Cardiology
Ata Firouzi; Alireza Raji Amir Hasani; naemeh Bahrami; Parnian Bahrami
Volume 10, Issue 2 , July 2024
Abstract
Objective: While PCI achieves high procedural success rates, persistent risks such as periprocedural thrombosis, inflammatory cascades, and myocardial hypoperfusion contribute to a bimodal pattern of early and late complications, underscoring gaps in current risk prediction models. This research focuses ...
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Objective: While PCI achieves high procedural success rates, persistent risks such as periprocedural thrombosis, inflammatory cascades, and myocardial hypoperfusion contribute to a bimodal pattern of early and late complications, underscoring gaps in current risk prediction models. This research focuses on identifying the risk factors contributing to recurrent coronary events, particularly stent thrombosis and in-stent restenosis, in patients admitted to the cardiac emergency department.Methods: A retrospective cohort study was conducted on 204 patients at Shahid Rajaei Hospital to analyze their clinical records, including demographic data, cardiovascular risk factors, and treatment history. Data collection utilized a structured checklist encompassing demographics, cardiovascular risk factors, treatment history, procedural details, and outcomes. Statistical analyses (PRISM version 9.0) included descriptive statistics and multivariable logistic regression to assess predictors of outcomes.Results: Multivariate logistic regression analysis revealed that for same-artery re-involvement, the duration after first myocardial infarction was significantly associated with increased risk (P < 0.0001, OR = 3.666). Regarding stent thrombosis, multiple factors including duration after myocardial infarction (P < 0.001), not taking Plavix (P = 0.033), MI type (P = 0.001), diabetes mellitus (P = 0.002), cigarette smoking (P = 0.029), and absence of family history (P = 0.03) all demonstrated significant effect. For in-stent restenosis, only the absence of diabetes (P = 0.018, OR = 0.432) was significantly associated with decreased likelihood of this outcome.Conclusion: The study also emphasizes the importance of early detection, regular follow-ups, and effective management strategies, such as pharmacological intervention and lifestyle changes, to reduce the risk of adverse cardiac outcomes. Additionally, it was found that a prolonged duration since the initial myocardial infarction significantly elevates the risks of same-artery re-occlusion and stent thrombosis.
Emergency Medical Services
Somaye Younesian; Reza Shirvani; Ali Tabatabaey
Volume 4, Issue 1 , January 2018, , Pages 3-8
Abstract
Objective: Patient satisfaction (PS) is a major quality assessment index for the emergency department (ED) which affects patient safety, litigation, reimbursements, and consumer satisfaction. In this study we aimed to recognize the factors affecting PS in our center. Method: Random shifts during a week ...
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Objective: Patient satisfaction (PS) is a major quality assessment index for the emergency department (ED) which affects patient safety, litigation, reimbursements, and consumer satisfaction. In this study we aimed to recognize the factors affecting PS in our center. Method: Random shifts during a week were selected and all patients disposed from the ED were asked to fill out a revised and validated Persian version of the Press-Ganey questionnaire with the help of a research assistant. Results were analyzed using a linear regression model by SPSS software version 21. Results: Findings reaffirmed some of the factors previously described. These included longer door to treatment area times having a negative effect on satisfaction (P < 0.001), and providing vivid discharge information improving PS (P < 0.001). Other important factors were also found that had not previously been focused on, namely cleanliness of the area (P < 0.0001) and courtesy of the staff in charge of patient transfer (P = 0.03). We also found that men had a more satisfying ED experience (P = 0.002). Conclusion: Cultural expectations may have an important effect on PS. Thus, every institution should determine and alter the expectations most relevant to them.
Emergency medicine
Hamid Reza Moretza Bagi; Amir Ghaffarzad; Peyman Fathipour; Reza Yazdani; Zhila Khamnian; Sama Rahnemayan
Volume 8, Issue 1 , January 2022, , Pages 3-7
Abstract
Objective: Nowadays, simulation of clinical environment in medical education system (simulation-based learning) has led to a huge revolution in the quality of education and has increased the safety of educators and patients. In this study, we investigated the effect of teacher-made neck and lung simulators ...
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Objective: Nowadays, simulation of clinical environment in medical education system (simulation-based learning) has led to a huge revolution in the quality of education and has increased the safety of educators and patients. In this study, we investigated the effect of teacher-made neck and lung simulators in teaching cricothyrotomy skills for emergency medicine residents.Methods: In this pre-post test study, all faculty member of emergency medicine of Tabriz University of medical sciences specialty were invited to participate. After holding an educational and training session for assistants on a teacher-made moulage, all emergency medicine residents performed a tracheostomy on the commercial moulages of the skill lab unit for the second time and their scores were recorded.Results: In this study, 23 emergency medicine residents participated. The mean ± standard deviation of age was 35.91 ± 3.57 years. There was a significant difference between the mean duration of cricothyrotomy before and after the training (P value = 0.006). There was also a significant difference between the mean scores obtained by residents in the pre- and post-training evaluation (P value < 0.001).Conclusion: Findings showed that the moulages constructed by teachers not only can be effective in improving the cricothyrotomy skills in emergency medicine residents but also can reduce the likelihood of failure in performing cricothyrotomy.
Internal Medicine
Leyli Asadabadi; Mohmmad Mehdy Heiran; Amirhosein Mirafzal
Volume 2, Issue 1 , January 2016, , Pages 7-10
Abstract
Objective: To evaluate the capability of ascitic fluid dipstick results for pH, glucose, and protein in order to predict a low serum-ascites albumin gradient (SAAG) at the bedside of the patient in the emergency department (ED). Methods: This prospective cross-sectional study was conducted during one ...
