Bulletin of Emergency And Trauma
Year:2018 | Volume:6 | Issue:3|Papers Count:15

Objective: To estimate the summation of mortality rate and the contributing factors in patients with traumatic thoracolumbar spinal cord injuries (TLSCI). Methods: A systematic search of observational studies that evaluated the mortality associated with TLSCI in MEDLINE and EMBASE was conducted. The study quality was evaluated using a modified quality assessment tool previously designed for observational studies. Results: Twenty-four observational studies involving 11, 205 patients were included, published between January 1, 1997, and February 6, 2016. Ten studies were of high quality, thirteen were of moderate quality, and one study was of low quality. Seventeen reports described risk factors for mortality and eleven of these studies used a multiple regression models to adjust for confounders. The reported mortality rate ranged from 0 to 37. 7% overall and between 0 and 10. 4% in-hospital. The sum of mortality for in-hospital, 6-month, and 12-month were 5. 2%, 26. 12%, 4. 3%, respectively. The mortality at 7. 7 years follow-up was 10. 07% and for 14 years follow-up reports ranged from 13. 47% to 21. 46%. Associated data such as age at injury, male to female ratio, pre-existing comorbidities, concomitant injuries, duration of follow-up, and cause of death have been underreported in studies investigating the mortality rate after TLSCI. Conclusion: Currently no study has accurately assessed mortality in the thoracolumbar spine, while there is general agreement that traumatic thoracolumbar spinal cord injuries are important.

Objective: To compare the healing effects of dried and acellular human amniotic membrane and Mepitel for coverage of split-thickness graft donor site (STGDS). Methods: Twenty patients who underwent STGDS regeneration surgery in identical anatomic regions were enrolled in this randomized controlled clinical trial conducted in Hazrate Fatemeh hospital (Iran). Patients were randomly assigned in 3 groups of wound dressing; group A by Mepitel, group B AmiCare (Dried amniotic membrane) and group C OcuReg-A (Acellular amniotic membrane). Re-epithelization rate (healing time), pain sensation, scar formation and infection rate were assessed till complete healing was achieved. Results: Our results showed no significant difference between Amicare, OcuReg-A and Mepitel in the features analyzed by us including: Re-epithelization rate (healing time) p=0. 573, Pain sensation p=day 4 th: 0. 131, day8 th: 0. 93 and day 12 th: 0. 365, Scar formation p>0. 05 and Infection rate. Conclusion: Our findings confirmed the safety and efficacy of AmiCare (dried amniotic membrane) and OcuReg-A (Acellular amniotic membrane) in treatment of split-thickness donor site in comparison with Mepitel as a standard wound dressing.

Objective: To determine the effects of chicken embryo brain extract (BE) on transects sciatic nerve in male rats. Methods: Thirty adult male Sprague-Dawley rats weighing 200 to 250 g, were randomized into three groups treated with (1) sham surgery, (2) normal saline (NS), and (3) brain extract (BE). The BE was taken from incubating chick embryos at day 8. The sciatic nerve was exposed and sharply transected at the mid thigh level. Immediate epineurial repair was then performed. The BE treated animals were given 400 μ l/kg of the chick embryo BE intraperitoneal, once daily, for 2 weeks. All animals were evaluated by sciatic functional index (SFI), electrophysiology, histology, and immunohistochemistry at days 28, 90 after surgery. Results: The mean SFI difference between BE and NS groups at days 28, 60 and 90 after surgery was statistically significant (p=0. 086). The mean number of myelinated fibers in the BE group was significantly greater than that of the NS group on days 28 and 90 after surgery (p=0. 034). At days 28 and 90 after surgery, the mean nerve conduction velocity (NCV) in the BE group was significantly faster than that of the NS group (p=0. 041). Conclusion: These results indicate for the first time that chick embryo brain extract can enhance peripheral nerve regeneration in rat.

