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 accuracy of a commercially available strip for urine drug screening, in patients presenting with LOC. Methods: One hundred fifty patients with LOC were enrolled in the current cross-sectional study. The diagnostic accuracy of a multidrug urinary strip rapid test was evaluated in comparison to blood analysis as the reference test, and the screening performance characteristics of the rapid test for each substance were estimated. Results: The average age of patients was 46.21±18.59 years (72.67% male). The most frequent false positive results of the test were related to Benzodiazepine (21.5%), Methamphetamine (7.5%), and Tramadol (5.4%), respectively. The screening performance characteristics of the test tape were the best in detection of Amitriptyline with 100.0% (95% CI: 30.99 – 100.0) sensitivity, Cocaine with 100.0% (95% CI: 5.46 – 100.0) sensitivity, and Methadone with 91.54% (95% CI: 81.88 – 96.51) sensitivity, respectively. Conclusion: The current study reveals that employing a urinary strip test for detecting drug intoxication in the setting of emergency department can lead to significant false positive and negative results. Accordingly, relying on a urine drug screen to determine the underlying etiology of LOC should be done with caution. https://fem.tums.ac.ir/index.php/fem/article/view/938 https://fem.tums.ac.ir/index.php/fem/article/download/938/409

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 4 2022 07 21 e52 e52 Alireza Baratloo Research Center for Trauma in Police Operations, Directorate of Health, Rescue & Treatment, Police Headquarter, Tehran, Iran Peyman Saberian Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran Mahdi Rezaie Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran Pirhossein Kolivand Department of Health Economics, Faculty of Medicine, Shahed University, Tehran, Iran Parisa Hasani-Sharamin Tehran Emergency Medical Service Center, Tehran, Iran Maryam Bahreini Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran 2022 07 10 2022 07 17 Objective: This study was implemented to assess various types of violent incidents involving emergency medical technicians (EMTs) working in Tehran, Iran. Furthermore, the characteristics of violent people and possible causes of their violence were assessed. Methods: In this cross-sectional study, 500 EMTs working in the capital city of Tehran were randomly invited. The participants were asked to fill out a questionnaire of workplace violence. Univariate and multivariate logistic regression were also performed for identifying the possible risk factors of violence. In addition, the distribution and association of violence patterns were also analyzed considering demographic features and characteristics of violent people. Results: In total, 320 EMTs with the mean age of 31.8 ± 6.7 years participated, 315 (98.4%) of whom were men. Overall, 279 (87.2%) out of the 320 participants experienced 654 episodes of violence, mostly bullying, in the last 4 months. The relationship between the level of education and experiencing violent incidents was statistically significant (p=0.035). Also, non-Persian EMTs had experienced significantly more violent behaviors than Persian EMTs [171 (91.0%) vs. 108 (81.8%); p=0.016]. Nonetheless, the prevalence of violent incidents was not significantly correlated with marital status, years of work experience, employment situation, and working hours. The odds of facing violent behavior among EMTs with associate degree was 2.9 times higher than those with technical diploma (p=0.048). Furthermore, the odds of experiencing violence among non-Persian EMTs was 2.2 times higher than Persian EMTs (p=0.039). Conclusion: We found that EMTs had faced numerous episodes of violence in their workplace, especially verbal threats, which were more prevalently committed by patients’ relatives during night shifts. https://fem.tums.ac.ir/index.php/fem/article/view/1042 https://fem.tums.ac.ir/index.php/fem/article/download/1042/415

