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Objective: To evaluate the clinical and epidemiological features of deceased patients and comparing the discrepancies between male and female patients based on high prevalence of coronavirus disease 2019 (COVID-19), its irreversible effects and the rising ‎mortality rate in Jahrom city, Methods: This is a descriptive-analytical retrospective study that was conducted from the beginning of March 2020 to the end of November 2020. The study population were included all patients with COVID-19 who admitted to Peymaniyeh Hospital in Jahrom and died of COVID-19. Clinical and demographic data were collected from medical records and analyzed by SPSS software. Results: In this study, 61 patients (57.54%) were men and 45 patients (42.36%) were women. The mean age was 68.7±18.33 in men and 68.82±14.24 in women. The mean hospitalization length was 9.69±7.75 days in men and 9.69±7.75 days in women patients. There was no statistically significant difference between men and women patients (p>0.05). The results showed that 17 (27.87%) men and 28 (45.9%) of women patients had hypertension and the prevalence of this disease was significantly higher in women than men (p=0.01). In this study, 7 (11.48%) men and 13 (21.31%) women had hyperlipidemia. The frequency of hyperlipidemia in women cases was significantly higher than in men patients (p=0.024). Men cases’ diastolic blood pressure (mean=77.53) was significantly higher than women’s diastolic blood pressure at the same time with a mean of 71.42 (p

Cyclosporine-A (CsA) and mycophenolate mofetil are immunosuppressive drugs used for the prevention of transplant rejection. Various clinical studies have been performed on different forms of CsA neurotoxicity, including tremor, paresthesia, confusion, ataxia, neuralgia, hemiplegia, occipital seizures, and transient cortical blindness. Mycophenolate is associated with several neurological side effects including headache, insomnia, dizziness, depression, confusion, hypertonia, and paresthesia. A 31-year-old male with a history of kidney transplantation was treated with CsA and mycophenolate mofetil, for 18 years. He had been referred to the emergency department with complaints of generalized tonic-clonic seizure for 1 minute and 15 minutes of the post-ictal phase. Almost all laboratory tests including cerebrospinal fluid analysis were within normal limits. Brain MRI findings were compatible with CsA-based neurotoxicity. The patient’s symptoms and MRI findings improved on decreasing CsA to the minimum dose. CsA neurotoxicity is more common in intravenous therapy, early days of CsA administration, P450 inhibitors administration, and following liver transplantation. MRI findings in CsA neurotoxicity include signal changes in the cerebral cortex and juxtacortical white matter of the occipital lobes, temporal, parietal, and frontal lobes. Every year, many solid organ transplantations are performed. Many of these patients received CsA-based regimens for the prevention of rejection. Therefore, it is necessary to consider CsA neurotoxicity in suspected patients.

Additional file 1: Sup table 1. Search strategy. Supplementary Fig. 1. Forrest plot of CVA symptoms onset to ED door time. Supplementary Fig. 2. Funnel plot of CVA symptoms onset to ED door time. Supplementary Fig. 3. Forrest plot of rt-PA administration proportion. Supplementary Fig. 4. Funnel plot of rt-PA administration proportion . Supplementary Fig. 5. Forest and Funnel plot of SAH Vasospasm (study 1, Fiorindi et al.; study 2, Aboukaïs et al.). Supplementary Fig. 6. Forest and Funnel plot of Fisher grade > 2 (study 1, Fiorindi et al.; study 2, Aboukaïs et al.). Supplementary Fig. 7. Forest and Funnel plot of WFNS > 3 (study 1, Fiorindi et al.; study 2, Aboukaïs et al.). Supplementary Fig. 8. Forrest plot of Orchiectomy rate in testicular torsion. Supplementary Fig. 9. Funnel plot of Orchiectomy rate in testicular torsion. Supplementary Fig. 10. Forrest plot of DKA presentation among newly diagnosed T1DM patients. Supplementary Fig. 11. Funnel plot of DKA presentation among newly diagnosed T1DM patients. Supplementary Fig. 12. Forrest plot of Perforated ectopic pregnancy. Supplementary Fig. 13. Funnel plot of Perforated ectopic pregnancy. Supplementary Fig. 14. trim-filled Forrest plot of Perforated ectopic pregnancy. Supplementary Fig. 15. trim-filled Funnel plot of Perforated ectopic pregnancy. Supplementary Fig. 16. Forest plot of perforated appendicitis proportion. Supplementary Fig. 17. Funnel plot of perforated appendicitis proportion. Supplementary Fig. 18. Forest plot of delayed appendicitis presentation. Supplementary Fig. 19. Funnel plot of delayed appendicitis presentation.

