Iranian Journal of Emergency Medicine

Background: Smoking is one of the most important risk factors for cardiovascular diseases. Although numerous studies have evaluated the long-term consequences of smoking, few studies have assessed the short-term effects of smoking, especially on the electrical activity of the heart. The aim of this study was the evaluation of the acute effect of smoking on cardiac electrical function and hemodynamic indices in smokers.

Materials: In this single-arm pretest-posttest study, 130 healthy smokers participated if they had smoked at least 100 cigarettes in their lifetime and were smoking daily. After considering the exclusion criteria, participants were monitored before and 10 minutes after smoking by electrocardiography (ECG) to measure QT dispersion (QTD) and P-wave dispersion (PWD), systolic blood pressure (SBP) and diastolic blood pressure (DBP), heart rate (HR), and respiration rate (RR). Finally, the data obtained before and after smoking were compared.

Results: The mean age of the participants was 40.3 ± 10.6 years (range 19 to 71 years). 55 (42.3%) participants smoked between 10-15 years and 67 (51.5%) smoked 10 to 20 pack-years. After smoking, SBP (127.3 ± 10.4 vs. 138.4 ± 12.8 mmHg), QTD (33.5 ± 9.6 vs. 43.9 ± 10.7 ms) and PWD (28.9 ± 6.6 vs. 34.5 ± 7.4 ms), HR (80.1±9.8 vs 87.6±9.9) increased significantly (P value <0.001). In other parameters, no significant differences were observed.

Conclusions: Smoking is associated with an acute increase in QTD and PWD, and thus an increased risk of ventricular arrhythmias (e.g. Torsade’s de pointes), atrial fibrillation, sudden death, and other heart problems.

Background: Emergency neurosurgery plays a critical role in the management of life-threatening neurological disorders. Previous studies have shown that the initial clinical status and prolonged time interval to surgery affect patient mortality and morbidity. This study aimed to describe the association of the baseline and clinical characteristics of patients and the timing of intervention with the emergency neurosurgical intervention outcomes. Methods: A retrospective cross-sectional study was conducted involving all patients who received emergency surgery in the theatre of Udayana University Hospital from June 2021 until 2023. Age, gender, type of surgical procedures, severity of trauma, Glasgow coma scale (GCS) at emergency room arrival, time to theatre (TTT), the duration of the operation, and length of stay (LOS) were collected. Mortality was defined as the primary outcome. Results: 43 emergency surgeries were included. The mean age was 42.35 (±21.85) years and the majority of patients were male (69.8%). 65.1% of patients were trauma cases and 51.2% underwent craniotomy. The median GCS at the time of admission was 9, the median TTT was 3 hours, the median duration of surgery was 2.41 hours, and the median LOS was 7 days. After the procedures, the survival rate was 67.4%. The GCS upon admission (p=0.003) and TTT (p=0.044) were significantly associated with the patient's mortality. Conclusion: GCS at emergency room arrival and TTT in emergency surgery were associated with the mortality of emergency neurosurgery patients.

Introduction: Diabetic foot is one of the long-term microvascular complications of diabetes mellitus (DM). The prevention of foot ulcers is the most effective way to reduce severe morbidity and mortality in patients with diabetes. Appropriate glycemic control is one of the most important preventive measures for diabetic foot ulcers. Glycosylated hemoglobin (HbA1C) is representative of long-term blood glucose levels over the prior three months. The present study evaluated the relationship between HbA1C levels and the development of diabetic foot ulcers.

Methods: The present study was an analytical case-control study conducted in Ali-ibn-Abitaleb Hospital in Zahedan, Iran, in 2022. 130 patients comprising 65 DM patients with diabetic foot ulcers and 65 DM patients without foot ulcers were included in this study. Demographic and laboratory information was collected by the researcher using a checklist. The data were analyzed using SPSS software.

Results: The average age of the control and case groups was 64.1 and 62.6 years, respectively. The results showed a significant relationship between the age of 60-70 years and the onset of diabetic foot ulcers. There was also a significant relationship between the female gender and the occurrence of diabetic foot. No significant relationship was observed between the duration of DM and the onset of diabetic foot. The results showed that 87.7% of the people in the control group had no previous history of diabetic foot. However, 76.9% of the people in the case group had a prior history of diabetic foot. There was a significant relationship between the previous history of the diabetic foot and its recurrence in diabetic patients. Regarding the serum level of HbA1C, 78.5% and 12.3% of patients in the case group had moderate (7-10%) and poor control (10-13%), respectively. 43.1%, 50.7%, and 6.2% of people in the control group had good, moderate, and poor control and in the multivariable model, only the previous history remained in the model, which showed that the probability of infection in people with a previous history is almost 24 times higher than in people without a previous history.

Conclusion: The results indicate that age, female gender, history of diabetic foot, and high serum level of HbA1c had a significant relationship with diabetic foot. Since the serum level of HbA1c is an important indicator of long-term blood sugar control, it can possibly be used as a reliable factor to predict diabetic foot complications.