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Objective: To evaluate the capability of ascitic fluid dipstick results for pH, glucose, and protein in order to predict a low serum-ascites albumin gradient (SAAG) at the bedside of the patient in the emergency department (ED). Methods: This prospective cross-sectional study was conducted during one year in the ED of Afzalipour hospital in Kerman, Iran. All patients with diagnostic or therapeutic paracentesis of ascitic fluid were considered as eligible patients. Exclusion criteria included clinical suspicion for spontaneous bacterial peritonitis (SBP), any contraindications to paracentesis, and patients’ refusal to participate in the study. Dipstick values were obtained at the bedside, and SAAG was calculated after the determination of serum and ascitic fluid albumin by laboratory. A low SAAG ascitic fluid was defined as the study outcome. We also used our study population as a test group to evaluate an equation proposed in one previous study: K = 0.012 Protein−0.012 Glucose−3.329 pH+23.498 Results: A total of 50 patients were enrolled in the study. Based on multivariate regression analysis, dipstick values for protein and glucose were independently predictive of a low SAAG ascitic fluid (P = 0.23, OR = 1.04; and P = 0.001, OR = 0.81, respectively). The formula proposed in one of the previous studies was tested by our data set, with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) at 84%, 83%, 84%, and 80%, respectively. Conclusion: Dipstick test of ascitic fluid for pH, glucose, and protein has an acceptable sensitivity and specificity as a point of care test, but it cannot be recommended as a substitute for SAAG determination based on the current findings.
Emergency Medical Services
Julius Gbenga Olaogun; Amarachukwu Chiduziem Etonyeaku; Joshua Taye Ige; Obafemi Kayode Wuraola
Volume 6, Issue 1 , January 2020, , Pages 7-12
Abstract
Objective: There has been a worldwide rise in the prevalence of penetrating abdominal injury (PAI), and there are both inter-country and intra-country variations in frequencies. This study evaluates the mechanisms and pattern of penetrating abdominal injuries and the treatment outcome in our center.Methods: ...
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Objective: There has been a worldwide rise in the prevalence of penetrating abdominal injury (PAI), and there are both inter-country and intra-country variations in frequencies. This study evaluates the mechanisms and pattern of penetrating abdominal injuries and the treatment outcome in our center.Methods: This descriptive study of adult patients managed for PAI was conducted at the Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti from January 2015 to December 2018. Data were prospectively collected and analyzed by using descriptive statistics from Statistical Package for Social Sciences (SPSS) version 20.0.Results: There were 96 patients managed for abdominal injuries during the study period. Forty-six (47.9%) of them had PAI, while 50 (52.1%) others sustained blunt trauma. Patients ages ranged from 17-72 years (mean = 34.2±10.8 years; median = 34 years). Majority, 42 (91.3%), were males, while 4 (8.7%) were females (M: F=11:1). The most afflicted age group was in the 4th decade. Majority of the injuries were due to gunshot (60.9%) followed by stab (26.1%), unsafe abortion (6.5%), road traffic injury (4.3%) and fall (2.2%). Gastrointestinal injuries were the most common with small bowel perforations predominating. Solid organ injuries were only seen in 3 (7.9%) patients. Eight (17.4%) had associated extra-abdominal injuries. Thirty-eight (82.6%) patients required exploratory laparotomy, while 8 (17.4%) were managed non-operatively. The negative laparotomy rate was 2.6%. Seven (15.2%) patients developed complications which were mostly wound infection (10.8%). The duration of hospital stay was 1-58 days (mean 12.7±10.5). Three patients (6.5%) with gunshot injuries died.Conclusion: Gunshot wounds were the major variant of PAI, and the highest cause of mortality from it. Gut injuries were most common, and exploratory laparotomy remains the main-stay of treatment, while non-operative management is practicable in carefully selected cases.
Trauma
Shahram Paydar; Armin Akbarzadeh; Ladan Nasermoadeli; Vahid Mohammadkarimi
Volume 9, Issue 1 , January 2023, , Pages 9-12
Abstract
Objective: The adherence of the physicians to guidelines in resuscitation of the patientsis of great importance since it can predict the outcome. To evaluate the adherence of thephysicians of our center in hydration of traumatic patients with crystalloids regarding theAdvanced Trauma Life Support (ATLS) ...
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Objective: The adherence of the physicians to guidelines in resuscitation of the patientsis of great importance since it can predict the outcome. To evaluate the adherence of thephysicians of our center in hydration of traumatic patients with crystalloids regarding theAdvanced Trauma Life Support (ATLS) guidelines.Methods: We designed an algorithm obtained from ATLS guidelines using vital signsand status of bleeding of the traumatic patients to classify them. After categorizing thepatients according to the algorithm, we evaluated the adherence of the physicians to theguideline in hydration of traumatic patients with crystalloids.Results: This is a cross-sectional study in which 998 traumatic patients who were admittedto the emergency ward of Rajaee trauma hospital were enrolled. Most of the patients weremen (89.6%) and the most common causes of traumatic injuries were traffic accidents.Proper hydration was seen in only 14.7% of the patients. Most of the patients were overhydrated (85%) regarding both our algorithm and the patients’ base excess.Conclusion: The present study showed that the adherence of physicians in our centerin resuscitation with crystalloid was low. Also, most of the traumatic patients wereoverhydrated with crystalloids. It is suggested that physicians retrain concerning theside effects of over hydration. In addition, we need a user friendly and more applicableguideline for hydration with crystalloids
Ultrasonography
Behrang Rezvani Kakhki; Mohsen Ebrahimi; Mahdi Foroughian; Samaneh Khajeh Nasiri; Vahid Eslami; Saeideh Anavri Ardakani; Sayyed Reza Ahmadi
Volume 7, Issue 1 , January 2021, , Pages 12-16
Abstract
Objective: The purpose of the current study was to assess the success rate of posterior tibial nerve block in the ankle with and without ultrasound guidance for pain management in emergency departments. Methods: This clinical trial was conducted on 80 individuals who needed posterior tibial nerve block ...
