Departments Worldwide Research Articles

Predicting Spontaneous Termination of Atrial Fibrillation Based on Analysis of Standard Electrocardiograms: ASystematic Review.

Forward prediction of atrial fibrillation (AF) termination is a challenging technical problem of increasing significance due to rising AF presentations to emergency departments worldwide. The ability to non-invasively predict which AF episodes will terminate has important implications in terms of clinical decision-making surrounding treatment and admission, with subsequent impacts on hospital capacity and the economic cost of AF hospitalizations. MEDLINE, EMCare, CINAHL, CENTRAL, and SCOPUS were searched on 29 July 2023 for articles where an attempt to predict AF termination was made using standard surface ECG recordings. The final review included 35 articles. Signal processing techniques fit into three broad categories including machine learning (n = 14), entropy analysis (n = 12), and time-frequency/frequency analysis (n = 9). Retrospectively processed ECG data was used in all studies with no prospective validation studies. Most studies (n = 33) utilized the same ECG database, which included recordings that either terminated within 1 min or continued for over 1 h. There was no significant difference in accuracy between groups (H(2) = 0.058, p-value = 0.971). Only one study assessed recordings earlier than several minutes preceding termination, achieving 92% accuracy using the central 10 s of paroxysmal episodes lasting up to 174. No studies attempted to forward predict AF termination in real-time, representing an opportunity for novel prospective validation studies. Multiple signal processing techniques have proven accurate in predicting AF termination utilizing ECG recordings sourced from a database retrospectively.

Changes in the ratio of neutrophils to albumin depending on the severity of abdominal sepsis in patients with benign and malignant non-traumatic perforation of the left colon

Background. According to the Third International Consensus (Sepsis-3), sepsis is defined as a life-threatening organ dysfunction caused by an uncontrolled response of the affected organism to a new infection, and septic shock as a sepsis-related condition characterized by the development of circulatory failure accompanied by arterial hypotension, with lactatemia and requiring maintenance of blood pressure with vasopressors. Despite progress in diagnosing and treating sepsis in patients with intra-abdominal infections, it continues to be the leading cause of mortality among patients in emergency departments worldwide. Purpose – the objective of this study was to ascertain the capacity of the neutrophilto-albumin ratio (NAR) before surgery to predict the severity of abdominal sepsis and 30-day mortality in patients with benign and malignant non-traumatic perforation left side of the colon. Methods. This was a retrospective, cross-sectional study that analyzed 117 patients of different age groups with sepsis caused by colon perforation who were hospitalized and operated on from January 2014 to March 2024. To evaluate the diagnostic value of INA in predicting sepsis severity and 30-day mortality, we analyzed the biomarker’s ROC curves, including the determination of optimal cut-off thresholds and associated specificity and sensitivity. The association of INA, sepsis severity, and perforation type with 30-day mortality was investigated using survival analysis, including the comparison of Kaplan–Meier curves and the development and analysis of Cox proportional hazards regression models. Comparisons between groups of study patients concerning quantitative characteristics were conducted, with the presence of septic shock and treatment outcome serving as the independent variables. This was done using nonparametric criteria for independent measurements, specifically the Kruskal–Wallis and Mann–Whitney tests. The statistical significance of the relationships between the qualitative indicators of the study was assessed based on the χ2 criterion and the odds ratio. Results. The results demonstrated that the INR has a high prognostic value in determining the severity of sepsis. This was evidenced by a high value of the area under the ROC curve (AUC = 0.948, p = 2, 309×10–41 < 0.05, 95% CI = 0.882–1.013). It has been demonstrated that the development of septic shock can be predicted by a preoperative INA value not exceeding 22.1, with the highest possible specificity (93.4%) and sensitivity (92.3%). The INA was also found to be an effective predictor of 30-day mortality in our data. The optimal INA threshold for mortality prediction was 23.8, with a specificity of 77.1 and sensitivity of 78.7% (AUC = 0.862, p = 6,072 ×10–28 < 0.05, 95% CI = 0.786-0.919). Furthermore, no statistically significant association was observed between the type of perforation and patient outcomes (χ2 = 0.00493, p = 0.944, p > 0.05). However, our study did confirm higher 30-day mortality in patients with colonic perforation in the presence of septic shock compared to patients with sepsis. Conclusions. The neutrophil-to-albumin ratio has been identified as an accurate and reliable biomarker for predicting the severity of abdominal sepsis. The biomarker demonstrated a specificity of 93.4%, a sensitivity of 92.3%, and a cut-off value of 22.1 for stratifying patients with septic shock. Furthermore, this biomarker was identified as an important predictor of 30-day mortality in both types of perforation, with an area under the ROC curve (AUC) of 0.862. Nevertheless, the value of this indicator for predicting mortality was somewhat lower than for determining septic shock. Furthermore, the results of the Cox regression analysis indicated that the impact of IA on survival was more pronounced in patients with malignant colon perforation. In patients with benign colon perforation, the model demonstrated a satisfactory fit to the input data. The presence or absence of septic shock did not influence the survival of patients in this category. The findings of the study indicated a significant correlation between INA and sepsis severity, suggesting that this indicator may serve as a straightforward prognostic tool for determining the severity of sepsis before surgery. Ultimately, the stratification of patients according to the severity of sepsis before surgery may lead to improved clinical outcomes for these patients.

