True Emergency Research Articles

METASTATIC SMALL CELL NEUROENDOCRINE CARCINOMA MANIFESTING AS SPONTANEOUS TUMOR LYSIS SYNDROME

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Tumor lysis syndrome is termed oncologic emergency that results from massive cell lysis. It can happen even before initiation of chemotherapy and can be an initial manifestation of malignancy itself which is termed as spontaneous tumor lysis syndrome (STLS). It is rare and is commonly associated with hematological malignancy where the proliferation and tumor burden are high. Solid tumors manifesting as STLS is extremely rare[1] CASE PRESENTATION: 62-year-old male presented after a fall to emergency department with facial and scalp laceration. Focused assessment with sonography for trauma showed multiple hypoechoic lesions of the liver. Labs showed severe metabolic acidosis with labs showing uric acid 9.9, potassium 5.7, bicarbonate 8, phosphate 8.4, creatine of 1.4, with base line creatine of 0.8, corrected calcium 8.4, Aspartate transaminase 664, Alanine transaminase 213, total bilirubin 10.1, direct bilirubin 5.3, Lactate dehydrogenase 12,677, INR 1.7, lactic acid 17. CT chest abdomen pelvis with intravenous contrast revealed small metastatic nodules in lung less than 5 mm, multiple masses in liver suggestive of metastasis, bilateral adrenal enlargement, irregularity in prostate and seminal vesicles, osteoblastic lesions in L4 lumbar vertebra. He was oliguric with no improvement with intravenous fluids requiring dialysis. A dose of rasburicase given for STLS which improved uric acid levels. He was admitted 2 weeks before fall for urinary retention requiring foley for 5 days. Prostate specific antigen (PSA) levels during present admission slightly elevated at 9. Liver biopsy showed small cell neuroendocrine carcinoma and immunohistochemical stain is negative for PSA. He developed multiorgan failure and family decided not proceed with any further interventions given poor prognosis. Primary location presumed to be prostate based on clinical findings and imaging. DISCUSSION: STLS in solid tumors is not common[2]. Close monitoring of electrolytes and kidney function is needed in patients with suspected extensive metastasis even before pathological diagnosis[2]. Although labelled as an oncologic emergency every physician need to be aware of STLS as this is true fatal emergency and can improve outcomes with timely initiation of treatment with IV fluids, rasburicase and dialysis if necessary PSA will not be significantly elevated in neuroendocrine differentiation and tumor stains will negative for PSA due to differentiation of prostate epithelium to neuroendocrine cells. CONCLUSIONS: High index of suspicion is necessary in diagnosis of STLS. Timely initiation of treatment improves patient outcome. STLS in solid tumors have poor prognosis Reference #1: 1. Serling-Boyd N, Quandt Z, Allaudeen N. Spontaneous tumor lysis syndrome in a patient with metastatic prostate cancer. Molecular and clinical oncology. 2017;6(4):589-592. doi:10.3892/mco.2017.1186 Reference #2: 2. Sommerhalder D, Takalkar AM, Shackelford R, Peddi P. Spontaneous tumor lysis syndrome in colon cancer: a case report and literature review. Clinical case reports. 2017;5(12):2121-2126. doi:10.1002/ccr3.1269 DISCLOSURES: No relevant relationships by Chandrakala Dadeboyina, source=Web Response No relevant relationships by Pushpa Khanal, source=Web Response No relevant relationships by JOYSON POULOSE, source=Web Response No relevant relationships by Harshil Shah, source=Web Response No relevant relationships by LITTY THOMAS, source=Web Response

Sort, Assess, Life-Saving Intervention, Triage With Drone Assistance in Mass Casualty Simulation: Analysis of Educational Efficacy.

