Abdolkhalegh Keshavarzi; Mehdi Ayaz; Maryam Dehghankhalili
Volume 4, Issue 4 , October 2016, , Pages 197-201
Abstract
Objective: To compare the outcome of patients with up to 60% total body surface area (TBSA) thermal burns undergoing ultra-early and early excision and grafting.Methods: This historical cohort study was performed in two referral burn centers of Shiraz during a 1-year period from 2015 to 2016. We included ...
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Objective: To compare the outcome of patients with up to 60% total body surface area (TBSA) thermal burns undergoing ultra-early and early excision and grafting.Methods: This historical cohort study was performed in two referral burn centers of Shiraz during a 1-year period from 2015 to 2016. We included those patients with thermal burns up to 60% TBSA who underwent ultra-early (48-72 hours) and early (7-10 days) excision and grafting. We excluded those who were hemodynamically unstable and those with electrical burns. The outcome of patients was determined by graft success, operation duration, blood loss, hospital length of stay and mortality rate. Results: We included a total number of 107 patients with mean age of 32.1 ± 11.6 years. There were 65 (60.7%) men and 42 (39.3%) women among the patients. Both study groups were comparable regarding the baseline characteristics. Ultra-early excision and grafting was associated with more, higher graft success rate (p=0.048), lower infection rate (p=0.037), shorter hospital length of stay (p=0.044) and lower mortality rate (p=0.027).Conclusion: Ultra-early excision and grafting in patients with thermal burns covering less than 60% TBSA was associated with higher graft success rate, shorter hospital length of stay, lower infection rate and lower mortality rate when compared to early surgery.
Fatemeh Rasouli-Sangani; Gholam Hossein Farjah; Sima Nasry
Volume 6, Issue 3 , July 2018, , Pages 201-206
Abstract
Objective: To determine the effects of chicken embryo brain extract (BE) on transects sciatic nerve in male rats.Methods: Thirty adult male Sprague-Dawley rats weighing 200 to 250 g, were randomized into three groups treated with (1) sham surgery, (2) normal saline (NS), and (3) brain extract (BE). The ...
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Objective: To determine the effects of chicken embryo brain extract (BE) on transects sciatic nerve in male rats.Methods: Thirty adult male Sprague-Dawley rats weighing 200 to 250 g, were randomized into three groups treated with (1) sham surgery, (2) normal saline (NS), and (3) brain extract (BE). The BE was taken from incubating chick embryos at day 8. The sciatic nerve was exposed and sharply transected at the mid thigh level. Immediate epineurial repair was then performed. The BE treated animals were given 400 µl/kg of the chick embryo BE intraperitoneal, once daily, for 2 weeks. All animals were evaluated by sciatic functional index (SFI), electrophysiology, histology, and immunohistochemistry at days 28, 90 after surgery.Results: The mean SFI difference between BE and NS groups at days 28, 60 and 90 after surgery was statistically significant (p=0.086). The mean number of myelinated fibers in the BE group was significantly greater than that of the NS group on days 28 and 90 after surgery (p=0.034). At days 28 and 90 after surgery, the mean nerve conduction velocity (NCV) in the BE group was significantly faster than that of the NS group (p=0.041).Conclusion: These results indicate for the first time that chick embryo brain extract can enhance peripheral nerve regeneration in rat.
Rebecka Ah; MB BChir; Yang Cao; Hakan Geijer; Kardo Taha; Sahar Pourhossein-Sarmeh; Peep Talving; Olle Ljungqvist; Shahin Mohseni
Volume 7, Issue 3 , July 2019, , Pages 223-231
Abstract
Objective: To evaluate the Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) in comparison with other risk factors for mortality including osteopenia as an indicator for frailty in geriatric patients subjected to emergency laparotomy. Methods: ...
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Objective: To evaluate the Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) in comparison with other risk factors for mortality including osteopenia as an indicator for frailty in geriatric patients subjected to emergency laparotomy. Methods: All geriatric patients (≥65 years) undergoing emergency laparotomy at a single university hospital between 1/2015 and 12/2016 were included in this cohort study. Demographics and outcomes were retrospectively collected from medical records. Association between prognostic markers and 30-day mortality was assessed using Poisson and backward stepwise regression models. Prognostic value was assessed using receiver operating characteristic (ROC) curves.Results: 209 patients were included with a mean age of 76 ± 7.3 years. American Society of Anesthesiologists (ASA) classification, age, indication and type of surgery, hypotension, transfusion requirement and current malignancy proved to be statistically significant predictors of 30-day mortality. P-POSSUM mortality was statistically significant in the backward stepwise regression (incidence rate ratio=1.58, 95% CI: 1.16–2.15, p=0.004) while osteopenia was not. P-POSSUM had poor prognostic value for 30-day mortality with an area under the ROC curve (AUC) of 0.59. The prognostic value of P-POSSUM improved significantly when adjusting for patient covariates (AUC=0.83).Conclusion: P-POSSUM and osteopenia alone hardly predict 30-day mortality in geriatric patients following emergency laparotomy. P-POSSUM adjusted for other patient covariates improves the prediction.
Sadettin Er; Sabri Özden; Umut Fırat Turan; Egemen Özdemir; Barış Saylam; Mesut Tez
Volume 8, Issue 4 , October 2020, , Pages 224-228
Abstract
Objective: To compare the differences in the clinical course of acute appendicitis between early elderly (60-79 years) and late elderly patients (≥80 years). Method: The sample consisted of 177 patients aged over 60 that underwent surgery at the emergency service with the diagnosis of acute appendicitis ...
