mohammad mehdi forouzanfar

The emergency department is amongst the most important parts of the hospital, which has a great impact on the performance of other departments. In this regard, Emergency Department Information System (EDIS) plays a vital role in providing effective and appropriate healthcare services.

To evaluate the user-perceived usability of admission and discharge sections of the Emergency Department Information System of Shohada-e-Tajrish Educational Hospital, the study is carried out utilizing SUS and PSSUQ scales. Research participants include all users in the admission and discharge sections of the emergency department of the Hospital.

The mean score of the system usability based on the results of the SUS scale was 49.62±23.23, which is lower than the acceptable level (score above 68). The results generated by the PSSUQ tool revealed that the information quality (4.79), interface quality (4.91), and system usefulness (4.42) of admission and discharge sections of the EDIS do not have appropriate scores and need to be improved in this regard. . The worst usability score was related to system usefulness There was no statistically significant correlation between the age of participants and usability scores. Moreover, there was no statistically significant difference between the user-perceived usability and the education level of participants (p>0.05).

The study revealed that users are not satisfied with system usability. In the event that the usability of the system is suboptimal, the user fails to effectively utilize the system, thereby impeding the attainment of the intended ultimate objective for which the system has been designed. Regarding the importance of admission and discharge sections in the EDIS, strides need to be made to improve the usability of the system which is used at the emergency department of Shohada-e-Tajrish educational hospital.

Rapid antigen tests have gained importance during the COVID-19 pandemic due to low prices and availability. The present study investigated the performance of the SARS-CoV-2 rapid diagnostic test in diagnosing patients with COVID-19 referred to the emergency department.

In this diagnostic accuracy study, patients with suspected COVID-19 referred to Imam Hossein and Shohadaye Tajrish Hospitals, Tehran, Iran, were examined. All patients were subjected to a rapid corona test according to the manufacturer’s guide and a chest computed tomography (CT) scan as the standard test. The screening characteristics of the rapid test compared to CT scan were calculated and reported.

183 people with an average age of 46.83 ± 14.26 (range: 21-83) years entered the study. 141 suspected cases of COVID-19 (77%) had evidence of lung involvement in CT, and the rapid test was positive in 83 (45%) cases. Out of 83 patients who tested positive for COVID-19, all (100%) had positive chest CT findings. Out of the 100 patients who tested negative, 42 patients (42%) had negative chest CT findings, and 58 patients (58%) had positive CT scans. The sensitivity, specificity, and accuracy of the mentioned test were 58.86, 100.00, and 68.30 percent, respectively.

Due to the relatively low sensitivity, the Rapid SARS-CoV-2 antigen test fails to screen for SARS-CoV-2 infection. However, it can be used to confirmthe presence of the disease in symptomatic individuals and reduce virus transmission during the COVID-19 pandemic.

Even though the basic principles of cardiopulmonary resuscitation (CPR) are simple, the patients’ outcome remains inconsistent. This study aimed to investigate the CPR outcomes and associated factors in the emergency department.

This cross-sectional study was conducted on patients who underwent in-hospital CPR following a cardiac arrest in the emergency department for one year. The patient’s baseline characteristics and CPR outcomes were recorded from patients’ profiles, and the association of patient-related and CPR-related variables with the outcomes was assessed.

220 patients with a mean age of 71.5 ± 16.9 (range: 20-100) years were included (60.5% male). 193 cases of cardiac arrests had occurred in the hospital. Presenting cardiac rhythm in 198 cases (90.0 %) was asystole (not requiring defibrillation). The mean duration of conducted CPR was 43.2 ± 15.6 (5-120) minutes. Only 7 patients (3.2%) achieved the return of spontaneous circulation (ROSC) and were discharged from the hospital, with one suffering from neurological impairment due to CPR. There was a significant association between age (p = 0.047), consciousness status at admission (p = 0.003), presenting cardiac rhythm at CPR initiation (p = 0.0001), and establishment of ROSC under 45 minutes (p = 0.043) with patients’ outcomes. Presenting cardiac rhythm at CPR initiation (p = 0.001), ROSC under 45 minutes (p = 0.012), and consciousness status at admission (p = 0.027) were independent predictive factors of survival. The area under the ROC curve for presenting cardiac rhythm and ROSC under 45 minutes was 0.817 (95% CI: 0.617-1.000) and 0.805 (95% CI: 0.606-1.000), respectively.

Based on the present study’s findings, the survival rate of patients after CPR in ED was 3.2%. Presenting cardiac rhythm, ROSC under 45 minutes, and consciousness status at admission was among the independent predictors of mortality.

