ORIGINAL_ARTICLE
The Challenge of Medication Errors in the Emergency Department Setting
Medication errors (MEs) are considered the most common medical errors and as one of the major challenges threatening the health system, which can be also reduced. MEs threaten patients' safety and may increase the length of hospital stay, lead to unexpected complications, mortality and side costs. In 2017, the World Health Organization launched Medication without Harm to reduce severe avoidable medication-related damage by 50%, globally in the next 5 years. Emergency Departments (EDs) are stressful care environments which making EDs more prone to MEs. Therefore, EDs need to be seriously considered to reduce MEs and increase patients' safety. In this regard, it is of great significance to know about the most common stage of error in pharmacotherapy, the most common type of medication error and the most common causes of MEs in the emergency department practice setting. in conclusion, the most common types of MEs in EDs include drug omission error, wrong dose and strong infusion rate. In addition, the administration and prescribing are the most common stages of MEs in EDs. Also, the most common causes of MEs in EDs in Iran include nursing shortage (fatigue) and poor medication knowledge .
http://www.jept.ir/article_91645_dc38dc2f112a3b52b27432b1ee781bf6.pdf
2022-01-01
1
2
10.34172/jept.2021.19
Medical error
patient safety
Emergency
Nursing
Drug
Mojtaba
Miladinia
miladimojtaba@gmail.com
1
Nursing Care Research Center in Chronic Diseases, School of Nursing & Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
LEAD_AUTHOR
Elham
Mousavi Nouri
miladinia.m@ajums.ac.ir
2
Emergency Clinical Nurse, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
AUTHOR
1. Miladinia M, Zarea K, Baraz S, Mousavi Nouri E, Pishgooie AH, Gholamzadeh Baeis M. Pediatric nurses’ medication error: the self-reporting of frequency, types and causes. Int J Pediatr 2016; 4(3): 1439-44. doi: 10.22038/ijp.2016.6593.
1
2. Asadi P, Modirian E, Dadashpour N. Medical errors in emergency department; a letter to editor. Emerg (Tehran) 2018; 6(1): e33.
2
3. World Health Organization (WHO). The third WHO Global Patient Safety Challenge: Medication Without Harm. WHO; 2017. Available from: https://www.who.int/ patientsafety/medication-safety/en/.
3
4. Dabaghzadeh F, Rashidian A, Torkamandi H, Alahyari S, Hanafi S, Farsaei S, et al. Medication errors in an emergency department in a large teaching hospital in Tehran. Iran J Pharm Res 2013; 12(4): 937-42.
4
5. Vazin A, Zamani Z, Hatam N. Frequency of medication errors in an emergency department of a large teaching hospital in southern Iran. Drug Healthc Patient Saf 2014; 6: 179-84. doi: 10.2147/dhps.s75223.
5
6. Flynn EA, Barker K, Barker B. Medication-administration errors in an emergency department. Am J Health Syst Pharm 2010; 67(5): 347-8. doi: 10.2146/ajhp090623.
6
7. Pérez-Díez C, Real-Campaña JM, Noya-Castro MC, Andrés-Paricio F, Reyes Abad-Sazatornil M, Bienvenido Povar-Marco J. [Medication errors in a hospital emergency department: study of the current situation and critical points for improving patient safety]. Emergencias 2017; 29(6): 412-5.
7
8. Zeraatchi A, Talebian MT, Nejati A, Dashti-Khavidaki S. Frequency and types of the medication errors in an academic emergency department in Iran: the emergent need for clinical pharmacy services in emergency departments. J Res Pharm Pract 2013; 2(3): 118-22. doi: 10.4103/2279- 042x.122384.
8
9. Ehsani SR, Cheraghi MA, Nejati A, Salari A, Haji Esmaeilpoor A, Mohammad Nejad E. Medication errors of nurses in the emergency department. J Med Ethics Hist Med 2013; 6: 11.
9
10. Shitu Z, Aung MMT, Tuan Kamauzaman TH, Ab Rahman AF. Prevalence and characteristics of medication errors at an emergency department of a teaching hospital in Malaysia. BMC Health Serv Res 2020; 20(1): 56. doi: 10.1186/s12913- 020-4921-4.
10
11. Selbst SM, Fein JA, Osterhoudt K, Ho W. Medication errors in a pediatric emergency department. Pediatr Emerg Care 1999; 15(1): 1-4. doi: 10.1097/00006565-199902000-00001.
11
12. Stasiak P, Afilalo M, Castelino T, Xue X, Colacone A, Soucy N, et al. Detection and correction of prescription errors by an emergency department pharmacy service. CJEM 2014; 16(3): 193-206. doi: 10.2310/8000.2013.130975.
12
13. Rothschild JM, Churchill W, Erickson A, Munz K, Schuur JD, Salzberg CA, et al. Medication errors recovered by emergency department pharmacists. Ann Emerg Med 2010; 55(6): 513-21. doi: 10.1016/j.annemergmed.2009.10.012.
13
14. Mohammad Nejad E, Ehsani SR, Salari A, Sajjadi A, Haji Esmaeilpoor A. Refusal in reporting medication errors from the perspective of nurses in emergency ward. Journal of Research Development in Nursing and Midwifery 2013; 10(1): 61-8. [Persian].
14
15. Macías Maroto M, Solís Carpintero L. [Medication administration errors at an emergency service: knowing to decrease risk]. Rev Esp Salud Publica 2018; 92.
15
16. Salavati S, Hatamvand F, Tabesh H, Salehi Nasab M. nurses’ perspectives on causes of medication errors and nonreporting at ED. Iran Journal of Nursing 2012; 25(79): 72- 83. [Persian].
16
ORIGINAL_ARTICLE
The effect of teacher-made simulation moulage on learning cricothyrotomy skills in emergency medicine physicians
Objective: Nowadays, simulation of clinical environment in medical education system (simulation-based learning) has led to a huge revolution in the quality of education and has increased the safety of educators and patients. In this study, we investigated the effect of teacher-made neck and lung simulators in teaching cricothyrotomy skills for emergency medicine residents.Methods: In this pre-post test study, all faculty member of emergency medicine of Tabriz University of medical sciences specialty were invited to participate. After holding an educational and training session for assistants on a teacher-made moulage, all emergency medicine residents performed a tracheostomy on the commercial moulages of the skill lab unit for the second time and their scores were recorded.Results: In this study, 23 emergency medicine residents participated. The mean ± standard deviation of age was 35.91 ± 3.57 years. There was a significant difference between the mean duration of cricothyrotomy before and after the training (P value = 0.006). There was also a significant difference between the mean scores obtained by residents in the pre- and post-training evaluation (P value < 0.001).Conclusion: Findings showed that the moulages constructed by teachers not only can be effective in improving the cricothyrotomy skills in emergency medicine residents but also can reduce the likelihood of failure in performing cricothyrotomy.
http://www.jept.ir/article_91603_8d25a3bba2b54a941438f0ddbc7d206e.pdf
2022-01-01
3
7
10.34172/jept.2021.10
Cricothyrotomy
Difficult airway
Teacher made models
Skills laboratory
Emergency medicine
Hamid Reza
Moretza Bagi
1
Emergency Medicine Research Team, Tabriz University of Medical Science, Tabriz, Iran
AUTHOR
Amir
Ghaffarzad
ghaffarzad@gmail.com
2
Department of Emergency Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
Peyman
Fathipour
peymanfathipoor@yahoo.com
3
Department of Emergency Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
Reza
Yazdani
ryazdani@hums.ac.ir
4
Trauma and Medical Emergencies Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
AUTHOR
Zhila
Khamnian
zhila.khamnian@gmail.com
5
Department of Community Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
Sama
Rahnemayan
samarahnemayan@gmail.com
6
Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
LEAD_AUTHOR
1. Soleimanpour H, Shams Vahdati S, Mahmoodpoor A, Rahimi Panahi J, Afhami MR, Pouraghaei M, et al. Modifiedcricothyroidotomy in skill laboratory. J Cardiovasc Thorac Res 2012; 4(3): 73-6. doi: 10.5681/jcvtr.2012.018.
1
2. Wang HE, Yealy DM. How many attempts are required to accomplish out-of-hospital endotracheal intubation? Acad Emerg Med 2006; 13(4): 372-7. doi: 10.1197/j.aem.2005.11.001.
2
3. Wang HE, Kupas DF, Greenwood MJ, Pinchalk ME, Mullins T, Gluckman W, et al. An algorithmic approach
3
to prehospital airway management. Prehosp Emerg Care 2005; 9(2): 145-55. doi: 10.1080/10903120590924618.
4
4. Kneebone R. Simulation in surgical training: educational issues and practical implications. Med Educ 2003; 37(3): 267-77. doi: 10.1046/j.1365-2923.2003.01440.x.
5
5. Dent JA. Current trends and future implications in the developing role of clinical skills centres. Med Teach 2001;23(5): 483-9. doi: 10.1080/01421590120075724.
6
6. Kozu T. Medical education in Japan. Acad Med 2006; 81(12): 1069-75. doi: 10.1097/01.ACM.0000246682.45610.dd.
7
7. Hao J, Estrada J, Tropez-Sims S. The clinical skills laboratory: a cost-effective venue for teaching clinical skills to third-year medical students. Acad Med 2002; 77(2): 152. doi: 10.1097/00001888-200202000-00012.
8
8. Kneebone R, Nestel D. Learning clinical skills-the place of simulation and feedback. Clin Teach 2005; 2(2): 86-90. doi:10.1111/j.1743-498X.2005.00042.x.
9
9. Weller J, Robinson B, Larsen P, Caldwell C. Simulationbased training to improve acute care skills in medical undergraduates. N Z Med J 2004; 117(1204): U1119.
10
10. Paparella SF, Mariani BA, Layton K, Carpenter AM. Patient safety simulation: learning about safety never seemed more fun. J Nurses Staff Dev 2004; 20(6): 247-52. doi: 10.1097/00124645-200411000-00001.
11
11. Galvagno SM Jr, Nahmias JT, Young DA. Advanced trauma life support® update 2019: management and applications for adults and special populations. Anesthesiol Clin 2019;37(1): 13-32. doi: 10.1016/j.anclin.2018.09.009.
12
12. Burkey B, Esclamado R, Morganroth M. The role of cricothyroidotomy in airway management. Clin Chest Med1991; 12(3): 561-71.
13
13. Fortune JB, Judkins DG, Scanzaroli D, McLeod KB, Johnson SB. Efficacy of prehospital surgical cricothyrotomy in trauma patients. J Trauma 1997; 42(5): 832-6. doi:10.1097/00005373-199705000-00013.
14
14. Wang J, Lin YI, Hou SY. A data mining approach for training evaluation in simulation-based training. ComputInd Eng 2015; 80: 171-80. doi: 10.1016/j.cie.2014.12.008.
15
15. Buonopane CE, Pasta V, Sottile D, Del Vecchio L, Maturo A, Merola R, et al. Cricothyrotomy performed with the Melker™ set or the QuickTrach™ kit: procedure times, learning curves and operators’ preference. G Chir 2014;35(7-8): 165-70.
16
16. Schaumann N, Lorenz V, Schellongowski P, Staudinger T, Locker GJ, Burgmann H, et al. Evaluation of Seldinger technique emergency cricothyroidotomy versus standard surgical cricothyroidotomy in 200 cadavers. Anesthesiology 2005; 102(1): 7-11. doi: 10.1097/00000542-200501000-00005.
17
17. Metterlein T, Frommer M, Ginzkey C, Becher J, Schuster F, Roewer N, et al. A randomized trial comparing two cuffed emergency cricothyrotomy devices using a wire-guided and a catheter-over-needle technique. J Emerg Med 2011; 41(3):326-32. doi: 10.1016/j.jemermed.2010.04.008.
18
18. Aneeshkumar MK, Jones TM, Birchall MA. A new indicator-guided percutaneous emergency cricothyrotomy device: in vivo study in man. Eur Arch Otorhinolaryngol 2009; 266(1): 105-9. doi: 10.1007/s00405-008-0698-5.
19
19. Shetty K, Nayyar V, Stachowski E, Byth K. Training for cricothyroidotomy. Anaesth Intensive Care 2013; 41(5):623-30. doi: 10.1177/0310057x1304100508.
20
20. Mandell D, Orebaugh SL. A porcine model for learning ultrasound anatomy of the larynx and ultrasound-guided cricothyrotomy. Simul Healthc 2019; 14(5): 343-7. doi:10.1097/sih.0000000000000364.
21
21. Aho JM, Thiels CA, AlJamal YN, Ruparel RK, Rowse PG, Heller SF, et al. Every surgical resident should know how to perform a cricothyrotomy: an inexpensive cricothyrotomy task trainer for teaching and assessing surgical trainees. J Surg Educ 2015; 72(4): 658-61. doi: 10.1016/j.jsurg.2014.12.012.
22
22. Hughes KE, Biffar D, Ahanonu EO, Cahir TM, Hamilton A, Sakles JC. Evaluation of an innovative bleeding cricothyrotomy model. Cureus 2018; 10(9): e3327. doi:10.7759/cureus.3327.
23
23. McCarthy MC, Ranzinger MR, Nolan DJ, Lambert CS, Castillo MH. Accuracy of cricothyroidotomy performed in canine and human cadaver models during surgical skills training. J Am Coll Surg 2002; 195(5): 627-9. doi: 10.1016/s1072-7515(02)01337-6.
24
24. Friedman Z, You-Ten KE, Bould MD, Naik V. Teaching lifesaving procedures: the impact of model fidelity on acquisition and transfer of cricothyrotomy skills to performance on cadavers. Anesth Analg 2008; 107(5): 1663-9. doi: 10.1213/ane.0b013e3181841efe.
25
25. Eaton BD, Messent DO, Haywood IR. Animal cadaveric models for advanced trauma life support training. Ann R Coll Surg Engl 1990; 72(2): 135-9.
26
26. Sergeev I, Lipsky AM, Ganor O, Lending G, Abebe-Campino G, Morose A, et al. Training modalities and self-confidence building in performance of life-saving procedures. Mil Med 2012; 177(8): 901-6. doi: 10.7205/milmed-d-12-00018.
27
27. Custalow CB, Kline JA, Marx JA, Baylor MR. Emergency department resuscitative procedures: animal laboratory training improves procedural competency and speed. Acad Emerg Med 2002; 9(6): 575-86. doi: 10.1111/j.1553-2712.2002.tb02294.x.
28
28. Cho J, Kang GH, Kim EC, Oh YM, Choi HJ, Im TH, et al. Comparison of manikin versus porcine models in cricothyrotomy procedure training. Emerg Med J 2008; 25(11): 732-4. doi: 10.1136/emj.2008.059014.
