Frontiers in Emergency Medicine (E-Journal)
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Allergic Acute Coronary Syndrome; A Fatal Presentation in the Emergency Department
Get PDFAllergic angina is not a rare disease, but it should be recognized at the earliest. We are reporting two cases of anaphylaxis, one with a history of unknown insect bite and the other due to intravenous (IV) contrast, leading to reversible myocardial ischemia, which we managed in our Emergency Department. These two patients clinically improved, and their ST-segment elevation on electrocardiogram (ECG) disappeared after intramuscular adrenaline. Allergic angina is an acute presentation in which anaphylaxis, or allergic insult, causes coronary spasm, which leads to angina. Early diagnosis and management initiation can minimize mortality and morbidity
The Prognostic Value of Echocardiographic Findings in Prediction of In-Hospital Mortality of COVID-19 Patients
Get PDFIntroduction: The correlation between echocardiographic findings and the outcome of COVID-19 patients is still under debate. Objective: In the present study it has been endeavored to evaluate the cardiovascular condition of COVID-19 patients using echocardiography and to assess the association of these findings with in-hospital mortality. Methods: In this retrospective cohort study, hospitalized COVID-19 patients from February to July 2020 with at least one echocardiogram were included. Data were extracted from patients’ medical records and the association between echocardiographic findings and in-hospital mortality was assessed using a multivariate model. The findings were reported as relative risk (RR) and 95% confidence interval (95% CI). Results: Data from 102 COVID-19 hospitalized patients were encompassed in the present study (63.7±15.7 mean age; 60.8% male). Thirty patients (29.4%) died during hospitalization. Tricuspid regurgitation (89.2%), mitral valve regurgitation (89.2%), left ventricular (LV) diastolic dysfunction (67.6%), pulmonary valve insufficiency (PI) (45.1%) and LV systolic dysfunction (41.2%) were the most common findings on patients’ echocardiogram. The analyses of data showed that LV systolic (p=0.242) and diastolic (p=0.085) dysfunction was not associated with in-hospital mortality of COVID-19 patients, while the presence of PI (RR=1.85; 95% CI: 1.02 to 3.33; p=0.042) and patients’ age (RR=1.03; 95% CI: 1.01 to 1.08; p=0.009) were the two independent prognostic factors of in-hospital mortality. Conclusions: It seems that LV systolic and diastolic dysfunction was not associated with in-hospital mortality of COVID-19 patients. However, presence and PI and old age are possible prognostic factors of COVID-19 in-hospital mortality. Therefore, using echocardiography might be useful in management of COVID-19
Acute electrocardiogram pseudoinfarction pattern and reversible left ventricular systolic dysfunction in a patient with diabetic ketoacidosis and hyperkalemia: a case report
Get PDFCoexisting myocardial infarction (MI) and diabetic ketoacidosis (DKA) are the most common causes of death in diabetic patients. We report a patient with ischemic heart disease manifestations who was finally diagnosed to have DKA as a predisposing factor. The case we present in this paper is a 57-year-old man who was found unconscious in a hotel and presented with complaints of vomiting, abdominal pain, and diarrhea. He had severe dyspnea and chest pain radiating to his back. He had ST-segment elevation in anterior leads on electrocardiogram (ECG), with non-obstructive coronary artery disease in the subsequent heart catheterization. MI patients should be treated with primary percutaneous coronary intervention (PCI) or fibrinolytic agents, but pseudoinfarction due to DKA responds to medical treatment. Thus, it is also important to know that coexistence of both DKA and MI is possible, and neglecting such situations can lead to lethal consequences
Basic life support awareness level among medical students in Jordan: a cross-sectional study
Get PDFObjective: Performing basic life support (BLS) in patients with cardiopulmonary arrest decreases mortality and morbidity. In addition, BLS knowledge is a prerequisite for medical graduation. The present study was conducted to determine the awareness level of undergraduate medical students in Jordan regarding BLS and background knowledge. Methods: This cross-sectional study was conducted between 17 April 2021 and 12 May 2021. A validated questionnaire was used as an online Google form and was posted in all medical student groups and Jordanian universities through various social medias. We categorized level of awareness into two groups: adequate awareness for those who got 60% or more, and inadequate awareness for those who got less than 60% in BLS test. Chi-square test was used to compare different variables. Results: A total of 886 students with a mean age of 21.5 (± 2.2) years completed the survey, including 552 females (62.3%). Among participated students, only 281 (31.7%) had adequate awareness, whereas 605 (68.3%) had inadequate awareness, with a mean score of 10 (± 3.8) out of 20. Surprisingly, there was no statistically significant correlation (P=0.210) between grade point average (GPA) and awareness level among participated students. On the contrary, we detected statistically significant relationships (P<0.001) between various variables and awareness level. Conclusion: Overall, we found that awareness of BLS among medical students in Jordan is not adequate. We can improve the awareness of medical students in this regard through obligating them to educate the general population, especially school students, as a volunteer campaign
