Kashan University of Medical SciencesArchives of Trauma Research2251-953X3120140301Application of Queuing Analytic Theory to Decrease Waiting Times in Emergency Department: Does it Make Sense?6215710.5812/atr.10473ENFernando-Miguel CanteroResearch Network for Health Services in Chronic Disease (REDISSEC), Costa del Sol Hospital, University of Malaga, Marbella, SpainMaximino RedondoResearch Network for Health Services in Chronic Disease (REDISSEC), Costa del Sol Hospital, University of Malaga, Marbella, SpainJournal Article19700101https://archtrauma.kaums.ac.ir/article_62157_221f60269ab3e7f5d0821423451214cf.pdfKashan University of Medical SciencesArchives of Trauma Research2251-953X3120140301Functional Abdominal Pain Syndrome in Morbidly Obese Patients Following Laparoscopic Gastric Bypass Surgery6215810.5812/atr.13110ENMohammad EidyTrauma Research Center, Kashan University of Medical Sciences, Kashan, IR IranAbdolreza PazoukiMinimally Invasive Surgery Research Centre, Iran University of Medical Sciences, Tehran, IR IranFahimeh RayganTrauma Research Center, Kashan University of Medical Sciences, Kashan, IR IranYazdan AriyazandMinimally Invasive Surgery Research Centre, Iran University of Medical Sciences, Tehran, IR IranMohadeseh PishgahroudsariMinimally Invasive Surgery Research Centre, Iran University of Medical Sciences, Tehran, IR IranFatemeh JesmiMinimally Invasive Surgery Research Centre, Iran University of Medical Sciences, Tehran, IR IranJournal Article19700101Background
Roux-en-Y gastric bypass surgery (RYGBP) is one of the most common bariatric surgeries, which is being performed using various techniques like gastrojejunostomy by hand swen, linear or circular stapler. Abdominal pain is a common complaint following laparoscopic gastric bypass procedure (LGBP), which has different aetiologies, such as overeating, adhesion, internal herniation, bile reflux and many more. In this study LGBP was performed in an ante-colic ante-gastric pattern in a double loop manner and the prevalence and distribution of pain in morbidly obese patients undergoing LGBP was assessed.
Objectives
The aim of this study was to analyze the distribution and frequency of post LGBP pain in morbidly obese patients.
Patients and Methods
This study was performed on 190 morbidly obese patients referred to Hazrat Rasoul Hospital in Tehran. After LGBP, pain was measured in the following intervals: 24 hours, one week and one month after the operation. Before the operation onset, 2 mg Keflin and 5000 IU subcutaneous heparin were administered as prophylaxis. LGBP was performed using five ports including: one 11 mm port was placed 15-20 cm far from the xiphoid, one 12-mm port in mid-clavicular line at the level of camera port, one 5-mm port in subcostal area in ante-axillary region in the left, another 5-mm port in the right mid-clavicular area and a 5-mm port in sub-xyphoid. All operations were done by the same team. Staple was used for all anastomoses and hand sewn technique to close the staple insertion site. The mesenteric defect was left open and no effort was made to repair it.
Results
The results of this study showed that 99.94 % of the patients had complains of pain in the first 24 hours of post operation, about 60% after one week and 29.5 % still had pain after one month. In addition, left upper quadrant (LUQ) was found to be the most prevalent site for the pain in 53.7% of the patients in the first 24 hours, 59.6% after one week and 16.8% after one month (except for obscure pain) with a significance of < 0.05.
Conclusions
In this study, the authors analyzed the location and disturbance level of pain after LGBP, which could serve as a cornerstone for further researches. The authors suggest that long-term follow-up (for more than a year after operation) should be considered in future studies and also the relationship between the drainage site and pain should be investigated.https://archtrauma.kaums.ac.ir/article_62158_6f078aaa53249cd1a59ac631416c7037.pdfKashan University of Medical SciencesArchives of Trauma Research2251-953X3120140301Traumatic Arteriovenous Fistula After Kickboxing Injury: A Case Report and Review of the Literature6215910.5812/atr.15575ENMasoud RezvaniDepartment of Surgery, Abington Memorial Hospital, Abington, Pennsylvania, USAJournal Article19700101Introduction:
A traumatic arteriovenous fistula (AVF) after repetitive blunt trauma has not been described previously. In a 34-year-old male, the first reported case of such an injury after repetitive blunt trauma is described.
