Mechanical dispersion is a superior echocardiographic feature to predict exercise capacity in preclinical and overt heart failure with preserved ejection fraction.

Background: Heart Failure with Preserved Ejection Fraction (HFpEF) is a syndrome characterized by different degrees of exercise intolerance, which leads to poor quality of life and prognosis. Recently, the European score (HFA-PEFF) was proposed to standardize the diagnosis of HFpEF. Even though Global Longitudinal Strain (GLS) is a component of HFA-PEFF, the role of other strain parameters, such as Mechanical Dispersion (MD), has yet to be studied.

Afterload increase challenge unmasks systolic abnormalities in heart failure with preserved ejection fraction.

Background: Provocative maneuvers have the potential to overcome the low sensitivity of resting echocardiography and biomarkers in the detection of heart failure with preserved ejection fraction (HFpEF). We investigate the mechanical response of the left ventricle to an afterload challenge in patients with preclinical and early-stage HFpEF (es-HFpEF).

Methods: Three groups of patients (non-HFpEF - n = 42, pre-HFpEF - n = 43, and es-HFpEF - n = 39) underwent echocardiography at rest and during an afterload challenge induced by handgrip maneuver combined with pneumatic constriction of limbs.

Longitudinal study comparing IgG antibodies induced by heterologous prime-boost COVID-19 vaccine.

Vaccines are critical cost-effective tools to control the COVID-19 pandemic. The heterologous prime-boost vaccination has been used by many countries to overcome supply issues, so the effectiveness and safety of this strategy need to be better clarified. This study aims to verify the effect of heterologous prime-boost COVID-19 vaccination on healthcare professionals from Dante Pazzanese Hospital in Brazil.

Comparison of self versus expert-assisted feedback for cricothyroidotomy training: a randomized trial.

Background: The self-video feedback method may have the potential to provide a low-cost alternative to physician-driven simulation-based training. This study aimed to assess the utility of two video feedback methods by comparing the improvement in performing cricothyroidotomy procedure following self video feedback (trainees review their performance by themselves) and expert-assisted video feedback (trainees review their performance while an emergency physician provides additional feedback).

Methods: This study was pretest-posttest and two-group designed research performed at a university simulation center with 89 final-year medical students and used a cricothyroidotomy simulation model.

Should Emergency Physicians and Nurses Direct Their Patients to YouTube for Heparin Self-Injection Training? A Systematic Review of Social Media Videos.

Background: The aim of this study was to examine the content, reliability, popularity, and quality of YouTube videos for patients learning how to self-administer subcutaneous low molecular weight heparin injections.

Methods: A systematic review of YouTube videos was conducted on August 20, 2021, using the keywords of "Low-molecular-weight heparin injection," "Enoxaparin injection," "Heparin injection," "Dalteparin injection," and "Tinzaparin injection." Two independent emergency physicians evaluated included videos separately with 5 different score systems (1- Journal of American Medical Association Score, 2-The Video Power Index, 3- Global Quality Scale, 4- Modified 5 Point DISCERN, 5- Total Comprehensiveness Score).

Sequential IgG antibody monitoring for virus-inactivated and adenovirus-vectored COVID-19 vaccine in Brazilian healthcare workers.

Vaccination certainly is the best way to fight against the COVID-19 pandemic. In this study, the seroconversion effectiveness of two vaccines against severe acute respiratory syndrome coronavirus 2 was assessed in healthcare workers: virus-inactivated CoronaVac (CV, n = 303), and adenovirus-vectored Oxford-AstraZeneca (AZ, n = 447). The immunoglobulin G (IgG) antibodies anti-spike glycoprotein and anti-nucleocapsid protein were assessed by enzyme-linked immunosorbent assay at the time before vaccination (T1), before the second dose (T2), and 30 days after the second dose (T3).

Zinc Supplementation Improved Neuropeptide Y, Nesfatin-1, Leptin, C-reactive protein, and HOMA-IR of Diet-Induced Obese Rats.