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Objective: The purpose of the current study was to assess the success rate of posterior tibial nerve block in the ankle with and without ultrasound guidance for pain management in emergency departments. Methods: This clinical trial was conducted on 80 individuals who needed posterior tibial nerve block in the ankle at the emergency department of Hashemi Nejad hospital and Edalatian emergency center in Mashhad, Iran. The eligible individuals were randomly assigned to one of two groups, designated the control (landmark-based nerve block) and the case group (ultrasound-guided nerve block). The two groups were compared in terms of the main measurable outcomes. The data were analyzed using SPSS software (version 20) by nonparametric tests. Results: According to the findings, the mean and median of nerve block success in the landmark-based and ultrasound-guided methods were significantly different between the two groups, both 15 (P=0.02) and 30 (P=0.001) min post-intervention. In this regard, nerve block with ultrasound guidance had a higher success rate compared to the landmark method. However, no significant difference between the two interventions was found in terms of the mean and median of the procedure duration (P=0.8) and injection frequency (P=0.4). On the other hand, the two groups were significantly different regarding the median and mean of patient satisfaction (P=0.00), duration of analgesia (P=0.004), and nerve block-related complications (P=0.03). Conclusion: The findings revealed that the relatively new technique of nerve block by ultrasound-guide resulted in better outcomes than the landmark-based method. Consequently, this method could be adopted to control acute pain in the emergency departments and improve patient care.
Procedure
Fereshte Zamani; Hydar Ali Abedi
Volume 1, Issue 1 , January 2015, , Pages 13-18
Abstract
Objective: According to the previous studies, several social, cultural, and organizational factors are involved in the decision of families of brain death victims for organ donation. The present study was performed to determine the effective factors in the decision of organ donation among families of ...
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Objective: According to the previous studies, several social, cultural, and organizational factors are involved in the decision of families of brain death victims for organ donation. The present study was performed to determine the effective factors in the decision of organ donation among families of brain death victims.
Methods: In this descriptive-comparative study data were gathered through a self-made questionnaire. The reliability of questionnaire was determined by calculating Cronbach’s alpha (0.81) and the face and content validity were studied and approved by a number of experts. Statistical population included all family members of brain death victims in Isfahan/Iran during 2012-2013. They were divided into two groups of with and without consent to organ donation. The whole population was considered as the study sample. Data analysis were done through SPSS using independent T-test, ANOVA, and Chi-square tests.
Results: According to the present study, age and marital status of the victims have no effect on their families’ consent to organ donation (P> 0.05); but sex, duration of hospitalization in the emergency department, having organ donation card ,and personal opinion of the brain death victim showed significant relationship with consent to organ donation (P< 0.05).
Conclusion: Since the rate of awareness, knowledge, and attitude of family members are effective in their decision for organ donation, improving cultural backgrounds required for this decision and increasing awareness and knowledge of people can improve the attitude of people in this regard and facilitate the acceptance of family members.
Trauma
Majid Zamani; Farhad Heydari; Mehrdad Esmailian
Volume 5, Issue 1 , January 2019, , Pages 14-18
Abstract
Objective: The present study examines the diagnostic accuracy of abdominal ultrasonography and urinalysis test in children with blunt abdominal trauma, compared with CT scan. The aim of this study was to compare the diagnostic value of ultrasound and urinalysis test with CT scan as a golden standard ...
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Objective: The present study examines the diagnostic accuracy of abdominal ultrasonography and urinalysis test in children with blunt abdominal trauma, compared with CT scan. The aim of this study was to compare the diagnostic value of ultrasound and urinalysis test with CT scan as a golden standard diagnostic method in predicting abdominal peritoneal injury in these patients.Methods: This prospective study, based on diagnostic accuracy evaluation, was performed on children with blunt abdominal traumas less than 12 years of age who were referred to the emergency department from 2017-2018 and for whom abdominal ultrasonography, urinalysis and abdominal CT scans were requested. Demographic data, mechanism of trauma, the results of urine tests, ultrasound and CT scan of the abdomen were recorded. Sensitivity, specificity, positive and negative predictive values were used to measure the diagnostic power of the tests.Results: In this study, 100 children with multiple traumas were included. The mean age of these patients was 5.75 ± 3 years with a range of 1-12 years. In terms of sexual distribution, 69 (69%) were boys and 31 (31%) were girls. According to the results, ultrasound with an abnormal urinalysis test had sensitivity of 85.7%, specificity of 91.9%, positive predictive value of 63.2% and negative predictive value of 97.5%. The accuracy was 91%.Conclusion: According to the results of this study, the combination of ultrasonography and urinalysis resulted in a significant increase in diagnostic value (P <0.001). Pediatric patients with a negative ultrasonography and urinalysis test should be observed rather than subjected to the radiation risk of CT.
Emergency medicine
Ehsan Alishapour; Samrad Mehrabi
Volume 10, Issue 1 , January 2024, , Pages 17-21
Abstract
Objective: The epidemiology of drug poisoning is an essential field of study in public health research that explores the many aspects of this urgent problem. Accidental poisoning is the third most common cause of death and the fifth most common reason for hospital visits in several developing countries. ...
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Objective: The epidemiology of drug poisoning is an essential field of study in public health research that explores the many aspects of this urgent problem. Accidental poisoning is the third most common cause of death and the fifth most common reason for hospital visits in several developing countries. Pharmaceutical poisoning is the second most common cause of hospital admissions and deaths in Iran, where unintentional poisoning remains a serious health concern. This research aims to thoroughly investigate all aspects of drug poisoning cases using epidemiological analysis.Methods: This study analyzed the records of 701 consecutive patients at Shiraz Faghihi hospital Medical Emergency Center in Iran between April 1 and September 30, 2022. Poisoning diagnosis was determined based on reports and documents. Data were collected from patient medical records and analyzed using SPSS software, with a significance level set at P < 0.05. The chi-square test was used to compare the means of drug-posing variables and demographic variables.Results: This study reviewed 701 cases, with an average age of 35.02 ± 16.104 (P < 0.001), 45.8% of whom had education levels higher than high school (P = 0.012). The majority (66.6%) had no psychiatric history (P < 0.001), and 55.6% had no history of addiction (P < 0.001). The predominant poisoning agent was opium (48.9%), followed by benzodiazepine poisoning (40.2%). About 10% were attributed to other causes. A mortality rate of 3.4% was observed, and 96.6% of the cases survived.Conclusion: The study underscores the crucial importance of addressing drug usage for both prevention and therapy. Additionally, the revelation that medicines often serve as the primary source of toxicity, particularly in developing countries, emphasizes the high accessibility and potential hazards associated with these medications.