Predictors of nursing home conveyances to emergency department

BackgroundWith increasing rates of patient conveyances from nursing homes to emergency departments worldwide, we aim to examine factors causing high rates of conveyances from nursing homes to the emergency department (ED) of an acute tertiary hospital.MethodsThis was a prospective study involving presentation of ED attendances from nursing home residents during out-of-hours over a 23-month period from April 2020 to February 2022. Data was collected from a standardized manual form used by the Emergency Department to document nursing home conveyances.ResultsA total of 338 pre-conveyance forms were reviewed. The most common reasons for conveyances to ED were neurological symptoms (16%), unstable hemodynamics (12%), fever (11%) and falls (10%). The peak conveyances occurred between 1600 and 1900 h on weekends. Respiratory rate, oxygenation requirements and high National Early Warning Score (NEWS) were significantly associated with increased conveyances to the emergency department. When the components of NEWS were analyzed individually, decision for ambulance conveyance to emergency department was significantly associated with respiratory rate (p < .001), oxygen saturation (p < .001), and the use of oxygen supplementation (p < .005).ConclusionsUnstable hemodynamics and falls were among the leading factors for nursing home conveyances to the emergency department, which highlights the need to implement better fall prevention strategies and standardized parameters monitoring in nursing homes. Future research should focus on outcomes of conveyances and the characteristics of nursing home with higher conveyance rates. This would aid to assess the appropriateness of conveyances and to identify strategies to decrease preventable conveyances.

The Gastroscopy RAte of Cleanliness Evaluation (GRACE) Scale: an international reliability and validation study.

mucosal visualization during upper gastrointestinal (UGI) endoscopy can be impaired by the presence of foam, bubbles, and mucus. Some UGI endoscopy visibility scales were proposed but without a multicenter validation. This study aimed to develop and validate the Gastroscopy RAte of Cleanliness Evaluation (GRACE) scale. a multicenter international cross-sectional study was conducted. The GRACE scale is based on a score from 0-worst to 3-excellent of esophagus, stomach, and duodenum, for a total ranging from 0 to 9. In the first phase, four expert endoscopists evaluated 60 selected images twice with a two-week interval; in the second phase, the same 60 images were scored twice by one expert and one non-expert endoscopist from 27 different Endoscopy Departments worldwide. For reproducibility assessment and clinical validation, a real-time scale application was performed on consecutive patients undergoing gastroscopy in each center. in the internal validation, the interobserver agreement was 0.81 (95%CI[0.73-0.87]) and 0.80 (95%CI[0.72-0.86]), with a reliability of 0.73 (95%CI[0.63-0.82]) and 0.72 (95%CI[0.63-0.81]), in the two rounds, respectively. In the external validation, the overall interobserver agreement was 0.85 (95%CI[0.82-0.88]) with a reliability of 0.79 (95%CI[0.73-0.84]). In the real-time evaluation phase, the overall percentage of correct classifications was 0.80 (95%CI[0.77-0.82]). the GRACE scale showed good interobserver agreement and reliability and good validity. The spread of this scale could enhance the quality and standardize the cleanliness of the mucosa assessment during UGI endoscopy, pushing endoscopists to obtain excellent visibility and reducing the risk of missing lesions.