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 4 2022 05 31 e53 e53 Niloofar Mohammadzadeh Department of Health Information Management and Medical Informatics, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran Soheila Saeedi Department of Health Information Management and Medical Informatics, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran Sorayya Rezayi Department of Health Information Management and Medical Informatics, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran 2022 04 18 2022 05 10 Providing early health care services in natural disaster is one of the essential applications of telemedicine. This narrative review aims to investigate the applications, advantages and challenges of telemedicine in natural disaster-stricken areas. Medline (through PubMed), Web of Science (WOS), and Scopus databases were searched for related articles published from beginning to 2022. The keywords used for the search included "telemedicine" and "natural disaster." After removing duplicate papers, irrelevant review articles and letters to editors, 44 relevant papers were selected and reviewed. Information sharing through audio, visual, and data-oriented services is among critical approaches that telemedicine services mainly use. Teleconsultation, tele-education, remote interpretation, tele-psychiatry, and tele-surgery are among measures that can be implemented in emergencies like earthquakes, fires, floods, storms, and drought. The fundamental requirements of a telemedicine-oriented system for providing emergency services in natural disasters include wireless scales, conversation tools, blood pressure monitor, respiratory rate monitor, spo2 sensor, glucometer, portable ultrasound unit, wearable thermometers, virtual stethoscopes, portable three leads electrocardiograph monitor, and digital otoscopes. Simple telemedicine systems can have many advantages in the natural disasters. However, the main challenge in this regard is to adapt the necessary communication systems to a telemedicine paradigm. Another critical challenge is to interpret and apply the summary of acquired information and the inevitable interaction outcomes at the required time and place. https://fem.tums.ac.ir/index.php/fem/article/view/1000 https://fem.tums.ac.ir/index.php/fem/article/download/1000/408

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 4 2022 08 09 e54 e54 Kenzie David Kao Saba University School of Medicine, Saba, Dutch Caribbean, Netherlands Saad Ahmed SUNY Downstate College of Medicine, NY, USA Reshma Pyala Medical University of Lublin, Lublin, Poland Mohammed Alsabri Department of Emergency Medicine, Al-Thawra Modern General Teaching Hospital, Sana’a City, Yemen 2022 07 10 2022 08 09 Since the authoring of the seminal report by the Institute of Medicine (IOM) “To Err is Human: Building a Safer Health System” in 2000, there has been an increased focus on patient safety and the responsibility born by the healthcare system to reduce what are known as adverse events (AE). One of the recommendations of the IOM report was the establishment and development of Incident Reporting System (IRS) that would track AE resulting in serious injury and death. The Joint Commission in the USA similarly requires all hospitals have and use an IRS. The objective of this review is to explore barriers and feature of IRS and patient safety.      https://fem.tums.ac.ir/index.php/fem/article/view/1043 https://fem.tums.ac.ir/index.php/fem/article/download/1043/419

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 4 2022 08 14 e55 e55 Roghayeh Mousazadeh Department of Obstetrics and Gynecology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran Mahnaz Dehdilani Department of Obstetrics and Gynecology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran 2022 06 09 2022 07 13 Evaluation of a pregnant trauma patient (PTP) in the emergency department (ED) is somehow challenging, as two patients should be managed simultaneously. Here, we reviewed recently published articles to provide up-to-date information on the management of PTPs. We examined 35 articles and categorized their topics as follows: trauma severity, management of trauma patients, general approach to pregnant women with trauma, primary evaluation of pregnant women with trauma, breathing and ventilation, airway, circulatory system evaluation simultaneous with bleeding control, uterine replacement, blood transfusion, uterine displacement, cardiovascular resuscitation, defibrillation, pneumatic anti-shock garment, and perimortem cesarean section. Concerning trauma during pregnancy, the basic principle should be successful maternal resuscitation, which is vital for fetus survival. https://fem.tums.ac.ir/index.php/fem/article/view/1023 https://fem.tums.ac.ir/index.php/fem/article/download/1023/420

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 4 2022 06 23 e56 e56 Zahra Ebadi Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran Fereshteh Ghadiri Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran Elnaz Asadollahzade Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran Abdorreza Naser Moghadasi Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran 2022 06 18 2022 06 23 Shortly after the onset of the coronavirus pandemic, different vaccines were developed to combat it. The vaccines had different mechanisms and triggered cellular and humoral immune responses against the virus. In addition to their positive effects, various side effects have been reported for them. They rarely cause severe complications. They can also rarely trigger latent infections. The present case report presents a patient who developed herpes simplex encephalitis after receiving the second dose of the Covaxin (BBV152). https://fem.tums.ac.ir/index.php/fem/article/view/1025 https://fem.tums.ac.ir/index.php/fem/article/download/1025/412

