Frontiers in Emergency Medicine (E-Journal)
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Personal protective equipment usage among Iranian police officers during COVID-19 pandemic; a cross-sectional study
Get PDFObjective: Due to the important role of police during COVID-19 pandemics and lack of previous studies on the impact of personal protective equipment (PPE) in reduction of COVID-19 infection among police officers, we aimed to investigate the role of using PPE in prevention of COVID-19 infection among Iranian police personnel. Methods: This cross-sectional survey was conducted in Tehran, Iran during January 2021 to November 2022. The study sample consisted of police personnel who were active in field operations. Demographics (age, height, weight, gender, marital status, number of children and underlying diseases) and job characteristics such as frequency and type of operations, involvement of colleagues with COVID-19, and COVID-19 infection history, using PPE, types of used PPE (mask, face shield, gloves, etc), protective strategies (such as social distancing) and COVID-19 vaccination were recorded. Statistical analysis was performed with IBM SPSS Statistics for Windows, version 25. Results: Totally, 340 participants were analyzed (33.54±9.74 years old, 91.2% males), of whom, 150 participants (44.1%) reported at least one episode of confirmed COVID-19 infection. The most common component of PPE used both during operations and daily life was face mask (44.7% and 75%, respectively). The most popular measure with higher adherence compared to others was social distancing with 70% popularity and an adherence score of 5.85±3.74. Three hundred subjects (88.2%) had received at least one dose of COVID-19 vaccine. Among PPE items, using face mask, washing hands with soap, social distancing and vaccination were significantly different between patients with and without prior COVID-19 infection (p>0.05). Conclusion: The findings showed that use of PPE is significantly efficacious in reduction of COVID-19 infection among police officers. Therefore, despite difficulties of using PPE among police forces, it is strongly recommended for virus spread control in this population
Frontiers in Emergency Medicine: A work overview for 2021
Get PDFIn 2021, Frontiers in Emergency Medicine published 47 papers on four distinct issues which all are indexed by SCOPUS, Web of Sciences, and some other databases. More than one hundred authors from various nationalities, including the UAE, Egypt, India, Turkey, Yemen, the USA, Palestine, Belgium, and Iran were involved. As is customary, we decided to review our work for the last year and evaluate our strengths and weaknesses. Therefore, we performed a brief appraisal of our published papers. This review may help the authors who are interested in publishing with us to become more familiar with the journal’s aims and scopes, and also the editorial’s priorities and preferences. The year 2021 came to an end with the ongoing COVID-19 pandemic as the hottest topic of research worldwide. We also tried to play our part to overcome the pandemic by publishing relevant and useful papers that we believed could help health systems and bring valuable findings from Iran as one of the most affected countries in the world, followed by neighboring countries and the Middle East region.
 
The meaning and importance of recording right-sided precordial leads
Get PDFThis is the fourth installment in the electrocardiogram (ECG) interpretation series by Jerry W. Jones MD FACEP FAAEM for this journal. At first, he discussed simple atrioventricular (AV) dissociation versus AV dissociation caused by third degree AV block; then, he shares some very important pearls regarding ECG interpretation. And in latest one, he pointed to the importance of Hexaxial Reference Grid. For this paper, some valuable references were reviewed
DRESS syndrome: carbamazepine induced anaphylactic shock
Get PDFA 51-year-old female of Southeast Asian ethnicity was referred to our Neurosurgery service for a newly diagnosed intracranial meningioma. She underwent surgical excision of the tumor and was discharged home on Carbamazepine. Four weeks later, she presented back to our Emergency Department (ED) with fever, generalized rash, and altered mental status. The rash appeared a week prior to the patient’s presentation to the ED, and she complained of spikes of fever for two days. On arrival, her temperature was 41 °C. She was tachypneic at 24 breaths/min, and hypotensive at 95/55 mm Hg, with a heart rate of 120 beats per minute (BPM). Soon after triage, she was moved to the resuscitation room for further assessment and management.
On examination, the patient appeared to be in moderate distress, anxious, and slightly confused with a Glasgow Coma Scale (GCS) of 14/15. She had a generalized, macular, pruritic, urticarial rash with irregular confluent margins that was consistent with an allergic reaction. Apart from the above-detailed findings, her examination was unremarkable. There was no mucosal surfaces involvement. Her chest was clear on auscultation. Her abdomen was soft, non-tender, with no organomegaly. No focal neurological deficits were detected.
Her investigations included a full septic panel. Laboratory workup revealed elevated Liver Function Tests {Alkaline Phosphatase (ALP) of 120 IU/L (Normal range 35 – 104), Aspartate Transaminase (AST) of 65 IU/L (Normal Range > 32), Alanine Aminotransferase (ALT) of 82 IU/L (Normal Range > 33)}, Lactate Dehydrogenase (LDH) of 367 IU/L (Normal Range 135 – 214), Procalcitonin of 1.01 ng/mL (Normal Range < 0.5), and C-Reactive Protein (CRP) of 150.2 mg/L (Normal Range < 0.5). Of note, she had no Leukocytosis nor eosinophilia.
The patient’s empirical treatment plan in the ED included the administration of Intravenous (IV) Fluids, antihistamines, and Ceftriaxone. Upon admission, she was commenced on IV Dexamethasone 4 mg twice a day. Additionally, Carbamazepine was stopped immediately.
The day following her admission, the patient’s lab work was repeated, and it showed an improvement in CRP, but most notably, her differential complete blood count revealed eosinophilia of 0.73x10^9/L (Normal Range > 0.7), which further went up to 1.33x10^9/L two days later. She was also reviewed by the dermatologist who agreed with the diagnosis of DRESS. A skin biopsy was proposed. However, the patient did not consent to the procedure.
