Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 2 2022 12 31 e14 e14 Alireza Baratloo Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran 2022 01 29 In 2021, Frontiers in Emergency Medicine published 47 papers on four distinct issues which all are indexed by SCOPUS, Web of Sciences, and some other databases. More than one hundred authors from various nationalities, including the UAE, Egypt, India, Turkey, Yemen, the USA, Palestine, Belgium, and Iran were involved. As is customary, we decided to review our work for the last year and evaluate our strengths and weaknesses. Therefore, we performed a brief appraisal of our published papers. This review may help the authors who are interested in publishing with us to become more familiar with the journal’s aims and scopes, and also the editorial’s priorities and preferences. The year 2021 came to an end with the ongoing COVID-19 pandemic as the hottest topic of research worldwide. We also tried to play our part to overcome the pandemic by publishing relevant and useful papers that we believed could help health systems and bring valuable findings from Iran as one of the most affected countries in the world, followed by neighboring countries and the Middle East region.   https://fem.tums.ac.ir/index.php/fem/article/view/948 https://fem.tums.ac.ir/index.php/fem/article/download/948/386

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 2 2021 12 07 e15 e15 Payman Salamati Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran. Vali Baigi Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran 2021 11 28 2021 11 30 To the Editor-in-Chief We read with interest Chardouli et al.’s paper entitled “A review on using ultrasound for evaluation of pediatric blunt abdominal trauma” and enjoyed it a lot. Now, we intend to add some of the results of our registry to their invaluable article. The National Trauma Registry of Iran was launched in 2016 at Sina Trauma and Surgery Research Center, and 24 different hospitals from various provinces collaborated in this project. Happily, more than 32,000 patients have been included so far, 4603 of which belong to Sina Hospital. Furthermore, ample evidence shows that blunt abdominal injury is one of the most common presentations in the emergency rooms. Hence, we analyzed our data to find the severity of blunt abdominal injuries compared to other injuries. Among 4603 patients, 208 people had blunt trauma, and 17 were in the abdominal region. The mean injury severity score (ISS) of patients with blunt abdominal injuries was 1.5 (standard deviation (SD)=1.1). Also, the mean ISS of patients with abdominal injuries with other mechanisms (other than blunt traumas) was 3.3 (SD=2.5). The difference was statistically significant (P=0.005). Moreover, the median of ISS among patients with blunt abdominal injuries was 1.0 (interquartile range (IQR)=0.0). Also, the median of ISS among patients with abdominal injuries with other mechanisms was 4.0 (IQR=3.0). All in all, our results show that if injuries are classified into two body regions of abdominal and others, and two mechanisms of blunt and others, blunt abdominal injuries can be less severe than injuries caused by other mechanisms and in other body regions. https://fem.tums.ac.ir/index.php/fem/article/view/901 https://fem.tums.ac.ir/index.php/fem/article/download/901/382

