Prashant Bhandarkar; Ashok Munivenkatappa; Nobhojit Roy; Vineet Kumar; Luis Rafael Moscote-Salazar; Amit Agrawal
Volume 6, Issue 4 , October 2018, , Pages 313-317
Abstract
Objective: To compare the shock index (SI – which is the ratio of heart rate to systolic blood pressure) and Age SI (Age in years multiplied by SI) with survival outcome of the patients across multicenter trauma registry in India.Methods: Study is based on Towards Improved Trauma Care Outcomes ...
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Objective: To compare the shock index (SI – which is the ratio of heart rate to systolic blood pressure) and Age SI (Age in years multiplied by SI) with survival outcome of the patients across multicenter trauma registry in India.Methods: Study is based on Towards Improved Trauma Care Outcomes (TITCO) project. Records with valid details of age, heart rate, systolic blood pressure, Injury Severity Scale (ISS) and Glasgow Coma Scale (GCS) score was considered. SI was categorized into four groups; Group I (SI<0.6) as no shock, group II (SI ≥0.6 to <1.0) as mild shock, group III (SI ≥1.0 to <1.4) as moderate shock and group IV (SI ≥1.4) as severe shock. Age SI was categorized decade wise into six groups. Mortality was dependent variable. GCS and ISS were considered as secondary variables.Results: 10843 participants from TITCO registry satisfying inclusion-exclusion criteria were considered for study. Mean SI score in group I to IV was increasing with 0.53 to 1.72 respectively. Age SI was seen to be increasing across its six groups. Gender wise no difference was found among SI group. For severe ISS and critical ISS, mortality in SI group IV was 50% and 56 % respectively. Mortality was increasing across mild to severe GCS among all SI groups.Conclusion: The categorized SI and Age SI had shown increase in death percentages from mild to severe severity of injuries. Similar to GCS and ISS, SI and Age SI should also be calculated and categorized in all health care and further plan for management aspects.
Adel Efftekhari; Abbas Ali Dehghani Tafti; Khadijeh Nasiriani; Majid Hajimaghsoudi; Hossein Fallahzadeh; Davoud Khorasani-Zavareh
Volume 7, Issue 4 , October 2019, , Pages 381-389
Abstract
Objective: To identify and prioritize the key Components of prehospital emergency system to prevent mortality in road traffic injuries. Methods: A total of 25 emergency medicine practitioners, emergency ward nurses, and managers of prehospital emergency centers participated in this adjusted Delphi study ...
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Objective: To identify and prioritize the key Components of prehospital emergency system to prevent mortality in road traffic injuries. Methods: A total of 25 emergency medicine practitioners, emergency ward nurses, and managers of prehospital emergency centers participated in this adjusted Delphi study in three rounds. After extracting the primary components through reviewing systematic studies and interviewing experts, the Delphi rounds were performed with the presence of experts. The data were analyzed with both qualitative content analysis and quantitative analysis using SPSS20 software. For the analysis and selection of the final priorities, the coefficient of agreement of over 70% was used. Results: After doing three Delphi rounds, in the final Delphi round, 10 superior components were selected respectively as follows: correct history taking of the victim, examining possible cervical injury, the time spent from the first call to arrival of technicians to the scene, the time spent from arriving at the scene to the time of hospital transport, passing of re-education courses by EMS technicians, coordination among the rescue organizations, police, the Red Crescent, fire station, and healthcare organizations, integrated commandership at scene, police attendance in the scene before EMS arrival at the scene, proper ambulance equipment with respect to the required equipment (A, B, C) on the basis of victim’s condition, and coordination with the target hospital for patient transport. Conclusion: This study determined the most applicable managerial methods of prehospital emergency components pertaining to preventable fatal road traffic injuries through empowerment of EMS systems in the fields of victim assessment, time management indices, personnel training, coordination between the involved organs, and the presence of the main commander in the scene.
Kasturi Mukherjee; Debojyoti Bhattacharjee; Jayati Roy Chowdhury; Raghunath Bhattacharyya
Volume 10, Issue 1 , January 2022, , Pages 33-39
Abstract
Objective: To determine correlation of important biochemical laboratory investigations in different trauma patients and their degree of injury severity and overall mortality association. Methods: In this hospital based retrospective observational study, 238 trauma patients were divided into two groups. ...
