Frontiers in Emergency Medicine (E-Journal)
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Potential therapeutic approaches in paraquat poisoning: a narrative review
Get PDFParaquat dichloride (PQ) poisoning is a relatively rare yet critical medical condition that has a high case fatality rate. Lung tissue is highly susceptible to PQ-induced injury, and respiratory failure is the leading cause of death in these patients. Unfortunately, there is a lack of an effective therapeutic approach to ameliorate outcomes. It is well-known that PQ interferes with a variety of cell signaling pathways and induces the generation of reactive oxygen species (ROS), which ultimately results in cell injury. The traditional treatment decisions have not been able to significantly change the clinical course of PQ poisoning. Moreover, novel therapeutic strategies for PQ poisoning have centered on the inhibition of PQ-induced signaling pathways. In the current review, we sought to provide a bird’s-eye view of the available therapeutic approaches in patients with PQ poisoning
Analgesic Effects of Ketamine Nebulizer vs. Intravenous Morphine in Limb Trauma Patients in Pre-Hospital Emergency Setting; A Randomized Double-Blinded Clinical Trial
Get PDFBackground: Limb trauma is one the main causes of emergency room (ER) referrals and patients often complain of pain from the very moment of arrival. Objective: We decided to compare the analgesic effect of ketamine nebulizer with intravenous (IV) morphine in trauma patients referred to ER. Methods: In this clinical trial study trauma patients referred to ER of Alzahra and Kashani hospitals in Isfahan, Iran were selected. All trauma patients older than 18 years with limb pain who had a pain score ≥ 7 based on visual analogue scale (VAS) criteria were included. During pre-hospital management, patients were divided into two groups of receiving ketamine nebulizer with a dose of 1.6 mg/kg and receiving IV morphine with a dose of 0.1 mg/kg. Pain score, vital signs and complications were recorded 5 and 15 minutes after receiving the first dose of drug and also at the time of arrival to ER. Results: Finally, the records of 391 patients were analysed. There was no significant difference between the two groups in terms of pain intensity, vital signs before intervention, the first 5 and 15 minutes after and the time of arrival in ER (P>0.05). But the changing of VAS scores in different times was significant in both groups (P<0.001). There was a significant difference between the two groups in complications including nausea and vomiting (P<0.001), and also delirium (P=0.010). Conclusion: Using ketamine nebulizer can produce similar analgesic effects as IV morphine in trauma patients referred to ER
The Effect of Oral Tamsulosin vs. Oral Tamsulosin and Oral Isosorbide Dinitrate in Acute Urinary Retention Patients Due to Benign Prostatic Hyperplasia: A Double-Blind Clinical Trial Study
Get PDFIntroduction: Acute urinary retention due to benign prostatic enlargement is one of the clinical complaints that patients refer to the emergency department. Selective α-blockers are used after urinary catheterization. Recently, the use of nitrate compounds has been shown to relieve bladder neck and to treat acute urinary retention. Objective: The aim of this study was to survey the addition of Isosorbide di nitrate to tamsulosin in the treatment of acute urinary retention in patients with benign prostatic hyperplasia. Methods: This is a randomized, double-blind placebo-controlled clinical trial. In all, 78 patients with benign prostatic hyperplasia-related acute urinary retention referred to the emergency department were divided into two groups and randomly assigned to receive either 0.4 mg tamsulosin plus placebo or 0.4 mg tamsulosin plus isosorbide dinitrate 40 mg extended-release tablets daily for 3 days. At the same first visit, the catheter was removed and the ability to void in same time and 1 month later was assessed in each group. Results: After catheter removal, 27 (67.5%) patients in the tamsulosin plus placebo group and 31 (81.6%) in the tamsulosin plus isosorbide dinitrate group voided successfully after 3 days (p = 0.155). After 1 month, 20 (50.0%) patients taking tamsulosin plus placebo and 23 (60.5%) taking tamsulosin plus isosorbide dinitrate could void, yet indicating no significant difference (p = 0.350). Conclusions: Addition of isosorbide dinitrate to α-blockers has advantage in improving benign prostatic hyperplasia-related acute urinary retention versus tamsulosin alone, although was not statistically significant
Professional Resilience among Trauma Emergency Department Nurses in Iran: A Qualitative Study
