Objectives: Anaphylaxis is an acute, life-threatening allergic reaction involving multiple systems caused by the sudden release of mediators from mast cells. This study aims to assess the current practice of emergency management of adults and children diagnosed with anaphylaxis at the Royal Hospital, against the recommendations of the National Institute for Health and Clinical Excellence (NICE) guidelines. Methods: This is an observational study of all anaphylaxis cases which took place at the emergency department (ED) during a 5-year period. Results: Of 100 patients with a preliminary diagnosis of anaphylaxis, 49% were true-anaphylaxis cases based on the WAO definition. All the 49-patients with true-anaphylaxis received adrenaline intramuscularly at ED. 24 (48.9%) of them were referred to an immunologist: 8/24 (33.3%) were adults and 16/24 (66.6%) were children. 16-children were admitted, seen by an immunologist and received an adrenaline autoinjector when indicated. 25 of the 33 adult patients (75.7%) were discharged from the ED with no onward referral to a specialist. None of the adult patients received an adrenaline autoinjector prior to discharge from ED and no one had a tryptase level checked. Conclusion: The paediatric emergency department fulfilled all the criteria for anaphylaxis management in accordance with NICE guidelines except for measuring serum tryptase where appropriate. By contrast, the adult patients were discharged from ED without an adrenaline autoinjector as an interim measure until seen by an allergist or immunologist. Therefore, education is the best strategy to improve the management of this severe and possible fatal condition.

Introduction: WHO has considered Major Congenital Anomalies (MCA) as a recognizable cause of morbidity and mortality in infants and children under five years of age. Method: This is a descriptive study of antenatal MCA over 10 years period from January 2009 to December 2018. All data were analyzed statistically using STATA software (Stata Corporation, College Station, TX). Results: During the study period, there were 147563 patients. Of which, 1502 cases found to have major congenital anomalies, among them 947 (63.05 %) fetuses with isolated major anomalies and 555 cases (36.95%) with MCA. The average antenatal prevalence of MCA for 10 years was 10.1 per 1000 pregnancies. The mean gestational age during the first visit was 27(5.5) weeks with range from 10 to 40 weeks. The maternal age was 30 (6.0) years. Coexisting maternal factors were observed in 481 (32%) of patients including gestational diabetes (8.8%), maternal age (6.59%) and recurrent early pregnancy loss (7.12%). Nervous system was the most common (29%) abnormalities observed and cardiothoracic system (24.9%) was the second most common. Perinatal outcomes showed that 9.6 % had early neonatal death, 19% had still births and 4 % had neonatal death. The perinatal mortality rate was 32.6% among fetuses with major congenital anomalies. Conclusions: The prevalence of major congenital anomalies in our papulation is double the international figures. This study emphasizes the need of national surveillance system and database for congenital anomalies and efforts should be focused in rising awareness of the occurrence and risk factors of congenital anomalies.