Current Issue : April-June
Volume : 2022
Issue Number : 2
Articles : 5 Articles
Inborn errors of metabolism (IEM) constitute an important group of conditions characterized
by an altered metabolic pathway. There are numerous guidelines for the diagnosis and
management of IEMs in the pediatric population but not for adults. Given the increasing frequency of
this group of conditions in adulthood, other clinicians in addition to pediatricians should be aware of
them and learn to identify their characteristic manifestations. Early recognition and implementation
of an appropriate therapeutic approach would improve the clinical outcome of many of these patients.
This review presents when and how to investigate a metabolic disorder with the aim of encouraging
physicians not to overlook a treatable disorder....
Background: To better understand the impact of the COVID-19 pandemic on hospital healthcare, we studied
activity in the emergency department (ED) and acute medicine department of a major UK hospital.
Methods: Electronic patient records for all adult patients attending ED (n = 243,667) or acute medicine (n = 82,899)
during the pandemic (2020–2021) and prior year (2019) were analysed and compared. We studied parameters
including severity, primary diagnoses, co-morbidity, admission rate, length of stay, bed occupancy, and mortality,
with a focus on non-COVID-19 diseases.
Results: During the first wave of the pandemic, daily ED attendance fell by 37%, medical admissions by 30% and
medical bed occupancy by 27%, but all returned to normal within a year. ED attendances and medical admissions fell
across all age ranges; the greatest reductions were seen for younger adults in ED attendances, but in older adults for
medical admissions. Compared to non-COVID-19 pandemic admissions, COVID-19 admissions were enriched for
minority ethnic groups, for dementia, obesity and diabetes, but had lower rates of malignancy. Compared to the prepandemic
period, non-COVID-19 pandemic admissions had more hypertension, cerebrovascular disease, liver disease,
and obesity. There were fewer low severity ED attendances during the pandemic and fewer medical admissions across
all severity categories. There were fewer ED attendances with common non-respiratory illnesses including cardiac
diagnoses, but no change in cardiac arrests. COVID-19 was the commonest diagnosis amongst medical admissions
during the first wave and there were fewer diagnoses of pneumonia, myocardial infarction, heart failure, cellulitis,
chronic obstructive pulmonary disease, urinary tract infection and other sepsis, but not stroke. Levels had rebounded
by a year later with a trend to higher levels of stroke than before the pandemic. During the pandemic first wave, 7-day
mortality was increased for ED attendances, but not for non-COVID-19 medical admissions.
Conclusions: Reduced ED attendances in the first wave of the pandemic suggest opportunities for reducing low
severity presentations to ED in the future, but also raise the possibility of harm from delayed or missed care.
Reassuringly, recent rises in attendance and admissions indicate that any deterrent effect of the pandemic on
attendance is diminishing....
Background: Diagnostic discrepancy (DD) is a common phenomenon in healthcare, but little is known about its
organisational determinants and consequences. Thus, the aim of the study was to evaluate this among selected
emergency department (ED) patients.
Method: We conducted an observational study including all consecutive ED patients (hip fracture or erysipelas) in
the Danish healthcare sector admitted between 2008 and 2016. DD was defined as a discrepancy between
discharge and admission diagnoses. Episode and department statistics were retrieved from Danish registers. We
conducted a survey among all 21 Danish EDs to gather information about organisational determinants. To estimate
the results while adjusting for episode- and department-level heterogeneity, we used mixed effect models of ED
organisational determinants and 30-day readmission, 30-day mortality and episode costs (2018-DKK) of DDs.
