Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
4
Issue 3
2016
07
01
Cisternostomy for Traumatic Brain Injury: A New Era Begins
119
120
EN
Giovanni
Grasso
giovanni.grasso@unipa.it
Iype
Cherian
drrajucherian@gmail.com
Traumatic brain injury,Cisternostomy,Microsurgical anatomy
https://beat.sums.ac.ir/article_44325.html
https://beat.sums.ac.ir/article_44325_f994567608b87f0ae4ccd9309a7c06e9.pdf
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
4
Issue 3
2016
07
01
Shiraz Trauma Transfusion Score: A Scoring System for Blood Transfusion in Trauma Patients
121
123
EN
Shahram
Paydar
0000-0002-6980-2576
paydarsh@gmail.com
Golnar
Sabetian
Hosseinali
Khalili
Hamid Reza
Abbasi
0000-0002-2016-9060
abbasimezy@yahoo.com
Shahram
Bolandparvaz
0000-0002-8875-5998
bolandpa@yahoo.com
Zahra
Ghahramani
0000-0002-7394-952X
BSc, Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
zghahreman@sums.ac.ir
Behnam
Dalfardi
Donat R.
Spahn
Guideline,Shiraz Trauma Transfusion Score,Transfusion,Trauma
https://beat.sums.ac.ir/article_44326.html
https://beat.sums.ac.ir/article_44326_232d56eb6aebe16782cb211a70f0428a.pdf
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
4
Issue 3
2016
07
01
Importance of Site Selection for Stockpiling Field Hospitals for Upcoming Disasters
124
125
EN
Mohammad Javad
Moradian
0000-0002-2577-4446
MD, MPH, PhD
Department of Disaster Public Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
moradianshiraz@gmail.com
Ali
Ardalan
1- Department of Disaster Public Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
2- Harvard Humanitarian Initiative, Harvard Chan School of Public Health
Amir
Nejati
Department of Emergency Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
Ali
Darvishi Boloorani
Department of Remote Sensing & GIS, University of Tehran, Tehran, Iran
Ali
Akbarisari
Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Behnaz
Rastegarfar
0000-0003-4590-6378
1- Department of Disaster Public Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
3- Department of Disaster and Emergency Health, I.R. Iran’s National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
dr.rastegarfar@gmail.com
Disaster,Field hospital,Preparedness phase,Site Selection,Stockpile
https://beat.sums.ac.ir/article_44327.html
https://beat.sums.ac.ir/article_44327_6c147c6d509760f51ad6caf38493c400.pdf
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
4
Issue 3
2016
07
01
Speed Management Strategies; A Systematic Review
126
133
EN
Homayoun
Sadeghi Bazargani
Road Traffic Injury Research Center, Department of statistics and epidemiology, Faculty of health, Tabriz University of Medical Sciences, Tabriz, Iran-WHO Collaborating Center on Safe Community Promotion, Stockholm, Sweden.
Mohammad
Saadati
0000-0003-3047-5624
2- PhD candidate, Road Traffic Injury Research Center, Iranian Center of Excellence in Health Management, Department of Health Service Management, School of Health Services Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
hcm.2020@gmail.com
Objective: To systematically identify the various methods of speed management and their effects. Methods: A systematic search was performed in Science Direct, Ovid Medline, Scopus, PubMed and ProQuest databases from April to June 2015. Hand searching and reference of selected articles were used to improve article identification. Articles published after 1990 which had reported on efficacy/effectiveness of speed management strategies were included. Data were extracted using pre-defined extraction table.Results: Of the 803 retrieved articles, 22 articles were included in this review. Most of the included articles (63%) had before-after design and were done in European countries. Speed cameras, engineering schemes, intelligent speed adaption (ISA), speed limits and zones, vehicle activated sign and integrated strategies were the most common strategies reported in the literature. Various strategies had different effects on mean speed of the vehicles ranging from 1.6 to 10 km/h. Moreover, 8-65% and 11-71% reduction was reported in person injured accidents and fatal accidents, respectively as a result of employing various strategies.Conclusion: Literature revealed positive effects of various speed management strategies. Using various strategies was mostly dependent on road characteristics, driver’s attitude about the strategy as well as economic and technological capabilities of the country. Political support is considered as a main determinant in selecting speed management strategies.
