Multi-drug resistant Staphylococcus aureus isolated from emergency ward of an Iranian hospital

Purpose: To study the prevalence of resistant strains of S. aureus isolated from surfaces, beds and various equipment of an Iranian hospital emergency ward.Methods: Two hundred swab samples were collected from the surfaces, beds, trolleys, surgical equipment and diagnostic medical devices in emergency ward. Samples were cultured and those that were S. aureus-positive were confirmed using polymerase chain reaction (PCR). Antimicrobial resistance pattern was analyzed using disk diffusion method.Results: Nine of 200 samples (4.5 %) collected were positive for S. aureus. Surfaces (8.8 %), beds (5 %) and trolleys (5 %) were the most commonly contaminated. S. aureus isolates exhibited varying levels of resistance against antibiotics with the following being the highest: tetracycline (88.8 %), penicillin (88.8 %) and ampicillin (77.7 %). The prevalence of resistance against methicillin, oxacillin and azithromycin were 44.4, 33.3 and 33.3 %, respectively. There was no pattern of resistance against imipenem.Conclusion: Efficient disinfection of surfaces, beds, trolleys and surgical instruments should be performed periodically to reduce colonization of resistant strains of S. aureus in various areas of emergency health care centers.Keywords: Staphylococcus aureus, Nocosomial infection, Antibiotic resistance, Hospital equipment, Emergency war

The Relationship between Clinical Findings of Shoulder Joint with Bone Damage of Shoulder Joint in Patients with Isolated Shoulder Blunt Trauma

BACKGROUND: Due to the prevalence of shoulder injuries among athletes and other people and the prevalence of radiography for these injuries, there are still no valid criteria for indication of doing shoulder radiography. AIM: This study aimed to examine the relationship between some signs and clinical examinations of the shoulder with shoulder bone injuries and the need for radiography. METHODS: This is a cross-sectional study. All patients aged 18-70 years who referred to the emergency ward of Imam Reza and Hasheminejad Hospital in the year 2014 due to blunt trauma and had criteria for entering the study and lacking exclusion criteria were included in the study process. Data on clinical symptoms, radiographic results, and final diagnosis were extracted from the patients' records through a questionnaire and analysed statistically. RESULTS: There was a significant relationship between the clinical signs of patients Existence of ecchymosis in the shoulder fractures with glenoid and humerus fractures (p = 0.029, p = 0.004 respectively). There was also a significant relationship between clavicle fracture and limitation in shoulder rotation and abduction (p = 0.000 and p = 0.001 respectively). Other clinical symptoms did not show any significant relationship with radiographs indicative of the problem requiring specific treatment. CONCLUSION: Although it is possible to define critters based on clinical symptoms that reduce the need for unnecessary radiographs that the does not reliably help inpatient treatment, but finding these critters to indicate the performance of the graphs in shoulder injuries requires further studies with the higher population and more clinical variables

Evaluation of sensitivity and the specificity of Canadian CT head rule and New Orleans criteria in patients with head injury

BackgroundMillions of people around the world are annually under emergency investigation due to severe head injuries. Computed tomography (CT) scans is a diagnostic procedure that can be done for most people. AimsThis study is aimed to evaluate the sensitivity and the specificity of Canadian and New Orleans criteria in determining the rate of head injury.Methods To obtain the relationship between clinical symptoms and CT scan results, the required information was obtained by filling out the records and physical examination in the emergency department and the results from the patients were statistically analysed. Data needed to complete the questionnaire was collected from patient, the patient, their concomitant examination, and the information in their medical records. The raw data from the questionnaire was analysed using SPSS version 17 software. In this study, after obtaining the CT scan results, the individuals were classified into two clinical criteria, New Orleans and Canadian, and their sensitivity and specificity were analysed using ROC curve analysis.Results ROC curve analysis data showed that the sensitivity and specificity of New Orleans criteria are 31 per cent and 69 per cent, respectively, and the sensitivity and specificity of Canadian criteria are 76 per cent and 74 per cent, respectively. Data shows that the Canadian curve has a significant difference compared to basic state (P-Value < 0.05).ConclusionDespite abnormal CT scan results in patients with head trauma, there is a significant relationship between headache and a combination of symptoms in patients. The results can be used in decision-making on involved in performing a CT scan. ROC curve analysis also showed that the Canadian criterion has higher sensitivity and specificity for the diagnosis of severe head trauma compared to New Orleans criteria

