Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 5 2 2020 06 11 e17 e17 Mehdi Pishgahi Cardiology Department, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mahmoud Yousefifard Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran Saeed Safari Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Fatemeh Ghorbanpouryami Cardiology Department, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2020 06 11 Introduction: Being infected with COVID-19 is associated with direct and indirect effects on the cardiopulmonary system and electrocardiography can aid in management of patients through rapid and early identification of these adversities.  Objective: The present study was designed aiming to evaluate electrocardiographic changes and their correlation with the outcome of COVID-19 patients.  Methods: This Prospective cohort study was carried out on COVID-19 cases admitted to the emergency department of an educational hospital, during late February and March 2020. Electrocardiographic characteristics of patients and their association with in-hospital mortality were investigated.  Results: One hundred and nineteen cases with the mean age of 60.52±13.45 (range: 29-89) years were studied (65.5% male). Dysrhythmia was detected in 22 (18.4%) cases. T-wave inversion (28.6%), pulmonale P-wave (19.3%), left axis deviation (19.3%), and ST-segment depression (16.8%) were among the most frequently detected electrocardiographic abnormalities, respectively. Twelve (10.1%) cases died. There was a significant correlation between in-hospital mortality and history of diabetes mellitus (p=0.007), quick SOFA score > 2 (p<0.0001), premature ventricular contraction (PVC) (p=0.003), left axis deviation (LAD) (p=0.039), pulmonale P-wave (p<0.001), biphasic P-wave (p<0.001), inverted T-wave (p=0.002), ST-depression (p=0.027), and atrioventricular (AV) node block (p=0.002). Multivariate cox regression showed that history of diabetes mellitus, and presence of PVC and pulmonale P-wave were independent prognostic factors of mortality.  Conclusions: Based on the findings of the present study, 18.4% of COVID-19 patients had presented with some kind of dysrhythmia and in addition to history of diabetes, presence of PVC and pulmonale P-wave were among the independent prognostic factors of mortality in COVID-19 patients. https://fem.tums.ac.ir/index.php/fem/article/view/470 https://fem.tums.ac.ir/index.php/fem/article/download/470/314

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 5 2 2020 06 21 e23 e23 Mahbube Ebrahimpur Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran Moloud Payab Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular -Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran Mahnaz Pejman Sani Department of Internal Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Bagher Larijani Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran 2020 05 21 2020 06 07 The COVID-19 pandemic is now an international concern. COVID-19 is first reported in Wuhan, China on 31 December 2019 and affects different people in different ways. Evidence suggests that people with underlying disease are at higher risk for more severe disease. People with diabetes are not only more likely than the general population to have COVID-19 but also they are among those high-risk categories that can have serious illness if they get the virus. https://fem.tums.ac.ir/index.php/fem/article/view/442 https://fem.tums.ac.ir/index.php/fem/article/download/442/316

