Department Of Emergency Research Articles

Emergency Department admissions for Acute Respiratory Infections: a retrospective analysis

Abstract Background Acute Respiratory Infections (ARIs) have a relevant impact on public health in terms of prevalence and costs associated with the diseases. The COVID-19 pandemic highlighted the need to adopt accurate surveillance systems to respond to new emergencies and meet the demand for access to care. The aim of our work is to describe the accesses at the Emergency Departement (ED) of the Pisa University Hospital (AOUP), Italy, for ARIs, from 2017 to 2021. Methods A retrospective analysis of electronic medical records from the AOUP was conducted from January 2017 to December 2021. The analysis focused on ED admissions and positive lab test results, examining their correlation with ED visits caused by ARI. Multiple linear regression models were used to understand the influence of viral laboratory results on ARI-related ED admissions, adjusting the results for age. The study also assessed the contribution of each virus incausing ARI within different age groups. Results 33,101 (annual average 5,520) ARI admissions in ED were registered, resulting in 7,426 hospital admissions (22.8%, annual average 1,163) with a seasonal pattern between week 42 of each year and week 17 of the following year. The reduction in emergency room admissions in 2020 (weekly average of 78.2, compared to 144.3 in 2017-2019) may be due to the restrictions implemented for the COVID-19 pandemic. Nevertheless, the average weekly rate of ED admissions caused by ARI was 30.8% in 2020, as compared with 21.7% in 2017-2019. Analysis by age group showed a peak of accesses in the last weeks of 2021 for the <1 and 1-4 years old age groups. Conclusions Data on ARI-related admissions provide valuable insights into the dynamic patterns of seasonal air-borne infections and age-related vulnerabilities. This could be useful in directing health policies to identify indicators of future epidemic waves, contributing to the ongoing efforts to enhance preparedness and response strategies for respiratory infections. Key messages • It is important to create an integrated surveillance system to monitor and respond to ARIs. • Strategies should prioritise vaccination campaigns, particularly for RSV and influenza.

APTT and D-dimer as biomarkers for heatstroke in patients with severe heat-related illnesses.

The objective of this study was to analyze the changes of activated partial thromboplastin time (APTT) and D-dimer in severe heatstroke (HS) patients and their value in identifying HS patients and to analyze clinical features and early laboratory test results of heat-related illnesses. Forty-five patients with heat-related illnesses who were admitted to the Department of Emergency and Intensive Care Medicine of Suining Central Hospital from June 2022 to April 2023 were retrospectively analyzed. Patients were divided into 3 groups based on their clinical diagnosis: classic HS group, exertional HS group, and control group. General date and laboratory test results were collected, especially APTT and D-dimer. The receiver operating characteristic curve was used to analyze D-dimer and APTT. : There were differences in gender distribution among the 3 groups. Exertional HS was dominated by male patients, and classic HS was dominated by elderly patients. Binary logistic regression analysis of coagulation index showed a significant correlation between D-dimer and APTT and HS. The receiver operating characteristic curve results showed that APTT and D-dimer had high sensitivity and specificity in the identification of HS with an area under the curve (AUC) of 0.846, sensitivity of 97%, and specificity of 58.3% for APTT and an AUC of 0.861, sensitivity of 72%, and specificity of 91.7% for D-dimer (D-dimer + APTT [AUC, 0.929; sensitivity, 81.8%-91.7%; P < .001]). : The mortality rate of HS is high, and early diagnosis is particularly important. APTT and D-dimer may be used as markers assisting in identifying HS.

THE ANALYSIS STUDY OF DIAGNOSTIC ACCURACY OF SINGLE SAMPLE RULE-OUT OF HIGH-SENSITIVITY CARDIAC TROPONIN IN DIAGNOSIS OF ACUTE MYOCARDIAL INFARCTION IN EMERGENCY DEPARTEMENT: A COMPREHENSIVE SYSTEMATIC REVIEW FROM LABORATORY DEPARTMENT

Background: High-sensitivity cardiac troponin (hs-cTn) assays has significantly enhanced the diagnostic of acute myocard infark (AMI). Recent studies have shown that hs-cTn assays can effectively rule out AMI with a single sample. This systematic review aim to evaluate the diagnostic accuracy of single sample rule-out of high-sensitivity cardiac troponin in diagnosis of acute myocardial infarction in emergency departement based on literatures of the last 10 years. Methods: The study adhered to PRISMA 2020 standards, examining English literature from 2014 to 2024. It excluded editorials, reviews from the same journal, and submissions without a DOI. PubMed, SagePub, SpringerLink, and Google Scholar were utilized as literature sources. Result: Initially retrieving 360 articles from online databases (PubMed, SagePub, SpringerLink and Google Scholar) eight relevant papers were selected after three rounds of screening for full-text analysis. Conclusion: High-sensitivity cardiac troponin I assays enable rapid AMI rule-out in emergency departments, offering high sensitivity and negative predictive value. However, caution is needed when ruling in AMI, and further research is required to optimize their use.

