Emergency Care and Medicine

Abstract

Background: Somatic symptom disorder (SSD) involves physical symptoms that cannot entirely be explained by an organic medical cause, accompanied by persistent thoughts, feelings and behaviours relating to one’s health. SSD is common yet underdiagnosed in emergency departments (EDs). This study aimed to [...] Read more.

Background: Somatic symptom disorder (SSD) involves physical symptoms that cannot entirely be explained by an organic medical cause, accompanied by persistent thoughts, feelings and behaviours relating to one’s health. SSD is common yet underdiagnosed in emergency departments (EDs). This study aimed to assess emergency physician (EP) readiness, attitudes and perceptions toward diagnosing SSD and explore demographic trends. Methods: In total, 1339 Canadian EPs were invited to respond to a survey collecting demographic information and assessing attitudes toward SSD in four domains: perceptions of SSD, attitudes toward patients, diagnostic confidence, and physician–patient communication. Data were analyzed using t-tests and ANOVA to determine associations with demographic information. Results: Of the 96 survey respondents, 75 met the eligibility criteria. In total, 44% estimated that emotional stress was the primary cause of symptoms in 11–20% of their patients. Most felt that SSD was underdiagnosed and that effective therapies exist. Concerns included medico-legal implications, managing patients’ emotions, and potential negative reactions to non-organic diagnoses. Most respondents felt prepared and confident broaching the diagnosis. More experienced EPs felt that there was time to broach the topic of SSD, while rural EPs were less concerned about patient offence than urban counterparts. Conclusions: EPs recognize SSD as common and underdiagnosed, acknowledging its diagnosis as part of their role. Challenges identified include managing patients’ emotions, time constraints, and reliance on only diagnosing SSD once an organic etiology is excluded. Training pathway, experience, and practice setting impact perceptions and attitudes around SSD. The findings suggest opportunities for improving SSD care through targeted interventions, communication training, and enhanced diagnostic education. Full article

Abstract

Background: Spontaneous rupture of the liver capsule secondary to the progression of hepatocellular carcinoma is a rare complication with high mortality. Case Description: This article presents the case of a 73-year-old male with no prior HCC diagnosis who presents acute abdominal pain and [...] Read more.

Background: Spontaneous rupture of the liver capsule secondary to the progression of hepatocellular carcinoma is a rare complication with high mortality. Case Description: This article presents the case of a 73-year-old male with no prior HCC diagnosis who presents acute abdominal pain and hemodynamic instability. Computed tomography reveals a heterogeneous liver lesion with capsular rupture and hemoperitoneum. Discussion: Management strategies focus on hemodynamic stabilization and bleeding control through transcatheter arterial embolization (TAE), surgical hemostasis or liver resection, the treatment selection is based on disease severity and patient condition. Conclusions: This case highlights the importance of considering HCC rupture in patients with acute abdominal pain and risk factors for liver disease, as early recognition and appropriate intervention significantly impact survival outcomes. Full article

Abstract

Background: Femoral shaft fractures are very common in the pediatric population; however, information is scarce. Methods: A total of 189 pediatric patient records were reviewed to identify the characteristics of diaphyseal fractures, including origin, type, pattern, surgical technique, and complications. Descriptive statistics were [...] Read more.

Background: Femoral shaft fractures are very common in the pediatric population; however, information is scarce. Methods: A total of 189 pediatric patient records were reviewed to identify the characteristics of diaphyseal fractures, including origin, type, pattern, surgical technique, and complications. Descriptive statistics were used to calculate frequencies and percentages. Meanwhile, continuous and categorical variables were analyzed using logistic regression to compare the different types of fractures in the population. Results: The proportion of males was higher compared to females (2:1). The highest prevalence was observed in the 10–14-year-old age group (n = 71; 37.5%). The primary mechanism of injury was traffic accidents (n = 93; 49.2%). Left femoral shaft fractures (n = 101; 53.4%) were the most prevalent. Transverse patterns predominated among the identified fractures (n = 105; 55.6%), most of which were closed fractures. Among the complications, non-union was the most frequent (n = 13; 6.9%), followed by wound infections (n = 3; 1.5%). Obesity (p < 0.001) and overweight (p < 0.001) were statistically significant in the left-sided femoral shaft fracture group. Conclusions: Non-union was the main complication identified in our study population. Obesity and overweight were identified as predictive variables for left-sided femoral shaft fractures. Meanwhile, none of the injury mechanisms showed statistical significance. Diaphyseal fractures in the pediatric population are underestimated, as well as the predictors causing them. Therefore, it is necessary to establish better management strategies for this type of fracture in pediatric patients. Full article