Introduction: COVID-19 has affected the pattern of referral to medical centers and quarantine against COVID-19 might delay referral and management of surgical emergencies. This study aimed to compare the pooled event rate of pediatric perforated appendicitis before and during the COVID-19 pandemic. Methods: This was a systematic review and meta-analysis study based on the PRISMA guidelines. Scopus, Web of Sciences, and PubMed databases were searched for studies reporting the rate of perforated appendicitis based on the post-appendectomy observations or imaging methods. The Egger bias test and funnel plot were used to detect and depict publication bias. Statistical analysis was performed in Comprehensive Meta-analysis package version 3. Results: Twelve studies were eligible for inclusion in our study. The pooled prevalence of pediatric perforated appendicitis in the pre-COVID era was 28.5% (CI95%: 28.3 to 28.7%) with a heterogeneity of 99%. In the COVID era, the event rate proportion was 39.4% (CI95%: 36.6 to 42.3%) with a heterogeneity of 99%. There was a significant difference in the subgroup analysis within the pre-COVID and COVID era (P

Introduction: According to statistics provided by the forensic medicine facility of Iran, there are a high number of Aluminum phosphide (ALP) poisoning-related deaths in the country; while the mortality rate varies in different studies. This study aimed to determine a pooled estimate of ALP poisoning mortality rate in Iran. Methods: The present study was a systematic review and meta-analysis of the mortality rate of ALP poisoning in Iran. Through the quarry of Persian and English databases, using “aluminum phosphide”, “phosphine”, “rice pills”, “poisoning”, and “Iran” as keywords, and no time restrictions, studies reporting mortality rate in ALP poisoning cases were collected. The random-effects model was used to pool the proportions of mortality and age of survivors versus non-survivors. Results: 21 studies with 3432 cases of ALP poisoning were included in this meta-analysis. The pooled mortality rate of ALP poisoning in Iran was 39.6%, (95% CI: 31.5%-47.9%; I2 = 95%). Since there was significant publication bias, the trim-and-fill correction was conducted and the corrected pooled mortality rate was estimated to be 27.3% (95% CI: 18.9%- 36.5%), which is the rate that should be considered for clinical guidance. Morality rate in male and female patients was 62.3% (95% CI: 53.5%-70.8%) and 37.7% (95% CI: 29.2%-46.5%), respectively (p < 0.01). Survivors had significantly lower mean age than non-survivors (SMD: -0.26 (95% CI: -0.37 to -0.15); p < 0.01; I2=0%). Conclusion: According to this report, the Mortality rate of ALP poisoning in Iranian population is about 27%, with men having a higher fatality rate than women. Poisoning at a younger age is associated with better results.

Background: Stroke is known to be the third most prominent cause of death in the developing countries and the most common debilitating neurologic disease. This study aimed to investigate the association of platelet count (PC) and mean platelet volume (MPV) index with various stroke types. Methods: This cross-sectional study was carried out on patients over the age of 18 years who presented with signs and symptoms of the first acute stroke. Exclusion criteria were underlying chronic liver or renal disease and the time more than 6 hours from symptom initiation, hematological and infectious disorders in patients. After recording of demographic data, a complete blood cell count (CBC) test was performed. Results: From 150 patients, who enrolled in the study, 54.7% of patients were males. The initial brain CT scan was normal in 13 (8.7%) patients and showed evidence of brain infarction and intracranial hemorrhage in 84 (56%) and 53 (35.3%) patients respectively. Patients with intracranial hemorrhage had significantly higher mean of MPV index than the patients with normal brain-CT scan and patients with evidence of brain infarction (p

