میزان همخوانی یافته های سی تی اسکن شکم با یافته های آزمایش ادرار در کودکان دچار هماچوری در اثر ضربه غیرنافذ شکمی

Introduction: The present study compares the diagnostic accuracy of urinalysis with computed tomography (CT) scan in pediatrics with blunt abdominal trauma. The aim of this study was comparing the diagnostic value of urinalysis and abdominal CT scan with contrast, as the gold standard, for predicting probable abdominal organ injury in these patients. Methods: The present diagnostic accuracy study was done on children with blunt abdominal trauma aged less than 16 years who were presented to emergency department and both urinalysis and abdominal CT scan had been done for them. Demographic data, trauma mechanism, and results of urinalysis, ultrasonography and abdominal CT scan regarding abdominal organs were recorded. To evaluate the diagnostic power of urinalysis, statistical indices such as sensitivity, specificity, positive and negative predictive value were used. Results: In this study, 70 children under 16 years old who visited ED were evaluated. Mean age of the studied population was 7.1 ± 4.86 years and 48 of the patients (68.6%) were male. The correlation between hematuria and positive CT scan findings was confirmed. Sensitivity, specificity and positive and negative predictive values of hematuria were calculated to be 26.67%, 92.73%, 50% and 82.26%, respectively. Conclusion: Based on the results of the present study, although presence of hematuria has acceptable specificity, its sensitivity is very low compared to CT scan for prediction of abdominal organ injuries in pediatrics with blunt abdominal trauma. In other words, absence of hematuria is not a good reference to dismiss abdominal organ injury, yet its presence can be an indicator of serious injury. مقدمه: مطالعه حاضر به بررسی دقت تشخیصی نتیجه آزمایش ادرار در مورد کودکان دچار آسیب غیرنافذ شکم، در مقایسه با سی تی اسکن می پردازد. هدف از این مطالعه بررسی مقایسه ای میان ارزش تشخیصی آزمایش ادرار و سی تی اسکن شکم با کنتراست به عنوان روش استاندارد طلایی تشخیص در پیشگویی آسیب احتمالی احشای شکمی در این بیماران است. روش کار: مطالعه حاضر از نوع ارزیابی دقت تشخیصی بر روی کودکان دچار ترومای بلانت شکم کوچکتر از 16 سال که به بخش اورژانس مراجعه کرده بودند و برای آنها آزمایش ادرار و سی تی اسکن شکم درخواست شده بود، انجام گرفت. اطلاعات دموگرافیک، مکانیسم تروما، نتایج آزمایش ادرار، سونوگرافی و سی تی اسکن شکم در خصوص آسیب احشای شکمی ثبت گردید. برای سنجش قدرت تشخیصی بیماران توسط آزمایش ادرار از شاخصهای آماری حساسیت، ویژگی، ارزش اخباری مثبت و منفی استفاده شد. يافته ها: در این مطالعه تعداد70 کودک بین 0 تا 16 سال مراجعه کننده به بخش اورژانس وارد مطالعه شدند. 48 نفر (6/68 درصد) از بیماران پسر بودند. میانگین سنی ایشان 6/4±1/7 سال بود. در این مطالعه ارتباط بین وجود خون در ادرار و یافته های مثبت سی تی اسکن تایید شد. میزان حساسیت،ویژگی،ارزش اخباری مثبت و منفی به ترتیب 67/26 % و 73/92 % و 50 % و 26/82 % بدست آمد. نتيجه گيری: طبق نتایج مطالعه حاضر وجود هماچوری با وجود ویژگی قابل قبول، از حساسیت بسیار پایینی در مقایسه با سی تی اسکن در پیشگویی آسیب احشای شکمی در کودکان دچار ترومای بلانت شکم دارد. به بیانی دیگر عدم وجود هماچوری معیار مناسبی برای رد آسیب احشای شکمی نیست ولی وجود آن می تواند مطرح کننده آسیب جدی باشد

Rate of Blood Product Transfusion and its Complications in the Emergency Department

