Mahir Gachabayov
Volume 5, Issue 2 , April 2017, , Pages 132-134
Abstract
Postoperative intussusception in adults is an extremely rare clinical entity. Postoperative intussusception caused by a jejunal peritoneal cyst is even rarer. Etiopathogenesis of this clinical condition is not well understood. In the given case it seems to be a complication of prolonged contact of a ...
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Postoperative intussusception in adults is an extremely rare clinical entity. Postoperative intussusception caused by a jejunal peritoneal cyst is even rarer. Etiopathogenesis of this clinical condition is not well understood. In the given case it seems to be a complication of prolonged contact of a draining tube with bowel. We present a case of postoperative spontaneous intussusception in a 72-year-old female patient after gastric surgery. The cause of intussusception appeared to be a jejunal peritoneal cyst which is extremely rare. Desinvagination and excision of cyst via laparotomy was performed and the postoperative course was uneventful. Abdominal draining tubes should be placed in a position which will avoid possible further prolonged contact with bowel.
Abbas Rasouli; Seyed Mojtaba Hosseini; Mohammad Karim Bahadori; Ramin Ravangard
Volume 6, Issue 2 , April 2018, , Pages 155-161
Abstract
Objective: To prioritize occupational hazards in a Pharmaceutical Company in Iran using the analytical hierarchy process (AHP).Methods: This was a cross-sectional study conducted in a Pharmaceutical Company in Iran in 2017. All employees working in the administrative, production, installations and facilities, ...
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Objective: To prioritize occupational hazards in a Pharmaceutical Company in Iran using the analytical hierarchy process (AHP).Methods: This was a cross-sectional study conducted in a Pharmaceutical Company in Iran in 2017. All employees working in the administrative, production, installations and facilities, and laboratory units were studied using the consensus method (N=n=130 employees). A data collection form was designed for identifying the hazards using the Nominal Group Technique (NGT) method, as well as a pair-wise questionnaire was used for collecting required data in the quantitative phase. The collected data were analyzed using Expert Choice 10.0 and SPSS 23.0.Results: The results showed that among hazards detected in the studied units, the highest and lowest weights and priorities were, respectively, related to "inhalation of toxic gases" (W=0.253) and “being exposed to radiation” (W=0.022) in the laboratory unit, "skin injuries" (W=0.205) and “bending and straightening for a long time” (W= 0.032) in the production unit, "falling down" (W=0.271) and “standing and sitting for a long time “ (W=0.037) in the installations and facilities unit, and "hand joint failure" (W=0.295) and “working in a low-light environment” (W=0.092) in the administrative unit.Conclusion: The results of the present study showed that there were hazards in all of the studied units. These results indicated a high level of hazards in the pharmaceutical company’s units. Due to the increased medication diversification and increased workload for these companies, paying attention to the preventive and corrective measures in order to reduce the risk of emerging hazards is essential.
Peyman Bakhshayesh; David Hullberg Risling; Anders Enocson
Volume 7, Issue 2 , April 2019, , Pages 156-161
Abstract
Objective: To assess the quality of applied pelvic binders using three dimensional computer tomography (3D CT).Methods: A local trauma registry was used to identify patients with pelvic fractures after high-energy trauma during 2011-2015. A 3D CT reconstruction was made from the initial trauma computer ...
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Objective: To assess the quality of applied pelvic binders using three dimensional computer tomography (3D CT).Methods: A local trauma registry was used to identify patients with pelvic fractures after high-energy trauma during 2011-2015. A 3D CT reconstruction was made from the initial trauma computer tomography images to assess the level of application, symmetricity of the binder and achieved fracture reduction. An acceptable application of the pelvic binder was deemed if it was at the trochanteric level, symmetric and minimized residual displacement.Results: We found 73 patients with a pelvic fracture and a pelvic binder on the initial trauma CT-scan. The mean (±SD) age of the patients was 46±17 years and 40% (n=29) were females. The median ISS score was 38 (IQR;29-50), the mean systolic blood pressure on arrival was 106±46 mmHg and the median GCS on arrival was 14 (IQR;7-15). We found that 59% (n=43) of the binders were correctly applied (symmetric at the trochanteric level, symmetrical and with acceptable residual displacement of the fracture). The 30-day mortality was higher in patients with non-correct application 17% (n=5/30) compared to patients with correct application of the pelvic binder 9.3% (n=4/43) however this was not statistically significant (p=0.562).Conclusion: A substantial number of patients had non-correct application of pelvic binders. Future studies using 3D technique are encouraged to further investigate clinical impacts of non-appropriate application of pelvic binders.
