bluuebunny/crossref_metadata_2025 huggingface dataset:
Feasibility of measuring psychological resilience in hospitalized patients with acute illness: The Resilience After the Trauma of Acute Illness (RAFT) study
Authors:   Cardiff University, School of Medicine, UHW Main Building, Heath Park, CF14 4XN, Cardiff, Verma Tanu , Taufik Abduahad ,   Cardiff University, School of Medicine, UHW Main Building, Heath Park, CF14 4XN, Cardiff, Vindla Roshan ,   Cardiff University, School of Medicine, UHW Main Building, Heath Park, CF14 4XN, Cardiff, Rose Lloyd Sarah ,   Cardiff University, School of Medicine, UHW Main Building, Heath Park, CF14 4XN, Cardiff, Rees Sarah ,   Cardiff University, School of Medicine, UHW Main Building, Heath Park, CF14 4XN, Cardiff, P Subbe Christian ,   Acute, Respiratory & Critical Care Medicine, Bangor University & Ysbyty Gwynedd Hospital Bangor, Wales
Published: June 2021

Resilience is the ‘ability to bounce back’. We want to investigate whether measurement of resilience during an acute hospital admission is feasible. We conducted a feasibility study. Resilience was measured using the Brief Resilience Scale. Results were contextualized by measuring chronic disease burden, anxiety, depression, coping strategies and personality traits. 56 or 103 patients approached took part in the study. A group of 12 patients undergoing pulmonary rehabilitation served as a control group. We found evidence of low resilience in 4/44 (9%) patients admitted as medical emergencies. Low resilience was statistically related to the Hospital Anxiety and Depression Scale and a number of coping strategies and personality traits. We found no relation between measures of resilience and previous admissions to hospital. The concept of resilience might be applicable to unscheduled admissions to hospital. Larger studies are required to establish whether low resilience is common and amenable to intervention. REC number 17/WA/0024.
Are vital sign abnormalities associated with poor outcomes after emergency department discharge?
Authors:   Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA, Y Chang Cindy , Abujaber Samer ,   Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA, J Pany Maximilian ,   Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA, Obermeyer Ziad ,   Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
Published: June 2021

To examine association between vital sign abnormalities in the emergency department (ED) and early death after ED discharge, we performed a matched case-control study. Conditional logistic regression showed that presence of any vital sign abnormality at ED discharge was significantly associated with over three-fold increase in likelihood of death within 15 days of ED discharge (OR: 3.06, 95%CI: 2.81-4.48). Even small changes were associated with increased risk: every additional beat increase in heart rate conferred additional risk (OR: 1.04, 95%CI: 1.02-1.06), while every additional oxygen saturation percentage point was protective (0.89, 0.80-0.98). However, none of these vital sign abnormalities was a good predictor of early death; there was poor discrimination and substantial overlap in values between cases and controls.
Management of Acute Admissions of Heart Failure Patients with Kidney Disease
Authors:   Renal and Transplantation Unit, St Georges University Hospital NHS Foundation Trust, Junarta Joey , Banerjee Anita ,   Diabetes and Endocrinology Department, Guys and St Thomas’ NHS Foundation Trust, Lowe-Jones Racquel ,   Renal and Transplantation Unit, St Georges University Hospital NHS Foundation Trust, Banerjee Debasish ,   Renal and Transplantation Unit, St Georges University Hospital NHS Foundation Trust
Published: June 2021

Acute heart failure (HF) admissions are common. They are often associated with prolonged hospitalisations and poor outcomes. One-third of chronic HF patients also suffer from chronic kidney disease (CKD). Hence, acute admissions of HF with CKD are common and are associated with longer length of stay and increased mortality. Hyperkalaemia and acute on chronic renal impairment are important challenges in the management of these cases. Cautious introduction of high-dose diuretic therapy, followed by the re-commencement of renin-angiotensin-aldosterone (RAAS) inhibitors, improves length of stay, quality of life, and prognosis. During an admission on to the medical assessment unit careful monitoring and management of the patient’s clinical condition and biochemistry is essential.
Prediction models for mortality in adult patients visiting the Emergency Department: a systematic review
Authors:   Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherlands, Brink A , Alsma J ,   Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherlands, Fortuin AW ,   Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherlands, Bramer WM ,   Erasmus MC, University Medical Center Rotterdam, the Netherlands, Zietse R ,   Erasmus MC, University Medical Center Rotterdam, the Netherlands, Lingsma HF ,   Erasmus MC, University Medical Center Rotterdam, the Netherlands, Schuit SCE ,   Erasmus MC, University Medical Center Rotterdam, the Netherlands
Published: June 2021