Obesity is a mild chronic inflammation that causes many metabolic diseases. It was aimed to investigate some parameters affective on the energy metabolism by adding zinc (Zn, ZnSO) to drinking water of diet-induced obese rats. Five-week aged, male Sprague Dawley rats divided into as control group, consuming standard rat diet, and high-fat diet (HFD) group.

Integrating patient management, reflective practice, and ethical decision-making in an emergency medicine intern boot camp.

Background: Integration of clinical skills, ethical decision-making, and reflection skills have emerged as cornerstones of clinical teaching in medical schools. This study aimed to detect whether a multimodal learning environment approach consisting of lectures, a drill, post-drill video debriefing, and written reflection in an emergency medicine rotation boot camp improves interns' patient management skills, ethical decision-making, and reflection skills.

Methods: A multimodal learning environment was created by the collaboration of emergency medicine, ethics, and medical education specialists.

Serological Testing for COVID-19, Immunological Surveillance, and Exploration of Protective Antibodies.

Serological testing is a powerful tool in epidemiological studies for understanding viral circulation and assessing the effectiveness of virus control measures, as is the case of SARS-CoV-2, the pathogenic agent of COVID-19. Immunoassays can quantitatively reveal the concentration of antiviral antibodies. The assessment of antiviral antibody titers may provide information on virus exposure, and changes in IgG levels are also indicative of a reduction in viral circulation.

Late Outcomes of Aortic Valve Replacement with Bioprosthesis and Mechanical Prosthesis.

Background: Despite constant improvement and refinement of the prostheses, the decision between mechanical and biological valves for aortic valve replacement is still controversial.

Objective: To compare outcomes of aortic valve replacement with bioprosthesis and mechanical prosthesis.

Methods: This was an observational, historical cohort study with review of medical records.

Pediatric Minor Head Trauma: Factors Affecting the Anxiety of Parents.

Managing the anxiety of the parents of pediatric patients with head trauma is challenging. This study aimed to examine the factors that affect anxiety levels of parents whose children were admitted to the emergency department with minor head trauma. In this prospective study, the parents of 663 consecutive pediatric patients were invited to answer a questionnaire.

Developing Cricothyroidotomy Skills Using a Biomaterial-Covered Model.

Introduction: Cricothyroidotomy is an advanced and life-saving technique, but it is also a rare and a difficult procedure. The purpose of the present study was to produce a low-cost simulation model with realistic anatomic features to investigate its effectiveness in developing cricothyroidotomy skills.

Methods: This study was performed at a university simulation center with 57 second-year student paramedics and a cricothyroidotomy simulation model.

Oxygen supplementation increases the total work and muscle damage markers but reduces the inflammatory response in COPD patients.

Introduction: Oxygen supplementation (O-Suppl) is recommended for pulmonary rehabilitation with higher exercise intensities. However, high-intensity exercise tends toward muscle damage and a greater inflammatory response. We aimed to investigate the effect of O-Suppl during exercise test (EET) on CRP level and muscle damage (CPK, LDH, lactate) in non-hypoxemic COPD patients.

Cardiology Training in Brazil and Developed Countries: Some Ideas for Improvement.

Huge variations exist in cardiology training programs across the world. In developing (middle-income) countries, such as Brazil, to find the right balance between training improvements and social and economic conditions of the country may be a difficult task. Adding more training years or different mandatory rotations, for instance, may be costly and not have an immediate direct impact on enhancing patient care or public health.

Comparison of the efficacy of ShotBlocker and cold spray in reducing intramuscular injection-related pain in adults. A prospective, randomized, controlled trial.

To compare the efficacy of ShotBlocker and cold spray in reducing intramuscular (IM) injection-related pain in adults. Methos: A prospective, randomized, controlled study carried out between January 2018 and March 2018 at the Department of Emergency Medicine, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey. Adult patients receiving IM injection of diclofenac sodium (75 mg/3 ml) were included.

