Case Report
Emergency medicine
Jessica Ann Nathan; Valerie Chew Sze Yen; Nur Fazlin Ab Manan
Articles in Press, Corrected Proof, Available Online from 14 February 2023
Abstract
Objective: Spontaneous uterine artery rupture in a non-pregnant woman is an extremelyuncommon event. To date, there have only been a few cases. Patients often present withacute abdomen and are hemodynamically unstable.Case Presentation: A 42-year-old female presented with multiple episodes of syncopalattack ...
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Objective: Spontaneous uterine artery rupture in a non-pregnant woman is an extremelyuncommon event. To date, there have only been a few cases. Patients often present withacute abdomen and are hemodynamically unstable.Case Presentation: A 42-year-old female presented with multiple episodes of syncopalattack associated with vomiting and generalized abdominal pain. Upon arrival, she washypotensive which required aggressive fluid resuscitation with crystalloids and bloodproducts. Urine pregnancy test was negative. In addition, ultrasound scan showedfree fluid in the abdomen mainly at the splenorenal area and organized clots aroundthe uterus. Computed tomography of the Abdomen revealed a moderate amount ofhemoperitoneum with hypodense clots at the left para-colic gutter and pelvis. Sheunderwent an exploratory laparotomy and intraoperatively noted bleeding from leftuterine artery with 1.2 L of hemoperitoneum with no other abnormalities detected.Intraoperatively, there was an estimated 5 L blood loss which required packed cell anddisseminated intravascular coagulation transfusion. Subsequently, the patient was sent tointensive care unit where she recovered well and was discharged home 5 days later.Conclusion: Spontaneous uterine artery rupture is an extremely rare occurrence with highmortality if there is failure to detect and intervene early
Case Report
Emergency medicine
Mamatha Nanjappa Siddalingappa; Anjan Kumar Shah; Susheen Dutt; Narahari Ranganath
Articles in Press, Corrected Proof, Available Online from 19 February 2023
Abstract
Objective: Penetrating injuries in the maxillofacial region pose a great challenge due tothe anatomical complexity inherent to the area compounded with vital functions suchas vision and airway. This paper highlights the importance of meticulous preoperativeplanning and a concerted effort of a multidisciplinary ...
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Objective: Penetrating injuries in the maxillofacial region pose a great challenge due tothe anatomical complexity inherent to the area compounded with vital functions suchas vision and airway. This paper highlights the importance of meticulous preoperativeplanning and a concerted effort of a multidisciplinary team in managing penetratingmaxillofacial injuries.Case Presentation: A 38-year -old man reported to the emergency department with aknife impacted in the medial wall of the orbit, travelling up to the base of the cranium. ACT scan aided in evaluating the site, depth, and relation of the foreign body to the adjacentstructures. A team of oral and maxillofacial surgeons, ENT and neurosurgeon successfullyretrieved the knife and the patient recovered with no morbidities.Conclusions: Penetrating injuries in the maxillofacial region are rare and there is a dearthof documentation in literature. A quick response with proper preoperative planning and ateam approach is paramount in the successful management of these patients.
Letter to Editor
Surgery
Mirko Barone; Massimo Ippoliti; Felice Mucilli
Articles in Press, Accepted Manuscript, Available Online from 13 April 2024
Abstract
Intra-abdominal infections still represent a challengefor surgeons. The systemic physiopathological effects ofinfection rapidly progress, leading to sepsis and multiorganfailure, whose prognosis is often dramatic. Mortality riskstratification using scoring systems would unequivocallyaid the early identification ...
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Intra-abdominal infections still represent a challengefor surgeons. The systemic physiopathological effects ofinfection rapidly progress, leading to sepsis and multiorganfailure, whose prognosis is often dramatic. Mortality riskstratification using scoring systems would unequivocallyaid the early identification of patients at risk of diseaseprogression.
Case Report
Cardiology
asghar mohamadi; Maryam Aliramezany; nazanin davari; elham sepahvand
Articles in Press, Accepted Manuscript, Available Online from 13 April 2024
Abstract
Objective: Dyspnea is a common symptom of heart disease that can also be related to otherdisorders, such as liver disease. In this case report, we aim to describe a rare case of metastatic livermass that presented with heart failure.Case Presentation: A 50-year-old woman without a past medical history ...
