bluuebunny/crossref_metadata_2025 huggingface dataset:
Facial bone fracture with dental injuries from a 4-WD air bag deployment: A case report in Qatar
Authors: Abdul-Aziz Azhar , Javid Sasha , Al Kahlout Baha , Bhat Imran Nazir
Published: May 2017

Background: Injuries from air bag deployment have long been documented and studied like orbital blowout fractures, auditory injuries, etc. However, we report here a case of an alveolar process fracture associated with dental injuries and clear history of face-to-air bag impact only, which has rarely been documented and hence important to be reported.

Case report: A 25-year old female front-seat passenger was involved in a head-on collision between her large four-wheel drive vehicle and another similar-sized vehicle. She was unrestrained and suffered facial and dental pain after the air bag was deployed. She denied hitting the dashboard or losing her consciousness.

On examination, there was mild skin erythema associated with marked tenderness over her left maxilla and left upper jaw. Her upper left medial incisor was missing, while the lateral incisor and adjacent canine seemed to have been pushed upwards and embedded in their respective sockets. No other injury was elicited and she remained vitally stable.

X-ray and CT scan imaging confirmed an alveolar bone fracture with upward displacement of the alveolar margin of the maxilla. Loss of medial upper left incisor, and impaction of the adjacent lateral incisor and canine teeth in the soft tissues at the left naso-labial fold, antero-lateral to the left nasolacrimal bones were also noted.

Discussion: It is important to report these to be included in the potential range of injuries associated with air bag impact MVC. It will help widen the physicians range of possible injuries while evaluating an air bag impact MVC patient, hence aiding diagnosis and management. It will also help in the ongoing research for further modifying the techniques and types of protective devices currently used in vehicles to help prevent such injuries, as well as further highlighting the use of restraint along with use of such devices.
Knowledge, awareness and practices of workers exposed to pesticides in Qatar
Authors: Salem Waleed A. , Alessai Galal S , Ravishankar Shalini , John Stanley , Ershad Muhammed , Mirza Mohsin Khalid , Prabhu Kirti Sathyananda , Khan Abdul Aziz Taj Muhammad , Abubaker Elmoubasher , Hameed Asmaa Abdul , Nadeem Sana
Published: May 2017

Background: Pesticide poisoning is a global public health problem. With growing population and rapid industrialisation in Qatar, there has been a natural increase in pesticide usage and hence, exposure amongst the workers handling them. It is therefore vital to understand existing knowledge, attitudes and practices about handling pesticides.

Methods: 100 municipality employees in Qatar who work with pesticides, were interviewed in person by trained bilingual staff using a structured questionnaire model.

Results: The mean age of the workers was 37.4 (SD-9.9) Of the interviewed workers, 81% did not know the contents or the name of the pesticides they were handling at work. Unsafe behaviours such as preparation of pesticides at the site of its usage rather than in a specified preparation room (29.6%), non-compliance with wearing protective clothing (38.8%), handling of drinking water (22%) and food (10%) on site where pesticides are used and not washing clothes every day after work (45.9%) were observed. Workers who received training in pesticides usage were more likely to be aware of its effects on the environment (61.6%) (OR-3.9), less likely to eat or drink while handling pesticides (83.6%) (OR-4.3) and more likely to give household members appropriate instructions prior to application of pesticides (90.4%) (OR-5.0). Workers who did not wear special protective clothes at work were found to be, more than twice as likely to visit hospitals per year, than those who wore (RR-2.2).

Conclusion: Unsafe practices were found to be significantly common amongst the personnel using pesticides. Workers who received prior training handled pesticides in a safer way.
A surprising case of bilateral ureteric stones causing acute renal failure and anuria
Authors: Alkahky Sherif , Qotb Mohmaed , Morley Kostantinos
Published: May 2017

Introduction: We present a case of bilateral ureteric colic that causes anuric acute renal failure. Bilateral ureteric colic causing acute renal failure is not a new presentation. However, the patient had only 3 mm calculi, making our case unique.

Background: Bilateral renal calculi are an uncommon cause of acute kidney injury (AKI). Obstructing ureteroliths rarely lead to AKI without any underlying renal disease or anatomic abnormalities, such as a solitary kidney or horseshoe kidney. The literature has reported the incidence of a unilateral ureterovesicular junction obstruction secondary to a stone as 20%. However, there are a very few case reports in the literature of urology, nephrology or emergency medicine regarding the incidence of bilateral ureteric calculi. Cases of bilateral ureteric calculi are rare, and cases with AKI and anuria are very rare.

Case presentation: A 30-year-old male presented with bilateral colicky flank pain for 4 days and started to develop macroscopic haematuria. After proper pain management in the Emergency Department, the patient was found to have a raised serum creatinine level (152 μmol/L). A CT scan was performed showing two 3 mm calculi in the left and right proximal ureters. Ultrasound showed moderate left and mild right hydroureteronephrosis. Due to the relatively small size of the stones, and the clinical image of the patient, he was planned for medical expulsive therapy. Surprisingly, the patient developed complete anuria for 2 days and presented to the ED with a serum creatinine level of 843 μmol/L. Bilateral double J stents were placed and urgent ureteroscopy was done. Following treatment, the patient's condition significantly improved and his renal function returned to normal within 4 days.