Clinical Toxicology
kavous Shahsavarinia; Ali Taghizadieh; Amir Ghaffarzad; Amin Shariati; Farzad Rahmani
Volume 3, Issue 1 , January 2017, , Pages 18-21
Abstract
Objective: Scorpion is one of the world’s most venomous arthropods and every year many people are bitten by it. In Iran, scorpion sting is a common health issue. The aim of this study was to evaluate the epidemiological and clinical status of patients with scorpion sting in the emergency department ...
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Objective: Scorpion is one of the world’s most venomous arthropods and every year many people are bitten by it. In Iran, scorpion sting is a common health issue. The aim of this study was to evaluate the epidemiological and clinical status of patients with scorpion sting in the emergency department of Sina hospital in 2014.
Methods: In this descriptive cross-sectional study, all patients with a history of scorpion sting during 2014 in the emergency department of Sina hospital in Tabriz entered the study. Required information such as sex, age, location and time of the sting, the patient’s symptoms, etc were extracted from the medical records. These findings were analyzed using SPSS version 15.
Results: Based on our results, 47.2% of patients were male. The mean ± SD of their age was 35.63 ± 18.87. Of 176 patients, 83% lived in urban areas, 87% of scorpion sting cases occurred in houses, and 81.3% of stings were done by yellow scorpion. Most of the bites were in upper extremities (47.2%). In evaluation of symptoms and signs of patients, 89.8% had pain, 48.8% had local erythema and redness, 21% had inflation of sting position and 0.6% had pulmonary symptoms.
Conclusion: Scorpion stings are more common in young people as they are more active. Scorpion stings occur more frequently during the night and in the summer. In our study, most of scorpion stings occurred in houses.
Emergency Medical Services
Samuel Olufemi Bolarinde; Isaiah Oyewole; Adesola Felix Abobarin
Volume 5, Issue 2 , July 2019, , Pages 41-46
Abstract
Objective: Musculoskeletal disorders (MSDs) are one of the major complaints in the work place. This study investigated the prevalence and pattern of work-related MSDs, risk factors and the strategies of management among nurses working in various specialty areas in a tertiary health institution in Nigeria.Methods: ...
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Objective: Musculoskeletal disorders (MSDs) are one of the major complaints in the work place. This study investigated the prevalence and pattern of work-related MSDs, risk factors and the strategies of management among nurses working in various specialty areas in a tertiary health institution in Nigeria.Methods: This cross-sectional survey recruited 150 nurses working in various specialty areas of a government own tertiary institution in South-west, Nigeria. Data were obtained on demographic characteristics, occupational profile, work-related musculoskeletal symptoms, perceptions on job risk factors and management strategies. Data were presented using descriptive statistics of percentages and frequency tables.Results: The most common MSD among the respondents was low back pain (LBP) (60.0%), followed by neck pain (48.0%), while elbow pain was the lowest work-related musculoskeletal pain (5.3%). Findings indicated that respondents working in Intensive Care Unit (100.0%), Dental Unit (100.0%), Accident and Emergency (77.8%), Orthopaedics (75.0%), Ear Nose and Throat (75.0%) and Medicine (72.7%) suffered from LBP more than other respondents in other specialty areas. Results also revealed that frequent bending (64.0%), prolonged standing (49.3%) and frequent lifting of patients (48.0%) were major factors that contributed to LBP among the respondents. Rest (56.0%), pain killer drugs (50.7%), and exercise (36.0 %) were the most preferred pain management strategies among the respondents, while only 12.0% preferred physiotherapy management.Conclusion: A great percentage of Nigerian nurses suffer from work-related MSDs in their professions with the low back being the most injured body part. Nurses working in Intensive Care Unit, Dental, Accident and Emergency and Orthopedics are more prone to work-related LBP. Education programs on back care and workplace ergonomics are recommended for reduction and prevention of occupational hazards among nurses.
Pulmonology
Hassan Amiri; Ali Bidari; Samad Shams Vahdati; Nilofar Ghodrati; Tayeb Ramim; Masoumeh Emamverdy
Volume 2, Issue 2 , July 2016, , Pages 42-45
Abstract
Objective: There are many communities at risk by a series of air pollution episodes. Tehran is one of the most polluted cities in the world. The presence of one or more air pollutants with a certain concentration in a particular period of time can cause several adverse effects on human and animals’ ...
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Objective: There are many communities at risk by a series of air pollution episodes. Tehran is one of the most polluted cities in the world. The presence of one or more air pollutants with a certain concentration in a particular period of time can cause several adverse effects on human and animals’ well-being that can cause much morbidity. There are several pollutants in the air but some of them can cause severe adverse effects on the lungs and air ways.Methods: In this retrospective cross-sectional study 1958 patients with exacerbation of chronic obstructive pulmonary disease (COPD) who were admitted in the emergency department (ED) of Rasol Akram hospital between March 2004 and March 2006 entered the study. Data such as number of admissions, air pollution particles (CO, SO2, O3, NO2, PM10) according to available documents were analyzed.Results: From 1958 patients who enrolled in this study, 887 (53.5%) were male and 771 (46.5%) were female. According to statistical analysis, we could observe a significant correlation between the concentration of Co, PM10, So2 with ED admission rate of COPD exacerbation (P: 0.031, 0.008, and 0.001 respectively). The effect of PM10, So2 and Co was more significant respectively in logistic regression on ED admission.Conclusion: There was significant correction between concentrations of air pollutants with number of ED admission for COPD exacerbation.
