Pub Date : 2020-11-01DOI: 10.30491/TM.2021.228558.1105
L. Yekefallah, P. Namdar, S. Yaghoubi, S. Mohammadi
Background: Assessing patients’ readiness for weaning through spontaneous breathing trial (SBT) is a reliable method for improving weaning and extubation outcomes. Until now, there are controversies over the best SBT method. Objective: This study aimed to compare the clinical outcomes of the T-piece and pressure support ventilation (PSV) SBT methods among patients with traumatic brain injury. Methods: In this randomized controlled trial, 72 patients under mechanical ventilation were purposively recruited from the intensive care unit of Shahid Rajaei hospital, Qazvin, Iran, and randomly allocated to an intervention and a control group. SBT was conducted in the intervention and control groups through the T-piece and PSV (with pressure support of less than 8 cm H2O), respectively. The groups were compared with each other respecting weaning outcomes, extubation success, length of mechanical ventilation, length of hospital stay, and mortality rate. Data were compared using the Chi-square and the independent-sample t-tests. Results: Weaning success rate in the T-piece group was significantly greater than the PSV group (P=0.024), while the post-weaning length of hospital stay in the T-piece group was significantly shorter than the PSV group (P=0.05). There were no significant differences in respecting extubation success rate and length of mechanical ventilation between the groups (P>0.05). Conclusion: The T-piece method for SBT could be better tolerated by patients with traumatic brain injury compared with PSV.
背景:通过自主呼吸试验(SBT)评估患者对脱机的准备程度是改善脱机和拔管结果的可靠方法。到目前为止，关于最佳的SBT方法存在争议。目的:比较创伤性脑损伤患者t片通气与压力支持通气(PSV) SBT方法的临床效果。方法:随机对照试验，从伊朗Qazvin市Shahid Rajaei医院重症监护病房有意招募72例机械通气患者，随机分为干预组和对照组。干预组和对照组分别通过T-piece和PSV(压力支持小于8 cm H2O)进行SBT。对两组患者的脱机结果、拔管成功率、机械通气时间、住院时间和死亡率进行比较。数据比较采用卡方检验和独立样本t检验。结果:T-piece组脱机成功率显著高于PSV组(P=0.024)， T-piece组脱机后住院时间显著短于PSV组(P=0.05)。两组患者拔管成功率、机械通气时间差异无统计学意义(P>0.05)。结论:与PSV法相比，t片法对创伤性脑损伤患者具有更好的耐受性。
{"title":"Spontaneous Breathing Trial with Pressure Support-Ventilation versus “T-Tube” for Head Trauma Patient: A Randomized Controlled Clinical Trial","authors":"L. Yekefallah, P. Namdar, S. Yaghoubi, S. Mohammadi","doi":"10.30491/TM.2021.228558.1105","DOIUrl":"https://doi.org/10.30491/TM.2021.228558.1105","url":null,"abstract":"Background: Assessing patients’ readiness for weaning through spontaneous breathing trial (SBT) is a reliable method for improving weaning and extubation outcomes. Until now, there are controversies over the best SBT method. Objective: This study aimed to compare the clinical outcomes of the T-piece and pressure support ventilation (PSV) SBT methods among patients with traumatic brain injury. Methods: In this randomized controlled trial, 72 patients under mechanical ventilation were purposively recruited from the intensive care unit of Shahid Rajaei hospital, Qazvin, Iran, and randomly allocated to an intervention and a control group. SBT was conducted in the intervention and control groups through the T-piece and PSV (with pressure support of less than 8 cm H2O), respectively. The groups were compared with each other respecting weaning outcomes, extubation success, length of mechanical ventilation, length of hospital stay, and mortality rate. Data were compared using the Chi-square and the independent-sample t-tests. Results: Weaning success rate in the T-piece group was significantly greater than the PSV group (P=0.024), while the post-weaning length of hospital stay in the T-piece group was significantly shorter than the PSV group (P=0.05). There were no significant differences in respecting extubation success rate and length of mechanical ventilation between the groups (P>0.05). Conclusion: The T-piece method for SBT could be better tolerated by patients with traumatic brain injury compared with PSV.","PeriodicalId":23249,"journal":{"name":"Trauma monthly","volume":"9 1","pages":"243-248"},"PeriodicalIF":0.5,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78926283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-23DOI: 10.30491/TM.2020.241407.1152
M. Eghbali, H. Khankeh, Seyed Ali Hosseini, V. Rahimi-Movaghar, A. Ebadi
