Journal of Surgery and Trauma
Volume:6 Issue: 3, Autumn 2018

The incidence rate of trauma in pregnancy is about 5 to 7 percent. More than 50% of the trauma during pregnancy is caused by motor vehicle accidents, and about 80% of fetal deaths occur during these automobile accidents. A traumatic pregnant woman should be visited and evaluated typically because placental abruption can have sudden consequences for the fetus with or without signs. Management strategies of maternal trauma should be reliant on accurate assessment of the mother. In order to accurately assess the patient's trauma, it is essential to provide a medical image of the patient. Radiography and CT scan are the first, fastest and most accessible imaging techniques in most health centers. Imaging techniques based on ionizing radiation present hazards and harmful effects to living organisms. The risk of ionizing radiation during pregnancy is highly dependent on the absorption dose and the age of the fetus. Absorbed doses for different radiographic examinations are different. The aim of this study was to evaluate the received radiation dose by the pregnant traumatic patient, and secondly assess the received dose by the fetus. In this narrative review, we concentrated on literature in three fields relating to firstly traumatic pregnant patients, secondly ionizing radiation dose from different medical imaging and finally, fetal dose and risk. Depending on the type of radiography, the dosage of the embryo is also different. For example, examinations in which the embryo is placed on the pathway of the primary beam increases the received dose. Considering the harmful effects of ionizing radiation in imaging traumatic patients with a large number of images, the examinations that include the abdominal and pelvic region should be justified in detail. And, as far as possible, use non-ionizing imaging techniques instead of ionizing methods. One of the most reliable methods for reducing fetal doses is the development and promotion of non-ionizing imaging methods in traumatic pregnant women, such as ultrasound and MRI. All efforts should be made on the pregnant women in such a way that the embryo dose is as low as possible. It is strongly recommended that physician and medical team staff have a good knowledge and attitudes towards the radiation protection principles and in practice use standard of radiation protection safety principles.

Unwanted hair growth is a common cosmetic problem. The need for a rapid method with long-term relief has led to the discovery of various light source techniques. Regarding this, the present study was conducted to evaluate the effect of intense pulsed light (IPL) source on unwanted facial hair growth in the Iranian women suffering from hirsutism. This clinical trial was conducted on 39 women with hirsutism. Data collection was performed by recording the demographic characteristics and skin type of the participants. The patients were subjected to five sessions of IPL treatment. The number of the remaining hair was counted at the end of each session; in addition, the effectiveness and side effects of the treatment were evaluated. The data were analyzed in SPSS software (version 13) using paired sample t-test. The p-value less than 0.05 was considered statistically significant. The results revealed an 85.6% reduction in hair follicles after the treatment. Furthermore, the mean number of hair follicles was reduced from 25.4 to 3.4 at the post-intervention stage (P<0.001). Additionally, eight patients experienced side effects, the most common of which was hyperpigmentation that was observed in 12.9% of the cases. Based on the findings, IPL is a safe and effective method for removing unwanted facial hair among the Iranian women with skin type II. Given the high efficacy of IPL (85.6%) and its lack of significant side effects, IPLS can be recommended as a safe and reliable method for the treatment of hirsutism.

Otitis media (OM) is a major health problem that usually results from adenoid hypertrophy. The diagnosis is given based on symptoms and imaging studies, such as mouth breathing and lateral neck radiography (LNR), respectively. However, there are huge controversies regarding the LNR role in the management of patients with OM. This study aimed to evaluate adenoid nasopharyngeal ratio (AN ratio) in children suffering from OM with effusion (OME) and related factors. This cross-sectional study was conducted on 27OME-suspected children referring to the Ear, Nose and Throat clinics (ENT) affiliated with Mashhad University of Medical Sciences, Mashhad, Iran, in 2016. All the children underwent standard LNRs and indirect laryngoscopy in order to have adenoidal and nasopharyngeal length assessment before surgery. After adenoidectomy, pathologic data were analyzed in SPSS software (version 21) using Pearson correlation, independent sample t-test, and Mann-Whitney U test. The p-value less than 0.05 was considered statistically significant. According to the results, 70.4% of the participants were male. The mean age of the participants was 7.81±2.52 years. All the patients in the study were symptomatic, and the most frequent symptom was mouth breathing (100%). The mean values of AN ratio, pathologic adenoid size, and laryngoscopic adenoid size were 0.825±0.099, 18.22±5.97, and 5.33±19.15 mm, respectively. The AN ratio was significantly correlated with laryngoscopic and pathologic adenoid sizes (r=+0.46, P=0.01, and r=+0.44, P=0.02, respectively). The findings indicated a significant correlation between AN ratio and adenoid real measurement. Therefore, researchers are recommended to use this procedure in the assessment of patients with OME due to its availability, inexpensiveness, and negligible sid effects.

Regarding the progress in surgeries, the mortality rate of coronary artery bypass grafting surgery is still low, despite advanced age and comorbidities. One of the independent causes of mortality rate is low ejection fraction (EF). This study aimed to assess mortality after coronary artery bypass grafting (CABG) operation in patients with ejection fraction under 30%. In the present study the experience of 20 patients with an EFbelow 30% and 20 patients with an EF above 30% was investigated in Birjand in which only three of the patients died within 2 years after the operation. This crross-sectional descriptive study was conducted on 40 patients in Birjand Vali-e-aser Hospital. Out of the 40 cases, 20 patients had EF below 30% and 20 subjects had EF above 30 %. The files of all the cases undergoing heart surgery with an EF were obtained since 2015 to 2017, and then their demographic features, such as addresses and phone numbers were collected. Afterwards, they were called and their mortality was checked and the data were analyzed with independent-samples t-test. In addition, the ratios were examined in SPSS Software (version 22) and P-value considered higher than 0.05. From 2015 to 2017, the two groups, including 20 patients with EF<30% and 20 patients with EF>30%, undergone CABG surgery in Birjand University of Medical Science, 65% of which were men and 35 % were women with the age range of 64.7 for the cases with EF<30 and 62.5 for the subjects EF>30. One of the patients died with an EF above 30% and two subjects died with EF below 30%. The mortality rate can be reduced with providing appropriate care despite the fact that an EF<30% is an independent cause of mortality and according to the results of the present study which showed three patients died after the CABG operation.

