child restraints for children was identified as a key risk factor that can be addressed by the adoption and enforcement of legislation that will increase their use. Currently, there are no child restraint laws in Qatar. The objective of the study is to report baseline data on child restraint use and to provide evidence to inform the passage of child passenger restraint laws in Qatar. This roadside observational survey was conducted as part of the Young Kids in Safe Seats Project funded by the Qatar Foundation. Trained observers conducted roadside observations of passenger restraint use in vehicles with children, less than 5 years, at 12 sampling sites. Standard data was collected per observation: seating position, restraint used and appropriateness of restraint used. Of 2232 observations of young child passengers: 41% were properly restrained, 21% improperly restrained and 38% unrestrained, 10.9% were on an adult’s lap. The most common seating location was right second row followed by left second row. These 2 locations also had the highest rates of proper restraint use. The positions with the lowest restraint use were the front and second row middle seat. One in 9 children observed was illegally seated in the front row, most on the lap of an adult [38.3%] or unrestrained [34.4%]. This is the first observational study in Qatar that measures child restraint rates in children younger than 5. Less than half of these children are traveling safely. Priority areas for intervention include: enforcement of existent laws banning children in the front seat, education about the risks for children in an adult’s lap and encouraging the proper use of age/size appropriate restraint systems. These findings can inform the development of national child passenger restraint laws. Reference: 1. Road safety in the Eastern Mediterranean Region Facts from the Global Status Report on Road Safety 2013.
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We described a rare case of vaccine‐induced acalculous cholecystitis (ACC). A 52‐year‐old female developed ACC after 8 h of receiving a 3rd dose of the Pfizer‐BioNTech COVID‐19 vaccination. The symptoms subsided completely with... more
We described a rare case of vaccine‐induced acalculous cholecystitis (ACC). A 52‐year‐old female developed ACC after 8 h of receiving a 3rd dose of the Pfizer‐BioNTech COVID‐19 vaccination. The symptoms subsided completely with conservative treatment for 12 days, and the ultrasound and laboratory findings went back to normal.
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Background: We aimed to study the clinical implication of high serum myoglobin levels in trauma patients. Methods: A retrospective analysis was conducted on data from trauma patients who were admitted to a level 1 trauma center between... more
Background: We aimed to study the clinical implication of high serum myoglobin levels in trauma patients. Methods: A retrospective analysis was conducted on data from trauma patients who were admitted to a level 1 trauma center between January 2012 and December 2015. A receiver operating characteristic (ROC) curve analysis was performed for the optimum myoglobin cutoff plotted against hospital length of stay of >1 week. Patients were divided into two groups (Group 1; low vs. Group 2; high myoglobin), and a comparative analysis was performed. Results: There were 898 patients who met the inclusion criteria with a mean age of 35.9 ± 14.6 years. Based on ROC, the myoglobin optimum cutoff was 1000 ng/ml (64% of patients were in Group 1 and 36% in Group 2). The mean myoglobin level was 328 ng/ml in patients with the Injury Severity Score (ISS) <15 versus 1202 ng/ml in patients with ISS ≥15 (P < 0.001). Patients in Group 2 had higher ISS (22.2 ± 10 vs. 18.8 ± 10), more musculoskeletal injuries (18.3% vs. 4.2%), more blood transfusion (74% vs. 39%), intubation (57% vs. 46.5%), and sepsis (12% vs. 7.3%). The length of hospital stays was significantly higher in Group 2, but mortality was comparable. High myoglobin levels had a crude odd ratio 2.41; 95% confidence interval (1.470–3.184) for a longer hospital stay with a positive predictive value of 89% and a specificity of 77%. Conclusions: One-third of the admitted trauma patients have elevated serum myoglobin level, which is associated with the prolonged hospital stay. The discriminatory power of myoglobin value of 1000 in trauma is fair, and further prospective assessments are needed.