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 4 2022 07 31 e57 e57 Mustafa Eid Emergency Department, Al Ain Hospital, Al Ain, UAE Thiagarajan Jaiganesh Emergency Department, Tawam Hospital, Al Ain, UAE 2022 07 23 2022 07 31 Spontaneous subcapsular renal hematoma is a rare complication with potentially fatal effects in clinical practice. We discuss a case of a patient who arrived at the emergency room with abrupt onset flank discomfort and hematuria. The damaged kidney was effectively embolized by interventional radiology, and the patient quickly recovered. Follow-up tests revealed that the hematoma had shrunk in size. We believe that early arterial embolization should be explored in the care of patients with renal bleeding because it may enhance outcomes. https://fem.tums.ac.ir/index.php/fem/article/view/1054 https://fem.tums.ac.ir/index.php/fem/article/download/1054/417

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 4 2022 05 12 e58 e58 Mohammad Ebrahim Kalantari Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Hossein Savadi Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Hamzeh Sherafati Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Ali Akbar Bagherzadeh Innovative Medical Research Center, Faculty of Medicine, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran Tooraj Zandbaf Department of General Surgery, Faculty of Medicine, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran 2022 05 03 2022 05 03 A 33-year-old woman presented to the emergency department with colicky abdominal pain, nausea and vomiting, constipation, obstipation, and rectorragia. She had a history of similar abdominal pain from a few months ago. She had no history of any specific disease and taking any medication. She had no history of surgery and specific family diseases. Her vital signs on admission were heart rate 90/minute, respiratory rate 18/minute, blood pressure 110/70 mmHg, and temperature of 37.1°C. There were several brown spots on her lips and inside her mouth. On abdominal examination, she had a generalized tenderness, especially in the LLQ. In the digital rectal examination, the rectum was empty. Lab tests showed the following results: leukocyte count 4000/mm3 with 80.9% neutrophils, hemoglobin 12.1 g/dl, platelet 320000/µl, and creatinine 0.6 mg/dl, BUN 14 mg/dl, glucose 152 mg/dl, sodium 137 mEq/L, potassium 4.5 mEq/L. Chest and abdominal radiographs were performed on the patient (Figure 1). No subdiaphragmatic free air was seen in the chest x-ray. The abdominal x-ray showed no air-fluid levels as well as any gas in the rectum. On abdominal and pelvic ultrasound, a moderate amount of free fluid was seen in the abdomen along with jejunoileal intussusception in the LLQ with an intestinal loops thickness increase. https://fem.tums.ac.ir/index.php/fem/article/view/1006 https://fem.tums.ac.ir/index.php/fem/article/download/1006/404

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 4 2022 06 18 e59 e59 Mohammad Mahmoud Bourini Department of Internal Medicine, Almakassed Hospital, Jerusalem, Palestine Basel Bassam Hasasnah Department of Internal Medicine, Almakassed Hospital, Jerusalem, Palestine Afnan W.M. Jobran Faculty of Medicine, Al-Quds University, Jerusalem, Palestine Baraa Matoor Faculty of Medicine, Al-Quds University, Jerusalem, Palestine Amira Yasmine Benmelouka Faculty of Medicine, University of Algiers, Algiers, Algeria 2022 05 24 2022 06 18 A 62 years old Palestinian woman with a history of diabetes mellitus presented to our department with a decrease in urine output since a week with a complete anuria with the onset of bilateral flank pain more prominent in the right side since the last 3 days. The pain was dull in nature, continuous, severe and changing with the position. Other symptoms included epistaxis, anorexia, nausea, and eye redness appearing 10 days before the admission which resolved in 2 days on home remedies (herbal compressor). https://fem.tums.ac.ir/index.php/fem/article/view/1018 https://fem.tums.ac.ir/index.php/fem/article/download/1018/410

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 4 2022 07 06 e60 e60 Jerry W. Jones Chief Instructor, Medicus of Houston, Texas, USA 2022 07 06 2022 07 06 This is the fourth installment in the electrocardiogram (ECG) interpretation series by Jerry W. Jones MD FACEP FAAEM for this journal. At first, he discussed simple atrioventricular (AV) dissociation versus AV dissociation caused by third degree AV block; then, he shares some very important pearls regarding ECG interpretation. And in latest one, he pointed to the importance of Hexaxial Reference Grid. For this paper, some valuable references were reviewed. https://fem.tums.ac.ir/index.php/fem/article/view/1040 https://fem.tums.ac.ir/index.php/fem/article/download/1040/413