We provide a systematic overview of literature on prediction models for mortality in the Emergency Department (ED). We searched various databases for observational studies in the ED or similar setting describing prediction models for short-term mortality (up to 30 days or in-hospital mortality) in a non-trauma population. We used the CHARMS-checklist for quality assessment. We found a total of 14.768 articles and included 17 articles, describing 22 models. Model performance ranged from AUC 0.63- 0.93. Most articles had a moderate risk of bias in one or more domains. The full model and PARIS model performed best, but are not yet ready for implementation. There is a need for validation studies to compare multiple prediction models and to evaluate their accuracy.
Diabetic ketoacidosis, a common disease with life-threatening pitfalls
Authors:   Medical Intensive Care Unit, Cochin Hospital, Hôpitaux Universitaires Paris Centre, de Roquetaillade Charles , Llitjos Jean-François ,   Medical Intensive Care Unit, Cochin Hospital, Hôpitaux Universitaires Paris Centre, Paul Marine ,   Medical Intensive Care Unit, Cochin Hospital, Hôpitaux Universitaires Paris Centre, Guillemet Lucie ,   Medical Intensive Care Unit, Cochin Hospital, Hôpitaux Universitaires Paris Centre, Salem Omar Ben Hadj ,   Medical Intensive Care Unit, Cochin Hospital, Hôpitaux Universitaires Paris Centre, Mira Jean-Paul ,   Medical Intensive Care Unit, Cochin Hospital, Hôpitaux Universitaires Paris Centre, Cariou Alain ,   Medical Intensive Care Unit, Cochin Hospital, Hôpitaux Universitaires Paris Centre
Published: June 2021

Diabetic ketoacidosis (DKA) is a common cause for admission in Emergency Department. Its treatment is well defined. Nevertheless, in some cases, type I diabetes combines with auto-immune polyendocrine syndrome, which can carry life-threatening consequences. Here we report the case of a young man with inaugural DKA who exhibited ventricular fibrillation and cardiac arrest due to significant hypokalaemia, following undiagnosed thyrotoxicosis with periodic paralysis.
Using trends in electronic recordings of vital signs to identify patients stable for transfer from acute hospitals
Authors:   Respiratory & Critical Care Medicine Bangor University & Ysbyty Gwynedd Hospital Bangor, Wales, Subbe Christian P , Weichert Jochen ,   Clinical Marketing 3000 Minuteman Road, M/S 4307, Andover, MA 01810, Duller Bernd ,   Perpet Production, Kolumbusstr. 29, 70439 Stuttgart, Germany
Published: June 2021

Patients who are stable might not be required to remain in hospital. We aimed to create objective criteria to indicate stability based on vital signs. An index based on NEWS (NBI) was compared to a Patient Stability Index (PSI) algorithm created by random forest analysis. Data from the VITAL II study was used to train the algorithm and data from the VITAL III study to validate it. Failure rate of the algorithms was set close to the rate of readmission to UK hospitals at 15%. After a training period of two days the NBI identified stability with acceptable failure rates only after a further 96 hours with a subsequent release of 2143 bed days compared to the PSI which identified stability after only 12 hours leading to potential earlier release of 2652 bed days. Vital sign-based algorithms might be able to predict safe transfer from hospital and inform management of flow.
MR-Brain Causing Confusion
Authors:   Department of Intensive Care Medicine, Glenfield Hospital, University Hospitals Of Leicester NHS Trust, UK, Farooqui Azhar , Ramzan Muhammad Tahir ,   Department of Acute Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, UK, Pattinson Joanne ,   Department of Elderly Care Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, UK, Zaidi Syed Habib Haider ,   Department of Acute Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, UK
Published: June 2021

An 82-year-old lady was found on the floor of her home, confused and surrounded by vomitus. She had a past medical history of type II diabetes, hypothyroidism, previous left total hip replacement, and previous hip fracture treated with right dynamic screw fixation. Prior to the current presentation she had been living alone, mobilizing independently with a walking stick and self-caring for her activities of daily living. She was last seen by her daughter on the previous day, and reported no concerning symptoms.
Spontaneous Thyroid Haemorrhage: A Cause of Upper Airway Obstruction
Authors:   Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia, Wong Micheal , Kanapaty Yogesvaran ,   Department of Otorhinolaryngology, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, Malaysia, Liew Yew Toong ,   Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia, Bakri Adzreil ,   Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
Published: June 2021

Background: Spontaneous thyroid haemorrhage is a very rare condition that is potentially life-threatening. We report an unusual case of spontaneous thyroid haemorrhage leading to airway compromise requiring urgent intervention. We highlight key clinical findings and management steps with comparison to similar cases in the literature. Case Summary: An adult male presented with sudden anterior neck swelling and bruises on his neck and chest with hoarseness and dysphagia. Clinical assessment and CT scan revealed a thyroid haemorrhage with laryngopharyngeal, neck and chest haematoma. He was intubated for airway protection and given intravenous steroids and antibiotics. He was extubated well after 3 days. Conclusion: Careful prompt management of the patient’s airway is of vital importance as worsening haematoma can lead to rapid airway compromise. Acute physicians should be aware of the clinical signs of thyroid haemorrhage, as this rare condition may present to the acute medical take.
Non traumatic spinal epidural haematoma
Authors:   University hospitals of Leicester NHS trust. Leicester Royal Infirmary., Khalid Naureen Abdul , Shah Nainal ,   University hospitals of Leicester NHS trust, Leicester Royal Infirmary.
Published: June 2021

Spinal epidural haematoma is a rare condition, which may be due to trauma, surgery, epidural catheterisation or disorders of coagulation. We report a case of 60 year old lady who was on warfarin for Atrial fibrillation (AF) presented with history of non-traumatic sudden onset pain in both legs and difficulty in walking. Magnetic resonance imaging (MRI) spine demonstrated epidural haematoma which was treated conservatively. Another dilemma was anticoagulation for AF. We examine the options to manage such case.
Non-Cardiac Chest Pain
Authors:   London Northwest Healthcare NHS Trust, Northwick Park Hospital, Watford Road, Harrow, de Wolff Jacob F , Fawcett Katherine M. ,   Northwick Park Hospital
Published: June 2021

