Emergency medicine
Mishal Gillani; Sabah Uddin Saqib; Russell Seth Martins; Hasnain Zafar
Volume 6, Issue 2 , Summer and Autumn 2020, , Pages 87-91
Abstract
Objective: Trauma is the significant non-obstetrical cause of maternal mortality in women aged 35 years or younger. It is expected to complicate around 1 in 12 pregnancies and accounts for 46% of such deaths. In this study, we present our experience of trauma during pregnancy at a tertiary care hospital ...
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Objective: Trauma is the significant non-obstetrical cause of maternal mortality in women aged 35 years or younger. It is expected to complicate around 1 in 12 pregnancies and accounts for 46% of such deaths. In this study, we present our experience of trauma during pregnancy at a tertiary care hospital in Karachi.Methods: A standardized form was used to extract data from online records for all pregnant women who presented with traumatic injuries to the Aga Khan University Hospital from 2014 to 2019.Results: A total of 48 pregnant females with a mean age of 28.80 (SD: 6.50) years were included in this study. Road traffic accidents (RTA) accounted for the commonest cause of injury in the first (66.7%) and second (65%) trimesters. However, fall (45.5%) followed by RTA (27.3%) was the most frequent mechanism of injury during the third trimester. Gunshot injuries were seen in 4 patients only. Overall, fetal ultrasound was the most commonly performed imaging (87.5%) followed by limb X-ray and focused abdominal sonography for trauma (FAST) ultrasound. Out of total, 52.1% of the patients were surgically managed. Fetal demise in utero and spontaneous abortion was reported in 2 patients only.Conclusion: Road traffic accidents and falls comprise a significant burden of maternal and fetal morbidity and mortality. In terms of prevention, several policies and interventions at the government level need to be introduced in order to reduce the incidence of traumatic events.
Clinical Toxicology
Sasan Zaeri; Zohre Aghaei; Navid Reza Mashayekhi; Ali Salemi; Ramin Seyedian
Volume 7, Issue 2 , Summer and Autumn 2021, , Pages 123-126
Abstract
Objective: Snake envenomation is common in tropical and subtropical countries of the Middle East areas including Iran. Cerastes cerastes gasperettii is a dangerous snake living in southwestern provinces of Iran. It causes massive edema at the bite site and coagulopathy leading to death if untreated. ...
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Objective: Snake envenomation is common in tropical and subtropical countries of the Middle East areas including Iran. Cerastes cerastes gasperettii is a dangerous snake living in southwestern provinces of Iran. It causes massive edema at the bite site and coagulopathy leading to death if untreated. Methods: The purpose of this preliminary animal study was to evaluate the toxicity and proteomic of this venom for the first time in Iran. Moreover, the hemodynamic changes with intravenous injection of the venom were assessed and inotropic in addition to arrhythmogenic properties of this venom were investigated. Results: The estimated amount of the LD50 with intraperitoneal injection was slightly less than the similar experiment in Saudi Arabia (1.32 mg/kg versus 978 µg/kg body weight). There were 8 distinct protein bands between 12 and 66 kDa in SDS-PAGE analysis that were different with Moroccan experiment due to inter and intra species variation. Inotropic potencies were not significant since the lethal dose with intravenous injection was much lower than the Arabian experiment in guinea pigs (2.4 mg/kg versus 0.8 mg/kg). Conclusion: According to the low hemodynamic changes induced with the venom, it seems that coagulopathy and edema are the most dangerous effects of this rare snake in Iran.
Mohammad Mohammadi; Abdolghani Abdollahimohammad; Mohammadreza Firouzkouhi; Maryam Shivanpour
Articles in Press, Corrected Proof, Available Online from 03 December 2021
Abstract
Objective: Pre-hospital emergency staff are involved in the front line of care for COVID-19 patients and face many challenges. The aim of this study was to explore the challenges of prehospital emergency staff in the COVID-19 pandemic.Methods: This qualitative research was conducted with a descriptive ...
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Objective: Pre-hospital emergency staff are involved in the front line of care for COVID-19 patients and face many challenges. The aim of this study was to explore the challenges of prehospital emergency staff in the COVID-19 pandemic.Methods: This qualitative research was conducted with a descriptive phenomenological approach. Purposeful sampling was applied and data collection was done through semi-structured interviews. Participants consisted of 16 pre-hospital emergency staff. Data analysis was performed using the Colaizzi approach.Results: Data analysis revealed five main themes including safety against COVID-19, knowledge deficit, fear and worry, challenges of transporting patients to the hospital, and selflessness.Conclusion: Pre-hospital emergency staff face many problems in personal, professional, equipment and cultural fields in the COVID-19 epidemic. In this regard, special attention from health systems is mandatory.
