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Table of Content

    01 July 2020, Volume 11 Issue 3
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    Original Articles
    Availability of basic life support courses for the general populations in India, Nigeria and the United Kingdom: An internet-based analysis
    Alexei Birkun, Fatima Trunkwala, Adhish Gautam, Miriam Okoroanyanwu, Adesokan Oyewumi
    2020, 11(3):  133-139.  doi:10.5847/wjem.j.1920-8642.2020.03.001
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    BACKGROUND: The number of lay people willing to attempt cardiopulmonary resuscitation (CPR) in real life is increased by effective education in basic life support (BLS). However, little is known about access of general public to BLS training across the globe. This study aimed to investigate availability and key features of BLS courses proposed for lay people in India, Nigeria and the United Kingdom (UK).

    METHODS: A Google search was done in December 2018, using English keywords relevant for community resuscitation training. Ongoing courses addressing BLS and suitable for any adult layperson were included in the analysis. On-site training courses were limited to those provided within the country’s territory.

    RESULTS: A total of 53, 29 and 208 eligible courses were found for India, Nigeria and the UK, respectively. In the UK, the number of courses per 10 million population (31.5) is 79 and 21 times higher than that in India (0.4) and Nigeria (1.5). Course geography is limited to 28% states and one union territory in India, 30% states and the Federal Capital Territory in Nigeria. In the UK, the training is offered in all constituent countries, with the highest prevalence in England. Courses are predominantly classroom-based, highly variable in duration, group size and instructors’ qualifications. For India and Nigeria, mean cost of participation is exceeding the monthly minimum wage.

    CONCLUSION: In contrast to the UK, the availability and accessibility of BLS courses are critically limited in India and Nigeria, necessitating immediate interventions to optimize community CPR training and improve bystander CPR rates.

    The importance of visualization of appendix on abdominal ultrasound for the diagnosis of appendicitis in children: A quality assessment review
    Muhammad Akhter Hamid, Ruqiya Afroz, Uqba Nawaz Ahmed, Aneela Bawani, Dilnasheen Khan, Rabia Shahab, Asim Salim
    2020, 11(3):  140-144.  doi:10.5847/wjem.j.1920-8642.2020.03.002
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    BACKGROUND: Ultrasound has the first line investigation role in the diagnosis of acute appendicitis in children. The purpose of this study was to perform a quality assessment review on the visualization rate of appendix on ultrasound in children in the community hospital setting.

    METHODS: A retrospective chart review of the abdominal ultrasound findings for the visualization of the appendix was performed on paediatric patients ranging from 5 to 18 years. Data were collected from the two community hospitals of Toronto by using hospital electronic medical record for the ultrasound findings in patients presented with abdominal pain.

    RESULTS: Data from two community hospitals indicated visualization rate of the appendix as 11.0% and 23.2% for site 1 and site 2 respectively. In cases where the ultrasound was repeated the visualization rate remains the same. A two-proportion z-test was performed to find whether the visualization of appendix increases the likelihood of diagnosing appendicitis. The results revealed that the visualization of an appendix (P=0.52), significantly improved the diagnosis of appendicitis (z=34, P<0.001).

    CONCLUSION: Visualization of an appendix on ultrasound increases the likelihood of correctly diagnosing appendicitis. In our study, we found low visualization rate of appendix on ultrasound that could be the result of many factors that contribute towards the low visualization rate of an appendix on ultrasound. Hence, the challenges in identifying appendix should be minimized to improve the visualization and diagnosis of appendicitis on ultrasound.

    Clinical characteristics and prognosis of community-acquired pneumonia in autoimmune disease-induced immunocompromised host: A retrospective observational study
    Zhong-shu Kuang, Yi-lin Yang, Wei Wei, Jian-li Wang, Xiang-yu Long, Ke-yong Li, Chao-yang Tong, Zhan Sun, Zhen-ju Song
    2020, 11(3):  145-151.  doi:10.5847/wjem.j.1920-8642.2020.03.003
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    BACKGROUND: Community-acquired pneumonia (CAP) in autoimmune diseases (AID)-induced immunocompromised host (ICH) had a high incidence and poor prognosis. However, only a few studies had determined the clinical characteristics of these patients. Our study was to explore the characteristics and predictors of mortality in CAP patients accompanied with AID-induced ICH.

