Reza Ranjbar; Alireza Yousefi
Volume 6, Issue 1 , January 2018, , Pages 8-15
Abstract
Objective: To assess effect of Aleo vera with chitosan nanoparticle biofilm on wound healing in full thickness infected wounds with antibiotic resistant gram positive bacteria.Method: Thirty rats were randomized into five groups of six rats each. Group I: Animals with uninfected wounds treated with 0.9% ...
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Objective: To assess effect of Aleo vera with chitosan nanoparticle biofilm on wound healing in full thickness infected wounds with antibiotic resistant gram positive bacteria.Method: Thirty rats were randomized into five groups of six rats each. Group I: Animals with uninfected wounds treated with 0.9% saline solution. Group II: Animals with infected wounds treated with saline. Group III: Animals with infected wounds were dressed with chitosan nanoparticle thin-film membranes. Group IV: Animals with infected wounds were treated topically with Aloe vera and Group V: Animals with infected wounds were treated topically with Aloe vera and dressed with chitosan nanoparticle thin-film membranes. Wound size was measured on 6, 9, 12, 15, 18 and 21days after surgery.Results: Microbiology, reduction in wound area and hydroxyproline contents indicated that there was significant difference (p<0.05) between group V and other groups. Quantitative histological studies and mean rank of the qualitative studies demonstrated that there was significant difference (p<0.05) between group V and other groups.Conclusion: The Aloe vera with chitosan nanoparticle thin-film membranes had a reproducible wound healing potential and hereby justified its use in practice.
Elham Pishbin; Maryam Ziyaei; elnaz vafadar moradi; Mohsen Foroughipour; Rahim Javadzadeh; Mahdi Foroughian
Volume 12, Issue 1 , January 2024, , Pages 8-14
Abstract
Objective: Cerebral Venous Sinus Thrombosis (CVST), a complex and infrequent cerebrovascular disordercharacterized by the formation of clots within the cerebral venous sinuses, occurs as a result of multiple riskfactors and casualties, and its epidemiological picture should be investigated.Methods: This ...
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Objective: Cerebral Venous Sinus Thrombosis (CVST), a complex and infrequent cerebrovascular disordercharacterized by the formation of clots within the cerebral venous sinuses, occurs as a result of multiple riskfactors and casualties, and its epidemiological picture should be investigated.Methods: This descriptive study was conducted retrospectively on patients with a final diagnosis of cerebralvein thrombosis, who were referred to the emergency room of Ghaem Hospital (Mashhad, Iran) between 2009and 2019. The study included all patients with cerebral vein thrombosis who were older than 18 years. Clinicalsymptoms and causes were documented and contrasted according to demographics.Results: During the 10 years of this study, 749 cases of cerebral vein thrombosis were observed, with womenaccounting for the majority (72.8%). The most prevalent symptom was headache (554 cases; 74.0%), followedby seizures (23.1%), blurred vision (16.0%), nausea (7.5%), vomiting (6.9%), double nose (4.9%), and dizziness(3.3%). There was no significant difference in the frequency of symptoms between the two genders (p<0.05). Themost commonly identified risk factors were OCP (110 cases; 14.7%), followed by infection (103 cases; 13.8%),malignancies (78 cases; 10.4%), and fasting (15 cases; 2.0%). There was no significant difference in risk factorsbetween the two genders, with the exception that all cases of fasting were in women, and the differences weresignificant (p=0.015). The most common site of involvement according to Magnetic Resonance Venography(MRV) was the upper sagittal sinus (427 cases; 57.0%). There was no significant difference in terms of the siteof the conflict between the two genders (p<0.05).Conclusion: The findings of the present study showed that deep vein thrombosis occurred mainly in womenand manifested itself mostly as a headache. Moreover, the upper sagittal sinus was the most common site ofinvolvement.
Haleh Mousavi Isfahani; Sogand Tourani; Hesam Seyedin
Volume 7, Issue 1 , January 2019, , Pages 9-20
Abstract
Objective: To perform a systematic review of the properties and results of the studies that their approaches are lean management in emergency departments and the factors which influence on their performance. Method: The necessary information in the ...
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Objective: To perform a systematic review of the properties and results of the studies that their approaches are lean management in emergency departments and the factors which influence on their performance. Method: The necessary information in the first stage was collected by searching these keywords: "Lean principles" “Lean Six Sigma", "Lean Process", “Lean thinking”, “Lean Methodology”, “Toyota Production System lean processing”, "lean techniques", "emergency department”, “emergency medicine”, “emergency room” and “emergency care”. And in the next stage the keywords such as “lean management” and “emergency” was collected from SID, Medlib, IranDoc, Google Scholar, MagIran, IranMedex data bases. For extracting the data data-extracting forms was prepared. The information we got from the forms was organized in information-extracting forms and was analyzed manually. The diagrams were drawn in Excel: 2010.Results: Finally, 26 essays have been included. Most of the studies were accomplished in Canada and U.S.A. only in one of the cases, the authors used the control group. Each of these terms, “lean techniques” and “lean principals”, with five times repetitions had the highest frequency. The most important team of implementation of lean management included: hospital management team or the manager of Emergency department, physicians, nurses, staffs and external counselors. Generally, 51 indicators were studied which among them the length of stay and the timing had the most frequency. After implementation of lean management, almost all studied indicators have significantly improved. 14 barriers, 14 facilitators and 10 effective factors were recognized in implementing the lean management.Conclusion: According to the studies, responsibility of organization’s senior management and his/her supports; increasing the knowledge of the characteristics and dimension of lean among the providers of health service; and decreasing the resistance and consulting with external counselors can have great effect on the success of lean management.
