Burnout and depression are global problems affecting healthcare providers, especially those working in stressful departments such as emergency departments (EDs) and critical care units (CCUs). However, pooled data analysis comparing healthcare providers operating in the ED and CCU is yet to be conducted. Therefore, this meta-analysis was systematically conducted to investigate and compare the prevalence of burnout and depression among emergency medicine (EM) and critical care medicine (CCM) professionals. We systematically searched for articles related to our research topic using the database search method and manual search method, which involved reviewing the reference lists of articles from electronic databases for additional studies. After screening the literature from the databases using the eligibility criteria, a quality appraisal using the Newcastle-Ottawa scale was performed on the eligible studies. In addition, a meta-analysis using the Review Manager software was performed to investigate the prevalence rates of burnout and depression. A total of 10 studies with 1,353 EM and 1,250 CCM professionals were included for analysis in the present study. The pooled analysis did not establish any considerable differences between EM and CCM healthcare workers on the prevalence of high emotional exhaustion (EE) (odds ratio (OR) = 1.01; 95% confidence interval (CI) = 0.46-2.19; p = 0.98), high depersonalization (OR = 1.16; 95% CI = 0.61-2.21; p = 0.64), low personal accomplishment (PA) (OR = 0.87; 95% CI = 0.67 - 1.12; p = 0.28), and depression (OR = 1.20; 95% CI = 0.74-1.95; p = 0.45). Moreover, pooled data showed no considerable differences in EE scores (mean difference (MD) = -1.07; 95% CI = -4.24-2.09; p = 0.51) and depersonalization scores (MD = -0.31; 95% CI = -1.35-0.73; p = 0.56). However, EM healthcare workers seemed to have considerably lower PA scores than their CCM counterparts (MD = 0.12; 95% CI = 0.08-0.16; p < 0.00001). No considerable difference was recorded in the prevalence of burnout and depression between EM and CCM healthcare workers. However, our findings suggest that EM professionals have lower PA scores than CCM professionals; therefore, more attention should be paid to the mental health of EM professionals to improve their PA.
Aortic dissection is a critical medical condition that poses a significant threat to life, and if left untreated, it can lead to high mortality and morbidity rates. The risk of various cardiovascular complications, including aortic dissection, is increased in individuals with coronavirus disease 2019 (COVID-19). However, the significance of aortic dissection as a complication in COVID-19 patients is often underestimated. Traditionally, aortic dissection without pain was considered uncommon. However, recent information indicates that symptoms in patients with aortic dissection can be more diverse than previously believed. The classic symptoms of tearing chest, back, or abdominal pain may be absent, making diagnosis challenging. We present the incidental detection of an asymptomatic Stanford type-B aortic dissection during a computed tomography (CT) scan conducted to evaluate COVID-19. The patient was managed through conservative treatment.
Paracetamol (acetaminophen) is an extensively used analgesic for acute and chronic pain management. Currently, paracetamol is manufactured for oral, rectal, and intravenous (IV) use. Research has shown varied results on the analgesic properties of IV paracetamol compared to oral and rectal paracetamol; however, research on the same doses of paracetamol is limited. Therefore, this review was constructed to explore the analgesic properties of IV paracetamol compared with oral and rectal paracetamol administered in equivalent doses. A broad and thorough literature search was performed on five electronic databases, including PubMed, ScienceDirect, Medline, Scopus, and Google Scholar. Statistical analysis of all outcomes in our review was then performed using the Review Manager software. Outcomes were categorized as primary (pain relief and time to request rescue analgesia) and secondary (adverse events after analgesia). An extensive quality appraisal was also done using the Review Manager software's Cochrane risk of bias tool. The literature survey yielded 2,945 articles, of which 12 were used for review and analysis. The pooled analysis for patients undergoing surgical procedures showed that IV paracetamol had statistically similar postoperative pain scores at two (mean difference (MD) = -0.14; 95% confidence interval (CI) -0.58-0.29; p = 0.51), 24 (MD = 0.09; 95% CI = -0.02-0.21; p = 0.12), and 48 (MD = 0.04; 95% CI = -0.08-0.16; p = 0.52) hours as oral paracetamol. Similarly, the data on time to rescue analgesia showed no considerable difference between the IV and oral paracetamol groups (MD = -1.58; 95% CI = -5.51-2.35; p = 0.43). On the other hand, the pooled analysis for patients presenting non-surgical acute pain showed no significant difference in the mean pain scores between patients treated with IV and oral paracetamol (MD = -0.35; 95% CI = -2.19-1.48; p = 0.71). Furthermore, a subgroup analysis of analgesia-related adverse events showed that the incidences of vomiting/nausea and pruritus did not differ between patients receiving IV and oral paracetamol (odds ratio (OR) = 0.71; 95% CI = 0.45-1.11; p = 0.13 and OR = 0.48; 95% CI = 0.18-1.29; p = 0.05, respectively). A review of information from two trials comparing equal doses of IV and rectal paracetamol suggested that the postoperative pain scores were statistically similar between the groups. IV paracetamol is not superior to oral or rectal paracetamol administered in equal doses. Therefore, we cannot recommend or refute IV paracetamol as the first-line analgesia for acute and postoperative pain.
