Rahul Chaurasia, N. Akhtar, S. Arulselvi, V. Arya, Sulekha Karjee
Objective: Type and crossmatch (TC) policy is the most common approach for pre-transfusion compatibility testing prior to issue of blood for transfusion. As it involves reserving of the blood units (usually up to 72 hours) prior to issue or un-reserving, it can lead to excessive blood cross matching, inventory management problems, undue workload, blood outdating and reagent wastage. Type and screen (TS) policy is an alternative approach without the need to cross match and reserve blood units prior to issue. The aim of the current study was to retrospectively assess the impact of the implementation of TS policy for pre-transfusion compatibility testing on blood transfusion services at an urban level Ι trauma center. Methods: The study was done in two phases in the Department of Transfusion Medicine at Jai Prakash Narayan Apex Trauma Center AIIMS, New Delhi, India. Transfusion data was collected and compared during two phases: initial phase (Oct 2016-Mar 2017) of TC policy and second phase (Apr 2017-Sept 2017) of TS policy. Results: TS policy resulted in the reduction of C:T ratio from 5.3 to 1.9. Transfusion probability increased to 29.5% during TS policy from 23.6% during TC policy. Issuable stock index (ISI) also showed reduction from 12.5 to 11.4 after TS policy. Wastage as percentage of issue (WAPI) was reduced from 2.3% (TC) to 1.3% (TS). TS policy also led to reduction in expenses incurred on pre-transfusion compatibility testing by 35%. No hemolytic transfusion reaction was reported during the study. Conclusion: TS policy was found to be a safe and an efficient alternative approach to TC policy for pre-transfusion compatibility at our center. We recommend the implementation of TS policy, but each center should first assess its feasibility based on patient population, blood bank resources and staff knowledge.
{"title":"Utility of type and screen policy for pretransfusion compatibility testing at an urban level Ι apex trauma center","authors":"Rahul Chaurasia, N. Akhtar, S. Arulselvi, V. Arya, Sulekha Karjee","doi":"10.34172/jept.2021.26","DOIUrl":"https://doi.org/10.34172/jept.2021.26","url":null,"abstract":"Objective: Type and crossmatch (TC) policy is the most common approach for pre-transfusion compatibility testing prior to issue of blood for transfusion. As it involves reserving of the blood units (usually up to 72 hours) prior to issue or un-reserving, it can lead to excessive blood cross matching, inventory management problems, undue workload, blood outdating and reagent wastage. Type and screen (TS) policy is an alternative approach without the need to cross match and reserve blood units prior to issue. The aim of the current study was to retrospectively assess the impact of the implementation of TS policy for pre-transfusion compatibility testing on blood transfusion services at an urban level Ι trauma center. Methods: The study was done in two phases in the Department of Transfusion Medicine at Jai Prakash Narayan Apex Trauma Center AIIMS, New Delhi, India. Transfusion data was collected and compared during two phases: initial phase (Oct 2016-Mar 2017) of TC policy and second phase (Apr 2017-Sept 2017) of TS policy. Results: TS policy resulted in the reduction of C:T ratio from 5.3 to 1.9. Transfusion probability increased to 29.5% during TS policy from 23.6% during TC policy. Issuable stock index (ISI) also showed reduction from 12.5 to 11.4 after TS policy. Wastage as percentage of issue (WAPI) was reduced from 2.3% (TC) to 1.3% (TS). TS policy also led to reduction in expenses incurred on pre-transfusion compatibility testing by 35%. No hemolytic transfusion reaction was reported during the study. Conclusion: TS policy was found to be a safe and an efficient alternative approach to TC policy for pre-transfusion compatibility at our center. We recommend the implementation of TS policy, but each center should first assess its feasibility based on patient population, blood bank resources and staff knowledge.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41325965","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}
Objective: The presence of air within the mediastinal compartment and retro-peritoneal compartment, in the setting of trauma, can be because of visceral and skeletal injuries. However, in absence of a local site injury, an approach based on anatomical communication between various body compartments should be utilized and all potential sites of injuries must be reviewed. Case Presentation: We present a case of a 40-year-old male patient with a history of trauma (fall from height), presenting to the emergency department with loss of consciousness and ear bleed. Chest radiographs showed pneumomediastinum. On cross-sectional imaging, pneumomediastinum and pneumoretroperitoneum were seen, however no esophageal, tracheal and skeletal injuries could be identified. On careful evaluation, fractures involving the base of skull were identified as a source of ectopic air. Conclusion: This case represents a situation where the fascial connections between various compartments of the body were utilized to find the site of injury and hence the source of ectopic air. Base of skull fractures are important to be identified since these require surgical attention at an early stage.
