Pankaj Kumar Mishra; Rishi Dwivedi; Charanjit Singh Dhillon
Volume 8, Issue 1 , January 2020, , Pages 34-40
Abstract
Objective: To evaluate the functional and radiological outcome of balloon kyphoplasty and to endorse the unilateral single balloon extrapedicular kyphoplasty as practically more feasible and safer method in comparison to the conventional methods.Methods: Totally, 81 patients were presented ...
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Objective: To evaluate the functional and radiological outcome of balloon kyphoplasty and to endorse the unilateral single balloon extrapedicular kyphoplasty as practically more feasible and safer method in comparison to the conventional methods.Methods: Totally, 81 patients were presented to our center with osteoporotic vertebral compression fracture. Among these, 59 patients (61 vertebrae) were enrolled with stable wedge osteoporotic compression fracture. Pre-operatively percentage of vertebral height loss and kyphotic angle were calculated and single balloon extrapedicular kyphoplasty was performed in all cases.Results: Postoperatively, anterior vertebral height improved to 79.61% of normal subjects. In our study, the mean segmental kyphosis correction following balloon kyphoplasty was 14.27°. Overall incidence of cement leak in our study was 15.25%.Conclusion: Although we encountered the few difficulties, but this technique holds the safety and feasibility measures. Furthermore, it is effective in restoring anterior vertebral height, alignment and angle of kyphosis.
Sayed Reza Ahmadi; Maliheh Ziaee; Humain Baharvahdat; Zahra Ahmadi; Morteza Talebi delouee; Behrange Rezvani Kakhki; Mohammad Salehi kareshk; Elnaz Vafadar Moradi
Volume 12, Issue 1 , January 2024, , Pages 35-41
Abstract
Objective: Subarachnoid hemorrhage (SAH) is still considered a life-threatening medical condition witha high mortality rate, particularly in developing countries. Thus, the present study aimed to investigate theangiographic findings of non-traumatic or spontaneous SAH.Methods: This retrospective cohort ...
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Objective: Subarachnoid hemorrhage (SAH) is still considered a life-threatening medical condition witha high mortality rate, particularly in developing countries. Thus, the present study aimed to investigate theangiographic findings of non-traumatic or spontaneous SAH.Methods: This retrospective cohort study included 642 health records of patients with non-traumatic SAH overa 10-year period, from 2010 to 2020. The required data, including demographic information, aneurysm type,size, location, disease severity classification, and secondary complications, were extracted.Results: The study included 642 patients, with 262 (40.8%) being male. The mean age of the participants was54.72±13.51 years. The most prevalent type of aneurysm was saccular (89.1%), while serpentine (0.2%) anddissecting saccular (0.2%) aneurysms had the least prevalence. The most frequently involved arteries were theanterior communicating artery (ACoA; 38%), internal carotid artery (ICA; 27.6%), and middle cerebral artery(MCA; 13.4%). There was a significant correlation between sex and aneurysms occurring at ACoA and ICA(p< 0.0001), and ACoA – A1 (p=0.02). Patient age and sex were also significantly correlated with one another(p<0.0001). There was no statistically significant correlation between sex, aneurysm size, Glasgow coma scale(GCS), and modified Rankin scale (MRS).Conclusion: Based on our findings, the presence of aneurysms at ACoA, ACoA – A1, and ICA should bethoroughly ruled out in patients with severe headaches of sudden onset, particularly male patients of youngerages.
Sara Emamgholipour; Mehdi Raadabadi; MohammadHosein Dehghani; Saeed Fallah Aliabadi
Volume 9, Issue 1 , January 2021, , Pages 36-41
Abstract
Objective: To investigate the factors affecting the hospital costs in the road traffic injuries.Methods: This applied study examined the information of patients presenting to Yazd Trauma Center in 2018. The data were extracted from Comprehensive Traffic Injuries System affiliated to the center, ...
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Objective: To investigate the factors affecting the hospital costs in the road traffic injuries.Methods: This applied study examined the information of patients presenting to Yazd Trauma Center in 2018. The data were extracted from Comprehensive Traffic Injuries System affiliated to the center, which were described with frequency, percentage, mean, and SD, and then analyzed using independent t-test and one-way ANOVA.Results: Most injuries (%66.4) are caused by motorcycle and pertained to head region (%61.8). Some significant correlations were found among gender, type of injury, patient’s final status, site of road accident, patient’s nationality, type of vehicle used at the time of accident, length of stay (hospital stay), patient’s age, and hospital costs (p <0.05). Moreover, the costs were higher in men, and in those with head and neck injuries, dead casualties, suburban high-way accidents, motor cyclists, hospital stay longer than three days, and older patients.Conclusion: Given the significant correlations between demographic and social variables under study, the results may be used in planning and designing strategies for controlling road traffic injuries and reducing the related hospitalization costs.
Seyed Amirreza Mesbahi; Ali Ghaemmaghami; Sara Ghaemmaghami; Pouya Farhadi
Volume 6, Issue 1 , January 2018, , Pages 37-44
Abstract
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 ...
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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.
Shahram Paydar; Golnoush Sadat Mahmoudi Nezhad; Mohammad Yasin Karami; Hossein Abdolrahimzadeh; Mojtaba Samadi; Alireza Makarem; Ali Noorafshan
Volume 7, Issue 1 , January 2019, , Pages 41-48
Abstract
Objective: To evaluate the effect of imbibed fibrinogen gauze on survival, bleeding and healing in liver trauma.Methods: This animal experimental study was conducted on 20 adult male Sprague-Dawley rats; with a mean weight of 300±50 gram; divided into two groups. Grade IV injury was induced ...
