فهرست مطالب

  • Volume:6 Issue: 2, 2018
  • تاریخ انتشار: 1397/01/28
  • تعداد عناوین: 15
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  • Mohamed H. Elshahidi, Nada Y. Monir, Mohamed A. Elzhery, Ahmed A. Sharaqi, Hames Haedaya, Basem I. Awad, Khaled Zaghloul Pages 75-89
    Objective
    To systematically search the literature and to summarize current evidence pertaining to the epidemiology of SCI in the MENA region incidence, gender, age, type of the injury and etiology of the injury.
    Methods
    Embase, PubMed, Scopus, Web of Science and EBSCOhost were systematically searched from their dates of inception till July 2017 for English and non-English language articles. Also, regional databases were searched. Data were extracted from eligible articles and pooled under the random effect model using R. References of the included articles were also screened for potentially relevant studies.
    Results
    We identified 29 articles from seven countries in the MENA region (Turkey, Iran, Saudi Arabia, Egypt, Jordan, Kuwait and Qatar). The mean age of the cases at time of injury was 31.32 (95% CI: 28.74-33.91). The random pooled annual incidence of TSCI per million was 23.24 (95% CI: 5.64-49.21). Pooled proportion of male gender was 77% (95% CI 73-80%) of the cases. Complete paraplegia was the most common type of injury. Thoracic level injury predominated. Also, the most commonly affected age group was 20-29 then 30-39. Motor vehicle accidents were found to be the leading cause of injury, then falls, gunshot, violence and sports. Further meta-regression analysis showed no association between age and etiology of the injury.
    Conclusion
    This review shows lack of evidence about SCI in most countries of the MENA region. More epidemiological studies are needed.
    Keywords: Spinal cord injury, Epidemiology, Incidence, Middle-East, North-Africa, Etiology, SCI
  • Saber Azami-Aghdash, Homayoun Sadeghi-Bazarghani, Mahdiyeh Heydari, Ramin Rezapour, Naser Derakhshani Pages 90-99
    Objective
    To review the effectiveness of Road Traffic Injuries (RTIs) interventions implemented for prevention of RTIs in Iran and to introduce some methodological issues.
    Methods
    Required data in this systematic review study were collected through searching the following key words: "Road Traffic Injuries", "Road Traffic accidents", "Road Traffic crashes", “prevention”, and Iran in PubMed, Cochrane Library electronic databases, Google Scholar, Scopus, MagIran, SID and IranMedex. Some of the relevant journals and web sites searched manually. Reference lists of the selected articles were also checked. Gray literature search and expert contact was also conducted.
    Results
    Out of 569 retrieved articles, finally 8 articles included. Among the included studies the effectiveness of 10 interventions were assessed containing: seat belt, enforcements of laws and legislations, educational program, wearing helmet, Antilock Braking System (ABS), motorcyclist's penalty enforcement, pupil liaisons’ education, provisional driver licensing, Road bumps and traffic improvement's plans. In 7 studies (9 interventions) reduction of RTIs rate were reported. Decreased rate of mortality from RTIs were reported in three studies. Only one study had mentioned financial issue (Anti-lock Brake System intervention). Inadequate data sources, inappropriate selection of statistical index and not mention about the control of Confounding Variables (CV), the most common methodological issues were.
    Conclusion
    The results of most interventional studies conducted in Iran supported the effect of the interventions on reduction of RTIs. However due to some methodological or reporting shortcoming the results of these studies should be interpreted cautiously.
    Keywords: Effectiveness, Interventions, Prevention, Road traffic injuries, Methodological issues
  • Hassan Mashbari, Mohannad Hemdi, Kevin L. Chow, James C. Doherty, Gary J. Merlotti, Steven L. Salzman, Eduardo Smith Singares Pages 100-107
    Objective
    To determine the optimal volume of abdominal irrigation that will prevent surgical site infections (both deep and superficial), eviscerations and fistula formations; and improve 30-day mortality in trauma patients.
    Methods
    We conducted a three-arm parallel clinical superiority randomized controlled trial comparing different volumes of effluent (5, 10 and 20 liters) used in trauma patients (both blunt and penetrating) age 14 and above undergoing an emergency laparotomy between April 2002 and July 2004 in a busy urban Level 1 trauma center.
    Results
    After randomization, a total of 204 patients were analyzed. All patient groups were comparable with respect to age, gender distribution, admission injury severity score, and mechanism of injury, estimated blood loss and degree of contamination. The mortality rate overall was 1.96% (4/204).No differences were noted with respect to contamination, wound infection, fistula formation, and evisceration. The twenty liter group (Group III) showed a trend toward an increased incidence of deep surgical site infections when compared to the five liter (Group I) (p=0.051) and ten liter (Group II) (p=0.057) groups. This did not however reach statistical significance.