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Advances in critical care in medicine during the last three decades have made a significant impact on the management of patients with devastating surgical and vascular conditions and life-threatening injuries. Patients who survive the... more
Advances in critical care in medicine during the last three decades have made a significant impact on the management of patients with devastating surgical and vascular conditions and life-threatening injuries. Patients who survive the initial general surgery, vascular, or trauma event might require multiple trips to the operating room for management of their multiple injuries, complications, and sequelae. Subsequently, some patients develop large and complex abdominal wall defects that require surgical reconstruction. Preoperative optimization of patients requiring major abdominal wall reconstructions is of paramount importance and has been shown to reduce morbidity and mortality. This optimization should be multidisciplinary and requires attention to details; the evaluation of operative risk should be clearly discussed with the patients and close relatives.
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Advances in trauma and critical care medicine have improved survival of severely injured patients and those with other acute surgical conditions. Surgeons are currently challenged by the significant number of patients with open abdomen... more
Advances in trauma and critical care medicine have improved survival of severely injured patients and those with other acute surgical conditions. Surgeons are currently challenged by the significant number of patients with open abdomen and major abdominal wall defects. Expertise of the surgeon is paramount for dealing with hostile abdomen, loss of domain, and major abdominal wall defects. An inability to close the abdomen is associated with significant morbidity and mortality. Component separation techniques offer a viable option in the armamentarium of a practicing surgeon for achieving a definitive closure of the abdomen in the semiacute setting as well during the planned ventral hernia repair. The procedure requires a multidisciplinary team to achieve better outcomes. As with any major surgical procedure, a clear understanding of the indication, risk, and possible complications should be explained and clearly communicated to the patients and close relatives.
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Damage control concepts and techniques have been part of our clinical armamentarium in trauma and emergency surgery for decades. In recent years, the damage control concept has expanded to other surgical disciplines: emergency general... more
Damage control concepts and techniques have been part of our clinical armamentarium in trauma and emergency surgery for decades. In recent years, the damage control concept has expanded to other surgical disciplines: emergency general surgery, orthopedics, thoracic, vascular, etc. Damage control is characterized by termination of the surgical intervention after control of bleeding and contamination, followed by definitive management. It is a staged approach to take in consideration the physiologic reserve of the patient and it is designed to avoid or treat the lethal triad of hypothermia, acidosis, and coagulopathy. The decision-making process is complex, however, and requires solid knowledge of physiology of the patient as well taking into account the associated injuries or comorbid disease. In this chapter, we aim to highlight the current principles and practices of damage control surgery and the decision-making process into this lifesaving maneuver.
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Motor vehicle crashes have been identified as one of the leading causes of death, injury and disability among young children, less than 5 years, in Qatar. Previous studies on the effectiveness of a child restraint have shown that if child... more
Motor vehicle crashes have been identified as one of the leading causes of death, injury and disability among young children, less than 5 years, in Qatar. Previous studies on the effectiveness of a child restraint have shown that if child occupants are properly restrained, the fatality risk is reduced by 28% and serious injury by 82%. The objective of this survey is to examine knowledge, attitudes and usage of CRS in a sample of parents with young children in Doha, Qatar. It has been predicted that by the year 2020, RTIs will be the third major cause of disability and hence is an alarming public health problem currently prevailing. A custom designed survey, containing 25 questions that tested CRS knowledge, attitudes and practice of participants, was applied by trained health communicators in 3 Well Baby Clinics of the Primary Health Care Corporation. The survey collected information from 602 parents on: method of child transport, use of CRS, knowledge of CRS, and demographic characteristics. The results showed that only 43% used a CRS for their children and only 53% had a car seat. The most common reasons for not using a safety seat included children crying when in CRS (56%) and a preference to hold the child (18.1%). Moreover, nearly all [94%] reported never witnessing enforcement of child passenger laws prohibiting children from riding in the front, concomitantly only 9% stated that a law requiring CRS use would make them use one for their children. Less than half of young children, in this study population, were benefitting from safety provided by CRS. There is a need to develop awareness programs that educate caregivers on the benefits and proper use of CRS. Other priority areas for intervention include the consistent enforcement of laws banning children in the front seat.
