مجله طب اورژانس ایران

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.

Background: The purpose of this study was to examine the outcomes of cardiopulmonary resuscitation (CPR) including return of spontaneous circulation (ROSC), survival to hospital discharge and neurological outcome in the emergency department (ED). Methods: This prospective observational study included 233 patients with 51 cases of Out-Of-Hospital Cardiac arrests (OHCA) and 182 cases of In-Hospital cardiac arrests (IHCA). The study was performed in the ED of a tertiary health care centre in North India from July 2018 to June 2021. Results: The majority of the study subjects (67.8%) were males, and the median age of patients was 47 years. 35.6% of cases (N=83) had a sustained ROSC after the first attempt of CPR. Survival to inpatient admission was seen in 20.2% of cases (N=47), and survival to hospital discharge was observed in 3.9% of cases (N=9). Out of 9 cases who survived, 7 cases (3%) were discharged with good neurological outcomes (mRS 0-2). For OHCA, the predictors of survival were witnessed arrest (Odds Ratio [OR]=4.58, 95% CI: 1.08-19.38),  bystander CPR (OR=3.78, 95% CI: 1.78-18.13), and time to reach the hospital (OR=0.70, 95% CI: 0.55-0.89). Whereas in IHCA, patients with initial shockable rhythm had increased odds of survival (OR=1.49, 95% CI: 1.35-1.74). Conclusion: In our study, in contrast to the developed countries, the survival to hospital discharge in cardiac arrest patients presenting to ED was very low. Therefore, this study proposes the development of a robust cardiac arrest registry in India, to address the gaps in the existing knowledge and facilitate future research.

Background: Clinical, radiological, and laboratory findings characteristic of the coronavirus disease 2019 (COVID-19) infection have already been investigated and identified; however, data on pregnant women infected with COVID-19 are limited. This study aims to examine the clinical, radiological, and laboratory characteristics of pregnant women compared to non-pregnant women with COVID-19 disease. Method: This hospital-based retrospective age-matched case-control study included two groups, pregnant and non-pregnant women, each consisting of 51 patients hospitalized with COVID-19 in Bushehr, Iran.  Demographic, clinical, and laboratory information was extracted from medical records using a predefined checklist. Results: Except for cough, there were no statistically significant differences in clinical signs and symptoms between pregnant and non-pregnant women. Although hemoglobin oxygen saturations are statistically significant among the two groups, this difference is not clinically significant (95% vs 93%). There were no statistically significant differences between pregnant and non-pregnant women in the pattern of pulmonary involvement in chest CT findings. Laboratory factors such as serum hemoglobin, red blood cell count, absolute lymphocyte count, prothrombin time and partial thromboplastin time, serum creatinine, serum potassium, and lactate dehydrogenase had statistically significant differences between the two groups. However, these differences were not clinically significant. Conclusion: In a few aspects, the clinical characteristics and laboratory test results of COVID-19 in pregnant patients seem to be distinctive from their nonpregnant controls. We believe our findings can guide the prenatal and postnatal considerations for COVID-19 pregnant patients.

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: Mechanical ventilation in emergency departments (ED) is crucial to airway management. Various factors significantly influence patient outcomes.

Objectives: This study aimed to evaluate the prognostic factors of mortality in patients undergoing mechanical ventilation in the ED.

Methods: This retrospective cross-sectional study examined patients over 18 who underwent mechanical ventilation in the ED of a referral hospital in Tehran, Iran, between August 2022 and September 2023. The association between patients characteristic and intubation-related parameters with in-hospital mortality was measured using univariate and multivariate logistic regression, as well as Kaplan-Meier survival curve analyses.

Results: We examined 430 patients with a mean age of 61.4 ± 22.0 (range: 18-103) years were studied (60.7% male). There was significant correlation between in-hospital mortality and age (P < 0.01); cancer (P = 0.002) and hypothyroidism (P = 0.009) as the underlying diseases; failure to protect airway (P = 0.27) and oxygenation failure (P = 0.04) as the causes of intubation; vasopressors usage (P < 0.001); medications which were used for rapid sequence intubation (P < 0.001); systolic blood pressure (P < 0.01) and diastolic blood pressure (P < 0.01); time to intubation (P = 0.006); platelet count (P < 0.001) and hemoglobin level (P= 0.003); and finally HCO₃ (P = 0.05) and PCO₂ levels (P = 0.013). Multivariate logistic regression analysis identified cancer (P = 0.019, OR = 0.13), oxygenation failure (P = 0.03, OR = 0.32), vasopressor medication (P < 0.001, OR = 0.07), systolic blood pressure (P = 0.035, OR = 1.03), platelet count (P = 0.042, OR = 0.99), and PCO₂ (P = 0.013, OR = 0.95) as independent predictive factors of mortality rate.

