Afsaneh Nowroozi; Hanieh Kianipour; Houshang Taleby; Bijan Yazdi
Volume 7, Issue 2 , April 2019, , Pages 118-123
Abstract
Objective: To compare the effects of ketamine-propofol and ketamine-thiopental on bispectral index values during monitored anesthesia care in minor orthopedic surgeries.Methods: This randomized double-blind clinical trial was performed on 90 patients undergoing minor orthopedic surgeries. Participants ...
Read More
Objective: To compare the effects of ketamine-propofol and ketamine-thiopental on bispectral index values during monitored anesthesia care in minor orthopedic surgeries.Methods: This randomized double-blind clinical trial was performed on 90 patients undergoing minor orthopedic surgeries. Participants were randomly allocated to either groups of propofol or thiopental. Bispectral index (BIS), non-invasive arterial blood pressure, SpO2, and electrocardiogram were monitored every 5 minutes. Patients in propofol group received a bolus dose of 0.5 mg/kg ketamine, plus 0.5 mg/kg propofol. In thiopental group, patients received a bolus dose of 0.5 mg/kg ketamine, plus 50-75 mg thiopental. After the surgery, recovery duration, patients’ pain score (VAS) and any intra-operative recall or awareness were recorded. Statistical analysis was performed using SPSS version 19.0Results: BIS was lower in ketamin-propofol group (p< 0.001). Mean arterial blood pressure, heart rate and O2 saturation showed a significant difference between two groups (p< 0.001), which were lower in ketamin–propofol group. VAS score was higher in ketamin-thiopental group (p< 0.001). Both groups were similar in intra-operative recall/awareness.Conclusion: Ketamine-propofol combination deliver a better control over monitored anesthesia during surgery, providing lower BIS, higher O2 saturation and lower heart rate and arterial blood pressure in patients undergoing minor traumatic orthopedic surgeries.Clinical trial registration: IRCT6N 2016032320258
Seyed Mohammad Motamed al Shariati; Mostafa Dahmardehei; Hasan Ravari
Volume 2, Issue 3 , July 2014, , Pages 121-124
Abstract
Objective: To report the outcome of subciliary approach for inferior orbital rim fractures in a series of Iranian patients.Methods: This was prospective cross-sectional, being performed during a 12-month period during 2013 in plastic surgery department of Emamreza Hospital of Mashhad. We included ...
Read More
Objective: To report the outcome of subciliary approach for inferior orbital rim fractures in a series of Iranian patients.Methods: This was prospective cross-sectional, being performed during a 12-month period during 2013 in plastic surgery department of Emamreza Hospital of Mashhad. We included 12 patients with traumatic inferior orbital rim fractures who underwent surgical repair through subciliary approach. All the patients were followed for 12 months and were evaluated regarding paresthesia and function as well as presence of a visible scar and lower-eyelid malposition.Results: There were 9 (75.0%) men and 3 (25.0%) women among the patients with mean age of 26.3±10.6 (range 16-48) years. Of the 12 patients treated with the subciliary approach, 4 (33.3%) experienced complications. One (8.3%) patient showed 1.5 mm sclera at the end of one year follow-up. No ectropion or entropion was reported in our series. In contrast to 3 (25.0%) cases of lower lid visible scar, there was no occurrence of hypertrophic scar.Conclusion: It would be expected that the transorbital approach as it offers good visualization of anterior fractures would result in good outcomes in cases of orbital rim and floor fracture.
Behrang Khafafi; Omid Garkaz; Saeed Golfiroozi; Sahar Paryab; Laia Ashouri; Sevda daei; Hamid Reza Mehryar; Mousa Ghelichi-Ghojogh
Volume 10, Issue 3 , July 2022, , Pages 122-127
Abstract
Objective: To compare the ability of quantitative trauma severity assessment methods based on Glasgow comascale, age, and arterial pressure (GAP), revised trauma score (RTS), and injury severity score (ISS) criteria indetermining the prognosis of accidental patients.Methods: This cross-sectional study ...
Read More
Objective: To compare the ability of quantitative trauma severity assessment methods based on Glasgow comascale, age, and arterial pressure (GAP), revised trauma score (RTS), and injury severity score (ISS) criteria indetermining the prognosis of accidental patients.Methods: This cross-sectional study was performed on random patients referred to Imam Khomeini Hospitalin Urmia from March 20, 2020 to September 21, 2020. The data were obtained by using a checklist includesitems such as age, sex, respiration rate, oxygen saturation level, pulse rate, primary blood pressure, initialGlascow coma scale (GCS), patient outcome and injury to different parts of body. After collecting the data, itwas entered into SPSS 18 and analyzed with the descriptive and analytical statistics include an independentt-test and receiver operating characteristic curve (ROC) curves.Results: Out of 1930 studied patients, 365 (18.9%) were women and 1565 (81.1%) were men. The mean age ofpatients was 37.05±17.11 years and women were significantly older than men. The mortality rate was 4.8% andwas significantly more in men compared to women. The mean blood pressure, GCS and oxygen saturation levelwere lower in deceased patients. The mean GAP, ISS and RTS values were 23.13±2.69, 4.07±3.82, 7.72±0.52,respectively. The mean values of GAP and RTS were significantly low in deceased patients whereas the meanISS value was significantly high in the deceased patients. The Area under the curve (AUS) for ISS was greaterthan the other two scoring systems.Conclusion: The findings of the current study showed that all three systems were adequately efficient toprognoses the final outcome in multi-trauma patients but the ISS measure was better than the other two criteria.