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 5 2 2020 12 17 e16 e16 Abdorreza Naser Moghadasi Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran Nassim Anjidani Medical Department, Orchid Pharmed Company, Tehran, Iran 2020 12 10 2020 12 16 We enthusiastically read Payandemehr et al.’s study, which examined the effect of interferon β-1a (ReciGen, CinnaGen Co., Iran) on the severity of the disease in patients with COVID-19 and revealed that taking interferon β-1a (INF) significantly reduced the duration of hospitalization and the rate of mortality of hospitalized COVID-19 patients. INF is one of the main drugs in patients with relapsing-remitting multiple sclerosis (RRMS), and these patients mainly use this drug for a long time. We decided to examine whether the drug has an effect on the incidence rate of COVID-19 in MS patients and whether it affects the course of COVID-19 in case of infection. In November 2020, 75 RRMS patients treated with INF (ReciGen, CinnaGen Co., Iran) were evaluated for COVID-19. Fifty-seven and eighteen cases were female and male, respectively. Patients had a mean age of 36.9±7.2 years, disease duration of 7.0±4.4 years, and the INF use duration of 3.5±1.7 years. Of these 75 patients, only one patient (1.33%) tested positive for COVID-19. The patient was a 29-year-old female nurse working in the pediatric intensive care unit (ICU) and had been receiving INF for six years since the diagnosis of MS. She developed symptoms of cough, shortness of breath, lethargy, anorexia, constipation, and diarrhea in June 2020. The lung computed tomography (CT) scan indicated mild lung involvement, and the reverse transcription polymerase chain reaction (RT-PCR) test was positive for COVID-19. The patient continued her INF treatment, and the symptoms completely disappeared after five days. The patient did not require to be hospitalized during her COVID-19 infection. Therefore, the hospitalization rate due to COVID-19, hospitalization in the ICU, and mortality rate were zero in INF users. In a study by Sahraian et al. addressing 4647 MS patients revealed that the incidence of COVID-19 was 1.46%, which was similar to our findings concerning patients receiving INF. However, the hospitalization rate in the mentioned study was 25%, which was very different from that of our study. It should be noted that patients were taking a wide range of drugs in the mentioned study, and most of them were taking rituximab. Nevertheless, there was no relationship between the type of the administered drug and the chance of hospitalization in the mentioned study. Our findings suggest that there might be a link between the use of INF and non-hospitalization and lack of mortality in patients with MS infected by COVID-19. The obtained findings are in line with the results provided by Payandemehr et al.’s study. Although our study was observational and did not have a control group, it revealed that the INF administration might reduce the severity of the infection. However, the use of INF did not prevent COVID-19 infection. The positive effect of interferons on reducing the severity of COVID-19 has been indicated in other studies, as well. Considering its positive effect on COVID-19 and the fact that interferons have been used in the treatment of MS disease for many years, more attention should be devoted to administering this drug in patients with MS during COVID-19 as it can significantly reduce the risk of COVID-19 related complications. https://fem.tums.ac.ir/index.php/fem/article/view/608 https://fem.tums.ac.ir/index.php/fem/article/download/608/328

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 5 2 2020 12 20 e24 e24 Sayyed Reza Ahmadi Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Saeideh Anvari Ardakani Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran Navid Kalani Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran Seyed Reza Habibzadeh Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Elnaz Vafadar Moradi Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Mahdi Foroughian Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran 2020 11 04 2020 11 10 Introduction: While our knowledge is limited about COVID-19 immunity, recent cases of reinfection have raised concerns. Case presentation: Here, we report a case of COVID-19 reinfection after three months from recovery in a healthcare worker with negative IgM and IgG at the second infection and positive nasopharyngeal swab Reverse transcription polymerase chain reaction (RT-PCR) test despite being discharged with two negative RT-PCR tests at the first admission. Symptoms at first admission were fever, headache, sore throat, diarrhea, and vomiting and got changed to myalgia and anosmia. Conclusion: The strength of this case report is the long period (three months) between the infection and reinfection while other cases reported in literature were reinfected less than one month after their first infection. https://fem.tums.ac.ir/index.php/fem/article/view/585 https://fem.tums.ac.ir/index.php/fem/article/download/585/329