Conclusion: This study identified several predictive factors of mortality in patients undergoing mechanical ventilation in the ED, including cancer, oxygenation failure, use of vasopressors, lower systolic blood pressure, lower platelet count, and lower PCO₂.

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.

Background: Stroke is considered as one of the most important causes of emergency medical services (EMS) dispatch worldwide. Stroke is a time-sensitive condition and rapid transport of the patients improves the prognosis. In this study, we described prehospital emergency response times for stroke patients in Isfahan, Iran. Methods: In the current cross-sectional descriptive study, suspected stroke patients who were transported by EMS in Isfahan, Iran, from June 2022 to June 2023 were included. The data was extracted from patients’ files. The time interval between the receipt of a call and the EMS arrival at the scene (arrival time), the time interval between on-scene EMS arrival and the ambulance departure to the medical center (stroke scene time), and the time it takes to reach the medical center (transport time) were collected. Results:  Overall, 79 patients with a mean age of 71.56 ± 12.03 were included. EMS diagnosed 63 (79.75%) of the patients with a definite diagnosis and 14 (17.72%) with probable stroke. Two false negative results were found. The average arrival time, was 11.56 ± 6.60 minutes, on-scene stroke time was 13.85 ± 7.23 minutes and the average transport time was 11.90 ± 6.08 minutes. The mean total EMS response time was 37.90 ±11.29 minutes. Conclusion: Overall, our study showed that while the EMS transport time is longer than ideal, the total time to transport to the hospital is short enough not to affect the outcome. EMS was also found to be adept at spotting the signs of stroke and rapidly starting the process of treatment.

Background: Visceral fat has been associated with severe COVID-19 outcomes due to its pro-inflammatory effects. While computed tomography (CT) is the standard for measuring visceral fat, ultrasound (US) offers a non-invasive and accessible alternative. This study aimed to evaluate whether abdominal fat thickness measured via US predicts clinical outcomes in COVID-19 pneumonia.

Method: This prospective cohort study included 83 hospitalized COVID-19 patients. Visceral fat thickness (VFT), subcutaneous fat thickness (SFT), and preperitoneal fat thickness (PFT) was measured with US. The primary outcome of interest was mortality. Multivariable logistic regression was used to analyze associations, adjusting for confounders such as age, sex and comorbidities.

Results: 83 patients with the median age of 62 (IQR: 49–73) years were included (53% male). Mortality was significantly higher in male (61.4% vs. 38.6%, p = 0.018); older age (73.5 vs. 59.5; p = 0.003); patients with lower median blood oxygen saturation (80% vs. 88%, p < 0.001), higher median levels of AST (66 vs. 39.5, p = 0.002), BUN (67 vs. 36.5, p < 0.001), and creatinine (1.6 vs. 1.2, p < 0.001); and patients under mechanical ventilation (p < 0.01).

Based on multivariate logistic regression analysis the independent predictors of mortality were VFT (aOR: 1.025, 95% CI: 1.001–1.051, p = 0.047), old age (aOR: 1.064, 95% CI: 1.016–1.115, p = 0.008), and male sex (aOR: 4.430, 95% CI: 1.169–16.769, p = 0.029). In contrast, SFT had an aOR of 1.059 (95% CI: 0.966–1.161, p = 0.223), and PFT had an aOR of 1.016 (95% CI: 0.880–1.172, p = 0.830), neither of which were statistically significant. The area under the ROC curve of VFT in predicting mortality was 0.643. The optimal cutoff value for VFT, determined using the Youden Index, was 80.4. At this cutoff point, the sensitivity was 52.2% while the specificity was 75.0%.

Conclusion: It seems that, ultrasound-measured VFT is a potential predictor of mortality in hospitalized COVID-19 patients, offering a cost-effective and accessible tool for risk assessment. Further research is needed to confirm its broader applicability.