Faramarz Pourasghar; Amin Daemi; Jafar Sadegh Tabrizi; Alireza Ala
Volume 3, Issue 4 , October 2015, , Pages 134-137
Abstract
Objective: To examine the inter-rater reliability of triages performed by the Electronic Triage System (ETS) which has recently developed and used in hospital emergency department (ED).Methods: This cross-sectional study was conducted prospectively and studied 408 visitors of Tabriz Imam Reza hospital’s ...
Read More
Objective: To examine the inter-rater reliability of triages performed by the Electronic Triage System (ETS) which has recently developed and used in hospital emergency department (ED).Methods: This cross-sectional study was conducted prospectively and studied 408 visitors of Tabriz Imam Reza hospital’s ED. The variables of interest were age, sex, nurse-assigned triage category, physician-assigned triage category, disease type (trauma, non-trauma), and the referred room within the ED. Cohen’s un-weighted kappa, linear weighted kappa, and quadratic weighted kappa were used to describe the reliability.Results: Un-weighted kappa observed to be 0.186 (95% CI: 0.123-0.249). Linear weighted kappa observed as 0.317 (95% CI: 0.251-0.384) and quadratic weighted kappa as 0.462 (95% CI: 0.336-0.589). In general, low agreement was seen between the triage nurses and ED physicians. For trauma patients and for those who were referred to the cardiopulmonary resuscitation room (CPR), all three types of kappa were higher than other visitors of the ED.Conclusion: Inter-rater reliability of the triages performed by the ETS observed as ranging from poor to moderate. Implementing interventions that would create a common language between nurses and physicians about the triage of the ED visitors seems necessary. The more agreement on the triage of trauma and CPR patients might be due to their condition and the more attention to them.
Fariborz Ghaffarpasand; Mostafa Shahrezaei; Maryam Dehghankhalili
Volume 4, Issue 3 , July 2016, , Pages 134-140
Abstract
Objective: To determine the effects of platelet rich plasma PRP on healing rates of long bone non-union fracture.Method: This was a randomized double-blind placebo controlled clinical trial being performed in a 12-month period. We included 75 adult (>18 years) patients suffering from long bone (Femur, ...
Read More
Objective: To determine the effects of platelet rich plasma PRP on healing rates of long bone non-union fracture.Method: This was a randomized double-blind placebo controlled clinical trial being performed in a 12-month period. We included 75 adult (>18 years) patients suffering from long bone (Femur, Tibia, Humerus and Ulna) non-union fracture who were randomly assigned to receive 5mL PRP (n=37) or 5mL normal saline as placebo (n=38) in the site of fracture after intramedullary nailing or open reduction and internal fixation (ORIF) along with autologous bone graft. Patients were followed each 45 days till 9 months and were evaluated both clinically and radiologically in each visit. The healing rate, failure rate, incidence of infection, mal-union and limb shortening were recorded and compared between groups after 9 months of follow-up.Results: The healing rate was significantly higher in PRP group compared to placebo (81.1% vs. 55.3%; p=0.025). The limb shortening was significantly higher in those who received placebo (2.61±1.5 vs. 1.88±1.2mm; p=0.030). Injection of PRP was also associated with lower pain scores (p=0.003) and shorter healing duration (p=0.046). The surgical site infection (p=0.262) and mal-union rate (p=0.736) were comparable between groups.Conclusion: Application of PRP along with autologous bone graft in the site of non-union of long bone after intramedullary nailing or ORIF results in higher cure rate, shorter healing duration, lower limb shortening and less postoperative pain. Higher infection rate might be a complication of PRP application.Keywords: Non-union; Long bone Fracture; Platelet rich plasma (PRP); Intramedullary nailing; Open reduction and internal fixation (ORIF).Clinical Trial Registry: This trial is registered with the Iranian Clinical Trials Registry (IRCT201208262445N1; www.irct.ir).
Orhan Delice; Samad Shams Vahdati; Senol Arslan; Alireza Ala; Hossein Hosseinifar; Faride Houshmand; Solomon Habtemariam; Aysa Rezabakhsh
Volume 9, Issue 3 , July 2021, , Pages 138-144
Abstract
Objective: To assess the patient’s satisfaction rate during two distinct registry procedures in the emergency department. Methods: A cross-sectional study was conducted in educational hospitals with a high volume of patient’s admission in Tabriz-Iran and Erzurum-Turkey. In this ...
Read More
Objective: To assess the patient’s satisfaction rate during two distinct registry procedures in the emergency department. Methods: A cross-sectional study was conducted in educational hospitals with a high volume of patient’s admission in Tabriz-Iran and Erzurum-Turkey. In this study, we used a Press Ganey questionnaire as a data collection tool that was filled out with patients or their companions before discharging or referred to other areas (wards). Finally, data were analyzed by using SPSS software version 16. Results: The included patients were from three-admission time courses includes morning, evening, and night shifts. The present study results indicated that the total satisfaction score was two scores higher than the classic one (p <0.001) in the model registry system. Furthermore, the findings of the current study interestingly showed a correlation between satisfaction rate and education level as well as patient’s location. Thus, patients with moderate education levels had a higher satisfaction rate in urban regions when compared with rural regions and higher/lower education levels (p=0.03). Conclusion: Patients’ satisfaction rate with multiple variables can be improved by designing an appropriate registry procedure.
Mohammad Farahmand; Siamak Farahangiz; Mahnaz Yadollahi
Volume 1, Issue 4 , October 2013, , Pages 147-151
Abstract
Objectives: To determine the diagnostic accuracy of magnetic resonance angiography (MRA) compared to intra-arterial digital subtraction angiography (DSA) in detection of intracranial aneurysms in those suffering from acute subarachnoid hemorrhage (SAH).Methods: This observational diagnostic study was ...