Emergency Medical Services
Davood Soroush; Morteza Talebi Deloei; Hamidreza Reihani; Vida Vakili; Azadeh Mahmoodi Gharaee; Azadeh Tafakori; Reza Farahmand Rad; Elham Pishbin
Volume 1, Issue 2 , July 2015, , Pages 48-51
Abstract
Objective: Road traffic injuries (RTIs) are the second leading causes of death in Iran. One of the most important steps in the prevention of traffic-related trauma and its consequences is gaining insight into the epidemiology of injuries. We conducted this study to describe the characteristics of RTIs ...
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Objective: Road traffic injuries (RTIs) are the second leading causes of death in Iran. One of the most important steps in the prevention of traffic-related trauma and its consequences is gaining insight into the epidemiology of injuries. We conducted this study to describe the characteristics of RTIs and to find strategies for its prevention.
Methods: This was a prospective cross-sectional study on consecutive road traffic trauma patients admitted to the emergency department (ED) of the second largest trauma center in the northeast of Iran, during July to September 2013. Demographic characteristics, type of vehicle, and injured area of the body were documented for each patient.
Results: Of 666 included patients, 562 (84.4%) were male and 104 (15.6%) were female, with a mean age of 28.89 ± 16.62 years. Most of the patients were uneducated. The highest frequency of RTIs was related to motorcyclists with an attributed risk of RTIs for motorcycles at 75.8%. The most common traumatized area was head, face, and lower extremities.
Conclusion: The largest number of traumatized patients was among motorcyclists and uneducated population underscores the importance of public training about motorcycle usage and security and increase social awareness about reasons behind traffic law.
Pediatrics
Esra Polat; Nevzat Aykut Bayrak; Günsel Kutluk; Hasret Ayyıldız Civan
Volume 6, Issue 2 , July 2020, , Pages 59-62
Abstract
Objective: Upper gastrointestinal bleeding (UGB) is one of the most important and serious cause of emergency admission in childhood. The aim of the study was to evaluate the etiological factors and the treatment approaches in patients with UGB.Methods: In this retrospective study, children with UGB admitted ...
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Objective: Upper gastrointestinal bleeding (UGB) is one of the most important and serious cause of emergency admission in childhood. The aim of the study was to evaluate the etiological factors and the treatment approaches in patients with UGB.Methods: In this retrospective study, children with UGB admitted to emergency clinics of Istanbul Health Sciences University Kanuni Sultan Suleyman Research and Training Hospital, Istanbul Bakirkoy Sadi Konuk Research and Training Hospital and Diyarbakir Children’s Hospital were evaluated between January 2014 and August 2017.Results: Of the 198 children, 14.6% had non-steroid anti-inflammatory drug (NSAID) history, and 12.6% had chronic liver disease. We detected esophagitis, esophagus varices and peptic ulcer with upper gastrointestinal endoscopic evaluation (47%, 11.1%, 18.1%, respectively). Helicobacter pylori was found in 61.6% of patients. Endoscopic therapeutic procedures (band ligation therapy, sclerotherapy, and adrenaline injection) were appied in 11.1% of patients. Eighty-four (42.4%) patients were hospitalized, and erythrocyte transfusion (ET) was ordered in 29 (14.6%) patients.Conclusion: Approximately in 20% of the pediatric patients, the source of gastrointestinal bleeding is the upper gastrointestinal system. The cause of UGB varies with age. Appropriate diagnostic and therapeutic approaches are very important for management and to reduce mortality.
Trauma
Julius Gbenga Olaogun; Olusoga Olusola Akute; Amarachuku Chiduziem Etonyeaku; Joshua Taye Ige; David Brown Ajibola; Jide Michael Afolayan; Eyitayo Ebenezer Emmanuel
Volume 4, Issue 2 , July 2018, , Pages 67-72
Abstract
Objective: There has been a global increase in the incidence of abdominal trauma in surgical patients. We conducted this study to evaluate the pattern of abdominal injuries, patient characteristics and the management outcome in our setting.Methods: It was a descriptive (combined retrospective and prospective) ...
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Objective: There has been a global increase in the incidence of abdominal trauma in surgical patients. We conducted this study to evaluate the pattern of abdominal injuries, patient characteristics and the management outcome in our setting.Methods: It was a descriptive (combined retrospective and prospective) study of all patients with abdominal trauma admitted and managed at Ekiti State University Teaching Hospital, Ado-Ekiti between January 2013 and December 2016. Data on socio-demographics, clinical profile, investigations, treatments and outcome were entered into a spread sheet and analyzed using SPSS version 20.0.Results: A total of 2728 trauma patients presented during the study period. Of these, 68 (2.5%) suffered from abdominal injuries. Their ages ranged from 6 to 72 years (mean 30.3±13.2). Fifty-nine (86.8%) were males while 9 (13.2%) were females (M: F ratio = 6.6:1). Forty-nine (72.1%) sustained blunt trauma while 19 (27.9%) had penetrating injuries. Road traffic incident (RTI) (n=41; 60.3%) was the most common source of trauma, followed by assault: gunshot (n=9; 13.2%), and stab (n=7; 10.3%). Spleen (n=23; 33.8%) was the most common solid organ injured followed by the liver (n=7; 10.3%) while small bowel (n=8; 11.8%) was the most common hollow viscous injured. Forty-seven (69.1%) required operative intervention. Post-operative complication rate was 17% with wound infection (12.5%) predominating. The mortality rate was 4 (5.9%).Conclusion: RTI and assault are major causes of abdominal injury. Measures to reduce RTI, youth restiveness and criminal activities will stem the tide.
Clinical Toxicology
Nastaran Eizadi-mood; laaya mokhtar; shiva samsamshariat; Gholamali dorooshi; arman otroshi; mohammad naghizadeh; Ali Mohammad Sabzghabaee
Volume 9, Issue 2 , July 2023, , Pages 92-96
Abstract
Objective: Poisoning is one of the most common methods of suicide in developing countries. We assessed the frequency of impaired hematological indices in patients with acute poisoning.Methods: The present study was a cross-sectional retrospective. Using the census sampling method, all patients who had ...