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Objective: To evaluate the effect of imbibed fibrinogen gauze on survival, bleeding and healing in liver trauma.Methods: This animal experimental study was conducted on 20 adult male Sprague-Dawley rats; with a mean weight of 300±50 gram; divided into two groups. Grade IV injury was induced to the subjects’ liver. Then, the bleeding site was packed with simple gauze in the control group, and imbibed fibrinogen gauze in the experimental group. All animals were re-evaluated for liver hemostasis 48 hours after the initial injury. Bleeding in the intra peritoneal cavity was measured using Tuberculosis Syringe in the first and second operations. Subjects were followed-up for 14 days. Eventually, the rats were sacrificed and their livers were sent to a lab for stereological assessment. Statistical comparisons were performed via Mann–Whitney U-test using SPSS. P-Values less than 0.05 were considered to be statistically significant.Results: Half of the rats in the control group died, while all the rats in the imbibed fibrinogen gauze group survived after two weeks (p= 0.032). Bleeding in the imbibed fibrinogen gauze was significantly less than control group, 48 hours’ post-surgery (p<0.001). According to the stereological results, granulation tissue in the imbibed fibrinogen gauze group were more than the control group (P= 0.032). Also, fibrosis in the imbibed fibrinogen gauze group were more than the control group (P= 0.014).Conclusion: Our study indicated that imbibed fibrinogen gauze can potentially control liver bleeding and improve survival through increasing granulation tissue and fibrosis in injured liver.
Mahnaz Yadollahi; Pooria Fazeli; Muhammad Ali Naqi; Mehrdad Karajizadeh; Sattar Parsaiyan
Volume 11, Issue 1 , January 2023, , Pages 41-46
Abstract
Objective: According to the reports of the World Health Organization approximately 300,000 deaths occuryearly worldwide due to burns or burn-associated injuries. This study aims to review the epidemiology of burnsin pediatrics and adolescents in Fars province between 2017 and 2018.Methods: This is a ...
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Objective: According to the reports of the World Health Organization approximately 300,000 deaths occuryearly worldwide due to burns or burn-associated injuries. This study aims to review the epidemiology of burnsin pediatrics and adolescents in Fars province between 2017 and 2018.Methods: This is a cross-sectional study that investigated all people ≤18 years old who suffered from burninjuries in Fars province between 2017 and 2018. We use data from the file of burn patients which was providedby pre-hospital emergency services of Fars province. This data comprises demographic information (age andgender), burn-related information (type, degree, and severity of burns), mode of transfer (outpatient surgery ortransfer to hospital) and the outcome of the disease (death before arrival to the hospital or alive).Results: The average age of the subjects of this study was 5.8±8.9. We also categorized the subjects into fourage groups, 1-4, 5-8, 9-13 and 15-18 years. The number of boys who suffered from burn injuries is significantlymore than the girls (p=0.011). Also, there is a remarkable correlation between burn with age (p<0.001) andburn with disease outcome (p=0.01). The Most common cause of burns in boys was nonchemical hot objectsand liquids (28.5%). Likewise, the possibility of mortality in burn patients who faced an electric shock was22.66%. ([95%CI=2.32-220.63], p<0.001 OR=22.66).Conclusion: This study shows that pediatrics and adolescents ≤ 4 have the most burn injuries, and boys havetwice as many burn events as girls. More importantly, the most common cause of burns in both genders wasburning with non-chemical hot objects and liquids, in particular, in the age group of 1-4 years, in which eventhappens at home.
Aliyeh Sargazi; Atefeh Sargazi; Prigil Kumar Nadakkavukaran Jim; HoseinAli Danesh; Forough Sargolzaee Aval; Zohre Kiani; AmirHosein Lashkarinia; Zahra Sepehri
Volume 4, Issue 1 , January 2016, , Pages 43-47
Abstract
Objective: To determine the economic burden of road traffic accidents (RTAs) in patients admitted to a single center in south eastern Iran.Methods: This cross-sectional study was conducted in Amir-Al-Momenin hospital of Zabol affiliated with Zabol University of Medical Sciences during a 12-month period ...
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Objective: To determine the economic burden of road traffic accidents (RTAs) in patients admitted to a single center in south eastern Iran.Methods: This cross-sectional study was conducted in Amir-Al-Momenin hospital of Zabol affiliated with Zabol University of Medical Sciences during a 12-month period from April 2012 to April 2013. All the RTAs patients who were admitted to our emergency department were included. The direct expenses of hospital care were recorded according to their medical charts and the accountant registration information. Data are presented according to different RTAs characteristics.Results: Overall 1155 patients were included in the current study with mean age of 36.7 ± 5.14 years among whom there were 673 (58.3%) men and 482 (41.7%) women. The annual incidence of RTAs were calculated to be 288 per 100,000 population. The RTAs economic burden in our center was 589,448.49 USD which accounted for 10.4% of total hospital expenses during the study period. The money spend on RTAs in our center was 130 times more than gross national income per capita. Cost of each patient in road traffic was 15 times more than cost of an average patient of the hospital in other sections.Conclusion: With considerable high ratio of accidents in Zabol, proper intervention is needed for controlling and preventing RTAs in order to decrease its injuries, impact and the associated economic burden.