Read More
Objectives: To determine the diagnostic accuracy of magnetic resonance angiography (MRA) compared to intra-arterial digital subtraction angiography (DSA) in detection of intracranial aneurysms in those suffering from acute subarachnoid hemorrhage (SAH).Methods: This observational diagnostic study was performed at a tertiary teaching hospital and reference center in Shiraz, Iran. We included 55 patients who presented to our center with the diagnosis of acute SAH. All the patients underwent MRA and DSA during their hospital course in order to detect the intracranial aneurysms. The time-of-flight MRA protocol was used and the results were compared to the results of DSA as the gold standard test. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for MRA.Results: The mean age of the patients was 46.3 ± 7.9 including 26 (47.3%%) men and 29 (52.7%) women. In46 patients, 51 intracranial aneurysms were diagnosed by DSA (5 patients had two aneurysms). No evidence of intracranial aneurysm was found in 9 patients with subarachnoid hemorrhage. MRA correctly identified 42 of the 51 aneurysms (sensitivity 82%) and missed 9 small aneurysms (less than 10 mm). MRA revealed one false- positive finding, resulting in a specificity of 88.8%. The PPC and NPV for MRA were 97% and 47%, respectively. The diagnostic accuracy per aneurysm was 0.83 for MRA.Conclusion: High sensitivity and specificity of MRA compared to DSA in diagnosis of intracranial aneurysms in those with acute SAH indicate that MRA could be reliably used as a diagnostic tool for this purpose. However we cannot recommend it as a routine substitute for DSA before surgery.
Nawal Kishore Jha; Sanjay Kumar Yadav; Rajshekhar Sharma; Dipendra Kumar Sinha; Sandip Kumar; Marshal Daud Kerketta; Mini Sinha; Abhinav Anand; Anjana Gandhi; Satish Kumar Ranjan; Jitin Yadav
Volume 2, Issue 4 , October 2014, , Pages 156-160
Abstract
Objective: To determine the presentation, anatomical distribution, diagnostic method, management and outcome of hollow viscus injury (HVI) from blunt abdominal trauma.Methods: This was a retrospective cross-sectional study including patients with blunt abdominal trauma leading to HVI admitted at Rajendra ...
Read More
Objective: To determine the presentation, anatomical distribution, diagnostic method, management and outcome of hollow viscus injury (HVI) from blunt abdominal trauma.Methods: This was a retrospective cross-sectional study including patients with blunt abdominal trauma leading to HVI admitted at Rajendra Institute of Medical Sciences, Ranchi, over a period of 4.5 years (January 2009 to July 2014). Data were retrieved from patients’medical records. Total 173 patients with HVI due to blunt abdominal trauma, who underwent laparotomy at our institute, were reviewed. Data regarding clinical presentation, anatomical distribution, management and outcome were recorded and analysed.Results: Out of 173 patients 87.1% were men and 12.9% were women. Mean age of patients was 29 ± 14.02 years. The most common site of injury was ileum (46.2%) followed by jejunum (44.5%). There were 5 gastric perforations (2.9%), 2 (1.15%) duodenal, 2 (1.15%) colonic, 2 (1.15%) sigmoidal and 2 (1.15%) rectal injuries. One caecal injury was also recorded. Road traffic accident was the most common mechanism of injury (57.2%) followed by fall from height (36.4%) and assault (6.4%). Free gas under diaphragm on erect abdomen radiography was seen in 85.5% of cases while preoperative CT Abdomen was done in 11.6% of cases. Treatment consisted of simple closure of the perforation (66.5%), resection and anastomosis (11.0%) and stoma (22.5%). Major complication was anastamotic leak which was recorded in 6.4% cases and 15.6% patients developed burst abdomen. Average hospital stay was 13 ± 6 days. Overall mortality rate was 12.7%. Conclusion: Although early recognition of intestinal injuries from blunt abdominal trauma may be difficult in all cases, it is very important due to its tremendous life threatening potential. Age of the patient, anatomical site and time of presentation are probably main prognostic factors.
Khodayar Oshvandi; Zahra Veladati; Marzieh Mahmoodi; Farshid Rahimi Bashar; Azim azizi
Volume 8, Issue 3 , July 2020, , Pages 156-162
Abstract
Objective: To determine the effects of foot massage on pain severity during in unconscious trauma patients admitted to the intensive care unit (ICU). Methods: In this randomized clinical trial (RCT), 80 unconscious trauma patients admitted in the ICU of a hospital in an urban area of Iran were ...
Read More
Objective: To determine the effects of foot massage on pain severity during in unconscious trauma patients admitted to the intensive care unit (ICU). Methods: In this randomized clinical trial (RCT), 80 unconscious trauma patients admitted in the ICU of a hospital in an urban area of Iran were included using the convenience sampling method. They were randomly assigned to the intervention and control groups (n=40 in each group). In both groups, the intensity of pain was measured immediately, 10 minutes after the first change position and without any intervention before the change of position using the Critical Care Pain Observation Tool (CCPOT). In the intervention group, before the second position change, classic foot massage was performed for 20 minutes, but the control group received routine care. Pain was re-evaluated after the change position at desired times. The pain intensity was compared between the two study groups. Results: The baseline characteristics were comparable between the two study groups and no difference was found. There was no statistically significant difference between the mean scores of pain after the change of position (immediately and ten minutes later) before the intervention in the groups (p=0.915 and 0.660, respectively). However, after the intervention, the pain intensity was significantly lower in the intervention groups compared to the control group (p<0.001). Conclusion: Foot massage decreases the pain intensity related to the change of position in unconscious trauma patients admitted in the ICU. Due to its simplicity and low cost, this method can be used along with analgesic drugs to reduce pain in patients. Clinical trial registry: IRCT2016121031327N1
Seyed Mohammad Hosseininejad; Hamed Amini Ahidashti; Farzad Bozorgi; Iraj Goli Khatir; Seyed Hosein Montazer; Fatemeh Jahanian; Mehran Amooei Khanabbasi
Volume 5, Issue 3 , July 2017, , Pages 165-170
Abstract
Objective: To compare the efficacy of combination therapy with ketorolac and morphine with monotherapy with each in patients with acute renal colic. Methods: This triple-blind, randomized clinical trial was conducted during a 6-month period from March to September 2014 in Northern Iran. We included ...
