Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 8 1 2024 01 31 e1 e1 Hamideh Akbari Emergency Medicine Department, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Jalili Emergency Medicine Department, Tehran University of Medical Sciences, editor-in-chief of Frontiers in Emergency Medicine (FEM), Tehran, Iran. 2024 01 28 2024 01 28 The year 2023 terminated and we need to prepare ourselves for a fresh start and a bright future in the coming year. To accomplish this task, the editorial team of Frontiers in Emergency Medicine (FEM) looks back on the past and reflects on the successes and failures of the journal. https://fem.tums.ac.ir/index.php/fem/article/view/1344 https://fem.tums.ac.ir/index.php/fem/article/download/1344/472

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 8 1 2024 01 29 e2 e2 Abdolghader Pakniyat Emergency Medicine Department, Kurdistan University of Medical Sciences, Sanandaj, Iran. Farzane Jafari Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran. Seyedeh Hoda Ahmadi Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran. Mohammad Ghasemi-Rad Department of Interventional Radiology, Baylor College of Medicine, Houston, Texas, USA. Mahan Ghasemi Department of Bioengineering, Texas A & M University, Texas, USA. Korush Akhbari Emergency Medicine Department, Kurdistan University of Medical Sciences, Sanandaj, Iran. 2023 06 25 2023 11 03 Objective: Chest computed tomography (CT) scans are the gold standard for identifying pulmonary involvement in pneumonia-like COVID-19 cases, albeit with certain drawbacks such as radiation exposure and high costs. This research aims to evaluate the diagnostic precision of a 12-point lung ultrasound (LUS) against a low-dose chest CT scan in identifying lung lesions associated with COVID-19. Methods: The study incorporated 100 consecutive patients, aged over 18 years, exhibiting suspected clinical symptoms of COVID-19 or inpatients requiring a low-dose chest CT scan for diagnosing asymptomatic COVID-19 lung lesions. All participants underwent a 12-point LUS, followed by a low-dose chest CT scan. Data analysis was conducted using STATA-16, with descriptive results presented as mean and standard deviation. Results: The study comprised 60 males and 40 females, with an average age of 43.0±16.9 years. The mean distribution of the patients' clinical features was calculated. The LUS demonstrated a sensitivity, specificity, and positive and negative predictive values of 97.5%, 86.4%, 83.3%, and 98%, respectively. Conclusion: The 12-point LUS exhibited high sensitivity and specificity in assessing pulmonary involvement in COVID-19 patients. Therefore, lung ultrasound results, combined with medical history and clinical examination, can serve as an effective triage tool for COVID-19 patients. The LUS, a swift, safe, and effective ionization tool, can potentially replace chest CT scans in scenarios such as CT scan unavailability, intensive care management, and patient follow-up. https://fem.tums.ac.ir/index.php/fem/article/view/1236 https://fem.tums.ac.ir/index.php/fem/article/download/1236/466

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 8 1 2024 02 05 e3 e3 Mustafa Ekici Emergency Medicine Department, Bitlis Provience Health Manager, Bitlis, Turkey. Gülşah Çıkrıkçı Işık Emergency Medicine Department, University of Health Sciences, Atatürk Sanatoryum Training and Research Hospital, Ankara, Turkey. Özge Dağcı Varhan Emergency Medicine Department, İzmir Bornova Türkan Özilhan State Hospital, İzmir, Turkey. Şeref Çorbacıoğlu Emergency Medicine Department, University of Health Sciences, Atatürk Sanatoryum Training and Research Hospital, Ankara, Turkey. Yunsur Çevik Emergency Medicine Department, University of Health Sciences, Atatürk Sanatoryum Training and Research Hospital, Ankara, Turkey. 2023 08 22 2024 01 27 Objective: Reactive oxygen radicals are generated in the early stages of acute pancreatitis (AP) and are responsible for its progression. Thiol/disulfide homeostasis (TDH) is an important antioxidative mechanism. This study aimed to evaluate the role of TDH in the differential diagnosis of AP and predict its clinical severity.  Methods: Patients admitted to the emergency department due to upper abdominal pain were evaluated. The study consisted of two groups: the AP group and the non-AP group (patients with diagnoses other than AP). The AP group was divided into mild and severe according to Acute physiology and chronic health evaluation II (APACHE-II) scores. TDH was measured with an automated assay from Erel et al. Statistical analyses were done with SPSS 16.0. Results: The results from 128 cases—58 in the AP group and 70 in the non-AP group—were evaluated. There was no difference in TDH parameters between the AP and non-AP groups. Among the AP subgroups, native thiol (sh) and total thiol (tt) were significantly lower in the severe AP group (sh: 313.9 μmol/L, 239.1 μmol/L; tt: 351.5 μmol/L, 303 μmo/L, respectively, in the mild and severe AP groups, P-value=0.006, P-value=0.013). Conclusion: TDH parameters change because of inflammatory processes in AP. Since this change does not occur for any specific reason, using TDH parameters for differential diagnosis of AP in patients with upper abdominal pain is not appropriate. However, in patients already diagnosed with AP, native and total thiol levels might be helpful in the prediction of clinical severity with a limited role. https://fem.tums.ac.ir/index.php/fem/article/view/1269 https://fem.tums.ac.ir/index.php/fem/article/download/1269/474

