ORIGINAL_ARTICLE
Effect of cervical collars on intracranial pressure in patients with head neurotrauma
Trauma patients are at high risk of cervical and associated injuries. The standard protocol includes immobilization of the cervical spine in a polytrauma as it will help to prevent spinal injuries in the prehospital settings. Hard cervical collar (or alternatives) is routinely used until the cervical spine clearance is obtained . In patients with traumatic brain injury avoiding any kind of maneuver may lead to increased intracranial pressure.
http://www.jept.ir/article_45959_7f8cfb5dfa08078d097be7201f804d69.pdf
2018-01-01
1
2
10.15171/jept.2017.03
Cervical collars
Intracranial pressure
Head neurotrauma
Luis Rafael
Moscote-Salazar
1
1Neurosurgeon-Critical Care, RED LATINO. Latin American Trauma & Intensive Neuro-Care Organization, Bogota, Colombia
LEAD_AUTHOR
Daniel A.
Godoy
2
Unidad de Cuidados Neurointensivos, Sanatorio Pasteur y Unidad de Terapia Intensiva, Hospital San Juan Bautista, Catamarca, Argentina
AUTHOR
Amit
Agrawal
dramitagrawal@gmail.com
3
Department of Neurosurgery, Narayna Medical College Hospital, Chinthareddypalem, Nellore-524003, Andhra Pradesh, India
AUTHOR
Andres M.
Rubiano
4
El Bosque University, RED LATINO. Latin American Trauma & Intensive Neuro-Care Organization, Bogota, Colombia
AUTHOR
1. Dunham CM, Brocker BP, Collier BD, Gemmel DJ. Risks associated with magnetic resonance imaging and cervical collar in comatose, blunt trauma patients with negative comprehensive cervical spine computed tomography and no apparent spinal deficit. Crit Care 2008; 12(4): R89. doi: 10.1186/cc6957.
1
2. Ho AMH, Fung KY, Joynt GM, Karmakar MK, Peng Z. Rigid cervical collar and intracranial pressure of patients with severe head injury. J Trauma 2002; 53(6): 1185-8.
2
3. Lemyze M, Palud A, Favory R, Mathieu D. Unintentional strangulation by a cervical collar after attempted suicide by hanging. Emerg Med J 2011; 28(6): 532. doi: 10.1136/ emj.2010.106625.
3
4. Stone MB, Tubridy CM, Curran R. The effect of rigid cervical collars on internal jugular vein dimensions. Acad Emerg Med 2010; 17(1): 100-2. doi: 10.1111/j.1553- 2712.2009.00624.x.
4
5. Carter KJ, Dunham CM, Castro F, Erickson B. Comparative analysis of cervical spine management in a subset of severe traumatic brain injury cases using computer simulation. PloS One 2011; 6(4): e19177. doi: 10.1371/journal. pone.0019177.
5
6. Craig GR, Nielsen MS. Rigid cervical collars and intracranial pressure. Intensive Care Med 1991; 17(8): 504-5.
6
7. Davies G, Deakin C, Wilson A. The effect of a rigid collar on intracranial pressure. Injury 1996; 27(9): 647-9.
7
8. Kuhnigk H, Bomke S, Sefrin P. Effect of external cervical spine immobilization on intracranial pressure. Aktuelle Traumatol 1993; 23(8): 350-3. [In German].
8
9. Mobbs RJ, Stoodley MA, Fuller J. Effect of cervical hard collar on intracranial pressure after head injury. ANZ J Surg 2002; 72(6): 389-91.
9
10. Como JJ, Thompson MA, Anderson JS, Shah RR, Claridge JA, Yowler CJ, et al. Is magnetic resonance imaging essential in clearing the cervical spine in obtunded patients with blunt trauma? J Trauma 2007; 63(3): 544-9. doi: 10.1097/ TA.0b013e31812e51ae.
10
11. Ham W, Schoonhoven L, Schuurmans MJ, Leenen LPH. Pressure ulcers from spinal immobilization in trauma patients: a systematic review. J Trauma Acute Care Surg 2014; 76(4): 1131-41. doi: 10.1097/TA.0000000000000153.
11
ORIGINAL_ARTICLE
Factors predicting patient satisfaction in the emergency department: a single-center study
Objective: Patient satisfaction (PS) is a major quality assessment index for the emergency department (ED) which affects patient safety, litigation, reimbursements, and consumer satisfaction. In this study we aimed to recognize the factors affecting PS in our center. Method: Random shifts during a week were selected and all patients disposed from the ED were asked to fill out a revised and validated Persian version of the Press-Ganey questionnaire with the help of a research assistant. Results were analyzed using a linear regression model by SPSS software version 21. Results: Findings reaffirmed some of the factors previously described. These included longer door to treatment area times having a negative effect on satisfaction (P < 0.001), and providing vivid discharge information improving PS (P < 0.001). Other important factors were also found that had not previously been focused on, namely cleanliness of the area (P < 0.0001) and courtesy of the staff in charge of patient transfer (P = 0.03). We also found that men had a more satisfying ED experience (P = 0.002). Conclusion: Cultural expectations may have an important effect on PS. Thus, every institution should determine and alter the expectations most relevant to them.
http://www.jept.ir/article_46515_ff22a48d60758aee4fb449e3e7c2908b.pdf
2018-01-01
3
8
10.15171/jept.2017.16
Emergency Department
Patient Satisfaction
Waiting times
Gender
Somaye
Younesian
1
Department of Emergency Medicine, Ayatollah Kashani Hospital, Tehran, Iran
AUTHOR
Reza
Shirvani
rshirvani@muq.ac.ir
2
Department of Emergency Medicine, Nekoee-Hedayati Hospital, Qom University of Medical Sciences, Qom, Iran
AUTHOR
Ali
Tabatabaey
alitabtab@gmail.com
3
Department of Emergency Medicine, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
LEAD_AUTHOR
1. Boudreaux ED, O’Hea EL. Patient satisfaction in the Emergency Department: a review of the literature and implications for practice. J Emerg Med 2004; 26(1): 13-26.doi: 10.1016/j.jemermed.2003.04.003.
1
2. Fenton JJ, Jerant AF, Bertakis KD, Franks P. The cost of satisfaction: a national study of patient satisfaction, health care utilization, expenditures, and mortality. Arch Intern Med 2012; 172(5): 405-11. doi: 10.1001/archinternmed.2011.1662.
2
3. Friedberg MW, Gelb Safran D, Schneider EC. Satisfied to death: a spurious result? Arch Intern Med 2012; 172(14): 1112-3. doi: 10.1001/archinternmed.2012.2060.
3
4. Welch SJ. Twenty years of patient satisfaction research applied to the emergency department: a qualitative review. Am J Med Qual 2010; 25(1): 64-72. doi: 10.1177/1062860609352536.
4
5. Johansen ML. Conflicting priorities: emergency nurses perceived disconnect between patient satisfaction and the delivery of quality patient care. J Emerg Nurs 2014; 40(1): 13-9. doi: 10.1016/j.jen.2012.04.013.
5
6. Soleimanpour H, Gholipouri C, Salarilak S, Raoufi P, Vahidi RG, Rouhi AJ, et al. Emergency department patient satisfaction survey in Imam Reza Hospital, Tabriz, Iran. Int J Emerg Med 2011; 4: 2. doi: 10.1186/1865-1380-1-2.
6
7. Arab M, Movahed Kor E, Mahmoodi M. The effect of time-to-provider, left-without-treatment and length-of stay on patient satisfaction in training hospitals’ emergency department, Iran. Iran J Public Health 2015; 44(10): 1411-7.
7
8. Atari M, Atari M. Brief Emergency Department Patient Satisfaction Scale (BEPSS); development of a new practical instrument. Emerg (Tehran) 2015; 3(3): 103-8.
8
9. Reihani H, Pishbin E, Abbasi Shaye Z, Ebrahimi M, Bolvardi E, Talebi Delooi M, et al. Patient satisfaction analysis in emergency department in Imam Reza hospital of Mashhad. Patient Saf Qual Improv 2015; 3(1): 179-83.
9
10. Taghizadeh H, Taghizadeh F. The comparing of health cares’s satisfaction in main and satellite villages of Qom province, Iran. Adv in Biol Res 2013; 7(6): 305-9. doi: 10.5829/idosi.abr.2013.7.6.11191.
10
11. Zohrevandi B, Tajik H. A survey of patients’ satisfaction in emergency department of Rasht Poursina hospital. Emerg (Tehran) 2014; 2(4): 162-5.
11
12. Sun BC, Adams J, Orav EJ, Rucker DW, Brennan TA, Burstin HR. Determinants of patient satisfaction and willingness to return with emergency care. Ann Emerg Med 2000; 35(5): 426-34. doi:10.1067/mem.2000.104195.
12
13. Sun BC, Adams JG, Burstin HR. Validating a model of patient satisfaction with emergency care. Ann Emerg Med 2001; 38(5): 527-32. doi: 10.1067/mem.2001.119250.
13
14. Rhee KJ, Bird J. Perceptions and satisfaction with emergency department care. J Emerg Med 1996; 14(6): 679-83. doi:10.1016/S0736-4679(96)00176-X.
14
15. Boquiren VM, Hack TF, Beaver K, Williamson S. What do measures of patient satisfaction with the doctor tell us? Patient Educ Couns 2015; 98(12): 1465-73. doi: 10.1016/j.pec.2015.05.020.
15
16. Taylor C, Benger JR. Patient satisfaction in emergency medicine. Emerg Med J 2004; 21(5): 528-32. doi: 10.1136/emj.2002.003723.
