Epidemiology and outcomes from severe hypoglycemia in Kuwait: a prospective cohort study.

BACKGROUND: The objective of this study was to describe the epidemiology of severe hypoglycaemia in Kuwait, aiming to provide a preliminary background to update the current guidelines and improve patient management. METHOD: This was a prospective analysis of severe hypoglycaemia cases retrieved from emergency medical services (EMS) archived data between 1 January and 30 June 2020. The severe hypoglycaemia cases were then sub-grouped based on EMS personal initial management and compared in terms of scene time, transportation rate, complications and outcomes. The primary outcomes were GCS within 10-30 min and normal random blood glucose (RBS) within 10-30 min. RESULTS: A total of 167 cases met the inclusion criteria. The incidence of severe hypoglycaemia in the national EMS was 11 per 100,000. Intramuscular glucagon was used on scene in 89% of the hypoglycaemic events. Most of the severe hypoglycaemia patients regained normal GCS on scene (76.5%). When we compared the two scene management strategies for severe hypoglycaemia cases, parenteral glucose administration prolonged the on-scene time (P = .002) but was associated with more favourable scene outcomes than intramuscular glucagon, with normal GCS within 10-30 min (P = .05) and normal RBS within 10-30 min (P = .006). CONCLUSION: Severe hypoglycaemia is not uncommon during EMS calls. Appropriate management by EMS personals is fruitful, resulting in favourable scene outcomes and reducing the hospital transportation rate. More research should be invested in improving and structuring the prehospital management of severe hypoglycaemia. One goal is to clarify the superiority of parenteral glucose over intramuscular glucagon in the prehospital setting.

The epidemiology of food allergy in primary care clinic: A cross-sectional study.

Food allergy (FA) is an increasing global public health concern. Little is known about FA counsel in primary care clinics. The objective of this study is to describe the characteristics of FA in primary care clinics. It also aims to report the national primary care physicians' current knowledge and practices. An electronic cross-sectional questionnaire was distributed to primary care physicians working at the Ministry of Health primary care clinics, across Kuwait's' 6 health districts, between May and June 2023. The questionnaire was made of 3 sections: participants' demographic, FA counsel characteristics, participants' knowledge and practices during FA counsel, and 37 variable tools. Eight-seven percent of primary care physicians counseled a patient with FA within the last 12 months. Most FA patients were children and infants. Approximately 2 out of 10 primary physicians counseled > 1 FA case/week. Prevalence of clinical presentation was: angioedema (23%), many skin hives (21%), few skin hives (19%), and mouth itch (9.4%). Prevalence of allergens was; peanuts (46%), shellfish (37%), eggs (36%), and tree nuts (36%), respectively. The mean of primary care physicians' correct answers about FA was 58% and only 26% of primary care physicians acquired a sufficient amount of knowledge about FA, scoring above 67%. Their Knowledge scores about FA: clinical presentation 7 ±â€…1.6, diagnostic tests 2 ±â€…1, treatment 2.6 ±â€…1, and prevention 3 ±â€…1. In practice, correct treatment was offered by 30% of physicians, and 55% made the right referrals 86% are longing for training about FA. FA is a common counsel in primary care clinics. The most common FA presentation is a severe allergic reaction in the pediatric population. The current primary care physicians have insufficient knowledge about counseling FA and long for further training. Collectively, protocols and training for FA counseling should be launched in primary care.

Medical Emergencies Requiring First Aid at Home: A Population-Based Survey Study.

