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- Journal of Emergency Medicine, Trauma and Acute Care
- الأعداد السابقة
- الأعداد السابقة
Journal of Emergency Medicine, Trauma and Acute Care - 2 - International Conference in Emergency Medicine and Public Health-Qatar Proceedings, أكتوبر ٢٠١٦
2 - International Conference in Emergency Medicine and Public Health-Qatar Proceedings, أكتوبر ٢٠١٦
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Needs assessment of breast health care in the Gaza Strip
المؤلفون: Mohamed Abdulla Lafi and Rola ShaheenBackground: Breast cancer is the most common malignancy and leading cause of cancer mortality among females in Gaza. Most cases are diagnosed at late stage. Survival rates are persistently low in contrast to improved rates worldwide. Our study examined awareness, knowledge, attitude, practice and access to breast healthcare among both health professionals and women in Gaza.
Methods: In May and June 2014, using convenience and representative sampling, 100 health professionals from medical, surgical and obstetrics-gynecology completed a survey on basic knowledge of breast cancer, attitudes and practices. Structured interviews were conducted with 100 women 30 years and older across all districts and socioeconomic backgrounds. Women were interviewed about basic knowledge of breast cancer, self-exam, attitude and practice when a breast problem encountered, access, and barriers. Data was analyzed using excel to find frequency distributions.
Results: The health professional surveys showed: Only 15% offer breast exam to their patients, 13% believe mammography can cause cancer, 48% do not know that radiotherapy is not available in Gaza, 4% believe cancer breast is contagious. Health professionals expressed the need for standardized protocols and guidelines. Only 25% of surveyed women reported practice of self-examination, 87% had never had a mammogram or had been offered a breast exam, 26% think mammogram can cause cancer. However 80% were positive about seeking healthcare when needed. Most women accepted screening if affordable and were interested in receiving information about breast care.
Conclusion: Knowledge gaps in breast healthcare exist among healthcare professionals and women in Gaza strip. Awareness sessions, capacity building and specialized training of healthcare professionals are needed to improve quality of breast healthcare in Gaza. Increasing utility of mammography among women with access to multidisciplinary breast care may improve survival rate, particularly because most women in Gaza are keen on seeking medical care when needed.
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Compartment syndrome- A rare complication of intraosseous access in adult patients
المؤلفون: Ashfaq Khan and Suresh Kumar Gopala PillaiBackground: Intraosseous (IO) access are being widely used in resuscitation of patients with difficult intra-venous (IV) access. The United Kingdom Resuscitation Council guidelines recommend the use of IO access, after two minutes of failed IV access in adult patients or two failed IV attempts in pediatric patients. There are various complications associated with IO access such as extravasation of the infusion fluid or medications, bleeding, infection and pain1. Compartment syndrome is a rare complication associated with IO access. This is reported commonly in children where in certain cases the affected limb required amputation. We report a case where an adult patient developed compartment syndrome secondary to IO access.
Methods: A 52-year-old lady who was on dialysis for renal failure presented to the Emergency Department (ED) with septic shock. She was in peri-arrest and had a difficult IV access. Therefore an IO needle was inserted to her right tibia and resuscitation was carried out with fluids and medications. She required emergency intubation and ventilation and was later admitted to the Intensive Care Unit (ICU). The following day, it was found that she developed a compartment syndrome of the right lower leg where she had the IO access.
Results: Patient was taken to the theatre for an urgent fasciotomy of the affected leg by the orthopedic surgeons with input from plastic surgeons. She made a steady but full recovery and was discharged home later.
Conclusions: Compartment syndrome is a rare complication of IO access (0.6%) 1. Careful monitoring of the IO site is recommended. It is advisable to remove the IO needle once a definitive IV access is established.
1. Complication with Intraosseous Access: Scandinavian Users' Experience. Hallas et al. West J Emerg Med. 2013 Sep; 14(5): 440–443.