Speed management,Speed reduction,effectiveness,Traffic
https://beat.sums.ac.ir/article_44328.html
https://beat.sums.ac.ir/article_44328_1c2231fe9a15a115e41a62e97a5489e2.pdf
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
4
Issue 3
2016
07
01
Effects of Platelet Rich Plasma on Healing Rate of Long Bone Non-union Fractures: A Randomized Double-Blind Placebo Controlled Clinical Trial
134
140
EN
Fariborz
Ghaffarpasand
0000-0002-1721-9987
Shiraz University of Medical Sciences
fariborz.ghaffarpasand@gmail.com
Mostafa
Shahrezaei
AJA University of Medical Sciences
Maryam
Dehghankhalili
Shiraz University of Medical Sciences
maryam_dhkh@yahoo.com
Objective: To determine the effects of platelet rich plasma PRP on healing rates of long bone non-union fracture.Method: This was a randomized double-blind placebo controlled clinical trial being performed in a 12-month period. We included 75 adult (>18 years) patients suffering from long bone (Femur, Tibia, Humerus and Ulna) non-union fracture who were randomly assigned to receive 5mL PRP (n=37) or 5mL normal saline as placebo (n=38) in the site of fracture after intramedullary nailing or open reduction and internal fixation (ORIF) along with autologous bone graft. Patients were followed each 45 days till 9 months and were evaluated both clinically and radiologically in each visit. The healing rate, failure rate, incidence of infection, mal-union and limb shortening were recorded and compared between groups after 9 months of follow-up.Results: The healing rate was significantly higher in PRP group compared to placebo (81.1% vs. 55.3%; p=0.025). The limb shortening was significantly higher in those who received placebo (2.61±1.5 vs. 1.88±1.2mm; p=0.030). Injection of PRP was also associated with lower pain scores (p=0.003) and shorter healing duration (p=0.046). The surgical site infection (p=0.262) and mal-union rate (p=0.736) were comparable between groups.Conclusion: Application of PRP along with autologous bone graft in the site of non-union of long bone after intramedullary nailing or ORIF results in higher cure rate, shorter healing duration, lower limb shortening and less postoperative pain. Higher infection rate might be a complication of PRP application.Keywords: Non-union; Long bone Fracture; Platelet rich plasma (PRP); Intramedullary nailing; Open reduction and internal fixation (ORIF).Clinical Trial Registry: This trial is registered with the Iranian Clinical Trials Registry (IRCT201208262445N1; www.irct.ir).
Non-union,Long bone fracture,Platelet rich plasma (PRP),Intramedullary nailing,Open reduction and internal fixation (ORIF)
https://beat.sums.ac.ir/article_44329.html
https://beat.sums.ac.ir/article_44329_f89d4ef6ff34c2a6c018bfbbfb7c698f.pdf
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
4
Issue 3
2016
07
01
Assessment of Neuroprotective Effects of Local Administration of 17- Beta- Estradiol on Peripheral Nerve Regeneration in Ovariectomized Female Rats
141
149
EN
Ahmadreza
Nobakhti-Afshar
Department of Clinical Sciences, Faculty of Veterinary Medicine, Urmia Branch, Islamic Azad University, Urmia, Iran
Alireza
Najafpour
Department of Clinical Sciences, Faculty of Veterinary Medicine, Urmia Branch, Islamic Azad University, Urmia, Iran
a.najafpour@yahoo.com
Rahim
Mohammadi
0000-0002-2104-9829
Department of Internal Medicine and Clinical Pathology, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran.
r.mohammadi@urmia.ac.ir
Leila
Zarei
0000-0001-8753-3667
Solid Tumor Research Center, Urmia University of Medical Sciences, Urmia, Iran.
leilazarei50@gmail.com
Objective: To assess the neuroprotective effects of local administration of 17- beta- estradiol on nerve regeneration.Methods: Sixty female Wistar rats were overiectomized and divided into four experimental groups (n = 15), randomly: In autograft group a segment of sciatic nerve was transected and re-implanted reversely. In sham-surgery group sciatic nerve was exposed and manipulated. In transected group left sciatic nerve was transected and stumps were fixed in adjacent muscle. In treatment group defect was bridged using a silicon conduit filled with 10 µL (0.1 mg/mL) 17- beta- estradiol. Each group was subdivided into four subgroups of five animals each and nerve fibers were studied in a 12-week period.Results: Behavioral, functional, biomechanical, electrophysiological and gastrocnemius muscle mass findings and morphometric indices confirmed faster recovery of regenerated axons in treatment group than in other groups (p<0.05). Immunohistochemical reactions to S-100 in treatment group were more positive than that in other groups.Conclusion: Local administration of 17-beta-estradiol improved functional recovery and morphometric indices of sciatic nerve. It could have clinical implications for the surgical management of patients after facial nerve transection.
