Day 1 :
Akershus University Hospital, Norway
Time : 10:30-11:10
Willy Aasebo is a Specialist in Internal Medicine and Nephrology and Leader of section of Nephrology (Medical Department), Akershus University Hospital, Norway. He has published a few scientific articles about alcohol intoxication, deaths in police cells and some nephrological topics including transplantation.
Alcohol (ethanol) is probably the most commonly used intoxication agent worldwide. During the latest decades the possible beneficial effects of moderate use of alcohol have been focused on. Alcohol abuse may cause death by a variety of causes, including accidents, violence and the many diseases that alcoholics may obtain. However, binge drinking may also cause unexpected sudden deaths, but the exact mechanism behind these deaths is not known. Many of the reports on alcohol related deaths have been casuistic, but sudden unexpected deaths have been reported more often in person drinking alcohol regularly than others. Alcoholics may have autonomic neuropathy (caused by functional changes in nervous vagus) increasing their risk of arrhythmias. In alcoholics cardiac arrhythmias, as the holiday heart syndrome, has been described in relation to binge, and atrial fibrillation may be caused by, or is at least associated with, alcoholism. Arrhythmias have also been reported when non- alcoholics drink. Thus, ventricular tachyarrhythmias degenerating into fibrillation is a possible cause of deaths by alcohol intoxication. In general, no single variable in the ECG can predict cardiac arrhythmias, though some features have been associated with later development of arrhythmia. Prolongation of the QTc interval has, during the last decade, been identified as such a risk factor. In an effort to create hypothesis on how alcohol in high blood concentrations affect the ECG, we collected ECGs from all patients that were admitted to our hospital for alcohol intoxication during a one year period and from before they were discharged. Mean alcohol blood concentration was 2.9‰. We measured durations of P-waves, PR intervals, QRS complexes and QTc intervals. We also measured voltage, thinking that if voltage differed from intoxicated to sober in the same patient; this might indicate a mechanism of action from alcohol. Finally, we measured QT dispersion (QTd), even though the significance of QTd has been disputed. We described prolongations in several ECG intervals, but also interesting differences in voltage and QTd in persons with high blood concentrations. Most important is, probably the QTc interval prolongation which has been described by other investigators also. The prolongation of QTc interval has also been found to persist during the abstinence phase in alcoholics. The studies on this topic are few and have methodological difficulties. However it is important to find out more about how alcohol (Ethanol), being as popular as it is worldwide, affects the risk of arrhythmias.
University of Pretoria, South Africa
Keynote: An audit of the management of tricyclic antidepressant overdose in the Emergency Unit of Steve Biko Academic Hospital, Pretoria, South-Africa from 2009 to 2012.
Time : 11:30-12:10
Andreas Engelbrecht is the Head of Emergency Medicine at the University of Pretoria/Steve Biko Academic Hospital. He completed his MBChB degree from the University of Pretoria. His other qualifications include FCEM, MMed (Fam Med), Dip PEC, DA, DTM&H and MMed in Pharmacology. He is the Director of Emergency Medicine at the University of Pretoria. He has published more than 13 papers in reputed journals and chapters in emergency medicine textbooks. He developed the VAPP course (venomous animals poisonous plants) and the Pearls and Pitfalls in Emergency Medicine.
Background: Tricyclic antidepressants (TCA) are frequently used in South-Africa due to their availability and low costs. These drugs are highly toxic in overdose. Aim: The aim of the study was to audit the key aspects in the management of patients with TCA overdose against an international benchmark.rnMethods: A cross sectional descriptive audit of clinical records was done. The findings were measured against the Guidelines for medical therapy of the emergency network (GEM net). rnResults: Thirty-two clinical records were recruited and audited. The following findings were made: The vital signs of 30 (93.7%) patients were recorded, 21 (70%) were abnormal. One case with hypotension was not managed appropriately. Eighteen (56%) patients had their blood pH analysed and 6 were abnormal. None of these were managed appropriately. Thirty (93.7%) EKG assessments were done. Only 17 (56.6%) were recorded. Five (29%) printouts could be found within the files. Of these 4 (80%) had an abnormal tracing but had not been treated. Of those EKGs only documented, 3 (25%) were described as abnormal but were managed inappropriately. Treatment with bicarbonate was either omitted or done inappropriately and without monitoring. The level of consciousness of 31 (96%) patients was recorded. Three who required intubation were not intubated.rnrnConclusion: The management of TCA overdose did not meet the standards prescribed by GEM net in our sample. This audit had a number of limitations but was used to improve the management of this condition in our unit and may be useful to others.
