Emergency medicine
Abbas Edalatkhah; Mohammad Ali Jafari; Sima Valizadeh; Alireza Esmaeili; Ehsan Zarepur
Volume 6, Issue 2 , July 2020, , Pages 115-117
Abstract
Objective: Necrotizing fasciitis of the perinea, referred to as Fournier’s gangrene, is a necrotizing infection of the perinea. To the best of our knowledge, there is no report on the Fournier’s gangrene following an ant bite and this is a rare case report of this type.Case Presentation: ...
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Objective: Necrotizing fasciitis of the perinea, referred to as Fournier’s gangrene, is a necrotizing infection of the perinea. To the best of our knowledge, there is no report on the Fournier’s gangrene following an ant bite and this is a rare case report of this type.Case Presentation: In this rare case report we describe a 20-year-old man who developed Fournier’s gangrene following an ant bite which resulted in his death. He sustained numerous ant bites in the perinea. Subsequently, he suffered from itching of the area and had scratched the area frequently leading to dermal ulcers and laceration, pain, and swelling of the scrotal area followed by fever and diminished consciousness. Finally, he presented to the emergency room (ER) after 72 hours of ant bites with a shock. Physical examination revealed extensive necrosis of scrotum. The primary treatments including antibiotic therapy, normal saline solution, and dopamine were not effective.Conclusion: Even a simple nonpoisonous insect bite can lead to Fournier’s gangrene and death. Paying greater attention to the site of bite, especially in the perinea which is anatomically more susceptible to infection, observing hygienic principles, and quick access to healthcare centers may prevent the patient’s death
Emergency medicine
Ganesh Singh Dharmshaktu; Tanuja Pangtey
Volume 7, Issue 2 , July 2021, , Pages 146-148
Abstract
Introduction: Inflammation of the infrapatellar bursa results from various causes like trauma, infection and overuse. Superficial skin or soft tissue infection can also lead to occasional septic bursitis. Infrapatellar bursa has two parts, superficial and deep bursae. Superficial bursa inflammation reactive ...
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Introduction: Inflammation of the infrapatellar bursa results from various causes like trauma, infection and overuse. Superficial skin or soft tissue infection can also lead to occasional septic bursitis. Infrapatellar bursa has two parts, superficial and deep bursae. Superficial bursa inflammation reactive to adjacent superficial skin infection may occasionally lead to secondary bursitis.Case Presentation: We report a rare finding of acute right knee pain with extraordinary amount of fluid collection within superficial part of infrapatellar bursa in an elderly male patient. A secondary, septic and massive superficial infrapatellar bursitis was unusual in its appearance mimicking neoplastic lesion. Judicious use of clinical assessment and imaging helped to diagnose the condition.Conclusion: Early diagnosis and treatment of bursitis can ensure optimal outcome and it can be used to check further complications. Atypical presentation of any bursitis should be acknowledged and the judici
Clinical Toxicology
Rouhullah Dehghani; Nasrullah Rastegar Pouyani; Shahrad Tajaddini; Masoomeh Varzandeh
Volume 8, Issue 2 , July 2022, , Pages 162-165
Abstract
Objective: Snakes are among the predators of any ecosystem and have been seen in different parts of Iran. The report on their distribution in Isfahan province was taken into consideration because of the importance of regional knowledge of these animals.Case report: During this survey, a sample of snakes ...
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Objective: Snakes are among the predators of any ecosystem and have been seen in different parts of Iran. The report on their distribution in Isfahan province was taken into consideration because of the importance of regional knowledge of these animals.Case report: During this survey, a sample of snakes was collected from north of Isfahan province, Kashan city, the University site of Medical Sciences and the sample was studied. The snake was identified by morphological and habitat characteristics and compared to other photos and data. The specimen belonged to the Colubridae family and non-venomous snakes. This species is distributed in the tropical climatic zone of the province. The species of the tropical region of Kashan city was identified as Platyceps karelini. or spotted snakeConclusion: We identified the habitat of this animal in Kashan city in Isfahan province. By identifying the species of Spotted Desert Racer from the Colubridae family, the number of non-venomous snakes in Kashan reached eight species.
Emergency medicine
Esmaeal Rayat Dost; Saeed Barazandehpour; Navid Kalani; Samaneh Abiri
Volume 7, Issue 1 , January 2021, , Pages 71-73
Abstract
Objective: Aortic dissection is an uncommon disorder with a high mortality rate, especially if misdiagnosis and mistreatment are not considered. Case Presentation: We present a 67-year old female with slurred speech and left sided plegia during her brother’s funeral. The patient did not have ...
