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Diagnostics
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Diagnostics in Medical/Surgical Emergency
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Diagnostics in Medical/Surgical Emergency

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (31 March 2023) | Viewed by 23065

Special Issue Editor

Prof. Dr. Timothy Craig Hardcastle

E-Mail Website
Guest Editor
1. Inkosi Albert Luthuli Central Hospital, Durban, South Africa
2. Department of Surgical Sciences, University of KwaZulu-Natal, Durban, South Africa
Interests: trauma and emergency care; trauma systems; vascular injury; LMIC/Global Surgery; intensive care of trauma and burns

Special Issue Information

Dear Colleagues,

Medical and surgical emergency admissions are a major burden on the health system. Diagnostic approaches with the use of both urgent point-of-care testing and other diagnostic tools are essential in making a timely diagnosis. This ensures that optimal treatment is provided in these time-sensitive conditions.

We invite Special Issue contributions that examine the role of diagnostic tools in the following emergency conditions in medical and surgical emergencies. Articles will undergo full peer review in line with the journal standards. Contributions can be in the form of case series, trials and review articles.

Submissions must be submitted by March 2023.

This Special Issue will explore, but is not restricted to, the following topics (key words):

Medical emergencies: (adult and pediatric)

  • Cardiac;
  • Respiratory;
  • Infection: role of septic markers in the care of sepsis.

Surgical emergencies:

  • POCUS: role of ultrasound in trauma and surgery;
  • CT: role of CT in surgery and trauma;
  • Diagnostic tools in emergencies in austere environments and LMICs.

We hope that the published data will contribute to scientific discussion concerning these global health problems.

Prof. Dr. Timothy Craig Hardcastle
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (4 papers)

