Journal of Emergency Medicine, Trauma and Acute Care - العدد الحالي

Cadaveric simulation involves using preserved or fresh human bodies or body parts to provide highly realistic surgical training opportunities for healthcare students and professionals. It is a helpful method in medical education as it enables trainees to practice on real human anatomical structures. At Cambridge University Hospital, cadavers are imported from the United States, leading to storage and procurement challenges. Ensuring the psychological safety of learners is a high priority, with strict guidelines and faculty supervision. Cadaveric training is considered superior to plastic or virtual reality simulators as it offers comprehensive anatomical understanding and skills development. However, concerns about cost, ethical implications, and psychological impact persist. Artificial intelligence and augmented reality innovations could be potential alternatives to mitigate ethical concerns and logistical challenges and improve psychological safety. While cadaveric simulation continues to be vital in medical training in many countries worldwide, integrating advanced technologies could enhance learning experiences and address current limitations.

Background: Distal femoral fractures (DFFs) present significant therapeutic challenges owing to their anatomical complexity and variable outcomes, particularly in resource-limited settings, such as Yemen, where high-energy trauma from road traffic accidents is prevalent. Locking compression plates (LCPs) have emerged as promising treatment modalities in such contexts; however, their efficacy remains underexplored. This study aimed to evaluate the functional outcomes and complications of DFFs treated with LCPs in Sana’a, Yemen.

Methods: This prospective cohort study was conducted at Al-Kuwait University Hospital from March 20, 2022, to April 20, 2024, enrolling 18 patients with DFFs treated using LCPs. Patients underwent monthly follow-ups for 9 months, with functional outcomes assessed using Neer’s scoring system, which categorizes results as excellent (>85), good (70–85), fair (55–69), or poor (<55). Data were analyzed using the Statistical Package for the Social Sciences (SPSS), version 26.0.

Results: Among 18 patients (mean age: 36.8 ± 13.8 years; 61.1% male), 50.0% sustained fractures from road traffic accidents, reflecting Yemen’s trauma profile. The Orthopedic Trauma Association (AO/OTA) classification identified A3 fractures as the most common (27.8%). Neer scores averaged 78.2 ± 12.6, with 38.9% excellent (7/18), 44.4% good (8/18), 11.1% fair (2/18), and 5.6% poor (1/18) outcomes. Excellent or good results (83.3%) were consistent across sexes (p ;= ;0.81) and fracture types (open vs. closed; p ;= ;1.0). Complications occurred in 27.8% (5/18) of patients, including superficial infection (11.1%), deep infection (5.6%), and delayed union (11.1%), with a non-significant trend toward poorer outcomes in affected patients (60% vs. 92.3%; p ;= ;0.15). No non-unions were observed.

Conclusion: LCPs achieved excellent or good functional outcomes in 83.3% of cases, with a 27.8% complication rate, supporting their efficacy for A-type and osteoporotic fractures in resource-constrained, trauma-heavy settings. Larger studies with extended follow-up periods are essential to validate these findings and assess long-term risks, such as posttraumatic arthritis.

Background: The implementation of quality indicators (QIs) in emergency departments (EDs) is relatively limited, and the factors underlying their poor implementation remain poorly understood. This study aimed to identify and explore the barriers and facilitators to successfully implementing pediatric respiratory disease QIs in the ED from the perspective of expert panels.

Materials and Methods: A qualitative study design was conducted in March 2024, using semi-structured face-to-face interviews with a purposive sample of 13 physicians. Thematic analysis was used to identify key themes related to the barriers and facilitators of QI implementation in Jordanian ED settings.

Results: Thematic analysis identified several key themes and subthemes regarding the barriers and facilitators of implementing pediatric respiratory disease QI initiatives in the ED. The main themes included human resources, infrastructure constraints, policy and organization, influence on quality culture, electronic health systems, documentation, and administrators. The subthemes included lack of staff, lack of QI experts, workstation issues, resource availability, data availability, time constraints, standardized guidelines, triage procedures, management, lack of QI knowledge, workforce support, education and training, automated processes, user-friendly systems, standardization, printed guidelines, awareness, legal requirements, stakeholder involvement, monitoring and feedback, and administrative support.