Ali Ghaemmaghami; Ehsan Fallah; Hamid Namazi; Mohammad Taghi Karimi; Seyed Iman Houseini
Volume 9, Issue 1 , January 2021, , Pages 9-14
Abstract
Objective: To compare the stability of the radius stabilized fractured parts by volar and dorsal planting based on modeling approach. Methods: Ten forearm models were created based on Computed Tomography (CT) Scan images by using of Mimics software. The distal part fracture of radius was induced in the ...
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Objective: To compare the stability of the radius stabilized fractured parts by volar and dorsal planting based on modeling approach. Methods: Ten forearm models were created based on Computed Tomography (CT) Scan images by using of Mimics software. The distal part fracture of radius was induced in the models. The stress were developed and implanted in various parts of the bone and and their displacement were evaluated in volar and dorsal inserted implants. Results: The results of this study showed that the stress developed in screws, implant and bony parts differed significantly between volar and dorsal plate conditions. The displacement of implant and bony parts in volar plating was more than dorsal plating (p=0.05). However, the screws displacement in dorsal plating significantly increased compared to volar plating. Conclusion: The stress developed in dorsal and volar implants is not too high to fail the structure. However, it seems that the irritation of soft tissue and tendon would be less in volar inserted implant than dorsal implant. It is recommended to use valor plating to be a good approach for stabilizing the distal part fracture of radius.
Mohammad Haji Aghajani; Roxana Sadeghi; Reza Miri; Mohammad Parsa Mahjoob; Fatemeh Omidi; Fatemeh Nasiri-Afrapoli; Asma Pourhosseingoli; Niloufar Taherpour; Amirmohammad Toloui; Mohammad Sistanizad
Volume 10, Issue 1 , January 2022, , Pages 9-15
Abstract
Objective: To describe the levels of troponin I in COVID-19 patients and its role in the prediction of their inhospital mortality as a cardiac biomarker. Methods: The current retrospective cohort study was performed on the clinical records of 649 COVID-19-related hospitalized cases with at leat ...
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Objective: To describe the levels of troponin I in COVID-19 patients and its role in the prediction of their inhospital mortality as a cardiac biomarker. Methods: The current retrospective cohort study was performed on the clinical records of 649 COVID-19-related hospitalized cases with at leat one positive polymerase chain reaction (PCR) test in Tehran, Iran from February 2020 to early June 2020. The on admission troponin I level divided into two groups of ≤0.03ng/mL (normal) and >0.03ng/mL (abnormal). The adjusted COX-regression model was used to determine the relationship between the studied variables and patient’s in-hospital mortality. Results: In this study, the median age of subjects was 65 years (54.8% men) and 29.53% of them had abnormal troponin I levels. Besides, the in-hospital mortality rate among patients with abnormal troponin I levels was found to be 51.56%; whereas, patients with normal levels exhibited 18.82% mortality. Also, the multivariable analysis indicated that the risk of death among hospitalized COVID-19 patients displaying abnormal troponin I levels was 67% higher than those with normal troponin I levels (Hazard ratio=1.67, 95% confidence interval=1.08-2.56, p=0.019). Conclusion: It seems that troponin I is one of the important factors related to in-hospital mortality of COVID-19 patients. Next, due to the high prevalence of cardiac complications in these patients, it is highly suggested to monitor and control cardiac biomarkers along with other clinical factors upon the patient’s arrival at the hospital.
Behrang Rezvani Kakhki; Melika Fugerdi; Zahra Abbasi; Hamideh Feiz Dysfani; elnaz vafadar moradi
Volume 11, Issue 1 , January 2023, , Pages 13-18
Abstract
Objective: To design and conduct the effectiveness of Ketamine vs Dexmedetomidine in children’s sedation atemergency department (ED).Methods: This randomized clinical trial study was carried out at the two trauma centers in Mashhad, Iran. Thepatients were divided into two groups by means of a random ...
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Objective: To design and conduct the effectiveness of Ketamine vs Dexmedetomidine in children’s sedation atemergency department (ED).Methods: This randomized clinical trial study was carried out at the two trauma centers in Mashhad, Iran. Thepatients were divided into two groups by means of a random numbers table to be treated with Ketamine (N=20)or Dexmedetomidine (N=20). Their demographic information and sedation times of drugs were collected andanalyzed.Results: In general, sedation time was significantly higher in the ketamine group, 14.35 minutes (IQR:9.82-19) than in the dexmedetomidine group, 9.7 minutes (8.35-14.23) (p=0.023). Time of injection to completeanesthesia was 45.25 (IQR:30-58) and 72 (IQR:60.25-82) minutes in ketamine and dexmedetomidine groups,respectively (p<0.01). In the case of recovery, grade 4 of the Ramsey scale was statistically more prevalent indexmedetomidine (45%) than in the ketamine group (p=0.0001).Conclusion: This study demonstrated that dexmedetomidine could be used in cases where a shorter sedationtime is vital. Ketamine could be a better choice where full recovery time (from injection) matters most.
