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   Table of Contents - Current issue
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April-June 2020
Volume 20 | Issue 2
Page Nos. 55-96

Online since Wednesday, May 27, 2020

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INVITED REVIEW ARTICLE  

Novel coronavirus pandemic: A global health threat p. 55
Gulfaraz Khan, Mohamud Sheek-Hussein, Ahmed R Al Suwaidi, Kamal Idris, Fikri M Abu-Zidan
DOI:10.4103/2452-2473.285016  
The world is facing one of its worst public health crises in modern history. Coronavirus 2019 (COVID-19) has shown how fragile our global preparedness for infectious diseases is. The world is a small-connected globe with short travel time between its remote parts. COVID-19 has spread globally and swiftly with major impacts on health, economy, and quality of life of communities. At this point in the time, April 9, 2020, >1,500,000 patients have been infected and >88,000 patients have died worldwide within the last 3 months. The status is evolving and the costly lessons learned over time are increasing. These lessons are global as this virus is. They involve different domains of health sciences including virology, public health, clinical, critical care, and disaster management. This review addresses our current knowledge of COVID-19 pandemic from the basic virology and transmission, through prevention, infection control, clinical management, and finally disaster management including the recovery period. This review has a multidisciplinary approach, which is needed at this time. After this difficult period passes, we have to carry the lessons we learned for the future so that we can be better prepared. One thing that has clearly emerged from this ongoing crisis is that infectious diseases have no borders and we have to work together, using the one world, one health approach, if we are to minimize the enormous impact such pandemics can cause.
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ORIGINAL ARTICLES Top

Efficacy of adding midazolam to paracetamol in pain control of patients with a primary headache: A randomized, clinical trial study p. 63
Mahin Amini-Parikhani, Amir Ghaffarazad, Hassan Soleimanpour, Haniyeh Ebrahimi-Bakhtavar, Farzad Rahmani
DOI:10.4103/2452-2473.285011  
OBJECTIVES: This study aimed to determine the effect of adding intravenous midazolam to paracetamol in the treatment of patients with primary headache referring to the emergency department. METHODS: In a randomized clinical trial, 120 patients (18–65 years old) with primary headache referring to the emergency department were enrolled. Patients were divided into two groups (case: paracetamol + midazolam and control: paracetamol + placebo), and the treatment was administered based on the treatment group. The severity of pain (according to the initial Visual Analog Scale) and at different times after the treatment onset (15, 30, and 60 min) and the degree of satisfaction with the treatment were compared in two groups of patients. RESULTS: There were no statistically difference between the two groups about the median of pain severity at the time of 0 min (case: 8 vs. control: 8), 15 min (case: 6 vs. control: 6), and 30 min (case: 4 vs. control: 4) with P > 0.05. Headache severity at 60 min after the treatment onset in the case group (median: 1) was less than that of the control group (median: 3). There was also a statistically significant difference in the median of patient satisfaction in the case group (case: 9 and control: 7 with P < 0.001) and satisfaction in the case group was higher. CONCLUSIONS: Based on our primary and secondary outcomes and the results of the study, we conclude that adding intravenous midazolam to paracetamol do not improve the therapeutic response ratio over time, but the effect of this intervention appeared after 1 h.
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Assessing psychometric properties of Turkish version of the stressor scale for emergency nurses p. 69
Sadik Hancerlioglu, Gülbin Konakci, Fisun Senuzun Aykar
DOI:10.4103/2452-2473.285012  
OBJECTIVES: This study was carried out as a methodological study to adapt the stressor scale for emergency nurses to Turkish and to test its validity and reliability. MATERIALS AND METHODS: Data were collected between April 2019 and December 2019 from 250 emergency nurses working in the emergency department of two different universities and two state hospitals. The scale was reapplied to 40 emergency nurses from the sample group 3 weeks after the first application. For the validity studies of the scale, language validity, content validity, and construct validity studies were used, and for the reliability studies, internal consistency and test–retest reliability methods were used. RESULTS: It was found that the content validity index of the final form was determined as 0.92 (0.78–1.00) according to expert opinions, the scale explained 69.19% of the total variance in four subdimensions, the Cronbach's alpha value was 0.90, and the test–retest intraclass correlation coefficient value was 0.97. CONCLUSION: It was concluded that the reliability and validity of the scale was high for Turkish society.
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Trends in medical students' career choice of emergency medicine: A 14-year study p. 75
Fikret Bildik, Mehmet Ali Aslaner, Isa Kiliçaslan, Ayfer Keles, Sakir Hakan Aksu, Merve Yazla, Mehmet Akif Karamercan, Ahmet Demircan
DOI:10.4103/2452-2473.285017  
INTRODUCTION: The long-term trends of medical students' choice for emergency medicine (EM) in Turkey are unclear. With this background, we aimed to determine the change in the rate of EM preferences of students over the years. METHODS: This was a cross-sectional study originated from 6th-year medical students' feedback forms, to examine trends of EM carrier preferences between 2005 and 2018 in a tertiary care academic emergency department. There are two main questions containing “would you choose EM as a specialty?” and “why?” as open-ended questions in the form. The answers to the open-ended question were classified as six main factors, which were perception of work, lifestyle, nature of work, personal job preference, mentorship/department experiences, and income. RESULTS: During the study, 2957 forms (80.6% of 3668) were completed by 6th-year medical students. Of the students, 26.5% (n = 784) responded “yes” to the question, which was “would you choose EM as a specialty?,” 6.1% (n = 181) responded “do not know,” and 67.4% (n = 1992) responded “no.” In 2005, 15% of students stated that they would choose EM, while this rate increased to 29% in 2018 (χ2: 9.67; P trend = 0.003). Perception of work was the most common reason for “yes” (46.3%), “no” (46%), and “do not know” answers. CONCLUSION: The rate of EM choice of medical students doubled during the study, and approximately one in three students stated that they could choose EM as their future career in the past year. Perception of work was the main factor for choosing or rejecting to EM.
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The assessment of ice pack effect in pain reduction during digital nerve block: A randomized clinical study p. 81
Fatemeh Rasooli, Mehran Sotoodehnia, Amir Nejati, Pooya Payandemehr
DOI:10.4103/2452-2473.281628  
OBJECTIVES: Digital nerve block is a painful procedure. Several methods have been proposed to decrease the injection pain. Applying an ice pack is a pertinent choice due to its effectiveness on pain reduction, convenience, and low costs. In this study, the degree of injection pain reduction was assessed after applying an ice pack to the site of anesthetic injection. METHODS: One hundred participants with traumatic finger injury were assessed. Digital nerve block was performed in fifty patients in the intervention group after 6 min of ice application. In the control group, this procedure was done without ice. The primary outcome was the difference between the needle stick and infiltration pain scores with and without ice pack. The secondary outcome the patient satisfaction score. The protocol of this study was approved by the Institutional Review Board, and it is registered in the Iranian Registry of Clinical Trials. RESULTS: The pain score was assessed using a Numeric Rating Scale. Both the needle skin and infiltration pain scores were statistically significantly lower in the intervention group (P < 0.001). The mean and median needle stick pain scores were 1.5 and 1.0 in the intervention group and 6.8 and 7.0 in the control group, respectively. Moreover, the mean and median infiltration pain scores were 2.7 and 2.0 in the intervention group and 8.5 and 9.0 in the control group, respectively. Patient satisfaction score was significantly higher in the intervention group. CONCLUSIONS: Ice pack is inexpensive, readily available, and is easy to apply. We recommend this method to reduce the injection pain before digital nerve block in the emergency department.
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CASE REPORTS Top

