seyed hossein ojaghi haghighi

Congestive heart failure is heart muscle failure that causes pulmonary congestion and eventually pulmonary edema, which despite recent medical advances, is still a progressive syndrome with high mortality, the prevalence of which has increased in recent decades. Therefore, in this study we compared lung ultrasound findings in acute heart failure patients with the BNP.

This study was performed in the emergency room of Imam Reza hospital in Tabriz. For patients entering the emergency room after taking a history, both standard gold (BNP) tests and beside ultrasound of the lung were performed. Ultrasound was performed at the same time as obtaining blood sample to ensure that the ultrasound specialist did not know the result of diagnosis. During the ultrasound, if there were multiple B-Lines that were at least 3 mm apart, patient was diagnosed with pulmonary edema due to heart failure.

Number of participants in this study was 108 people, 54.6% of whom were men and the rest were women. The correlation coefficient between width and number of kerley lines was 0.79, between NT-pro BNP and width of kerley lines was 0.65 and between NT-pro BNP and number of kerley lines was 0.77, which indicates a significant positive correlation (P value <0.001).

The results of present study showed that in patients with acute heart failure, the number and width of kerley lines in pulmonary ultrasound evaluation increase rapidly. There is also a high correlation between number and length of kerley lines with NT-pro BNP serum values.

Early cervical spine clearance is very important in trauma settings. Waiting for cervical spine clearance by CT scan mandates prolonged cervical spine immobilization and consequently, the delay in subsequent emergency procedures in polytrauma patients.

The study aimed to assess the value of cervical spine ultrasonography (US) for detecting cervical spine injuries in severe polytrauma patients.

A cross-sectional analytical study was conducted on 172 severe polytrauma patients with Glasgow coma scale (GCS) score of < 12 or triage revised trauma score (TRTS) of < 8. The researcher performed bedside cervical spine US without impeding the ongoing routine trauma management. The researcher was blind to the computed tomography (CT) scan findings. The data were analyzed by SPSS software and sensitivity, specificity, and positive/negative predictive values were determined based on CT findings. The results were also compared between children (≤ 14 year) and adult (> 14 year) age groups.

Bedside US had a sensitivity of 74.5%, specificity of 97.6%, positive predictive value (PPV) of 92.1%, negative predictive value (NPV) of 91%, and accuracy of 91.3% in detecting spinal injuries in comparison with CT findings. Moreover, US had a sensitivity of 100%, specificity of 87.6, PPV of 50%, NPV of 100%, and accuracy of 88.9% in detecting spinal injuries with the movement of fractured or dislocated particles. Also, it had a sensitivity of 33.3%, specificity of 87.58, PPV of 100%, NPV of 97.2%, and accuracy of 97.2% in ≤14-year-old patients. The modality had a sensitivity of 76.2%, specificity of 94.7, PPV of 91.4%, NPV of 84.4%, and accuracy of 86.9% in > 14-year-old patients.

The diagnostic value of bedside US was higher in adults and injured patients with the movement of fractured or dislocated particles.

The goal of continuing medical education is improving the skills, performance and updating the knowledge of health care professions. To achieve this goal, need assessment should be performed prior designing programs. The purpose of this study was to systematically review the variety of the need assessment methods and extracting need assessment gaps in continuing medical education. This systematic review was performed by searching the Medline/PubMed, Web of Science, Scopus, Eric, ProQest, Google Scholar, Magiran, Iran Medex, and SID databases by both Persian and English keywords. We included studies from 1987 to 2018. The results of all studies were reviewed by two researchers using CASP checklists. Among 631 articles, 27 articles were included in the study. The results showed that 41% of need assessments were based on felt need by the learners. Need assessment based on patients need and overlapping service delivery by several professions has been less performed. Need assessments were focused more on medicine, dentistry and nursing. Some of the studies had used several approaches to extract needs. So, the patients and overlap services need assessment could be expressed as a missing link in the continuing medical education need assessments, which it will eventually cause damage to the community. For achievement comprehensive needs assessment, we can be used several need assessment approaches. Since medical service is a team work, those in charge of continuing medical education need to perform educational need assessment to promote education and treatment by empowering the members of treatment team.