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Objective: To determine correlation of important biochemical laboratory investigations in different trauma patients and their degree of injury severity and overall mortality association. Methods: In this hospital based retrospective observational study, 238 trauma patients were divided into two groups. Group I with injury severity score (ISS)16. Haemoglobin (Hb), international normalized ratio, serum creatinine, blood urea nitogen (BUN), serum electrolyte, serum uric acid and liver function parameters were recorded and statistically analyzed. Results: Group II had statistically significant (p <0.0001) elevated levels for referral pulse rate, creatinine, BUN, liver enzymes and decreased level in Hb% and potassium level compared to Group I. Strong positive correlation only exists between BUN and severity score, moderate positive correlation exists between creatinine, aspartate transaminase, and alanine transaminase, alkaline phosphatase and severity score and negative correlation between potassium and severity score. In this study, higher odds of high BUN and creatinine and lower potassium to normal values are associated with bad outcome such as higher mortality in the population of high ISS (>16). Conclusion: The study establishes the absolute need of doing three laboratory parameters (serum creatinine, serum blood urea nitrogen and serum potassium) instead of doing laboratory tests battery at the time of trauma victims admission and predicting survival among injured patients in trauma population from Indian settings.
Shahram Bolandparvaz; Behzad Ghaffari; Seyed Mohsen Mousavi; Shahram Paydar; Hamid Reza Abbasi
Volume 1, Issue 1 , January 2013, , Pages 34-37
Abstract
Objective: To evaluate the predictive value of some biochemical markers in the outcome of extremity vascular trauma.Methods: This study comprised 30 patients with traumatic arterial injury and acute limb ischemia referred to Namazi hospital affiliated with Shiraz University of Medical Ssciences, over ...
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Objective: To evaluate the predictive value of some biochemical markers in the outcome of extremity vascular trauma.Methods: This study comprised 30 patients with traumatic arterial injury and acute limb ischemia referred to Namazi hospital affiliated with Shiraz University of Medical Ssciences, over a period of 8 months, from Sep 2009 to Jul 2010. Venous blood samples were drawn from distal ischemic limb to determine pH, HCO3 - , PCO2 , PO2 , Na+, and K+ before definitive surgical intervention. Comparable samples were also obtained from veins of non- ischemic upper extremities. The biochemical assays were compared after monitoring the revasculurized limbs and evaluation of viability during a period of 7 days.Results: The mean age of the patients was 28.3 ± 7.8 (range: 18–56) years. Two (6.6%) patients underwent amputation because of developing irreversible limb ischemia after vascular reconstruction. Both patients had blunt traumatic knee injury accompanied by nerve, vein and soft tissue damage. The statistical analysis showed correlations between parameters, except for Na+, of local (ischemic limb) and systemic samples. In this context, the highest correlation was observed in regard to HCO3 - .Conclusion: The correlation was most pronounced with respect to HCO3 - . Ischemic limbs exhibited reduction in pH and PO2 but, PCO2 and K increased after ischemia of injured limbs. PO2 reflects tissue perfusion and is of value in predicting the outcome. We believe that blunt trauma and associated nerve, vein and soft tissue injuries pose negative prognostic effects on limb survival postoperatively.
Swagat Mahapatra; Vineet Thomas Abraham
Volume 5, Issue 1 , January 2017, , Pages 36-41
Abstract
Objective: To evaluate and report the functional results of surgical management of intercondylar fractures of the humerus in adults using a novel dual plating technique.Methods: A total number of 60 patients with Riseborough and Radin type II, III, and IV intercondylar humerus fractures were operated ...
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Objective: To evaluate and report the functional results of surgical management of intercondylar fractures of the humerus in adults using a novel dual plating technique.Methods: A total number of 60 patients with Riseborough and Radin type II, III, and IV intercondylar humerus fractures were operated with open reduction through a Trans-olecranon approach and internal fixation using two plates in inverted-Y configuration. Patients were followed for 6 weeks, 3 and 6 months were evaluated using the Mayo Elbow performance score and Quick-DASH score.Results: There were 50(83.33%)men and 10 (16.67%)women with mean age of 34.9 ± 12.63 years. 63.3% of the cases were following Motor vehicle accident and rest following fall. The right upper limb was more commonly affected than the left side. Riseborough and Radin type II fractures accounted for 3.33% of cases; type III fractures accounted for 50% of cases and type IV accounted for 46.67%. Excellent to Good results were seen in almost 80% of cases as per the Mayo Elbow performance score at 6-month follow-up. Quick-DASH scores for the series at 6-month follow-up was on average of 15.96 ± 9.92.Conclusion: Dual plating in inverted Y configuration offers a reliable fixation, which permits early mobilization and good functional outcome.