Case Presentation:
A 34-year-old gentleman presented with a non-healing ulcer near his medial malleolus. A bone scan was performed and then treated for presumed osteomyelitis. An arteriogram confirmed an AVF, and coil embolization was performed with complete occlusion of the AVF. Subsequently, the ulcer healed rapidly with no complication. Along with the cause of AVF, this case is notable for symptom presentation.
Conclusions:
Arteriovenous fistula after blunt trauma can present as a non-healing venous stasis ulcer, which could be treated non-invasively.https://archtrauma.kaums.ac.ir/article_62159_9c6aeb5704beabe367bee6db91381e9c.pdfKashan University of Medical SciencesArchives of Trauma Research2251-953X3120140301Agreement of Cerebral State Index and Glasgow Coma Scale in Brain-Injured Patients6216010.5812/atr.15892ENMehrdad MahdianTrauma Research Center, Kashan University of Medical Sciences, Kashan, IR IranMohammad Reza FazelTrauma Research Center, Kashan University of Medical Sciences, Kashan, IR IranEsmaeil FakharianTrauma Research Center, Kashan University of Medical Sciences, Kashan, IR IranHossein AkbariTrauma Research Center, Kashan University of Medical Sciences, Kashan, IR IranSoroush MahdianStudent Research Committee, Arak University of Medical Sciences, Arak, IR IranSoheila YadollahiShahid-Beheshti Hospital, Kashan University of Medical Sciences, Kashan, IR IranJournal Article19700101Background
Variables derived from electroencephalogram like cerebral state index (CSI) have been used to monitor the anesthesia depth during general anesthesia. Observed evidences show such variables have also been used as a detector of brain death or outcome predictor in traumatic brain-injured (TBI) patients.
Objectives
The current study was designed to determine the correlation between Glasgow coma score (GCS) and CSI among TBI patients.
Patients and Methods
In 60 brain-injured patients who did not need and receive sedatives, GCS and CSI were daily measured during the first ten days of their hospital stay. Correlation between GCS and CSI was studied using the Pearson's correlation test. The Gamma agreement coefficient was also calculated between the two variables for the first day of hospitalization.
Results
A significant correlation coefficient of 0.611-0.796 was observed between CSI and GCS in a ten-day period of the study (P < 0.001). Gamma agreement coefficient was 0.79 ( P < 0.001) for CSI and GCS for the first day of hospitalization. An increased daily correlation was observed in both CSI and GCS values. However, this increase was less significant in CSI compared with the GCS.
Conclusions
A statistically significant correlation and agreement was found between GCS and CSI in the brain-injured patients and GCS was also found to be more consistent and reliable compared with CSI.https://archtrauma.kaums.ac.ir/article_62160_4df862a59f2c2099b1cb84deffc12173.pdfKashan University of Medical SciencesArchives of Trauma Research2251-953X3120140301Disabilities and Activities of Daily Living Among Veterans With Old Hip Disarticulation and Transpelvic Amputation6216110.5812/atr.16003ENAmir Reza KachooeiDepartment of Orthopedic Surgery, Orthopedic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR IranMohamad Hosein EbrahimzadehDepartment of Orthopedic Surgery, Orthopedic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR IranMohamad Hallaj MoghadamDepartment of Orthopedic Surgery, Orthopedic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR IranAsieh-sadat FattahiEndoscopic and Minimally Invasive Surgery Research Center, Department of Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR IranShiva RaziDepartment of Orthopedic Surgery, Orthopedic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR IranMaryam SalehiCommunity Medicine Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR IranHasan AzemaJanbazan Medical and Engineering Research Center, Tehran, IR IranJournal Article19700101Background
The Iran-Iraq imposed war lasted eight years and was one of the longest wars of the last century. Twenty-three years have passed since the war ended, but little has been discussed about the long-term results of war amputations in the literature.
Objectives
In this long-term study, we have evaluated the activities of daily living among veterans with hip or hemipelvis amputations.
Patients and Methods
A cross-sectional study was performed on Iran-Iraq war veterans with hip or hemipelvis amputations in Iran. Eighty-four (96.5%) veterans out of 87 registered veterans with hip or hemipelvis amputations participated in the study. The degree of independence for activities of daily living (ADL) was assessed by the Barthel index. The degree of independence for instrumental activities of daily living (IADL) was assessed by the Lawton-Brody scale.
