The Utility of rRT-PCR in Diagnosis and Assessment of Case-fatality rates of COVID-19 In the Iranian Population. Positive Test Results are a Marker for Illness Severity.

The utility of PCR-based testing in characterizing patients with COVID-19 and the severity of their disease remains unknown. We performed an observational study among patients presenting to hospitals in Iran who were tested for 2019-nCoV viral RNA by rRT-PCR between the fourth week of February 2020 to the fourth week of March 2020. Frequency of symptoms, comorbidities, intubation, and mortality rates were compared between COVID-19 positive vs. negative patients. 96103 patients were tested from 879 hospitals. 18754 (19.5%) tested positive for COVID-19. Positive testing was more frequent in those 50 years or older. The prevalence of cough (54.5% vs. 49.7%), fever (49.5% vs. 44.7%), and respiratory distress (43.0% vs. 39.0%) but not hypoxia (46.9% vs. 56.7%) was higher in COVID-19 positive vs. negative patients (p<0.001 for all). More patients had cardiovascular diseases (10.6% vs. 9.5%, p<0.001) and type 2 diabetes mellitus (10.8% vs. 8.7%, p<0.001) among COVID-19 positive vs. negative patients. There were fewer patients with cancer (1.1%, vs. 1.4%, p<0.001), asthma (1.9% vs. 2.5%, p<0.001), or pregnant (0.4% vs. 0.6%, =0.001) in COVID-19 positive vs. negative groups. COVID-19 positive vs. negative patients required more intubation (7.7% vs. 5.2%, p<0.001) and had higher mortality (14.6% vs. 6.3%, p<0.001). Odds ratios for death of positive vs negative patients range from 2.01 to 3.10 across all age groups. In conclusion, COVID-19 test-positive vs. test-negative patients had more severe symptoms and comorbidities, required higher intubation, and had higher mortality. rRT-PCR positive result provided diagnosis and a marker of disease severity in Iranians.

The Efficacy of Ketamine Administration in Prehospital Pain Management of Trauma Patients; a Systematic Review and Meta-Analysis.

INTRODUCTION: Although previous articles and reviews suggest that ketamine might effectively manage pain in trauma patients, these articles have serious limitations. Accordingly, the current meta-analysis aims to investigate the efficacy of ketamine administration in prehospital pain management of trauma patients. METHOD: In the present meta-analysis, controlled human studies were included. An extensive search was conducted in electronic databases including Medline (via PubMed), Embase, Central, Scopus, Web of Science, and ProQuest, gathering data to the end of 2018. The efficacy and side effects of ketamine administration in pre-hospital pain management were compared with those of opioid analgesics based on standard mean difference (SMD) and odds ratio (OR) calculations with 95% confidence interval (95% CI). RESULTS: Data from seven articles were included in the present meta-analysis. Ketamine administration was not more effective than administrating morphine or fentanyl in prehospital pain management of trauma patients (SMD = -0.56, 95% CI: -1.38 to 0.26, p = 0.117). However, co-administration of ketamine+morphine was considerably more effective than ketamine alone, in alleviating pain in prehospital settings (SMD = -0.62, 95% CI: -1.12 to -0.12, p = 0.010). Finally, it was concluded that ketamine alone had less side effects than morphine alone (OR = 0.25, 95% CI: 0.11 to 0.56, p = 0.001). However, co-administration of ketamine+morphine increases the risk of side effects to 3.68 times compared to when morphine is prescribed solely (OR=3.68, 95% CI: 1.99 to 6.82, p<0.001). CONCLUSION: For the first time, findings of the current meta-analysis demonstrated that ketamine, being administered alone, is an effective and safe medication in prehospital pain management in trauma patients, and can be considered as an acceptable alternative to opioid analgesics.

Validity of Triage Performed by Nurses Educated by Train-of-Trainer Workshop Participants; a Cross-sectional Study for Assessment of Cascade Training System.