Conclusion: Even small bilateral stones can result in acute kidney injury.
Direct laryngoscopy using video-laryngoscope for endo-tracheal intubation in the Emergency Department: An educational and patient safety initiative
Authors: Yusof Alhady Bin Alfian , Mostafa Zeinab , Farook Saleem , Morley Kostantinos , Rasool Mudassar , Shukla Dharmesh
Published: May 2017

Background: Conventional endotracheal intubation (ETI) is challenging and requires high level of individual skills and experience. At the same time we are also committed to provide ETI training for Emergency Medicine Residents (EMR). Video laryngoscope (VDL) like the C-MAC (by Karl Storz) is designed to have a similar blade to the normal Macintosh blades (size 3 and 4). It has a bright light source and blade thickness that allow Direct Laryngoscopy (DL) and hence ETI under direct vision. We organised several sessions of ETI training using an intubating manikin. We found that the view from the C-MAC screen captured by the C-MAC video camera is the same view described by the operator doing the DL. There were enough consistencies reported during several training sessions that we decided to use the C-MAC for DL in real cases of ETI in the resuscitation room. We have done several ‘live’ cases and all intubations successfully as DL, with the added benefit of ‘video supervision’ and ‘video confirmation’ of the tube positioning. We also used the video recording and playback functions to give feedback to the EMR at the end of the procedure.

Methods (Case Report): In this educational poster, we describe a step-by-step laryngoscopic and ETI view seen on the C-MAC screen during one of our airway training session with the manikin. We also include several views of possible poor technique in laryngoscopy that may result in a failed intubation attempt.

Results: We discuss the potential safety and training benefits in conventional ETI using C-MAC VDL.

Conclusion: We conclude that promoting the use of this technique in ED, especially for ETI undertaken by a trainee improves patient safety and supervision.
Airway trolley in the Emergency Department – A service development project case report
Authors: Alfian Yusof Alhady Bin , Thomas Stephen , Al-Naemi Enaam , Sebastian Binu , John Gijo
Published: May 2017

Background: Hamad General Hospital (HGH) houses the main Emergency Department (ED) in Qatar. This busy ED has a 27 bedded resuscitation area. Within a 24 hour period there could be any number between 1 to 10 cases that needed emergency or urgent intubation. Over the years, there has been multiple addition of new life saving devices to the resuscitation areas. All these devices add to the clutter of the already crowded resuscitation area, and may indirectly add to the chaos and occupational risk typically seen in a busy environment.

Methods: We aim to develop an airway trolley (by re-cycling available parts in the hospital) which can accommodate all standard airway equipment and all of our current difficult airway devices – Glidoscope, Stortz CMAC video laryngoscope and Stortz Flexible Intubating Video Endoscope.

Results: We created a robust and easy to clean trolley, with ample of work platform and storage spaces within easy reach. At the same time it is also small and mobile enough to tolerate our narrow resuscitation room floor space. It has multiple power sockets to charge all of the video intubating devices, and its main power cord is long enough to reach any wall socket without significantly obstructing medical staff movements.

Conclusion: With the help of the Engineering Department, we managed to create an airway trolley that fulfills our exact requirement more than what we can find in the current medical equipment market. At the same time we also declutter our busy ED resuscitation room.
Raising awareness about driving safety in an ambulance service
Authors: Alinier Guillaume , Meyer John , Hutton David , Farhat Hassan , Bayoumy Ahmed , Gonzales Edwin , Ragbheer Sunjay , Singh Kanhaiya , Aguila Noe , El-Khady Mohmoud , Al Yazidi Khaled , Campbell Craig , Al-Bakri Ahmed
Published: May 2017

Background: Worldwide ambulances are regularly involved in accidents as staff may not anticipate other drivers' actions, suffer from fatigue, or overestimate their driving privileges. An ambulance driving safety campaign started in June 2015 targeting some 935 registered HMCAS drivers. We aim to determine if our approach is effective in changing behaviours and believes, and reducing the number of accidents involving HMCAS vehicles.

Methods: This study was ethically approved as a quality improvement project and is still ongoing. The campaign made use of ambulance dashboard stickers and posters at ambulance stations' exits with respectively 4 and 6 key messages covering frequent issues resulting in collisions. An official circular also informed staff of the campaign. A month later a survey started to be distributed to staff.

Results: In two month, 189 anonymous online or paper questionnaires were fully completed. 69.2% of respondents had an HMCAS driving qualification (13.7% of qualified HMCAS drivers). On average, they reported having been involved in 0.90 accident requiring vehicle repair. Using a 5-point Likert scale (1 = very unsafe, 5 = very safe) respondents rated themselves as being safe drivers (4.24/5) and underestimated the monthly number of accidents with HMCAS vehicles to be 15.3 (Actual 21.2/month registered in 2014). Other data about self-reported driving behaviour and comparison between their perception about accidents and real data was analysed along with visibility and memorisation of the key messages.