Nerve regeneration,Sciatic nerve,17-beta-estradiol,Local administration,Rat
https://beat.sums.ac.ir/article_44330.html
https://beat.sums.ac.ir/article_44330_4637db6b52c50703f73c3ce6c09ab7b0.pdf
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
4
Issue 3
2016
07
01
Thorax Trauma Severity Score: Is it reliable for Patient’s Evaluation in a Secondary Level Hospital?
150
155
EN
Isidro
Martínez
Casas
MD, PhD, FACS, HFEBS Em-Surg.
General and Digestive Surgery.
Complejo Hospitalario de Jaén
María Auxiliadora
Amador Marchante
General and Digestive Surgery.
Complejo Hospitalario de Jaén
Mihai
Paduraru
0000-0003-1143-1722
General and Digestive Surgery.
Hospital de Tomelloso.
paduraru_mihai@yahoo.com
Ana Isabel
Fabregues Olea
General and Digestive Surgery.
Hospital General de Elda.
Andreu
Nolasco Bonmatí
Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science. University of Alicante
Juan Carlos
Medina
Emergency Service.
Hospital Universitario de Torrevieja. Alicante
Objective: To determine the predictive and diagnostic value of thorax trauma severity score (TTSS) in a population of thoracic trauma patients admitted to a secondary level trauma center.Methods: A Retrospective analysis of patients admitted over a period of two years with IDC-9 codes related to thoracic trauma was undertaken. The association of TTSS with complications and mortality was evaluated. We also determined the predictive value of TTSS using receiver operating characteristic curve (ROC).Results: 238 patients with thoracic trauma, mostly middle-aged (62.2 ± 15 years), were included. The main mechanisms of injury were falls and traffic accidents. Thirty-three patients had important extra-thoracic injuries, but only 9 presented an ISS> 15. The average ISS was 3 ± 5; Morbidity was 2.5% and mortality was 2.1% as a result of thoracic injury and these patients had significantly higherTTSS values. Each score component was analyzed separately, showing significant association with complications and mortality. The area under the curve for TTSS was significant for predicting complications (0.848) and mortality (0.856) values. TTSS with a cut off value of 8 points had a sensitivity of 66% and specificity of 94% to predict complications and 80% sensitivity and 94% specificity for predicting mortality.Conclusions: The TTSS is an appropriate and feasible tool to predict the development of complications or mortality in a population of mostly mild thoracic trauma.
Thorax Trauma Severity Score (TTSS),Thoracic Trauma,Mortality,Morbidity,Predictive value
https://beat.sums.ac.ir/article_44331.html
https://beat.sums.ac.ir/article_44331_09107a89e83fc97090a7e8206b7ce2c5.pdf
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
4
Issue 3
2016
07
01
Effects of Intraperitoneal Administration of Simvastatin in Prevention of Postoperative Intra-abdominal Adhesion Formation in Animal Model of Rat
156
160
EN
Mojtaba
Javaherzadeh
Ali
Shekarchizadeh
Marjan
Kafaei
Abass
Mirafshrieh
Nariman
Mosaffa
Babak
Sabet
Shahid beheshti university of medical sceinces-faculty of medicine
sabet@crc.mui.ac.ir
Objective: To determine the preventive effects of local administration of simvastatin for postoperative intra-abdominal adhesion formation in animal model of rat.Methods: In this experimental study, 32 Wistar albino rats as the animal model of intra-abdominal adhesion formation were included. Adhesions were induced in all the animals via abrasion of the peritoneal and intestinal surface during laparotomy. Afterwards, the rats were randomly assigned to receive simvastatin (30 mg/kg body weight) as a single intraperitoneal dose at the time of laparotomy (n=16) or normal saline in same volume at the same time (n=16). At the day 21, animals were euthanized and the adhesions were quantified clinically (via repeated laparotomy) and pathologically and compared between the two groups.Results: The baseline characteristics of the animals were comparable between two study groups. Clinically, in simvastatin group, 10 rats (62.5%) did not develop any adhesion and 6 (37.5%) had first-grade adhesion; whereas in the control group, 11 (68.8%) rats had first- and 5 (31.2%) had second-grade adhesions (p<0.001). Pathologically, in simvastatin group, 6 rats (37.5%) had first-grade adhesion, while in control group, 11 rats (68.8%) had first- and 5 (31.2%) had second-grade adhesions (p<0.001).Conclusion: Our findings suggest that intraperitoneal administration of simvastatin is an effective method for prevention of postoperative intra-abdominal adhesion formation in animal model of rat.
