Reviewing brachial plexus injury in a trauma registry center

Dear editor We read with interest Abdolrazaghi and his colleague’s paper entitled ‘’ Brachial plexus injury following blunt trauma; an anatomical variation in electrodiagnostic findings’’ and enjoyed it a lot. They presented a brachial plexus injury (BPI) case, which was rare in clinical practice because blunt traumas did not commonly cause BPI. There is ample evidence that most cases are men and adolescents aged 15 to 25 years, and the main mechanism of injury (70%) is motor vehicle accidents. As BPI is increasing, we will provide some epidemiologic and clinical characteristics of our cases registered at Sina Hospital, affiliated with the National Trauma Registry of Iran (NTRI). The Sina Trauma and Surgery Research Center launched the NTRI in 2016 and first recorded the related data from Sina Hospital. As the registry expanded, the NTRI included some other Iranian hospitals from different cities in the next step. The inclusion criteria were discussed elsewhere. We have registered 10 cases of BPI since 2016 at Sina Hospital. All of them were men, ranging from 19 to 45 years. The cause of injury was cut/stab in nine and road traffic accidents in one patient; seven were intentional, and most were due to interpersonal violence. Five of the injuries happened outdoors, three cases in commercial and service departments, and two at homes. Furthermore, the median injury severity score (ISS) was 5.0 (IQR=1). All of the patients had surgical operations. No death or need for ventilators was reported. Only one patient needed intensive care unit (ICU) admission and stayed for three days in the ward. We hope this information can be helpful for the Frontiers in Emergency Medicine’s readers to know more about BPI and can compare similarities and differences between our cases and the others included in the literature

Patency rate and factors affecting the clinical outcome of patients with aortoiliac artery occlusion undergoing intra-arterial stenting

Background Occluding plaques are commonly found inthe infrarenal aorta and the iliac artery in patients with peripheralarterial disease (PAD). Aortoiliacocclusive disease(AIOD) occurs commonly in patients with PAD.Methods: This is a prospective study was carried out between2015 and 2017 in Sina hospital. Patients with occlusionin aortoiliac artery and its branches were included.Stent was placed for patients, if they had any obstructionor stenosis in aortoiliac artery in angiography. Patientswere examined in terms of clinical status and ABI calculationand underwent Color Doppler ultrasound of aortoiliacartery to determine patency rate at 1, 3, 12, and 24months after stent placement.Results: The mean age of patients was 64.60 (±10.41).The main symptoms of the patients were claudication(41.8%), ulcer (27.3%), pain at rest (20%), and gangrene(20%). The lesion was bilateral in 21 patients (38.2%).According to TASC stratification, lesions were of type A in26 patients (47.3%), type B in 4 patients (7.3%), type Cin 5 patients (9.1%), and type D in 20 patients (36.4%).The six-month, one-year, and two-year patency rates were89.1%, 83.6%, and 72.7%, respectively. The mean annualABI of patients was 0.79 (±0.11) and two year ABIwas 0.68 (±0.1).Conclusion: It seems that stenting and angioplasty areeffective in improving patients’ conditions and result in agood short and medium-term patency

The association between the outcomes of trauma, education and some socio-economic indicators

Background: There are many debates on socioeconomic indicators influencing trauma outcomes.Objectives: This study aimed to determine the association between education as a socioeconomic indicator and trauma outcomes.Methods: This descriptive-analytical study was conducted on 30,448 trauma patients during 2016-2021. The data were based on the minimum dataset of the National Trauma Registry of Iran (NTRI) from six different trauma centers in various cities of the country. The variables used in this study included age, education level, marital status, cause of injury, Glasgow Coma Scale (GCS), intensive care unit (ICU) admission, Injury Severity Score (ISS), and in-hospital mortality. Logistic regression was used to investigate the association between independent variables and trauma outcomes.Results: The study included 30,448 trauma patients with male predominance (75.8%). The mean age was 36.9 years. The most frequent education level was secondary education, with 14,228 (46.6%). Education levels had significant relationships with ISS, death, and ICU admission (P<0.001). Moreover, after applying the multiple logistic regression, the odds of deaths for trauma patients with no formal, primary, and secondary education levels were 3.36, 5.03, and 3.65 times, respectively, more than the odds of deaths at the higher education level after controlling for other factors (all Ps<0.05). However, there were no such relationships between education levels and the odds of ICU admission.Conclusion: Findings of the present study showed a significant association between the education levels and trauma outcomes. Adjusted for other covariates, the chance of death for trauma patients with no formal, primary, or secondary education levels was higher than that at the higher education level

A Novel Dual Energy CT-Based Attenuation Correction Method in PET/CT Systems: A Phantom Study A Novel DECT Attenuation Correction Method in PET/CT Teimourian et al