Babak Pourabbas; Mohammad Ali Effani; Asghar Namdari
Volume 4, Issue 3 , July 2016, , Pages 170-173
Abstract
Traumatic retrolisthesis is a rare injury and may result in intervertebral disc extrusion and nerve root injury. These injuries are highly unstable and require surgery for decompression and stabilization. Traumatic retrolisthesis of L5 with acute L5/S1 disc extrusion associated with nerve root injury ...
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Traumatic retrolisthesis is a rare injury and may result in intervertebral disc extrusion and nerve root injury. These injuries are highly unstable and require surgery for decompression and stabilization. Traumatic retrolisthesis of L5 with acute L5/S1 disc extrusion associated with nerve root injury has not been reported previously in English literatures. We herein report a case of traumatic retrolisthesis of L5 and extruded disc. A 22 year-old patient presented with lower extremity weakness due to L5/S1 retrolisthesis and traumatic acute L5/S1 disc extrusion after falling of 8 meters height. The patient underwent surgical decompression and reduction with instrumentation. Accordingly complete recovery of neurologic deficit was occurred. Therefore, early decompression of the nerve roots followed by circumferential instrumentation and fusion of the involved segment results in dramatic improvement in neurologic symptoms.
Majid Forouzesh; Laleh Ghanbarzadegan; Masoomeh Rahimi; Leila Ghahramani
Volume 1, Issue 4 , October 2013, , Pages 179-181
Abstract
Cystic disease of the spleen is not frequently encountered in surgical practice. It is broadly classified as parasitic and non-parasitic, the latter being a rare entity. In this case report, an epidermoid cyst of spleen led to acute abdomen in young age pregnant woman is presented.A 26-year-old woman ...
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Cystic disease of the spleen is not frequently encountered in surgical practice. It is broadly classified as parasitic and non-parasitic, the latter being a rare entity. In this case report, an epidermoid cyst of spleen led to acute abdomen in young age pregnant woman is presented.A 26-year-old woman with 15 weeks gestational age second pregnancy referred to emergency ward with left upper quadrant pain and tenderness that ultra sonography revealed large cyst (100х110mm) with internal echo in spleen in favor of hydatic cyst or abscess. The patient was managed medically for one week but developed her abdominal pain, epigastric fullness, anorexia and fever. New sonography was done for her and large cyst was detected in spleen (120х110mm). She had severe pain accompanied with anorexia and vomiting. Fetus was normal in sonography. Exploratory laprotomy with splenectomy was performed. Splenomegaly (200х130х90mm) with a cyst without any adhesion and inflammation was detected. Histopathology examination showed epidermoid cyst of spleen. (140х10х90mm). Though splenic epidermoid cyst is an uncommon entity, it should be considered in the differential diagnosis of an abdominal mass in a young individual. An attempt should be made to preserve the spleen provided there is adequate parenchyma otherwise splenectomy is the rule.
Hossein Akbarialiabad; Hossein Aabdolrahimzadeh fard; Hamid Reza Abbasi; Shahram Bolandparvaz; Shahin Mohseni; Vahid Mehrnoush; Mina Salehi; Sima Roushenas; Shahram Paydar
Volume 8, Issue 3 , July 2020, , Pages 199-201
Abstract
During the past few months, the novel coronavirus 2019 (COVID-19) pandemic has significantly affected medical service provision. In Iran, it has caused around 197,000 inflictions and 9200 deaths up to June 18, 2020. While many departments turned to telehealth in this era, the trauma service should provide ...