Intra-abdominal adhesion,Simvastatin,Laparotomy,Rat,Prevention
https://beat.sums.ac.ir/article_44332.html
https://beat.sums.ac.ir/article_44332_95114b55c9fc51c772b355c066201d4a.pdf
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
4
Issue 3
2016
07
01
Cisternostomy for Management of Intracranial Hypertension in Severe Traumatic Brain Injury; Case Report and Literature Review
161
164
EN
Mohammad
Sadegh
Masoudi
shiraz university of medical sciences
masoudims@sums.ac.ir
Elahe
Rezaee
shiraz university of medical sciences
Hasan
Ali
Hakiminejad
Maryam
Tavakoli
Tayebe
Sadeghpoor
Main goal in the management of patients with severe traumatic brain injury (TBI) is control of intracranial pressure (ICP). Decompressive craniectomy is an accepted technique for control of refractory intracranial hypertension in patients with severe TBI. Because of high complication rate after decompressive craniectomy, new techniques such as basal cisternostomy have developed. We herein report a case of severe TBI in a 13-year-old boy treated by cisternostomy. The patient was admitted following a motor vehicle accident. Brain CT scan showed diffuse brain edema, left frontal contusion and posterior interhemispheric subdural hematoma. The patient underwent ICP monitoring. Subsequently, with 26 mmHg mean-value of ICP, he was treated surgically by cisternostomy technique. A progressive improvement of the neurological conditions in the following hours. After 5 days the boy was discharged and in the 3-months follow-up he was completely recovered. Cisternostomy could be an appropriate alternative to decompressive craniectomy for management of intracranial hypertension in patietns with sever TBI.
Severe traumatic brain injury,Intracranial hypertension,Cisternostomy,Outcome
https://beat.sums.ac.ir/article_44333.html
https://beat.sums.ac.ir/article_44333_e63a5f7d990f92eaa2e7b69b5982a743.pdf
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
4
Issue 3
2016
07
01
Ketamine Infusion Therapy as an Alternative Pain Control Strategy in Patients with Multi-Trauma including Rib Fracture; Case Report and Literature Review
165
169
EN
Ashley
K
Losing
Sanford Health
ashley.losing@sanfordhealth.org
Justin
M
Jones
Sanford Health
Adis
Keric
Sanford Health
Steven
E
Briggs
Sanford Health
David
D
Leedahl
Sanford Health
david.leedahl@sanfordhealth.org
Ketamine is a promising alternative agent for pain control that offers benefit to traditional strategies, particularly in the setting of rib fracture. Current pharmacologic therapies have clear adverse effects, and other options may be invasive, cost prohibitive, or marginally effective. We describe three consecutive patients with traumatic injuries including rib fracture for which a ketamine infusion was utilized as part of their pain control strategy. For each patient, use of a ketamine infusion trended toward reduced opioid requirements with stable pain scores. One patient experienced a dissociative adverse effect prompting decrease and discontinuation of ketamine. No pulmonary complications in the form of emergent intubation or new diagnosis of pneumonia were observed. We believe the addition of ketamine infusion to be a valid alternative strategy for managing pain associated with rib fracture.
