As a diagnostic aid in emergency services, ultrasound has expanded considerably in recent years. Among its applications, ocular ultrasonography allows for a better evaluation of patients with ophthalmological emergencies. In addition, it provides a simple and easy technique to obtain clinical information that may not be easily accessible either through the clinical examination or by using the ophthalmoscope. Ocular ultrasonography can help to diagnose hemorrhage and retinal detachment and/or vitreous, eye infections, foreign bodies, retrobulbar hematomas, papilledema, and eye trauma. By measuring the diameter of the optic nerve sheath, intracranial hypertension could be screened. This article reviewed the approach to eye exam by ultrasound and common ophthalmic pathologies diagnosed with ultrasound in the emergency department.

SARS-CoV-2 is the causative agent of COVID-19. Since its outbreak in December 2019, COVID-19 has swept the globe. By 17 July 2020, the World Health Organization (WHO) had confirmed 13 119 239 cases and 573 752 deaths, and the numbers are still rising. Current evidence shows that COVID-19 is lower than severe acute respiratory syndrome and Middle East respiratory syndrome in terms of severity and mortality risk, although the infections are particularly more severe in patients with underlying medical conditions. The bulk of COVID-19 patients had close contact with confirmed cases, but an exact origin and specific transmission for COVID-19 are still unknown. As there is no approved antiviral treatment for COVID-19 infection, proper prevention and control practices are essential to control the infection. To have an insight view of COVID-19, we summarized and compared the etiology, clinical manifestations, diagnosis, treatment, and prevention measures of COVID-19, severe acute respiratory syndrome, and Middle East respiratory syndrome.

Objective: To describe the epidemiological distribution of injury cases in the Philippines from 2011 to 2018. Methods: A retrospective review of records from the Online National Electronic Injury Surveillance System involving trauma cases was done, and data were collated, tabulated, and statistically analyzed. Results: A total of 668 179 injury cases were recorded, and 68.99% of these cases involved males. Vulnerable individuals belonged to the group aged 15-29 years (34.01%). The most populated regions in the country, the National Capital Region (14.90%) and Region IVA (13.96%), incurred the highest number of recorded cases. Traffic crash (32.67%) was reported to be the major cause of injury; and open wounds (37.56%) and abrasion (26.23%) were found to be the most common types of injury. Conclusions: The burden of injury remains high in the Philippines due to the lack of resources and inadequate healthcare. The findings of the present study on the distribution of injury cases provide useful information for taking appropriate preventive measures, developing effective safety guidelines, allocating limited resources in an appropriate manner, and implementing necessary public health programs.

Objective: To assess the clinical and microbiological characteristics as well as the risk factors of early readmission (<72 h) in acute pyelonephritis (APN) patients discharged from emergency department (ED). Methods: The medical records of patients discharged with a diagnosis of APN between January 1, 2014 and December 31, 2015 were reviewed. Epidemiological, clinical, ultrasound results, and laboratory characteristics were collected, and the risk factors of prompt readmission and non-prompt readmission were assessed. Results: A total of 423 APN patients were included. The mean age was (44.3±19.0) years. The bulk of the patients were women (79.9%), and 20% of cases had episodes previously. Urine cultures were requested in 77.5% of cases, with Escherichia coli being the most frequently isolated bacterium (80.1%). Resistance to one or more antibiotics was found in 68.1% of the bacteria. The most widely used antibiotics were beta-lactam with beta-lactamases inhibitor (46%), and aminoglycosides in 24.4% of cases. Altogether, 73.5% of the patients received antibiotic treatment in the ED, and 46.8% of the patients were discharged. Furthermore, 6.1% of the patients discharged from the ED had re-admission without associated risk factors. Conclusions: Given the high rate of resistance, it is important to know the profile of antibiotics in different areas. Likewise, the administration of antibiotics in the ED is useful in the prevention of early readmissions of APN (<72 h).

