Open reduction and internal fixation of the bilateral proximal humeral fracture dislocation with head splitting in an active young adult: a rare case

Proximal humeral fracture is a common injury particularly in elderly. A proper management of these fractures is very challenging, based on the various characteristics of patient, fracture anatomy, equipment and the surgeon experience. Bilateral PHF is a rare condition, which almost always caused by seizure, electric shock and trauma, respectively. An appropriate treatment of these patients needs especial attention to obtain a good clinical outcome. We report a 29-year-old patient who suffered from bilateral proximal humeral fracture with posterior dislocation and splitted humeral head due to the combined mechanism of injury including severe trauma after high voltage electric shock. We did not find similar case(s) reported before in the literature. The patient treated with bilateral open reduction and internal fixation (ORIF). He was able to do his daily activities after 6 month

Effect of aqueous and ethanolic extract of Eucalyptus camaldulensis L.

Herbs have been used for its medicinal properties from several thousand years ago. Herbs, essences and extracts, possess a variety level of biological activities and antimicrobial activities of a large number of them have been proved. Eucalyptus is one of these plants which the anti-virus effects of its extract has long been used to treat influenza and colds in most parts of the world. The aim of this study is evaluating antimicrobial effects of aqueous and alcoholic Eucalyptus camaldulensis leaves against some of the important food pathogens. Antimicrobial effects of extracts were evaluated on Staphylococcus aureus PTCC 2592, Escherichia coli PTCC1330 and Penicillium digitatum by “using the method of Collins” and “disk agar diffusion method”. The results showed that aqueous and ethanolic extract were quite effective in 2000 μg/ml concentration on Staphylococcus aureus and Penicillium digitatum, while both extracts have no certain antimicrobial effect on Escherichia coli. In “disk agar diffusion method” 20, 40, 60 and 80 mg/ml aqueous and ethanolic extract concentrations, was inhibition effect on Staphylococcus aureus and Penicillium digitatum, and 60 and 80 mg/ml aqueous and ethanolic extract concentrations, has deterrent effect on Escherichia coli, but at 20 and 40 mg/ml concentrations, no inhibitory effect on Escherichia coli was observed. Minimum Inhibitory Cconcentration (MIC) of ethanolic extract of Eucalyptus camaldulensis leaves and Minimal Bactericidal Concentration (MBC) for bacteria and Minimum Fungicidal Concentration (MFC) for fungi were performed. The results indicate that ethanolic and aqueous extracts of Eucalyptus camaldulensis leaves have the greatest effect on gram-positive bacteria Staphylococcus aureus. Escherichia coli were resistant to most of the aqueous and ethanolic Eucalyptus camaldulensis extracts. In conclusion, using Eucalyptus as a natural antimicrobial compounds in vitro have considerable antimicrobial ability over the studied strains.

Antimicrobial effect of Carboxy Methyl Cellulose (CMC) containing aqueous and ethanolic Eucalyptus camaldulensis L. leaves extract against Streptococcus pyogenes, Pseudomonas aeruginosa and Staphylococcus epidermidis

Oil from the eucalyptus tree (Eucalyptus camaldulensis L.) is used today in many over the counter cough and cold products, to relieve congestion. Eucalyptus oil is also used in creams and ointments to relieve muscle and joint pain, and in some mouthwashes. In this study Eucalyptus camaldulensis leaves extracted with water and ethanol 96°and the antimicrobial effects of extracts were evaluated by “using the method of Collins” and “disk agar diffusion method”. Antimicrobial properties of Carboxy Methyl Cellulose (CMC) films containing 20, 40, 60, and 80 mg/ml concentration of the extract studied against on Streptococcus pyogenes PTCC 1447, Pseudomonas aeruginosa PTCC 1310 and Staphylococcus epidermidis PTCC 1435. The results showed that aqueous and alcoholic extract were quite effective in 2000 μg/ml concentration on Streptococcus pyogenes and Staphylococcus epidermidis and have inhibition effect, while both extracts have no certain antimicrobial effect on Pseudomonas aeruginosa. Minimum Inhibitory Concentration (MIC) of ethanolic extract of Eucalyptus camaldulensis leaves were performed for each microorganism. Minimal Bactericidal Concentration (MBC) for bacteria was performed using the dilution method. The edible films containing mangrove extract presented more effective impact on the growth of Streptococcus pyogenes than Pseudomonas aeruginosa (p<0.05). The result indicates extracts of Eucalyptus camaldulensis leaves have the greatest effect on gram-positive bacterium Streptococcus pyogenes. As a result, aqueous and ethanloic extracts of Eucalyptus camaldulensis leaves, have been strong antimicrobial activity against many food pathogen bacteri

An Improved Performance Measurement Approach for Knowledge-Based Companies Using Kalman Filter Forecasting Method

Performance measurement and forecasting are crucial for effective management of innovative projects in emerging knowledge-based companies. This study proposes an integrated performance assessment and forecasting model based on a combination of earned schedule methodology and the learning curve theory under risk condition. The operational performance is measured in terms of time and cost at completion indicators. As a novelty, the learning effects and Kalman filter forecasting method are employed to accurately estimate the future performance of the company. Furthermore, in order to predict the cost performance accurately, a logistic growth model is utilized. The validity of this integrated performance measurement model is demonstrated based on a case study. The computational results confirmed that the developed performance measurement framework provides, on average, more accurate forecast in terms of mean and standard deviation of the forecasting error for the future performance as against the traditional deterministic performance measurement methods