Naser Mohammad Gholi Mezerji; Mohammad Rafeie; Zahra Shayan; Ghasem Mosayebi
Volume 3, Issue 2 , April 2015, , Pages 65-69
Abstract
Objective: To determine the diagnostic value of blood cells surface markers in patients with acute appendicitis. Methods: In this cross-sectional study, 71 patients who underwent appendectomy following a diagnosis of appendicitis were recruited during a one-year period. The patients were divided into ...
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Objective: To determine the diagnostic value of blood cells surface markers in patients with acute appendicitis. Methods: In this cross-sectional study, 71 patients who underwent appendectomy following a diagnosis of appendicitis were recruited during a one-year period. The patients were divided into two groups: patients with histopathologically confirmed acute appendicitis and subjects with normal appendix. Blood cell surface markers of all patients were measured. Univariate and multivariate analytical methods were applied to identify the most useful markers. Receiver operating characteristics (ROC) curves were also used to find the best cut-off point, sensitivity, and specificity.Results: Overall we included 71 patients with mean age of 22.6±10.7 years. Of the 71 cases, 45 (63.4%) had acute appendicitis while 26 (36.6%) were normal. There was no significant difference between two study groups regarding the age ( p=0.151) and sex ( p=0.142). The initial WBC count was significantly higher in those with acute appendicitis ( p=0.033). Maximum and minimum area under the ROC curve in univariate analysis was reported for CD3/RA (0.71) and CD38 (0.533), respectively. Multivariate regression models revealed the percentage of accurate diagnoses based on the combination of g/d TCR, CD3/RO, and CD3/RA markers to be 74.65%. Maximum area under the ROC curve (0.79) was also obtained for the same combination.Conclusion: the best blood cell surface markers in the prediction of acute appendicitis were HLA-DR+CD19, α/b TCR, and CD3/RA. The simultaneous use of g/d TCR, CD3/RA, and CD3/RO showed the highest diagnostic value in acute appendicitis.
Hamid Reza Abbasi; Seyed Mohsen Mousavi; Ali Taheri Akerdi; Mohammad Hadi Niakan; Shahram Bolandparvaz; Shahram Paydar
Volume 1, Issue 2 , April 2013, , Pages 81-85
Abstract
Objective: To record and classify mechanisms of injury and injury severity score (ISS) in trauma patients admitted to the largest trauma center in Southern Iran.Methods: This was a prospective cross-sectional study including all the patients who were admitted to Nemazee hospital from 2009 to 2010. We ...
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Objective: To record and classify mechanisms of injury and injury severity score (ISS) in trauma patients admitted to the largest trauma center in Southern Iran.Methods: This was a prospective cross-sectional study including all the patients who were admitted to Nemazee hospital from 2009 to 2010. We recorded the trauma injury information of 1217 patients who were admitted to of emergency room of the Nemazee hospital during a 13-months period by means of a standard questionnaire. ISS was then obtained for every single patient.Results: The mean age of patients was 26.6 ± 15.1 (range 1–95) years. The commonest type of trauma including 279 cases (22.9%) was car accident and the least resulted from shotgun injuries in 13 (1.1%) patients. The lowest ISS was due to assault multiple blunt traumas and the highest ISS resulted from shotgun injury. The mean ISS was about 6.3 ± 1.8 (range 1-66). Overall, 86 patients had scores above 17 (7.1%). A total of 69 male patients (7.5%) compared to 17 females (5.7%) had severe injury (ISS>17). Trauma injuries were significantly more severe in males compared to females (p=0.014). In the sunny and hot seasons total number of patient was higher. The mean ISS was highest in during spring (p<0.001).Conclusion: In Shiraz, most of the trauma injuries are occurred during summer and hot weather. Men have greater number of injuries and higher ISS compared to women. The lowest ISS was due to assault multiple blunt trauma and the highest ISS was caused by shotgun injury, and car accident was the commonest cause of trauma with head and neck being the most frequent sites in our patients.
Seyed Javad Sadat; ardashir afrasiabifar; Davoud Khorasani-zavareh; Mohammad Javad Moradian; Mohammadreza Vafaeenasab; Abbas Ali Dehghani Tafti; Hossein Fallahzadeh; Mahsa Khodayarian
Volume 9, Issue 2 , April 2021, , Pages 86-95
Abstract
Objective: To investigate and understand the current status of inter-organizational management in relief organizations as well as the relief organizations personnel behavior when facing mass traffic incidents (MCTI). The inter-organizational barriers and facilitators are also discussed in response ...
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Objective: To investigate and understand the current status of inter-organizational management in relief organizations as well as the relief organizations personnel behavior when facing mass traffic incidents (MCTI). The inter-organizational barriers and facilitators are also discussed in response to MCTI management and in order to help direct future actions to improve pre-hospital emergency services. Methods: The current qualitative study was performed through face-to-face, semi-structured interviews with 31 individuals from pre-hospital emergency services authorities and personnel, Red Crescent and Yazd, Kohgiluyeh and Boyer-Ahmad, Fars, and Qom provinces police. These provinces were selected by purposive sampling in 2018-2019. The conventional content analysis method was applied to analyze the data in this research. Results: Three main categories and 14 subcategories were determined. The categories are including relief organizations coordination (having four subcategories: independent relief organizations, interdepartmental services integration, insufficient knowledge of organizations about one other, and performance based on job descriptions), resource and infrastructure management (having four subcategories: adverse information management, proper information management, lack of medical resources and capacities considered, and upgrading of medical resources and capacities considered), and response management of relief organizations (having six subcategories: incomplete assessment, improving the quality of assessment, weakness in establishing scene security, scene security management, poor response, and cooperation in response). Conclusion: Relief organizations need to perform under a unified command. It has inter-organizational cooperation and provide integration of interdepartmental services in order to manage responsiveness at the scene. It also prevents an independent, chaos, and inability of the injured to properly understand and needs in MCTI.