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 5 2 2021 01 15 e22 e22 Farzaneh Jafari Najafabadi Emergency Medicine Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Majid Shojaee Emergency Medicine Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Negin Mousaeinezhad Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran Omid Azadbakht Department of Radiobiology and Radiation Protection, Behbahan Faculty of Medical Sciences, Behbahan, Iran Ali Arhami Dolatabadi Emergency Medicine Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2021 01 15 Introduction: Limb swelling is among the frequent complaints of patients referring to the emergency room (ER). Objective: We decided to take a step towards facilitating the diagnostic process of patients who refer to ER with such complaint, and find out whether emergency medicine physicians (EMPs) can play an effective role in this regard.  Methods: This was a diagnostic accuracy study in which all patients who referred to the ER with a complaint of unilateral leg swelling were studied. The patients underwent bedside sonography by the researchers, who were emergency medicine physicians (EMPs), and also underwent a second sonography by the in-charge radiologist using the same device and probe. The accuracy of the diagnoses made by researchers was evaluated using the radiologists’ opinion as the gold standard.  Results: In this study, the data of 52 patients were analyzed. In general, the agreement rate between the EMPs and radiologists was 0.863, which indicates a proper agreement. Based on the findings, Kappa agreement for the four differential diagnoses ranged from 0.639 to 0.919 and the AUC was between 0.750 and 0.976.  Conclusions: In this study, the overall agreement between the EMPs and radiologists was appropriate. https://fem.tums.ac.ir/index.php/fem/article/view/629 https://fem.tums.ac.ir/index.php/fem/article/download/629/336

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 5 2 2021 02 14 e25 e25 EN Gopikrishna Duvvada Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar 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 2021 01 23 2021 01 29 Allergic angina is not a rare disease, but it should be recognized at the earliest. We are reporting two cases of anaphylaxis, one with a history of unknown insect bite and the other due to intravenous (IV) contrast, leading to reversible myocardial ischemia, which we managed in our Emergency Department. These two patients clinically improved, and their ST-segment elevation on electrocardiogram (ECG) disappeared after intramuscular adrenaline. Allergic angina is an acute presentation in which anaphylaxis, or allergic insult, causes coronary spasm, which leads to angina. Early diagnosis and management initiation can minimize mortality and morbidity. https://fem.tums.ac.ir/index.php/fem/article/view/643 https://fem.tums.ac.ir/index.php/fem/article/download/643/343

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 5 2 2020 06 14 e18 e18 Iraj Golikhatir Department of Emergency Medicine, Mazandaran University of Medical Sciences, Sari, Iran Behzad Feyzzadeh Kerigh Department of Urology, Mazandaran University of Medical Sciences, Sari, Iran Mohammad Sazgar Department of Emergency Medicine, Mazandaran University of Medical Sciences, Sari, Iran Fatemeh Jahanian Department of Emergency Medicine, Mazandaran University of Medical Sciences, Sari, Iran Touraj Assadi Department of Emergency Medicine, Mazandaran University of Medical Sciences, Sari, Iran Zakaria Zakariae Department of Emergency Medicine, Mazandaran University of Medical Sciences, Sari, Iran Reza Amri Sarokolaei Department of Emergency Medicine, Mazandaran University of Medical Sciences, Sari, Iran Hamed Aminiahidashti Department of Emergency Medicine, Mazandaran University of Medical Sciences, Sari, Iran 2020 01 25 2020 06 07 Introduction: Acute urinary retention due to benign prostatic enlargement is one of the clinical compy invite other experts in this regard. https://fem.tums.ac.ir/index.php/fem/article/view/1152 https://fem.tums.ac.ir/index.php/fem/article/download/1152/433