Cardiology
Amin Mahdavi; Meysam Moravej; Maryam Aliramezany
Volume 8, Issue 1 , Winter and Spring 2022, , Pages 37-42
Abstract
Objective: Coronavirus disease 2019 (COVID-19) is an infection which can present itself bythe involvement of various organs, but the most common manifestations are respiratorysymptoms, fever and dyspnea with a high mortality rate. In order to study the prognosis ofpatients and also to determine the treatment ...
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Objective: Coronavirus disease 2019 (COVID-19) is an infection which can present itself bythe involvement of various organs, but the most common manifestations are respiratorysymptoms, fever and dyspnea with a high mortality rate. In order to study the prognosis ofpatients and also to determine the treatment plan, we need non-invasive methods whichcan be easily used in the triage of patients. In this study, we investigated the diagnosticvalue of electrocardiographic (ECG) changes and troponin levels in patients with thisdisease.Methods: This is a descriptive study. Confirmed COVID-19 patients participated in thepresent study. Data were collected by taking history and referring to medical records. Weanalyzed data by using chi square, t test and logistic regression through SPSS softwareversion 22.Results: One hundred and five patients with COVID-19 disease were examined. Mostpatients were men (53.3%) and the mean age was 54.53 years. The most common underlyingdiseases were hypertension and diabetes mellitus. Ninety-five patients had abnormalelectrocardiography including eleven with long QT; seven with arrhythmia; 78 with sinustachycardia; 7 with hemi-block; 1 with hemi-block and first degree atrioventricular block;4 with abnormal axis and 28 with ischemic changes. Eleven patients (10.5%) had positivetroponin level, whose length of hospital stay was higher (12.73 vs. 12.07 days). Furthermore,their mean length of intensive care unit (ICU) stay was also higher. In addition, among thetroponin-positive group, 100% had abnormal electrocardiography.Conclusion: The findings of the present study showed that ECG abnormalities and troponinlevels could provide good information about the prognosis of patients. Moreover, it seemsthat ECG changes in COVID-19 patients, whether indicative of underlying heart disease orresulted from infection, can affect the prognosis of patients. Therefore, considering ECGfindings and troponin levels can help select patients at a higher risk for triage.
Emergency medicine
Seyyed Hosein Montazer; Behzad Feizzadeh; Farzad Bozorgi; Seyed Mohammad Hosseininejad; Ayyoub Barzegarnezhad; Iraj Golikatir; Fatemeh Jahanian; Hasan Motamed; Hamed Aminiahidashti
Volume 4, Issue 1 , Winter and Spring 2018, , Pages 39-43
Abstract
Objective: The main purpose in the treatment of renal colic patients in emergency department is pain management. This study aimed to compare the analgesic effects of intravenous (IV) acetaminophen and morphine sulfate in this regard.
Methods: This double blind clinical trial was conducted on >18 ...
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Objective: The main purpose in the treatment of renal colic patients in emergency department is pain management. This study aimed to compare the analgesic effects of intravenous (IV) acetaminophen and morphine sulfate in this regard.
Methods: This double blind clinical trial was conducted on >18 years old renal colic patients in need of pain management in emergency department. Pain severity was recorded as 15, 30, and 60 minutes before injection, and 120 minutes after injection. In addition, side effects were compared between IV acetaminophen and morphine sulfate groups using SPSS version 16.
Results: A total of 355 patients were randomly allocated to one of the treatment groups. There were no significant differences between the two groups regarding baseline characteristic of participants. There was no significant difference in the pain intensity of the groups; 15 (P = 0.13) and 30 (P = 0.15) minutes after treatment. Although, the difference in pain severity was statistically significant between the two groups; 60 (P = 0.02) and 120 (P = 0.003) minutes after the infusion. This was not clinically important. The prevalence of side effects in morphine group was higher than the acetaminophen group (RR: 2.14, 95% CI: 1.53-2.98, P< 0.0001).
Conclusion: Based on the findings, IV morphine sulfate and acetaminophen had equal effectiveness regarding acute renal colic pain management, but considering the significantly higher frequency of side effects, IV acetaminophen seems to be a more reasonable choice in this regard.
Emergency Medical Services
Sahar Mirbaha; Mohammadmehd Forouzanfar; Amin Saberinia; Amir Salimi; Hamid Kariman; Mozhgan Farmahini Farahani
Volume 6, Issue 1 , Winter and Spring 2020, , Pages 43-46
Abstract
Objective: Each imaging technique has a special application and usage, and should be used in the right situation. Physicians choose the type of imaging technique by considering the type of tissue and the benefits and disadvantages of the imaging method as well as its financial burden on the patient. ...
