bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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.
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.
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.
Acute brachial artery thrombosis with diabetic ketoacidosis
Authors: Khan Ejaz Salam , Rahman Syed Abdul , Kumar Neeraj 
Published: May 2017

Background: Diabetes Mellitus is a worldwide disease that leads to several acute complications including diabetic ketoacidosis. Diabetic ketoacidosis is usually preceded by infection, acute myocardial infarction, stroke, or other dire events. There is one report where diabetic ketoacidosis was reported to be associated with acute arterial embolism. Acute arterial thrombosis is a rare disease that requires immediate treatment.

Methods: We present a diabetic patient who presented with acute arterial embolism and developed diabetic ketoacidosis. This is the first case in our hospital in which we have reported with acute brachial artery thrombosis and DKA.

Results: We present a 68 years old male chronic smoker with a 25 year history of type 2 Diabetes (non-compliant to medications), Peripheral vascular disease, dyslipidemia and transient ischemic attack. He experienced severe pain and numbness in his right arm and forearm with no wound, puncture lesion or ecchymosis. Forearm was cold, pale with delayed capillary refill on right hand. Right brachial, right radial and right ulnar arteries were not palpable. Strong pulsations of the right subclavicular and right carotid arteries were palpated. This led to a strong suspicion of an acute thrombosis of the right brachial artery. Emergency thrombectomy with +/ − fasciotomy was planned. Patient was anticoagulated with intravenous heparin. Patient's blood sugar was persistently elevated and blood gases showed mild acidosis. Urinary examination confirmed presence of diabetic ketoacidosis.

Conclusions: A high index of suspicion of diabetic ketoacidosis in patients with acute arterial thrombosis may lead to early recognition and treatment, avoiding any adverse outcome.
Progress towards measles, rubella and congenital rubella syndrome elimination: Oman experience
Authors: Al Awaidy Salah Thabit 
Published: May 2017

Oman has committed to the goal of eliminating measles, rubella and congenital rubella syndrome (CRS) by 2015 year. Elimination is defined as the absence of endemic measles and rubella transmission in a defined geographical area for ≥ 12 months in the presence of a well-performing surveillance system and for rubella without the occurrence of CRS cases associated with endemic transmission in the presence of high-quality surveillance system. Strategies to reach this goal included: a) achieving and maintenance high rates of vaccination coverage; b) syndromic surveillance programs to monitor fever and rash illness syndromes for effective detection of cases; c) and high-quality surveillance system, and sensitive for CRS. Measles and rubella was a leading cause of infant and child morbidity and mortality in Oman before the introduction of measles vaccine by 1975 and thereafter until 1994. With the introduction of a second dose of measles and first rubella vaccines in 1994, coverage for first and second doses of measles and rubella vaccines increased more than 95% in 1996 and has been sustained thereafter. A national measles and rubella immunization catch-up campaign targeting children ages 15 months to 18 years was conducted in 1994 that achieved 94% coverage. As a result, the incidence of measles and rubella have declined markedly in recent years, to ≤ 1 case per million persons in 2012 and to zero cases for measles and rubella in 2013. Similarly, no case of CRS has been notified since 2007. Oman has made signiﬁcant progress toward measles and rubella elimination and has met the regional elimination goals. However, new challenges faced by Oman, for instance with increased globalization, has led to issues such as outbreaks from imported cases. Additional challenges still remain with regard to increasing identiﬁcation and immunization of unvaccinated non-Omani workers and their families.
The effect of demographic and lifestyle factors on mode of travel in school-aged children in the UK, from understanding society database, 2009–2010
Authors: Fadl Sahar , Millett Christopher , Laverty Anthony 
Published: May 2017

Background: Increasing levels of physical inactivity is associated with growing trends of childhood obesity as evidence suggests today's children physically inactive and unfit. The study aims to assess the effect of socio-demographic and lifestyle factors on mode of travel in school-aged children (10–15 years).

Methods: 4,497 school-aged children were selected from wave-1 of Understanding Society database in a multi-stage random sample with 81.8% response rate. Cross-sectional design was used to examine the relationship between active travel with demographic and lifestyle factors.

Results: Univariate analysis showed significant relation of age, region, smoking and eating fast food to the active commuter school-children. Multivariate adjusted analyses shows that children of ages 13 to 15 years were more likely to travel actively compared to those aged 10 to 12 years (OR = 1.92, 95%CI:1.65-2.23). Those engaged in sporting activity 3 times or more per week were more likely to be active travel compared to those less than twice per week (OR = 1.21, 95%CI:1.02-1.43). Children eating fast food once or less than per week were more likely to travel actively compared to unhealthy eaters. Most children living in their respective regions were less likely to travel actively.

