Medical Emergency Research Articles

Association Between Acute Ischemic Stroke and Raised Serum Gamma Glutamyl Transferase

The serum gamma-glutamyl transferase level predicts the development of cardiovascular illnesses. Serum gamma-glutamyl transferase levels have been linked to atherosclerosis in several investigations, indicating that gamma-glutamyl transferase may be utilized as an early indicator of atherosclerosis. Objective: To determine the association between acute ischemic stroke and raised serum gamma-glutamyl transferase. Methods: After obtaining ethical approval, in this case-control study, 310 patients fulfilling the selection criteria were included from the Medical Emergency Department of, KEMU/ Affiliated hospital, Lahore from August 2022 to February 2023. Informed consent was obtained. After matching for age (40-80 years) and gender (both male and female), 155 controls enrolled preferably the accompanying healthy attendants of the patients and 155 cases i.e. ischemic stroke patients. Venous blood samples were obtained from cases at the time of presentation in the Emergency Department for serum gamma-glutamyl transferase (GGT). Data was collected in structured proforma. Data scrutiny was done using SPSS version 26.0. Mean and standard deviation were used for quantitative variables and frequency for qualitative data. Data were stratified for effect modifiers, and p≤0.05 was taken as significant. Results: In the current study, the frequency of raised GGT was found more among cases as compared to controls i.e. 74% vs 20%, p<0.00001 and OR calculated was 11.5. Conclusions: It was concluded that a considerable percentage of patients had raised gamma-glutamyl transferase at the time of presentation with acute ischemic stroke. These results emphasize the need to keep an eye on GGT levels in ischemic stroke patients as a possible stroke marker.

A cross-sectional study on utilization and barriers of eSanjeevani telemedicine services in rural areas of South India: Curing at a distance

Background: Telemedicine services are essential in a country like India, where the doctor-to-patient ratio and hospital-topopulation ratio are lower than the World Health Organization (WHO)-recommended ratio. To prevent the long waiting time for doctor appointments, diagnosis, and treatment plans in person, an alternative system such as eSanjeevani telemedicine is necessary to tackle medical emergencies in a populated country like India. Objectives: To assess the utilization and barriers affecting the utilization of eSanjeevani services among residents of rural areas in Karnataka. Materials and Methods: A Cross sectional community study was conducted in the rural areas of south India, using a pre-tested semi-structured interview schedule. Multistage cluster sampling method was used to select 400 households. The collected data has been expressed in terms of frequencies and percentages. Results: The study identified that most of the study participants were from lower middle class as per the modified Kuppuswamy Scale. Only 34.8% were aware of the eSanjeevani services and among them 22% utilized eSanjeevani services in which General medicine services (86.3%) were used the most. Major barriers for utilization included network issues (29%) followed by no room for queries/questions (20%). Conclusion: Telemedicine has the potential to enhance the availability and accessibility of healthcare to everyone. At the moment, lack of awareness, low network connectivity, and inherent technological limits pose major challenges for accessing telemedicine. Utilization of telemedicine can be increased by making people aware about the advantages of using it through strong Information, Education and Communication and media publicity

Assessment of the approach to managing medical emergencies during dental procedures.

This study aims to investigate the knowledge of dental interns and post-graduated doctors regarding dental emergencies and their occurrence in the clinic and examine the doctors' ability to intervene in these emergencies. Note that, 150 dental interns and 101 post-graduated doctors were surveyed with sixteen questions regarding their knowledge and experience with syncope, orthostatic hypotension, myocardial infarction, angina pectoris, asthma, and anaphylactic shock. Also, post-graduate doctors answered nine additional questions about their emergency response capabilities. This study found that interns and doctors exhibited similar knowledge about emergencies. Nonetheless, the count of dental interns encountering emergencies is relatively limited. Syncope was the most frequently encountered condition (61.8%). Doctors' increase in years of experience correlated positively with a higher rate of intervention in epilepsy, orthostatic hypotension, and anaphylactic shock (p=0.001, 0.024, and 0.02, respectively). The ability to check the carotid pulse and to perform intramuscular injections was high in post-graduated doctors (90.09% and 81.2%, respectively). Although interns believe their knowledge about emergencies to be sufficient, their intervention skills may need to be improved due to the low frequency of encounters. After graduation, their inability to intervene adequately during emergencies in the clinic can lead to fatal consequences. The lack of improvement in doctors' knowledge and intervention abilities with experience could be attributed to insufficient training after completing their formal education. To prevent such scenarios, regular training sessions should be provided to interns and doctors, focusing on the emergencies they may encounter.