IntroductionMass casualty incident (MCI) simulation and triage are educational methods used to provide high fidelity training to first response teams. Simulation and triage need to be as effective as possible to train professionals for true emergencies involving mass casualty. Although MCI simulation and triage have been used in the pre-professional setting (i.e. medical school, nursing school, etc.), more data is required regarding quality improvement of these simulations. This study focuses on quality improvement of MCI simulation and triage in the pre-professional training. In order to evaluate simulation quality to optimize future triage simulations, this study had three specific aims: (1) assess participant accuracy of triage after training in Sort, Assess, Life-Saving Interventions, Triage/Transport (SALT); (2) evaluate the role of stress and confidence in participants of triage simulation; (3) determine trainees’ perception of unmanned aerial vehicles (drones) in the setting of mass casualty simulation.MethodsA total of 44 attendees of the University of Central Florida (UCF) College of Medicine Global Health Conference participated in this study across three groups. Each group was provided a 15-minute lecture on SALT protocol. After the training, the participants continued to a 30-minute simulation in which they were asked to accurately triage up to 46 patient-actors. Each participants’ triage designations were compared to the previously assigned designations of each patient-actor. Pre- and post-simulation surveys were collected and analyzed using Statistical Package for the Social Sciences (SPSS) (IBM Corp., Chicago, IL). All other data were analyzed using descriptive statistics. ResultsQualitative and Likert data for the simulation were collected from 44 participants. Given a total of 1,113 triage scores (average of 25.29 triage designations per person), there was data to support that novice learners in this study tended to under-triage using the SALT protocol after 15-minute SALT training, with an overall accuracy of 52.43%. Survey data showed that confidence in mass casualty triage improved post-simulation, improving from median 3/10 to 5/10. Most participants were unaware of the use of unmanned aerial vehicles in MCI but most had positive opinions of their usefulness in MCI after the simulation, with a median score of 8/10.ConclusionsParticipant accuracy of triage after undergoing a 15-minute training in SALT triage was 52.43%, with a non-statistically significant tendency to under-triage. This accuracy level is consistent with other studies of SALT triage in MCI, but the tendency to undertriage requires further study for validation. Stress levels during the simulation were significantly elevated, while post-simulation confidence increased significantly from pre-simulation. The perception of drone utility in MCI was favorable among participants in this study, indicating drones may be useful for first response teams in future mass casualty simulations.

Comparison of total midgut volvulus and segmental volvulus in neonates

BackgroundIntestinal volvulus in a neonate, complete or segmental, is a true surgical emergency, which when the diagnosis is delayed can bring detrimental results. The aim of this study was to describe the clinical characteristics of intestinal volvulus during the neonatal period by comparing total midgut volvulus (TMV) and segmental volvulus (SV). MethodsThe medical records of 44 neonates who were operated on for intestinal volvulus from 1993 to 2019 were retrospectively reviewed. The patients were divided into TMV and SV groups, and clinical features were compared. ResultsOperations were performed on 27 patients for TMV and 17 for SV. All cases of TMV were associated with intestinal malrotation, while those with SV were not. Gestational age, birth weight, and ratio of prematurity showed no differences between the groups. Preoperative diagnosis of TMV or SV was possible in 23 and 5 (85% and 29%) cases, respectively. Intestinal resection was required in 16/17 patients (94%) with SV, while it was required in 5/27 (19%) patients with TMV. When bowel resection was performed in TMV, all but one patient suffered from short bowel syndrome leading to two mortalities, while SV group showed good recovery. ConclusionDiagnosis of SV before laparotomy can be difficult. Even though performing intestinal resection in SV neonates is highly likely, it shows a favorable outcome. TMV neonates are less likely to undergo intestinal resection; however, when bowel ischemia is present, significant morbidity can occur. Type of studyTreatment study. Level of evidenceLevel IV.

Combined Intratympanic and Systemic Steroid Therapy in Sudden Sensorineural Hearing Loss.

Sudden sensorineural hearing loss (SSNHL) is a true otological emergency that must be diagnosed and treated immediately. This study aimed to assess the efficacy of treatment with intratympanic dexamethasone (ITD) plus oral prednisolone with that of oral prednisolone or intratympanic dexamethasone alone and to determine factor affecting treatment outcome for SSNHL. Forty-five patients with SSNHL that had been present within 2weeks of onset of symptoms were included in this prospective case control study. Patients were allocated to three different groups. Patients in group A were treated with oral prednisolone 1mg/kg/d full dose 14days then tapered over next 14days. Patients in group B were treated with ITD 0.5ml (4mg/ml) every 7days for a total 4weeks along with oral prednisolone 1mg/kg/d in tapering dose for 4weeks. Patients in group C were got ITD 0.5ml (4mg/ml) every 7days for a total 4weeks. Audiogram was performed before each subsequent injection and at completion of treatment course. Among all participants, 22 patients (48.89%) showed improvement in pure tone audiogram to within 50% of pre- sudden hearing loss. On comparing the results of group A, B and C, there were no statistically significant difference with each other (p value 0.185). The mean audiometric gain was 37.71dB in recovered cases. The combination therapy of intratympanic dexamethasone and oral steroid is more effective in comparison with intratympanic or oral steroid alone in the treatment of SSNHL as the patients benefitted from the therapeutic effects of both local and systemic steroids.