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Introduction Qatar is a rapidly developing high-income country in the Middle East with a rapidly growing expatriate worker population working on road and FIFA World Cup 2022 infrastructure projects. Heavy Vehicles (HVs) are a very common... more
Introduction Qatar is a rapidly developing high-income country in the Middle East with a rapidly growing expatriate worker population working on road and FIFA World Cup 2022 infrastructure projects. Heavy Vehicles (HVs) are a very common sight in Qatar but their effect/s on work-related road traffic injuries (WRTIs) in Qatar has not been reported previously. This study aims to analyze the work related injuries caused by HVs; it was conducted as part of a larger ‘A Unified Registry for Workplace Injury Prevention in Qatar’ grant [NPRP 7–1120–3–288] funded by the Qatar Foundation and designed to initiate and implement a targeted unified workplace injury registry to inform policies and programs to reduce the health burden, in terms of deaths and disabilities, and the healthcare costs from WRI’s in Qatar Methods A free text search using heavy vehicle terms like ‘crane’, ‘truck’, ‘bulldozer’ etc. was carried out on the Trauma Registry of the national trauma center of Qatar. All WRTI patients, from 1 January 2015 to 31 December 2016, were included and their data analyzed according to road user type and key epidemiologic characteristics. Results Forty percent (40%) of all WRTIs in Qatar involved heavy vehicles. 57% worked in the transportation industry, 83.8% were truck drivers and only 8% of them were restrained. The driver victims were involved in head-on collisions (32%) and fixed object crashes (22%). It was also found that pedestrians (20%) and falling object victims (4.6%) had more severe injuries when compared to other mechanisms. Conclusion HV-WRTIs are underappreciated as a major cause of severe WRTI in Qatar. Occupational safety programs should focus on decreasing operating hours by HV drivers and increasing restraint use, pedestrian worksite environmental modifications and HV maintenance and repair standards. The limited available evidence necessitates more focused data capture and analysis in the future.
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Introduction Injuries are the leading cause of death in Qatar, primarily those that occur at work or on the road. However, there is a paucity of data on work-related road traffic injuries [WRTIs] in Qatar. This study will describe the... more
Introduction Injuries are the leading cause of death in Qatar, primarily those that occur at work or on the road. However, there is a paucity of data on work-related road traffic injuries [WRTIs] in Qatar. This study will describe the epidemiology of WRTIs in Qatar and make recommendations for targeted prevention programs. It was conducted as part of a larger ‘A Unified Registry for Workplace Injury Prevention in Qatar’ grant [NPRP 7-1120-3-288] funded by the Qatar Foundation and designed to initiate and implement a targeted unified workplace injury registry to inform policies and programs to reduce the health burden, in terms of deaths and disabilities, and the healthcare costs from WRI's in QatarMaterials and MethodsData, on patients with WRTIs treated at the Hamad Trauma Center [HTC] Trauma Registry from January 2015 to September 2016 was collected and analyzed according to road user type and characteristics.ResultsThere were 260 WRTIs admitted during the study period, 25.5% of all work-related injuries. The in-hospital mortality rate was 5.4 %. Motor vehicle crashes [MVCs] comprised 74% of WRTIs: 51% involved heavy vehicles [trucks or buses], 40 % were unrestrained drivers, 15% were rollovers and 10% were against fixed objects. Twenty-one percent of victims were pedestrians, 81.8% from left-hand driving countries. There were no significant differences for age, mean ISS, ICU a hospital LOS but the mortality rate for pedestrians was twice that for MVC victims [10.9% vs. 4.2%, pl 0.05].ConclusionOne-fourth of all work-related injuries in Qatar are WRTIs. Occupational safety programs should focus on increasing restraint use by drivers of heavy vehicles, driver education to prevent rollovers and pedestrian education for workers from left-hand driving countries. The significantly higher mortality rate for pedestrians merits more focused analysis in the future.
