gpidemiology and characteristics of acute poisoning treated at an emergency center

BACKGROUND： Acute poisoning is frequently encountered at emergency department. This study was to investigate the epidemiology and characteristics of patients with acute poisoning who were treated at the Emergency Center, Fujian Provincial Hospital, China.METHODS： We retrospectively analyzed the gender, age, causes of poisoning, types of poisons, poisoning route, emergency diagnoses, outcomes, and prognoses of these patients.RESULTS： Altogether 2867 patients with acute poisoning were treated from January 2004 to December 2009. The ratio of male to female was 1：1.04, and their average age was 33.8 years. Of the 2867 patients, 76.39% were between 18 and 40 years old. The incidence of acute poisoning was as high as 11.33% in January each year. The incidence of poisoning was in a descending order： alcohol poisoning （54.55%）, medication poisoning （25.95%）, pesticide poisoning （5.65%）, and drug poisoning （4.88%）. Most （56.44%） of the patients with drug poisoning were under 25 years and their mean age was significantly lower than that of patients with medication poisoning or alcohol poisoning （P 〈 0.01）. Approximately 69.54% of the patients were followed up after emergency treatment, 30.39% were hospitalized, and four patients died.CONCLUSION： Acute poisoning is largely alcohol poisoning and medication poisoning in a city. The emergency green channel ＂pre-hospital emergency care-emergency department-hospital treatment＂ can significantly improve the survival rate of patients with acute poisoning.

Evaluation of the Use of Long-Lasting Impregnated Mosquito Nets (LLINs) in the Health District of Dimbokro (Center of Côte d’Ivoire)

The Dimbokro health district has one of the highest incidences of malaria in Côte d’Ivoire, despite numerous campaigns to distribute Long-Acting Impregnated Mosquito Nets (LLINs). Given this observation, what are the population’s attitudes towards LLINs that could explain the high endemicity of malaria in Dimbokro? The aim of this study is to assess the knowledge, attitudes and practices of people in the health area of Nofou, one of the villages in the Dimbokro health district where malaria is most prevalent, with a view to strengthening malaria control strategies. A collection of historical health data (malaria cases and LLIN usage rates) and a cross-sectional questionnaire survey was carried out from July 20 to August 03, 2022 in 400 households selected by systematic random sampling. Data were entered using Epi Info 7 and multivariate statistical analyses were performed using IBM SPSS 22 software. In the Dimbokro health district, the rate of LLIN use was negatively correlated (r = -0.771) with malaria incidence over the six years of historical data collection. Households had an average of 53% good knowledge, 68.6% good practices and 28.4% good attitudes towards LLINs. The study also revealed that the main factors explaining LLIN use in the Nofou health area are mosquito bite (ORa = 5.29 (1.12 - 25.04)), age of household members (ORa = 1.07 (1.01 - 1.14)) and marital status (ORa = 8.45 (1.70 - 45.02)). Awareness-raising on the use of LLINs should be intensified in the Dimbokro health district. Other control strategies, such as vector control and environmental sanitation, should be considered to combat malaria.

Partial Amputation of the Penis with Total Rupture of the Urethra: About a Case in the Urology Department of the Bonamoussadi District Medical Center

Penis amputations are rare, they are most often observed in a criminal context or in the context of self-mutilation. We present the case of a partial amputation of the shaft in the context of a domestic accident. This is a 53-year-old patient received in the emergency department for partial amputation of the penis occurred, whose mechanism of occurrence would be the fall of a sheet metal from the roof of his house, with reception on the proximal end of the shaft leading to a partial rupture of it—here, with total urethral section. He has no medical-surgical history. The physical examination finds a good general condition, a partial tearing of the ventral face of the penis associated with a total rupture of the urethra followed by a hemorrhage, the rest of the examination was without particularity. The emergency assessment carried out was without particularity. The treatment consisted initially of catheterizing the urethra by a urinary tube ch 20, then a urethral replacement, followed by a Peno plastie. The surgical suites were enamelled with parietal suppuration plus necrosis at J 14 post-operative. A more bidaily dressing debridement followed with a favorable evolution at 2 months. Subsequently, a penile graft was performed more urethrolastic, with removal of the flap on the inner side of the thigh, the surgical suites were favorable on the sexual plane gradual resumption of night erections.

