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EMERGENCY AND INTENSIVE CRITICAL CARE (121 journals)                     

Showing 1 - 124 of 124 Journals sorted alphabetically
AACN Advanced Critical Care     Full-text available via subscription   (Followers: 36)
Academic Emergency Medicine     Hybrid Journal   (Followers: 90)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acute and Critical Care     Open Access   (Followers: 9)
Acute Cardiac Care     Hybrid Journal   (Followers: 11)
Acute Medicine     Full-text available via subscription   (Followers: 8)
Advances in Emergency Medicine     Open Access   (Followers: 16)
Advances in Neonatal Care     Hybrid Journal   (Followers: 43)
African Journal of Anaesthesia and Intensive Care     Full-text available via subscription   (Followers: 7)
African Journal of Emergency Medicine     Open Access   (Followers: 7)
AINS - Anasthesiologie - Intensivmedizin - Notfallmedizin - Schmerztherapie     Hybrid Journal   (Followers: 5)
American Journal of Emergency Medicine     Hybrid Journal   (Followers: 54)
Annals of Emergency Medicine     Hybrid Journal   (Followers: 126)
Annals of Intensive Care     Open Access   (Followers: 37)
Annals of the American Thoracic Society     Full-text available via subscription   (Followers: 15)
Archives of Academic Emergency Medicine     Open Access   (Followers: 6)
Archives of Trauma Research     Open Access   (Followers: 4)
ASAIO Journal     Hybrid Journal   (Followers: 2)
Australasian Journal of Paramedicine     Open Access   (Followers: 7)
Australian Critical Care     Full-text available via subscription   (Followers: 21)
Bangladesh Critical Care Journal     Open Access   (Followers: 1)
BMC Emergency Medicine     Open Access   (Followers: 25)
BMJ Quality & Safety     Hybrid Journal   (Followers: 65)
Burns Open     Open Access  
Canadian Journal of Respiratory, Critical Care, and Sleep Medicine     Hybrid Journal   (Followers: 2)
Case Reports in Acute Medicine     Open Access   (Followers: 3)
Case Reports in Critical Care     Open Access   (Followers: 13)
Case Reports in Emergency Medicine     Open Access   (Followers: 19)
Chronic Wound Care Management and Research     Open Access   (Followers: 7)
Clinical and Applied Thrombosis/Hemostasis     Open Access   (Followers: 32)
Clinical Intensive Care     Hybrid Journal   (Followers: 6)
Clinical Medicine Insights : Trauma and Intensive Medicine     Open Access   (Followers: 3)
Clinical Risk     Hybrid Journal   (Followers: 5)
Crisis: The Journal of Crisis Intervention and Suicide Prevention     Hybrid Journal   (Followers: 15)
Critical Care     Open Access   (Followers: 74)
Critical Care and Resuscitation     Full-text available via subscription   (Followers: 29)
Critical Care Clinics     Full-text available via subscription   (Followers: 34)
Critical Care Explorations     Open Access   (Followers: 3)
Critical Care Medicine     Hybrid Journal   (Followers: 279)
Critical Care Research and Practice     Open Access   (Followers: 13)
Current Emergency and Hospital Medicine Reports     Hybrid Journal   (Followers: 5)
Current Opinion in Critical Care     Hybrid Journal   (Followers: 73)
Disaster and Emergency Medicine Journal     Open Access   (Followers: 12)
Egyptian Journal of Critical Care Medicine     Open Access   (Followers: 2)
EMC - Urgenze     Full-text available via subscription  
Emergency Care Journal     Open Access   (Followers: 7)
Emergency Medicine (Medicina neotložnyh sostoânij)     Open Access  
Emergency Medicine Australasia     Hybrid Journal   (Followers: 17)
Emergency Medicine Clinics of North America     Full-text available via subscription   (Followers: 19)
Emergency Medicine International     Open Access   (Followers: 8)
Emergency Medicine Journal     Hybrid Journal   (Followers: 53)
Emergency Medicine News     Full-text available via subscription   (Followers: 7)
Emergency Nurse     Full-text available via subscription   (Followers: 17)
Enfermería Intensiva (English ed.)     Full-text available via subscription  
European Burn Journal     Open Access   (Followers: 10)
European Journal of Emergency Medicine     Hybrid Journal   (Followers: 23)
Frontiers in Emergency Medicine     Open Access   (Followers: 8)
Global Journal of Transfusion Medicine     Open Access   (Followers: 1)
Hong Kong Journal of Emergency Medicine     Full-text available via subscription   (Followers: 5)
Indian Journal of Burns     Open Access   (Followers: 2)
Injury     Hybrid Journal   (Followers: 20)
Intensive Care Medicine     Hybrid Journal   (Followers: 82)
Intensive Care Medicine Experimental     Open Access   (Followers: 2)
Intensivmedizin up2date     Hybrid Journal   (Followers: 4)
International Journal of Critical Illness and Injury Science     Open Access   (Followers: 1)
International Journal of Emergency Medicine     Open Access   (Followers: 9)
International Journal of Emergency Mental Health and Human Resilience     Open Access   (Followers: 2)
International Paramedic Practice     Full-text available via subscription   (Followers: 14)
Iranian Journal of Emergency Medicine     Open Access  
Irish Journal of Paramedicine     Open Access   (Followers: 2)
Journal Européen des Urgences et de Réanimation     Hybrid Journal   (Followers: 1)
Journal of Acute Care Physical Therapy     Hybrid Journal   (Followers: 3)
Journal of Cardiac Critical Care TSS     Open Access   (Followers: 1)
Journal Of Cardiovascular Emergencies     Open Access  
Journal of Concussion     Open Access  
Journal of Critical Care     Hybrid Journal   (Followers: 48)
Journal of Critical Care Medicine     Open Access   (Followers: 18)
Journal of Education and Teaching in Emergency Medicine     Open Access   (Followers: 1)
Journal of Emergencies, Trauma and Shock     Open Access   (Followers: 13)
Journal of Emergency Medical Services     Full-text available via subscription   (Followers: 12)
Journal of Emergency Medicine     Hybrid Journal   (Followers: 53)
Journal of Emergency Medicine, Trauma and Acute Care     Open Access   (Followers: 25)
Journal of Emergency Practice and Trauma     Open Access   (Followers: 6)
Journal of Intensive Care     Open Access   (Followers: 9)
Journal of Intensive Care Medicine     Hybrid Journal   (Followers: 22)
Journal of Intensive Medicine     Open Access  
Journal of Neuroanaesthesiology and Critical Care     Open Access   (Followers: 3)
Journal of Stroke Medicine     Hybrid Journal  
Journal of the American College of Emergency Physicians Open     Open Access   (Followers: 1)
Journal of the Intensive Care Society     Hybrid Journal   (Followers: 4)
Journal of the Royal Army Medical Corps     Hybrid Journal   (Followers: 6)
Journal of Thrombosis and Haemostasis     Hybrid Journal   (Followers: 81)
Journal of Translational Critical Care Medicine     Open Access   (Followers: 5)
Journal of Trauma and Acute Care Surgery, The     Hybrid Journal   (Followers: 34)
La Presse Médicale Open     Open Access  
Médecine de Catastrophe - Urgences Collectives     Hybrid Journal  
Medicina Intensiva     Open Access   (Followers: 3)
Medicina Intensiva (English Edition)     Hybrid Journal   (Followers: 1)
Mediterranean Journal of Emergency Medicine & Acute Care : MedJEM     Open Access  
Notfall + Rettungsmedizin     Hybrid Journal   (Followers: 3)
OA Critical Care     Open Access   (Followers: 3)
OA Emergency Medicine     Open Access   (Followers: 2)
Open Access Emergency Medicine     Open Access   (Followers: 6)
Open Journal of Emergency Medicine     Open Access   (Followers: 2)
Palliative Care : Research and Treatment     Open Access   (Followers: 19)
Palliative Medicine     Hybrid Journal   (Followers: 54)
Prehospital Emergency Care     Hybrid Journal   (Followers: 19)
Regulatory Toxicology and Pharmacology     Hybrid Journal   (Followers: 41)
Research and Opinion in Anesthesia and Intensive Care     Open Access   (Followers: 3)
Resuscitation     Hybrid Journal   (Followers: 54)
Resuscitation Plus     Open Access   (Followers: 2)
Saudi Critical Care Journal     Open Access   (Followers: 2)
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine     Open Access   (Followers: 11)
Seminars in Thrombosis and Hemostasis     Hybrid Journal   (Followers: 46)
Shock : Injury, Inflammation, and Sepsis : Laboratory and Clinical Approaches     Hybrid Journal   (Followers: 10)
Sklifosovsky Journal Emergency Medical Care     Open Access  
The Journal of Trauma Injury Infection and Critical Care     Full-text available via subscription   (Followers: 24)
Therapeutics and Clinical Risk Management     Open Access   (Followers: 2)
Transplant Research and Risk Management     Open Access  
Trauma Case Reports     Open Access   (Followers: 1)
Trauma Monthly     Open Access   (Followers: 3)
Visual Journal of Emergency Medicine     Full-text available via subscription   (Followers: 1)
Western Journal of Emergency Medicine     Open Access   (Followers: 11)
 AEM Education and Training : A Global Journal of Emergency Care     Open Access   (Followers: 1)


