Epidemiological and Demographic Status of Violence and Strife in the Emergency Department of Sabzevar Emdad Hospital

Background: Violence and strife are among the most important causes of health threats and account for more than half a million deaths per year, especially at young ages. Considering the young population of Iran and the occurrence of identity crisis in the young age group and the fact that this phenomenon is costly for our country’s health care system, this study was conducted to investigate the factors related to violence and strife and the related mortality in patients admitted to the Sabzevar Emdad Emergency department. Methods: In this descriptive cross-sectional study, 207 patients who were admitted to Sabzevar Emdad Hospital in 2017 following strife were included. The inclusion criterion was hospitalized patients who were referred to the Emergency department following the strife and the exclusion criterion was incomplete registration of patients’ information. The data collection tool was a researcher-made checklist. Data analysis was performed using SPSS software version 18. Results: The Mean±SD age of patients was 34.81±14.75 years. Most patients were from urban living places, while the mortality rate, gender, and the cause of trauma were not statistically associated with patients’ place of residence. The most common type of lesions following strife was bruising, tearing, and scratching accounting for nearly 70% of cases. The most common site of injury was bruising and scratching in the head and neck, followed by tears and fractures in the limbs. In general, the most common site of injury was the upper extremity followed by the head and neck. The majority of patients (52%) underwent medical treatment, including receiving medication, dressing, and splinting, while 37% of patients were referred to the operation room for surgery. A significant relationship was observed between mortality rate and the site of injury (P=0.001).Conclusion: The results showed that in Sabzevar city, the prevalence of strife ‎ is higher among men. Also, the most common effects following these types of trauma are bruising, scratching, and tearing. It seems that by providing appropriate solutions and creating a culture and increasing people’s awareness of injuries caused by strife, it would be possible to pave the way for reducing such injuries in the future

Prevalence of Opioid Poisoning and Related Factors in Under 17-year-olds

Background: Poisoning is among the leading causes of childhood injuries. With the increasing prevalence of substance dependence in the community, there is a rise in the frequency of children admitted to hospitals with drug intoxication. Therefore, we investigated the prevalence of acute opioids poisoning in children. Methods: The present cross-sectional study was performed on children under 17 years of age who were admitted to Sabzevar hospitals with a diagnosis of opioids poisoning. A researcher-made checklist was used for data collection, including the patient’s age, gender, intoxication agent, drug consumption route and form, hospitalization length and outcome, family’s educational level, occupational status, and living area. Besides, descriptive tests were used in SPSS to analyze the obtained data.Results: In total, 129 cases of opioids poisoning were reported during the study period. The mean±SD age of the studied children was 2.74±3.05 years. The minimum and maximum ages of poisoned children were 1 and 16 years, respectively. The liquid-soluble form was the most common form of opioids used (38.3%). Opium was also the most commonly used substance (68.45%). In 85 (65.89%) children, a decrease in Glasgow Coma Scale (GCS) was observed at baseline. Moreover, 7 of the explored children have died. Besides, 90.7% of their fathers and 95.3% of their mothers had an educational level of a diploma or below. The most common factor associated with opium poisoning was the family’s substance dependence in 120 (93%) cases. Substance dependence in children was mostly observed in those aged 3-5 years. Conclusion: Poisoning with opium is the most common type of children’s opioid poisoning in Sabzevar. A decreased level of consciousness is the most frequent manifestations in these patients. Therefore, in all children, by observing a sudden decrease in the level of consciousness without apparent reasons, especially along with other symptoms, such as acute diarrhea, restlessness, etc., it is recommended to consider opioids poisoning

Investigating the Characteristics of Tramadol-induced Seizures: A Cross-sectional Study

Background: According to statistics, tramadol intoxication is one of the most common drug poisoning cases in Iran. Because seizure is one of the severe and dangerous side effects of tramadol, the present study aimed to investigate the characteristics of tramadol-induced seizures. Methods: In this cross-sectional descriptive study, all patients who referred to the emergency departments due to the tramadol-induced seizures were examined by the census method. The patients’ data were collected with a checklist. Then, the data were analyzed with descriptive and inferential statistical tests in SPSS v. 23 and at a significant level of P<0.05. Results: In this study, 350 patients (52.9% male, and 47.1% female) were examined. The Mean±SD dose consumed was 1171.4±802.77 mg. The minimum dose that caused the seizure was 200 mg, and the average dose consumed of tramadol was different in patients who had one, two, or three seizures outside the hospital (P=0.002). The consumed average dose of tramadol was 1144.5 mg, 2017.7 mg, and 511.1 mg for patients who had one, two, or three seizure(s), respectively. There was a significant relationship between dose consumed and the number of seizures (P=0.001). The study showed that patients who had a one-time seizure, have experienced this condition outside the hospital. There was a significant relationship between the number of seizures and the location of the seizure (outside or inside the hospital) (P=0.001). Conclusion: The results showed no significant relationship between consumed dose and location of the seizure. The number of seizures is not dependent on the consumed dose. It means that increasing the consumed dose, the number of seizures does not increase, and there is no significant relationship between the amount of dose consumed and the number of seizures

