دکتر حمیدرضا مهریار

Medicines that are used to prevent and cure disease may affect patients if used incorrectly, and this study was conducted with the aim of evaluating the frequency of drug interactions in patients admitted to the emergency department of Imam Khomeini Hospital in Urmia.

This study is descriptive-analytical in a cross-sectional way, From March 20, 2020 to September 21, 2020, a census was conducted on patients admitted to the emergency department of Imam Khomeini Hospital in Urmia, who were 1901 people. The data was collected using a checklist that included information (age, sex, type of drug and severity of interference and type of interference). After collecting the data, it was entered into SPSS software, version 18 (IBM SPSS, Armonk, NY, USA) and analyzed with the help of descriptive and analytical statistics.

In this study, the results showed that out of 1901 studied patients, 1101(57.9) were male and the rest were female 801(42.1), And the average age of the patients was 61.67±17.13 years, and 1160(60.9) patients did not have drug interactions and 724(39.01) had drug interactions, and the most common type of drug interaction was the moderate type, which was present in 75.1% of cases; And the final clinical outcome of the patients was 1088(57.2) discharge, 296(15.5) personal consent discharge and 506(26.6) death. Also, the most common drug interactions were serotide/salbutamol, azithromycin/ondansetron, and aspirin/nitroglycerin, respectively. And there was no significant relationship between the occurrence of drug interactions and the gender of patients (P=0.27) and finally, the average age of patients with drug interactions was 17.7±61.2 years and in patients without drug interactions was 16.7±61.9 years.

The overall incidence of drug interactions in the studied patients was equal to 39.01, and the most common drug interactions in patients were of moderate and mild type; and there was no statistically significant relationship between the age of the patients and the gender of the patients and the incidence of drug interactions.

The emergence of thrombolytic drugs has opened new horizons in the treatment of patients with acute ischemic stroke, and this study was conducted with the aim of evaluating the barriers of receiving tissue plasminogen activator in patients with acute ischemic stroke in Imam Khomeini Hospital of Urmia.

This descriptive-analytical, cross-sectional study was conducted from April 21, 2015 to March 19, 2016 on patients with acute ischemic stroke referred to the emergency department of Imam Khomeini Hospital in Urmia using census sampling method. To collect data, a checklist containing demographic information was used. After collecting the data, it was entered into SPSS 18 and analyzed with the help of descriptive statistics.

In this study, the results showed that out of 100 patients, most of the participants were male (58%)58 and the rest were female, and the average age was 63.71±17.3 years, and 86% were in the age range of 18-80 years, which was the appropriate age to receive or thrombolytics. and the rest were over 80 years old. The fastest visit time was 25 minutes and the latest was 10080 minutes (168 hours). Among these 40 people, only four people (40%) were in the golden time period of thrombolytic drug, i.e. Three hours from the onset of symptoms to the final evaluation. Among the four people who were placed in the golden time, in 50% of the cases there was a history of taking anticoagulants, in 25% a history of head injury, in 50% of the blood sugar less than 50 and finally 1 person (25% of the people placed in the golden time) that is, 1% of all patients were eligible to receive rtPA. About 24% of patients had NIHSS<4 and 2% had NIHSS>25, and the average number obtained was 10.

The most important obstacle in the timely initiation of thrombolytic therapy is the delay in visiting the emergency room. Therefore, public education in order to improve the level of general awareness of the society can be effective in reducing this time delay.

Today, one of the most important dangers threatening the process of promoting public health and its development is traffic accidents.

The aim of this study was to determine the demographic characteristics of traffic accident victims in the patients referred to Imam Khomeini Hospital in Urmia from October 2018 and September 2019.

This descriptive cross-sectional study was performed on 4717 people traumatized in traffic accidents who referred to Imam Khomeini Hospital in Urmia between October 1, 2018 and September 21, 2019. Data were collected using a checklist in which demographics and random information of the injured were collected. After that, the data were entered into SPSS18 software and analyzed using descriptive statistics (frequency, percentage, mean and standard deviation). (P <0.05)

The results of the study showed that from 4717 randomized patients referred to the hospital, 3275 (69.5%) were male and 1442 (30.5%) were female. The mean age of the patients was 31.2±18 years with the oldest group being between 21-30 years and 1182 (25%). Most people 1272 (27.2%) held a high school diploma and 1993 (67.2%) worked in the private sector. Most of the injured cases, 3715 (78.7%), were treated on an outpatient basis and the most common injuries included multiple injuries, right shoulder, right hand, and left leg trauma, respectively.