Management of Mandibular Condyle Fractures in Pediatric Patients: A Multicentric Retrospective Study with 180 Children and Adolescents.

Background: Mandibular condyle fractures in pediatric patients can lead to crippling sequelae such as ankylosis, pain and facial deformity if not managed properly. However, there is no consensus on the best approach for treating these fractures in children. Objective: This study aimed to describe the management of mandibular condyle fractures in growing patients across 14 maxillofacial departments worldwide. Methods: A retrospective multicenter study was conducted on children and adolescents aged 0 to 16 who had at least one mandibular condyle fracture. This study included patients who underwent expectant, closed, or open management and were treated over an 11-year period. Results: 180 patients had at least one mandibular condyle fracture, and 37 had a second condylar fracture. One hundred sixteen patients (65%) were males, and 64 (35%) were females (ratio 1.8:1). An expectant strategy was chosen in 51 (28%) patients, a closed treatment-stand-alone maxillomandibular fixation (MMF)-in 47 (26%), and open reduction and internal fixation (ORIF) was performed in 82 (46%) patients. The management varied significantly between the different departments (p < 0.0001). Significant differences were also identified between the fracture type (non-displaced, displaced or comminuted) and the management of the 180 patients with a single condylar fracture. Out of 50 non-displaced fractures, only 3 (6%) had ORIF, 25 (50%) had expectant management, and 22 (44%) had MMF. Out of 129 displaced fractures, 79 (62%) had ORIF, 25 (19%) had a soft diet, and 25 (19%) had MMF. Conclusions: Expectative management, MMF, and ORIF were all effective in treating pediatric mandibular condyle fractures, with a low incidence of complications and asymmetry.

A Retrospective Review of the Management of Impacted Coin Ingested in Children.

Accidental coin ingestion is a common presentation amongst paediatric patients in emergency departments (ED) worldwide, necessitating prompt management to prevent complications. This study aimed to describe the clinical features of paediatric patients with impacted oesophageal coins at Dr. George Mukhari Academic Hospital ED and compare outcomes between the balloon catheter and oesophagoscopic techniques for coin extraction. This was a retrospective review of the medical records of patients aged ≤12 years over 5 years. Data were collected from the hospital records and analysed using SAS® (SAS Institute Inc, Cary, NC), Release 9.3, running under Microsoft Windows. The analysis included 95 patients (51 females, 44 males) with a median age of 3 years, ranging from 0.70 to 10 years. Coins were predominantly located in the upper oesophagus (71.6%). Thirty-five (36%) children presented 8 h after the ingestion of the coin. At presentation, 82 (86.3%) patients were asymptomatic. The most observed symptoms were hypersalivation in 17 (17.9%) patients and vomiting in eight (8.4%) patients. Of the 62 patients for whom the balloon catheter was solely used, it was successful in 77.4% of the cases. Rigid oesophagoscopy was used in 33 patients as the first procedure (34.7%), and its overall success rate was 100% (44 patients). This study contributes valuable insights into the management of oesophageal coin ingestion in a resource-constrained setting, emphasising the safety and efficacy of the balloon catheter and the role of rigid oesophagoscopy in cases of failure or delayed presentation.

Otomycosis, Review

The word "otomycosis" refers to a specific type of fungal infection affecting the external auditory canal. It appears to be a highly prevalent clinical condition seen in otorhinolaryngology outpatient departments worldwide. Most Aspergillus and Candida species are the etiological microorganisms that form biofilm inside the ear canal. The development of otomycosis can be caused by improper self-cleaning, self-medication, and the insertion of needless instruments into the ear canal. Ear pain, discharge from the ears, and hearing loss are the main signs of otomycosis. Therefore, in order to take a percussive action during the primary stage of infection, the correct diagnosis is imperative. However, special medical attention is required, particularly in patients with low immunity, when infection spreads to a mastoid area with a suppurative condition. The purpose of this thorough review is to raise awareness of the importance of good health education and self-hygiene in order to maintain a healthy lifestyle. The majority of cases of otomycosis affect one ear, and immunocompromised patients are more likely to experience bilateral involvement. The most often mentioned risk factors include swimming, applying mustard oil to ears, overusing antibiotic ear drops, using Q-tips, wooden sticks, metal pickers, and self-cleaning of ears with these items. Staphylococcus aureus is the most frequently implicated bacterium in cases of concurrent otomycosis. In order to lower the incidence of otomycosis, this literature review emphasizes the necessity of education in order to eliminate the previously mentioned predisposing risk factors.