29
ORIGINAL_ARTICLE
Assessing the effectiveness of ketorolac in pain management of traumatic injuries in prehospital emergency care services
Objective: Pain is usually one of the most common symptoms among all traumatic injuries. One of the drugs that has recently entered the Iranian prehospital emergency system is ketorolac. Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis by inhibiting cyclooxygenase activity and reduces pain and inflammation. It can be considered as the strongest analgesic drug in this category. The aim of this study was to evaluate the effectiveness of ketorolac in pain management of traumatic injuries in a prehospital setting.Methods: This descriptive cross-sectional study was undertaken to evaluate the effectiveness of a treatment method in the pain management of traumatic injuries in the prehospital environment of Lorestan province in Iran. We included 134 injured patients from road emergency bases of Lorestan province. In order to control the pain of these injured patients, 30 mg of ketorolac was injected slowly intravenously in one minute. Pain was measured in the time interval of zero minutes (before injection), 15 minutes, 30 minutes, and 45 minutes by visual acuity scale (VAS). The analysis of the obtained data was performed by SPSS software version 23.Results: The mean age of participants was 37.42±23.6. There were 47 female injuries (35.1%) and 87 male injuries (64.9%). In terms of pain intensity, 49 patients (36.6%) had moderate pain (VAS = 4-6) and 85 patients (63.4%) had severe pain (VAS = 7-10). The average of pain relief in the injured group with severe and moderate pain 15 minutes after the injection was 0.471 and 0.878 (P = 0.001), respectively. In addition, the mean of pain relief in the injured group with severe and moderate pain 30 minutes after the injection was 1.124 and 1.796, respectively (P = 0.001). Pain reduction in the group of severely injured patients with moderate pain in the first 30 minutes was statistically significant.Conclusion: Findings revealed that ketorolac is a suitable drug in pain management for trauma patients with moderate and severe pain in trauma patients. On the other hand, due to the peak effect (more than 30 minutes), it is not an effective drug for trauma patients with severe pain in a short period transferred to the prehospital environment.
http://www.jept.ir/article_91605_d9bae3db1367f7e23dcaba1c759fc243.pdf
2022-01-01
8
12
10.34172/jept.2021.01
Ketorolac
Traumatic injuries
Pain management
Pre-hospital emergency
Seyyed Meysam
Amini
1
Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
LEAD_AUTHOR
Mehriyar
Yoldashkhan
2
Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
AUTHOR
Sima
Zohari
3
Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
AUTHOR
Malihe
Nasiri
malihenasiri@gmail.com
4
Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
AUTHOR
Zahra
Mousavi
zahramousavi786@yahoo.com
5
Department of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
AUTHOR
Seyed Mohammad
Amini
6
Radiation Biology Research Center, Iran University of Medical Sciences.Tehran, Iran
AUTHOR
1. Rhee P, Joseph B, Pandit V, Aziz H, Vercruysse G, Kulvatunyou N, et al. Increasing trauma deaths in the
1
United States. Ann Surg 2014; 260(1): 13-21. doi: 10.1097/sla.0000000000000600.
2
2. Ahmadi A, Bazargan-Hejazi S, Heidari Zadie Z, Euasobhon P, Ketumarn P, Karbasfrushan A, et al. Pain management in trauma: a review study. J Inj Violence Res 2016; 8(2): 89-98.doi: 10.5249/jivr.v8i2.707.
3
3. Dijkstra BM, Berben SA, van Dongen RT, Schoonhoven L. Review on pharmacological pain management in trauma patients in (pre-hospital) emergency medicine in the Netherlands. Eur J Pain 2014; 18(1): 3-19. doi:10.1002/j.1532-2149.2013.00337.x.
4
4. Khan MS, Shuaib W, Evans DD, Swain FR, Alweis R, Mehta AS, et al. Evidence-based practice: best imaging practice in musculoskeletal disorders. J Trauma Nurs 2014; 21(4): 170-9. doi:10.1097/jtn.0000000000000059.
5
5. Berben SA, Meijs TH, van Grunsven PM, Schoonhoven L, van Achterberg T. Facilitators and barriers in pain
6
management for trauma patients in the chain of emergency care. Injury 2012; 43(9): 1397-402. doi: 10.1016/j.injury.2011.01.029.
7
6. Katzung BG, Trevor AJ. Basic & Clinical Pharmacology, SMARTBOOK™. McGraw Hill Professional; 2014.
8
7. Mallinson DTE. A review of ketorolac as a prehospital analgesic. Journal of Paramedic Practice 2019; 11(11): 1-6.doi: 10.12968/jpar.2019.11.11.CPD1.
9
8. Farahmand S, Shafazand S, Alinia E, Bagheri-Hariri S, Baratloo A. Pain management using acupuncture method in migraine headache patients; a single blinded randomized clinical trial. Anesth Pain Med 2018; 8(6): e81688. doi:10.5812/aapm.81688.
10
9. Yousefifard M, Askarian-Amiri S, Madani Neishaboori A, Sadeghi M, Saberian P, Baratloo A. Pre-hospital pain management; a systematic review of proposed guidelines. Arch Acad Emerg Med 2019; 7(1): e55.
11
10. Ellerton J, Milani M, Blancher M, Zen-Ruffinen G, Skaiaa SC, Brink B, et al. Managing moderate and severe pain in mountain rescue. High Alt Med Biol 2014; 15(1): 8-14. doi:
12
10.1089/ham.2013.1135.
13
11. Delavar Kasmaei H, Amiri M, Negida A, Hajimollarabi S, Mahdavi N. Ketorolac versus magnesium sulfate in migraine headache pain management; a preliminary study. Emerg (Tehran) 2017; 5(1): e2.
14
12. Neri E, Maestro A, Minen F, Montico M, Ronfani L, Zanon D, et al. Sublingual ketorolac versus sublingual tramadol for moderate to severe post-traumatic bone pain in children: a double-blind, randomised, controlled trial. Arch Dis Child 2013; 98(9): 721-4. doi: 10.1136/archdischild-2012-303527.
15
13. Mahshidfar B, Rezai M, Abbasi S, Farsi D, Hafezimoghadam P, Mofidi M, et al. Intravenous acetaminophen vs. ketorolac in terms of pain management in prehospital emergency services: a randomized clinical trial. Adv J Emerg Med 2019; 3(4): e37. doi: 10.22114/ajem.v0i0.130.
16
14. Faridaalaee G, Mohammadi N, Merghati SZ, Keyghobadi Khajeh F, Naghipour B, Pouraghaei M, et al. Intravenous morphine vs intravenous ketofol for treating renal colic; a randomized controlled trial. Emerg (Tehran) 2016; 4(4):202-6.
17
15. Eftekharian HR, Ilkhani Pak H. Effect of intravenous ketorolac on postoperative pain in mandibular fracture surgery; a randomized, double-blind, placebo-controlled trial. Bull Emerg Trauma 2017; 5(1): 13-7.
18
ORIGINAL_ARTICLE
Pattern of injuries in blunt trauma abdomen: A retrospective evaluation of imaging findings at a high-volume tertiary care trauma centre
Objective: Contrast-enhanced computed tomography (CECT) is the investigation of choice in trauma patients. The purpose of this study was to retrospectively evaluate the pattern, severity and association of abdominal injuries based on imaging at a high-volume tertiary trauma care centre. Methods: Retrospective evaluation of the CT records of patients over a period of 5 years was done at our institute. A total of 1519 patients who had undergone contrast-enhanced abdominal CT at a 64-slice Multidetector CT for abdominal trauma were included in this study. Inclusion criteria were: 1) History of blunt abdominal trauma, 2) Patients who had undergone a biphasic CECT abdomen scan. Exclusion criteria were: 1) Patients with penetrating injury, 2) Patients with incomplete data set/records. Results: Liver was the most common injured organ in both adult (38.8%) and paediatric population (40.9%). Significant higher incidence of mesenteric injury, bladder injury, spinal and rib fractures were seen in adult patients. Significant association of anorectal injuries (P=0.003) and bladder/urethral injuries with pelvic fractures was also seen (P <0.001). Conclusion: Our study provided important insights about the pattern, severity and association between the various abdominal injuries based on imaging findings in a large patient population. Larger studies with incorporation of clinical outcome in such patients can help in formulating appropriate management strategies.
http://www.jept.ir/article_91647_1d9e6cb5a3d1e6f1c6f546711ae13ab4.pdf
2022-01-01
13
18
10.34172/jept.2021.18
Abdominal injury
Multidetector computed tomography
Blunt injury
Vikas
Bhatia
drvikasbhatia@gmail.com
1
Department of Radio-Diagnosis, Nehru hospital, Postgraduate Institute of Medical Education and Research, Chandigarh , India
LEAD_AUTHOR
Suzanne
Koshi
2
Department of Radio-Diagnosis, Nehru hospital, Postgraduate Institute of Medical Education and Research, Chandigarh , India
AUTHOR
Varun
Bansal
varunbansal59@gmail.com
3
Department of Radio-Diagnosis, Nehru hospital, Postgraduate Institute of Medical Education and Research, Chandigarh , India
AUTHOR
Uma
Debi
debi_uma@yahoo.co.in
4
Department of Radio-Diagnosis, Nehru hospital, Postgraduate Institute of Medical Education and Research, Chandigarh , India
AUTHOR
Lokesh
Singh
dr.lokeshsingh@gmail.com
5
Department of Radio-Diagnosis, Nehru hospital, Postgraduate Institute of Medical Education and Research, Chandigarh , India
AUTHOR
Manavjit Singh
Sandhu
6
Department of Radio-Diagnosis, Nehru hospital, Postgraduate Institute of Medical Education and Research, Chandigarh , India
AUTHOR
Pinto F, Bode PJ, Tonerini M, Orsitto E. The role of the radiologist in the management of politrauma patients. Eur J
1
Radiol 2006; 59(3): 315-6. doi: 10.1016/j.ejrad.2006.04.021.
2
2. Radwan MM, Abu-Zidan FM. Focussed Assessment Sonograph Trauma (FAST) and CT scan in blunt abdominal
3
trauma: surgeon’s perspective. Afr Health Sci 2006; 6(3): 187-90. doi: 10.5555/afhs.2006.6.3.187.
4
3. Stengel D, Bauwens K, Sehouli J, Porzsolt F, Rademacher G, Mutze S, et al. Systematic review and meta-analysis
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of emergency ultrasonography for blunt abdominal trauma. Br J Surg 2001; 88(7): 901-12. doi: 10.1046/j.0007-
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1323.2001.01777.x.
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4. Hamilton JD, Kumaravel M, Censullo ML, Cohen AM, Kievlan DS, West OC. Multidetector CT evaluation of
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active extravasation in blunt abdominal and pelvic trauma patients. Radiographics 2008; 28(6): 1603-16. doi: 10.1148/rg.286085522.
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5. Elton C, Riaz AA, Young N, Schamschula R, Papadopoulos B, Malka V. Accuracy of computed tomography in the
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detection of blunt bowel and mesenteric injuries. Br J Surg 2005; 92(8): 1024-8. doi: 10.1002/bjs.4931.
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6. Talari H, Moussavi N, Abedzadeh-Kalahroudi M, Atoof F, Abedini A. Correlation between intra-abdominal free fluid and solid organ injury in blunt abdominal trauma. ArchTrauma Res 2015; 4(3): e29184. doi:10.5812/atr.29184.
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7. Natarajan B, Gupta PK, Cemaj S, Sorensen M, Hatzoudis GI, Forse RA. FAST scan: is it worth doing in hemodynamically stable blunt trauma patients? Surgery 2010; 148(4): 695-700. doi: 10.1016/j.surg.2010.07.032.
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8. Lee BC, Ormsby EL, McGahan JP, Melendres GM, Richards JR. The utility of sonography for the triage of blunt
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abdominal trauma patients to exploratory laparotomy. AJR Am J Roentgenol 2007; 188(2): 415-21. doi: 10.2214/
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ajr.05.2100.
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9. Yasuhara H, Naka S, Kuroda T, Wada N. Blunt thoracic and abdominal vascular trauma and organ injury caused by road traffic accident. Eur J Vasc Endovasc Surg 2000; 20(6):517-22. doi: 10.1053/ejvs.2000.1235.
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10. Beaunoyer M, St-Vil D, Lallier M, Blanchard H. Abdominal injuries associated with thoraco-lumbar fractures after motor vehicle collision. J Pediatr Surg 2001; 36(5): 760-2.doi: 10.1053/jpsu.2001.22954.
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11. Kwon HM, Kim SH, Hong JS, Choi WJ, Ahn R, Hong ES. Abdominal solid organ injury in trauma patients with
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pelvic bone fractures. Ulus Travma Acil Cerrahi Derg 2014; 20(2): 113-9. doi: 10.5505/tjtes.2014.72698.
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12. Hamidi MI, Aldaoud KM, Qtaish I. The role of computed tomography in blunt abdominal trauma. Sultan Qaboos Univ Med J 2007; 7(1): 41-6.
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13. El Wakeel AM, Habib RM, Ali AN. Role of CT in evaluation of blunt abdominal trauma. Int J Med Imaging 2015; 3(5): 89-93. doi: 10.11648/j.ijmi.20150305.11.
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14. Clancy TV, Gary Maxwell J, Covington DL, Brinker CC, Blackman D. A statewide analysis of level I and II trauma
23
centers for patients with major injuries. J Trauma 2001; 51(2): 346-51. doi: 10.1097/00005373-200108000-00021.
24
15. Matthes G, Stengel D, Seifert J, Rademacher G, Mutze S, Ekkernkamp A. Blunt liver injuries in polytrauma: results from a cohort study with the regular use of whole-body helical computed tomography. World J Surg 2003; 27(10):1124-30. doi: 10.1007/s00268-003-6981-0.
25
16. Rabinovici R, Ovadia P, Mathiak G, Abdullah F. Abdominal injuries associated with lumbar spine fractures in blunt trauma. Injury 1999; 30(7): 471-4. doi: 10.1016/s0020-1383(99)00134-5.
26
17. Demetriades D, Karaiskakis M, Toutouzas K, Alo K, Velmahos G, Chan L. Pelvic fractures: epidemiology and
27
predictors of associated abdominal injuries and outcomes. J Am Coll Surg 2002; 195(1): 1-10. doi: 10.1016/s1072-
28
7515(02)01197-3.
29
18. Metz CM, Hak DJ, Goulet JA, Williams D. Pelvic fracture patterns and their corresponding angiographic sources of hemorrhage. Orthop Clin North Am 2004; 35(4): 431-7.doi: 10.1016/j.ocl.2004.06.002.
30
19. Cestero RF, Plurad D, Green D, Inaba K, Putty B, Benfield R, et al. Iliac artery injuries and pelvic fractures: a national trauma database analysis of associated injuries and outcomes. J Trauma 2009; 67(4): 715-8. doi: 10.1097/
31
TA.0b013e3181af6e88.
32
20. Corwin MT, Sheen L, Kuramoto A, Lamba R, Parthasarathy S, Holmes JF. Utilization of a clinical prediction rule
33
for abdominal-pelvic CT scans in patients with blunt abdominal trauma. Emerg Radiol 2014; 21(6): 571-6. doi:
34
10.1007/s10140-014-1233-1.
