ORIGINAL_ARTICLE
Delayed Cardiac Rupture Induced by Traumatic Myocardial Infarction: Consequence of a 45-Magnum Blast Injury; A Comprehensive Case Review
A penetrating chest trauma, a myocardial contusion or a myocardial infarction can lead to a cardiac rupture, which is linked to an extreme high death rate. Only few cases with delayed perforation of the myocardium have been reported in literature. We report about a penetrating gunshot injury, which led to a myocardial contusion with secondary delayed rupture of the left ventricle and the left inferior lobe of the lung. The leakage of the lesion in the left ventricle could be sealed sufficiently with fibrin-coated collagen fleeces after adapting stitches with Prolene 2-0. For additional stabilization of the vulnerable myocardium area, a bovine patch has been placed on the damaged ventricle. Fibrin fleeces are used successfully in cardiac surgery, as in our case, to seal the leakage of the lesion in the left ventricle. The implantation of a bovine patch in the pericardium could prevent a cardiac compartment syndrome with a fatal pericardial tamponade. To prohibit a thoracic compartment syndrome a modified Bogota bag could be sewed in for temporarily closure of the chest. In most cases penetrating cardiac injuries can be treated without heart-lung-machines. An immediate transfer to a cardio-surgical center is, due to the acute situation, not possible. If a surgeon with thoraco-surgical expertise is present a transfer is not absolutely necessary.
https://beat.sums.ac.ir/article_44406_cfb2a90bbd466be3e632ad70009b4829.pdf
2018-01-01
1
7
Shotgun
myocardial infarction
Delayed cardiac rupture
Damage control
Thoracic compartment syndrome
Holger
Rupprecht
1
AUTHOR
Katharina
Gaab
katharina@gaab-web.de
2
LEAD_AUTHOR
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72
ORIGINAL_ARTICLE
Effects of Aloe Vera and Chitosan Nanoparticle Thin-Film Membranes on Wound Healing in Full Thickness Infected Wounds with Methicillin Resistant Staphylococcus Aureus
Objective: To assess effect of Aleo vera with chitosan nanoparticle biofilm on wound healing in full thickness infected wounds with antibiotic resistant gram positive bacteria.Method: Thirty rats were randomized into five groups of six rats each. Group I: Animals with uninfected wounds treated with 0.9% saline solution. Group II: Animals with infected wounds treated with saline. Group III: Animals with infected wounds were dressed with chitosan nanoparticle thin-film membranes. Group IV: Animals with infected wounds were treated topically with Aloe vera and Group V: Animals with infected wounds were treated topically with Aloe vera and dressed with chitosan nanoparticle thin-film membranes. Wound size was measured on 6, 9, 12, 15, 18 and 21days after surgery.Results: Microbiology, reduction in wound area and hydroxyproline contents indicated that there was significant difference (p<0.05) between group V and other groups. Quantitative histological studies and mean rank of the qualitative studies demonstrated that there was significant difference (p<0.05) between group V and other groups.Conclusion: The Aloe vera with chitosan nanoparticle thin-film membranes had a reproducible wound healing potential and hereby justified its use in practice.
https://beat.sums.ac.ir/article_44417_b7fe35128e763c624b62e940a177ce31.pdf
2018-01-01
8
15
Aloe vera
Chitosan nanoparticle
Thin-film membrane
MRSA
Wound
Rat
Reza
Ranjbar
1
Molecular Biology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
AUTHOR
Alireza
Yousefi
alireza.yousefi4@yahoo.com
2
Department of Surgery and Diagnostic Imaging, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
LEAD_AUTHOR
Cotran R, Kumar V, Collins T. Robbins SL. Pathologic basis of disease. 6th ed. Philadelphia: Saunders. 1999.
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Ranjbar R, Takhtfooladi MA. The effects of low level laser therapy on Staphylococcus aureus infected third-degree burns in diabetic rats. Acta Cir Bras. 2016;31(4):250-5.
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Ranjbar R, Takhtfooladi MA. The effects of photobiomodulation therapy on Staphylococcus aureus infected surgical wounds in diabetic rats. A microbiological, histopathological, and biomechanical study. Acta Cir Bras. 2016;31(8):498-504.
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Moghaddasi MS. Aloe vera chemicals and usages. Advances in Environmental Biology. 2010:464-9.
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16
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18
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19
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20
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21
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22
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23
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26
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27
Azad AK, Sermsintham N, Chandrkrachang S, Stevens WF. Chitosan membrane as a wound-healing dressing: characterization and clinical application. J Biomed Mater Res B Appl Biomater. 2004;69(2):216-22.
28
Seetharaman S, Natesan S, Stowers RS, Mullens C, Baer DG, Suggs LJ, et al. A PEGylated fibrin-based wound dressing with antimicrobial and angiogenic activity. Acta Biomater. 2011;7(7):2787-96.
29
Archana D, Dutta J, Dutta PK. Evaluation of chitosan nano dressing for wound healing: characterization, in vitro and in vivo studies. Int J Biol Macromol. 2013;57:193-203.
30
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Vázquez B, Avila G, Segura D, Escalante B. Antiinflammatory activity of extracts from Aloe vera gel. Journal of ethnopharmacology. 1996;55(1):69-75.
34
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Dogan S, Demirer S, Kepenekci I, Erkek B, Kiziltay A, Hasirci N, et al. Epidermal growth factor-containing wound closure enhances wound healing in non-diabetic and diabetic rats. Int Wound J. 2009;6(2):107-15.
36
Martin JM, Zenilman JM, Lazarus GS. Molecular microbiology: new dimensions for cutaneous biology and wound healing. J Invest Dermatol. 2010;130(1):38-48.
37
Das S, Baker AB. Biomaterials and Nanotherapeutics for Enhancing Skin Wound Healing. Front Bioeng Biotechnol. 2016;4:82.
38
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39
ORIGINAL_ARTICLE
Descriptive Analysis of Right and Left-sided Traumatic Diaphragmatic Injuries; Case Series from a Single Institution
Objective: To investigate the presentation, management and outcomes of left and right-sided traumatic diaphragmatic injury (TDI) in a single level I trauma center.Methods: This cross-sectional study was conducted during a 7-year period from 2008 to 2015 in a level I trauma center in Qatar. We included all the patients who presented with TDIs during the study period. Data included demographics, mechanism of injury, associated injuries, initial vitals, emergency department disposition, length of ICU and hospital stay, ventilator days, management, and outcomes. The variables were analyzed and compared for patients with left (LTDI) and right (RTDI).Results: A total of 52 TDI cases (79% LTDI and 21% RTDI) were identified with a mean age of 31±11. LTDI patients were more likely to have higher Injury severity scores (p=0.50) and greater AAST organ injury scoring (p=0.661 for all) than RTDI patients. Surgical repair was performed for 85% LTDI vs. 73% RTDI (p=0.342). Recurrent DIs was reported only in LTDI (5.1% vs. 0.0%; p=0.911). Twelve patients died (9 LTDI and 3 RTDI), of them 5 had associated head injury.Conclusion: This single-institution study confirms that LTDI are more commonly diagnosed than RTDI. Exploratory laparotomy is the most frequent procedure considered for the management of diaphragmatic injuries in the emergency settings. To improve outcomes in patients presenting with TDI, large prospective multicenter studies are needed to standardize the TDI management protocols including the diagnostic workup, timing of surgical intervention, and the most appropriate approach of treatment.
https://beat.sums.ac.ir/article_44407_a7513756b6459814936567ccd3ccd8b9.pdf
2018-01-01
16
25
Diaphragmatic
Injury
Rupture
Herniation, Blunt trauma
Penetrating injury
Hassan
Al-Thani
1
AUTHOR
Gaby
Jabbour
2
AUTHOR
Ayman
El-Menyar
aymanco65@yahoo.com
3
Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
LEAD_AUTHOR
Husham
Abdelrahman
4
AUTHOR
Ruben
Peralta
5
AUTHOR
Ahmad
Zarour
6
AUTHOR
Zarour AM, El-Menyar A, Al-Thani H, Scalea TM, Chiu WC. Presentations and outcomes in patients with traumatic diaphragmatic injury: a 15-year experience. J Trauma Acute Care Surg. 2013;74(6):1392-8; quiz 611.
1
Bosanquet D, Farboud A, Luckraz H. A review diaphragmatic injury. Respiratory Medicine CME. 2009;2(1):1-6.