Background: Availability and efficiency of early rehabilitation care is crucial for the restoration and improvement of brain function. Moreover, it can help increase the possibility of the patient’s successful future integration in the community. However, there is no clear and general consensus over this concept (regarding patients with traumatic brain injury) and it is considered a poorly developed area of research. Hence, the purpose of this study is to analysis the concept of early rehabilitation care in patients with traumatic brain injury (TBI). Methods: Walker and Avant’s (2011) approach was employed to analyze this concept. Various databases and search engines were explored to find all the relevant data regarding the concept of early rehabilitation care from 1990 to 2020. Finally, the definition, usage, features, antecedents, attribute, consequences, and empirical referents on the subject of early rehabilitation care were extracted. Results: The results of the concept analysis demonstrated that the most important features of early rehabilitation care include early specialized comprehensive care, purposeful and patient-centered care, and teamwork. Hence, the objectives are to decrease the bad consequence caused by immobility, contracture, bladder and intestinal dysfunction, pressure ulcer, and sleeping disorders. Conclusions: It is believed that the concept of early rehabilitation care is not fully established in the literature in patients with traumatic brain injury, and there are only rudimentary ideas and steps toward applying this concept. Therefore, clarifications on this concept can pave the way for further application of early rehabilitation care.
{"title":"Early Rehabilitation Care for Patients with Traumatic Brain Injury (TBI): a Concept Analysis study","authors":"M. Eghbali, H. Khankeh, Seyed Ali Hosseini, V. Rahimi-Movaghar, A. Ebadi","doi":"10.30491/TM.2020.241407.1152","DOIUrl":"https://doi.org/10.30491/TM.2020.241407.1152","url":null,"abstract":"Background: Availability and efficiency of early rehabilitation care is crucial for the restoration and improvement of brain function. Moreover, it can help increase the possibility of the patient’s successful future integration in the community. However, there is no clear and general consensus over this concept (regarding patients with traumatic brain injury) and it is considered a poorly developed area of research. Hence, the purpose of this study is to analysis the concept of early rehabilitation care in patients with traumatic brain injury (TBI). Methods: Walker and Avant’s (2011) approach was employed to analyze this concept. Various databases and search engines were explored to find all the relevant data regarding the concept of early rehabilitation care from 1990 to 2020. Finally, the definition, usage, features, antecedents, attribute, consequences, and empirical referents on the subject of early rehabilitation care were extracted. Results: The results of the concept analysis demonstrated that the most important features of early rehabilitation care include early specialized comprehensive care, purposeful and patient-centered care, and teamwork. Hence, the objectives are to decrease the bad consequence caused by immobility, contracture, bladder and intestinal dysfunction, pressure ulcer, and sleeping disorders. Conclusions: It is believed that the concept of early rehabilitation care is not fully established in the literature in patients with traumatic brain injury, and there are only rudimentary ideas and steps toward applying this concept. Therefore, clarifications on this concept can pave the way for further application of early rehabilitation care.","PeriodicalId":23249,"journal":{"name":"Trauma monthly","volume":"72 3 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2020-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80313430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Hip hemiarthroplasty (HHA) is the selected procedure among patients with femoral neck fracture and ages more than 70 years old. Lots of different approaches have been proposed for this surgery. However, none of them is confirmed to be superior to others. Objective: The purpose of this study was to compare the posterolateral vs. direct lateral approach regarding their dislocation and mortality rates. Methods: For this retrospective study, 154 patients with femoral neck fracture were investigated from 2012 to 2018. Demographic data, surgical sheet reports, and plain radiography were evaluated. Postoperative dislocation, reoperation, infection, thromboembolic events, one-year mortality and total mortality rates were extracted through interviews and medical documents. Results: There was no significant difference between these two surgical approaches in terms of age, gender, time delayed to perform the surgery, Garden classification, and the etiology of fracture. The duration of the surgery was longer in the posterolateral approach without statistical significance. 36 months later, dislocation, infection, and one-year mortality rates were higher in the direct lateral approach. Recurrent dislocation and total mortality rates were higher in the posterolateral approach. No statistical significance was found between two groups regarding the above mentioned variables. Conclusion: The two HHA approaches were similar in terms of the duration of the surgery, dislocation, reoperation, and mortality rates. None of the approaches was superior to the other one.