Hamad Medical Corporation, Qatar
Time : 12:10-12:50
Aisha Larem is an ORL-HNS Consultant at Qatari nationality. She graduated from Gulf University Otology subspecialty. She is an Associate Program Director and worked as a Fellowship Program Director and is a Clinical Instructor at Weill corneal at Qatar.
We present a unique and challenging case of a remnant foreign body that presented to us in a child, disguised as a strongly suspected congenital branchial cleft anomaly. This case, featuring a 2 years old male child, entailed oropharyngeal trauma, with a delayed presentation as a retroauricular cyst accompanied by otorrhea that mimicked the classic presentation of an infected first branchial cleft anomaly. During surgical excision of the presumed branchial anomaly, a large wooden stick was found in the tract. The diagnostic and therapeutic obstacles in the management of such cases are highlighted. In addition to exploring the existing literature, we retrospectively analyzed a plausible explanation of the findings of this case.
- Obstetric TraumaBlunt TraumaTrauma-Emergency MedicineTrauma in Nursing & MidwiferyraumaTrauma Therapy
Akershus University Hospital, Norway
University of Alexandria, Egypt
King Khalid University Hospital, Saudi Arabia
Time : 12:50-13:20
Mohamed A Elhoseny have graduated in Faculty of Medicine, University of Alexandria, Egypt in 2004; where he joined the Critical Care Medicine Residency Program to finish his master of science in critical care and toxicology in 2009.He joined King Khalid University Hospital in 2010 as an intensivist. During his whole career, he always showed interest in spreading the message of how to save more lives. He is a distinguished instructor of the ATLS (advanced trauma life support) courses as well as a TCF (training center faculty) and instructor of ACLS; PALS; PEARS; ACLS EP; AHA ECG & Pharmacology courses. He is also a member of the royal colleges of physicians of the United Kingdom and a member of the royal college of physicians of Ireland.
The most common type of shock in trauma is hemorrhagic shock. Treatment entails two arms: source control as well as resuscitation. Blood transfusion is a corner stone in resuscitation and inspite of the fact that it is routine process since the evolution of modern medicine; but we are still trying to optimize it. Another important aspect in blood transfusion is the concept of ‘Balanced resuscitation’ which needs to be more clarified to those working on patient resuscitation. Fresh versus old PRBCs transfusion …. A debate between the theory and practice .while the theory might support the use of fresh transfusion; the studies failed to prove any difference in the outcome. Due to the shortage in blood supply all over the world; there has been an increasing international demand for the blood substitutes; which might be showing a promising future; how true can this be?
Japanese Red Cross Toyota College Of Nursing, Japan
Time : 14:10-14:40
Yuko Harding has completed Post-doctoral studies from Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of Ryukyus, Japan in 2014. She had been a Midwife/Nurse for 24 years. At present she is working as a Lecturer, Japanese Red Cross Toyota College Of Nursing, Japan.
Objective: To specify clinicopathological risk factors that influence sexual function after radiotherapy for cervical cancer. Methods: This observational and cross-sectional study includes a population of 60 adult women with stage I to III cervical cancer who underwent radiotherapy. Sexual function was assessed using a self-reported standardized questionnaire, the Female Sexual Function Index (FSFI). Age, clinical stage, tumor diameter, type of radiotherapy, use of hormone replacement therapy, and period of time elapsed since the completion of radiotherapy at the time of data collection were documented using participants' medical records. Multivariate logistic regression was used to identify independent risk factors for sexual morbidity. Results: The median age of participants was 53 years (Interquartile range, IQR, 45-60 years). Using the FSFI total score compared by variable, sexual dysfunction was significantly more prevalent among women in FIGO stage III than those in stage I /II (P=0.038), and at ≥12 months after the completion of radiotherapy than at <12 months after completion (P=0.008). Multivariate analysis revealed that sexual morbidity was significantly more likely in stage III women (OR 4.60, 95% CI, 1.07-24.39, P=0.040), or where radiotherapy had occurred more than 12 months before (OR 4.78, 95% CI, 1.17- 25.20, P = 0.028). Conclusion: FIGO stage III and a period of ≥12 months after radiotherapy are associated with reduced sexual function. In medical consultations with women in these categories, adequate treatment should be provided where appropriate.
