Infectious disease
Akash Singhal; Anil Kapoor
Articles in Press, Corrected Proof, Available Online from 19 February 2022
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has been universal and swift in its spread. As orthopaedic surgeons, for the most of us this timeframe has reduced our activity to emergency and trauma cases only, with virtual outpatient clinics and no elective surgeries. With some of the common deformity ...
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The coronavirus disease 2019 (COVID-19) pandemic has been universal and swift in its spread. As orthopaedic surgeons, for the most of us this timeframe has reduced our activity to emergency and trauma cases only, with virtual outpatient clinics and no elective surgeries. With some of the common deformity problems including clubfoot etc, which comprises a large number of children in the developing world, the management has been deferred, without any regional and national guidelines being framed. Updated guidelines relating to the management of clubfoot patients, in which parents can safely consult with the orthopaedic surgeon and physical rehabilitation specialists will allow them to cope with this unprecedented situation. We revisit the current scenario and the possible management protocol in the context of COVID-19 pandemic.
Emergency medicine
Mohammad Mohammadi; Abdolghani Abdollahimohammad; Mohammadreza Firouzkouhi; Maryam Shivanpour
Articles in Press, Corrected Proof, Available Online from 03 December 2021
Abstract
Objective: Pre-hospital emergency staff are involved in the front line of care for COVID-19 patients and face many challenges. The aim of this study was to explore the challenges of prehospital emergency staff in the COVID-19 pandemic.Methods: This qualitative research was conducted with a descriptive ...
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Objective: Pre-hospital emergency staff are involved in the front line of care for COVID-19 patients and face many challenges. The aim of this study was to explore the challenges of prehospital emergency staff in the COVID-19 pandemic.Methods: This qualitative research was conducted with a descriptive phenomenological approach. Purposeful sampling was applied and data collection was done through semi-structured interviews. Participants consisted of 16 pre-hospital emergency staff. Data analysis was performed using the Colaizzi approach.Results: Data analysis revealed five main themes including safety against COVID-19, knowledge deficit, fear and worry, challenges of transporting patients to the hospital, and selflessness.Conclusion: Pre-hospital emergency staff face many problems in personal, professional, equipment and cultural fields in the COVID-19 epidemic. In this regard, special attention from health systems is mandatory.
Infectious disease
Mohsen Eshraghi; Enayatollah Noori; Ahmad Kachoie; Moien Zolmafakher
Articles in Press, Corrected Proof, Available Online from 23 April 2021
Abstract
Objective: Bronchopleural fistula (BPF) is a pathological communication between thebronchial tree and pleural space. BPFs are commonly seen after lung surgery, and are lesscommon in trauma, lung abscess, and radiation therapy. In this study, we describe theclinical course and surgery of a case of pulmonary ...
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Objective: Bronchopleural fistula (BPF) is a pathological communication between thebronchial tree and pleural space. BPFs are commonly seen after lung surgery, and are lesscommon in trauma, lung abscess, and radiation therapy. In this study, we describe theclinical course and surgery of a case of pulmonary necrosis and BPF in a patient infectedwith coronavirus disease 2019 (COVID-19).Case Presentation: The patient was a 54-year-old man with multiple myeloma and endstagerenal disease from the last 8 years. He had a history of coronary artery bypass graftingfrom the last 3 years. He also suffered from progressive shortness of breath and dry coughsince March 2019.Conclusion: The results of this study showed that BPF is one of the most severecomplications after thorax surgery, and there is no effective prevention methodparticularly in this patient who had COVID-19 pneumonia. Therefore, early intervention,especially when diagnosed at an early stage, by strengthening the stump inside the thoraxor thoracotomy in the open window may eventually accelerate the closure of the BPF andimprove the survival.
Cardiology
Amin Mahdavi; Meysam Moravej; Maryam Aliramezany
Volume 8, Issue 1 , January 2022, , Pages 37-42
Abstract
Objective: Coronavirus disease 2019 (COVID-19) is an infection which can present itself bythe involvement of various organs, but the most common manifestations are respiratorysymptoms, fever and dyspnea with a high mortality rate. In order to study the prognosis ofpatients and also to determine the treatment ...