Clinical spectrum of acute poisoning among children visiting emergency at national institute of child health.

Objective: To determine the clinical spectrum of acute poisoning among children visiting emergency department. Study Design: Cross-sectional study. Setting: Department of Emergency, National Institute of Child Health, Karachi, Pakistan. Period: July 2023 to December 2023. Methods: Children of either gender, aged below 12 years and presenting with acute poisoning were analyzed. Demographic, clinical characteristics and final outcomes of children were reported. Results: In a total of 264 children, 139 (52.7%) were boys. The mean age was 4.79±2.02 years. Mode of poisoning was intentional in 31 (11.7%) children. Non-pharmaceutical exposure was reported in 183 (69.3%) children. Route of poisoning was through oral route in 178 (67.4%) children. The mean time to reach hospital was 80.95±77.77 minutes. Respiratory distress, drowsiness, vomiting, and cough were the most frequent presenting complaints, noted in 111 (42.0%), 43 (16.3%), 38 (14.4%), and 32 (12.1%) children, respectively. Type of poisoning substance were found to have significant association with age (p&lt;0.001), time of presentation (p&lt;0.001), mode of poisoning (p=0.011), place of poisoning (p&lt;0.001), route of poisoning (p&lt;0.001), first aid given (p&lt;0.001), ambulance carrying the child to hospital (p&lt;0.001), and final outcome (p&lt;0.001). No mortality was reported. Conclusion: Acute poisoning most commonly affects children up to 5 years of age. Non-pharmaceutical exposure was reported in majority of acute poisoning cases. Respiratory distress, drowsiness, vomiting, and cough were the most frequent presenting complaints.

Clinical characteristics and outcome of critically ill children referred to a tertiary hospital in Indonesia: a prospective observational study

BackgroundThe clinical characteristics of pediatric critically ill patients who need referral to a tertiary hospital is often unknown in resource limited settings where constraints in diagnosis capacity, resources, and infrastructures are common. There is a need to increase insight in the characteristics of these patients for capacity building strengthening and appropriate resource allocation. The aim of this study was to describe the clinical characteristics and outcomes of critically ill children who are referred to a tertiary referral teaching hospital in Yogyakarta.MethodsA prospective observasional study was carried out from July 1st, 2022 -January 31st, 2023 which included all critically ill pediatric patients who were referred through the Integrated Referral System (SISRUTE) to the Pediatric Intensive Care Unit (PICU) of dr. Sardjito hospital. We excluded patients who were referred with a request for admission to the PICU, but were not admitted to the PICU due to their stable condition and lack of the need for intensive care.ResultDuring the study period, we received 1046 emergency referral requests for pediatric patients via SISRUTE, of those, 562 (53.7%) patients were critically ill. The reasons of PICU referral request were the need of solely intensive care 504 (89.7%), the need of multidisciplinary team care, including intensive care 57 (10.1%) and parents request 1 (0.3%). The pre-referral emergency diagnosis was shock 226 (40.3%), respiratory distress/failure 151 (26.7%), central nervous system (CNS) dysfunction 135 (24.1%), trauma 33 (5.9%) and sepsis 17 (3%). Of the 562 critically ill PICU referral requests, 473 (84.2%) requests were accepted. One hundred and eighty-one (58.7%) patients were finally admitted to the PICU, 125 (40.3%) admitted to our regular ward due to stable condition, 4 (1.3%) patients died in Emergency Departement (ED). The remaining accepted patients on request did not arrive in our facility due to various reasons. The mean (SD) response time was 9.1 (27.6) minutes. The mean (SD) transfer time was 6.45 (4.73) hours. Mean (SD) PICU and hospital length of stay was 6.7 (8.3) days and 10.2 (9.2) days respectively. PICU and hospital mortality was 24.3% and 29.7%, respectively.ConclusionThe mortality rate for critically ill pediatric patients referred to a tertiary PICU still high, with shock being the most common pre-referral emergency diagnosis. There is a discrepancy between the referring hospital’s and the referral hospital’s indication for PICU admission. The time required to reach the referral hospital is quite lengthy.