Abstract

Background/Objectives: This study aimed to explore the feasibility of predicting short stays among urgent admissions to an acute hospital in Singapore. With an increase in the average length of stay (LOS) in hospitals in recent years, accurately predicting short stays could enable hospitals [...] Read more.

Background/Objectives: This study aimed to explore the feasibility of predicting short stays among urgent admissions to an acute hospital in Singapore. With an increase in the average length of stay (LOS) in hospitals in recent years, accurately predicting short stays could enable hospitals to better manage inpatient demand and reduce emergency department (ED) overcrowding. Methods: This was a retrospective study of urgent admissions to Changi General Hospital, Singapore, from 1 January 2016 to 30 June 2022. To identify potential short stayers, a total of 25 features comprising demographic characteristics, admission and clinical characteristics, and healthcare utilization history were analyzed for each admitted patient at the point when the ED physician decided to admit the patient. The dataset was further split into a development dataset and an external validation dataset based on the year of admission. A CatBoost classifier was trained using 75% of the development dataset. Apart from reporting the model’s prediction accuracy, we conducted various analyses and simulations to study the effects of the features crucial to the prediction output. Results: The prediction accuracy of the model was evaluated on both the development test dataset (25%) and the external validation dataset. On the former, the area under the receiver operating characteristic (AUROC) and the area under the precision-recall curve (AUPRC) were 0.803 (95% CI: 0.799, 0.808) and 0.755 (95% CI: 0.749, 0.762), respectively, with the precision = 0.700 (95% CI: 0.694, 0.707) and recall = 0.692 (95% CI: 0.685, 0.699). On the external validation dataset, the performance was similar. The ED diagnosis and whether the admission required a surgical procedure were the most important features for making the prediction. Conclusions: The LOS prediction model could help providers to identify short stayers early in the course of their inpatient journeys so they could make interventions to better manage the overall utilization of hospital beds. Full article

Abstract

Introduction: Sedative and antipsychotic (SAP) agents are amongst the most common overdoses seen clinically, with few available antidotes. The proposed “lipid shuttle” mechanism of action for intravenous lipid emulsion (ILE) could augment the redistribution of SAP agents from the central nervous system in [...] Read more.

Introduction: Sedative and antipsychotic (SAP) agents are amongst the most common overdoses seen clinically, with few available antidotes. The proposed “lipid shuttle” mechanism of action for intravenous lipid emulsion (ILE) could augment the redistribution of SAP agents from the central nervous system in overdoses. We reviewed randomised controlled clinical trials to evaluate the effect of intravenous lipid emulsion when the indication for use was a reduction in the level of consciousness in SAP overdoses. Methods: We searched for human randomized controlled trials comparing the use of ILE to placebos in SAP drug overdoses. Animal and non-randomised human studies were excluded. Relevant databases were searched with two independent reviewers assessing studies for inclusion and risk of bias using the ROB 2 tool. Results: Five identified studies enrolled 270 patients in total, of whom 226 had isolated tramadol or clozapine toxicity. One study was assessed as having serious concerns for bias, and the other four as having some potential for bias. In all studies, there was a statistically significant increase in the Glasgow Coma Scale (GCS), favouring the ILE groups. This effect does not appear to have been due to changes in haemodynamics. Secondary outcomes on length of stay and QT interval were also positive. No patient died in any study. Conclusions: In the five reported randomised human trials of the effect of ILE on level of consciousness post-SAP overdose, patients receiving ILE had a greater increase in GCS over time. The potential for bias existed in all studies, and trial results may be true but specific to the intoxicants and situations studied, which prevents the generalisability of findings. More research is both feasible and necessary in this area. Full article

Abstract

Self-awareness among nurses involved in inter-hospital transport is crucial, as recognizing their limitations helps them improve their skills and make better use of tools that support inter-hospital transport, ultimately resulting in more efficient care. Objectives: To evaluate nurses’ self-perceived competences in an emergency [...] Read more.

