bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence of post-partum metabolic syndrome (Mets) in women with gestational diabetes mellitus (GDM) in tertiary care hospital Lahore 2013–2014
Authors: Bashir Saira
Published: May 2017

Background: Gestational diabetes mellitus is characterized by high blood glucose levels during pregnancy. The reported prevalence of GDM is 7% worldwide while 8% in Pakistan. About 19.5% of the women with GDM develop post-partum metabolic syndrome.

Methods: A prospective cohort study carried out at tertiary-care hospital in Lahore from Jan 2013 - Dec 2014 to determine the incidence of Mets in women with GDM. After informed consent, women with and without GDM were enrolled during 28th week of pregnancy. Demographic and personal data were recorded. Presence of Mets was evaluated 6 months after delivery measuring their blood pressure, anthropometry, fasting blood sugar (FBS) and triglycerides. Cumulative incidence of Mets, means of blood pressure, anthropometric measures were calculated. Comparisons of general characteristic and component of metabolic syndrome were done by student t-test.

Results: 102 women with GDM and 104 without GDM were followed. The Cumulative Incidence of Mets was 33% in GDM while 15.4% in non-GDM (P-value = 0.002). GDM group were significantly older than non-GDM group (P-Value < 0.001). In GDM group 29 (28.4%) had impaired FBS while in non-GDM group 7 (7%) had impaired FBS. Diabetes developed in 27 (26.5%) of GDM group while none of non-GDM group. BMI blood pressure fasting glucose, and triglycerides were significantly higher in GDM group than non-GDM group.

Conclusion: The study highlights that GDM group has more risk of developing Mets. They should be monitored as high risk for other cardiovascular diseases along with diabetes after delivery.

Keywords: metabolic syndrome, gestational diabetes mellitus, postpartum period
Atypical presentation of achalasia cardia: A case report
Authors: Alhadi Bassem , Abdelaziz Hani , El Sayed Rana , Khaled Muayad
Published: May 2017

Background: Primary achalasia is a disease of unknown etiology in which there is a loss of peristalsis in the distal esophagus and a failure of lower esophageal sphincter to relax with swallowing. Typical Clinical manifestations including dysphagia for solids (91%) and liquids (85%) and regurgitation food (76 to 91%) are the most frequent symptoms in patients with achalasia. Regurgitation may also result in aspiration (8%). However, atypical presentation of achalasia may cause delayed diagnosis and mismanagement.

Objective: This case report presents atypical presentation of achalasia in which patients presenting primarily with prolonged cough. This case report discusses possible mechanisms explaining the atypical presentation of achalasia including chronic cough.

Methods: We report a 45-year-old female patient presented to Emergency Department at Al Wakra Hospital with a history of cough and shortness of breath for more than two weeks. Oxygen saturation was 90% on room air with no history of vomiting, fever, hemoptysis, hematemesis or weight loss. Additionally, there was no significant past medical history except for recent diagnosis with bronchial asthma. In ED, patient was managed as a case of bronchial asthma exacerbation and received beta-2 agonist nebulization, intravenous corticosteroid and oxygen mask. Minimal improvement in the her condition was noted after treatment. Initial investigations were conducted including complete blood count, comprehensive metabolic panel and chest X-Ray. A radiolucent space in upper mediastinum with a query of pneumomediastinum was determined. Further imaging was conducted using computed tomography which showed diffuse dilatation of the esophagus.

Conclusion: Chronic cough could be the only presentation in achalasia cardia.This a typical presentation may cause misdiagnosis or delayed treatment and should be considered in differential diagnosis.
Migration crisis emergency public health services delivery: Quality and effectiveness challenges and opportunities
Authors: Tao Ernest
Published: May 2017

Despite substantial progress emergency public health and medicine, there is no doubt that recent European Union (EU) migration crisis has provide a new dimension and complexity in public health and lives of millions are in peril, while international aid organizations are unable to effectively deal with associated emergencies. Health risks related to migration process associated with emergency or crises situations are not fully studied despite the growing number and intensity of such events. In globalization and health systems are increasingly becoming topical issues due to range of risks diseases vulnerability challenges irrespective of race, ethnic and gender across all levels of the society. The paper aimed at examining the quality of care and effectiveness of emergency public health services delivery in contemporary Mediterranean, Balkans and Africa to EU migration crisis. Our finding showed that the quality of care of migrants in emergency situations varied considerable from one entry points to another and limited optimal Emergency public health engagement and responsibility of EU members' countries. Barriers and challenges to quality care included limited health access to traveller preventive services such as vaccines, essential medicines, and basic health care, chaotic over-crowding, long queue of asylum claims, linguistics, social exclusion, limited emergency local and humanitarian staff availability, police barricades, detentions centers, culture and limited protection against pathogens dynamics, infectious diseases and importation vulnerability. In addition to decreased hygiene, unsanitary conditions, and exposure to disease vectors, increased risk of physical and sexual violence, mental distress, and scarcity of food and water. The quality care index was highly compromised particular methodological strengths and weaknesses in most camps and transitory shelters centers. In conclusion, practical and efficient evidence-based emergency public health policies, services delivery quality and effectiveness metrics in preventing human suffering are crucial in upholding the common moral imperatives and responsibility to global health security.
Service evaluation of the 2-tiered trauma call system in a London Trauma Unit
Authors: Kumar Thirumoorthy Samy Suresh , Nguyen Nam Long
Published: May 2017