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Immunization coverage among children 12–23 months of age and reasons for non-immunization, Bahr Alarab Locality, East Darfur State, 2015
المؤلفون: Tawfeeg Hassan AliBackground: Vaccine preventable diseases continue to kill large numbers of young children each year UNICEF estimates that 1.2 million deaths to children under five years of age could be prevented at low cost by vaccinating children. For example, it is estimated that measles related deaths have been reduced from about 2.5 million per year in 1980 to less than one million in 1990 (2)-a decline of more than 60 percent during the decade of the 1980s.
Purpose: Vaccinations are one of the most cost effective means to reduce morbidity and mortality associated with infectious diseases. The introduction of the vaccine has led to nearly a 90–100 percent reduction in target disease morbidity and mortality.
Methods: The information was collected used adopted WHO cluster survey 210 children to satisfy the research objectives_30 clusters with respondent in each were randomly chosen.
Findings: The result obtained showed that: Percentage of coverage with the BCG the number of vaccinated children by card (143) and from memory (12) with total percentage 74% and non-immunized (55) 26% for Penta3 and OPV3 the coverage was (57%) and the PCV3 coverage was (71%). The major reasons for non-immunization were unawareness of need for immunization or not able to return back to the second or third doses because of long distance and finance constrain. The study recommended that Strengthen social mobilization to increase routine immunization coverage and screening of defaulter children during the campaigns besides spending more efforts to decrease the dropout rate.
Conclusion: Darfur conflict during last decade, leads to massive population movement (nomads – refugees) that can threat the coverage all targeted children and reach every area but EPI in Sudan do effort to cover all population during campaign and routine immunization.
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Carbamates are not cardio mate
المؤلفون: Ahmed Ebrahim, Galal Alessai, Rana Jaafar, Robert Hoffman and Sameer PathanIntroduction: The mechanism for carbamate toxicity is reversible cholinesterase inhibition, which leads to accumulation of acetylcholine at the neuromuscular junction.1 The cardiac manifestations of carbamate toxicity are rare. We report a case of carbamate toxicity with atrial fibrillation as the cardiac manifestation.
Case presentation: A 28-year-old patient, previously healthy, presented to the ED complaining of diplopia, dizziness, palpitation, and one episode of vomiting. The symptoms began two hours before when he was spraying pesticide at a farm. According to the patient he sprayed 9 liters of pesticide over a short period of two hours. The patient was not using any personal protective equipment. The pesticide used was later identified as Lannate, which contain Methomyl (carbamate). On examination, a chemical odor was noted. His initial vital signs were normal except heart rate of 134/min. The patient was decontaminated in the decontamination room to avoid further exposure. He had constricted pupils of 2 mm. There were no other signs of organophosphate or carbamate toxicity. His initial ECG showed atrial fibrillation (AF) with fast ventricular response rate. The pseudo-cholinesterase level was. The toxicology service was consulted, and they advised not to start antidote treatment only for the AF, as other signs and symptoms were absent. The cardiology on call assessed the patient and started amiodarone infusion presuming new onset of AF. The patient's rhythm reverted back to sinus 12-hour post-presentation. He was discharged next day with a diagnosis of paroxysmal AF secondary to carbamate poisoning.
Discussion: AF in carbamate toxicity is rare and only few cases have been reported in the literature.2,3 It is postulated that, enhanced nicotinic activity stimulates postganglionic sympathetic terminals and produces a dramatic release of norepinephrine.4 Norepinephrine mediates its arrhythmogenic effects by increasing automaticity of cardiac cells and by decreasing the cardiac muscle fibrillatory threshold.5
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Trends of the management of acute meningococcal septicaemia in Al-Nasser Paediatric Hospital, Gaza, Palestine
المؤلفون: Nabil M.A Al Barqouni, Awni Al Shorafa, Belal Dabour and Loai N AlbarqouniBackgrounds: Infection with Neisseria meningitides can produce a variety of clinical manifestations. Mortality and long-term morbidity can be very high in patients with invasive meningococcal disease if the infection is not treated appropriately. Our main objective was to evaluate mortality of all children admitted with acute meningococcal septicaemia (AMS).
Methods: We conducted a retrospective study of all paediatric-cases of acute meningococcal septicaemia admitted to Al-Nasser Paediatric Hospital, the largest paediatric hospital in Gaza Strip, between January-2009 and September-2015. All AMS cases were diagnosed based on the clinical presentation, skin smear and blood culture. Outcome measures were predicted mortality using Paediatric Risk of Mortality score III (PRISM III), actual mortality and standardised mortality ratio.