Get PDFIntroduction: Nursing staff’s professional resilience plays an important role in overcoming the stressful and adverse situations common to the trauma emergency department and helps to achieve positive outcomes. Objective: This study intended to explore the concept of resiliency among Iranian trauma emergency department nurses. Methods: Data were collected using semi-structured interviews with 21 trauma emergency department nurses and analysed through a deductive content analysis based on the general conceptual model of resilience derived from King and Rothstein’s study. Results: All codes were nested into the four main categories of the above-mentioned model including: 1) Personal characteristics; 2) Opportunities, supports and resources; 3) Self-regulatory processes; 4) Positive outcomes. Some new sub-categories including Professional abilities (sub-category of Personal characteristics) and Cooperation with colleagues and Volunteers’ declaration of readiness (sub-categories of opportunities, supports and resources) were developed in this study. In the positive outcomes category, three sub-categories including Improved professional abilities, Personal growth, and Job retention were developed. Conclusion: Our results demonstrated that Iranian trauma emergency department nurses could achieve positive outcomes using specific affective, cognitive, and behavioural personality traits, professional abilities and effective external supports from different resources during self-regulatory processes. It is suggested that nurses should be selected for work in the emergency department based on appropriate characteristics and skills
The Effects of the COVID-19 pandemic in the UK- at a Local, National and International level perspective from the Emergency Department
Get PDFContext: There is a significant burden on all emergency services in the management and prevention of the novel COVID-19 transmission. The effects are felt right across the World with certain geographical areas being most affected, it has affected all countries irrespective of their healthcare infrastructure. It has been suggested that certain parts of World that are prone to natural disasters are better prepared for pandemics. However, this is completely unfound as major economies are overwhelmed with the effects of the COVID-19 and it becomes completely irrelevant of any past experiences as these have been in never seen before scale. Evidence acquisition: The national fight against COVID-19 has been dubbed as the greatest fight for the National Health Service (NHS) with the entire United Kingdom under lockdown and the unfamiliar situation not seen before in peacetime. The general understanding of the disease process is that it has profound effects on the elderly and those with significant underlying health conditions such as cardiovascular, respiratory amongst others. However, it has surfaced from time to time that the very young are being affected and at times unfortunately been fatal. Results/Measures: The United Kingdom has been in a lockdown just like several nations across the globe in a desperate measure to limit the spread of the virus. There have been weeks of planning at every level for all possible eventualities with regards to the ongoing COVID-19 pandemic. All routine operations and procedures have been cancelled only procedures that emergency life and limb saving and cancer surgery continue to take place in hospitals all across the hospitals in the NHS. Widespread measures such as social distancing, calling a dedicated helpline for information and advice rather than attending the nearest Emergency Department have led to a significant number of presentations to the Emergency Department. Conclusions: The main concerns that remains for the NHS and other countries that have been affected is that once the lockdown restrictions are slowly eased will lead to a significant resurgence of cases that will overwhelm their respective healthcare infrastructures. From a clinician perspective, the main concern is the potential late presentations of the acutely unwell patients. This is the sentiment that is likely to be felt by many of my critical care colleagues working across NHS hospitals
Factors Contributing to the Containment of the COVID-19 in Kurdistan Region of Iraq
Get PDFA highly contagious coronavirus disease 2019 (COVID-19) is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which was first identified in Wuhan, China in December 2019. The virus primarily affects the respiratory system of human beings and results in the symptoms of headache, fever, dry cough, sore throat, shortness of breath and fatigue with abnormal chest computed tomography (CT) scan. In some cases, nasal sputum discharge and diarrhea have been also reported. Up to the 26th of April 2020, more than three million laboratory confirmed cases of COVID-19 have been recorded worldwide with more than 220,000 confirmed deaths. In the Kurdistan region of Iraq, the first case of laboratory confirmed COVID-19 was recorded in March 1st, 2020 in Sulaymaniyah province. 