Results
The average follow-up time was 26.6 ± 3.7 years. The average age of veterans was 44.1±7 years old. Of 84 amputees, 57 (67.85%) had limitations in at least one domain of the ADL. The most common single item that affected the patients was ascending and descending stairs seen in 45 (78.9%) veterans, followed by eating seen in 4 (7.01%) veterans. In addition, 70 (83.33%) had limitations in at least one domain of the IADL. The most common single item that affected the veterans was shopping seen in 56 (80%), followed by responsibility for own medications seen in 13 (18.57%) veterans. Spearman correlation coefficient of the sum scores of ADL and IADL showed an intermediate to strong correlation (r = 0.58).
Conclusions
Increasing dependency in ADL is accompanied by increasing dependency in IADL. In the past, the duty of health care providers was saving the life of veterans due to injuries while at present, because these injuries occurred in young and healthy individuals, the need for increased function is being highlighted.https://archtrauma.kaums.ac.ir/article_62161_cffdaeb6e6e421820884de5dbd388b38.pdfKashan University of Medical SciencesArchives of Trauma Research2251-953X3120140301The Reliability of Red Flags in Spinal Cord Compression6216210.5812/atr.17850ENNicholas Tobias Johannes RaisonDepartment of Trauma and Orthopaedics, Ashford and St Peter’s NHS Trust, London, England.Wisam AlwanDepartment of Trauma and Orthopaedics, Ashford and St Peter’s NHS Trust, London, England.Amit AbbotDepartment of Trauma and Orthopaedics, Ashford and St Peter’s NHS Trust, London, England.Mohamed FarookDepartment of Trauma and Orthopaedics, Ashford and St Peter’s NHS Trust, London, England.Arshad KhaleelDepartment of Trauma and Orthopaedics, Ashford and St Peter’s NHS Trust, London, England.Journal Article19700101Background
Acute low back pain is a common cause for presentation to the emergency department (ED). Since benign etiologies account for 95% of cases, red flags are used to identify sinister causes that require prompt management.
Objectives
We assessed the effectiveness of red flag signs used in the ED to identify spinal cord and cauda equine compression.
Patients and Methods
It was a retrospective cohort study of 206 patients with acute back pain admitted from the ED. The presence or absence of the red flag symptoms was assessed against evidence of spinal cord or cauda equina compression on magnetic resonance imaging (MRI).
Results
Overall, 32 (15.5%) patients had compression on MRI. Profound lower limb neurologic examination did not demonstrate a statistically significant association with this finding. The likelihood ratio (LR) for bowel and bladder dysfunction (sensitivity of 0.65 and specificity of 0.73) was 2.45. Saddle sensory disturbance (sensitivity of 0.27 and specificity of 0.87) had a LR of 2.11. When both symptoms were taken together (sensitivity of 0.27 and specificity of 0.92), they gave a LR of 3.46.
Conclusions
The predictive value of the two statistically significant red flags only marginally raises the clinical suspicion of spinal cord or cauda equina compression. Effective risk stratification of patients presenting to the ED with acute back pain is crucial; however, this study did not support the use of these red flags in their current form.https://archtrauma.kaums.ac.ir/article_62162_210534d69be0ceb1eeb22426b415e160.pdfKashan University of Medical SciencesArchives of Trauma Research2251-953X3120140301Traumatic Dental Injuries Among 12-15-Year-Old-School Children in Panchkula6216310.5812/atr.18127ENAmandeep ChopraDepartment of Public Health Dentistry, Swami Devi Dyal Hospital and Dental College, Panchkula, Haryana, IndiaManav LakhanpalDepartment of Public Health Dentistry, Swami Devi Dyal Hospital and Dental College, Panchkula, Haryana, IndiaNC RaoDepartment of Public Health Dentistry, Swami Devi Dyal Hospital and Dental College, Panchkula, Haryana, IndiaNidhi GuptaDepartment of Public Health Dentistry, Swami Devi Dyal Hospital and Dental College, Panchkula, Haryana, IndiaShelja VashisthDepartment of Public Health Dentistry, Swami Devi Dyal Hospital and Dental College, Panchkula, Haryana, IndiaJournal Article19700101Background:
Traumatic dental injury (TDI) in children and adolescents has become one of the most serious dental public health problems. Despite such a high prevalence of dental trauma, very less attention has been paid to TDI, its etiology, and prevention.
Objectives:
To determine the prevalence of anterior tooth traumatic dental injuries in 12-15-year-old school children of Panchkula district, India, and to find any correlation with the cause, gender, extent of overbite as well as over-jet, and previous treatment.