{"title":"Base of skull fracture leading to pneumomediastinum and pneumo-retroperitoneum: a case report with review of literature","authors":"G. Sharma, Sanya Vermani, A. Syed","doi":"10.34172/jept.2021.25","DOIUrl":"https://doi.org/10.34172/jept.2021.25","url":null,"abstract":"Objective: The presence of air within the mediastinal compartment and retro-peritoneal compartment, in the setting of trauma, can be because of visceral and skeletal injuries. However, in absence of a local site injury, an approach based on anatomical communication between various body compartments should be utilized and all potential sites of injuries must be reviewed. Case Presentation: We present a case of a 40-year-old male patient with a history of trauma (fall from height), presenting to the emergency department with loss of consciousness and ear bleed. Chest radiographs showed pneumomediastinum. On cross-sectional imaging, pneumomediastinum and pneumoretroperitoneum were seen, however no esophageal, tracheal and skeletal injuries could be identified. On careful evaluation, fractures involving the base of skull were identified as a source of ectopic air. Conclusion: This case represents a situation where the fascial connections between various compartments of the body were utilized to find the site of injury and hence the source of ectopic air. Base of skull fractures are important to be identified since these require surgical attention at an early stage.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45615098","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}
A. Abbasian, Maryam Beladi, Elnaz Vahidi, Amirhosein Jahanshir, Javad Seyedhosseini
Objective: Disposition in acute coronary syndrome (ACS) is pivotal in an emergency department (ED). HEART score is a recent scoring system for finding primary endpoints in undetermined ACS. This study aimed at evaluating the predictive value of HEART score in ACS outcome and disposition. Methods: In this prospective study, all patients with chest pain presentation compatible with our inclusion criteria referring to ED were enrolled during one year. Demographic data, triage level, hospital length of stay, admission ward, coronary angiography result, HEART score, thrombolysis in myocardial infarction (TIMI) score, 1-month primary ACS endpoints and major adverse cardiac events (MACE) were evaluated. Results: In our studied population (200 cases), 49 patients (24.5%) had at least one score for MACE. Comparing the prognostic values of TIMI vs HEART score in MACE revealed that the HEART had a larger AUC. The best cut-off point of HEART score in MACE prediction was calculated to be ≥5. There was a statistically significant relation between HEART score and hospital length of stay. The higher the HEART score, the more probability of patients being admitted to either hospital cardiac ward or coronary care unit (CCU). There was a significant relationship between the triage level and HEART score. Patients with higher HEART score had more acuity (lower triage level 1 or 2). Conclusion: HEART predicted MACE better than TIMI in low risk ACS. Patients with higher HEART score were more admitted to the hospital with longer hospital stay and patients with lower HEART score had higher triage level with less acuity.
