Accident And Emergency Department Research Articles

Psychosis in adults with autism spectrum disorder and attention deficit hyperactivity disorder at acute psychiatric wards

Background and objectivesPsychotic symptoms, such as delusions and hallucinations, in autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) have been increasingly reported in recent literature. In the present study, the prevalence and duration of psychotic symptoms, comorbid psychotic disorders, and clinical characteristics of adults with ASD and ADHD were retrospectively examined via a chart review. MethodsThe participants were 98 adults (mean age, 28.5 years; 72 men) who were admitted to the psychiatric emergency wards of Showa University Karasuyama Hospital, and who were diagnosed with ASD and/or ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria. ResultsAmong 69 individuals with ASD, 21 (30.4%) experienced psychotic symptoms, and among 29 individuals with ADHD, 5 (17.2%) exhibited psychosis. While all psychotic symptoms were classified as transient and none had comorbidity with schizophrenia and other psychotic disorders in adults with ADHD, 38.1% of psychosis was classified as prolonged and 10.3% had comorbidity with schizophrenia and other psychotic disorders in adults with ASD. ConclusionThe results showed that a significant proportion of adults with ASD and ADHD experience psychosis during their course of illness, and provide evidence for the existence of a shared etiology between neurodevelopmental and psychotic disorders.

Transmission and microevolution of methicillin-resistant Staphylococcus aureus ST88 strain among patients, healthcare workers, and household contacts at a trauma and orthopedic ward.

Surgical sites infections (SSIs) caused by Methicillin-resistant Staphylococcus aureus (MRSA) constitute a major clinical problem. Understanding the transmission mode of MRSA is important for its prevention and control. We investigated the transmission mode of a MRSA outbreak in a trauma and orthopedic hospital ward. Clinical data were collected from patients (n = 9) with MRSA infection in a trauma and orthopedic ward from January 1, 2015 to December 31, 2019. The wards (n = 18), patients (n = 48), medical staff (n = 23), and their households (n = 5) were screened for MRSA. The transmission mode of MRSA isolates was investigated using next-generation sequencing and phylogenetic analyses. The resistance genes, plasmids, and single-nucleotide variants of the isolates were analyzed to evaluate microevolution of MRSA isolates causing SSIs. The MRSA colonization-positive doctor was asked to suspend his medical activities to stop MRSA spread. Nine MRSA infected patients were investigated, of which three patients were diagnosed with SSI and had prolonged hospitalization due to the persistent MRSA infection. After screening, MRSA isolates were not detected in environmental samples. The surgeon in charge of the patients with SSI caused by MRSA and his son were positive for MRSA colonization. The MRSA from the son was closely related to the isolates detected in MRSA-induced SSIs patients with 8-9 single-nucleotide variants, while ST88-MRSA isolates with three different spa types were detected in the surgeon's nasal cavity. Comparative genomic analysis showed that ST88-MRSA isolates acquired mutations in genes related to cell wall synthesis, colonization, metabolism, and virulence during their transmission. Suspending the medical activity of this surgeon interrupted the spread of MRSA infection in this ward. Community-associated MRSA clones can invade hospitals and cause severe postoperative nosocomial infections. Further MRSA surveillance in the households of health workers may prevent the transition of MRSA from colonization to infection.

Efficacy of Tranexamic Acid in the Treatment of Massive Upper Gastrointestinal Bleeding: A Randomized Clinical Trial.

Background Upper gastrointestinal bleeding (GIB) is an important cause of emergency ward admission. Antifibrinolytic agents including tranexamic acid (TXA) have been used for controlling GIB. However, there have been concerns regarding the safety and efficacy of TXA in patients with GIB. Thus, in this study, we aimed to determine the efficacy of TXA in the treatment of massive upper GIB. Methodology This double-blind randomized clinical trial was conducted among 86 consecutive patients who were referred to Imam Hossein Hospital in Tehran, Iran from 2018 to 2019 with the chief complaint of massive upper GIB. Patients were chosen to be in the TXA or placebo groups based on a 1:1 allocation using the block randomization method. The rate of rebleeding, need for blood transfusion, hospital stay, adverse effects, and mortality rate were evaluated and compared across the groups. Results Of the 86 patients enrolled in this study, 55.8% (n = 48) were males. The mean age of all patients was 53.1 ± 10.6 years (TXA group: 54.9 ± 11.5 years, and placebo group: 51.4 ± 9.7 years). Rebleeding was seen in 11(25.6%) patients in the TXA group and in 20 (46.5%) patients in the control group, which was statistically significant (p = 0.043). Blood transfusion was carried out in only three (7%) patients in the TXA group compared with 14 (32.6%) patients in the placebo group (p = 0.003). Six (14%) patients experienced a hospital stay of longer than five days in the TXA group and 15 (34.9%) patients in the control group, which was statistically significant (p = 0.024). There were no significant differences in the mortality rate across both groups (p > 0.05). Conclusions TXA has no effect on mortality associated with severe upper GIB. However, it was associated with a lower rate of rebleeding and hospitalization time, without significant adverse effects.

