Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 9 3 2025 08 07 e20 e20 Kambiz Eftekhari Pediatric Gastroenterology and Hepatology Research Center, Division of Gastroenterology, Department of Pediatrics, Bahrami Children's Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Hadi Majd Department of Pediatrics, Bahrami Children's Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Monsour Mollaeian Department of Pediatric Surgery, Bahrami Children's Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Seyedmehdi Alehossein Division of Radiology, Bahrami Children's Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Mohamadreza Tolou-ostadan-yazd Department of Pediatric Surgery, Bahrami Children's Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Masoumeh Ghasempour-alamdari Department of Pediatric pulmonology, Bahrami Children's Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Alireza Shafiei Division of Allergy and Clinical Immunology, Department of Pediatrics, Bahrami Children's Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2024 10 28 2025 05 04 Objective: Aspiration of a foreign body in the airways of children is one of the important emergencies in children, which is associated with high mortality and morbidity if not diagnosed promptly or managed effectively. The aim of this study was to investigate the clinical and radiographic findings in children with foreign body aspiration.   Methods: In a large cross-sectional retrospective study at a tertiary hospital from 2009 to 2019, children with foreign body aspiration were evaluated. The required information (demographics, clinical examination findings, and results of radiological and bronchoscopy reports) was extracted from the medical records of the patients in the hospital archive.   Results: In this study, 330 patients were enrolled, 61.2% of whom were male. The mean age of the patients was 2.65±2.68 years. The average time interval from the onset of symptoms to the final diagnosis was 11.54 days. The most common location and type of aspirated foreign body were the right main bronchus (60%) and seeds (39.1%), respectively. Cough and decreased unilateral lung sounds were the most common clinical symptoms (91.5%) and physical findings (50.6%), respectively. The most common finding on chest X-ray was local emphysema (43%).   Conclusion: Foreign body aspiration can lead to irreparable injuries if it is not recognized and managed promptly. Aspiration of a foreign body can result in serious harm if not quickly diagnosed and properly managed. Clinical suspicion of aspiration and the management of these children are critical. https://fem.tums.ac.ir/index.php/fem/article/view/1497 https://fem.tums.ac.ir/index.php/fem/article/download/1497/524

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 9 3 2025 08 07 e21 e21 Alexander Joachim Department of Pharmacy, Houston Methodist West Hospital, 18500, Houston, US. Kevin Mercer Department of Pharmacy, University of Texas at Austin College of Pharmacy, Austin, US. Mario Gutierrez Department of Pharmacy, University of Houston College of Pharmacy, Houston, US. Chase Waxler Memorial Hermann Health System, Houston, US. Sunil Aradhya Department of Emergency Medicine, Houston Methodist West Hospital, Houston, US. 2025 01 24 2025 05 25 Objective: As emergency department (ED) visits for atrial fibrillation (AF) grow, comorbidities lead to challenging treatment scenarios. There are limited data evaluating the safety of diltiazem in the acute management of AF with rapid ventricular rate (RVR) in patients with heart failure with reduced ejection fraction (HFrEF). The objective of this study was to evaluate the safety of diltiazem vs metoprolol in patients presenting to the ED with AF with RVR with HFrEF.  Methods: This multicenter, retrospective, cohort study evaluated patients with AF with RVR with HFrEF who received either intravenous (IV) diltiazem or metoprolol in the ED. The primary endpoint was worsening heart failure, defined as an increase in supplemental oxygen requirement, acute kidney injury (AKI), or inotrope administration. Secondary endpoints included bradycardia, systolic blood pressure (SBP) <90 mmHg, or atropine administration.  Results: Of the 5,465 patients screened, 62 (1.1%) patients were included for analysis. Forty-nine (79%) patients received IV diltiazem and 13 (21%) received IV metoprolol. The primary endpoint of worsening heart failure occurred in 26.5% in the diltiazem cohort and 15.4% in the metoprolol cohort (P=0.493). There were no differences in increased need for supplemental oxygen, incidence of AKI, or inotropic support. There were no differences in the secondary safety endpoints.  Conclusion: For ED management of patients with AF with RVR with HFrEF, treatment with IV diltiazem did not lead to an increase in worsening heart failure compared to IV metoprolol. Future prospective trials are needed to evaluate this treatment approach in this population. https://fem.tums.ac.ir/index.php/fem/article/view/1544 https://fem.tums.ac.ir/index.php/fem/article/download/1544/525