Results: A total of 240-children were admitted with proven AMS. Aged range from 1-month to 12-years, and 113 of them (47%) were male. The number of admitted children with AMS was decreased from 47–59 cases/year in the 2009–2011 period to 21–22 cases/year in the 2012-201. The total mortality predicted by PRISM III was 25.56%, however the actual overall mortality was 49 children (20.8%): 16(48.5%) aged less than-a-year, 17(22.1%) 1–3 year-old, 9(18.8%) 3–5 year-old and 7(8.5%) 5–12 year-old (p value = 0.00299). Standardised mortality ratio was 0.814. Forty-one children (82%) were died within the first 24-hours of admission. Sixty-nine (28.8%) children received corticosteroid, 85(35.4%) received inotropic medications and 46(19.2%) required mechanical ventilation for a median of 24-hours. In 75(31.3%) children, AMS was associated with meningitis. Multi-organ failure (n = 22, 9.2%) was the most common complication, followed by skin necrosis (n = 13, 5.4%), convulsions (n = 13, 5.4%), and disseminated intravascular coagulopathy (n = 10, 4.2%).
Interpretation: The mortality rate of the disease still high, however, this can be explained by the high predicted score of mortality, which reflect the severity of admitted cases. The mortality was significantly associated with younger age-group. New model of treatment (e.g. plasmapheresis) may be useful in decreasing mortality.
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Preparing for infectious disease threats at FIFA sporting events: What Qatar should learn from the available practices?
Background: Qatar is about to host the 2022 FIFA World Cup-WC, this can stress the public health system and resources of Qatar as hosting country. Reducing public health risks and ensuring people's safety at The Qatar 2022WC requires thorough planning and coordination. The aim is to obtain a comprehensive insight into the available practices concerning the infectious diseases preparedness and response for major Sporting events and to advise Qatar W.C-2022 health committee accordingly.
Methods: A desk review of WHO literature in public health considerations during mass gatherings was done, with particular focus on the Communicable Disease alert and response for mass gatherings.
Results: The literature suggests certain critical factors and preconditions for success that are common to most events as well as strategic, organizational, and tactical lessons learned that can be applied for Qatar WC 2022 includes, Comprehensive risk assessment should be conducted before the event, this will allows planners in Qatar to reduce the risk of communicable disease outbreaks associated with WC2022. Plans for risk management and risk communication need to be developed. New surveillance system should be in place for a sufficient length of time prior to the WC and this surveillance need to be divided into three phases, Pre-WC surveillance, WC-based surveillance and Post-WC surveillance.
Conclusion: The challenge for Qatar is to recognize the possible benefits from the outset of planning for the coming 2022WC and to build a positive and Strategic approach to communicable diseases issues into the earliest stages.
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Evaluation of an intervention to decrease false positive blood culture contamination rates in Emergency Department
المؤلفون: Parvathy VenugopalBackground: The HGH Microbiology lab indicator showed that our blood culture contamination rate has been consistently higher than the international benchmark thereby we aim to reduce it in the critical area of Emergency Department by 50% by the end of July 2015 and at least 90% by end of February 2016.
Methods: A pilot area was chosen in the Emergency Department to do a study for 44 weeks after which blood culture kits (previously trolleys & trays were used) containing sterile gloves, masks, and blood culture supplies were introduced into the Critical area of ED-HGH in August 2015. Training included- new instructions to have two staff members present when drawing blood cultures (preceptor-preceptee methodology) thereby prohibiting drawing blood cultures from pre-existing lines and proper follow-up of every step. False positive blood culture rates were measured in the weeks preceding and the weeks following, this intervention.
Results: In the 8 weeks following the intervention, the average false positive blood culture contamination rate in HGH ED reached 1.9% (which was the benchmark) out of 318 blood culture samples. In the 6 months preceding, the blood culture contamination rates ranged from 4% to 1.5% each month.