Hypoglycemia prevention practice and its associated factors among diabetes patients at university teaching hospital in Ethiopia: Cross-sectional study.

Hypoglycemia is a true medical emergency, which needs prompt recognition and treatment to prevent organ damage and mortality. Knowledge about the prevention of hypoglycemia is an important step to self-care practice because informed people are more likely to have a better hypoglycemia prevention practice. The aim of this study was to explore hypoglycemia prevention practice and its associated factors among diabetes patients at a university teaching hospital in Ethiopia. A cross-sectional study was carried out on a total of 422 systematically selected diabetic patients at the University of Gondar Referral and Teaching Hospital. Data were collected using a pre-tested, structured, and interviewer-administered questionnaire. The collected data was analyzed by SPSS version 20 and associated variables were measured using binary logistic regression and within 95% confidence interval. A p-value <0.05 was considered as statistically significant. From the total of 422 diabetic patients, 61.6% were males, 70.1% of them were urban dwellers, 37.9% of them were unable to write and read, and 70.6% of the participants were taking insulin. The majority of respondents had good knowledge of (77.5%) and practice of (93.1%) hypoglycemia prevention. Only good participant knowledge about hypoglycemia prevention was strongly associated with the practice of its prevention (AOR: 2.87 (1.2-6.8), p = 0.01). Even though diabetic patients with good knowledge of hypoglycemia and its prevention was strongly associated with good prevention practice, there exists a gap in knowledge of hypoglycemia prevention. Hence, we recommend counseling be offered to patients regarding hypoglycemia during their visit to the diabetic clinic. Counseling points such as common clinical symptoms, its negative consequence, as well as remedial options are essential elements for the improvement of their practice on its prevention.

COVID-19 &amp; its implications on Dental practice: A Orthodontist’s perspective- Review

The coronavirus (COVID-19) epidemic is a public health worldwide problem for which specific guidelines are published, constantly updated by the World Health Organization (WHO). Considering the uncertainty surrounding the COVID-19 situation, it is evident that there is a need for clinical measures and guidelines for use in orthodontic practices during pandemic situations. Orthodontic problems, like general dentistry problems, represent urgencies, not true emergencies, so a video call or message with a photo might be the best options to evaluate the case. By providing appropriate timely management, inconvenience and distress to both the patient and parents may be minimized with the efficacy of the appliance still being maintained. These guidelines should provide priority for COVID-19 testing and guidelines for PPE needed in orthodontic practices for specific procedures; and comprehensive protocols for proper virtual based consultations and appointments that assure adequate patient care. With the passing days it seems inevitable that COVID-19 has and will forever change the way we practice orthodontics, but with unity and collegiality in the orthodontic community, we can surmount this together. With focus on virtual assistance devices and classification of emergencies. A brief summary of guidelines on the management of orthodontic patients during COVID-19 emergency is proposed. key words: Covid, Orthodontics,Infection control

Accuracy of a Symptom-Based Approach to Identify Hypertensive Emergencies in the Emergency Department.

Background: A hierarchical symptoms-based diagnostic strategy relying on the presence of five main symptoms (chest pain, acute dyspnea, neurological symptoms, headache, visual impairment) was recently proposed to diagnose patients with hypertensive emergency. However, poor scientific evidence is available about the role of symptoms in both diagnosis and management of acute hypertensive disorders. Methods: Data from 718 patients presenting to the emergency department of the “Città della Salute e della Scienza” Hospital of Turin with systolic blood pressure > 180 and/or diastolic blood pressure > 110 mm/Hg were retrospectively analyzed. The accuracy of the typical symptoms for identification of hypertensive emergencies was assessed. Results: A total of 79 (11%) out of 718 patients were diagnosed with hypertensive emergencies (51% had cardiovascular and 49% neurovascular acute organ damage). Patients with hypertensive emergencies were older and with higher prevalence of coronary artery disease and chronic heart failure than patients with uncontrolled hypertension. Typical symptoms could discriminate true hypertensive emergency from uncontrolled hypertension with 64% accuracy, 94% sensitivity, and 60% specificity. Conclusion: Typical symptoms might be used as a simple screening test (99% negative predictive value) in the emergency department to select for further evaluations of patients with suspected hypertensive emergencies among those with acute hypertensive disorders.