Mahnaz Yadollahi; Narges Shamseddini; Leila Shayan; Abbas Rezaianzadeh; Shahram Bolandparvaz
Volume 2, Issue 1 , January 2014, , Pages 44-51
Abstract
Objective: To compare and evaluation of scores of trauma research center of Shiraz University of Medical Sciences in Iran with other trauma research centers in Iran.Methods: The assessment scores of each center were gathered from Iran medical research and Ministry of Health and Medical Education website. ...
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Objective: To compare and evaluation of scores of trauma research center of Shiraz University of Medical Sciences in Iran with other trauma research centers in Iran.Methods: The assessment scores of each center were gathered from Iran medical research and Ministry of Health and Medical Education website. Each score is recorded in helical year which is defined from the 21th of March of every year until the 20th of March of the next. They are ranked and scored by knowledge production, capacity development, and research projects.Results: The total evaluation scores of the trauma research center of Iran's Universities of Medical Sciences have increased from establishment. The highest increase in assessment scores was related to Tehran Trauma Research Center. An upward trend was observed in the total indicators of knowledge production index of all the trauma research centers from 2001/2002 to 2011/2012. An ascending trend was showed in the published articles score of Shiraz and Kashan Trauma Research Centers through the recent years.Conclusion: The increasing trend in scores of trauma research centers in Iran indicated a significant role in the knowledge production but it is need to find barriers of research and doing interventional projects to promote trauma care and prevention.
Rizwan Khan; Arvind Kumar; Mukesh Kumar; Javed Jameel
Volume 9, Issue 1 , January 2021, , Pages 46-47
Abstract
The current COVID-19 situation has been taking a high toll on the healthcare workers who are at constant risk of exposure to the contagion, especially those who are involved in treating the COVID-19 infected patients. The risk of exposure is further high during the surgical procedures, considering the ...
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The current COVID-19 situation has been taking a high toll on the healthcare workers who are at constant risk of exposure to the contagion, especially those who are involved in treating the COVID-19 infected patients. The risk of exposure is further high during the surgical procedures, considering the aerosol generation and prolonged contact with the patients. Performing orthopedic surgeries in PPEs (personal-protective-equipment) is not an easy task. Besides the cumbersome body coverage of PPE gown and hood, and the N95 masks which result in early fatigue and exhaustion, a constantly frustrating issue is the fogging of eyewear which limits surgeon’s vision and ability to perform fine tasks [1].
Daniel Quesada; Larissa Morsky; Phillip Aguìñiga-Navarrete; Laura Castro; Luke Kim
Volume 8, Issue 1 , January 2020, , Pages 47-48
Abstract
An eleven-month-old male was brought in for a 1-day history of abdominal distension and anorexia associated with increased fussiness and multiple bouts of non-bloody diarrhea without any vomiting. A kidney, ureter and bladder (KUB) radiograph and abdominal ultrasound were obtained (Figure 1). (Figure ...
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An eleven-month-old male was brought in for a 1-day history of abdominal distension and anorexia associated with increased fussiness and multiple bouts of non-bloody diarrhea without any vomiting. A kidney, ureter and bladder (KUB) radiograph and abdominal ultrasound were obtained (Figure 1). (Figure 1). After placing a nasogastric (NG) tube (Figure 2), a repeated KUB showed gastric decompression with the NG tube extending into the stomach. An abdominal ultrasound showed transient small bowel to small bowel intussusception in the left lower quadrant, which spontaneously decreased during the course of the examination (Figure 3).
Majid Akrami; Mohamamd Yasin Karami; Vahid Zangouri; Iman Deilami; Mehrnoush Maalhagh
Volume 4, Issue 1 , January 2016, , Pages 51-53
Abstract
Femoral hernias account for 2% to 4% of groin hernias, are more common in women, and are more appropriate to present with strangulation and require emergency surgery. This condition may lead to symptoms of bowel obstruction or strangulation and possible bowel resection-anastomosis. To the best of our ...
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Femoral hernias account for 2% to 4% of groin hernias, are more common in women, and are more appropriate to present with strangulation and require emergency surgery. This condition may lead to symptoms of bowel obstruction or strangulation and possible bowel resection-anastomosis. To the best of our knowledge, there is few reports of strangulated femoral hernia. We herein present an 82-year-old lady who presented with a 5-day history of abdominal pain, nausea and vomiting. On examination, the patient had a generalized tenderness and distention. The working diagnosis at this time was a bowel obstruction. A computed tomography scan revealed the hernia occurring medial to the femoral vessels and below the inguinal ligament. Laparotomy was performed and patient was treated successfully with surgical therapy. Hernia was repaired and a small bowel resection was performed with end to end anastomosis. The postoperative course was uneventful, and the patient was doing well at a 12-month follow-up visit. Obstructing femoral hernia of the small bowel is rare and the physician should suspect femoral hernia as a bowel obstruction cause.