Mohsen Koosha; Hossein Nayeb Aghaei; Hamid Reza Khayat Kashani; Sepideh Paybast
Volume 8, Issue 2 , April 2020, , Pages 89-97
Abstract
Objective: To compare the effectiveness of surgical intervention to conservative treatment in patients with thoracolumbar fracture and thoracolumbar injury classification and severity score (TLICS) of 4. Methods: Twenty-five patients with TLICS 4 were enrolled in this non-randomized clinical trial. Based ...
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Objective: To compare the effectiveness of surgical intervention to conservative treatment in patients with thoracolumbar fracture and thoracolumbar injury classification and severity score (TLICS) of 4. Methods: Twenty-five patients with TLICS 4 were enrolled in this non-randomized clinical trial. Based on clinical symptoms and radiologic findings, patients were considered under surgical or conservative treatments. The JOA Back Pain Evaluation Questionnaire (JOABPEQ) was assessed at baseline and at 3, 6, 12 months after treatment. A 20-point improvement from the baseline JOABPEQ scores was considered as clinical success in both the conservative and surgery groups. Additionally, residual canal, angulations and height loss were determined in all patients. Results: Eight patients received conservative and 17 surgical treatment. Both study groups were comparable regarding the baseline characteristics. Both study demonstrated treatment success, regarding functional recovery when compared to baseline (p<0.001). However, those undergoing surgical intervention had significantly better JOABPEQ score (p<0.001) and higher residual canal (p=0.042) when compared to those receiving conservative therapy. The success rate of treatment was comparable between the two study groups in 6- (p=0.998) and 12-month (p=0.852) intervals; however, surgical therapy had significantly higher success arte in 3-month interval (p=0.031). Conclusion: Our findings revealed that surgical treatment was preferred more in comparison to conservative treatment in patients with TLICS 4. Additionally, residual canal might be a modifying factor to decide the ideal therapeutic approach. Clinical Trial Registry: IRCT2017010920258N25
Hosseinali Khalili; Nima Derakhshan; Zahed Malekmohammadi; Fariborz Ghaffarpasand
Volume 2, Issue 2 , April 2014, , Pages 92-95
Abstract
Mycotic aneurysm of external carotid artery is extremely rare. We herein report a case of external carotid artery (ECA) aneurysm following severe traumatic brain injury. A 24-year-old man with severe traumatic brain injury (TBI) following a car accident was referred to Rajaee Trauma Center Emergency ...
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Mycotic aneurysm of external carotid artery is extremely rare. We herein report a case of external carotid artery (ECA) aneurysm following severe traumatic brain injury. A 24-year-old man with severe traumatic brain injury (TBI) following a car accident was referred to Rajaee Trauma Center Emergency Room affiliated to Shiraz University of Medical Sciences in Shiraz, Iran. He underwent ventriculostomy on arrival for intracerebral pressure (ICP) monitoring and for a second time due to hydrocephalus following decompressive craniectomy. He developed fulminant meningitis and ventriculitis during his hospital course. A bulged pulsatile lesion under the frontotemporal scalp resulted into the suspicion to underlying vascular pathology. Six-vessel angiography of brain was done which revealed mycotic aneurysm of external carotid artery. The patient underwent a two-week course of a combination of intravenous antibiotics. Follow-up angiography was performed which confirmed successful treatment of mycotic aneurysm of ECA. Mycotic aneurysm of ECA is extremely rare. To our knowledge, this is the first report of mycotic aneurysm of ECA following severe TBI which was successfully treated with antimicrobial therapy.
Mansoor Shahriari; Mohammad Sistanizad; Maryam Foruzani Haghighi; Ghader Mohammadnezhad; Hadi Esmaily
Volume 11, Issue 2 , April 2023, , Pages 96-101
Abstract
Objective: This study aimed to evaluate the Iranian ophthalmologists’ knowledge of prescribing prophylacticantibiotics to patients with open globe injury (OGI) in Iran.Methods: In this cross-sectional study, we utilized a questionnaire to evaluate the ophthalmologists’ knowledgeabout prescribing ...
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Objective: This study aimed to evaluate the Iranian ophthalmologists’ knowledge of prescribing prophylacticantibiotics to patients with open globe injury (OGI) in Iran.Methods: In this cross-sectional study, we utilized a questionnaire to evaluate the ophthalmologists’ knowledgeabout prescribing antibiotics as prophylaxis. This survey was conducted in Tehran and its suburbs. Thequestionnaire included demographic information as well as ophthalmologists’ knowledge levels. Cronbach’salpha was used to determine its validity and reliability. The obtained data were analyzed using SPSS 24.0.Results: Of 192 subjects, 111 (35 women, 76 men) were included. About 65 (58.6%) specialists and 45 (41.4%)subspecialists with different orientations completed the questionnaires. The total knowledge score was13.04±2.96. The following are the results of ophthalmologists’ responses to questions regarding the cornea/scleral injury (1.09±1.72), prophylactic antibiotics administration (2.79±1.11), the infectious agents in eyesurgeries (3.21±1.49), diagnosis and treatment (2.84±0.944), and the effects of ocular antibiotics as well as theirproper dosage (2.96±2.35). There was no significant relationship between some demographic information suchas sex, working hours, workplace, and the number of studied articles (p>0.05). In addition, ophthalmologistswith less work experience had significantly higher levels of knowledge than those with more work experience.Conclusion: The findings indicated that the majority of ophthalmologists had a basic knowledge of prescribingprophylactic antibiotics in OGI.
