Dermatological Emergencies in Family Medicine: Recognition, Management, and Referral Considerations

Numerous people with skin disorders who have real dermatologic crises show up at the emergency room. Family doctors need to be able to identify potentially fatal dermatological disorders quickly since they could be the first to encounter patients with these illnesses. The purpose of this review is to provide guidance for early recognition, help identify distinct symptoms, and enable early diagnosis of emerging dermatological conditions. Necrotizing fasciitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, Rocky Mountain spotted fever, and other possible emergencies that might manifest as dermatological symptoms are examples of these conditions. In this article we will be discussing the dermatological emergencies present at primary care settings and encountered by family physician, recognition and management of those emergencies, referral considerations, role of family medicine in dermatological emergencies and other topics

Prevalence, Recognition, And Management Of Mental Disorders In Primary Care

According to latest figures, 50% of individuals will have a minimum of one mental health issue in their lifetime, with at least 25% experiencing a mental condition in the previous year. primary care doctors are overwhelmingly responsible for recognition, evaluation, therapy, and referral, with at least one-third of their consultations containing a direct and obvious mental aspect Primary care physicians are the foundation of the majority of medical care programs that involve recognizing, diagnosing, treating, and referring patients to specialists for every kind of diseases, whether physical, mental, or both. Over the last two decades, there has been a greater emphasis on this position, notably in the treatment of mental problems in primary care

Assessment and Management of Scabies in Primary Care Settings

Scabies is an overlooked tropical illness that yet has significant worldwide effects and lasting health repercussions. The condition is caused by the mite Sarcoptes scabei var. hominis, which is a parasitic organism that dwells on the outer layer of the human skin. Scabies is prevalent in impoverished neighborhoods as a result of the high population density in locations such as nursing homes, correctional facilities, and among homeless and displaced children. Nevertheless, modern nations are also prone to scabies infestations, particularly in cases of institutional outbreaks or mini epidemics occurring after conflict or natural calamities. Scabies diagnosis can be aided by both invasive and noninvasive techniques. This paper reviews assessment diagnosis, and management of scabies in primary health care settings

Evaluation of inhaled nitric oxide (iNO) treatment for moderate-to-severe ARDS in critically ill patients with COVID-19: A multicenter cohort study

Background: Inhaled nitric oxide (iNO) is used as rescue therapy in patients with refractory hypoxemia due to severe COVID-19 acute respiratory distress syndrome (ARDS) despite the recommendation against the use of this treatment. To date, the effect of iNO on the clinical outcomes of critically ill COVID-19 patients with moderate-to-severe ARDS remains arguable. Therefore, this study aimed to evaluate the use of iNO in critically ill COVID-19 patients with moderate-to-severe ARDS. Methods: This multicenter, retrospective cohort study included critically ill adult patients with confirmed COVID-19 treated from March 01, 2020, until July 31, 2021. Eligible patients with moderate-to-severe ARDS were subsequently categorized into two groups based on inhaled nitric oxide (iNO) use throughout their ICU stay. The primary endpoint was the improvement in oxygenation parameters 24 h after iNO use. Other outcomes were considered secondary. Propensity score matching (1:2) was used based on the predefined criteria. Results: A total of 1598 patients were screened, and 815 were included based on the eligibility criteria. Among them, 210 patients were matched based on predefined criteria. Oxygenation parameters (PaO2, FiO2 requirement, P/F ratio, oxygenation index) were significantly improved 24 h after iNO administration within a median of six days of ICU admission. However, the risk of 30-day and in-hospital mortality were found to be similar between the two groups (HR: 1.18; 95% CI: 0.77, 1.82; p = 0.45 and HR: 1.40; 95% CI: 0.94, 2.11; p= 0.10, respectively). On the other hand, ventilator-free days (VFDs) were significantly fewer, and ICU and hospital LOS were significantly longer in the iNO group. In addition, patients who received iNO had higher odds of acute kidney injury (AKI) (OR (95% CI): 2.35 (1.30, 4.26), p value = 0.005) and hospital/ventilator-acquired pneumonia (OR (95% CI): 3.2 (1.76, 5.83), p value = 0.001). Conclusion: In critically ill COVID-19 patients with moderate-to-severe ARDS, iNO rescue therapy is associated with improved oxygenation parameters but no mortality benefits. Moreover, iNO use is associated with higher odds of AKI, pneumonia, longer LOS, and fewer VFDs

Physicians’ Characteristics Associated with Their Attitude to Family Presence during Adult Cardiopulmonary Resuscitation

Healthcare providers have disparate views of family presence during cardiopulmonary resuscitation; however, the attitudes of physicians have not been investigated systematically. This study investigates the patterns and determinants of physicians’ attitudes to FP during cardiopulmonary resuscitation in Saudi Arabia. A cross-sectional design was applied, where a sample of 1000 physicians was surveyed using a structured questionnaire. The study was conducted in the southern region of Saudi Arabia for over 11 months (February 2014–December 2014). The collected data was analyzed using the Pearson chi-square test. Spearman’s correlation analysis and chi-square test of independence were used for the analysis of physicians’ characteristics with their willingness to allow FP. 80% of physicians opposed FP during cardiopulmonary resuscitation. The majority of them believed that FP could lead to decreased bedside space, staff distraction, performance anxiety, interference with patient care, and breach of privacy. They also highlight FP to result in difficulty concerning stopping a futile cardiopulmonary resuscitation, psychological trauma to family members, professional stress among staff, and malpractice litigations. 77.9% mostly disagreed that FP could be useful in allaying family anxiety about the condition of the patient or removing their doubts about the care provided, improving family support and participation in patient care, or enhancing staff professionalism. Various concerns exist for FP during adult cardiopulmonary resuscitation, which must be catered when planning for FP execution