Knowledge, Attitude, and Practices of Emergency Management of Ocular Chemical Injury Among Primary Responders

Introduction: Chemical injuries are considered as one of the true ocular emergencies where timely management can save vision and years of visual rehabilitation. Thus, knowledge of the injury and its management is very important for medical professionals as well as the general population.

Cambio climático en tiempos de emergencia. Las comunidades autónomas en las veredas del "federalismo climático" español

The latest national and subnational legislative developments in the field of climate change and energy transition are taking place in a context of climate emergency to which a health crisis has added, what shows the causal relationships between pollutants of anthropogenic origin, climate change and the increase in pandemic or epidemic events that require urgent measures by public authorities. Against this backdrop, climate emergency is considered a true constitutional emergency and the evolution of the political and legal framework in which the subnational laws have opened the way to a difficult but necessary climate federalism is observed.

Myxedema Coma: a Review

Myxedema coma, represents the extreme degree of severity of hypothyroidism, whose mortality can reach very high percentages, therefore, it is a true medical emergency. In general, its development is associated with the presence of a triggering factor in a controlled hypothyroid patient and manifests with multisystem alteration. Currently, tools have been developed for clinical diagnosis that use the profile and clinical models, and have good sensitivity-specificity. They allow an early diagnosis which favored the early start of treatment and therefore improves the prognosis. The patient with myxedema coma needs an integral approach, with intensive treatment and close monitoring of hemodynamic parameters. However, the basis of treatment remains hormone replacement, which should be initiated with a combination of levothyroxine and triiodothyronine.

Targeting the Immune System for Pulmonary Inflammation and Cardiovascular Complications in COVID-19 Patients.

In December 2019, following a cluster of pneumonia cases in China caused by a novel coronavirus (CoV), named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the infection disseminated worldwide and, on March 11th, 2020, the World Health Organization officially declared the pandemic of the relevant disease named coronavirus disease 2019 (COVID-19). In Europe, Italy was the first country facing a true health policy emergency, and, as at 6.00 p.m. on May 2nd, 2020, there have been more than 209,300 confirmed cases of COVID-19. Due to the increasing number of patients experiencing a severe outcome, global scientific efforts are ongoing to find the most appropriate treatment. The usefulness of specific anti-rheumatic drugs came out as a promising treatment option together with antiviral drugs, anticoagulants, and symptomatic and respiratory support. For this reason, we feel a duty to share our experience and our knowledge on the use of these drugs in the immune-rheumatologic field, providing in this review the rationale for their use in the COVID-19 pandemic.

COVID-19 and Paediatric Dentistry after the lockdown.

Coronaviruses are a large family of respiratory RNA viruses that can cause severe infections of the airways, as we have seen in the past, difficult months. We know that the route of transmission of the disease is through saliva droplets produced by speaking, coughing and sneezing. The virus is highly infectious, and each infected individual infects 2.5 people on average. The average incubation period is about 5 days, with an estimated range from 2 to 14 days; the incubation period in children is similar, however some have exhibited a longer incubation. The virus binds to the cellular receptor ACE2, which in children has a structural and functional immaturity thus offering lower affinity to the pathogen; this could explain the lower incidence of infection from SARS-CoV-2 in this segment of the population.The common clinical observation is that COVID-19 is less severe in children, and in this group the disease is often asymptomatic. Pending further clinical studies able to clarify the infection and transmission dynamics, it is therefore important to apply also in children all preventive and hygiene measures recommended by the health authorities during dental treatment. We should avoid procedures that generate aerosols as much as possible, minimising the use of the air syringe. When possible, it is recommended to employ minimally invasive procedures and ART (Atraumatic Restorative Treatment). The latter is a technique that can also be employed in very young and uncooperative patients with widespread carious lesions, in order to avoid more invasive and complex procedures. Ozone therapy could be of great help in the control of the progression of the asymptomatic carious lesions, especially during the Phase 2 of reopening, when we should to minimise the use of rotating instruments producing aerosols. The above introduces a new concept of "no aerosol" that will possibly guide our therapeutic choices not only in the immediate future but also in the long term, opening scenarios of prevention and cure that are more efficient, safe, and sustainable. During procedures that generate aerosols, the use of proper PPE is crucial to minimise the risk of transmission. It is also strongly recommended to work with an assistant, and to use double suction and a rubber dam. We will have to rethink and review the schedule of daily activities, in terms of timing and mode of delivery of care, on the basis of an agenda which can be divided into "no aerosol" and "aerosol" procedures, and "virtual visits" (including management of true emergencies), creating a virtuous optimisation of care for the safety of operators and office staff, as discussed in an article published on this very EJPD issue. In the coming months we will perhaps deliver more "patient-oriented" than "tooth-oriented" treatments, and this is true not only for young patients!

