Education
Amin Beigzadeh; Bahareh Bahmanbijri; Elham Sharifpoor; Masoumeh Rahimi
Volume 2, Issue 1 , January 2016, , Pages 25-28
Abstract
In order to equip medical students with all the necessary skills in dealing with patients to provide optimal treatment, the need for the use of real patients in educational settings has become prominent. But all the required skills cannot be practiced on real patients due to patients’ safety and ...
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In order to equip medical students with all the necessary skills in dealing with patients to provide optimal treatment, the need for the use of real patients in educational settings has become prominent. But all the required skills cannot be practiced on real patients due to patients’ safety and well-being. Thus, the use of standardized patients (SPs) or simulated patients (SiPs) as a substitute for real patients signifies their importance in simulation-based medical education. One question raised in regard to using SPs or SiPs in order to enhance medical students’ tangible and intangible skills in a safe controlled environment is whether these two terminologies are the same or different? Various studies use these terms interchangeably and do not consider a difference between them. Based on our literature review, there seems to be differences between these two modalities. We also try to highlight the advantages of these modalities in clinical encounters.
Emergency medicine
Morteza Talebi Doluee; Maryam Salehi; Azadeh Mahmoudi Gharaee; Majid Jalalyazdi; Hamidreza Reihani
Volume 4, Issue 1 , January 2018, , Pages 29-33
Abstract
Objective: Septic shock is a response to infection and tissue hypoperfusion which does not respond to fluid therapy and eventually leads to organ dysfunction. Aggressive treatment of a broad-spectrum antimicrobial and supportive measures are the cornerstones of successful treatment. In addition to the ...
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Objective: Septic shock is a response to infection and tissue hypoperfusion which does not respond to fluid therapy and eventually leads to organ dysfunction. Aggressive treatment of a broad-spectrum antimicrobial and supportive measures are the cornerstones of successful treatment. In addition to the main treatment, there are adjunctive therapies. Steroids are one of the treatments which have been studied in the management of refractory septic shock. Despite numerous studies on the role of steroids in the mortality of severe sepsis and septic shock, still lots of controversies exist. These conflicts are often about the steroid dose and duration of administration.Methods: This was a prospective, randomized-controlled, two-group assignment study. Patients referred to Imam Reza (AS) hospital in Mashhad who had refractory septic shock criteria were randomly divided into two groups: 80 patients were included in each group. After obtaining the baseline cortisol level and cosyntropin test, one group was treated with intravenous hydrocortisone, and the other group was treated with placebo. The response to hydrocortisone, the return of shock duration, and mortality at 28 days were investigated. The data were analyzed using SPSS version 16. For the normally distributed variables, a t test was used for comparisons. Concerning qualitative variables, the chi-square test or Fisher exact test were applied accordingly.Results: The return of shock duration and mortality in intervention group patients was more than control group, but it was not statistically significant.Conclusion: Despite numerous studies in this field, there are various outcomes (mortality rate, rate of return of shock, time of return of shock). These differences can be attributed to high degree of heterogeneity. Perhaps considering the underlying disease and more differentiation could change the return of shock and mortality rate.
Emergency medicine
Ali Delirrooyfard; Maria Cheraghi; Mehdi Sayyah; Zahra Farahbakhsh
Volume 8, Issue 1 , January 2022, , Pages 32-36
Abstract
Objective: People with a significant childhood history of abuse may exhibit emotionaldysregulations and psychiatric disorders and, in some cases, present suicidal ideation.Methods: In this descriptive-analytical and cross-sectional study data were collectedfrom suicidal patients referred to two grand ...
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Objective: People with a significant childhood history of abuse may exhibit emotionaldysregulations and psychiatric disorders and, in some cases, present suicidal ideation.Methods: In this descriptive-analytical and cross-sectional study data were collectedfrom suicidal patients referred to two grand hospitals in 2019. One hundred ninetyfive participants were evaluated concerning child abuse and neglect history. Data werereported as mean, SD, frequency, and percent. T-test and chi-square tests were used forstatistical analyses accordingly.Results: Child abuse regarding suicidal people were to the following order, neglect(n=103), child emotional abuse (n=102), child physical abuse (n=101), malnutrition (n=96),and child sexual abuse (n=87). Suicide was different between the two genders, but it wasnot different based on parents’ education and marital status.Conclusion: The harassed child is not equipped with proper behavioral skills and issubjected to low self-esteem due to incorrect training. Therefore, he/she may commitsuicide in adolescence by facing some problems and failures. In this regard, communityplays an important role, parents must be informed and use the right culture to reward thechild.
Ali Reza Shafiee-Kandjani; Shahrokh Amiri; Nima Sarihi; Elham Hossein; Salman Safikhanlou; Mohsen Jafarzadeh-Ghareziaaddin
Volume 6, Issue 1 , January 2020, , Pages 33-37
Abstract
Objective: Two temperamental components that are mostly associated with suicide are high novelty seeking (NS) and high harm avoidance (HA). This study aimed to evaluate the temperament and character personality dimensions of self-poisoning in suicidal attempters in an Iranian population.Methods: A descriptive-analytic ...