{"title":"Predictive value of HEART score in the outcome of acute coronary syndrome and disposition","authors":"A. Abbasian, Maryam Beladi, Elnaz Vahidi, Amirhosein Jahanshir, Javad Seyedhosseini","doi":"10.34172/JEPT.2021.17","DOIUrl":"https://doi.org/10.34172/JEPT.2021.17","url":null,"abstract":"Objective: Disposition in acute coronary syndrome (ACS) is pivotal in an emergency department (ED). HEART score is a recent scoring system for finding primary endpoints in undetermined ACS. This study aimed at evaluating the predictive value of HEART score in ACS outcome and disposition. Methods: In this prospective study, all patients with chest pain presentation compatible with our inclusion criteria referring to ED were enrolled during one year. Demographic data, triage level, hospital length of stay, admission ward, coronary angiography result, HEART score, thrombolysis in myocardial infarction (TIMI) score, 1-month primary ACS endpoints and major adverse cardiac events (MACE) were evaluated. Results: In our studied population (200 cases), 49 patients (24.5%) had at least one score for MACE. Comparing the prognostic values of TIMI vs HEART score in MACE revealed that the HEART had a larger AUC. The best cut-off point of HEART score in MACE prediction was calculated to be ≥5. There was a statistically significant relation between HEART score and hospital length of stay. The higher the HEART score, the more probability of patients being admitted to either hospital cardiac ward or coronary care unit (CCU). There was a significant relationship between the triage level and HEART score. Patients with higher HEART score had more acuity (lower triage level 1 or 2). Conclusion: HEART predicted MACE better than TIMI in low risk ACS. Patients with higher HEART score were more admitted to the hospital with longer hospital stay and patients with lower HEART score had higher triage level with less acuity.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69815544","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}
V. Bhatia, Suzanne Koshi, Varun Bansal, U. Debi, Lokesh Singh, M. Sandhu
Objective: Contrast-enhanced computed tomography (CECT) is the investigation of choice in trauma patients. The purpose of this study was to retrospectively evaluate the pattern, severity and association of abdominal injuries based on imaging at a high-volume tertiary trauma care centre. Methods: Retrospective evaluation of the CT records of patients over a period of 5 years was done at our institute. A total of 1519 patients who had undergone contrast-enhanced abdominal CT at a 64-slice Multidetector CT for abdominal trauma were included in this study. Inclusion criteria were: 1) History of blunt abdominal trauma, 2) Patients who had undergone a biphasic CECT abdomen scan. Exclusion criteria were: 1) Patients with penetrating injury, 2) Patients with incomplete data set/records. Results: Liver was the most common injured organ in both adult (38.8%) and paediatric population (40.9%). Significant higher incidence of mesenteric injury, bladder injury, spinal and rib fractures were seen in adult patients. Significant association of anorectal injuries (P=0.003) and bladder/urethral injuries with pelvic fractures was also seen (P<0.001). Conclusion: Our study provided important insights about the pattern, severity and association between the various abdominal injuries based on imaging findings in a large patient population. Larger studies with incorporation of clinical outcome in such patients can help in formulating appropriate management strategies.
{"title":"Pattern of injuries in blunt trauma abdomen: A retrospective evaluation of imaging findings at a high-volume tertiary care trauma centre","authors":"V. Bhatia, Suzanne Koshi, Varun Bansal, U. Debi, Lokesh Singh, M. Sandhu","doi":"10.34172/jept.2021.18","DOIUrl":"https://doi.org/10.34172/jept.2021.18","url":null,"abstract":"Objective: Contrast-enhanced computed tomography (CECT) is the investigation of choice in trauma patients. The purpose of this study was to retrospectively evaluate the pattern, severity and association of abdominal injuries based on imaging at a high-volume tertiary trauma care centre. Methods: Retrospective evaluation of the CT records of patients over a period of 5 years was done at our institute. A total of 1519 patients who had undergone contrast-enhanced abdominal CT at a 64-slice Multidetector CT for abdominal trauma were included in this study. Inclusion criteria were: 1) History of blunt abdominal trauma, 2) Patients who had undergone a biphasic CECT abdomen scan. Exclusion criteria were: 1) Patients with penetrating injury, 2) Patients with incomplete data set/records. Results: Liver was the most common injured organ in both adult (38.8%) and paediatric population (40.9%). Significant higher incidence of mesenteric injury, bladder injury, spinal and rib fractures were seen in adult patients. Significant association of anorectal injuries (P=0.003) and bladder/urethral injuries with pelvic fractures was also seen (P<0.001). Conclusion: Our study provided important insights about the pattern, severity and association between the various abdominal injuries based on imaging findings in a large patient population. Larger studies with incorporation of clinical outcome in such patients can help in formulating appropriate management strategies.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46225701","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}
S. Zaeri, Z. Aghaei, N. Mashayekhi, A. Salemi, R. Seyedian
Objective: Snake envenomation is common in tropical and subtropical countries of the Middle East areas including Iran. Cerastes cerastes gasperettii is a dangerous snake living in southwestern provinces of Iran. It causes massive edema at the bite site and coagulopathy leading to death if untreated. Methods: The purpose of this preliminary animal study was to evaluate the toxicity and proteomic of this venom for the first time in Iran. Moreover, the hemodynamic changes with intravenous injection of the venom were assessed and inotropic in addition to arrhythmogenic properties of this venom were investigated. Results: The estimated amount of the LD50 with intraperitoneal injection was slightly less than the similar experiment in Saudi Arabia (1.32 mg/kg versus 978 µg/kg body weight). There were 8 distinct protein bands between 12 and 66 kDa in SDS-PAGE analysis that were different with Moroccan experiment due to inter and intra species variation. Inotropic potencies were not significant since the lethal dose with intravenous injection was much lower than the Arabian experiment in guinea pigs (2.4 mg/kg versus 0.8 mg/kg). Conclusion: According to the low hemodynamic changes induced with the venom, it seems that coagulopathy and edema are the most dangerous effects of this rare snake in Iran.
