shiva samsam shariat

Paraquat poisoning is a common and often fatal herbicide poisoning in society. This study presents a clinical case series of patients who survived after paraquat poisoning.

This study evaluated patients hospitalized between March 2016 and March 2021 with paraquat (PQ) poisoning who survived. Out of 115 patients with PQ poisoning, three cases of severe toxicity with an average age of 24.33 years are presented here. The urinary sodium dithionate test result was positive in all three surviving patients. All patients arrived at the poisoning emergency center within an hour of ingestion and received gastric lavage and charcoal therapy. They were also treated with corticosteroids, N-acetylcysteine (NAC), vitamins C and E, Curcumin, and Livergel. Hemodialysis was performed for the patients, with one undergoing hemodialysis and hemoperfusion after ingesting 250 mL of PQ 20%. After a six-month follow-up, all surviving patients were in good health.

Various factors, such as early admission after exposure, prompt gastrointestinal (GI) decontamination, corticosteroids with Curcumin and Livergel, antioxidants, hemodialysis, and hemoperfusion in one case may have contributed to the survival of patients with PQ poisoning in this study. However, individual vulnerability should also be considered a crucial factor requiring further investigation.

 Ethanol poisoning is one of the most common poisonings in the toxicologic emergency department. This study aimed to investigate the clinical symptoms of ethanol poisoning in children and the outcome of treatment of these patients.

This retrospective cross-sectional study was conducted in 1402. The inclusion criteria were ethanol-poisoned patients (children under 18 years old) who were admitted to Imam Hossein Children's Specialized Hospital and Khurshid Hospitals in Isfahan from the beginning of 2015 to the end of November 2014. Demographic information, clinical symptoms, length of hospitalization, and the outcome of treatment of the patients were recorded.

364 patients were included in this study, of which 320 were in Khurshid Hospital and 44 were in Imam Hossein (AS) Hospital. These patients had an age range of 1 to 18 years and an average of 14.73 ± 3.77 years (P = 3.7), of which 85.2% were boys. 86.1% of patients were older than 12 years old. The highest manifestation of the disease was related to nausea and vomiting in 196 cases (53.8%), followed by a decreased level of consciousness in 123 cases (33.8%). Most of the patients (98.1%) were discharged from the hospital in less than 24 hours and with the improvement of their symptoms. Also, 3 cases of patients were hospitalized in the intensive care unit of the ICU.

Ethanol poisoning was significantly higher in boys under 18 than in girls. A significant percentage of poisoning cases are abuse cases. Although the prognosis of ethanol poisoning in children was a complete recovery, a small percentage required long-term hospitalization.

Aluminum phosphate (ALP) poisoning has a high mortality rate (MR) secondary to cardiogenic shock. Recently, extracorporeal membrane oxygenation (ECMO) showed a successful result in this issue. We conducted a systematic review and meta?analysis to compare the MR of patients with ALP poisoning who underwent ECMO versus those with conventional treatment.

Two parallel databases’ reviews were done to find the ECMO treatment?applied studies or conventional treatment?applied studies according to the PRISMA protocol. All studies in any languages and English conference abstracts wereincluded for ECMO treatment?applied studies. Only English?language human  observational studies, which reported MR, were included in conventional treatment?applied studies. All ETAS case reports were summarized and used as a newly generated cross?sectional study (NGCSS) for inclusion in the meta?analysis.

Out of 167 and 1043 records, 17 case reports (24 cases), 3 cross?sectionalstudies, and 9 conventional treatment?applied studies were selected. In meta- analysis NGCSS applied as the fourth cross?sectional ECMO treatment?applied studies. The overall MR of ECMO?treated cases (23% [95% confidence interval (CI): 7%– 39%]) was significantly less than conventionally treated cases (60% [95% CI: 39%–63%]; P < 0.001). In ECMO?treated cases, the weighted mean difference (WMD) for age, blood pH, ALP dose, hospitalization, ECMO lag time, and ECMO duration were not statistically significant between survived and nonsurvived cases. However, WMD of cardiac ejection fraction (4.6%; 95% CI: 2.76%–6.39%; P < 0.0001), exposure to hospitalization lag time (?2.05; 95% CI: ?4.05–0.14 h; P = 0.06), and length of hospital stay (16; 95% CI: 12.0–20.5 days; P < 0.0001) between survived and  nonsurvived ETC were significant.