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Objective: Poisoning is one of the most common methods of suicide in developing countries. We assessed the frequency of impaired hematological indices in patients with acute poisoning.Methods: The present study was a cross-sectional retrospective. Using the census sampling method, all patients who had attempted suicide by poisoning and were admitted from 2013 to 2023 were included in this study. Different variables, including age, gender, hematological index on admission, hospital stay, and outcome (mortality), were recorded in a data-gathering form. ANOVA and chi-square or Fisher’s exact tests were used for analysis.Results: This study was conducted on 48186 patients, 53.4% of whom were male. The average age of the patients was 34.92 (±13.23). Of all patients, 6% had anemia, 15.1% leukocytosis, 15% higher than average hemoglobin, and 9.1% lower than average platelet count. White blood cell (WBC) count was higher (mean difference=3741.85, SD=151.35, 95% CI=3445.21–4038.5) in deceased patients, while platelet count was significantly lower in deceased patients (mean difference=17.19, SD=2.57, 95% CI=12.14–22.24) (P<0.001). Anemia correlated with more extended hospital stayby an average of 1.61 days (SD=0.27, 95% CI=0.98–2.24) compared to patients with normal hemoglobin. Thrombocytopenia also correlated with more extended hospital stays by an average of 1.38 days (SD=0.21, 95% CI=0.88–1.89).Conclusion: The frequency of abnormal hematological indices was not high in patients with acute poisoning. Deceased patients had higher WBC and lower platelet counts compared to surviving patients. Patients with anemia and thrombocytopenia had more extended hospital stays
Clinical Toxicology
Javad Mesbahi; Shahin Shadnia; Hossein Hassanian-Moghaddam; Nasim Zamani; Peyman Erfan Talab Evini; Delara Hazegh Fetratjoo; Alireza Kargar; Mitra Rahimi
Volume 7, Issue 2 , July 2021, , Pages 93-96
Abstract
Objective: Delirium is one of the most common complications in patients admittedto intensive care units (ICUs). Delirium is a definite cause for more extended hospitalstays, higher mortality rates, and possibly persistent cognitive decline in the future.Antipsychotics have been frequently evaluated as ...
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Objective: Delirium is one of the most common complications in patients admittedto intensive care units (ICUs). Delirium is a definite cause for more extended hospitalstays, higher mortality rates, and possibly persistent cognitive decline in the future.Antipsychotics have been frequently evaluated as first drugs of choice, but the mostappropriate, evidence-based treatment is yet to be discovered. This study aims to comparethe efficacy of haloperidol and olanzapine in patients admitted to our toxicology ICU.Methods: This double-blind, randomized controlled clinical trial was undertaken on 35 ICUadmitted patients with delirium in Loghman Hakim hospital in Tehran, Iran. The diagnosiswas based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition(DSM-V) criteria for delirium, and clinical toxicologists included the patients accordingto the study’s inclusion and exclusion criteria. Patients received either haloperidol orolanzapine based on computerized randomization. The severity of delirium was measuredwith the Memorial Delirium Assessment Scale (MDAS) scoring on days 0 and 3 of ICUadmission.Results: The total sample size was 35 in which 16 patients received haloperidol, and 19patients received olanzapine. The doses of haloperidol and olanzapine were 3 mg threetimes a day and 5 mg three times a day, respectively. There was no significant difference inbaseline characteristics and the scores of MDAS between groups.Conclusion: Olanzapine and haloperidol have the same efficacy in the managementof delirium in toxicology ICU-admitted patients. They can be interchangeably used fordelirium treatment in these patients
Trauma
Raheleh Faramarzi; Mohammad Davood Sharifi; Elnaz Vafadar Moradi; Behnaz Alizadeh
Volume 8, Issue 2 , July 2022, , Pages 95-98
Abstract
Objective: Partial dislocation of radius head (pulled elbow) is the most common trauma observed in out-patient orthopedic treatment of children. The typical mechanism of this trauma includes exertion of longitudinal force along the forearm in a pronation position, causing partial dislocation of the radius ...
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Objective: Partial dislocation of radius head (pulled elbow) is the most common trauma observed in out-patient orthopedic treatment of children. The typical mechanism of this trauma includes exertion of longitudinal force along the forearm in a pronation position, causing partial dislocation of the radius head.Methods: This Retrospective descriptive and cross-sectional study was undertaken on patients referring to the emergency ward of Imam Reza hospital of Mashhad with typical history of partial dislocation of radius head (pulled elbow). The present study was conducted between March 20, 2018 and March 20, 2019. Based on the number of patients at the emergency ward, the sample size was determined to be 80. Descriptive statistics such as mean and standard deviation were used to describe the collected data.Results: From among 80 children diagnosed with partial radius bone dislocation, 66.23% were girls and 33.77% were boys. The age range of patients was 28.08 months for girls and 31.04 months for boys. Findings also showed that 32 patients had a history of recent respiratory infection within 1 week before the pulled elbow incident.Conclusion: Findings revealed that, similar to previous studies, the pulled elbow injury was more common in girls than in boys. Successful reduction in first and second attempts, notwithstanding the maneuvers used indicated that the success rate of first attempts at reduction was 93%. The history of recent respiratory infections during 1 week before the injury was taken into account, where 40% of the children had some history of such respiratory infections.
Pulmonology
Ali Mohammad Rousts; Saeed Safari; Mehri FarhangRanjbar; Seyed Hadi Aghili
Volume 10, Issue 2 , July 2024
Abstract
Objective: Acute exacerbation of chronic obstructive pulmonary disease (COPD) is a significanthealthcare burden. This study aimed to compare three risk assessment tools in predicting theoutcomes of COPD exacerbation.Methods: This prospective cohort study was conducted between October 2023 and November2024 ...