目的:蛇中毒在包括伊朗在内的中东地区的热带和亚热带国家很常见。cerecastgasperettii是一种生活在伊朗西南部省份的危险蛇。如果不治疗，它会在咬伤部位引起大面积水肿和凝血功能障碍，导致死亡。方法:首次在伊朗对该毒液的毒性和蛋白质组学进行初步的动物研究。此外，我们还评估了静脉注射该毒液后血液动力学的变化，并研究了该毒液的肌力和致心律失常特性。结果:腹腔注射LD50的估计量略低于沙特阿拉伯的类似实验(1.32 mg/kg vs 978µg/kg体重)。由于种内和种间的差异，SDS-PAGE分析结果显示在12 ~ 66 kDa之间有8条不同的蛋白带，与摩洛哥实验结果不同。由于静脉注射的致死剂量远低于阿拉伯实验中的豚鼠(2.4 mg/kg对0.8 mg/kg)，因此肌力的效力并不显著。结论:根据该毒液引起的低血流动力学变化，凝血功能障碍和水肿似乎是该伊朗稀有蛇最危险的影响。
{"title":"Pharmacoligical characterization of the iranian Cerastes cerastes gasperettii (Reptilia: Ophidia: Viperidae) venom","authors":"S. Zaeri, Z. Aghaei, N. Mashayekhi, A. Salemi, R. Seyedian","doi":"10.34172/JEPT.2021.22","DOIUrl":"https://doi.org/10.34172/JEPT.2021.22","url":null,"abstract":"Objective: Snake envenomation is common in tropical and subtropical countries of the Middle East areas including Iran. Cerastes cerastes gasperettii is a dangerous snake living in southwestern provinces of Iran. It causes massive edema at the bite site and coagulopathy leading to death if untreated. Methods: The purpose of this preliminary animal study was to evaluate the toxicity and proteomic of this venom for the first time in Iran. Moreover, the hemodynamic changes with intravenous injection of the venom were assessed and inotropic in addition to arrhythmogenic properties of this venom were investigated. Results: The estimated amount of the LD50 with intraperitoneal injection was slightly less than the similar experiment in Saudi Arabia (1.32 mg/kg versus 978 µg/kg body weight). There were 8 distinct protein bands between 12 and 66 kDa in SDS-PAGE analysis that were different with Moroccan experiment due to inter and intra species variation. Inotropic potencies were not significant since the lethal dose with intravenous injection was much lower than the Arabian experiment in guinea pigs (2.4 mg/kg versus 0.8 mg/kg). Conclusion: According to the low hemodynamic changes induced with the venom, it seems that coagulopathy and edema are the most dangerous effects of this rare snake in Iran.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48451577","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}
Medication errors (MEs) are considered the most common medical errors and as one of the major challenges threatening the health system, which can be also reduced. MEs threaten patients' safety and may increase the length of hospital stay, lead to unexpected complications, mortality and side costs. In 2017, the World Health Organization launched Medication without Harm to reduce severe avoidable medication-related damage by 50%, globally in the next 5 years. Emergency Departments (EDs) are stressful care environments which making EDs more prone to MEs. Therefore, EDs need to be seriously considered to reduce MEs and increase patients' safety. In this regard, it is of great significance to know about the most common stage of error in pharmacotherapy, the most common type of medication error and the most common causes of MEs in the emergency department practice setting. in conclusion, the most common types of MEs in EDs include drug omission error, wrong dose and strong infusion rate. In addition, the administration and prescribing are the most common stages of MEs in EDs. Also, the most common causes of MEs in EDs in Iran include nursing shortage (fatigue) and poor medication knowledge .
