Advanced Journal of Emergency Medicine最新文献

Introduction: Resilient schools can warranty students' health and survival at disasters. It is obligatory that schools be prepared for natural challenges through local programs. Considering the great population of students, disaster-resilient schools can be a safe and suitable environment for students at the time of disaster.

Objective: This study aims to identify certain operational strategies for establishing schools resilient to natural disasters.

Method: This qualitative study was based on conventional content analysis. Using purposive sampling method, 24 experts in the fields of health in disasters, construction engineering, psychology, teaching, and administrative management participated in the study. Maximum variation sampling continued until data saturation was achieved. The data collected via unstructured interviews were analyzed with Graneheim and Lundmen's conventional content analysis.

Results: Content analysis resulted in four main categories as operational strategies for establishing disaster-resilient schools including: 1) "construction and non-construction optimization", with four subcategories of construct risk management, optimization of construct architecture and physical structure, correct construct localization, and promotion of non-construct safety, 2) "promotion of organizational coordination and interactions" with two subcategories, namely improvement in intra-organizational communication and improvement in extra-organizational communication, 3) "improvement in education" with three subcategories of holding educational courses for families and students, holding educational courses for managers and personnel, and holding simulated exercises, and 4) "process promotion" with four subcategories of increased preparedness, correct planning, creation of organizational structure, and rehabilitation facilitation.

Conclusion: Various factors affecting schools' response to disasters form operational strategies to establish disaster-resilient schools. These strategies influence pre- and post-disaster preparedness. Awareness of these components followed by preparedness prior to disasters can save students' lives, improve school performance after disasters, and aid in establishing disaster-resilient schools as safe lodgings.

Introduction: Repolarization abnormalities such as prolongation of QT interval and changes in ST segment and T wave are the most usual electrocardiogram (ECG) changes in patients with intracranial hemorrhage (ICH). It has recently been recommended that prolonged QTc interval raises the risk of death due to malignant ventricular arrhythmias or sudden cardiac death.

Objective: The goal of this study was to evaluate the relationship between QT interval and death in patients with ICH.

Method: This cross-sectional study was performed on patients with ICH who referred during 2015-2017 to Poursina Hospital, Rasht, Iran. The QT interval was manually measured based on the BAZETT formula. Max QT and Max QTc and QT dispersion were the variables evaluated by the ECG of the patients. The outcome under the study was the death or survival of patients during hospitalization.

Results: Finally, 466 cases with the mean age of 69±12 years were studied of whom 68.7% were male. The average QT-Max interval was 350.4±56.5 milliseconds, and the average QTc-Max was 583.6±57.6 msec. Totally, 22.7% of the patients died. There was a significant statistical relationship between QTc-MAX and death (p=0.001). However, there was no statistically significant relationship between QT-MAX and the outcome (p=0.593).

Conclusion: It is likely that, prolonged QT interval is correlated with in-hospital mortality of patients with ICH. Therefore, it can be expected that assessing ECG abnormalities, especially prolonged QTc could be valuable in these patients.

Context: An emergency is any medical problem that could cause death or permanent injury if not treated quickly. In some occasions, the kind of urgent intervention depends on patient's exact genetic background. Unfortunately, the importance of genes in medical emergencies has been forgotten in recent decades.

Evidence acquisition: In order to find relevant articles, we searched two databases of Pubmed and Embase. The exact words of "genes", "genetics", "epigenetics", "DNA", and "emergency" were used alone and in combination. All studies like randomized clinical trials (RCT), case/controls, case series, case reports, and review articles were studied to find the related data. No time limitation was considered for the studies.

Results: Several aspects of genetic testing are newly considered in emergency departments including cell-free DNA (cfDNA) for disease diagnosis, pharmacogenetics for decreasing the adverse drug effects, and personalized medicine for exact emergency interventions in diseases like Vascular Ehlers-Danlos syndrome (vEDS). Data from genetic testing and genome wide association studies have yielded promising results to make medical emergency interventions more beneficial in the near future.

Conclusion: Taking everything into consideration, several advanced genetic and epigenetic alteration technologies can change emergency medicine for the better. Personalized genetic data of patients can turn emergency medicine to personalized medicine.

