فهرست مطالب mohammad sazgar

Trauma to the knee is one of the most common injuries in people, especially young people, and delay in the diagnosis of knee fractures and soft tissue injuries in the knee causes limitation of movement, instability, and constant knee pain. In this research can show the correlation between the initial symptoms of the patients and the need for further procedures. To be able to identify traumatic knee injuries that are not clear in the simple knee radiography and to evaluate the findings of the patients for further procedure.

This research is an observational study in which all patients who presented with knee trauma during the course of the study were included in the study. All the information of these patients in a form including age, age group and sex, admission and discharge information such as visit date, discharge date, duration of hospitalization, mechanism of trauma, underlying disease, knee pain, limitation of range of motion, hemarthrosis, associate injury, skin abrasion, Inability to walk, history of knee trauma, radiography findings, knee CT findings, MRI findings, arthroscopy findings, Lysholm and Tegner knee score, probable diagnosis in the emergency room, type of treatment the emergency room, duration of hospitalization in the emergency room, discharge from the emergency room, in The hospitalization form of the performed procedures, the time of hospitalization in the ward and the definitive diagnosis were collected, and then 4 weeks after discharge, they were followed up by phone call with referral to the orthopedic clinic, and other diagnostic and therapeutic measures were reviewed in these patients. The information was provided by the project manager without interfering in the patient care process. Quantitative data were expressed as mean and standard deviation and qualitative data were expressed as frequency and percentage. Independent student t-tests were used to evaluate quantitative variables in two groups, and the Chi-Square test and Fisher's exact test were used to evaluate qualitative variables.

During the study period, 177 people were studied. The average age of the patients was 24.21±13.08, of which 138 (76.7%) were men. Most of the injury was caused by traffic accidents. The initial diagnosis in the emergency department had a significant relationship with the definite diagnosis. A statistically significant relationship was seen between MRI findings with knee movement limitation and non-weight bearing. There was a statistically significant relationship between the existence of definitive injury in the knee, limitation of knee movement, lacerations and scratches on the knee, and non-weight bearing. The mechanism of knee injury and laceration, the inability to weight bearing, and the positive findings of X-ray and MRI in the patients who underwent invasive procedures were significantly different from those who received conservative treatment.

Injury mechanisms in patients and clinical symptoms such as knee range of motion limitation and non-weigh bearing and abrasion or laceration of the skin on the knee, despite the lack of findings in the initial investigations in the emergency department, is a high chance of injury to the knee joint and they need further evaluation and follow-up.

Investigation for an accurate, reliable, and non-invasive method for assessing volume responsiveness in septic shock patients is of high priority in the emergency department. Carotid artery Doppler sonography can be easily performed at the bedside. Therefore, this study used carotid Doppler sonographic parameters to determine and evaluate the need for volume in patients with septic shock.

The present single-center, prospective, observational study was performed on all patients with septic shock admitted to emergency department during the study period. Vital signs, diameter of the inferior vena cava (IVC), and the carotid Doppler peak velocity (CDPV) were evaluated on arrival and two hours after resuscitation. Data description and analysis were done using SPSS.

Forty-four patients enrolled in this study, of which 30 (68.2%) were men. The average age of these patients was 62.55±17.91 years.The findings indicated a statistically significant increase in IVC min (P=0.016), CDPV max (P=0.001), and ΔCDPV (P<0.0001) in patients after two hours of treatment.

Carotid Doppler sonographic parameters can be implemented, as a dynamic criterion, to determine the fluid responsiveness in patients.

Testicular torsion is an important and critical issue in patients with acute scrotum referring toemergency department (ED). Early detection is very important to save the testicles. This study aimed to de-termine the diagnostic accuracy of clinical variables in predicting the presence of testicular torsion.

This prospective cross-sectional study was done using the information of patients hospitalized from September2015 to September 2020, with complaint of acute scrotum (ICD 10 code: N50.8), referring to ED for evaluationof the clinical predictors of testicular torsions, which were confirmed by surgery.

