Letter to Editor
Trauma
Usha Rana; Rupender Singh
Volume 10, Issue 1 , January 2024, Pages 1-3
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.
Letter to Editor
Emergency medicine
Amin Beigzadeh; Elham Sharifpoor; Maryam Maroufi
Volume 10, Issue 1 , January 2024, Pages 4-6
Abstract
A significant portion of medical students learning is dedicated to clinical education, especially in the field of Emergency Medicine (EM). Clinical rotations in the Emergency Department (ED) are of utmost importance, given the vital role emergency medicine plays within the healthcare system. Emergency ...
Read More
A significant portion of medical students learning is dedicated to clinical education, especially in the field of Emergency Medicine (EM). Clinical rotations in the Emergency Department (ED) are of utmost importance, given the vital role emergency medicine plays within the healthcare system. Emergency departments represent the forefront of medical care, frequently addressing life-threatening circumstances that necessitate swift decision-making, advanced clinical expertise, and the capacity to operate effectively under pressure. Familiarizing medical students with this high-stakes environment provides them with critical competencies, including acute care management, collaborative teamwork, and proficient communication skills, all of which are relevant across various medical disciplines. In this regard, the Society for Academic Emergency Medicine outlines a four-year curriculum for emergency medicine training. First-year students learn basic first aid, CPR, and the local EMS system. Second-year students apply pathophysiology to acute presentations and practice diagnosis skills. Third-year students refine history-taking and examination techniques, working with residents in lower-acuity areas and beginning differential diagnoses. Throughout, students focus on professionalism, communication, and teamwork, preparing them for future roles in emergency medicine.
Original Article
Surgery
Vishnu Vardhan P. Reddy; Srujan Dharap; Reyaz Ahmad; Ajeet Pratap Maurya; Meena Kumari; Bharati Pandya
Volume 10, Issue 1 , January 2024, Pages 7-16
Abstract
Objective: COVID-19 caused one of the most prolonged global pandemics, disturbing the routine of hospital protocols beyond measure, especially affecting surgical specialties, emergencies, and cancer care.Methods: This observational study was conducted on 129 patients of pediatric and adult age groups ...
Read More
Objective: COVID-19 caused one of the most prolonged global pandemics, disturbing the routine of hospital protocols beyond measure, especially affecting surgical specialties, emergencies, and cancer care.Methods: This observational study was conducted on 129 patients of pediatric and adult age groups who presented with abdominal emergencies from March 1, 2020 to March 31, 2022 and were recruited for the study from the department of General Surgery, All India Institute of Medical Sciences, Bhopa. The analysis done using the chi-square or Fisher’s exact test. P values < 0.05 were considered significant. The outcomes were compared with the pre-existing standard protocols using SPSS.Results: Among the 129 patients, 104 were COVID-19-negative and 15 were COVID-19-positive, and in 10 cases, the results were inconclusive. The abdominal presentations observed in the study were as follows: two patients with hemorrhagic and five with septic shock. Emergency surgeries were done in 80 (62.1%) patients, and conservative approaches were used in 49 (37.9%) patients; of the 80 patients who underwent operation, 30 (37.5%) required deviation from standard established protocols. The ICU admitted a larger number of COVID-19-positive patients as compared to COVID-19-negative patients [8 (57%) vs. 24 (25%)] who needed operations, and 18 (13.9%) patients were treated conservatively in the ICU. Mortality was higher in COVID-19-positive as compared to COVID-19-negative patients [4 (28%) vs. 9 (8%)].Conclusion: The present study demonstrated the definite negative impact of COVID-19 on emergencies but provided useful lessons for emergency surgeons. A high standard of care, such as evaluating if a procedure can be postponed till the patient is less infectious or at a lesser risk of morbidity and mortality, is warranted during COVID-19 or similar pandemics. Ensuring adequate safety measures in the operating theatre is essential. We recommend a careful and judicious evaluation of every surgical indication.
Original Article
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. ...
Read More
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.
