Emergency medicine
Navid Kalani; Masoud Tavasolian; Khaterh Dehghani; Seyed Reza Mousavi; Erfan Ghanbarzadeh; Masihallah Shakeri; Elahe Rahmanian; Poorya Aryanpoor; Naser Hatami; Zhila Rahmanian; Samaneh Abiri
Volume 9, Issue 1 , January 2023, , Pages 19-24
Abstract
Objective: The goal of our study was to determine the prognostic value of CURB-65,Sequential Organ Failure Assessment (SOFA), pneumonia severity index (PSI), MuLBSTA,and Acute Physiology and Chronic Health Evaluation (APACHE) II upon admission inpatients with coronavirus disease 2019 (COVID-19, as well ...
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Objective: The goal of our study was to determine the prognostic value of CURB-65,Sequential Organ Failure Assessment (SOFA), pneumonia severity index (PSI), MuLBSTA,and Acute Physiology and Chronic Health Evaluation (APACHE) II upon admission inpatients with coronavirus disease 2019 (COVID-19, as well as the prediction cut-off valuefor death regarding these parameters.Methods: This observational retrospective study was performed in COVID-19 triagein Peymaniyeh hospital in Jahrom in 2021. In order to calculate SOFA, APACHE II, PSI,MuLBSTA, and CURB-65, data were collected from patients who were selected by availablesampling method from PCR-confirmed COVID-19 patients. Thirty-day mortality wasassessed as the primary outcome. ROC analysis was conducted using the STATA software toevaluate the prognostic value of the scoring systems. DeLong test was utilized to compareAUC of scores using a web based tool.Results:Ninety-two patients were included in this study with the mean age of 51.02±17.81years (male to female ratio was 1:1). SOFA had an AUC of 0.656 (P=0.130), but other indiceshad statistically significant values of AUC. Based on the comparison of the AUCs, SOFAwas the worst scoring system in COVID-19 as it had significantly lower AUC than PSI andAPACHE II (P<0.05); while its comparison with MULBSTA and CURB65 was not statisticallysignificant (P>0.05).Conclusion: It seems that APACHE II and PSI are the best prognostic factors in our studywith no statistical difference compared together (P>0.05). The sensitivity of APACHE II andPSI was 0.857 with the specificity of 0.927 and 0.976, respectively. The optimal cut-off pointwas 13 and 50 for APACHE II and PSI, respectively
Emergency medicine
Khadigesadat Kazemi; Hooman Esfahani; Hadis Amiri; Asghar Tavan; Hojjat Farahmandnia
Volume 9, Issue 1 , January 2023, , Pages 38-43
Abstract
Objectives: Pandemics would certainly have a negative impact on mental health. Positivemodifications as well as negative alterations have been documented in earlier viralpandemic according to previous investigations. Teenagers face a variety of challengesduring adolescence. Adolescents may become more ...
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Objectives: Pandemics would certainly have a negative impact on mental health. Positivemodifications as well as negative alterations have been documented in earlier viralpandemic according to previous investigations. Teenagers face a variety of challengesduring adolescence. Adolescents may become more concerned if this time coincides withother worries. This study aims to investigate the positive changes that occur in a youngadolescent’s life after COVID-19 pandemic, and to see how they relate to perceived socialsupport.Methods: This cross-sectional study was performed on adolescents who were randomlyselected from high schools in Kerman, Iran 2020 during the COVID-19. the sample sizewas 108 and for sampling wes used multi-stage random sampling at the end the data wasanalyzed by Pearson correlation test. Demographic information, the MultidimensionalScale of Perceived Social Support (MSPSS) and Posttraumatic Growth Inventory short form(PTGI-SF) were used to collect data. The data were subjected to descriptive and analyticalstatistical tests (Pearson correlation) using SPSS software version 24.Results: Statistically a positive correlation was found between the PTG total score andyoung homeschooled adolescents, parents working remotely, income loss and COVID-19experience. Moreover, during the COVID-19 pandemic, a positive association was foundbetween perceived social support and PTG total scores in young adolescents. There werealso substantial positive connections between the MSPSS subscales and the PTGI overallscore.Conclusion: Based on the findings, an overall growth in all areas of PTG was observedduring the COVID-19 among young adolescents. Perceived social support scores have apositive and significant relationship with COVID-19 effects. In the crises we face throughoutlife, intimate family members and friends play a significant supporting role in adapting tothese situations
Infectious disease
Zahra Rezaie; Shima Heidari; Ahmad Salimzadeh; Fatemeh Sadat Pirooz; Farhad Najmeddin
Volume 9, Issue 1 , January 2023, , Pages 66-71
Abstract
Objective: Since the identification and spread of the novel coronavirus disease 2019(COVID-19) in December 2019, respiratory presentations have been introduced as themain symptoms of this new type of viral disease; however, the extra-pulmonary featuresare raising awareness for researchers due to the ...
