Intraperitoneally located tip of femoral vein catheter; clinical suspicion for avoidance of unnecessary laparotomy

Central venous catheterization is a common procedure in critical care and trauma patients. Complications are not rare and in some studies more than 15 incidence has been reported (1). Femoral vein is one of the commonest site for this purpose yet it carries complications, such as infection and misplacement. The current study reports an unexpected secondary malposition of right femoral CVC in the peritoneal cavity. It was concluded that in any case of acute abdominal issues, following insertion of femoral venous catheter, evaluation of catheter misplacement by the means of contrast injection through it can be helpful for better diagnosis, and may help avoid unnecessary surgical interventions. © 2017, Anesthesiology and Pain Medicine

Intraperitoneally located tip of femoral vein catheter; clinical suspicion for avoidance of unnecessary laparotomy

Central venous catheterization is a common procedure in critical care and trauma patients. Complications are not rare and in some studies more than 15 incidence has been reported (1). Femoral vein is one of the commonest site for this purpose yet it carries complications, such as infection and misplacement. The current study reports an unexpected secondary malposition of right femoral CVC in the peritoneal cavity. It was concluded that in any case of acute abdominal issues, following insertion of femoral venous catheter, evaluation of catheter misplacement by the means of contrast injection through it can be helpful for better diagnosis, and may help avoid unnecessary surgical interventions. © 2017, Anesthesiology and Pain Medicine

Gastrointestinal presentation in a patient with COVID-19 without respiratory tract symptoms: A case report from Qom, Iran

Introduction: Considering the increasing number of patients referred to gastroenterology clinics, we report a suspected case of coronavirus disease 2019 (COVID-19) with only gastrointestinal (GI) presentation in Qom, Iran. Case Presentation: A 74-year-old man with epigastric pain, diarrhea and vomiting for one week was treated, based on the routine abdominal treatment protocol. Since all GI symptoms were resistant to therapy, we decided to perform laboratory assays for a more accurate diagnosis of the disease. Considering the persistence of abdominal pain and nausea, abdominal and pelvic computed tomography (CT) scans, as well as endoscopy and colonoscopy, were performed. After performing the chest CT scan, we noticed the involvement of the lungs. The patient did not have any respiratory symptoms, and at the time of his hospitalization, the COVID-19 epidemic had been reported in Iran. With the progression of the disease, he started to experience mild fever (38°C). Using a specific COVID-19 kit, he was diagnosed with COVID-19 after precise evaluations. However, without any medications, all of his symptoms subsided after 2-3 weeks. Conclusions: It is important for all physicians to know that some pure GI symptoms, which are resistant to therapy, may be the only symptoms in suspected COVID-19 patients. Timely diagnosis and isolation of these patients can guarantee population to avoid the spread of this highly contagious infection. © 2020, Author(s)

Clinical manifestation of patients who died due to COVID-19; A retrospective study from Qom-Iran

Background: The coronavirus disease 2019 (COVID-19) has become a pandemic health problem worldwide. In this study, we attempted to explain the clinical and laboratories characteristics of non-surviving patients, to identify the probable factors affecting disease progression. Methods: In a retrospective study, we assessed the data from dead adult patients who were hospitalized and laboratory diagnosed with COVID-19 during March 2020. The data were obtained from electronic medical records. Moreover, a checklist including demographic, clinical, laboratorial, imaging, and treatment data was completed for each one of the patients. In case of lack of information, a member of the research team contacted the first-degree relatives via phone. Results: Totally, 50 patients were enrolled in this study. The mean age was 68.0 ± 14.1 years. Of them, 29 (58) patients were male. Notably, the median (IQR) hospitalization time was 4.0 (2.7�6.2) days and the duration between the first symptoms to death was 10.0 (5.0�14.5) days. Also, pre-existing morbidity was reported in 42 (84) patients, and hypertension was the most common one with 28 (54) patients. Interestingly, body temperature more than 37.5°C was reported in only 20 (40) patients. Nevertheless, neutrophilia (�7109/L) and lymphopenia (<1.0 109/L) were observed in 27 (54) and 29 (58) patients, respectively. Also, elevated levels of creatinine, lactate dehydrogenase (LDH), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were common, which may be indicators of aggravation of the patients� status. Conclusion: Besides age and underlying diseases, elevated creatinine level, neutrophil count, and the inflammatory indices along with the reduced lymphocyte count can be considered as indicators of disease progression. Hence, they should be considered for admission and surveillance of patients. © 2020 Academy of Medical Sciences of I.R. Iran. All rights reserved

Evaluation of Pressure Distribution in Buried Pipes with Liquid in the Explosion

In this Paper, a parametric study on pipes buried in soil was performed illustrating the results of blast loading. Effects of various parameters such as the physical properties of water, oil, gas, air, soil, pipes, and TNT have been investigated. The arbitrary Lagrangian-Eulerian (ALE) method was employed using LS-DYNA software. The maximum pressure in a buried pipe explosive was observed at an angle of about 0° to 45° and the minimum pressure occurred at an angle of about 45° to 90°. Therefore, all figures in this study illustrate that fluid pressure levels in buried pipes can help in their stabilization. In generally, by increasing the 1.23 times of liquid density under the explosion, the pressure levels in the soil decreased by 1.3 percent. The gas pressure has been increasing more than oil and water pipes 39.73 and 40.52 percent, respectively