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Objective: To compare the differences in the clinical course of acute appendicitis between early elderly (60-79 years) and late elderly patients (≥80 years). Method: The sample consisted of 177 patients aged over 60 that underwent surgery at the emergency service with the diagnosis of acute appendicitis between January 2010 and May 2018. Patients’ data were retrospectively obtained from electronic records. Patients that had undergone appendectomy or negative appendectomy or had an appendix tumor were excluded from the study. The patients were divided into two groups by age; early elderly (60-79 years) and late elderly (≥80 years). Results: Of the 177 patients included in the study, 162(91%) were 60-79 years old and 15 (9%) were over 80. A statistically significant difference was found between the early and late elderly groups in terms of perforation, requirement for intensive care (p =0.001), red cell distribution width (p =0.025), the Clavien-Dindo classification (p =0.020), and the Charlson comorbidity index (p =0.005). The mean hospital stay was four and 11 days for early and late elderly groups, respectively. Multivariate analysis revealed that age alone was an independent factor with a statistically significant effect on mortality (OR=Odds Ratio: 53, 95% CI: 16.91-166.08; (p <0.001)). Conclusion: In particular, in the elderly patients over 80 years old, the clinical manifestation of acute appendicitis at hospital admission is in the form of perforation. Therefore, in this age group, a careful, precise and prompt diagnosis is crucial.
Maryam Iman; Mostafa Araghi; Yunes Panahi; Rahim Mohammadi
Volume 5, Issue 4 , October 2017, , Pages 240-248
Abstract
Objective: To determine the effects of chitosan-zinc oxide nanocomposite conduit on transected sciatic nerve in animal model of rat.Methods: Sixty male White Wistar rats were used in this study. A 10-mm sciatic nerve defect was bridged using a chitosan-zinc oxide nanocomposite conduit (CZON) filled with ...
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Objective: To determine the effects of chitosan-zinc oxide nanocomposite conduit on transected sciatic nerve in animal model of rat.Methods: Sixty male White Wistar rats were used in this study. A 10-mm sciatic nerve defect was bridged using a chitosan-zinc oxide nanocomposite conduit (CZON) filled with phosphate buffered saline. In chitosan group (CHIT) the chitosan conduit was filled with phosphate buffered saline solution. In sham-operated group (SHAM), sciatic nerve was exposed and manipulated. In transected group (TC), left sciatic nerve was transected and nerve cut ends were fixed in the adjacent muscle. The regenerated fibers were studied within 12 weeks after surgery.Results: The behavioral and functional tests confirmed faster recovery of the regenerated axons in CZON group compared to Chitosan group (p<0.05). The mean ratios of gastrocnemius muscles weight were measured. There was statistically significant difference between the muscle weight ratios of CZON and Chitosan groups (p<0.05). Morphometric indices of regenerated fibers showed number and diameter of the myelinated fibers were significantly higher in CZON than in Chitosan. In immuohistochemistry, the location of reactions to S-100 in CZON was clearly more positive than Chitosan group.Conclusion: Chitosan-zinc oxide nanocomposite conduit resulted in acceleration of functional recovery and quantitative morphometric indices of sciatic nerve.
Saber Azami-Aghdash; Mir Hossein Aghaei; Homayoun Sadeghi-Bazarghani
Volume 6, Issue 4 , October 2018, , Pages 279-291
Abstract
Objective: To systematically review the epidemiological patterns and interventions for prevention of road traffic injuries (RTIs) among elderly.Methods: Searching keywords including: accident, trauma, road injury, road traffic injuries, aging, old, elder, strategy, intervention, road traffic crash prevention ...
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Objective: To systematically review the epidemiological patterns and interventions for prevention of road traffic injuries (RTIs) among elderly.Methods: Searching keywords including: accident, trauma, road injury, road traffic injuries, aging, old, elder, strategy, intervention, road traffic crash prevention and traffic accident in databases including, Google scholar, SID, IranMedex, PubMed and Scopus. English and non-Persian articles, articles presented in congresses, articles that considered elderly people to have age under than 60 years were excluded. The reporting quality of articles was assessed by two experts using Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) check list.Results: RTIs compromised 23.6% of total injuries among elderly. The most frequent injuries were about car accidents (51.4%). Pedestrian injuries composed 48.1% of the RTIs. Head and neck (32.1%) were most injured body parts. There was a significant difference between elderly and non-elderly people in terms of RTIs associated mortality (Odd=2.57 [1.2-5.4 CI 95%]). Overall 25 main domains of intervention and 73 subordinate domains were extracted in five categories (human, road and environment, tools and cars, medical, legal and political issues).Conclusion: According to the notable prevalence and fatality of RTIs, lack of sufficient studies and valid evidence of the present study can provide an appropriate evidence for better interventions for RTIs prevention among elderly.
Veldurti Ananta Kiran Kumar; Narayanam Sai Kiran; Valluri Anil Kumar; Amrita Ghosh; Ranabir Pal; Vishnu Vardhan Reddy; Amit Agrawal
Volume 7, Issue 4 , October 2019, , Pages 355-360
Abstract
Objectives: To assess the impact, timing, the intra and early post-operative complications and the survival outcome of tracheostomy in critically ill neurosurgery patients. Methods: This study was a retrospective data mining where data was collected from hospital records from 175 consecutive patients ...
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Objectives: To assess the impact, timing, the intra and early post-operative complications and the survival outcome of tracheostomy in critically ill neurosurgery patients. Methods: This study was a retrospective data mining where data was collected from hospital records from 175 consecutive patients who underwent tracheostomy in the department of Neurosurgery at the Narayna Medical College Hospital, Nellore, India from Jan 2016 to April 2018. A proforma was used to note down the details on the patient status before and after tracheostomy: Glasgow coma scale (GCS), procedure and intra and post-operative complications, type of tracheostomy cannula, details of decannulation, respiration difficulties, and problems with wound, swallowing difficulties, and voice difficulties, stay in intensive care unit (ICU) and hospital and survival status of the patient. Results: In our series, mean age of TBI cases was 47.42±16.62; mean hospital stay and ICU stay was 18.81±10.22 and 12.58±7.36 days respectively. In all age groups, more tracheostomy was needed in cranial injury cases and surgery was major intervention. Commoner complications were mucous deposition (6.86%), blockage of tracheostomy canula (6.29%), bleeding from multiple attempts (6.06%), excessive bleeding (2.94%). Cranial injury needed tracheostomy more in all age groups and more done at operation theatre without significant improvement of GCS score. Survival was statistically higher after tracheostomy irrespective of GCS status or venue of intervention. Conclusion: Tracheostomy should be considered as soon as the need for airway access is identified during intervention of the critically ill neurosurgical patients.
