Journal of Emergency Medicine, Trauma and Acute Care - الأعداد السابقة

Background: Envenomation caused by snakebites and scorpion stings is a neglected disease responsible for significant morbidity and mortality. In Qatar, little information is available on the epidemiological aspects of snakebites and scorpion stings. This study describes the demographic and epidemiological characteristics of patients treated for scorpion stings or snakebites at Qatar’s Primary Health Care Corporation (PHCC).

Methods: A retrospective data analysis was applied to investigate the number of scorpion stings and snakebites reported at the PHCC health centers between January 1, 2018, and December 31, 2022. The data were electronically extracted from the medical records of the registered population at PHCC.

Results: 581 scorpion stings and 21 cases of snakebites were reported between January 1, 2018, and December 31, 2022. The highest number of scorpion stings reported in 2020 was 141 cases. The distribution of scorpion stings was higher among males than females, with rates of 86% and 14%, respectively, and the highest number of cases occurred in the age group of 19–39 years. Among the total cases, Bangladeshi and Qatari were the most affected, with a rate of 41% and 14%, respectively. The western region had the highest incidence of scorpion stings, at 7.47 per 10,000 persons.

Conclusion: According to this research, the western region had the highest occurrence of scorpion stings cases, primarily among Bangladeshis and Qataris, particularly in the age group of 19–49 years. This study also found similar patterns in snakebite cases. Consequently, this study emphasizes the need for increased investment in antivenom and the training of healthcare professionals to address scorpion stings effectively.

Background: Traumatic cerebral contusion is a major global health concern due to its association with poor clinical prognosis. The aim of this study is to determine the risk factors and clinical presentation of traumatic cerebral contusion in Sudan.

Methods: A prospective cross- sectional observational hospital-based study was conducted in 90 patients with traumatic cerebral hemorrhagic contusion admitted to the National Center for Neurological Sciences (NCNS) over a period of six months.

Results: The results show that most patients were male, age 25 to 44 years, 75.6% from rural areas, and 67.8 % from Afro-Asiatic linguistic affiliated tribes. The most common cause of traumatic brain hemorrhagic contusion was road traffic accidents (RTA) 68.9%, followed by assault 24.4%, and fall 6.7%. About 60% of the patients suffered a frontal lobe injury while 14.4% of the patients had multiple injury sites. Brain edema was observed in 22.2% of the patients. According to the Glasgow Coma Scale, 11.1% suffered severe, 30% moderate and 58.9% mild brain injury. Death rate was 8.9%

Conclusion: In conclusion, male gender, age 25-44 years, rural residents and victims of RTA were the most common characteristics observed in patients with traumatic hemorrhagic brain contusion in Sudan. The study also observed that brain edema and anatomical site of hemorrhage were not associated with death while male gender and GCS were. Traumatic cerebral hemorrhagic contusion is a major public health issue in Sudan carrying significant socioeconomic effects.

Effective communication regarding the physician-patient relationship and empathy in an emergency setting is paramount for optimal care. In this regard, teaching intangible skills such as empathy to medical students as part of the formal curriculum should be considered accordingly. Teaching and evaluating intangible skills are essential competencies to be fostered by any practicing doctor, and their insufficiency as required skills may lead to better patient outcomes and patient satisfaction. In this letter, our primary focus is on empathy as an essential component in medical education and its development in emergency settings.

Trauma care is a vital part of the US healthcare system, given that it is the leading cause of death for non-elderly individuals. The need for improved systems of trauma care—particularly in rural areas—has been acknowledged over recent years. Arkansas was one of several states to build a trauma system in the 2000s and demonstrated its economic and health benefits through research after implementation. In this article, we briefly review the history of rural trauma care in the United States leading up to the creation of the Arkansas Trauma System (ATS), discuss the development and components of the ATS, and focus on future directions and needs. The lessons learned from the system developed in Arkansas and the work yet to be done are generalizable to other states with large rural populations.