We read with interest “Non-Cardiac Chest Pain: Management in the Ambulatory Clinic setting” (Acute Med 2019;18(3)165-70). It is useful to know about the various musculoskeletal causes of chest pain, especially where specific treatment may be available. We were alarmed, however, about the discussion of pleural pain. This is a common presenting complaint to acute medical teams both on the acute medical take and on ambulatory care units. The authors do not list a differential diagnosis for pain of pleural origin, apart from pulmonary embolism. A chest radiograph is recommended, as well as either a WELL’s (sic) score or D-dimer. Furthermore, bedside lung ultrasound is recommended if the chest radiograph is normal, despite limited availability and training in the UK. Ironically, the reference provided (Aydogdu M et al, Tuberk Toraks 2014;62:12-21) is much more reflective of the modern approach to suspected pulmonary embolism. It discusses the PERC (PE rule-out criteria) which perform very well in people who present with chest pain, and reduces reliance on D-dimer testing. D-dimer testing should never be performed without determining a pre-test probability using validated scores such as the Wells score. As the authors suggest, not all chest pain that worsens with inspiration is “pleuritic”. In addition, substernal pain with a respiratory component does not increase the likelihood of PE, whereas lateral and posterior pain does (Kline J, Thomb Res 2018;163:207-20). Kind regards, Jacob F. de Wolff FRCP Katherine M. Fawcett FRCP Consultant Acute Physicians Northwick Park Hospital
Editorial Volume 19 Issue 1 – “Eternal Winter”: Acute Medicine the key to providing longer periods of summer
Authors:   Consultant in Acute Medicine, Manchester University Foundation Trust and The Christie, Manchester, UK, Cooksley Tim
Published: June 2021

As another winter season passes, many colleagues will continue to be working under immense pressures striving to provide high quality care for increasingly larger numbers of patients. The work of Acute Medicine teams to keep the “front door” safe are fundamental to the delivery and sustainability of acute care services. The challenges of innovating and enacting positive changes at times of such high service demand are not insignificant; but the specialty is blessed with rapidly expanding driven and dedicated international, national and local leaders. The first winter SAMBA has recently been performed. SAMBA is an increasingly rich data source that will serve both nationally and locally to help improve performance and ultimately patient outcomes.1 Higher quality Acute Medicine is being produced. Acute Physicians are leading in many acute sub-specialties. Pleasingly, there has a been a significant rise in the number of trainees applying to train in Acute Medicine in the UK reflecting the traction the specialty is achieving. Ambulatory care remains a fundamental tenet to the sustainability of acute care services. Point of care testing is a key element in driving efficient performance in this setting and in this issue Verbakel et al. perform an important analysis on the reliability of point of care testing to support community based ambulatory care.2 This work should field the way for further research defining the impact of point of care testing and how it should be implemented in ambulatory clinical practice. The performance of respiratory rate observation remains poorly performed in acute care settings despite its well validated predictive value. Nakitende et al. describe an app that allows respiratory rate to calculated more quickly and accurately by using a touch screen method.3 Technological innovations to improve the recording and accuracy of physiological parameters in acute care, which can also be used in resource poor settings, will be a focus of large quantities of research in the upcoming years. Blessing et al. describe an important modelling study on the impact of integrated radiology units.4 Co-ordination between Acute Medicine and Radiology departments is essential in a high functioning AMU, especially as increasingly Acute Physicians are trained in point of care ultrasound. Lees-Deutsch et al. provide a fascinating insight into the patient’s perspective of discharge lounges.5 Often used to help maintain flow through the hospital, they elucidate that patients and caregivers transferred from AMU do not find this aspect of their journey a positive one. In times of significant organisational pressures, it is important that clinicians continue to examine the impact of flow measures on the quality of patient care and experience.
Respiratory rates observed over 15 seconds compared with rates measured using the RRate app. Practice-based evidence from an observational study of acutely ill adult medical patients during their hospital admission
Authors:   Department of Medicine, Enrolled Nurse, Department of Medicine, Kitovu Hospital, Masaka, Uganda, Nakitende Immaculate , Namujwiga Teopista ,   Department of Medicine, Enrolled Midwife, Department of Medicine, Kitovu Hospital, Masaka, Uganda, Dunsmuir Dustin ,   Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, Canada, Ansermino J. Mark ,   Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, Canada, Wasingya-Kasereka Lucien ,   Deputy Medical Director, Kitovu Hospital, Masaka, Uganda, Kellett John ,   Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
Published: June 2021

Background: counting respiratory rate over 60 seconds can be impractical in a busy clinical setting. Methods: 870 respiratory rates of 272 acutely ill medical patients estimated from observations over 15 seconds and those calculated by a computer algorithm were compared. Results: The bias of 15 seconds of observations was 1.85 breaths per minute and 0.11 breaths per minute for the algorithm derived rate, which took 16.2 SD 8.1 seconds. The algorithm assigned 88% of respiratory rates their correct National Early Warning Score points, compared with 80% for rates from 15 seconds of observation. Conclusion: The respiratory rates of acutely ill patients are measured nearly as quickly and more reliably by a computer algorithm than by observations over 15 seconds.
Bedside Point-of-Care Ultrasound of an Adult with Diffuse Intermittent Abdominal Pain
Authors:   Harvard Medical School, Boston, MA, USA, C Nwanaji-Enwerem Jamaji , Landry Adaira ,   Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
Published: June 2021

