Applications of End-Tidal Carbon Dioxide (ETCO2) Monitoring in Emergency Department; a Narrative Review

Capnograph is an indispensable tool for monitoring metabolic and respiratory function. In this study, the aim was to review the applications of end-tidal carbon dioxide (ETCO2) monitoring in emergency department, multiple databases were comprehensively searched with combination of following keywords: “ETCO2”, “emergency department monitoring”, and “critical monitoring” in PubMed, Google Scholar, Scopus, Index Copernicus, EBSCO and Cochrane Database

The Effect of Oral Tamsulosin vs. Oral Tamsulosin and Oral Isosorbide Dinitrate in Acute Urinary Retention Patients Due to Benign Prostatic Hyperplasia: A Double-Blind Clinical Trial Study

Introduction: Acute urinary retention due to benign prostatic enlargement is one of the clinical complaints that patients refer to the emergency department. Selective α-blockers are used after urinary catheterization. Recently, the use of nitrate compounds has been shown to relieve bladder neck and to treat acute urinary retention. Objective: The aim of this study was to survey the addition of Isosorbide di nitrate to tamsulosin in the treatment of acute urinary retention in patients with benign prostatic hyperplasia. Methods: This is a randomized, double-blind placebo-controlled clinical trial. In all, 78 patients with benign prostatic hyperplasia-related acute urinary retention referred to the emergency department were divided into two groups and randomly assigned to receive either 0.4 mg tamsulosin plus placebo or 0.4 mg tamsulosin plus isosorbide dinitrate 40 mg extended-release tablets daily for 3 days. At the same first visit, the catheter was removed and the ability to void in same time and 1 month later was assessed in each group. Results: After catheter removal, 27 (67.5%) patients in the tamsulosin plus placebo group and 31 (81.6%) in the tamsulosin plus isosorbide dinitrate group voided successfully after 3 days (p = 0.155). After 1 month, 20 (50.0%) patients taking tamsulosin plus placebo and 23 (60.5%) taking tamsulosin plus isosorbide dinitrate could void, yet indicating no significant difference (p = 0.350). Conclusions: Addition of isosorbide dinitrate to α-blockers has advantage in improving benign prostatic hyperplasia-related acute urinary retention versus tamsulosin alone, although was not statistically significant

Evaluation of clinical features of snakebite in patients referred to Razi Hospital in Qaemshahr City

Background: Snakebites are one of the most important health issues globally that cause morbidity, discomfort, and even death. This study aimed to evaluate the clinical features of snakebite in patients referred to Razi Hospital in Ghaemshahr city. Methods: In this descriptive, cross-sectional study, 325 snakebite patients admitted to Razi Hospital in Qaemshahr city between the years 2014 and 2019 were studied. All information was extracted from patients' medical records. SPSS software version 25 was used to analyze the data. Results: Patients ranged in age from 9 to 71 years with a mean of 36.6±10.7 years. 238 cases (73.2%) were male and 87 cases (26.8%) were female. The highest frequency of bites with 162 cases (49.8%) was related to the lower extremities and summer with 122 cases (37.5%) had the highest frequency of bites. The highest frequency of local symptoms was related to bruising (17.8%), erythema (16.9%), and pain (15.7%), and the highest frequency of systemic symptoms were related to weakness (24%), and sweating (14.2%). For 88.2% of cases, antivenom was used. 33.8% of the patients received antibiotics, mostly ciprofloxacin+clindamycin. Conclusion: The results obtained in this study showed that common local complications in patients included bruising, erythema, and edema and systemic complications such as weakness, subcutaneous bleeding, and sweating. Antivenom was used for most of the cases and no deaths were reported. Also, unscientific actions such as incision and suction are still performed in cases that require more awareness and training. Resumen: Antecedentes: Las mordeduras de serpientes son uno de los problemas de salud más importantes a nivel mundial que causan morbilidad, malestar e incluso la muerte. Este estudio tuvo como objetivo evaluar las características clínicas de la mordedura de serpiente en pacientes remitidos al Hospital Razi en la ciudad de Ghaemshahr. Métodos: En este estudio descriptivo transversal, se estudiaron 325 pacientes con mordedura de serpiente ingresados en el Hospital Razi en la ciudad de Qaemshahr entre los años 2014 a 2019. Toda la información se extrajo de las historias clínicas de los pacientes. Se utilizó el software SPSS versión 25 para analizar los datos. Resultados: Los pacientes tenían edades comprendidas entre 9 y 71 años con una media de 36,6±10,7 años. 238 casos (73,2%) eran hombres y 87 casos (26,8%) eran mujeres. La mayor frecuencia de mordeduras con 162 casos (49,8%) estuvo relacionada con las extremidades inferiores y verano con 122 casos (37,5%) tuvo la mayor frecuencia de mordeduras. La mayor frecuencia de síntomas locales se relacionó con hematomas (17,8%), eritema (16,9%) y dolor (15,7%), y la mayor frecuencia de síntomas sistémicos se relacionó con debilidad (24%) y sudoración (14,2%). En el 88,2% de los casos se utilizó antiveneno. El 33,8% de los pacientes recibieron antibióticos, en su mayoría ciprofloxacino + clindamicina. Conclusión: Los resultados obtenidos en este estudio mostraron que las complicaciones locales comunes en los pacientes incluyeron hematomas, eritemas y edemas y complicaciones sistémicas como debilidad, sangrado subcutáneo y sudoración. Se usó antiveneno en la mayoría de los casos y no se informaron muertes. Además, todavía se realizan acciones no científicas como la incisión y la succión en casos que requieren más conciencia y capacitación

