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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
Archives of Academic Emergency Medicine
Number of Followers: 6  

  This is an Open Access Journal Open Access journal
ISSN (Online) 2645-4904
Published by Shahid Beheshti University of Medical Sciences Homepage  [20 journals]
  • Comparing the Outcomes of Surgical and Non-Surgical Approaches in
           Management of Older Patients with Distal Radius Fracture; a Retrospective
           Cohort Study

    • Authors: Mehdi Teimouri, Milad Ghaderi, Saeed Hatami
      Abstract: Introduction: Distal radius fractures (DRFs) are the most common orthopedic injuries in emergency department. This study aimed to compare the outcomes of conservative and surgical managements of DRFs in the aged population. Methods: In this retrospective cohort study, ninety patients with unilateral DRFs were treated using either surgical or conservative (casting) approach and the management outcomes as well as complications were compared between the two groups at 3 and 6-month follow-ups. Results: A total of 90 patients over 70 years old were included (45 treated with cast immobilization, and 45 using the surgical method). The mean age (p = 0.56) and gender (p = 0.85) was similar in the two groups. Except for quality of life in both follow-up times, patients treated with surgical methods showed better outcomes in other aspects, including 3-month (p = 0.042) and 6-month (p = 0.022) mean Disability of the Arm Shoulder Hand (DASH) score, 3-month (p = 0.013) and 6-month (p = 0.006) mean range of motion (ROM), and 3-month (p = 0.003) and 6-month (p = 0.033) pain intensity based on Visual Analogue Scale (VAS). A total of 70 (77.77%) adverse events were registered (33 (36.6%) in the casting group and 37 (41.1%) in the surgical group; p = 0.05). The rate of mal-union (p = 0.021) and superficial radial nerve injury (p = 0.026) were significantly lower in the surgical group. Conclusion: The findings suggest that surgical approach for management of DRFs in elder cases has better clinical and functional outcomes than cast immobilization.
      PubDate: 2022-08-02
      DOI: 10.22037/aaem.v10i1.1606
      Issue No: Vol. 10, No. 1 (2022)
       
  • Jejunal Dieulafoy’s Lesion as a Rare Cause of Massive Gastrointestinal
           Bleeding; a Case Report and Literature Review

    • Authors: Mohammad Ebrahim Kalantari, Newsha Sardarzadeh, Ali Mirsadeghi , Ali Akbar Bagherzadeh, Tooraj Zandbaf
      Abstract: Jejunal Dieulafoy's lesion is difficult to diagnose due to its rarity, intermittent hemorrhage, and lesion site, which is largely inaccessible to conventional endoscopes. A 39-year-old man, who had no underlying disease, presented to the emergency department (ED) with weakness, dizziness, and dry cough with a history of several rectal bleeding episodes in the last few years. Endoscopy was normal, and the colon was full of clots on colonoscopy, and no gross pathology was found. On computed tomography (CT) angiography, a hyperdensity was seen in the middle of the jejunum, possibly suggesting contrast extravasation. Due to decreased hemoglobin of the patient, and hemodynamic instability, the patient became a candidate for surgery. A palpable lesion in the Jejunum was touched that opened longitudinally, which revealed active arterial bleeding from the nipple-like lesion. This segment was resected, and an anastomosis was performed. Histopathological examination of the small intestine confirmed a Dieulafoy’s lesion. It seems that, when upper endoscopy and colonoscopy fail to identify the cause of gastrointestinal bleeding, a Dieulafoy’s lesion should be included in the differential diagnoses.
      PubDate: 2022-07-27
      DOI: 10.22037/aaem.v10i1.1623
      Issue No: Vol. 10, No. 1 (2022)
       
  • Monkeypox Outbreak in Non-Endemic Areas: Will it Cause a New Pandemic'
           a Letter to Editor

    • Authors: Mostafa Alavi-Moghaddam
      Abstract: Monkeypox (MP) is a rare endemic infection found in tropical rainforest areas of west or central Africa. The recent world health organization (WHO) reports of confirmed MP cases from non-endemic areas have raised global concern over the risk of a new pandemic. Monkeypox is a misnomer, as the first confirmed case of MP was diagnosed in a monkey in 1958; however, MP virus is a viral zoonosis that belongs to Orthopoxvirus genus of the Poxviridea family and in addition to old and new world monkeys and apes, it can infect rats, mice, squirrels, prairie dogs, and rabbits (1). MP virus can be transmitted through touching blood, body fluids, spots, blisters or scabs of infected animals or infected persons. MP virus is also spread through touching the clothing, bedding, or towels of infected persons. Face to face exposure to infected persons and eating raw or under-cooked meat from infected animals are other sources of infection (2).
      PubDate: 2022-07-25
      DOI: 10.22037/aaem.v10i1.1706
      Issue No: Vol. 10, No. 1 (2022)
       
  • Evaluating the Ability of PRISM4 and PIM3 to Predict Mortality in Patients
           Admitted to Pediatric Intensive Care Unit; a Diagnostic Accuracy Study

    • Authors: Victoria Chegini, Hamidreza Hatamabadi, Sima Jedari Attaran, Abolfazl Mahyar, Monirsadat Mirzadeh, Venus Chegini
      Abstract: Introduction : Limited resources and the large number of children in need of services in the pediatric intensive care unit (PICU) emphasize the need for effective allocation of resources for improving the outcome of at-risk patients. This study aimed to evaluate and compare the accuracy of PRISM4 and PIM3 systems in prediction of in-hospital mortality of patients admitted to PICU. Methods: The present retrospective cross-sectional study was a diagnostic accuracy study performed on patients admitted to PICU of Qods Hospital, Qazvin, Iran, during one year. Scores of PRISM4 and PIM3 scales were calculated for each patient using the available calculators, and the outcome of patients regarding in-hospital mortality was recorded. Finally, screening performance characteristics of the mentioned scales in prediction of patients’ mortality were calculated and reported. Results: 218 patients with the mean age of 40.68 ± 37.92 (2-160) months were studied (57.8% female). There was a significant direct correlation between PIM3 score and duration of stay in PICU (p < 0.0001; r = 0.259), need for inotropic drug administration (p = 0.001), and mortality rate (p = 0.001). In addition, area under the receiver operating characteristic (ROC) curve of PIM3 and PRISM4 in prediction of mortality among patients admitted to the PICU was 0.939 (95%CI: 0.880 – 0.998) and 0.660 (95%CI: 0.371 – 0.950), respectively (p = 0.001). Based on the findings, the best cut-off point for PIM3 scale in prediction of mortality was the score of 4 and it was estimated to be the core of 8 for PRISM4 scale. Sensitivity and specificity of PIM3 scale in prediction of mortality in the cut-off of 4 points were 100.00 (95% CI: 56.09- 100.00) and 81.51 (95% CI: 75.47- 86.38), respectively. These measures were 42.85 (95%CI: 11.80- 79.76) and 98.10 (95%CI: 94.89- 99.39) for PRISM4 model, which indicates the higher sensitivity of PIM3 system in this regard. Conclusion: based on the results of the present study, the accuracy of PIM3 is significantly higher than PRISM4 in prediction of in-hospital mortality among patients admitted to the PICU. It seems that considering the 100% sensitivity of PIM3 in prediction of outcome, this model is a better tool for screening patients who are at risk for in-hospital mortality in order to pay more attention and allocate more resources to improve their outcome.
      PubDate: 2022-07-21
      DOI: 10.22037/aaem.v10i1.1738
      Issue No: Vol. 10, No. 1 (2022)
       
  • An Epidemiologic Overview of Traumatic Vascular Injures in Emergency
           Department; a Retrospective Cross-Sectional Study

    • Authors: Niloofar Mirdamadi, Maryam Bakhtiari, Alireza Baratloo, Mohammad Reza Fattahi, Pezhman Farshidmehr
      Abstract: Introduction: Vascular system injuries (VSIs) are one of the main causes of preventable mortality and morbidity of trauma patients. This study aimed to evaluate baseline characteristics, presenting signs, managements, and outcomes of patients presenting to emergency department (ED) with traumatic VSIs.  Methods: This retrospective cross-sectional study was conducted on patients with traumatic VSIs admitted to the ED of a referral tertiary trauma center, during one year. Using a pre-prepared checklist, demographics, pre-hospital care, type of VSIs, injury severity score (ISS), anatomical location of trauma, associated injuries, method of surgery, complications, and outcome were collected from patients’ profiles and reported. Results: One hundred and twelve patients with the mean age of 33.5 ± 14.7 (range = 8 - 80) years were studied (90.2% male). Most of the patients were categorized as mild or moderate in terms of their ISS. 90 (80.4%) patients had at least one soft sign and 99 (88.4%) patients had at least one hard sign. Isolated arterial injury was diagnosed in 90 (80.4%) patients, isolated venous injuries in 12 (10.7%) cases, and combined arteriovenous injuries in 10 (8.7%) patients. The most common associated injury was tendon rupture (63.4%) and nerve injuries were present in 60.7% of patients. 1 (0.9%) patient died, 6 (5.4%) patients went through amputation, and 3 (2.7%) patients were discharged against medical advice. The rest of the patients were discharged in perfect health. There was a significant correlation between trauma type (p = 0.001), upper and lower extremity trauma (p < 0.001), presence of distal ischemia and lack of pulse (p = 0.041), penetrating injury close to a major vessel (p = 0.006), type of injured vessels and arteries (p<0.001), injury to nerve (p = 0.011) and tendon (p = 0.007), presence of open fracture (p = 0.005), multiple trauma (p < 0.001), method of surgery (p < 0.001), and number of postoperative complications (p< 0.001) with poor outcome. Conclusion: The findings showed that the majority of the studied patients were young males, most of whom were discharged in perfect situation. Those who presented with higher ISS, or were affected by blunt trauma or injury to lower limb arteries had worse outcome than the others.
      PubDate: 2022-07-21
      DOI: 10.22037/aaem.v10i1.1663
      Issue No: Vol. 10, No. 1 (2022)
       
  • Effect of Interposed Abdominal Compression on Cardiopulmonary
           Resuscitation Outcomes; a Randomized Clinical Trial

    • Authors: Atefeh Ghanbari Khanghah, Mohammad Taghi Moghadamnia, Latif Panahi, Somaye Pouy, Marjan Aghajani Nargesi, Ehsan Kazemnezhad Leyli
      Abstract: Introduction: Standard cardiopulmonary resuscitation (STD-CPR) is successful in only 10-15% of cases in emergency department (ED). This study aimed to determine the effect of interposed abdominal compression (IAC) during resuscitation on outcomes of ED cardiac arrests. Methods: In this randomized clinical trial study, non-trauma patients aged 18-85 years, patients with in-hospital cardiac arrest hospitalized in the ED were randomly assigned into two either STD-CPR or IAC-CPR group on a 1:1 basis and using computer-generated random numbers. Participants in the intervention group, received abdominal compression during the diastole phase of STD-CPR. The rate of return of spontaneous circulation (ROSC), heart rate (HR), respiratory rate (RR), arterial blood gas (ABG) indicators, and survival rate were compared between the two groups. Results: Ninety patients were enrolled (45 in each group). There were no differences between the two groups regarding age (p = 0.76), sex (p = 0.39), employment status (p = 0.62) and Charlson comorbidity scale (p = 0.46). Abdominal compression had a positive effect on heart rate (p < 0.001), mean arterial pressure (p = 0.003), arterial blood oxygen pressure (p = 0.001), and arterial blood carbon dioxide pressure (p = 0.001) as well as a negative effect on arterial blood oxygen saturation (p = 0.029) 30 minutes after resuscitation. Out of the 90 CPR cases, 8 (17.7%) cases in intervention group and 8 (17.7%) cases in control group were successful, among which all of the 8 patients in the intervention group and 5 of the patients in the control group had been discharged from hospital without any complications. Conclusion: The results showed that abdominal compression during CPR can improve resuscitation outcomes in patients with cardiac arrest. Therefore, in order to use this technique, further research is recommended.
      PubDate: 2022-07-16
      DOI: 10.22037/aaem.v10i1.1678
      Issue No: Vol. 10, No. 1 (2022)
       
  • Comparing the Characteristics of Mucormycosis Between Cases with and
           without COVID-19; a Cross-sectional Study

    • Authors: Mohammad Sistanizad, Mohammad Haji Aghajani, Mehrdad Haghighi, Hossein Amini, Asma Pourhoseingholi, Niloufar Taherpour, Shadi Ziaie, Sara Salarian, Omid Moradi
      Abstract: Introduction: Mucormycosis as a rare but life-threatening disease with 46-96% mortality, which challenged the healthcare system during the COVID-19 pandemic. This study aimed to compare the characteristics of mucormycosis between cases with and without COVID-19. Methods: This cross-sectional study was done in two referral hospitals, Imam Hossein and Labbafinezhad Hospitals, Tehran, Iran, between 21 March to 21 December 2021. Data related to all hospitalized adults subject with the diagnosis of mucormycosis during the study period was collected from patients’ profiles and they were divided into two groups of with and without COVID-19 based on the results of real time PCR. Then demographic, clinical, and laboratory findings as well as outcomes were compared between the two groups. Results: 64 patients with the mean age of 53.40±10.32 (range: 33-74) years were studied (53.1% male). Forty-three (67.2%) out of the 64 subjects had a positive COVID-19 PCR test. The two groups had significant differences regarding some symptoms (cough (p < 0.001), shortness of breath (p = 0.006)), acute presentation (p = 0.027), using immunosuppressive (p = 0.013), using corticosteroid (p < 0.001), and outcomes (mortality (p = 0.018), need for intubation (p < 0.001)). 22 (34.3%) patients expired during hospital admission. Univariate analysis showed the association of in-hospital mortality with need for ventilation (p < 0.001), sinus involvement (p = 0.040), recent use of dexamethasone (p = 0.011), confirmed COVID-19 disease (p = 0.025), mean body mass index (BMI) (p =0.035), hemoglobin A1c (HbA1c) (p = 0.022), and median of blood urea nitrogen (BUN) (p =0.034). Based on the multivariate model, confirmed COVID-19 disease (OR = 5.01; 95% CI: 1.14-22.00; p = 0.033) and recent use of dexamethasone (OR= 4.08, 95% CI: 1.05-15.84, p = 0.042) were independent predictors of mortality in this series. Conclusion: The mucormycosis cases with concomitant COVID-19 disease had higher frequency of cough and shortness of breath, higher frequency of acute presentation, higher need for immunosuppressive, corticosteroid, and ventilator support, and higher mortality rate. The two groups were the same regarding age, gender, BMI, risk factors, underlying diseases, symptoms, and sites of involvement.
      PubDate: 2022-07-12
      DOI: 10.22037/aaem.v10i1.1608
      Issue No: Vol. 10, No. 1 (2022)
       
