Journal of Surgery and Trauma
Volume:8 Issue: 3, Autumn 2020

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a new virus from the coronavirus family (1) regarded as enveloped, positive-sense, single-stranded ribonucleic acid (RNA) viruses with helical symmetric nucleocapsid (2). According to the whole genome sequencing and phylogenetic analysis of coronavirus strains, a distinct clade of betacoronavirus is shown to be associated with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (3). This novel clade is called the 2019 novel coronavirus (2019-nCoV) and due to more similarity to the SARS virus is also called severe acute respiratory syndrome coronavirus 2. The disease is known as COVID-19.

Surgical site infection is one of the most common health-related infections, which can cause problems for health care providers by increasing morbidity and mortality, length of hospital stay, and costs. Undoubtedly, one of the most efficient and cost-effective ways to fight infection is to prevent it. An essential measure in infection control is the disinfection of the surgical team members to remove fat and contamination, eliminate transient microorganisms, and prevent the growth and proliferation of resident microorganisms on the skin. This study aimed to introduce different types of soap and alcohol disinfectant solutions for surgical scrub and describe the advantages and disadvantages of each by reviewing several recent research studies. This study is a brief overview of the recently conducted articles as searched in library resources, the Google Scholar Search Engine, Pubmed, UpToDate, Cochran, and Scopus databases using the English keywords of "hand hygiene", "infection control", "hand disinfection/methods", "hand disinfection/standards", and "Surgical Procedures, Operative" as well as the Persian keywords of "surgical scrub", "Povidone-iodine", "alcohol", and "hand disinfection". After reviewing 76 articles and eliminating the duplicate sources, 43 studies published from 2007 to 2019 were fully reviewed. Finally, 26 sources were selected as eligible with substantial relevance to the subject matter and subsequently reviewed. Based on the review of articles, it can be concluded that alcoholic solutions are often effective alternatives to soap scrub solutions due to their high disinfecting properties, safety, rapid effectiveness, and greater compliance with instructions.

The current study compared the amount of bleeding in propofol and isoflurane anesthesia in patients undergoing lumbar disc and cerebral hemorrhage surgery in Birjand teaching hospitals within 2017-2018.

This retrospective quasi-experimental study was conducted based on a nonequivalent group design. It was performed on patients within the age range of 18-75 years undergoing spinal surgery and cerebral hemorrhage who were referred to Imam Reza (AS) and Razi hospitals in Birjand within 2017-2018. Patient information was retrospectively collected using their medical records. The data were analyzed in SPSS software (version16) using the independent t-test, paired t-test, and Mann-Whitney test. A p-value less than 0.05 was considered statistically significant.

A number of 36 and 35 patients underwent propofol and isoflurane anesthesia, respectively. Both groups were individually matched on gender, and the propofol patients were not significantly younger than the isoflurane patients (P=0.006). There was no significant difference between the two groups in terms of pre- and postoperative bleeding, hemoglobin level, systolic blood pressure, and diastolic blood pressure. Preoperative hemoglobin, systolic blood pressure, and diastolic blood pressure in the propofol group were reported as 13.8±1.69 g/dl, 127.2±15 mmHg, and 80±8 mmHg, respectively. These values decreased to 13.03±2.01 g/dl (P=0.0001), 122.3±12.8 mmHg (P=0.079), and 76.5±9.7 mmHg (P=0.034) postoperatively. On the other hand, in the isoflurane group, preoperative hemoglobin, systolic blood pressure, and diastolic blood pressure were obtained at 13.7±1.62 g/dl, 128.4±18 mmHg, and 78.5±12.6 mmHg, respectively. These values also decreased to 12.8±1.9 g/dl (P=0.0001), 124.1±15.8 mmHg (P=0.217), and 76.0±11.9 mmHg (P=0.365) postoperatively.

Based on the obtained results, the amount of bleeding is similar in patients undergoing central nervous system surgery under either propofol or isoflurane anesthesia. Nevertheless, hypotension was higher in propofol-anesthetized patients. Inhaled anesthesia is advantageous over propofol anesthesia due to the possibility of metabolic acidosis in patients with controlled hypotension.

Although various factors have been recognized influencing the short-term and long-term survival of patients suffering from a heart attack, there are some other factors that have not been determined as prognostic factors affecting the survival of patients. One of these factors is the history of opioid use among patients. This study was conducted to investigate the relationship between the survival of patients suffering from acute myocardial infarction (AMI) and the use of opioids.

This prospective cohort study was carried out on 222 patients suffering from AMI admitted to two teaching hospitals. The patients who passed away in the emergency department were excluded from this study. All patients were divided into two consumers or non-consumers groups according to the past and present use of opioids. The patientschr('39') status was investigated within 3 months of hospitalization while their clinical symptoms were recorded. The collected data were analyzed in SPSS software (Version 18) using the Mann–Whitney U test and independent t-test. A p-value of < 0.05 was considered significant.