Conclusions: Staff underestimated the number of accidents. Campaign material has been noticed by most staff except for the stickers inside the ambulances driving compartment which is not accessed by 23.2% of the respondents. Staff who saw the posters and stickers remembered nearly half of the information it contained. Although a significant decline accidents occurrences was noticed in September, the impact of the campaign cannot yet be reliably assessed over this relatively short period of time.
Patterns of trauma injuries and predictors of in-hospital mortality in patients admitted to a tertiary care setting in Saudi Arabia
Authors: Abolfotouh Mostafa , Al-Marzoug Alanoud , Alteriqi Suliman , Al-Suwailem Abeer , Hijazi Ra'ed
Published: May 2017

Background: Trauma is a major cause of death worldwide that can result death or permanent disability. Globally, 6–10% of all deaths are attributed to traumatic injuries. In Saudi Arabia, trauma is a public burden as a result of its socioeconomic impact. Our aim is to describe the pattern of traumatic injuries and predictors of in-hospital mortality among patients admitted through the ED of King Abdulaziz Medical City.

Methods: A retrospective cohort study was conducted on 3786 trauma-injured patients admitted from 2012 to 2014. Data on: patient characteristics, trauma characteristics and outcome characteristics, were extracted from a prospectively collected database. Logistic regression analysis and ROC curve were applied.

Results: Of 3786, (77.5%) of victims were males, (29.8%) injuries occurred in the age group (15–25 years). Blunt injuries constituted (87.1%), followed by burns (7%), intentional injuries (5%) and drowning & foreign body (1%). Data showed seasonal variation with two main peaks in March and August (p < 0.001). In-hospital mortality rate was (4.7%. Significant predictors of in-hospital mortality were age (p < 0.001), intubation need (p = 0.009), ISS (p < 0.001), RTS (p = 0.007), GCS (p = .004) and road traffic accidents (p = 0.001). The cut-off points for prediction of in-hospital mortality: were as follows: ISS = 22, AUC = 93%, ATS = 9, AUC = 78% and GCS = 8, AUC = 83%.

Conclusions: Our recommendation is targeted to ED policy makers to recognize the patterns of injury and the seasonal variation to structure and distribute the facilities and staff in a cost-effective manner. Also, enforcing trauma preventative measures should be encouraged. Secondly, for ED physicians to enhance the use of in-hospital predictors of mortality. Finally, educational programs targeting the general population are essential to cover all aspects.
The impact of integrating behavioral health care in the Emergency Department at HGH
Authors: Zaraa Adel
Published: May 2017

Background: Patients experiencing psychiatric emergencies often require resources not available at the hospital to which they present and frequently require transfer to an appropriate psychiatric facility as it is the case at the Emergency Department of HGH. This typically involves being held in the Emergency Department (ED) until a psychiatric bed is available. Boarding of psychiatric patients, (defined as a length of stay greater than four hours after medical clearance), is ubiquitous throughout emergency departments nationwide (USA) and in Qatar.

Methods: The Emergency Department at HMC established in May 2014 an innovative and pioneering psychiatric liaison service based in ED, it is the first in the Gulf Area. In this study we are set to look at the difference in response time, boarding time, and disposition during the last six month compared to a similar period of a previous year.

Results: When initiated treatment in ED and mobilized the community based services available in Qatar, the preliminary results indicate a substantial decrease of total admissions, a similar decrease in overnight boarding and a shorter turnaround time to disposition. A 18% decrease of total admissions, and a 300% decrease in overnight boarding.

Conclusion: Having a dedicated psychiatric team embedded in a busy emergency department is conducive to providing a higher quality of mental health care, decrease the adverse occurrences associated with boarding the severely mentally ill. We established a training program (C&L Fellowship with one year ER psychiatry and educational modules for the medical ED Staff).
Rapidly progressive complete airway obstruction by acute retropharyngeal hematoma
Authors: Kumar Neeraj , Yakout Ibrahim Haitham Ibrahim , Khanna Maneesh
Published: May 2017

Background: Although Retropharyngeal Hematoma (RPH) has unknown frequency but considered a rare condition which can cause a life threatening airway obstruction. Various precipitating factors have been mentioned as causes of RPH as blunt head or neck trauma, whiplash injury, coagulopathy, central line insertion, stellate ganglion block, sneezing, severe coughing as well as spontaneous RPH.

Methods: We report a case of severe life threatening retropharyngeal hematoma secondary to a closed stable C5-C6 fracture that caused severe upper airway obstruction.

Results: As the RPH can develop hours or days, even after an apparently minor precipitating injury, in our patient it took almost 3 hours from time of accident till the development of severe upper airway obstruction (picture to be added in main poster). It was such a large collection hematoma that caused severe upper airway obstruction with cannot intubate cannot intubate situation.

Conclusion: RPH can cause a mechanical displacement of the pharynx & larynx making securing airway with ETT almost impossible with conventional laryngoscopy or even video-assisted techniques. On the other hand, the time taken for RPH to develop and to cause mechanical obstruction can be limited enough to allow proper preparations as well as availability of fiberoptic technique. We should keep a high index of suspicion of retropharyngeal hematoma and airway involvement in cases of cervical spine fracture, in order to help other physician to increase their awareness and anticipation of such life threatening & meantime avoidable condition.

