mehri farhang ranjbar

Transfusion of packed red blood cells (PRBCs) following severe bleeding from multiple trauma can reduce mortality. The present study aimed to compare the accuracy of eight different scoring systems for predicting the need for blood transfusion in such patients. The present diagnostic accuracy study was conducted at the emergency department of Shohadaye Tajrish Hospital in Tehran, From March to September 2023. Medical records of multiple trauma patients admitted to the emergency department were reviewed. The predictive performances of eight scoring systems including Glasgow coma scale (GCS), revised trauma score (RTS), trauma associated severe hemorrhage (TASH), Prince of Wales hospital score (PWH), emergency transfusion score (ETS), base deficit, assessment of blood consumption (ABC), and the Shock index in predicting the need for PRBC transfusion were assessed. The area under the ROC curve of TASH in predicting PRBC transfusion was calculated 0.959, significantly higher than the area under the ROC curves for PWH, GCS, Shock index, Base deficit, ETS, RTS, and ABC (0.902, 0.899, 0.882, 0.857, 0.846, 0.824, and 0.810 respectively; p < 0.001). Sensitivity and specificity of TASH at the optimal cut-off were 98.72% and 51.56% respectively. A new score, the MTTP (Multiple Trauma Transfusion Predictor), developed by evaluating the association of clinical and laboratory variables with PRBC transfusion in the ED, showed an AUC of 0.964, not significantly higher than the AUC of TASH (p=0.804). The sensitivity and specificity of MTTP at the optimal cut-off were 93.59% and 91.84%, respectively. Among the evaluated scores, TASH was the most accurate for predicting PRBC transfusion in multiple trauma patients in the ED. Furthermore, among the pre-hospital scores, the Shock index was identified as the most accurate predictor for PRBC transfusion. This score is recommended for use in the ED due to its simplicity, rapid calculation and high prediction accuracy. The MTTP, the newly developed scoring system in this study, outperformed all the other scores.

Transcription errors pose significant risks to patient well-being, potentially leading to morbidity, mortality, and financial burdens on healthcare systems and society. This study assessed the prevalence of transcription errors and their impacts on medical treatment approaches, hospitalization duration, and associated costs.

Direct observation was used to evaluate and compare all patients’ medical records, identifying errors, costs, and hospitalization duration. Physician orders and patient applications were checked, with intervention and control groups categorized based on the presence or absence of errors, respectively. Data were analyzed using descriptive and quantitative methods such as the chi-square, student’s t-test, Mann-Whitney test, and ANCOVA, to assess statistical significance.

No significant differences were observed in gender (P=0.73) and age (P=0.89) between patients. Omission errors and incorrect dosage forms were the most common. Errors were more frequent in patients with underlying diseases (P<0.001), with nurses frequently involved (P<0.001). Errors were more prevalent in intensive care units (ICUs) (P=0.002) and during morning and night shifts (P<0.001). A significant association was found between trauma severity and medication error occurrence (P<0.001). Moreover, patients with transcription errors had higher medical expenses and extended hospital stays (P<0.001).

Effective preventive measures are crucial to avoid transcription errors and their adverse consequences. Recommendations include minimizing abbreviations, ensuring complete and explicit orders, rigorous training, double-checking, using technology such as Electronic Prescription and Physician Orders, maintaining a distraction-free, ergonomic work environment, and fostering open communication among healthcare providers and patients to enhance medication safety.

Traumatic brain injury (TBI) represents a critical medical condition imposing a substantial disease burden globally. Appropriate fluid resuscitation is essential for trauma recovery. This study evaluated optimal fluid strategies for TBI patients.

This cross-sectional study examined 358 traumatic brain injury patients admitted to the emergency department of a hospital in Mashhad from June 2018 to June 2021. Patients were categorized into four groups per total pre-hospital fluid volume received, five groups per fluid type received, and three groups per pre-hospital transport times. Variables, such as the Glasgow Coma Scale (GCS), blood pressure, mortality, and morbidity, were recorded.

In patients with normal blood pressure, there was no difference in outcomes between normal saline versus balanced crystalloids. In hypotensive or severely injured patients with injury severity scores greater than 16, 1-2L normal saline was associated with shorter hospital stays than >2L fluids. Pre-hospital transport times < 15 minutes were correlated with lower mortality and shorter hospitalizations versus > 15 minutes.

Fluid volume impacts outcomes in traumatic brain injury. In hypotensive or severely injured patients (ISS>16), 1-2L normal saline was linked to shorter hospital stays versus >2L fluid volumes. The type of crystalloid did not affect outcomes in normotensive patients. Minimizing pre-hospital transport times below 15 minutes may improve patient survival and recovery. Optimizing fluid resuscitation protocols has the potential to improve traumatic brain injury prognosis.