  • Ethanol Sclerotherapy versus Laparoscopic Surgery in Management of Ovarian
           Endometrioma; a Randomized Clinical Trial

    • Authors: Hatav Ghasemi Tehrani, Raheleh Tavakoli, Maryam Hashemi, Somayeh Haghighat
      Abstract: Introduction: A variety of therapeutic modalities are available in management of ovarian endometrioma. This study aimed to compare the effects of ethanol sclerotherapy and laparoscopic surgery on disease recurrence and ovarian factors of these patients. Methods: 70 women with ovarian endometrioma and chronic pelvic pain were randomly divided into two groups. The first group underwent sclerotherapy with a puncture needle (cook) and the second group underwent laparoscopic surgery. Both groups were followed up every three months to investigate the recurrence rate. In this regard, ultrasonography was performed 3 months and 12 months after treatment, and serum anti-Müllerian hormone (AMH) levels were also reassessed 12 weeks after the intervention. Results: 70 women with the mean age of 31.46 ± 4.71 years, and the mean body mass index (BMI) of 23.12 ± 1.01 were studied. The two groups were similar regarding age (p = 0.770), BMI (p = 0.371), history of gastrointestinal signs (p = 0.794), history of urinary diseases (p = 0.324), dysmenorrhea (p = 0.403), pelvic pain (p = 0.454), dyspareunia (p = 0.448), location of cyst (p = 0.448), and diameter of cyst (p = 0.250). In the laparoscopic group, a significant decrease in anti-Müllerian hormone (AMH) levels was observed after 12 weeks (p < 0.0001), while in the sclerotherapy group, no significant changes were found between pre-and post-operative AMH levels (p = 0.120). Cyst size decreased significantly in both groups three months (p < 0.001) and twelve months (p < 0.0001) after treatment. In the third month, 8 patients in the sclerotherapy group and 13 patients in the laparoscopic group had recurrences, and in the twelfth month, 17 patients in the sclerotherapy group and 15 patients in the laparoscopic group had recurrence of symptoms (p > 0.05). Conclusions: Although AMH level and mean cyst diameter were significantly lower one year after laparoscopy, recurrence rate of ovarian endometrioma was similar between ethanol sclerotherapy and laparoscopy methods.
      PubDate: 2022-07-07
      DOI: 10.22037/aaem.v10i1.1636
      Issue No: Vol. 10, No. 1 (2022)
       
  • Safety and Adverse Events Related to Inactivated COVID-19 Vaccines and
           Novavax; a Systematic Review

    • Authors: Omid Dadras, Esmaeil Mehraeen, Amirali Karimi, Marcarious M. Tantuoyir, Arian Afzalian, Newsha Nazarian, Hengameh Mojdeganlou, Pegah Mirzapour, Ahmadreza Shamsabadi, Mohsen Dashti, Afsaneh Ghasemzadeh, Farzin Vahedi, Parnian Shobeiri, Zahra Pashaei, SeyedAhmad SeyedAlinaghi
      Abstract: Introduction: Knowledge of the safety of vaccines is crucial, both to prevent and cure them and to decrease the public hesitation in receiving vaccines. Therefore, this study aimed to systematically review the adverse events reported for inactivated vaccines and Novavax. Methods: In this systematic review, the databases of PubMed, Scopus, Cochrane, and Web of Science were searched on September 15, 2021. Then we identified the eligible studies using a two-step title/abstract and full-text screening process. Data on the subjects, studies, and types of adverse events were extracted and entered in a word table, including serious, mild, local, and systemic adverse events as well as the timing of side effects’ appearance. Results: Adverse effects of inactivated coronavirus vaccines side effects were reported from phases 1, 2, and 3 of the vaccine trials. The most common local side effects included injection site pain and swelling, redness, and pruritus. Meanwhile, fatigue, headache, muscle pain, fever, and gastrointestinal symptoms including abdominal pain and diarrhea were among the most common systemic adverse effects. Conclusion: This systematic review indicates that inactivated COVID-19 vaccines, including Sinovac, Sinopharm, and Bharat Biotech, as well as the protein subunit vaccines (Novavax) can be considered as safe choices due to having milder side effects and fewer severe life-threatening adverse events.
      PubDate: 2022-07-07
      DOI: 10.22037/aaem.v10i1.1585
      Issue No: Vol. 10, No. 1 (2022)
       
  • Predicting the 28-Day Mortality of Non-Trauma Patients using REMS and
           RAPS; a Prognostic Accuracy Study

    • Authors: Omid Garkaz, Farzin Rezazadeh, Saeed Golfiroozi, Sahar Paryab, Sadaf Nasiri, Hamidreza Mehryar , Mousa Ghelichi-Ghojogh
      Abstract: Introduction: Various scoring systems have been designed for calculating the mortality risk of patients. This study evaluated the accuracy of Rapid Emergency Medicine Score (REMS) and Rapid Acute Physiology Score (RAPS) in predicting the 28-day mortality of non-trauma patients. Methods: This prospective cross-sectional study was conducted on 1003 adult non-trauma patients, who referred to the emergency department of Imam Khomeini Hospital, Urmia, Iran, in the second half of 2018, using the census sampling. We determined the screening performance characteristics of REMS and RAPS in predicting the 28-day mortality of patients.    Results: This study examined 1003 non-trauma patients with a mean age of 61.5±18.05 years (60.6% male). The mean REMS (8.7 ± 3.2 vs. 6.0 ± 3.6; p < 0.001) and RAPS (3.7 ± 2.8 vs. 2.7 ± 2.0; p < 0.001) scores were significantly higher in deceased cases. Sensitivity and specificity of REMS in predicting the risk of non-trauma patients’ mortality were 85.19% (95%CI: 78.05% - 90.71%) and 78.34% (95%CI: 75.45% - 81.04%), respectively. While, the Sensitivity and specificity of RAPS in this regard were 61.39% (95%CI: 53.33% - 69.02%) and 71.12% (95%CI: 67.94% - 74.16%), respectively. The area under the receiver operating characteristic (ROC) curve of REMS and RAPS were 0.72 (95% CI: 0.68 -0.75) and 0.62 (95% CI: 0.56 - 0.65) in predicting the patients’ 28-day mortality, respectively (p = 0.001). Conclusion: The total accuracies of REMS and RAPS in predicting the 28-day mortality of non-trauma patients were in good and poor range, respectively. The screening performance characteristics of REMS were a little better in this regard.
      PubDate: 2022-07-04
      DOI: 10.22037/aaem.v10i1.1601
      Issue No: Vol. 10, No. 1 (2022)
       
  • COVID-19 Vaccines’ Protection Over Time and the Need for Booster
           Doses; a Systematic Review

    • Authors: Omid Dadras, SeyedAhmad SeyedAlinaghi, Amirali Karimi, Alireza Shojaei, Ava Amiri, Sara Mahdiabadi, Amirata Fakhfouri, Armin Razi, Hengameh Mojdeganlou, Paniz Mojdeganlou, Alireza Barzegary, Zahra Pashaei, Amir Masoud Afsahi, Parnian Shobeiri, Esmaeil Mehraeen
      Abstract: Introduction: Controversies existed regarding the duration of COVID-19 vaccines’ protection and whether receiving the usual vaccine doses would be sufficient for long-term immunity. Therefore, we aimed to systematically review the studies regarding the COVID-19 vaccines’ protection three months after getting fully vaccinated and assess the need for vaccine booster doses. Methods: The relevant literature was searched using a combination of keywords on the online databases of PubMed, Scopus, Web of Science, and Cochrane on September 17th, 2021. The records were downloaded and the duplicates were removed. Then, the records were evaluated in a two-step process, consisting of title/abstract and full-text screening processes, and the eligible records were selected for the qualitative synthesis. We only included original studies that evaluated the efficacy and immunity of COVID-19 vaccines three months after full vaccination. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement to ensure the reliability of results. Results: Out of the 797 retrieved records, 12 studies were included, 10 on mRNA-based vaccines and two on inactivated vaccines. The majority of included studies observed acceptable antibody titers in most of the participants even after 6 months; however,it appeared that the titers could also decrease in a considerable portion of people. Due to the reduction in antibody titers and vaccine protection, several studies suggested administering the booster dose, especially for older patients and those with underlying conditions, such as patients with immunodeficiencies. Conclusion: Studies indicated that vaccine immunity decreases over time, making people more susceptible to contracting the disease. Besides, new variants are emerging, and the omicron variant is continuing to spread and escape from the immune system, indicating the importance of a booster dose.
      PubDate: 2022-07-04
      DOI: 10.22037/aaem.v10i1.1582
      Issue No: Vol. 10, No. 1 (2022)
       
  • Premature Coronary Artery Disease and Plasma Levels of Interleukins; a
           Systematic Scoping Review and Meta-Analysis

    • Authors: Mohammad Haji Aghajani, Amirmohammad Toloui, Koohyar Ahmadzadeh, Arian Madani Neishaboori, Mahmoud Yousefifard
      Abstract: Introduction: Interleukins (ILs) can act as a predictive indicator of Premature Coronary Artery Disease (pCAD) and may be useful in screening of high-risk patients. However, there is no consensus on the relationship of serum levels of ILs and pCAD, yet. As a result, this study has been conducted in order to review the literature on the relationship between serum levels of different ILs and pCAD. Methods: Medline, Scopus, Embase, and Web of Science databases were searched until December 7th 2020. Two reviewers independently screened and summarized eligible articles. A meta-analysis was performed to assess the relationship of ILs and pCAD. Results: 12 case-control articles were included. IL-6 plasma changes do happen in pCAD patients with a standardized mean difference (SMD) of 0.51 (95% CI: 0.12-0.90; p=0.010) compared with the control group. This difference was also observed when evaluating the plasma levels of IL-1 and IL-17, with an SMD of 1.42 (95% CI: 1.11-1.73; p<0.001) and 0.59 (95% CI: 0.14-1.04; p=0.011), respectively. Meanwhile, no significant difference existed in plasma levels of IL-10 (SMD=0.26; 95% CI: -0.17-0.70; p=0.236), and IL-18 (SMD=1.44; 95% CI: -0.19-3.07; p=0.083) between pCAD patients and those in the control group. Conclusion: Low level of evidence showed that there may be a significant relationship between increased plasma levels of ILs and the occurrence of pCAD. As a result, prospective cohort studies with serial assessments of serum ILs during follow up period, focusing on controlling classical risk factors of pCAD and increase in level of ILs, should be conducted.
      PubDate: 2022-06-27
      DOI: 10.22037/aaem.v10i1.1605
      Issue No: Vol. 10, No. 1 (2022)
       
  • Diagnostic Accuracy of Ultrasonography by Emergency Medicine Resident in
           Detecting Intestinal Obstruction; a Pilot Study

    • Authors: Anita Sabzghabaei, Majid Shojaei, Miromid Chavoshzadeh
      Abstract: Introduction: There are many ambiguities regarding the application of ultrasound in detection of intestinal obstruction. This study aimed to evaluate the diagnostic accuracy of ultrasound in diagnosis of intestinal obstruction. Methods: This cross-sectional study was performed on patients with symptoms and signs of bowel obstruction between November19 and July 2020 in Shohadaye-Tajrish and Imam Hossein General Hospitals, Tehran, Iran. After a brief explanation and getting verbal consent, the patients underwent ultrasound examination in the emergency department by the emergency medicine resident. The results of ultrasound were compared with the surgical findings as the gold standard. Results: 24 patients with the mean age of 57.50±18.26 (range: 28 – 81) years were studied (58.3% male). Ultrasonography findings revealed the lumen diameter ≥ 2.5 cm in 21 (87.5%) cases, wall thickness ≥ 3 mm in 3 (12.5%) cases and inter-loop free fluid in 3 (12.5%) cases. Sensitivity, positive predictive value, and accuracy of ultrasound in detection of intestinal obstruction were found to be 85.00% (95%CI: 61.13 – 96.03), 80.95% (95%CI: 57.42 – 93.71), and 70.83% (95%CI: 48.91 – 87.38), respectively. Conclusion: It seems that point-of-care ultrasound has good sensitivity and accuracy in detection of intestinal obstruction when performed in the emergency department by a trained emergency medicine resident.
      PubDate: 2022-06-26
      DOI: 10.22037/aaem.v10i1.1628
      Issue No: Vol. 10, No. 1 (2022)
       
  • Clinical and Laboratory Predictors of COVID-19-Related In-hospital
           Mortality; a Cross-sectional Study of 1000 Cases

