Letter to Editor
Trauma
Usha Rana; Rupender Singh
Volume 10, Issue 1 , January 2024
Abstract
The rapid integration of artificial intelligence (AI) and digital technologies into daily life has brought about unprecedented advancements, yet it has also exacerbated the phenomenon of digital disenfranchisement. This exclusion, stemming from disparities in access to digital resources, literacy, and ...
Read More
The rapid integration of artificial intelligence (AI) and digital technologies into daily life has brought about unprecedented advancements, yet it has also exacerbated the phenomenon of digital disenfranchisement. This exclusion, stemming from disparities in access to digital resources, literacy, and infrastructure, particularly affects vulnerable groups such as the elderly, low-income individuals, rural communities, and those residing in digitally underserved regions. As AI increasingly permeates critical areas like healthcare, education, and employment, those who lack the necessary digital tools and skills face profound psychological and social consequences. This paper explores the hidden trauma of digital disenfranchisement, emphasizing the resulting feelings of isolation, inadequacy, and helplessness that contribute to mental health issues such as anxiety, depression, and chronic stress. Through a multidimensional analysis, the paper highlights how digital exclusion not only perpetuates existing social inequalities but also introduces new forms of marginalization in an AI-driven world. The study calls for a holistic approach to address these challenges, including expanding digital literacy programs, improving access to technology, and ensuring that AI systems are designed inclusively and ethically. By addressing both the root causes and effects of digital disenfranchisement, we can foster a more equitable and inclusive digital society.
Original Article
Surgery
Bharati Pandya; Vishnu Vardhan P. Reddy; Srujan Dharap; Reyaz Ahmad; Meena Kumari; Ajeet Pratap Maurya
Volume 10, Issue 1 , January 2024
Original Article
Emergency medicine
Samrad Mehrabi; Ehsan Alishapour
Volume 10, Issue 1 , January 2024
Abstract
Introduction: 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. ...
Read More
Introduction: 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. Interestingly, 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.Materials and methods: This study analyzed the records of 701 consecutive patients at Shiraz Faghihi Hospital's Medical Emergency Center in Iran between April 1 and September 30, 2022. Poisoning diagnosis was determined based on reports and papers. Data were collected from patient medical records and analyzed using the SPSS program, 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: A study reviewed 701 cases, with an average age of 35.02 ± 16.104(p<0.001), and 45.8% had education levels higher than a diploma(p=0.012). The majority (66.6%) had no favorable 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, while 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 heightened accessibility and potential hazards associated with these medications.
Original Article
Anesthesiology
Thushara Madathil; Cassie Carvalho; Sunil Rajan
Volume 10, Issue 1 , January 2024
Abstract
Objective: Fluids are administered to optimize hemodynamics during off-pump coronary arterybypass grafting (CABG), which may lead to a positive fluid balance and increased lung water,lung congestion, hypoxemia, prolonged mechanical ventilation, and longer hospital stays. Lungultrasound can assess extravascular ...
Read More
Objective: Fluids are administered to optimize hemodynamics during off-pump coronary arterybypass grafting (CABG), which may lead to a positive fluid balance and increased lung water,lung congestion, hypoxemia, prolonged mechanical ventilation, and longer hospital stays. Lungultrasound can assess extravascular lung water and help titrate diuretics and fluids, thus preventinghypoxemia. The primary objective of this study was to study the correlation between B-line scoresmeasured by lung ultrasound and the PaO2/FiO2 ratio (the ratio of arterial partial pressure of oxygento fractional inspired oxygen) after off-pump CABG.Methods: Forty off-pump CABG patients were included in this prospective observational study in atertiary care center from 2022 to 2023. The correlation coefficient from an earlier study was used tocalculate the sample size. A four-sector lung ultrasound was utilized for B-line scoring. B-line scoresand PaO2/FiO2 ratios were recorded at three time points: before the surgery commenced and at 24and 48 hours post-operation. The fluid balance was calculated at 24 and 48 hours post-operation.Pearson correlation coefficient was used to evaluate the correlation between B-line scores and fluidbalance with oxygenation, and its significance was assessed through a linear regression test.Results: The PaO2/FiO2 ratio and B-line scores exhibited a statistically significant moderate negativecorrelation at 24 hours post-surgery (r=-0.44; SD=-0.66, 95% CI=-0.66, -0.15; P=0.004) and a B-linescore exceeding 8 was associated with the lowest PaO2/FiO2 ratio. However, fluid balance and PaO2/FiO2 ratios revealed no correlation at 24 or 48 hours post-surgery. Additionally, fluid balance andB-line scores demonstrated a moderate positive correlation after 48 hours but no correlation at 24hours post-surgery.Conclusion: B-line scores always negatively correlated with PaO2/FiO2ratios, and scores greaterthan eight corresponded to the lowest ratio.