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Objective: Each imaging technique has a special application and usage, and should be used in the right situation. Physicians choose the type of imaging technique by considering the type of tissue and the benefits and disadvantages of the imaging method as well as its financial burden on the patient. The aim of this study was to estimate the cost of imaging tests performed in the emergency department (ED) of an educational hospital and determine their financial burden on both the patients and the healthcare system of the country. Methods: This retrospective descriptive cross-sectional single-center study was conducted in Shohadaye Tajrish, an educational hospital, during one year. The study population consisted of all patients who had undergone some type of imaging (CT scan, ultrasound, radiography, magnetic resonance imaging [MRI]) in the ED. The information was collected using a predesigned checklist. The costs of a variety of imaging methods for patients referred to the ED were calculated using different types of accounting units and PACS system. Results: The number of patients who visited the ED of the studied hospital during a one year period was 63507. The total cost of performing different types of imaging methods in the studied center throughout the one-year target period was 44018695695 Rials (≃$US 423745) (59.27% of which was spent on CT scan, 16.09% on ultrasound, 13.75% on plain radiography and 10.87% on MRI). Conclusion: According to the collected data, the total cost of radiology was 44018695695 Rials. The highest cost was related to CT scan modality, and the lowest belonged to MRI.
Forensic Medicine
Maryam Ameri; Maryam Akhgari; Roya Kordrostami
Volume 5, Issue 2 , Summer and Autumn 2019, , Pages 71-74
Abstract
This study aimed at describing demographic information of the deceased resulting from hanging by means of different methods of suicide. In this cross-sectional study, the file of suicide cases referred to the Central Legal Medicine Organization was investigated retrospectively. Of 1681 suicide cases, ...
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This study aimed at describing demographic information of the deceased resulting from hanging by means of different methods of suicide. In this cross-sectional study, the file of suicide cases referred to the Central Legal Medicine Organization was investigated retrospectively. Of 1681 suicide cases, the highest suicide mode was hanging by 993 cases (57.4%) and intoxication by 674 cases (39%). The mean age of hanging was 36.22±15.76 and for other suicide methods it was 32.61±13.70 (P=0.000). Hanging was higher in males. Female victims used other methods like intoxication (P=0.000). The most common seasons for hanging were spring and winter. Toxicological analysis in cases of hanging was positive with opioid alkaloids in 95 cases (9/9%) and methamphetamine in 68 cases (7%). Intoxication with aluminum phosphide was in 35.8% of cases. Most of the cases (68.3%) were self-employed victims. A total of 534 (63%) cases were married. There was a statistically significant difference between hanging and other suicide modes concerning age, gender, occupation, marital status, and drug abuse history (P<0.001). The frequency of hanging was higher in males, marrieds, self-employed, unemployed and drug abusers. Students were victims of intoxication. Self-employed victims, unemployed victims and drug abusers were exposed to successful attempts more than others. Screening plans can be helpful in preventing suicide by prioritizing the people at risk.
Emergency medicine
Pir-Hossein Kolivand; Peyman Saberian; Mostafa Sadeghi; Maryam Modabber; Parisa Hasani-Sharamin
Volume 6, Issue 2 , Summer and Autumn 2020, , Pages 92-97
Abstract
Objective: The current study was performed to provide real-time bedside ultrasonography for emergency medical technicians (EMTs) and assess the advantages and disadvantages of its application in dealing with trauma patients in pre-hospital setting from their viewpoints.Methods: This semi-experimental ...
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Objective: The current study was performed to provide real-time bedside ultrasonography for emergency medical technicians (EMTs) and assess the advantages and disadvantages of its application in dealing with trauma patients in pre-hospital setting from their viewpoints.Methods: This semi-experimental study was conducted in Tehran, Iran. Twenty EMTs were selected purposefully and underwent a training program. Thereafter, they were asked to perform extended focused assessment with sonography in trauma (eFAST) using a handheld ultrasound device on trauma patients, and also filled a questionnaire prepared (in four components including C1: coherence, C2: cognitive participation, C3: collective action, and C4: reflexive monitoring) based on the normalization process theory (NPT).Results: All 20 participants were men and their average age was 37.8 years (SD = 4.7). For C1, the median total score was 10.5 out of a score of 4-20; For C2, the median score was 6 out of 3-15; For C3, the median total score was 18 out of a score of 6-30; and for C4, the median total score was 11 out of a score of 5-25.Conclusion: Overall, it seems that EMTs welcomed using ultrasonography in dealing with trauma patients in pre-hospital setting. Although they thought that it might somewhat lead to an increase in their workload; but they believed that sufficient training was not provided for them yet. The EMTs were uncertain about the viewpoints of the patients and did not know how it could affect patients’ outcome.