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Objective: Two temperamental components that are mostly associated with suicide are high novelty seeking (NS) and high harm avoidance (HA). This study aimed to evaluate the temperament and character personality dimensions of self-poisoning in suicidal attempters in an Iranian population.Methods: A descriptive-analytic study was conducted with random sampling in which 77 self-poisoning patients and equal normal counterparts were selected. Cloninger’s Temperament and Character Inventory (TCI) and clinical interview were used as study procedures. Data were analyzed by SPSS software version 18 using chi-square, Mann-Whitney U and regression. P values<0.05 were considered statistically significant.Results: Findings showed that people attempting suicide were significantly different from general population in terms of character and temperament. NS and HA yielded high scores in the suicide group, while reward dependence (RD), self-directedness (SD), cooperativeness (CO) and self-transcendence (ST) variables revealed significantly higher scores in the healthy group. No significant difference was observed among suicide attempters in terms of gender.Conclusion: The results confirm the difference between non-suicidal individuals and suicide attempters in terms of character and temperament in a way that suicidal patients have high harm-avoidance and introversion. In addition, the history of attempts and early alcohol consumption might be considered as suicide re-attempt predictors.
Critical Care
Mahesh Chand Meena; Kuldeep Panchal; Mukta Rani
Volume 3, Issue 1 , January 2017, , Pages 34-37
Abstract
Oculocardiac reflex (OCR) sometimes occurs as a result of pressure on the eye or traction of the intraorbital surrounding structures during ophthalmic surgery. This can result in bradycardiac arrhythmia and cardiac arrest. A 45-year-old female was undergoing an elective squint correction surgery of one ...
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Oculocardiac reflex (OCR) sometimes occurs as a result of pressure on the eye or traction of the intraorbital surrounding structures during ophthalmic surgery. This can result in bradycardiac arrhythmia and cardiac arrest. A 45-year-old female was undergoing an elective squint correction surgery of one eye under local anaesthesia in a private hospital in December 2013. The patient was preoperatively examined, investigated and admitted to the hospital one day prior to operation. There was no previous history of any chronic illnesses. The patient collapsed during surgery and declared dead. Doctors attempting strabismus surgery under local anaesthesia should be familiar with this phenomenon.
Emergency medicine
Mulla Mahammad Rafi; Mohammed Ismai Nizami; Uppaluri Sarath Chandra; Ashima Sharma; Gaddam Dharani Reddy; Lubna Tarannum
Volume 7, Issue 1 , January 2021, , Pages 36-40
Abstract
Objective: COVID-19 has become a major public health concern in recent times with detrimental effects on health and economy of the nation exerting unbearable pressure on health care personnel. It is vital for the caretakers and the people accompanying those patients to be aware of the ongoing pandemic ...
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Objective: COVID-19 has become a major public health concern in recent times with detrimental effects on health and economy of the nation exerting unbearable pressure on health care personnel. It is vital for the caretakers and the people accompanying those patients to be aware of the ongoing pandemic and its impact on the society and to realize their responsibility towards curbing the spread of the disease. The aim of this study is to assess the awareness of COVID-19 among the attendants accompanying the patients at emergency department (ED) and to determine their perception of the disease. Methods: A questionnaire was prepared and the attendants were approached with it. The attendants responded to the questionnaire by choosing the appropriate answers. Illiterates were explained about the questions in the language they understood and the responses were recorded. The survey was conducted from May 25th, 2020 to June 10th, 2020. Descriptive analysis was done to represent the study characters. Results: A total of 509 participants responded to the questionnaire with the mean age between 30 to 50 years. Participants were fairly conversant of the preventive measures but a significant portion lacked the knowledge of transmission and the impact of COVID-19. Education was observed to have a positive correlation with the correct responses given. Conclusion: Public education for the spread of awareness is yet to reach the illiterate section of the society. The need exists for educating the attendants of the patients as well who actually are potential candidates for contracting and also for spreading the disease
Emergency medicine
Khadigesadat Kazemi; Hooman Esfahani; Hadis Amiri; Asghar Tavan; Hojjat Farahmandnia
Volume 9, Issue 1 , January 2023, , Pages 38-43
Abstract
Objectives: Pandemics would certainly have a negative impact on mental health. Positivemodifications as well as negative alterations have been documented in earlier viralpandemic according to previous investigations. Teenagers face a variety of challengesduring adolescence. Adolescents may become more ...
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Objectives: Pandemics would certainly have a negative impact on mental health. Positivemodifications as well as negative alterations have been documented in earlier viralpandemic according to previous investigations. Teenagers face a variety of challengesduring adolescence. Adolescents may become more concerned if this time coincides withother worries. This study aims to investigate the positive changes that occur in a youngadolescent’s life after COVID-19 pandemic, and to see how they relate to perceived socialsupport.Methods: This cross-sectional study was performed on adolescents who were randomlyselected from high schools in Kerman, Iran 2020 during the COVID-19. the sample sizewas 108 and for sampling wes used multi-stage random sampling at the end the data wasanalyzed by Pearson correlation test. Demographic information, the MultidimensionalScale of Perceived Social Support (MSPSS) and Posttraumatic Growth Inventory short form(PTGI-SF) were used to collect data. The data were subjected to descriptive and analyticalstatistical tests (Pearson correlation) using SPSS software version 24.Results: Statistically a positive correlation was found between the PTG total score andyoung homeschooled adolescents, parents working remotely, income loss and COVID-19experience. Moreover, during the COVID-19 pandemic, a positive association was foundbetween perceived social support and PTG total scores in young adolescents. There werealso substantial positive connections between the MSPSS subscales and the PTGI overallscore.Conclusion: Based on the findings, an overall growth in all areas of PTG was observedduring the COVID-19 among young adolescents. Perceived social support scores have apositive and significant relationship with COVID-19 effects. In the crises we face throughoutlife, intimate family members and friends play a significant supporting role in adapting tothese situations
Emergency medicine
Esmaeil Fakharian; Zahra Sehat; Mojtaba Sehat
Volume 5, Issue 2 , July 2019, , Pages 65-70
Abstract
Objective: Traumatic spine injuries are seriously important and are associated with considerable morbidity and mortality. The goal of this study is to determine the epidemiology of the traumatic spine injuries in Shahid Beheshti Hospital of Kashan University of Medical Sciences (KAUMS), the main trauma ...