Read More
Objective: To compare the efficacy of combination therapy with ketorolac and morphine with monotherapy with each in patients with acute renal colic. Methods: This triple-blind, randomized clinical trial was conducted during a 6-month period from March to September 2014 in Northern Iran. We included 300 patients with clinical diagnosis of acute renal colic and pain score greater than 4 on 10 cm visual analogue scale (VAS) score. Patients were randomly assigned to three study groups to receive 0.1 mg/kg morphine in combination with 30 mg ketorolac (n=100), or only 0.1 mg/kg morphine (n=100) or only 30mg ketorolac (n=100). All the patients were evaluated at 0, 20 minute,40 minute later. Our outcomes were pain reduction and need for additive morphine in 20 and 40 minutes. We also recorded and compared the adverse effects between the study groups.Results: There was no significant difference between the study groups. The pain intensity was comparable between three study groups after 20-min of intervention. However, we found that the pain intensity was significantly lower in balanced analgesia group when compared to morphine (3.01±0.98 vs. 3.66±1.02; p=0.012) or ketorolac alone (3.01±0.98 vs. 3.68±0.88; p=0.018). However, those receiving the balanced analgesia, required significantly less rescue analgesia when compared to morphine (16% vs. 20%; p=0.041) or ketorolac (16% vs. 24%; p=0.012) alone. Conclusion: Balanced analgesia with morphine and ketorolac is more effective compared to morphine or ketorolac alone determine by lower pain scores after 40-min of injection and lower need for rescue analgesia.
Nasrin Shahedifar; Homayoun Sadeghi-bazargani; Mohammad Asghari-Jafarabadi; Mostafa Farahbakhsh; Shahrzad Bazargan-Hejazi; Alireza Razzaghi; Mina Goletsani; Faramarz Pourasghar
Volume 10, Issue 4 , October 2022, , Pages 181-188
Abstract
Objective: To assess psychometric properties of the European Quality of Life 5-Dimension 3-Level Version(EQ-5D-3L) commonly used tool for measuring road traffic injury (RTI) patients’ quality of life.Methods: The psychometric study assessed the reliability and applicability of EQ-5D-3L through ...
Read More
Objective: To assess psychometric properties of the European Quality of Life 5-Dimension 3-Level Version(EQ-5D-3L) commonly used tool for measuring road traffic injury (RTI) patients’ quality of life.Methods: The psychometric study assessed the reliability and applicability of EQ-5D-3L through phonesurveys, based on a national cohort platform. Data of 150 RTI patients recruited from the cohort study wereincluded as 50 patients per each follow-up phase (one, six, and twelve months after discharge). A 12- day-timespan was between test and retest. We measured psychometric properties (internal consistency reliability andstability reliability) and agreement using Kappa coefficients and percentages of agreement and Bland-Altmanmethod. Data were analysed using software STATA statistical package.Results: The majority of patients were men (80%) with mean age (SD) of 41(14.7%), employed (78%) andeducated (86%). The Persian version represented high internal consistency reliability at total level (Cronbach’sα=0.81) and moderate to good reliability at phase levels (0.62-0.87). The stability reliability was excellent attotal (ICC=0.98, 95% CI: 0.97, 0.98) and phase levels (0.97-0.98. The kappa agreement coefficients were valuedmoderate to perfect (0.6-0.8, p>0.0001). The Bland-altman plot illustrated high agreement between test andretest scores. No floor and ceiling effects were found.Conclusion: The study revealed that EQ-5D-3L was highly reliable and responsive to be applied through phoneinterviews at three different times post injury and discharge, as no previous study considered its psychometricproperties at various phone follow-ups after RTIs.
Rohit Bharti; Sindhu Sapru; Ponraj Kamatchi Sundaram; Ganesh Chauhan
Volume 9, Issue 4 , October 2021, , Pages 188-194
Abstract
Objective: To evaluate the impact of the early tracheostomy on operated patients with severe head injury. Methods: This prospective observational study was conducted at a level 1 trauma center and medical college over one-year period. The study included all surgically managed severe head injury patients ...
Read More
Objective: To evaluate the impact of the early tracheostomy on operated patients with severe head injury. Methods: This prospective observational study was conducted at a level 1 trauma center and medical college over one-year period. The study included all surgically managed severe head injury patients without any other life-threatening major injuries. Patients who underwent tracheostomy within 7 days were classified as early tracheostomy. Results: The patient’s mean age of this cohort study was 43.4±14.5 years. Motor-vehicle accidents were being the most common cause of severe head injury. Operated patients were undergoing early tracheostomy on an average of 2.9 days. We were observed that the patients spent on a mechanical ventilation on an average 3.67±2.26 days. This was significantly lower than previous four published studies (p <0.05) which had a range of mean 9.8-15.7 days. Conclusion: We have shown that it is possible to decrease mechanical ventilation (MV) time, intensive care unit (ICU) stay and total hospital stay by doing early tracheostomy in operated severe head injury patients.