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 9 3 2025 08 30 e22 e22 Fauzia Kusuma Medical Education Study Program, Faculty of Medicine, Sriwijaya University, Palembang, Indonesia. Arie Hasiholan Lumbang Tobing Department of Thoracic and Cardiovascular Surgery, Mohammad Hoesin General Hospital, Palembang, Indonesia. Tia Sabrina Department of Microbiology, Faculty of Medicine, Sriwijaya University, Palembang, Indonesia. 2024 12 11 2025 07 29 Objective: Thoracic trauma is frequently encountered in Indonesia, contributing to significant rates of mortality and morbidity. A considerable number of patients with thoracic injuries succumb before reaching medical facilities, as the prevalence of such trauma continues to escalate. Nevertheless, the risk of fatal outcomes can be mitigated through timely emergency intervention, precise diagnosis, and appropriate treatment. This study aimed to present an overview of the demographic characteristics, treatment outcomes, and duration of hospitalization for thoracic trauma patients admitted to Dr. Mohammad Hoesin Palembang during the years 2020 and 2021.  Methods: This descriptive observational study utilized secondary data derived from the medical records of thoracic trauma patients admitted to Dr. Mohammad Hoesin Palembang from January 1, 2020, to December 31, 2021, who satisfied the established inclusion and exclusion criteria.  Results: A total of 78 thoracic trauma patients were treated at Dr. Mohammad Hoesin Palembang Hospital during 2020–2021, with a sociodemographic profile predominantly consisting of males (91.3%) and individuals aged 45 years and older (66.3%). Penetrating injuries caused by sharp objects accounted for 45% of cases. The most prevalent diagnosis among these patients was hemopneumothorax (23.1%), followed by thoracic trauma without associated injuries (62.5%). The majority of patients (97.5%) were discharged from the hospital. Notably, 58.8% of patients arrived at the hospital more than six hours post-trauma, and nearly half (48%) had a hospital stay ranging from one to five days.  Conclusion: The cohort of thoracic trauma patients admitted to Dr. Mohammad Hoesin Palembang hospital in 2020–2021 was primarily male, aged 45 years or older, sustained injuries from sharp objects, diagnosed with hemopneumothorax without associated thoracic injuries, arrived at the hospital after more than six hours, and were discharged within one to five days. https://fem.tums.ac.ir/index.php/fem/article/view/1522 https://fem.tums.ac.ir/index.php/fem/article/download/1522/526

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 9 3 2025 08 30 e23 e23 Natan Alemseged Department of Emergency and Critical Care Medicine, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia. Melaku Getachew Department of Emergency and Critical Care Medicine, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia. Derejie Woldasilase Department of Radiology, School of Medicine, Haramaya University, Harar, Ethiopia. Fenta Wondimneh School of Nursing, Haramaya University, Harar, Ethiopia. Ellen Weber Department of Emergency Medicine, University of California San Francisco, San Francisco, California, USA. 2025 05 01 2025 06 01 Objective: Emergency department length of stay (EDLOS) is a critical measure of healthcare efficiency and quality, and prolonged stays are associated with worse outcomes, particularly for patients requiring intensive care unit (ICU) admission. This study evaluates the impact of a digital consultation management system implemented at Hiwot Fana Comprehensive University Hospital in Ethiopia between May 2020 and May 2024.  Methods:  A pre–post quasi-experimental design was utilized to compare EDLOS for ICU patients before and after the implementation of the new consultation system. The traditional consultation process was characterized by multi-step verbal communication among healthcare providers. The new system employed a secure Telegram channel to facilitate real-time communication, whereby all physicians in the consulting service were simultaneously notified of the patient requiring ICU care. We determined the proportion of patients admitted to the ICU staying more than 24 hours in the emergency department (ED) between pre- and post-implementation of the Telegram system using chi-squared tests and mean difference in LOS using Mann Whitney U.  Results: This study included 415 patients with 202 patients in the pre-implementation period (May 01, 2020, to May 31, 2022) and 213 in the post-implementation period (June 01, 2022, to May 31, 2024). The mean age was 43.3 years (SD: 18.75 years), and no significant demographic or clinical differences were observed between the pre- and post-intervention groups, except for payment method. Before implementation, 32.6% of patients stayed in the ED> 24 hours while after the implementation 28.8% stayed > 24 hours (P=0.03) The mean EDLOS decreased from 2.83 (SD: 2.5) days to 2.27(SD: 1.64) days following implementation (P=0.04), with a reduction of approximately 13.2 hours in EDLOS. Overall ICU mortality decreased from 31.4% to 25.8%, though this was not statistically significant.  Conclusion: A digital consultation system can reduce EDLOS in a limited-income country, consistent with findings from similar studies. Further research is needed to explore long-term impacts and scalability, especially in low-resource settings. https://fem.tums.ac.ir/index.php/fem/article/view/1591 https://fem.tums.ac.ir/index.php/fem/article/download/1591/527