Objective: To investigate effects of intraperitoneally administration of α-tocopherol loaded nanoparticles (TNP) on ischemia-reperfusion injury in ovaries. Methods: Thirty-five healthy female Wistar rats ~250g were randomized into seven experimental groups (n=5): Group SHAM: The rats underwent only laparotomy. Group Ischemia: A 3-hour ischemia only. Group I/R: A 3-hour ischemia and a 3-hour reperfusion. Group I/T: A 3-hour ischemia only and 100 mg/kg intraperitoneal administration (IP) of α-tocopherol 2. 5 hours after induction of ischemia. Group I/R/T: A 3-hour ischemia, a 3-hour reperfusion and 100 mg/kg IP of α-tocopherol 2. 5 hours after induction of ischemia. Group I/TNP: A 3-hour ischemia only and 1 mg/kg IP of TNP 2. 5 hours after induction of ischemia. Group I/R/TNP: A 3-hour ischemia, a 3-hour reperfusion and 1 mg/kg IP of TNP 2. 5 hours after induction of ischemia. Results: Animals treated with α TNP showed significantly ameliorated development of ischemia and reperfusion tissue injury compared to those of other groups (p=0. 001). The significant higher values of SOD, tGSH, GPO, GSHRd and GST were observed in I/R/NC animals compared to those of other groups (p=0. 001). Damage indicators (NOS, MDA, MPO and DNA damage level) were significantly lower in I/R/NC animal compared to those of other groups (p=0. 001). Conclusion: Intraperitoneal administration of TNP could be helpful in minimizing ischemia-reperfusion injury in ovarian tissue exposed to ischemia.

Objective: To determine if there exists an upper limit for amount of blood transfused in trauma patients before it reaches a point of futility. Methods: A prospective cohort study was conducted on 131 patients who received massive blood transfusion (MBT), defined as 10 U or higher of PRBCs received in the initial 24 hours. Data collected from a Level II trauma center registry were used to analyze reports of adult patients from July 2014 to 2017. Cohorts were divided by amount of blood received-0 to 9 U, 10-19 U, 20 to 29 U, 30-39 U, 40 U or higher-odds ratio for mortality and p-values for mean Injury Severity Score and overall hospital length of stay were calculated for each group. Results: Odds ratios for massive blood transfusion groups from 10 units to 39 units each contained the null value, while our 40 units and above group did not (OR 12. 52, 95% CI 1. 3-117. 7). Conclusion: Although this study is limited by its sample size, these results suggests that 40 units of PRBCs may be a threshold at which survival rates begin to decrease significantly.

Objective: To assess availability, experience, and knowledge about the Pelvic Circumferential Compression Device (PCCD) in Sweden. Methods: A telephone interview with the current on-call trauma doctors at all trauma units in Sweden was conducted. After a short presentation and oral consent, the doctors were asked to answer four short questions. We asked the doctors to answer whether they knew if they had PCCDs available in their emergency room, how many times had they applied a PCCD, which is the correct level of application for a PCCD, and if a PCCD can stop arterial bleeding. Results: The on-call trauma doctors at the nine University hospitals, twenty-two General hospitals and twentyone District General hospitals, with response rate of 100%, were interviewed. Availability of PCCD was 85 % and there was no difference between hospital types (p=0. 546). In all hospitals 29/52 (56%) of those interviewed had used a PCCD at least once. There were significantly more doctors that had used a PCCD at least once in the University hospitals (8/9), compared to General hospitals (13/22) and District General hospitals (8/21) (p=0. 034). A total of 43/52 (83 %) doctors defined the greater trochanters as the correct level of application for a PCCD. No difference was found when comparing hospitals (p=0. 208). Only 22/52 (42 %) of doctors answered that a PCCD could not stop an arterial bleeding. No difference was found between hospitals (p=0. 665) Conclusion: Less than half of the doctors knew that a PCCD cannot stop arterial bleeding, while the majority knew the correct level of application of a PCCD.

