Frontiers in Emergency Medicine (E-Journal)
Not a member yet
430 research outputs found
Sort by
A 34-year-old Pregnant Woman with Chickenpox Re-infection
Get PDFA 34-year-old pregnant woman was referred to our emergency ward, complaining of intensification of skin lesions which had started six days earlier. Initially, vesicular lesions had started from head and face accompanied by fever which turn to generalized pustular lesions expanded to the whole body within four days (figure 1). By investigating the patient's personal contact history, we found that same symptoms were detected in her 9-year-old child 19 days prior to admission which was diagnosed as chickenpox. The patient also had mentioned previous history of chicken pox infection at her age of seven. She was ill but not toxic and was conscious with a blood pressure of 98/59 mmHg, respiratory rate of 18 breaths per minute, heart rate of 100 beats per minute and oral temperature of 37.2 °C in physical examination. She didn't have respiratory distress, dyspnea, meningism symptoms (Kernig Sign, Brudzinksi, and Nuchal Rigidity), ataxia or sensory defect and her all other physical examinations were normal. Upon diagnosis of chickenpox, intravenous (IV) acyclovir 750 mg three times a day and also IV clindamycin 900 mg TDS in combination with IV fluid were administered and finally the patient was admitted in Infectious diseases ward
Invitation to the GNS-I Study; a Global Evaluation of Traumatic Brain Injury in Low-, Middle-, and High- income Countries
Get PDFWe invite worldwide neurosurgeons, trauma surgeons, emergency medicine physicians, anaesthesiologists, and trainees to join the GNS team. Any worldwide hospital the receives and manages TBI patients is eligible for participation in the study. Collaborators can register through the official GNS website available here:
https://www.globalneurosurg.org/
There are several ways in which collaborators can participate in the GNS team, these roles can be found on the GNS website here:
https://www.globalneurosurg.org/collaborator-roles
Propagating Relationship of Cerebral Oximetric Volume and the Clinical Outcome of Recombinant Tissue Plasminogen Activator (r-TPA) Therapy on Acute Cerebral Ischemic Stroke Patients
Get PDFIntroduction: Currently, the most available treatment for acute ischemic stroke (AIS) is thrombolytic therapy with recombinant tissue plasminogen activator (r-TPA). A challenge in r-TPA therapy is the prediction of recovery in each case. Objective: The aim was to find a possible relationship between the cerebral oximetry indexes and the clinical outcome of r-TPA therapy to assess the cerebral oximetry as a non-invasive monitoring agent for therapy. Methods: The inclusion criteria were all patients with AIS who received r-TPA. The neurologic status was evaluated based on the national institutes of health stroke scale (NIHSS) score at arrival, and after a period of 24 hours. In addition, the levels of brain oxygenation in both hemispheres were measured before and continuously over the first 24 hours after r-TPA injection, using an oximetric sensor in the frontal lobes. The clinical success was defined as a 4-point improvement from the baseline NIHSS. Results: Total 44 patients with the mean age of 58.2 ± 2.18 years were enrolled, of whom 68.18% were male. Twenty-eight patients remained clinically unimproved and 16 patients were improved. A significant difference was found in the mean surface area under the brain oximetric curve in the 24 hour, in the affected hemisphere in the improved group, compared to the unimproved group (P = 0.007). There was a significant difference between the mean increase in brain oxygenation within 24 hours in the improved and unimproved groups (P = 0.002). Conclusion: The cerebral oximetry could contribute to predict the likelihood of r-TPA prognosis in patients with AIS
Distal Catheter Migration into Scrotum as a Rare Complication of Ventriculoperitoneal Shunt in Pediatrics; A Case Series
Get PDFIntroduction: Ventriculoperitoneal (VP) shunt placement is the common treatment approach in children with hydrocephalus. Complications of VP shunt are not uncommon but some are unusual and rare. Except infection and obstruction, other complications of VP shunts are uncommon and distal catheter migration into scrotum is one of the rarest ones. Case presentation: Here we present a rare complication of VP shunt, distal catheter migration into scrotum, in 4 patients that presented with scrotal swelling or bulging in the inguinal region, who underwent surgery for replacment of the distal cathether in peritoneum and processus vaginalis repair.Conclusion: In patients with a history of VP shunt placement who candidate for surgery due to inguinal hernia or hydrocele, possible migration of distal catheter should keep in mind by the surgeon. This complication can occur as early as at the time of shunt placement or delayed. 