Mehdi Shirazi; Mehdi Salehipour; Mohammad Amin Afrasiabi; Alireza Amin Sharifi
Volume 3, Issue 2 , April 2015, , Pages 41-45
Abstract
Objective: To compare the efficacy of desmopressin (DDAVP), tramadol and indomethacin on pain intensity of patients with acute renal colic caused by urolithiasis.Methods: This prospective, randomized clinical trial was conducted between July 2005 and July 2006 including120 patients (70 men and 50 women, ...
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Objective: To compare the efficacy of desmopressin (DDAVP), tramadol and indomethacin on pain intensity of patients with acute renal colic caused by urolithiasis.Methods: This prospective, randomized clinical trial was conducted between July 2005 and July 2006 including120 patients (70 men and 50 women, mean age 38.2±5.8 years) referring to emergency room of Shahid Faghihi hospital with renal colic caused by urolithiasis without any previous treatment. The patients were randomly assigned to three groups: group A received tramadol 50mg intramuscularly (n=40), group B received desmopressin40 µg intranasally (n=40) and group C received indomethacin 100mg rectally (n=40). The pain was assessed both on admission and 30 minutes after the intervention. The pain intensity and the side effects were compared between two study groups.Results: There was no significant difference between two study groups regarding the baseline characteristics. The intensity of pain of presentation was almost similar in all groups. In group A, 30 patients (75%), in group B, 15 patients (37.5%) and in group C, 19 patients (47.5%) had complete pain relief. The pain intensity decreased significantly after the intervention within all three groups ( p<0.001).Conclusion: According to the results of the current study, rectal indomethacin, intramuscular tramadol and intranasal desmopressin are effective and safe routs of controlling pain in acute renal colic secondary to urolithiasis. Tramadol was the most effective agent in controlling the pain.Clinical Trial Registry: The current study is registered with Iranian Registry for Clinical Trials (www.irct.ir; IRCT2015030919470N18)
Zahra Ghahramani; Golnoosh Mehrabani
Volume 1, Issue 2 , April 2013, , Pages 56-59
Dushyant Chouhan; Sanjay Meena; Kulbhushan Kamboj; Mukesh Meena; Amit Narang; Siddhartha Sinha
Volume 8, Issue 2 , April 2020, , Pages 56-61
Abstract
Objective: To compare the outcome of distal locked and unlocked intramedullary nailing in patients with intertrochanteric fractures through systematic review and meta-analysis of randomized and non-randomized clinical trials. Methods: Randomized or non-randomized controlled studies comparing the ...
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Objective: To compare the outcome of distal locked and unlocked intramedullary nailing in patients with intertrochanteric fractures through systematic review and meta-analysis of randomized and non-randomized clinical trials. Methods: Randomized or non-randomized controlled studies comparing the effects of unlocked and locked nails for treatment of intertrochanteric fractures were searched using the search strategy of Cochrane collaboration up to April 2019. Four eligible studies involving 691 patients were included. Their methodological quality was assessed, and data were extracted independently for meta-analysis. Results: The results showed that the unlocked group has significantly less operative time (MD: -8.08; 95%CI -11.36 to -4.79; P< 0.00001), fluoroscopy time (MD: -7.09, 95%CI -7.09 to -4.79; p<0.00001), length of incision (MD: -2.50, 95%CI 2.85 to -2.14; p< 0.00001) than the locked group. The complication rate was significantly higher in the locking group (OR: 0.55, 95%CI 0.26 to 1.15; p=0.03). No significant differences were found in the Harris hip score between the two groups (MD: 0.68, 95% CI -0.83 to 2.19, p<0.08). Conclusion: The present meta-analysis suggests that intramedullary nailing without distal locking is reliable and acceptable option for treating intertrochanteric fracture. The advantages are reduced operative time, decreased fluoroscopy time, smaller size of incision and decreased complication rate. However, owing to the low-quality evidence currently available, additional high quality Randomized controlled trials are needed to confirm these findings.
Mohsen Ebrahimi; Behrang Rezvani Kakhki; Baharak Davoudpour; Zahra Abbasi Shaye; Hossein Zakeri; Seyed Mohammad Mousavi; Sayyed Majid Sadrzadeh; Seyed Aliakbar Shamsian; Azadeh Mahmoudi Gharaee
Volume 10, Issue 2 , April 2022, , Pages 59-64
Abstract
Objective: To investigate the relationship between salivary amylase level and computed tomoraphy (CT scan) findings in patients with isolated mild traumatic Brain Injury (mTBI) referred to the emergency department of Shahid Hasheminejad Hospital. Methods: Patients with isolated mTBI and indication ...