Background: Each hospital in the UK has a hospital trauma team which includes a multi-disciplinary team. However, the use of such team for minor trauma can lead to inappropriate use of healthcare resources. Thus, an “Emergency Department (ED) trauma team” including only ED staff was developed. The 2 teams together form the 2-tiered trauma system. Each team has its own activation criteria. Its effectiveness in the UK still requires further evaluations. Thus, an evaluation of its effectiveness is important. Only a few UK hospitals adopt this system. St Helier Hospital (SHH) is one of them.

Objectives: Our aim is to evaluate the effectiveness of new service which has been implemented in the Trauma Unit and its impact on the trauma care and service delivery.

Methods: Patients who activated the ED trauma system at SHH from 01/11/2014 to 30/04/2015 were included. This is a retrospective work, clinical notes were reviewed against two tiered trauma calls using SHH database.

Results: A total of 103 ED trauma calls were recorded. 65 cases (63.1%) should have been managed using the hospital team but were not. Overall, patient care was not adversely affected. In most cases, guidelines on “initial assessors”, “primary survey” and “fast scans” were followed. The survival rate was 100% with 55.3% home discharges. Injury mechanism was looked at to explain for the deviation. The “2 or more systems involved” sub-criterion was activated the most and could be argued to bring about most over-triage cases if trust trauma calls had been used.

Conclusions: The ED team at SHH have managed its patients safely and effectively despite a high guideline non-adherence rate. Improvements of the 2-tiered system effectiveness need an increase in the system awareness and a review of the system activation criteria.
Risk factors of cerebrovascular accidents among survivors in the Gaza Strip: A case-control study
Authors: Abedelaal Eyad
Published: May 2017

Background: Cerebrovascular Accident or stroke is a global health problem and is a leading cause of disability. It is one of the leading causes of mortality and morbidity worldwide.

Materials and methods: A retrospective case-control study carried out on stroke patients admitted to the main Ministry of Health hospitals from May to November 2014. The study consisted of 110 proved cases of stroke and 110 controls (selected from patients who attended the study hospital for conditions other than stroke). For each case of stroke, one control was selected. The controls matched to cases in respect to age ( ± 3 years), sex and locality. Analyses performed by calculation of Chi-Square test and confidence interval using SPSS program version 20.

Results: Out of 110 patients, (61.8%) were females and (38.2%) males. Mean age of cases was 65.80 years compared to 65.46 for controls. Most of them were living in Gaza city. The ischemic type found in 81.8% patients. The most important medical risk factors associated with CVA was diabetes mellitus and hypertension; which represent 61.9% diabetes mellitus among cases compared to 38.1% among controls (P-value < 0.001) and represent 61.4% among hypertension cases compared to 38.6% among controls (P-value < 0.001). For cardiac disorders, 60.3% of cases compared to 39.7% of controls have cardiac disorders (P-value < 0.021). For lifestyle risk factors, obese represent 56.9% among cases compared to 43.1% among controls (P-value < 0.010), smoking represent 63.6% among cases compared to 36.4% among controls (P-value < 0.001). Sedentary level represent 78.2% among cases compared to 21.8% among controls, (P-value < 0.001) and stress represent 83.8% among cases compared to 16.2% among controls, (P-value < 0.001).

Conclusion: Hypertension and diabetes are the biggest risk factors for stroke in, which can be controlled with appropriate medication and lifestyle changes.
Stop sepsis, save lives
Authors: Labib Ahmed , Khan Samina
Published: May 2017

Introduction: A large number of patients present to the Emergency Department (ED) with sepsis, severe sepsis or septic shock. Septic shock is associated with 40% mortality risk and is the most common cause of death in the ICU. Moreover, survivors of septic shock are at risk of permanent organ dysfunction, prolonged hospital stay and long term institutionalization. Many of these complications can be minimized and may be avoided by prevention via public health improvement and education, early identification of sepsis, and timely effective intervention.

Methods: IHI quality improvement methodology applied to guide our work. The Quality Leaders from ED, ICUs and general wards were invited to participate and collaborate to develop and test the Sepsis 6 Pathway. From the data collected so far we noted the following: Sepsis patients ages range from as young as 19 to 89 years. The most common sepsis diagnoses are septic shock, pneumonia and urosepsis. For the initial management of sepsis patients 49% are managed in the ED. In August we started monitoring delays in time between the patient's admission and criteria met for sepsis diagnosis; and the time between criteria met for sepsis and referral to ICU. If the patient is admitted to the ward this can be as long as days. If the patient is admitted to MICU or ED it ranges from 0 minutes – 1 hrs. The time between criteria met for sepsis and treatment initiated is the most important indicator we are monitoring, which based on the data collected so far averages between 0 minutes – 1 day.