Conclusions: Blood culture kits and educational training on proper technique resulted in significant reduction (>60%) in the false positive blood culture rate in the Critical areas of ED-HGH. Studies at other institutions have suggested that reducing the false positive blood culture rate could decrease costs by preventing unnecessary hospitalizations and administration of unnecessary antibiotics, as well as helping to prevent the development of multi-drug resistant organisms. 0000-0003-0866-6512 0000-0002-1057-2438.
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Pediatric parapneumonic effusion and empyema - Criteria to predict the need for surgical intervention
To assess if stratification of patients based on clinical severity, laboratory markers and radiological findings at presentation would enable better prediction for the need for a surgical intervention. Single-centre retrospective cohort study done in the in-patient pediatric wards of a tertiary care centre in the State of Qatar. Participants – 56 children (aged 6 months – 14 years) with empyema or parapneumonic effusion, from July 2009- June 2013. Patients were classified into mild and severe clinical presentation based on the 2011 British thoracic society (BTS) pneumonia guidelines. Interventions were categorized as conservative (antibiotics only), non-conservative (antibiotic and surgical intervention). The values of CRP, ESR, WBC count, upon admission and follow up were also assessed, along with pleural fluid markers such as LDH, glucose and PH. The chest X-ray and chest USG were also assessed for severity and loculations. Of the 56 patients included, 29 (52%) had severe and 27 (48%) had mild clinical presentation. 26 patients (46.4%) were managed conservatively, while 30 patients (53.6%) required intervention. Younger patients (3.8 ± 3 years) tend to have increased risk for intervention, severe clinical presentation and loculations on USG. Age ≤ 5 years, severe clinical presentation, serum WBC count ≥ 20,000/mm3, ESR ≥ 80 mm/hr, serum CRP ≥ 100 mg/dl, moderate to severe effusion on chest radiograph and presence of loculation on USG individually increased the likelihood for a surgical intervention in pediatric patients with parapneumonic effusion. Having ≥ 4 out of 7 criteria accurately predicted a high risk for the need for surgical intervention (OR-6.93, 95%CI-1.2-37, p-0.023, sensitivity 72%, specificity 73%). Having ≥ 4 out of 7 criteria accurately predicted a high risk for the need for surgical intervention. Prospective trials are recommended to see if this would enable homogeneity in deciding when to intervene in patients with parapneumonic effusion thereby reducing the LOS and cost-burden on the healthcare system.
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Does knowing hands only CPR improve willingness to use it?
المؤلفون: Edward Kakish, Jessica M Debelly, Nael L Bahhur and Viviane M KazanBackground: Approximately 1,000 U.S. citizens suffer from sudden cardiac arrest daily outside of the hospital setting. Providing cardiopulmonary resuscitation (CPR) improves survival if appropriately administered; however, many are resistant to initiate mouth to mouth. Hands only CPR (HOCPR) was developed by the American Heart Association to improve technique retention and increase the willingness to administer CPR.
Methods: Participants watched a teaching video from the American Heart Association, followed by a mannequin demonstration. Participants then filled out a survey immediately after practicing HOCPR on the mannequin and at one month.
Results: 75 Subjects received HOCPR training and completed a survey and 44 (59%) of the subjects completed a one month follow-up survey. The initial survey revealed that 100% (n = 75) were able to correctly recall the HOCPR process and 79% (n = 59) were very likely to provide HOCPR to a person suffering from a cardiac episode. 76% (n = 57) were more willing to assist a person in need as a result of not having to provide breathes to the person in need. At the one month follow-up, 100% (n = 59) of the respondents remembered the order of steps and 73% (n = 32) were willing to provide HOCPR since no rescue breathing was required. After learning the material, 15% (n = 11) of the participants tried to teach their family and friends about HOCPR.
Conclusion: HOCPR is a simple method which the average person is able to recall after a brief training in proper technique. Subjects were more willing to provide HOCPR and teach family and friends.
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Analysis of dengue surveillance data in Punjab, Pakistan, 2013
المؤلفون: Asim AltafIntroduction: 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.