Why do patients who are triaged as low-acuity visit the emergency department? – A Polish perspective

BackgroundEmergency departments (EDs) worldwide are dealing with overcrowding, system fragmentation, and coordination problems, which impact patient wait times, staff job satisfaction, and patient outcomes. Inappropriate ED visits, particularly those for low acuity conditions, exacerbate these challenges. However, the motivations behind these visits are poorly understood, with limited data from the patient perspective. This study investigated patient-reported motives behind ED visits triaged as low acuity in Poznan, Poland, to propose health care system flow enhancements. Material and methodsA cross-sectional survey and retrospective chart review were conducted in the ED of the Hipolit Cegielski Medical Center in Poznań, Poland, over three months in 2022–23. Patients who were triaged to have low acuity conditions were invited to participate in the survey. The data collected through the questionnaire included patient and ED visit characteristics. Additional information on the visits was extracted from the patient charts. Main resultsThis study involved 293 patients who underwent low-acuity triage. Among them, 58 % were deemed to have conditions that could have been treated in primary care. Most of the patients (74 %) visited the ED of their own volition due to concerns about their health. Other reasons for ED attendance were challenges accessing primary care or a specialist clinic (11 %), system navigation problems (5 %), or a lack of trust in their primary care provider (2 %). ConclusionsThis study showed that of the patients surveyed, the majority had conditions that could have been treated outside of the ED setting. We recommend prioritizing education, particularly among younger adults, to increase awareness about nonurgent care options while improving health care policies.

Health care utilization of patients with acute abdominal pain before and after emergency department visits

BackgroundAcute abdominal pain (AAP) is a major driver for capacity-use in emergency departments (EDs) worldwide. Yet, the health care utilization of patients with AAP before and after the ED remains unclear. The primary objective of this study was to describe adult patients presenting to the ED with AAP and their outpatient care (OC) use before and after the ED. Secondary objectives included description of hospitalization rates, in-hospital mortality, ED re-visits, and exploration of potential risk factors for hospitalization and ED re-visits.MethodsFor the analysis, we combined routine hospital data from patients who visited 15 EDs in Germany in 2016 with their statutory health insurance OC claims data from 2014 to 2017. Adult patients were included based on a chief complaint or an ED diagnosis indicating unspecific AAP or the Manchester Triage System indicator “Abdominal pain in adults”. Baseline characteristics, ED diagnosis, frequency and reason of hospitalization, frequency and type of prior-OC (prOC) use up to 3 days before and of post-OC use up to 30 days after the ED visit.Main resultsWe identified 28,085 adults aged ≥ 20 years with AAP. 39.8% were hospitalized, 33.9% sought prOC before the ED visit (48.6% of them were hospitalized) and 62.7% sought post-OC up to 30 days after the ED visit. Hospitalization was significantly more likely for elderly patients (aged 65 and above vs. younger; adjusted OR 3.05 [95% CI 2.87; 3.25]), prOC users (1.71 [1.61; 1.90]) and men (1.44 [1.37; 1.52]). In-hospital mortality rate was 3.1% overall. Re-visiting the ED within 30 days was more likely for elderly patients (1.32 [1.13; 1.55) and less likely for those with prOC use (0.37 [0.31; 0.44]).ConclusionsprOC use was associated with more frequent hospitalizations but fewer ED re-visits. ED visits by prOC patients without subsequent hospitalization may indicate difficulties of OC resources to meet the complex diagnostic requirements and expectations of this patient population. Fewer ED re-visits in prOC users indicate effective care in this subgroup.

Evaluating the Effectiveness of Transcutaneous Electrical Nerve Stimulation for Various Outcomes in Emergency Department Settings: A Systematic Review and Meta-Analysis.