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Significant advances have been made in the management of medical and surgical conditions of critically injured patients; these advances have led to improved survival and reduced morbidity. However, the practicing surgeon when faced with... more
Significant advances have been made in the management of medical and surgical conditions of critically injured patients; these advances have led to improved survival and reduced morbidity. However, the practicing surgeon when faced with the management of the open abdomen and large abdominal wall defects that require major reconstruction needs to be able to provide preoperative care that would ensure optimal operative outcomes. A multidisciplinary and systematic approach should be undertaken by all members involved in the operative management of the patients. This chapter focuses on the multidisciplinary approach and measures to take into consideration in the preoperative optimization of complex cases, which are frequently associated with complications, high rate of hernia recurrence requiring multiple procedures, and mortality.
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Qatar is a rapidly developing country in the Arabian Gulf. This growth is fueled by the over 80% of its population that work as migrant workers, Information on the risk factors for occupational injuries in this population is needed.This... more
Qatar is a rapidly developing country in the Arabian Gulf. This growth is fueled by the over 80% of its population that work as migrant workers, Information on the risk factors for occupational injuries in this population is needed.This survey was conducted during the Supreme Council of Health World Day for Safety and Health at Work, to identify the work related injuries and risk factors for workers in various industries. 262 workers were interviewed using a standard questionnaire, none refused interview. Nurses and doctors from the Hamad Trauma Centre conducted the interviews. Questions were translated into the workers native language when it was needed. Males made up 98% of all respondents. The main occupations were: construction workers of 53% and transportation workers 12%. The majority were from Nepal, India and Bangladesh. The percent who could read English was 64% and speak English was 80%. Those who could read Arabic was 5% and speak Arabic was 10%. The mean duration in Qatar was 24 months and mean age was 33.4 years. One in five had no formal schooling, 60% were secondary school graduates, and only 3% had college degrees. Only 6.4% of the workers declared a WRI in the last 12–24 months. No statistically significant differences were noted between the group injured when compared to those not injured. Further research is needed to identify risk factors for worker injury in Qatar. Acknowledging language barriers and creating safety education targeted to key populations and appropriate literacy levels should be implemented in future occupational safety initiatives in Qatar.
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Background Beta-adrenergic receptor blockers (BB) play an important role in the protection of organs that are susceptible for secondary injury due to stress-induced adrenergic surge. However, the use of BB in traumatic brain injury (TBI)... more
Background Beta-adrenergic receptor blockers (BB) play an important role in the protection of organs that are susceptible for secondary injury due to stress-induced adrenergic surge. However, the use of BB in traumatic brain injury (TBI) patients is not yet the standard of care which necessitates clear scientific evidence to be used. The BBTBBT study aims to determine whether early administration of propranolol based on the high-sensitive troponin T(HsTnT) status will improve the outcome of TBI patients. We hypothesized that early propranolol use is effective in reducing 10- and 30-day mortality in TBI patients. Secondary outcomes will include correlation between serum biomarkers (troponin, epinephrine, cytokines, enolase, S100 calcium binding protein B) and the severity of injury and the impact of BB use on the duration of hospital stay and functional status at a 3-month period. Methods The BBTBBT study is a prospective, randomized, double-blinded, placebo-controlled three-arm tria...