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Objective: Coronavirus disease 2019 (COVID-19) is an infection which can present itself bythe involvement of various organs, but the most common manifestations are respiratorysymptoms, fever and dyspnea with a high mortality rate. In order to study the prognosis ofpatients and also to determine the treatment plan, we need non-invasive methods whichcan be easily used in the triage of patients. In this study, we investigated the diagnosticvalue of electrocardiographic (ECG) changes and troponin levels in patients with thisdisease.Methods: This is a descriptive study. Confirmed COVID-19 patients participated in thepresent study. Data were collected by taking history and referring to medical records. Weanalyzed data by using chi square, t test and logistic regression through SPSS softwareversion 22.Results: One hundred and five patients with COVID-19 disease were examined. Mostpatients were men (53.3%) and the mean age was 54.53 years. The most common underlyingdiseases were hypertension and diabetes mellitus. Ninety-five patients had abnormalelectrocardiography including eleven with long QT; seven with arrhythmia; 78 with sinustachycardia; 7 with hemi-block; 1 with hemi-block and first degree atrioventricular block;4 with abnormal axis and 28 with ischemic changes. Eleven patients (10.5%) had positivetroponin level, whose length of hospital stay was higher (12.73 vs. 12.07 days). Furthermore,their mean length of intensive care unit (ICU) stay was also higher. In addition, among thetroponin-positive group, 100% had abnormal electrocardiography.Conclusion: The findings of the present study showed that ECG abnormalities and troponinlevels could provide good information about the prognosis of patients. Moreover, it seemsthat ECG changes in COVID-19 patients, whether indicative of underlying heart disease orresulted from infection, can affect the prognosis of patients. Therefore, considering ECGfindings and troponin levels can help select patients at a higher risk for triage.
Infectious disease
Manas Sharma; Rajendra B Nerli; Shridhar C Ghagane
Volume 8, Issue 1 , January 2022, , Pages 55-59
Abstract
The COVID-19 pandemic will have numerous consequences in the management of patientswith genitourinary cancers. As we are struggling to best exploit our limited health-careresources in managing COVID-19 infected patients, we need to rethink our approach toprovide the best medical care for cancer patients ...
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The COVID-19 pandemic will have numerous consequences in the management of patientswith genitourinary cancers. As we are struggling to best exploit our limited health-careresources in managing COVID-19 infected patients, we need to rethink our approach toprovide the best medical care for cancer patients in the time of this global crisis. Thereis a need for a decision-making algorithm which takes into account the age, presentingsymptoms, comorbid illnesses, access to health-care services, and availability of qualifiedhealth-care personnel. We must provide support, a clear and comprehensible informationalong with essential care to the patients seeking medical opinion during a time of thisunforeseen global health crisis. In this mini review we have made an attempt to prioritizethe necessity of intervention in urological oncology patients as per various national andinternational guidelines. This approach should be tailored as per locally available healthcare resources and the burden of COVID-19 infected cases in that region.
Infectious disease
Enayatollah Noori; Mostafa Vahedian; Sajjad Rezvan; Neda Minaei; Reihane Tabaraii
Volume 8, Issue 1 , January 2022, , Pages 60-63
Abstract
Objective: Since the outbreak of coronavirus disease 2019 (COVID-19), the triage ofpatients diagnosed with corona virus has been a very important issue. The aim of thisstudy was to introduce a triage scoring system according to the clinical and para-clinicalfindings of patients in order to be admitted ...