Pain is a prevalent complaint in emergency departments (EDs) worldwide. Traditional pharmacological methods for pain relief, such as opioids and non-steroidal anti-inflammatory drugs (NSAIDs), have notable side effects and risks. Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological alternative that has shown promise in various clinical settings. This systematic review and meta-analysis aimed to evaluate the effectiveness of TENS for pain management and other outcomes in ED settings. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted across six major databases: PubMed, Web of Science (WOS), Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL), from inception until June 25, 2024. Randomized clinical trials involving the use of TENS in ED settings were included. Data extraction and quality assessment were performed independently by two reviewers, with conflicts resolved by a third reviewer. The search yielded 3,569 papers, of which 2,889 were screened after removing duplicates. Thirteen full-text articles were reviewed, and seven studies met the inclusion criteria for qualitative synthesis, with five of these suitable for meta-analysis. The studies demonstrated that TENS significantly reduced pain, heart rate, and the requirement for rescue medication in some cases, while also improving patient satisfaction and overall well-being. However, no significant changes were observed in blood pressure. The quality of the included studies varied, with some failing to meet the criteria for blinding and intention-to-treat analysis. TENS is an effective non-pharmacological intervention for pain management in ED settings, with additional benefits such as reduced heart rate and increased patient satisfaction. Further high-quality randomized controlled trials are necessary to confirm these findings and better understand the potential of TENS in acute care environments.

Utilizing Blockchain Technology to Modernize Police Operations: Ensuring Security, Transparency, and Efficiency

This article explores the transformative potential of blockchain technology in police operations, focusing on enhancing security, transparency, and efficiency. Initially recognized for its role in cryptocurrencies, blockchain's inherent immutability and distributed ledger features are now being leveraged to revolutionize data management within law enforcement. The technology ensures the secure, auditable, and tamper-resistant recording of all transactions and data related to police operations, from investigation records to evidence management, ensuring accessibility only to authorized personnel. Key areas examined include the enhancement of security and transparency through blockchain's immutable and distributed records, ensuring data integrity and evidence management by providing an unalterable record of all transactions and data, and improving interoperability among various police departments and agencies. The integration of advanced technologies like Zero-Knowledge Proofs and Layer 2 solutions further strengthens privacy protection and operational speed, contributing to a more efficient and reliable police information system. Practical implementations in police departments worldwide, such as Delhi Police's blockchain initiative for evidence tracking and Dubai Police's collaboration with Cardano Blockchain for secure data sharing, demonstrate significant improvements in transparency, integrity, and security of processes. The article concludes by addressing the ongoing challenges of scalability, interoperability, and privacy, emphasizing the need for continued development and standardization to fully realize blockchain's benefits in modernizing police operations. By evaluating these aspects, the article highlights blockchain's critical role in the digital transformation of law enforcement, promoting greater public trust and cooperation among police units at both national and international levels.

Factors Associated With Adverse Radiographic Outcomes Following Operative Management of Ankle Fractures: A Single-Center Study.

Introduction Ankle fractures arecommonly encountered fractures in emergency departments worldwide. These fractures often have significant articular involvement that requires anatomic surgical reduction and stabilization. Radiographs can be used in everyday practice to evaluate ankle fractures utilizing various parameters to assess reduction quality intraoperatively and postoperatively. Several factors have been found to influence the reduction quality of fractures across body regions.This retrospective study aimed to evaluate the influence of several factors on the reduction quality of ankle fractures in a tertiary care center in the Kingdom of Bahrain. Materials and methods A total of 462 records were identified during the search, and 68 records were excluded. A total of 394 ankle fractures met the inclusion criteria for the study. Five orthopedic surgeons then evaluated the operative films in accordance with the Delphi consensus parameters for evaluating ankle fractures, and the reductions were graded as good, adequate, or poor. Results The study included 394 ankle fractures that met the inclusion criteria, and four significant associations were notedto affect the quality of reduction. Ankle fractures with posterior malleolus involvement (PMI) were significantly associated (p = 0.001) with fragments smaller than 15% and larger than 20% having decreased outcomes. The number of daysfrom admission to operation was also significant (p = 0.009), with the best reductions observed between zero and one day from admission. Operating surgeon was also a significant factor (p = 0.038), with inferior reductions noted in specialist surgeons compared to trainees. The last significant association was the number of malleoli (p = 0.001), with an inferior reduction with a larger number of malleoli involved. Conclusion Ankle fractures are a common and significant orthopedic injury. Reduction quality is important for optimal outcomes after surgical stabilization. Various factors including the number of malleoli, the grade of the operating surgeon, and the time of surgery were significantly related to the quality reduction in this single-center study. Expedited surgical management of fractures that are amenable to early fixation, careful assessment, and meticulous technique in fixation offractures with multiple fractured malleoli is indicated to reduce the chance of malreduction particularly in complex injuries.Further assessment of factors related to reduction quality with large-scale prospective studies would provide orthopedicsurgeons with insights into the identification and optimal treatment of such fractures.