Hadid Hamrah; Sarah Mehrvarz; Amir Mohammad Mirghassemi
Volume 6, Issue 1 , January 2018, , Pages 54-58
Abstract
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 ...
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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.
Hamidreza Habibpour; Mehdi Torabi; Moghaddameh Mirzaee
Volume 7, Issue 1 , January 2019, , Pages 55-59
Abstract
Objective: To investigate the role of red cell distribution width (RDW) in comparison with Trauma-Associated Severe Hemorrhage (TASH) system in predicting the mortality of multiple trauma patients, referred to the hospital emergency department.Methods: This follow-up study was conducted on multiple trauma ...
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Objective: To investigate the role of red cell distribution width (RDW) in comparison with Trauma-Associated Severe Hemorrhage (TASH) system in predicting the mortality of multiple trauma patients, referred to the hospital emergency department.Methods: This follow-up study was conducted on multiple trauma patients (age ≥ 18 years) with Injury Severity Scores (ISS) of ≥ 16, who were referred to the emergency department from March 1, 2017, to December 1, 2017. First, all patients were evaluated based on the Advanced Trauma Life Support (ATLS) guidelines, and then, their blood samples were sent for RDW measurements at baseline and 24 hours after admission. The ISS, Revised Trauma Score (RTS), and TASH were measured in the follow-ups and recorded by third-year emergency medicine residents. Hospital mortality was considered as the outcome of the study.Results: In this study, 200 out of 535 multiple trauma patients were recruited. The frequency of hospital mortality was 19 (9.5%). In the univariate analysis, there was no significant relationship between hospital mortality and RDW at baseline, RDW on the first day, and ΔRDW (RDW at baseline - RDW on the first day), unlike ISS, RTS, TASH (p=0.97, P= 0.28, and p=0.24, respectively). On the other hand, in the multivariate analysis, ISS, RTS, and TASH showed a significant relationship with hospital mortality. The greatest area under the ROC curve (AUC) was attributed to TASH and RTS systems (0.94 and 0.93, respectively).Conclusion: TASH scoring system, which was mainly designed to predict the need for massive transfusion, may be of prognostic value for hospital mortality in multiple trauma patients, similar to ISS and RTS scoring systems.
Seyed Vahid Hosseini; Babak Sabet; Abbas Rezaianzadeh; Leila Ghahramani; Seyed Hossein Hosseini; Alireza Safarpour; Salar Rahimikazerooni
Volume 1, Issue 2 , April 2013, , Pages 90-92
Abstract
Objective: To evaluate the role of physical examination in decision making for exploring patients with penetrating zone II neck injury.Methods: This was a cross-sectional study being performed in a level I trauma center between 2006 and 2010. The present study reviewed the records of 150 patients with ...
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Objective: To evaluate the role of physical examination in decision making for exploring patients with penetrating zone II neck injury.Methods: This was a cross-sectional study being performed in a level I trauma center between 2006 and 2010. The present study reviewed the records of 150 patients with penetrating neck injuries. Of 46 cases with zone II deep platysma neck injuries, 3 patients died before taking any significant medical measure.Results: Thirty of 43 patients (70%) presented with hard sings while 13 (30%) did not show these sings. All patients underwent neck exploration. Two patients (4.6%) without hard sings exhibited positive findings, whereas 29 cases (67%) with hard sings reported positive on exploration.Conclusion: Briefly, we hold the view that it seems reasonable to follow an algorithmic approach by using physical examination of the patients with zone II penetrating neck injuries. This prevents unnecessary exploration for management of such patients.
Abbas Heydari; Amir Emami Zeydi
Volume 2, Issue 2 , April 2014, , Pages 99-100
José Roberto Alves; Gustavo Busch Justino; Leonardo Busch Justino; Caique Martins Pereira Ternes; João Vítor Ternes Rech; Fabrissio Portelinha Graffunder
Volume 9, Issue 2 , April 2021, , Pages 101-104
Abstract
Meckel’s diverticulum is the most common gastrointestinal congenital defect, which, although asymptomatic in adults, may present symptoms in obstruction, inflammation, bleeding and foreign body perforation. There are only 8 cases reported of Meckel’s diverticulum perforation by ...