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Objective: To investigate the relationship between salivary amylase level and computed tomoraphy (CT scan) findings in patients with isolated mild traumatic Brain Injury (mTBI) referred to the emergency department of Shahid Hasheminejad Hospital. Methods: Patients with isolated mTBI and indication for brain CT scan who referred to the trauma center of Shahid Hasheminejad Hospital, Mashhad, Iran in 2019 were included in a cross-sectional study. In the initial examination, the patient’s level of consciousness was measured using the Glasgow Coma Scale (GCS), and saliva samples were taken at the emergency department to determine the level of salivary amylase. A brain CT scan was performed for all patients. Age, gender, cause of trauma, the trauma severity and CT scan results were recorded. Statistical analysis was performed on the data. Results: One-hundred fifty patients were enrolled in this study (men=101, women=49). The trauma causes were included accidents (n=88; 58%), falls (n=37; 25%) and miscellaneous factors (e.g., quarrels; n=25; 17%). GCS was 15 in 142 patients and 14 in the rest. In all patients, the trauma severity was mild to high risk (Minor). CT scan results unfolded pathology in 10 cases (7%), while the residues (93%) had normal CT scans with no pathological evidence. Salivary amylase level in the patients’ saliva samples was between 137 to 8000 units per liter. Using the t-test to evaluate the relationship between salivary amylase levels and CT scan results uncovered a significant relationship. Spearman correlation revealed no significant relationship between the amylase and GCS levels. Conclusion: Data statistical analysis from 150 patients with isolated head trauma manifested that salivary amylase levels were significantly higher in the patients with pathological findings on CT scans. However, no significant relationship was found between salivary amylase level and age, gender, cause of trauma, and level of consciousness.
Gaurav Kaushik; Ankita Sharma; Dinesh Bagaria; Subodh Kumar; Sushma Sagar; Amit Gupta
Volume 9, Issue 2 , April 2021, , Pages 60-66
Abstract
Objective: To describe the restructuring if in-hospital systems of care at a Level -1 trauma center in India and to analyze volume and patterns of injury for future preparedness as well as to institute preventive measures for specific injuries during health emergencies like COVID-19.Methods: The data ...
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Objective: To describe the restructuring if in-hospital systems of care at a Level -1 trauma center in India and to analyze volume and patterns of injury for future preparedness as well as to institute preventive measures for specific injuries during health emergencies like COVID-19.Methods: The data were extracted from a prospectively managed trauma registry at level-1 trauma center in India. We compared data of lockdown period with data of the same number of days from the pre-lockdown period. Patients were grouped according to age, gender, cause of injury, place of injury, injury severity, and injury outcome for comparative analysis between two periods.Results: Total emergency department (ED) footfall due to trauma decreased significantly by 73% during lockdown period. Injuries resulting due to blunt forces, increased significantly. There was a significant decrease in the percentage of patients having major injury. The road traffic injuries (RTIs) cases were less, but number of falls reported increased significantly during lockdown. Significantly less number of patients presented without receiving primary care. Majority of the patients were transported using private cars, police vehicle, and two wheelers during lockdown, however, as expected significantly less number of patients were transported by three wheelers. The comparative analysis between quantitative data points shows significant difference in median ISS and length of stay during lockdown. Conclusion: This study highlighted that the preparedness during health emergencies should not focus solely on the response to treatment of infectious disease but also on ensuring access and provision of reasonable quality of care for non-infectious illnesses, especially acute conditions like trauma.
Armin Akbarzadeh; Ehsan Fallah; Seyed Ali Hashemi; Seyed Mohammad Tahami; Babak Pourabbas; Saeed Solooki
Volume 11, Issue 2 , April 2023, , Pages 69-74
Abstract
Objective: This study aimed to evaluate the radiologic and clinical outcomes of TKA with non-stemmed tibial components in relation to their body mass index (BMI).Methods: In this retrospective cohort study, the outcome of TKA with non-stemmed tibial components based on their BMI was evaluated (BMI<30 ...
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Objective: This study aimed to evaluate the radiologic and clinical outcomes of TKA with non-stemmed tibial components in relation to their body mass index (BMI).Methods: In this retrospective cohort study, the outcome of TKA with non-stemmed tibial components based on their BMI was evaluated (BMI<30 vs. BMI≥30). The patients’ function was assessed using the International Knee Documentation Committee (IKDC) and Lysholm knee questionnaires. Radiologic evaluation for probable signs of loosening was performed using two quantitative scoring systems by Ewald and Bach et al. Moreover, we reviewed the current literature on the application of non-stemmed tibial components in obese patients.Results: Twenty-one patients (two men and 19 women) with BMI≥30 and a mean age of 65.1±9.5 years, and 22 patients (three men and 19 women) with BMI<30 and a mean age of 63.6±8.5 years were studied. The mean follow-up periods with BMI≥30 (47.0±19.8 months) and BMI<30 (49.2±18.7 months) were comparable (p=0.618). No patients in either group experienced clinical loosening. Besides, none of the patients had any kind of revision surgery. The patients in both BMI groups had comparable IKDC scores (both the total score and its sub-scores; p>0.05). Furthermore, the total Lysholm knee scores were similar in both groups (p=0.122). Using both scoring systems, the peri-prosthetic bone radiolucency near the tibial components was similar in both groups (p>0.999).Conclusion: The present study found no significant difference in the radiologic or clinical outcome of unstemmed TKA in patients with BMIs under and over 30.