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Objective: Since the outbreak of coronavirus disease 2019 (COVID-19), the triage ofpatients diagnosed with corona virus has been a very important issue. The aim of thisstudy was to introduce a triage scoring system according to the clinical and para-clinicalfindings of patients in order to be admitted or discharged with COVID-19.Methods: After confirming the positive polymerase chain reaction (PCR) test for patients,we used a scoring system which included: the age of patient (less than 40 years and >40years), early vital signs at the time of admission, lab tests including C-reactive protein (CRP),white blood count (WBC), lactate dehydrogenase (LDH), D-dimer, chest imaging findings,comorbidity and shortness of breath.Results: The clinical score obtained for each variable in this scoring system was a numberbetween 0 and 3. The total score was a minimum of 0 and a maximum of 17. A higher scoreindicated an increase in the intensity and the need for intensive care. These scores wereclassified into 3 groups: 0-4, 5-10 and above 10. In the next stage, patients were dividedinto three groups: mild, moderate and severe. In this regard, patients with mild symptomswere suggested to receive home quarantine and home treatment, patients with moderatesymptoms were recommended hospitalization and medical care, and finally patients withsevere symptoms were inclined to intensive care.Conclusion: In order to treat and manage patients with COVID-19, it is necessary to payparticular attention to clinical and para-clinical findings and prioritize these findings basedon the severity and the condition of patients.
Clinical Toxicology
Elham Pishbin; Hamidreza Reihani; Bahram Zarmehri; Mahdi Foroughian
Volume 8, Issue 1 , January 2022, , Pages 64-65
Abstract
Objective: Methanol poisoning is a dangerous life-threatening event, manifested withvarious symptoms, sometimes very rare ones, that all should be addressed to preventmisdiagnosis of the methanol-poisoned patients.Case Presentation: A 21-year-old young man was brought to the emergency department(ED) ...
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Objective: Methanol poisoning is a dangerous life-threatening event, manifested withvarious symptoms, sometimes very rare ones, that all should be addressed to preventmisdiagnosis of the methanol-poisoned patients.Case Presentation: A 21-year-old young man was brought to the emergency department(ED) with a generalized tonic-clonic (GTC) seizure and he was diagnosed with methanolintoxication. A non-contrast computed tomography (NCCT) of the brain demonstratedfindings similar to subarachnoid hemorrhage (SAH). After the brain CT, he had a GlasgowComa Score (GCS) of 3 and all brainstem reflexes were absent. Neurology consultantagreed with the diagnosis of pseudo-SAH. Brain death was confirmed by a positive apneatest within 24 hours of presentation.Conclusion: It is suggested that compression of dural sinuses due to severe brain edema,reduces the venous drainage and leads to venous engorgement, which appears highattenuated in the background of low-density edematous brain matter.
Emergency medicine
Sadaf Sheikh
Volume 7, Issue 2 , July 2021, , Pages 80-81
Abstract
Interleukin-6 is pro-inflammatory cytokine which plays a role in cytokine storm and brought into notice with corona virus disease of 2019. Lymphopenia and dysregulated immune response were seen in the critically ill patients of corona virus disease of 2019. IL-6 inhibitors were proposed as a treatment ...
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Interleukin-6 is pro-inflammatory cytokine which plays a role in cytokine storm and brought into notice with corona virus disease of 2019. Lymphopenia and dysregulated immune response were seen in the critically ill patients of corona virus disease of 2019. IL-6 inhibitors were proposed as a treatment option in this pandemic with a concept that it will reduce inflammation, infection and organ failure. Tocilizumab, a monoclonal antibody against soluble and membrane IL‐6 receptors was considered as forefront treatment option as it was used previously in rheumatologic disorder as a licensed agent. Tocilizumab is an immunosuppressive agent and serious or fatal infections could occur. Presence of superimposed bacterial infections in critically ill patients with corona virus disease of 2019 should be aggressively treated. However clinical experiences showed higher rates of superimposed bacterial infections which renders for extreme caution while prescribing such therapies. Perspective is needed when using the rheumatologic literature of IL-6 into corona virus disease of 2019 and their range observed in these conditions.
Emergency medicine
Nazanin Jannati; Vahid Yazdi-Feyzabadi; Roghayeh Ershad Sarab; Simin Salehinejad
Volume 7, Issue 2 , July 2021, , Pages 127-129
Abstract
The coronavirus disease (COVID-19) pandemic is a global health crisis of our time. The mental health and wellbeing of whole societies have been severely impacted by this crisis and are a priority to be addressed urgently. In addition, the COVID-19 pandemic has disrupted or halted critical mental health ...
