Impact of diff erent waves of COVID-19 on emergency medical services and out-of-hospital cardiopulmonary arrest in Madrid, Spain

Out-of-hospital cardiac arrest(OHCA)is one of the three leading causes of death in industrialized countries.[1,2]Some studies have described the impact of the first COVID-19 pandemic wave in terms of the number of cases and OHCA survival rates in various regions,[3-5]but few have addressed the relationship between the successive phases and how they affected OHCA.[6,7]The 14-d cumulative incidence peaked at more than 990 cases,with these rates remaining above 200 for an eight-month period between 15 March 2020 and 15 March 2021 in Madrid,Spain.

Medical services for sports injuries and illnesses in the Beijing 2022 Olympic Winter Games

BACKGROUND:Beijing 2022 Olympic Winter Games was the second Games held amid the COVID-19 pandemic.To a certain extent,it has altered the way sporting activities operate.There is a lack of knowledge on injury risk and illness occurrence in elite winter sport athletes amid the COVID-19 pandemic.This study aimed to describe the incidence of injuries and illnesses sustained during the XXIV Olympic Winter Games in Beijing from February 4 to 20,2022.METHODS:We recorded the daily number of injuries and illnesses among athletes reported by Beijing 2022 medical staff in the polyclinic,medical venues,and ambulance.We calculated injury and illness incidence as the number of injuries or illnesses occurring during competition or training,respectively,with incidence presented as injuries/illnesses per 100 athlete-days.RESULTS:In total,2,897 athletes from 91 nations experienced injury or illness.Beijing 2022 medical staff reported 326 injuries and 80 illnesses,equaling 11.3 injuries and 2.8 illnesses per 100 athletes over the 17-day period.Altogether,11%of the athletes incurred at least one injury and nearly 3%incurred at least one illness.The number of injured athletes was highest in the skating sports(n=104),followed by alpine skiing(n=53),ice track(n=37),freestyle skiing(n=36),and ice hockey(n=35),and was the lowest in the Nordic skiing disciplines(n=20).Of the 326 injuries,14(4.3%)led to an estimated absence from training or competition of more than 1 week.A total of 52 injured athletes were transferred to hospitals for further care.The number of athletes with illness(n=80)was the highest for skating(n=33)and Nordic skiing(n=22).A total of 50 illnesses(62.5%)were admitted to the department of dentistry/ophthalmology/otolaryngology,and the most common cause of illness was other causes,including preexisting illness and medicine(n=52,65%).CONCLUSION:Overall,11%of athletes incurred at least one injury during the Games,which is similar to the findings during the Olympic Winter Games in 2014 and 2018.Regarding illness,2%of athletes were affected,which is approximately one-third of the number affected in the 2018 Olympic Winter Games.

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.METHODS: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.In2011,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.

Community Knowledge and Attitude about Burns First Aid (BFA) in Jazan, Saudi Arabia

Introduction and Significance: Burn injury (BI) is a considerable health issue which is responsible for around 300,000 deaths and affecting about 11 million people every year worldwide. In Saudi Arabia, the prevalence of BIs array from 112 to 518 per 100,000 per year. The appropriate awareness of performing first aid could facilitate to improve the outcomes of burns. Purpose and Objectives: To appraise the community that acknowledges burns, first aid, and associated factors among the community population in Jazan City, Saudi Arabia. The paper aims to identify limitations to encourage additional research and persuade legislators to develop improved burn-injury care recommendations and training programs. Materials and Methods: An observational-based sample survey was conducted among the people who live in Jazan City aging 13 years or more, during April 5 to May 5, 2023. Data collection was done by a validated online self-administrated questionnaire sent randomly to community members in different parts of Jazan City via social media platforms. Collected data were coded and cleaned by an excel program, and finally exported on SPSS 26.0 software. The variables were analyzed using descriptive statistics like frequencies and percentages. Also, the Chi-square test was used to investigate the relation between different variables, with a significance value of P Results: This study included 243 participants (about 62%) among them were mostly male participants (151) having a university degree. The majority of participants 75% did not take any form of BFA training in the past. This study shows that 69.9% of the participants have inadequate awareness, despite 72% having a constructive attitude towards burn first aid. Previous burn-related first aid training was significantly associated with participants’ knowledge of BFA at a p-value less than 0.05. Conclusion: This study indicates a high frequency of Jazan population having inadequate knowledge of burn first aid despite the high prevalence of a favorable attitude. There is a need to develop an effective nationwide burn prevention program and early burn first aid treatment in Saudi Arabia and promote a consistent guideline for burn first aid.

