Background: Although the Canadian Triage and Acuity Scale (CTAS) have been developed since two decades ago, the reliability of the CTAS has not been questioned comparing to moderating variable. Aims: The study was to provide a meta-analytic review of the reliability of the CTAS in order to reveal to what extent the CTAS is reliable. Materials and Methods: Electronic databases were searched to March 2014. Only studies were included that had reported samples size, reliability coefficients, adequate description of the CTAS reliability assessment. The guidelines for reporting reliability and agreement studies (GRRAS) were used. Two reviewers independently examined abstracts and extracted data. The effect size was obtained by the z-transformation of reliability coefficients. Data were pooled with random-effects models and meta-regression was done based on method of moments estimator. Results: Fourteen studies were included. Pooled coefficient for the CTAS was substantial 0.672 (CI 95%: 0.599-0.735). Mistriage is less than 50%. Agreement upon the adult version, among nurse-physician and near countries is higher than pediatrics version, other raters and farther countries, respectively. Conclusion: The CTAS showed acceptable level of overall reliability in the emergency department but need more development to reach almost perfect agreement.

Background: The current West Africa epidemic of Ebola virus disease (EVD), which began from Guinea in December 2013, has been the longest and deadliest Ebola outbreak to date. With the propagation of the internet, public health officials must now compete with other official and unofficial sources of information to get their message out. Aims: This study aimed at critically appraising videos available on one popular internet video site (YouTube) as a source of information for Ebola virus disease (EVD). Materials and Methods: Videos were searched in YouTube (http://www.youtube.com) using the keyword "Ebola outbreak" from inception to November 1, 2014 with the default "relevance" filter. Only videos in English language under 10 min duration within first 10 pages of search were included. Duplicates were removed and the rest were classified as useful or misleading by two independent reviewers. Video sources were categorized by source. Inter-observer agreement was evaluated with kappa coefficient. Continuous and categorical variables were analyzed using the Student t-test and Chi-squared test, respectively. Results: One hundred and eighteen out of 198 videos were evaluated. Thirty-one (26.27%) videos were classified as misleading and 87 (73.73%) videos were classified as useful. The kappa coefficient of agreement regarding the usefulness of the videos was 0.68 (P < 0.001). Independent users were more likely to post misleading videos (93.55% vs 29.89%, OR = 34.02, 95% CI = 7.55-153.12, P < 0.001) whereas news agencies were most likely to post useful videos (65.52% vs 3.23%, OR = 57.00, 95% CI = 7.40-438.74, P < 0.001). Conclusions: This study demonstrates that majority of the internet videos about Ebola on YouTube were characterized as useful. Although YouTube seems to generally be a useful source of information on the current outbreak, increased efforts to disseminate scientifically correct information is desired to prevent unnecessary panic among the among the general population.

Background: Polycystic ovary syndrome (PCOS) is of clinical and public health importance, affecting up to one in five women of reproductive age. It has significant and diverse clinical implications including reproductive, metabolic, and psychological features. Aim: The study was to investigate the effect of anti-inflammatory dietary combo on metabolic, endocrine, inflammatory, and reproductive profiles in overweight and obese women with PCOS. Materials and Methods: A total of 100 nonpregnant, overweight, and obese adult females with PCOS according to the Rotterdam criteria, were screened during the year 2012, and 75 completed the trial. At baseline and study end, fasting blood samples were drawn to measure biological markers, body fat percent (BFP), and visceral fat area (VFA) were assessed by the InBody720 device and anthropometric measurements were done for all participants who were subjected to an anti-inflammatory hypocaloric diet and physical activity for 12 weeks. Results: At study completion, we achieved moderate weight loss of (± 7%) and significant improvements in body composition, hormones and menstrual cyclicity, blood pressure, glucose homeostasis, dyslipidemia, C-reactive protein (CRP), and serum amyloid A (SAA) (surrogate measures of cardiovascular risk (CVR)). This was a clinically relevant weight loss that is associated with a reduced prevalence of type 2 diabetes mellitus (DM2) and metabolic syndrome (MS) in the general population and improved fertility outcomes in PCOS. We achieved 63% regain of menstrual cyclicity and 12% spontaneous pregnancy rate within 12 week. Conclusions: We have explored an additional dietary treatment option with good prognostic metabolic and reproductive responses to weight loss that occur in overweight and obese PCOS.

