ABSTRACT
PURPOSE@#To identify risk factors for developing pressure ulcers (PUs) in the acute care period of traumatic spinal fracture patients with or without spinal cord injuries (SCIs).@*METHODS@#Data were collected prospectively in participating the National Spinal column/Cord Injury Registry of Iran (NSCIR-IR) from individuals with traumatic spinal fractures with or without SCIs, inclusive of the hospital stay from admission to discharge. Trained nursing staff examined the patients for the presence of PUs every 8 h during their hospital stay. The presence and grade of PUs were assessed according to the European Pressure Ulcer Advisory Panel classification. In addition to PU, following data were also extracted from the NSCIR-IR datasets during the period of 2015 - 2021: age, sex, Glasgow coma scale score at admission, having SCIs, marital status, surgery for a spinal fracture, American Spinal Injury Association impairment scale (AIS), urinary incontinence, level of education, admitted center, length of stay in the intensive care unit (ICU), hypertension, respiratory diseases, consumption of cigarettes, diabetes mellitus and length of stay in the hospital. Logistic regression models were used to estimate the unadjusted and adjusted odds ratio (OR) with 95% confidence intervals (CI).@*RESULTS@#Altogether 2785 participants with traumatic spinal fractures were included. Among them, 87 (3.1%) developed PU during their hospital stay and 392 (14.1%) had SCIs. In the SCI population, 63 (16.1%) developed PU during hospital stay. Univariate logistic regression for the whole sample showed that marital status, having SCIs, urinary incontinence, level of education, treating center, number of days in the ICU, age, and Glasgow coma scale score were significant predictors for PUs. However, further analysis by multiple logistic regression only revealed the significant risk factors to be the treating center, marital status, having SCIs, and the number of days in the ICU. For the subgroup of individuals with SCIs, marital status, AIS, urinary incontinence, level of education, the treating center, the number of days in the ICU and the number of days in the hospital were significant predictors for PUs by univariate analysis. After adjustment in the multivariate model, the treating center, marital status (singles vs. marrieds, OR = 3.06, 95% CI: 1.55 - 6.03, p = 0.001), and number of days in the ICU (OR = 1.06, 95% CI: 1.04 - 1.09, p < 0.001) maintained significance.@*CONCLUSIONS@#These data confirm that individuals with traumatic spinal fractures and SCIs, especially single young patients who suffer from urinary incontinence, grades A-D by AIS, prolonged ICU stay, and more extended hospitalization are at increased risk for PUs; as a result strategies to minimize PU development need further refinement.
Subject(s)
Humans , Spinal Fractures/etiology , Pressure Ulcer/complications , Iran/epidemiology , Spinal Cord Injuries/epidemiology , Risk Factors , Spine , Registries , Urinary Incontinence/complications , Suppuration/complicationsABSTRACT
PURPOSE@#Injuries are one of the leading causes of death and lead to a high social and financial burden. Injury patterns can vary significantly among different age groups and body regions. This study aimed to evaluate the relationship between mechanism of injury, patient comorbidities and severity of injuries.@*METHODS@#The study included trauma patients from July 2016 to June 2018, who were admitted to Sina Hospital, Tehran, Iran. The inclusion criteria were all injured patients who had at least one of the following: hospital length of stay more than 24 h, death in hospital, and transfer from the intensive care unit of another hospital. Data collection was performed using the National Trauma Registry of Iran minimum dataset.@*RESULTS@#The most common injury mechanism was road traffic injuries (49.0%), followed by falls (25.5%). The mean age of those who fell was significantly higher in comparison with other mechanisms (p < 0.001). Severe extremity injuries occurred more often in the fall group than in the vehicle collision group (69.0% vs. 43.5%, p < 0.001). Moreover, cases of severe multiple trauma were higher amongst vehicle collisions than injuries caused by falls (27.8% vs. 12.9%, p = 0.003).@*CONCLUSION@#Comparing falls with motor vehicle collisions, patients who fell were older and sustained more extremity injuries. Patients injured by motor vehicle collision were more likely to have sustained multiple trauma than those presenting with falls. Recognition of the relationship between mechanisms and consequences of injuries may lead to more effective interventions.