The Effect of Distraction With Watching Cartoons on the Level of Pain at Preparation Before Suturing Children in the Emergency Ward

Background: Distraction is a technique that has had positive effects on reducing children’s pain in painful interventions, such as venipuncture, and replacing the burn dressing. Based on the available data, very few articles exist about the application of this technique when suturing children. Objectives: This study was designed to determine the effect of distraction by watching cartoons on the level of pain during preparation before suturing children in the emergency ward. Methods: This study is a randomized controlled trial. The research population included all children aged 3-12 years who were referred to the emergency ward of Bu Ali Sina Hospital in Sari City, Iran. Forty-three subjects were selected from each group. In the intervention group, playing cartoons on the tablet was initiated from the time of placing the child on the bed for suturing, and continued until the end of the anesthetic injection, and this time was recorded. In the control group, the suturing was performed conventionally. The behavioral reactions of both groups were measured twice based on the pain behavioral reactions scale. The first time was when the child was placed on the bed and before cleaning for the anesthetic agent, while the second time was observed and recorded by the researcher immediately after injecting the anesthetic agent. Results: The comparison of mean pain before injecting the anesthetic agent (after playing the cartoon) showed a significant difference between the intervention and control groups based on Mann-Whitney test (P=0.0001). The comparison of mean pain immediately after termination of anesthetic injection also showed a significant difference in both the intervention and control groups based on the Mann-Whitney test (P=0.0001). Based on the results of the present research, the pain in the intervention group was less before the anesthetic injection and less in the control group immediately after the injection. Conclusions: The results suggested that distraction from watching cartoons has a positive effect on reducing the pain of preparation before suturing children. Therefore, this technique can be used in emergency departments.

Why are patients with acute traumatic brain injury not routinely assessed or treated for vestibular dysfunction in the UK? A qualitative study

ObjectivesVestibular dysfunction is common in patients with acute traumatic brain injury (aTBI). Persisting vestibular symptoms (ie, dizziness and imbalance) are linked to poor physical, psychological and socioeconomic outcomes. However, routine...

Culture results of lumbar puncture samples in the emergency ward: A descriptive study

Culture results of lumbar puncture samples in the emergency ward: A descriptive study

Assessment of Common Pediatric Cases at Emergency Ward in Kirkuk City

Assessment of Common Pediatric Cases at Emergency Ward in Kirkuk City

Health care worker carriage of drug-resistant bacteria and infection control practices at a tertiary care hospital in Uganda: a cross-sectional survey.

bacterial carriage by health care workers (HCWs) is a major risk factor for transmission of healthcare-associated infections (HAIs). Often, these pathogens are multiple drug resistant (MDR) and are transmitted from hospital environments. We aimed to study the carriage of pathogenic bacteria among HCWs at a tertiary care hospital in Uganda. a cross-sectional study was done at Naguru Regional Referral Hospital from June 2017 to August 2017. Five finger imprints of both hands-on blood and MacConkey agar were done. We assessed pathogenic bacterial carriage by HCWs and characterized drug sensitivity and relatedness of these isolates. Genotyping of extended-spectrum beta-lactamase (ESBL) and Methicillin-resistant Staphylococcus aureus (MRSA) positive isolates was done to determine intra-hospital transmission. A survey of the hospital's IPC de program was done. one hundred and eight (108) HCWs were enrolled. Carriage of pathogenic bacteria was highest in surgical and emergency wards at 36% and 35.6% respectively, p-value of 0.00. The proportion of microbial carriage was highest among nurses 16 (34.8%) followed by medical officers 11 (23.9%). Among the isolated pathogenic bacteria, 25 (36.2%) were Gram-positive and 44 (63.8%) were Gram-negative. Fifty percent of Staphylococcus aureus were methicillin-resistant, and one isolate was vancomycin-resistant. Fifty-four percent (54.6%) of HCWs had never been trained on moments of hand hygiene, only 44.4% recognized the presence of an IPC program in the hospital and 49% were not aware of problems associated with poor IPC practices. this study demonstrated that hands of HCWs at Naguru Regional Referral Hospital were colonized with pathogenic bacteria with varying prevalence, some with multidrug-resistant strains including MRSA and ESBL.