35
ORIGINAL_ARTICLE
Predictive value of HEART score in the outcome of acute coronary syndrome and disposition
Objective: Disposition in acute coronary syndrome (ACS) is pivotal in an emergency department (ED). HEART score is a recent scoring system for finding primary endpoints in undetermined ACS. This study aimed at evaluating the predictive value of HEART score in ACS outcome and disposition.Methods: In this prospective study, all patients with chest pain presentation compatible with our inclusion criteria referring to ED were enrolled during one year. Demographic data, triage level, hospital length of stay, admission ward, coronary angiography result, HEART score, thrombolysis in myocardial infarction (TIMI) score, 1-month primary ACS endpoints and major adverse cardiac events (MACE) were evaluated.Results: In our studied population (200 cases), 49 patients (24.5%) had at least one score for MACE. Comparing the prognostic values of TIMI vs HEART score in MACE revealed that the HEART had a larger AUC. The best cut-off point of HEART score in MACE prediction was calculated to be ≥5. There was a statistically significant relation between HEART score and hospital length of stay. The higher the HEART score, the more probability of patients being admitted to either hospital cardiac ward or coronary care unit (CCU). There was a significant relationship between the triage level and HEART score. Patients with higher HEART score had more acuity (lower triage level 1 or 2).Conclusion: HEART predicted MACE better than TIMI in low risk ACS. Patients with higher HEART score were more admitted to the hospital with longer hospital stay and patients with lower HEART score had higher triage level with less acuity.
http://www.jept.ir/article_91709_9ca22b9bf5fde3374cc87ccdc866b7e1.pdf
2022-01-01
19
25
10.34172/jept.2021.17
Acute coronary syndrome
HEART score
TIMI score
MACE score
Disposition
elnaz
vahidi
evahidi62@yahoo.com
1
Emergency Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
LEAD_AUTHOR
Maryam
Beladi
mry.bld@gmail.com
2
Emergency Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
AUTHOR
Ahmad
Abbasian
a.abbasian@yahoo.com
3
Emergency Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
AUTHOR
Amirhosein
Jahanshir
4
Emergency Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
AUTHOR
Javad
Seyedhosseini
jshosseini@gmail.com
5
Emergency Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
AUTHOR
1. Niska R, Bhuiya F, Xu J. National Hospital Ambulatory Medical Care Survey: 2007 emergency department
1
summary. Natl Health Stat Report 2010(26):1-31.
2
2. Bolvardi E, Raoufi P, Vakili V, Jahed Taherani H, Movaffaghi M, Bahramian M, et al. Evaluation efficacy of HEART score
3
in prediction of major advanced cardiac events in patients with chest pain. Biosci Biotechnol Res Asia 2016;13(2):999-
4
1005. doi:10.13005/bbra/2126
5
3. Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J 2008;16(6):191-6. doi:10.1007/bf03086144
6
4. Amsterdam EA, Kirk JD, Bluemke DA, Diercks D, Farkouh ME, Garvey JL, et al. Testing of low-risk patients presenting
7
to the emergency department with chest pain: a scientific statement from the American Heart Association. Circulation
8
2010;122(17):1756-76. doi:10.1161/CIR.0b013e3181ec61df
9
5. Six AJ, Backus BE, Kingma A, Kaandorp SI. Consumption of diagnostic procedures and other cardiology care in chest pain patients after presentation at the emergency department. Neth Heart J 2012;20(12):499-504.
10
doi:10.1007/s12471-012-0322-6
11
6. Hoffmann U, Truong QA, Schoenfeld DA, Chou ET, Woodard PK, Nagurney JT, et al. Coronary CT angiography
12
versus standard evaluation in acute chest pain. N Engl J Med 2012;367(4):299-308. doi:10.1056/NEJMoa1201161
13
7. National Clinical Guideline Centre for Acute and Chronic Conditions. Chest Pain of Recent Onset: Assessment and
14
Diagnosis of Recent Onset Chest Pain or Discomfort of Suspected Cardiac Origin. London: National Clinical
15
Guideline Centre for Acute and Chronic Conditions; 2010.
16
8. Eslick GD. Classification, natural history, epidemiology, and risk factors of noncardiac chest pain. Dis Mon 2008;54(9):593-603. doi:10.1016/j.disamonth.2008.06.003
17
9. Chan GW, Sites FD, Shofer FS, Hollander JE. Impact of stress testing on 30-day cardiovascular outcomes for lowrisk
18
patients with chest pain admitted to floor telemetry beds. Am J Emerg Med 2003;21(4):282-87. doi:10.1016/
19
s0735-6757(03)00080-9
20
10. Davis B. Rosen’s emergency medicine: Concepts and clinical practice. Prehospital Emergency Care 2004;8(3):334-5.
21
11. Antman EM, Cohen M, Bernink PJ, McCabe CH, Horacek T, Papuchis G, et al. The TIMI risk score for unstable
22
angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA 2000;284(7):835-
23
42. doi:10.1001/jama.284.7.835
24
12. Fox KA, Eagle KA, Gore JM, Steg PG, Anderson FA. The global registry of acute coronary events, 1999 to 2009--GRACE. Heart 2010;96(14):1095-101. doi:10.1136/hrt.2009.190827
25
13. Hermans WR, Foley DP, Rensing BJ, Rutsch W, Heyndrickx GR, Danchin N, et al. Usefulness of quantitative and
26
qualitative angiographic lesion morphology, and clinical characteristics in predicting major adverse cardiac events
27
during and after native coronary balloon angioplasty.CARPORT and MERCATOR Study Groups. Am J Cardiol
28
1993;72(1):14-20. doi:10.1016/0002-9149(93)90211-t
29
14. Keane D, Buis B, Reifart N, Plokker TH, Ernst JM, Mast EG, et al. Clinical and angiographic outcome following
30
implantation of the new less shortening wallstent in aortocoronary vein grafts: introduction of a second generation stent in the clinical arena. J Interv Cardiol 1994;7(6):557-64. doi:10.1111/j.1540-8183.1994.tb00496.x
31
15. Poldervaart JM, Langedijk M, Backus BE, Dekker IMC, Six AJ, Doevendans PA, et al. Comparison of the GRACE,
32
HEART and TIMI score to predict major adverse cardiac events in chest pain patients at the emergency
33
department. Int J Cardiol 2017;227:656-61. doi:10.1016/j.ijcard.2016.10.080
34
16. World Health Organization (WHO). The World Health Report 2002: Reducing Risks, Promoting Healthy Life.WHO; 2002.
35
17. Faxon DP, Creager MA, Smith SC Jr, Pasternak RC, Olin JW, Bettmann MA, et al. Atherosclerotic Vascular Disease Conference: executive summary: atherosclerotic Vascular Disease Conference proceeding for healthcare professionals from a special writing group of the American Heart Association. Circulation 2004;109(21):2595-604. doi:10.1161/01.cir.0000128517.52533.db
36
18. Six AJ, Cullen L, Backus BE, Greenslade J, Parsonage W, Aldous S, et al. The HEART score for the assessment of patients with chest pain in the emergency department: a multinational validation study. Crit Pathw Cardiol 2013;12(3):121-6. doi:10.1097/HPC.0b013e31828b327e
37
19. Backus BE, Six AJ, Kelder JC, Bosschaert MA, Mast EG, Mosterd A, et al. A prospective validation of the HEART
38
score for chest pain patients at the emergency department. Int J Cardiol 2013;168(3):2153-8. doi:10.1016/j.
39
ijcard.2013.01.255
40
20. Sun BC, Laurie A, Fu R, Ferencik M, Shapiro M, Lindsell CJ, et al. Comparison of the HEART and TIMI risk scores for suspected acute coronary syndrome in the emergency department. Crit Pathw Cardiol 2016;15(1):1-5. doi:10.1097/hpc.0000000000000066
41
21. Jain T, Nowak R, Hudson M, Frisoli T, Jacobsen G, McCord J. Short- and long-term prognostic utility of the HEART
42
score in patients evaluated in the emergency department for possible acute coronary syndrome. Crit Pathw Cardiol
43
2016;15(2):40-5. doi:10.1097/hpc.0000000000000070
44
22. Backus BE, Six AJ, Kelder JH, Gibler WB, Moll FL,Doevendans PA. Risk scores for patients with chest pain: evaluation in the emergency department. Curr Cardiol Rev 2011;7(1):2-8. doi:10.2174/157340311795677662
45
23. Visser A, Wolthuis A, Breedveld R, ter Avest E. HEART score and clinical gestalt have similar diagnostic accuracy
46
for diagnosing ACS in an unselected population of patients with chest pain presenting in the ED. Emerg Med J 2015;32(8):595-600. doi:10.1136/emermed-2014-203798
47
24. Chen XH, Jiang HL, Li YM, Chan CPY, Mo JR, Tian CW, et al. Prognostic values of 4 risk scores in Chinese patients with chest pain: prospective 2-centre cohort study. Medicine (Baltimore) 2016;95(52):e4778. doi:10.1097/md.0000000000004778
48
25. Manini AF, Dannemann N, Brown DF, Butler J, Bamberg F, Nagurney JT, et al. Limitations of risk score models
49
in patients with acute chest pain. Am J Emerg Med 2009;27(1):43-8. doi:10.1016/j.ajem.2008.01.022
50
ORIGINAL_ARTICLE
Frequency of opium use in traumatic patients admitted to Shahid Rahnemoon hospital
Objective: Narcotic and alcohol use are recognized as the two important underlying factors in all types of trauma. In this study, the prevalence of opium consumption was investigated in traumatic patients who referred to Shahid Rahnemoon hospital in Yazd in 2018.Methods: In this descriptive cross-sectional study, 252 patients with trauma admitted to Shahid Rahnemoon Hospital from October to December 2018 were studied. In order to collect the data, a checklist was administered including the patients’ demographic information (age and gender), opium consumption, location of trauma, day of occurrence of trauma and cause of trauma.Results: The mean of patients’ age was 31.33 ± 19.46 years ranging from 2 to 90 years and 71.4% of them were males. The most common causes of trauma included accidents with motor vehicles (56%), falls from height (19.8%), and intimate partner violence (6%), respectively. Regarding opium consumption, 87.3% of patients did not use it, while 10.3% consumed opium. Narcotic abuse was significantly different with regard to the patients’ gender (P = 0.000) and age (P = 0.000).Conclusion: Opium consumption increases the risk of error and accident while driving. People on methadone treatment also show high-risk behaviors and are at greater risk of accidents.
http://www.jept.ir/article_91798_724ce0cdb67a2098315fec0ca4c9cf16.pdf
2022-01-01
26
31
10.34172/jept.2021.15
Opium
Accident
Multiple trauma
alcohol consumption
Malek
Moradi
m.malekm@yahoo.com
1
Student Research Committee, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
AUTHOR
Amir
Motamedi
amir.mtmd@yahoo.com
2
Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
AUTHOR
Adele
Pouyafard
a.pouyafard@gmail.com
3
Department of Oral Medicine, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
AUTHOR
Mostafa
Gavahi
mostafagavahi@gmail.com
4
Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
AUTHOR
Mohsen
Barzegar
drmohsenbarzegar@yahoo.com
5
Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
LEAD_AUTHOR
1. Carrigan TD, Field H, Illingworth RN, Gaffney P, Hamer DW. Toxicological screening in trauma. J Accid Emerg Med
1
2000;17(1):33-7.
2
2. Azizi A, Abdoli G. Mortality rates in Kermanshah province – 2000, J Kermanshah Univ Med Sci. 2003 ; 7(3):e81256.
3
3. Mackersie RC. Field triage, and the fragile supply of “optimal resources” for the care of the injured patient. Prehosp Emerg Care 2006;10(3): 347-50.
4
4. Batista AM, Ferreira Fde O, Marques LS, Ramos-Jorge ML, Ferreira MC. Risk factors associated with facial fractures.
5
Braz Oral Res 2012;26(2):119-25.
6
5. Buchanan J, Colquhoun A, Friedlander L, Evans S, Whitley B, Thomson M. Maxillofacial fractures at Waikato Hospital, New Zealand: 1989 to 2000. N Z Med J 2005;118(1217):U1529.
7
6. Chrcanovic BR. Factors influencing the incidence of maxillofacial fractures. Oral Maxillofac Surg 2012;16(1):3-17.
8
7. Roccia F, Bianchi F, Zavattero E, Tanteri G, Ramieri G. Characteristics of maxillofacial trauma in females: a retrospective analysis of 367 patients. J Craniomaxillofac Surg 2010;38(4):314-9.
9
8. Longo MC, Hunter CE, Lokan RJ, White JM, White MA. The prevalence of alcohol, cannabinoids, benzodiazepines
10
and stimulants amongst injured drivers and their role in driver culpability: part ii: the relationship between drug
11
prevalence and drug concentration, and driver culpability. Accid Anal Prev 2000;32(5):623-32.
12
9. Majdzadeh R, Feiz-Zadeh A, Rajabpour Z, Motevalian A, Hosseini M, Abdollahi M, et al. Opium consumption and
13
the risk of traffic injuries in regular users: a case-crossover study in an emergency department. Traffic Inj Prev 2009;10(4):325-9.
14
10. Pournaghash Tehrani S. Drugs And Behavior. Tehran 2013. Page 4-78
15
11. Schuur JD, Hsia RY, Burstin H, Schull MJ, Pines JM. Quality measurement in the emergency department: past and
16
future. Health Aff (Millwood) 2013;32(12):2129-38.
17
12. London JA, Mock CN, Quansah RE, Abantanga FA, Jurkovich GJ. Priorities for improving hospital-based trauma care in an African city. J Trauma 2001;51(4):747-53.
18
13. Chandra Shekar BR, Reddy C. A five-year retrospective statistical analysis of maxillofacial injuries in patients
19
admitted and treated at two hospitals of Mysore city. Indian J Dent Res 2008;19(4):304-8
20
14. Lee JH, Cho BK, Park WJ. A 4-year retrospective study of facial fractures on Jeju, Korea. J Craniomaxillofac Surg
21
2010;38(3):192-6.
22
15. Lone P, Singh AP, Kour I, Kumar M. A 2-year retrospective analysis of facial injuries in patients treated at department of oral and maxillofacial surgery, IGGDC, Jammu, India. Natl J Maxillofac Surg 2014;5(2):149-52.
23
16. Paes JV, de Sa Paes FL, Valiati R, de Oliveira MG, Pagnoncelli RM. Retrospective study of prevalence of face fractures in southern Brazil. Indian J Dent Res 2012;23(1):80-6.
24
17. Zargar M, Modaghegh MH, Rezaishiraz H. Urban injuries in Tehran: demography of trauma patients and evaluation
25
of trauma care. Injury 2001;32(8):613-7.
