The Effects of Air Pollution on Ischemic Stroke Admission Rate / 전남의대학술지

The present study aimed to determine the relationship between the level of air pollutants and the rate of ischemic stroke (IS) admissions to hospitals. In this retrospective cross-sectional study, stroke admissions (January-March 2012 and 2013) to an emergency department and air pollution and meteorological data were gathered. The relationship between air pollutant levels and hospital admission rates were evaluated using the generalize additive model. In all 379 patients with IS were referred to the hospital (52.5% male; mean age 68.2+/-13.3 years). Both transient (p<0.001) and long-term (p<0.001) rises in CO level increases the risk of IS. Increased weekly (p<0.001) and monthly (p<0.001) average O3 levels amplifies this risk, while a transient increase in NO2 (p<0.001) and SO2 (p<0.001) levels has the same effect. Long-term changes in PM(10) (p<0.001) and PM(2.5) (p<0.001) also increase the risk of IS. The findings showed that the level of air pollutants directly correlates with the number of stroke admissions to the emergency department.

The Effects of Air Pollution on Ischemic Stroke Admission Rate / 전남의대학술지

The present study aimed to determine the relationship between the level of air pollutants and the rate of ischemic stroke (IS) admissions to hospitals. In this retrospective cross-sectional study, stroke admissions (January-March 2012 and 2013) to an emergency department and air pollution and meteorological data were gathered. The relationship between air pollutant levels and hospital admission rates were evaluated using the generalize additive model. In all 379 patients with IS were referred to the hospital (52.5% male; mean age 68.2+/-13.3 years). Both transient (p<0.001) and long-term (p<0.001) rises in CO level increases the risk of IS. Increased weekly (p<0.001) and monthly (p<0.001) average O3 levels amplifies this risk, while a transient increase in NO2 (p<0.001) and SO2 (p<0.001) levels has the same effect. Long-term changes in PM(10) (p<0.001) and PM(2.5) (p<0.001) also increase the risk of IS. The findings showed that the level of air pollutants directly correlates with the number of stroke admissions to the emergency department.

Analgesic effects of inhalation of nitric oxide [Entonox] and parenteral morphine sulfate in patients with renal colic; a randomized clinical trial

Objective: To compare the analgesiceffects of Nitrous oxide and morphine sulfate in patients with acute renal colic due to urolithiasis

Methods: This was randomized clinical trial being performed in Imam Hossein hospital affiliated with Shahid Beheshti University of Medical Sciences during a 1-year period from May2013 to May2014. A total of number of 100 patients, with an age range of 20-50 years, who presented with renal colic secondary to urolithiasis confirmed by ultrasonography were randomly assigned to receive morphine sulfate injection [0.1 mg/kg] with 100 mg diclofenac suppository [n=50] or Entonox exhalation [50% nitric oxide and 50% oxygen]for 30-minutes with 100 mg diclofenac suppository [n=50]. Quantitative measurement was of pain was performed according to a visual analogue scale [VAS], before, 3, 5, 10 and 30-minute after the intervention. The pain severity and side effects were measured between two study groups

Results: The baseline characteristics of the patients in two study groups were comparable. The frequencies of pain persistence [at least 50%] at 3-, 5-, 10- and 30-minute intervals in morphine sulfategroup were 96%, 80%, 50% and 8%, respectively; these frequencies in Entonex were 82%, 42%, 12% and 2%, respectively [p<0.001]. Cox regression modeling showed that use of Entonox was the only effective agent in the success of treatment, compared to the use of morphine, i.e. use of Entonox increased the success of treatment up to 2.1 folds compared to the use of morphine [HR=2.1; 95% CI: 1.2-3.6; p=0.006]

Conclusion: The results of the present study demonstrate that inhalation of Entonox is an effective and safe analgesic regimen for acute renal colic. It acts more rapidly and is more potent in relieving renal colic when compared to morphine sulfate.Entonox can be regarded as an appropriate alternative to analgesics like opioids in this ground

A diagnostic challenge of an unusual presentation of pneumomediastinum / 中华创伤杂志(英文版)

A 77-year-old man who had underwent orthopedic surgery 17 days ago due to his left femur fracture caused by a pedestrian-car accident came to our emergency department with the chief complaint of a 2 days history of sore throat and cough and also swelling of eyelids. He had no respiratory distress or any other life-threatening symptoms. Subsequent physical examination revealed remarkable edema and crepitus over the whole face, neck, proximal upper limbs and the anterior and posterior chest regions, and also bilateral hyperresonance was detected in pulmonary auscultation. The imaging studies showed pneumomediastinum and bilateral subcutaneous emphysema. The diagnosis of pneumomediastinum and mild left pneumothorax and massive subcutaneous emphysema was definitely made. He underwent bilateral tube thoracostomy by using a 32 French chest tube under local anesthesia in the fifth intercostal space on the anterior axillary line. The patient was discharged with no complications 10 days postoperatively.