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Objective: Since the identification and spread of the novel coronavirus disease 2019(COVID-19) in December 2019, respiratory presentations have been introduced as themain symptoms of this new type of viral disease; however, the extra-pulmonary featuresare raising awareness for researchers due to the vast diversity of vital organs affectedby the virus. Among the wide range of clinical manifestations, limited data are availableregarding rhabdomyolysis (RML) in COVID-19.Case Presentation: In this report, we present a 58-year-old woman with COVID-19presenting with RML, with extremely elevated creatinine phosphokinase (CPK) and lactatedehydrogenase (LDH) levels (3283 and 1280 U/L, respectively) as the second sign ofdisease. Since the onset of the COVID-19 pandemic, several COVID-19 induced RML caseshave been reported, and timely diagnosis and proper management are of paramountimportance.Conclusion: Due to the findings that rhabdomyolysis can be a critical and missed cause ofmyalgia in COVID-19 patients, the importance of checking the serum level of CPK in patientswith myalgia and fatigue in the era of COVID-19 upon their arrival will be highlighted.
Infectious disease
Mojtaba Miladinia; Farhad Abolnezhadian; Joachim G. Voss; Kourosh Zarea; Naser Hatamzadeh; Mandana Ghanavati
Volume 8, Issue 2 , July 2022, , Pages 90-94
Abstract
Objective: Final patient triage determines which patients can be home-isolated andwhich patients require hospitalization on the basis to predict the patient’s prognosismost accurately. Final triage is an important link in the clinical management chain of thecoronavirus disease 2019 (COVID-19) pandemic, ...
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Objective: Final patient triage determines which patients can be home-isolated andwhich patients require hospitalization on the basis to predict the patient’s prognosismost accurately. Final triage is an important link in the clinical management chain of thecoronavirus disease 2019 (COVID-19) pandemic, and a comprehensive review of variouspatient triage methods is very important to guide decision making and triage efficiency.Decision by clinicians about hospitalization or home-discharge is one of the main challengesin places with limited hospital facilities compared to the high volume of COVID-19 patients.This review was designed to guide clinicians on how to address this challenge.Methods: In this mini review we searched scientific databases to obtain the final triagemethods of COVID-19 patients and the important criteria in each method. In order toconducted searches a period from December 2019 to July 2020 was considered. All searcheswere done in electronic databases and search engines.Results: Findings revealed four current methods for final triage (decision-making regardinghome-isolation or hospitalization of COVID-19 patients). These methods included 1)demographic and background information, 2) clinical information, 3) laboratory indicatorsand 4) initial chest CT-scan. Each of the aforementioned methods encompassed significantcriteria according to which decisions on the patient’s prognosis and final triage were made.Finally, by evaluating each final triage method, we found that each method had somelimitations.Conclusion: An effective and quick final triage requires simultaneous complementary useof all four methods to compensate for each other’s weaknesses and add to each other’sstrengths. It is therefore suggested to assure that clinicians are trained in all four COVID-19patient’s triage methods and their useful criteria in order to achieve evidence-basedperformance for better triage (decision between home-isolation versus hospitalization).
Infectious disease
Abbas Edalatkhah; Fateme Samadi Khorshidi; Hamidreza Mohammadi; Razieh Hassannejad; Faezeh Jafari; Mohammad Lame; Amirhossein Zarepur; Ehsan Zarepur
Volume 8, Issue 2 , July 2022, , Pages 115-121
Abstract
Objective: An outbreak of coronavirus disease 2019 (COVID-19) occurred in late 2019. A better understanding of this disease will help us in preventing and managing it. This study evaluated the risk factors and clinical and laboratory characteristics of patients admitted to Shahid Sadoughi hospital in ...
