Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 5 1 2020 05 03 e14 e14 Parichehr Pooransari Perinatalogy Department, Shohada-y-Tajrish Hospital, Shahid Beheshti Univetsity of Medical Science, Tehran, Iran Atefeh Ebrahimi Perinatalogy Department, Shohada-y-Tajrish Hospital, Shahid Beheshti Univetsity of Medical Science, Tehran, Iran 2020 05 03 Trauma due to accidents or violence is a common complication during pregnancies. Every woman in reproductive age who has been admitted due to trauma should be considered pregnant until proven otherwise. A multidisciplinary approach is usually warranted to optimize the outcome for both the mother and her fetus and some headlines should always be taken into consideration when dealing with a pregnant trauma patient. In major trauma, obstetrician consultation should be done as soon as possible. You should not delay indicated radiographic studies due to concerns regarding fetal exposure to radiation. It is preferable to perform one computed tomography (CT) scan with iodinated contrast rather than multiple suboptimal imaging procedures without contrast. Physiologic changes during pregnancy put injured pregnant woman at increased risk, necessitates special attention. In this paper we try to overview on some important aspects of a pregnant trauma patient management. https://fem.tums.ac.ir/index.php/fem/article/view/417 https://fem.tums.ac.ir/index.php/fem/article/download/417/289

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 5 1 2020 05 17 e3 e3 Sayed Hamed Khajebashi Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Tayebeh Cholmaghani Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Mohamad Nasr-Esfahani Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran 2020 02 27 2020 04 28 Introduction: Physiologic indexes for therapeutic assessment of shock were introduced long time ago. Recent studies have evaluated central venous pressure (CVP), central venous oxygen saturation (ScvO2), lactate and end-tidal carbon dioxide (ETCO2) levels in this regard. Objective: To understand the potential diagnostic capability of ETCO2 in comparison with ScvO2, CVP and lactate in patients with suspected septic shock, we aimed to compare these parameters through a quantitative resuscitation treatment approach. Methods: In this cross-sectional study, 84 patients with suspected septic shock were selected randomly. All patients underwent quantitative resuscitation treatment approach. The following parameters were measured and recorded at baseline: ETCO2, CVP, ScvO2, mean arterial pressure (MAP), percentage of arterial oxygen saturation (SatO2), blood lactate levels, heart rate (HR), respiratory rate (RR), and the exact amount of urine output. At the time of treatment, and 3 hours and 6 hours after, all of the tests and measurements were re-implemented and registered by an emergency medicine specialist. Results: There was a significant positive correlation between ETCO2 and ScvO2 at all times (baseline: r=0.566, p<0.001; after 3 hours: r=0.409, p<0.001; after 6 hours: r=0.170, p>0.05). Furthermore, there was a significant inverse correlation between ETCO2 and lactate at all times (baseline: r= -0.538, after 3 hours: r= -0.677, after 6 hours: r= -0.799). There was no significant correlation between ETCO2 and CVP at any time (p>0.05). Conclusions: All parameters significantly changed over time, and the correlation between changes in ETCo2, ScvO2 and lactate clearance was significant. https://fem.tums.ac.ir/index.php/fem/article/view/349 https://fem.tums.ac.ir/index.php/fem/article/download/349/297

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 5 1 2020 07 29 e1 e1 EN Parichehr Pooransari Department of Obstetrics and Gynecology, Shohaday-e-Tajrish Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran Guitti Pourdowlat Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2020 07 22 2020 07 29 COVID-19 has currently become a major global health problem. Due to novelty and high morbidity and mortality, there are some important medical challenges to achieve proper management and treatment of the disease. Different pharmaceutical categories have been candidate for viral or cytokine phase control, and in this regard many clinical trials are underway to obtain evidences and acceptable results. One of these compounds is magnesium (Mg) sulfate which may have potential therapeutic effect on the cytokine phase of COVID-19. Mg compounds have long been used in practice under various indications and purposes as supplemental compounds, electrolyte regulation and also prevention of drugs side effects. In addition, the effectiveness of Mg sulfate in controlling asthma