Perspectives on Preparedness for Chemical, Biological, Radiological, and Nuclear Threats in the Middle East and North Africa Region: Application of Artificial Intelligence Techniques.

Over the past 3 decades, the diversity of ethnic, religious, and political backgrounds worldwide, particularly in countries of the Middle East and North Africa (MENA), has led to an increase in the number of intercountry conflicts and terrorist attacks, sometimes involving chemical and biological agents. This warrants moving toward a collaborative approach to strengthening preparedness in the region. In disaster medicine, artificial intelligence techniques have been increasingly utilized to allow a thorough analysis by revealing unseen patterns. In this study, the authors used text mining and machine learning techniques to analyze open-ended feedback from multidisciplinary experts in disaster medicine regarding the MENA region's preparedness for chemical, biological, radiological, and nuclear (CBRN) risks. Open-ended feedback from 29 international experts in disaster medicine, selected based on their organizational roles and contributions to the academic field, was collected using a modified interview method between October and December 2022. Machine learning clustering algorithms, natural language processing, and sentiment analysis were used to analyze the data gathered using R language accessed through the RStudio environment. Findings revealed negative and fearful sentiments about a lack of accessibility to preparedness information, as well as positive sentiments toward CBRN preparedness concepts raised by the modified interview method. The artificial intelligence analysis techniques revealed a common consensus among experts about the importance of having accessible and effective plans and improved health sector preparedness in MENA, especially for potential chemical and biological incidents. Findings from this study can inform policymakers in the region to converge their efforts to build collaborative initiatives to strengthen CBRN preparedness capabilities in the healthcare sector.

Delayed presentation of spinal cord injury without radiographic abnormality (SCIWORA): a case report.

Spinal Cord Injury without Radiographic Abnormality (SCIWORA) is an unprecedented event to occur in adults but may lead to serious complications including permanent neurological impairments and death. In this article, we report a case of a 60-year-old male presenting to the emergency for a head and neck trauma after a motorbike accident, who reported only a neck ache and a normal primary neurological exam. The evolution was marked by the occurrence of paraplegia with a diminished sphincter tone and hypoesthesia beneath the T12 dermatome level after six hours, confirmed by the Magnetic Resonance Imaging (MRI). He underwent a deferred laminectomy within 30 days after receiving methylprednisolone, with partial neurological improvement after two months. An early recognition of the diagnosis was challenge for the emergency physician, given the wide variability of clinical presentations. Magnetic resonance imaging (MRI) is a key examination to guide the diagnosis and the management of these patients.

Efficacy and safety of two protocols of intravenous insulin therapy in the management of diabetic ketoacidosis.

INTRODUCTION: The correction of insulin deficiency in ketoacidosis DKA is recommended by intravenous (IV) route. Despite abundant literature, the place of the initial bolus of insulin has remained controversial. AIMS: This study was designed to compare the safety and the efficacy of two protocols of intravenous (IV) insulin therapy in the management of DKA admitted in the emergency department. Protocol (A): IV bolus of regular insulin 0.10 UI/Kg followed by a continuous IV infusion of insulin 0.10 UI/kg/H. Protocol (B): No bolus, a continuous IV infusion of regular insulin 0.14 UI/kg/H. METHODS: This was a prospective, not blinded, randomized study including patients aged more than 16 years with moderate to severe DKA. Fluid therapy and potassium replacement were standardized. Patients were randomized into two groups: Bolus-maintenance 0.10 group received protocol (A) and Maintenance 0.14 group received protocol (B). The Primary outcome data was the time to recovery defined by the time to acidosis resolution. The safety was tested by the occurrence of complications: hypoglycemia and hypokalemia. RESULTS: We enrolled 129 consecutive DKA patients. There were no differences between the two groups in clinical and biochemical data on admission, Bolus-maintenance 0.10 group versus Maintenance 0.14 group: mean age (37±18 vs. 38±17 years; p=0.810), Type 1 diabetes n (%): 34(55.7) vs. 34(50); p=0.911, pH (7.14±0.13 vs. 7.15±0.12; p=0.43). There were no differences between the two groups in the outcomes data: Bolus-maintenance 0.10 group versus Maintenance 0.14 group: Time to recovery (17 vs. 16 hours; p=0.76), complication n (%): Hypoglycemia (7(11.5) vs. 10(15.9); p=0.57) and hypokalemia (32(56.1) vs. 30(46.9); p=0.30). CONCLUSION: In the treatment of diabetic ketoacidosis, the two protocols of IV insulin were safe and had a comparable efficiency.

Predictive value of shock index ≥ 1 in severe trauma patients in emergency department.