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Introduction Work related injuries (WRIs) are a leading cause of trauma admission in Qatar; their epidemiologic trends and high-risk populations have been reported. This study aims to explore the work circumstances and environments... more
Introduction Work related injuries (WRIs) are a leading cause of trauma admission in Qatar; their epidemiologic trends and high-risk populations have been reported. This study aims to explore the work circumstances and environments leading to severe WRIs, to inform the creation of targeted interventions to improve worker safety. It was conducted as part of a larger ‘A Unified Registry for Workplace Injury Prevention in Qatar’ grant [NPRP 7–1120–3–288], funded by the Qatar Foundation, designed to initiate and implement a unified workplace injury registry to inform policies and programs to reduce the health burden, in terms of deaths and disabilities, and the healthcare costs from WRI’s. Methods WRI patients who were admitted to the Hamad Trauma Center were interviewed by trained interviewers using a standard questionnaire. A proportionate sampling method was implemented based on the leading mechanisms of injuries. Results Fifty patients were consented and interviewed. 58% had some kind of safety training and 82% were aware about the risks at work. Seventy eight percent used one form of personal protection: 58% -safety helmet, 62% -foot protection, 54% – high visibility jacket/vest and 50% – antistatic gloves. Approximately 50% of the patients had one form of health insurance. Almost everyone was given treatment on-site prior to being transported to the nearest treatment facility. Self-reported contributory factors, for WRI, included: ‘inadequate training for a new task’, ‘sub-optimal working environment’ and ‘psychological factors’. Almost all classified their injuries as ‘accidental’ or unexpected. Conclusion In this study population, WRIs are still thought of as ‘accidental’ by the workers themselves. Areas for improvement include: 1.) culturally appropriate safety training 2.) increased use and availability of personal protective equipment 3.) health insurance and 4.) training for new tasks. Further studies on knowledge and attitudes of workers towards safety are needed to better inform occupational injury prevention programs in Qatar.
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Background: Trauma is a major cause of death and disability worldwide. Renal injuries account for 8–10% of abdominal trauma. We aimed to describe the incidence, presentation, and management of traumatic kidney injury in our institution.... more
Background: Trauma is a major cause of death and disability worldwide. Renal injuries account for 8–10% of abdominal trauma. We aimed to describe the incidence, presentation, and management of traumatic kidney injury in our institution. Methods: This is a retrospective analysis of all patients admitted with traumatic kidney injury at a level 1 trauma center between January 2014 and December 2017. Results: During a period of 3 years, a total of 152 patients with blunt renal trauma were admitted to a level 1 trauma center; 91% of these were males, with a mean age of 32.8 ± 13.7 years. Motor vehicle crashes accounted for 68% of cases, followed by fall from height (23%). Seventy-one percent of patients had associated chest injuries, 38% had pelvis injuries, and 32% had head injury. Associated abdominal injuries included the liver (35%) and spleen (26%). The mean abdominal abbreviated injury scale was 2.8 ± 1.0; and for those with severe renal injury, it was 3.9 ± 0.9. The mean injury se...
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Traumatic cardiac arrest studies have reported improved survival rates recently, ranging from 1.7-7.5%. This population-based nationwide study aims to describe the epidemiology, interventions and outcomes, and determine predictors of... more
Traumatic cardiac arrest studies have reported improved survival rates recently, ranging from 1.7-7.5%. This population-based nationwide study aims to describe the epidemiology, interventions and outcomes, and determine predictors of survival from out-of-hospital traumatic cardiac arrest (OHTCA) in Qatar. An observational retrospective population-based study was conducted on OHTCA patients in Qatar, from January 2010 to December 2015. Traumatic cardiac arrest was redefined to include out-of-hospital traumatic cardiac arrest (OHTCA) and in-hospital traumatic cardiac arrest (IHTCA). A total of 410 OHTCA patients were included in the 6-year study period. The mean annual crude incidence rate of OHTCA was 4.0 per 100,000 population, in Qatar. OHTCA mostly occurred in males with a median age of 33. There was a preponderance of blunt injuries (94.3%) and head injuries (66.3%). Overall, the survival rate was 2.4%. Shockable rhythm, prehospital external hemorrhage control, in-hospital blood ...
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Significant advances have been made in the management of medical and surgical conditions of critically injured patients; these advances have led to improved survival and reduced morbidity. However, the practicing surgeon when faced with... more
Significant advances have been made in the management of medical and surgical conditions of critically injured patients; these advances have led to improved survival and reduced morbidity. However, the practicing surgeon when faced with the management of the open abdomen and large abdominal wall defects that require major reconstruction needs to be able to provide preoperative care that would ensure optimal operative outcomes. A multidisciplinary and systematic approach should be undertaken by all members involved in the operative management of the patients. This chapter focuses on the multidisciplinary approach and measures to take into consideration in the preoperative optimization of complex cases, which are frequently associated with complications, high rate of hernia recurrence requiring multiple procedures, and mortality.