چالش های آموزش مجازی در دانشگاه های علوم پزشکی کشور در دوران کرونا؛ مروری بر مطالعات کیفی انجام شده در ایران

Introduction: With the emergence of the corona virus, the educational system as well as other areas of the society has faced many challenges. This research was conducted with the aim of the challenges of virtual education in the country's medical sciences universities during the Corona era as a review of the qualitative studies conducted in Iran. Methodology: In this review study (a review of qualitative studies) in order to comprehensively search the available evidence and studies, SID, Iranmedex, Magiran and Google Scholar search engine were analyzed. The search criteria did not limit the start date, but the end date was set at the end of September 2022. The search was conducted to find articles with the keywords of virtual education, corona, students, professors as a combination of words. Results: From a total of 6 studies, the themes of "inefficient education, lack of educational infrastructure, confusion in organization, communication challenges and weak interactive platform" were identified as the main factors of virtual education challenges in the Corona era. Conclusion: The results of the present study showed that the students and professors of Iranian medical sciences universities were facing serious challenges in the field of virtual education, which is necessary in each university specifically and in accordance with the structure of that environment, effective solutions to adjust and solve them. Present problems.مقدمه: بـا پیدایـش ویـروس کرونـا نظـام آموزشـی نیـز چـون دیگـر عرصـه هـای جامعـه بـا چالـش هـای متعـددی روبـرو گردیـده اسـت. ایـن پژوهـش بـا هـدف چالش های آموزش مجازی در دانشگاه های علوم پزشکی کشور در دوران کرونا به صورت مروری بر مطالعات کیفی انجام شده در ایران صورت گرفت. روش کار: در این مطالعه مروری (مرور بر مطالعات کیفی) به منظور جستجوی جامع شواهد و مطالعات موجود پایگاه‌های اطلاعاتی فارسی زبان؛SID ،Iranmedex ،Magiran &nbsp;و موتور جستجوگر Google Scholar مورد واکاوی قرار گرفت. در ضوابط جستجو محدودیتی در تاریخ شروع داده نشد، ولی انتهای آن پایان ماه سپتامبر سال 2022 قرار داده شد. جستجو برای یافتن مقالات با کلید واژه‌های آموزش مجازی، کرونا، دانشجویان، اساتید به صورت ترکیب واژگان انجام شد. نتایج: از مجموع 6 مطالعه انجام شده درون مایه های" آموزش ناکارآمد، نبود زیر ساخت های آموزشی، آشفتگی در سازمان دهی، چالش های ارتباطی و بستر تعاملی ضعیف"&nbsp;&nbsp; به عنوان عوامل اصلی چالش های آموزش مجازی در دوران کرونا شناسایی شدند. نتیجه گیری: نتایج مطالعه حاضر نشان داد که دانشجویان و اساتید دانشگاه های علوم پزشکی ایران با چالش های جدی در زمینه آموزش مجازی مواجه بودند که ضروری است در هر دانشگاه به طور ویژه و متناسب با ساختار آن محیط، راهکارهای موثری در جهت تعدیل و حل مشکلات ارائه نمایند

Evaluation of the ability of emergency medicine residents in teaching and supervising emergency medicine interns