 In addition to having high costs, making changes to any of the wards in medical centers requires legal coordination and accepting many risks to prevent a decline in quantity and quality of health care provision. The present study was performed with the aim of evaluating optimization of service provision in the emergency department (ED) using value flow mapping and simulation.

 In the present qualitative study, initially, the processes in the ED of Shohadaye Tajrish hospital were drawn and a graphic model was built for simulating the processes. To perform simulation, in addition to the sequence of activities, the time required for each activity, waiting time, present resources, and etc. were extracted as the inputs of the simulation model. Then, after determining the mean time frames obtained, intended scenarios of the emergency team were executed on the simulated model so that the best scenario can be determined by comparing the outputs of each scenario.

 Based on the patient flow map, the patient’s journey in the ED begins from the first visit and continues until discharge. Stages such as asking for consultations or visits by other services, laboratory test requests, imaging requests, and asking for medications are passed during this time. Results of analyzing the flow of 60 patients showed that in this department, the mean time interval between first visit to first laboratory test was 58.5 minutes, mean interval between requesting the first laboratory test and its implementation was 28.4 minutes, mean interval between the first visit and computed tomography (CT) scan request was 45.8 minutes, mean interval between CT scan request and its performance was 16.3 minutes, mean interval between the first visit to asking for medication was 46.2 minutes, and, finally, mean interval between the first visit to discharge was 275 minutes (4 hours 35 minutes). The overall ED flow might be optimized through: having one senior nurse and physician for all patients in a supervision unit; having an information systems that makes observation of capacity and flow in the ED and all the hospital possible; having patient sites that are observable from central positions, while preserving privacy; easy access to acute care unit, radiology, and other acute care spaces; easy access to clinical history of patients from other hospitals and primary care.

 It seems that solutions for improving health care provision for patients and increasing patient safety can be reached through drawing patient flow map in the ED and using smart modeling.

Early decompression within the first 24 hours after spinal cord injury (SCI) is proposed in currentguidelines. However, the possible benefits of earlier decompression are unclear. Thus, the present meta-analysisaims to investigate the existing evidence regarding the efficacy of ultra-early decompression surgery (within 12hours after SCI) in improving patients’ neurological status.

A search was performed in Medline, Em-base, Scopus and Web of Science electronic databases, until the end of August 2021. Cohort studies and clinicaltrials were included in the present study. Exclusion criteria were absence of an early or late surgery group, fail-ure to report neurological status based on the American spinal injury association impairment scale (AIS) grade,failure to perform the surgery within the first 12 hours after SCI, and duplicate reports and review articles. Twoindependent reviewers performed data collection, and risk of bias and certainty of evidence assessments. Theoutcome was reported as odds ratio (OR) and 95% confidence interval (CI).

Data from 16 articles, whichstudied 868 patients, were included. Compared to early or late decompression surgery, ultra-early decompres-sion surgery significantly improves patients’ neurological status (OR = 2.25; 95% CI: 1.41 to 3.58). However,ultra-early surgery in thoracolumbar injuries is not significantly more effective than early to late surgery. More-over, ultra-early surgery in patients with a baseline AIS A increases the chance of neurologic resolvent up to 3.86folds (OR=3.86; 95% CI: 1.50 to 9.91). Contrastingly, ultra-early surgery does not result in significant improve-ment compared to early to late surgery in patients with AIS B (OR = 1.32; 95% CI: 0.51 to 3.45), AIS C (OR = 1.83;95% CI: 0.72 to 4.64), and AIS D (OR = 0.99; 95% CI: 0.31 to 3.17).

Current guidelines emphasizethat spinal decompression should be performed within 24 hours after SCI, regardless of injury severity and loca-tion. However, results of the present study demonstrated that certain considerations may be taken into accountwhen performing decompression surgery: 1) in patients with AIS A injury, decompression surgery should beperformed as soon as possible, since its efficacy in neurological improvement is 3.86 folds higher in the first 12hours after injury. 2) ultra-early decompression surgery in patients with cervical injury is more effective than inpatients with thoracic or lumbar injuries. 3) postponing decompression surgery to 24 hours in SCI patients withAIS B to D does not significantly affect the neurological outcome.

Malignancy is a known risk factor of coronavirus disease 2019 (COVID-19) severe involvement. Information about this infection in patients with cancer is limited.

This study aimed at reporting the clinical and imaging characteristics of COVID-19 infection in patients with cancer.

All the patients were known cases of a solid tumor with COVID-19 infection in one center, between February and May 2020. Clinical presentation and imaging involvement of COVID-19 infection in addition to cancer features were documented from medical records/patient interviews.