Mihai Paduraru; Luca Ponchietti; Isidro Martinez Casas; Peter Svenningsen; Mauro Zago
Volume 5, Issue 2 , April 2017, , Pages 70-78
Abstract
Objective: To evaluate the current scientific evidence for the applicability, safety and effectiveness of pathways of enhanced recovery after emergency surgery (ERAS).Methods: We undertook a search using PubMed and Cochrane databases for ERAS protocols in emergency cases. The search generated 65 titles; ...
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Objective: To evaluate the current scientific evidence for the applicability, safety and effectiveness of pathways of enhanced recovery after emergency surgery (ERAS).Methods: We undertook a search using PubMed and Cochrane databases for ERAS protocols in emergency cases. The search generated 65 titles; after eliminating the papers not meeting search criteria, we selected 4 cohort studies and 1 randomized clinical trial (RCT). Data extracted for analysis consisted of: patient age, type of surgery performed, ERAS elements implemented, surgical outcomes in terms of postoperative complications, mortality, length of stay (LOS) and readmission rate.Results: The number of ERAS items applied was good, ranging from 11 to 18 of the 20 recommended by the ERAS Society. The implementation resulted in fewer postoperative complications. LOS for ES patients was shorter when compared to conventional care.Mortality, specifically reported in three studies, was equal or lower with ERAS. Readmission rates varied widely and were generally higher for the intervention group but without statistical significance.Conclusions: The studies reviewed agreed that ERAS in emergency surgery (ES) was feasible and safe with generally better outcomes. Lower compliance with some of the ERAS items shows the need for the protocol to be adapted to ES patients. More evidence is clearly required as to what can improve outcomes and how this can be formulated into an effective care pathway for the heterogeneous ES patient.
Hassan Ravari; Masoud Pezeshki Rad; Aria Bahadori; Orkideh Ajami
Volume 2, Issue 2 , April 2014, , Pages 72-76
Abstract
ABSTRACTObjective: To compare the conventional angiographic findings in extremity trauma patients with or without runoff. Methods: This was cross-sectional study including all the patients with extremity trauma who underwent conventional angiography during the ...
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ABSTRACTObjective: To compare the conventional angiographic findings in extremity trauma patients with or without runoff. Methods: This was cross-sectional study including all the patients with extremity trauma who underwent conventional angiography during the 2 year period from 2011 to 2013 in Angiography departments of Mashhad University of Medical Sciences. Mechanism of trauma, type of injury and angiographic findings were recorded in a questionnaire for each patient. After completion of treatment and discharge, the treatment type was added. The characteristics as well as clinical findings were compared between those who were diagnosed to have arterial runoff ad those who did not.Results: One hundred and forty eight traumatic patients including 15 female with age range of 11-82 years and 133 men ranging from 25 to 40 years were enrolled. Abnormal angiographic findings were provided in 99 (66.9%) patients including cutoff with distal runoff (n=60, 60.6% of abnormalities), cut off without distal runoff (n=21,21.2%) and spasm (n=14, 14.1%) and other findings (n=4, 4%). Fifty one cases were treated under open surgery and amputation of traumatic limb was done for 13 patients. Amputation rate was higher in patients with cutoff and without runoff than those with cutoff and runoff (33.3% vs. 6.78%; p=0.002).Conclusion: Causes and types of traumatic arterial injury in our study were different with other reports. It was shown that angiographic findings were less important in prognosis and management of patients. Patients with spasm in angiographic findings had a better prognosis than other patients and mostly did not need any vascular surgery. The presence or absence of a distal run off in primary angiographic findings can have a predictive value in the final amputation rate.
Hamid Reza Abbasi; Mitra Amini; Shahram Bolandparvaz; Shahram Paydar; Jameel Ali; Sepideh Sefidbakht
Volume 4, Issue 2 , April 2016, , Pages 75-79
Abstract
Objective: To evaluate the effect of advance trauma life support (ATLS®) training on general surgery residents clinical reasoning skills using the national boards-style objective structured clinical examination (OSCE).Methods: This cross-sectional single-center study was conducted in Shiraz University ...
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Objective: To evaluate the effect of advance trauma life support (ATLS®) training on general surgery residents clinical reasoning skills using the national boards-style objective structured clinical examination (OSCE).Methods: This cross-sectional single-center study was conducted in Shiraz University of Medical Sciences including 51 surgery residents that participated in a mandatory national board style OSCE between May 2014 and May 2015. OSCE scores of two groups of general surgery residents including 23 ATLS® trained and 28 non-ATLS® trained were compared using Mann-Whitney U test. The exam was graded out of 20 points and the passing score was ≥14 including 40% trauma cases.Results: There were 8(15.7%) women and 43(84.3%) men among the participants with mean age of 31.12 ± 2.69 and 33.67 ± 4.39 years in women and men respectively. Overall 7 (87.5%) women and 34 (79.07%) men passed the OSCE. The trauma section OSCE score was significantly higher in the ATLS® trained participants when compared to non-ATLS®(7.79 ± 0.81vs.6.90 ± 1.00; p=0.001). In addition, the total score was also significantly higher in ATLS® trained residents (16.07 ± 1.41 vs. 14.60 ± 1.40; p=0.001). There was no association between gender and ATLS® score (p=0.245) or passing the OSCE (p=0.503).Conclusion: ATLS® training is associated with improved overall OSCE scores of general surgery residents completing the board examinations suggesting a positive transfer of ATLS learned skills to management of simulated surgical patients including trauma cases.