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Objective: Acute exacerbation of chronic obstructive pulmonary disease (COPD) is a significanthealthcare burden. This study aimed to compare three risk assessment tools in predicting theoutcomes of COPD exacerbation.Methods: This prospective cohort study was conducted between October 2023 and November2024 at five hospitals in Iran (three in Tehran, one in Shahr-e-Rey, and one in Nehbandan). A total of392 patients admitted with acute exacerbation of COPD were enrolled using consecutive sampling.The predictive accuracy of the Ottawa COPD Risk Scale (OCRS), DECAF, and BAP-65 for adverseoutcomes (ICU admission, mechanical ventilation, and mortality) was assessed. The area under thereceiver operating characteristic curve (AUC-ROC) and performance metrics (sensitivity, specificity,predictive values, and likelihood ratios) were calculated for each score. AUCs were compared usingpaired sample ROC analysis with significance set at P<0.05.Results: The AUCs for OCRS, DECAF, and BAP-65 in predicting cumulative adverse outcomes (CAO)were 0.78 (95% CI: 0.73–0.83), 0.79 (95% CI: 0.74–0.83), and 0.79 (95% CI: 0.74–0.83), respectively(P<0.05). For CAO, DECAF and BAP-65 demonstrated the most balanced performance at optimalcutoff, with sensitivities of 69.8% (95% CI: 61.9–75.4) and 68.2% (95% CI: 59.7–75.6) and specificitiesof 78.7% (95% CI: 0.74.5–0.81.8) and 78% (95% CI: 72.5–82.5). OCRS had a sensitivity of 61.2% (95%CI: 52.6–0.77) and a specificity of 84.8% (95% CI: 80.3–89.5). No significant confounding or effectmodifications from demographics, lifestyle factors, or comorbidities were found except for age withDECAF, which performed better in younger patients.Conclusion: DECAF and BAP-65 showed the most balanced performances in predicting CAOamongst the three tools. Paired with a clinician’s judgment, these tools offer valuable insights forbetter triage and clinical decision-making in managing acute COPD exacerbation.
Trauma
Seyyed Meysam Amini; Mehriyar Yoldashkhan; Sima Zohari; Malihe Nasiri; Zahra Mousavi; Seyed Mohammad Amini
Volume 8, Issue 1 , January 2022, , Pages 8-12
Abstract
Objective: Pain is usually one of the most common symptoms among all traumatic injuries. One of the drugs that has recently entered the Iranian prehospital emergency system is ketorolac. Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis by inhibiting cyclooxygenase ...
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Objective: Pain is usually one of the most common symptoms among all traumatic injuries. One of the drugs that has recently entered the Iranian prehospital emergency system is ketorolac. Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis by inhibiting cyclooxygenase activity and reduces pain and inflammation. It can be considered as the strongest analgesic drug in this category. The aim of this study was to evaluate the effectiveness of ketorolac in pain management of traumatic injuries in a prehospital setting.Methods: This descriptive cross-sectional study was undertaken to evaluate the effectiveness of a treatment method in the pain management of traumatic injuries in the prehospital environment of Lorestan province in Iran. We included 134 injured patients from road emergency bases of Lorestan province. In order to control the pain of these injured patients, 30 mg of ketorolac was injected slowly intravenously in one minute. Pain was measured in the time interval of zero minutes (before injection), 15 minutes, 30 minutes, and 45 minutes by visual acuity scale (VAS). The analysis of the obtained data was performed by SPSS software version 23.Results: The mean age of participants was 37.42±23.6. There were 47 female injuries (35.1%) and 87 male injuries (64.9%). In terms of pain intensity, 49 patients (36.6%) had moderate pain (VAS = 4-6) and 85 patients (63.4%) had severe pain (VAS = 7-10). The average of pain relief in the injured group with severe and moderate pain 15 minutes after the injection was 0.471 and 0.878 (P = 0.001), respectively. In addition, the mean of pain relief in the injured group with severe and moderate pain 30 minutes after the injection was 1.124 and 1.796, respectively (P = 0.001). Pain reduction in the group of severely injured patients with moderate pain in the first 30 minutes was statistically significant.Conclusion: Findings revealed that ketorolac is a suitable drug in pain management for trauma patients with moderate and severe pain in trauma patients. On the other hand, due to the peak effect (more than 30 minutes), it is not an effective drug for trauma patients with severe pain in a short period transferred to the prehospital environment.
emergency nursing
Farzad Rahmani; Pegah Sepehri Majd; Haniyeh Ebrahimi Bakhtavar; Farnaz Rahmani
Volume 4, Issue 1 , January 2018, , Pages 9-13
Abstract
Objective: Triage refers to the evaluation and categorization of patients for better management to deliver services. A good triage system should be able to accurately specify the patients who require urgent care. Thus, this study aimed to evaluate the accuracy of emergency nurses in correct triage ...
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Objective: Triage refers to the evaluation and categorization of patients for better management to deliver services. A good triage system should be able to accurately specify the patients who require urgent care. Thus, this study aimed to evaluate the accuracy of emergency nurses in correct triage using Emergency Severity Index (ESI) triage. Methods: In this descriptive cross-sectional study 750 patients, who referred to the emergency department (ED) of Sina teaching hospital, participated from 23 July to 22 August in 2015. Participants were selected using convenience sampling method. The patients’ triage level was determined by physicians and nurses separately and the results were compared. To define the level of agreement between two groups (inter-rater agreement), the kappa index was evaluated. Data were analyzed using SPSS version 17. Results: Among 750 patients, 577 patients (76.9%) were classified in correct triage group, 90 patients (12%) in undertriage group and 83 patients (11.1%) in overtriage group. Kappa agreement coefficient between the ESI triage level of physicians and nurses was 0.659 (95% CI: 0.646-0.667). There was statistically significant difference between the triage level of physicians and nurses (P < 0.001). Conclusion: This study showed that there was moderate agreement between the triages of physicians and nurses. It seems that improving nurses’ skills and knowledge might increase the accuracy of emergency nurses in patients’ correct triage. Therefore, planning programs based on training correct triage for emergency nurses is strongly suggested.