Thirty-one patients with solid tumors and COVID-19 involvement were included. The most prevalet presentation was fever, cough, and myalgia. Breast and gastrointestinal malignancies were the most common cancer types. The mortality rate was 22.5% and all deceased patients suffered from stage 4 of their underlying cancer disease. Lung computed tomography scan (CT scan) features in these patients were not different from the non-cancer patients with COVID-19.

COVID-19 involvement in patients with cancer seems to be more severe with higher mortality rates especially in patients with other comorbidity and in metastatic cases. Treatment modifications during the pandemic era sound to be logical in decreasing the infection rate.

 There is a global concern for the susceptibility of patients with cancer to the adverse effects of novel coronavirus disease (COVID-19). Nevertheless, there is a signal of potentially increased vulnerability of patients with cancer to more COVID-19-induced mortality, this notion needs to be further evaluated in various societies with different cancer epidemiology and practice.

 To investigate the outcomes of cancer patients admitted due to COVID‐19 and compare them with data of COVID‐19 infected patients without a history of cancer.

 In this case-control study, the medical records of patients with cancer (Ca+ patients) who infected with COVID-19 were evaluated and compared with patients without a medical history of cancer (Ca- patients). Clinical data were collected from 19 February 2020 to 17 May 2020. The extracted data were classified into demographics, underlying medical conditions, clinical manifestations, imaging and laboratory findings, and clinical outcomes.

 A total of 24 Ca+ patients were compared with 44 Ca- patients in terms of clinical manifestations and outcomes of COVID-19. The Ca- patients significantly developed more dry cough (75.0% vs 29.2%, P = 0.01) and fever (72.7% vs 45.8%, P = 0.02). Findings of the chest CT scan was comparable between groups, except for pleural effusion and lymphadenopathy that exclusively reported in Ca+ patients. (3% and 4%, respectively). At the end of observation, 13 (19.1%) patients died from COVID-19. This rate was significantly higher in Ca+ patients (41.7 vs 6.8%, P = 001). Likewise, Ca+ patients experienced more mechanical ventilation (25.0 vs 4.7%, P = 0.01). However, the rate of ICU admission was comparable between groups (P = 0.29).

 The patients with cancer had a higher rate of mechanical ventilation and COVID-19-induced mortality.

Recent studies suggest that the spleen has an important role as a source of multipotent stemcells and precursors of beta cells of pancreas islets. In addition, increased risk of developing hyperglycemiawas reported in patients who underwent splenectomy due to trauma in long-term follow up. Therefore, theremight be an association between splenectomy and an increased risk of type 2 diabetes mellitus. In this study,we evaluated the risk of type 2 diabetes and its risk factors including hyperglycemia, dyslipidemia, obesity andhypertension in trauma patients with splenectomy.

In this study, 221 patients whounderwent splenectomy surgery due to trauma in the surgical ward of Imam Hossein Hospital 5 to 10 yearsago were selected. Those with a history of diabetes, cancer, hyperthyroidism, Cushing’s syndrome, pancreatitis,renal failure, and cirrhosis were excluded from the study. Then fasting plasma glucose, hemoglobin A1c (HbA1c),triglyceride, cholesterol and high density lipoprotein (HDL), body mass index and blood pressure have beenevaluated in 90 patients who had had a history of splenectomy due to trauma from 2007, July 23 to 2012, July 22.

The results indicate that none of these patients has diabetes, 14.4 percent are in pre-diabetic stage, 56.6percent has dyslipidemia, 57.7 percent has obesity and 20 percent has hypertension.

The resultsof this study suggest that splenectomy does not increase the risk of type 2 diabetes. Prevalence of diabetes riskfactors was approximately the same with those of Tehran population.

Abdominal aortic aneurysm (AAA, triple A) is one of the less common but important causes of abdominal pain. This study aimed to evaluate the characteristics and outcome of patients presenting to emer- gency department with triple A.

In this retrospective cross-sectional study, all cases with confirmed triple A, who were presented to the emergency department of Shohadaye Tajrish Hospital, Tehran, Iran from 2006 to 2017 (10 years) were enrolled using census sampling method.

500 cases with the mean age of 68.11 ± 11.98 (25 - 94) years were studied (84% male). The mean duration of symptoms was 2.32 ± 9.58 months and mean aneurysmal size was 63.91 ± 20.08 mm. In 4 (0.8%) cases, atrial fibrillation (AF) was found during cardiac monitoring. Patients stayed in the hospital for an average of 7.06 ± 6.32 days. Aneurysmal leak was seen in 130 (26%) cases based on abdominal computed tomography (CT) scan findings. 369 (73.8%) cases underwent aneurysmorrhaphy, 126 (25.2%) were treated with non-surgical approaches, and 5 (1%) underwent grafting. 104 (20.8%) died and 396 (79.2%) were treated successfully. Older age (p = 0.017), shock state at the time of presenta- tion (p < 0.0001), leakage of aneurysm (p < 0.001), larger size of aneurysm (p = 0.024), and aneurysmorrhaphy (p < 0.001) were among the factors significantly associated with mortality.