The Effect of Iodinated Contrast Media Sensitivity on the Prognosis of Patients with STEMI

Background and Objectives: Iodinated Contrast Media (ICM) is used daily in many imaging departments worldwide. The main risk associated with ICM is hypersensitivity. When a severe hypersensitivity reaction is not properly managed and treated swiftly, it may be fatal. Currently, there is no data to demonstrate how ICM sensitivity affects the prognosis of cardiac patients, especially those diagnosed with ST elevation myocardial infarction (STEMI), in whom urgent coronary angiography is indicated. This study aimed to identify and characterize this relationship. Materials and Methods: We included patients hospitalized with STEMI between 2016 and 2019 from the National Inpatient Sample. The population was compared based on ICM sensitivity status, sensitive vs. non-sensitive. The primary endpoint was in-hospital mortality, with additional endpoints: length of stay and in-hospital complications. Results: The study included 664,620 STEMI patients, of whom 4905 (0.7%) were diagnosed with ICM sensitivity. ICM-sensitive patients were older, more often white, females, and had more comorbidities and cardiovascular risk factors. Both groups show similarities in management but are slightly less probable to undergo PCI or CABG. Multivariable logistic regression models found that the ICM-sensitive population had similar odds of in-hospital mortality (OR: 1.02, 95% CI: 0.89–1.16) and MACCE (OR: 1.05, 95% CI: 0.95–1.16), and less major bleeding (OR: 0.73, 95% CI: 0.60–0.87). Conclusions: Our study found that ICM sensitivity status was not a significant factor for worse prognosis in patients hospitalized with STEMI.

“I do not know the advantages of having a general practitioner” - a qualitative study exploring the views of low-acuity emergency patients without a regular general practitioner toward primary care

BackgroundEmergency departments (ED) worldwide have to cope with rising patient numbers. Low-acuity consulters who could receive a more suitable treatment in primary care (PC) increase caseloads, and lack of PC attachment has been discussed as a determinant. This qualitative study explores factors that contribute to non-utilization of general practitioner (GP) care among patients with no current attachment to a GP.MethodQualitative semi-structured telephone interviews were conducted with 32 low-acuity ED consulters with no self-reported attachment to a GP. Participants were recruited from three EDs in the city center of Berlin, Germany. Data were analyzed by qualitative content analysis.ResultsInterviewed patients reported heterogeneous factors contributing to their PC utilization behavior and underlying views and experiences. Participants most prominently voiced a rare need for medical services, a distinct mobility behavior, and a lack of knowledge about the role of a GP and health care options. Views about and experiences with GP care that contribute to non-utilization were predominantly related to little confidence in GP care, preference for directly consulting medical specialists, and negative experiences with GP care in the past. Contrasting their reported utilization behavior, many interviewees still recognized the advantages of GP care continuity.ConclusionUnderstanding reasons of low-acuity ED patients for GP non-utilization can play an important role in the design and implementation of patient-centered care interventions for PC integration. Increasing GP utilization, continuity of care and health literacy might have positive effects on patient decision-making in acute situations and in turn decrease ED burden.Trial registrationGerman Clinical Trials Register: DRKS00023480; date: 2020/11/27.

Frequency and Patterns of Traumatic Dental Injuries Reported at Islamabad Dental Hospital: A Retrospective Study.