Self-awareness among nurses involved in inter-hospital transport is crucial, as recognizing their limitations helps them improve their skills and make better use of tools that support inter-hospital transport, ultimately resulting in more efficient care. Objectives: To evaluate nurses’ self-perceived competences in an emergency department in Portugal regarding the inter-hospital transport of critically ill patients, implement interventions to facilitate the development of nurses’ competences, and evaluate the interventions carried out. Methods: A quality improvement project was conducted in three phases. The first phase involved a diagnostic study, the second phase focused on implementing interventions to improve nurses’ performance, and the third phase consisted of a descriptive study to evaluate the interventions implemented. Results: A total of 40 nurses participated in the study, with an average age of 39 (39.10 ± 11.83) years old, an average of 16 (16.09 ± 11.06) years of professional nursing experience, and an average of 11 (10.94 ± 10.91) years of experience in inter-hospital transport of critically ill patients. The nursing records during inter-hospital transport received the lowest self-perception rating, prompting the implementation of an intervention in the form of a nursing records checklist. Conclusions: The interventions implemented led to a change in self-perceptions of competence. Nurses’ self-awareness of their competences and limitations is crucial to deliver safe and quality nursing care. Providing opportunities for reflection on skills is therefore crucial to improving care delivery and encouraging the development of professional skills, attitudes, and behaviors. Full article

Abstract

Background/Objectives: During the early phase of the coronavirus disease 2019 (COVID-19) pandemic, people were advised to stay at home and the American College of Surgeons suggested the nonoperative management (NOM) of uncomplicated appendicitis. We hypothesized that patients presented with more cases of [...] Read more.

Background/Objectives: During the early phase of the coronavirus disease 2019 (COVID-19) pandemic, people were advised to stay at home and the American College of Surgeons suggested the nonoperative management (NOM) of uncomplicated appendicitis. We hypothesized that patients presented with more cases of complicated appendicitis during the early phase of COVID-19 compared with the previous year; we further hypothesized that more patients had NOM. Methods: Adults diagnosed with appendicitis were retrospectively reviewed from electronic medical records throughout a single county-wide hospital system. The pre-pandemic period (3 January 2019–30 June 2019, PRE) was compared with the pandemic period (3 January 2020–30 June 2020, POST). The primary outcome was AAST grade of appendicitis. Results: There were 278 cases of appendicitis in PRE and 269 in POST. The rate of complicated appendicitis (grades II–V) was higher in POST (39% vs. 30%, p = 0.0375), most prominently in the northern hospitals in the county (41% vs. 27%, p = 0.004), with non-operative management in six (3.2%) cases. Grades III–V, consistent with perforation, were seen in 33% of POST vs. 27% of PRE cases (p = 0.098). Grade I appendicitis was managed non-operatively in only six (1.6%) patients. There were fewer readmissions in POST (4% vs. 8%, p = 0.0427) and no mortalities during the study period. Conclusions: There was a significant increase in presentation with complicated appendicitis during the early phase of the COVID-19 pandemic in the northern hospitals in the county. There was no increase in NOM of uncomplicated appendicitis and no change in hospital LOS but there were fewer readmissions during COVID-19. Full article

Abstract

Background: Overcrowding in emergency services (ESs) is an escalating issue in many countries worldwide, and it is also evident in the paediatric context. Specifically, in paediatric emergency departments (PEDs) in Europe, there has been a noticeable upward trend in demand for care [...] Read more.

Background: Overcrowding in emergency services (ESs) is an escalating issue in many countries worldwide, and it is also evident in the paediatric context. Specifically, in paediatric emergency departments (PEDs) in Europe, there has been a noticeable upward trend in demand for care over the past decade, peaking at 9.1 million visits in 2020. Objectives: To identify interventions aimed at reducing non-urgent presentations (NUPs) and attendance rate PEDs. Methods: A systematic review of the last five years was conducted using various databases (Web of Science, PubMed, Scopus, and CINAHL) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: A total of 15 articles were included in the final review, detailing five types of interventions: (1) telemedicine-based interventions, (2) the continuity of care interventions, (3) health literacy-based interventions, (4) interventions focused on establishing a point of access prior to emergency care, and (5) multidisciplinary interventions. Conclusions: The results of this review suggest the implementation of telemedicine-based interventions, the promotion of continuity of care, and the enhancement of parental health literacy as strategies to address the issue of overcrowding in PEDs. Full article