Based on the findings, the most frequent presenting symptom of patients was abdominal pain. The mortality rate of this series was 21% and older age, shock state, leakage of aneurysm, larger size of aneurysm, and performing aneurysmorrhaphy were among the factors significantly associated with mortality.

Osteomyelitis is one of the complications of diabetic foot infection. The present study aimedto evaluate the diagnostic value of erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) in detec-tion of osteomyelitis in patients with diabetic foot.

In this cross-sectional study, serum levels of ESRand CRP were measured for patients with diabetic foot referring to emergency department or endocrinologyclinic and the screening performance characteristics of these markers in detection of osteomyelitis were calcu-lated. The diagnosis of osteomyelitis was based on clinical examination and positive probe-to-bone test, whichwas confirmed by plain x-rays or MRI.

142 diabetic patients with an average age of 61.2±11.8 yearswere evaluated (66.2% male). The area under the ROC curve of ESR in detection of osteomyelitis in diabeticfoot cases was 0.70 (95% CI: 0.62-0.79). The best ESR cut-off point in this regard was 49 mm/hour. Sensitiv-ity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of ESR in 49mm/Hour cut-point were 74.6% (95% CI: 62.9-83.9), 57.7% (95% CI: 45.5-69.2), 63.9% (95% CI: 52.5-73.9), 69.5%(95% CI: 56.0-80.0), 1.8 (95% CI: 1.3-2.4) and 0.4 (95% CI: 0.3-0.7), respectively. The area under the ROC curveof CRP in detection of osteomyelitis was 0.67 (95% CI: 0.58-0.76). The best cut-off point for CRP in this regardwas 35 mg/liter with sensitivity, specificity, positive and negative predictive values, and positive and negativelikelihood ratios of 76% (95% CI: 64.2-85), 54.9% (95% CI: 42.7-66.6), 62.8% (95% CI: 51.6-72.8), 69.6% (95% CI:51.7-80.8), 1.7 (95% CI, 1.3-2.2), and 0.4 (95% CI: 0.3-0.7), respectively.

Based on the findings ofROC curve analysis, ESR and CRP had fair and poor accuracy, respectively, in detecting the diabetic foot caseswith osteomyelitis.

Endotracheal suctioning is a method commonly used to clean airway secretions in patients under mechanical ventilation (MV ). This study aimed to compare the effects of open and closed suction methods on the occurrence of ventilator associated pneumonia (VAP).

This comparative study was carried out on adult intensive care unit (ICU) patients in need of MV for more than 48 hours, from October 2018 to January 2019. Patients were randomly allocated to either closed tracheal suction system (CTSS) group or open tracheal suction system (OTSS) group. Patients were monitored for developing VAP within 72 hours of intubation and the findings were compared between groups.

120 cases with the mean age of 57.91 ± 19.9 years were randomly divided into two groups (56.7% male). The two groups were similar regarding age (p = 0.492) and sex (p = 0.713) distribution. 22 (18.3%) cases developed VAP (12 (20%) in OSST group and 10 (16.7%) in CSST; p = 0.637). The most prevalent bacterial causes of VAP were Acinetobacter_Baumannii (72.7%), Klebsiella pneumoniae (18.2%), and Methicillin-Resistant Staphylococcus aureus (9.1%), respectively. There was not any significant difference between groups regarding the mean duration of remaining under MV (p = 0.623), mean duration of hospitalization (p = 0.219), frequency of VAP (p = 0.637), and mortality (p = 0.99).

It seems that type of endotracheal suction system (OSST vs. CSST) had no effect on occurrence of VAP and other outcomes such as duration of need for MV and ICU stay as well as mortality.

We aimed to examine the available evidence regarding the efficacy and safety of corticosteroids on the management of coronavirus disease 2019 (COVID-19), severe acute respiratory syndrome (SARS-CoV) and Middle East respiratory syndrome (MERS-CoV).

An extensive search was conducted in Medline, Embase, and Central databases until the end of March 2020, using keywords related to corticosteroids, COVID-19, SARS-CoV and MERS-CoV. The main outcome was considered to be the mortality rate, length of stay, virus clearance time, symptom improvement, and lung function improvement. The findings are presented as odds ratio (OR) with 95% confidence interval (95% CI).

