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1.  Cognitive schemes and strategies in diagnostic and therapeutic decision making: a primer for trainees 
Perspectives on Medical Education  2013;2(5-6):321-331.
Unlike novices, expert clinicians develop refined schemes and strategies that predictably allow them to provide a better quality, prompt and less error-prone patient care input. Empowering novices with cognitive aids or mental schemes as early as possible in their clinical career may significantly improve their critical thinking, problem-solving and decision-making skills. These cognitive aids may also improve trainees’ use of evidence-based medicine in addition to reducing their diagnostic errors and improving their therapeutic care inputs.
doi:10.1007/s40037-013-0070-3
PMCID: PMC3824754  PMID: 24203860
Schemes; Decision-making; Novices; Experts
4.  Status epilepticus and cardiopulmonary arrest in a patient with carbon monoxide poisoning with full recovery after using a neuroprotective strategy: a case report 
Introduction
Carbon monoxide poisoning can be associated with life-threatening complications, including significant and disabling cardiovascular and neurological sequelae.
Case presentation
We report a case of carbon monoxide poisoning in a 25-year-old Saudi woman who presented to our facility with status epilepticus and cardiopulmonary arrest. Her carboxyhemoglobin level was 21.4 percent. She made a full recovery after we utilized a neuroprotective strategy and normobaric oxygen therapy, with no delayed neurological sequelae.
Conclusions
Brain protective modalities are very important for the treatment of complicated cases of carbon monoxide poisoning when they present with neurological toxicities or cardiac arrest. They can be adjunctive to normobaric oxygen therapy when the use of hyperbaric oxygen is not feasible.
doi:10.1186/1752-1947-6-421
PMCID: PMC3533874  PMID: 23241416
Cardiac arrest; Carbon monoxide poisoning; Neuroprotective strategy; Seizure; Status epilepticus
5.  Are Sudanese community pharmacists capable to prescribe and demonstrate asthma inhaler devices to patrons? A mystery patient study 
Pharmacy Practice  2012;10(2):110-115.
Although community pharmacists have become more involved in the care of asthma patients, several studies have assessed pharmacists’'ability to illustrate appropriately inhalation technique of different asthma devices. Many studies addressed inappropriate use of asthma devices by patients and pharmacists, in addition to its clinical, humanistic and economic burden.
Objective
To evaluate community pharmacists' practical knowledge and skills of demonstrating proper inhalation technique of asthma inhaler devices available in Sudan.
Methods
Three hundred community pharmacies located around the three major hospitals in the capital city (Khartoum) and four other provinces were approached, and four asthma devices were assessed: Metered-dose inhaler (MDI) (n=105), MDI with Spacer (n=83), Turbuhaler (n=61), and Diskus (n=51). Investigator (a pharmacist) acted as a mystery patient. He selected one device and asked the serving pharmacist to demonstrate how to use the device. Investigator completed a checklist of 9 steps of inhaler device use immediately after leaving the pharmacy. Essential steps derived from published literature were pre-specified for each device. Five evaluation categories were accordingly formulated as follows: optimal technique, adequate technique, poor technique, totally unfamiliar with the device, and does not know.
Results
More than half of the pharmacists approached with metered dose inhaler did not know how to use optimal technique (ie all steps correct) all through. A third poorly demonstrated the technique, and only one pharmacist was categorized as being able to demonstrate an "optimal technique". The majority of pharmacists approached with spacing chamber and dry powder inhalers (Turbuhaler and Diskus) either did not know proper technique or were totally unfamiliar with the devices.
Conclusions
The majority of community pharmacists, who were expected to educate asthma patients on their dispensed inhalers, lack the basic knowledge of proper use of commonly dispensed asthma inhaler devices.
PMCID: PMC3780485  PMID: 24155826
Nebulizers and Vaporizers; Asthma; Community Pharmacy Services; Pharmacists; Patient Simulation; Sudan
7.  Systemic vasculitis with prolonged pyrexia, recurrent facial urticaria, skin nodules, pleural effusions and venous thrombosis: an unusual presentation of an uncommon disease 
Classically presenting with multiple or single peripheral cytopenias of variable severity, the myelodysplastic syndromes may occasionally present with bizarre manifestations that confuse the clinical picture and result in significant delays in making the correct diagnosis. We describe the case of an elderly male patient whose presentation with prolonged unexplained fever coupled with cutaneous, pulmonary and other systemic features of inflammation was finally diagnosed as having a primary myelodysplastic syndrome with associated vasculitis after a delay of 4 years.
doi:10.3205/000150
PMCID: PMC3198116  PMID: 22031795
myelodysplastic syndrome; vasculitis; diagnosis
8.  Raised D-dimer levels in acute sickle cell crisis and their correlation with chest X-ray abnormalities 
Objective: Quantitation of D-dimer level during a sickling crisis and its correlation with other clinical abnormalities.
Design: Prospective longitudinal study.
Setting: Armed Forces Hospital, Southern Region, Kingdom of Saudi Arabia.
Patients: Adult patients (12 years and older) admitted acutely with a sickle cell crisis who consent to taking part in the study. Candidates may re-participate if they are readmitted with a further acute painful crisis.
Results: 36 patients with homozygous sickle cell disease consented to take part in the study. D-dimer levels were raised in 31 (68.9%) of 45 episodes of painful crisis of whom 13 had an abnormal chest X-ray. Of those with a normal chest X-ray only one patient had a raised D-dimer level: sensitivity of 92.3%, specificity 40.6%, positive predictive value 38.7% and negative predictive value of 92.9% for an abnormal chest X-ray.
Conclusion: D-dimer levels are frequently raised during an acute painful crisis. A normal level has a high negative predictive value for an abnormal chest X-ray.
doi:10.3205/000114
PMCID: PMC2975260  PMID: 21063468
coagulation; hemoglobinopathy; lung; painful

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