Thoracic injury,Rib fracture,Pain management,Ketamine
https://beat.sums.ac.ir/article_44334.html
https://beat.sums.ac.ir/article_44334_ef7c0f1399ada47a326b0e32633df5aa.pdf
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
4
Issue 3
2016
07
01
Traumatic Retrolisthesis of L5 and L5/S1 Extruded Disc Herniation; A Case Report and Review of the Literature
170
173
EN
Babak
Pourabbas
assistant professor of Shiraz University of medical science
Mohammad Ali
Effani
associate professor of Shiraz University of medical science
Asghar
Namdari
fellowship in spine surgery, shiraz university of medical science
namdarias@gmail.com
Traumatic retrolisthesis is a rare injury and may result in intervertebral disc extrusion and nerve root injury. These injuries are highly unstable and require surgery for decompression and stabilization. Traumatic retrolisthesis of L5 with acute L5/S1 disc extrusion associated with nerve root injury has not been reported previously in English literatures. We herein report a case of traumatic retrolisthesis of L5 and extruded disc. A 22 year-old patient presented with lower extremity weakness due to L5/S1 retrolisthesis and traumatic acute L5/S1 disc extrusion after falling of 8 meters height. The patient underwent surgical decompression and reduction with instrumentation. Accordingly complete recovery of neurologic deficit was occurred. Therefore, early decompression of the nerve roots followed by circumferential instrumentation and fusion of the involved segment results in dramatic improvement in neurologic symptoms.
Traumatic retrolisthesis,Lumbar disc extrusion,Neurologic deficit
https://beat.sums.ac.ir/article_44335.html
https://beat.sums.ac.ir/article_44335_b190c4467b9827692560bb855ce6aa07.pdf
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
4
Issue 3
2016
07
01
Community Acquired Spondylodiscitis caused by Escherichia Coli; Case Report and Literature Review
174
179
EN
F
Javier
Fonseca del Pozo
Joaquín
Valle Alonso
Miguel
Ángel
Caracuel Ruiz
Siyamini
Vythilingam
Daniel
Lopez Ruiz
Vertebral osteomyelitis, or spondylodiscitis, is a rare disease with increasing prevalence in recent years due to a greater number of spinal surgical procedures, nosocomial bacteraemia, an aging population and intravenous drug addiction. Haematogenous infection is the most common cause of spondylodiscitis. We report a 47-year-old man diagnosed with Escherichia coli spondylodiscitis. The patient initially presented with a 4-day history of inflammatory, mechanical pain in the lower back suggesting sciatica. Treatment included NSAIDs and opioids. Two days after discharge from hospital following an admission due to an upper GI bleeding, the back pain intensified, precipitating a new attendance to the emergency department; during which lumbosacral radiography showed marked reduction of L2/L3 intervertebral space. After a new admission to the rheumatology unit due to worsening of symptoms and raised inflammatory markers, an expedited MRI showed loss of intervertebral disc space at L2/L3, with an irregular high intensity area at L2; suggesting a fluid collection extending to adjacent soft tissues. Fluoroscopy-guided core needle bone biopsies were reported positive for Escherichia coli sensitive to ceftriaxone. The patient was treated (received treatment) with a three week course of ceftriaxone following a formal diagnosis of E. coli spondylodiscitis. Follow-up MRI demonstrated complete recovery with the patient able to return (has returned) to normal activity. In this case we highlight the importance of correct and timely diagnosis of spondylodiscitis. Diagnosis of spondylodiscitis is often difficult, delayed or even missed due to the rarity of the disease but can lead to devastating consequences. Therefore a high index of suspicion is needed for prompt diagnosis to ensure improved long-term outcomes.
Spondylodiscitis,Escheria coli,Back pain
https://beat.sums.ac.ir/article_44336.html
https://beat.sums.ac.ir/article_44336_f6b23d14786616b38446354699cc4f05.pdf
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
4
Issue 3
2016
07
01
Diffuse Punched out Lesions in Multiple Myeloma
180
181
EN
Rohat
Ak
0000-0002-8324-3264
Fatih Sultan Mehmet Education and Research Hospital,Istanbul
rohatakmd@gmail.com
Ebru
Ünal Akoğlu
Fatih Sultan Mehmet Education and Research Hospital,Istanbul
Özge
Ecmel Onur
Fatih Sultan Mehmet Education and Research Hospital,Istanbul
Multiple myeloma,Skull radiography,Punched out lesion
https://beat.sums.ac.ir/article_44337.html
https://beat.sums.ac.ir/article_44337_d8337067a250508c9b4564ca90608d0e.pdf