Background: Traumatic dental injuries (TDIs) are increasingly becoming a public health concern, with a significant number of cases presenting to emergency departments worldwide. They affect a diverse age range, particularly children and adolescents, and are influenced by various etiological factors such as falls, sports injuries, and road traffic accidents. Previous studies have indicated a gender predisposition, with males more frequently affected, and a pattern of injury that varies by region. Objective: This study aimed to investigate the frequency and patterns of TDIs treated at the Department of Operative Dentistry, Islamabad Dental Hospital, and to analyze the management strategies employed. Methods: A retrospective cross-sectional analysis was conducted, examining patient records from 2015 to 2022. Approval was obtained from the institutional review board, aligning with the Declaration of Helsinki. Data from complete TDIs forms were extracted, detailing the type of injury, timing, and treatment administered. Statistical analysis was performed using SPSS v.23, with chi-square tests applied to examine the association between the type of trauma and demographic variables. Results: A total of 88 teeth with TDIs were recorded. The most common injuries were complicated crown fractures (28.4%) and root fractures (17.0%), with splinting (31.8%) and root canal treatments (29.5%) being the most frequent management procedures. Male patients were predominantly affected. Notably, adult cases surpassed those of children and adolescents, contrary to global trends. Conclusion: TDIs constitute a significant portion of dental emergency cases, with specific patterns and treatments that vary by demographics. Immediate and appropriate management, guided by current guidelines, is essential. Efforts should focus on increasing awareness and providing adequate training to healthcare providers for timely and effective treatment of TDIs.

Head injuries and their wound treatment

Head injuries are frequent occurrences in emergency departments worldwide and are notable for the fact that attention must be paid to the sequelae of intracranial and extracranial trauma. It is crucial to assess potential intracranial injuries and to strive for both medically sound and esthetically pleasing extracranial outcomes. The aim of this continuing education article is to provide arefresher on knowledge of head injuries and the associated nuances for wound care.

Enhancing Pavement Sustainability: Prediction of the Pavement Condition Index in Arid Urban Climates Using the International Roughness Index

Municipalities and transportation departments worldwide are striving to keep road pavement conditions acceptable, thus enhancing pavement sustainability. Although the pavement condition index (PCI) is widely used to assess distress conditions, traditional visual surveys used for PCI estimation can be laborious, expensive, and time-consuming. The international roughness index (IRI) can be measured more economically and conveniently than PCI; however, it does not directly indicate the surface condition of the pavement. In this study, a PCI–IRI correlation is proposed for urban roads located in the New Beni-Suef region, Egypt. For this purpose, a total of 44 km of urban roads was divided into homogenous sections. A visual distress survey was conducted to measure PCI considering typical distress patterns. The IRI values for the same sections were measured using an ultrasonic distance sensor mounted on an automobile. An exponential model was proposed to capture the relationship between IRI and PCI. With a coefficient of determination of 0.82, the exponential model seems to outperform reported IRI-PCI correlations. Model validation, along with a comparison to the existing models, supports its applicability to a wide range of roads. The proposed model provides a cost-effective means for accurately predicting PCI based on IRI, which is particularly useful for pavement maintenance management programs on limited budgets.

B-Mode Sonography Versus Color Doppler Twinkling Artifact in the Diagnosis of Nephrolithiasis

Background: Nephrolithiasis, or kidney stones, is a prevalent condition that prompts numerous patient visits to emergency departments worldwide. The diagnosis of this condition and its complications, such as hydronephrosis, has traditionally relied on various imaging modalities, with ultrasound being a primary, non-invasive option. Recent advancements, including the utilization of the color Doppler twinkling artifact, have potentially enhanced the diagnostic capabilities of ultrasound for nephrolithiasis. Objective: This study aims to evaluate the effectiveness of B-mode sonography and the color Doppler twinkling artifact in the diagnosis of nephrolithiasis and to compare their sensitivity in detecting renal stones and associated hydronephrosis. Methods: A cross-sectional study was conducted at the Department of Radiology, Mahaban Medical and Research Hospital, Topi, Pakistan, from December 2023 to March 2024. Seventy patients presenting with flank pain and aged above 18 years were enrolled. Sonographic examinations were performed using a TOSHIBA Xario Prime ultrasound machine. Data were analyzed using SPSS version 25.0, focusing on the presence of renal stones and hydronephrosis as detected by B-mode sonography and the color Doppler twinkling artifact. Results: Of the 70 patients studied, renal stones were detected in 70% (n=49) via the color Doppler twinkling artifact, while 30% (n=21) showed no stones. Hydronephrosis was observed in 30% (n=21) of patients, with an equal distribution between the left and right kidneys. The mean age of participants was 34.56 years, with a gender distribution of 62.9% male and 37.1% female. The twinkling artifact demonstrated a 100% sensitivity in identifying renal calculi among patients presenting with flank pain. Conclusion: The color Doppler twinkling artifact, when used alongside B-mode sonography, provides a highly sensitive diagnostic tool for nephrolithiasis, underscoring its potential as a primary imaging modality in the evaluation of patients with suspected renal stones. This study highlights the importance of ultrasound in the early detection and management of kidney stones, offering significant implications for improving patient care in healthcare settings lacking advanced imaging technologies.

