Spontaneous Spinal Epidural Hematoma; a Case Report

Spontaneous spinal epidural hematoma (SSHE) is a rare entity can have several reasons. Its prevalence in population is 0.1 per 100,000 with the male to female ratio of 1/4:1. For the first time Jackson in 1869 reported a case of SSHE and after that it was declared as several hundred cases in literatures. Here, a case of SSHE was reported in a 52 year-old male referred to emergency department following severe low back pain

Development of an Easy-to-Use Tool for the Assessment of Emergency Department Physical Design

Physical design of the emergency department (ED) has an important effect on its role and function. To date, no guidelines have been introduced to set the standards for the construction of EDs in Iran. In this study we aim to devise an easy-to-use tool based on the available literature and expert opinion for the quick and effective assessment of EDs in regards to their physical design. For this purpose, based on current literature on emergency design, a comprehensive checklist was developed.  Then, this checklist was analyzed by a panel consisting of heads of three major EDs and contradicting items were decided. Overall 178 crude items were derived from available literature. The Items were categorized in to three major domains of Physical space, Equipment, and Accessibility. The final checklist approved by the panel consisted of 163 items categorized into six domains. Each item was phrased as a “Yes or No” question for ease of analysis, meaning that the criterion is either met or not.

Validation of CRASH Model in Prediction of 14-day Mortality and 6-month Unfavorable Outcome of Head Trauma Patients

Introduction: To date, many prognostic models have been proposed to predict the outcome of patients withtraumatic brain injuries. External validation of these models in different populations is of great importancefor their generalization. The present study was designed, aiming to determine the value of CRASH prognosticmodel in prediction of 14-day mortality (14-DM) and 6-month unfavorable outcome (6-MUO) of patients withtraumatic brain injury. Methods: In the present prospective diagnostic test study, calibration and discriminationof CRASH model were evaluated in head trauma patients referred to the emergency department. Variablesrequired for calculating CRASH expected risks (ER), and observed 14-DM and 6-MUO were gathered. Then ERof 14-DM and 6-MUO were calculated. The patients were followed for 6 months and their 14-DM and 6-MUOwere recorded. Finally, the correlation of CRASH ER and the observed outcome of the patients was evaluated.The data were analyzed using STATA version 11.0. Results: In this study, 323 patients with the mean age of 34.0´s 19.4 years were evaluated (87.3% male). Calibration of the basic and CT models in prediction of 14-day and6-month outcome were in the desirable range (P Ç 0.05). Area under the curve in the basic model for predictionof 14-DM and 6-MUO were 0.92 (95% CI: 0.89–0.96) and 0.92 (95% CI: 0.90–0.95), respectively. In addition,area under the curve in the CT model for prediction of 14-DM and 6-MUO were 0.93 (95% CI: 0.91–0.97) and0.93 (95% CI: 0.91–0.96), respectively. There was no significant difference between the discriminations of thetwo models in prediction of 14-DM (p Æ 0.11) and 6-MUO (p Æ 0.1). Conclusion: The results of the presentstudy showed that CRASH prediction model has proper discrimination and calibration in predicting 14-DMand6-MUO of head trauma patients. Since there was no difference between the values of the basic and CT models,using the basic model is recommended to simplify the risk calculations

Emergency Department Performance Indexes Before and After Establishment of Emergency Medicine

Introduction: Emergency department performance index (EPI) greatly influences the function of other hospital’s units and also patient satisfaction. Recently, the Iranian Ministry of Health has defined specific national EPI containing five indexes. In the present study, the performance indexes of emergency department (ED) in one educational hospital has been assessed before and after establishment of emergency medicine. Methods: In the present cross-sectional study the ED of Shohadaye Tajrish Hospital, Tehran, Iran has been assessed during one-year period from March 2012 to February 2013. The study was divided into two six-month periods, before and after establishment of emergency medicine. Five performance indexes including: the percentage of patients were disposed during 6-hour, leaved the ED in a 12-hour, had unsuccessful cardiopulmonary resuscitations (CPR), discharged against medical advice, and the mean time of triage were calculated using data of department of medical records on daily patients’ files. Then, Mann-Whitney U test was used to make comparisons at P<0.05. Results: The average triage time decreased from 6.04 minutes in the first six months to 1.5 minutes in the second six months (P=0.06). The percentage of patients leaving the ED in a 12-hour decreased from 97.3% to 90.4% (P=0.004). However, the percentage of disposed patients during 6-hour (P=0.2), unsuccessful CPR (P=0.34) and discharged against medical advice (P=0.42) did not differ between the two periods. Conclusion: It seems that establishment of emergency medicine could be able to improve ED performance indexes such as time to triage and leave in a 12-hour period.