attacks, gynecological cases and pre-natalogical problems has also been proven. Herein we briefly reviewed immunomodulatory and respiratory effects of Mg and its potential benefits in COVID-19 treatment. Mg sulfate can be used both systemically and by inhalation, but nebulizer route has potential effect on rapid onset of action on respiratory system and reduced incidence of systemic side effects. To the best of our knowledge, in COVID-19 patients, as other viral infections, airway hyper-reactiveness can be overrepresented. In this regard ventilation improvement and reducing of airway resistance should be considered. Some bronchodilators, such as β2-agonists and anti-muscarinic agents used to relieve these symptoms. Another option has provided for hospitalized patients, is nebulized Mg sulfate. It has been suggested in the literature that Mg sulfate can cause bronchodilation in asthmatic patients by various mechanisms, including by inhibition of calcium influx into the cytosol, prevention of acetylcholine secretion, inhibition of histamine release; and finally, by β2-receptor affinity enhancement, increases bronchodilator effect of β2-agonists. On the other hand, according to some researches, low Mg level is associated with increased inflammatory response.  in vitro studies showed that short-term exposure to Mg sulfate without affecting on viability and function of phagocytes, diminished cytokine gene and protein expression, and consequently could reduce production of TNF-α and IL-6 from neonatal monocytes. Moreover, Mg sulfate can reduce the level of interleukin 1β, that is a potent pro-inflammatory cytokine. Another study of the anti-inflammatory effect of Mg compounds showed that neutralized Mg ions can convert THP-1-derived macrophages to the M2 phenotype (anti-inflammatory macrophages), thereby reduce the production of inflammatory cytokines and enhance the secretion of anti-inflammatory cytokines. As well as, according to in vitro and in vivo studies, Mg sulfate significantly reduces baseline level along with LPS-stimulated cytokine production. Altogether, given that the cytokine phase of COVID-19 plays a very significant role in patient morbidity and mortality, therefore proper management and control of this stage of the disease is important on rescuing patients. It seems that, administration of Mg compounds as an adjuvant treatment may improve this condition of disease. Our preliminary experiences indicated the potential positive effects of Mg sulfate on the improvement process in covid-19. However, in order to achieve more accurate and reliable results, adequate randomized clinical trials are needed. It should be considered that intravenous administration of this drug can be performed only in the intensive care unit (ICU) and or under close observation, but the Inhaler form does not require close monitoring. Moreover, oral Mg supplementation in outpatients may also reduce the inflammatory response in COVID-19 https://fem.tums.ac.ir/index.php/fem/article/view/508 https://fem.tums.ac.ir/index.php/fem/article/download/508/331

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 5 1 2020 08 21 e13 e13 Shahrokh Karbalai Saleh Department of Cardiology, Sina hospital, Tehran University of Medical Sciences, Tehran, Iran Alireza Oraii Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran Abbas Soleimani Department of Cardiology, Sina hospital, Tehran University of Medical Sciences, Tehran, Iran Ehsan Saraee Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Haleh Ashraf Cardiac Primary Prevention Research Center (CPPRC), Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran 2020 08 08 2020 08 13 Cardiovascular diseases, especially ST-elevation myocardial infarction (STEMI), are among the major health concerns in Iran. Although primary percutaneous coronary intervention (pPCI) is performed as the treatment of choice in Iranian hospitals, there is limited data on its efficacy, safety, procedural variations, and clinical outcomes after implementation of the new Protocol-247, which transfers patients with STEMI directly to pPCI-capable hospitals. The Primary Angioplasty Registry of Sina (PARS) is an ongoing prospective hospital-based registry enrolling patient with STEMI undergoing pPCI in Sina Hospital, which is a high-volume referral PCI-capable general hospital in Tehran, Iran. This registry aims to gather high-quality data on patient characteristics, hospital-based quality of care, coronary interventions, and in-hospital as well as long-term clinical outcomes of patients undergoing pPCI due to STEMI. In addition, the findings will be used to identify independent predictors of mortality and adverse events and form the basis of future clinical trials and quality improvement strategies. https://fem.tums.ac.ir/index.php/fem/article/view/531 https://fem.tums.ac.ir/index.php/fem/article/download/531/321