Similar Journals
Journal Cover
Journal of Emergency Medicine, Trauma and Acute Care
Journal Prestige (SJR): 0.102
Number of Followers: 25  

  This is an Open Access Journal Open Access journal
ISSN (Print) 1999-7086 - ISSN (Online) 1999-7094
Published by QScience Homepage  [13 journals]
  • The World Society of Emergency Surgery Sepsis Severity Score shows no
           prognostic superiority over the Mannheim Peritonitis Index in patients
           with complicated intra-abdominal infections

    • Authors: Evgeni Dimitrov; Georgi Minkov, Emil Enchev Yovcho Yovtchev
      Abstract: Introduction: Although various scoring systems are already available for early prognostic evaluation of patients with complicated intra-abdominal infections (cIAIs), none has shown the ideal characteristics in everyday practice. In this study, we aimed to find the most reliable prognostic score in patients with cIAIs. Methods: This retrospective study involved 110 patients with cIAIs admitted to the Department of Surgical Diseases at University Hospital, “Prof. Dr. Stoyan Kirkovich” Stara Zagora from January 2017 to July 2019. We compared the prognostic values of Mannheim Peritonitis Index (MPI), World Society of Emergency Surgery Sepsis Severity Score (WSES SSS), quick sequential (sepsis-related) organ failure assessment score (qSOFA), and systemic inflammatory response syndrome (SIRS) using area under receiver operating characteristics (AUROC) curves. Bivariate correlation analysis was used to evaluate the association between scoring systems and the final outcome. Results: The observed in-hospital mortality was 22.7%. Significant correlations were found between MPI and outcome (r = 0.500, p <  0.001), WSES SSS and outcome (r = 0.483, p <  0.001), and qSOFA and outcome (r = 0.356, p <  0.001). Of all the scoring systems, MPI showed the best prognostic performance (AUROC = 0.844, 95% confidence interval (CI) = 0.763–0.924). The identified sensitivity and specificity for MPI cut-off value >25 points were 80% and 77.6%, respectively. Conclusion: The MPI is still one of the best options for prognostic evaluation of patients with cIAIs.
      PubDate: 2022-07-22T00:00:00Z
  • Retrospective application and validation of Tokyo 18 guidelines for
           diagnosis and stratification of acute cholangitis in Qatar

    • Authors: Mohamed Said Ghali; Omer Al-Yahri, Mahmood Al Dhaheri, Amjad Ali Shah, Ali Toffaha, Rajvir Singh Ahmad Zarour
      Abstract: Background: Acute cholangitis (AC) is a life-threatening condition with a mortality risk of 8%–10%. Despite no gold standard for diagnosis, Charcot's triad was introduced to diagnose AC. However, the triad had a low sensitivity (50%–70%). Recently, Tokyo guidelines (TG) for the diagnosis of AC gained international recognition for their excellent diagnostic rate. Objective: In this study, we aimed to apply TG18 guidelines in a retrospective manner to diagnose AC in Qatar to validate TG18. Methods: This retrospective observational study recruited 295 patients with clinically proven AC between January 2016 and July 2018. Results: Of the 213 patients, 72.2% were men. The mean age was 51.4 ± 17.5 years. The most common co-morbidity was hypertension (36.3%). Common bile duct stones were the most common cause of biliary obstruction found in 165 (55.9%) patients. The diagnostic rate of TG18 was 91.9% in contrast to Charcot's triad (34.9%). By TG18 grading, 150 (50.8%) patients were grade I. ERCP was done in 62% patients, and 52.5% of them were grade I. Conclusion: AC management in Qatar meets the international standards with a low mortality rate. TG18 guidelines had a high diagnostic rate among our patient population.
      PubDate: 2022-07-18T00:00:00Z
  • Comparing nebulized ketamine with Entonox for acute traumatic pain in the
           Emergency Department: A pilot randomized trial