{"title":"Impacts of Hip Hemiarthroplasty with Direct Lateral vs. Posterolateral Approach for Femoral Neck Fracture in Elderly","authors":"Hossein Akbari-Aghdam, Abozar Maleki, Erfan Sheikhbahaei","doi":"10.30491/TM.2020.233380.1127","DOIUrl":"https://doi.org/10.30491/TM.2020.233380.1127","url":null,"abstract":"Background: Hip hemiarthroplasty (HHA) is the selected procedure among patients with femoral neck fracture and ages more than 70 years old. Lots of different approaches have been proposed for this surgery. However, none of them is confirmed to be superior to others. Objective: The purpose of this study was to compare the posterolateral vs. direct lateral approach regarding their dislocation and mortality rates. Methods: For this retrospective study, 154 patients with femoral neck fracture were investigated from 2012 to 2018. Demographic data, surgical sheet reports, and plain radiography were evaluated. Postoperative dislocation, reoperation, infection, thromboembolic events, one-year mortality and total mortality rates were extracted through interviews and medical documents. Results: There was no significant difference between these two surgical approaches in terms of age, gender, time delayed to perform the surgery, Garden classification, and the etiology of fracture. The duration of the surgery was longer in the posterolateral approach without statistical significance. 36 months later, dislocation, infection, and one-year mortality rates were higher in the direct lateral approach. Recurrent dislocation and total mortality rates were higher in the posterolateral approach. No statistical significance was found between two groups regarding the above mentioned variables. Conclusion: The two HHA approaches were similar in terms of the duration of the surgery, dislocation, reoperation, and mortality rates. None of the approaches was superior to the other one.","PeriodicalId":23249,"journal":{"name":"Trauma monthly","volume":"308 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2020-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83446703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.30491/TM.2020.213594.1024
M. Peyravi, F. Rahnavard, M. Marzaleh
Background: Iran is a disaster-prone country, and many flood events occur in its provinces annually. The unprecedented amount of rainfall in the northern region of Iran (from March 17 to 22, 2019) led to flash flooding of the Golestan Province. Objectives: This study assessed the challenges and strengths of health-related needs in the first 10 days after the great flood in Golestan; via interviews with experts. Methods: This cross-sectional and qualitative study was carried out in Gonbad-e-Kavoos, Anbar Alum, Aq-Qala, Simin Shahr, and Gomishan cities of the flood-hit province of Golestan from March 21 to April 13, 2019. The data were collected using the researcher’s field observations and interviews with 26 experts and policymakers. Results: The findings were categorized into 10 main groups namely mental health, environmental health, health education, maternal, infant, and child health, nutrition, epidemics, drugs, mobile hospitals, non-communicable diseases, and management. Environmental health issues were faced with a wide range of challenges. Conclusion: Due to the insufficient development of many health infrastructures in underdeveloped and developing countries, health policymakers and disaster management experts should collaborate before and after the disaster to detect and resolve the flaws. This will help reduce health problems and challenges when a natural disaster occurs, particularly by diminishing the number of morbidities and mortalities.
