Randomized, controlled trial of povidone-iodine to reduce simple traumatic wound infections in the emergency department

Introduction: Povidone Iodine (PVI) has been used to prevent wound infection for a long time, yet the merits and effectiveness of this agent in reducing the rates of infection in simple traumatic wounds have been debated. The aim of this study is determine the effect of PVI as skin disinfectant in preventing simple traumatic wound infection after repair in emergency departments. Methods: This study is a single-blind, randomized, controlled trial, conducted at the emergency departments of two university hospitals. In this trial, those collecting and analyzing data were unaware of the assigned treatment. Participants included ED patients with simple traumatic wounds, randomly assigned to either experiment or control groups. Wounds were similarly irrigated with normal saline in both groups. But the skin around the wounds of patients in the experiment group was cleansed by PVI solution. The patients were followed till their next ED visit for stitch removal. The presence or absence of wound infection was considered as the primary outcome and assessed by an ED physician. Results: In total, 444 patients were screened and included in the study. The patients were statistically similar according to their baseline characteristics. Men constituted 85% of the study participants. The highest numbers of reported wound sites belonged to head (30%), lower limbs (24%) and upper limbs (19%) accordingly. The rates of infections in the experiment and control groups were similar (p = 0.231) but a significant association was observed between the rate of infections and wound location. Lower limbs (OR = 9.23, p < 0.0001) and upper limbs (OR = 5.47, p = 0.011) indicated the highest risks of wound infections among other locations. Conclusion: Our study showed that using PVI in the management of traumatic wounds did not reduced rate of infections

The Role of Pre-Hospital Telecardiology in Reducing the Coronary Reperfusion Time; a Brief Report

Objective: The determination of pre-hospital triage based on electrocardiogram and telecardiology in shortening the initial angioplasty time in patients with ST segment elevation myocardial infarction (STEMI) treated with PCI. Methods: This cross-sectional study was conducted from September 2015 to January 2018 in six hospitals equipped with 24-hour angioplasty facilities in Tehran, Iran. Patients referred to the hospital with a diagnosis of STEMI by Emergency Medical Services (EMS) and undergoing primary angioplasty in the equipped centers were included. Patients were divided into two groups: 1) Patients who were transferred to Cath Lab after electrocardiography (ECG) and telecardiology by EMS (EMS247 group); 2) Patients who did not have ECG and telecardiology in the ambulance and were transferred to the emergency department. Results: A total of 1205 people with the mean age of 58.99 ± 12.33 years (19-95 years) entered the study of whom 996 (82.65%) were male. Of these, 841 (69.8%) patients were transmitted via EMS, who have a 12-lead ECG carried out in the ambulance and after consultation with the cardiologist emphasizing the need for direct transmission to the angioplasty for PPCI. In the study, time interval of Symptom-to-device in the EMS247 group was less than the EMS routine group (P = 0.001). There was a similar finding about the time interval of First medical contact (FMC) to device. Mean differences of interval time in two groups were 100.4 and 22.5 min for symptom-to-Device and FMC-to-Device, respectively. Conclusions: It is likely that the use of telecardiology in prehospital triage plays an important role in reducing time of PPCI for patients with acute myocardial infarction with ST segment elevation

Assessment of request, distribution and using of platelet concentrates in hospital’s emergency department of Rasool Akram in Tehran

Background: Indiscriminate or no indication prescribed blood products can increase health care costs, transmission of infection, infusion-related complications and improper disposal of blood products and inappropriate distribution of blood products can reduce blood bank reserves. Objective: This study was performed to determine the index of platelet concentrate transfusion in an emergency department. Methods: A cross-sectional study was done on 28 patients admitted in the emergency department, Rasool Akram hospital, Tehran for one year (October, 2014-2015). Infusion index include crossmatch / transfusion ratio (C/T Ratio), transfusion ratio (T%) and transfusion index (TI), separately were identified. Also, the non-infusion or incomplete injection units were recorded. For data analysis student T-Test and analysis of variance and chi-square were used. Findings: 17 (60.7%) cases were men and 11 (39.3%) were female with mean age 47.36±21.30 years. The most requests for platelet concentrate were pre-operation preparation (16 cases). In 15 cases, 10 units of platelet concentrate was request for the each patient. A total of 249 units of platelet concentrate were requested for 28 patients, which 141 units were used (56.62%). Transfusion ratio, C/T ratio and TI were 71.42%, 1.76 and 5.03, respectively. Conclusion: Based on the findings, the platelet concentrate transfusion indexes in the emergency department were acceptable and can be used as a suitable approach in the management of blood products in emergency departments of the hospital

Assessment of request, distribution and using of fresh frozen plasma in Hospital’s Emergency Department in Rasool Akram Hospital