Effects of a closed-loop system against SARS-CoV-2 at the Beijing 2022 Olympic Winter Games:a descriptive and modeling study

BACKGROUND:To assess the efficacy of the epidemic prevention measures of the“closed-loop”system adopted by the Beijing 2022 Olympic Winter Games(BOWG).METHODS:We retrospectively collected and analyzed information,including age,sex,nationality,vaccination status,date of diagnosis,and date of entry,from 280 SARS-CoV-2-positive individuals identified during the BOWG.A susceptibility-exposed-infectious-remove model was employed to evaluate the effectiveness of epidemic prevention strategies on controlling the spread of SARS-CoV-2 under different scenarios during the BOWG.RESULTS:Regarding SARS-CoV-2-positive cases,97.9%were imported,and 96.4%were asymptomatic.The median age was 37 years(range:29–47 years),and 73.9%were male,with the majority of cases being broadcasters and European attendees.Regarding vaccination status,93.5%were fully vaccinated,and six cases were considered to have been infected in the closed-loop system during the BOWG.Assuming that the BOWG adopted a semi-closed-loop management system,the cumulative number of confirmed cases would be 1,137 for quick quarantine measures(3 d later)implemented and 5,530 for delayed quarantine measures(9 d later)implemented.This modeling revealed that stringent pandemic prevention measures and closed-loop management effectively controlled the spread of SARS-CoV-2 during the BOWG.CONCLUSION:Imported cases are considered the main risk factor for SARS-CoV-2 transmission during mass gatherings,but a comprehensive closed-loop system could minimize transmission among attendees and general personnel.

Prevalence of Post-Traumatic Stress Disorder (PTSD) among Healthcare Workers Following COVID-19 Pandemic in Jazan Region, KSA

Background: COVID-19 was declared a worldwide pandemic by the World Health Organization in 2020. Many pieces of research have been published on the virus’s pattern and transmission routes, and a few studies have been published on its psychological repercussions for the general public and health care workers in particular. We aimed in this study to figure out the impact of COVID-19 pandemic on the mental health of health care workers in the Jazan region and compare it to non-health care workers. Results: There were 221 participants in this study conducted in the Jazan region KSA, during the first part of 2022. 117 participants were non-HCWs (Health Care Workers) and 104 participants were HCWs. 31.7% of HCWs had high score of PTSD symptoms which may suppress their immunity, PTSD was a clinical concern in 12.5%, 6.7% had probable PTSD, and 49% had no PTSD. The average PTSD score in HCWs was 26.14. In contrast, the great majority of non-HCWs (69.2%) had no PTSD;PTSD was a clinical concern in 16.2%, 11.1% had a score indicating PTSD had the potential for immunosuppression, and 3.4% had probable PTSD. Conclusion: The COVID-19 pandemic did not affect just those who were infected with the virus, nor was it restricted to the mental health of those afflicted;rather, the influence expanded until it reached the general public and, in particular, those who had contact with patients, such as health care workers. As a result, mental health investigation, follow-up, and therapy are required to preserve the mental health of health care workers as well as the general population.

Neuroprotective Effect of Chrysophanol as a PI3K/AKT/mTOR Signaling Inhibitor in an Experimental Model of Autologous Blood-induced Intracerebral Hemorrhage

Objective Intracerebral hemorrhage(ICH)refers to predominant,sporadic,and non-traumatic bleeding in the brain parenchyma.The PI3K/AKT/mTOR signaling pathway is an important signal transduction pathway regulated by enzyme-linked receptors and has many biological functions in mammals.It plays a key role in neuronal metabolism,gene expression regulation,and tissue homeostasis in the healthy and diseased brain.Methods In the present study,the role of the PI3K/AKT/mTOR pathway inhibitor chrysophanol(CPH)(10 mg/kg and 20 mg/kg,orally)in the improvement of ICH-associated neurological defects in rats was investigated.Autologous blood(20µL/5 min/unilateral/intracerebroventricular)mimics ICH-like defects involving cellular and molecular dysfunction and neurotransmitter imbalance.The current study also included various behavioral assessments to examine cognition,memory,and motor and neuromuscular coordination.The protein expression levels of PI3K,AKT,and mTOR as well as myelin basic protein and apoptotic markers,such as Bax,Bcl-2,and caspase-3,were examined using ELISA kits.Furthermore,the levels of various neuroinflammatory cytokines and oxidative stress markers were assessed.Additionally,the neurological severity score,brain water content,gross brain pathology,and hematoma size were used to indicate neurological function and brain edema.Results CPH was found to be neuroprotective by restoring neurobehavioral alterations and significantly reducing the elevated PI3K,AKT,and mTOR protein levels,and modulating the apoptotic markers such as Bax,Bcl-2,and caspase-3 in rat brain homogenate.CPH substantially reduced the inflammatory cytokines like interleukin(IL)-1β,IL-6,and tumor necrosis factor-α.CPH administration restored the neurotransmitters GABA,glutamate,acetylcholine,dopamine,and various oxidative stress markers.Conclusion Our results show that CPH may be a promising therapeutic approach for overcoming neuronal damage caused by the overexpression of the PI3K/AKT/mTOR signaling pathway in ICH-induced neurological dysfunctions in rats.