ABSTRACT
PURPOSE@#The median time from the event leading to the spinal cord injury (SCI) to the time of decompressive surgery is estimated to be 6.9 days in Iran, which is much longer than the proposed ideal time (less than 24 h) in published guidelines. The current qualitative study aimed to determine the reasons for the observed decompression surgery delay in Iran from the perspective of neurosurgeons.@*METHODS@#This qualitative study is designed to perform content analysis on the gathered data from face-to-face semi-structured interviews with 12 Iranian neurosurgeons.@*RESULTS@#The findings of the current study suggest that patient-related factors constitute more than half of the codes extracted from the interviews. Overall, the type of injury, presence of polytrauma, and surgeons' wrong attitude are the main factors causing delayed spinal cord decompression in Iranian patients from the perspective of neurosurgeons. Other notable factors include delay in transferring patients to the trauma center, delay in availability of necessary equipment, and scarce medical personnel.@*CONCLUSION@#In the perspective of neurosurgeons, the type of injury, presence of polytrauma, and surgeons' wrong attitude are the leading reasons for delayed decompressive surgery of individuals with SCI in Iran.
Subject(s)
Humans , Decompression , Iran , Neurosurgeons , Spinal Cord Injuries/surgeryABSTRACT
The National Spinal Cord Injury Registry of Iran (NSCIR-IR) is a not-for-profit, hospital-based, and prospective observational registry that appraises the quality of care, long-term outcomes and the personal and psychological burden of traumatic spinal cord injury in Iran. Benchmarking validity in every registry includes rigorous attention to data quality. Data quality assurance is essential for any registry to make sure that correct patients are being enrolled and that the data being collected are valid. We reviewed strengths and weaknesses of the NSCIR-IR while considering the methodological guidelines and recommendations for efficient and rational governance of patient registries. In summary, the steering committee, funded and maintained by the Ministry of Health and Medical Education of Iran, the international collaborations, continued staff training, suitable data quality, and the ethical approval are considered to be the strengths of the registry, while limited human and financial resources, poor interoperability with other health systems, and time-consuming processes are among its main weaknesses.
ABSTRACT
The study was undertaken to answer the question that how many patients with pigmentation of back and arms actually have amyloid deposits in pathology. 44 patients presenting with diffuse pigmentation of back and arms [DPOBA] were selected. Skin biopsies were performed in all cases from the affected sites. On all formalin fixed and paraffin embedded specimens, the following histochemical stains were performed: Haematoxylin and eosin [H and E], Congo red and immunohistochemical staining using anti-cytokeratin monoclonal antibody. In 9 of 44 cases [20%], amyloid deposits were found. In the remaining 35 cases [80%], H and E, Congo red and immunohistochemical staining failed to show any amyloid deposition. We were unable to find amyloid deposition in most of the patients presented with DPOBA. It seems that the signs may be attributable other disorders with similar clinical but different pathophysiologic aspects
ABSTRACT
The aim of this study was to estimate the frequency of preterm birth [PTB] and premature rapture of membranes [PROM] and their associations with maternal factors. This cross sectional study was carried out at Akbar-Abadi hospital in Tehran during January 2009-Aprile 2010. Four hundred sixty six primiparous women with gestational age more than 20 weeks and singleton pregnancy were enrolled in the study. Data were analyzed using SPSS-16. P<0.05 was considered as being significant. maternal age, maternal height, maternal education, pre-pregnancy maternal weight, occupation and smoking during pregnancy were compared between two groups [with or without PTB/PROM]. This study shows the incidence of PTB to be 27.9% and PROM to be 34.7%. None of maternal factors in this study showed significant relation with PTB. Significant relation was found between maternal age and PROM, p<0.001. PROM was related to PTB significantly [p=0.040]. Findings highlighted the importance of maternal age as a cause of adverse pregnancy outcomes. Since this study showed PROM and PTB to be two common adverse pregnancy outcomes in Iran assembling appropriate services can lead mothers to improved pregnancy outcomes especially among older pregnant women