Multilocular thymic cysts can be easily misdiagnosed as malignant tumor on computer tomography:A case report

BACKGROUND Multilocular thymic cyst(MTC)is a rare mediastinal lesion which is considered to occur in the process of acquired inflammation.It is usually characterized by well-defined cystic density and is filled with transparent liquid.CASE SUMMARY We report on a 39-year-old male with a cystic-solid mass in the anterior mediastinum.Computer tomography(CT)imaging showed that the mass was irregular with unclear boundaries.After injection of contrast agent,there was a slight enhancement of stripes and nodules.According to CT findings,it was diagnosed as thymic cancer.CONCLUSION After surgery,MTC accompanied by bleeding and infection was confirmed by pathological examination.The main lesson of this case was that malignant thymic tumor and MTC of the anterior mediastinum sometimes exhibit similar CT findings.Caution is necessary in clinical work to avoid misdiagnosis.

Pulmonary embolism secondary to acute anterior ST-elevation myocardial infarction:a case report

Thrombophilia denotes a condition,whether acquired or hereditary,characterized by increased susceptibility to hypercoagulation.[1]This condition was first described in 1965,coinciding with the discovery of an inherited predisposition to venous thromboembolism(VTE)in patients deficient in antithrombin III.[2]While arterial and venous thromboses are common in hospitalized patients,acute myocardial infarction(AMI)and pulmonary embolism(PE)stand out as lifethreateningconditions.However,theoccurrenceof AMI complicated by PE is exceedingly rare,especially when considering cases where paradoxical embolism originating from a patent foramen ovale is absent.This report presents a case of AMI complicated with PE.A comprehensive understanding of the pathophysiology of this rare yet critical condition is important for ensuring prompt diagnosis and treatment.

Relationship between nutritional therapy and beneficial bacteria ratio in severe disease

Objective:To evaluate relationship between changes in the beneficial bacteria in intensive care unit(ICU)patients and nutritional therapy type.Methods:Ten patients aged≥18 years admitted to the ICU between January and December 2020,were included.Good enteral nutrition was defined as early achievement of target calorie intake through enteral feeding.The ratio of beneficial bacteria at the first and second bowel movements after each patient’s admission was calculated and the patients were classified into the increase or decrease group.Among all patients,five each were in the increase and decrease groups.We investigated patient background,changes in sequential organ failure assessment(SOFA)and acute physiology and chronic health evaluation(APACHE)Ⅱscores,nutritional doses or methods,and clinical outcomes.Results:No relationship was found between changes in the ratio of beneficial bacteria and changes in SOFA/APACHEⅡscores at the time of admission.The rate of good enteral nutrition was significantly higher in the increase group than in the decrease group(4/5 vs.0/5,P=0.01).Conclusions:An increase in beneficial bacteria may be significantly related to the early establishment of enteral nutrition.In the future,accumulating cases may make it possible to establish a new nutritional strategy for critically ill patients from an intestinal microbiota perspective.

Cerebral fat embolism following autologous fat injection in facial reconstruction:A case report

BACKGROUND Autologous fat injection in facial reconstruction is a common cosmetic surgery.Although cerebral fat embolism(CFE)as a complication is rare,it carries serious health risks.CASE SUMMARY We present a case of a 29-year-old female patient who developed acute CFE following facial fat filling surgery.After the surgery,the patient experienced symptoms including headache,nausea,vomiting,and difficulty breathing,which was followed by neurological symptoms such as slurred speech and left-sided weakness.Comprehensive physical examination and auxiliary investigations,including blood tests,head and neck computed tomography angiography,and cranial magnetic resonance diffusion-weighted imaging,were performed upon admission.The clinical diagnosis was acute cerebral embolism following facial fat filling surgery.Treatment included measures to improve cerebral circulation,dehydration for intracranial pressure reduction,nutritional support,and rehabilitation therapy for left limb function.The patient showed a significant improvement in symptoms after 2 weeks of treatment.She recovered left limb muscle strength to grade 5,had clear speech,and experienced complete relief of headache.CONCLUSION Our case highlights the potential occurrence of severe complications in patients undergoing fat injection in facial reconstruction.To prevent these complications,plastic surgeons should enhance their professional knowledge and skills.

Correction:Establishment of a prediction model for prehospital return of spontaneous circulation in out-of-hospital patients with cardiac arrest

This is an erratum to an already published paper named“Establishment of a prediction model for prehospital return of spontaneous circulation in out-ofhospital patients with cardiac arrest”.We found errors in the affiliated institution of the authors.We apologize for our unintentional mistake.Please note,these changes do not affect our results.