    Conclusion
    The old surgical adage “the solution to pollution is dilution” is not applicable to trauma patients. Our results suggest that using more irrigation, even when large amounts of contamination have occurred, does not reduce post-operative complications or affect mortality; and it may predispose patients to increased incidence of abscess formation.
    Keywords: Intra-abdominal irrigation, Intra-abdominal abscess, Sepsis, Randomized clinical trial, Peritoneal lavage
  • Rahim Mohammadi, Dana Anousheh, Mohammad-Hazhir Alaei, Amin Nikpasand, Hawdam Rostami, Rasoul Shahrooz Pages 108-114
    Objective
    To determine the effects of bone marrow derived mast cells (BMMCs) on functional recovery of transected sciatic nerve in animal model of cat.
    Method
    A 20-mm sciatic nerve defect was bridged using a silicone nerve guide filled with BMMCs in BMMC group. In Sham-surgery group (SHAM), the sciatic nerve was only exposed and manipulated. In control group (SILOCONE) the gap was repaired with a silicone nerve guide and both ends were sealed using sterile Vaseline to avoid leakage and the nerve guide was filled with 100 μL of phosphate-buffered saline alone. In cell treated group ([SILOCONE/BMMC) the nerve guide was filled with 100 μL BMMCs (2× 106 cells/100 μL). The regenerated nerve fibers were studied, biomechanically, histologically and immunohiscochemically 6 months later.
    Results
    Biomechanical studies confirmed faster recovery of regenerated axons in BMMCs transplanted animals compared to control group (p
    Conclusion
    BMMCs xenotransplantation could be considered as a readily accessible source of cells that could improve recovery of transected sciatic nerve.
    Keywords: Sciatic nerve, Mast cells, Biomechanical properties, Cats
  • Mojtaba Karimipour, Sara Shojaei Zarghani, Majid Mohajer Milani, Hamid Soraya Pages 115-121
    Objective
    To explore the effects of pre versus post ischemic treatment with metformin after global cerebral ischemia in rats.
    Methods
    Male Wister rats underwent forebrain ischemia by bilateral common carotid artery occlusion for 17 min. Metformin (200 mg/kg) or vehicle was given orally by gavage for 7-14 days. Rats were divided into: control, metformin pre-treatment, metformin post-treatment and metformin pre and post continuous treatment groups. Cerebral infarct size, histopathology, myeloperoxidase and serum malondialdehyde were measured 7 days after ischemia.
    Results
    Histopathological analysis showed that metformin pre-treatment significantly decreased leukocyte infiltration, myeloperoxidase activity and also malondialdehyde level. Metformin pre-treatment and metformin post-treatment reduced infarct size compared with the control group, but it was not significant in the pre and post continuous treatment group.
    Conclusion
    Our findings suggest that pre-treatment with metformin in comparison with post-treatment in experimental stroke can reduce the extent of brain damage and is more neuroprotective at least in part by inhibiting oxidative stress and inflammation.
    Keywords: Global cerebral ischemia, Metformin, Oxidative stress, Inflammation
  • Somaye Bazdar, Maryam Dehghankhalili, Shekoofeh Yaghmaei, Maryam Azadegan, Amirhossein Pourdavood, Mohammad Hadi Niakan, Ali Mohammad Bananzadeh Pages 122-127
    Objective
    To determine the effects of pregnancy on the presentation, management, surgical and obstetrics outcome of patients with acute appendicitis.
    Methods
    This prospective cohort study was conducted during a 2-year period from 2014 to 2016 in Shahid Faghihi hospital of Shiraz University of Medical Sciences. We enrolled all the pregnant individuals with acute appendicitis who required surgical appendectomy. We also enrolled age-matched controls of non-pregnant women undergoing open appendectomy during the study period. The presentation, clinical and laboratory characteristics, surgical and obstetrics outcomes were determined in both study groups and were further compared between them. In order to determine the determinants of outcome, we also ran a multivariate logistic regression model.