On day 3 of her admission, the patient clinically improved on treatment and remained afebrile and vitally stable. She was therefore discharged home with a follow-up clinic appointment.
Written patient consent for publishing the case with no identifiable personal information was obtained
Giant megacolon caused by anterior displacement of the anus in a 71-year-old woman
Get PDFThe patient was a 71-year-old woman who was referred to the general surgery clinic due to a severe colonic dilatation and a fecal mass that was found in her abdominopelvic CT scan, which was ordered by a nephrologist for approaching her right flank pain. The patient had experienced bloating and progressive abdominal distension in the year prior to the current visit. The last defecation had occurred approximately 20 days prior to the visit, and the last gas passage had occurred the day before the visit. 
Five tips to help keep you from making a big mistake!
Get PDFThis is the second installment in the electrocardiogram (ECG) interpretation series by Jerry W. Jones MD FACEP FAAEM for this journal. In the previous installment, he discussed simple atrioventricular (AV) dissociation versus AV dissociation caused by third degree AV block; in this issue, he also shares some very important pearls regarding ECG interpretation
Concomitant COVID-19 and acute ischemic stroke in patients transferred by emergency medical service during first wave of pandemic in Tehran, Iran; a cross-sectional study
Get PDFObjective: We conducted this study to evaluate the prevalence of concomitant COVID-19 in acute ischemic stroke (AIS) patients admitted to stroke centers of Tehran, Iran. Methods: We conducted a retrospective cross-sectional study in a 45-day period. AIS patients transferred by emergency medical service (EMS) to all medical centers of the city were included. Information was recorded and compared in two groups: patients who tested positive for COVID-19 and those who were negative. Result: Emergency medical technicians (EMTs) screened 348 patients as AIS cases, of whom, AIS was ultimately confirmed in 311 (89.4%) patients; and 58 (18.6%) of the 311 AIS patients were diagnosed with concomitant COVID-19 infection. The National Institutes of Health Stroke Scale (NIHSS) scores of COVID-19 positive AIS patients were significantly higher than non-COVID-19 AIS patients (16.3±3.7 vs. 11.8±4.3; p<0.001). There was also a significant difference in length of hospital stay between the two groups (11.1±1.8 vs. 8.8±4.3 days; p<0.001). However, data showed no significant difference regarding prevalence of in-hospital mortality between the two groups (1.6% vs. 3.5%; p=0.320). Conclusion: Our study results showed that AIS patients with concomitant COVID-19 infection had higher NIHSS scores and longer length of hospital stay compared to patients without concomitant COVID-19 infection
Ultrasound versus computed tomography scan findings in pediatric blunt abdominal traumas
Get PDFObjective: We aimed to evaluate the performance of ultrasonography (US) versus computed tomography (CT) scan in detecting intra-abdominal injury among pediatric patients with blunt abdominal trauma. Methods: Pediatric patients aged<18, who were admitted to the emergency department (ED) due to abdominal trauma and underwent both US and CT scan were evaluated retrospectively. Results: A total of 732 pediatric patients were included in this study. Pathology was detected on US of 418 (57.1%) cases, whereas, intra-abdominal pathology was detected in CT scan of 359 (48.7%) cases. The sensitivity of US in detecting pathology (fluid and/or organ injury) was 95.3%, and its specificity was 79.6%. The sensitivity of US in detecting free fluid was 94.9%, and its specificity was 80.5%. In patients with unstable and stable hemodynamic, the sensitivities of US in detection of pathology (fluid and/or organ injury) were 97.6% and 91.6%, and its specificities were 74.3% and 80.9%, respectively. Conclusions: In our study, the sensitivity of US in terms of detecting pathology in pediatrics with blunt abdominal trauma was high, whereas the specificity of US was low
Is prior use of renin-angiotensin system (RAS) inhibitors associated with more favourable outcome in COVID-19 hospitalized patients?
Get PDFObjective: We aimed to investigate the extent of pulmonary involvement and adverse outcomes in patients receiving angiotensin-converting enzyme inhibitor (ACEI)/ angiotensin II receptor blocker (ARB) versus who did not, in hospitalized coronavirus infectious disease 2019 (COVID-19) patients. Methods: All COVID-19 patients with a positive polymerase chain reaction (PCR) test, who were admitted to our tertiary referral hospitals in Tehran, Iran between January 2021 and May 2021, and had an on-admission chest computed tomography (CT) scan, were included. The patients were divided into two groups (receiving ACEI/ARB and who did not) for further analysis. The outcomes of interest in our study were the extent of pulmonary involvement, intensive care unit (ICU) admission, and death. Results: A total of 893 participants (mean age of 58.6±15.4 years; female, 522 (58.4%)) were enrolled. Among them, 368 (41.2%) participants had hypertension, and use of ACEI/ARB was reported in 183 (20.5%) participants. Of all, 409 (45.8%) participants required ICU admission, and 259 (29%) participants succumbed to death. We found that participants who received ACEI/ARB were less likely to progress critical disease and experienced significantly lower ICU admission (P=0.022) and death (P<0.001). On multivariable analysis adjusting for age, sex, and comorbidities, this relationship remained statistically significant for death [OR: 0.23 (0.14-0.38); P<0.001] and ICU admission [OR: 0.49 (0.32-0.73); P=0.001]. Conclusion: Our findings showed that COVID-19 patients who receiving ACEI/ARB prior to hospitalization vs. those who did not, had more favorable outcomes
Emergency medicine journey in Turkey: almost thirty years with humble enthusiasm
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