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Objective: Traumatic spine injuries are seriously important and are associated with considerable morbidity and mortality. The goal of this study is to determine the epidemiology of the traumatic spine injuries in Shahid Beheshti Hospital of Kashan University of Medical Sciences (KAUMS), the main trauma center in Kashan, Iran.Methods: This cross-sectional study was undertaken on all cases of traumatic spinal injuries that were admitted to Shahid Beheshti hospital of KAUMS from 2014 to 2017. A checklist was used to collect demographic characteristics (age, gender, education, marital) and mechanism of the injury of the spine. According to ICD-10, the level of the injury was detected by diagnostic tests such as radiologic imaging and magnetic resonance imaging and computed tomography scans, and also multi-trauma final outcome of the patients with traumatic spine injury (TSI) and rate of the spinal cord injury (SCI), hospital length of stay and surgery treatment was investigated.Results: The number of patients with traumatic spine injuries was 986. Among this batch, 77% were males. The mean age of the patients was 39.5 years. Most injuries occurred in the age group of 15 to 30 years. Traffic accident was the most common mechanism of the trauma (35.2%) followed by the falls (26.95%) motorcycle accident (17.9%), assault by a sharp object or an unspecified object (10.13%) and other reasons (5.6%). The most common site of injury was in lumbar section (24.41%). Patients with traffic accident injury had the longest hospitalization. The rate of SCI was 2.63% and the rate of mortality was 2.3%.Conclusion: The TSI is an important and serious public health problem and a major cause of disability. Understanding the epidemiology can help us contrive appropriate preventative measures.
Radiology
Mustafa Mahmood Eid; Maythem Al-Kaisy
Volume 6, Issue 2 , July 2020, , Pages 82-86
Abstract
Background:Trauma is considered to be a major cause of morbidity and mortality all over the world. This descriptive study has an emphasize on the epidemiology, mechanism and patterns of trauma, with a consideration of why trauma code was activated, and the imaging results in regard to the severity of ...
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Background:Trauma is considered to be a major cause of morbidity and mortality all over the world. This descriptive study has an emphasize on the epidemiology, mechanism and patterns of trauma, with a consideration of why trauma code was activated, and the imaging results in regard to the severity of the trauma. Method: A descriptive study was conducted in Al Ain Hospital over the year of 2017. Totally 886 patients were included who presented with a trauma and considered dangerous according to hospital guidelines. They underwent a full body trauma CT, and were admitted to the hospital. We looked at the mechanisms, patterns, time of the day and radiological findings. Injury severity score (ISS) and Revised trauma score (RTS) were calculated, and the cause of trauma code activation was evaluated.Results: The study showed that; positive imaging findings were found in 364 (41%) of patients while 522 (59%) had normal radiological tests. The principal mechanism of injury was motor vehicle accident (54.4%) followed by falls (21.4%) and pedestrian accidents (10.2%). Overall, 69.75% (618 patients) were admitted to the hospital, 22 patients (2.5 %) needed immediate interventions and 36 patients (4 %) needed ICU admission. Only 2 patients (0.25 %) died in the emergency room.Conclusion:The hospital policy in activating a trauma code should be revised, with more care being paid to the mechanisms of injury and the condition of the patient, without missing any injury that could harm the patient. So, the emergency physician should be better prepared to do a detailed physical examination and weigh the risk of radiation against missing a dangerous injury.
Emergency medicine
Krishna Prasad; Susan Tharian; Jebu A Thomas
Volume 4, Issue 2 , July 2018, , Pages 89-91
Abstract
Traumatic spinal epidural hematoma (TSEH) is a neurosurgical emergency which is considered as one of the rare causes of back pain. The onset of symptoms presentation can vary especially following a trauma. Here, we report a case where a young girl had a trivial fall and presented symptoms of back pain ...
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Traumatic spinal epidural hematoma (TSEH) is a neurosurgical emergency which is considered as one of the rare causes of back pain. The onset of symptoms presentation can vary especially following a trauma. Here, we report a case where a young girl had a trivial fall and presented symptoms of back pain three days later. She developed abrupt onset of lower limb weakness during her stay in the emergency department (ED). X-ray and computed tomography (CT) imaging of the spine did not show any obvious abnormality whereas, Magnetic resonance imaging (MRI) imaging revealed hyper-intense lesions in the thoracic spinal segment which led to the diagnosis of TSEH. Our case highlights the importance of the atypical and varied nature of presentation and the choice of investigation which would help in the early diagnosis of this entity.