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 2 2021 11 03 e16 e16 Kaveh Hedayati Emami Department of Anesthesiology & Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Atabak Najafi Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Mojtaba Mojtahedzadeh Department of Clinical Pharmacy, Pharmaceutical Research Institute, Tehran University of Medical Sciences, Tehran, Iran Reza Shariat Moharari Department of Anesthesiology & Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Arezoo Ahmadi Department of Anesthesiology & Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Hamidreza Sharifinia Department of Anesthesiology & Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Elnaz Vahidi Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran Tayebeh Zarei Department of Anesthesiology & Critical Care, Shahid Mohammadi Hospital, Hormozgan University of Medical.Sciences, Bandar Abbas, Iran Setareh Hedayati Emami Department of Anesthesiology & Critical Care, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran 2021 08 24 2021 08 24 Objective: The present study was conducted to compare mechanically ventilated patients with and without COVID-19 in terms of hemodynamic instability using cardiovascular indicators. Methods: This prospective cohort study assigned intubated and mechanically ventilated patients to two groups, i.e. with COVID-19 and without COVID-19. The hemodynamic parameters measured and compared between the two groups on the first day of ICU admission and the following four consecutive days using an ultrasonic cardiac output monitor (USCOM) included cardiac output (CO), systemic vascular resistance (SVR), stroke volume (SV), flow time corrected (FTc), minute distance (MD) and potential kinetic energy (PKE). Results: Forty-three patients (males: 62.7%) were assigned to the COVID-19 group and 40 (males: 64.1%) to the one without COVID-19. Insignificant differences were observed between the two groups at baseline in terms of the mean homodynamic variables measured using the USCOM (P>0.05). The mean CO increased (P=0.020), the mean SVR insignificantly changed (P=0.267), the mean MD increased (P=0.005) and PKE decreased (P=0.066) in the COVID-19 group during the five days of evaluation. In the same period, the mean CO insignificantly changed (P=0.937), the mean SVR increased (P=0.028) and changes in MD (P=0.808) and PKE (P=0.539) were insignificant in the group without COVID-19. The two groups were not significantly different in terms of the other homodynamic parameters during the follow-up (P>0.05). Conclusion: The five-day changes in the USCOM-measured homodynamic parameters were lower in the group without COVID-19 compared to in that with COVID-19. In the group without COVID-19, no statistically-significant differences were observed between the mean follow-up values of the variables, excluding SVR, and their baseline values. https://fem.tums.ac.ir/index.php/fem/article/view/840 https://fem.tums.ac.ir/index.php/fem/article/download/840/374

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 2 2021 11 14 e17 e17 Laleh Farzadi Cardiology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Shahram Bagheri-Hariri Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran Ali Mehrakizadeh Cardiology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Fatima Ahmed Alshaikh Cardiology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Farnoosh Larti Cardiology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran 2021 07 09 2021 08 18 Objective: This study was conducted to evaluate the association of echocardiographic parameters used in left ventricular (LV) diastology with the early results of non-ST elevation acute coronary syndrome (NSTE-ACS) workup in the hospital. Methods: This cross-sectional study was performed on patients presenting with acute chest pain and a diagnosis of NSTE-ACS including only patients with unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI). All patients underwent transthoracic echocardiography in the emergency room (ER) within 12 hours of the last episode of chest pain. An invasive approach was not uniformly pursued in all of the patients so analysis was performed in two different settings. First, analysis was performed in the patients that underwent coronary angiography (CAG) and echocardiographic data were compared between those with normal and abnormal CAG results. Finally, echocardiographic data of the patients with normal diagnostic results (i.e., normal exercise tolerance test (ETT), myocardial perfusion imaging (MPI) or coronary angiography (CAG) results) were compared with the data of the patients with abnormal test results. Results: Eighty patients with a mean age of 54.43 ± 12.38 years were included in the study, of whom 57 (71.2%) were male. Fifty-three patients underwent CAG. In these 53 patients, there was significant difference in mitral annular velocity in early diastole (e’), ratio of mitral inflow velocity to e’ (E/e’), left ventricular end-diastolic diameter (LVEDD) and left ventricular end-diastolic pressure (LVEDP) between patients with coronary artery involvement and those with normal coronary artery (P<0.05). The area under the receiver operating characteristic (ROC) curve to predict CAG results for e’, E/ e’, LVEDD and LVEDP was more than 0.65. The sensitivity and specificity of the LV diastolic dysfunction for predicting coronary involvement was 94.4% and 35.29%, respectively. Comparison of echocardiographic data between patients with normal test results (non-invasive and invasive) and those with abnormal diagnostic tests showed a significant difference in e’, E/e’, acceleration time of E, LV end-diastolic diameter index, size of interventricular septum and left atrial volume. Conclusion: The results suggest that diastolic dysfunction data can be used as an adjunctive method to evaluate ACS patients in the ER. https://fem.tums.ac.ir/index.php/fem/article/view/793 https://fem.tums.ac.ir/index.php/fem/article/download/793/378