Original Article
Emergency medicine
Amir Ghaffarzad; Neda Seyedi; Abazar Fathollahzadeh; Homayon Sadeghi Bazargani; Hassan Vaezi; Farzad Rahmani
Volume 10, Issue 1 , January 2024
Abstract
Objective: The vehicle's heaviness increases the severity of the accident and the probability of death. The study aimed to compare the severity of injuries and the outcome of the injuries caused by accidents between heavy vehicles and light vehicles. The physiological variables of the patients, the variables ...
Read More
Objective: The vehicle's heaviness increases the severity of the accident and the probability of death. The study aimed to compare the severity of injuries and the outcome of the injuries caused by accidents between heavy vehicles and light vehicles. The physiological variables of the patients, the variables related to the accident, and the patients' outcomes were evaluated to achieve this goal. The output was based on bivariate analysis.Methods: This cross-sectional descriptive study was conducted in the emergency department of Imam Reza (AS) Hospital of Tabriz between March 2022 and July 2024. Four hundred nine multi-trauma patients related to road traffic accidents (RTAs) were included. The sampling method employed was a full census. Physiologic variables about patients and trauma severity were recorded. All data entered into SPSS 24.0 were compared between two groups using chi-square and independent samples t-tests.Results: This study included 314 (76.8%) patients injured by light-vehicle accidents and 95 (23.2%) patients injured by heavy-vehicle accidents. The mean of trauma severity scores including GAP, RGAP, NTS, RTS, and REMS in heavy-vehicle accidents group were 17.0 ± 5.9, 16.3 ± 6.5, 15.6 ± 6.5, 6.2 ± 1.9, and 5.9 ± 5.6 respectively, and they were 22.4 ± 3.3, 21.8 ± 3.7, 21.8 ± 3.5, 7.6 ± 0.9, and 2.4 ± 3.1, respectively, in light-vehicle accidents. There were significant statistical differences between the two groups concerning the trauma severity scores of patients based on vehicle type (p-value < 0.001).Conclusion: The study results show that the severity of trauma in heavy-vehicle accidents is higher, and the injured are in more critical conditions. Therefore, it is necessary to identify the factors involved in heavy-vehicle accidents and take measures to reduce them.
short communication
Surgery
maryam kouhestani; Seyed Vahid Hossein; Alimohammad Bananzadeh; ali reza safarpour; khadije gorgi; mohammad masoud andalib
Volume 10, Issue 1 , January 2024
Abstract
Objective: Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become the restorative procedure of choice for medically refractory ulcerative colitis (UC). In patients who undergo proctocolectomy with IPAA, fecal continence outcomes are an issue. The present study evaluated fecal incontinence ...
Read More
Objective: Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become the restorative procedure of choice for medically refractory ulcerative colitis (UC). In patients who undergo proctocolectomy with IPAA, fecal continence outcomes are an issue. The present study evaluated fecal incontinence in patients who underwent IPAA for UC.Methods: This was a case series study. We reviewed the clinical records of all patients who had undergone a proctocolectomy with IPAA for UC at the Colorectal Department of Shiraz University of Medical Sciences, Iran, between January 2010 and December 2022. Each patient completed a Cleveland Clinic Florida Fecal Incontinence Scoring System (CCFFIS) questionnaire to evaluate fecal incontinence one year after the closure of the colostomy. Data analysis was conducted utilizing various statistical measures such as mean, count (percentage), chi-square, and one-way ANOVA tests. The entire analysis was performed using SPSS 26 software. P values less than 0.05 were deemed statistically significant.Results: From January 2010 to December 2022, 159 patients who underwent IPAA surgery were included in the study. Of these patients, 108 (67.9%) had no complaint about fecal incontinence (score 0). The median CCFFIS score was 2.19, and there were no significant differences between gender, age, technique, and number of procedures regarding fecal incontinence (P values 0.475,0.125, 0.319, and 0.376, respectively).Conclusion: This study confirmed that total proctocolectomy with IPAA is a complex surgery that could have good functional results if patients are selected carefully and an experienced surgeon performs the procedure.
Case Report
Pediatrics
Anahita Alizadeh Ghamsari; Nafiseh Pourbadakhshan
Volume 10, Issue 1 , January 2024
Abstract
Objective: Snake bites represent a significant public health issue worldwide, as venomous snake bites can result in dangerous and sometimes lethal consequences. Sometimes, the diagnosis is difficult. Herein, we present the case of a 4-year-old child who posed a challenge to diagnosis.Case Presentation: ...
