Prognostic Value of Arterial Blood Gas Indices Regarding the Severity of Traumatic Injury and Fractures of the Femur and Pelvis.

OBJECTIVE: To evaluate the prognostic value of arterial blood gas (ABG) indices, especially base excess (BE), regarding the severity of traumatic injury. METHODS: A total number of 96 trauma patients with fractures of femur and pelvis were included in this study. Demographic characteristics and clinical information of samples were recorded. The results of ABG test and hemoglobin (Hb) were evaluated at two time intervals (on admission and 6 hours later). The outcome of the patients was evaluated at the end of the study (dead or alive). The ABG indices included O2 saturation (O2Sat), PH, PO2, PCO2, bicarbonate (HCO3) and base excess (BE). The mean of the hemodynamic and ABG indices were compared between those who were discharged and mortality cases. The confounders were compensated using a multivariate logistic regression model. RESULTS: Overall 94 trauma patients with long and pelvic fractures were included. There were 69 (73.4%) men and 25 (26.6%) women among the patients with mean age of 37.43 ± 20.07 years. The mortality rate was 10 (10.6%). The most common mechanism of injury was motorcycle accident in 41 (43.6%) and car collision in 43 (45.7%) patients. We found that mortality was significantly associated with amount of FFP transfusion (p=0.005), but was not associated with amount of transfused packed cells (p=0.113). We also found that mortality was associated with lower BP after 6 hours of admission (p=0.001), higher HR on admission (p=0.036), lower HR after 6 hours (p=0.017), lower O2Sat on admission (p<0.001), higher PCO2 after 6 hours and lower BE on admission (p=0.025). CONCLUSION: The ABG indices including O2Sat, BE and PCO2 are considered prognostic determinants of outcome in trauma patients with long and pelvic fractures. These findings can be considered as fundamental studies to achieve new diagnostic methods.

Spontaneous Bacterial Peritonitis in Afebrile Cirrhotic Patients; Report from a Referral Transplantation Center.

Spontaneous bacterial peritonitis (SBP) is a complication of liver cirrhosis with adverse effect on patient prognosis. Early diagnosis and treatment is highly important, especially in patients without remarkable manifestations. We designed this study to determine the prevalence of SBP among afebrile cirrhotic patients and identify high-risk subgroups in a referral center in southern Iran. This cross-sectional study evaluated all afebrile cirrhotic patients, admitted to the gastroenterology ward of Namazi hospital (affiliated with Shiraz University of Medical Sciences, Shiraz, Iran) over a 6-month period in 2017, for the presence and correlates of SBP. Demographic data, clinical findings, and comorbidities were recorded. Ascitic fluid white blood cells (WBC) count >500 and neutrophil count >250 indicated bacterial peritonitis. In total, 97 afebrile cirrhotic patients comprising of 63 (64.9%) men and 34 (35.1%) women were included. All patients had ascites and 89 (91.8%) had abdominal tenderness. Accordingly, abdominal distension was the top presentation. Confirmed etiologies or comorbidities such as HBS, HCV, and liver cancer or metastasis existed in 46 patients. Thirteen (13.4%) had SBP. The correlations of gender (p=0.331), decreased level of consciousness (p=0.145), tenderness (p=0.315). With regards to the type of presentations, only DLOC showed to be significantly higher in SBP negative patients (p=0.022, OR=0.09. 95%CI=0.01-0.62). Also, using binary logistic regression, the correlation of age with SBP was statistically non-significant (coefficient= ⎼0.013, p=0.595). Our findings indicated that routine paracentesis in all cirrhotic patients regardless of fever can help diagnose a number of potentially neglected patients and improve their outcome.

Firecracker injuries during chaharshanbeh soori festival in iran: a case series study.

On the last Wednesday of every year Iranians celebrate the sanctity of fire in the annual festival of Chaharshanbeh Soori. Each year many cases of firecracker-related injuries (FRI) are reported during this festival. The aim of this study was to assess the pattern of injuries and the frequency of disabilities during this period. In 2011, a cross-sectional study was conducted at the emergency departments (EDs) of three educational hospitals in Tehran, to assess the extent and demographics of FRI. The age and sex of the patient, type of referral to the hospital, type of injury, its region and treatment process were recorded for each patient by the physicians. Data were analyzed by SPSS version 20. Thirty-five patients suffering from FRI were admitted to the hospitals during the festival. The majority of patients were under 30 years-old and most of them were male (83% male and 17% female). The injuries were mostly lacerations and cuts (n = 17, 49%) and scratches (n = 12, 34%). One patient suffered amputation. The most common site of the injuries were the hands (n = 13, 37%) followed by the face (n = 10, 29%). There were 10 patients (29%) with more than one site of injury. Twenty-one patients were hospitalized, 12 patients (34%) received outpatient treatment and two patients were referred to other hospitals. There are still many victims during Chaharshanbeh Soori festival despite efforts and legislations by the government. Education and raise of awareness among people especially for youth are the most important ways to prevent and reduce Red Wednesday injuries.