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 5 1 2020 11 05 e15 e15 Ramkumar Swaminathane Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar Thirumoorthy Samy Suresh Kumar Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar Gopikrishna Duvvada Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar Chinnakaruppan Shanmugavel Department of Radiology, Al Khor Hamad Hospital, Hamad Medical Corporation, Doha, Qatar 2020 11 05 Introduction: Foreign body (FB) in throat is one of the common presentations in emergency departments (ED). The foreign body may be stuck in the neck region through ingestion or due to iatrogenic injury. FB ingestion is rare in adults but still occurs. The ED treatment plan for patients suspected to have ingested a foreign body depends on the type and location of the FB, as well as the patient’s condition. In adults, the most common FBs ingested are chicken bone and fishbone. The ingested FB often gets lodged in the oropharynx and cricopharyngeal muscle regions. Case presentation: We report a 15-year-old female patient who presented with a foreign body in the throat. Lateral neck radiograph (LNR) revealed a radio-dense vegetable foreign body in the supraglottic region, lying transversely above the vocal cord. This is an unusual clinical and radiological presentation. A 4-cm long piece of beetroot was removed successfully via direct laryngoscopy under safe procedural sedation. Post-procedure, the patient recovered well, discharged within a few hours. Conclusion: Even though foreign body in throat is a common presentation, we report this case due to its anatomical position, type, size, and the unusual radiological appearance of the FB. https://fem.tums.ac.ir/index.php/fem/article/view/588 https://fem.tums.ac.ir/index.php/fem/article/download/588/325

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 5 1 2020 05 24 e4 e4 Shabnam Asadi School of Medicine, Iran University of Medical Sciences, Tehran, Iran Mohammad Ghadirivasfi Research Center for Addiction and Risky Behaviors, Iran University of Medical Sciences, Tehran, Iran Kaveh Alavi Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran Morteza Hassanzadeh Department of Internal Medicine, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran Fahimeh Hajiakhoundi Department of Neurology, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran Seyed Vahid Shariat Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran 2019 08 08 2020 04 27 Introduction: Many medical diseases and their related signs and symptoms are not identified in routine assessments in emergency departments. Objective: We investigated the prevalence of abnormal findings in physical examination of the patients who were newly admitted to emergency department (ED) of a psychiatric hospital. Methods: We studied 200 patients (143 males, 71.5%) who were recently admitted to the ED of a psychiatric university hospital during a 4-month period in 2018. A thorough physical and neurological examination was performed on each subject. Results: Nearly all of the patients (99.3%) had at least one positive finding in physical (non-neurological) examination and 95% had at least one positive neurological finding. We also found at least one problem in gastrointestinal, respiratory or cardiac system of 22.1%, 24% and 33% of the subjects, respectively. The most frequent findings were in cranial nerve I (30%, more common in substance abuse disorder), and visual acuity (52.6%), as well as recent memory (%68.7), attention (%33.7), orientation to time (%29.5), hypokinetic movements (%28.1, more common in females and psychotic patients), akathisia (41.6%), and skin (%85.1, more common in substance abuse and personality disorders). T wave changes were seen in 31.9% and arrhythmia in 16% of the patients. Conclusions: Abnormal findings in examination of the patients admitted to EDs are very prevalent, but most of the abnormalities are not detected or reported in the routine ward examinations. More emphasis should be placed on the examination of olfactory nerve (especially in patients with substance abuse disorder), cognition (especially in older adults), extrapyramidal system, heart, abdomen and skin (especially in patients with personality disorder) during the first week of admission in a psychiatric emergency setting. https://fem.tums.ac.ir/index.php/fem/article/view/234 https://fem.tums.ac.ir/index.php/fem/article/download/234/333