The Role of Insulin-Like Growth Factor-1 and Pregnancy-Associated Plasma Protein-A in Diagnosis of Acute Coronary Syndrome and Its Related Morbidities
Get PDFIntroduction: Pregnancy-associated plasma protein-A (PAPP-A) is a metalloproteinase that plays a role in atherosclerotic plaque destabilization. In recent studies, insulin-like growth factor-1 (IGF-1) has been introduced as a mediator of atherosclerosis. PAPP-A and IGF-1 level may be important diagnostic indicators of acute coronary syndrome (ACS). Objective: The present study tried to assess the diagnostic role of IGF-1 and PAPP-A biomarkers in ACS spectrum. Methods: The serum level of IGF-1, PAPP-A and troponin I was determined in 121 consecutive patients with ACS. Relationships were assessed by t-test, ANOVA and the non-parametric equivalent. Accuracy of biomarkers was measured by the area under the ROC curve (AUC) and optimal cut-off points to diagnose STEMI and NSTEMI using Youden index. Results: In patients with acute ST segment elevation myocardial infarction (STEMI), all of these three biomarkers were significantly higher than those in patients with unstable angina (P= 0.028 for IGF-1, P<0.001 for PAPP-A and Troponin-I). Mean level of IGF-1 in patients with renal failure was significantly higher than that in patients without renal failure (137.9±35.1 vs 105.1±46.9, P=0.003), but PAPP-A and serum Troponin-I level had no significant difference in renal failure groups (P>0.05). ROC curve analysis showed that after Troponin-I, PAPP-A was a good discriminator between patients with STEMI and patients with unstable angina (AUC=0.79). Optimum cut-off value for PAPP-A was found to be 89.2 ng/ml, with sensitivity and specificity of 66.7% and 83.8%, respectively. Conclusion: PAPP-A can be a novel biomarker for both identification of patients with STEMI and risk stratification in patients with ACS
The Patency Rate of Endovascular Procedure in Patients with Superior Vena Cava Syndrome Caused by Intravenous Catheterization: A Case Series and Longitudinal Study
Get PDFIntroduction: Different methods have been well addressed in literature in terms of treating superior vena cava (SVC) syndrome; nevertheless, the patency of endovascular treatment has rarely been investigated in patients with SVC syndrome in patients with central venous access. Objectives: The present study was performed to assess the patency rate of endovascular procedure in patients with SVC syndrome caused by intravenous catheterization. Methods: The present case series and longitudinal study was conducted on patients with SVC syndrome in presence of central venous catheter who underwent venoplasty. Computed tomography (CT) venography was performed 1, 6 and 12 months after venoplasty. Facial swelling, facial discomfort, extremity edema, arteriovenous fistula (AVF) dysfunction, impairment in dialysis and SVC stenosis were measured at baseline and 1, 6 and 12 months after venoplasty. Results: Out of 20 investigated patients, 11 (55%) were male. Significantly decreases were observed in the median grades of facial swelling and extremity edema in the follow-up (P<0.001). The decrease in facial discomfort was statistically insignificant (P=0.129), and the median grade of SVC stenosis significantly decreased from 1.5 to zero in the follow-up (P<0.001). A statistically-significant decrease was observed in AVF dysfunction (P=0.007), and impairment in dialysis significantly decreased after the intervention during the follow-up (P<0.001). Conclusion: Findings of the present study revealed the appropriate patency rate of endovascular treatment in patients with SVC syndrome in presence of central venous catheter
The Quality of the Maternity Triage Process: a Qualitative Study