Keywords: retropharyngeal hematoma, airway obstruction
High-dose potassium resuscitation in a peritoneal dialysis patient with severe hypokalemia and torsades de pointes
Authors: Baiou Anas , Yusof Alhady , Fituri Omar , Pathan Sameer
Published: May 2017

Background: The American Heart Association (AHA) recommends to treat cardiac arrest due to Torsade de Pointes (TdP) with 1–2 grams of intravenous (IV) magnesium over 5 minutes. A second dose can be repeated within 5–15 minutes, and a continuous infusion may be considered. In cases of TdP due to severe hypokalemia, the doses and rate of administration of IV potassium chloride (KCL) are not described explicitly in the guidelines.

Methods: In this case report, we describe a peritoneal dialysis (PD) patient who had a prolonged history of hospital stay with infected diabetic foot. He was on the medical ward, but recently admitted to the Intensive Care Unit with septic shock needing inotropic support. He developed a TdP cardiac arrest with a serum potassium of 2.4 millimol/litre. We managed the cardiac arrest according to AHA guidelines and also administered a total of 120 milliEquivalent (mEq) of KCL over 2 hours. The severe refractory hypokalemia improved, and the recurrent TdP subsequently stopped only after we urgently drained the PD fluid during the resuscitation as a last resort. We also avoided administration of sodium bicarbonate even though he was severely acidotic during and after the resuscitation.

Results: To compliment this case report, we reviewed the literature available on hypokalemia in PD patient, and also on the established treatment of TdP.

Conclusion: In cardiac arrest situation secondary to hypokalemia, repeated high doses of IV KCL, up to a total of 120 mEq may be required, provided point of care testing is available. Draining the PD fluid during resuscitation, might expedite the correction of the refractory hypokalemia and malignant arrhythmias.
Reducing the time to disposition of patients with abdominal pain admitted to the Male Urgent Area ED-HGH
Authors: Joudeh Hussein Joudeh Fawwaz , Radhakrishnan Pradeep , Ghafour Biju , Qazaz Mustafa , Shaikh Hamza , Zainalabdeen Wala , Jinson J.K.
Published: May 2017

Background: Abdominal pain is one of the most common presenting symptoms in Emergency Department. During a recent audit, it was found that Patients presenting to HGH emergency room with a chief complaint of abdominal pain are the most common patient's category to be delayed to disposition. Currently 62% of patients with abdominal pain admitted to Male Urgent Area in Emergency Department HGH were delayed to Disposition for more than 6 hrs.

Aim: To decrease the percentage of patients with abdominal pain delayed in Male Urgent Area ED, HGH for more than 6 hrs from 62% to 50% by May 2015 Project Scope; Project period: February 10th to 24th May 2015; Place: Male Urgent Area, Emergency HGH; Population: Male patients Expected Benefits of the project; Improve Patient Flow; Improve Patient safety; Improve patient Satisfaction.

Intervention: All abdominal pain patients must first be reviewed by the consultant of the See & Treat before transfer to male urgent area. Dedicated bed for reassessment of abdominal pain in Male Urgent Area. Flagging of patients when ready for reassessment.

Results: Post-intervention length of Stay Male Urgent Area has reduced by 2.28 hrs.

Conclusions: Early senior involvement has an impact on decreasing the Length of Stay in abdominal pain patients. Flagging patients for reassessment had an impact on the Length of Stay. It was very challenging to implement the changes and reach out to every staff being a big department.

Next steps: Quarterly Audit _ Publication of the Audit _ Continuous Education & Implementing to other Areas of the ED.
Primary health-care use and health-care accessibility among adolescents: A case study from the United Arab Emirates
Authors: Barakat-Haddad Caroline , Siddiqua Ayesha
Published: May 2017

Background: Utilization of primary health care services is an important determinant of health. Individuals who receive primary health care are generally healthier than those who do not. Despite the importance of primary health care use, there are many barriers to health care access that are experienced by populations in Arab countries. This study examined primary health-care use and accessibility among adolescents living in the United Arab Emirates.

Methods: In a cross-sectional study, we collected primary health-care use, sociodemographic and residential data for 6363 local and expatriate adolescents. Analysis consisted of descriptive statistics, and bivariate and multivariate analyses. Logistic regression modelling was employed to examine predictors of health-care use, specifically ‘not receiving care when needed’, ‘having a routine physical check-up without having a specific problem’, and ‘travelling for medication or treatment to other countries’.

Results: The most-consulted health professionals were dentists or orthodontists, family doctors and eye specialists. Local adolescents were more likely to attend public clinics or hospitals than private clinics or hospitals, while the opposite was true for expatriate adolescents. In the last 12 months 22.6% of participants had not obtained needed health care, and 19.5% had not had a routine physical health check-up. Common reasons for not obtaining care were busy schedules, dislike/fear of doctors and long waiting times. Predictors of not obtaining needed care included nationality and income, while those for having a routine check-up were mother's education and car ownership.

Conclusions: Improvements to the health-care sector are needed in order to increase health-care accessibility among adolescents.
Meningitis retention syndrome - Case report
Authors: Ara Naseem , Purayil Nishan , Palol Azeez , Para Firjeeth
Published: May 2017

Background: Urinary retention is a common presenting complaint in Emergency Department. Meningitis can be an unusual cause for this. This combination is referred to as Meningitis Retention Syndrome (MRS). We present 2 cases of MRS diagnosed in A&E, Alkhor.