The Risk of Venous Thromboembolism with Different Generation of Oral Contraceptives; a Systematic Review and Meta-Analysis

Introduction: Oral contraceptives (OCs) are considered as one of the most common risk factor of venous thromboembolism (VTE) in child bearing age. Some of the recent researches indicate that the odds of VTE may be even higher with newer generations of OCs. The present meta-analysis was designed to evaluate the effect of different generation of OCs on the occurrence of VTE. Methods: Two researchers independently ran a thorough search in Pubmed, ISI Web of Science, EMBASE, CINAHL and Scopus databases regarding study keywords including thromboembolic event, thromboembolism, embolism, thromboembolic, thrombotic and thrombosis, combined with oral contraceptive. The outcomes were the incidence of diagnosed thromboembolism, such as deep vein thrombosis, pulmonary embolism and cerebral venous thrombosis. Based on the heterogeneity of the studies, random effect model was used and pooled odds ratio was reported. Results: Three cohort and 17 case-control studies with 13,265,228 subjects were entered into meta-analysis. Analysis showed that the odds of VTE in women taking OCs are more than three-fold (OR=3.13; 95% CI: 2.61-3.65). The risk of VTE in women taking first-, second- and third-generation OCs are 3.5 fold (OR=3.48; 95% CI: 2.01-4.94), 3 fold (OR=3.08; 95% CI: 2.43-3.74) and 4.3 fold (OR=4.35; CI: 3.69‒5.01), respectively. Conclusion: It seems that the risk of VTE is not same between different generations of OCs, so that third-generation has highest risk. Taking second and third-generation OCs increases the risk of VTE up to 3 and 4.3 fold, respectively. The researchers of the present study suggest that more clinical trials be designed in relation to the effect of newer generations of OCs in different communities.

Effects of Echinacea purpurea Extract on Sperm Characteristics and Hematology Following Testicular Ischemia-Reperfusion Injury in Rat

Objectives: The aim of the present study was to investigate the effects of Echinacea purpurea extract on sperm characteristics following testicular ischemia/reperfusion (I/R) injury in rats. Materials and Methods: To evaluate this hypothesis, 30 adult rats were randomly divided into 5 groups: sham operations, I/R group and 3 groups of treatment with E. purpurea extract (25, 50 and 100 mg/kg). To achieve testicular I/R, torsion (720°) of spermatic cord for 2 hours and reperfusion of the tests for 24 hours were performed. Treatment was done by intraperitoneal injection of 3 different doses of E. purpurea extract, 1 hour after ischemia. Then, the sperm count, motility and mobility were determined. Results: There was a significant increase in sperm count, motility and mobility in treatment groups compared to I/R group (P<0.05). Treatment with E. purpurea extract (25, 50 and 100 mg/kg) significantly attenuated the adverse effect of testicular I/R on sperm mortality compared to the control group (P < 0.05). No significant difference was observed in hemograms. Conclusions: These results confirmed beneficial effects of E. purpurea extract on sperm characteristics after testicular I/R injury in rats

مقایسه میزان رضایتمندی مراجعین اورژانس مرکز شهدای تجریش قبل و بعد از استقرار طرح تحول نظام سلامت