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During the past few months, the novel coronavirus 2019 (COVID-19) pandemic has significantly affected medical service provision. In Iran, it has caused around 197,000 inflictions and 9200 deaths up to June 18, 2020. While many departments turned to telehealth in this era, the trauma service should provide non-stop in presence service to the trauma victims. Our trauma center is the largest in the southwest of Iran, with the mean annual admission of 18,500 polytrauma patients. In this center, we designed a safety protocol to mitigate the spread of disease and also have a more robust case finding system, especially among asymptomatic carriers who attend hospitals based on their trauma. In brief, all unstable patients were considered SARS-COV-2 positive and were directed toward the Specialized COVID-19 related ICU. For all stable patients, history, physical examination, CXR, and lab test (Complete Blood Count, Erythrocyte Sedimentation Rate, C-Reactive Protein) were ordered before entering the wards. If there was any suspicion of COVID-19, the stable patient was admitted to the COVID-19 specialized ward. Among all 1805 patients admitted during a ten weeks interval (from January 30, 2020, to April 14, 2020), 84 had a red flag and toward to COVID-19 related wards. Of those, 67 had positive PCR or evidence in CT in favor of the COOVID-19. Moreover, during regular workups, we found that 19 completely asymptomatic trauma victims had typical Chest CT scan findings of COVID-19.
Adeyi A. Adoga; Daniel D. Kokong; Kenneth N. Ozoilo
Volume 5, Issue 3 , July 2017, , Pages 206-211
Abstract
Objectives: To report the incidence, socio-demographic characteristics, otorhinolaryngological presentations and outcomes of management of patients at the Jos University Teaching Hospital following terror attacks.Methods: A prospective descriptive hospital based study of consecutive patients presenting ...
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Objectives: To report the incidence, socio-demographic characteristics, otorhinolaryngological presentations and outcomes of management of patients at the Jos University Teaching Hospital following terror attacks.Methods: A prospective descriptive hospital based study of consecutive patients presenting with ear, nose and throat injuries as a result of bomb blasts and ethno-religious crises within a six-year period and managed at the Jos University Teaching Hospital were studied for age, gender, ear, nose and throat presentations, injury mechanism, interventions and outcome of interventions. A designed proforma was used for data collection.Results: There were 107 ear, nose and throat injuries from a total 468 terror-related injuries consisting of 66 (61.7%) males and 41 (38.3%) females (M:F ratio of 1.6:1), aged between 5 and 77 years (mean= 36.7 years; SD= +/- 16.2). Two peak age incidences of injuries in the first and third decades were recorded. The commonest source of injuries was bomb blasts in 47 (44%) patients. Multiple facial fractures with soft tissue injuries were the commonest seen in 78 (72.9%) patients. The commonest associated injuries were head injuries (n= 36). Ninety-four (87.9%) patients presented via the Accident and Emergency department, 16 (15%) received pre-hospital care. Patients with multiple injuries stayed longer in the hospital (p-value= 0.028). Complications were recorded in 19 (17.8%) patients. A case fatality rate of 5.6% was recorded.Conclusion: Bomb blasts were the major form of terror attacks in our region. The presence of multiple injuries is a significant negative predictor of patient outcomes.
Francisco Igor B. Macedo; Alice J. Race; Laszlo M. Hoesel
Volume 4, Issue 4 , October 2016, , Pages 244-247
Abstract
The majority of blunt trauma is secondary to motor vehicle crashes,especially in those wearing seatbelts or sitting in the front or passenger seat location.Hollow viscus gastrointestinal injuries occur more frequently in small bowel, followed by colorectal, duodenum, stomach and appendix. A 25-year-old ...
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The majority of blunt trauma is secondary to motor vehicle crashes,especially in those wearing seatbelts or sitting in the front or passenger seat location.Hollow viscus gastrointestinal injuries occur more frequently in small bowel, followed by colorectal, duodenum, stomach and appendix. A 25-year-old male presents after being involved in a motor vehicle accident. Initialworkup was significant for moderate amount of pelvic free fluid and curvilinear,cysticlike structures in the pelvis. He subsequently developed peritonitis and underwentdiagnostic laparoscopy, which revealed multiple cystic nodules arising from theperitoneum. Pathology demonstrated benign cystic mesothelioma (BCM). BCM is a very rarecondition of mesotheliallined, variably sized, fluidfilled cysts that arises from theserous, pericardial or peritoneal lining. Due to the scarcity of cases, its management and prognosis are not fully established. This singular case highlights the necessity for a clinician to have a widedifferential forunusual causes of free pelvic fluid after blunt abdominaltrauma.
