Assessment of patients with thoracic trauma in emergency department

Objective: Thoracic trauma is a common cause of significant morbidity and mortality. The present study presents a series of thoracic trauma and evaluation of epidemiologic features, distribution of pathologies, diagnosis, additional systemic injuries, management and outcome

Materials and Methods: Between May 2016 and April 2017, all patients with thorax trauma admitted to the emergency service of King Abdulaziz hospital were retrospectively reviewed with respect to age, gender, etiological factors, distribution of pathologies, additional systemic injuries, diagnosis, treatment modalities, referral and outcome

Results: A total of 228 patients with thorax trauma were encompassed in the study. Of all the patients, [140] , 61.4% were male and 88 [38.6%] were female. The majority of the patients presented with blunt thoracic trauma [218 of 228 [95.6%]], whereas 10 [4.4%] presented with penetrating injuries. Etiological factors included falls in 158 [69.3%] patients, motor vehicle accidents in 52 [22.8%], animal related accidents in 8 [3.5%] and penetrating injuries in 10 [4.4%]. Among penetrating injuries, 6 [2.6%] were stabbing injuries and 4 [1.8%] were firearm injuries. The patients aged between 16 and 85 [mean 52.2 +/- 16.9] years. The vast majority [69.3%] of the patients aged between 31 and 70 years. Blunt thoracic traumas were observed most frequently in patients aged 51-70 years [36.8%], while penetrating traumas were observed most frequently in those aged 31-50 [32,5%] years

Conclusion: Even though majority of the patients with thorax trauma received treatment as outpatients; thoracic traumas can be a life threatening condition, and should be recognized and treated immediately. Mortality differs based on etiological factors, additional systemic pathologies, capabilities of the hospital especially diagnostic and treatment facilities in emergency services. We believe that a multidisciplinary method to the patients with severe thorax trauma, and the opportunities of emergency bedside thoracotomy in emergency services will significantly decrease the morbidity and mortality

Fixed zirconia partial denture

Background: Ceramics have anextended history in fixed prosthodontics of attaining optimal esthetics. Yttrium tetragonal zirconia polycrystal [Y-TZP]-based systems are a recent addition to the high-strength, all- ceramic systems used for crowns and fixed partial dentures, the highly esthetic nature of zirconia coupled with its superior physical properties and biocompatibility have resulted in restorative systems that meet optimal recent demands

Aim of the study: systematically review relevant contemporary literature regarding investigating the strength and accuracy of fit of zirconia fixed partial dentures [FPD]

Methods: A systematic review of the scientific literature from 2000 to 2017[PubMed, Embase and CENTRAL Cochrane Central Register of Controlled Trials, CINAHL, Google Scholar as well as individual Dentistry journals such as International Journal of Prosthodontics, International Journal of Periodontics and Restorative Dentistry. We followed PRISMA/STROBE guidelines. Medline s were retrieved using an algorithm comprising relevant MeSH terms

Results: The search yielded 11 studies enrolling 231 cases that met the inclusion criteria of the review. Absolute, Vertical and Horizontal margin gaps were recorded. Four of them were in- vivo studies while seven were in Vitro. The study outcome was focused on the assessment of the internal fit as well as the Marginal fit of zirconia FPDs versus the effect of various parameters of CAD / CAM and CAM systems, post-sintered and pre-sintered milling, framework configuration, veneer application and ageing. Average absolute marginal [AM] gap= 92 microns. For each system, the values were; Everest= 121, Lava= 71, Cercon = 93.5, Procera = 51, Xawex = 147, CerecInLab = 88.8

Conclusion: It was concluded that CAD/CAM have more accurate marginal and internal fit compared to CAM in fabricating zirconia frameworks. Moreover, post-sintered milling will most likely result in complex geometry and longer span FPDs. Nevertheless, the clinical implications of this difference have yet to be determined, and the pros and cons need to be taken into account first provided the hardship of post sintered milling. Veneering zirconia frameworks resulted in deterioration in fit, ageing of zirconia had no implications on the fit

Prehospital tracheal intubation versus emergency department intubation for trauma patients

Background: Patients with severe traumatic brain injury [TBI] are at high risk for airway obstruction and hypoxia at the accident scene, and routine prehospital endotracheal intubation has been widely advocated. Aim of the Study: to evaluate and compare the outcome and mortality rates of trauma patients undergoing Prehospital Tracheal Intubationversus those undergoing Emergency Department Intubation

Methods: A literature search was carried out on MEDLINE [including MEDLINE in-process], CINAHL, Embase and the Cochrane Library [from 1990 to October 2017]. Databases using "Prehospital Tracheal Intubation", "Emergency Department Intubation ", "Adults? trauma", and "mortality" as a MeSH heading and as text word. High yield journals were also had searched