Introduction: After long discussions, carrying out health sector evolution (HSE) plan began on May 5, 2014 throughout Iran. Shohadaye Tajrish Hospital, Tehran, was also included in this plan. This study aimed to evaluate the level of emergency department patient satisfaction, before and after running this plan. Methods: This cross-sectional study analyzed the data extracted from a standard questionnaire filled out by the patients presented to the emergency department of Shohadaye Tajrish Hospital over 6-month periods before and after the beginning of HSE. Results: 3665 patients were surveyed. After the execution of the plan, satisfaction decreased significantly regarding pre-discharge training (p = 0.03), hospitalization room condition (p = 0.0002), restroom sanitation (p = 0.007), waiting time to be visited by the physician (p = 0.04), accuracy and duration of physical examination (p = 0.007), feeling confident and desirable outcome (p = 0.03), commitment to religious and moral principles (p = 0.01), and handling financial affairs (p = 0.03). Conclusion: Based on the results of the present study, after execution of HSE plan, patient satisfaction has decreased significantly regarding pre-discharge training, hospitalization room condition, restroom sanitation, timely visit of the physicians, accuracy and duration of physical examination, suggestions for wellbeing of the patient, handling financial affairs, and commitment to religious and moral principles. مقدمه: سرانجام طرح تحول نظام سلامت بعد از مدت‌ها بحث و بررسی در تاریخ 15 اردیبهشت 1393 در بیمارستان شهدای تجریش به طور همزمان با سایر بیمارستان های کشور به اجراء در آمد. این مطالعه با هدف مقایسه میزان رضایتمندی مراجعین بخش اورژانس مرکز شهدای تجریش، قبل و بعد از طرح تحول نظام سلامت طراحی گردیده است. روش کار: مطالعه حاضر یک پژوهش مقطعی می باشد که با ارزیابی نتایج حاصل از پرسشنامه های تکمیل شده توسط مراجعین بخش اورژانس مرکز شهدای تجریش در یک دوره 6 ماهه قبل و یک دوره 6 ماهه بعد از آغاز طرح تحول نظام سلامت انجام گرفته است. پرسشنامه های مورد استفاده شامل چک لیستهای استاندارد وزارت بهداشت جهت سنجش میزان رضایتمندی بود. يافته ها: در پژوهش حاضر داده های حاصل از نظرسنجی 3665 بیمار مورد ارزیابی قرار گرفت. در دوره پس از اجرای طرح، میزان رضایتمندی در خصوص ارائه آموزش های قبل از ترخیص (0/03=p)، وضعیت اتاق های بستری (0/0002=p)، نظافت سرویس های بهداشتی (0/007=p)، انجام به موقع ویزیت پزشکان (0/04=p)، صرف دقت و زمان برای معاینه (0/007=p)، توصیه در خصوص بهبودی و بهزیستی بیمار (0/01=p)، احساس اطمینان خاطر و نتیجه مطلوب (0/03=p)، وضعیت رسیدگی به امور مالی (0/03=p) و میزان رعایت موازین شرعی و اصول اخلاقی (0/01=p) به طور چشمگیری کاهش یافته بود. نتيجه گيری: بر اساس نتایج مطالعه حاضر، پس از اجرای طرح تحول سلامت رضایتمندی از ارائه آموزش های قبل از ترخیص، وضعیت اتاق های بستری، نظافت سرویس های بهداشتی، ویزیت به موقع پزشکان، صرف دقت و زمان برای معاینه، توصیه های در خصوص بهبودی و بهزیستی بیمار، وضعیت رسیدگی به امور مالی و همچنین میزان رعایت موازین شرعی و اصول اخلاقی به طور معنی داری کاهش یافته بود

