Rectus Muscle Hematoma as a Rare Differential Diagnosis of Acute Abdomen; a Case Report

Rectus sheath hematoma is a rare but well-known problem. Exercise, pregnancy, subcutaneous injection of insulin, abdominal surgery and severe coughs can be predisposing factors of hemorrhage in the mentioned muscle sheath. Here, we will discuss a case of rectus sheath hematoma in a 28 year-old female patient who presented to emergency department with complaint of abdominal pain and improved in 1 week with palliative care

Intravenous Lidocaine Compared to Fentanyl in Renal Colic Pain Management; a Randomized Clinical Trial

Introduction: Using alpha blockers such as intravenous (IV) lidocaine has been deemed effective in controlling acute pain. Therefore, the current study was designed with the aim of evaluating the efficiency of IV lidocaine in comparison to IV fentanyl in pain management of patients with renal colic in emergency department (ED). Methods: In this double blind clinical trial, 18-65 year old patients that presented to ED with colicky flank pain and met the inclusion criteria of the study were allocated to either lidocaine or fentanyl group using block randomization and compared regarding pain severity 5, 10, 15, and 30 minutes after drug administration. Results: 90 patients with the mean age of 35.75±8.87 years were divided into 2 groups of 45 (90% male). The 2 groups were not significantly different regarding the studied baseline variables. Pain severity was not significantly different between the 2 groups at various times after injection. Treatment failure rate 15 minutes after injection was 44.4% (20 cases) in IV lidocaine and 17.8% (8 cases) in IV fentanyl group (p = 0.006). These rates were 26.6% (12 patients) versus 22.2% 30 minutes after injection (p = 0.624). Absolute risk increase of treatment failure in case of using lidocaine was 26.7 (95% CI: 8.3-44.9) in the 15th minute and 4.4 (95% CI: 13.3-22.2) 30 minutes after injection. Number needed to harm (NNH) in treatment with lidocaine 15 and 30 minutes after injection were 4 (95% CI: 2.2-12.0) and 23, respectively. Conclusion: Although mean pain severity was not significantly different between IV fentanyl and lidocaine at various times after injection, treatment failure rate was significantly higher in the IV lidocaine group 15 minutes after injection

Comparison of the health indicators of the state health sites and health indicators which have been outsourced to private sector healt facility south of Tehran, Iran in 2009

Background and aim: After 4 years of delegating health services to private health centers in south of Tehrant, it is necessary to evaluate reaching the goals. The aim of this study was to examine the outcomes of delegating health service to private sector via comparing the private sector with governmental ones. Methods: In this analytical study, 2 sites from the number of non-governmental sites were chosen and checked and its health indicators were addressed. A form was used to collect data from the findings of these paper-based information services units and data were analyzed using descriptive statistics and χ 2 test in the minitab software. Results: Among the health indicators of children, those that were related to infants under 2 months and 5-year children were more favorable in private sector and those differences were statistically significant (P<0.05). In other children age groups, the public sector indicators were more favorable (P<0.05). In addition, the coverage of family planning programs and under 1- year vaccination were significantly lower in private sector (P<0.05). But, maternal care was significantly igher in private sector (P<0.05). h Conclusion: According to the results of this study, it seems necessary to promote the programs related to under 5-year care and family planning and vaccination. So, financial regulations with the aim of improving service delivery seems essential

Eosinophilic Ascites and Duodenal Obstruction in a Patient with Liver Cirrhosis

Eosinophilic gastroenteritis (EG) is a rare disease characterized by eosinophilic infiltration of portions of the gastrointestinal tract. Eosinophilic ascites is probably the most unusual and rare presentation of EG and is generally associated with the serosal form of EG. Hereby, we report a case of eosinophilic ascites with duodenal obstruction in a patient with liver cirrhosis. A 50-year-old womanwas admitted to our hospital because of abdominal pain, nausea, bloating, and constipation. She had a history of laparotomy because of duodenal obstruction 2 years ago. Based on clinical, radiological, endoscopic, and pathological findings, and given the excluding the other causes of peripheral eosinophilia, the diagnosis of eosinophilic gastroenteritis along with liver cirrhosis and spontaneous bacterial peritonitis was established. Based on the findings of the present case, it is highly recommended that, in the patients presented with liver cirrhosis associated with peripheral blood or ascitic fluid eosinophilia, performing gastrointestinal endoscopy and biopsy can probably reveal this rare disorder of EG

A qualitative study of the current situation of elderly care in Iran : what can we do for the future?

