Traumatic Injuries Caused by Fall in the Elderly Referred to the Emergency Department; an Epidemiologic Study

مقدمه: سقوط و صدمات ناشی از آن از مشکلات مهم سالمندان در سراسر جهان محسوب شده و افزایش بار مالی و مراقبتی قابل توجهی را برای سیستم های بهداشتی و درمانی بدنبال دارد. در راستای دستیابی به اطلاعات صحیح جهت برنامه ریزی های پیشگیرانه و یا درمانی دقیق تر، مطالعه حاضر با هدف بررسی اپیدمیولوژیک آسیب های ناشی از سقوط در سالمندان مراجعه کننده به بخش اورژانس طراحی شده است. روش کار: پژوهش حاضر یک مطالعه مقطعی گذشته نگر می باشد که طی سال های 93- 1392 بر روی سالمندان مراجعه کننده بدنبال سقوط به بخش اورژانس، بیمارستان امام رضا، مشهد، ایران، انجام شده است. نمونه گیری به روش سرشماری و شامل تمامی بیماران با سن 60 سال و بالاتر بود. اطلاعات دموگرافیک، ویژگی های حادثه، طول مدت بستری، نوع آسیب و شکستگی، تعداد دفعات مراجعه و پیامد نهایی بیماران با استفاده از آماره توصیفی گزارش گردید. يافته ها: 1033 بیمار با میانگین سنی 07/9 ± 37/73 (دامنه سنی بین60 تا 106سال) در طی مدت دو سال مورد مطالعه قرار گرفتند. از این بین 8/64 درصد زن و بقیه مرد بودند و نسبت جنسی زن به مرد 83/1 بود (5/69 درصد متاهل). میانگین سنی خانم های آسیب دیده (89/8 ± 07/73) تفاوت معنی داری با میانگین سنی مردان آسیب دیده (36/9 ± 92/73) نداشت (156/0=p). بیشتر آسیب دیدگان (6/56 درصد) در گروه سنی 74-60 سال قرار داشتند. وقوع حادثه در فصل تابستان (6/29 درصد) و در ماه شهریور بیشتر از سایر زمان ها بود. متوسط طول مدت بستری 96/6 ± 05/5 روز (دامنه مدت بستری از یک ساعت تا 98 روز) بود. بیشترین تعداد روز بستری به دلیل شکستگی فمور بود. متوسط تعداد مراجعه مجدد در بین زنان (84/0 ± 34/1) و مردان (43/1± 48/1) تفاوت معنی داری نداشت (078/0=p). بررسی مکان های سقوط نشان داد که در 6/73 درصد موارد سقوط از سطح همتراز، 23 درصد سقوط از ارتفاع و 7/2 درصد نیز سقوط اشیاء روی سالمند و بقیه موارد نامشخص بود. 7/65 درصد از زنان سقوط را از سطح همتراز و 9/78 درصد مردان سقوط اشیاء روی سالمند را تجربه نموده بودند (001/0 >p). در بررسی نوع شکستگی به تفکیک جنسیت به ترتیب شکستگی فمور (4/34 درصد)، شکستگی ساعد (34 درصد) و شکستگی شانه (9/8 درصد) در زنان و در مردان به ترتیب شکستگی فمور (3/48 درصد)، شکستگی ساعد (7/13 درصد) و بعد از آن شکستگی ساق (6/10 درصد) شایعترین علل شکستگی بوده اند (001/0 > p). در مجموع 7/2 درصد از موارد سقوط منجر به فوت شده بود. بررسی میانگین سنی بین افراد زنده مانده (97/8 ± 20/73) و فوت شده (50/10 ± 57/97) نشان دهنده تفاوت معنی دار بین این دو گروه بود (001/0 > p). اغلب فوت شدگان در گروه سنی 75-89 سال (50 درصد) و در میان مردان (6/53 درصد) بوده اند. نتيجه گيری: بر اساس یافته های مطالعه حاضر بیشترین موارد سقوط در سالمندان مربوط به خانم های متاهل با متوسط سنی 73 سال، در فصل تابستان (ماه شهریور)، به دنبال سقوط همتراز و بین ساعات 18 -13اتفاق افتاده بود. شایعترین آسیب ناشی از سقوط در سری حاضر شکستگی اندام فوقانی و تحتانی بود و میزان مرگ و میر ناشی از سقوط 7/2 درصد گزارش گردید.Introduction: Falling and its resulting injuries are among the important problems of the elderly all over the world and bring about a considerable rise in financial and care burdens for health care systems. To gain accurate data for prevention or treatment planning, the present study aimed to epidemiologically assess the injuries resulting from falling in elderly patients presenting to emergency department (ED).Methods: The present study is a retrospective cross-sectional study carried out on elderly patients presenting to ED of Imam Reza Hospital, Mashhad, Iran, during 2011 and 2012 following falling. Consecutive sampling was used and patients over the age of 60 were included. Demographic data, accident characteristics, hospitalization duration, type of injury and fracture, frequency of visits and final outcome of the patients were recorded using descriptive statistics. Results: 1033 patients with the mean age of 73.37 ± 9.07 years (range: 60 – 106) were studied during 2 years. 64.8% were female and the female to male ratio was 1.83 (69.5% married). Mean age of the injured women (73.07 ± 8.89) was not significantly different from that of injured men (73.92 ± 9.36) (p = 0.156). Most patients (56.6%) were in the 60-74 years age group. Frequency of accidents was higher in summer (29.6%) and was the highest in September. Mean duration of hospitalization was 5.05 ± 6.96 days (range: 1 hour-98 days). The longest duration of hospitalization was due to femur fraction. Mean frequency of revisits was not significantly different between women (1.34 ± 0.84) and men (1.48 ± 1.43) (p = 0.078). Evaluation of falling locations revealed falling from the same level in 73.6% of cases, falling from a height in 23% of cases, objects falling on the patient in 2.7% of cases and other cases were undefined. 65.7% of females had fallen from the same level and 78.9% of males had experienced falling of objects (p < 0.001). In assessing the type of fracture based on gender, fractures of femur (34.4%), forearm (34%), and shoulder (8.9%) in women and femur (48.3%), forearm (13.7%), and leg (10.6%) in men were the most common types, respectively (p < 0.001). In total, 2.7% of falling cases had led to death. Comparison of mean age between those who survived (73.20 ± 8.97) and those who died (97.57 ± 10.50) showed a significant difference (p < 0.001). Most patients that died were in the 75-89 years age group (50%) and male (53.6%). Conclusion:Based on the results of the present study, the highest frequency of falling in the elderly happened in married women with the mean age of 73 years, in summer (September), following same level falling between 1pm and 6 pm. The most common injury caused by falling in this population was fraction of upper and lower extremities and mortality rate due to falling was 2.7%