How does trauma secondary to unexpected extreme weather affect orthopaedic surgery departments? : An epidemiological study on the Filomena snowstorm

Trauma secondary to extreme weather events may heavily impact the normal activity of orthopaedic surgery departments, especially in places not prepared to deal with them. The Filomena snowstorm, which happened in January 2021, was one of the greatest snowstorms ever in Spain. During it, the constant influx of trauma patients caused Orthopaedic Emergencies Department (OED) to collapse. The primary objective of this study was to describe the orthopaedic injuries and changes in fracture's epidemiology observed during this exceptional period. Secondary objectives were to analyse the collected variables in order to minimize the future impact of these unexpected extreme weather events. A retrospective cohort study between patients that came to the OED during the snowstorm (Filomena group) and those who came on the same period of the previous year (Control group) was made. The following data were collected: age, sex, injury location, injury mechanism, diagnosis, AO/OTA fracture classification, treatment type (conservative vs surgical) and delay of surgical treatment. Atotal of 1237 patients were included, 655 patients from the Filomena group and 582 from the Control group. One in two patients in the Filomena group sustained afracture (50.7% vs 23.2%). The most frequent diagnosis on the Filomena group was distal radius fracture (16.2%), which was five times more frequent than in the Control group (3.4%). Asignificant increment was also observed in the incidence of ankle (21.7%) and proximal humerus (33%) fractures. In the Filomena group, surgically treated fractures increased by 168%, being more severe, as C‑type fractures were more prevalent (23% vs 13%). Mean delay to surgery was 6.78 days during the snowstorm. Unexpected snowstorms entail an exponential rise in orthopaedic care demand and OED pressures. Asignificant increment in orthopaedic trauma surgery, up to 168% more, particularly distal radius, proximal humerus and ankle fractures, is to be expected, which will imply elective surgery cancellation, hurting patients and increasing costs.

Sociodemographic Factors Associated With Emergent Eye-Related Emergency Department Visits: A Multicenter Analysis

ObjectiveTo compare sociodemographic factors in patients presenting to the emergency department (ED) with emergent and non-emergent eye-related concerns. DesignCross-sectional multicenter study. Subjects60,677 patients with eye-related concerns who visited EDs at Bascom Palmer Eye Institute, Wills Eye Hospital, Massachusetts Eye and Ear, and Johns Hopkins Hospital/Wilmer Eye Institute from January 1st, 2019 until December 31st, 2019. MethodsDescriptive statistics were performed using STATA 17. Main Outcome Measures1) Sociodemographic factors associated with emergent diagnoses, 2) Visit patterns across ED settings (i.e. standard ED vs eye ED), and 3) the most common emergent and non-emergent diagnoses. ResultsA total of 60,677 eye-related ED encounters were included in the study, including 22,434 at Bascom Palmer Eye Institute, 16,124 at Wills Eye Hospital, 15,487 at Massachusetts Eye and Ear, and 6,632 at Johns Hopkins Hospital/Wilmer Eye Institute. Most patients had non-emergent diagnoses (56.7%). Males (OR 1.85, 95% CI 1.79-1.92) were more likely to have an emergent diagnosis than females. Patients with private/employer-based insurance (OR 0.88, 95% CI 0.81-0.96), Medicare (OR 0.80, 95% CI 0.72-0.87), and Medicaid (OR 0.81, 95% CI 0.74-0.89) were all less likely to have an emergent diagnosis than uninsured patients. Those with veteran/military insurance (OR 1.08, 95% CI 0.87-1.34) were equally likely to have an emergent diagnosis compared to uninsured patients. Non-White Hispanic patients (OR 1.26, 95% CI 1.12-1.42) were more likely to present with an emergent condition than White patients. Patient seen in the standard ED setting were more likely to have emergent diagnoses than those who visited standalone eye EDs (P < 0.001). The most common emergent diagnoses were corneal abrasion (12.97%), extraocular foreign body (7.61%), and corneal ulcer (7.06%). The most common non-emergent diagnoses were dry eye (7.90%), posterior vitreous detachment (7.76%), and chalazion (6.57%). ConclusionsED setting was associated with the acuity of patient diagnoses. Lack of insurance coverage and non-White Hispanic race/ethnicity were associated with emergent eye-related ED visits. Improving access to ophthalmic care in these populations may reduce the incidence of preventable eye emergencies related to untreated chronic conditions. This combined with measures to redirect non-emergent issues to outpatient clinics may alleviate ED overload.

What are the Characteristics of Oral Injuries Caused by Playground Equipment?

