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Background Apart from infecting a large number of people around the world and causing the death of many people, the COVID-19 pandemic seems to have changed the healthcare processes of other diseases by changing the allocation of health resources and changing people’s access or intention to healthcare systems. Objective To compare the incidence of endpoints marking delayed healthcare seeking in medical emergencies, before and during the pandemic. Methods Based on a PICO model, medical emergency conditions that need timely intervention was selected to be evaluated as separate panels. In a systematic literature review, PubMed was quarried for each panel for studies comparing the incidence of various medical emergencies before and during the COVID-19 pandemic. Markers of failure/disruption of treatment due to delayed referral were included in the meta-analysis for each panel. Result There was a statistically significant increased pooled median time of symptom onset to admission of the acute coronary syndrome (ACS) patients; an increased rate of vasospasm of aneurismal subarachnoid hemorrhage; and perforation rate in acute appendicitis; diabetic ketoacidosis presentation rate among Type 1 Diabetes Mellitus patients; and rate of orchiectomy among testicular torsion patients in comparison of pre-COVID-19 with COVID-19 cohorts; while there were no significant changes in the event rate of ruptured ectopic pregnancy and median time of symptom onset to admission in the cerebrovascular accident (CVA) patients. Conclusions COVID-19 has largely disrupted the referral of patients for emergency medical care and patient-related delayed care should be addressed as a major health threat.

The results of our study showed that SMT even without medication is a safe, rapid and relatively painless technique in reducing anterior shoulder dislocation in the ED that might reduce medical resource utilization and can be cost-effective.

Background:Little is known about biomarkers which are used to classification of patients in order to diagnosis severity of sepsis among clients of emergency units. It seems that Lactate’s clearance can be used in this regard. This study aimed to determine the relationship between Lactate’s clearance, mortality and organ’s dysfunction with severe sepsis.Materials and methods:In this study 90 patients with severe sepsis, were visited and examined exactly. Para clinical tests, serum venous lactate, organ’s dysfunction scores, Acute Physiology and Chronic Health Evaluation II (APACHE-II) and Sequential Organ Failure Assessment (SOFA) were applied upon admission and 6 hours after it. According to clinical and laboratory criteria, dysfunction in main organs were examined and Lactate’s Clearance was accounted. All the patients were cured according to early goal-directed therapy protocol.Results:Among the participants 49 and 41 were male and female respectively. The mean age of the group was 49.37±1.41. The patients were classified to groups, less or more than 10% lactate’s clearance. Mortality rate of the patients was 18.9% (17 people). Mean age of the dead group was 49.71±13.33. The mean of dysfunctional organs which is assessed in terms of clinical, laboratory and SOFA criteria was significantly higher among the dead group than other. The Lactate’s clearance in the dead group was significantly lower than the other group (p<.05).Conclusion:It was concluded that patients with severe sepsis is a marker which is related to tissue hypoxia, also lactate’s clearance increasing is related to drastic reduction in biomarkers, mortality, and incidence of organ’s dysfunction. Overall, patients with lower lactate’s clearance are counted a high risk group for mortality and organs’ dysfunction.

PurposeTo accurately assess the mechanism, type and severity of injury in Iranian multiple trauma patients of a trauma center.MethodsPatients with multiple traumas referring to the emergency department of Hasheminejad University Hospital in Mashhad, Iran, entered this cross sectional study from March 2013 to December 2013. All the patients with injury severity score (ISS) > 9 were included in this study. Data analysis was performed by SPSS software (Version 11.5) and P values less than 0.05 were considered as significant differences.ResultsAmong the 6306 hospitalized trauma patients during this period, 148 had ISS>9. The male female ratio was 80%. The mean age of the patients was (33.5 ± 19.3) years. And 71% of the patients were younger than 44 years old. There were 19 (13%) deaths from which 68.5% were older than 44 years old. The mean transfer time from the injury scene to hospital was (55 ± 26) minutes. The most frequent mechanisms of injury were motorcycle crashes and falling from height, which together included 66.2% of all the injuries. A total of 84% of hospital deaths occurred after the first 24 h of hospitalization. Head and neck were the most common body injured areas with a prevalence of 111 cases (75%).ConclusionMotorcycle crashes have high frequency in Iran. Since most victims are young males, injury prevention strategies should be considered to reduce the burden of injuries.