Fifteen paper compromising 5 studies on COVID-19, 8 studies on SARS-CoV and 2 studies on MERS-CoV were included. One study was clinical trial and the rest were cohort. The analyses showed that corticosteroids were not reduce the mortality rate of COVID-19 (OR=1.08; 95% CI: 0.34 to 3.50) and SARS-CoV (OR=0.77; 95% CI: 0.34 to 1.3) patients, while they were associated with higher mortality rate of patients with MERS-CoV (OR = 2.52; 95% CI: 1.41 to 4.50). Moreover, it appears that corticosteroids administration would not be effective in shortening viral clearance time, length of hospitalization, and duration of relief symptoms following viral severe acute respiratory infections.

There is no evidences that corticosteroids are safe and effective on the treatment of severe acute respiratory infection when COVID-19 disease is suspected. Therefore, corticosteroids prescription in COVID-19 patients should be avoided.

Emphysematous pyelonephritis (EPN) is a urologic emergency, which needs immediate medical attention. It is a life-threatening gas-producing infection affecting the renal parenchyma. In this study, we present a 35-year-old male Afghan patient, who was admitted to the Emergency department with low-grade fever, jaundice, abdominal pain, nausea and vomiting, burning urine, and obstructive urinary symptoms. His laboratory data showed serum creatinine 5.4 mg/dl, bilirubin 10.4 mg/dl and thrombocytopenia. Abdominopelvic computed tomography (CT) scan showed gas in the right renal parenchyma and the patient was sent to the operation room with diagnosis of EPN and emergency cystostomy and nephrectomy were performed. The patient was discharged one week later in good condition. Voidingcystogram and retrograde urethrogram were scheduled and performed 2 months later, which revealed long anterior urethral stricture. Anterior urethroplasty with buccal graft was successfully performed later.

In the present study, we aimed to compare the number of brain stroke cases presenting to the Emergency Department (ED) of a major referral hospital in Tehran during summer and winter.

A cross-sectional retrospective hospital-based study was carried out in 2016 - 2017 in Tehran, Iran. The study population consisted of all patients admitted with a diagnosis of brain stroke. The data of all patients were extracted from their medical profiles and analyzed via SPSS V.16 software using descriptive statistics (mean and percentage).

In this study, we enrolled 179 patients with a mean age of 68.0 ± 14.5 years (62.0% males). The rate of brain stroke was 63% in summer, and 37% in winter (62% vs. 38%; P = 0.014), and this difference did not correlate with sex or age of the patients (P > 0.05).

Comparing the prevalence of brain stroke in summer and winter in this study showed that the frequency of brain stroke was significantly higher in the three months of summer (warm season) than winter (cold season).

Determining the need for performing brain imaging for patients presenting to emergency department following seizure is one of the most important questions that emergency medicine specialists face. The present study has been designed with the aim of evaluating risk factors of abnormal computed tomography (CT) scan in patients presenting to emergency department following seizure.

This cross-sectional study was performed on patients with seizure presenting to the emergency department of Shohadaye Tajrish Hospital from April 2017 to March 2019using convenience sampling. Demographic data and factors possibly related to presence of brain pathologic findings in patients were gathered and their correlation with findings of CT scan, performed for all patients, was evaluated.

352 patients with the mean age of 34.99 ± 22.30 (6 months to 95) years were evaluated (58.8% male). Most studied patients (40.9%) had an education level less than high school diploma. 164(46.6%) patients had a history of seizure from childhood or as a congenital disorder and 86 (24.4%) had a family history of seizure. 51.1% consumed anti-seizure medications and 31.8% would regularly take medications. Recent lack of sleep with a frequency of 174 (49.4%) cases and heavy physical activity before seizure with a frequency of 11 (3.1%) cases had the highest and lowest frequencies among predisposing factors of seizure. 138 (39.2%) patients had at least one pathologic finding in their brain imaging. The most common findings were subdural hemorrhage (7.1%) and brain tumors (6.8%), respectively. Based on these findings, a significant correlation was observed between age over 40 years (p < 0.001), supine position at the time of seizure (p < 0.001), positive history of seizure in childhood (p < 0.001), positive family history of seizure (p < 0.001), consumption or ceasing to consume anti-seizure medication (p < 0.001), acute head trauma (p < 0.001), consuming anti-coagulant medication (p < 0.001), presence of fever (p < 0.001), positive history of malignancy (p < 0.001), focal seizure (p < 0.001), and headache (p = 0.003) with abnormal CT findings. However, there was no statistically significant correlation between sex, time of seizure onset, education, drug abuse, presence of seizure stimulating factors, focal neurologic disorder, and altered level of consciousness with presence of pathologic findings in brain CT scan.