During recent years, the occurrence of terroristic attacks throughout the Middle East and occasionally in Iran have proposed that bioterrorists have the ability to disseminate biologic agents in the region and cause widespread social panic. Medical, health and laboratory personnel have a serious responsibility towards their public community in terms of the prevention, detection, and treatment of potential bioterrorism attacks. To fulfill their responsibilities, they need to be trained by taking part in the relevant courses during their undergraduate education. In case of potential bioterrorism attacks, an appropriate level of knowledge and preparedness is essential for medical, health and laboratory personnel to ensure a proper medical response to such outbreaks. This study aimed to evaluate the level of knowledge, preparedness, and attitude of medical, dentistry, nursing, and laboratory science technology students in Birjand University of medical sciences, Birjand, Iran on a potential bioterrorism attack. This study is a cross-sectional analytical study. A total of 182 students of Birjand University of Medical Sciences in medicine (Med), nursing (Nurse), laboratory science technology (Lst) and dentistry (Dent) who had just passed their microbiology courses took part in this study, in 2017. Students who were not willing to complete the questionnaire were excluded from the study. A non-probabilistic sampling method was used. Data were collected using a licensed questionnaire. The data were extracted from the questionnaires, corrected and analyzed in SPSS software (version 24). All data were analyzed by the Kruskal-Wallis and Mann-Whitney Tests. P-value less than 0.05 was considered statistically significant. The result of the study showed that the mean scores (out of 100) of knowledge and preparedness of medicine , dental , laboratory science technology, and nursing students were obtained as 45.5±15.9 and 63.2±13.8, 41.3±6.5 and 66±12.5, 35.7±12.8 and 57.5±11.6 , and 36.3±6.5 and 61.5±7.5, respectively. The knowledge score between Med and laboratory science technology students was significantly different (P=0.003). The same significant difference was also found between medicine and nursing students (P=0.007). Moreover, there was a statistically significant difference between dental and laboratory science technology students in terms of preparedness scores (P=0.002). However, no significant difference between dental and medicine students neither on their knowledge nor on their preparedness scores was observed (P=0.376, P=0.257). It can be concluded that the level of knowledge and preparedness of medical, health and medical laboratory science students regarding bioterrorism is relatively low. Therefore, enclosing educational programs about bioterrorism in curriculum of all academic disciplines of medical sciences is suggested.

Acute digoxin intoxication is a relatively common cause of poisoning. It might be fatal especially in patients with cardiovascular underlying diseases or the cases ingesting a large dose of digoxin intentionally or accidentally. The aim of this study was to investigate the outcome of the patients admitted to the Emergency Department with digoxin intoxication. Moreover, the prognostic factors were studied. This observational cross-sectional study investigated the outcome of patients with acute digoxin intoxication during 2004 to 2016. All the patients were admitted to the emergency department, with acute or acute on chronic poisoning entered the study within 13 years. The documents of emergency departments, ordinary wards, and intensive care units (ICUs) were studied. The outcome and mortality of the patients was investigated. The collected data were analyzed using SPSS software (version 18). The significance level was considered less than 0.05. The chi-squared test and Fisher’s exact test were applied to compare the qualitative variables. Furthermore, binary logistic regression was used to find out the factors predicting the outcome of patients with acute digoxin poisoning. Totally, 81 patients with acute digoxin intoxication were enrolled in the study. Out of the 81 patients, nine patients (11.11%) were admitted to the ICUs. Four cases (4.9%) were intubated and underwent mechanical ventilation, and four subjects (4.9%) died. All the patients that were intubated or died had serum potassium level above normal ranges at the time of admission. In the logistic regression model (admission to ICU or ordinary wards), age, and high potassium level were found to be as an independent factor for adverse outcome (odd ratio=3.11, confidence interval=95%, 2.22-4.5, and odd ratio=12.2; confidence interval=95%, 10.1-14, respectively). In the present study, it was found that acute digoxin intoxication could result in worse outcomes. Moreover, it was noticed that in patients with higher age and abnormal potassium level, the incidence of morbidity and mortality is higher and requires more careful treatment.

Arteriovenous graft fistula (AVG) is used in chronic hemodialysis patients. Depending on graft materials, AVG is associated with common complications that may need several interventions. Pseudoaneurysm is one of the rare complications with various reasons. Patients with this complication require access revision and even surgical repair. However, a new method using covered-stent graft may be applied in several cases. In this study, we presented a young male hemodialysis patient with AVG referred with a pseudoaneurysm and treated with covered-stent graft. After a year, he was referred with pseudoaneurysms on two separate occasion of AVG. He was again treated with covered-stent graft.

Foreign body ingestion is remarkable in adults although the incidence of this issue is more common in children. The complication level of foreign body ingestion depends on the site and type of foreign body. Moreover, partial denture with sharp metal hooks, metal springs, and sharp bone pieces are among the most difficult and hazardous foreign bodies result in fistula formation or esophagus puncture. The reported case in this study was a man with a sharp steel wire in his throat. Rigid and flexible endoscopy are the interventions for the removal of foreign bodies; however, surgery is regarded as a safer and more effective treatment for difficult and hazardous cases.