Pre- and apnoeic high-flow oxygenation for rapid sequence intubation in the emergency department (the Pre-AeRATE trial): A multicentre randomised controlled trial

INTRODUCTION@#Evidence regarding the efficacy of high-flow nasal cannula (HFNC) oxygenation for preoxygenation and apnoeic oxygenation is conflicting. Our objective is to evaluate whether HFNC oxygenation for preoxygenation and apnoeic oxygenation maintains higher oxygen saturation (SpO2) during rapid sequence intubation (RSI) in ED patients compared to usual care.@*METHODS@#This was a multicentre, open-label, randomised controlled trial in adult ED patients requiring RSI. Patients were randomly assigned 1:1 to either intervention (HFNC oxygenation at 60L/min) group or control (non-rebreather mask for preoxygenation and nasal prongs of at least 15L/min oxygen flow for apnoeic oxygenation) group. Primary outcome was lowest SpO2 during the first intubation attempt. Secondary outcomes included incidence of SpO2 falling below 90% and safe apnoea time.@*RESULTS@#One hundred and ninety patients were included, with 97 in the intervention and 93 in the control group. Median lowest SpO2 during the first intubation attempt was 100% in both groups. Incidence of SpO2 falling below 90% was lower in the intervention group (15.5%) compared to the control group (22.6%) (adjusted relative risk=0.68, 95% confidence interval [CI] 0.37-1.25). Post hoc quantile regression analysis showed that the first quartile of lowest SpO2 during the first intubation attempt was greater by 5.46% (95% CI 1.48-9.45%, P=0.007) in the intervention group.@*CONCLUSION@#Use of HFNC for preoxygenation and apnoeic oxygenation, when compared to usual care, did not improve lowest SpO2 during the first intubation attempt but may prolong safe apnoea time.

Evaluation of hearing impairment in children of school going age

The timely identification of severity of hearing loss in school age children will decrease the morbidity and this morbidity can be corrected by timely treatment. Community-base cohort study. This study was conducted in ENT department of Abbasi Shaheed Hospital, KMC,Karachi from January 2011 to Jan 2012. The suspected cases were referred to the ENT department of Abbasi Shaheed Hospital adjoining schools and suspected cases of hearing difficulty noticed by the parents. After taking informed consent from both sexes and age ranges from 6-16 years were included in the study. This study shows male were slight more 54 patients. Highest number of patients was found in 13 years of age 16 patients i.e 16%. In 53 patients risk factor was present. Maximum number of children had moderate hearing loss 26 children [26%]. Early school going child with mild to moderate hearing loss is difficult to detect during routinr examination. Audiological screening is necessary for detection of hearing loss in early school going child

Pathological findings of chronic supparative otitis media in tertiary care hospital

Objectives: To see the clinico-pathological pattern of findings in the chronic supparative otitis media [CSOM] during surgery

Study Design: A prospective observational study

Place And Duration: This study was conducted in Karachi Medical and Dental College and Abbasi Shaheed Hospital during the period of October 2006 to October 2010

Methodology: For this study, 288 patients were selected. After complete history, examination and relevant investigations surgery was performed and intra-operative findings of middle ear cleft were noted

Results: Total number of patients selected were 288, in which female were dominating slightly with 54.1%. Maximum incidence was noted between the ages of 16-30 years of age in 180 patients [62.5%]. 140 cases [48.61%] had no ossicles damage while 148 cases[51.38%] had one or more ossicles damage. Granulation tissue found in 99 patients [34.37%], while cholesteatoma found in 77 patients [26.73%]

Conclusion: Pathological changes varies from simple mucosal edema to extensive destruction of the middle ear cleft

Sleep quality among university students in the UAE

Identify the factors affecting quality of sleep, and assess the impact of low quality sleep on the daily activities of students. A descriptive, cross-sectional survey was done, using self-administered questionnaires. Sleep quality was assessed using the Pittsburgh Sleep Quality Index [PSQI]. Data was collected, sleep quality was determined, and then data was analyzed using SPSS v.17 software. This study included 290 university students of different majors aged 17-29 years. Analysis of sleep perception revealed that 67.2% of students suffered from poor sleep. Non-smokers showed a better sleeping quality [25%] than smokers [75%]. Of the students who never missed any class 62% had a good pattern. Non-users of social networking, such as Facebook, MSN, and twitter, had a better sleep than users. Poor sleep quality was strongly associated with higher anxiety level [p<0.001], and more morning classes missed [p<0.014]. Most university students suffer from poor sleep quality which is directly influencing their behavior and anxiety levels

