Immediate sonography and intervention in blunt chest trauma: A case report.

Cardiac tamponade is a leading cause of death in blunt thoracic trauma. Ultrasound improved the recognition of cardiac tamponade and therefore has a vital role in acute critical situations in the Emergency Department and in the Intensive Care Unit. Besides recognition of cardiac tamponade, treatment protocols are important. In trauma patients with hemodynamic stable cardiac tamponade, time should be taken for a proper workup for an explorative sternotomy. In hemodynamic unstable trauma patients, the pericardium should be drained, and fluid resuscitation should be performed followed by emergency sternotomy. In this case report we describe a blunt thoracic trauma victim, a 28-year-old male patient without any medical history. He suffered from the unique combination of a tear in the left atrial appendage and a papillary muscle rupture of the right ventricle because of blunt thoracic trauma. Transthoracic echocardiography revealed massive pericardial effusion with diastolic collapse of the right ventricle in our patient. Due to his hemodynamic situation, the patient was brought into the OR for immediate sternotomy and cardiac repair. The patient made a full recovery, was discharged home, and is back to work. This case report emphasizes the relevance of early recognition and treatment of cardiac tamponade in blunt thoracic trauma victims and suggests a multidisciplinary management strategy.

Sexual Dimorphism in the Buccolingual Dimensions of Permanent Anterior Teeth in the Young Iranian Population.

Objective: Evaluation of sexual dimorphism is a crucial concern for anthropologists, forensic scientists, and archaeologists. Teeth have been used as an alternative tool to determine sex in forensic anthropology. However, it is necessary to use data specific to a particular population, as different populations exhibit varying degrees of sexual dimorphism. This study aimed to determine the sexual dimorphism in the buccolingual dimensions of permanent anterior teeth in the young Iranian population. Materials and methods:A total of 100 students (50 females and 50 males) participated in the current study. A total of 1200 permanent anterior teeth were examined. The buccolingual dimension of all anterior teeth was measured using Vernier Calipers with a calibration of 0.01 mm. Data were analyzed using an independent sample T-test and paired sample T-test, and a P-value of less than 0.05 was considered statistically significant. Results:The mean values of the buccolingual dimension of the maxillary canines on the right and left sides (13, 23) were statistically greater in males than females (P=0.04, P=0.03) and had the greatest percentage of sexual dimorphism (4.08% and 5.26%, respectively). Conclusion:The buccolingual dimension of Iranian canines could be used as a reliable material to identify gender in forensic studies, and the degree of sexual dimorphism varies among different populations. Therefore, it is essential to use the relevant data samples for each population. It was concluded that Europeans had the greatest amount of sexual differences in the anterior teeth, while Iranians had the least amount of sexual dimorphism in the anterior teeth.

Swimming training reduced inflammation and apoptotic changes in pulmonary tissue in type 1 diabetic mice.

Background: Despite the vulnerability of pulmonary tissue to diabetic conditions, there are few reports related to the detrimental effects of hyperglycemia and therapeutic modalities on lung parenchyma. Here, the apoptotic changes were monitored in the diabetic pulmonary tissue of mice (DM1) subjected to a four‒week swimming plan. Methods: The mice were randomly allocated into Control; Control + Swimming (S); Diabetic group (D); and Diabetic + Swimming (D + S) groups (each in 8 mice). In the D and D + S groups, mice received intraperitoneally 50 mg/kg of streptozotocin (STZ). After 14 days, swimming exercise was done for four weeks. The expression of il-1ß, bcl-2, bax, and caspase-3 was investigated using real-time PCR analysis. A histological examination was performed using H&E staining. Results: DM1 significantly upregulated il-1ß, bax, and caspase-3, and down-regulated bcl-2 compared to the non-diabetic mice (p < 0.05). We noted that swimming exercises reversed the expression pattern of all genes in the diabetic mice and closed to basal levels (p < 0.05). Data indicated that swimming exercise could diminish emphysematous changes, and interstitial pneumonitis induced by STZ. Along with these changes, swimming exercise had protective effects to reduce the thickness of the inter-alveolar septum and mean alveolar area in diabetic mice. Conclusion: These data demonstrated that swimming exercises could decrease DM1-related pathologies in mouse lungs by regulating apoptosis and inflammatory response.

Intra-and inter-observer variability of point of care ultrasound measurements to evaluate hemodynamic parameters in healthy volunteers.

BACKGROUND: Point-of-care ultrasound (POCUS) is a valuable tool for assessing the hemodynamic status of acute patients. Even though POCUS often uses a qualitative approach, quantitative measurements have potential advantages in evaluating hemodynamic status. Several quantitative ultrasound parameters can be used to assess the hemodynamic status and cardiac function. However, only limited data on the feasibility and reliability of the quantitative hemodynamic measurements in the point-of-care setting are available. This study investigated the intra- and inter-observer variability of PoCUS measurements of quantitative hemodynamic parameters in healthy volunteers. METHODS: In this prospective observational study, three sonographers performed three repeated measurements of eight different hemodynamic parameters in healthy subjects. An expert panel of two experienced sonographers evaluated the images' quality. The repeatability (intra-observer variability) was determined by calculating the coefficient of variation (CV) between the separate measurements for each observer. The reproducibility (inter-observer variability) was assessed by determining the intra-class correlation coefficient (ICC). RESULTS: 32 subjects were included in this study, on whom, in total, 1502 images were obtained for analysis. All parameters were in a normal physiological range. Stroke volume (SV), cardiac output (CO), and inferior vena cava diameter (IVC-D) showed high repeatability (CV under 10%) and substantial reproducibility (ICC 0.61-0.80). The other parameters had only moderate repeatability and reproducibility. CONCLUSIONS: We demonstrated good inter-observer reproducibility and good intra-observer repeatability for CO, SV and IVC-D taken in healthy subjects by emergency care physicians.