Corticosteroids and Duration of Medical Induction for Mid-Trimester Abortion

Background: Abortion is defined as the termination of pregnancy (TOP) before fetal viability, regardless of the method used. It has been shown that using misoprostol alone to medically end an abortion in the second trimester is successful. Aim and objectives: The purpose of the research was to assess the impact of intramuscular dexamethasone on the length of induced second trimester abortion in pregnant women between the ages of 16 and 24 weeks of gestation. Patient and methods: From January 2020 to May 2021, this research was conducted in the Obstetrics and Gynecology Department of Qena General Hospital and Qus Central Hospital. A total of 200 pregnant women consented to participate in this research and they were selected from the emergency wards. All women considered for this study were in the second trimester at gestational age from 16 to 24weeks, who were planned for medical induction of abortion. These inclusion and exclusion criteria were used to recruit women. Result: most of cases (94.5%) and (98%) at two groups respectively were Satisfied, there was statistical substantial variation between groups as regard to satisfaction. Conclusion: the administration of dexamethasone intra- muscularly (12 mg every 24h) with the medical induction of abortion by misoprostol (200 mcg intra vaginally every 4hr) appears to be effective as regard shortening the induction-abortion interval (duration between the initiation of induction and expulsion of fetus), reducing the overall misoprostol dosage and the duration of the hospitalization. Its cost effective and availability are apparent benefits

Assessment of nurse’s knowledge towards diabetic ketoacidosis in children in Mosul City, Iraq

Objective: To assess of nurse’s knowledge toward diabetic ketoacidosis (DKA) among children Mosul hospitals. Methodology: This descriptive study was conducted at emergency, intensive care and pediatric wards. Non-random purposive sampling method was used to select 30 nurses. We used Diabetic Ketoacidosis based DKA-Guideline. The data were collected by interview and SPSS 24 was used for the statistical analysis. Results: Most nurses (56.7%) lacked adequate knowledge about DKA and most of them had poor knowledge about IV fluid for patient with DKA. Most of nurses’ knowledge about insulin management were acceptable (66.7%). Conclusion: Nurses' knowledge regarding DKA was slightly more than half of the sample, and their knowledge was poor towards intravenous fluids and electrolytes balancing. The study recommends the need for an educational program regarding DKA and diabetic patients, especially for nurses working in emergency and intensive care units.

Implementation of a care pathway based computerized order entry system streamlines test ordering and offers tools for benchmarking clinical practice

Background and aimsThis is a narrative report on the development of specifications and of the stepwise implementation of a computerized physician order entry system (CPOE) in the University Hospitals Leuven, based on order sets integrated in care pathways. Integration of the CPOE into the electronic health record optimally supports those care pathways. Materials and methodsWe investigated adherence to consensus-based use of laboratory tests. We analysed data post- versus pre-implementation test requests for departments selected to cover various patient populations, using the Mann-Whitney U test corrected for the False Discovery Rate. ResultsWe investigated the effect on the number of tests post- versus pre-implementation. In the emergency and inpatient wards, the CPOE implementation resulted in decreases in requests for uric acid, total protein, direct bilirubin, reticulocyte count, and increases in requests for albumin, glucose and calcium. In the outpatient clinics, where the medical specialties already used non-computerized consensus-based test requesting strategies, effects on the number of requested tests were marginal. In all settings, operational improvements could be inferred: the centrally managed CPOE system resulted in fast and well-controlled management of test strategies, digital traceability of the laboratory test requesting process, automatic archiving of requests, assurance of availability of obligatory information. ConclusionsOverall, test requesting strategies improved towards more consensus-based and operational benefits resulted in time gains and improved efficiency of time spend.

Vision Screening in Older Adults Admitted with a Fragility Hip Fracture: A Healthcare Quality Improvement Report.

