Emergency airway management in neck trauma

Airway management in patients who have sustained direct trauma to the airway is among the most challenging problems for emergency clinicians. Blunt or penetrating injuries to the head, oropharynx, neck, or upper chest can result in immediate or delayed airway obstruction. Immediate, definitive airway management is needed when the patient cannot protect his airway or is unable to sufficiently oxygenate or ventilate. Emergent or urgent airway management is specified when a patient develops respiratory distress or when symptoms are progressing rapidly. In addition, airway management often is indicated when the patient appears clinically stable, but the clinician anticipates clinical decline [e.g., smoke inhalation, edema, subcutaneous air, hematoma] or feels that an unprotected airway presents a risk to the patient who requires transport to another facility or to radiology for extensive diagnostic studies. The higher rate of complicated airways in this population mandates that the clinician has to be prepared to use advanced airway techniques, including a surgical airway

Early epinephrine administration in patients with cardiac arrest in case of shockable rhythm in ER

The objective of the review was to investigate the scientific production and evaluate the effectiveness of epinephrine in the treatment of cardiac arrest in terms of survival and neurological status. PubMed, Embase, and Google Scholar databases were searched up till November 2017 for published studies in English language and human subjects discussing early epinephrine administration in patients with cardiac arrest in case of shockable rhythm in emergency medicine. Prehospital epinephrine management may increase short-term survival [ROSC] yet does not improve survival to release, or neurologic results after out-of-hospital cardiac arrest OHCA. Although there is no clear proof of long-lasting advantages complying with the use of epinephrine in OHCA, there is insufficient evidence to sustain altering present guidelines which recommend its management [1 mg every 3-5 min] throughout resuscitation. As a result, there is a need for additional clinical trials to analyze whether lower dosages or alternative regimes of epinephrine administration. Furthermore, one of the most important aspects of care in cardiac arrest is basic life support [BLS] measures, consisting of adequate compressions and early defibrillation

Narrative review on different clinical aspects of thrombocytopenia

This review article aims to summarize the major causes of thrombocytopenia and characterize the main general symptoms of thrombocytopenia. As well we summarize the diagnosis and treatment methods. We conducted the search using electronic biomedical databases such as; Medline, and Embase, for studies published up to September 2017 in the English language concerning the thrombocytopenia in general. Thrombocytopenia can either be primary or secondary, in that it could go along with a broad spectrum of syndromes and diseases and may be triggered by different systems. Trigger investigation and recognition might be important and sometimes life-saving as in TTP, heparin-induced thrombocytopenia, acute leukemia or perhaps severe ITP. Taking a detailed history and a thorough physical examination can give clues concerning possible underlying illness and clinical treatments. Cautious evaluation of the peripheral blood smear is necessary. When the differential diagnosis is problematic, sometimes a short trial of therapy could help to clarify the reason. For instance, it might be difficult to differentiate inherited thrombocytopenia [without a family history] from immune thrombocytopenia [ITP]; in this example, intravenous immunoglobulin infusion will likely have no effect in inherited thrombocytopenia, however, will generally be useful in ITP

Head and neck malignancies are mostly from dermatological origin

Head and neck cancer includes epithelial malignancies of the upper aerodigestive tract [UADT], including the paranasal sinuses, nasal cavity, oral cavity, pharynx, and larynx; and, as the sixth most common cancer worldwide, head and neck cancer represents about 6% of solid tumors. Advances in surgery, radiation therapy, and chemotherapy have improved locoregional control, survival, and quality of life. The outcomes of these treatment modalities have shifted the focus of curative efforts from radical ablation to preservation and restoration of function. This evolution has been documented in the pages of Cancer for the past 6 decades. The median age of diagnosis is in the sixth decade of life, and there is a large male-to-female predominance. Although there has been a slight decrease in overall incidence of head and neck cancer over the past two decades, an increase in base of tongue and tonsillar cancer recently has been observed

Prevalence of metabolic syndrome among patients with hypothyroidism

Background: hypothyroidism is of concern in our society; it has an effect on metabolic parameters

Objective: this study aimed to predict the prevalence of metabolic syndrome [MetS] among patients with hypothyroidism in Jeddah, Saudi Arabia and to determine the effect of treating hypothyroidism on MetS

Methods: we conducted this cross-sectional study, in which MetS was defined by presence of at least three of the five AHA/NHLBI criteria. We included patients with hypothyroidism that were managed in an outpatient department or admitted in King Abdulaziz University Hospital from 1 March to 30 April 2016. We measured lipid parameters, blood pressure [BP], waist circumference [WC] and serum fasting blood glucose [FBG]

Results: in total 57 patients were included in our study, of which 47 [82%] were females. the majority of patients were greater than 50 years of age [n=35, 60%]. We found that 36.8% of patients uncontrolled for hypothyroidism had high levels of TSH [serum level of TSH >5 mlu/L], while 64.9% of patients who were controlled for hypothyroidism had normal levels of TSH [serum level of TSH 0.5 - 5 mlu/L]. Overall, 71.9% [n=41] of hypothyroidism patients had MetS. However, we found that 51.8% [n=21] uncontrolled hypothyroidism patients suffered from MetS and 48.2% [n= 20] patients controlled for hypothyroidism suffered from MetS. However, 70.68%, 31.03%, 34.48%, 79.31% and 70.6% of participants had abnormal waist circumference [WC], hypertriglyceridemia, abnormal high-density lipoprotein [HDL], hypertension and elevated serum levels of fasting blood sugar, respectively

