ABSTRACT
Objective: To evaluate the lethal area 50 [LA50] and determinants of mortality in burn patients admitted to a single burn center
Methods: This retrospective cross-sectional study was conducted in a tertiary burn center affiliated with Shiraz University of Medical Sciences, Shiraz, Iran, during a 1 year period from 2015 to 2016. To determine prognostic factors in fatal burns, medical records of eligible burn patients were reviewed for demographic and clinical variables, as well as patient outcome. Also, LA50 was calculated using Probit analysis
Results: Overall 559 patients with the mean age of 27.2 +/- 23.65 years and including 343 [61.4%] males and 216 [38.6%] females were enrolled in this study. The average burn TBSA% was 31.38 +/- 24.41% [1-100%]. Duration of hospital stay ranged from 1 to 67 days [15.11 +/- 10.64]. With 93 expired patients, the mortality rate was calculated to be 16.6%. The total LA50 was 66.55% [58.4-79.3]. Fire was the most common cause of burn injury
Conclusion: Compared to developed countries, in our burn center the LA50 and survival rate of burn patients are lower. This indicates an urgent need for prompt attention in order to improve current policies regarding this public health issue to reduce mortality
ABSTRACT
Objective: To determine the effects of pregnancy on the presentation, management, surgical and obstetrics outcome of patients with acute appendicitis
Methods: This prospective cohort study was conducted during a 2-year period from 2014 to 2016 in Shahid Faghihi hospital of Shiraz University of Medical Sciences. We enrolled all the pregnant individuals with acute appendicitis who required surgical appendectomy. We also enrolled age-matched controls of non-pregnant women undergoing open appendectomy during the study period. The presentation, clinical and laboratory characteristics, surgical and obstetrics outcomes were determined in both study groups and were further compared between them. In order to determine the determinants of outcome, we also ran a multivariate logistic regression model
Results: Overall we included a total number of 584 patients with presumed appendicitis among whom there were 58 [9.94%] and 526 [90.06%] non-pregnant individuals. The pregnant patients had significantly longer duration of symptoms [p=0.038], lower temperature [p=0.026], longer duration of hospital stay [p=0.026] and higher rate of hospital admission longer than 2 days [p=0.031]. The complications of the surgical procedure were comparable between the two study groups except for the pneumonia which was significantly higher in pregnant patient [p=0.041]. After adjusting for confounders such as age and ethnicity, pregnancy remained significantly associated with lower temperature [p=0.018], longer symptom duration [p=0.042] and higher rate of pneumonia [p=0.049]
Conclusion: Acute appendicitis during the pregnancy was associated with longer duration of symptoms, lower body temperature and higher rate of pneumonia. The pregnancy and neonatal outcomes were comparable to the previously reported data
ABSTRACT
Objective: To determine the antimicrobial activity and entity of several local herbal plants against Acintobacters isolated from trauma patients admitted to a Level-I trauma center
Methods: The antibacterial activities of the Satureja bachtiarica oil and some selected Iranian medicinal plants [Artemisia sieberi and Tanacetum dumosum belonging to the Asteraceae/Compositae; Salvia mirzayanii and Mentha mozaffarianii belonging to the Lamiaceae/Labiatae] were assayed on A. baumannii by microdilution and agar disc diffusion methods. Having obtained the acceptable antibacterial data, the shade-dried aerial parts of the plants were extracted by hydrodistillation method using Clevenger apparatus according to European pharmacopeia for 3 h. The analysis of S. bachtiarica essential oil accompanied by other herbal drug oils were performed by using GC/FID and GC/MS methods
Results: Outcomes revealed that the S. bachtiarica essential oil exhibited the potent antibacterial capability against Acinetobacter strains in comparison with Colistin, as a positive control. For S. bachtiarica, the growth inhibition zone and minimum inhibitory concentration [MIC] values were 21 mm and 0.5 mg/ml, while, for Colistin, the data were in order: 8 mm and 0.016 mg/ml. Consequently, GC/MS outcomes demonstrated that the major components of the essence were carvacrol [48.6%], followed by p-Cymene [16.6%], ã-terpinene [6.9%] and linalool [5.3%]
Conclusion: Based on the considerable inhibitory activity against nosocomial infections by essential oil of S. bachtiarica, it could be considered as the suitable candidate in the food industry and pharmaceutical uses
ABSTRACT
Objective: To determine the effects of platelet rich plasma PRP on healing rates of long bone non-union fracture
Method: This was a randomized double-blind placebo controlled clinical trial being performed in a 12-month period. We included 75 adult [>18 years] patients suffering from long bone [Femur, Tibia, Humerus and Ulna] non-union fracture who were randomly assigned to receive 5mL PRP [n=37] or 5mL normal saline as placebo [n=38] in the site of fracture after intramedullary nailing or open reduction and internal fixation [ORIF] along with autologous bone graft. Patients were followed each 45 days till 9 months and were evaluated both clinically and radiologically in each visit. The healing rate, failure rate, incidence of infection, mal-union and limb shortening were recorded and compared between groups after 9 months of follow-up
