A Possible Case of Hypertensive Crisis With Aortic Dissection After an Anti-COVID-19 Vaccine.

Aortic dissection, a potentially fatal event, usually presents with acute intense chest or back pain. Painless aortic dissections constitute about 10% of all cases. High blood pressure is a common finding in both painless and painful aortic dissections. During the coronavirus disease (COVID-19) pandemic, various anti-COVID vaccines have been massively used. Although these vaccines are generally safe, there is a small risk of adverse effects which are mostly mild and transient, but sometimes they could be life-threatening. We report a case of painless aortic dissection that occurred within minutes of receiving the COVID-19 inactivated vaccine. A 65-year-old woman with chronic controlled systemic hypertension developed slurred speech, decreased level of consciousness, generalized weakness, and dyspnea without chest, back, or abdominal pain a few minutes after receiving the second dose of inactivated COVID-19 vaccine; she had a systolic blood pressure of 220 mmHg and left-sided pleural effusion. Drainage of the pleural effusion revealed gross blood and a spiral chest and mediastinum CT with intravenous contrast showed a penetrating atherosclerotic ulcer in the descending aorta. Therefore, thoracic endovascular aortic repair (TEVAR) was carried out, and the patient was discharged in satisfactory condition after 3 days.

Transferred Patients by Fars Province's Helicopter Emergency Medical Service (HEMS); A 2-Years Cross-Sectional Study in Southern Iran.

OBJECTIVE: To investigate the patients transferred by helicopters, as well as an emergent medical services that were performed for them. METHODS: In this retrospective cross-sectional study, all patients who were transferred by Fars province of Helicopter Emergency Medical Services (HEMS) to Shiraz hospitals, southern Iran (March 2017-March 2019) were investigated. Patients' information was collected and analyzed includes age, gender, dispatch reason, trauma mechanisms, take hold of emergent medical services, as well as the air transportation time, time between dispatch from the origin hospital and starting the procedures, and patients' outcome. RESULTS: Eighty-three patients were enrolled with the mean±SD age of 36.9±19.47 years that 75.9% had trauma (p<0.0001). Mental status deterioration (25.3%) was the most dispatched indications. The mortality rate was 13.25% totally (11.11% in traumatic vs. 10% in non-traumatic). The mean±SD of air transportation time was significantly lower than ground transportation in both traumatic (p=0.0013) and non-traumatic (p<0.0001) patients. Also, the mean±SD of time between dispatch from the origin hospital and starting the procedures was statistically lower in air transportation in both traumatic (p=0.0028) and non-traumatic (p=0.0017) patients. CONCLUSION: Most of the patients transferred by HEMS were traumatic. The air transportation time as well as the time between dispatches from the origin hospital to the starting of the procedures were significantly lower in HEMS in comparison with ground transportation for both traumatic and non-traumatic patients.

Diagnosing skull fracture in children with closed head injury using point-of-care ultrasound vs. computed tomography scan.

Diagnostic and therapeutic interventions in children for traumatic brain injury, which is known as the most important complication in trauma, require special attention. This study aimed to evaluate the accuracy of point-of-care ultrasound (POCUS) in diagnosing skull fracture in children with closed head injury in comparison with computed tomography (CT) scan. The current prospective cross-sectional study was conducted on children (0-14 years old), who were referred to the emergency department of a general teaching hospital in Shiraz, southern Iran (January-March 2018), with close head injury and were suspected of bone fracture. The participants were selected using a convenience sampling. The results of POCUS performed by emergency medicine (EM) residents were compared with the results of CT scan, which was reported by radiologists and considered a gold standard. Then, diagnostic tests were calculated. A total of 168 children were enrolled, with the mean ± standard deviation age of 6.21 ± 3.99. The most affected areas in the skull were the frontal (34.5%) and occipital areas (33.3%). POCUS had a sensitivity and specificity of 81.8% (95%CI, 48.2-97.7%) and 100% (95%CI, 97.7-100%), respectively. Positive and negative predictive values were 100% and 98.7%, with an accuracy of 98.8% in comparison with CT scan in the diagnosis of skull fracture.Conclusion: The results showed that POCUS with a portable ultrasonography machine, performed by the EM's physicians, have high diagnostic precision and can be considered a tool in the management of patients with closed head injury. What is Known: • Some studies have investigated the accuracy of ultrasound in diagnosing skull bone fractures in children with closed head injury, but before conducting this survey, no definite evidence recommended POCUS for skull fracture in children with closed head trauma in the ED. What is New: • POCUS with a portable ultrasonography machine, performed by the EM's physicians, has high diagnostic precision and can be considered a tool in the management of patients with closed head injury.

Low cost ergonomic interventions to reduce risk factors for work related musculoskeletal disorders during dairy farming.

BACKGROUND: Workers engaged in dairy farming are exposed to awkward and poor postures that may result in work-related musculoskeletal disorders (WMSDs). OBJECTIVE: This study carried out ergonomic interventions in order to eliminate and reduce awkward postures in dairy farming. METHODS: This quasi-experimental study applied rapid entire body assessments (REBA) to evaluate the risks associated with each posture while performing the assigned tasks on a dairy farm in Iran to identify high and very high-risk tasks. A participatory ergonomics model was used that incorporated suggestions by dairy workers to design the used interventions. RESULTS: In the first intervention, by using an automatic transmission system for pouring milk, one high and one very high-risk task- pouring milk into a bucket and pouring milk from a bucket into a tank, respectively- were eliminated. In the second intervention, two high-risk tasks- filling corn containers and pouring corn into the milling machine- were eliminated by using a material conveying vacuum pump to transfer corn from the ground to the opening of the milling machine. In the third intervention, a simple and cheap holding device for the bag was designed to reduce the posture risk score from very high to medium. The fourth intervention involved the use of a shovel with a handle appropriate to the anthropometric characteristics of the workers that reduced the posture risk from very high to medium. CONCLUSIONS: The results indicated that applying participatory ergonomic principles along with low cost and simple designs with high performance resulted in significant reductions in postural risks pertaining to of musculoskeletal disorders on Iran dairy farms.