Studies regarding oral injuries from playground equipment in children remain limited. This study aimed to clarify the characteristics of oral injury caused by playground equipment and identify associations with concomitant head injury. Children treated between 2011 and 2021 at an oral surgery clinic for oral injuries from playground equipment were retrospectively investigated. The following factors were analyzed: demographic characteristics, mechanism of injury, type of equipment causing the injury, classification of oral injury, and whether the Department of Emergency and Critical Care Medicine was consulted regarding the head injury. The data collected were statistically analyzed using the Fisher-Freeman-Halton test with significance adopted at the 5% level. This study analyzed data from 82 children. Injuries were concentrated in age groups of 2 to 3 years (32.9%), 4 to 5 years (28.0%), and 6 to 7 years (25.6%). Regarding the mechanism of injury, falls were more common (89.0%) than impact/striking (11.0%). The type of equipment most frequently causing injury was slides (29.3%), followed by swings (23.2%) and iron bars (18.3%). Injuries were classified as soft tissue injury alone (56.1%) or tooth injury and/or jaw fracture (43.9%). Consultation with the Department of Emergency and Critical Care Medicine for head injury was uncommon (13.4%), and all consultations for brain injury diagnosed minor injuries. Oral injuries caused by playground equipment were frequent between 2 and 7 years old. The most common cause was falls, with most injuries caused by slides, swings, or iron bars. Approximately half of the oral injuries were soft tissue injuries only, while the other half were associated with tooth and/or jaw injuries. Department of Emergency and Critical Care Medicine consultations for head trauma were uncommon and consistently confirmed minor injuries.

Assessment of disaster awareness and attitudes toward disasters among emergency and disaster management students at the Somali faculty of health sciences

Abstract Background: Disasters cause significant material and spiritual destruction within communities, resulting in significant damage to societal structures. Objective: This study aims to assess disaster awareness and attitudes toward disasters among emergency and disaster management students. Materials and Methods: This study included undergraduate students enrolled in the Department of Emergency and Disaster Management during the 2022–2023 academic year. A total of 85 students participated in this study and were contacted via an online Google form to assess their disaster awareness and attitudes toward disasters. The survey, consisting of a total of 23 items, was designed to assess participants’ cognitive, affective, and behavioral characteristics. Results: The study included 85 participants studying in the Emergency and Disaster Management department. Females made up 64.7% of the participants. The mean score of the responses given in the cognitive subfactor was 2.69 ± 0.56, the mean score of the responses given in the affective subfactor was 3.13 ± 0.47, and the mean score of the responses given in the behavioral subfactor was 2.67 ± 0.76. Conclusion: Having previously experienced a disaster, being male, belonging to a higher socio-economic class, and being older increase the average Disaster Attitude Scale score, and the increase in the average score indicates an increase in disaster awareness.

The Role of N-Terminal-Pro-B-Type Natriuretic Peptide (NT-proBNP) and High-Sensitivity Troponin T (Hs-Troponin T) in the Evaluation of the Syntax Score in Patients With Acute Coronary Syndrome.

Background N-terminal-pro-B-type natriuretic peptide (NT-proBNP) is used to diagnose acute and chronic heart failure, but many studies show a strong and independent correlation between NT-proBNP serum levels and the severity and number of coronary artery damage. Meanwhile, the serum of high-sensitivity Troponin T (hs-Troponin T) has a very high prognostic value for the degree of coronary artery damage in patients with acute coronary syndrome. The SYNTAX score was developed to better predict the risks of percutaneous or surgical revascularization by considering the functional impact of the coronary circulation with all of its anatomic components, such as the presence of bifurcations, total occlusions, thrombus, calcification, and small vessels. Therefore, we conducted this study to understand the role of NT-proBNP and hs-troponin T in SYNTAX score evaluation in patients with acute coronary syndrome. Methodology A cross-sectional descriptive study of 86 patients diagnosed with acute coronary syndrome with indications for coronary angiography and intervention in the Department of Emergency and Interventional Cardiology, Cardiovascular Center, Hue Central Hospital, was conducted from June 2020 to May 2022. Results The mean age was 66.94 ± 10.61 years. The concentrations of NT-proBNP and hs-Troponin T in our study were 1115.9 ± 1623.3 pg/mL and 0.86 ± 1.55 ng/mL, respectively. The mean SYNTAX score in the study was 16.5 ± 7.5. There was a positive moderate correlation between the mean levels of NT-proBNP and the degree of coronary artery damage, as indicated by the SYNTAX score (P< 0.01, rho= +0.453). Conversely, there was a weak positive correlation between hs-Troponin T concentrations and the severity of coronary artery disease, based on the SYNTAX score (P < 0.01, rho = +0.387). The area under the curve (AUC) of the hs-Troponin T concentration value was 0.701, using a cutoff point of 0.109 ng/mL for hs-Troponin T concentration. This predicted the intermediate and high SYNTAX scores, with a sensitivity of 76% and a specificity of 59%. In comparison, the AUC of the NT-proBNP concentration value was 0.75, utilizing a cutoff point of 1120.5 pg/mL for NT-proBNP concentration. This predicted the intermediate and high SYNTAX scores, with a sensitivity of 60% and a specificity of 80.3%. Conclusions The levels of NT-proBNP had a positivemoderate correlation with the degree of coronary artery damage according to the SYNTAX score in patients with acute coronary syndrome. Hs-Troponin T levels of 0.109 ng/mL had higher sensitivity (76%) but lower specificity (59%) in predicting intermediate and high SYNTAX scores in patients with acute coronary syndromes than those of NT-proBNP levels of 1120.5 pg/mL, with a sensitivity of 60% and a specificity of 80.3%.

