Original Article
Joao Augusto; Miguel Santos; Daniel Faria; Paulo Alves; David Roque; Jose; Morais; Victor Gil; Carlos Morais
Articles in Press, Accepted Manuscript, Available Online from 20 April 2020
Abstract
Objective: To evaluate the impact of a real-time visual feedback device on CCs rate and depth delivered by healthcare professionals.Methods: In a simulated scenario a sensor was placed on a manikin’s chest and connected to a defibrillator which provided real-time visual feedback on the ...
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Objective: To evaluate the impact of a real-time visual feedback device on CCs rate and depth delivered by healthcare professionals.Methods: In a simulated scenario a sensor was placed on a manikin’s chest and connected to a defibrillator which provided real-time visual feedback on the rate and depth of CCs. Thirty-two healthcare professionals performed sequentially 5 cycles of 30 CCs without (FeedOFF) and with (FeedON) feedback. CCs with a depth between 50 and 60mm and a rate between 100 and 120cpm were considered optimal.Results: Visual feedback resulted in a significant increase in the proportion of CCs with optimal depth (median 8.7 [interquartile range 0.7–55.5]% FeedOFF vs 63.3 [17.6–88.1]% FeedON, p=0.002) and optimal rate (median 51.3 [1.3–81.3]% FeedOFF vs 68.3 [45.3–86.1]% FeedON, p=0.018). Overall, CCs were too shallow and too fast in the FeedOFF cycle. There was also a significant increase in optimal CCs (optimal depth and rate) with the use of the feedback device (from median 0.7 [0–26.9]% FeedOFF to 31.9 [3.6-59.9]% FeedON, p=0.001). Participants’ factors such as age, sex, body mass index, job or time since last CPR training did not have a significant impact on CPR quality.Conclusion: In the absence of visual feedback, there is a tendency towards lower depth and higher rate of CCs. The use of feedback technology significantly improves the quality of CCs.
Original Article
Mohammad Ali Ashja Zadeh; Mohsen Ebrahimi; Amir Ahmad Salarian; Seyyed Reza Abtahi; Alireza Jahandideh
Articles in Press, Accepted Manuscript, Available Online from 21 May 2020
Abstract
Objective: To evaluate the wound healing activity of Crocus pallasii subsp. haussknechtii boiss leaves extract on infected wounds in diabetic rats. Methods: Fifty male diabetic rats were randomized into two sets of 25 animals each. Each group was sub divided into five groups of five animals, each for ...
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Objective: To evaluate the wound healing activity of Crocus pallasii subsp. haussknechtii boiss leaves extract on infected wounds in diabetic rats. Methods: Fifty male diabetic rats were randomized into two sets of 25 animals each. Each group was sub divided into five groups of five animals, each for excisional and incisional wound models, respectively. Induction of diabetes was achieved using 60 mg/kg streptozotocin. In group I, 0.1 mL sterile saline 0.9% solution was added to the wounds with no infection. In group II, the wounds were infected with Methicillin-resistant staphylococcus aureus (MRSA) and only treated with 0.1 mL the sterile saline 0.9% solution. In group III, infected wounds were treated with application of base formulation ointment. In group IV, animals with infected wounds were treated with 0.1 mL topical application of 1 mg/mL methicillin and base formulation ointment. In group V, animals with infected wounds were treated with topical application of 0.1 mL solution of methicillin (1 mg/mL) and with 1g of powder extract of the plant material in ointment. The healing of the wound was assessed based on planimetry, hydroxyproline estimation, microbiological, biomechanical and biochemical studies Results: Microbiological examination, planimetric, histological and quantitative morphometric studies and determination of hydroxyproline levels showed that there was significant difference between animals in group V compared to other groups (p=0.001). Biomechanical indices in incisional groups showed there was significant difference between animals in group V compared to other groups (p=0.001). Conclusion: It was possible to conclude that the ointment of the extract of Crocus pallasii subsp. haussknechtii boiss. leaves have significant wound-healing activity in diabetes.
Original Article
Jose Ramon Auso-Perez; Gloria Maria Rodríguez-Blanes
Articles in Press, Accepted Manuscript, Available Online from 30 May 2020
Abstract
Objective: To describe the demographic characteristics and to assess possible risk factors related to the moment of presentation at Emergency Department (ED) for pediatric humeral supracondylar fractures.
Methods: This was cross-sectional study being conducted during 5-year period from 2013 to 2017 ...
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Objective: To describe the demographic characteristics and to assess possible risk factors related to the moment of presentation at Emergency Department (ED) for pediatric humeral supracondylar fractures.