Seyed Hadi Aghili; Arshia Zardoui; Mehri Farhang Ranjbar; Alireza Baratloo
Volume 11, Issue 4 , October 2023, , Pages 190-195
Abstract
Objective: This study aims to characterize the demographic, clinical, and radiological features of gunshotwound (GSW) patients as well as identify predictors of prolonged hospitalization.Methods: In this retrospective study, a consecutive sampling method was used, including all patients withGSWs in any ...
Read More
Objective: This study aims to characterize the demographic, clinical, and radiological features of gunshotwound (GSW) patients as well as identify predictors of prolonged hospitalization.Methods: In this retrospective study, a consecutive sampling method was used, including all patients withGSWs in any anatomical region. Data collection included demographic and clinical information, radiologicalfindings, treatment specifics, and outcome variables, such as hospitalization length of stay (LOS) as the primaryoutcome. To identify predictive factors associated with prolonged LOS, logistic regression analysis was used.Results: We studied 212 GSW cases, including 95.8% were men and 4.2% were women. The mean age of thestudied group was 30.17±7.80 years. GSWs occurred in extremities (80.2%), abdomen (9.0%), thorax (4.7%),and head or neck (5.2%). Two patients (0.9%) had both abdominal and thoracic GSWs. The most prevalentradiological study was an X-ray (83.0%). Patients with head and neck GSWs had the longest emergencydepartment stay, while patients with abdominal GSW patients had the shortest (p=0.068). The highest ratesof blood product transfusion were observed in abdominal GSWs (63.2%), emergency surgery (63.2%), andICU admission (42.1%). Head and neck GSWs had the longest hospitalization LOS (7.5 days). Longer LOSwas significantly associated with abnormalities in radiological findings, receiving blood products, and ICUadmission (p≤0.001). Significant predictors of prolonged LOS were major abnormalities in radiological findings[odds ratio (OR)=5.3; 95% confidence interval (CI):2.8-10.2], head and neck GSWs (OR=6.1; 95% CI:1.2-31.9),and blood product transfusion (OR=4.1; 95% CI: 1.0-16.3).Conclusion: This study provides insights into factors influencing prolonged hospitalization in GSW patients,highlighting the importance of radiological findings, head and neck injuries, and blood product transfusion.
Faramarz Pourasghar; Jafar Sadegh Tabrizi; Alireza Ala; Amin Daemi
Volume 4, Issue 4 , October 2016, , Pages 211-215
Abstract
Objective: To validate the triage ratings performed by the Electronic Triage System (ETS) using hospitalization, length of stay, resource use, in-hospital mortality and patient bills as outcome measures.Methods: In this retrospective cross-sectional study the medical records of 387 patients were reviewed ...
Read More
Objective: To validate the triage ratings performed by the Electronic Triage System (ETS) using hospitalization, length of stay, resource use, in-hospital mortality and patient bills as outcome measures.Methods: In this retrospective cross-sectional study the medical records of 387 patients were reviewed in a one-week period. The data included triage category and the outcome measures were hospitalization, length of stay, in-hospital mortality, patient bill, and used resources. The association between the triage category and hospitalization and death was assessed. The association between the triage category and the number of resources, length of stay, and the bill was also assessed.Results: The mean age of the patients was 43.65 ±21.17 years. Women comprised 40% (n=155) of 387 people who were included in the study. The frequency of Emergency Severity Index (ESI) 1, 2, 3, 4 and 5 categories were 18, 61, 127, 181 and 0 respectively. Phi and Cramer’s V for hospitalization and death were 0.365 (p<0.001) and 0.305 (p<0.001). Spearman's rho for bill, length of stay, and resource use were -0.483 (p<0.001), -0.228 (p<0.001) and -0.490 (p<0.001). The association between triage category and resource consumption was stronger than other outcomes.Conclusion: The ETS was valid in predicting all studied patient outcomes. The ETS has also the advantages of providing quick reports, giving feedback and providing data for research purposes.
Steven Liu; Quinn Fujii; Farris Serio; Andrew McCague
Volume 6, Issue 3 , July 2018, , Pages 217-220
Abstract
Objective: To determine if there exists an upper limit for amount of blood transfused in trauma patients before it reaches a point of futility.Methods: A prospective cohort study was conducted on 131 patients who received massive blood transfusion (MBT), defined as 10 U or higher of PRBCs received in ...
Read More
Objective: To determine if there exists an upper limit for amount of blood transfused in trauma patients before it reaches a point of futility.Methods: A prospective cohort study was conducted on 131 patients who received massive blood transfusion (MBT), defined as 10 U or higher of PRBCs received in the initial 24 hours. Data collected from a Level II trauma center registry were used to analyze reports of adult patients from July 2014 to 2017. Cohorts were divided by amount of blood received - 0 to 9 U, 10-19 U, 20 to 29 U, 30-39 U, 40 U or higher - odds ratio for mortality and p-values for mean Injury Severity Score and overall hospital length of stay were calculated for each group.Results: Odds ratios for massive blood transfusion groups from 10 units to 39 units each contained the null value, while our 40 units and above group did not (OR 12.52, 95% CI 1.3-117.7).Conclusion: Although this study is limited by its sample size, these results suggests that 40 units of PRBCs may be a threshold at which survival rates begin to decrease significantly.
Ehsan Sarbazi; Mohamadreza Sarbazi; Saber Ghaffari-fam; Towhid Babazadeh; Sohrab Heidari; Khadijeh Aghakarimi; Ismail Jamal; Ali Sherini; Javad Babaie; Ghader Darghahi
Volume 8, Issue 4 , October 2020, , Pages 236-242
Abstract
Objectives: The aim of the present study was identifying factors associated with h delayed initiation of post-exposure prophylaxis (PEP) among animal bite victims. Methods:This cross-sectional study assessed biting patterns among 3032 cases that were referred to Tabriz Rabies Center. The delay was described ...