Kuldip Salgotra; Sarabjeet Kohli; Nilesh Vishwakarma
Volume 4, Issue 2 , April 2016, , Pages 101-104
Abstract
Neglected, untreated and delayed femur neck fractures are commonly encountered and the treatment dilemma arises especially when the patient is physiologically young and osteosynthesis is the preferred option. Controversy exists in the current literature as the various head salvage surgeries like valgus ...
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Neglected, untreated and delayed femur neck fractures are commonly encountered and the treatment dilemma arises especially when the patient is physiologically young and osteosynthesis is the preferred option. Controversy exists in the current literature as the various head salvage surgeries like valgus subtrochanteric osteotomy, non-vascularized fibular bone grafting, muscle pedicle bone grafting (Tensor fascia lata and Quadratus femoris graft) and vascularized bone grafting do not have clear lines of indications. The current study is a case series of 7 patients with femur neck fractures with delayed presentation beyond the vascular emergency period who were treated with osteosynthesis with muscle pedicle bone graft (MPBG) using tensor fascia lata muscle pedicle graft. Patients were followed clinical and radiologically at 6 weeks, 3 and 6 months, 1 year and 3 years and patients were regularly followed. The mean age of the patients was 47 ± 1.1 ranging from 38 to 55 years. There were 6 (85.7%) men and 1 (14.3%) women among the patients. Overall 5 (71.5%) patients had transcervical and 2 (28.5%) had subcapital fractures. At the end of 6 months, 6 (85.7%) patients were pain free and on plain radiographs fracture union was noted. One (14.3%) patient developed collapse and persistent nonunion. Younger group less than 50 years presenting with neglected fracture neck femur should always be give an option of head salvage surgery in selected cases. Muscle pedicle bone grafting has been proven although inconsistently as a valid option for fracture neck femur. We encourage osteosynthesis with the use of tensor fascia lata muscle pedicle grafting along with cancellous cannulated screws as a first option in selected cases of neglected femur neck fractures.
Saber Ghaffari-fam; Ehsan Sarbazi; Amin Daemi; Mohamadreza Sarbazi; Lachin Riyazi; Homayoun Sadeghi-Bazargani; Ali Allahyari
Volume 3, Issue 3 , July 2015, , Pages 104-110
Abstract
Objective: To describe the epidemiological and clinical characteristics of fall injuries in East Azerbaijan, Iran.Methods: This cross-sectional study was based on Hospital Information System (HIS) data for patients referred to the Imam Reza Hospital between 2008 and 2013. We recorded the demographic ...
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Objective: To describe the epidemiological and clinical characteristics of fall injuries in East Azerbaijan, Iran.Methods: This cross-sectional study was based on Hospital Information System (HIS) data for patients referred to the Imam Reza Hospital between 2008 and 2013. We recorded the demographic characteristics and epidemiological patterns of patients who were admitted to our center due to fall injuries. To standardize the reports the International Classification of Diseases (ICD), the International Classification of Diseases 9 Clinical Modification (ICD-9-CM)was used. Equally, the hospitalization period and number, admission ward, and the final status of victims after discharge from the hospital were extracted from the HIS.Results: Overall we included a total number of 3397 patients with mean age of 39.2±22.7 years. There were 2501 (73.6%) men among the patients. Long bone fracture (48.1%) and intracranial injury (24.2%) were the most frequent injuries among fall injury victims. Operations on spinal cord and spinal canal structures (12.0%), Operations on nose (11.6%) were the most common operations being performed in these patients. The survival was significantly lower in patients with age more than 60 years when compared to other age groups (p=0.001).The survival rate was significantly lower in age group of >60 years, compared to other age groups (p=0.001).Conclusion: Given the high rate of fall injuries and death among the elderly that increases with age, appropriate measures must be taken to control and prevent injuries while prioritizing the elderly.
Amir Mirhaghi; Hojjat Shafaee; Javad Malekzadeh; Farzaneh Hasanzadeh
Volume 5, Issue 2 , April 2017, , Pages 104-109
Abstract
Objective: To develop decision-support tools to identify patients experiencing sudden cardiac arrest (SCA).Methods: Eighty calls related to SCA were content analyzed, and the contextual patterns that emerged were organized into a checklist. Two researchers independently analyzed the recorded calls and ...
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Objective: To develop decision-support tools to identify patients experiencing sudden cardiac arrest (SCA).Methods: Eighty calls related to SCA were content analyzed, and the contextual patterns that emerged were organized into a checklist. Two researchers independently analyzed the recorded calls and compared their findings. Eighteen dispatchers scored 20 cases (which included SCA and non-SCA cases) both with and without the checklist. Correct responses for each case and agreement among dispatchers have been reported.Results: Eighty audio files (total time, 96 min) were analyzed, and a total of 602 codes were extracted from the text and recordings. The caller’s tone of voice and presence or absence of background voices, calling for an ambulance and giving the dispatcher the address promptly, and description of the primary complaint and respirations accounted for 38%, 39%, and 23% of all codes, respectively. A 15-item complementary checklist has been developed. The mean percentages of correct responses were 66.9%+27.96% prior to the use of checklist and 80.05%+10.84% afterwards. Results of the independent t test for checklist scores showed that statistically significant differences were present between the SCA and non-SCA cases (t=5.88, df=18, p=0.000).Conclusion: Decision support tools can potentially increase the recognition rate of SCA cases, and therefore produce a higher rate of dispatcher-directed CPR.