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 8 1 2024 02 05 e4 e4 Karamatollah Rahmanian Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran. Vahid Rajabpour School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran. Vahid Rahmanian Department of Public Health, Torbat Jam Faculty of Medical Sciences, Torbat Jam, Iran. Mohammad Jokar Department of Public Health, Torbat Jam Faculty of Medical Sciences, Torbat Jam, Iran. Hossein Kargar Jahromi Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran. 2023 06 14 2023 12 04 Objective: Road traffic crashes are a significant health problem worldwide, causing injury, disability, and death. This study aims to identify associated factors with intensive care unit (ICU) admission and mortality among road traffic accident victims using data from a trauma registry. Methods: This descriptive study examined 368 road traffic accident patients in the national trauma registry system fromMarch 2021 toMarch 2023. Following the objectives of the study, a checklist was created that included information on age, gender, marital status, level of education, injury severity score (ISS), Glasgow coma scale (GCS), and abbreviated injury scale (AIS). The factors associated with ICU admission and mortality among road traffic accident victims were found significant according to univariate andmultivariable logistic regression analyses results. Results: 87.8% of the 368 patients included in this study were men, with a mean age of 33.54±18.95 years. Ten patients (2.71%) of total died, and 46 (12.5%) needed to be admitted to the ICU. In-hospital mortality and gender were not significantly associated (P=0.081). However, univariate logistic regression revealed several factors significantly associated with in-hospital mortality, including GCS<8 (OR: 60.05, 95% CI: 11.67,309), ISS>16 (OR: 11.39, 95% CI: 2.67,48.55), ICU admission (OR: 5,01, 95% CI: 1.36,18.50), underwent surgery (OR: 0.055, 95% CI: 0.014,0.223), respiratory rate (OR: 0.726, 95% CI: 0.630,0.836), O2 saturation (OR: 0.906, 95% CI: 00.852,0.963), systolic blood pressure (OR: 0.910, 95% CI:0.865,0.957) and temperature (OR: 0.932, 95% CI: 00.891,0.975). Furthermore, the odds of ICU admission was found to be increased with an ISS>16 (OR: 2072.12, 95% CI: 17.29,50644.09), being a pedestrian (OR: 366.53, 95% CI: 31.44,389.85), GCS<8 on admission (OR: 87.64, 95% CI: 29.04,264.43), smoking (OR: 11.92, 95% CI: 1.45,97.64), drug usage before the accident (OR: 11.47, 95% CI: 7.09,18.56), being amotorcyclist (OR: 5.72, 95% CI: 1.06,29.22), age (OR: 1.19, 95% CI: 1.05,1.34) and the time duration between the event and admission (OR: 1.01, 95% CI: 1.003,1.02). Conclusion: This study underscores the critical role of timely and effective medical interventions, including surgical procedures, in improving the outcomes of road accident victims. It also highlights the need for targeted preventivemeasures and interventions for high-risk groups pedestrians and motorcyclists. Hospital Mortality https://fem.tums.ac.ir/index.php/fem/article/view/1232 https://fem.tums.ac.ir/index.php/fem/article/download/1232/469