Emergency medicine
Nazanin Jannati; Vahid Yazdi-Feyzabadi; Roghayeh Ershad Sarab; Simin Salehinejad
Volume 7, Issue 2 , Summer and Autumn 2021, , Pages 127-129
Abstract
The coronavirus disease (COVID-19) pandemic is a global health crisis of our time. The mental health and wellbeing of whole societies have been severely impacted by this crisis and are a priority to be addressed urgently. In addition, the COVID-19 pandemic has disrupted or halted critical mental health ...
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The coronavirus disease (COVID-19) pandemic is a global health crisis of our time. The mental health and wellbeing of whole societies have been severely impacted by this crisis and are a priority to be addressed urgently. In addition, the COVID-19 pandemic has disrupted or halted critical mental health services in many countries worldwide. One way to overcome this situation is to use Telemental health services and people can take advantage of these services to meet their mental health needs. However, there are some barriers to provide Telemental health services, which should be considered by policymakers before the crisis.
Emergency medicine
Harish Kodisiddaiah Shivanna; Aruna Chala Ramesh; Keshava Murthy M Rangaswamy
Volume 8, Issue 1 , Winter and Spring 2022, , Pages 43-48
Abstract
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 ...
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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.
Emergency Medical Services
Seyedhossein Ojaghihaghighi; Samad Shams Vahdati; Simin Taghavi; Aydin Rahimzade Jahandari; Pegah Sepehri Majd; Mohammad Mirza-Aghazadeh-Attari
Volume 4, Issue 1 , Winter and Spring 2018, , Pages 44-47
Abstract
Objective: Pregnancy is an important psychological and biological phenomenon in women’s life. Pregnancy has many complications jeopardizing the well-being of the mother and the child. Methods: In this retrospective study, the data including demographic information, chief complaint, the initial ...
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Objective: Pregnancy is an important psychological and biological phenomenon in women’s life. Pregnancy has many complications jeopardizing the well-being of the mother and the child. Methods: In this retrospective study, the data including demographic information, chief complaint, the initial diagnosis, referral decision, final diagnosis, hospitalization outcome and pregnancy outcomes were studied on 239 pregnant women admitted to the emergency departments of the general hospitals of East Azerbaijan province. Results: The average age of patients was 27.54 years. The time period from the initial presentation to completely leave the emergency department was reported to be 3.66 hours on average. In this study, most patients (74.5%) did not have a history of abortion. Exploring the time of admission for all cases, most patients were admitted from 8 pm to 8 am (67.8%), and 32.2% were referred from 8 am to 8 pm. Concerning the time of pregnancy, 46.4% were at their second trimester of pregnancy. Most of the patients were admitted in cold seasons of the year. The most common chief compliant was abdominal pain with 32.2% frequency. In addition, the most frequent primary diagnoses were an acute abdomen and trauma at 25.5% and 14.2% respectively. Conclusion: Abdominal pain and acute abdomen have the most frequency as the chief compliant and initial diagnosis especially during the second trimester of pregnancy. In this regard, appropriate training and skillful staff are needed to deal with the complaints and complications of abdominal pain. More than half of pregnant women referred to the emergency departments were hospitalized or admitted to the intensive care unit (ICU). This signals the necessity of adequate facilities to provide proper care for this group.
Education
Amin Beigzadeh; Nikoo Yamani; Elham Sharifpoor; Kambiz Bahaadinbeigy; Peyman Adibi
Volume 7, Issue 1 , Winter and Spring 2021, , Pages 46-55
Abstract
Objective: Literature on the obstacles of clinical rounds is dispersed and has not been well established under a unified systematic investigation. Teaching and learning in clinical rounds, where a variety of skills important for the medical profession, cannot be augmented if barriers related to main ...
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Objective: Literature on the obstacles of clinical rounds is dispersed and has not been well established under a unified systematic investigation. Teaching and learning in clinical rounds, where a variety of skills important for the medical profession, cannot be augmented if barriers related to main factors in the clinical environment are not identified. Methods: A systematic review of English articles using Web of Science, PubMed, Embase, Scopus and Cochrane library were conducted. Relevant keywords and their synonyms were used for the domains “medical students/clinical teachers/barriers and clinical round”. Additional studies were identified by searching reference lists of retrieved articles. All searches for English language articles were conducted within a 10-day period from 25 May to 3 June 2017. No time limit was considered for article searching. We contacted Kerman University of Medical Sciences to locate some studies due to access limitation. In this systematic review, studies on the subject of barriers to clinical rounds from clinical teachers’ and medical students’ perspectives were identified. Our search strategy yielded 600 articles. After title and abstract review, 43 of these were obtained and finally 20 were included in the study. All data were abstracted from the included studies. Two authors independently screened the studies. We used inductive content analysis and categories of barriers were derived from the data. MAXQDA software version 10 was used for data analysis. Results: A total of 20 articles were included and analyzed in depth. Content analysis yielded identification of 320 codes concerning barriers to clinical rounds in six categories classified as system-, climate-, teacher-, student-, patient-, and personnel-related factors. Conclusion: Our investigation depicts primarily main barriers in teaching on rounds. In this regard, effective teaching in clinical rounds is not obtained unless barriers concerning the learning triad and its environment are explored and necessary actions are adopted accordingly
Emergency medicine
Mohit Kumar Arora; Ela Madaan; Rajnand Kumar
Volume 6, Issue 1 , Winter and Spring 2020, , Pages 47-49
Abstract
Objective: Patella is a sesamoid bone which develops in the quadriceps tendon. It is an uncommon site for neoplasms. The most common primary tumors which involve patella are benign. These include chondroblastoma, giant cell tumor (GCT) and aneurysmal bone cyst. Malignant lesions are less common in patella. ...