ABSTRACT In present PET/CT scanners, PET attenuation correction is performed by relying on the information given by CT scan. In the CT-based attenuation correction methods, dual-energy technique (DECT) is the most accurate approach, which has been limited due to the increasing patient dose. In this feasibility study, we have introduced a new method that can implement dual-energy technique with only a single energy CT scan. The implementation was done by CT scans of RANDO phantom at tube voltages of 80 kV P and 140 kV P . The acquired data was used to obtain conversion curves (which scale CT numbers at different kV P to each other), in three regions including lung tissue (HU&lt;-100), soft tissue (-100&lt;HU&lt;200) and bone tissue (HU&gt;200) for the combination of 80 kV P /140 kV P . Therefore, with having the CT image in one energy, we generate the CT image at the second energy (from now we call it virtual dual-energy technique) using these kV P conversion curves. The attenuation map at 511 keV was generated using bilinear (the most commonly used method in commercially available PET/CT scanners), real dual-energy and virtual dual-energy technique in a polyethylene phantom. In the phantom study, the created attenuation map using mentioned methods are compared to the theoretical values calculated using XCOM cross section library. The results in the phantom data show 10.1 %, 4.2 % and 4.3 % errors for bilinear, dual-energy and virtual dual-energy techniques respectively. Further evaluation using a larger patient data is underway to evaluate the potential of the technique in a clinical setting

Therapeutic Effects of Successful Angioplasty on the Aorta and Lower Limb Arteries on the Healing of Chronic Ischemic Wounds

Background: Chronic wounds are a serious problem for the patient and can increase the socioeconomic burden on the healthcare system and community. This study aimed at investigating the effect of angioplasty on chronic ischemic wound healing. Methods: This study was conducted in Sina Hospital, affiliated to Tehran University of Medical Sciences. Thirty-eight patients with chronic ischemic wounds and a suspicion of the narrowing or blockage of arteries underwent peripheral angiography. Arteries under angioplasty in different patients comprised the aorta and the iliac, superficial femoral, popliteal, and tibial arteries. The patients were evaluated in terms of wound healing in weekly and monthly visits. Wound healing was measured based on the Bates–Jensen criteria. Results: The patients were followed up at a median of 4.5 months. The mean age of the patients was 61.1 ± 7.5 years. Of 38 patients, 12 (31.6%) were female. The involvement of arteries on angiography consisted of 16 (42.2%) cases of total occlusion and 22 (57.8%) cases of stenosis. Following angioplasty, the level of the narrowing of arteries and the wound score showed a significant reduction in all the patients (p value < 0.001). Wound healing was observed in 29 (76.3%) patients. Hematoma, pseudoaneurysm, and thrombosis comprised the complications. No significant differences were observed in terms of age, gender, and history of risk factors between the 2 groups of wound healing and nonhealing. The wound evaluation scores before (p value = 0.044) and after (p value < 0.001) angioplasty were lower in the wound healing group than in the nonhealing group. Conclusion: Angioplasty of the aorta and lower limb arteries improved the healing of chronic ischemic wounds in our patients

Buerger’s Disease in Tehran University of Medical Sciences Hospitals: A Fifteen Years Study

Buerger&apos;s disease is an occlusive inflammatory disease of the small and medium-sized arteries and accounts for a variable proportion of patients with peripheral vascular disease throughout the world. The aim of this study was to review the records of Buerger&apos;s disease patients admitted to surgery wards of our university hospitals. 277 patients with Buerger&apos;s disease were surgically treated between 1987 and 2002, in affiliated hospitals of Tehran University of Medical Sciences, in Iran. Two hundred and seventy three (98.6%) of the patients were male, aged 41.5 &amp;plusmn; 11 years (mean &amp;plusmn; SD); 99.6% of which were smokers with an average of 22.9 pack/years tobacco use. The major complaints included: ischemic ulcers in 203 (73.3%, CI 95%: 0.68-0.77) patients, rest pain in 201 (72.6%, CI 95%: 0.64-0.73), paresthesia in 143 (51.3%, CI 95%: 0.48- 0.58). Vascular bypass, sympathectomy and amputation were performed in 9.7% (CI 95%: 0.08-0.14) and 69.3% (CI 95%: 0.51-0.60) and 59.6% (CI 95%: 0.65-0.73) of the patients, respectively. Lumbar sympathectomy was carried out in 177 (63.9%) patients, while 15 (5.4%) patients underwent thoracic sympathectomy. In our study, afflicted patients were mostly young males, inveterate tobacco smokers. Patients presented frequently with ischemic ulcers or severe rest pain; thrombophlebitis and Raynaud&apos;s phenomenon were infrequent. Vascular reconstruction was rarely possible due to distal and segmental involvement; therefore sympathectomy and amputation were inevitable in a large group of patients in this study