The mean age scores of subjects in the case and control groups were 61.3±13.2 and 61.5±12.6, respectively. Both groups had the same history of diabetes, hyperlipidemia, hypertension, and ischemic heart disease. Based on the results, although the mean score of survival of patients in the opioid user group was slightly higher than that in the control group within 1, 2, and 3 months after the hospitalization, this difference was not significant (P>0.05).

Opioid use has not any significant effect on the pain severity or mortality (survival) of patients after heart attack during 1, 2, or 3 months.

Thyroid surgery is one of the most common surgeries performed on the neck. There is a possibility of nerve injury and vocal cord paralysis due to the close anatomical relationship between recurrent laryngeal nerve and thyroid. Considering the importance of this study, it was performed to determine nerve damage during thyroid surgery.

This cross-sectional descriptive study was conducted on patients undergoing thyroidectomy at Gorgan University of Medical Sciences, Golestan Province, Iran, from 2016-2017. After providing a list of patients, their files were obtained. The demographic data relating to the type of surgery, type of pathology, and condition of the larynx after surgery were recorded. The patients were asked for a re-examination (if necessary), and the current condition of their larynx was determined. The collected data were recorded and analyzed in SPSS software (version 16).

The statistical population of this study consisted of 195 patients, among which 12.3% were male (24 cases), and 87.7% were female (171 patients). The type of surgery in 65.6% (n=128), 28.7% (n=56), and 5.6% (n=11) cases was thyroidectomy, hemithyroidectomy, and subtotal thyroidectomy, respectively. It was revealed that the most common pathology was papillary carcinoma. In terms of complications, there were two cases of laryngeal nerve injury, which persisted in only one case of unilateral paralysis. The type of surgery in both cases was total thyroidectomy.

Although recurrent laryngeal nerve injury is not common, in cases of total thyroidectomy, greater care should be taken to preserve the nerve.

Depressed skull fracture means to have a fracture that has a depth of more than a bone thickness. Consequently, the force is very small to a blunt object, which is often seen in the frontoparietal region due to the low bone thickness in the area. On the other hand, tearing of the dura matter beneath the depressed fractures has a great value from the prognostic and surgical point of view. This study aimed to investigate the relationship between the area of the depressed fracture and dural tear using computerized tomography scan at admission.

This cross-sectional study was performed on 40 patients who had been diagnosed with depressed skull fractures atImam Reza Educational Center, Tabriz University of Medical Sciences, Tabriz, Iran,within2016-2017. The level of consciousness, the Glasgow Coma Scale, and symptoms on admission were evaluated for each patient. The collected data were analyzed in SPSS software (version 22) using studentchr('39')s t-test and Chi-square test for statistical analysis of parametric and nonparametric variables. A p-value of less than 0.05 was considered significant.

The mean age of the cases was obtained as 34/9±14/32 (18-60) years. The mean depressed fracture area (6/93±5/52) ranged from 0/79-19/63cm² (7.13±5.99) for the patients with dural tear and 6.93±5.66 for the ones with intact dura. The cut-off point for predicting dural tear was determined 6.92 cm² with 84% sensitivity.

It was revealed that there was a significant correlation between the area of fracture depression and dural tear. Furthermore, in patients with dural tear, fracture depression level was considerably higher than that in patients with intact dura.

Patent ductus arteriosus (PDA) is an inborn heart defect in which the ductus arteriosus (i.e., a vascular structure between the pulmonary artery and aorta that usually closes shortly after birth) remains open. Because most patients with PDA are diagnosed and treated when they are infants, this is a relatively rare congenital heart defect among adults. Herein, we present the cases of PDA in adults, which were detected during cardiac surgery.

Hemangioma is a benign vascular lesion, which is common in the head and neck but rare in the oral cavity. Oral hemangioma presents as a smooth, soft, painless mass, which may be sessile or pedunculated in any size. However, most of the lesions will diminish spontaneously. Several therapeutic approaches are used for hemangiomas, such as cautery, cryotherapy, laser therapy, and sclerosing agents. Herein, we reported the case of a 36-year-old female who had a swelling on the top of her upper lip since birth. We proposed laser therapy as an efficient treatment plan because of its benefits, such as the achievement of coagulation, comfort for both practitioner and patient, and esthetic advantages. Moreover, this approach eliminates the chance of recurrence if performed perfectly.

Volvulus of the gallbladder or gallbladder torsion (GT), is a condition in which an organ twists along its long axis leading to the vascular source compromise. The GT was first diagnosed in 1898 as a rare cause of idiopathic cholecystitis. Some 500 cases have been reported ever since, and they account for 0.1% in acute cholecystitis cases. An 85-year-old male patient presented with epigastric abdominal pain that was referred to as the upper abdominal quadrant (UAQ). The pain did not radiate elsewhere but was constant and severe. Moreover, it did not change with eating; nonetheless, the patient had anorexia, nausea, and biliary vomiting that occur two times. Fever and chills, weight loss, and icterus were not observed. According to the ultrasound report, flat cholecystitiswas diagnosed, and the patient underwent cholecystectomy. During the operation, GT was confirmed. Diagnosis of GT in elderly patients without symptoms of acute abdomen and cholecystitis should be considered in differential diagnosis to prevent complications and mortality.