Archives of Academic Emergency Medicine最新文献

Introduction: Automatic systems based on Artificial intelligence (AI) algorithms have made significant advancements across various domains, most notably in the field of medicine. This study introduces a novel approach for identifying COVID-19-infected regions in lung computed tomography (CT) scan through the development of two innovative models.

Methods: In this study we used the Squeeze and Excitation based UNet TRansformers (SE-UNETR) and the Squeeze and Excitation based High-Quality Resolution Swin Transformer Network (SE-HQRSTNet), to develop two three-dimensional segmentation networks for identifying COVID-19-infected regions in lung CT scan. The SE-UNETR model is structured as a 3D UNet architecture with an encoder component built on Vision Transformers (ViTs). This model processes 3D patches directly as input and learns sequential representations of the volumetric data. The encoder connects to the decoder using skip connections, ultimately producing the final semantic segmentation output. Conversely, the SE-HQRSTNet model incorporates High-Resolution Networks (HRNet), Swin Transformer modules, and Squeeze and Excitation (SE) blocks. This architecture is designed to generate features at multiple resolutions, utilizing Multi-Resolution Feature Fusion (MRFF) blocks to effectively integrate semantic features across various scales. The proposed networks were evaluated using a 5-fold cross-validation methodology, along with data augmentation techniques, applied to the COVID-19-CT-Seg and MosMed datasets.

Results: experimental results demonstrate that the Dice value for the infection masks within the COVID-19-CT-Seg dataset improved by 3.81% and 4.84% with the SE-UNETR and SE-HQRSTNet models, respectively, compared to previously reported work. Furthermore, the Dice value for the MosMed dataset increased from 66.8% to 69.35% and 70.89% for the SE-UNETR and SE-HQRSTNet models, respectively.

Conclusion: These improvements indicate that the proposed models exhibit superior efficiency and performance relative to existing methodologies.

After a burn injury, pre-hospital care, which includes first aid measures before transfer to a burns center, is considered to be a significantly important step in the process of burn treatment. Individuals who receive medical care at a hospital following initial first aid administered at home experience a better outcome. This letter aimed to discuss about the importance and obstacles of prehospital management of burn injuries.

Aortic dissection (AD), a life-threatening cardiovascular emergency, is characterized by the separation of the aorta's inner and middle layers due to a tear in the intima. It is classified as Stanford type A or B based on the tear's location and extent. Symptoms vary but commonly include severe pain in the chest, back, or abdomen, along with atypical presentations such as shock, heart failure, or syncope. End-organ ischemia, including stroke and limb necrosis, may occur. Timely diagnosis and intervention are crucial for survival. Here, we report a 31-year-old male patient who presented with acute neurological symptoms, initially suspected of having a stroke, but was ultimately diagnosed with Stanford type A AD upon computed tomography (CT) angiography. This case underscores the importance of considering AD in the differential diagnosis of patients with neurological symptoms for accurate and prompt management.

Introduction: Traumatic optic neuropathy (TON) is a serious condition resulting from optic nerve injury, often due to head trauma. This study systematically reviews the existing literature to evaluate the effectiveness of various treatments in improving visual outcomes in TON patients.

Methods: A comprehensive literature search was conducted across databases including Medline (via PubMed), Web of Science, Cochrane Library, and EMBASE from January 1992 to October 2024. Studies were selected based on inclusion criteria that focused on TON patients treated with corticosteroids, conservative therapy, erythropoietin therapy, or surgical interventions. Quality assessment of the included studies was performed using the Joanna Briggs Institute (JBI) Risk of Bias Tool for each design. Data extraction and quality assessment were performed by two independent reviewers, with a meta-analysis conducted to evaluate the pooled visual acuity (VA) improvement rates.

