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Introduction: The COVID-19 pandemic caused by SARS-CoV-2 has been the major health concern in 2019 globally. Considering the severity and phase of the disease, various pharmacotherapy schedules were proposed. Here, we set out to provide close-up insights on the clinical utility of Tocilizumab (TCZ), a biologic monoclonal antibody in this regard. Methods: In this comprehensive review, various databases, including Scopus, PubMed Central, Medline, Embase, Google Scholar, and preprint publishers (med/bioRxiv) were searched until January 30, 2024, according to the keywords and search criteria. Results: Besides the pros and cons, compelling evidence purported the safety and efficacy of TCZ and indicated that it exhibits great potential to reduce short-term and all-cause (28-30-day) mortality. TCZ significantly drops the adverse events if administered in the right time course (in the inflammatory phase) during critical/severe COVID-19 pneumonia. Despite contradictory results, the benefits of TCZ appear significant, especially in combination with add-on therapies, such as corticosteroids. Although the safety of TCZ is acceptable, solid data is lacking as to its benefits during pregnancy. There are limited data on TCZ combination therapies, such as hemoperfusion, intravenous immunoglobulin (IVIG), simple O2 therapy, vasopressor support, convalescent plasma therapy, and even in vaccinated patients and COVID-19 reinfection, especially in elderly persons. In addition, the impact of TCZ therapy on the long-lasting COVID-19 is unclear. Conclusion: Personalized medicine based on individual characteristics and pertinent clinical conditions must be considered in the clinicians' decision-making policy. Finally, to mitigate the risk-to-benefit ratio of TCZ, a treatment algorithm, based on available literature and updated national institute of health (NIH) and Infectious Diseases Society of America (IDSA) guidelines, is also proposed.
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As a major component of innate immunity and a positive regulator of interferons, the Stimulator of interferon gene (STING) has an immunotherapy potential to govern a variety of infectious diseases. Despite the recent advances regarding vaccines against COVID-19, nontoxic novel adjuvants with the potential to enhance vaccine efficacy are urgently desired. In this connection, it has been well-documented that STING agonists are applied to combat COVID-19. This approach is of major significance for boosting immune responses most likely through an autophagy-dependent manner in susceptible individuals against infection induced by severe acute respiratory syndrome Coronavirus (SARSCoV2). Given that STING agonists exert substantial immunomodulatory impacts under a wide array of pathologic conditions, these agents could be considered novel adjuvants for enhancing immunogenicity against the SARS-related coronavirus. Here, we intend to discuss the recent advances in STING agonists' recruitment to boost innate immune responses upon vaccination against SARS-related coronavirus infections. In light of the primordial role of autophagy modulation, the potential of being an antiviral vaccine adjuvant was also explored.
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Autofagia , COVID-19 , Proteínas de Membrana , SARS-CoV-2 , Autofagia/imunologia , Autofagia/efeitos dos fármacos , Humanos , Proteínas de Membrana/imunologia , SARS-CoV-2/imunologia , COVID-19/imunologia , COVID-19/prevenção & controle , Animais , Vacinas contra COVID-19/imunologia , Imunidade Inata/efeitos dos fármacos , Adjuvantes de Vacinas/uso terapêutico , Adjuvantes de Vacinas/farmacologia , Adjuvantes Imunológicos/farmacologiaRESUMO
PURPOSE: The classification of trauma patients in emergency settings is a constant challenge for physicians. However, the Injury Severity Score (ISS) is widely used in developed countries, it may be difficult to perform it in low- and middle-income countries (LMIC). As a result, the ISS was calculated using an estimated methodology that has been described and validated in a high-income country previously. In addition, a simple scoring tool called the Kampala Trauma Score (KTS) was developed recently. The aim of this study was to compare the diagnostic accuracy of KTS and estimated ISS (eISS) in order to achieve a valid and efficient scoring system in our resource-limited setting. METHODS: We conducted a cross-sectional study between December 2020 and March 2021 among the multi-trauma patients who presented at the emergency department of Imam Reza hospital, Tabriz, Iran. After obtaining informed consent, all data including age, sex, mechanism of injury, GCS, KTS, eISS, final outcome (including death, morbidity, or discharge), and length of hospital stay were collected and entered into SPSS version 27.0 and analyzed. RESULTS: 381 multi-trauma patients participated in the study. The area under the curve for prediction of mortality (AUC) for KTS was 0.923 (95%CI: 0.888-0.958) and for eISS was 0.910 (95% CI: 0.877-0.944). For the mortality, comparing the AUCs by the Delong test, the difference between areas was not statistically significant (p value = 0.356). The diagnostic odds ratio (DOR) for the prediction of mortality KTS and eISS were 28.27 and 32.00, respectively. CONCLUSION: In our study population, the KTS has similar accuracy in predicting the mortality of multi-trauma patients compared to the eISS.