Evaluation of characteristics and prognosis of COVID-19 patients requiring invasive mechanical ventilation during dominance of nonvariant, alpha, delta, and omicron variants in tertiary hospitals of Japan

BackgroundIn November 2021, the B.1.1.529 (omicron) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detected in South Africa and subsequently rapidly spread around the world. Despite the reduced severity of the omicron variants, many patients become severely ill after infection and undergo invasive mechanical ventilation, but there are few reports on their background and prognosis throughout all variant periods. This study aimed to evaluate risk factors affecting patients requiring invasive mechanical ventilation with each variant of COVID-19 pandemic in Japan from nonvariants to omicron variants.MethodThis retrospective observational study was conducted at the Department of Emergency and Critical Care Medicine, Kansai Medical University Hospital and Kansai Medical University Medical Center, Osaka, Japan, from March 2020 to March 2023. Eligible patients were those who underwent invasive ventilation for COVID-19 pneumonia. We set the primary endpoint as in-hospital mortality. Multivariable logistic regression analysis adjusted for clinically important variables was performed to evaluate the clinical outcomes.ResultsWe included 377 patients: 118 in the Nonvariant group, 154 in the Alpha group, 42 in the Delta group, and 63 patients in the Omicron group. Mortality rates for each group were 23.7% for the Nonvariant group, 12.3% for the Alpha group, 7.1% for the Delta group, and 30.5% for the Omicron group. Patient age was significantly associated with increased mortality (adjusted odds ratio [AOR]: 1.097; 95% confidence interval [CI]: 1.057–0.138, P < 0.001). Immunodeficiency (AOR: 3.388, 95% CI: 1.377–8.333, P = 0.008), initial SOFA score (AOR: 1.190, 95% CI: 1.056–1.341, P = 0.004), dialysis prior to COVID-19 (AOR: 3.695, 95% CI: 1.117–11.663, P = 0.026), and smoking history (AOR: 2.548, 95% CI: 1.153–5.628, P = 0.021) were significantly associated with increased mortality. Differences in variants were not significant factors associated with high mortality.ConclusionWe compared the background and prognosis of patients with COVID-19 pneumonia requiring invasive mechanical ventilation between SARS-CoV-2 variants. In these patients, differences in variants did not affect prognosis. Hospital mortality in critically ill COVID-19 patients was significantly higher in the older patients with bacterial coinfection, or patients with immunodeficiency, COPD, and chronic renal failure on dialysis.

The Characteristics of Epitaxis Patients at Sumedang Regional Public Hospital Emergency Departement in 2021-2022

Epitaxis is a term from Greek, epistaizein, which means bleeding from the nose. Epitaxis is common problem ranging from minor traces of blood or clot to isolated massive bleeds that may be life-threatening and one of the common ear, nose, throat emergencies that present to emergency department or the primary care clinic . From an epidemiological of view, the lifetime incidence of epitaxis has been reported to be as high as 60% people worldwide during their lifetime. However, a real number is difficult to be estimated as only a very small proportion requires specialist management and therefore many cases escape to evaluation. Only 10% of patients with epitaxis will present to a physician. This study aims the characteristics of epitaxis patients in Emergency Departement of Sumedang Regional Public Hospital from January 2021 to December 2022. This study was designed as a retrospective descriptive study. Research used medical records on patients diagnosed with epitaxis. The research's results showed that there are 74 patients in that period with 7 patients experiencing recurrent epitaxis, 2 patients with hypotension and 27 patients with anemia. The incidence in male is higher than female. Patients with epitaxis more common in the age group &gt;45 years. The most common cause of epitaxis is by systemic cause.