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Lewis JD, Starnes SL, Pandalai PK, Huffman LC, Bulcao CF, Pritts TA, et al. Traumatic diaphragmatic injury: experience from a level I trauma center. Surgery. 2009;146(4):578-83; discussion 83-4.
3
Bergin D, Ennis R, Keogh C, Fenlon HM, Murray JG. The "dependent viscera" sign in CT diagnosis of blunt traumatic diaphragmatic rupture. AJR Am J Roentgenol. 2001;177(5):1137-40.
4
Kumar S, Pol M, Mishra B, Sagar S, Singhal M, Misra MC, et al. Traumatic Diaphragmatic Injury: A Marker of Serious Injury Challenging Trauma Surgeons. Indian J Surg. 2015;77(Suppl 2):666-9.
5
Iochum S, Ludig T, Walter F, Sebbag H, Grosdidier G, Blum AG. Imaging of diaphragmatic injury: a diagnostic challenge? Radiographics. 2002;22 Spec No:S103-16; discussion S16-8.
6
Scharff JR, Naunheim KS. Traumatic diaphragmatic injuries. Thorac Surg Clin. 2007;17(1):81-5.
7
Mihos P, Potaris K, Gakidis J, Paraskevopoulos J, Varvatsoulis P, Gougoutas B, et al. Traumatic rupture of the diaphragm: experience with 65 patients. Injury. 2003;34(3):169-72.
8
Leiva Flores JR, Ramirez Rivera JI, Ramirez Rivera ME. Late presentation of traumatic diaphragmatic hernia. Cir Pediatr. 2016;29(2):82-4.
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Grimes OF. Traumatic injuries of the diaphragm. Diaphragmatic hernia. Am J Surg. 1974;128(2):175-81.
10
Burch JM, Moore EE. Injuries to the liver, biliary tract, spleen, and diaphragm. ACS Surgery. Principles and Practice. Editado por DW Wilmore. American College of Surgeons. WebMD Corporation: New York; 2002.
11
Rashid F, Chakrabarty MM, Singh R, Iftikhar SY. A review on delayed presentation of diaphragmatic rupture. World J Emerg Surg. 2009;4:32.
12
Shreck GL, Toalson TW. Delayed presentation of traumatic rupture of the diaphragm. J Okla State Med Assoc. 2003;96(4):181-3.
13
Ties JS, Peschman JR, Moreno A, Mathiason MA, Kallies KJ, Martin RF, et al. Evolution in the management of traumatic diaphragmatic injuries: a multicenter review. J Trauma Acute Care Surg. 2014;76(4):1024-8.
14
Thiam O, Konate I, Gueye ML, Toure AO, Seck M, Cisse M, et al. Traumatic diaphragmatic injuries: epidemiological, diagnostic and therapeutic aspects. Springerplus. 2016;5(1):1614.
15
D'Souza N, Bruce JL, Clarke DL, Laing GL. Laparoscopy for Occult Left-sided Diaphragm Injury Following Penetrating Thoracoabdominal Trauma is Both Diagnostic and Therapeutic. Surg Laparosc Endosc Percutan Tech. 2016;26(1):e5-8.
16
Khan M, Dutta S. Traumatic diaphragmatic rupture managed at a tertiary level hospital in eastern India. Eur J Pharm Med Res. 2016;3:288-91.
17
Okada M, Adachi H, Kamesaki M, Mikami M, Ookura Y, Yamakawa J, et al. Traumatic diaphragmatic injury: experience from a tertiary emergency medical center. Gen Thorac Cardiovasc Surg. 2012;60(10):649-54.
18
Ahmed R, Hammoud H. Traumatic Diaphragmatic Injuries, A Hospital Based Study at Al-Yarmouk teaching Hospital. Med J Babylon. 2015;12:428-436.
19
Fair KA, Gordon NT, Barbosa RR, Rowell SE, Watters JM, Schreiber MA. Traumatic diaphragmatic injury in the American College of Surgeons National Trauma Data Bank: a new examination of a rare diagnosis. Am J Surg. 2015;209(5):864-8; discussion 8-9.
20
Gao JM, Du DY, Li H, Liu CP, Liang SY, Xiao Q, et al. Traumatic diaphragmatic rupture with combined thoracoabdominal injuries: Difference between penetrating and blunt injuries. Chin J Traumatol. 2015;18(1):21-6.
21
Panda A, Kumar A, Gamanagatti S, Patil A, Kumar S, Gupta A. Traumatic diaphragmatic injury: a review of CT signs and the difference between blunt and penetrating injury. Diagn Interv Radiol. 2014;20(2):121-8.
22
Kumar S, Pol M, Mishra B, Sagar S, Singhal M, Misra MC, et al. Traumatic Diaphragmatic Injury: A Marker of Serious Injury Challenging Trauma Surgeons. Indian J Surg. 2015;77(Suppl 2):666-9.
23
Radjou AN, Balliga DK, Uthrapathy M, Pal R, Mahajan P. Injury to the diaphragm: Our experience in Union Head quarters Hospital. Int J Crit Illn Inj Sci. 2013;3(4):256-61.
24
Gaine FA, Lone GN, Chowdhary MA, Lone H. The Etiology, Associated Injuries and Clinical Presentation of Post Traumatic Diaphragmatic Hernia. Bull Emerg Trauma. 2013;1(2):76-80.
25
Alanezi K, Azabi T, Abdul Bary H, Al Thani H, Milnecoff S, Cadeddu M, et al. observational study of outcome following surgical repair of traumatic diaphragmatic rupture. Middle East Journal of Emergency Medicine [The]. 2006:21-7.
26
Bilal A, Salim M, Nishtar T, Nabi S, Muslim M, Ahmed M, et al. Diaphragmatic injuries, a retrospective analysis of 50 patients. Annals of King Edward Medical University. 2016;11(4): 423-426.
27
Hanna WC, Ferri LE. Acute traumatic diaphragmatic injury. Thorac Surg Clin. 2009;19(4):485-9.
28
Shah R, Sabanathan S, Mearns AJ, Choudhury AK. Traumatic rupture of diaphragm. Ann Thorac Surg. 1995;60(5):1444-9.
29
Gwely NN. Outcome of blunt diaphragmatic rupture. Analysis of 44 cases. Asian Cardiovasc Thorac Ann. 2010;18(3):240-3.
30
Tan KK, Yan ZY, Vijayan A, Chiu MT. Management of diaphragmatic rupture from blunt trauma. Singapore Med J. 2009;50(12):1150-3.
31
Desir A, Ghaye B. CT of blunt diaphragmatic rupture. Radiographics. 2012;32(2):477-98.
32
Kaur R, Prabhakar A, Kochhar S, Dalal U. Blunt traumatic diaphragmatic hernia: Pictorial review of CT signs. Indian J Radiol Imaging. 2015;25(3):226-32.
33
Ocak I, Strollo DC. Fractured Ribs and the CT Funky Fat Sign of Diaphragmatic Rupture. Case Rep Radiol. 2016;2016:6723632.
34
Sangster GP, Gonzalez-Beicos A, Carbo AI, Heldmann MG, Ibrahim H, Carrascosa P, et al. Blunt traumatic injuries of the lung parenchyma, pleura, thoracic wall, and intrathoracic airways: multidetector computer tomography imaging findings. Emerg Radiol. 2007;14(5):297-310.
35
de Nadai TR, Lopes JC, Inaco Cirino CC, Godinho M, Rodrigues AJ, Scarpelini S. Diaphragmatic hernia repair more than four years after severe trauma: Four case reports. Int J Surg Case Rep. 2015;14:72-6.
36
Ahmad Ganie F, Nabi Lone G, Chowdhary M, Lone H. The Characteristics and Surgical Approach in Post-Traumatic Diaphragmatic Hernia: A Single Center Experience. Bull Emerg Trauma. 2013;1(3):108-11.
37
Murray JG, Caoili E, Gruden JF, Evans SJ, Halvorsen RA, Jr., Mackersie RC. Acute rupture of the diaphragm due to blunt trauma: diagnostic sensitivity and specificity of CT. AJR Am J Roentgenol. 1996;166(5):1035-9.
38
Haciibrahimoglu G, Solak O, Olcmen A, Bedirhan MA, Solmazer N, Gurses A. Management of traumatic diaphragmatic rupture. Surg Today. 2004;34(2):111-4.