Risk management strategies for the 2022 Olympic Winter Games:The Beijing scheme

As the first international sporting event scheduled since the outbreak of the novel coronavirus disease 2019(COVID-19)pandemic,the Beijing XXIV Olympic Winter Games were officially held in China between the 4th and 20th of February 2022.1 According to the International Olympic Committee(IOC),there were approximately 2900 elite athletes from 91 National Olympic Committees competing in 109 events during the 16 days of the Games.2 In fact,under the conditions of a global pandemic,mass gatherings during large-scale sporting events represent a conducive environment for viral transmission given the close,prolonged,and frequent interactions between participants;this includes an increased risk of transmission of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).

Knowledge, Attitudes, Beliefs and Perceived Risk of Acute Coronary Syndrome among Jordanian Patients

Background: Acute Coronary Syndrome (ACS)-associated mortality is considered high and still raising, where outcomes can be improved through immediate treatment initiation. Knowledge, attitudes, beliefs and perceived risk are cognitive factors that can affect patient’s decision to seek care immediately. Therefore, this study aimed to explore knowledge, attitudes, beliefs, and perceived risk for future ACS event among Jordanian ACS patients. Methods: A descriptive, cross-sectional, correlational design was used to conveniently recruit 160 ACS patients from CCUs and medical floors at three Jordanian hospitals using the Modified ACS Response Questionnaire. Results: Almost, 65% of participants had low level of ACS knowledge, specifically regarding untraditional ACS symptoms. Some negative attitudes and beliefs toward ACS were found. There was a moderate positive correlation between knowledge score and all of attitudes, beliefs and perceived risk score (r = 0.549, p Conclusion: Inadequate ACS knowledge, negative attitudes and beliefs toward ACS were associated with low perceived risk for future ACS event. Therefore, it is a priority to develop strategies that consider improving ACS patients’ knowledge, attitudes, beliefs and perceived risk. This could be effective to enhance patient’s decision to seek care and reduce ominous outcomes.

Status epilepticus as a complication after COVID-19 mRNA-1273 vaccine:A case report

BACKGROUND We present a rare case of status epilepticus in a 56-year-old man which arose as a complication after vaccination with the coronavirus disease 2019(COVID-19)mRNA-1273 vaccine.The patient's history included well-compensated secondary epilepsy.The root cause of the situation was a fever which had developed as a side effect of the vaccination.CASE SUMMARY A 56-year-old man received the first dose of mRNA-1273 vaccine against the severe acute respiratory syndrome-coronavirus-2.The vaccine was administered intramuscularly(100 mg,0.5 mL).The next morning the man was found to be suffering from fever and headaches while at the same time experiencing general weakness.He lost consciousness suddenly and experienced generalized clonic seizures which turned into status epilepticus.When the Emergency Medical Service arrived the patient was unconscious with spontaneous breathing and generalized clonic seizures.It was necessary to administer diazepam repeatedly.It was also necessary to administer high doses of levetiracetam and temporary propofol.The status epilepticus was brought under control approximately 90 min after the patient’s transport to the Emergency Department.A follow-up electroencephalogram no longer revealed abnormal indications of epileptic fit.The patient was temporarily hospitalized in the Intensive Care Unit and after seven days care was discharged without any further apparent effects.CONCLUSION There is currently no specific treatment against COVID-19.Therefore,the benefits of COVID-19 vaccine protection outweigh the risks.

Case of morphine-induced ventricular fi brillation

Morphine is considered as a traditional and safemedication to relieve pain and dyspnea in the setting of acutecoronary syndrome and cardiogenic pulmonary edema.[1,2]It is also attributed to dispose an antiarrhythmic effect.[3] Wereport a case of morphine-induced ventricular fi brillation inthe prehospital emergency treatment. The patient presentedacute myocardial infarction with ST segment elevationscomplicated with uncontrolled hypertension and cardiogenicpulmonary edema.

