Helicopter emergency medical service in Fars province: the referral trauma center of South of Iran

Considering the limited available resources, high cost of the helicopter emergency medical service [HEMS], and high load of trauma patients especially in our centers, a careful assessment of HEMS in our center seemed to be necessary for trauma patients. From April 2001 to September 2007, the data of all patients transferred by HEMS were extracted including: Annual number of services, clinical category, number of proper or improper services, and rescue time for HEMS and ground ambulance. The criteria for the properly transferred group included: Death or being operated in the first 24 hours of admission, admission in ICU care units, and transfer of more than three patients in one mission. Others were considered as improper group. In this period through 185 flights, 225 victims were transferred. The most common reason of HEMS dispatching was trauma. The most difference of rescue time between ground ambulance and HEMS was recorded in Lamerd that was transferring patients with HEMS needed 3 hours less than ground ambulance. However, in Sarvestan, Dashte-Arjan, and Marvdasht, transferred patients with ground ambulance needed less time than air transfer. Most of transferred patients were from Kazeroon, Nourabad and Lamerd respec-tively while 46.3% of patients were in the proper group, and the rest were considered as improper group. Our study revealed that helicopter dispatch to the cities like Lamerd, Lar, Khonj, Abadeh can be more effective, whereas, for the towns like Marvdasht, Dashte-Arjan, Sarvestan, Sepidan, Saadatshar, Tang Abolhayat use of HEMS should be limited to specific conditions. Our study showed inclusion of physicians in the decision making team increased the number of transferred cases

[To evaluate the costs of prevention on incidence of cutaneous leishmaniasis due of earthquake in Bam]

Cutaneous leishmaniasis [CL] is an endemic disease in district of Bam. It has created considerable concerns by people and health authorities. The objective of this study was to assess the effect of the earthquake and costs of prevention on CL prevalence after earthquake This research is based on a natural intervention, in which the information related to the costs and prevalence of CL were collected and analyzed three years after the earthquake [2006-2008] and then compared with similar data three years before the earthquake [2000-2002] as control group. The earthquake increased the CL prevalence approximately 5.2 fold, although the cost of prevention had no significant effect on control of disease. The average cost of prevention was determined to be two US dollars per capita during the years after the earthquake. It figures up an overall estimation of 600000 US dollars for the three years after the earthquake. Meanwhile the cost of prevention before the earthquake was determined less than 5% comparing to after earthquake. The findings of this cost-analysis showed that the current and conventional methods of CL prevention seem not useful. It could be concluded that current preventive measures such as spraying and impregnated bed nets particularly in natural disasters would have no effect on control of disease. Further researches are needed to find out the best method of prevention of CL disease. At present, it seems that early case-finding and prompt treatment of cases would be a proper method to control anthropometric CL

[Causes and severity of fatal injuries in autopsies of victims of fatal traffic accidents]

In this retrospective study, we decided to determine the death causes and severity of injuries in traffic accidents according to reports of the forensic medical center of Yazd. A total of 251 fatalities due to traffic accidents that had undergone autopsy examinations at the Yazd forensic medicine center from 2006 till 2008 were included in the study by census method. Data regarding gender, road user type, type of vehicle [car, motorcycle, autobus or minibus], consciousness level, and intensive care unit [ICU] admission was gathered. For evaluation of injury severity, we used Injury Severity Score [ISS]. The population under study consisted of 202 men [80.5%] and 49 women [19.5%] with an average age of 34.1 years [range 1-89 years]. Motorcycle-pedestrian accidents were the most common type of injury [100, 39.8%]. Head [220, 87.6%] and face [169, 67.3%] were the two most common sites of injuries. Mean [ +/- SD] of ISS was 23.2 [ +/- 10.4]. According to autopsy records, the main cause of death was head trauma [146, 58.1%]. Public awareness in terms of primary prevention of road accidents should be considered important. Also, regarding the high prevalence of brain injuries and complications associated with skull fractures, accessibility to neurosurgeons and availability of imaging devices have an important role in decreasing the mortality rate of traffic accidents

Surgical emergency room workload charecteristics: single center experience during one year