EhsanAli Alibai; Fahim Baghban; Majid Reza Farrokhi; Navideh Mohebali; Mohammad Hossein Ashraf
Volume 3, Issue 3 , July 2015, , Pages 79-85
Abstract
Objective: To determine the effects of recombinant human erythropoietin (rhEPO) on functional outcome and disability of patients with traumatic cervical spinal cord injury (SCI). Methods: This was a randomized, double blind, placebo controlled clinical trial being performed in Nemazee and Shahid Rajaei ...
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Objective: To determine the effects of recombinant human erythropoietin (rhEPO) on functional outcome and disability of patients with traumatic cervical spinal cord injury (SCI). Methods: This was a randomized, double blind, placebo controlled clinical trial being performed in Nemazee and Shahid Rajaei hospitals of Shiraz during a 3-year period from 2011 to 2014. A total number of 20 patients with acute traumatic cervical SCI less than 8 hours after injury were included. We excluded those with anatomic cord dissection, penetrating cord injury and significant concomitant injury. Patients were randomly assigned to receive rhEPO in 500IU/mL dosage immediately and 24-hour later (n=11) or placebo (n=9). All the patient received standard regimen of methylprednisolone. Neurological function was assessed on admission, 1, 6 and 12 months after the injury according to the American Spinal Cord Injury Association (ASIA).Results: Overall we include a total number of 20 patients. The mean age of the patients was found to be 40.1 ± 9.5 (ranging from 19 to 59) years. There were 18 (90.0%) men and 2 (10.0%) women among the patients. There was no significant difference between two study groups regarding the baseline characteristics. The baseline ASIA score was comparable between two study groups. The motor and sensory ASIA scores were comparable between two study groups after 1, 6 and 12 months follow-ups. We also found that there was no significant difference between two study groups regarding the motor and sensory outcome in complete cord injury and incomplete cord injury subgroups. Conclusion: Administration of rhEPO does not improve the functional outcome of patients with traumatic cervical SCI.Clinical trial registration: The study has been registered with Iranian Registry for Clinical Trials (www.irct.ir; IRCT2014122920471N1)
Saber Azami-Aghdash; Homayoun Sadeghi-Bazarghani; Mahdiyeh Heydari; Ramin Rezapour; Naser Derakhshani
Volume 6, Issue 2 , April 2018, , Pages 90-99
Abstract
Objective: To review the effectiveness of Road Traffic Injuries (RTIs) interventions implemented for prevention of RTIs in Iran and to introduce some methodological issues.Methods: Required data in this systematic review study were collected through searching the following key words: "Road Traffic Injuries", ...
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Objective: To review the effectiveness of Road Traffic Injuries (RTIs) interventions implemented for prevention of RTIs in Iran and to introduce some methodological issues.Methods: Required data in this systematic review study were collected through searching the following key words: "Road Traffic Injuries", "Road Traffic accidents", "Road Traffic crashes", “prevention”, and Iran in PubMed, Cochrane Library electronic databases, Google Scholar, Scopus, MagIran, SID and IranMedex. Some of the relevant journals and web sites searched manually. Reference lists of the selected articles were also checked. Gray literature search and expert contact was also conducted.Results: Out of 569 retrieved articles, finally 8 articles included. Among the included studies the effectiveness of 10 interventions were assessed containing: seat belt, enforcements of laws and legislations, educational program, wearing helmet, Antilock Braking System (ABS), motorcyclists' penalty enforcement, pupil liaisons’ education, provisional driver licensing, Road bumps and traffic improvement's plans. In 7 studies (9 interventions) reduction of RTIs rate were reported. Decreased rate of mortality from RTIs were reported in three studies. Only one study had mentioned financial issue (Anti-lock Brake System intervention). Inadequate data sources, inappropriate selection of statistical index and not mention about the control of Confounding Variables (CV), the most common methodological issues were.Conclusion: The results of most interventional studies conducted in Iran supported the effect of the interventions on reduction of RTIs. However due to some methodological or reporting shortcoming the results of these studies should be interpreted cautiously.
Mehdi Moradinazar; Farid Najafi; Mohammad Reza Baneshi; Ali Akbar Haghdoost
Volume 7, Issue 2 , April 2019, , Pages 99-104
Abstract
Objective: To estimate (under reporting) UR of SDS (Suicide deaths) and SAS (suicide attempts) in Kermanshah Province which is among provinces with high suicide rate in Iran.Methods: For estimating the size of UR suicide death registers, all cases of SAS and suicide deaths were retrieved from forensic ...