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Objective: Aortic dissection is an uncommon disorder with a high mortality rate, especially if misdiagnosis and mistreatment are not considered. Case Presentation: We present a 67-year old female with slurred speech and left sided plegia during her brother’s funeral. The patient did not have any chest pain. she was referred to our emergency department by EMS due to being suspicious of cerebrovascular accident (CVA) )as code 724). However, owing to low blood pressure and atypical symptoms of the patient, we did RUSH exam in the emergency department to detect aortic dissection. After doing the Computed tomography (CT) angiography, the diagnosis of aortic dissection was confirmed. As the vascular surgeon was not present in our surgery department, we transferred the patient to Namazi hospital by air ambulance to undergo the surgery. She was discharged from hospital with complete recovery.Conclusion: Aortic dissection symptoms can be manifested in different ways such as pulmonary embolism, ACS, and CVA. Therefore, clinicians must always have the differential diagnosis of aortic dissection in their mind and be aware of its various manifestations.
Emergency medicine
Mustafa Bolatkale; Çağdaş Can; Ahmet Çağdaş Acara; Aydın Sarıhan
Volume 3, Issue 2 , July 2017, , Pages 75-76
Abstract
Preparing to manage weapons of mass destruction events challenges emergency services systems neighboring Syria every day. Understanding injury from explosives is essential for all providers of emergency care in both civilian and military settings. In this case, the authors present a 22-year-old ...
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Preparing to manage weapons of mass destruction events challenges emergency services systems neighboring Syria every day. Understanding injury from explosives is essential for all providers of emergency care in both civilian and military settings. In this case, the authors present a 22-year-old man who was admitted to the emergency department with displaced skull fracture, epidural hemorrhage and cerebral contusion due to barrel bomb tertiary blast effect. A 22-year-old man who complained of pain in the right temporal head region after barrel bomb explosion was admitted in the emergency department. The patient could not remember the explosion and found himself on the ground. In his medical history, there was not a record of any diseases, operations or traumas. Examination of the head revealed scalp hematoma and slump in the skull on the right temporal region. Patients computed tomography (CT) scan showed a displaced skull fracture, epidural hematoma and cerebral contusion.
Internal Medicine
Zahra Ataee; Saeed Shokoohi-rad; Saman Soleimanpour
Volume 8, Issue 2 , July 2022, , Pages 166-169
Abstract
Objective: Hypothyroidism has many causes and manifestations in children. One of the causes is autoimmunity, which is known as autoimmune thyroiditis or Hashimoto thyroiditis. Pseudotumor cerebri is a rare manifestation of Hashimoto thyroiditis. Here we report a 10-year-old girl with asymptomatic papillary ...
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Objective: Hypothyroidism has many causes and manifestations in children. One of the causes is autoimmunity, which is known as autoimmune thyroiditis or Hashimoto thyroiditis. Pseudotumor cerebri is a rare manifestation of Hashimoto thyroiditis. Here we report a 10-year-old girl with asymptomatic papillary edema who was treated with levothyroxine and acetazolamide.Case Presentation: A 10-year-old girl suffered from left eye trauma while playing volleyball and went to an ophthalmology center due to redness in the same eye. During the examination, they noticed a bilateral optic disc swelling without ocular inflammation and the other eye examination was within normal limits. Encephalopathy may rarely occur during autoimmune thyroiditis, which is known as Hashimoto encephalopathy, and it is stated that the autoimmune disorder is not related to the thyroid dysfunction characterized by the symptoms of decreased level of consciousness and seizures.Conclusion: The diagnosis of hypothyroidism in children is usually made by examining the thyroid-stimulating hormone (TSH), and T4 in which TSH is elevated and T4 is decreased as in our patient.
Emergency medicine
Mamatha Nanjappa Siddalingappa; Anjan Kumar Shah; Susheen Dutt; Narahari Ranganath
Articles in Press, Corrected Proof, Available Online from 19 February 2023
Abstract
Objective: Penetrating injuries in the maxillofacial region pose a great challenge due tothe anatomical complexity inherent to the area compounded with vital functions suchas vision and airway. This paper highlights the importance of meticulous preoperativeplanning and a concerted effort of a multidisciplinary ...