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Meckel’s diverticulum is the most common gastrointestinal congenital defect, which, although asymptomatic in adults, may present symptoms in obstruction, inflammation, bleeding and foreign body perforation. There are only 8 cases reported of Meckel’s diverticulum perforation by chicken bone. We report a case of a 24-yearold man presenting a 2-day-history of periumbilical pain that shifted to the right lower quadrant in 24 hours. Clinical and laboratory findings led to an appendicitis diagnosis, followed by laparotomy. Normal appendix was found intraoperatively along with an incidental finding of an inflamed and perforated Meckel’s diverticulum by chicken bone. Diverticulectomy and enteroanastomosis were performed and the patient had a successful recovery, being discharged 5 days after. Although rare, its clinical presentation might be similar to acuteappendicitis, which restate the importance of collecting a detailed clinical history and examining the small bowel towards to investigate a possible Meckel’s diverticulum complication in the differential diagnosis.
Maryam Zavarmousavi; Fatemeh Eslamdoust-Siahestalkhi; Alireza Feizkhah; MohammadReza Mobayen; Seyed Armin Fazeli Masouleh; Mahshid Badrikoohi; Parissa Bagheri
Volume 11, Issue 2 , April 2023, , Pages 106-107
Abstract
Some non-pharmacological techniques have been shown to effectively reduce pain, including cognitive-behavioral therapy, hypnosis, relaxation techniques, and interaction through television, music, and storytelling. Recently, new advanced technologies such as virtual reality immersion therapy (VRIT) and ...
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Some non-pharmacological techniques have been shown to effectively reduce pain, including cognitive-behavioral therapy, hypnosis, relaxation techniques, and interaction through television, music, and storytelling. Recently, new advanced technologies such as virtual reality immersion therapy (VRIT) and simulation for therapy (SFT) have been used in post-burn rehabilitation. Immersive VR is a cognitive–behavioral technique based on distraction used for treating physical and psychological pain. A comprehensive evaluation of nine clinical trials demonstrated that VR technology combined with pharmaceutical analgesics was significantly more effective in reducing pain and anxiety in burn patients. On the other hand, to improve therapeutic effectiveness in rehabilitation settings such as post-burn conditions, the combined use of related methods such as interactive game consoles (IGC) is increasingly used. IGCs are more favored for use in burn rehabilitation because they are less cumbersome than other forms of VR. Virtual reality games can provide practical and attractive therapy that allows the child to amuse by artificial scenes that appear and feel similar to real-world scenes.In general, it can be said that new technological developments, such as interactive virtual reality, gamification, powerful computers, and portable tablets, and their universal popularity, now offer the chance to integrate knowledge from clinical practice, neuroscience knowledge, and design ideas. In addition, the wide range of virtual communication options and computer games provide physicians to choose appropriate tools that help in treatment. This perspective aims to explain the potential of game design principles to generate more motivation and content for therapy integrated with the proper technological context, like virtual reality.
Sait Saif; Yahya Ibrahim; Peyman Bakhshayesh
Volume 8, Issue 2 , April 2020, , Pages 107-110
Abstract
Objectives: To assess whether intentional traumatic injuries are associated with higher mortality rate when compared to unintentional injuries. Methods: Data from SweTrau (Swedish National Trauma Registry). Information regarding age, gender, injury severity score (ISS), new injury severity score (NISS), ...
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Objectives: To assess whether intentional traumatic injuries are associated with higher mortality rate when compared to unintentional injuries. Methods: Data from SweTrau (Swedish National Trauma Registry). Information regarding age, gender, injury severity score (ISS), new injury severity score (NISS), Glasgow coma scale (GCS), systolic blood pressure, and respiratory rate were collected via “SweTrau”. “Mortality within 30 days of injury” was defined as having been registered as dead within 30 days following the injury. Intentional injuries compared to non-intentional injuries. Multivariate regression analysis was conducted. Stepwise forward and backward regression was conducted. Results: A total number of 3875 patients were included. There were 3613 (93%) non-intentional and 262 (7%) intentional patients. The 30-day mortality rate was higher in the intentional group compared to non-intentional group, 10% vs. 4% (p<0.001). Patients in the intentional group were younger than the non-intentional group, at 39±18 vs. 47±21 years old (p<0.001). In both, the forward and backward tests injury intention remained statistically significant with OR 2 (CI 1.1-3.7). Shock (OR 4.7, CI 2.9-7.8), Severe Head Injury (OR 8.9, CI 5.3-14.7), Age ≥ 60 (OR 6.7, CI 4.1-10.8), ISS ≥16 (OR 10.8, CI 6.9-16.9) and ASA (OR 3.5, CI 2.2-5.7) were other factors affecting mortality. Conclusion: Injury intention was an independent factor contributing to mortality in our study. This particular cohort needs further attention during trauma management with a holistic insight to improve their survival.