A 29-year-old woman with a history of obesity status post Roux-en-Y gastric bypass greater than five years prior presented to the emergency department with four hours of sudden-onset stabbing left-sided abdominal pain associated with nausea and non-bloody emesis. She denied melaena and hematochezia, but did report two weeks of diarrhoea that was unchanged with this new onset abdominal pain.
Gaps in point of care ultrasound provision and the cost of ultrasound equipment provision: results of a nationwide audit of acute medical units
Authors:   Sandwell and West Birmingham NHS Trust, Department of Acute Medicine, Birmingham, United Kingdom, Knight Thomas , Clare Sarbjit ,   Sandwell and West Birmingham NHS Trust, Department of Acute Medicine, Birmingham, United Kingdom, Smallwood Nicholas ,   Acute Internal Medicine Surrey and Sussex NHS Trust, Lasserson Daniel ,   Sandwell and West Birmingham NHS Trust, Department of Acute Medicine, Birmingham, United Kingdom
Published: June 2021

Introduction: Advances in ultrasound technology have allowed an investigation previously restricted to the radiology department to be used more liberally in clinical decision making. Point-of-Care-Ultrasound (PoCUS) has superior diagnostic performance to traditional clinical examination across a range of pathologies in the hands of a suitably experienced practitioner. The utilisation of PoCUS has the potential to greatly influence the delivery of acute care, but little is known about the current level of resource provision within the acute medical setting. Methods: To establish the availability of ultrasound equipment and appropriately trained clinicians within Acute Medical Units (AMUs) in the United Kingdom (UK) we asked specific questions with an annual day of care survey, undertaken by the Society for Acute Medicine. We compared data across two years to assess interval changes. Results: 58.1% (75/129) of AMUs had access to dedicated ultrasound equipment in SAMBA’19. This represents a small increase from SAMBA’18. Ultrasound expertise is concentrated across a small number of AMUs. Growth in the number of ultrasound trained clinicians is greatest units with established expertise. Conclusion: The equipment to provide PoCUS is not present on all AMUs and appropriately trained clinicians are not distributed evenly across units. This is likely to affect individual AMUs ability to deliver bedside ultrasound to appropriate patients who may benefit. Bridging the gap to ensure all AMUs have the option to use PoCUS will require planning and investment.
Ferric carboxymaltose (Ferinject®) associated hypophosphataemia: case report illustrating the need for increased awareness to minimise incidence and risk
Authors:   North Cumbria Integrated Care, Carlisle CA1 3SX, UK, Fisher Stacey , Jonker Leon ,   North Cumbria Integrated Care NHS Foundation Trust, Carlisle CA1 3SX, UK
Published: June 2021

Ferric carboxymaltose (Ferinject®) is an infusion administered for the treatment of iron deficiency anaemia. A number of previous case reports have shown the occurrence of hypophosphataemia after Ferinject® treatment, supposedly managed though high dose phosphate therapy. This case report highlights the risk associated with, and futility of, managing this adverse effect through high dose phosphate infusion. A review of the available literature suggests that if hypophosphataemia develops as a result of Ferinject®, through upregulation of the renal protein Fibroblast Growth Factor-23, it cannot be readily reversed and on average persists for circa 50 days. Acute medical units should be aware of this – likely underreported – adverse effect, and avoid treating these hypophosphataemic patients with high dose phosphate since it can compound symptoms.
The utility of peripheral venous lactate in emergency department patients with normal and higher lactate levels: A prospective observational study
Authors:   Department of Internal Medicine, OLVG Amsterdam, The Netherlands Current: Department of Intensive Care, Amsterdam University Medical Centre, VU University, The Netherland, Jon Van Tienhoven Arne , AJ Van Beers Cornelis ,   Department of Internal Medicine, OLVG Amsterdam, The Netherlands, EH Siegert Carl ,   Department of Internal Medicine, OLVG Amsterdam, The Netherlands, WB Nanayakkara Prabath ,   Department of Internal Medicine, Section Acute Medicine, Amsterdam University Medical Centre, VU University, The Netherlands
Published: June 2021

Objective: to assess the utility of peripheral venous lactate (PVL) in Emergency Department patients. Methods: arteriovenous agreement was assessed in three subgroups: PVL <2 mmol/l, PVL ≥ 2 mmol/l to < 4 mmol/l and PVL ≥ 4 mmol/l. The predictive value of PVL to predict arterial lactate (AL) ≥2 mmol/l was assessed at different cut-off values. Results: 74 samples were analysed. The venous-arterial mean difference and 95% limits of agreement for the subgroups were 0.25 mmol/l (-0.18 to 0.68), 0.37 mmol/l (-0.57 to 1.32) and -0.89 mmol/l (-3.75 to 1.97). PVL ≥2 mmol/l predicts AL ≥2 mmol/l with 100% sensitivity. Conclusion: PVL <2 mmol/l rules out arterial hyperlactatemia. As agreement declines in higher levels, arterial sampling should be considered.
Limited Prognostic Utility of a Simplified Vital Sign Based Risk Calculator in Acute Medical Admissions
Authors:   MED Directorate, St James’s Hospital, Dublin 8, Ireland., Conway Richard , Byrne Declan , O’Riordan Deirdre ,   MED Directorate, St James’s Hospital, Dublin 8, Ireland., Silke Bernard ,   MED Directorate, St James’s Hospital, Dublin 8, Ireland.
Published: June 2021