Get PDFIntroduction: There is no consensus on what the bases and criteria are for the dynamic process of maternity triage. Properly performing the maternity triage process requires reliable data to ensure the correct implementation of this process and the identification of existing deficiencies, and find strategies to modify, improve and enhance the quality of this process. Objective: The present study was conducted to explain the quality of the maternity triage process. Methods: The present qualitative study performed a directed content analysis on 19 maternity triage service providers and key informants selected through purposive sampling. The data were collected through semi-structured interviews in 2018 and analyzed using directed content analysis based on the Donabedian’s model. The accuracy and rigor of the qualitative data were then investigated and confirmed. Results: The participants identified the most important factors affecting the quality of the services provided in maternity triage as two categories of measures and care, and interactions and communication. The category of measures and care included two subcategories of examinations and obtaining a medical history. Conclusion: The present study comprehensively identified different dimensions of the quality of maternity triage services at different levels. The participants identified the quality of the maternity triage process as a multi-dimensional and important concept. Different dimensions of the maternity triage process are recommended that be addressed when designing and implementing maternity triage guidelines and instructions so as to maintain the quality of this process and satisfy their needs
Comparison of Analgesic Effects of Nebulized Morphine with Fentanyl Transdermal Patch and Oral Methadone for Cancer Patients in Terminal Stages; a Double-blind Randomized Controlled Study
Get PDFIntroduction: Recent years have witnessed widespread reports on the effectiveness of nebulized morphine for dyspnea, yet there is no evidence for its effectiveness in analgesic therapy. Objective: This study aims to compare effectiveness and side effects of inhalation morphine with oral methadone and transdermal fentanyl in sequential days in end stage cancer patients. Method: This double-blind, randomized controlled study conducted between April and September 2017. Ninety eligible cancer patients presenting to Sayed al-Shohada Hospital were selected non-randomly according to inclusion criteria and then divided to 3 groups in random order. Pain severity was scored by Visual Analog Scale (VAS). Patients were followed up for 3 days and then data were analyzed by SPSS. The benchmark of success was set as marking 4 or below on VAS and a reduction ratio of 50 percent. Results: Pain severity was equal for 3 groups before the first administration (p>0.05), but it decreased significantly from 8.45 (range 6-10) at baseline to 2.46 (range 1-4) at the end of the 3rd day in the nebulized group. The decrease ratio was equal to 70.8% after three days (p<0.05). Pain severity reduced from 8.45 (range 7-10) to 1.8 (range 1-3) (p<0.05) in the methadone group, and reduced from 8.5 (range 6-10) to 2.13 (range 1-3) in the fentanyl group. Conclusion: Our study showed that nebulized morphine, just like oral methadone and transdermal fentanyl, is effective, safe, and well-tolerated for pain management in patients with cancer
Demography of Medical Journals in Iran; a Cross-Sectional Study
Get PDFIntroduction: Policymaking in order to increase the quality of medical journals needs having accurate data from their current status. Objective: The present study was designed with the aim of introducing a demographic scheme of Iranian journals in the field of medical sciences. Method: This cross-sectional study was performed on all the medical journals being published in Iran in 2016. The list of all journal titles was extracted by referring to the medical journals databanks (ministry of health, Magiran, IranMedex, Irandoc and…), and the data required for the study were gathered using journals’ homepages or by phone or in person, by attending the journal’s office. Results: Totally, 521 journals were assessed. Publication language used was English in 297 (57%) journals and 515 (98.85%) were open access. 381 (73.1%) journals were published quarterly and the year of starting publication was 2010 onwards in case of 245 (48.0%) of journals. There were 29 (5.56%) journals, which were indexed in all 3 databases of ISI, PubMed and Scopus. Only 4.81% of the journals had an official impact factor announced by Thomson-Reuters or Clarivate Analytics Company. Mean time needed for review of articles was 1.89 ± 1.52 (0.5 – 12) months (n = 146) and mean time interval between accepting an article and its print or electronic publication was 3.63 ± 2.17 (0 – 12) months (n = 144). Rate of membership of these journals in COPE and ICMJE were 40% and 27%, respectively. Conclusion: Most medical journals being published in Iran were English quarterly journals that were regularly published in the fields of general medicine, open access, with university affiliations, centered in the capital, and more than 80% of them had started publishing from 2000 and afterwards