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Traumatismo Múltiplo , Humanos , Masculino , Feminino , Estudos Transversais , Adulto , Pessoa de Meia-Idade , Irã (Geográfico) , Traumatismo Múltiplo/mortalidade , Traumatismo Múltiplo/diagnóstico , Escala de Gravidade do Ferimento , Valor Preditivo dos Testes , Serviço Hospitalar de Emergência , Idoso , Índices de Gravidade do TraumaRESUMO
Polycyclic aromatic hydrocarbons (PAHs) are a serious threat to the health of the environment. This study investigated the potential of Azolla filiculoides for the uptake, accumulation, and biodegradation of phenanthrene and pyrene. A- filiculoides plants were treated with 10 and 30 mg L-1 concentrations of phenanthrene and pyrene for the experimental duration of ten days. Phenanthrene and pyrene concentrations were measured using the high-performance liquid chromatography (HPLC) technique. Identification of the intermediate by-products resulting from the biological degradation of PAHs was performed by gas chromatography-mass spectrometry (GC/MS). The quantities of phenanthrene and pyrene in the ten-day treatments with 10 and 30 mg L-1 were 0.007 and 0.011 mg g-1 FW, and 0.048 and 0.079 mg g-1 FW, respectively. The growth parameters in the plants such as fresh weight, dry weight and RFN as well as the content of photosynthetic pigment of the plant decreased significantly compared to the control sample (p < 0.05). Ten compounds were identified from the plant tissue during the decomposition of pyrene and phenanthrene, and none of the PAHs were identified in the aquatic environment. Therefore, the use of A-filiculoides for phytoremediation of water resources contaminated with PAHs is an effective and promising method.
This study estimated the efficiency of Azolla filiculoides phytoremediation in the uptake, accumulation and biodegradation of phenanthrene and pyrene in polluted waters as a total of 100%. High accumulation of pyrene and phenanthrene in the plant tissue decreased plant growth and the number of photosynthetic pigments. GC-MS analysis, identified ten by-products resulting from the degradation of pyrene and phenanthrene in A-filiculoides plant tissue. HPLC analysis showed that there are no substances of PAHs in the water environment.
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Fenantrenos , Hidrocarbonetos Policíclicos Aromáticos , Poluentes do Solo , Biodegradação Ambiental , Poluentes do Solo/metabolismo , Fenantrenos/análise , Fenantrenos/metabolismo , Pirenos/metabolismo , Hidrocarbonetos Policíclicos Aromáticos/análise , Plantas/metabolismoRESUMO
BACKGROUND: In emergency cases, lack of other treatment alternatives may affect a person's decision, but it does not render that decision involuntary. Being able to make choices is a crucial (but not necessary) element of trust. We aimed to develop a tool to evaluate the Trust in Trauma Care in an Emergency Department (TTC-ED) among traumatic patients. METHODS: This psychometric study was carried out on 498 trauma patients who referred to the Imam Reza hospital in Tabriz, Iran, 2022. Patient-focused interviews, expert/key informants' opinions, and literature reviews were used to generate the items. Several statistical techniques were used to evaluate the TTC-ED trust tool's content validity, reliability, and construct validity, including the modified Kappa (k*), the Intra-Class Correlation (ICC) coefficient, and Exploratory Factor Analysis (EFA). Data were analyzed using SPSS version 26.0 and STATA 14 statistical software packages. RESULTS: A tool with 22 items was developed. As a measure of content validity assessment, the k* coefficient was 0.97. Regarding the evaluation of reliability, a good level of internal consistency was noted with a Cronbach's α 0.93, and the scale's test-retest reliability (as measured by ICC) was 0.96. The results of exploratory factor analysis indicated that the TTC-ED had a two-component tool fitted the data. Factor 1 includes 13 items covered 43.0% of the variance (eigenvalue = 9.47) and factor 2 consisted of nine items which accounted for 5.64% of the variance (eigenvalue: 1.24). CONCLUSION: The Trust in TTC-ED has been shown to be a valid and reliable test for assessing patients' trust in emergency room settings delivering trauma care. Future research may examine the validity in other contexts and create a TTC-ED instrument with a shorter version.