INTRODUCTION: In 2010, a national triage train-of-trainer (TOT) workshop was held in Tehran, Iran. OBJECTIVE: The present study aimed to assess the validity of the triage performed by the nurses educated by those who participated in TOT workshop. METHOD: This cross-sectional study was carried out in 6 teaching hospitals from 4 universities in Iran. Inter-rater and intra-rater reliability of performed triage by participations was measured. Thirteen nurses were randomly selected. Thereafter, at the end of each working shift, patient data recorded in the daily data registry forms were collected. Then, duration of hospital stay, number of cases admitted to general wards or intensive care units, number of cases discharged from the ED within 12 hours and mortality rate were compared with the triage level determined by the nurse. RESULTS: In total, 30 nurses with a mean age of 28.4 ± 3.7 years were enrolled. In this study, 1491 triage cases (61.6% male) were evaluated, of which 4.2% were triaged as level 1, 18.3% as level 2, 37.1% as level 3, 20.4% as level 4 and 20.0% as level 5. The following outcome was observed: 3.64% were discharged, 6.29% were hospitalized, 3% died and 2.3% were discharged against medical advice without completing treatment. The correlation of determined triage level and patients' duration of hospitalization was significant based on one-way ANOVA test (p = 0.000). The outcome of the patients significantly correlated with the level of triage determined by the study nurses (p = 0.000). CONCLUSION: Based on the findings, it appears that triage performed by the study nurses educated by those who participated in TOT workshop through cascade training system had perfect validity.

Does intramuscular ondansetron have an effect on intramuscular ketamine-associated vomiting in children? A prospective, randomized, double blind, controlled study.

OBJECTIVE: This study was conducted to determine the effect of intramuscular ondansetron on ketamine-associated vomiting in children undergoing procedural sedation. METHODS: This randomized, double-blind, placebo-controlled, parallel-group clinical trial was conducted at the emergency departments of two university-affiliated tertiary care hospitals. Eligible participants included all 6-month to 16-year-old children who received IM ketamine for PSA in the ED. A convenience sampling approach was used and a block randomization method was applied (blocks of four) using a computer-generated random sequence. Patients received ketamine 4 mg/kg or ketamine 4 mg/kg plus ondansetron 0.1 mg/kg intramuscularly. All findings including the occurrence of vomiting and its frequency were then recorded in the data collection sheets. RESULTS: Of 56 patients who received ondansetron plus ketamin, 7 (12.5%) and 1 (1.8%) experienced vomiting during recovery and before discharge and Of 65 patients in the control group, 14 (21.5%) and 6 (9.2%) experienced vomiting during recovery and before discharge, respectively. The observed differences in the rates of vomiting during recovery and at discharge were statistically significant between the two groups (P-value of 0.03 and <0.001, respectively). CONCLUSION: Intramuscular ondansetron is effective in controlling ketamine-associated vomiting.

Diagnostic value of standard electrocardiogram in acute right ventricular myocardial infarction.

Myocardial infarction (MI) (i.e., heart attack) is the irreversible death (necrosis) of heart muscle secondary to prolonged lack of oxygen supply (ischemia) which accounts for a large number of deaths in the hospital. Diagnosis of myocardial infarction is confirmed based on clinical manifestations and electrocardiographic changes along with increased cardiac enzymes. Electrocardiogram (ECG) is one of the safest and easiest methods in the first place. Therefore, this study aimed to investigate the diagnostic value of standard electrocardiogram in the diagnosis of acute right ventricular infarction following lower cardiac infarction. This research was carried out at a time interval of one and a half years to diagnose acute primary infarction. In this method, the diagnostic value of ST↓ in lead I, ST↓ in lead aVL and I ST↓ + aVL, compared with ST↑ in lead V4R was investigated for diagnosis of right ventricular infarction. ST↑ in the lead V4R is a gold standard for the detection of right ventricular MI. All the patients who had the inclusion criteria were allowed to participate in the study. A total of 66 patients participated in the study. Accordingly, 58 (87%) were male and 8 (13%) were female. The mean age of the population was 54.9 ± 11.41. According to the ST↑ standard in lead V4R, 26 patients (39%) had right ventricular myocardial infarction. There was no significant relationship between angina pectoris and premature infarction (P-Value = 0.869). In this study, the right ventricular was most commonly involved in right coronary artery (78%). There was no significant relationship between the occlusion of right coronary artery and right ventricular infarction in 60 patients (P-Value = 0.94). The results showed that electrocardiogram manifestations help determine the occlusion site and the area at risk (ST↓ in lead aVL and aVL + I, sensitivity = 96%). In myocardial infarction, symptoms such as the ST-Segment elevation in lead aVR and ST-Segment depression in the lower leads are possible. Accordingly, in the lower infarction, ST changes in the leads V1-V6 are helpful in detecting patients at risk. Thus, the use of electrocardiogram in acute myocardial infarction helps detect more invasive patients and prevents extensive myocardial damage and other complications.