Carbon monoxide (CO) poisoning is a toxicological emergency and may be responsible for more than half of all fatal poisonings worldwide. Serious effects of CO are frequently seen in the brain and heart as well as other organs that are particularly sensitive to hypoxia. Cardiac manifestations include dysrhythmias, myocardial infarction, and even cardiac arrest. Even in mild cases of CO poisoning with absent chest pain, the emergency physician should evaluate features of myocardial injury, as this can serve as a predictor of mortality and morbidity. A case of a young, healthy man with severe CO poisoning presented with atrial fibrillation (AF) and vasospastic angina, and he was managed successfully with high-flow oxygen.
Procedural sedation is essential in the ED to conduct painful procedures effectively. Ketamine and benzodiazepines/opioids are commonly used, with ketamine providing adequate analgesia and preserving airway muscle tone. However, ketamine is associated with adverse effects while benzodiazepines/opioids can lead to respiratory depression. This study compares the safety and efficacy of ketamine and midazolam/fentanyl. Two search methods were used to identify studies related to our topic, including a database search and a manual search involving screening reference lists of articles retrieved by the database search. A methodological quality appraisal was conducted on the articles suitable for inclusion using Cochrane's risk of bias tool in the Review Manager software (Review Manager (RevMan) (Computer program). Version 5.4, The Cochrane Collaboration, 2020). Moreover, pooled analysis was performed using the Review manager software. The study analyzed 1366 articles, of which seven were included for analysis. Pooled data showed that ketamine and midazolam/fentanyl had similar effects on pain scores during procedures and sedation depth measured by the University of Michigan sedation scale. However, the Modified Ramsay Sedation Score showed significantly more profound sedation in the ketamine group. The only significant adverse events were vomiting and nausea, which had a higher incidence in the ketamine group. Our data suggest that ketamine is as effective as the midazolam/fentanyl combination for procedural sedation but is associated with higher incidences of adverse events. Therefore, midazolam/fentanyl can be recommended for procedural sedation in the ED. However, it should be provided in the presence of a physician comfortable with airway management due to high incidences of oxygen desaturation.
Abdominal pain in a pediatric patient with diabetic ketoacidosis (DKA) can be mistaken for surgical or septic causes of acute abdomen. Both DKA and surgical abdominal emergencies can cause lactic acidosis (LA), which makes it challenging to differentiate between them. Fluid therapy resulting in quick alleviation of metabolic acidosis could be a valuable sign in differentiating surgical abdomen from DKA. In this report, we present a case of the surgical abdomen with stress hyperglycemia that mimicked DKA.
(1) Background: Body mass index (BMI) was observed to affect COVID-19 outcomes; however, the complete spectrum of clinical outcomes concerning BMI remains unexplored. The current study aimed to investigate the correlation between BMI and the severity and mortality of COVID-19, as well as ICU admission, radiological findings, clinical presentation, and time to viral clearance. (2) Methods: This retrospective study included 1796 multiethnic patients with COVID-19 treated at NMC Royal Hospital, Abu Dhabi, UAE. (3) Results: COVID-19's adjusted odds of severity increased by 3.7- and 21.5-fold in classes I and III, respectively (p = 0.001). The odds of mortality were not significantly different after adjustment for age, sex, and race. The adjusted odds of ICU admission increased significantly by 3-fold and non-significantly by 4-fold in obesity classes I and II, respectively. Pneumonia was significantly higher in patients who were overweight and class I, II, and III obese. Furthermore, class III obese patients had a greater risk of presenting with combined respiratory and gastrointestinal manifestations (p < 0.001). The median time to viral clearance with a BMI > 40 kg/m2 was moderately higher than that with a BMI < 40 kg/m2. (4) Conclusions: High BMI was associated with pneumonia, ICU admission, severity, and mortality due to COVID-19.
