Frontiers in Emergency Medicine
Volume:7 Issue: 4, Autumn 2023

To the editor-in-chief Emergency medicine (EM) is one of the most difficult fields of medicine, and specialists in this field should handle different tasks, simultaneously. According to some reports, this group has the highest burnout level among different medical specialities. It is necessary for the professionals in this field to zoom out once in a while. Sabbaticals are good opportunity for this purpose among academics. This period not only provides a time window to get away from work stress, it also helps to broaden people's view via learning new materials. Over one year, September 2022 – August 2023, I completed my Master of Science in epidemiology degree at the University of Ottawa. In addition, the work at the Ottawa hospital research institute (OHRI) which is well known across the world for its excellence in EM research provided me a unique opportunity to participate in some research studies. I detail a few observations below.

Urolithiasis is responsible for the majority of urological emergencies. Although computed tomography (CT) scan can identify urinary obstruction caused by stones, there is a growing concern about exposure to radiation made by this method. Renal scintigraphy can provide valuable insights regarding the functional status of kidneys and can significantly reduce exposure to radiation. The goal of present study was to assess renal function through renal scintigraphy in patients with acute renal colic and it explores the association between renal scintigraphy performance and ultrasound in terms of detecting hydronephrosis. 

For this study, 20 patients with acute renal colic were chosen. Each patient underwent renal ultrasonography and subsequently received renal scintigraphy with Technetium-99m diethylenetriaminepentaacetic acid (Tc-99m DTPA). Cohen's Kappa coefficient and Cramer's V correlation were employed to demonstrate the extent of agreement between ultrasound and renal scintigraphy. 

12 (60%) patients were male. Glomerular filtration rate (GFR) values were correlated with Cockcroft-Gault equation and the Gates method (P=0.002, r=0.642). There was a good agreement and a statistically significant relationship between ultrasound and renal scintigraphy in terms of detecting obstructive uropathy in both kidneys. 

To conclude, GFR values were correlated between Cockcroft-Gault equation and the Gates method in patients with acute renal colic. There was a good agreement and statistically significant relationship between ultrasound and obstructive renography results in both kidneys. However, we found no association between perfusion phase of renal scintigraphy and ultrasonography in terms of hydronephrosis detection.

In developing staffing plans for emergency departments (EDs), a multifaceted approach must be considered without compromising quality of care, patient safety and personnel satisfaction. This study aims to determine the temporal trend of patient attendance and staffing in a major tertiary hospital ED to assist in establishing an optimal staffing pattern. 

A 1-year retrospective ED census review of adult patients at the University of the Philippines-Philippine General Hospital (UP-PGH) was undertaken. One-way analysis of variance (ANOVA) with post hoc Fisher-Hayter pairwise comparisons were utilized to determine if the ED consults and admissions were significantly (P<0.05) associated with the month of the year and day of the week. 

 A total 43,632 consults at the UP-PGH ED, averaging of 3,636 per month or 121 per day, were seen in 2019. Results indicated statistically significant differences between monthly [F (11,353) =16.45; P<0.0001] and between daily means [F (6,358) =4.19; P=0.0004]. The most number of consults occur during August, September, October and November while admissions were highest during April and October.  It was busiest during Mondays and afternoon shifts (1400-2200 hours) with majority arriving as urgent in acuity. Mortality was also highest during the afternoon shifts. 

The temporal variations in patient visits and acuity described in our study can be used as a template for workforce scheduling and resource allocation to meet the demands in the provision of care at the ED.

Psychological problems like depression, anxiety, and stress are common in the general population and they have a negative impact on the well-being of the community as well as the country. Pandemic diseases like COVID-19 increase the prevalence of psychological problems in the community. Studying psychological problems and associated factors in the community is very crucial for community mental health management. However, evidence is scarce in Ethiopia. Therefore, this study aimed to assess the prevalence of psychological problems and factors in the community during the COVID-19 pandemic in Shashemene Town, Oromia, Ethiopia. 

A community-based cross-sectional study was conducted from February 01,2012 to February 28, 2021.  A structured, pretested, and interviewer-administered questionnaire was used to collect data from 889 study participants selected through a simple random sampling technique. The data was collected using the depression, anxiety, and stress scale (DASS-21) questionnaire and analyzed using SPSS version 25.0. Bivariable and multivariable logistic regression was done to determine factors associated with DAS. Adjusted odds ratio with their 95% confidence intervals were calculated to identify the presence and strength of an association, while statistical significance was reported at P<0.05. 

The prevalence of psychological problems was 96.6% [95% Cl: 95.9,98.1]. The overall prevalence of depression and anxiety were 30% and 43.5% respectively. Having COVID-19 symptoms in the past two weeks before the survey (AOR=0.34; 95% Cl: 0.15,0.77) and having known medical problems (AOR=0.28; 95% Cl: 0.13,0.59) were factors significantly associated with a psychological problem in response to COVID-19 pandemic. 

