Medical Errors in Emergency Department; a Letter to Editor

Medical error is the third leading cause of death in the United States of America and almost 100000 patients lose their life due to medical errors every year

Phantom Limb Sensation (PLS) and Phantom Limb Pain (PLP) among Young Landmine Amputees

How to Cite This Article: Poor Zamany Nejat Kermany M, Modirian E, Soroush M, Masoumi M, Hosseini M. Phantom Limb Sensation (PLS) and Phantom Limb Pain (PLP) Among Young Landmine Amputees. Iran J Child Neurol. Summer 2016; 10(3):42-47. AbstractObjectiveTo determine the frequency of phantom limb sensation (PLS) and phantom limb pain (PLP) in children and young adults suffering landmine-related amputation.Materials & MethodsAll youths with amputation due to landmine explosions participated in this study. The proportions of patients with phantom limb sensation/pain, intensity and frequency of pain were reported. Chi square test was used to examine the relationship between variables. Comparison of PLP and PLS between upper and lower amputation was done by unpaired t-test.ResultsThere were 38 male and 3 female with the mean age of 15.8±2.4yr. The mean interval between injury and follow-up was 90.7±39.6 months. Twelve (44.4%) upper limb amputees and 11 (26.8%) lower limb amputees had PLS. Nine (33.3%) upper limb amputees and 7 (17.1%) lower limb amputees experienced PLP. Of 27 upper limb amputees, 6 (14.6%) and among 15 lower limb amputees, 6 (14.6%) had both PLS and PLP. One case suffered amputation of upper and lower limbs and was experiencing PLS and PLP in both parts. PLS had a significant difference between the upper and lower amputated groups. Significant relationship was observed between age of casualty and duration of injury with PLP.ConclusionPhantom limb sensation and pain in young survivors of landmine explosions appear to be common, even years after amputation. References Nikolajsen L, Jensen TS. Phantom limb pain. Br J Anaesth 2001; 87:107-16.Tseng CC, Chen PY, Lee YC. Successful treatment of phantom limb pain and phantom limb sensation in the traumatic amputee using scalp acupuncture. Acupunct Med 2014;32(4):356-8.Davis RW. Phantom sensation, phantom pain, and stump pain. Arch Phys Med Rehabil 1993;74:79–91.Jensen TS, Krebs B, Nielsen J, Rasmussen P. 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The association between serum 25-hydroxyvitamin D level and recurrent falls in the elderly population: a cohort study

Introduction: Serum vitamin D concentration is a major contributing factor for increasing the risk of fall and fall-related injuries in older adults. However, when prescribed and supplemented for these populations, the outcomes are controversial, and in several cases no improvement has been reported in reducing the risk of recurrent falls. This study aimed to examine the association between serum vitamin D concentration and recurrent falls in Iranian older adults. Methods: This cohort study was conducted in the emergency departments of two university hospitals. A cohort of 82 elderly participants aged over 60 and suffered from an unintentional episode of falling was evaluated six months after their first ED visit. A structured, self-administered checklist was developed to obtain the participants’ demographic and clinical information. Participants also were asked about any recurrent fall experience during follow-up. Results: The mean (SD) age of the study population was 75 (8). Over half of the participants were male (57.3%). The mean (median) serum 25-hydroxyvitamin D (25 (OH)D) concentration was 38 (34) ng/ml. Mean serum 25(OH)D levels varied slightly between gender groups (p=0.450). An inverse but insignificant association was found between the age of participants and their serum 25(OH)D levels (r=-0.03, p=0.7). A small but insignificant association also was found between the mean serum 25(OH)D level and the number of recurrent falls in elderly patients irrespective of their age, gender, or physical activity groups (OR=1.008, p=0.992). Conclusion: In contrast to previous studies, no significant association of serum 25(OH)D concentration was found with recurrent falls in Iranian older adults. Keywords: 25-hydroxyvitamin D,falls, Vitamin D insufficiency, Iran, Elderl

Excessive endotracheal tube cuff pressure: Is there any difference between emergency physicians and anesthesiologists?