BACKGROUND: the shock index (SI) defined by the ratio of systolic blood pressure to heart rate was demonstrated as a simple tool in the triage and orientation of severe trauma patients to trauma centers. AIM: To assess the prognostic value of the SI ≥ 1 in terms of mortality in severe trauma patients admitted to the emergency room. METHODS: We performed a prospective, observational and descriptive study with the inclusion of severe trauma patients over the age of 18 years admitted to the Vital Emergency Room over a 21-month period. SI was calculated at admission: SI = heart rate / systolic blood pressure, a SI threshold value ≥1 was fixed to define two groups: SI<1 and SI≥1. RESULTS: A total of 290 trauma patients were included, 231 (79%) had a SI<1, whereas 59 (21%) had an SI≥1. Mean age was 43.5 ± 18 years, 82% were male. There was a significant difference in hospital mortality at 7 days and at 30 days between the two groups respectively (group SI<1 vs group SI≥1): [12% vs 40%; p <0.001 and 15% vs 47%; p <0.001]. In multivariate analysis, SI≥1 appears as an independent factor of hospital mortality at 7 days [OR = 2.03; 95% CI = 1.3-3.3; p =0.001] and at 30 days [OR = 2.69; 95% CI = 1.4- 5; p =0.002]. CONCLUSION: In severe trauma patients admitted to the emergency department; a SI ≥1 represents a predictive factor of hospital mortality at 7 days and one month.

[Epidemiological and prognostic profile of acute heart failure: experience in the emergency department at the Charles Nicole Hospital of Tunis from 2013 to 2014]. / Profil épidémiologique et pronostic de l'insuffisance cardiaque aiguë: expérience du service d'accueil des urgences de l'hôpital Charles Nicole de Tunis de 2013 à 2014.

INTRODUCTION: Acute Heart Failure (AHF) is a specific syndromic disorder grouping several heterogeneous clinical conditions frequently seen in the emergency department. This study aimed to describe the epidemiological, clinical, therapeutic and prognostic features of patients with AHF admitted to the emergency department. METHODS: We conducted a prospective, descriptive study in the emergency department. It included all patients admitted with AHF. We studied the epidemiological, clinical, therapeutic and prognostic features of these patients. RESULTS: The study enrolled 180 patients with AHF admitted to the emergency department. Sex ratio was 1.27. The average age of patients was 66±12 years. Eighty-two percent of patients were hypertensive and 69% were known diabetic patients. The causes of decompensation included primarily hypertensive crisis (61.7% of patients), acute coronary syndrome (24% of patients). Respiratory support was mainly provided by CPAP (Continuous Positive Airway Pressure) in 73.3% of cases. Pharmacological treatment was based on nitrate derivatives (70% of cases) and diuretic (40.5% of cases). Acute heart failure incidence at one month was 21.7% (n=39 patients) and mortality rate at 3 months was 13.3%. CONCLUSION: Patients with AHF treated in the emergency department mainly had hypertensive crisis. Treatment is primarily based on CPAP, vasodilators and diuretics. Recurrence rate and mortality rate were high.

[Epidemiological profiles of diabetic ketoacidosis in the Emergency Department]. / Profils épidémiologiques des acidocétoses diabétiques aux urgences.

INTRODUCTION: Diabetic ketoacidosis (DKA) is a severe metabolic complication of diabetes. Recent years have seen a marked increase in prevalence of diabetic ketoacidosis, but mortality is low. This study aimed to describe the epidemiological, clinical, therapeutic and prognostic features of patients with severe or moderate DKA admitted to the Emergency Department. METHODS: He conducted a prospective, descriptive study including patients with moderate or severe DKA. Standardized care protocol. We studied the epidemiological, clinical, therapeutic and prognostic features of these patients. RESULTS: The study involved 185 patients with moderate or severe DKA. The average age of patients was 38+/-18 years, with a sex ratio of 0.94. Known diabetes was reported in 159 patients (85%) of whom 116 had type 1 diabetes. The most common factors of decompensation were treatment discontinuation in 42% and infection in 32%. Average blood glucose was 32.7+/-12 mmol/L, pH =7.14+/-0.13, HCO3- =7.2+/-3.56 mmol/L. The mean duration of intravenous insulin was 17.3 +/- 16 hours. Hypoglycaemia was reported in 26 patients (14%), hypokalemia in 80 (43%) patients and hyperchloraemic mineral acidosis in 43 patients (23%). Intrahospital mortality was 2.1%. CONCLUSION: Diabetic ketoacidosis occurs in young subjects treated with insulin therapy. Treatment is based on intravenous insulin associated with correction of fluid deficit. Complications mainly include hypokalemia and hypoglycemia and mortality is low.