ECMO reduced the MR of ALP?poisoned patients; however, it is a highly invasive and complicated procedure.

This study evaluates the role of oral melatonin in improving vision in methanol toxicity since vision disorders are one of the side effects related to methanol toxicity and assumes the potential effects of melatonin in protecting neurons and optic nerves. Meanwhile, little attention has been paid by researchers to the effect of melatonin in these patients.

A double-blind randomized controlled clinical trial study was conducted on 40 patients diagnosed with methanol toxicity who were referred to Khorshid Hospital of Isfahan City, Iran, from May 2022 to May 2023. These patients were randomly divided into two groups. In the first group (the intervention group), in addition to the usual treatment, the patients were prescribed orally 3 mg of melatonin every morning and 6 mg of melatonin every night for 10 days. In the second group (the control group), in addition to the usual treatment, a placebo was administered similar to the intervention group protocol. Then, the clinical and vision parameters of the patients were evaluated before, during, and after the intervention.

The mean pH, PCO2 and HCO3 increased significantly after the intervention compared to the pre-intervention in both groups (P<0.05); however, no significant difference was found between the two groups in any of the two follow-up times (P>0.05). The most common visual complication caused by methadone toxicity was blurred vision with 71.4% and 90% in the melatonin and non-melatonin groups, respectively. Visual complications improved significantly after the intervention compared to the pre-intervention; accordingly, the complete improvement of vision complications in the melatonin group (76.2%) was significantly more than the non-melatonin group (53.3%) (P=0.040).

Melatonin improves blurred or snowfield vision in methanol poisoning. Therefore, the administration of melatonin plus routine treatment can be effective in improving vision disorders (blurred or snowfield vision) caused by methanol poisoning.

The purpose of this research is to investigate the effect of using the poster advertising model in the field of public health. In terms of purpose, this research is descriptive-survey in the category of applied research and based on the method of data collection. The statistical population of this research includes all managers of health centers in Isfahan province who were employed in 1401 and their number was 249 people, of which 150 people were selected as the research sample by stratified random sampling method. A researcher-made questionnaire was used whose validity and reliability were confirmed. To analyze the collected data, Kolmogorov-Smirnov tests were used for the normality of the data, as well as confirmatory factor analysis and structural equation method using the software (AMOS24).The findings showed that among the studied components, respectively: solutions with path coefficient (0.80), effectiveness (0.84), ruling platforms (0.92), obstacles with path coefficient (0.94) and effective components (0.97) are most effective in the poster advertising model in the field of public health. The model obtained from this research can open the way for practitioners and planners of the health and treatment sector to plan for the effectiveness of poster advertising campaigns in the field of public health and to improve the level of public health and health, as well as to create innovative opportunities to increase productivity in this field.

Poisoning with Organophosphates (OP) and/or Pyrethroids (PYR) pesticides is common. We present a rare case of OP+PYR poisoned patient who suffered from Atrial Fibrillation (AF) at the beginning of treatment by a low dose of atropine and reviewed the literature. 

A 50-year-old man had ingested about 5-10 ml of a mixture of chlorpyrifos/cypermethrin.  Half an hour later, he went to the rural hospital and 2 hr later, after gastrointestinal decontamination, he was referred to the clinical toxicology department with normal vital signs except normal sinus tachycardia [Heart rate (HR)]=105. On admission, he had nausea, vomiting, diarrhea, mild sialorrhea, symmetric mid-size pupils, wet skin, and bilateral moist rales in his lungs. His cardiac rhythm changed to rapid AF (HR >140 beats/min) after treatment with 3 mg midazolam followed by 0.3 mg of atropine (0.1 mg every 1-3 min). Atropine administration was discontinued and he was treated with 0.5 mg of digoxin. 6 hr later, his arrhythmia disappeared and all cardiac and laboratory evaluations changed to normal except reduced serum cholinesterase activity.  