Conclusions: Successfully implementing pediatric respiratory disease QIs in ED requires addressing both key barriers and facilitators. This includes resolving infrastructure constraints, enhancing data availability through rigorous documentation, and ensuring robust administrative support. Additionally, adopting standardized forms and clear written protocols can streamline processes, while accountability measures and motivational strategies encourage the consistent implementation of QIs.

This study investigates the complex and often devastating impact of societal stigma on the emotional regulation and mental health of individuals with perceived ties to the Islamic State of Iraq and Syria (ISIS), with particular attention to survivors of forced marriages. Stigma, a pervasive social phenomenon characterized by negative attitudes and discriminatory behaviors, poses serious barriers to reintegration and healing for these vulnerable populations. By historically and theoretically underpinning stigma and emotion regulation relations, and highlighting quantitative analyses that point toward a strong relation between perceived stigma and emotion regulation difficulties, this article discusses implications vital to the understanding of professionals in mental health, policymakers’ concerns, and general social interests. The paper considers its implications for effective interventions and strategies for rehabilitation, fostering supportive and inclusive communities. This article identifies the deep-seated psychological impacts of societal judgment and argues for a shift in empathy, understanding, and comprehensive support to survivors who attempt to put their lives together.

Purpose: Spinal cord injury (SCI) is a complex event and causes biopsychosocial changes influencing the health and quality of life (QOL) of the patient and his/her family caregiver providing care at home. The current study aims to investigate the association between caregiver burden (CB) and patient-related factors in individuals with SCI.

Methods: A cross-sectional study on 50 SCI patients and their primary caregivers was conducted. SCIM III and SCS were used to collect information on functional status. Primary caregiver filled CB scale, SF-36, and 4DSQ (Four-Dimensional Symptom Questionnaire).

Results: The mean CB was found to be 36.64 ± 16.43. CB was significantly associated with ASIA grading (p value <0.001), financial strain (p value, 0.001), education level (p value <0.004), and age and independence (p value <0.001). The QOL and psychological factors of caregivers were associated with CB. All the domains of SF-36 and 4DSQ were significantly (p value <0.001) associated with caregivers’ burden.

Conclusion: CB was significantly associated with the SCI patient-related factors, and perceived burden impacted the QOL and mental health of the caregivers. Higher CB was associated with poor QOL and the presence of symptoms like distress, anxiety, depression, and somatization among caregivers.

Background: The study aimed to assess and compare the ease and success of intubation using channeled (Airtraq [AT]) versus non-channeled (McGrath [MG]) videolaryngoscopes in a simulated difficult airway.

Methods: This prospective, randomized, single blind study was conducted on 50 patients of either sex, aged between 20 and 60 years, belonging to American Society of Anesthesiologists I–II physical status, undergoing a surgical procedure requiring intubation. The appropriate size Philadelphia rigid cervical collar was applied to all patients. After the induction of anesthesia, patients were randomly allocated to one of two groups comprising 25 patients, using sealed envelopes. Group AT (n = 25) were intubated using Airtraq laryngoscope and group MG (n = 25) were intubated with McGrath laryngoscope. In all the patient’s successful intubation times, the first attempt success rate, Percentage of Glottic Opening (POGO), and Intubation Difficulty Scale score were noted. Hemodynamic changes were recorded immediately after intubation thereafter at 1, 3, and 5 minutes after successful intubation. Any kind of Airway trauma and postoperative sore throat was taken into note.

Results: Mean age in group AT was 39.68 ± 20.13 years compared to 37.56 ± 10.20 years in group MG. Intubation time was recorded and was found to be 87.28 ± 28.85 seconds with Airtraq and 65.60 ± 29.48 seconds with McGrath (p = 0.011). The POGO score was better in group AT than in group MG. The first attempt success rate was 84.0% in group AT compared to 76.0% in group MG (p = 0.725).

Conclusion: Though the channeled laryngoscope offers superior intubating conditions, enhanced ease, and an improved glottic view compared to the McGrath laryngoscope.

Background: The global ramifications of the COVID-19 pandemic prompt daily investigations into its multifaceted complications. This study aims to assess the potential effect of COVID-19 on the incidence and prognosis of stroke.

Methods: In this cross-sectional study, all patients referred to the Emergency Department of Imam Reza Hospital in Tabriz, Iran, between September 2021 and March 2022 with a stroke diagnosis underwent assessments and were checked for COVID-19 infection in the last 30 days. Findings were presented in mean ± standard deviation and frequency (percentage). The quantitative findings were compared using an independent sample t-test, and the string variables were analyzed using the chi-square test. All the patient’s demographic and clinical data were analyzed.

