Rationale: Presenting this case report is of essential importance to shed the light on this rare clinical situation. Patient Concerns: A 68-year-old man presented with generalised weakness, shortness of breath, mild fever and loss of smell and taste for three days. Diagnosis: A filling deficiency of the cavernous sinus was detected by contrast-enhanced CT scanning of the brain. Interventions: He received intravenous injection of remdesivir with intravenous antibiotics (amoxicillin-A clavulanic 1.2 g/metronidazole 500 mg), and tocilizumab 400 mg intravenous once.He was also taken one unit of plasma transfusion with supportive care. Outcomes: After 1 week, the patient recovered from pneumonia and also recovered from features of cavernous sinus thrombosis. Lessons: COVID-19 infections are a serious cause of hypercoagulation condition which increases the chance of cavernous sinus thrombosis,which need early diagnosis and treatment.
{"title":"A Coronavirus Disease-2019 patient presenting with cavernous sinus thrombosis in the second wave of the Coronavirus Disease-2019 pandemic","authors":"S. Swain, Debasmita Dubey","doi":"10.4103/hmj.hmj_109_22","DOIUrl":"https://doi.org/10.4103/hmj.hmj_109_22","url":null,"abstract":"Rationale: Presenting this case report is of essential importance to shed the light on this rare clinical situation. Patient Concerns: A 68-year-old man presented with generalised weakness, shortness of breath, mild fever and loss of smell and taste for three days. Diagnosis: A filling deficiency of the cavernous sinus was detected by contrast-enhanced CT scanning of the brain. Interventions: He received intravenous injection of remdesivir with intravenous antibiotics (amoxicillin-A clavulanic 1.2 g/metronidazole 500 mg), and tocilizumab 400 mg intravenous once.He was also taken one unit of plasma transfusion with supportive care. Outcomes: After 1 week, the patient recovered from pneumonia and also recovered from features of cavernous sinus thrombosis. Lessons: COVID-19 infections are a serious cause of hypercoagulation condition which increases the chance of cavernous sinus thrombosis,which need early diagnosis and treatment.","PeriodicalId":34280,"journal":{"name":"Hamdan Medical Journal","volume":"16 1","pages":"111 - 114"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45957056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Elmoselhi, Zeinab Ibrahim, Mohamed I. Madkour, M. Allah
Introduction: Cardiovascular diseases (CVDs) are the leading cause of death both globally and in the United Arab Emirates (UAE). Vitamin D deficiency, obesity and diabetes mellitus (DM) are significantly prevalent in the UAE population and are considered high-risk factors for CVDs. In the meantime, arterial stiffness has been reported to be an independent predictor of CVDs with a strong association with vascular inflammatory reactions. Aims and Objectives: Identify and analyze specific inflammatory biomarkers associated with arterial stiffness in order to enhance the detection and prevention of cardiovascular diseases (CVDs) among high-risk patients. Materials and Methods: We have recruited 23 middle-aged Emiratis with the following criteria: 11 individuals as controls (Vitamin D level >20 ng and body mass index [BMI] <30), 9 patients with Vitamin D deficiency (Vitamin D level ≤20 ng) and obese (BMI ≥30) and 3 patients with Vitamin D deficiency (Vitamin D level ≤20 ng), obese (BMI ≥30) and previously diagnosed with type 2 DM. Several inflammatory biomarkers were measured in the plasma samples using Luminex Human Cytokine Pre-mixed Kit. Results: Arterial stiffness was measured using pulse-wave velocity (PWV). The PWV relative to age was significantly higher in both patient groups compared to the control group. Furthermore, there is a significant increase in the plasma protein levels of interleukin (IL)-6 cytokine (P = 0.0229) and tumor necrosis factor-alpha (TNF-α) cytokine (P = 0.0258) in Vitamin D deficiency, obese and diabetic patients compared to the control group. The rest of the inflammatory markers did not show statistically significant changes in the plasma levels. Conclusion: Our findings reveal that individuals with Vitamin D deficiency, obesity, and DM exhibit elevated plasma protein levels of IL-6 and TNF-α cytokines when compared to the control group and individuals with only Vitamin D deficiency or obesity. These increased levels of cytokines are closely associated with arterial stiffness, highlighting their potential as biomarkers for early detection of vascular damage in high-risk patients, thereby aiding in the prevention of CVDs. However, further research with a larger cohort is warranted to validate and explore these significant pathways and biomarkers in greater detail.