Prognostic value of clinical signs and CT-scan findings in renal colic patients referred to emergency department of Imam hospital in sari in 2021

Background: The aim of this study was to investigate the positive predictive value of CT scan findings and clinical signs in choice of clinical management of renal colic patients referred to the emergency department of Imam Hospital in Sari in 2020-2021. Method: A cross-sectional study was performed on all patients with renal colic who were admitted to the emergency department in Sari Imam Khomeini Hospital, in 2021. 167 patients with acute renal colic in terms of clinical manifestations, laboratory findings, and CT scan findings were evaluated.Results: In the present study, 55 patients (32.9%) underwent TUL treatment and 112 patients (67.1%) had spontaneous excretion. 48.9% of people with clinical symptoms of abdominal pain and 27% of people without symptoms of abdominal pain finally underwent TUL treatment (p = 0.008). The incidence of TUL in patients with stone size> 5 mm was significantly higher than those with stones ≤5 mm (P <0.001) and the majority of patients with stones in the upper and middle third of the ureter were in the TUL group. The majority of patients had spontaneous excretion despite stones in the lower third and UVJ (p = 0.021).&nbsp

Comparison of the diagnostic accuracy of CT scan with oral and intravenous contrast versus CT scan with intravenous contrast alone in the diagnosis of blunt abdominal trauma

Purpose: Abdominal CT scan using oral and intravenous (IV) contrast is helpful in the diagnosis of intra-abdominal injuries. However, the use of oral and IV contrast delays the process of diagnosis and increases the risk of aspiration. It has also been shown that CT scan with IV contrast alone is as helpful as CT scan with oral and IV contrast and rectal CT scan in detecting abdominal injuries. Therefore, the present study aims to prospectively compare the diagnostic value of CT scan with oral and IV contrast versus CT scan with IV contrast alone in the diagnosis of blunt abdominal trauma (BAT). Methods: Altogether 123 BAT patients, 60 (48.8%) women and 63 (51.2%) men with the mean age of (40.4 ± 18.7) years who referred to the emergency department of Imam Khomeini Educational and Medical Center in Sari, Iran (a tertiary trauma center in north of Iran) from November 2014 to March 2017 and underwent abdominal CT scans + laparotomy were investigated. Those with penetrating trauma or hemodynamically unstable patients were excluded. The participants were randomly allocated to two groups: abdominal CT scan with oral and IV contrast (n = 63) and CT scan with IV contrast alone (n = 60). No statistically significant difference was found between two groups regarding the hemodynamic parameters, age, gender, injury mechanisms (all p > 0.05). The results of CT scan were compared with that of laparotomy results. The collected data were recorded in SPSS version 22.0 for Windows. Quantitative data were presented as mean and SD. Results: The sensitivity and specificity of CT scan using oral and IV contrast in the diagnosis of BAT were estimated at 96.48 (95% CI: 90.73 – 99.92) and 92.67 (95% CI: 89.65 – 94.88), respectively; while CT scan with IV contrast alone achieved a comparable sensitivity and specificity of 96.6 (95% CI: 87.45 – 99,42 and 92.84 (95% CI: 89.88 – 95.00), respectively. Conclusion: CT scan with IV contrast alone can be used to assess visceral injuries in BAT patients with normal hemodynamics to avoid diagnostic delay

Prevalence of hearing loss among high risk newborns hospitalized in hospitals affiliated to Tehran University of Medical Sciences

"n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: American pediatric Association proposes to screen all neonates with Oto-Acoustic Emission (OAE). In developing countries, because of several limitations, health policy makers recommend to screen only in high risk patients. This study is performed with the aim to screen hearing loss in 950 high risk newborns hospitalized in hospitals affiliated to Tehran University using the OAE test."n"nMethods: A total of 950 neonates hospitalized in the Neonatal and NICU wards of Vali-e-Asr, Shariati, Medical Center and Bahrami Hospitals during the years 2004-2006 who showed at least one risk factor using TEOAE hearing test were enrolled into this cross-sectional descriptive analytical study and were diagnosed with mild deafness and total deafness. Blood exchange due to hyperbillirubinemia, septicemia, congenital heart disease, the fifth minute apgar scores below six, PROM more than six hours, epilepsia, need to NICU more than five hours, pneumonia and Oto-Toxic drugs were considered as risk factors. Data was past medical history, current disease, admission cause, sign & symptoms and complications of disease."n"nResults: Multivariate logistic regression and paired t-test showed that blood exchange, low birth weight and low first minute Apgar scores had the highest independent risk for hearing loss among newborn."n"nConclusion: Despite of the low prevalence of neonatal hearing loss, screening of hearing loss at early stages is important