Farooq Ahmad Ganie; Hafeezulla Lone; Ghulam Nabi Lone; Mohd Lateef Wani; Shyam Singh; Abdual Majeed Dar; Nasir-u-din Wani; Shadab nabi wani; Nadeem-ul Nazeer
Volume 1, Issue 1 , January 2013, , Pages 7-16
Abstract
Lung contusion is an entity involving injury to the alveolar capillaries, without any tear or cut in the lung tissue. This results in accumulation of blood and other fluids within the lung tissue. The excess fluid interferes with gas exchange leading to hypoxia. The pathophysiology of lung contusion ...
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Lung contusion is an entity involving injury to the alveolar capillaries, without any tear or cut in the lung tissue. This results in accumulation of blood and other fluids within the lung tissue. The excess fluid interferes with gas exchange leading to hypoxia. The pathophysiology of lung contusion includes ventilation/perfusion mismatching, increased intrapulmonary shunting, increased lung water, segmental lung damage, and a loss of compliance. Clinically, patient’s presents with hypoxiemia, hypercarbia and increase in laboured breathing. Patients are treated with supplemental oxygen and mechanical ventilation whenever indicated. Treatment is primarily supportive. Computed tomography (CT) is very sensitive for diagnosing pulmonary contusion. Pulmonary contusion occurs in 25–35% of all blunt chest traumas.
Hamid Reza Eftekharian; Homa Ilkhani pak
Volume 5, Issue 1 , January 2017, , Pages 13-17
Abstract
Objective: To evaluate the effects of intravenous ketorolac on early postoperative pain in patients with mandibular fractures, who underwent surgical repair.Methods: This prospective, randomized, placebo-controlled clinical trial was conducted in Shahid Rajaei Hospital, affiliated with Shiraz University ...
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Objective: To evaluate the effects of intravenous ketorolac on early postoperative pain in patients with mandibular fractures, who underwent surgical repair.Methods: This prospective, randomized, placebo-controlled clinical trial was conducted in Shahid Rajaei Hospital, affiliated with Shiraz University of Medical Sciences during a 1-year period from 2015 to 2016. We included a total number of 50 patients with traumatic mandibular fractures who underwent surgical repair. Patients with obvious contraindications to ketorolac such as asthma, renal dysfunction, peptic ulceration, bleeding disorders, cardiovascular disease, mental retardation, or allergy to ketorolac or NSAIDS, were excluded. The patients were randomly assigned to receive intravenous ketorolac (30 mg) at the end of operation in post anesthesia care unit immediately upon the onset of pain (n=25), or intravenous distilled water as placebo (n=25). Postoperative monitoring included non-invasive arterial blood pressure, ECG, and peripheral oxygen saturation. The postoperative pain was evaluated by a nurse using visual analog scale (VAS) (0–100 mm) pain score 4 hours after surgery and was compared between the two study groups.Results: Overall we included 50 patients (25 per group) in the current study. The baseline characteristics including age, gender, weight, operation duration, anesthesia duration and type of surgical procedure were comparable between two study groups. Those who received placebo had significantly higher requirements for analgesic use compared to ketorolac group (72% vs. 28%; p=0.002). Ketorolac significantly reduced the pain intensity 30-min after the operation (p<0.001). There were no significant side effects associated with ketorolac.Conclusion: Intravenous single-dose ketorolac is a safe and effective analgesic agent for the short-term management of mild to moderate acute postoperative pain in mandibular fracture surgery and can be used as an alternative to opioids.
Siyamak Tahmasebi; Seyyed Mohammad Hosein Javadi; Tahereh Azari Arghun; Forough Edrisi; Alireza Tajlili
Volume 8, Issue 1 , January 2020, , Pages 19-26
Abstract
Objective: To identify the human factors contributing to traffic accidents with a special focus on psychosocial factors amongst young girls of Tehran, Iran.Methods: In a descriptive study conducted in Tehran, Iran in 2013, 108 girls aged 18-24 were enrolled by using a stratified cluster sampling ...
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Objective: To identify the human factors contributing to traffic accidents with a special focus on psychosocial factors amongst young girls of Tehran, Iran.Methods: In a descriptive study conducted in Tehran, Iran in 2013, 108 girls aged 18-24 were enrolled by using a stratified cluster sampling method. Participants filled a wide range of validated questionnaires about traffic psychology.Results: The developed psychological model about behaviors of drivers’ factors as well as agreeable and aggressive personality trait with B coefficient of 0.25% and 0.37% were able to predict violation, driving style, perception of police laws, and off hook scheme and the mistrust with B coefficient of 0.33%, 0.23% and 0.28% in the level of 0.1 were able to predict violations and lapses of sample group, respectively. Extroversion with B coefficient of 0.27% also predicted unintentional violations of girls. B coefficient for perception of police laws was 0.22%. This was 0.25% for openness to experiences. Concerning driving accidents, the perception ofpolice rules has the highest predictability.Conclusion: According to the results of the current research amongst girls in Tehran, a gender-sensitive interventional model can be designed for reduction of traffic accidents for this population group.
Seyed Mahmoudreza Sajjadi; Fatemeh Rahmanian; Razieh Sadat Mousavi-Roknabadi; Faramarz Farahmand; Afsaneh Dehbozorgi; Hadid Hamrah; Mohamad Javad Moradian
Volume 9, Issue 1 , January 2021, , Pages 21-27
Abstract
Objective: To investigate the patients transferred by helicopters, as well as an emergent medical services that were performed for them.Methods: In this retrospective cross-sectional study, all patients who were transferred by Fars province of Helicopter Emergency Medical Services (HEMS) to ...