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Objective: An outbreak of coronavirus disease 2019 (COVID-19) occurred in late 2019. A better understanding of this disease will help us in preventing and managing it. This study evaluated the risk factors and clinical and laboratory characteristics of patients admitted to Shahid Sadoughi hospital in Yazd with a diagnosis of COVID-19.Methods: This cross-sectional study was conducted on patients with the diagnosis of COVID-19 admitted to Shahid Sadoughi hospital in Yazd in May 2020, Iran. Patients’ clinical information, including their symptoms at admission, history of smoking or drug/ alcohol abuse, history of Td (tetanus, diphtheria) vaccine, radiographic/computed tomography (CT) scan findings, and blood oxygen saturation, was recorded. The patients were also asked about their previous history of diabetes, hypertension, autoimmune disorder, and cancer or history of diseases in heart, lung, liver, and thyroid. Laboratory findings, height, weight and body mass index of the patients were also recorded. Statistical analyses were performed using SPSS 21.Results: The mean age of 86 patients enrolled in the study was 61.40±17.37 years, of which 56 (65.11%) had mild pulmonary involvement and 30 (34.89%) had severe pulmonary involvement, according to CT scan results. Also, 26 (30.2%) of all patients had diabetes and about 30 (36%) had high blood pressure, but current smokers (6%) were rare. In patients with severe pulmonary involvement, the level of neutrophil, creatinine, and lactate dehydrogenase (LDH) was higher than patients with mild pulmonary involvement. Out of 56 patients with mild pulmonary involvement, 47 patients had a history of Td vaccination in the last 5 years. Only one patient in the severe group had a history of Td vaccination.Conclusion: A lower percentage of blood lymphocytes as well as higher levels of neutrophils, creatinine, and LDH were observed in patients with severe pulmonary involvement. Numerous factors, especially more prominent laboratory abnormalities, determine the severity of the disease, and a better understanding of these factors can help physicians know the severity of the disease and its prognosis. These findings help us to further clarify the characteristics of COVID-19. Also, the effect of Td vaccine should be investigated in future studies.
Emergency medicine
Sadaf Sheikh
Volume 7, Issue 2 , July 2021, , Pages 80-81
Abstract
Interleukin-6 is pro-inflammatory cytokine which plays a role in cytokine storm and brought into notice with corona virus disease of 2019. Lymphopenia and dysregulated immune response were seen in the critically ill patients of corona virus disease of 2019. IL-6 inhibitors were proposed as a treatment ...
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Interleukin-6 is pro-inflammatory cytokine which plays a role in cytokine storm and brought into notice with corona virus disease of 2019. Lymphopenia and dysregulated immune response were seen in the critically ill patients of corona virus disease of 2019. IL-6 inhibitors were proposed as a treatment option in this pandemic with a concept that it will reduce inflammation, infection and organ failure. Tocilizumab, a monoclonal antibody against soluble and membrane IL‐6 receptors was considered as forefront treatment option as it was used previously in rheumatologic disorder as a licensed agent. Tocilizumab is an immunosuppressive agent and serious or fatal infections could occur. Presence of superimposed bacterial infections in critically ill patients with corona virus disease of 2019 should be aggressively treated. However clinical experiences showed higher rates of superimposed bacterial infections which renders for extreme caution while prescribing such therapies. Perspective is needed when using the rheumatologic literature of IL-6 into corona virus disease of 2019 and their range observed in these conditions.
Infectious disease
Sohil Pothiawala
Volume 6, Issue 2 , July 2020, , Pages 102-108
Abstract
Introduction: Emerging viral diseases (EVDs) pose a significant threat to public health. There have been a few viral epidemics in the last two decades. Coronavirus disease 2019 (COVID-19) is now a global pandemic.Objective: To provide emergency physicians an update on severe acute respiratory syndrome ...
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Introduction: Emerging viral diseases (EVDs) pose a significant threat to public health. There have been a few viral epidemics in the last two decades. Coronavirus disease 2019 (COVID-19) is now a global pandemic.Objective: To provide emergency physicians an update on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its dynamic impact on the emergency department (ED) in terms of preparedness and management of patients presenting to ED with suspected COVID-19 disease.Discussion: COVID-19 has a human-to-human transmission through close contact and even from asymptomatic carriers. Symptoms are similar to a viral respiratory illness. The disease is mild and self-limiting in most patients, but some develop severe illness like pneumonia, acute respiratory distress syndrome (ARDS) and multiorgan failure. Emergency physicians should prioritize early identification of these patients at risk, isolate them and after collaborating with relevant hospital and national authorities, develop clinical pathways to safely evaluate, manage and dispose patients with COVID-19. Various strategies for managing these patients in the ED are discussed. Disposition of these patients depends on symptoms and hemodynamic status and potential to self quarantine versus admission to an isolation facility.Conclusion: This review provides an overview of patients presenting to the ED with suspected COVID-19 and its impact on the ED. It reiterates the fact that emergency physicians, in close collaboration with relevant hospital authorities, play a pivotal role during EVDs. It emphasizes the need for pandemic preparedness, enabling us to better manage such events in the future.