Case 1: A 43-year-old male presented to ED with low grade fever, head ache of 10 days and dysuria of 2 days duration. Examination was unremarkable except for palpable bladder. Examination of CNS was normal. He was discharge on antibiotic after catheterisation of urinary bladder. He was readmitted to ED after few days with worsening of symptoms. Physical examination was unremarkable. CT head (contrast) showed meningeal enhancements and CSF study showed lymphocytic pleocytosis. He was initiated on anti-tubercular treatment (ATT). Patient improved and was discharged.

Case 2: A 42-year-old male presented to ED with fever and dysuria. He was managed as a case of urinary tract infection. He was readmitted to ED with fever and urinary retention. Physical examination was unremarkable except for temperature 38.5°C. Blood test and urinalysis were normal. He was discharged on medication. 2 days later he was admitted with altered sensorium high grade fever and clinical features of meningitis. CSF study showed lymphocytic pleocytosis. Patient was initiated on ATT. Patient had a prolonged and stormy hospital stay and later improved.

Discussion: Meningitis Retention syndrome is thought to be a very minute form of acute disseminated encephalomyelopathy. Urinary retention might reflect acute shock phase of this disorder. Most of the previously reported cases were due to aseptic meningitis but here we report two cases of MRS due to tuberculous meningitis Acute urinary retention can provide a critical clue to the diagnosis of meningitis as a cause of fever of unknown origin.
Aneurysmal bone cyst of thoracic spine in polyostotic fibrous dysplasia causing acute myelopathy
Authors: Mgaram Mohamed , Mohamed Riyas Segu , Al Dulaimi Hani
Published: May 2017

Background: Fibrous dysplasia affecting the spine is considered an uncommon entity in polyostotic fibrous dysplasia and aneurysmal bone cysts occurring in this setting is rare. Although, these are benign conditions, they may present with acute cord compression and fractures which necessitate emergency treatment.

Clinical course: Our patient is a 38-year-old Egyptian male who presented to the Emergency Department with a 2-week history of increasing pain over the thoracolumbar spine with acute bilateral lower limb weakness and difficulty walking. There was no history of trauma or fever. Physical examination revealed significant sensory loss below the level of the umbilicus with paraparesis of bilateral lower limbs. X-rays revealed large expansile lesion over the mid thoracic vertebrae and multiple expansile lesions involving the ribs. Subsequent CT and MRI showed features of multiple areas of polyostotic fibrous dysplasia with secondary cystic degeneration and aneurysmal bone cysts formation, worst at T6-7 complicated with severe central spinal canal stenosis, cord compression. The patient underwent urgent spinal cord decompression with laminectomy at T6 and T7 and hemilaminectomy at T4 and T5 with aneurysmal cyst curettage and fat graft placement and subsequent physiotherapy and rehabilitation with complete resolution of motor and sensory deficits.

Discussion: This case highlights the presentation of benign, non-malignant, non-infectious, and non-traumatic acute spinal cord compression in the Emergency Department. This case also showcases classical radiological images of a rare combination of polyostotic fibrous dysplasia of the spine with subsequent cystic degeneration and aneurysmal bone cyst formation causing acute spinal cord compression.
Popping pills? Over-the-counter medication use among adolescents: A case study from the United Arab Emirates
Authors: Barakat-Haddad Caroline , Siddiqua Ayesha
Published: May 2017

Background: While there are benefits for over-the-counter medication (OTC) use, there are serious risks associated with OTC usage. These include self-misdiagnosis, possible delay in receiving needed therapy, use of suboptimal therapy, and increased resistance to antimicrobial agents. The patterns of (OTC) usage among adolescents remains largely understudied. The objectives of this study are: (1) to determine the profile of OTC use among adolescents from the United Arab Emirates (UAE); and (2) to determine the biological or physical, psychological or behavioral, and social predictors of OTC use among the UAE adolescent population.

Methods: In a cross-sectional study, we collected data on the prevalence of OTC use for a sample of 6,363 adolescents aged 13 to 20 years. We also collected demographic, socioeconomic, residential, and behavioral data. Analysis consisted of descriptive statistics, and bivariate and multivariate analyses. Logistic regression modelling was employed to examine predictors of over-the-counter medication use.

Results: Overall, 51% of participants in this study reported OTC use. The most common form of OTC used was acetaminophen. Significant predictors of OTC use include nationality (UAE, GCC, Arab/Middle East, Arab/Africa, Western, Other), needed health care but did not receive it, sex (female), age (15–18 years), any medical diagnosis, unconventional drug use, spending more than 5 hours using TV and computer daily, and using prescription medicine.

Conclusions: Considering the high prevalence of OTC use among adolescents from the UAE, public health policies and strategies that promote appropriate use of OTC in this population are needed.
Injuries, motor vehicles, and adolescence: A case study from the United Arab Emirates
Authors: Barakat-Haddad Caroline , Siddiqua Ayesha
Published: May 2017

Background: Globally, almost half of all adolescent deaths occur due to injury. Injuries related to accidental fall, being struck by an object or person, and road traffic injury (RTI) are particularly relevant among adolescents. Accidental falls and RTI are the most common causes of injury among children and adolescents. This study examines the profile of injuries among adolescents in the United Arab Emirates (UAE), including motor vehicle injuries (MVI), and identifies related factors associated with injury.