39
Leppäniemi AK. Thoracoscopy in chest trauma: an update. Trauma. 2001;3(2):111-7.
40
Shanmuganathan K, Killeen K, Mirvis SE, White CS. Imaging of diaphragmatic injuries. J Thorac Imaging. 2000;15(2):104-11.
41
Meyers BF, McCabe CJ. Traumatic diaphragmatic hernia. Occult marker of serious injury. Ann Surg. 1993;218(6):783-90.
42
Al-Refaie RE, Awad E, Mokbel EM. Blunt traumatic diaphragmatic rupture: a retrospective observational study of 46 patients. Interact Cardiovasc Thorac Surg. 2009;9(1):45-9.
43
ORIGINAL_ARTICLE
The Predictive Value of Repeated Abdominal Ultrasonography in Patients with Multiple Trauma and Decreased Level of Consciousness: The Experience of a Resource-Limited Centre
Objective: To determine the predictive value of repeated abdominal ultrasonography in patients with multiple trauma and decreased level of consciousness (LOC).Methods: This prospective cross-sectional study was conducted over a six-month period at Shahid Rajaee Trauma Hospital, Shiraz, Iran. We included hemodynamically stable blunt abdominal trauma patients with a decreased LOC (Glasgow Coma Scale ≤ 13) who were referred to the neurosurgery ICU ward. Included cases underwent 1 contrast-enhanced CT scan and two-time ultrasonographic study of the abdomen with an interval of 48 hours. The diagnostic accuracy of the ultrasonography was determined according to the CT-scan results.Results: Overall 80 patients with mean age of 37.75 ± 18.67 years were included. There were 17 (21.3%) women and 63 (78.8%) men among the patients. Compared with the CT-Scan, the first ultrasonography showed a sensitivity of 60%, specificity of 80%, PPV of 16.60%, NPV of 96.80%, and a diagnostic accuracy of 70%. The same values for the second ultrasonographic study were 80%, 79%, 20%, 98%, and 79%, respectively. In 4 (5%) patients whose first ultrasonography and CT scan results were negative, the second ultrasonography was positive for injury.Conclusion: In patients with blunt trauma to the abdomen, when the only indication of abdominal CT scan is a decreased LOC, two ultrasonographic studies can replace a CT imaging.
https://beat.sums.ac.ir/article_44408_8013117eff7b3dd3c07c8fce75acbad6.pdf
2018-01-01
26
30
Blunt Injury
Computed Tomography
Ultrasonography
Traumatic brain injury
Sensitivity
Specificity
Shahram
Paydar
paydarsh@gmail.com
1
AUTHOR
Behnam
Dalfardi
dalfardibeh@gmail.com
2
LEAD_AUTHOR
Bardia
Zangbar-Sabegh
3
AUTHOR
Hossein
Heidaripour
4
AUTHOR
Leila
Pourandi
5
AUTHOR
Alireza
Shakibafard
6
AUTHOR
Mehdi
Tahmtan
7
AUTHOR
Leila
Shayan
shayanl_85@yahoo.com
8
AUTHOR
Mohammad Hadi
Niakan
9
AUTHOR
Ghaffarpasand F, Paydar S, Foroughi M, Saberi A, Abbasi H, Karimi AA, et al. Role of cervical spine radiography in the initial evaluation of stable high-energy blunt trauma patients. J Orthop Sci. 2011;16(5):498-502.
1
Griffin XL, Pullinger R. Are diagnostic peritoneal lavage or focused abdominal sonography for trauma safe screening investigations for hemodynamically stable patients after blunt abdominal trauma? A review of the literature. J Trauma. 2007;62(3):779-84.
2
Fang JF, Wong YC, Lin BC, Hsu YP, Chen MF. Usefulness of multidetector computed tomography for the initial assessment of blunt abdominal trauma patients. World J Surg. 2006;30(2):176-82.
3
Isenhour JL, Marx J. Advances in abdominal trauma. Emerg Med Clin North Am. 2007;25(3):713-33, ix..
4
Jansen JO, Yule SR, Loudon MA. Investigation of blunt abdominal trauma. BMJ. 2008;336(7650):938-42.
5
Cothren CC, Biffl WL, Moore EE. Trauma. In: Brunicardi FC, Andersen DK, et al., eds. Schwartz's Principles of Surgery. The McGraw-Hill Companies, Inc: USA; 2010.
6
Wu SR, Shakibai S, McGahan JP, Richards JR. Combined head and abdominal computed tomography for blunt trauma: which patients with minor head trauma benefit most? Emerg Radiol. 2006;13(2):61-7.
7
Paydar S, Dalfardi B. Trauma computed tomography: benefits and hazards. World J Surg. 2014;38(10):2735.
8
Myers J. Focused assessment with sonography for trauma (FAST): the truth about ultrasound in blunt trauma. J Trauma. 2007;62(6 Suppl):S28.
9
Paydar S, Ghaffarpasand F, Foroughi M, Saberi A, Dehghankhalili M, Abbasi H, et al. Role of routine pelvic radiography in initial evaluation of stable, high-energy, blunt trauma patients. Emerg Med J. 2013;30(9):724-7.
10
Mathews JD, Forsythe AV, Brady Z, Butler MW, Goergen SK, Byrnes GB, et al. Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ. 2013;346:f2360.
11
Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012;380(9840):499-505.
12
Paydar S, Ahmadi A, Dalfardi B, Shakibafard A, Abbasi H, Bolandparvaz S. Clinical and economic effects of selective radiological evaluation of high-energy trauma patients: a prospective experience of a level 1 busy trauma centre. Emerg Med J. 2015;32(7):535-8.
13
Bakker J, Genders R, Mali W, Leenen L. Sonography as the primary screening method in evaluating blunt abdominal trauma. J Clin Ultrasound. 2005;33(4):155-63.
14
Nural MS, Yardan T, Guven H, Baydin A, Bayrak IK, Kati C. Diagnostic value of ultrasonography in the evaluation of blunt abdominal trauma. Diagn Interv Radiol. 2005;11(1):41-4.
15
Tas F, Ceran C, Atalar MH, Bulut S, Selbes B, Isik AO. The efficacy of ultrasonography in hemodynamically stable children with blunt abdominal trauma: a prospective comparison with computed tomography. Eur J Radiol. 2004;51(1):91-6.
16
Sessa B, Trinci M, Ianniello S, Menichini G, Galluzzo M, Miele V. Blunt abdominal trauma: role of contrast-enhanced ultrasound (CEUS) in the detection and staging of abdominal traumatic lesions compared to US and CE-MDCT. Radiol Med. 2015;120(2):180-9.
17
McStay C, Ringwelski A, Levy P, Legome E. Hollow viscus injury. J Emerg Med. 2009;37(3):293-9.
18
Bhagvan S, Turai M, Holden A, Ng A, Civil I. Predicting hollow viscus injury in blunt abdominal trauma with computed tomography. World J Surg. 2013;37(1):123-6.
19
Bhan C, Forshaw MJ, Bew DP, Kapadia YK. Diagnostic peritoneal lavage and ultrasonography for blunt abdominal trauma: attitudes and training of current general surgical trainees. Eur J Emerg Med. 2007;14(4):212-5.