Axillary nerve block in comparison with intravenous midazolam/fentanyl for painless reduction of upper extremity fractures

The painful nature of fractures has made it inevitable to use various anesthetic techniques to reduce or immobilize fractured parts. In the present study, axillary nerve block was compared with intravenous midazolam/fentanyl to induce anesthesia for Painless Reduction of Upper Extremity Fractures. The subjects in the present clinical trial consisted of 60 patients with upper extremity fractures. They were randomly divided into two equal groups of intravenous sedation [IVS] with midazolam/fentanyl and axillary nerve block [ANB]. Rate of anesthesia induction, recovery time, and pain intensities at baseline, during the procedure and at the end of the procedure were recorded in both groups. Data was analyzed and compared between the two groups with SPSS 18 statistical software using appropriate tests. Demographic data, vital signs and means of pain intensities at the beginning of the procedure were equal in the two groups. In the IVS group, the overall duration of the procedure was shorter with more rapid onset of anesthesia [P<0.05]. In contrast, the recovery time was much shorter in the ANB group [P<0.001]. No life or organ threatening complications were observed in the two groups. Axillary nerve block can be considered an appropriate substitute for intravenous sedation in painful procedures of the upper extremity

[ national program and Eliza test on tetanus profelaxy in Imam Hussein hospital, Tehran, Iran: a comparative study]

Injuries and realed wounds are one of the most common causes of admission in emergency departments. In this study the national protocol for tetanus prevention is compared with Eliza as the golden standard for detecting immunity of person. In a cross sectional study 200 individuals with wound admitted at Imam Hussein hospital [a teaching hospital in Tehran, Iran] were assessed and questionnaires were filled in based on physician decision as protocol recommended and also the result of Eliza. Agreement of physician decision and Eliza result has been evaluated by Kappa index. Sensitivity, specificity, predictive values, likelihood ratios and accuracy were also detected for different methods of vaccine and immunoglobulin administration. Immunoglobulin was administered for 30 percent of persons and vaccine for 23.5 percent. Kappa index for agreement between protocol administration and real administration in emergency department was 0.307 for immunoglobulin and 0.136 for vaccine [p<0.05]. It was 0.081 [P>0.05] and 0.199 [P<0.001] for agreement of protocol administration and Eliza and 0.008 and 0.054 [P>0.05] for agreement of administration in emergency depertment and Eliza respectively. For immunoglobuline sensitivity was 0.33, specificity 0.24, positive predictive value 0.25, negative predictive value 0.82, positive likelihood ratio 1.38, negative likelihood ratio 0.88 and accuracy 0.68. For vaccine sensitivity was 0.82, specificity 0.52, positive predictive value 0.29, negative predictive value 0.92, positive likelihood ratio 2.2, negative likelihood ratio 0.35 and accuracy 0.58. The sensitivity, specificity, predictive value, likelihood ratio and accuracy for national protocol are not enough for using in emergency department. It seems that there is need for another reliable and valid substitute method

[Association of provisional driver licensing intervention by police with changes in incidence and severity of road traffic injuries in Iran]

This study was conducted for external evaluation of one intervention that has been carried out by traffic police. In this study the efficacy of provisional driver licensing on reducing traffic injuries and the intensity of injuries [fatal or non-fatal] was investigated. Data on traffic accidents and injuries from one year before till two years after the implementation of provisional driver licensing were obtained from traffic police data base. After data cleaning and stratification traffic injuries and mortalities, the implementation of graduate driver licensing compared in those in early years of their driving experience. Drivers under 23 years of age consisted 22.8% of total road traffic injuries [RTIs] in the year prior to the implementation of graduate driver licensing. This proportion reduced to 15.5% and 16.1% in the first and second year after implementation, respectively, among holders of provisional B1 type driver license [P<0.001]. Our findings suggested that this intervention was efficient in reduction of intensity of traffic injuries and provisional driver licensing was also efficient in reducing the crude number of traffic injuries. More interventions such as demerit points, license suspensions and vehicle confiscation might be implemented to prevent RTIs in long term