Abstract

Post-COVID-19, significant triage modifications were made in emergency hospital medical care. Previous scoping reviews investigated triage changes during COVID-19. This scoping review uniquely considers post-pandemic effects. It searches the parameters “COVID-19, triage, hospital, emergency medical care” in four primary databases, one register, and [...] Read more.

Post-COVID-19, significant triage modifications were made in emergency hospital medical care. Previous scoping reviews investigated triage changes during COVID-19. This scoping review uniquely considers post-pandemic effects. It searches the parameters “COVID-19, triage, hospital, emergency medical care” in four primary databases, one register, and a supplementary database to determine the range of emergency hospital triage changes. Following PRISMA guidelines, studies included are post-2023 publications, those in English, and research studies. Excluded were duplicates, reviews, books, and reports lacking research studies or including irrelevant information on COVID-19, triage, hospital, or emergency medical care. Identified are 1071 records: OVID (n = 20), PubMed (n = 2), Scopus (n = 46), Web of Science (n = 20), Cochrane COVID-19 Register (n = 18), and Google Scholar (n = 965). Six studies are included from the Web of Science (n = 1) and Google Scholar (n = 5). One study includes reports from six different countries; thus, there are 11 reports. The modification of triage was concerning four ways, with each country focusing on a specific triage change. Adaptive changes were proactive rather than reactive. Triage-related future research suggestions include the four triage aspects, international comparisons, and longitudinal change. The recommendation is for research assessing Google Scholar. Full article

Abstract

Background: Abnormalities in the canal of the Nuck are rare clinical entities with presentation in the early adulthood of females. Given their rarity, they can be misdiagnosed with a strangulated inguinal hernia. Methods: Herein, we report a young female with painful swelling of [...] Read more.

Background: Abnormalities in the canal of the Nuck are rare clinical entities with presentation in the early adulthood of females. Given their rarity, they can be misdiagnosed with a strangulated inguinal hernia. Methods: Herein, we report a young female with painful swelling of the right inguinal hernia and its surgical approach. Results: A 37-year-old female presented to the emergency department with pain in the right lower abdominal quadrant and an edematous inguinal mass. Physical examination showed a palpable inguinal mass, setting the suspicion for possible incarcerated inguinal hernia. Laboratory exams were within normal ranges. The patient was subsequently treated surgically. During the operation, a cystic well-rounded mass was identified and completely excised. The mesh and plug technique was the chosen technique for the restoration of the inguinal canal. The hospitalization length was one day, and the post-operative course was uneventful. Conclusions: Although a Nuck cyst is a rare entity, it should be taken into consideration in female adults who present with an inguinal mass. Full article

Abstract

Intensive Care Unit-Acquired Weakness (ICU-AW) is a common and severe complication in critically ill patients, characterized by profound and often prolonged muscle weakness. The complexity of its diagnosis and management requires a multidimensional approach that integrates clinical, electrophysiological, and imaging tools. This review [...] Read more.

Intensive Care Unit-Acquired Weakness (ICU-AW) is a common and severe complication in critically ill patients, characterized by profound and often prolonged muscle weakness. The complexity of its diagnosis and management requires a multidimensional approach that integrates clinical, electrophysiological, and imaging tools. This review focuses on the challenges in diagnosing ICU-AW, emphasizing the limitations of traditional methods such as manual muscle testing and electrophysiological studies, and highlights the emerging role of neuromuscular ultrasound (NMUS) as a promising, non-invasive diagnostic aid. Despite its utility, no gold standard exists for NMUS, making it an evolving area of research. The pathophysiological basis of ICU-AW involves multiple mechanisms, including critical illness polyneuropathy (CIP), critical illness myopathy (CIM), and muscle atrophy due to disuse. Understanding these underlying mechanisms is crucial for advancing diagnostic strategies and informing therapeutic interventions. Recent insights into the molecular and cellular pathways involved, such as the role of oxidative stress, mitochondrial dysfunction, and the ubiquitin-proteasome system, have opened new avenues for targeted therapies. Management of ICU-AW remains challenging as no specific treatment has been proven fully effective. Current strategies focus on early mobilization, minimizing sedation, and optimizing nutritional support. Emerging therapies targeting molecular pathways involved in muscle degradation are under investigation, highlighting the potential to translate pathophysiological understanding into therapeutic innovations. This review underscores the need for ongoing research to establish standardized diagnostic protocols and develop targeted treatments for ICU-AW. Full article