Reteplase versus Streptokinase in Management of ST-segment Elevation Myocardial Infarction; a Letter to the Editor
Get PDFAlthough the ideal treatment route for management of patients with ST-segment elevation myocardial infarction (STEMI) is rapid diagnosis and direct transfer to the catheterization unit and undergoing primary angioplasty, using thrombolytic still has its place in cases that the equipment are not available or there is not enough time for performing angioplasty. Of course these drugs are associated with specific side effects such as probability of gastrointestinal (GI) and cerebral bleeding, allergic reactions and etc. Therefore, finding drugs with fewer side effects and limitations for use has always been interesting in this regard. The drug which has been used all around the world since 1970 and is also traditionally used in Iran for managing patients with STEMI is streptokinase. This drug is a protein extracted from beta hemolytic streptococci, which combines with plasminogen and facilitates transformation of plasminogen to plasmin. However, recently fibrin specific drugs or recombinant tissue plasminogen activators (rtPA) such as alteplase, urokinase, tenecteplase, reteplase and etc. have become available to emergency medicine physicians and cardiologists. Having longer half-lives, fewer side effects, and easier method of use, these drugs have opened a new door for physicians regarding use of thrombolytic drugs in treatment of STEMI and brain stroke. Studies regarding comparison of safety and effectiveness of these drugs are ongoing. In a systematic review and meta-analysis, Tourani et al. showed that the safety and effectiveness of streptokinase and tenecteplase were in the same level. Reteplase is an rtPA peptide, which converts endogenous plasminogen to plasmin. Plasmin causes destruction of the fibrin present in the clot and the clot disappears. In a prospective case-control study in Amiralmomenin Hospital, Tehran, Iran, we divided 152 patients with STEMI and the mean age of 56.41 ± 10.40 (27 – 85) years who were candidates for receiving thrombolytic therapy into 2 groups receiving either streptokinase (from CSL Behring GmbH Co, Germany) or reteplase (from Reliance Life Sciences Co, India) (83.6% male). Then we compared outcomes such as GI bleeding, mortality, hypotension, arrhythmia, and etc. between the 2 groups. The 2 groups were in a similar condition regarding sex (p = 0.331) and age distribution (p = 0.393), blood pressure on admission (p = 0.378), and the rate of positive troponin on admission (p = 0.113). Overall, 61 (40.1%) patients showed at least one of the outcomes that we studied (13 cases in the streptokinase group and 48 cases in the reteplase group; p < 0.0001). In this study, all 20 cases of GI bleeding observed following thrombolytic prescription were in the reteplase group. Additionally, out of the 19 cases of death observed, 14 were in reteplase group and 5 had received streptokinase. One case of arrhythmia and 2 cases of hypotension were seen in streptokinase group. Based on the findings of this study, it seems that despite factors such as longer serum half-life and ease of use, the rate of side effects of this drug should be carefully considered before use. Based on some existing studies, it seems that in the most optimistic scenario, these 2 groups have similar side effects and effectiveness. For a more accurate assessment at least regarding the Iranian race, more accurate studies with larger sample size are required. This topic might have received less attention in developed countries as considering availability of equipment in those countries, treatment protocols are mostly based on angioplasty and not using thrombolytic drugs there. This subject becomes more important when we are aware of the higher treatment costs of these new drugs for patients since insurance does not cover them. Performing cost/benefit studies and evaluating the safety of treatment are suggested for future studies