Hossein Aslani; Mohammad Reza Bazavar; Ali Sadighi; Ali Tabrizi; Asghar Elmi
Volume 4, Issue 2 , April 2016, , Pages 110-112
Abstract
Carpal fracture-dislocation is regarded as an unusual orthopedic injury and, thus, orthopedic surgeons are less experienced in dealing with and treating these fractures and dislocations. We report a 20-year-old worker man suffering from an unusual carpal fracture-dislocation. There was trans-scaphoid ...
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Carpal fracture-dislocation is regarded as an unusual orthopedic injury and, thus, orthopedic surgeons are less experienced in dealing with and treating these fractures and dislocations. We report a 20-year-old worker man suffering from an unusual carpal fracture-dislocation. There was trans-scaphoid fracture and lunate dislocation with other carpal proximal bones toward volar of the wrist. Two volar and dorsal approaches were used to treat and stabilize the fracture. It was completely stabilized after open reduction and fixation using several pins. After two days, neural symptoms were completely recovered and the patient was discharged. Postoperative radiographies revealed complete restitution of lesser and greater arcs and normalization of Gilula's line. Scapholunate and lunatocapitate angles reached to less than 60° and 10°, respectively. The combined approach had favorable results for treatment of this unusual type of carpus fracture dislocation. However longer follow up is need to evaluate the arthritis and degenerative changes in wrist.
Faranak Sherafati; Enayatollah Homaie-Rad; Abolhassan Afkar; Ramin Gholampoor Sigaroodi; Soheil Sirusbakht
Volume 5, Issue 2 , April 2017, , Pages 116-121
Abstract
Objectives: To investigate the differences in death after receiving emergency services in traffic accidents between urban and rural regions, and decompose factors of the gap in Langerood, Northern Iran.Methods: This cross-sectional study was conducted in Langrood, Northern Iran during a 1-year period ...
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Objectives: To investigate the differences in death after receiving emergency services in traffic accidents between urban and rural regions, and decompose factors of the gap in Langerood, Northern Iran.Methods: This cross-sectional study was conducted in Langrood, Northern Iran during a 1-year period from 2013 to 2014. The hospital data of traffic crashes were used. Data contained those patients who survived at the scene of accident. Injury severity score, time to admission, age, gender, season of crash and type of collision were variables used in this study. Oaxaca decomposition technique was used to show the amount of inequity. In addition, three regression models were used to show the reason of inequity.Results: Overall 1520 patients with road traffic accidents were admitted to our center during the study period. The mean age of the patients was 35.45 ± 17.9 years, and there were 1158 (76.1 %) men among the victims. Motorbike accidents accounted for 869 (57.1%) injuries and 833 (54.8 %) accidents occurred in rural regions. The in-hospital mortality rate was 60 (3.9%). The results of this study showed that 95% of inequity came from factors used in this study and 2.04% disadvantages were for rural crashes. Severity of crash and time to admission had relationship with death, while the effects of time to admission was higher in rural region and severity of the accident had more effect on mortality in urban regions in comparison with rural ones.Conclusion: The high rate of fatal accidents could be decreased by deleting the gap of access to health care services between urban and rural regions. This study suggested that more efforts of health system are needed to reduce the gap.
Khalil Zarrabi; Parsa Ravanfar; Azimeh Azimifar; Fariborz Ghaffarpasand
Volume 1, Issue 3 , July 2013, , Pages 130-132
Abstract
Proximity of the vagus nerve to a patent ductus arteriosus (PDA) can cause traction or entrapment of vagus nerve during surgical closure of the in rare occasions. This can lead to a life threatening postoperative bradycardia. Herein, we report a case of bradycardia caused by unexpected irritation of ...
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Proximity of the vagus nerve to a patent ductus arteriosus (PDA) can cause traction or entrapment of vagus nerve during surgical closure of the in rare occasions. This can lead to a life threatening postoperative bradycardia. Herein, we report a case of bradycardia caused by unexpected irritation of the vagal trunk by the end of operation. The patient was managed by re-opening the chest, lung retraction and removal of mediastinal pleura sutures. The vagal trunk entrapped in the suture line was released immediately. Heart rate accelerated and hemodynamic restored after a short period of observation. The operation terminated as routine, patient extubated in OR and discharged within 24 hours with no further complication. This irritation of vagus results in vagal bradycardia during or by the end of operation. Awareness of a surgeon of this issue can minimize the risks and complications of the open closure of PDA.