Watson-Jones Anatomical Approach for Open Reduction and Internal Fixation of Proximal Femoral Fractures without Image Intensifier in a Low-Resource Setting

Introduction: Standard procedures for surgical fixation of proximal femoral fractures (PFF) require an image intensifier which in developing countries remains a luxury. We hypothesized that, with a well-codified technique, the Watson Jones approach (WJA) without image intensifier nor traction table, can allow open reduction and internal fixation (ORIF) of PFF using Dynamic hip screw (DHS), with satisfactory outcome. Patients and methods: Forty one consecutive patients (mean age 59.5 ± 21.6 years, 61% males) who were followed in a Teaching Hospital for PFF treated by ORIF using the WJA and DHS from January 2016 to December 2020 were reassessed. The outcome measures were the quality of the reduction, the positioning of the implants, the tip-apex distance (TAD), the rate and delay of consolidation, the functional results using Postel Merle d’Aubigné (PMA) score, the rate of surgical site infection (SSI) and the overall mortality. Logistic regression was used to determine factors associated with mechanical failure. Results: The mean follow-up period was 33.8 ± 15.0 months. Fracture reduction was good in 31 (75.6%) cases and acceptable in 8(19.5%) cases. Implant position was fair to good in 37 (90.2%) patients. The mean TAD was 26.1 ± 3.9 mm. Three patients developed SSI. Consolidation was achieved in 38 (92.6%) patients. The functional results were good to excellent in 80.5% of patients. The overall mortality rate was 7.3%. There were an association between mechanical failure and osteoporosis (p = 0.04), fracture reduction (p = 0.003), and TAD (p = 0.025). In multivariate logistic regression, no independent factors were predictive of mechanical failure. Conclusion: This study shows that ORIF using DHS for PFF via the Watson-Jones approach without an image intensifier can give satisfactory anatomical and functional outcomes in low-resource settings. It provides and validates a reliable and reproducible technique that deserves to be diffused to surgeons in austere areas over the world.

Is it a normal phenomenon for pediatric patients to have brain leptomeningeal contrast enhancement on 3-tesla magnetic resonance imaging?

Determining whether sevoflurane sedation in children leads to“pseudo”prominent leptomeningeal contrast enhancement(pLMCE)on 3 Tesla magnetic resonance imaging will help reduce overdiagnosis by radiologists and clarify the pathophysiological changes of pLMCE.

A Meta-Analysis of the Effect of Modified Gastric Tube Length on Enteral Nutrition in Stroke Patients

Objective:To systematically evaluate the effect of modified length of gastric tube implantation in stroke patients.Methods:Randomized controlled studies on the effect of narrative therapy on negative emotions of malignant tumor patients were published in PubMed,EMbase,Web of Science,Cochrane Library,CNKY.Wanfang Data,VIP Database and CBM disc from database establishment to May 2021.RewMan 5.2 software was used for the meta-analysis.Results:Ten articles were included,involving 1140 patients in total.Results of meta-analysis showed that improved length of gastric tube implantation could reduce the incidence of aspiration pneumonia in stroke patients with enteral nutrition[OR=0.18,95%CI(0.10,0.31),P<0.00001],reduce gastroesophageal reflux rate[OR=0.13,95%CI(0.04,0.38),P<0.0002],the incidence of aspiration[OR=0.23,95%CI(0.11,0.38),P<0.00001],the incidence of abdominal distension and diarrhea[OR=0.13,95%CI(0.06,0.28),P<0.00001],the incidence of choking cough[OR=0.20,95%CI(0.07,0.61),P<0.005],but no difference between the two groups in terms of reducing gastric residual[OR=0.10,95%CI(2.40,2.60),P=0.94].Conclusions:The modified length of the gastric tube can replace the traditional length of the gastric tube in the application of stroke patients,can reduce the complications of enteral nutrition,is safe and feasible.However,due to the limitation of the quality and quantity of the included studies,we should be cautious about the results of this meta-analysis and expect to carry out more large-sample and high-quality randomized controlled trials for demonstration.