Given the high importance of road accidents as a social problem and the predictability and controllability of these accidents, planning should be done to elevate the road safety and vehicle transport standards. It is also necessary to develop educational programs for the youth population as the most important group at risk.

Health care methods have made undeniable progress in maintaining patients' health, but assessing the expected recovery and health of these methods is still done by basic criteria such as mental estimates and approximate physicians. These methods have a high probability of error in predicting patient mortality and survival. The aim of this study was to investigate the comparison between REMS and APACHEIII criteria in non-surgical patients referred to the emergency department of Imam Khomeini Hospital in Urmia in the second half of 2019.

In this cross-sectional descriptive study, 662 patients were enrolled in the study by census method. Data were collected by checklist. Finally, the mortality rate was predicted using REMS and APACHE III systems.

The results of the study showed that out of 662 patients (55.9%), 370 were male and (44.1%) were 292 females, the mean age of patients was 62.56±14.61 years. The mean scores of APACHE III and REMS in all patients were 53.32±17.96 and 9.79±4.05, respectively. The mean REMS in living patients was 7.21±3.8 And in deceased patients was 13.29±4.41. Also, a significant direct relationship was observed between APACHE III score (r=0.437) and REMS (r=0.241) with the length of hospital stay. The area below the ROC curve chart for APACHE III was higher than REMS, indicating that APACHE III was better at predicting patients' clinical outcome.

Overall, the APACHE III criterion performed better than the REMS in predicting the clinical outcome of non-surgical patients referred to the emergency department, and the mean scores of REMS and APACHE III were higher in deceased patients than in surviving patients.

Early referral after stroke and the use of modern intravenous therapies and blood pressure control accelerates the improvement of post-stroke symptoms. Therefore, this study was performed to investigate the relationship between the time interval between the onset of stroke symptoms and referral to the emergency department with demographic characteristics of patients with cerebrovascular accidents referred to the emergency department of Imam Khomeini Hospital in Urmia in the first half of 2018.

This descriptive-analytical study was performed on 296 patients referred to Imam Khomeini Hospital in Urmia in the first half of 2018 by census method. Data were collected using a demographic questionnaire.

In this study, the mean age of patients was 68.87±14.75 years, of which 153 (51.7%) were male and 143 (48.3%) were female. The mean time from the onset of symptoms to the emergency room was 36.21 ± 4.04 hours, the mean time required to reach the emergency room was 35.98± 2.48 minutes and the mean distance to the time of arrival to the emergency room was 41.11± 3.95 km, 291 patients (98.3%) had ischemic stroke and 5 patients (1.7%) had hemorrhagic stroke. Dimensions, level of education of the patient and his companions and the mode of transmission had a significant relationship with the delay in visiting the hospital emergency department.

The results of our study, like other studies, showed that the time to go to the hospital to treat patients after a stroke has a high average, and factors such as long distance from the treatment center, how patients are transferred, level of education that can indicate insufficient knowledge in clinical signs of stroke were involved in this affair.

Wound management of trauma patients is one of the most important and common measures in the emergency department. Following trauma, hemodynamic and metabolic changes occur in the body that are sometimes very complex and lead to many complications and deaths, even with great care. The aim of this study was to investigate the risk factors for managed wounds in trauma patients referred to the emergency department of Imam Khomeini Hospital in Urmia.

This descriptive-analytical study was performed on all trauma patients referred to the emergency department of Imam Khomeini Hospital in Urmia from October 1, 2017 to March 20, 2017 by census. Data were collected using a checklist that includes demographic characteristics, underlying diseases, wound characteristics and wound management of patients in terms of complications and recovery in the sixth month according to the Vancouver Oscar criteria.

Of 350 patients studied, 86 (24.6%) were female and 264 (75.4%) were male and the mean age of patients was 37.3±11.1 years. The most common complications were infection (9%) and inflammation around the wound (5%). Smoking (P<0.05), diabetes (P = 0.03) and wound infection (P = 0.03) were associated with infection, Antibiotic prophylaxis (P=0.02) and keeping the wound clean were also associated with a reduced incidence of infection (P=0.01). The mean degree of wound was 6.4 ± 2.3 at the beginning of admission for patients and 3.1±1.6 after 6 months; Statistical evaluation showed that there was a significant decrease in the degree of wounds after 6 months (P=0.001).