20
ORIGINAL_ARTICLE
Efficacy and Safety of Morphine and Low Dose Ketamine for Pain Control of Patients with Long Bone Fractures: A Randomized, Double-Blind, Clinical Trial
Objective: To compare the effects of intravenous morphine and a low dose of ketamine on pain intensity of patients with traumatic fractures of the long bones.Methods: This randomized, controlled, double-blinded, clinical trial was conducted in the adult emergency department (ED) of Emam Khomeini hospital, a tertiary general hospital affiliated with Mazandaran University of Medical Sciences, in Northern Iran, during a 6-month period. Patients were randomly assigned to receive intravenous morphine (0.1 mg/kg) or low dose ketamine (0.5 mg/kg) for control of the pain in the emergency room. The pain intensity was checked by a nurse using the visual analogue scale (VAS) at 30, 60, 90, 120, 180 and 240, minutes after the intervention.Results: Overall we included a total number of 156 patients with mean age of 35.87±3.38 years. There were 111 (71.2%) men and 4 (28.8%) women among the patients. Patients were randomly assigned to receive intravenous morphine (n=78) or low dose ketamine (n=78). The pain intensity decreased significantly in both study groups after 240 minutes of intervention. However, there was no significant difference between the two study groups regarding the pain intensity at 30 (p=0.378), 60 (p=0.927), 90 (p=0.434), 120 (p=0.557), 180 (p=0.991) and 240 (p=0.829) minutes. The side effects were comparable while low dose ketamine was associated with higher need for rescue analgesic (p=0.036). Conclusion: The results of the current study demonstrates that the intravenous low dose ketamine leads to successful pain control in patients with long bone fractures and the effects are comparable with intravenous morphine.The study is registered with the Iranian Registry for Clinical trials (www.irct.ir; IRCT2017041221480N6)
https://beat.sums.ac.ir/article_44409_4f1adcbff0caca2d82f49d8d5abdc11e.pdf
2018-01-01
31
36
Morphine
Ketamine
Bone Fracture
Pain management
Fatemeh
Jahanian
sheilaml442@gmail.com
1
Mazandaran University of Medical Science
LEAD_AUTHOR
Seyed Mohammad
Hosseininejad
2
AUTHOR
Hamed
Amini Ahidashti
3
AUTHOR
Farzad
Bozorgi
farzadbozorgi1356@gmail.com
4
AUTHOR
Iraj
Goli Khatir
5
AUTHOR
Seyyed Hosein
Montazar
6
AUTHOR
Vahideh
Azarfar
7
AUTHOR
Barata I, Spencer R, Suppiah A, Raio C, Ward MF, Sama A. Emergency ultrasound in the detection of pediatric long-bone fractures. Pediatr Emerg Care. 2012;28(11):1154-7.
1
Cordell WH, Keene KK, Giles BK, Jones JB, Jones JH, Brizendine EJ. The high prevalence of pain in emergency medical care. Am J Emerg Med. 2002;20(3):165-9.
2
Marx J, Walls R, Hockberger R. Rosen's Emergency Medicine-Concepts and Clinical Practice E-Book: Elsevier Health Sciences; 2013.
3
Todd KH, Sloan EP, Chen C, Eder S, Wamstad K. Survey of pain etiology, management practices and patient satisfaction in two urban emergency departments. Cjem. 2002;4(4):252-6.
4
Neighbor ML, Honner S, Kohn MA. Factors affecting emergency department opioid administration to severely injured patients. Acad Emerg Med. 2004;11(12):1290-6.
5
Nejati A, Moharari RS, Ashraf H, Labaf A, Golshani K. Ketamine/propofol versus midazolam/fentanyl for procedural sedation and analgesia in the emergency department: a randomized, prospective, double-blind trial. Acad Emerg Med. 2011;18(8):800-6.
6
Majidinejad S, Esmailian M, Emadi M. Comparison of Intravenous Ketamine with Morphine in Pain Relief of Long Bones Fractures: a Double Blind Randomized Clinical Trial. Emerg (Tehran). 2014;2(2):77-80.
7
Panzer O, Moitra V, Sladen RN. Pharmacology of sedative-analgesic agents: dexmedetomidine, remifentanil, ketamine, volatile anesthetics, and the role of peripheral Mu antagonists. Anesthesiol Clin. 2011;29(4):587-605, vii.
8
Howard PK, Gisness CM. Is Subdissociative Ketamine As Safe and Effective As Morphine for Pain Management in the Emergency Department? Adv Emerg Nurs J. 2017;39(2):81-5.
9
Shimonovich S, Gigi R, Shapira A, Sarig-Meth T, Nadav D, Rozenek M, et al. Intranasal ketamine for acute traumatic pain in the Emergency Department: a prospective, randomized clinical trial of efficacy and safety. BMC Emerg Med. 2016;16(1):43.
10
Li NL, Yu BL, Hung CF. Paravertebral Block Plus Thoracic Wall Block versus Paravertebral Block Alone for Analgesia of Modified Radical Mastectomy: A Retrospective Cohort Study. PLoS One. 2016;11(11):e0166227.
11
Khajavi MR, Sabouri SM, Shariat Moharari R, Pourfakhr P, Najafi A, Etezadi F, et al. Multimodal Analgesia With Ketamine or Tramadol in Combination With Intravenous Paracetamol After Renal Surgery. Nephrourol Mon. 2016;8(4):e36491.
12
Othman AH, El-Rahman AM, El Sherif F. Efficacy and Safety of Ketamine Added to Local Anesthetic in Modified Pectoral Block for Management of Postoperative Pain in Patients Undergoing Modified Radical Mastectomy. Pain Physician. 2016;19(7):485-94.
13
Greze J, Vighetti A, Incagnoli P, Quesada JL, Albaladejo P, Palombi O, et al. Does continuous wound infiltration enhance baseline intravenous multimodal analgesia after posterior spinal fusion surgery? A randomized, double-blinded, placebo-controlled study. Eur Spine J. 2017;26(3):832-9.
14
Conde Ruiz C, Cruz Benedetti IC, Guillebert I, Portier KG. Effect of Pre- and Postoperative Phenylbutazone and Morphine Administration on the Breathing Response to Skin Incision, Recovery Quality, Behavior, and Cardiorespiratory Variables in Horses Undergoing Fetlock Arthroscopy: A Pilot Study. Front Vet Sci. 2015;2:58.
15
Barcelos A, Garcia PC, Portela JL, Piva JP, Garcia JP, Santana JC. Comparison of two analgesia protocols for the treatment of pediatric orthopedic emergencies. Rev Assoc Med Bras (1992). 2015;61(4):362-7.
16
Beaudoin FL, Lin C, Guan W, Merchant RC. Low-dose ketamine improves pain relief in patients receiving intravenous opioids for acute pain in the emergency department: results of a randomized, double-blind, clinical trial. Acad Emerg Med. 2014;21(11):1193-202.
17
Miller JP, Schauer SG, Ganem VJ, Bebarta VS. Low-dose ketamine vs morphine for acute pain in the ED: a randomized controlled trial. Am J Emerg Med. 2015;33(3):402-8.
18
Eftekharian HR, Ilkhani Pak H. Effect of Intravenous Ketorolac on Postoperative Pain in Mandibular Fracture Surgery; A Randomized, Double-Blind, Placebo-Controlled Trial. Bull Emerg Trauma. 2017;5(1):13-7.
19
Hosseininejad SM, Amini Ahidashti H, Bozorgi F, Goli Khatir I, Montazar SH, Jahanian F, et al. Efficacy and Safety of Combination Therapy with Ketorolac and Morphine in Patient with Acute Renal Colic; A Triple-Blind Randomized Controlled Clinical Trial. Bull Emerg Trauma. 2017;5(3):165-70.
20
Losing AK, Jones JM, Keric A, Briggs SE, Leedahl DD. Ketamine Infusion Therapy as an Alternative Pain Control Strategy in Patients with Multi-Trauma including Rib Fracture; Case Report and Literature Review. Bull Emerg Trauma. 2016;4(3):165-9.
21
ORIGINAL_ARTICLE
Outcome after Surgical Management of Acetabular Fractures: A 7-Year Experience
Objective: To determine the functional and radiologic results of surgical treatment in patients with acetabular fractures.Methods: This was a retrospective cross-sectional study. We retrospectively reviewed medical records of patients operatively treated acute acetabular fractures at a level I trauma center (Shahid Rajaee) and an orthopedic center (Shahid Chamran) both in southern Iran (Shiraz) with minimally 1 year follow up over a period of 7 years from April 2009 to March 2016. Functional and radiographic outcomes, and complication were considered as main outcomes.Results: A total number of 79 patients completed the study. Fifty-five patients were operated through Kocher–Langenbeck approach, and 18 were operated through the standard ilioinguinal approach, and 6 patients were operated through the standard ilioinguinal approach combined with Kocher–Langenbeck approach. The mean follow-up of patients was 45.6 months. The average operative time was 162.4±78.5 min, and the median blood loss was 500 ml. Functional results were excellent in 41 patients (51.9%), good in 12 (15.2%), fair in 13 (16.5%), and poor in 13 patients (16.5%). Radiologic results were excellent in 27 cases (34.2%), good in 17 cases (21.5%), fair in 18 cases (22.8%), and poor in 16 (16.5%). Osteoarthritis of hip (60.8%) and AVN of head of femur (22.8%) were two most common complications. In addition, there wasn’t any significant difference between surgical approaches regarding clinical and radiographic outcomes.Conclusion: The operative treatment for acetabular fractures gives universally satisfactory results. Thereafter, this study provides evidence that ilioinguinal approach is a good choice for anterior fractures, Kocher–Langenbeck is a good choice for posteriors fractures, and combined approach may be a good choice in the management of acetabular fractures involving two columns.