Evaluation of the Effectiveness and Efficiency of the Combination of Levamlodipine Besylate and Valsartan in the Treatment of Hypertension

Objective:To investigate the effectiveness and efficiency of combining levamlodipine besylate and valsartan in the treatment of hypertension.Methods:This study selected 28 patients with hypertension as observation subjects.The treatment duration ranged from January 2020 to June 2023.Using the random number table method,patients were divided into two groups.The control group received treatment with valsartan,while the observation group received a combination of valsartan and levamlodipine besylate.Therapeutic effects and safety were compared between the groups,and changes in the patient’s blood pressure and renal function index levels were assessed.Results:The total clinical effective rate of the observation group was significantly higher than that of the control group(P<0.05).The observation group demonstrated better diastolic blood pressure,systolic blood pressure,and renal function indicators compared to the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:The combined treatment of levamlodipine besylate and valsartan in patients with hypertension showed significant clinical efficacy and holds broad application value.

A prediction model for large vessel occlusion in suspected stroke patients based on available prehospital information

Objective:Early and accurate identification of large vessel occlusion(LVO)acute ischemic stroke(AIS)patients is critically important for stroke management.Practicable scales with simple items can facilitate prehospital paramedics distinguishing LVO-AIS patients with high efficiency and help to avoid unnecessary and costly delays.The current study aims to develop a screening tool to predict AIS-LVO patients based on prehospital available data.Method:A total of 251 suspected stroke patients who were transported to the emergency department of our hospital via emergency medical services were consecutively enrolled from August,2020 to January,2022.Data including demographic information,medical history,clinical manifestations,and vital signs were collected.A multivariate logistic regression model was developed based on statistically significant variables selected from univariate analysis.Result:Forty-two patients(16.7%)were diagnosed as LVO-AIS based on imaging validation at admission.A comprehensive model was developed with past medical history factors such as atrial fibrillation and coronary heart disease,vital signs such as systolic blood pressure,and prominent symptoms and signs such as gaze palsy,facial paralysis,and dysarthria.The model showed better diagnostic performance in terms of area under the receiver operating characteristic curves(0.884,95%CI,0.830-0.939),which was higher than other common prehospital prediction scales such as the Face,Arm,Speech,Time test(FAST),the Field Assessment Stroke Triage for Emergency Destination(FAST-ED)scale,and the Gaze-Face-Arm-Speech-Time test(G-FAST).Calibration curve analysis,decision curve analysis,and clinical impact curve analysis further validated the reliability,net benefit,and potential clinical impact of the prediction model,respectively.Conclusion:We conducted a prediction model based on prehospital accessible factors including past history of atrial fibrillation and coronary heart disease,systolic blood pressure,and signs such as gaze palsy,facial palsy,and dysarthria.The prediction model showed good diagnostic power and accuracy for identification of the high-risk patients with LVO and may become an effective tool for the LVO recognition in prehospital settings.Future studies are warranted to refine and validate the model further in order to enhance the accuracy and objectivity of clinical judgments.

Overview of the Shenzhen Emergency Medical Service Call Pattern

BACKGROUND：In Shenzhen, the Emergency Medical Service （EMS） system has been in service since 1997. This study aims to examine the operation of Shenzhen 120 EMS center and to identify the reasons of calling EMS.BACKGROUND：In this retrospective quantitative descriptive study, the data from the Shenzhen 120 EMS registry in 2011 were analyzed.RESULTS：Shenzhen 120 EMS center is a communication command center. When the number of 120 are dialed, it is forwarded to the closest appropriate hospital for ambulance dispatch. In 2011, the Shenzhen 120 EMS center received 153 160 ambulance calls, with an average of 420 calls per day. Calling emergency services was mainly due to traffic accidents. Trauma and other acute diseases constituted a majority of ambulance transports. The adult patients aged 15-60 years are the principal users of EMS. There are no recognized ＇paramedic＇ doctors and nurses. The pre-hospital emergency service is under the operation of emergency departments of hospitals. Shenzhen at present does not have specialized pre-hospital training for doctors and nurses in posttrauma management. Moreover, specialized pre-hospital training, financial support, and public health education on proper use of EMS should be emphasized.CONCLUSION：The Shenzhen 120 EMS center has its own epidemiology characteristics. Traumatic injury and traffic accident are the main reasons for calling ambulance service. In-depth study emphasizing the distribution and characteristics of trauma patients is crucial to the future development of EMS.