{"title":"The challenge of medication errors in the emergency department setting","authors":"Mojtaba Miladinia, Elham Mousavi Nouri","doi":"10.34172/JEPT.2021.19","DOIUrl":"https://doi.org/10.34172/JEPT.2021.19","url":null,"abstract":"Medication errors (MEs) are considered the most common medical errors and as one of the major challenges threatening the health system, which can be also reduced. MEs threaten patients' safety and may increase the length of hospital stay, lead to unexpected complications, mortality and side costs. In 2017, the World Health Organization launched Medication without Harm to reduce severe avoidable medication-related damage by 50%, globally in the next 5 years. Emergency Departments (EDs) are stressful care environments which making EDs more prone to MEs. Therefore, EDs need to be seriously considered to reduce MEs and increase patients' safety. In this regard, it is of great significance to know about the most common stage of error in pharmacotherapy, the most common type of medication error and the most common causes of MEs in the emergency department practice setting. in conclusion, the most common types of MEs in EDs include drug omission error, wrong dose and strong infusion rate. In addition, the administration and prescribing are the most common stages of MEs in EDs. Also, the most common causes of MEs in EDs in Iran include nursing shortage (fatigue) and poor medication knowledge .","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46885374","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}
Interleukin-6 is pro-inflammatory cytokine which plays a role in cytokine storm and brought into notice with corona virus disease of 2019. Lymphopenia and dysregulated immune response were seen in the critically ill patients of corona virus disease of 2019. IL-6 inhibitors were proposed as a treatment option in this pandemic with a concept that it will reduce inflammation, infection and organ failure. Tocilizumab, a monoclonal antibody against soluble and membrane IL‐6 receptors was considered as forefront treatment option as it was used previously in rheumatologic disorder as a licensed agent. Tocilizumab is an immunosuppressive agent and serious or fatal infections could occur. Presence of superimposed bacterial infections in critically ill patients with corona virus disease of 2019 should be aggressively treated. However clinical experiences showed higher rates of superimposed bacterial infections which renders for extreme caution while prescribing such therapies. Perspective is needed when using the rheumatologic literature of IL-6 into corona virus disease of 2019 and their range observed in these conditions.
{"title":"Interleukin-6 blockade and cytokine release syndrome in coronavirus disease of 2019: Is that a lot? Thoughts from the emergency department","authors":"S. Sheikh","doi":"10.34172/jept.2021.21","DOIUrl":"https://doi.org/10.34172/jept.2021.21","url":null,"abstract":"Interleukin-6 is pro-inflammatory cytokine which plays a role in cytokine storm and brought into notice with corona virus disease of 2019. Lymphopenia and dysregulated immune response were seen in the critically ill patients of corona virus disease of 2019. IL-6 inhibitors were proposed as a treatment option in this pandemic with a concept that it will reduce inflammation, infection and organ failure. Tocilizumab, a monoclonal antibody against soluble and membrane IL‐6 receptors was considered as forefront treatment option as it was used previously in rheumatologic disorder as a licensed agent. Tocilizumab is an immunosuppressive agent and serious or fatal infections could occur. Presence of superimposed bacterial infections in critically ill patients with corona virus disease of 2019 should be aggressively treated. However clinical experiences showed higher rates of superimposed bacterial infections which renders for extreme caution while prescribing such therapies. Perspective is needed when using the rheumatologic literature of IL-6 into corona virus disease of 2019 and their range observed in these conditions.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45764554","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}
Objective: The purpose of the current study is to determine the prevalence and pattern of maxillofacial trauma. Methods: This is a cross sectional study of maxillofacial trauma cases treated in the referral trauma center of south of Iran. Data of 264 patients were extracted from patients’ records and analyzed. Data included patient’s demographics, injury mechanism, types of maxillofacial injuries, Injury Severity Score (ISS), associated injuries, length of hospital stay and outcome. Binary logistic regression by backward method was applied to determine the effects of independent variables on mortality odds ratio. Results: 85.23% of patients were males and of all patients 87.5% survived. The mean of age was 34.95 ± 16.51. The commonest cause of maxillofacial injury was road traffic accidents (86.31%). The median of ISS was 20.39± 10.24 and patients aged 30-39 years had the highest ISS. Overall, the most common maxillofacial injuries were orbital (59.47%, n=157) followed by maxillary (48.11%, n=127); common associated injuries were related to head (81.44%, n=215) followed by thorax (58.33%, n=154). Age and gender (being male) increased the odds ratio of mortality. An increase in ISS decreased the odds ratio of mortality, but it was not significant. Conclusion: Most of maxillofacial trauma patients suffered from orbital injuries and there were a huge percentage of associated injuries. Gender (male), age and length of hospital stay were the significant variables of mortality in maxillofacial patients. The findings of the current study sheds light on further investigation to treat these patients and enforce road traffic legislation and public education to prevent these traumas.
