Comparison of chest CT scan findings between COVID-19 and pulmonary contusion in trauma patients based on RSNA criteria: Established novel criteria for trauma victims / 中华创伤杂志(英文版)

PROPOSE@#In this study, we re-assessed the criteria defined by the radiological society of North America (RSNA) to determine novel radiological findings helping the physicians differentiating COVID-19 from pulmonary contusion.@*METHODS@#All trauma patients with blunt chest wall trauma and subsequent pulmonary contusion, COVID-19-related signs and symptoms before the trauma were enrolled in this retrospective study from February to May 2020. Included patients (Group P) were then classified into two groups based on polymerase chain reaction tests (Group Pa for positive patients and Pb for negative ones). Moreover, 44 patients from the pre-pandemic period (Group PP) were enrolled. They were matched to Group P regarding age, sex, and trauma-related scores. Two radiologists blindly reviewed the CT images of all enrolled patients according to criteria defined by the RSNA criteria. The radiological findings were compared between Group P and Group PP; statistically significant ones were re-evaluated between Group Pa and Group Pb thereafter. Finally, the sensitivity and specificity of each significant findings were calculated. The Chi-square test was used to compare the radiological findings between Group P and Group PP.@*RESULTS@#In the Group PP, 73.7% of all ground-glass opacities (GGOs) and 80% of all multiple bilateral GGOs were detected (p < 0.001 and p = 0.25, respectively). Single bilateral GGOs were only seen among the Group PP. The Chi-square tests showed that the prevalence of diffused GGOs, multiple unilateral GGOs, multiple consolidations, and multiple bilateral consolidations were significantly higher in the Group P (p = 0.001, 0.01, 0.003, and 0.003, respectively). However, GGOs with irregular borders and single consolidations were more significant among the Group PP (p = 0.01 and 0.003, respectively). Of note, reticular distortions and subpleural spares were exclusively detected in the Group PP.@*CONCLUSION@#We concluded that the criteria set by RSNA for the diagnosis of COVID-19 are not appropriate in trauma patients. The clinical signs and symptoms are not always useful either. The presence of multiple unilateral GGOs, diffused GGOs, and multiple bilateral consolidations favor COVID-19 with 88%, 97.62%, and 77.7% diagnostic accuracy.

Should we change our approach to resuscitating victims of femoral fracture? A clinical experience in a busy trauma hospital in Shiraz, Iran / 中华创伤杂志(英文版)

PURPOSE@#Traumatic hemorrhagic shock is a life-threatening event worldwide. Severe brain trauma accompanying femoral fractures can trigger inflammatory responses in the body and increase pre-inflammatory cytokines such as TNF-α, IL-1. The primary treatment in these cases is hydration with crystalloids, which has both benefits and complications. The purpose of this study was to investigate the effects of fluid therapy on the hemodynamics, coagulation profiles, and blood gases in such patients.@*METHODS@#In this cross-sectional study, patients were divided into two groups: femoral fracture group and non-femoral group. The hemodynamic status, coagulation profile, and blood gases of patients in both groups were evaluated upon arrival at the hospital and again 2 h later. Data were analyzed by t-test and ANOVA with repeated data and paired samples t-test.@*RESULTS@#A total of 681 trauma patients (605 men and 76 women) participated in this study, including 69 (86.3%) men and 11 (13.8%) women in femoral fracture group and 536 men (89.2%) and 65 women (10.8%) in non-femoral group. The laboratory parameters were evaluated in response to the equal amount of crystalloid fluid given upon arrival and 2 h later. Blood gases decreased in the fracture group despite fluid therapy (p < 0.003), and the coagulation profile worsened although the change was not statistically significant.@*CONCLUSION@#The treatment of multiple-trauma patients with femoral bone fractures should be more concerned with the need for the infusion of vasopressors such as norepinephrine. If there is evidence of clinical shock, excessive crystalloid infusion (limited to 1 L) should be avoided, and blood and blood products should be started as soon as possible.