A Multi-disciplinary Journey to Developing a Delirium Friendly Emergency Department

Abstract Background Delirium is a syndrome characterized by an acute change in attention, awareness and cognition. It has an organic cause and is likely to be reversible or preventable. It is a medical emergency that can often go undetected in an acute hospital setting. Currently the best management strategies for a delirium are multi-domain interventions that focus on treating precipitating conditions, medication review, managing distress and mitigating complications. An audit in 2022 identified that 40% of patients in the Emergency Department (ED) had an undetected delirium. A quality improvement initiative using Plan, Do, Study, Act (PDSA) methodology was undertaken to address this. A multi-disciplinary local working group was developed. The overall aim was to improve the patient's journey through early identification and management of delirium. This involved environmental changes such as high support chairs, signage and a delirium trolley. All staff received training on the identification and management of a delirium. In December 2023 delirium screening on all patients > 65 years was introduced in the ED as part of a delirium pathway. In April 2024 the pathway was re-audited. Methods Retrospective audit of the delirium pathway. Medical and nursing notes on all patients >65 years presenting to the ED over a 30-hour period were reviewed. Results (n=40) patients > 65 years presented to the ED over the 30-hour period. 6 medical notes could not be retrieved. (n=34) medical records were reviewed. The audit showed 14.7% of patients had a delirium screen recorded in their medical notes. One patient had an acute delirium on the ward that was not identified in the ED. There was no positive delirium score. Conclusion Delirium screening in the ED is sub-optimal. It is unclear from the audit why delirium screening compliance is so low. Conclusions can be drawn that processes around the identification of delirium need to be reviewed.

Detecting Delirium: The Missed Medical Emergency

Abstract Background Delirium is among the most common of medical emergencies with approximately 1 in 5 patients aged 65 and above presenting with or developing delirium, during their acute hospital admission. Delirium is more common in certain patient groups including those with hip fractures, dementia, previous delirium, frailty and other comorbidities. It is associated with poorer outcomes and complications. Delirium also has the potential to cause significant patient and carer stress. Despite the significance of delirium, it is frequently underdiagnosed. It can be prevented and treated if it is identified early. As per the National Dementia Office all acute Hospitals have to complete the Delirium care algorithm for all patients aged 65 years and above, admitted to hospital or who have any known risk factors for delirium. Methods The Delirium Multidisciplinary Care Bundle was rolled out across the hospital with education provided both face to face and via eLearning. Using the Quality Care Metrics (QCM) delirium indicator and a locally developed audit tool, medical and nursing records where reviewed to identify the level of concordance with the Delirium Multidisciplinary Care Bundle. Results The gradual increase in the compliance in use of the care bundle reached up to hundred percent. The bundle use was audited utilising the Quality Care Metrics (QCM) with the delirium indicator showing an improvement of an average of 60-80% hospital-wide. The hospital-wide audit on the compliance of the delirium care bundle was conducted and identified that compliance on the bundle had improved to 60-100%. Conclusion Continuous evaluation, monitoring and improvement plans are in place. This will be further supported by providing multiple methods of education delivery throughout the organisation to meet the needs of all learners. Ultimately continuing to improve delirium detection and management for our patient group.