Results: We identified 776 patients with stroke and 13 patients with diagnosed COVID-19 infection in the 30 days prior. Patients with a history of COVID-19 did not differ significantly from those without a history in terms of age distribution (62.7 ± 10.6 vs. 64.8 ± 15.8; p value = 0.63). Notably, a higher proportion of patients with a previous COVID-19 diagnosis were male (76.92% vs. 22.15%; p value <0.001). Any statistically significant differences were detected in the clinical signs, symptoms, and brain computed tomography findings. However, we found that patients with a history of COVID-19 had significantly higher mortality rates compared to the other group (53.8% vs. 28.8%; p value = 0.04).

Conclusion: Patients with stroke with concurrent COVID-19 infection exhibited worse prognostic outcomes. Given the single-center design, small sample size, and lack of long-term follow-up, further multicenter and longitudinal studies are needed to explore long-term outcomes.

Background: Data on the functional outcomes and shoulder stiffness following treatment with proximal humeral internal locking system (PHILOS) plates for proximal humerus fractures (PHFs) are limited. This study aims to evaluate the functional outcomes and postoperative shoulder stiffness, as well as their predictors, in PHF patients treated with PHILOS plates.

Methods: This retrospective study included 53 patients with PHF who underwent surgical treatment using PHILOS plates between January 2021 and January 2023. The primary endpoint measured was the Constant-Murley Score (CMS) and its associated factors, while secondary outcomes included variables related to shoulder stiffness.

Results: Over a mean follow-up period of 19.6 ± 4.0 months, the union was achieved in 47 patients (89.3%). The mean postoperative CMS and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were 83.6 ± 10.4 and 23.6 ± 6.93 points, respectively. The CMS was rated excellent in 18 patients (34.0%), good in 20 patients (37.7%), fair in nine patients (17.0%), and poor in six patients (11.3%). Complications arose in 34% of patients, notably shoulder stiffness (22.6%), followed by screw penetration and varus malunion (both 5.7%). Postoperative CMS was positively associated with DASH score (r = 5.35, p < 0.001) and comorbidities (r = 2.88, p = 0.003). Conversely, it was negatively associated with age (r = −3.22, p = 0.014) and complications (r = −3.40, p = 0.005). In multivariate analysis, only high-energy injuries were identified as independent predictors of shoulder stiffness (adjusted odds ratio, 10.07 [95% CI, 1.06–95.81]; p = 0.045).

Conclusion: PHILOS plating demonstrates a reliable approach for managing PHFs, achieving a commendable union rate of 89.3% and positive functional outcomes. Postoperative CMS results are significantly affected by patient comorbidities and specific fracture characteristics. Furthermore, the predictive value of high-energy injuries on shoulder stiffness is crucial in devising targeted strategies to optimize recovery and reduce complications. These insights emphasize the importance of tailoring treatment plans to individual patient profiles, thereby enhancing the overall effectiveness of PHF management.

Background: Dermatologic emergencies are frequently missed in emergency department (ED) visits globally. Toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), necrotizing fasciitis (NF), disseminated infections, and severe allergic reactions can rapidly progress to systemic complications, requiring prompt diagnosis and intervention. Despite their critical nature, many emergency healthcare providers lack adequate training in recognizing and managing life-threatening dermatologic conditions.

Objective: To explore the prevalence, classification, and management strategies of dermatologic emergencies in emergency medicine settings.

Methodology: It is a narrative review. The duration of the study spanned 6 months. A structured search strategy was applied across major electronic databases, including PubMed, Scopus, and Google Scholar. Qualitative thematic analysis was used to categorize studies on dermatologic emergencies, identifying key themes, critical appraisals, gaps in knowledge, and opportunities for future research.

Results: Among 127 studies reviewed, burns comprised 4% to 7% of dermatologic ED cases, stings and bites 6%, and allergic reactions 22%, with 4% progressing to anaphylaxis. NF and TEN showed mortality rates of 24% to 34% and 25% to 35%, respectively. Systemic corticosteroids were used in 79% of immunologic emergencies, and antibiotics in 92% of infectious cases. Pediatric and geriatric patients accounted for 18% and 26% of cases. Prevention strategies were discussed in 41% of studies.