In vitro fertilization (IVF) is the most common assisted reproductive technology used to treat infertility. Embryo selection for transfer in IVF cycles relies on the morphological evaluation by embryologists, either by conventional microscopic assessment or more recently by time-lapse imaging systems. Despite the introduction of time-lapse imaging improvements in IVF success rates have failed to materialize, therefore alternative approaches are needed. Recent studies have shown that embryos resulting in successful pregnancy differ in their secretome and metabolism compared to embryos that fail to implant, suggesting that molecular analysis of embryo culture medium could assist in non-invasive single embryo selection. However, this approach has yet to be adopted clinically due to the lack of appropriate highly sensitive screening technologies needed to assess volume-limited samples. Here we report the detection of hCGß, IL-8 and TNFα from conditioned culture media of single human embryos using electrochemical impedance spectroscopy. The impedimetric immunosensors revealed that morphologically non-viable embryos produce higher levels of IL-8 and TNFα, associated with abnormal cell division and cell death, respectively. More importantly, hCGß detection was able to discriminate apparently morphologically identical viable embryos. This work brings an objective dimension to embryo selection, which could overcome the major limitations of morphology-based embryo selection for implantation. Future work should include the validation of these biomarkers in a large patient cohort.
Chorionic Gonadotropin, beta Subunit, Human/analysis , Culture Media, Conditioned/metabolism , Embryo, Mammalian/metabolism , Interleukin-8/analysis , Tumor Necrosis Factor-alpha/analysis , Biosensing Techniques/methods , Cell Line , Chorionic Gonadotropin, beta Subunit, Human/metabolism , Culture Media, Conditioned/analysis , Embryo Culture Techniques , Embryo Implantation , Embryonic Development , Female , Fertilization in Vitro , Humans , Immunoassay/methods , Interleukin-8/metabolism , Pregnancy , Tumor Necrosis Factor-alpha/metabolism
Ovarian hyperstimulation syndrome (OHSS) is a potentially serious complication of assisted reproductive treatment. Management of women with severe OHSS has traditionally included hospitalisation for close monitoring and supportive treatment. The aim of this review is to assess the evidence for safety and efficacy of outpatient management of severe OHSS. A systematic review of studies describing outpatient management options was performed. Current guidance from advisory bodies was also reviewed. Outpatient management has been found in observational studies to be safe and cost-effective compared to inpatient management. Paracentesis of ascitic fluid seems to be effective treatment for severe OHSS along with supportive management including maintenance of fluid balance and preventative measures against thrombo-embolism. GnRH antagonist was shown in few studies to be effective in treatment of early severe OHSS although further research is required to assess its role in this context. Appropriate outpatient set up and protocols are essential to provide safe outpatient management for women with severe OHSS.
Gonadotropin-Releasing Hormone/antagonists & inhibitors , Hormone Antagonists/therapeutic use , Ovarian Hyperstimulation Syndrome/therapy , Paracentesis , Female , Humans , Outpatients , Ovarian Hyperstimulation Syndrome/drug therapy , Practice Guidelines as Topic , Pregnancy , Treatment Outcome
Caesarean scar pregnancy (CSP) is implantation of the gestational sac within the hysterotomy scar. Ultrasound is the main diagnostic tool. Early diagnosis and termination of pregnancy is crucial to avoid the risk of uterine rupture. The termination modalities available are dilatation and curettage, methotrexate therapy, hysteroscopy, uterine artery embolization and laparotomy. We present a case of undisturbed CSP which presented at 6 weeks + 6 days gestation. Our management was termination of pregnancy by exploratory laparotomy and hysterotomy for excision of the mass. The postoperative period was uneventful and there was rapid decline of beta human chorionic gonadotrophin to the normal level.
Cesarean Section/adverse effects , Cicatrix/complications , Hysterotomy , Pregnancy, Ectopic/diagnostic imaging , Pregnancy, Ectopic/surgery , Adult , Biomarkers/blood , Chorionic Gonadotropin, beta Subunit, Human/blood , Female , Humans , Pregnancy , Ultrasonography
