Bulletin of Emergency And Trauma
Volume:1 Issue: 4, Oct 2013

To explain an important aspect of violence, the spatiotemporal pattern of trauma in victims of violence visited in emergency room of Rajaei hospital, Shiraz, Iran This cross-sectional prospective study comprised 109 randomly selected victims of violence visited in emergency room of Rajaei hospital, a tertiary referral hospital affiliated to Shiraz University of Medical Sciences in winter 2013. We recorded the demographic information as well as data regarding the type and time of the injuries. The data collected for each victim was then entered in a data gathering form. The study included 88% males with mean age 27.8 ± 8.8 years, which encompassed more than 60% young adults. Our study showed a temporal pattern with triple peaks. Moreover, 64% of assault trauma occurred at night. Furthermore, our study showed the majority of our patients suffered from stab wounds and about 57% of patients studied lacked high school diploma. Moreover it was revealed that violence was more common in downtown Shiraz, especially in the Fifth city district with simultaneous presence of many risk factors for violence. The result of this study showed that age, gender, educational status and temporal peak of violence were shown to be similar to other investigations conducted in other countries. Despite these similarities, stabbing were more prevalent in our study. Additionally, the Fifth city district of Shiraz seems to be the main city district where preventive intervention is needed to reduce violence- related injuries.

To determine the diagnostic accuracy of magnetic resonance angiography (MRA) compared to intra-arterial digital subtraction angiography (DSA) in detection of intracranial aneurysms in those suffering from acute subarachnoid hemorrhage (SAH). This observational diagnostic study was performed at a tertiary teaching hospital and reference center in Shiraz, Iran. We included 55 patients who presented to our center with the diagnosis of acute SAH. All the patients underwent MRA and DSA during their hospital course in order to detect the intracranial aneurysms. The time-of-flight MRA protocol was used and the results were compared to the results of DSA as the gold standard test. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for MRA. The mean age of the patients was 46.3 ± 7.9 including 26 (47.3%%) men and 29 (52.7%) women. In 46 patients, 51 intracranial aneurysms were diagnosed by DSA (5 patients had two aneurysms). No evidence of intracranial aneurysm was found in 9 patients with subarachnoid hemorrhage. MRA correctly identified 42 of the 51 aneurysms (sensitivity 82%) and missed 9 small aneurysms (less than 10 mm). MRA revealed one false- positive finding, resulting in a specificity of 88.8%. The PPC and NPV for MRA were 97% and 47%, respectively. The diagnostic accuracy per aneurysm was 0.83 for MRA. High sensitivity and specificity of MRA compared to DSA in diagnosis of intracranial aneurysms in those with acute SAH indicate that MRA could be reliably used as a diagnostic tool for this purpose. However we cannot recommend it as a routine substitute for DSA before surgery.

To determine the effects of Meperidine (Pethedine®) on pain intensity, clinical findings, final diagnosis and management of patients with acute abdominal pain. This was a randomized clinical trial including 100 patients, with lower abdominal pain lasting for less than 48 hours who were referred to the emergency department of Imam Khomeini hospital affiliated with Ilam University of Medical Sciences, over a period of 11 months. Hemodynamically unstable patients were not included in the study. The baseline pain severity was measured using a visual analogue scale (VAS). Patients were randomly assigned to receive 25 mg of intramuscular Meperidine (Pethedine®) (n=50) or 5 mL of intravenous normal saline as placebo intravenously (n=50). After 1-hour the patients were then re-examined and the pain severity was re-assessed and the clinical diagnosis was recorded. There was no significant difference between two study groups regarding the baseline characteristics. The mean pain score on arrival was comparable between groups (6.80 ± 1.6 vs. 6.81 ± 1.2; p=0.956). The abdominal tenderness was not affected in Meperidine group. Rebound tenderness disappeared in 4% of the Meperidine group and in 2% of the placebo group. Nausea was decreased in 14% of the Meperidine group and 32% of the placebo group. Changes in the clinical pattern and diagnostic peritoneal signs in patients were negligible and did not significantly interfere with the diagnosis (p=0.133). Diagnostic accuracy was 96% in the Meperidine group and 98% in placebo group, which was not significantly different (p=0.554). Administration of Meperidine reduces pain intensity in patients with acute abdominal pain without interference with the clinical diagnosis. Thus analgesics could be safely administered to the patients with acute abdominal pain for increasing the patients comfort.

To evaluate the accuracy of sonography in diagnosing acute appendicitis in patients with Alvarado score 4–7. This is a retrospective cross-sectional study being performed in Namazee hospital affiliated with Shiraz University of Medical sciences during a one year period from 9/2007 to 9/2008. We evaluated all patients with Alvarado score 4-7 and divided them in two groups: those with Ultrasound study prior to surgery and those without any imaging modalities for diagnosis of AA. The demographic information, histopathology, physical examination, laboratory data, sonography report and histopathological reports of patients were gathered. A total of 238 patients had Alvarado scores 4-7 including 160 males and 78 females. 110 patients did not have any imaging and 128 had undergone sonography before operation. Ultrasound had overall sensitivity of 75 %, specificity 69.2 %, PPV 88 %, NPV 46.1% and accuracy of 73.6 %. Negative appendectomy rate was 20.9 % and 23.4 % in those without sonography and inpatients with sonography respectively, with a higher rate in females. Ultrasound is more useful when the patient is female and the result of sonography is positive; however, it is not reliable when the result is negative and maybe other diagnostic modalities such as CT scan can help us in better diagnosis of Acute Appendicitis.

