Ebola Hemorrhagic Fever as a Public Health Emergency of International Concern; a Review Article

Ebola hemorrhagic fever (EHF) was first reported in 1976 with two concurrent outbreaks of acute viral hemorrhagic fever centered in Yambuku (near the Ebola River), Democratic Republic of Congo, and also in Nzara, Sudan. The current outbreak of the Ebola Virus was started by reporting the first case in March 2014 in the forest regions of southeastern Guinea. Due to raising infection rates of over 13,000% within a 6-month period, now is considered as a global public health emergency and in August 8, 2014 the World Health Organization (WHO) has declared the epidemic to be a Public Health Emergency of International Concern. With more than 5000 involved cases and also nearly 3000 deaths, this event has turned to the largest and most dangerous Ebola virus outbreak in all around the world. Based on above mentioned, the present article aimed to review the virologic characteristics, transmission, clinical manifestation, diagnosis, treatment, and prevention of Ebola virus disease

Pregnancy Screening before Diagnostic Radiography in Emergency Department; an Educational Review

Radiation exposure during pregnancy may have serious teratogenic effects to the fetus. In modern medical practice, there is an increasing dependence on imaging techniques in most medical specialties. Therefore, checking the pregnancy status before imaging women of child bearing age is essential. Lack of international regulations and standard protocols exposes the patient to unexpected fetal radiation effects and the health professionals to medicolegal suits. Recently, the American Academy of Radiology and the European community of Medical Ionizing Radiation Protection released national guidelines regarding pregnancy screening before imaging potentially pregnant females. However, different methods of pregnancy screening exist among different radiology centers. This review aims to discuss the most recent guidelines for imaging females of childbearing age and highlight the need for an international regulation to guide pregnancy screening before radiological exposure

The Risk of Venous Thromboembolism with Different Generation of Oral Contraceptives; a Systematic Review and Meta-Analysis

Introduction: Oral contraceptives (OCs) are considered as one of the most common risk factor of venous thromboembolism (VTE) in child bearing age. Some of the recent researches indicate that the odds of VTE may be even higher with newer generations of OCs. The present meta-analysis was designed to evaluate the effect of different generation of OCs on the occurrence of VTE. Methods: Two researchers independently ran a thorough search in Pubmed, ISI Web of Science, EMBASE, CINAHL and Scopus databases regarding study keywords including thromboembolic event, thromboembolism, embolism, thromboembolic, thrombotic and thrombosis, combined with oral contraceptive. The outcomes were the incidence of diagnosed thromboembolism, such as deep vein thrombosis, pulmonary embolism and cerebral venous thrombosis. Based on the heterogeneity of the studies, random effect model was used and pooled odds ratio was reported. Results: Three cohort and 17 case-control studies with 13,265,228 subjects were entered into meta-analysis. Analysis showed that the odds of VTE in women taking OCs are more than three-fold (OR=3.13; 95% CI: 2.61-3.65). The risk of VTE in women taking first-, second- and third-generation OCs are 3.5 fold (OR=3.48; 95% CI: 2.01-4.94), 3 fold (OR=3.08; 95% CI: 2.43-3.74) and 4.3 fold (OR=4.35; CI: 3.69‒5.01), respectively. Conclusion: It seems that the risk of VTE is not same between different generations of OCs, so that third-generation has highest risk. Taking second and third-generation OCs increases the risk of VTE up to 3 and 4.3 fold, respectively. The researchers of the present study suggest that more clinical trials be designed in relation to the effect of newer generations of OCs in different communities.

Social media; resolving tunnel vision in practicing medicine

Background: With the emergence of social media, physicians who use social media, including emergency medicine physicians, have shared their experiences with their colleagues instead of working alone and keeping their experiences to themselves. Objective: This study aimed to evaluate the rate and type of use of electronic online sources and social media, in order to improve learning and education among emergency medicine residents. Methods: This was a cross-sectional study carried out from September 2015 until August 2016 on emergency medicine residents of two main medical universities of Tehran, Iran. A questionnaire was prepared by reviewing the existing studies and asking emergency medicine professors inside and outside Iran for opinions. Census sampling method was applied and all emergency medicine residents were included. The gathered data were analyzed using statistical tests of chi square, Independent-samples t-test and Pearson’s correlation coefficient via SPSS version 21. Results: Seventy three residents with the mean age of 34.2±5.2 years participated in this study (60.3% female). Smart phone is the most important tool they use for connecting to the Internet. About 30% use the Internet for about 1-2 hours a day. In half of these participants less than 25% of this time is spent on something related to their academic field of study. The correlation of sex (p=0.034) and age (p=0.049) with extent of using social media related to the academic field of study were significant. Other analytical analyses were not statistically significant (p>0.05). Conclusion: In summary, the findings of current study showed that despite sufficient access to proper technology, use of social media and online sources by high majority of the studied EM residents regarding improvement of their learning and educational level is very limited