Conclusion: Sepsis causes avoidable and preventable patient harm. A multi-faceted approach may help reduce morbidity and mortality. Early implementation of the sepsis 6 pathway is underway in HMC across main acute care areas. Outcome measures will be collected and compared against international standards.
Child-friendly approaches to care in the emergency medicine setting
Authors: Goltz Deirdre , Hopkinson Stephanie
Published: May 2017

Background: Children cite needlesticks and invasive procedures as anxiety-provoking, which can have a negative impact on coping. This distress can lead to increased fear of medical settings and avoidance of care. Providing children with care that reduces the fear of pain associated with medical procedures can support positive experiences that can reduce anxiety. Thus, this will allow the child to better cope with and cooperate during medical procedures.

Methods: The available literature and the authors' professional experiences highlight the implementation and effectiveness of these approaches.

Results: Four main practices highlight a child-friendly approach: language, information, procedural support, and comfort positioning. Child-friendly language includes using a clear, concise, directed language. It avoids using confusing terms and focuses on the sensory experience of the child. Information is provided both in timing and content to children based on their developmental level and allows for the safe exploration of the equipment being used to promote mastery. Procedural support includes distraction, oral sucrose use, and encouraging positive coping skills such as breathing and imagery. Comfort positioning maintains access and safety for the healthcare professional while meeting the needs of the child to stay in proximity to its caregiver and not to lie on its back.

Conclusions: Child-friendly practices raise the standard of care for children in emergency settings. These practices can reduce procedural challenges for staff and improve the patient's experience. Implementation can be done across the provider spectrum and can be enhanced through the use of a child life specialist, a pediatric healthcare professional trained in supporting patients, families, and staff in the medical environment.
Concordance of diagnosis between the ambulance services and emergency departments
Authors: Kamel Hany , Osman Hanaa , Mohamed Jassim , Mishreky Larisa , Jundi Ibrahim Abu
Published: May 2017

Introduction: Diagnosis of patients in a pre-hospital setting is a challenging process that depends primarily on clinical evaluation. The pre-hospital environment presents particular challenges such as scanty information and limited diagnostic tools. Nonetheless, accurate diagnosis is key to activate the appropriate cascade of management, level(s) of dispatch and disposition. This study aims to compare the ambulance paramedic diagnosis with that determined in the Emergency Department (ED).

Method: This is a multi-centered cohort prospective study comparing pre-hospital diagnosis with emergency physicians' primary diagnosis. We included all adult patients in the ED of Hamad General Hospital, Al Khor Hospital and Al Wakrah Hospital, but excluded all poly-trauma patients (trauma level 1). Pre-hospital diagnosis was reviewed from the ambulance patient care record and compared with documented primary diagnosis provided by ED physicians during August 2015.

Results: A total of 747 records were reviewed; of which, 154 records were excluded from the Study due to missing data. The comparison results showed that 389 files were congruent and 200 were non-congruent. They included common diagnoses such as trauma (9%), abdominal pain (12%) and renal colic (12%), and had concordance as high as 90.5%.

Conclusion: Pre-hospital diagnosis was congruent in 66% of the cases reviewed when compared with emergency physicians' provisional diagnosis. As the study did not include the final diagnosis, accuracy of diagnosis was not assessed for both the pre-hospital setting and ED physicians. The most common cause of incongruity was documenting a specific diagnosis instead of provisional diagnosis, which increases the risk of missing related differential diagnosis.

Recommendations: Such studies may help identify opportunities of improvement for healthcare providers to make optimal decisions. Therefore, further studies are required to reveal the areas of improvement.
Foreign body aspiration in children under 10 years at Al Bashir Hospital in the year 2011
Authors: Hasan Kamal
Published: May 2017

Background: Despite the great success in controlling infectious disease in children, house accidents have increased, especially in developing countries, in the last years. WHO has reported that more than 20% of hospital cases involve children under 5 years of age and are caused by house accidents. Foreign body aspiration (FBA) is a preventable accident with a high risk of mortality. The objective of this study is to identify the epidemiology of FBA in children admitted to Al Bashir Hospital in 2011.

Methods: A retrospective cross-sectional study was conducted in 135 children who were admitted to the hospital and bronchoscopy was conducted for diagnosis and treatment. Data was collected from the files of those patients by using a questionnaire, which included variables (age, sex, type of foreign body, location of foreign body, main presenting symptoms, referred status). SPSS 17 used for analysis.

Results: A majority of the patients (63%) were between 1 and 3 years, mean age 3.2 years, (59% male, 41%female) with a M:F ratio 1.4:1. Bronchoscopy findings 113 out of 135 (84%) showed positive foreign bodies, Rt main bronchus is the common site 56% of the cases. Most of the foreign bodies were organic, seeds and peanuts (72%). The majority of the cases presented with cough (97%), choking (64%), and shortness of breathing (39%). Thirty percent of the cases were referred from peripheral hospitals. Mean hospital stay was 2.1 days. One patient developed cardiac arrest and convulsion occurred in one case. Chest infection was seen in 10 cases. No other complication was seen.