Abstract

Background: Geriatric trauma patients often present with multiple comorbidities, which can complicate their treatment and impact outcomes. This study examines the effect of common pre-existing comorbidities on mortality and recovery in polytrauma patients, comparing them to polytrauma patients without these conditions. Methods [...] Read more.

Background: Geriatric trauma patients often present with multiple comorbidities, which can complicate their treatment and impact outcomes. This study examines the effect of common pre-existing comorbidities on mortality and recovery in polytrauma patients, comparing them to polytrauma patients without these conditions. Methods: We conducted a retrospective cohort study of patients with an Injury Severity Score (ISS) ≥ 16, admitted to a Level I trauma center between 2006 and 2019. A total of 315 patients were analyzed, including 235 with at least one comorbidity (COPD, type II diabetes, or anticoagulation due to atrial fibrillation) and 80 patients without any comorbidities, who served as the control group. Results: While comorbid patients had similar ISS scores compared to controls, they experienced significantly longer hospital and ICU stays. No significant difference in overall survival was found between the groups. However, patients with comorbidities were more prone to secondary complications, such as sepsis and thrombosis. Conclusions: The presence of common comorbidities, while associated with longer recovery times and increased complication rates, did not significantly impact mortality in polytrauma patients. Full article

Abstract

In recent years, the integration of informatics in emergency medicine has led to significant improvements in clinical decision-making, patient management, and overall healthcare delivery. This literature review explores the most recent trends and applications of informatics in the field of emergency medicine, including [...] Read more.

In recent years, the integration of informatics in emergency medicine has led to significant improvements in clinical decision-making, patient management, and overall healthcare delivery. This literature review explores the most recent trends and applications of informatics in the field of emergency medicine, including electronic health records, telemedicine, artificial intelligence, and mobile health technologies. The goal is to provide a comprehensive overview of the state-of-the-art technologies, their current implementations, and the challenges that remain to be addressed. Full article

Abstract

Introduction: Non-compressible torso hemorrhage (NCTH) is a major cause of preventable mortality in trauma, particularly when immediate surgical intervention is not available. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has emerged as a promising technique to control severe hemorrhaging and stabilize patients [...] Read more.

Introduction: Non-compressible torso hemorrhage (NCTH) is a major cause of preventable mortality in trauma, particularly when immediate surgical intervention is not available. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has emerged as a promising technique to control severe hemorrhaging and stabilize patients until definitive surgical care can be performed. Case Presentation: We report the case of a 45-year-old woman who sustained multiple traumatic injuries—including thoracic, pelvic, and aortic damage—after a fall from approximately 5 m in an apparent suicide attempt. She arrived at a secondary-level trauma center in profound hemorrhagic shock, unresponsive to standard resuscitation. Interventions: As the patient’s condition deteriorated to cardiac arrest, an emergent REBOA procedure was performed by emergency physicians. This intervention rapidly restored hemodynamic stability, enabling damage control resuscitation and safe transfer to a Level 1 Trauma Center for definitive surgical management, including thoracic endovascular aortic repair and splenectomy. Outcomes: After prolonged intensive care, the patient recovered sufficiently to be discharged for rehabilitation. This case illustrates the life-saving potential of early REBOA deployment in a non-surgical, resource-limited setting to bridge patients to definitive care. Conclusions: This case supports integrating REBOA into emergency trauma protocols, particularly in centers without immediate surgical capabilities. Further research is warranted to refine REBOA deployment strategies, balloon positioning, patient selection, and the role of imaging guidance. Full article

Abstract

Background: Emphysematous pyelonephritis (EPN) is an infectious disease of the renal system caused by gas-producing microorganisms harboring the kidneys. Patients with diabetes mellitus (DM), an endocrine disease with hyperglycemia, are particularly susceptible to the EPN as their immune system is compromised in [...] Read more.