Emergency medicine
Mahnaz Yadollahi; sarina sahmeddini
Volume 7, Issue 2 , July 2021, , Pages 118-122
Abstract
Objective: The purpose of the current study is to determine the prevalence and pattern of maxillofacial trauma.Methods: This is a cross sectional study of maxillofacial trauma cases treated in the referral trauma center of south of Iran. Data of 264 patients were extracted from patients’ records ...
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Objective: The purpose of the current study is to determine the prevalence and pattern of maxillofacial trauma.Methods: This is a cross sectional study of maxillofacial trauma cases treated in the referral trauma center of south of Iran. Data of 264 patients were extracted from patients’ records and analyzed. Data included patient’s demographics, injury mechanism, types of maxillofacial injuries, Injury Severity Score (ISS), associated injuries, length of hospital stay and outcome. Binary logistic regression by backward method was applied to determine the effects of independent variables on mortality odds ratio.Results: 85.23% of patients were males and of all patients 87.5% survived. The mean of age was 34.95 ± 16.51. The commonest cause of maxillofacial injury was road traffic accidents (86.31%). The median of ISS was 20.39± 10.24 and patients aged 30-39 years had the highest ISS. Overall, the most common maxillofacial injuries were orbital (59.47%, n=157) followed by maxillary (48.11%, n=127); common associated injuries were related to head (81.44%, n=215) followed by thorax (58.33%, n=154). Age and gender (being male) increased the odds ratio of mortality. An increase in ISS decreased the odds ratio of mortality, but it was not significant.Conclusion: Most of maxillofacial trauma patients suffered from orbital injuries and there were a huge percentage of associated injuries. Gender (male), age and length of hospital stay were the significant variables of mortality in maxillofacial patients. The findings of the current study sheds light on further investigation to treat these patients and enforce road traffic legislation and public education to prevent these traumas.
Clinical Toxicology
Morteza Talebi Doluee; Bita Dadpoor; Behrang Rezvani Kakhki; Veda Vakili; Elahe Barati; Elnaz Vafadar Moradi
Volume 8, Issue 2 , July 2022, , Pages 122-127
Abstract
Objective: Intoxication is among the most common causes of emergency department (ED) visits. Activated charcoal is one of the useful treatments preventing poison absorption. However, nausea caused by using charcoal has made this substance less acceptable among patients. This study aims at investigating ...
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Objective: Intoxication is among the most common causes of emergency department (ED) visits. Activated charcoal is one of the useful treatments preventing poison absorption. However, nausea caused by using charcoal has made this substance less acceptable among patients. This study aims at investigating the influence of using cold charcoal on reducing the nausea among poisoned patients.Methods: This clinical experimental trial study approved by the Medical Ethics Committee of Regional School of Medicine of Mashhad University of Medical Sciences with the code 930106. Randomization was provided by Sealed Envelope. Accordingly, the experimental group received cold charcoal (4ᵒC), while the control group received room temperature charcoal (23ᵒC).We used the coding method in order to double blind the study. After half and one hour, nausea was checked in patients by visual numeric scale (VNS). Data were described by using descriptive and analytic test indices including frequency, mean ± standard deviation and suitable charts and tables.Results: The average age of participants was 25.83±7.05. The severity of nausea half an hour after consuming charcoal in cold charcoal group and experimental group was 1.3 and 2.73, respectively (P < 0.001). One hour after consuming charcoal, the severity of nausea in cold charcoal group and experimental group was 0.39 and 1.38 (P < 0.001). As indicated by the results of the study and after investigating the changing trend of nausea severity, nausea severity decreased in both groups by passing time from half to one hour (P < 0.001).Conclusion: Cold charcoal can reduce the rate of nausea and make it more acceptable among patients.
Clinical Toxicology
Gholamreza Faridaalaee; Seyed Hesam Rahmani; Sajjad Ahmadi; Amin Mahboubi
Volume 2, Issue 1 , January 2016, , Pages 29-30
Abstract
Ingestion and inhalation of phosphine are 2 forms of toxicity and their clinical manifestation is extremely wide. A 22-year-old girl was admitted with complaints of nausea, vomiting and epigastric pain after eating lunch. She had a history of celiac disease. On arrival, she was alert and hemodynamically ...
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Ingestion and inhalation of phosphine are 2 forms of toxicity and their clinical manifestation is extremely wide. A 22-year-old girl was admitted with complaints of nausea, vomiting and epigastric pain after eating lunch. She had a history of celiac disease. On arrival, she was alert and hemodynamically stable. There was not any abdominal tenderness or guarding. Food poisoning treatment initiated but after 1 hour her condition deteriorated with hypotension, tachycardia, and epigastric pain. Venous blood gas (VBG) showed severe metabolic acidosis. She denied any drug ingestion again. New Electrocardiogram (ECG) showed extensive inferolateral ST elevation myocardial infarction (STEMI). Bicarbonate plus dopamine was initiated. After 8 hours of admission, rhythm became ventricular fibrillation (VF) and cardiopulmonary resuscitation (CPR) began. Peritoneal dialysis was performed. Next morning frequent VF occurred again but CPR was unsuccessful. Family found aluminum phosphide (AIP) tablets in her purse. Early diagnosis and supportive treatment may be effective but the most important factor is the dose of ingestion.