Trauma is a leading cause of death and disability in developing countries, with maxillofacial fractures being a significant part of such cases. This study focuses on maxillofacial traumas among insured patients in Razavi Khorasan province (2016-2021), exploring the impact of gender, age, and trauma causes on injury prevalence and treatment approaches.

This retrospective cross-sectional study utilized the records of the patients who were treated for maxillofacial fractures in Mashhad Shahid Kamyab Hospital or a Private Trauma Center, from 2016 to 2021. Demographic characteristics of the patients (age and gender), educational backgrounds of surgeons, accident causes, year and location of the fractures, and reasons for referrals were recorded. The data were statistically analyzed using SPSS 20, and the significance level was set at 0.05.

We examined the records of 60 patients (44 males, 16 females). Males (73.4%) exhibited a significantly higher prevalence of maxillofacial traumas compared to females (26%) (P Value < 0.05). Falling was identified as the most common cause of fractures (51.7%), followed by impacts from hard objects and motor vehicle accidents (MVA) (P Value = 0.63). Mandible fractures were observed in 48% of patients, followed by zygomaticomaxillary and panfacial fractures, subsequently (P Value < 0.05).

The study findings highlight the impact of age, gender, and trauma causes on maxillofacial fractures and treatments among patients with certain insurance. Understanding the origins and patterns of these fractures offers crucial insights for shaping effective health policies, providing valuable guidance for addressing such injuries in this population.

Overcrowding in emergency departments (ED) is a global concern, emphasizing the need for effective resource allocation. Triage plays a crucial role in prioritizing patients based on medical needs. This study aimed to evaluate the accuracy of National Early Warning Score (NEWS) in predicting the ED patients’ outcomes.

A cross-sectional study was conducted in two tertiary hospitals in Tehran, Iran, from June to July 2023. Adult patients presenting to ED were included. Data for calculating the NEWs and emergency severity index (ESI), as well as outcomes were recorded by trained nurses, and then the accuracy of each score in predicting the outcomeswas evaluated.

A total of 2,085 patients were analyzed. The majority were male (57%) with a mean age of 54.4 years. The primary outcome, cardiopulmonary resuscitation (CPR) within 24 hours of admission, occurred in 1.9% of patients, while the need for intensive care unit (ICU) care and/or mechanical ventilation happened in 3.4%, and CPR or need for ICU care and/or mechanical ventilation was observed in 4.3% of studied cases. Each one-point increase in NEWS was associated with a 52% higher likelihood of CPR (95% confidence interval (CI): 1.41 to 1.65, p<0.001). Receiver operating characteristic curve analyses for the NEWS yielded the optimum cut-off value to be 6 for all three outcomes, with an overall area under the curve (AUC) of 0.856 (95% CI: 0.840 to 0.871), 0.834 (95% CI: 0.817 to 0.850), and 0.854 (95%CI: 0.838 to 0.869) for the primary, secondary, and tertiary outcomes, respectively.

NEWS 6 was associated with a higher incidence of adverse outcomes, including ICU admission and need for CPR. The good predictive validity of NEWS highlights its value in identifying patients at higher risk of adverse outcomes.

This study aims to characterize the demographic, clinical, and radiological features of gunshotwound (GSW) patients as well as identify predictors of prolonged hospitalization. In this retrospective study, a consecutive sampling method was used, including all patients withGSWs in any anatomical region. Data collection included demographic and clinical information, radiologicalfindings, treatment specifics, and outcome variables, such as hospitalization length of stay (LOS) as the primaryoutcome. To identify predictive factors associated with prolonged LOS, logistic regression analysis was used. We studied 212 GSW cases, including 95.8% were men and 4.2% were women. The mean age of thestudied group was 30.17±7.80 years. GSWs occurred in extremities (80.2%), abdomen (9.0%), thorax (4.7%),and head or neck (5.2%). Two patients (0.9%) had both abdominal and thoracic GSWs. The most prevalentradiological study was an X-ray (83.0%). Patients with head and neck GSWs had the longest emergencydepartment stay, while patients with abdominal GSW patients had the shortest (p=0.068). The highest ratesof blood product transfusion were observed in abdominal GSWs (63.2%), emergency surgery (63.2%), andICU admission (42.1%). Head and neck GSWs had the longest hospitalization LOS (7.5 days). Longer LOSwas significantly associated with abnormalities in radiological findings, receiving blood products, and ICUadmission (p≤0.001). Significant predictors of prolonged LOS were major abnormalities in radiological findings[odds ratio (OR)=5.3; 95% confidence interval (CI):2.8-10.2], head and neck GSWs (OR=6.1; 95% CI:1.2-31.9),and blood product transfusion (OR=4.1; 95% CI: 1.0-16.3). This study provides insights into factors influencing prolonged hospitalization in GSW patients,highlighting the importance of radiological findings, head and neck injuries, and blood product transfusion.