    • Authors: Cangitaa Arumugam; Nik Azlan Nik Muhamad
      Abstract: Background: In this study, we compared the efficacy, patient satisfaction, and adverse effects of nebulized ketamine to those of Entonox in reducing acute traumatic pain in the Emergency Department. Methods: This was a randomized, single-centre pilot study. Eligible patients were selected from triage and divided into two groups which was nebulized ketamine and Entonox. Nebulized ketamine 50 mg (mean 0.7 mg/kg for an average adult) was administered in a concentration of 5 mL of 10 mg/mL diluted with 1 mL normal saline in a nebulizer. Entonox delivery was self-regulated by the patients. The primary outcome was efficacy of pain reduction according to the visual analogue scale (VAS) in 30 minutes. Adverse effects were monitored in both the groups. Results: A total of 26 patients were divided equally into two groups with n = 13 for each group. Mean reduction in VAS after 5 and 30 minutes was 0.62 ± 0.77 mm and 28.5 ± 12.1 mm for nebulized ketamine and 0.46 ± 0.78 mm and 30 ± 5.8 mm for Entonox. No significant difference was seen in pain reduction (5 min p = 0.616, 30 min p = 0.684). Mean satisfaction with analgesia according to a Likert scale of 1 to 6 was ketamine 4.92 ± 0.64 and Entonox 5.0 ± 0.41 (p = 0.718). No serious adverse events were reported. Conclusion: Nebulized ketamine is a comparable substitute to Entonox in managing acute traumatic pain in the Emergency Department. Further studies are required on the use of inhaled ketamine as an adjunct in managing severe pain and reducing the need for opioids.
      PubDate: 2022-07-13T00:00:00Z
  • JEMTAC and global sharing of science – without limits

    • Authors: Sandro Rizoli; Hassan Al Thani
      PubDate: 2022-07-13T00:00:00Z
  • Awake prone position for COVID-19 pneumonia patients: A prospective
           analysis at a tertiary care center

    • Authors: Omar Albaroudi; Bilal Albaroudi, Kaleem Basharat, Mahmoud Haddad, Mohamad Talal Basrak, Hussam Elmelliti, Stephen H. Thomas Tim Harris
      PubDate: 2022-07-13T00:00:00Z
  • Value of project management during a crisis: Successes and lessons from
           three large projects in Qatar

    • Authors: Yasmin Ali Morad; Arun Chandrashekhar
      Abstract: Background: The coronavirus disease 2019 (COVID-19) pandemic has tested the limits of national public health infrastructures to an unprecedented extent. A huge challenge has been regarding how to safely manage large public gatherings and how to efficiently administer vaccines to a large population. Method: We evaluated three case studies in project management implemented by the Primary Healthcare Corporation (PHCC) over the course of 2020 and 2021, including: COVID-19 screening for the HH Amir Cup and Asian Football Confederation (AFC) Finals 2020, the FIFA Club World Cup 2020, and finally Qatar's National COVID-19 Mass Vaccination Project in the Qatar National Convention Centre (QNCC) in 2021. Results: The key themes arising from all the three projects include the importance of developing a strategic plan, project management planning, clarifying and communicating roles and responsibilities, situational decision making, strong leadership, flexibility, result orientation in implementing the project, strong logistical support for providing necessary resources on the ground, and ensuring that staff at all levels are fully supported in performing their duties. In addition, the project management team was successful in building knowledge and experience across events with each successive project benefitting from lessons learned from previous projects. As a result of the strong record of project management established over the course of these experiences, PHCC was able to successfully manage the mass vaccination project with a high level of efficiency in comparison to similar national programs implemented elsewhere, both regionally and globally. Conclusion: The successful implementation of these projects, maintaining a high level of client and staff safety and satisfaction, demonstrates the value of project planning and continuous monitoring in successful implementation even in the context of uncertain conditions such as a global pandemic. Public and community health authorities may benefit by applying similar principles as the COVID-19 pandemic continues to unfold.
      PubDate: 2022-07-13T00:00:00Z
  • Severity of SARS-CoV-2 infection in vaccinated and unvaccinated patients

    • Authors: Sabah MH Zangana
      Abstract: Background: Vaccination proved useful in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection; however, there were instances of breakthrough infection occurred. Unvaccinated people are liable to have a severe infection while infection in vaccinated people has different outcomes, especially in relation to the type of vaccine. In this study, we aimed to assess the severity of the disease in unvaccinated people and the severity of break through infection in vaccinated people in relation to the type of vaccines available in Iraq. Method: Two groups of Iraqi patients were studied, of which the first included 8,096 patients with COVID-19 pneumonia, including their vaccination status; and the second group included 1,124 patients who received the vaccine and developed the disease later. The severity of infection in these groups in relation to the three types of vaccine administered in Iraq was evaluated. Results: Among the 8,096 patients who developed severe and critical COVID-19 pneumonia, most (96%) were not vaccinated. Among 1,124 patients who received the vaccine and developed breakthrough infection, Sinovac was associated with mild cases while Pfizer and AstraZeneca were associated with moderate and severe cases. Conclusion: Infection in unvaccinated people tended to be more severe and critical than that in vaccinated people, where it was mild or moderate. Of the vaccines given in Iraq, Sinopharm appeared to be superior to the other two in terms of breakthrough infection.
      PubDate: 2022-07-12T00:00:00Z
  • Appendiceal Tourniquet, an extremely rare condition with an equally rare
           presentation: A case report and an integrative review

    • Authors: Shah Touseef Arajmand; Yaqoob Hassan
      Abstract: Small bowel obstruction is a common surgical emergency and needs timely intervention to prevent the development of complications. Acute appendicitis is a very rare, uncommon, and unnoticed cause of intestinal obstruction. Although functional obstruction due to paralytic ileus is common in acute appendicitis, mechanical obstruction is a fairly uncommon complication of this extremely prevalent disease. Furthermore, a normal appendix causing full-blown small bowel obstruction due to the tourniquet effect on the terminal ileum is exceptionally rare and the diagnosis is often overlooked. This work report on an extremely rare case of mechanical small bowel obstruction caused by a normal appendix forming tourniquet around an ileum loop. A 40-year-old male patient presented with clinical manifestations of small bowel obstruction, and the appendiceal tourniquet was discovered to be the cause during laparotomy. The patient was subjected to an appendectomy. The histopathological examination of the specimen reported normal appendiceal morphology. The case is unique in that it is the first report of a mechanical small bowel obstruction caused by an appendiceal tourniquet with normal histopathology.
      PubDate: 2022-07-07T00:00:00Z
  • Inter-facility transfer for patients with STEMI in Bahrain:
           Characteristics and timings