Pneumatosis intestinalis: An important radiological clue in a case of missed perforated appendicitis p. 86
Khairul Najmi Muhammad Nawawi, Azlan Helmy Abd Samat, Nik Farhan Nik Fuad, Lim Li Yi
DOI:10.4103/2452-2473.278560  
Pneumatosis intestinalis (PI) is a rare radiological finding, characterized by the presence of gas in the bowel wall. It has a wide spectrum of possible underlying diagnosis ranging from benign to life-threatening conditions. We present a case of a previously healthy male who was initially presented with missed diagnosis of acute appendicitis which had led to perforated appendix. Failure to recognize the significance of PI and its correlation with other clinical information had caused the delay in his surgical intervention. Fortunately, the patient made a steady recovery and was discharged well. It is important to have a high clinical suspicion of life-threatening conditions whenever patients presented with a radiological clue of PI. Failure to incorporate this finding with other clinical clues might lead to devastating consequences and delay the necessary treatment.
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Successful intravenous thrombolysis in acute ischemic stroke after reversal of dabigatran etexilate with idarucizumab at the end of therapeutic time window p. 90
Gorana Vukorepa, Sabina Deveđija*, Miljenko Crnjaković, Mirna Karakaš, Zeljka Cuk
DOI:10.4103/2452-2473.285015  
Dabigatran is a direct oral anticoagulant that is widely used for stroke prevention in patients with atrial fibrillation. We report a case of an 80-year-old stroke patient on dabigatran for permanent atrial fibrillation, who presented with an initial National Institutes of Health Stroke Scale (NIHSS) of 8. Dabigatran was reversed with idarucizumab, and intravenous tissue-type plasminogen activator (IV-tPA) was administrated beginning 4 h and 28 min after the symptom onset. The patient was discharged with an NIHSS of 1. Our case is an additional proof of safety and efficiency of idarucizumab in the clinical setting of ischemic stroke before the administration of IV-tPA.
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Cardiac compression of a hepatic cyst in polycystic liver disease: A rare cause of hemodynamic instability p. 93
Abdullah Algin, Serdar Özdemir, Mehmet Sarıaydın, Mehmet Özgür Erdoğan, Ibrahim Inan
DOI:10.4103/2452-2473.279558  
Polycystic liver disease (PLD) develops due to embryonic ductal plate malformation of intrahepatic bile ducts. Cysts in the liver can range from a simple compression effect to severe liver failure. The most common complication is rupture and inflammation of cyst. It can sometimes progress to the extent of pushing the heart to the left or compressing the inferior vena cava, thereby reducing the venous return. Here, we present a case with giant liver cyst-related symptoms that caused external compression of the right ventricle and atrium. A 71-year-old female patient was admitted to our emergency department with increasing dyspnea, chest pain, and abdominal distension. Her vital signs were as follows: temperature 38°C, pulse 140 beats/min, and blood pressure 70/40 mmHg. Her abdomen was distended, and there was minimal epigastric tenderness. Hepatomegaly was also present. Posteroanterior chest radiography revealed opacity that erased the right diaphragm contour at the right inferior hemithorax. In thoracoabdominal computed tomography, the heart was deviated toward the left due to the compression of a large cystic formation located in the hepatic right lobe, pushing the diaphragm to the superior. Piperacillin/tazobactam 3 g × 4.5 g treatment was initiated, and external drainage was performed by interventional radiology. Following this procedure, significant improvement was observed in the patient's condition. Her symptoms significantly improved, and the drainage catheter was removed on the seventh day. Hepatic cysts in patients with PLD may compress adjacent structures, and cardiac compression can be life-threatening if hemodynamic instability occurs.
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