Read More
Objectives: The aim of the present study was identifying factors associated with h delayed initiation of post-exposure prophylaxis (PEP) among animal bite victims. Methods:This cross-sectional study assessed biting patterns among 3032 cases that were referred to Tabriz Rabies Center. The delay was described as the initiation of PEP more than 48 hours (h) after possible exposure to the rabies virus. Determinants of delay in initiating PEP were recognizing by a decision tree model. Results: Totally, 8.5% of the victims who were bitten by an animal had a delay of more than 48 h in the initiation of PEP. The relative frequency of delay more than 48 h in females was higher than the males (12.9% compared to 8.5%) (p-value= 0.004). Relative frequency of delay more of 48 h from carnivorous (dog, jackal, fox) was significantly less than others (p -value< 0.001). Of the decision tree, the overall classification accuracy was 89.5%, with 44.1% sensitivity and 92.3% specificity. The identified variables included gender,biting place (rural, urban), and type of animal. Conclusion: Based on the study findings on various variables that affect the delayed initiation of PEP, particularly being female, and rural residents were the major factors associated with a delay in the initiation of PEP for rabies prevention. We found relatively low rates of vaccine completion. Our findings indicate that provider training and patient education are required to ensure the completion of appropriate treatment.
Rasoul Salimi; Rasool Haddadi; Abbas Moradi; Farnoush Jalilvand; Farzin Firozian
Volume 7, Issue 3 , July 2019, , Pages 240-244
Abstract
Objective: To compare the anesthetic effects of topical amitriptyline 2% with lidocaine 2% in isolated limb wound repair with suturing.Methods: In a randomized clinical trial, 90 patients with a complaint of isolated ulcer and require a preliminary repair by suturing were selected from patients referred ...
Read More
Objective: To compare the anesthetic effects of topical amitriptyline 2% with lidocaine 2% in isolated limb wound repair with suturing.Methods: In a randomized clinical trial, 90 patients with a complaint of isolated ulcer and require a preliminary repair by suturing were selected from patients referred to emergency department of Beast Hospital in Hamadan. First, the scars were washed and anesthetized with lidocaine 2%. If after the peak period effect of lidocaine, the pain score of patients did not decrease, they randomly assigned to two groups, Lidocaine or Amitriptyline gel. After the intervention and during the suturing, the patient's pain score was measured at the intervals specified time by the visual analogous scale (VAS) and results recorded on the checklist. Finally, the collected data were analyzed by SPSS software version 20 at 95% confidence levelResults: In the lidocaine and amitriptyline group, the mean age of the patients was 29.08 and 27.34 years, and male gender frequency was 71.1% and 80% respectively. Both groups were matched for age and sex. Mean score of pain in both groups decreased from the score of 10 before the intervention to 7.33 in the lidocaine group and 0.53 in amitriptyline group. Based on the results of the ANOVA repeated measure test, there was a statistically significant difference between the mean score of pain in the two groups (p<0.001).Conclusion: In patients with isolated limbs ulcers, requiring initial repair with suturing, numbness and analgesia effect of amitriptyline 2% gel, with dose 2 mg/kg is better than lidocaine 2%. Clinical Trial Registry: IRCT20120215009014N216
Vikram Khanna; Ashish Gupta; Sanjeev Kumar
Volume 5, Issue 4 , October 2017, , Pages 259-265
Abstract
Objective: To assess the outcome long standing ulno-humeral dislocation managed by open reduction and stabilization with V-Y plasty.Methods: This cross-sections study included 14 patients with elbow dislocation that was more than 3 months without joint ankylosis, myositis ossificans or nerve injury. ...
Read More
Objective: To assess the outcome long standing ulno-humeral dislocation managed by open reduction and stabilization with V-Y plasty.Methods: This cross-sections study included 14 patients with elbow dislocation that was more than 3 months without joint ankylosis, myositis ossificans or nerve injury. The surgical management not only included open reduction of the elbow joint, but also elongation of the triceps aponeurosis, collateral ligament repair along with the stabilization of the elbow joint. The results were analyzed using the Mayo Elbow score and the range of motion at 3 months and results were compared with the function of the patients elbows before surgery.Results: Among the 14 included patients, there were 9 (64.3%) men and 5 (35.7%) women. The mean age of the patients was 27.8 ± 8.3 (ranging from 21 to 34) years. The average ROM at the time of admission was found to be 37.0° ± 25.8° (10° to 65°) in flexion and 15.5° ± 14.6° (0° to 30°) in extension lag. Patients’ preoperative Mayo clinic elbow performance assessment showed an index score of 47.3 ± 10.3 (range of 35 to 53).Conclusion: This results of the current study demonstrates that relative good function with a pretty low risk can be obtained when comparing the functional results after 3 months with preoperative status. Based on these results we recommend that neglected elbow dislocation should be managed by surgical intervention even if the dislocations are old.
Alireza Esmaeili; Vahideh Salimi; Naser Mohammad Karimi; Majid Hajimaghsoudi; Mahmoud Vakili; Ehsan Zarepur
Volume 6, Issue 4 , October 2018, , Pages 300-305
Abstract
Objective: To evaluate the effect of hyoscine on pain and tenderness, rebound tenderness and appendicitis patients before surgery and this study can be considered as the first study investigated the efficacy of hyoscine on pain, tenderness, and rebound tenderness in patients with appendicitis.Methods: ...