Emergency medicine
Payman Moharamzadeh; Kavous Shahsavari Nia; Mohammadhossein Somi; Mahboub Pouraghaei; Akbar Fadaeihaghi; Farzad Rahmani
Volume 4, Issue 1 , January 2018, , Pages 34-38
Abstract
Objective: In recent years, there has been a great attention concerning red blood cell distribution width (RDW) in clinical decisions as well as determining the severity of diseases. This study was conducted to evaluate the primary level of RDW to predict hospital mortality in pancreatitis.
Methods: ...
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Objective: In recent years, there has been a great attention concerning red blood cell distribution width (RDW) in clinical decisions as well as determining the severity of diseases. This study was conducted to evaluate the primary level of RDW to predict hospital mortality in pancreatitis.
Methods: This was a descriptive analytical study performed on 100 patients with acute pancreatitis in the emergency department of Imam Reza hospital of Tabriz University of Medical Sciences. In this study, the primary level of RDW in patients with acute pancreatitis presenting to the emergency ward was collected and after patients’ admission we followed them. Also, the admission outcome (mortality or discharge) of patients was registered, and finally we evaluated the predictive value of RDW in determining the patient’s outcome in hospital.
Results: In our study, 47 patients were male, and 53 patients were female. Mean RDW in patients was 13.82 ± 1.69. Five patients died during the study. Mean RDW in dead patients and other patients was 16.44 ± 4.22 and 13.68 ± 1.37, respectively (P < 0.001). The cut-off point of 14.55 for RDW with 80% sensitivity and 85% specificity was determined for predicting mortality in patients.
Conclusion: Based on our study results, the initial RDW level is an independent factor for predicting in-hospital mortality in pancreatitis but not for determining the need for surgery or admission to the intensive care unit (ICU).
Emergency medicine
Peyman Saberian; Mostafa Sadeghi; Parisa Hasani-Sharamin; Maryam Modaber; Amirreza Farhoud; Mehrad Aghili
Volume 6, Issue 1 , January 2020, , Pages 38-42
Abstract
Objective: This study aimed to compare the efficacy of rescue blankets with conventional blankets in terms of preventing hypothermia in the pre-hospital setting. Methods: In this randomized clinical trial, patients older than 18 years old with Cold Discomfort Scale (CDS) > 2, and those who were transferred ...
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Objective: This study aimed to compare the efficacy of rescue blankets with conventional blankets in terms of preventing hypothermia in the pre-hospital setting. Methods: In this randomized clinical trial, patients older than 18 years old with Cold Discomfort Scale (CDS) > 2, and those who were transferred to the emergency department (ED) by emergency medical service entered the study. Patients were randomly divided into two groups based on the type of transfer. In this regard, one group was transferred with rescue blankets and the other group was transferred with conventional blankets. The tympanic temperature in patients and CDS were recorded before the use of blanket (primary) and at the time of arrival in the ED (secondary). Results: Finally, 161 patients with the mean age of 45.31±19.8 years were included (63.4% were male). Totally, 88 cases (54.7%) were transferred with rescue blankets and 73 cases (45.3%) with conventional blankets. The mean of the primary tympanic temperatures in the rescue and conventional blanket groups were 36.20±0.84°C and 36.34±0.65°C, respectively (P=0.23). The mean of the primary CDS in rescue and conventional blanket groups were 6.55±1.95 and 5.89±2.29, respectively (P=0.05). Also, the mean of the secondary tympanic temperatures in the rescue and conventional blanket groups were 36.59±0.47°C and 36.76±0.48 °C, respectively (P=0.03). Besides, the mean of the secondary CDS in the rescue and conventional blanket groups were 2.64±2.80 and 2.41±1.29, respectively (P=0.48). Conclusion: According to the results, there is no significant difference in the tympanic temperature and CDS of the patients transferred with the rescue blanket compared with the conventional blanket
Emergency medicine
Fardin Shahbazzadeh; Sajjad Narimani; Shiva Ahmadi; Zahra Anvari; Mehdi Khezeli
Volume 7, Issue 1 , January 2021, , Pages 41-45
Abstract
Objective:This study aimed to determine the motivation to helmet use among motorcyclists in Ardabil city using the trans-theoretical model (TTM) motivational interview. Methods: Random cluster sampling was used for this study. Five gas stations were selected from the crowded areas of Ardabil city and ...
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Objective:This study aimed to determine the motivation to helmet use among motorcyclists in Ardabil city using the trans-theoretical model (TTM) motivational interview. Methods: Random cluster sampling was used for this study. Five gas stations were selected from the crowded areas of Ardabil city and motorcyclists who came to these places were randomly interviewed. In this descriptive cross-sectional study, 350 motorcyclists in Ardabil were selected and interviewed by TTM Motivational questionnaire. We used one-way analysis of variance (ANOVA) and linear regression for analysis of data in SPSS software version 20. Results: Findings revealed that 12.6% of respondents consistently wore a helmet when they rode a motorcycle, while 45.2% of helmet non-wearers were uncertain about wearing a helmet in the future. Decisional balance (pros), self-efficacy (decreasing the negative affect situation score), and behavioral process of change can motivate participants to helmet use. Conclusion: Reducing negative social situations and increasing positive emotional states can motivate people to use helmet.
Emergency medicine
Mohammad Nikzadian; Sima Hashemi; Reza Beiranvand; Maryam Khormehr
Volume 9, Issue 1 , January 2023, , Pages 44-51
Abstract
Objective: One of the most important indicators used in the evaluation of emergency centers is the chronometric analysis of patients’ workflow. The aim of this study was to provide a chronometric analysis of patients’ workflow (patients’ waiting time in the emergency department) and ...