    Results
    Overall we included a total number of 584 patients with presumed appendicitis among whom there were 58 (9.94%) and 526 (90.06%) non-pregnant individuals. The pregnant patients had significantly longer duration of symptoms (p=0.038), lower temperature (p=0.026), longer duration of hospital stay (p=0.026) and higher rate of hospital admission longer than 2 days (p=0.031). The complications of the surgical procedure were comparable between the two study groups except for the pneumonia which was significantly higher in pregnant patient (p=0.041). After adjusting for confounders such as age and ethnicity, pregnancy remained significantly associated with lower temperature (p=0.018), longer symptom duration (p=0.042) and higher rate of pneumonia (p=0.049).
    Conclusion
    Acute appendicitis during the pregnancy was associated with longer duration of symptoms, lower body temperature and higher rate of pneumonia. The pregnancy and neonatal outcomes were comparable to the previously reported data.
    Keywords: Acute Appendicitis, Pregnancy, Open Appendectomy, Outcome
  • Pages 128-132
    Objective
    To investigate the clinical, imaging and laboratory findings for diagnosis of acute appendicitis (AA) in patients with a normal white blood cell count (WBCC).
    Methods
    This retrospective cross-sectional study was conducted in Ankara Numune Training and Research Hospital, Ankara, Turkey, during a 1-year period. To determine diagnostic factors in AA in patients with normal WBCC, medical records of eligible patients were reviewed for demographic and clinical variables, as well as patient outcome.
    Results
    A total of 105 patients that had undergone appendectomy and were found to have a normal WBCC were included in the study. Of these patients, 53 (50.5%) were men and 52 (49.5%) were women. The mean age of the patients was 34.2±12.3 (min 14, max 78). The negative exploration rate was identified as 19%. In the multivariate analysis, only the diameter of appendix was statistically significant (p=0.002). ROC analysis revealed the cut off appendiceal diameter as 8 mm.
    Conclusion
    In patients suspected of AA due to ≥8 mm appendiceal diameter determined by imaging, we recommend surgical treatment even if WBCC and neutrophil count are normal.
    Keywords: Acute appendicitis, White blood cell count, Diagnosis, Appendix diameter
  • Abdolkarim Rahmanian, Nima Derakhshan, Alireza Mohsenian Sisakht, Najme Karamzade Ziarati, Hadi Raeisi Shahraki, Soheil Motamed Pages 133-140
    Objectives
    To evaluate the odds for unfavorable outcome of each risk factor and a combination of them in patients with aneurysmal subarachnoid hemorrhage (SAH) undergoing surgical clipping in Southern Iran
    Methods
    A total of 367 patients who were operated between March 2007 and March 2016 due to aneurysmal SAH were analyzed according to patients’ factors, aneurysm characteristics and intra-operative data. Correlation between outcomes of patients measured by modified Rankin Scale at 6-months with each factor were analyzed. Market Basket analysis was also used to identify the odds of unfavorable outcome for combinations of factors.
    Results
    A total of 367 patients, including 199 females and 168 males with a mean age of 47.27± 11.53 years, who underwent operation between March 2007 and March 2016 due to aneurysmal SAH were analyzed. Unlike gender, higher age was associated with unfavorable outcome. Ischemic heart disease, Duration of operation and amount of bleeding were also found to increase the odds of unfavorable outcome (p=0.01, 0.02, 0.04 respectively). DM, Cigarette smoking and opium addiction as well as the location and multiplicity of aneurysms did not have an adverse effect on outcome. (p≥0.05)
    Conclusion
    Among the numerous risk factors presumed to result in unfavorable outcome in aneurysmal SAH, only older age, duration of operation more than 60 minutes, previous known history of ischemic heart disease, poorer clinical grade and intra-operative bleeding more than 500 mL were found to be significant factors.
    Keywords: Cerebral aneurysm, Risk factors, Market basket analysis, Outcome
  • Amir Nik, Mohammad Sobhan Sheikh Andalibi, Mohammad Reza Ehsaei, Ahmadreza Zarifian, Ehsan Ghayour Karimiani, Gholamreza Bahadoorkhan Pages 141-145
    Objective
    To compare the efficacy and functional outcome of Glasgow Coma Scale (GCS) score with that of Acute Physiology and Chronic Health Evaluation Score II (APACHE II) in patients with multiple trauma admitted to the ICU.
    Methods
    This cross-sectional study included 125 patients with traumatic brain injury associated with systemic trauma admitted to the ICU of Shahid Kamyab Hospital, Mashhad, between September 2015 and December 2016. On the day of admission, data were collected from each patient to calculate GCS and APACHE II scores. Sensitivity, specificity, and correct outcome prediction was compared between GCS and APACHE II.
