bluuebunny/crossref_metadata_2025 huggingface dataset:
A study to improve the standard of care for patients in ED with bronchial asthma by peak flow rate measurement
Authors: Francisco Cecilia , Abraham Sonia , Chacko Bejoy , Dela Cruz Marilein
Published: May 2017

Background: There are cases of ED visits with chief complaints of Shortness of Breath which are managed as a Case of Bronchial Asthma, URTI or Cardiac Origin with the total number of 13047 ED visits in Female Urgent Area in December 2014, random sample of 180 patients with complaints of SOB and diagnosed as BA, 90% were given nebulization therapy without measuring PEFR. There is 0% compliance of PEFR measurement of the staff.

Methods: Retrospective data was collected from patient's record who presented with shortness of breath from 01 December 2014 to 30 December 2014 at Emergency Department, Hamad General Hospital. Data was analyzed to find out the compliance rate of peak flow measurement. Vigorous teaching was carried out among the staff nurses in Emergency Department to improve the awareness of the peak flow measurement as a standard of care for all Asthma patients. Prospective data was collected to compare the compliance rate of post-educational period.

Results: The 50 patients who received nebulization in ED (MST, FST) were reviewed to identify the compliance rate of PEFR measurement Before, After and In-between the nebulization. Retrospective data of pre implementation phase showed poor compliance rate. (Eighteen percentage (18%) before nebulization, six percentage (6%) after nebulization and zero (0%) in between nebulization's. Prospective data of post-implementation showed tremendous improvement. The compliance rate of PEFR measurement before nebulization increased to seventy six percentage (76%), after nebulization to seventy two percentage(72%) and in between nebulization monitoring to 10%.

Conclusions: The implementation of the Peak flow project made a tremendous improvement in the staff compliance in measuring PEFR which can lead to better care and management Bronchial Asthma patients. Meticulous teaching is required to improve PEFR monitoring in between the nebulization in order to achieve 100% compliance.
Days, weekends and diurnal variations in the presentation of ST-elevation and non-ST elevation MI: An insight from Primary PCI/ACS Registry
Authors: Gehani Abdurrazak , Al Suwaidi Jassim , Al Qahtani Awad , Arabi A Rahman , Tamimi Omer , Arafa Salah , Rafie Ihsan , Asaad Nidal , Nabti A Rahman , Abujalala Salem , Yacoub Magdi
Published: May 2017

Background: There appear to be variations in the time of presentation patients with ACS around the world. The working days and weekends differ in Qatar from the Western world.

Methods: In 1846 patients admitted with ACS, 721 had Primary PCI for STEMI and 1125 had Non-ST Elevation ACS (NSTE-ACS). The days and time of onset of symptoms, Door to Balloon Time (DBT) and Out of Hospital Delay were compared in different time periods in relation to the weekend (Friday/Saturday), and 2-days before (B-WKE), or 2-days after (A-WKE). The intra-day variation was compared in day time (6AM-6PM), and night time (6PM-6AM).

Results: Overall, almost half ACS patients (both STEMI and NSTE-ACS) presented in 2 days After WKE (Sun & Mon), with 60% of these presenting on Sunday alone, compared to only 16% over WKE (Fri & Sat). This was true for males with both STEMI and NSTEMI and for females with NSTE-ACS. However, the pattern was reversed in females with STEMI, 39% presented during week days vs only 19% After WKE (Sun & Mon). For both sexes and all ages, most (58%) presented early day time with modal symptoms starting time around 4 AM. In Primary PCI patients, the DBT was longer (77.5 min) during the night vs (61 min) during day, but in both >90% were within 90 min. 66% of STEMI total occlusion (TIMI-0) during the night. TIMI-3 flow was achieved in 94% during the day vs (87%) at night. Out of Hospital Delay was longer at night (270 min) vs (200 min) during the day. However, in-hospital mortality and LV function was similar.

Conclusions: There are interesting variations diurnal and gender variation in time of presentation of ACS. However, this does not seem to make significant impact on in-hospital outcome in the Primary PCI, perhaps because majority achieved optimal Door to Balloon Time.
An observational study to analyze compliance with infection control practices among ED nurses during outbreak of MERS-COV disease
Authors: Chacko Bejoy , Camacho Marita
Published: May 2017

Background: Early identification and isolation of suspected communicable diseases are a major health concern, especially when there is an outbreak of a communicable disease. The ED is an essential component of the health care system and subject to workflow challenges, which may hinder ED personnel adherence to guideline based infection prevention practices.

Methods: In total, 993 suspected MERS-COV patients and their assigned nurses were screened, prospective data was recorded to study the compliance with set infection control practices. That is, hand hygiene (HH), proper use of personnel protective equipments (PPE), isolation techniques, and use of isolation indicators. Data was collected for a period of six months from Nov 2013 to April 2014. Data was then transferred into an excel sheet to calculate the percentage of compliance and non-compliance with each indicator. Each indicator was analyzed separately to find out the poor compliance.