Results: A total of 23 studies were included, encompassing 1,851 patients with TON. The meta-analysis revealed a pooled VA improvement rate of 50.6% across all treatment modalities. Specifically, corticosteroid-only treatment resulted in a 56.2% improvement rate, while combined corticosteroid and surgical decompression showed a 42.9% improvement rate. Conservative therapy had a 47.8% improvement rate. The heterogeneity among studies was significant (I²= 89.9%), and no significant publication bias was detected. Subgroup analyses indicated varied outcomes, with some studies reporting better results with early intervention.

Conclusion: The treatment of TON remains challenging, with no single modality showing clear superiority. The corticosteroids and surgical interventions provide potential benefits; however, conservative therapy might be appropriate for certain cases. Future research should focus on optimizing treatment protocols and exploring new therapeutic options, such as erythropoietin to improve visual outcomes in TON patients.

Introduction: Torsade de pointes (TdP) is a deadly complication from drug-induced QT prolongation. Each of the 12 lead of an electrocardiogram (ECG) has a different length of QT interval, and thus might have a different performance in TdP prediction. This study aimed to determine the best ECG lead or set of leads in this regard.

Methods: This is a comparative prognostic accuracy study using a two-gate data gathering design. The population in this study was from two sources, a case group (Patients who had drug-induced TdP, which were identified through a systematic Medline search) and a control group (those who overdosed on QT-prolonging drugs, which included patients who were under the consultation of Medical Toxicology Services). The areas under the receiver operating characteristic curve (AUROC) of heart rate-corrected QT (QTc) in each single ECG lead and of a mean/median QTc from a set of ECG leads (17 index test) in predicting the risk of TdP were calculated and compared with each other, trying to find the best lead for this propose. QTc Interval measurements were done by four investigators (Interrater reliabilities 0.95).

Results: Finally, we included 136 and 148 ECGs from TdP cases and controls, respectively. V3 lead had the highest frequency of longest QTc interval, among the leads. The lead having the longest QTc yielded the greatest AUROC in predicting TdP regardless of QT correction formulas (QTcFRA=0.9915, QTcRTH=0.9893, QTcBZT=0.9904). The mean QTc of 3 leads (lead II, plus any two of leads V2-V4), and a median QTc of 6 leads (I, II, aVF, V2, V4, V6) provided similar overall performance for TdP prediction (regardless of the type of QTc formula).

Conclusion: The longest QTc provided the greatest AUROC in predicting drug-induced TdP, however, the longest QTc is not located in a fixed individual lead in any patient. A less time-consuming method with comparable performance to that of the longest QTc was to use a mean QTc from 3 leads (lead II, plus any two of leads V2-V4). The potential clinical impact of this finding needs to be verified in a prospective cohort study.

Foreign body airway obstruction (FBAO) frequently occurs unwitnessed. In the absence of external assistance and the ability to rapidly reach help, immediate self-management of FBAO could be the only way to avoid impending death from asphyxia. In this letter, relevant evidence of real-life self-management of severe FBAO from public comments posted on social media were gathered and reported. The results indicate that in cases of severe FBAO, laypeople apply self-management maneuvers notwithstanding that self-help is omitted from the current resuscitation guidelines.

Introduction: Adequate knowledge and positive attitude among nurses are essential for successful pain management as a fundamental aspect of patients' rights. This study aimed to assess the knowledge, attitude and perceived barriers of nurses regarding acute pain management in emergency department.

Methods: In this cross-sectional study, participating nurses were selected using a consecutive sampling technique within a medical university. Data were collected using 4 questionnaires, which consisted of demographic information checklist, Pain Management Principles Assessment Tool (PMPAT), Nurses' Attitude Survey (NAS), and Nurses' practice checklist. The correlation between knowledge, attitude, and barriers with each other and with baseline characteristics of participates were studied.