Background: Emphysematous pyelonephritis (EPN) is an infectious disease of the renal system caused by gas-producing microorganisms harboring the kidneys. Patients with diabetes mellitus (DM), an endocrine disease with hyperglycemia, are particularly susceptible to the EPN as their immune system is compromised in fighting against infections. Case Description: We present a case of a 50-year-old female with a history of chronic diabetes and persistent hypertension. She presented with symptoms of pyrexia and flank pain. Following findings from ultrasound, she was advised to undergo computed tomographic (CT) scans that reveal air-filled hypodense areas at the upper and mid pole of the right kidney and in the renal pelvis of the right ureter, which confirms the class I EPN in the patient. Urine culture identifies Escherica coli as the causative agent for EPN. The patient was managed with third-generation antibiotics over two weeks, leading to full recovery without surgical intervention. Discussion: The availability of CT imaging makes early diagnosis and reduces mortality associated with EPN. Conservative medical management should be the initial treatment strategy for EPN. However, severe cases require immediate therapeutic action. In our case, the patient was treated with antibiotic therapy and recovered. Conclusions: CT scan seems to be the optimal diagnosis in patients with acute emphysematous pyelonephritis. Patients with EPN class I respond well to medical treatment with excellent outcomes. Full article

Abstract

Introduction: The literature has suggested two variants of appendicitis: a simple variant that may even resolve spontaneously and a more aggressive variant that may proceed to complication. We review two cohorts compatible with “mild” appendicitis: children with acute appendicitis that presented with normal [...] Read more.

Introduction: The literature has suggested two variants of appendicitis: a simple variant that may even resolve spontaneously and a more aggressive variant that may proceed to complication. We review two cohorts compatible with “mild” appendicitis: children with acute appendicitis that presented with normal inflammatory markers (NIMs), and confirmed on pathological examination, and children with sonographically confirmed appendicitis that resolved without medical or surgical intervention. Methods: We identified all children diagnosed with appendicitis from June 2016 to June 2024. To confirm the accuracy of the initial sonographic diagnosis of appendicitis in children with spontaneous resolution, two study radiologists, blinded to clinical data, reviewed the images for signs of appendiceal inflammation. We compared cases of NIM with cases presenting with elevated inflammatory markers, and cases of spontaneous resolution with cases of uncomplicated appendicitis treated medically. Results: A total of 999 children were diagnosed with appendicitis, with 845 confirmed on pathology. Of these 845, 17 had NIMs and were less likely to present with vomiting than children with elevated inflammatory markers (24% versus 61%, p = 0.002). Fourteen had spontaneous resolution and twenty-five were treated medically. White blood cell count (14.1 versus 10.2, p = 0.005) and appendiceal diameter (8.6 mm versus 7.6 mm, p = 0.078) were higher for children with conservative treatment. Children receiving medical treatment received intravenous analgesia more frequently (88% versus 50%, p = 0.009). More resources were used for medical treatment—these children had longer hospitalizations (3.5 versus 1.6 days, p = 0.001) and more frequently received repeat bloodwork (68% versus 36%, p = 0.051). Conclusions: Appendicitis that resolves spontaneously, and appendicitis that presents with normal inflammatory markers, may represent rare, low-risk forms of appendicitis that may not be associated with progression to complication. While pediatric appendicitis should not be ruled out in the presence of a normal laboratory evaluation, cases that present without gastrointestinal symptoms, without severe pain, and with an appendiceal diameter and inflammatory markers below a certain threshold may warrant continued observation and serial ultrasound to evaluate for progression prior to initiating therapy. Full article

Abstract

Background: This study compared outcomes of pregnant females with and without COVID-19 and their fetuses/newborns. Methods: This is a retrospective study from 2020 to 2023 utilizing the United States Collaborative Network of the TriNetX Database. We compared the outcomes of pregnant females with [...] Read more.