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 5 1 2020 11 08 e2 e2 EN Pooneh Farshbaf Dadju School of Management and Medical informatics, Tabriz University of Medical Science, Tabriz, Iran 2020 11 08 2020 11 08 Dear Editor in Chief Advanced Journal of Emergency Medicine I am writing you to point to an error in the article written by Shahverdi et al. entitled "Induced Demand after Implementing the Health Reform Plan in Selected Emergency Departments Affiliated to Isfahan University of Medical Sciences: a Cross-Sectional Study", which was published in your Journal. Variables have been proposed to increase the chance of induced demand on both patient and supplier (physicians, service providers and etc.) parts. For example, on the supply-side: "physicians' income, physician/population ratio, price of services, payment methods, consultation time per visit or service, type and size of hospital, and etc." and on the demand-side "patients' insurance coverage and etc.". The study aimed to assess the induced demand after implementing the health reform plan (HRP) in the selected emergency departments, but the findings focus on calculating the percentage of changes in services provided before and after HRP; and it has not been shown that the studied factors have led to induced demand. So, the calculated increases might be due to uncertainty. Furthermore, based on the statistics presented in table1, there is an increase of about 65% in radiographic images, from 0.02 (in 2012-13) to 0.33 (in 2015-2016) image/person, and the mean difference is 0.13. It seems that, there is a miscalculation. The mean difference should be 0.013, and so the increased amount will be 0.033. https://fem.tums.ac.ir/index.php/fem/article/view/589 https://fem.tums.ac.ir/index.php/fem/article/download/589/332

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 5 1 2020 05 25 e5 e5 Saeed Majidinejad Emergency Medicine Department, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Mahdi Ebrahimi Emergency Medicine Department, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Reza Azizkhani Emergency Medicine Department, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Mojtaba Mansouri Anesthesiology Department, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Mahdi Ahmadpour Emergency Medicine Department, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Mehrdad Esmailian Emergency Medicine Department, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Manizhe Pakdel Students Research Committee, Neyshabur University of Medical Sciences, Neyshabur, Iran 2019 12 23 2020 04 07 Introduction: Ketamine is a commonly used medicine for reducing pain and stress in patients, including children in emergency department (ED). The intravenous (IV) injection of ketamine is gold standard though difficult in children, but other routes are also possible. Objective: This study was conducted to compare the effects of the submucosal at different doses versus IV injections of ketamine on sedation with proper consciousness in children candidates for diagnostic-therapeutic procedures in ED. Methods: This randomized clinical trial was conducted with 4 groups; groups 1, 2 and 3 respectively received 4, 3 and 2 mg/kg of submucosal ketamine and group four 1.5 mg/kg of IV ketamine. Eligible subjects selected from 46 patients of children’s age as the candidates for subcutaneous wound healing were randomly assigned to the four groups and followed up 5, 10, 15 and 30 minutes after the injection. The Ramsay score was obtained by measuring the heart rate, the breathing rate, the time to start affecting and duration of the effect. The data were ultimately analyzed in SPSS and Excel. Results: The baseline data were matched and confounding variables eliminated included age, gender, weight and hemodynamics. Compared to other doses of submucosal ketamine, 4 mg/kg was found to exert its effect the fastest (4.08±1.01 minutes) (p<0.05) and for the longest duration (23.09±1.12 minutes) (p<0.05). The Ramsay score in groups 1 and 4, i.e. 5.9, was significantly higher than that in groups 2 and 3 (p<0.05). Conclusions: The results showed that 4 mg/kg and 3 mg/kg of submucosal ketamine are appropriate alternatives to IV ketamine. Although the time to start affecting was shorter in the intravenous group compared to in the other groups, the duration of the effect was the longest with 4 mg/kg of submucosal ketamine. Surgeon satisfaction scores were found to be very good and not significantly different between groups 1, 2 and 4. Vomiting was also prevalent with no significant differences between the four groups. https://fem.tums.ac.ir/index.php/fem/article/view/315 https://fem.tums.ac.ir/index.php/fem/article/download/315/334

