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Purpose: To assess the ability of trained emergency medicine (EM) residents to diagnose neurogenic stunned myocardium (NSM) in patients with acute intracranial events in the emergency department (ED) using the Focused Assessment diagnostic Echocardiography (FADE). Methods: This prospective cross-sectional study was conducted between February 2018 and January 2019. First, four postgraduate year-3 (PGY-3) EM residents were trained through participation in 10 hours of theoretical FADE education and 20 hands-on FADE on ED patients. Then, adult patients (aged over 18 years old) with acute cerebrovascular accidents (CVAs) were enrolled in the study. Patients with a history of prior cardiac disease, concurrent CVA and ST-elevation myocardial infarction (STEMI), and cardiopulmonary arrest in the ED were excluded. The results of echocardiography by the cardiologists were considered as the gold standard. Results: Eighty-five cases were enrolled in the final analysis. The mean age of participants was 62.7 years, and 47 (55.3%) were male. There was a good agreement between the EM residents and cardiologists in diagnosing left ventricular (LV) dysfunction (Cohen's Kappa=0.7, 95%CI=0.65-0.8). Troponin I was positive in 3 (3.5%) patients. Based on the diagnosis of cardiologists, all three patients had heart failure and received a definitive diagnosis of NSM. Whereas, according to the FADE exam by EM residents, 2 out of 3 cases with positive enzyme had heart failure (interrater agreement= 66.6%). Conclusion: Our study showed that trained EM residents could use the FADE exam to diagnose the NSM in CVA patients in the ED. [ABSTRACT FROM AUTHOR]

Background: Mental and physiological responses to the repeated use of drugs are called dependency. Opioid bowel dysfunction (OBD) is common side effect associated with opium. OBD has many manifestations such as abdominal pain, abdominal cramping, bloating and gastroesophageal reflux but is known commonly by constipation. Narcotic bowel syndrome (NBS) is a subset of OBD characterized by recurrent and chronic abdominal pain getting worse by continuing or increasing doses of opium. Due to ever increasing incidence of consumption of narcotics drugs and also expanded spread of gastrointestinal disorders in people of society and due to lack of precise studies in such cases in Iran, research in this field seemed vital. Methods: In this cross-sectional study, among all methadone maintenance therapy (MMT) clinics in Isfahan, Iran, 4 centers were selected by easy non-probability sampling method in 2012 fall. A questionnaire was distributed among the opioid consumers. The questionnaire contained demographic information sucs as age, sex, occupation, and duration of drug use, drug type, duration of MMT, gastrointestinal symptoms and the severity of the symptoms. Findings: From 192 completed and collected questionnaires, 184 were acceptable. The most common gastrointestinal symptoms in patients were constipation, abdominal pain, belching and bad taste in the mouth, respectively. The severity of symptoms and extent of methadone use in patients were assessed and gastrointestinal symptoms were not associated significantly with methadone dose of patients. Conclusion: In this study, the prevalence of gastrointestinal symptoms among patients in addiction clinics was assessed and the most common digestive complaint of these patients was constipation. Severity of constipation and other gastrointestinal symptoms were unrelated with amount of methadone use and the type and amount of prior drug use. [ABSTRACT FROM AUTHOR]