A Rare Case of Gastrointestinal Tract Foreign Body; Glassy Stomach

Ingestion of foreign bodies is common and conservative treatment can eliminated most particlesfrom the gastrointestinal tractunless peritoneal signs appear. A 22-year-old man presented to emergency department who had ingested glass particles of a crushed beverage bottle. He complained of epigastric and periumbilical pain. Physical examination did not revealany peritoneal signs. Abdominal X-ray showed stomach full of small glass particles. Conservative treatment, without any surgical intervention,resulted insafely eliminating glass particlesin this patient

Successful Treatment of Acute Aluminum Phosphide Poisoning by Aloe Vera Syrup: A Case Report

Background: Aluminum phosphide, known as rice pill in Iran, is a very effective pesticide for commercial and industrial ‎use. The high lethality of Aluminum phosphide is due to Phosphine gas (PH3) which is released by its ‎reaction with water. One of the most important properties of aluminum phosphide, which despite being ‎very lethal to almost all living creatures, still makes it one of the most widely used pesticides, is its very ‎high yield, ease of use, and, most importantly, the absence of residues in products after application; while ‎its exposure to the human body is associated with high mortality.‎Case Presentation: In this article, we reported the successful treatment of rice pill-induced poisoning in a 30-year-old man using a novel approach. Accordingly, we used sodium bicarbonate (50 ccs) and aloe vera syrup (1-2 L), followed by olive oil (150 cc olive oil was given every 2 hours).Conclusion: While numerous studies recommend observing patient conditions as the treatment approach, our presented case was a successful experience of treating acute aluminum phosphide poisoning

Comparing the Analgesic Effect of Aminophylline and Hyoscine with Morphine on Renal Colic: a Randomized Clinical Trial

Introduction: Although narcotics are effective for pain relief in these patients, they have little impact on the underlying cause. Therefore, surveys have been conducted to find more effective agents. Objective: This study conducted to compare the analgesic effect of aminophylline and hyoscine combination with morphine on renal colic patients. Methods: This double-blind clinical trial was conducted on patients with renal colic caused by urinary tract stones. Subjects were selected via convenience sampling method. Patients were randomly divided into two groups based on whether they received aminophylline + hyoscine or morphine. Before drug administration, one researcher was asked to measure the pain of the patients using Graduated Numbered Visual Analogue Scale (GN-VAS). Afterward, 20 mg of hyoscine along with 3 mg/kg of aminophylline in 100 cc normal saline was injected during 10 minutes into patients in the one group, whereas 0.1 mg/kg of morphine was intravenously with 100 cc normal saline to align two groups, administered to the subjects in another group. Half an hour after the administration of drugs, pain was measured for the second time. Vital signs and side effects were all recorded. Results: In this study, 95 patients (47 patients in the aminophylline+hyoscine group and 48 patients in the morphine group) remained in the trial until the end. The difference in sex distribution(p=0.227) and age(p=0.680) of the two groups was not statistically significant. Median of pain intensity was not significantly different between the two study groups (p<0.05), neither before nor after administration of the drugs. The mean time required for pain relief in morphine group was significantly lower than aminophylline+hyoscine group (5.9±1.6 vs. 11.1±1.6 minutes; p<0.001). Conclusion: Overall, our findings indicated that aminophylline + hyoscine combination was effective in reducing renal colic pain and there is no significant difference between this combination and morphine in terms of pain relief

Teaching Approach to Tachycardia and Bradycardia in Medical Students: A Quasi-Experimental Study to Compare Team-Based Learning and Lecture Method