Profils épidémiologiques des acidocétoses diabètiques aux urgences

Introduction: l'acidocétose diabétique (ACD) est une complication métabolique grave du diabète. Son incidence est en augmentation ces dernières années, cependant sa mortalité reste faible. L'objectif de cette étude a été de décrire les caractéristiques épidémiologiques, cliniques, thérapeutiques et pronostiques des patients admis aux urgences pour ACD sévère ou modérée. Méthodes: il s'agissait d'une étude prospective, descriptive qui a inclus les ACD modérée ou sévère. Standardisation du protocole de prise en charge thérapeutique. Nous avons étudié les caractéristiques épidémiologiques, cliniques, thérapeutiques et pronostiques chez ces patients. Résultats: nous avons inclus 185 patients avec ACD sévère ou modérée. L'âge moyen a été de 38±18 ans; le sexe ratio=0,94. Diabète connue= 159 patients (85%) dont 116 étaient des diabétiques type 1. Les facteurs de décompensation les plus fréquents étaient l'arrêt du traitement chez 42% et l'infection chez 32%. La glycémie moyenne a été de 32,7±12mmol/L, pH =7,14±0,13, HCO-3 =7,2±3,56 mmol /L. La durée moyenne de l'insuline intraveineuse était de 17,3±16 heures. L'hypoglycémie a été observée chez 26 patients (14%), l'hypokaliémie chez 80 (43%). La mortalité au cours de l'hospitalisation a été de 2,1%. Conclusion: l'acidocétose diabétique survient chez les sujets jeunes traités par insulinothérapie. Le traitement est à base d'insuline par voie intraveineuse en plus de la correction du déficit hydrique. Les complications sont essentiellement l'hypokaliémie et l'hypoglycémie; et la mortalité reste faible

Drug-adverse related events in emergency department : Epidemiological,clinical profile and prognosis.

INTRODUCTION: Adverse-drug events (ADe) are frequent in emergency medicine and remain misdiagnosed depending on the clinical polymorphism and the underlying comorbidities. Older patients with multiple comorbidities and polypharmacy are more frequently affected and makes poor prognosis. AIM OF THE STUDY: The aim of this study was to evaluate the epidemiology of ADe in the emergency department (ED) visits and to identify the prognostic value mortality within 30 days. METHODS: Prospective, monocentric study. Patients were included if they met criteria of aADe. We evaluated severity and mortality at 30 days. Moreover, misuse and preventabilty were studied. RESULTS: We included 159 cases within 113,272 ED visits. Mean age = 64 ± 19 years, sex ratio =0.6.The average number of drugs was 4.5 ± 3. Polymedication was found in 54%. In 10 cases, the prescription contained twice the same molecule. A double ADe was found in 11 patients. We identified 55 cases of misuse, 94% of them were due to physician. An interaction was found in 23 patients. Improper prescription with age, renal function or presence of contra-indications was found in 46 patients. In 41% cases, ADR events were preventable. An ADR event was considered severe in 44% of cases and 30-Days mortality's rate was 9.4%. Drugs n (%): Anticoagulants 53(34,6); Antihypertensive 29(19); Antiarrhythmic 15(10). Multivariate analysis of mortality at day 30: Misuse and polyapthology were independent predictors; Respective Odds ratios: (OR: 2.6; 95% CI [1.25-5.38]; p=0,001) and (OR 2.31; 95% CI [1,16 - 4,61]; p=0,017). CONCLUSION: Drug-related ED visits are common in elderly. ADe is severe in 44% cases and preventable in 41%. Mortality rate was 9,4%. Misuse, polypharmacy and comorbidities were independent predictors of severity and mortality.

[Iatrogenic adverse drug reaction in the emergency consultation of elderly people: epidemiological observational prospective study]. / Part de la iatrogénie médicamenteuse dans le recours des personnes âgées aux urgences: Etude épidemiolgique observationnelle propective.

BACKGROUND: Emergency units are one of the main access roads to the hospital for the elderly people. Research on adverse drug related events therefore find a field of study previligie. aim: To analyze the part of iatrogenic event in the emergency consultation of elderly people, and identify class of drug responsible. METHODS: We conducted a prospective chart review on treatments and potentials adverse drug-related events on all elderly patient consecutively presented in emergency unit of Ben Arous hospital in August 2008. We conducted a comparative study between: adverse drug related group and no adverse drug related group. RESULTS: Two hundred one elderly patients were prospectively included. Eighty -four per cent are medicated. The number of medications consumed ranged between 0 to 11 and averaged 2, 85 drugs. Adverse drug related events accounted in 28 cases (16, 5%).There were no difference in demographic characteristic and drugs consumed between the two groups. However the treatments were recently modified more frequently in adverse drug related group.Drugs more frequently associated with adverse events were no steroidal anti-inflammatory in 37% cases and Anti vitamin K or warfarine in 20% cases. Patients of drug related events group need more prescription modification at discharge. CONCLUSIONS: We note polymedication in frail elderly patients presented to emergency unit. Adverse drug related events were frequent and favorised by recent modified prescription.