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Objective: To estimate (under reporting) UR of SDS (Suicide deaths) and SAS (suicide attempts) in Kermanshah Province which is among provinces with high suicide rate in Iran.Methods: For estimating the size of UR suicide death registers, all cases of SAS and suicide deaths were retrieved from forensic medicine and health centers. Then, using network scale up method, a sample of 500 cases, aged 18 to 65 years, were randomly selected from the general population on the basis of age - sex proportion. To find the 95% confidence interval, bootstrap technique was used.Results: The average coverage of SDS was 58.4%, the lowest and highest coverage rate of SDS were attributed to self-immolation (34.2%) and hanging (80.7%), respectively. The coverage rate of SAS for self-immolation and deliberate self-poisoning were 82.4% and 77.2%, respectively. Size estimation of SAS by NSU method revealed that deliberate self-poisoning with medication (61.7%), poisoning with toxins and chemicals (20.6%), and self-immolation (7.7%) were the most frequent methods of SAS.Conclusion: Given the low coverage of suicide registers, all causes of death, especially deaths classified as accident or deaths with undetermined category, are required to be accurately registered. Investigations of causes of death, correction of wrong codes, as well as interviews with survivors to give them assurance can reduce the rate of suicide denial and result in increased accuracy of death register coverage.
Seyed Masoud Lahsaee; Sina Ghaffaripour; Hossein Hejr
Volume 1, Issue 3 , July 2013, , Pages 102-107
Abstract
Objective: To investigate the decrease in hemoglobin concentration and hematocrit during elective surgery.Methods: This was a prospective study being performed in Nemazee Hospital of Shiraz University of Medical Sciences. We included a total of 50 American Society of Anesthesiology (ASA) I and II patients ...
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Objective: To investigate the decrease in hemoglobin concentration and hematocrit during elective surgery.Methods: This was a prospective study being performed in Nemazee Hospital of Shiraz University of Medical Sciences. We included a total of 50 American Society of Anesthesiology (ASA) I and II patients undergoing elective minor surgeries. Perioperative fluid administration was performed for all the patients and hemoglobin and hematocrit levels were measured three times: Once before the operation, once one hour after start of operation and once in the recovery room. Values were compared using paired sample t-test.Results: The mean age of the patients and controls was 39.66 ± 8.27 years. Hemoglobin level decreases significantly after one hour (p<0.001) and after the end of operation (p<0.001). In the same way hematocrit level was decreased significantly after one hour (p<0.001) and after the end of operation (p<0.001).Conclusion: In this patient population undergoing elective minor operations, there was significant decrease in the hemoglobin and hematocrit levels in response to the IV fluids administration.
Shahram Paydar; Mojtaba Mahmoodi; Mohammad Jamshidi; Hadi Niakan; Mohammad Keshavarz; Nader Moeenvaziri; Mohammad Esmaeil Ghorbaninejad; Farnaz Farrokhnia; Forough Izadi Fard; Zahra Jaafari; Yalda Golshan; Hamidreza Abbasi; Shahram Bolandparvaz; Behnam Honarvar
Volume 2, Issue 3 , July 2014, , Pages 103-109
Abstract
Objective: To explore the pros and cons of early versus delayed intervention when dealing with severe blunt liver injury with significant hemoperitoneum and hemodynamic instability.Methods: This retrospective cross-sectional study was performed at the Nemazi hospital, Shiraz, Southern Iran, level I trauma ...
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Objective: To explore the pros and cons of early versus delayed intervention when dealing with severe blunt liver injury with significant hemoperitoneum and hemodynamic instability.Methods: This retrospective cross-sectional study was performed at the Nemazi hospital, Shiraz, Southern Iran, level I trauma Center affiliated with Shiraz University of Medical Sciences. The study population comprised of all patients who were operated with the impression of blunt abdominal trauma and confirmed diagnosis of liver trauma during an 8-year period. All data were extracted from patients’ hospital medical records during the study period. The patients’ outcome was compared between those who underwent perihepatic packing or primary surgical repair.Results: Medical records of 76 patients with blunt abdominal liver trauma who underwent surgical intervention were evaluated. Perihepatic packing was performed more in patients who have been transferred to operation room due to unstable hemodynamics (p<0.001) as well as in patients with more than 1000 milliliters of hemoperitoneum based on pre-operative imaging studies (e.g. CT/US) (p=0.002).Conclusion: We recommend that trauma surgeons should approach perihepatic packing earlier in patients who have been developed at least two of these three criteria; unstable hemodynamics, more than 1000 milliliters hemoperitoneum and more than 1600 milliliters of intra-operative estimated blood loss. We believe that considering these criteria will help trauma surgeons to diagnose and treat high risk patients in time so significant hemorrhage (e.g. caused by dilatational coagulopathy, hypothermia and acidosis, etc.) can ultimately be prevented and more lives can be saved.
Hamed Ghoddusi Johari; Seyed Arman Moein; Ahmad Hosseinzadeh; Javad Kojuri; Amirhossein Roshanshad; Reza Shahriarirad
Volume 10, Issue 3 , July 2022, , Pages 103-109
Abstract
Objective: To evaluate the efficacy of chest x-ray (CXR) in blunt traumatic aortic injury (BTAI) as a primaryimaging tool in trauma patients.Methods: We retrospectively reviewed our hospital records for blunt thoracic aortic injury patients who had atherapeutic intervention from January 2015 to February ...