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Objective: Dyspnea is a common symptom of heart disease that can also be related to otherdisorders, such as liver disease. In this case report, we aim to describe a rare case of metastatic livermass that presented with heart failure.Case Presentation: A 50-year-old woman without a past medical history arrived at our hospitalwith a history of dyspnea and swelling in the lower extremities. She did not complain of pain,arthralgia, trauma, or chest pain but complained of exertional dyspnea and fatigue that had startedone month before and had aggravated two days before. Her laboratory test indicated anemia. Inechocardiography, we saw mild right ventricle enlargement and dysfunction, but the left heart wasnormal with acceptable systolic and diastolic function. In the subcostal view, the inferior vena cava(IVC) was dilated but under compression of a large liver mass. According to our literature review, thisis the first case in which a metastatic liver mass had presented with heart failure.Conclusion: In patients presenting with dyspnea, despite normal echocardiographic findings, theexact evaluation of the IVC should be considered.
Original Article
Critical Care
Mahshid Dehghan; Moloud Balafar; Mahboub Pouraghaei; Mahnaz Ranjkesh; Ali Delkhorrami; Samad Shams Vahdati
Articles in Press, Accepted Manuscript, Available Online from 13 April 2024
Abstract
Objective: According to the most recent guidelines, the recommended imaging approaches forthe diagnosis of pneumonia are chest X-ray (CXR) and computed tomography (CT) scan. However,there are limitations to these approaches. Lung ultrasound (LUS) has attracted a lot of attentionin intensive care units ...
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Objective: According to the most recent guidelines, the recommended imaging approaches forthe diagnosis of pneumonia are chest X-ray (CXR) and computed tomography (CT) scan. However,there are limitations to these approaches. Lung ultrasound (LUS) has attracted a lot of attentionin intensive care units (ICUs) and emergency departments. Considering the importance of thetimely diagnosis and proper treatment of pneumonia, this study aimed to determine the diagnosticvalue of bedside LUS in comparison to chest CT scans in patients with suspected pneumonia orunspecified CXR findings in the emergency department.Methods: This prospective descriptive-analytic study was conducted in the emergency departmentof Imam Reza hospital. Patients aged 3 years and older with early diagnosis of pneumonia orany unspecified CXR findings with an indication of CT scan were included in the study. LUS wasperformed with a deep curved and linear surface probe. The results obtained from the chestultrasound were compared with the results obtained by CT scan as the diagnostic gold standard.Results: A total of 175 patients were included in this study. According to the results, the sensitivityand specificity of LUS in the diagnosis of subpleural consolidation were 94.1% and 100%,respectively, and the positive predictive value and the negative predictive value were 100% and33.3%, respectively. The sensitivity and specificity of LUS in diagnosing pleural effusion were69.2% and 100%, respectively, and the positive predictive value and the negative predictive valuewere 100% and 90.7%, respectively. Furthermore, the sensitivity of LUS in diagnosing dynamic airbronchogram was 98%.Conclusion: According to the findings of the present study, in patients suspected of pneumonia,LUS is more sensitive and specific in the diagnosis of pneumonia and is less time-intensive andcostly. Additionally, the ultrasound device is easily portable and accessible. It can be widely used anddoes not have the secondary side effects of ionizing radiation in patients. However, the technician’sskill in performing ultrasound is a matter of importance.
Original Article
Clinical Toxicology
mohammad naghizadeh; Nastaran Eizadi-mood; laaya mokhtar; shiva samsamshariat; Gholamali dorooshi; arman otroshi; Ali Mohammad Sabzghabaee
Articles in Press, Accepted Manuscript, Available Online from 13 April 2024
Abstract
Introduction: Poisoning is one of the most common methods of suicide in developing countries. We assessed the frequency of impaired hematological indices in patients with acute poisoning.
Methods: The present study was a cross-sectional retrospective. Using the census sampling method, all patients ...
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Introduction: Poisoning is one of the most common methods of suicide in developing countries. We assessed the frequency of impaired hematological indices in patients with acute poisoning.
Methods: The present study was a cross-sectional retrospective. Using the census sampling method, all patients who had attempted suicide by poisoning and were admitted from 2013 to 2023 were included in this study. Different variables, including age, gender, hematological index on admission, hospital stay, and outcome (mortality), were recorded in a data-gathering form. ANOVA and chi-square or Fisher’s exact tests were used for analysis.
