Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 4 2023 11 24 e33 e33 Esmaeil Gharepapagh Medical Radiation Sciences Research Team, Tabriz University of Medical Sciences, Tabriz, Iran. Kamaleddin Hassanzadeh Urology Department, Tabriz University of Medical Sciences, Tabriz, Iran. Amir Ghabousian Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Faezeh Tarighat Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Seyed Pouya Paknezhad Emergency and Trauma Care Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Moloud Balafar Emergency and Trauma Care Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Robab Mehdizadeh Esfanjani Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Hassan Soleimanpour Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. 2023 06 29 2023 11 03 Objective: Urolithiasis is responsible for the majority of urological emergencies. Although computed tomography (CT) scan can identify urinary obstruction caused by stones, there is a growing concern about exposure to radiation made by this method. Renal scintigraphy can provide valuable insights regarding the functional status of kidneys and can significantly reduce exposure to radiation. The goal of present study was to assess renal function through renal scintigraphy in patients with acute renal colic and it explores the association between renal scintigraphy performance and ultrasound in terms of detecting hydronephrosis. Methods: For this study, 20 patients with acute renal colic were chosen. Each patient underwent renal ultrasonography and subsequently received renal scintigraphy with Technetium-99m diethylenetriaminepentaacetic acid (Tc-99m DTPA). Cohen's Kappa coefficient and Cramer's V correlation were employed to demonstrate the extent of agreement between ultrasound and renal scintigraphy. Results: 12 (60%) patients were male. Glomerular filtration rate (GFR) values were correlated with Cockcroft-Gault equation and the Gates method (P=0.002, r=0.642). There was a good agreement and a statistically significant relationship between ultrasound and renal scintigraphy in terms of detecting obstructive uropathy in both kidneys. Conclusion: To conclude, GFR values were correlated between Cockcroft-Gault equation and the Gates method in patients with acute renal colic. There was a good agreement and statistically significant relationship between ultrasound and obstructive renography results in both kidneys. However, we found no association between perfusion phase of renal scintigraphy and ultrasonography in terms of hydronephrosis detection. https://fem.tums.ac.ir/index.php/fem/article/view/1240 https://fem.tums.ac.ir/index.php/fem/article/download/1240/457

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 4 2023 11 28 e39 e39 Aarti Vaid Department of Internal Medicine, Postgraduate Institute of Medical Science and Research, Chandigarh-12, India Ashish Behera Department of Internal Medicine, Postgraduate Institute of Medical Science and Research, Chandigarh-12, India Navneet Sharma Department of Internal Medicine, Postgraduate Institute of Medical Science and Research, Chandigarh-12, India 2023 04 19 2023 10 03 Hyperhomocysteinemia as a hypercoagulable state has been debatable, but when associated with other highrisk factors like severe vitamin B12 and folate deficiency, smoking, high altitude, and antiphospholipid syndrome can present with thromboembolism. Vegans are at high risk of severe B12 deficiency as the primary source is animal products. Right now, the total number of vegans, vegetarians, and all related categories, is close to 14 per cent of the world population. We here present a young vegan with severe B12 deficiency presenting with sub-massive thromboembolism. https://fem.tums.ac.ir/index.php/fem/article/view/1200 https://fem.tums.ac.ir/index.php/fem/article/download/1200/459