Comparing the Therapeutic Effects of Dexamethasone-Metoclopramide with Ketorolac in Relieving Headache in Patients with Acute Migraine Attacks Presenting to the Emergency Department.

INTRODUCTION: Migraine is a frequent chief complaint of patients in the emergency department. A wide range of treatments are used for acute migraine. OBJECTIVE: This study aimed to compare the therapeutic effects of a combination of metoclopramide + dexamethasone with those of ketorolac for treatment of acute migraine in the emergency department. METHOD: This quasi-experimental study enrolled patients identified as migraine headache cases admitted to the emergency departments of Shohadaye Tajrish and Sina hospitals, Tehran, Iran. The patients were divided into two groups and treated with either 8 mg Dexamethasone + 10 mg Metoclopramide or 60 mg ketorolac, and then compared regarding the rate of pain control based on visual analogue scale (VAS) on arrival and 1 and 2 hours afterward. RESULTS: Overall, 86 patients were recruited, of whom 50 were male (58.1%). Their mean age was 37.6 ± 10.3 years. Thirty-five (40.7%) were in the ketorolac group and 51 (59.3%) were in the dexamethasone + metoclopramide group. Treatment success was defined as a reduction of at least 3 points in pain severity in comparison to the admission time. One hour after administration of medications, the reported pain intensity was 4.7 ± 2.0 and 6.2 ± 2.3 in ketorolac group and dexamethasone + metoclopramide group, respectively. By the second hour, pain intensity was 3.4 ± 1.2 and 2.9 ± 1.3 in ketorolac group and dexamethasone + metoclopramide group, respectively. The two groups did not show a significant difference in terms of the reported pain at this time (p= 0.04). CONCLUSION: Based on our findings, the pain reduction time was relatively shorter for ketorolac in acute migraine, but the final response was identical in the two groups.

Jejunal Perforation Following Blunt Abdominal Trauma; a Case Report.

INTRODUCTION: The possibility of intestinal injury for all patients presenting to emergency department (ED) with blunt abdominal trauma, despite minimal physical signs should be considered. To highlight the patient management, hear, we report a case of hollow viscus injuries resulting from blunt abdominal trauma referring to a teaching hospital in Tehran, Iran. CASE PRESENTATION: A 30-year-old man presented to the ED after "falling into a hole" with his back and had direct blunt abdominal trauma by a heavy bag of cement. In physical examination, there was a mild abdominal tenderness on right upper quadrant. On bedside ultrasonography, there was small free fluid in his Morison's pouch without hypotension. So abdominal CT scan was performed which revealed free fluid in pelvic, perihepatic, and perisplenic spaces. Mural hematoma of proximal part of jejunum with mural wall hypodensity in mid jejunal loop were also revealed. The patient underwent surgery, and there was damage to the colon serosa and jejunal perforation which was primarily repaired. CONCLUSION: The presented case highlights the importance of obtaining history and physical exam and paying attention to the nature and mechanism of injury. Emergency physicians should be aware of hollow viscus injury in traumatic patients. Any delay in diagnosis and operative management are associated with an increase in mortality.

Comparing the brain CT scan interpretation of emergency medicine team with radiologists' report and its impact on patients' outcome.

Requesting non-enhanced brain CT scans for trauma and non-trauma patients in ER is very common. In this study, the impact of incorrect brain CT scan interpretations by emergency medicine team on patients' primary and secondary outcome was evaluated in the setting where neuroradiologist reports are not always available. During a 3-month period, 450 patients were enrolled and followed for 28 days. All CT scans were interpreted by the emergency medicine team, and the patients were managed accordingly. Neuroradiologists' reports were considered as gold standard, and the patients were then grouped into the agreement or disagreement group. A panel of experts further evaluated the disagreement group and placed them in clinically significant and insignificant. The agreement rate between emergency medicine team and neuroradiologists was 86.4 %. The inter-rater reliability between emergency team and neuroradiologists was substantial (kappa = 0.68) and statistically significant (p < 0.0001). Only five patients did not receive the necessary management, and among them, only one patient died, and 12 patients received unnecessary management including repeated CT scan, brain MRI, and lumbar puncture. Forty-one patients were managed clinically appropriate in spite of misinterpretation. A 28-day follow-up showed a mortality rate of 0.2 %; however, expert panel believed the death of this patient was not related to the CT scan misinterpretation. We conclude that although the disagreement rate in this study was 13.6 %, primary and secondary outcomes were not clinically jeopardized according to the expert panel idea and 28-day follow-up results.