Somaye Bazdar; Maryam Dehghankhalili; Shekoofeh Yaghmaei; Maryam Azadegan; Amirhossein Pourdavood; Mohammad Hadi Niakan; Ali Mohammad Bananzadeh
Volume 6, Issue 2 , April 2018, , Pages 122-127
Abstract
Objective: To determine the effects of pregnancy on the presentation, management, surgical and obstetrics outcome of patients with acute appendicitis.Methods: This prospective cohort study was conducted during a 2-year period from 2014 to 2016 in Shahid Faghihi hospital of Shiraz University of Medical ...
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Objective: To determine the effects of pregnancy on the presentation, management, surgical and obstetrics outcome of patients with acute appendicitis.Methods: This prospective cohort study was conducted during a 2-year period from 2014 to 2016 in Shahid Faghihi hospital of Shiraz University of Medical Sciences. We enrolled all the pregnant individuals with acute appendicitis who required surgical appendectomy. We also enrolled age-matched controls of non-pregnant women undergoing open appendectomy during the study period. The presentation, clinical and laboratory characteristics, surgical and obstetrics outcomes were determined in both study groups and were further compared between them. In order to determine the determinants of outcome, we also ran a multivariate logistic regression model.Results: Overall we included a total number of 584 patients with presumed appendicitis among whom there were 58 (9.94%) and 526 (90.06%) non-pregnant individuals. The pregnant patients had significantly longer duration of symptoms (p=0.038), lower temperature (p=0.026), longer duration of hospital stay (p=0.026) and higher rate of hospital admission longer than 2 days (p=0.031). The complications of the surgical procedure were comparable between the two study groups except for the pneumonia which was significantly higher in pregnant patient (p=0.041). After adjusting for confounders such as age and ethnicity, pregnancy remained significantly associated with lower temperature (p=0.018), longer symptom duration (p=0.042) and higher rate of pneumonia (p=0.049).Conclusion: Acute appendicitis during the pregnancy was associated with longer duration of symptoms, lower body temperature and higher rate of pneumonia. The pregnancy and neonatal outcomes were comparable to the previously reported data.
Shahram Paydar; Parisa Javidi Parsijani; Armin Akbarzadeh; Alireza Manafi; Fariborz Ghaffarpasand; Hamid Reza Abbasi; Shahram Bolandparvaz
Volume 1, Issue 3 , July 2013, , Pages 123-126
Abstract
Objectives: To evaluate the short-term outcome of open appendectomy, the rate of negative appendectomy as well as pathology reports after surgery in patients with suspected acute appendicitis.Methods: This was a retrospective cross-sectional study being performed in Nemazee hospital affiliated with Shiraz ...
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Objectives: To evaluate the short-term outcome of open appendectomy, the rate of negative appendectomy as well as pathology reports after surgery in patients with suspected acute appendicitis.Methods: This was a retrospective cross-sectional study being performed in Nemazee hospital affiliated with Shiraz University of Medical Science during a 2-year period between 2008 and 2010. The medical records of all consecutive patients who underwent open appendectomy in our center due to acute appendicitis were included in the study. The elective and laparoscopic appendectomies were excluded. The demographic information, clinical findings, laboratory investigations and the histopathological examination of the appendix were recorded and reported.Results: A total of 337 patient including 137 (36.4%) females, and 240 (63.6%) males with the mean age of 16.26 ± 9.81 (range 3 to 76) years were stduied. Anorexia (64.7%) and fever (20.7%) were more prevalent symptoms. The mean duration between pain initiation and operation ranged from 0 to 14 days with mean 1.88 ± 1.63 days. Right lower quadrant (RLQ), periumbilical, epigastria, left lower quadrant (LLQ), and Right upper quadrant (RUQ), pain were manifest in 78.8%, 41.6%, 12.2%, 3.2%, and 1.3% of patients, respectively. Pathological evaluation of the appendix showed appendicitis in 70.4% of patients.Conclusion: The higher rate of negative appendectomy accounts for wasteful tapping of medical resources and causing further complication in patients. Therefore it is essential to conduct more accurate studies to detect the root cause of the disease. This would help improve the management of appendicitis which is an emergency condition with high incidence.
Ali Abdoli; Farshid Rahimi-Bashar; Saadat Torabian; Sepideh Sohrabi; Hamid Reza Makarchian
Volume 7, Issue 2 , April 2019, , Pages 124-129
Abstract
Objective: To investigate the safety and efficacy of simultaneous administration of nimodipine, progesterone, magnesium sulfate in patients suffering from severe traumatic brain injury (TBI).Methods: Overall, 90 patients with blunt head trauma who were admitted to the Besat hospital, Hamadan University ...