Antimicrobial survey of local herbal drugs against acinetobacter baumannii Isolated from patients admitted to a level-I trauma center

Objective: To determine the antimicrobial activity and entity of several local herbal plants against Acintobacters isolated from trauma patients admitted to a Level-I trauma center

Methods: The antibacterial activities of the Satureja bachtiarica oil and some selected Iranian medicinal plants [Artemisia sieberi and Tanacetum dumosum belonging to the Asteraceae/Compositae; Salvia mirzayanii and Mentha mozaffarianii belonging to the Lamiaceae/Labiatae] were assayed on A. baumannii by microdilution and agar disc diffusion methods. Having obtained the acceptable antibacterial data, the shade-dried aerial parts of the plants were extracted by hydrodistillation method using Clevenger apparatus according to European pharmacopeia for 3 h. The analysis of S. bachtiarica essential oil accompanied by other herbal drug oils were performed by using GC/FID and GC/MS methods

Results: Outcomes revealed that the S. bachtiarica essential oil exhibited the potent antibacterial capability against Acinetobacter strains in comparison with Colistin, as a positive control. For S. bachtiarica, the growth inhibition zone and minimum inhibitory concentration [MIC] values were 21 mm and 0.5 mg/ml, while, for Colistin, the data were in order: 8 mm and 0.016 mg/ml. Consequently, GC/MS outcomes demonstrated that the major components of the essence were carvacrol [48.6%], followed by p-Cymene [16.6%], ã-terpinene [6.9%] and linalool [5.3%]

Conclusion: Based on the considerable inhibitory activity against nosocomial infections by essential oil of S. bachtiarica, it could be considered as the suitable candidate in the food industry and pharmaceutical uses

Comparison of the impact of applications of Targeted Transfusion Protocol and Massive Transfusion Protocol in trauma patients / 대한마취과학회지

BACKGROUND: The current study assessed a recently developed resuscitation protocol for bleeding trauma patients called the Targeted Transfusion Protocol (TTP) and compared its results with those of the standard Massive Transfusion Protocol (MTP). METHODS: Per capita utilization of blood products such as packed red blood cells (RBCs), fresh frozen plasma (FFP), and platelet concentrates was compared along with mortality rates during two 6-month periods, one in 2011 (when the standard MTP was followed) and another in 2014 (when the TTP was used). In the TTP, patients were categorized into three groups based on the presence of head injuries, long bone fractures, or penetrating injuries involving the trunk, extremities, or neck who were resuscitated according to separate algorithms. All cases had experienced motor vehicle accidents and had injury severity scores over 16. RESULTS: No statistically significant differences were observed between the study groups at hospital admission. Per capita utilization of RBC (4.76 ± 0.92 vs. 3.37 ± 0.55; P = 0.037), FFP (3.71 ± 1.00 vs. 2.40 ± 0.52; P = 0.025), and platelet concentrate (1.18 ± 0.30 vs. 0.55 ± 0.18; P = 0.006) blood products were significantly lower in the TTP epoch. Mortality rates were similar between the two study periods (P = 0.74). CONCLUSIONS: Introduction of the TTP reduced the requirements for RBCs, FFP, and platelet concentrates in severely injured trauma patients.

Management of deep vein thrombosis [DVT] prophylaxis in trauma patients

Deep vein thrombosis [DVT] and pulmonary embolism [PTE] are known as venous thromboembolism [VTE]. DVT occurs when a thrombus [a blood clot] forms in deep veins of the body, usually in the lower extremities. It can cause swelling or leg pain, but sometimes may occur with no symptoms. Awareness of DVT is the best way to prevent the VTE. Patients with trauma are at increased risk of DVT and subsequent PE because of coagulopathy in patients with multiple trauma, DVT prophylaxis is essential but the VTE prophylaxis strategy is controversial for the trauma patients. The risk factors for VTE includes pelvic and lower extremity fractures, and head injury

Objective structured clinical examination [OSCE]-based assessment of the advanced trauma life Support [ATLS] course in Iran

Objective: to evaluate the effect of advance trauma life support [ATLS[registered sign]] training on general surgery residents clinical reasoning skills using the national boards-style objective structured clinical examination [OSCE]

Methods: this cross-sectional single-center study was conducted in Shiraz University of Medical Sciences including 51 surgery residents that participated in a mandatory national board style OSCE between May 2014 and May 2015. OSCE scores of two groups of general surgery residents including 23 ATLS[registered sign] trained and 28 non-ATLS[registered sign] trained were compared using Mann-Whitney U test. The exam was graded out of 20 points and the passing score was >/=14 including 40% trauma cases

Results: there were 8[15.7%] women and 43[84.3%] men among the participants with mean age of 31.12 +/- 2.69 and 33.67 +/- 4.39 years in women and men respectively. Overall 7 [87.5%] women and 34 [79.07%] men passed the OSCE. The trauma section OSCE score was significantly higher in the ATLS[registered sign] trained participants when compared to non-ATLS[registered sign] [7.79 +/- 0.81vs.6.90 +/- 1.00; p=0.001]. In addition, the total score was also significantly higher in ATLS[registered sign] trained residents [16.07 +/- 1.41 vs. 14.60 +/- 1.40; p=0.001]. There was no association between gender and ATLS[registered sign] score [p=0.245] or passing the OSCE [p=0.503]

Conclusion: ATLS[registered sign] training is associated with improved overall OSCE scores of general surgery residents completing the board examinations suggesting a positive transfer of ATLS learned skills to management of simulated surgical patients including trauma cases

Tube thoracostomy [chest tube] removal in traumatic patients: what do we know? What can we do?