Methods: This was cross-sectional study being conducted during 5-year period from 2013 to 2017 at ED of a regional hospital in Spain. We have included all the pediatric patients (<14 years) with supracondylar fractures referring to our center during the study period. The demographic, clinical and radiological characteristics of the patients were recorded. The outcome and treatment strategies were also recorded. The risk factors of the pediatric supracondylar fracture were also assessed in our series.
Results: We have included 52 pediatric patients with supracondylar fractures in this series. The mean age was 7.48 ± 2.97 years with a minimum age of 2 years and a maximum of 14 years. Among the patients there were 32 (61.54%) male and 20 (38.46%) female. Age less than 7 years found to be a protective factor against unstable fractures [OR 0.33 (0.10 - 1.02)]. Fractures presented during daytime hours showed a greater instability [OR 3.49 (1.07-11.39)]. However, the risk of presentation at nighttime was higher during the summer months (June to September).
Conclusion: The older is the child, the greater is the risk of suffering an unstable fracture, which increases the need for surgery. This risk is greater during the daytime. Otherwise, during the summer months, there is a higher risk of patient presentation at nighttime.
Original Article
Reza Hosseinpour; Amir Barghi; Saadat Mehrabi; Shirvan Salaminia; Paria Tobeh
Articles in Press, Accepted Manuscript, Available Online from 30 May 2020
Abstract
Objective: To investigate the prognosis and survival rates of a group of Iranian patients with traumatic injuries using the trauma and injury severity score (TRISS) model.
Methods: In this prospective cohort study, all the patients with multi-trauma referring to the Yasuj Shahid Beheshti hospital during ...
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Objective: To investigate the prognosis and survival rates of a group of Iranian patients with traumatic injuries using the trauma and injury severity score (TRISS) model.
Methods: In this prospective cohort study, all the patients with multi-trauma referring to the Yasuj Shahid Beheshti hospital during 2018 were included. The patients’ demographic information, trauma and history of previous illness were recorded. Vital symptoms including respiratory rate, heart rate, hypertension, pulse rate and Glasgow coma scale (GCS) score were assessed. The injury severity score (ISS) was calculated based on the type and location of the injuries and according to the abbreviated injury scale (AIS) classification. The survival probability of the patients was assessed according to the TRISS model.
Results: Overall, 252 trauma patients were evaluated out of whom, 195 (77.4%) were men and 57 (22.6%) women. The mean TRISS score was 24.2 ± 9.32 and the maximum score was 99.7. If we consider the TRISS score probability above 0.5 as the chance of being alive, the mortality rate was 6.75%, that was lower than our series (7.1%). The ISS score and GCS had a positive significant relationship with other variables except respiratory rate, body temperature and hospitalization. Revised trauma score (RTS) was significantly associated with other variables including age, GCS, hemoglobin, systolic blood pressure and respiratory rate. TRISS had an area under curve (AUC) of 0.988 indicating a high prognostic accuracy.
Conclusion: The mortality rate was lower than that of being predicted by TRISS. This might be due to treatment effectiveness and care for traumatic patients leading to decreased mortality. TRISS had high prognostic accuracy in trauma patients. We also reported an association between hemoglobin and survival rate. Therefore, it seems that considering the laboratory parameters can be useful in patients with trauma.
Original Article
Farzad Bozorgi; Ebrahim Salehifar; Seyed Mohammad Hosseininejad; Siavash Moradi; Ghazaleh Janbazi; Aroona Chabra
Articles in Press, Accepted Manuscript, Available Online from 14 June 2020
Abstract
Objective: To evaluate the utilization of the parenteral morphine in Emergency Department (ED) using the Anatomical Therapeutic Chemical Classification/Defined Daily Doses (ATC/DDD) system. Methods: In this retrospective cross-sectional study, morphine administration was recorded in 4-year time period ...
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Objective: To evaluate the utilization of the parenteral morphine in Emergency Department (ED) using the Anatomical Therapeutic Chemical Classification/Defined Daily Doses (ATC/DDD) system. Methods: In this retrospective cross-sectional study, morphine administration was recorded in 4-year time period from January 2013 to December 2016 in the ED of a referral center. The dose of the administered morphine was evaluated using the ATC/DDD system. The ATC/DDD of the parenteral morphine was calculated based on the world health organization (WHO). The data was evaluated based on the different diagnosis and conditions using the ATC/DDD protocol. Results: In this study, 500 patients referred to ED with mean age of 48.29 ± 10.10 years were included. There were 306 (61.2%) men and 194 (38.8%) women among the patients. The lowest and highest DDD of parenteral morphine were 0.1 and 0.43, respectively. The utilization of parenteral morphine was significantly higher in men when compared to women (p<0.001). Those with history of tricyclic anti-depressant (TCA) consumption (p<0.001) and opium addiction (p<0.001) had significantly higher parenteral morphine utilization. Those with pain in the extremities and chest pain had significantly higher parenteral morphine utilization (p<0.001). Conclusion: The utilization of parenteral morphine in the ED of our center was higher than the WHO standard dosage. The morphine utilization was associated with male gender, opium addiction and TCA consumption.
