Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 4 1 2019 08 25 The Current Status of Genes and Genetic Testing in Emergency Medicine: A Narrative Review e10 e10 Seyed-Mohammad-Kazem Aghamir Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran Mehdi Ebrahimi Department of Internal Medicine, Faculty of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran Iran Fatemeh Khatami Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran 2019 07 16 2019 07 24 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. https://fem.tums.ac.ir/index.php/fem/article/view/216 https://fem.tums.ac.ir/index.php/fem/article/download/216/212
level of functional safety to be 51.48%, that of structural safety 33.97%, that of non-structural safety 54.82% and that of overall safety 43.72%. Moreover, an evaluation of the safety level of Iranian health centers in the face of disasters in 2015 reported a functional safety level of 29%, a structural safety level of 36%, a non-structural safety level of 21% and an overall safety level of 29%. The safety levels of healthcare centers in Ilam province were therefore lower than those reported as the national mean safety indices. In addition, the present results were expressed through their root cause analysis. The unsatisfactory preparedness level of healthcare centers in Ilam province on a national scale based on the hazard assessment guidelines developed by the Ministry of Health can be attributed to the following factors: • The very old building structures of the health centers contributing to lower safety and higher risks • Failing to complete the checklists according to the instructions provided for national assessment tools; the checklists should have been completed by skilled, well-educated experts who were informed of how to use the instruments and how to complete the checklists. • The invalidity of the obtained results associated with completing the checklists by experts of the Deputy of Health and subsidiary units, who lacked knowledge about structural engineering and building architecture. In fact, the intrinsic features of some of the instruments required asking for assistance from engineering experts such as architects, civil engineers and urban engineers to complete the checklists; nevertheless, financial limitations prevented the use of specialist expertise. • Failing to take the necessary measures to promote the safety and efficiency of the healthcare centers despite the neglect reflected in the annually-completed preparedness assessment tools; the annual status of safety and preparedness of healthcare centers in Ilam was reported to be unsatisfactory. • As a major component of management, control is a combination of actions required for identifying strengths, weaknesses, threats and opportunities through monitoring and evaluating the processes and solving the system problems by performing appropriate intervention. The improvement of the status quo is not guaranteed unless controls lead to interventions. The results obtained through assessing the preparedness and safety of hospitals appear to have not affected the strategic programs, policies and procedures of the health system authorities in a way that safety levels are enhanced in healthcare facilities. The policy makers are therefore recommended to revise the methods used to take advantage of this information. https://fem.tums.ac.ir/index.php/fem/article/view/227 https://fem.tums.ac.ir/index.php/fem/article/download/227/204