Patients and Methods:
A multistage sample of 12-15-year-old school children (n = 810) in Panchkula district, Haryana, was selected. The children were screened using WHO criteria for oral examination and a trained dental surgeon examined the children. Those with clinical TDI were examined further for the type of traumatic injuries using Elis classification modified by Holland. Overjet and overbite were recorded. After examination, questions regarding the cause of trauma and its treatment were asked. Data were subjected to statistical analysis using the Chi square and Mantel-Haenszel tests by SPSS version 20.0.
Results:
The results showed that out of 810 children, 86 (10.2 %) had TDI. Males had higher prevalence of trauma than females (P < 0.05). The common cause of trauma was fall (51.11%) followed by sports injuries (41.86%). Enamel-dentin fracture without pulpal involvement was the most common type of trauma and the most frequent involved teeth were maxillary central incisors. A significant association was observed between overjet and overbite and trauma. Only 3.5% of the children affected with trauma had received treatment.
Conclusions:
The prevalence of traumatic injuries to permanent incisors in 12-15-year-old Panchkula school children was relatively high. TDI was associated with gender, overjet, and lip competence. There was a great unmet treatment need.https://archtrauma.kaums.ac.ir/article_62163_9bd9d166a006ccff48c1727f46867c64.pdfKashan University of Medical SciencesArchives of Trauma Research2251-953X3120140301Validity and Reliability of Behavioral Pain Scale in Patients With Low Level of Consciousness Due to Head Trauma Hospitalized in Intensive Care Unit6216410.5812/atr.18608ENHamideh DehghaniDepartment of Nursing, School of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, IR IranHossein TavangarDepartment of Nursing, School of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, IR IranAkram GhandehariDepartment of Nursing, School of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, IR IranJournal Article19700101Background:
Estimating pain in patients of intensive care unit (ICU) is essential, but because of their special situation, verbal scales cannot be used. Therefore, to estimate the level of pain, behavioral pain scale was developed by Payen in 2001.
Objectives:
The aim of this study was to investigate the validity and reliability of behavioral pain scale in patients with low level of consciousness due to head trauma hospitalized in ICU.
Patients and Methods:
This descriptive prospective study was performed in Yazd in 2013. In this study, fifty patients, including thirteen women and thirty seven men, were involved. To collect the data a questionnaire including demographic and Glasgow coma scale (GCS) information as well as a list of behavioral pain scale (BPS) were used. SPSS software (version 18) was used to analyze the data.
Results:
There was no significant difference in reliability proving of average score of BPS recorded by two day and night assessors (P > 5). Cronbach’s alpha was 85 for painful procedures and 76 for non-painful procedures. In addition, known groups’ technique (painful and non-painful procedures) was used to assess validity. The average scores were 7.75 during painful procedures and 3.28 during non-painful procedures (P = 0.001). The results stated that BPS scores during these two procedures were significantly different.
Conclusions:
BPS in patients with low level of consciousness due to head trauma has strong reliability and validity. Therefore, this scale can be used for patients hospitalized in ICU to assess the level of pain.https://archtrauma.kaums.ac.ir/article_62164_bc8d1ee614378c3626cacf6fb0ddef72.pdfKashan University of Medical SciencesArchives of Trauma Research2251-953X3120140301The Path of Science6216510.5812/atr.19125ENEsmaeil FakharianTrauma Research Center, Kashan University of Medical Sciences, Kashan, IR IranJournal Article19700101https://archtrauma.kaums.ac.ir/article_62165_65b3efcf6d09d77310e405d4c2bc0650.pdfKashan University of Medical SciencesArchives of Trauma Research2251-953X3120140301Gabapentin in Burns6216610.5812/atr.6471ENNicholas SheppardDepartment of Plastic Surgery, Norfolk and Norwich University Hospital, Colney Lane, Norwich, UKJournal Article19700101https://archtrauma.kaums.ac.ir/article_62166_7a4dc32273b46f1b543cb9289783d11f.pdfKashan University of Medical SciencesArchives of Trauma Research2251-953X3120140301A Different Approach to Traffic Accidents as the Main Cause of Trauma in Developing Countries6216710.5812/atr.9034ENPezhman BagheriDepartment of Education and Research, Jiroft University of Medical Science, Jiroft, IR IranMahdi MoshkiDepartment of Public Health, School of Health; Social Development & Health Promotion Research Center, Gonabad University of Medical Science, Gonabad, IR IranJournal Article19700101https://archtrauma.kaums.ac.ir/article_62167_692fd22f3c4537e539b340e2da3b9daf.pdf