Relationship of the optic nerve sheath diameter and repeated invasive intracranial pressure measures in traumatic brain injury patients; a diagnostic accuracy study
Get PDFObjective: The purpose of this study was to quantitatively evaluate if the use of the optic nerve sheath diameter (ONSD) can be a suitable noninvasive surrogate approach for repeated invasive intracranial pressure (ICP) measures. Methods: The study used a sample of 22 adult patients with traumatic brain injury (TBI) from an in intensive care unit (ICU). ICP levels were measured using the gold standard and recorded in cmH20. ONSD was measured using ultrasonography with 5.6-5.7 MHz linear probe and recorded in millimeters. The data analysis was done using STATA software version 15. Results: The results showed a strong positive correlation between ICP and ONSD (r = 0.743, p = 0.001). The accuracy of the sonographic ONSD declined over time, starting from a high of 90.9% at the baseline and declining to a low of merely 20.0% after 48 hours. Conclusion: These findings indicate that the ONSD approach could be very useful alternative and noninvasive method for monitoring ICP.  
The Relationship between the Results of Coagulation Profile and Severity of Pulmonary Involvement in COVID-19 Patients
Get PDFIntroduction: COVID-19 is currently a global pandemic, and coagulation-related mortality has been widely reported in patients suffering from it. Objective: this article aimed to investigate the coagulation profile of COVID-19 patients. Methods: This was a cross-sectional study conducted using a retrospective research design. We recruited patients with COVID-19 admitted to a hospital from June 15th to July 7th, 2020. Upon patients' entering a blood sample was drawn from each patient for assessing patient’s coagulation profile (PT, PTT, INR, Platelet count); and a chest high-resolution computed tomography (HRCT) scan was performed for each patient. The study patients were divided in to sever group (CO-RADS score 5) and non-sever group (CO-RADS score <5). Results: Thirty-six patients (20 males and 16 females) with a mean age of 54.7±17.5 years were studied. Of them, 11 cases (30.56%) had severe pulmonary involvement. Also, the coagulation profiles were longer in the severe group than non-sever group. As well, the means of platelet count that were 232.440 per microliter in the non-severe group and 289.180 per microliter in the severe and non-sever groups, respectively; but still not statistically significant (p>0.05). The Area under the ROC Curve (AUC) for PT and INR was 0.615 and 0.611, respectively. The AUC for platelet count was 0.680 (95% CI: 0.501 to 0.859) and had an acceptable discriminating power. Conclusions: In this study, we did not find any statistically significant relationship between the results of coagulation tests and the severity of pulmonary involvement according to HRCT scan findings in COVID-19 patients. But further analyses suggest that, except PTT, the other coagulation tests (PT, INR, and platelet count) may discriminate severe COVID-19 patients
Antiemetic effect of ondansetron versus metoclopramide in nauseous isolated head trauma patients: a double-blind randomized clinical trial
Get PDFObjective: As nausea is one of the most common annoying symptoms in isolated head trauma (IHT) and needs timely management to prevent further adverse outcomes, this study was performed to compare ondansetron and metoclopramide as therapeutic agents in nauseous IHT. Methods: This study was a double-blind clinical trial. Participants were patients visiting the ED with the chief complaint of nauseous IHT event. Group A received 10mg/2ml of metoclopramide and group B 4mg/2ml of ondansetron through slow intravenous (IV) injection. The primary outcome was the severity of nausea 20 minutes after the intervention based on the visual analogue scale (VAS) score. Results: A total of 130 patients participated in the study (65 in each group). The mean age was 30.5±20.5 years, and 73.1% of the participants were male. The decrease in the mean nausea severity scores was statistically significant in both group A (78.3±9.7 before vs. 29.8±16.8 mm after the intervention; P < 0.001) and group B (78.5±11.1 vs. 27.8±13.9 mm; P < 0.001). There was no significant difference between the mean nausea severity scores of groups A and B before the intervention (P = 0.93) or after it (P = 0.65). The decrease in the severity score of nausea was 48.5 mm in group A and 50.6 mm in group B, with no significant difference between the two groups (P = 0.63). Conclusion: Both Ondansetron and metoclopramide significantly reduced the severity of nausea in patients with mild IHT visiting ED but no treatment arm was superior. Both drugs showed good safety profiles