Conclusions: Detailed history from the parents about foreign body aspiration is important for diagnosis of FBA, when suspected prompt bronchoscopy should done to prevent further complication, the doctors should not depend exclusively on radiological examination for the diagnosis of FBA as most foreign bodies are radiopaque.
Role of point-of-care ultrasound in renal colic patients without hydronephrosis to decrease the length of stay in HGH-ED
Authors: Lamei Mishreky Larissa Michael , Abbasy Mohammed , Khan Saad Salahuddin , Shukla Dhramesh , Pathan Sameer Abdulsattar
Published: May 2017

Introduction: Renal colic is one of the common abdominal emergency presentations to an ED. The cost of imaging, health care resources and time spent in the Emergency Department (ED) is huge. There is good evidence supporting the role of ED bedside ultrasound in detecting hydronephrosis.1,2 We plan to study the role of bedside ultrasound in renal colic as a pilot audit for the QIP.

Method: A convenience sample was selected prospectively. In all patients, a bedside ultrasound was performed by emergency ultrasound fellow, focused to answer presence or absence of hydronephrosis was performed. The results of ultrasound were recorded using online Google docs. A CT-KUB scan was performed for all these patients as per departmental guidelines. The results of CT and USG finding, disposition, and timings for the registration, to perform USG, and to get CT reports were recorded and analyzed.

Results: A total of 24 patients aged between 18 and 65 years were included in the study. The average length of stay (LOS) in ED was 15.1 hours (3.7–60.3 hours). The mean time to perform bedside USG was 4.0 ± 2.4 hour. The average time to get the CT-KUB results was 6.0 ± 2.4 hours. The negative predicative value of bedside USG was 80%. None of the patients without hydronephrosis had obstructing stone or required admission. In patients without hydronephrosis, the average LOS of ED stay, in disposition based on CT results, was 2.08 hours higher than the disposition bedside USG results.

Conclusion: These observations are limited as part of small audit data. However, it could be future direction to explore, the role of bedside USG performed by ED physicians, in renal colic to decrease the ED LOS.
Hamad General Hospital-Emergency Department (HGH-ED) staff with mass casualty incident/disaster involving children
Authors: Jundi Ibrahim Abu , Guerrero Aldwin , Rull Sandra
Published: May 2017

Introduction: A mass casualty incident (MCI) or disaster can happen at any time. People at the extremes of ages are affected more especially children. Working in the nation's biggest Emergency Department (ED), Hamad General Hospital (HGH)-ED, staff preparedness is crucial to handle such unfortunate event or events. This study aims to assess the preparedness level, knowledge and the willingness of the HGH-ED staff to deal with MCI/Disaster involving children.

Methods: A prospective descriptive study design-using questionnaire to gather data. The study included a 21-item Questionnaire examining preparedness level, knowledge and the willingness of HGH-ED staff dealing with MCI/Disaster involving children. The questionnaire was send to 720 HGH-ED staff, descriptive statistics were used to describe study variables.

Results: Out of the total responders, 73.5% were ED nurse and 26.4% ED physician the average work experience was 7.81 ± 4.94 years. 74% reported that they have never been involved in disaster/MCI involving children's and 82% of the total responders they don't have any formal training in regard of dealing with pediatric victims of disaster. 64% where either unaware or uncertain about the existence of HGH-ED pediatric specific disaster plan.

Conclusion: The result of our study showed that the preparedness level and the knowledge to deal with disaster/MCI involving children in our ED staff were found to be low due to lack of knowledge of children special needs and lack of experience to deal with children involved in MCI and low level of training that ED staff had.
An inquiry into the perceived clinical handover of patients arriving in a large tertiary care emergency department
Authors: Khalid Muhammad Masood , Bashir Khalid
Published: May 2017

Background: Delays in clinical handover can compromise a patient's care. The handover is not the sole responsibility of the ambulance personnel or the emergency departments. Reducing delays requires the working together of the entire organization, as well as designing efficient emergency and ambulance departments.

Objectives: The study aims at exploring the quality of clinical handover between the emergency department personnel and the ambulance personnel at Hamad General Hospital.

Methods: This is a descriptive study using two kinds of anonymous questionnaire surveys to gauge the current opinion regarding patient handover. One was aimed at physicians, who are the hospital employees, and the second was intended for the ambulance personnel. The employees of the Emergency Department were asked to provide their opinion of the handovers that the ambulance employees provided in a given clinical situation. The clinical situations in question included: cardiac arrest, pediatric emergencies, sepsis, chest pain, head injury, and trauma.

Results: A total of 65 ambulance employees and 70 medical employees completed the survey. The findings of the study indicate that there is a formal training procedure for patient handover, and that, in general, the quality of communication of history, the general quality of handover, and the knowledge of vital signs reported were high. The ambulance personnel were satisfied with their quality of handover. However, the medical staff were less positive, particularly for sepsis and pediatric emergencies. The findings also indicate that the ambulance employees perceived a high level of delay regarding patient handover.