Acute compartment syndrome in the limb.

Compartment syndrome of the limb is a true orthopaedic emergency that warrants prompt evaluation and treatment. Acute compartment syndrome of the limb is not uncommon and has the potential to cause devastating morbidity and mortality. Failure to provide urgent surgical intervention once established can lead to irreversible tissue damage within hours of onset. Compartment syndrome can occur across all limbs, the buttocks and even the abdomen, but this article focuses solely on the diagnosis of acute compartment syndrome of the limb. Acute compartment syndrome can have a wide range of causes, with trauma representing approximately 70% of cases.

Surgical Infection Society Guidance for Operative and Peri-Operative Care of Adult Patients Infected by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2).

Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-associated viral infection (coronavirus disease 2019, COVID-19) is a virulent, contagious viral pandemic that is affecting populations worldwide. As with any airborne viral respiratory infection, surgical and non-surgical patients may be affected. Methods: Review and synthesis of pertinent English-language literature pertaining to COVID-19 infection among adult patients. Results: COVID-19 disease that requires hospitalization results in critical illness approximately 25% of the time and requires mechanical ventilation with positive airway pressure. Acute kidney injury, a marked hypercoagulable state, and sometimes myocarditis can be features of COVID-19 in addition to the characteristic severe acute lung injury. Even if not among the most seriously afflicted, older patients with medical comorbidities are both predisposed to infection and risk increased morbidity and mortality, however, all persons presenting for surgical intervention should be suspected of infection (and thus transmissibility) even if asymptomatic. Although most elective surgery has been curtailed by administrative or governmental fiat, patients will still need urgent or emergency operative intervention for time-sensitive disease processes such as malignant neoplasia or for true emergencies such as perforated viscus or traumatic injury. It is possible to provide safe surgical care for SARS-CoV-2-positive patients and minimize nosocomial transmission to healthcare workers. Conclusions: This guidance will facilitate appropriate protection of patients and staff, and maintenance of infection control measures to assist surgical personnel and facilities to prepare for COVID-19-infected adult patients requiring urgent or emergent operative intervention and to provide optimal patient care.

High Throughput siRNA Screening for Sulfur Mustard‐Induced Corneal Epithelial Cell Injury

Chemical injuries to the eyes are true ocular emergencies due to the potential to inflict significant tissue damage that can lead to vision impairment or eventual loss of vision. Sulfur mustard (HD) is a chemical warfare agent that was originally used in World War I and has been used as recently as 2016 in the Syrian conflict. As with many potential chemical threats, no specific treatment for HD ocular exposure is currently available. We previously utilized a high throughput small inhibitory RNA (siRNA) screening model to identify potential therapeutic targets for two different toxicant‐induced ocular injuries: chloropicrin and hydrogen fluoride. Several targets for these injuries are now being evaluated in mouse models of injury. We proposed utilizing the same high throughput screening (HTS) method to identify potential therapeutic targets involved in the response to HD‐induced ocular injury. The model utilized SV40 large T antigen immortalized human corneal epithelial cells (SV40‐HCEC). Selected endpoints were cell viability and IL‐8 expression, as targets of interest should mediate cell health and/or the inflammatory response. Primary screen results were used to down‐select 300 targets from the original 3,027. Deconvolution of these 300 targets narrowed the target list down to 25, which are currently undergoing in vitro validation. Various pathways are implicated by the current target list, including ubiquitination, transcription regulation, signal transduction, and membrane transport. We anticipate that approximately ten validated targets will be transitioned to study in a mouse model to further determine potential therapeutic efficacy for HD‐induced ocular injury. Although work for HD is still in progress, we have compared the target lists that entered in vitro validation studies for all three toxicants evaluated thus far. Only one target was found in common: NR3C1, a glucocorticoid receptor. Additionally, there were two targets in common between chloropicrin and hydrogen fluoride: KMT5A and RELA. These findings show little similarity in the early molecular responses to these toxicants and support the hypothesis that specific therapeutics will be needed to treat different chemical‐related injuries.Support or Funding InformationDisclaimer: The views expressed in this abstract are those of the authors and do not reflect the official policy of the Department of Army, Department of Defense, or the U.S. Government.Funding Sources: This research was supported in part by an appointment to the Postgraduate Research Participation Program at the U.S. Army Medical Research Institute of Chemical Defense administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the U.S. Department of Energy and U.S. Army Medical Research and Materiel Command. Support is also provided by a CounterACT inter‐agency agreement between the NIH/NINDS (Y1‐O6‐9613‐01) and USAMRICD (A120‐B.P2009‐2).