Read More
Objective: Snake bites represent a significant public health issue worldwide, as venomous snake bites can result in dangerous and sometimes lethal consequences. Sometimes, the diagnosis is difficult. Herein, we present the case of a 4-year-old child who posed a challenge to diagnosis.Case Presentation: A 4-year-old child was brought to the emergency department with sudden, severe general weakness and impaired consciousness. Initially, the cause of these symptoms was unclear and difficult to diagnose. However, after a more thorough examination, it was determined that the likely cause was a neurotoxic snake bite. The child was hospitalized for three days. He received anti-venom, painkillers, and symptomatic treatments and left the hospital in good general condition.Conclusion: Snakebites are very dangerous and sometimes have unusual manifestations, so adequate personnel and physician information is necessary for timely diagnosis and appropriate management.
Case Report
Emergency medicine
Aloysius Ugwu-Olisa Ogbuanya; Daniel AA Umezurike; Bieda Fongue; Ifeoma Ekwunife
Volume 10, Issue 1 , January 2024
Abstract
Objective: The spleen is the most frequently injured organ in blunt abdominal trauma (BAT). We present an interesting case of traumatic splenic rupture in pregnancy managed successfully by emergency splenectomy in a low-resource setting.Case Presentation: A 27-year old multiparous woman at 23 weeks gestational ...
Read More
Objective: The spleen is the most frequently injured organ in blunt abdominal trauma (BAT). We present an interesting case of traumatic splenic rupture in pregnancy managed successfully by emergency splenectomy in a low-resource setting.Case Presentation: A 27-year old multiparous woman at 23 weeks gestational age presented to the emergency department with a history of BAT following a road traffic accident (RTA). This study was conducted in the Department of Surgery, General Surgery Unit, College of Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Southeast Nigeria, in 2023. A vehicle strayed and hit her from the left side of the abdomen while she was sitting down. She suddenly developed abdominal pain, bruises on the left upper abdomen, andprogressive abdominal distension. The abdominal ultrasound report showed a deep trabecular laceration and massive hemoperitoneum. The fetus was viable from obstetric and ultrasound assessments. The patient was hemodynamically unstable and was subsequently prepared for emergency exploratory laparotomy. Intraoperatively, incomplete hilar avulsion injury and multiple parenchymal lacerations of the spleen were noted. An accessory spleen without injury was also noted. Splenectomy with preservation of the accessory spleen was performed.Postoperatively, the fetus remained viable, and the patient was hemodynamically stable. The mother had no morbidities other than paralytic ileus and fever, and both were amenable to conservative management.Conclusion: Emergency splenectomy is a life-saving procedure in hemodynamically unstable patients with splenic trauma, even in pregnancy.
Case Report
Trauma
Em Thong Huynh; Khai Duong; Duy Khai Lam; Tung Thanh Thach; Duoc Minh Le; Bao Tu Thai Nguyen
Volume 10, Issue 1 , January 2024
Abstract
Objective: This case report aims to demonstrate an instance of superficial femoral artery (SFA) rupture after an open femoral shaft fracture.Case Presentation: Our patient was a 22-year-old man admitted to the emergency department after a motorbike accident with a deformity at the distal third of the ...
Read More
Objective: This case report aims to demonstrate an instance of superficial femoral artery (SFA) rupture after an open femoral shaft fracture.Case Presentation: Our patient was a 22-year-old man admitted to the emergency department after a motorbike accident with a deformity at the distal third of the thigh and an open wound on the medial side. Radiographs and computed tomography angiography revealed a left distal third femoral fracture with ipsilateral SFA injury. We performed fracture reduction external fixation following SFA reconstruction using a 5-cm saphenous vein autograft. Prophylaxis fasciotomy was not performed. At a 6-month follow-up, the wound was well-healed, the Doppler ultrasound showed good blood flow at the reconstructed artery, and a rigid callus entirely covered the fracture.At 1-year follow-up, the patient could walk with full weight-bearing. Maximum knee range of motion was restored, and the patient could return to daily activities.Conclusion: Vascular injury after femoral shaft fracture is rare, and accurate diagnosis with timely and appropriate surgery plays a crucial role in achieving limb salvage, reducing the risk of complications, and improving the overall quality of patient life.
