Evaluation of clinical and laboratory causes of burns in pre-school children

We investigate characteristics of burns in children aged up to seven years and hospitalized at Velayat burn center unit for two years to evaluate clinical and laboratory causes of burns in pre-school children. In a retrospective study, all patients under 6 years who were admitted to Velayat hospital due to burn injuries between 20 march 2016 and 20 march 2017 participated in this study. Baseline data and information collected from hospital HIS system and patient records. The burn-injured children were 283 patients, of which 54.1% were male and 45.9% were female. These injuries mostly were caused by hot liquid (78.7%). The greatest number of burn victims were boys between one and two years old. Almost all the accidents occurred in the home environment (90.1%). A significant correlation was observed between contact burns, serum albumin level, and serum C-reactive protein (CRP) levels with burn severity. Our data demonstrate the importance of developing a program for the prevention of pediatric scalds with the education of family members to be aware of the danger. This knowledge may contribute. the most important and major discovery in our studies so far has been the hypothesis of estimating Albumin 1b peptides (A1b) and CRP laboratory factors during the initial week of hospitalization in the prognosis of children and its constant relation with the severity level of the burns

Short Communications: : Causes and Consequences of Complaints Against Anesthesiologists: A 5-year Retrospective Study

Background: Nowadays, complaints against the medical staff and the demand for physicians’ malpractice compensation are increasing. Anesthesiologists are also faced with medical litigation. Because of the importance of this issue and lack of such a research in Guilan Province, this study was conducted to determine the causes and consequences of complaints against anesthesiologists. This study aimed to reveal the anesthesia malpractice claims and underlying factors of its medico-legal litigations.Methods: This study surveyed all complaints against anesthesiologists from the Medical and Forensic Medicine Organization of Rasht from 2011 to 2015. Results: In this study period, 40 complaints against anesthesiologists were registered. The patients who complained were mostly male (52.5%), married (72.5%), and aged >50 years (62.5%). Of these, 6 medical malpractice were occurred (15%). Death of patients (55%) was the most common cause of complaints and negligence is the highest rate of failure by anesthesiologists (90%). Patients in general surgery wards under general anesthesia in governmental educational hospitals were affected the most; 45% in recovery and 27.5% in ICU sectors. In addition, 15% of all referred anesthesia-related malpractice claims positive legal action.Conclusion: Based on the results, a great concern over the performance of assistants in educational care centers, especially in general surgery ward is recommended. It is also necessary to monitor patient’s status carefully in the recovery room and use experienced personnel in there as well as intensive care units

Pneumomediastinum, pneumopericardium pneumothorax and subcutaneous emphysema in Iranian COVID-19 patients

Recently, spontaneous pneumomediastinum (PM), pneumopericardium (PP), pneumothorax (PT), and subcutaneous emphysema (SE) were reported as infrequent complications in coronavirus disease 2019 (COVID-19) patients in intensive care (ICU). Here we report these complications in nine Iranian patients of COVID-19. Nine patients with reported PM, PP, PT, and SE in COVID-19 who were hospitalized in Arya hospital, Rasht, Iran, for three months, were followed to record demographic data and clinical characteristics of these patients. In nine PM-developed patients, six cases represented PT, one patient with PP, and four patients with PT and SE. Four patents expired and only five patients survived. PM, PP, PT, and SE are uncommon complications in COVID-19 patients and were reported frequently in male patients. Early diagnosis and treatment could save the patients since these complications are related to poor prognosis and prolonged hospitalization. Patients with mild COVID-19 and mild pulmonary damage have a favorable outcome.