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 2 2021 11 25 e18 e18 Reza Azizkhani Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Asieh Maghami-Mehr Department of Statistics, Yazd University, Yazd, Iran Mehdi Nasr Isfahani Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran 2021 06 26 2021 09 08 Objective: The present study aimed at evaluating the role of training in improving emotional intelligence (EI) skills and assessing its indirect effect on reducing job stress in emergency medicine residents (EMRs). Methods: In the present study, 20 EMRs were trained for EI skills while 22 EMRs received no training. Then, all participants’ EI level and job stress were assessed and compared before and after the intervention using the Bar-On Emotional Quotient Inventory(EQ-I) and the Osipow job stress questionnaire, respectively. Results: The results of the present study revealed that the EI level in the training group with a mean score of 338.27 ± 27.57 was significantly higher than the control group with a mean score of 320.50 ± 28.50 after training intervention (P = 0.043). In addition, job stress in the training group with a mean score of 170.82 ± 16.11 was significantly lower than the control group with a mean score of 183.30 ± 22.21 (P=0.045). Moreover, in the training group, the relationship between EI and job stress was inverse and significant (r = -0.746, P<0.001), but in the control group it was non-significant (r = 0.017, P=0.938). Conclusion: According to the results of the present study, training for EI skills can play a significant role in improving EI and reducing stress in EMRs. https://fem.tums.ac.ir/index.php/fem/article/view/778 https://fem.tums.ac.ir/index.php/fem/article/download/778/381

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 2 2021 01 20 e19 e19 Hossein Alimohammadi Department of Emergency Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Hossein Partovinezhad Department of Emergency Medicine, Ayatollah Mousavi Hospital, Zanjan University of Medical Sciences, Tehran, Iran Ehsan Aliniagerdroudbari School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Sepideh Babaniamansour School of Medicine, Islamic Azad University of Tehran Medical Sciences, Tehran, Iran Effat Partovinezhad Department of Emergency Medicine, Ayatollah Mousavi Hospital, Zanjan University of Medical Sciences, Tehran, Iran Majid Shojaee Department of Emergency Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2021 01 17 2021 01 17 Objective: As nausea is one of the most common annoying symptoms in isolated head trauma (IHT) and needs timely management to prevent further adverse outcomes, this study was performed to compare ondansetron and metoclopramide as therapeutic agents in nauseous IHT. Methods: This study was a double-blind clinical trial. Participants were patients visiting the ED with the chief complaint of nauseous IHT event. Group A received 10mg/2ml of metoclopramide and group B 4mg/2ml of ondansetron through slow intravenous (IV) injection. The primary outcome was the severity of nausea 20 minutes after the intervention based on the visual analogue scale (VAS) score. Results: A total of 130 patients participated in the study (65 in each group). The mean age was 30.5±20.5 years, and 73.1% of the participants were male. The decrease in the mean nausea severity scores was statistically significant in both group A (78.3±9.7 before vs. 29.8±16.8 mm after the intervention; P < 0.001) and group B (78.5±11.1 vs. 27.8±13.9 mm; P < 0.001). There was no significant difference between the mean nausea severity scores of groups A and B before the intervention (P = 0.93) or after it (P = 0.65). The decrease in the severity score of nausea was 48.5 mm in group A and 50.6 mm in group B, with no significant difference between the two groups (P = 0.63). Conclusion: Both Ondansetron and metoclopramide significantly reduced the severity of nausea in patients with mild IHT visiting ED but no treatment arm was superior. Both drugs showed good safety profiles. https://fem.tums.ac.ir/index.php/fem/article/view/630 https://fem.tums.ac.ir/index.php/fem/article/download/630/339

