predictive value of repeated abdominal ultrasonography in patients with multiple trauma and decreased level of consciousness: the experience of a resource-limited centre

Objective: To determine the predictive value of repeated abdominal ultrasonography in patients with multiple trauma and decreased level of consciousness [LOC]

Methods: This prospective cross-sectional study was conducted over a six-month period at Shahid Rajaee Trauma Hospital, Shiraz, Iran. We included hemodynamically stable blunt abdominal trauma patients with a decreased LOC [Glasgow Coma Scale

Results: Overall 80 patients with mean age of 37.75 +/- 18.67 years were included. There were 17 [21.3%] women and 63 [78.8%] men among the patients. Compared with the CT-Scan, the first ultrasonography showed a sensitivity of 60%, specificity of 80%, PPV of 16.60%, NPV of 96.80%, and a diagnostic accuracy of 70%. The same values for the second ultrasonographic study were 80%, 79%, 20%, 98%, and 79%, respectively. In 4 [5%] patients whose first ultrasonography and CT scan results were negative, the second ultrasonography was positive for injury

Conclusion: In patients with blunt trauma to the abdomen, when the only indication of abdominal CT scan is a decreased LOC, two ultrasonographic studies can replace a CT imaging

Comparison of the impact of applications of Targeted Transfusion Protocol and Massive Transfusion Protocol in trauma patients / 대한마취과학회지

BACKGROUND: The current study assessed a recently developed resuscitation protocol for bleeding trauma patients called the Targeted Transfusion Protocol (TTP) and compared its results with those of the standard Massive Transfusion Protocol (MTP). METHODS: Per capita utilization of blood products such as packed red blood cells (RBCs), fresh frozen plasma (FFP), and platelet concentrates was compared along with mortality rates during two 6-month periods, one in 2011 (when the standard MTP was followed) and another in 2014 (when the TTP was used). In the TTP, patients were categorized into three groups based on the presence of head injuries, long bone fractures, or penetrating injuries involving the trunk, extremities, or neck who were resuscitated according to separate algorithms. All cases had experienced motor vehicle accidents and had injury severity scores over 16. RESULTS: No statistically significant differences were observed between the study groups at hospital admission. Per capita utilization of RBC (4.76 ± 0.92 vs. 3.37 ± 0.55; P = 0.037), FFP (3.71 ± 1.00 vs. 2.40 ± 0.52; P = 0.025), and platelet concentrate (1.18 ± 0.30 vs. 0.55 ± 0.18; P = 0.006) blood products were significantly lower in the TTP epoch. Mortality rates were similar between the two study periods (P = 0.74). CONCLUSIONS: Introduction of the TTP reduced the requirements for RBCs, FFP, and platelet concentrates in severely injured trauma patients.

Haly Abbas' [? 930-994 AD] pulsology

Abu l-Hasan Ali ibn al-'Abbas al-Majusi Ahvazi [? 930-994 AD], best known as Haly Abbas in the West, was a 10th century Persian physician whose lifetime coincided with the flourishing of medical science in the Near East, the Islamic Medicine Golden Age, an era extending from the 9th to the 12th centuries AD. Haly Abbas, in his extant book Kamil al-Sina'ah al-Tibbiyah [The Perfect Book of the Art of Medicine], provided a detailed description of the pulse and its features. He practiced the evaluation of the pulse cycles to distinguish between the state of well-being and various diseases. These 10th century views on the pulse are explored in this text through a discussion of Haly Abbas' surviving book, the Kamil al-Sina'ah al-Tibbiyah [The Perfect Book of the Art of Medicine]

medieval origins of the concept of hypertension

Despite the well-known history of hypertension research in the modern era, like many other cardiovascular concepts, main points in the medieval concept of this disease and its early management methods remain obscure. This article attempts to make a brief review on the medieval origin of the concept of this disease from the Hidayat of Al-Akhawayni [?-983 AD]. This article has reviewed the chapter of "Fi al-Imtela" [About the Fullness] from the Hid?yat al-Muta'allimin fi al-Tibb [The Students' Handbook of Medicine] of Al-Akhawayni. The definition, symptoms and treatments presented for the Imtela are compared with the current knowledge on hypertension. Akhawayni believed that Imtela could result from the excessive amount of blood within the blood vessels. It can manifest with symptoms including the presence of a pulsus magnus, sleepiness, weakness, dyspnea, facial blushing, engorgement of the vessels, thick urine, vascular rupture, and hemorrhagic stroke. He also suggested some ways to manage al-Imtela'. These include recommendations of changes in lifestyle [staying away from anger and sexual intercourse] and dietary program for patients [avoiding the consumption of wine, meat, and pastries, reducing the volume of food in a meal, maintaining a low-energy diet and the dietary usage of spinach and vinegar]. Al-Akhawayni's description of "Imtela," despite of its numerous differences with current knowledge of hypertension, can be considered as medieval origin of the concept of hypertension

[Avicenna's views on bone fractures in canon of medicine]

The human knowledge on orthopedics traces back to dawn of the medical history. During the history of medicine, several scholars including Persian scientists investigated orthopedics and contributed to its flowering. Abu Ali al-Hussain ibn Abdullah ibn-Sina is a great Persian physician whose opinions on various aspects of medicine, including the science of orthopedics, are so remarkable. In this paper, we will review Avicenna's viewpoints and recommendations for diagnosis, care and treatment of different bones fractures which can be representative of the early knowledge on orthopedics in Persia

[Al-Akhawayni, an influencial contributor to medieval Persian science of neurology]

Al-Akhawayni Bukhari [?-983 AD], great 10th century Persian physician, in his extant book entitled Hidayat[Guide] discussed different aspects of some neurologic diseases that include prevention, clinical findings, treatment, and sometimes prognosis. Without doubt, Al-Akhawayni's knowledge on neurology, in addition to his familiarity to the works of his predecessors is obviously indebted to his experimental approach to medicine. These features resulted in providing a number of innovations. Another evidence is that, Al-Akhawayniwas known as insane's physician during his lifetime as a doctor. Therefore, it seems to be essential that this physician's only surviving book is evaluated with more emphasis, and Al-Akhawayni is being introduced to the modern world of science

[Women's medical rights in ancient Persia]

Nowadays and throughout the history, medical rights and ethics were among the most important subjects in relation with the field of medicine. Women's medical rights including issues about sickness, sex, abortion and so on are among main branches of medical ethics. It should be stated that this matter was not investigated sufficiently about ancient Persia [since the beginning of historical period to 638 AD] up to this time. Therefore women's medical rights were studied in this research using remained ancient Iranian and non-Iranian manuscripts and also recent works conducted on this topic. Finally, the results of our survey on women's medical rights were presented, as follows: 1- Women's situation in ancient Persian society and their beliefs about this. 2- Medical laws about pregnancy and pregnant women. 3- Sexual issues. 4- Women's sickness and their rights and laws related to this issue. Although, some laws were strict and unacceptable as good ones, ancient Persian society had notable laws about women and their rights compared with contemporaries