Enhancing Delirium Recognition: Assessing The Impact Of Educational Interventions In A Model Three Hospital - A Retrospective Analysis

Abstract Background Delirium is a common medical emergency which is well-known to be associated with adverse outcomes but often remains under-recognised in the acute care setting. In recent years, efforts have been made by our gerontology department to increase awareness of the importance of recognising delirium as a medical condition. Initiatives carried out included the roll-out of education sessions at ward level, medical and nursing grand rounds. Utilising HIPE (Hospital Inpatient Enquiry) data, we assessed whether such interventions have translated into increased recognition of delirium in hospital inpatients. Methods We collated data from the HIPE department in our hospital. HIPE assessed all hospital inpatient medical charts for patients that were discharged each year to assess whether delirium was recorded as a diagnosis in such patients. The data for each discharge year spanning from 2018 to 2022 inclusively was compared. We assessed the number of patients discharged during those years that had a diagnosis of delirium recorded in their chart. Additionally, in conjunction with the frailty team, we reviewed all formal interventions made in our hospital since 2018 to promote awareness around delirium. Results A year-on-year increase in the number of cases of chart-recorded delirium among hospital inpatients between 2018 and 2022 was observed. In 2018, there were 308 diagnoses of delirium made in patients being discharged from hospital that year. This was followed by 342 in 2019, 424 in 2020, 501 in 2021 and 609 in 2022. There were nine different initiatives identified to have been carried out by the gerontology team to increase education around delirium. Conclusion Interventions made have shown to increase the recognition and diagnoses of delirium. With diagnoses increasing by nearly 98% over a five-year period, this shows that interventions to improve awareness of delirium can have significant impact. Recognising delirium is the first step to improving outcomes for patients.

Frailty Assessment and Management: A Qualitative Study of the Educational and Training Experiences of Postgraduate Doctors

Abstract Background Understanding and addressing frailty, a complex syndrome commonly found in older adults, demands a deep understanding and proficiency across various health domains. Existing research indicates a disparity between medical education and the hands-on management of frailty in practice. There is a scarcity of research on the educational requirements of postgraduate doctors in caring for frail patients. Methods Qualitative semi-structured interviews were conducted with post-internship doctors working in an AMU, using transcripts to analyse themes. The focus was on frailty conceptualisation, educational training, and clinical experience. Results Several themes were noted, particularly the lack of focus and variation on frailty teaching in undergraduate curriculums. This, coupled with limited hands-on experience, an emphasis on acute care over chronic management, inadequate multidisciplinary training, and a need for more structured education on frailty assessment tools, underscores the need for ongoing education and support. Many interviewees shared their experiences of being well-equipped to handle acute medical emergencies, demonstrating the effectiveness of their current medical education. However, they also pointed out that this preparation did not adequately equip them for the ongoing, multidimensional care that frail patients require. Several interviewees stressed the role of continued education and support for healthcare professionals managing frailty, suggesting ongoing professional development opportunities could effectively bridge the gap between initial medical education and the evolving demands of clinical practice. The potential of mentorship from experienced geriatricians adds invaluable guidance for early career doctors. Conclusion This qualitative study underscores a significant gap between medical education and the practical management of frailty. Addressing this gap requires a multifaceted approach that integrates frailty-focused content into undergraduate curricula, provides hands-on experience, fosters multidisciplinary collaboration, and offers ongoing professional development. By enhancing frailty education and training, healthcare systems can improve the quality of care for this vulnerable population, leading to better patient outcomes and more efficient use of resources.

Cost-Effectiveness of Influenza Vaccination in Healthy Children: A 10-Year Population-Based Study