Original Article
Anesthesiology
Thushara Madathil; Cassie Carvalho; Sunil Rajan
Volume 10, Issue 1 , January 2024, Pages 22-26
Abstract
Objective: Fluids are administered to optimize hemodynamics during off-pump coronary artery bypass grafting (CABG), which may lead to a positive fluid balance and increased lung water, lung congestion, hypoxemia, prolonged mechanical ventilation, and longer hospital stays. Lung ultrasound can assess ...
Read More
Objective: Fluids are administered to optimize hemodynamics during off-pump coronary artery bypass grafting (CABG), which may lead to a positive fluid balance and increased lung water, lung congestion, hypoxemia, prolonged mechanical ventilation, and longer hospital stays. Lung ultrasound can assess extravascular lung water and help titrate diuretics and fluids, thus preventing hypoxemia. The primary objective of this study was to study the correlation between B-line scores measured by lung ultrasound and the PaO2/FiO2 ratio (the ratio of arterial partial pressure of oxygen to fractional inspired oxygen) after off-pump CABG.Methods: Forty off-pump CABG patients were included in this prospective observational study in a tertiary care center from 2022 to 2023. The correlation coefficient from an earlier study was used and a sample size of 9 was calculated. Random sampling technique was used. A four-sector lung ultrasound was utilized for B-line scoring. B-line scores and PaO2/FiO2 ratios were recorded at three time points: before the surgery commenced and at 24 and 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 fluid balance 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 negative correlation at 24 hours post-surgery (r = -0.44; SD = -0.66, 95% CI = -0.66, -0.15; P = 0.004) and a B-line score 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 and B-line scores demonstrated a moderate positive correlation after 48 hours but no correlation at 24 hours post-surgery.Conclusion: B-line scores always negatively correlated with PaO2/FiO2 ratios, and scores greater than 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, Pages 27-32
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, ...
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 < 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.
Original Article
Orthopedics
Amir Aghaei Aghdam; Ramin Askarinejad; Amin Jahad Sarvestani
Volume 10, Issue 1 , January 2024, Pages 33-37
Abstract
Objective: Adult spinal deformity is a common public health issue worldwide caused by changes in the normal curves of the spine, at times leading to axial spine pain. This study measures changes in the normal curves of the spine, especially thoracic kyphosis and lumbar lordosis, and correlates them with ...
Read More
Objective: Adult spinal deformity is a common public health issue worldwide caused by changes in the normal curves of the spine, at times leading to axial spine pain. This study measures changes in the normal curves of the spine, especially thoracic kyphosis and lumbar lordosis, and correlates them with subjective axial pain scores to find how anatomic changes in thoracic and lumbar curves relate to the subjective pain.Methods: This is a descriptive-analytical epidemiological study conducted in Ahvaz Golestan Hospital. In this study, 52 patients were selected by non-randomized convenience sampling of patients with axial spine pain referred to Golestan Hospital between October 2023 and June 2024. Thoracic kyphosis and lumbar lordosis were detected in the selected patients using long-standing radiographs. Then, using pelvic incidence, ΔTK and ΔLL were calculated, and their relation to axial spine pain was studied. We used the Pearson correlation coefficient to examine the relation between spine-related measurements and Visual Analogue Scale (VAS) scores. The distribution of the changes followed a normal distribution (Gaussian distribution) pattern, so Pearson correlation coefficient was employed.Results: On average, lumbar lordosis in these people showed a mean decrease of 10 degrees compared to normal lumbar lordosis, and average thoracic kyphosis showed a mean increase of 15 degrees compared to the normal thoracic kyphosis. In the study of the global pain scale and comparing the intensity of pain with changes in thoracic kyphosis (ΔTK) and lumbar lordosis (ΔLL), axial pain was most associated with changes in thoracic kyphosis (ΔTK) (P < 0.001).Conclusion: In the treatment of axial spine pain, the intensity of pain is more related to changes in thoracic kyphosis rather than lumbar lordosis. This can help researchers to propose further studies on correcting thoracic kyphosis to obtain better axial spine pain relief.
Original Article
Education
Amin Beigzadeh; Ali Reza Yusefi; Elham sharifpoor; Maryam Okhovati
Volume 10, Issue 1 , January 2024, Pages 38-46
Abstract
Objective: Emergency department (ED) rotations are vital for medical education, fostering clinical skills and teamwork. However, these high-stress environments pose significant mental health risks, including stress, burnout, and depression. Despite their importance, research on the specific stressors ...