The Chinese guideline for management of snakebites

In 2009,the World Health Organization included snakebite on the list of neglected tropical diseases,acknowledging it as a common occupational hazard for farmers,plantation workers,and others,causing tens of thousands of deaths and chronic physical disabilities every year.This guideline aims to provide practical information to help clinical professionals evaluate and treat snakebite victims.These recommendations are based on clinical experience and clinical research evidence.This guideline focuses on the following topics:snake venom,clinical manifestations,auxiliary examination,diagnosis,treatments,and prevention.

The Effectiveness of Antiviral Treatment in Severe COVID-19 Patients in Wuhan,China:A Multicenter Study

Coronavirus disease 2019(COVID-19)has inarguably caused the most challenging pandemic.In less than 2 years,greater than 200 million cases of COVID-19 and 4.5 million deaths have been reported worldwide[1].The treatment strategy of an emerging infectious disease is a huge challenge for clinical practitioners because of missing key knowledge about the disease.

Clinical characteristics of patients with black widow spider bites: A report of 59 patients and single-center experience

Dear editor,The black widow spider species, also known as the Latrodectus species by its biological nomenclature, is one of more than 40,000 different spider species and one of the most common poisonous species to humans.[1] It is reported to be responsible for most of the clinically significant envenomation among all species of spiders in the USA.

A study on medical rescue model of trans-regional emergency response linkage and its application

This paper explores medical rescue model of trans-regional emergency response which shall be suited to administrative border areas for the sake of more efficient performance of emergency medical rescue in border areas. Benefited from the existing emergency medical resources in the regional cooperation and the grid management theory, this paper establishes the emergency rescue mechanism featuring'information exchange, resource sharing, and authorized command' by analyzing the shortcomings of current emergency management mechanism in the border areas around Yinchuan. A linkage mechanism should also be set up between two parties (multiple parties) in the border areas for a better command and dispatch platform, as well as drawing up emergency response plan and organizing trans-regional emergency drills. The solution lies in the more efficient treatment of emergency response in border areas. Taking response time for emergency call as the sole criterion, this paper suggests on the establishment of'integrated, coordinated, linked, and effective' medical rescue mode of regional emergency response linkage in a multi-level and grid-based way and an emergency rescue mechanism with characteristics of'information exchange, resource sharing, and authorized command'. It is of great significance to improve emergency response time in the border areas around Yinchuan and utilization of emergency rescue resources, to enhance coordinating work of emergency systems in different administrative regions, and to achieve an emergency response network seamlessly connected with different regions.

Overexpression of vascular endothelial growth factor enhances the neuroprotective effects of bone marrow mesenchymal stem cell transplantation in ischemic stroke

Although bone marrow mesenchymal stem cells(BMSCs)might have therapeutic potency in ischemic stroke,the benefits are limited.The current study investigated the effects of BMSCs engineered to overexpress vascular endothelial growth factor(VEGF)on behavioral defects in a rat model of transient cerebral ischemia,which was induced by middle cerebral artery occlusion.VEGF-BMSCs or control grafts were injected into the left striatum of the infarcted hemisphere 24 hours after stroke.We found that compared with the stroke-only group and the vehicle-and BMSCs-control groups,the VEGF-BMSCs treated animals displayed the largest benefits,as evidenced by attenuated behavioral defects and smaller infarct volume 7 days after stroke.Additionally,VEGF-BMSCs greatly inhibited destruction of the blood-brain barrier,increased the regeneration of blood vessels in the region of ischemic penumbra,and reducedneuronal degeneration surrounding the infarct core.Further mechanistic studies showed that among all transplant groups,VEGF-BMSCs transplantation induced the highest level of brain-derived neurotrophic factor.These results suggest that BMSCs transplantation with vascular endothelial growth factor has the potential to treat ischemic stroke with better results than are currently available.

Construction of cough refl ex intensity score for critically ill patients based on the Delphi method

Airway management is important for critically ill patients.Improper airway management can directly threaten the life of patients.[1]Early correct airway assessment and effective airway management can improve patient prognosis.[2]Coughing ability plays an important role in the decision-making process of airway management.Patients with impaired coughing ability have a higher risk of tracheal intubation during treatment.The concept of cough strength was first proposed by Khamiees in 2001,[3]but the evaluation criteria did not include coughing ability.The purpose of this study was to assess patients’coughing ability through the Delphi method and expert consultation,to provide data support for establishing a cough reflex intensity score and to construct an advanced airway management model for quick and eff ective evaluation.[4,5]