Pregnancy is an important psychological and biological phenomenon in women’s life. Pregnancy has many complications jeopardizing the well-being of the mother and the child.
In this retrospective study, the data including demographic information, chief complaint, the initial diagnosis, referral decision, final diagnosis, hospitalization outcome and pregnancy outcomes were studied on 239 pregnant women admitted to the emergency departments of the general hospitals of East Azerbaijan province.
The average age of patients was 27.54 years. The time period from the initial presentation to completely leave the emergency department was reported to be 3.66 hours on average. In this study, most patients (74.5%) did not have a history of abortion. Exploring the time of admission for all cases, most patients were admitted from 8 pm to 8 am (67.8%), and 32.2% were referred from 8 am to 8 pm. Concerning the time of pregnancy, 46.4% were at their second trimester of pregnancy. Most of the patients were admitted in cold seasons of the year. The most common chief compliant was abdominal pain with 32.2% frequency. In addition, the most frequent primary diagnoses were an acute abdomen and trauma at 25.5% and 14.2% respectively.
Abdominal pain and acute abdomen have the most frequency as the chief compliant and initial diagnosis especially during the second trimester of pregnancy. In this regard, appropriate training and skillful staff are needed to deal with the complaints and complications of abdominal pain. More than half of pregnant women referred to the emergency departments were hospitalized or admitted to the intensive care unit (ICU). This signals the necessity of adequate facilities to provide proper care for this group.

Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in the prevention of death or delaying it in a person with cardiac arrest. In this regard, demographic information about patients who need CPR is vital.
In this cross-sectional study patients with cardiopulmonary arrest or arrhythmias admitted to Imam Reza and Sina educational hospitals of Tabriz University of Medical Sciences from 22 December 2013 to 21 December 2014 entered the study. Demographic information such as age, sex, cardiopulmonary resuscitation time, the place of cardiopulmonary arrest (outside or inside the hospital), the duration of resuscitation process, success or failure of the resuscitation process and the mechanism of cardiopulmonary arrest were obtained.
From a total of 354 cases of cardiopulmonary resuscitation, 281 cases (79%) were unsuccessful and 73 cases (21%) were successful. The average age of patients was 59 ± 22 years. The average time of the resuscitation process was 31 ± 12 minutes. There was a significant difference between the mean of age and resuscitation time in patients who had experienced successful or unsuccessful resuscitation (P = 0.0001). There was a significant relationship between sex and the success rate of resuscitation (P = 0.0001). In addition, a significant relationship between the success of the resuscitation operation and the ward of resuscitation was observed (P = 0.0001).
The most common mechanism leading to cardiopulmonary arrest among patients was asystole. In this regard, no significant difference was observed between successful and unsuccessful resuscitation processes. It was also observed that the success of resuscitation from 8 am to 4 pm was more than any other time period.

Pain relief after surgery is an essential component of postoperative care.. The purpose of this study was to compare the efficacy of intravenous acetaminophen and intravenous meperidine in pain relief after outpatient urological surgery..Patients and In a prospective, randomized, double-blind clinical trial, 100 outpatients of urological surgery were studied in two groups of acetaminophen (A) and meperidine (M). Patients in group A received 1g of acetaminophen in 100 mL saline within 15 minutes and patients in group M received a single intravenous injection of meperidine 0.5 mg/kg, 15 minutes prior to the end of operation. Postoperative pain was recorded using visual analog scale (VAS). Vital signs, nausea, vomiting, dizziness and respiratory depressions were compared between the two groups.. Pain severity in patients treated with intravenous acetaminophen six hours after the operation within one-hour interval was significantly lower than meperidine group (P < 0.0001). Ninety patients in the meperidine group and five patients in the acetaminophen group required additional doses of analgesics. Nausea was significantly lower in acetaminophen group than meperidine group.. Intravenous acetaminophen reduced pain following outpatient urological surgery more significantly than meperidine..

Traumatic eye injuries (TEI) involved about 3% of cases referred to the emergency departments of developing countries. Lens dislocation is one of the critical cases of ophthalmic emergencies. The present study was aimed to evaluate the diagnostic accuracy of ultrasonography in detection of traumatic lens dislocation. In this cross-sectional study the findings of ultrasonography and orbital computed tomography (OCT) of head and face trauma patients, referred to Imam Reza hospital, Tabriz, Iran, from July 2013 to June 2014, have been compared. The sensitivity, specificity, positive and negative likelihood ratio, positive and negative predictive value, and accuracy of ultrasonography were calculated. Cohen's kappa coefficient was presented to assess the agreement of ultrasonography with OCT findings. One hundred thirty patients with the mean age of 35.4±18.0 were evaluated (75.4% male). Sensitivity and specificity of ultrasonography were 84.6% (95% Cl: 53.7-97.3) and 98.3% (95% Cl: 93.3- 99.7), respectively. Also, positive and negative likelihood ratio were calculated 49.5 (95% Cl: 12.3-199.4) and 0.15 (95% Cl: 0.04- 0.56), respectively. Cohen's kappa coefficient of 0.83 (95% Cl: 0.66-1.0; p<0.0001) was representative of excellent agreement of these two tests. The finding of this project was representative of 84.6% sensitivity, 98.3% specificity, and 96.9% accuracy of ultrasonography in detection of traumatic lens dislocation. It seems that in cases which OCT is not possible, ultrasonography could be an acceptable option to assess traumatic eye injuries.