Evaluation of sequential organ failure assessment (SOFA) score efficiency in predicting the mortality of intensive care unit admitted COVID-19 patients

Assessing the severity of the disease at the time of hospitalization can reduce the mortality of patients with coronavirus disease 2019 (COVID-19). For this stance, various scoring systems have been described to predict mortality rates. Sequential organ failure assessment (SOFA) is one of the scoring systems which have been used in this study. In order to calculate the SOFA score, demographic and characteristics information, clinical status, and laboratory findings were recorded from 154 patients with COVID-19, who have been admitted to the intensive care unit (ICU) for a period of 6 months. SOFA score was calculated in three time periods at the time of hospitalization, 72 hours after hospitalization, and the last day of hospitalization. Based on the outcome of the disease (death or recovery), patients were divided into two groups, and the results were analyzed in both groups. Statistical analysis has represented that the SOFA score was significantly higher in patients who died to compare with recovered ones in all time periods. Our findings suggest that SOFA scoring system can be used to predict mortality rate in ICU admitted COVID-19 patients

The Effectiveness of Intravenous lidocaine in Burn Pain Relief: A Randomized Double-Blind Controlled Trial

Objectives: Poor pain control in burn patients as a great public health problem disrupts the healing and rehabilitation process and results in several adverse outcomes. The aim of this study was to investigate the efficacy and safety of intravenous lidocaine in reducing the pain of burn injuries. Materials and Methods: From August 2014 to March 2015, 66 eligible burn patients participated in the study and were randomly divided into two groups of lidocaine (L) and placebo (P). In group L, lidocaine 2% was injected at a bolus dose of 1.5 mg/kg followed by infusion at the dosage of 1.5 mg/kg/h, and in group P, saline was administrated. Pain severity was measured during 24 hours at baseline and 1, 2, 4, 8, 12, 16, 20, 24 hours after intervention based on Numerical Rating Scale (NRS-11). Morphine consumption, Ramsay score, and side effects were also documented. Results: Finally the data from 60 patients were analyzed. Comparing baseline with 24 hours after intervention, NRS-11 scores decreased from 7.12±1.42 to 3.33±0.76 (P<0.001) in group P and from 6.45±1.02 to 2.50±0.72 (P<0.001) in group L. Moreover, the mean of NRS scores during 24 hours in the lidocaine group was significantly lower compared to the placebo group, 3.93±0.72 vs 4.73 ±1.14, (P=0.03). The mean amounts of morphine consumption in group L were significantly lower compared to group P, 14.41 ± 4.86 vs 21.07±6.86, (P=0.001). The mean of Ramsay score in group L was significantly lower compared to group P, 1.38±0.59 vs 1.45±0.6, (P=0.014). Conclusions: This study revealed that intravenous lidocaine was an effective and safe drug for pain reduction in burn patients

Organ procurement and transplantation during the COVID-19 pandemic in Iran

Minimally invasive surgery reduces perioperative pain and morbidity, facilitating rapid recovery. However, the field of kidney transplantation has lagged in this regard, its customary open surgical techniques going nearly unchanged until recently. Robotic kidney transplantation (RKT) is a novel and welcomed innovation yielding good surgical outcomes. In Korea, the first RKT performed (November 2019) involved a 30-year-old man (body mass index, 22 kg/m2) with end-stage hypertensive nephrosclerosis. A left donor kidney from his 28-year-old sister was successfully transplanted using the daVinci Robotic Surgical System. Transperitoneal regional hypothermia (Vattikuti Urology Institute-Medanta technique) was also implemented across the main periumbilical incision (up to 6 cm). Total operative time was 260 minutes (cold ischemia, 34 minutes; rewarming, 54 minutes), with 50 mL of blood loss. There was immediate graft function, unencumbered by surgical complications (e.g., postoperative bleeding, leakage, or lymphocele). The patient was discharged on postoperative day 8, with serum creatinine at 1.27 mg/dL. RKT with regional hypothermia may be a viable, minimally invasive intervention that is safe and effective in select patients, showing good surgical results

بررسی ارتباط سطح هموگلوبین با میزان مرگ و میر در بیماران ضربه به سر مراجعه کننده به اورژانس مرکز آموزشی درمانی پورسینای رشت در سال 1396