    METHODS: From 2013 to 2018, a total of 94 CAP patients accompanied with AID-induced ICH, admitted to Emergency Department of Zhongshan Hospital, Fudan University, were enrolled in this study. Clinical data and the risk regression estimates of repeated predictors were evaluated by generalized estimating equations (GEEs) analysis. An open-cohort approach was used to classify patient’s outcomes into the survival or non-survival group.

    RESULTS: The hospital mortality of patients with CAP occurring in AID-induced ICH was 60.64%. No significant differences were found with respect to clinical symptoms and lung images between survival and non-survival groups, while renal insufficiency and dysfunction of coagulation had higher proportions in non-survival patients (P<0.05). Both noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) were performed more frequently in non-survival group (P< 0.05). By the multivariate GEEs analysis, the repeated measured longitudinal indices of neutrophil-to-lymphocyte ratio (NLR) (odds ratio [OR]=1.055, 95% confidence interval [95%CI] 1.025-1.086), lactate dehydrogenase (LDH) (OR=1.004, 95%CI 1.002-1.006) and serum creatinine (sCr) (OR=1.018, 95%CI 1.008-1.028), were associated with a higher risk of mortality.

    CONCLUSION: The CAP patients in AID-induced ICH had a high mortality. A significant relationship was demonstrated between the factors of NLR, LDH, sCr and mortality risk in these patients.

    The life-saving emergency thoracic endovascular aorta repair management on suspected aortoesophageal foreign body injury
    Wei-shuyi Ruan, Yuan-qiang Lu
    2020, 11(3):  152-156.  doi:10.5847/wjem.j.1920-8642.2020.03.004
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    BACKGROUND: Fatal aortic rupture caused by esophageal foreign body (EFB), is associated with a high mortality, but can be prevented by thoracic endovascular aorta repair (TEVAR) that performed increasingly as technology improves. This study aims to investigate the cause, management and prognosis of suspected penetrating aortoesophageal foreign body injury.

    METHODS: Twelve cases who met the criteria were enrolled in this study. The demographic and clinical data were reviewed for evaluating the characteristics of EFB.

    RESULTS: Among 12 cases enrolled, 7 were males and 5 were females, with an age 27-86 years. The distance of EFB from aorta (DFA) of 7 cases were less than or equal to 0 mm, 5 cases were 0-2 mm. Eleven cases were managed with TEVAR, only one case was with open surgery standby but finally treated by flexible endoscopy (FE) successfully, without TEVAR. In group with TEVAR, EFB of 7 cases were successfully removed by rigid endoscopy (RE), and one of them was failed at the first RE treatment. EFB of 2 cases were successfully removed by open surgery with TEVAR, and other 9 cases were managed by endoscopies with TEVAR. The mean length of stay of hospitalization (LOS) and length of ICU stay of patients treated by open surgery with TEVAR (18.50±2.12 days and 5.50±0.71 days) was significantly longer than those of patients treated by endoscopy with TEVAR (7.00±2.74 days and 1.33±1.12 days, P<0.001 and P=0.001, respectively). Five cases had severe complications.

    CONCLUSION: Rational application of TEVAR can be a life-saving management for aortoesophageal foreign body injury, and jointed with endoscopy is safe and effective with a shorter length of ICU or total hospital stay.

    Effects of intracoronary injection of nicorandil and tirofiban on myocardial perfusion and short-term prognosis in elderly patients with acute ST-segment elevation myocardial infarction after emergency PCI
    Guo-xiong Chen, Hong-na Wang, Jin-lin Zou, Xiao-xu Yuan
    2020, 11(3):  157-163.  doi:10.5847/wjem.j.1920-8642.2020.03.005
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    BACKGROUND: This study investigated the effects of the intracoronary injection of nicorandil and tirofiban on myocardial perfusion and short-term prognosis in elderly patients with acute ST-segment elevation myocardial infarction (STEMI) after emergency percutaneous coronary intervention (PCI).