Increasing attention to engaging spinal cord injury (SCI) patients with their rehabilitation entails self-assessment of their functional status. The Spinal Cord Independence Measures Self-Report (SCIM-SR) was specifically developed to allow individuals with SCI to assess their functional status and report improvements or deficits. This review was done as a preliminary phase to examine the development process of the SCIM-SR and assess the advantages of using the SCI self-reported functional status measure in Qatar. An integrative literature review was conducted using Whittemore and Knafl’s framework, searching three databases: CINAHL, Embase, and Medline. The initial search yielded 793 articles published between 2010 and 2022. After further evaluation of the literature, 12 articles were included in the subsequent analysis. This integrative literature review identified two major themes: SCIM-SR tool development and the advantages of using SCIM-SR. Tool development involved tool translation, language and cultural adaptation, and psychometric testing. Reported advantages included increased patient engagement, independence and convenience. This integrative review identified the required processes for translation, language and culture adaptation, and psychometric testing to facilitate the adoption of SCIM-SR in Qatar. To develop an Arabic version of the SCIM-SR, following a specific guideline as described in this integrative review is recommended. Before implementing the Arabic SCIM-SR tool, it is critical to evaluate its validity and reliability.

Purpose: Neuroimaging and electrodiagnostic studies are used to evaluate the changes in the spinal cord after trauma, both for clinical and research purposes. The aim of the present study was to find a correlation between the MRI and electrodiagnostic testing for acute traumatic spinal cord injury (SCI) over different points in time.

Methods: Thirty-five patients with acute SCI presenting within 48 h of injury and completing a minimum of 6 months of regular follow-up comprised the study population. Patients were examined clinically for neurological involvement as per international guidelines. Magnetic resonance imaging (MRI) spine and electrodiagnostic testing of both lower limbs [two motor (tibial and peroneal) and one sensory (sural) nerve] and five muscles (Iliopsoas, Vastus medialis, Tibialis anterior, Gastrocnemius, and Extensor hallucis longus (EHL)] were done at admission, 3 and 6 months.

Results: Quantitative MRI parameters [maximum spinal cord compression (MSCC), maximum canal compromise (MCC), and lesion length (LL)] showed a significant correlation to motor nerve conduction velocity and sensory nerve conduction velocity at all points in time. Electromyography of tested muscles at admission showed a significant correlation (Spearman’s correlation test) with MRI quantitative parameters (−0.818 to −0.510); stenosis (−0.564 to −0.347) except right EHL for peak to peak amplitude; and disk herniation (−0.427 to −0.339) except tibialis anterior for recruitment of motor unit potential (MUP) and iliopsoas, right gastrocnemius, and EHL for peak to peak amplitude. This correlation remained significant even at 3 and 6 months post-acute SCI.

Conclusion: The quantitative MRI parameters, along with a few of the qualitative parameters, show a significant correlation with electrodiagnostic features at different points in acute traumatic SCI.

Global concern has focused on reducing the potential hazards to public health from unintentional pesticide poisoning. As a result, notorious agents have been banned from the market, and new materials that maintain their effectiveness against harmful insects with low human toxicity have been developed. Despite the development of several recent agents targeting the nervous system of insects, their clinical effects on humans are rarely known. We report a novel human intoxication with a mixture of flonicamid and sulfoxaflor pesticides, which presented with acute stroke manifestations.

An 83-year-old man presented to the emergency department (ED) in a confused mental state and with right-sided hemiparesis for 2 h prior to the visit. The primary evaluation targeted a new onset of hemorrhagic stroke. Clinical manifestations showed no definite interval change for 2 days, and the diagnosis of stroke was ruled out after previous radiologic results revealed the presence of a pre-existing lesion.

After 3 days, the patient recovered with an alert mentality and appropriate orientation. The patient remembered that he took the package of pesticide but flatly denied the intentional intake of toxic agents. The patient was discharged 5 days after admission without any neurological deficits.

We present the first report of human intoxication with flonicamid or sulfoxaflor. Although the total amount of ingestion was not high, the patient showed unique clinical manifestations of stroke. Physicians should be aware of particular toxic materials when a differential diagnosis of stroke is required. Further investigations should be performed to estimate and reveal human toxicity.

Background: The coronavirus disease (COVID-19) has resulted in more than 6 million deaths worldwide since it was identified in 2019, resulting in significant morbidity and mortality. The impact of COVID-19 on the acquisition of multi-drug-resistant organisms (MDRO) remains uncertain. This study aims to investigate the effect of COVID-19 on the acquisition of MDRO in the intensive care unit (ICU).