Family physicians' attitude and interest toward participation in urban family physician program and related factors

Introduction: Every family physician has a key role in achieving the goals of the family physician program (FPP). Low satisfaction of physicians in certain areas of Iran and their low maintenance level in the program is quite challenging. The aims of the present study were; (1) to assess the attitude of rural/rural-urban family physicians about FPP and (2) to investigate their interest toward participation in urban FPP and (3) to explore the influencing factors. Methods: This cross-sectional study was performed on 137 family physicians who were working in rural/rural-urban FPP in Mashhad University of Medical Sciences (Iran). A self-designed valid and reliable questionnaire including demographic data and thirty questions on the participants' attitudes toward the FPP in Likert scale were used. Data were analyzed by multiple logistic regression models using SPSS software. Results: 49.3% of physicians were interested in continuing their cooperation in the urban-FPP. The mean total attitude score was 62.18 out of 100. The highest agreement and positive attitude of physicians were related to achievements of the program goals dimension. Multiple analyses showed that gender (odds ratio [OR] =5.5; male vs. female) and employment status (OR = 16.7 and 10.9 for permanent employment and by contract compared to legal obligation, respectively) were significantly associated with physicians' willingness toward participation in the urban-FPP. Conclusion: About half of the studied physicians were interested toward participation in the urban-FPP; Male physicians more than females and permanent employees more than others were willing and interested to participate in the urban-FPP