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Objective: One of the most important indicators used in the evaluation of emergency centers is the chronometric analysis of patients’ workflow. The aim of this study was to provide a chronometric analysis of patients’ workflow (patients’ waiting time in the emergency department) and related factors.Methods: This hospital-based prospective cohort study was carried out in Khatam al-Anbia hospital in Shoushtar in 2020. Random sampling was used and patients referred to the emergency ward in three shifts based on the ESI 5-level triage system. The research tools were the emergency workflow chronometry form and a questionnaire of determining the factors related to the speed of emergency services and using a stopwatch. In order to analyse the data, Stata software version 16 and Weibull model of survival analysis were used.Results: Of 468 participants, the most common cause of referral was trauma with 21.7%. The median ± interquartile range duration of giving the final result was 6.06 ± 4.48 hours, which was more than 0.54 times shorter in clients with level 3. There was a statistically significant difference in the duration of making the final decision based on the request for testing, manner of referring and the type of initial diagnosis (P < 0.05).Conclusion: The duration of service provision in the studied hospital is appropriate for an Iranian hospital, but it should be closer to international standards. At level 2 triage, patients stayed longer. This can be reduced by lessening the time of consultations which can help the emergency ward.
Emergency medicine
Mishal Gillani; Sabah Uddin Saqib; Russell Seth Martins; Hasnain Zafar
Volume 6, Issue 2 , July 2020, , Pages 87-91
Abstract
Objective: Trauma is the significant non-obstetrical cause of maternal mortality in women aged 35 years or younger. It is expected to complicate around 1 in 12 pregnancies and accounts for 46% of such deaths. In this study, we present our experience of trauma during pregnancy at a tertiary care hospital ...
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Objective: Trauma is the significant non-obstetrical cause of maternal mortality in women aged 35 years or younger. It is expected to complicate around 1 in 12 pregnancies and accounts for 46% of such deaths. In this study, we present our experience of trauma during pregnancy at a tertiary care hospital in Karachi.Methods: A standardized form was used to extract data from online records for all pregnant women who presented with traumatic injuries to the Aga Khan University Hospital from 2014 to 2019.Results: A total of 48 pregnant females with a mean age of 28.80 (SD: 6.50) years were included in this study. Road traffic accidents (RTA) accounted for the commonest cause of injury in the first (66.7%) and second (65%) trimesters. However, fall (45.5%) followed by RTA (27.3%) was the most frequent mechanism of injury during the third trimester. Gunshot injuries were seen in 4 patients only. Overall, fetal ultrasound was the most commonly performed imaging (87.5%) followed by limb X-ray and focused abdominal sonography for trauma (FAST) ultrasound. Out of total, 52.1% of the patients were surgically managed. Fetal demise in utero and spontaneous abortion was reported in 2 patients only.Conclusion: Road traffic accidents and falls comprise a significant burden of maternal and fetal morbidity and mortality. In terms of prevention, several policies and interventions at the government level need to be introduced in order to reduce the incidence of traumatic events.
Clinical Toxicology
Sasan Zaeri; Zohre Aghaei; Navid Reza Mashayekhi; Ali Salemi; Ramin Seyedian
Volume 7, Issue 2 , July 2021, , Pages 123-126
Abstract
Objective: Snake envenomation is common in tropical and subtropical countries of the Middle East areas including Iran. Cerastes cerastes gasperettii is a dangerous snake living in southwestern provinces of Iran. It causes massive edema at the bite site and coagulopathy leading to death if untreated. ...
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Objective: Snake envenomation is common in tropical and subtropical countries of the Middle East areas including Iran. Cerastes cerastes gasperettii is a dangerous snake living in southwestern provinces of Iran. It causes massive edema at the bite site and coagulopathy leading to death if untreated. Methods: The purpose of this preliminary animal study was to evaluate the toxicity and proteomic of this venom for the first time in Iran. Moreover, the hemodynamic changes with intravenous injection of the venom were assessed and inotropic in addition to arrhythmogenic properties of this venom were investigated. Results: The estimated amount of the LD50 with intraperitoneal injection was slightly less than the similar experiment in Saudi Arabia (1.32 mg/kg versus 978 µg/kg body weight). There were 8 distinct protein bands between 12 and 66 kDa in SDS-PAGE analysis that were different with Moroccan experiment due to inter and intra species variation. Inotropic potencies were not significant since the lethal dose with intravenous injection was much lower than the Arabian experiment in guinea pigs (2.4 mg/kg versus 0.8 mg/kg). Conclusion: According to the low hemodynamic changes induced with the venom, it seems that coagulopathy and edema are the most dangerous effects of this rare snake in Iran.
Emergency medicine
Pegah Sepehri Majd; Amirhossein Alimohammadi Siyabani; Haniyeh Ebrahimi Bakhtavar; Farzad Rahmani
Volume 8, Issue 2 , July 2022, , Pages 128-133
Abstract
Objective: Awareness of the severity of trauma and the outcome of patients can help physicians decide how long to treat patients. The objective of this study is to design a new score (R-GAP: Revised-GCS, Age, Pressure) for multi-trauma patients and determine its predictive value concerning in-hospital ...