{"title":"An overview of the prevalence and pattern of maxillofacial trauma in the south of Iran","authors":"Mahnaz Yadollahi, Sarina Sahmeddini","doi":"10.34172/JEPT.2021.13","DOIUrl":"https://doi.org/10.34172/JEPT.2021.13","url":null,"abstract":"Objective: The purpose of the current study is to determine the prevalence and pattern of maxillofacial trauma. Methods: This is a cross sectional study of maxillofacial trauma cases treated in the referral trauma center of south of Iran. Data of 264 patients were extracted from patients’ records and analyzed. Data included patient’s demographics, injury mechanism, types of maxillofacial injuries, Injury Severity Score (ISS), associated injuries, length of hospital stay and outcome. Binary logistic regression by backward method was applied to determine the effects of independent variables on mortality odds ratio. Results: 85.23% of patients were males and of all patients 87.5% survived. The mean of age was 34.95 ± 16.51. The commonest cause of maxillofacial injury was road traffic accidents (86.31%). The median of ISS was 20.39± 10.24 and patients aged 30-39 years had the highest ISS. Overall, the most common maxillofacial injuries were orbital (59.47%, n=157) followed by maxillary (48.11%, n=127); common associated injuries were related to head (81.44%, n=215) followed by thorax (58.33%, n=154). Age and gender (being male) increased the odds ratio of mortality. An increase in ISS decreased the odds ratio of mortality, but it was not significant. Conclusion: Most of maxillofacial trauma patients suffered from orbital injuries and there were a huge percentage of associated injuries. Gender (male), age and length of hospital stay were the significant variables of mortality in maxillofacial patients. The findings of the current study sheds light on further investigation to treat these patients and enforce road traffic legislation and public education to prevent these traumas.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45036431","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}
Objective: During the late 2019, a group of patients had unexplained chest infections in Wuhan which turned out to be the new pandemic coronavirus disease 2019 (COVID-19). New neurological symptoms have been reported in COVID-19 patients. Posterior reversible encephalopathy syndrome (PRES) is a new neurological finding and is associated or caused by COVID-19. Case Presentation: A 32-year-old lady, with no medical background had COVID-19 infection and needed mechanical ventilation. After surviving the intensive care, she started to have multiple seizures that required general anesthesia to be aborted. The patient turned out to have PRES. Conclusion: PRES is a neurological syndrome causing seizures, headaches, and blurred vision. It is usually associated with high blood pressure, renal failure, and other risk factors. The patient in this case had nearly normal blood pressure, but still had a diagnosis of PRES. The new reported neurological symptoms associated with COVID-19 infection need further research and attention from the academic society to predict and prevent the morbidity and mortality of COVID-19 patients.