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Review: Injury Severity Score (ISS) >15 in trauma units within the South West London and Surrey Major Trauma Network
المؤلفون: Christopher Francis Baron and Suresh KumarBackground: In April 2014, the South West London and Surrey Major Trauma Network entered its 4th year as an operational network, consisting of one Major Trauma Centre (MTC) and 7 acute Trauma Units (TUs) over a wide geographical area. In the year ending March 2014, 75% of the major trauma patients were taken to the MTC. However many patients with ISS >15 were admitted to TUs. Regular governance meetings are key to ensure these patients have received an appropriate level of care.
Case description: A service evaluation of care provided under governance framework, using the ISS as a guideline, was carried out. Patients who sustain traumatic injuries are managed in accordance with the Major Trauma Clinical Standards, the Trauma Audit and Research Network (TARN) measurable quality indicators and Trauma Quality Network System (TQuINS) recommendations. Available data indicates that there is a possibility that patients who present to a TU rather than a MTC may receive less than optimal care. In order to mitigate this difference it is necessary to have a governance system to ensure the patient care is optimal.
Methods: A proforma was developed for data collection with key trauma measures as quality indicators and the results collated in an Excel spreadsheet. A standard operating procedure and flow chart processes were developed to review major trauma cases. The TARN Office identified suitable patients and a multidisciplinary team reviewed the notes. Issues with care were formally registered with trust incident reporting system and registered in the trauma risk register. Findings were presented in the trust audit study day, in the Trust governance committee and disseminated for development.
Conclusions: Initiating a robust governance system and process will minimise substandard care and help standardise care across the network.
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Creating a sustainable mission
المؤلفون: Kristopher Brickman, Tyson Ramsey, Brianna Crosby, Viviane Kazan and Edward KakishBackground: Medical missions have become a part of the Global Health Programs at many academic institutions. Commonly these programs involve annual trips to locations in the United States and around the world. The University of Toledo Medical Center (UTMC) sought to develop a sustainable mission that has educational and clinical value to both the local community and academic institution.
Methods: The Department of Emergency Medicine at UTMC has worked with Salud Total, a small health clinic in La Ceiba, Honduras. Salud Total is staffed by a general practitioner, nurse and ancillary staff. During a mission the clinical volume increases over 100 patients a day. UTMC staff and senior ED residents see general medical complaints and perform small surgical procedures. Specialists, such as cardiologists and obstetricians see those needing specialty care. Education is provided in the form of bedside clinical teaching and materials distributed to staff and patients.
Results: This mission has provided clinical services to an underserved population, providing specialty medical care that otherwise was unavailable to these patients. Returning every 3 to 4 months allows the mission team to follow-up on treatment or procedures initiated on prior visits and provides the opportunity to advance clinical care through ongoing teaching and education.
Conclusions: Through our approach, we have enhanced clinical capabilities, increased the knowledge and skill set of the local practitioner as well as provided education to the patient and local community. Future expansion involves incorporation of telemedicine to provide real-time support for this clinic population and medical staff.
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Case report: Gallbladder volvulus
المؤلفون: Razana Verupurath MohammedIntroduction: Gallbladder volvulus is a rare entity, with a predilection for elderly women in their 7th or 8th decades of life. The condition results in rotation of the gallbladder on its mesentery along the axis of cystic duct and artery. Presence of redundant mesentery is a prerequisite. The disease is a frequent mimicker of acute cholecystitis, often difficult to diagnose preoperatively. Till date only about 300 cases have been reported in the literature, with children and adolescent presentations being exceedingly rare.
Case description: We report a case of an 18-year-old female who presented to emergency with right upper quadrant pain for a day associated with repeated vomiting. The patient was stable, had tenderness in right hypochondrium. Patient was evaluated as a potential case of acute cholecystitis. Laboratory investigations have shown normal white cell count, double normal liver function tests. Ultrasound showed that the gallbladder was out of the fossa with significant edema and wall thickness suggestive of gallbladder torsion. Further workup with MRCP was done, which showed retrohepatic gallbladder, with partial volvulus and hemorrhagic acalcular cholecystitis. The patient underwent laparoscopic detorsion and cholecystectomy and had an intraoperative evidence of gallbladder volvulus with gangrene with an uneventful course of hospital stay.