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 5 1 2020 05 26 e6 e6 Mehdi Nasr Isfahani Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Farhad Heydari Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Ahmad Azizollahi Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Pegah Noorshargh Young Researchers and Elite Club, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran 2019 07 09 2020 02 01 Introduction: Tubular feeding is used, in patients who cannot take food through their mouths, but their digestive system is able to digest food. This method is safe and affordable for the patient and results in maintaining the function of the digestive system and reducing the risk of infection and sepsis. Objective: The purpose of this study was to compare the three methods of the NG tube placement in intubated patients in the emergency department. Methods: This study is a randomized, prospective clinical trial conducted between 2016 and 2018. 75 patients who had been referred to the emergency department were enrolled in the study and divided into three groups, to have their NG tube insertion using either the conventional method (Group C), or using brake cable (Group B) or applying Rusch intubation stylet (Group S) for highwayman's hitch or draw hitch. Results: The mean duration of NG tube insertion was not significant between three groups (p=0.459), but the mean duration of NG tube insertion in group B was 18.43 ± 2.71 seconds and less than the other groups. NG tube insertion by first attempt in the group B was associated with the highest success rate. There was no significant difference, however, in the success rate in NG tube insertion on first and second attempts (p=0.376, p=0.353). Conclusions: The use of brake cable as a guide wire during insertion of a nasogastric tube increases the success rate on first attempt. No meaningful difference, however, was noted in the overall success rate in NG tube insertion on first and second attempts. https://fem.tums.ac.ir/index.php/fem/article/view/210 https://fem.tums.ac.ir/index.php/fem/article/download/210/335

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 5 1 2020 06 09 e7 e7 Farhad Tavakoli Brain and Spinal Cord Injury Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran Abbas Tafakhori Department of Neurology, Iranian Center of Neurological Research, Imam Khomeini Hospital Complex, Tehran, Iran Jeyran Zebardast Institute for Cognitive Sciences Studies, Tehran, Iran Zahid Hussain Khan Department of Anesthesia and Critical Care, Imam Khomeini Medical Complex, Tehran University of Medical Sciences, Tehran, Iran 2019 10 20 2020 01 27 Introduction: Migraine, is a common neurological disorder, and its pathology and acute treatment has not been determined so far. In the contemporary literature, there is no remedy that can abort an acute episode of migraine. Objective: We aimed to evaluate the effect of transient presser on the middle part of common carotid artery for terminating an acute attack of migraine headache. Methods: It is an interventional study without a control limb, performed on patients within age range of 18-45 years. Patients with established migraine headache based on International Classification of Headache Disorders (ICHD) guidelines, who had no atheromatous plaque in their common carotid arteries were included. Pain intensity was evaluated by Universal Pain Assessment Tools (UPAT). In safe position, applying vital signs monitoring and ipsilateral of headache, a gentle pressure was applied on the common carotid artery, lateral to the cricothyroid membrane and medial border of the Sterno-Cleido-Mastoid (SCM) muscle, by using both index and middle fingers, till the headache was relieved, following which the pressure was maintained for a period of 15 seconds. Then the middle finger was maintained at its position and the index finger slid caudally with the same pressure as far a distance of four centimeters and the pressure withdrawn slowly. After 2 minutes, patients were asked to report any change in headache which was recorded. Results: Totally, 215 patients entered this study. The mean of pain score before and after using the technique regarding to UPAT, was 6.28±1.34 and 0.4±0.64, respectively; Also, the pain decreases equal 5.88 score was significant, special by according sex (p<0.001). No side effect was seen. Conclusions: It seems that pressure on the common carotid artery and extending the pressure caudally, helped a rapid, safe and significant reduction in pain score for patients with acute attack of migraine headache. https://fem.tums.ac.ir/index.php/fem/article/view/267 https://fem.tums.ac.ir/index.php/fem/article/download/267/313