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Objective: To investigate the patients transferred by helicopters, as well as an emergent medical services that were performed for them.Methods: In this retrospective cross-sectional study, all patients who were transferred by Fars province of Helicopter Emergency Medical Services (HEMS) to Shiraz hospitals, southern Iran (March 2017-March 2019) were investigated. Patients’ information was collected and analyzed includes age, gender, dispatch reason, trauma mechanisms, take hold of emergent medical services, as well as the air transportation time, time between dispatch from the origin hospital and starting the procedures, and patients’ outcome.Results: Eighty-three patients were enrolled with the mean±SD age of 36.9±19.47 years that 75.9% had trauma (p <0.0001). Mental status deterioration (25.3%) was the most dispatched indications. The mortality rate was 13.25% totally (11.11% in traumatic vs. 10% in non-traumatic). The mean±SD of air transportation time was significantly lower than ground transportation in both traumatic (p=0.0013) and non-traumatic (p <0.0001) patients. Also, the mean±SD of time between dispatch from the origin hospital and starting the procedures wasstatistically lower in air transportation in both traumatic (p=0.0028) and non-traumatic (p=0.0017) patients.Conclusion: Most of the patients transferred by HEMS were traumatic. The air transportation time as well as the time between dispatches from the origin hospital to the starting of the procedures were significantly lower in HEMS in comparison with ground transportation for both traumatic and non-traumatic patients.
Navid Kalani; Naser Hatami; Sajed Ali; Neema John Mehramiz; Fatemeh Rahmanian; Esmaeel Raeyat doost; Marzieh Haghbeen; Samaneh Abiri; Mahdi Foroughian; Mohsen Ebrahimi
Volume 10, Issue 1 , January 2022, , Pages 21-26
Abstract
Objective: To compare the characteristics of the emergency medical services (EMS) brought COVID-19 patients versus self-referred walk-in patients. Methods: This was a Cross-sectional study of COVID-19 infected cases in Jahrom, south of Iran. Age, sex, the symptoms of beginning days’ passing, ...
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Objective: To compare the characteristics of the emergency medical services (EMS) brought COVID-19 patients versus self-referred walk-in patients. Methods: This was a Cross-sectional study of COVID-19 infected cases in Jahrom, south of Iran. Age, sex, the symptoms of beginning days’ passing, respiratory distress, PO2 at arrival, admission length and inhospital death were retrieved for confirming COVID-19 cases in the whole 2020 year. Respiratory distress was considered as the sign that agitates the patient to call EMS care. Survival analysis was used to evaluate the possible difference of the hospitalization outcome in EMS brought or Self-referred walk-in (SRW) patients. Results: There was 704 (27.1%) registries patients transfer to the hospital by EMS and 1895 (72.9%) cases with SRW referred to the hospital. The survival distributions for the EMS group were statistically significant and lower than SRW group (p <0.05). Despite the SRW patients, respiratory distress was associated with lower survival in EMS group (p <0.05). Days passing the symptom’s beginning was significantly different between EMS group (6.1±5.3 days) and SRW group (6.9±4.6 days). Cox regression showed higher mortality rate in patients higher than 75 years old in both groups (p <0.05). Higher PO2 at arrival was associated with lower mortality rate of Hazard Ratio of 0.959 (p <0.001) and 0.903 (p <0.001) in EMS and SRW groups, respectively. The history of heart disease and hypertension were associated with 1.011 and 1.088 times more than mortality risk in EMS group; while cancer history was associated with 2.74 times more of mortality risk in SRW group. Conclusion: It seems that severe acute respiratory syndrome occurs soon in some patients that lead to the need for an ambulance to transfer the patient to the hospital. Therefore, EMS transfer patients should be considered for more risk of severe COVID-19; considering comorbidities of heart disease and hypertension as red flags.
Seyed Mostafa Mirakbari; Amir Mohammad Kazemifar; Abbas Allami; Ameneh Barikani
Volume 12, Issue 1 , January 2024, , Pages 21-25
Abstract
Objective: This study aimed to investigate the incidence and pattern of tramadol-induced seizures and injuriesin patients admitted to the hospital.Methods: The cross-sectional study included 300 patients with alleged tramadol intoxication. Demographicinformation, tramadol dosage and duration of abuse, ...
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Objective: This study aimed to investigate the incidence and pattern of tramadol-induced seizures and injuriesin patients admitted to the hospital.Methods: The cross-sectional study included 300 patients with alleged tramadol intoxication. Demographicinformation, tramadol dosage and duration of abuse, co-existing illicit drug abuse, hospital stay length, andoccurrence of seizures and trauma (type and site of injuries) were collected. Different statistical tests, includingthe Mann-Whitney U-test, Pearson’s Chi-square test, and Student’s t-test, were conducted to compare thepatients with and without seizures, trauma, and co-ingestion of illicit drugs. The analysis was performed usingSPSS software (version 21.0). A p value of less than 0.05 was considered statistically significant.Results: The average patient’s age was 24.66±5.64 years, with males comprising 84.3% of the sample. Themean tramadol dose and duration of abuse were 1339.3±1310.2 mg and 2.43±1.35 years, respectively. Seizureswere observed in 66% of patients, with men having a higher incidence (69.6% vs. 46.8%; p=0.004). Trauma wasreported in 23% of patients, accounting for 35.4% of seizure cases. All trauma patients had experienced seizures,with the head and neck being the most prevalent injury sites (55.1%), typically presenting as abrasions (55.9%).Patients with seizures and trauma had an average hospital stay of 1.73±0.94 days, which was significantlylonger.Conclusion: Trauma occurs in more than one-third of tramadol-induced seizures, highlighting the needto perform physical examinations to detect and localize injuries. Tramadol-associated traumas prolongedhospitalization times and thus required prompt attention to prevent further injuries during pre-hospital handlingand transferring to hospitals.