16
17. Taylor D, Kennedy MP, Virtue E, McDonald G. A multifaceted intervention improves patient satisfaction and perceptions of emergency department care. Int J Qual Health Care 2006; 18(3): 238-45. doi: 10.1093/intqhc/mzl002.
17
18. Hargraves JL, Wilson IB, Zaslavsky A, James C, Walker JD, Rogers G, et al. Adjusting for patient characteristics when analyzing reports from patients about hospital care. Med Care 2001; 39(6): 635-41.
18
19. McKinley RK, Stevenson K, Adams S, Manku-Scott TK. Meeting patient expectations of care: the major determinant of satisfaction with out-of-hours primary medical care? Fam Pract 2002; 19(4): 333-8. doi: 10.1093/fampra/19.4.333.
19
20. Son H, Yom YH. Factors influencing satisfaction with emergency department medical service: patients’ and their companions’ perspectives. Jpn J Nurs Sci 2017; 14(1): 27-37. doi: 10.1111/jjns.12132.
20
21. Abolfotouh MA, Al-Assiri MH, Alshahrani RT, Almutairi ZM, Hijazi RA, Alaskar AS. Predictors of patient satisfaction in an emergency care centre in central Saudi Arabia: aprospective study. Emerg Med J 2017; 34(1): 27-33. doi:10.1136/emermed-2015-204954
21
22. Morgan MW, Salzman JG, LeFevere RC, Thomas AJ, Isenberger KM. Demographic, operational, and healthcare utilization factors associated with emergency department patient satisfaction. West J Emerg Med 2015; 16(4): 516-26. doi: 10.5811/westjem.2015.4.25074.
22
23. Pines JM, Iyer S, Disbot M, Hollander JE, Shofer FS, Datner EM. The effect of emergency department crowding on patient satisfaction for admitted patients. Acad Emerg Med 2008;8;15(9):825-31. doi:10.1111/j.1553-2712.2008.00200.x.
23
24. Damghi N, Belayachi J, Armel B, Zekraoui A, Madani N, Abidi K, et al. Patient satisfaction in a Moroccan emergency department. Int Arch Med 2013; 6: 20. doi: 10.1186/1755-7682-6-20.
24
25. Davis BA, Duffy E. Patient satisfaction with nursing care in a rural and an urban emergency department. Aust J Rural Health 1999; 7(2): 97-103. doi: 10.1046/j.1440- 1584.1999.00231.x.
25
26. Cowan P. Press Ganey scores and patient satisfaction in the emergency department (ED): the patient perspective. Pain Med 2013; 14(7): 969. doi: 10.1111/pme.12170_3.
26
27. Chandra A, Sieck S, Hocker M, Gerardo CJ, Villani J, Harrison D, et al. An observation unit may help
27
improve an institution’s Press Ganey satisfaction score. Crit Pathw Cardiol 2011; 10(2): 104-6. doi:10.1097/HPC.0b013e31821c5da8.
28
28. Zakerimoghadam M, Sadeghi S, Ghiyasvandian S, Kazemnejad A. The effect of trauma intervention on the satisfaction of patients admitted to the emergency department: a clinical trial study. Iran Red Crescent Med J 2016; 18(4): e26452. doi: 10.5812/ircmj.26452.
29
29. Hwang CE, Lipman GS, Kane M. Effect of an emergency department fast track on Press-Ganey patient satisfaction scores. West J Emerg Med 2015; 16(1): 34-8. doi: 10.5811/westjem.2014.11.21768.
30
ORIGINAL_ARTICLE
Evaluating the accuracy of emergency nurses in correct triage using emergency severity index triage in Sina hospital of Tabriz: a cross-sectional analysis
Objective: Triage refers to the evaluation and categorization of patients for better management to deliver services. A good triage system should be able to accurately specify the patients who require urgent care. Thus, this study aimed to evaluate the accuracy of emergency nurses in correct triage using Emergency Severity Index (ESI) triage. Methods: In this descriptive cross-sectional study 750 patients, who referred to the emergency department (ED) of Sina teaching hospital, participated from 23 July to 22 August in 2015. Participants were selected using convenience sampling method. The patients’ triage level was determined by physicians and nurses separately and the results were compared. To define the level of agreement between two groups (inter-rater agreement), the kappa index was evaluated. Data were analyzed using SPSS version 17. Results: Among 750 patients, 577 patients (76.9%) were classified in correct triage group, 90 patients (12%) in undertriage group and 83 patients (11.1%) in overtriage group. Kappa agreement coefficient between the ESI triage level of physicians and nurses was 0.659 (95% CI: 0.646-0.667). There was statistically significant difference between the triage level of physicians and nurses (P < 0.001). Conclusion: This study showed that there was moderate agreement between the triages of physicians and nurses. It seems that improving nurses’ skills and knowledge might increase the accuracy of emergency nurses in patients’ correct triage. Therefore, planning programs based on training correct triage for emergency nurses is strongly suggested.
http://www.jept.ir/article_46516_78596829ae0ec85c2f9f1d03ec4ecf1a.pdf
2018-01-01
9
13
10.15171/jept.2017.19
Emergency Department
triage
Nurses
physicians
Farzad
Rahmani
rahmanif@tbzmed.ac.ir
1
Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
Pegah
Sepehri Majd
pegah.sm87@gmail.com
2
Department of Internal Medicine, Tabriz branch, Islamic Azad University, Tabriz, Iran
AUTHOR
Haniyeh
Ebrahimi Bakhtavar
3
Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
Farnaz
Rahmani
4
Student Research Committee, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
LEAD_AUTHOR
1. Khatiban M, Khazaei A, Karampourian A, Soltanian A, Kimiaie Asadi H, Salimi R, et al. The effects of the
1
Emergency Severity Index triage education via problem based learning on the triage nurses’ performance and the patients’ length of stay in the Emergency Department. Journal of Clinical Research in Paramedical Sciences 2014; 3(2): 63-74. [in Persian].
2
2. Tabatabai A, Mohammadnejad E, Salari A. Nursing students’ awareness of triage in the emergency ward. Hakim Seyed Esmail Jorjani Journal 2014; 1(1): 30-4. [In Persian].
3
3. Kamrani F, Ghaemipour F, Nikravan M, Alavi Majd H. Prevalence of miss triage and outcomes under triage of patients in emergency department. Journal of Health Promotion Management 2013; 2(3): 17-23. [in Persian]
4
4. Gilboy N, Tanabe P, Travers D, Rosenau AM. Emergency Severity Index (ESI): A Triage Tool for Emergency Department Care. 4th ed. Rockville, MD: AHRQ Publication; 2012.
5
5. Kariman H, Joorabian J, Shahrami A, Alimohammadi H, Noori Z, Safari S. Accuracy of emergency severity index of triage in Imam Hossein hospital-Tehran, Iran (2011). Journal of Gorgan University of Medical Sciences 2013; 15(1): 115-20. [in Persian]
6
6. Esmailian M, Zamani M, Azadi F, Ghasemi F. Interrater agreement of emergency nurses and physicians in Emergency Severity Index (ESI) Triage. Emerg (Tehran) 2014; 2(4): 158-61. doi: 10.22037/emergency.v2i4.6449.
7
7. Grossmann FF, Zumbrunn T, Ciprian S, Stephan FP, Woy N, Bingisser R, et al. Undertriage in older emergency department patients–tilting against windmills? PLoS One 2014; 9(8): e106203. doi:10.1371/journal.pone.0106203.
8
8. Newgard CD, Staudenmayer K, Hsia RY, Mann NC, Bulger EM, Holmes JF, et al. The cost of overtriage: more than one-third of low-risk injured patients were taken to major trauma centers. Health Aff (Millwood) 2013; 32(9): 1591-9. doi: 10.1377/hlthaff.2012.1142.
9
9. Faul M, Wald MM, Sullivent EE, Sasser SM, Kapil V, Lerner EB, et al. Large cost savings realized from the 2006 Field Triage Guideline: reduction in overtriage in U.S. trauma centers. Prehosp Emerg Care 2012; 16(2): 222-9. doi:10.3109/10903127.2011.615013.
10
10. Eshghi M, Rahmani F, Derakhti B, Abdollahi F, Tajoddini S. Patient satisfaction in the emergency department: a case of Sina hospital in Tabriz. Journal of Emergency Practice and Trauma 2016; 2(1): 16-20. doi: 10.15171/jept.2015.06.
11
11. Lehmann R, Brounts L, Lesperance K, Eckert M, Casey L, Beekley A, et al. A simplified set of trauma triage criteria to safely reduce overtriage: a prospective study. Arch Surg 2009; 144(9): 853-8. doi: 10.1001/archsurg.2009.153.
12
12. Kalantarimeibidi M, Yadollahi A, Esfandiari S. The effect of education on the knowledge and practice of emergency department’s nurses regarding the patients’ triage. Iran J Emerg Med 2014; 1(1):40-44.
13
13. Tanabe P, Gimbel R, Yarnold PR, Kyriacou DN, Adams JG. Reliability and validity of scores on The Emergency Severity Index version 3. Acad Emerg Med 2004; 11(1):59-65. doi: 10.1197/S1069-6563(03)00585-2.
14
14. Wuerz RC, Milne LW, Eitel DR, Travers D, Gilboy N. Reliability and validity of a new five-level triage
15
instrument. Acad Emerg Med 2000; 7(3): 236-42. doi:10.1111/j.1553-2712.2000.tb01066.x.
16
15. Platts-Mills TF, Travers D, Biese K, McCall B, Kizer S, LaMantia M, et al. Accuracy of the Emergency Severity Index triage instrument for identifying elder emergency department patients receiving an immediate life-savingintervention. Acad Emerg Med 2010; 17(3): 238-43. doi: 10.1111/j.1553-2712.2010.00670.x.