Commentary: Challenges to Achieve Conceptual Clarity in the Definition of Pandemics.

From a scientific standpoint, the world is more prepared than ever to respond to infectious disease outbreaks; paradoxically, globalization and air travel, antimicrobial resistance, the threat of bioterrorism, and newly emerging pathogens driven by ecological, socioeconomic, and environmental factors, have increased the risk of global epidemics.1,2,3 Following the 2002-2003 severe acute respiratory syndrome (SARS), global efforts to build global emergency response capabilities to contain infectious disease outbreaks were put in place.4,5,6 But the recent H1N1, Ebola, and Zika global epidemics have shown unnecessary delays and insufficient coordination in response efforts.7,8,9,10 In a thoughtful and compelling essay,11 Thana C. de Campos argues that greater clarity in the definition of pandemics would probably result in more timely effective emergency responses, and pandemic preparedness. In her view, a central problem is that the definition of pandemics is based solely on disease transmission across several countries, and not on spread and severity together, which conflates two very different situations: emergency and nonemergency disease outbreaks. A greater emphasis on severity, such that pandemics are defined as severe and rapidly spreading infectious disease outbreaks, would make them "true global health emergencies," allowing for priority resource allocation and effective collective actions in emergency response efforts. Sympathetic to the position taken by de Campos, here I highlight some of the challenges in the definition of severity during an infectious disease outbreak.

Frequency of Hypoglycemia in Type 2 Diabetic Patients in Sample of Egyptian People in Clinic Based Study

Abstract Background Hypoglycemia is a true medical emergency which requires prompt recognition and treatment to prevent organ and brain damage. Hypoglycemia is not a disease in itself; it is a sign of a health problem; whose importance lies in its effects upon brain function. With increasing incidence of diabetes and with various modalities of intensive control of blood glucose levels, there is always a risk of a proportional increase in the incidence of hypoglycemia. Aim of The Work we measured the frequency of hypoglycemic attacks in type 2 diabetic patients (T2DM) in clinic based study and correlate the attacks of hypoglycemia with treatment regimens and duration of the diabetes mellitus (DM) Methods Copies of pre-tested questionnaire were administered directly to 1000 patients with T2DM at the study site. This questionnaire was previously published as a part of the Workgroup of the American Diabetes Association and The Endocrine Society (ADA) on 2013. After translating it into public traditional Egyptian Arabic language. Results Our main finding was that for people with T2DM the incidence of hypoglycemia was 36% (360 out of 1000 patients). 26.39% (95 out of 360 patients) on oral hypoglycemic drugs compared to 71.94% (259 from 360 patients) on insulin. hypoglycemia was 48.42% (46 out of 95 patients) in Diabetic patients having diabetes for more than five years and on oral hypoglycemic drugs, compared to 76.83% (199 out of 259 patients) in diabetic patients on insulin. there is a highly statistically significant difference between diabetic patients on insulin and long duration of diabetes (p &amp;lt; 0.001). Also show that there is a statistically significant difference between diabetic patients on oral hypoglycemic and long duration of diabetes p value 0.034. Prevalence of (IAH) impaired awareness of hypoglycemia is 49.94%&amp;unawareness 27.72% Conclusion Hypoglycemia is common in T2DM (36%). It is a significant complication of diabetes therapy and although mild hypoglycemia causes unpleasant symptoms and disrupts patients’ daily activities, severe hypoglycemia can result in coma, seizures, and death.