Background/Objectives: Seasonal influenza annually puts a significant burden on the pediatric population, especially the youngest, causing severe illness and death. Additionally, associated healthcare costs cause a significant financial strain on healthcare systems. While vaccination is the most effective prevention method, its cost-effectiveness for healthy children remains unassessed. Methods: Using the Pedianet database spanning from 2009 to 2019, we analyzed influenza cases among 6-month-olds to 14-year-olds in Italy. Data included influenza-related medical visits, prescriptions, exams, emergency visits, hospitalizations, and costs. Adverse events and quality-adjusted life years (QALYs) were considered from the existing literature. A static decision-tree model compared annual vaccination strategies, assessing probabilities for influenza or influenza-like illnesses by vaccination status. Incremental cost-effectiveness ratios (ICERs) were calculated, along with sensitivity analyses and cost-effectiveness acceptability curve generation. Results: Mean total influenza costs for vaccinated children averaged EUR 18.6 (range 0–3175.9, including EUR 15.79 for the influenza vaccination), whereas costs for unvaccinated children were consistently lower at around EUR 4.6 (range 0–3250.1). The average ICER for years where vaccine and virus strains are matched was EUR 29,831 per QALY, which is below the EUR 40,000 threshold set by the Italian National Health Services. The ICER values range from EUR 13,736 (2017/2018) to EUR 72,153 (2013/2014). Averted influenza costs averaged EUR 23 per case, with fluctuations over the years. In most observed years, influenza vaccination was cost-effective from the healthcare providers’ standpoint. The exception was 2009–2010, due to a mismatch between vaccine and virus strains. Conclusions: This study highlights the economic viability of influenza vaccination, especially when virus and vaccine strains align. It demonstrates the potential of vaccination programs in preserving children’s health and well-being while managing healthcare costs.

Increasing public awareness through education and the implementation of routine blood donations

This community service program aims to increase public awareness and participation in blood donation activities through education and the regular implementation of blood donation. Adequate blood availability in blood transfusion units is critical to saving lives, but community participation in blood donation is still low in some areas. Through this activity, counselling was carried out to the community about the benefits of blood donation, health requirements, and the importance of blood donation continuity for medical emergency needs. This program collaborates with the Indonesia Red Cross (PMI) and local health facilities to organize routine blood donation activities every three months. It is hoped that with this program, community participation in blood donation will increase significantly, and sustainable awareness about the importance of sharing and helping others through blood donation will be created. The results of this activity were measured through an increase in the number of blood donation participants and an evaluation of community knowledge after counselling was carried out

A prognostic prediction model for acute pulmonary embolism.

Acute pulmonary embolism (APE) is a very common and important medical emergency in intensive care units with an unfavorable prognosis. This study aims to explore the prognostic factors of APE and to construct a prognostic prediction model. A retrospective analysis was conducted on 252 APE patients in the emergency department of our hospital from January 2020 to March 2024. The initial observation endpoint was set as the mortality status of patients within 30 days of admission. Cox multivariate regression analysis was used to identify independent risk factors for prognosis. Based on these factors, a nomogram predictive model was constructed and evaluated using R software. Within 30 days of admission, 42 patients died with an overall mortality rate of 16.6% (42/252). Binary Cox multivariate regression analysis indicated that age ≥ 62.5 (HR: 2.64, 95% CI: 1.23-5.63, p = 0.012), right ventricular dysfunction (RVD) (HR: 4.58, 95% CI: 1.76-11.96, p = 0.002), white blood cell count (WBC) ≥ 13.1 (HR: 2.35, 95% CI: 1.20-4.60, p = 0.013), albumin/fibrinogen ratio (AFR) < 9.15 (HR: 3.36, 95% CI: 1.76-6.42, p < 0.001), Prognostic Nutritional Index (PNI) < 50.3 (HR: 4.35, 95% CI: 1.62-11.71, p = 0.004), and Systemic Inflammation Response Index (SIRI) ≥ 1.05 (HR: 7.21, 95% CI: 3.38-15.37,p < 0.001) were independent risk factors for mortality. The nomogram model based on these factors demonstrated a good predictive value for 30-day mortality, with an AUC of 0.908. The nomogram model based on age, RVD, WBC, AFR, PNI, and SIRI has a well prognostic value for APE patients.