Conclusion: We believe that this may be the first documented case of this rare condition from Qatar. Gallbladder volvulus mostly occurs in elderly, but it might occur in young patients as well and should be included in differential diagnosis of abdominal pain. Ultrasound is a safe, feasible diagnostic tool, as sensitive as MRI in diagnosis of gallbladder volvulus.
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Diagnostic value of procalcitonin and other related inflammatory markers for severe sepsis and septic shock: A single tertiary center experience
المؤلفون: Abdel-Naser Elzo, Saibu George, Merlin Thomas, Sumaira Rafiqui, Karen Desouza and Muna Al-MaslamaniBackground/objective: Several inflammatory biomarkers of infection including procalcitonin (PCT) and C – reactive protein (CRP) have been shown to be useful in diagnosis of infection in different clinical settings. The purpose of this study was to determine the diagnostic value of serum PCT, CRP and White Blood Cells (WBC) as markers of sepsis in critically ill patients in Qatar.
Materials and methods: The PCT levels and other related inflammatory markers (CRP and WBC) were measured in 137 adult patients with a suspected diagnosis of sepsis and admitted to Internal Medicine inpatient service (i.e., Medical Wards and Medical Intensive Care Unit) at Hamad General Hospital, Hamad Medical Corporation-Qatar during the period from January 2011 to December 2013.
Results: The serum PCT was measured by chemoluminiscence immunoassay and the results were compared with other inflammatory markers between the patients with and without proven sepsis. A significantly higher PCT level was observed among patients with severe sepsis and septic shock compared to those without sepsis (19.34 ± 50 and 25.91 ± 61.3 vs. 4.72 ± 10, respectively; (p = 0.011). No significant differences were found in CRP and WBC between these groups. Non-survivors of both septic and non-septic groups had a mean PCT level of 22.48 ± 8.26 significantly higher than that measured in survivors of both groups (p = 0.01), a difference not evident in other inflammatory parameters.
Conclusion: PCT is a highly efficient inflammatory laboratory parameter for the diagnosis of severe sepsis and septic shock but WBC and CRP levels were of little value. PCT value assists in diagnosis of septic shock hence supporting appropriate disposition of patients. Levels of PCT also have prognostic implications with regards to mortality suggesting intensification of antibiotic therapy and supportive measures including appropriate family counseling.
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Public health emergency: Review on cholera preparedness and response Sudan, 2015
Background: The last cholera epidemic in Sudan occurred in 2006/07, over 20,000 cases (4% case fatality rate) were recorded, index case was coming from South Sudan. In regard to recent outbreak in South Sudan June 2015, Sudan carried out preparedness procedures to prevent cholera spread. The uncontrollable open borders and the South Sudan refugees-over 198,000 – settled in Sudan poses a great cholera spread risk.
Objective: To illustrate cholera preparedness and response activities.
Methods: Comprehensive study utilize data collected from reports of cholera higher committee, investigation for cholera rumors, risk assessment missions for refugee camps and preparedness strengthening missions to States bordering South Sudan.
Findings: Higher committee was developed to undertake and follow preparedness activities under areas of surveillance, health promotion, environmental health, case management and points of entry (POE). Surveillance system was enhanced in all sentinel sites (1522) including refugee camps, daily zero reports were activated. Training for Rapid response teams and health cadres at hospital were achieved in all States with (70%) of the target. 39 rumors for cholera were investigated, laboratory test indicated negative results. Regarding case management; Cholera kits, protocols and leaflets were distributed to all States, isolation areas were established in Khartoum and bordering States. Preventative precautions at POE were implemented to rehabilitated isolation area at Khartoum airport and establish case referral system. Trips coming from South Sudan were observed throughout the period of the outbreak and leaflet distributed to passengers Actions were carried out urgently to allow chlorination of water in all States and provide deep trench latrines with 50% of target with focusing on refugee camps. Administration of cholera vaccine recommended by WHO assessment mission at refugee camps.
Conclusion: Significant government and partners commitment to avail resources was observed. Efforts done lead to reduce possibility of cholera spread especially at refugee camps.