Based on the findings of the present study it seems that using a series ofclinical decision rules, we might be able to predict the probability of pathologic findings being present in the CT scan of patients with seizure and avoid brain imaging in cases with low probability.

Since the guideline of American Heart Association (AHA) for cardiopulmonary resuscitation (CPR) is the basis for performing CPR in emergency department, updating the knowledge of residents and specialists in this field can play an important role in increasing the survival rate of the patients. This study has been designed with the aim of assessing the rate of adherence to AHA guideline for resuscitation of patients with brady/tachy dysrhythmia.

The present study was performed as a cross-sectional study on all emergency medicine residents of Shahid Beheshti University of Medical Sciences in 2018-2019. Ten well-known brady/tachy Dysrhythmia cases, which have a specific treatment, were simulated using a simulator and the measures taken by the residents in dealing with these cases were evaluated considering AHA standards. Items adhered to or not were scored as 1 and 0, respectively. Finally, the percentage of adherence to the guideline was calculated for each resident as well as all residents.

In the common initial encounter with brady/tachy dysrhythmia scenarios, all the residents performed well in diagnosis, assessing ventilation, asking for oxygen in case of hypoxia, cardiac assessment of the patient, pulse oximetry and blood pressure evaluation. Not ordering proper peripheral artery and 12 leads electrocardiogram in the proper time occurred in 25% of cases among those who had not studied the guideline and 13.8% of cases among those who had taken training classes. Studying the guideline significantly raised awareness of unstable symptoms in treating tachyarrhythmia, and increased diagnosis of wide and narrow QRS and regular and irregular rhythm, yet was not effective regarding use of adenosine for treatment of unstable symptoms with regular andnarrow complex. In addition, studying the guideline significantly increased pointing out cardioversion, considering patient sedation before cardioversion and using proper cardioversion energy in treating unstable tachyarrhythmia. Studying the guideline significantly increased use of adenosine as well as procainamide and amiodarone in treating stable tachyarrhythmia with wide and monomorphic QRS, but did not affect using sotalol. Studying the guideline led to significant increase in use of atropine as the first-line medication in treating unstable brady dysrhythmia. In addition, studying the guideline significantly increased the use of 3 temporary alternative treatments in treating unstable brady dysrhythmia. Studying the guideline did not affect asking for cardiology consultation and coordination for permanent treatment.

The results of the present study showed that adherence to the guideline in the studied items of tachy/brady dysrhythmia ranged between 15% and 100%. Overall, passing the trainingprogram in addition to studying the guideline significantly improved the rate of adherence to AHA guideline in many case

Patients with acute renal colic need to choose between undergoing medical treatments and re- ceiving interventions. The Aim of this study is to evaluate the outcomes of patients who are discharged from emergency departments with ureteral stones lesser than 6 millimeters. In doing so, the effect of diagnostic treat- ment approaches on clinical outcomes and referral rate is to be assessed.

This study was performed on patients with ureteral stones referred to emergency department of Shohadaye Tajrish Hospital between May2015 to June 2018. A checklist was filled out for each patient and it included their complete medical history, physical examination results and paraclinical data. Patients were then studied for 4 weeks to determine referral times to hospital and clinical outcomes.

105 patients include 81 men (77.14%) with average age of 37.1±12.4 years were studied. The mean stone diameter was 4.2±2.1 mm. Most of ureteral stones were seen in the right- hand side (60 percent). 71 patients (67.6%) did not have any history of nephrolithiasis and 73 (69.5%) did not have positive family history for nephrolithiasis. Ureteral stones were still observed in 42 patients (40%) after two weeks of studies and only one patient (1.1%) had stone in Ultrasound Imaging after 4 weeks of observations.

Most Patients (95%) with stones smaller than 6 mm responded to Medical Expulsive Therapy (MET) after 4 weeks and passed spontaneously ureteral calculi.