Introduction: Acute appendicitis is the most common cause of the abdominal pain in surgery. Despite its significant prevalence, the diagnosis is associated with many problems in some cases, which leads to false appendectomy.

Objective: The aim of this study was to determine the validity of diagnostic tests of mean platelet volume (MPV) and red cell distribution width (RDW), as a new possible tool in the diagnosis of acute appendicitis. Methods: In this study, all patients who referred to the emergency department of Besat Hospital, Hamadan, Iran, in 2015, with abdominal pain and first impression of acute appendicitis, undergone appendectomy, were evaluated. The diagnostic markers of pre-operative and post-operative pathology and the validity of MPV and RDW were determined in diagnosis of acute appendicitis.

Results: Laboratory and clinical data from 438 patients, presenting the signs and symptoms of acute appendicitis with the mean age of 26.51±13.9 years, were examined (55.6% men). The sensitivity, specificity, positive and negative predictive value of MPV in the diagnosis of acute appendicitis were 59.77, 98.66, 99.5 and 34.26 percent, and for the RDW were 57.79, 56.00, 86.07 and 21.98 percent, respectively. The area under the receiver operating characteristic (ROC) curve for RDW and MPV was 0.61and 0.90, respectively. The mean of MPV in patients with normal pathologic outcome was 9.52±1.60 and in patients with acute appendicitis was 7.51±1.22. There was a significant difference between the mean MPV in both groups (p<0.001). The mean of RDW in patients with normal pathology were 13.42±1.97 and 13.05±1.09, in patients with acute appendicitis. There was a significant difference between the mean RDW of the two groups (p=0.009).

Conclusion: MPV and RDW indexes have the potential to be used by the surgeons in diagnosis of acute and perforated appendicitis, especially in adults, in order to reduce unnecessary appendectomy, but MPV is more valid in screening acute appendicitis, compared to the RDW.

Introduction: Pregnancy-associated plasma protein-A (PAPP-A) is a metalloproteinase that plays a role in atherosclerotic plaque destabilization. In recent studies, insulin-like growth factor-1 (IGF-1) has been introduced as a mediator of atherosclerosis. PAPP-A and IGF-1 level may be important diagnostic indicators of acute coronary syndrome (ACS).

Objective: The present study tried to assess the diagnostic role of IGF-1 and PAPP-A biomarkers in ACS spectrum.

Methods: The serum level of IGF-1, PAPP-A and troponin I was determined in 121 consecutive patients with ACS. Relationships were assessed by t-test, ANOVA and the non-parametric equivalent. Accuracy of biomarkers was measured by the area under the ROC curve (AUC) and optimal cut-off points to diagnose STEMI and NSTEMI using Youden index.

Results: In patients with acute ST segment elevation myocardial infarction (STEMI), all of these three biomarkers were significantly higher than those in patients with unstable angina (P= 0.028 for IGF-1, P<0.001 for PAPP-A and Troponin-I). Mean level of IGF-1 in patients with renal failure was significantly higher than that in patients without renal failure (137.9±35.1 vs 105.1±46.9, P=0.003), but PAPP-A and serum Troponin-I level had no significant difference in renal failure groups (P>0.05). ROC curve analysis showed that after Troponin-I, PAPP-A was a good discriminator between patients with STEMI and patients with unstable angina (AUC=0.79). Optimum cut-off value for PAPP-A was found to be 89.2 ng/ml, with sensitivity and specificity of 66.7% and 83.8%, respectively.

Conclusion: PAPP-A can be a novel biomarker for both identification of patients with STEMI and risk stratification in patients with ACS.

Introduction: Chiari malformations are a group of congenital anomalies which involve the hindbrain and the cervical spinal canal.

Case presentation: Here, we describe a patient who presented with acute diplopia and gait unsteadiness which was first deigned with Chiari malformation type-1. However due to progression of the ataxia the full neurologic evaluation was considered which established the diagnosis of spinocerebellar ataxia type 3 (Machado-Joseph-Disease).