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Serviço Hospitalar de Emergência , Confiança , Humanos , Psicometria/métodos , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
Introduction: Laryngospasm is a life-threatening condition caused due to involuntary contraction in laryngeal muscles. It can last seconds to minutes and may cause hypoxemia, loss of consciousness, and death. Case Presentation: We report a case of laryngospasm in a patient with Coronavirus-2 infection who was admitted to the emergency department for the first time. Laryngospasm was revealed after treatment. Conclusions: The clinician should note that laryngospasm can be triggered by Coronavirus-2 infection.
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The daily intake of trace elements through water resources and their adverse health effects is a critical issue. The purpose of this research was to assess the carcinogenic and non-carcinogenic risks of exposure to iron (Fe), copper (Cu), manganese (Mn), zinc (Zn), chromium (Cr), lead (Pb), and arsenic (As) in groundwater resources of Sari city, Iran. The concentrations of the trace elements in a total number of 66 samples from the groundwater sources were measured using inductively coupled plasma mass spectrometry (ICP-MS). The hazard index (HI) levels of exposure to the trace elements from the groundwater sources for adults, teenagers, and children were 0.65, 0.83, and 1.08, respectively. The carcinogenic risk values of Cr and As in the groundwater sources for children, teenagers, and adults were 0.0001, 0.00009, 0.00007, 0.0003, 0.0002, and 0.0001, respectively, causing a total carcinogenic risk value higher than the acceptable range, and removing Cr and As from the groundwater resources is recommended for safe community water supply.
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Arsênio , Água Subterrânea , Metais Pesados , Oligoelementos , Adulto , Criança , Adolescente , Humanos , Oligoelementos/análise , Monitoramento Ambiental/métodos , Carcinógenos/análise , Irã (Geográfico) , Arsênio/análise , Cromo/análise , Água Subterrânea/química , Medição de Risco , Metais Pesados/análiseRESUMO
Background: Emergency department (ED) physicians often need to quickly assess patients and determine vital signs to prioritize them by the severity of their condition and make optimal treatment decisions. Effective triage requires optimal scoring systems to accelerate and positively influence the treatment of trauma cases. To this end, a variety of scoring systems have been developed to enable rapid assessment of ED patients. The present systematic review and meta-analysis aimed to investigate the accuracy of the rapid emergency medicine score (REMS) system in predicting the mortality rate in non-surgical ED patients. Methods: A systematic search of articles published between 1990 and 2020 was conducted using various scientific databases (Medline, Embase, Scopus, Web of Science, ProQuest, Cochrane Library, IranDOC, Magiran, and Scientific Information Database). Both cross-sectional and cohort studies assessing the REMS system to predict mortality in ED settings were considered. Two reviewers appraised the selected articles independently using the National Institutes of Health (NIH) quality assessment tool. The random-effects model was used for meta-analysis. I2 index and Q statistic were used to examine heterogeneity between the articles. Results: The search resulted in 1,310 hits from which, 29 articles were eventually selected. Out of these, for 25 articles, the area under the curve value of REMS ranged from 0.52 to 0.986. The predictive power of REMS for the in-hospital mortality rate was high in 19 articles (67.85%) and low in nine articles (32.15%). Conclusion: The results showed that the REMS system is an effective tool to predict mortality in non-surgical patients presented to the ED. However, further evidence using high-quality design studies is required to substantiate our findings.