    • Authors: Zohreh Mohammadi , Masood Faghih Dinevari, Nafiseh Vahed, Haniyeh Ebrahimi Bakhtavar, Farzad Rahmani
      Abstract: Introduction: Identifying patients at risk for mortality and using appropriate treatment for each patient based on their situation could be an effective strategy in improving their outcome. This study aimed to evaluated the predictors of COVID-19 in-hospital mortality. Methods: This descriptive cross-sectional study was conducted on all adult COVID-19 patients who were managed in Imam-Reza and Sina Hospitals, Tabriz, Iran, from November 2020 until December 2021. The demographic, clinical, and laboratory characteristics of patients were evaluated and predictors of in-hospital mortality were identified using logistic regression model. Results: 1000 patients with the mean age of 56.34 ± 18.00 years were studied (65.7% male). There were significant associations between COVID-19 in-hospital mortality and hospitalization above five days (p = 0.001), white blood cell count (WBC) > 4000 Cells*103/mL (p < 0.01), aspartate aminotransferase (AST) above 40 IU/L (p = 0.001), alanine transaminase (ALT) above 40 IU/L (p = 0.001), creatinine above 1.4 mg/dL (p = 0.007), urea above 100 mg/dL (p = 0.024), and SaO2 below 80% (p = 0.001). Hospital stay above five days (OR: 3.473; 95%CI: 1.272 - 9.479; p = 0.15), AST above 40 IU/L (OR: 0.269, 95%CI: 0.179 - 0.402; p = 0.001), creatinine above 1.4 mg/dL (OR: 0.529; 95%CI: 0.344 - 0.813; p = 0.004), urea above 100 mg/dL (OR: 0.327, 95%CI: 0.189 - 0.567; p = 0.001), and SaO2 below 80% (OR: 8.754, 95%CI: 5.413 - 14.156; p = 0.001) were among the independent predictors of COVID-19 in-hospital mortality. Conclusion: The mortality rate of patients with COVID-19 in our study was 29.9%. Hospitalization of more than five days, AST above 40 IU/L, creatinine above 1.4 mg/dL, urea above 100 mg/dL and SaO2 < 80% were independent risk factors of in-hospital mortality among patients with COVID-19.
      PubDate: 2022-06-23
      DOI: 10.22037/aaem.v10i1.1574
      Issue No: Vol. 10, No. 1 (2022)
       
  • Risk Factors of Readmission in COVID-19 Patients; a Retrospective 6-Month
           Cohort Study

    • Authors: Mohammad Haji Aghajani, Reza Miri, Mohammad Sistanizad, Amirmohammad Toloui, Arian Madani Neishaboori, Asma Pourhoseingholi, Ziba Asadpoordezaki, Roxana Sadeghi, Mahmoud Yousefifard
      Abstract: Introduction: The available literature regarding the rate of readmission of COVID-19 patients after discharge is rather scarce. Thus, the aim in the current study was to evaluate the readmission rate of COVID-19 patients and the components affecting it, including clinical symptoms and relevant laboratory findings. Methods: In this retrospective cohort study, COVID-19 patients who were discharged from Imam Hossein hospital, Tehran, Iran, were followed for six months. Data regarding their readmission status were collected through phone calls with COVID-19 patients or their relatives, as well as hospital registry systems. Eventually, the relationship between demographic and clinical characteristics and readmission rate was assessed. Results: 614 patients were entered to the present study (mean age 58.7±27.2 years; 51.5% male). 53 patients were readmitted (8.6%), of which 47 patients (7.6%) had a readmission during the first 30 days after discharge. The reasons for readmission were relapse of COVID-19 symptoms and its pulmonary complications in 40 patients (6.5%), COVID-19 related cardiovascular complications in eight patients (1.3%), and non-COVID-19 related causes in five patients (0.8%). Older age (OR=1.04; 95% CI: 1.01, 1.06; p=0.002) and increased mean arterial pressure during the first admission (OR=1.04; 95% CI: 1.01, 1.08; p=0.022) were found to be independent prognostic factors for the readmission of COVID-19 patients. Conclusion: Readmission is relatively frequent in COVID-19 patients. Lack of adequate hospital space may be the reason behind the early discharge of COVID-19 patients. Hence, to reduce readmission rate, extra care should be directed towards the discharge of older or hypertensive patients.
      PubDate: 2022-06-20
      DOI: 10.22037/aaem.v10i1.1514
      Issue No: Vol. 10, No. 1 (2022)
       
  • Effect of Sofosbuvir on Length of Hospital Stay in Moderate COVID-19
           Cases; a Randomized Controlled Trial

    • Authors: Rama Bozorgmehr, Farbod Amiri, Mohammad Hosein Zade, Fariba Ghorbani, Arash Khameneh Bagheri, Esmat Yazdi, Sayyed Mojtaba Nekooghadam, Guitti Pourdowlat, Alireza Fatemi
      Abstract: Introduction: Efforts to control the COVID-19 pandemic are still on. This study aimed to evaluate the effect of sofosbuvir on length of hospital stay and complications in COVID-19 cases with moderate severity. Methods: This randomized clinical trial was done on moderate COVID-19 cases, who were admitted to Shohadaye Tajrish Hospital, Tehran, Iran, from 4/2021 to 9/2021. Eligible patients were randomly allocated into two groups of intervention (sofosbuvir) and control, and their outcomes were compared regarding the length of hospital stay and complications. Results: 100 COVID-19 cases were randomly divided into two groups of 50 patients, as the intervention and control groups. The mean age of patients was 50.56 ± 12.23 and 57.1±14.1 years in the intervention and control groups, respectively (p = 0.02). The two groups were similar regarding distribution of gender (p = 0.15), underlying diseases (p = 0.08), the severity of COVID-19 (p = 0.80) at the time of admission, signs and symptoms (p > 0.05), and essential laboratory profile (p > 0.05). The length of hospital stay in the control and intervention groups was 7.7 ± 4.09 days and 4.7±1.6 days, respectively (p = 0.02). None of our patients needed ICU or mechanical ventilation. Conclusion: Sofosbuvir may decrease the length of hospital stay of COVID-19 cases with moderate severity, without a significant effect on the rate of intensive care unit (ICU) need and mortality.
      PubDate: 2022-06-09
      DOI: 10.22037/aaem.v10i1.1621
      Issue No: Vol. 10, No. 1 (2022)
       
  • Point-Of-Care Ultrasonography for Diagnosis of Medial Collateral Ligament
           Tears in Acute Knee Trauma; a Diagnostic Accuracy Study

    • Authors: Farhad Heydari, Omid Ahmadi, Keihan Golshani, Sirous Derakhshan
      Abstract: Introduction: The use of point-of-care ultrasonography (POCUS) for identifying medial collateral ligament (MCL) tears has increased in recent years. This study aimed to evaluate the diagnostic accuracy of POCUS in the diagnosis of acute MCL tears of the knee. Methods: This prospective cross-sectional study was performed on patients with suspected MCL tear of the knee in the emergency department (ED). After history taking and primary physical examination, radiographic imaging of the knee was done. If there was no fracture in the knee X-ray, the POCUS examination was done. All of the patients were asked to refer to an orthopedic clinic, 7-10 days after discharge from ED, for Magnetic Resonance Imaging (MRI) evaluation. The second POCUS was done in the orthopedic clinic. Finally, the findings of POCUS and MRI were compared in diagnosing MCL injury. Results: Two hundred and fifty patients with a mean age of 25.05 ± 9.12 years were analyzed (86.8% male). According to the MRI findings, as the gold standard, 55(22.0%) patients had MCL injury. The sensitivity, specificity, positive and negative predictive values (PPV and NPV), and accuracy of ultrasound in detection of MCL injury, in comparison with MRI were 83.64 (95% CI, 71.20 to 92.23), 94.36% (95% CI, 90.13 to 97.15), 80.70% (95% CI, 69.95 to 88.25), 95.34% (95% CI, 91.83 to 97.38), and 92.00% (95% CI, 87.92 to 95.05), respectively. The area under the receiver operating characteristic (ROC) curve of POCUS was 0.890 (95% CI, 0.844 to 0.926). Conclusion: It seems that POCUS can be applied in screening patients with MCL tears following blunt knee trauma.
      PubDate: 2022-06-09
      DOI: 10.22037/aaem.v10i1.1480
      Issue No: Vol. 10, No. 1 (2022)
       
  • Optimization of Service Process in Emergency Department Using Discrete
           Event Simulation and Machine Learning Algorithm

    • Authors: Sayyed_Morteza Hosseini_Shokouh, Kasra Mohammadi, Maryam Yaghoubi
      Abstract: Background - Emergency Department(ED) are operating with limited resources and high levels of unexpected requests. As a result, it is really precious to try for improving the productivity level of EDs. The aims of this study was minimizing the patients waiting time at ED as well as maximizing the percentage of units’ engagement in order to improve the ED efficiency in a public hospital in Iran. Methods - Optimization method used in this research is a comprehensive combination method. After simulating the case and making sure about the validity of the model, experiments were designed to study the effects of change in individuals – equipment on the average time that patients wait, as well as units’ engagement in ED. In order to determine objective functions, Artificial Neural Network (ANN) algorithm was used and MATLAB software was used to train it. Finally, after estimating objective functions and adding related constraints to the problem, fractional Genetic Algorith (GA) was used to solve the model. Results – The results show that the average waiting time in triage section reached near to zero and the average waiting time in screening section reduced to 158/97 min and also coefficient of units’ engagement in both sections has been 69% and 84%. Conclusions- The optimization of patient stream at ED is possible through appropriate allocation of the human and material resources.  
      PubDate: 2022-06-08
      DOI: 10.22037/aaem.v10i1.1545
      Issue No: Vol. 10, No. 1 (2022)
       
  • The Effect of Exercise-Based Pulmonary Rehabilitation on Quality of Life
           in Recovered COVID-19 Patients; a Quasi-Experimental Study

    • Authors: Seyed Mansoor Rayegani, Rama Bozorgmehr, Leila Angooti Oshnari, Amir Hossein Mahdi Kaghazi
      Abstract: Introduction: The coronavirus disease 2019 (COVID-19) is associated with a variety of physical and emotional disorders, and subsequently lower Quality of Life (QOL). This study aimed to investigate the effect of a 2-week exercise-based pulmonary rehabilitation on clinical characteristics and QOL of severe COVID-19 patients after discharge from intensive care unit (ICU). Methods: In this quasi-experimental study, eligible severe COVID-19 cases, who had survived and were discharged from ICU were selected using convenience sampling method. O2 saturation (SpO2), pulse rate, dyspnea, and QOL were evaluated and compared before and after two weeks of exercise-based pulmonary rehabilitation (PR). Results: 35 cases with the mean age of 57.86 ± 11.73 (18-75) years were studied (51.4% female). The mean SpO2 increased from 90.41 ± 3.97 to 95.11 ± 1.96% after two weeks of pulmonary rehabilitation (p<0.0001). In addition, the mean pulse rate (98.97±16.23 to 88.91±14.03 pulse/minute; p<0.001) and the mean dyspnea severity (5.6±1.97 to 3.45±1.97; p<0.0001) decreased after two weeks of intervention. Besides, the mean total QOL and its dimensions, including general health (p<0.0001), physical status (p<0.0001), emotional status (p = 0.036), and social function (p<0.0001) of patients, had significantly increased after intervention. Conclusion: Based on the findings of this study, it seems that two-week exercise-based pulmonary rehabilitation could be effective in increasing the SpO2, decreasing dyspnea and pulse rate, and improving the QOL of patients with severe COVID-19 after discharge from ICU.
      PubDate: 2022-06-08
      DOI: 10.22037/aaem.v10i1.1569
      Issue No: Vol. 10, No. 1 (2022)
       
  • Adherence to Referral Criteria for Burn Patients; a Systematic Review

    • Authors: Ali Bazzi, Mohammad Javad Ghazanfari, Masoumeh Norouzi, Mohammadreza Mobayen, Fateme Jafaraghaee, Amir Emami Zeydi, Joseph Osuji, Samad Karkhah
      Abstract: Introduction: Burn injuries are under-appreciated trauma, associated with substantial morbidity and mortality. It is necessary to refer patients in need of specialized care to more specialized centers for treatment and rehabilitation of burn injuries. This systematic review aimed to assess the adherence to referral criteria for burn patients. Methods: An extensive search was conducted on Scopus, PubMed, and Web of Science online databases using the relevant keywords from the earliest to October 7, 2021. The quality of the included studies was assessed using the appraisal tool for cross-sectional studies (AXIS tool). Results: Among a total of 7,455 burn patients included in the nine studies, 60.95% were male. The most frequently burned areas were the hands (n=3) and the face (n=2). The most and least common burn mechanisms were scalds (62.76%) and electrical or chemical (2.88%), respectively. 51.88% of burn patients had met ≥ 1 referral criteria. The overall adherence to the referral criteria for burn patients was 58.28% (17.37 to 93.39%). The highest and lowest adherence rates were related to Western Cape Provincial (WCP) (26.70%) and National Burn Care Review (NBCR) (4.97%) criteria, respectively. Conclusion: The overall adherence to the referral criteria for burn patients was relatively desirable. Therefore, well-designed future studies are suggested in order to uncover approaches to improve adherence to referral criteria for burn patients.
      PubDate: 2022-06-02
      DOI: 10.22037/aaem.v10i1.1534
      Issue No: Vol. 10, No. 1 (2022)
       
  • An 18-Month Epidemiologic Survey of 3364 Deceased COVID-19 Cases; a
           Retrospective Cross-sectional Study

    • Authors: Ayoub Tavakolian, Seyed Hassan Ashrafi Shahri, Mohammad Ali Jafari, Elham Pishbin, Hamid Zamani Moghaddam, Mahdi Foroughian, Hamidreza Reihani
      Abstract: Introduction: The COVID-19 pandemic has been considered an international problem. This study aimed to survey the demographic and clinical characteristics of the deceased COVID-19 patients. Methods: The present cross-sectional study was performed on all deceased COVID-19 patients who died in Imam Reza Hospital, Mashhad, Iran, from March 20, 2020, to September 23, 2021. Their data, including age, gender, complaints, and clinical symptoms at the time of admission, as well as information at the time of death (hour, shift, holiday/non-holiday) were analyzed and reported. Results: 3364 deaths due to COVID-19 have been registered during the study period (60.46% male). The patients' mean age was 66.99±16.97 (range: 1-101) years (92.7% of them were Iranian). The mortality at night shifts was less than day shifts (1643 vs. 1721). The average amount of deaths/day on holidays and workdays was (5.63 vs. 6.24). The number of deaths varied during the various hours of the day and night. Diabetes and cardiovascular diseases were the most common confounding factors, which were observed in 22.44% and 15.36% of the cases, respectively. Conclusion: Based on the findings of this series, COVID-19 mortality was frequently observed in male patients, those with the mean age of 66.99 years, morning shifts, and workdays.
      PubDate: 2022-05-31
      DOI: 10.22037/aaem.v10i1.1568
      Issue No: Vol. 10, No. 1 (2022)
       