Discussion: The positive association between active mode of travel and elder school children (13–15 years), who perform sport activities three times or greater per week and eating fast food once or less per week with active travel, reflect their free choice of mode of travel. Children who practiced sport more than three times per week and who ate less fast food showed healthy behaviors.
Delivering of safe and effective CPR by means of an external chest compression device at Hamad Medical Corporation
Authors: Meyer John Thomas , Campbell Craig , Hamzaoui Mourad 
Published: May 2017

Objective: The objective of this study was to collect feedback from Ambulance Paramedics (AP) with respect of their experience of using an External Chest Compression Device (ECCD) on cardiac arrest patients. Aspects of particular interest were ease of use and their perceived effectiveness of delivered CPR.

Background: HMCAS crews attend to several hundreds of cardiac arrests a year. To achieve Return of Spontaneous Circulation (ROSC), the key requirements are the provision of effective chest compressions delivering oxygen to the brain, maintaining coronary perfusion pressure, and priming the heart for successful defibrillation. Providing effective manual chest compressions in the austere Qatar pre-hospital setting with high temperatures is challenging, hence all HMCAS emergency vehicles have been equipped with ECCD.

Methods: HMCAS receives daily reports compiled by its Documentation Officers. These reports highlight specific cases in which use of the ECCD was indicated but not implemented. These cases are followed up and audited to assess if non-provision of automated chest compressions was clinically acceptable. HMCAS monitors specific key performance indicators, i.e. ’Use of the LUCAS™2 in Adult Medical CPR Cases’ as well as ’ROSC in Medical CPR’. Feedback was collected over a 3-month period using a 10-point Likert scale type questionnaire distributed to ambulance paramedic teams who had used the ECCD during a real medical cardiac arrest case.

Results: The results are based on 54 returned feedback questionnaires. Using a scale with 1 being very difficult and 10 being very easy, ambulance paramedics’ mean rating of the device's ease of use was of 8.8/10. Similarly, on a scale indicating perceived effectiveness, staff indicated that they found the chest compressions provided by ECCD to be highly effective (mean = 9.41/10).

Conclusion: HMCAS staffs are highly satisfied with making use of the device since it provides them with a safer work environment and they are less fatigued after finishing a CPR case, especially during the summer months.
Analysis of dengue surveillance data in Punjab, Pakistan, 2013
Authors: Altaf Asim 
Published: May 2017

Introduction: Pakistan has seen repeated outbreaks of the disease over the past decade or so. In 2011 the largest outbreak was seen in Punjab where 20,864 cases were reported. This study was conducted to estimate the disease burden and analyze epidemiological trends using data from the provincial Dengue Surveillance System, Punjab.

Methods: A descriptive analysis of data from January 1 to December 31, 2013, was undertaken. A case of dengue fever was defined as any person with fever from 2–10 days with any three of the following symptoms: headache, retro-orbital pain, myalgia, arthralgia, rash, hemorrhagic manifestation, leucopenia, abdominal pain and restlessness. Population estimates from Federal Bureau of Statistics were used to calculate attack rates.

Results: From January 1 to December 31, 2013, a total of 14,145 suspected cases were reported and 2,662 were confirmed. Out of cases 9,038 (69.3%) were males and 03 deaths were reported with CFR 0.11%. Mean age was 28.5 years (range 1–99 years). About 28 (0.2%) had previous history of dengue fever. Lahore was the most severely hit city (AR = 173/100,000) followed by Rawalpindi (AR = 52/100,000), Kasur (AR = 6.8/100,000) and Faisalabad (AR = 3.1/100,000). Most severely affected age group was 15–49 (AR = 30.8/100,000) followed by 50+ age group (AR = 15.5/100,000). Males were more affected (AR = 26.3/100,000) than females (AR = 11.8/100,000). The cases started increasing in August (1,128), peaking in November with 4,210 cases reported and then declining in December (758).

Conclusion: The analysis showed predominant involvement of adult males. Moreover highest number of cases was reported in the post-monsoon months of September through December. Age, gender specific health education and area specific larvae and vector control activities should be initiated. In 2014 there was significant decrease in dengue cases in Punjab and especially in Lahore where age and area specific targeted activities were conducted and AR was decreased to 21/100000.
Belofte, pijn en medicijn: het verantwoorden van publieke waardecreatie aan de lokale politiek en maatschappelijke partners
Authors: van de Noort Mijke , Douglas Scott , van der Torre Lieske 
Published: May 2017

Promise, pain and medicine. Organizing accountability for public value creation to local politicians and societal partners
Public value management encourages public organizations to move beyond existing frameworks and create value in flexible collaboration with societal partners. However, this approach creates problems for the accountability processes, because reports to politicians are often still directed at quantitative goals and rigid frameworks. This creates uncertainty and disagreement around the definition of value, the legitimacy of the new governance styles and the complexity of the new collaborations. This article describes the experiences of a large Dutch municipality where we conducted an experiment with an innovative accountability process for public value creation in the public health domain. Political administrators, council members, civil servants and societal partners have jointly assessed, through an interactive Public Value Table meeting format, what value their combined efforts in complex societal challenges have created. This experiment gives insight in the growing pains of public value creation, but also shows some possible solutions to address these tensions.