Medical Emergencies in Dental Practice

Medical emergencies in Dental Practice:Abstract "In the middle of difficulty lies opportunity."– Albert Einstein.In the realm of dental practice, the presence of medical emergencies poses both challenges and opportunities for dental professionals.We will look into specific emergencies such as syncope,seizures, asthma attacks, allergic reactions, anaphylaxis, airway obstruction,diabetes-related issues, and cardiac emergencies. Each emergency will be discussed in terms of its occurrence in dental practice, underlying causes,symptoms, and effective treatment protocols. Two more important topics:Importance of history taking,Medico legal aspect of medical emergency in dental office will be seen.

Surgical Treatment of Craniocervical Junction Tumors: Neurosurgery Department Experience of “Hôpital Principal De Dakar”

Introduction: Craniocervical tumors are uncommon but represent a medical emergency for diagnosis and treatment. Their approaches require of course surgical expertise in addition to adapted technical platform. In light of the limited resources available in our practice, we consequently made the decision to share our experience with the surgical treatment of this pathology. Patients and method: We performed a retrospective analysis on eight observations of patients treated in the neurosurgery department of “Hôpital Principal de Dakar” between July 2015 and December 2022 for progressive tumor spinal cord compression at the craniocervical junction. Results: We observed a 10% frequency, a mean age of 39.25 years, and extremes between 8 and 62 years. There was a 0.6 sex ratio. The most common risk factor was type I neurofibromatosis, and one case of Von Hippel-Lindau disease. All of our patients had pyramidal syndrome. Overall, there were 2 tumors with posterolateral extradural site and 4 tumors with extramedullary intradural location, including 2 posterolateral and 2 anterolateral. The location was intramedullary and cerebella-medullary in one case each. The posteromedial occipitocervical approach, which was employed on six patients, was the most utilized method. Five patients had total tumor resection, whereas three had partial resection. Two of our patients had postoperative complications: a worsening of motor deficit and a death following dependence on mechanical ventilation. We only received four histological confirmations for the anatomopathological samples. Our patients&amp;apos; evolution was positive over an average follow-up of 21 months, with neurological improvement and walking autonomy. Conclusion: Tumors affecting the craniocervical junction are still treated surgically. Despite the need for improvement in our working conditions, our results appear to be satisfactory.

Medical Toxicology vs. Emergency Medicine and Internal Medicine — Are We Really Full of Case Reports?

IntroductionCase reports are perceived as having diminished value relative to other study designs. It has been said that medical toxicology (MT) is based largely upon case report literature and thought to be unique in this regard. We sought to quantify recent MT publication of case reports compared with top periodicals from emergency medicine (EM) and internal medicine (IM) journals.MethodsA retrospective review examined 5 years of articles in 6 U.S.-based medical journals–MT (Journal of Medical Toxicology, Clinical Toxicology), EM (Annals of Emergency Medicine, Journal of Emergency Medicine), and IM (JAMA Internal Medicine, New England Journal of Medicine) was performed using on-line resources. Every article in each issue was categorized into Case report vs. Research and Analysis articles vs. Excluded. “Case report” was defined as one (or ≤ 5) individual patients, one patient’s data, etc. Total articles per issue were reported after removing Excluded items.ResultsBetween 2018 and 2022, these 6 periodicals published 522 issues; with 2644 case reports; and 8246 total included articles. Comparison of MT case reports vs. EM revealed a significant difference and odds (Odds Ratio = 1.7, (95% CI: [1.49, 2.03], p < 0.001); MT compared with IM was not significantly different (Odds Ratio = 1.1, (95% CI: [0.96, 1.30], p = 0.150). The percent of case reports increased in the IM and EM journals compared with a relative decrease in the MT journals. Cumulative case report precents were consistently greater in EM and IM than in MT.Conclusion In the past 5 years, MT journals published fewer and had a declining trend of case reports compared with leading EM and IM journals. Future research is needed to determine the effect on MT practice resulting from the diminished body of case report literature.

Best Practices in Training and Preparedness for Medical Emergencies: From Dental School to Private Practice

Best Practices in Training and Preparedness for Medical Emergencies: From Dental School to Private Practice

Exploring Prehospital Data for Pandemic Preparedness: A Western Brazilian Amazon Case Study on COVID-19.

