Frontiers in Emergency Medicine (E-Journal)
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Outcomes of Catheter-Directed Thrombolysis in Patients with Acute Arterial Thrombotic Limb Ischemia: A Prospective Interventional Case Series
Get PDFIntroduction: Acute limb ischemia is a critical medical condition that can quickly become a life threat. Therapeutic modalities such as catheter-directed thrombolysis (CDT) have demonstrated various levels of efficacy in previous studies. Objective: This study presents the descriptive findings of a series of cases who presented with acute arterial thrombotic limb ischemia and underwent CDT. Methods: This was a cross-sectional single-hospital-based case series, in which all patients who were diagnosed with acute arterial thrombotic limb ischemia, and consequently underwent CDT during the one-year study period were included. Detailed baseline characteristics and clinical findings of the studied patients on presentation, after intervention and at one-year follow-up are presented. Results: A total of 21 patients with a mean age of 60.7±15.2 years, including 16 males (76.2%) were included. The initial technical and treatment success rates were 20 (95.2%) and 14 (66.7%), respectively. The amputation-free and the overall survival rates after the one-year follow-up were 15 (71.4%) and 17 (81%), respectively. Four patients (19%) developed complications, two (9.5%) of which were significant (pulmonary hemorrhage and intraventricular hemorrhage). Amputation was performed in 6 (28.6%) cases. Conclusion: In this study, the treatment success rate and the technical success rate were satisfactory
Ultrasonic cardiac output monitoring in intubated patients with and without COVID-19 in the ICU: a prospective cohort study
Get PDFObjective: The present study was conducted to compare mechanically ventilated patients with and without COVID-19 in terms of hemodynamic instability using cardiovascular indicators. Methods: This prospective cohort study assigned intubated and mechanically ventilated patients to two groups, i.e. with COVID-19 and without COVID-19. The hemodynamic parameters measured and compared between the two groups on the first day of ICU admission and the following four consecutive days using an ultrasonic cardiac output monitor (USCOM) included cardiac output (CO), systemic vascular resistance (SVR), stroke volume (SV), flow time corrected (FTc), minute distance (MD) and potential kinetic energy (PKE). Results: Forty-three patients (males: 62.7%) were assigned to the COVID-19 group and 40 (males: 64.1%) to the one without COVID-19. Insignificant differences were observed between the two groups at baseline in terms of the mean homodynamic variables measured using the USCOM (P>0.05). The mean CO increased (P=0.020), the mean SVR insignificantly changed (P=0.267), the mean MD increased (P=0.005) and PKE decreased (P=0.066) in the COVID-19 group during the five days of evaluation. In the same period, the mean CO insignificantly changed (P=0.937), the mean SVR increased (P=0.028) and changes in MD (P=0.808) and PKE (P=0.539) were insignificant in the group without COVID-19. The two groups were not significantly different in terms of the other homodynamic parameters during the follow-up (P>0.05). Conclusion: The five-day changes in the USCOM-measured homodynamic parameters were lower in the group without COVID-19 compared to in that with COVID-19. In the group without COVID-19, no statistically-significant differences were observed between the mean follow-up values of the variables, excluding SVR, and their baseline values
Reviewing blunt abdominal injuries in the National Trauma Registry of Iran
Get PDFTo the Editor-in-ChiefWe read with interest Chardouli et al.’s paper entitled “A review on using ultrasound for evaluation of pediatric blunt abdominal trauma” and enjoyed it a lot. Now, we intend to add some of the results of our registry to their invaluable article.The National Trauma Registry of Iran was launched in 2016 at Sina Trauma and Surgery Research Center, and 24 different hospitals from various provinces collaborated in this project. Happily, more than 32,000 patients have been included so far, 4603 of which belong to Sina Hospital. Furthermore, ample evidence shows that blunt abdominal injury is one of the most common presentations in the emergency rooms. Hence, we analyzed our data to find the severity of blunt abdominal injuries compared to other injuries. Among 4603 patients, 208 people had blunt trauma, and 17 were in the abdominal region. The mean injury severity score (ISS) of patients with blunt abdominal injuries was 1.5 (standard deviation (SD)=1.1). Also, the mean ISS of patients with abdominal injuries with other mechanisms (other than blunt traumas) was 3.3 (SD=2.5). The difference was statistically significant (P=0.005). Moreover, the median of ISS among patients with blunt abdominal injuries was 1.0 (interquartile range (IQR)=0.0). Also, the median of ISS among patients with abdominal injuries with other mechanisms was 4.0 (IQR=3.0).All in all, our results show that if injuries are classified into two body regions of abdominal and others, and two mechanisms of blunt and others, blunt abdominal injuries can be less severe than injuries caused by other mechanisms and in other body regions