Introduction: It is crucial to find ways to improve the durability of learning in clinical units. One of these methods is team-based learning (TBL). This learning method is active and students must study the subject before the session. Objective: This study examined TBL and compared it with conventional lecture method (LM) in an educational approach to tachycardia and bradycardia in adult patients. Method: In this quasi-experimental study, medical students (interns) were randomly divided into two groups of TBL and LM. Two faculty members of emergency medicine were responsible for teaching in both LM and TBL groups. Data collection tool was a checklist including demographic information and a researcher-made questionnaire for assessing knowledge about tachycardia and bradycardia in adult patients. Two sets of questions with the same difficulty were designed to be used for pre-test and post-test. Both groups completed pre-test and post-test, which were finally compared. Results: Totally 65 medical interns with the mean age of 28.75±2.26 years were participated of whom 37 persons (56.9%) were female. There was no significant difference in terms of the mean age of the participants in the two groups (p=0.914). The two groups were also matched in terms of male/female ratio (p=0.416). There was no significant difference between TBL and LM groups regarding pre-test score (p=0.935). However, they were significantly different in post-test (p=0.001) when TBL group scored higher than the LM group. Conclusion: Based on the research findings, it seems that TBL was more effective than LM on students' understanding of approach to tachycardia and bradycardia in adult patients

Teaching Approach to Tachycardia and Bradycardia in Medical Students: A Quasi-Experimental Study to Compare Team-Based Learning and Lecture Method

Introduction: It is crucial to find ways to improve the durability of learning in clinical units. One of these methods is team-based learning (TBL). This learning method is active and students must study the subject before the session. Objective: This study examined TBL and compared it with conventional lecture method (LM) in an educational approach to tachycardia and bradycardia in adult patients. Method: In this quasi-experimental study, medical students (interns) were randomly divided into two groups of TBL and LM. Two faculty members of emergency medicine were responsible for teaching in both LM and TBL groups. Data collection tool was a checklist including demographic information and a researcher-made questionnaire for assessing knowledge about tachycardia and bradycardia in adult patients. Two sets of questions with the same difficulty were designed to be used for pre-test and post-test. Both groups completed pre-test and post-test, which were finally compared. Results: Totally 65 medical interns with the mean age of 28.75±2.26 years were participated of whom 37 persons (56.9%) were female. There was no significant difference in terms of the mean age of the participants in the two groups (p=0.914). The two groups were also matched in terms of male/female ratio (p=0.416). There was no significant difference between TBL and LM groups regarding pre-test score (p=0.935). However, they were significantly different in post-test (p=0.001) when TBL group scored higher than the LM group. Conclusion: Based on the research findings, it seems that TBL was more effective than LM on students' understanding of approach to tachycardia and bradycardia in adult patients

Comparing the Analgesic Effect of Aminophylline and Hyoscine with Morphine on Renal Colic: a Randomized Clinical Trial

Introduction: Although narcotics are effective for pain relief in these patients, they have little impact on the underlying cause. Therefore, surveys have been conducted to find more effective agents. Objective: This study conducted to compare the analgesic effect of aminophylline and hyoscine combination with morphine on renal colic patients. Methods: This double-blind clinical trial was conducted on patients with renal colic caused by urinary tract stones. Subjects were selected via convenience sampling method. Patients were randomly divided into two groups based on whether they received aminophylline + hyoscine or morphine. Before drug administration, one researcher was asked to measure the pain of the patients using Graduated Numbered Visual Analogue Scale (GN-VAS). Afterward, 20 mg of hyoscine along with 3 mg/kg of aminophylline in 100 cc normal saline was injected during 10 minutes into patients in the one group, whereas 0.1 mg/kg of morphine was intravenously with 100 cc normal saline to align two groups, administered to the subjects in another group. Half an hour after the administration of drugs, pain was measured for the second time. Vital signs and side effects were all recorded. Results: In this study, 95 patients (47 patients in the aminophylline+hyoscine group and 48 patients in the morphine group) remained in the trial until the end. The difference in sex distribution(p=0.227) and age(p=0.680) of the two groups was not statistically significant. Median of pain intensity was not significantly different between the two study groups (p<0.05), neither before nor after administration of the drugs. The mean time required for pain relief in morphine group was significantly lower than aminophylline+hyoscine group (5.9±1.6 vs. 11.1±1.6 minutes; p<0.001). Conclusion: Overall, our findings indicated that aminophylline + hyoscine combination was effective in reducing renal colic pain and there is no significant difference between this combination and morphine in terms of pain relief