Conclusion: Dermatologic emergencies, though infrequent, carry high morbidity and mortality. Early recognition, multidisciplinary management, and preventive strategies are essential. Improved education and training of emergency and critical care physicians are crucial to optimizing patient outcomes.

Objectives: To prospectively evaluate the correlation between the anatomical zone of the external wound and the location of internal injuries in patients undergoing exploration for penetrating neck trauma (PNT) in Sana’a, Yemen.

Methods: We prospectively enrolled patients presenting to teaching hospitals in Sana’a (January 2020–April 2021) with PNT who required neck exploration. The collected data included demographics, injury mechanisms, clinical presentation, imaging findings, intraoperative findings (external wound zone vs. internal injury site), and outcomes. Correlation was defined as an internal injury occurring within the same anatomical zone as the external wound. Statistical analysis was performed using Chi-square or Fisher’s exact test (p < 0.05).

Results: Fifty-five male patients (mean age, 30.0 ± 9.2 years) were included. Gunshot wounds were the most common mechanism (61.8%), and most external wounds were located in Zone II (90.9%). Internal injuries were correlated with the external wound zone in 33 (60.0%) patients, whereas 22 (40.0%) had internal injuries in a different zone (most often inferior). No statistically significant association was found between the external wound zone and internal injury site (p = 0.208) or when analyzing specific zones or injury mechanisms (p > 0.05). Computed tomography angiography (CTA) was performed in 85.1% of patients. Morbidity occurred in 32.7% of the patients, with a mortality rate of 1.8%.

Conclusion: The anatomical zone of the external wound demonstrated a poor correlation and no statistically significant association with the site of internal injury in this cohort of patients with PNT requiring exploration. These findings challenge the utility of the traditional zone-based approach in guiding patient management. Patient hemodynamic status, clinical signs, and selective imaging (particularly CTA) appear to be more reliable determinants for intervention, supporting a “no-zone” management strategy.

Background: Acute gastroenteritis (AGE) is a common disease observed in emergency departments (ED). Most cases of AGE are of viral causes and are self-limiting; however, in some patients, this can lead to acute kidney injury (AKI), which can lead to serious complications. Several variables have been studied to diagnose and measure the extent of morbidity due to these conditions, with neutrophil gelatinase-associated lipocalin (NGAL) being important. The present study was conducted with the aim to ascertain whether plasma NGAL levels can be used as a marker for diagnosing AKI in patients with dehydration due to AGE.

Patients and Methods: A prospective cohort study was conducted among patients admitted to the ED of a tertiary healthcare centre between the years 2015 and 2017. Patients aged between 15 and 65 years who were diagnosed with AGE were included in the study. Patients with known major comorbidities or drug use were excluded from this study. The classification of dehydration was calculated in conjunction with measurements of plasma NGAL, serum creatinine (SCr), and blood urea nitrogen.

Results: Of the 50 selected patients, most participants (72%) reported a SCr < 1.1 (normal). Plasma NGAL levels >100 ng/mL were observed among 44% patients, while 28% had plasma NGAL <100. There was a significant difference (p < 0.001) between the mean plasma NGAL levels in patients with mild dehydration (104.88 ± 51.38 ng/mL) when compared to those with moderate dehydration (243.83 ± 120.62 ng/mL). SCr also showed a similar trend with p < 0.002, with mean SCr of mild and moderately dehydrated groups being 0.78 ± 0.23 and 1.03 ± 0.30, respectively. Plasma NGAL and SCr levels showed a significant positive correlation (r = 0.486; p < 0.001), whereas plasma NGAL and glomerular filtration rate showed a significant negative correlation (r = −0.428; p < 0.002).

Conclusion: Mild and moderately dehydrated AGE patients had significantly higher plasma NGAL concentrations, even in the early stages, with normal SCr values. Plasma NGAL levels may be used as an early biomarker to identify adults with mild or moderate dehydration who are at increased risk for developing AKI.

Background: Kite-flying festivals, while culturally significant, have been associated with an increase in traumatic injuries. This study aims to analyze and compare the epidemiological trends of kite-related injuries over two consecutive years (2023 and 2024), assess shifts in injury mechanisms, and recommend preventive strategies.