Having information on characteristics of work load of emergency surgical room in 3 working-shifts per day help to manage facilities and health care providers more efficiently. The aim of this study is to evaluate the workload pattern of 3 working-shifts of a day in Nemazee Hospital, southern Iran. The patients who were admitted in the surgical Emergency Room from April 2007 to May 2008 were enrolled including the patients' demographics, referral sources, the busiest working-shifts and the type of procedures performed in the Emergency Room. 33,837 emergency surgery referrals were recorded, of which 74.7% were male and 25.3% were female with a mean age of 30.8 +/- 20.1 years. The busiest working-shift of the day was between 8.00 PM and 8.00 AM, when 48.4% patients were admitted. 12.1% were admitted in the Emergency Room while 4.8% patients were admitted in the hospital wards and 5.6% underwent emergency surgery. 32.4% of them were discharged while 39.7% left the hospital with their own responsibility and 4.7% patients escaped from the hospital. The total number of the deaths during the study period was 0.7%. Our results showed that patients were mainly male teenagers and most of the accidents happened by motorbike during the busiest working-shift of the day from 8 PM to 8 AM. Therefore, it would be useful to persuade health system administrators to set up some educational programs to increase the awareness of families and teenagers regarding trauma and also to allocate more resources to shorten waiting lists

effect of co-administration of aquous extract of bunium persicum and endurance training on plasma lipids in hypercholesterolemic male mice

The effect of endurance training on lipid profile and cardiovascular endurance in normal rat after Bunium Persicum Extract [BPE] administration has been previously investigated. In the present study, the effect of co-administration of endurance training and persicum extract on plasma lipid and lipoproteins in hypercholesterolemic male mice was examined. In this experimental study, 60 male mice were, randomly, divided into 4 groups: Vehicle, Endurance Training [ET], Bunium Persicum Extract Administer [BPEA] and ET-BPEA group. The Exercise protocol was performed at a speed of 18 m/min, 40 min/day, 5 day/week for 6-weeks. The Bunium Persicum Extract was also administered in the same period and the desired dose [0.8 mg] was reconstituted in 0.4 ml of distilled water. The amount of Triglyceride [TG], Total Cholesterol [TC], HDL-c, LDL-c and Body Weight were registered at the beginning and also at the end of the 6 weeks. Data were analysed using one-way ANOVA method. The results indicated that the 6-week endurance training accompanied by Bunium Persicum aquous extract administration reduced TC [pretest; 297.7 +/- 37.08, post test; 146.1 +/- 30.8, p=0.019] and LDL-c concentrations [pretest; 151.8 +/- 14.4, post test; 0.12 +/- 8.7, p=0.00l]. On the other hand, Bunium Persicum aquous extract administration increased HDL-c concentration significantly [pretest; 75.9 +/- 12.1, post test; 119.9 +/- 17.9, p=0.003]. Furthermore, the results showed that body weight changes were not significant. These results suggest that co-administration of BPE and ET could significantly affect plasma lipid and lipoproteins. Therfore performing such program maybe useful for preventing cardiovascular diseases

Cardiopulmonary arrest outcome in Nemazee hospital, southern Iran

Many factors are important determinants in the outcome of cardiopulmonary resuscitation [CPR] such as quality of CPR, age of patients, co morbidities, time and location of arrest, and skill of rescuers. This study was conducted to evaluate the efficacy of CPR in Shiraz, southern Iran. From October 2007 to March 2008, all patients who received in-hospital CPR in Nemazee Hospital affiliated to Shiraz University of Medical Sciences were enrolled. Two standard scales of ROSC [Return of Spontaneous Circulation] and DR [Discharge Rate] were used to evaluate the efficacy of CPR. Two hundred and seventy one patients [45.1%] had ROSC while 329 [54.9%] died immediately after resuscitation. Among ROSC patients, 18 [6.6%] cases were discharged from the hospital [3% of study population]. Although ROSC was comparable with developed countries, but the DR was lower. It shows that in our area, post-resuscitation care needs more attention in relation to organized trainings and the skills in post-resuscitation care together with expansion of the facilities

Percutaneous vertebroplasty

Percutaneous vertebroplasty is a promising therapeutic technique for pain control in patients with pathologic fractures of vertebral bodies. Percutaneous vertebroplasty is an appropriate treatment for vertebral pathologic fractures, which is resistant to other usual treatment. It is a useful and only choice in special cases, because of less tissue damage and there is no risk of open surgery and patient's embolization is rapid. Herein we described the first case of percutaneous vertebroplasty in Yazd shahid sadoughi teaching hospital, which was done in ordybehesht 1386 in a 72 years old male with pathologic fracture of 2 lumbar vertebrae. He was suffered from pain and disability and open surgery was not appropriate treatment for him