Seyed Mohsen Mousavi; Shahram Paydar; Sedigheh Tahmasebi; Leila Ghahramani
Volume 2, Issue 1 , January 2014, , Pages 22-26
Abstract
Objective: To determine the effects of intravenous Acetaminophen (Apotel®) on pain severity and clinical findings of peritonitis in patients with acute appendicitis.Methods: This randomized cross-over clinical trial was carried out duringa 6-month period from August 2012 to February 2013 and comprised ...
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Objective: To determine the effects of intravenous Acetaminophen (Apotel®) on pain severity and clinical findings of peritonitis in patients with acute appendicitis.Methods: This randomized cross-over clinical trial was carried out duringa 6-month period from August 2012 to February 2013 and comprised 107 patients diagnosed with acute appendicitis. Patients were randomly assigned to received placebo (n=) or Apotel® (n=). Patients were evaluated before, 30 minutes, 1 hour and 4 hours after administration of Apotel® or placebo,and were told to fill in two forms. The first form required patientsto measure their painintensityaccording to visual analogue scale (VAS). The second form was filled by a surgeon who examined the patients and recorded his or her findings using Alvarado score criteria for diagnosis of acute appendicitis at foregoing time points.Results: Of 72 patients, 37 (51.4%) were men and 35 (48.6%) were women. The mean age of the patients was 34.1±13.5 years. The mean pain score in 107 patients included in this study was 7.96±2.3. Those who received Apotel® had significantly lower pain scores when compared to placebo at 30 minutes (p<0.001), 1 hour (p<0.001) and 4 hours of administration. There was no significant difference between two study groups regarding the frequency of Alvarado score; however the frequency of fever was significantly lower in those who received Apotel® (p<0.001). We found that Apotel® was not associated with resolved physical findings of acute appendicitis in different time intervals.Conclusion: Apotel® does not affect the clinical findings of acute appendicitis and dos not interfere with the accurate diagnosis. Therefore, it could safely be used as a reliable pain relieving agent, in patients with acute appendicitis.
Majid Akrami; Ali Ghaeini Hesarooeih; Maryam Barfei; Vahid Zangouri; Zahra Alborzi
Volume 3, Issue 1 , January 2015, , Pages 22-26
Abstract
Objective: To determine the epidemiological, clinical, laboratory characteristics as well as outcome of 411 patients with bowel obstruction in Southern Iran. Methods: This was a cross-sectional study being performed in Shahid Faghihi hospital of Shiraz between 2006 and 2012. We reviewed the medical charts ...
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Objective: To determine the epidemiological, clinical, laboratory characteristics as well as outcome of 411 patients with bowel obstruction in Southern Iran. Methods: This was a cross-sectional study being performed in Shahid Faghihi hospital of Shiraz between 2006 and 2012. We reviewed the medical charts of the 411 patients with initial diagnosis of bowel obstruction who were admitted to our center during the study period. The patients’ demographic, clinical and laboratory findings as well as their management and outcome was recorded in data gathering forms. The data were then analyzed according to the outcome and clinical characteristics. Results: Among the 411 patients with initial diagnosis of bowel obstruction, 253 (61.5%) were men and 158 (38.5%) were women. The mean age of the patients was 48.2±19.7 years. Besides, 73.6% were observed and 26.4% were operated. Those who were operated had those who underwent operation had significantly lower frequency of obstipation (28.1% vs. 71.9%; p=0.045) and abdominal distention (32.3% vs. 67.7%; p=0.007). Intraoperative findings included adhesion band formation in 50 (48.1%), mass 18 (17.3%), and hernia 7 (6.7%). We found that the frequency of malignancy was significantly higher in those who were managed conservatively compared to those undergoing operation (64.3% vs. 35.7%; p=0.042). The mean hospital stay was significantly higher in those who underwent operation (8.1 ±7.5 vs. 2.6±2.2 days; p=0.035).Conclusion: The results of this study demonstrates although some signs and symptoms, such as abdominal pain, vomiting, abdominal tenderness, abdominal distention, and obstipation, were more common among the patients with bowel obstruction, they were not sensitive and specific enough for definite diagnosis. Due to the lack of positive predictive value of clinical signs and symptoms in diagnosis of bowel obstruction, a reasonable and logical modality is needed for bowel obstruction diagnosis with better accuracy.
Shahram Paydar; Behnam Dalfardi; Bardia Zangbar-Sabegh; Hossein Heidaripour; Leila Pourandi; Alireza Shakibafard; Mehdi Tahmtan; Leila Shayan; Mohammad Hadi Niakan
Volume 6, Issue 1 , January 2018, , Pages 26-30
Abstract
Objective: To determine the predictive value of repeated abdominal ultrasonography in patients with multiple trauma and decreased level of consciousness (LOC).Methods: This prospective cross-sectional study was conducted over a six-month period at Shahid Rajaee Trauma Hospital, Shiraz, Iran. We included ...
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Objective: To determine the predictive value of repeated abdominal ultrasonography in patients with multiple trauma and decreased level of consciousness (LOC).Methods: This prospective cross-sectional study was conducted over a six-month period at Shahid Rajaee Trauma Hospital, Shiraz, Iran. We included hemodynamically stable blunt abdominal trauma patients with a decreased LOC (Glasgow Coma Scale ≤ 13) who were referred to the neurosurgery ICU ward. Included cases underwent 1 contrast-enhanced CT scan and two-time ultrasonographic study of the abdomen with an interval of 48 hours. The diagnostic accuracy of the ultrasonography was determined according to the CT-scan results.Results: Overall 80 patients with mean age of 37.75 ± 18.67 years were included. There were 17 (21.3%) women and 63 (78.8%) men among the patients. Compared with the CT-Scan, the first ultrasonography showed a sensitivity of 60%, specificity of 80%, PPV of 16.60%, NPV of 96.80%, and a diagnostic accuracy of 70%. The same values for the second ultrasonographic study were 80%, 79%, 20%, 98%, and 79%, respectively. In 4 (5%) patients whose first ultrasonography and CT scan results were negative, the second ultrasonography was positive for injury.Conclusion: In patients with blunt trauma to the abdomen, when the only indication of abdominal CT scan is a decreased LOC, two ultrasonographic studies can replace a CT imaging.