Methods: A cross-sectional study design determined incidence of injury for a sample of 6,363 adolescents aged 13 to 19 years. Data collected information on injury in the past 12 months, socio-demographic, behavioral, sensory data, and traffic-related behaviors. Logistic regression modeling was used to examine predictors of physical injury for the past 12 months, including injuries from motor vehicle collisions.

Results: Among participants, 18% experienced injury; the three top causes include accidental falls (38%), being struck by an object or person (18%), and MVI (13%). Identified risk factors that are amenable for prevention include smoking behavior, exposure to smoking, physical activity profile, family income, and speeding behavior. In relation to MVI, significant predictors are attending private schools (OR = 2.58), physical activity (OR = 1.11), family income (OR = 16.25), and speeding (OR = 2.34). Additionally, expatriates were less likely to experience MVI than locals.

Conclusion: Our findings highlight the need for public health policies and education programs that reduce injury among the UAE adolescent population. Future studies should build upon these findings to plan and implement tailored injury prevention strategies for this sub-population.
Cigarette smoking lowers blood pressure in adolescents: The Irbid-TRY
Authors: Alomari Mahmoud , Al-Sheyab Nihaya A.
Published: May 2017

Background: Tobacco consumption adversely affects cardiovascular (CV) disease (CVD) and risk profile, including hypertension. The long-term effect of cigarette smoking on blood pressure (BP) in adolescents is still, however, equivocal. Thus, the current study examined the CV hemodynamics in male adolescent cigarette smokers versus non-smokers.

Methods: Resting heart rate, systolic (SBP) and diastolic (DBP) BP, mean arterial pressure (MAP), pulse pressure (PP), and rate pressure products (RPP) were examined using automatic oscillatory method, while smoking status was determined with Youth Risk Behavior Survey (YRBS).

Results: After covariating for cofactors, the ANCOVA showed that CV hemodynamics were lower (p <  0.05), in the male adolescent smokers versus non-smokers. Additionally, regression showed that smoking predicted the reduction in SBP (20.6%), DBP (5.0%), MAP (13.4%), PP (7.5%), and RPP (13.4%).

Conclusion: The results suggest that cigarette smoking lowers CV hemodynamics in adolescent. However, more studies are needed to describe the mechanism(s) for lowering CV hemodynamics and explain the relationship of adolescent smoking with adulthood CVDs.
Audit about pain management and patient satisfaction in HGH ED
Authors: Ebrahim Ahmed , Mohamed Mazin Elsayed , Khan Keebat , John Stanley , Dafa Alla Mohamed , Kodumayil Ashid
Published: May 2017

Introduction: Pain is a very common reason for presenting to the Emergency Department (ED). While the causes for pain are diverse, ranging from fractures and other injuries to chest or abdominal pain or headache, the provision of effective, timely analgesia should be one of the principal goals of emergency staff . Inadequate pain relief and poor treatment in pain management in ED was highlighted by Wilson and Pendleton and they coined the term oligoanalgesia to describe this phenomenon. They found that only 44% of patients with pain received analgesics in the ED, and sub therapeutic dosing was common.

Methods: This was a prospective observational study conducted in HGH ED after approval from Department of Emergency Medicine Audit & Ethical Committee, investigators were divided over shifts in ED for 2 weeks. Total of 448 patients were recruited. Inclusion criteria were any patient presented to Ed in acute pain over the last 24 hour, age >18 years old. Patients in life threatening conditions, major trauma, altered mental status or communication difficulties were excluded.

Results: Total of 448 patients were recruited. Of which 358 number were males, 90 Number were females. Trauma-related cases composed about 100 number (22.3%) of the pain cases. The number of pain medications prescribed to patients throughout the ED course and upon discharge was recorded.

Conclusion: The administration of pain-relieving medications in the ED was associated with significant pain reduction upon disposition. However, pain was still inadequately treated and scoring was not adequately recorded in patient files. Need for proper structured approach for pain management in HGH ED is warranted.
The use of ice packs for pain associated with arterial punctures
Authors: Mayel Masoud , Bastami Mohammadreza , Azadi Arman
Published: May 2017

Background: Arterial punctures for monitoring respiratory problems are one of the most painful procedures in hospitalized patients. The knowledge regarding non-pharmacologic methods of pain management, including cold application is limited.

Objective: This aim of this study was to determine if the application of ice packs before the procedure would decrease the pain perception of patients during the arterial puncture.

Materials and methods: This experimental study was undertaken among patients admitted to emergency ward in a public educational center affiliated to Ilam University of Medical Sciences, Ilam/Iran. Sixty-one eligible subjects were randomly assigned to two groups. The treatment group (n = 31) received ice packs before arterial puncture, whereas the control group (n = 30) received no intervention for pain management. Pain immediately and 5 minute after the arterial puncture were scored on a visual analog scale (VAS) from 0 to 10.