26
18. Taghipour H, Panahi F, Khoshmohabat H, Moharamzadeh Y, Abasi A, Hojjatifirozabadi N. Injury severity and causes of death Autopsy deals cost incurred due to theCar Accidents. Shaheed Sadoughi University of Medical Sciences. 2010;17(5):358-64.
27
19. Kadkhodaie MH. Three-year review of facial fractures at a teaching hospital in northern Iran. Br J Oral Maxillofac
28
Surg 2006;44(3):229-31.
29
20. Ellis E 3rd, Moos KF, el-Attar A. Ten years of mandibular fractures: an analysis of 2,137 cases. Oral Surg Oral Med
30
Oral Pathol 1985;59(2):120-9.
31
21. Al Ahmed HE, Jaber MA, Abu Fanas SH, Karas M. The pattern of maxillofacial fractures in Sharjah, United Arab
32
Emirates: a review of 230 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;98(2):166-70.
33
22. Adekeye EO. The pattern of fractures of the facial skeleton in Kaduna, Nigeria. A survey of 1,447 cases. Oral Surg Oral Med Oral Pathol 1980;49(6):491-5.
34
23. Pandey S, Roychoudhury A, Bhutia O, Singhal M, Sagar S, Pandey RM. Study of the pattern of maxillofacial fractures
35
seen at a tertiary care hospital in north India. J Maxillofac Oral Surg 2015;14(1):32-9.
36
24. Ungari C, Filiaci F, Riccardi E, Rinna C, Iannetti G. Etiology and incidence of zygomatic fracture: a retrospective study
37
related to a series of 642 patients. Eur Rev Med Pharmacol Sci 2012;16(11):1559-62.
38
25. Potenza BM, Hoyt DB, Coimbra R, Fortlage D, Holbrook T, Hollingsworth-Fridlund P. The epidemiology of serious
39
and fatal injury in San Diego County over an 11-year period. J Trauma 2004;56(1):68-75.
40
26. argar M, Khaji A, Karbakhsh M, Zarei MR. Epidemiology study of facial injuries during a 13 month of trauma registry
41
in Tehran. Indian J Med Sci 2004;58(3):109-14.
42
27. Yaghubi AA, Cyrus A, Azizabadi-Farahani M, Amini M, Noori GR, Gudarzi D, et al. Epidemiolgical Assessment of Trauma Patients Referring to Arak Vali-Asr Hospital. Journal of Rescue and Relief 2010;2(1):1-9.
43
28. Barbone F, McMahon AD, Davey PG, Morris AD, Reid IC, McDevitt DG, et al. Association of road-traffic accidents
44
with benzodiazepine use. Lancet 1998; 352(9137):1331-6.
45
29. Elvik R. Risk of road accident associated with the use of drugs: a systematic review and meta-analysis of evidence
46
from epidemiological studies. Accid Anal Prev 2013;60:254-67.
47
30. Ramaekers JG, Berghaus G, van Laar M, Drummer OH. Dose related risk of motor vehicle crashes after cannabis
48
use. Drug Alcohol Depend 2004;73(2):109-19.
49
31. Vitale S, van de Mheen D. Illicit drug use and injuries: A review of emergency room studies. Drug Alcohol Depend
50
2006;82(1):1-9.
51
32. Gjerde H, Normann PT, Christophersen AS, Samuelsen SO, Morland J. Alcohol, psychoactive drugs and fatal road
52
traffic accidents in Norway: a case-control study. Accid Anal Prev 2011;43(3):1197-203.
53
33. Al-Abdallat IM, Al Ali R, Hudaib AA, Salameh GA, Salameh RJ, Idhair AK. The prevalence of alcohol and psychotropic
54
drugs in fatalities of road-traffic accidents in Jordan during2008-2014. J Forensic Leg Med 2016;39:130-4.
55
34. Canfield DV, Hordinsky J, Millett DP, Endecott B, Smith D. Prevalence of drugs and alcohol in fatal civil aviation
56
accidents between 1994 and 1998. Aviat Space Environ Med 2001;72(2):120-4.
57
35. Carfora A, Campobasso CP, Cassandro P, Petrella R, Borriello R. Alcohol and drugs use among drivers injured in
58
road accidents in Campania (Italy): A 8-years retrospective analysis. Forensic Sci Int 2018;288:291-296.
59
36. Christophersen AS, Gjerde H. Prevalence of alcohol and drugs among car and van drivers killed in road accidents
60
in Norway: an overview from 2001 to 2010. Traffic Inj Prev 2014;15(6):523-31.
61
37. Holmgren P, Holmgren A, Ahlner J. Alcohol and drugs in drivers fatally injured in traffic accidents in Sweden during
62
the years 2000-2002. Forensic Sci Int 2005;151(1):11-7.
63
38. O’Malley PM, Johnston LD. Unsafe driving by high school seniors: national trends from 1976 to 2001 in tickets and
64
accidents after use of alcohol, marijuana and other illegal drugs. J Stud Alcohol 2003;64(3):305-12.
65
39. Pelicao FS, Peres MD, Pissinate JF, de Paula DM, de Faria M, Nakamura-Palacios EM, et al. Predominance of alcohol
66
and illicit drugs among traffic accidents fatalities in an urban area of Brazil. Traffic Inj Prev 2016;17(7):663-7.
67
40. Ricci G, Majori S, Mantovani W, Zappaterra A, Rocca G, Buonocore F. Prevalence of alcohol and drugs in urine
68
of patients involved in road accidents. J Prev Med Hyg 2008;49(2):89-95.
69
41. Rodriguez NN, Dalri MC, Alonso Castillo MM, Garcia KS. Accidents and injuries due to consumption of alcohol or
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drugs in patients treated at an emergency room. Rev Lat Am Enfermagem 2010;18 Spec No:521-8.
71
42. Bakhtiyari M, Soori H, Ainy E, Salehi M, Mehmandar MR. The survey of the role of humans’ risk factors in the severity of road traffic injuries on urban and rural roads. Safety promotion and injury prevention (Tehran) 2014;2(3):245-252.
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44. Afshar A, Asadzadeh M, Kargar H, Aghdashi MM, Mirzatolooei F. Opium and opioid abuse in orthopedic inpatients: a cross sectional study in Urmia University of Medical Sciences. Acta Med Iran 2012;50(1):66-9.
74
45. Tabibi Z. The influence of addiction on aberrant driving behaviors and traffic safety. Applied Research Psychological
75
Applied 2017;8(3):89-105
76
ORIGINAL_ARTICLE
Association between a history of child neglect, abuse and the suicidal patient: a cross-sectional study
Objective: People with a significant childhood history of abuse may exhibit emotionaldysregulations and psychiatric disorders and, in some cases, present suicidal ideation.Methods: In this descriptive-analytical and cross-sectional study data were collectedfrom suicidal patients referred to two grand hospitals in 2019. One hundred ninetyfive participants were evaluated concerning child abuse and neglect history. Data werereported as mean, SD, frequency, and percent. T-test and chi-square tests were used forstatistical analyses accordingly.Results: Child abuse regarding suicidal people were to the following order, neglect(n=103), child emotional abuse (n=102), child physical abuse (n=101), malnutrition (n=96),and child sexual abuse (n=87). Suicide was different between the two genders, but it wasnot different based on parents’ education and marital status.Conclusion: The harassed child is not equipped with proper behavioral skills and issubjected to low self-esteem due to incorrect training. Therefore, he/she may commitsuicide in adolescence by facing some problems and failures. In this regard, communityplays an important role, parents must be informed and use the right culture to reward thechild.
http://www.jept.ir/article_91805_4522ee24d3483fafc69d88ee43bb35b6.pdf
2022-01-01
32
36
10.34172/jept.2021.34
Suicide
child abuse
Child neglect
Family characteristics
Ali
Delirrooyfard
adelir2891@gmail.com
1
Imam Khomeini Hospital Clinical Research Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
LEAD_AUTHOR
Maria
Cheraghi
mariacheraghi@gmail.com
2
Department of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
AUTHOR
Mehdi
Sayyah
sayah-m@ajums.ac.ir
3
Department of Psychiatry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz Iran
AUTHOR
Zahra
Farahbakhsh
farahbakhshz@ajums.ac.ir
4
Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
AUTHOR
1. Pipe ME, Lamb ME, Orbach Y, Cederborg AC. Child Sexual Abuse: Disclosure, Delay, and Denial. Psychology Press; 2013.
1
2. Arensman E, Larkin C, McCarthy J, Leitao S, Corcoran P, Williamson E, et al. Psychosocial, psychiatric and workrelated
2
risk factors associated with suicide in Ireland: optimised methodological approach of a case-control psychological autopsy study. BMC Psychiatry 2019; 19(1):275. doi: 10.1186/s12888-019-2249-6.
3
3. Page A, Sperandei S, Spittal MJ, Milner A, Pirkis J. The impact of transitions from employment to retirement
4
on suicidal behaviour among older aged Australians. Soc Psychiatry Psychiatr Epidemiol 2021; 56(5): 759-71. doi:
5
10.1007/s00127-020-01947-0.
6
4. Chang Q, Yip PSF, Chen Y-Y. Gender inequality and suicide gender ratios in the world. J Affect Disord 2019; 243: 297-
7
304. doi: 10.1016/j.jad.2018.09.032
8
5. Szanto K, Bruine de Bruin W, Parker AM, Hallquist MN, Vanyukov PM, Dombrovski AY. Decision-making competence and attempted suicide. J Clin Psychiatry 2015;76(12): e1590-7. doi: 10.4088/JCP.15m09778.
9
6. MacMillan HL, Tanaka M, Duku E, Vaillancourt T, Boyle MH. Child physical and sexual abuse in a community sample of young adults: results from the Ontario Child Health Study. Child Abuse Negl 2013; 37(1): 14-21. doi:10.1016/j.chiabu.2012.06.005.
10
7. Devries KM, Mak JY, Child JC, Falder G, Bacchus LJ, Astbury J, et al. Childhood sexual abuse and suicidal behavior: a meta-analysis. Pediatrics 2014; 133(5): e1331-44. doi: 10.1542/peds.2013-2166.
11
8. Bagley C, Mallick K. Prediction of sexual, emotional, and physical maltreatment and mental health outcomes in a
12
longitudinal cohort of 290 adolescent women. Child Maltreat 2000; 5(3): 218-26. doi: 10.1177/1077559500005003002.
13
9. Tomoda A, Navalta CP, Polcari A, Sadato N, Teicher MH. Childhood sexual abuse is associated with reduced gray matter volume in visual cortex of young women. Biol Psychiatry 2009; 66(7): 642-8. doi: 10.1016/j.biopsych.2009.04.021.
14
10. Andersen SL, Tomada A, Vincow ES, Valente E, Polcari A, Teicher MH. Preliminary evidence for sensitive periods
15
in the effect of childhood sexual abuse on regional brain development. J Neuropsychiatry Clin Neurosci 2008; 20(3):
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292-301. doi: 10.1176/jnp.2008.20.3.292.
17
11. Ito Y, Teicher MH, Glod CA, Ackerman E. Preliminary evidence for aberrant cortical development in abused children: a quantitative EEG study. J Neuropsychiatry Clin Neurosci 1998; 10(3): 298-307. doi: 10.1176/jnp.10.3.298.
18
12. Braquehais MD, Oquendo MA, Baca-García E, Sher L. Is impulsivity a link between childhood abuse and suicide?
19
Compr Psychiatry 2010; 51(2): 121-9. doi: 10.1016/j.comppsych.2009.05.003.
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13. Laird JJ, Klettke B, Hall K, Clancy E, Hallford D. Demographic and psychosocial factors associated with child sexual exploitation: a systematic review and metaanalysis. JAMA Netw Open 2020; 3(9): e2017682. doi:10.1001/jamanetworkopen.2020.17682.
21
14. Lim L, Hart H, Mehta M, Worker A, Simmons A, Mirza K, et al. Grey matter volume and thickness abnormalities in
22
young people with a history of childhood abuse. Psychol Med 2018; 48(6): 1034-46. doi: 10.1017/s0033291717002392.
23
15. Lim L, Hart H, Howells H, Mehta MA, Simmons A, Mirza K, et al. Altered white matter connectivity in young people
24
exposed to childhood abuse: a tract-based spatial statistics (TBSS) and tractography study. J Psychiatry Neurosci 2019;
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44(4): E11-E20. doi: 10.1503/jpn.170241.
26
16. Harford TC, Yi HY, Grant BF. Associations between childhood abuse and interpersonal aggression and suicide attempt among U.S. adults in a national study. Child Abuse Negl 2014; 38(8): 1389-98. doi: 10.1016/j.chiabu.2014.02.011.
27
17. Afifi TO, MacMillan HL, Boyle M, Taillieu T, Cheung K, Sareen J. Child abuse and mental disorders in Canada. CMAJ 2014; 186(9): E324-32. doi: 10.1503/cmaj.131792.
28
18. Salokangas RKR, Luutonen S, Heinimaa M, From T, Hietala J. A study on the association of psychiatric diagnoses and childhood adversities with suicide risk. Nord J Psychiatry 2019; 73(2): 125-31. doi: 10.1080/08039488.2018.1493748.
29
19. Simbar M, Golezar S, Alizadeh S, Hajifoghaha M. Suicide risk factors in adolescents worldwide: a narrative review. J
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Rafsanjan Univ Med Sci 2018; 16(12): 1153-68. [Persian]. 20. Maniglio R. The role of child sexual abuse in the etiology of
31
suicide and non-suicidal self-injury. Acta Psychiatr Scand 2011; 124(1): 30-41. doi: 10.1111/j.1600-0447.2010.01612.x.
32
21. Yaghoubi Doust M, Enayat H. Sociological factors of domestic violence towards adolescent female children (case
33
study: high schools in Ahwaz). Woman & Study of Family 2012; 4(14): 143-71. [Persian].
34
22. Der EM, Dakwah IA, Derkyi-Kwarteng L, Badu AA. Hanging as a method of suicide in Ghana: a 10 year autopsy
35
study. Pathol Discov 2016; 4: 2. doi: 10.7243/2052-7896-4-2.
36
23. Asscher JJ, Van der Put CE, Stams GJ. Gender differences in the impact of abuse and neglect victimization on adolescent offending behavior. J Fam Violence 2015; 30(2): 215-25. doi: 10.1007/s10896-014-9668-4.
37
24. Higgins DJ, McCabe MP. Multiple forms of child abuse and neglect: adult retrospective reports. Aggress Violent Behav 2001; 6(6): 547-78. doi: 10.1016/s1359-1789(00)00030-6.
38
25. Vanderminden J, Hamby S, David-Ferdon C, Kacha- Ochana A, Merrick M, Simon TR, et al. Rates of neglect in a national sample: child and family characteristics and psychological impact. Child Abuse Negl 2019; 88: 256-65.
39
doi: 10.1016/j.chiabu.2018.11.014.