Case Report
Orthopedics
marcus vinicius bianchi; Leonardo Comerlatto; Cristina vicioli; Ramesses Akamefula; Marcio Balbinotti Ferrari
Volume 10, Issue 1 , January 2024
Abstract
Objective: Quadriceps tendon ruptures are rare injuries affecting the knee extensor mechanism, typically occurring in middle-aged patients with underlying pathologies. Bilateral simultaneous quadriceps tendon ruptures are even more uncommon, and almost all reported cases in the literature are associated ...
Read More
Objective: Quadriceps tendon ruptures are rare injuries affecting the knee extensor mechanism, typically occurring in middle-aged patients with underlying pathologies. Bilateral simultaneous quadriceps tendon ruptures are even more uncommon, and almost all reported cases in the literature are associated with an underlying disease. Case Presentation: A 62-year-old Caucasian male complained of pain in the anterior-superior aspect of both knees following a fall while walking, during which his knees were in a semi-flexed position. Physical examination revealed a loss of active knee extension in both limbs and a palpable gap between the superior pole of the patella and the quadriceps tendon. Magnetic resonance imaging (MRI) of both knees confirmed bilateral quadriceps tendon ruptures. Both injuries were addressed simultaneously using the same technique. At an eight-month follow-up, the patient was asymptomatic, ambulating normally, and had full knee extension with 120° of flexion bilaterally. However, hypotrophy of the quadriceps muscle was noted bilaterally.Conclusion: Proper evaluation and treatment of these injuries are crucial to achieve good outcomes, as they can lead to significant knee pain and disabilities.
Case Report
Imaging
Sergio Miravent; Carla Gomes; Andreea Basescu; Ana Martins; Manuel Duarte Lobo; Rui Pedro Almeida
Volume 10, Issue 1 , January 2024
Abstract
Abstract Objective: Bladder diverticula, while not exceptionally rare in clinical practice, present significant diagnostic challenge, particularly in remote pre-hospital emergencies where technological limitations and the absence of specialized medical expertise prevail. This report aims to emphasize ...
Read More
Abstract Objective: Bladder diverticula, while not exceptionally rare in clinical practice, present significant diagnostic challenge, particularly in remote pre-hospital emergencies where technological limitations and the absence of specialized medical expertise prevail. This report aims to emphasize the role of screening ultrasound in the pre-hospital setting, Case Presentation: A patient experiencing severe lower abdominal pain presented at a Basic Emergency Service for the third time presenting same symptoms. A renal and pelvic ultrasound screening was performed, revealing suspected images traducing bladder distention and adjacent fluid-filled cavities, consistent with multiple bladder diverticula. Subsequently, the patient was referred to referral central hospital for management by medical experts and execute comprehensive evaluation which confirmed the findings of the Basic Emergency Service.Conclusion: results of the screening ultrasound enabled the Basic Emergency Service team to initiate clinical interventions to mitigate the patient's discomfort. Screening ultrasound was crucial in identifying imaging markers that provided the doctor with clinical data for correct and prompt patient orientation.
Case Report
Clinical Toxicology
Zohreh Oghabian; Maral Ramezani; Shahin Shadnia; Farah Pouramiri; Babak Mostafazadeh; Masoomeh varzandeh; Peyman Erfan Talab Evini; Shahrad Tajoddin; Mitra Rahimi
Volume 10, Issue 1 , January 2024
Abstract
Background: Hemoperfusion is an alternative treatment for paraquat poisoning. This study aimed to evaluate the effect of hemoperfusion therapy using the Jafron HA230 hemoperfusion cartridge on patients with paraquat poisoning.Method: This was a case series study on paraquat poisoning patients in Tehran's ...
Read More
Background: Hemoperfusion is an alternative treatment for paraquat poisoning. This study aimed to evaluate the effect of hemoperfusion therapy using the Jafron HA230 hemoperfusion cartridge on patients with paraquat poisoning.Method: This was a case series study on paraquat poisoning patients in Tehran's Loghman Hakim and Kerman's Afzalipour hospitals. In addition to the usual treatment of poisoning patients, the patients underwent hemoperfusion through the HA230 cartridge three times at 24-hour intervals, each time lasting 180-240 minutes. Before and after the treatment program, patient information and lab results were recorded. Statistical analysis was performed using SPSS software version 21.Results: This study included 9 patients, 5 (55.6%) were male and 4 (44.4%) were female. The average age of the subjects was 40.78 ± 21.3 years. The mortality rate of patients was 88.9%. Except for the significant decrease in blood hemoglobin and potassium levels after hemoperfusion, no significant differences were observed in other parameters.Conclusion: Our study found that hemoperfusion with HA230 cartridge does not significantly improve the survival of patients poisoned by paraquat.