Background:Rapid ultrasound in shock (RUSH) is the most recent emergency ultrasound protocol, designed to help clinicians better recognize distinctive shock etiologies in a shorter time frame.Objectives:In this study, we evaluated the accuracy of the RUSH protocol, performed by an emergency physician or radiologist, in predicting the type of shock in critical patients.Patients and Methods:An emergency physician or radiologist performed the RUSH protocol for all patients with shock status at the emergency department. All patients were closely followed to determine their final clinical diagnosis. The agreement between the initial impression provided by RUSH and the final diagnosis was investigated by calculating the Kappa index. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of RUSH for diagnosis of each case.Results:We performed RUSH on 77 patients. Kappa index was 0.71 (P Value = 0.000), reflecting acceptable general agreement between initial impression and final diagnosis. For hypovolemic, cardiogenic and obstructive shock, the protocol had an NPV above 97% yet it had a lower PPV. For shock with distributive or mixed etiology, RUSH showed a PPV of 100% but it had low sensitivity. Subgroup analysis showed a similar Kappa index for the emergency physician and radiologist (0.70 and 0.73, respectively) in performing rush.Conclusions:This study highlights the role of the RUSH exam performed by an emergency physician, to make a rapid and reliable diagnosis of shock etiology, especially in order to rule out obstructive, cardiogenic and hypovolemic shock types in initial exam of shock patients.

Bedside ultrasonography (BUS) has been widely used in many emergency evaluations, but the technique was not thoroughly evaluated for use in adult fractures. The water bath technique (WBT) is a modality which overcomes some important limitations of using BUS in extremity fractures. The study aims to evaluate and compare diagnostic values of BUS and WBT. The sensitivity, specificity, positive and negative predictive values (PPV and NPV), positive and negative likelihood ratios (LR+ and LR-), and accuracy of BUS and WBT were calculated and compared by the McNemar chi-square test. BUS had the highest sensitivity, specificity, PPV, and LR+ in the distal forearm. The highest NPV and LR- of BUS were seen in phalangeal and wrist injuries, respectively. The WBT examination had the highest sensitivity in phalangeal injuries and the highest specificity, PPV, and LR+ in the distal forearm. The highest NPV and LR- of the WBT examination were seen in phalangeal and wrist injuries, respectively. The McNemar χ (2) values for the comparison of BUS and WBT indicate that the two techniques provide statistically different results. The ultrasound revealed excellent diagnostic values which make it a favorable alternative in evaluating upper extremity fractures in adults. The WBT provides even better results.

Background:Rapid Ultrasound in Shock (RUSH) is a recently reported emergency ultrasound protocol designed to help clinicians better recognize distinctive shock etiologies in a short time. We tried to evaluate the accuracy of early RUSH protocol performed by emergency physicians to predict the shock type in critically ill patients.Materials and Methods:Our prospective study was approved by the ethics committee of trauma research center, Baqiyatallah University of Medical Science, Iran. We enrolled 52 patients with shock state in the emergency department from April 2013 to October 2013. We performed early bed-side sonographic examination for participants based on RUSH protocol. Patients received all needed standard therapeutic and diagnostic interventions without delay and were followed to document their final diagnosis. Agreement (Kappa index) of initial impression provided by RUSH with final diagnosis, and also sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of RUSH for diagnosis of each shock type were calculated.Results:Fifty-two patients were enrolled in our study. Kappa index was 0.7 (P value = 0.000), reflecting acceptable general agreement between initial impression and final diagnosis. For hypovolemic and obstructive shocks, the protocol had sensitivity of 100% but had lower PPV. For shocks with distributive or mixed etiology, RUSH showed PPV of 100% but had low sensitivity. For cardiogenic shocks, all reliability indices were above 90%.Conclusion:We highlight the role of RUSH examination in the hands of an emergency physician in making a rapid diagnosis of shock etiology, especially in ruling out obstructive, cardiogenic, and hypovolemic types.

In this study of access models, we compared citation performance in journals that do and do not levy article processing charges (APCs) as part of their business model. We used a sample of journals from the Directory of Open Access Journals (DOAJ) science class and its 13 subclasses and recorded four citation metrics: JIF, H-index, citations per publication (CPP) and quartile rank. We examined 1881 science journals indexed in DOAJ. Thomson Reuters Journal Citation Reports and Web of Science were used to extract JIF, H-index, CPP and quartile category. Overall, the JIF, H-index and CPP indicated that APC and non-APC open access (OA) journals had equal impact. Quartile category ranking indicated a difference in favour of APC journals. In each science subclass, we found significant differences between APC and non-APC journals in all citation metrics except for quartile rank. Discipline-related variations were observed in non-APC journals. Differences in the rank positions of scores in different groups identified citation advantages for non-APC journals in physiology, zoology, microbiology and geology, followed by botany, astronomy and general biology. Impact ranged from moderate to low in physics, chemistry, human anatomy, mathematics, general science and natural history. The results suggest that authors should consider field- and discipline-related differences in the OA citation advantage, especially when they are considering non-APC OA journals categorised in two or more subjects. This may encourage OA publishing at least in the science class.

Introduction. Citrullus colocynthis Schrad. is a commonly used medicinal plant especially as a hypoglycemic agent. Case Presentation. Four patients with colocynth intoxication are presented. The main clinical feature was acute rectorrhagia preceeded by mucosal diarrhea with tenesmus, which gradually progressed to bloody diarrhea and overt rectorrhagia within 3 to 4 hours. The only colonoscopic observation was mucosal erosion which was completely resolved in follow-up colonoscopy after 14 days. Conclusion. The membranolytic activity of some C. colocynthis ingredients is responsible for the intestinal damage. Patients and herbalists should be acquainted with the proper use and side effects of the herb. Clinicians should also be aware of C. colocynthis as a probable cause of lower GI bleeding in patients with no other suggestive history, especially diabetics.