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

Diaphragmatic perforation without penetration into the peritoneum in sharp thoracoabdominal injury

In diaphragm injuries, especially those which are left sided, it is recommended to repair diaphragm perforation to prevent complications. However, we found two cases of diaphragm injuries including two 27 and 31 years old men who were injured with stab but they were not repaired at thoracoscopy. Both patients were haemodynically stable. Chest X-ray and CT-scan were not in favor of diaphragm perforation in both cases. The thoracoscopic finding was a 1.5 [case 1] and 1 cm teasing on the left diaphragm on the left muscular past of the diaphragm without penetrating into the abdominal cavity and with an intact peritoneum documented by probing. Due to intact peritoneum and absence of peritoneal signs, no further thoracotomy was performed. The patients were followed for 6 months with CXR and also physical examination. They did not develop any complication on the follow-up. In conclusion, in spite of diaphragm injuries, since peritoneum was intact in both cases, neither underwent thoracotomy which is invasive. They were asymptomatic during the 6 months of the follow up

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

Molecular detection of leishmania major in the vectors and reservoir hosts of cutaneous leishmaniasis in Kakaleh district, Golestan province, Iran

An epidemiological study was carried out on the vector[s] and reservoir[s] of cutaneous leishmaniasis in rural areas of Kalaleh District, Golestan Province during 2006 - 2007. Totally 4900 sand flies were collected using sticky papers and were subjected to molecular methods for detection of leishmanial parasite. Phlebotomus papatasi was the common species in outdoor and indoor resting places. Employing PCR technique showed only 1 out of 372 P. papatasi [0.3%] was positive to parasite due Leishmania major. Sixteen rodent reservoir hosts were captured by Sherman traps and identified as Rhombomys opimus. Microscopic investigation on blood smear of the animals for amastigote parasites revealed 6[37.5%] infected rodents. Infection of these animals to L. major was then confirmed by PCR against rDNA loci of the parasite. This is the first molecular report of parasite infection of both vector [P. papatas] and reservoir [R. opimus] to L. major. The results indicated that P. papatas was the primary vector of the disease and circulating the parasite between human and reservoirs, and R. opimus was the most important host reservoir for maintenance of the parasite source in the area

Cardiac sources of embolic cerebral infarction in transesophageal echocardiography

Previous reports have suggested that 6% to 39% of ischemic strokes are caused by cardiogenic emboli [1] Thrombus formation associated with atrial fibrillation has been reported as one of the most important cardiac sources of embolism[2] Using transesophageal echocardiography [TEE], other possible sources of embolism, including atrial septal aneurysm,[3] patent foramen ovale [PFO],[4] aortic atherosclerotic plaque,[5] annular calcification of the mitral valve,[6] mitral valve prolapse [MVP],[7] prosthetic cardiac valves and endocarditis,[8] mural thrombi,[9] cardiac tumors[10], and cardiac transplants[11] have been reported as risk factors for ischemic stroke. TEE is considered more sensitive than transthoracic echocardiography [TTE] in detecting cardiac abnormalities in patients with stroke and transient ischemic attacks [12] As there is no data available in Iran regarding TEE findings after embolic cerebrovascular accident [CVA], this study was undertaken to assess the prevalence of cardiac abnormalities by the TEE technique in patients with stroke