Scapular fracture: lower severity and mortality / Fratura escapular: menor gravidade e mortalidade

CONTEXT AND OBJECTIVE: The presence of scapular fracture is believed to be associated with high rates of other injuries and accompanying morbidities. The aim was to study injury patterns and their overall outcomes in patients with scapula fractures. DESIGN AND SETTING: Cross-sectional study of trauma patients treated at six general hospitals in Tehran. METHODS: One-year trauma records were obtained from six general hospitals Among these, forty-one had sustained a scapular fracture and were included in this study. RESULTS: Scapular fracture occurred predominantly among 20 to 50-year-old patients (78 percent). Road traffic accidents (RTAs) were the main cause of injury (73.2 percent; 30/41). Pedestrians accounted for 46.7 percent (14/30) of the injuries due to RTAs. Falls were the next most common cause, accounting for seven cases (17.1 percent). Body fractures were the most common type of scapular fractures (80 percent). Eighteen patients (43.9 percent) had isolated scapular fractures. Limb fracture was the most common associated injury, detected in 18 cases (43.9 percent). Three patients (7.3 percent) had severe injuries (injury severity score, ISS > 16) which resulted in one death (2.4 percent). The majority of the patients were treated conservatively (87.8 percent). CONCLUSIONS: Patients with scapula fractures have more severe underlying chest injuries and clavicle fractures. However, this did not correlate with higher rates of injury severity score, intensive care unit admission or mortality.

CONTEXTO E OBJETIVO: Acredita-se que a presença de fraturas escapulares esteja associada a alta freqüência de outras lesões e morbidades relacionadas. O objetivo foi avaliar o padrão de lesões e os desfechos gerais em pacientes com fraturas escapulares. DESENHO E LOCAL: Trabalho transversal com pacientes apresentando trauma, tratados em seis hospitais gerais em Teerã. MÉTODOS: Registros de trauma foram obtidos em seis hospitais gerais no período de um ano. Entre estes pacientes, 41 sofreram fratura escapular e foram incluídos no estudo. RESULTADOS: A faixa etária predominante para fratura escapular foi 20-50 anos, sendo 78 por cento. Acidentes automobilísticos (AAs) foram a maior causa de lesão, em 73,2 por cento (30/41). Observou-se também que os acidentes com pedestres correspondiam a 46,7 por cento (14/30) das lesões devidas a AAs. Quedas foram a segunda causa mais freqüente, com sete casos (17,1 por cento). Fraturas do corpo estavam o tipo mais freqüente das fraturas escapulares (80 por cento). Dezoito pacientes (43,9 por cento) apresentaram apenas fratura escapular. Fraturas de extremidades foram as lesões mais comumente associadas, observadas em 18 (43,9 por cento). Três pacientes (7,3 por cento) tiveram lesões graves (escala de gravidade das lesões > 16), o que resultou em um caso (2,4 por cento) de óbito. A maioria dos pacientes foi tratada de forma conservadora (87,8 por cento). CONCLUSÕES: Pacientes com fraturas escapulares tiveram lesões torácicas e fraturas de clavícula basicamente mais graves. Porém, não houve correlação com maiores índices da escala de gravidade das lesões, admissão na unidade de terapia intensiva ou mortalidade.

What women think about their husbands' opinions might influence women's body image: An explorative study.

Background : Self-perception of weight status is an important factor in food consumption and weight-loss-related behaviors. Aims : To determine women's self-perception of weight status, married women's perception of their husbands' opinions regarding women's weight status, the relationship between socio-demographic factors and under-assessment of weight status in overweight/obese women. Settings and Design : In a cross-sectional study in the year 2003 in Islamshahr, 704 adult women aged 19 to 65 years were included. Materials and Methods : Women's self-perception of weight and married women's perception of husbands' opinions regarding women's weight status were compared with actual weight group categorized according to body mass index (BMI). Statistical Analysis Used : Results were expressed as frequency and percentage. Logistic regression was used to assess the independent effects of various socio-demographic factors on under-assessment of weight status in overweight and obese women. Data were analyzed using SPSS 11.5 for Windows (SPSS, Chicago, IL). Results : Overall, 48% (338) women misclassified their weight status relative to their actual weight. Married women's perception of husbands' opinion regarding women's weight status showed about 57% (266) misclassification. Multivariate regression analysis revealed place of residence and women's perception of husbands' opinion regarding women's weight status to be independently associated with under-assessment of weight status by overweight and obese women. Conclusions : Overweight and obese women's perception of their husbands' opinion regarding women's weight status has a significant effect on assessment of weight status by women. Women of Islamshahr should be taught to more accurately assess weight status and to initiate action to prevent or correct excessive weight.

Percutaneous nephrolithotomy with and without retrograde pyelography: a randomized clinical trial

OBJECTIVE: Since the introduction of percutaneous nephrolithotomy (PCNL), many changes have been added regarding the entrance to pyelocalyceal system such as insertion of the needle pointed to an opaque stone as a guided landmark. We aim at comparing the outcomes of managing renal calculi with and without retrograde pyelography. MATERIALS AND METHODS: In a randomized clinical trial, 55 cases with opaque renal calculi candidates for PCNL with stone in one calyce, in the pelvis or both in one calyce and the pelvis simultaneously were included in a nine-month study. They were randomized into 2 groups, noncatheterized (n = 28) and catheterized (n = 27), called intervention and control groups, respectively. RESULTS: The 2 groups had similar distributions regarding gender, age, duration of operation, length of hospital stay, past history of any surgical procedures on kidney, and stone size. Outcome (residual stone based on aforementioned management) was evaluated with plain X-ray on the morning following the operation. Postoperative hemoglobin decrease was significantly higher in controls than in the intervention group (p < 0.001) (with no clinical significance). No difference in outcome, postoperative fever, duration of surgery, duration of hospital stay and radiation exposure was observed between the 2 groups. CONCLUSION: Our findings showed no differences in major clinical outcomes between the 2 groups (with and without catheter insertion for retrograde pyelography).