Read More
Objective: Emergency department (ED) rotations are vital for medical education, fostering clinical skills and teamwork. However, these high-stress environments pose significant mental health risks, including stress, burnout, and depression. Despite their importance, research on the specific stressors medical students face in these settings is limited, indicating a crucial gap in understanding their experiences. This study aims to identify and analyze the significant stressors affecting medical students during ED rotations.Methods: This mixed-method sequential explanatory study, conducted at Kerman University of Medical Sciences in 2024, had two phases. In the quantitative phase, the Medical Student Stressor Questionnaire (MSSQ) survey was completed by 184 participants selected using the convenience sampling technique. In the qualitative phase, in-depth semi-structured interviews were undertaken with 16 medical students to explore their perspectives on ED stressors. Quantitative data were analyzed by mean and standard deviation. Frequency counts were used to assess students’ responses to items across the six survey scales. In the qualitative phase, content analysis using the steps proposed by Graneheim and Ludman was employed to identify and analyze key themes and concepts from the interviews. The data were validated based on Goba and Lincoln’s criteria. Data analysis was performed using MAXQDA-10 software.Results: The 184 participants comprised 52.72% female students, and 62.50% were in their internship. The results indicated that female students reported higher stress levels in academic, teaching-learning, and drive/desire-related areas, while males faced more social-related stress. The top stressors included insufficient medical skill practice (M = 3.60), heavy workloads (M = 3.44), tests (M = 3.15), and poor grades (M = 3.20). The qualitative interviews with 16 students reinforced these findings, revealing themes of clinical demands and educational challenges during ED rotations.Conclusion: This study identified significant stressors for medical students, including gender-based differences, inadequate clinical skill practice, excessive workload, anxiety over exams, and low test performance. To enhance professional development and resilience during ED rotations, we recommend increasing opportunities for hands-on clinical practice, managing workloads to reduce stress, and providing targeted resources for exam preparation. By addressing these key issues, ED rotations can become valuable growth opportunities, ultimately fostering a more supportive educational environment that promotes the well-being and development of medical students.
Original Article
Trauma
Shirin Abbaszadeh; Neda Gilani; keyvan Amini; Homayoun Sadeghi-Bazargani
Volume 10, Issue 1 , January 2024, Pages 47-55
Abstract
Objective: Elderly people live longer and are more active nowadays; however, their bodily conditions make them more susceptible to injuries. An appropriate prognostic tool tailored for the needs and conditions of the elderly who sustain injuries has not been well elaborated in trauma research. To fill ...
Read More
Objective: Elderly people live longer and are more active nowadays; however, their bodily conditions make them more susceptible to injuries. An appropriate prognostic tool tailored for the needs and conditions of the elderly who sustain injuries has not been well elaborated in trauma research. To fill a gap in existing general models, this study has developed a modified model based on injury severity in order to predict trauma-related mortality in older people.Methods: Data belonging to 643 older patients aged 55 and above who were admitted due to trauma to Fatemi University Hospital in Ardabil between 2019 and 2022 were analyzed. A convenience sampling approach was used, where all eligible patients were included. The study used regression modeling to examine the association between predictor variables and death. A geriatric injury prognostic scale (GIPS) was constructed and evaluated for its efficacy in distinguishing mortality statuses using binary logistic regression. The adjusted odds ratios (ORs), area under the ROC curve (AUC), and Hosmer-Lemeshow test results were reported. The statistical analyses were conducted utilizing the STATA statistical software package, version 17.Results: The study enrolled 643 trauma patients aged between 55 and 95 years, 62.36% of whom were male. The mean pulse rate (PR) of the patients assessed in the emergency department was 81.7 (SD = 8.2), and 5% had Glasgow Coma Scale (GCS) scores below 13. The mean Injury Severity Score (ISS) for 636 patients was 8 (SD = 8.5), and the in-hospital case fatality proportion was 6.2%. A comprehensive multivariate model was developed using PR per minute, GCS, and ISS that effectively predicted 83.2% (P value < 0.001) of trauma-related mortality in the study population. The model’s area under the ROC curve was 0.995 for GIPS.Conclusion: The GIPS accurately predicts death probability in the older population, aiding in decision-making for appropriate treatment approaches in the geriatric-specific population.