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Evaluation of multiple trauma patients presenting to Emergency Department at Al Wakra Hospital
المؤلفون: Hanaa Ahmed Abdelrahman Osman, Hany Abdelazia, Ahmed Gouily and Muayad KasimBackground: Multiple trauma patients are evaluated and managed by the Emergency Department (ED) in Al Wakra. The assessment, management, and disposition of this population have become a significant workload component. The aim of this study was to evaluate the trauma service at Al Wakra ED.
Methods: In our study, we aimed to collect data on the trauma patients, admitted between July 2014 and October 2015, who presented to the ED, at Al Wakra Hospital, and then transferred to the major trauma unit at Hamad General Hospital (HGH), Doha, if further subspecialty management was needed. The data analyzed was for demographic characteristics, triage categories, and need for transfer to the level one trauma center for further management.
Results: Total of 59 patients with multiple trauma were admitted to Al Wakra ED, with mean age of 28 ± 19 years. Of these 91% were male. Based on the trauma severity, majority of the cases were level 2 trauma (92.73%), while trauma level 1 and trauma level 3 were (5.45%) and (1.82%) respectively. The most frequent anatomical type was head trauma (62.71%) followed by extremities trauma (33.9%). Other types included chest trauma (23.73%), spinal trauma (18.64%) and abdominal trauma (15.25%). The most common consultation services requiring transfer to level trauma center at HGH, were the neurosurgery (59.32 %) followed by the orthopedics (33.9%). It was found that 61.2% of the patients were admitted. The mean length of stay (LOS) was 8.35 days, while the median LOS was 4 days.
Conclusions: The Emergency Department at Al Wakra Hospital was able to receive and do the initial stabilization of multi-trauma patients. However, lack of certain sub-specialties mainly neurosurgery required transfer of two thirds of the patients to level one trauma center for further management. This may point to the future need of implementing neurosurgery services at Al Wakra Hospital.
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Viral hepatitis C serological and behavioral survey among single male laborers in Qatar
Background: Hepatitis C viral infection is a public health concern worldwide and a major cause of morbidity and mortality in several countries that supply the State of Qatar with many of its laborers. The objectives were to measure the prevalence of hepatitis C viral infection among single male laborers; detect the practices that may catalyze the spread of the infection; and assess the knowledge gap.
Methods: A cross-sectional study was conducted in 2014 and involved 504 expatriate single male laborers seeking health care in two Qatar Red Crescent health centers.
Results: Results showed that only 5% of the total participants have ever been tested for hepatitis C and positive serology was detected in 4 respondents (0.8%), three of them from Egypt and one from Nepal. Three out of the 4 positive cases did not know they were infected and 2.5% lived with someone harboring the infection. Respondents appeared to have varying healthcare needs with 57% subject to medical procedures outside Qatar. Various risk practices for hepatitis C infection were reported including ear/body piercing (21.9%), tattooing (13.3%), contact with blood (17.0%), sharing personal equipment (12.2%) and injecting with used needles or syringes (7.4%). Less than 40% of respondents had knowledge of all modes of hepatitis C transmission.
Conclusion: Further actions notably building HCV monitoring system, setting a prevention plan, building screening strategy were need to be complemented by a contract renewal or a 3-year screening policy.
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Forty-eight hours return visits at Hamad General Hospital Emergency Department on January 2015
المؤلفون: Mohamed E. Abbasy, Salem Abosalah, Aboubakr Mohamed Awad Mohamed, Adel Zahran Tqm, Ahmed Felaya, Ahmed Alaa Awad, Amr Elmoheen, Ayman M. Hereiz, Besma Ayari Ep Issaoui, Ehab Badawy, Mahmoud Saqr Ebeem, Mohamed Fawzy Elsayed Ebem, Mohamed Qotb Ebem, Mohamed Sultan, Rana Jaffer, Ramy Abdelkader Ebem Tq and Sherif AlkahkyBackground: Hamad General Hospital (HGH) Emergency Department (ED) provided 465,942 patient visits in 2014. (ED) use has increased annually resulting in overcrowding, longer wait periods for service and increased stress on health care workers. Much attention has been paid to factors contributing to this increased usage such as the return visit of an (ED) patient within 48 hours of the initial visit. 48 hours is the benchmark time period used in measuring (ED) return visits utilized by many countries and it became a mandatory quality indicator of performance by the Supreme Council of Health in Qatar on April 2015. This study was conducted to identify factors associated with scheduled and unscheduled 48 hours return visits to serve as a basis for a Quality Improvement Project (QIP) for development of interventions to decrease unscheduled returns.