81 patients with themean age of 20.07 ± 9.64 (3- 45) years were studied. After surgical exploration, 70 patients (86.4%) had testiculartorsion. Patients with torsion had lower age (p < 0.0001), lower time from symptom to ED visit (p < 0.0001), sud-den onset pain (p = 0.003), left side pain (p < 0.0001), and lower white blood cell (WBC) count (p = 0.001). Thefrequency of dysuria (p = 0.032), diarrhea/vomiting (p = 0.005), and fever (p = 0.002) was significantly lower inpatients with torsion. The cremasteric reflex was absent in 57 (81.4%) cases who suffered from testicular torsion(p = 0.001). Based on the results of binary logistic regression analysis, age (B = -0.175, SE = 0.45; p < 0.0001)was the sole independent predictor of testicular torsion. The highest area under the receiver operating char-acteristics (ROC) curve in predicting the presence of torsion belonged to lower age [91.0 (95%CI: 83.2 – 98.7)],pain in left testis [0.931 (95%CI: 0.828-0.987)], and lower WBC count [0.805 (95%CI: 0.684-0.926)], respectively.

It seems that clinical variables are not accurate enough to be considered as the sole predictor oftesticular torsion and they should be used with caution and in combination with other available screening toolslike Doppler ultrasonography in this regard.

Septic shock is a critical medical condition and immediate intervention is required as well as hemodynamic stability using fluid and vasopressor. Direct relationship between changes in ETco2 and changes in the cardiac output. We evaluated the study by comparing the effect of using norepinephrine or dopamine on ETco2 of patients with septic shock.

A clinical trial study was performed on 138 patients with primary diagnosis of septic shock. 70 patients received norepinephrine and 68 patients received dopamine. Patientschr('39') end tidal carbon dioxide (ETco2), mean arterial pressure (MAP), pulse rate (PR), arterial blood gas (ABG) levels in two groups were measured and compared at baseline and after 30 and 120 minutes after inotrope infusion. Variables were compared by means of an unpaired student t-test, an unadjusted chi-square test.

138 patients, 70 treated with norepinephrine infusion and 68 with dopamine infusion were included in the study. ETco2 level significantly increased within 120 minutes of treatment in the norepinephrine group (31.10±9.65) compared to the dopamine group (23.71±9.66) (P=0.001). MAP significantly decreased in the group of norepinephrine 30 minutes after treatment (71.71±20.460) (P=0.014) and pulse rate also significantly decreased in the norepinephrine group compared to the dopamine group in 30 minutes (98.07±10.63 vs 106.43±13.54) and 120 minutes (91.15±6.18 vs 103.51±2057) after treatment (P=0.001).

Tissue perfusion and fluid responsiveness of the shock in the norepinephrine group showed improvement. Using ETco2 as a measure for determining volume assessment in patients undergoing mechanical ventilation by septic shock is applicable.

Acute urinary retention due to benign prostatic enlargement is one of the clinical complaints that patients refer to the emergency department. Selective α-blockers are used after urinary catheterization. Recently, the use of nitrate compounds has been shown to relieve bladder neck and to treat acute urinary retention. 

The aim of this study was to survey the addition of Isosorbide di nitrate to tamsulosin in the treatment of acute urinary retention in patients with benign prostatic hyperplasia. 

This is a randomized, double-blind placebo-controlled clinical trial. In all, 78 patients with benign prostatic hyperplasia-related acute urinary retention referred to the emergency department were divided into two groups and randomly assigned to receive either 0.4 mg tamsulosin plus placebo or 0.4 mg tamsulosin plus isosorbide dinitrate 40 mg extended-release tablets daily for 3 days. At the same first visit, the catheter was removed and the ability to void in same time and 1 month later was assessed in each group. 

After catheter removal, 27 (67.5%) patients in the tamsulosin plus placebo group and 31 (81.6%) in the tamsulosin plus isosorbide dinitrate group voided successfully after 3 days (p = 0.155). After 1 month, 20 (50.0%) patients taking tamsulosin plus placebo and 23 (60.5%) taking tamsulosin plus isosorbide dinitrate could void, yet indicating no significant difference (p = 0.350). 