Trauma
payman Asadi; Vahid Monsef Kasmaei; Seyyed Mahdi Zia Ziabari; Behzad Zohrevandi
Volume 2, Issue 1 , January 2016, , Pages 11-15
Abstract
Objective: Low back pain is the most common skeletal disorder worldwide that 50% to 80% of people experience it at least once in their lifetime. Physical and psychological factors in the work environment can relatively contribute to low back pain. In this study, we examined the prevalence of low back ...
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Objective: Low back pain is the most common skeletal disorder worldwide that 50% to 80% of people experience it at least once in their lifetime. Physical and psychological factors in the work environment can relatively contribute to low back pain. In this study, we examined the prevalence of low back pain and influential factors in its development among nursing staff. Methods: In this cross-sectional study we assessed the prevalence of low back pain among nurses working in Poursina hospital, Rasht, Iran, during March and April 2012. Demographic data and information on the status of skeletal pain, as well as, associated factors were collected using a pre-designed check list. Data were analyzed using SPSS version 16. Results: A total of 350 nurses with a mean age of 32.00 ± 8.24 years (minimum 22 and maximum 56 years) were studied (90.3% female). 246 participants (70.3%) had a history of low back pain. There was no significant difference between gender and the incidence of low back pain, (P = 0.286). 96 participants (27.4%) aged 27 to 31 had the highest rate of low back pain and 11 participants (3.1%) aged 52 to 56 were the least frequent age group. Low back pain significantly differed by age (P = 0.001), body mass index (BMI) (P = 0.222), and physical activity (P = 0.050). Conclusion: The results of this study showed a prevalence of 70% for low back pain among nurses working in Poursina hospital in Rasht, in Gilan province. Age, BMI, and physical activity were significantly associated with the prevalence of low back pain. However, gender, occupation, marital status, smoking, family history, frequency of lifting heavy things, work experience, and workplace did not show a significant relationship
Laboratory
Hamid Zamani Moghadam; Fatemeh Maleki; Mohsen Ebrahimi; Mahdi Foroughian
Volume 6, Issue 1 , January 2020, , Pages 13-17
Abstract
Objective: The purpose of this study is to evaluate the diagnostic value of nitrite test in comparison with urine culture (U/C) results in patients with Urinary tract infection (UTI) symptoms.Methods: This cross-sectional study was performed on 203 patients with UTI symptoms. Middle urine sample was ...
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Objective: The purpose of this study is to evaluate the diagnostic value of nitrite test in comparison with urine culture (U/C) results in patients with Urinary tract infection (UTI) symptoms.Methods: This cross-sectional study was performed on 203 patients with UTI symptoms. Middle urine sample was taken into sterile plastic containers, and simultaneously the urine sample and the nitrite test were done by the use of urine dipstick test. Data were analyzed using SPSS software version 23.Results: The results of the urine culture test indicated that the highest excreted organisms in both sexes were E. coli (58.8%), Candida (17.6%), Klebsiella (8.8%), E. coli (MDR) (5.9%), Pseudomonas (2.9%), Enterococcus (2.9%) and Acinetobacter (2.9%). The results showed that there was a significant correlation between U/C and urine analysis (U/A) test results (P = 0.01), and in U/C positive results, U/A results were significantly positive for UTI. Other findings showed a significant relationship between the results of nitrite one and nitrite two tests (P = 0.001). There was a significant correlation between urinary, and nitrite1 levels (P = 0.04). Also, in this study, the sensitivity and specificity of diagnostic tests for U/A and nitrite 1 and 2 with U/C were calculated as the Golden Standard method.Conclusion: Overall, the results of this study showed that the negative nitrite test and urine dipstick test could be performed in emergency cases to prevent ectopic dysfunction and inadequate diagnosis. Also, it can reduce the unreasonable expenses for U/A.
Emergency medicine
Mehdi Momeni; Elnaz Vahidi; Neda Karimi Tafti; Zeinab Naderpour; Javad Seyedhosseini; Morteza Saeedi
Volume 9, Issue 1 , January 2023, , Pages 13-18
Abstract
Objective: Hand lacerations are among the most frequent causes of visiting emergencydepartments (EDs). Wound infection is one of its complications. There is still an ongoingdisagreement on the administration of oral versus intravenous (IV) antibiotics (ABs). Theobjective of this study is to compare the ...
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Objective: Hand lacerations are among the most frequent causes of visiting emergencydepartments (EDs). Wound infection is one of its complications. There is still an ongoingdisagreement on the administration of oral versus intravenous (IV) antibiotics (ABs). Theobjective of this study is to compare the effectiveness of oral versus IV ABs in preventingwound infection of hand lacerations.Methods: In this double-blind, randomized clinical trial, we enrolled all patients with handlacerations (based on the inclusion criteria) during 6 months in the EDs of 2 tertiary referralcenters. Convenient sampling was done. Finally, in the first group, 382 patients receivedoral AB (two 500 mg cephalexin capsules) and the other 382 patients in the second groupreceived IV AB (1 gr IV cefazolin) before wound management. Both groups were followedand received oral cephalexin during 48 hours after suturing. Rates of wound infection anddifferent complications were compared between the two groups. T-test, Mann-Whitney Utest, Chi square and Fisher analysis were used.Results: Both groups had the same age and gender distribution rate (79.8% of males withthe mean age of 30.8 years in the first group, and 83.5% of males with the mean age of 32.6years in the second group (P = 0.19 and 0.39, respectively). In our study, wound infectiondeveloped in 2.6% and 1.8% of patients in the first and second groups, respectively (P =0.46).Conclusion: Based on the results of this study, oral and IV ABs were not significantlydifferent in terms of preventing wound infection