Results: The mean of pain score immediately after the arterial puncture were 3.12 (1.68) and 4.6 (1.56) for treatment and control group, respectively (p < 0. 001). The mean pain score 5 minute after the punctures were 1.9 (1.51) for treatment group and 2.53 (1.85) for control group. This difference was not statistically significant. The mean of heart rate during the procedure were 75.45 (9.76) beats/min for the treatment subjects and 75.46 (9.36) beats/min for the control group (p>0.05). Patients with previous arterial puncture reported higher pain intensity.

Conclusion: Cold packs is a simple, non-invasive and inexpensive technique for pain management before the arterial puncture. However, there is a need for further research regarding this topic.
Moving towards an interactive teaching and learning curriculum - Analysis of Qatar's Emergency Medicine Residency Training Program
Authors: Shariff Mohammed , Farook Saleem , Gafoor Biju , Qotb Mohamed , Alkahlout Baha
Published: May 2017

Background: The Emergency Medicine Residency Training Program (EMRTP) conducts weekly didactic teaching activities to deliver the curriculum for the Arab Board of Emergency Medicine. Traditional teaching methods often serve to deliver content to the learner passively, while an interactive model engages the resident, and aligns with principles of adult learning. With the accreditation of the EMRTP by the Accreditation Council for Graduate Medical Education - International (ACGME-I), the mode of teaching has also been modified to a more interactive model.

Methods: We analysed the EMRTP annual academic planner for 2015–2016 along with the format of teaching and broadly classified the topics and content into traditional vs interactive modes of delivery.

Results: The results showed that in 2012–2013, 75% of the content was through lectures but in 2015–2016 this had diminished to 21%, with the remaining 79% being delivered through various interactive means such as multidisciplinary grand rounds, joint conferences, morbidity & mortality meetings, journal clubs, oral board simulations, objective structured clinical examination (OSCE) slide presentations and faculty led clinical skills workshops.

Conclusion: The analysis showed an impressive reversal from a traditional to an interactive educational format with clear demonstration of adult learning principles.
Acute pain assessment among critically ill adult patients: Nurses' knowledge, practices, and perceived barriers
Authors: Kizza N Irene Betty , Muliira Joshua Kanaabi
Published: May 2017

Background: Pain, a universal health problem, affects a substantive number of individuals in chronic or acute form. In the emergency and critical care settings, patients suffer moderate-to-severe acute pain from numerous sources. If not adequately managed, acute pain can transform to a chronic pain syndrome. The physical disabilities and psychological disorders associated with poorly controlled pain diminish patients' comfort and quality of life among the survivors. The study aimed at describing the knowledge and practices related to pain assessment, and perceived barriers among nurses caring for critically ill - adult patients (CIAP).

Methods: A descriptive cross-sectional design was employed to collect data from 170 nurses caring for CIAP in Uganda using a standardized survey tool.

Results: Nurses had adequate knowledge levels with gaps regarding the need for pre-emptive analgesia for painful procedures like airway suctioning, invasive line placement, and spontaneous breathing trial. Substantively, nurses did not know that the patient is the most accurate rater of their pain experience. Nurses reported poor pain assessment practices, including lack of use of pain assessment tools and guidelines, which were significantly associated with workload and the low priority set to pain assessment and management. Physicians' prescription of adequate analgesics was the only perceived enabler.

Conclusion: There is need to reprioritize pain management in emergency and critical care settings. This can be achieved through strategies that enhance the quality and quantity of resources for health care to reduce the perceived barriers and boost the enablers. Continuous professional education, provision of medication, human resources and guidelines for pain management can promote good pain assessment and management practices.
Sentinel surveillance for influenza in Oman, January 2008-June 2013
Authors: Al Awaidy Salah Thabit
Published: May 2017

Background: Acute respiratory infections, including influenza, comprise a leading cause of morbidity and mortality globally. Influenza surveillance provides important information to inform policy on influenza control and vaccination. While the epidemiology of influenza has been well characterized in western countries, few data exist on influenza epidemiology in the Eastern Mediterranean Region. We describe the epidemiology of influenza virus in Oman.

Methods: Using syndromic case definitions and protocols, patients from four regional hospitals in Oman were enrolled in a descriptive prospective study to characterize the burden of severe acute respiratory infections (SARI) and influenza. Patients meeting the SARI case definition provided demographic information as well as oropharyngeal and nasopharyngeal swabs. Specimens were tested for influenza A and influenza B. Influenza A viruses were subtyped using RT-PCR.

Results: From January 2008 through June 2013, a total of 5,147 cases were enrolled and tested for influenza. Influenza strains were detected in 8% of cases for whom samples were available. Annual incidence rates ranged from 0.5 to 15.4 cases of influenza-associated SARI per 100,000 population. The median age of influenza patients was 6 years with children 0–2 years accounting for 34% of all influenza-associated hospitalizations. By contrast, the median age of non-influenza SARI cases was 1 year, with children 0–2 years comprising 59% of SARI. Compared to non-influenza SARI cases, a greater proportion of influenza cases had pre-existing chronic conditions and underwent ventilation during hospitalization.