Point-of-care bedside ultrasound examination for the exclusion of clinically significant ankle and fifth metatarsal bone fractures; a single blinded prospective diagnostic cohort study.

OBJECTIVE: The aim of this study was to assess the diagnostic value of point-of-care bedside ultrasound (PoCUS) as in usual clinical practice in suspected ankle and fifth metatarsal bone fractures, compared to the standard of radiographic imaging. METHODS: This prospective study included patients ≥17 years presenting to the Emergency Department with ankle trauma and positive Ottawa Ankle Rules. All patients underwent PoCUS of the ankle by a (resident) emergency physician, the images were assessed by an ultrasound expert. Both were blinded for the medical history and clinical findings of the patients. Radiography of the ankle followed, evaluated by a radiologist blinded from the PoCUS findings. Primary outcome measures were sensitivity and specificity of PoCUS. RESULTS: A total of 242 patients were included, with 35 (22%) clinically significant (non-avulsion) fractures observed with radiography. The sensitivity of PoCUS in detecting clinically significant fractures by all sonographers was 80.0% (95% Confidence Interval (CI) 63.0 to 91.6%), specificity 90.3% (95% CI 83.7 to 94.9%), positive predictive value 70.0% (95% CI 57.0 to 80.3%) and the negative predictive value 94.1% (95% CI 89.1 to 96.9%). The sensitivity of PoCUS in detecting clinically significant fractures by the expert was 82.8% (95% CI 66.3 to 93.4%), specificity 99.2% (95% CI 95.5 to 99.9%), positive predictive value 96.7% (95% CI 80.3 to 99.5%) and the negative predictive value 95.3% (95% CI 91.0 to 98.2%). CONCLUSION: PoCUS combined with the OAR has a good diagnostic value in usual clinical practice in the assessment of suspected ankle and fifth metatarsal bone fractures compared to radiographic imaging. More experience with PoCUS will improve the diagnostic value. TRIAL REGISTRATION: Registered in the local Research Register, study number 201500597.

Prevalence and Length of the Anterior Loop of the Inferior Alveolar Nerve in Iranians.

The anterior loop of the inferior alveolar nerve is a sensitive anatomical feature that should be taken into account during installation of dental implants anterior to the mental foramen. This study was conducted to explore the controversy regarding prevalence and length. A total of 452 mandible quadrants of 234 patients (age: 50.1 ± 13.3 years, 113 males, 121 females) were studied using cone-beam computerized tomography. After reconstructing axial, frontal, and sagittal slices, the region between the most anterior point on the mental foramen and the most anterior part of the mandibular nerve was inspected for signs of anterior loop presence. If positive, the length of the anterior loop was measured in mm as the distance between the anterior border of mental foramen and the anterior border of the loop. Prevalence and length of the anterior loop were compared statistically between sexes and age groups. The anterior loop was observed in 106 quadrants (23.5% of 451 quadrants) of 95 patients (40.6% of 234 patients), of whom 11 had bilateral anterior loops. Prevalences were similar in males (41%) and females (39%, chi-square P =.791). The mean anterior loop length was 2.77 ± 1.56 mm (95% CI: 2.5-3.1 mm), without significant sex (regression beta = -0.159, P = .134) or age (beta = -0.059, P = .578) differences. The anterior loop might exist in about 40% of patients, regardless of their gender. The mean safe anterior distance from the anterior loop is about 3 mm + (2.5-3.1 mm) = 5.5-6.1 mm, regardless of age.

Ventricular Tachycardia After Naloxone Administration: a Drug Related Complication? Case Report and Literature Review.

OBJECTIVE: To present a case of ventricular tachycardia following naloxone administration and to review current literature concerning ventricular tachycardia associated with naloxone. METHODS: We present a case and review the literature concerning ventricular tachycardia (VT) as a complication of naloxone administration. RESULTS: In our patient, a 44-year old male intoxicated multi-drug user, VT presented on the electrocardiogram shortly after naloxone (twice 0.4 mg intra-osseous) administration for suspected methadone overdose. After initial medical treatment he was treated with electro cardioversion because of hemodynamic instability. Our patient was subsequently stabilized and admitted to our intensive care unit (ICU). Eight comparable cases concerning VT after administration of naloxone were found in the literature, both in multi-drug uses as in patients receiving opiates for elective surgery. CONCLUSION: We suggest VT as a possible, but rarely reported serious complication of naloxone administration (Naranjo scale possible to probable). Patients who are multi-drug users or receive opiates in high doses may be prone to VT/VF due to acute (iatrogenic) opiate withdrawal or reduction of sympathetic suppression and therefore overstimulation. Also, antagonism of the protective mechanism of opioids against sympathetic excess (due to substance abuse, cardiac disease or hypoxia, as seen in all cases) may induce VT/VF. We suggest the use of small dosages (0.1 mg vs 0.4 mg), cardiac monitoring, and to have defibrillation devices stand-by.