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Objective: To investigate the safety and efficacy of simultaneous administration of nimodipine, progesterone, magnesium sulfate in patients suffering from severe traumatic brain injury (TBI).Methods: Overall, 90 patients with blunt head trauma who were admitted to the Besat hospital, Hamadan University of Medical Sciences, Iran through the Emergency Department in 2017 to 2018 were randomly assigned to the study or control groups each containing 45 patients. In the study group, intravenous nimodipine 60 mg every 12 hours for 5 days, intramuscular progesterone 1 mg/kg daily for 5 days, and magnesium sulfate 5 grams stat followed by 2.5 grams every 4 hours for 21 days were administered. Daily GCS and jugular venous oxygen saturation (SjvO2) of the patients were measured on admission day (day 0) through hospitalization day 4 at the intensive care unit. Then, all patients were visited at three months after discharge.Results: The mean age of the patients was 31.4 ± 12.8 years including 59 (65.6%) men with no significant difference between the groups. The baseline GCS and SjvO2 of the patients were comparable in both groups, however, GCS of the patients in the study group were significantly higher in the next 4 hospitalization days compared to the controls. Whereas, the SjvO2 of the patients were not significantly different between the groups during these days. Three-month mortality rate of the patients in the study group was significantly lower than the three-month mortality rate of the patients in the control groups (22.2% vs. 42.2%, p=0.042).Conclusion: Administration of combined protocol of magnesium sulfide, progesterone and nimodipine may be safe and effective in patients suffering from severe TBI.Clinical Trial Registry: IRCT201210229534N2
Ammar Heidar; Parsa Ravanfar; Golnaz Namazi; Taha Nikseresht; Hadi Niakan
Volume 2, Issue 3 , July 2014, , Pages 125-129
Abstract
Objectives: To identify the predictive factors of successful non-operative management of patients with intraperitoneal bleeding following blunt abdominal trauma.Methods: This was cross-sectional study being performed in our Level I trauma center in southern Iran between 2010 and 2011. We included ...
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Objectives: To identify the predictive factors of successful non-operative management of patients with intraperitoneal bleeding following blunt abdominal trauma.Methods: This was cross-sectional study being performed in our Level I trauma center in southern Iran between 2010 and 2011. We included adult (>14 years) patients with blunt abdominal trauma and intraperitoneal hemorrhage detected by CT-Scan who were hemodynamically stable and did not require any surgical intervention. Patients were managed conservatively in ICU. Those who required laparotomy during the study period were named as non-operative management failure (NOM-F) while the other were nonoperative management success (NOM-S). The baseline, clinical and laboratory characteristics were compared between two study groups in order to detect the predictors of successful NOM of intra-peritoneal bleeding.Results: Overall we included 80 eligible patients among whom there were 55 (68.7%) men and 25 (31.3%) women with mean age of 30.63.6± years. Finally, 43 (53.8%) were successfully managed conservatively (NOM-S) while 37 (46.2%) required laparotomy (NOM-F). We found that those who underwent emergency laparotomy had significantly higher ĘHb (p=0.016) and lower base deficit (p=0.005) when compared to those who were successfully managed conservatively. Those who required surgical intervention had significantly lower baseline systolic blood pressure (p<0.001) and higher shock index (p=0.002). The other parameters such as pulse rate and respiratory rate were comparable between two study groups.Conclusion: In patients with intra-peritoneal bleeding following blunt abdominal trauma, the most reliable predictive clinical and para-clinical factor of successful non-operative management are shock index and systolic blood pressure on arrival, base deficit and hemoglobin drop within first 12 hours of admission.
Hossein Abdolrahimzadeh fard; Roham Borazjani; Amir Hossein Shams; Vala Rezaee; Shiva Aminnia; Maryam Salimi; Mahsa Ahadi; Shahram Paydar; Shahram Bolandparvaz; Nikta Rabiei; Sanaz Zare; Leila Shayan; Mina Sadeghi
Volume 10, Issue 3 , July 2022, , Pages 128-134
Abstract
Objective: To evaluate the presence/severity of depression, anxiety, and stress among health care workers(HCWs) who work on the specially allocated COVID-19 ward (Group A) and HCWs on the other wards(Group B).Methods: This questionnaire-based study was conducted from January 25 to February 28, 2021. ...
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Objective: To evaluate the presence/severity of depression, anxiety, and stress among health care workers(HCWs) who work on the specially allocated COVID-19 ward (Group A) and HCWs on the other wards(Group B).Methods: This questionnaire-based study was conducted from January 25 to February 28, 2021. The mentalstatus was assessed using the Persian version of the 42-item Depression, Anxiety, and Stress score (DASS-42).Gathered data was analyzed using SPSS version 25. The independent T-test and Chi-square tests were used tocompare quantitative and qualitative variables.Results: Two-hundred and twenty two questionnaires were eligible for analysis. Group A consisted of 33HCWs, and 189 (85.1%) individuals were working on the other wards. No statistically significant differenceswere seen regarding the Socio-demographic features except for the marital status (p=0.005). The depressions’mean score was comparable between group A and B (p=0.102). The mean scores of anxiety and stress weresignificantly lower in group A than group B (p=0.006), although the frequency of DASS-42 parameters did notdiffer between these two groups (p>0.05).Conclusion: Contrary to our assumptions, this study showed that the DASS-42 parameters were not higher inHCWs working on the COVID-19 wards. This might be justified by developing coping mechanisms, being onthe honeymoon phase of the disaster, compassion satisfaction, promising vaccine news, and working on theless impacted hospital.
Shahram Bolandparvaz; Hamid Mohajer; Mansoor Masjedi; Ehsan Mohammadhoseini; Leila Shayan
Volume 3, Issue 4 , October 2015, , Pages 138-143
Abstract
Objectives: To determine the correlation between the success rates of the cardiopulmonary cerebral resuscitation (CPCR) and the team’s leader education and skill level in Shiraz, southern Iran.Method: This cross-sectional study was conducted during a 6-month period from October 2007 to March 2008 in ...