Faramarz Dobakhti; Ali Zargar; Taraneh Naghibi
Volume 11, Issue 1 , January 2023, , Pages 26-31
Abstract
Objective: Ventilator-associated pneumonia is the common cause of morbidity and mortality in the intensivecare unit. Due to the antimicrobial effect of chlorhexidine, and the long-lasting result of mucoadhesive drugs,this study aimed to determine the effect of chlorhexidine mucoadhesive gel on the prevention ...
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Objective: Ventilator-associated pneumonia is the common cause of morbidity and mortality in the intensivecare unit. Due to the antimicrobial effect of chlorhexidine, and the long-lasting result of mucoadhesive drugs,this study aimed to determine the effect of chlorhexidine mucoadhesive gel on the prevention of ventilatorassociatedpneumonia in critical patients.Method: In this clinical trial, 64 ventilated patients were selected and randomly allocated into two groups. Thefirst group received 0.2% chlorhexidine mucoadhesive gel and the second group received 0.2% chlorhexidinesolution as a mouthwash. Every three days, the incidence of ventilator-associated pneumonia was evaluatedby the clinical score of pulmonary infection. The data were analyzed by SPSS statistical software version 20.Results: There was no statistically significant difference in demographic characteristics between the twogroups. In the control group, 25% of the patients had ventilator-associated pneumonia, while it was only 15.6%in the intervention group; however, the incidence of ventilator-associated pneumonia revealed no significantdifference between the two groups (HR ratio, 0.86; 95% confidence interval, 0.49 to 1.83 p=0.356).In addition,there was no statistically significant difference between the number of days connected to the ventilator(p=0.854), the number of days hospitalized in the intensive care unit (p=0.423), and the death rate (p=0.634)between the two groups.Conclusion: Although no significant statistical difference was detected between chlorhexidine mucoadhesivegel and chlorhexidine solution in the prevention of ventilator-associated pneumonia, the incidence of pneumoniain the mucoadhesive gel group was clinically less than in the control group. It is better to repeat the study witha larger statistical population.
Mahan Alizadeh- Mohajer; Abbas Raisi; Ghasem Farjanikish; Rahim Mohammadi
Volume 7, Issue 1 , January 2019, , Pages 28-34
Abstract
Objective: To assess the effect of locally administered verapamil on transected peripheral nerve regeneration and functional recovery.Methods: Sixty male healthy white Wistar rats were divided into four experimental groups (n=15), randomly: In transected group (TC), left sciatic nerve was transected ...
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Objective: To assess the effect of locally administered verapamil on transected peripheral nerve regeneration and functional recovery.Methods: Sixty male healthy white Wistar rats were divided into four experimental groups (n=15), randomly: In transected group (TC), left sciatic nerve was transected and stumps were fixed in the adjacent muscle. In treatment group defect was bridged using chitosan tube (CHIT/Verapamil) filled with 10 µL verapamil (100ng/mL). In chitosan conduit group (CHIT), the tube was filled with phosphate-buffered saline alone. In sham-operated group (SHAM), sciatic nerve was exposed and manipulated. The repair trend was examined based on behavioral and performance tests as well as the variations of the gastrocnemius muscle, morphometric indices, and immunohistochemical indices.Results: Sciatic nerve functional study, muscle mass and morphometric indices confirmed faster recovery of regenerated axons in CHIT/Verapamil than CHIT group (P=0.001). When loaded in a chitosan tube verapamil accelerated and improved functional recovery and morphometric indices of sciatic nerve. Immunohistochemical analysis revealed the S-100 protein was vastly present in the transverse nerve sections and the myelin sheath. In the treatment group (chit/verapamil), the immunohistochemical susceptibility of the axons being repaired and the axons in the myelin sheath to S-100 protein was higher than the other groups.Conclusion: The present study demonstrated that a single local application of verapamil could accelerate functional recovery after transection of sciatic nerve.
Rahim Mohammadi; Moein Mehrtash; Moeid Mehrtash; Nava Hassani; Ali Hassanpour
Volume 4, Issue 1 , January 2016, , Pages 29-37
Abstract
Objective: To assess the effects of platelet rich plasma (PRP) with chitosan biodegradable film on full thickness wound healing in rat.Methods: This was an experimental study being performed in 2015 during a 4-month period. Twenty-four male white Wistar rats were divided into four groups of 12 rats each, ...
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Objective: To assess the effects of platelet rich plasma (PRP) with chitosan biodegradable film on full thickness wound healing in rat.Methods: This was an experimental study being performed in 2015 during a 4-month period. Twenty-four male white Wistar rats were divided into four groups of 12 rats each, randomly: Control group (SHAM) with creation of wounds and no treatment, PRP group with creation of wounds and application of one milliliter PRP, Chitosan group (CHIT) with dressing the wound with chitosan and CHIT/PRP group with application of one mL PRP and dressing the wound with chitosan. The wounds were created by cutting healthy skin. Wound size was measured on 6, 9, 12, 15, 18 and 21 post surgery and was compared between groups.Results: Reduction in wound area, hydroxyproline contents and biomechanical parameters indicated there was significant difference (p=0.001) between group CHIT/PRP and other groups. Biomechanical testing was performed on day 9 post surgery in incisional model. Quantitative histological studies and mean rank of the qualitative studies demonstrated that there was significant difference (p<0.001) between group CHIT/PRP and other groups.Conclusion: PRP with chitosan have beneficial effects on wounds repair and could be suggested for treating various types of wounds in animals and human being.
