Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 4 2022 05 24 e45 e45 Akram Fekry Elgazzar Department of Ophthalmology, Damietta Faculty of Medicine, Al-Azhar University, Egypt Walid Shaban Abdella Faculty of Medicine Al-Azhar University, Damietta, Egypt Ramadan Abdelmoez Farahat Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt 2022 05 09 2022 05 19 War is an organized and prolonged armed dispute between states or nations. It is characterized by high mortality, violence, and social or economic costs. There are multiple causes of war and conflict, including extreme poverty, high unemployment, and social, political, or economic disparities. The incidence of wars has increased since 1950, especially between states. Small Arms Survey reports that warfare kills nearly 133,750 persons, yearly. The rates of disability and death caused by war are more than many major diseases globally. It destroys the healthcare systems and public health services of the included states or societies, which results in more diseases and deaths. https://fem.tums.ac.ir/index.php/fem/article/view/1010 https://fem.tums.ac.ir/index.php/fem/article/download/1010/406

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 4 2022 07 21 e46 e46 Somayeh Mehrpour Department of Anesthesiology and Critical Car, Qom University of Medical Sciences, Qom, Iran Narges Kalhor Student Research Committee, Qom University of Medical Sciences, Qom, Iran Sarah Afshari Student Research Committee, Qom University of Medical Sciences, Qom, Iran Reihane Tabaraii Clinical Research Development Center, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran 2022 07 06 2022 07 07 To the Editor-in-Chief In viral pandemics, the possibility of accompanied bacterial infections is always a serious challenge for health care providers. In the recent pandemic with COVID-19, studies showed an increase in bacterial infections in patients with COVID-19, especially those requiring intensive care unit (ICU) admission. Various meta-analyses have shown that the prevalence of some secondary bacterial infections, especially infection with Mycoplasma pneumoniae, Gram-negative germs like extended-spectrum beta-lactamase, and Klebsiella pneumoniae, has increased significantly. Recent studies have also shown that the pathogens that cause bloodstream infections have changed during the COVID-19 pandemic for a variety of reasons, including the widespread use of antibiotics, the effects of COVID-19 on the immune system, and so on. Increased prevalence of bloodstream infections with Gram-negative bacteria that are resistant to third generation of cephalosporins and carbapenems in patients with COVID-19 has been reported in several studies. Studies have also shown increased isolation of pathogens such as members of the Enterobacteriaceae family, including Klebsiella and Escherichia specimens, from blood cultures of patients hospitalized due to COVID-19. https://fem.tums.ac.ir/index.php/fem/article/view/1038 https://fem.tums.ac.ir/index.php/fem/article/download/1038/416

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 4 2022 03 22 e47 e47 Farhad Heydari Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Mehdi Nasr Isfahani Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Azita Azimi Meibody Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Fleuria Flechon-Meibody Department of Nephrology, French Center for Nephrology and Hemodialysis, Metz, France. Javad Shahabi Department of Cardiology, Cardiovascular Research Institute, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Seyyed Taghi Hashemi Department of Anesthesiology, Anesthesiology and Critical Care Research Center, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Omid Ahmadi Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Neda Al Sadat Fatemi Trauma Registry Center, Isfahan University of Medical Sciences, Isfahan, Iran Khatere Ghaznavi Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran 2021 12 23 2022 03 02 Objectives: Acute kidney injury (AKI) is an independent risk factor in critically ill patients. This study aimed to evaluate the prevalence of AKI in resuscitated cardiac arrest (CA) patients, its potential risk factors, and outcomes of AKI in cardiac arrest survivors. Methods: A hundred and forty-nine cases of post-CA that survived for at least 24 hours, were admitted to three hospitals between 2016 and 2020, were studied. AKI was defined by the RIFLE (Risk, Injury, Failure, Loss, and End-stage) criteria. Baseline demographic data, resuscitation variables, the prevalence of AKI, in-hospital and six-month mortality were collected. Logistic regression evaluated the factors associated with AKI occurrence and mortality. Results: AKI occurred in 59 (39.6%) of the patients. Of these, nine patients (15.3%) required renal replacement therapy (RRT) during their hospital stay. There were 47 (52.2%) in-hospital mortality in patients without AKI and 41 (69.5%) in patients with AKI (P=0.036). Post-CA AKI was significantly associated with six-month mortality (OR 1.65 [1.39-2.88]; p = 0.029). Older age, the higher cumulative dosage of epinephrine during cardiopulmonary resuscitation, post-CA shock, in-hospital CA, PEA/asystole rhythm, longer duration of cardiac arrest, as well as higher admission creatinine and lactate levels were independently associated with AKI, in contrast, higher admission Base Excess level was negatively associated with AKI. Conclusion: AKI occurred in nearly 40% of CA patients. AKI was associated with a higher in-hospital and six-month mortality rates. https://fem.tums.ac.ir/index.php/fem/article/view/920 https://fem.tums.ac.ir/index.php/fem/article/download/920/407

