A comparative, epidemiological study of acute renal colic presentations to emergency departments in Doha, Qatar, and Melbourne, Australia

Abstract

BackgroundThis study aimed to compare the epidemiology, clinical presentations, management, and outcomes of renal colic presentations in two major academic centers from geographically diverse populations: Qatar (a country in the Afro-Asian stone belt) and South-Eastern Australia (not within a stone belt).MethodsWe undertook a retrospective cohort study of patients with renal colic who presented to the Hamad General Hospital Emergency Department (HGH-ED), Qatar, and The Alfred ED, Melbourne, Australia, during a period of 1 year from August 1, 2012, to July 31, 2013. Cases were identified using ICD-9-CM codes, and an electronic template was used to record the data on predefined clinical variables.ResultsA total of 12,223 from the HGH-ED and 384 from The Alfred ED were identified as renal colic presentations during the study period. The rate of renal colic presentations at the HGH-ED was 27.9 per 1000 ED visits compared to 6.7 per 1000 ED visits at The Alfred ED. Patients presenting to the HGH-ED were significantly younger [34.9 years (29.0–43.4) than The Alfred ED [48 years (37–60); P < 0.001].The median stone size was larger in the HGH-ED group [6 (4–8) mm] versus The Alfred ED group [4 (3–6) mm, P < 0.001]. The intervention rate in the stone-positive population was significantly higher in the HGH-ED group as opposed to The Alfred ED group (38.7 versus 11.9%, P < 0.001). At the time of discharge, The Alfred ED group received fewer analgesic prescriptions (55.8 versus 83.5%, P < 0.001) and more tamsulosin prescriptions (25.3 versus 11.7%, P < 0.001).ConclusionsRenal colic presentations to the HGH-ED, Qatar, were younger, with larger stone size mostly located in the lower ureter, compared to The Alfred ED, Melbourne, Australia. The findings suggest that the benefits of treatment including medical expulsion therapy will vary between the two populations. Differences in epidemiology and patient mix should be considered while tailoring strategies for effective management of patients with renal colic in a given setting.

A rare case of multi-focal non-contiguous necrotizing soft tissue infections and literature review

“…NF can be classified into four types: type I, polymicrobial (at least one anaerobic species in combination with one or more facultative anaerobic species); type II, monomicrobial infection, most commonly by Group A Streptococci (less frequently other Streptococci or Staphylococci); type III, monomicrobial, usually Gram negative, including marine organisms; and type IV, fungal. The common sites of NF are the upper limb (10–48%), lower extremities (28%), perineum (21%) or trunk (18%), from which it expand to contiguous areas [2].…”

“…The incidence rate is one in 100 000 with mortality rate between 40–70% [1]. The typical finding that should raise suspicion is severe pain that is disproportional to examination findings, accompanied by local oedema and erythema which can rapidly spread and lead to sudden clinical deterioration [2]. Multi-focal non-contiguous necrotizing fasciitis (NF) is extremely rare, and the atypical presentation involving multiple sites can be challenging and misleading for diagnosis and may lead to delay in management.…”

Emergency medicine clerkship curriculum in a high-income developing country: methods for development and application

“…Another advantage of online learning environment in our curriculum is to provide continuous feedback to students. One of the significant advantages of using e-learning tools in our clerkship was guiding the students with continuous feedback regarding their e-Portfolio logs to achieve the curriculum recommendations [ 50 ]. Medical students highly valued the use of e-learning platforms even in the clinical skills education [ 51 ].…”

Diagnostic role of ultrasonography and X-RAY combined versus intravenous urography in evaluation of renal colic.

“…Average prevalence of renal colic worldwide is 5-15% which varies according to distribution of disease in different geographical areas. 1 Its incidence varies with seasonal temperature variations but definitive association of temperature variations with renal colic has not been studied worldwide. 2 Acute renal colic is an emergency condition and should be treated immediately.…”