Introduction. Endotracheal tube (ETT) cuff pressure is not usually measured by manometer and the providers rely on their estimation of cuff pressure by palpating the pilot balloon. In this study, we evaluated the pressure of ETT cuffs inserted by emergency physicians or anesthesiologists, and assessed the accuracy of manual pressure testing in different settings using a standard manometer. Methods. In this cross sectional study, the cuff pressure of 100 patients in emergency department (ED) and intensive care units (ICU) of two university hospitals was evaluated by using a sensitive and accurate analog standard manometer after insertion of the ETT and checking the pilot balloon by the provider. All measurements were performed by a person who was blinded to the study purpose and an ideal pressure range of 20 to 30 cmH 2 O was used for analysis. Results. Emergency physicians (n=58) and anesthesiologists (n=42) performed the intubations. The mean measured cuff pressure in our study was 69.2±29.8 cmH ded standard value of 25 cmH 2 2 O (range: 10-120 cmH 2 O) which was significantly different from the recommen- O (P<0.0001, one-sample t-test). No difference was found between anesthesiologists and emergency physicians in cuff inflation pressures (Anesthesiologists = 71.1 ± 25.7; Emergency physicians = 67.9±32.6). Conclusion. Estimation of cuff pressure using palpation techniques is not accurate. In order to prevent adverse effects of cuff overinflation, it is better to recheck the pressure using a manometer, regardless of place, time and the inserter of the endotracheal tube

Mental health disorders in child and adolescent survivors of post-war landmine explosions.

BACKGROUND: To describe the mental health status of 78 child and adolescent survivors of post-war landmine explosions. METHODS: Child and adolescent survivors of landmine explosions who were younger than 18 years old at the time of the study were identified and enrolled in this study. The mental health status of the participants was assessed by general health assessment and psychiatric examinations. Psychiatric assessment and diagnosis were undertaken using the Diagnostic and Statistical Manual for mental disorders (DSM-IV) criteria. A psychiatrist visited and interviewed each survivor and identified psychiatric disorders. RESULTS: Seventy-eight child and adolescent survivors with a mean age of 16.11 ± 2 years old were identified and agreed to participate in the study. The mean age of the victims at the time of injury was 8.2 ± 3.12 years old (range 2-15). Thirty-seven (47.4 %) of the adolescent survivors suffered from at least one psychiatric disorder. Twenty-nine survivors (37.1 %) were newly diagnosed and needed to start medication and psychiatric treatment. The most common findings were anxiety disorders (34.6 %), including posttraumatic stress disorder (PTSD) in 20 (25.6 %), and generalized anxiety disorder (GAD) in 7 (9 %) subjects. Mild-Moderate depression was found in 5 (6.4 %) subjects. No personality disorders were observed, and two patients suffered from mental retardation. The study results revealed a significant association between age of casualty, duration of injury and limb amputation, and types of psychological disorders. CONCLUSION: Child and adolescent survivors of landmine explosions had a high prevalence of psychiatric disorders

Global incidence of helminthic contamination of vegetables, cucurbits and fruits: A systematic review and meta-analysis

