Pattern of Traumatic Injuries in Patients with Tramadol Poisoning: A Cross-Sectional Study in a Tertiary Care Hospital

Objective: This study aimed to investigate the incidence and pattern of tramadol-induced seizures and injuriesin patients admitted to the hospital.Methods: The cross-sectional study included 300 patients with alleged tramadol intoxication. Demographicinformation, tramadol dosage and duration of abuse, co-existing illicit drug abuse, hospital stay length, andoccurrence of seizures and trauma (type and site of injuries) were collected. Different statistical tests, includingthe Mann-Whitney U-test, Pearson’s Chi-square test, and Student’s t-test, were conducted to compare thepatients with and without seizures, trauma, and co-ingestion of illicit drugs. The analysis was performed usingSPSS software (version 21.0). A p value of less than 0.05 was considered statistically significant.Results: The average patient’s age was 24.66±5.64 years, with males comprising 84.3% of the sample. Themean tramadol dose and duration of abuse were 1339.3±1310.2 mg and 2.43±1.35 years, respectively. Seizureswere observed in 66% of patients, with men having a higher incidence (69.6% vs. 46.8%; p=0.004). Trauma wasreported in 23% of patients, accounting for 35.4% of seizure cases. All trauma patients had experienced seizures,with the head and neck being the most prevalent injury sites (55.1%), typically presenting as abrasions (55.9%).Patients with seizures and trauma had an average hospital stay of 1.73±0.94 days, which was significantlylonger.Conclusion: Trauma occurs in more than one-third of tramadol-induced seizures, highlighting the needto perform physical examinations to detect and localize injuries. Tramadol-associated traumas prolongedhospitalization times and thus required prompt attention to prevent further injuries during pre-hospital handlingand transferring to hospitals

Factors Determining Primary Coronary Slow Flow Phenomenon among Opium Users and Non-users: A Case Control Study in Northern Iran

Background: Coronary slow flow phenomenon (CSFP) represents a clinical entity with recurrent chest pain leading to living impairment. The present study aimed to investigate whether opium use correlates with primary CSFP. Methods: This study included Iranian patients with suspected coronary artery disease who underwent myocardial perfusion imaging. Coronary blood flow was measured quantitatively using the thrombolysis in myocardial infarction (TIMI) frame count and slow flow was defined as TIMI grade 2 standard deviations. Age and clinical conditions including diabetes mellitus (DM), hypertension (HTN), hyperlipidemia (HLP), history of chest pain, and opium use were recorded. First, the characteristics of the two groups were compared and then the main analyses were conducted to examine the relationship between CSFP and opium use. Data were analyzed using t test and chi-square test via SPSS 25.0. The significance level was set at P<0.05. Findings: This study was conducted on 44 male patients with documented CSFP who had no stenotic lesions and 134 control group male patients who had normal coronary arteries with normal flow. The mean age was similar in the two groups (54.25 vs.52.69, P=0.474). Two groups were significantly different in terms of history of chest pain (P=0.003), but there was no significant difference in HTN (P=0.084), DM (P=0.284), HLP (P=0.183), smoking (P=0.696), and opium use (P=0.107).  Conclusion: This study indicated that opium use is not associated with primary CSFP

What priorities should be considered for Iranian veterans with ankle-foot injuries? A health needs assessment study, 25 years post-conflict

Abstract Despite the passage of time, a large number of veterans are still affected by injuries acquired during Iran-Iraq war. In addition to their primary injuries, the majority of veterans also experience difficulty with long-term, secondary effects. Studies have shown that the most common of these include a range of disabilities, pain, and dramatic decline in mental health and quality of life. Improving living conditions and providing rehabilitation services to veterans has always been a main priority of authorities. The goal of this study was to explain the methods and materials with which these priorities were explored

Assessment of orthotic needs in Iranian veterans with ankle and foot disorders

Abstract Background War-related traumas can lead to orthopedic and neurological disorders in victims. However, the scope of such disorders may expand months or even years after the trauma. Orthotic treatment as a rehabilitation process aims to enable people with disabilities to reach and maintain their optimal physical, sensory, intellectual, psychological, and social functional levels. This study aimed to investigate the rate of using orthoses among Iranian veterans with neuromuscular and skeletal disorders of the ankle and foot. Furthermore, the priorities of orthotic treatment in those veterans were explored. Methods This qualitative study was a national health needs assessment conducted in 11 provinces of Iran during 2011–2016. A stakeholder research group was established to survey the veterans in respect to their demographic variables, activities of daily living, current health conditions, and rate of using orthoses. Results Overall, 907 of the 1124 veteran participants completed the survey (response rate: 80.7%). Most of the veterans were men (97.7%), and their age and disability rate were 52.07 ± 8.13 years and 31.92% ± 14.93%, respectively. Nearly 42% of the veterans had experience in using orthoses on a daily and weekly basis. As physical ambulation was the main problematic activity in veterans, most of them were using medical shoes and foot orthoses. Nearly 37% of veterans were in need of some type of lower limb orthoses on the contralateral side to compensate for their hip inequality. In sequential order, the most in need orthoses for veterans were foot orthoses (n = 538), medical shoes (n = 447), lower limb orthoses on the contralateral side (n = 320), spinal orthoses (n = 273), and upper limb orthoses (n = 86). Conclusions In spite of the high demands for orthoses among Iranian veterans with ankle and foot disorders, the use of orthoses is insufficient. Hence, there is a discrepancy between the current rate of orthoses use and its ideal situation, and more resources should be provided for service providers to be able to serve veterans. Moreover, veterans should be educated regarding orthoses, their use, and their impacts on the user’s health status. The findings of a needs assessment of orthoses can be used in strategic planning and decision making to improve health care services for Iranian veterans