Shahram Bolandparvaz; Sina Jelodar; Mina Heidari Esfahani; Sam Moslemi
Volume 2, Issue 3 , July 2014, , Pages 133-135
Abstract
Burkitt lymphoma of stomach is among the most rapidly growing gastric cancersassociated with several gasterointestinal symptoms including hematemesis, anorexia, vomiting and etc. Gastric perforation in patients with Burkitt lymphoma of stomach is a very rare condition especially after ...
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Burkitt lymphoma of stomach is among the most rapidly growing gastric cancersassociated with several gasterointestinal symptoms including hematemesis, anorexia, vomiting and etc. Gastric perforation in patients with Burkitt lymphoma of stomach is a very rare condition especially after chemotherapy. We herein present a 21-year old man who was kwon case of gastric Burkitt lymphoma who had undergone chemotherapy and presented with acute onset gastric pain and tenderness. He was diagnosed to suffer from perforated gastric lymphoma for which laparotomy and total gastrectomy was performed. Treatment was continued by chemotherapy. Closed observation is thus recommended for those patients with gastric Burkitt lymphoma undergoing chemotherapy.
Abdolkarim Rahmanian; Nima Derakhshan; Alireza Mohsenian Sisakht; Najme Karamzade Ziarati; Hadi Raeisi Shahraki; Soheil Motamed
Volume 6, Issue 2 , April 2018, , Pages 133-140
Abstract
Objectives: To evaluate the odds for unfavorable outcome of each risk factor and a combination of them in patients with aneurysmal subarachnoid hemorrhage (SAH) undergoing surgical clipping in Southern IranMethods: A total of 367 patients who were operated between March 2007 and March 2016 due to aneurysmal ...
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Objectives: To evaluate the odds for unfavorable outcome of each risk factor and a combination of them in patients with aneurysmal subarachnoid hemorrhage (SAH) undergoing surgical clipping in Southern IranMethods: A total of 367 patients who were operated between March 2007 and March 2016 due to aneurysmal SAH were analyzed according to patients’ factors, aneurysm characteristics and intra-operative data. Correlation between outcomes of patients measured by modified Rankin Scale at 6-months with each factor were analyzed. Market Basket analysis was also used to identify the odds of unfavorable outcome for combinations of factors.Results: A total of 367 patients, including 199 females and 168 males with a mean age of 47.27± 11.53 years, who underwent operation between March 2007 and March 2016 due to aneurysmal SAH were analyzed. Unlike gender, higher age was associated with unfavorable outcome. Ischemic heart disease, Duration of operation and amount of bleeding were also found to increase the odds of unfavorable outcome (p=0.01, 0.02, 0.04 respectively). DM, Cigarette smoking and opium addiction as well as the location and multiplicity of aneurysms did not have an adverse effect on outcome. (p≥0.05) Conclusion: Among the numerous risk factors presumed to result in unfavorable outcome in aneurysmal SAH, only older age, duration of operation more than 60 minutes, previous known history of ischemic heart disease, poorer clinical grade and intra-operative bleeding more than 500 mL were found to be significant factors.
Keyvan Eghbal; Maziar Oveisee; Javad Safaee; Saber Zafar Shamspour; Arash Saffarian; Abbas Rakhsha
Volume 10, Issue 3 , July 2022, , Pages 135-137
Abstract
Traumatic cervical translational injury is a notably rare and highly unstable subtype of type C sub-axial cervical spine injury with high morbidity and mortality rates. Hereby, we report a 41-years-old man who was a case of multiple trauma due to car rollover. He was completely conscious, complaining ...
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Traumatic cervical translational injury is a notably rare and highly unstable subtype of type C sub-axial cervical spine injury with high morbidity and mortality rates. Hereby, we report a 41-years-old man who was a case of multiple trauma due to car rollover. He was completely conscious, complaining of cervical pain, with a GCS score of 15/15. His neurological examination was unremarkable. The cervical CT scan revealed a vertical translation at the C6-C7 level (roughly 11 mm) and bilateral facet joint diastases which are highly unstable injuries. A two-stage combined anterior and posterior fixation operation was performed. First, an anterior cervical discectomy and fusion with autologous graft and plate fixation, and then a posterior approach with lateral mass screw fixation was performed. Disruption of the anterior longitudinal ligament, annulus fibrosis, facet capsules, and severe strain of ligamentum flavum was noted intraoperatively. He had no early and late complications within 2 years of follow-up.