{"title":"Interleukin-6 and tumour necrosis factor-alpha inflammatory markers association with arterial stiffness in Vitamin D3 deficiency, obese and diabetic emirati population","authors":"A. Elmoselhi, Zeinab Ibrahim, Mohamed I. Madkour, M. Allah","doi":"10.4103/hmj.hmj_89_22","DOIUrl":"https://doi.org/10.4103/hmj.hmj_89_22","url":null,"abstract":"Introduction: Cardiovascular diseases (CVDs) are the leading cause of death both globally and in the United Arab Emirates (UAE). Vitamin D deficiency, obesity and diabetes mellitus (DM) are significantly prevalent in the UAE population and are considered high-risk factors for CVDs. In the meantime, arterial stiffness has been reported to be an independent predictor of CVDs with a strong association with vascular inflammatory reactions. Aims and Objectives: Identify and analyze specific inflammatory biomarkers associated with arterial stiffness in order to enhance the detection and prevention of cardiovascular diseases (CVDs) among high-risk patients. Materials and Methods: We have recruited 23 middle-aged Emiratis with the following criteria: 11 individuals as controls (Vitamin D level >20 ng and body mass index [BMI] <30), 9 patients with Vitamin D deficiency (Vitamin D level ≤20 ng) and obese (BMI ≥30) and 3 patients with Vitamin D deficiency (Vitamin D level ≤20 ng), obese (BMI ≥30) and previously diagnosed with type 2 DM. Several inflammatory biomarkers were measured in the plasma samples using Luminex Human Cytokine Pre-mixed Kit. Results: Arterial stiffness was measured using pulse-wave velocity (PWV). The PWV relative to age was significantly higher in both patient groups compared to the control group. Furthermore, there is a significant increase in the plasma protein levels of interleukin (IL)-6 cytokine (P = 0.0229) and tumor necrosis factor-alpha (TNF-α) cytokine (P = 0.0258) in Vitamin D deficiency, obese and diabetic patients compared to the control group. The rest of the inflammatory markers did not show statistically significant changes in the plasma levels. Conclusion: Our findings reveal that individuals with Vitamin D deficiency, obesity, and DM exhibit elevated plasma protein levels of IL-6 and TNF-α cytokines when compared to the control group and individuals with only Vitamin D deficiency or obesity. These increased levels of cytokines are closely associated with arterial stiffness, highlighting their potential as biomarkers for early detection of vascular damage in high-risk patients, thereby aiding in the prevention of CVDs. However, further research with a larger cohort is warranted to validate and explore these significant pathways and biomarkers in greater detail.","PeriodicalId":34280,"journal":{"name":"Hamdan Medical Journal","volume":"16 1","pages":"74 - 78"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47026358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Juby Mathew, J. Paul, S. Rajan, N. Sasikumar, Pulak Tosh, L. Kumar
Background: Disposition refers to the level of care, to which patients get discharged after surgery. Pre-operative physical status of patients and intraoperative adverse events may impact post-operative disposition of surgical patients. Aims and Objectives: We aimed to assess the nature of the disposition of patients 3 months after major head-and-neck reconstructive surgery. Effects of pre-operative status and perioperative adverse events on disposition patterns were also assessed. Materials and Methods: This prospective, observational study was conducted in 260 patients over 1.5 years at a tertiary care institute. Details of patients undergoing major head-and-neck reconstructive surgeries were noted and they were contacted over the telephone after 3 months of surgery. Results: Chi-square test and one-way ANOVA with post hoc Bonferroni test were used for analysis. Initially 260 patients were included in the study. But we lost follow-up of 45 patients. 65% of patients who were followed up (n = 139) were found to be in level 1 disposition at 3 months. Disposition to levels 2, 3, 4 and 5 was 14%, 6.5%, 6.5% and 8.4%, respectively. Hyponatraemia, intraoperative hypotension, need for blood transfusions and length of stay in the intensive care unit were found to have a significant effect on disposition patterns (P < 0.001) with worse levels of disposition. Perioperative hypoalbuminaemia and hypothermia also had similar trends, but they were not statistically significant. The majority (65%) of the patients got discharged home and the percentage mortality was low (8.4%) in the study population. Conclusion: Pre-operative status of the patient and the occurrence of perioperative adverse events had an impact on the nature of the disposition of patients after major head-and-neck reconstructive surgery.