Chest tube [CT] or tube thoracostomy placement is often indicated following traumatic injuries. Premature movement of the chest tube leads to increased hospital complications and costs for patients. Placement of a chest tube is indicated in drainage of blood, bile, pus, drain air, and other fluids. Although there is a general agreement for the placement of a chest tube, there is little consensus on the subsequent management. Chest tube removal in trauma patients increases morbidity and hospital expense if not done at the right time. A review of relevant literature showed that the best answers to some questions about time and decision-making have been long sought. Issues discussed in this manuscript include chest tube removal conditions, the need for chest radiography before and after chest tuberemoval, the need to clamp the chest tube prior to removal, and drainage rate and acceptability prior to removal

Correlation between success rates of cardiopulmonary cerebral resuscitation and the educational level of the team leader; a cross-sectional study

Objectives: To determine the correlation between the success rates of the cardiopulmonary cerebral resuscitation [CPCR] and the team's leader education and skill level in Shiraz, southern Iran

Method: This cross-sectional study was conducted during a 6-month period from October 2007 to March 2008 in Nemazee hospital of Shiraz. We included all the patients who underwent CPCR due to cardiopulmonary arrest in emergency room of Nemazee hospital during the study period. We recorded the rates of return of spontaneous circulation [ROSC] and discharge rate [DR] of all the patients. The correlation between these two parameters and the team leader's education and skill level was evaluated

Results: Overall we included total number 600 patients among whom there were 349 men [58.1%] and 251 [41.8%] women with mean age of 58.9 +/- 42.6. We found that 270 [45.1%] patients had ROSC, while 330 [54.9%] patients died. Overall 18 [6.6%] patients were discharged from hospital [3% of all participants]. We found that the ROSC was significantly higher in those with specialist leader [anesthesiologist or pediatrician] when compared to those in whom CPCR was conducted by technicians [55.2% vs. 30.7%; p=0.001]

Conclusion: Conducting CPCR by persons with higher medical degrees resulted in higher rate of ROSC but not in more discharge rate. Inspite of the fact that the rate of ROSC following CPCR was closely analogous to that of developed countries, discharge rate was lower. This indicates that in our region, much more attention needs to be paid to post-resuscitation care and organizing training programs and to cover more resuscitation by CPCR team, conducted by the specialists

effect of blood loss in the presence and absence of severe soft tissue injury on hemodynamic and metabolic parameters; an experimental study

The effect of severe soft tissue injury on the severity of hemorrhagic shock is still unknown. Therefore, the present study was aimed to determine hemodynamic and metabolic changes in traumatic/hemorrhagic shock in an animal model. Forty male rats were randomly divided into 4 equal groups including sham, hemorrhagic shock, soft tissue injury, and hemorrhagic shock + soft tissue injury groups. The changes in blood pressure, central venous pressure [CVP] level, acidity [pH], and base excess were dynamically monitored and com-paredsented. Mean arterial blood pressure decreased significantly in hemorrhagic shock [df: 12; F=10.9; p<0.001] and severe soft tissue injury + hemorrhagic shock [df: 12; F=11.7; p<0.001] groups 15 minutes and 5 minutes after injury, respectively. A similar trend was observed in CVP in severe soft tissue injury + hemorrhagic shock group [df: 12; F=8.9; p<0.001]. After 40 minutes, pH was significantly lower in hemorrhagic shock [df: 12; F=6.8; p=0.009] and severe soft tissue injury + hemorrhagic shock [df: 12; F=7.9; p=0.003] groups. Base excess changes during follow ups have a similar trend. [df: 12; F=11.3; p<0.001]. The results of this study have shown that the effect of hemorrhage on the decrease of mean arterial blood pressure, CVP, pH, and base excess is the same in the presence or absence of soft tissue injury

[Evaluation and reconstruction of Alzahrawi's puncturing instruments]