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Medicina de Emergência , Médicos , Estudos Transversais , Mortalidade Hospitalar , Humanos , TriagemRESUMO
BACKGROUND: Cohort studies play essential roles in assessing causality, appropriate interventions. The study, Post-crash Prospective Epidemiological Research Studies in IrAN Traffic Safety and Health Cohort, aims to investigate the common health consequences of road traffic injuries (RTIs) postcrash through multiple follow-ups. METHODS: This protocol study was designed to analyse human, vehicle and environmental factors as exposures relating to postcrash outcomes (injury, disability, death, property damage, quality of life, etc). Population sources include registered injured people and followed up healthy people in precrash cohort experienced RTIs. It includes four first-year follow-ups, 1 month (phone-based), 3 months (in-person, video/phone call), 6 and 12 months (phone-based) after crash. Then, 24-month and 36-month follow-ups will be conducted triennially. Various questionnaires such as Post-traumatic Stress Disorder Questionnaire, Patient Health Questionnaire, WHO Disability Assessment Schedules, Cost-related Information, etc are completed. Counselling with a psychiatrist and a medical visit by a practitioner are provided accompanied by extra tools (simulator-based driving assessment, and psychophysiological tests). Through preliminary recruitment plan, 5807, 2905, 2247 and 1051 subjects have been enrolled, respectively at the baseline, first, second and third follow-ups by now. At baseline, cars and motorcycles accounted for over 30% and 25% of RTIs. At first follow-up, 27% of participants were pedestrians engaged mostly in car crashes. Around a fourth of injuries were single injuries. Car occupants were injured in 40% of collisions. DISCUSSION: The study provides an opportunity to investigate physical-psychosocial outcomes of RTIs, predictors and patterns at follow-up phases postinjury through longitudinal assessments, to provide advocates for evidence-based safety national policy-making.
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Pedestres , Ferimentos e Lesões , Acidentes de Trânsito , Humanos , Motocicletas , Estudos Prospectivos , Qualidade de Vida , Ferimentos e Lesões/epidemiologiaRESUMO
Besides the common symptoms in COVID-19, it has been thought to be a more imperative measure to identify the extraordinary manifestations of the illness, which would be more helpful to improve clinical management. In the current report, a 39-year-old woman and a 44-year-old man showed reactive cervical and preauricular lymphadenopathies, respectively, upon a range of the common symptoms of the disease. Interestingly, none of them showed the symptoms of lower respiratory tract infection as well. Notably, a herpes-like skin lesion was also observed on the right lower eyelid in one of the positive patients.
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Based on the recent reports, cardiovascular events encompass a large portion of the mortality caused by the COVID-19 pandemic, which drawn cardiologists into the management of the admitted ill patients. Given that common laboratory values may provide key insights into the illness caused by the life-threatening SARS-CoV-2 virus, it would be more helpful for screening, clinical management and on-time therapeutic strategies. Commensurate with these issues, this review article aimed to discuss the dynamic changes of the common laboratory parameters during COVID-19 and their association with cardiovascular diseases. Besides, the values that changed in the early stage of the disease were considered and monitored during the recovery process. The time required for returning biomarkers to basal levels was also discussed. Finally, of particular interest, we tended to abridge the latest updates regarding the cardiovascular biomarkers as prognostic and diagnostic criteria to determine the severity of COVID-19.