AF may be induced by Organophosphates (OP) and Pyrethroids (PYR) intoxication or during the treatment by atropine. We could not find any known risk factor (cardiac or medical issues) for AF in the current case. It may be suggested that poisoning with OP, PYR (alone or mixed) or atropine (in general or in low dose), or combination is the trigger of AF. However, AF is not life threating and can easily cure by antiarrhythmic therapy.

This study aimed to assess the severity of poisoning, various scoring systems, including Sequential Organ Failure Assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II), Simplified Acute Physiology Score (SAPS II), Modified APACHE II, and poisoning severity score (PSS) were used. In this study, we compared the predictive value of these scoring systems on the outcome of pesticide‑poisoned patients.

This is a cross‑sectional study of pesticide‑poisoned patients (140 patients) who were admitted to the intensive care unit (ICU) of Khorshid Hospital, Isfahan, Iran, between January 2015 and 2019. The area under the receiver operating characteristic (AUC) curve and the predictive value of scoring systems were compared.

Poisoning was higher in the male population (72.8%). The causes of poisoning were paraquat, (38.6%), aluminum phosphide, (32.1%), and organophosphate, (29.3%). The mean age of the patients was 33.9 years. Most patients (79.3%) attempted suicide. The mortality rate was 46.43%. The mean of “SOFA score,” “APACHE II,” “SAPS II,” “Modified APACHE II,” and “PSS” was 5.9; 15.7; 30.02; 15.8; and 1.9, respectively. There was a significant difference in the mean of all scoring systems for outcome prediction. Among all scoring systems, the SAPS II score with the cutoff point (16.5) had the best criteria for outcome prediction (AUC (0.831 ± 0.037), sensitivity (83.1%, 95% confidence interval [CI]: [71.7–91.2]), specificity (75.7%, 95% CI: [64.3–84.9]), positive predictive values (75.0%, 95% CI: [66.4–82.0]), negative predictive values (83.6%, 95% CI: [74.5–89.9]).

The SAPS II scoring system may be a suitable indicator for outcome predictions in pesticide‑poisoned patients in the ICU.

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. 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. 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). 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

 Medical students serve as frontline individuals to COVD-19 patients, and their mental health affects the quality and safety of the provided services.

 The present study aimed to identify the relationship between anxiety, resilience, and posttraumatic growth of medical interns during COVID-19 pandemic.

 This descriptive-correlational study was conducted in Kerman and Isfahan, Iran, from June to September 2020. The socio-demographic questionnaire, Beck Anxiety Inventory (BAI), Connor-Davidson Resilience Scale (CD-RIS), and Posttraumatic Growth Inventory (PTGI) were completed by 235 medical students. Pearson correlation test and descriptive statistics were used to analyze the data.

 The mean and standard deviation scores of anxiety, resilience, and posttraumatic growth were 10.49, 1.08, and 50.60, as well as 13.39, 65.70, and 15.90, respectively. The results showed no significant relationship between anxiety and resilience (r = 0.16 and P = 0.057). A positive and significant correlation was observed between resilience and posttraumatic growth (r = 0.42 and P = 0.000). Furthermore, a significant negative correlation was found between anxiety and posttraumatic growth scores (r = -0.20 and P = 0.002).

 In sum, the more resilient and less anxious a person was, the greater his/her posttraumatic growth became. Therefore, it was recommended that appropriate psychological interventions be designed and implemented to improve the mental health of medical interns.

Poisoning by opium and stimulants brings many patients to the poison emergency departments every year. This study planned to determine the risk factors for Opioid and Stimulant poisoning among patients admitted to the Khorshid Hospital.