Masoud Hashemi; Payman Dadkhah; Mehrdad Taheri; Kasra Dehghan; Rohollah Valizadeh
Volume 7, Issue 2 , April 2019, , Pages 137-143
Abstract
Objective: To compare parasagittal interlaminar cervical epidural steroid injection (PSIL-CESI) and the classic midline interlaminar cervical epidural steroid injection (MIL-CESI) in terms of pain relief and functional improvement in patients with unilateral upper extremity radicular pain.Methods: This ...
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Objective: To compare parasagittal interlaminar cervical epidural steroid injection (PSIL-CESI) and the classic midline interlaminar cervical epidural steroid injection (MIL-CESI) in terms of pain relief and functional improvement in patients with unilateral upper extremity radicular pain.Methods: This was a randomized clinical trial being conducted in a single pain center in Tehran. Twenty-six patients were allocated into two groups of 13, undergoing either PSIL-CESI or MIL-CESI. After confirmation of radiocontrast spread in the epidural space by fluoroscopic guidance, dexamethasone 8 mg and bupivacaine 0.125% in a volume of 5 ml were delivered to the epidural space. Evaluation of functional state and pain intensity before and 1 month after the procedure was accomplished using the neck disability index (NDI) and the numeric rating scale (NRS) respectively.Results: Demographic and baseline characteristics of the cases showed no significant statistical difference. Improvements in the NDI and the NRS were observed in both groups; meanwhile, improvements were more pronounced in the PSIL-CESI group as compared to the MIL-CESI group (P<0.001). With the PSIL approach the ventral spread of radiocontrast was significantly higher (38%) than with the MIL approach (0.7%) (P<0.001). All patients in PSIL group showed radiocontrast spread ipsilateral to the painful side and all patients in the MIL group showed a midline distribution of radiocontrast.Conclusion: PSIL-CESI provides superior pain relief and improvement of functional disability in patients with unilateral upper extremity radicular pain in comparison to the classic MIL-CESI.Clinical trial registry: IRCT20180524039816N1
Hassan Esfandiar; Mahmoudreza Peyravi; Milad Ahmadi Marzaleh; Hojatolah Najafi
Volume 9, Issue 3 , July 2021, , Pages 155-157
Abstract
Disasters are an integral part of human life, which have been grown increasingly in recent years. Disasters are divided into human-made and natural categories [1]. In this study, two cases are considered. One is deliberate human-made disasters in such conditions that human crimes or vicious crimes occur ...
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Disasters are an integral part of human life, which have been grown increasingly in recent years. Disasters are divided into human-made and natural categories [1]. In this study, two cases are considered. One is deliberate human-made disasters in such conditions that human crimes or vicious crimes occur in countries, and the government is the criminal factor or is not able to control the crimes. The other case is natural disasters in which people are hurt and suffer from death and diseases, and although the host country is not able to be responsive which it refuses to accept international grants.
Mojtaba Javaherzadeh; Ali Shekarchizadeh; Marjan Kafaei; Abass Mirafshrieh; Nariman Mosaffa; Babak Sabet
Volume 4, Issue 3 , July 2016, , Pages 156-160
Abstract
Objective: To determine the preventive effects of local administration of simvastatin for postoperative intra-abdominal adhesion formation in animal model of rat.Methods: In this experimental study, 32 Wistar albino rats as the animal model of intra-abdominal adhesion formation were included. Adhesions ...
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Objective: To determine the preventive effects of local administration of simvastatin for postoperative intra-abdominal adhesion formation in animal model of rat.Methods: In this experimental study, 32 Wistar albino rats as the animal model of intra-abdominal adhesion formation were included. Adhesions were induced in all the animals via abrasion of the peritoneal and intestinal surface during laparotomy. Afterwards, the rats were randomly assigned to receive simvastatin (30 mg/kg body weight) as a single intraperitoneal dose at the time of laparotomy (n=16) or normal saline in same volume at the same time (n=16). At the day 21, animals were euthanized and the adhesions were quantified clinically (via repeated laparotomy) and pathologically and compared between the two groups.Results: The baseline characteristics of the animals were comparable between two study groups. Clinically, in simvastatin group, 10 rats (62.5%) did not develop any adhesion and 6 (37.5%) had first-grade adhesion; whereas in the control group, 11 (68.8%) rats had first- and 5 (31.2%) had second-grade adhesions (p<0.001). Pathologically, in simvastatin group, 6 rats (37.5%) had first-grade adhesion, while in control group, 11 rats (68.8%) had first- and 5 (31.2%) had second-grade adhesions (p<0.001).Conclusion: Our findings suggest that intraperitoneal administration of simvastatin is an effective method for prevention of postoperative intra-abdominal adhesion formation in animal model of rat.