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Objective: Penetrating injuries in the maxillofacial region pose a great challenge due tothe anatomical complexity inherent to the area compounded with vital functions suchas vision and airway. This paper highlights the importance of meticulous preoperativeplanning and a concerted effort of a multidisciplinary team in managing penetratingmaxillofacial injuries.Case Presentation: A 38-year -old man reported to the emergency department with aknife impacted in the medial wall of the orbit, travelling up to the base of the cranium. ACT scan aided in evaluating the site, depth, and relation of the foreign body to the adjacentstructures. A team of oral and maxillofacial surgeons, ENT and neurosurgeon successfullyretrieved the knife and the patient recovered with no morbidities.Conclusions: Penetrating injuries in the maxillofacial region are rare and there is a dearthof documentation in literature. A quick response with proper preoperative planning and ateam approach is paramount in the successful management of these patients.
Emergency medicine
Atul Rai Sharma; Akash Singhal; Anurag Patil; Gladson David Masih
Volume 8, Issue 1 , January 2022, , Pages 66-68
Abstract
Objective: Distal radioulnar joint (DRUJ) subluxation with associated both bones forearm fracture is a rare clinical entity and is easily missed, leading to significant functional limitations.Case Presentation: A 28-year-old male fell on the outstretched hand and suffered left side both bones forearm ...
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Objective: Distal radioulnar joint (DRUJ) subluxation with associated both bones forearm fracture is a rare clinical entity and is easily missed, leading to significant functional limitations.Case Presentation: A 28-year-old male fell on the outstretched hand and suffered left side both bones forearm shaft fracture with ipsilateral DRUJ disruption. Operative intervention in the form of plating was done for both bones forearm shaft fracture and DRUJ was stabilised with one k wire and above elbow plaster splint in full supination was given for 6 weeks. At one-year follow-up, fracture was united and Disabilities of the Arm, Shoulder and Hand (DASH) score was 11.7, and he was well satisfied.Conclusion: DRUJ disruption should be carefully evaluated in all the patients with associated shaft fractures of radius and ulna. Timely diagnosis and optimal intervention may prevent any functional limitations.
Clinical Toxicology
Hamidreza Reihani; Maryam Ziadi Lotfabadi
Volume 7, Issue 1 , January 2021, , Pages 74-76
Abstract
Objective: We are going to alert the emergency physicians to be aware of drugs side effects. Some drugs like methotrexate are not routine drugs, and the symptoms may be miss diagnosed if not completely notified.Case Presentation: We present two patients under treatment with methotrexate. Both of them ...
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Objective: We are going to alert the emergency physicians to be aware of drugs side effects. Some drugs like methotrexate are not routine drugs, and the symptoms may be miss diagnosed if not completely notified.Case Presentation: We present two patients under treatment with methotrexate. Both of them suffered from methotrexate poisoning due to improper use. We discuss the causes of methotrexate poisoning and its prevention.Conclusion: A significant proportion of methotrexate users may not be completely aware of its proper use and the side effects. One of the important ways to prevent the toxicity of methotrexate is educating patients and their companions in order to use it correctly.
Emergency medicine
Anton Kasatkin; Aleksandr Urakov; Alekse Shchegolev; Vadim Matreshkin; Ivan Zlobin
Volume 9, Issue 1 , January 2023, , Pages 76-78
Abstract
Objective: Ultrasound assessment of inferior vena cava (IVC) collapsibility is performed todetermine the volume status of critically ill patients. We propose a new acoustic windowfor visualizing a vein in a prone patient.Case Presentation: A healthy volunteer took part in the study. The study protocol ...
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Objective: Ultrasound assessment of inferior vena cava (IVC) collapsibility is performed todetermine the volume status of critically ill patients. We propose a new acoustic windowfor visualizing a vein in a prone patient.Case Presentation: A healthy volunteer took part in the study. The study protocol includestwo stages: 1) performing a magnetic resonance imaging (MRI) examination to determinethe projection of a certain IVC area on the posterior chest surface (holotopy), 2) performingan ultrasound scanning in the area of IVC projection in order to identify it and determineits dimensions.Conclusion: The 11th intercostal space parallel to the paraspinal line allows to visualizethe IVC in the prone position. This gives a potential opportunity to use it to assess the IVCcollapsibility. Its potential advantage is the ability to assess the compressibility of IVC inthe antero-posterior direction
Emergency medicine
Parvin Aَbbaslou; Maryam Ahmadipour
Volume 6, Issue 2 , July 2020, , Pages 118-120
Abstract
Objective: Foreign body swallowing is a common pediatric problem. A foreign body in the pharynx is a medical emergency that requires urgent intervention. Evaluation and treatment of pharyngeal foreign bodies is much more difficult in children than in adults and sometimes requires hospitalization and ...