The present cross-sectional study was performed on 243 patients poisoned with opioids or stimulants in Khorshid Hospital of Isfahan during December 2018 to the December 2019. The data about demographic variables including: (sex, age, marital status, occupation), type of intoxication (opium, heroin), and or stimulants(hashish, cannabis, marijuana, amphetamine) and intoxication with other substances, cause of intoxication, type of intoxication (accidental, intentional), method of intoxication (oral, inhalation, intravenous injection, intramuscular or subcutaneous injection, etc.), poisoning with other drugs, vital signs at entering the ward, length of stay in the poisoned ward, treatment outcome (recovery or death), and cause of death were extracted from the patients' files. The data were analyzed using the ANOVA and the Chi-square tests.

The results of this study showed that the most substance poisoning in individual of Iranian nationality was heroin and in non-Iranian was opium. In addition, substance poisoning was more common in men, especially in the age group of 31-35 years, and among the unemployed or self-employed, as well as among those with a diploma or lower.

According to the results of the present study, among opioid, heroin poisoning was the most and among stimulants, amphetamine was the most. Also, most of the poisoned people were under 40 years old and had low education.

Ethanol is a chemical that is easily absorbed in all parts of the gastrointestinal tract. This feature increases the risk of poisoning by ingesting this chemical at any amount; the signs and symptoms depend on the poisoned individual. Common symptoms of ethanol poisoning include sedation, poor coordination, vomiting, slurred speech, ataxia, respiratory depression, coma, and death. A rare manifestation of alcohol consumption is the raccoon eye. This article presents a 5-year-old girl who gradually showed a unilateral raccoon eye following ethanol consumption.

Aspiration pneumonia is among overdose complications, requiring timely appropriate treatment. The present study aimed to evaluate the effects of ampicillin-sulbactam, compared to our usual regimen ceftriaxone + clindamycin on aspiration pneumonia in opioid-poisoned patients.

In a randomized-controlled clinical trial, opioid-poisoned patients with aspiration pneumonia were randomly divided into the experimental and control groups to receive ampicillin-sulbactam 3 g Intravenously (IV) every 6 hours (experimental group) and ceftriaxone 1 g IV every 12 hours + clindamycin 600 mg IV every 8 hours (control group) followed by co-amoxiclav 625 mg orally every 8 hours and cefixime 400 mg once daily + clindamycin 600 mg orally every 8 hours in experimental and control groups, respectively, to complete a 7-day course of therapy. White blood cell count and temperature (axillary) at baseline and the third day of the intervention and the treatment outcome on the third day of the intervention, defined as either complete response, partial response, or failure, were evaluated and recorded for all patients.

Except for the number of cases of leukocytosis on the third day of the intervention, i.e., lower in the control group (5 patients, 26.30%) than the experimental group (13 patients, 68.40%) (P=0.020), no significant difference was observed between the study groups regarding other outcome variables. Clinical response was similar between the study groups; so that, 10.50% and 63.20% of patients in the experimental group and 21.10% and 47.4% of patients in the control group presented complete and partial responses, respectively (P=0.550).

The obtained data suggested that ampicillin-sulbactam is an effective antibiotic for the treatment of aspiration pneumonia in patients with opioid overdose, in which case, it has the same efficacy as the two-drug regimen of ceftriaxone + clindamycin.

Acute low back pain is a common ailment and causes pain and disability. Physicians often prescribe nonsteroidal anti‑inflammatory drugs (NSAIDs) to treat acute low back pain; however, due attention has recently been drawn to muscle relaxants to reduce the severity of patients’ daily physical dysfunction. Therefore, this study aimed to evaluate the therapeutic effect of the administration of indomethacin alone compared with methocarbamolas a muscle relaxant and indomethacin as an NSAID on the treatment of acute low back pain.