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 8 1 2024 01 29 e5 e5 EN Mahgol Sadat Hassan Zadeh Tabatabaei Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Vali Baigi Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mohammadreza Zafarghandi Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Vafa Rahimi-Movaghar Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Amin Valizade Hasanloei Department of Anesthesiology, Urmia University of Medical Sciences, Urmia, Iran. Seyed Mohammad Piri Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Armin Khavandegar Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Khatereh Naghdi Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Payman Salamati Research Center for War-affected People, Tehran University of Medical Sciences, Tehran, Iran. 2023 07 29 2023 10 03 Objective: Trauma is one of the major causes of mortality and morbidity globally. The current study aimed to improve the understanding of characteristics, severity of injuries and outcomes of trauma patients admitted to Imam Khomeini Hospital, Urmia, Iran. Methods: Data were obtained from the trauma registry of Imam Khomeini Hospital, a level 1 trauma referral center, for all patients admitted to the center from 17 september 2016 to 21 January 2023. Patients’ demographics, injury mechanisms, and patients' outcomes were analyzed. Results: The emergency department attended to 5555 trauma patients. The gender distribution was with 3998 (71.9%) males and 1557 (29.1%) females. Patients' age ranged from 1 to 101 years, with a mean±standard deviation (SD) of 33.1 (±20.7) years. Road traffic accidents followed by falls were the most common causes of traumas reported in 2138 (38.5%) and 1298 (23.4%) trauma patients, respectively. The in-hospital mortality rate was 0.9% (53 patients). The mean (±SD) age of death was 43.5 (±22.4) years. 569 (10.2%) patients were admitted to the intensive care unit (ICU). The univariable logistic regression models showed that there were significant associations between age (P<0.001), Glasgow coma scale (GCS) (P<0.001), injury severity score (ISS) (P<0.001), and mechanical ventilation (P<0.001) as independent variables and death outcome. The univariable and multiple logistic regression analyses showed statistically significant associations between age, cause of trauma, ISS, GCS and body site injury with ICU admission. The odds of ICU admission in patients after being adjusted for age, ISS, GCS, cause of trauma and type of transportation was 1.73 times higher in head, face, and neck injuries compared to limb injuries.  (adjusted OR: 1.73, [95% CI: 1.23,2.42]; P<0.01). Conclusion: Older age, low GCS, higher ISS and mechanical ventilation were associated with higher mortality. Older age, higher ISS, lower GCS, body site injury, type of transportation, and cause of trauma were all significant independent predictors of ICU admission. https://fem.tums.ac.ir/index.php/fem/article/view/1246 https://fem.tums.ac.ir/index.php/fem/article/download/1246/467

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 8 1 2024 01 29 e6 e6 Melika Hajiaghaei Shahir Tabriz Student Research committee, Tabriz university of medical sciences, Tabriz, Iran. Parham Maroufi Department of Orthopedy, school of medicine, Tabriz university of medical sciences, Tabriz, Iran. Seyed Pouya Paknezhad Emergency and Trauma Research Center, Tabriz university of medical sciences, Tabriz, Iran. Seyed Ehsan Mousavi Social Determinants of Health Research Center, Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Gholamreza Faridaalaee Emergency and Trauma Research Center, Tabriz university of medical sciences, Tabriz, Iran. 2023 05 27 2023 09 16 Objective: Wrist trauma is a common chief complaint in emergency departments and radiography is used to make the diagnosis. Excessive usage of radiographs would utilize resources, exert risk of radiation exposure, and overcrowding. Amsterdam wrist rules (AWR) have been proposed as a tool for clinical decision-making regarding the need for wrist fracture diagnosis. This study assessed the diagnostic test performance of this rule in wrist trauma for wrist fracture. Methods: All patients over 18 years old with the chief complaint of acute wrist trauma were included. They were excluded if Glascow coma scale (GCS) was below 15, needed emergency surgery without an X-ray, and had a history of wrist fracture in the past 3 months. Anteroposterior and lateral radiographs were obtained and the AWR predictors were assessed before going to the radiology unit. The presence of a fracture of the distal radius was confirmed by treating emergency physician or radiologist. Results: 205 participants were recruited in this study, of which 6 patients (2.9%) were excluded due to missing data. The median age was 40 (IQR: 30-50) and 74 (37.2%) patients were female. There were 66 (33.2%) patients with a wrist fracture, which distal radius accounted for most of them. The AWR had sensitivity and specificity of 0.71 (95% CI: 0.49,0.87) and 1 (95% CI: 0.92,1), respectively. Although the negative likelihood ratio of AWR was 0.29 (95% CI: 0.16,0.54), the positive likelihood ratio was infinite. The positive predicted value was 1 (95% CI:  0.80,1), whereas the negative predictive value was 0.86 (95% CI: 0.74,0.94). Conclusion: The AWR showed great specificity and positive predictive. It had fair sensitivity, negative predictive value, and negative likelihood ratio for diagnosis of wrist fracture in patients with wrist trauma. https://fem.tums.ac.ir/index.php/fem/article/view/1225 https://fem.tums.ac.ir/index.php/fem/article/download/1225/470