Knowledge, attitude and practice study on breastfeeding among mothers in Ajman, UAE

Assess the knowledge, attitude and practice of breastfeeding among women attending the Gulf Medical College Hospital and Research Center in Ajman, UAE. A cross sectional study was conducted between February 2012 and April 2012. The study included 332 mothers who had at least one child under 5 years of age and who attended GMCHRC during the study period. A validated, pilot-tested, self-administered questionnaire was used which included statements dealing with information on knowledge, attitude and practice of participants with regard to breast feeding in addition to demographic data. To assess knowledge and attitudes of participants, the percentage of correct responses for each question was considered. Inadequate knowledge [gap in the knowledge] or attitude was identified if <60% of participants had correct response for each question. Data were analyzed using the SPSS software version 19. Chi square test was done to find the significance of association between variables with less than 0.05 level of significance. adequate knowledge about most of breast feeding facts and benefits was identified, except for the statements that lactation helps losing weight that was gained during pregnancy, the hormones released during breast feeding help in bringing back the uterus to its normal physiology after child birth, and the ideal duration of excusive breastfeeding is six months. More than 60% of the participants responded positive to all attitudes questions except to one on their willingness to attend classes for education on breast feeding [77.9% of the participants did not want to attend]. Only 46% of the participants exclusively breastfed their babies in the first six months. Higher proportion of women who had received antenatal education during their pregnancy exclusively breast fed their babies, but the association was not statistically significant. A higher frequency of exclusive breastfeeding was observed with low parity. Higher frequency of breast feeding was noticed among women who had not experienced any difficulties in breastfeeding [P>0.05] and who had not sought medical advice on problems during breast feeding [p<0.05]. Family and friends were identified to be the main source of information with regard to breastfeeding [reported by 74.7%]. Participants had adequate knowledge with regard to the benefits of breast feeding and those who received antenatal education practiced exclusive breast feeding. For the majority the source of information was family and friends

Bone mineral density of patients attending a clinic in Dubai

The study was conducted to assess the frequency of osteoporosis and to test factors that can have relationship with BMD. A cross sectional study was done during the period from October 2011 to February 2012. Adults [age >20 years] who attended an osteoporosis clinic in Dubai were included in the study. A validated pilot-tested questionnaire was used as a tool for data collection. The questionnaire included statements on history of chronic diseases, and participants' habits related to smoking, exercise, and intake of calcium supplementation, in addition to demographic data. Bone Mineral Density [BMD] had been assessed at the left proximal femur using dual energy x-ray absorptiometery [DXA]. The results of DEXA were taken from the participants' records and included in the analysis. WHO criteria were used to classify patients into normal BMD, osteoporosis and osteopenia. Analysis was performed with the use of SPSS software version 19, and Chi-square was done to test the association between variables. P values <0.05 were considered significant. Of the 135 participants, 54.8% [n=74] were males and 45.2% [n=61] were females. The frequency of normal BMD, osteopenia and osteoporosis was 37.8%, 43.7%, and 18.5% respectively. The frequency of osteoporosis among age groups <50 years, 50-59 years, and >/= 60 years were 2.6%, 12.7% and 57.7% respectively. Osteoporosis was more common among females [21.3%] than among males [16.2%], and among smokers [35.7%] than non- smokers [14%]. A lower frequency of osteoporosis was noticed among patients taking calcium supplements of doing exercise compared to those who were not having these life styles [10.8% vs 27.9%] and [8.8% vs 25.3%] respectively. A significant association was found between BMD and age [<0.001], history of renal diseases [<0.001], history of calcium supplement intake [p<0.001], exercise habit [p<0.05], and smoking habit [p<009]. The frequency of osteoporosis was 18.5%, and it was most common among the older age [ >/= 60 years] participants [57.7%]. Bone Mineral Density [BMD] was significantly associated with age [p<0.001], history of calcium supplement intake [p<0.001], exercise habit [p<0.05], smoking habit [p<0.01] and history of renal diseases [p<0.001]

Prevalence of sports injuries among high school students in United Arab Emirates

The study intended to assess the prevalence of sports injuries among high school students. This cross sectional study was carried out using data from 300 students aged 9 to 18 years at Dubai International School and Universal American High School, UAE. A self-administered questionnaire was employed with open- and close-ended questions to collect the data. Data was analyzed using SPSS software version 19.0 and Chi-square test was applied to find the association between variables. The study population included 43.7% males and 56.3% females. Most of the students [74.3%] belonged to 13-15 year age group. More than half the respondents [58.3%] were in Grade 9. Over half the students [67.6%] had been injured during sports activities, the most common type of injury was sprains [34.5%]. Chi square test showed a significant association between history injury and participation [p<0.03]. Upon being injured medical treatment [66.7%] had been used as the most common option among the students. Sports injuries are common among the high school students. Therefore, awareness of possible sport injuries should be included in the school health programs

effects of physical exercise on mental health among adults in Ajman, United Arab Emirates