Sweet food improves chronic stress-induced irritable bowel syndrome-like symptoms in rats

AIM:To investigate whether palatable sweet foods have a beneficial effect on chronic stress-induced colonic motility and inflammatory cytokines.METHODS:Adult male rats were divided into 3groups:control(CON,n=5),chronic variable stress with chow(CVS-A,n=6),and chronic variable stress with chow and sweet food(CVS-B,n=6).The rats were fed standard rodent chow as the chow food and/or AIN-76A as the sweet food.A food preference test for AIN-76A was performed in another group of normal rats(n=10)for twelve days.Fecal pellet output(FPO)was measured for 6 wk during water bedding stress in the CVS groups.The weight of the adrenal glands,adrenocorticotropic hormone(ACTH)and corticosterone levels in plasma were measured.The expression levels of transforming growth factor-β,interleukin(IL)-2,and interferon-gamma(IFN-γ)were measured in the distal part of colonic tissues and plasma using Western blot analysis.RESULTS:In sweet preference test,all rats initially preferred sweet food to chow food.However,the consumption rate of sweet food gradually decreased and reduced to below 50%of total intake eight days after sweet food feeding.Accumulated FPO was higher in the CVS-A group compared with the CVS-B group over time.All stress groups showed significant increases in the adrenal to body weight ratio(CVS-A,0.14±0.01;CVS-B,0.14±0.01)compared with the control group(0.12±0.01,P<0.05).The plasma corticosterone and ACTH levels were significantly higher in the CVS-A(537.42±32.95,44.44±6.54 pg/mL)and CVS-B(655.07±30.82,65.46±4.44 pg/mL)groups than in the control group(46.96±13.29,8.51±1.35 pg/mL,P<0.05).Notably,the ratio of corticosterone to ACTH was significantly increased in the CVS-A group only.Rats exposed to CVS displayed significantly increased expression of IL-2 and IFN-γin the plasma and distal colon compared to the control group,whereas this effect was significantly attenuated in the CVS-B group.CONCLUSION:These results suggest that concurrent sweet food ingestion during CVS might have an effect on the reduction of stress-induced colonic hyper-motility and pro-inflammatory cytokine production in rats.

Thoracic aortic rupture due to airbag deployment

Dear editor,Airbags are an example of passive preventive measures reducing the risk of severe injury or death from a motor vehicle accident. However, airbags have also been described as a source of injuries related to airbag deployment. Typical airbag-related injuries are eye injuries, cervical spine injuries, rib fractures, cardiac injuries, extremity injuries, and thoracic aortic rupture(TAR).[1-3] Approximately one-third of patients with TAR who survive till hospital admission die before surgical treatment.[4] We present a patient with TAR after a lowspeed motor vehicle accident with rapidly deteriorating vital signs and subsequent death on the scene.

Current situation of mechanical CPR devices in donors after cardiac death

Mechanical CPR (cardiopulmonary resuscitation) devices help performing correct chest compressions in the event of a cardiorespiratory arrest. These devices are comfortable and useful, they keep chest compression following the recommendations as they do not depend on interpersonal variability, they do not get tired, their use is simple and one of the rescuers is released from this task, thus facilitating the assistance. Besides, their use in transport conditions makes it safer. However, when coming to results, these mechanical CPR devices have not clearly demonstrated such an advantage, neither in the field of cardiac arrest, nor in organ preservation in the case of donors after cardiac death. In donors after cardiac death they are widely used by most of the emergency services involved, but a number of injuries produced in lungs during the early years of their use have made it controversial. In this paper we make a review of the road traveled by mechanical CPR devices and of the main articles which mark the way.

Investigating Physical Exercise among Jordanians with Diabetes Mellitus

This study is aimed to investigate exercise behaviors (frequency and duration) among Jordanian diabetic patients, and their correlation with their physical characteristics and perceived exercise benefits and barriers, exercise self efficacy, and exercise planning. An exploratory descriptive design was utilized using the cross-sectional survey with self-reported questionnaires (Demographics, Charlson Comorbidity Index, Exercise Self-Efficacy Scale, Exercise Benefits and Barriers Scale, and Commitment to a Plan for Exercise Scale). A convenience sample of 115 Jordanians with diabetes mellitus was recruited from diabetes outpatient clinics. Participants reported an average number of 3.2 physical activities per week (average of 2.9 hours), with walking being the most common activity. Participant’s body mass index, comorbidity index, and exercise self-efficacy were correlated with both frequency and duration of exercise (r = -0.393, -0.286, 0.219 and -0.272, 0.383, 0.260, respectively). A predictive model of five predictors (age, BMI, CCI, exercise self efficacy, and perceived exercise barriers) that significantly predicted exercise duration (R2 = 0.34, F = 9.14, P < 0.000) was found. Diabetic patients were found to exercise less than optimum. Illness itself was not a cause of not exercising compared to lack of time and desire. Factors that can enhance or inhibit participants’ engagement in exercise should be included in designing tailored exercise educational programs.

