Emergency management of upper GI variceal bleeding

Background: Upper gastrointestinal bleeding is the most common gastrointestinal cause of admission in emergency departments worldwide with about 10% inpatient mortality rate that has not decreased during the last three decades

Aim: In this review, we aim to study the pathophysiology behind the development of upper gastrointestinal bleeding, and explore the approach to its management in emergency situation

Materials and Methods: We conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE, January 2001, through February 2017. The following search terms were used: upper gastro intestinal bleeding, variceal bleeding, emergency management of gastrointestinal hemorrhage, varices, esophageal bleeding

Results: Managing patients with bleeding varices must have two goals that should be considered: to stop the bleeding, and to prevent rebleeding since 60% of patients will rebleed after the acute bleeding was stopped leading to a mortality rate of 33%, unless adequately treated

Conclusion: Bleeding varices are always considered urgent emergencies due to associated morbidity and mortality. Moreover, bleeding varices can cause hemodynamic instability and end-organ failure. The most important intervention is therapeutic endoscopy. Other approaches include vasoactive drugs, and prophylactic antibiotics. After acute management of the bleeding, patients should undergo further evaluation and treatment to prevent the recurrence of another bleeding

Assessment of knowledge, attitudes and practices regarding pulmonary tuberculosis among Saudi Arabia community in 2017

Background: despite the improvements in the health care education of management in KSA, the prevalence of tuberculosis remains alarming

Objectives: evaluation of the knowledge, attitude and practice among Saudi population regarding pulmonary tuberculosis [TB] in Kingdom of Saudi Arabia [KSA]

Methods: a multi-center community cross sectional study was assessed among random sample of 2056 adult Saudi subjects from different regions in KSA. All participants filled out a questionnaire that included questions about demographics, awareness, attitude and practice about pulmonary tuberculosis

Results: most of participants [76.8%] had general knowledge about TB disease and only 23.2% haven't heard about TB before. The majority of Saudi adult [74.9%] have inadequate knowledge about TB and only 25.1% have good knowledge regarding TB. The attitude of respondents about TB was negative among most of them while most of participants had a good practice level but it needs to be increased. There was a significant association between young age and high educational degree with good knowledge about TB

Conclusion: KAP of Saudi population toward TB seems to be facing some challenges in the Kingdom of Saudi Arabia. The awareness, attitude and practice need to be significantly evaluated in different studies to improve control policies for reducing the disease incidence in our society. The prevention of TB and management are based on good knowledge and education of Saudi population thus the health authorities should intensify efforts and arranging specific educational programs about the disease and the consequences of spreading infection among large sector of the population . Also, means of discovery, medication should receive special attention by the governmental medical authorities

Management of pain in the intensive care unit

Background: Pain assessment in ICU patients turns out to be a daily challenge for the attending teams, particularly in those patients who are intubated endotracheally; on mechanical ventilation or analgosedated as such patients are unable to self-assess existence and intensity of pain. Guidelines to identify pain in these patients are crucial for physicians for effective management

Methodology: We conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE, January 1994, through March 2017. The following search terms were used: pain management in ICU, pain in ICU, pain assessment by behavior, pain assessment in intubated patients

Aim: Our aim in this study was to understand how to assess and manage pain in an intensive care unit patient, particularly those patients who are unable to self-report or assess

Conclusion: Physical clues given by comatose or intubated patients in critical care unit must be used as a method to identify existence of pain, and must be managed effectively to decrease discomfort and prevent short and long term adverse effects