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Review

16 pages, 2812 KiB  
Review
Severe Acute Bronchial Asthma with Sepsis: Determining the Status of Biomarkers in the Diagnosis of the Disease
by Susmita Sinha, Santosh Kumar, Mahendra Narwaria, Arya Singh and Mainul Haque
Diagnostics 2023, 13(16), 2691; https://doi.org/10.3390/diagnostics13162691 - 16 Aug 2023
Cited by 2 | Viewed by 6154
Abstract
Bronchial asthma is a widely prevalent illness that substantially impacts an individual’s health standard worldwide and has a significant financial impact on society. Global guidelines for managing asthma do not recommend the routine use of antimicrobial agents because most episodes of the condition [...] Read more.
Bronchial asthma is a widely prevalent illness that substantially impacts an individual’s health standard worldwide and has a significant financial impact on society. Global guidelines for managing asthma do not recommend the routine use of antimicrobial agents because most episodes of the condition are linked to viral respiratory tract infections (RTI), and bacterial infection appears to have an insignificant impact. However, antibiotics are recommended when there is a high-grade fever, a consolidation on the chest radiograph, and purulent sputum that contains polymorphs rather than eosinophils. Managing acute bronchial asthma with sepsis, specifically the choice of whether or not to initiate antimicrobial treatment, remains difficult since there are currently no practical clinical or radiological markers that allow for a simple distinction between viral and bacterial infections. Researchers found that serum procalcitonin (PCT) values can efficiently and safely minimize antibiotic usage in individuals with severe acute asthma. Again, the clinical manifestations of acute asthma and bacterial RTI are similar, as are frequently used test values, like C-reactive protein (CRP) and white blood cell (WBC) count, making it harder for doctors to differentiate between viral and bacterial infections in asthma patients. The role and scope of each biomarker have not been precisely defined yet, although they have all been established to aid healthcare professionals in their diagnostics and treatment strategies. Full article
(This article belongs to the Special Issue Diagnostics in Medical/Surgical Emergency)
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17 pages, 5273 KiB  
Review
Establishing a Novel Diagnostic Framework Using Handheld Point-of-Care Focused-Echocardiography (HoPE) for Acute Left-Sided Cardiac Valve Emergencies: A Bayesian Approach for Emergency Physicians in Resource-Limited Settings
by Kamlin Ekambaram and Karim Hassan
Diagnostics 2023, 13(15), 2581; https://doi.org/10.3390/diagnostics13152581 - 3 Aug 2023
Cited by 3 | Viewed by 2171
Abstract
Acute severe cardiac valve emergencies, such as acute severe mitral regurgitation (AMR) and acute severe aortic regurgitation (AAR), present significant challenges in terms of diagnosis and management. Handheld point-of-care ultrasound devices have emerged as potentially pivotal tools in ensuring the prompt and accurate [...] Read more.
Acute severe cardiac valve emergencies, such as acute severe mitral regurgitation (AMR) and acute severe aortic regurgitation (AAR), present significant challenges in terms of diagnosis and management. Handheld point-of-care ultrasound devices have emerged as potentially pivotal tools in ensuring the prompt and accurate diagnosis of these left-sided valve emergencies by emergency physicians, particularly in resource-limited settings. Despite the increased utilisation of point-of-care ultrasound by emergency physicians for the management of patients in states of acute cardiorespiratory failure, current diagnostic protocols cannot perform sufficient quantitative assessments of the left-sided cardiac valves. This review elucidates and evaluates the diagnostic utility of handheld point-of-care focused-echocardiography (HoPE) in native AMR and AAR by reviewing the relevant literature and the use of clinical case examples from the Emergency Department at Port Shepstone Regional Hospital (PSRH-ED)—a rural, resource-limited hospital located in KwaZulu-Natal, South Africa. Combining the findings of the review and clinical case illustrations, this review proceeds to synthesise a novel, Bayesian-inspired, iterative diagnostic framework that integrates HoPE into the evaluation of patients with acute cardiorespiratory failure and suspected severe left-sided valve lesions. Full article
(This article belongs to the Special Issue Diagnostics in Medical/Surgical Emergency)
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15 pages, 1858 KiB  
Review
Detecting Diabetic Ketoacidosis with Infection: Combating a Life-Threatening Emergency with Practical Diagnostic Tools
by Rahnuma Ahmad, Mahendra Narwaria, Arya Singh, Santosh Kumar and Mainul Haque
Diagnostics 2023, 13(14), 2441; https://doi.org/10.3390/diagnostics13142441 - 21 Jul 2023
Cited by 3 | Viewed by 8058
Abstract
Background: Diabetic ketoacidosis (DKA) is a life-threatening acute complication of diabetes mellitus and can lead to patient demise if not immediately treated. From the recent literature, the diabetic ketoacidosis mortality rate, depending on age, is 2–5%. Insulin discontinuation and infection remain the two [...] Read more.
Background: Diabetic ketoacidosis (DKA) is a life-threatening acute complication of diabetes mellitus and can lead to patient demise if not immediately treated. From the recent literature, the diabetic ketoacidosis mortality rate, depending on age, is 2–5%. Insulin discontinuation and infection remain the two most common triggers for diabetic ketoacidosis. About 50% of cases of ketoacidosis result from bacterial infections like urinary tract infections and pneumonia. It is also important to diagnose the presence of infection in diabetic ketoacidosis patients to prevent the excessive use of antibiotics, which may lead to antibiotic resistance. Although performing bacterial culture is confirmatory for the presence or absence of bacterial infection, the time required to obtain the result is long. At the same time, emergency treatment needs to be started as early as possible. Methods: This narrative review examines various septic markers to identify the appropriate tools for diagnosis and to distinguish between diabetic ketoacidosis with and without infection. Electronic databases were searched using the Google engine with the keywords “Diabetes Mellitus”, “Diabetic Ketoacidosis”, “Infection with Diabetic Ketoacidosis”, “biomarkers for infection in Diabetic Ketoacidosis”, “Procalcitonin”, “Inflammatory cytokines in DKA”, “Lactic acidosis in DKA”, and “White blood cell in infection in DKA”. Results: This narrative review article presents the options for diagnosis and also aims to create awareness regarding the gravity of diabetic ketoacidosis with infection and emphasizes the importance of early diagnosis for appropriate management. Diabetes mellitus is a clinical condition that may lead to several acute and chronic complications. Acute diabetic ketoacidosis is a life-threatening condition in which an excess production of ketone bodies results in acidosis and hypovolemia. Infection is one of the most common triggers of diabetic ketoacidosis. When bacterial infection is present along with diabetic ketoacidosis, the mortality rate is even higher than for patients with diabetic ketoacidosis without infection. The symptoms and biomarkers of diabetic ketoacidosis are similar to that of infection, like fever, C reactive protein, and white blood cell count, since both create an environment of systemic inflammation. It is also essential to distinguish between the presence and absence of bacterial infection to ensure the appropriate use of antibiotics and prevent antimicrobial resistance. A bacterial culture report is confirmatory for the existence of bacterial infection, but this may take up to 24 h. Diagnosis needs to be performed approximately in the emergency room upon admission since there is a need for immediate management. Therefore, researching the possible diagnostic tools for the presence of infection in diabetic ketoacidosis patients is of great importance. Several of such biomarkers have been discussed in this research work. Full article
(This article belongs to the Special Issue Diagnostics in Medical/Surgical Emergency)
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14 pages, 3314 KiB  
Review
Diagnosis and Management of Severe Water-Related Skin and Soft Tissue Sepsis: A Summative Review of the Literature
by Shanisa Naidoo, Arnold M. Zwane, Ahmed Paruk and Timothy Craig Hardcastle
Diagnostics 2023, 13(13), 2150; https://doi.org/10.3390/diagnostics13132150 - 23 Jun 2023
Cited by 2 | Viewed by 5971
Abstract
Background: Skin and soft tissue infections (SSTIs) are common presentations in the emergency department. However, this is less common after contact with contaminated saltwater or freshwater. This review presents the diagnosis and management of water-related soft tissue sepsis in this vulnerable and difficult-to-treat [...] Read more.
Background: Skin and soft tissue infections (SSTIs) are common presentations in the emergency department. However, this is less common after contact with contaminated saltwater or freshwater. This review presents the diagnosis and management of water-related soft tissue sepsis in this vulnerable and difficult-to-treat subgroup of necrotizing soft tissue sepsis. Methods: A summative literature overview is presented regarding bacterial and fungal SSTI after contact with contaminated water, with practical diagnostic and management aspects. Results: The literature indicates that these wounds and infections remain difficult to treat. An approach using appropriate diagnostic tools with both medical and surgical management strategies is provided. Conclusions: SSTIs due to water contamination of wounds involve unusual organisms with unusual resistance patterns, and require a nuanced and directed diagnostic approach with an adaptation of the usual antibiotic or antifungal selection to achieve a successful cure, along with aggressive debridement and wound care. Full article
(This article belongs to the Special Issue Diagnostics in Medical/Surgical Emergency)
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