Introduction: Traumatic brain injuries are one of the main causes of death and disability worldwide. Anemia may lead to worse outcomes in patients with traumatic brain injury. Considering that there have been limited studies on the role of anemia and blood transfusion in primary resuscitation of patients with traumatic brain injuries, the purpose of this study was to investigate the relationship between hemoglobin level and mortality rate in patients suffering from this condition. Methods: This is a retrospective analytical cross-sectional study. The study population consisted of patients with traumatic brain injuries admitted to the emergency department of Poursina Hospital in Rasht, Iran, in 2017. Patients were classified into two groups, according to blood hemoglobin level, anemic (Hb ≤10) and non-anemic (Hb&gt;10). Age, sex, clinical information, treatment measures, duration of hospitalization, and mortality rate in these two groups were recorded and compared. Also, in order to determine the risk factors for mortality in patients with traumatic brain injury, the above variables, along with laboratory findings, were compared in the two groups of patients with survival and death. Data were analyzed using SPSS21 software, and descriptive and inferential statistical tests. Results: The total number of participants in the study was 297 (249 (83.8%) male and 48 (16.2%) female), with a mean age of 41.8 ± 22.3 years. 120 (40.4%) patients had anemia. Patients without anemia had higher levels of consciousness than those with anemia (P &lt;0.001). There was a statistically significant difference between the anemic and non-anemic patients in terms of the use of vasopressor and patient status at discharge (P &lt;0.0001). The number of packed cells received showed a statistically significant difference between the patients with and without anemia (P &lt;0.0001). Multivariate analysis based on logistic regression model showed that the duration of hospitalization, hypotension, blood transfusion, and hypothermia are risk factors associated with mortality. Conclusion: The results of this study showed that although anemia is not a predictor of mortality, but blood transfusion is one of the most important factors associated with mortality in patients with traumatic brain injury.مقدمه: آسیب های تروماتیک مغزی به عنوان یکی از علل اصلی مرگ و میر و ناتوانی در سراسر جهان به شمار می روند. کم خونی ممکن است منجر به پیامدهای بدتری در بیماران دچار آسیب های تروماتیک مغزی شود. با توجه به اینکه تاکنون مطالعات محدودی در رابطه با&nbsp; نقش آنمی و تزریق خون در احیای اولیه در بیماران مبتلا به آسیب های تروماتیک مغزی صورت پذیرفته است، هدف از مطالعه حاضر بررسی ارتباط بین سطح هموگلوبین و میزان مرگ و میر در بیماران دچار این عارضه می باشد. روش مطالعه: این یک مطالعه تحلیل-مقطعی گذشته نگر است. جمعیت مورد مطالعه بیماران با آسیبهای تروماتیک مغزی بستری شده در واحد اورژانس بیمارستان پورسینای شهر رشت در سال 1396 میباشد. بیماران براساس میزان هموگلوبین خون، در دو گروه دارای آنمی (10) و&nbsp; فاقد آنمی (10Hb&gt;) طبقه بندی شدند. سن، جنس، اطلاعات بالینی، اقدامات درمانی انجام شده، طول مدت بستری و میزان مرگ و میر در این دو گروه ثبت و مورد مقایسه قرار گرفت. همچنین به منظور تعیین عوامل خطر مرگ و میر در بیماران با آسیبهای تروماتیک مغزی، متغیرهای فوق به همراه یافته های آزمایشگاهی در دو گروه از بیماران دارای بقا و فوت شده مورد مقایسه قرار گرفت. تجزیه و تحلیل اطلاعات با استفاده از نرم افزار spss نسخه 21 و با استفاده از آزمون های آماری توصیفی و استنباطی انجام شد. یافته ها: مجموع افراد شرکت کننده در مطالعه&nbsp; نفر شامل 249 (8/83 درصد) مرد و 48 (2/16 درصد) زن با میانگین سنی 3/22±8/41 سال بودند. 120 (4/40 درصد) نفر از بیماران آنمی داشتند. بیماران فاقد آنمی از میانگین سطح هوشیاری بالاتری در مقایسه با بیماران دارای آنمی برخوردار بودند (001/0 &gt; P). درصد آنمی بر حسب استفاده از پرسور و وضعیت بیمار در هنگام ترخیص در دو گروه مورد مطالعه از لحاظ آماری دارای تفاوت معنی دار بود(0001/0 &gt; P). تعداد پکد سل های دریافتی در دو گروه از بیماران با و بدون آنمی از لحاظ آماری تفاوت معنی دار داشت (0001/0 &gt; P). آنالیز چندگانه براساس مدل رگرسیون لوجستیک نشان داد که مدت زمان بستری، افت فشار خون، تزریق خون و کاهش دمای بدن به عنوان عوامل مرتبط با مرگ و میر می باشند. نتیجه گیری: نتایج مطالعه حاضر نشان داد که اگرچه آنمی به عنوان یک متغیر پیش بینی کننده مرگ و میر نمی باشد اما تزریق خون از عوامل مهم مرتبط با مرگ و میر در بیماران دچار آسیب تروماتیک مغزی است