Rose Cecile Dean-Paccagnella; Matthew Creed; Mahendra Kakollu; Suresh Kumar Gopala Pillai
Volume 6, Issue 3 , July 2018, , Pages 249-252
Abstract
Drug induced hyperthermia is a rare presentation which can rapidly lead to gross metabolic abnormality and death. These presentations are further complicated by the wide range of potentially causative agents. We present a case of rigidity and hyperthermia, following overdose of an initially unknown substance ...
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Drug induced hyperthermia is a rare presentation which can rapidly lead to gross metabolic abnormality and death. These presentations are further complicated by the wide range of potentially causative agents. We present a case of rigidity and hyperthermia, following overdose of an initially unknown substance leading to challenging management decisions in the Emergency Department. This case was later identified as Serotonin Syndrome. The patient presented with trismus which was managed with rapid sequence induction of anaesthesia to allow airway protection. On extubation a significant degree of laryngeal oedema complicated weaning, a possible complication of Serotonin Syndrome not previously described in the literature. We discuss the pathophysiology of Serotonin Syndrome, important differentials and practical considerations in managing hypertonicity of unknown origin in a young person.
Alireza Pedram; Fatemeh Asadian; Naghmeh Roshan
Volume 7, Issue 3 , July 2019, , Pages 278-283
Abstract
Objective: To evaluate the diagnostic accuracy of ultrasonography in pediatric acute appendicitis.Methods: In this cross-sectional study, 230 children aged 5-15 years with the diagnosis of acute appendicitis were studied. This study included the evaluation of demographic indices, ultrasound findings ...
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Objective: To evaluate the diagnostic accuracy of ultrasonography in pediatric acute appendicitis.Methods: In this cross-sectional study, 230 children aged 5-15 years with the diagnosis of acute appendicitis were studied. This study included the evaluation of demographic indices, ultrasound findings at diagnosis, and then comparing the results with the description of the patient's procedure and the pathology report of these patients. Patients who did not undergo ultrasound before surgery or their ultrasound did not include the evaluation of appendicitis or their pathologic report was not available were excluded.Results: Overall, we have included a total number of 230 children with clinical diagnosis of acute appendicitis among whom there were 121 (52.6%) girls and 109 (47.4%) boys with mean age of 11.44 ± 2.90 years. Preoperative ultrasound report showed that 51.3% were normal and 48.7% had acute appendicitis. 34.8% had normal appendix and 65.2% had a pathological diagnosis of acute appendicitis. The sensitivity and specificity of ultrasound in these children were 58% and 68%, respectively. Positive and negative predictive values were 77% and 46%, respectively. The area under curve (AUC) was 0.853 (CI 95% 0.788-0.917) indicating a test with moderate accuracy. Conclusion: According to the obtained results, abdominal ultrasonography is of acceptable diagnostic accuracy in pediatric patients with acute appendicitis. The use of auxiliary techniques in ultrasound would increase the sensitivity and specificity in the diagnosis of acute appendicitis in children.
Mohammad Karim Bahadori; Ahmad Hajebrahimi; Khalil Alimohammadzadeh; Ramin Ravangard; Seyed Mojtaba Hosseini
Volume 5, Issue 4 , October 2017, , Pages 299-302
Abstract
Objective: To identify and prioritize factors affecting the location of road emergency bases in Iran using Analytical Hierarchy Process (AHP).Methods: This was a mixed method (quantitative-qualitative) study conducted in 2016. The participants in this study included the professionals and experts in the ...
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Objective: To identify and prioritize factors affecting the location of road emergency bases in Iran using Analytical Hierarchy Process (AHP).Methods: This was a mixed method (quantitative-qualitative) study conducted in 2016. The participants in this study included the professionals and experts in the field of pre-hospital and road emergency services issues working in the Health Deputy of Iran Ministry of Health and Medical Education, which were selected using purposive sampling method. In this study at first, the factors affecting the location of road emergency bases in Iran were identified using literature review and conducting interviews with the experts. Then, the identified factors were scored and prioritized using the studied professionals and experts' viewpoints through using the analytic hierarchy process (AHP) technique and its related pair-wise questionnaire. The collected data were analyzed using MAXQDA 10.0 software to analyze the answers given to the open question and Expert Choice 10.0 software to determine the weights and priorities of the identified factors.Results: The results showed that eight factors were effective in locating the road emergency bases in Iran from the viewpoints of the studied professionals and experts in the field of pre-hospital and road emergency services issues, including respectively distance from the next base, region population, topography and geographical situation of the region, the volume of road traffic, the existence of amenities such as water, electricity, gas, etc. and proximity to the village, accident-prone sites, University ownership of the base site, and proximity to toll-house.Conclusion: Among the eight factors which were effective in locating the road emergency bases from the studied professionals and experts' perspectives, "distance from the next base" and "region population" were respectively the most important ones which had great differences with other factors.