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Objective: Awareness of the severity of trauma and the outcome of patients can help physicians decide how long to treat patients. The objective of this study is to design a new score (R-GAP: Revised-GCS, Age, Pressure) for multi-trauma patients and determine its predictive value concerning in-hospital outcome of these patients.Methods: This cross-sectional study was performed in the emergency ward of Imam Reza (AS) and Shohada hospitals (referral centers for trauma patients) affiliated to Tabriz University of Medical Sciences from 2019 to 2020. The sample size of this study was estimated to be 2000 people. Required information was collected and the final diagnosis of the patients was recorded. The hospital outcome was recorded at the time of discharge. Patients’ outcome was also recorded using the Glasgow Outcome Scale (GOS) system. Based on the obtained data, GAP, R-GAP, new trauma score (NTS) scores were also collected and their results were compared with the designed model. Receiver operating characteristic (ROC) curve and logistic regression were used to analyze the predictive value of the scores.Results: The mean age of the subjects was 34.09 (± 15.23) years. The highest outcome of patients based on the GOS system was recovery, moderate disability, and severe disability with 1309 cases (54.9%), 743 cases (31.2%), and 212 cases (8.9%), respectively. The mean of GAP, R-GAP, and NTS scores were 21.83 (± 3.1), 21.47 (± 3.4), and 21.27 (± 3.3), respectively. The intensity of GAP, R-GAP, and NTS in most subjects was low with 2143 cases (89.9%), 1994 cases (83.6%), and 2138 cases (89.7%). Among the significant variables included in the regression model, O2sat, primary GCS, GAP, R-GAP, and NTS with modulation on other variables, significantly equalized the mortality chance by 0.416, 0.622, 0.595, 0.601, 0.637, respectively (P value < 0.001).Conclusion: According to the study results, it seems that GAP, R-GAP, and NTS respectively, have the highest strength of predictive value in the survival of patients with multiple traumas. It is suggested that a comprehensive study be conducted to better estimate this issue.
Cardiology
Amin Mahdavi; Meysam Moravej; Maryam Aliramezany
Volume 8, Issue 1 , January 2022, , Pages 37-42
Abstract
Objective: Coronavirus disease 2019 (COVID-19) is an infection which can present itself bythe involvement of various organs, but the most common manifestations are respiratorysymptoms, fever and dyspnea with a high mortality rate. In order to study the prognosis ofpatients and also to determine the treatment ...
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Objective: Coronavirus disease 2019 (COVID-19) is an infection which can present itself bythe involvement of various organs, but the most common manifestations are respiratorysymptoms, fever and dyspnea with a high mortality rate. In order to study the prognosis ofpatients and also to determine the treatment plan, we need non-invasive methods whichcan be easily used in the triage of patients. In this study, we investigated the diagnosticvalue of electrocardiographic (ECG) changes and troponin levels in patients with thisdisease.Methods: This is a descriptive study. Confirmed COVID-19 patients participated in thepresent study. Data were collected by taking history and referring to medical records. Weanalyzed data by using chi square, t test and logistic regression through SPSS softwareversion 22.Results: One hundred and five patients with COVID-19 disease were examined. Mostpatients were men (53.3%) and the mean age was 54.53 years. The most common underlyingdiseases were hypertension and diabetes mellitus. Ninety-five patients had abnormalelectrocardiography including eleven with long QT; seven with arrhythmia; 78 with sinustachycardia; 7 with hemi-block; 1 with hemi-block and first degree atrioventricular block;4 with abnormal axis and 28 with ischemic changes. Eleven patients (10.5%) had positivetroponin level, whose length of hospital stay was higher (12.73 vs. 12.07 days). Furthermore,their mean length of intensive care unit (ICU) stay was also higher. In addition, among thetroponin-positive group, 100% had abnormal electrocardiography.Conclusion: The findings of the present study showed that ECG abnormalities and troponinlevels could provide good information about the prognosis of patients. Moreover, it seemsthat ECG changes in COVID-19 patients, whether indicative of underlying heart disease orresulted from infection, can affect the prognosis of patients. Therefore, considering ECGfindings and troponin levels can help select patients at a higher risk for triage.
Emergency medicine
Seyyed Hosein Montazer; Behzad Feizzadeh; Farzad Bozorgi; Seyed Mohammad Hosseininejad; Ayyoub Barzegarnezhad; Iraj Golikatir; Fatemeh Jahanian; Hasan Motamed; Hamed Aminiahidashti
Volume 4, Issue 1 , January 2018, , Pages 39-43
Abstract
Objective: The main purpose in the treatment of renal colic patients in emergency department is pain management. This study aimed to compare the analgesic effects of intravenous (IV) acetaminophen and morphine sulfate in this regard.
Methods: This double blind clinical trial was conducted on >18 ...
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Objective: The main purpose in the treatment of renal colic patients in emergency department is pain management. This study aimed to compare the analgesic effects of intravenous (IV) acetaminophen and morphine sulfate in this regard.
Methods: This double blind clinical trial was conducted on >18 years old renal colic patients in need of pain management in emergency department. Pain severity was recorded as 15, 30, and 60 minutes before injection, and 120 minutes after injection. In addition, side effects were compared between IV acetaminophen and morphine sulfate groups using SPSS version 16.