The timely management of rapidly evolving epidemiological scenarios caused by disease outbreaks is crucial to prevent devastating consequences. However, delayed laboratory diagnostics can hamper swift health policy and epidemic response, especially in remote regions such as the western Brazilian Amazon. The aim of the article is to analyze the impact of the COVID-19 pandemic on the volume and characteristics of emergency medical services (EMS) in Manaus, focusing on how the pandemic affected sensitive indicators such as response time and the use of advanced life support ambulances. Additionally, the study seeks to understand how changes in prehospital EMS patterns, triggered by the pandemic, could be utilized as health surveillance tools, enabling a more rapid response in epidemic scenarios. This retrospective, descriptive study included data from the SAMU (Serviço de Atendimento Móvel de Urgência) medical records between January and June 2020. A total of 45,581 calls resulted in mobile units being dispatched during this period. These patients were predominantly male (28,227, 61.9%), with a median age of 47 years (IQR 30-67). The median response time significantly increased during the pandemic, reaching a median of 45.9 min (IQR 30.6-67.7) (p < 0.001). EMS calls were reduced for trauma patients and increased for other medical emergencies, especially respiratory conditions, concomitantly to an escalation in the number of deaths caused by SARS and COVID-19 (p < 0.001). The employment of advanced life support ambulances was higher during the pandemic phase (p = 0.0007). The COVID-19 pandemic resulted in a temporary disorder in the volume and reason for EMS calls in Manaus. Consequently, sensitive indicators like the response time and the employment of advanced life support ambulances were negatively affected. Sudden prehospital EMS pattern changes could play an important role in health surveillance systems, allowing for earlier establishment of countermeasures in epidemics. The impact of the COVID-19 pandemic on prehospital EMS and its role in health surveillance should be further explored.

Disorders of potassium homeostasis after kidney transplantation.

Disturbances of potassium balance are often encountered when managing kidney transplant recipients (KTR). Both hyperkalemia and hypokalemia may present either as medical emergencies or chronic outpatient abnormalities. Despite the high incidence of hyperkalemia and its potential life-threatening implications, consensus on its management in KTR is lacking. Hypokalemia in KTR is also well-described, although it is given less attention by clinicians compared to hyperkalemia. This article discusses the etiology, pathophysiology and management of both types of potassium disorders in KTR. Once any emergent situation has been corrected, treatment approaches include correcting insulin deficiency if present, adjusting non-immunosuppressive and immunosuppressive medications, eliminating or supplementing potassium as needed, and dietary counselling. Although commonly of multifactorial etiology, ascertaining the specific cause in a particular patient will help guide successful management. Monitoring KTR through regular laboratory testing is essential to detect serious disturbances in potassium balance since patients are often asymptomatic.

When an inguinal hernia is more than just a hernia with ovary and fallopian tube involvement: a case report

BackgroundFinding an ovary and/or fallopian tube within an indirect inguinal hernia is a rare occurrence that can be detected incidentally during elective surgery or present as a medical emergency requiring immediate intervention. Hence, it poses a difficult clinical picture in a reproductive-age woman with groin mass.Clinical presentationWe describe the case of a 45-year-old Ethiopian woman of Amhara ethnicity who presented with a left inguinal swelling that persisted for 5 years. Physical examination revealed an irreducible, non-tender lump in the left groin and an ultrasonography scan confirmed the presence of an indirect inguinal hernia. The patient was then scheduled for elective hernia repair. During the surgery, both her left ovary and fallopian tube were found within the hernial sac. The contents were released from the sac, high ligation performed, and the inguinal floor repaired with mesh.DiscussionInguinal hernias in women are rare and often present a diagnostic challenge. Although the exact pathogenesis of inguinal hernias containing female genital organs is unknown, some risk factors have been postulated. Diagnosis should start with a physical exam and imaging, but many of the cases have been intraoperative surprises. Management is primarily surgical, ranging from simple reduction and hernia repair to salpingo-oophorectomy depending on the status of the hernia contents.ConclusionThis report emphasizes the importance of maintaining a high index of suspicion when examining females with inguinal hernias to ensure accurate diagnosis and management of tubo-ovarian hernias. Although rare, inguinal hernias containing female genital organs should be considered in the differential diagnosis of inguinal hernias, as early detection and appropriate surgical management can prevent potential complications.