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 9 3 2025 10 03 e24 e24 Zeinab Momeni pour Department of Electrical Engineering, Iran University of Science and Technology, Tehran, Iran. Ali Asghar Beheshti Shirazi Department of Electrical Engineering, Iran University of Science and Technology, Tehran, Iran. 2025 02 13 2025 07 02 Background: Deep learning-based automatic segmentation provides significant advantages over traditional manual segmentation methods in medical imaging. Current approaches for segmenting regions of Coronavirus disease 2019  (COVID-19) infections mainly utilize convolutional neural networks (CNNs), which are limited by their restricted receptive fields (RFs) and consequently struggle to establish global context connections. This limitation negatively impacts their performance in accurately detecting complex details and boundary patterns within medical images.  Methods: This study introduces a novel dual-path Swin Transformer-based network to address these limitations and enhance segmentation accuracy. Our proposed model extracts more informative 3D input patches to capture long-range dependencies and represents both large and small-scale features through a dual-branch encoder. Furthermore, it integrates features from the two paths via the new Transformer Interactive Fusion (TIF) module. The architecture also incorporates an inductive bias by including a residual convolution (Res-conv) block within the encoder.  Results: The proposed network has been evaluated using a 5-fold cross-validation technique, alongside data augmentation, on the publicly available COVID-19-CT-Seg and MosMed datasets. The model achieved Dice coefficients of 0.872 and 0.713 for the COVID-19-CT-Seg and MosMed datasets, respectively, demonstrating its effectiveness relative to prior methodologies.  Conclusion: The significant improvements in segmentation accuracy, demonstrated by the achieved Dice coefficients on the COVID-19-CT-Seg and MosMed datasets, highlight the potential of our approach to enhance automated segmentation in medical imaging. https://fem.tums.ac.ir/index.php/fem/article/view/1553 https://fem.tums.ac.ir/index.php/fem/article/download/1553/528