Hemodynamics and tissue oxygenation effects after increased in positive end-expiratory pressure in coronary artery bypass surgery.

Background: Cardiac surgery is widely used in the treatment of cardiovascular diseases. However, several complications can be observed during the postoperative period. Positive end expiratory pressure (PEEP) improves gas exchange, but it might be related to decreased cardiac output and possible impairment of tissue oxygenation.

Analysis of Circulating miR-1, miR-23a, and miR-26a in Atrial Fibrillation Patients Undergoing Coronary Bypass Artery Grafting Surgery.

Atrial fibrillation (AF) is the most common arrhythmia after cardiac surgery. From a pathophysiological point of view, a myriad of factors such as trauma, atrial dilation, ischemia, mechanical myopericarditis, autonomic imbalance, loss of connexins, AF nest remodeling, inflammation, sutures, and dysfunction caused by postextracorporeal circulation can contribute to postoperative atrial fibrillation (POAF) resulting in a longer hospital stay and consequently higher cost. Recent studies showed that short fragments of RNA, called microRNA (miRNA), can contribute to the development of several cardiovascular diseases, including AF.

Heart rate recovery improvement in patients following acute myocardial infarction: exercise training, β-blocker therapy or both.

Heart rate recovery (HRR) is a strong mortality predictor. Exercise training (ET) and β-blocker therapy have significant impact on the HRR of patients following myocardial infarction (MI). However, the combination of ET and β-blocker therapy, as well as its effectiveness in patients with a more compromised HRR (≤12 bpm), has been under-studied.

Prevalence of pneumatized uncinate process and accompanying neighboring variations.

Objectives: This study aims to investigate the prevalence of uncinate process (UP) pneumatization and also to investigate the association of UP pneumatization with concurrent morphological variations in neighboring structures and the presence of maxillary sinusitis.

Patients And Methods: This was a retrospective study where coronal computed tomography scans of 1,500 UPs in 750 patients (483 males, 267 females; mean age 36.3±14.

The effect of the presence of the accessory maxillary ostium on the maxillary sinus.

This study was conducted to investigate the presence of the accessory maxillary ostium and its effects on the maxillary sinus, and the concurrent occurrence of morphological variations of neighboring anatomical structures. This study was performed in a tertiary referral center. This is a cross-sectional retrospective study that evaluated coronal CTs of patients to determine the frequency of the accessory maxillary ostium and investigated any simultaneous morphological variations in neighboring anatomical structures.

What do we miss without contrast in patients with flank pain?

Flank pain is a common complaint in the emergency department, and the most frequent cause of flank pain is urolithiasis. Spontaneous renal artery dissection and renal artery thrombosis are rare causes of abdominal pain which can result in renal parenchymal injury. They are mostly difficult to diagnose and treat in the emergency setting.

Radiological classification of the infraorbital canal and correlation with variants of neighboring structures.

This study aims to classify the infraorbital canal according to its position related to the maxillary sinus as observed by axial CT. It is a retrospective, cross-sectional study. This study was performed in a tertiary referral center.

Myocardial protection with prophylactic oral metoprolol during coronary artery bypass grafting surgery: evaluation by troponin I.

Introduction: Biochemical markers of myocardial injury are frequently altered after cardiac surgery. So far there is no evidence whether oral beta-blockers may reduce myocardial injury after coronary artery bypass grafting.

Objective: To determine if oral administration of prophylactic metoprolol reduces the release of cardiac troponin I in isolated coronary artery bypass grafting, not complicated by new Q waves.

Bedside ultrasonography by emergency physicians for anterior talofibular ligament injury.

Objective: Our objective was to study the accuracy of emergency physician (EP) performed bedside ultrasonography (BUS) in patients with suspected anterior talofibular ligament (ATFL) injury.

Materials And Methods: After a 6-h training program, from January to December 2011, an EP used BUS to prospectively evaluate patients presenting to the emergency department (ED) with suspected ATFL injury. Then, patients underwent ankle X-ray and Magnetic Resonance (MR) imaging.