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Objective: Foreign body swallowing is a common pediatric problem. A foreign body in the pharynx is a medical emergency that requires urgent intervention. Evaluation and treatment of pharyngeal foreign bodies is much more difficult in children than in adults and sometimes requires hospitalization and removal of the foreign bodies under general anesthesia due to children’s lack of cooperation. Fish and chicken bones are the most common swallowed foreign bodies, but an interesting case of a piece of dishwashing steel wool stuck in a child’s pharynx is reported in this article.Case Presentation: A 10-year old boy was presented with a history of dysphagia from five weeks ago. Oral examination did not reveal anything significant. In lateral neck radiographs of the patient, a metal wire was observed in the hypopharyngeal region opposite the 4th and 5th cervical vertebrae. Endoscopic attempts to remove the foreign body were not successful. Therefore, the foreign body was removed from the patient’s pharynx in the operating room under general anesthesia. No complications were observed.Conclusion: Despite the prevalence of swallowing foreign bodies in children, ingestion of a piece of dishwashing steel wool not diagnosed for three weeks was considered interesting to report. Pharyngeal foreign bodies are medical emergencies; therefore, it is particularly important to suspect the presence of a foreign body and perform diagnostic procedures.
Emergency medicine
Mustafa Mahmood Eid
Volume 7, Issue 1 , January 2021, , Pages 77-79
Abstract
Objective: Epidural anesthesia is one of the famous, generally safe, and most requestedpain relief measures in labor. Nevertheless, it can have some complications thoughpneumocephalus and subdural effusion are very rare complications.Case Presentation: A 32-year-old woman presented with a severe persistent ...
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Objective: Epidural anesthesia is one of the famous, generally safe, and most requestedpain relief measures in labor. Nevertheless, it can have some complications thoughpneumocephalus and subdural effusion are very rare complications.Case Presentation: A 32-year-old woman presented with a severe persistent headacheafter a vaginal delivery, where epidural anesthesia was used for pain control. Her braincomputerized tomography (CT) scan confirmed pneumocephalus and subdural effusionas a complication of the procedure.Conclusion: Although headache can be present in many women post-delivery,investigations should run in susceptible women with alerting signs.
Clinical Toxicology
Jyoti Aggarwal; Zainab Mehdi; Baldeep Kaur; Yuvraj Singh Cheema; Monica Gupta
Volume 8, Issue 1 , January 2022, , Pages 69-73
Abstract
Objective: Lithium is a principal drug used in the treatment of bipolar disorder (BPD). Due to its narrow therapeutic index, serum levels need to be monitored regularly. In elderly patients with renal dysfunction lithium toxicity can develop paradoxically within the therapeutic range. This can lead to ...
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Objective: Lithium is a principal drug used in the treatment of bipolar disorder (BPD). Due to its narrow therapeutic index, serum levels need to be monitored regularly. In elderly patients with renal dysfunction lithium toxicity can develop paradoxically within the therapeutic range. This can lead to erroneous diagnosis and delayed treatment resulting in irreversible neurological sequelae as is described in our case.Case Presentation: A 65-year-old hypertensive female, with a 7-year history of BPD presented with decreased oral intake since 5-7 days, followed by altered sensorium. Neurological examination revealed coarse tremors in bilateral upper and lower limbs with spasticity, hyperreflexia, bilateral knee clonus. Twenty-five days earlier, she was prescribed Lithium carbonate. On evaluation she was found to have chronic kidney disease. Serum lithium levels came out to be 1.18 mg/dL (borderline high). After ruling out other differentials, a diagnosis of lithium toxicity was considered and she underwent two sessions of hemodialysis (HD) leading to significant improvement in sensorium; however, the patient had persistent dysarthria, difficulty in walking and proximal myopathy predominantly in the lower limbs. Nerve conduction studies confirmed the presence of axonal neuropathy. These findings of peripheral neuropathy (both sensory and motor) were suggestive of SILENT (syndrome of irreversible lithium-effectuated neurotoxicity).Conclusion: Unintended lithium toxicity can occur even at therapeutic levels especially in the elderlies owing to its narrow therapeutic window, complex pharmacokinetics and numerous drug interactions. Lithium can result in irreversible neurotoxicity including SILENT; therefore, a high level of suspicion is required to prevent such permanent disability.