This healthcare quality improvement report focussed on the effectiveness of an orthoptic-led inpatient vision screening service at Nottingham University Hospitals for older adults admitted with a fragility hip fracture. The service was developed in response to national guidance, which recommended a multifactorial assessment, including a vision assessment for older adults presenting following a fall. Vision screening was carried out by orthoptists on eligible patients ≥65 years of age admitted to the trauma and orthopaedic wards with a hip fracture. Retrospective data for patients screened between 2015-2019 were analysed, including: patient demographics; screening eligibility and outcome; ophthalmology referrals made; ophthalmology appointment attendance; and outcome. Of the 3321 patients admitted with a hip fracture between 2015-2019, 2033 (61%) were eligible for vision screening and 1532 (75%) of these were screened. Furthermore, 784 (51%) of the patients screened had an ocular abnormality requiring an ophthalmology referral, or a sight test at an optician. Only 144 of the 383 (38%) who required an ophthalmology referral via the GP were successfully referred, and only 107 of the 186 (58%) patients who were given appointments attended them. Additionally, 98 of 107 had pathology, with cataracts the most common finding (51%), and 61 of 98 (62%) patients had treatable vision impairment. We found a large proportion of fragility hip fracture patients with impaired vision, much of which was treatable and could be detected effectively with orthoptic-led bedside screening. The most common eye problem in those referred to ophthalmology was cataracts. An internal referral pathway to ophthalmology is proposed. There is a need to investigate reasons for disengagement with eye care services in this population.

Pneumotórax espontâneo como manifestação inicial de Influenza A (H1N1) em pediatria: relato de caso

OBJECTIVE: To report on a case of a child with influenza subtype A H1N1 who exhibited a spontaneous pneumothorax as an initial manifestation of the illness. CASE DESCRIPTION: A 8-year-old male patient experienced a dry cough in the 24 hours prior developed dyspnea, productive cough, tachypnea, tachycardia, and subcutaneous emphysema. Upon admission to the emergency ward, the patient was tachycardic with bilaterally palpable subcutaneous emphysema in the thoracic wall, was reliant on an oxygen mask, and experienced drops in arterial oxygen saturation. Chest and lung examinations revealed coarse crackles, expiratory wheezing, and suprasternal retraction. Patient received a corticosteroid, a bronchodilator, and an antibiotic. Imaging exams revealed bilateral pneumothoraces and bilateral subcutaneous emphysema. Patient was hospitalized in the Pediatric Intensive Care Unit (ICU). Bilateral chest drainage was installed; intubation and mechanical ventilation were initiated. On the sixth day after admission, the test for A/H1N1 came back positive. Patient was released from the Pediatric ICU on the ninth day and was released from the hospital the following day without symptoms. COMMENTS: A pneumothorax as an early manifestation of A/H1N1 is a rare occurrence in children. This case reflects the need for broader differential diagnostic options in children with spontaneous pneumothoraces.

Accuracy evaluation of pediatric appendicitis scoring (PAS) method in differentiating nonspecific abdominal pain from appendicitis

Background: This study aimed at evaluating the accuracy of the pediatric appendicitis scoring method in differentiating nonspecific abdominal pain (NSAP) from appendicitis. Methods: This cross-sectional study was conducted on 391 children who were hospitalized in the emergency ward due to acute abdominal pain suspected of appendicitis . Pediatric Appendicitis Score (PAS), C-reactive protein (CRP), and appendicitis pathology results of patients undergoing surgery were recorded. Results: The results showed that the no significant difference was found among patients in the three experimental groups (appendicitis, specific abdominal pain except appendicitis, and NSAP) with respect to temperature (p = 0.212), but the other variables were significantly different. Findings showed that high CRP frequency, pain migration to right lower quadrant (RLQ), tenderness in right iliac fossa (RIF), anorexia, leukocytosis, high neutrophil, and mean tenderness in RLQ in the appendicitis group were higher than those in the other two groups (p = 0.001). The PAS questionnaire can also be used as a reliable questionnaire with appropriate sensitivity (0.929) and specificity (0.993), and this questionnaire along with detailed clinical examinations could reduce the rate of negative appendectomy to less than 1%. Conclusions: This study showed high accuracy of PAS in diagnosing children with appendicitis and differentiating appendicitis from cases of NSAP and specific abdominal pain other than appendicitis. The PAS system could also significantly reduce cases of negative appendicitis. Although high CRP had an excellent ability to diagnose appendicitis, its accuracy was lower than PAS.

