Frontiers in Emergency Medicine (E-Journal)
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Wegner's granulomatosis presented as fever and anuria
Get PDFA 62 years old Palestinian woman with a history of diabetes mellitus presented to our department with a decrease in urine output since a week with a complete anuria with the onset of bilateral flank pain more prominent in the right side since the last 3 days. The pain was dull in nature, continuous, severe and changing with the position. Other symptoms included epistaxis, anorexia, nausea, and eye redness appearing 10 days before the admission which resolved in 2 days on home remedies (herbal compressor)
The ideal applicant to emergency medicine residency programs in Saudi Arabia; Program directors’ view
Get PDFObjective: Emergency medicine (EM) is considered a competitive specialty worldwide with an acceptance rate of 57% in Canada but more competitive in Saudi Arabia with 18.7%. Factors that influenced the applicant’s acceptance include letters of recommendation, interview performance, research experience, and gender. This study aims to determine the factors playing a role in applicants matching to EM residency programs in Saudi Arabia from the view of program directors. Methods: A pilot study was done using a self-administered-questionnaire distributed to EM residency program directors (PDs) in Saudi Arabia in the period of 16-21 November 2021. The data were analyzed using SPSS, and all ethical considerations were ensured. Results: Twenty-seven PDs participated in the study, 19 (70.4%) were males, and most were former PDs (59.3%). The most crucial aspect in the applicant’s acceptance was the excellent impression in the interview (4.00 ± 1.00). The most crucial aspect of recommendation letters was a recommendation from a program director (29.6%), total duration of electives (40.7%) was superior; quality in EM research (29.6%) played a more critical role, and professionalism (29.6%) was the sought factor during the interview. There was no significant influence of the gender or the status of the PD and region of the program on the preference of the applicant’s gender. Conclusion: For those considering EM residency programs in Saudi Arabia, the chance of acceptance can be increased by getting a recommendation from a program director, increasing the duration of electives in EM, focusing on the research quality, and showing professionalism during the interview
Management of pregnant trauma patients in emergency department: a narrative review to provide the most recent evidence
Get PDFEvaluation of a pregnant trauma patient (PTP) in the emergency department (ED) is somehow challenging, as two patients should be managed simultaneously. Here, we reviewed recently published articles to provide up-to-date information on the management of PTPs. We examined 35 articles and categorized their topics as follows: trauma severity, management of trauma patients, general approach to pregnant women with trauma, primary evaluation of pregnant women with trauma, breathing and ventilation, airway, circulatory system evaluation simultaneous with bleeding control, uterine replacement, blood transfusion, uterine displacement, cardiovascular resuscitation, defibrillation, pneumatic anti-shock garment, and perimortem cesarean section. Concerning trauma during pregnancy, the basic principle should be successful maternal resuscitation, which is vital for fetus survival
Herpes simplex encephalitis after receiving COVID-19 vaccine; a case report
Get PDFShortly after the onset of the coronavirus pandemic, different vaccines were developed to combat it. The vaccines had different mechanisms and triggered cellular and humoral immune responses against the virus. In addition to their positive effects, various side effects have been reported for them. They rarely cause severe complications. They can also rarely trigger latent infections. The present case report presents a patient who developed herpes simplex encephalitis after receiving the second dose of the Covaxin (BBV152)
Evaluation of intoxication in patients with acute impaired consciousness using rapid urine test tape; a diagnostic accuracy study
Get PDFObjective: Determining the exact underlying etiology of loss of consciousness (LOC) can become a real challenge for physicians due to the broadness of differential diagnoses. The current study aimed to assess the accuracy of a commercially available strip for urine drug screening, in patients presenting with LOC. Methods: One hundred fifty patients with LOC were enrolled in the current cross-sectional study. The diagnostic accuracy of a multidrug urinary strip rapid test was evaluated in comparison to blood analysis as the reference test, and the screening performance characteristics of the rapid test for each substance were estimated. Results: The average age of patients was 46.21±18.59 years (72.67% male). The most frequent false positive results of the test were related to Benzodiazepine (21.5%), Methamphetamine (7.5%), and Tramadol (5.4%), respectively. The screening performance characteristics of the test tape were the best in detection of Amitriptyline with 100.0% (95% CI: 30.99 – 100.0) sensitivity, Cocaine with 100.0% (95% CI: 5.46 – 100.0) sensitivity, and Methadone with 91.54% (95% CI: 81.88 – 96.51) sensitivity, respectively. Conclusion: The current study reveals that employing a urinary strip test for detecting drug intoxication in the setting of emergency department can lead to significant false positive and negative results. Accordingly, relying on a urine drug screen to determine the underlying etiology of LOC should be done with caution
Cardiac arrest: an interdisciplinary scoping review of clinical literature from 2021
Get PDFThe Interdisciplinary Cardiac Arrest Research Review (ICARE) group was formed in 2018 to conduct an annual search of peer-reviewed literature relevant to cardiac arrest. Now in its fourth year, the goals of this review are to highlight annual updates on clinically relevant and impactful clinical and population-level studies in the interdisciplinary world of cardiac arrest research from 2021. To achieve these goals, a search of PubMed using keywords related to clinical research in cardiac arrest was conducted. Titles and abstracts were screened for relevance and sorted into seven categories: Epidemiology & Public Health; Prehospital Resuscitation; In-Hospital Resuscitation & Post-Arrest Care; Prognostication & Outcomes; Pediatrics; Interdisciplinary Guidelines; and Coronavirus disease 2019. Screened manuscripts underwent standardized scoring of methodological quality and impact by reviewer teams lead by a subject matter expert editor. Articles scoring higher than 99th percentile by category were selected for full critique. Systematic differences between editors’ and reviewers’ scores were assessed using Wilcoxon signed-rank test. A total of 4,730 articles were identified on initial search; of these, 1,677 were scored after screening for relevance and deduplication. Compared to the 2020 ICARE review, this represents a relative increase of 32% and 63%, respectively. Ultimately, 44 articles underwent full critique. The leading category was In-Hospital Resuscitation, representing 41% of fully reviewed articles, followed by Prehospital Resuscitation (20%) and Interdisciplinary Guidelines (16%). In conclusion, several clinically relevant studies in 2021 have added to the evidence base for the management of cardiac arrest patients including implementation and incorporation of resuscitation systems, technology, and quality improvement programs to improve resuscitation