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 9 3 2025 10 03 e25 e25 Mohammad Alnaeem School of Nursing, Al-Zaytoonah University of Jordan, Amman, Jordan. Asma Islaih School of Nursing, Al-Zaytoonah University of Jordan, Amman, Jordan. Mohammad Abu Sabra School of Nursing, The University of Jordan - Aqaba Campus, Aqaba, Jordan. Manar Bani-Hani School of Nursing, Al-Zaytoonah University of Jordan, Amman, Jordan. 2025 04 12 2025 07 29 Objective: Emergency departments (EDs) are critical to healthcare systems, yet in Jordan, overcrowding and resource limitations challenge care quality. This study assessed how Jordanian patient satisfaction with nursing care at EDs related to their understanding of triage systems and wait times.  Method: A prospective cross-sectional design was used. Data were collected from largest two healthcare hospitals in Jordan which utilizing Canadian triage system. A convenience sampling method was utilized. All adult patients (≥18 years) were included. However, patient’s triaged at level 1 (resuscitation) or 2 (emergent) based on Canadian triage system, pediatric patients, and/or those with documented history of psychiatric illness were excluded. Valid and reliable tools were used.  Result: The mean age of patients was 37.6 years (SD=11.4), with a mean satisfaction score of 15.79/20 (SD=3.22), reflecting high satisfaction. Most patients (61.3%) were unaware of triage processes; however, their satisfaction with nursing care was related with triage understanding (P<0.05). Younger patients (t=2.045, P<0.05), Jordanian nationals (t=1.817, P<0.05), unmarried individuals (F=3.32, P<0.05), and government-sector workers (F=3.42, P< 0.05) reported significantly higher satisfaction than others.  Conclusion: Enhancing patient satisfaction in EDs relies on optimizing nursing care, particularly through staff training in triage systems and patient education about triage processes. Implementing standardized protocols, along with accessible educational materials for differences from week 2 onward (P=0.042 to P=0.001). Pain intensity similarly declined more steeply with pregabalin (repeated measures P=0.001) compared with the control group (P=0.236). Persistent chronic pain was markedly less frequent with pregabalin (8 vs. 19 patients; P=0.001). SF‑36 scores improved significantly across all subscales in the pregabalin group (P<0.05) and remained higher than in controls post‑treatment (P=0.018–0.025). Conclusion: Adjunctive pregabalin significantly reduced the severity and persistence of chronic post‑traumatic chest pain when added to naproxen therapy. Its effects are likely mediated through modulation of neuropathic pathways and central sensitization, resulting in decreased analgesic requirements. While no major safety concerns emerged, conclusions regarding tolerability are limited by sample size and warrant confirmation in larger trials. https://fem.tums.ac.ir/index.php/fem/article/view/1703 https://fem.tums.ac.ir/index.php/fem/article/download/1703/551

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 10 1 2026 06 08 e7 e7 Moojan Shabani Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran. Samrand Fattah Ghazi Department of Anesthesiology and Intensive Care, Tehran University of Medical Sciences, Tehran, Iran. Morteza Daraie Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran. Hamed Kazemi Khaledi Department of Endocrine Surgery, Tehran University of Medical Sciences, Tehran, Iran. Shahram Bagheri-Hariri Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2025 10 15 2025 12 05 Rare tumors that release catecholamines and originate in the adrenal medulla are called pheochromocytomas. They usually manifest as headaches, diaphoresis, palpitations, and hypertension, but occasionally they can resemble panic disorder. We report the case of a 51-year-old man who had dyspnea, chest pain, and a hypertensive crisis. Despite treatment with antihypertensives and anxiolytics, his symptoms persisted. Imaging revealed a large hemorrhagic adrenal mass consistent with a ruptured pheochromocytoma. Following laparoscopic adrenalectomy, histopathological analysis confirmed pheochromocytoma with a Zellballen pattern and vascular invasion but no capsular invasion. This case highlights the importance of considering secondary causes of hypertension, particularly pheochromocytoma, in patients with refractory symptoms and overlapping psychiatric features. https://fem.tums.ac.ir/index.php/fem/article/view/1671 https://fem.tums.ac.ir/index.php/fem/article/download/1671/547

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 10 1 2026 06 08 e8 e8 Ahmad Abbasian Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran. Hadi Mirfazaelian Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran. AmirAli Soltani School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2026 02 06 2026 05 02 A 34-year-old man presented to the emergency department with a chief complaint of shortness of breath and sore throat. On examination, the patient exhibited stridor and noisy breathing with the rest of the physical examination being within normal range, ultimately leading to a diagnosis of acute uvulitis. We present a case of acute uvulitis in this report. https://fem.tums.ac.ir/index.php/fem/article/view/1722 https://fem.tums.ac.ir/index.php/fem/article/download/1722/549

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 10 1 2026 05 06 e9 e9 Hesam Seyedin Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran. Shandiz Moslehi Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran. Asghar Tavan Health in Disasters and Emerge