Background: There is considerable evidence which suggests that Omega 3 polyunsaturated fatty acids may have a potential use in the treatment of epilepsy. Aim: The study was to investigate the effect of Omega 3 polyunsaturated fatty acids (as fish oil supplementation) in reducing the frequency and severity of epileptic seizures in children with medically resistant epilepsy. Materials and Methods: In the case-control study, a total of 70 children with medically resistant epilepsy underwent assessment of the frequency and severity of the epileptic attacks at baseline, after one month, two months and three months from the beginning of the study; 35 children received fish oil and the other 35 children received placebo. Results: The number of children who received fish oil, having 0 epileptic attacks increased from 0%, before starting the study, up to 57.1% at the end of the third month, while the improvement was minimal in the placebo group, with a significant difference in the improvement between the intervention and the control groups. There was no statistically significant difference in improvement in the severity of the seizures either between cases and control or between the beginning and the end of the study. Conclusion: Omega 3 polyunsaturated fatty acids elevated the seizure threshold in epileptic patients and may help in achieving seizure control.

Background: Stress in nurses may increase the prevalence of musculoskeletal discomforts. Aim: The aim of this study was to determine the prevalence of musculoskeletal discomforts and job stress among nurses and to investigate the association between musculoskeletal discomforts and occupational stressors. Materials and Methods: In this cross-sectional study, 144 nurses in one of the main referral hospitals of Tehran-Iran were randomly selected and studied. Data were collected by HSE job stress questionnaire and The Cornell Musculoskeletal Discomfort Questionnaire through interviews with nurses in their workplace. Results: Most reported musculoskeletal discomforts localized in the neck, back, knee and shoulder and the minimal discomforts were in wrist and elbow. On the other hand, stressors such as demand, changes in workplace, control and responsibilities had significant effect on increasing musculoskeletal discomforts of organs such as neck, shoulders and back (P < 0.001). Conclusion: There was a significant association between stressors such as demand, control, responsibilities and changes in workplace and reported musculoskeletal disorders, especially in neck, shoulders and back. It is suggested to use defined programs for management and control of stressors to control occupational stress in nurses. Moreover, prevention of musculoskeletal discomforts due to their high prevalence in the study population is important.

Context: Lithium carbonate is a psychiatric medication commonly used in the treatment of bipolar disorder. It has been implicated in inducing nephrogenic diabetes inspidus, chronic tubulointerstitial nephropathy, and acute tubular necrosis. We describe a case of lithium-induced minimal change disease (MCD) and acute kidney injury (AKI). Case Report: A 32-year-old female with a medical history of bipolar disorder treated with chronic lithium therapy presented with anasarca, fatigue, and tremors. Work-up revealed supra-therapeutic lithium levels, hypoalbuminemia, and significant proteinuria. The patient was treated conservatively with fluids and discontinuation of lithium therapy. Subsequently, she developed significant AKI and persistent proteinuria. She underwent a renal biopsy that demonstrated effacement of podocyte foot processes consistent with lithium-induced MCD. This was treated with corticosteroids, which decreased the proteinuria and resolved all the patient's symptoms. Conclusion: Lithium-induced MCD is a rare disease that affects patients of all ages. It is often associated with therapeutic lithium and is typically resolved with discontinuation of lithium. In some cases, concurrent AKI may result due to vascular obstruction from hyperalbuminuria and associated renal interstitial edema. Corticosteroids may be needed to reduce the proteinuria and prevent progression to chronic kidney disease. As such, patients on lithium therapy may benefit from monitoring of glomerular function via urinalysis to prevent the onset of nephrotic syndrome.

Context: Emphysematous cystitis (EC) is a rare infection of the urinary tract that results in gas production in the bladder. It is more common in diabetic and female patients, and can be associated with more serious complications, including pyelonephritis. Case Report: We describe a case of recurrent bacterial cystitis caused by Escherichia coli (E. coli). An incidental finding in our patient of pneumaturia on computed tomography (CT) scan prompted further work-up. Differential diagnoses for pneumaturia include infection, trauma, and fistula, most commonly colovesicular. The patient history ruled out trauma and CT scanning ruled out a fistula; culture of the urine then showed a bacterial load greater than 100,000 E. coli/mL. The patient was then diagnosed with EC. She was treated with ceftriaxone and released in stable condition. Conclusion: The literature was scarce when it came to diagnoses of EC based on bacterial load. We present this case to increase health care providers' awareness of recurrent EC with a urine culture bacterial load greater than 100,000 E. coli/mL.

Context: Giant coronary artery aneurysm (CAA) in adults is a rare clinical entity with an estimated incidence of 0.02%. CAA is commonly found in the right coronary artery with significant number of cases associated with fistula formation. Case Report: We describe a rare case of an 87 year-old man with large CAA with fistulous drainage into the right ventricle (RV) along with RV free wall vegetation as a cause of chronic weakness and lethargy. Conclusion: Giant CAA with fistulous drainage to the RV could present in the form of infective endocarditis. Early detection and surgical treatment would provide a significant benefit to these patients.