The present double-blind clinical trial was performed on 64 patients with acute low back pain. The patients were categorized into two groups and received the treatments as follows. Indomethacin capsules of 25 mg every 8 h and placebo tablets every 8 h were administered in the first group (Group I). Indomethacin capsules of 25 mg every 8 h and methocarbamol tablets of 500 mg every 8 h were administered in the second group (Group I + M). Patient pain intensity and physical function based on Back Pain Function Scale (BPFS) were recorded before and 1 week after the intervention.

The present study results revealed that the mean pain reduction of patients in Group I + M was significantly higher than that of Group I (3.66 ± 3.17 vs. 1.84 ± 1.53; P < 0.001). Moreover, the mean BPFS increase in Group I + M was significantly higher than that of Group I (19.44 ± 8.66 vs. 4.75 ± 4.35; P < 0.001).

According to the results of the present study, concomitant administration of indomethacin and methocarbamol can be more effective in reducing pain intensity and improving the patient’s physical function (or performance).

Valproic acid is prescribed in many clinical cases. Decreased level of consciousness is one of the most prominent symptoms of valproic acid poisoning. The aim of this study was to investigate the relationship between the level of consciousness and other symptoms of poisoning and therapeutic outcome in patients poisoned with oral valproic acid.

This study was performed as a cross-sectional study using the information of patients with valproic acid poisoning admitted to Khorshid hospital in Isfahan, Iran, during the years 2018 and 2019. The data about demographic characteristics and patients’ signs and symptoms were collected from hospital records by using a checklist, and were analyzed.

Data of 243 patients poisoned with valproic acid were analyzed. At the time of admission, 194 patients (79.8%) were alert, and respiratory status was normal in 237 cases (97.5%). Sodium levels in 218 patients (92.8%) and potassium levels in 212 cases (91%) were normal. Analysis of venous blood gases showed metabolic acidosis in 45 cases (19.2%). In these patients, respiratory status showed a significant relationship with the level of consciousness (P < 0.001), and the level of consciousness had a significant relationship with therapeutic outcome (aspiration pneumonia) (P < 0.001).

The results of this study showed that most of the patients poisoned with valproic acid had benign disorders, and would have complete recovery with treatment. In cases of acute poisoning and decreased level of deep consciousness, it is important to pay attention to the patients’ respiratory status, and the necessary measures should be taken to prevent aspiration as a therapeutic consequence.

Opioid abuse is widespread throughout the world. Aspiration pneumonia is a serious problem following opioid overdose and poisoning. This study aimed to evaluate the safety and effectiveness of antimicrobial management of opioid-overdose induced aspiration pneumonia in a referral poisoning management university hospital in Iran.

In an observational cross-sectional study (September–March 2019), opioid poisoned patients diagnosed with aspiration pneumonia within a maximum of 48 h of their overdose were evaluated regarding several variables, including the level of consciousness on admission, drug regimen used for the treatment of aspiration pneumonia, and its appropriateness, and the correctness of the used antibiotics dose and the therapeutic outcome.

During the study, 53 eligible patients were identified and included in the study. The most frequently abused opioids were methadone (60.4%) and opium (17%). “Ceftriaxone + Clindamycin” (54.7%) and “Meropenem + Vancomycin” (9.5%) were the most frequently administered regimens. Regarding treatment outcome, most cases (n = 36, 67.9%) were discharged with a stable and satisfying medical status, while 3.8% of the cases (n = 2) died.

The use of antibiotics in the treatment of aspiration pneumonia in hospitalized patients with opioid overdose in our referral university hospital is associated with notable antibiotic regimen choice issues. The implementation of strategies for improving the pattern of antibiotic prescribing for these patients is necessary

Paraquat has been recognized as a highly toxic agent for pest removal and is used worldwide.In adults, paraquat poisoning for suicidal attempts is much more common than accidental exposure poisoning. Approximately 20% of patients with paraquat poisoning develop pneumomediastonium as a complication with a mortality rate of approximately 100%. A 19‑year‑old man patient was admitted to the poisoning emergency department of Khorshid hospital, who had ingested paraquat. He had nausea and vomiting and had normal vital signs and examination in admission. Initial treatment for the patient was done. The patient signs got worsened on the 21st day of hospitalization and had severe emphysema of the superficial and deep spaces of the neck, followed by bilateral pneumothorax, and severe pneumomediastinum. Unfortunately, the patient died on the 27th day of hospitalization. Purpose of the current study is to raise awareness of rare paraquat toxicity complications, treatment, and especially its lethal complications, including pneumomomediastonium.