Conclusions: It was encouraging that both groups had a positive perception about the handover. The areas for improvement identified by the medical employees were sepsis and pediatric emergencies, while the ambulance employees perceived a significant delay in the handover. In conclusion, the study proposes the following recommendations as possible solutions: interdisciplinary training, addressing organizational culture, and flexibility in organizational processes.
Implementation of “CODE SEPSIS” for septic patients at Al Wakra Hospital: A practice improvement initiative
Authors: Abdelaziz Hani , Khatib Mohamad , El Sayed Rana , Khaled Muayad , Al Anany Rasha , Smidi Wesam , Mitwally Hassan , Saad Mohamed , Batir Mohsen , Mitwalli Mohamed , Irfan Ayesha , AbuSaifain Mohammed , Al Khawaldeh Amjad , Al-jonidi Mohammed , Dwamena David , Zakaria Almunzer , Elshafei Moustafa , El Zeer Hani , Al Hail Amira , Al Heidous Mahmoud
Published: May 2017

Introduction: Sepsis is a major cause of hospitalization with a high mortality rate. Early recognition and management of sepsis have shown to improve mortality outcomes. A proactive alert system for improving the response of the interdisciplinary team may decrease the time to intervention and improve patient outcomes.

Objective: The study evaluated the impact of an early alert system, “CODE SEPSIS”, on adherence to the sepsis management bundle and time to intervention among patients at risk for sepsis.

Method: Patients presenting to the Emergency Department (ED) and meeting two or more criteria on the sepsis screening tool were intended to trigger an overhead alert known as CODE SEPSIS, which was activated based on the physician's decision. Data were retrospectively collected over a 3-month period for all hospitalized adult patients with confirmed sepsis (age above 18 years). We evaluated the time from ED presentation to diagnostic and treatment interventions. A data collection tool was designed to record information.

Results: A total of 36 sepsis patients were identified, among which 18 were classified as CODE SEPSIS and 18 were classified as non-CODE SEPSIS. We found that the CODE SEPSIS group showed greater improvement than the non-CODE SEPSIS group from ED presentation to intravenous catheter insertion (37.3 to 31.5 minutes, 15.6%), fluid administration (41 to 39 minutes, 4.9%), microbiological workup (91 to 33 minutes, 63.7%), lactate level (69 to 66 minutes, 4.3%), prescribing antimicrobial therapy (92 to 44 minutes, 52%), and administration of antimicrobial therapy (88 to 46 minutes, 47.7%). Patients in the non-CODE SEPSIS group showed a 1-day decrease in length of hospital stay.

Conclusion: The CODE SEPSIS alert system developed at Al Wakra Hospital promoted early and standardized management among patients at risk for sepsis, which may lead to improved patient outcomes.
Read between the lines – Subtle ECG changes to be recognised as a risk factor for sudden cardiac death
Authors: Chalihadan Sajid , Purayil Nishan K.
Published: May 2017

Background: Although the majority of sudden cardiac deaths (SCD) are due to CAD and poor LVEF, there is a considerable fraction of idiopathic ventricular fibrillation (IVF) causing SCD that is secondary to channelopathies and other inherited arrhythmias.

Objective: The present report aims to raise awareness about the prevalence of inherited arrhythmogenic disorders, besides the commonly attributed CAD causing SCD.

Case report: We report the case of a patient with a history of sudden collapse after routine duty. He had ventricular fibrillation and was successfully defibrillated to normal sinus rhythm. On examination, he was found to have a structurally normal heart, and the ECG showed early repolarisation (ERPS) with a short QT interval.

Review of the literature: SCD is defined as IVF in the absence of an identifiable cause. IVF could be the manifestation of concealed forms of arrhythmogenic disorders exacerbated by appropriate triggers. Long QT syndrome presents with structurally normal heart, QT prolongation, syncope, and SCD. Incomplete penetrance gene presents as Brugada syndrome, short QT syndrome, ERPS, sinus node dysfunction, and progressive conduction defects. Subtle ECG changes may be present, which, if identified early, can lead to further focused evaluation, leading to the prevention of a potentially life-threatening arrhythmia. ECG changes that should be looked for include: ERPS changes, especially in the inferior and lateral leads, ‘Rs’ in the inferior leads – >2 mm deep in lead II, small slurred S wave in the inferior leads, incomplete or complete RBBB with J point elevation and coved ST segment in V1 and V2 for Brugada, and long or short QT interval.

Conclusion/summary: It is important to recognise channelopathies causing SCD. This is because a majority of these channelopathies are ‘inherited’ and can cause more deaths in the family. Such potential information obtained from ECG features can help categorise patients as ‘suspected high-risk’ and provide appropriate advice.
A wireless oxygen saturation and heart rate monitoring and alarming system based on the Qatar Early Warning Scoring system
Authors: Alshorman Sami Saleh , Bensaali Faycal , Jaber Fadi
Published: May 2017

Background: Peripheral oxygen saturation (SpO2) and heart rate (HR) are important indicators for various medical conditions such as cardiopulmonary disorders and respiratory diseases. The main objectives of this study is to design and implement a portable embedded medical system. This system wirelessly obtains SpO2 and HR data from a patient as well as his/her coordination, and sends a short messaging service (SMS) alarm to the emergency control room to contact the patient and confirm his/her health status or dispatch an ambulance in case of his/her measurements are outside the normal range based on the Qatar Early Warning Scoring (QEWS) system.