Introduction: Due to blood supply problems, the cost of blood processing, and the complications of blood transfusion, it is very important to observe the indications for blood transfusion. In addition, necessary precautions should be taken for blood transfusion. Therefore, this study was performed to evaluate the criteria for receiving blood products as well as transfusion complications in patients referring to the emergency department. Methods: This study was a descriptive-analytical and cross-sectional study. All patients who referred to Imam Hossein and Shohadaye Tajrish Hospitals and needed to receive blood products during 36 months from April 2016 to March 2018 were evaluated. The data collection tool was a researcher-made checklist that included demographic characteristics, injection indication, and transfusion complications. After collection, the data were entered into SPSS statistical software version 18 and analyzed using Chi-square and Fisher's exact tests. Results: The mean age of patients was 43.51 ± 20.05 years. Sex distribution showed that 61.5% were male. The results showed that the amount of blood products consumed was 2041.28±161.309 units for all patients and 410.89±52.056 units in the emergency department. O and AB blood groups had the highest and lowest frequencies, respectively. In terms of injection indication, trauma was the most common. A difference was observed between the amounts of reserved and consumed products in the emergency department: 357.25±62.105 units for packed cells, 123.33±28.238 units for fresh frozen plasma, 71.533±21.313 units for blood platelets, and 53.78±12.069 units for cryoprecipitate. In terms of complications, shivering (22 cases) was the most common. The results showed that the difference between the mean reserve of compressed blood cells in 2016 and 2017 was significant (P = 0.029). There was also a significant difference between reserved platelete units in 2016 and 2018 (P=0.031). Conclusion: Blood reservation should be done according to specific instructions, and quantitative and qualitative control in the field of blood reservation and consumption in medical centers is necessary. Also, reducing the number of unnecessary injections of blood product units to patients can be one of the effective factors in reducing the complications of blood transfusion.مقدمه: با توجه به مشکلات تهیه خون، هزینه فراوری خون، عوارض مصرف خون الزام به رعایت اندیکاسیون تزریق خون اهمیت زیادی دارد و باید احتیاطات لازم برای تزریق خون صورت پذیرد. لذا این مطالعه با هدف ارزیابی معیارهای دریافت فراورده های خونی و عوارض آن در بیماران مراجعه کننده به اورژانس انجام شده است. روش کار: این مطالعه به صورت توصیفی تحلیلی و مقطعی انجام گرفت. تمامی بیماران نیازمند به دریافت فراورده های خونی مراجعه کننده به بیمارستان های امام حسین و شهدای تجریش طی مدت 36 ماه از فروردین سال 1395 تا اسفند سال 1397 بررسی شدند. ابزار جمع آوری اطلاعات چک لیست محقق ساخته، شامل ویژگی های جمعیت شناختی، اندیکاسیون تزریق و عوارض ترانسفوزیون بود. داده ها پس از جمع آوری وارد نرم افزار آماری spss نسخه 18 شد و با استفاده از آزمونهای مجذور کای و دقیق فیشر تجزیه و تحلیل شد. یافته ها: میانگین سنی بیماران 20.05 ± 43.51 سال بود . توزیع جنسی نشان داد که %61.5 مرد بودند. نتایج نشان داد که میزان فراورده خون مصرفی در کل بیماران 161.309±2041.48 واحد و در بخش اورژانس 52.056±410.89 واحد بود. گروه خونی O و AB به ترتیب دارای بیشترین و کمترین فراوانی بود. از نظر اندیکاسیون تزریق، تروما بیشترین فراوانی را داشت. بین میزان سلول خونی فشرده رزرو شده و مصرفی در بخش اورژانس 62.105±375.25 واحد، پلاسمای تازه منجمد رزروی و مصرفی [1] 28.238±123.33واحد، بین میزان پلاکت خون[2] رزروی و مصرفی 21.313±71.533 واحد و برای کرایوپرسیپیتات[3] به طور متوسط 12.069±53.78 واحد تفاوت مشاهده شد. از نظر عوارض جانبی نیز لرز (22 مورد) بیشترین فراوانی را داشت. نتایج نشان داد که اختلاف بین میانگین رزرو سلول خونی فشرده [4] در سال 1395 و 1396 معنی‌دار بود (P=0.029). همچنین میانگین رزرو پلاکت‌ در سال های 1395 و 1397 اختلاف معنی داری داشت (P=0.031). نتیجه‌گیری: رزرو خون باید بر اساس دستورالعمل مشخصي انجام شود و كنترل كمی و كيفي در زمينه رزرو و مصرف خون در مراكز درماني امري لازم مي باشد. همچنین کاهش تعداد واحدهای تزریقی غیرضروری به بیماران می تواند یکی ازعوامل موثر در کاهش میزان خطرات تزریق خون باشد. &nbsp