17
16. Goransson KE, von Rosen A. Interrater agreement: a comparison between two emergency department triage scales. Eur J Emerg Med 2011; 18(2): 68-72. doi: 10.1097/ MEJ.0b013e32833ce4eb.
18
17. Abbasi E, Nosrati A, Nabipour I, Emami SR. Assessment of the level of knowledge of physicians in Bushehr province about preparedness and response for nuclear emergency. Iranian Sought Medical Journal 2005; 7(2): 183-89. [in Persian]
19
18. Worster A, Sardo A, Eva K, Fernandes CM, Upadhye S. Triage tool inter-rater reliability: a comparison of live versus paper case scenarios. J Emerg Nurs 2007; 33(4): 319- 23. doi: 10.1016/j.jen.2006.12.016.
20
19. Buschhorn HM, Strout TD, Sholl JM, Baumann MR. Emergency medical services triage using the emergency severity index: is it reliable and valid? J Emerg Nurs 2013; 39(5): e55-63. doi:10.1016/j.jen.2011.11.003.
21
20. KällbergAS, GöranssonKE, Östergren J, Florin J, Ehrenberg A. Medical errors and complaintsin emergency department care in Sweden as reported by care providers, healthcare staff, and patients - a national review. Eur J Emerg Med 2013; 20(1): 33-8. doi: 10.1097/MEJ.0b013e32834fe917.
22
21. Mirhaghi AH, Roudbari M. Survey on knowledge level of the nurses about hospital triage. Iranian Journal of Critical Care Nursing 2011; 3(4): 167-74. [in Persian]
23
22. Sedaghat S, Aghababaeian H, Taheri N, Sadeghi Moghaddam A, Maniey M, Araghi Ahvazi L. Study on the level of knowledge and performance of North Khuzestan medical emergency 115 personnel on prehospital triage. Iran J Crit Care Nurs 2012; 5(2): 103-8.
24
23. Considine J, Botti M, Thomas S. Do knowledge and experience have specific roles in triage decision‐making? Acad Emerg Med 2007; 14(8): 722-6.
25
24. Hitchcock R. Speeding up the ED care process. Three hospital organizations mitigate overcrowding by improving patient flow, processes and documentation. Health Management Technology 2012; 33(12): 6-8.
26
25. Göransson KE, Ehrenberg A, Marklund B, Ehnfors M. Emergency department triage: is there a link between nurses’ personal characteristics and accuracy in triage decisions? Accid Emerg Nurs 2006; 14(2): 83-8. doi: 10.1016/j.aaen.2005.12.001
27
26. Hedayati H, Mogharrab M, Moasheri N, Sharifzadeh G. Studying of BUMS’ students’ knowledge about hospital triage in 2011. Modern Care Journal 2013; 9(3): 237- 44. [In Persian]
28
27. Dadashzadeh A, Abdollahzadeh F, Shams Vahdati S, Lotfi M, Ghojazadeh M, Bagheri Mehmandousti S. Causes of delay in patient triage in the emergency departments of Tabriz hospitals. Turk J Emerg Med 2011; 11(3): 95-8. doi: 10.5505/1304.7361.2011.59354.
29
28. Azhough R, Shams Vahdati S, Faraji F, Faraji M, Ghorbanian M, Ramouz A, Tajoddini S. One-day triage course for nurses, it is essential. Journal of Emergency Practice and Trauma 2015; 1(2): 52-5.
30
ORIGINAL_ARTICLE
The effect of training on the management of nuclear disasters by emergency department nurses and physicians
Objective: On account of the widespread use of nuclear energy in different fields, nuclear accidents and disasters have been on a rise. Thus, it is crucial for medical staff especially emergency department personnel to be aware of the nature of these accidents. This study was designed to evaluate the effect of training on the knowledge of physicians and nurses regarding nuclear disasters. Methods: This pre-and post-intervention study was conducted on 97 emergency department personnel including physicians and nurses of educational hospitals in Tabriz University of Medical Sciences. Educational classes and training about nuclear disasters and managing these events were held. A standard questionnaire was used to evaluate the knowledge before and after training, and the effect of education on personnel’s knowledge. Results: Our participants included 41 males and 56 females. The mean age was 32.88 years. The mean score of participants before and after the class was 4.03 ± 1.54 and 7.93 ± 1.55 respectively; which showed a statistically significant difference (P < 0.001). Among medical staff, physicians had better knowledge compared with the other group. Conclusion: This study showed that the knowledge of medical staff about nuclear disasters is low and educational classes are necessary to increase their knowledge.
http://www.jept.ir/article_46517_c1e2207d314b5e2ba061be1e4b1bfb2c.pdf
2018-01-01
14
17
10.15171/jept.2017.20
Disasters
Nuclear accidents
Education
Emergency Service
Hospital
Alireza
Ala
ala.alireza@gmail.com
1
Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
Farzad
Rahmani
rahmanif@tbzmed.ac.ir
2
Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
LEAD_AUTHOR
Reza
Aslzad
rad1388@yahoo.com
3
Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
Zahra
Parsian
z.parsian@yahoo.com
4
Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
1. IAEA. Diagnosis and Treatment of Radiation Injuries, Safety Reports Series No. 2. Vienna: IAEA; 1998. p. 49.
1
2. Monfared AS. Nuclear weapons, triage of injured and therapeutic approach to the acute radiation syndrome. Annals of Military and Health Sciences Research 2004; 2(4): 463-6. [In Persian].
2
3. Ghobeishavi V, Forughizadeh M. External decontamination in nuclear accidents. Journal of Military Medicine 2003; 5(1): 57-68. [In Persian].
3
4. Moroni M, Elliott TB, Deutz NE, Olsen CH, Owens R, Christensen C, et al. Accelerated hematopoietic syndrome after radiation doses bridging hematopoietic (H-ARS) and gastrointestinal (GI-ARS) acute radiation syndrome: Early hematological changes and systemic inflammatory response syndrome in minipig. Int J Radiat Biol 2014; 90(5): 363-72. doi: 10.3109/09553002.2014.892226.
4
5. Poorheidari G, Najafi A, Khatami M, Modares MS. How to prepare a general hospital emergency ward to admit nuclear casualties. Kowsar Medical Journal 2003; 7(4): 333-9. [In Persian].
5
6. Meineke V, van Beuningen D, Sohns T, Fliedner TM. Medical management principles for radiation accidents. Mil Med 2003; 168(3): 219-22.
6
7. Turai I, Veress K, Gunalp B, Souchkevitch G. Medical response to radiation incidents and radionuclear threats. BMJ 2004; 328(7439): 568-72. doi: 10.1136/ bmj.328.7439.568.
7
8. Quinn A, Taylor C, Sabharwal T, Sikdar T. Radiation protection awareness in non-radiologists. Br J Radiol 1997; 70(829): 102-6. doi: 10.1259/bjr.70.829.9059306.
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9. Tavakoli H, Modarresi SM, Azad Marzabadi E. Educational needs of hospital personnel for medical response to nuclear injuries. Journal of Military Medicine 2008; 10(3): 209-16. [In Persian].
9
10. Hoseini A, Musarezaie A, Eslamian J. Awareness of radiological accidents and how to deal with it: a study of nurses and nursing faculties of Isfahan University of Medical Sciences. Iranian Journal of Medical Education 2014; 14(1): 78-86. [In Persian].
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11. Lopez AM, Stephani JA. Radiation injuries. In: Tintinalli JE, Stapczynski JS, Ma OJ, Cline DM, Cydulka RK, Meckler GD, et al, eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 8th ed. USA: McGraw Hill; 2016. p. 51-7.
11
12. Schleipman AR, Gerbaudo VH, Castronovo FP. Radiation disaster response: preparation and simulation experience at an academic medical center. J Nucl Med Technol 2004; 32(1): 22-7.
12
13. Jaques T. Issue management and crisis management: an integrated, non-linear, relational construct. Public Relat Rev 2007; 33(2): 147-57. doi: 10.1016/j.pubrev.2007.02.001.
13
14. Drennan LT, McConnell A. Managing the acute phase of crisis. In: Drennan LT, McConnell A, et al. Risk and Crisis Management in the Public Sector. New York: Routledge; 2007. p. 145-74.
14
15. Mettle FA Jr, Voelz GL. Major radiation exposure-What to expect and how to respond. N Eng J Med 2002; 346(20): 1554-61. doi: 10.1056/NEJMra000365.