{"title":"Patterns of disposition in patients following major head-and-neck reconstructive surgery – A hospital-based follow-up study","authors":"Juby Mathew, J. Paul, S. Rajan, N. Sasikumar, Pulak Tosh, L. Kumar","doi":"10.4103/hmj.hmj_94_22","DOIUrl":"https://doi.org/10.4103/hmj.hmj_94_22","url":null,"abstract":"Background: Disposition refers to the level of care, to which patients get discharged after surgery. Pre-operative physical status of patients and intraoperative adverse events may impact post-operative disposition of surgical patients. Aims and Objectives: We aimed to assess the nature of the disposition of patients 3 months after major head-and-neck reconstructive surgery. Effects of pre-operative status and perioperative adverse events on disposition patterns were also assessed. Materials and Methods: This prospective, observational study was conducted in 260 patients over 1.5 years at a tertiary care institute. Details of patients undergoing major head-and-neck reconstructive surgeries were noted and they were contacted over the telephone after 3 months of surgery. Results: Chi-square test and one-way ANOVA with post hoc Bonferroni test were used for analysis. Initially 260 patients were included in the study. But we lost follow-up of 45 patients. 65% of patients who were followed up (n = 139) were found to be in level 1 disposition at 3 months. Disposition to levels 2, 3, 4 and 5 was 14%, 6.5%, 6.5% and 8.4%, respectively. Hyponatraemia, intraoperative hypotension, need for blood transfusions and length of stay in the intensive care unit were found to have a significant effect on disposition patterns (P < 0.001) with worse levels of disposition. Perioperative hypoalbuminaemia and hypothermia also had similar trends, but they were not statistically significant. The majority (65%) of the patients got discharged home and the percentage mortality was low (8.4%) in the study population. Conclusion: Pre-operative status of the patient and the occurrence of perioperative adverse events had an impact on the nature of the disposition of patients after major head-and-neck reconstructive surgery.","PeriodicalId":34280,"journal":{"name":"Hamdan Medical Journal","volume":"16 1","pages":"101 - 105"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46747045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sunil Rajan, SherjinD S. Raveendran, Jacob Mathew, Jerry Paul
Dear Editor, Klippel–Trenaunay syndrome (KTS) is a rare congenital disorder and the main features include port-wine stain birthmark, capillary and venous malformations, varicose veins, lymphatic malformations and overgrowth of soft tissues and bones.[1] We are reporting a case of a 25-year-old-female having KTS with arteriovenous (AV) malformations. The patient was posted for left above-knee amputation for ischemic below-knee (BK) stump. She had large AV malformations of the left thigh, gluteal region and pelvis and underwent BK amputation 11 years back due to ischaemic limb. The current aortogram with peripheral angiogram showed high-flow AV malformation in the left lower limb with feeders from the left superficial femoral artery, external iliac artery and multiple right internal iliac artery branches. Transarterial embolisation was done 1 day before surgery. Pre-operative haemoglobin was 10.2 g/dL. Other blood investigations and echocardiography were normal. The patient was on enoxaparin 40 mg twice daily, which was stopped on the night before surgery. Our plan of anaesthesia was general anaesthesia (GA) with invasive haemodynamic monitoring. The patient received midazolam 1 mg, fentanyl 100 μg and propofol 80 mg and was intubated following vecuronium 4 mg. Two 16G peripheral venous accesses were obtained. The left radial artery and internal jugular vein were cannulated for haemodynamic monitoring. Anaesthesia was maintained with isoflurane (1%–2%) in oxygen-air (1:1) mixture. Intra-operatively, despite the application of tourniquet above the knee with pressures kept at 250 mmHg, the patient bled profusely, mainly from the bone. The patient lost approximately 2 L of blood intraoperatively and received six units of packed red blood cells, four units of fresh frozen plasma, 1 L of hydroxyethyl starch and 4 L of Ringer’s lactate. Noradrenaline at 0.02–0.1 μg/kg was required to maintain mean arterial pressure >60 mmHg. The patient was extubated on the table at the end of surgery and the post-operative period was unremarkable. Anaesthetic concerns in patients with KTS are the possibility of difficult airway (facial anomalies, upper airway angiomas and soft-tissue hypertrophy of airway), the potential for massive intraoperative bleeding, local intravascular coagulation within the malformation, disseminated intravascular coagulation, consumptive coagulopathy and thrombocytopenia.[2,3] In patients with KTS, venous thrombophlebitis is common, which could lead to pulmonary thromboembolism, pulmonary hypertension and right ventricular failure.[4] AV malformations can produce high-output congestive heart failure. Therefore, pre-operative echocardiography and anti-thrombotic prophylaxis are mandatory. Intraoperative surges in blood pressure should be avoided in view of possible brain haemangiomas leading to cerebrovascular accidents. The central neuraxial block may be considered only in those patients who do not have haemangioma of the spine and surrounding
