Emergency department management for an unusual case of penile entrapment and strangulation

Penile entrapment and strangulation are uncommon urological injuries especially in the pediatric population. These can result in necrosis, urethral injuries, amputation, and adverse psychological effects. Urgent management should be initiated to restore blood flow to the penis and maintain urethral continuity to prevent long term complications including urethral strictures, erectile dysfunction, cosmetic deformities and priapism. We report the case of a 11-year-old boy with a delayed presentation of penile strangulation from a glass ring that resulted in partial injury to the cavernosal bodies. Patient had an uneventful recovery after surgery without any devastating consequences

The diagnostic value of the field assessment stroke triage for emergency destination tool in identifying the obstruction of large cerebral vessels; a systematic review and meta-analysis

Objective: In this study, we investigate the diagnostic value of the Field Assessment Stroke Triage for Emergency Destination (FAST-ED) tool in the diagnosis of large vessels occlusion (LVO) in a systematic review and meta-analysis. Methods: We conducted a search in Medline (PubMed), Embase, Scopus and Web of Science databases until the 21st of September 2022, as well as a manual search in Google and Google scholar to find related articles. Studies of diagnostic value in adult population were included. Screening, data collection and quality control of articles were done by two independent researchers. The data were entered and analyzed in STATA 17.0 statistical program. Results: The data from 30 articles were entered. The best cut-off points for FAST-ED were 3 or 4. The sensitivity and specificity of FAST-ED at cut-off points 3 were 0.77 (95% CI: 0.73-0.80) and 0.76 (95% CI: 0.72-0.80), respectively. These values ​​for cut-off point 4 were 0.72 (95% CI: 0.65-0.78) and 0.79 (95% CI: 0.75-0.82), respectively. Meta-regression showed that the sensitivity and specificity of FAST-ED performed by a neurologist was more accurate compared to emergency physician (p for sensitivity=0.01; p for specificity<0.001) and emergency medical technicians (p for sensitivity=0.03; p for specificity<0.001). Finally, it was found that the sensitivity of FAST-ED performed by the emergency physician and the emergency medical technician has no statistically significant difference (p=0.76). However, the specificity of FAST-ED reported by the emergency physician is significantly higher (p<0.001). The false negative rate of this tool at cut-off points 3 and 4 is 22.5% and 28.8%, respectively. Conclusion: Although FAST-ED has an acceptable sensitivity in identifying LVO, its false negative rate varies between 22.5% and 28.8%. A percentage this high is unacceptable for a screening tool to aide in the diagnosis of strokes considering it has a high rate or morbidity and mortality. Therefore, it is recommended to use another diagnostic tool for the stroke screening

Value of Los Angeles Motor Scale (LAMS) in the detection of large vessels occlusion in suspected stroke patients; a systematic review and meta-analysis

Introduction Los Angeles Motor Scale (LAMS) is a validated prehospital scoring tool to identify stroke patients with large vessel occlusions (LVOs). While some studies have reported conflicting data in regards to the diagnostic value of LAMS, this systematic review and meta-analysis aims to provide a more concrete evidence for the value of this clinical decision tool in the diagnosis of LVO in suspected stroke patients. Method Online databases of PubMed, Embase, Scopus, and Web of Science were searched until the end of October 2022, for studies evaluating the diagnostic performance of LAMS in the detection of LVOs in suspected stroke patients. Results The results of our analysis demonstrated an AUC of 0.83 (95% CI: 0.79, 0.86), sensitivity of 0.65 (95% CI: 0.54, 0.74), and specificity of 0.83 (95% CI: 0.79, 0.86) for the diagnostic value of LAMS score with a cut-off value of ≥ 4. The diagnostic odds ratio of LAMS score was 8.81 (95% CI: 6.24, 12.45). Sensitivity analyses reveled that diagnostic performance of LAMS improves when utilized for detection of occlusion in the more proximal segments of large vessels, with a sensitivity of 0.75 and specificity of 0.83. Conclusion A high level of evidence showed that LAMS scale does not have a promising diagnostic value in the identification of LVOs in suspected stroke patients. The sensitivity of 0.65 for this tool makes it obsolete as a proper triaging tool. As a suggestion, LAMS could be utilized in conjunction with other additional factors to increase its diagnostic performance