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 5 1 2020 07 19 e8 e8 EN Mustafa Eid Department of Emergency Medicine, Al Ain Hospital, Al Ain, UAE. Maythem Al-Kaisy Department of Emergency Medicine, Al Ain Hospital, Al Ain, UAE. Walaa Regeia Department of Emergency Medicine, Al Ain Hospital, Al Ain, UAE. Hakimuddin Jiwa Khan Department of Emergency Medicine, Al Ain Hospital, Al Ain, UAE. 2020 06 13 2020 07 14 Introduction: COVID-19 is a newly emerging pandemic viral disease. Multiple management guidelines were introduced; nevertheless, their efficacy is still under debate. Thus, the presences of prognostic factors are essential for predicting which patients will need more invasive treatments. Objective: The study aims to investigate the prognostic accuracy of neutrophil-lymphocyte ratio in COVID-19 infection. Methods: This is a prospective study done in Al-Ain Hospital in the United Arab Emirates. All the Covid-19 patients presenting to the hospital were enrolled over 1 month from 20/3 to 20/4/2020. We gathered information about their age, sex, mode of transmission, and calculated their Neutrophils/Lymphocytes ratio (NLR) from the first complete blood picture on admission. We divided the patients into two groups: those whose age was 50 years and above and the those aged less than 50 years. We chose the best NLR cut-off value based on the Youden index and receiver operating characteristic (ROC) curve analysis and the target endpoint was presence or absence of intensive care unit (ICU) admission. Results: The study revealed that 48 patients (14%) needed ICU admission, while 296 patients (86%) were admitted to a ward or quarantine facilities. When the patient's age was > 50, and NLR was ≥ 3.10, it showed a sensitivity of 95.24% and a specificity of 92.86% for predicting the need for ICU admission. When NLR was ≥ 4.21, and the patient's age was < 50, the sensitivity and specificity were 70.3% and 93.7%, respectively. Conclusions: NLR proved to be highly specific and sensitive in helping to identify patients who need more invasive care among people over 50 years of age with COVID-19. https://fem.tums.ac.ir/index.php/fem/article/view/472 https://fem.tums.ac.ir/index.php/fem/article/download/472/318

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 5 1 2020 08 31 e9 e9 Melika Khaleghi-Nekou Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran Ali Moradi Occupational Health & Safety Research Center, Hamadan University of Medical Sciences, Hamadan, Iran Mohammadreza Zafarghandi Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran Ahmad Fayaz-Bakhsh Department of Health Sciences Education Development, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Mina Saeednejad Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran Vafa Rahimi-Movaghar Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran Mahdi Sharif-Alhoseini Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran Esmaeil Fakharian Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran Moein Khormali Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran Mahdi Mohammadzadeh Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran Homayoun Sadeghi-Bazargani Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Hamid Pahlavanhosseini Trauma Research Center, Shahid Sadoughi University of Medical Sciences, Yazd,Iran. Habibollah Pirnejad Patient Safety Research Center, Urmia University of Medical Sciences, Urmia, Iran Aria Rahmani Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran Saeid Soltani Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran Khatereh Naghdi Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran Somayeh Bahrami Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran Melika Ozlaty Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran Payman Salamati Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran 2020 05 12 2020 07 29 Introduction: Injuries cause high rates of mortality and harm to millions of people annually. Objective: The aims of this study were to assess some characteristics of hospitalized trauma patients and determine the variables which were associated with increased rates of mortality. Methods: Data were extracted from the National Trauma Registry of Iran (NTRI) data bank. Among all trauma patients admitted to Sina Hospital, those who had one of the following were registered in the NTRI: hospitalization for more than 24 hours, death less than 24 hours in the hospital, and transferring from the intensive care unit (ICU) of another hospital. Recorded data relating to the interval between 24 July 2016 and 10 October 2019 were analyzed. Results: A total number of 3430 patients were studied, of whom 78 (0.02%) did not survive. The mean age of survivors was 38.4 (±18.5) and it was 58.1 (±23.7) for non-survivors (p<0.001). The mean Glasgow coma scale (GCS) of survivors was 14.9 (±0.7) and it was 11.7 (±4.4) for non-survivors (p<0.001). The most important predictors of death were ICU admission (OR 4.31; 95% CI 1.65-11.26) and not having surgical operation (OR 6.08; 95% CI 2.30-16.03). The injuries with higher injury severity score (ISS) had higher risks of death (OR 1.20; 95% CI 1.06-1.36). Conclusions: In this study, Road Traffic Crashes (RTCs) were the main cause of injuries. The elder age, lower GCS score, ICU admission, higher ISS and not having surgical operation were the worst factors of death. More studies are needed to reveal other prognostic factors of fatal injuries. https://fem.tums.ac.ir/index.php/fem/article/view/427 https://fem.tums.ac.ir/index.php/fem/article/download/427/322

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 5 1 2020 09 21 e10 e10 EN Ali Gur Department of Emergency Medicine, School of Medicine, Ataturk University, Erzurum, Turkey Adem Kose Department of Infectious Diseases, School of Medicine, Inonu University, Malatya, Turkey Hakan Oguzturk Department of Emergency Medicine, School of Medicine, Inonu University, Malatya, Turkey 2020 07 29 2020 09 13 Introduction: Since patients who have undergone liver transplantation should take immunosuppressants for life, the prevalence of systemic infections after this procedure is very high. These infections are associated with increased mortality and morbidity. Objective: This study aimed to investigate the prognostic value of routine biochemistry profile and its relationship with mortality in liver transplant patients admitted to the emergency department (ED) with a suspected infection. Methods: Patients who had undergone liver transplantation were included in the study. The patients were divided into three groups of culture-negative, culture-positive and control. White blood cell (WBC) count, hemoglobin (Hb), platelet (Plt), international normalized ratio (INR), creatinine (Cr), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values as well as vital sign findings were comparatively evaluated in terms of their ability to show the presence of any infection and their correlation with mortality. Results: Totally, 142 patients were enrolled and were divided into the following three groups: 41 cases in culture-negative group, 30 cases in culture-positive group, and 71 cases in control group. There was not any significant difference between study groups in terms of age and sex ratio (p>0.05). The Hb and Plt values ​​of the culture-positive patients were significantly lower, and their INR was significantly higher compared to those in control group (p<0.05). Fever, Hb, Plt, INR, AST and ALT values ​​were factors that had a significant correlation with mortality in patients with an infection whethere culture-positive or culture-negative ones (p<0.05). Conclusions: In patients admitted to the ED with a history of liver transplantation, we recommend the evaluation of vital signs and Hb, PLt, and INR values to determine whether there is an infection or not. We can also state that mortality risk is higher in cases with low Hb and Plt levels and high INR, ALT, and AST values. https://fem.tums.ac.ir/index.php/fem/article/view/516 https://fem.tums.ac.ir/index.php/fem/article/download/516/323

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 5 1 2020 11 01 e11 e11 Reza Jalili Khoshnood Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Davood Ommi Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Alireza Zali Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Farzad Ashrafi Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mohammad Vahidi School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Arash Azhide School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Dorsa Shirini School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Ghazal Sanadgol School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Laya Jalilian Khave School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Shabnam Nohesara Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Science, Tehran, Iran Shahrzad Nematollahi Men’s Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mehran Arab-Ahmadi Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, Iran Misaagh Haji Miragha School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Taha Hassanzadeh School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Reza Taherian Department of Radiology, Hamedan University of Medical