Rare case in Somalia: Fahr’s syndrome

Introduction and importance: Fahr’s syndrome is primarily familial, autosomal dominant, and genetically diverse. Basal ganglia calcification that is bilaterally symmetrical is a hallmark of this illness. Although the specific origins of this illness are unknown, it may be brought on by problems with calcium metabolism, infections, toxins, hereditary factors, hypoparathyroidism, and pseudohypoparathyroidism. The prevalence of this syndrome is less than 0.5%. Case presentation: An 11-year-old female comes to the Emergency Department with her parents complaining of high-grade fever and convulsions for 1 week. Convulsion, which is a generalized tonic–clonic seizure, duration was ~5 min and associated with urinary incontinence and biting tongue. On examination, the patient was confused and irritable. Vital signs were normal; there is weakness in the right arm and right leg, associated with irregular movement. There was alternation in her level of consciousness, slurring of speech, and psychiatric symptoms. Another aspect of the neurological examination and systems was normal, and there was no meningeal irritation. Clinical discussion: The pathogenesis of Fahr’s syndrome is not completely known. The calcification is caused by flaws in the transport of radioactive particles and tissue damage caused by free radicals. Bilateral calcification found on a computed tomography (CT) scan of the brain, autosomal dominant inheritance, the absence of any infection, drugs, or toxins, the absence of mitochondrial dysfunction, and the presence of progressive neurological dysfunction is the clinical criteria for diagnosing Fahr’s syndrome. Conclusion: Basal ganglia calcification that is bilaterally symmetrical is a hallmark of Fahr’s syndrome. CT scans are the gold standard for conclusively diagnosing Fahr’s syndrome.

Tachycardia Unresponsive to Crystalloid Bolus

Dehydration is a common complaint in the pediatric emergency department. The treatment is typically focused on oral or intravenous rehydration with the goal of normalization of vital signs, primarily the heart rate but potentially also the blood pressure. The failure of routine therapy may lead to the consideration of other etiologies, including potential chronic conditions. We present a unique case of a twenty-three-month-old female who initially presented to the pediatric emergency department with signs of dehydration secondary to vomiting and diarrhea as well as tachycardia that did not improve with fluid resuscitation. Although physical examination findings were subtle, laboratory testing later confirmed the diagnosis of thyrotoxicosis. She was started on treatment with atenolol and methimazole. This case describes thyroid disease in a young child without a history of maternal autoimmune illness, which is rarely diagnosed in the emergent department. Healthcare providers should be cognizant of the spectrum of clinical findings in pediatric hyperthyroidism, since the early recognition and treatment is crucial for improved outcomes with this life-threatening pediatric condition. We discuss the consequences of undiagnosed Grave’s disease and review common findings that can assist with early diagnosis in the emergency department.

Impact of renal dysfunction on the diagnosis of acute pancreatitis using urinary trypsinogen-2: A retrospective study.

Early diagnosis of acute pancreatitis is crucial, and urinary trypsinogen has been recently reported as a useful biomarker for diagnosing acute pancreatitis. We aimed to evaluate the impact of renal dysfunction on the diagnostic performance of urinary trypsinogen-2 for acute pancreatitis. We conducted a retrospective study using the clinical data of patients who visited the Department of Emergency and Critical Care at the University of Tokyo Hospital between 1 October, 2021, and 30 June, 2022. Patients with available data on qualitative urinary trypsinogen-2 levels were identified. We compared the urinary trypsinogen-2 levels among patients who were clinically diagnosed with acute pancreatitis. We further stratified the patients according to renal function parameters, such as serum creatinine level, blood urea nitrogen level, and estimated glomerular filtration rate, and evaluated the performance of urinary trypsinogen-2 as a biomarker for acute pancreatitis. Within 9 months, 35 patients were identified. Of them, 22 patients showed positive results and 13 showed negative results on the urinary trypsinogen-2 test. The sensitivity, specificity, positive predictive value, and negative predictive value were 0.80, 0.40, 0.18, and 0.92, respectively. Based on the blood urea nitrogen level and estimated glomerular filtration rate, the prevalence of false-positive results was significantly higher in patients with reduced renal function than in those with normal renal function. In patients with reduced renal function, the urinary trypsinogen-2 qualitative test results might be interpreted with caution when used for diagnosing acute pancreatitis.

Evaluation of the District Health Information System in District Kotli, Azad Jammu and Kashmir: A Retrospective Analysis.