40
26. Grudet C, Malm J, Westrin A, Brundin L. Suicidal patients are deficient in vitamin D, associated with a pro inflammatory status in the blood. Psychoneuroendocrinology 2014; 50: 210-9. doi: 10.1016/j.psyneuen.2014.08.016.
41
27. Stickley A, Koyanagi A, Inoue Y, Leinsalu M. Childhood hunger and thoughts of death or suicide in older adults. Am
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J Geriatr Psychiatry 2018; 26(10): 1070-8. doi: 10.1016/j.jagp.2018.06.005.
43
28. Auersperg F, Vlasak T, Ponocny I, Barth A. Long-term effects of parental divorce on mental health - a metaanalysis.
44
J Psychiatr Res 2019; 119: 107-15. doi: 10.1016/j.jpsychires.2019.09.011.
45
29. Léveillée S, Doyon L, Cantinotti M. “Evolution of paternal filicide-suicide in the province of Quebec”. Encephale 2019;45(1): 34-9. doi: 10.1016/j.encep.2017.10.007. [French].
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30. Houtepen LC, Heron J, Suderman MJ, Fraser A, Chittleborough CR, Howe LD. Associations of adverse childhood experiences with educational attainment and adolescent health and the role of family and socioeconomic factors: a prospective cohort study in the UK. PLoS Med 2020; 17(3): e1003031. doi: 10.1371/journal.pmed.1003031.
47
ORIGINAL_ARTICLE
Electrocardiographic abnormalities and troponin levels provide insight on the prognosis of COVID-19 patients: A single center experience from Iran
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.
http://www.jept.ir/article_91818_f6c3d95c90e6df6ea2ba38db86fa208b.pdf
2022-01-01
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42
10.34172/jept.2021.29
Electrocardiography
Troponin
COVID-19
Myocardial damage
Amin
Mahdavi
mahdaviamin@yahoo.com
1
Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran.
AUTHOR
Meysam
Moravej
meymor14@gmail.com
2
Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences , Kerman, Iran
AUTHOR
Maryam
Aliramezany
maliramezany@yahoo.com
3
Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
LEAD_AUTHOR
1. Moazenzadeh M, Jafari F, Farrokhnia M, Aliramezany M. First reported case of unrepaired tetralogy of Fallot complicated with coronavirus disease-19 (COVID-19). Cardiol Young 2020; 30(9): 1339-42. doi: 10.1017/
1
s1047951120001821.
2
2. Long B, Brady WJ, Koyfman A, Gottlieb M. Cardiovascular complications in COVID-19. Am J Emerg Med 2020; 38(7): 1504-7. doi: 10.1016/j.ajem.2020.04.048.
3
3. Bandyopadhyay D, Akhtar T, Hajra A, Gupta M, Das A, Chakraborty S, et al. COVID-19 pandemic: cardiovascular complications and future implications. Am J Cardiovasc Drugs 2020; 20(4): 311-24. doi: 10.1007/s40256-020-00420-2.
4
4. He J, Wu B, Chen Y, Tang J, Liu Q, Zhou S, et al. Characteristic electrocardiographic manifestations in patients with COVID-19. Can J Cardiol 2020; 36(6): 966.e1-966.e4. doi: 10.1016/j.cjca.2020.03.028.
5
5. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus
6
in Wuhan, China. Lancet 2020; 395(10223): 497-506. doi:10.1016/s0140-6736(20)30183-5.
7
6. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel
8
coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323(11): 1061-9. doi: 10.1001/jama.2020.1585.
9
7. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with
10
COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395(10229): 1054-62. doi: 10.1016/s0140-
11
6736(20)30566-3.
12
8. Tersalvi G, Vicenzi M, Calabretta D, Biasco L, Pedrazzini G, Winterton D. Elevated troponin in patients with coronavirus disease 2019: possible mechanisms. J Card Fail 2020; 26(6): 470-5. doi: 10.1016/j.cardfail.2020.04.009.
13
9. Angeli F, Spanevello A, De Ponti R, Visca D, Marazzato J, Palmiotto G, et al. Electrocardiographic features of patients
14
with COVID-19 pneumonia. Eur J Intern Med 2020; 78: 101-6. doi: 10.1016/j.ejim.2020.06.015.
15
10. Yang Z, Shi J, He Z, Lü Y, Xu Q, Ye C, et al. Predictors for imaging progression on chest CT from coronavirus disease
16
2019 (COVID-19) patients. Aging (Albany NY) 2020; 12(7): 6037-48. doi: 10.18632/aging.102999.
17
11. Mann D, Zipes D, Libby P, Bonow R. Braunwalds Heart Disease: A Textbook of Cardiovascular Medicine. Saunders:
18
Elsevier; 2015.
19
12. McCullough SA, Goyal P, Krishnan U, Choi JJ, Safford MM, Okin PM. Electrocardiographic findings in coronavirus
20
disease-19: insights on mortality and underlying myocardial processes. J Card Fail 2020; 26(7): 626-32. doi: 10.1016/j.
21
cardfail.2020.06.005.
22
13. Driggin E, Madhavan MV, Bikdeli B, Chuich T, Laracy J, Biondi-Zoccai G, et al. Cardiovascular considerations for
23
patients, health care workers, and health systems during the COVID-19 pandemic. J Am Coll Cardiol 2020; 75(18):
24
2352-71. doi: 10.1016/j.jacc.2020.03.031.
25
14. Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, et al. Cardiovascular implications of fatal outcomes of patients
26
with coronavirus disease 2019 (COVID-19). JAMA Cardiol 2020; 5(7): 811-8. doi: 10.1001/jamacardio.2020.1017.
27
15. Wan Y, Shang J, Graham R, Baric RS, Li F. Receptor recognition by the novel coronavirus from Wuhan: an
28
analysis based on decade-long structural studies of SARS coronavirus. J Virol 2020; 94(7): e00127-20. doi: 10.1128/
29
jvi.00127-20.
30
16. Lippi G, Lavie CJ, Sanchis-Gomar F. Cardiac troponin I in patients with coronavirus disease 2019 (COVID-19): evidence from a meta-analysis. Prog Cardiovasc Dis 2020; 63(3): 390-1. doi: 10.1016/j.pcad.2020.03.001.
31
17. Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, et al. Association of cardiac injury with mortality in hospitalized patients
32
with COVID-19 in Wuhan, China. JAMA Cardiol 2020; 5(7): 802-10. doi: 10.1001/jamacardio.2020.0950.
33
18. Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol 2020; 109(5): 531-8.doi: 10.1007/s00392-020-01626-9.
34
19. Pishgahi M, Yousefifard M, Safari S, Ghorbanpouryami F. Electrocardiographic findings of COVID-19 patients and their correlation with outcome; a prospective cohort study. Front Emerg Med 2020; 5(2): e17. doi: 10.18502/fem.v5i2.5608.
35
20. Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020; 579(7798): 270-3. doi:10.1038/s41586-020-2012-7.
36
21. Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med 2020; 8(4): e21. doi: 10.1016/s2213-2600(20)30116-8.
37
22. Khajali Z, Sanati HR, Pouraliakbar H, Mohebbi B, Aeinfar K, Zolfaghari R. Self-expandable stent for repairing
38
coarctation of the left-circumferential aortic arch with right-sided descending aorta and aberrant right subclavian
39
artery with Kommerell’s aneurysm. Ann Vasc Surg 2017; 38: 318.e7-318.e10. doi: 10.1016/j.avsg.2016.05.116.
40
ORIGINAL_ARTICLE
Implementation and evaluation of the five-level emergency triage (emergency severity index tool): A hospital-based, prospective, observational study
Objective:To implement the 5-level Emergency Severity Index (ESI) triage tool into nursingpractice in the emergency department (ED) and validate it with a population-based cohortusing hospitalization and length of stay (LOS) as outcome measures.Methods: The study included 850 patients, irrespective of age and gender, reporting tothe ED of a tertiary care hospital. Each patient was assessed by the triage nurse as perthe 5-level ESI triage tool and categorized. The number and type of resources used by thepatient, LOS in the ED and the outcome were noted. Data were statistically analyzed byusing RStudio Team software, 2015. A P value of < 0.05 was considered to be statisticallysignificant.Results: The majority of patients belonged to ESI-4 (46.82%), followed by ESI-1 (19.41%),ESI-2 (17.06%), ESI-3 (10.35%), and ESI-5 (6.35%). In most patients, the LOS in the ED was<120 minutes (55.65%). ESI showed a statistically significant association with all the clinicalcharacteristics, as well as resources used, interventions needed, maximum time allowedbefore initiating physician assessment, duration of stay in ED, and patient outcomes(P=0.000). ESI was found to have a sensitivity of 100% and specificity of 78%.Conclusion: ESI is a useful and valid tool for the emergency triage and has the potential tobecome the standard triage acuity assessment in EDs in India.
http://www.jept.ir/article_91815_c8505ba144036d0e2cbaae6db9337d9f.pdf
2022-01-01
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10.34172/jept.2021.33
triage
Length of stay
cohort
Harish Kodisiddaiah
Shivanna
1
Department of Emergency Medicine, Ramaiah Medical College, Rajiv Gandhi University of Health Sciences (RGUHS), Bangalore, Karnataka, India
LEAD_AUTHOR
Aruna Chala
Ramesh
2
Department of Emergency Medicine, Ramaiah Medical College, Rajiv Gandhi University of Health Sciences (RGUHS), Bangalore, Karnataka, India
AUTHOR
Keshava Murthy M
Rangaswamy
3
Department of Emergency Medicine, Ramaiah Medical College, Rajiv Gandhi University of Health Sciences (RGUHS), Bangalore, Karnataka, India
AUTHOR
Wuerz RC, Milne LW, Eitel DR, Travers D, Gilboy N. Reliability and validity of a new five-level triage instrument.
1
Acad Emerg Med 2000; 7(3): 236-42. doi: 10.1111/j.1553-2712.2000.tb01066.x.
2
2. Gilboy N, Tanabe T, Travers D, Rosenau AM. Emergency Severity Index (ESI): A Triage Tool for Emergency Department Care, Version 4. Implementation Handbook .2012 Edition. AHRQ Publication No. 12-0014. Rockville,MD: Agency for Healthcare Research and Quality (AHRQ); 2011.
3
3. Wuerz R, Fernandes CM, Alarcon J. Inconsistency of emergency department triage. Emergency Department Operations Research Working Group. Ann Emerg Med 1998; 32(4): 431-5. doi: 10.1016/s0196-0644(98)70171-4.
4
4. Brillman JC, Doezema D, Tandberg D, Sklar DP, Davis KD, Simms S, et al. Triage: limitations in predicting need for
5
emergent care and hospital admission. Ann Emerg Med 1996; 27(4): 493-500. doi: 10.1016/s0196-0644(96)70240-8.
6
5. Travers DA, Waller AE, Bowling JM, Flowers D, Tintinalli J. Five-level triage system more effective than three-level in
7
tertiary emergency department. J Emerg Nurs 2002; 28(5): 395-400. doi: 10.1067/men.2002.127184.
8
6. Eitel DR, Travers DA, Rosenau AM, Gilboy N, Wuerz RC. The emergency severity index triage algorithm version 2 is
9
reliable and valid. Acad Emerg Med 2003; 10(10): 1070-80. doi: 10.1111/j.1553-2712.2003.tb00577.x.
10
7. Worster A, Gilboy N, Fernandes CM, Eitel D, Eva K, Geisler R, et al. Assessment of inter-observer reliability of two fivelevel triage and acuity scales: a randomized controlled trial. CJEM 2004; 6(4): 240-5. doi: 10.1017/s1481803500009192.
11
8. Wuerz R. Emergency severity index triage category is associated with six-month survival. ESI Triage Study Group. Acad Emerg Med 2001; 8(1): 61-4. doi: 10.1111/j.1553-2712.2001.tb00554.x.
12
9. Singer RF, Infante AA, Oppenheimer CC, West CA, Siegel B. The use of and satisfaction with the Emergency Severity Index. J Emerg Nurs 2012; 38(2): 120-6. doi: 10.1016/j.jen.2010.07.004.
13
10. Travers DA, Waller AE, Katznelson J, Agans R. Reliability and validity of the emergency severity index for pediatric triage. Acad Emerg Med 2009; 16(9): 843-9. doi:10.1111/j.1553-2712.2009.00494.x.
14
11. Durani Y, Brecher D, Walmsley D, Attia MW, Loiselle JM. The Emergency Severity Index version 4: reliability in
15
pediatric patients. Pediatr Emerg Care 2009; 25(11): 751-3.
16
12. Baumann MR, Strout TD. Triage of geriatric patients in the emergency department: validity and survival with the Emergency Severity Index. Ann Emerg Med 2007; 49(2): 234-40. doi: 10.1016/j.annemergmed.2006.04.011.
17
13. Platts-Mills TF, Travers D, Biese K, McCall B, Kizer S, LaMantia M, et al. Accuracy of the Emergency Severity
18
Index triage instrument for identifying elder emergency department patients receiving an immediate life-saving
19
intervention. Acad Emerg Med 2010; 17(3): 238-43. doi:10.1111/j.1553-2712.2010.00670.x.
20
14. Baumann MR, Strout TD. Evaluation of the Emergency Severity Index (version 3) triage algorithm in pediatric
21
patients. Acad Emerg Med 2005; 12(3): 219-24. doi:10.1197/j.aem.2004.09.023.
22
15. Tanabe P, Gimbel R, Yarnold PR, Kyriacou DN, Adams JG. Reliability and validity of scores on The Emergency Severity Index version 3. Acad Emerg Med 2004; 11(1): 59-65. doi:10.1197/j.aem.2003.06.013.
23
16. Elshove-Bolk J, Mencl F, van Rijswijck BT, Simons MP, van Vugt AB. Validation of the Emergency Severity Index
24
(ESI) in self-referred patients in a European emergency department. Emerg Med J 2007; 24(3): 170-4. doi: 10.1136/emj.2006.039883.
25
17. Chi CH, Huang CM. Comparison of the Emergency Severity Index (ESI) and the Taiwan Triage System in predicting resource utilization. J Formos Med Assoc 2006; 105(8): 617-25. doi: 10.1016/s0929-6646(09)60160-1.