To determine the prevalence and predisposing factors of mucormycosis in patients with diabetes mellitus (DM) in a Shiraz referral centers. This retrospective case control study, reviewed the medical records of 162 patients with pathologically confirmed diagnosis of mucormycosis hospitalized in two major Shiraz University hospitals during the last 21 years. For each diabetic patient, two patients with diabetic ketoacidosis (DKA) matched for age, sex and the date of admission was selected as control group. Age, type of diabetes mellitus (DM) and duration of involvement as well as paraclinical findings were compared between cases and controls. There were 162 patients with murormycosis of which 30 (18.5%) had DM as predisposing factor. Diabetes was the second common predisposing disease next to leukemia. There were 19 (63.3%) women and 11 (36.7%) men among the patients. The overall mortality rate was 53.33% mortality rate. The mean age of the patients was 45.3 ± 17.6 years. The mean duration of diabetes in case and control groups were 5.75 ± 5.43 and 7.2 ± 7.85 years respectively, without any statistical significance between them (p=0.063). Blood sugar in patients was lower than control group (p=0.012). Serum bicarbonate level in case group was higher than in control group (p<0.001). Arterial pH in control group was more acidic than case group (p<0.001). Insulin dependent DM was significantly more prevalent in control group compared to case group (73.4% vs. 36.6%; p=0.002). Our study showed that the number of hospitalized patients with mucormycosis over the last 7 years has been decreased which is due to better control of infection in diabetics. In addition to hyperglycemia and acidosis, several other unknown factors like immune defects may predispose diabetics to this fungal infection.

To describe the clinical characteristics, presentation and management of Pardah pin inhalation in female teenagers of single center in northern India. This was a prospective cross-sectional study being performed in department of cardiovascular and thoracic surgery of Sher-i-Kashmir institute of medical sciences located in northern India from January 2009 to December 2012. We included 36 female patients with Pardah pin inhalation who were admitted to our center during the study period. All patients underwent rigid bronchoscopy under local or general anesthesia. We recorded the baseline characteristics including the demographic information, the site of the pin and clinical findings as well as the management strategies and the outcome of these patients. All patients were female using scarf to wrap their head and neck as religious obligation. Mean age of the patients was 14.3 ± 3.6 years. The most common symptom was chocking followed by cough being reported in all (100%) and 31 (86.1%) patients respectively. Bronchoscopy was successful in removing the pin in 31 (86.1%) patients. Pins were located in right main bronchus in 20 (55.5%) patients, and in left main bronchus in 10 (27.7%) patients. There was no mortality in our series. Pin was removed in 31 (86.1%) patients with the help of bronchoscope, but 5 (13.9%) patients needed bronchotomy for removal of the pin. Average hospital stay was 12.43 ± 1.6 hours. Rigid bronchoscopy is an ideal approach in management of Pardah pin inhalation. However some patients may need bronchotomy to remove the Pardah pin.

This is a case series which report the clinical results of decompressive craniectomy in 4 patients with dilated pupils secondary to traumatic brain injury and postoperative edema. Between 2011 and 2012, four patients, 3 males and 1 female, aged between 35 and 64 with mean age of 50.1 ± 8.9 years, underwent decompressive craniectomy due to brain traumatic edema. The follow up period ranged between 1 to 6 months. All patients had Glasgow coma score (GCS) of 3-4 at admission, and the duration of pupils being mydriatic was less than 20 minutes before the operation. All patients had moderate disability with GCS of 4 after the operation. Decompressive craniectomy can be a life-saving procedure which provides a better outcome in patients with dilated pupils secondary to brain trauma injury and postoperative edema with timing of less than 20 minutes. However, the small number of the patients in this study is the main limitation to the accuracy of the results, and more studies with larger number of patients are warranted to evaluate the efficiency of decompressive craniectomy in patients with dilated pupils.

Cystic disease of the spleen is not frequently encountered in surgical practice. It is broadly classified as parasitic and non-parasitic, the latter being a rare entity. In this case report, an epidermoid cyst of spleen led to acute abdomen in young age pregnant woman is presented.A 26-year-old woman with 15 weeks gestational age second pregnancy referred to emergency ward with left upper quadrant pain and tenderness that ultra sonography revealed large cyst (100х110mm) with internal echo in spleen in favor of hydatic cyst or abscess. The patient was managed medically for one week but developed her abdominal pain, epigastric fullness, anorexia and fever. New sonography was done for her and large cyst was detected in spleen (120х110mm). She had severe pain accompanied with anorexia and vomiting. Fetus was normal in sonography. Exploratory laprotomy with splenectomy was performed. Splenomegaly (200х130х90mm) with a cyst without any adhesion and inflammation was detected. Histopathology examination showed epidermoid cyst of spleen. (140х10х90mm). Though splenic epidermoid cyst is an uncommon entity, it should be considered in the differential diagnosis of an abdominal mass in a young individual. An attempt should be made to preserve the spleen provided there is adequate parenchyma otherwise splenectomy is the rule.

The co-existence of acquired immune deficiency syndrome (AIDS) and tuberculosis is a major cause of morbidity and mortality because of a widespread organ involvement. The gastrointestinal tract is a common site for localization of opportunistic microorganisms in AIDS. However, surgical abdominal emergencies such as intestinal perforation resulted from tuberculosis are uncommon in these patients. The asymptomatic occurrence of such intestinal perforation has not been reported our knowledge. We represent an HIV and HCV co-infected man with miliary tuberculosis and an incidentally detected free air under diaphragm in the chest X-ray eventually resulting in exploratory laparotomy which then revealed two tubercular-induced intestinal perforations. It seems that as the tuberculosis is increasing in incidence, mostly due to reactivation in HIV-infected patients especially in developing countries, we should not underestimate its acute abdominal emergencies such as bowel perforation.