To study the frequency of anxiety, depression amongst those who exercise regularly and those who do not. A cross-sectional study was conducted in different gyms and health clubs in Ajman during March 2012. A self-administered questionnaire was completed by 350 people aged 18 to 65 years selected using a convenient sampling technique. Females [55.0%] are more likely to be anxious than men [46.4%]. Females [39.9%] are also more likely to be depressed compared to males [26.4%]. Chi square test showed anxiety levels were significantly increased in non-exercisers compared to exerciser [p value <0.015. Individuals that exercised had a lower prevalence of depression [28.9%] than non-exercisers [41.8%]. Physical exercise activity was significantly associated with decreased anxiety level and decreased depression. Results suggest the need for educating on the positive health effects of exercise

Complications of diabetes mellitus encountered in a tertiary care hospital in Ajman, United Arab Emirates

To determine the profile of complications in patients with diabetes in the region of Ajman. Data was collected from GMC Hospital records of patients presenting with complications of diabetes from 1 January 2010-31 December 2010. Data analysis was done on SPSS and Chi square test was done to test associations. Out of 162 patients, there were 15 patients with acute complications of which the most commonly observed was hyperglycemia [69.6%] and there were 90 patients with chronic complications of which CVD was the most frequently [48.8%]. It was also found that the age group with the most cases of acute and chronic complications were 20-39 years [66%] and 40-59 years [55.6%]. 24.7% out of 162 patients had co-morbidities, with the most common being liver disorders, followed by thyroid disorders and anemia. Most patients in our study presented with hyperglycemia and cardiovascular disease, with the former seen most commonly in the younger age group and the latter in the older age group. Also a significant number of patients with complications had high RBG and HbAlc levels. Therefore greater efforts are needed in controlling the blood glucose level in order to prevent long term complications

Prevalence of dysmenorrhea in young women [16-25 years]: a cross-sectional study

To determine the frequency of dysmenorrhea among women in the 16-25 age groups in Ajman. A cross-sectional survey was done in 300 female students from two universities in Ajman United Arab Emirates. The data was collected using a pilot tested, self administered questionnaire. Data was analyzed using the SPSS-19 and is presented mainly as tables and graphs. To verify associations the Chi square test was done. The study found that the prevalence of dysmenorrhea among women within the age group of 16-25 years was 75%. Females with heavy menstrual flow with clots have higher prevalence of dysmenorrhea [91.7%] than women with slight and moderate menstrual flow [69.7%]. The most common symptoms reported by females suffering from dysmenorrhea are mild fatigue, moderate cramps, moderate back pain and mild premenstrual tension. Most common remedies taken for dysmenorrhea were taking rest [13%] and taking over the counter painkillers [41%]. The frequency of dysmenorrhea among women of age group 16-25 was high with three fourth of the study subjects reporting dysmenorrhea. Most common symptoms suffered were cramps followed by back pain and fatigue. Mostly dysmenorrhea was managed with over the counter pain killers

Needle sticks and sharps injury: frequency and awareness among nurses in two hospitals in Ajman, United Arab Emirates

To estimate the frequency of needle stick and sharp injuries [NSSI] among nurses in two hospitals in Ajman and to determine the nurses' awareness about the consequences and precautions regarding NSSI. A cross sectional study was conducted from July 2011 to March 2012 among registered nurses in two hospitals in Ajman, UAE, namely GMC Hospital and Sheikh Khalifa Hospital. A total of 186 respondents filled a self-administered questionnaire regarding their experience in handling needles and sharps and any encounter with a needle stick and/or sharps injury in the years of service in the current hospital. Their knowledge and awareness of consequences and prevention of NSSIs were also assessed. The data were expressed as frequencies and percentages. Out of 186 nurses, 51 [29%] reported NSSIs. 26 [28.3%], were from GMC Hospital and 25[30.5%], were from Sheikh Khalifa hospital. 46 [29.1%], were females, while 5 [35.7%], were males. 28 [54.9%], had reported Needle Sticks and Sharps Injuries, while 23 [45.1%], did not report any history of injury. The most common instrument to cause injury were disposable syringes, 26 [51%], The majority of the nurses attributed NSSI to being rushed 22 [45.8%], and the majority of the NSSIs had occurred in the ward or at the bedside 13[25.5%]. NSSIs are frequent in hospitals in Ajman. Most of these are sustained through disposable syringes, and the nurses perceived that being rushed was the cause. Most nurses understood that infection with HIVAIDS virus, Hepatitis B virus and Hepatitis C virus are possible consequences of NSSIs