ارزیابی شاخص های عملکردی بخش اورژانس

Introduction: The importance of evaluating performance indicators in the emergency department, as one of the most important departments of hospital, is obvious to everyone. Therefore, in this study we aimed to appraise the five performance indicators, approved by the ministry of health, in Shohadaye Tajrish hospital, Tehran, Iran. Methods: In a descriptive cross-sectional study based on the profiles of all the patients admitted to the emergency department, performance indicators in the emergency department were evaluated. The study was divided into 2 parts about the establishment of emergency medicine system and training the medical staff: the first 6 months of 1392 and the second. Then these 2 periods were compared using Mann-Whitney U test while P&lt; 0.05 was considered as the level of significance. Results: Of the studied indicators, mean triage time was 6.04 minutes in the first 6 months which was reduced to 1.5 minutes in the second 6 months (p=0.016). In addition, the percentage of patients who moved out of the department in 12 hours was lowered from 97.3% in the first period to 90.4% in the second (p=0.004). While, the percentage of patients who were decided upon in 6 hours (p=0.2), unsuccessful CPR percentage (p=0.34) and patients discharged against medical advice (p=0.42) showed no significant difference. Conclusion: The results of this study showed that the establishment of the emergency medicine system in the emergency department could lead to more efficient triage. Due to the differences made after their establishment including: different pattern of the patients admitted, increased stay of the patients in the department due to their need for prolonged intensive care, a raise in patient referral to the hospital by pre-hospital services and a higher percentage of occupied hospital beds, other indicators have not shown a significant improvement.مقدمه: اهمیت ارزیابی شاخص‌های عملکردی بخش اورژانس به عنوان یکی از مهمترین بخش‌‌های بیمارستانی بر همگان آشکار است. لذا در پژوهش حاضر اقدام به ارزیابی شاخص‌های پنجگانه مصوب وزارت بهداشت در اورژانس بیمارستان شهدای تجریش گردید. روش کار: در یک مطالعه توصیفی-مقطعی بر مبنای پرونده تمامی بیماران مراجعه کننده به اورژانس شاخص‌های عملکردی بخش اورژانس ارزیابی گردید. بر اساس استقرار رزیدنت‌های طب اورژانس و ارائه آموزش‌ به پرسنل کادر درمان؛ مطالعه به دو دوره شش ماه اول و دوم سال 1391 تقسیم شد. سپس با استفاده از آزمون Mann-Whitney U با در نظر گرفتن 0/05&gt;p مقایسات بین این دو زمان انجام پذیرفت. يافته ها: از بین شاخص‌های مورد ارزیابی، میانگین زمان تریاژ در شش ماه اول 6/04 دقیقه بود که در شش ماه دوم به 1/5 دقیقه تقلیل یافت (0/016=p). همچنین درصد بیماران خارج شده از بخش ظرف 12 ساعت از 97/3 در شش ماه اول به 90/4 درصد در شش ماه دوم کاهش یافت (0/004=p). اما درصد بیماران تعیین تکلیف شده طی 6 ساعت (0/2=p)، درصد موارد احیا غیرموفق (0/34=p) و درصد ترک بیمار با مسئولیت شخصی (0/42=p) تفاوتی بین دو دوره مورد بررسی نداشت. نتيجه گيری: یافته های پژوهش حاضر نشان داد استقرار مجموعه طب اورژانس در بخش اورژانس می تواند موجب تریاژ کاراتر شود اما با توجه به تغییرات ایجاد شده بعد از استقرار این رشته شامل: تغییر الگویی بیماران بستری شده و تغییر به سمت افزایش بیمارن بدحال تر، افزایش ماندگاری بیماران به دلیل نیاز به مراقبت های ویژه و طولانی تر، افزایش ارجاع بیماران توسط سرویس پیش بیمارستانی و افزایش درصد اشغال تخت های بیمارستان سایر شاخص ها بهبود معنی داری نداشته اند

Human monkeypox: history, presentations, transmission, epidemiology, diagnosis, treatment, and prevention

Human monkeypox is a zoonotic infection that is similar to the diseases caused by other poxviruses. It is endemic among wild rodents in the rainforests of Central and Western Africa, and can be transmitted via direct skin contact or mucosal exposure to infected animals. The initial symptoms include fever, headache, myalgia, fatigue, and lymphadenopathy, the last of which is the main symptom that distinguishes it from smallpox. In order to prevent and manage the disease, those who are infected must be rapidly diagnosed and isolated. Several vaccines have already been developed (e.g., JYNNEOS, ACAM2000 and ACAM3000) and antiviral drugs (e.g., cidofovir and tecovirimat) can also be used to treat the disease. In the present study, we reviewed the history, morphology, clinical presentations, transmission routes, diagnosis, prevention, and potential treatment strategies for monkeypox, in order to enable health authorities and physicians to better deal with this emerging crisis