Methods: An exploratory quantitative study using a descriptive correlational design was performed. The sample consisted of all patients had a return visits to (ED) within 48 hours from the discharge time during January 2015 at the study facility. Data were abstracted from electronic patients’ records utilizing the data collection tool, all electronic records was reviewed by experienced emergency physicians.
Results: For the study month of January 2015 there were 1023 return visits within 48 hours from the discharge time (2%) out of 42981 (ED) patients. 906 visits (89%) was unplanned out of them 102 visits (11%) was clinically significant. 85 cases(9%) were admitted on the return visit and we had no mortality cases. Abdominal pain was the main presenting complaint (28%) of all revisits followed by musculoskeletal pain (13%) for patients whom presenting with the same complaint.
Conclusion: Abdominal pain is the most frequent complaint associated with unscheduled return visits. Further Study is important to design and implement interventions to decrease the frequency of unscheduled returns.
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Physician's perspective on point-of-care ultrasound: Experience at a tertiary care emergency department in Qatar
المؤلفون: Sohaib Chaudhry, Khalid Bashir, Israr Bashir and Peter CameronBackground: Point-of-care ultrasound is an invaluable tool in the diagnosis and management of many conditions presenting to emergency departments across the world. It has also improved the success rate of invasive bedside procedures.
Objectives: This study aimed to investigate the current utilization of point of care ultrasound in a large tertiary care emergency department in the Middle East and to identify barriers to its utilization.
Methods: A cross sectional survey of emergency physician's experience with ultrasound was conducted, examining training, exposure and barriers to use. This paper-based survey was completed by the participants in the presence of study authors to improve compliance. Data was collected over a period of two months, from October to November 2014.
Results: One hundred and five (105) physicians participated in the survey. Fifty-six physicians had prior training in ultrasonography from courses approved by The Royal College of Emergency Medicine in the United Kingdom, and The Royal College of Physicians and Surgeons of Canada. Twenty-two physicians had undertaken other non-accredited ultrasound courses. All of them reported an improvement in their procedural skills by employing ultrasound. Perceived lack of time in the Emergency Department was the main barrier to scanning. Other hurdles included a deficiency of trained personnel for guidance, shortage of equipment and a lack of experience and interest. Hands on training were stated as the preferred method for enhancing ultrasonography skills.
Conclusions: There has been underutilization of point-of-care ultrasound by emergency physicians. Availability of dedicated time, equipment, supervision and training will help to increase its usage.
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Patients who leave without being seen: Al Wakra Hospital experience and analysis of associated factors
Background: The rate of patients who arrive at the Emergency Department (ED) but leave before being seen (LWBS) is considered an important marker of the quality of care.
Objectives: To evaluate the rate of LWBS at ED in Al Wakra Hospital (AWH) and to identify predictive factors associated with LWBS.
Methods: This was a retrospective study of patients who left the Emergency Department without being seen by physicians between January 1, 2015 and May 31, 2015. Factors associated with LWBS such as the age, sex, time of the day, day of the week, median ED waiting times and common ED presentation were analyzed.
Results: Out of 95,375 patient visits; there were 426 cases of LWBS over the 5-month period. The highest rate of LWBS was seen on the month of March. Independent factors associated with LWBS patients include patients who are middle age (19-43 years), female (56%), and patients being presented at non-critical areas (100%), night shift visits (46%), on weekend (52.8%). Musculoskeletal complaint was the most frequent complaint associated with LBWS (31%) and the median waiting time was 45 minutes among LBWS patients.
Conclusion: The rate of patients leaving without being seen at ED in AWH is very low. More investigations need to be conducted to improve LWBS rate during night and weekends.
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An overwhelming post-splenectomy infection (OPSI)
المؤلفون: O Elbadawi, SR Ali, A Waheed and S Khan
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