Conclusion: hypothyroidism plays an important role in MetS. Future advanced studies including larger numbers of patients are needed to test the effect of treating hypothyroidism on MetS. Routine screening for cardiovascular risk factors in patients with hypothyroidism may unmask MetS

Diagnostic procedures for cardiac arrhythmias, MI or hypertension

Background: the goal of this study was to highlight the diagnostic methods and approaches toward most devastating cardiac disorders which are cardiac arrhythmias, MI and hypertensive

Methods: we searched thorough electronic databases as, MEDLINE, EMBASE using the following terms individually and/or in combination: 'Cardiac arrhythmias', 'myocardial infarction [MI] ', 'hypertension', 'ventricular arrhythmias'and 'diagnosis', to look for the most important and relevant articles concerning with the diagnostic approaches of hypertension, MI, and arrhythmias in general

Conclusion: some ideal cardiac biochemical markers need to have not only high level of sensitivity but additionally high specificity to coronary infarction. The creatine kinase-MB, a reasonably certain cardiac marker, could be elevated in situations other than acute myocardial infarction. The ECG continues to be a cornerstone in the diagnosis of MI as well as need to be regularly duplicated, particularly if the first ECG is not analysis of MI. The diagnosing high blood pressure consist of 24-h ambulatory blood pressure monitoring [ABPM] as well as self-home] BP surveillance [SBPM] as optional methods for determining hypertensive patients. None of the current standards have actually yet consisted of ABPM or SBPM as essential devices for detecting hypertension, preferring instead to depend on standard workplace analyses tape-recorded by mercury sphygmomanometry

Factors influencing time to CT in ER for patients with suspected subarachnoid hemorrhage

Background: in our present review, the main goal was to determine the factors that influence the time of CT in diagnosis of SAH in emergency department, since the ED physicians are the first who are approaches to the patients, awareness and attitude of those physicians are very important for the benefit of SAH patients

Methods: we conducted a comprehensive search using following databases; PUBMED, EMBASE, SCOPUS of studies that involving data on the roles and time of CT in diagnosis of subarachnoid hemorrhage [SAH] in ED patients with acute headache, published in English language up to 2017

Conclusion: CT within 6 hours might be considered enough to rule out SAH in the following circumstances: a neurologically regular patient, a thunderclap headache presentation, a clear time of beginning, and a modern-day CT scan carried out within 6 hours of beginning read by a going to radiologist. Time from headache beginning to imaging is reasonably associated with favorable imaging for SAH. Postpone to health center presentation represent the biggest portion of time to imaging, especially those without SAH. These findings recommend restricted opportunity to minimize lumbar puncture rates merely by accelerating in-hospital processes when imaging hold-ups are under 2 hours, as diagnostic yield of imaging decreases beyond the 6-hour imaging window from headache beginning

Color stability evaluation of different provisional materials immersed in beverages

Objective: the aim of the study is to evaluate the surface topography [Polished vs. Non-polished] and color stability of different provisional materials: 1] Bis-acryl Composite [System C and B - IvoclairVivadent]; 2] Bis-acryl Composite [ProTemp IV - 3M ESPE]; 3] Bis-acryl Composite [Success CD - Promedica]; 4] Polymethyl Methacrylate [Trim II - Bosworth]; and 5] Light-cure Polymethyl Methacrylate [UniFast TRAD - GC Europe] immersed in commonly used beverages

Material and Methods: the color change value of each specimen after immersion in different beverages i.e. 1] Coffee with artificial saliva; 2] Tea with artificial saliva; 3] Cola with artificial saliva; 4] Apple juice with artificial saliva; and 5] Saline with artificial saliva was measure using spectrophotometer with CIE LAB system before and after immersion at 2 days, 1, 2 weeks, and 1 month

Results: proTemp IV was found to be the most color stabile material, followed by System CandB, Success CD, Trim II, and UniFast TRAD respectively. It was found that coffee had the most staining ability, followed by tea, cola, and apple juice

Conclusion: bis-acryl composites showed the highest color stability values [ProTemp IV, System C and B, and Success CD], followed by Polymethyl Methacrylate [Trim II], then light cured polymethyl methacrylate [UniFast TRAD]. Polishing decreases the color changing values of the provisional materials. Coffee had the most color changing effect

Effect of Viscum schimperi on advanced glycation endproducts formation

Diabetes is a disease characterized by elevated uncontrolled glucose level. Hyperglycemia results in diabetic complication due to a reaction between sugar and amino acid of proteins to form advanced glycation endproducts [AGEs] in different tissues. Medicinal plants are considered as a great source of bioactive compounds that affect many ailments. In this regard; AGEs formation could be inhibited by many bioactive compounds isolated from medicinal plants. Viscum schimperi Engl. is a plant belongs to Loranthaceae and known for its antidiabetic activity. In this study; total methanol extract of V. schimperi [VT] was prepared, suspended in water and subjected to fractionation with chloroform followed by n-butanol to give [VC] and [VB] fractions respectively. The aqueous mother liquor was evaporated to form [VA] fraction. The inhibitory effect of all prepared fraction on the formation of advanced glycation endproducts [AGEs] was studied. The results revealed that V. schimperi extract and its different fractions inhibited protein glycation and oxidation of BSA induced by ribose together with decrease of protein aggregation. In conclusion; V. schimperi will be useful in management of diabetic complications based on its inhibition of advanced glycation endproduct formation