Original Article
Ali Akbary; Seyed Taghi Heydari; Yaser Sarikhani; Mehrdad Vossoughi; Reza Tabrizi; Maryam Akbari; Najmeh Movahhedian; Arash Mani; Homayoun Sadeghi-Bazargani; Tahereh Ostovar; Kamran Bagheri Lankarani
Articles in Press, Accepted Manuscript, Available Online from 04 July 2020
Abstract
Objective: To investigate the association between attention-deficit/hyperactivity disorder (ADHD) score and driving behaviors among motorcycle drivers in Iran. Methods: This multi-center cross-sectional study was conducted on 1747 motorcyclists in three cities of Iran. We used a random sampling method ...
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Objective: To investigate the association between attention-deficit/hyperactivity disorder (ADHD) score and driving behaviors among motorcycle drivers in Iran. Methods: This multi-center cross-sectional study was conducted on 1747 motorcyclists in three cities of Iran. We used a random sampling method in this study and gathered data using two standard questionnaires. Data were presented using descriptive statistics, also t-test, and ANOVA used for analysis. Results: The mean age of participants was 27.41±8.80 years. ADHD scores of the participants ranged from 0 to 87, with a mean score 31±15.86. All risky driving behaviors (RDBs) were significantly associated with a higher mean of ADHD score. For example, driving with illegal speed (p<0.001), not wearing a crash helmet (p=0.016), driving while exhausting (p<0.001), talking with other passengers (p<0.001), being fined by the police in the past year (p=0.028), and maneuvering while driving (p<0.001) were related to a higher mean of ADHD score. Conclusion: All RDBs were significantly associated with the ADHD score among motorcyclists in Iran. In this regard, health care providers should inform people with ADHD about the negative consequences associated with driving and ADHD. Public health policymakers should consider management of ADHD through a comprehensive approach to improve driving performance and competencies among motorcyclists in order to decrease RDBs and traffic accidents.
Original Article
Khodayar Oshvandi; Zahra Veladati; Marzieh Mahmoodi; Farshid Rahimi Bashar; Azim azizi
Articles in Press, Accepted Manuscript, Available Online from 20 July 2020
Abstract
Objective: To determine the effects of foot massage on pain severity during in unconscious trauma patients admitted to the intensive care unit (ICU). Methods: In this randomized clinical trial (RCT), 80 unconscious trauma patients admitted in the ICU of a hospital in an urban area of Iran were ...
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Objective: To determine the effects of foot massage on pain severity during in unconscious trauma patients admitted to the intensive care unit (ICU). Methods: In this randomized clinical trial (RCT), 80 unconscious trauma patients admitted in the ICU of a hospital in an urban area of Iran were included using the convenience sampling method. They were randomly assigned to the intervention and control groups (n=40 in each group). In both groups, the intensity of pain was measured immediately, 10 minutes after the first change position and without any intervention before the change of position using the Critical Care Pain Observation Tool (CCPOT). In the intervention group, before the second position change, classic foot massage was performed for 20 minutes, but the control group received routine care. Pain was re-evaluated after the change position at desired times. The pain intensity was compared between the two study groups. Results: The baseline characteristics were comparable between the two study groups and no difference was found. There was no statistically significant difference between the mean scores of pain after the change of position (immediately and ten minutes later) before the intervention in the groups (p=0.915 and 0.660, respectively). However, after the intervention, the pain intensity was significantly lower in the intervention groups compared to the control group (p<0.001). Conclusion: Foot massage decreases the pain intensity related to the change of position in unconscious trauma patients admitted in the ICU. Due to its simplicity and low cost, this method can be used along with analgesic drugs to reduce pain in patients. Clinical trial registry: IRCT2016121031327N1
Original Article
Rohit Bhoil; Neeti Aggarwal; Vineet Aggarwal; Mukesh Surya; Sanjiv Sharma; Ajay Kumar Alhuwalia; Sabina Bhoil; Surya Pratap Singh; Manveer Thakur; Siddharth Sood
Articles in Press, Accepted Manuscript, Available Online from 20 July 2020
Abstract
Objective: To establish the incidence of arterial corona mortis variant in angiographic studies being performed using a 64 slice CT scan machine in a series of patients.Methods: This was a prospective cross-sectional study including 100 consecutive patients undergoing routineclinically indicated, ...