Conclusions: Influenza virus is associated with a substantial proportion of SARI in Oman. Influenza in Oman approximately follows northern hemisphere seasonality, with major peaks in October to December and a lesser peak around April. The burden of influenza was greatest in children and the elderly. Future efforts should examine the burden of influenza in other potential risk groups such as pregnant women to inform interventions including targeted vaccination.
Exploring the variables that impact on self-reported back in nurses working in critical care environments
Authors: Milligan Fiona , Hatamleh Aseel , Hassan Nesiya , Khial Noor , Sebastian Nirmala , Shaji Mincy , Shiju Shiny , Thomas Shiney , Almomani Emad , Alomari Hussein , Alsabou Abdelqader , Alatoum Ibrahim , Fernandez Dave , Okour Mohammad , Chandra Prem
Published: May 2017

Background: There is little evidence of research outcome data or studies into self-reported back pain in Middle Eastern or Gulf region countries. Within HMC there is anecdotal evidence that suggests that back pain in nurses working in critical care environments accounts for a significant percentage of all sick cause leave. This has the potential to impact on productivity, patient care and quality of life in nurses working within critical care in environments.

Methods: A cross center mixed methodology study looking at back pain in nurses working in critical care environments data collection included demographic, occupational, and health characteristics and a Likert questionnaire. This comprised of 10 questions relating to manual handling education, equipment, staffing levels and ergonomics and was distributed in critical care and emergency departments across five hospital sites responses rate n = 450.

Results: Outcome data identified 65% of the respondents reported experiencing back pain over the last year with subsequent negative impact on quality of life. There was statically significant association between gender and quality of life p = 0.001; with more women verbalizing a negative impact on quality of life secondary to back pain. There were also statically significant relationships between age with younger age group reporting negative impact on quality of life p = 0.001 and length of time employed in HMC with respondents who have been employed between 1–5 years experiencing the greatest impact p = 0.001.

Conclusions: Back pain is an under reported occupational health concern that impacts on productivity and quality of life. Mandatory training in manual handling should feature in corporate educational agenda. Occupational health initiatives' are essential in the management of chronic health conditions.
Survey of consultants regarding Emergency Medicine (EM) educational program system change in private hospital setting
Authors: Mishra Deepak Geetaprasad
Published: May 2017

Emergency Medicine (EM) is an officially recognized medical specialty in over 60 countries, with the rate of specialty recognition accelerating in recent years. EM care delivery systems are specifically focused on managing the acute consequences of non-communicable as well as communicable disease processes, and therefore represent an important public health tool for reducing the present and future global. According to the 2006 World Health Organization studies on the Global Burden of Disease, worldwide demographic and epidemiologic shifts now show non-communicable diseases to have become the single largest cause of morbidity and mortality worldwide. At Max Health Care, George Washington University started a 3 years Master course in Emergency (MEM International) since 2008.

Aim: Efficacy or value of Emergency Medicine (EM) as a medical specialty and of clinical care delivered by trained emergency physicians. Primary objective: Has MEM Educational program at Max Health Care brought an Improvement in patient care in Max Emergency Department? Secondary objective: Factors which can help in Improving Quality of course. Inclusion criteria: Consultants of any Specialty worked for more than 2 years in Max Health care. Exclusion criteria: Senior resident and Junior resident of other specialty Incompletely filled survey form.

Methods: It was an observational study and questionnaire in Annexure 1 was used for the survey. The questionnaire will be given to 49 consultants of various departments in Max Group. Data has shown that 91.86% of Consultants have accepted that the course has brought improvement. Private Health sector has accepted Emergency Medicine as an Individual Specialty. 4 areas of suggestion turned up at final assessment: More hands-on training in Ultrasound Gynecology, Pediatrics and Anesthesia - advised more dedicated training time in their specialties Internal Medicine and Critical Care suggested follow up till discharge. Increased emphasis on communication skills.
Prevalence of awareness of car seat use amongst parents in State of Qatar - A cross-sectional study
Authors: Al Yafei Khalid , Aslam Ameer , Imanullah Sameera , Othman Shadi , Qusad Mohammed , Karanam Himabindu , Madhavi Venkata , Youssef Bashir
Published: May 2017

Introduction: MVC accident is one of the major cause of mortality and morbidity in children. In 2010, road traffic accidents were the major cause of 228 deaths and 568 major injuries in Qatar.(4). Children in cars who are not restrained, have a great risk of being injured. Our aim from this study is to check parents' awareness of the important of using child restrain (car seat) and reasons behind preventing them from not using it.

Objectives: Check parents' awareness of using car seat in Qatar. And do they know related information about installing car seat in their car and how to use it? Methods: A prospective cross sectional qualitative survey study was conducted at PEC Alsadd of Hamad Medical Corporation from (May 1st 2015 to October 31st 2015). A total number of 212 sample questionnaires were filled by parents whom visited PEC because of their children illness. All have been given survey questionnaire to fill while they are in waiting area. Then research assistants collect filled questionnaires.

Results: Distribution of Male: female is 40.6% (86) and 59.4% (126) 70.8% (150) have car seat and 29.2% (62) have no car seat. The Qatari: non-Qatari population is 10% (21): 90% (121) in the study. Among the Qatari respondent, 85.7% (18) have car seat and 14.3% (3) have no car seats. 12% of cases were children with chronic illness. 84% parents have 4wd cars. 80% of parents have university certification, though only 65% of them who have car seat. And 31% of them who use always car seats.

Conclusion: This study showed the importance of doing more parents education about the importance of using car seats.