Background: This study compared outcomes of pregnant females with and without COVID-19 and their fetuses/newborns. Methods: This is a retrospective study from 2020 to 2023 utilizing the United States Collaborative Network of the TriNetX Database. We compared the outcomes of pregnant females with COVID-19 and pregnant females without COVID-19. Maternal outcomes evaluated were death, intubation, intensive care unit (ICU) admission, and premature rupture of membranes (PROM) within 9 months of the diagnosis of pregnancy. Fetal outcomes included preterm birth and intrauterine death (IUD). A subgroup analysis of outcomes was performed based on the mother’s vaccine status. Results: The risks of maternal death (RR = 1.97), maternal intubation (RR = 3.33), and maternal (ICU) admission (RR = 1.76) were significantly higher in pregnant females with COVID-19. For the neonate, there was a higher risk of preterm birth (RR = 1.12). When the confounders were eliminated with propensity matching, there was still an increase in maternal intubation (RR = 3.24) and maternal ICU admission (RR = 1.60). For the neonate/fetus, there was a decreased risk of PROM (RR = 0.83) and IUD (RR = 0.74) for the fetuses of the mothers with COVID-19. For the subgroup analysis, the mother was at an increased risk of ICU admission (RR = 0.04) when unvaccinated. Conclusions: There is an increased risk of poor outcomes for pregnant women infected with COVID-19; however, fetal outcomes are generally favorable. When unvaccinated, there was an increased risk of ICU admission for the mother. Full article

Abstract

Background: We report a case of an adult patient with newly diagnosed human immunodeficiency virus (HIV) infection, acquired immune deficiency syndrome (AIDS), and acute respiratory distress syndrome (ARDS) secondary to pneumocystis and cytomegalovirus pneumonia that were present on presentation, which were successfully managed [...] Read more.

Background: We report a case of an adult patient with newly diagnosed human immunodeficiency virus (HIV) infection, acquired immune deficiency syndrome (AIDS), and acute respiratory distress syndrome (ARDS) secondary to pneumocystis and cytomegalovirus pneumonia that were present on presentation, which were successfully managed with venovenous extracorporeal membrane oxygenation (VV-ECMO). Case Presentation: A 40-year-old patient with a past medical history of asthma was admitted to a local hospital due to dyspnea, cough, and wheezing, where the patient was diagnosed with HIV infection, ARDS, and combined pneumocystis and cytomegalovirus pneumonia. Their pulmonary function quickly declined, necessitating mechanical ventilation (MV). After all conventional therapies failed, the patient was transferred to a tertiary medical center for VV-ECMO therapy. The patient was successfully treated with antiretroviral therapy (ART), antibiotics, antivirals, steroids, and 48 days of VV-ECMO support, with complete resolution of their respiratory symptoms. The patient was discharged on hospital day 82. Conclusions: HIV-positive patients with ARDS that is complicated by opportunistic pulmonary infections can be successfully managed with ART, appropriate anti-infective therapies, and VV-ECMO. Full article

Abstract

Introduction: A large proportion of the existing voluminous disaster mental health research literature represents the quantitative study of psychopathology, especially posttraumatic stress disorder. Subjective disaster experience is relatively unexplored. Qualitative narratives of surviving a disaster may provide insight into individual experiences of it [...] Read more.

Introduction: A large proportion of the existing voluminous disaster mental health research literature represents the quantitative study of psychopathology, especially posttraumatic stress disorder. Subjective disaster experience is relatively unexplored. Qualitative narratives of surviving a disaster may provide insight into individual experiences of it and efforts to derive meaning from it. Methods: From an initial random sample of 182 survivors of the Oklahoma City bombing, narrative descriptions of this experience were collected 7 years after the bomb blast from 116 of the original sample, for the purpose of examining persistent as well as newly evolving content through qualitative analysis. The narrative content was analyzed for the evolution of thematic content in narrative data also collected at 6 months post-disaster and 1 year later. Results: The thematic content of the bombing experience was structured in a chronological fashion from the bomb blast (sensory, cognitive, and emotional), its immediate aftermath (e.g., escaping danger), and later experiences, (e.g., leaving the bomb site and receiving hospital treatment). During the time between interviews, the focus and general content of the narratives changed minimally, despite considerable compression of detail. Conclusions: The consistency of the material in these narratives over 7 years may reflect the persistence and salience of disaster memories, with the potential for its continuation for the rest of their lives. Full article