The prevalence of psychological problems in response to the COVID-19 pandemic infection was very high in the study area. It needs immediate action to alleviate this psychological problem crisis in the community.

  The hypermetabolic response has undoubtedly evolved to help survive burns, but this physiological response has inconsistent consequences and increases the clinical consequences, such as increased heart work and ultimately its decline, decreased immune system function, risk of  sepsis, increased long-term  hospitalization, which increases the mortality of patients. This study aims to examine the effect of propranolol on post-traumatic stress disorder and clinical outcomes in burn patients. 

  This was an open-labeled randomized clinical trial in a single center with two parallel groups without placebo control. Propranolol was given 48 hours after starting of resuscitation. 

  In this study, the burn wound of the patients who used propranolol healed faster. In addition, the administration of propranolol reduced the size of the burning surface, the size of the tissue required skin graft, the rejection rate of skin grafts, and also the length of stay in the hospital. 

  Using propranolol in treating burns can play an influential role in the recovery of burn patients,  and reduce the post-traumatic stress disorder.

Coronavirus Disease 2019 (COVID-19)-related mortality includes several risk variables that are country-specific in nature. The development of a scoring system is necessary regarding the appearance of novel virus variants. The objective of this research is to develop a prognostic score for COVID-19 patients in resource-constrained settings. 

This study used a retrospective and prospective cohort design to identify variables that influence COVID-19 patients' in-hospital mortality. The receiver operating characteristic (ROC) curve analysis was utilized to determine the laboratory variables cut-off. Cox regression analysis was undertaken to determine the exact variables influencing the survival of COVID-19 patients. A scoring system was created using the best model based on the Hosmer-Lemeshow test (calibration) and the area under the curve (AUC) (discrimination ability). 

Based on calibration and discrimination testing, model 2 (immune disorders, unconsciousness, cerebrovascular disease, onset, and oxygen saturation) was rated as the most advantageous model. Model 2 (without age adjustment) had a superior AUC than model 2A (with age). Cut-off was determined at 2, and calculated for onset ≥7 days (AUC=0.816, 95% CI: 0.742,0.890) and <7 days (AUC=0.850, 95% CI: 0.784,0.916). There was no difference in scoring system utilization for subjects recruited during Delta or Omicron waves (P=0.527). 

The model (cut-off value ≥2) which incorporated age ≥65 years, immune disorders, decreased consciousness, increased respiratory rate, and oxygen saturation <95% is the best model in our study to predict COVID-19 patient mortality.

The prehospital emergency system, as the front line of the health system, has played a very prominent role in the management of the COVID-19 pandemic. Given that identifying the challenges of this area in facing various crises, especially COVID-19, can be a road map for preparing and planning for crisis management in the future, the current study was conducted with the aim of identifying the challenges of prehospital emergency in facing the corona pandemic. 

The present systematic review was carried out based on the PRISMA protocol. The search was conducted using the keywords “challenges, obstacles, prehospital emergency and COVID-19” in PubMed, Scopus, and Web of Science databases, and Google Scholar search engine between December 15, 2019 and March 20, 2023. Non-English articles and articles outside the scope of the COVID-19 pandemic were excluded from the study. CASP (critical appraisal skills program), JBI (Joanna Briggs institute) and MMAT (mixed methods appraisal tool) checklists were used to evaluate the quality of the articles. 

Based on the searches, 12 articles were finally evaluated. Challenges extracted from the analysis of studies were classified into 3 main categories and 7 subcategories including the main categories of “process, structural, and psychological challenges” and the subcategories of “lack of equipment, inappropriate management of human resources, deficiencies in protocols and instructions, weak staff training, occupational burnout, and weak socio-organizational support”. 

The prehospital emergencies of the countries have faced some challenges after the outbreak of COVID-19, which requires the implementation of adaptive strategies and the efforts of the authorities to solve them to prepare for similar crises.

Hyperhomocysteinemia as a hypercoagulable state has been debatable, but when associated with other highrisk factors like severe vitamin B12 and folate deficiency, smoking, high altitude, and antiphospholipid syndrome can present with thromboembolism. Vegans are at high risk of severe B12 deficiency as the primary source is animal products. Right now, the total number of vegans, vegetarians, and all related categories, is close to 14 per cent of the world population. We here present a young vegan with severe B12 deficiency presenting with sub-massive thromboembolism.

Acute dyspnea, sometimes dramatic, is most often caused by cardiovascular or respiratory disease. However, although rare, thyroid dysfunction may present a similar clinical picture with equally serious and life-threatening consequences. Therefore, every occurrence of acute dyspnea represents a special medical challenge in diagnosis and treatment. We present a case of 81-year-old male admitted to the rehabilitation department five days after a knee joint total endoprosthesis and developed acute dyspnea two days later. An emergency diagnostic was performed and confirmed an airway stenosis through a previously undiagnosed enlarged thyroid gland. Although in most cases an acute life-threatening postoperative dyspnea indicates a cardiac or pulmonary problem, other diseases must be taken into consideration.