Methods: A single-center, retrospective observational study at Wollongong ICU compared the acquisition rate of MDRO, especially vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA), pre- and post-COVID.

Results: There was a significant increase in MDRO incidence post-COVID compared to pre-COVID, with incidence rates increasing from 1.6% to 4.56%, especially in MRSA acquisitions, which increased from 0.91% to 5.71%. This increase was associated with a longer ICU length of stay (LOS) but did not have a significant effect on hospital LOS or mortality. The increased incidence of MDRO was potentially related to increased antibiotic use and staffing changes during the COVID period.

Conclusion: COVID-19 significantly impacted the acquisition of MDRO, particularly MRSA.

Background: Road traffic accidents (RTAs) are a significant contributor to morbidity and mortality in East Africa. Lower extremity (LE) injuries are especially debilitating, negatively impacting quality of life and employment prospects. This systematic review characterizes the proportion of LE injuries due to RTAs in four members of the East African Community: Kenya, Rwanda, Tanzania, and Uganda.

Methods: Embase, Medline, Web of Science, and PubMed were queried for studies from 2010 to 2022 providing information on lower extremity injuries caused by RTAs in the countries of interest. Proportions of RTA-related LE injuries were extracted from eligible papers. Study quality and bias were assessed using the framework for systematic reviews established by Zaza et al.¹

Results: Seven studies met the eligibility criteria–four for Kenya, two for Uganda, and one for Tanzania; however, no eligible studies were found for Rwanda. The proportion of RTA-related injuries affecting the lower extremities ranged from 0.39 to 0.49. In patients presenting with LE injuries, RTAs were the most frequent cause, representing more than 70% of cases in the examined studies. Motorcycle accidents were not more likely to cause LE injuries, but they were the most significant contributor to the overall LE injury burden due to their prevalence.

Conclusions: With urbanization and the increased adoption of low-cost motorcycles, RTAs will continue to pose a public health challenge. Investments in traffic enforcement and physical infrastructure will alleviate the risks to both motorists and pedestrians. In addition to primary prevention, there is a significant need for improvements in emergency care and surgical capacity.

The development of messenger ribonucleic acid (mRNA) vaccines has revolutionized the field of preventive medicine. These came into the spotlight during the COVID-19 pandemic. Despite the fact that vaccines are broadly safe, some rare, life-threatening side effects have been reported in the recent past, and myocarditis is one of them. We present a case of COVID-19 mRNA vaccine-induced myocarditis in a young male. Three days after receiving the third dose of the BNT-162b2 mRNA vaccine for COVID-19, he presented to the emergency department after experiencing palpitations. He was admitted to the hospital due to raised cardiac enzymes and a concerning echocardiogram. Magnetic resonance imaging the following day revealed myocarditis. There have been multiple cases of myocarditis reported in the literature owing to the COVID-19 mRNA vaccine. This case stands out because of the presence of regional wall motion anomalies in the echocardiogram, which is an unusual finding in patients with myocarditis. We recommend keeping a low threshold for investigating young patients presenting with cardiovascular symptoms who have received a recent COVID-19 mRNA vaccine.

Background: Point-of-care ultrasound (POCUS) has been introduced in the training curricula of several residency programs. However, it is yet to be routinely integrated into general surgery (GS). This study aims to identify the attitudes of the GS Canadian academic community towards POCUS.

Methods: A multiple-choice survey was sent to all Canadian GS programs. The survey was comprised of three sections: baseline characteristics, current perceived knowledge of POCUS, and barriers to POCUS implementation.

Results: The targeted sample included 609 surgeons and 593 residents (a total of 1202). Of these, 58 surgeons and 79 residents responded (11.3% response rate). Overall, only 5.2% reported using POCUS daily, and 44.8% of the staff surgeons reported never using POCUS. The most reported indications included extended focused assessment with sonography in trauma (eFAST) and the insertion of central lines. Staff surgeons were reluctant to operate solely on the findings of POCUS. The perceived sensitivity of POCUS for various surgical indications was significantly lower than that reported in the literature. Examples include diagnosing the etiology of shock where only 58.6% of staff and 50.6% of residents chose the correct answer reported in the literature for that indication. However, for diagnosing cholecystitis, only 46.6% of staff and 34% of residents responded correctly as per the literature. The majority of the residents (69.5%) believed that POCUS should be implemented in training programs. Perceived barriers to POCUS implementation included lack of time for training, lack of confidence in POCUS, and concerns about medicolegal consequences.