Choosing a proper medication for pain management of patients with acute renal colic has been a challenge for physicians treating these patients. The present study was performed with the aim of comparing intravenous (IV) ibuprofen and IV ketorolac in pain management of these patients. In the present double-blind clinical trial study, patients suspected with renal colic presented to the emergency department were randomly divided into 2 groups receiving IV ibuprofen or IV ketorolac and were compared regarding effectiveness (pain reduction 15, 30, and 60 minutes after injection), treatment success, and possible side effects. In total, 240 patients suspected with renal colic with the mean age of 27.38 ± 12.32 years were randomly divided into 2 groups of 120 individuals treated with IV ketorolac or ibuprofen (66.4% male). The two groups were in a similar condition regarding age (P = 0.56), sex (P = 0.78) history of kidney stone (P = 0.40), vital signs (P > 0.05), stone size (P = 0.73), stone location (P = 0.13), and pain severity on admission (P = 0.32). 15, 30, and 60 minutes after drug injection, pain severity in the ketorolac group was significantly higher than the group receiving ibuprofen (P < 0.0001 for all comparisons), yet these differences were not clinically significant. Fifteen minutes after the injection, the rate of treatment success was significantly higher in the group receiving IV ibuprofen (P < 0.0001). After 60 minutes, the number of completely relieved cases reached 37 (30.8%) patients in the ketorolac group and 83 (69.1%) patients in the ibuprofen group. No significant difference was seen in side effects between the two groups (P = 0.35). The findings of the present study show that ibuprofen is a more rapid acting drug compared to ketorolac in controlling pain caused by renal colic. In addition, its rate of complete relief from pain was twice as much as that of ketorolac. Since the side effects observed for ibuprofen in the present study were very mild, it is suggested to use this drug in treatment and pain control of renal colic patients.

Elimination of preventable deaths due to acute kidney injury (AKI) in low-income countries by 2025 is an important healthcare goal at the international level. The present study was designed with the aim of evaluating the prevalence and outcome of AKI in patients presenting to emergency department. The present cross-sectional, retrospective study was performed on patients that presented to the emergency departments of 3 major teaching hospitals, Tehran, Iran, between 2005 and 2015 and were diagnosed with AKI. Patient selection was done using consecutive sampling and required data for this study was extracted by referring to the medical profiles of the patients and filling out a checklist designed for the study. 770 AKI patients with the mean age of 62.72 ± 19.79 (1 – 99) years were evaluation (59.1% male). 690 (89.61%) cases of AKI causes were pre-renal or renal. Among the pre-renal causes, 74 (73.3%) cases were due to different types of shock (p < 0.001). The most common etiologic causes of AKI in pre-renal group were hypotension (57.3%) and renal vascular insufficiency (31.6%). In addition, regarding the renal types, rhabdomyolysis (35.0%), medication (17.5%) and chemotherapy (15.3%) and in post-renal types, kidney stone (34.5%) were the most common etiologic causes. 327 (42.5%) patients needed dialysis and 169 (21.9%) patients died. Sex (p = 0.001), age over 60 years (p = 0.001), blood urea nitrogen level (p < 0.001), hyperkalemia (p < 0.001), metabolic acidosis (p < 0.001), cause of failure (p = 0.001), and type of failure (p = 0.009) were independent risk factors of mortality. The total prevalence of AKI in emergency department was 315 for each 1000000 population and preventable mortality rate due to AKI was estimated to be 28.2 cases in each 1000000 population. The most important preventable AKI causes in the pre-renal group included shock, sepsis, and dehydration; in the renal group they included rhabdomyolysis and intoxication; and stones in the post-renal group.

Epidemiologic evaluation generally starts with recording the raw data regarding mortality, and healthcare managers should have a national plan executed for this purpose. The present study was planned and performed with the aim of epidemiologically evaluating mortality cases among patients admitted to the emergency department (ED) of a major hospital in Tehran, Iran in order to plan and provide proper equipment for decreasing the mortality of patients. This cross-sectional study was performed in Shohadaye Tajrish Hospital, Tehran, Iran. All cases of mortality, recorded in the ED of the studied hospital from 20 March 2016 until 21 June 2016, were included in the study. A checklist was prepared for gathering data and the clinical profiles of all the considered patients were reviewed. Using this checklist, demographic data, chief complaint, history of underlying disease, pathologic findings of imaging modalities, and cause of death were extracted from the patients’ profiles. Over the mentioned period of time, in total, the data of 8420 admissions to the ED were recorded. Out of these patients, 76 (0.9%) had died, the mean age of whom was 67.66 ± 21.40 years. Based on these findings, among patients who had presented to the ED, 42.1% died due to the complications of heart attack and 13.2% died from complications caused by cancer. Based on the findings of the present study, cardiovascular complications were the most leading cause of mortality in the studied ED and complications resulting from malignancy were in the second place. Trauma and accidents leading to intracranial hemorrhage were in the next places.

It is essential to adjust the responsibilities and function of medical education offices (MEOs) in regard to the current societal requirements. Therefore, it is a good idea to learn lessons from the experiences about the establishment and function of these offices around the world. The aim of the present study was to carry out a comparative study to investigate the function and structure of MEOs at some of the medical universities from America, Europe, and Asia.

This is a comparative, descriptive study that was conducted in 2015. Eleven offices around the world (in America, Europe, and Asia) were selected for the study. Expert group discussion and literature review were used in order to select research sample. The data were gathered using self‑constructed checklists. Content and face validity of the checklist was assessed by gathering feedback from experts. The Kappa coefficient was used to determine the inter‑rater reliability.

