Review Article
Eman E. Shaban; Mohamed AM Elgassim; Ahmed Shaban; Amira Shaban; Amina Ahmed; Amro Abdelraman; Moayad Elgassim; Stuart A Lloyd; Hany A. Zaki
Volume 12, Issue 4 , October 2024, Pages 149-161
Abstract
Objective: The present study was performed to investigate the efficacy of different resuscitation fluids in critically ill patients presenting any type of hypovolemic shock.Methods: We comprehensively searched PubMed, Web of Science, ScienceDirect, Cochrane Library, and Google Scholar for randomized ...
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Objective: The present study was performed to investigate the efficacy of different resuscitation fluids in critically ill patients presenting any type of hypovolemic shock.Methods: We comprehensively searched PubMed, Web of Science, ScienceDirect, Cochrane Library, and Google Scholar for randomized trials published in English from January 1990 to August 2023. The risk of bias and methodological quality assessment was performed using Cochrane’s risk of bias tool embedded within the Review Manager software (RevMan 5.4.1). Moreover, this software was used to perform all the statistical analyses in the present study. During these analyses, the random effects model and 95% confidence interval was employed. The overall effect sizes for continuous and dichotomous data were calculated using the Mean Difference (MD) and Risk ratio (RR), respectively.Results: Our initial database search resulted in 4768 articles, of which only 16 were reviewed and analyzed. A subgroup analysis of data from 4 of these studies showed that hydroxyethyl starches (HES), gelatins and albumins had no significant mortality benefit compared to crystalloids (RR: 0.94; 95% CI: 0.75–1.17; P=0.58, RR: 0.71; 95% 0.46–1.08; P=0.11 and RR: 1.05; 95% CI: 0.77–1.43; P=0.77, respectively). Similarly, a subgroup analysis of data from 9 studies showed that hypertonic saline plus dextran (HSD) had no significant mortality benefit over normal saline (RR: 0.84; 95% CI: 0.62–1.13; P=0.24) or Lactated ringer’s solution (RR: 1.03; 95% CI: 0.75–1.42; P=0.87). In addition, we found that hypertonic saline had a similar effect on the overall mortality as isotonic crystalloids (RR: 0.92; 95% CI: 0.68–1.25; P=0.60). Also, our analysis shows that modified fluid gelatins had a similar mortality effect as HES ((RR: 1.02; 95% CI: 0.52–2.02; P=0.95).Conclusion: Colloids, whether individually or in hypertonic crystalloids (HSD), had no mortality benefit over crystalloids in adult patients with hypovolemic shock.
Original Article
hassanreza mohammadi; Ali Erfani; Aminollah Vasigh; Hosein Karimiyarandi; Sohrab Sadeghi
Volume 12, Issue 4 , October 2024, Pages 162-167
Abstract
Objectives: Laminectomy is one of the most prevalent back surgeries. Considering the importance of controlling and minimizing surgical complications, this study was conducted to determine the effect of Sevoflurane and Propofol on the state of renal complications in patients undergoing laminectomy surgery.Methods: ...
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Objectives: Laminectomy is one of the most prevalent back surgeries. Considering the importance of controlling and minimizing surgical complications, this study was conducted to determine the effect of Sevoflurane and Propofol on the state of renal complications in patients undergoing laminectomy surgery.Methods: This clinical trial was conducted in Ilam (Iran). The study used a double-blind random sampling procedure, and the patients were divided into three groups receiving Sevoflurane (n=25), Propofol (n=25), and the combination of Sevoflurane and Propofol (n=25). The research tool included a checklist of demographic characteristics as well as a clinical examination. Kidney complications were diagnosed based on history, clinical examinations, and laboratory test results. The obtained data were analyzed using SPSS software.Results: In this study, the patient’s mean age in the Propofol group was 52.4±5.6, the Sevoflurane group was 50.8±2.5, and Sevoflurane plus Propofol group was 53.5±3.4. The Sevoflurane plus Propofol group had the highest rate of urinary retention (n=7, 28%). In addition, there was no difference between laboratory results of creatinine and urinary retention in the studied groups (P>0.05). Besides, the comparison of the mean of renal laboratory indicators in the research patients indicated that the level of serum creatinine, and cystatin C of the patients had no significant change.Conclusion: There was no significant difference between the complications in the three groups. Therefore, all three drugs can be administered to patients.
Original Article
Muhammad Ali Naqi; Mehrdad Karajizadeh; Mohammad Reza Yousefi; Leila Shayan; Shahram Paydar
Volume 12, Issue 4 , October 2024, Pages 168-176
Abstract
Objective: This study aimed to determine the prevalence and survival rate of trauma patients who underwent resuscitative thoracotomy (RT) in a level I trauma center in southern Iran.Methods: This cross-sectional descriptive study conducted at Rajaee Hospital (Shiraz, Iran) from March 2018 to October ...