{"title":"Anaesthetic Management of a Patient with Klippel–Trenaunay Syndrome for Above-knee Amputation","authors":"Sunil Rajan, SherjinD S. Raveendran, Jacob Mathew, Jerry Paul","doi":"10.4103/hmj.hmj_36_23","DOIUrl":"https://doi.org/10.4103/hmj.hmj_36_23","url":null,"abstract":"Dear Editor, Klippel–Trenaunay syndrome (KTS) is a rare congenital disorder and the main features include port-wine stain birthmark, capillary and venous malformations, varicose veins, lymphatic malformations and overgrowth of soft tissues and bones.[1] We are reporting a case of a 25-year-old-female having KTS with arteriovenous (AV) malformations. The patient was posted for left above-knee amputation for ischemic below-knee (BK) stump. She had large AV malformations of the left thigh, gluteal region and pelvis and underwent BK amputation 11 years back due to ischaemic limb. The current aortogram with peripheral angiogram showed high-flow AV malformation in the left lower limb with feeders from the left superficial femoral artery, external iliac artery and multiple right internal iliac artery branches. Transarterial embolisation was done 1 day before surgery. Pre-operative haemoglobin was 10.2 g/dL. Other blood investigations and echocardiography were normal. The patient was on enoxaparin 40 mg twice daily, which was stopped on the night before surgery. Our plan of anaesthesia was general anaesthesia (GA) with invasive haemodynamic monitoring. The patient received midazolam 1 mg, fentanyl 100 μg and propofol 80 mg and was intubated following vecuronium 4 mg. Two 16G peripheral venous accesses were obtained. The left radial artery and internal jugular vein were cannulated for haemodynamic monitoring. Anaesthesia was maintained with isoflurane (1%–2%) in oxygen-air (1:1) mixture. Intra-operatively, despite the application of tourniquet above the knee with pressures kept at 250 mmHg, the patient bled profusely, mainly from the bone. The patient lost approximately 2 L of blood intraoperatively and received six units of packed red blood cells, four units of fresh frozen plasma, 1 L of hydroxyethyl starch and 4 L of Ringer’s lactate. Noradrenaline at 0.02–0.1 μg/kg was required to maintain mean arterial pressure >60 mmHg. The patient was extubated on the table at the end of surgery and the post-operative period was unremarkable. Anaesthetic concerns in patients with KTS are the possibility of difficult airway (facial anomalies, upper airway angiomas and soft-tissue hypertrophy of airway), the potential for massive intraoperative bleeding, local intravascular coagulation within the malformation, disseminated intravascular coagulation, consumptive coagulopathy and thrombocytopenia.[2,3] In patients with KTS, venous thrombophlebitis is common, which could lead to pulmonary thromboembolism, pulmonary hypertension and right ventricular failure.[4] AV malformations can produce high-output congestive heart failure. Therefore, pre-operative echocardiography and anti-thrombotic prophylaxis are mandatory. Intraoperative surges in blood pressure should be avoided in view of possible brain haemangiomas leading to cerebrovascular accidents. The central neuraxial block may be considered only in those patients who do not have haemangioma of the spine and surrounding","PeriodicalId":34280,"journal":{"name":"Hamdan Medical Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135263302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Assessments in the domain of medical education play a pivotal role in defining the kinds of learning experiences and the outcomes of medical graduates. Programmatic assessment has emerged as the need of the hour, as it ensures quality monitoring and brings about an alignment with intended learning outcomes. Programmatic assessment consists of five elements, and each one of them is important to ensure that we can maximise learning amongst medical students and also come up with a robust assessment system, wherein each decision taken by the educators during the high-stakes assessment is data driven and not on the basis of solitary assessments. In conclusion, the programmatic assessment provides educators with a framework to continuously monitor learning through systems of assessment, and the entire process remains student-centred and authentic. The five elements in the programmatic assessment framework provide a comprehensive and integrated approach to assessment in the field of medical education and eventually facilitate the growth and development of medical students, including progression in their academic careers.