15
16. Farazmand A. Handbook of Crisis and Emergency Management. USA: Marcel Dekker; 2001.
16
ORIGINAL_ARTICLE
The relationship between attention-deficit/ hyperactivity disorder and trauma in adolescents
Objective: Attention-deficit/hyperactivity disorder (ADHD) is characterized by persistent and impairing levels of inattention, impulsivity and hyperactivity. Evidence shows that adolescents with ADHD are more exposed to trauma. This study aimed to investigate the relationship between ADHD symptom severity and trauma severity. Methods: In this descriptive correlational study, the study population included traumatic adolescents aged 12-18 years referred to Shohada hospital in Tabriz, Iran in 2016. Among this population, 91 subjects were selected. In order to exclude subjects with other psychiatric disorders, a psychiatrist performed clinical interviews with them. In this regard, the short form of Conner’s Comprehensive Behavior Rating Scales Revised Edition (CBRS-R) and Pediatric Trauma Scale were used. For data analysis, Pearson correlation coefficient and independent t test were applied. Data were analyzed using SPSS software version 22. Results: There was a significant positive relationship between trauma severity and ADHD score, hyperactivity, and oppositional/Impulsivity (P < 0.01). Conversely, no statistical significance was observed between attention deficiency and trauma severity. The severity of trauma was higher among ADHD group than normal individuals. There were also correlations between socioeconomic status (SES) and oppositional/impulsive patients. In this regard, higher scores of oppositional/impulsivity were observed among patients with lower SES. Conclusion: Traumas have significant effects on economic and humanistic aspects of life in modern era. Our findings showed that there was a statistically significant relationship between hyperactivity-inattention and trauma intensity in adolescents. Therefore, to prevent traumatic events, ADHD screening at schools is suggested. By the same token, informing parents through mass media can help reduce the consequences of inattention/ hyperactivity disorder in the society.
http://www.jept.ir/article_48849_c235f5ccafdcd723e3fe062d71e778b3.pdf
2018-01-01
18
23
10.15171/jept.2017.23
Hyperactivity
Trauma severity
Attention deficit
Impulsivity
ADHD
Ali Reza
Shafiee-Kandjani
shafieear@tbzmed.ac.ir
1
Road Traffic Injury Research Center (RTIR), Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
Seyed Gholamreza
Noorazar
2
Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
LEAD_AUTHOR
Saeed
Aslanabadi
3
Department of Surgery, Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
Nasim
Rashedi
nasimrashedi@gmail.com
4
Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
Mehrnaz
Dadkhah
5
Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
Mohsen
Jafarzadeh-Gharehziaaddin
6
Department of Psychology, Islamic Azad University of Ahar, Tabriz, Iran
AUTHOR
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18. Lara C, Fayyad J, De Graaf R, Kessler RC, Aguilar-Gaxiola S, Angermeyer M, et al. Childhood predictors of adult attention-deficit/hyperactivity disorder: results from the World Health Organization World Mental Health Survey Initiative. Biol Psychiatry 2009; 65(1): 46-54. doi: 10.1016/j. biopsych.2008.10.005.
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19. Zargarinezhad G, Yekeh Y. Efficacy of parent’s training on problem behaviors in ADHD children. Psychological Studies 2007; 3(2): 29–48. [In Persian].
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21. Amiri S, Shafiee-Kandjani AR, Fakhari A, Abdi S, Golmirzaei J, Akbari Z. Psychiatric comorbidities in ADHD children: an iranian study among primary school students. Arch Iran Med 2013; 16(9): 513-7.
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22. Abolhassanzadeh M, Shafiee-Kandjani AR, Vaziri Z, Molavi P, Sadeghi-Movahhed F, Noorazar G, et al. The prevalence and risk factors of attention deficit hyperactivity disorder among the elementary school students in Ardabil, Iran, in 2011-2012. J Anal Res Clin Med 2016; 4(3): 146-52. doi:10.15171/jarcm.2016.024.
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23. Bener A, Qahtani RA, Abdelaal I. The prevalence of ADHD among primary school children in an Arabian society. J Atten Disord 2006; 10(1): 77-82. doi: 10.1177/1087054705284500.
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24. Mugnaini D, Masi G, Brovedani P, Chelazzi C, Matas M, Romagnoli C, et al. Teacher reports of ADHD symptoms in Italian children at the end of first grade. Eur Psychiatry 2006; 21(6): 419-26. doi:10.1016/j.eurpsy.2005.04.011.
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25. Rappley MD. Clinical practice. Attention deficithyperactivity disorder. N Engl J Med 2005; 352(2): 165-73. doi: 10.1056/NEJMcp032387.
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30. Kouchakzadeh Talami S, Namazi A, Zarkesh M. Symptoms related to attention deficit hyperactivity disorder among preschool children based on parents report. J Holist Nurs Midwifery 2015; 25(1): 35-44. [In Persian].
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31. Biederman J, Petty CR, Spencer TJ, Woodworth KY, Bhide P, Zhu J, et al. Examining the nature of the comorbidity between pediatric attention deficit/hyperactivity disorder and post-traumatic stress disorder. Acta Psychiatr Scand 2013; 128(1): 78-87. doi: 10.1111/acps.12011.
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34. Brault MC, Lacourse É. Prevalence of prescribed attentiondeficit hyperactivity disorder medications and diagnosis among Canadian preschoolers and school-age children: 1994–2007. Can J Psychiatry 2012; 57(2): 93-101. doi: 10.1177/070674371205700206.
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35. Ghanizadeh A. Distribution of symptoms of attention deficit-hyperactivity disorder in schoolchildren of Shiraz, south of Iran. Arch Iran Med 2008; 11(6): 618-24.
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37. Nichols JQVA. Human factors and driving behaviors differentiating high risk and low risk drivers with attention deficit hyperactivity disorder [dissertation]. Charlottesville, VA: University of Virginia; 2012.
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38. Fischer M, Barkley RA, Smallish L, Fletcher K. Hyperactive children as young adults: driving abilities, safe driving behavior, and adverse driving outcomes. Accid Anal Prev 2007; 39(1): 94-105. doi: 10.1016/j.aap.2006.06.008.
38
ORIGINAL_ARTICLE
The use of ultrasonography for the confirmation of pulled elbow treatment
Objective: The aim of this study was to use ultrasonography for the diagnosis and confirmation of Pulled Elbow treatment.Methods: 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.Results: 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%.Conclusion: 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%.
http://www.jept.ir/article_50284_92de5b5ec9c2e3d6552a1c5a9c250e93.pdf
2018-01-01
24
28
10.15171/jept.2017.24
Ultrasonography
X-ray
Pulled elbow injury
Farhad
Heydari
farhad.heidary@yahoo.com
1
Emergency Medicine Research Center, Alzahra Hospital, Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
AUTHOR
Shiva
Samsam Shariat
2
Emergency Medicine Department, Alzahra Hospital, Medical University of Isfahan, Isfahan, Iran
LEAD_AUTHOR
Saeed
Majidinejad
3
Emergency Medicine Research Center, Alzahra Hospital, Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
AUTHOR
Babak
Masoumi
bamasoumi@yahoo.com
4
Emergency Medicine Research Center, Alzahra Hospital, Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
AUTHOR
1-Krul M, Van der Wouden JC, Koes BW, Schellevis FG, Van Suijlekom-Smit LW. Nursemaid’s elbow: Its diagnostic clues
1
and preferred means of reduction. J Fam Pract 2010; 59(1):E5-7.
2
2. Kim MC, Eckhardt BP, Craig C, Kuhns LR. Ultrasonography of the annular ligament partial tear and recurrent “pulled
3
elbow”. Pediatr Radiol 2004; 34(12): 999-1004. doi: 10.1007/s00247-004-1284-7.
4
3. Krul M, van der Wouden JC, van Suijlekom-Smit LW, Koes BW. Manipulative interventions for reducing pulled elbow
5
in young children. Cochrane Database Syst Rev 2012; 1:CD007759. doi: 10.1002/14651858.CD007759.pub3.
6
4. Sevencan A, Aygün Ü, İnan U, Ömeroğlu H. Pulled elbow in children: a case series including 66 patients. J Pediatr Orthop B 2015; 24(5): 385-8. doi: 10.1097/BPB.0000000000000182.
7
5. Kajiwara R, Sunagawa T, Ishida O, Ochi M. Irreducible pulled elbow in an adult: a case report. J Shoulder Elbow
8
Surg 2007;16(1):e1-4. doi: 10.1016/j.jse.2006.03.007.
9
6. Jongschaap HC, Youngson GG, Beattie TF. The epidemiology of radial head subluxation (‘pulled elbow’)
10
in the Aberdeen city area. Health Bull (Edinb) 1990; 48(2):58-61.
11
7. Hagroo GA, Zaki HM, Choudhary MT, Hussain A. Pulled elbow—not the effect of hypermobility of joints. Injury
12
1995; 26(10): 687-90. doi: 10.1016/0020-1383(95)00133-6.
13
8. Brown D. Emergency department visits for nursemaid’s elbow in the United States, 2005–2006. Orthop Nurs 2009;
14
28(4): 161-2. doi: 10.1097/NOR.0b013e3181ada779.
15
9. Martinoli C, Bianchi S, Giovagnorio F, Pugliese F. Ultrasound of the elbow. Skeletal Radiol 2001; 30(11): 605-
16
14. doi: 10.1007/s002560100410.
17
10. Dohi D. Confirmed specific ultrasonographic findings of pulled elbow. J Pediatr Orthop 2013; 33(8): 829-31. doi:
18
10.1097/BPO.0000000000000087.
19
11. Scapinelli R, Borgo A. Pulled elbow in fancy: diagnostic role of imaging. Radiol Med 2005; 110(5-6): 655-64.
20
12. Kosuwon W, Mahaisavariya B, Saengnipanthkul S, Laupattarakasem W, Jirawipoolwon P. Ultra-sonography of
21
pulled elbow. J Bone Joint Surg Br1993; 75(3): 421-2.
22
13. Taha AM. The treatment of pulled elbow: a prospective randomized study. Arch Orthop Trauma Surg 2000; 120(5-
23
6): 336-7.
24
14. Diab HS, Hamed MM, Allam Y. Obscure pathology of pulled elbow: dynamic high-resolution ultrasound-assisted
25
classification. J Child Orthop 2010; 4(6): 539-43. doi:10.1007/s11832-010-0298-y.
26
15. Minagawa H. Diagnostic and interventional musculoskeletal ultrasound. J Jpn Orthop Assoc 2012; 86(11): 1057-64.
27
16. Lee YS, Chou YH, Chiou HJ, Lai YC . Use of sonography in assessing elbow medial collateral ligament injury after
28
arm wrestling . J Chin Med Assoc 2014; 77(3): 163-5. doi:10.1016/j.jcma.2013.11.003.
29
17. Irie T, Sono T, Hayama Y, Matsumoto T, Matsushita M. Investigation on 2331 cases of pulled elbow over the
30
last 10 years. Pediatr Rep 2014; 6(2): 5090. doi: 10.4081/pr.2014.5090.