Results: Out of 993 observations made 76.74% of nurses adhered to hand hygiene practices and 57.30% used proper PPE as recommended by CDC guidelines, 69.59% of suspected MERS-COV patients were isolated using the right technique and 73.31% used correct isolation indicators. The lowest indicator identified is in the use of proper PPE, were 42.70% of nurses are not complying with the standard.

Conclusion: Compliance with the infection control indicators showed improvement over time except in the use of proper PPE. Focused training, vigorous awareness campaigning is required to achieve a target of 100% compliance with infection control practices.
Patient care round led by pharmacist in Emergency Department – Innovative experience
Authors: Abdelaziz Hani , Elmalik Ashraf , Salameh Rawan , Sayed Mona Ghannam Ahmed Abdelmoneim Mohammed
Published: May 2017

Background: As part of improving the service in ED, we conduct Pharmacist-led Pharmacy round (PLPR) led by Pharmacist to ensure best patient care is provided by pharmacist.

Objective: No such experience was reported in the literature up to our knowledge so we decided to describe our experience, in the successful establishment of PLPR in ED and to identify whether implementing a pharmacy based round, provide better patients care in terms of finding more drug related problems and providing educations to all clinical pharmacists.

Methods: The PLPR started daily at 11 am by brief meeting to discuss any pharmacy related issue then the PRPR team start rounding according to a planned schedule. The PLPR often involves ED pharmacists of different levels of experience the ED pharmacy specialist, clinical pharmacists who have reviewed the patient's case, pharmacy fellows and medical and pharmacy students. During the round, the pharmacist assigned for the area present each case using the Care Plan Form (CPF) to review the suggested recommendations or interventions, further recommendations to the clinical pharmacist may be given if necessary. The extra recommendations or discussion (ERD) conducted during the PLPR are documented and analyzed to evaluate the impact of the pharmacy based round. For each intervention, the following data were documented: date, time, medication, types of intervention.

Results: A total of seventy five ERD were documented during this period. Interventions related to adding, initiating or selecting drug therapy were the most common performed 58 (77%), pharmacotherapy options were the second most common interventions done by the team 13 (17.3%), requesting laboratory tests to optimize pharmacotherapy management were made 7 (9%) followed by dosage adjustment 6 (8%).

Conclusion: Implementation of PLPR is an initiative to improve pharmaceutical care in ED and training among Clinical pharmacist at point of care.
Disaster-resistant communities, public awareness program
Authors: Elsaeidy Abdallah Mohamed Elsafti , Saboor Ahmed Abdul , Soliman Hassan Ahmed Ali , Redwan Atef
Published: May 2017

Background: The tremendous increase in disasters in the Middle East whether natural or man-made is unforeseen in its characters and/or catastrophic effects to the communities and infrastructure, thus making public awareness is a mandate to plan, respond and mitigate the community.

Methods: We run Public Awareness program targeting non-medical university students, aiming at raising their knowledge about first aid and response during disasters by designing and conducting hands on First Aid and disaster preparedness course, pretest and post-test was done, graded from 0 to 10 for evaluation of the candidates and their level of knowledge, aiming at achieving 3 grades or above change in the candidates knowledge.

Results: Of 95 candidates attended the course, 84 pre and dost were complete and included in this study. More than half of them were male (n = 55; 65%). There was a significant difference in the candidates grades in the pre and post-test, with near 95% achieved the goal and almost 90% was satisfied by the program.

Discussion and conclusion: The surge in disasters over the last decades is unforeseen, in order to meet that threat national disaster plans should focus on effective disaster public awareness programs, targeting especially the most active and largest part of the community, which is university students.
One year exploring Qatar's ambulance service: Views from an Emergency Medicine Fellow
Authors: Kamel Hani , Alinier Guillaume , Morris Brendon David , Al Shaikh Loua Asad Hanna , Cameron Peter Alistair
Published: May 2017

Introduction: Pre-hospital care professionals work outside or in confined spaces. Issues like population demography, cultural diversity, geography, roads, and climate regularly challenge them. Some of these factors might be overlooked by the hospital-based mentality of other clinicians. Providing them an opportunity to accompany paramedics in their own environment may help them better understand the paramedics' role and scope of practice, and improve the patient handover process between these two “alienated worlds” of medical professionals.

Methods: An Emergency Medicine Specialist spent 12 months within Qatar's national Ambulance Service. Regular rotations through its various departments were facilitated, including an 8-week ride along with a Rapid Response Vehicle (Delta unit) dealing with emergency calls. A daily journal was written to record the experiences and audit data was accessed to gain a deeper understanding of the Service.

Results: This experience was an eye opener. Delta officers are very experienced and can provide a global perspective of the operations. Their main focus is safety from a 360-degree scene perspective, team leadership, and communication. The type of calls and circumstances provided a unique view of the scene realities. Ambulance crews were observed dealing with difficult situations, assessing patients, and initiating treatment in challenging environments. Depending on the type of emergency, Ambulance Paramedics were joined by a Critical Care Paramedic who has more advanced skills and the ability to administer a broader range of medications.