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 2 2022 01 05 e20 e20 Yunus Diler Department of Neurology, University of Health Sciences Umraniye Training and Research Hospital, Istanbul, Turkey Serdar Ozdemir Department of Emergency Medicine, University of Health Sciences Umraniye Training and Research Hospital, Istanbul, Turkey Ibrahim Altunok Department of Emergency Medicine, University of Health Sciences Umraniye Training and Research Hospital, Istanbul, Turkey Serkan Emre Eroglu Department of Emergency Medicine, University of Health Sciences Umraniye Training and Research Hospital, Istanbul, Turkey 2021 10 21 2021 11 29 Objective: To assess changes in blood gas parameters, such as pH, partial carbon dioxide pressure (PaCO2), bicarbonate (HCO3), base deficit, and lactate values, in patients who present to the emergency care unit after a seizure. Methods: This is a prospective study on patients who suffered a generalized tonic-clonic seizure. The demographic and biochemical data of the patients and their blood gas parameters were recorded both at the time of presentation to the emergency department and during the follow-up examination. Results: A total of 68 patients were included in the study. Among the patients, 60.3% (41) were male. The median age of the patients was 43 years (IQR: 29-65.25). The median initial lactate value was 5.7 mmol/L (25th and 75th percentiles: 3.5–8.5 mmol/L). The median follow-up lactate value was 1.8 mmol/L (25th and 75th percentiles: 1.1–2.8 mmol/L). The statistical analysis of the blood gas parameters revealed a statistically significant difference in the pH, PaCO2, base deficit, and lactate values between the initial and follow-up evaluations (P<0.001). Conclusion: The results of our study suggest that metabolic acidosis with high anion gap may develop due to the increase in the lactate levels as a result of a tonic-clonic seizure https://fem.tums.ac.ir/index.php/fem/article/view/882 https://fem.tums.ac.ir/index.php/fem/article/download/882/387

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 2 2022 01 05 e21 e21 Ramin Eskandari Department of Cardiology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran Nasim Torabi Department of Cardiology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran Saba Athari Department of Cardiology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran Yousef Rezaei Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran 2022 01 05 Objective: This study aimed to determine the association between the baseline serum uric acid (SUA) level and the short-term outcomes of patients with acute coronary syndrome (ACS). Methods: In this retrospective, bi-institutional study, patients with a diagnosis of ACS were recruited and followed-up for 30 days regarding the development of major adverse cardiovascular and cerebrovascular events (MACCEs). The associations between the SUA level upon admission and cardiovascular morbidities and patient prognosis were examined using univariate and multivariate analyses. Results: A total of 145 patients with ACS, with a mean age of 67.5±12.2 years, were recruited in this study. The rates of cardiovascular risk factors were higher in patients with elevated SUA levels. A cumulative MACCE was reported in 42 (29%) patients (19.5% in normal individuals and 39.7% in patients with elevated SUA levels, respectively; P=0.007). Based on the receiver operating characteristic (ROC) curve analysis, an on-admission SUA level above 6.9 mg/dL could discriminate patients with MACCE from those without MACCE during 30 days of follow-up (AUC=0.637; 95% CI: 0.553–0.715), with 64.3% sensitivity and 66% specificity. Based on multivariate logistic regression analysis, an elevated SUA level was associated with an increased risk of MACCE (odds ratio, 15.353; 95% CI: 2.026–116.328). Conclusion: In patients with ACS, an elevated baseline SUA level was associated with a higher prevalence of cardiovascular risk factors and morbidities, as well as an increased risk of MACCE in a short-term follow-up.  https://fem.tums.ac.ir/index.php/fem/article/view/932 https://fem.tums.ac.ir/index.php/fem/article/download/932/384