EVALUATION OF LOCALIZED PAIN IN THE TRANSTIBIAL RESIDUAL LIMB

PURPOSE The socket is the main component of a prosthesis which surrounds the residual limb and transfers loads and motions between the residual limb and prosthesis. A misfit socket may lead to excessive stresses on the residual limb, pistoning of the prosthesis during walking, patient discomfort, pain, and skin damage. The quality of socket-skin interface directly affects quality of life, prosthesis use, and satisfaction from prosthesis in amputees. Pain is a devastating condition that prohibits prosthesis use1-4. The present study aimed to evaluate pain threshold and tolerance of the transtibial residual limb to improve its socket design and fit.   Abstract PDF  Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32028/24445 How to cite: Ghoseiri K, Rastkhadiv M.Y, Allami M. EVALUATION OF LOCALIZED PAIN IN THE TRANSTIBIAL RESIDUAL LIMB. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32028                                                                          Abstracts were Peer-reviewed by the AOPA 2018 National Assembly Scientific Committee

EVALUATION OF LOCALIZED PAIN IN THE TRANSTIBIAL RESIDUAL LIMB

PURPOSE The socket is the main component of a prosthesis which surrounds the residual limb and transfers loads and motions between the residual limb and prosthesis. A misfit socket may lead to excessive stresses on the residual limb, pistoning of the prosthesis during walking, patient discomfort, pain, and skin damage. The quality of socket-skin interface directly affects quality of life, prosthesis use, and satisfaction from prosthesis in amputees. Pain is a devastating condition that prohibits prosthesis use1-4. The present study aimed to evaluate pain threshold and tolerance of the transtibial residual limb to improve its socket design and fit. &nbsp; Abstract PDF&nbsp; Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32028/24445 How to cite:&nbsp;Ghoseiri K, Rastkhadiv M.Y, Allami M. EVALUATION OF LOCALIZED PAIN IN THE TRANSTIBIAL RESIDUAL LIMB. CANADIAN PROSTHETICS &amp; ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018.&nbsp;DOI: https://doi.org/10.33137/cpoj.v1i2.32028 &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee.&nbsp; http://www.aopanet.org

Assistive technologies for pain management in people with amputation: a literature review

Abstract The prevalence of limb amputation is increasing globally as a devastating experience that can physically and psychologically affect the lifestyle of a person. The residual limb pain and phantom limb pain are common disabling sequelae after amputation surgery. Assistive devices/technologies can be used to relieve pain in people with amputation. The existing assistive devices/technologies for pain management in people with amputation include electrical nerve block devices/technologies, TENS units, elastomeric pumps and catheters, residual limb covers, laser systems, myoelectric prostheses and virtual reality systems, etc. There is a great potential to design, fabricate, and manufacture some portable, wireless, smart, and thin devices/technologies to stimulate the spinal cord or peripheral nerves by electrical, thermal, mechanical, and pharmaceutical stimulus. Although some preliminary efforts have been done, more attention must be paid by researchers, clinicians, designers, engineers, and manufacturers to the post amputation pain and its treatment methods

Efficacy of long-term outcomes and prosthesis satisfaction in war related above knee amputees of Tehran

Background and purpose: Amputation is one of the most deleterious events that one may experience throughout his/her life. Gait patterns adopted by Amputees with prosthesis can cause such various types of pain as back pain, hip joint pain and contralateral pain. Knowledge about existing problems associated with amputated limb can be useful in making decisions about appropriate treatment plans and rehabilitation programs for these patients. The aim of this study was to evaluate long-term outcomes and prosthesis satisfaction in persons with war-related above-knee amputations. Material and methods: Sixty-one Iranian subjects with above knee amputation were requested to fill out the Persian version of Prosthesis Evaluation Questionnaire (PEQ) and to judge whether they were satisfied with their current prosthesis. Results: Phantom sensation, phantom pain, residual limb pain, lateral limb pain and back pain was respectively reported in 88.5%, 77%, 36.1%, 33% and 72.1% of the subjects. Moreover, it became evident that 19.67% of the subjects were truly satisfied with their current prosthesis. Conclusion: According to study results, phantom sensation, phantom pain, back pain, residual limb pain and pain in the lateral limb are the most prevalent outcomes of war related amputations. Satisfaction rates were higher than moderate in more than half of the patients studied. Key words: limb loss, phantom pain, phantom sensation, satisfactio