Conclusion: This program has been effective at introducing a hospital-based clinician to the pre-hospital world and should be Considered to all Emergency Fellows. It highlighted the complexities of working in the community with limited resources and the importance of communication to ensure the provision of safe and effective care. Understanding the Ambulance Service staff's level of competency will also enhance the handover process and help build trust in the Paramedics.
Strengthening community emergency preparedness and resilience in emerging natural and man-made threats and epidemics in Saudi Arabia and EMRO countries
Authors: Tambo Ernest , Fouad Ahmed Mohammed , Khater I.M. Emad
Published: May 2017

Background: Globalization, increasing intense urbanization and climate changes has been linked to natural and man-made evolution and curiosity resulting in multiple threats and vulnerability. The degree, nature and extent community and household preparedness and resiliency programs and activities defined the robustness and effectiveness of local, national to regional EMRO timely response policy decision maker by policy makers, health planners and implementers.

Methods: This paper analyses existing community emergency preparedness and resilience implementation and translation challenges and bottlenecks against emerging natural and man-made threats and epidemics disaster in Saudi Arabia and other EMRO countries.

Results: Our results showed inefficiencies to identify, understanding and mapping of potential risks/threats and weak community early alarm and surveillance systems in threats or disaster occurrence. Also, showed that real time community-based programs are poorly interrelated and nurtured in most EMRO countries, and require fostering community guidelines and prevention and control activities. Such include social mobilization, health education in increasing alertness, awareness and community mass literacy outreach. Critically, adequate community knowledge and attitudes on preparedness and resilience on mass pilgrims influx during Hajj and Ramadan seasons, potential vulnerability to epidemics and floods indicates that policy planners and implementers could capitalize on these strengths and address the weaknesses in scaling up practical community and household emergency preparedness and management approach on and across borders populations for common beneficial expectations in upholding safety and security, healthy lives and well-being. In conclusion, we advocate that establishment of a comprehensive evidence-based local, national and regional laboratory and digital surveillance systems, community-based partnerships, investment projects and related preventive resilient measures are vital in revamping the evolving and future threats and disaster situations in Saudi Arabia and other EMRO countries in line with One Health Surveillance systems.
Creatinine phosphokinase elevation among exertional heat stroke patients
Authors: Oommen Roney Mathew , Abujaber Ahmad
Published: May 2017

Background: Rhabdomyolysis, which can be defined as a CPK level greater than five times the upper limit of normal, is related to muscle breakdown and hypovolemia in heat stroke patients.1 CPK levels will likely be higher because of increased muscle breakdown in exertional heat stroke when compared with classic heat stroke.

Methods: We reviewed 50 patients who came into the Emergency Department of Hamad General Hospital during the months of July to September 2015, and who were diagnosed with exertional heat stroke.

Results: In 44 out of 50 heat stroke patients, the level of serum CPK was markedly elevated (mean 20,300 ± 25,500 U/l) compared with the elevated levels of other lab values (serum myoglobin 2500 ± 3000 ng/ml, creatinine 1.8 ± 2.4 mg/dL, BUN 90 ± 104 mg/dL, potassium 2.6 ± 3.6 mEq/L, sodium 135 ± 155 mEq/L) on admission. The repeated lab values after the 12th hour showed that the CPK rose further (28,500 ± 32,500 U/L) while the others (serum myoglobin 800 ± 1,200 ng/ml, creatinine 1.1 ± 1.4 mg/dl, BUN 35 ± 60 mg/dL, potassium 2.2 ± 3.4 mEq/L, sodium 110 ± 130 mEq/L) recorded a decrease.

Conclusion: In our cohort of patients, CPK levels were significantly high in the setting of exertional heat stroke. A possible relation to renal failure need to be explored in a prospective research design.

Keywords: exertional heat stroke, rhabdomyolysis, creatinine phosphokinase REFERENCE: [1] Santelli J, Sullivan J. An evidence based approach on emergency medicine. Emerg Med Prac. 2014;16:6–15.
Epidemiology of Neisseria meningitidis in Qatar: 5-year trend analysis
Authors: Hasnain Samina , Ganesan Nandakumar , Romaihi Hamad
Published: May 2017

Background:
Neisseria meningitidis (NM) is a leading cause of meningitis and septicemia. NM has an overall dispersion at rate of 11%, assuming that 10%–20% of the population carries NM in their throat at any given time, and increased carriage rate may be seen during epidemics.

Objective: This study aimed to describe the incidence and epidemiological characteristics NM in Qatar.

Methods: A retrospective review of epidemiological data for cases of NM reported to the Department of Public Health, HP & CDC section in 2010–2014 form all active surveillance sites in the health region. NM types of isolates from cases were serogrouped at Microbiology Laboratory in Hamad Medical Corporation. Estimates of the incidence and number of cases in the state of Qatar were calculated by sex and age group.

Results: A total of 41 cases of NM were reported during the study period. The incidence of NM in Qatar ranged between 0.8, 0.2, 0.3 and 0.4 cases per 100,000 population in 2010, 2011, 2012, and 2013 respectively and then considerably increased by end of 2014 (0.6 per 100,000 population). The incidence of NM was highest among males (37 cases) than females (4 cases), while NM occurred mainly in young adult group of the population.