{"title":"Overview of the Strengths and Challenges Associated with Healthcare Service Rendered in the First 10 Days after the Great Flood in Northern Iran, 2019","authors":"M. Peyravi, F. Rahnavard, M. Marzaleh","doi":"10.30491/TM.2020.213594.1024","DOIUrl":"https://doi.org/10.30491/TM.2020.213594.1024","url":null,"abstract":"Background: Iran is a disaster-prone country, and many flood events occur in its provinces annually. The unprecedented amount of rainfall in the northern region of Iran (from March 17 to 22, 2019) led to flash flooding of the Golestan Province. Objectives: This study assessed the challenges and strengths of health-related needs in the first 10 days after the great flood in Golestan; via interviews with experts. Methods: This cross-sectional and qualitative study was carried out in Gonbad-e-Kavoos, Anbar Alum, Aq-Qala, Simin Shahr, and Gomishan cities of the flood-hit province of Golestan from March 21 to April 13, 2019. The data were collected using the researcher’s field observations and interviews with 26 experts and policymakers. Results: The findings were categorized into 10 main groups namely mental health, environmental health, health education, maternal, infant, and child health, nutrition, epidemics, drugs, mobile hospitals, non-communicable diseases, and management. Environmental health issues were faced with a wide range of challenges. Conclusion: Due to the insufficient development of many health infrastructures in underdeveloped and developing countries, health policymakers and disaster management experts should collaborate before and after the disaster to detect and resolve the flaws. This will help reduce health problems and challenges when a natural disaster occurs, particularly by diminishing the number of morbidities and mortalities.","PeriodicalId":23249,"journal":{"name":"Trauma monthly","volume":"28 1","pages":"220-226"},"PeriodicalIF":0.5,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88813544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.30491/TM.2020.247028.1170
M. Safi-Keykaleh, Ali Sahebi, Iman Farahi-Ashtiani, A. Mousavi, H. Safarpour
Cardiovascular emergencies have a high prevalence and are important among other pre-hospital emergencies. In such emergency situations, making decisions to provide the best care and transport to the hospital are brought with many challenges. The current study reports paramedics’ on-scene decision-making challenges in relation to a patient with the acute coronary syndrome. The case was an old woman who complained of sudden dizziness and weakness. The patient’s vital signs included a blood pressure of 100/70 mm Hg, heart rate of 58 beats per minute, respiratory rate of 17 breaths per minute, O2 sat of 96% and blood sugar of 145 mg/dL. The past medical history of the patient indicated that she had no previous disease or use of medications. In the hospital emergency unit, electrocardiography was recorded and ST-segment elevation myocardial infarction was observed. Paramedics face many challenges in on-scene decision making, which affect the time, process, and consequences of their decisions. In low and middle-income countries, due to resource limitations, all ambulances are not equipped with diagnostic equipment including portable sonograph and electrocardiograms. In such contexts, decision-making protocols need to be designed and used at the emergency scenes to guide the paramedic and ensure their optimal performance.
心血管急症发病率高，在其他院前急症中占有重要地位。在这种紧急情况下，决定提供最好的护理和运送到医院面临许多挑战。目前的研究报告了护理人员在与急性冠状动脉综合征患者相关的现场决策挑战。病人是一位老妇人，她抱怨自己突然头晕乏力。患者生命体征为血压100/70 mm Hg，心率58次/分，呼吸频率17次/分，血氧饱和度96%，血糖145 mg/dL。病人的既往病史表明她以前没有疾病或使用过药物。在医院急诊科记录心电图，观察st段抬高型心肌梗死。护理人员在现场决策时面临许多挑战，这些挑战会影响他们决策的时间、过程和后果。在低收入和中等收入国家，由于资源限制，并非所有救护车都配备诊断设备，包括便携式超声心动图和心电图。在这种情况下，需要在紧急情况下设计和使用决策协议，以指导护理人员并确保其最佳表现。
{"title":"Decision-Making Challenges of Paramedics in Prehospital Emergency Care","authors":"M. Safi-Keykaleh, Ali Sahebi, Iman Farahi-Ashtiani, A. Mousavi, H. Safarpour","doi":"10.30491/TM.2020.247028.1170","DOIUrl":"https://doi.org/10.30491/TM.2020.247028.1170","url":null,"abstract":"Cardiovascular emergencies have a high prevalence and are important among other pre-hospital emergencies. In such emergency situations, making decisions to provide the best care and transport to the hospital are brought with many challenges. The current study reports paramedics’ on-scene decision-making challenges in relation to a patient with the acute coronary syndrome. The case was an old woman who complained of sudden dizziness and weakness. The patient’s vital signs included a blood pressure of 100/70 mm Hg, heart rate of 58 beats per minute, respiratory rate of 17 breaths per minute, O2 sat of 96% and blood sugar of 145 mg/dL. The past medical history of the patient indicated that she had no previous disease or use of medications. In the hospital emergency unit, electrocardiography was recorded and ST-segment elevation myocardial infarction was observed. Paramedics face many challenges in on-scene decision making, which affect the time, process, and consequences of their decisions. In low and middle-income countries, due to resource limitations, all ambulances are not equipped with diagnostic equipment including portable sonograph and electrocardiograms. In such contexts, decision-making protocols need to be designed and used at the emergency scenes to guide the paramedic and ensure their optimal performance.","PeriodicalId":23249,"journal":{"name":"Trauma monthly","volume":"6 1","pages":"231-233"},"PeriodicalIF":0.5,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87937921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.30491/TM.2020.239177.1143
