Case Report: Subcutaneous Emphysema and Pneumomediastinum Following Dental Extraction.

Introduction: Emergency physicians should be cognizant of complications following common procedures (including dental) and be able to readily care for patients with acute dental pain.

Case Report: A 22-year-old female presented with dental pain and difficulty swallowing that developed 48 hours after she underwent a dental extraction. The physical exam showed an uncomfortable, afebrile female with dysphonia, inability to tolerate secretions, and crepitus over the neck and anterior chest wall.

Jejunal Dieulafoy's Lesion: A Systematic Review of Evaluation, Diagnosis, and Management.

Jejunal Dieulafoy's lesion is an exceedingly rare but important cause of gastrointestinal bleeding. It frequently presents as a diagnostic and therapeutic conundrum due to the rare occurrence, intermittent bleeding symptoms often requiring prompt clinical action, variability in the detection and treatment methods, and the risk of rebleeding. We performed a systematic literature search of MEDLINE, Cochrane, Embase, and Scopus databases regarding jejunal Dieulafoy's lesio from inception till June 2020.

Is There a Need for Abdominal CT Scan in Trauma Patients With a Low-Risk Mechanism of Injury and Normal Vital Signs?

Background Clinically significant injuries are often missed in trauma patients with low-risk mechanisms of injury and lack of "red flags," such as abnormal vital signs. The purpose of this retrospective analysis was to evaluate the efficacy of computed axial tomography (CT) for identifying occult injuries in a high-volume trauma center. Methods Records from our institutional trauma registry were retrospectively extracted, examining encounters from January 2015 to October 2019.

Medical therapy early revascularization in diabetics with chronic total occlusions: A meta-analysis and systematic review.

Background: Management of chronic total occlusions (CTO) in diabetics is challenging, with a recent trend towards early revascularization [ER: Percutaneous coronary intervention (PCI) and bypass grafting] instead of optimal medical therapy (OMT). We hypothesize that ER improves morbidity and mortality outcomes in diabetic patients with CTOs as compared to OMT.

Aim: To determine the long term clinical outcomes and to compare morbidity and mortality between OMT and ER in diabetic patients with CTOs.

The combined effects of alcohol and marijuana use prior to traumatic brain injury on mortality.

Background: Alcohol (ETOH) intoxication is a common comorbidity in traumatic brain injury (TBI), and marijuana (THC) has been implicated as a major risk factor for trauma. The objective this study was to investigate the combined effects of ETOH and THC on mortality after TBI.

Materials And Methods: A retrospective review of patient data was performed to assess adult (>18 years) patients with brain injuries between January 2012 and December 2018.

Emergency Department Boarding of Non-Trauma Patients Adversely Affects Trauma Patient Length of Stay.

Introduction Emergency Department (ED) boarding delays initiation of time-sensitive protocols for trauma patients and makes them susceptible to increased mortality and morbidity. In this study, we compared the ED boarding times of non-trauma patients and ED length of stay (LOS) of trauma patients. Methods This was a single-center retrospective cohort study in a Level 1 trauma center.

Frequency, Trends, and Outcomes of Cerebrovascular Events Associated With Atrial Fibrillation Hospitalizations.

The main objective is to estimate the frequency, temporal trends, and outcomes of cerebrovascular events associated with atrial fibrillation (AF) hospitalization in the United States. The national inpatient sample data was utilized to identify hospitalizations with a primary or secondary diagnosis of AF from January 1, 2005 through September 31, 2015 for the present analysis. Jonckheere-Terpstra Trend was utilized to analyze trends from 2005 to 2015.

Safety of bariatric surgery in patients with inflammatory bowel disease: A systematic review and meta-analysis.

The efficacy of bariatric surgery in achieving weight loss and preventing long-term comorbidities such as cardiovascular diseases, diabetes mellitus and osteoarthritis is well established. Data regarding safety of bariatric surgery in patients with inflammatory bowel disease (IBD) is scarce. We attempted a systematic review and meta-analysis to evaluate the complications following bariatric surgery in patients with IBD.

The black esophagus and duodenum: a rare case report.

Acute esophageal necrosis is a rare esophageal disease, typically characterized by the circumferential black appearance of the esophagus mucosa that usually affects the distal esophagus. It commonly affects elderly men with multiple comorbidities. In the medical literature, some cases have been reported regarding acute necrotizing esophagus, but according to our knowledge, only one case has been reported concerning a patient with ischemic duodenum and esophagus.

The effects of alcohol and marijuana on survival after severe traumatic brain injury: A retrospective cohort study.

Background: Alcohol (ETOH) and marijuana (THC) use have previously shown to improve outcomes after Traumatic Brain Injury (TBI). However, whether TBI severity impacts outcomes among patients tested positive for both ETOH and THC remains unclear.

Materials And Methods: A retrospective review from the Northern Ohio Regional Trauma Registry, which includes deidentified data from six regional hospitals, including three Level 1 and three Level 3 trauma centers, was performed to assess adult (>18 years) patients with severe TBI (head Abbreviated Injury Score ≥ 3) between January 2012 and December 2018 having an alcohol and drug toxicology screen and data regarding outcome at discharge.

Drug-Eluting Stents Versus Bare-Metal Stents in Large Coronary Artery Revascularization: Systematic Review and Meta-Analysis.

Objectives: We aim to determine if drug eluting stents (DES) are better than bare-metal stents (BMS) in large coronary artery (diameter ≥ 3 mm) percutaneous coronary intervention (PCI).

Background: DES have become the standard of care for PCI in coronary artery disease (CAD). However, the superiority of DES over BMS in large vessel CAD is not clear and previous studies have shown conflicting results.