Results: A total of 355 patients were randomly allocated to one of the treatment groups. There were no significant differences between the two groups regarding baseline characteristic of participants. There was no significant difference in the pain intensity of the groups; 15 (P = 0.13) and 30 (P = 0.15) minutes after treatment. Although, the difference in pain severity was statistically significant between the two groups; 60 (P = 0.02) and 120 (P = 0.003) minutes after the infusion. This was not clinically important. The prevalence of side effects in morphine group was higher than the acetaminophen group (RR: 2.14, 95% CI: 1.53-2.98, P< 0.0001).
Conclusion: Based on the findings, IV morphine sulfate and acetaminophen had equal effectiveness regarding acute renal colic pain management, but considering the significantly higher frequency of side effects, IV acetaminophen seems to be a more reasonable choice in this regard.
Emergency Medical Services
Sahar Mirbaha; Mohammadmehd Forouzanfar; Amin Saberinia; Amir Salimi; Hamid Kariman; Mozhgan Farmahini Farahani
Volume 6, Issue 1 , January 2020, , Pages 43-46
Abstract
Objective: Each imaging technique has a special application and usage, and should be used in the right situation. Physicians choose the type of imaging technique by considering the type of tissue and the benefits and disadvantages of the imaging method as well as its financial burden on the patient. ...
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Objective: Each imaging technique has a special application and usage, and should be used in the right situation. Physicians choose the type of imaging technique by considering the type of tissue and the benefits and disadvantages of the imaging method as well as its financial burden on the patient. The aim of this study was to estimate the cost of imaging tests performed in the emergency department (ED) of an educational hospital and determine their financial burden on both the patients and the healthcare system of the country. Methods: This retrospective descriptive cross-sectional single-center study was conducted in Shohadaye Tajrish, an educational hospital, during one year. The study population consisted of all patients who had undergone some type of imaging (CT scan, ultrasound, radiography, magnetic resonance imaging [MRI]) in the ED. The information was collected using a predesigned checklist. The costs of a variety of imaging methods for patients referred to the ED were calculated using different types of accounting units and PACS system. Results: The number of patients who visited the ED of the studied hospital during a one year period was 63507. The total cost of performing different types of imaging methods in the studied center throughout the one-year target period was 44018695695 Rials (≃$US 423745) (59.27% of which was spent on CT scan, 16.09% on ultrasound, 13.75% on plain radiography and 10.87% on MRI). Conclusion: According to the collected data, the total cost of radiology was 44018695695 Rials. The highest cost was related to CT scan modality, and the lowest belonged to MRI.
Emergency medicine
Smita Bhat; Amal Suresh; Apeksha Inamdar; Anil Kumar Desai; Gopal Krishnan
Volume 9, Issue 1 , January 2023, , Pages 52-53
Abstract
Objective: Fractures of orbital rims are common and restoration of these fractures back toits normal anatomic form is essential to maintain the function and aesthetics of the eyes.Low profile miniplates are the rigid fixation device of choice for such fractures. But in caseof sagittal and grossly displaced ...
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Objective: Fractures of orbital rims are common and restoration of these fractures back toits normal anatomic form is essential to maintain the function and aesthetics of the eyes.Low profile miniplates are the rigid fixation device of choice for such fractures. But in caseof sagittal and grossly displaced fractures of orbital rims it is difficult to achieve stability byusing miniplate osteosynthesis. The low profile miniplates may not be able to withstandthe forces to reduce this kind if grossly displaced fractures, another stable option needs tobe considered in these situations.Case presentation: This case report presents a simple and effective technique of reductionand fixation of an oblique fracture of infraorbital rim fracture using lag screw principle.A standard titanium screw of 2 mm diameter and 10 mm length is being used in thedescribed technique for stable fixation of fractured segments.Conclusion: The technique is simple, hardware’s are easily available and can be practisedin emergency circumstances where newer advanced technologies are not available
Forensic Medicine
Maryam Ameri; Maryam Akhgari; Roya Kordrostami
Volume 5, Issue 2 , July 2019, , Pages 71-74
Abstract
This study aimed at describing demographic information of the deceased resulting from hanging by means of different methods of suicide. In this cross-sectional study, the file of suicide cases referred to the Central Legal Medicine Organization was investigated retrospectively. Of 1681 suicide cases, ...
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This study aimed at describing demographic information of the deceased resulting from hanging by means of different methods of suicide. In this cross-sectional study, the file of suicide cases referred to the Central Legal Medicine Organization was investigated retrospectively. Of 1681 suicide cases, the highest suicide mode was hanging by 993 cases (57.4%) and intoxication by 674 cases (39%). The mean age of hanging was 36.22±15.76 and for other suicide methods it was 32.61±13.70 (P=0.000). Hanging was higher in males. Female victims used other methods like intoxication (P=0.000). The most common seasons for hanging were spring and winter. Toxicological analysis in cases of hanging was positive with opioid alkaloids in 95 cases (9/9%) and methamphetamine in 68 cases (7%). Intoxication with aluminum phosphide was in 35.8% of cases. Most of the cases (68.3%) were self-employed victims. A total of 534 (63%) cases were married. There was a statistically significant difference between hanging and other suicide modes concerning age, gender, occupation, marital status, and drug abuse history (P<0.001). The frequency of hanging was higher in males, marrieds, self-employed, unemployed and drug abusers. Students were victims of intoxication. Self-employed victims, unemployed victims and drug abusers were exposed to successful attempts more than others. Screening plans can be helpful in preventing suicide by prioritizing the people at risk.