Atropine is a drug of choice for muscarinic effects in organophosphate (OP) poisoning. Allergic reaction to atropine is rare. Here, we report a case of a 17‑year‑old male who was admitted with clinical manifestations of acute OP poisoning. After intravenous atropine injection, cutaneous signs of hypersensitivity including erythema and urticarial were observed on his body. Atropine injection was stopped, and antihistamines and hydrocortisone were administered. His condition was improved, and he discharged with a good condition after 2 days hospitalization. Adverse allergic reaction to atropine should be in mind when managing OP poisoning cases.

Poisoning with any of the colchicine or chloroquine drugs is rare. These drugs exert therapeutic and toxic effects on tissues by different mechanisms. Colchicine is used to treat a number of rheumatologic diseases and heart problems. In addition, chloroquine is used to treat malaria and some inflammatory diseases. There is a small gap between the therapeutic and toxic doses of these drugs. Gastrointestinal symptoms are the initial causes of poisoning with these drugs and then widespread organ failure in later stages can lead to sudden cardiac death. We introduce a case of concurrent poisoning with both drugs, in which the patient presented with a headache, nausea, and vomiting several hours after suicide. On the 1st day, the patient's status was stable, but on the 2nd day, the patient suddenly becomes ill and died even though the patient received supportive therapy. Concurrent poisoning with chloroquine and colchicine is extremely lethal, and early aggressive management is recommended even in an apparently stable patient.

One of the most frequent causes of death is poisoning worldwide. Investigating the causes of mortality due to poisoning profoundly affects making decisions and improving standards for preventing adverse events. Therefore, to better understand this problem and evaluate the causes, this study aimed to determine the risk of suicide using the SAD PERSONS Scale (SPS) criteria and its relationship with the birth month in poisoned patients.

This cross-sectional descriptive-analytic study was conducted on poisoned patients admitted to Khorshid Hospital in Isfahan City, Iran, in 2018. First, the patients’ age, gender, and birth month were recorded. Then, their suicide risk was assessed by SPS.

From 2735 referred patients with poisoning, 1839 (67.2%) attempted suicide, and 896(32.8%) cases were poisoned. The Mean±SD SPS score in patients with suicidal attempts was 4.89±1.94, and in the poisoned patients was equal to 2.74±1.46 (P<0.001). There was no significant relationship between suicide and birth month; however, gender (male), age, depression, previous suicidal attempts, ethanol abuse, rational thinking loss, social support lacking, and being unmarried significantly increased the risk of suicide (P<0.01). In addition, the SPS scores ≥5 with a sensitivity of 43.77%, and specificity of 98.44% had an acceptable diagnostic value in identifying the risk of suicide (P<0.0001).

As SPS criteria have an appropriate diagnostic value for suicide prediction, it is recommended that these criteria be assessed among individuals with susceptible suicide characteristics (e.g. males, elders, depression, the lack of social support, etc.), to prevent future suicide attempts and appropriate medical-psychological measures.