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 4 2023 12 02 e38 e38 EN Adel Eftekhari Health in Emergencies and Disasters, Department of Nursing, Meybod School of Nursing, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Tahereh Sharifi Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran Najmeh Baghian Trauma Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Roohollah Askari Department of Health Management and Economics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 2023 04 29 2023 11 11 Objective: The prehospital emergency system, as the front line of the health system, has played a very prominent role in the management of the COVID-19 pandemic. Given that identifying the challenges of this area in facing various crises, especially COVID-19, can be a road map for preparing and planning for crisis management in the future, the current study was conducted with the aim of identifying the challenges of prehospital emergency in facing the corona pandemic. Methods: The present systematic review was carried out based on the PRISMA protocol. The search was conducted using the keywords “challenges, obstacles, prehospital emergency and COVID-19” in PubMed, Scopus, and Web of Science databases, and Google Scholar search engine between December 15, 2019 and March 20, 2023. Non-English articles and articles outside the scope of the COVID-19 pandemic were excluded from the study. CASP (critical appraisal skills program), JBI (Joanna Briggs institute) and MMAT (mixed methods appraisal tool) checklists were used to evaluate the quality of the articles. Results: Based on the searches, 12 articles were finally evaluated. Challenges extracted from the analysis of studies were classified into 3 main categories and 7 subcategories including the main categories of “process, structural, and psychological challenges” and the subcategories of “lack of equipment, inappropriate management of human resources, deficiencies in protocols and instructions, weak staff training, occupational burnout, and weak socio-organizational support”. Conclusion: The prehospital emergencies of the countries have faced some challenges after the outbreak of COVID-19, which requires the implementation of adaptive strategies and the efforts of the authorities to solve them to prepare for similar crises.  https://fem.tums.ac.ir/index.php/fem/article/view/1211 https://fem.tums.ac.ir/index.php/fem/article/download/1211/462

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 4 2023 12 13 e32 e32 Hadi Mirfazaelian Emergency Medicine Department & Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran. Venkatesh Thiruganasambandamoorthy Department of Emergency Medicine, School of Epidemiology and Public Health, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada. 2023 12 03 2023 12 04 To the editor-in-chief Emergency medicine (EM) is one of the most difficult fields of medicine, and specialists in this field should handle different tasks, simultaneously. According to some reports, this group has the highest burnout level among different medical specialities. It is necessary for the professionals in this field to zoom out once in a while. Sabbaticals are good opportunity for this purpose among academics. This period not only provides a time window to get away from work stress, it also helps to broaden people's view via learning new materials. Over one year, September 2022 – August 2023, I completed my Master of Science in epidemiology degree at the University of Ottawa. In addition, the work at the Ottawa hospital research institute (OHRI) which is well known across the world for its excellence in EM research provided me a unique opportunity to participate in some research studies. I detail a few observations below. https://fem.tums.ac.ir/index.php/fem/article/view/1310 https://fem.tums.ac.ir/index.php/fem/article/download/1310/464

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 4 2023 11 18 e34 e34 Scarlett Mia Tabuñar Department of Emergency Medicine, College of Medicine/Philippine General Hospital, University of the Philippines, Manila, Philippines Paulo Maria Pagkatipunan Department of Ophthalmology & Visual Sciences, College of Medicine/ Philippine General Hospital, University of the Philippines, Manila, Philippines 2023 07 05 2023 10 08 Objective: In developing staffing plans for emergency departments (EDs), a multifaceted approach must be considered without compromising quality of care, patient safety and personnel satisfaction. This study aims to determine the temporal trend of patient attendance and staffing in a major tertiary hospital ED to assist in establishing an optimal staffing pattern. Methods: A 1-year retrospective ED census review of adult patients at the University of the Philippines-Philippine General Hospital (UP-PGH) was undertaken. One-way analysis of variance (ANOVA) with post hoc Fisher-Hayter pairwise comparisons were utilized to determine if the ED consults and admissions were significantly (P<0.05) associated with the month of the year and day of the week. Results:  A total 43,632 consults at the UP-PGH ED, averaging of 3,636 per month or 121 per day, were seen in 2019. Results indicated statistically significant differences between monthly [F (11,353) =16.45; P<0.0001] and between daily means [F (6,358) =4.19; P=0.0004]. The most number of consults occur during August, September, October and November while admissions were highest during April and October.  It was busiest during Mondays and afternoon shifts (1400-2200 hours) with majority arriving as urgent in acuity. Mortality was also highest during the afternoon shifts. Conclusion: The temporal variations in patient visits and acuity described in our study can be used as a template for workforce scheduling and resource allocation to meet the demands in the provision of care at the ED. https://fem.tums.ac.ir/index.php/fem/article/view/1243 https://fem.tums.ac.ir/index.php/fem/article/download/1243/456