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Objective: Patella is a sesamoid bone which develops in the quadriceps tendon. It is an uncommon site for neoplasms. The most common primary tumors which involve patella are benign. These include chondroblastoma, giant cell tumor (GCT) and aneurysmal bone cyst. Malignant lesions are less common in patella. These encompass metastasis, osteosarcoma and hemangioendothelioma. The most common complaint in patients of GCT patella is anterior knee pain. Early diagnosis and optimal management are necessary for improving survival rate in these patients.Case Presentation: The authors present a case report of GCT of patella in a 16-year old child. Incisional biopsy was done to confirm the diagnosis. Further radiological examination showed that the tumor involved almost whole of the patella. Hence, surgical management in the form of patellectomy and extensor mechanism repair was done to improve the outcome of the disease. The patient did not have any clinical or radiological symptoms at the end of the final follow up of 22 months.Conclusion: Primary tumor of patella is a rare entity. Benign tumors like GCT present only with anterior knee pain and should be included in the differential diagnosis of anterior knee pain. MRI is useful to determine the extent of involvement of tumor in the patella. Treatment may vary from curettage and bone grafting to total patellectomy with extensor mechanism repair
emergency nursing
Sahar Mirbaha; Parvin Kashani; Ali Arhami Dolatabadi; Afshin Amini; Farahnaz Meschi; Alireza Baratloo
Volume 3, Issue 2 , Summer and Autumn 2017, , Pages 59-63
Abstract
Objective: Personality disorder is a multi-factorial condition in which workplace stress plays a significant role. This study was undertaken due to scarcity of information regarding the role of workplace stress which can cause personality disorder among nurses. We aimed to evaluate the prevalence of ...
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Objective: Personality disorder is a multi-factorial condition in which workplace stress plays a significant role. This study was undertaken due to scarcity of information regarding the role of workplace stress which can cause personality disorder among nurses. We aimed to evaluate the prevalence of personality disorders in nurses working in different hospital departments and assess factors affecting its onset. Methods: In this cross-sectional study the personality disorders of nurses working in various hospital departments were evaluated based on Minnesota Multiphasic Personality Inventory-2 (MMPI-2) test. After the completion of questionnaires, data were entered to MMPI-2 test’s special software and the final result was interpreted based on the opinion of a clinical psychologist. Finally, multivariate logistic regression model was used to assess the independent effect of the mentioned factors on prevalence of personality disorders in nurses. Results: We gathered data from 2 groups of participants (n = 206). These groups included nurses in emergency departments and nurses in other hospital units. The mean of age was 32.5 ± 6.9 years. Overall, 54.3% (n = 38) of non-emergency nurses and 45.7% (n = 32) of emergency nurses showed symptoms of personality disorders respectively. Multivariate logistic regression analysis showed that history of a serious accident or trauma increased the odds of detecting personality disorders up to 3.8 times (odds ratio [OR] = 3.84; 95% CI: 1.33-11.06; P = 0.01). In addition, an unpleasant incident in the past year increased it up to 2.2 times (OR = 2.23; 95% CI: 1.18 – 4.22; P = 0.01) in both groups. Conclusion: The present study showed that there was no significant difference between emergency departments and other units of hospitals regarding the prevalence of personality disorders among nurses. Overall, somatization, hysteria, and pollyannaish were the most common personality disorders among the studied population
Trauma
Seyyed Mahdi Mirhamidi; Davood Soroosh; Alireza Abadi; Elahe Fahimi
Volume 5, Issue 2 , Summer and Autumn 2019, , Pages 75-77
Abstract
Compartment syndrome is a rare vascular disorder and an orthopedic emergency caused by high intramuscular pressure following bone fractures and some other etiologies. It mostly involves extremities, but can affect other parts of the body. The syndrome is diagnosed based on extensively varying signs and ...