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 2 2022 01 03 e22 e22 Mahmoud Yousefifard Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran Mostafa Hosseini Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Alireza Oraii Department of Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Alexander Vaccaro Department of Orthopedics and Neurosurgery, Rothman Institute, Thomas Jefferson University Philadelphia, USA. Vafa Rahimi-Movaghar Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2021 12 13 2021 12 23 Objective: Assessment of spinal cord injuries (SCI) severity is usually done according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). However, a limitation of ISNCSCI has not been thoroughly evaluate; therefore, a systematic review was performed to gather current evidence on the limitations of the ISNCSCI for assessing SCI. Methods: An extensive literature search was performed using Medline, Embase, Web of Science, Cochrane library, and Scopus for all articles up until the end of 2017 and then was updated to the end of 2020. Data was summarized by two independent reviewers and limitations of the ISNCSCI was further categorized. Results: 31 studies were included in the analysis. The limitations of ISNCSCI were classified into 6 domains: 1) lack of assessment of autonomic nervous system; 2) low value in assessing severity of SCI severity in children; 3) confounding factors which impact outcome are not accounted for by ISNCSCI; 4) lack of an established optimal cut off time point for administering the ISNCSCI; 5) low predictive and diagnostic value for assessing incomplete motor injuries; 6) poor classification and predictive value of the ISNCSCI. Conclusion: Although the ISNCSCI is a commonly used tool to assess the severity of SCI, there are several limitations. https://fem.tums.ac.ir/index.php/fem/article/view/912 https://fem.tums.ac.ir/index.php/fem/article/download/912/383

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 2 2022 01 11 e23 e23 Peyman Saberian Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran Seyed-Hossein Seyed-Hosseini-Davarani Department of Emergency Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Mahtab Ramezani Department of Neurology, Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Sahar Mirbaha Department of Emergency Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mahdi Zangi Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran Sepideh Aarabi Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran 2021 09 17 2021 09 28 Objective: We conducted this study to evaluate the prevalence of concomitant COVID-19 in acute ischemic stroke (AIS) patients admitted to stroke centers of Tehran, Iran. Methods: We conducted a retrospective cross-sectional study in a 45-day period. AIS patients transferred by emergency medical service (EMS) to all medical centers of the city were included. Information was recorded and compared in two groups: patients who tested positive for COVID-19 and those who were negative. Result: Emergency medical technicians (EMTs) screened 348 patients as AIS cases, of whom, AIS was ultimately confirmed in 311 (89.4%) patients; and 58 (18.6%) of the 311 AIS patients were diagnosed with concomitant COVID-19 infection. The National Institutes of Health Stroke Scale (NIHSS) scores of COVID-19 positive AIS patients were significantly higher than non-COVID-19 AIS patients (16.3±3.7 vs. 11.8±4.3; p<0.001). There was also a significant difference in length of hospital stay between the two groups (11.1±1.8 vs. 8.8±4.3 days; p<0.001). However, data showed no significant difference regarding prevalence of in-hospital mortality between the two groups (1.6% vs. 3.5%; p=0.320). Conclusion: Our study results showed that AIS patients with concomitant COVID-19 infection had higher NIHSS scores and longer length of hospital stay compared to patients without concomitant COVID-19 infection. https://fem.tums.ac.ir/index.php/fem/article/view/863 https://fem.tums.ac.ir/index.php/fem/article/download/863/385

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 2 2021 11 25 e24 e24 Ella Bah Faculty of Medicine and Biomedical Sciences, University of Ngaoundere, Garoua, Cameroon Frank Njoume Faculty of Medicine and Biomedical Sciences, University of Ngaoundere, Garoua, Cameroon Laurel Nague Faculty of Medicine and Biomedical Sciences, University of Ngaoundere, Garoua, Cameroon Yvanah Mbozo’o Faculty of Medicine and Biomedical Sciences, University of Ngaoundere, Garoua, Cameroon Astel Dongmo Faculty of Medicine and Biomedical Sciences, University of Ngaoundere, Garoua, Cameroon Emilie Mback Faculty of Medicine and Biomedical Sciences, University of Ngaoundere, Garoua, Cameroon Mercy Berinyuy Faculty of Medicine and Biomedical Sciences, University of Ngaoundere, Garoua, Cameroon Paul Ravana Faculty of Medicine and Biomedical Sciences, University of Ngaoundere, Garoua, Cameroon Souleymanou Kourfed Faculty of Medicine and Biomedical Sciences, University of Ngaoundere, Garoua, Cameroon Rosalie Noah Faculty of Medicine and Biomedical Sciences, University of Ngaoundere, Garoua, Cameroon Leslie Jogo Faculty of Medicine and Biomedical Sciences, University of Ngaoundere, Garoua, Cameroon Ahmed Negida Harvard Medical School, Harvard University, Boston, MA, United States Ignatius Esene Neurosurgery Division, Faculty of Health Sciences, University of Bamenda, Bambili, Cameroon 2021 08 24 2021 09 08 The involvement of medical students in scientific research has been advocated recently in medical education. With the voices calling for evidence-based practice, scientific research skills emerge as a critical factor in preparing future generations of physician-scientists. However, Africa is a developing continent with limited financial resources, economic problems, conflicts, and political instabilities that slow the developments in medical education. The involvement of medical students of Africa in scientific research has taken a new shape recently with the formulation of student interest groups, collaboration based on personal communications, and non-governmental research societies. The present review highlights the importance, challenges, and solutions to involve African medical students in scientific research. https://fem.tums.ac.ir/index.php/fem/article/view/841 https://fem.tums.ac.ir/index.php/fem/article/download/841/380