Materials and Methodology: This retrospective study was conducted in the department of emergency medicine at a tertiary care hospital during the time period of the kite flying festival in January of the years 2023 and 2024. All patients with kite-flying–related injuries occurring in the study period were included in this study. The medical records, including demographic details, injury pattern, presenting complaints, mechanism of injury, time of injury, and arrival in the emergency department, whether the patient was directly involved in kite flying or not, were recorded and reviewed. Injury severity score was calculated for each patient, and the treatment given to the patient was recorded.

Results: A total of 145 patients with kite-flying–related injuries were included in the study; 72 and 73 patients in 2023 and 2024, respectively. Males aged 21 to 40 years were the highest-risk group across both years. Thread cut injuries on the face and neck, either alone or in combination, were the highest presentation seen in 64.13% of patients. Most of the patients had abrasion and laceration-type injuries. A significant shift in injury mechanisms was observed (p = 0.011), with increased falls and thread-handling injuries in 2024. Most of the patients were discharged from the ED (77.2%), and seven were shifted to the ICU. Eleven patients had an injury severity score of more than 10.

Conclusion: The kite flying festival–related injuries cause an extra burden on the health system and a negative impact on society. Policy-level interventions, including traffic safety regulations and bans on hazardous kite strings, are recommended.

Introduction: Effective reduction of post-operative pain is vital for patient care, early mobilization, quick recovery, and a brief hospital stay. Vitamin C has been explored for its potential analgesic properties in postoperative settings, but its clinical utility remains inconclusive. Our study aimed to assess the effect of vitamin C on post-operative pain in patients undergoing lower limb surgery and its safety profile.

Methods: This randomized, open-label, parallel-group study investigated the effectiveness of vitamin C supplementation as an additional treatment alongside standard pain management in patients undergoing lower limb orthopaedic surgery. The study was conducted by the Departments of Pharmacology and Orthopaedics. Participants were randomly divided into two groups. One group received vitamin C 500 mg orally twice daily for 5 consecutive days postoperatively, with the first dose administered 6 hours after surgery, while the other group was the control. Both groups received diclofenac 50 mg intramuscularly twice daily. Pain levels were measured using the Visual Analogue Scale (VAS) and the Behavioural Pain Assessment Scale (BPAS) at different time intervals. The unpaired t-test was applied to compare the pain scores between the two groups.

Results: A total of 100 patients were recruited, with 50 in each group. Demographic parameters were comparable. Mean age was 41.98 ± 14.91 and 38.1 ± 13.87 years in the vitamin C and control groups, respectively, with 80% men in both groups. Pain intensity was comparable, and all patients had severe limitation of joint movements in both groups at baseline. Reduction in VAS and BPAS score was significant (p < 0.05) with vitamin C. No adverse effects were reported with vitamin C.

Conclusion: Vitamin C supplementation significantly improved pain management outcomes postoperatively, suggesting its potential as an adjunct to traditional analgesics for patients undergoing lower limb orthopaedic surgery.

Introduction and Aims: There are serious physical, psychological, and social repercussions associated with intimate partner violence (IPV), which is a serious public health concern. Since emergency departments (EDs) are frequently the initial point of contact for victims of IPV, medical personnel play a crucial role in recognizing and treating these instances. Despite legislative efforts to address IPV in Tunisia, effective intervention is hampered by cultural stigmas and healthcare personnel’s ignorance. The purpose of this study was to evaluate IPV-related knowledge, attitudes, and practices in urban Tunisian EDs and identify barriers to effective intervention.

Methods: A cross-sectional, analytical study was carried out among healthcare professionals employed in the EDs of three public tertiary-care large Tunisian hospitals (January–March 2023). The study included 128 participants, comprising 40% physicians, 50% nurses, and 10% other healthcare professionals. The Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) French version, a validated instrument for evaluating IPV-related knowledge, attitudes, and behaviors, was used to gather data. Data were analyzed descriptively and via logistic regression. Ethical approval was obtained.

Results: Of the 128 participants, 70% said they were confident in their ability to identify IPV, but 40% said they were ready to handle situations. Actual knowledge ratings averaged 55%, with significant weaknesses in legal concerns, screening tools, and referral systems. Routine IPV screening was reported by 30% of participants. Cultural sensitivity (50%), lack of training (65%), and fear of upsetting patients (45%) were the main obstacles. Analytical results showed that individuals with previous training scored considerably higher on knowledge measures (p < 0.001), and doctors were more likely than nurses to have confidence in identifying IPV (OR = 2.1; p < 0.01).