Sciences, Hamedan, Iran Maryam Karami School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran Yasaman Keshmiri School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Alireza Fatemi Men’s Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2020 09 01 2020 10 19 Introduction: Following the widespread pandemic of the novel coronavirus diseases (COVID-19), this study has reported demographic and laboratory findings and clinical outcomes of patients with COVID-19 admitted to a tertiary educational hospital in 99 days in Iran. Objective: We aimed to investigate in-hospital death risk factors including underlying diseases and describe the signs, symptoms, and demographic features of COVID-19 patients. Methods: All confirmed COVID-19 cases admitted from 22 February to 30 May 2020 were extracted from hospital records. A follow-up telephone survey was conducted 30 days after discharge to acquire additional data such as survival status. Distribution of demographic and clinical characteristics was presented based on survival status during hospitalization. All analyses were performed using STATA version 14 with a level of significance below 5%. Results: Among 1083 recorded patients, the rate of survival and death was 89.2% (n=966) and 10.8% (n=117), respectively. 62% of the cases (n=671) were male. The mean recovery time was 1.90 (3.4) days in survived cases, which was significantly lower than that in deceased cases 4.5 (5.2) days, p<0.001). A significantly higher rate of death was observed among patients above the age of 60 years (24.8%, p<0.001), cases with hypertension (25.4%, P<0.001) and cases without cough (17 %, p=0.002) but with shortness of breath (16.5%, p=0.001). Conclusions: Our study emphasized the significant effect of different underlying conditions as mortality factors among COVID-19 patients, namely older age spectrum, hypertension, and ischemic heart disease. By acknowledging the epidemiologic pattern and mortality factors, we have more tools to prioritize and make better judgments, and more lives can be saved. https://fem.tums.ac.ir/index.php/fem/article/view/547 https://fem.tums.ac.ir/index.php/fem/article/download/547/324

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 5 1 2020 08 04 e12 e12 EN Masoud Nouri-Vaskeh Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Neda Khalili School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Akbar Sharifi Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Pouya Behnam Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Zahra Soroureddin Cardiovascular Division, Imam Hossein Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran Erfan Ahmadi Ade Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Nastaran Khalili School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Nafiseh Fadavi Department of Pediatric Pulmonology, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Behzad Baradaran Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran 2020 07 09 2020 07 29 Introduction: The rapid worldwide spread, in addition to the morbidity and mortality associated with the novel coronavirus disease 2019 (COVID-19), have raised concern throughout the world. Identifying the characteristics of patients who died of COVID-19 is essential to implement preventive measures. Objective: We aimed at investigating these characteristics among the Iranian population in Tabriz. Methods: In this case series, we analyzed clinical characteristics, laboratory parameters, and imaging findings of 111 patients with a reverse transcriptase-polymerase chain reaction (RT-PCR)-confirmed COVID-19 diagnosis who died during hospitalization. The studied patients had been admitted to the hospital between February 2020 and May 2020. Results: The median age of patients was 73 years (IQR, 62-82 years) and approximately 70% of them were male. The median oxygen saturation on admission was 88% (IQR, 80-92%) and dyspnea, cough, and fever were the most common presenting symptoms. Among comorbidities, diabetes, hypertension, and cardiovascular diseases were more frequently observed among patients who had a fatal outcome. While ground-glass opacity was the most commonly reported finding on chest computed tomography, 5% of the patients had no abnormal finding on imaging. Chloroquine was the most frequently used medication for treatment. Conclusion: Our results showed that the majority of COVID-19 deaths occurred in male elderly with decreased levels of oxygen saturation and elevated levels of lactate dehydrogenase and erythrocyte sedimentation rate on admission. https://fem.tums.ac.ir/index.php/fem/article/view/499 https://fem.tums.ac.ir/index.php/fem/article/download/499/320