Radial head subluxation (RHS) is a common disorder in children. Although it is not accompanied by any important short- or long-term sequel, it could make the parents worried about.
The purpose of this study was to determine the possible effective factors that may influence time to use the affected limb. This cross-sectional study was conducted prospectively during the years 2014 to 2016. All children under the age of 6 years who visited the emergency department (ED) and were diagnosed as having RHS were eligible. The patients’ baseline information was recorded. After the reduction, the time until the affected arm use returned was recorded. The possible relationship between the baseline data and time to re-use the affected limb was assessed.
During the study period, 112 children with a mean age of 30.18 ± 18.18 months were evaluated (53% male). Among the children who visited the ED during the first 4 hours and thereafter, 84% and 60%, respectively, re-used their limb in less than 10 minutes after reduction (p = 0.004). Also, 55% of children less than or equal to 24 months and 89% over the age of 24 months re-used the arm in 10 minutes (p It is likely that age less than or equal to 24 months and ED visit after 4 hours of the event lead to a longer duration for re-using the affected arm following reduction.

We aimed to provide an epidemiological description of radius head dislocation, effective factors in treatment and relapse.
This cross-sectional prospective study was done using census method on all patients with 7 years of age and younger with radius head dislocation, who were admitted to the emergency department of Kashani hospital, Isfahan City, Iran, between January 1, 2014, and December 31, 2015. Required data were gathered using a checklist consisting of questions regarding demographic data (age and sex), weight, trauma mechanism, affected arm, success rate of reduction maneuver, and the time of using the affected arm after reduction.
Findings: During a 24-month period, 112 children with a mean age of 30.98 ± 13.18 months entered the study. 59 patients were boys (53%), and the left arm was affected in 67 cases (60%). Most of the patients with recurrence were over the 75th percentile for weight, and 18.75% of them had recurrence. The success rate of initial reduction maneuver was significantly less in patients with recurrence (P There was a significant relationship between overweight and recurrence of radius head dislocation. Recurrence had effect on the success rate of initial reduction maneuver. A delay of more than 24 hours was significantly associated with failure of initial reduction maneuver. Age had a relative risk for one or more recurrences.

The aim of this study was to use ultrasonography for the diagnosis and confirmation of Pulled Elbow treatment.
This descriptive cross-sectional study initiated in 2014 and continued until 2015. We used simple sampling method and recruited 60 samples among patients aged 4 months to 6 years. The apparatus used in this study was an ultrasonogram with transducer 12 MHz probe. Ultrasound evaluation of both hands was undertaken and after reduction, the physical examination was performed to confirm the diagnosis made by ultrasonography. Then, the results were recorded by a physician in a checklist and entered into SPSS software (version 20) for further analysis.
In this study, 60 children with pulled elbow injuries were studied. Of these, 27 patients (45%) were girls (female) and 33 (55%) were boys (male). This indicates the higher incidence of injury among males than females. The highest incidence of pulled elbow injury was observed in children aged 3 (15%). The accuracy of ultrasonography method for the confirmation of treatment was reported to be 92%.
This study aimed to confirm the considered therapeutic method based on the result of ultrasonography performed after the treatment. Accordingly, the sensitivity and specificity of ultrasonography in confirming the considered therapeutic method for the treatment of pulled elbow was obtained higher than 90%.

After the introduction of surfactant, the survival rate of preterm neonates has increased significantly. This issue attracted much attention towards this fragile population. Many studies have demonstrated that massage plays a role in the weight gain of preterm infants. This study compares the effect of massage therapy on infants who were massaged by a nurse or their mother with those who did not receive massage therapy at all. This randomized clinical trial was conducted on three groups:(1) The infants who only received routine care and no massage,(2) Those who received massage by an expert nurse and (3) Those who received massage by their mothers. We recorded daily weight gain, the length of hospital stay and fluid intake of infants. Kruskal Wallis test and SPSS software were used for statistical analysis. The gestational age of infants ranged between 28 to 34 weeks. At the end of the fifth day the group massaged by a nurse had significantly more weight gain compared to the other two groups (6.5+1.5 in the nurse group, +4.6 1 in the mother group and +3.7 1.5 in the control group, p-value = 0.001). Those who were massaged by their mothers also gained weight significantly more than the control group (P-value=0.05). There was no significant difference in the length of hospital stay among the understudy groups. Our study showed that the five-day massage therapy is a safe technique mothers can perform for stable preterm infants to facilitate weight gain in neonate.