  • Safety and Adverse Events Related to COVID-19 mRNA Vaccines; a Systematic
           Review

    • Authors: SeyedAhmad SeyedAlinaghi, Amirali Karimi, Zahra Pashaei, Arian Afzalian, Pegah Mirzapour, Kobra Ghorbanzadeh, Afsaneh Ghasemzadeh, Mohsen Dashti, Newsha Nazarian, Farzin Vahedi, Marcarious Tantuoyir, Ahmadreza Shamsabadi, Omid Dadras, Esmaeil Mehraeen
      Abstract: Introduction: Knowledge of vaccine-related adverse events is crucial as they are among the most ‎important factors ‎that cause hesitation in receiving vaccines. Therefore, we aimed to systematically ‎review the adverse events ‎related to the mRNA vaccines reported in the literature.‎ Method: A systematic literature search was carried out in the databases of Scopus, PubMed, ‎Cochrane, and Web ‎of Science. We selected original studies that explored the side effects of ‎mRNA ‎COVID-19 vaccines using a two-phase (title/abstract and full-text) screening process.‎ Results: Cardiac ‎complications were the most commonly reported severe adverse events. It appeared that ‎systemic adverse reactions are more ‎common after the second dose of vaccines. The number of ‎adverse effects reported after the Pfizer vaccine was ‎higher than other vaccines, mostly due to its ‎earlier approval and more widespread use throughout the world. Cardiac adverse events had a ‎‎higher prevalence but no significant association has been found between COVID-19 mRNA vaccines ‎and cardiac ‎adverse events except for myopericarditis. ‎ Conclusion: Vaccines ‎play a crucial role in controlling the COVID-19 pandemic and decreasing ‎mortalities and the results of the present ‎review acknowledge the fact that the benefits outweigh the ‎adverse events of these vaccines.‎
      PubDate: 2022-05-28
      DOI: 10.22037/aaem.v10i1.1597
      Issue No: Vol. 10, No. 1 (2022)
       
  • Prolonged Resuscitation with Multiple Defibrillations; a Case Report

    • Authors: Shaghayegh Rahmani, Elham Mokhtari Amirmajdi, Rana Kolahi Ahari, Roohie Farzaneh
      Abstract: Although American Heart Association Guidelines (AHA) are practical and standardized in many aspects of cardiopulmonary resuscitation (CPR) performance, recommendations on when to terminate resuscitation are not fully understood and clear. There is not enough evidence about how long we can continue CPR in shockable rhythms and how many shocks can be delivered to patients, and if there is an end point for it or not. This issue is more challenging when we read papers published on survival rates and good functional and neurological outcomes after prolonged CPRs. Here, we demonstrate a case of cardiac arrest receiving CPR in the emergency room, for whom it was hard and challenging to make a decision on when to terminate the resuscitation attempts.
      PubDate: 2022-05-26
      DOI: 10.22037/aaem.v10i1.1583
      Issue No: Vol. 10, No. 1 (2022)
       
  • Nurses' Knowledge Regarding Oxygen Therapy; a Cross-Sectional Study

    • Authors: Maryam Hassanzad, Hosseinali Ghaffaripour, Mahsa Rekabi, Mahsa Mirzendehdel, Elham Sadati, Nasrin Elahimehr, Hojjat Derakhshanfar
      Abstract: Introduction: Oxygen therapy, if done correctly, can save patients' life promptly. However, improper use will be just as dangerous. The present study aimed to investigate the level of nurses’ knowledge on properly using oxygen. Method: This was a cross-sectional study with a minimum sample size of 72 nurses who were randomly selected from various wards of Masih Daneshvari Hospital, Tehran, Iran. To determine the level of knowledge about oxygen therapy, a questionnaire was used to collect data. This questionnaire consists of seven items, each of which is designed to determine the level of the individual’s knowledge about the various details of oxygen therapy. Results: Seventy-eight nurses with the mean age of 35.80±7.42 years participated in the study (87% female). The mean knowledge score of nurses regarding oxygen therapy was 8.89 ± 2.79 out of 16 points. 84.6% of the nurses were able to differentiate various types of oxygen masks. Accordingly, 94.9% of nurses had good knowledge on oxygen humidification. Also, 50% of the nurses had sufficient knowledge about the amount of oxygen flow produced by different masks. 10.3% of the nurses could choose the most appropriate mask for different clinical conditions. 6.4% of the nurses had knowledge of working with flowmeters, and 15.4% of the nurses had sufficient information about the maximum level of oxygen required for the patient. 17.9% of the nurses were familiar with measuring the appropriate amount of oxygen for patients. There was no statistically significant relationship between age (p = 0.57), gender (p = 0.09), employment status (p = 0.38), workplace (p = 0.86), current position (p = 0.11), degree (p = 0.27), and graduation time (p = 0.58) of nurses with good knowledge of using oxygen. However, a statistically significant relationship was reported between nurses' related work experience and their knowledge of the proper use of oxygen (p = 0.03). Conclusion: In general, the nurses’ knowledge at Masih Daneshvari Hospital on how to properly use oxygen is at a moderate level. Nurses' knowledge in some areas, such as working with the flowmeter, choosing the suitable mask for specific clinical conditions, and the maximum oxygen required for patients, is meager and requires training intervention.
      PubDate: 2022-05-18
      DOI: 10.22037/aaem.v10i1.1553
      Issue No: Vol. 10, No. 1 (2022)
       
  • Orthopedic Trauma During Pregnancy; a Narrative Review

    • Authors: Meisam Jafari Kafiabadi, Amir Sabaghzadeh, Seyyed Saeed Khabiri, Mehrdad Sadighi, Amir Mehrvar, Farsad Biglari, Adel Ebrahimpour
      Abstract: Introduction: Blunt traumas, like road accidents and falls, are common causes of injuries to pregnant women, and the major risk factors are young age and low socioeconomic level. Due to physiological and anatomical changes specific to pregnancy, such as changes in blood pressure and hemoglobin drop, trauma management involves certain complexities. Physical trauma is estimated to cause at least 1 complication in every 12 pregnancies. This study aims to evaluate orthopedic trauma during pregnancy and appreciate the different approaches to circumvent the resultant challenges. Methods:  We reviewed 55 articles, published on orthopedic trauma during pregnancy between 2011 and 2021. The articles were identified by searching PubMed, google-scholar, Scopus, and Science-Direct. We utilized the search terms: fall in pregnancy, traumas in pregnancy, motor vehicle accident/crash in pregnancy, blunt trauma in pregnancy, pregnant trauma patient, penetrating injury during pregnancy, assault, interpersonal violence in pregnancy, and mortality and pregnancy. Results: According to available reports, after stabilizing the pregnant patient, diagnostic procedures, including radiography, and even gadolinium-based techniques when needed, can be performed to examine extensive trauma. In contrast to elective orthopedic surgery, emergency orthopedic surgeries, including reduction of open fractures, should be performed promptly. Conclusion: Based on our investigation, pregnant women with orthopedic injuries that are severe, or even seemingly less severe, experience significantly increased adverse pregnancy outcomes, which include preterm birth, placental abruption, poor infant condition at birth, infant death, and even maternal death.
      PubDate: 2022-05-18
      DOI: 10.22037/aaem.v10i1.1573
      Issue No: Vol. 10, No. 1 (2022)
       
  • Impact of COVID-19 Pandemic on Emergency Department Referrals with
           Urologic Complaints; a Retrospective Cross-Sectional Study

    • Authors: Anahita Ansari Djafari, Babak Javanmard, Amirhossein Rahavian, Ahmad Reza Rafiezadeh Rafiezadeh, Nasrin Borumandnia, Seyyed Ali Hojjati, Seyyed Mohammad Hosseininia, Hormoz Karami
      Abstract: Introduction: Medical and surgical priorities were dramatically changed during the COVID-19 pandemic. This study aimed to evaluate the impact of this pandemic on presentation to emergency department (ED) with urologic complaint. Method: This cross-sectional study was conducted at a tertiary urology referral center in Tehran, Iran. The data of all ED admissions were collected and the frequency of admissions with urologic complain and their outcomes were compared between two 90-day periods (before and during COVID-19 era). Results: 480 ED admissions were studied. The number of patients visiting the ED with urologic complaint during COVID-19 era was significantly lower than the same period in the pre-COVID-19 period (125 vs. 355 admissions; p = 0.01). The mean hospitalization days for patients in the pre-COVID-19 period were significantly higher (5.6 ± 4.4 vs. 3.2 ± 4.2 days; p <0.001). The most common patient complaints before and during COVID-19 period were flank pain (32.7%) and gross hematuria (32.8%), respectively. The number of patients discharged against medical advice in the COVID-19 period was significantly higher than before (22 (17.6%) vs. 10(2.8%); p < 0.001). The number of patients who developed severe complications was significantly higher in the COVID-19 period than in the pre-COVID-19 period (p = 0.001). Conclusion: During the COVID-19 pandemic we were faced with decreasing frequency of admission with urologic complaint, change in the pattern of referrals, decrease in the duration of hospitalization, increase in the number of patients discharged against medical advice, and increase in the number of cases with irreversible urologic complications or complications requiring surgery due to deferred treatment.
      PubDate: 2022-05-17
      DOI: 10.22037/aaem.v10i1.1563
      Issue No: Vol. 10, No. 1 (2022)
       
  • CURB-65, qSOFA, and SIRS Criteria in Predicting In-Hospital Mortality of
           Critically Ill COVID-19 Patients; a Prognostic Accuracy Study

    • Authors: Sorour Khari, Atefe Salimi Akin Abadi, Marzieh Pazokian, Mahmoud Yousefifard
      Abstract: Introduction: Outcome prediction of intensive care unit (ICU)-admitted patients is one of the important issues for physicians. This study aimed to compare the accuracy of Quick Sequential Organ Failure Assessment (qSOFA), Confusion, Urea, Respiratory Rate, Blood Pressure and Age Above or Below 65 Years (CURB-65), and Systemic Inflammatory Response Syndrome (SIRS) scores in predicting the in-hospital mortality of COVID-19 patients. Methods: This prognostic accuracy study was performed on 225 ICU-admitted patients with a definitive diagnosis of COVID-19 from July to December 2021 in Tehran, Iran. The patients' clinical characteristics were evaluated at the time of ICU admission, and they were followed up until discharge from ICU. The screening performance characteristics of CURB-65, qSOFA, and SIRS in predicting their mortality was compared. Results: 225 patients with the mean age of 63.27±14.89 years were studied (56.89% male). The in-hospital mortality rate of this series of patients was 39.10%. The area under the curve (AUC) of SIRS, CURB-65, and qSOFA were 0.62 (95% CI: 0.55 - 0.69), 0.66 (95% CI: 0.59 - 0.73), and 0.61(95% CI: 0.54 - 0.67), respectively (p = 0.508). In cut-off ≥1, the estimated sensitivity values of SIRS, CURB-65, and qSOFA were 85.23%, 96.59%, and 78.41%, respectively. The estimated specificity of scores were 34.31%, 6.57%, and 38.69%, respectively. In cut-off ≥2, the sensitivity values of SIRS, CURB-65, and qSOFA were evaluated as 39.77%, 87.50%, and 15.91%, respectively. Meanwhile, the specificity of scores were 72.99%, 34.31%, and 92.70%. Conclusions: It seems that the performance of SIRS, CURB-65, and qSOFA is similar in predicting the ICU mortality of COVID-19 patients. However, the sensitivity of CURB-65 is higher than qSOFA and SIRS.
      PubDate: 2022-05-10
      DOI: 10.22037/aaem.v10i1.1565
      Issue No: Vol. 10, No. 1 (2022)
       
  • Demographic and Clinical Characteristics of 907 Cases with Naltrexone
           Intoxication; a 14-Year Cross-Sectional Study

    • Authors: Mitra Rahimi, Alireza Kargar, Delara Hazegh Fetratjoo, Sayed Masoud Hosseini, Arezou Mahdavinejad, Shahin Shadnia
      Abstract: Introduction: Opioids have been the leading cause of death from poisoning in Iran for several years. This study aimed to evaluate the clinical and para-clinical presentations of naltrexone intoxication, its toxic dose, and its epidemiological properties. Methods: This retrospective cross-sectional study was conducted on medical records of patients presenting to Toxicology Department of Loghman Hakim Hospital, Tehran, Iran, following naltrexone intoxication, from 2002 to 2016. Patients’ demographic and laboratory data, clinical signs, supposed ingested dose, and intent of naltrexone consumption were collected, analyzed, and then interpreted. Results: 907 patients with the mean age of 36.6 ±11.7 years were evaluated (94.3% male).  The mean amount of naltrexone consumed by the intoxicated patients reported in the medical records was 105.8 ± 267.8 mg. One hundred thirty patients (14.3%) used naltrexone to treat substance use disorder. Two hundred eighty-seven poisoned patients (31.6%) were current opium users who intentionally or unintentionally used naltrexone concomitantly. The most common symptoms observed in these patients were agitation (41.8%), vomiting (16.4%), and nausea (14.8%). Among patients with naltrexone poisoning, 25 patients were intubated (2.8%), and three passed away. Aspartate aminotransferase (AST) levels were significantly higher in patients intoxicated with naltrexone who needed intubation (p = 0.02). Conclusion: The probability of intubation of cases with naltrexone intoxication was associated with AST elevation. It seems that, the number of intensive care unit (ICU) admissions and mortality rates are not high among these patients.
      PubDate: 2022-05-01
      DOI: 10.22037/aaem.v10i1.1554
      Issue No: Vol. 10, No. 1 (2022)
       
