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Objectives: To identify patients who are at risk for a first cardiovascular event, mitigate the risk, and institute early intervention. The triglyceride to high-density lipoprotein-C (TG/HDL-C) ratio has been found to be a very useful biomarker for directing treatment and prevention therapy., Methods: This retrospective cross-sectional study included adult patients (aged >18 years) experiencing first-time acute coronary syndrome (ACS). We examined all patient databases for a definite diagnosis of angina, non-ST segment elevation myocardial infarction (NSTEMI), or ST-segment elevation myocardial infarction (STEMI). Lipid profiles were obtained prior to or at the time of admission., Results: A total of 265 patients were included in the study (mean age 57.83 ± 11.4 years) and 79.2% were men. Male gender, presence of diabetes, raised total cholesterol, raised low-density lipoprotein (LDL), and raised troponin level on admission were significantly positively correlated with STEMI ( p =0.004, p =0.001, p <0.001, and p <0.001), whereas TG/HDL-C ratio was significantly negatively correlated with STEMI ( p =0.048), while there was no significant results with NSTEMI ( p =0.264) and angina ( p =0.326). Total cholesterol and raised low-density lipoprotein (LDL) were significantly positively correlated with NSTEMI ( p =0.013 and p =0.024)., Conclusion: Patients with first-time ACS may not have an increased TG/HDL-C ratio. High LDL levels had the most significant association with an ACS event, along with total cholesterol and diabetes. Further research is needed on a larger scale to determine the association of TG/HDL-C ratio with ACS and differentiate the different types of ACS events according to their clinical and laboratory characteristics., (Copyright: © Saudi Medical Journal.)

Objectives: The objective of this study is to prospectively analyze emergency physicians' (EP's) abilities to interpret noncontrast computed tomography (NCCT) brain images in a blinded fashion and assess whether they can make medical decisions solely based on their interpretations., Methods: A cross-sectional study was conducted at the emergency department (ED), King Saud University Medical City (KSU-MC), Saudi Arabia, over a period of one year, from May 2014 to May 2015. Any patient who underwent plain brain NCCT during the study period in our ED was included in this study. An independent attending neuroradiologist compared the EP's interpretations with the official final reports dictated by an on-call radiologist., Results: A brain NCCT prospective chart audit of 1,524 patients was interpreted by ED physicians (EP) at KSU-MC from 2014-2015. The ages of patients were between 14 and 107 years, and the mean ± SD age was 45.6 ± 22.1 years. Radiological brain lesions were confirmed by EPs and radiology physicians in 230 (15.09) and 239 (15.68) patients, respectively, out of which concordance was observed in 170 (71.13) cases, with a kappa value of r  = 0.675. Normal, chronic, and nil acute reports were made by EPs and radiology physicians for 1,295 (84.97) patients and 1,285 (84.32) patients, respectively, out of which concordance was observed in 1,225 (95.33) cases, with a kappa value of r  = 0.672. The study results demonstrated that the overall agreement between EPs and radiologist specialists was 91.6, with a kappa value of .675 ( p < 0.001)., Conclusion: Emergency physicians are moderately accurate at interpreting brain NCCT compared to radiologists. More research is needed to discover the most cost-effective technique for reducing the number of significant misinterpretations., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 Zohair Al Aseri et al.)

Objectives: To determine the ultrasound guidance for central venous catheter (USG-CVC) placement rate of emergency physicians (EPs) in Kingdom of Saudi Arabia., Methods: A cross-sectional survey study regarding the respondents' demographic profiles, formal and informal training in USG-CVC placement, experiences, and attitudes towards the procedure was emailed to all EPs registered with the Saudi Commission for Health Specialties (SCFHS) between October and December 2018., Results: In total, 234/350 SCFHS-registered EPs completed the survey; the response rate was 66.9%. Most respondents (70.5%) were board-certified in emergency medicine (EM). Ninety percent indicated that US device for CVC placement assistance was available. Most EPs (78.2%) had performed USG-CVC placement; the US usage rate correlated significantly with recent graduation from residency (p=0.048). In total, 83.3% received formal training during residency. Of the 234 respondents, 53.8% felt extremely comfortable with CVC placement with USG and 19.7% without USG (p less than 0.01). Nevertheless, most respondents desired further USG-CVC training., Conclusion: Despite existing evidence and a consensus on its superiority over the landmark technique, USG-CVC placement has not been adopted by a small proportion of EPs into clinical practice. Formal training, education, and institutional provision of permanent onsite US machines may address any barriers.

Clinical Question: How many patients who had a negative computed tomography and lumbar puncture result on initial evaluation were diagnosed with subarachnoid hemorrhage in the subsequent 6 months to 3 years?, Article Chosen: Perry J, Spacek A, Forbes M, et al. Is the combination of negative computed tomography result and negative lumbar puncture result sufficient to rule out subarachnoid hemorrhage? Ann Emerg Med 2008;51:707-13., Objective: To determine the sensitivity of both a negative computed tomography and a negative lumbar puncture in ruling out subarachnoid hemorrhage.