Mina Mohseni; Tahereh Khaleghdoust Mohammadi; Zahra Mohtasham-Amiri; Ehsan Kazemnejad; Morteza Rahbar Taramsari; Leila Kouchakinejad-Eramsadati
Volume 6, Issue 4 , October 2018, , Pages 334-340
Abstract
Objective: To determine the status of pre-hospital emergency care and its associated factors in traumatic patients.Methods: In across-sectional study, 577 traumatic patients who were transferred to Poursina hospital by EMS (Emergency Medical Services) personnel were selected by simple random sampling ...
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Objective: To determine the status of pre-hospital emergency care and its associated factors in traumatic patients.Methods: In across-sectional study, 577 traumatic patients who were transferred to Poursina hospital by EMS (Emergency Medical Services) personnel were selected by simple random sampling method. Pre-hospital emergency services were observed. Then the mean of taken measures scores for each domain was determined in percent and evaluated in terms of associated factors (age, working experience of staff and number of missions per day) and compared using Spearman's test.Results: Out of 577 patients, 454 were men (78.7%) and 123 women (21.3%). Their mean age was 35.1 years old. Accident (82.7%) was the most common mechanism of injury. Most vehicles involved in the accident were light-weight cars (48.5%) and motorcycles (32.2%). A significant relationship was found between age, general domain (p=0.039) and hemodynamic (p=0.019) as well as between work experience and general domain (p=0.018).Conclusion: Given that pre-hospital emergency services provided in most of the domains are relatively far from world standard, results of this research can provide information for managers to improve strategic planning on care and medical services, appropriation of budget, knowledge of personnel and necessary equipment.
Amir Reza Vosoughi; mohammad Emami
Volume 7, Issue 4 , October 2019, , Pages 411-415
Abstract
Transcalcaneal talonavicular fracture dislocation is an extremely rare debilitating injury with high complication rates. The present case report demonstrates highly comminuted joint-depressed fracture of left calcaneus treated with primary subtalar arthrodesis following reduction and fixation of the ...
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Transcalcaneal talonavicular fracture dislocation is an extremely rare debilitating injury with high complication rates. The present case report demonstrates highly comminuted joint-depressed fracture of left calcaneus treated with primary subtalar arthrodesis following reduction and fixation of the calcaneus. The right ankle sustained a highly comminuted fracture of calcaneal body with completely-destroyed posterior facet, fracture dislocation of the calcaneocuboid joint, dorsally dislocated talonavicular joint, fracture of anterior of tibial plafond, and subluxation of the tibiotalar joint. At first, talonavicular joint was reduced and fixed using a plate followed by reduction of calcaneus and arthrodesis of subtalar and calcaneocuboid joints. The plate of talonavicular joint was removed after 70 days. Logical approach to this injury can lead to an acceptable function.
Shahram Paydar; Pouya Farhadi; Fariborz Ghaffarpasand
Volume 1, Issue 1 , January 2013, , Pages 49-50
Mehdi Ayaz; Reza Moein
Volume 5, Issue 1 , January 2017, , Pages 58-62
Abstract
Mucormycosis is a rare opportunistic fungal infection that can implicate cranial sinuses, brain, lungs, gastrointestinal tract and skin. Although it can occur in patients with competent and incompetent immunity such as patients with diabetes mellitus, lymphoma, leukemia and burns, but it has an aggressive, ...