{"title":"Transforming medical education through resorting to programmatic assessment: A paradigm shift","authors":"SaurabhRamBihariLal Shrivastava, RachmadyaNur Hidayah","doi":"10.4103/hmj.hmj_61_23","DOIUrl":"https://doi.org/10.4103/hmj.hmj_61_23","url":null,"abstract":"Assessments in the domain of medical education play a pivotal role in defining the kinds of learning experiences and the outcomes of medical graduates. Programmatic assessment has emerged as the need of the hour, as it ensures quality monitoring and brings about an alignment with intended learning outcomes. Programmatic assessment consists of five elements, and each one of them is important to ensure that we can maximise learning amongst medical students and also come up with a robust assessment system, wherein each decision taken by the educators during the high-stakes assessment is data driven and not on the basis of solitary assessments. In conclusion, the programmatic assessment provides educators with a framework to continuously monitor learning through systems of assessment, and the entire process remains student-centred and authentic. The five elements in the programmatic assessment framework provide a comprehensive and integrated approach to assessment in the field of medical education and eventually facilitate the growth and development of medical students, including progression in their academic careers.","PeriodicalId":34280,"journal":{"name":"Hamdan Medical Journal","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135263310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The sound of silence: Enhancing medical education through moments of quiet","authors":"SaurabhRamBihariLal Shrivastava, PrateekSaurabh Shrivastava","doi":"10.4103/hmj.hmj_83_23","DOIUrl":"https://doi.org/10.4103/hmj.hmj_83_23","url":null,"abstract":"","PeriodicalId":34280,"journal":{"name":"Hamdan Medical Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135312369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Infodemiology of cataract in India: An analysis of online search behaviour using google trends from 2011 to 2022","authors":"Praveena Tandon, Ashok Kumar","doi":"10.4103/hmj.hmj_65_23","DOIUrl":"https://doi.org/10.4103/hmj.hmj_65_23","url":null,"abstract":"","PeriodicalId":34280,"journal":{"name":"Hamdan Medical Journal","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135311348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abeer Alzuabi, A. Amini, M. Nassef, A. Shorrab, Hala Khudher
Rationale: Showcasing this case report is of essential importance to shed the light on this rare situation propelling advancement in clinical rationale to detect and manage such cases. Patient Concerns: A 25-year-old male patient presented with suicidal injury by cutting his throat open using a knife due psychiatric history of depression. Diagnosis: Clear-cut injuries to the neck area present with significant impairment to the human body functions from breathing to vascular injuries that eventually will lead to obstructed airways and haemorrhagic shock later. Interventions: In this case, we stress on the essentialness of the multidisciplinary team to manage and treat such critical situations, and this underlines the involvement of the anaesthesiologist to protect the airways in such difficult situations and immediately shifting the patient to the operation theatre involving the otolaryngologist, vascular surgeon and postoperatively by intensivists and psychiatrists. As the patient was arrested in the accident and emergency department, it was not applicable to take the patient to any imaging modality and this even created more challenge for the team to exclude any further injuries and to treat according to the standard acute care approach. Outcomes: Improved physical and psychiatric status which helped the patient to return to pre-injury state after fatal suicidal attempt. Lessons: Here, we highlight the urgency and the importance of immediate action in protecting the airways while following the ABCDE guidelines in addition to the rapid intervention, while minimizing time for imaging and shifting of the patient in such critical situations. Importance of the multidisciplinary team involvement while harmonizing treatment to avoid relapse and failure.
