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Biomedical subjects

Muhammad Waseem

Publications and source records attributed to Muhammad Waseem.

At least 19 recordsLinked to original sources

An unusual cause of dyspnea.

Dyspnea is an alarming symptom for both the patient and the emergency physician. There are many causes of dyspnea, some of which are life-threatening, especially in the elderly patient. In addition to the usual cardiac and pulmonary causes such as congestive heart failure, asthma exacerbation, COPD, pneumonia, and pulmonary embolism, there are less common causes of dyspnea, which if not diagnosed and managed expeditiously may have dire consequences for both the patient and physician. We present a case of an elderly patient with a life-threatening unusual cause of acute shortness of breath, a diaphragmatic hernia with sepsis.

Aged↗

Apparent life-threatening event or child abuse?

Children with apparent life-threatening events (ALTEs) often pose a diagnostic and management dilemma in a pediatric emergency department. Although the term ALTE is nonspecific and symptoms are vague, it may have alarming connotations and may signal serious life threatening conditions. It may be a subtle presentation of child abuse. We report an infant who was presented with an ALTE and subsequently determined to have subdural hematoma caused by nonaccidental injury.

Child Abuse↗

Megacolon: constipation or volvulus?

Pediatric abdominal complaints are common presentations in emergency departments, and emergency physicians are challenged every day with a vast array of gastrointestinal disorders. Differentiating the child with a benign abdominal process from the child with a more serious condition can be difficult. We report a case of massive dilatation of the colon due to fecal impaction. Means for distinguishing constipation from alternative diagnoses are discussed.

Abdominal Pain↗

Latex-induced anaphylactic reaction in a child with spina bifida.

Allergy to natural rubber latex presents a unique challenge in the emergency department. Latex allergy in children is most commonly identified in patients who have undergone multiple operations for neural tube defects or genitourinary anomalies. We report a life-threatening anaphylactic reaction to latex in a patient with spina bifida even with latex-free precautions.

Adolescent↗

Two adolescents with ectopic pregnancies: experience with methotrexate.

An ectopic pregnancy is a life-threatening form of pregnancy that is increasing in frequency especially in adolescents. Whenever a woman of childbearing age, including adolescents, presents with abdominal pain, the diagnosis of ectopic pregnancy must be considered as a possibility because if it is not diagnosed and treated expediously and appropriately, there will be considerable morbidity and mortality. Methotrexate has been shown to be effective in the management of ectopic pregnancy, but few reports are described in the literature regarding its use in teenagers. We report the cases of 2 adolescents with ectopic pregnancies who were treated successfully with methotrexate.

Abortifacient Agents, Nonsteroidal↗

Fell on outstretched hand.

Radial neck fractures in children are not uncommon. Most are minimally displaced or nondisplaced. Severely displaced fractures or angulated radial neck fractures in children often have poor outcomes, especially if not reduced, and even after open reduction.

Accidental Falls↗

Preparedness of selected pediatric offices to respond to critical emergencies in children.

OBJECTIVE: To determine the preparedness of pediatric offices that had activated emergency medical services (EMS) for a critically ill child requiring airway management. METHODS: Fifteen patients who initially presented to pediatric or family practice offices but required EMS activation and cardiac and/or respiratory support were identified from a previous prospective study of airway management in children. Two to 4 years after the emergency requiring EMS activation, the offices were contacted to complete a written survey about office preparedness for pediatric emergencies. RESULTS: Eight of 15 offices (53%) returned a survey. Pediatricians staffed all responding offices, and all offices were within 5 miles of an emergency department. Airway emergencies were the most common emergencies seen in the offices. Availability of emergency equipment and medications varied. All offices stocked albuterol, and most (7/8) had an oxygen source with a flowmeter. However, only half of the offices had a fast-acting anticonvulsant, and a quarter had no anticonvulsant. Three offices lacked bag-mask (manual) resuscitators with all appropriate sized masks, and 3 offices lacked suction. The most common reasons cited for not stocking all emergency equipment and drugs were quick response time of EMS and proximity to an emergency department. CONCLUSIONS: Even after treating a critically ill child who required advanced cardiac and/or pulmonary support, offices were ill prepared to handle another serious pediatric illness or injury.

Airway Obstruction↗

Giant bulla mimicking pneumothorax.

It is usually thought by emergency physicians that the diagnosis of a pneumothorax is straightforward and easy to make and to treat, but the diagnosis may sometimes pose a challenge. The present report describes a case of a giant pulmonary bulla in a 40-year-old man that progressed to occupy almost the entire left hemithorax and also subsequently ruptured to produce a large left pneumothorax. The giant bulla was diagnosed only as a pneumothorax, and initially managed with a chest tube only. The differentiation between pneumothorax and a giant bulla can be very difficult, and often leads to inaccurate diagnosis and management. This case report demonstrates the clinical presentation of giant bulla and its complications such as pneumothorax and also highlights the difficulty in making this diagnosis and appropriately treating it. In this article, we emphasized how to differentiate between giant bulla and pneumothorax utilizing history, physical examination, and radiological studies including computed tomography (CT) scan.

Adult↗

Two teenagers with syncope.

We report the cases of 2 teenagers with syncope and headaches who were subsequently found, on head computed tomography examinations, to have central nervous system etiologies (arteriovenous malformation and arachnoid cyst) of their syncope. These cases highlight the importance of a focused history and physical examination when evaluating patients who present with syncope.

Adolescent↗

"Doctor" or "doctora": do patients care?

BACKGROUND: The topic of gender and medical care is receiving increased attention but has not been studied in children. We noticed that several children undergoing laceration repair in emergency department requested to be sutured by a female physician. This study attempted to find gender preferences of children and parents for the physician in the emergency department. OBJECTIVE: We undertook this study to determine whether pediatric patients or their parents have a preference for physicians of a particular gender. We also tried to determine whether they would be willing to wait longer to be seen to accommodate their choice. METHODS: A total of 200 children aged between 8 and 13 years presenting to our pediatric emergency department for laceration repair were enrolled. With the knowledge and consent of their parents, the enrolled children were given a short questionnaire. They were asked, if they had a choice, would they prefer to have a male or a female doctor or would they prefer the doctor with the most experience. Their parents were also then given the questionnaire. They were also asked if they would be willing to wait longer to be seen by the doctor of their choice. RESULTS: The study sample comprised 200 children, 139 boys and 61 girls. Among boys, 78% (n = 109) said they would prefer a female physician. Only 21% (n = 30) preferred a male physician. Among girls, 80% (n = 49) reported they would prefer a female physician, 20% (n = 12) preferred a male physician. None of the children surveyed wanted the "best" physician. When the parents were surveyed, 60% (n = 120) preferred a male physician as compared with 19% (n = 38) who expressed a preference for female physician. Only 21% (n = 42) of parents desired the most experienced physician of either sex to repair the laceration. All the parents who expressed a preference for the "most experienced" physician said they were willing to wait (42/42) until that physician was available as compared with less than a third of parents who were willing to wait for the physician of a specific gender (44/158). CONCLUSIONS: Most children (79%) preferred a female physician for their sutures, whereas parents overall (60%) appeared to prefer a male physician. The children did not appear to care if the physician was the "best." Surprisingly, many parents also chose physician gender rather than physician experience. One hundred percent of the parents who chose the most experienced physician were willing to wait longer to be seen as compared with 29% who preferred a physician of a particular gender.

Adolescent↗