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 2 2021 11 07 e25 e25 Natan Muluberhan Department of Emergency and Critical Care Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia Semir Abdi Department of Internal Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia Amanuel Alemayehu Department of Emergency and Critical Care Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia Melaku Getachew Department of Emergency and Critical Care Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia 2021 08 29 2021 10 30 COVID-19 is a systemic infectious disease that primarily affects the respiratory system, however, the involvement of  extra-pulmonary systems have also been reported. We report a 25-year-old female patient visited the emergency department with a four-day history of severe burning epigastric pain associated with vomiting. The patient was diagnosed as  severe acute pancreatitis with concomitant critical COVID-19 based on clinical, biochemical, and imaging findings. The patient was managed with antibiotics, anticoagulation and ventilatory support. Despite aggressive treatment efforts, the patient sustained cardiac arrest in the setting of refractory hypoxemia and passed away on day three of her hospital admission. https://fem.tums.ac.ir/index.php/fem/article/view/844 https://fem.tums.ac.ir/index.php/fem/article/download/844/376

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 2 2021 08 01 e26 e26 Hosseinali Abdolrazaghi Department of Hand and Reconstructive Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Maryam Haghshomar Students’ Scientific Research Center, Tehran University ofMedical Sciences, Tehran, Iran Mohaddeseh Azadvari Department of Physical Medicine and Rehabilitation, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran 2021 05 27 2021 06 20 Damage to the brachial plexus branches is one of themost important events during traumatic events, whichmay cause various disabilities. Electrodiagnostic testing is the preferred method to evaluate the extent of damage to the brachial plexus following trauma. The case presented in this paper, is a 26-year-old man who had near normal function of pronator teres and flexor carpi radialis muscles on electrodiagnostic testing following a right upper limb severe blunt injury at the level of his arm. After surgical investigation, we found a rare variation in the proximal part of the median nerve. In this case, branches to the pronator teres muscle and flexor carpi radialis had emerged from the proximal section of themedian nerve in the armregion. This new variation holds important clinical implications especially in trauma patients presenting with weakness in forearmflexion. https://fem.tums.ac.ir/index.php/fem/article/view/764 https://fem.tums.ac.ir/index.php/fem/article/download/764/365

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 2 2021 11 14 e27 e27 EN Moloud Balafar Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran Zahra Parsian Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran Reza Javad Rashid Department of Radiology, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran Navid Elmdust Students Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran Houri Arjmandi Emergency Medicine Department, Qazvin University of Medical Sciences, Qazvin, Iran Hassan Soleimanpour Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran 2021 09 12 2021 09 15 A 47-year-old female with a history of antiphospholipid syndrome and ischemic stroke was presented to the emergency department due to abdominal pain and bloody vomiting. Ultrasonography showed double inferior vena cava and bilateral mild hydronephrosis. Furthermore, the abdominal computed tomography (CT) scan did not show any evidence of urolithiasis. The ultrasound images of distinctive developmental variations of inferior vena cava and other veins are important to be known. Vascular anomalies, although rare, should be taken into account in the differential diagnosis of focal lesions within the abdominal cavity. Double IVC might have been the cause of hydronephrosis in our patient. https://fem.tums.ac.ir/index.php/fem/article/view/855 https://fem.tums.ac.ir/index.php/fem/article/download/855/379