BACKGROUND: Most medical emergencies requiring first-aid occur at home. Little is known about the prevalence of these medical emergencies. OBJECTIVE: The objective of this study is to describe medical emergencies occurring at people's homes requiring first aid; characteristics, burdens and impact on functional outcome, and to address the national public knowledge and practice of first aid. METHOD: A confidential, cross-sectional survey, primarily based on the 2015 American Heart Association (AHA) and American Red Cross first aid guidelines, was conducted among adults (>18 years) from 12 educational centers, under the Ministry of Awqaf and Islamic affairs, State of Kuwait. RESULTS: A total of 3000 self-administered questionnaires were distributed from September 16 2019 to November 30, 2019. The response rate was 34% (n = 1033 participants) of which 1% (n = 11) were partially answered questionnaires leaving 1022 questionnaires for valid statistical analysis. The prevalence of medical emergencies was 118.5 out of 100000 per year and the level of public knowledge was 19%. Medical emergencies were more likely to occur in Hawali province (49%, n = 149), women were more likely to encounter medical emergencies (78%, n = 238). Victims above 18 years of age were more likely to experience hypoglycemia (39%, n = 55) and children were more likely to suffer from hypoglycemia (19%, n = 22) or burns (17%, n = 20). Compliance with First aid guidelines was seen in hypoglycemia (31%, n = 44) but lacking in burn incidents (44%, n = 15). Participants called the ambulance in seizures (50%, n = 13), with 62% of medical emergencies requiring attendance at a health-care facility and 29% requiring hospital admission. Of the victims, 15% missed school or a day of work, and 25% had impaired functional outcomes. CONCLUSION: Medical emergencies occurring at home are relatively common in Kuwait, and public training on first aid is low. Kuwait has unique medical emergencies, with hypoglycemia, seizures and burns being the most frequent emergencies that occur at home. These emergencies cause a burden on the health-care system with a quarter of them having negative impact on the victim's functional outcome.

Out-of-hospital cardiac arrest in countries of the Gulf Cooperation Council: a scoping review.

BACKGROUND: Published data are lacking on response to and outcomes of out-of-hospital cardiac arrest in the Middle East. What data there are have not been comprehensively analysed. AIMS: This study aimed to assess the characteristics of people with out-of-hospital cardiac arrest in Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and United Arab Emirates) and the response to and outcomes of such incidents. METHODS: This was a scoping review of published and grey literature on out-of-hospital cardiac arrest in GCC countries from 1990 to June 2019. Studies in English and Arabic were eligible for inclusion. MEDLINE, CINAHL, Web of Science and EMBASE were searched as well as relevant non-indexed journals. Google searches were also done. References of included studies were scanned for relevant articles. Experts on the subject in the region were consulted. RESULTS: Of 647 citations retrieved, 24 studies were included for data extraction and analysis. No literature was identified for Bahrain. People with out-of-hospital cardiac arrest in the region were younger, predominantly male and had more comorbidity than reported in other regions of the world. Use of emergency medical services was low across the GCC countries, as was bystander cardiopulmonary resuscitation, return of spontaneous circulation and survival to discharge. CONCLUSIONS: A coordinated effort to address out-of-hospital cardiac arrest, including the generation of research, is lacking within and among GCC countries. Establishment of lead agencies responsible for developing and coordinating strategies to address out-of-hospital cardiac arrest, such as community response, public education and reporting databases, is recommended.

Epidemiology and Outcomes from Out-of-Hospital Cardiac Arrest in Kuwait.

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) survival remains low in most countries. Few studies examine OHCA outcomes out of the Middle East region. This is the first study to describe characteristics and outcomes of patients with OHCA treated by emergency medical services (EMS) in regions of Kuwait. OBJECTIVES: To describe characteristics and outcomes of adult patients affected with OHCA in regions of Kuwait. METHODS: This was a retrospective observational study on all adult OHCA patients transported by EMS to regional emergency departments over a 10- month period (21 February-31 December 2017). Data were collected from various sources: national emergency medical services archived data, emergency department, intensive care unit, and cardiac care unit of two hospitals. RESULTS: A total of 332 EMS-treated OHCA cases were reviewed, and 286 incidents with OHCA from cardiac aetiology were included in the study. Most were non-Kuwaiti (60.8%) males (67.1%) with mean age 61 (+-16) years. Most OHCA cases occurred at home (76%) but with low witness rate (11.5%). Bystander CPR rate was low (8.7%). ROSC was achieved in ten patients (3.5%), but only 1 (0.3%) patient survived to hospital discharge. CONCLUSION: OHCA survival rates in this region of Kuwait are low. Targeted measures such as creating cardiac registry, dispatcher-assisted CPR with ongoing training and quality improvement, and community-based CPR education program are needed to improve the survival rates of OHCA victims.