Histological study of the effect of granulocyte colony-stimulating factor on experimentally induced corneal burn in adult male albino rats

ABSTRACT Chemical injuries to the eye represent one of the true ophthalmic emergencies that require immediate and intensive intervention to minimize severe complications and visual loss. Granulocyte colony-stimulating factor (G-CSF) is a potent hematopoietic cytokine that influences the proliferation, survival, maturation, and the functional activation of granulocytes. The present work was performed to evaluate the histological effect of G-CSF in treating rat corneal alkali burn model. Thirty adult male albino rats were divided equally into three main groups: Group I was served as a control group, and in Group II and III, their corneas of the right eyes were injured by applying a piece of filter paper soaked in 1M NaOH. Group II (alkali burn-induced group) was left without any treatment, while Group III (G-CSF-treated group) was injected subcutaneously by 100 µg/kg of G-CSF for 5 consecutive days. All animals were sacrificed after 3 weeks. Cornea specimens were processed for histological and immunohistochemical staining for P63 followed by morphometry. Microscopic examination of Group II revealed marked alterations in the corneal epithelium, inflammatory cellular infiltration, and neovascularization. Treatment with G-CSF showed great improvement of the corneal structure, disappearance of the neovascularization and the inflammatory cells, and decreased p63 reaction of the basal layers.

Management of endodontic emergencies at a tertiary care hospital during the lockdown phase of the COVID-19 pandemic

Context: Coronavirus disease 2019 (COVID-19) is declared as a global pandemic by the WHO. Due to lack of proper vaccine, social distancing and restriction of movement in the form of“lockdown” have been implemented to curb the spread. This has crippled dental care in the country.Aims: The aim of this article is to highlight the management of endodontic emergencies during the COVID-19 lockdown phase.Settings and Design: Retrospective analysis of patient's data at a tertiary care centerMaterials and Methods: The data of 247 patients referred to the specialty clinic between March 23 and May 31, 2020, were retrospectively analyzed. COVID-19 risk assessment was performed for all the patients. Based on the diagnosis, the cases were classified as emergency, urgent, or nonemergency. The endodontic intervention was performed for all the emergency cases. Minimally invasive dentistry and pharmacotherapy were provided for urgent and nonemergency cases.Results: One hundred and seventeen patients presented with true endodontic emergencies (symptomatic irreversible pulpitis with or without apical periodontitis [80%], pulp necrosis and acute apical abscess [18%] or traumatic dental injury [2%]). About 82% of the emergency cases were managed by nonsurgical endodontic therapy, and vital pulp therapy was performed in 15.4% of the cases.Conclusions: Management of most of the endodontic emergencies required the use of aerosol-generating procedures. Irreversible pulpitis was the most common cause for the patients seeking emergency endodontic treatment.

Patterns of the Eye Emergencies Referring to the Valiasr Hospital in Birjand, Iran, During the “Nowruz” Holiday 2019

BackgroundOcular trauma is an important cause of preventable morbidity, and accounts for half a million cases of monocular blindness worldwide.ObjectivesThis study conducted to evaluate the profile of ophthalmic emergencies in a tertiary educational hospital during the “Nowruz” holiday 2019 in Birjand, Iran.MethodsThis cross-sectional survey included all patients visiting the eye-related Emergency Department during “Nowruz” holiday 2019 in the Valiasr Hospital of Birjand. The demographic information and clinical findings, such as presented complaints, the diagnosed eye disease, and the need for hospitalization were recorded. Descriptive statistics (i.e., frequencies and percentages) were calculated.ResultsIn the study, 86 patients with a mean age of 42.9 years were enrolled. The number of male subjects was more than female patients (60 (69.8%) and 26 (30.2%), respectively). The most presenting complaints were foreign body sensation (34.9%), followed by red-eye (30.2%) and ocular pain (11.6%). The most frequent diagnosis was corneal metal foreign body (24.4%), followed by conjunctivitis (16.3%) and ocular trauma (10.5%). All patients with penetrating injuries were younger than 12 years. Five patients (5.8%) needed hospitalization and surgery. Approximately, half of the patients were not considered as true emergency case.ConclusionsIn holidays, work-related injuries were the major causes of referral to eye emergency ward with the worse prognosis for children. Therefore, special educational prevention programs to care children should be provided for their parents.