The Use of Point-of-Care Ultrasound to Accurately Measure Cardiac Output in Flight.

Cardiac point-of-care ultrasound (POCUS) is a quick and accurate tool to assess a patient's cardiovascular and hemodynamic status by measuring the E-point septal separation (EPSS) and left ventricular ejection fraction. The case presented here highlights the potential for increased use of POCUS to guide resuscitation in the prehospital setting and during critical care transport. A 56-year-old male presented to a rural emergency department with chest pain and was found to have an inferior STelevation myocardial infarction (STEMI).

Comparing Transcatheter Aortic Valve Replacement (AVR) With Surgical AVR in Lower Risk Patients: A Comprehensive Meta-Analysis and Systematic Review.

Background: Transcutaneous aortic valve replacement (TAVR) is a novel percutaneous procedure for severe aortic stenosis and has been recently approved by Food and Drug Administration in lower risk patients. We performed the first ever meta-analysis and literature review of clinical trials comparing both 30-day and 1-year outcomes in lower risk patients undergoing TAVR vs. surgical aortic valve replacement (SAVR, having Society of Thoracic Surgeons score < 4% or equivalent).

Anomalous Origin of Left Main Coronary Artery from the Right Sinus of Valsalva: A Case Series-based Review.

Congenital anomalies involving the origin of coronary arteries are rare and the most common anomaly is left circumflex (LCX) arising from the right sinus of Valsalva (RSV). Other anomalies include a single coronary artery from the left sinus of Valsalva, both coronary arteries from RSV and left anterior descending coronary artery (LAD) from RSV. Anomalous origin of left main from RSV carries a high risk of sudden cardiac arrest.

Prevalence of cardiovascular risk factors and financial burden in younger adults hospitalized with atrial fibrillation.

Introduction: Atrial fibrillation is the most frequently occurring and studied arrhythmia. There is a limited data on young patients presenting with atrial fibrillation.

Objective: The objective of this research article was to assess the trend of hospitalization, epidemiological characteristics and economic burden in the young adult, aged 18-45 years, presenting with atrial fibrillation.

Should we be vaccinating our patients against influenza?

There is a long history of vaccination administration from the Emergency Department. The morbidity, mortality and economic costs from influenza are staggering and an increasing body of literature supports initiatives for influenza vaccination from the Emergency Department. This article calls attention to this opportunity for Emergency Physicians to fill an unmet need with minimal impact to work-flow.

Heart failure mortality prediction using PRISM score and development of a classification and regression tree model to refer patients for palliative care consultation.

Introduction: We sought to assess one-year mortality in heart failure (HF) patients by using (Placement Resource Indicator for Systems Management) PRISM, a disease nonspecific risk stratification score, and use it along with modified Seattle Heart Failure Model (SHFM) to guide patient selection for palliative care consultation.

Methods: A retrospective study design was used to examine 1-year mortality in 689 HF patients admitted from 2012 to 2014. One-year mortality was calculated using Pmort30/PRISM and modified SHFM scores, and the predicted scores were validated using the area under the ROC curve.

Meta-Analysis of Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Patients With Low Surgical Risk.

Transcatheter aortic valve implantation (TAVI) is the current standard of care for patients with severe aortic stenosis who are at high risk for surgery. However, several recent studies have demonstrated the comparable safety and efficacy of TAVI in low-risk patients as well. We sought to pool the existing data to further assert its comparability.

A Case of Multiple Myeloma Presenting with Gastrointestinal Bleeding and Evans Syndrome.

Autoimmune events are rare in multiple myeloma (MM). Herein, we report a rare case of a patient presenting with recurrent gastrointestinal (GI) bleeding of unknown origin, also having pancytopenia eventually diagnosed as MM with Evans syndrome. This is an uncommon disorder presenting as autoimmune hemolytic anemia (AIHA) with immune thrombocytopenia purpura (ITP).

Meta-analysis Comparing Combined Use of Eicosapentaenoic Acid and Statin to Statin Alone.

Role of omega-3-Fatty acids, especially eicosapentaenoic acid (EPA), in reducing cardiovascular events is not clear. We conducted a meta-analysis including trial sequential analysis (TSA) of all available randomized controlled trials (RCTs) assessing the impact of EPA + statin on cardiovascular risk reduction. The aim is to appraise cardiovascular risk reduction with EPA and statin taken together.

Incidence, 30-day readmission rates and predictors of readmission after new onset atrial fibrillation who underwent transcatheter aortic valve replacement.

Introduction: New onset Atrial Fibrillation (NOAF) is frequently seen post transcatheter aortic valve replacement (TAVR). NOAF in the setting of TAVR has also been recognized as predictor of worse outcomes, including higher readmission rates. Data assessing the effect and predictors of NOAF on 30-day readmission rates post TAVR is limited.

Frequency of Cardiovascular Events and In-hospital Mortality With Opioid Overdose Hospitalizations.

The United States is in the kernel of cataclysmic opioid misuse epidemic with over 33,000 deaths per year from both prescription and illegal opioids use. One of the most common pernicious effects of opioids is on the cardiovascular system. The purpose of this analysis was to determine the incidence of opioid overdose associated cardiovascular events and its impact on short-term outcomes.

CMV gastric ulcer in a patient with pauci immune crescentic glomerulonephritis on rituximab - a rare combination.

Cytomegalovirus (CMV) infections are asymptomatic in immunocompetent patients but in immunocompromised patients, CMV infections have varying manifestations depending on their location. Patient who are organ transplant recipients, taking immunosuppressive therapy for a long time are at increased risk of CMV infections. CMV-induced gastric ulcer is very rare but many cases have been reported in the literature.