    • Authors: Feras H. Abuzeyad; Mohammed Amin, Yasser Chomayil, Moonis Farooq, Leena Alqasem, Priya Das, Daya Ram Makwana, Wael Kamkoun, Sujith Nair Ahmed ElHobi
      Abstract: Background: The outcomes of patients with ST-elevation myocardial infarction (STEMI) transferred to percutaneous coronary intervention (PCI) facility is strongly related to certain demographic and clinical factors, important timelines, door-to-electrocardiography (ECG) time, door-in door-out (DIDO) time, door to balloon time (DTBT), the use of emergency medical services (EMS), and the existence of a STEMI network. In the study, we examined the inter-facility transfer for patients with STEMI analyzing certain characteristics and timings between the involved institutions. Method: This was a retrospective observational study on the inter-facility transfer of patients with STEMI admitted between January 01, 2018, and December 31, 2019. The electronic medical records of both the institutions were used to collect data on patient demographics, clinical characteristics and scores, ECG manifestations, laboratory values, treatment interventions, and outcomes with a major focus on the timelines for door-to-ECG, DIDO, and DTBT. Results: A total of 141 patients with STEMI who were transferred to a PCI center were included in this study. Their mean age was 52.26 ± 12.45 years and were mainly men (87.9%, p <  0.001). Men developed STEMI at a younger mean age (53.15 ± 12.53 years, p = 0.003). Chest pain was the most common notable symptom (129, 91.5%). Diabetes mellitus (DM) and hypertension were noted to be the comorbid factors in a majority of patients (70, 49.6%). Only 47 patients (33.3%, p <  0.001) were brought by EMS. Mean door-to-ECG and DIDO times were 8 minutes (IQR: 4–12) and 32.5 minutes (IQR: 24–46), respectively. Only 112 patients (79.4%) underwent PCI on arrival with a DTBT of 90 minutes (IQR: 70.5–105). Only door-to-ECG time and DTBT could be attained as required in this study (p <  0.001). Conclusion: This study reveals a few beneficial statistics for the inter-facility transfer of patients with STEMI concerning their demographics, clinical characteristics, and important timelines. The door-to-ECG time, DTBT, and DIDO time were in the considerable recommended time, and this reflects the importance of establishing a STEMI network.
      PubDate: 2022-07-07T00:00:00Z
  • Fish skin as a biological dressing for burn injuries

    • Authors: Adel Kotkot; Saif Ghabisha, Faisal Ahmed, Saleh Al-wageeh, Ebrahim Al-shami, Abdu Al-hajri, Waleed Aljbri Fawaz Mohammed
      Abstract: Background: Recently, biological dressings have become popular in treating burn injuries. Fish skin has non-infectious microbiota, high levels of type 1 and type 3 collagen, and a structural property similar to human skin, making it a promising xenograft for managing burn wounds. In this study, we aimed to evaluate the effectiveness of fish skin as a physiological dressing cover in patients with burn injuries. Method: From June 2017 to June 2021, 18 patients who were admitted to our center within 3 days from a thermal injury, burns with a partial thickness of approximately 20% of the total body surface area (TBSA) or complete partial-thickness burns ranging from 5% to 15% of the TBSA, and treated with the Shaour (Lethrinus lentjan) fish skin xenografts were enrolled in this retrospective study. The demographic characteristics of the participants, wound healing process, and final outcome were analyzed. Results: The mean age of the patients was 31.86 ± 9.14 years (range 19–46) which encompassed 12 (66.7%) men and 6 (33.3%) women. Superficial partial-thickness burns were seen in 13 (72.2%) patients, whereas full-thickness burns were seen in five (27.8%) patients. The mean time to 90% epithelialization and 100% epithelialization were 11.05 ± 2.57 days and 17.27 ± 2.05 days, respectively. The mean pain scores were 6.94 ± 0.72 and 5.22 ± 0.64 on days 7 and 15, respectively. Neither negative consequence nor allergic reaction was associated with using the fish skin grafts. The main reduction in the pain score from the first visit (7 days) to the second visit (15 days) was 1.72 ± 0.95 (p <  0.001). Conclusion: Acellular fish skin is a useful tool for wound healing treatment in complete and partial thickness burns. To validate this result, prospective cohort studies with long-term post-procedural follow-up are needed.
      PubDate: 2022-07-05T00:00:00Z
  • Penetrating trauma to scrotum and penis caused by a gunshot in 17-year old
           man: A case report

    • Authors: Saif Ghabisha; Faisal Ahmed, Saleh Al-wageeh, Ebrahim Al-shami, Qasem Alyhari, Menawar Dajenah Fawaz Mohammed
      Abstract: Penetrating trauma to male external genitalia is a rare trauma case. It accounts for 20% of all genitourinary trauma cases, and penile involvements are presented between 10- 16% of all cases. Male genital trauma is considered a urological emergency due to the high risk of infection, sexual dysfunction, and infertility. In this work, a 17-year-old male patient presented with scrotal and penile injuries due to a low-velocity gunshot wound. Genital examination revealed tissue loss in the foreskin, glans, anterior urethra (distal third), cavernous corpora, and total loss of right testis with a scrotal laceration. The patient was treated with partial penectomy, penile reconstruction, and urethral repair with an excellent uneventful postoperative cosmetic and functional outcome. In conclusion, penetrating male external genital injuries are rare with extremely serious consequences due to the functional, psychological, and aesthetic consequences. The best treatment with penile reconstruction and urethral and cavernous corpora repair may be achieved.
      PubDate: 2022-07-05T00:00:00Z
  • Methemoglobinemia induced by Dapsone: A case report

    • Authors: Mohamed Z. Peediyakkal; Mohamad Y. Khatib, Moustafa S. Elshafei, Dore C. Ananthegowda, Hani El Zeer, Karimulla S. Shaik, Aans Baiou, Nevin Kannappilly, Solaiman Allafi, Arunkumar Venkatesan Abdulqadir J. Nashwan
      Abstract: Many drugs can cause methemoglobinemia, and dapsone is one of the most familiar. Dapsone is used to treat skin disorders like leprosy, and infections like Pneumocystis jiroveci pneumonia. It is also used off-label in conditions like dermatitis herpetiformis, and relapsing polychondritis. In this case report, a 26-year-old male presented to the emergency department with fever and generalized weakness complaints. He was on treatment for lepromatous leprosy with dapsone, clofazimine, and rifampicin. His room air oxygen saturation was 80 %, so he was started on high-flow oxygen therapy and vitamin C. His blood gas and methemoglobin levels were frequently monitored till the methemoglobin level was normal. By the third day, he maintained his saturation above 95% on room air. The results in this work emphasize the importance of evaluating hypoxia for uncommon causes like methemoglobinemia as misdiagnosis can lead to fatal complications.
      PubDate: 2022-07-05T00:00:00Z
  • Estrogen can improve the prognosis of patients with diffuse axonal injury
           due to severe traumatic brain injury: A Randomized Triple-blind
           Placebo-controlled Trial