Evaluation of the primary medical treatments based on the advanced trauma life support principles in trauma patients

Objective In Iran, road traffic accidents were responsible for 14716 deaths in 2015. This study aimed to compare the initial resuscitation of traumatically injured patients to the internationally recognized ATLS standards. Materials and methods As a cross-sectional study, 506 traumatically injured patients who were referred to the tertiary referral major trauma center in Poursina Hospital during the study period, were evaluated. All therapeutic interventions were compared to the ATLS standards. Data on mortality by demographic was compared to those in whom the ATLS standards were met and in those whom it was not met Results Mean age of the patients was 37.37 ± 19.72 and motorcycle was the most common cause of accidents (40.9%). ATLS guideline interventions were completely performed in 18.2% of the patients in their primary hospital, and in rest of 414 cases (81.8%), ATLS algorithms were not fully carried out. The mortality rate was significantly higher in the second group: 10.86% vs 32.36%, respectively. Conclusion Application of ATLS principles in multiple trauma patients can reduce the mortality rate. Keywords Trauma, emergency, ATL

Atracurium as an Alternative to Succinylcholine in Electroconvulsive Therapy: A Randomized Clinical Trial

Background: Electroconvulsive Therapy (ECT) is a successful treatment option for various psychiatric disorders. It is performed under general anesthesia where succinylcholine is the preferred muscle relaxant in this process. However its several contraindications and potential adverse effects, and the fact that it is not always available should be considered. Therefore, finding an effective and safe alternative is crucial. Objectives: This study aims to assess the safety and efficacy of atracurium in ECT. Materials & Methods: This single-blind clinical trial was conducted at Shafa hospital affiliated to Guilan University of Medical Sciences from November 2020 to April 2021. Participants were 67 eligible patients with ECT, randomly assigned into two groups receiving succinylcholine (0.5 mg/ kg), and atracurium (0.2 mg/kg). Seizure duration, hemodynamic parameters, the time to return to spontaneous breathing, and recovery time were assessed and compared between the two groups. Results: Seizure duration was longer in the succinylcholine group (P=0.071), while the time to return to spontaneous breathing (P=0.0001) and the recovery time (P=0.0001) were significantly longer in  the atracurium group. The trend of changes in the Mean Arterial Pressure (MAP) and Heart Rate (HR) were significant over time; however, the difference between the two groups was significant only in HR one minute after the seizure induction (P=0.001). None of patients was reported serious adverse effects. Conclusion: When succinylcholine can't be used, atracurium can be a safe alternative in the ECT process

بررسی ارتباط شکستگی های صورت و جمجمه با پیامد آسیب های مغزی در بیماران ضربه به سر مراجعه-کننده به اورژانس مرکز آموزشی درمانی پورسینا از سال 1394 تا 1396