Background:Brucellosis is an endemic zoonotic disease, especially in the Middle East and Mediterranean regions and can involve many organs and tissue. Osteoarticular involvement is the most common complication. Spondylitis is its most prevalent clinical form in adults, and there may be difficult in diagnosis and treatment. In present study, we aimed to assess these diagnostic value of MRI, in patients with spondylitis due to brucella, comparing with clinical and laboratory findings.Method:Patients with low back pain who were admitted to Sheikhol-raees MRI center were included in this study. None of these patients had any documented infectious disease. Diagnosis of brucellosis was made, based on MRI findings, which would be approved by serology. After confirmation with serology, the group with positive serology were compared with the negative group, in sex, age, MRI findings level of vertebral involvements, signal intensity in T1 weighted and T2 weighted.Results:Among 53 patients with diagnosis of brucella spondylitis, 33 underwent serology study, 20 were positive and 13 were negative and the others consider out of study. From these 20, 3 had tuberculosis spondylitis, whose mean age was 56 and the 67% of them were male. Mean age in the positive brucella spondylitis were 46 and 67% of them were male. In negative group mean age was 55, and of whom 57% were male. There was no statistically significant difference in MRI findings such as changes in signal intensity, disk space narrowing, Intracanalicular mass, Abscess formation. Level of invlovment in vertebrae.Conclusion:The results of this study shows that although MRI is Modality of choice in diagnosis of spondylitis, it is not enough specific to diagnosis the reasons of spondylitis.

Spontaneous pneumomediastinum is an unusual and benign condition in which air is present in mediastinum. A 20-year-old male patient presented to ED with complaint of hoarseness and odynophagia from the day before, after weightlifting. The patient was nonsmoker and denied history of other diseases. On physical examination he had no dyspnea with normal vital signs. Throat examination and pulmonary auscultation were normal and no crepitation was palpable. We could not find subcutaneous emphysema in neck and chest examination. In neck and chest X-ray we found that air is present around the trachea. There was no apparent pneumothorax in CXR. In cervical and chest CT free air was present around trachea and in mediastinum. Subcutaneous emphysema was also evident. But there was no pneumothorax. The patient was admitted and went under close observation, oxygen therapy, and analgesic. The pneumomediastinum and subcutaneous emphysema gradually resolved within a week by conservative therapy and he was discharged without any complication. Many different conditions could be trigged because of pneumomediastinum but it is rarely seen in intense physical exertion such as weightlifting and bodybuilding. Two most common symptoms are retrosternal chest pain and dyspnea. But the patient here complained of hoarseness and odynophagia.

BackgroundPseudomonas aeruginosa, a ubiquitous opportunistic pathogen, is one of the main causative agents of human superficial infections. Infections due to these bacteria are difficult to heal and cause serious economic issues.ObjectivesThe present study was carried out to investigate the antibiotic resistance pattern of P. aeruginosa isolated from cases of superficial infections referred to the emergency health care units of Iranian Hospitals.Materials and MethodsThree hundred swab samples were collected from patients with superficial infections. Samples were cultured and those that were P. aeruginosa positive were analyzed by the disk diffusion method.ResultsOne hundred and seventy-two out of 300 swab samples (57.3%) were positive for P. aeruginosa. The results of the culture technique were also confirmed using the polymerase chain reaction (PCR). Females had a higher prevalence of P. aeruginosa than males, patients older than 70 years were the most infected age group and finally burn infections had the highest prevalence of bacteria. P. aeruginosa strains had the highest levels of resistance against ampicillin (93%), gentamycin (89.5%), ciprofloxacin (82.5%) and amikacin (77.3%). The most effective drugs were meropenem (2.3%, imipenem (2.9%), polymyxin B (21.5%) and cotrimoxazole (31.9%).ConclusionsIt is logical to primarily prescribe meropenem, imipenem, polymyxin B and cotrimoxazole in the cases of superficial infections caused by P. aeruginosa. Medical practitioners should be aware of the presence of such levels of antibiotic resistance in cases of superficial infections in Iran.