{"title":"Posterior reversible encephalopathy syndrome due to COVID-19","authors":"M. Al-Kaisy","doi":"10.34172/jept.2021.11","DOIUrl":"https://doi.org/10.34172/jept.2021.11","url":null,"abstract":"Objective: During the late 2019, a group of patients had unexplained chest infections in Wuhan which turned out to be the new pandemic coronavirus disease 2019 (COVID-19). New neurological symptoms have been reported in COVID-19 patients. Posterior reversible encephalopathy syndrome (PRES) is a new neurological finding and is associated or caused by COVID-19. Case Presentation: A 32-year-old lady, with no medical background had COVID-19 infection and needed mechanical ventilation. After surviving the intensive care, she started to have multiple seizures that required general anesthesia to be aborted. The patient turned out to have PRES. Conclusion: PRES is a neurological syndrome causing seizures, headaches, and blurred vision. It is usually associated with high blood pressure, renal failure, and other risk factors. The patient in this case had nearly normal blood pressure, but still had a diagnosis of PRES. The new reported neurological symptoms associated with COVID-19 infection need further research and attention from the academic society to predict and prevent the morbidity and mortality of COVID-19 patients.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":"4 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41263590","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}
Objective: Recently, emergency and essential surgical and anesthesia care at district hospitals is increasingly gaining recognition as a critical, though neglected element of health care system in Africa and other developing nations. Emergency laparotomy is a versatile procedure that can cure a great deal of acute abdominal conditions. The aim of this study was to document the indications and outcomes of laparotomy for emergency abdominal surgical conditions in our district hospitals. Methods: This retrospective study was undertaken in district hospitals from January 2009 to December 2018. Associations between different variables were measured and compared using statistical tests of significance. Results: Of the 879 patients evaluated, appendicitis (n=361, 41.1%) was the most frequent indication for emergency laparotomy followed by complicated external hernias (n=120, 13.7%). Other indications were adhesive intestinal obstruction (n=111, 12.6%), typhoid perforation (n=98, 11.1%), perforated peptic ulcer (n=89, 10.1%), trauma (n=58, 6.6%), colorectal cancer (CRC) (n=18, 2.0%) and others (n=24, 2.8%). The vast majority of patients (n=726, 82.6%) were presented after 24 hours of the onset of disease. Approximately, one-third of patients (n=278, 31.6%) had comorbidities, 867 (98.6%) had high ASA scores (III and IV) and 105 (11.9%) received intestinal resection with or without stoma. The main independent predictors of mortality were late presentation (P=0.003), generalized peritonitis (P=0.001), bowel resection (P=0.000) and high ASA (III and IV) scores (P=.000). Overall, the mortality rate was 10.6%. The commonest complication was wound infection (39.7%), followed by intra-abdominal collection (10.0%). Conclusion: The most common indication for emergency laparotomy was appendicitis followed by complicated hernias. The major independent predictors of mortality included bowel resection, high ASA score, late presentation and generalized peritonitis.
{"title":"Emergency laparotomy at district hospitals in a developing nation: a review of indications and outcomes of treatment","authors":"A. Ogbuanya, N. Ugwu","doi":"10.34172/JEPT.2021.06","DOIUrl":"https://doi.org/10.34172/JEPT.2021.06","url":null,"abstract":"Objective: Recently, emergency and essential surgical and anesthesia care at district hospitals is increasingly gaining recognition as a critical, though neglected element of health care system in Africa and other developing nations. Emergency laparotomy is a versatile procedure that can cure a great deal of acute abdominal conditions. The aim of this study was to document the indications and outcomes of laparotomy for emergency abdominal surgical conditions in our district hospitals. Methods: This retrospective study was undertaken in district hospitals from January 2009 to December 2018. Associations between different variables were measured and compared using statistical tests of significance. Results: Of the 879 patients evaluated, appendicitis (n=361, 41.1%) was the most frequent indication for emergency laparotomy followed by complicated external hernias (n=120, 13.7%). Other indications were adhesive intestinal obstruction (n=111, 12.6%), typhoid perforation (n=98, 11.1%), perforated peptic ulcer (n=89, 10.1%), trauma (n=58, 6.6%), colorectal cancer (CRC) (n=18, 2.0%) and others (n=24, 2.8%). The vast majority of patients (n=726, 82.6%) were presented after 24 hours of the onset of disease. Approximately, one-third of patients (n=278, 31.6%) had comorbidities, 867 (98.6%) had high ASA scores (III and IV) and 105 (11.9%) received intestinal resection with or without stoma. The main independent predictors of mortality were late presentation (P=0.003), generalized peritonitis (P=0.001), bowel resection (P=0.000) and high ASA (III and IV) scores (P=.000). Overall, the mortality rate was 10.6%. The commonest complication was wound infection (39.7%), followed by intra-abdominal collection (10.0%). Conclusion: The most common indication for emergency laparotomy was appendicitis followed by complicated hernias. The major independent predictors of mortality included bowel resection, high ASA score, late presentation and generalized peritonitis.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42884867","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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