Results: This study was conducted on 48186 patients, 53.4% of whom were male. The average age of the patients was 34.92 (± 13.23). Of all patients, 6% had anemia, 15.1% leukocytosis, 15% higher than average hemoglobin, and 9.1% lower than average platelet count. White blood cell (WBC) count was higher (mean difference = 3741.85, SD = 151.35, 95% CI = 3445.21–4038.5) in deceased patients, while platelet count was significantly lower in deceased patients (mean difference = 17.19, SD = 2.57, 95% CI = 12.14–22.24) (P < 0.001). Anemia correlated with more extended hospital stay by an average of 1.61 days (SD = 0.27, 95% CI = 0.98–2.24) compared to patients with normal hemoglobin. Thrombocytopenia also correlated with more extended hospital stays by an average of 1.38 days (SD = 0.21, 95% CI = 0.88–1.89).
Conclusion: The frequency of abnormal hematological indices was not high in patients with acute poisoning. Deceased patients had higher WBC and lower platelet counts compared to surviving patients. Patients with anemia and thrombocytopenia had more extended hospital stays.
Case Report
Emergency medicine
Zainab mehdi; Daljinderjit Kaur; Parv kamra; Narinder kaur; Nidhi arora
Articles in Press, Accepted Manuscript, Available Online from 13 April 2024
Abstract
Objective: Dependency on agriculture and the unregulated sale of paraquat makes it an easyalternative for homicidal and suicidal use in developing nations. It kills by multiorgan failure,predominantly pulmonary fibrosis, and ARDS. We report a case of alleged paraquat ingestionwith spontaneous pneumothorax, ...
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Objective: Dependency on agriculture and the unregulated sale of paraquat makes it an easyalternative for homicidal and suicidal use in developing nations. It kills by multiorgan failure,predominantly pulmonary fibrosis, and ARDS. We report a case of alleged paraquat ingestionwith spontaneous pneumothorax, spontaneous pneumomediastinum, and pneumorrhachis.Aim is to reinforce the importance of a high index of suspicion in early diagnosis when theabove findings are present with ARDS in absence of trauma and a history of alleged substanceingestion.Case Presentation: A 35-year-old male presented with loose stool occasionally bloody, oralulcers, yellow discoloration of eyes with fever, and decreased urine output for three days afterconsuming some substance with his seafood. On examination, he had yellow discoloration ofeyes and oral mucosa along with multiple ulcers on the buccal region as well as the dorsumof the tongue and lateral margins with generalized subcutaneous emphysema. In addition,decreased air entry in the bilateral lung field and muffled heart sounds were present. He hadan acute hepatorenal failure and severe metabolic acidosis with respiratory failure. Urine testedpositive for myoglobin and muscle enzymes (creatinine kinase and LDH) were raised. He wasintubated and shifted to the intensive care unit. Injectable N-acetyl cysteine (NAC) for acute liverfailure was started with empirical antibiotics and intravenous fluids. We supplemented thiamineand vitamin K, and hemodialysis was done in view of progressive renal failure. Radiologicalevaluation showed spontaneous pneumothorax, pneumomediastinum, and pneumorrhachiswhich were managed conservatively. His respiratory parameters worsened despite maximalventilatory support. Renal failure and metabolic acidosis worsened in spite of hemodialysis. Hesuccumbed to his illness on day five of admission and seven days after toxin ingestion.Conclusion: We recommend that the sale of paraquat be restricted and regulated to avoid itsuse for suicidal and homicidal purposes. More research is required to find measures to interveneearly and prevent pulmonary fibrosis. We propose that paraquat toxicity be considered early in apatient with the triad in an atraumatic setting with acute respiratory distress syndrome (ARDS)
Case Report
Pediatrics
Anahita Alizadeh Ghamsari; Nafiseh Pourbadakhshan
Articles in Press, Accepted Manuscript, Available Online from 13 April 2024
Abstract
Objective: Snake bites represent a significant public health issue worldwide, as venomous snake bites can result in dangerous and sometimes lethal consequences. Sometimes, the diagnosis is difficult. Herein, we present the case of a 4-year-old child who posed a challenge to diagnosis.
Case presentation: ...
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Objective: Snake bites represent a significant public health issue worldwide, as venomous snake bites can result in dangerous and sometimes lethal consequences. Sometimes, the diagnosis is difficult. Herein, we present the case of a 4-year-old child who posed a challenge to diagnosis.
Case presentation: A 4-year-old child was brought to the emergency department with sudden, severe general weakness and impaired consciousness. Initially, the cause of these symptoms was unclear and difficult to diagnose. However, after a more thorough examination, it was determined that the likely cause was a neurotoxic snake bite. The child was hospitalized for three days. He received anti-venom, painkillers, and symptomatic treatments and left the hospital in good general condition.
Conclusion: Snakebites are very dangerous and sometimes have unusual manifestations, so adequate personnel and physician information is necessary for timely diagnosis and appropriate management.