    • Authors: Farhad Mirzaei; Faezeh Emami Sigaroudi, Firooz Salehpour, Javad Aghazadeh, Ghaffar Shokouhi, Ali Meshkini, Iman Nasiri Dafchahi, Keyvan Aalizadeh Seyed Ahmad Naseri Alavi
      Abstract: Objective: To evaluate the effects of estrogen on the prognosis of patients with diffuse axonal injury due to severe traumatic brain injury. Design: Triple-blind placebo-controlled randomized clinical trial study Setting: The study was conducted at the Neurosurgery Department of Imam Reza Hospital of Tabriz University of Medical Sciences Patients: A total of 200 patients were enrolled in the study Methods: Two hundred patients were randomly allocated into two cases, with a control group of 100 each. The case group daily received 8μg/kg of estrogen by nasogastric for three days and the control group only received a placebo. The Glasgow Coma Scale (GCS) at discharge, Glasgow Outcome Score (GOS) at discharge, and the GOS three months later were investigated to evaluate the effect of estrogen on patients with diffuse axonal injury (DAI) following traumatic brain injury (TBI) in the case and control group. Results: It was shown that there is a significant difference between the case and control groups based on GCS at discharge (p-value = 0.007), GOS at discharge (p-value = 0.02), and GOS at a 3-months follow-up period (p-value = 0.025). Ten patients (5 patients in each group) died during the study. Conclusion: This study indicated the efficacy of estrogen in patients with Diffuse Axonal Injury (DAI) following TBI.
      PubDate: 2022-07-05T00:00:00Z
  • Modified nutrition risk (mNUTRIC) score in critically ill patients: Is it
           a reliable predictor of outcome in the intensive care unit'

    • Authors: Shreya Gattani; Sunil Kumar, Sourya Acharya, Anil Wanjari, Shilpa Bawankule, Sachin Agrawal Dhruv Talwar
      Abstract: Background: Till date, there is no consensus reached on the foremost tool for identifying the propensity of risk in critically sick patients. In this study, we plan to assess the nutritional risk in critically ill patients admitted to the medical ICU using the modified nutrition risk in critically ill (mNUTRIC) score and to anticipate the outcome in terms of overall mortality, 72-hour mortality, and the use of mechanical ventilation. Method: A total of 1,990 patients were analyzed by calculating their mNUTRIC scores using various variables, which were a part of the scoring system, such as age, a thorough history and clinical examination, and pre-existing comorbidities. Group differences were compared using the t-test or the Wilcoxon test for continuously distributed data and the chi-squared test for categorical data. Results: In this study, the mean age of the patients were 50.48 ± 17.58 years. Of them, 395 died while 1,595 survived; and 799 had a high ( ≥ 6) mNUTRIC score, and 1191 had a low ( ≤ 5) mNUTRIC score. The area under the curve for mNUTRIC score in predicting overall mortality and 72-hour mortality was 0.938 and 0.89, respectively, thus demonstrating better diagnostic performance. Conclusion: The discriminative performance of mNUTRIC scores for assessing overall mortality and the need for mechanical ventilation was found to be effective in this study.
      PubDate: 2022-07-05T00:00:00Z
  • Special issue on the first conference on COVID-19 in Iraq: The
           international scientific conference of Alnahrain College of Medicine and
           Iraqi colleges of Medicine in Iraq confronting COVID-19 pandemic

    • Authors: Ahmed Sahib Abdulamir
      Abstract: Since December 2019, a local outbreak in China of atypical pneumonia has gradually spread all over the world in a few months; this set off a worldwide pandemic of a newly designated viral respiratory disease called COVID-19 which is caused by a new member of the Coronaviridae family, being named SARS-CoV-2 with multiple emerging variants1. This pandemic shed a burden on different sectors of life particularly health, economy, and education2. The current issue is dedicated to the first of its kind conference held by Alnahrain College of Medicine and Iraqi colleges of Medicine namely "The international scientific conference of Alnahrain College of Medicine and Iraqi colleges of Medicine in Iraq confronting COVID-19 pandemic". This conference aimed at providing a platform for demonstrating and analyzing observational and analytical studies and efforts of Colleges of Medicine and Iraqi health bodies in confronting the COVID-19 pandemic in Iraq. Such conference is necessary to discuss the burden of COVID-19 as well as the efforts and solutions toward this pandemic in Iraq. Moreover, this event shall serve as a good model for other low-income and third-world countries especially those in the region of the Middle East3.The participating studies in this conference and the selected manuscripts published in this issue cover the challenges of medical education in colleges of Medicine during the pandemic and during the health quarantine, highlighting the role of medical faculties in researching and finding solutions to unprecedented challenges laid by the pandemic. Up to 66 observational and experimental studies on COVID-19 participated in the conference and 14 full articles on these studies are published in this special issue. These studies collectively turned up with essential conclusions and recommendations on how to tackle similar pandemics in the future. The current issue includes community medicine studies on the attitude of the population and medical students in Iraq toward the vaccination programs of COVID-19, efficiency and adverse effects of current therapeutics and immunization programs, severity and spread rate of the disease, the use of social media and telemedicine for online consultation, the impact of the pandemic on the surgical and medical practice, and the particular radiological changes in lungs of COVID-19 patients. In addition, the issue included immunological and virological studies on the causative agent of the disease, SARS-CoV-2, and its related morbid sequel.It is firmly believed that the current issue on this pioneering conference on COVID-19 in Iraq serves a great purpose, analyzing the previous and current efforts laid for confronting COVID-19 pandemic and drawing conclusions and recommendations for proper alertness for future pandemics of comparable scale whether in Iraq or in the whole region of the Middle East.
      PubDate: 2022-06-30T00:00:00Z
  • Evaluating IL6/D-dimer serum levels and genotypes of rs5186 (A1166C) in
           AGTR1 angiotensin II receptor type 1 gene as prognostic biomarkers for
           COVID-19 disease outcome in the Iraqi population