Addition of isosorbide dinitrate to α-blockers has advantage in improving benign prostatic hyperplasia-related acute urinary retention versus tamsulosin alone, although was not statistically significant.

Acute scrotum syndrome is one of the complaints in emergency departments which has several causes. This study was performed to determine the causes and symptoms of acute scrotal pain in patients attending emergency departments in Mazandaran province, Iran.

A cross-sectional study was done in all patients with acute scrotum syndrome in emergency departments affiliated to Mazandaran University of Medical Sciences, 2011- 2016. Patients’ medical records (clinical and paraclinical information, and diagnostic and therapeutic procedures) were investigated. Data analysis was done applying Chi- square test and t-test.

The study included 205 patients with a mean age of 34.10±17.34. Patients were diagnosed with testicular torsion (n=60, 29.3%), epididymo-orchitis (n= 63, 30.7%), inguinal hernia (n= 69, 33.7%), varicocele (n=11, 5.4%), and testicular torsion (n=2, 2.1%). In testicular torsion, the pain was most sudden (23.9%) and the duration of symptoms onset and arrival at emergency department was 3.62±4.38 hours. The definitive diagnoses were consistent with ultrasound findings in 91.7% of the cases with testicular torsion, 96.8% of those with epididymis orchitis, 95.7% of patients with hernia, and in 54.5% of cases with varicocele.

Younger age, duration of pain, sudden pain, and cremaster reflex are helpful in differentiating testicular torsion from other causes of acute scrotum syndrome. Ultrasonography of the testis should be immediately performed as the main diagnostic measure for acute scrotum syndrome.

About one third of patients referring to emergency department (ED) with abdominal pain, are discharged without a definite diagnosis. This study aimed to investigate the one-month outcome of patients with unspecified abdominal pain. This cohort study was conducted on subjects who were evaluated in ED with unspecified abdominal pain and were referred to the gastroenterology clinic and followed for one month. Finally, they were divided into two groups of cases with clear cause of abdominal pain and unclear cause of abdominal pain and patients’ characteristics were compared between the groups. 150 cases with the mean age of 40.68 ± 18.34 years were studied (53.3% female). After one month, 67 (44.7%) patients still complained of abdominal pain. A definitive cause of abdominal pain was established in 88 (58.7%) cases. There was not any significant difference between groups regarding, sex distribution (p = 012), duration of pain (p = 0.11), history of previous similar pain (p = 0.136), pain radiation (p = 0.737), length of hospital stay (p = 0.51), and presence of anorexia (p = 0.09), nausea and vomiting (p= 0.50), fever (p = 1.0), diarrhea (p = 0.23), and constipation (p = 0.07). There was a significant difference between the groups regarding location of pain (p = 0.017), age (p = 0.001) and history of comorbid diseases (p = 0.046). The predictive factors of finding a clear cause for abdominal pain in one-month follow-up, were leukocytosis (OR: 5.92 (95% CI: 2.62 – 13.39); p < 0.001), age (OR: 2.78 (95% CI: 1.15 – 6.71); p = 0.023), and outpatient follow-up (OR: 1.04 (95% CI: 1.02 – 1.07); p < 0.001). Approximately, 40% of patients who were discharged with unspecified abdominal pain did not receive a clear diagnosis after one month of follow-up. Older age, leucocytosis in initial evaluations, and outpatient follow-up increased the probability of finding a clear cause for abdominal pain in the mentioned cases.

Capnograph is an indispensable tool for monitoring metabolic and respiratory function. In this study, the aim was to review the applications of end-tidal carbon dioxide (ETCO2) monitoring in emergency department, multiple databases were comprehensively searched with combination of following keywords: “ETCO2”, “emergency department monitoring”, and “critical monitoring” in PubMed, Google Scholar, Scopus, Index Copernicus, EBSCO and Cochrane Database.