Background: Accurate efficient prognostication in acute medical admissions remains challenging.Methods: We constructed a Vital Sign based Risk Calculator using vital parameters and Major Disease Categories to predict 30-day in-hospital mortality using a multivariable fractional polynomial model. Results: We evaluated 113,807 admissions in 58,126 patients. The Vital Sign based Risk Calculator predicted 30-day inhospital mortality to increase from 2 points – 3.6% (95%CI 3.4, 3.7) to 12 points – 14.8% (95%CI 14.0, 15.7). AUROC was 0.74 (95%CI 0.72, 0.74). The addition of illness severity and comorbidity data improved AUROC to 0.90 (95%CI 0.89, 0.90). Conclusion: The Vital Sign based Risk Calculator is limited by its simplicity; inclusion of illness severity and comorbidity data improve prediction.
Pacemaker Lead Perforation Mimicking Symptoms of Acute Pulmonary Embolism
Authors:   Department of Intensive Care Medicine, Glenfield Hospital, University Hospitals Of Leicester NHS Trust, UK, Farooqui Azhar , Key Thomas ,   Department of Cardiology, Kettering General Hospital, United Kingdom, Ihekwaba Ugochukwu ,   Department of Cardiology, Kettering General Hospital, United Kingdom, Hogrefe Kai ,   Department of Cardiology, Kettering General Hospital, United Kingdom
Published: June 2021

Myocardial perforation is a rare yet serious complication following cardiac pacemaker or defibrillator device procedures. In this article, the authors describe a case of right ventricular pacemaker lead perforation presenting to our hospital’s medical assessment unit with a clinical presentation suggestive of an acute pulmonary embolism. Treatment dose low molecular weight heparin (LMWH) was commenced while awaiting CT scan. CT images were negative for PE however demonstrated RV lead perforation. Echocardiogram demonstrated pericardial effusion with the tip of RV lead in the pericardial free space. A rapid deterioration in the patient’s haemodynamics prompted an emergency pericardial drain insertion and successful RV lead re-position in the cardiac catheter lab. The patient recovered well and was discharged with routine pacemaker clinic follow-up.
Total Occlusion of the Left Descending and circumflex Coronary Artery without ST Elevation: the De Winter electrocardiographic pattern
Authors:   Okmeydani Training and Research Hospital, Department of Emergency Medicine, İstanbul, Turkey, Kalkan Asim , Cekmen Bora ,   Okmeydani Training and Research Hospital, Department of Emergency Medicine, İstanbul, Turkey, Bas Behlul ,   Okmeydani Training and Research Hospital, Department of Emergency Medicine, İstanbul, Turkey, Taylan Kocer Mehmet ,   Okmeydani Training and Research Hospital, Department of Emergency Medicine, İstanbul, Turkey, Demirel Ahmet ,   Okmeydani Training and Research Hospital, Department of Emergency Medicine, İstanbul, Turkey, Deniz Tayfun Bilge ,   Okmeydani Training and Research Hospital, Department of Emergency Medicine, İstanbul, Turkey
Published: June 2021

de Winter syndrome, or anterior ST segment elevation myocardial infarction (STEMI), constitutes 2% of acute myocardial infarctions. In contrast to classic ST segment elevation as seen with STEMI, it involves ST depression with precordial derivations and sharp waves. de Winter syndrome indicates critical narrowing of the left ascending coronary artery (LAD). Recognizing this presentation is important in terms of both mortality and morbidity. We present the case of a 71-year old patient presenting at the Emergency Department with chest pain, who had findings of de Winter syndrome on their ECG. Coronary angiography confirmed occlusions in the LAD and circumflex (CX) coronary arteries.
Acute, non-COVID related medical admissions during the first wave of COVID-19: A retrospective comparison of changing patterns of disease
Authors:   University Hospitals Birmingham NHS FoundationTrust, Birmingham, United Kingdom, Riley Bridget , Packer M ,   University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom, Gallier S ,   Pioneer Hub, Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom, Sapey Elizabeth ,   Elizabeth Sapey, Atkin Cat ,   Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University Hospital Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, United Kingdom
Published: June 2021

COVID-19 may have altered the case-mix of non-COVID acute medical admissions. Retrospective analysis of acute medical admissions to University Hospitals Birmingham NHS Foundation Trust, showed that medical admissions decreased in April 2020 compared to April 2019. The proportion of young adults, non-cardiac chest pain, musculoskeletal conditions and self-discharges decreased. The proportion of admissions due to alcohol misuse, psychiatric conditions, overdoses and falls increased. There were a higher number of patients admitted to ICU and greater inpatient mortality but not once COVID diagnoses were excluded. There was a significant change in hospitalised case-mix with conditions potentially reflecting social isolation increasing and diagnoses which rarely require hospital treatment, reducing. This analysis will help inform service planning.
Approach to dyspnoea in pregnancy in the COVID-19 era
Authors:   Diabetes and Endocrinology Department, Guys and St Thomas’ NHS Foundation Trust, Banerjee Anita , Arrandale Lindsay A ,   Department of Anaesthesia, Guys and St Thomas’ Hospitals NHS Foundation Trust, Sankaran Srividhya ,   Guys and St Thomas’ Hospitals NHS Foundation Trust, Glover Guy W ,   Guys and St Thomas’ Hospitals NHS Foundation Trust, Nelson-Piercy Catherine ,   Guy’s and St. Thomas’ NHS Foundation Trust, UK
Published: June 2021