PNEUMOTÓRAX ESPONTÂNEO COMO MANIFESTAÇÃO INICIAL DE INFLUENZA A (H1N1) EM PEDIATRIA, RELATO DE CASO

Objective: To report on a case of a child with influenza subtype A H1N1 who exhibited a spontaneous pneumothorax as an initial manifestation of the illness. Case Description: A 8-year-old male patient experienced a dry cough in the 24 hours prior developed dyspnea, productive cough, tachypnea, tachycardia, and subcutaneous emphysema. Upon admission to the emergency ward, the patient was tachycardic with bilaterally palpable subcutaneous emphysema in the thoracic wall, was reliant on an oxygen mask, and experienced drops in arterial oxygen saturation. Chest and lung examinations revealed coarse crackles, expiratory wheezing, and suprasternal retraction. Patient received a corticosteroid, a bronchodilator, and an antibiotic. Imaging exams revealed bilateral pneumothoraces and bilateral subcutaneous emphysema. Patient was hospitalized in the Pediatric Intensive Care Unit (ICU). Bilateral chest drainage was installed; intubation and mechanical ventilation were initiated. On the sixth day after admission, the test for A/H1N1 came back positive. Patient was released from the Pediatric ICU on the ninth day and was released from the hospital the following day without symptoms. Comments: A pneumothorax as an early manifestation of A/H1N1 is a rare occurrence in children. This case reflects the need for broader differential diagnostic options in children with spontaneous pneumothoraces.

Congenital Pulmonary Airway Malformation in a Two-Month Old Infant: A Case Report

Congenital Pulmonary Airway Malformations (CPAM) are rare clinical conditions that affect the lungs. They are characterised by the formation of large, multiloculated, cystic structures due to the overgrowth of the terminal bronchioles. This report presents the case of a two-month-old female infant who was referred to the pediatric emergency ward with a diagnosis of aspiration with collapse of the left lung. The patient exhibited progressively worsening respiratory distress accompanied by fever. The infant had a history of breast milk aspiration and had been admitted to the hospital multiple times due to respiratory distress since birth. Even after discharge, she required moist oxygen therapy at home. Upon presentation, a chest X-ray showed left lung collapse, and her respiratory rate was measured at 70 breaths/min. Other vital parameters and laboratory examinations were within normal limits. A high-resolution Computed Tomography (CT) scan of the thorax confirmed the diagnosis of CPAM. The patient was placed on ventilator support and received antibiotic treatment. Once stabilised, she underwent right postero-lateral thoracotomy with right middle and lower lobectomy under general anesthesia. Following surgery, she was discharged in stable condition on the seventh postoperative day, with her respiratory distress resolved. The child continues to receive regular follow-up care, including immunisations and appropriate nutritional support.

Assessment of Magnesium Sulfate Infusion in Combination with Ketorolac for the Pain Management in Intertrochanteric Fractures; A Randomized Clinical Trial.

Intertrochanteric fracture is a common fracture that mainly occurs in the elderly. Diverse pain management strategies have been applied; however, considering the age of the patients, analgesia-related complications should be concisely considered. The current study aims to evaluate the efficacy and adverse effects of Ketorolac plus placebo versus Ketorolac plus magnesium sulfate for pain management in intertrochanteric fractures. The current randomized clinical trial has been conducted on 60 patients with intertrochanteric fractures assigned into two groups of treatment with Ketorolac (30 mg) plus placebo (n=30) versus Ketorolac (30 mg) plus magnesium sulfate (15 mg/kg) (n=30). Pain scores using the visual analog scale (VAS), hemodynamic parameters, and complications (nausea and vomiting) were assessed at baseline and within 20, 40, and 60 minutes after the interventions. Additional morphine sulfate requirements were compared between the groups. Demographic characteristics in both groups were similar (P>0.05). All the assessments showed statistically significantly less pain severity in the magnesium sulfate/Ketorolac group (P<0.05), except for the baseline assessments (P=0.873). The two groups did not differ regarding hemodynamic parameters, nausea, and vomiting complaints (P>0.05). Although the frequency of additional morphine sulfate requirement was not different between the groups (P=0.06), the administered dose of morphine sulfate was significantly higher in those treated with ketorolac/placebo (P=0.002). Based on the findings of this study, Ketorolac alone or in combination with magnesium sulfate led to significant pain reduction in patients with intertrochanteric fractures admitted to the emergency ward; however, the combination therapy had superior outcomes. Further studies are strongly recommended.