    • Authors: Ghuroob Dalil Dhumad; Haider sabah kadhim, Haider Ahmad Shamran Hatem Dheyab Abed
      Abstract: Background: On January 30, 2020, the World Health Organization (WHO) declared the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, also called coronavirus disease 2019 (COVID-19) a pandemic after its emergence in Wuhan, China, in December 2019. In this study, we aimed to evaluate the potential of interleukin-6 (IL-6) and D-dimer serum levels and genotypes of rs5186 (A1166C) in the AGTR1 gene as potential prognostic markers for COVID-19 disease outcome in Iraq. Methods: This cross-sectional study was conducted with 100 Iraqi adults of both sexes, aged 21–81 years, and recently diagnosed with COVID-19. The participants of this study were admitted to Al-Al-Kindy Teaching Hospital and Ibn Al-Qiph in Baghdad City from February 01, 2020, to May 01, 2020. Patients with COVID-19 were divided into two categories; those who recovered and were discharged and those who were admitted to the intensive care unit (ICU)/died. Ethical concerns were considered in accordance with the consent form provided by the Iraqi Ministry of Health for the purpose of collecting samples. Interleukin-6 (IL-6) levels in the patients’ serum samples were estimated using the Sandwich-Enzyme Linked Sorbent Assay (ELISA) method with horseradish peroxidase (HRP) conjugated antibody specific for IL-6. D-dimer was estimated in the serum samples using antigen-antibody (anti-human D-dimer antibodies) reaction. Genotyping of rs5186 (A1166C) in the AGTR1 angiotensin II receptor type 1 gene in the cohort study was determined using an allele-specific PCR approach. Results: D-dimer serum levels (1.55 μg/mL) was significantly (P <  0.001) higher in patients admitted to the ICU or those who died compared with those (0.2 μg/mL) of patients who recovered and were discharged. The IL-6 levels in patients admitted to the ICU or those who died and in patients who recovered and were discharged were 12.31 and 11.65 pg/mL, respectively, without significant difference (P > 0.05). The frequency of AC+CC genotypes of rs5186 (A1166C) in the AGTR1 gene in patients who were admitted to the ICU or those who died was 30.43%, higher than that of patients who recovered and were discharged (11.69%) with a significant difference (Odds ratio [OR] = 3.31, 95% confidence interval [CI] = 1.07–10.21, P = 0.038). Analysis of allele distribution revealed a higher frequency of the A allele among patients who recovered and were discharged (93.51% versus 82.61%) than among those who were admitted to the ICU or those who died with a significant difference (OR = 3.03, 95% CI = 1.12–8.21, P = 0.029). Conclusion: D-dimer may be a prognostic biomarker for poor COVID-19 disease outcomes. The genotype AC+CC of rs5186 (A1166C) in the AGTR1 gene seems to be a risk factor and may be a prognostic factor for poor COVID-19 disease outcomes. However, a bigger sample size is highly recommended in prospective studies for better assessment of the potential of IL-6, D-dimer, and genotyping of rs5186 (A1166C) in the AGTR1 gene as prognostic biomarkers for COVID-19 disease outcome.
      PubDate: 2022-06-16T00:00:00Z
  • Penetrating abdominal trauma: Evaluation in Baghdad during the pandemic

    • Authors: Mohammed A. Hamdawi; Anees K. Nile Wisam Mohammed Abed
      Abstract: Background: Trauma is one of the leading causes of deaths worldwide for all age groups, especially in the younger age group. The purpose of the current study is to assess/analyze the factors for mortality in penetrating abdominal traumas with respect to the total number of intra-abdominal organs injured, related extra-abdominal injuries, gender, type of injury, time of arrival, and amount of blood transfusion needed during the pandemic. Methods: A retrospective study including 523 patients underwent laparotomy in Al-Emamien Al-Kadhimin Medical City from March 2020 to September 2021 for a penetrating abdominal injury due to blast injury, bullet, shrapnel injury, and stab wounds. The study population with penetrating abdominal traumas and indicative abdominal signs was subjected to exploratory laparotomy. Results: In this study, 465 (88.9%) males and 58 (11.1%) females participated; the highest rate was found in small bowel injuries (40.73%) followed by large bowel injuries (21.99%), whereas the lowest rate was found in gallbladder injury (1.34%). Chest injuries represent the highest rate among extra-abdominal injuries (18.36%), whereas head and neck represent the lowest rate (1.34%). Regarding the risk factors affecting the mortality rate, the highest rate of mortality was found in the case of gunshot (13.11%), followed by shrapnel (6.38%) and stab wound injuries (5.26%), which was the lowest. Conclusion: Penetrating abdominal injuries were the most common among males, small bowel injuries are the commonest organs affected by the penetrating abdominal injuries, shrapnel injuries were the commonest causes in our country, and the highest mortality rate was related to gunshot and number of organs affected and delay of arrival to the hospital and number of pints of blood received.
      PubDate: 2022-06-16T00:00:00Z
  • Effect of dexamethasone in two different doses on specific biochemical
           markers in patients with COVID-19

    • Authors: Basim Herez Ali; Ammar Ali Hamza
      Abstract: Background: Severe acute respiratory syndrome coronavirus 2 is the causative agent of coronavirus disease 2019 (COVID-19). The release of alarmins results in a “cytokine storm,” which can be attenuated by the immunomodulatory and anti-inflammatory effects of dexamethasone. Aim: To evaluate and assess the effect of dexamethasone in two different doses, on D-dimer, serum ferritin, C-reactive protein (CRP) levels, and granulocyte/lymphocyte (%) in patients with COVID-19. Patients and methods: A total of 100 patients were randomly divided into two groups; group A patients received a higher dose of dexamethasone than those in group B. Measurements of certain hematological and biochemical markers, including D-dimer, serum ferritin, CRP, and granulocyte/lymphocyte ratio were done for all the patients in both groups. These indices were compared at different times of treatment between the two groups. Results: The D-dimer and granulocyte/lymphocyte ratio measurements were statistically non-significant in both the groups in all three readings. The serum ferritin measurement was significant only on the 6th day of treatment. The results demonstrated that group A patients had significantly lower CRP levels on both the 3rd and 6th days of treatment. Conclusion: Administration of a slightly higher dose of dexamethasone (8 mg per day for three days, then 6 mg per day for another 3 days) in patients hospitalized with COVID-19 effectively reduces the inflammatory and hematological biomarkers in patients who required supplemental oxygen therapy.
      PubDate: 2022-06-16T00:00:00Z
  • Community-Acquired Pneumonia with rapidly progressing pleural effusion
           within 24 hours: A case report

    • Authors: Bassem N. Alhariri; Ayisha Ameen Abdulqadir J. Nashwan
      Abstract: Patients with Community-Acquired Pneumonia (CAP) complicated with pleural effusion mostly present with shortness of breath and pleuritic chest pain, and usually, pleural fluid (PE) progresses gradually. In this report, a case of CAP patient complicated with PE presented with left shoulder pain is discussed. The PE was found to have rapidly accumulated as a massive effusion within 24 hours of presentation. Thoracocentesis was performed and revealed an exudative picture. Patients with CAP can present with atypical symptoms on admission but may develop massive parapneumonic pleural effusion within a short time that would need definite management via urgent chest tube placement.
      PubDate: 2022-06-14T00:00:00Z
  • Attenuated effects of rivastigmine in induced cytokine storm in mice