Importance: Dyspnoea and hypoxia in pregnant women during the COVID-19 pandemic may be due to causes other than SARS Co-V-2 infection which should not be ignored. Shared decision-making regarding early delivery is paramount. Objective: To highlight and discuss the differential diagnoses of dyspnoea and hypoxia in pregnant women and to discuss the risks versus benefit of delivery for maternal compromise. Design, setting and participants: Case series of two pregnant women who presented with dyspnoea and hypoxia during the COVID-19 pandemic. Results: Two pregnant women presented with dyspnoea and hypoxia. The first case had COVID-19 infection in the 3rd trimester. The second case had an exacerbation of asthma without concurrent COVID-19. Only the first case required intubation and delivery. Both recovered and were discharged home. Conclusion and relevance: Our two cases highlight the importance of making the correct diagnosis and timely decision-making to consider if delivery for maternal compromise is warranted. Whilst COVID-19 is a current healthcare concern other differential diagnoses must still be considered when pregnant women present with dyspnoea and hypoxia.
Biomarker negative pancreatitis caused by Influenza B infection. A case presentation and review of the literature
Authors:   Acute Medicine Department United Lincolnshire Hospitals NHS Trust, Zafeiris Pavlos D.
Published: June 2021

Background: Influenza B is considered to cause milder illness compared to influenza A. There has been no known association between influenza B and acute pancreatitis. Case report: We present a case of an influenza B infection complicated with acute pancreatitis. Furthermore, the biochemical markers that are used to diagnose pancreatitis were normal in this case. Discussion: We present the case that Influenza B can present with severity compared to this of Influenza A. We review the literature on infectious causes and diagnostic criteria for acute pancreatitis and on acute pancreatitis with normal pancreatic enzymes. Conclusion: Influenza B can rarely cause acute pancreatitis. The absence of biochemical confirmation should not exclude the diagnosis of pancreatitis in the appropriate clinical setting.
Idiopathic Pulmonary Arterial Hypertension Unmasked by Pregnancy
Authors:   Great Western Hospital, Swindon, Maxwell Adam , Holman Thomas ,   Great Western Hospital, Swindon, Novak Timea ,   Great Western Hospital, Swindon
Published: June 2021

A 31-year old woman presented to the acute medical unit 9 days post-partum with shortness of breath and peripheral oedema. Initially suspected to have either a pulmonary embolism or post-partum cardiomyopathy, she proceeded to have imaging including a CT Pulmonary angiogram and echocardiogram, which were suggestive of pulmonary hypertension and severe right heart failure. Her history and other investigations did not reveal any obvious cause for this. She was transferred to a specialist centre where she was diagnosed with Idiopathic Pulmonary Arterial Hypertension (IPAH), previously known as primary pulmonary hypertension. Shortness of breath during pregnancy and in the postpartum period is a relatively common acute medical presentation. Whilst IPAH is a rare diagnosis, it carries a high mortality rate, particularly in pregnancy, and requires prompt specialist investigation, diagnosis and management.
What the acute physician needs to know about Anti-NMDA receptor encephalitis: two case presentations
Authors:   Royal Liverpool University Hospital, Liverpool, United Kingdom, Gall Stephanie Louise , Healy Sarah Mary ,   Walton Centre NHS Foundation Trust, Liverpool, United Kingdom, Michael Benedict Daniel ,   Walton Centre NHS Foundation Trust, Liverpool, United Kingdom, Price Vicky Anne ,   Royal Liverpool University Hospital, Liverpool, United Kingdom, Ellis Richard James Booth ,   Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
Published: June 2021

These case reports look at two patients with anti-N-methyl-D-aspartate receptor (NMDAr) encephalitis presenting to the same acute medical unit within a month of each other. The following covers the characteristic signs, symptoms and timeline associated with this condition and discusses whether we should be sending CSF for anti-NMDAr antibody testing more readily.
Hospital trainees’ worries, perceived sufficiency of information and reported psychological health during the COVID-19 pandemic
Authors:   Barnet Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom, Aziminia Nikoo , Khani Aria ,   Barnet Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom, Smith Colette ,   Institute for Global Health, University College London, London, United Kingdom, Bakhai Ameet ,   Barnet Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom, Lisk Clifford ,   Barnet Hospital, Royal Free London NHS Foundation Trust, Wellhouse Lane, Barnet
Published: June 2021

