Intoxication with Low-Dose Baclofen: A Case Report

Background & Objective: One of the most common causes of decreased level of consciousness has many causes, especially in young patients, is drug poisoning. Baclofen is used to reduce muscle spasm and acts through the presynaptic inhibition of motor neurons. Oral intoxication with this drug is not common, if seen, it is due to excessive drug use or underlying renal dysfunction. Case: A 25-year-old woman was brought to our emergency department by her husband with complaining of decreased level of consciousness. The urine sample was sent for toxicology examination and then brain CT scan was done which was normal. After 36 hours she regained consciousness. During a retrospective history taking she stated the baclofen use repeatedly five times a day for two days because of  severe muscle spasms before she came to the hospital. Conclusion: The most common cause of severe baclofen poisoning is arbitrary use of drugs, and accidental use of the drug causes fewer symptoms. Side-effects of baclofen include drowsiness, convulsions, severe cardiac disorder and coma. What is essential for an emergency medicine specialist is to know that, regardless of the underlying cause of the patient's symptoms, the patient must first be stable and pay attention to maintaining the patient's airway

First Seizure Due to a Ruptured Brain Dermoid Cyst

Introduction: first seizure is an unpleasant experience, the underlying cause and probability of recurrence is critical for the patient. Case: A 72 years old female was brought to our emergency department with a complaint of first seizure. Her daughter stated that she had had a tonic colonic generalized seizure that lasted about 10 seconds. She was complaining of a headache at the time of arrival in the ED, and the seizure had ended. The physical examination was normal and she had no past medical history. Spiral axial brain CT scanning demonstrated a sharp, round lesion with peripheral calcification near the pineal gland which compressed the third ventricle. Multiple nodules with fat density were seen in the subarachnoid space. Phenytoin was started for seizure prophylaxis and a neurosurgery consultation was requested. Tumor was completely reacted. Conclusion: This is a rare case of dermoid cyst near the pineal which compressed the third ventricle and caused midline shift and hydrocephaly. The cause of seizure may be the cyst rupturing. Complete cyst resection is the preferred treatment

APACHE II scoring system to predict mortality of covid-19 patients: a cross-sectional study

Background: The coronavirus disease-2019 (COVID-19) pandemic has significantly impacted global health, resulting in millions of reported cases and deaths worldwide. The Acute Physiologic and Chronic Health Evaluation (APACHE) II is a commonly used assessment system for determining the severity of illness in critically unwell patients. This study investigates the feasibility of using the APACHE II scoring system as a mortality predictor for COVID-19. Materials and Methods: In this cross-sectional study, we evaluated 499 confirmed patients with COVID-19 before COVID-19 vaccination, all of whom received standard treatment. Patients with confirmed COVID-19 by polymerase chain reaction (PCR) test were enrolled in this study, and their demographic data, chest computed tomographic (CT) findings, APACHE II score, need for mechanical ventilation, length of in-hospital stay, and outcome (discharge or death) were collected in a checklist. Results: The mean age of the patients was 62.24 ± 18.48 years, composed of 52.5% male and 47.5% female. Respiratory complaints, such as cough, dyspnea, and chest pain, were observed in 56.9% of patients, and 8.8% presented with palpitations, decreased blood pressure (BP), and cardiac arrest. Among these patients, 96.3% were discharged, and 3.6% died. Non-survived patients had significantly higher APACHE II scores than survived patients (12.3 vs. 17.7, P = 0.007). The ROC curve analysis revealed an APACHE II cutoff of 18.5 for predicting mortality in patients with COVID-19, with sensitivity and specificity values of 63% and 84%, respectively. Conclusion: The APACHE II scoring system can be valuable in the emergency department for prioritizing patients based on their severity of illness

COVID-19 Reinfection in a Healthcare Worker; Is There a Definitive Immunity Against SARS-CoV-2?

Introduction: While our knowledge is limited about COVID-19 immunity, recent cases of reinfection have raised concerns. Case presentation: Here, we report a case of COVID-19 reinfection after three months from recovery in a healthcare worker with negative IgM and IgG at the second infection and positive nasopharyngeal swab Reverse transcription polymerase chain reaction (RT-PCR) test despite being discharged with two negative RT-PCR tests at the first admission. Symptoms at first admission were fever, headache, sore throat, diarrhea, and vomiting and got changed to myalgia and anosmia. Conclusion: The strength of this case report is the long period (three months) between the infection and reinfection while other cases reported in literature were reinfected less than one month after their first infection

تحلیل علم سنجی مجلات طب اورژانس و تروما در پایگاه داده های اسکوپوس و ISI : تحلیل علم سنجی مجلات طب اورژانس و تروما در پایگاه داده های اسکوپوس و ISI