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COVID-19/sangue , Doenças Cardiovasculares/sangue , Sistema Cardiovascular/metabolismo , SARS-CoV-2/patogenicidade , Biomarcadores/sangue , COVID-19/complicações , COVID-19/diagnóstico , COVID-19/imunologia , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/imunologia , Sistema Cardiovascular/patologia , Sistema Cardiovascular/virologia , Quimiocina CCL2/sangue , Creatina Quinase Forma MB/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Homocisteína/sangue , Humanos , Interferon gama/sangue , Interleucina-6/sangue , L-Lactato Desidrogenase/sangue , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Prognóstico , SARS-CoV-2/crescimento & desenvolvimento , SARS-CoV-2/imunologia , Troponina I/sangue , Troponina T/sangue , Fator de Necrose Tumoral alfa/sangueRESUMO
Introduction: Stroke is known as a common cause of disability all over the world. Stroke prognosis estimation has always been a topic of interest. In this study, it was tried to investigate the prognostic value of laboratory findings of complete blood count in a systematic review. Methods: In this systematic review, literature from Medline via (PubMed, Ovid) Embase, Scopus, Cochrane Library, and ProQuest between 1988 and 2020 were included. A combination of Mesh and free terms were included in the search strategy: "Stroke", "Red Cell Distribution Width", "Blood Cell Count", "Mean corpuscular hemoglobin", and "Mean Corpuscular Volume" and with the abbreviation, in all fields. Data synthesis was achieved using content analysis. Results: Elevated red blood cell distribution width was associated with stroke, cardiovascular events, and all-cause deaths among patients with prior stroke. Mean platelet volume has not any prognostic significance in ischemic stroke. There was a poor association between mean corpuscular volume (MCV) and stroke prognosis. Globulin and hemoglobin level predicted short-term mortality following acute ischemic stroke. Conclusion: Complete blood count as a routine and efficient test performed in health care centers can be used to estimate the prognosis of stroke.
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BACKGROUND: Neurological involvements of COVID-19 are one of the most reported manifestations of this infection. This study aims to systematically review the previous systematic reviews which addressed the neurological manifestations of the COVID-19 infection. METHODS: Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, a comprehensive search was conducted in PubMed, Embase, Scopus, Web of Science databases and Google Scholar from December 2019 to December 2020. Articles were critically screened by two independent reviewers and if met the inclusion criteria, entered the study. Assessment of methodological quality was conducted by Assessment of Multiple Systematic Reviews-2 (AMSTAR-2) tool. Statistical analysis was not applicable. From a total of 1302 studies, 308 studies were removed due to their irrelevant title and abstract. After screening the full texts, a total of 66 found to be eligible. Twenty-one studies reported general manifestations of the COVID-19, 13 studies reported cerebrovascular events, 19 olfactory and oral dysfunctions, 5 systematic reviews on Guillen-Barré syndrome (GBS) and 8 articles on the sporadic manifestations like ocular signs and symptoms. The majority of the studies were classified as critically low or low in terms of quality. CONCLUSION: Despite great heterogeneity in the current literature, neurological involvements are an important extra-pulmonary aspect of the COVID-19; most commonly in the form of general manifestations like headache and olfactory disturbances. Long-term effects of this virus on the nervous system must be a research priority for future references. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s41983-021-00366-5.
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PURPOSE: The purpose of this study was to compare the effect of two types of cervical collars (Philadelphia and Miami-J) on pulmonary function and ventilation in healthy volunteers through spirometry, peak flow meter, and capnograph. METHOD: Initially, subjects were randomized into two groups in which the sequence of collars' fixation was reversed. Afterward, we assessed the pulmonary parameters without a cervical collar in all participants. Each group underwent two additional test conditions, including measurements after wearing a Philadelphia and Miami-J cervical collar. In any case, we took the measurements half an hour after the collar fixation. RESULTS: The mean age of participants was 48.34 ± 1.35 years. Following either type of collars application, there was a statistically significant decrease in FEV1, FEV1/FVC, FEF25-75%, and PEF (p < .001). However, FVC was not significantly changed (p = .157). CONCLUSION: In summary, we noted a statistically significant expiratory flow obstruction after both the Philadelphia and Miami-J cervical collar. These changes were not clinically significant in healthy volunteers, albeit may have ramifications in patients with pre-existing respiratory compromise.