Physical injuries affect the psychological dimension of human beings. This study aimed to investigate the impact of physical injuries on the psychological dimension of people.

This is a cross-sectional descriptive study that was conducted on traffic police staff who were referred to Valiasr hospital in Tehran, Iran due to injuries between April 2015 and November 2021. The required information was collected from the database using medical documents and registered files of injured employees. After coding data, SPSS version 26 software was used for statistical analysis.

Among the 120 injured people, the highest average score evaluated by the GHQ questionnaire was obtained by the ear, nose, and throat group (22%), upper limb (20%), eye (19%), lower limb (17%), and digestion (14%), which shows that in some cases (physical scale, anxiety and sleep disorder, symptoms of social action, symptoms of depression) are exposed to damage. The urology-affected group got the lowest score among the different groups with 8%, which indicates that this group is in a very favorable state in terms of mental health.

The results of this study showed that the most type of physical injury that affected the psychological dimension of people was the ear, nose, and throat injury, and the least injury was related to urology.

Skeletal muscle damage in rhabdomyolysis can cause the release of the contents of damaged myocytes into the bloodstream and acute kidney damage as a serious complication. In this syndrome, the levels of serum creatine kinase and urine myoglobin increase significantly. Better knowledge of the pathophysiology of rhabdomyolysis and its resulting acute kidney damage can help maintain kidney function by increasing treatment options.

This review study focuses on epidemiology, pathophysiology, causes, effective mechanisms, diagnosis, and management of acute renal injury following rhabdomyolysis. Any form of muscle injury can cause rhabdomyolysis. Ageing, trauma, drug abuse, and infections have been identified as the most common causes of rhabdomyolysis.

Paying attention to the underlying pathology and effective mechanisms in the incidence of acute renal injury following rhabdomyolysis can play a key role in measuring the severity of injury, triage, and treatment of patients. Also, the study of biological findings can play a key role in identifying rhabdomyolysis patients at risk of acute kidney injury, predicting different stages of injury, reducing mortality and morbidity, and improving treatment protocols.

Rhabdomyolysis has been introduced as an important clinical challenge. Non-specific symptoms, presence of multiple causes for its onset, and systemic problems in patients complicate diagnosis and treatment. Understanding the pathology of myoglobin-induced acute kidney injury and extensive fluid therapy are the cornerstones of treatment. All physicians should be aware of the common causes, diagnosis, and treatment options because one of the most important treatment goals in these conditions is to avoid acute kidney damage.

Occurrence of oxidative stress in uncontrolled diabetes mellitus affects spermatogenesis and the testicular functions. As the promising antioxidant activities of fullerene C60 nanomaterial have been demonstrated by previous reports, the current study aimed to determine the fullerene C60 effects on the markers of oxidative stress damage in testes of streptozotocin-induced diabetes in rats.

To perform the current study, 32 male Wistar rats were assigned to four groups (each group, n=8) as follows: two control (normal and diabetic) and two treated (normal and diabetic) groups. Streptozotocin at dose of 45 mg/kg (i.v. injection) was used to induce diabetes at the beginning of the test. Treated rats orally received fullerene C60 (1 mg/kg/day) for 8 weeks. The markers of oxidative stress damage were assessed in the testes at the end of the study, including malondialdehyde (MDA) and glutathione (GSH) contents as well as superoxide dismutase (SOD) and catalase (CAT) activities. One-way ANOVA and Tukey’s post-hoc test were used to analyze the data.

Blood glucose level was not altered in the fullerene-treated normal and diabetic animals. Diabetes induction increased MDA level, but decreased CAT activity in the testes of diabetic animals compared to the normal animals. Administering fullerene C60 significantly decreased MDA content and increased the activity of CAT in the testes of diabetic animals compared to the untreated diabetic rats. Fullerene C60 administration in normal animals also decreased the activity of SOD in the testes.  

According to our findings, fullerene C60 nanoparticle could reduce oxidative stress damage in diabetic condition in the rat testicular tissue probably through potentiating the antioxidant defense system.