Conclusion: This study reveals the need to support POCUS training by GS residents despite their low current usage. Addressing barriers to its implementation and knowledge gaps regarding POCUS could lead to its wider adoption.

Pulmonary hypertension (PH) is characterized by remodeling of the pulmonary blood vessels, resulting in structural and functional changes. While dyspnea and angina are common symptoms associated with the disease, rarely do they might stem from atypical factors like compression of the coronary arteries. Hence, it is crucial to consider anatomical imaging studies when assessing these patients. Treatment decisions depend on several factors, including disease severity and concurrent medical conditions. In this case report, we present a patient with both PH and a sizable pulmonary artery (PAA), which significantly compressed the left main coronary artery (LMCA). Conservative management was pursued, leading to a successful outcome. The occurrence of angina due to PAA in PH patients, although rare, underscores the importance of conducting a comprehensive evaluation for an accurate diagnosis.

Background: The coronavirus disease (COVID-19) has devastating pervasiveness throughout the world. Moreover, the presence of comorbidities could worsen the effects of COVID-19. Therefore, our aim was to study the types of comorbidities in COVID-19 patients admitted to a tertiary care hospital and to assess the impact of comorbidities and their outcomes in COVID-19 patients admitted to a tertiary care hospital.

Methods and Materials: This was a single-center, observational, ambispective study that included consecutive patients with COVID-19 admitted to a tertiary care hospital in India between April 2020 and March 2022. The data was collected regarding the patients with COVID-19 admitted to the hospital through medical records. Comorbidities were determined based on the patient’s self-report on admission. The primary endpoint of the study was a composite measure that consisted of admission to an intensive care unit (ICU), invasive ventilation, or death.

Results: A total of 2323 patients were included in the study. The mean age of the patients was 50 years. Hypertension was the most common comorbidity observed in 24.8% of patients, followed by diabetes mellitus in 17.5% of patients. Around 9.5% of patients required invasive ventilation; the ICU admission rate was 14.3%, and the death rate was 10.1%. There was a significant association between the presence of any comorbidity (except cancer) and the death of the patients as well as admission to the ICU (p < 0.001).

Conclusion: In view of the results, it can be concluded that the comorbidities, namely hypertension, diabetes mellitus, coronary artery disease, COPD/bronchial asthma, chronic kidney disease, and cerebrovascular accidents, except for cancer, were found to have an association with the severity of the illness in terms of ICU admission as well as the death rate in COVID-19 patients.

Background: The liver heals remarkably after different forms of injury. However, healing can be lengthy following high-grade injuries. We hypothesize that injected mesenchymal stem cells (MSCs) could locate in the liver and differentiate into hepatocytes after blunt trauma using a rat liver trauma model.

Methods: Blunt liver trauma was induced in Lewis rats. MSCs were transfected with LacZ retrovirus so that they express the beta-galactosidase enzyme, giving their nuclei a blue color on light microscopy. Each rat received a dose of MSCs (n = 6 × 10⁶) within 24 h of trauma. Through different steps of the experiment, the route of injection was the tail vein (TV) in nine rats, the portal vein (PV) in 19 rats, and directly to the injured liver (DI) in four rats. Rats were euthanized at 48 h or 7 days after the injection of MSCs. Livers were harvested and examined under light microscopy to identify the MSCs.

Results: Liver sections showed localization and migration of MSCs to trauma sites in the PV group euthanized at 48 h (3/10 rats). Some MSCs differentiated into hepatocytes. Similar findings were present in 1/9 rats euthanized at 7 days in the PV group. There was no evidence of MSC localization in TV and DI groups.

Discussion: MSCs can locate and differentiate into liver-like cells in blunt liver injury. Portal vein injection of MSC has emerged as the most effective method of delivery to the liver among the other methods. Optimizing homing to injured tissue and evaluating differentiated stem cell functionality are future areas of research.