Development and validation of SALT Triage method to facilitate the identification and classification of patients in Mass Casualty Incidents.

BACKGROUND: Mass Casualty Incidents (MCIs) have caused great financial losses. These incidents are referred to a situation in which the number of casualties caused by the accident temporarily increases to such an extent that it is not possible to treat all these patients with the facilities and capacities available in the area. To offer fair and proportionate medical services to all patients, it is necessary to use a process called patient triage. This study aimed to modify the Sort Assess Lifesaving Intervention Treatment/transport (SALT) triage method to simplify the differentiation of patients from green from yellow and gray from red. METHODS: This is a methodological study with a descriptive cross-sectional approach that by studying the SALT triage method and using the criteria defined in the Reference Standard, facilitates the identification of patients with a minor (Outpatient) and fatal injury (Expectant). Then, using two common and modified SALT triage methods, 100 simulated patients were triaged and the obtained data were evaluated and compared in terms of accuracy and speed. RESULTS: The improvement made in the SALT triage method was able to reduce 22% of the total triage error of the first nurse and improved 18% in green, 43% in yellow, 15% in red, and 13% in the gray category. In the second nurse, this method was able to reduce 29% of the errors and in the category of green patients, 41%, yellow 47%, red was unchanged, and gray 38% improvement was observed. Furthermore, the average triage rate was 4 and 5 seconds shorter per patient in the first and second nurses, respectively. CONCLUSIONS: With this modification, the diagnostic power has increased by 22% in the first nurse and 29% in the second nurse. Due to the significant increase in the accuracy of the mSALT (Modified SALT) triage method, this modification can be considered useful and can be used to advance the goals of triage in MCIs.

COVID-19 patients at referral to hospital during the first peak of disease: Common clinical findings including myalgia and fatigue.

The wide range of manifestations and clinical symptoms of COVID-19 has made it a unique disease. Investigating the epidemiology of different clinical manifestations of this disease in patients referred to medical centers is one of the most effective steps in adopting a suitable diagnostic and treatment approach. These findings also provide a basis for comparing the evolution of the virus and its clinical manifestations over time and at different peaks of the disease. Therefore, the present study was aimed at investigating common clinical findings at the time of referral in patients with COVID-19 in Afzalipour Hospital, Kerman, during the first peak of the disease. This descriptive-analytical cross-sectional study was performed on hospitalized patients diagnosed with COVID-19, between March 2020 and June 2020. The patients were included in the study by census method, and the research variables related to demographic indicators, disease course and clinical symptoms were extracted from the patients' medical records, and then subjected to statistical analysis. In this study, a total of 210 patients were examined, consisted mainly of male patients (59.5%). The mean age was found to be 53.95 ± 19.55 years. Also, 20.3% of patients needed admission in the intensive care unit. In addition, 1% of patients were infected in February 2020, 24% in March 2020, 47.4% in April 2020 and 27.4% in May 2020. The mean onset of symptoms until hospitalization was also found as 6.51 days. The most common clinical symptoms included shortness of breath (75.7%), dry cough (52.9%), fever (50.5%), myalgia (45.7%) and fatigue (41.9%). Fever at admission time was significantly more common in ages less than 50 years (p=0.034). Our study showed that the most common clinical symptoms were shortness of breath, dry cough, fever, myalgia and fatigue. No statistically significant difference was found in common symptoms between men and women. Among the common clinical symptoms, only fever at admission time was observed to be significantly higher in those under 50 years of age.

The Value of Lactate Dehydrogenase in Predicting Rhabdomyolysis-Induced Acute Renal Failure; a Narrative Review.

INTRODUCTION: Determining the diagnostic value of available biomarkers in predicting rhabdomyolysis-induced acute kidney injury (AKI) is a priority. This study aimed to review the current evidence about the value of lactate dehydrogenase (LDH) in this regard. METHODS: In this narrative review, the papers in PubMed, Embase, and web of science were studied. The keywords prognosis, prognoses, prognostic, LDH, rhabdomyolysis, emergency patients, and acute kidney failure or AKI had been selected from MeSH medical dictionary. Related papers written in English and published from November 2007 to December 2020 were selected. RESULTS: Finally, 14 articles were accepted for analysis. Among the selected articles, four were randomized clinical trials, seven were cross-sectional, and three were case-control studies. The results of the present review showed that abuse of illegal drugs is the most common cause of rhabdomyolysis. AKI is the most serious complication of rhabdomyolysis reported in the studies. These studies have shown a three-fold increase in AKI following drug-induced rhabdomyolysis. The review of the included articles shows that high LDH can predicts AKI, especially in critical and emergency situations such as rhabdomyolysis where there is a risk of death if diagnosed late. These studies show that LDH increases in the presence of renal failure and tissue damage. CONCLUSION: Serum LDH is an appropriate and cost-effective prognostic indicator that can be used for risk classification of patients at risk for rhabdomyolysis-induced AKI.