Abu al-Qasim Khalaf Ibn-e-Abbas Zahrawi [936-1013 A.D.], known as Albucasis in west, was one of the greatest physicians in the Islamic world. To many historians, he was considered as the father of modern surgery. His book, Al-Tasrif, e.g., written in 30 chapters, was, in fact, a medical encyclopedia of that era. It was used as one of the main references in medical academic centers for centuries. The 30th chapter of this weighty book was dedicated to surgery. In this chapter, Zahrawidescribed many surgical procedures and introduced about 200 instruments invented for those procedures. In addition to drawing some of the instruments, he explained their size, shape, and application, as well. In the second section of this chapter, named "surgery and instruments", he explained about the functions of various surgical instruments, used for spliting, piercing and phlebotomizing, including Gamaneh, surgical blade, Makhda', Nishtar and experiment rod, all of which were available for the surgeon to choose from as needed. The aim of this study, was to describe, design and evaluate the functional quality of a hypothetical module of the instrument "experiment rod", used for piercing, as presented in Al-Tasrif

Accuracy of surgeon's intraoperation diagnosis of acute appendicitis, compared with the histopathology results

Objective: To evaluate the accuracy of surgeons' intraoperative diagnosis in open appendectomy and compare it with the histopathology examination results afterwards

Methods: This was a cross-sectional retrospective study accomplished in Namazee hospital affiliated with Shiraz University of Medical Sciences, in a one-year period from 2007 to 2008. Medical charts of all the patients who were admitted with impression of acute appendicitis and underwent open appendectomy in our center were included. Demographic information, intraoperative findings as in the operation note based on a method used by our surgeons, and histopathology examination of the removed appendix were recorded and reported

Results: A total of 342 patients were studied including 229 [67%] males and 113 [33%] females, with the mean age of 16.02 +/- 9.89 [range 3 to 76] years, with a large proportion from 10 to 15 years. Surgeons reported 97.4% of the patients to have acute appendicitis, 29.5%, 10.2% and 5.6% with severe, moderate and mild inflammation respectively, whereas 26.6% and 9.4% with suppurated and gangrenous appendicitis separately, 14.6% to have perforated appendicitis and only 1.5%hadperforated appendicitis with peritonitis. However, 79.5% of cases showed appendicitis in the histopathology review. The accuracy of surgeons' intraoperative diagnosis is 81.6%, 85.2% for men and 72.6% for women

Conclusion: The method used by our surgeon is not completely indicative in mild to severe inflamed appendix but it is almost always compatible with the pathology results in suppurated, gangrened, and perforated appendix. Therefore surgeons' gross observation of the inflamed appendix may not always be in concordance with the histopathology examination of the resected appendix

Epidemiology and clinical characteristics of mucormycosis in patients with leukemia; a 21-year experience from Southern Iran

Objectives: To determine the epidemiological aspect of mucormycosis, the nature of malignancies complicated by mucormycosis, the initial site of involvement and the subsequent outcome

Methods: This was a cross-sectional study which was performed by reviewing the medical records of 95 patients with leukemia complicated with biopsy-proven mucormycosis admitted to the educational hospitals affiliated with Shiraz University of Medical Sciences over a 21-year period. We recorded demographic information including age and sex and disease characteristics such as type of leukemia, site of involvement, paraclinical findings at the time of admission and the outcome of the patients. The incidence of mucormycosis in leukemia was determined by identifying the number of leukemia patients diagnosed within the last 17 years

Results: The male to female ratio was 2.39:1 in of 95 patients studied. The overall incidence rate of mucormycosis was 4.27 per 100 leukemic patients in last 17 years which showed a decreasing trend from 2001 to 2011. The most frequent type of leukemia was acute myelogenous leukemia [AML] which was found in 58 patients [61.5%]. The most common site of initial tumor involvement was sinonasal [90.16%]. The mortality rate was about 54%, compared to the mortality rate of about 43.24% in patients with best prognosis of AML

Conclusion: The incidence of mucormycosis in leukemia showed a decreasing trend in our country and its recent incidence is comparable to that of other regions. The best preventive method against this lethal infection is to modify and control the environment which reduces the risk of exposure to air-born fungal spores

performance of Trauma Research Centers of Iran during the past 10 years; a science monitor survey

Objective: To compare and evaluation of scores of trauma research center of Shiraz University of Medical Sciences in Iran with other trauma research centers in Iran

Methods: The assessment scores of each center were gathered from Iran medical research and Ministry of Health and Medical Education website. Each score is recorded in helical year which is defined from the 21[th] of March of every year until the 20[th] of March of the next. They are ranked and scored by knowledge production, capacity development, and research projects