Conclusion: The incidence of NM was very low in Qatar with young adults being at the highest risk. Active surveillance and dynamic research, fast conspicuous verification, and serotyping of NM will support public health decision making in the control of rising strains in Qatar.

Keywords:
Neisseria meningitidis, Qatar, active surveillance, epidemiology, Supreme Council of Healt
Aortic dissection “the great and deadly mimicker”: A case report
Authors: Nadeem Sana , Baiou Anas , Shukla Dharmesh , Fitori Gamal A.L. , Gehani A.A.
Published: May 2017

Introduction: Acute aortic dissection (AAD) is one of the most challenging cardiovascular emergencies presenting to the Emergency Department (ED). Prompt diagnosis and treatment is the key to patient survival. Though most AADs present with typical symptoms, it has been reported to present with a myriad of symptoms. We report a case of an AAD, which presented to our ED with predominant neurological symptoms.

Case description: A 47-year-old male was brought to our ED with acute confusion and history of seizure. He did not have any history of trauma or report any chest pain, headache or fever. He was vitally stable except for slight tachycardia and his physical examination was unremarkable. All investigations including a CT head were reported normal except leukocytosis (27 × 109/L). A few hours after admission, he started deteriorating, developed hypotension and became more agitated. Resuscitative measures were started. Ultrasound scan of the heart was performed to confirm central venous access showed a pericardial effusion and a flap in the ascending aorta. A diagnosis of AAD was made. An urgent CT was performed, which showed an extensive Type A aortic dissection extending into the branches, with rupture into pericardial cavity. During transportation for surgery, the patient had a cardiac arrest from which he could not be resuscitated.

Conclusion: AADs may present in an unusual manner with predominantly neurological manifestations such as acute confusion and seizure. In patients with unexplained acute confusional state the possibility of an AAD should be considered in the differential diagnosis. Bedside TTE has a limited sensitivity but high specificity in diagnosis of Type A AD and its early utilization may facilitate timely diagnosis improving outcome. Given the high specificity of TTE and time-dependent survival in Type A AD, institutional protocols to expedite the transfer to the operating room without waiting for CT confirmation might be considered.
Reasons for increased number of x-rays done in emergency department for injuries. A dilemma of delay and overcrowding
Authors: Anjum Shahzad , Khan Saad Salahuddin , Taj Khan Abdul Aziz
Published: May 2017

Background: In the past 3 years, average length of stay in the emergency department has increased by 20–30%. It was found that one of the most important factor causing this was increased number of X-rays done. At an average one x-ray adds 4–5 hours to disposition time. An observational study was done to find out reasons for the low compliance with usage of Ottawa ankle rules.

Methods: Initially observational study was done where 100 physicians were observed while they examine ankle and foot sprain cases for requesting x-ray. This was done without their knowledge. Then a questionnaire was distributed among 100 Emergency doctors to determine the factors that lead to non-compliance with use of Ottawa rules as screening tool for requesting x-ray.

Result: In the initial observational study done on 100 cases we found that, only 20 patients presenting with symptoms of ankle /foot injury had bony injury ruled out by Ottawa rules and in 11 out of these, Ottawa rule was not done appropriately. The questionnaire was completed by 100 physicians. The result showed that 64% of physicians were afraid of the liability of missing fracture. 56% were not comfortable because of difficulty in follow up. 24% expressed that increased number of patients with limited time to assess patient thoroughly put a pressure to do X-ray. 48% were not aware of Ottawa rules. 32% mentioned that lack of emergency follow-up clinics for those with persistent symptoms compel them to request x-rays than to decide clinically.

Conclusion: A proper follow-up system for patients discharged after screening will reduce the fear of liability of missing fractures. This will reduce the number of x-rays and length of stay in ED.
A new approach to assure safe and efficient major trauma care and patient experience in a London Trauma Unit
Authors: Suresh Kumar Thirumoorthy Samy , Eden Teresa , Baron Christopher
Published: May 2017

Background: The South West London & Surrey Trauma Network has one major trauma centre (MTC) and seven acute trauma units (TUs) over a wide geographical area. Seventy-five percent of the major trauma patients (injury severity score >15) were taken to MTC. However, many were admitted in trauma units. Available data indicates that there is a possibility that patients in TU rather than MTC may receive less than optimal care.

Aims: We would like to describe the development of a new system and process to review the management of ISS>15 cases under governance framework, assuring the delivery of safe and effective trauma care outside a MTC.

Description: The standard operating procedure and flow chart process were developed for review of major trauma cases. TARN Office identified patients were reviewed using a proforma, with key trauma measures as quality indicators. The notes were initially reviewed by clinicians, and in due course by the MDT team for the whole patient journey from arrival to discharge.

Outcomes: The commonest age group is >65 years. Head injury is most common, resulting from a fall from standing height (64%) causing subdural haemorrhage (57%). Most arrive by blue-light ambulance (86%). There is evidence of specialist team involvement in 64% of the cases and multidisciplinary team involvement in 55% of the cases. However, there are issues with the quality of record keeping, Timely CT scans and incorporating rehabilitation prescriptions into discharge letters were done.

Issues with care were formally registered with hospital incident reporting system and registered in the trauma risk register. Findings were presented in the hospital audit study day, in the Trust Governance Committee and disseminated for development. This governance system has evolved with more concrete systems now in place.