https://beat.sums.ac.ir/article_44410_905b6eb99f7499fb7bbf13d53c0a561d.pdf
2018-01-01
37
44
Acetabular fracture
Internal fixation
Open reduction
Ilioinguinal approach
Kocher–Langenbeck approach
Seyed Amirreza
Mesbahi
1
Shiraz University of Medical Sciences
AUTHOR
Ali
Ghaemmaghami
ghaemmaghami.ali@gmail.com
2
Shiraz University of Medical Sciences
LEAD_AUTHOR
Sara
Ghaemmaghami
3
Shiraz University of Medical Sciences
AUTHOR
Pouya
Farhadi
pouya.farhadi@yahoo.com
4
Shiraz University of Medical Sciences
AUTHOR
Gupta RK, Singh H, Dev B, Kansay R, Gupta P, Garg S. Results of operative treatment of acetabular fractures from the Third World--how local factors affect the outcome. Int Orthop. 2009;33(2):347-52.
1
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Guerado E, Cano JR, Cruz E. Fractures of the acetabulum in elderly patients: an update. Injury. 2012;43 Suppl 2:S33-41.
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Cole JD, Bolhofner BR. Acetabular fracture fixation via a modified Stoppa limited intrapelvic approach. Description of operative technique and preliminary treatment results. Clin Orthop Relat Res. 1994;(305):112-23.
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27
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Negrin LL, Seligson D. Results of 167 consecutive cases of acetabular fractures using the Kocher-Langenbeck approach: a case series. J Orthop Surg Res. 2017;12(1):66.
31
Shrestha D, Dhoju D, Shrestha R, Sharma V. Acetabular Fracture: Retrospective Analysis of Thirty Three Consecutive Cases with Operative Management. Kathmandu Univ Med J (KUMJ). 2014;12(48):279-87.
32
Rocca G, Spina M, Mazzi M. Anterior Combined Endopelvic (ACE) approach for the treatment of acetabular and pelvic ring fractures: A new proposal. Injury. 2014;45 Suppl 6:S9-s15.
33
Sen RK, Kumar A, Tripathy S, Aggarwal S, Khandelwal N. Risk factors of venous thromboembolism in Indian patients with pelvic-acetabular trauma. J Orthop Surg (Hong Kong). 2011;19(1):18-24.
34
Neal B. Effects of heterotopic bone formation on outcome after hip arthroplasty. ANZ J Surg. 2003;73(6):422-6.
35
Slone HS, Walton ZJ, Daly CA, Chapin RW, Barfield WR, Leddy LR, et al. The impact of race on the development of severe heterotopic ossification following acetabular fracture surgery. Injury. 2015;46(6):1069-73.
36
ORIGINAL_ARTICLE
Epidemiology and Pattern of Traumatic Brain Injury in a Developing Country Regional Trauma Center
Objective: To determine the epidemiological aspects of patients with traumatic brain injury (TBI) in a regional trauma center.Methods: A cross-sectional study was conducted on patients with TBI during 2013 to 2016 in a single center in Hamedan, central Iran. The distribution and relationships of TBI was assessed with gender, age, type of trauma, traumatic cause, exiting status and Length of Hospitalization (LOH). Data were analyzed by Stata V11 statistical software.Results: In general, 9426 patients with TBI were enrolled in analyses. The mean ± SD age of patients was 29.70 (± 21.46) years. Multivariate logistic regression indicated that being male [OR: 1.29; 95% CI (2.92-4.73), P ≤0.001], 41-50 to 71-80 and 90+ years old' age groups (1.32<OR<3.12, 0.029<p≤0.001), having surgery [OR: 5.58; 95% CI (4.89-6.37), p≤0.001], and different types of trauma (p≤0.001) were significantly related to LOH. Moreover, odds ratio of mortality was 1.52 times greater in males than females (p≤0.001). As the age increases, the odds ratio of mortality was also rising. However, having surgery [OR: 3.72; 95% CI (2.92-4.73), p≤0.001], LOH >5 days [OR: 2.01; 95% CI (1.60-2.52), p≤0.001] and different types of trauma were significantly related to mortality.Conclusion: TBI is one of the main causes of mortality and LOH of the young population. By providing preventive measures and a traumatic care system, the burden of trauma can be greatly reduced, the implementation of the trauma care system in Hamedan province is a necessity.
https://beat.sums.ac.ir/article_44411_2c6be68c711c2976676dbc551ae1b861.pdf
2018-01-01
45
53
Epidemiology
Trend
Trauma
Injury
Head injury
Head trauma
Brain injury
Trauma care
Iran
Mohamadreza
Saatian
1
AUTHOR
Jamal
Ahmadpoor
ahmadpour.jml@gmail.com
2
Department of epidemiology, hamadan university of medical sciences, hamadan, iran
LEAD_AUTHOR
Younes
Mohammadi
3
AUTHOR
Ehsan
Mazloumi
4
AUTHOR
Mahran DG, Farouk O, Qayed MH, Berraud A. Pattern and Trend of Injuries Among Trauma Unit Attendants in Upper Egypt. Trauma Mon. 2016;21(2):e20967.
1
Rangarajan V, Mavani SB, Nadkarni TD, Goel AH. Traumatic cervical epidural hematoma in an infant. J Craniovertebr Junction Spine. 2013;4(1):37-9.
2
Bae JY, Groen RS, Kushner AL. Surgery as a public health intervention: common misconceptions versus the truth. Bull World Health Organ. 2011;89(6):394.
3
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4
Pant PR, Towner E, Pilkington P, Ellis M, Manandhar D. Community perceptions of unintentional child injuries in Makwanpur district of Nepal: a qualitative study. BMC Public Health. 2014;14:476.
5
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Qubty WF, Mrelashvili A, Patterson MC. Epidural hematoma in a patient on pegylated-L-asparginase therapy. J Child Neurol. 2015;30(5):636.
9
Kim YS, Moon KS, Lee KH, Jung TY, Jang WY, Kim IY, et al. Spontaneous acute epidural hematoma developed due to skull metastasis of hepatocelluar carcinoma: A case report and review of the literature. Oncol Lett. 2016;11(1):741-4.
10
Jalalvandi F, Arasteh P, Safari Faramani R, Esmaeilivand M. Epidemiology of Pediatric Trauma and Its Patterns in Western Iran: A Hospital Based Experience. Glob J Health Sci. 2015;8(6):139-46.
11
Zamani M, Esmailian M, Mirazimi MS, Ebrahimian M, Golshani K. Cause and final outcome of trauma in patients referred to the emergency department: a cross sectional study. Iranian journal of emergency medicine. 2014;1(1):22-7.
12
Asadi P, Asadi K, Monsef-Kasmaei V, Zohrevandi B, Kazemnejad-leili E, Kouchakinejad Eramsadati L, et al. Evaluation of Frequency of Cervical Spine Injuries in Patients with Blunt Trauma. Journal of Guilan University of Medical Sciences. 2015;23(92):31-6.
13
Zolotor AJ, Runyan DK, Shanahan M, Durrance CP, Nocera M, Sullivan K, et al. Effectiveness of a Statewide Abusive Head Trauma Prevention Program in North Carolina. JAMA Pediatr. 2015;169(12):1126-31.
14
O'Reilly GM, Gabbe B, Cameron PA. Trauma registry methodology: a survey of trauma registry custodians to determine current approaches. Injury. 2015;46(2):201-6.
15
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16
Moini M, Rezaishiraz H, Zafarghandi MR. Characteristics and outcome of injured patients treated in urban trauma centers in Iran. J Trauma. 2000;48(3):503-7.
17
Gowing CJ, McDermott KM, Ward LM, Martin BL. Ten years of trauma in the 'top end' of the Northern Territory, Australia: a retrospective analysis. Int Emerg Nurs. 2015;23(1):17-21.
18
Mehmood A, Allen KA, Al-Maniri A, Al-Kashmiri A, Al-Yazidi M, Hyder AA. Trauma care in Oman: A call for action. Surgery. 2017;162(6s):S107-s16.
