Comparing of Frequent Central Venous Catheter Insertion and Selection Procedure and its Complications

Background: Central venous catheterization is used for several goals in the emergency department. Common sites of insertion of central venous lines are the right and left jugular veins as well as the right and left subclavian veins. The aim of this study was to evaluate the tendency frequency of emergency medicine residents to choose central venous line insertion route and also to determine the post-procedure complications. Methods: In this descriptive cross-sectional study, all patientswhounderwent central venous catheterization and were in the emergency ward of the Imam Reza hospital, Tabriz, Iran during March 21, 2015 to September 23, 2015 were included, preferences route of insertion and complications of both right and left jugular and subclavian veins were descriptively analyzed. Results: Of all the 134 evaluated patients, 54.5% were catheterized in course of shock. 88.1% of patients underwent right jugular vein catheterization and only 4.5% experienced post-procedure complications. In 91.8% of cases, the decision-making was done by the physician and 75.4% of the catheterizations were fulfilled by second-year emergency medicine residents. Conclusions: The most common route of catheterization was through the right jugular vein. Additionally, the most common complication was hematoma of the insertion site. In most of the cases, decision making was made by the physician and most of the catheterization procedures were fulfilled by second-year emergency medicine residents

Diagnostic Accuracy of Chest x-Ray and Ultrasonography in Detection of Community Acquired Pneumonia; a Brief Report

Introduction: Chest x-ray (CXR) is the simplest diagnostic tool of Community Acquired Pneumonia (CAP), but it has some limitation. Therefore, the aim of this study is comparing the diagnostic accuracy of CXR and chest ultrasonography (CUS) in detection of CAP. Methods: In the present study, a consecutive sample of suspected patients with CAP was underwent CUS, CXR, and chest computed tomography (CT) scan. Diagnostic accuracy of CUS and CXR was assessed by calculating the sensitivity, specificity, predictive values, and likelihood ratios using SPSS 20 statistical software. Results: 30 patients with CAP were enrolled (93.3% male with mean age of 63.8 ± 18.3 years). Sensitivity of CUS and CXR in detection of CAP were 100.0% (95% Cl: 85.4-100.0) and 93.1% (95% Cl: 75.8-98.8), respectively. Specificity of CXR was 0.0 (95% Cl: 0.0-94.5), while the CUS specificity was not calculable. Conclusion: Findings of the present study demonstrated on the higher diagnostic accuracy of CUS versus CXR in detection of pneumonia

Evaluation of exposure to phthalate esters through the use of various brands of drinking water bottled in polyethylene terephthalate (PET) containers under different storage conditions

Background: There are many concerns about the migration of phthalates into bottled water. These compounds are hazardous to consumers. In this study, the risk factors of the use of various brands of drinking water bottled in polyethylene terephthalate (PET) containers under different storage conditions were examined. Methods: Phthalate esters were measured and analyzed using air-assisted liquid-liquid microextraction (AALLME) and gas chromatography-mass spectrometry (GC-MS). Subsequently, the risk of exposure to the desired compounds was evaluated by calculating the risk factor and excess cancer risk. Data were statistically analyzed using SPSS version 24 software. Results: The average concentration of phthalate esters (DEHP, DBP, DIBP, DEP, and DMP) after 5 and 15 days of storage at incubator temperature of 42°C, and after 15, 45, and 75 days at incubator temperature of 25°C by increasing the initial level of the conditions was 7.28, 8.99, 1.78, 5.6, 6.45, and 8.55 ppb, respectively. The risk factor of non-carcinogenic effects of phthalates for consumers was low and can be ignored (HQ<1). Also, the risk of additional cancer due to the presence of diethylhexyl phthalate (DEHP) in bottled water is very low (4.8551×10-6). Conclusion: However, due to the increase in the concentration of phthalate esters in bottled water by increasing the storage time and temperature, as well as increasing the ethylene hexyl phthalate content from its established limit, the use of bottled water kept in unsuitable conditions for the society, and especially the sensitive groups, is not appropriate. Keywords: Phthalate esters, Bottled water, Storage conditions, Risk assessment, Various brand

Differentiation of Cocaine-Induced Midline Destructive Lesions from ANCA-Associated Vasculitis