Results: The total evaluation scores of the trauma research center of Iran's Universities of Medical Sciences have increased from establishment. The highest increase in assessment scores was related to Tehran Trauma Research Center. An upward trend was observed in the total indicators of knowledge production index of all the trauma research centers from 2001/2002 to 2011/2012. An ascending trend was showed in the published articles score of Shiraz and Kashan Trauma Research Centers through the recent years

Conclusion: The increasing trend in scores of trauma research centers in Iran indicated a significant role in the knowledge production but it is need to find barriers of research and doing interventional projects to promote trauma care and prevention

Perihepatic packing versus primary surgical repair in patients with blunt liver trauma; an 8-year experience

Objective: To explore the pros and cons of early versus delayed intervention when dealing with severe blunt liver injury with significant hemoperitoneum and hemodynamic instability

Methods: This retrospective cross-sectional study was performed at the Nemazi hospital, Shiraz, Southern Iran, level I trauma Center affiliated with Shiraz University of Medical Sciences. The study population comprised of all patients who were operated with the impression of blunt abdominal trauma and confirmed diagnosis of liver trauma during an 8-year period. All data were extracted from patients' hospital medical records during the study period. The patients' outcome was compared between those who underwent perihepatic packing or primary surgical repair

Results: Medical records of 76 patients with blunt abdominal liver trauma who underwent surgical intervention were evaluated. Perihepatic packing was performed more in patients who have been transferred to operation room due to unstable hemodynamics [p<0.001] as well as in patients with more than 1000 milliliters of hemoperitoneum based on pre-operative imaging studies [e.g. CT/US] [p=0.002]

Conclusion: We recommend that trauma surgeons should approach perihepatic packing earlier in patients who have been developed at least two of these three criteria; unstable hemodynamics, more than 1000 milliliters hemoperitoneum and more than 1600 milliliters of intra-operative estimated blood loss. We believe that considering these criteria will help trauma surgeons to diagnose and treat high risk patients in time so significant hemorrhage [e.g. caused by dilatational coagulopathy, hypothermia and acidosis, etc.] can ultimately be prevented and more lives can be saved

Chemotherapy-induced perforation of gastric Burkitt lymphoma; a case report and review of the literature

Burkitt lymphoma of stomach is among the most rapidly growing gastric cancersassociated with several gasterointestinal symptoms including hematemesis, anorexia, vomiting and etc. Gastric perforation in patients with Burkitt lymphoma of stomach is a very rare condition especially after chemotherapy. We herein present a 21-year old man who was kwon case of gastric Burkitt lymphoma who had undergone chemotherapy and presented with acute onset gastric pain and tenderness. He was diagnosed to suffer from perforated gastric lymphoma for which laparotomy and total gastrectomy was performed. Treatment was continued by chemotherapy. Closed observation is thus recommended for those patients with gastric Burkitt lymphoma undergoing chemotherapy

Outcome of penetrating cardiac injuries in southern Iran, Shiraz / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Cardiac injuries are one of the most challenging injuries in the field of trauma surgery. Their management often requires immediate surgical intervention, excellent surgical technique and the ability to provide excellent postoperative critical care to patients. The aim of this study was to evaluate the outcome and survival rate of patients with penetrating cardiac injury in southern Iran, Shiraz.</p><p><b>METHODS</b>From January 2001 to June 2007, medical records of all patients suffering from penetrating cardiac injuries were reviewed and their outcomes were investigated. The inclusion criterion was the presence of a confirmed penetrating cardiac injury intraoperatively or by autopsy. Patients with blunt cardiac injuries were excluded from the study.</p><p><b>RESULTS</b>The study consisted of 37 patients, including 1 gunshot wound (2.7%), 35 stab wounds (94.6%) and 1 (2.7%) shotgun wound. The overall survival rate was 76% (28 in 37) and that in stab wound patients was 80%. The collected data of 9 expired patients revealed 11% death on arrival, 67% hypotensive, and 22% normotensive considering physiologic presentation. Paired sample test showed significant correlation between mortality and electrocardiographic changes, amount of retained blood in pericardium, clinical stage and physiologic condition at presentation, as well as associated injury type (gunshot more than stab wound).</p><p><b>CONCLUSION</b>Our results show that injury mechanism and initial cardiac rhythm are significant predictors of outcomes in patients with penetrating cardiac injuries. Besides, gunshot injury and exsanguination are the most important predictive variables of mortality.</p>