    METHODS: Seventy-eight STEMI patients with age >65 years who underwent emergency PCI were consecutively enrolled. These patients received conventional PCI and were randomly divided into a control group and a treatment group (n=39 per group). The control group received an intracoronary injection of tirofiban followed by a maintenance infusion for 36 hours after surgery. The treatment group received intracoronary injection of tirofiban and nicorandil, and then intravenous infusion of tirofiban and nicorandil 36 hours after surgery. The following parameters were measured: TIMI grade, corrected TIMI frame count (cTFC), TIMI myocardial perfusion grade (TMPG), ST-segment resolution (STR) rate 2 hours post-operatively, resolution of ST-segment elevation (STR) at 2 hours postoperatively, peak level of serum CK-MB, left ventricular end diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) at 7-10 days postoperatively, and major adverse cardiac events (MACEs) in-hospital and within 30 days post-operatively.

    RESULTS: Compared with the control group, more patients in the treatment group had TIMI 3 and TMPG 3, and STR after PCI was significantly higher. The treatment group also had significantly lower cTFC, lower infarction relative artery (IRA), lower peak CK-MB, and no reflow ratio after PCI. The treatment group had significantly higher LVEDD and LVEF but lower incidence of MACEs than the control group.

    CONCLUSION: The intracoronary injection of nicorandil combined with tirofiban can effectively improve myocardial reperfusion in elderly STEMI patients after emergency PCI and improve short-term prognoses.

    Morbidity and mortality risk factors in emergency department patients with Acinetobacter baumannii bacteremia
    Rui-xue Sun, Priscilla Song, Joseph Walline, He Wang, Ying-chun Xu, Hua-dong Zhu, Xue-zhong Yu, Jun Xu
    2020, 11(3):  164-168.  doi:10.5847/wjem.j.1920-8642.2020.03.006
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    BACKGROUND: Acinetobacter baumannii (AB) bacteremia is an increasingly common and often fatal nosocomial infection. Identification of morbidity and mortality risk factors for AB bacteremia in emergency department (ED) patients may provide ways to improve the clinical outcomes of these patients.

    METHODS: The records for 51 patients with AB bacteremia and 51 patients without AB infection were collected and matched in a retrospective case-control study between 2013 and 2015 in a single-center ED. Risk factors were analyzed by Chi-square and multivariate logistic regression statistical models.

    RESULTS: A significant risk factor for morbidity was the presence of a central venous catheter (CVC) (P<0.001). The mortality rate for the 51 patients with AB bacteremia was 68.6%. Risk factors for mortality were the presence of a CVC (P=0.021) and an ED stay longer than two weeks (P=0.015).

    CONCLUSION: AB infections lead to high morbidity and mortality. The presence of a CVC was associated with higher morbidity and mortality in patients with AB bacteremia. Avoiding CVC insertions may improve outcomes in ED patients with AB bacteremia.

    Prognostic value of intracranial pressure monitoring for the management of hypertensive intracerebral hemorrhage following minimally invasive surgery
    Xiao-ru Che, Yong-jie Wang, Hai-yan Zheng
    2020, 11(3):  169-173.  doi:10.5847/wjem.j.1920-8642.2020.03.007
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    BACKGROUND: The incidence of hypertensive intracerebral hemorrhage (HICH) has been increasing during the recent years in low- and middle-income countries. With high mortality and morbidity rates, it brings huge burden to the families. It lacks evidence regarding the application of intracranial pressure (ICP) monitoring in HICH. In the current study, the authors aimed to evaluate whether ICP monitoring could make any difference on the prognosis of HICH patients after minimally invasive surgery.

    METHODS: A retrospective review of 116 HICH patients admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine, between 2014 and 2016, was performed. The effects of ICP monitoring on 6-month mortality and favorable outcomes were evaluated by univariate and logistic regression analysis.