26
ORIGINAL_ARTICLE
Candida isolation from peritoneal fluid: Its role in the outcome of patients with perforation peritonitis
Objective: Perforation peritonitis is a common surgical emergency which is treated bysurgery and antibiotics. Candida isolation in peritoneal fluid and antifungal treatment isnot a norm. The aim of this study was to determine the incidence of Candida in peritonealfluid and its role in the outcome of patients with perforation peritonitis.Methods: This prospective observational study was conducted on 70 patients withperforation peritonitis from October 2016 to February 2018. Intraoperatively, peritonealfluid was taken and sent for microbiological culture and sensitivity. Perforation wasmanaged according to the site of perforation and condition of bowel.Results: The mean age of the patients was 38.74 years with male predominance (58,82.85%). Forty-seven (67.14%) patients had positive peritoneal cultures. Escherichia coliwas the most common bacteria (n=29), while Candida was found to be the most commonfungi and was found in 18 patients. The incidence of Candida was higher in upper gastroduodenal perforation (30, 42.85%). Patients found positive for Candida had APACHE IIseverity score 10 or more which was higher than the rest of the patients. The mortality washigher in patients with positive peritoneal cultures (10/47) as compare to negative ones(2/23, P<0.001). The mortality in mixed bacterial and fungal-positive cultures (7/18) wasalso higher as compared to isolated bacterial culture (3/29, P <0.001). The overall mortalityrate was 17.14%.Conclusion: Patients with Candida positive peritoneal culture had a significant mortalityand morbidity as compared to Candida negative. Peritoneal fluid culture and sensitivity forbacterial and fungal were helpful in the early diagnosis and treatment
http://www.jept.ir/article_91822_69dbc621a4c9ae58ea3b67b2c33cd813.pdf
2022-01-01
49
54
10.34172/jept.2021.20
Perforation peritonitis
Candida
Fungal peritonitis
outcome
Primary peritonitis
Abdominal cavity
laparotomy
Shyam
lal
1
General Surgery, ESIC-PGIMSR and Model Hospital Basaidarapur, New Delhi, India
LEAD_AUTHOR
Vinod
Kumar Singh
2
Department of General Surgery, ESIC-PGIMSR and Model Hospital, Basaidarapur, News Delhi, India
AUTHOR
Suhas
Agarwal
3
Department of General Surgery, ESIC-PGIMSR and Model Hospital, Basaidarapur, News Delhi, India
AUTHOR
Carneiro HA, Mavrakis A, Mylonakis E. Candida peritonitis: an update on the latest research and treatments.
1
World J Surg 2011; 35(12): 2650-9. doi: 10.1007/s00268-011-1305-2.
2
2. Shan YS, Hsu HP, Hsieh YH, Sy ED, Lee JC, Lin PW. Significance of intraoperative peritoneal culture of fungus
3
in perforated peptic ulcer. Br J Surg 2003; 90(10): 1215-9.doi: 10.1002/bjs.4267.
4
3. Lee SC, Fung CP, Chen HY, Li CT, Jwo SC, Hung YB, et al. Candida peritonitis due to peptic ulcer perforation:
5
incidence rate, risk factors, prognosis and susceptibility to fluconazole and amphotericin B. Diagn Microbiol Infect
6
Dis 2002; 44(1): 23-7. doi: 10.1016/s0732-8893(02)00419-4.
7
4. Dupont H, Bourichon A, Paugam-Burtz C, Mantz J, Desmonts JM. Can yeast isolation in peritoneal fluid be
8
predicted in intensive care unit patients with peritonitis?Crit Care Med 2003; 31(3): 752-7. doi: 10.1097/01.
9
ccm.0000053525.49267.77.
10
5. Montravers P, Dupont H, Eggimann P. Intra-abdominal candidiasis: the guidelines-forgotten non-candidemic
11
invasive candidiasis. Intensive Care Med 2013; 39(12): 2226-30. doi: 10.1007/s00134-013-3134-2.
12
6. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical practice guideline
13
for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis
14
2016; 62(4): e1-50. doi: 10.1093/cid/civ933.
15
7. Cornely OA, Bassetti M, Calandra T, Garbino J, Kullberg BJ, Lortholary O, et al. ESCMID* guideline for the
16
diagnosis and management of Candida diseases 2012: nonneutropenic adult patients. Clin Microbiol Infect 2012; 18
17
Suppl 7: 19-37. doi: 10.1111/1469-0691.12039.
18
8. Pramod J, Vijayakumar C, Srinivasan K, Maroju NK, Raj Kumar N, Balasubramaniyan G. Clinical significance of
19
Candida in an intraoperative peritoneal specimen with perforation peritonitis: an institutional perspective. Cureus
20
2018; 10(3): e2275. doi: 10.7759/cureus.2275.
21
9. Prakash A, Sharma D, Saxena A, Somashekar U, Khare N, Mishra A, et al. Effect of Candida infection on outcome in
22
patients with perforation peritonitis. Indian J Gastroenterol 2008; 27(3): 107-9.
23
10. Jindal N, Arora S, Pathania S. Fungal culture positivity in patients with perforation peritonitis. J Clin Diagn Res 2015;
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9(6): DC01-3. doi: 10.7860/jcdr/2015/13189.6050.
25
11. Zhan J, Shu G, Yuan L, Zhu J, Xie B. Clinical features of fungal peritonitis with Candida albicans infection after
26
gastric and duodenal perforation. Emerg Med (Los Angel) 2015; 5(4): 264. doi: 10.4172/2165-7548.1000264.
27
12. Knitsch W, Vincent JL, Utzolino S, François B, Dinya T, Dimopoulos G, et al. A randomized, placebo-controlled
28
trial of preemptive antifungal therapy for the prevention of invasive candidiasis following gastrointestinal surgery for
29
intra-abdominal infections. Clin Infect Dis 2015; 61(11): 1671-8. doi: 10.1093/cid/civ707.
30
13. Johnson DW, Cobb JP. Candida infection and colonization in critically ill surgical patients. Virulence 2010; 1(5): 355-6.doi: 10.4161/viru.1.5.13254.
31
14. Hsu FC, Lin PC, Chi CY, Ho MW, Ho CM, Wang JH. Prognostic factors for patients with culture-positive
32
Candida infection undergoing abdominal surgery. J Microbiol Immunol Infect 2009; 42(5): 378-84.
33
15. Dupont H, Guilbart M, Ntouba A, Perquin M, Petiot S, Regimbeau JM, et al. Can yeast isolation be predicted in
34
complicated secondary non-postoperative intra-abdominal infections? Crit Care 2015; 19(1): 60. doi: 10.1186/s13054-
35
015-0790-3.
36
16. Katlana A, Vyas AK, Jain R, Rathi A, Sharma NK, Yadav AK, et al. Incidence and significance of intra-operative peritoneal fluid fungal culture in patients of perforated peptic ulcers. J Med Sci Clin Res 2017; 5(3): 18987-91. doi:
37
10.18535/jmscr/v5i3.110.
38
17. Bassetti M, Merelli M, Ansaldi F, de Florentiis D, Sartor A, Scarparo C, et al. Clinical and therapeutic aspects of
39
candidemia: a five year single centre study. PLoS One 2015; 10(5): e0127534. doi: 10.1371/journal.pone.0127534.
40
18. Bassetti M, Righi E, Montravers P, Cornely OA. What has changed in the treatment of invasive candidiasis? a look at
41
the past 10 years and ahead. J Antimicrob Chemother 2018;73(Suppl 1): i14-i25. doi: 10.1093/jac/dkx445.
42
19. Vergidis P, Clancy CJ, Shields RK, Park SY, Wildfeuer BN, Simmons RL, et al. Intra-abdominal candidiasis:
43
the importance of early source control and antifungal treatment. PLoS One 2016; 11(4): e0153247. doi: 10.1371/
44
journal.pone.0153247.
45
20. Grim SA, Berger K, Teng C, Gupta S, Layden JE, Janda WM, et al. Timing of susceptibility-based antifungal drug
46
administration in patients with Candida bloodstream infection: correlation with outcomes. J Antimicrob Chemother 2012; 67(3): 707-14. doi: 10.1093/jac/dkr511.
47
21. Timsit JF, Azoulay E, Schwebel C, Charles PE, Cornet M, Souweine B, et al. Empirical micafungin treatment
48
and survival without invasive fungal infection in adults with ICU-acquired sepsis, Candida colonization, and
49
multiple organ failure: the EMPIRICUS randomized clinical trial. JAMA 2016; 316(15): 1555-64. doi: 10.1001/
50
jama.2016.14655
51
.22. Khoury W, Szold O, Soffer D, Kariv Y, Wasserlauf R, Klausner JM, et al. Prophylactic fluconazole does not
52
improve outcome in patients with purulent and fecal peritonitis due to lower gastrointestinal perforation. Am
53
Surg 2010; 76(2): 197-202.
54
23. Li WS, Lee CH, Liu JW. Antifungal therapy did not improve outcomes including 30-day all-cause mortality in patients suffering community-acquired perforated peptic ulcerassociated peritonitis with Candida species isolated from their peritoneal fluid. J Microbiol Immunol Infect 2017;50(3): 370-6. doi: 10.1016/j.jmii.2015.07.004.
55
24. Montravers P, Perrigault PF, Timsit JF, Mira JP, Lortholary O, Leroy O, et al. Antifungal therapy for patients with
56
proven or suspected Candida peritonitis: Amarcand2, a prospective cohort study in French intensive care units.
57
Clin Microbiol Infect 2017; 23(2): 117.e1-117.e8. doi:10.1016/j.cmi.2016.10.001.
58
ORIGINAL_ARTICLE
Urologic oncology during the COVID-19 pandemic
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.
http://www.jept.ir/article_91821_5194c3bb8c6b0d687e670bd3e220e939.pdf
2022-01-01
55
59
10.34172/jept.2021.31
Urology
Oncology
COVID-19
Pandemic
Manas
Sharma
drmanasmsharma@gmail.com
1
Department of Urology, JN Medical College, KLE Academy of Higher Education & Research, JNMC Campus, Belagavi-590010, Karnataka, India
AUTHOR
Rajendra B
Nerli
2
Department of Urology, JN Medical College, KLE Academy of Higher Education & Research, JNMC Campus, Belagavi-590010, Karnataka, India
LEAD_AUTHOR
Shridhar C
Ghagane
3
Urinary Biomarkers Research Centre, Department of Urology, KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital & Medical Research Centre, Nehru Nagar, Belagavi-590010, Karnataka, India
AUTHOR
Nouhaud FX, Bernhard JC, Bigot P, Khene ZE, Audenet F, Lang H, et al. Contemporary assessment of the correlation between Bosniak classification and histological characteristics of surgically removed atypical renal cysts (UroCCR-12 study). World J Urol 2018; 36(10): 1643-9. doi:10.1007/s00345-018-2307-6.
1
2. Mehrazin R, Smaldone MC, Kutikov A, Li T, Tomaszewski JJ, Canter DJ, et al. Growth kinetics and short-term outcomes of cT1b and cT2 renal masses under active surveillance. J Urol 2014; 192(3): 659-64. doi: 10.1016/j.juro.2014.03.038.
2
3. McIntosh AG, Ristau BT, Ruth K, Jennings R, Ross E, Smaldone MC, et al. Active surveillance for localized
3
renal masses: tumor growth, delayed intervention rates, and > 5-yr clinical outcomes. Eur Urol 2018; 74(2): 157-64.doi: 10.1016/j.eururo.2018.03.011.
4
4. Pierorazio PM, Johnson MH, Ball MW, Gorin MA, Trock BJ, Chang P, et al. Five-year analysis of a multi-institutional prospective clinical trial of delayed intervention and surveillance for small renal masses: the DISSRM
5
registry. Eur Urol 2015; 68(3): 408-15. doi: 10.1016/j.eururo.2015.02.001.
6
5. Nerli RB. Cytoreductive nephrectomy for metastatic renal cell carcinoma. J Sci Soc. 2013; 40(2): 64-7. doi: 10.4103/kleuhsj.kleuhsj_116_20.
7
6. Méjean A, Ravaud A, Thezenas S, Colas S, Beauval JB, Bensalah K, et al. Sunitinib alone or after nephrectomy in
8
metastatic renal-cell carcinoma. N Engl J Med 2018; 379(5): 417-27. doi: 10.1056/NEJMoa1803675.
9
7. Bex A, Mulders P, Jewett M, Wagstaff J, van Thienen JV, Blank CU, et al. Comparison of immediate vs deferred
10
cytoreductive nephrectomy in patients with synchronous metastatic renal cell carcinoma receiving sunitinib: the
11
SURTIME randomized clinical trial. JAMA Oncol 2019; 5(2): 164-70. doi: 10.1001/jamaoncol.2018.5543.
12
8. Barghi MR, Rahmani MR, Hosseini Moghaddam SM, Jahanbin M. Immediate intravesical instillation of mitomycin C after transurethral resection of bladder tumor in patients with low-risk superficial transitional cell
13
carcinoma of bladder. Urol J 2006; 3(4): 220-4.
14
9. Jones JS. Non-muscle-invasive bladder cancer (Ta, T1, and CIS). In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia: Elsevier;2016. p. 2214-15.
15
10. Little P. Non-steroidal anti-inflammatory drugs and COVID-19. BMJ 2020; 368: m1185. doi: 10.1136/bmj.m1185.
16
11. Boeri L, Soligo M, Frank I, Boorjian SA, Thompson RH, Tollefson M, et al. Delaying radical cystectomy after
17
neoadjuvant chemotherapy for muscle-invasive bladder cancer is associated with adverse survival outcomes.
18
Eur Urol Oncol 2019; 2(4): 390-6. doi: 10.1016/j.euo.2018.09.004.
19
12. Waldert M, Karakiewicz PI, Raman JD, Remzi M, Isbarn H, Lotan Y, et al. A delay in radical nephroureterectomy
20
can lead to upstaging. BJU Int 2010; 105(6): 812-7. doi:10.1111/j.1464-410X.2009.08821.x.
21
13. Pryor A. SAGES Recommendations Regarding Surgical Response to COVID-19 Crisis - SAGES [Internet]. Society of American Gastrointestinal and Endoscopic Surgeons.2020 [cited 24 Apr 2020]. Available from: https://www.sages.org/recommendationssurgical-response-covid-19/.
22
14. Updated Intercollegiate General Surgery Guidance on COVID-19 [Internet]. Royal College of Surgeons. 2020
23
[cited 24 Apr 2020]. Available from: https://www.rcseng.ac.uk/coronavirus/joint-guidance-for-surgeons-v2/.
24
15. Spinelli A, Pellino G. COVID-19 pandemic: perspectives on an unfolding crisis. Br J Surg 2020; 107(7): 785-7. doi:10.1002/bjs.11627.
25
16. Fossati N, Rossi MS, Cucchiara V, Gandaglia G, Dell’Oglio P, Moschini M, et al. Evaluating the effect of time from prostate cancer diagnosis to radical prostatectomy on cancer control: can surgery be postponed safely? Urol Oncol 2017;35(4): 150.e9-150.e15. doi: 10.1016/j.urolonc.2016.11.010.
26
17. Loeb S, Folkvaljon Y, Robinson D, Makarov DV, Bratt O, Garmo H, et al. Immediate versus delayed prostatectomy: nationwide population-based study. Scand J Urol 2016; 50(4): 246-54. doi:10.3109/21681805.2016.1166153.
27
18. Shabbir M, Kayes O, Minhas S. Challenges and controversies in the management of penile cancer. Nat Rev Urol 2014;11(12): 702-11. doi: 10.1038/nrurol.2014.307.