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Braquetes/efeitos adversos , Ventilação Pulmonar , Vértebras Cervicais , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço , Estudos Prospectivos , Método Simples-Cego , EspirometriaRESUMO
BACKGROUND: Road Traffic Injuries (RTIs) impose a worldwide burden on public health and economy. RTIs result in a wide range of immediate and long-term consequences. However, little is known about post-discharge consequences of RTIs at national levels. In addition, reliable and producing valid data mostly through prospective studies is fundamentally required to address the issue. The aim of this paper was to describe the research protocol for development and psychometric evaluation of post-discharge consequences of road traffic injuries as part of the Persian Traffic Cohort (PTC) and complementary to the Iranian Integrated Road Traffic Injury Registry (IRTIR). METHODS: Literature review and expert's opinion were used to develop data collection tools. Registry timeframe was designed based on experts' opinion. Reliability of tools will be assessed using intra- and inter-rater reliability. The pilot phase of the Phone interviews on Post-discharge Consequences of Road Traffic Injuries (PCRTI) will be conducted in Tabriz in 2019. RESULTS: The PCRTI is designed to be applied at three different time points: one, six and twelve months after the crash. The PCRTI tools' main domains are: demographic, psychological, medical, social and financial which will be assessed through PC-PTSD, PHQ2, WHODAS, SES-Iran, EQ-5D-3L and Economic assessment standardized tools. The descriptive outcomes will be reported to the Ministry of Health and Medical Education of Iran. CONCLUSIONS: The protocol satisfies the requirements of developing valid data collection tools for PCRTI.
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INTRODUCTION: Despite a high burden of traffic injuries, effective integrated or linked injury surveillance systems are rarely available in many low- and middle-income countries (LMICs). The aim of the current study was to define a conceptual model for developing a national integrated traffic injury registry in Iran. METHODS: A mult-method study financially and technically supported by the World Health Organization, Iranian Ministry of Health, Iranian Traffic Police, and the Iranian Legal Medicine Organization was conducted. A theoretical framework, forming the core conceptual components, was developed based on expert reviews. The preliminary conceptual model was developed by a panel of experts and tailored through a national workshop of 50 scientists, authorities and experts from nearly all sectors related to road safety promotion and injury management. It was then sent out to external reviewers in order to assess and improve the content validity of the model. RESULTS: The conceptual model was developed to have six components. These included 1) aims and core definitions; 2) content and core measurements; 3) data flow; 4) data collection routines; 5) organizational matrix; 6) implementation organization. The Haddon's matrix was adapted to be used as the theoretical framework in defining the content and data flow components of IRTIR. Five subcomponents were defined in the content and core measurements component with each having several subcategories. Each subcomponent/subcategory was finally divided into several item groups to guide defining the final data measurement variables. The data flow component was defined with six data sequence stations. Through the organizational matrix component, five major organizations relevant to road traffic safety were defined as core data production contributors. Some organizations also owned several sub-organizations which contributed in this regard. CONCLUSION: It is concluded that the IRTIR conceptual model includes the required six components for developing a national integrated registry for Iran. Its main component called, content and core measurements, leads the researchers in developing final data collection tools in developing the national registry of road traffic injuries in Iran.
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BACKGROUND AND AIMS: Multiple scoring systems are designed and prepared nowadays that can be used to determine and predict the severity, morbidity, and mortality rate of patients. Among them, the rapid emergency medicine score (REMS) system has been designed to predict the motility of nonsurgical patients admitted to the emergency department (ED). This study was performed with the aim of evaluating the predictive value of REMS in the mortality rate of nonsurgical patients. MATERIALS AND METHODS: This study was carried out in 2017 among 300 nonsurgical patients referred to the ED. Data were collected using a checklist containing two parts of demographic information and REMS scale. RESULTS: Based on the results, we found a significant correlation between the duration of hospitalization and other parameters of the study. The results of this study indicated that the REMS of patients increased by 11%, 3%, and 5%, per each unit rise in patient's age, heart rate, and respiratory rate, respectively. On the contrary, 12% and 22% decrements for every unit increase in SPO2 and GCS levels were observed, respectively. All the reported findings were statistically significant. CONCLUSION: In sum, the outcomes of the present study corroborate the REMS system as a successful scale in predicting mortality and the duration of hospitalization in nonsurgical ED patients. HOW TO CITE THIS ARTICLE: Ala A, Vahdati SS, Jalali M, Parsay S. Rapid Emergency Medicine Score as a Predictive Value for 30-day Outcome of Nonsurgical Patients Referred to the Emergency Department. Indian J Crit Care Med 2020;24(6):418-422.
