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.

Decisions on life-sustaining treatment depend on evaluating fundamental ethical principles regarding taking human life. This study aimed to compare the Islamic standpoint with secular views on ethical decision-making in end-of-life care. We conducted a scoping review to analyze and compare articles published in 2000-2022, regarding ethical criteria for withdrawing life-prolonging treatments in dying patients, and the final decision-maker in such cases. The main difference between the two viewpoints, however, lies in the perspective that in Islam to save human life is of utmost importance, and therefore the criteria for treatment benefits, indications, and goals should all be evaluated in the light of this profound Islamic concept. The most significant similarity discovered between the two standpoints was that a terminal patient's wish not to prolong the process of dying should be respected, and the physician's opinion in determining the benefit or futility of treatment is of utmost importance. Comparison of Islamic and Secular perspectives about ethical decision-making in end-of-life care regarding life sustaining treatment indicates that benefits of treatments for patients, and healthcare goals are among the major factors in decision-making according to both viewpoints, and patients, their families, physicians, and the medical team are all involved in making the final decision.

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.

Monkeypox (Mpox), an uncommon zoonotic Orthopoxvirus, is commonly manifested by blisters on the skin and has a mortality rate of approximately 0-10%. Approximately two decades after the cessation of global smallpox vaccination, the number of confirmed cases of Mpox has been growing, making it the most common Orthopoxvirus infection. Therefore, in this narrative review, we aimed to shed light on recent advancements in the pathophysiology, transmission routes, epidemiology, manifestations, diagnosis, prevention, and treatment of Mpox, as well as the application of artificial intelligence (AI) methods for predicting this disease. The clinical manifestations of Mpox, including the onset of symptoms and dermatologic characteristics, are similar to those of the infamous smallpox, but Mpox is clinically milder. Notably, a key difference between smallpox and Mpox is the high prevalence of lymphadenopathy. Human-to-human, animal-to-human, and animal-to-animal transmission are the three main pathways of Mpox spread that must be considered for effective prevention, particularly during outbreaks. PCR testing, as the preferred method for diagnosing Mpox infection, can enhance early detection of new cases and thereby improve infection control measures. JYNNEOS and ACAM2000 are among the vaccines most commonly recommended for the prevention of Mpox. Brincidofovir, Cidofovir, and Tecovirimat are the primary treatments for Mpox cases. Similar to other viral infections, the best approach to managing Mpox is prevention. This can, in part, be achieved through measures such as reducing contact with individuals displaying symptoms, maintaining personal safety, and adhering to practices commonly used to prevent sexually transmitted infections.

After the implementation of vaccination against Haemophilus Influenza Type B (Hib), adult patients comprise the majority of patients with acute epiglottitis. Its presentation with stridor mandates swift recognition and intervention to prevent airway compromise and mortality. Here, we present a case of a 44-year-old male with diabetes mellitus who presented with acute onset of shortness of breath and stridor following days of throat soreness and fever. Initial treatment for suspected anaphylaxis provided partial relief, and emergency department evaluation revealed characteristic signs of acute epiglottitis on lateral soft tissue neck x-ray and nasopharyngoscopy. Treatment was initiated with intravenous ampicillin/sulbactam and dexamethasone, and the patient was discharged home on day 4. This case underscores the critical importance of maintaining a high index of suspicion for acute epiglottitis in adults presenting with stridor and respiratory distress. Prompt recognition, airway management, and appropriate antibiotic therapy are paramount in mitigating the potentially devastating outcomes associated with this condition. As demographics shift and vaccination impacts epidemiology, heightened vigilance in emergency settings is essential to improve outcomes in adult patients with acute epiglottitis.

Introduction: Trauma is a significant global public health concern and the leading cause of morbidity and mortality in children. This study aimed to assess the independent predictors of trauma severity as well as mortality in pediatric patients admitted to the intensive care unit (ICU).