Investigation of Relationship between Occupational Stress and Cardiovascular Risk Factors among Nurses.

BACKGROUND: One of the major causes of various work-related health problems among nurses is occupational stress. Hence, the main purpose of the present research was to find association between occupational stress of nurses and risk factors of cardiovascular disease. METHODS: In this cross-sectional study, the Osipow job stress questionnaire was employed to assess the occupational stress among the 250 nurses in Emam Khomeini hospital of Tehran in 2018. Based on stress score for participants, subjects divided into two groups: Scoring of group one was 60-179 (mild and average stress) and group two between 180 and 300 (average to acute and acute stress). Systolic and diastolic blood pressures were recorded for subjects after 10hrs fasting. Then the blood samples were collected to measure cholesterol, triglyceride and glucose levels. For determining the association between education level, job experience and study groups, the Chi-square test and for comparing job stress between two groups of study the Mann-Whitney U test was used. RESULTS: Subjects with job stress in group one was 70(28%) and group two was 180(72%). The association between level of education and two study groups was not significant (P=0.129) while between job experience and two study groups was significant (P=0.004). Mean of Blood glucose levels for group I (98.0± 37.5), was higher than group II (82.5±12.0) and statistically significant (P=0.001). No significant difference was found between two groups of study for other parameters. CONCLUSION: High level of work-related stress among subjects affected the values related to blood glucose level, but no significant relationship was found between other risk factors of cardiovascular diseases and occupational stress among nurses.

The prevalence of metabolic syndrome in drivers: A meta-analysis and systematic review.

BACKGROUND: Metabolic syndrome is an increasing disorder, especially in night workers. Drivers are considered to work during 24 hours a day. Because of job characteristics such as stress, low mobility and long working hours, they are at risk of a metabolic syndrome disorder. OBJECTIVES: The purpose of this study is a meta-analysis and systematic review of the prevalence of metabolic syndrome in drivers. METHODS: In this systematic review, articles were extracted from national and international databases: Scientific Information Database (SID), Iran Medex, Mag Iran, Google Scholar, Science Direct, PubMed, ProQuest, and Scopus. Data analysis was performed using meta-analysis and systematic review (random effect model). The calculation of heterogeneity was carried out using the I2 index and Cochran's Q test. All statistical analyses were performed using STATA software version 11. RESULTS: A total of nine articles related to the prevalence of metabolic syndrome in drivers in different regions of the world from 2008 to 2016 were obtained. The total sample size studied was 26156 with an average of 2906 samples per study. The prevalence of metabolic syndrome in drivers was 34% (95% CI: 30-37)CONCLUSIONS:According to the results of this study, the prevalence of metabolic syndrome in drivers is high. Occupational stress, unhealthy diet and physical inactivity cannot be cited as causes of metabolic syndrome prevalence in drivers. Therefore, to maintain and to improve the health of this group, the implementation of preventive, therapeutic and rehabilitation measures for these people as well as training should be considered.

A narrative review on the management of Acute Heart Failure in Emergency Medicine Department.

The main urgent symptom presented to an emergency department is acute heart failure (AHF). In that considerable risksof morbidity and mortality, it is important to plan precision medicine to achieve the most suitable outcomes. The object of this review is to provide a summary of contemporary management procedures of emergency medicine in a department of acute heart failure. Heart failure could be presented with a broad range of symptoms, in particular a sudden worsening of those of Chronic Obstructive Pulmonary Disease. The treatment should focus on acute and chronic underlying disorders with instructions focusing on haemodynamics and blood pressure status. Treatment of patients suffering with worsening symptoms of AHF mainly focuses on intravenous diuretics. In emergency situations, patients suffering with AHF with low blood pressure must receive emergency consultation and a primary fluid bolus therapy (range 250-500 mL) followed by inotropic therapy with or without antihypotensive agents. For treatment of severe heart failure and cardiogenic shock in patients treated with noradrenalin, when blood pressure support is required, a direct-acting inotropic agent, dobutamine, could be applied effectively. When non-invasive positive pressure ventilation is needed, suppliers must track for any possibility of sudden worsening, i.e., for acute decompensated heart failure. When cardiac output is high the disorder could be treated with vasopressors.

Oncogenic miRNAs and target therapies in colorectal cancer.