Read More
Objective: To evaluate the effect of hyoscine on pain and tenderness, rebound tenderness and appendicitis patients before surgery and this study can be considered as the first study investigated the efficacy of hyoscine on pain, tenderness, and rebound tenderness in patients with appendicitis.Methods: In this single-group, prospective interventional study (before-after) according to inclusion and exclusion criteria, 70 patients with pain in the right lower abdomen and typical symptoms of appendicitis were evaluated and after surgery, diagnostic accuracy was examined by pathologic results. The pain was evaluated before and after administration of hyoscine by numerical and verbal examination. Tenderness and rebound tenderness were also determined.Results: The mean age of patients was 26.81±7.66. Totally, 42 patients (60%) had reduction in pain, 50 patients (71% percent) had reduction in tenderness, and 39 (55%) had reduction in rebound tenderness after treatment with the drug. A statistically significant reduction of pain and tenderness, rebound tenderness was observed in all of men after administration of hyoscine (p<0.001) but in women, the reduction of severity of tender results was only significant (p=0.002). Data analysis in women and men together showed the significant reduction of pain, tenderness, and rebound tenderness (p<0.001).Conclusion: According to the results, hyoscine can reduce pain, tenderness, and rebound tenderness. So, it seems that hyoscine is a good candidate for patients with appendicitis.IRCT registration number: IRCT2015111825123N1
Amin Nikpasand; mohammad reza parvizi
Volume 7, Issue 4 , October 2019, , Pages 366-372
Abstract
Objective: To evaluate effects of titanium dioxide /gelatin nanocomposite on wound healing in mice as a model study. Methods: Fifty male rats were randomized into five groups of ten animals each. In group I, 0.1 mL sterile saline 0.9% solution was added to the wounds with no infection. In group ...
Read More
Objective: To evaluate effects of titanium dioxide /gelatin nanocomposite on wound healing in mice as a model study. Methods: Fifty male rats were randomized into five groups of ten animals each. In group I, 0.1 mL sterile saline 0.9% solution was added to the wounds with no infection. In group II, the wounds were infected with MRSA and only treated with 0.1 mL the sterile saline 0.9% solution. In group III, infected wounds were treated with gelatin. In group IV, animals with infected wounds were treated with 0.1 mL titanium dioxide nanoparticles. In group V, animals with infected wounds were treated with titanium dioxide /gelatin nanocomposite. Wound size was measured on 2, 6, 10, 14, 18 and 20 days after surgery. Results: Reduction in wound area indicated that there was significant difference between group IV and other groups (p <0.05). Quantitative histological and morphometric studies and mean rank of the qualitative studies demonstrated that there was significant difference between group IV and other groups (p <0.05). Conclusion: Titatnium dioxide nanoparticles/gelatin composite offered potential advantages in wound healing acceleration and fibroblast proliferation on early days of healing phases. Acceleration in wound repair could be associated with earlier wound contraction and stability of damaged area by rearrangement of granulation tissue and collagen fibers.
Sajjad Ebrahimi; Sedigheh Tahmasebi; Mohammad Reza Rouhezamin; Seyed Mohsen Mousavi; Hamid Reza Abbasi; Shahram Bolandparvaz; Shahram Paydar
Volume 1, Issue 1 , January 2013, , Pages 22-27
Abstract
Objective: To evaluate the efficacy of modified perihepatic packing (MPHP) in reducing the rate of re-bleeding rate after packing removal.Methods: This was an experimental study being performed in Shiraz animal laboratory. High grade liver parenchymal injury was induced in 30 transgenic Australian rabbits ...
Read More
Objective: To evaluate the efficacy of modified perihepatic packing (MPHP) in reducing the rate of re-bleeding rate after packing removal.Methods: This was an experimental study being performed in Shiraz animal laboratory. High grade liver parenchymal injury was induced in 30 transgenic Australian rabbits which were then divided into two groups. Group A (control) included 14 and group B (experimental) comprised 16 rabbits. The animals in group A underwent standard perihepatic packing (SPHP) and those in group B were subjected to MPHP. Re-bleeding was assessed and compared between the two groups, after removal of perihepatic packings.Results: There was no significant difference between two study groups regarding baseline and perioperative characteristics. Rabbits in group A had significantly lower rate of postoperative re-bleeding compared to those in group A (57.1% vs. 12.5%; p=0.019). The mean bleeding volume was also significantly lower in group B compared to group A (76.88 ± 22.12 vs. 98.93 ± 33.8 mL; p<001). Although the survival rate was higher in group A compared to group B (93.8% vs. 78.6%) but the difference was not statistically significant (p=0.315).Conclusion: MPHP is a simple and safe procedure for surgical management of high grade liver parenchymal injury concomitant with severe loss of glisson’s capsule. This procedure significantly decreases re-bleeding after packing removal in comparison with SPHP.
Hossein Hodjati; Ahmad Hoseinzadeh; Seyed Masoud Mousavi; Seifollah Dehghani Nazhavi; Viginda Kumar; Maryam Sehhatpour
Volume 5, Issue 1 , January 2017, , Pages 24-28
Abstract
Objective: To evaluate the feasibility and results of using serosal patch of small bowel for repair and replacement of inferior vena cava (IVC) after resection of a part of infra-renal IVC in an animal model, as it may be encountered in extensive tumors of retroperitoneal and trauma patients.Methods: ...