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 4 2022 05 12 e48 e48 Utsav Anand Mani Department of Emergency Medicine, King George’s Medical University, Lucknow, India Mukesh Kumar Department of Emergency Medicine, King George’s Medical University, Lucknow, India Haider Abbas Department of Emergency Medicine, King George’s Medical University, Lucknow, India Pranay Gupta Department of Emergency Medicine, King George’s Medical University, Lucknow, India 2022 03 28 2022 05 03 Objective: Through the reporting of this case series, we aim to establish whether a conservative approach, through managing arrhythmias and vital signs, can be reliably used as a treatment modality for oleander poisoning in developing countries. Methods: This study is a case series of 11 patients who presented with oleander poisoning and were conservatively managed in the absence of standard antidote. Results: All 11 patients treated with conservative approach survived. Conservative approach included use of atropine for management of symptomatic bradycardia followed by Dopamine infusion, correction of serum potassium and magnesium levels, standby defibrillation, and transvenous pacing. Conclusion: The absence of reliable dosage of poison ingested, the lack of facilities for serum digoxin estimation, and the unavailability of digoxin fab antibodies pose challenges for the management of patients with oleander poisoning. Patients can, however, be managed conservatively following the Advanced Cardiac Life Support (ACLS) algorithm in a setting that lacks the standard treatment of this poison. https://fem.tums.ac.ir/index.php/fem/article/view/990 https://fem.tums.ac.ir/index.php/fem/article/download/990/405

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 4 2022 05 15 e49 e49 Ahmad Abbasian Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran Leyla Farshidpour UC Davis School of Medicine, Davis, California, USA Mehdi Chegin Emergency Medicine Department, Imam Khomaini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Talayeh Mirkarimi Emergency Medicine Department, Qazvin University of Medical Sciences, Qazvin, Iran Amin Doosti-Irani Department of Epidemiology, School of Public Health and Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran Hadi Mirfazaelian Emergency Medicine Department, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran 2022 05 15 2022 05 15 Objective: About one out of every 10 patients with chest pain in the emergency department (ED) are finally diagnosed with acute coronary syndrome (ACS). A HEART score of ≤ 3 has been shown to rule out ACS with a low risk of major adverse cardiac events (MACE) occurrence. It has been proposed that a negative CARE rule (≤1), which stands for the first four elements of the HEART score and excludes the troponin assay requirement, may have similar rule-out reliability. This study aimed to externally validate the CARE rule. Methods: In this multicenter, observational study a convenience sample consisting of patients over the age of 15 who had at least one troponin study were included. The performance of the CARE rule at the cut-off ≤1 for MACE prediction was assessed and compared to a HEART score of ≤3 and physicians’ gestalt. MACE was defined as myocardial infarction, coronary angioplasty, coronary artery bypass graft, and all-cause mortality in 6 weeks. Results: The data of 154 patients was analyzed. Of these, 121 patients had a negative CARE score of ≤1 and 33 individuals had a positive CARE score. Of those with a negative CARE score, only 1 (3%) experienced an adverse cardiac event while in those with a positive CARE score, 26 individuals (16.88 %) experienced MACE. The sensitivity of the CARE rule was 96.15% and the specificity was 25% with a negative likelihood ratio (LR-) of 0.15. The indices for HEART score were 88%, 59.69%, and 0.2, respectively. In comparison, physicians' gestalt had a sensitivity of 96%, specificity of 49.22%, and a LR- of 0.08. Of note, utilizing the CARE rule with a cut-off of <3 showed sensitivity of 96%, specificity of 41.86%, and a LR- of 0.1. Conclusion: The CARE rule miss rate in MACE was more than 2% and while its performance was better than the HEART score, physicians’ gestalt outperformed both rules for ruling out MACE. https://fem.tums.ac.ir/index.php/fem/article/view/1014 https://fem.tums.ac.ir/index.php/fem/article/download/1014/418

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 4 2022 06 18 e50 e50 Abdulbary Alhalimi College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia Khalid Almulhim Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia 2022 04 30 2022 06 18 Objective: Emergency medicine (EM) is considered a competitive specialty worldwide with an acceptance rate of 57% in Canada but more competitive in Saudi Arabia with 18.7%. Factors that influenced the applicant’s acceptance include letters of recommendation, interview performance, research experience, and gender. This study aims to determine the factors playing a role in applicants matching to EM residency programs in Saudi Arabia from the view of program directors. Methods: A pilot study was done using a self-administered-questionnaire distributed to EM residency program directors (PDs) in Saudi Arabia in the period of 16-21 November 2021. The data were analyzed using SPSS, and all ethical considerations were ensured. Results: Twenty-seven PDs participated in the study, 19 (70.4%) were males, and most were former PDs (59.3%). The most crucial aspect in the applicant’s acceptance was the excellent impression in the interview (4.00 ± 1.00). The most crucial aspect of recommendation letters was a recommendation from a program director (29.6%), total duration of electives (40.7%) was superior; quality in EM research (29.6%) played a more critical role, and professionalism (29.6%) was the sought factor during the interview. There was no significant influence of the gender or the status of the PD and region of the program on the preference of the applicant’s gender. Conclusion: For those considering EM residency programs in Saudi Arabia, the chance of acceptance can be increased by getting a recommendation from a program director, increasing the duration of electives in EM, focusing on the research quality, and showing professionalism during the interview. https://fem.tums.ac.ir/index.php/fem/article/view/1003 https://fem.tums.ac.ir/index.php/fem/article/download/1003/411

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 4 2022 06 19 e51 e51 Behrooz Hashemi Research Center for Trauma in Police Operation, Directorate of Health, Rescue and Treatment, Police Headquarter, Tehran, Iran Zahra Eshghi Emergency Medicine Department, School of Medicine, Shohadaye Tajrish Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Amir Ghabousian Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Saeed Safari Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2022 01 25 2022 06 19 Objective: Determining the exact underlying etiology of loss of consciousness (LOC) can become a real challenge for physicians due to the broadness of differential diagnoses. The current study aimed to assess the accuracDiler 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 sy