Conclusion: Initiating a robust governance system and process will minimise substandard care and help standardise care across the network.
Wait a minute: Not all cases of paracetamol overdose need N-acetylcysteine, quality improvement project in Hamad General Hospital Emergency Department
Authors: Salem Waleed A. , Qotb Mohamed , Alkahky Sherif , Elessaei Galal , Elmoheen Amr
Published: May 2017

Background: Management of serious paracetamol overdose with N-acetylcysteine (NAC) is an effective strategy. Early treatment with NAC prevents the formation of a toxic metabolite that leads to hepatic injury. However, inappropriate treatment with NAC and overtreatment with NAC can lead to potential adverse side effects and unnecessary hospital admission.

The aim of the study was to assess the administration of NAC in the setting of paracetamol overdose and determine whether the institutional use of this antidote is consistent with the international standards. We hypothesize that some patients receive antidotal NAC unnecessarily after paracetamol exposure, and that a simple quality improvement intervention in educational activity may improve the administration of this antidote.

Methods: A retrospective quality improvement chart review evaluated charts of patients who were treated with NAC for paracetamol exposure over a 2-month period in the Emergency Department of Hamad General Hospital. The quality improvement intervention consisted of establishing a paracetamol clinical practice guideline, providing access to a treatment nomogram for NAC use, enhancing educational activities to improve the clinician's understanding of appropriate NAC use, and establishing a clinical toxicology service for all paracetamol exposures.

Results: NAC administration to 67% of the cases after paracetamol exposure were found to be medically unnecessary according to the established international guidelines for management of paracetamol overdose. Post-intervention measurement showed significant improvement by decreasing unnecessary NAC administration to only 33%.

Conclusion: In our institution, NAC treatment after paracetamol exposure is usually administered unnecessarily. Inappropriate administration of this antidote results in a significant waste of resources and unnecessarily prolonged hospital stay.

Adherence to the clinical practice guidelines may lead to a significant improvement in this antidote use after paracetamol exposure. Given that this antidote is used inappropriately despite widespread knowledge that guidelines for paracetamol exposure exist, we believe that continuous education on the topic, chart audits and feedback, and use of a clinical toxicology service may improve the knowledge and appropriate use of this antidote and will improve patient care.
Epidemic of obesity among mothers in the Gaza Strip-Palestine
Authors: El Kishawi Rima , Soo Kah Leng , Abed Yehia , Muda Wan Abdul Manan Wan
Published: May 2017

Background: Obesity is a public health concern in both developed and developing countries, and it is a main risk factor for chronic diseases. Thus, Palestinian adults aren't spared from obesity and non-communicable diseases epidemic. This study aimed to assess the pattern of obesity among mothers in the Gaza Strip.

Methods: A cross-sectional study was conducted on of 357 mothers aged 18–50 years between April-October 2012 in the Gaza Strip. A structured questionnaire was used to collect sociodemographic information and the short form of the International Physical Activity Questionnaire (IPAQ) was used to assess the physical activity pattern. Mother's nutrition knowledge was evaluated using 16-item questionnaire. Anthropometric measurements were conducted among the mothers, and body mass index (BMI) ≥  30.0 kg/m2 was computed to determine the prevalence of obesity. Multiple logistic regression was conducted to predict the associated factors of obesity.

Results: The prevalence of obesity among mothers was high (29.6%). About 78% of mothers were classified as moderately active, 21.6% of them were inactive, whereas, vigorous activity was not observed. Results revealed that as the age increased, the risk of mothers to be obese increased (OR: 1.11; 95% CI: 1.06–1.15; p < 0.001). Mothers with the medium education level have higher risks of being obese (OR: 2.39; 95% CI: 1.20–4.78; p = 0.013). Increased scores of nutrition knowledge to a participant increased the risk of being obese (OR: 1.17; 95% CI: 1.03–1.32.0; p = 0.013).

Conclusions: This study highlights obesity as a public health concern in the Gaza Strip. Age, educational level, and nutritional knowledge were found to have more influence on the prevalence of obesity. Community-based intervention programs should be applied to increase awareness among women and to help them to translate their nutrition knowledge into healthy dietary practices. In addition, effective program is required to increase physical activity levels for women.
Urticaria - It's not only itch
Authors: Purayil Nishan , Ara Naseem , Para Firjeeth , Mohammad Osama
Published: May 2017

Urticaria is a common presentation in Emergency Department. Most of the time its idiopathic or immune mediated. In a small proportion of cases it may be a symptom of serious medical illness. We report two case of urticaria with underlying medical causes.

Case 1: A 33-year-old female presented to emergency with recurrent urticaria, which started 5 months back. Even though it responded to antihistamines, symptoms recurred on discontinuing medicines. No other symptom and no other past medical illness. Clinical examination was unremarkable, except for extensive urticaria. Her laboratory evaluation showed hyperthyroidism, and deranged liver function test (LFT). She was started on carbimazole and symptoms improved after a few weeks. Symptom recurred after 3 months when dose was reduced and promptly relieved on restarting old dose. After few weeks she discontinued her medication and symptom recurred. On restarting the medicine she improved again. Her LFT also improved on follow up.