Measurement of Central Venous Pressure Using Ultrasound in Emergency Department.

BACKGROUND: In order to assessment of intravascular fluid measurement of central venous pressure (CVP) is used via central venous catheterization (CVC). This procedure is highly invasive and may cause serious complications such as pneumothorax, infection, hematoma and etc. It is so valuable procedure if we can uses a less invasive or noninvasive procedure to assess patients intravascular fluid in critical positions. OBJECTIVES: In this study, the ultrasound was used to measure the central venous pressure (CVP). PATIENTS AND METHODS: In this study, patients with Central venous catheterization were selected using simple random sampling. The largest diameter of longitudinal, transverse views and the cross-section of inferior vena cava (IVC) and internal jugular vein (IJV) were measured using the ultrasound in the bedside of the patients. Central venous pressure was measured using routine methods. Correlations between variables were analyzed using SPSS and linear regression. RESULTS: Twenty patients with the mean age of 60.3 were studied. The main reason for cardiac catheterization was shock. There are no relationship between anterior posterior diameter of inferior vena cava and CVP of patients (P = 0.257). The longest diameter of IVC in ultrasonographic transverse view had significant association with CVP of patients (P = 0.045) but in patients with BMI > 25 it was not significant. Cross section of internal jugular vein had significant association with CVP of patients (P = 0.003). Longitudinal diameter of internal jugular vein had no significant association with CVP of patients (P = 0.052), but transverse diameter of internal jugular generally had significant association with CVP of patients (P = 0.003). Cross section of internal jugular had significant association with CVP (P = 0.001). CONCLUSIONS: Noninvasive assessment of the patient hydration condition using the ultrasound is a simple and practicable measure in emergency. With regard to the considerations, it is possible to estimate CVP via diameter measurement and cross-section of the central veins.

Evaluation of emergency medicine residents competencies in electrocardiogram interpretation.

An electrocardiogram (ECG) leads physicians to diagnose many potentially life-threatening cardiac, metabolic, electrolyte, and toxicological conditions. This study was designed to evaluate the competency of emergency medicine residents (EMRs) in comparison with cardiologists in the interpretation of ECG when an interpretation checklist is used. This clinical trial was done in the emergency wards of the first grand general hospital of Iran. Patients were categorized in three classes of disorder severity based on ECG abnormalities. The two stages of the study included the survey phase (Stage I), training phase and intervention phase (Stage II). Accuracy of ECG interpretation by EMRs and cardiologists was compared before and after using a Daily ECG Check List (DECKList). One hundred and fifty ECGs were evaluated in Stage I, before DECKList usage, and 150 ECGs were evaluated in stage II, after DECKList usage by EMRs. Mean age of participants was 60.13 years in Stage I and 61.66 years in Stage II. Stage I and II were similar to each other in terms of disorder severity (P=0.22). Mean the ECG interpretation score was significantly different between Stages I and II (P<0.001). Concordance of ECG diagnosis between EMRs and cardiologists was significantly different in Stages I and II (P<0.01). In first-year EMRs, ECG diagnosis scores in stages I and II were not changed significantly. However, ECG interpretation scores increased significantly in first-year EMRs (P=0.04). In second-year EMRs, both ECG interpretation and ECG diagnosis scores improved significantly (P<0.05 and P<0.01, respectively). In third year EMRs, ECG interpretation was not improved but ECG diagnosis based on two methods improved significantly (P<0.05). The significant increase in accuracy of ECG interpretation and final diagnosis can be attributed to the utilization of a checklist by EMRs especially in the first year and second residents.

Nebulized fentanyl vs intravenous morphine for ED patients with acute limb pain: a randomized clinical trial.