This study is part of the first author's PhD dissertation (17 Goharinezhad S. Foresight of elderly care in Iran: a scenario approach. PhD dissertation. 2016; Tehran, Iran: Iran University of Medical Sciences. [Google Scholar]) in Iran University of Medical Sciences, School of Health Management and Information Sciences (IUMS_ SHMIS: 65/2014). The authors would like to make special thanks to all participants for their cooperation to this study. The authors would also like to thank all reviewers who helped improve the manuscript.Peer reviewedPublisher PD

Futures of elderly care in Iran : A protocol with scenario approach

This study is the first author’s PhD Thesis, which has been supported by Iran University of Medical Sciences (IUMS_SHMIS: 65/2014). The authors would like to make special thanks to all participants for their kind contributions to this project and are also grateful to Dr. Mohammad Azmal and Dr. Hesam Seyedin for their insightful comments on the earlier manuscript.Peer reviewedPublisher PD

Interstitial Keratitis, Vertigo, and Vasculitis: Typical Cogan’s Syndrome

Cogan’s syndrome (CS) is a chronic inflammatory disorder of unknown etiology that most commonly affects young adults. Clinical hallmarks are bilateral interstitial keratitis and vestibuloauditory dysfunction. Association between CS and systemic vasculitis as well as aortitis also exists. The diagnosis of CS is based upon presence of characteristic inflammatory eye disease and vestibuloauditory dysfunction. We describe classic Cogan’s syndrome in a 47-year-old female from Ardabil. The patient was admitted with headache, vertigo, nausea, vomiting, right leg claudication, musculoskeletal pains, bilateral hearing loss, and blindness for the past two months. Ophthalmologic examination revealed that visual acuity was 0.1 bilaterally. Conjunctival hyperemia, bilateral cataract, and interstitial keratitis were detected with a slit lamp examination. Pure tone audiogram (PTA) and auditory brain stem response (ABR) showed bilateral sensorineural hearing loss. The other differential diagnosis of CS was studied and ruled out. Pulse i.v. methylprednisolone and cyclophosphamide were given and were followed by oral prednisolone and cyclophosphamide. Clinical follow-up showed partial improvement

Ketamine Associated Vomiting in Children Requiring Sedation: A Prospective Randomized Open Trial Study

Background In recent years, ketamine has been the most used sedative in Emergency Department (ED) procedures for pain management. Therefore, this study evaluated ketamine associated vomiting (KAV) in children requiring sedation. Materials and Methods This is a prospective, randomized, and open trial study carried out on children of ages 3 months to 13 years requiring sedation for medical diagnostic or treatment procedures. The patients were randomized into 1 mg/kg IV, 2 mg/kg IV, 3 mg/kg IM and 5 mg/kg IM groups. Results A total of 190 patients were enrolled for this study. In total, 17.37% of the children were reported to have vomited after ketamine administration. In the IV group, 21.69% of the children vomited, while in the IM group, 14.02% vomited (p= 0.18). In the 1 mg/kg IV group, 22.72% of the children vomited compared to 20.51% (p= 0.51) in the 2 mg/kg IV group.  In the 3 mg/kg IM group, 14.54% of the children vomited as against 13.46% in the 5 mg/kg IM group (p= 0.54). There were no significant differences between sex and dose group on the incidence of vomiting (p= 0.40). Conclusion This study showed that the administration of ketamine via IV and IM in a standard dose is a safe method for sedating children. However, there is need to study the combination of ketamine with anti-vomiting agents in different injection routes, as well as to review the combination with tranquilizer to minimize the rate of vomiting in children requiring sedation in the ED

A Review of Future Studies in the Field of Health Information Technology

Introduction: In order to adopt the right technologies, policy makers should have adequate information about the present and future advances. This study aimed to review future studies in the field of health information technology. Method: This review study was conducted in 2015. The databases including Scopus, Web of Science, ProQuest, Ovid Medline, and PubMed were sought between 2000 and 2015. Results: 11 papers were selected for the study. The papers were divided into two groups: forecasting the future of health information technology (n=7) and health information technology foresight (n=4). According to the results, it is better to use foresight approach for big and long-term goals. Conclusion: The results of foresight studies can be useful for making decision and policy-making in the field of health information technology, particularly at the national level