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Objectives: To determine the correlation between the success rates of the cardiopulmonary cerebral resuscitation (CPCR) and the team’s leader education and skill level in Shiraz, southern Iran.Method: This cross-sectional study was conducted during a 6-month period from October 2007 to March 2008 in Nemazee hospital of Shiraz. We included all the patients who underwent CPCR due to cardiopulmonary arrest in emergency room of Nemazee hospital during the study period. We recorded the rates of return of spontaneous circulation (ROSC) and discharge rate (DR) of all the patients. The correlation between these two parameters and the team leader’s education and skill level was evaluated.Results: Overall we included total number 600 patients among whom there were 349 men (58.1%) and 251(41.8%) women with mean age of 58.9±42.6. We found that 270 (45.1%) patients had ROSC, while 330 (54.9%) patients died. Overall 18 (6.6%) patients were discharged from hospital (3% of all participants). We found that the ROSC was significantly higher in those with specialist leader (anesthesiologist or pediatrician) when compared to those in whom CPCR was conducted by technicians (55.2% vs. 30.7%; p=0.001).Conclusion: Conducting CPCR by persons with higher medical degrees resulted in higher rate of ROSC but not in more discharge rate. Inspite of the fact that the rate of ROSC following CPCR was closely analogous to that of developed countries, discharge rate was lower. This indicates that in our region, much more attention needs to be paid to post-resuscitation care and organizing training programs and to cover more resuscitation by CPCR team, conducted by the specialists.
Ahmadreza Nobakhti-Afshar; Alireza Najafpour; Rahim Mohammadi; Leila Zarei
Volume 4, Issue 3 , July 2016, , Pages 141-149
Abstract
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 ...
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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.
Shahla Chaichian; Abolfazl Mehdizadehkashi; Shahla Mirgaloybayat; Neda Hashemi; Farahnaz Farzaneh; Roya Derakhshan; Samaneh Rokhgireh
Volume 9, Issue 3 , July 2021, , Pages 145-150
Abstract
Objective: To evaluate the maternal and fetal outcomes of COVID-19 up to three months after the delivery in pregnant women. Methods: This case series study was conducted on all pregnant women with COVID-19 hospitalized in Hazrat -E- Rasoul Akram Hospital, Tehran, Iran from March 8, 2020 ...
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Objective: To evaluate the maternal and fetal outcomes of COVID-19 up to three months after the delivery in pregnant women. Methods: This case series study was conducted on all pregnant women with COVID-19 hospitalized in Hazrat -E- Rasoul Akram Hospital, Tehran, Iran from March 8, 2020 to December 28, 2020. Data were included maternal age and gestational age (GA) which presenting signs and symptoms were collected at hospital admission. To confirm COVID-19 diagnosis, high-resolution computed tomography (HRCT) or reverse transcription-polymerase chain reaction (RT-PCR) tests were conducted. Both the mothers and the newborns were followed up to three months after delivery. Results: Fourteen pregnant women with the median age of 31.5 were enrolled. HRCT was done in twelve mothers (85.7%), and eleven mothers (78.6%) were evaluated via RT-PCR; four of them (36.36%) were positive. Two mothers (14.28%) were admitted to ICU. The cesarean section (C/S) was done following fetal distress in only three mothers due to their concerns of vertical transmission. Two mothers were admitted to the intensive care unit (ICU), and one of them died of pneumomediastinum. Fortunately, no neonatal death was reported three months after the delivery. Conclusion: COVID-19 affects mothers more in the last trimester of the pregnancy. Although no fetal death was reported in the recent study, physicians should closely monitor pregnant women to reduce the adverse event.
Vahid Hattami; Sajjad Hatami; Khairolah Asadolahi; Mahtab Anvari
Volume 1, Issue 4 , October 2013, , Pages 152-157
Abstract
Objectives: To determine the effects of Meperidine (Pethedine®) on pain intensity, clinical findings, final diagnosis and management of patients with acute abdominal pain.Methods: This was a randomized clinical trial including 100 patients, with lower abdominal pain lasting for less than 48 hours ...
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Objectives: To determine the effects of Meperidine (Pethedine®) on pain intensity, clinical findings, final diagnosis and management of patients with acute abdominal pain.Methods: This was a randomized clinical trial including 100 patients, with lower abdominal pain lasting for less than 48 hours who were referred to the emergency department of Imam Khomeini hospital affiliated with Ilam University of Medical Sciences, over a period of 11 months. Hemodynamically unstable patients were not included in the study. The baseline pain severity was measured using a visual analogue scale (VAS). Patients were randomly assigned to receive 25 mg of intramuscular Meperidine (Pethedine®) (n=50) or 5 mL of intravenous normal saline as placebo intravenously (n=50). After 1-hour the patients were then re-examined and the pain severity was re-assessed and the clinical diagnosis was recorded.Results: There was no significant difference between two study groups regarding the baseline characteristics. The mean pain score on arrival was comparable between groups (6.80 ± 1.6 vs. 6.81 ± 1.2; p=0.956). The abdominal tenderness was not affected in Meperidine group. Rebound tenderness disappeared in 4% of the Meperidine group and in 2% of the placebo group. Nausea was decreased in 14% of the Meperidine group and 32% of the placebo group. Changes in the clinical pattern and diagnostic peritoneal signs in patients were negligible and did not significantly interfere with the diagnosis (p=0.133). Diagnostic accuracy was 96% in the Meperidine group and 98% in placebo group, which was not significantly different (p=0.554).Conclusion: Administration of Meperidine reduces pain intensity in patients with acute abdominal pain without interference with the clinical diagnosis. Thus analgesics could be safely administered to the patients with acute abdominal pain for increasing the patients comfort.