ABSTRACT
Chronic graft versus host disease [ch.GVHD] is the most frequent late complication after allogenic stem-cell transplantation. Systemic immunosuppressive agents are usually required to control the disease. Psoralen plus UVA [PUVA] has been used for the treatment of ch.GVHD with variable beneficial effects. The objective of this study was to assess the efficacy and safety of a relatively lower dose of oral psoralen compared with previous reports, for the treatment of ch.GVHD patients with PUVA. Eleven patients who received allogenic bone marrow transplantation and had severe progressive ch.GVHD that was unresponsive to conventional immunosuppressive treatments were treated with oral 8-methoxypsoralen [0.2 mg/kg, up to 10 mg] two hours before exposure to UVA. The patients received a median of 43 treatments [range: 18 to 72]. Mean cumulative dose of UVA was 200.5 J/cm2 [range, 116.5-306.5 J/cm2]. In four of the 11 patients, there was a complete resolution of cutaneous ch.GVHD and the remaining seven patients achieved partial response with PUVA treatment. Complete and partial remission was observed in four and six patients with lichenoid lesions, respectively, but all of the four patients with sclerodermoid GVHD showed partial response to PUVA treatment. We observed no side effects like phototoxicity, nausea and vomiting, and exacerbation of GVHD. Liver enzymes raised in five patients, causing no significant morbidity for them. Low-dose psoralen plus UVA can be a safe and effective therapy for chronic cutaneous GVHD. Although the number of treatments and total cumulative exposure to UVA was rather high in our study, we observed no phototoxic reaction or severe irreversible liver damage due to phototherapy, which may be because of a relatively lower dose of methoxsalen used in our patients. Psoralen plus UVA is effective particularly in lichenoid GVHD lesions but sclerodermoid lesions may also benefit from this therapy
Subject(s)
Humans , Adolescent , Adult , Male , Female , Child , PUVA Therapy , Treatment Outcome , Bone Marrow Transplantation/adverse effectsABSTRACT
Geographic tongue is an inflammatory disorder of unknown etiology that affects the epithelium of the tongue. It has been associated with several cutaneous diseases. To determine the prevalence of geographic tongue and its association with other cutaneous diseases in patients referred to the dermatology clinic of Razi Hospital .A cross-sectional study was performed on all patients referred to one of the dermatology clinics of Razi Hospital between February 21 and March 18, 1996 to determine the prevalence of geographic tongue and other diseases. One-thousand and one-hundred and sixty referred patients were studied. The prevalence of geographic tongue was 6.2%. There was a statistically significant association between geographic tongue and seborrheic dermatitis [P=0.0053]. Geographic tongue is associated with some cutaneous diseases. Detection of these associations could be a clue to the etiology and pathogenesis of geographic tongue
Subject(s)
Humans , Glossitis, Benign Migratory/diagnosis , Glossitis, Benign Migratory/etiology , Skin Diseases , Dermatitis, Seborrheic , Tongue, Fissured , Psoriasis , Dermatitis, Atopic , PityriasisABSTRACT
Chronic graft versus host disease [GVHD] remains the most common late complication of allogenic stem cell transplantation and the most frequent cause of morbidity and mortality in these patients. To control this condition, immunosuppresive drugs are usually administered at a high dose and for a long time, which may result in several side effects. Five patients with clinically and histopathologically established cGVHD [3 lichenoid, 1 sclerodermoid and 1 mixed lichenoid-sclerodermoid], who failed to respond to conventional immunosuppressive therapy were treated with psoralen and UVA [PUVA].Treatment was administered in a standard protocol three times a week on nonconsecutive days and were continued at least for 12 weeks. All 3 lichenoid cases showed complete improvement. In the sclerodermoid case there was partial response and in the mixed type case the partial response of sclerodermoid lesion and complete response of lichenoid lesions were observed. With the exception of a slight increase in liver tranferases, no other adverse reactions occurred. In conclusion, PUVA can be a safe and effective therapy in conjunction with systemic agents for chronic GVHD especially in lichenoid form