{"title":"Deadly suicidal attempt and burdensome airway management, challenges to anesthesiologist with exposed airway","authors":"Abeer Alzuabi, A. Amini, M. Nassef, A. Shorrab, Hala Khudher","doi":"10.4103/hmj.hmj_73_22","DOIUrl":"https://doi.org/10.4103/hmj.hmj_73_22","url":null,"abstract":"Rationale: Showcasing this case report is of essential importance to shed the light on this rare situation propelling advancement in clinical rationale to detect and manage such cases. Patient Concerns: A 25-year-old male patient presented with suicidal injury by cutting his throat open using a knife due psychiatric history of depression. Diagnosis: Clear-cut injuries to the neck area present with significant impairment to the human body functions from breathing to vascular injuries that eventually will lead to obstructed airways and haemorrhagic shock later. Interventions: In this case, we stress on the essentialness of the multidisciplinary team to manage and treat such critical situations, and this underlines the involvement of the anaesthesiologist to protect the airways in such difficult situations and immediately shifting the patient to the operation theatre involving the otolaryngologist, vascular surgeon and postoperatively by intensivists and psychiatrists. As the patient was arrested in the accident and emergency department, it was not applicable to take the patient to any imaging modality and this even created more challenge for the team to exclude any further injuries and to treat according to the standard acute care approach. Outcomes: Improved physical and psychiatric status which helped the patient to return to pre-injury state after fatal suicidal attempt. Lessons: Here, we highlight the urgency and the importance of immediate action in protecting the airways while following the ABCDE guidelines in addition to the rapid intervention, while minimizing time for imaging and shifting of the patient in such critical situations. Importance of the multidisciplinary team involvement while harmonizing treatment to avoid relapse and failure.","PeriodicalId":34280,"journal":{"name":"Hamdan Medical Journal","volume":"16 1","pages":"53 - 57"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41494519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Manzoor Ahmad, A. Singh, Mehtab Ahmad, J. Kumar, Syed Muhammad Hannan Ali Rizvi
Background: Bladder cancer is the most common malignancy of the urinary tract. Pre-operative tumour staging and grading play a significant role in treatment planning and prognosis estimation for bladder cancer. Aims and Objectives: This study aims to evaluate the utility of multiparametric-magnetic resonance imaging (mp-MRI) in detecting and staging bladder cancers and hence its role in final management. Materials and Methods: A total of 40 patients with documented urinary bladder mass undergoing mp-MRI before transurethral resection of bladder tumours for primary bladder cancer were identified and compared with post-operative histopathological reports. The data were collected and analysed using SPSS software. Results: The mean age in the study population was 53.68 ± 13.2 years, including 7 (17.5%) females and 33 (82.5%) males. Twenty-three (57.5%) of our patients had muscle invasion on the MRI pelvis. In muscle-invasive urothelial carcinoma, there were significantly more patients with Vesical Imaging-Reporting and Data System (VIRADS) 3, VIRADS 4 and VIRADS 5 than in non-muscle invasive urothelial carcinoma. The proportion of patients with VIRADS 1 and VIRADS 2 on MRI pelvis was significantly lower in muscle-invasive urothelial carcinoma than in non-muscle-invasive urothelial carcinoma (P = 0.0001). Histopathology and muscle invasion on the MRI pelvis agree well in the current study (κ = 0.742; P = 0.0001). There was an overall concordance rate of 87.5% and an overall discordance rate of 12.5% between histopathology and muscle invasion on the MRI pelvis. The sensitivity, specificity, area under the curve, positive predictive value, negative predictive value and diagnostic accuracy of the mp-MRI scan were 87.5%, 87.5%, 0.88, 91.3%, 82.35% and 87.50%, respectively. Conclusion: The mp-MRI and VIRADS scoring is an effective comprehensive tool with satisfactory sensitivity, specificity and diagnostic value for detecting muscle invasiveness of primary bladder cancer. We recommend VIRADS scoring for all bladder cancer patients for better pre-operative staging and overall management.