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The coronavirus disease (COVID-19) pandemic is a global health crisis of our time. The mental health and wellbeing of whole societies have been severely impacted by this crisis and are a priority to be addressed urgently. In addition, the COVID-19 pandemic has disrupted or halted critical mental health services in many countries worldwide. One way to overcome this situation is to use Telemental health services and people can take advantage of these services to meet their mental health needs. However, there are some barriers to provide Telemental health services, which should be considered by policymakers before the crisis.
Emergency medicine
Shaghayegh Rahmani; Kosar Deldar; Sara Hemati Ali
Volume 7, Issue 2 , July 2021, , Pages 133-134
Abstract
Objective: Nowadays, many countries all over the world are involved with COVID-19 and the number of new cases and deaths are on a rise. The role of emergency medicine and physician-led triage is important in this period. We report some near missed cases in our academic center related to this pandemic.Case ...
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Objective: Nowadays, many countries all over the world are involved with COVID-19 and the number of new cases and deaths are on a rise. The role of emergency medicine and physician-led triage is important in this period. We report some near missed cases in our academic center related to this pandemic.Case Presentation: We report 5 cases that missed triage or received delayed diagnosis because of COVID-19 suspicion. Some cases are life threatening.Conclusion: Although COVID-19 is the main health concern these days, other critical conditions should be considered. Stabilizing patients before transferring them between hospitals should be the essential goal of emergency department whether the patient is Corona virus infected or not. And before any intervention, the safety of healthcare workers must be ensured.
Infectious disease
Maythem Abdulhassan Al Kaisy
Volume 7, Issue 2 , July 2021, , Pages 143-145
Abstract
Objective: During the late 2019, a group of patients had unexplained chest infections in Wuhan which turned out to be the new pandemic coronavirus disease 2019 (COVID-19). New neurological symptoms have been reported in COVID-19 patients. Posterior reversible encephalopathy syndrome (PRES) is a new neurological ...
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Objective: During the late 2019, a group of patients had unexplained chest infections in Wuhan which turned out to be the new pandemic coronavirus disease 2019 (COVID-19). New neurological symptoms have been reported in COVID-19 patients. Posterior reversible encephalopathy syndrome (PRES) is a new neurological finding and is associated or caused by COVID-19.Case Presentation: A 32-year-old lady, with no medical background had COVID-19 infection and needed mechanical ventilation. After surviving the intensive care, she started to have multiple seizures that required general anesthesia to be aborted. The patient turned out to have PRES.Conclusion: PRES is a neurological syndrome causing seizures, headaches, and blurred vision. It is usually associated with high blood pressure, renal failure, and other risk factors. The patient in this case had nearly normal blood pressure, but still had a diagnosis of PRES. The new reported neurological symptoms associated with COVID-19 infection need further research and attention from the academic society to predict and prevent the morbidity and mortality of COVID-19 patients.
Emergency medicine
Mulla Mahammad Rafi; Mohammed Ismai Nizami; Uppaluri Sarath Chandra; Ashima Sharma; Gaddam Dharani Reddy; Lubna Tarannum
Volume 7, Issue 1 , January 2021, , Pages 36-40
Abstract
Objective: COVID-19 has become a major public health concern in recent times with detrimental effects on health and economy of the nation exerting unbearable pressure on health care personnel. It is vital for the caretakers and the people accompanying those patients to be aware of the ongoing pandemic ...