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 4 2023 11 28 e40 e40 Bojan Miletic Department of Rehabilitation and Geriatrics, Luzerner KantonsspitalWolhusen, Switzerland Anna Röschel Department of Rehabilitation and Geriatrics, Luzerner KantonsspitalWolhusen, Switzerland Zeljko Jovanovic Faculty of Health studies, University of Rijeka, Croatia Udo Courteney Department of Rehabilitation and Geriatrics, Luzerner KantonsspitalWolhusen, Switzerland 2023 08 04 2023 11 03 Acute dyspnea, sometimes dramatic, is most often caused by cardiovascular or respiratory disease. However, although rare, thyroid dysfunction may present a similar clinical picture with equally serious and life-threatening consequences. Therefore, every occurrence of acute dyspnea represents a special medical challenge in diagnosis and treatment. We present a case of 81-year-old male admitted to the rehabilitation department five days after a knee joint total endoprosthesis and developed acute dyspnea two days later. An emergency diagnostic was performed and confirmed an airway stenosis through a previously undiagnosed enlarged thyroid gland. Although in most cases an acute life-threatening postoperative dyspnea indicates a cardiac or pulmonary problem, other diseases must be taken into consideration. https://fem.tums.ac.ir/index.php/fem/article/view/1258 https://fem.tums.ac.ir/index.php/fem/article/download/1258/460

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 4 2023 11 30 e35 e35 Aster Yalew Department of Nursing, School of Health Sciences, Madda Walabu University, Shashemene Campus, Shashemene, Ethiopia Megersso Urgessa Department of Public Health, School of Health Sciences, Madda Walabu University, Shashemene Campus, Shashemene, Ethiopia Kebede Kumsa Department of Public Health, School of Health Sciences, Madda Walabu University, Shashemene Campus, Shashemene, Ethiopia Amsal Ferede Department of Nursing, School of Health Sciences, Madda Walabu University, Shashemene Campus, Shashemene, Ethiopia Negeso Gebeyehu Department of Midwifery, School of Health Sciences, Madda Walabu University, Shashemene Campus, Shashemene, Ethiopia 2023 06 18 2023 11 03 Objective: Psychological problems like depression, anxiety, and stress are common in the general population and they have a negative impact on the well-being of the community as well as the country. Pandemic diseases like COVID-19 increase the prevalence of psychological problems in the community. Studying psychological problems and associated factors in the community is very crucial for community mental health management. However, evidence is scarce in Ethiopia. Therefore, this study aimed to assess the prevalence of psychological problems and factors in the community during the COVID-19 pandemic in Shashemene Town, Oromia, Ethiopia. Methods: A community-based cross-sectional study was conducted from February 01,2012 to February 28, 2021.  A structured, pretested, and interviewer-administered questionnaire was used to collect data from 889 study participants selected through a simple random sampling technique. The data was collected using the depression, anxiety, and stress scale (DASS-21) questionnaire and analyzed using SPSS version 25.0. Bivariable and multivariable logistic regression was done to determine factors associated with DAS. Adjusted odds ratio with their 95% confidence intervals were calculated to identify the presence and strength of an association, while statistical significance was reported at P<0.05. Results: The prevalence of psychological problems was 96.6% [95% Cl: 95.9,98.1]. The overall prevalence of depression and anxiety were 30% and 43.5% respectively. Having COVID-19 symptoms in the past two weeks before the survey (AOR=0.34; 95% Cl: 0.15,0.77) and having known medical problems (AOR=0.28; 95% Cl: 0.13,0.59) were factors significantly associated with a psychological problem in response to COVID-19 pandemic. Conclusion: The prevalence of psychology invite other experts in this regard. https://fem.tums.ac.ir/index.php/fem/article/view/1152 https://fem.tums.ac.ir/index.php/fem/article/download/1152/433

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

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