Methods: The system mainly consists of a Bluetooth finger pulse oximeter, a Bluetooth-enabled microcontroller, a global positioning system (GPS) and a General Packet Radio Service (GPRS) module. It is divided into three main stages. In the first stage, the readings of SpO2 and HR are obtained from the patient in real time. During the second stage, the readings obtained are sent over Bluetooth to the signal acquisition and processing unit. The received data is processed and a decision is made whether a SMS alarm should be sent or not. The final stage is concerned with sending the alarming SMS to the emergency control room over the GPRS network based on the QEWS system.

Results: The system was implemented and successfully tested as a stand-alone unit by avoiding the use of a PC or a smartphone for data processing. The transmitted SMS alarm includes the SpO2 and HR readings, the QEWS score and the GPS coordinates.

Conclusions: The designed system is wireless, portable, and user-friendly. This system possibly promotes quality of care for the patient living outside hospital and could improve response time from an ambulance service point of view by determining the exact location of the patient.
ED case presentations during the largest sandstorm in the Middle East
Authors: Irfan Furqan B. , Pathan Sameer A. , Bhutta Zain A. , Abbasy Mohamed E. , Elmoheen Amr , Alsaeidy Abdallah M. , Tariq Tooba , Hugelmeyer Charles D. , Dardouri Habib , Khial Noor B. , Daniel Colene Y. , Silva Ashwin D. , Farook Kaleelullah S. , Sharma Yogdutt , Thomas Stephen H.
Published: May 2017

Background: The State of Qatar experienced a sandstorm on 1 April 2015, lasting approximately 12 hours, with winds blowing at more than 100 km/hr and average particulate matter of approximately 10 μm in diameter. The Emergency Department of the main tertiary hospital in Qatar managed 62% of the total emergency calls. The peak load of patients during the event manifested approximately 6 hours after the onset.

Methods: A retrospective review of patient mix and case load was performed for patients presenting to Emergency Department during and after the sandstorm.

Results: A total of 254 cases with respiratory illness presented to the Emergency Department within 12 hours of sandstorm onset. Of these cases, 42 had respiratory failure, of which 19 required intubation and 23 were managed conservatively. Of the remaining 212 cases, 28 with severe respiratory exacerbation of asthma, 15 with COPD exacerbation and 169 with minor asthma exacerbation were managed conservatively. In addition, a total of 26 patients presented with ophthalmological complaints. Of these, 12 had foreign body removed from the eye under slit lamp and took topical medication and antibiotics. The remaining 14 patients with anterior eye chamber emergencies were managed conservatively.

Conclusions: Patients presented mainly with exacerbations of asthma and respiratory distress, ophthalmic emergencies and vehicular trauma. Surprisingly, incidence of pedestrian injuries did not vary. With the outline of adaptations and specific areas for improvement identified in this review, we hope that future sandstorm emergencies will be better positioned to respond with optimum efficiency and effectiveness.
Post sleeve gastrectomy acute foot drop, Case presentation
Authors: Hassanen Walid Sayed Abdelkader , Serhan Maysa
Published: May 2017

Introduction: Sleeve gastrectomy has been a rising trend in management of morbid obesity in the Qatari population. National health insurance has included sleeve gastrectomy in the coverage scheme for patients with BMI of 40 or above, which has contributed to the consistent increase.

Objective: We aim to highlight one complication that we saw in our clinical practice of a 32 years old female who developed acute foot drop after sleeve gastrectomy. Clinical Scenario: We have been consulted to see a wheel chair bound 26 years old female who suffers from acute foot drop. The presentation was dramatic to the extent that hindered the patient from walking properly. Few weeks before this presentation, the patient has undergone a successful sleeve gastrectomy that was followed by a smooth period of convalescence and no reported post-operative complications.

Results and Conclusion: Sudden loss of popliteal pad of fat can fairly explain vague foot drop after sudden and rapid weight loss following bariatric surgery. Conservative management has proved to be effective saving the patient another surgical intervention.

