International Research Journal of Medicine and Medical Sciences

Number 1, 2018

1-9
The use of point of care ultrasound (POCUS) in UAE emergency departments (ED)

Authors: Varsha Arjandas, Fatema Salem Al Ameri, Mehmood Chaudhry and Rasha Buhumaid

Abstract

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Number of views: 582

Point of care ultrasound (POCUS) performed at bedsides is an invaluable tool and is used to evaluate clinical manifestations, to facilitate accurate diagnosis, and to assist procedures in emergency and critical care. This study aimed to characterize the current practice of emergency physician-performed POCUS in UAE Emergency Departments. An online survey of all government emergency departments in the UAE was conducted from January 2016 to August 2016 in order to determine how POCUS was used. A 20-question survey, including Emergency department demographics, ownership of ultrasound (US) equipment, and frequency of POCUS performance in general and by examination type, credentialing patterns, quality assurance methods, and billing patterns was conducted. Overall, 70% of respondents reported lack of training as the greatest barrier for the use of POCUS. Other shortcomings included not owning equipment, concerns regarding liability, not beneficial financially, and adequate coverage by other specialists. In conclusion, the study identified an underutilization of POCUS in UAE government Emergency Departments, with only a quarter of them performing POCUS regularly. Most of the respondents stated that attending a training course is the minimal requirement for the physicians to perform POCUS. Recent educational and training advancements might help to overcome this barrier.

10-17
Research Evaluation of care and treatment clinics using a four-year retrospective cohort of patients receiving anti-retroviral therapy in Mbeya Region, Tanzania

Authors: Aifello W. Sichalwe, J. Renju, G. W. Rutherford, J. Nondi, E. M. Martin, F. Tenu and J. Todd

Abstract

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Number of views: 421

Evaluations of sub-national anti-retroviral therapy (ART) programmes’ performance are important to support regional programme planning and epidemic response. We constructed a four-year retrospective cohort of clients from 10 care and treatment clinics (CTC) in the Mbeya region of Tanzania using routinely collected data from patients initiating ART between January 1, 2008 and March 31, 2012. Our primary outcomes were mortality rate and lost to follow up. We calculated ART coverage based on regional prevalence estimates and used medical cards, drug registers and quarterly reports to assess data quality. We enrolled 17,813 participants into the cohort. More patients initiated ART at WHO stages 3 (58.9%), and at CD4 cell counts between 50-199 cells/µl (56%). The proportion of patients initiating ARTs at a CD4 counts <50 cells/µl decreased from 40.7% in 2008 to 33.8% in 2012 (p-value <0.001). A total of 10,155 (57.0%) patients were lost to follow up (LTFU) during the 4 years of follow up; 59.2% were female. The overall mortality rate was 17.8 per 1000 person years; the six-month mortality was 6.2 per 1000 person years. The risk of mortality for patients at WHO stage III and IV was more than twice as high (hazard ratio [HR] 2.15; 95% confidence interval [CI], 1.05-4.39 and HR 2.29; 95% CI, 1.39-6.37, respectively) as compared to stage I and II. Those patients initiating ART with CD4 cell count between 50 and 199 cells/µl had significantly lower hazard of death compared to those initiating ART with CD4 cells counts <50 cells/µl (HR 0.51, 95% CI 0.34-0.78). In conclusion, during the study, a high proportion of patients were lost to follow up, and the majority of them were female. Most patients initiated ARTs at lower CD4 count (<200 cells/mm3) and at WHO stages III and IV, and they had higher risk of mortality compared to those initiated at higher CD4 counts and WHO stage I and II. Emphasis needs to be placed on strategies of early diagnosis of HIV infection, prompt initiation of ART, and support for ART adherence to minimise lost to follow up.

18-34
Renal arterial resistive index in Egyptian patients with lupus nephritis: Correlation with disease activity and biopsy parameters

Authors: Hala El-Wakil, Eman Khalil, Dalia Maharem, El-Said Mahena and Mohamed Hasab

Abstract

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Number of views: 492

Lupus nephritis (LN) affects up to 60% of patients with systemic lupus erythematosus (SLE), either as the initial manifestation or during the disease course. Moreover, LN has a negative impact on survival of SLE patients. Accordingly, it is mandatory to identify specific and feasible markers able to guide clinicians towards the adequate therapeutic option in LN patients. The aim of this work was to evaluate the predictive value of renal resistance index (RRI), measured by Doppler Sonography in comparison with disease activity score, serologic and biopsy parameters in patients with LN. This study was carried out on forty three SLE patients, they were categorized into two groups: Group I included thirty three patients with LN and Group II included ten patients without LN and Group III included ten healthy subjects of matched age and sex as control group. All were subjected to history taking, clinical examination, assessment of disease activity by SLEDAI, laboratory investigations including FBG, blood urea, serum creatinine, serum albumin, CBC, ESR, CRP, complete urine analysis, 24 hour urine protein, eGFR, serum ANA, anti ds-DNA titre, C3, C4 and renal Doppler with measurement of RRI. Renal biopsy was done for those with LN. The mean value of RRI was statistically significantly higher in group I than that of group II and group III. Out of 33 cases of LN cases, 6 patients had RRI of 0.7 and above giving a percentage of 18.18%. LN patients with RRI higher than 0.7 had statistically significant higher age, mean serum creatinine and blood urea levels and a lower eGFR, higher chronicity index of renal biopsy. RRI is of clinical significance in predicting the chronicity index of renal biopsy which is a major determinant of renal outcome so it is useful as non invasive technique to evaluate chronicity in patients with LN, therefore justifying aggressive immune suppression but further follow-up studies are needed to evaluate its role in predicting response to treatment.