Quantitative and Spatial Analysis of the Spatial Pattern of Wild Cherry (Prunus avium L.) in Hyrcanian Forests of Iran (Case Study: Forest Management Plan of Hajikola-Tirankoly)

Knowing spatial pattern of plant communities is necessary to recognition of forest ecology and management. In order to investigation on  the spatial distribution pattern of wild cherry, forest management plan of Hajikola-Tirancoly in Mazandaran Province was selected. The locations of Prunus avium L.individuals with 100% inventory were recorded through GPS equipment in three areas of case study such as: Fagus type, protective area and plantation area. Qualitative characteristic of trees crown (symmetrical or unsymmetrical) and diameter at breast height was recorded. In order to achive spatial structure, landscape analysis and metrics in class level ( with symmetrical and unsymmetrical crown) was applied using Fragstats and Arc Gis softwares. The results indicated that number of Prunus avium L. were 160 trees in our case study. Highest and lowest distance among trees was observed 67 and 121 meters, respectively. The results of metrics analysis showed that the distribution pattern of wild cherry in Fagus type was clumped pattern and protective area was uniform. The results of metrics Shannon- Wieners evenness (uniformity) and Simpson’s diversity showed that the highest diversity and spatial arrangement was in Fagus type

The comparison of total capacity antioxidant in the serum of people with pterygium and control subjects

AIM: To investigate the comparison of total antioxidant capacity in the serum of patients with pterygium and control subjects.METHODS: This case-control study was conducted on all persons referred to Ophthalmology Clinic of teaching Hospital of Vali-Asr(peace upon to him)with clinical symptoms of pterygium during the year 2016. The control group was selected among patients referred to the Ophthalmology Clinic of Vali-Asr(peace without pterygium)that the two groups were matched in terms of age, gender and place of residence. Sixty-six persons \〖31 people(47%)in patient group and 35 people(53%)in the control group\〗 were enrolled by convenience sampling. Venous blood sample was taken from all patients after the sampling using ferric reducing antioxidant power(FRAP); FRAP- as a quick 10min measurement, the antioxidant power measurement of samples according to the conversion of ferric iron(Fe3+)to ferrous iron(Fe2+)was checked. The collected data ware entered to software SPSS 21 and were analyzed by chi-square and Mann-Whitney tests at the level of α =0.05.RESULTS: The mean of antioxidant capacity in patients was 842.55±161.46 μmol/L and antioxidant capacity in healthy controls was 856.77±209.41 μmol/L(P=0.8). In the comparison of mean serum antioxidant capacity in healthy individuals and in the serum of people with pterygium based on gender the results showed that the antioxidant capacity mean in male control subjects has been 894.05±176.82 μmol/L and in females control 780.01±118.33 μmol/L that the observed difference have been reported statistically significant(P=0.008)but the other comparison according the gender between cases and control does not show any significant difference.CONCLUSION: The results of this study showed that the full level of serum antioxidant capacity in patients has been less than the mean of antioxidant capacity in control subjects, however the observed difference has not been significant. The results of this study were consistent with basic results carried out on the damaging effects of oxidative stress in the pterygium pathogenesis. Recommending diet with minerals and vitamins containing antioxidants may be preventing the onset and progression of pterygium

Effects of atorvastatin on biomarkers of acute kidney injury in amikacin recipients: A pilot, randomized, placebo-controlled, clinical trial