28
19. Chipollini J, Tang DH, Gilbert SM, Poch MA, Pow-Sang JM, Sexton WJ, et al. Delay to inguinal lymph node dissection greater than 3 months predicts poorer recurrence-free survival for patients with penile cancer. J Urol 2017; 198(6):1346-52. doi: 10.1016/j.juro.2017.06.076.
29
20. Ficarra V, Akduman B, Bouchot O, Palou J, Tobias-Machado M. Prognostic factors in penile cancer. Urology 2010; 76(2Suppl 1): S66-73. doi: 10.1016/j.urology.2010.04.008.
30
21. Leone A, Diorio GJ, Pettaway C, Master V, Spiess PE. Contemporary management of patients with penile cancer and lymph node metastasis. Nat Rev Urol 2017; 14(6): 335-47. doi: 10.1038/nrurol.2017.47.
31
22. Bourgade V, Drouin SJ, Yates DR, Parra J, Bitker MO, Cussenot O, et al. Impact of the length of time between
32
diagnosis and surgical removal of urologic neoplasms on survival. World J Urol 2014; 32(2): 475-9. doi: 10.1007/
33
s00345-013-1045-z.
34
ORIGINAL_ARTICLE
The proposed scoring system for hospitalization or discharge of patients with COVID-19
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.
http://www.jept.ir/article_91557_04e17c43d7c2694d39fb9924051f239f.pdf
2022-01-01
60
63
10.34172/jept.2021.08
COVID-19
Scoring system
Hospitalization
Discharge
triage
Enayatollah
Noori
enayatnoori68@gmail.com
1
General Practitioner, Qom University of Medical Sciences, Qom, Iran
LEAD_AUTHOR
Mostafa
Vahedian
vahedian58@gmail.com
2
Department of Family and Community Medicine, School of Medicine, Qom University of Medical Sciences, Qom, Iran
AUTHOR
Sajjad
Rezvan
3
Rafsanjan University of Medical Sciences, Rafsanjan, Iran
AUTHOR
Neda
Minaei
enoori@muq.ac.ir
4
Medical Research Committee, Qom University of Medical Sciences, Qom, Iran
AUTHOR
Reihane
Tabaraii
5
Department of Internal Medicine, School of Medicine, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
AUTHOR
Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China,
1
2019. N Engl J Med. 2020; 382(8): 727-33. doi: 10.1056/NEJMoa2001017.
2
2. Salunke AA, Nandy K, Pathak SK, Shah J, Kamani M, Kotakotta V, et al. Impact of COVID-19 in cancer patients
3
on severity of disease and fatal outcomes: a systematic review and meta-analysis. Diabetes Metab Syndr. 2020;
4
14(5): 1431-7. doi: 10.1016/j.dsx.2020.07.037.
5
3. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of 2019 novel coronavirus infection
6
in China. MedRxiv. 2020. doi: 10.1101/2020.02.06.20020974.
7
4. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA.2020; 323(11): 1061-1069. doi: 10.1001/jama.2020.1585.
8
5. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of
9
2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020; 395(10223): 507-13. doi:
10
10.1016/S0140-6736(20)30211-7.
11
6. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223): 497-506. doi:10.1016/S0140-6736(20)30183-5.
12
7. CDC. Interim infection prevention and control recommendations for hospitalized patients with Middle
13
East respiratory syndrome coronavirus (MERS-CoV). Availeble from: https://www.cdc.gov/coronavirus/mers/
14
infection-prevention-control.html. [cited 2015 Jul 20]. 2017.
15
8. Memberships M, Join T. Guidance on Coronavirus Disease 2019 (COVID-19) for Transplant Clinicians. Availeble
16
from: https://tts.org/23-tid/tid-news/657-tid-update-andguidance- on-2019-novel-coronavirus-2019-ncovfortransplant-id-clinicians. Updated 8 June 2020.
17
9. Salunke AA, Pathak SK, Dhanwate A, Warikoo V, Nandy K, Mendhe H, et al. A proposed ABCD scoring system
18
for patient’s self assessment and at emergency department with symptoms of COVID-19. Diabetes Metab Syndr. 2020; 14(5): 1495-501. doi: 10.1016/j.dsx.2020.07.053.
19
10. Shi Y, Yu X, Zhao H, Wang H, Zhao R, Sheng J. Host susceptibility to severe COVID-19 and establishment of a
20
host risk score: findings of 487 cases outside Wuhan. Crit Care. 2020;24(1):108. doi: 10.1186/s13054-020-2833-7.
21
11. Duca A, Piva S, Focà E, Latronico N, Rizzi M. Calculated decisions: Brescia-COVID Respiratory Severity Scale
22
(BCRSS)/algorithm. Emerg Med Pract. 2020; 22(5 Suppl):CD1-2.
23
12. Ji D, Zhang D, Xu J, Chen Z, Yang T, Zhao P, et al. Prediction for progression risk in patients with COVID-19 pneumonia: the CALL Score. Clin Infect Dis. 2020; 71(6): 1393-9. doi:10.1093/cid/ciaa414.
24
13. Wallis LA. COVID-19 Severity Scoring Tool for low resourced settings. Afr J Emerg Med. 2020. doi: 10.1016/j.afjem.2020.03.002.
25
14. Hu H, Yao N, Qiu Y. Comparing rapid scoring systems in mortality prediction of Critically Ill patients with novel
26
coronavirus disease. Acad Emerg Med. 2020; 27(6): 461-8. doi: 10.1111/acem.13992.
27
ORIGINAL_ARTICLE
Pseudo-SAH in a patient with methanol poisoning
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.
http://www.jept.ir/article_91602_6dc58e240cedeeb0ed5fbc85c68fd743.pdf
2022-01-01
64
65
10.34172/jept.2021.05
Methanol
Brain edema
Pseudo-subarachnoid hemorrhage
COVID-19
Toxicity
Elham
Pishbin
1
Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Hamidreza
Reihani
2
Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Bahram
Zarmehri
zarmehrib@mums.ac.ir
3
Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Mahdi
Foroughian
foroughianmh@mums.ac.ir
4
Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
1. Iranpour P, Firoozi H, Haseli S. Methanol poisoning emerging as the result of COVID-19 outbreak; radiologic perspective. Acad Radiol 2020; 27(5): 755-6. doi: 10.1016/j.acra.2020.03.029.
1
2. Soltaninejad K. Methanol mass poisoning outbreak: a consequence of COVID-19 pandemic and misleading messages on social media. Int J Occup Environ Med 2020;11(3): 148-50. doi:10.34172/ijoem.2020.1983.
2
3. Spiegel SM, Fox AJ, Vinuela F, Pelz DM. Increased density of tentorium and falx: a false positive CT sign of subarachnoid hemorrhage. Can Assoc Radiol J 1986; 37(4): 243-7.
3
4. Lin CY, Lai PH, Fu JH, Wang PC, Pan HB. Pseudosubarachnoid hemorrhage: a potential imaging pitfall.
4
Can Assoc Radiol J 2014; 65(3): 225-31. doi: 10.1016/j.carj.2013.07.003.
5
5. Md Noh MSF, Abdul Rashid AM. Development of pseudo-subarachnoid hemorrhage secondary to hypoxicischemic injury due to bleeding pulmonary arterio-venous malformation. BMC Neurol 2018; 18(1): 157. doi: 10.1186/s12883-018-1161-x.
6
6. Patzig M, Laub C, Janssen H, Ertl L, Fesl G. Pseudosubarachnoid haemorrhage due to chronic hypoxaemia: case report and review of the literature. BMC Neurol 2014; 14: 219. doi: 10.1186/s12883-014-0219-7.
7
7. Yuzawa H, Higano S, Mugikura S, Umetsu A, Murata T, Nakagawa A, et al. Pseudo-subarachnoid hemorrhage found in patients with postresuscitation encephalopathy: characteristics of CT findings and clinical importance. AJNR Am J Neuroradiol 2008; 29(8): 1544-9. doi: 10.3174/ajnr.A1167.
8
8. Ramanathan RS. Pseudo-subarachnoid hemorrhage sign. Ann Indian Acad Neurol 2018; 21(1): 83-4. doi: 10.4103/aian.AIAN_152_17.
9
ORIGINAL_ARTICLE
An unusual case of both bones forearm shaft fracture with ipsilateral distal radio-ulnar joint disruption
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.
http://www.jept.ir/article_91797_76f2a04b16d10eee84de6d2f68d73683.pdf
2022-01-01
66
68
10.34172/jept.2021.12
Distal Radioulnar Joint
Forearm Fracture
Ipsilateral
Case report
Atul Rai
Sharma
1
Department of Orthopaedics, Government Medical College Hospital, Sector 32, Chandigarh, 160030, India
AUTHOR
Akash
Singhal
akash15636@ymail.com
2
Department of Orthopaedics, Government Medical College Hospital, Sector 32, Chandigarh, 160030, India
LEAD_AUTHOR
Anurag
Patil
patilanum7@gmail.com
3
Department of Orthopaedics, Government Medical College Hospital, Sector 32, Chandigarh, 160030, India
AUTHOR
Gladson
David Masih
4
Department of Orthopaedics, Government Medical College Hospital, Sector 32, Chandigarh, 160030, India
AUTHOR
1. Kim SB, Heo YM, Yi JW, Lee JB, Lim BG. Shaft fractures of both forearm bones: the outcomes of surgical treatment
1
with plating only and combined plating and intramedullary nailing. Clin Orthop Surg 2015; 7(3): 282-90. doi: 10.4055/
2
cios.2015.7.3.282.
3
2. Dumont CE, Thalmann R, Macy JC. The effect of rotational malunion of the radius and the ulna on supination and
4
pronation. J Bone Joint Surg Br 2002; 84(7): 1070-4. doi: 10.1302/0301-620x.84b7.12593.
5
3. Matthews LS, Kaufer H, Garver DF, Sonstegard DA. The effect on supination-pronation of angular malalignment of
6
fractures of both bones of the forearm. J Bone Joint Surg Am 1982; 64(1): 14-7.
7
4. Mirghasemi AR, Lee DJ, Rahimi N, Rashidinia S, Elfar JC. Distal radioulnar joint instability. Geriatr Orthop Surg
8
Rehabil 2015; 6(3): 225-9. doi: 10.1177/2151458515584050.
9
5. Streubel PN, Pesántez RF. Diaphyseal fractures of the radius and ulna. In: Rockwood, Green, and Wilkins Fractures in
10
Adults and Children. 8th ed. Wolters Kluwer Health Adis (ESP); 2014.
11
6. Rodriguez-Martin J, Pretell-Mazzini J. The role of ultrasound and magnetic resonance imaging in the
12
evaluation of the forearm interosseous membrane. A review. Skeletal Radiol 2011; 40(12): 1515-22. doi: 10.1007/
13
s00256-011-1190-7.
14
7. Henry AK. Complete Exposure of the Radius. Bristol, England: John Wright & Sons Ltd; 1927.
15
8. Catalano LW 3rd, Zlotolow DA, Hitchcock PB, Shah SN, Barron OA. Surgical exposures of the radius and
16
ulna. J Am Acad Orthop Surg 2011; 19(7): 430-8. doi:10.5435/00124635-201107000-00006.
17
9. Gummesson C, Atroshi I, Ekdahl C. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire:
18
longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord
19
2003; 4: 11. doi: 10.1186/1471-2474-4-11.
20
10. Kose O, Durakbasa MO, Islam NC. Posterolateral elbow dislocation with ipsilateral radial and ulnar diaphyseal
21
fractures: a case report. J Orthop Surg (Hong Kong) 2008; 16(1): 122-3. doi: 10.1177/230949900801600129.
22
11. Fleming FJ, Flavin R, Poynton AR, Glynn T. Elbow dislocation with ipsilateral open radial and ulnar diaphyseal
23
fractures--a rare combination. Injury 2004; 35(1): 90-2. doi: 10.1016/s0020-1383(02)00143-2.
24
12. Wijffels M, Brink P, Schipper I. Clinical and non-clinical aspects of distal radioulnar joint instability. Open Orthop J
25
2012; 6: 204-10. doi: 10.2174/1874325001206010204.
26
13. Dukan R, Kassab Hassan S, Delvaque JG, Khaled I, Nizard R. Isolated volar dislocation of the distal radioulnar joint:
27
a case report. J Orthop Case Rep 2020; 10(2): 97-100. doi:10.13107/jocr.2020.v10.i02.1716
28
ORIGINAL_ARTICLE
When numbers can be misleading: lithium induced irreversible neurotoxicity at therapeutic drug levels
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.
http://www.jept.ir/article_91801_1b137bdb5cb303dadaafd1578d031d56.pdf
2022-01-01
69
73
10.34172/jept.2021.36
elderly
Toxicity
Lithium
Peripheral neuropathy
Jyoti
Aggarwal
aggarwalsja.1990@gmail.com
1
Department of General Medicine, Government Medical College and Hospital, Sector 32, Chandigarh, India
AUTHOR
Zainab
Mehdi
ir.zainab@gmail.com
2
Department of General Medicine, Government Medical College and Hospital, Sector 32, Chandigarh, India
AUTHOR
Baldeep
Kaur
dr.baldeep.brar@gmail.com
3
Department of General Medicine, Government Medical College and Hospital, Sector 32, Chandigarh, India
LEAD_AUTHOR
Yuvraj
Singh Cheema
4
Department of General Medicine, Government Medical College and Hospital, Sector 32, Chandigarh, India
AUTHOR
Monica
Gupta
monicamanish2001@gmail.com
5
Department of General Medicine, Government Medical College and Hospital, Sector 32, Chandigarh, India
AUTHOR
1. Machado-Vieira R, Manji HK, Zarate CA Jr. The role of lithium in the treatment of bipolar disorder: convergent
1
evidence for neurotrophic effects as a unifying hypothesis. Bipolar Disord 2009; 11 Suppl 2: 92-109. doi: 10.1111/j.1399-5618.2009.00714.x.
2
2. Arancibia A, Corvalan F, Mella F, Concha L. Absorption and disposition kinetics of lithium carbonate following
3
administration of conventional and controlled release formulations. Int J Clin Pharmacol Ther Toxicol 1986;24(5): 240-5.
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3. Cameron P, Little M, Mitra B, Deasy C. Textbook of Adult Emergency Medicine. 5th ed. Edinburgh: Churchill Livingstone; 2000. p. 753-5.
5
4. Ivkovic A, Stern TA. Lithium-induced neurotoxicity: clinical presentations, pathophysiology, and treatment.
6
Psychosomatics 2014; 55(3): 296-302. doi: 10.1016/j.psym.2013.11.007.
7
5. Haussmann R, Bauer M, von Bonin S, Grof P, Lewitzka U. Treatment of lithium intoxication: facing the need for
8
evidence. Int J Bipolar Disord 2015; 3(1): 23. doi: 10.1186/s40345-015-0040-2.