Clinical Toxicology
Mehran Shahi; Seyed Hamid Moosavy; Hossein Sanaei-Zadeh
Volume 6, Issue 2 , July 2020, , Pages 121-125
Abstract
Objective: Scorpion stings are common in tropical regions of Iran. Hemiscorpius enischnochela are distributed in southern part of Iran. The venom of this scorpion causes severe hemolysis, hemoglobinuria, and occasionally death.Case Presentation: This report describes the clinical manifestations of envenomation ...
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Objective: Scorpion stings are common in tropical regions of Iran. Hemiscorpius enischnochela are distributed in southern part of Iran. The venom of this scorpion causes severe hemolysis, hemoglobinuria, and occasionally death.Case Presentation: This report describes the clinical manifestations of envenomation by H. enischnochela in a 3-year-old boy from Ruydar city in south of Iran.Conclusion: Special attention should be paid to the painless stings of yellow scorpions and more studies are needed to set out a protocol for the management of these cases in areas with this envenomation to be a common one.
Emergency medicine
Chui King Wong; Glen Chiang Hong Tan; Mohd Johar Jaafar
Volume 8, Issue 1 , January 2022, , Pages 74-76
Abstract
Objective: ST-elevations in electrocardiogram (ECG) secondary to an acute myocarditis may mimic ST-elevation myocardial infarction (STEMI). It is vital to distinguish between the two entities to avoid inappropriate clinical management and complications.Case Presentation: A previously well 19-year-old ...
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Objective: ST-elevations in electrocardiogram (ECG) secondary to an acute myocarditis may mimic ST-elevation myocardial infarction (STEMI). It is vital to distinguish between the two entities to avoid inappropriate clinical management and complications.Case Presentation: A previously well 19-year-old male presented with two episodes of central chest pain which were resolved spontaneously. His presentation was preceded by multiple episodes of vomiting, diarrhoea and abdominal pain. Physical examination was unremarkable except for a low-grade temperature of 37.7°C. The first ECG revealed ST-segment elevations in anterior leads without reciprocal changes. Serial ECGs showed increasing ST elevations and his cardiac markers were significantly raised. As the initial clinical presentation was potentially an acute coronary syndrome, he was instinctively treated with anti-platelets. Fortunately, this patient was not given thrombolysis as there were clinical suspicions of an acute myocarditis due to his young age, presence of viral symptoms, and absence of cardiac risk factors. Subsequent cardiac MRI confirmed the diagnosis of an acute myocarditis.Conclusion: An acute myocarditis is well known but less common presentation of viral infections. ST-segment elevations in ECG of any young patients with chest pain but without risk factors for acute coronary syndrome should always raise the suspicion of acute myocarditis especially in the presence of viral symptoms. Investigations such as cardiac magnetic resonance imaging (MRI) should be carried out emergently to distinguish both conditions.
Emergency medicine
Garima Sharma; Sanya Vermani; Anjum Syed
Volume 8, Issue 1 , January 2022, , Pages 77-79
Abstract
Objective: The presence of air within the mediastinal compartment and retro-peritoneal compartment, in the setting of trauma, can be because of visceral and skeletal injuries. However, in absence of a local site injury, an approach based on anatomical communication between various body compartments should ...
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Objective: The presence of air within the mediastinal compartment and retro-peritoneal compartment, in the setting of trauma, can be because of visceral and skeletal injuries. However, in absence of a local site injury, an approach based on anatomical communication between various body compartments should be utilized and all potential sites of injuries must be reviewed.Case Presentation: We present a case of a 40-year-old male patient with a history of trauma (fall from height), presenting to the emergency department with loss of consciousness and ear bleed. Chest radiographs showed pneumomediastinum. On cross-sectional imaging, pneumomediastinum and pneumoretroperitoneum were seen, however no esophageal, tracheal and skeletal injuries could be identified. On careful evaluation, fractures involving the base of skull were identified as a source of ectopic air.Conclusion: This case represents a situation where the fascial connections between various compartments of the body were utilized to find the site of injury and hence the source of ectopic air. Base of skull fractures are important to be identified since these require surgical attention at an early stage.
Emergency medicine
Luis Miguel Castro; Rui Manuel Mendes; Coelho Fátima Borges; Capella Vanessa; Ávila Leonor
Volume 8, Issue 1 , January 2022, , Pages 80-82
Abstract
Objective: A Perforation of hollow viscus is the most common cause of pneumoperitoneumafter a blunt thoracoabdominal trauma and demands prompt surgical exploration.Alternative routes into the peritoneal cavity, such as the presence of a diaphragmaticlaceration associated with pneumothorax, although rare, ...