Introduction: The COVID-19 pandemic has been unsurpassed in clinical severity or infectivity since the 1918 Spanish influenza pandemic and continues to impact the world. During the A/H1N1 pandemic, healthcare workers presented concerns regarding their own and their families’ health, as well as high levels of psychological distress. We aim to assess hospital trainees’ concerns, perceived sufficiency of information, behaviour and reported psychological health during the COVID-19 pandemic. Design: Single 39-point questionnaire. Setting: A large NHS foundation trust in London. Participants: 204 hospital trainee doctors. Results: 204 trainees participated, of whom 91.7% (n=187) looked after COVID-19 patients. 91.6% (n=164) were worried about COVID-19; the most frequent concern was that of family and friends dying from COVID-19 (74.6%, n=126). 22.2% (n=36) reported being infected with COVID-19. 6.8% (n=11) of trainees considered avoiding going to work. Perceived sufficiency of information about COVID-19 was moderately high. 25.9% (n=42) reported social distancing at work compared with 94.4% (n=152) outside work. 98.2% (n=159) reported using PPE and 24.7% (n=40) were confident the provided PPE protected them. 41.9% (n=67) reported their psychological health had been adversely affected. 95.6% (n=153) supported provision of psychological support services and 62.5% (n=100) stated they would consider using them. Conclusions: A significant proportion of hospital trainees expressed worries about COVID-19, above all with regards to the wellbeing of their loved ones over their own. Confidence in sufficiency of provided information was high and in utilised infection control measures low. A larger proportion of trainees reported psychological as compared with physical health concerns, with a smaller proportion confirming having been infected with COVID-19 although most perceived their risk of infection as high. Seeking solutions to support hospital trainees in their duties and their wellbeing with their input would help to empower them and improve their health and morale while working during pandemics.
A rare, but life-threatening sore throat: A case of Lemierre’s syndrome
Authors:   Royal Victoria Hospital, Belfast, McCleane A , Hunter M ,   Royal Victoria Hospital, Belfast, Johnston PC ,   Royal Victoria Hospital, Belfast, Trimble M ,   Royal Victoria Hospital, Belfast, Malloy J ,   Royal Victoria Hospital, Belfast, Wallace IR ,   Royal Victoria Hospital, Belfast
Published: June 2021

We present the case of a previously healthy, immunocompetent male with Lemierre’s Syndrome. He presented with headache, sore throat and pyrexia. Initial blood tests revealed raised inflammatory markers and electrolyte abnormalities. Blood cultured Fusobacterium necrophorum. He developed respiratory distress and imaging confirmed lung abscess and empyema due to septic emboli. He required surgical drainage and a prolonged course of antibiotics. This case highlights the rare, but life-threatening condition of Lemierre’s Syndrome. We discuss the importance of prompt recognition and early antibiotic therapy.
Work Based Assessments (WBAs) amongst UK medical trainees during the COVID-19 pandemic: How have we adapted?
Authors:   Bolton NHS Foundation Trust, Sheik Ali Shirwa , Sheik Ali Sharaf ,   Oxford University Hospitals NHS Trust, O'Connor Alex ,   North West School of Surgery, R Abbas Jonathan ,   Bolton NHS Foundation Trust
Published: June 2021

Severe Acute Respiratory Syndrome Coronavirus type 2 (SARS-CoV-2) was recently identified as the RNA virus resulting in the Coronavirus disease (COVID-19). This was following cases of pneumonia identified in Hubei Province in China. The World Health Organisation (WHO) recently declared COVID-19 as a pandemic in March The COVID-19 pandemic has resulted in medical, financial and social disruption on an international scale. Such disruption has additionally impacted postgraduate medical training. This has been reflected in the attainment of Work Based Assessments amongst medical trainees in the United Kingdom.
UMA ANÁLISE MULTIDIMENSIONAL DA PRÁTICA DO PROSELITISMO NO ENSINO RELIGIOSO FRENTE AO ART. 33 DA LDB
Authors: Castello Branco Gustavo Leite
Published: June 2021

No presente trabalho, apresentamos a questão do proselitismo como um fenômeno intrínseco às religiões em geral e como elemento integrante da própria espiritualidade dos chamados “monoteísmos históricos”. A partir do Art. 33 da LDB, empreendemos uma análise multifocal da vedação de proselitismo no Ensino Religioso ministrado em instituições públicas. Nessa análise contemplamos as dimensões pedagógica, jurídica, teológica e epistemológica. Ao final, com base na análise feita, sugere-se algumas diretrizes em torno da postura a ser tomada no trato da questão do proselitismo dentro do Ensino Religioso.
A LIBERDADE RELIGIOSA NAS COMUNIDADES INDÍGENAS BRASILEIRAS
Authors: Almeida Edmilson
Published: June 2021

O Direito Fundamental à Liberdade Religiosa no Brasil é amplo e transversal, pois abrange diversas manifestações e sujeitos. Por esta razão, seguindo a orientação do texto magno de privilegiar a pluralidade e a convivência com diversas matrizes culturais, aquele direito também deve ser usufruído e garantido às comunidade e aos sujeitos indígenas. Neste sentido, a melhor exegese do art. 231, da CF/88, deve atender, dentre outros, ao princípio da autonomia, não sendo a preservação das tradições indigenistas entendida como um dever objetivo do Estado, mas um direito público subjetivo do beneficiário. Por sua vez, na jurisprudência do Tribunal de Contas da União, a corte analisou a atuação da Fundação Nacional do Índio e não fez qualquer ressalva quanto à presença de organizações religiosas nestes espaços, não sendo o TCU contrário ao exercício de atividades religiosas estrangeiras à cultura e cosmologia locais em áreas indígenas, desde que respeitadas a autonomia das comunidades e a liberdade individual. Assim, entendemos que a Funai precisa se adequar urgentemente, nos moldes das orientações e motivações expostas pela jurisprudência do TCU, a fim de regular favoravelmente a presença missionária em áreas indígenas, evitando, assim, insegurança jurídica, tanto pelas organizações religiosas, quanto pelas comunidades indígenas, assegurando seus direitos constitucionais.
Os Pilares Teóricos da Pedagogia Crítica:
Authors: Oliveira Jhonathan Jarison dos Anjos de , Marinho Gabriela Medeiros
Published: June 2021