    • Authors: Ahmed F. Abed Mansoor; Ahmed R. Abu Raghif
      Abstract: Background: A cytokine storm is a serious clinical condition that complicates infectious diseases, for example, coronavirus disease 2019 (COVID-19), and non-infectious diseases such as autoimmune diseases and cancer and may often lead to death. The patients who are affected by the cytokine storm are almost always severe/critical and at risk for acute respiratory distress syndrome or eventually death. Pro-inflammatory cytokines such as interleukin 6 (IL-6), IL-1 beta, and tumor necrosis factor alpha (TNF-α) have been repeatedly shown to be related to the COVID-19 disease severity and mortality. In this study, our objective was to evaluate the attenuated effect of rivastigmine (RA) in a cytokine storm in Swiss Albino mice in which the cytokine storm was induced by lipopolysaccharide (LPS) and to explore their effects on IL-1 β, IL-6, and TNF-α levels. Methods: This study was carried with 60 male Swiss albino mice that were divided equally and randomly into six groups as follows:
      • Group AH: Apparently healthy control group which received no induction, not treated.
      • Group LPS: Induced using LPS at 5 mg/kg and no treatment administered.
      • Group DMSO: Induced and treated with 1% dimethyl sulfoxide (DMSO).
      • Group RA: Induced and treated with 0.5 mg/kg RA.
      • Group MPA: Induced and treated with 50 mg/kg methylprednisolone (MPA).
      • Group RMPA: Induced and treated with 0.25 mg/kg rivastigmine and 25 mg/kg of methylprednisolone.All the mice were treated with drugs or vehicles for three consecutive days before LPS induction. The mice were then injected with LPS intraperitoneally at a dosage of 5 mg/kg for systematic inflammatory stimulation. After 48 hours of LPS induction, all the mice were euthanized by light anesthesia with chloroform, and blood was collected for the quantitative determination of IL-1β, IL-6, and TNF-α levels using the enzyme-linked immunosorbent assay (ELISA) technique. Results: Administration of LPS to Swiss albino mice caused a significant elevation of IL-1β, IL-6, and TNF-α levels than in the healthy control group. Significant reduction of these parameters were observed in the RA and MPA groups when compared with those in the non-treated group. Conclusion: RA was found to be effective in attenuating the induced cytokine storm by suppressing IL-1β, IL-6, and TNF-α levels, and the results with RA were comparable to that of MPA. A combination of half-doses of both RA and MPA administered together shows no obvious advantage when compared with that of each of them alone.
      PubDate: 2022-06-06T00:00:00Z
  • SARS-CoV-2 S1-RBD IgG and IL-6 serum level reduction after 120 days (4
           months) of the second dose of Pfizer–BioNTech vaccine administration to
           the medical students in the University of Diyala

    • Authors: Abeer Aied Abdulameer; Ahmed Rushdi Abdullah Ismail Ibrahim Latif
      Abstract: Background: SARS-CoV-2 mRNA vaccines such as Pfizer–BioNTech have confirmed a high efficiency; however, there is a limitation of data existence about the duration of immune responses and their relation to age and side effects. The aim of this study is to estimate the SARS-CoV-2 S1-RBD IgG level after 30 days (1 month) and 120 days (4 months) of the second dose of Pfizer–BioNTech vaccine administered to the medical students of the University of Diyala. Methods: The study was conducted after the approval of the Medical College of Al-Iraqia University, the Medical College of the University of Diyala, and the Iraqi Ministry of Health. We selected 45 students from the Medical College of the University of Diyala randomly who were fully vaccinated (two doses of Pfizer–BioNTech vaccine, 0.5 ml of the vaccine for each dose), and they agreed to give 5 ml of their blood twice (after 1 month and 4 months), which was carried out in the Higher Education Laboratory inside the Medical College, University of Diyala. The period of sample collection was 5 months (from September 2021 until February 2022). A serological analysis to measure SARS-CoV-2 S1-RBD IgG was done by using Diasino, SARS-CoV-2 S1-RBD IgG ELISA Kit, China, which was carried out in the Higher Education Laboratory, inside the Medical College, University of Diyala. Demographic data were taken from the study participants (age and gender). The same individuals of the study were divided into two groups according to the time frame (1 month and 4 months) after the second dose of the Pfizer–BioNTech vaccine administration. For statistical analysis, we used SPSS version 26 and STATISTICA version 12 to input, check, and analyze data. For qualitative variables, standard approaches of frequencies and percentages were used, whereas for quantitative variables, mean and standard deviation were used. A P-value of less than 0.05 was considered as significant for SARS CoV-2 S1-RBD IgG plasma levels. Results: The study found that the male–female ratio was 17.8: 82.2, and the mean of the age of the vaccinated students was 20.977 years. The serum quantities of SARS-CoV-2 S1-RBD IgG and IL-6 levels post second dose of the Pfizer–BioNTech vaccine after 30 days (1 month) and 120 days (4 months) were shown to be statistically non-parametric. Using the independent two-sample Mann–Whitney test, a significant difference (P <  0.05) was observed for SARS-CoV-2 S1-RBD IgG and IL-6 levels between 120 days (4 months) after the second dose of the Pfizer–BioNTech vaccine and 30 days (1 month). Conclusion: SARS-CoV-2 S1-RBD IgG and IL-6 levels decreased significantly after 120 days (4 months) of the second dose of Pfizer–BioNTech vaccination.
      PubDate: 2022-06-06T00:00:00Z
  • Impact of the COVID-19 pandemic on surgical practice in Iraq

    • Authors: Anees K. Nile; Mohammed A. Hamdawi NawfalK. Khiro
      Abstract: Background: The COVID-19 pandemic affects all aspects of life all over the world; general surgeons are highly affected along with other healthcare personnel. A gloomy course of the disease makes it hazardous till now; its impact and ways of protection should be of concern for us so that we can keep on our works. Methods: A survey was carried out at our hospital among general surgeons and surgeons of other specialties of the course with junior doctors and residents. A questionnaire was answered by them concerning their work with the impact of the virus, collecting data from the statistical unit electronically. Iraq has started lockdown for a period of 24 months from March 2020 to March 2022. Results: This study is a cross-sectional study using Google Forms and spread over surgical teams of different specialties at the Imemein Kadhumein Medical City Center. From about 248 responses, 118 responses were taken from the survey. Out of the 50 surgeons, 40 (80%) were infected and out of the 68 residents 62 (91.1%) were infected in our hospital (open and laparoscopic). About 20% of the doctors completely stopped attending outpatient clinics, until vaccination started on March 2021, an overall decrease of 60%. A drop of >75% of income was noticed by 45% of them; and 25% of them feel  < 75% of the income was received. But others have no change or increase in income as patients shift toward private hospitals because the government ones become loaded with COVID patients. Information about the illness and its sequelae was found through the net to be about 81% and through television to be 16%, whereas others were through national and institutional announcements. Conclusion: Standardized measures in detection, treatment, and/or vaccination should be taken into consideration based on the solid scientific facts to have a road map for surgeries during this or subsequent pandemics, getting the best outcome for doctors and patients.
      PubDate: 2022-06-06T00:00:00Z
  • Level of β-defensin among Iraqi patients with COVID-19 in relation to
           oral health status