OncomiRNAs involved in human colorectal cancer (CRC) are capable of suppressing the expression of their targets via cleavage or translational arrest. Therefore, an improved understanding the functions of these oncomiRNAs and the molecular pathways in CRC development that they are involved in will assist in the manipulation of miRNAs, providing a novel therapeutic approach against CRC. In this review, we provide a particular perspective of miRNAs implicated in the progression of CRC. We describe an interaction network of CRC-associated miRNAs and their targets involved in tumor growth, proliferation, migration/invasion, epithelial-to-mesenchymal transition (EMT) formation, metastasis, and anticancer resistance. Additionally, the therapeutic potentials of these miRNAs in CRC are fully discussed. Thus, key oncogenic miRNAs involved in progression and metastasis of CRC (e.g., miR-181a/b, miR-135a/b, miR-150 and miR-150-5p, miR-155, miR-181b, miR-200 a/c, miR-22, miR-106a, hsa-miR-103a, hsa-miR-1827, miR-135b, miR-150 and miR-150-5p, miR-181b, and let-7f-5p) are considered in this review. Furthermore, proangiogenic and antiapoptotic miRNAs, their molecular regulatory networks, biological functions, and target genes are also discussed. An in-depth understanding of the molecular mechanisms underlying the regulation of miRNAs will increase the knowledge of miRNA regulatory function in the progression of CRC and promote the development of novel therapeutic measures.

Management of multiple traumas in emergency medicine department: A review.

One of the main causes of adults' disability during their working age is multiple trauma. The process of medical care of patients who are injured seriously is still a challenging job. The primary treatment of these patients in the emergency medicine departments is the most required choice after the wilderness first aid and also would be very required before definitive care in the hospital. The main aim of emergency medicine departments is quick recognition and treatment of injuries which pose severe threat to patients' life in appropriate order of priority. The procedure of primary evaluation in emergency medicine department with the help of medical routine examination and ultrasonography is based on the concept of focused assessment with sonography in trauma (FAST) for identifying spontaneous intraperitoneal hemorrhage. Emergency patients who suffer from massive hematothorax, serious lung and heart traumas, and penetrating traumas to the chest would undergo thoracotomy and patients who have few symptoms of perforated hollow viscous will undergo emergency laparotomy. Based on the trauma severity, emergency treatment could be the way to fast recovery of the structure of injured organ and its function. The subsequent goal, in the acute phase, will concentrate on preventing and stopping bleeding and secondary injuries like painful compartment syndrome or intra-abdominal infections (IAIs). However, the main aim of emergency medicine department in taking care of severely injured patients is the management of airway, protecting circulation and breathing, identification of neurologic problems, and whole body clinical examination with the help of healthcare providers.

2015 Estimation of Hospitals Safety from Disasters in I.R.Iran: The Results from the Assessment of 421 Hospitals.

BACKGROUND AND OBJECTIVE: Iran's health system has developed a Farsi edition of the Hospital Safety Index (HSI) and has integrated the related assessment program into the health information system. This article presents the results of the 2015 estimation of hospital safety from disasters in I.R.Iran using HSI. METHODS: We analyzed data from 421 hospitals that had submitted a complete HSI assessment form on the Ministry of Health and Medical Education Portal System. Data collection was based on the self-assessments of the hospital disaster committees. HSI includes 145 items categorized in three components including, structural, non-structural and functional capacity. For each item, safety status was categorized into three levels: not safe (0), average safety (1) and high safety (2). A normalized scoring scheme on a 100-point scale was developed. 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 43.0 out of 100 (± 11.0). Eighty-two hospitals (19.4%) were classified as not safe, and 339 hospitals (80.6%) were classified in the average safety category. No hospital was placed in the high safety category. Average safety scores were 41.0, 47.0, and 42.0 for functional capacity, non-structural safety, and structural safety respectively. The average safety score increased between 2012 and 2015, from 34.0 to 43.0. CONCLUSIONS: Hospital safety in the event of disasters has improved in Iran in recent years and more hospitals have joined the HSI program. This is a result of continuous efforts invested in capacity building programs and promotion of the 2012 HSI estimation. The HSI should be maintained to monitor the progress of Iran's health system in regards to hospital safety in the case of disasters. It is recommended that WHO continue advocacy of HSI, establish a HSI monitoring system, and add it to country profiles on WHO website.

Methanol mass poisoning in Iran: role of case finding in outbreak management.

BACKGROUND: There are no guidelines addressing the public health aspects of methanol poisoning during larger outbreaks. The current study was done to discuss the role of active case finding and a national guideline that organizes all available resources according to a triage strategy in the successful management of a methanol mass poisoning in Rafsanjan, Iran, in May 2013. METHODS: A retrospective cross-sectional study was performed reviewing the outbreak Emergency Operation Center files. The objectives were to describe the characteristics, management and outcome of a methanol outbreak using Active Case Finding to trace the victims. RESULTS: A total of 694 patients presented to emergency departments in Rafsanjan after public announcement of the outbreak between 29th May and 3rd June 2013. The announcement was mainly performed via short message service (SMS) and local radio broadcasting. A total of 361 cases were observed and managed in Rafsanjan and 333 were transferred to other cities. Seventy-five and 100 patients underwent hemodialysis (HD), retrospectively. The main indication for HD was refractory metabolic acidosis. Eight patients expired due to the intoxication. Except for the deceased cases, no serum methanol level was available. CONCLUSION: In developing countries, where diagnostic resources are limited, use of active case finding and developing national guidelines can help in the management of large outbreaks of methanol poisonings.