Multiplex detection of meningitis pathogens by a vertical flow paper microarray and signal enhancement suitable for low-resource settings: Proof of concept

ObjectivesMeningitis is a medical emergency, and it is crucial to diagnose it accurately and promptly in order to manage patients effectively. It would, therefore, be essential to introduce and have fast, accurate, and user-friendly methods to determine the cause of these infections. This study aimed to demonstrate a potentially cost-effective new approach for detecting meningitis using a paper-based vertical flow microarray, which could be useful in settings with limited resources. MethodsWe describe a multiplex paper microarray for detecting Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae, and Salmonella spp. by the passive vertical flow of PCR-amplified clinical samples. A multibiotinylated amplicon was obtained as a product of PCR in the presence of both a biotinylated primer and biotin-11-dUTP. An enhancement step based on an enzyme-free gold enhancement protocol was also used to facilitate visual detection. ResultsThis study showed that the vertical flow microarray (previously evaluated for one pathogen) can discriminately detect the amplification results down to the 102 copies of DNA limit for four meningitis pathogens in a multiplexed set-up. The study further demonstrated the ability of this device and setup to detect three of the four pathogens from clinical biosamples. DiscussionThis study demonstrated the capacity of a vertical flow microarray device to detect amplification products for four prevalent meningitis pathogens in a multiplex format. The vertical flow microarray demonstrated consistent visualization of the expected gene amplification results; however, indicating limitations in the pre- and amplification steps. This study highlights the potential of this multiplexing method for diagnosing meningitis and other syndromic diseases caused by various pathogens, especially in resource-limited areas.

Cardiac tamponade in a patient with chagas disease and pericardiocentesis. Case report

Introduction: Cardiac tamponade is considered a medical emergency, which is characterized by the accumulation of fluid, pus, blood or clots in the pericardial space. Chagas disease is considered one of the potential causes of cardiac tamponade due to the myocarditis and pericarditis it can produce.Clinical case: 58-year-old male patient who went to the emergency department, with a condition characterized by: dizziness, fatigue, productive cough with whitish expectoration, moderate dyspnea, general and mild chest discomfort. With a history of Chronic Chagas, smoker. A P-A chest x-ray, electrocardiogram and transthoracic echocardiogram were performed, confirming the diagnosis of cardiac tamponade. Discussion: Although Beck's triad can guide the diagnosis, it occurs in a small percentage of cases. In our case, after diagnosis, ultrasound-guided pericardiocentesis was performed and allowed the evacuation of blood content, improving the hemodynamic condition after performing the procedure and stable vital parameters. Conclusions: Chronic Chagas and some associated risk factors triggered the development of plugging. The pericardiocentesis was successful, allowing the evacuation of blood content, improving the hemodynamic condition and avoiding complications. Atypical presentation requires multidisciplinary management, early diagnosis related to clinical and ultrasound findings are essential for management, these will be determining factors in the evolution and prognosis of our patients

Cornual Ectopic Pregnancy Rupture Early Diagnosis and Treatment: A Case Report

Cornual pregnancy is a severe form of ectopic pregnancy, comprising 2-4% of such cases and presenting a mortality rate 6-7 times higher than typical ectopic pregnancies. It is often confused with interstitial pregnancy which arises from the implantation of the gestational sac in the myometrium’s proximal part. Diagnosis and treatment are challenging and considered medical emergencies due to potential for significant maternal haemorrhage. This is a case report of a 26-year-old woman in hypovolemic shock due to a ruptured ectopic pregnancy, confirmed via ultrasound and treated with emergency laparotomy, revealing a left corneal ectopic pregnancy, which was successfully repaired.