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Objective: A Perforation of hollow viscus is the most common cause of pneumoperitoneumafter a blunt thoracoabdominal trauma and demands prompt surgical exploration.Alternative routes into the peritoneal cavity, such as the presence of a diaphragmaticlaceration associated with pneumothorax, although rare, should be considered whenapproaching these patients.Case Presentation: We present the case of a 78-year-old male admitted to the emergencydepartment after being ran over by a car resulting in right thoracoabdominal trauma,presenting with dyspnea and signs of peritoneal irritation. CT scan identified rightpneumothorax, pneumoperitoneum and free abdominal fluid. The pneumothoraxwas drained and posteriorly he underwent exploratory laparotomy where a traumaticlaceration of the diaphragm was identified as the cause of pneumoperitoneum.Conclusion: Alternative causes of pneumoperitoneum should be considered in bluntthoracoabdominal trauma with possibility of conservative management in the absenceof peritoneal irritation signs. Pneumothorax drainage is mandatory before intubation toavoid creation of a tension pneumothorax.
Clinical Toxicology
Rouhullah Dehghani; Kobra Taji; Amrollah Mahmoudi; Masoomeh Varzandeh
Volume 8, Issue 1 , January 2022, , Pages 83-85
Abstract
Objective: A Scorpion sting is one of the most important health and medical problems in most parts of Iran.Case Presentation: This case report occurred in Chaharmahal Bakhtiari province of Bazoft city. The injured person was a 48-year-old woman, weighing about 69 kg. Two documentary filmmakers were on ...
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Objective: A Scorpion sting is one of the most important health and medical problems in most parts of Iran.Case Presentation: This case report occurred in Chaharmahal Bakhtiari province of Bazoft city. The injured person was a 48-year-old woman, weighing about 69 kg. Two documentary filmmakers were on their way to work and suddenly one of them felt pain caused by a sting in the thigh area of her lower limb. The patient was referred to the medical center with the ‘scorpion’ sample, where she was examined by a doctor. The doctor prescribed some medicine for the patient. The pain from the sting lasted for about three hours. The patient recovered after taking the medication and received counseling three days after the sting. A photo of the dorsal and ventral surface of the scorpion specimen was sent to the animal identification specialist along with the size and color record. Scorpion specimen with a size of 4 cm was identified as Compsobuthus matthiesseni.Conclusion: According to the findings of this report, the clinical signs of C. matthiesseni sting are mild in the injured person and comparable to the stings of yellow bees Vespa germania. There is local pain two to three hours after the sting. Other systemic clinical manifestations can improve after a maximum of 2 to 3 days.
Surgery
Mirko Barone; Massimo Ippoliti; Felice Mucilli
Articles in Press, Accepted Manuscript, Available Online from 13 April 2024
Abstract
Intra-abdominal infections still represent a challengefor surgeons. The systemic physiopathological effects ofinfection rapidly progress, leading to sepsis and multiorganfailure, whose prognosis is often dramatic. Mortality riskstratification using scoring systems would unequivocallyaid the early identification ...
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Intra-abdominal infections still represent a challengefor surgeons. The systemic physiopathological effects ofinfection rapidly progress, leading to sepsis and multiorganfailure, whose prognosis is often dramatic. Mortality riskstratification using scoring systems would unequivocallyaid the early identification of patients at risk of diseaseprogression.
Cardiology
asghar mohamadi; Maryam Aliramezany; nazanin davari; elham sepahvand
Articles in Press, Accepted Manuscript, Available Online from 13 April 2024
Abstract
Objective: Dyspnea is a common symptom of heart disease that can also be related to otherdisorders, such as liver disease. In this case report, we aim to describe a rare case of metastatic livermass that presented with heart failure.Case Presentation: A 50-year-old woman without a past medical history ...
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Objective: Dyspnea is a common symptom of heart disease that can also be related to otherdisorders, such as liver disease. In this case report, we aim to describe a rare case of metastatic livermass that presented with heart failure.Case Presentation: A 50-year-old woman without a past medical history arrived at our hospitalwith a history of dyspnea and swelling in the lower extremities. She did not complain of pain,arthralgia, trauma, or chest pain but complained of exertional dyspnea and fatigue that had startedone month before and had aggravated two days before. Her laboratory test indicated anemia. Inechocardiography, we saw mild right ventricle enlargement and dysfunction, but the left heart wasnormal with acceptable systolic and diastolic function. In the subcostal view, the inferior vena cava(IVC) was dilated but under compression of a large liver mass. According to our literature review, thisis the first case in which a metastatic liver mass had presented with heart failure.Conclusion: In patients presenting with dyspnea, despite normal echocardiographic findings, theexact evaluation of the IVC should be considered.