  • The Challenges of Emergency Medical Services Response to Arasbaran Twin
           Earthquakes; a Content Analysis

    • Authors: Mahboub Pouraghaei, Javad Babaie, Laleh Rad Saeed
      Abstract: Introduction: One of the most important concerns in responding to disasters is providing Basic Life Support (BLS) services. Considering the key role of Emergency Medical Services (EMS) in providing BLS, the purpose of this study is to investigate the experience of provincial EMS during their response to the Arasbaran twin earthquakes and its challenges in Iran. Methods: This study was conducted using a qualitative approach and the conventional content analysis method. Data were collected through Focused Group Discussions (FGD) and semi-structured in-depth interviews with purposively-selected EMS paramedics and officials in East Azerbaijan Province, Iran. To form the main categories, the interviews were encoded in three stages and the similar codes were placed under the same subcategories and merged. Results: A total of 26 EMS paramedics participated in the study. The codes extracted from the interviews, after three stages of reduction, were placed in the top ten categories, including the lack of preparedness and coordination, dead bodies' management challenges, responders’ psychosocial support, deficiencies in supplies and ambulances, difficulty of access to rural areas, volunteer management, non-documentation of the experiences, communication challenges, recalling, and deploying of EMS responders.  Conclusion: Timely response of the EMS and paramedics’ sense of responsibility for providing services were positive and successful points about the emergency response operations. The weaknesses of EMS should, therefore, be addressed through transferring of experiences and by planning and arranging training courses.
      PubDate: 2022-05-01
      DOI: 10.22037/aaem.v10i1.1571
      Issue No: Vol. 10, No. 1 (2022)
       
  • Resident Productivity in the Emergency Department After Implementation of
           an Automated Patient Assignment System; a Brief Report

    • Authors: Christian Rosenow, Sophia Aguirre, Thomas Polveroni, Zachary Ginsberg, Jordan Pollock, Stephen Traub, Douglas Rappaport
      Abstract: Introduction: The clinical diversity of patients presenting to the emergency department (ED) allows emergency medicine (EM) and non-EM residents to sharpen their clinical skills. In most EDs, residents self-assign patients at their discretion. Our institution transitioned from a self-assignment-system to an automated-system, after which we sought to determine the productivity of our non-EM residents compared to the previous system. Methods: In this retrospective cross-sectional study, resident productivity was measured as number of patient visits per hour and per 8.5-hour shift before and after the implementation of an automated patient assignment system in emergency department. The automated-system assigns one patient at the start of the shift, another 30 minutes later, and one patient every hour thereafter, throughout the shift. Results: 28 residents performed 406 total shifts prior to implementation and 14 residents performed 252 total shifts post-implementation. The average number of patient visits per hour significantly increased from 0.52 ± 0.18 (95% CI 0.45-0.59, IQR 0.43-0.60) to 0.82 ± 0.11 (95% CI 0.75-0.88, IQR 0.74-0.89) after implementation of our assignment system (p<0.00001; figure 1). Additionally, the average number of patient visits per 8.5-hour shift significantly increased from 4.46 ± 1.53 (CI 3.86-5.05, IQR 3.66-5.08) to 6.52 ± 0.86 (CI 6.02-7.02, IQR 5.90-7.09) after the implementation of our system (p<0.00001; figure 1). Conclusion: These findings warrant further evaluation of the impact of patient assignment systems on trainee education.
      PubDate: 2022-04-30
      DOI: 10.22037/aaem.v10i1.1516
      Issue No: Vol. 10, No. 1 (2022)
       
  • Accuracy of Triage Systems in Disasters and Mass Casualty Incidents; a
           Systematic Review

    • Authors: Jafar Bazyar, Mehrdad Farrokhi, Amir Salari, Hamid Safarpour, Hamid Reza Khankeh
      Abstract: Introduction: To prioritize patients to provide them with proper services and also manage the scarce resources in emergencies, the use of triage systems seems to be essential. The aim of this study was to evaluate the accuracy of the existing triage systems in disasters and mass casualty incidents. Methods: The present study is a systematic review of the accuracy of all triage systems worldwide. The results of this study were based on the articles published in English language journals. In this research, all papers published from the beginning of 2000 to the end of 2021 were sought through different databases. Finally, a total of 13 articles was ultimately selected from 89 articles. Results: 13 studies on the accuracy of triage systems were reviewed. The START, mSTART, SALT, Smart, Care Flight, ASAV, MPTT, Sieve and ESI triage systems, had an accuracy, sensitivity, and specificity of less than 90%. Only the Smart triage system had an overall accuracy of more than 90%. Conclusion: According to the findings of the current systematic review, the performance of the existing triage systems in terms of accuracy of prioritizing the injured people and other performance indexes is not desirable. Therefore, to improve the performance and increase the precision of triage systems, the world nations are recommended to change or revise the indexes used in triage models and also identify other influential factors affecting the accuracy of triage systems.
      PubDate: 2022-04-30
      DOI: 10.22037/aaem.v10i1.1526
      Issue No: Vol. 10, No. 1 (2022)
       
  • Mortality and Years of Life Lost due to Burn Injury Among Older Iranian
           People; a Cross-Sectional study

    • Authors: Farideh Sadeghian, Sahar Saeedi Moghaddam, Zahra Ghodsi, Parinaz Mehdipour, Ali Ghanbari, Gerard O'Reilly, Nazila Rezaei, Sahar Mohammadi Fateh, Ali H. Mokdad, Vafa Rahimi-Movaghar
      Abstract: Introduction: The mortality of burn injury is a serious health problem among older people. The present study aimed to determine the epidemiological characteristics of burn mortality and Years of Life Lost (YLLs) among people aged ≥ 60. Methods: The National and Subnational Burden of Disease (NASBOD) study includes population-based cross-sectional data from the death registration system of Iran and those recorded by the cemeteries of Tehran and Esfahan were used in this study. Spatio-temporal and Gaussian process regression models were applied to estimate rates and trends of mortality and cause-specific mortality fractions. YLLs were calculated using Iranian life expectancy and the number of deaths. Results: The mortality rate for 1990 and 2015 was 17.4 and 4.5 per 100,000, respectively. From 1990 through 2015, the annual percentage of change in burn mortality rate was -6.1% in females and -4.4% in males. During 2015, there were 326 deaths following burns in people aged 60+ with 4586 person YLLs, and in 1990 there were 523 deaths with 4862 person-YLLs. The male-female ratio for 1990 and 2015 were 0.80 and 0.88, respectively. The age-standardized mortality rate was higher than 8.5 per 100,000 in border provinces in 2015. The provinces with better socioeconomic situations, such as Tehran, had a lower mortality rate than poor provinces, such as Sistan va Baluchistan. Conclusion: Although burn mortality in old people decreased in those 26 years, it is still high compared to high-income countries. Continued efforts to increase preventive measures and adequate access to quality care, especially in border provinces, is suggested.
      PubDate: 2022-04-27
      DOI: 10.22037/aaem.v10i1.1547
      Issue No: Vol. 10, No. 1 (2022)
       
  • Factors Associated with 24-Hour Clinical Outcome of Emergency Patients; a
           Cohort Study

    • Authors: Kannika Katsomboon, Siriorn Sindhu, Ketsarin Utriyaprasit, Chukiat Viwatwongkasem
      Abstract: Introduction: Pre-hospital and in-hospital emergency management play an important role in quality of care for emergency patients. This prospective cohort study aimed to determine factors associated with the 24-hour clinical outcome of emergency patients. Methods: The sample included 1,630 patients, randomly selected through multi-stage stratified sampling from 13 hospitals in 13 provinces of Thailand. Data were collected during January-November 2018. Clinical outcome was determined using pre-arrest sign score. Data were analyzed via ordinal multivariate regression analysis. Results: Factors influencing 24-hour clinical outcome of emergency patients were age (OR: 0.965; 95% CI: 0.96-0.97), having coronary vascular disease (CAD) (OR: 1.41; 95% CI: 1.05-1.88), and severity of illness based on Rapid Emergency Medical Score (REMS) (OR:1.09; 95% CI: 1.05-1.15). Self-transportation and being transported by emergency medical service ambulance with non-advanced life support (EMS-Non-ALS) did not influence clinical outcome when compared to EMS-ALS transport. Being transported from a community hospital increased pre-arrest sign score 1.78 times when compared to EMS-ALS (OR: 1.78; 95% CI: 1.17-2.72). Increased transportation distance increased the risk of poor clinical outcome (OR: 1.01; 95% CI: 1.002-1.011). Length of stay in emergency department (ED-LOS) more than 4 hours (OR: 0.21; 95% CI: 0.15-0.29) and between 2-4 hours (OR: 0.60; 95% CI: 0.47-0.75) decreased the risk of poor clinical outcome when compared to ED-LOS less than 2 hours. Conclusion: Having CAD, severity of illness, increased transport distance, and ED-LOS less than 2 hours were found to negatively influence 24-hour clinical outcome of emergency patients.
      PubDate: 2022-04-24
      DOI: 10.22037/aaem.v10i1.1590
      Issue No: Vol. 10, No. 1 (2022)
       
  • A 27-year-old Female Patient with Acute nausea/vomiting and Pelvic pain; a
           Photo Quiz

    • Authors: Murat Ozsarac, Yusuf Yurumez, Onur Karakayalı
      Abstract: A 27-year-old female patient, G2P1, presented to the emergency department (ED) with acute onset nausea, vomiting, and mild chronic abdominopelvic pain. Physical examination revealed bilateral lower quadrant tenderness without rebound, guarding, or rigidity, and vital signs were within normal limits. Electrolytes, complete blood count, and liver and kidney function tests were normal. A pregnancy test was negative, and urinalysis did not reveal any abnormalities. No free fluid was observed in the abdominal ultrasound, and the ovaries and other intra-abdominal structures were found to be normal. The patient underwent intravenous contrast-enhanced abdomiopelvic computed tomography (CT) scan.
      PubDate: 2022-04-24
      DOI: 10.22037/aaem.v10i1.1508
      Issue No: Vol. 10, No. 1 (2022)
       
  • Efficacy of Sumatriptan/Placebo versus Sumatriptan/Propofol Combination in
           Acute Migraine; a Randomized Clinical Trial

    • Authors: Reza Farahmand Rad, Akram Zolfaghari Sadrabad, Mohammadali Jafari, Marzieh Ghilian
      Abstract: Introduction: Migraine headaches can cause severe pain for patients and lead them to multiple visits to the emergency department (ED). This study aimed to evaluate the efficacy of propofol + sumatriptan combination in comparison with sumatriptan alone in the management of acute migraine headaches. Methods: This triple-blind clinical trial involved patients who referred to two emergency departments with acute migraine headaches. Patients were randomly assigned to control (sumatriptan and placebo) or intervention (propofol and sumatriptan) groups for comparison of the efficacy and side effects of treatment. Results: In this study, 60 patients were included whose mean age was 31±8.8 years, and headaches were more common among women. After 30 and 60 minutes from the beginning of treatment, the mean pain score reduction in the intervention group was significantly greater than that in the control group (p=0.012, p=0.024). In addition, the rate of chest tightness in the control group was significantly higher than the intervention group. The absolute risk reduction of adverse events (Chest tightness, Bradycardia, hypotension, and etc.), in patients with acute migraine headache taking propofol and sumatriptan treatment, was 32.18% (95% CI: 8.02 – 56.35). Conclusions: This study supports the use of propofol for treatment of acute migraine headaches and shows that combining sumatriptan with propofol is more effective in relieving migraine headaches and the associated symptoms than using sumatriptan alone. However, more studies with longer follow-ups are still needed.
      PubDate: 2022-04-14
      DOI: 10.22037/aaem.v10i1.1510
      Issue No: Vol. 10, No. 1 (2022)
       
  • Alveolar Arterial Gradient and Respiratory Index in Predicting the Outcome
           of COVID-19 Patients; a Retrospective Cross-Sectional Study

    • Authors: Abhishek Singh, Kapil Dev Soni, Yudhyavir Singh, Richa Aggarwal, Vineeta Venkateswaran, Mohd Suhail Ashar, Anjan Trikha
      Abstract: Introduction: Alveolar arterial (A-a) oxygen gradient and respiratory index can be of immense help for the critical care physician in clinical decision making. This study aimed to evaluate the potential application of A-a oxygen gradient and respiratory index in predicting the survival of COVID-19 patients in intensive care unit (ICU). Method: This is a retrospective cross-sectional study involving 215 adult patients with COVID-19 disease, admitted to the ICU between 1st April 2020 and 30 June 2021. Details regarding demographic variables, comorbidities, laboratory and arterial blood gas (ABG) findings were recorded. Alveolar-arterial gradient and respiratory index were calculated and tested as predictors of survival. Result: The mean age of the patients was 51.92 years (65.6 % male). Hypertension was the most common comorbidity and oxygen via non-rebreathing mask was the most common modality used at the time of ICU admission. Mortality was 28.37% and average length of stay was 12.84 days. Patients who died were older (p=0.02), mostly male (p=0.017), had at least one comorbidity (p<0.001), and higher heart rate and respiratory rate (<0.001 and p=0.03, respectively), lower pH on arterial blood gas (ABG) (p=0.002), higher FiO2 requirement (p<0.001), and increased A-a oxygen gradient on admission compared to survivors. According to receiver operating characteristic (ROC) curve analysis, A-a oxygen gradient and respiratory index were not sensitive or specific in predicting mortality in the studied patient subset. Conclusion: A-a oxygen gradient and respiratory index calculated at time of admission to ICU in patients with COVID-19 were poor predictors of survival.
      PubDate: 2022-04-14
      DOI: 10.22037/aaem.v10i1.1543
      Issue No: Vol. 10, No. 1 (2022)
       
  • Potential Impact of 3% Hypertonic Saline Infusion on Tramadol
           Poisoning-Induced Electrocardiogram Changes; a Randomized Clinical Trial