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 2 2022 01 31 e28 e28 Yaman Hukan Emergency Medicine Department, Tawam Hospital, Al Ain, United Arab Emirates Asim Nayeem Emergency Medicine Department, Tawam Hospital, Al Ain, United Arab Emirates Mohsin Malik Emergency Medicine Department, Tawam Hospital, Al Ain, United Arab Emirates 2022 01 30 2022 01 30 A 51-year-old female of Southeast Asian ethnicity was referred to our Neurosurgery service for a newly diagnosed intracranial meningioma. She underwent surgical excision of the tumor and was discharged home on Carbamazepine. Four weeks later, she presented back to our Emergency Department (ED) with fever, generalized rash, and altered mental status. The rash appeared a week prior to the patient’s presentation to the ED, and she complained of spikes of fever for two days. On arrival, her temperature was 41 °C. She was tachypneic at 24 breaths/min, and hypotensive at 95/55 mm Hg, with a heart rate of 120 beats per minute (BPM). Soon after triage, she was moved to the resuscitation room for further assessment and management. On examination, the patient appeared to be in moderate distress, anxious, and slightly confused with a Glasgow Coma Scale (GCS) of 14/15. She had a generalized, macular, pruritic, urticarial rash with irregular confluent margins that was consistent with an allergic reaction. Apart from the above-detailed findings, her examination was unremarkable. There was no mucosal surfaces involvement. Her chest was clear on auscultation. Her abdomen was soft, non-tender, with no organomegaly. No focal neurological deficits were detected. Her investigations included a full septic panel. Laboratory workup revealed elevated Liver Function Tests {Alkaline Phosphatase (ALP) of 120 IU/L (Normal range 35 – 104), Aspartate Transaminase (AST) of 65 IU/L (Normal Range > 32), Alanine Aminotransferase (ALT) of 82 IU/L (Normal Range > 33)}, Lactate Dehydrogenase (LDH) of 367 IU/L (Normal Range 135 – 214), Procalcitonin of 1.01 ng/mL (Normal Range < 0.5), and C-Reactive Protein (CRP) of 150.2 mg/L (Normal Range < 0.5). Of note, she had no Leukocytosis nor eosinophilia. The patient’s empirical treatment plan in the ED included the administration of Intravenous (IV) Fluids, antihistamines, and Ceftriaxone. Upon admission, she was commenced on IV Dexamethasone 4 mg twice a day. Additionally, Carbamazepine was stopped immediately. The day following her admission, the patient’s lab work was repeated, and it showed an improvement in CRP, but most notably, her differential complete blood count revealed eosinophilia of 0.73x10^9/L (Normal Range > 0.7), which further went up to 1.33x10^9/L two days later. She was also reviewed by the dermatologist who agreed with the diagnosis of DRESS. A skin biopsy was proposed. However, the patient did not consent to the procedure. On day 3 of her admission, the patient clinically improved on treatment and remained afebrile and vitally stable. She was therefore discharged home with a follow-up clinic appointment. Written patient consent for publishing the case with no identifiable personal information was obtained. https://fem.tums.ac.ir/index.php/fem/article/view/949 https://fem.tums.ac.ir/index.php/fem/article/download/949/388

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 2 2022 02 10 e29 e29 Jerry W. Jones Chief Instructor, Medicus of Houston, Texas, USA 2022 02 10 2022 02 10 This is the second installment in the electrocardiogram (ECG) interpretation series by Jerry W. Jones MD FACEP FAAEM for this journal. In the previous installment, he discussed simple atrioventricular (AV) dissociation versus AV dissociation caused by third degree AV block; in this issue, he also shares some very important pearls regarding ECG interpretation. https://fem.tums.ac.ir/index.php/fem/article/view/959 https://fem.tums.ac.ir/index.php/fem/article/download/959/389