ASSISTIVE TECHNOLOGIES FOR PAIN MANAGEMENT IN AMPUTEES: A REVIEW

INTRODUCTION The prevalence of limb amputation is increasing globally as a devastating experience that can physically and psychologically affect the lifestyle of a person. The residual limb pain and phantom limb pain are common disabling sequelae after amputation surgery. Assistive devices/technologies can be used to relieve pain in people with amputation. The present review aimed to introduce the existing assistive devices/technologies for pain management in people with amputation. Abstract PDF&nbsp; Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32008/24427 How to cite:&nbsp;Ghoseiri K, Allami M, Soroush M.R, Rastkhadiv M.Y. ASSISTIVE TECHNOLOGIES FOR PAIN MANAGEMENT IN AMPUTEES: A REVIEW. CANADIAN PROSTHETICS &amp; ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; &nbsp;ABSTRACT, POSTER PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. &nbsp;DOI: https://doi.org/10.33137/cpoj.v1i2.32008 Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee.&nbsp; http://www.aopanet.org/ &nbsp

INVESTIGATION OF LOCALIZED SKIN TEMPERATURE DISTRIBUTION ACROSS THE TRANSTIBIAL RESIDUAL LIMB

BACKGROUND: Interventions to resolve thermal discomfort as a common complaint in amputees are usually chosen based on the residual limb skin temperature while wearing prosthesis; whereas, less attention has been paid to residual limb skin temperature while outside of the prosthesis. The objective of this study was to explore the localized and regional skin temperature over the transtibial residual limb (TRL) while outside of the prosthesis. METHODOLOGY: Eight unilateral transtibial adults with traumatic amputation were enrolled in this cross-sectional study. Participants sat to remove their prostheses and rested for 30 minutes. Twelve sites were marked circumferentially in four columns (anterolateral, anteromedial, posteromedial, and posterolateral) and longitudinally in three rows (proximal, middle, and distal) over the residual limb and used for attachment of analog thermistors. Skin temperature was recorded and compared for 11 minutes. Furthermore, the relationship of skin temperature with participants’ demographic and clinical characteristics was explored. FINDINGS: The whole temperature of the TRL was 27.73 (SD=0.83)°C. There was a significant difference in skin temperature between anterior and posterior columns. Likewise, the distal row was significantly different from the proximal and middle rows. The mean temperature at the middle and distal zones of the anteromedial column had the highest and lowest skin temperatures (29.8 and 26.3°C, p&lt;0.05), respectively. The mean temperature of the whole TRL had no significant relationships (p&gt;0.05) with participants’ demographic and clinical characteristics. CONCLUSIONS: An unequal distribution of temperature over the TRL was found with significantly higher and lower temperatures at its anterior column and distal row, respectively. This temperature pattern should be considered for thermoregulation strategies. Further investigation of the residual limb temperature with and without prosthesis, while considering muscles thickness and blood perfusion rate is warranted. Layman's Abstract The socket is a plastic hard-shell interface between the residual limb, the remaining part of the amputated limb, and a prosthesis. Heat buildup inside the prosthetic socket and perspiration of the residual limb are major discomforts in amputees when wearing a prosthesis. The majority of prior research measured residual limb skin temperature while the prosthesis was worn. However, less attention has been paid to skin temperature without prostheses. Skin temperature of eight adults with one-sided traumatic below-knee amputation was measured. Participants sat and removed their prostheses. Twelve anatomical sites were marked circumferentially in four columns and longitudinally in three rows over the residual limb and used for temperature recording using temperature sensors. The whole temperature of the residual limb was 27.73 (SD=0.83)°C. Skin temperature was higher at anterior columns compared to posterior columns. Similarly, the distal row of the residual limb had the lowest temperature compared to its middle and proximal rows. From a localized standpoint, the middle part at the anterior medial surface of the residual limb had the highest temperature, whereas the distal part at the anterior-medial surface had the lowest skin temperature. There was no noticeable relationship between the average of the residual limb skin temperature and participants’ demographic and clinical characteristics. Some strategies need to be developed to regulate and control heat dissipation over the residual limb's surface when amputees do not wear prostheses. Further temperature recording research by considering muscle thickness and arterial blood flow rate of the residual limb with and without prosthesis is suggested. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/35070/27313 How To Cite: Ghoseiri K, Allami M, Murphy J.R, Page P, Button D.C. Investigation of localized skin temperature distribution across the transtibial residual limb. Canadian Prosthetics &amp; Orthotics Journal. 2021;Volume 4, Issue 1, No.2. https://doi.org/10.33137/cpoj.v4i1.35070 Corresponding Author: Duane C Button, PhDSchool of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada.E-mail: [email protected]: https://orcid.org/0000-0001-6402-8545&nbsp;&nbsp; &nbsp