Boerhaave\u27s syndrome: a diagnostic dilemma in the emergency room

Boerhaave\u27s syndrome is a potential lethal condition which presents not only a diagnostic but also a therapeutic challenge. Errors in diagnosis are usually caused by unawareness of its varied and atypical presentations. All clinicians need to be aware of this lethal disease, its frequent unusual presentations and the importance of early diagnosis

Constrictive pericarditis presenting as chylothorax

Chylothorax is a rare clinical condition that can be attributed to a damaged thoracic duct. The condition is suggested by aspiration of milky white fluid from the pleural cavity and is commonly associated with either malignant diseases or trauma (e.g. cardiothoracic surgery). We present the case of a 15-year-old boy with chylothorax, whose effusion was due to constrictive pericarditis. The definitive treatment of chylothorax involves identification and management of the underlying pathology. We suggest that when dealing with cases of chylothorax, constrictive pericarditis should be considered among the causes

An assessment of facility-based care of diabetes, hypertension, and heart failure across western Kenya

Background: Low- and middle- income countries account for three-fourths of the global non- communicable disease related mortality. In response to the increasing number of non- communicable disease diagnoses in Kenya, the government released a national strategy for non- communicable disease in 2015. The purpose of this study was to assess facility-based care of diabetes, hypertension, and heart failure across western Kenya.Methods: A 71-question cross-sectional survey was administered among facility-based healthcare workers in Siaya County, western Kenya, between October 2015 and January 2016. All Level 4 and 5 facilities, as well as a cohort of lower-level facilities were surveyed.Results: Of the 21 health facilities surveyed, six (31.6%) had specific non-communicable disease clinics. Eleven of the 21 (52.4%) facilities had glucometers, and providers indicated that even these glucometers were often not functional. Three of the 21 facilities (14.3%) had a diabetic registry, one a functioning electrocardiogram machine, and one other a congestive heart failure registry.Conclusions: Facilities at every level were lacking equipment and medications expected by the Kenya’s Essential Package of Health Services. Improvement for follow up and referral services could be achieved through the development of comprehensive non-communicable disease registries

Trends in hospital-based management of acute asthma from a teaching hospital in South Asia.

The aim of this study is to evaluate the hospital-based management of acute asthma in south Asia and to compare practices over a 10-year period. Adult patients (n = 102) admitted at a teaching hospital with acute asthma were studied. Documentation of precipitating factors, family history and physical signs were inadequate in more than half of patients. Pulse oximetry was documented in 95 (93%) patients, but peak flow monitoring was performed only in 50 (49%) patients. Ten-year trend showed deterioration in history and physical examination skills, under use of peak flow readings, and poor pre-discharge instructions. Some aspects of improved care included frequent use of pulse oximeter, preference of inhaled over systemic bronchodilators and increased use of systemic steroids. Significant deficiencies were identified in hospital-based management of acute asthma. Most aspects of asthma care continued to fall short of asthma guidelines

Prevalence of Nocturnal Enuresis among Schoolchildren in Sana’a City, Yemen

Objective: To estimate the prevalence, frequency and time of nocturnal enuresis (NE) among primary schoolchildren in Sana’a city, Yemen. Methods: This was a cross-sectional study was conducted among 2689 schoolchildren in the primary schools of four randomly selected districts in Sana’a city in the period from September 2012 to December 2013. Data about sociodemographic characteristics, frequency, time, psycho-social effects and the factors possibly associated with NE among children were collected using a pre-designed questionnaire and analyzed using appropriate statistical tests. Results: The overall prevalence of NE was 11.2%, which was significantly higher among males than females (13.0% vs. 10.0%, respectively; P = 0.044) and decreased significantly with increasing age (P <0.001). More than half of children (55.3%) in Sana’a city had the habits of drinking excess fluids and tea at night and/or deep sleeping. Of physical and health disorders, difficulty in breathing and urinary tract infections were the two most frequent conditions among children with NE, being observed among 29.6% and 23.9% of cases, respectively. However, urogenital anomalies and mental retardation were the least frequent conditions in children with NE, being observed among 5.8% and 1.3% of cases, respectively. On the other hand, marital problems (24.8%) and arrival of a new baby (17.9%) were the most frequently observed social conditions among children with NE, while death in the family (8.5%) and parental separation (6.0%) were the least frequently observed conditions. Conclusions: NE is prevalent among 11.2% of schoolchildren in Sana’a city with a significantly higher, though slight, rate among males. This rate is lower than the rates reported from Aden and Mukalla cities in the country and from Saudi Arabia and Turkey. However, it is higher than those reported from Iran and Malaysia. About a third of children experience nightly NE, whereas the lowest proportion of children experience NE twice a month. The habits of drinking excess fluid and tea at night and/or deep sleeping, the disorders of difficulty in breathing and urinary tract infections and the social conditions of marital problems and arrival of a new baby are the most frequent observations among children with NE in Sana’a city

Fractional residual plot for model validation

A pairwise comparison is important to measure the goodness-of-fit of models. Error measurements are used for this purpose but it only limit to the value, thus a graph is used to help show the precision of the models. These two should show a tally result in order to defense the hypothesis correctly. In this study, a fractional residual plot is proposed to help showing the precision of forecasts. This plot improvises the scale of the graph by changing the scale into decimal ranging from -1 to 1. The closer the point to 0 will indicate that forecast is robust and value closer to -1 or 1 will indicate that the forecast is poor. Two error measurements which are mean absolute error (MAE) and mean absolute percentage error (MAPE) and residual plot are used to justify the results and make comparison with the proposed fractional residual plot. Three difference data are used for this purpose and the results have shown that the fractional residual plot could give as much information as the residual plot but in an easier and meaningful way. In conclusion, the error plot is important in visualize the accurateness of the forecast