Demographics of Fall-Related trauma among the Elderly Presenting to Emergency Department; a Cross-Sectional Study

Introduction: Falling is reported to be the most common cause of mortality due to trauma in individuals over the age of 75 years. The present study is designed with the aim of determining the demographics of fall-related trauma among the elderly presenting to emergency department (ED). Methods: The present prospective cross-sectional study was carried out on all elderly patients ≥ 60 years old presenting to ED of a major referral trauma center in North West of Iran during 1 year. Demographic data, location and height of falling, duration of hospitalization, trauma severity and in-hospital outcome of the patients were gathered and reported via descriptive statistics. Results: 228 patients with the mean age of 70.96 ± 5.2 years were studied (53.9% female). Most patients were in the 66-70 years age range (32.6%) and had a history of hypertension (22.3%), who had visited following a fall inside the house (69.3%), due to slipping (73.7%), and from a height equal to or less than 2m (71.9%). 6 (2.6%) patients died in the hospital. Mean trauma severity of patients based on ISS, RTS, and TRISS were 10.65 ± 3.95 (3-19), 7.84 ±.21 (1.4-14.5) and 1.66 ±1.31 (-1.49-3.82), respectively. Regarding need for hospitalization, only ISS shows a significant difference between outpatients and inpatients (p = 0.023). Patients who died had a significantly higher trauma severity based on ISS (p < 0.0001) and RTS (p < 0.0001). Conclusion: Based on the findings of the present study, slipping and syncope are the most common causes of  falling in the studied elderly that had mostly happened inside the house and from a height less than 2m. Therefore, most patients were in the mild to moderate range of trauma severity. ISS and RTS were significantly higher in the 6 (2.6%) patients who died

The Comparison of Apotel plus Low Dose of Morphine and Full Dose of Morphine in Pain ‎Relief in Patients with Acute Renal Colic

Background: Renal colic is an acute flank pain which may radiate to the groin, lower abdomen, or external genitalia due to the passage of a urinary stones. Pain management is the most important task in emergency wards when a patient with renal colic attends. This study aims to compare intravenous acetaminophen plus a low dose of morphine with a full dose of morphine in renal colic. Methods: In present randomized clinical trial, 100 patients with confirmed renal colic were recruited from the emergency ward of Imam Reza Teaching Hospital affiliated to Tabriz University of Medical Sciences, Tabriz, Iran, during a one-year period. These patients randomly received either intravenous acetaminophen (Apotel, 1 g) plus a low dose of morphine (n = 50), or a high dose of morphine (5 mg) (n = 50). Visual analogue scale was used for reporting pain during 35 minutes. Side effects and rescue analgesic demand were recorded after 30 minutes. Findings: The two groups were matched for the patients' age and gender. Intra-group analysis showed significant gradual decreases in pain intensity after 35 minutes for both groups. Inter-group analysis, however, did not show a significant difference between the two groups in this regard. There was no significant difference between the two groups in terms of side effects. The rate of rescue analgesic demand was 36% in the first and 40% in the second group (P = 0.68). Conclusion: According to the results study, Apotel plus a low dose of morphine is at least as effective and safe as a full dose of morphine in patients with renal colic

Clinical Scoring Systems in Predicting the Outcome of Acute Upper Gastrointestinal Bleeding; a Narrative Review

Prediction of the outcome and severity of acute upper gastrointestinal bleeding (UGIB) has significant importance in patient care, disposition, and determining the need for emergent endoscopy. Recent international recommendations endorse using scoring systems for management of non-variceal UGIB patients. To date, different scoring systems have been developed for predicting the risk of 30-day mortality and re-bleeding. We have discussed the screening performance characteristics of Baylor bleeding score, the Rockall risk scoring score, Cedars-Sinai Medical Center predictive index, Glasgow Blatchford score, T-score, and AIMS65 systems, in the present review.Based on the results of this survey, there are only 3 clinical decision rules that can predict the outcome of UGIB patients, independent from endoscopy. Among these, only Glasgow Blatchford score was highly sensitive for predicting the risk of 30-day mortality and re-bleeding, simultaneously.

Epidemiology of Alcohol Poisoning and Its Outcome in the North-West of Iran

Introduction: Alcohol poisoning is one of the main preventable causes of death, disability, and injury in many societies. Ethanol and methanol are the most prevalent kinds of alcohol used. There is no any exact reports of alcohol poisoning and its outcome in Iranian society. Therefore, the present study was assessed the status of alcohol poisoning and its outcome in referees to the emergency department. Methods: This is a cross-sectional study which was done from July 2013 to 2014 in Sina Trauma Center, Tabriz, Iran. The studied population included all alcohol poisoning cases referred to this center. Demographic variables, clinical evaluation, laboratory tests, and patient's outcome were evaluated. To assess the relation between evaluated factors and outcome of alcohol poisoning. After univariate analysis a multivariate logistic regression was applied to evaluate independent risk factors for death. P<0.05 was considered as a significant level. Results: Lastly 81 patients with alcohol poisoning were entered to the study (91.4% male) with the mean age of 27.9±10.4 years. Ten (12.3%) subjects were dialyzed and 34 (42%) cases hospitalized that 3 (3.7%) of them died. The multivariate logistic regression test displayed that plasma creatinine level (OR=2.2 95%Cl: 1.8-2.5; p=0.015) and need for dialysis (OR=6.4; 95%Cl: 5.3-7.5; p<0.001) were the only risk factors of death among these patients. Conclusion: The findings of the present study revealed that total mortality rate of referees to the emergency with alcohol poisoning was 3.7% all of whom related to methanol poisoning. Based on this result, the mortality rate of methanol poisoning was estimated 20%. Need for dialysis and increasing the creatinine level were accounted as independent risk factors of death