    • Authors: Ali Omraninava, Ahmad Mehdizade, Ebrahim Karimi, Amir Ghabousian
      Abstract: Introduction: Tramadol is a synthetic analgesic with weak mu-opioid receptor agonist activity. Tramadol overdose is associated with adverse cardiac effects due to inhibiting cardiac Na+ and K+ channels. This study aimed to investigate the potential ameliorative role of 3% hypertonic saline on the electrocardiogram (ECG) changes in patients presenting with tramadol poisoning. Methods: This was a single-center, controlled, randomized, single-blind clinical trial. Patients were randomized into the case (received hypertonic saline) and control (received placebo) groups. ECG was obtained twice in each group (upon arrival and following the intervention). Response to therapeutic interventions was evaluated using Wilcoxon Signed Ranks Test. Results: A total of 76 patients were included. The mean age of patients was 24.88 ± 4.29 years, and 62 (81.6%) were male. The mean ingested dose of tramadol was 1673.68 ± 608.85 (range: 550-2750) mg. The number needed to treat and the absolute risk reduction of 3% hypertonic saline in the treatment of wide QRS were 1 (95% CI: 1.00 – 1.00) and 100%, respectively. In the treatment of long QTc, these measures were 1.9 (95%CI: 1.2 – 4.5) and 53.85% (95%CI: 22.00 – 85.69), respectively. Conclusion: Given that hypertonic saline infusion can significantly ameliorate tramadol-mediated ECG changes, including QRS prolongation and QT lengthening, it can be regarded as a potential therapeutic strategy to prevent the development of life-threatening ventricular arrhythmias caused by tramadol toxicity.
      PubDate: 2022-04-13
      DOI: 10.22037/aaem.v10i1.1567
      Issue No: Vol. 10, No. 1 (2022)
       
  • Relationship Between Income Level and Hospitalization Rate in COVID-19
           Cases; an Example of Social Factors Affecting Health

    • Authors: Ali Maher, Hamed Dehnavi, Elham Salehian, Mona Omidi, Khatereh Hannani
      Abstract: Introduction: Considering the population's socioeconomic status and clinical features is essential in planning and performing interventions related to disease control. The main purpose of this study was to investigate the relationship between income level and hospitalization rate of COVID-19 patients‌. Methods: A cross-sectional study was performed on 198,944 hospitalized COVID-19 patients in Tehran province between March 2020 and March 2021. Data of hospitalized COVID-19 patients was obtained from the Hospital Intelligent Management System (HIM). The income data of patients were obtained from the Iranian Database on Targeted Subsidies belonging to the Ministry of Cooperatives, Labor, and Social Welfare. Data analyses were performed using SPSS software. Results: About 2.5% of the inpatients were from the first decile, while 20.6% were from the tenth. The share of the lower three deciles of total hospitalization was about 11%, while the share of the upper three deciles was 50%. There was a big difference between the upper- and lower-income deciles regarding death rates. In the first decile, 30% of inpatients died, while the proportion was 10% in the tenth decile. There was a significant and positive relationship between income decline and hospitalization (r = 0.75; p = 0.02). Also, there was a significant and negative relationship between income decline and death rate (r = -0.90; p = 0.01). Conclusion: Low-income groups use fewer inpatient services, are more prone to severe illness and death from COVID-19‌, and treatment in this group has a lower chance of success. Using a systemic approach to address socioeconomic factors in healthcare planning is crucial.
      PubDate: 2022-04-09
      DOI: 10.22037/aaem.v10i1.1600
      Issue No: Vol. 10, No. 1 (2022)
       
  • Glasgow Coma Scale Versus Physiologic Scoring Systems in Predicting the
           Outcome of ICU admitted Trauma Patients; a Diagnostic Accuracy Study

    • Authors: Sorour Khari, Mitra Zandi, Mahmoud Yousefifard
      Abstract: Introduction: There is no consensus on the performance of decision rules in predicting the prognosis of trauma patients. Therefore, the present study aimed to compare the value of Glasgow coma scale (GCS) and physiologic scoring systems in predicting mortality and poor outcome of trauma patients. Methods: This diagnostic accuracy study was conducted on multiple trauma patients admitted to the intensive care units of two hospitals in Tehran, Iran, from 21 November 2020 to 22 May 2021. The patients' demographic characteristics, length of stay in the intensive care unit (ICU), the vital signs, and the GCS on admission were recorded. Finally, the mortality, disability, and complete recovery of patients at the time of discharge were evaluated and receiver operating characteristics (ROC) curve analysis was used to compare the performance of physiologic scoring systems with GCS. Results: 200 trauma patients with the mean age of 43.53±19.84 years were evaluated (74% male). The area under the ROC curve for New Trauma Score (NTS), Revised Trauma Score (RTS), Worthing Physiological Scoring System (WPSS), Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS), Modified Early Warning Score (MEWS), National Early Warning  Score (NEWS), Glasgow Coma Scale (GCS), Age, and Systolic Blood Pressure (GAPS) in prediction of mortality were 0.95, 0.95, 0.83, 0.89, 0.91, 0.84, 0.77, 0.98, and 0.97 respectively. The performance of GCS was statistically superior to RTS (P=0.005), WPSS (P=0.0001), RAPS (P=0.0002), REMS (P=0.002), MEWS (P<0.0001), and NEWS (P<0.0001). However, the performance of GCS, NTS (P=0.146), and GAPS (P=0.513) were not significantly different. Also, in prediction of poor outcomes, the AUC of GCS (0.98) was significantly higher than RTS (0.95), RAPS (0.85), REMS (0.85), MEWS (0.84), NEWS (0.77), and WPSS (0.75). Conclusion: The GCS score seems to be a better instrument to predict mortality and poor outcome in trauma patients compared to other tools due to its high accuracy, wide application, and easy calculation.
      PubDate: 2022-04-09
      DOI: 10.22037/aaem.v10i1.1483
      Issue No: Vol. 10, No. 1 (2022)
       
  • 21-Year-Old Female with Pneumothorax and Massive Air Leak Following Blunt
           Trauma; a Photo Quiz

    • Authors: Ahmad Shirinzadeh-Dastgiri, Ali Saberi, Mohammad Vakili, Sayed Mahdi Marashi
      Abstract: A 21-year-old female presented to the emergency department, about 20 minutes after a motorcycle accident. She was agitated and complaining of shortness of breath. Her vital signs were: heart rate 110 bpm, respiratory rate 32/minute, blood pressure 89/67 mmHg, oxygen saturations 79% on room air, temperature 36.5°C and GCS 15. Chest auscultation revealed decreased breath sounds on the left side. The diagnosis of pneumothorax was made for the patient and a left thoracostomy tube was inserted; however, massive air leak was noted and the clinical symptoms did not improve. Computed tomography scan of the chest in the mediastinal window showeda doubtful pathology, crumpled laminated membrane.
      PubDate: 2022-04-09
      DOI: 10.22037/aaem.v10i1.1513
      Issue No: Vol. 10, No. 1 (2022)
       
  • Video Laryngoscopy in Emergency Airway Management - a Paradigm Shift from
           ‘I’ to ‘We’; a Letter to Editor

    • Authors: Sadaf Sheikh, Faisal Shamim
      Abstract: Emergency medicine has evolved as a speciality but airway management is still a challenge. Traditionally, direct laryngoscopy (DL) is used for intubation with maneuvers to directly visualize the vocal cords. Most tracheal intubations in the emergency department (ED) are done on an emergent basis and enhancing the technicalities of intubation can be life-saving. Video laryngoscopy (VL) is available in the emrgenyc department and can help reduce the intubation failure rate; hence, it has been recommended for maintaining airways in obese patients.
      PubDate: 2022-03-20
      DOI: 10.22037/aaem.v10i1.1474
      Issue No: Vol. 10, No. 1 (2022)
       
  • Right Upper Quadrant Pain Following Endoscopic Retrograde
           Cholangiopancreatography; a Case Report

    • Authors: Lan Thi Nguyen, Dang Hai Do, An Duc Thai, Hoa Thi Nguyen
      Abstract: Endoscopic retrograde cholangiopancreatography (ERCP) is a standard for diagnosing and treating hepato-pancreatico-biliary (HPB) diseases in clinical settings. ERCP-related complications are relatively common, ranging from 4 to 30%. The most common one is acute pancreatitis. ERCP-related necrotizing pancreatitis accounts for 7.7% of ERCP-related pancreatitis cases. This complication may still be misdiagnosed, which might lead to inappropriate treatment with a worse prognosis. Here, we report a 34-year-old case with ERCP-related necrotizing pancreatitis who was successfully managed, but initially misdiagnosed with biliary peritonitis.
      PubDate: 2022-03-16
      DOI: 10.22037/aaem.v10i1.1535
      Issue No: Vol. 10, No. 1 (2022)
       
  • Skin Cooling to Reduce the Pain Associated with Local Anesthetic
           Injection; a Randomized Controlled Trial

    • Authors: Saeed Majidinejad, Farhad Heidari, Amir Chitgarian
      Abstract: Introduction: Different methods have been proposed for the reduction of the pain caused by the injection of local anesthetics. This study aimed to evaluate the effect of skin cooling on reduction of pain associated with local injection of lidocaine buffered with sodium bicarbonate. Methods: This randomized controlled trial included 108 adult patients with arm/forearm wounds who referred to the emergency departments. Participants were randomly allocated to two equal groups. Patients in both groups received subcutaneous injection of buffered lidocaine. In the intervention group, an ice cube measuring 2 × 2 × 2 cm (at 0 ° C) in sterile gloves were placed on the wound for 2 minutes before the injection of buffered lidocaine. The primary outcome was severity of pain during lidocaine injection using a visual analog scale (VAS). Results: One hundred and eight patients were enrolled in the study, 54 in each group. There was no statistically significant difference in age (p = 0.777), sex (p = 0.466), and length of laceration (p = 0.410) between the two groups. The pain scores during lidocaine injection were significantly lower in the intervention group compared to control group (2.39 ± 1.14 vs 4.26 ± 0.94, p < 0.001). Conclusions: Skin cooling prior to the injection of local anesthetics can significantly reduce the pain caused by local anesthetic infiltration
      PubDate: 2022-03-10
      DOI: 10.22037/aaem.v10i1.1562
      Issue No: Vol. 10, No. 1 (2022)
       
  • Propofol + Granisetron vs. Propofol + Metoclopramide in Symptom Management
           of Acute Migraine Headache; a Double-Blind Randomized Clinical Trial

    • Authors: Samaneh Abiri, Mehdi Chegin, Reza Soleimani, Naser Hatami, Navid Kalani, Esmail Rayatdoost
      Abstract: Introduction: Acute headache is one of the most common reasons for emergency department (ED) visits. This study aimed to compare the combination of propofol and granisetron with propofol and metoclopramide in symptom management of acute migraine headache. Methods: In this double-blind randomized clinical trial, 60 adult patients with acute migraine headache who referred to ED were randomly divided into two groups of propofol + metoclopramide and propofol + granisetron. Pain and nausea/vomiting severity as well as blood pressure were compared between groups 30, 45, and 60 minutes after treatment. Results: The two groups had similar situation regarding mean age (p = 0.606), sex distribution (p = 0.793), baseline severity of pain (p = 0.642), frequency of nausea/vomiting (p = 0.488), and vital signs (p > 0.05). The severity of pain was similar in the two groups 30 (p = 0.731), 45 (p = 0.460), and 60 (p = 0.712) minutes after treatment. The number of patients with resistant nausea and vomiting 60 minutes after treatment was significantly higher in metoclopramide group (30.0% versus 10.0%; p = 0.033). Diastolic pressure 60 minutes after treatment (81.43 ±8.94 vs. 74.97 ± 4.8; p = 0.001) and heart rate 30 minutes after treatment (68.87 ±6.52 vs. 73.57± 7.62; p = 0.013) had statistically significant differences between the groups. Conclusion: The combination of propofol and granisetron was superior to propofol and metoclopramide in case of controlling nausea and vomiting of cases with acute migraine headache; meanwhile, no differences were observed in case of pain relief and hemodynamic status between the two groups.
      PubDate: 2022-03-05
      DOI: 10.22037/aaem.v10i1.1561
      Issue No: Vol. 10, No. 1 (2022)
       
  • Inferior Hip Dislocation in a 60-Year-Old Man; a Case Report

    • Authors: Ali Yeganeh, Nader Tavakoli, Mohammad Soleimani, Seyed Nima Taheri, Sahand Cheraghiloohesara
      Abstract: Inferior hip dislocation or luxatio erecta femoris is among the rarest hip dislocations, which has been described in limited studies. The patients usually present with their hip in flexion, abduction, and external rotation. Hip dislocation is an orthopedic emergency, and a reduction needs to be performed promptly to avoid devastating complications such as avascular necrosis. Here, we present a rare case of inferior hip dislocation in a 60-year-old man following a car-motorcycle collision. The patient presented to the emergency department with left hip flexion, abduction, external rotation, and inability to move his leg due to pain. Closed reduction under procedural sedation was attempted in the emergency department once, which was unsuccessful. The patient was then taken to the operating room for another attempt of closed reduction under general anesthesia. The patient was discharged after two days with pin traction and double crutches. After two weeks, the pin was removed, and full weight-bearing was permitted. After 12 weeks, the patient had mild pain with unusual activity and slight limping; however, imaging revealed no signs of any complications.
      PubDate: 2022-02-27
      DOI: 10.22037/aaem.v10i1.1498
      Issue No: Vol. 10, No. 1 (2022)
       
  • An Overview of Published Articles in Archives of Academic Emergency
           Medicine in 2021