ABSTRACT Accidental ingestion of infective stages of helminths through consumption of contaminated vegetables and fruits causes a wide range of food-borne diseases in humans. This systematic review and meta-analysis evaluated the global incidence of helminthic contamination of vegetables, cucurbits and fruits. Several databases (Science Direct, Web of Science, PubMed, Scopus, and Google Scholar) were searched for literature published prior to November 2020. Overally, 184 articles (32 countries) met the inclusion criteria. Among these, 137 studies documented helminthic contamination in vegetables, 46 in cucurbits and 9 were in fruits. The pooled incidence (95% confidence interval) was 31% (26%–37%) for vegetables, 20% (14%–27%) for cucurbits and 20% (8%– 37%) for fruits. The highest incidence rate was found in the Western Pacific WHO region (54%; 9%–95%). The most prevalent parasitic agents were Ascaris lumbricoides eggs (12%; 9%–15%) and Strongyloides stercoralis larvae (12%; 8%–16%) in vegetables, S. stercoralis larvae (10%; 5%–15%) and Toxocara spp. eggs (10%; 3%–21%) in cucurbits, and Trichuris trichiura eggs (9%; 1%–22%) in fruits. The highest incidence rate was found to be associated with lower-middle income countries (34%, 28%–41%) and regions with a tropical rainforest climate (50%, 10%–91%). The potential role of vegetables, cucurbits, and fruits in the spread of helminthic parasites was revealed. Utilizing clean water for irrigation, proper washing and cooking of vegetables and improved sanitary practices can decrease the public health hazard regarding the consumption of vegetables, cucurbits, and fruits. Keywords: Vegetable Cucurbits Fruits Helminthic contamination Public health Food safet

Global incidence of helminthic contamination of vegetables, cucurbits and fruits: A systematic review and meta-analysis

Accidental ingestion of infective stages of helminths through consumption of contaminated vegetables and fruits causes a wide range of food-borne diseases in humans. This systematic review and meta-analysis evaluated the global incidence of helminthic contamination of vegetables, cucurbits and fruits. Several databases (Science Direct, Web of Science, PubMed, Scopus, and Google Scholar) were searched for literature published prior to November 2020. Overally, 184 articles (32 countries) met the inclusion criteria. Among these, 137 studies documented helminthic contamination in vegetables, 46 in cucurbits and 9 were in fruits. The pooled incidence (95% confidence interval) was 31% (26%–37%) for vegetables, 20% (14%–27%) for cucurbits and 20% (8%–37%) for fruits. The highest incidence rate was found in the Western Pacific WHO region (54%; 9%–95%). The most prevalent parasitic agents were Ascaris lumbricoides eggs (12%; 9%–15%) and Strongyloides stercoralis larvae (12%; 8%–16%) in vegetables, S. stercoralis larvae (10%; 5%–15%) and Toxocara spp. eggs (10%; 3%–21%) in cucurbits, and Trichuris trichiura eggs (9%; 1%–22%) in fruits. The highest incidence rate was found to be associated with lower-middle income countries (34%, 28%–41%) and regions with a tropical rainforest climate (50%, 10%–91%). The potential role of vegetables, cucurbits, and fruits in the spread of helminthic parasites was revealed. Utilizing clean water for irrigation, proper washing and cooking of vegetables and improved sanitary practices can decrease the public health hazard regarding the consumption of vegetables, cucurbits, and fruits

Global prevalence of intestinal protozoan contamination in vegetables and fruits: A systematic review and meta-analysis

A B S T R A C T Environmental contamination of vegetables and fruits with intestinal protozoan trophozoites, cysts and oocysts is a means of transmitting parasitic agents of public health importance. The purpose of this systematic review and meta-analysis was to determine the global prevalence of intestinal protozoan parasite contamination in vege- tables and fruits. Several databases (Web of Science, PubMed, Scopus, ProQuest and Google Scholar) were searched for literature published up to August 2021. Pooled prevalence was determined using the meta-package in R (version 3.6.1). Out of 90,404 publications, 189 articles (202 datasets) met the inclusion criteria. Among these, 183 investigations documented protozoan contamination in vegetables and 20 in fruits. The pooled prevalence (95% confidence interval) was 20% (16%–24%) for vegetables and 13% (7%–21%) for fruits. The highest pooled prevalence was found in South-East Asian WHO region 37% (6%–76%). The most prevalent protozoan parasite in vegetables was Cryptosporidium spp. (11%, 7%–15%). As well, Entamoeba histolytica was the most common agent found in fruits (9%, 4%–14%). Furthermore, the unwashed samples had the highest pooled prevalence of contamination (22%, 3%–49%). Our data suggest a possible risk of protozoan infection in humans via unwashed vegetables and fruits. Accidental ingestion of protozoa occurs through consumption of contami- nated vegetables and fruits that have been improperly washed and prepared under poor sanitation. Using san- itary irrigation water, consuming properly cleaned and cooked vegetables, and practicing good hygiene can all assist to reduce the risk of protozoa infection Keywords: Vegetables Fruits, Protozoan contamination, Public health, Food-borne, disease

