The Relationship between the Results of Coagulation Profile and Severity of Pulmonary Involvement in COVID-19 Patients

Introduction: COVID-19 is currently a global pandemic, and coagulation-related mortality has been widely reported in patients suffering from it. Objective: this article aimed to investigate the coagulation profile of COVID-19 patients. Methods: This was a cross-sectional study conducted using a retrospective research design. We recruited patients with COVID-19 admitted to a hospital from June 15th to July 7th, 2020. Upon patients' entering a blood sample was drawn from each patient for assessing patient’s coagulation profile (PT, PTT, INR, Platelet count); and a chest high-resolution computed tomography (HRCT) scan was performed for each patient. The study patients were divided in to sever group (CO-RADS score 5) and non-sever group (CO-RADS score <5). Results: Thirty-six patients (20 males and 16 females) with a mean age of 54.7±17.5 years were studied. Of them, 11 cases (30.56%) had severe pulmonary involvement. Also, the coagulation profiles were longer in the severe group than non-sever group. As well, the means of platelet count that were 232.440 per microliter in the non-severe group and 289.180 per microliter in the severe and non-sever groups, respectively; but still not statistically significant (p>0.05). The Area under the ROC Curve (AUC) for PT and INR was 0.615 and 0.611, respectively. The AUC for platelet count was 0.680 (95% CI: 0.501 to 0.859) and had an acceptable discriminating power. Conclusions: In this study, we did not find any statistically significant relationship between the results of coagulation tests and the severity of pulmonary involvement according to HRCT scan findings in COVID-19 patients. But further analyses suggest that, except PTT, the other coagulation tests (PT, INR, and platelet count) may discriminate severe COVID-19 patients

Evaluation of Medical negligence of Emergency Department specialists referred to Forensic Medicine in Fars Province from 2012 to 2019

مقدمه:‏ افزایش خطاهای پزشکی به یک نگرانی عمومی در میان سیاستگزاران سلامت تبدیل شده است. با توجه به اهمیت آگاهی از علل وقوع خطاهای پزشکی و پیشگیری از تداوم آنها علی الخصوص در بخش اورژانس، لذا این مطالعه بررسی فراوانی قصور متخصصان طب اوراژانس ارجاعی به پزشکی قانونی استان فارس از سال ۹۲ تا ۹۸ انجام شد. روش کار: مطالعه حاضر از نوع توصیفی و بر اساس تحلیل دوباره داده ها انجام گرفت. جمعیت مورد مطالعه شامل کلیه قصور ارجاعی به دفتر کمیسیون پزشکی اداره کل پزشکی قانونی استان فارس با موضوع شکایت از متخصصان طب اورژانس طی سال های 1392 تا 1398 بود. روش جمع آوری داده ها بر اساس چک لیست و استفاده از اطلاعات موجود در پرونده های موجود در کمیسیون پزشکی اداره کل پزشکی قانونی استان فارس صورت گرفت. چک لیست شامل سن بیمار، تحصیلات بیمار، شغل بیمار، بیماری زمینه ای، علل قصور، نوع مرکز درمانی، علت و انگیزه شکایت، نوع خدمت ارائه شده، نحوه کسب اطلاع از قصور، محل آسیب وارده، نوع آسیب وارده و میزان ارش تعیین شده میباشد. تجزیه و تحلیل دادها با استفاده از نرم افزار spss نسخه 21 و با استفاده از آمارهای توصیفی انجام شد. نتایج: از تعداد 92 پرونده،91 پزشک مرد (9/98%) و 1 نفر پزشک زن (1/1%) بودند. بیشترین فراوانی صدور رأی در سال¬های 1398 با 40 رأی (5/43 %) و سال 1397 با 28 رأی (4/30 %) بوده است. 54 نفر (7/58 %) از افراد شاکی فوت نموده‌اند و 19 نفر (7/20 %) دچار نقص عضو شده بودند. همچنین میزان افراد شاکی در حال بهبودی 11 نفر (0/12 %) و بهبود یافته 6 نفر (5/6 %) بوده است. از 92 پرونده مورد بررسی، 77(7/83 %) پرونده نهایتاً تبرئه شده و 15(3/16 %) پرونده نیز به محکومیت افراد ختم گردیده است. بیشترین فراوانی قصور تائید شده، قصور بی مبالاتی 9(8/9%) و بی‌احتیاطی 2(2/2 %) بوده است.  نتیجه گیری: نتایج این مطالعه حاکی از آن بود که بیشترین علت قصور پزشکی متخصصان طب اورژانس از نوع بی مبالاتی می باشد. لذا پیشنهاد می شود با برگزاری کارگاه های آموزشی جهت متخصصان طب اورژانس، باعث کاهش این نوع مبالاتی ها شویم.Introduction: The rise of medical errors has become a public concern among health policymakers. Due to the importance of knowing the causes of medical errors and preventing their continuation, especially in the emergency department, so this study was conducted to investigate the frequency of negligence of emergency medicine specialists referred to forensic medicine in Fars province from 2012 to 2019. Methods: The present study was a descriptive study based secondary data analysis. The study population included all negligence referred to the office of the Medical Commission of the General Directorate of Forensic Medicine of Fars Province with the subject of complaints from emergency medicine specialists during the years 2012 to 2020. The method of data collection is based on a questionnaire and the use of information in the files of the Medical Commission of the General Directorate of Forensic Medicine of Fars Province. Data collection form including patient's age, patient's education, patient's occupation, underlying illness, causes of negligence, type of treatment center, cause and motive of complaint, type of service provided, how to obtain information about negligence, location of injury, type of injury and amount of injury is. Data analysis was performed using SPSS software version 21 and descriptive Statistics. Results: Out of 92 cases, 91 were male physicians (98.9%) and 1 was a female physician (1.1%). The highest frequency of voting was in 1398 with 40 votes (43.5%) and in 1397 with 28 votes (30.4%). 54 (58.7%) of the complainants died and 19 (20.7%) had disabilities. Also, the number of complainants was improving 11 (0.12%) and improved 6 (6.5%). Of the 92 cases reviewed, 77 (83.7%) were finally acquitted and 15 (16.3%) were convicted. The highest frequency of confirmed negligence was negligence negligence 9 (9.8%) and negligence 2 (2.2%). Conclusion: The results of this study indicated that the most common cause of medical malpractice in emergency medicine specialists is negligence. Therefore, it is suggested to reduce this type of negligence by holding training workshops for emergency medicine specialists