Background: Uncontrolled prescribing of blood products can cause reduce blood bank reserves and inappropriate distribution of blood products. Objective: The goal of this study was to determine of fresh frozen plasma (FFP) transfusion indicators in emergency department. Methods: A cross-sectional study was done in patients admitted to the emergency department of Rasoul Akram, Tehran, Iran for one year (September 2016 to 2017). Findings: Seventy patients (47M/23F) were assessed with the mean age 57.96±18.22 years. Totally 294 units of fresh frozen plasma (FFP) were requested for patients and 93 units (31.64%) were used. The most indication for FFP unit request was acute and chronic anemia. Conclusion: Transfusion rate and index were within acceptable limits, while the crossmatch to transfusion ratio (C/T) was undesirable. Keywords: Products blood, Fresh frozen plasma, Transfusion ratio, Transfusion inde

A large gastrointestinal stromal tumor of duodenum: a case report

Background: Gastrointestinal stromal tumors are gastrointestinal tract mesenchymal tumors with gene mutations. The most common site of gastrointestinal stromal tumors is in stomach (40-60%) and small intestine (30-40%), and rare cases about 3-5% of them occur in the duodenum. Case presentation: The patient is a forty six years old man. He complained of frequent colic pain in left upper quadrant of abdomen for two months before admitting to the hospital. The pain resolved spontaneously after a few hours. This situation almost has been repeated every week. The patient had severe repeated melena and faint for two weeks. As soon as the patient was entered the Sina Hospital in 2012, supportive care was started. Then upper gastrointestinal endoscopy was performed for him and the bleeding point was detected. Also abdominal and pelvic computed tomography with oral and intravenous contrast was done. Finally the patient was operated on tumor diagnosis in duodenal area according to classic Whipple procedure. Conclusion: Gastrointestinal bleeding is the most common symptom of gastrointestinal stromal tumors. The bleeding is minimal and chronic. It will be progress to sudden and severe bleeding. Diagnosis is done by upper gastrointestinal endoscopy and biopsy. The large tumors with high mitoti

Correlation between emotional intelligence and educational consent of students of Tehran University of Medical Students

Background: Personal characteristics such as gender, ethnicity, disability, age, goals and personal expectations and academic variables such as the number of classes and grades are among the factors that could have an important role in the development of student satisfaction. Besides these factors, the relationship between emotional intelligence (EI) and academic satisfaction has received little attention. Methods: This descriptive cross-sectional study was done in Tehran University of Medical Sciences, Tehran, 2013. Cluster sampling was applied in this study. First, faculties randomly selected from Tehran University of Medical Sciences then randomly selected classes from the faculties. Self-report and Barr-On's emotional Intelligence questionnaires were used to collect data and measuring the variables of educational satisfaction. Questionnaires were completed by students. Overall reliability test using Cronbach's alpha coefficient was 0.73. The cut-off point of questionnaires was considered 70. This means that scores below 70 points showed the low level of satisfaction and scores more than 70 points were considered as a high level of satisfaction. Results: One hundred sixty eight students participated in the study. Average emotional intelligence was 3.25±0.45, the scale of consciousness 3.44±0.59, the self-control scale 3.90±0.59, scale spontaneous 3.17±0.46, Social skills 3.30±0.59, social consciousness 3.24±0.67, satisfactory academic 96.55±14.66 respectively. There was a significant relationship between self-consciousness and educational satisfaction (P=0.002) but self-control variable did not significantly correlated with educational satisfaction (P=0.249). The results showed that emotional intelligence on academic satisfaction can be explained. A change in the variance in one unit emotional intelligence was as much as five unit of the variance student satisfaction in based on standardized beta coefficient. There is a positive and direct relationship between them. Conclusion: The promotion of education satisfaction will increase indirectly possibility of job satisfaction in students in the future. Our results showed self-awareness and motivation skills in students increase their educational satisfaction

Investigation the frequency of asymptomatic hemorrhagic transformation of infarction in CT scan of acute ischemic stroke patients

Background: Asymptomatic hemorrhagic transformation infarct (AHTI) is known as a complication of ischemic attack and maybe occurs in the entire stroke. However, the role of AHTI in the result of the treatment is still not clear, because it is based on the definition of an asymptomatic and not identifiable. The aim of this study was assessment and evaluation frequency of AHTI in acute ischemic stroke patients. Methods: This prospective cross-sectional study was done in Neurologic Department, Tehran University of Medical Sciences, Tehran, Iran, from April 2015 to April 2016. Second evaluation was done about new neurologic signs and symptoms ten days after stroke. In addition, brain CT scan was used to diagnose of hemorrhagic event in infarct area. If the hemorrhagic event was occur in different area, the patient was consider as a non-hemorrhagic transformation and excluded from the study. Other exclusion criteria include intracranial hemorrhage (ICH), trauma to the head during admission, cerebral vein thrombosis, coagulation disorder, anti-coagulant (heparin, warfarin) administration, induced transformation within 10 days of onset of ischemia, lacunar ischemic and unobservable in thirty T-brain scan, patient's lack of referral for examination and CT scan 10 days after the onset of symptoms, died before CT was considered. Results: Three hundred and eighty seven patients had inclusion criteria. 249 cases were excluded due to lost following, vein thrombosis of the brain, lacunar ischemia, anti-coagulants recipient (heparin, warfarin), asymptomatic hemorrhagic transformation and death. Finally, 138 cases (86 men, 52 women) with 66.61±9.37 years (50-101 years) were participated in data analysis. Frequency of positive CT scan was evaluated for ischemic stroke evidence in two stages. Of the 138 patients who participated in the study, 75 (54.3%) were positive in the first and 63 (45.7%) cases in the second time. 27 cases (19.6%) had AHTI. Conclusion: Coronary artery bypass graft (CABG) had significant correlation with ATHI in acute ischemic attack. However, stroke history correlated with decreasing of ATHI. Concerning smoking and consuming the results showed that smoking did not affect the asymptomatic hemorrhagic transformation. Also, the results showed that the use of aspirin and Plavix also had no significant effect on increasing the incidence of ATHI