The Role of Exercise in the Alleviation of Neuropathic Pain Following Traumatic Spinal Cord Injuries: A Systematic Review and Meta-analysis

OBJECTIVE: The objective of this systematic review and meta-analysis was to assess the efficacy of exercise in neuropathic pain following traumatic spinal cord injuries. METHODS: The search was conducted in MEDLINE, Embase, Scopus, and Web of Science by the end of 2022. Two independent researchers included the articles based on the inclusion and exclusion criteria. A standardized mean difference was calculated for each data and they were pooled to calculate an overall effect size. To assess the heterogeneity between studies, I2 and chi-square tests were utilized. In the case of heterogeneity, meta-regression was performed to identify the potential source. RESULTS: Fifteen preclinical studies were included. Meta-analysis demonstrated that exercise significantly improves mechanical allodynia (standardized mean difference [SMD], -1.59; 95% confidence interval [CI], -2.16 to -1.02; p \u3c 0.001; I2 = 90.37%), thermal hyperalgesia (SMD, 1.95; 95% CI, 0.96-2.94; p \u3c 0.001), and cold allodynia (SMD, -2.92; 95% CI, -4.4 to -1.43; p \u3c 0.001). The improvement in mechanical allodynia is significantly more in animals with a compression model of SCI (meta-regression coefficient, -1.33; 95% CI, -1.84 to -0.57; p \u3c 0.001) and in mild SCI (p \u3c 0.001). Additionally, the improvement was more prominent if the training was started 7 to 8 days postinjury (coefficient, -2.54; 95% CI, -3.85 to -1.23; p \u3c 0.001) and was continued every day (coefficient, -1.99; 95% CI, -3.07 to -0.9; p \u3c 0.001). Likewise, voluntary exercise demonstrated a significantly more effect size (coefficient, -1.45; 95% CI, -2.67 to -0.23; p = 0.02). CONCLUSION: Exercise is effective in the amelioration of neuropathic pain. This effect in mechanical allodynia is more prominent if voluntary, continuous training is initiated in the subacute phase of mild SCI

The Role of Exercise in the Alleviation of Neuropathic Pain Following Traumatic Spinal Cord Injuries: A Systematic Review and Meta-analysis

Objective The objective of this systematic review and meta-analysis was to assess the efficacy of exercise in neuropathic pain following traumatic spinal cord injuries. Methods The search was conducted in MEDLINE, Embase, Scopus, and Web of Science by the end of 2022. Two independent researchers included the articles based on the inclusion and exclusion criteria. A standardized mean difference was calculated for each data and they were pooled to calculate an overall effect size. To assess the heterogeneity between studies, I2 and chi-square tests were utilized. In the case of heterogeneity, meta-regression was performed to identify the potential source. Results Fifteen preclinical studies were included. Meta-analysis demonstrated that exercise significantly improves mechanical allodynia (standardized mean difference [SMD], -1.59; 95% confidence interval [CI], -2.16 to -1.02; p < 0.001; I2 = 90.37%), thermal hyperalgesia (SMD, 1.95; 95% CI, 0.96–2.94; p < 0.001), and cold allodynia (SMD, -2.92; 95% CI, -4.4 to -1.43; p < 0.001). The improvement in mechanical allodynia is significantly more in animals with a compression model of SCI (meta-regression coefficient, -1.33; 95% CI, -1.84 to -0.57; p < 0.001) and in mild SCI (p < 0.001). Additionally, the improvement was more prominent if the training was started 7 to 8 days postinjury (coefficient, -2.54; 95% CI, -3.85 to -1.23; p < 0.001) and was continued every day (coefficient, -1.99; 95% CI, -3.07 to -0.9; p < 0.001). Likewise, voluntary exercise demonstrated a significantly more effect size (coefficient, -1.45; 95% CI, -2.67 to -0.23; p = 0.02). Conclusion Exercise is effective in the amelioration of neuropathic pain. This effect in mechanical allodynia is more prominent if voluntary, continuous training is initiated in the subacute phase of mild SCI