Accuracy of SARS-CoV-2 Detection in Saliva for COVID-19 Diagnosis: A Systematic Review and Meta-Analysis
Get PDFContext: There is an unmet clinical need to develop simple, easy, rapid, and accessible testing for the detection of SARS-CoV-2. Recent reports suggested that saliva may be a host for the virus. The existence of SARS-CoV-2 in saliva can be associated with oral manifestations in infected patients. A systematic review was conducted as well as a meta-analysis to evaluate the diagnostic accuracy of detecting SARS-CoV-2 in saliva and investigate the association between positive saliva test and oral manifestations of COVID-19. Evidence acquisition: A literature search in MEDLINE via PubMed, Scopus, Web of Science, and Cochrane was done in June 2020 and updated in February 2021 using relevant keywords. We screened studies for eligibility. The extracted data were analyzed using Meta-Disc software. Results: Eighteen studies were included. Pooled data from eligible studies showed that the sensitivity of diagnosis of SARS-CoV-2 in saliva was 0.86 (95% CI, 0.83–0.89), and the specificity was 0.98 (95% CI, 0.96–0.98). COVID-19 was associated with oral diseases as amblygeustia, dry mouth, dryness, inflammation of the mouth, and enlargement of lymph nodes in the submandibular regions. Conclusions: Our results showed that the saliva has a high accuracy in the detection of SARS-CoV-2
Pregnancy and Childbirth During COVID-19 Pandemic: A Case Series and Review of Literature
Get PDFIntroduction: In March 2020, the World Health Organization introduced the Coronavirus disease 2019 (COVID-19) pandemic as a global health concern and predicted that without any changes in the transmission process, the disease would reach its peak in April. Hence, it was not unreasonable to expect the referral of pregnant women in all trimesters. Since respiratory illnesses can increase the risk of infectious diseases and maternal mortality, it is justifiable to consider COVID-19-positive cases as high-risk pregnancies. Case presentation: The present study introduced six pregnant women with COVID-19 and discussed the points to consider in managing these patients. Conclusions: Pregnant women are at increased risk in all epidemics of infectious diseases due to their physiological and immunological changes. Moreover, the safety of the fetus is another important issue to consider
A Comparative Analysis of Clinical Characteristics and Laboratory Findings of COVID-19 between Intensive Care Unit and Non-Intensive Care Unit Pediatric Patients: A Multicenter, Retrospective, Observational Study from Iranian Network for Research in Viral
Get PDFIntroduction: To date, little is known about the clinical features of pediatric COVID-19 patients admitted to intensive care units (ICUs). Objective: Herein, we aimed to describe the differences in demographic characteristics, laboratory findings, clinical presentations, and outcomes of Iranian pediatric COVID-19 patients admitted to ICU versus those in non-ICU settings. Methods: This multicenter investigation involved 15 general and pediatrics hospitals and included cases with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based on positive real-time reverse transcription polymerase chain reaction (RT-PCR) admitted to these centers between March and May 2020, during the initial peak of the COVID-19 pandemic in Iran. Results: Overall, 166 patients were included, 61 (36.7%) of whom required ICU admission. The highest number of admitted cases to ICU were in the age group of 1–5 years old. Malignancy and heart diseases were the most frequent underlying conditions. Dyspnea was the major symptom for ICU-admitted patients. There were significant decreases in PH, HCO3 and base excess, as well as increases in creatinine, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), and potassium levels between ICU-admitted and non-ICU patients. Acute respiratory distress syndrome (ARDS), shock, and acute cardiac injury were the most common features among ICU-admitted patients. The mortality rate in the ICU-admitted patients was substantially higher than non-ICU cases (45.9% vs. 1.9%, respectively; p<0.001). Conclusions: Underlying diseases were the major risk factors for the increased ICU admissions and mortality rates in pediatric COVID-19 patients. There were few paraclinical parameters that could differentiate between pediatrics in terms of prognosis and serious outcomes of COVID-19. Healthcare providers should consider children as a high-risk group, especially those with underlying medical conditions