Rhabdomyosarcoma with Skin Metastasis: Report of a Case

Rhabdomyosarcomas are the most common soft tissue sarcoma in adult and children that accompany with skeletal muscle differentiation. Skin metastasis of rhabdomyosarcomas is unusual and has only been sporadically reported in literature. In this paper we present a case of skin metastasis of rhabdomyosarcoma in an 8-year-old girl that has treated with chemotherapy

Harris hip score assessment after total hip arthroplasty with short-stem versus standard-stem: randomized clinical trial

Background: Short-stem prosthesis for total hip arthroplasty (THA) have been designed to overcome the weakness of standard-stem prostheses and improve surgical outcomes. The aim of this study was to compare short-stem with standard-stem prosthesis outcomes. Methods: This study was performed as a randomized clinical trial. Subjects were selected among patients referred to Sina University Hospital, Tehran, Iran from April 2010 to 2012. THA were performed with short-stem or standard-stem prostheses after obtaining written informed consent from patients. Balanced block randomization method was used to get a random sample in each group. Clinical outcomes were evaluated based on Harris Hip Score (HHS). Patients were followed up for at least one year. All patients were examined at 2 weeks, 6 weeks, 3 months, 6 months and one year after surgery. In each visit, Control X-ray was obtained and bone and prosthetic position were assessed. Also, the symptoms such as infection, pain, claudication, ability to climb stairs, using crutches and weight bearing were rechecked. Student t-test was used to compare outcomes in the two groups. Results: A total of eighty four THA were studied. 13 patients were lost to follow-up or had infection and failure. One patient died with the prosthesis in situ from causes not related to the surgery. Therefore, a total of 70 patients were analyzed. Of these, 34 and 36 hips underwent small stem and standard stem THA, respectively. The mean age of the patients at the time of operation was 61.1±8.68 years (range, 48-86 years). Most common reasons for arthroplasty were osteoarthritis, avascular necrosis and dysplasia of hip. There were significant differences between the two study groups in bleeding during surgery (P=0.001). There were no significant differences among the study groups in HHS except for 6th week and 3th month (P=0.000). Conclusion: The use of short-stem prosthesis can improve the performance of patients in short-term but no significant difference with standard-stem prosthesis in long- term

Serum Zinc level and liver pathological grading correlation in nonalcoholic steatohepatitis, in a university hospital in Tehran

Background: Nonalcoholic fatty liver disease (NAFLD) includes steatosis, nonalcoholic steatohepatitis, fibrosis and liver cirrhosis. The oxidative stress enzymes are the diagnostic markers to prediction of histologic status of liver in nonalcoholic steatohepatitis disease. The aim of the study was to assessment of relationship between serum Zinc (Zn) levels with pathologic manifestation in patients with nonalcoholic steatohepatitis. Methods: This cohort study was done in patients with nonalcoholic steatohepatitis that had been visited in gastrointestinal clinic of Sina Hospital, Tehran, Iran from April, 2014 to April, 2015. Control group included the patients with no clinical manifestation of nonalcoholic steatohepatitis and normal liver ultrasonography, lab test and liver biopsy. Serum Zn level was measured with atomic absorption spectroscopy. Normal Serum level of Zn was considered 10.7-22.9 &micro;mol/L (70-150 &micro;g/dL) and less than 7 &micro;g/dL was considered as Zn deficiency. Pathological findings were grading according to NAFLD activity score. Results: One hundred twenty patients were selected for the study in two equal groups. Six and 26 patients were excluded in case and control groups, respectively due to no consent to lab test. Finally, 54 patients (35 male/19 female) and 34 patients (22 male/12 female) in control group were participated in data analysis. The mean age on case and control group was 37.02&plusmn;9.82 year and 33.24&plusmn;12.01 year, respectively (P= 0.111). Zn level in case and control groups were 90.82&plusmn;13.69 and 88.82&plusmn;13.10, respectively. There were no statistically significant differences between two group in serum Zn level (P= 0.50). Also, there were no statistically significant differences between pathological grading in case group participants (steatosis: P= 0.640; Lobular inflammation: P= 0.882; fibrosis: P= 0.531). Conclusion: The finding of the study showed no significant association between serum zinc level and hepatic steatosis, lobular inflammation and fibrosis of the liver in nonalcoholic steatohepatitis