حسین اتحاد

Delirium is a recurrent cognitive disorder which is one of the most common neurologic diagnosis in patients who have had pelvic surgeries. This complication occurs in a short time and early diagnosis results in early management. Current study was done to investigate the frequency of delirium and identifying the factors affecting its incidence in patients with pelvic surgeries. This analytical study was performed in patients >60 years of age admitted in orthopedic wards in Rasht hospitals, Iran, due to pelvic surgery. The samples (n=252) were selected using convenience sampling. Data were collected using a demographic questionnaire and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. All patients were examined before the surgery, at 6, 24, 48, and 72 hours after the surgery and also before discharge in which their cognitive status and average cognitive scores were recorded. We investigated 252 patients (mean age: 72.90±7.33) including 67 (26.6%) males and 185 (73.4%) females of whom 69% were married. Overall incidence of delirium was 18.3%. Significant association was found between the incidence of delirium and history of smoking, psychiatric medications (P< 0.001), and the type of anesthesia (P< 0.05). This study showed high prevalence of delirium in patients who have had pelvic surgery. Therefore, more focus on the factors affecting the incidence of delirium before the surgery and evaluation of patients early after the surgery could be beneficial in reducing the rate of delirium.

Sport is an important issue in matter of health. It can increase the risk of injury, which in turn causes economic, physical and psychological burden. Due to adverse effects of sports injuries on life, it is of great importance to investigate sports injuries and the factors influencing them. This study aimed to determine the prevalence of sports injuries and the factors associated with injury in patients admitted to Poursina Hospital in Rasht, Iran, in 2014.
This cross-sectional study was conducted on patients admitted to Emergency Department of Poursina Hospital, Rasht in 2014. All patients with sport injuries were studied by an available sampling method instead of sampling. In this study, data were collected via questionnaire including items on demographic characteristic and items on factors associated with sports injuries. Data collected after obtaining a license and Satisfaction with research samples. Finally, the data were analyzed with SPSS (version 20) using descriptive statistics and inferential statistics (ANOVA and chi-square).
The mean age of study population was 22.98±10.01 years. Most participants practiced ball games (63.4%) and martial arts (16.5%). The most common type of injury was fracture (58.5%) and the most prevalent anatomical part was upper and lower extremities (74.4%). 46% of injured patients were treated with splints or casts. There was a statistically significant relationship between the body part injured and sport type (p=0.008), type of injury and treatments received (p=0.0001), and injury outcomes (p= 0.007).
Many sports injuries and resulting complications are preventable. Therefore, the best way to deal with injuries is to become familiar with causes of injury before prevention and treatment.

Aims and Tuberous sclerosis is an autosomal dominant disease characterized by hamartomas lesions in multiple organs. This article reports the case with tuberous sclerosis candidate femur surgery that was performed under general anesthesia without any problem.
case report: The patient was a 44 years old man with a weight of 48 kg and height of 162 cm, known case tuberous sclerosis with mental retardation and recurrent seizure under treatment and urology complication lived in disabled sanitarium. After pre operative visite and necessary implementation , patient was underwent general anesthesia with endotracheal intubation and surgery was performed successfully without complications. After surgery the patient was fully conscious and transferred to recovery room with good general appearance and was discharged after three days

Evaluation of clinical competency of medical students can give very useful information to the authorities for setting educational aims according to student’s requirements and qualitative promotion in the educational process. The present study has been evaluated the clinical competency of fourth-year medical students. This cross-sectional study has been done in 2011 to assess clinical competence of all the fourth-year students of Guilan University of Medical Sciences, that all of them had passed the skills lab course. Data-gathering tool was a questionnaire which assessed nine main competencies in medical students. All data was analyzed by Chi-square and analysis variances by SPSS software. 68 students enrolled in the study with the mean age of 24-year old. In the field of effective communication, 78% of students scored excellent. In the clinical skills, applying sciences as guidelines in diagnosis and management of patients, lifetime learning, self-awareness, socio-medical affairs and understanding the role of a professional physician fields, result in 84% of the students were average.Most of students had low scores only in the field of ethical understanding and judgement. There was no significant relation in the clinical competency of the different fields according to the age and sex. Generally, the students in our study reached a reasonable level of competence in participating in clinical treatment.

Low blood levels of vitamin D in different communities is common. In this study، we evaluated the blood levels of 25-hydroxy vitamin D in patients presented with musculoskeletal pain. Evaluation of 25- hydroxy Vitamin D Blood Levels in Patients with Musculoskeletal Pain In a descriptive study، blood levels of vitamin D in 358 patients with musculoskeletal pain، that presented to the orthopedic clinic of Poorsina Hospital of Rasht during 2007-2008 years، were measured by serum levels of 25- hydroxy vitamin D using Radio Immunoassay (RIA). Normal range of vitamin D in this study، was 32 -100 ngr/milt. Amounts between 15 -32 ngr/milt، was introduced as mild vitamin D deficiency and amounts lower than 15 ngr/milt as severe vitamin D deficiency. Normal range of vitamin D was seen in 65 cases (16. 68%)، severe vitamin D deficiency in 182 cases (51. 96%) and mild vitamin D deficiency in 107 cases (29. 89%). Average serum levels of vitamin D among all cases، was 20. 1ngr/milt. Severe vitamin D deficiency belong to the patients with musculoskeletal pain in the ages younger than 20 years، compared to other ages and only 4% of them had normal range of this vitamin. Given vitamin D severe deficiency in (51. 96%)، i. e.، majority of cases who were studied، there seems to be a significant association between vitamin D levels and risk of musculoskeletal disorders.