Air pollution and bronchiolitis: a case-control study in Antwerp, Belgium.

This case-control study aimed to investigate the association between short-term (1 to 5days) and medium-term (31days) exposure to air pollutants (PM2.5, PM10, BC, NO2) at home/daycare and the risk of 'severe bronchiolitis' (defined as 'requiring hospitalization for bronchiolitis') in children under 2years in Antwerp, Belgium. We included 118 cases and 79 controls admitted to three general hospitals from October 2020 to June 2021. Exposure levels were predicted using an interpolation model based on fixed measuring stations. We used unconditional logistic regression analysis to assess associations, with adjustment for potential confounders. There were hardly any significant differences in the day-to-day air pollution values between cases and controls. Medium-term (31days) exposure to PM2.5, PM10, and NO2 was however significantly higher in cases than controls in univariate analysis. Logistic regression revealed an association between severe bronchiolitis and interquartile range (IQR) increases of PM2.5 and PM10 at home and in daycare, as well asIQR increases of NO2 in daycare. Controls were however overrepresented in low pollution periods. Time-adjustment reduced the odds ratios significantly at home for PM2.5 and PM10 (aOR 1.54, 95%CI 0.51-4.65; and 2.69, 95%CI 0.94-7.69 respectively), and in daycare for. PM2.5 (aOR 2.43, 95%CI 0.58-10.1). However, the association between severe bronchiolitis and medium-term air pollution was retained in daycare for IQR increases of PM10 (aOR 5.13, 95%CI 1.24-21.28) and NO2 (aOR 3.88, 95%CI 1.56-9.61) in the time-adjusted model. Conclusion: This study suggests a possible link between severe bronchiolitis and medium-term (31days) air pollution exposure (PM10 and NO2), particularly in daycare. Larger studies are warranted to confirm these findings. What is Known: • Bronchiolitis is a leading cause of hospitalization in infants globally and causes a yearly seasonal wave of admissions in paediatric departments worldwide. • Existing studies, mainly from the USA, show heterogeneous outcomes regarding the association between air pollution and bronchiolitis. What is New: • There is a possible link between severe bronchiolitis and medium-term (31 days) air pollution exposure (PM10 and NO2), particularly in daycare. • Larger studies are needed to validate these trends.

Incidence, Pattern, Causes, and Outcome of Acute Chest Pain Among Patients Presenting in the Emergency Department of a Tertiary Care Hospital in North India.

Acute chest pain is a common presentation in emergency departments worldwide. Differentiating between cardiac and non-cardiac chest pain is crucial for patient management and resource allocation. This study analyzed 714 patients presenting with acute chest pain in a tertiary care hospital in North India. We investigated demographic characteristics, chief complaints, risk factors, ECG findings, and final diagnoses to identify patterns associated with cardiac (CCP) and non-cardiac chest pain (NCCP). CCP was diagnosed in 53.7% (n=383) and NCCP in 46.3% (n=331). Significant predictors of CCP included age (OR=1.05, p<0.001), smoking (OR=2.22, p<0.001), diabetes (OR=1.57, p=0.003), hypertension (OR=1.82, p<0.001), and family history of ischemic heart disease (IHD) (OR=1.42, p=0.01). Central chest pain was more common in CCP (60% vs. 40%, p<0.001), as were abnormal ECG findings such as ST-segment depression (35% vs. 10%, p<0.001) and elevation (29% vs. 6%, p<0.001). Normal ECG was more prevalent in NCCP (60%, p<0.001). Traditional cardiovascular risk factors remain strongly associated with CCP. Smoking has a particularly high odds ratio, suggesting the need for targeted interventions. ECG findings significantly aid in differentiating CCP from NCCP. This study underscores the importance of a comprehensive approach in evaluating acute chest pain to ensure accurate diagnosis and effective treatment.