Frontiers in Emergency Medicine: A work overview for 2021

In 2021, Frontiers in Emergency Medicine published 47 papers on four distinct issues which all are indexed by SCOPUS, Web of Sciences, and some other databases. More than one hundred authors from various nationalities, including the UAE, Egypt, India, Turkey, Yemen, the USA, Palestine, Belgium, and Iran were involved. As is customary, we decided to review our work for the last year and evaluate our strengths and weaknesses. Therefore, we performed a brief appraisal of our published papers. This review may help the authors who are interested in publishing with us to become more familiar with the journal’s aims and scopes, and also the editorial’s priorities and preferences. The year 2021 came to an end with the ongoing COVID-19 pandemic as the hottest topic of research worldwide. We also tried to play our part to overcome the pandemic by publishing relevant and useful papers that we believed could help health systems and bring valuable findings from Iran as one of the most affected countries in the world, followed by neighboring countries and the Middle East region. &nbsp

Current Medical Journalism Needs Major Revisions

Medical journalism commenced during early nineteenth century as an impressive adjunct for medical education. It is considered as a platform to share the results of the research studies and to disseminate medical information that could impact the present concept and practice of the medicine field. Medical journalism gained immense attention over the years; however, the present scenario revealed certain limitations. A rise in the number of researchers, by interest or forcefully, has led to an increase in the journal count, resulting in several fake research articles being published in the journals. This leads to inappropriate research and low quality of journals, where the data appearing in the research articles is not authentic; thus, the journals publishing such articles face several issues while verifying the authenticity of the data provided. All journals, in particular, the recent ones strive to achieve immense importance in regards to the impact factor, h-index, and similar quality assessments; however, attaining similar scores as that of the well-known journals is impossible. Hence, as a futile effort, the editorial team of the new or latest journals consider adding more references in their articles in order to achieve a higher score; however, certain references from the previously published papers, may decode as a conflict of interest. Based on an unwritten and unavailable rule, all new journals try to publish papers in same format as publishing in famous journals, and do not dare to deconstruct it. It seems that deconstruction should also be performed by the old journals founded the current style! In order to avoid the aforementioned issues, the Advanced Journal of Emergency Medicine emerged with the concept of being different, deconstructive, and without any futile competition with the other journals. Accordingly, we consider a large audience with several degrees of medical education to participate in the field of research, make the journal a unique one aim to augment of medical education through medical research charm.  To the best of our knowledge, at present, we do not have appropriate solutions to aforementioned problems. We request the authors, directors, and editorial members of the journals to have a detailed discussion on this topic, and we are ready to publish articles on the topic that is briefly discussed in this article

Frontiers in Emergency Medicine: A work overview for 2022

In 2022, Frontiers in Emergency Medicine published 60 papers in four distinct issues with authors from various nationalities, including Mexico, Turkey, Egypt, India, Yemen, the USA, Palestine, Poland, Saudi Arabia, the Netherlands, the UAE, Algeria, Ethiopia, Jordan, Cameroon, the UK, and Iran. As we did last year, we decided to review and evaluate various aspects of our work in the previous year. In the year 2022, despite the not-yet-ended pandemic, COVID-19 apparently missed its priority as the hottest topic of research and it seems that researchers took time to focus on their main research lines. Therefore, we were able to publish articles in different fields and cover more topics; however, we still received so many papers on COVID-19 and published some of them, not only on treatment but also on other aspects of the disease, and also some case reports. We also published a letter in which the authors pointed to increased prevalence of bloodstream infection with Klebsiella species in patients with recent COVID-19 infection, which may be an interesting issue for further investigations. We had two other papers that were published as “Letter to the Editor”. One was related to blunt abdominal injuries in the National Trauma Registry of Iran, and the other was concerned with Eye emergencies during wars, which was published around the beginning of Russia's war against Ukraine. There were 25 published papers in 2022 that fulfilled the criteria of an original article. Of these, only 7 were focused on COVID-19, and the rest covered other topics including critical care, neurological emergencies, experimental studies, point of care ultrasound, cardiovascular emergencies, emergency department management topics, trauma, and prehospital emergency care. Interestingly, the most viewed article was the one in which a series of oleander poisoning cases were reported by a group of authors from India. In addition to original articles, there were also one umbrella review, one systematic review, and some other types of reviews that have their own value and specific audiences, in which some recommendations were reviewed by experts in the fields. Case presentation maybe the most popular part of the journals. We have various structures in this regard, so that we can respond to the passion of our addressees. We published 5 Case reports, and also 5 papers categorized as “case-based learning points”. However, there are some other structures available for those interested in sharing their experience with their patients, which we regularly suggest to the authors in the peer review process of their submissions. We are honored to have published a series of educational papers on “electrocardiogram interpretation”, all written by Jerry W. Jones as an invited author, and we are very grateful for his participation and companionship. We also intend to introduce historical aspects of emergency medicine in various countries; therefore, an editorial paper written by Ozgur Karcioglu was published, which points to the emergency medicine journey in Turkey. We are very eager to have this type of papers from other countries and we will certainly invite other experts in this regard

Description of a Working Day as a Senior Emergency Medicine Resident; Burning Candle at Both Ends!