Critical Care
Mahshid Dehghan; Moloud Balafar; Mahboub Pouraghaei; Mahnaz Ranjkesh; Ali Delkhorrami; Samad Shams Vahdati
Articles in Press, Accepted Manuscript, Available Online from 13 April 2024
Abstract
Objective: According to the most recent guidelines, the recommended imaging approaches forthe diagnosis of pneumonia are chest X-ray (CXR) and computed tomography (CT) scan. However,there are limitations to these approaches. Lung ultrasound (LUS) has attracted a lot of attentionin intensive care units ...
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Objective: According to the most recent guidelines, the recommended imaging approaches forthe diagnosis of pneumonia are chest X-ray (CXR) and computed tomography (CT) scan. However,there are limitations to these approaches. Lung ultrasound (LUS) has attracted a lot of attentionin intensive care units (ICUs) and emergency departments. Considering the importance of thetimely diagnosis and proper treatment of pneumonia, this study aimed to determine the diagnosticvalue of bedside LUS in comparison to chest CT scans in patients with suspected pneumonia orunspecified CXR findings in the emergency department.Methods: This prospective descriptive-analytic study was conducted in the emergency departmentof Imam Reza hospital. Patients aged 3 years and older with early diagnosis of pneumonia orany unspecified CXR findings with an indication of CT scan were included in the study. LUS wasperformed with a deep curved and linear surface probe. The results obtained from the chestultrasound were compared with the results obtained by CT scan as the diagnostic gold standard.Results: A total of 175 patients were included in this study. According to the results, the sensitivityand specificity of LUS in the diagnosis of subpleural consolidation were 94.1% and 100%,respectively, and the positive predictive value and the negative predictive value were 100% and33.3%, respectively. The sensitivity and specificity of LUS in diagnosing pleural effusion were69.2% and 100%, respectively, and the positive predictive value and the negative predictive valuewere 100% and 90.7%, respectively. Furthermore, the sensitivity of LUS in diagnosing dynamic airbronchogram was 98%.Conclusion: According to the findings of the present study, in patients suspected of pneumonia,LUS is more sensitive and specific in the diagnosis of pneumonia and is less time-intensive andcostly. Additionally, the ultrasound device is easily portable and accessible. It can be widely used anddoes not have the secondary side effects of ionizing radiation in patients. However, the technician’sskill in performing ultrasound is a matter of importance.
Clinical Toxicology
mohammad naghizadeh; Nastaran Eizadi-mood; laaya mokhtar; shiva samsamshariat; Gholamali dorooshi; arman otroshi; Ali Mohammad Sabzghabaee
Articles in Press, Accepted Manuscript, Available Online from 13 April 2024
Abstract
Introduction: Poisoning is one of the most common methods of suicide in developing countries. We assessed the frequency of impaired hematological indices in patients with acute poisoning.
Methods: The present study was a cross-sectional retrospective. Using the census sampling method, all patients ...
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Introduction: Poisoning is one of the most common methods of suicide in developing countries. We assessed the frequency of impaired hematological indices in patients with acute poisoning.
Methods: The present study was a cross-sectional retrospective. Using the census sampling method, all patients who had attempted suicide by poisoning and were admitted from 2013 to 2023 were included in this study. Different variables, including age, gender, hematological index on admission, hospital stay, and outcome (mortality), were recorded in a data-gathering form. ANOVA and chi-square or Fisher’s exact tests were used for analysis.
Results: This study was conducted on 48186 patients, 53.4% of whom were male. The average age of the patients was 34.92 (± 13.23). Of all patients, 6% had anemia, 15.1% leukocytosis, 15% higher than average hemoglobin, and 9.1% lower than average platelet count. White blood cell (WBC) count was higher (mean difference = 3741.85, SD = 151.35, 95% CI = 3445.21–4038.5) in deceased patients, while platelet count was significantly lower in deceased patients (mean difference = 17.19, SD = 2.57, 95% CI = 12.14–22.24) (P < 0.001). Anemia correlated with more extended hospital stay by an average of 1.61 days (SD = 0.27, 95% CI = 0.98–2.24) compared to patients with normal hemoglobin. Thrombocytopenia also correlated with more extended hospital stays by an average of 1.38 days (SD = 0.21, 95% CI = 0.88–1.89).
