Saeed T Saeed Consultant Stroke/internal medicine at Hazm Mebaireek General Hospital part of Hamad Medical Corporation, relocated to Qatar from London (UK) on May 2018. Undertaken all my training and postgraduate degree in the United Kingdom. I started my carrier as Consultant in Stroke/internal medicine on

Feb 2017 at one of the prestigious Hospital in London called Royal London Hospital-Bart’s Health NHS Trust, it is one the biggest Trust in the UK and consider of the biggest hospital around Europe.

A standardized definition of “young adults” is lacking. People under 40, 45, 50 or even 55 years of age have been classified as young adults. Strokes in young adults are reported as comprise 10%–15% of all stroke patients. The nature and aetiology of stroke in young adults is different from that in older patients. Stroke in the young has a disproportionately large economic impact by leaving victims disabled before their most productive years. Recent publications report an increased incidence of stroke in young adults. Stroke was caused by atherosclerotic large artery disease in 4%, cardioembolism in 24%, small vessel disease in 9%, another determined aetiology in 30% and undetermined aetiology in 33%.

 

Modifiable risk factors for stroke, such as dyslipidemia, smoking and hypertension are highly prevalent in the young stroke population. The best form of secondary stroke prevention is directed toward stroke aetiology as well as treatment of additional risk factors. A systematic review on the incidence of stroke in young adults was published by Marini et al., who analyzed 29 studies including 3,589 patients under 45 years of age with first-ever stroke, published between 1980 and 2009. Crude rates ranged from 5.76/100,000 to 39.79/100,000. Etiologic diagnosis of stroke in young adults requires a different and more complex diagnostic work-up than that of stroke in older adults.

 

Overall, cardiac embolism and nonatherosclerotic vasculopathy are the main etiologies of cerebral infarct in younger patients.

• Arteriovenous malformation and arterial hypertension are the main etiologies of cerebral hemorrhages.

• Overall and despite thorough investigation, the causes of up to one-third of ischemias and hemorrhages remain undetermined.

Background: We evaluate the morbidity and mortality in pediatric post cardiotomy extracorporeal membrane oxygenation to determine independent factors affecting outcomes.

 

Methods: Between January 2002 and December 2017. 82 extracorporeal membrane oxygenation after cardiac surgery in 76 children were reviewed retrospectively. Follow-up was completed in December 2018. Logistics regression analysis and Cox proportional hazard model was used for the predictive risk analysis.

 

Results: Age and weight were 14.0±25.3 months and 6.6±5.1 kg respectively. Median support time was 8.3±4.5 days.

Sixty nine (84%) were successfully weaned off ECMO and 50 (61%) survived to hospital discharge. Multivariate logistic regression analysis distinguished the first day to obtain negative fluid balance after initiation of support (adjusted odds ratio=0.43), the highest lactate (0.95) and bilirubin (0.83) during support as significant independent factors associated with successful separation from extracorporeal membrane oxygenation. The day of first negative fluid balance (0.64) after successful decannulation was independent risk factors on survival to the hospital discharge.

Actuarial 1 year, 5 year and 10 year survival rate after hospital discharge was 94%, 82% and 81%, respectively. Impact factors affecting multivariable Cox hazard model indicated weight had impact on survival after hospital discharge.

 

Conclusions: Higher serum lactate/bilirubin, unable to obtain earlier negative fluid balance during the support had impact on mortality of decannulation. Later obtaining negative fluid balance and continuation of peritoneal dialysis in post-extracorporeal membrane oxygenation increased independent risk of death after successful weaning.

Neonatal withdrawal or Neonatal Abstinence Syndrome (NAS) is a withdrawal syndrome in Neonates due to acute cessation of the exposure to either illicit or prescribed drugs. Similar to tolerance or dependence, withdrawal may occur as a result of repeated or chronic administration of drugs but also after short-term high dose use like, example., during neonatal stay. Consequently NAS can appear both following discontinuation of drugs taken by the pregnant mother as well as following discontinuation of drugs administered intentionally to the newborn. The most commonly involved compounds are opioids, selective serotonin reuptake inhibitors (SSRIs), benzodiazepines as well as cannabis or nicotine. The incidence of opioid related neonatal abstinence syndrome (NAS) has increased significantly in the last decade, co-linear with the increased medical use of prescription opioids in adults including in young women. The clinical picture of neonatal abstinence syndrome mimics to a large extent the syndrome of opioid withdrawal in adults (‘cold turkey’) and includes both neurological symptoms (e.g. agitation, crying, sleep disturbance, feeding difficulties but also seizures) as well as extra-neurological symptoms (e.g., diarrhea, vomiting, perianal excoriations, sneezing, sweating and hyperthermia). Besides pharmacological interventions, we strongly recommend to consider the impact of other interventions like swaddling, traditional supportive interventions but also breastfeeding since this results in a reduced incidence and severity of NAS (NNT 6-8). This diagnosis is also associated with subsequent impaired neurological outcome.

Background: The ongoing refugee crises around the world have raised significant concerns among medical communities worldwide. By the end of 2016, there were 40,274 registered refugees residing in Israel according to immigration authorities. It is estimated that among them 5500 are children.

 

Aim: To examine and identify the differences between refugee and Israeli children admitted to the pediatric department.

 

Methods: All data relevant to admissions to the pediatric department at "Wolfson Medical Center" in Israel, between the years 2013-2017 was collected. We than compared the data between two groups; refugees and local Israeli children.

 

Results: During our study, there were 654 refugee and 11,858 Israeli children admitted to the pediatric department from the Pediatric Emergency Department (admissions rate of 28.3% and 13.8% respectively). Average age of admission was 1.2 among refugees and 4.7 years in the local group (P<0.01). Average duration for a single hospital stay was 3.13 days in the refugee group and 2.49 days in the local group (P<0.01), with prolonged stay (i.e., longer than 14 days) also found to be significantly different with 2.7% of all admissions in the refugee group, whereas the control group had 2.3% prolonged admissions. We further found differences in common diagnoses leading to hospitalization with leading cause among refugees being skin infections whilst the gastrointestinal system was the predominant cause for admissions in the local group. Important information emerged regarding healthcare coverage. While refugee children had a coverage percentage of 76.76%, among Israeli children health care program coverage was of 98.35%.

 

Conclusions: In this retrospective study we found evidence of significant morbidity in children of refugees as compared to local Israeli Pediatric population. This is supported by higher admissions rates, younger age of admission and higher percentage in long duration of stay. Furthermore, there are major differences between the two populations in diagnosis leading to admission. With the ever growing global refugee crises generating an ever growing number of displaced children, these findings should prompt further study in order to benefit refugee children in welcoming communities worldwide.