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Mucormycosis is a rare opportunistic fungal infection that can implicate cranial sinuses, brain, lungs, gastrointestinal tract and skin. Although it can occur in patients with competent and incompetent immunity such as patients with diabetes mellitus, lymphoma, leukemia and burns, but it has an aggressive, malignant and lethal course in patients with incompetent immunity. To enforce the importance of burn in patients with underlaying diseases such as diabetes, we are going to report a rare case of diabetic burnt patient complicated by right upper extremity myocutaneous mucormycosis. We selected this case to emphasis the importance of underlying disease (diabetes mellitus) with cutaneous burn, aggressive treatment of fungal infection in these patients and referring such case to burn center to prevent catastrophic results. A 50-year-old woman was introduced to us after several days of medical and surgical care of right upper extremity and trunk split-thickness burn. Due to gross muscle necrosis of right upper extremity and poor general condition of the patient, she was taken to the operating room that led to right upper extremity amputation and several times of aggressive debridement to save her life. Pathologic report was indicative of mucormycosis. We can conclude from this case that: 1) Burn, even partially thickness and with little body surface area, should be referred to burn center for better care 2) No response to usual medical treatment should make us more sensitive to consider the unusual causes of infection such as fungi 3) Suspected dead tissues should be excised aggressively especially if suspiciousness to wound sepsis and fungal infection is present especially in an immunocompromised patient.
Saeid Pasban-Noghabi; Ali-Reza Moslem; Naser Godarzi
Volume 2, Issue 1 , January 2014, , Pages 62-63
Adel Hamid; Mohammad Shirvani; Mehrnoosh Maalhagh; Ali Rasti
Volume 7, Issue 1 , January 2019, , Pages 76-79
Abstract
Scorpion bite has different manifestations in vital organs and may cause blindness secondary to involvement in the circulation of these vital organs. We report a case of abrupt vision loss and periorbital edema and redness due to scorpion bite in the eyebrow in an endemic region of southern Iran. A 45-year-old ...
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Scorpion bite has different manifestations in vital organs and may cause blindness secondary to involvement in the circulation of these vital organs. We report a case of abrupt vision loss and periorbital edema and redness due to scorpion bite in the eyebrow in an endemic region of southern Iran. A 45-year-old woman referred to the emergency room of our ophthalmology center due to abrupt vision loss and periorbital edema in her right eye. Involvement of ocular vasculature by localizing stroke due to the coagulative disorder caused by scorpion venom leads to retinal vein occlusion in this case. Management of BRVO was done with intravitreal injection of bevacizumab in the early phase. The outcome was complete vision recovery. To the best of our knowledge, this is the first case of macular branch retinal vein occlusion after scorpion bite.
Deepak Kumar; Praveen Sodavarapu
Volume 8, Issue 2 , April 2020, , Pages 125-128
Abstract
Injury to the femoral artery usually occurs either in open penetrating injuries or in association with fractures, but is unlikely with closed blunt trauma without fracture. We reported a 24-year-old female with a right-sided closed complete rupture of the superficial femoral artery without any bone injury ...
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Injury to the femoral artery usually occurs either in open penetrating injuries or in association with fractures, but is unlikely with closed blunt trauma without fracture. We reported a 24-year-old female with a right-sided closed complete rupture of the superficial femoral artery without any bone injury and contralateral femoral shaft fracture following riding a bike and hitting by a tractor over both lower limbs. The right thigh and knee were swollen and tender with absent distal pulses without any knee instability. The left lower limb was shorter with crepitus and abnormal movement in the left thigh and intact distal pulses. Radiographs showed left femoral shaft fracture and no bony injury on the right lower limb. Angiogram showed non-opacification of the right distal superficial femoral artery. Fogartisation of distal and proximal ends were done and femoral artery was reconstructed using reversed saphenous vein interposition graft. So the clinical necessity of looking routinely for any arterial injury, even in cases of blunt trauma without bony injury is of great importance.
Biplab Mishra; Mohit Joshi
Volume 5, Issue 2 , April 2017, , Pages 135-139
Tanja Pekez-Pavlisko; Maja Racic; Drinka Jurišić
Volume 6, Issue 2 , April 2018, , Pages 162-168
Abstract
Objective: To explore family physicians’ attitudes, previous experience and self-assessed preparedness to respond or to assist in mass casualty incidents in Croatia.Methods: The cross-sectional survey was carried out during January 2017. Study participants were recruited through a Facebook group ...