31
18. Schunk JE. Radial head subluxation: epidemiology and treatment of 87 episodes. Ann Emerg Med 1990; 19(9):1019-23.
32
19. Macias CG, Bothner J, Wiebe R. A comparison of supination/flexion to hyperpronation in the reduction of radial head subluxations. Pediatrics 1998; 102(1):e10.
33
ORIGINAL_ARTICLE
The effect of physiologic dose of intravenous hydrocortisone in patients with refractory septic shock: a randomized control trial
Objective: Septic shock is a response to infection and tissue hypoperfusion which does not respond to fluid therapy and eventually leads to organ dysfunction. Aggressive treatment of a broad-spectrum antimicrobial and supportive measures are the cornerstones of successful treatment. In addition to the main treatment, there are adjunctive therapies. Steroids are one of the treatments which have been studied in the management of refractory septic shock. Despite numerous studies on the role of steroids in the mortality of severe sepsis and septic shock, still lots of controversies exist. These conflicts are often about the steroid dose and duration of administration.Methods: This was a prospective, randomized-controlled, two-group assignment study. Patients referred to Imam Reza (AS) hospital in Mashhad who had refractory septic shock criteria were randomly divided into two groups: 80 patients were included in each group. After obtaining the baseline cortisol level and cosyntropin test, one group was treated with intravenous hydrocortisone, and the other group was treated with placebo. The response to hydrocortisone, the return of shock duration, and mortality at 28 days were investigated. The data were analyzed using SPSS version 16. For the normally distributed variables, a t test was used for comparisons. Concerning qualitative variables, the chi-square test or Fisher exact test were applied accordingly.Results: The return of shock duration and mortality in intervention group patients was more than control group, but it was not statistically significant.Conclusion: Despite numerous studies in this field, there are various outcomes (mortality rate, rate of return of shock, time of return of shock). These differences can be attributed to high degree of heterogeneity. Perhaps considering the underlying disease and more differentiation could change the return of shock and mortality rate.
http://www.jept.ir/article_50285_a830d1a10a8b2fb88b40ff3cbfa4dbe8.pdf
2018-01-01
29
33
10.15171/jept.2017.25
Hydrocortisone
Septic shock
Adrenal insufficiency
cortisol
Morteza
Talebi Doluee
talebidm@mums.ac.ir
1
Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Maryam
Salehi
salehim@mums.ac.ir
2
Research Centre for Patient Safety, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Azadeh
Mahmoudi Gharaee
azadeh_gharai@yahoo.com
3
Taleghani Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
Majid
Jalalyazdi
4
Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Hamidreza
Reihani
5
Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
1. Munford RS, Suffredini AF. Sepsis, severe sepsis, and septic shock. In: Mandell GL, Bennett JE, Dolin R, eds. Principles
1
and Practice of Infectious Diseases. London: Elsevier/Churchill-Livingstone; 2005. p. 906-26.
2
2. Shapiro NI, Zimmer GD, Barkin AZ. Sepsis syndromes. In: Marx, JA, Hockberger RS, Walls RM, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014.
3
3. Tunctan B, Korkmaz B, Sari AN, Kacan M, Unsal D, Serin MS, et al. A novel treatment strategy for sepsis and septic
4
shock based on the interactions between prostanoids, nitric oxide, and 20-hydroxyeicosatetraenoic acid. Antiinflamm
5
Antiallergy Agents Med Chem 2012; 11(2): 121-50.
6
4. Patel GP, Balk RA. Systemic steroids in severe sepsis and septic shock. Am J Respir Crit Care Med 2012; 185(2): 133-9. doi: 10.1164/rccm.201011-1897CI.
7
5. Annane D. Corticosteroids for severe sepsis: an evidencebased guide for physicians. Ann Intensive Care 2011; 1(1):
8
7. doi: 10.1186/2110-5820-1-7.
9
6. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving sepsis campaign: international
10
guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008; 36(1): 296-327.
11
7. Arafah BM. Hypothalamic pituitary adrenal function during critical illness: limitations of current assessment methods. J Clin Endocrinol Metab 2006; 91(10): 3725-45.
12
8. Marik PE, Pastores SM, Annane D, Meduri GU, Sprung CL, Arlt W, et al. Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American College of Critical Care Medicine. Crit Care Med 2008; 36(6): 1937-49. doi:10.1097/CCM.0b013e31817603ba.
13
9. Annane D, Sébille V, Troché G, Raphaël JC, Gajdos P, Bellissant E. A 3-level prognostic classification in septic shock based on cortisol levels and cortisol response to corticotropin. JAMA 2000; 283(8): 1038-45.
14
10. Bollaert PE, Charpentier C, Levy B, Debouverie M, Audibert G, Larcan A. Reversal of late septic shock with supraphysiologic doses of hydrocortisone. Crit Care Med 1998; 26(4): 645-50.
15
11. Yildiz O, Doğanay M, Aygen B, Güven M, Keleştimur F, Tutuş A. Physiological-dose steroid therapy in sepsis [ISRCTN36253388]. Crit Care 2002; 6(3): 251-9. doi:10.1186/cc1498.
16
12. Oppert M, Schindler R, Husung C, Offermann K, Gräf K-J, Boenisch O, et al. Low-dose hydrocortisone improves shock
17
reversal and reduces cytokine levels in early hyperdynamic septic shock. Crit Care Med 2005; 33(11): 2457-64.
18
13. Sprung CL, Annane D, Keh D, Moreno R, Singer M, Freivogel K, et al. Hydrocortisone therapy for patients with septic shock. N Engl J Med 2008; 358(2): 111-24. doi:10.1056/NEJMoa071366.
19
14. Annane D, Bellissant E, Bollaert PE, Briegel J, Confalonieri M, De Gaudio R, et al. Corticosteroids in the treatment of
20
severe sepsis and septic shock in adults: a systematic review. JAMA 2009; 301(22): 2362-75. doi:10.1001/jama.2009.815.
21
15. Wang C, Sun J, Zheng J, Guo L, Ma H, Zhang Y, et al. Lowdose hydrocortisone therapy attenuates septic shock in
22
adult patients but does not reduce 28-day mortality: a metaanalysis of randomized controlled trials. Anesth Analg 2014;
23
118(2): 346-57. doi: 10.1213/ANE.0000000000000050.
24
16. Sherwin RL, Garcia AJ, Bilkovski R. Do low-dose corticosteroids improve mortality or shock reversal in patients with septic shock? A systematic review andposition statement prepared for the American Academy of Emergency Medicine. J Emerg Med 2012; 43(1): 7-12. doi:10.1016/j.jemermed.2011.08.015.
25
17. Casserly B, Gerlach H, Phillips GS, Lemeshow S, Marshall JC, Osborn TM, et al. Low-dose steroids in adult septic
26
shock: results of the Surviving Sepsis Campaign. Intensive Care Med 2012; 38(12): 1946-54. doi: 10.1007/s00134-012-
27
18. Dalegrave D, Silva RL, Becker M, Gehrke LV, Friedman G. Relative adrenal insufficiency as a predictor of disease
28
severity and mortality in severe septic shock. Rev Bras Ter Intensiva 2012; 24(4): 362-8. doi: 10.1590/S0103-
29
507X2012000400012.
30
19. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving Sepsis Campaign Guidelines
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Committee including the Pediatric Subgroup Surviving sepsis campaign: international guidelines for management
32
of severe sepsis and septic shock: 2012. Intensive Care Med 2013; 39(2): 165-228. doi: 10.1007/s00134-012-2769-8.
33
20. Chen Z, Yang C, He H, He Z. The impacts of low-dose corticosteroids infusion given in different manners on
34
refractory septic shock patients. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2015; 27(6): 443-7. doi: 10.3760/cma.j.is
35
sn.2095-4352.2015.06.006. [In Chinese].
36
21. Briegel J, Bein T, Möhnle P. Update on low-dose corticosteroids. Curr Opin Anaesthesiol 2017; 30(2): 186-191.doi: 10.1097/ACO.0000000000000442.
37
22. Tagami T, Matsui H, Fushimi K, Yasunaga H. Low-dose corticosteroid treatment and mortality in refractory abdominal septic shock after emergency laparotomy. Ann Intensive Care 2015; 5(1): 32. doi: 10.1186/s13613-015-0074-8.
38
23. Torres A, Sibila O, Ferrer M, Polverino E, Menendez R, Mensa J, et al. Effect of corticosteroids on treatment failure
39
among hospitalized patients with severe communityacquired pneumonia and high inflammatory response: a
40
randomized clinical trial. JAMA 2015; 313(7): 677-86. doi:10.1001/jama.2015.88.
41
24. Volbeda M, Wetterslev J, Gluud C, Zijlstra J, van der Horst I, Keus F. Glucocorticosteroids for sepsis: systematic review
42
with meta-analysis and trial sequential analysis. Intensive Care Med 2015; 41(7): 1220-34. doi: 10.1007/s00134-015-
43
ORIGINAL_ARTICLE
Red blood cell distribution width: a determinant of hospital mortality in pancreatitis
Objective: In recent years, there has been a great attention concerning red blood cell distribution width (RDW) in clinical decisions as well as determining the severity of diseases. This study was conducted to evaluate the primary level of RDW to predict hospital mortality in pancreatitis.
Methods: This was a descriptive analytical study performed on 100 patients with acute pancreatitis in the emergency department of Imam Reza hospital of Tabriz University of Medical Sciences. In this study, the primary level of RDW in patients with acute pancreatitis presenting to the emergency ward was collected and after patients’ admission we followed them. Also, the admission outcome (mortality or discharge) of patients was registered, and finally we evaluated the predictive value of RDW in determining the patient’s outcome in hospital.