Objective: To explore the value of complete blood count (CBC), including neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and monocyte lymphocyte ratio (MLR) in diagnosis of testicular torsion (TT) and differential diagnosis from epididymo-orchitis. Methods: The study was conducted at the Antalya Training and Research Hospital Emergency Department in Turkey with acute scrotal pain patients from January 1st, 2016 to January 1st, 2018. The patients were categorized into 3 groups: the TT group who underwent an operation for TT (n=70), the epididymo-orchitis group who received epididymo-orchitis treatment (n=120), and the healthy control group (n=100). NLR, PLR, and MLR of the three groups were analysed and compared. The optimum cut-off values of NLR, MLR, and PLR were analyzed. Results: Mean NLR and MLR values were significantly higher in the epididymo-orchitis group and the TT group compared to the control group (P<0.001). Receiver operating characteristic analysis revealed a sensitivity of 77.1% and a specificity of 80% for NLR (77.1) and a sensitivity of 68.2% and a specificity of 78% for PLR (124.80). Moreover, when MLR was used to differentiate the two treatment groups, the optimal cut-off value had a sensitivity of 67.1% and a specificity of 75% (AUC: 0.677-0.826, P<0.001). Conclusions: NLR, PLR, and MLR might be associated with the diagnosis of TT. These parameters provide a useful and economical method to help diagnose TT in the emergency department.

Objective: To assess the effect of proximal femur nail anti-rotation on the functional and radiological outcome of unstable intertrochanteric fractures. Methods: This prospective observational study was conducted in the orthopedic department of a tertiary care hospital. Altogether 86 patients with unstable intertrochanteric fractures treated with proximal femur nail anti-rotation between January 2010 and January 2015 were included. Patients were followed in the outpatient clinic at regular intervals after discharge to assess the radiological union of fractures and complications. The functional outcomes were evaluated after 2 years by Harris hip score. Results: All patients achieved a radiological union of fractures after a mean duration of 24.6 weeks. The follow up showed 23 complications (systemic and local). Eight patients developed urinary tract infections, and three patients developed chest infections, two patients had screw cut-out, one patient had knee stiffness, one patient developed superficial surgical site infection, and four patients developed varus collapse and shortening subsequently. The two year follow up showed that 69 (80.2%) patients had an excellent and good functional outcome according to Harris hip score. Conclusions: With lower complication rates, proximal femur nail is a valid and reasonable option especially in treating unstable intertrochanteric fractures.

Objective: To assess the antibacterial activity of 5 selected plants against 4 pathogenic bacteria. Methods: Three solvents with different polarities were used to extract antimicrobial agents from the plants via maceration technique. The agar-disc diffusion technique was adopted to primarily screen antibacterial activities. Broth-dilution assay was employed to determine the minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC). Results: Among all extracts, the ethanol extract of Piper betle Linn showed highest antibacterial activity against Gram-positive and the negative bacteria. MIC and MBC of the ethanol extract of Piper betle Linn against Salmonella typhimurium were the same (1 562.50 mg/L); while it showed the highest MIC and MBC against Pseudomonas aeruginosa of 6 250 mg/L and 12 500 mg/L, respectively. Conclusions: Salmonella typhimurium is the most susceptible bacteria while Pseudomonas aeruginosa is the most resistant bacteria towards the ethanol extract of Piper betle Linn. Piper betle possesses compounds with potential antibacterial activity and might be useful as an alternative to control infectious diseases.

Rationale: Primary adenocarcinoma of the lacrimal gland is rare, and its presentation as corneal perforation is even rarer. Corneal perforation is an ocular emergency that warrants urgent ophthalmic surgery, yet complete staging of lacrimal gland tumor pre-operatively is essential for optimal oncological management. Patient’s concerns: A 57-year-old man presented with left eye pain was found to have left eye proptosis and fleshy tissue mass around the eyeball. Uveal tissue was prolapsing over the perforated keratitis cornea, and the eye was full of discharge. Diagnosis: Bedside ultrasound B-scan confirmed vitreous haze, and emergency contrast computed tomography (CT) revealed soft tissue density mass (>40 mm) molding around the left globe and optic nerve without any rim enhancing abscess. Left exogenous endophthalmitis from exposure keratopathy secondary to proptosis caused by the bulky lacrimal tumor located in the confined orbital cone was diagnosed. Interventions: Emergency enucleation surgery of the left eyeball was done for this painful blind eye to control the infection from spreading. Orbital walls were biopsied intra-operatively, and tumor staging was completed by positron emission tomography- CT scan and magnetic resonance imaging. Without evidence of metastasis, left orbital exenteration was followed by adjuvant orbital chemoradiotherapy for the sake of close proximity of resection margin. Outcomes: Left exenterated orbit was fully epithelialized at around 2 months, and there was no recurrence of the disease up to present at the 1 year follow-up. Lessons: Thorough workup on the staging of the disease to minimize the number of operations for oncological patients is always a top priority, yet it may not always be possible as in our case presenting with corneal perforation.