Introduction: Cocaine-induced midline destructive lesions (CIMDL) are complications of regular nasal cocaine inhalation. CIMDL can mimic systemic diseases with positive anti-neutrophil cytoplasmic antibodies (ANCA), such as granulomatosis with polyangiitis (GPA).   Case Report: In this article, we describe the case of a young woman who presented with nasal perforation induced by cocaine, along with positive perinuclear ANCA test (proteinase 3 antigen), misdiagnosed as limited GPA. The patient was treated with immunosuppressive therapy, which partially improved her symptoms. Admittance of cocaine use aided in the diagnosis of CIMDL. This patient was advised to stop cocaine use. Three-month follow-up revealed no further complications.   Conclusion: Considering the seropositivity of ANCA in both CIMDL and GPA, early diagnosis of CIMDL and its differentiation from GPA is crucial, and clinicians play an important role in this regard. Lack of distinct histologic characteristics of vasculitis or unresponsiveness to standard therapeutic regimens may favor the diagnosis of CIMDL syndrome. It is crucial to recognize that these conditions may have similar presentations, so that undesired and potentially toxic treatments can be prevented

Evaluation of the presence of coliform in bottled drinking water, released in Sari in 2016

Background: Today, bottled water is used in many countries of the world due to its relatively low cost, better taste, ease of access and low levels of impurities. In unfavorable conditions, the maintenance of microorganisms due to hydrophobicity and adherence to bottles and as a result of increased lipolytic activity can lead to undesirable changes in color, taste and odor, and in cases of more severe load, microbial contamination may cause unhealthy water and flooding. In this study, the presence or absence of coliform in a number of bottled water brands was examined. Methods: The microbial quality of 10 markers of bottled water present in the market of Sari that was randomly selected from each mark and three samples was examined. The samples were analyzed using the coliform - presence/absence (P-A) test. The results were compared with national standards and the World Health Organization (WHO) guidelines. Data were analyzed using SPSS version 24 and EXCEL. Results: Samples showed no microbial contamination Also, coliform and fecal coliforms were not observed in any of the samples. Finally, it was revealed that all cases were in accordance with national standards and WHO guidelines. Conclusion: Increasing the health indexes of places, food supply and distribution centers, and maintaining health conditions and measures that have been considered especially in the recent years on the health of bottled water, have greatly reduced the problems. Keywords: Taste, Drinking water, Bacteria, World Health Organization, Bottled wate

Epidemiological study of trauma patients referred from Imam Reza trauma center to Shohada orthopedic center in Tabriz, Iran, during 2015

Introduction: Traumas are one of the most common causes of morbidity and mortality all over the world, especially in developing countries. The economic and social burdens of the disease vastly affect both developed and developing countries in different ways. Although the importance of this issue is obvious, there are few documentations about the characteristics of trauma patients in Iran. This study aimed to evaluate the characteristics of trauma patients referred to orthopedic center in Tabriz, Iran, during 2015. Methods: Eight hundred twenty-one patients with trauma that needed orthopedic interventions were studied in this cross-sectional study during 2015 in Tabriz. Age, sex, trauma type and date were collected and analyzed by SPSS. Results: From 821 patients, 70.9% were male. Most of the patients were referred in summer (33.6%) in June (11.6%). The mean age was 40.67 ± 20.4 with a tendency toward young ages (skewness = 0.28). The most common trauma types were car accidents (54.8%) and falling traumas (33.5%). Falling trauma was higher among females (42.31% vs 31.91%). Car accidents increased in cold seasons of the year. Most falling traumas were in spring and summer. Falling increased with increase in age while bicycle and motorcycle accidents decreased. Conclusion: According to high incidence of traffic injuries, an integrated multidisciplinary intervention to reduce the rate of traumas and their burden is essential

Developing a National Integrated Road Traffic Injury Registry System: A Conceptual Model for a Multidisciplinary Setting