Background: The most common clinical indication of aminoglycosides (AG) is the treatment of serious Gram-negative infections. The aim of this study was to evaluate plausible effects of atorvastatin on the biomarkers of acute kidney injury (AKI) in patients receiving amikacin. Materials and Methods: In this double-blinded randomized clinical trial, fifty patients (25 in each group) receiving amikacin (15 mg/kg/day) were randomly assigned to either atorvastatin (40 mg/day) or placebo (40 mg/day) groups for 7 days. Blood urea nitrogen (BUN), serum creatinine (SCr), and urinary neutrophil gelatinase-associated lipocalin (NGAL) levels were measured at days 0, 1, and 7 of amikacin treatment. Results: During the study period, 4 (8%) patients including two patients in each atorvastatin and placebo group experienced AKI. Urine NGAL/urine Cr did not change significantly between and within placebo and atorvastatin groups during the study period. Similarly, the mean changes in SCr, BUN, and urine NGAL/urine Cr values did not differ significantly between and within patients with and without AKI. Conclusion: Our data suggested that the changing pattern of urine NGAL/urine Cr ratio did not differ significantly between the atorvastatin and placebo groups during the early phase of amikacin treatment

Medication errors in patients with enteral feeding tubes in the intensive care unit

Objective: Most patients admitted to Intensive Care Units (ICU) have problems in using oral medication or ingesting solid forms of drugs. Selecting the most suitable dosage form in such patients is a challenge. The current study was conducted to assess the frequency and types of errors of oral medication administration in patients with enteral feeding tubes or suffering swallowing problems. Methods: A cross-sectional study was performed in the ICU of Shahid Sadoughi Hospital, Yazd, Iran. Patients were assessed for the incidence and types of medication errors occurring in the process of preparation and administration of oral medicines. Findings: Ninety-four patients were involved in this study and 10,250 administrations were observed. Totally, 4753 errors occurred among the studied patients. The most commonly used drugs were pantoprazole tablet, piracetam syrup, and losartan tablet. A total of 128 different types of drugs and nine different oral pharmaceutical preparations were prescribed for the patients. Forty-one (35.34%) out of 116 different solid drugs (except effervescent tablets and powders) could be substituted by liquid or injectable forms. The most common error was the wrong time of administration. Errors of wrong dose preparation and administration accounted for 24.04% and 25.31% of all errors, respectively. Conclusion: In this study, at least three-fourth of the patients experienced medication errors. The occurrence of these errors can greatly impair the quality of the patients' pharmacotherapy, and more attention should be paid to this issue

Antibiotic use during the first 6 months of COVID-19 pandemic in Iran : a large-scale multi-centre study

WHAT IS KNOWN AND OBJECTIVE: Although antibiotics are ineffective against viral infections, epidemiological studies have revealed that the COVID‐19 pandemic resulted in the overuse of antibiotics and disruption of antimicrobial stewardship programmes. We investigated the pattern of antibiotic use during the first 6 months of the COVID‐19 pandemic in Iran. METHODS: A multi‐centre retrospective study was designed to investigate the use of 16 broad‐spectrum antibiotics in 12 medical centres. The rate of antibiotic use was calculated and reported based on the Defined Daily Dose (DDD) per 100 hospital bed‐days. The bacterial co‐infection rate was also reported. RESULTS AND DISCUSSION: Totally, 43,791 hospitalized COVID‐19 patients were recruited in this study. It was found that 121.6 DDD of antibiotics were used per 100 hospital bed‐days, which estimated that each patient received approximately 1.21 DDDs of antibiotics every day. However, the bacterial co‐infections were detected only in 14.4% of the cases. A direct correlation was observed between the rate of antibiotic use and mortality (r[142] = 0.237, p = 0.004). The rate of antibiotic consumption was not significantly different between the ICU and non‐ICU settings (p = 0.15). WHAT IS NEW AND CONCLUSION: In this study, widespread antibiotic use was detected in the absence of the confirmed bacterial coinfection in COVID‐19 patients. This over‐consumption of broad‐spectrum antibiotics may be associated with increased mortality in hospitalized COVID‐19 patients, which can be an alarming finding