Conclusion: Although they encounter major obstacles in terms of knowledge, readiness, and institutional support, healthcare personnel in some Tunisian EDs show a willingness to handle IPV. To enhance IPV management in emergencies, specialized training programs, standardized procedures, and interdisciplinary cooperation are desperately needed.

Background: Continuing Professional Development (CPD) is critical for healthcare professionals to remain current in their clinical practice. In Qatar, Critical Care Paramedics (CCP) are required to collect 40 CPD points (measured in credit hours) per year to maintain their healthcare practitioner license, but achieving this can prove challenging. This study was conducted to determine and explore the barriers perceived by CCPs working for Qatar’s National Ambulance Service to undertake CPD activities.

Methods: This qualitative research study was informed by phenomenological research methodology. A judgement sampling strategy was used, and data were collected through semi-structured individual interviews conducted via “Microsoft Teams”. Data were collected and analyzed using a framework analysis until data saturation was achieved.

Results: From the eight interviews, six main themes were identified, which appear to significantly impact CCPs’ ability and motivation to attend CPD activities. These included (1) finding relevant CPD activities and their availability, (2) financial implications, (3) logistical challenges around CPD activities, (4) the quality and value of CPD activities, (5) challenges faced in attending CPD activities, and (6) achieving the Department of Healthcare Professions’ (DHP) requirements.

Conclusion: Although contextual, other ambulance services may benefit from this study’s findings. Work-life balance, high working demands with constant schedule adjustments, and finding relevant and accessible CPD activities create a major challenge to CCPs being available for these activities and accumulating the required number of CPD credits in a meaningful manner. The feedback collected will be shared with the leadership of the National Ambulance Service to attempt to remediate as many of the barriers identified.

Background: Patient rights are fundamental principles that guarantee ethical, respectful, equal, and fair treatment within healthcare systems, encompassing aspects such as informed consent, confidentiality, and active participation in decision-making. Understanding these rights is crucial for healthcare providers and patients, as it helps improve trust, enhances communication, and optimizes the overall healthcare experience.

Methodology: This cross-sectional study was conducted at the King Abdulaziz University Hospital at the Emergency Department in Jeddah. The study included adult patients who visited the emergency department and were willing to complete a survey. Data were collected through electronic questionnaires. The study aimed to assess patients’ awareness and understanding of their rights, analyze factors influencing it, and identify areas for improvement. Univariate and bivariate analyses were conducted, with statistical significance set at p < 0.05.

Results: The study included 201 participants. The findings revealed significant variation in patients’ rights awareness. Among satisfied participants, 54.5% demonstrated good awareness, compared to only 6.7% of dissatisfied participants (p < 0.001). The main sources of information were social media (26%) and physicians (23%), with a significant difference in awareness based on the source (p < 0.001). While 75% of participants were aware that they had patient rights, only 52% knew where to find a list of these rights. Additionally, 40% of participants were unaware that they could seek a second opinion. Overall, 56% of participants demonstrated poor awareness, indicating a need for further intervention.

Conclusion: The results of this study highlight significant variation in patients’ awareness of their rights and the factors that influence it. This variation can impact the delivery of comprehensive care. Future interventions should focus on strengthening healthcare providers’ roles as educators and reliable sources of information to bridge awareness gaps. Addressing these issues is crucial for creating an environment in emergency departments where patient rights are universally understood and respected.

Background: Urolithiasis in children is associated with high recurrence rates and complications, and its prevalence has been rising in recent decades due to metabolic and non-metabolic risk factors. This study aimed to evaluate the prevalence of pediatric urolithiasis in the Eastern Mediterranean Region (EMRO).

Methods: This systematic review was conducted using international databases, including Scopus, PubMed/MEDLINE, Web of Science, Embase, Google Scholar, and ProQuest, covering available data up to the end of August 2024. The Cochran test and I² statistics were applied to assess study heterogeneity. Additional analyses were performed using STATA software version 14.