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Objective: To evaluate the efficacy of chest x-ray (CXR) in blunt traumatic aortic injury (BTAI) as a primaryimaging tool in trauma patients.Methods: We retrospectively reviewed our hospital records for blunt thoracic aortic injury patients who had atherapeutic intervention from January 2015 to February 2021. Patients’ characteristics, initial chest x-rays, andcomputed tomography (CT) scan were extracted and re-evaluated.Results: Eighteen patients matched the criteria of our research. The mean age and the injury severity score(ISS) was 29.8±11.2 and 38.4±14.4, respectively. Seven patients (38.9%) underwent thoracic endovascularaortic repair (TEVAR), and 11 (61.1%) had open surgery. The TEVAR group had significantly lower meanintensive care unit stay days (6.6±3.9 vs. 10.8±6.9 in open aortic repair (OAR), p<0.05). The percentile ofpatients requiring blood transfusion was significantly lower in the TEVAR group (57% vs. 100% in OAR,p<0.05). Mediastinal widening (66.7%) was the most common finding during the evaluation of initial chestx-rays. Interestingly, 22.2% of the initial x-rays were not remarkable for BTAI.Conclusion: TEVAR is an advantageous choice in the management of BTAI. However, open aortic repair is theoptimal decision in certain situations. It is suggested that the Interventional management of the BTAI must beperformed by experienced vascular surgeons in a medical center capable of both OAR and TEVAR.
Shahram Paydar; Golnar Sabetian; Zahra Ghahramani; Seyed Mohsen Mousavi; Hosseinali Khalili; Hamid Reza Abbasi; Shahram Bolandparvaz
Volume 3, Issue 4 , October 2015, , Pages 118-121
Pitsucha Sanguanwit; Chaiyaporn Yuksen; Nishapa Laowattana
Volume 9, Issue 3 , July 2021, , Pages 118-124
Abstract
Objective: To compare the intubation success rate of the first attempt between Video Laryngoscopy (VDL) and Direct Laryngoscopy (DL) in the emergency department (ED). Methods: This is a study of a randomized control trial includes the patients with acute respiratory failure and the emergency ...
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Objective: To compare the intubation success rate of the first attempt between Video Laryngoscopy (VDL) and Direct Laryngoscopy (DL) in the emergency department (ED). Methods: This is a study of a randomized control trial includes the patients with acute respiratory failure and the emergency physician who intended to perform intubation in the ED from July 2015 to June 2016. We were selected the patients randomly by the sequentially numbered opaque sealed envelopes technique and were assigned to undergo the first attempt of either VDL (n=78) or DL (n=80). We collected the data information regarding the demographic characteristics, predictors of difficult intubation, rapid sequence intubation, attempt, Cormack–Lehane view, and immediate complications. Results: The success of VDL in the first attempt was 73.1%, which were tended to be better than DL (58.8%) (p=0.060). Glottis view (Cormack–Lehane view 1–2) of VDL was significantly better (88.5%) than of DL (72.5%) (p=0.010). The immediate complications were not different. Conclusions: VDL showed a trend of better success than DL. VDL can increase the first-attempt intubation success and provide a better glottis view in emergency intubation. Trial registration: The trial was registered in the Thai Clinical Trial Registry, identifier TCTR 20200503003. Registered 16 June 2020, ‘Retrospectively registered’, http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=6186
Shahram Paydar; Golnar Sabetian; Hosseinali Khalili; Hamid Reza Abbasi; Shahram Bolandparvaz; Zahra Ghahramani; Behnam Dalfardi; Donat R. Spahn
Volume 4, Issue 3 , July 2016, , Pages 121-123
Joao Augusto; Miguel Santos; Daniel Faria; Paulo Alves; David Roque; Jose; Morais; Victor Gil; Carlos Morais
Volume 8, Issue 3 , July 2020, , Pages 135-141
Abstract
Objective: To evaluate the impact of a real-time visual feedback device on CCs rate and depth delivered by healthcare professionals.Methods: In a simulated scenario a sensor was placed on a manikin’s chest and connected to a defibrillator which provided real-time visual feedback on the ...
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Objective: To evaluate the impact of a real-time visual feedback device on CCs rate and depth delivered by healthcare professionals.Methods: In a simulated scenario a sensor was placed on a manikin’s chest and connected to a defibrillator which provided real-time visual feedback on the rate and depth of CCs. Thirty-two healthcare professionals performed sequentially 5 cycles of 30 CCs without (FeedOFF) and with (FeedON) feedback. CCs with a depth between 50 and 60mm and a rate between 100 and 120cpm were considered optimal.Results: Visual feedback resulted in a significant increase in the proportion of CCs with optimal depth (median 8.7 [interquartile range 0.7–55.5]% FeedOFF vs 63.3 [17.6–88.1]% FeedON, p=0.002) and optimal rate (median 51.3 [1.3–81.3]% FeedOFF vs 68.3 [45.3–86.1]% FeedON, p=0.018). Overall, CCs were too shallow and too fast in the FeedOFF cycle. There was also a significant increase in optimal CCs (optimal depth and rate) with the use of the feedback device (from median 0.7 [0–26.9]% FeedOFF to 31.9 [3.6-59.9]% FeedON, p=0.001). Participants’ factors such as age, sex, body mass index, job or time since last CPR training did not have a significant impact on CPR quality.Conclusion: In the absence of visual feedback, there is a tendency towards lower depth and higher rate of CCs. The use of feedback technology significantly improves the quality of CCs.