Hosseinali Khalili; Golnaz Yadollahikhales; Mohammad Isaee
Volume 3, Issue 2 , April 2015, , Pages 53-58
Abstract
Objective: To determine the diagnostic value of serum white blood cell (WBC) count, fever (>38˚C) and WBC rise (>10%) for bacterial meningitis in patients with severe traumatic brain injury (TBI).Method: This cross-sectional study was conducted in Shahid Rajaei hospital affiliated with Shiraz ...
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Objective: To determine the diagnostic value of serum white blood cell (WBC) count, fever (>38˚C) and WBC rise (>10%) for bacterial meningitis in patients with severe traumatic brain injury (TBI).Method: This cross-sectional study was conducted in Shahid Rajaei hospital affiliated with Shiraz University of Medical Sciences during a 1-year period from 2013 to 2014. We included consecutively all the patients with severe TBI admitted to our center during the study period who were febrile (>38˚C orally) and underwent lumbar puncture (LP) and analysis and culture of cerebrospinal fluid (CSF). Laboratory analysis of CSF and blood were performed within 2 hours of LP. CSF culture was considered the gold standard for diagnosis of bacterial meningitis. The sensitivity, specificity, positive and negative predictive value (PPV, NPV) of peripheral blood WBC count, fever (>38˚C) and WBC rise (>10%) was determined according to the CSF culture.Results: Overall we included242 consecutive patients with severe TBI. The mean age of the participants was 32.8 ± 17.4 years. Acinetobacter was the most common organism found in the CSF cultures. The sensitivity and specificity of peripheral WBC count (>10,000)was 48.4% (95% CI: 0.42-0.56) and 47% (95% CI: 0.37-0.58) respectively. The PPV and NPV was 13.1% (95% CI: 0.33-0.52) and 84.8% (95% CI: 0.42-0.61), respectively. The AUC for WBC count was 0.478 (95% CI: 0.37-0.58) indicating low accuracy for the diagnosis of bacterial meningitis. The AUC for WBC rise (>10%) and temperature >38˚C was0.460 (95% CI: 0.351-0.569) and 0.517 (95% CI: 0.410-0.624) respectively, both indicating low accuracy for diagnosis of bacterial meningitis. Conclusion: The results of the current study indicates that peripheral blood leukocyte count, fever (>38˚C) and WBC rise (>10%) is a non-reliable marker for diagnosis of bacterial meningitis in patients with severe TBI.
Hashem Rahmati; Mahboobeh Azmoon; Mohammad Kalantari Meibodi; Najaf Zare
Volume 1, Issue 2 , April 2013, , Pages 69-75
Abstract
Objective: To determine the effects of triage education based on emergency severity index (ESI) on promoting the knowledge and performance of nurses and qualitative indices of emergency department.Methods: This study was a quasi-interventional study being performed in Vali Asr Hospital of Fasa University ...
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Objective: To determine the effects of triage education based on emergency severity index (ESI) on promoting the knowledge and performance of nurses and qualitative indices of emergency department.Methods: This study was a quasi-interventional study being performed in Vali Asr Hospital of Fasa University of Medical Sciences during 2012. For this purpose, 50 members of staff including nurses and technicians of emergency medicine in the Emergency department with the inclusion criteria for participation were selected. Data collection instruments included a questionnaire consisting of two parts, (personal characteristics, and knowledge) and the performance assessment checklist was prepared. Content validity was used to determine the validity. The test-retest method and quder-Richardson 20 were applied to determine the reliability of the questionnaire. Interobserver reliability and the correlation between the two observers and imaging modalities were measured to determine the reliability of the performance checklist. The questionnaires and checklist were completed by the participants before, 2 days and 6 weeks after completion of the training. Workshop in two 9-hour sessions was provided which consisted of lectures, questions and answers.Results: The triage scores were 10.7±3.1, 17.8± 1.6 and 16.1±2.3 before, 2 days and 6 weeks after training, respectively. Triage performance score increased from 48.9 ± 9.9 before training to 59.8 ± 7.6, two days after training and to 59.7 ± 8.1 six weeks later (p=0.001). In addition to triage training of the nurses the emergency department qualitative indices were impressively upgraded. Other results showed that there was no significant correlation between individual characteristics and personal knowledge of triage score 6-week after training (r=0.018, p=0.126). However, significant positive correlation was found between nursing work experience, work experience in emergency ward and type of employment and performance scores 6 weeks after training (r=0.258, p=0.032).Conclusion: The results of the present study showed that triage education influences the practice and knowledge of nurses and improves the qualitative indices of emergency department. Therefore, it is recommended to include theoretical and practical training of triage for nurses in hospitals.
Ali Mohammad Bananzadeh; Abtin Vahidi; Sarvenaz Salahi; Ali Foroutan; Leila Ghahramani
Volume 10, Issue 2 , April 2022, , Pages 71-76
Abstract
Objective: To evaluate the role of heart rate variability (HRV) in predicting pre-operative severity of appendicitis. Methods: In this cross-sectional study, 171 cases of acute appendicitis who underwent appendectomy were enrolled. Pre-anesthetic pulse rate of included patients were documented while ...
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Objective: To evaluate the role of heart rate variability (HRV) in predicting pre-operative severity of appendicitis. Methods: In this cross-sectional study, 171 cases of acute appendicitis who underwent appendectomy were enrolled. Pre-anesthetic pulse rate of included patients were documented while the severity of appendicitis was determined by intra-operative evidences reported by two independent surgeons. Demographic characteristics, laboratory variables, and Alvarado criteria were recorded. Results: The mean age of patients was 28.75±4.21 years; 54% were men. HRV negatively associated the severity of appendix inflammation. A positive association was found between HRV and omental wrapping and Alvarado score (p <0.01). The receiver operating characteristic (ROC) curve analysis demonstrated that HRV could differentiate simple and complicated appendicitis with a sensitivity of 78.5% and specificity of 97.2%. Conclusion: The present findings revealed that HRV may predict the pre-operative severity of appendicitis and help differentiate simple and complicated appendicitis.