Effect of allopurinol in chronic nonbacterial prostatitis: a double blind randomized clinical trial

INTRODUCTION: The exact mechanism of chronic nonbacterial prostatitis has not been yet elucidated and the outcome with the current management is dismal. In this trial, we studied the effect of allopurinol in the treatment of this disease. MATERIALS AND METHODS: In this randomized double blind controlled trial, a calculated sample size of 56 were grouped into "intervention group" who received allopurinol (100 mg tds for 3 months) with ofloxacin (200 mg tds) for 3 weeks (n = 29) and "control group" who received placebo tablets with ofloxacin (n = 27). PatientsÆ scores based on the National Institute of Health Chronic Prostatitis Symptom Score were recorded before therapy and then every month during the study. A four-glass study was performed before intervention and after 3 months. RESULTS: The 2 groups were similar regarding outcome variables. In the first month of study, a significant but similar improvement in symptom scores was observed in both groups. Microscopic examination of prostate massage and post-massage samples were also similar in both groups. No side effects due to allopurinol were observed in patients. CONCLUSION: We did not find any advantage for allopurinol in the management of chronic prostatitis versus placebo in patients receiving routine antibacterial treatment.

The full moon and admission to emergency rooms.

OBJECTIVE: The purpose of this study was to investigate an ancient hypothesis; the moon effect might increase incidence of injuries and hence admission of patients with trauma to Emergency Rooms (ERs) on full moon days. METHODS: During thirteen months, 58000 trauma patients admitted in three hospitals that had the highest load of trauma patients in Tehran were studied. Due to lack of complete data, 3543 patients (6.1%) were excluded from the study, leaving 54457 cases for further analysis. We selected lunar calendar for our study, so dates of patients' admissions were converted to lunar months and three day- periods with 15th as middle day were defined as full moon days. RESULTS: In our study the number of trauma patients was not increased during the full moon days against other days of lunar month. Statistical analyses of data didn't exhibit a positive relation between full moon days and increasing of trauma patient admission to ERs. An association between assault and attempted suicide was not observed around the full moon days either. The results did not show significant reduction of GCS score of patients on full moon days and there was not any increase in severity of traumatic injury sustained during full moon days. CONCLUSIONS: It seems necessary to conduct studies regarding the probability of moon effect through on different database, geographic areas and for appropriate periods in order to reach a conclusive result.

Epidemiology study of facial injuries during a 13 month of trauma registry in Tehran.

BACKGROUND: Many studies have recently noted a shift in the causative mechanism of facial injuries away from traffic accident to assaults. AIMS: Our study aimed to investigate patterns of facial injuries in trauma patients during 13 months study of trauma patients in six general hospitals in Tehran. MATERIAL AND METHODS: Trauma patients who were hospitalized for more than 24 hours and had sustained injuries within seven days from admission were included in the study. Of the 8000 trauma patients, four hundred (5%) sustained facial injuries. RESULTS: Male to female ratio was 4.5:1. Among them, 53.3% were aged 11-30 years. Traffic accidents were by the far the commonest cause of injury. Motorcyclists who wore a helmet sustained facial fractures less often during traffic accident than those patients who did not wear helmet. Soft tissue injury and facial bone fracture comprised 43.3% and 40.8% of facial injuries, respectively. The majority of Soft tissue injuries (79%) were located extra orally. The mandible and nasal bone were the most commonly fractured facial bones. Victims of assault sustained more severe injuries compared to those involved in falls and traffic accidents. CONCLUSIONS: Use of helmets by motorcyclists and the separation of pedestrians routes from motor vehicles could reduce the number of victims and consequently injuries due to road traffic accidents. For implementation of effective prevention programs for reduction of facial injuries due to assault, it seems to be necessary to conduct studies investigating causes and pattern of injuries resulting in assault.

Breast cancer in Iran: results of a multi-center study.

INTRODUCTION: Breast Cancer is the most common cancer in Iranian women. This study aims to demonstrate the characteristics of breast diseases- and especially breast cancer- according to pathologic records in Tehran, Iran. METHODS: In this cross-sectional study, all records of pathologic specimens (biopsy or mastectomy) categorized as "breast diseases" from 1996 to 2000 in five teaching hospitals in Tehran were studied. For each patient, sex, age, breast pathology, pathological staging of malignant lesions, side and location of the tumor and the type of surgery were reviewed by a trained general practitioner. SPSS version 10 was used for statistical analysis. RESULTS: The mean age of women with breast cancer was 48.8. The highest frequency of malignancies was observed in the 40-49 age group (31.8%). Twenty-three percent of breast cancers were observed in women younger than 40 years. About 83 percent of malignant lesions in women were in T2, T3 or T4 at diagnosis. Only about 4 percent of women with breast cancers had tumors in stage I or in-situ carcinomas. Nearly 70 percent of the cancers were detected only after lymph node involvement. Only 4.3 percent of our female cases had the chance of conservative mastectomy. Twenty-eight percent of specimens from biopsies in women were malignant. DISCUSSION AND CONCLUSION: In Iran, breast cancer affects women at least one decade younger than their counterparts in developed countries. A considerable proportion of our cases (96%) were in stage II or III at diagnosis. These results show advanced cases at presentation in Iran which further mandate a national cancer detection program involving more effective public education and encouragement of women for breast self-examination and participation in screening campaigns.