Diabetes and smoking are common risk factors for infection and reduced wound healing.
 

Road accidents often cause severe damage to their victims and have a direct impact on community members. Iran has the highest rate of road accidents. The purpose of this study was to determine the model for predicting road deaths and injuries in West Azerbaijan province based on the data of the years (2010-2017) in a time series: Box-Jenkins model.

In this descriptive study, all deaths and injuries caused by traffic accidents were analyzed during 2010-2017. In order to determine the process of death and injury caused by traffic accidents in West Azerbaijan province, time series and Jenkins series models were used and the process of death and injury from traffic accidents was predicted in the province.

In this study, it was found that the accidents trend was unstable in the study period and the best model to predict which one had the least value is the ARIMA model (2, 0, 1) with AIC = 78/38 As a suitable model for series fitting, due to the lack of seasonal trend of road accidents in West Azerbaijan province the trend is decreasing That is, in 2018 there were about 269 deaths which decreased by 7.4% compared to the year 2017.

According to the results, the trend of accidents for the coming year has also been declining, which is a good trend.

Seizure is a common disorder and is also one of the most important reasons for referring to emergency departments of hospitals which has multiple causes. It is believed that early diagnosis of this disorder is extremely important. This study aimed to investigate the causes of the first generalized seizure of adult patients referring to the Emergency Department of Imam Khomeini of Urmia during the second half of 2018.

This study was a cross-sectional descriptive study conducted in the second half of 2017 on all patients suffering with seizure over 18 years of age who had referred to the emergency department of Imam Khomeini Hospital in Urmia by census method. Data were gathered using a checklist which included different variables (age, gender, marriage, and place of residence, education, diagnostic tools, and the ultimate cause of seizures).

The results showed that among the total 120 studied patients, 55 were males (45.8%) and 65 patients were females (54.2%). The average age of the participants was52.50 ±20.42 years and most of the participants were married 86(71.5%) and in the age group over 60 (34.4%) were 52, The procedure of diagnostic tests CBD diff / Na / K / Ca / Bs and ESR / CRP in most cases, diagnosis of the causes seizures and CT scan imaging technique (74.5%) of 89 cases necessary that ultimately the most common cause of seizure disorders The cerebral arteries (28.3%) were 34.

In this study, the most common cause of seizures is cerebrovascular injury, but due to the high prevalence of seizures following trauma, drug deprivation, elimination of underlying factors and social anomalies will be an important step in preventing seizures.

Hospital emergencies are of particular importance as they are considered as the first-line treatment for patients. Patient mortality in the emergency department is considered to be a problem as it has intensified in recent years. The aim of this study was to investigate the causes of mortality in patients admitted to the Emergency Department of Imam Khomeini Hospital in Urmia in the first half of 2017.

In this cross-sectional descriptive study, after obtaining permission, the medical file of all those patients who had referred to the emergency department during the period of April 1st to September 31st, 2017 and who had died in the emergency for any reason was gathered. Data were collected from the archive and were collected for variables such as age, sex, marital status, residence, initial complaint, length of hospital stay, visitation service, place of death and cause of death.

A total of 133 cases were studied, of which 77 (57.9%) were male, 114 (85.7%) were married and 71 (53.4%) were residents of Urmia and the mean age of patients was 66/8±18/9. The most common complaints reported by patients or their companions were about consciousness loss and the least reported were chest pain, hematuria, and lower extremity swelling, respectively. A high percentage of mortality (58.6%) had occurred in patients who had been in the emergency department for 24 hours or less. The most common causes of mortality were cardiopulmonary deaths and cardiovascular disease, and ultimately in the evaluation of the duration of the disease (acute or chronic), 38 (28.6%) had acute disorder and 95 (71.4%) had a previous chronic disease.

According to the results of the present study, most of the causes of mortality included cardiopulmonary arrest and cardiovascular problems. These findings reveal the  importance of controlling and preventing these diseases and on the other hand, shows the necessity of proper planning, staff training and equipping the emergency departments in order to reduce mortality rates.