All the 11 offices in our study (100%) dealt with the issues of faculty development and research and scholarship activities. Only one out of the 11 offices (27%) dealt with the issues of society and patient education. Five out of the 11 offices (36%) dealt with the continuing medical education and continuing professional development. Consultation services are provided at seven of the 11 offices (64%).

This study revealed both commonalities and differences in the function and structure of MEO among the 11 offices we examined. Based on this study, effective goals and strategies for MEO can be recommended.

Traumatic diaphragmatic hernia (TDH) is one of the critical complications resulting from penetrating chest trauma. The rate of undiagnosed TDH equivocates 12-60%. The significant part of complications happens 1-4 years after the primary damage. Here, we report a case of delayed TDH presented with upper gastrointestinal bleeding (GIB) as an excuse to discuss this issue.
The patient was a 35-year-old man, admitted with objection of abdominal pain. A nasogastric tube was inserted and fixed that resulted in drainage of about 500cc dark blood. He was candidate for emergent endoscopy due to upper GIB. During resuscitation measures, he suddenly developed respiratory distress that could not be justified by upper GIB alone. Therefore, bedside sonography discovered some soft tissue apart from lung tissue in the left hemithorax. After performing diagnostic measures, with diagnosis of diaphragmatic herniation and strangulation he underwent emergent surgery.
Small diaphragmatic lesions, which usually result from stab wounds, may develop into larger injuries if left untreated and they might lead to a diaphragmatic hernia with a potential risk of early or late complications and mortality. One of the rare complications is GIB, which should be considered in a patient with past history of trauma and presentation of GIB.

Leaving the hospital without notice is among the problems that can inflict financial and non-financial burdens on the health care system of a country. The present study was carried out with the aim of evaluating the prevalence of leaving without notice cases in the emergency department (ED) of one of the major teaching hospitals of Tehran affiliated with Shahid Beheshti University of Medical Sciences and calculating the direct costs resulting from it.
This study was a retrospective cross-sectional one carried out during 1 year from 2016 to 2017 in one of the teaching hospitals of Tehran affiliated with Shahid Beheshti University of Medical Sciences. Sampling was performed via census method and the study population consisted of the profiles of all the patients who had left the hospital without notice or checking out after being admitted to the hospital. To gather the required data for this study, a checklist consisting of questions regarding sex, age, insurance coverage, and the amount of money they owed the hospital was used. Statistical analysis was performed using the software IBM Statistics for Windows v22 and P-value Out of the total of 39946 patients visiting the ED of the studied hospital during 1 year, 1692 (4.2%) had left the hospital without checking out. Below 30 years age range was the most common age range with 46.9% (794 patients) and 72.9% of the patients leaving without notice were men. Based on the findings obtained, male patients without insurance coverage had attempted to leave the hospital without notice more than others (p Throughout the year this study was performed, a total of 1.2% of all the visitors of the ED of a hospital affiliated with Shahid Beheshti University of Medical Sciences left the hospital without notice or checking out, which inflicted a considerable cost on the ED.

Road traffic injuries (RTI) are among the most important health problems worldwide as they cause more than 1.2 million deaths and 50 million injuries each year. The present study aims to evaluate the outcome and aftermath of RTI in those who were injured and hospitalized due to traffic accidents.

In the present retrospective cohort study with a one-year follow-up, data were extracted from the profiles of the RTI hospitalized patients. Outcome of the patients was evaluated at the time of discharge and 1-year later including their living state, presence of a disability or complete recovery.

1471 patients were studied (mean age of 32.8§17.0; 80.3% male). 571 (38.8%) had mild disability, 684 (46.5%) moderate disability, and 85 (5.8%) had severe disability at the time of discharge. In the end, 53 (3.6%) died. In the 1-year follow-up, 194 (13.2%) had mild disability, 43 (2.9%) had moderate disability, 9 (0.6%) had severe disability, and 7 (0.5%) were in a vegetative state. Presence of an underlying disease (p=0.03), loss of consciousness for more than 24 hours (p=0.04), spinal injury (p=0.002), presence of multiple trauma (p=0.01), increased ISS (p<0.001), need for ventilator (p<0.001), and organ injuries during hospitalization (p<0.001) are independent factors that increase the risk of poor outcome in RTI patients.

Based on the results of the present study, underlying illnesses, loss of consciousness for more than 24 hours, spinal injury, multiple trauma, increased ISS, need for ventilator, and organ injuries during hospitalization were independent factors that increased the probability of poor outcome in RTI injuries.