Results: In our study, 47 patients were male, and 53 patients were female. Mean RDW in patients was 13.82 ± 1.69. Five patients died during the study. Mean RDW in dead patients and other patients was 16.44 ± 4.22 and 13.68 ± 1.37, respectively (P < 0.001). The cut-off point of 14.55 for RDW with 80% sensitivity and 85% specificity was determined for predicting mortality in patients.
Conclusion: Based on our study results, the initial RDW level is an independent factor for predicting in-hospital mortality in pancreatitis but not for determining the need for surgery or admission to the intensive care unit (ICU).
http://www.jept.ir/article_53304_ca6d7b67079801be4bd99b46c798c413.pdf
2018-01-01
34
38
10.15171/jept.2017.26
Pancreatitis
mortality
Prognosis
Payman
Moharamzadeh
1
Gastrointestinal and Liver Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
Kavous
Shahsavari Nia
2
Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
Mohammadhossein
Somi
3
Gastrointestinal and Liver Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
Mahboub
Pouraghaei
pouraghaeim@yahoo.com
4
Gastrointestinal and Liver Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
Akbar
Fadaeihaghi
5
Student’s Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
Farzad
Rahmani
rahmanif@tbzmed.ac.ir
6
Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
LEAD_AUTHOR
1. Fisher WE, Anderson DK, Bell RH, Saluja AK, Brunicardi FC. Pancreas. In: Brunicardi FC, Anderson DK, Billiar TR, eds. Schwartzs Principles of Surgery. 8th ed. New York: McGraw-Hill; 2005. p. 1231-40.
1
2. Wang X, Cui Z, Zhang J, Li H, Zhang D, Miao B, et al. Early predictive factors of in hospital mortality in patients with
2
severe acute pancreatitis. Pancreas 2010; 39(1): 114-5. doi:10.1097/MPA.0b013e3181b65dd5.
3
3. Yoldas O, Koc M, Karakose N, Kilic M, Tez M. Prediction of clinical outcomes using artificial neural networks for patients with acute biliary pancreatitis. Pancreas 2008;36(1): 90-2. doi: 10.1097/MPA.0b013e31812e964b.
4
4. Senol K, Saylam B, Kocaay F, Tez M. Red cell distribution width as a predictor of mortality in acute pancreatitis. Am J Emerg Med 2013; 31(4): 687-9. doi: 10.1016/j.ajem.2012.12.015.
5
5. Song CS, Park DI, Yoon MY, Seok HS, Park JH, Kim HJ, et al. Association between red cell distribution width and disease activity in patients with inflammatory bowel disease. Dig Dis Sci 2012; 57(4): 1033-8. doi: 10.1007/s10620-011-1978-2.
6
6. Zorlu A, Bektasoglu G, Guven FM, Dogan OT, Gucuk E, Ege MR, et al. Usefulness of admission red cell distribution width as a predictor of early mortality in patients with acute pulmonary embolism. Am J Cardiol 2012; 109(1): 128-34. doi:10.1016/j.amjcard.2011.08.015.
7
7. Jo YH, Kim K, Lee JH, Kang C, Kim T, Park HM, et al. Red cell distribution width is a prognostic factor in severe sepsis and septic shock. Am J Emerg Med 2013; 31(3): 545-8. doi:10.1016/j.ajem.2012.10.017.
8
8. Wang F, Pan W, Pan S, Ge J, Wang S, Chen M. Red cell distribution width as a novel predictor of mortality in ICU patients. Ann Med 2011; 43(1): 40-6. doi:10.3109/07853890.2010.521766.
9
9. Naing L. Sample size for sensitivity and specificity studies. Available from: http://www.kck.usm.my/ppsg/statistical_resources/samplesize_forsensitivity_specificitystudiesLinNaing.xls.
10
10. Hemphill RR, Santen SA. Disorders of the Pancreas In: Marx JA, ed. Rosen’s Emergency Medicine. Philadelphia: Elsevier Saunders; 2014. p. 1205-15.
11
11. Safari S, Rahmani F, Soleimanpour H, Ebrahimi Bakhtavar H, Mehdizadeh Esfanjani R. Can APACHE II score predict
12
diabetic ketoacidosis in hyperglycemic patients presenting to emergency department? Anesth Pain Med 2014; 4(4): e21365. doi: 10.5812/aapm.21365.
13
12. Wu BU, Bakker OJ, Papachristou GI, Besselink MG, Repas K, van Santvoort HC, et al. Blood urea nitrogen in the early
14
assessment of acute pancreatitis: an international validation study. Arch Intern Med 2011; 171(7): 669-76. doi: 10.1001/
15
archinternmed.2011.126.
16
13. Anderson JL, Ronnow BS, Horne BD, Carlquist JF, May HT, Bair TL, et al. Usefulness of a complete blood countderived
17
risk score to predict incident mortality in patients with suspected cardiovascular disease. Am J Cardiol 2007;99(2): 169-74. doi: 10.1016/j.amjcard.2006.08.015.
18
14. Yao J, Lv G. Association between red cell distribution width and acute pancreatitis: a cross-sectional study. BMJ Open
19
2014; 4(8): e004721. doi: 10.1136/bmjopen-2013-004721.
20
15. Kolber W, Sporek M, Dumnicka P, Kusnierz-Cabala B, Kuzniewski M, Gurda-Duda A, et al. Acute pancreatitis and
21
red cell distribution width (RDW)I at early phase of disease. Przegl Lek 2013; 70(11): 916-9. [In Polish].
22
16. Carnovale A, Rabitti PG, Manes G, Esposito P, Pacelli L, Uomo G. Mortality in acute pancreatitis: is it an early or a
23
late event? Jop 2005; 6(5): 438-44.
24
17. Makhoul BF, Khourieh A, Kaplan M, Bahouth F, Aronson D, Azzam ZS. Relation between changes in red cell distribution
25
width and clinical outcomes in acute decompensated heart failure. Int J Cardiol 2013; 167(4): 1412-6. doi: 10.1016/j.
26
ijcard.2012.04.065.
27
18. Hong N, Oh J, Kang SM, Kim SY, Won H, Youn JC, et al. Red blood cell distribution width predicts early mortality in
28
patients with acute dyspnea. Clin Chim Acta 2012; 413(11-12): 992-7. doi: 10.1016/j.cca.2012.02.024.
29
19. Braun E, Domany E, Kenig Y, Mazor Y, Makhoul BF, Azzam ZS. Elevated red cell distribution width predicts poor outcome in young patients with community acquired pneumonia. Crit Care 2011; 15(4): R194. doi: 10.1186/
30
20. Horne BD. A changing focus on the red cell distribution width: why does it predict mortality and other adverse
31
medical outcomes? Cardiology 2012; 122(4): 213-5. doi:10.1159/000341244.
32
21. Kurt M, Tanboga IH, Buyukkaya E, Karakas MF, Akcay AB, Sen N. Relation of red cell distribution width with CHA2DS2-VASc score in patients with nonvalvular atrial fibrillation. Clin Appl Thromb Hemost 2014; 20(7): 687-92.
33
doi: 10.1177/1076029613478157
34
22. Felker GM, Allen LA, Pocock SJ, Shaw LK, McMurray JJ, Pfeffer MA, et al. Red cell distribution width as a novel prognostic marker in heart failure: data from the CHARM Program and the Duke Databank. J Am Coll Cardiol 2007;50(1): 40-7. doi: 10.1016/j.jacc.2007.02.067.
35
23. Tonelli M, Sacks F, Arnold M, Moye L, Davis B, Pfeffer M. Relation between red blood cell distribution width and cardiovascular event rate in people with coronary disease. Circulation 2008; 117(2): 163-8. doi: 10.1161/
36
circulationaha.107.727545.
37
24. Spell DW, Jones DV Jr, Harper WF, David Bessman J. The value of a complete blood count in predicting cancer of the colon. Cancer Detect Prev 2004; 28(1): 37-42. doi:10.1016/j.cdp.2003.10.002.
38
25. Ani C, Ovbiagele B. Elevated red blood cell distribution width predicts mortality in persons with known stroke. J Neurol Sci 2009; 277(1-2): 103-8. doi: 10.1016/j.jns.2008.10.024.
39
ORIGINAL_ARTICLE
Intravenous acetaminophen versus morphine sulfate in pain management of acute renal colic: a randomized clinical trial
Objective: The main purpose in the treatment of renal colic patients in emergency department is pain management. This study aimed to compare the analgesic effects of intravenous (IV) acetaminophen and morphine sulfate in this regard.
Methods: This double blind clinical trial was conducted on >18 years old renal colic patients in need of pain management in emergency department. Pain severity was recorded as 15, 30, and 60 minutes before injection, and 120 minutes after injection. In addition, side effects were compared between IV acetaminophen and morphine sulfate groups using SPSS version 16.
Results: A total of 355 patients were randomly allocated to one of the treatment groups. There were no significant differences between the two groups regarding baseline characteristic of participants. There was no significant difference in the pain intensity of the groups; 15 (P = 0.13) and 30 (P = 0.15) minutes after treatment. Although, the difference in pain severity was statistically significant between the two groups; 60 (P = 0.02) and 120 (P = 0.003) minutes after the infusion. This was not clinically important. The prevalence of side effects in morphine group was higher than the acetaminophen group (RR: 2.14, 95% CI: 1.53-2.98, P< 0.0001).