Objective: To determine the incidence and predictive factors of the falls in elderly women in Northern Iran. Methods: A total of 717 elderly women aged 60 years and above in Amirkola, Northern of Iran participated in this study. Age, history of falls during the 12 months leading to the study, accompanying diseases, status of balance, cognitive status, orthostatic hypotension, state of depressive symptoms, strength of quadriceps muscles and serum vitamin D level were assessed as independent variables during baseline measurement. Incidence of fall (dependent variable) was recorded during a six-month follow-up period. Results: Of the participants, 7. 8% had experience of fall, out of which 50. 0% experienced it once, 25. 0% twice, and the rest three times or more. With aging, the incidence of orthostatic hypotension also increased and symptomatic depression became aggravated. In the final model, the variables of the number of accompanying diseases (RR=1. 78, 95% CI: 1. 00-3. 18), severe cognitive impairment (RR=12. 70, 95% CI: 3. 05-52. 86), and depressive symptoms (RR=3. 19, 95% CI: 1. 48-6. 86) remained as strong associated variables for incidence of fall. Conclusion: With increasing severity of depressive symptoms and cognitive impairment along with the comorbidities, incidence of fall also increases in the elderly. Thus, psychological aspects of the elderly and comorbidities in this group should be taken care of seriously.

Objective: To investigate the epidemiological aspects of all-cause injuries in Hamadan province during a 6-year period. Methods: We conducted a cross-sectional study on injured subjects admitted to private or governmental hospitals in Hamadan province during March 2009 to March 2015. The epidemiological characteristics were retrieved from a registry-based system including gender, residency, injury mechanism and date of injury occurrence, outcome of hospitalization (full recovery/disability/death). Results: Totally, 135, 925 hospitalized injured cases were recorded. The majority of cases were male (72. 6%) and were occurred in urban areas (60%), about 40% of patients were in 20-34 years’ age group, and the highest proportion (30. 13%) of injuries occurred in summer. Logistic regression showed that the odds of disability vs. recovery was significantly higher in rural areas [Adjusted odds ratio (AOR)=3. 42] and the odds of death vs. recovery was higher among male gender (AOR=1. 46). In addition, comparing to the 0-4-year age-group, odds of death were significantly higher in middle aged and elderly victims. Conclusion: Our findings showed that middle age groups, male gender and urban area increase the odds of death. Injured males and old age subjects had the highest odds of death and out of residential area injuries were common cause of leading death injuries.

Objective: To address the epidemiology of animal bites and associated factors with delay in post-exposure prophylaxis (PEP) in Nahvand district, western Iran. Methods: Data were obtained from Rabies Treatment Center (RTC) in Nahavan district from March 2015 to March 2017. All of referred cases to RTC include 1448 cases of animal bites using the census method were recruited. Epidemiological profile of participants was demonstrated using descriptive statistics and determinants of PEP was addressed by logistic regression model. Results: The majority of victims were males 1167(80. 5%). superficial bites were more prevalent than deep status injuries (1145(79. 0%) VS. 303(20. 9%)). The biting rate differed according to season in the period of the study (p<0. 001). Cases who experienced animal biting in the autumn was more likely to refer timely for PEP than cases in spring season (OR, 0. 39; 95% CI: 0. 26-0. 59, p<0. 001). Conclusion: Our findings addressed the pattern of potential delays in PEP including the role of season. Local authorities of Nahavand district should considered preventive activities and educational interventions to reduce animal biting and provide timely prophylaxis.

Suicide is a serious public health concern in the world. Epidemiologists are considered the mainstay of the management of problem. The purpose of this study was to investigate the trend of suicide (attempts and completed) by age and gender in a 6-year time period and to compare the suicide rates between in age and gender groups in Ilam. In this cross-sectional study, a total of number of suicidal attempts during a 6-year period from 2011 to 2016 were recorded. The data were derived from the systematic registration suicide data (SRSD) which collects official statistics from the Ilam University of Medical Sciences. Suicide rate in period of the study in men was reported to be 24. 0 in 2011 to 17. 9 in 2016 per 100, 000 populations; also this rate in women was between 16. 2 in 2011 to 7. 3 in 2016 per 100, 000 populations. Trend analysis revealed a decreasing trend (r=-0. 82, p=0. 043), in attempts, as well as completed suicides (r=-0. 53, p=0. 048). The current data demonstrated a decreasing trend in both attempts and completed suicide rates from 2011 to 2016. Also we found that the rate of completed suicide in all age groups were higher in men compared to women.