Venoplasty and Venous Stenting in Patients with Chronic Venous Insufficiency in the Lower Extremities

Background: Venoplasty and stenting is a minimally invasive therapy that can be used for patients with deep venous insufficiency in the lower extremities. This study aimed at investigating the effect of venoplasty and venous stenting in patients with chronic venous insufficiency in the lower limbs. Methods: This prospective case-series study recruited patients with chronic deep venous insufficiency in the lower limbs candidated for venoplasty in the Vascular Clinic of Sina Hospital in Tehran, Iran. Venoplasty and stenting was done if the deep venous system in the lower extremities had stenosis or obstruction on venography. The patients were visited 1, 3, and 6 months after venoplasty to assess their symptoms, venous clinical severity, and venous disability. Primary and secondary patency was evaluated with Doppler ultrasound. Results: Seventy-three patients were included in the study. The follow-up of the patients’ clinical symptoms showed significant improvement rates of about 90%, 88.7%, 92.5%, and 100% in claudication, edema, pain, and ulcers-respectively- only 1 month after the procedure. The stent patency rates were 93.2, 91.5, and 92.4 in the 1st, 2nd, 3rd, and 6th postprocedural months, correspondingly. The venous clinical severity score and the venous disability score before the procedure were 14.2 and 2.73, respectively, which were decreased to 5 and 1.1, correspondingly, at 6 months’ follow-up (p value < 0.001). Conclusion: Venoplasty and stenting in our patients with chronic deep venous insufficiency in the lower extremities conferred a significant improvement in clinical symptoms and a high percentage of patency

Comparison of results of placement of cuffed –tunneled hemodialysis catheter in internal jugular vein with subclavian vein for long -term dialysis

Aim of the study was to comparison between internal jugular vs. subclavian vein cuffed tunnel catheter placement for dialysis. Material and methods. Cases who required central venous catheter for dialysis were included in this study. Forty cases were included in this study and divided to two groups. Catheters were placed randomly in internal jugular vein or subclavian. Patients were followed for 6 months. Early and late complications of catheter’s placement were recorded. Analysis was done using Spss ver 13.0 (Chicago, IL, USA). Results. There were no significant differences between subclavian and internal jugular vein regarding occurrence of infection resulted in extraction or treatment. Also there were no significant differences regarding occurrence of thrombosis resulted in extraction or treatment. Failure rate was significantly higher in cases with internal jugular vein catheter compared to cases with subclavian vein catheter (p=0.04). Conclusion. Failure rate was significantly higher in cases with internal jugular vein catheter compared to subclavian cathether. Subclavian catheter is more appropriate route for catheter placement

A novel energy mapping approach for CT-based attenuation correction in PET.

Dual-energy CT (DECT) is arguably the most accurate energy mapping technique in CT-based attenuation correction (CTAC) implemented on hybrid PET/CT systems. However, this approach is not attractive for clinical use owing to increased patient dose. The authors propose a novel energy mapping approach referred to as virtual DECT (VDECT) taking advantage of the DECT formulation but using CT data acquired at a single energy (kV(P)). For this purpose, the CT image acquired at one energy is used to generate the CT image at a second energy using calculated kV(P) conversion curves derived from phantom studies

Drug-related community issues and the required interventions in open drug scenes in Tehran, Iran: a qualitative study protocol

Background and objectivesMany low-income and middle-income countries experience problems with open drug scenes and drug-related community issues (DRCIs). These experiences occur in settings with varying levels of health and law enforcement initiatives, and accordingly a range of approaches are implemented to curb the problem. Most of the published literature stems from Western and high-income societies. With this concern, the present study aims to describe a planned project to explore DRCIs in the open drug scenes of Tehran, including its typology, and predisposing and reinforcing factors. In addition, the study attempts to investigate the perceptions with respect to the required interventions and barriers to their accessibility.To this end, the current study focuses on the Farahzad drug scene due to its structure and the difficult access to the scene by harm reduction providers. Data collection techniques encompass field observation, indepth interview and focus group discussion. Further, semistructured interviews are conducted with people who use drugs and other key informants who are engaged at this drug scene, including business, community, voluntary and statutory stakeholders, for an average of 90 min (average of 45 min for each part of the study). Furthermore, as a complementary method, field observation is performed regarding the themes of DRCIs at this scene. Then, focus group discussions are held to further describe the themes of DRCIs as well as to explore the required interventions, for an average of 90 min. Finally, the results are evaluated using qualitative content analysis.Ethics and disseminationEthical approval for the study was obtained from the Ethics Committee of Iran University of Medical Sciences, Iran. Additionally, participants are to provide written informed consent. The findings of the study are expected to play a role in promoting the current intervention