M. Behzadnia, F. Sabouri
{"title":"COVID-19 Concerns- Patient Priority or Emergency Department Overcrowding?","authors":"M. Behzadnia, F. Sabouri","doi":"10.30491/TM.2020.239177.1143","DOIUrl":"https://doi.org/10.30491/TM.2020.239177.1143","url":null,"abstract":"","PeriodicalId":23249,"journal":{"name":"Trauma monthly","volume":"60 1","pages":"191-192"},"PeriodicalIF":0.5,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89278042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.30491/TM.2020.233780.1130
P. Kolivand, B. Mahshidfar, P. Saberian, N. Tavakoli, Parisa Hasani-Sharamin, A. Abdollahi
Background: The investigation of trauma-related mortality is one of the key components in trauma studies and it is used as a performance index and measure of health care quality. Objective: The present study aimed to evaluate the performance of pre-hospital interventions and identify possible mismanagements in dealing with trauma patients transferred by emergency medical services (EMS) to the hospital and died. Methods: This study was conducted in 2019, in Tehran, Iran. All trauma patients who were transferred to the emergency department (ED) of three main referral hospitals, by Tehran EMS and died at the hospital within 24 hours of admission, were studied retrospectively. The required information was collected from the EMS and the hospital records. A panel of experts was asked to identify possible errors based on standards for each patient. Results: During the one-year study period, almost 14000 trauma patients were transported by Tehran EMS to the studied hospitals. Of them, a total of 197 deaths were recorded. The most and least provided services were breathing management (87.3%) and intravenous (IV) fluid therapy (12.2%), respectively. Needle thoracostomy, IV fluids therapy, life supports (basic and advanced cardiac), and airway management had the highest percentage of mismanagement among provided services. Bleeding control and resuscitation were consistent with the recommended standard. Conclusion: In the current study, bleeding control and immobilization was performed appropriately. Needle tracheostomy was not performed at all. Airway management and life supports of the victims were not performed properly.
{"title":"Audit on in-hospital mortality of trauma patients: EMS Management and Mismanagement","authors":"P. Kolivand, B. Mahshidfar, P. Saberian, N. Tavakoli, Parisa Hasani-Sharamin, A. Abdollahi","doi":"10.30491/TM.2020.233780.1130","DOIUrl":"https://doi.org/10.30491/TM.2020.233780.1130","url":null,"abstract":"Background: The investigation of trauma-related mortality is one of the key components in trauma studies and it is used as a performance index and measure of health care quality. Objective: The present study aimed to evaluate the performance of pre-hospital interventions and identify possible mismanagements in dealing with trauma patients transferred by emergency medical services (EMS) to the hospital and died. Methods: This study was conducted in 2019, in Tehran, Iran. All trauma patients who were transferred to the emergency department (ED) of three main referral hospitals, by Tehran EMS and died at the hospital within 24 hours of admission, were studied retrospectively. The required information was collected from the EMS and the hospital records. A panel of experts was asked to identify possible errors based on standards for each patient. Results: During the one-year study period, almost 14000 trauma patients were transported by Tehran EMS to the studied hospitals. Of them, a total of 197 deaths were recorded. The most and least provided services were breathing management (87.3%) and intravenous (IV) fluid therapy (12.2%), respectively. Needle thoracostomy, IV fluids therapy, life supports (basic and advanced cardiac), and airway management had the highest percentage of mismanagement among provided services. Bleeding control and resuscitation were consistent with the recommended standard. Conclusion: In the current study, bleeding control and immobilization was performed appropriately. Needle tracheostomy was not performed at all. Airway management and life supports of the victims were not performed properly.","PeriodicalId":23249,"journal":{"name":"Trauma monthly","volume":"25 1","pages":"200-206"},"PeriodicalIF":0.5,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89418026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.30491/TM.2020.240116.1145
K. Motamedi, M. Hassan
A 51-year-old war veteran referred to us with typical chest pain and dyspnea on exertion. He had a history of hypertension from several years before, for which he had been prescribed anti-hypertensive medications. He also gave a history of missile fragment injury to his chest from the Iran-Iraq war, for which he had been hospitalized, but had received conservative medical treatment only. After admission and initial workup, echocardiography revealed mild left ventricular dysfunction with an ejection fraction of 45% and a metallic fragment at the diaphragmatic surface of the right ventricle. Coronary angiography showed significant stenosis at the LAD – Diagonal bifurcation, as well as a metallic fragment occluding the PDA branch of the right coronary artery. Coronary artery bypass surgery was performed successfully and the patient was discharged uneventfully. To the best of our knowledge, this is the first report of an embolized missile fragment to the coronary artery found incidentally in a patient undergoing surgery for coronary artery disease.