Prevalence of urinary tract infections among diabetes mellitus and non-diabetic patients attending a teaching hospital in Ajman, United Arab Emirtaes

To explore the prevalence and determinants of UTI among diabetic and non-diabetic patients attending the Gulf Medical College Hospital and Research Center, Ajman, UAE. Across sectional comparative study was conducted during February and March 2012. 400 adults [aged >20 years] attending the Internal Medicine Department outpatient in GMCHRC [200 diabetes mellitus patients and 200 non-diabetic patients] were included in the study. A validated pilot-tested questionnaire was used as a tool for data collection. A positive association was found between diabetes mellitus and the development of urinary tract infections. Contributing factors that showed a significant association were age >40 years, female gender, lower education level, employment status, poor diabetic control, and age at diagnosis of diabetes [>60 years]. Factors such as diagnosis at older age, poor diabetes control, and socio-demographic factors like age, gender, education, and occupation were significantly associated with UTI

Factors influencing academic performance of second and third year health science students in Ajman, United Arab Emirates

To identify factors influencing the perceived academic performance among second and third year health sciences students in Ajman. A cross sectional study was conducted in Gulf Medical University and Ajman University of Science and Technology during February and March, 2012. Incidental sampling was used in the study. A self-administered questionnaire was completed by 300 students aged 18 to 28 years. The study population comprised 39.3% males and 60.7% females. 54.7% of the students were in the 18 to 20 year age group. 98 respondents were Arabs. 173 respondents were second year health science students, who formed the majority. 38.2% of students who spent more time in academic-related activities were better performers than those who spent less time on these activities [7.9%]. Chi square test showed a p value< 0.00Ion association between time management skill and academic performance, which was found to be significant. Many academic and non- academic factors can influence academic performance by students. Of these factors, time management skill was statistically the most significant factor influencing perceived academic performance. The results suggest a guideline for student counselors and for students to improve or maintain the academic performance of the latter in educational institutions

Comparison of three different ceruminolytic agents [soda-bicarbonate, almond oil and normal saline] with respect to their efficacy

To compare the efficacy of three ceruminolytic agents for cerumen impaction with respect to its ease of complete removal via suctioning or probe. A comparative prospective study. This study was conducted carried out at the outpatient department of ENT, Abbasi Shaheed hospital, Karachi from November 2010 to March 2011. A comparative prospective study of 75 adult patients with cerumen impaction in either or both of the ears carried out at the outpatient department of ENT, Abbasi Shaheed hospital, Karachi. The study was done after taking the consent of the patients. All the adult patients of age 18 years or greater, of either sex with the symptoms in the ear[s] because of cerumen which was hard/dry and difficult to remove were included in the study. Those of age less than 18 years and not having any symptomatology because of the cerumen or with soft wax which was easy to clear were not included in the study. The study was carried out from November 2010 till March 2011. the patients with problematic, difficult to remove cerumen or cerumen impaction with symptoms were divided in to three groups: Groups A, Group B and Group c; all having equal number of cases that is 25 each. In group A they were given soda-bicarbonate in glycerin based ear drops; in group B almond oil and group C the normal saline for instillation in ear. The doses and timings for drops were equal in all the group and it was 3 drops in the affected ear every 6-hourly for 1-week. They were councilled that the dose should not be missed and they have to lay down for 5 minutes so that drops are absorbed and does not come out of the ear. After one week they were called in the OPD, was compared with completeness of removal of impacted cerumen for the three groups. Ease and completeness of cerumen removal was 80% in group A, followed by 60% for group C and 20% for group B. We found soda-glycerin to be superior to almond oil and normal saline as ceruminolytic agent

unusual foreign body in trachea

We report a very unusual case of foreign body [FB] in the tracheo-bronchial tract of a male child, who presented to us in the emergency department at our tertiary care centre with the complaint of FB in throat, cough bouts and choking sensation with pain and difficulty in breathing for whom an emergency rigid endoscopy was carried out after appropriate investigations

Synovial cell sarcoma: rare presentation in head and neck area

We report a case of a 17 years young male who presented to us with a huge neck swelling on the left side of the neck that has been present for about 2 years. He presented to us with the complains of mild pain and disfiguring swelling