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Objective: To explore family physicians’ attitudes, previous experience and self-assessed preparedness to respond or to assist in mass casualty incidents in Croatia.Methods: The cross-sectional survey was carried out during January 2017. Study participants were recruited through a Facebook group that brings together family physicians from Croatia. They were asked to complete the questionnaire, which was distributed via google.docs. Knowledge and attitudes toward disaster preparedness were evaluated by 18 questions. Analysis of variance, Student t test and Kruskal-Wallis test t were used for statistical analysis.Results: Risk awareness of disasters was high among respondents (M = 4.89, SD=0.450). Only 16.4 of respondents have participated in the management of disaster at the scene. The majority (73.8%) of physicians have not been participating in any educational activity dealing with disaster over the past two years. Family physicians believed they are not well prepared to participate in national (M = 3.02, SD=0.856) and local community emergency response system for disaster (M = 3.16, SD=1.119). Male physicians scored higher preparedness to participate in national emergency response system for disaster (p=0.012), to carry out accepted triage principles used in the disaster situation (p=0.003) and recognize differences in health assessments indicating potential exposure to specific agents (p=0,001) compared to their female colleagues.Conclusion: Croatian primary healthcare system attracts many young physicians, who can be an important part of disaster and emergency management. However, the lack of experience despite a high motivation indicates a need for inclusion of disaster medicine training during undergraduate studies and annual educational activities.
Stevan J. Jordan; Roozbeh Shafafy; Amelia E. Davidson; Christopher J. To; Kathryn Gill; Matthew C. Solan
Volume 7, Issue 2 , April 2019, , Pages 162-168
Abstract
Objective: To investigate the incidence of trampoline park injuries (TPIs) at a local recreational facility and to quantify the burden on emergency and orthopaedic services at our institute.Methods: All patients that presented to the Emergency Department (ED) from the trampoline park via ambulance from ...
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Objective: To investigate the incidence of trampoline park injuries (TPIs) at a local recreational facility and to quantify the burden on emergency and orthopaedic services at our institute.Methods: All patients that presented to the Emergency Department (ED) from the trampoline park via ambulance from July 2014 to November 2015 were included in the study. Patients’ medical records were reviewed for clinical details including date, location and type of injury, treatment received, length of stay and outpatient follow-up. A cost analysis was performed to estimate the financial impact of each injury.Results: A total of 71 patients were included in the study, with a mean age of 20 (7-48). Soft tissue sprains (n=29, 41%) and fractures (n=25, 35%) were the most common injuries, with the majority occurring in the lower limb. Two patients sustained open tibial fractures necessitating transfer to level 1 trauma centres. Fourteen patients (20%) underwent surgery, predominantly requiring open reduction and internal fixation. Overall, 18 patients (25%) required admission to hospital with mean length of stay of 2 days. The cost for pre-hospital, emergency and in-patient care amounted to over £80,000.Conclusion: TPIs pose a significant financial cost for local orthopaedic and emergency services. Contrary to studies evaluating home trampoline injuries, the majority of fractures at trampoline parks occurred in the lower limbs. Improved injury prevention strategies are required to help reduce morbidity and lower the financial implications for local NHS trusts.
F Javier Fonseca del Pozo; Joaquín Valle Alonso; Miguel Ángel Caracuel Ruiz; Siyamini Vythilingam; Daniel Lopez Ruiz
Volume 4, Issue 3 , July 2016, , Pages 174-179
Abstract
Vertebral osteomyelitis, or spondylodiscitis, is a rare disease with increasing prevalence in recent years due to a greater number of spinal surgical procedures, nosocomial bacteraemia, an aging population and intravenous drug addiction. Haematogenous infection is the most common cause of spondylodiscitis. ...
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Vertebral osteomyelitis, or spondylodiscitis, is a rare disease with increasing prevalence in recent years due to a greater number of spinal surgical procedures, nosocomial bacteraemia, an aging population and intravenous drug addiction. Haematogenous infection is the most common cause of spondylodiscitis. We report a 47-year-old man diagnosed with Escherichia coli spondylodiscitis. The patient initially presented with a 4-day history of inflammatory, mechanical pain in the lower back suggesting sciatica. Treatment included NSAIDs and opioids. Two days after discharge from hospital following an admission due to an upper GI bleeding, the back pain intensified, precipitating a new attendance to the emergency department; during which lumbosacral radiography showed marked reduction of L2/L3 intervertebral space. After a new admission to the rheumatology unit due to worsening of symptoms and raised inflammatory markers, an expedited MRI showed loss of intervertebral disc space at L2/L3, with an irregular high intensity area at L2; suggesting a fluid collection extending to adjacent soft tissues. Fluoroscopy-guided core needle bone biopsies were reported positive for Escherichia coli sensitive to ceftriaxone. The patient was treated (received treatment) with a three week course of ceftriaxone following a formal diagnosis of E. coli spondylodiscitis. Follow-up MRI demonstrated complete recovery with the patient able to return (has returned) to normal activity. In this case we highlight the importance of correct and timely diagnosis of spondylodiscitis. Diagnosis of spondylodiscitis is often difficult, delayed or even missed due to the rarity of the disease but can lead to devastating consequences. Therefore a high index of suspicion is needed for prompt diagnosis to ensure improved long-term outcomes.