{"title":"Missile Fragment Embolism of the Coronary Artery in a Patient with Coronary Artery Disease","authors":"K. Motamedi, M. Hassan","doi":"10.30491/TM.2020.240116.1145","DOIUrl":"https://doi.org/10.30491/TM.2020.240116.1145","url":null,"abstract":"A 51-year-old war veteran referred to us with typical chest pain and dyspnea on exertion. He had a history of hypertension from several years before, for which he had been prescribed anti-hypertensive medications. He also gave a history of missile fragment injury to his chest from the Iran-Iraq war, for which he had been hospitalized, but had received conservative medical treatment only. After admission and initial workup, echocardiography revealed mild left ventricular dysfunction with an ejection fraction of 45% and a metallic fragment at the diaphragmatic surface of the right ventricle. Coronary angiography showed significant stenosis at the LAD – Diagonal bifurcation, as well as a metallic fragment occluding the PDA branch of the right coronary artery. Coronary artery bypass surgery was performed successfully and the patient was discharged uneventfully. To the best of our knowledge, this is the first report of an embolized missile fragment to the coronary artery found incidentally in a patient undergoing surgery for coronary artery disease.","PeriodicalId":23249,"journal":{"name":"Trauma monthly","volume":"9 1","pages":"227-230"},"PeriodicalIF":0.5,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86048105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.30491/TM.2020.213582.1023
Jamile Mohammadi, Ali Sadr, M. Farahani, H. Rasouli, A. vahedian-azimi, M. Salesi
Background: The international standing of a nation is based on its status in science production. Objectives: We aimed to assess the scientific growth and global ranking of Iran regarding the domain of medical sciences, based on the Scopus database. Methods: In the scientometric evaluation, we considered two indicators for the evaluation of Iran's global ranking in medical sciences and "emergency medicine", as a subcategory of medical science namely the number of documents and citations using the Scopus database (ranking of countries was extracted from the SCImago website). Results: Iran’s trend in the number of documents and citations was progressive. This improvement trend had a slower slope in the medical sciences and emergency medicine. Conclusion: The results showed Iran's scientific growth to be consistent. It is recommended that indexing Iranian journals in the Scopus database, promoting scientific collaborations, and providing the necessary funding could promote Iran's scientific growth.
{"title":"Iran's global scientific growth in the medical sciences: A 23-year Scientometric Evaluation","authors":"Jamile Mohammadi, Ali Sadr, M. Farahani, H. Rasouli, A. vahedian-azimi, M. Salesi","doi":"10.30491/TM.2020.213582.1023","DOIUrl":"https://doi.org/10.30491/TM.2020.213582.1023","url":null,"abstract":"Background: The international standing of a nation is based on its status in science production. Objectives: We aimed to assess the scientific growth and global ranking of Iran regarding the domain of medical sciences, based on the Scopus database. Methods: In the scientometric evaluation, we considered two indicators for the evaluation of Iran's global ranking in medical sciences and \"emergency medicine\", as a subcategory of medical science namely the number of documents and citations using the Scopus database (ranking of countries was extracted from the SCImago website). Results: Iran’s trend in the number of documents and citations was progressive. This improvement trend had a slower slope in the medical sciences and emergency medicine. Conclusion: The results showed Iran's scientific growth to be consistent. It is recommended that indexing Iranian journals in the Scopus database, promoting scientific collaborations, and providing the necessary funding could promote Iran's scientific growth.","PeriodicalId":23249,"journal":{"name":"Trauma monthly","volume":"11 9 1","pages":"207-211"},"PeriodicalIF":0.5,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82872287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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