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Objective: This study aimed to determine the prevalence and survival rate of trauma patients who underwent resuscitative thoracotomy (RT) in a level I trauma center in southern Iran.Methods: This cross-sectional descriptive study conducted at Rajaee Hospital (Shiraz, Iran) from March 2018 to October 2022, included trauma patients who underwent RT surgery. Demographic information, vital signs at arrival, mechanism of injury, type of trauma, admission and discharge dates, length of hospital stay, blood transfusions, associated injuries, and clinical and laboratory parameters were evaluated. Statistical analyses were conducted using SPSS software.Results: A total of 147 trauma patients underwent RT. The patients’ mean age was 39±18.49 years. The majority of participants were men (82.40%). The most prevalent type of damage was blunt trauma, with a survival rate of 3%, followed by penetrating trauma, which had a 20% survival rate. The leading cause of trauma-related fatalities was road traffic accidents (78.9%). The majority of RT procedures (75.5%) took place in cardiopulmonary resuscitation (CPR) rooms. The survival group had lower systolic and diastolic blood pressure levels than the non-survival (83.0±34.96 vs. 97.83±33.10) and (40.75±20.91 vs. 62.48±25.36), respectively. Survivors exhibited a significantly higher Glasgow Coma Scale than non-survivors (8.40±6.14 vs. 4.75±3.84).Conclusion: The study revealed a low survival rate among trauma patients undergoing RT. Blunt chest trauma emerged as an independent predictor of poor outcomes. Future studies should further explore indications and outcomes of RT to better inform clinical practice.
Original Article
Pirhossein Kolivand; Peyman Saberian; Samad Azari; Peyman Namdar; Fereshte Karimi; Arash Parvari; Seyed Jafar Ehsanzadeh; Behzad Raei; Mehdi Raadabadi; Soheila Rajaie
Volume 12, Issue 4 , October 2024, Pages 177-184
Abstract
Objective: This study emphasized the importance of providing equal access to rescue and emergency services for all individuals involved in road accidents, regardless of their geographical location or socioeconomic status.Methods: This study involved gathering data on the number of Iranian Red Crescent ...
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Objective: This study emphasized the importance of providing equal access to rescue and emergency services for all individuals involved in road accidents, regardless of their geographical location or socioeconomic status.Methods: This study involved gathering data on the number of Iranian Red Crescent Society (IRCS) and Emergency Medical Services (EMS) stations in 31 provinces of Iran. It entailed calculating the Gini coefficient and creating the Lorenz curve to assess the station distribution. To present road traffic injuries (RTIs) mortality, Disability-Adjusted Life Years (DALYs), and prevalence in Iran from 1990 to 2019, the Global Burden of Disease (GBD) 2019 estimates were utilized.Results: The findings revealed that Tehran, Khorasan Razavi, Isfahan, Fars, and Khuzestan provinces were equipped with the most stations; whereas, Ilam, Semnan, and Kohgiluyeh and Boyer Ahmad had the fewest. The Gini coefficient for the distribution of RCS and EMS stations was found to be 0.23 and 0.38, respectively. Additionally, the study examined the prevalence, DALYs, and mortalities caused by road injuries across the 31 provinces and presented the findings in the form of a geographical representation.Conclusion: The results of this study highlighted the importance of ongoing efforts to ensure the equitable allocation of RCS and emergency services, with a particular emphasis on road accidents and disaster management scenarios.
Original Article
abbas naboureh; Mehrdad Farrokhi; Mohammad Saatchi; Shokofeh Ahmadi; Babak Farzinnia; Ferydon layeghi; Hamidreza Khankeh
Volume 12, Issue 4 , October 2024, Pages 185-192
Abstract
Objective: This qualitative study aimed to identify the key issues within Emergency Medical Services (EMS) in large urban regions.Methods: This study used qualitative content analysis as its research methodology. The study was conducted in 2023 and involved 21 Iranian EMS stakeholders, selected through ...
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Objective: This qualitative study aimed to identify the key issues within Emergency Medical Services (EMS) in large urban regions.Methods: This study used qualitative content analysis as its research methodology. The study was conducted in 2023 and involved 21 Iranian EMS stakeholders, selected through purposive sampling with maximum diversity to ensure a broad range of expertise. Data were collected through semi-structured, in-depth interviews, which were conducted until data saturation was reached. The analysis followed the method proposed by Landman and Graneheim, which involved systematic coding and categorization to identify key themes and patterns related to EMS challenges.Results: The study included 17 men and 4 women. The data analysis identified eight subcategories, which were then divided into three main categories based on their similarities. These main categories addressed challenges in EMS delivery, emerging issues in EMS demand, and resource constraints.Conclusion: This study highlighted the challenges that Iran’s EMS encountered in megacities due to rapid urbanization and an elderly population. Key issues included operational inefficiencies, increasing demand, and limited resources. Addressing these challenges is crucial for enhancing the effectiveness and sustainability of EMS. Further research is required to develop strategies for overcoming these obstacles and strengthening EMS in large urban regions.