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 8 1 2024 01 31 e7 e7 Yousef Pashaei Asl Department of Health Policy & Management, Tabriz University of Medical Sciences, Tabriz, Iran. Mohammad Meshkini Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Gholamreza Faridaalaee Emergency Medicine and Trauma Research Center, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. 2023 09 16 2024 01 28 Objective: Disasters increase the incidence of infectious and contagious diseases, non-communicable diseases, and trauma. This systematic review aims to investigate the impact of man-made disasters on cardiovascular diseases (CVDs). Methods: This is a systematic review conducted following the PRISMA protocol. The population, intervention, control, outcome (PICO) framework utilized for this research is as follows: P: people with CVDs; I: various man-made disasters; C: no intervention is being compared; O: prevalence, treatment, and management of the disease. In the present study, English-language articles published until November 9, 2022 that investigated CVDs in human-made disasters were included. We conducted an extensive search in Medline, Web of Science, Embase, and SCOPUS. Results: The primary search of the databases resulted in 1878 articles, from which 1219 non-duplicate records. Finally, 18 articles were included; 13 studies were in the area of nuclear and atomic accidents, four studies were related to the sulfur mustard gas, and one was related to methyl chloride. Conclusion: CVDs increased in prevalence after man-made disasters, particularly among high-risk individuals. The likelihood of developing CVDs is higher with increasing dose, intensity, and duration of exposure. https://fem.tums.ac.ir/index.php/fem/article/view/1279 https://fem.tums.ac.ir/index.php/fem/article/download/1279/471

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 8 1 2024 01 29 e8 e8 EN Çağrı Buyurgan Department of Emergency Medicine, Faculty of medicine, Mersin University, Mersin, Turkey. Akif Yarkaç Department of Emergency Medicine, Faculty of medicine, Mersin University, Mersin, Turkey. Burcu Köse Department of Emergency Medicine, Faculty of medicine, Mersin University, Mersin, Turkey. 2023 07 25 2024 01 25 Intracranial dermoid cysts (IDC) are rare cystic lesions that are present from birth. After rupture of these cysts, patients may present to the hospital with ischemic cerebral symptoms, headaches, seizures, syncope, and meningitis. Brain magnetic resonance imaging (MRI) is the most sensitive radiologic method in the diagnosis of IDC rupture, which has a high mortality rate. Patients should be rapidly evaluated for surgery if a symptomatic and ruptured cyst is detected. In this presentation, we aimed to describe the diagnosis and treatment of IDC in a 23-year-old male patient brought to the emergency department after syncope https://fem.tums.ac.ir/index.php/fem/article/view/1252 https://fem.tums.ac.ir/index.php/fem/article/download/1252/468

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 8 1 2024 02 02 e9 e9 Maria Leis University of Toronto, Faculty of Medicine, 1 King’s College Cir, Toronto, Ontario, Canada. Brendan Kelly University of Toronto, Faculty of Medicine, 1 King’s College Cir, Toronto, Ontario, Canada. Rajani Vairavanathan University of Toronto, Faculty of Medicine, 1 King’s College Cir, Toronto, Ontario, Canada. 2024 01 14 2024 02 01 Postpartum headache is a common emergency department complaint with a wide differential diagnosis. Distinguishing primary from secondary, more sinister, causes of headache is an important skill for the emergency physician. We present a case of a 31-year-old G1P1 woman who presented at five days postpartum with a 48-hour headache and an otherwise uncomplicated pregnancy. She had several precipitating postpartum risk factors, including use of hypotonic fluids in labour, oxytocin to augment labour, changes in food and drink patterns, and was mildly hypertensive. Urgent investigations in the emergency department found her to be severely hyponatremic (sodium: 121 mmol/L (normal: 136-144)) without evidence of preeclampsia. She was admitted to hospital to correct her electrolyte imbalance. This case highlights the importance of remaining vigilant in differentiating concerning causes of postpartum headache, as well as identifying key precipitants which may put women at risk for postpartum hyponatremia. https://fem.tums.ac.ir/index.php/fem/article/view/1330 https://fem.tums.ac.ir/index.php/fem/article/download/1330/473

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 8 1 2024 01 28 e10 e10 EN Meltem Kaba Department of Pediatric Surgery, Sisli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey. 2023 10 12 2024 01 04  As a pediatric surgeon, I have read your case titled "Giant megacolon caused by anterior displacement of the anus in a 71-Year-old woman" (1) with great interest. I would like to extend my congratulations to the authors and editors for this successful article and offer some contributions. There is limited information in the literature about the long-term follow-up of patients with an anteriorly located anus. This case appears to be the oldest patient in the literature to be diagnosed with this anomaly and to have had the longest follow-up. In this respect, the case holds significant value. https://fem.tums.ac.ir/index.php/fem/article/view/1284 https://fem.tums.ac.ir/index.php/fem/article/download/1284/465