Trauma Monthly
Volume:19 Issue: 1, Jan-Feb2014

Several systemic factors and hormones are thought to regulate the fracture healing process. Vitamin D has emerged as a compound or hormone that actively participates in the regulation of calcium homeostasis and bone metabolism.

The aim of this study is to determine the serum changes in the level of vitamin D during the acute healing period of tibial and femoral shaft fractures.

This cross-sectional study included of 73 patients with tibial and femoral shaft fractures referred to the Poursina Hospital between February 2011 and February 2012. Changes in the serum levels of vitamin D were assessed three times in a period of three weeks (at the first visit, end of first week, and end of the third week). Variables such as age, gender, fractured bone, concomitant fracture of tibia and fibula, type of fracture, time of measurement and serum levels of 25-hydroxyvitamin D were assessed. All statistical analyses were performed using the SPSS software.

Forty tibial fractures and 33 femoral fractures were recorded. Mean vitamin D levels at the time of admission, after one week and at the end of the third week for the 73 participants included in the study were 39.23, 31.49, and 28.57 ng/mL, respectively. The overall reduction of vitamin D level was significantly more evident in the first week versus the following (P < 0.0001).

Serum levels of vitamin D in patients with tibial or femoral fractures were reduced during the curative period of the fracture. This can be related the role of vitamin D in the formation and mineralization of the callus. Patients with tibial or femoral shaft fractures may benefit from the administration of vitamin D supplements during the fracture healing process.

Exposure to chemical warfare gases significantly changes the quality of life (QoL) of victims and has significant chronic adverse effects.

This study sought to assess the health-related QoL (HRQoL) of chemical victims by means of a tool specifically designed for this purpose. The correlation of their QoL with several demographic factors was evaluated as well.

In this descriptive cross-sectional study, 120 chemical warfare victims were selected from subjects presenting to selected medical centers in Tehran in 2012 using convenience sampling. Two questionnaires of demographic information and HRQoL of chemical warfare victims (specific tool) were used for data collection. The data were analyzed using SPSS version 20 software (IBM, Armonk, NY, USA).

The mean and standard deviation (mean ± SD) of scores obtained by chemical warfare victims in physical, psychosocial and spiritual domains was 39.6 ± 16.5, 42.1 ± 15.2 and 82.4 ± 15.4, respectively. Different age groups showed a significant difference in the psychosocial domain score (P < 0.01). Also, the physical and spiritual domain scores had significant differences with respect to the level of education (P < 0.001). The occupational status showed significant differences in the psychosocial and spiritual domains scores of QoL (P < 0.001). The physical and psychosocial domain scores also accounted for a significant difference with respect to the duration and severity of pulmonary symptoms (P < 0.05).

Considering the importance and high value of spirituality in chemical warfare victims, it can be used as strategically for these patients to help them cope with their injury and improve their physical and psychosocial health and QoL.

Pain management with the use of sedatives and analgesics has several advantages and few complications or side effects.

In this study, we planned to evaluate the effects of pain control on oxygen saturation independent of other factors, such previous cardio-pulmonary conditions or respiratory rate.

Sixty-seven adult patients with direct trauma to extremities, who were referred to Imam Hossein Educational Hospital emergency room were enrolled in this study. Exclusion criteria were trauma to parts of the body other than extremities, and comorbidity with cardiovascular, pulmonary, or other disorders. Pain was evaluated using a numerical rating scale and scored between 0-10. Patients’ respiratory rates (RR) were recorded by a physician and blood oxygen saturations were measured using a pulse oximeter. Then, fentanyl 1 μg/kg was administered under direct supervision of a physician. After five minutes, pain score, oxygen saturation, and RR were measured in the above-mentioned order.

The data from 67 patients with a average age of 30 years were collected: 77% were male and 23% were female. The average pain score of these patients was 7.3 at the time of admission, which significantly decreased to 3.8 after fentanyl administration (P < 0.001). Upon arrival in emergency department the mean oxygen saturation and RR were 97.1% and 21.5/minute, respectively. After pain control, mean oxygen saturation and RR were 94.9% and 19.2 /minute, respectively, showing a significant decrease only for RR in comparison with that at the time of admission (P < 0.001). Regression analysis of pain score and O2 saturation differentiation showed no significant relation between these variables. There were no side effects or complications of fentanyl observed in these patients.

The results of our study revealed no independent causative relationship between pain control and oxygen saturation.

Burn injuries impose a considerable burden on healthcare systems in Iran. It is among the top ten causes of mortality and a main cause of disability.

This study aimed to examine factors influencing mortality in burn patients admitted to the main educational tertiary referral hospital in Kermanshah.

All patients admitted to the Imam Khomeini Hospital (from March 2011 to March 2012), due to thermal burn injuries were included in the study. We applied multiple logistic regressions to identify risk and protective factors of mortality. Also we calculated lethal area fifty percent (LA50), as an aggregate index for hospital quality.

During the study period, 540 burn patients were admitted. Male to female ratio was 1.12:1. Twenty three percent of the patients were less than 15 years-old. Median of age was 25 years (Inter Quartile Range, 16 - 37). Overall, probability of death was 25.8%. Lethal area fifty percent (LA50) was 50.82 (CI 95%: 47.76 - 54.48). In the final model, after adjustment of sex, age, total body surface area (TBSA), cause of burn and it’s severity, female gender (P < 0.05), age ≥ 60 years (in comparison with age less than 15 years, P < 0.05) and larger burn size (P < 0.0001) were identified as the main risk factors of death in these patients.

Findings showed that the main risk factors of death were female gender, burn size and old age. Directing more attention to these vulnerable patients is required to reduce mortality and improve patient survival.

Hypertension (HTN) is a serious health problem that threatens one fourth of the adult population in some countries.

This study aimed to assess the prevalence and outcome of undiagnosed hypertensive patients admitted to the emergency department.

This cross-sectional study was conducted from March 2009 to March 2010 at Imam Hossein Medical and Educational Center, Teheran, Iran. A total of 2070 patients aged 18 years and older were admitted to the emergency department without previous HTN history. Blood pressure was taken and repeated 10 minutes later if initial systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg. Those who matched the inclusion criteria entered the study for further follow-up. A numerical pain score was also used for pain intensity assessment. Chi-Square and Mann Whitney U tests were performed to compare differences between sex, age and education of the participants.

Based on the inclusion criteria, 346 patients entered the study, out of which 168 qualified for further evaluation and follow-up. Forty eight patients (28.6%) were finally diagnosed with high blood pressure. Our study showed that the prevalence of undiagnosed HTN was 4.8%. Significant differences between blood pressure, age, pain score and education level (P < 0.001) were found. This implies that old age, poor education and low pain score are positively associated with hypertension.

Blood pressure readings in emergency departments should not be readily attributed to pain or anxiety. Diagnosis must be based on meticulous follow-up and precise examinations.