    • Authors: Mehrnoosh Yazdanbakhsh, Somayeh Saghaei Dehkordi
      Abstract: Archives of Academic Emergency Medicine has published 70 articles in 2021, which have been authored by more than three hundred researchers from various countries, including but not limited to the United States, Australia, India, Japan, Thailand, Iraq, Pakistan, France, Greece, and Iran. In this editorial, we intend to provide an overview of our publications in 2021, so that we can identify our strengths and weaknesses and provide a brief report on our performance to readers and authors, which they might find useful in becoming more familiar with the journal.
      PubDate: 2022-02-27
      DOI: 10.22037/aaem.v10i1.1555
      Issue No: Vol. 10, No. 1 (2022)
       
  • Clinical Features and Outcomes of Acute Chlorine Gas Inhalation; a Brief
           Report

    • Authors: Taymmia Ejaz, Sheema Saadia, Safia Akhlaq, Adil Aziz, Muhammad Arslan Ahmed, Aisha Fareed Siddiqui
      Abstract: Introduction: On March 6th,2020, chlorine gas leak was reported at Engro Polymer & Chemicals Plant in Karachi City, Pakistan. This study aimed to evaluate the clinical features and outcomes of patients who presented to emergency department (ED) following this event. Methods: This retrospective cross-sectional study, evaluated the clinical features and outcomes (length of hospital stay, complications, and mechanical ventilation requirement) of patients presenting to ED of Aga Khan University Hospital, Karachi, Pakistan, with history of chlorine gas exposure at the Engro Plant from 6th March to 14th March 2020. Results: 38 patients with mean age of 33.1 ± 8.1 years presented to ED with history of chlorine gas exposure (100% male).  4 (10.5%) cases had comorbid diseases. Most common presenting symptom was dyspnea, observed in 33 (86.8%) cases, followed by cough, seen in 27 (71.1%) subjects. 13.2% (5/38) patients had infiltration on chest x-ray and 33 (86.8 %) required hospitalization. 6 (15.8%) patients had repeat presentation requiring hospitalization or ED visit. 18 (47.4%) were managed with high flow oxygen therapy, 9 (23.7%) required non-invasive ventilation and one patient was intubated due to development of pneumo-mediastinum. Mean length of stay was 1.55 ± 1.58 days and no patients died. Presence of tachycardia was the only finding significantly associated with need for oxygen (p = 0.033) and non-invasive ventilation (p = 0.012). Conclusion: The majority of patients presenting with acute chlorine gas exposure showed good clinical outcomes and rapid recovery, however, a high index of suspicion and vigilance should be maintained for complications such as pneumomediastinum and acute respiratory distress syndrome in these patients.
      PubDate: 2022-02-14
      DOI: 10.22037/aaem.v10i1.1448
      Issue No: Vol. 10, No. 1 (2022)
       
  • Correlation Between TIMI Risk Score and the Number of Vessels Involved in
           the Angiographic Study; a Cross-sectional Study

    • Authors: Mohammad Hasan Namazi, Seyedeh Slimeh Mazloomi, Mohammad Kalate Aghamohammadi
      Abstract: Introduction: TIMI (Thrombolysis in Myocardial Infarction) score is a model for predicting the severity of vascular diseases. This study aimed to evaluate the correlation between this score and the number of vessels involved in patients with Unstable Angina (UA) or Non-ST Elevation Myocardial Infarction (NSTEMI). Methods: This prospective cross-sectional study was designed to evaluate the correlation between TIMI score, and the number of vessels involved in the angiographic study of NSTEMI and UA patients presenting to emergency department. Results: 297 patients with the mean age of 62.16±36.59 years were entered (58.2% male; 193 (65%) UA and 104 (35%) NSTEMI). The Mean TIMI score among patients was 3.21±1.55. Based on the TIMI score, patients were categorized into 3 groups. 105 (35.35%) patients had a TIMI score of 0 to 2, 120 (40.40%) had a score of 3 to 4, and 72 (24.24%) had a score of 5 to 7. Patients with a TIMI score of 5 to 7 had a greater likelihood of three-vessel coronary artery disease compared to patients with a TIMI score of 3 to 4 (OR: 5.34, 95% CI: 2.64 to 10.80; p < 0.0001) or those with a TIMI score of 0 to 2. (OR: 29.45, 95% CI: 12.87 to 67.37; p < 0.0001). Two-vessel coronary artery disease was more likely to be found in patients with a TIMI score of 3 to 4 or those with a score of 5 to 7 compared to patients with a TIMI score of 0 to 2 (OR: 3.69, 95% CI: 1.60 to 8.51; p <0.0001 and OR: 2.67, 95% CI: 1.04 to 6.82; p = 0.04, respectively). Conclusion: There is a direct and significant correlation between TIMI score and the number of coronary vessels involved in patients presenting to emergency department following UA or NSTEMI.
      PubDate: 2022-02-14
      DOI: 10.22037/aaem.v10i1.1466
      Issue No: Vol. 10, No. 1 (2022)
       
  • Dorsal Approach in the Surgical Treatment of Complex Dorsal Dislocation of
           Index Metacarpophalangeal Joint; a Case Report

    • Authors: Shahab Aldin Sattari, Ali Reza Sattari, Kamran Heydari, Seyed Matin Sadat Kiaei, Farshad Zandrahimi, Mehdi Mohammadpour
      Abstract: Complex metacarpophalangeal (MCP) joint dislocation is an uncommon entity, which occurs following a hyperextension injury. Closed reduction is not feasible due to entrapped volar plate and/or coexisting fractures. Various approaches and techniques have been proposed for treatment of complex MCP dislocation; however, controversies exist over which one is superior. This study describes a right-handed 14-year-old boy who fell on the outstretched hand and sustained a dorsal dislocation of the left index MCP joint. The dislocation was complicated by an epiphyseal metacarpal head fracture with dorsal-ulnar displacement of the osteochondral fragment. The patient underwent open reduction through the dorsal approach, and the metacarpal head was fixed via the two-screw technique. The patient resumed left-hand function after six weeks. At the two-year follow-up, the range of motion and grip strength were normal, the patient was pain-free, and no sign of growth disturbance or joint stiffness was detected. Dorsal surgical approach with screw fixation is a feasible technique for the treatment of complex MCP dislocation, especially when it is complicated by a large epiphyseal head fracture.
      PubDate: 2022-02-09
      DOI: 10.22037/aaem.v10i1.1479
      Issue No: Vol. 10, No. 1 (2022)
       
  • Intravenous Lipid Emulsion for treating Tramadol-Induced Seizures:
           Surprising but Worth Considering for Future Studies; a Letter to Editor

    • Authors: Bruno Megarbane, Ahmed S. Gouda
      Abstract: None
      PubDate: 2022-02-09
      DOI: 10.22037/aaem.v10i1.1541
      Issue No: Vol. 10, No. 1 (2022)
       
  • Ultra-early Spinal Decompression Surgery Can Improve Neurological Outcome
           of Complete Cervical Spinal Cord Injury; a Systematic Review and
           Meta-analysis

    • Authors: Mahmoud Yousefifard, Behrooz Hashemi, Mohammad Mehdi Forouzanfar, Rozita Khatamian Oskooi, Arian Madani Neishaboori, Reza Jalili Khoshnoud
      Abstract: Introduction: Early decompression within the first 24 hours after spinal cord injury (SCI) is proposed in current guidelines. However, the possible benefits of earlier decompression are unclear. Thus, the present meta-analysis aims to investigate the existing evidence regarding the efficacy of ultra-early decompression surgery (within 12 hours after SCI) in improving patients’ neurological status. Methods: A search was performed in Medline, Embase, Scopus and Web of Science electronic databases, until the end of August 2021. Cohort studies and clinical trials were included in the present study. Exclusion criteria were absence of an early or late surgery group, failure to report neurological status based on the American spinal injury association impairment scale (AIS) grade, failure to perform the surgery within the first 12 hours after SCI, and duplicate reports and review articles. Two independent reviewers performed data collection, and risk of bias and certainty of evidence assessments. The outcome was reported as odds ratio (OR) and 95% confidence interval (CI). Results: Data from 16 articles, which studied 868 patients, were included. Compared to early or late decompression surgery, ultra-early decompression surgery significantly improves patients’ neurological status (OR = 2.25; 95% CI: 1.41 to 3.58). However, ultra-early surgery in thoracolumbar injuries is not significantly more effective than early to late surgery. Moreover, ultra-early surgery in patients with a baseline AIS A increases the chance of neurologic resolvent up to 3.86 folds (OR=3.86; 95% CI: 1.50 to 9.91). Contrastingly, ultra-early surgery does not result in significant improvement compared to early to late surgery in patients with AIS B (OR = 1.32; 95% CI: 0.51 to 3.45), AIS C (OR = 1.83; 95% CI: 0.72 to 4.64), and AIS D (OR = 0.99; 95% CI: 0.31 to 3.17). Conclusion: Current guidelines emphasize that spinal decompression should be performed within 24 hours after SCI, regardless of injury severity and location. However, results of the present study demonstrated that certain considerations may be taken into account when performing decompression surgery: 1) in patients with AIS A injury, decompression surgery should be performed as soon as possible, since its efficacy in neurological improvement is 3.86 folds higher in the first 12 hours after injury. 2) ultra-early decompression surgery in patients with cervical injury is more effective than in patients with thoracic or lumbar injuries. 3) postponing decompression surgery to 24 hours in SCI patients with AIS B to D does not significantly affect the neurological outcome.
      PubDate: 2022-01-31
      DOI: 10.22037/aaem.v10i1.1471
      Issue No: Vol. 10, No. 1 (2022)
       
  • A 25-Year-Old Chronic Ketamine User with Urinary Symptoms; a Case Report

    • Authors: Chin-Chu Wu, Aming Chor-Ming Lin
      Abstract: Ketamine is mainly used for short-acting general anesthesia, chronic pain, sedation, depression, and bipolar disorder. Long-term ketamine use may cause lower urinary tract symptoms and voiding dysfunction. Small capacity and fibrotic bladder can be associated with chronic ketamine use. Here, we present a 25-year-old male with a history of chronic ketamine use complicated with contracted heart-shape bladder.  
      PubDate: 2022-01-31
      DOI: 10.22037/aaem.v10i1.1449
      Issue No: Vol. 10, No. 1 (2022)
       
  • Clinical, Laboratory and Imaging Characteristics of Hospitalized COVID-19
           Patients with Neurologic Involvement; a Cross-Sectional Study

    • Authors: Ali Zare Dehnavi, Mohammadreza Salehi, Mehran Arab Ahmadi, Mohammad Hossein Asgardoon, Farzad Ashrafi, Nasrin Ahmadinejad, Atefeh Behkar, Ramin Hamidi Farahani, Hassan Hashemi, Abbas Tafakhori, Hamze Shahali, Mohammad Rahmani, Alireza Ranjbar Naeini
      Abstract: Introduction: Although neurologic involvement and neuroimaging abnormalities have been frequently identified in COVID-19 patients, the underlying factors remain unclear. In this study, we assessed the association of the neurological manifestations and neuroimaging features of hospitalized COVID-19 patients with their clinical, laboratory, and imaging characteristics. Methods: This multicenter cross-sectional study was conducted between September 2020 and March 2021 at two large academic hospitals in Tehran, Iran. We used census sampling from medical records to enroll hospitalized patients with a positive COVID-19 Polymerase chain reaction (PCR) test who underwent brain imaging due to presenting any acute neurologic symptom during hospital stay. Results: Of the 4372 hospitalized patients with COVID-19, only 211 met the inclusion criteria (35.5% with severe infection). Central nervous system and psychiatric manifestations were significantly more common in severe cases (p ≤ 0.044). Approximately, 30% had a new abnormality on their neuroimaging, with ischemic (38/63) and hemorrhagic (16/63) insults being the most common. The most frequent reasons that provoked cranial imaging were headache (27%), altered consciousness (25.6%), focal neurologic signs (19.9%), and delirium (18%). Analysis revealed a positive correlation for age, neutrophilia, lymphopenia, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) with the emergence of neuroimaging abnormalities (p ≤ 0.018). In addition, patients with new neuroimaging abnormalities had a significantly higher lung CT score than those without any pathologic findings (11.1 ± 4.8 vs. 5.9 ± 4.8, p < 0.001). Conclusion: Approximately 30% of the study population had various acute neuroimaging findings. The lung CT score, neutrophil count, and age were strong predictors of acute neuroimaging abnormalities in hospitalized COVID-19 patients.
      PubDate: 2022-01-30
      DOI: 10.22037/aaem.v10i1.1507
      Issue No: Vol. 10, No. 1 (2022)
       
  • Clinical Predictors of Testicular Torsion in Patients with Acute Scrotum;
           a Cross-Sectional Study

    • Authors: Mohammad Sazgar, Seyed Hossein Montazer, Seyed Mohammad Hosseininejad, Fatemeh Jahanian, Behkam Rezaimehr, Mohammad Behbohaninia, Hamed Aminiahidashti
      Abstract: Introduction: Testicular torsion is an important and critical issue in patients with acute scrotum referring to emergency department (ED). Early detection is very important to save the testicles. This study aimed to determine the diagnostic accuracy of clinical variables in predicting the presence of testicular torsion. Methods: This prospective cross-sectional study was done using the information of patients hospitalized from September 2015 to September 2020, with complaint of acute scrotum (ICD 10 code: N50.8), referring to ED for evaluation of the clinical predictors of testicular torsions, which were confirmed by surgery. Results: 81 patients with the mean age of 20.07 ± 9.64 (3- 45) years were studied. After surgical exploration, 70 patients (86.4%) had testicular torsion. Patients with torsion had lower age (p < 0.0001), lower time from symptom to ED visit (p < 0.0001), sudden onset pain (p = 0.003), left side pain (p < 0.0001), and lower white blood cell (WBC) count (p = 0.001). The frequency of dysuria (p = 0.032), diarrhea/vomiting (p = 0.005), and fever (p = 0.002) was significantly lower in patients with torsion. The cremasteric reflex was absent in 57 (81.4%) cases who suffered from testicular torsion (p = 0.001). Based on the results of binary logistic regression analysis, age (B = -0.175, SE = 0.45; p < 0.0001) was the sole independent predictor of testicular torsion. The highest area under the receiver operating characteristics (ROC) curve in predicting the presence of torsion belonged to lower age [91.0 (95%CI: 83.2 – 98.7)], pain in left testis [0.931 (95%CI: 0.828-0.987)], and lower WBC count [0.805 (95%CI: 0.684-0.926)], respectively. Conclusion: It seems that clinical variables are not accurate enough to be considered as the sole predictor of testicular torsion and they should be used with caution and in combination with other available screening tools like Doppler ultrasonography in this regard.  
      PubDate: 2022-01-11
      DOI: 10.22037/aaem.v10i1.1484
      Issue No: Vol. 10, No. 1 (2022)
       