Serum lactate is a useful predictor of death in severe sepsis and septic shock

The severe sepsis and septic shock are as common and lethal that emergency physicians routinely confront. Actually, more than two thirds of sepsis patients present initially to the ED. Only a few laboratory tests for markers of sepsis are currently available. The serum lactate level can help in determining prognosis and to risk-stratify patients with severe sepsis. This independent review of the literature includes 83 studies published in all electronic-based database such as Elsevier, PubMed, and SID during the last 18 years (40–320 patients in each). Data gathered from English language articles and books published between 1995 and 2013. The serum lactate concentrations measured in almost all patients with severe sepsis raised at admission and were higher in patients who had the worst outcomes such as higher Apache-II and SOFA score. Serum lactate was associated with mortality independent of clinically apparent organ dysfunction and shock in patients with severe sepsis admitted to the emergency department and intensive care unit.  This review focuses on the association between initial and serial serum lactate level and mortality in patients presenting to the emergency department with severe sepsis

Clinicopathologic aspects and treatment results in malignant sex cord-stromal tumor of ovary

Background: Ovarian sex cord-stromal tumors (SCST) account for rare ovarian malignancy. These tumors are 5-8% of all ovarian neoplasms. The most common type of sex cord ovarian tumors is granulosa cell tumor (GCT). In this study our purpose was to have a look at some of clinicopathologic aspects and treatment results of these tumors. Methods: In a retrospective study, all documents of patients with SCST was referred to tumor clinics of Ghaem and Omid Hospitals, from 1998 to 2008. The data of patients were collected and analyzed. Results: In 39 (5.9) of the 398 cases, ovarian malignancies was present in SCST. Eight Patients omitted from the study because there were not enough data for them. The commonest pathology was adult granulosa cell tumor in 25 patients (80.6%). Two patients (8.33%) had juvenile granulosa cell tumor, they were 25 and 38 years old. At time of diagnosis, 27 cases (87.1%) were in early stages (stage I). Mean age of patients was 41 years (range 16-76 years) at time of diagnosis of disease. Surgical staging of cancer was performed in 14 patients (46.7%). We did fertility sparing surgery in 12 patients (40%). Two patients were pregnant after surgery. 17 patients (54.80%) did not receive chemotherapy. Three patients (9.7%) received radiotherapy. Overall survival rates were 95% at both 2 years and 5 years. Longer survival had correlation with early stages of disease (P= 0.002). Age, conservative surgery and chemotherapy had no correlations with survival. Conclusion: The prognosis of SCST is almost good. Most of the patients were diagnosed in early stage of disease. In sex cord ovarian tumor, the only factor that have a full effect on survival, is stage of the disease. If the patients desire to preserve fertility, we can do fertility sparing surgery with minimal effect on survival

A comparative study of osteopontin and MMP-2 protein expression in peripheral and central giant cell granuloma of the jaw