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Evaluation of atypical presentation of angina chest pain in emergency department is difficult. Hospitalization of this patient may impose additional costs and waste the time, early discharge may lead to miss the patients. The aim of this study was to determine volubility of Single Photon Emission Computed Tomography (SPECT) in management of patients admitted to emergency department with atypical manifestations of angina pain, un-diagnostic Electrocardiogram (ECG) and negative enzyme. Half of 100 patients admitted to emergency department with atypical chest pain and un-diagnostic ECG who were candidate for admission, underwent ECG gated resting SPECT. According to the results of SPECT, low risk patient discharged after negative stress SPECT. All discharged patients were followed up for major cardiac events (cardiac death, nonfatal myocardial infarction and repeat admission for congestive heart failure) for 12 months. According to rest SPECT Myocardial Perfusion Imaging (MPI), about 70% of patients in case group was low risk and 30% of them had moderate or high risk. Case group represented lower hospitalization rate and lower need for Coronary Artery Angiography (CAG) in comparison with control group. Mean cost in case group was significantly lower than control group (175.15$ vs. 391.33$, P < 0.001). In one year follow- up no cases of mortality or major cardiovascular events as cardiac infraction were found in discharged patients in case group. our study showed that rest SPECT fulfillment in admitted patients in emergency department was validated method for assessing patients' risk which avoids unnecessary hospitalizations and additional costs.
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Angina Pectoris/diagnóstico por imagem , Eletrocardiografia , Serviço Hospitalar de Emergência , Isquemia Miocárdica/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Tomografia Computadorizada de Emissão de Fóton Único , Angina Pectoris/fisiopatologia , Angina Pectoris/terapia , Estudos de Casos e Controles , Tomada de Decisão Clínica , Diagnóstico Precoce , Hospitalização , Humanos , Isquemia Miocárdica/fisiopatologia , Isquemia Miocárdica/terapia , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Fatores de Risco , Fatores de Tempo , Procedimentos DesnecessáriosRESUMO
INTRODUCTION: The most common cause of hospital emergency department visits is trauma resulting from a variety of underlying mechanisms. Unknown neck and spinal cord injuries and a lack of early diagnosis can have catastrophic consequences, such as paralysis of some or all limbs. The use of imaging techniques reduces the number of patients suffering from severe injuries. OBJECTIVE: To assess and compare the effectiveness and ease of utilizing two different sets of guidelines, the National Emergency X-Radiography Utilization Study guidelines (NEXUS) and the Canadian C-Spine guidelines (CCR), on trauma patients. METHODS: This study was approved by the Ethics Committee of Tabriz University of Medical Sciences. Of all the patients presenting to the hospital, 200 trauma patients were randomly included in the study. NEXUS and CCR were surveyed for each patient, and subsequent radiographies were also requested. The specificity and sensitivity of each of the methods was calculated, and the two methods were compared using Kendall's W test. RESULTS: A total of 200 trauma patients who met the inclusion criteria were included in the study. A total of 69.5% of the patients were male, and 30.5% were female. According to NEXUS guidelines, 47.5% of the patients were required to undergo neck radiography. According to CCR guidelines, 57.5% of the patients were required to undergo neck radiography. The sensitivity was found to be 90% for neck radiography by both NEXUS and CCR guidelines, while specificities were found to be 54.73% and 44.2% for NEXUS and CCR guidelines, respectively. CONCLUSION: This study showed that the two guidelines have the same sensitivity for evaluating which trauma patients need to undergo radiography. It seems that the NEXUS guidelines have the same effectiveness as CCR for determining which trauma patients need to undergo radiography. They also perform better than CCR guidelines in terms of ruling out which cases need no further radiologic investigation.