    Results
    Positive predictive value (PPV) at the cut-off points was higher in APACHE II (80.6%) compared with GCS (69.2%). However, negative predictive value (NPV) of GCS was slightly higher in comparison with APACHE II. Moreover, the area under the receiver operating characteristic (ROC) curve for sensitivity and specificity of GCS and APACHE II showed no significant difference (0.81±0.04 vs. 0.83±0.04; p=0.278 respectively).
    Conclusion
    Our study suggested that there was no considerable difference between GCS and APACHE II scores for predicting mortality in head injury patients. Both scales showed acceptable PPV, while APACHE II showed better results. However, the utilization of GCS in the initial assessment is recommended over APACHE II as the former provides higher time- and cost-efficiency.
    Keywords: Head trauma, GCS, APACHE II, Mortality
  • Homayoun Sadeghi-Bazargani, Bahram Samadirad, Nasrin Shahedifar, Mina Golestani Pages 146-154
    Objective
    To study the epidemiology of car user road traffic fatalities (CURTFs) during eight years, in East Azerbaijan, Iran.
    Methods
    A total of 3051 CURTFs registered in East Azerbaijan forensic medicine organization database, Iran, during 2006-2014, were analyzed using Stata 13 statistical software package. Descriptive statistics (p
    Results
    Of the 7818 road traffic injury (RTI) deaths, 3051 (39%) were car users of whom 71% were male (mean age of 36.7±18.5 years). The majority of accident mechanisms were vehicle-vehicle crashes (63.95%), followed by rollover (26.24%). Crash causing vehicle fall increased the pre-hospital death likelihood by 2.34 times. The prominent trauma causing death was head trauma (in 62.5%). In assessing the role of type of counterpart vehicle on pre-hospital mortality, considering the other cars to be the reference group for comparison, deceased victims were 1.83 times more likely to die before hospital when the counterpart vehicle was a truck and 1.66 times more for buses.
    Conclusion
    Decreasing the car users’ fatalities using appropriate strategies such as separating the roads for heavy and light vehicles and improving the injury related facilitation may be effective. Male drivers with low education could be prioritized for being trained.
    Keywords: Car Users, Injury, Mortality, Road traffic accidents, Epidemiology
  • Abbas Rasouli, Seyed Mojtaba Hosseini, Mohammad Karim Bahadori, Ramin Ravangard Pages 155-161
    Objective
    To prioritize occupational hazards in a Pharmaceutical Company in Iran using the analytical hierarchy process (AHP).
    Methods
    This was a cross-sectional study conducted in a Pharmaceutical Company in Iran in 2017. All employees working in the administrative, production, installations and facilities, and laboratory units were studied using the consensus method (N=n=130 employees). A data collection form was designed for identifying the hazards using the Nominal Group Technique (NGT) method, as well as a pair-wise questionnaire was used for collecting required data in the quantitative phase. The collected data were analyzed using Expert Choice 10.0 and SPSS 23.0.
    Results
    The results showed that among hazards detected in the studied units, the highest and lowest weights and priorities were, respectively, related to "inhalation of toxic gases" (W=0.253) and “being exposed to radiation” (W=0.022) in the laboratory unit, "skin injuries" (W=0.205) and “bending and straightening for a long time” (W= 0.032) in the production unit, "falling down" (W=0.271) and “standing and sitting for a long time “ (W=0.037) in the installations and facilities unit, and "hand joint failure" (W=0.295) and “working in a low-light environment” (W=0.092) in the administrative unit.
    Conclusion
    The results of the present study showed that there were hazards in all of the studied units. These results indicated a high level of hazards in the pharmaceutical company’s units. Due to the increased medication diversification and increased workload for these companies, paying attention to the preventive and corrective measures in order to reduce the risk of emerging hazards is essential.
    Keywords: Occupational hazards, Safety, Pharmaceutical company, Analytical Hierarchy Process (AHP), Iran
  • Tanja Pekez-Pavlisko, Maja Racic, Drinka JuriŠ, IĆ Pages 162-168
    Objective
    To explore family physicians’ attitudes, previous experience and self-assessed preparedness to respond or to assist in mass casualty incidents in Croatia.
    Methods
    The cross-sectional survey was carried out during January 2017. Study participants were recruited through a Facebook group that brings together family physicians from Croatia. They were asked to complete the questionnaire, which was distributed via google.docs. Knowledge and attitudes toward disaster preparedness were evaluated by 18 questions. Analysis of variance, Student t test and Kruskal-Wallis test t were used for statistical analysis.