Results: 400 nurses with the mean age of 38.26±10.39 years were studied (63% male). The average knowledge score of studied nurses was 7.38 ± 2.16 (range: 1 -14). All 400 (100%) nurses exhibited a low level of knowledge. The mean attitude score of participants was 58.47± 22.08 (range:26-100). 214 (53.5%) cases had low attitude, 44 (11.0 %) average attitude, and 142 (35.5%) cases exhibited a high attitude score. The mean score of barriers about pain management was 36.48 ± 23.52 (range: 0 - 80). 23 (5.8%) participants answered the perceived barriers as never, 113 (28.3%) as seldom, 71 (17.8%) as sometimes, 133 (33.3%) as often, and 60 (15.0%) as routine. There was an reverse relationship between the knowledge score and perceived barriers of pain management (r=-0.164, p<0.001). No significant relationship was found between the average knowledge score and nurses' attitudes (r = 0.092; p > 0.065).

Conclusions: The findings of this study highlight the need for ongoing training and the organization of workshops for nurses due to their low levels of knowledge and attitude. These training sessions should focus on the concept of pain, assessment methods, pain relief, as well as pharmacology and the physiology of pain.

Introduction: In infectious diseases, there are essential indices used to describe the disease state. In this study, we estimated the basic reproduction number, R0, peak level, doubling time, and daily growth rate of COVID-19.

Methods: This ecological study was conducted in 5 provinces of Iran. The daily numbers of new COVID-19 cases from January 17 to February 8, 2020 were used to determine the basic reproduction number (R0), peak date, doubling time, and daily growth rates in all five provinces. A sensitivity analysis was conducted to estimate epidemiological parameters.

Result: The highest and lowest number of deaths were observed in Hamedan (657 deaths) and Chaharmahal and Bakhtiari (54 deaths) provinces, respectively. The doubling time of confirmed cases in Kermanshah and Hamedan ranged widely from 18.59 days (95% confidence interval (CI): 17.38, 20) to 76.66 days (95% CI: 56.36, 119.78). In addition, the highest daily growth rates of confirmed cases were observed in Kermanshah (0.037, 95% CI: 0.034, 0.039) and Sistan and Baluchestan (0.032, 95% CI: 0.030, 0.034) provinces.

Conclusion: In light of our findings, it is imperative to tailor containment strategies to the unique epidemiological profiles of each region in order to effectively mitigate the spread and impact of COVID-19. The wide variation in doubling times underscores the importance of flexibility in public health responses. By adapting measures to local conditions, we can better address the evolving dynamics of the pandemic and safeguard the well-being of communities.

Introduction: Acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH) are among the acute cerebrovascular diseases (CVDs) that have been reported as a result of COVID-19. It will be a significant step forward if our research helps improve the compilation and analysis of existing data from other studies.

Methods: The study is registered on PROSPERO with an ID of CRD42023464058. It encompasses articles published until December 2023 and involves searching databases such as PubMed, Scopus, Web of Knowledge, Embase, and Cochrane. Additionally, we conducted manual searches in respected publications within this discipline, utilized the Google Scholar search engine, and conducted reference checks, citation checks, and study of gray literature. The publications' reporting quality was assessed using the "Assessment of Multiple Systematic Reviews" (AMSTAR) checklist. The meta-analysis was conducted using Stata software (StataCorp, version 16).

Results: We analyzed the findings of 23 meta-analyses, which included 795 articles and encompassed 5,937 patients who had previously experienced a stroke. The average age of these patients was 62.3 years, and 68.3% were male. The findings indicated that the collective incidence of stroke among individuals with COVID-19 is roughly 1.75% [95% confidence interval (CI): 0.4%-3.03], with 1.59% for ischemic strokes and 0.3% for hemorrhagic strokes. 32.3% (95% CI: 27.8%-36.9%) of COVID-19 patients with stroke passed away, approximately 27% were discharged from the hospital with very mild or no complications, and around 28.1% (95% CI: 14.1%-42.1%) were referred for rehabilitation.

Conclusions: The overall rate of stroke in COVID-19 patients was approximately 1.75%, with a higher incidence in males and those with an average age of 62.3 years. Almost 80% of the strokes were ischemic, and the mortality rate was approximately 32%. Finally, 27% of the patients were discharged without complications, and 28% required rehabilitation.