Conclusion: We aim to highlight the importance of careful examination in order to avoid misdiagnosis of even rare diseases.

Introduction: Currently, the most available treatment for acute ischemic stroke (AIS) is thrombolytic therapy with recombinant tissue plasminogen activator (r-TPA). A challenge in r-TPA therapy is the prediction of recovery in each case.

Objective: The aim was to find a possible relationship between the cerebral oximetry indexes and the clinical outcome of r-TPA therapy to assess the cerebral oximetry as a non-invasive monitoring agent for therapy.

Methods: The inclusion criteria were all patients with AIS who received r-TPA. The neurologic status was evaluated based on the national institutes of health stroke scale (NIHSS) score at arrival, and after a period of 24 hours. In addition, the levels of brain oxygenation in both hemispheres were measured before and continuously over the first 24 hours after r-TPA injection, using an oximetric sensor in the frontal lobes. The clinical success was defined as a 4-point improvement from the baseline NIHSS.

Results: Total 44 patients with the mean age of 58.2 ± 2.18 years were enrolled, of whom 68.18% were male. Twenty-eight patients remained clinically unimproved and 16 patients were improved. A significant difference was found in the mean surface area under the brain oximetric curve in the 24 hour, in the affected hemisphere in the improved group, compared to the unimproved group (P = 0.007). There was a significant difference between the mean increase in brain oxygenation within 24 hours in the improved and unimproved groups (P = 0.002).

Conclusion: It is likely that, The cerebral oximetry could contribute to predict the likelihood of r-TPA prognosis in patients with AIS.

Introduction: The continuing-to-grow number of older adults with traumatic brain injury (TBI) presenting to emergency departments (EDs) and hospitals necessitates the investigation of TBI in these patients.

Objective: The present study was conducted to investigate the epidemiology of TBI and the factors affecting intracranial lesions and patient outcomes in older adults.

Method: The present retrospective cross-sectional study was performed between March 2016 and March 2018. The study population comprised all TBI patients with a minimum age of 60 years presenting to the ED. The eligible candidates consisted of patients presenting to the ED within 24 hours of the occurrence of traumas and requiring head CT scan as part of their examination. The patients' baseline information was also recorded.

Results: A total of 306 older adult patients with a mean age of 70.61±8.63 years, of whom 67.6% were male, underwent CT scan for TBI during the study period. Falls were the major cause of head injuries, and intracranial lesions were observed in 22.9% (n=70) of the patients. Subdural hematoma (SDH) was observed as the most prevalent injury in 27.6% of the patients, 22.9% (n=16) were transferred to the operating room, and 7.5% (n=23) died. Moreover, the severity of trauma was significantly different between the two genders (P=0.029). Midline shift, SDH, subarachnoid hemorrhage (SAH) and moderate-to-severe head injuries were also significantly associated with poor outcomes (P<0.05).

Conclusion: Death from TBIs was more likely in the patients with SDH, SAH and midline shift or in those with an initial Glasgow coma scale (GCS) of below 13. These predictions are clinically relevant, and can help improve the management of older adults with TBI.

Introduction: Electrolyte disorder is a prevalent complication in multiple trauma patients; nevertheless, the role of chloride has been rarely addressed in literature when evaluating serum electrolytes.

Objective: The present study was conducted to determine the correlation between serum chloride changes and hospital mortality in multiple trauma patients.

Method: The present cross-sectional study measured serum chloride levels in 100 multiple trauma patients upon their admission to the emergency department and 24 hours later. All these patients were followed up in terms of hospital mortality using their medical records. Exact logistic regression was used to measure the effects of independent variables on hospital mortality in the patients.

Results: Hospital mortality was found to be 15 (15%), and the mean serum chloride level to be 106.37±4.53 mmol/l upon admission and 112.18±6.16 mmol/l 24 hours later. Although the univariate analysis suggested that serum chloride levels were independently associated with mortality 24 hours after admission (P=0.005), this correlation was insignificant in the multivariate analysis.

Conclusion: The present study rejected the hypothesis suggesting the potential role of serum chloride levels in predicting hospital mortality in multiple trauma patients.