Hooman Esfahani; Zahra Khazaeipour; Arash Safaie; Seyed Mojtaba Aghili
Volume 9, Issue 2 , April 2021, , Pages 73-79
Abstract
Objective: To compare the ketamine efficacy at a sub-dissociative morphine dose to reduce pain in isolated limb traumatic injuries. Methods: A double-blind randomized clinical trial study was carried out on patients referred to emergency departments (EDs) due to isolated limb traumatic injuries. Eligible ...
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Objective: To compare the ketamine efficacy at a sub-dissociative morphine dose to reduce pain in isolated limb traumatic injuries. Methods: A double-blind randomized clinical trial study was carried out on patients referred to emergency departments (EDs) due to isolated limb traumatic injuries. Eligible patients were divided into two groups which one group received 0.1 mg/kg ketamine and the other group received 0.05 mg/kg morphine, intravenously. An observed side effect includes pain scores and vital signs were recorded at baseline of every 5 minutes for 30 minutes. Results: Totally, 73 patients with the mean age of 32.9±10.4 were enrolled of whom 59 (80.8%) individuals were men. The baseline characteristics difference of the two study groups was not statistically significant. The results showed that the change of mean pain score was -6.2 (95% CI: -5.72 to -6.69) points in the group receiving ketamine compared to -5.8 (95%CI: -5.15 to – 6.48) in the group who were administered morphine. At all assessed checkpoints, the pain mean score was lower in the ketamine group than in the morphine group (p <0.05); the mean of total pain reduction was greater in the ketamine group during the observation period compared with patients who received morphine (p=0.002). Conclusion: The study findings suggest that the sub-dissociative ketamine efficacy in controlling of the acute pain is not lower than morphine sulfate in patients with isolated limb trauma in ED’s. Thus, it can be considered as a safe and effective alternative approach.
Arash Farbood; Saeed Khademi; Ramin Tajvidi; Minoo Hooshangi; Saeed Salari; Mandana Ghani; Sakineh Tahmasebi; Hamid Jamali
Volume 8, Issue 2 , April 2020, , Pages 77-82
Abstract
Objective: To investigate the effect of intravenous regional anesthesia with single-cuff forearm tourniquet and hematoma block on intraoperative and postoperative pain intensity of patients with distal radial bone fracture. Methods: In this randomized clinical trial, a total number of 52 patients with ...
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Objective: To investigate the effect of intravenous regional anesthesia with single-cuff forearm tourniquet and hematoma block on intraoperative and postoperative pain intensity of patients with distal radial bone fracture. Methods: In this randomized clinical trial, a total number of 52 patients with distal radius fractures were randomly assigned to receive either a traditional Bier block with 3 mg.kg-1 lidocaine (D group) or a single-cuff forearm tourniquet intravenous regional anesthesia with 1.5 mg.kg-1 lidocaine and a hematoma block with 10 mL 0.5% bupivacaine (S group). Pain intensity score of numerical rating scale (NRS) was measured hourly for 6 hours, then every two hours till 12th hour and every 4 hours until 24th postoperative hour. Total morphine consumption in the first 24 hours after surgery, its side effects and the patients’ global satisfaction were assessed in each group. Results: Mean total morphine consumption during the first 24 hours after surgery was 11.68±7.88 mg in group D and 7.12±4.42 mg in group S (p=0.13). Pain intensity score of NRS both during recovery room and surgical ward stay was less in S group compared to D group (0.016 and 0.02, respectively). Conclusion: Intravenous regional anesthesia with single cuff forearm tourniquet and hematoma block compared to the traditional Bier block reduced intraoperative and postoperative pain intensity more effectively in patients with distal fracture of the radius bone and also reduced morphine consumption during the first 24 hours after surgery. Clinical Trial Registry: IRCT201604223213N4
Samad Shams Vahdati; Amir GhafarZad; Farzad Rahmani; Farid Panahi; Amir Omrani Rad
Volume 2, Issue 2 , April 2014, , Pages 82-85
Abstract
Objective: To determine the patterns,complications and casualties of road traffic accidents in North West of Iran during 2013 New Year holidays.Methods: One hundred and eighty one patients with trauma-related vehicle crashes were investigated in a cross sectional-descriptive study. We only included those ...
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Objective: To determine the patterns,complications and casualties of road traffic accidents in North West of Iran during 2013 New Year holidays.Methods: One hundred and eighty one patients with trauma-related vehicle crashes were investigated in a cross sectional-descriptive study. We only included those road traffic accidents which were recorded during the 2013 Iranian New Year holidays. Severity of injury based on Glasgow Coma Scale (GCS) score, patient transmission type, damaged organ and the final diagnosis was determined. The mortality rate as well as complications were also recorded and reported. The pattern was analyzed and presented using descriptive statistics.Results: Overall we included 181 patients who were victims of road traffic accidents during the study period. Most cases of multiple traumas were from two car accident (49.2%). Of 181 cases, 71 (39.2%), 66 (36.5%), 16 (8.8%) and 11 (6.1%) subjects had limb, head and neck, abdominal, and spinal cord injuries respectively, while 16 cases (8.8%) did not have any organ damage. In final diagnosis, a limb fracture was noticed in 32 cases (17.7%) and skull fractures in 5 subjects (2.8%) as the first and second causes.Conclusion: As head and neck were the most damaged organs after the limbs in patients with multiple traumas, it seems that there is a necessity for these patients in transmission and examination of head traumas. So there is a need for a proper referral system.