  • Risk Stratification of Pulmonary Thromboembolism using Brain Natriuretic
           Peptide and Troponin I; a Brief Report

    • Authors: Mohsen Ebrahimi, Mohammad Mohsen Arab, Hamid Zamani Moghadam, Majid Jalal Yazdi, Esmail Rayat doost, Mahdi Foroughian
      Abstract: Introduction: Pulmonary thromboembolism (PTE) is one of the most prevalent medical disorders, with a notable annual fatality rate. This study aimed to evaluated the accuracy of serum pro-BNP and troponin I levels in PTE diagnosis. Methods: This cross-sectional study was implemented on 267 patients with suspected PTE (sudden chest pain or sudden dyspnea) in Imam Reza Hospital in Mashhad, Iran. All patients underwent pulmonary computed tomography (CT) angiography (as the gold standard test) and their serum levels of troponin I and pro-BNP were measured. The screening performance characteristics of pro-BNP in detection of PTE cases were measured and reported using receiver operating characteristic (ROC) curve analysis. Results: Two-hundred-sixty-seven patients with a mean age of 67.7 ±11.5 years were evaluated (60.1% male). PTE was confirmed via CT angiography in 121 patients. The area under the ROC curve of troponin I and pro-BNP in detection of PTE was 0.501 ng/mL and 0.972 pg/mL, respectively. The sensitivity and specificity of proBNP at the best cut-off point (100 pg/ml) were 85.4% and 80.2%, respectively. The sensitivity and specificity of troponin I at the best cut-off point (0.005 ng/ml) were 65.5% and 42%, respectively. Conclusion: Due to the comparatively good sensitivity and specificity of proBNP in diagnosis of pulmonary thromboembolism, it can be employed as a diagnostic determinant in patients with suspected pulmonary thromboembolism along with other laboratory tests.
      PubDate: 2022-01-08
      DOI: 10.22037/aaem.v10i1.1453
      Issue No: Vol. 10, No. 1 (2022)
       
  • Proposing an Emergency Medicine Ethical Guideline; a Qualitative Study

    • Authors: Leili Asadabadi, Kamran Soltani Nejad, Atefeh Zolfagharnasab, Mina Mobasher
      Abstract: Introduction: Emergency medicine physicians face major ethical challenges in their practices. Furthermore, they need to be aware of the principles of ethical analysis and clinical decision-making in order to provide quality care. This study aimed to propose professional ethics codes in the emergency medicine department. Method: This is a qualitative study, which was performed using narrative review and expert panel, and was conducted in three steps, including: literature review and preparation of the initial draft of the ethical concepts, obtaining expert opinions on this initial draft and its validation, and finalizing main ethical components in emergency medicine. In this study, we received the opinions of an expert panel including 10 medical ethicists and 12 emergency medicine specialists using a survey form. Results: The ethical guide to emergency medicine can be formulated in 34 key ethical concepts, 6 sub-components, and 5 main components including emergency physician-patient relationship, and emergency physicians’ relationships with other professionals, students, researchers, and community. Conclusion: Emergency care providers need to be familiar with ethical guidelines in order to improve quality of care in emergency departments. The findings of this study suggest that a guideline on patient-physician relationship as well as the emergency physicians’ ethical obligations for other professionals, students, researchers, and community should be developed in line with ethical norms.
      PubDate: 2022-01-01
      DOI: 10.22037/aaem.v10i1.1391
      Issue No: Vol. 10, No. 1 (2022)
       
  • Remote Analysis and Transmission System of Electrocardiogram in
           Prehospital Setting; a Diagnostic Accuracy Study

    • Authors: Elmira Almukhambetova, Murat Almukhambetov, Abdugani Musayev, Ainur Yeshmanova, Vildan Indershiyev, Zhadira Kalhodzhaeva
      Abstract: Introduction: One of the trends in the development of medical technologies is considered to be telemedicine. This study aimed to evaluate the accuracy of a remote electrocardiogram (ECG) analysis and transmission system in prehospital setting. Methods: In this cross-sectional study, the data of 19,265 ECGs was gathered from emergency medical service (EMS) database of Almaty city, Kazakhstan, from 2015 to 2019. All ECGs were recorded in the prehospital setting by a paramedic, using "Poly-Spectrum" ECG recording device. Subsequently, all ECGs were sent to the cardiologist for interpretation and the findings were compared between software and cardiologist. Results: 19,265 ECGs were registered. The average time from taking ECGs to receiving an expert’s conclusion was 9.2 ± 2.5 minutes. The medical teams were called in 17.9% of cases after paramedic ECG recording; however, in the rest of the cases there was no need to call those teams. Using the device reduced the number of visits of specialist teams. The overall sensitivity, specificity, and accuracy of ECG analysis device in diagnosis of ECG abnormalities were 83.8% (95%CI: 82.6 – 84.9), 95.5% (95%CI: 95.1 – 95.8), and 93.3% (95%CI: 92.9 – 93.7), respectively. Conclusion: The findings of this study showed the 93.3% accuracy of automatic ECG analysis device in interpretation of ECG abnormalities in prehospital setting compared with the cardiologist interpretations. Using the device causes a decrease in the number of cardiologist visits needed as well as reduction in cost and elapsed time.
      PubDate: 2022-01-01
      DOI: 10.22037/aaem.v10i1.1399
      Issue No: Vol. 10, No. 1 (2022)
       
  • Nifekalant versus Amiodarone for Out-Of-Hospital Cardiac Arrest with
           Refractory Shockable Rhythms; a Post Hoc Analysis

    • Authors: Hiraku Funakoshi, Shotaro Aso, Yosuke Homma, Ryuta Onodera, Yoshio Tahara
      Abstract: Introduction: It is still unclear that which anti-arrhythmics are adequate for treating refractory dysrhythmia. This study aimed to compare amiodarone and nifekalant in management of out-of-hospital cardiac arrest cases with refractory shockable rhythm. Methods: This was a post hoc analysis of cases registered in a nationwide, multicentre, prospective registry that includes 288 critical care medical centres in Japan. From June 2014 to December 2017, we included all out-of-hospital cardiac arrest patients aged ≥18 years who presented with refractory arrhythmia (sustained ventricular fibrillation or ventricular tachycardia following delivery of at least two defibrillator shocks) and treated with nifekalant or amiodarone after arrival to hospital. Overlap weight was performed to address potential confounding factors. Results: 1,317 out-of-hospital cardiac arrest patients with refractory arrhythmia were enrolled and categorized into amiodarone (n = 1,275) and nifekalant (n = 42) groups. After overlap weight was performed, there were no significant intergroup differences in increased the rate of admission after return of spontaneous circulation [–5.9% (95%CI: –7.1 to 22.4); p = 0.57], 30-day favourable neurological outcome [0.1% (95%CI: –14 to 13.9); p = 0.99], and 30-day survival [–3.9% (95% CI: –19.8 to 12.0); p = 0.63]. Conclusion: This nationwide study showed that nifekalant was not associated with improved outcomes regarding admission after return of spontaneous circulation, 30-day survival, and 30-day favourable neurological outcome compared with amiodarone.
      PubDate: 2022-01-01
      DOI: 10.22037/aaem.v10i1.1425
      Issue No: Vol. 10, No. 1 (2022)
       
  • Association of CT Scan Parameters with the Risk of Renal Angiomyolipoma
           Rupture; a Brief Report

    • Authors: Razieh Heidari, Mostafa Ghadamzadeh, Mansour Bahardoust, Forugh Khezrian, Afrooz Moradkhani, Parmida Ghadimi, Seyed Morteza Bagheri
      Abstract: Introduction: Rupture of renal angiomyolipoma (AML) is an emergency and life-threatening complication. This study aimed to evaluate the association of computed tomography (CT) scan parameters with the risk of rupture in renal AMLs. Methods: In this retrospective cross-sectional study, patients who were referred to a referral university hospital with diagnosis of AML, between 2007 and 2019, were included. Patients were divided into ruptured and non-ruptured cases based on surgery and CT scan findings and the baseline characteristics as well as CT scan parameters were compared between the two groups. Results: 20 AML patients with the mean age of 39.6 ± 12.5 years were included (75% female). The lesion was ruptured in 8 (40%) patients. The mean size of the lesion was ‎97.0 ± 15.9 mm‎‏ in the ruptured and ‏‎72.0 ± 29.4‎‏ in the non‎-‎ruptured AML ‏‎(‎p ‎= ‎‏0.045). The ‎mean fat density based on non-contrast enhanced CT (NCCT) scan (-‎56.1 ± 16.3 ‎vs ‎-‎‎74.9±24.1; ‏p = ‏‎0.018) and contrast enhanced CT (CECT) scan (-‎20.8 ± 16.9 ‎vs ‎-‎‎50.5 ± 31.7; ‏p ‏= ‏‎0.‎016) was significantly higher in the ruptured cases. Total tumor density based on NCCT scan was significantly greater in the ruptured ‎AMLs ‏(‏‎19.6 ± 25.9 ‎‏ vs‎ ‎-22.7±41.6, p=0.033). Conclusion: It seems that some CT scan parameters such as mean fat density and ‎total tumor density ‏could be used for differentiation between ruptured and non-ruptured AMLs.
      PubDate: 2022-01-01
      DOI: 10.22037/aaem.v10i1.1472
      Issue No: Vol. 10, No. 1 (2022)
       
  • Incidence of Pediatric Perforated Appendicitis during the COVID-19
           Pandemic; a Systematic Review and Meta-Analysis

    • Authors: Gholamreza Motazedian, Poorya Aryanpoor, Ehsan Rahmanian, Samaneh Abiri, Navid Kalani, Naser Hatami, Farhad Bagherian, Mohammad Etezadpour, Roohie Farzaneh, Fatemeh Maleki, Mahdi Foroughian, Mojtaba Ghaedi
      Abstract: Introduction: COVID-19 has affected the pattern of referral to medical centers and quarantine against COVID-19 might delay referral and management of surgical emergencies. This study aimed to compare the pooled event rate of pediatric perforated appendicitis before and during the COVID-19 pandemic. Methods: This was a systematic review and meta-analysis study based on the PRISMA guidelines.  Scopus, Web of Sciences, and PubMed databases were searched for studies reporting the rate of perforated appendicitis based on the post-appendectomy observations or imaging methods. The Egger bias test and funnel plot were used to detect and depict publication bias. Statistical analysis was performed in Comprehensive Meta-analysis package version 3. Results:  Twelve studies were eligible for inclusion in our study. The pooled prevalence of pediatric perforated appendicitis in the pre-COVID era was 28.5% (CI95%: 28.3 to 28.7%) with a heterogeneity of 99%.  In the COVID era, the event rate proportion was 39.4% (CI95%: 36.6 to 42.3%) with a heterogeneity of 99%. There was a significant difference in the subgroup analysis within the pre-COVID and COVID era (P<0.001), showing a higher perforation rate in the COVID era. Conclusion: Our study showed that during the COVID-19 pandemic, the rate of perforated appendicitis has significantly increased in comparison to before the COVID-19 pandemic.
      PubDate: 2022-01-01
      DOI: 10.22037/aaem.v10i1.1421
      Issue No: Vol. 10, No. 1 (2022)
       
  • Removal of Coin Cell Lithium Battery Lodged in the Pediatric
           Pharyngoesophageal Junction by Rigid Esophagoscopy; a Case Report

    • Authors: Hisataka Ominato, Takumi Kumai, Yasuaki Harabuchi
      Abstract: A coin cell lithium battery is a common foreign body that can become lodged in the pediatric pharyngoesophageal junction. Because the voltage of such batteries is relatively high, their rapid removal is necessary to avoid mucosal necrosis. Despite being the initial choice for removal, flexible endoscopy cannot remove such foreign bodies from the esophagus. Various removal methods, including rigid esophagoscopy, should be considered for removing lithium coin cell batteries. The transcervical approach is feasible for removing esophageal foreign bodies, but it carries the risk of complications such as esophageal stenosis. Here we report a case of lithium coin battery ingestion that was successfully removed using a rigid esophagoscope. A 2-year-old girl was referred to a local doctor with cough and general fatigue. Chest X-ray and flexible endoscopy revealed a coin cell lithium battery stuck in the pharyngoesophageal junction, but it could not be removed. The foreign body was removed using Nishihata forceps through a rigid esophagoscope under general anesthesia.
      PubDate: 2022-01-01
      DOI: 10.22037/aaem.v10i1.1430
      Issue No: Vol. 10, No. 1 (2022)
       
  • Advance Without Cut and Retrograde Removal of Embedded Fishhook;
           Introducing a Novel Technique

    • Authors: Abdolghader Pakniyat, Kourosh Akhbari , Fatemeh Radfar
      Abstract: Removing embedded fishhook without causing further tissue damage from the barbed nature of the hook is a challenge in emergency department (ED). The four most commonly used techniques include advance and cut, string-yank, needle cover, and retrograde removal. This study aims to describe a modified push- through technique without cutting the barb, namely advance without cut and retrograde removal, as an effective technique of successful removal of fishhooks. There is no risk of additional injury to patients and healthcare staff, and the technique does not need tools that are not generally readily available in EDs.
      PubDate: 2022-01-01
      DOI: 10.22037/aaem.v10i1.1403
      Issue No: Vol. 10, No. 1 (2022)
       
 
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