Malnutrition is the cause of many problems in orthopedic patients. In this study، we aimed to determine the prevalence of malnutrition in patients who were hospitalized for ten days.

Control the potential damage caused by malnutrition in orthopedic patients

This is a cross-sectional study in which the prevalence of malnutrition in patients admitted to the Poursina hospital during the year 2011 was determined. A researcher -made questionnaire was formulated for each patient and their features were recorded on the first day of hospitalization، then، on the same day and the tenth day of hospitalization in these patients by nutritional tests، and lymphocyte count and serum albumin levels، were evaluated as well. Upon data collection، they were entered into SPSS version 16.

Of the 377 patients admitted to the orthopedic ward on the first day، 99 patients with malnutrition were recorded that reached to 81 cases on the tenth day. Malnutrition rate in open fractures increased in day 10 of hospitalization but reduced during the same period in closed fractures (P<0،005). Most of the malnourished patients had fracture of the femur. In patients with fractures of the femur، pelvis and multiple injuries، unlike other fracture sites، an increased incidence or severity of malnutrition during 10 days hospitalization was seen.

Due to the negative impact of malnutrition on patient improvement and orthopedic complications، dietary control is essential in these patients.

Tibial shaft fracture is the most common fractures of long bones. The aim of this study was to report the short-term results of intramedullary (IM) nailing in tibial shaft fractures in emergency setting. In a prospective study، 226 cases (193 men، 33 women) treated with IM nailing during 2 years (2009-2011) in a training hospital in Rasht-Iran، and followed for two years. The mean age was 34±3 years old. We investigated for open or closed fractures، accompanied with fibular fractures، proneal nerve or anterior tibialis artery injury، degenerative changes in knee joint، knee pain، atrophy of quadericeps muscle، malunion، chronic osteomyelitis، delayed union، and nonunion. Short musculoskeletal function assessment questionnaire (SMFA) was also completed and the data were analysed by statistical software. There were 151 Open fractures and 75 closed fractures. Open procedure was used in 155 cases and closed one in 71 cases. Knee pain was the most frequenct and non union the least common complication. Musculoskeletal limitation appeared more in open fractures and in association with fibular fracture and was more in female than male patients (p<. 001). SMFA score also raised by passing time. Intramedullary nailing is a proper and effective method in emergency treatment of tibial shaft fractures.

Spinal Anesthesia (S.A) is currently becoming a more common and popular method for orthopedic surgeries. Unfortunately, Backache (BA) and Post Dural Puncture Headache (PDPH) are both frequent and troublesome. Several factors (including needle shape and size, frequency rates of puncture attempts, and age and gender) have been shown to affect the rates of such complications. To determine these factors and evaluate some modalities to prevent them. This is a prospective study on 200 patients-15 to 65 years old with class type 1 and 2 A.S.A(American Society of Anesthesiology), who were candidates for orthopedic lower extremity surgeries. Anesthetic procedure was performed using a standard 24G needle Lidocaine 5% plus Epinephrine. Symptom questionnaire was filled for the history of Headache and Backache and history of former S.A. post-op puncture complications of 1st day, 1st week and 1st month were added to the forms. Statistical analysis was performed using SPSS version 16 and the results were considered significant at p<0.05. Rates of BA and PDPH were 12.5% and 17%, respectively. Post anesthetic BA for first day, week, and month were 16%, 9%, and 3.5%, respectively and PDPH were 6.5%. 3.5% and1% respectively with no significant differences. History of former spinal anesthesia with BA and PDPH revealed notable differences (p<0.001). The results of this study support the idea that history of previous spinal anesthesia could be a triggering factor for backache and headache in prior Spinal anesthetic procedures.

The case report that will be presented is an inherited methemoglobinemia، during general anesthesia of 36year old patient and was suspected by some clinical xamination such a decrease oxygen saturation in pulse oximetry and a normal finding in ABG sample that have been prepared at the preparation of patient for anesthesia. So we are going to write about this problem in the perioperative period and how to manage it.

Traumatic hip dislocation represents an orthopaedic emergency. Given the severity of associated complications every effort should be made to ensure prompt diagnosis and treatment. Bilateral traumatic dislocation of the hip is rare and simultaneous asymmetric traumatic dislocation even more unusual. This is a report on 17-year-old male patient with asymmetric bilateral dislocation of the hip joint with no bony fracture following a motor-cycle accident. The right hip was reduced by closed manipulation but the left hip required open reduction through a posterior approach. After 3 months there was a local osteoporosis in left hip which had an anterior dislocation initially.