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Objective: To establish the incidence of arterial corona mortis variant in angiographic studies being performed using a 64 slice CT scan machine in a series of patients.Methods: This was a prospective cross-sectional study including 100 consecutive patients undergoing routineclinically indicated, standard protocol, CT-angiography for the abdominal aorta and/or lower limbs using a 64 slice CT scanner. Patients having severe arterial insufficiency (Grade 4 stenosis on CT angiography), pelvic infections and tumours, patients with past pelvic trauma and those who had previous pelvic surgery were excluded from the study. In total 200 hemi-pelvises were evaluated for the presence or absence of corona morti.Results: Overall, we included 100 patients in this series including 67 men and 33 women with mean age of 40.1±2.3 (ranging from 22-74) years. The arterial variant was identified on thin, 0.625-mm-thick images in 24 out of 100 patients studied (unilateral in 20 patients and bilateral in 4 patients; 28 out of 200 hemipelvises evaluated, having an incidence of 14%). We found that the distance of corona mortis artery from the symphysis was significantly greater for women compared to men, both on right (p=0.034) and left sides (p=0.046).Conclusion: Corona mortis may be prospectively identified at contrast-enhanced multidetector CT especially in pelvic trauma patients and help guide subsequent endovascular embolization or surgical interventions.
Case Report
Nabil Muhammad Al Kuddoos; Ahmad Khaldun Ismail; Kevin Wong Chuing Shen; Nur Amirah Shibraumalisi; Asmil Yuzairi Yunus
Articles in Press, Accepted Manuscript, Available Online from 29 April 2020
Abstract
Pancreatic injury in paediatrics is a rare condition and can be difficult to diagnose. The diagnostic challenge is due to its symptom of vague abdominal pain which usually results in late presentation. Elevated biochemical markers such as amylase and lipase can aid in the evaluation of pancreatic injury, ...
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Pancreatic injury in paediatrics is a rare condition and can be difficult to diagnose. The diagnostic challenge is due to its symptom of vague abdominal pain which usually results in late presentation. Elevated biochemical markers such as amylase and lipase can aid in the evaluation of pancreatic injury, however, it is not specific and is only evident after several hours of trauma. Ultrasound is commonly used as a primary modality to evaluate abdominal organ injuries, but its role in detecting pancreatic injury is limited due to low sensitivity. High index of suspicion is needed to avoid undiagnosed pancreatic injury which could be lethal to children. We herein report a case of delayed presentation of isolated pancreatic tail injury in a child who was sufficiently diagnosed with ultrasound and treated conservatively. Proper initial assessment and diagnosis will allow appropriate management of pancreatic injury. Conservative management should include serial imaging to look at the evolution of pancreatic injury and detect complications such as pseudocyst or abscess formation.
Case Report
Mauricio Gonzalez-Urquijo; Mario Zambrano Lara
Articles in Press, Accepted Manuscript, Available Online from 16 June 2020
Abstract
We present a case of a 23-year-old male patient who presented with a blade knife completely wedged and penetrated on his humerus after a stab wound to his left upper extremity. On palpation, a foreign body was palpated under the skin on the deltoid area. The blade was stuck in the bone, so the surrounding ...
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We present a case of a 23-year-old male patient who presented with a blade knife completely wedged and penetrated on his humerus after a stab wound to his left upper extremity. On palpation, a foreign body was palpated under the skin on the deltoid area. The blade was stuck in the bone, so the surrounding bone tissue was osteotomised until the blade was released. The patient evolved favorably, and at three months follow up, he has a full functional recovery of his arm. Stab wounds are prevalent in emergency departments; however, stab wounds with bone involvement have rarely been reported in the literature. When encountering a blade stuck in bone tissue, removing the blade while avoiding orthopedic, neurological and vascular injuries should be the main goal of the treatment. To the best of our knowledge, this is the third reported case of an intraosseous foreign body in the humerus secondary to a stab wound.
Letter to the Editor
MohammadBagher Shamsi; Siavash Vaziri; HamidReza Mozaffari; Maryam Mirzaei
Articles in Press, Accepted Manuscript, Available Online from 20 April 2020
Letter to the Editor
Uttam Chand Saini; Deepak Neradi; Deepak Kumar; Vikas Bacchal; Praveen Sodavarapu; Akshay Shetty
Articles in Press, Accepted Manuscript, Available Online from 19 April 2020
Letter to the Editor
Mukesh Meena; Karmbeer Singh; Sanjay Meena; Chetan Kumbhare; Dushyant Chouhan
Articles in Press, Accepted Manuscript, Available Online from 19 April 2020