Results: Eleven studies enrolling 17317 patients were included, out of which 4545 underwent PTI while 12772 underwent EDI. Median mortality rate in patients undergoing pre-hospital intubation was 52.12% [7.8-90.16%], compared to 27.98% [6.25-41.56%] in patients undergoing intubation in the emergency department. The overall quality of evidence was very low. Six of the eleven studies found a significantly higher mortality rate after pre-hospital intubation whilst five found no significant differences

Conclusion: Study outcome suggests that EDI was superior to PHI. Nevertheless, prehospital intubation was a marker for more severely ill patients who would have had higher mortality thus, the suggestion of the association between pre-hospital intubation and a higher mortality rate does not essentially oppose the importance of the intervention, but rather a need for further investigation of the possible causes for this finding

Predictors, complications and outcome of coronary artery bypass surgery patients attending the cardiac center of arar city, northern saudi arabia

Background: The increased incidence of cardiovascular disease between patients nowadays led to upsurge in the number of cardiac operations. After coronary artery bypass surgery, most patients remain free of symptoms for up to 15 years. The surgery also reduces the risk of heart attack and improves survival

Objective: to determine the predictors and outcome of coronary artery bypass surgery in patients attending the cardiac center in Arar, KSA all over the study period

Methods: The current study is a cross sectional study conducted during the period from September 2017 to March 2018. The current study included 72 individuals attending the cardiac center in Arar City. Collecting patients’ data was conducted through interviewing the patients included in the study and reviewing their medical files. A predesigned questionnaire was used for data collection

Results: We found that 81.9% of cases were males, 61.1% aged from 30 to 39 years old, 34.4% of cases have a myocardial infraction as a clinical diagnosis before the operation, 25% had angina pain, and 50.0% were smokers. Hyperlipidemia, chronic kidney disease, and chronic obstructive lung disease were found in 59.7%, 83.3% and 77.8% respectively. There were 41.6% who had postoperative arrhythmia, 13.9% had bacterial infection in the site of operation and another 13.9% had hypotension, 11.1% re-operated due to bleeding, and 6.9% got postoperative acute myocardial infarction. After 6 month of the operation, 69.4% of cases were quite good while recurrence of chest pain found in12.5%, heart failure in 2.8% and 8.3% died. There was significant association between outcome of cases after 6 months of operation and patients age [P<0.05] and all the dead cases were males

Conclusion: Our findings indicated that, among cardiac patients attending the cardiac center in Arar, KSA, the preoperative characteristics are suggestive of 30 to 39 years old males with myocardial infraction, angina pain, smokers, have hyperlipidemia, chronic kidney disease, and chronic obstructive lung disease is undergoing coronary artery bypass surgery. The death rate was low and 69.4% of cases were quite good

Seizures; a pediatrics emergency in maternity and children's hospital, Arar, Northern Saudi Arabia

Background: seizures are the most common neurologic emergency in pediatrics and can be terrifying for patients and families

Aim of the work: this study aimed to determine the etiologies and sex distribution of seizure in children admitted to Emergency Department of Maternity and Children's Hospital in Arar city, Northern Saudi Arabia, during the period from 1 January to 30 July 2017

Methods: this was a descriptive hospital-based study conducted in the Department of Pediatrics Emergency, Maternal and Child Hospital of Arar City during the period from 1 January to 30 July 2017. All the children below 12 years of age who were hospitalized at emergency department were enrolled in this study. The final diagnosis of seizure was made by a pediatric neurologist. The age, sex, type of seizure, associated fever, history of head trauma and other variables related to seizure in pediatric group were reviewed from the medical records

Results: a total of 158 children with diagnosis of seizures were included in this study. The proportion of male to female was about 2:1 as the percentage of males was 65.8% of patients. All patients up to 12 years were included with a mean age of 26.3 +/- 15.8 months. Less than quarter [16.5%] of the patients had focal seizures, while 83.5% had generalized seizures. Family history of seizures disorders were noted in only 15.2% patients. A previous history of seizure was mentioned in 19% patients. Febrile seizure was the most common etiology [72.2% of patients]. Epilepsy in 17.7% and vaccine-associated seizure in 5.1% of the patients. Hypoglycemia, intracranial hemorrhage, encephalitis and hyponatremia were reported 2[1.3%] for each of them

Conclusion and recommendations: as this is the first study conducted in Arar maternity and children's hospital to differentiate of the etiology of seizure in children attending the emergency department. Indeed, we suggested other researchers to follow the patients to show the repetitions of seizure and the prognosis in them especially those with dangerous etiologies as epilepsy, diabetes, encephalitis and intracranial hemorrhage. Fever coexistence, seizure type, physical and neurological examinations and history of head injury and measurement of serum blood sugar level may provide important information for primary emergency physicians when evaluating children with attack of seizures