OBJECTIVE: Intravenous morphine has been used as a common method of pain control in emergency care. Nebulized fentanyl is also an effective temporary substitute. This study was designed to compare the effectiveness of nebulized fentanyl with intravenous (IV) morphine on management of acute limb pain. METHODS: This was a placebo-controlled, double-blind randomized clinical trial. Ninety emergency department patients with moderate to severe pain aged 15 to 50 years were blocked randomized and enrolled in this study. Forty-seven patients in the experimental group received nebulized fentanyl (4 µg/kg) and IV normal saline as placebo, and the remaining 43 patients in the control group received IV morphine (0.1 mg/kg) and nebulized normal saline as placebo. All participants' pain scores were assessed by Numerical Rating Scale before and after intervention at 5-, 10-, 15-, 30-, 45-, and 60-minute intervals. Patients' vital sign and possible adverse effects were recorded respectively. Finally, all participants were assessed for their satisfaction. RESULTS: The mean initial pain score in the experimental group was 8.7 and 8.4 in the control group (P = .1). Pain relief in both groups after 5 and 10 minutes were similar (P = .72). Although the pain relief was significantly greater with fentanyl at 15 minutes, this difference is not clinically significant. Pain management in both groups was successful and was more than 3 scores reduction in Numerical Rating Scale. Patient satisfaction in both groups was similar. No adverse effects were reported in the experimental group. CONCLUSION: This study suggests that nebulized fentanyl is a rapid, safe, and effective method for temporary control of acute limb pain in emergency department patients.

Hospitals safety from disasters in I.R.iran: the results from assessment of 224 hospitals.

BACKGROUND AND OBJECTIVE: Iran's hospitals have been considerably affected by disasters during last decade. To address this, health system of I.R.Iran has taken an initiative to assess disaster safety of the hospitals using an adopted version of Hospital Safety Index (HSI). This article presents the results of disaster safety assessment in 224 Iran's hospitals. METHODS: A self-assessment approach was applied to assess the disaster safety in 145 items categorized in 3 components including structural, non-structural and functional capacity. For each item, safety level was categorized to 3 levels: not safe (0), average safe (1) and high safe (2). A raw score was tallied for each safety component and its elements by a simple sum of all the corresponding scores. All scores were normalized on a 100 point scale. Hospitals were classified to three safety classes according to their normalized total score: low (≤34.0), average (34.01-66.0) and high (>66.0). RESULTS: The average score of all safety components were 32.4 out of 100 (± 12.7 SD). 122 hospitals (54.5%) were classified as low safe and 102 hospitals (45.5%) were classified as average safe. No hospital was placed in the high safe category. Average safety scores out of 100 were 27.3 (±14.2 SD) for functional capacity, 36.0 (±13.9 SD) for non-structural component and 36.0 (±19.0 SD) for structural component. Neither the safety classes nor the scores of safety components were significantly associated with types of hospitals in terms of affiliation, function and size (P>0.05). CONCLUSIONS: To enhance the hospitals safety for disaster in Iran, we recommend: 1) establishment of a national committee for hospital safety in disasters; 2) supervision on implementation of the safety standards in construction of new hospitals; 3) enhancement of functional readiness and safety of non-structural components while structural retrofitting of the existing hospitals is being taken into consideration, whenever is cost-effective; 4) considering the disaster safety status as the criteria for licensing and accreditation of the hospitals. Key words: Hospital, safety, disaster, emergency, Iran Correspondence to: Ali Ardalan MD, PhD. Tehran University of Medical Sciences, Harvard Humanitarian Initiative, Email: aardalan@tums.ac.ir, ardalan@hsph.harvard.edu.

Secondary confirmation of endotracheal tube position by diaphragm motion in right subcostal ultrasound view.

AIMS: To assess the sensitivity and specificity of right subcostal ultrasound view to confirm correct endotracheal tube intubation (ETT). MATERIALS AND METHODS: In this prospective study, apneic or paralyzed patients who had an indication of intubation were selected. Intubation and ventilation with bag were performed by the skilled third-year emergency medicine residents. The residents, following a brief training course of ultrasonography, interpreted the diaphragm motion, and identified either esophageal or tracheal intubation. The confirmation of ETT placement was done by the sonographer. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for tracheal versus esophageal intubation. RESULTS: A total of 57 patients aged 59 ± 5 who underwent ETT insertion were studied. Thirty-four of them were male (60%). Ultrasound correctly identified 11 out of 12 esophageal intubations for a sensitivity of 92% (95% CI = 62-100), but misidentified one esophageal intubation as tracheal. Sonographers correctly identified 43 out of 45 (96%) tracheal intubations for a specificity of 96% (95% CI = 85-99), but misdiagnosed two tracheal intubations as esophageal. CONCLUSIONS: This study suggests that diaphragm motion in right subcostal ultrasound view is an effective adjunct to diagnose ETT place in patients undergoing intubation in emergency department.

Evaluation of emergency medical technicians intermediate prediction about their transported patients final disposition in emergency department of Imam Khomeini Hospital.