Alexandria University, Egypt
Title: Blunt abdominal trauma in Bilharzial hepatic fibrosis patients; How does it differ in managment?
Time : 14:40-15:10
Mahmoud A Alhussini is a lecturer in general surgery department, Alexandria faculty of Medicine in Egypt. He succeded to finish his Ms thesis in 2010 from Alexandria University. He completed his Md in 2014 from Alexandria University also. He was trained in Alexandria Main Universty Hospital which is a tertiary refferal hospital for more than 3 governates in Egypt including the second,capital.
Bilharzial hepatic fibrosis is an endemic disease in Egypt. This disease affects the liver both anatomically and functionally. There is portal hypertension together with bleeding tendency. Portal hypertension causes backflow in the portal circulation. Thus, collaterals are formed in many sites including the retroperitoneum and abdominal wall. Splenomegaly is another consequence. This enlarged spleen is more vulnerable to trauma and rupture. Conservative measures usually fail. Also, splenorraphy is unreliable. Furthermore, this enlarged spleen is complicated by hypersplenism in many cases. All these present a challenge in managing these patients if exposed to blunt abdominal trauma. Both conservative measures and interventions carry major risk to the patient. Hence, those patients should have special care during their managemnt.
King Saud bin Abdul-Aziz University for Health Sciences, Saudi Arabia
Title: The effect of a designed triage management protocol on complications and hospital stay among patients with blunt abdominal trauma, at a University Hospital in Egypt
Time : 15:30-16:00
Seham A Elgamal has completed her Master’s and PhD from College of Nursing- Cairo University- Egypt. She is working as an Assisstant Professor at College of Nursing- King Saud Bin Abdulaziz University for Health Sciences. She is the Chairperson for the life support commitee and member in clinical simulation commitee. Her research intrest is emergency nursing, organ transplantation, critical care nursing, and clinical simulation.
Abdominal trauma is a leading cause of morbidity and mortality among all age groups. So, it is essential to understand the nature of injury (blunt/penetrating) and the affected abdominal organs to avoid complications in the recovery period. The aim of the study was to evaluate the effect of a designed triage management protocol on the complications and the length of hospital stay among patients with blunt abdominal trauma. The sample was comprised of 60 male and female patients (30 study and 30 control). Three tools were utilized for data collection in addition to structured interviews and direct nursing care for the patients were utilized. The results revealed that, in relation to traumatic complication`s signs and symptoms, the study subjects were having relatively low complications as compared to control group. The improvement was obvious in: nausea & vomiting (6.7% vs 26.7%), fever & wound infection (43.3% vs 76.7%), and abdominal distention & absent/diminished bowel sound (36.7% vs 67.7%), dyspnea (26.7% compared to 36.7%), and abdominal pain, rigidity, guarding and tenderness (73.3% vs 93.3%) respectively. In relation to length of hospital stay the mean number of hospital stay period is 4.9+2.9 & 5.8+3.7 of the study and control group subjects. Significant relationship was found between complications and hospital stay with (P<0.01, P<0.05) among study and control group subjects. Conclusion, despite the differences documented between the two groups, no statistical significant differences were found between the two groups in relation to complications and hospital stay.
Beni-suef University, Egypt
Title: Effect of exercise and self- care guidelines on relieving urinary incontinence among women in Beni-Suef-University Hospital
Time : 16:00-16:30
Amal Roshdi Ahmed has completed her PhD at the age of 33 years from Benha University on Maternal & Neonatal Health Nursing. she is the manager of Information Technology unit and quality management unit at the faculty of nursing Beni-Suef University.
