Bulletin of Emergency And Trauma
Volume:3 Issue: 1, Jan 2015

To determine the effects of local administration of platelet rich plasma (PRP) on peripheral nerve regeneration in rat sciatic nerve transection model. Forty-five male white Wistar rats were randomized into three experimental groups (n = 15): Normal control group (NC), silicon group (SIL), PRP treated group (SIL/PRP). In NC group left sciatic nerve was exposed through a gluteal muscle incision and after homeostasis muscle was sutured. In SIL group left sciatic nerve was exposed the same way and transected proximal to tibio-peroneal bifurcation leaving a 10-mm gap. Proximal and distal stumps were each inserted into a silicone conduit and filled with 10 µL phosphate buffered solution. In SIL/PRP group silicon conduit was filled with 20 µL PRP. Each group was subdivided into three subgroups of five animals each and were studied 4, 8, 12 weeks after surgery. The animals were comparable regarding the baseline characteristics. Behavioral testing, sciatic nerve functional study and gastrocnemius muscle mass showed earlier regeneration of axons in SIL/PRP than in SIL group. Local administration of PRP combined with silicon grafting could accelerate functional recovery of peripheral nerve. Easily available growth factors and bioactive proteins present in PRP may have clinical implications for the surgical management of patients after nerve transection.

To locate the road emergency stations in Fars province based on using spatial multi-criteria decision making (Delphi method). In this study, the criteria affecting the location of road emergency stations have been identified through Delphi method and their importance was determined using Analytical Hierarchical Process (AHP). With regard to the importance of the criteria and by using Geographical Information System (GIS), the appropriateness of the existing stations with the criteria and the way of their distribution has been explored, and the appropriate arenas for creating new emergency stations were determined. In order to investigate the spatial distribution pattern of the stations, Moran’s Index was used. The accidents (0.318), placement position (0.235), time (0.198), roads (0.160), and population (0.079) were introduced as the main criteria in location road emergency stations. The findings showed that the distribution of the existing stations was clustering (Moran’s I=.3). Three priorities were introduced for establishing new stations. Some arenas including Abade, north of Eghlid and Khoram bid, and small parts of Shiraz, Farashband, Bavanat, and Kazeroon were suggested as the first priority. GIS is a useful and applicable tool in investigating spatial distribution and geographical accessibility to the setting that provide health care, including emergency stations.

To develop a clear criteria for classifying the patients in triage unit of a tertiary healthcare center according to five-level triage system. This study is a qualitative study being conducted in five stages at Vali-Asr Hospital of Qom in 2013. After two survey, the experts were interviewed using focus group discussion (FDG) and study was continue with. Data were analyzed through studying the opinions of the specialized teams'' members, summarizing and classifying the data in qualitative phase. Changes proposed in the triage form communicated by Iran''s emergency department according to the participants'' opinions include informing all the patients in the emergency department of some necessary information. Therefore, three parts of medical and medicinal history, vital signs and level of consciousness were added to the first part of the form and necessary emergency facilities were also added to the third level of triage. Measuring each item added to the general part of the triage form provides more precise diagnosis and more scientific classification, since the level to which the patient belongs should be identified based on medical history, clinical signs and level of consciousness.

To determine the epidemiological, clinical, laboratory characteristics as well as outcome of 411 patients with bowel obstruction in Southern Iran. This was a cross-sectional study being performed in Shahid Faghihi hospital of Shiraz between 2006 and 2012. We reviewed the medical charts of the 411 patients with initial diagnosis of bowel obstruction who were admitted to our center during the study period. The patients’ demographic, clinical and laboratory findings as well as their management and outcome was recorded in data gathering forms. The data were then analyzed according to the outcome and clinical characteristics. Among the 411 patients with initial diagnosis of bowel obstruction, 253 (61.5%) were men and 158 (38.5%) were women. The mean age of the patients was 48.2±19.7 years. Besides, 73.6% were observed and 26.4% were operated. Those who were operated had those who underwent operation had significantly lower frequency of obstipation (28.1% vs. 71.9%; p=0.045) and abdominal distention (32.3% vs. 67.7%; p=0.007). Intraoperative findings included adhesion band formation in 50 (48.1%), mass 18 (17.3%), and hernia 7 (6.7%). We found that the frequency of malignancy was significantly higher in those who were managed conservatively compared to those undergoing operation (64.3% vs. 35.7%; p=0.042). The mean hospital stay was significantly higher in those who underwent operation (8.1 ±7.5 vs. 2.6±2.2 days; p=0.035). The results of this study demonstrates although some signs and symptoms, such as abdominal pain, vomiting, abdominal tenderness, abdominal distention, and obstipation, were more common among the patients with bowel obstruction, they were not sensitive and specific enough for definite diagnosis. Due to the lack of positive predictive value of clinical signs and symptoms in diagnosis of bowel obstruction, a reasonable and logical modality is needed for bowel obstruction diagnosis with better accuracy.

To determine the characteristics and etiologies of occupational trauma associated mortality in Tabriz megacity, Northern Iran. In a cross-sectional study, we included all the recorded cases of occupational mortalities referring to Tabriz forensic medicine center, labor institute and Imam Reza and Sina hospitals between March 2011 and March 2012. We recorded the demographic and clinical characteristics including age, gender, type of occupational accident, experience of work and permanent or temporary jobs for all the cases. The death etiology was also recorded according to the forensic medicine report. The data are presented as descriptive analytics. Overall we included 32 occupational trauma associated mortality out of whom 30 (93.8%) were men and 2 (6.2%) were women. The mean age of the patients was 44.1 ± 16.3 years old with most of them (31.3%) being younger than 30 years old. The occupation was recorded to be structural in 13 (40.6%), industrial in 5 (15.6%), agricultural in 5 (15.6%) and office work in 6 (18.8%). In 20 (62.5%) patients the occupation was seasonal and in 12 (37.5%) was permanent. Summer was the most common season in which occupational trauma associated mortality was recorded (40.6%) followed by fall by 34.4% of all mortalities. Most frequent causes of occupational traumas were the result of nonuse of safety wares (71.9%), inattention during work time (84.4%) and inappropriate instructions (18.8%). Most of the fatalities occurred in young and less-experienced workers, not having enough attention while working. Regarding this fact we conclude that with continuous education and supervision especially in young workers, most of the occupational accidents are preventable.

Foreign body ingestion and aspiration is among the most common causes of emergency department visit associated with high morbidity and mortality. Ingested and aspirated denture is rare conditions being scarcely reported in the literature. We herein report a 57-year-old man who presented with 2-day history of liquid and solid dysphagia who was diagnosed to have impacted denture in esophagus since 3 years prior to presentation. He was diagnosed to have esophagus adenocarcinoma and had undergone esophageal radiotherapy. The denture was removed successfully using esophagoscopy and the patient was discharged after 48-hour care with good condition. To prevent accidental ingestion, dentures should be made to fit properly. Damaged or malfitting dentures should be discarded and replaced. Patients should be strongly advised against wearing them during sleep-time.