Conclusion: The frequency of abnormal hematological indices was not high in patients with acute poisoning. Deceased patients had higher WBC and lower platelet counts compared to surviving patients. Patients with anemia and thrombocytopenia had more extended hospital stays.
Emergency medicine
Zainab mehdi; Daljinderjit Kaur; Parv kamra; Narinder kaur; Nidhi arora
Articles in Press, Accepted Manuscript, Available Online from 13 April 2024
Abstract
Objective: Dependency on agriculture and the unregulated sale of paraquat makes it an easyalternative for homicidal and suicidal use in developing nations. It kills by multiorgan failure,predominantly pulmonary fibrosis, and ARDS. We report a case of alleged paraquat ingestionwith spontaneous pneumothorax, ...
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Objective: Dependency on agriculture and the unregulated sale of paraquat makes it an easyalternative for homicidal and suicidal use in developing nations. It kills by multiorgan failure,predominantly pulmonary fibrosis, and ARDS. We report a case of alleged paraquat ingestionwith spontaneous pneumothorax, spontaneous pneumomediastinum, and pneumorrhachis.Aim is to reinforce the importance of a high index of suspicion in early diagnosis when theabove findings are present with ARDS in absence of trauma and a history of alleged substanceingestion.Case Presentation: A 35-year-old male presented with loose stool occasionally bloody, oralulcers, yellow discoloration of eyes with fever, and decreased urine output for three days afterconsuming some substance with his seafood. On examination, he had yellow discoloration ofeyes and oral mucosa along with multiple ulcers on the buccal region as well as the dorsumof the tongue and lateral margins with generalized subcutaneous emphysema. In addition,decreased air entry in the bilateral lung field and muffled heart sounds were present. He hadan acute hepatorenal failure and severe metabolic acidosis with respiratory failure. Urine testedpositive for myoglobin and muscle enzymes (creatinine kinase and LDH) were raised. He wasintubated and shifted to the intensive care unit. Injectable N-acetyl cysteine (NAC) for acute liverfailure was started with empirical antibiotics and intravenous fluids. We supplemented thiamineand vitamin K, and hemodialysis was done in view of progressive renal failure. Radiologicalevaluation showed spontaneous pneumothorax, pneumomediastinum, and pneumorrhachiswhich were managed conservatively. His respiratory parameters worsened despite maximalventilatory support. Renal failure and metabolic acidosis worsened in spite of hemodialysis. Hesuccumbed to his illness on day five of admission and seven days after toxin ingestion.Conclusion: We recommend that the sale of paraquat be restricted and regulated to avoid itsuse for suicidal and homicidal purposes. More research is required to find measures to interveneearly and prevent pulmonary fibrosis. We propose that paraquat toxicity be considered early in apatient with the triad in an atraumatic setting with acute respiratory distress syndrome (ARDS)
Pediatrics
Anahita Alizadeh Ghamsari; Nafiseh Pourbadakhshan
Articles in Press, Accepted Manuscript, Available Online from 13 April 2024
Abstract
Objective: Snake bites represent a significant public health issue worldwide, as venomous snake bites can result in dangerous and sometimes lethal consequences. Sometimes, the diagnosis is difficult. Herein, we present the case of a 4-year-old child who posed a challenge to diagnosis.
Case presentation: ...
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Objective: Snake bites represent a significant public health issue worldwide, as venomous snake bites can result in dangerous and sometimes lethal consequences. Sometimes, the diagnosis is difficult. Herein, we present the case of a 4-year-old child who posed a challenge to diagnosis.
Case presentation: A 4-year-old child was brought to the emergency department with sudden, severe general weakness and impaired consciousness. Initially, the cause of these symptoms was unclear and difficult to diagnose. However, after a more thorough examination, it was determined that the likely cause was a neurotoxic snake bite. The child was hospitalized for three days. He received anti-venom, painkillers, and symptomatic treatments and left the hospital in good general condition.
Conclusion: Snakebites are very dangerous and sometimes have unusual manifestations, so adequate personnel and physician information is necessary for timely diagnosis and appropriate management.
Clinical Toxicology
Rouhullah Dehghani; Shahrad Tajaddini; masoomeh varzandeh
Articles in Press, Accepted Manuscript, Available Online from 25 April 2024