Introduction: Traumatic brain injury is one of the leading causes of death and disability. Traumatic brain injuries have multifactorial injury mechanisms and are often associated with other injuries. A large proportion of patients who suffer from traumatic brain injury also have facial injuries. Due to the anatomical proximity of the face and skull, patients with facial injuries are expected to be at higher risk for brain injuries. The present study was performed with the aim of investigating the relationship between facial and cranial fractures and brain consequence in head trauma patients. Methods: This is an analytical cross-sectional study. The study population consisted of patients with skull and facial injuries due to head trauma. Fractures of the skull and face were classified into two categories: mandibular and middle part of the face. Brain consequence was considered as intracranial concussion and injury. Age, sex, mechanism of trauma, time and type of fracture, associated clinical symptoms, and level of consciousness of patients were recorded. Data were analyzed using STATA software. Results: Out of 1625 patients with head injuries, 958 (60%) suffered facial and skull fractures. 700 people (71%) suffered brain injuries following a head injury, of which only 29% had no brain consequences. 50% of brain outcomes following facial and cranial bone fractures together, cranial bone fractures accounted for 29%, and facial fractures accounted for 21% of total brain outcomes. Most patients had brain concussions. Local pain was the most common symptom (75.2%). Overall, 36% of all facial fractures and 88% of skull fractures resulted in brain outcome. Conclusion: There is a direct relationship between cranial and facial bone fractures and brain consequences in head trauma patients and concussion was the most common brain outcome in these patients. Urgent and timely measures are required in patients with skull and facial bone fractures to reduce the consequences and brain damage.مقدمه: آسیب های تروماتیک مغزی یکی از دلایل اصلی مرگ و میر و ناتوانی است. آسیب های تروماتیک مغزی دارای مکانیزم های آسیب چند عاملی هستند و اغلب&nbsp; همراه با دیگر آسیب ها می باشند. بخش زیادی از بیماران دچار آسیب های تروماتیک مغزی دچار آسیب های صورت نیز هستند. به دلیل نزدیکی آناتومیکی صورت و جمجمه انتظار می رود که بیماران مبتلاء به آسیب صورت در معرض خطر بیشتری برای صدمات مغزی باشند. این مطالعه با هدف بررسی ارتباط شکستگی های صورت وجمجمه با پیامد مغزی در بیماران ضربه به سر انجام شد. روش اجرا: این یک مطالعه تحلیلی- مقطعی است. جمعیت مورد مطالعه بیماران دچار شکستگی جمجمه وصورت ناشی از ضربه سر می باشد. شکستگی جمجمه وصورت در دو دسته مندیبولار و قسمت میانی صورت طبقه بندی شدند. پیامد مغزی به صورت کانکاشن و آسیب های اینتراکرانیال در نظر گرفته شد. سن، جنسیت، مکانیزم تروما، زمان و نوع شکستگی، علائم بالینی همراه و سطح هوشیاری بیماران ثبت گردید. داده ها با استفاده از نرم افزار STATA &nbsp;&nbsp;مورد تجزیه تحلیل قرار گرفت. نتایج: از 1625 بیمار دچار ضربه به سر 958 (60درصد) دچار شکستگی صورت و جمجمه شدند. 700 نفر(71درصد) دچار آسیب های مغزی به دنبال ضربه به سر شدند، که تنها 29درصد آنها فاقد پیامد مغزی بودند. 50 درصد از پیامدهای مغزی به دنبال شکستگی استخوان صورت و جمجمه با هم و شکستگی استخوان جمجمه 29درصد و شکستگی صورت 21 درصد از کل پیامدهای مغزی را شامل شدند. اکثر بیماران دچارکانکاشن مغزی بودند. درد موضعی شایعترین علامت همراه بود (2/75 درصد). به طورکلی 36درصد از کل شکستگی های صورت و 88درصد از شکستگی های جمجمه منجر به پیامد مغزی شدند. نتیجه گیری: ارتباط مستقیمی بین شکستگی استخوان های جممجمه و صورت با پیامدهای مغزی در بیماران ضربه به سر وجود دارد و کانکاشن شایعترین پیامد مغزی در این بیماران بود. اقدامات اورژانسی و به موقع در بیماران با شکستگی استخوان های جمجمه و صورت الزامی است تا از پیامدها و آسیب های مغزی حاصل از آن کاست