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Compartment syndrome is a rare vascular disorder and an orthopedic emergency caused by high intramuscular pressure following bone fractures and some other etiologies. It mostly involves extremities, but can affect other parts of the body. The syndrome is diagnosed based on extensively varying signs and symptoms including feeling pain, pallor, pulselessness, and some other signs among patients. It causes irreversible complications that may even lead to death in some cases. If not treated promptly, muscle and nerve necrosis, myoglobinuria, and ultimately extremity gangrene and renal failure may occur. Timely diagnosis requires close attention to patient’s signs and symptoms and repeated measurements of pressure in the compartment. The reported case was an 11-year-old girl suffering from a closed double fracture in her forearm following blunt trauma. Inappropriate treatment done by a local therapist resulted in compartment syndrome. The aim of this study was to obtain an accurate knowledge on it and to do timely action when facing with this syndrome.
Infectious disease
Manas Sharma; Shridhar C. Ghagane; Shubhashree Muralidhar; Shashank Patil; Naina R. Nerli; Rajendra B. Nerli
Volume 6, Issue 2 , Summer and Autumn 2020, , Pages 98-101
Abstract
The current coronavirus pandemic forces us to realize the significance of the careful utilization of financial and health-care resources. At the same time, it is important to ensure the ability of urologists to function through this crisis to provide essential and emergency services. With regards to ...
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The current coronavirus pandemic forces us to realize the significance of the careful utilization of financial and health-care resources. At the same time, it is important to ensure the ability of urologists to function through this crisis to provide essential and emergency services. With regards to urological procedures, a triage of non-emergent operations is hence recommended considering various disease-related factors. Case conduct should also be categorized based on the up-to-date information of the evolving national, regional and local conditions of this pandemic, as marked variation in these conditions can lead to significant differences in decision-making. Over the coming weeks and months, we are bound to face an increasingly difficult task of treating Coronavirus disease 2019 (COVID-19) infected patients presenting with urological ailments. Instituting well-thought plans to perform the un-deferrable urological procedures and emergencies during this pandemic will go a long way in keeping the surgeons and health-care workers safe to perform essential duties.
Emergency medicine
Seyed Reza Habibzadeh; Samaneh Abiri; Saeed Barazandehpour; Mohammad Javad Zarei; Mahdi Foroughian; Hamideh Akbari; Navid Kalani; Esmaeil Rayat Dost; Seyed Hamed Hojati
Volume 7, Issue 2 , Summer and Autumn 2021, , Pages 130-132
Abstract
Objective: Brugada syndrome (BrS) is a disorder in which the electrical activity in the heart is abnormal and affects individuals with cardiac dysrhythmia. In the present study, we introduce a case diagnosed with BrS, admitted to intensive care unit (ICU) and received treatments following sudden cardiac ...
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Objective: Brugada syndrome (BrS) is a disorder in which the electrical activity in the heart is abnormal and affects individuals with cardiac dysrhythmia. In the present study, we introduce a case diagnosed with BrS, admitted to intensive care unit (ICU) and received treatments following sudden cardiac arrest. Case Report: The patient was a male 25-year-old medical student enrolled in the sixth academic year who suffered from loss of consciousness due to sudden cardiac arrest. The patient immediately received cardiopulmonary resuscitation (CPR) measures, was visited by a cardiologist and a neurologist, and was consequently treated with medications. After an 8-day stay in the coronary care unit (CCU), the patient regained his level of consciousness and he was transferred to the ICU of Faghihi hospital in the city of Shiraz, Iran. Being diagnosed with BrS and following pulmonary aspiration treatments, he finally implanted with an implantable cardioverter defibrillator (ICD). Conclusion: Fortunately, necessary measures had been taken on time for the introduced patient and he was discharged with full recovery after 6 days
Disaster
Simin Salehinejad; Nazanin Jannati; Roghayeh Ershad Sarabi; Kambiz Bahaadinbeigy
Volume 7, Issue 1 , Winter and Spring 2021, , Pages 56-62
Abstract
Objective: Both natural and man-made disasters need near-term and long-term interventions to reduce morbidity and mortality among the affected population. Recently, telemedicine has been effectively used in both man-made and natural disasters and showed its effectiveness in eliminating the adverse consequences ...