Efficacy of levamisole with standard care treatment vs. standard care in clinical presentations of non-hospitalized patients with COVID-19: a randomized clinical trial
Get PDFObjective: The aim of this study was to evaluate the influence of adding a 10-day course of levamisole (LVM) to the standard care compared with standard care alone, on the clinical status of COVID-19 patients with mild to moderate disease. Methods: In this randomized open-label trial, we enrolled non-hospitalized patients with mild to moderate COVID-19 at nine health centers in Tehran province, Iran, in 2021. Patients were randomly assigned to receive a 10-day course of LVM with standard care (n=185) or standard care alone (n=180) in a 1:1 ratio. On days 1 to 10, LVM was administered orally at a dosage of 50 mg. The participants were called and followed on days 1, 3, 5, 7, 9, and 14. The measured parameters were general health condition, hospitalization rate, signs and symptoms, and adverse events. The generalized estimating equations model was used for analysis. Results: Among 507 randomized patients, 473 patients started the experiment and received LVM plus standard care or received the standard care alone; 385 patients included in the analysis; 346 (98%) patients completed the trial. The median age of the patients was 40 years [IQR: 32-50.75]; and 201 (55.1%) patiens were male. The mean age, sex ratio, and frequency of the underlying diseases of the patients in the two study groups had no statistically significant differences (P>0.05). Compared to the control group, LVM improved the general health condition of the patients (B=-0.635; 95% CI: -0.041,-0.329; P<0.001). Patients receiving LVM compared with standard care group had significantly lower odds of developing fever (OR=0.260; 95% CI: 0.113,0.599; P=0.002), chills (OR=0.223; 95% CI: 0.076,0.648; P= 0.006), fatigue (OR=0.576; 95% CI: 0.346,0.960; P=0.034), and myalgia (OR=0.544; 95% CI: 0.317,0.932; P=0.027). No significant difference was observed in the rate of hospitalization. Although the intervention group had greater adverse effects than the control group, the difference was not statistically significant. Conclusion: Findings of this study suggest that LVM has clinical benefits in improving patients’ health condition with mild to moderate COVID-19
Rare presentation of COVID-19 in 6-year-old girl: myocarditis with severe restrictive diastolic dysfunction
Get PDFSince the emergence of COVID-19 in late December 2019, patients were presented at the hospitals with different symptoms, including cardiac manifestations. Recent records of coronavirus infection in children and adolescents have been accompanied by multisystem inflammatory syndrome (MIS-C). Here, we describe a 6 -year-old girl with no history of cardiac disease, infected with COVID-19 and presented at the emergency department with fever and cardiac manifestations. Her echocardiography findings favored myocarditis with restrictive (severe) diastolic dysfunction, a rare manifestation of COVID-19 among children. Unfortunately, despite standard treatment of myocarditis and supportive care, the patient passed away. Therefore, it seems necessary to develop a guideline for the recent cardiac consequences of the pandemic among children and follow their presentations carefully
Serum uric acid levels on admission and prognosis of acute coronary syndrome: a bi-institutional report
Get PDFObjective: This study aimed to determine the association between the baseline serum uric acid (SUA) level and the short-term outcomes of patients with acute coronary syndrome (ACS). Methods: In this retrospective, bi-institutional study, patients with a diagnosis of ACS were recruited and followed-up for 30 days regarding the development of major adverse cardiovascular and cerebrovascular events (MACCEs). The associations between the SUA level upon admission and cardiovascular morbidities and patient prognosis were examined using univariate and multivariate analyses. Results: A total of 145 patients with ACS, with a mean age of 67.5±12.2 years, were recruited in this study. The rates of cardiovascular risk factors were higher in patients with elevated SUA levels. A cumulative MACCE was reported in 42 (29%) patients (19.5% in normal individuals and 39.7% in patients with elevated SUA levels, respectively; P=0.007). Based on the receiver operating characteristic (ROC) curve analysis, an on-admission SUA level above 6.9 mg/dL could discriminate patients with MACCE from those without MACCE during 30 days of follow-up (AUC=0.637; 95% CI: 0.553–0.715), with 64.3% sensitivity and 66% specificity. Based on multivariate logistic regression analysis, an elevated SUA level was associated with an increased risk of MACCE (odds ratio, 15.353; 95% CI: 2.026–116.328). Conclusion: In patients with ACS, an elevated baseline SUA level was associated with a higher prevalence of cardiovascular risk factors and morbidities, as well as an increased risk of MACCE in a short-term follow-up. 
Cutaneous vasculitis following COVID-19 vaccination: a case-based review
Get PDFSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emerging virus that causes a disease mainly known by its pulmonary and thrombotic complications. Although cutaneous complications, including vasculitis, have been reported in infected patients, the development of vasculitis after receiving vaccine is a rare clinical finding. Here, we report a case of vasculitis in a female patient who received a COVID-19 vaccine and was later infected with SARS-CoV-2, and was also diagnosed with hepatitis B during hospitalization. Our patient did not have a previous history of similar cutaneous manifestations of vasculitis, and the development of the symptoms approximately one month from the vaccination suggests immune complex hypersensitivity reaction