Independent Predictors of One-Month Mortality in Patients with Intracranial Hemorrhage; a Cohort Study
Get PDFIntroduction: Predicting the outcome is one of the most frequent and important issues when approaching patients with intracranial hemorrhage (ICH). Objective: This study aimed to evaluate the correlation of SUSPEKT score variables plus electrocardiogram (ECG) abnormalities with one-month mortality of patients with ICH presenting to emergency department (ED). Methods: In this cohort study, adult patients presenting to the EDs of three educational hospitals, during one year, were followed and their one-month mortality rate as well as independent predictors of outcome among the variables of SUSPEKT score plus electrocardiography findings were evaluated. Results: One hundred seventy-seven patients with the mean age of 63.07±14.89 years were studied (59.9%). The most common locations of intra-parenchymal hemorrhage were basal ganglia (53.7%) and cortex (36.2%). Ninety-two (52.0%) of cases had at least one ECG abnormality. The most frequent ECG abnormalities were ST segment depression (20.3%), T wave inversion (16.4%), and left ventricular hypertrophy (14.7%). Thirty (16.9%) cases died during the 30-day follow-up. Survived and non-survived cases were significantly different regarding the location of intra-parenchymal hemorrhage (p < 0.0001), presence of intraventricular hemorrhage (IVH) (p = 0.007), ST segment elevation (p < 0.0001), bradycardia (p < 0.0001), tachycardia (p < 0.0001), arterial fibrillation (p < 0.0001), blood sugar (p = 0.044), and serum level of potassium (p = 0.022). Conclusions: The location of hemorrhage (basal ganglia), higher blood sugar, and presence of ECG abnormalities (ST segment elevation, tachycardia, bradycardia, atrial fibrillation) were among the independent predictors of one-month mortality of ICH patients in this study
A review on using ultrasound for evaluation of pediatric blunt abdominal trauma
Get PDFThis study reviewed the former studies conducted on the usefulness of accuracy of focused assessment withsonography for trauma (FAST) or any plain ultrasonography (US) scan in pediatric blunt abdominal trauma(BAT), to assess its accuracy, sensitivity, specificity, and positive and negative predictive values (PPV and NPV).Searches were conducted using the predefined keywords and Medical Subject Headings (MeSH) terms acrossMEDLINE (PubMed), Scopus, Web of Science, Cochrane Collaboration Library, Embase, ClinicalTrials.gov, Magiran and SID.ir databases. Duplicate publications were excluded; then the titles and abstracts of eligible studies were reviewed for how they report blunt trauma, pediatric patients, and ultrasound modality in their text. Cochrane RevMan version 5.3 was used for the results analysis and assessing the risk of bias in the studies.Out of 923 studies, 902 were excluded, and only 19 articles were included in this review, out of which one wasa randomized clinical trial (RCT), three were cohort studies, two were contrast-enhanced US (CEUS) studies,and 13 were prospective or retrospective descriptive studies. The total population studied in the articles was3454 patients. The results showed that the specificity of US in pediatric BAT was 93%, the sensitivity was 54%,and the PPV in comparison to clinical examination was 73% versus 37%. CEUS protocol achieved 100% in bothsensitivity and specificity analysis. The only RCT study which included about 28% of the studies population alsoreached a sensitivity and specificity of 97% and 98%, respectively using a combinational protocol of clinical examination, laboratory investigation, and US assessment. Ultrasonography does not provide more results than clinical examination, though better PPV results. A combination of follow-up, US examination, and laboratory requests may also have more accurate results. Moreover, a CEUS protocol may reach that goal with an acceptable time-saving outcome, but it needs more studies to be confirmed
Renal mucormycosis following COVID-19 treatment with immune modulators: a case report
Get PDFMucormycosis is an opportunistic fungal infection that occurs primarily in immunocompromised individuals, usually affecting the rhino-orbital areas followed by the lungs. This case report presents renal mucormycosis in a young man after COVID-19 pneumonia that escalates the need for regular follow-up of COVID-19 patients. Post-COVID-19 fungal infections are on a steep rise, and the increased use of steroids and immune modulators for COVID-19-associated immune dysregulation and cytokine syndrome increases the risk among patients treated for COVID-19
Severe acute pancreatitis as a complication of COVID-19; a case report