short communication
Surgery
Alimohammad Bananzadeh; Seyed Vahid Hossein; Ali reza Safarpour; Mohammad masoud Andalib; Khadije Gorgi; Maryam Kouhestani
Volume 10, Issue 1 , January 2024, Pages 56-61
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, Pages 62-64
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
Daniel AA Umezurike; Aloysius Ugwu-Olisa Ogbuanya; Bieda Fongue Jean Robert; Ifeoma Cecilia Ekwunife
Volume 10, Issue 1 , January 2024, Pages 65-69
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, Pages 70-73
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, Pages 74-76
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 presented complaining of pain in the anterior-superior aspect of both knees following a fall while walking that same day, 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. MRI of both knees was performed two days after the injury, confirming bilateral quadriceps tendon ruptures. Twelve days after the initial injury, the patient underwent surgical intervention, and both injuries were addressed simultaneously using a transosseous tunnel technique. The transosseous technique consisted of three longitudinal and parallel tunnels drilled into the patella, and a modified Kessler suture was used to secure and reattach the quadriceps tendon back to the superior pole of the patella. At the patient’s eight-month follow-up, the patient was asymptomatic, ambulating normally, and had full knee extension with 120° flexion bilaterally. However, hypotrophy of the quadriceps muscle was noted bilaterally.Conclusion: Proper evaluation and treatment of these injuries are crucial to achieving 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, Pages 77-81
Abstract
Objective: Bladder diverticula, while not exceptionally rare in clinical practice, presents a 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 ...
Read More
Objective: Bladder diverticula, while not exceptionally rare in clinical practice, presents a 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 (BES) for the third time presenting the same symptoms. Renal and pelvic ultrasound screening was performed, revealing suspected bladder distention and adjacent fluid-filled cavities, consistent with multiple bladder diverticula. Subsequently, the patient was referred to a referral central hospital for management by medical experts. Comprehensive evaluation confirmed the findings of the BES.Conclusion: The results of the screening ultrasound enabled the BES team to initiate clinical interventions to mitigate the patient’s discomfort. Screening ultrasound was crucial in identifying imaging markers that provided the physician 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 Tajaddini; Mitra Rahimi
Volume 10, Issue 1 , January 2024, Pages 82-87
Abstract
Objective: Paraquat poisoning is a critical condition with a high mortality rate, and there are currently no established treatment guidelines for managing this toxin. Hemoperfusion constitutes an alternative treatment for paraquat poisoning. This study aimed to evaluate the efficacy of hemoperfusion ...
Read More
Objective: Paraquat poisoning is a critical condition with a high mortality rate, and there are currently no established treatment guidelines for managing this toxin. Hemoperfusion constitutes an alternative treatment for paraquat poisoning. This study aimed to evaluate the efficacy of hemoperfusion therapy using the Jafron HA330 hemoperfusion cartridge in patients with paraquat poisoning.Case Presentations: This case series study was conducted on paraquat poisoning patients in Tehran’s Loghman Hakim and Kerman’s Afzalipour hospitals. In addition to the standard treatment of poisoning patients, the patients underwent hemoperfusion using the HA330 cartridge three times at 24-hour intervals, each time lasting 180–240 minutes. Before and following the completion of the treatment program, patients’ information and laboratory results were meticulously documented. Statistical analysis was performed using SPSS software version 21. The study noted that eight of the nine patients passed away. A notable finding was the significant reduction in potassium levels in the blood. Seven patients required intubation. A notable reduction in hemoglobin levels was detected following treatment. Furthermore, a decline in bicarbonate and pH levels was observed in patients, in post-treatment, though this decrease did not attain statistical significance. Conversely, the total bilirubin levels exhibited an increase in patients following treatment; however, this change was not statistically significant.Conclusion: The findings of this study suggest that hemoperfusion with HA330 cartridges does not yield a substantial improvement in the survival of patients poisoned by paraquat.