It is essential to implement a high-quality electronic database for keeping important information. The District Health Information System (DHIS) is an active data-keeping system in Pakistan. This study aimed to evaluate the patients' data from the DHIS dashboard for the District Headquarters Hospital, Kotli, Azad Jammu and Kashmir (AJK). The data was requested from the hospital administration at District Headquarters Hospital, Kotli, AJK, and the data was analyzed after permission was granted. The data was given in two forms; one was a hard copy of the data for August and September and the other was a comma-separated values file for October and November, 2023. The highest frequency of patients was received in the department of emergency and trauma and the patient's median age was between 15 and 49 years. The second department was medicine with the >50 years of age. Common conditions that needed more attention were chronic obstructive pulmonary disease, acute respiratory infection, diarrhea, pneumonia, diabetes mellitus, hypertension, and ischemic heart disease. For nations with constrained healthcare systems and funds, primary health care (PHC) is the only viable approach for managing non-communicable diseases (NCDs). However, PHC systems intended for infectious diseases have not sufficiently adapted to the growing requirement of chronic care for NCD. Research using health information databases offers numerous benefits, such as the evaluation of large data sets and unexpected prevalence of disease in certain populations, such as a higher prevalence of disease in one gender or age group. Health information system-based data analysis or studies are less expensive and faster but lack scientific control over data collection.

When gallbladder oedema comes as a chronic disease – diagnosis and treatment

Diagnosis of the gallbladder oedema is difficult during the clinical examination because the clinical signs are not specific for this disease. The causes of this pathology are multiple and can be divided into emergencies (such as anaphylactic shock, right-sided hearth failure, pericardial effusion) and chronic pathologies (such cholecystitis, pancreatitis or immune-mediated hemolytic anemia). Imagistics methods complete the information of the clinical exam and ultrasound is considered the golden standard for diagnosing this pathology. Normally, at the ultrasound exam, the gallbladder has a hyperechoic wall, with a diameter of 2-3 mm; while in case of gallbladder oedema, the wall is thick and has a triple stratification, with 2 hyperechoic rows, separated by a hypoechoic line. This pathognomonic description of the gallbladder oedema is also known as the ‘Halo Sign’ or ‘Double Rim Effect’. Making a correct differential for the appearance of the sign is vital for the outcome of the case. The main focus is to exclude every emergency cause in order to start treating the chronic pathologies. This paper presents the pathologies leading to gallbladder oedema, met at the Radiology and Emergencies Departments from the Faculty of Veterinary Medicine Iasi during the period march 2020 – may 2022. The clinical case presented was diagnosed and treated at the Center of Endoscopy and Minimally Invasive Surgery Bucharest.

Prevalence of Comorbidity among the Patients with Angina in a Divisional City of Bangladesh

Bangladesh has experienced a significant increase in the presence of non-communicable chronic diseases and associated mortality and morbidity in the last few decades. Chest pain is a common complaint and reason for consultation among them. This study aimed to analyze the prevalence of comorbidity among patients with angina in a divisional city in Bangladesh. Method This Prospective cross-sectional study was conducted at the Department of Emergency, Delta Health Care, Chittagong Ltd and CSCR (pvt) Ltd, Chattogram, Bangladesh. The study duration was January’20 to June’22. A total of 420 patients presenting in the emergency department were enrolled in this study following the inclusive criteria. Data were collected using the predesigned semi-structured questionnaire. A consecutive sampling technique was used. Data were processed and analyzed by SPSS version 20.0. Unpaired t-tests and Chi-square tests were performed to observe the association between the study variables, where p&lt;0.05 was considered the level of significance with 95% CI. Verbal consent was taken before recruiting the study population. Ethical clearance of this study was taken from the Ethical Review Committee of Delta Health Care, Ctg. Ltd and CSCR Ltd, Chattogram. The information was kept confidential only to be used for the study purpose. Result In this study, most of the patients (123, 29.3%) belonged to the age group of 50-59 years, with a minimum of 35 years and a maximum of 90 years of age. The mean age was 57.18±11.57. most of the patients (222, 52.9%) were male and the rest were female with a male-to-female ratio of 1.1:1. 95 (31.6%) patients from the 50-59 years age group, followed by, 82 (27.2%) patients from the 60-69 years age group complained of chest pain among all the study subjects with male preponderance (169, 56.1%). In contrast, 37 (31.1%) patients from the 60-69 years age group did not experience chest pain, and female preponderance was seen in the patients who did not complain of chest pain. There was no significant association of chest pain with age distribution but with sex. The comorbid conditions were DM, HTN, IHD, CAD. Chest pain was present in 122 (40.5%) and absent in 53 (44.5%) diabetic patients, it was also present in 150 (49.8%) and absent in 59 (49.6%) patients with IHD. Chest pain was present in 94 (31.2%) and absent in 37 (31.1%) patients with CAD and present in 188 (62.5%) absent in 77 (64.7%) hypertensive patients as well. There was no significant association between the comorbidities and chest pain. There was no significant relation between blood pressure with chest pain. Conclusion This study concluded that the mentioned comorbid conditions (DM, HTN, IHD, CAD, dyslipidemia) did not show any significant prevalence rate in patients with angina. However, some patients had one or more such conditions along with chest pain which was not statistically significant.