[ role of hypothalamus-pituitary-adrenal [HPA] axis on anti-inflammatory effects of the trifluoperazine in male rats]

Previous studies, have been shown the anti-inflammatory effects of the trifluoperazine. The present study was performed to investigate the role of hypothalamus-pituitary-adrenal [HPA] axis activity as a possible mechanism for these effects. This experimental study was carried out on 100 male rats. Inflammation was induced by intraplantar injection of 0.1 ml of 0.5% carrageenan solution in to the rat's left hind paw. Rats were divided randomly into three groups of control, the adrenalectomized [ADX] and the CRH antagonist receiving group. Adrenalectomy was performed bilaterally on the rats. The CRH antagonist at 20 micro g/rat was administered intraventriculary, and Trifluoperazine [0.2 and 8 mg/kg] was used intraperitoneally [i.p] on the rats. Four hours after injections, paw edema was assessed by calculating the volume changes and extravasations of Evans blue dye. Furthermore, the serum levels of prolactin and ACTH were measured. Both doses of trifluoperazine significantly reduced the paw volume and tissue content of Evans blue dye in the control and ADX rats. Therefore, the paw edema induced by carrageenan, was reduced in the control and ADX groups by 48% and 65%, and the tissue content of Evans blue dye was decreased by 60% and 20% respectively. In the CRH antagonist receiving rats, different doses of drug reduced the volume of inflamed paw by 50%. Adrenalectomy induced an increase in the ACTH level 9 times more than control and both doses of the trifluoperazine blocked this elevation by 82%. Adrenalectomy procedure had no significant influence on plasma level of prolactin. These results suggest that trifluoperazine may have an in-vivo anti-inflammatory effect on experimental model, which possibly is independent of HPA axis activity

Comparison between two methods of excision and primary closure of pilonidal sinus

Controversy still exists about the best surgical method for the treatment of pilonidal sinus. The aim of this study was to compare two methods of excision and primary closure. One hundred and seventy-three patients with pilonidal sinus, 119 [69%] men and 54 [31%] women, and a mean age of 23.3 +/- 7.5 yrs and divided into two Groups of A [electrocautery] and B [excision] for the removal of pilonidal sinus. Wound complications, hospital stay, times to heal, return to work, patient's comfort and recurrence rate were recorded for the two groups. The postoperative follow-up was 6 months. All patients were able to resume their normal lives and activities 7-9 days after the operation. Wound infection and recurrence rate were significantly [P<0.05] less prevalent in Group A [5% and 3.8%] than in Group B [1% and 0%]. There was no significant difference between two groups in regard to hospital stay, time to heal, time to return to work and patients' comfort after 6 months of follow-up. The use of electrocautery at the base of the wound is not recommended because it may obscure the exact extent of the pilonidal sinus and increase the rate of recurrences

[ relationship between the plasma level of cyclosporine-A and drug dose in patients of Kermanshah kidney transplantation center]

Nowadays the main problem in transplantation is the complexity of host immune system protection against the immunological and destructive reactions of the transplanted organ. High serum level of the immunosuppressive drug may cause toxicity and low serum level leads to the rejection of the transplanted organ. Cyclosporine has been known as the most effective immunosuppressive drug. Our goal in this study was to determine the relationship between cyclosporine serum level and administered dose in renal transplant recipients in order to find the optimum cyclosporine dose in Kermanshah kidney transplantation center. Methods: This descriptive-analytical study with simple sampling was done on 80 renal transplant recipients [51 males and 29 females] in Kermanshah transplantation center. At least 6 months after transplantation, in patients with stable conditions, cyclosporine peak and through levels were measured by specific monoclonal., Radio Immuno Assay [RIA] method over a period of 3 months. Other biochemical parameters were measured too. Data were analyzed by chi[2] and ANOVA tests. Mean cyclosporine Trough and Peak levels were 271.9 +/- 85.2 and 904.5 +/- 414.2 ng/ml respectively, for the treatment dose of 3.25 +/- 1.46 mg/kg B.W. There was no significant difference between trough and peak levels in all three administered doses and the range of administered dose was 1.79-4.71 mg/kg B.W. According to the findings, cyclosporine serum concentrations and the administered dose range differed from other studies. This may be due to pharmacologic and pharmacokinetic differences of the drug and individual physiological characteristics of patients. The minimum dose of 1.79 and maximum dose of 4.71 led to optimum treatment in stable patients and could prevent rejection or toxic effects. Cyclosporine peak level was obviously different from other studies; however it showed better relationship with clinical status. Conversion from the routine cyclosporine C[trough] monitoring to C[peak] monitoring is recommended in Kermanshah kidney transplantation center