19
Consunji R, Ameratunga S, Hyder AA. Trauma care in the developing world: Introduction to special issue. Surgery. 2017;162(6s):S2-s3.
20
In: Statistical Center of Iran. Statistical information Tehran: Instituto Nacional de Estadística; 1390. [cited 1 February 2017]. Available from: https://www.amar.org.ir/.
21
Saadat S, Rashidi-Ranjbar N, Rasouli MR, Rahimi-Movaghar V. Pattern of skull fracture in Iran: report of the Iran National Trauma Project. Ulus Travma Acil Cerrahi Derg. 2011;17(2):149-51.
22
Rasouli MR, Nouri M, Zarei MR, Saadat S, Rahimi-Movaghar V. Comparison of road traffic fatalities and injuries in Iran with other countries. Chin J Traumatol. 2008;11(3):131-4.
23
Chardoli M, Rahimi-Movaghar V. Analysis of trauma outcome at a university hospital in Zahedan, Iran using the TRISS method. East Afr Med J. 2006;83(8):440-2.
24
Magnone S, Ghirardi A, Ceresoli M, Ansaloni L. Trauma patients centralization for the mechanism of trauma: old questions without answers. 2017.
25
Janssens L, Holtslag HR, Leenen LP, Lindeman E, Looman CW, van Beeck EF. Trends in moderate to severe paediatric trauma in Central Netherlands. Injury. 2014;45(8):1190-5.
26
Ghaem H, Soltani M, Yadollahi M, ValadBeigi T, Fakherpour A. Epidemiology and Outcome Determinants of Pedestrian Injuries in a Level I Trauma Center in Southern Iran; A Cross-Sectional Study. Bull Emerg Trauma. 2017;5(4):273-9.
27
Mohtasham-Amiri Z, Dastgiri S, Davoudi-Kiakalyeh A, Imani A, Mollarahimi K. An Epidemiological Study of Road Traffic Accidents in Guilan Province, Northern Iran in 2012. Bull Emerg Trauma. 2016;4(4):230-5.
28
Haghparast-Bidgoli H, Saadat S, Bogg L, Yarmohammadian MH, Hasselberg M. Factors affecting hospital length of stay and hospital charges associated with road traffic-related injuries in Iran. BMC Health Serv Res. 2013;13:281.
29
Kobusingye OC, Hyder AA, Bishai D, Hicks ER, Mock C, Joshipura M. Emergency medical systems in low- and middle-income countries: recommendations for action. Bull World Health Organ. 2005;83(8):626-31.
30
Carney N, Totten AM, O'Reilly C, Ullman JS, Hawryluk GW, Bell MJ, et al. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery. 2017;80(1):6-15.
31
Bhat G, Beck L, Bergen G, Kresnow MJ. Predictors of rear seat belt use among U.S. adults, 2012. J Safety Res. 2015;53:103-6.
32
Lukasiewicz AM, Grant RA, Basques BA, Webb ML, Samuel AM, Grauer JN. Patient factors associated with 30-day morbidity, mortality, and length of stay after surgery for subdural hematoma: a study of the American College of Surgeons National Surgical Quality Improvement Program. J Neurosurg. 2016;124(3):760-6.
33
Hu J, Ugiliweneza B, Meyer K, Lad SP, Boakye M. Trend and geographic analysis for traumatic brain injury mortality and cost based on MarketScan database. J Neurotrauma. 2013;30(20):1755-61.
34
Zargar M, Kalantar Motamedi SM, Karbakhsh M, Ghodsi SM, Rahimi-Movaghar V, Panahi F, et al. Trauma care system in Iran. Chin J Traumatol. 2011;14(3):131-6.
35
Kobusingye OC, Hyder AA, Bishai D, Hicks ER, Mock C, Joshipura M. Emergency medical systems in low- and middle-income countries: recommendations for action. Bull World Health Organ. 2005;83(8):626-31.
36
ORIGINAL_ARTICLE
The Frequency of Brain CT-Scan Findings in Patients with Scalp Lacerations Following Mild Traumatic Brain Injury; A Cross-Sectional Study
Objective: To determine the frequency of the brain CT-scan findings in patients with mild traumatic brain injury (TBI) and scalp lacerations.Methods: This cross-sectional study was conducted during a 1-year period from March 2016 to March 2017 in Level I trauma center in Shiraz, Southern Iran. We included all the adult patients (≥18 years) admitted to our emergency room with mild TBI (GCS on admission of 15) and scalp lacerations. All the patients underwent Brain CT-Scan and the scans were reviewed by two radiologists who were unaware of the patients’ clinical findings. The results are reported as proportions and frequencies.Results: Overall we included a total number of 94 patients with minimal TBI who had a scalp laceration on admission. The mean age of the patients was 30.78 ± 8.01 (ranging from 18 to 47) years. There were 58 (61.7%) men and 36 (38.3%) women among the patients. The most common finding of the Brain CT-Scan was subgaleal hematoma in 76 (80.9%) patients followed by base skull base fracture in 7 (7.4%), linear skull fracture in 7 (7.4%), brain contusion in 3 (3.2%) and subdural hematoma in 1 (1.1%). Conclusion: The results of the current study indicate that scalp lacerations are associated with intracranial injuries in about 20% of the patients with mild TBI. Thus brain CT-scan is recommended in all the patients with mild TBI and scalp lacerations.
https://beat.sums.ac.ir/article_44412_e75d20647af871202b2d16bffd94fa1e.pdf
2018-01-01
54
58
Traumatic brain injury
Minimal
Scalp Laceration
Brain CT-Scan
Subdural hematoma
Hadid
Hamrah
1
AUTHOR
Sarah
Mehrvarz
sarah_mehrvarz@yahoo.com
2
shiraz medical university
LEAD_AUTHOR
Amir Mohammad
Mirghassemi
3
AUTHOR
Heydari ST, Hoseinzadeh A, Ghaffarpasand F, Hedjazi A, Zarenezhad M, Moafian G, et al. Epidemiological characteristics of fatal traffic accidents in Fars province, Iran: a community-based survey. Public Health. 2013;127(8):704-9.
1
Heydari ST, Hoseinzadeh A, Sarikhani Y, Hedjazi A, Zarenezhad M, Moafian G, et al. Time analysis of fatal traffic accidents in Fars Province of Iran. Chin J Traumatol. 2013;16(2): 84-8.
2
Corrigan JD, Yang J, Singichetti B, Manchester K, Bogner J. Lifetime prevalence of traumatic brain injury with loss of consciousness. Inj Prev. 2017. pii: injuryprev-2017-042371.
3
Lee CJ, Felix ER, Levitt RC, Eddy C, Vanner EA, Feuer WJ, et al. Traumatic brain injury, dry eye and comorbid pain diagnoses in US veterans. Br J Ophthalmol. 2017. pii: bjophthalmol-2017-310509.
4
Thurman DJ, Alverson C, Dunn KA, Guerrero J, Sniezek JE: Traumatic brain injury in the United States: A public health perspective. J Head Trauma Rehabil. 1999;14(6): 602-15.
5
Servadei F, Teasdale G, Merry G: Defining acute mild head injury in adults: a proposal based on prognostic factors, diagnosis, and management. J Neurotrauma. 2001;18(7):657-64.
6
Simon B, Letourneau P, Vitorino E, McCall J. Pediatric minor head trauma: indications for computed tomographic scanning revisited. J Trauma. 2001;51(2): 231-7; discussion 237-238.
7
Malli N, Ehammer T, Yen K, Scheurer E. Detection and characterization of traumatic scalp injuries for forensic evaluation using computed tomography. Int J Legal Med. 2013;127(1):195-200.
8
Currie KB, Ross P, Collister P, Gurunluoglu R. Analysis of Scalp and Forehead Injuries in a Level I Trauma Center. J Craniofac Surg. 2017;28(5):1350-3.
9
Gurunluoglu R, Glasgow M, Arton J, Bronsert M. Retrospective analysis of facial dog bite injuries at a Level I trauma center in the Denver metro area. J Trauma Acute Care Surg. 2014;76(5):1294-1300.
10
Masoumi B, Heydari F, Hatamabadi H, Azizkhani R, Yoosefian Z, Zamani M. The Relationship between Risk Factors of Head Trauma with CT Scan Findings in Children with Minor Head Trauma Admitted to Hospital. Open Access Maced J Med Sci. 2017;5(3): 319-23.