Barriers of Asthma Care among Asthmatic Children in Saudi Arabia: Maternal Perspectives

Background Bronchial asthma is one of the most common chronic conditions among children. Despite the improvement in asthma treatment regimens, its prevalence and related morbidity are increasing, especially among underserved, minority children. There are barriers in the management of asthma, which may impact the quality of outcomes. The goal of this study is to explore these barriers. Methods A cross-sectional study was conducted on interview data collected through 2019 from mothers of children (aged 6 - 12 years) with asthma visiting, for convenience, a public shopping mall. The interviewees were randomly selected, because they met the inclusion criteria. Participants were considered if the mother answered “yes” to the following questions: Has your child had physician-diagnosed asthma? Is your child currently taking asthma medications of asthma? Two community nurses conducted the interviews. Data was obtained using administrative questionnaires. Data were analyzed using SPSS version 21.0 (IBM Inc., Chicago, IL, USA). Descriptive statistics of percentage, mean, frequency and standard deviation were applied for categorical and continuous variables. Results Three hundred mothers participated in this study. Their average age was 36.8 years, 55% were housekeepers by profession, and 34% had obtained less than high school education. The majority of children (61%) were males, 45% had moderate asthma, and 42% had mild asthma. The most frequent types of barriers identified by parents were environmental factors (67.7%), followed by health care providers (63%), the health care system (48%), and patient or family characteristics (43%). Mothers were specifically concerned about the use, safety, and long-term complications of medications, the impact of exercise limitation on their child’s quality of life, and their own quality of life. Conclusion This study showed several barriers against asthma care in Saudi Arabia, which mainly related to environmental or personal characteristics. This highlights the need to enhance current policies within the health care system in Saudi Arabia to overcome these barriers.

Expert consensus on difficult airway assessment

Background:Identifying a potentially difficult airway is crucial both in anaesthesia in the operating room(OR)and non-operation room sites.There are no guidelines or expert consensus focused on the assessment of the difficult airway before,so this expert consensus is developed to provide guidance for airway assessment,making this process more standardized and accurate to reduce airway-related complications and improve safety.Methods:Seven members from the Airway Management Group of the Chinese Society of Anaesthesiology(CSA)met to discuss the first draft and then this was sent to 15 international experts for review,comment,and approval.The Grading of Recommendations,Assessment,Development and Evaluation(GRADE)is used to determine the level of evidence and grade the strength of recommendations.The recommendations were revised through a three-round Delphi survey from experts.Results:This expert consensus provides a comprehensive approach to airway assessment based on the medical history,physical examination,comprehensive scores,imaging,and new developments including transnasal endoscopy,virtual laryngoscopy,and 3D printing.In addition,this consensus also reviews some new technologies currently under development such as prediction from facial images and voice information with the aim of proposing new research directions for the assessment of difficult airway.Conclusions:This consensus applies to anesthesiologists,critical care,and emergency physicians refining the preoperative airway assessment and preparing an appropriate intubation strategy for patients with a potentially difficult airway.

Trauma care system in Iran

客观在伊朗的损害的高负担要求一个全面损伤照顾系统的建立。这份报纸的目的是关于部件和功能描述损伤系统的当前的地位。在一个损伤系统的所有部件的损伤系统的当前的地位通过与损伤专家和政策制造者一起的专家面板和半结构化的会见被描述的方法。当前结果，各种各样的组织涉及损害，而是损伤的一条综合系统途径的预防，管理和康复是相当缺乏的。在通过媒介，交通规定加强，医院照顾和 prehospital 服务的公共教育的区域有进行中的进步。同时，关于高风险组资助，立法和教育有差距。教育和前面的训练标准上的问题衬里医疗队和持续教育和评估还有待于被探讨。损伤登记在一些省被驾驶了，但是作为它需要开发得好的基础结构(关于职员，维护，金融资源) ，它还没在我们损伤照顾的系统被建立。看起来，有损伤的问题之一在伊朗在乎的结论是在损伤系统组织之中的协作的缺乏。尽管损伤病人的临床的管理在最近的十年在我们的国家改善了，减少损害的负担在一个损伤系统的上下文要求一条组织途径到损伤的预防和管理。