Tendo em vista a influência de tendências pedagógicas que buscam emancipar o indivíduo, levando-o a negar sua natureza e desvincular-se de qualquer herança do passado na tentativa de justificar o progresso em detrimento da desvalorização da verdade, sendo a instituição escolar a principal agente de propagação de uma filosofia, este artigo vista, através do método bibliográfico, esclarecer os pilares teóricos da pedagogia crítica. As linhas de pensamento expressas nessa tendência educacional partem do marxismo, seus pressupostos sobre a natureza humana e o conceito da práxis, passando pela escola de Frankfurt e sua teoria crítica, a influência dessa escola no movimento reconstrucionista, até que cheguemos a Antonio Gramsci e sua concepção de revolução cultural. Essa pedagogia ultrapassa os limites da teoria e atravessa o campo epistemológico, mas cruza também os campos éticos, econômicos, políticos e culturais, pois quando é posta em prática, influencia todas as esferas da sociedade, pois serve de veículo de divulgação ideológica. A avidez por transformar ao invés de conhecer põe o caráter principal da educação, que é a adaptação ao conhecimento legado em nulidade, formando homens que alçam-se deuses sedentos pelo futuro.
Communication and COVID-19 Physical Distancing Behavior Among Dutch Youth
Authors: Rozendaal Esther , Van Woudenberg Thabo , Crone Eveline , Green Kayla , Van de Groep Suzanne , De Leeuw Rebecca , Sweijen Sophie , Buijzen Moniek
Published: June 2021

Background: Although most young people do not become seriously ill from the coronavirus causing the COVID-19 disease, they do play a role in its spread. It is therefore important that they adhere to the recommended preventive behaviors, most importantly, physical distancing. This study aims to gain a better understanding of the psychosocial determinants of young people’s physical distancing behavior and the role that direct (i.e., interpersonal) and mediated communication (i.e., mass media, social media) about COVID-19 plays in this.Methods: A daily diary study was conducted among 481 Dutch adolescents (secondary school students; age range 10–18 years) and 404 young adults (university students; age range 17–25 years), involving 10 identical daily surveys administered on weekdays during a 2-week period during the first wave of the COVID-19 pandemic (May 2020). The hypotheses were tested with preregistered univariate and multivariate linear mixed-effects models.Results: The perceived descriptive norm (i.e., what friends are doing) was the most important determinant of physical distancing behavior among both adolescents and young adults. The perceived injunctive norm, perceived response efficacy, and perceived severity were also positively associated with physical distancing, albeit less strong. Among adolescents, exposure to information about COVID-19 in the mass media increased their perceptions of the descriptive norm, which in turn increased their physical distancing behavior.Conclusions: For those involved in studying and designing COVID-19-related behavioral interventions and campaigns targeting youth, it is important to consider the social norms that they relate to, and to take into account their perceived severity and response efficacy.
Síndrome inflamatorio multisistémico en niños asociado a infección por SARS-CoV-2
Authors: Escalante Prieto Elias , Guzmán Flores Luis José , Barahona Escobar Guillermo Edgardo
Published: June 2021

El siguiente reporte de caso describe la presentación del síndrome inflamatorio multisistémico asociado a la infección por el coronavirus 2 del síndrome respiratorio agudo grave en niños, que inicialmente se comparó con el síndrome mucocutáneo linfonodular, mejor conocido como enfermedad de Kawasaki clásica. Sin embargo, existen marcadas diferencias entre ambos síndromes, como se observará en el desarrollo del caso clínico, el cual cursa con un importante compromiso pulmonar, desarrollando un síndrome de distress respiratorio agudo pediátrico y posteriormente secuelas cardiovasculares que determinan el desenlace desfavorable. En este caso, la paciente desarrolló las manifestaciones de gravedad al sexto día de enfermedad y se inició cuidados intensivos oportunos con soporte aminérgico, ventilación con maniobras de protección alveolar e inicio temprano de inmunoglobulinas, lo que permitió el destete progresivo de todas las medidas instauradas. Así como se obtuvieron aciertos en el manejo intensivo, otros aspectos de la terapéutica se van dejando de lado con el mayor conocimiento de esta entidad y su reconocimiento temprano.
The Impact of the PSR Rural Insurance Program on the Agricultural Productivity in the Matopiba Region of Brazil
Authors: Tabosa Francisco José da Silva , Castelar Pablo Urano de Carvalho , Vieira Filho José Eustáquio Ribeiro , Amorim Domingos Isaías Maia , Da Silva Maria Josiell Nascimento
Published: June 2021

The present work aims to analyze the impact of a government subsidy program of rural insurance in Brazil, (called the Programa de Subvenção ao Prêmio de Seguro Rural - PSR), on the productivity of insured producers in the MATOPIBA region of the country, which encompasses four Brazilian states, Maranhão, Tocantins, Piauí and Bahia, between the years 2008 to 2019. For this, municipalities were selected that had at least one insured producer throughout the analyzed period. The variables used were the number of producers, the number of insurance policies, the planted area, the productivity obtained and the insured financial amount of the producers. The methodological procedure was based on Auto-regressive Vectors (VAR) for panel data. The results showed a concentration, of all the variables used in the research, in the state of Bahia, mainly in the municipalities of Formosa do Rio Preto and São Desidério, whose main economic activity is soy production. It was also found that the impulse response functions on productivity obtained through a shock in the other variables, except the planted area variable, the others showed positive initial (short-term) responses until the second year. The average time for responses to smooth over time occurs from the sixth year onwards.