Aim: The aim of the present study was to evaluate effect of exercise and self-care guidelines on relieving urinary incontinence among women in Beni-Suef. Methods: Design was intervention study. Sampling was purposive sample included 100 women attended at gynecological outpatient clinic of Ben-Suef University Hospital. Data collection tool consisted of an interviewing questionnaire sheet covering socio-demographic data, knowledge assessment, and exercise scale and self-care guideline regarding preventive measure urinary incontinence. Results: The results revealed that there was a lack of information regarding urinary incontinence in about 92% of study sample. The majority of women couldn't make proper self-care for relieving urinary incontinence before intervention in comparison (97%) gain knowledge and made proper self-care regarding Urinary Incontinence after intervention. Conclusion: The women’s knowledge and practices of self-care guideline regarding preventive measures of symptoms of urinary incontinence has marked positive effect on relieving it after utilization of self-care guideline carefully. Recommendation: Apply the same study on large sample in other setting to distribute awareness guideline regarding preventive measure of Urinary Incontinence.
Beni-suef University, Egypt
Title: Effect of exercise and self- care guidelines on relieving Urinary Incontinence among women in Beni-Suef University Hospital
Time : 16:00-16:30
Mohamed Ibrahim Mohamed as PhD in Sport Psychology from Helwan university , lecturer of Psychology at pharmacy & Nursing faculties. He is the manager of quality management unit of Faculty of Physical Education,Beni-suef University.
The aim of the present study was to evaluate effect of exercise and Self-care guideline on relieving Urinary Incontinence among women in beni-suef. Design was intervention study. Sampling was purposive sample included 100 women attended at gynecological outpatient clinic of Ben-Suef University Hospital. Tool: Data collection tool consisted of an interviewing questionnaire sheet covering socio demographic data, knowledge assessment, and exercise scale and self-care guideline regarding preventive measure Urinary Incontinence. The results revealed that there was a lack of information regarding Urinary Incontinence in about 92% of study sample. The majority of women couldn't make proper self-care for relieving Urinary Incontinence before intervention in comparison (97%) gain knowledge and made proper self-care regarding Urinary Incontinence after intervention. Conclusion: The women knowledge and practices of self-care guideline regarding preventive measures of symptoms of Urinary Incontinence has marked positive effect on relieving it after utilization of self-care guideline carefully. Recommendation: Apply the same study on large sample in other setting in to distribute awareness guideline regarding preventive measure of Urinary Incontinence.
Northeast Ohio Medical University, USA
Time : 16:30-17:00
Hiba Abdel Aziz received her Medical degree from the Royal College of Surgeons in Ireland. Her general surgery residency and fellowship in trauma/critical care were at the prestigious Institutes of Case Western Reserve University. She joined the staff at the Cleveland Clinic Foundation, University Hospitals of Cleveland and St. Elizabeth Medical Center, Ohio. She is working as an Assistant Professor at Northeast Ohio Medical University and a diplomate of the American Board of Surgery with added qualifications in Surgical Critical Care. She Chairs the Trauma guidelines committee and is program Director of the trauma critical care fellowship at Hamad General Hospital.
Introduction: Pulmonary embolus (PE) is thought to arise from lower extremity DVT. Lower extremity (LE) DVT surveillance is commonly used in trauma patients at risk for DVT. Methods: A comprehensive DVT surveillance literature review over the past 23 years was performed assessing: the effect of surveillance on DVT and PE rates; efficacy of chemoprophylaxis (CP) and mechanical prophylaxis (MP); and the relationship between DVT and PE. 24 publications including over 13,000 patients were found. Results: DVT rates are significantly higher with surveillance with a rate of 8.5% vs 2.6% without surveillance. PE rate without surveillance was 1.3% similar to a rate of 1.1% with surveillance (p=0.6093). There is no association between DVT rates and PE rates (P=0.7574). CP was associated with a reduction in DVT rate to 4.4%, no CP had a much higher DVT rate of 11.7%. Similarly, PE rate was lower at 0.8% on CP vs 1.5%. MP decreased DVT rate to 7.9% vs 13% without MP. PE rate was similar without MP, 1.5%, vs 1.2% with MP. With no CP and no MP, DVT rate was 13% and PE rate was 1.5% vs 7.8% and 1.2% respectively with CP and/or MP. Conclusions: DVT surveillance of the lower extremities appears to be very effective in diagnosing DVT; however the risk of PE is not decreased. Our data suggest that PE rates are not associated with (LE) DVT rates. The historical notion of their relationship may not be true. New paradigms need to be developed.