Case 2: One young female was seen in emergency with episodic urticaria for 6 months. She responded to antihistamines but recurred on discontinuing medicine. No significant illness in past. Clinical examination showed anaemia and generalised urticaria. Her laboratory test showed microcytic hypo chromic anaemia and her iron profile was suggestive iron deficiency. Urticaria symptoms improved after she was initiated on iron replacement.

Discussion: The above two cases represents two systemic causes of urticaria. Exact mechanism of how these disorder produce urticaria is unknown. In case of iron deficiency, iron therapy even in the absence of anaemia, is found to improve urticaria. The prevalence of thyroid autoimmunity is high in patients with chronic idiopathic urticaria. Mast cell over stimulation by thyroid hormone is thought to be the mechanism behind the urticaria in hyperthyroidism. Physicians should look for systemic causes when patients present with recurrent symptoms.
Primary omental infarct presenting as acute abdomen in Emergency Department
Authors: Sultan Mohamed , Dardouri Habib , Pathan Sameer A.
Published: May 2017

Introduction: Omental infarction is a rare cause of acute abdomen resulting from vascular compromise of the greater omentum. Vague symptoms and non-specific signs at presentation make the clinical presentation diagnostically challenging. Evidence to guide the management of omental infarct is still controversial and limited. However, general approach is to manage it conservatively and to consider surgery only if there is a deterioration in the clinical condition. We report a case of omental infraction presented to the ED with acute abdomen that showed fruitful recovery by conservative management without requiring surgery or prolonged hospitalization.

Case Report: A 23-year-old Ethiopian male patient, presented to the ED with colicky abdominal pain of few hours duration, which was sudden in onset and was increasing in the severity. The pain started in the right side of the abdomen just lateral to the umbilicus associated with anorexia. On the physical examination; he appeared to be in pain and on the palpation of the abdomen, there was tenderness and minimal rebound tenderness over the right iliac fossa and to a lesser degree over the right lumbar region. CT scan with contrast revealed an ill-defined focal area of increased fat stranding in the omental fat in the right lumbar region, anterior to the mid ascending colon, typical to that of focal area of omental infraction.

Conclusion: Omental infarction is a rare benign cause of acute abdomen. The widespread availability of CT allows us to recognize the cases while they are in the Emergency Department.
The impact of conflict on the health situation in Yemen 2015
Authors: Dureab Fekri Ali
Published: May 2017

The present paper was designed to reflect the impact of conflict on the health situation in Yemen. A total of 2,305,048 people are displeased from their residences. The consequences of conflict permeate countless aspects of society, and are not limited to the mass causality (death and injured), inaccessibility to the health services and disturbance of health system. The most vulnerable group is the children who are highly affected by the current conflict, data shows that Acute malnutrition is dramatically increased in 2015 survey from 2014 survey, in Hodeida and Aden governorates GAM rates is 31% and 23 in 2015 respectively while in 2014 it was 18% in Hodeida and 10% in Aden. This analysis shows that the negative effect of war on health is particularly intense in the short term following the onset of a conflict, and children are the most affected group.
Waterpipe smoking changes cardiovascular hemodynamics in adolescents: The Irbid-TRY
Authors: Alomari Mahmoud , Al-Sheyab Nihaya A.
Published: May 2017

Introduction: Tobacco consumption contributes substantially to cardiovascular (CV) diseases (CVD), including hypertension. However, the effect of waterpipe (WP) smoking on CV hemodynamics in adolescents is unknown. Thus, the current study investigated the relationship of WP smoking with CV indices.

Methods: Indices including heart rate (HR), systolic (SBP), and diastolic (DBP) blood pressures, mean arterial blood pressure (MAP), pulse pressure (PP) and rate pressure product (RPP) were obtained from 7th–10th grade male students.

Results: After controlling for confounding factors, SBP, DBP, MAP, and RPP were significantly lower (p < 0.05) in WP smokers versus non-smokers.

Conclusion: The results indicate that WP smoking lowers CV hemodynamics, which is perplexing given that tobacco smoking is associated with an immediate increase in CV hemodynamics and CVDs in adulthood. Therefore, future studies are needed to determine the mechanism(s) for lowered CV hemodynamics and the pathway between WP smoking and heightened risk of developing CV diseases adulthood, namely hypertension.
Prevalence and associated factors of physical activity among mothers in the Gaza Strip-Palestine
Authors: El Kishawi Rima , Soo Kah Leng , Abed Yehia , Muda Wan Abdul Manan Wan
Published: May 2017

Background: The high prevalence of obesity was observed in numerous developed and developing countries. A reduce in energy expenditure due to the low physical activity level is a factor contributed to the increase in obesity. In the Gaza Strip there is a lack of studies on the pattern of physical activity among adults. The aim of this study was to determine the physical activity prevalence among mothers aged 18–50 years and its associated factors.

Methods: A mixed methods design was conducted using quantitative and qualitative methods. A total of 357 mothers were recruited from the Gaza Strip. The short form of the International Physical Activity Questionnaire (IPAQ) was used to assess the physical activity pattern. Focus groups discussion (FGDs) were conducted for qualitative study.