The Comparison of Apotel plus Low Dose of Morphine and Full Dose of Morphine in Pain Relief in Patients with Acute Renal Colic

Abstract Background: Renal colic is an acute flank pain which may radiate to the groin, lower abdomen, or external genitalia due to the passage of a urinary stones. Pain management is the most important task in emergency wards when a patient with renal colic attends. This study aims to compare intravenous acetaminophen plus a low dose of morphine with a full dose of morphine in renal colic. Methods: In present randomized clinical trial, 100 patients with confirmed renal colic were recruited from the Emergency Ward of Imam Reza Teaching Hospital affiliated to Tabriz University of Medical Sciences, Iran, during a one-year period. These patients randomly received either intravenous acetaminophen (Apotel, 1 g) plus a low dose of morphine (n = 50), or a high dose of morphine (5 mg) (n = 50). Visual analogue scale (VAS) was used for reporting pain during 35 minutes. Side effects and rescue analgesic demand were recorded after 30 minutes. Findings: The two groups were matched for the patients' age and gender. Intra-group analysis showed significant gradual decreases in pain intensity after 35 minutes for both groups. Inter-group analysis, however, did not show a significant difference between the two groups in this regard. There was no significant difference between the two groups in terms of side effects. The rate of rescue analgesic demand was 36% in the first and 40% in the second group (P = 0.68). Conclusion: According to the results study, Apotel plus a low dose of morphine is at least as effective and safe as a full dose of morphine in patients with renal colic. Keywords: Renal colic, Intravenous acetaminophen, Morphin

Report: Holding clinical competency examination among medical students in Faculty of Medicine, Tabriz, Iran

Introduction: The purpose of evaluating educational curriculums is to improve training programs. The application of the results obtained from these evaluations is the proof of success or failure of the program. This study was carried out to report codification of operational plan of the clinical competence examination for medical students. Methods: In this descriptive-analytical study, the operating process of evaluation program is explained by details step by step. This survey was based on a questionnaire collected from 200 participants of the first clinical competence examination of medical students. Finally, data were analyzed using SPSS. Results: Of all the participants, 55.8% of were female and 44.2% were male. There was no statistically significant difference in score averages between male and female students (14.55 ± 1.72 vs.14.55 ± 1.3; P = 0.970). Mean pre-internship exam score among male students was 126.73 ± 21.04 and 128.18 ± 20.96 among female students, and the difference was not statistically significant (P = 0.630). There was a statistically significant but weak correlation between examination and pre-internship scores (r = 0.27, P < 0.001). Exam scores were statistically higher as the absent sessions of students decreased (P = 0.010).Conclusion: Codification of the administrative process and consequently obtaining results has been effective in success of evaluation program and application of the results in future programs. Also it informs authorities how much the goals of training program is satisfied and reminds the necessity of execution of corrective programs

Comparison of four techniques on facility of two-hand Bag-valve-mask (BVM) ventilation: E-C, Thenar Eminence, Thenar Eminence (Dominant hand)-E-C (non-dominant hand) and Thenar Eminence (non-dominant hand) – E-C (dominant hand)

Introduction: Bag-valve-mask (BVM) ventilation is the first and important part of the airway management. The aim of present study was to evaluate the quality of four different BVM ventilation techniques – E-C, Thenar Eminence, Thenar Eminence (Dominant hand)-E-C (Non dominant hand), and Thenar Eminence (Non dominant hand)-E-C (Dominant hand) – among two novice and experienced groups. Methods: In a case-control and mannequin based study that was conducted in Tabriz University of medical sciences, 120 volunteers were recruited and divided into two groups. 60 participants in experienced and other 60 as novice group who observed BVM ventilation but hadn’t practical experience about BVM ventilation. Every participant in both groups performed 4 BVM ventilation techniques under the supervision of an experienced assessor. Quality of mannequin chest expansion was recorded by two other experienced assessors who were blind to ventilation process. The data were analyzed with SPSS 17.0. Results: In novice group, when evaluating each technique performance, they did Thenar Eminence (non-dominant hand) - E-C (dominant hand) technique much better than the others (P < 0.0001). But in the experienced group, there was no meaningful difference between the all four techniques (P = 0.102). Conclusion: Novice participants did Thenar Eminence (non-dominant hand) - E-C (dominant hand) technique better than the others. Therefore, it is recommended that training of this technique was placed in educational program of medical students