Introduction: Scientometrics is a scientific field that can guide readers, academic institutions, and researchers in objective evaluation of the path that human knowledge takes. In recent years, new indicators have been used to rank and validate journals. The aim of this study was to investigate the relationship between new and common scientometric indicators of journals in the field of emergency medicine and trauma. Methods: In the present descriptive-analytical study, journals specialized in emergency medicine were identified in Scopus and ISI databases. Our target indicators were related to data of journal publications published in 2019, which were collected using online databases of Clarivate Analytics, SCOPUS, PubMed, and SJR. Statistical analysis was performed using SPSS software version 19 and R software. Results: In the present study, 57 journals in the field of trauma and emergency medicine were included. Among the journals indexed in Scopus, 24 were also indexed in ISI. In terms of article rankings in the Scopus database, Annals of Emergency Medicine, a Journal based in America and published by Elsevier, ranked first. The average CiteScore of journals specialized in trauma and emergency medicine was 2.16 ± 1.7. Their mean SJR was 0.53 ± 0.34. Mean h-index of these journals was 34.55 ± 28.27 and their mean impact factor (IF) was 1.88 ± 1.08. The average Eigenfactor Score was 0.0047 ± 0.00501. Eigenfactor Score was more correlated with IF and number of published articles compared to CiteScore and SJR. Conclusion: Our findings may help authors figure out which indicators are most relevant to Total Cites or IF. Authors can use this information to make a decision regarding choosing the best bibliographic index to rank the target journals in the field of emergency medicine before submitting articles.  مقدمه: علم سنجی دانشی است که برای هدایت خوانندگان، مؤسسات دانشگاهی و محققان برای ارزیابی عینی مسیری که دانش بشری می پیماید مورد استفاده قرار می گیرد. در سال های اخیر از  شاخص های جدیدی برای رتبه دهی و اعتبار سنجی مجلات استفاده شده است. هدف از این مطالعه نیز بررسی ارتباط بین شاخص های علم سنجی جدید و متداول در مجلات حوزه طب اورژانس و تروما  بوده است. روش کار: در مطالعه توصیفی تحلیلی حاضر مجلات تخصصی طب اورژانس در پایگاه داده اسکوپوس و ISI شناسایی شد. شاخص های هدف ما مربوط به داده های انتشار یافته از مجلات در سال 2019 بود که با استفاده از پایگاه داده های آنلاین از Clarivate Analytics ، SCOPUS ، پابمد و SJR  جمع آوری شدند. تجزیه و تحلیل آماری با استفاده از نرم افزار SPSS  ورژن 19 و نرم افزار R انجام شد. نتایج: در مطالعه حاضر تعداد 57 ژورنال در زمینه تخصصی طب اورژانس و تروما وارد مطالعه شدند. . از میان مجلات نمایه در اسکوپوس، تعداد 24 مورد در ISI نیز نمایه بودند. از نظر رتبه دهی مقالات در نمایه اسکوپوس، مجله Annals of Emergency Medicine به مرکزیت آمریکا که توسط انتشارات الزویر منتشر می شود، رتبه اول را به خود اختصاص داده بود. میانگین شاخص CiteScore در مجلات تخصصی طب اورژانس و تروما برابر 1.7±2.16  بود. میانگین شاخص SJR برابر 0.34±0.53 بود. میانگین h-index این مجلات برابر 28.27±34.55 بود. میانگین شاخص IF برابر 1.08±1.88 بود. میانگین شاخص Eigenfactor Score برابر 0.00501±0.0047 بود. Eigenfactor Score در مقایسه با CiteScore و SJR همبستگی بیشتری با IF و تعداد مقالات منتشر شده داشت. نتیجه گیری: یافته های ما ممکن است به نویسندگان کمک کند تا بفهمند کدام شاخص ها بهترین ارتباط را با Total Cites یا IF دارند. نویسندگان می توانند از این اطلاعات برای تصمیم گیری در انتخاب ایندکس کتاب شناسی مناسب برای رتبه بندی مجلات هدف رشته طب اورژانس قبل از ارسال مقلات استفاده کنند

A Rare Manifestation of a Common Disease

Introduction: Ectopic pregnancy (EP) is considered a common disease worldwide. This study is intended to present a case report of ectopic pregnancy presented with syncope, a rare symptom. Case: A 31 years old woman presented in emergency department of an academic trauma center with the chief complaint of head trauma. She was suffering of severe headache following falling down because of syncope. In prices exam she had unstable vital signs and was complaining of abdominal pain and tenderness. Routine laboratory tests including β-hCG, head CT scan, complete abdominal and abdominopelvic sonography were ordered for the patient. Results showed positive β-hCG and abundant free fluid in the abdominal cavity in sonography. After approval of ruptured ectopic pregnancy diagnosis, patient underwent laparotomy, salpingectomy and cystectomy