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Objective: COVID-19 has become a major public health concern in recent times with detrimental effects on health and economy of the nation exerting unbearable pressure on health care personnel. It is vital for the caretakers and the people accompanying those patients to be aware of the ongoing pandemic and its impact on the society and to realize their responsibility towards curbing the spread of the disease. The aim of this study is to assess the awareness of COVID-19 among the attendants accompanying the patients at emergency department (ED) and to determine their perception of the disease. Methods: A questionnaire was prepared and the attendants were approached with it. The attendants responded to the questionnaire by choosing the appropriate answers. Illiterates were explained about the questions in the language they understood and the responses were recorded. The survey was conducted from May 25th, 2020 to June 10th, 2020. Descriptive analysis was done to represent the study characters. Results: A total of 509 participants responded to the questionnaire with the mean age between 30 to 50 years. Participants were fairly conversant of the preventive measures but a significant portion lacked the knowledge of transmission and the impact of COVID-19. Education was observed to have a positive correlation with the correct responses given. Conclusion: Public education for the spread of awareness is yet to reach the illiterate section of the society. The need exists for educating the attendants of the patients as well who actually are potential candidates for contracting and also for spreading the disease
Infectious disease
Shaghayegh Rahmani
Volume 6, Issue 2 , July 2020, , Pages 53-54
Abstract
Four weeks have passed from the first reported case of covid-19 in Iran. During the past month, thousands of patients ran to emergency departments (EDs) due to respiratory complaints. From the beginning of coronavirus disease 2019 (COVID-19) outbreak, EDs have become particular units for admitting patients ...
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Four weeks have passed from the first reported case of covid-19 in Iran. During the past month, thousands of patients ran to emergency departments (EDs) due to respiratory complaints. From the beginning of coronavirus disease 2019 (COVID-19) outbreak, EDs have become particular units for admitting patients with respiratory complaints. The question is “what happens to other routine patients of ED?”
Infectious disease
Manas Sharma; Shridhar C. Ghagane; Shubhashree Muralidhar; Shashank Patil; Naina R. Nerli; Rajendra B. Nerli
Volume 6, Issue 2 , July 2020, , Pages 98-101
Abstract
The current coronavirus pandemic forces us to realize the significance of the careful utilization of financial and health-care resources. At the same time, it is important to ensure the ability of urologists to function through this crisis to provide essential and emergency services. With regards to ...
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The current coronavirus pandemic forces us to realize the significance of the careful utilization of financial and health-care resources. At the same time, it is important to ensure the ability of urologists to function through this crisis to provide essential and emergency services. With regards to urological procedures, a triage of non-emergent operations is hence recommended considering various disease-related factors. Case conduct should also be categorized based on the up-to-date information of the evolving national, regional and local conditions of this pandemic, as marked variation in these conditions can lead to significant differences in decision-making. Over the coming weeks and months, we are bound to face an increasingly difficult task of treating Coronavirus disease 2019 (COVID-19) infected patients presenting with urological ailments. Instituting well-thought plans to perform the un-deferrable urological procedures and emergencies during this pandemic will go a long way in keeping the surgeons and health-care workers safe to perform essential duties.
Infectious disease
Sohil Pothiawala
Volume 6, Issue 2 , July 2020, , Pages 102-108
Abstract
Introduction: Emerging viral diseases (EVDs) pose a significant threat to public health. There have been a few viral epidemics in the last two decades. Coronavirus disease 2019 (COVID-19) is now a global pandemic.Objective: To provide emergency physicians an update on severe acute respiratory syndrome ...
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Introduction: Emerging viral diseases (EVDs) pose a significant threat to public health. There have been a few viral epidemics in the last two decades. Coronavirus disease 2019 (COVID-19) is now a global pandemic.Objective: To provide emergency physicians an update on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its dynamic impact on the emergency department (ED) in terms of preparedness and management of patients presenting to ED with suspected COVID-19 disease.Discussion: COVID-19 has a human-to-human transmission through close contact and even from asymptomatic carriers. Symptoms are similar to a viral respiratory illness. The disease is mild and self-limiting in most patients, but some develop severe illness like pneumonia, acute respiratory distress syndrome (ARDS) and multiorgan failure. Emergency physicians should prioritize early identification of these patients at risk, isolate them and after collaborating with relevant hospital and national authorities, develop clinical pathways to safely evaluate, manage and dispose patients with COVID-19. Various strategies for managing these patients in the ED are discussed. Disposition of these patients depends on symptoms and hemodynamic status and potential to self quarantine versus admission to an isolation facility.Conclusion: This review provides an overview of patients presenting to the ED with suspected COVID-19 and its impact on the ED. It reiterates the fact that emergency physicians, in close collaboration with relevant hospital authorities, play a pivotal role during EVDs. It emphasizes the need for pandemic preparedness, enabling us to better manage such events in the future.