Get PDFCOVID-19 is a systemic infectious disease that primarily affects the respiratory system, however, the involvement of extra-pulmonary systems have also been reported. We report a 25-year-old female patient visited the emergency department with a four-day history of severe burning epigastric pain associated with vomiting. The patient was diagnosed as severe acute pancreatitis with concomitant critical COVID-19 based on clinical, biochemical, and imaging findings. The patient was managed with antibiotics, anticoagulation and ventilatory support. Despite aggressive treatment efforts, the patient sustained cardiac arrest in the setting of refractory hypoxemia and passed away on day three of her hospital admission
Left Ventricular Pseudoaneurysm as a Complication of Myocardial Infarction; A Case Series and Review of the Literature
Get PDFIntroduction: Pseudoaneurysm may occur as a rare complication of myocardial infarction (MI) when a hemorrhagic process is covered by adherence of the visceral or parietal pericardium or of both, preventing the formation of cardiac tamponade. Pseudoaneurysm is prone to rupture because they are not easy to diagnose. Case presentation: Here, we report three cases of left ventricular pseudo-aneurysm (LVP) that all were related to MI. Two patients were managed conservatively, one of them was lost to follow-up, and the other one expired one month later. One patient underwent surgery, but he expired during post-operation period. Conclusions: High mortality rate of LVP emphasizes the importance of looking for it in cardiac evaluation of patients with history of MI. Due to available non-invasive modalities, the ability to differentiate LVP from other cardiac pathologies is improving. Still, the most recommended management of LVP is early surgery
Echocardiographic assessment of diastolic function in non-ST elevation acute coronary syndrome patients and its association with in-hospital diagnosis
Get PDFObjective: This study was conducted to evaluate the association of echocardiographic parameters used in leftventricular (LV) diastology with the early results of non-ST elevation acute coronary syndrome (NSTE-ACS)workup in the hospital. Methods: This cross-sectional study was performed on patients presenting with acute chest pain and a diagnosis of NSTE-ACS including only patients with unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI). All patients underwent transthoracic echocardiography in the emergency room (ER) within 12 hours of the last episode of chest pain. An invasive approach was not uniformly pursued in all of the patients so analysis was performed in two different settings. First, analysis was performed in the patients that underwent coronary angiography (CAG) and echocardiographic data were compared between those with normal and abnormal CAG results. Finally, echocardiographic data of the patients with normal diagnostic results (i.e., normal exercise tolerance test (ETT), myocardial perfusion imaging (MPI) or coronary angiography (CAG) results) were compared with the data of the patients with abnormal test results. Results: Eighty patients with a mean age of 54.43 ± 12.38 years were included in the study, of whom 57 (71.2%) were male. Fifty-three patients underwent CAG. In these 53 patients, there was significant difference in mitral annular velocity in early diastole (e’), ratio of mitral inflow velocity to e’ (E/e’), left ventricular end-diastolic diameter (LVEDD) and left ventricular end-diastolic pressure (LVEDP) between patients with coronary artery involvement and those with normal coronary artery (P<0.05). The area under the receiver operating characteristic (ROC) curve to predict CAG results for e’, E/ e’, LVEDD and LVEDP was more than 0.65. The sensitivity and specificity of the LV diastolic dysfunction for predicting coronary involvement was 94.4% and 35.29%, respectively. Comparison of echocardiographic data between patients with normal test results (non-invasive and invasive) and those with abnormal diagnostic tests showed a significant difference in e’, E/e’, acceleration time of E, LV end-diastolic diameter index, size of interventricular septum and left atrial volume. Conclusion: The results suggest that diastolic dysfunction data can be used as an adjunctive method to evaluate ACS patients in the ER
Early introduction of African medical students into scientific research: a viewpoint and literature review of the importance, barriers, and proposed solutions
Get PDFThe involvement of medical students in scientific research has been advocated recently in medical education. With the voices calling for evidence-based practice, scientific research skills emerge as a critical factor in preparing future generations of physician-scientists. However, Africa is a developing continent with limited financial resources, economic problems, conflicts, and political instabilities that slow the developments in medical education. The involvement of medical students of Africa in scientific research has taken a new shape recently with the formulation of student interest groups, collaboration based on personal communications, and non-governmental research societies. The present review highlights the importance, challenges, and solutions to involve African medical students in scientific research