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Objective: Both natural and man-made disasters need near-term and long-term interventions to reduce morbidity and mortality among the affected population. Recently, telemedicine has been effectively used in both man-made and natural disasters and showed its effectiveness in eliminating the adverse consequences of disasters. Therefore, the purpose of this study was to identify the application of telehealth in different phases of disaster. Methods: We systematically searched all English papers regarding the use of telemedicine in different phases of disaster indexed in PubMed, Embase, and Web of Science databases until June 2020. A data collection form was designed to extract the required data such as types of systems, telecommunication technologies, and phases of disaster. Results: In this study, 16 out of 4490 retrieved articles were selected as relevant and reviewed by the authors. Findings indicated that the majority of studies highlighted the use of telemedicine in natural disasters (n=12), and only four discussed it in a man-made disaster like war and terrorist attacks. In 6 studies out of 16, telemedicine was used to treat and assess mental disorders among the affected population. And the internet was the most common technology for telemedicine development. Conclusion: Providing health care during a disaster is necessary, and telemedicine is important for such care. This systematic review helps define the components and application of telemedicine in disaster as a new technology in recent days, but we need to consider it and develop this technology in all phases of disaster management, especially during the response phase.
Emergency medicine
Mohit Kumar Arora; Ela Madaan; Sandeep Kumar
Volume 5, Issue 2 , Summer and Autumn 2019, , Pages 78-80
Abstract
Simultaneous fracture of lateral condyle and medial epicondyle of humerus along with elbow dislocation is very rare injury in adults. Only a few cases have been reported in literature in pediatric age groups. The authors describe a case report of fracture of lateral condyle and medial epicondyle of humerus ...
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Simultaneous fracture of lateral condyle and medial epicondyle of humerus along with elbow dislocation is very rare injury in adults. Only a few cases have been reported in literature in pediatric age groups. The authors describe a case report of fracture of lateral condyle and medial epicondyle of humerus along with elbow dislocation in a young adult. The patient sustained injury in the form of fall from bike. Clinically the patient had swelling and deformity of the elbow joint. There were contusions present in the skin around the elbow joint. There was no distal neuro-vascular deficit. Appropriate radiological investigations were done. The elbow joint was then reduced and found to be unstable. Hence, patient was taken up for surgery in the form of open reduction and internal fixation. The functional outcome of the surgery is presented in the case report. Open reduction and internal fixation are the treatment of choices in these types of cases.
Infectious disease
Sohil Pothiawala
Volume 6, Issue 2 , Summer and Autumn 2020, , Pages 102-108
Abstract
Introduction: Emerging viral diseases (EVDs) pose a significant threat to public health. There have been a few viral epidemics in the last two decades. Coronavirus disease 2019 (COVID-19) is now a global pandemic.Objective: To provide emergency physicians an update on severe acute respiratory syndrome ...
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Introduction: Emerging viral diseases (EVDs) pose a significant threat to public health. There have been a few viral epidemics in the last two decades. Coronavirus disease 2019 (COVID-19) is now a global pandemic.Objective: To provide emergency physicians an update on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its dynamic impact on the emergency department (ED) in terms of preparedness and management of patients presenting to ED with suspected COVID-19 disease.Discussion: COVID-19 has a human-to-human transmission through close contact and even from asymptomatic carriers. Symptoms are similar to a viral respiratory illness. The disease is mild and self-limiting in most patients, but some develop severe illness like pneumonia, acute respiratory distress syndrome (ARDS) and multiorgan failure. Emergency physicians should prioritize early identification of these patients at risk, isolate them and after collaborating with relevant hospital and national authorities, develop clinical pathways to safely evaluate, manage and dispose patients with COVID-19. Various strategies for managing these patients in the ED are discussed. Disposition of these patients depends on symptoms and hemodynamic status and potential to self quarantine versus admission to an isolation facility.Conclusion: This review provides an overview of patients presenting to the ED with suspected COVID-19 and its impact on the ED. It reiterates the fact that emergency physicians, in close collaboration with relevant hospital authorities, play a pivotal role during EVDs. It emphasizes the need for pandemic preparedness, enabling us to better manage such events in the future.
Emergency medicine
Shaghayegh Rahmani; Kosar Deldar; Sara Hemati Ali
Volume 7, Issue 2 , Summer and Autumn 2021, , Pages 133-134
Abstract
Objective: Nowadays, many countries all over the world are involved with COVID-19 and the number of new cases and deaths are on a rise. The role of emergency medicine and physician-led triage is important in this period. We report some near missed cases in our academic center related to this pandemic.Case ...
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Objective: Nowadays, many countries all over the world are involved with COVID-19 and the number of new cases and deaths are on a rise. The role of emergency medicine and physician-led triage is important in this period. We report some near missed cases in our academic center related to this pandemic.Case Presentation: We report 5 cases that missed triage or received delayed diagnosis because of COVID-19 suspicion. Some cases are life threatening.Conclusion: Although COVID-19 is the main health concern these days, other critical conditions should be considered. Stabilizing patients before transferring them between hospitals should be the essential goal of emergency department whether the patient is Corona virus infected or not. And before any intervention, the safety of healthcare workers must be ensured.