9
6. Baird-Gunning J, Lea-Henry T, Hoegberg LCG, Gosselin S, Roberts DM. Lithium poisoning. J Intensive Care Med
10
2017; 32(4): 249-63. doi: 10.1177/0885066616651582.
11
7. Mégarbane B, Hanak AS, Chevillard L. Lithium-related neurotoxicity despite serum concentrations in the
12
therapeutic range: risk factors and diagnosis. Shanghai Arch Psychiatry 2014; 26(4): 243-4. doi: 10.3969/j.issn.1002-
13
0829.2014.04.009.
14
8. Foulser P, Abbasi Y, Mathilakath A, Nilforooshan R. Do not treat the numbers: lithium toxicity. BMJ Case Rep 2017;
15
2017. doi: 10.1136/bcr-2017-220079.
16
9. Peng J. Case report on lithium intoxication with normal lithium levels. Shanghai Arch Psychiatry 2014; 26(2): 103-
17
4. doi: 10.3969/j.issn.1002-0829.2014.02.008.
18
10. Strayhorn JM Jr, Nash JL. Severe neurotoxicity despite “therapeutic” serum lithium levels. Dis Nerv Syst 1977;
19
38(2): 107-11.
20
11. Nguyen L. Lithium II: irreversible neurotoxicity after lithium intoxication. J Emerg Nurs 2008; 34(4): 378-9. doi:
21
10.1016/j.jen.2008.04.026.
22
12. Adityanjee, Munshi KR, Thampy A. The syndrome of irreversible lithium-effectuated neurotoxicity. Clin
23
Neuropharmacol 2005; 28(1): 38-49. doi: 10.1097/01.wnf.0000150871.52253.b7.
24
13. Schou M. Long-lasting neurological sequelae after lithium intoxication. Acta Psychiatr Scand 1984; 70(6): 594-602.
25
doi: 10.1111/j.1600-0447.1984.tb01254.x.
26
14. Decker BS, Goldfarb DS, Dargan PI, Friesen M, Gosselin S, Hoffman RS, et al. Extracorporeal treatment for lithium
27
poisoning: systematic review and recommendations from the EXTRIP workgroup. Clin J Am Soc Nephrol 2015;
28
10(5): 875-87. doi: 10.2215/cjn.10021014.
29
15. Ristic DI, Siapera MS, Jovic J, Marjanovic VS, Radovanovic M, Fountoulakis KN. Unrecognized acute lithium toxicity: a case report. Cent Eur J Med 2012; 7(6): 700-3. doi: 10.2478/s11536-012-0058-0.
30
16. Olfson M. Surveillance of adverse psychiatric medication events. JAMA 2015; 313(12): 1256-7. doi: 10.1001/
31
jama.2014.1574
32
ORIGINAL_ARTICLE
An acute ST-elevation myocardial infarction which went viral
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.
http://www.jept.ir/article_91802_c155fc1ce96e231c4fb4eaa04d09495f.pdf
2022-01-01
74
76
10.34172/jept.2021.27
Myocarditis
ST Elevation Myocardial Infarction
Viral infections
Chui King
Wong
1
Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, 56000 Kuala Lumpur, Malaysia
LEAD_AUTHOR
Glen Chiang
Hong Tan
2
Department of Emergency Medicine, Hospital Tengku Ampuan Rahimah, Jalan Langat, 41200 Klang, Selangor Darul Ehsan, Malaysia
AUTHOR
Mohd Johar
Jaafar
3
1Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, 56000 Kuala Lumpur, Malaysia
AUTHOR
1. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli- Ducci C, Bueno H, et al. 2017 ESC Guidelines for the
1
management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for
2
the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European
3
Society of Cardiology (ESC). Eur Heart J 2018; 39(2): 119-77. doi: 10.1093/eurheartj/ehx393.
4
2. Vos T, Barber RM, Bell B, Bertozzi-Villa A, Biryukov S, Bolliger I, et al. Global, regional, and national incidence,
5
prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; 386(9995): 743-800. doi: 10.1016/s0140-6736(15)60692-4.
6
3. Li YD, Hsiao FT, Lai CP, Chen CW. Acute viral myocarditis mimicking ST elevation myocardial infarction:
7
manifestation on cardiac magnetic resonance. Acta Cardiol Sin 2010; 26: 44-7.
8
4. Zhang T, Miao W, Wang S, Wei M, Su G, Li Z. Acute myocarditis mimicking ST-elevation myocardial infarction:
9
a case report and review of the literature. Exp Ther Med 2015; 10(2): 459-64. doi: 10.3892/etm.2015.2576.
10
5. Van Linthout S, Tschöpe C. Viral myocarditis: a prime example for endomyocardial biopsy-guided diagnosis
11
and therapy. Curr Opin Cardiol 2018; 33(3): 325-33. doi: 10.1097/hco.0000000000000515.
12
6. Ang KP, Quek ZQ, Lee CY, Lu HT. Acute myocarditis mimicking ST-elevation myocardial infarction: a diagnostic
13
challenge for frontline clinicians. Med J Malaysia 2019; 74(6): 561-3.
14
ORIGINAL_ARTICLE
Base of skull fracture leading to pneumomediastinum and pneumo-retroperitoneum: a case report with review of literature
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.
http://www.jept.ir/article_91803_fd1f1faae8b1328a17987f4fbdc760ba.pdf
2022-01-01
77
79
10.34172/jept.2021.25
Trauma
Pneumomediastinum
Pneumo-retroperitoneum
Garima
Sharma
garimasharmavns@gmail.com
1
Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, India
LEAD_AUTHOR
Sanya
Vermani
drsanyavermani@gmail.com
2
Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, India
AUTHOR
Anjum
Syed
anjumsyed27@gmail.com
3
Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, India
AUTHOR
1. Frias Vilaça A, Reis AM, Vidal IM. The anatomical compartments and their connections as demonstrated
1
by ectopic air. Insights Imaging 2013; 4(6): 759-72. doi:10.1007/s13244-013-0278-0.
2
2. Maunder RJ, Pierson DJ, Hudson LD. Subcutaneous and mediastinal emphysema. Pathophysiology, diagnosis, and
3
management. Arch Intern Med 1984; 144(7): 1447-53.
4
3. Roncati L, Pusiol T, Scialpi M. The endothoracic fascia: an anatomic site in which primary liposarcoma may arise.
5
Lung 2015; 193(6): 1055-6. doi: 10.1007/s00408-015-9798-3.
6
4. Kleinman PK, Brill PW, Whalen JP. Anterior pathway for transdiaphragmatic extension of pneumomediastinum.
7
AJR Am J Roentgenol 1978; 131(2): 271-5. doi: 10.2214/ajr.131.2.271.
8
5. Lidid L, Valenzuela J, Villarroel C, Alegria J. Crossing the barrier: when the diaphragm is not a limit. AJR Am J
9
Roentgenol 2013; 200(1): W62-70. doi: 10.2214/ajr.11.8264.
10
6. Allard E, Selim J, Veber B. Pneumocephalus and pneumorachis after blunt chest trauma without spinal
11
fractures: a case report. J Med Case Rep 2019; 13(1): 317.doi: 10.1186/s13256-019-2208-3.
12
7. Anbarasu A, Khajanchi M. Pneumocephalus following thoracic trauma: a rare entity along the carotid sheath. ANZ
13
J Surg 2018; 88(4): 382-3. doi: 10.1111/ans.13388.
14
ORIGINAL_ARTICLE
Pneumoperitoneum due to pneumothorax in blunt thoracoabdominal trauma: A diagnostic challenge
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.
http://www.jept.ir/article_91819_2c01206bfe050040fb6e561050aacd40.pdf
2022-01-01
80
82
10.34172/jept.2021.30
Blunt Injuries
Traumatic Diaphragmatic Hernia
Emergency care
Pneumoperitoneum
Luis Miguel
Castro
1
General Surgery Department, Hospital de Egas Moniz, Lisbon Portugal
LEAD_AUTHOR
Rui Manuel
Mendes
2
General Surgery Department, Hospital de Egas Moniz, Lisbon Portugal
AUTHOR
Coelho Fátima
Borges
3
General Surgery Department, Hospital de Egas Moniz, Lisbon Portugal
AUTHOR
Capella
Vanessa
4
General Surgery Department, Hospital de Egas Moniz, Lisbon Portugal
AUTHOR
Ávila
Leonor
5
General Surgery Department, Hospital de Egas Moniz, Lisbon Portugal
AUTHOR
1. American College of Surgeons Committee on Trauma. ATLS: Advanced Trauma Life Support Student Course
1
Manual. 10th ed. Chicago: American College of Surgeons; 2018. p. 82-99.
2
2. Di Saverio S, Filicori F, Kawamukai K, Boaron M, Tugnoli G. Combined pneumothorax and pneumoperitoneum
3
following blunt trauma: an insidious diagnostic and therapeutic dilemma. Postgrad Med J 2011; 87(1023): 75-8.
4
doi: 10.1136/pgmj.2010.110262.
5
3. Allan Z, Peng C, Chandra R. Traumatic diaphragmatic rupture with underlying lung laceration and tension
6
pneumoperitoneum. J Surg Case Rep 2017; 2017(6): rjx120. doi: 10.1093/jscr/rjx120.
7
4. Marek AP, Deisler RF, Sutherland JB, Punjabi G, Portillo A, Krook J, et al. CT scan-detected pneumoperitoneum:
8
an unreliable predictor of intra-abdominal injury in blunt trauma. Injury 2014; 45(1): 116-21. doi: 10.1016/j.injury.2013.08.017.
9
5. Grosfeld JL, Boger D, Clatworthy HW Jr. Hemodynamic and manometric observations in experimental airblock
10
syndrome. J Pediatr Surg 1971; 6(3): 339-44. doi: 10.1016/0022-3468(71)90476-3.
11
6. Williams NM, Watkin DF. Spontaneous pneumoperitoneum and other nonsurgical causes of intraperitoneal free
12
gas. Postgrad Med J 1997; 73(863): 531-7. doi: 10.1136/pgmj.73.863.531.
13
7. Ahmad R, Mohamad N, Latiff AK, Ahmad Z, Idrus II. Pneumoperitoneum following blunt abdominal injury:
14
does it warrant laparotomy. Int J Case Rep Imag 2011; 2(12): 23-7. doi: 10.5348/ijcri-2011-12-76-CR-6.
15
8. Filosso PL, Guerrera F, Sandri A, Lausi PO, Lyberis P, Bora G, et al. Surgical management of chronic diaphragmatic
16
hernias. J Thorac Dis 2019; 11(Suppl 2): S177-S85. doi: 10.21037/jtd.2019.01.54.
17
ORIGINAL_ARTICLE
Compsobuthus matthiesseni sting from Bazoft: A case report
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.
http://www.jept.ir/article_91839_3f86c18510342da7c9359bb0f7e94baa.pdf
2022-01-01
83
85
10.34172/jept.2021.37
Scorpion sting
Compsobuthus matthiesseni
Buthidae
Bazoft
Iran
Rouhullah
Dehghani
1
Social Determinants of Health (SDH) Research Center and Department of Environment Health, Kashan University of Medical Sciences, Kashan, Iran
AUTHOR
Kobra
Taji
digifars@yahoo.com
2
Social Determinants of Health (SDH) Research Center and Department of Environment Health, Kashan University of Medical Sciences, Kashan, Iran
AUTHOR
Amrollah
Mahmoudi
digifars1@yahoo.com
3
Social Determinants of Health (SDH) Research Center and Department of Environment Health, Kashan University of Medical Sciences, Kashan, Iran
AUTHOR
Masoomeh
Varzandeh
4
Department of Clinical toxicology and Poisoning, Afzalipour hospital, Kerman University of Medical Sciences, Kerman, Iran
LEAD_AUTHOR
1-Kassiri H, Kassiri A, Kasiri E, Safarpor S, Lotfi M. A hospital-based study on scorpionism in Khorram-Shahr
1
county, southwestern Iran. Asian J Epidemiol 2014; 7(2): 28-35. doi: 10.3923/aje.2014.28.35.
2
2. Nazari M, Hajizadeh MA. A faunistic study on scorpions and the epidemiology of scorpionism in Bam, southeast
3
of Iran. Glob J Health Sci 2017; 9(2): 177-83. doi: 10.5539gjhs.v9n2p177.
4
3. Kassiri H, Kassiri A, Sharififard M, Shojaee S, Lotfi M, Kasiri E. Scorpion envenomation study in Behbahan
5
county, southwest Iran. J Coast Life Med 2014; 2(5): 416-20. doi: 10.12980/jclm.2.201414j24.
6
4. Nejati J, Mozafari E, Saghafipour A, Kiyani M. Scorpion fauna and epidemiological aspects of scorpionism in
7
southeastern Iran. Asian Pac J Trop Biomed 2014; 4(Suppl1): S217-21. doi: 10.12980/apjtb.4.2014c1323.
8
5. Dehghani R, Kamiabi F, Mohammadi M. Scorpionism by Hemiscorpius spp. in Iran: a review. J Venom Anim Toxins
9
Incl Trop Dis 2018; 24: 8. doi: 10.1186/s40409-018-0145-z.
10
6. Barahoei H, Navidpour S, Aliabadian M, Siahsarvie R, Mirshamsi O. Scorpions of Iran (Arachnida: Scorpiones):
11
annotated checklist, DELTA database and identification key. Journal of Insect Biodiversity and Systematics 2020;
12
6(4): 375-474.
13
7. Shahi M, Sanaei-Zadeh H. Clinical manifestations of Compsobuthus persicus scorpion envenomation in southern
14
Iran. Iran J Toxicol 2020; 14(3): 171-8. doi: 10.32598/ijt.14.3.415.2.
15
8. Dehghani R, Dinparast N, Shahbazzadeh D, Bigdelli S. Introducing Compsobuthus matthiesseni (Birula, 1905)
16
scorpion as one of the major stinging scorpions in Khuzestan, Iran. Toxicon 2009; 54(3): 272-5. doi: 10.1016/j.
17
toxicon.2009.04.011.
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9. Farzanpey R. Scorpion Recognition. Tehran, Iran: Publications of University Press Center; 1987. p. 231.[Persian].
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10. Farzanpey R. Scorpion sting and the fallowing of it. Pajouhesh va Sazandegi 1994; 25(3): 123-5. [Persian].
20
11. Mohammadi Bavani M, Rafinejad J, Hanafi-Bojd AA, Oshaghi MA, Navidpour S, Dabiri F, et al. Spatial
21
distribution of medically important scorpions in north west of Iran. J Arthropod Borne Dis 2017; 11(3): 371-82.
22
12. Jalali A, Rahim F. Epidemiological review of scorpion envenomation in iran. Iran J Pharm Res 2014; 13(3): 743-56.
23
13. Radmanesh M. Clinical study of Hemiscorpius lepturus in Iran. J Trop Med Hyg 1990; 93(5): 327-32.
24