Molecular Characterization of Leishmania Species among Patients with Cutaneous Leishmaniasis in Asir Province, Saudi Arabia

Anthroponotic cutaneous leishmaniais (ACL) and zoonotic cutaneous leishmaniasis (ZCL) caused by Leishmania tropica and Leishmania major, respectively, are endemic vector-borne diseases in southern Saudi Arabia. In 2021, an outbreak of cutaneous leishmaniasis occurred in the province of Asir. The main objective of our investigation was to analyze the epidemiological features of CL in southern Saudi Arabia. The ministry of health recorded 194 CL patients between January and December 2021 from the Asir province. Our findings showed that the majority of CL patients (87.1%) originated from the governorates of Khamis-Mushait and Abha. Most of the patients were males (62.3%). While CL affected all age groups, those under 13 years old were the most affected (38.1%). For both genders, CL patients were mostly Saudi citizens (90.7%) compared to non-Saudi expatriates. The majority of CL patients (75.2%) suffered from a single lesion, and the majority of lesions (61.3%) were located on the face. The seasonal prevalence of CL showed two peaks, a small one in July–August and a larger one in March. Of a total of 194 Giemsa slides samples, 188 showed positive amplification of Leishmania ITS1 gene. Based on PCR-RFLP and PCR-HMR, 183 patients showed positive amplification of L. tropica and five patients showed positive amplification of L. major. Phylogenetic analysis revealed a clear distinct separation between L. major and L. tropica sequences. Our results provided strong evidence of the pre-domination of L. tropica, the main etiological agent of ACL in Asir province. We reported for the first time the presence of L. major, an etiological agent of ZCL in the study areas. The co-circulation of ACL and ZCL highlighted the complexity of the epidemiology of CL in southern Saudi Arabia, and subsequently, further studies to identify competent vectors and reservoir hosts for the establishment of control strategies are needed

HASHIMOTO THYROIDITIS IN PAEDIATRIC POPULATION- AN OVERVIEW

The most frequent cause of goitre and acquired hypothyroidism in children and teenagers is Hashimoto's thyroiditis (HT). An imperfection or error in immunoregulation leads to a cascade of events that develops from thyroid lymphocyte infiltration to thyroid follicular cell damage caused by T cells and cytokines and apoptotic cell death. Approximately 70% of illness risk is linked to genetic predisposition, with environmental variables also contributing to disease onset in vulnerable individuals. The main reasons for referral in children and adolescents with HT include goitre, hypothyroid symptoms, and outcomes that occur while treating separate disorders or for high-risk groups. Children and adolescents with HT may not have any symptoms. Thyroid hormone replacement is the preferred medical approach for treating Hashimoto thyroiditis. Levothyroxine sodium, taken orally, is the preferred medication, typically for life. To prevent insufficient absorption, it shouldn't be administered along with calcium or iron supplements, aluminium hydroxide, or proton pump inhibitors

Drug shortages in Saudi Arabia: Root causes and recommendations

Drug shortages are a multifaceted problem that has been recurring in Saudi Arabia over the past decade with its significant negative impact on patient care. However, there is a dearth of evidence about possible domestic reasons, if any, behind this recurring problem. Recently, the Pharmacy Education Unit at King Saud University College of Pharmacy has called for a meeting with multiple stakeholders from academia, pharmaceutical care, pharmaceutical industry, purchasing and planning, and regulatory bodies to unveil the root domestic causes of the drug shortages in the Kingdom. Four major topics were used to guide the discussion in this meeting, including: current situation of drug shortages in Saudi Arabia, major factors contributing to drug shortages, challenges and obstacles to improve drug supply, and stakeholders’ recommendations to manage drug shortages. The meeting was audio-recorded and transcribed into verbatim by five authors. The text was then reviewed and analyzed to identify different themes by the first and third authors. Multiple causes were identified and several recommendations were proposed. The main domestic causes of drug shortages that were explored in this study included poor medication supply chain management, lack of government regulation that mandates early notification of drug shortages, a government procurement policy that does not keep pace with the changes in the pharmaceutical market, low profit margins of some essential drugs, weak and ineffective law-violation penalties against pharmaceutical companies and licensed drug importers and distributors, and overdependence on drug imports. The participants have also proposed multiple recommendations to address drug shortages. Policy makers should consider these factors that contribute to drug shortages in Saudi Arabia as well as the recommendations when designing future initiatives and interventions to prevent drug shortages. Keywords: Shortage, Drugs, Patient safet

Treatment of Middle East respiratory syndrome with a combination of lopinavir/ritonavir and interferon-β1b (MIRACLE trial): statistical analysis plan for a recursive two-stage group sequential randomized controlled trial

Abstract The MIRACLE trial (MERS-CoV Infection tReated with A Combination of Lopinavir/ritonavir and intErferon-β1b) investigates the efficacy of a combination therapy of lopinavir/ritonavir and recombinant interferon-β1b provided with standard supportive care, compared to placebo provided with standard supportive care, in hospitalized patients with laboratory-confirmed MERS. The MIRACLE trial is designed as a recursive, two-stage, group sequential, multicenter, placebo-controlled, double-blind randomized controlled trial. The aim of this article is to describe the statistical analysis plan for the MIRACLE trial. The primary outcome is 90-day mortality. The primary analysis will follow the intention-to-treat principle. The MIRACLE trial is the first randomized controlled trial for MERS treatment. Trial registration ClinicalTrials.gov, NCT02845843. Registered on 27 July 2016