Results: The prevalence of physical inactivity was 21.6%, about 78% of mothers were classified as moderately active, while vigorous activity was not observed. Results revealed that, physical activity level decreased among mothers who lived in households with low income (OR: 2.30; 95%CI: 1.20–4.45; p = 0.013), and those with high nutrition knowledge were more likely to be physically inactive (OR: 1.15; 95%CI: 1.0–1.314; p = 0.040), while mothers who had low or medium education level were more active (OR: 0.31; 95%CI: 0.15–0.62; p = 0.001), or (OR: 0.47; 95%CI: 0.23–0.96; p = 0.039). The qualitative results showed that most of the mothers believed home chores are kind of exercises and could substitute for practicing sports. The main constraints to physical activity practice attributed to the sociocultural factors due to the limited availability of exercising facilities for Palestinian women and restrictions on their freedom.

Conclusions: Results of this study are important to monitor physical activity levels among mothers in the Gaza Strip. Effective community-based intervention programs should be implemented to improve physical activity levels among mothers in the Gaza Strip.
A prospective study regarding factors related to unscheduled revisit within 72 hours in adult Emergency Department, Al Khor Hospital, State of Qatar
Authors: Hassan Nesiya , Mustafa Wafa , Mercado Ann Cristine , Varughese Bincy Mary , Mohanan Chippy , Nair Deepa , Yohannan Jessy , Jose Jisha , Sebastian Joby , George Saritha , Augustine Vipin
Published: May 2017

Background: Crowding in hospital Emergency Departments (EDs) is a commonly observed problem all over the world.

Objectives: To identify the factors related to patients’ unscheduled revisits to ED.

Methods: The Al Khor Hospital annual ED patient volume of 158,000. The census sample of patients who had revisited within 72 hours of discharge from the ED was recruited in the study. The CERNER system was utilized to collect all revisited patients’ data. Two experts from the pool of ED consultants reviewed the data independently.

Results: During the study period, 24,933 patients visited in ED, 849 revisited within 72 hours of their discharge, which accounts for 3.4%. The characteristics of revisited patients included young adults between 20–40 years of age (59.79%), mostly males (78.94%). Physician-related factors were: missed diagnosis (1.6%), adverse drug reaction (1.3%) and discharged without home medication (8.4%). Patient related, 60.26% (331) perceived that they were not improved with initial treatment. The vast majority of this patients (97.2 %) were discharged from the ED. Illness-related factors were the most common reason for revisits to ED; 52.9% (362) returned with same complaints while 21.3% (146) returned with related complaints, out of which 97.6% patients were discharged and 1.3 % (7) were admitted to the hospital. Of the remainder, 22.8% of the patients (156) reported to ED with new complaints. System related factors: 23.49% revisited patients lived in Al Khor or nearby, with their primary health center facility being 70 km away from their residential area.

Conclusion: From our study, we found the majority of revisits were due to illness or system-related factors. Effective educational program and initiation of telenursing service for discharged patients can prevent unnecessary ED visits.
Epidemiological investigation of measles outbreak in Mansehra Colony Landhi, Karachi. Sindh, Pak, March 2015
Authors: Khan Jahed Ahmed , Nabil Muhammad Furqan
Published: May 2017

Background: On 3rd March the local newspaper published report regarding measles outbreak in Mansehra Colony Landhi, Karachi. In response to the report the Executive District Office health Karachi constituted a three members investigating team with the objectives to investigate the outbreak and propose recommendations for control of outbreak the affected Mansehra Colony Landhi having population of 600 households.

Methods: Investigation was carried out from 4th to 7th March, 2015. Case was defined as a child having 15 years of age residing in Mansehra Colony Landhi, with: a generalized rash and fever for three or more days and one or more of the associated symptoms, including cough, or coryza or conjunctivitis from 1st March to 7th March, 2015. Active case finding was carried out, line list maintained and six blood samples were taken and shipped to NIH Islamabad for lab confirmation.

Results: Sixteen cases were line listed, out of which 75% (n = 12) were females. Median age was 9 years (range: 3 to 13 years). All cases were from same family. Index case was 6 years old girl who visited her parents at Balochistan province (measles endemic) 6 days prior to development of sign symptoms. NIH Lab confirmed four cases positive out of six. As per EPI record all cases were fully immunized against measles.

Conclusion: Cases appeared in vaccinated children implicate that either there is some problem with the quality of vaccine, cold chain maintenance or vaccination techniques. Mopping -up activities conducted in Mansehra colony Landhi and surroundings, Health Education sessions conducted by Lady Health Workers on hygiene and disease prevention.

Keywords: measles outbreak, vaccinated, Health Education
Prevalence of main risk factors of diabetic foot among diabetic patients attending specialized center for diabetes in Baghdad, Iraq 2013
Authors: Saleh Hana Khudair , Raheem Yousif Abdul
Published: May 2017

Introduction: Diabetic foot is one of the most disabling complications with substantial morbidity. It remains the most common reason for hospital admission, impairs quality of life, engenders high treatment costs and is the most important risk factor for amputation.