Conclusion: Based on the findings, IV morphine sulfate and acetaminophen had equal effectiveness regarding acute renal colic pain management, but considering the significantly higher frequency of side effects, IV acetaminophen seems to be a more reasonable choice in this regard.
http://www.jept.ir/article_53321_99eb115daf6554af4fb5e91ab0acb469.pdf
2018-01-01
39
43
10.15171/jept.2017.33
Renal colic
Morphine
Acetaminophen
Pain management
Emergency Service
Seyyed Hosein
Montazer
1
Department of Emergency Medicine, Mazandaran University of Medical Science, Sari, Iran
AUTHOR
Behzad
Feizzadeh
2
Department of Urology, Mazandaran University of Medical Science, Sari, Iran
AUTHOR
Farzad
Bozorgi
3
Department of Emergency Medicine, Mazandaran University of Medical Science, Sari, Iran
AUTHOR
Seyed Mohammad
Hosseininejad
4
Department of Emergency Medicine, Mazandaran University of Medical Science, Sari, Iran
AUTHOR
Ayyoub
Barzegarnezhad
5
Department of Urology, Mazandaran University of Medical Science, Sari, Iran
AUTHOR
Iraj
Golikatir
6
Department of Emergency Medicine, Mazandaran University of Medical Science, Sari, Iran
AUTHOR
Fatemeh
Jahanian
7
Department of Emergency Medicine, Mazandaran University of Medical Science, Sari, Iran
AUTHOR
Hasan
Motamed
8
Department of Emergency Medicine, Mazandaran University of Medical Science, Sari, Iran
AUTHOR
Hamed
Aminiahidashti
hamedaminiahidashti@yahoo.com
9
Department of Emergency Medicine, Mazandaran University of Medical Science, Sari, Iran
LEAD_AUTHOR
Gupta R, Gupta A, Singh G, Suri A, Mohan SK, Gupta CL. PCNL--A comparative study in nonoperated and in previously operated (open nephrolithotomy/ pyelolithotomy) patients--a single-surgeon experience. Int Braz J Urol 2011; 37(6): 739-44.
1
Smith AD, Preminger G, Badlani G, Kavoussi LR. Smith’s Textbook of Endourology. 3rd ed. John Wiley & Sons; 2012.
2
Dave C. Nephrolithiasis. Updated Dec 3, 2016. http:// www.emedicine.com/med/topic3437.htm.
3
Rezakhaniha B, Safari Nezhad MR, Markazi Moghaddam N, Valimanesh HA, Abd Elahian M. The comparison of the efficay of commom pain management in acute renal colic. Annals of Military and Health Sciences Research 2004; 2(3): 381-5.
4
Masarani M, Dinneen M. Ureteric colic: new trends in diagnosis and treatment. Postgrad Med J 2007; 83(981): 469-72. doi: 10.1136/pgmj.2006.055913.
5
Kallidonis P, Liourdi D, Liatsikos E. Medical treatment for renal colic and stone expulsion. Eur Urol Suppl 2011; 10(5): 415-22. doi: 10.1016/j.eursup.2011.07.003.
6
Safdar B, Degutis LC, Landry K, Vedere SR, Moscovitz HC, D’Onofrio G. Intravenous morphine plus ketorolac is superior to either drug alone for treatment of acute renal colic. Ann Emerg Med 2006; 48(2): 173-81.
7
Bektas F, Eken C, Karadeniz O, Goksu E, Cubuk M, Cete Y. Intravenous paracetamol or morphine for the treatment of renal colic: a randomized, placebo-controlled trial. Ann Emerg Med 2009; 54(4): 568-74. doi: 10.1016/j.annemergmed.2009.06.501.
8
Romero V, Akpinar H, Assimos DG. Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol 2010; 12(2-3): e86-96.
9
Cattabriga I, Pacini D, Lamazza G, Talarico F, Di Bartolomeo R, Grillone G, et al. Intravenous paracetamol as adjunctive treatment for postoperative pain after cardiac surgery: a double blind randomized controlled trial. Eur J Cardiothorac Surg 2007; 32(3): 527-31. doi: 10.1016/j.ejcts.2007.05.017.
10
Remy C, Marret E, Bonnet F. State of the art of paracetamol in acute pain therapy. Curr Opin Anaesthesiol 2006; 19(5): 562-5. doi: 10.1097/01.aco.0000245285.30282.70.
11
Kesimci E, Gumus T, Izdes S, Sen P, Kanbak O. Comparison of efficacy of dexketoprofen versus paracetamol on postoperative pain and morphine consumption in laminectomy patients. Agri 2011; 23(4): 153-9. doi: 10.5505/agri.2011.86548.
12
Jahr JS, Lee VK. Intravenous acetaminophen. Anesthesiol Clin 2010; 28(4): 619-45. doi: 10.1016/j. anclin.2010.08.006.
13
Goodman Gilman A, Rall TW, Nies AS, Taylor P. Opioid analgesics and antagonists. In: Goodman and Gilman’s: The Pharmacological Basis of Therapeutics. New York: McGraw-Hill; 1990. p. 485-521.
14
Elvir-Lazo OL, White PF. The role of multimodal analgesia in pain management after ambulatory surgery. Curr Opin Anaesthesiol 2010; 23(6): 697-703. doi: 10.1097/ACO.0b013e32833fad0a.
15
Juhl GI, Norholt SE, Tonnesen E, Hiesse-Provost O, Jensen TS. Analgesic efficacy and safety of intravenous paracetamol (acetaminophen) administered as a 2 g starting dose following third molar surgery. Eur J Pain 2006; 10(4): 371-7. doi: 10.1016/j.ejpain.2005.06.004.
16
Morteza-Bagi HR, Amjadi M, Mirzaii-Sousefidi R. The comparison of apotel plus low dose of morphine and full dose of morphine in pain relief in patients with acute renal colic. Addict Health 2015; 7(1-2): 66-73.
17
Masoumi K, Forouzan A, Asgari Darian A, Feli M, Barzegari H, Khavanin A. Comparison of clinical efficacy of intravenous acetaminophen with intravenous morphine in acute renal colic: a randomized, double-blind, controlled trial. Emerg Med Int 2014; 2014: 571326. doi: 10.1155/2014/571326.
18
Grissa MH, Claessens YE, Bouida W, Boubaker H, Boudhib L, Kerkeni W, et al. Paracetamol vs piroxicam to relieve pain in renal colic. Results of a randomized controlled trial. Am J Emerg Med 2011; 29(2): 203-6. doi: 10.1016/j.ajem.2009.09.019.
19
Hyllested M, Jones S, Pedersen JL, Kehlet H. Comparative effect of paracetamol, NSAIDs or their combination in postoperative pain management: a qualitative review. Br J Anaesth 2002; 88(2): 199-214.
20
Azizkhani R, Pourafzali SM, Baloochestani E, Masoumi B. Comparing the analgesic effect of intravenous acetaminophen and morphine on patients with renal colic pain referring to the emergency department: A randomized controlled trial. J Res Med Sci 2013; 18(9): 772-6.
21
Serinken M, Eken C, Turkcuer I, Elicabuk H, Uyanik E, Schultz CH. Intravenous paracetamol versus morphine for renal colic in the emergency department: a randomised double-blind controlled trial. Emerg Med J 2012; 29(11): 902-5. doi: 10.1136/emermed-2011-200165.
22
ORIGINAL_ARTICLE
Epidemiological study of pregnant women admitted to the emergency department
Objective: Pregnancy is an important psychological and biological phenomenon in women’s life. Pregnancy has many complications jeopardizing the well-being of the mother and the child. Methods: In this retrospective study, the data including demographic information, chief complaint, the initial diagnosis, referral decision, final diagnosis, hospitalization outcome and pregnancy outcomes were studied on 239 pregnant women admitted to the emergency departments of the general hospitals of East Azerbaijan province. Results: The average age of patients was 27.54 years. The time period from the initial presentation to completely leave the emergency department was reported to be 3.66 hours on average. In this study, most patients (74.5%) did not have a history of abortion. Exploring the time of admission for all cases, most patients were admitted from 8 pm to 8 am (67.8%), and 32.2% were referred from 8 am to 8 pm. Concerning the time of pregnancy, 46.4% were at their second trimester of pregnancy. Most of the patients were admitted in cold seasons of the year. The most common chief compliant was abdominal pain with 32.2% frequency. In addition, the most frequent primary diagnoses were an acute abdomen and trauma at 25.5% and 14.2% respectively. Conclusion: Abdominal pain and acute abdomen have the most frequency as the chief compliant and initial diagnosis especially during the second trimester of pregnancy. In this regard, appropriate training and skillful staff are needed to deal with the complaints and complications of abdominal pain. More than half of pregnant women referred to the emergency departments were hospitalized or admitted to the intensive care unit (ICU). This signals the necessity of adequate facilities to provide proper care for this group.
http://www.jept.ir/article_46518_7cdd4b260818a1468d86c30778255e17.pdf
2018-01-01
44
47
10.15171/jept.2017.21
Pregnant women
Emergency Service
General hospitals
Seyedhossein
Ojaghihaghighi
1
Emergency Medicine Research Team,Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
Samad
Shams Vahdati
sshamsv@gmail.com
2
Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
Simin
Taghavi
simintagh@yahoo.com
3
Department of Gynecology, Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
Aydin
Rahimzade Jahandari
4
Emergency Medicine Research Team,Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
Pegah
Sepehri Majd
pegah.sm87@gmail.com
5
Emergency Medicine Research Team,Tabriz University of Medical Sciences, Tabriz, Iran
LEAD_AUTHOR
Mohammad
Mirza-Aghazadeh-Attari
6
Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
1. Spence NJ. The long-term consequences of childbearing physical and psychological well-being of mothers in later life. Res Aging 2008; 30(6): 722-51. doi: 10.1177/0164027508322575.
1
2. United Nations Secretary-General. Global strategy for women’s and children’s health. The Partnership for Maternal, Newborn and Child Health; 2010.
2
3. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014; 2(6): e323-33. doi: 10.1016/S2214-109X(14)70227-X.