Introduction: Oral peripheral and central giant cell granulomas are lesions with little-known etiology and pathogenesis. Objective: The aim of this study was to compare matrix metalloproteinases-2 and osteopontin protein expression in the multinucleated giant cells and mononuclear cells of the peripheral and central giant cell granuloma lesions. Methods: In this retrospective study, the presence of matrix metalloproteinases-2 and osteopontin in 37 cases of central giant cell granuloma and 37 cases of peripheral giant cell granuloma paraffin blocks were assessed by streptavidin-biotin immunohistochemistry. Independent sample t-test, Chi-square, Mann–Whitney tests and Spearman's rank correlation coefficient were used. Results: The osteopontin was expressed in both multinucleated giant cells and mononuclear cells in all cases of peripheral and central giant cells granulomas. However, the matrix metalloproteinases-2 expression was positive in 86.5% of giant cells and it was positive in all of mononuclear cells in peripheral giant cells granuloma. In central giant cells granulomas, 91.8% of giant cells and all mononuclear cells were positive for matrix metalloproteinases-2 marker. Percentage and Intensity of staining were significantly higher in central than peripheral giant cells lesions, for both markers (p ˂ 0.05). Conclusion: This study showed that the expression of osteopontin in giant cells supports the theory of osteolcastic nature of these cells. Also, the presence of osteopontin and matrix metalloproteinases-2 in mononuclear cells may indicate the monocyte-macrophage origin of these cells, as the differentiation of the precursors of the mononuclear stromal monocyte/macrophage to osteoclasts is possibly affected by the expression of osteolytic factors. Also, may be differences in biological behaviors of these lesions are associated with the level of osteopontin and matrix metalloproteinases-2 expression. Resumo: Introdução: Os granulomas periféricos e centrais de células gigantes são lesões com etiologia e patogênese pouco conhecidas. Objetivo: O objetivo deste estudo foi comparar a expressão das proteínas metaloproteinases da matriz-2 e osteopontina nas células gigantes multinucleadas e células mononucleares no granuloma periférico e central de células gigantes. Método: Neste estudo retrospectivo, a presença de metaloproteinases da matriz-2 e osteopontina em 37 casos de granuloma central de células gigantes e 37 casos de granuloma periférico de células gigantes em blocos de parafina foram avaliadas por imunohistoquímica pela estreptavidina-Biotina. Foram utilizados teste t para amostra independente, teste de Qui-quadrado, Mann-Whitney e coeficiente de correlação de Spearman. Resultados: A osteopontina foi expressa em células gigantes multinucleadas e células mononucleares em todos os casos de granuloma periférico de células gigantes e granuloma central de células gigantes. No entanto, a expressão de metaloproteinases da matriz-2 foi positiva em 86,5% de células gigantes e foi positiva em todas as células mononucleares em granuloma periférico de células gigantes. Em granuloma central de células gigantes, 91,8% das células gigantes e todas as células mononucleares foram positivas para o marcador metaloproteinases da matriz-2. A porcentagem e intensidade de coloração em granuloma central de células gigantes foram significantemente maiores do em granuloma periférico de células gigantes para ambos os marcadores (p ˂ 0,05). Conclusão: Este estudo mostrou que a expressão de osteopontina em células gigantes apoia a teoria da natureza osteoclástica dessas células. Além disso, a presença de osteopontina e metaloproteinases da matriz-2 em células mononucleares pode indicar a origem dos monócitos-macrófagos dessas células, uma vez que a diferenciação dos precursores do monócito/macrófago estromal mononuclear em osteoclastos é possivelmente afetada pela expressão de fatores osteolíticos. Além disso, as diferenças nos comportamentos biológicos dessas lesões estão associadas ao nível de expressão de osteopontina e metaloproteinases da matriz-2. Keywords: Osteopontin, MMP-2, PGCG, CGCG, Immunohistochemistry, Palavras-chave: Osteopontina, MMP-2, PGCG, CGCG, Imunohistoquímic

The effect of topical olive oil application on the symptoms of infantile colic: A randomized, double‐blind, placebo‐controlled clinical trial

Abstract Background and Aims Infantile colic is one of the most common disorders in the first months of infants' lives. This condition hurts parents' moods. This study was carried out to investigate the effect of the topical use of olive oil on infantile colic symptoms. Methods The study was carried out on 80 infants 1–3 months old, randomly allocated into two groups, receiving abdominal massage with olive oil thrice a day in the intervention group (n = 40) and the same procedure with liquid paraffin in the placebo group (n = 40), for 14 successive days. During this period, the parents recorded the episodes of colic, duration of colic, crying intensity, and episodes of defecation. These variables were assessed and compared at the beginning and on the 7th and 14th days. Results The mean crying duration changed from 4.05 ± 2.44 to 1.41 ± 1.03 h/day (65% decrease) in the olive oil group and from 3.85 ± 1.37 to 1.60 ± 1.32 h/day (58% decrease) in the paraffin group (p = 0.38). The episodes of crying were reduced from 5.79 ± 4.56 to 2.51 ± 4.93 episodes/day (↓57%) in the olive group and from 6.01 ± 3.40 to 3.01 ± 2.40 episodes/day (↓50%) in the paraffin oil group (p = 0.14). Furthermore, the intensity of crying was decreased from 9.04 ± 1.54 to 4.48 ± 2.17 (p < 0.001) in the olive oil group and from 9.0 ± 1.20 to 4.77 ± 1.68 (p < 0.001) in the paraffin oil group. On the 14th day, the crying intensity showed no significant difference between the two groups. Conclusion Abdominal massage with olive oil has the same effect as massage with paraffin oil in reducing the symptoms of infantile colic