Rahul Chaurasia; Naveen Akhtar
Articles in Press, Accepted Manuscript, Available Online from 20 December 2021
Abstract
Objective: Type and crossmatch (TC) policy is the most common approach for pretransfusion compatibility testing prior to issue of blood for transfusion. As it involvesreserving of the blood units (usually up to 72 hours) prior to issue or un-reserving, it can leadto excessive blood cross matching, inventory ...
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Objective: Type and crossmatch (TC) policy is the most common approach for pretransfusion compatibility testing prior to issue of blood for transfusion. As it involvesreserving of the blood units (usually up to 72 hours) prior to issue or un-reserving, it can leadto excessive blood cross matching, inventory management problems, undue workload,blood outdating and reagent wastage. Type and screen (TS) policy is an alternativeapproach without the need to cross match and reserve blood units prior to issue. The aimof the current study was to retrospectively assess the impact of the implementation of TSpolicy for pre-transfusion compatibility testing on blood transfusion services at an urbanlevel Ι trauma center.Methods: The study was done in two phases in the Department of Transfusion Medicineat Jai Prakash Narayan Apex Trauma Center AIIMS, New Delhi, India. Transfusion data wascollected and compared during two phases: initial phase (Oct 2016-Mar 2017) of TC policyand second phase (Apr 2017-Sept 2017) of TS policy.Results: TS policy resulted in the reduction of C:T ratio from 5.3 to 1.9. Transfusionprobability increased to 29.5% during TS policy from 23.6% during TC policy. Issuable stockindex (ISI) also showed reduction from 12.5 to 11.4 after TS policy. Wastage as percentageof issue (WAPI) was reduced from 2.3% (TC) to 1.3% (TS). TS policy also led to reductionin expenses incurred on pre-transfusion compatibility testing by 35%. No hemolytictransfusion reaction was reported during the study.Conclusion: TS policy was found to be a safe and an efficient alternative approach to TCpolicy for pre-transfusion compatibility at our center. We recommend the implementationof TS policy, but each center should first assess its feasibility based on patient population,blood bank resources and staff knowledge
Trauma
Mohit Kumar Arora; Ela Madaan
Volume 4, Issue 1 , Winter and Spring 2018, , Pages 48-50
Abstract
Patellar fracture is a relatively uncommon fracture especially the vertical sagittal type. In cases of high energy trauma injury, it is usually associated with fracture of ipsilateral distal femur or proximal tibia. However, the combination of vertical sagittal fracture patella and ipsilateral fracture ...
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Patellar fracture is a relatively uncommon fracture especially the vertical sagittal type. In cases of high energy trauma injury, it is usually associated with fracture of ipsilateral distal femur or proximal tibia. However, the combination of vertical sagittal fracture patella and ipsilateral fracture lateral condyle is very rare. This necessitates judicious diagnosis and appropriate management to ensure optimal functional outcome. Open reduction and internal fixation is the treatment of choice in managing these types of injuries. This should be followed by gradual mobilization of the affected knee joint. Weight bearing can be started once the fracture starts showing signs of union on X-rays. Literature search shows only one case report describing this pattern. The aim of this case report is to highlight the rarity of this injury, to understand the injury mechanism and surgical approach used for these injuries. The knowledge of this combination will help us manage these injuries so that good functional outcome is achieved
Emergency medicine
Shyam lal; Vinod Kumar Singh; Suhas Agarwal
Volume 8, Issue 1 , Winter and Spring 2022, , Pages 49-54
Abstract
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 ...
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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
Trauma
Ganesh Singh Dharmshaktu
Volume 3, Issue 2 , Summer and Autumn 2017, , Pages 64-65
Abstract
Simultaneous combination of fracture of the lateral condyle and postero-medial elbow dislocation is a rare event and limited to few reports or case series in the literature. Rarity of the injury also necessitates judicious diagnosis and appropriate management to ensure optimal functional outcome. Various ...
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Simultaneous combination of fracture of the lateral condyle and postero-medial elbow dislocation is a rare event and limited to few reports or case series in the literature. Rarity of the injury also necessitates judicious diagnosis and appropriate management to ensure optimal functional outcome. Various authors have reported about the condition including the management which mostly includes surgical intervention. A report of one such injury pattern in an 8 years old male child with operative management and satisfactory outcome is presented to highlight the presence of this rare combination and adherence to standard treatment protocols to address them. The report is an addition to the limited resources available on similar fractures and highlights the importance of ruling out possible associated injuries in cases of elbow dislocations. A good fixation of lateral condyle fracture is instrumental to avoid late complications leading to poor functional outcome. The early and supervised rehabilitation also plays a role in ensuring successful return to activities of daily living.