Methods: In this cross-sectional study, following the STROBE checklist, we retrospectively analyzed the clinical and baseline characteristics of pediatric patients with trauma injuries admitted to the ICU of Children's Hospital of Zhejiang University School of Medicine, China, over a decade.

Results: 951 pediatric patients with a mean age of 4.79 ± 3.24 years (60.78% Boys) were studied (mortality rate 8.41%). Significant associations were observed between ISS and place of residence (p = 0.021), location of the injury (p = 0.010), year of injury (p <0.001), and injury mechanism (p <0.001). The two independent factors of trauma severity were the year of injury (β = 0.47; 95%CI: 0.28 - 0.65) and injury mechanism (β = -0.60; 95%CI: -0.88 - -0.31). Significant differences were observed between survived and non-survived regarding age (p <0.001), ISS score (p <0.001), time elapsed from injury to ICU (p <0.001), duration of mechanical ventilation (p <0.001), GCS score (p <0.001), and the proportion of patients requiring mechanical ventilation (p <0.001 ). The results of multivariate analysis indicated that age (OR = 0.805; 95%CI: 0.70 - 0.914; p = 0.001) and GCS score at ICU admission (OR = 0.629; 95%CI: 0.53 - 0.735; p < 0.001) acted as protective factors, whereas mechanical ventilation in the ICU (OR = 7.834; 95%CI: 1.766 - 34.757; p = 0.007) and ISS score at ICU admission (OR = 1.088; 95%CI: 1.047 - 1.130; p < 0.001) served as risk factors for mortality.

Conclusion: Automobile-related injuries represent the leading cause of trauma in children, with escalating severity scores year over year among pediatric patients admitted to the ICU with trauma injuries. Based on the findings the independent predictors of mortality of pediatric trauma patients admitted to the ICU were age, GCS score at ICU admission; mechanical ventilation in the ICU, and ISS score at ICU admission. Also, the year of injury and injury mechanism were independent predictors of trauma severity.

Introduction: In January 2020, WHO declared the 2019 Coronavirus Disease (COVID-19) a pandemic. Though COVID-19 vaccines are recommended, ongoing surveillance is crucial due to potential unforeseen events. Evaluation of long-term effectiveness and safety and addressing emerging variants are vital. This study integrates systematic reviews to assess COVID-19 vaccine efficacy, immunogenicity, and safety comprehensively.

Methods: This study was an umbrella review study on the feasibility and effectiveness of vaccines for COVID-19. We conducted a comprehensive search in PubMed, Web of Sciences, and Scopus, using MeSH terms and keywords related to COVID-19 vaccines. Inclusion criteria comprised peer-reviewed systematic reviews and meta-analyses in English, focusing on feasibility and effectiveness. Exclusion criteria targeted non-systematic reviews exclusively on vaccine safety and duplicates. Two independent reviewers screened and resolved discrepancies. Data extraction included key details. Methodological quality was assessed using the ROBIS tool. Data synthesis involves narrative and, if applicable, quantitative synthesis (meta-analysis). Reporting followed PRISMA guidelines.

Results: A total of 32 systematic reviews were included in the study, of which 20 also conducted a meta-analysis. The studies investigated in the included reviews ranged from 7 to 74. The included articles were conducted in various countries around the globe. The findings indicated that COVID-19 vaccines are generally safe and effective for individuals with various medical conditions. The overall risk of bias for the included studies was assessed as low risk.

Conclusion: The study outcomes indicated that mRNA vaccines exhibit a higher incidence of adverse events but demonstrate greater efficacy. Conversely, inactivated and protein subunit vaccines are safer but exhibit lower efficiency. Moreover, the vaccine is considered safe for individuals with specific conditions such as inflammatory bowel disease, solid organ transplant recipients, children, pregnant individuals, and those with hematologic problems. Ultimately, the acceptance of the COVID-19 vaccine among individuals is influenced by various factors, including geographic, socioeconomic, and pandemic-related considerations.