Global prevalence of intestinal protozoan contamination in vegetables and fruits: A systematic review and meta-analysis

Environmental contamination of vegetables and fruits with intestinal protozoan trophozoites, cysts and oocysts is a means of transmitting parasitic agents of public health importance. The purpose of this systematic review and meta-analysis was to determine the global prevalence of intestinal protozoan parasite contamination in vegetables and fruits. Several databases (Web of Science, PubMed, Scopus, ProQuest and Google Scholar) were searched for literature published up to August 2021. Pooled prevalence was determined using the meta-package in R (version 3.6.1). Out of 90,404 publications, 189 articles (202 datasets) met the inclusion criteria. Among these, 183 investigations documented protozoan contamination in vegetables and 20 in fruits. The pooled prevalence (95% confidence interval) was 20% (16%–24%) for vegetables and 13% (7%–21%) for fruits. The highest pooled prevalence was found in South-East Asian WHO region 37% (6%–76%). The most prevalent protozoan parasite in vegetables was Cryptosporidium spp. (11%, 7%–15%). As well, Entamoeba histolytica was the most common agent found in fruits (9%, 4%–14%). Furthermore, the unwashed samples had the highest pooled prevalence of contamination (22%, 3%–49%). Our data suggest a possible risk of protozoan infection in humans via unwashed vegetables and fruits. Accidental ingestion of protozoa occurs through consumption of contaminated vegetables and fruits that have been improperly washed and prepared under poor sanitation. Using sanitary irrigation water, consuming properly cleaned and cooked vegetables, and practicing good hygiene can all assist to reduce the risk of protozoa infection

Investigating the Relationship Between End Tidal Carbon Dioxide and Arterial Carbon Dioxide Pressure in Patients With Respiratory Distress Referred to the Emergency Room of Hazrat Rasool Akram Hospital

Background: Measuring end-tidal carbon dioxide (ETCO2) can be a non-invasive, fast, and reliable method to predict partial pressure of carbon dioxide (PaCO2) in patients with respiratory distress. This method, which can be a suitable substitute to measure PaCO2, is being used in many emergency rooms and operating rooms in developed countries, but its exact relationship with PaCO2 has not been confirmed yet. This study aims to investigate the relationship between PaCO2 and ETCO2 in patients with respiratory distress referred to the emergency. Materials and Methods: Arterial blood gases were measured in patients referred to the emergency room of Hazrat Rasool Akram (PBUH) Hospital with the main complaint of respiratory distress, and the ETCO2 of the patient was measured simultaneously with a capnograph. At the same time, the blood pressure and body temperature of the patients were also measured. The obtained information was collected in a sheet and statistically analyzed using SPSS software, version 15. Results: A total of 120 patients were included in the study whose mean age was 48.3. The Mean PaCO2 and ETCO2 were 47.45 and 26.9, respectively. The mean respiratory rate was 37.4 and diastolic (89.9) and systolic (124.9) blood pressure. A total of 48.33% of patients were women. Statistical analysis showed a significant relationship between PaCO2 and ETCO2 (P=0.0001; CC=0.436). Linear regression analysis showed that ETCO2 predicts PaCO2 with R=0.424. Conclusion: A good correlation was found between PaCO2 and ETCO2 and this correlation was higher in diseases such as sepsis and COPD. Variables such as age, sex, and blood pressure did not affect this correlation. Of course, more studies on healthy people are necessary to confirm these findings