11
Korley FK, Kelen GD, Jones CM, Diaz-Arrastia R: Emergency Department Evaluation of Traumatic Brain Injury in the United States, 2009-2010. J Head Trauma Rehabil. 2016;31(6): 379-87.
12
Prichep LS, Naunheim R, Bazarian J, Mould WA, Hanley D. Identification of hematomas in mild traumatic brain injury using an index of quantitative brain electrical activity. J Neurotrauma. 2015;32(1): 17-22.
13
Bazarian JJ, Veazie P, Mookerjee S, Lerner EB. Accuracy of mild traumatic brain injury case ascertainment using ICD-9 codes. Acad Emerg Med. 2006;13(1):31-8.
14
Yuh EL, Mukherjee P, Lingsma HF, Yue JK, Ferguson AR, Gordon WA, et al. Magnetic resonance imaging improves 3-month outcome prediction in mild traumatic brain injury. Ann Neurol. 2013;73(2):224-35.
15
Brenner DJ, Hall EJ. Computed tomography--an increasing source of radiation exposure. N Engl J Med. 2007;357(22):2277-84.
16
McGinnis JM, Stuckhardt L, Saunders R, Smith M. Best care at lower cost: the path to continuously learning health care in America: National Academies Press; 2013.
17
Korley FK, Pham JC, Kirsch TD. Use of advanced radiology during visits to US emergency departments for injury-related conditions, 1998-2007. JAMA. 2010;304(13):1465-71.
18
Jacobs B, Beems T, Stulemeijer M, van Vugt AB, van der Vliet TM, Borm GF, et al. Outcome prediction in mild traumatic brain injury: age and clinical variables are stronger predictors than CT abnormalities. J Neurotrauma. 2010;27(4):655-68.
19
Lannsjo M, Backheden M, Johansson U, Af Geijerstam JL, Borg J. Does head CT scan pathology predict outcome after mild traumatic brain injury? Eur J Neurol. 2013;20(1):124-9.
20
van der Naalt J, Timmerman ME, de Koning ME, van der Horn HJ, Scheenen ME, Jacobs B, et al. Early predictors of outcome after mild traumatic brain injury (UPFRONT): an observational cohort study. Lancet Neurol. 2017;16(7):532-40.
21
ORIGINAL_ARTICLE
Determinants of the Lethal Area 50 Index (LA50) in Burn Patients Admitted to a Tertiary Referral Burn Center in Southern Iran
Objective: To evaluate the lethal area 50 (LA50) and determinants of mortality in burn patients admitted to a single burn center.Methods: This retrospective cross-sectional study was conducted in a tertiary burn center affiliated with Shiraz University of Medical Sciences, Shiraz, Iran, during a 1-year period from 2015 to 2016. To determine prognostic factors in fatal burns, medical records of eligible burn patients were reviewed for demographic and clinical variables, as well as patient outcome. Also, LA50 was calculated using Probit analysis.Results: Overall 559 patients with the mean age of 27.2±23.65 years and including 343 (61.4%) males and 216 (38.6%) females were enrolled in this study. The average burn TBSA% was 31.38±24.41% (1-100%). Duration of hospital stay ranged from 1 to 67 days (15.11±10.64). With 93 expired patients, the mortality rate was calculated to be 16.6%. The total LA50 was 66.55% (58.4-79.3). Fire was the most common cause of burn injury.Conclusion: Compared to developed countries, in our burn center the LA50 and survival rate of burn patients are lower. This indicates an urgent need for prompt attention in order to improve current policies regarding this public health issue to reduce mortality.
https://beat.sums.ac.ir/article_44413_3a3c23234dd76c72dedb2fbfbb06b69f.pdf
2018-01-01
59
63
Body surface area
Burn
Lethal area 50
Mortality
Risk factors
Abdolkhalegh
Keshavarzi
1
AUTHOR
Sina
Kardeh
sina.xix@gmail.com
2
LEAD_AUTHOR
Amirhosein
Pourdavood
3
AUTHOR
Mana
Mohamadpour
4
AUTHOR
Maryam
Dehghankhalili
5
AUTHOR
Berg L, Meyer S, Ipaktchi R, Vogt PM, Muller A, de Zwaan M. Psychosocial Distress at Different Time Intervals after Burn Injury. Psychother Psychosom Med Psychol. 2017;67(6):231-9.
1
Stavrou D, Weissman O, Tessone A, Zilinsky I, Holloway S, Boyd J, et al. Health related quality of life in burn patients--a review of the literature. Burns. 2014;40(5):788-96.
2
Connell KM, Coates R, Doherty-Poirier M, Wood FM. A literature review to determine the impact of sexuality and body image changes following burn injuries. Sexuality and Disability. 2013;31(4):403-12.
3
Randall SM, Fear MW, Wood FM, Rea S, Boyd JH, Duke JM. Long-term musculoskeletal morbidity after adult burn injury: a population-based cohort study. BMJ Open. 2015;5(9):e009395.
4
Gullick JG, Taggart SB, Johnston RA, Ko N. The trauma bubble: patient and family experience of serious burn injury. J Burn Care Res. 2014;35(6):e413-27.
5
Sundara DC. A review of issues and concerns of family members of adult burn survivors. J Burn Care Res. 2011;32(3):349-57.
6
Tyson AF, Boschini LP, Kiser MM, Samuel JC, Mjuweni SN, Cairns BA, et al. Survival after burn in a sub-Saharan burn unit: challenges and opportunities. Burns. 2013;39(8):1619-25.
7
Ayaz M, Bahadoran H, Arasteh P, Keshavarzi A. Early Excision and Grafting versus Delayed Skin Grafting in Burns Covering Less than 15% of Total Body Surface Area; A Non- Randomized Clinical Trial. Bull Emerg Trauma. 2014;2(4):141-5.
8
Rybarczyk MM, Schafer JM, Elm CM, Sarvepalli S, Vaswani PA, Balhara KS, et al. A systematic review of burn injuries in low-and middle-income countries: Epidemiology in the WHO-defined African Region. African Journal of Emergency Medicine. 2017.
9
Charles AG, Gallaher J, Cairns BA. Burn Care in Low- and Middle-Income Countries. Clin Plast Surg. 2017;44(3):479-83.
10
Gupta S, Wong EG, Mahmood U, Charles AG, Nwomeh BC, Kushner AL. Burn management capacity in low and middle-income countries: a systematic review of 458 hospitals across 14 countries. Int J Surg. 2014;12(10):1070-3..
11
Karimi H, Momeni M, Motevalian A, Bahar MA, Boddouhi N, Alinejad F. The burn registry program in Iran - First report. Ann Burns Fire Disasters. 2014;27(3):154-9.
12
Cassidy JT, Phillips M, Fatovich D, Duke J, Edgar D, Wood F. Developing a burn injury severity score (BISS): adding age and total body surface area burned to the injury severity score (ISS) improves mortality concordance. Burns. 2014;40(5):805-13.
13
Bull JP, Squire JR. A Study of Mortality in a Burns Unit: Standards for the Evaluation of Alternative Methods of Treatment. Ann Surg. 1949;130(2):160-73.
14
Hettiaratchy S, Papini R. Initial management of a major burn: II--assessment and resuscitation. Bmj. 2004;329(7457):101-3.
15
Fazeli S, Karami-Matin R, Kakaei N, Pourghorban S, Safari-Faramani R, Safari-Faramani B. Predictive factors of mortality in burn patients. Trauma Mon. 2014;19(1):e14480.
16
Aghakhani N, Sharif Nia H, Soleimani MA, Bahrami N, Rahbar N, Fattahi Y, et al. Prevalence burn injuries and risk factors in persons older the 15 years in Urmia burn center in Iran. Caspian J Intern Med. 2011;2(2):240-4.
17
Shahabi Shahmiri S, Kolahdouzan M, Omrani A, Khazaei M, Salehi H, Motavalian A, et al. Determinants of Mortality and the Lethal Area 50 Index (LA50) in Burn Patients Admitted to a Large Burn Center; A Single Center Experience. Bull Emerg Trauma. 2017;5(3):184-9.
18
Seyed-Forootan K, Karimi H, Motevalian SA, Momeni M, Safari R, Ghadarjani M. LA50 in burn injuries. Ann Burns Fire Disasters. 2016;29(1):14-7.