Original Article
Naema Khodadadi-Hassankiadeh; Farshad Sedaghati Voshme Saraei; Leila Kouchakinejad‑Eramsadati; Fateme Keihanian; Marieh Hosseinpour
Volume 12, Issue 4 , October 2024, Pages 193-201
Abstract
Objective: Cycling is a healthy and pleasurable activity, but it can also be hazardous. The risk factors for cycling injury are unknown, considering the cycling infrastructure and cyclists’ behavior in northern Iran. This study aimed to explain the experiences of injured cyclists admitted to Poursina ...
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Objective: Cycling is a healthy and pleasurable activity, but it can also be hazardous. The risk factors for cycling injury are unknown, considering the cycling infrastructure and cyclists’ behavior in northern Iran. This study aimed to explain the experiences of injured cyclists admitted to Poursina Educational and Medical Center, Rasht in 2021, as one of the risk factors associated with cycling.Methods: A content analysis was conducted on the experiences of cyclists over the age of 18 who had one or more injured limbs due to a crash or fall while riding a bicycle. The data were obtained from the registration system of the Guilan Road Trauma Research Center. Potentially eligible participants were contacted by telephone. Twenty people with various characteristics in terms of age, sex, and other features were included in the interview. Results: Cyclists’ experiences with risk factors were divided into 13 categories; including lack of laws, lack of training, poor traffic culture, easy to lose balance, cycling infrastructure, inappropriate roads, darkness, bad weather conditions, unsafe behavior, non-standard bicycle, unsafe protection, intentional injury to female road users, and risk of collision with other road users.Conclusion: The extracted risk factors can be used as the ABC of cycling to novice cyclists. Thus, responsible efforts to regulate, educate, promote, and monitor cycling can encourage people to ride.
Case Report
Mridula Goswami; Vashi Narula; Ramanandvignesh Pandiyan
Volume 12, Issue 4 , October 2024, Pages 202-206
Abstract
Dental injury is a common anesthesia-related adverse event, with a high incidence of damage to teeth and surrounding tissues during oro-endotracheal intubation. Poor oral hygiene, compromised periodontium, faulty or loose prosthesis, proclined maxillary incisors along with increased difficulty level ...
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Dental injury is a common anesthesia-related adverse event, with a high incidence of damage to teeth and surrounding tissues during oro-endotracheal intubation. Poor oral hygiene, compromised periodontium, faulty or loose prosthesis, proclined maxillary incisors along with increased difficulty level of airway management, improper use of laryngoscope, and use of maxillary anterior teeth as a fulcrum for achieving accessibility to the airway are all risk factors for iatrogenic dental injury. This type of injury provides additional physical and psychological trauma to patients who have already undergone medical surgical procedures. The consequences of such mishaps might potentially result in medico-legal suits and financial claims.The present case series described three cases of managing iatrogenic dental lesions during oro-endotracheal intubation, after obtaining written informed consent, as well as methods for preventing such accidental injuries. This study emphasized the importance of collaboration between medical and dental professionals in preventing and successfully managing accidental dental injuries.
Letter to the Editor
Seyed Mostafa Mirakbari
Volume 12, Issue 4 , October 2024, Pages 207-208
Abstract
ABSTRACT: Methanol poisoning (MP) poses a significant health hazard to public health. It has led to repeated outbreaks of poisoning in our country. However, there is currently no confirmatory test for methanol toxicity, which results in both diagnosis and management, as well as related research, lacking ...
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ABSTRACT: Methanol poisoning (MP) poses a significant health hazard to public health. It has led to repeated outbreaks of poisoning in our country. However, there is currently no confirmatory test for methanol toxicity, which results in both diagnosis and management, as well as related research, lacking reasonable standards. Definitive confirmation of MP requires the measurement of methanol levels in the blood through gas or liquid chromatography. Unfortunately, such testing is often unavailable, even in prestigious medical centers. The absence of advanced laboratory examinations to confirm methanol toxicity represents a significant limitation in the studies of MPs. The diagnosis of MP in outbreak studies does not appear to have been fully elucidated. The process of patient selection is uncertain and requires clarification. Academic readers learn that the studies rely on patients who were admitted after consuming an alcoholic beverage and subsequently exhibited clinical symptoms commonly associated with MP, such as decreased consciousness, seizures, abdominal pain, blurred vision, and metabolic acidosis. This pattern of approach is consistent with suspected MP but may also be observed in cases of other toxic alcohols. While the combination of these symptoms strongly suggests MP, it does not definitively confirm it. Based on a combination of alleged alcohol consumption history, clinical observations, medical assessments, and metabolic acidosis, MP is assumed to be the primary diagnosis. A breakdown of inclusion criteria, including a confirmatory test, is essential to render the methodology reliable. This paper addresses the deficits in ongoing studies while also introducing recently developed handheld, low-cost and rapid confirmatory methanol tests.Key Words: Diagnosis, Methanol, Poisoning