This text is a real-time description of an emergency medicine resident’s shift in an overcrowded emergency department (ED), Tehran, Iran

Atypical Presentation of Massive Pulmonary Embolism, a Case Report

The lack of pathognomonic signs and symptoms makes the diagnosis of pulmonary embolism (PE) difficult. Here, we report a case of a 42-year-old man presented to the emergency department with worsening epigastric pain, hypotension, frank bradycardia, and final diagnosis of PE. Although previous studies have indicated that abdominal pain was observed in 6.7% of patients with PE, the exact reason for abdominal pain in PE still remains unknown. Tension on the sensory nerve endings, hepatic congestion, and distention of Gilson’s capsule are some of the possible mechanisms of abdominal pain in PE. We conclude that emergency physicians should pay more attention to PE, which is an important differential diagnosis of shock state. In this context, rapid ultrasound in shock (RUSH) should be considered as a vital sign that needs to be evaluated when recording the history of patients presented to the emergency department with signs and symptoms of shock

Medical Journalism and Emergency Medicine

Nowadays, many researches in the field of medicine are conducting all around the world and medical journalism is a way to share the results. In fact, dissemination of the related manuscripts can prevent the repetitive research or may even lead to conducting a better survey. Therefore high quality medical journals are considered as up-to-date resources for further investigations. Medical journals are propagating their papers in various media including television programs, newspapers, internet websites and different social media. So they can influence the government policy makers, health-care professionals and even public. Moreover, most researchers hear about medical discoveries for the first time through medical journals and their related social media. So as well a high quality journal can help to improve medical science, a journal of poor quality can be damaging and distorting. Indeed, popular journals have the power of inventing a “communication storm” to draw attention to a certain topic. Thus they have to respect the accepted international principles to prevent spreading inaccurate and misleading data. This paper aims to review the previous and current situation of medical journalism by focus on field of emergency medicine

Spontaneous Spinal Epidural Hematoma; a Case Report

Spontaneous spinal epidural hematoma (SSHE) is a rare entity can have several reasons. Its prevalence in population is 0.1 per 100,000 with the male to female ratio of 1/4:1. For the first time Jackson in 1869 reported a case of SSHE and after that it was declared as several hundred cases in literatures. Here, a case of SSHE was reported in a 52 year-old male referred to emergency department following severe low back pain

A 33-year-old woman with severe postpartum headache

 Patient was a 33-year-old woman underwent her first time cesarean section combined with spinal epidural anesthesia 5 days before and discharged the day after with good condition. She got severe headache with pain score about 8-9, 2 days after discharge from hospital. Her headache was severe, bilateral, pulsatile and almost likely sudden onset accompanied with nausea that mildly progressed after starting. She went to the hospital which her delivery was taken; with impression of Post Dural Puncture Headache (PDPH) 10mg IV morphine sulfate was administered totally and subsequently discharged home with relative decreased headache. The day after first headache attack, when she admitted in our Hospital, claimed that could not hold her baby for breast feeding. In minimental status examination, time disorientation was obvious but orientation to place and person was intact. In motor examination we found right side hemiparesis and also decreased right upper and lower limbs tone. Brain CT Scan and then MRI was performed and reveal massive cortico-subcortical hemorrhagic infarction on left parieto-occipital lobes. With attention due to significant nonhomogene occupying lesion, brain MRI with gadolinium and also MRV was per-formed.What is your doagnosis

Evidence Based Medicine; Receiver Operating Characteristic Curve and Area under the Curve

ابزارها و تستهای تشخیصی متفاوتی توسط پزشکان اورژانس بر بالین بیماران مورد استفاده قرار می گیرند. در این بین ابزارهای جدید نیز با هدف به دست آوردن نتایج دقیق تر و کاهش زمان و هزینه در مقایسه با موارد قدیمی ارزیابی می شوند. در قسمت های قبلی این مجموعه آموزشی پزشکی مبتنی بر شواهد، برخی از خصوصیات عملکردی تست های تشخیصی از جمله حساسیت، ویژگی، دقت، ارزش اخباری مثبت و منفی و همچنین احتمال پیش و پس از آزمون شرح داده شدند. منحنی مشخصه عملکرد سیستم (receiver operating characteristics (ROC)) روشی گرافیکی برای بیان خصوصیات غربالگری یک تست محسوب می شود. از منحنی راک برای تعیین بهترین نقطه برش و مقایسه ارزش تشخیصی دو یا چند تست به وسیله اندازه گیری سطح زیر منحنی  استفاده می شود. در این بخش از مجموعه آموزشی، منحنی راک و دو روش برای تعیین بهترین نقطه برش بر روی آن توضیح داده شده است.Multiple diagnostic tools are used by emergency physicians, every day. In addition, new tools are evaluated to obtain more accurate methods and reduce time or cost of conventional ones. In the previous parts of this educational series, we described diagnostic performance characteristics of diagnostic tests including sensitivity, specificity, positive and negative predictive values, and likelihood ratios. The receiver operating characteristics (ROC) curve is a graphical presentation of screening characteristics. ROC curve is used to determine the best cutoff point and compare two or more tests or observers by measuring the area under the curve (AUC). In this part of our educational series, we explain ROC curve andtwo methods to determine the best cutoff value

Part 4: Pre and Post Test Probabilities and Fagan’s Nomogram

Emergency physicians face numerous questions regarding proper management of patients and selection of the best laboratory test or imaging every day. Knowledge on screening performance characteristics of the diagnostic tools used in this department plays an important role in finding the answers to these questions. We assessed these characteristics in the previous parts of educational article series in Emergency journal. In the present manuscript, we will describe how to use these screening characteristics for selecting the right diagnostic tools.