[ relationship between the plasma level of cyclosporine-A and drug dose in patients of Kermanshah Kidney Transplantation Center]

Nowadays the main problem in transplantation is the complexity of host immune system protection against the immunological and destructive reactions of the transplanted organ. High serum level of the immunosuppressive drug may cause toxicity and low serum level leads to the rejection of the transplanted organ. Cyclosporine has been known as the most effective immunosuppressive drug. Our goal in this study was to determine the relationship between cyclosporine serum level and administered dose in renal transplant recipients in order to find the optimum cyclosporine dose in Kermanshah kidney transplantation center. This descriptive-analytical study with simple sampling was done on 80 renal transplant recipients [51 males and 29 females] in Kermanshah transplantation center. At least 6 months after transplantation, in patients with stable conditions, cyclosporine peak and trough levels were measured by specific monoclonal, Radio Immuno Assay [RIA] method over a period of 3 months. Other biochemical parameters were measured too. Data were analyzed by 2 and ANOVA tests. Mean cyclosporine Trough and Peak levels were 271.9 +/- 85.2 and 904.5 +/- 414.2 ng/ml respectively, for the treatment dose of 3.25 +/- 1.46 mg/kg B.W. There was no significant difference between trough and peak levels in all three administered doses and the range of administered dose was 1.79-4.71 mg/kg B.W. According to the findings, cyclosporine serum concentrations and the administered dose range differed from other studies. This may be due to pharmacologic and pharmacokinetic differences of the drug and individual physiological characteristics of patients. The minimum dose of 1.79 and maximum dose of 4.71 led to optimum treatment in stable patients and could prevent rejection or toxic effects. Cyclosporine peak level was obviously different from other studies; however it showed better relationship with clinical status. Conversion from the routine cyclosporine C[trough] monitoring to C[peak] monitoring is recommended in Kermanshah kidney transplantation center

clinicolaboratory scoring system for the management of acute appendicitis

Despite widespread imaging techniques which have significantly improved the management of acute appendicitis, cost-effective clinical decision-making concerning this condition is still a matter of debate. The aim of this study was to design a simple scoring system based on routine clinical and paraclinical data in patients suspected of having acute appendicitis. In this cross-sectional study, 402 consecutive patients, clinically suspected of having acute appendicitis and who were referred for general surgery consultation were evaluated. Nine common clinical and laboratory data including abdominal guarding, fever, shifting pain, leukocytosis, rebound tenderness, tenderness on rectal examination, vomiting, right lower quadrant tenderness and anorexia/nausea were recorded in each case and individually evaluated for sensitivity, specificity, positive predicted value and accuracy based on final outcome. A score of 3 was attributed to sign/symptoms with an accuracy of >/= 80%, 2 to sign/symptoms with an accuracy of 60-70%, and 1 to sign/symptoms with an accuracy of 50-70%. By selecting a cut-off point of more than 7 for operation and 6-7 for observation, the proposed scoring system decreased the negative appendectomy rate to 6.6% and observation rate to 3.5% as compared to 29% and 18% respectively, in conventional decision making. Applying this scoring system can improve clinical decision-making in acute appendicitis and effectively reduce negative appendectomy rates without increasing the rate of complications

Evaluation of the role of mannitol in radioprotection of amifostine

Mannitol is present in the Ethyol [R] [the trade name of amifostine] as an excipient. The mechanism of radioprotection of amifostine is radical scavenging. Since mannitol is another known radical scavenger, we studied the probable additive or synergistic effect of mannitol on the effect of amifostine. Material and Mice were irradiated with Co-60 Y -ray in the presence 400mg/kg mannitol alone or in combination with 400mg/kg amifostine. Survival of mice was assessed within 30 days after irradiation [LD 50/30]. Moreover, the protective effect of drugs was evaluated using micronuclei [MN] assay. Slides were prepared using femoral bone marrow flush and stained in May-Giemsa. The frequency of MN was determined in polychromatic erythrocytes [PCE] for each sample. Similar LD50/30 was observed for irradiated mice in the presence of amifostine alone or in combinations with mannitol. High frequency of MN was produced by 3 Gy Y -rays. Amifostine reduced radiation induced MN dramatically, but mannitol had no effect on