19
Ekrami A, Hemadi A, Kalantar E, Latifi M, Kayedani A. Epidemiology of hospitalized burn patients during 5 years in Khuzestan province, Iran. Archives of Clinical Infectious Diseases. 2010;5(1):40-4.
20
Shirkhoda M, Kaviani Far K, Narouie B, Shikhzadeh A, Ghasemi Rad M, Hanfi Bojd H. Epidemiology and evaluation of 1073 burn patients in the southeast of Iran. Shiraz E Medical Journal. 2011;12(1):11-21.
21
Zarei MR, Dianat S, Eslami V, Harirchi I, Boddouhi N, Zandieh A, et al. Factors associated with mortality in adult hospitalized burn patients in Tehran. Ulus Travma Acil Cerrahi Derg. 2011;17(1):61-5..
22
Mohammadi-Barzelighi H, Alaghehbandan R, Motevallian A, Alinejad F, Soleimanzadeh-Moghadam S, Sattari M, et al. Epidemiology of severe burn injuries in a Tertiary Burn Centre in Tehran, Iran. Ann Burns Fire Disasters. 2011;24(2):59-62.
23
Saffle JR. Predicting outcomes of burns. Mass Medical Soc; 1998. p. 387-8.
24
Lin GA, Yang XD, Qin SL, Li WJ, Zhao GH. Influence of age on median lethal burn area of burn patients. Zhonghua Shao Shang Za Zhi. 2013;29(1):37-40..
25
Cheng W, Yan-hua R, Fang-gang N, Wei-li D, Guo-an Z. Epidemiology of 1974 burn patients at a major burn center in Beijing: a nine-year study. J Burn Care Res. 2012;33(5):e228-33.
26
Jackson PC, Hardwicke J, Bamford A, Nightingale P, Wilson Y, Papini R, et al. Revised estimates of mortality from the Birmingham Burn Centre, 2001-2010: a continuing analysis over 65 years. Ann Surg. 2014;259(5):979-84.
27
Brusselaers N, Monstrey S, Vogelaers D, Hoste E, Blot S. Severe burn injury in Europe: a systematic review of the incidence, etiology, morbidity, and mortality. Crit Care. 2010;14(5):R188.
28
Keshavarzi A, Ayaz M, Dehghankhalili M. Ultra-Early versus Early Excision and Grafting for Thermal Burns up to 60% Total Body Surface Area; A Historical Cohort Study. Bull Emerg Trauma. 2016;4(4):197-201.
29
Fan X, Ma B, Zeng D, Fang X, Li H, Xiao S, et al. Burns in a major burns center in East China from 2005 to 2014: Incidence and outcome. Burns. 2017;43(7):1586-95.
30
Knowlin L, Stanford L, Moore D, Cairns B, Charles A. The measured effect magnitude of co-morbidities on burn injury mortality. Burns. 2016;42(7):1433-8.
31
ORIGINAL_ARTICLE
Characteristics of the Traumatic Forensic Cases Admitted To Emergency Department and Errors in the Forensic Report Writing
Objective: To identify errors in forensic reports and to describe the characteristics of traumatic medico-legal cases presenting to the emergency department (ED) at a tertiary care hospital.Methods: This study is a retrospective cross-sectional study. The study includes cases resulting in a forensic report among all traumatic patients presenting to the ED of Adiyaman University Training and Research Hospital, Adiyaman, Turkey during a 1-year period. We recorded the demographic characteristics of all the cases, time of presentation to the ED, traumatic characteristics of medico-legal cases, forms of suicide attempt, suspected poisonous substance exposure, the result of follow-up and the type of forensic report.Results: A total of 4300 traumatic medico-legal cases were included in the study and 72% of these cases were male. Traumatic medico-legal cases occurred at the greatest frequency in July (10.1%) and 28.9% of all cases occurred in summer. The most frequent causes of traumatic medico-legal cases in the ED were traffic accidents (43.4%), violent crime (30.5%), and suicide attempt (7.2%). The most common method of attempted suicide was drug intake (86.4%). 12.3% of traumatic medico-legal cases were hospitalized and 24.2% of those hospitalized were admitted to the orthopedics service. The most common error in forensic reports was the incomplete recording of the patient's “cooperation” status (82.7%). Additionally, external traumatic lesions were not defined in 62.4% of forensic reports.Conclusion: The majority of traumatic medico-legal cases were male age 18-44 years, the most common source of trauma was traffic accidents and in the summer months. When writing a forensic report, emergency physicians made mistakes in noting physical examination findings and identifying external traumatic lesions. Physicians should make sure that the traumatic medico-legal patients they treat have adequate documentation for reference during legal proceedings. The legal duties and responsibilities of physicians should be emphasized with in-service training.
https://beat.sums.ac.ir/article_44414_a2038a6483577a99154020cc90ff50a9.pdf
2018-01-01
64
70
Medico-legal case
Forensic reports
Trauma
Emergency department
Nurettin
Aktas
1
AUTHOR
Umut
Gulacti
umutgulacti@gmail.com
2
LEAD_AUTHOR
Ugur
Lok
3
AUTHOR
Irfan
Aydin
4
AUTHOR
Tayfun
Borta
5
AUTHOR
Murat
Celik
6
AUTHOR
Korkmaz T, Kahramansoy N, Erkol Z, Sarıçil F, Kılıç A. Evaluation of Medico-legal Case applied to Emergency service and the Judicial Reports. Haseki Tip Bülteni. 2012;50(1). [in Turkey]
1
Brahmankar TR, Sharma SK. A record based study of frequency and pattern of medico-legal cases reported at a tertiary care hospital in Miraj. International Journal of Community Medicine and Public Health. 2017;4(4):1348-52
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ORIGINAL_ARTICLE
Tips on Reporting a Systematic Review
https://beat.sums.ac.ir/article_44415_aa6d79df2d5999581f8f7f68af2dc4a2.pdf
2018-01-01
71
72
Systematic review
Research design
Transparency
Morteza
Arab-Zozani
arab.hta@gmail.com
1
Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
LEAD_AUTHOR
Djavad
Ghoddoosi-Nejad
2
AUTHOR
Mohammad
Dehghani
3
AUTHOR
Dehghani M, Moftian N, Rezaei-Hachesu P, Samad-Soltani T. A Step-by-Step Framework on Discrete Events Simulation in Emergency Department; A Systematic Review. Bull Emerg Trauma. 2017;5(2):79-89.
1
Arabzoozani M, Bayegi V. Improve the quality of review articles reporting. Iranian Journal of Medical Education. 2014;14(5):465-8.
2
Kozlowski D, Mogensen CB, Petersen NC. Discrete event simulation modelling for an improved patient flow at the Emergency Department, Sygehus Lillebælt, Kolding. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2012;20(S2):P14.
3
Bair AE, Song WT, Chen Y-c, Morris BA, editors. The impact of inpatient boarding on emergency department crowding: a discrete-event simulation study. Proceedings of the 2009 Spring Simulation Multiconference; 2009: Society for Computer Simulation International.
4
Hoerning S, Song J, Wu T, Shi L, editors. Improving discrete event simulation in the emergency department with innovative and robust input analysis tools. Automation Science and Engineering (CASE), 2012 IEEE International Conference on; 2012: IEEE.
5
Arab-Zozani M, Mahdavi-Mazdeh M, Hasanpoor E, Ghoddoosi Nejad D, Sokhanvar M, Kakemam E. Safety and Efficacy of Two Different Doses of Everolimus in Kidney Transplantation: a Systematic Review and Meta-Analysis. Iran J Kidney Dis. 2016;11(1):1-11.
6
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.
7
ORIGINAL_ARTICLE
Letter to the Editor Regarding “Tips on Reporting Systematic Reviews”
https://beat.sums.ac.ir/article_44416_1be6087cb771c33c1ad8eaaffdf8a7b0.pdf
2018-01-01
Report
Systematic reviews
Taha
Samad Soltany
t-ssoltany@razi.tums.ac.ir
1
Tabriz University of Medical Sciences
LEAD_AUTHOR
1. Dehghani M, Moftian N, Rezaei-Hachesu P, Samad-Soltani T. A Step-by-Step Framework on Discrete Events Simulation in Emergency Department; A Systematic Review. Bull Emerg Trauma. 2017;5(2):79-89.
1