Hyperkalemia-induced complete heart block

Background: Potassium, as an extracellular ion, plays an important role in the electrophysiologic function of the myocardium and any change in extracellular concentration of this ion might have a marked impression upon myocyte electrophysiologic gain. High serum potassium levels are thought to impair pulse conduction in Purkinje fibers and ventricles more than that in the Atrioventricular (AV) node. Therefore, although complete AV block can occur, it is a rare initial presentation. Case Report: We describe a 62-year-old man with a history of diabetes mellitus, ischemic heart disease and previous Coronary Artery Bypass Graft (CABG), who came to our emergency department due to generalized weakness starting 2 days before admission. The patient also had decreased force in lower limbs, exacerbating from the morning, and was finally diagnosed as a hyperkalemia-induced Complete Heart Block (CHB). It should also be noted that the patient responded dramatically to the administration of 10 mL of 10% calcium gluconate along with external pacing until potassium level correction became effective. Conclusion: In spite of the fact that Hyperkalemia can be associated with frequent Electrocardiogram (ECG) abnormality, advanced heart blocks (second- and third-degree AV blocks) are usually found only in patients with pre-existing heart failure, conduction abnormalities, or other cardiac diseases. Institution of effective treatment rapidly and forgiveness of traditional non-effective, time consumptive and sometimes risking full-adjustment modalities, such as sodium bicarbonate infusion or exchange resins that prevent their use in the emergent phase, can help minimize patient morbidity and mortality

Classification of Limping Causes in Children Referred to the Emergency Department; a Literature Review

Unusual walking and non-weight bearing on one side of the body is called limping. The incidence of this complication, as an acute complaint in children, is among the causes of emergency department visits and considered as one of the medical challenges in this unit. It is safe to claim that in emergency department, finding the exact cause is not a priority; conversely, it is more important to know that it is not caused by a serious condition. In other words, in the emergency department, ensuring that the cause does not threaten the patient’s life or limb is prioritized over reaching the final diagnosis. Emergency medicine specialists play an important role in detection, diagnosis, and proper referral of these patients. The current manuscript was written in order to facilitate clinical decision-making regarding treatment of children with acute limping visiting emergency department

تقسیم بندی علل لنگش حاد کودکان مراجعه کننده به بخش اورژانس؛ یک مقاله مروری

Unusual walking and non-weight bearing on one side of the body is called limping. The incidence of this complication, as an acute complaint in children, is among the causes of emergency department visits and considered as one of the medical challenges in this unit. It is safe to claim that in emergency department, finding the exact cause is not a priority; conversely, it is more important to know that it is not caused by a serious condition. In other words, in the emergency department, ensuring that the cause does not threaten the patient’s life or limb is prioritized over reaching the final diagnosis. Emergency medicine specialists play an important role in detection, diagnosis, and proper referral of these patients. The current manuscript was written in order to facilitate clinical decision-making regarding treatment of children with acute limping visiting emergency department. راه رفتن یک حرکت هارمونیک و منظم می باشد که از دو فاز ایستایی و آویز تشکیل می شود. هرگونه تغییر در این حرکت هارمونیک را لنگش می نامند. بروز این عارضه به صورت حاد در کودکان از جمله علل مراجعه به بخش اورژانس بوده و یکی از چالش های پزشکان در این بخش می باشد. شاید بتوان ادعا کرد که در بخش اورژانس اینکه علت دقیقا چه هست اواویت ندارد و در مقابل اینکه علت چه مواردی نباشد بیشتر مد نظر قرار دارد. به بیانی دیگر در بخش اورژانس رد تشخیص های افتراقی تهدید کننده حیات و یا عضو به نسبت رسیدن به تشخیص نهایی در الویت قرار دارد. متخصصین طب اورژانس نقش بسیار مهمی در شناسایی، تشخیص و ارجاع صحیح این بیماران برعهده داشته و مطالعه حاضر در جهت تسهیل روند تصمیم گیری بالینی در برخورد با کودک دچار لنگش حاد مراجعه کننده به بخش اورژانس نگارش شده است

The Value of Urinalysis in Detection of Abdominal Organ Injuries in Children with Hematuria Following Blunt Abdominal Trauma; A Diagnostic Study

Background Currently, almost all patients with probable abdominal injury undergo urinalysis in emergency department (ED). The present survey was conducted with the aim of assessing the diagnostic values of urinalysis compare with abdominal computed tomography (CT) scan with contrast for predicting possible intra-abdominal injuries in children affected by blunt trauma. Materials and Methods: The present diagnostic accuracy study was accomplished on patients' < 16-year-old with blunt abdominal trauma who were admitted to emergency department (ED) and underwent both urinalysis and abdominal CT scan. Demographic and baseline characteristics data, and the results of urinalysis and abdominal CT scan were recorded. Thereafter, screening performance characteristics were calculated. Results Seventy eligible patients with the mean age of 7.1 ± 4.86 years were enrolled (68.6% male). Screening performance characteristics including sensitivity, specificity and positive and negative predictive values of hematuria were 26.7%, 92.7%, 50.0% and 82.3%, respectively. Positive and negative likelihood ratios were calculated as 3.67 and 0.79, respectively. Conclusion It is likely that, presence of hematuria has acceptable specificity, but very low sensitivity in comparison with CT scan for prediction of abdominal organ injuries in children with blunt abdominal trauma. Therefore, urinalysis is not useful for screening the presence of organ injuries in this population