Objectives: To determine the prevalence of diabetic foot among diabetic patients and the prevalence of main related risk factors.

Methods: A cross-sectional study was performed in Specialized Center for Diabetes in Baghdad - Iraq in which 410 diabetic patients age range 30–83 years were selected using convenient sample from 1st June - 31st September 2013. Data was collected by direct interview using a questionnaire, physical examination, patients' records and laboratory investigations. The data was analyzed using Minitab software version 16.

Results: Among 410 diabetic patients, females (56.83%) and males (43.17%). The prevalence of diabetic foot among diabetic patients was 19.27%. The following risk factors showed a statistically significant association with diabetic foot development: male gender (P = 0.047), duration of diabetes mellitus (P = 0.001), history of bare foot (P = 0.001), non-self-cleaning of foot (P = 0.001), hypertension (P = 0.006), irregular visits to diabetes center (P = 0.016) and uncontrolled level of HbA1c (P = 0.001). Applying binary logistic regression analysis revealed an independent significant association with diabetic foot development with: history of barefoot (AOR = 2.95), non-self-cleaning of foot (AOR = 2.24), male gender (AOR = 2.17), duration of diabetes mellitus (AOR = 1.37) and uncontrolled level of HbA1c level (AOR = 5).

Conclusions and recommendations: There is a high prevalence of diabetic foot among diabetic patients. The study recommends implementing the knowledge of main risk factors into preventive policies and investing more financial support on training programs in primary health care and specialized centers, patient education and DF problem awareness programs.
Assessment of functional outcome using GOSE over 3 years post-injury in patients with moderate and severe trauma
Authors: Chan Stewart , Graham Colin , Yuen Kai Yeung , Yeung Janice , Poon Wai Sang , Ho Hiu Fai , Kam Chak Wah , Rainer Timothy
Published: May 2017

Background: The aim of this study was to evaluate post-injury functional recovery over three years in patients with moderate and major trauma in Hong Kong.

Methods: This is a multicentre prospective cohort study conducted in Hong Kong. The inclusion criteria were: trauma patients admitted to one of three trauma centres, with age ≥ 18 years, injury severity score (ISS) ≥ 9, meeting Trauma Registry criteria, and surviving to 48 hours. Functional outcome was measured by the extended Glasgow Outcome Scale (GOSE) at 3 years post-injury. Good outcomes were defined as an extended Glasgow Outcome Scale (GOSE) ≥ 7, i.e. trauma patients' status rated as lower good recovery or upper good recovery categories.

Results: From 1st January 2010 to 30th September 2010, 400 patients were included. Mean age was 53.3 years; range 18–106 years; and 70% were male. 139 (35%) patients had ISS 9–15; 261 (65%) patients had ISS ≥ 16. Among those included, 38 % required ICU admission; and 58% had healthy pre-existing comorbidity status. For the GOSE analysis, the number of surviving responders at 3 years post-injury reaching a GOSE ≥ 7 was 86, which represented 54.1% of the 159 surviving responders, and 21.5% (86/400) of the original cohort. As there were no statistically significant differences between surviving responders and non-responders at baseline, the assumption is made that 54.1% of the 167 non-responders (N = 90) also reached a GOSE ≥ 7. The total number of cases reaching a GOSE ≥ 7 is therefore estimated to be (86+90), or 176, which is 44.1% of the original 400 cases.

Conclusion: The proportion of cases reaching a GOSE ≥ 7 at 3 years post-injury is 44.1%.
Pediatric cancer incidence & survival 2001–2011 for Jordanian population
Authors: Arqowb Kamal Hasan
Published: May 2017

Background: Marked variations in the incidence and survival of particular types of childhood cancer exist between countries. This study is to explore epidemiology, survival and trends of pediatric cancers in Jordan 2001–2011.

Methods: Descriptive study done. Cases were identified from Jordan cancer registry. All Jordanian pediatric cancers which diagnosed during 2001–2011 were included. Data about age, sex, site, morphology, vital status (alive, dead), date of last visit were collected. SPSS software20 used for analysis & Kaplan Meier method was used to calculate five- and ten-year survival rate.

Results: There were 2267 (5%) registered malignant tumor during the period 2001–2011. Crude incidence rate for cancers is 99/million in children (111 for males and 85 for females). It is more common in males (57.8%), than in females (42.2%), M:F ratio 1.4:1, Median age was 5 years. The highest percent for pediatric cancers was seen in the age group 0–4 years 41.8%. The most common types of cancers were leukemia (31%), brain and CNS (16.5%), Lymphoma (15.9%). Five and ten years Survival rate for pediatric cancers is 70% and 65% respectively. Five Survival rate was best seen in eye cancer patients 91%, and the poorest survival rate was seen in neuroblastoma cancers patients (46%) leukemia (73%), brain CNS (58%) and lymphoma (86%).

Conclusion: The pattern of childhood cancer in Jordan seems to be similar to other countries in our region, where leukemia, lymphoma and brain & CNS were the most common cancers in Jordan and countries in the region, although survival rate is slightly better in Jordan than in other countries in the region.