Detection of Legionella pneumophila in the bronchoalveolar lavage samples by real time PCR in patients with ventilator-associated pneumonia in ICU

زمینه و هدف: لژیونلا پنوموفیلا به خاطر توانایی آن در ایجاد پنومونی ناشی از ونتیلاسیون مکانیکی مورد توجه مراکز درمانی است. هدف از این مطالعه ردیابی گونه های لژیونلا پنوموفیلا در نمونه های بدست آمده از برونکوآلوئولار لاواژ با روشReal Time PCR در بیماران بستری در بخش مراقبت های ویژه ی بیمارستان الزهرا(س) اصفهان می باشد. روش بررسی: در یک مطالعه توصیفی تحلیلی سی و نه نمونه برونکوآلوئولار لاواژ در بیماران مبتلا به پنومونی همراه با ونتیلاتور بستری در بخش مراقبت های ویژه (ICU) بیمارستان الزهرای اصفهان در سال 1390 گرفته و تا زمان آزمایش در 20- درجه سانتیگراد نگهداری شد. DNA به روش فنل کلروفرم استخراج و آزمایش Real Time PCR در 45 چرخه شامل oC95 برای 4 ثانیه و oC58 برای 30 ثانیه انجام شد. در حالی که پروب به روش Taq Man عمل می کرد. یافته ها: نتیجه برای حضور باکتری لژیونلا پنوموفیلا در همه نمونه ها منفی شد. حداقل سن افراد در مطالعه 20 و حداکثر 86 سال بوده است. مدت زمان بستری افراد مورد مطالعه در ICU حداقل 2 روز و حداکثر 65 روز است. مدت زمان ونتیلاسیون افراد مورد مطالعه حداقل 2 روز و حداکثر 65 روز بود. نتیجه گیری: این مطالعه عدم حضور لژیونلا پنوموفیلا در بیماران دچار پنومونی وابسته به ونتیلاتور در ICU بیمارستان الزهرای اصفهان رادریک مقطع زمانی نشان می دهد؛ لذا بر اساس مطالعه فوق، شناخت الگوی میکروبیولوژیک لژیونلا پنوموفیلا در سایر مراکز درمانی نیز امری منطقی به نظر می رسد

Utilization of Failure Mode and Effects Analysis (FMEA) Method in Increasing the Revenue of Emergency Department; a Prospective Cohort Study

Introduction: The balance between revenue and cost of an organization/system is essential to maintain its survival and quality of services. Emergency departments (ED) are one of the most important parts of health care delivery system. Financial discipline of EDs, by increasing the efficiency and profitability, can directly affect the quality of care and subsequently patient satisfaction. Accordingly, the present study attempts to investigate failure mode and effects analysis (FMEA) method in identifying the problems leading to the loss of ED revenue and offer solutions to help fix these problems. Methods: This prospective cohort study investigated the financial records of ED patients and evaluated the effective errors in reducing the revenue in ED of Imam Hossein hospital, Tehran, Iran, from October 2007 to November 2009. The whole department was divided based on FMEA into one main system and six subsystems. The study was divided in two phases. In the first phase, the problems leading to the loss in the revenue in each subsystem were identified and weighted to four groups using risk priority number (RPN), and the solutions for fixing them were planned. Then, at the second phase discovered defects in the first phase were fixed according to their priority. Finally, the impact of each solution was compared before and after interventions using the repeated measure ANOVA test. Results: At last, 100 financial records of ED patients were evaluated during the first phase of the study. The average of ED revenue in the six months of the first phase was 73.1±3.65 thousands US dollar/month. 12 types of errors were detected in the predefined subsystems. ED revenue rose from 73.1 to 153.1, 207.06, 240, and 320 thousands US dollar/month after solving of first, second, third, and fourth priority problems, respectively (337.75% increase in two years) (p<0.001). 111.0% increase in the ED revenue after solving of first priority problems reveals that they were extremely indispensable in decreasing the revenue (p<0.0001). Conclusion: The findings of the present study revealed that FMEA could be considered as an efficient model for increasing the revenue of emergency department. According to this model, not recording the services by nursing unit and lack of specific identifying code for the patients' files, moving from ED to any other department, were the two first priority problems in decreasing our ED revenue.

Exploring Managers’ Experiences of Hospital Disaster Preparedness: A Qualitative Study

Background: Preparedness is one of the important and effective pre-crisis management stages and involves all actions and programs that enable the organization to respond quickly and effectively in critical situations. To this end, this study aimed to explore the experiences of crisis managers and experts in hospital disaster preparedness. Methods: This qualitative study was conducted using conventional content analysis in 2019. The research population included hospital managers and crisis specialists in Ardabil Province. The participants were 14 managers and crisis specialists who were selected using purposive sampling. The data were collected through semi-structured interviews and analyzed using Griesheim and Landman’s qualitative content analysis approach. Results: The analysis of the data revealed four main categories including management and planning, infrastructural development, human resources, and intersectoral coordination. Conclusion: The findings of the present study highlighted the significance of preparedness for emergencies, management and planning, having codified instructions, and implementation and evaluation to increase the preparedness of hospitals to deal with emergencies