    • Authors: Batool H. Al-Ghurabi; Zeina S. Adham Ahmed A. Abbas
      Abstract: Background: Innate immunity plays an important role in deciding the severity of coronavirus disease 2019 (COVID-19) and disease outcomes. Defensins are antimicrobial peptides that are produced by epithelial cells in mucosal locations and play a key role in innate immunity. Understanding COVID-19 mucosal agents and their role in disease severity is critical for developing therapeutic options and identification of prognostic markers for COVID-19. Objective: In this study, we aimed to determine the role of β-defensin-1 in patients with COVID-19 and compare it with that of the control group, as well as to look into the link between β-defensin-1 and oral hygiene and disease severity. Methods: This case-control study included 50 patients with COVID-19 and 35 controls of similar ages and sexes. From November 2020 to January 2021, the patients were admitted to Baghdad Teaching Hospital/Medical City. The simplified oral hygiene index was used to determine oral hygiene status. Blood samples were obtained from all subjects (patients and controls), and the serum levels of β-defensin-1 were measured using enzyme-linked immunosorbent assay (ELISA). Results: Findings showed a non-significant reduction (P>0.05) in the β-defensin-1 level among patients compared with that of the controls. In addition, patients with severe disease had a significantly lower level of β-defensin-1 than those with mild disease. There were no significant variations in the levels of β-defensin-1 between patients with good oral hygiene and those with poor oral hygiene (P>0.05). Conclusions: The reduction in β-defensin-1 levels indicates an abnormal immune response in these patients and may require a new treatment option for this condition in the future. Furthermore, in patients with severe disease, a considerable drop in β-defensin-1 might be used as an indicator of illness severity.
      PubDate: 2022-05-31T00:00:00Z
  • Use of social media for online consultation during the COVID-19 pandemic:
           Attitudes of the medical professionals

    • Authors: Loma Al-Mansouri; Firas R. AL-Obaidi
      Abstract: Background: Healthcare providers are facing unprecedented challenges in the era of the coronavirus disease 2019 (COVID-19) pandemic. The current situation compels the use of alternatives for communication between the patients and healthcare providers. The use of telemedicine has expanded globally during the COVID-19 pandemic. The range of online consultations varies from advising patients to providing diagnosis and follow-up. Methods: We assessed the attitudes of health professionals toward the use of social media for online consultations during the COVID-19 pandemic using an online survey that was distributed to medical professionals in Iraq. Results: The total number of participants was 124 Iraqi medical professionals in different specialties (72.4% men and 27.6% women). The majority of participants (71.6%) reported that they had previous experience with online consultation and patient communication using social media before the onset of the COVID-19 pandemic. A large proportion of the participants (72.2%) indicated that online consultation was useful for patient health and safety. Conclusions: Despite the limitations facing online consultation and lack of proper infrastructure for telemedicine in Iraq, many health professionals indicated a positive attitude and recommend extending the use of online consultation after the era of the COVID-19 pandemic.
      PubDate: 2022-05-31T00:00:00Z
  • Acute arterial thrombosis in patients admitted with COVID-19 infection:
           Clinical experience

    • Authors: Sameer Mohialdeen; Noor Abbas Hummadi Fayadh, Abbas Jaafar Khaleel Al-Anbari Bassam Maddah H. Al-Alosi
      Abstract: Background: Acute limb arterial thrombosis (LAT) is defined as a sudden reduction in arterial supply to the extremity to a degree that affects its viability. Patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease 2019 [COVID-19]) have unbalanced coagulation profiles and are prone to thromboembolic events. Prompt diagnosis of LAT and appropriate urgent intervention, whenever possible, can help decrease morbidity and mortality among these patients and increase the chance of limb rescue. Therefore, this was the stimulus for this study, where based on our clinical experience, we aimed to identify the prevalence and analyze the outcomes of acute LAT in patients admitted with COVID-19 in Baghdad, Iraq. Methods: This study included 135 patients admitted with COVID-19, aged 35–70 years. During admission, these patients were referred to the consultation vascular surgeons because of ischemic changes in their limbs. History, demographics, clinical history, and laboratory tests were collected from all the patients. Vascular Doppler ultrasound and CT angiography were performed in some patients (especially those with re-thrombosis) to finalize the diagnosis and to plan for vascular intervention. Appropriate therapeutic anticoagulants were immediately initiated and once the diagnosis of LAT was established, surgical intervention (under local anesthesia), including thrombo-embolectomy and revascularization, was performed. After postoperative management and anticoagulation were completed, post discharge followup was the final step. Results: The mean age of the enrolled patients was 55.3 ± 7.8 (range 35.1–70.9) years, 86 (63.7%) were males. The mean number of days after the initial COVID-19 manifestation was 22 (16–28). The mean serum levels of D-dimer, CRP, and ferritin were high (795.8 ng/mL, 49.1 mg/mL, and 994.7 ng/mL, respectively). The prevalence of associated risk factors including diabetes, hypertension, and ischemic heart diseases was relatively high. Two-thirds of the patients with LAT had involvement of lower limbs and mostly (69.6%) on the left side. The men represented more than half of the patients affected by LAT in their lower limbs. Re-thrombosis was encountered in 29.6% of the patients, mostly women. Of the total 135 patients with LAT, 14 (10.4%) underwent surgical amputation on presentation to surgical wards or afterwards, however; and unfortunately, 13 (9.6%) of the total patients with LAT died. Most of the recorded mortality among the patients with LAT occurred during hospitalization for COVID-19, nine (75%), regardless of their etiologies. Conclusions: COVID-19 is associated with a high risk of thromboembolic events including LAT. Those with blood group A tend to develop more “re-thrombotic events” than other groups. Even with the successful prescription of prophylactic anticoagulants, young and otherwise healthy cases may be prone to LAT. In patients with COVID-19 and owing to their hypercoagulable state, the surgical intervention of LAT might be harder and more challenging than anticipated. Cardiovascular surgeons and physicians should consider the benefits of extended postoperative anticoagulant administration.
      PubDate: 2022-05-31T00:00:00Z
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Heriot-Watt University
Edinburgh, EH14 4AS, UK
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