Drug induced hyperthermia is a rare presentation which can rapidly lead to gross metabolic abnormality and death. These presentations are further complicated by the wide range of potentially causative agents. We present a case of rigidity and hyperthermia, following overdose of an initially unknown substance leading to challenging management decisions in the Emergency Department. This case was later identified as Serotonin Syndrome. The patient presented with trismus which was managed with rapid sequence induction of anaesthesia to allow airway protection. On extubation a significant degree of laryngeal oedema complicated weaning, a possible complication of Serotonin Syndrome not previously described in the literature. We discuss the pathophysiology of Serotonin Syndrome, important differentials and practical considerations in managing hypertonicity of unknown origin in a young person.

Scorpionism is the clinical picture resulting from the inoculation of scorpion venom. It is considered a major public health problem, especially in countries with low resources and tropical or subtropical climate. Poisoning can be fatal especially in the first hours due to respiratory and / or cardiovascular collapse. The compromise of the central nervous system (CNS) is infrequent but varied and complex, being able to be triggered due to multiple and different neurotoxic properties of the toxin. We report here a severe case of poisoning with cardiovascular and neurological compromise in an endemic region of Argentina. After cardiorespiratory stabilization, neurological deterioration is detected secondary to intracerebral hemorrhage that required surgery and multimodal neuromonitoring. The outcome was fatal due to multiple neurological and systemic complications. Scorpion sting poisoning is a true neurologic and neurosurgical life-threatening emergency.

Blunt trauma abdomen is a very common entity but traumatic abdominal wall hernia is not that common. Herniation through abdominal wall usually occurs following trauma with seat belt, motor cycle, bicycle handle bar etc. Handlebar hernia is a less known variety of traumatic abdominal wall hernia as a consequence of injury with handlebar of a bicycle. It is difficult to diagnose and one should have high index of suspicion. Management in traumatic abdominal wall hernia is individualized based on various factors. We herein present an interesting case of a14-year-old boy, who sustained blunt trauma abdomen from bicycle handlebar leading to triple herniation and perforation of the small bowel and hematoma of the mesentery. Patient was resuscitated and operated with a favorable outcome. Blunt trauma abdomen is a very common and the possibility of traumatic abdominal wall hernia should always be borne in mind.

Bungee jumping is a recreational sport that is accepted to carry a level of risk. We present the case of a femoral fracture sustained during bungee jumping and examine the published literature on bungee jumping-related injuries. A previously well 31-year old female performed a 200ft bungee jump from a crane. The apparatus was performed as expected and documented on the bystander video footage. As the bungee-cord became taut for the second time, there was an audible crack with accompanying scream. A closed, neurovascularly-intact injury was sustained to her right thigh. Radiographs revealed a comminuted mid-diaphyseal spiral femoral fracture, which was treated with intra-medullary nail fixation the following day. Following loss of position with proximal fragment flexion, the intramedullary nail was revised with open reduction and cerclage wiring 6 weeks later. Progression to clinical and radiological union was uneventful. Fatalities in bungee jumping are generally secondary to trauma as a result of equipment malfunction, user error, or related to pre-existing comorbidity2. As no records are kept on bungee jumping injuries in the UK, reliable statistics are not available regarding the relative risks of this sport. We conclude that incidence of bungee jumping injuries is likely to remain low, but consider that improved recording of bungee jumping-related injury data will allow providers to give customers a realistic quantification of risk before engaging in this sport.

A 17-year-girl presented with recurrent pain in abdomen of 10-year duration. The pain used to start as dull ache on right side of her abdomen, which gradually would increase over few hours to become moderately severe. This was not associated with nausea, vomiting, abdominal distension, respiratory, bowel or urinary symptoms, jaundice or fever. The pain usually lasted for 4-6 hours and subside on its own mostly or at times with oral analgesics. Such episodes became more frequent with increasing severity of pain from last 2 years. She visited many local practitioners for same to no avail. On careful evaluation, she revealed history of significant blunt trauma to abdomen at the age of 5 years due to fall from a swing.