Recommendations: Loss of popliteal pad of fat can fairly explain vague and sudden acute foot drop following rapid weight loss. Watchful waiting accompanied by physiotherapy proved to be effective management for this case and saved the patient surgical intervention of popliteal nerve decompression.
Better communication is envisaged for the information system of the integrated child care program in Rabat Sale Zemmour Zaer District
Authors: Kharti Kawtar Kharti
Published: May 2017

Infant mortality is a sensitive indicator of development of a country and investing in the health of children. Since 1997 Morocco has been engaged in a the program of the integrated care of the child. We evaluated the information system of the integrated child-care program and the opportunity for collecting reliable data and good quality necessary to identify priorities. We conducted an evaluation of the information system of the integrated child-care program performed at the province of Salé and that of Rabat. We included 135 health professionals. The evaluation was carried out according to World Health Organisation criteria. We used a comprehensive sample of Provincial Epidemiology Units' involved health professionals, Service Infrastructure and all Health Centers in the region involved in the integrated child-care program. We administered a questionnaire The Rate of participation 65s%. The system was considered easy by 72.7%. The reports were timely sent for 27.2%. These Reports we reproduced in 60% of health professionals involved in the integrated child-care program. The System was useful for 63.6%. The Data were only processed locally and in 27.2%. The Feedback was provided to the relevant structures in 9%. 81% have received training in the integrated child-care. This system is considered useful to estimate the burden of disease and allows the allocation of resources necessary for its operations, it is simple, relatively acceptable hence the need to provide significant efforts to improve the quality of the information produced: Generalizing the integrated child-care program to the entire region; Promoting the decentralization of the system at the regional level; Further developing the communication network between different levels: information and feedback; Adapting the system to the needs of users by simplifying collections of records and promoting the analysis of data collected.
A lady with repeated vomiting - unexpected diagnosis
Authors: Chan Stewart
Published: May 2017

Background: Vomiting is a symptom commonly encountered in emergency settings, with many differential diagnoses. In the following case, the diagnosis was nearly missed and the outcome could have been critical.

Methods: A case study was performed, supported by literature review. A 32 year-old lady presented to the Emergency Department with repeated vomiting for one day. She has had epigastric discomfort for several days. Her blood pressure was 119/74 mmHg, heart rate 118/minute, and she was afebrile. She had been under the in-vitro fertilisation program and received human chorionic gonadotrophin, oocyte retrieval and embryo transfer 8, 6, and 3 days respectively prior to presentation. On examination, her abdomen was soft, non-tender. Urinary pregnancy test was negative. Her sodium level was 131 mmol/l, Hb 17.0 g/dL, white cell count 20.5 ×  10*9/L, and platelet 485 ×  10*9/L. The rest of the renal and liver functions and amylase, were normal. She was admitted to the Emergency Ward with a working diagnosis of gastritis. On reassessment, her abdomen was noted to be slightly distended although no tenderness or guarding was elicited. Ovarian hyperstimulation syndrome was suspected, and gynaecology was consulted for further evaluation.

Results: Transvaginal ultrasound scan showed a normal-sized uterus with thickened endometrium and no intrauterine sac. Both ovaries were enlarged, left ovary 6.1 ×  4.3 cm and right ovary 5.0 ×  5.3 cm. Significant pelvic free fluid was present. The diagnosis was confirmed to be early ovarian hyperstimulation syndrome. Ovarian hyperstimulation syndrome is an iatrogenic complication from assisted reproduction technology. Following gonadotropin therapy, this condition usually develops several days after oocyte retrieval or assisted ovulation, with ovarian enlargement due to multiple ovarian cysts. Complications include ascites, haemoconcentration, hypovolaemia, and electrolyte imbalances.

Conclusion: Emergency physicians should consider ovarian hyperstimulation syndrome in patients who had received assisted reproduction presenting with repeated vomiting.
Value of routine blood cultures in febrile children presenting to the Emergency Department
Authors: Awean Galia Zaied , Salamah Khalel , Elkum Naser , Hedin Lars , Shah Abdussalam Shah Ak
Published: May 2017

Background: A minority of children attend an Emergency may have a serious underlying, systemic infection as a cause of fever. Blood culture remains the gold standard approach to establish the diagnosis and presence of pathogens in a child with suspected, serious bacterial infection. This study describes the proportion of positive blood cultures and correlation with a basic investigation (C-reactive protein, absolute neutrophil count) and clinical presentation in children visiting an emergency.

Methods: A retrospective study at Qatar- Al Wakra Hospital- pediatric emergency over one year. Patients younger than or equal to 3 months of age, patients with any form of immune deficiency and patient with no fever were excluded.

Results: A total 828 patients (mean age 3.83 years), presenting with fever or a history of fever, 121 (14.6%) admitted to the pediatric ward, 10 (1.2%) admitted to the pediatric intensive care unit, 1 (0.12%) admitted to the pediatric surgery. In total, 20 (2.4%) had positive blood culture, of these 20, 4 (20%) were admitted to the pediatric ward, and 9 (45%) were observed in the hospital less than 24 hrs, 7 (35%) were sent to their home after the investigations. We find no differences in the mean value of ANC (p = 0.934) or CRP (p = 0.572) in patient with positive or negative blood culture.

Conclusion: The yield of positive Blood Culture in routine care in an emergency department setting is low, 2.4%. There were no significant differences in associated clinical and laboratory investigations (ANC and CRP) between the groups with positive and negative blood cultures.
Exploring the link between emotional intelligence and perceived stress among female medical undergraduates of Saudi Arabia
Authors: Hasan Tabinda , Ansari Mahmood Fauzi
Published: May 2017

Background: Previous reports suggest prevalence of high stress levels and psychological morbidity among medical students. This study aimed to elucidate factors for Perceived Stress (PS), role of Emotional Intelligence (EI) in the experience of PS and its association with academic background and satisfaction with career choice among medical students.