Background: Approximately 25% of the residents’ time in each shift is allocated to educating lower-level assistants and interns. Assistants have played a major role in interns’ education. Aim: To assess the teaching abilities of emergency medicine assistants in the training and monitoring of medical interns and undergraduate students. Methods: This cross-sectional study was performed in 2015 at the emergency center of Imam Reza hospital in Mashhad University of Medical Sciences. We employed a researcher-made questionnaire to search the capability of emergency medicine residents to assess the teaching capabilities of emergency medicine residents to interns. This questionnaire was completed by 106 interns. The Validity of the questionnaire was confirmed by three specialist experts and reliability of the questionnaire was confirmed by Cronbach's alpha (0.94). This questionnaire consists of 24 questions in six areas. The analysis was performed by descriptive statistics using SPSS 16. Result: The study showed that the least favorable score was related to “residents get feedback on each shift” and the highest score was given to “a friendly relationship with the Interns and residents”. Conclusion: Considering the key role of residents in the education and training of future healthcare specialists, training interventions and allocating sufficient time to the proper education of different members of healthcare teams and medical students could largely contribute to the development of clinical training systems

First Seizure Due to a Ruptured Brain Dermoid Cyst

Introduction: first seizure is an unpleasant experience, the underlying cause and probability of recurrence is critical for the patient. Case: A 72 years old female was brought to our emergency department with a complaint of first seizure. Her daughter stated that she had had a tonic colonic generalized seizure that lasted about 10 seconds. She was complaining of a headache at the time of arrival in the ED, and the seizure had ended. The physical examination was normal and she had no past medical history. Spiral axial brain CT scanning demonstrated a sharp, round lesion with peripheral calcification near the pineal gland which compressed the third ventricle. Multiple nodules with fat density were seen in the subarachnoid space. Phenytoin was started for seizure prophylaxis and a neurosurgery consultation was requested. Tumor was completely reacted. Conclusion: This is a rare case of dermoid cyst near the pineal which compressed the third ventricle and caused midline shift and hydrocephaly. The cause of seizure may be the cyst rupturing. Complete cyst resection is the preferred treatment

Rupture of Posterior Urethra without Pelvic Fracture: A Rare Presentation

Rupture of the posterior urethra is a rather uncommon finding in patients with pelvic trauma. It is usually accompanied by pelvic fractures. Herein, we report the case of a 27-year-old man with isolated rupture of the posterior urethra –without pelvic fracture- after falling. The patient was successfully treated with primary suprapubic cystostomy and delayed urethral reconstruction surgery, after which he was discharged in good condition with no urologic complication. The consensus on these cases is either to perform an early realignment or to do late reconstructive surgery

APACHE II scoring system to predict mortality of covid-19 patients: a cross-sectional study

Background: The coronavirus disease-2019 (COVID-19) pandemic has significantly impacted global health, resulting in millions of reported cases and deaths worldwide. The Acute Physiologic and Chronic Health Evaluation (APACHE) II is a commonly used assessment system for determining the severity of illness in critically unwell patients. This study investigates the feasibility of using the APACHE II scoring system as a mortality predictor for COVID-19. Materials and Methods: In this cross-sectional study, we evaluated 499 confirmed patients with COVID-19 before COVID-19 vaccination, all of whom received standard treatment. Patients with confirmed COVID-19 by polymerase chain reaction (PCR) test were enrolled in this study, and their demographic data, chest computed tomographic (CT) findings, APACHE II score, need for mechanical ventilation, length of in-hospital stay, and outcome (discharge or death) were collected in a checklist. Results: The mean age of the patients was 62.24 ± 18.48 years, composed of 52.5% male and 47.5% female. Respiratory complaints, such as cough, dyspnea, and chest pain, were observed in 56.9% of patients, and 8.8% presented with palpitations, decreased blood pressure (BP), and cardiac arrest. Among these patients, 96.3% were discharged, and 3.6% died. Non-survived patients had significantly higher APACHE II scores than survived patients (12.3 vs. 17.7, P = 0.007). The ROC curve analysis revealed an APACHE II cutoff of 18.5 for predicting mortality in patients with COVID-19, with sensitivity and specificity values of 63% and 84%, respectively. Conclusion: The APACHE II scoring system can be valuable in the emergency department for prioritizing patients based on their severity of illness