{"title":"Role of magnetic resonance imaging in urinary bladder carcinoma: A tertiary care experience","authors":"Manzoor Ahmad, A. Singh, Mehtab Ahmad, J. Kumar, Syed Muhammad Hannan Ali Rizvi","doi":"10.4103/hmj.hmj_75_22","DOIUrl":"https://doi.org/10.4103/hmj.hmj_75_22","url":null,"abstract":"Background: Bladder cancer is the most common malignancy of the urinary tract. Pre-operative tumour staging and grading play a significant role in treatment planning and prognosis estimation for bladder cancer. Aims and Objectives: This study aims to evaluate the utility of multiparametric-magnetic resonance imaging (mp-MRI) in detecting and staging bladder cancers and hence its role in final management. Materials and Methods: A total of 40 patients with documented urinary bladder mass undergoing mp-MRI before transurethral resection of bladder tumours for primary bladder cancer were identified and compared with post-operative histopathological reports. The data were collected and analysed using SPSS software. Results: The mean age in the study population was 53.68 ± 13.2 years, including 7 (17.5%) females and 33 (82.5%) males. Twenty-three (57.5%) of our patients had muscle invasion on the MRI pelvis. In muscle-invasive urothelial carcinoma, there were significantly more patients with Vesical Imaging-Reporting and Data System (VIRADS) 3, VIRADS 4 and VIRADS 5 than in non-muscle invasive urothelial carcinoma. The proportion of patients with VIRADS 1 and VIRADS 2 on MRI pelvis was significantly lower in muscle-invasive urothelial carcinoma than in non-muscle-invasive urothelial carcinoma (P = 0.0001). Histopathology and muscle invasion on the MRI pelvis agree well in the current study (κ = 0.742; P = 0.0001). There was an overall concordance rate of 87.5% and an overall discordance rate of 12.5% between histopathology and muscle invasion on the MRI pelvis. The sensitivity, specificity, area under the curve, positive predictive value, negative predictive value and diagnostic accuracy of the mp-MRI scan were 87.5%, 87.5%, 0.88, 91.3%, 82.35% and 87.50%, respectively. Conclusion: The mp-MRI and VIRADS scoring is an effective comprehensive tool with satisfactory sensitivity, specificity and diagnostic value for detecting muscle invasiveness of primary bladder cancer. We recommend VIRADS scoring for all bladder cancer patients for better pre-operative staging and overall management.","PeriodicalId":34280,"journal":{"name":"Hamdan Medical Journal","volume":"16 1","pages":"26 - 31"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42054390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: This study aimed to showcase the innovation process and strategy applied and implemented in the Ministry of Health and Prevention (MOHAP) – United Arab Emirates as a case and how it is helped in coping with the changing environment in the field of healthcare. Methods: A comprehensive review of literature was conducted to provide an overview of the current research on the topic, particularly focusing on the MOHAP innovation strategy. Results: MOHAP's innovation system has established a supportive environment that has enabled employees to create numerous innovative projects and ideas. Discussion: This, in turn, has led to an improvement in the services provided to the customers. Furthermore, it's worth noting that MOHAP is consistently striving to enhance their innovation system. Conclusion: The strategy and processes implemented brought innovation in the organisation to new levels of functioning. It is essential to acknowledge and foster such continuing processes of innovation, rather than exclusively focusing on innovations as externally created 'things' that await 'implementation.'
{"title":"Coping with changes and innovation strategy in healthcare implemented by the ministry of health and prevention: Findings from the literature","authors":"Mariam Alowais, H. Razzak","doi":"10.4103/hmj.hmj_78_22","DOIUrl":"https://doi.org/10.4103/hmj.hmj_78_22","url":null,"abstract":"Introduction: This study aimed to showcase the innovation process and strategy applied and implemented in the Ministry of Health and Prevention (MOHAP) – United Arab Emirates as a case and how it is helped in coping with the changing environment in the field of healthcare. Methods: A comprehensive review of literature was conducted to provide an overview of the current research on the topic, particularly focusing on the MOHAP innovation strategy. Results: MOHAP's innovation system has established a supportive environment that has enabled employees to create numerous innovative projects and ideas. Discussion: This, in turn, has led to an improvement in the services provided to the customers. Furthermore, it's worth noting that MOHAP is consistently striving to enhance their innovation system. Conclusion: The strategy and processes implemented brought innovation in the organisation to new levels of functioning. It is essential to acknowledge and foster such continuing processes of innovation, rather than exclusively focusing on innovations as externally created 'things' that await 'implementation.'","PeriodicalId":34280,"journal":{"name":"Hamdan Medical Journal","volume":"16 1","pages":"1 - 6"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41882313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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