Methods: A cross-sectional survey was conducted in Riyadh-Medical-College-Saudi-Arabia on First (n = 40) and Final year (n = 35) Female medical undergraduates during year 2015. Students were administered Schutte's Emotional Intelligence Inventory and Cohen's Perceived Stress Scale. Additional information was collected on participant demographics, previous qualification in higher education and career satisfaction level. Basic descriptive statistics –correlation & regression were used for data analysis.

Results: The survey had a 99% response rate. Seniors were more stressed than Juniors. Although there was no significant difference for EI scores between the two groups, still, there existed a ‘definite trend’ of ‘Low EI Scores’ being associated with ‘High Perceived Stress Levels’. ‘Low scorers’ on the EI were more likely to be (i) younger age group, (ii) without a previous higher education qualification (iii) not satisfied with their decision to study medicine (p < 0.01).

Conclusions: There is an inverse correlation between EI and PS. Significant predictors of PS are age, previous higher education qualification, satisfaction with the decision to study medicine and EI level. It would be interesting to explore by further research, if any possible difference exists between genders. The ‘t’ statistic indicates EI as a pivotal predictor of PS in medical profession. We suggest that health profession institutions could organize regular programs to enhance students' EI. Considering substantial previous research evidence on Stress and Professionalism being an interrelated phenomenon in Health professions, it would be logical to consider EI as a possible qualitative selection criterion for medical students to improve eventual outcomes.
Factors linked to tobacco smoking among adolescents who reside in the United Arab Emirates
Authors: Barakat-Haddad Caroline , Dghaim Rania , Siddiqua Ayesha
Published: May 2017

Background: Tobacco consumption among youth is a growing public health concern worldwide. This paper examines the prevalence, profile, and predictors of tobacco-use among expatriate and national adolescents attending secondary schools in the United Arab Emirates (UAE).

Methods: Using a cross-sectional study design, we collected data on the prevalence of tobacco-use for a sample of 6,363 adolescents aged 13 to 20 years, including current smoking of cigarettes, midwakh, shisha, and any other form of tobacco. We also collected demographic, socioeconomic, residential, and behavioural data.

Results: Results suggest that 8.9% of participants smoked cigarettes, 6.3% smoked midwakh, 7.4% smoked shisha, and 6.4% smoked any other form of tobacco in the past 30 days. Overall, 14.0% of adolescents were current smokers, defined as participants who reported occasional or daily use of at least one form of tobacco in the past 30 days. Results consistently indicate that the prevalence of tobacco use is higher among males than females, regardless of age and tobacco form. Among males, cigarette usage is the most popular whereas shisha is the most smoked tobacco form among females. Consistent predictors of tobacco smoking include being male, age, parents' marital status, ever using illegal drugs, exposure to smoking at home or with friends, ethnicity, and location of residence.

Conclusions: Findings of this study emphasize the need for continued public health strategies and education campaigns to discourage adolescents from using tobacco. Knowledge of predictors of tobacco-use can be used to target at-risk adolescents through various anti-tobacco use initiatives and tobacco control measures.
Neurocysticercosis - the Alkhor experience
Authors: Purayil Nishan , Mohammad Osama Hashim , Naushad Aboobaker , Parmaba Firjeeth , Chandra Prem
Published: May 2017

Background: Neurocysticercosis (NCC) is the most common parasitic disease of the central nervous system. On the basis of an incorrect assumption that human NCC does not occur in countries in which law prohibit swine breeding and consumption of pork, the disease has been considered rare in Arab world.

Materials and methods: A retrospective study carried out in Emergency Department, Alkhor hospital, HMC from April 2014 to May 2015 (14170/14). All patients above age of 18 yrs diagnosed to have neurocysticercosis from August 2005 to December 2013 were included. Data were retrieved from medical record department and electronic data base. This included baseline demography, clinical presentation and radiological findings.

Results: Out of a total of 137 subjects enrolled 9 were excluded. All the 128 subjects were male Majority of the subjects was in the age group 21–30 yrs (n = 86). Majority were from Nepal 76 (58.1%). 30 (20.3%) patients gave history of previous episodes of seizure, however only 8 of them were on antiepileptic medication. 107 patients presented to A&E with seizures (83.5%). Among which GTCS was the most common form 85%. Use of tobacco was seen in 20 subjects (13.6%) and alcohol in 10 (6.8%). Radiological examination, CT scan revealed solitary lesion in 84 (65.5%) subjects and majority were calcified. 114 patients were admitted to the hospital out of which 5 required ICU care. Anti-epileptic medication was initiated in all patients except 10 patients. Reason could not be identified. Except 13 patients all other patients received short course of oral steroids.

Conclusion: 1) Majority of the patients are young males from Asian countries, 2) GTCS is the most common mode of presentation, 3) Solitary lesion is the most common radiological finding. The increased ease of international travel and increasing number of immigration from developing countries have led to widespread recognition of NCC developed countries.