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 1 2022 07 07 e4 e4 Ali Vafaye Department of Emergency Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Kamran Heydari Department of Emergency Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Hossein Mardanparvar Department of nursing, Faculty of nursing & midwifery, Hormozgan University of Medical Sciences, Bandar Abbas, Iran Ali Alizadeh Kaseb Department of Emergency Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Saeed Safari Men’s Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2022 07 03 2022 07 07 Introduction: Emergency medicine (EM) is a relatively new medical specialty, which concerns patients who need vital and urgent medical care. This study aimed to evaluate the general medicine interns’ attitude in continuing their education in EM residency programs. Methods: This study is a prospective cross-sectional study, which was performed on 180 medical students during their internship using convenience sampling. Data were collected using a valid and reliable researcher-made questionnaire and analyzed using SPSS 26 software. Results: One hundred and eighty medical students in the internship period with the mean of 25.65 ± 2.72 (23 – 46) years were studied (53.3% male; 76.7% single). Only 33 (18.3%) interns indicated their interest in continuing their education in EM residency programs. 30 (16.66) cases were not interested in continuing their education in any residency program (61.1% of whom cited migration as the reason, 13% cited not working as a specialist, 14.8% indicated lack of economic justification, and 11.1% cited other reasons for not wanting to enter residency programs). The mean overall interest score to EM residency program was 59.61 ± 12.66 % (20 – 96.41%). The lowest and highest interest scores obtained in the economic status (47.91 ± 21.13%) and education status (70.59 ± 15.77%) of EM specialty, respectively. The mean overall interest score was not statistically different between male and female students (p = 0.366). There was a significant statistical correlation between gender and type of discipline chosen, and female mostly chose non-surgical disciplines (p = 0.001). Conclusion: The interest of general medicine interns in continuing their education in EM residency program was average. The economic field of EM has been one of the best factors in attracting students to continue their studies in this field. https://fem.tums.ac.ir/index.php/fem/article/view/1034 https://fem.tums.ac.ir/index.php/fem/article/download/1034/414

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 1 2023 01 04 e11 e11 Sakher Awadalla Emergency Department, King’s College Hospital London, Dubai, UAE Ahmed Kamal Mohamed Emergency Department, NMC Royal Hospital Khalifa City, Abu Dhabi, UAE 2022 12 01 2022 12 06 An 8-month-old, male child was brought to the emergency department (ED) by his parents with difficulty of breathing. The child developed shortness of breath for one day with cough, but he had no fever. According to the parents, they did not notice the abdominal distension. The child was born prematurely at 25 weeks of gestation and stayed in the neonatal intensive care unit (NICU) for 2 months. Otherwise, he was healthy with minor repeated chest infections and bronchiolitis. In triage, his vital signs were as follows: heart rate: 180 beats/min; respiratory rate: 35 breaths/min; temperature: 35± C; oxygen saturation: 70%; and his blood pressure was undetected. The child was immediately transferred to the resuscitation room. The primary survey showed that the patient was comatose with a Glasgow coma scale of 3/15, the pupils were brisk with an unstable airway, and there was bilateral diminished air entry. The oxygen saturation did not improve despite assisted ventilation using an Ambu bag. The central and peripheral pulsation was weak with a delayed capillary refill, and the blood glucose level was 9 mmol/L. The abdomen was hugely distended and rigid with minimal rectal bleeding. The patient was immediately intubated and connected to mechanical ventilation with subsequent rising of his oxygen saturation to 100%. A plain chest X-ray examination followed the patient’s intubation. Intravenous access was obtained followed by administration of normal saline (20 ml/kg) with subsequent elevation of the blood pressure (82/50mmHg) and decrease in heart rate (160 beats/minute). Initial arterial blood gases (ABG) analysis after intubation showed pH: 6.6; PaCO2 >150 mmHg; PaO2: 100 mmHg; HCO3: 10mEq/L; and lactic acid: 9 mg/dL. Therefore, a bolus of sodium bicarbonate was given, intravenously. Ventilator parameters were set at the maximum limits to wash out carbon dioxide. Repeated ABG analysis showed pH: 6.7; PaCO2: 135 mmHg; PaO2: 150 mmHg; HCO3: 17 mEq/L; and lactic acid: 6.5 mg/dL. Immediate bedside abdominal X-ray and ultrasonography were carried out to rule out intussusception. The child remained critically ill and unstable with fluctuating vital signs. Despite high ventilator parameters and gasgastric tube suction, the child showed no improvement in the respiratory parameters. The child was then transferred to the operation theatre for decompression laparotomy, which showed small bowel (ileum) ischemia. After surgical decompression, the respiratory parameters improved, and the ventilator parameters were set back to normal settings for the patient’s age and weight. Unfortunately, the child remained critically ill. Then, he developed sepsis and multiple systems organ failure and died after 2 days. https://fem.tums.ac.ir/index.php/fem/article/view/1120 https://fem.tums.ac.ir/index.php/fem/article/download/1120/426