Interferon beta-1a as a Candidate for COVID-19 Treatment; An Open-Label Single-Arm Clinical Trial
Get PDFIntroduction: Since December 2019, an outbreak of Covid-19 has caused growing concern in multiple countries. Researchers around the world are working to find a treatment or a vaccine for Covid-19 and different treatment approaches have been tested in this regard. Objective: This study was designed and conducted to assess the possible efficacy of Interferon beta-1a as a safe and efficient candidate for Covid-19 treatment. Methods: This is an investigator-initiated, open-label, single-arm clinical trial. Twenty patients with suspected Covid-19, who were admitted to Sina hospital in Tehran, Iran, with moderate to severe symptoms, from 6 to 10 March, 2020, were enrolled. Patients were treated with antiviral and hydroxychloroquine combination therapy, along with subcutaneous Interferon beta-1a for 5 consecutive days. Baseline characteristics and findings during the course of admission and 5 days after discharge were recorded for all the patients. Results: In total, 20 patients with suspected Covid-19 were included in this study, 12 (60%) of which were male. The median (Interquartile (IQ) range) of patients’ age was 55.5 (43-63.5). The most common symptom of the patients at onset of disease was fever. The median (IQ range) of duration of hospital stay was 5.0 (3-6) days. Only 2 cases were admitted to ICU. At the time of follow-up, 15 (94%) patients reported that they generally felt good and had oral tolerance, 1 patient had suffered from dyspnea, 5 patients had suffered from cough, none of them had experienced fever and no case of re-admission or death was reported after discharge. Conclusions: Results of the current study are in favor of using Interferon beta-1a in addition to recommended antiviral treatment in Covid-19 patients
The Prognostic Accuracy of Neutrophil-Lymphocyte Ratio in COVID-19 Patients
Get PDFIntroduction: COVID-19 is a newly emerging pandemic viral disease. Multiple management guidelines were introduced; nevertheless, their efficacy is still under debate. Thus, the presences of prognostic factors are essential for predicting which patients will need more invasive treatments. Objective: The study aims to investigate the prognostic accuracy of neutrophil-lymphocyte ratio in COVID-19 infection. Methods: This is a prospective study done in Al-Ain Hospital in the United Arab Emirates. All the Covid-19 patients presenting to the hospital were enrolled over 1 month from 20/3 to 20/4/2020. We gathered information about their age, sex, mode of transmission, and calculated their Neutrophils/Lymphocytes ratio (NLR) from the first complete blood picture on admission. We divided the patients into two groups: those whose age was 50 years and above and the those aged less than 50 years. We chose the best NLR cut-off value based on the Youden index and receiver operating characteristic (ROC) curve analysis and the target endpoint was presence or absence of intensive care unit (ICU) admission. Results: The study revealed that 48 patients (14%) needed ICU admission, while 296 patients (86%) were admitted to a ward or quarantine facilities. When the patient's age was > 50, and NLR was ≥ 3.10, it showed a sensitivity of 95.24% and a specificity of 92.86% for predicting the need for ICU admission. When NLR was ≥ 4.21, and the patient's age was < 50, the sensitivity and specificity were 70.3% and 93.7%, respectively. Conclusions: NLR proved to be highly specific and sensitive in helping to identify patients who need more invasive care among people over 50 years of age with COVID-19
The Primary Angioplasty Registry of Sina (PARS); A Brief Report of Design and Rationale
Get PDFCardiovascular diseases, especially ST-elevation myocardial infarction (STEMI), are among the major health concerns in Iran. Although primary percutaneous coronary intervention (pPCI) is performed as the treatment of choice in Iranian hospitals, there is limited data on its efficacy, safety, procedural variations, and clinical outcomes after implementation of the new Protocol-247, which transfers patients with STEMI directly to pPCI-capable hospitals. The Primary Angioplasty Registry of Sina (PARS) is an ongoing prospective hospital-based registry enrolling patient with STEMI undergoing pPCI in Sina Hospital, which is a high-volume referral PCI-capable general hospital in Tehran, Iran. This registry aims to gather high-quality data on patient characteristics, hospital-based quality of care, coronary interventions, and in-hospital as well as long-term clinical outcomes of patients undergoing pPCI due to STEMI. In addition, the findings will be used to identify independent predictors of mortality and adverse events and form the basis of future clinical trials and quality improvement strategies
COVID-19 Reinfection in a Healthcare Worker; Is There a Definitive Immunity Against SARS-CoV-2?
Get PDFIntroduction: While our knowledge is limited about COVID-19 immunity, recent cases of reinfection have raised concerns. Case presentation: Here, we report a case of COVID-19 reinfection after three months from recovery in a healthcare worker with negative IgM and IgG at the second infection and positive nasopharyngeal swab Reverse transcription polymerase chain reaction (RT-PCR) test despite being discharged with two negative RT-PCR tests at the first admission. Symptoms at first admission were fever, headache, sore throat, diarrhea, and vomiting and got changed to myalgia and anosmia. Conclusion: The strength of this case report is the long period (three months) between the infection and reinfection while other cases reported in literature were reinfected less than one month after their first infection