Read More
Objective: To evaluate the feasibility and results of using serosal patch of small bowel for repair and replacement of inferior vena cava (IVC) after resection of a part of infra-renal IVC in an animal model, as it may be encountered in extensive tumors of retroperitoneal and trauma patients.Methods: Five healthy sheep of both sexes were prepared. After general anesthesia and laparotomy, a defect with 1 cm width and 4cm length was made on anterior aspect of infra-renal IVC, and then an adjacent loop of small bowel was brought and sutured continuously to cover the defect of IVC as a patch graft. The observation period was two months.Results: Three of five IVCs were macroscopically patent without stenosis and thrombosis. Pathologic assay revealed complete endothelialization of serosal surface of the patch of small bowel loop. One of IVCs was completely occluded in gross evaluation and fibrous formation in pathologist review. The sheep had no sign of venous hypertension and edema of limbs. One sheep died at the night of first operation due to internal bleeding.Conclusion: Serosal patch of small bowel is an accessible and feasible alternative in repair and reconstruction of IVC especially when there is restriction for use of prosthetic material in a contaminated space of abdomen.
Zahra Mohtasham Amiri; Iraj Barge-Gol; Leila Kouchakinejad‑Eramsadati; Payam Abedian; Helya Jafari-Shakib
Volume 10, Issue 1 , January 2022, , Pages 27-32
Abstract
Objective: To find out factors that influence the use/non-use of pedestrian bridges in Northern Iran. Methods: In this observational study, 4 pedestrian bridges at four different places in Rasht, North of Iran was studied. In addition to demographic data, pedestrians were interviewed for reasons ...
Read More
Objective: To find out factors that influence the use/non-use of pedestrian bridges in Northern Iran. Methods: In this observational study, 4 pedestrian bridges at four different places in Rasht, North of Iran was studied. In addition to demographic data, pedestrians were interviewed for reasons of use/not use the pedestrian bridge. The data analyzed with SPSS software version 18 by non-parametric tests such as Chi Square. Results: From all 499 participants, more than one-third of pedestrians had not used pedestrian bridges. The most reasons for bridges use among respondents were feeling of safety and security (79.2%) and obey the rules (53.6%). The reasons for the non-use of bridges were time saving (63.7%), laziness (48.7%) and inappropriate of the bridge (34.2%). There were no significant differences in age, sex, education level, and road accidents’ history with use of bridge but there was a significant difference between the bridge usage with having a driver’s license, rash-hour time, and the presence of a mechanical elevator (p <0.001). Conclusion: The results of this study show that in order to increase the pedestrian bridges use, it is necessary to pay more attention to make standard facilities such as installing escalators or elevators of these bridges.
Hamid Reza Kamravan; Ali Haghnegahdar; Shahram Paydar; Mohamad Khalife; Mahsa Sedighi; Fariborz Ghaffarpasand
Volume 2, Issue 1 , January 2014, , Pages 32-37
Abstract
Objective: To describe the epidemiological characteristics of patients with cervical spine injury admitted to Rajaee hospital, Shiraz, Iran.Methods: This cross-sectional study includes all patients admitted with impression of cervical column injury with or without cervical cord injury from October 2009 ...
Read More
Objective: To describe the epidemiological characteristics of patients with cervical spine injury admitted to Rajaee hospital, Shiraz, Iran.Methods: This cross-sectional study includes all patients admitted with impression of cervical column injury with or without cervical cord injury from October 2009 to March 2012 to our level I trauma center in Shiraz. We recorded the patients’ characteristics including age, sex, marital status, mechanism of injury, level of injury, concomitant injury, treatment(non-operative or operative) and clinical outcome. The data were described and compared with the international literature.Results: Among 261 patients referred with impression of spinal cord injury, the diagnosis of spinal column injury (with or without spine cord injury) was confirmed in 206 patients. The mean age of patients was 37.2±15.9 years with Male/Female ratio of 3:1. Car turn-over and car-collisions were the leading causes of injury. The most common spine fracture was C6 vertebra involving 60 (29.1%) patients. Fracture of upper and lower extremities were the most concomitant fractures observed in 31(15.1%) patients. Open surgery was performed in 65(31.6%).Mortality rate was 7.3% (15 patients).Patients with brain, lung and cord injuries had increased risk of death, among 15 deaths,9 patients had brain injury, 5 individuals had lung injury and 10 patients suffered from cord injury.Conclusion: Cervical spine injuries mostly affect young males, and comprise 206 (10%) cases out of 2100 spine injuries in our country. Preventive measures should be taken to reduce cervical spine injuries especially in young age group.
Gulzar Ahmad Dar; Farooq Ahmad Ganie; Mohammad Ishaq; Kowsar Jan; Zargar Showkat Ali; Ghulam Nabi Lone; Mashkoor Beigh; Tariq Abdullah; Maqsood Ahmad Dar; Mir Mudasir Sidiq
Volume 3, Issue 1 , January 2015, , Pages 32-35
Abstract
Foreign body ingestion and aspiration is among the most common causes of emergency department visit associated with high morbidity and mortality. Ingested and aspirated denture is rare conditions being scarcely reported in the literature. We herein report a 57-year-old man who presented with 2-day history ...
Read More
Foreign body ingestion and aspiration is among the most common causes of emergency department visit associated with high morbidity and mortality. Ingested and aspirated denture is rare conditions being scarcely reported in the literature. We herein report a 57-year-old man who presented with 2-day history of liquid and solid dysphagia who was diagnosed to have impacted denture in esophagus since 3 years prior to presentation. He was diagnosed to have esophagus adenocarcinoma and had undergone esophageal radiotherapy. The denture was removed successfully using esophagoscopy and the patient was discharged after 48-hour care with good condition. To prevent accidental ingestion, dentures should be made to fit properly. Damaged or malfitting dentures should be discarded and replaced. Patients should be strongly advised against wearing them during sleep-time.