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 1 2022 12 26 e5 e5 Seyedmohammadmehdi Samimiardestani Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran Meisam Sharifi Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran Mehri Farhange Ranjbar Research Center for Trauma in Police Operations, Directorate of Health, Rescue & Treatment, Police Headquarter, Tehran, Iran 2022 12 26 Objective: Due to the important role of police during COVID-19 pandemics and lack of previous studies on the impact of personal protective equipment (PPE) in reduction of COVID-19 infection among police officers, we aimed to investigate the role of using PPE in prevention of COVID-19 infection among Iranian police personnel. Methods: This cross-sectional survey was conducted in Tehran, Iran during January 2021 to November 2022. The study sample consisted of police personnel who were active in field operations. Demographics (age, height, weight, gender, marital status, number of children and underlying diseases) and job characteristics such as frequency and type of operations, involvement of colleagues with COVID-19, and COVID-19 infection history, using PPE, types of used PPE (mask, face shield, gloves, etc), protective strategies (such as social distancing) and COVID-19 vaccination were recorded. Statistical analysis was performed with IBM SPSS Statistics for Windows, version 25. Results: Totally, 340 participants were analyzed (33.54±9.74 years old, 91.2% males), of whom, 150 participants (44.1%) reported at least one episode of confirmed COVID-19 infection. The most common component of PPE used both during operations and daily life was face mask (44.7% and 75%, respectively). The most popular measure with higher adherence compared to others was social distancing with 70% popularity and an adherence score of 5.85±3.74. Three hundred subjects (88.2%) had received at least one dose of COVID-19 vaccine. Among PPE items, using face mask, washing hands with soap, social distancing and vaccination were significantly different between patients with and without prior COVID-19 infection (p>0.05). Conclusion: The findings showed that use of PPE is significantly efficacious in reduction of COVID-19 infection among police officers. Therefore, despite difficulties of using PPE among police forces, it is strongly recommended for virus spread control in this population. https://fem.tums.ac.ir/index.php/fem/article/view/1144 https://fem.tums.ac.ir/index.php/fem/article/download/1144/423

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 1 2023 01 04 e6 e6 Mohmmad Reza Khajavi Department of Anesthesiology, Tehran University of Medical Sciences, Tehran, Iran Sanaz Kharazmi School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Hossein Dialameh Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran Azam Biderafsh Epidemiology and Biostatistics Department, Health Faculty, Tehran University of Medical Sciences, Tehran, Iran 2022 11 06 2022 12 15 Objective: In this randomized clinical trial study, the impact of prophylactic administration of methadone during surgery on postoperative pain and analgesic requirement following cadaveric renal transplantation was assessed. Methods: Ninety patients were randomized to receive either methadone 0.15 mg/kg or 0.15mg/kg morphine after tracheal intubation. Both groups were treated with acetaminophen 1 gr before extubation. Protocol of anesthesia was the same in both groups and the anesthetist was blinded to the study groups. The primary outcome was defined as total opioid consumption during recovery and first day after surgery. Secondary outcomes were pain scores and level of patients’ sedation during the recovery period and first postoperative day as well as opioid-related complications. Results: Data of eighty-five eligible patients were analyzed. The mean pain and sedation scores were lower in the methadone group compared to the morphine group during recovery and the first 24 hours after surgery. The time of first rescue analgesic requirement was later in the methadone group (10.4 vs 6.3 hours). Also, postoperative morphine consumption was significantly less in the methadone group compared to patients receiving morphine (3.5 vs. 6.9 mg; P < 0.001). Conclusion: Intraoperative administration of methadone decreased postoperative pain scores, reduced opioid consumption after surgery and improved level of sedation during the first 24 hours after surgery. https://fem.tums.ac.ir/index.php/fem/article/view/