Characterization of Emergency Department Poisoning Epidemiology in Belize

Objective: Little is known about the epidemiology of poisonings in Belize. The purpose of this study was to characterize poisonings presenting to Karl Heusner Memorial Hospital, Department of Accident and Emergency in Belize City, Belize. Methods: Charts were reviewed for patients with possible toxicologic exposures, presenting between May 31, 2016 – December 31, 2018. Variables of interest included patient age and sex, type and route of poisoning, reason for exposure, and disposition. Results: Of the 60,310 patient visits during the study period, 768 patients, 1.3%, presented after a toxicologic exposure. The age distribution of poisoned patients varied with the largest proportion being between 19-30 years of age, 29.3%. There was a male predominance of patients, 60.4%. Approximately 44% of all poisonings involved ethanol only. Marijuana was the most common drug of abuse. Other common inhalation and ingested exposures included cleaning agents, household agents, acetaminophen, NSAIDs, pesticides, organophosphates, sedating medications, antibiotics, and ciguatera poisoning. Nearly 48 % of intoxication cases were due to intentional abuse, while about eight percent were from suicide attempts. Of identified poisoned patients, 84.4% were ultimately discharged, 13.8% were admitted, 1.6% were “self-discharged,” 0.13% were transferred, and 0.13% died. Conclusions: This study illustrates that poisoning is an important cause of Accident and Emergency visits in Belize, whose patterns may differ from those in other countries. Understanding the current state of poisonings in Belize can aid in the development of treatment protocols, antidote stocking, and educational activities for poisoning prevention.

High Plasma Fibrinogen Level Elevates the Risk of Cardiac Complications Following Spontaneous Intracerebral Hemorrhage

Cardiac complications are related to poor prognosis after spontaneous intracerebral hemorrhage (ICH). This study aims to predict the cardiac complications arising from small intracranial hematoma at ultraearly stage. The data of this work were derived from the Risk Stratification and Minimally Invasive Surgery in Acute ICH Patients study (ClinicalTrials.gov Identifier: NCT03862729). This work included patients with ICH but without brain herniation, as confirmed by a brain computed tomography scan within 48hours of symptom onset. Every Patient's information recorded at the emergent department, including clinical, laboratory, electrocardiogram, and medical records, was derived from the electronic data capture. Cardiac complications were defined as the occurrence of myocardial damage, arrhythmias, and ischemic electrocardiogram changes during hospitalization. Variables associated with cardiac complications were filtrated by univariate and multivariate regression analyses. Independent risk factors were used to form the early predictive model. The restricted cubic splines were employed to investigate the nonlinear associations in a more sophisticated and scholarly manner. A total of 587 ICH patients were enrolled in this work, including 72 patients who suffered from cardiac complications after ICH. Out of the 78 variables, 24 were found to be statistically significant in the univariate logistic regression analysis. These significant variables were then subjected to multivariate logistic regression analysis and utilized for constructing risk models. Multivariate logistic regression analysis showed high plasma fibrinogen (FIB) level [odds ratio (OR) per standard deviation (SD) 1.327, 95% confidence intervals (CI) 1.037-1.697; P=0. 024)] and older age (OR per SD 1.777, 95% CI 1.344-2.349; P ＜0.001) were associated with a higher incidence of cardiac complications after ICH. High admission pulse rate (OR 0.620, 95% CI 0.451-0.853; P=0. 003) was considered a protective factor for cardiac complications after ICH. In the restricted cubic spline regression model, FIB and cardiac complications following ICH were positively correlated and almost linearly (P for nonlinearity=0.073). The reference point for FIB in predicting cardiac complications after ICH was 2.64g/L. Emergent factors, including plasma FIB level, age, and pulse rate, might be independently associated with cardiac complications after ICH, which warrants attention in the context of treatment.