    Results
    Risk awareness of disasters was high among respondents (M = 4.89, SD=0.450). Only 16.4 of respondents have participated in the management of disaster at the scene. The majority (73.8%) of physicians have not been participating in any educational activity dealing with disaster over the past two years. Family physicians believed they are not well prepared to participate in national (M = 3.02, SD=0.856) and local community emergency response system for disaster (M = 3.16, SD=1.119). Male physicians scored higher preparedness to participate in national emergency response system for disaster (p=0.012), to carry out accepted triage principles used in the disaster situation (p=0.003) and recognize differences in health assessments indicating potential exposure to specific agents (p=0,001) compared to their female colleagues.
    Conclusion
    Croatian primary healthcare system attracts many young physicians, who can be an important part of disaster and emergency management. However, the lack of experience despite a high motivation indicates a need for inclusion of disaster medicine training during undergraduate studies and annual educational activities.
    Keywords: Family physicians, Disaster, Attitude, Mass casualty, Knowledge, Disaster response
  • Avulsion of Ampulla of Vater Secondary to a Blunt Abdominal Injury Treated with Pancreatoduodenectomy; A Case Report and Literature Review
    Mustafa Ozsoy, Ogun Ersen, Zehra Ozsoy, Sezgin Yilmaz, YÜksel Ari, Kan Pages 169-173
    The incidence of complex hepatobiliary injury secondary to blunt abdominal injuries varies between 3.4 and 5%. A 25-year old male patient underwent an urgent operation due to a motorcycle accident. During intraabdominal exploration, Grade 4 laceration was detected at the liver and bleeding was controlled through primary repair. In the postoperative seventh day, he was referred due to 1500 cc bile leakage from the drainage tube. During the operation, an extensive Kocher maneuver was done and the second part of duodenum was observed to be exposed to total avulsion from the head of the pancreas. Pancreatoduodenectomy was planned due to presence of ischemic changes in the second part of duodenum. In the postoperative follow-up, the abdomen was closed with a controlled abdominal closure procedure. The clinical findings of biliary tract injuries secondary to blunt abdominal injuries often manifest themselves late and early diagnosis is possible only with suspicion.
    Keywords: Ampulla vater, Blunt abdominal trauma, Duodenal trauma, Avulsion
  • Delayed Progressive Intraparenchymal Tension Pneumocephalus after Craniotomy for Recurrent Pituitary Macroadenoma: A Case Report
    Samer S. Hoz, Khatab Baban, Mohammad Sabah, Awfa Aktham, Alexis Rafael Narvaez-Rojas, Luis Rafael Moscote-Salazar Pages 174-177
    Pneumocephalus is defined as the presence of air in the intracranial cavity. In most cases, its evolution is asymptomatic and benign. Pneumocephalus post-surgery is a frequent complication of cranial surgery. We herein report delayed tension pneumocephalus after craniotomy for pituitary macroadenoma. A 73-year-old man with recurrent pituitary macroadenoma underwent subtotal resection via subfrontal approach. The postoperative course was uneventful and the patients regained his normal daily living activities. Two months after the surgery the patients developed decreased level of consciousness and was diagnosed to suffer from tension pneumocephalus. Another craniotomy was performed and the dural defect at the base was repair with secondary graft and bone wax. The patient improved neurologically and had no pneumocephalus. The follow-up revealed good condition and outcome. In conclusion, tension pneumocephalus can occur at any time after craniotomy and post-surgical deterioration after resection of a giant pituitary tumor should be immediately assessed. There is not enough evidence to correlated tumor size with rates of pneumocephalus in this particular report, but further cases may need to be studied to come to a conclusion.
    Keywords: Tension pneumocephalus, Craniotomy, Pituitary adenoma
  • An Unforeseeable Complication; Posterior Ischemic Optic Neuropathy after Penetrating Injury to the Heart
    Joseph J. Eid, Brian C. Cronin, Susan Seman Pages 178-180
    Trauma surgeons are currently encountering unusual adverse events after traumatic injuries. Ischemic optic neuropathy is a rare complication that may occur in trauma and burn patients that present in extremis and require massive resuscitation. A 29-year-old male patient sustains a penetrating injury to the heart that required primary repair. He remained hemodynamically stable and required a limited amount of resuscitative fluids and products. Postoperatively, the patient develops acute painless bilateral loss of vision. These findings were consistent with posterior ischemic optic neuropathy. Ischemic optic neuropathy are uncommon entities that arise in trauma patients who require massive resuscitation. Given the limited treatment options, early diagnosis is key in limiting the hemodynamic insult to the optic nerve.
    Keywords: Ischemic optic neuropathy, Posterior ischemic optic neuropathy penetrating wound, Postoperative complication