This was a prospective cross-sectional study of consecutive transported patients by emergency medical service (EMS) to a referral hospital. The goal of this study was the evaluation of emergency medical technician intermediate prediction about their transported patients disposition in Emergency Department of Imam Khomeini Hospital. 2950 patients were transported to this hospital, Questionnaires were submitted in 300 of consecutive patient transports and completed data were obtained and available upon arrival at hospital for 267 of these cases. Emergency medical technicians intermediate (EMT-I) were asked to predict whether the transported patient would require admission to the hospital, and if so, what will be their prediction of patient actual disposition. Their predictions were compared with emergency specialist physicians. EMT-I predicted that 208 (78%) transports would lead to admission to the hospital, after actual disposition, 232 (%87) patients became admitted. The sensitivity of predicting any admission was 65%, with positive predictive value (PPV) of 39% and specificity of 86% with negative predictive value (NPV) of 94%. The sensitivity of predicting trauma patients (56.2% of total patients) was 55% with PPV of 38%, specificity of 86% and for Non-trauma patients' sensitivity was 80% with PPV of 40% and specificity of 82%. EMT-I in our emergency medical system have very limited ability in prediction of admission and disposition in transported patients and their prediction were better in Non-trauma patients. So in our EMS, the pre-hospital diversion and necessity of transporting policies should not be based on EMS personnel disposition.

Frequency and types of the medication errors in an academic emergency department in Iran: The emergent need for clinical pharmacy services in emergency departments.

OBJECTIVE: Emergency departments (EDs) are characterized by simultaneous care of multiple patients with various medical conditions. Due to a large number of patients with complex diseases, speed and complexity of medication use, working in under-staffing and crowded environment, medication errors are commonly perpetrated by emergency care providers. This study was designed to evaluate the incidence of medication errors among patients attending to an ED in a teaching hospital in Iran. METHODS: In this cross-sectional study, a total of 500 patients attending to ED were randomly assessed for incidence and types of medication errors. Some factors related to medication errors such as working shift, weekdays and schedule of the educational program of trainee were also evaluated. FINDINGS: Nearly, 22% of patients experienced at least one medication error. The rate of medication errors were 0.41 errors per patient and 0.16 errors per ordered medication. The frequency of medication errors was higher in men, middle age patients, first weekdays, night-time work schedules and the first semester of educational year of new junior emergency medicine residents. More than 60% of errors were prescription errors by physicians and the remaining were transcription or administration errors by nurses. More than 35% of the prescribing errors happened during the selection of drug dose and frequency. The most common medication errors by nurses during the administration were omission error (16.2%) followed by unauthorized drug (6.4%). Most of the medication errors happened for anticoagulants and thrombolytics (41.2%) followed by antimicrobial agents (37.7%) and insulin (7.4%). CONCLUSION: In this study, at least one-fifth of the patients attending to ED experienced medication errors resulting from multiple factors. More common prescription errors happened during ordering drug dose and frequency. More common administration errors included dug omission or unauthorized drug.

Approach to Pandemic 2009 influenza: first report from a main referral hospital for Pandemic H1N1 influenza care in Iran.

INTRODUCTION: Pandemic H1N1 influenza A (pdmH1N1) was a major health threat worldwide. METHODOLOGY:   A prospective cross-sectional study was conducted at Imam Khomeini Hospital in Iran. Cases of suspicious pdmH1N1 patients referred to the emergency ward of the hospital were enrolled in the study, regardless of whether the final location of treatment was the community, the hospital ward, or the intensive care unit.  Oseltamivir was administered within three hours of the patient's admission.  The median length of stay for hospitalized patients was 3 days. RESULTS: Gastrointestinal symptoms (nausea [164/434; 37.8%] and vomiting [98/434; 22.6%]) were the most common adverse reactions to oseltamivir in the study population, followed by dizziness (74/434; 17.1%). Out of 434 patients, 209 (48.2%) were treated in the community, 201 (46.3%) were admitted to the general ward in the hospital, and 24 (5.5%) were admitted to an ICU. CONCLUSIONS: This study provided insight on the effectiveness of oseltamivir in treating pandemic influenza A, as well as possible adverse reactions to the drug.  The study further drew attention to a variety of pdmH1N1 complications, in particular secondary bacterial pneumonia. We also determined that 2009 influenza A (H1N1) infection-related critical illness and mortality affected fewer elderly than younger patients. Additionally, it was shown that our approach to patients with suspected Influenza A/H1N1 virus in our hospital was compatible with World Health Organization pandemic flu guidelines in our country.