Causative organisms and visual prognosis of endophthalmitis in Cairo University Hospitals, Cairo, Egypt

Purpose The aim of this study was to identify the most common causative organisms, treatment modalities, and visual prognosis of cases of endophthalmitis in Cairo University Hospitals, Cairo, Egypt. Patients and methods This was a prospective study that was carried out on consecutive patients presenting with exogenous endophthalmitis to Cairo University Hospital Casualty Unit, Cairo, Egypt, during the period from June 2021 to February 2022. Demographic and clinical characteristics of all patients were collected and analyzed. Vitreous tap was obtained from all patients and cultured. Treatment modalities were tabulated and analyzed. Factors influencing the final visual outcome were studied. Results The study included 31 eyes of 31 patients, with a mean age of 41.8±17.9 years (range=8–69 years). All cases had exogenous endophthalmitis, where 17 were postoperative, 12 posttraumatic, and two postintravitreal injection. Positive vitreous culture was detected in only nine (29%) patients. The most commonly identified organism was Streptococcus pneumoniae (four of nine patients, 44.4%). Cultures were positive for fungi in only two patients. Cultures were positive in 35% of postoperative endophthalmitis and in 25% of posttraumatic endophthalmitis. Treatment modalities included intravitreal antibiotics only (n=15; 48.4%), intravitreal antibiotics and delayed vitrectomy (n=8; 25.8%), immediate vitrectomy (n=7; 22.6%), and evisceration (n=1; 3.2%). The mean follow-up after presentation was 5.1±1.6 months (range=3–9 months). The factors associated with poor visual outcome were older age (P=0.032), history of ocular trauma (P<0.001), early presentation after trauma (P=0.021), and presence of corneal infection (P=0.001). The visual outcome was significantly better in those who had vitrectomy either immediately or after intravitreal injection (P=0.004). Conclusion S. pneumoniae was the most commonly identified organism in exogenous endophthalmitis in Cairo University Hospitals. Early vitrectomy and absence of corneal infection were associated with better visual outcome.

Using Weibull model of survival analysis workflow and its relevant factors: A prospective cohort study

Objective: One of the most important indicators used in the evaluation of emergency centers is the chronometric analysis of patients’ workflow. The aim of this study was to provide a chronometric analysis of patients’ workflow (patients’ waiting time in the emergency department) and related factors. Methods: This hospital-based prospective cohort study was carried out in Khatam al-Anbia hospital in Shoushtar in 2020. Random sampling was used and patients referred to the emergency ward in three shifts based on the ESI 5-level triage system. The research tools were the emergency workflow chronometry form and a questionnaire of determining the factors related to the speed of emergency services and using a stopwatch. In order to analyse the data, Stata software version 16 and Weibull model of survival analysis were used. Results: Of 468 participants, the most common cause of referral was trauma with 21.7%. The median±interquartile range duration of giving the final result was 6.06±4.48 hours, which was more than 0.54 times shorter in clients with level 3. There was a statistically significant difference in the duration of making the final decision based on the request for testing, manner of referring and the type of initial diagnosis (P&lt;0.05). Conclusion: The duration of service provision in the studied hospital is appropriate for an Iranian hospital, but it should be closer to international standards. At level 2 triage, patients stayed longer. This can be reduced by lessening the time of consultations which can help the emergency ward.

The Frequency of Use of Warfarin-Interfering Drugs in Patients Suffering from Warfarin Toxicity Referred to the Emergency Department of Imam Reza Hospital, Mashhad

Aims: With the progress made in the treatment of cardiovascular patients, the use of anticoagulants such as warfarin, aspirin, ticlopidine, etc. have increased. This study aimed to investigate the frequency of use of warfarin-interfering drugs in warfarin toxicity patients admitted to the emergency ward of Imam Reza Hospital, Mashhad, Iran, from March to August 2016.&#x0D; Materials and Methods: In this original cross-sectional study after obtaining the approval of the university's ethics committee, 133 patients with warfarin toxicity admitted from March to August 2016 were included in the study. The hospital records of the patients were reviewed, and based on the detailed history taken from the patients the information related to the simultaneous use of different drugs, the duration of warfarin use, the reasons for warfarin use, and the symptoms of warfarin toxicity were extracted. SPSS version 24 software was used for data analysis (p&lt;0.05).&#x0D; Results: Artificial heart valve was the most common indication for warfarin use (48%). Potentially fatal bleeding occurred in 85% of patients, and gastrointestinal bleeding was the most common symptom of warfarin toxicity (37.6%). The most common drugs used were aspirin (62.4%), metoprolol (33.1%), and statins (28.8%).&#x0D; Conclusion: In this study, a high frequency of drug interactions with warfarin was observed, which seems to play a significant role in the occurrence of warfarin toxicity. The most common drug interactions were observed in the simultaneous use of aspirin, metoprolol, and statins. Careful monitoring of the type of drugs used by patients is extremely important in providing safe and effective treatment and reducing side effects.