3
4. AbouZahr C. Global burden of maternal death and disability. Br Med Bull 2003; 67(1): 1-11. doi: 10.1093/bmb/ ldg015.
4
5. Borthen I, Gilhus NE. Pregnancy complications in patients with epilepsy. Curr Opin Obstet Gynecol 2012; 24(2): 78- 83. doi: 10.1097/GCO.0b013e32834feb6a.
5
6. Nakimuli A, Nakubulwa S, Kakaire O, Osinde MO, Mbalinda SN, Kakande N, et al. The burden of maternal morbidity and mortality attributable to hypertensive disorders in pregnancy: a prospective cohort study from Uganda. BMC Pregnancy Childbirth 2016; 16: 205. doi: 10.1186/s12884-016-1001-1.
6
7. Moradi M. Pulmonary thromboembolism in pregnancy: Diagnostic imaging and related consideration. J Res Med Sci 2013;18(3):255-9.
7
8. Patel HC, Singh BB, Moitra M, Kantharia SL. Obstetricreferrals: scenario at a primary health centre in Gujarat. National Journal of Community Medicine 2012; 3(4): 711-14.
8
9. Fathi Najafi T, Latifnejad Roudsari R, Hejazi M. Iron supplementation protocols for iron deficiency anemia: a comparative review of iron regimens in three countries of India, Iran and England. Journal of Midwifery and Reproductive Health 2014; 2(1): 89-96. doi: 10.22038/ jmrh.2013.2088.
9
10. Ndidi E, Oseremen I. Reasons given by pregnant women for late initiation of antenatal care in the niger delta, Nigeria. Ghana Med J 2010; 44(2): 47-51.
10
11. Solanke D, Rathi C, Pandey V, Patil M, Phadke A, Sawant P. Etiology, clinical profile, and outcome of liver disease in pregnancy with predictors of maternal mortality: a prospective study from Western India. Indian Journal of Gastroenterol 2016; 35(6): 450-8. doi: 10.1007/s12664-016- 0704-6
11
12. Vigil-De Gracia P. Maternal deaths due to eclampsia and HELLP syndrome. Int J Gynaecol Obstet 2009; 104(2): 90- 4. doi: 10.1016/j.ijgo.2008.09.014.
12
13. Haram K, Svendsen E, Abildgaard U. The HELLP syndrome: clinical issues and management. A Review. BMC Pregnancy Childbirth 2009; 9: 8. doi: 10.1186/1471-2393-9-8. doi: 10.1186/1471-2393-9-8.
13
14. Brandenburg VM, Frank RD, Heintz B, Rath W, Bartz C. HELLP syndrome, multifactorial thrombophilia and postpartum myocardial infarction. J Perinat Med 2004; 32(2): 181-3. doi: 10.1515/JPM.2004.033.
14
15. Mehdizadeh A, Akbarian AR, Sarlak Z, Eghtesadi Eraghi P. Evaluation of acute abdomen in 100 pregnant women at teaching centers of iran university of medical sciences. Razi Journal of Medical Sciences 2003; 10(35): 433-9. [In Persian].
15
16. Kosai N, Amin-Tai H, Gendeh H, Salleh S, Reynu R, Taher M, et al. Pregnant and severe acute abdominal pain: A surgical diagnostic dilemma. Clin Ter 2015; 166(3): 110-3. doi: 10.7417/CT.2015.1839.
16
17. Kennedy A. Assessment of acute abdominal pain in the pregnant patient. Semin Ultrasound CT MR 2000; 21(1): 64-77. doi: 10.1016/S0887-2171(00)90014-3.
17
ORIGINAL_ARTICLE
Open vertical sagittal fracture patella with fracture lateral condyle femur: approach to a rare injury
Patellar fracture is a relatively uncommon fracture especially the vertical sagittal type. In cases of high energy trauma injury, it is usually associated with fracture of ipsilateral distal femur or proximal tibia. However, the combination of vertical sagittal fracture patella and ipsilateral fracture lateral condyle is very rare. This necessitates judicious diagnosis and appropriate management to ensure optimal functional outcome. Open reduction and internal fixation is the treatment of choice in managing these types of injuries. This should be followed by gradual mobilization of the affected knee joint. Weight bearing can be started once the fracture starts showing signs of union on X-rays. Literature search shows only one case report describing this pattern. The aim of this case report is to highlight the rarity of this injury, to understand the injury mechanism and surgical approach used for these injuries. The knowledge of this combination will help us manage these injuries so that good functional outcome is achieved
http://www.jept.ir/article_45212_702a9033218770d0580b0017d26157c1.pdf
2018-01-01
48
50
10.15171/jept.2017.01
Sagittal
Patella
Ipsilateral
Femoral condyle
Mohit Kumar
Arora
1
Department of Orthopedics, UCMS and GTB Hospital, Delhi University, India
LEAD_AUTHOR
Ela
Madaan
ela.madaan@gmail.com
2
Department of Orthopedics, UCMS and GTB Hospital, Delhi University, India
AUTHOR
1. Galla M, Lobenhoffer P. Patella fractures. Chirurg 2005; 76(10): 987-97. [In German].
1
2. Eric EJ. Fraturas do joelho. In: Rockwood CAJ, Green DP, Bucholz RW, eds. Fraturas em adultos. 3rd ed. Philadelphia: Lippincott; 1991. p. 1729–44.
2
3. Nummi J. Fracture of the patella. A clinical study of 707 patellar fractures. Ann Chir Gynaecol Fenn Suppl 1971; 179: 1-85.
3
4. Tandogan RN, Demirors H, Tuncay CI, Cesur N, Hersekli M. Arthroscopic-assisted percutaneous screw fixation of select patellar fractures. Arthroscopy 2002; 18(2): 156- 62. doi: 10.1053/jars.2002.30486.
4
5. Pailo AF, Malavolta EA, Santos AL, Mendes MT, de Rezende MU, Hernandez AJ, et al. Fraturas da patela: umadecada de tratamento no IOT-HC-FMUSP - parte1: analisefuncional. Acta Ortop Bras 2005; 13(5): 221-4. doi: 10.1590/S1413-78522005000500001.
5
6. Torchia ME, Lewallen DG. Open fractures of the patella. J Orthop Trauma 1996; 10(6): 403-9.
6
7. Larangeira JA, Bellenzier L, Rigo Vda S, Ramos Neto EJ, Krum FF, Ribeiro TA. Vertical open patella fracture, treatment, rehabilitation and the moment to fixation. J Clin Med Res 2015; 7(2): 129-33. doi: 10.14740/ jocmr2005w.
7
8. Kolmert L, Wulff K. Epidemiology and treatment of distal femoral fractures in adults. Acta Orthop Scand 1982; 53(6): 957-62.
8
9. Sasbou Y, Boussaidane M, Lukulunga LU, Azzouz M, Mhammdi Y, Benchebba D, et al. Lateral condylar fracture of the femur associated with sagittal vertical ipsilateral fracture of the patella. Pan Afr Med J 2015; 20: 218. doi: 10.11604/pamj.2015.20.218.6346. [In French].
9
ORIGINAL_ARTICLE
Heart attack or rhabdomyolysis?
Statins are commonly used drugs in the treatment of hyperlipidemia (HL), despite some undesirable side effects. These range from mild symptoms such as myopathy, muscle weakness and myalgia to severe muscle weakness associated with chronic myopathy and acute renal failure (ARF) as a result of rhabdomyolysis. The most serious and deadly side effect of statins is rhabdomyolysis. The case presented here is of a patient with rhabdomyolysis due to treatment with the antihyperlipidemic drug, atorvastatin.
http://www.jept.ir/article_46325_35f5d65ac2d27d84e84097a96d1776cc.pdf
2018-01-01
51
52
10.15171/jept.2017.02
Rhabdomyolysis
Atorvastatin
Heart attack
Statin
Mustafa
Bolatkale
dr.mustafa46@hotmail.com
1
Department of Emergency Medicine, Medipol University Hospital, İstanbul, Turkey
AUTHOR
Muhittin
İşsever
2
Department of Emergency Medicine, Medipol University Hospital, İstanbul, Turkey
AUTHOR
Ulaş
Karaoğlu
3
Department of Emergency Medicine, Medipol University Hospital, İstanbul, Turkey
AUTHOR
Ahmet Cagdas
Acara
4
Department of Emergency Medicine, Gaziemir State Hospital, Izmir, Turkey
LEAD_AUTHOR
Mehtap
Bulut
mbulu94@yahoo.com
5
Department of Emergency Medicine, Gaziemir State Hospital, Izmir, Turkey
AUTHOR
1. Yılmaz G, Çavuş T, Çakır H, Narlı E. Fibrat kullanımına bağlı rabdomiyoliz gelişimi ile ilişkili akut böbrek yetersizliği. Journal of Istanbul Faculty of Medicine 2011; 74(1): 13-14. [in Turkey].
1
2. Hansen KE, Hildebrand JP, Ferguson EE, Stein JH. Outcomes in 45 patients with statin-associated myopathy. Arch Intern Med 2005; 165(22): 2671-6. doi: 10.1001/archinte.165.22.2671.
2
3. Pasternak RC, Smith SC Jr, Bairey-Merz CN, Grundy SM, Cleeman JI, Lenfant C, et al. ACC/AHA/NHLBI clinical advisory on the use and safety of statins. Circulation 2002; 106(8): 1024-8. doi: 10.1161/01. CIR.0000032466.44170.44.
3
4. Liu KD, Chertow GM. Acute renal failure. In: Braunwald E, Kaspar DL, Hauser SL, Longo DL, Jameson JL, eds. Harrison’s Principles of Internal Medicine. 17th ed. New York: McGraw-Hill; 2008. pp. 1752-61.
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