Sedigheh Tahmasebi; Sam Moslemi; Maryam Tahamtan; Lohrasb Taheri; Mohammad Ali Davarpanah
Volume 1, Issue 4 , October 2013, , Pages 182-185
Abstract
The co-existence of acquired immune deficiency syndrome (AIDS) and tuberculosis is a major cause of morbidity and mortality because of a widespread organ involvement. The gastrointestinal tract is a common site for localization of opportunistic microorganisms in AIDS. However, surgical abdominal ...
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The co-existence of acquired immune deficiency syndrome (AIDS) and tuberculosis is a major cause of morbidity and mortality because of a widespread organ involvement. The gastrointestinal tract is a common site for localization of opportunistic microorganisms in AIDS. However, surgical abdominal emergencies such as intestinal perforation resulted from tuberculosis are uncommon in these patients. The asymptomatic occurrence of such intestinal perforation has not been reported our knowledge. We represent an HIV and HCV co-infected man with miliary tuberculosis and an incidentally detected free air under diaphragm in the chest X-ray eventually resulting in exploratory laparotomy which then revealed two tubercular-induced intestinal perforations. It seems that as the tuberculosis is increasing in incidence, mostly due to reactivation in HIV-infected patients especially in developing countries, we should not underestimate its acute abdominal emergencies such as bowel perforation.
Mauricio Gonzalez-Urquijo; Mario Zambrano Lara
Volume 8, Issue 3 , July 2020, , Pages 202-204
Abstract
We present a case of a 23-year-old male patient who presented with a blade knife completely wedged and penetrated on his humerus after a stab wound to his left upper extremity. On palpation, a foreign body was palpated under the skin on the deltoid area. The blade was stuck in the bone, so the surrounding ...
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We present a case of a 23-year-old male patient who presented with a blade knife completely wedged and penetrated on his humerus after a stab wound to his left upper extremity. On palpation, a foreign body was palpated under the skin on the deltoid area. The blade was stuck in the bone, so the surrounding bone tissue was osteotomised until the blade was released. The patient evolved favorably, and at three months follow up, he has a full functional recovery of his arm. Stab wounds are prevalent in emergency departments; however, stab wounds with bone involvement have rarely been reported in the literature. When encountering a blade stuck in bone tissue, removing the blade while avoiding orthopedic, neurological and vascular injuries should be the main goal of the treatment. To the best of our knowledge, this is the third reported case of an intraosseous foreign body in the humerus secondary to a stab wound.
Holger Rupprecht; Marius Ghidau; Katharina Gaab
Volume 5, Issue 3 , July 2017, , Pages 212-214
Abstract
Fracture and intrathoracic dislocation of the humeral head are extremely rare and often the result of a severe trauma. We herein report a case of humeral head fracture and dislocation with displacement into the chest cavity. A 75-year-old man fell down the stairs at home, landing on the right half of ...
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Fracture and intrathoracic dislocation of the humeral head are extremely rare and often the result of a severe trauma. We herein report a case of humeral head fracture and dislocation with displacement into the chest cavity. A 75-year-old man fell down the stairs at home, landing on the right half of his body. Clinical impressive was a massive skin emphysema on the right hemithorax. A chest x-ray was performed. Conspicuous was a dubious opacity in the right subfield of the lung. The following CT-scan showed an additional fracture of the right scapula, a lung contusion and as “corpus delicti” a right intrathoracic dislocated humeral head fracture. The current case is extremely rare pattern of injury and the surgical emergency management is discussed. In most patients, a thoracotomy, which is related to a higher lethality and higher morbidity, can be avoided, if after stabilization a video assisted thoracoscopy is performed for revision of the pleural cavity and extraction of the humeral head.