Results: The healing rate was significantly higher in PRP group compared to placebo [81.1% vs. 55.3%; p=0.025]. The limb shortening was significantly higher in those who received placebo [2.61 +/- 1.5 vs. 1.88 +/- 1.2mm; p=0.030]. Injection of PRP was also associated with lower pain scores [ p=0.003] and shorter healing duration [ p=0.046]. The surgical site infection [ p=0.262] and mal-union rate [ p=0.736] were comparable between groups
Conclusion: Application of PRP along with autologous bone graft in the site of non-union of long bone after intramedullary nailing or ORIF results in higher cure rate, shorter healing duration, lower limb shortening and less postoperative pain. Higher infection rate might be a complication of PRP application
Clinical Trial Registry: This trial is registered with the Iranian Clinical Trials Registry [IRCT201208262445N1; www.irct.ir]
ABSTRACT
Objective: To compare the outcome of patients with up to 60% total body surface area [TBSA] thermal burns undergoing ultra-early and early excision and grafting
Methods: This historical cohort study was performed in two referral burn centers of Shiraz during a 1-year period from 2015 to 2016. We included those patients with thermal burns up to 60% TBSA who underwent ultraearly [48-72 hours] and early [7-10 days] excision and grafting. We excluded those who were hemodynamically unstable and those with electrical burns. The outcome of patients was determined by graft success, operation duration, blood loss, hospital length of stay and mortality rate
Results: We included a total number of 107 patients with mean age of 32.1+/-11.6 years. There were 65 [60.7%] men and 42 [39.3%]women among the patients. Both study groups were comparable regarding the baseline characteristics. Ultra-early excision and grafting was associated with more, higher graft success rate [p=0.048], lower infection rate [p=0.037], shorter hospital length of stay [p=0.044] and lower mortality rate [p=0.027]
Conclusion: Ultra-early excision and grafting in patients with thermal burns covering less than 60% TBSA was associated with higher graft success rate, shorter hospital length of stay, lower infection rate and lower mortality rate when compared to early surgery
ABSTRACT
<p><b>OBJECTIVE</b>To identify the main characteristics of victims of motorcycle accidents in Fars Province, Iran.</p><p><b>METHODS</b>This cross-sectional study was conducted in Fars Province which has the fourth largest population of all 31 provinces in Iran from March 2009 to June 2010. We included data from all 542 recorded cases of fatalities due to motor vehicle accidents. Data were recorded from the forensic medicine registry consisting of demographic and accident-related information. Demographic information consisted of name, age, sex, status of fatal victim (motorcycle driver vs passenger) and educational level.</p><p><b>RESULTS</b>Of the 2 345 autopsy records from the forensic medicine archives, 542 (23.1%) gave the cause of death as motor vehicle accidents. Mean age of these victims was (31.4+/-6.5) years, and the male to female ratio was 28. Head injury was the most common cause of death in these victims, and overall they tended to have a low level of education. Motorcycle accidents frequently involved younger age groups (15-35 years), and head trauma related with non-use of a helmet was the most common cause of death.</p><p><b>CONCLUSIONS</b>Head injury is frequent among victims in the province we studied. This situation may be related to the victims' low socioeconomic status and little education regarding traffic laws leading to speeding and disregard of these laws along with their weak enforcement.</p>
Subject(s)
Humans , Accidents, Traffic , Cross-Sectional Studies , Iran , Epidemiology , Motorcycles , Surveys and QuestionnairesABSTRACT
To evaluate the efficacy of preoperative intravenous or peritonsillar infiltration of ketamine for postoperative pain control in children following adenotonsillectomy. Patients and 78 children between 5 and 18 years of age who were scheduled for elective adenotonsillectomy were randomly assigned to four groups: group 1 [n=19] received intravenous ketamine [0.5 mg/kg], group 2 [n=21] intravenous normal saline, group 3 [n=19] ketamine [0.5 mg/kg] injected through the tonsillar capsule, and group 4 [n=19] normal saline injected in the same location. The incidence of postoperative pain and vomiting as well as the severity of postoperative pain were compared between study groups during the 6-hour postoperative period using a visual analog scale [VAS] at rest, upon swallowing saliva, drinking liquids and eating ice cream. There were no demographic differences between the four groups. The incidence of postoperative pain was significantly lower in groups 1 [7 [36.8%] vs. 10 [47.6%]; p=0.032] and 3 [5 [31.5%] vs. 12 [63.2%]; p=0.001] compared with their controls. The amount [in milligrams] of pethidine and metoclopramide used for pain and nausea control was significantly lower in groups 1 [12.5 +/- 5.3 vs. 19.6 +/- 9.6 mg, p=0.038, and 2.9 +/- 1.1 vs. 4.6 +/- 2.6 mg, p=0.042, respectively] and 3 [8.6 +/- 3.1 vs. 21.6 +/- 8.4 mg, p<0.001, and 1.6 +/- 0.9 vs. 5.3 +/- 3.2 mg, p=0.002, respectively] compared with their controls. These values were also higher in group 1 compared with group 3. The VAS scores on swallowing saliva [3.9 +/- 2.7 vs. 2.7 +/- 1.2; p=0.018], on drinking liquids [3.7 +/- 2.6 vs. 2.8 +/- 1.6; p=0.013] and on eating ice-cream [4.3 +/- 2.4 vs. 2.8 +/- 1.5; p=0.001] were also significantly higher in group 1 compared with group 3. Conclusions: Our results show that peritonsillar infiltration of ketamine was more effective in reducing the postoperative pain severity, need for analgesics and need for antiemetics. Thus, peritonsillar infiltration of ketamine is suggested for postoperative pain control in those undergoing adenotonsillectomy