Results: DD was observed in 2308 (3.3%) of 69,928 hip fracture episodes and 3206 (8.5%) of 37,558 erysipelas
episodes. The main organisational determinant of DD was senior physicians (nonspecific medical specialty) being
employed at the ED (hip fracture: odds ratio (OR) 2.74, 95% confidence interval (CI) 2.15–3.51; erysipelas: OR 3.29,
95% CI 2.65–4.07). However, 24-h presence of senior physicians (nonspecific medical specialty) (hip fracture) and
availability of external senior physicians (specific medical specialty) (both groups) were negatively associated with
DD. DD was associated with increased 30-day readmission (hip fracture, mean 9.45% vs 13.76%, OR 1.46, 95% CI
1.28–1.66, p < 0.001) and episode costs (hip fracture, 61,681 DKK vs 109,860 DKK, log cost 0.58, 95% CI 0.53–0.63,
p < 0.001; erysipelas, mean 20,818 DKK vs 56,329 DKK, log cost 0.97, 95% CI 0.92–1.02, p < 0.001) compared with
episodes without DD....
Background: Deciding whether a cranial Computed Tomography (CT) scan in a patient with minor head trauma
(MHT) is necessary or not has always been challenging. Diagnosing Traumatic Brain Injury (TBI) is a fundamental
part of MHT managing especially in children who are more vulnerable in terms of brain CT radiation consequences
and TBI. Defining some indications to timely and efficiently predict the likelihood of TBI is necessary. Thus, we
aimed to determine the impact of clinical findings to predict the need for brain CT in children with MHT.
Methods: In a prospective cohort study, 200 children (2 to 14 years) with MHT were included from 2019 to 2020.
The data of MHT-related clinical findings were gathered. The primary and secondary outcomes were defined as a
positive brain CT and any TBI requiring neurosurgery intervention, respectively. In statistical analysis, we performed
Binary Logistic regression analysis, Fisher’s exact test and independent samples t-test using SPSS V.26.
Results: The mean age of participants was 6.5 ± 3.06 years. Ninety patients underwent brain CT. The most common
clinical finding and injury mechanism were headache and falling from height, respectively. The results of brain CTs
were positive in seven patients (3.5%). We identified three predicting factors for an abnormal brain CT including
headache, decreased level of consciousness, and vomiting.
Conclusion: We showed that repetitive vomiting (≥2), headache, and decreased level of consciousness are
predicting factors for an abnormal brain CT in children with MHT....
Background: Pre-hospital services are not well developed in Vietnam, especially the lack of a trauma system of
care. Thus, the prognosis of traumatic out-of-hospital cardiac arrest (OHCA) might differ from that of other
countries. Although the outcome in cardiac arrest following trauma is dismal, pre-hospital resuscitation efforts are
not futile and seem worthwhile. Understanding the country-specific causes, risk, and prognosis of traumatic OHCA
is important to reduce mortality in Vietnam. Therefore, this study aimed to investigate the survival rate from
traumatic OHCA and to measure the critical components of the chain of survival following a traumatic OHCA in the
Methods: We performed a multicenter prospective observational study of patients (> 16 years) presenting with
traumatic OHCA to three central hospitals throughout Vietnam from February 2014 to December 2018. We
collected data on characteristics, management, and outcomes of patients, and compared these data between
patients who died before hospital discharge and patients who survived to discharge from the hospital.
Results: Of 111 eligible patients with traumatic OHCA, 92 (82.9%) were male and the mean age was 39.27 years
(standard deviation: 16.38). Only 5.4% (6/111) survived to discharge from the hospital. Most cardiac arrests (62.2%;
69/111) occurred on the street or highway, 31.2% (29/93) were witnessed by bystanders, and 33.7% (32/95) were
given cardiopulmonary resuscitation (CPR) by a bystander. Only 29 of 111 patients (26.1%) were taken by the
emergency medical services (EMS), 27 of 30 patients (90%) received pre-hospital advanced airway management,
and 29 of 53 patients (54.7%) were given resuscitation attempts by EMS or private ambulance. No significant
difference between patients who died before hospital discharge and patients who survived to discharge from the
hospital was found for bystander CPR (33.7%, 30/89 and 33.3%, 2/6, P > 0.999; respectively) and resuscitation
attempts (56.3%, 27/48, and 40.0%, 2/5, P = 0.649; respectively).
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