    RESULTS: ICP monitors were inserted into 50 patients. Patients with ICP monitoring had a significantly better outcome (P<0.05). The average in-hospital duration in patients with ICP monitoring was shorter than that in the patients without ICP monitoring (16.68 days vs. 20.47 days, P<0.05). Mortality rates between ICP monitoring and no ICP monitoring did not differ significantly (16.0% vs. 15.1%, P=0.901). On univariate analysis, age, Glasgow Coma Scale (GCS) on admission and presence of ICP monitor were independent predictors of 6-month favorable outcomes.

    CONCLUSION: ICP monitoring is associated with a better 6-month functional outcome compared with no ICP monitoring. Future study is still needed to confirm our results and elucidate which subgroup of HICH patients will benefit most from the minimally invasive surgical intervention and ICP monitoring.

    Evaluation of gastric lavage efficiency and utility using a rapid quantitative method in a swine paraquat poisoning model
    Yun-fei Jiang, Jian Kang, Pei-pei Huang, Jia-xi Yao, Zhong-he Wang, Lei Jiang, Jun Wang, Li Qiao, Bao-li Zhu, Hao Sun, Jin-song Zhang
    2020, 11(3):  174-181.  doi:10.5847/wjem.j.1920-8642.2020.03.008
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    BACKGROUND: Gastric lavage (GL) is one of the most critical early therapies for acute paraquat (PQ) poisoning; however, details of the treatment protocol remain to be established.

    METHODS: A rapid quantitative method involving sodium dithionite testing was developed. It was validated for the determination of the PQ concentrations in gastric juice and eluate samples from a swine acute PQ poisoning model with early or delay GL, or without. The vital signs, laboratory testing, and PQ plasma concentrations were collected for therapeutic effect evaluation.

    RESULTS: The reaction conditions of the test were optimized for two types of samples. Early GL at one hour (H1) could improve the signs and symptoms after acute PQ poisoning at 24 hours (H24). In contrast, GL at 6 hours (H6) could only partially relieve the vital signs. The H1 GL group effectively reduced the peak of the plasma PQ concentration. In addition, the PQ concentrations in the plasma and the gastric juice were significantly decreased in both the GL groups as compared to the untreated group at H24. Moreover, there was no significant difference in the washing efficiencies calculated from the total eluates between the two GL groups. However, the washing efficiency of the first 10 L eluate is superior to that of the additional 10 L eluate.

    CONCLUSION: GL only at an early stage may it benefit PQ poisoning in an animal model. The currently used 20 L GL volume may need to be reduced in view of the low washing efficiency in the later 10 L eluate. The rapid quantitative method can be used for gastric juice samples and has a certain value for clinical GL practices.

    Case Letters
    A case of diffuse alveolar hemorrhage following synthetic cathinone inhalation
    Masakazu Nitta, Taro Tamakawa, Natsuo Kamimura, Tadayuki Honda, Hiroshi Endoh
    2020, 11(3):  182-184.  doi:10.5847/wjem.j.1920-8642.2020.03.009
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    A case of rhabdomyolysis with compartment syndrome in the right upper extremity
    Hui-ming Zhong, Guang-feng Zhao, Peng-chao Guo
    2020, 11(3):  185-187.  doi:10.5847/wjem.j.1920-8642.2020.03.010
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    Syncope in a 3-year-old male: A case report
    Neha Gupta, Saurabh Talathi, Sarika Kalantre
    2020, 11(3):  188-190.  doi:10.5847/wjem.j.1920-8642.2020.03.011
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    Letter to the Editor
    Do PaCO2 and peripheral venous PCO2 become comparable when the peripheral venous oxygen saturation is above a certain critical value?
    Lauren McGarey, Patrick Liddicoat, Matthew Gaines, Martyn Harvey, Grant Cave
    2020, 11(3):  191-192.  doi:10.5847/wjem.j.1920-8642.2020.03.012
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    Myalgia may not be associated with severity of coronavirus disease 2019 (COVID-19)
    Giuseppe Lippi, Johnny Wong, Brandon Michael Henry
    2020, 11(3):  193-194.  doi:10.5847/wjem.j.1920-8642.2020.03.013
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