Introduction: Despite a high burden of traffic injuries, effective integrated or linked injury surveillance systems are rarely available in many low- and middle-income countries (LMICs). The aim of the current study was to define a conceptual model for developing a national integrated traffic injury registry in Iran.Methods: A mult-method study financially and technically supported by the World Health Organization, Iranian Ministry of Health, Iranian Traffic Police, and the Iranian Legal Medicine Organization was conducted. A theoretical framework, forming the core conceptual components, was developed based on expert reviews. The preliminary conceptual model was developed by a panel of experts and tailored through a national workshop of 50 scientists, authorities and experts from nearly all sectors related to road safety promotion and injury management. It was then sent out to external reviewers in order to assess and improve the content validity of the model.Results: The conceptual model was developed to have six components. These included 1) aims and core definitions; 2) content and core measurements; 3) data flow; 4) data collection routines; 5) organizational matrix; 6) implementation organization. The Haddon's matrix was adapted to be used as the theoretical framework in defining the content and data flow components of IRTIR. Five subcomponents were defined in the content and core measurements component with each having several subcategories. Each subcomponent/subcategory was finally divided into several item groups to guide defining the final data measurement variables. The data flow component was defined with six data sequence stations. Through the organizational matrix component, five major organizations relevant to road traffic safety were defined as core data production contributors. Some organizations also owned several sub-organizations which contributed in this regard.Conclusion: It is concluded that the IRTIR conceptual model includes the required six components for developing a national integrated registry for Iran. Its main component called, content and core measurements, leads the researchers in developing final data collection tools in developing the national registry of road traffic injuries in Iran.</div

The effect of training on the management of nuclear disasters by emergency department nurses and physicians

Objective: On account of the widespread use of nuclear energy in different fields, nuclear accidents and disasters have been on a rise. Thus, it is crucial for medical staff especially emergency department personnel to be aware of the nature of these accidents. This study was designed to evaluate the effect of training on the knowledge of physicians and nurses regarding nuclear disasters. Methods: This pre-and post-intervention study was conducted on 97 emergency department personnel including physicians and nurses of educational hospitals in Tabriz University of Medical Sciences. Educational classes and training about nuclear disasters and managing these events were held. A standard questionnaire was used to evaluate the knowledge before and after training, and the effect of education on personnel’s knowledge. Results: Our participants included 41 males and 56 females. The mean age was 32.88 years. The mean score of participants before and after the class was 4.03 ± 1.54 and 7.93 ± 1.55 respectively; which showed a statistically significant difference (P < 0.001). Among medical staff, physicians had better knowledge compared with the other group. Conclusion: This study showed that the knowledge of medical staff about nuclear disasters is low and educational classes are necessary to increase their knowledge

Demographic information and risk factors of stroke patients younger than 65 years old

Objective: The main objective of this study is to evaluate the prevalence of risk factors for and demographics ofpatients younger than 65 years old with stroke.&nbsp;Methods: This retrospective cross-sectional study took into consideration all patients younger than 65 years&nbsp;old who were admitted to the emergency department from 2016 to 2018. Some significant criteria such as age,&nbsp;sex, type of stroke, stroke risk factors, and modified Ranking Scale (mRS) were extracted from patients’ medical&nbsp;records. Based on their age, these patients were divided into three groups: younger than 35 years old (Group A),&nbsp;between 35-50 years old (Group B), and older than 50 years old (Group C). Data analysis was carried out using&nbsp;IBM® SPSS® Statistics 20.0 software.&nbsp;Results: A total of 392 patients with stroke were included in this study. Groups A, B, and C included 31, 124,&nbsp;and 237 patients, respectively. Among them, 313 patients (79.84%) were admitted to the hospital in cold seasons, while 73 patients (18.6%) had no symptoms related to stroke at the time of admission. The most common&nbsp;adjustable risk factor among the patients was hypertension (HTN) with a frequency of 230 (58.7%). Of note,&nbsp;the frequency of HTN, diabetes, atrial fibrillation (AF), oral contraceptive pill (OCP) consumption, and coronary&nbsp;artery disease (CAD) in patients was significantly different among these three groups.&nbsp;Conclusion: According to the findings of the present study, the prevalence rate of stroke probably varies for male&nbsp;and female (gender) in the studied groups, which is significantly correlated with age. Among the adjustable risk&nbsp;factors for stroke, HTN, diabetes, AF, OCP consumption, and CAD are significantly correlated with the age