Results: A total of 1,365 studies were reviewed, and 24 studies met the inclusion criteria. The overall prevalence of urinary stones in children was 2.34% (95% CI, 1.93–2.75). The highest prevalence rates were reported in Somalia (12.8% from one study), Pakistan (11.71% from four studies), and Turkey (9.28% from two studies). In contrast, the lowest prevalence rates were observed in Saudi Arabia (1.09% from one study), Egypt (3.48% from two studies), and Iran (4.45% from eight studies). Additionally, a non-significant decrease in the prevalence of urolithiasis was observed with increasing Human Development Index (HDI; Reg Coef = −2.60 [95% CI, −7.49 to 2.29]).

Conclusion: This study highlights the relatively low prevalence of urinary stones in children across EMRO countries. Furthermore, factors such as income levels and HDI were shown to be relevant, providing valuable insights for both regional and global health authorities in improving the management, screening, and treatment of pediatric urolithiasis.

Introduction: The presence of comprehensive studies in the field of emergency nursing care during chemical incidents is essential for an appropriate response to evolving needs. The objective of the present study is to identify the scope of studies conducted regarding emergency nursing care in chemical incidents.

Methods: In March 2023, databases including PubMed, Scopus, Web of Science, and Persian-language databases Magiran and Scientific Information Database (SID) were systematically searched without any time limitations. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart, two researchers independently reviewed articles based on inclusion and exclusion criteria, focusing on titles and abstracts. Subsequently, the researchers examined the full text of selected studies, identifying relevant articles. The data were then synthesized descriptively and presented in a summary table.

Results: A total of 33 reviewed articles published between 1979 and 2021 were identified. The main domains included decontamination (seven articles), structural preparedness (11 articles), pre-hospital interventions (two articles), triage (two articles), respiratory care (one article), vision care (five articles), and skin and burn care (three articles), as classified.

Conclusion: The results of the investigations indicated that emergency nursing care in chemical incidents possesses multiple dimensions, requiring a logical approach where care considerations involve strict adherence to a chronological sequence and precise attention to each dimension. A holistic and comprehensive perspective towards these cases can serve as a guiding path in response to the needs of the casualties.

Anaphylaxis is a severe, life-threatening reaction that usually occurs after exposure to an allergen. This case report describes a 29-year-old man who presented with anaphylaxis due to an unruptured hydatid cyst. Hydatid disease, caused by the parasitic tapeworm Echinococcus, usually manifests as cystic lesions in organs such as the liver and lungs. In this case, the patient exhibited sudden-onset anaphylaxis without any trauma or known allergen. Diagnostic imaging revealed an intact hydatid cyst without evidence of rupture. Despite intact walls, elevated intracystic pressure can lead to leakage of antigen-rich fluid into the bloodstream, triggering the reaction. This case presents a challenging diagnosis of a nontraumatic hydatid cyst leak, emphasizing the importance of early recognition and effective management of such cases, especially in endemic areas, to prevent potential morbidity and mortality. It underlines the need for increased clinical suspicion of hydatid disease in patients with unexplained anaphylaxis, even when the cyst wall appears intact on imaging.

Background: Intracardiac mass is a rare medical emergency and may present with signs of heart failure, like syncope. The current use of cardiac point-of-care ultrasound (POCUS) in pediatric emergency departments does not visualize pulmonic valve pathologies as a standard of care.

Case presentation: We report a case of a previously well Arab male child who presented with a history of cardiac syncope, with other symptoms of heart failure. Using cardiac POCUS, we were able to identify sonographic signs of heart failure and also accidentally identify a mass in the right ventricle on the pulmonic valve after some manipulation of the probe during the 4-apical chambers view. Confirmation was followed using echocardiography, computed tomography angiography, and cardiac magnetic resonance imaging. The patient underwent medical treatment for his heart failure and then surgical removal and histopathological examination of the mass, which was found to be an organized hematoma.

Conclusion: A cardiac POCUS has emerged as a readily available tool to evaluate global cardiac systolic function and both ventricular size for emergency physicians. Mitral valve closure is the main goal for using focused cardiac POCUS in the emergency department, but assessing other valves in terms of closure, appearance, and regurgitation can also be addressed. We suggest in our case some modifications to the 4-apical chambers view as an additional evaluation to visualize any pathologies to the pulmonic valve. These modifications may be used by pediatric emergency medicine physicians to enhance pulmonic valve assessment further when using POCUS in emergency settings.