Bahram Zarmehri,1 Ali Teimouri,1 Navid Ebrahimipour,2 Mahdi Foroughian,1 Vahid Talebzadeh,3 Morteza Saeidi,4 Mehran Alirezaei5 1Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; 2Department of Emergency Medicine, Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran; 3Department of Emergency Medicine, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran; 4Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; 5Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranCorrespondence: Mehran AlirezaeiDepartment of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 99199- 91766, IranTel +98-51-38012613Fax +98-51-38413493Email Mehran.alirezaeii@gmail.comIntroduction: Regarding the complications and costs of CT imaging for patients, this study aimed at investigating the necessity of CT scans in patients visiting the emergency unit with first-onset seizure.Methods: One hundred patients who had experienced their first seizure were enrolled. Their CT scan was studied, and based on the radiology report, the type of probable pathologies and their percentage were determined.Results: The patient’s mean age was 39.78± 17.43 yrs. CT scan abnormalities were reported in 27 cases as follows: nonspecific senile changes in 11 (40.7%), encephalomalacia in 3 (11.1%), acute infarct in 5 (18.5%), lacunar infarct in 3 (11.1%), mass-like lesion in 4 (14.8%) and cerebral venous thrombosis (CVT) evidence in 1 (3.7%). Acute infarct and mass-like lesions were seen together in the CT scan of one patient. In only 9 of the 27 abnormal CT scans, the findings were in accordance with seizure consisting of an acute infarct, mass-like lesion, and CVT evidence.Discussion: It seems that performing a CT scan in all patients referring to the emergency department with a first-onset seizure is not necessary.Keywords: seizures, diagnostic imaging, tomography, cerebral infarction

Hamidreza Reihani,1 Neda Azarfardian,2 Mohsen Ebrahimi,1 Mahdi Foroughian1 1Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; 2Department of Emergency Medicine, Mashhad University of Medical Sciences, Mashhad, IranCorrespondence: Mahdi ForoughianDepartment of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranTel +985138525312Email foroughianmh@mums.ac.irIntroduction: Electrocardiogram (ECG), behind medical examination, is the easiest way to check the heart diseases, especially in an emergency department. Although the acquisition of Terrace from patients in the right method does not require a high level of expertise, the interpretation of this Terrace needs adequate knowledge, proficiency, and experience. The purpose of this study was to examine the effect of using the checklist in the ECG interpretation by medical interns.Methods: The present cross-section descriptive study was carried out on medical interns of Mashhad University of Medical Sciences in 2015. 40 students who were attending a one-month emergency medicine course were randomly divided into two groups of 20. In one group, 9 standard tracings classified with equal difficulty level (easy, medium, and hard) with a standard checklist form and a questionnaire for each were completed and in the other group, the same tracings of the first group were first handed without checklists and then handed with checklists for the second time. Finally, the scores of completing the checklists and the correctness of tracing interpretations were recorded in both groups. Data analysis was done using descriptive and inferential statistical tests.Results: There was no statistically significant difference between the two groups in terms of baseline variables. The first group identified 41.6% of the terraces correctly using the checklist. The second group, without using the checklist, correctly identified 25.5% of the terraces; and after using the checklist, this indicator increased to 32.7% in this group. Considering at least three correct responses in the ECG interpretation as “desirable response”, it was found that 50% of the subjects in the first group (using the checklist) (n=10) and only 15% (n=3) of the second group (without using the checklist) had desirable responses (p = 0.531). On the other hand, the comparison of responses before and after the use of the checklist in the second group showed a significant improvement in the number of desirable responses (15% (n=3) versus 25% (n=5), p = 0.009).Conclusion: The use of a checklist for the ECG interpretation by interns of emergency medicine did not affect improving the accuracy of the interpretation than the object-oriented system, but was effective in the diagnostic review and confirmation step.Keywords: checklist, electrocardiogram, medicine

Introduction: The Quebec Decision Rule (QDR) has been developed for deciding on the necessity of radiography for patients with shoulder dislocation. This study aimed to investigate the diagnostic value of QDR in this regard. Method: This diagnostic accuracy study was conducted on patients with shoulder dislocation visiting the emergency department. After filling out the QDR-based checklist for all patients, they underwent radiography and the obtained radiography results were compared to QDR-based clinical diagnostic findings. Results: ‌ 143 patients with the mean age of 32.1±12 years were evaluated (88.8% males). Sensitivity, specificity, and positive and negative predictive values of QDR were 50%, 58.2%, 3.3%, and 97.6%, respectively. The sensitivity and specificity were 100% and 50% in patients >40 years old, and 33.3% and 59.8% in those