Publications by authors named "Hamid Reza Abbasi"

53 Publications

The Neutrophil-to-Lymphocyte Ratio at the Time of Admission: A New Prognostic Indicator for Hospital Mortality of Trauma Patients.

Iran J Allergy Asthma Immunol 2021 Jan 30;20(1):33-45. Epub 2021 Jan 30.

Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.

The elevated neutrophil-to-lymphocyte ratio (NLR) is associated with poor clinical outcomes, especially in pro-inflammatory states such as surgical injuries and severe hemorrhages. Therefore, it was hypothesized whether NLR value at the time of admission could be a prognostic indicator of hospital mortality in trauma patients. This retrospective cohort study was conducted on 865 trauma patients referred to Rajaee Hospital between April 2016 and July 2019. The NLR value was calculated at the time of admission, and receiver operating characteristics (ROC) curve analysis was used to determine the cut-off point value of admission NLR related to hospital mortality of trauma patients. Furthermore, Kaplan-Meier survival analysis and Cox regression models have been applied to determine the effectiveness and prognostic potential of the admission NLR in the hospital mortality of trauma patients. The median age of the trauma patients was 32 years with an interquartile range (IQR) of 23 to 48 years, and most of them were male (83.9%). Also, trauma patients had a median injury severity score (ISS) of 9 (IQR=4-16) and a median Glasgow coma scale (GCS) of 14 (IQR=9-15). The cut-off value for admission NLR was 5.27 (area under the curve: 0.642, 95%CI: 0.559-0.726, p=0.001). In Kaplan-Meier survival analysis, the admission NLR>5.27 was an indicator of hospital mortality in trauma patients (p=0.001). Multivariate Cox regression models demonstrated that trauma patients with an admission NLR>5.27 had a 2.33-fold risk of hospital mortality (hazard ratio=2.33, 95%CI: 1.02-5.38, p=0.041). Furthermore, the admission NLR>5.27 was associated with a higher risk of hospital mortality in trauma patients with age≥65 years, systolic blood pressure≤90 mmHg, blood potassium>4.5 mmol/L, blood sodium>144 mEq/L, blood potential hydrogen (pH)≤7.28, GCS≤8, ISS>24 and blood base excess≤-6.1 mEq/L. The NLR value greater than 5.27 at the time of admission was associated with poorer outcomes, and it can be considered an independent prognostic indicator of hospital mortality in trauma patients.
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http://dx.doi.org/10.18502/ijaai.v20i1.5411DOI Listing
January 2021

Our Experience of Trauma Management During Novel Coronovirus 2019 (COVID-19) Pandemic in a Busy Trauma Center in Southern Iran.

Bull Emerg Trauma 2020 Jul;8(3):199-201

Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.

During the past few months, the novel coronavirus 2019 (COVID-19) pandemic has significantly affected medical service provision. In Iran, it has caused around 197,000 inflictions and 9200 deaths up to June 18, 2020. While many departments turned to telehealth in this era, the trauma service should provide non-stop in presence service to the trauma victims. Our trauma center is the largest in the southwest of Iran, with the mean annual admission of 18,500 polytrauma patients. In this center, we designed a safety protocol to mitigate the spread of disease and also have a more robust case finding system, especially among asymptomatic carriers who attend hospitals based on their trauma. In brief, all unstable patients were considered SARS-COV-2 positive and were directed toward the Specialized COVID-19 related ICU. For all stable patients, history, physical examination, CXR, and lab test (Complete Blood Count, Erythrocyte Sedimentation Rate, C-Reactive Protein) were ordered before entering the wards. If there was any suspicion of COVID-19, the stable patient was admitted to the COVID-19 specialized ward. Among all 1805 patients admitted during a ten weeks interval (from January 30, 2020, to April 14, 2020), 84 had a red flag and toward to COVID-19 related wards. Of those, 67 had positive PCR or evidence in CT in favor of the COOVID-19. Moreover, during regular workups, we found that 19 completely asymptomatic trauma victims had typical Chest CT scan findings of COVID-19.
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http://dx.doi.org/10.30476/BEAT.2020.87029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468226PMC
July 2020

Should we change our approach to resuscitating victims of femoral fracture? A clinical experience in a busy trauma hospital in Shiraz, Iran.

Chin J Traumatol 2021 Feb 15;24(1):30-33. Epub 2020 Aug 15.

Trauma Research Center, Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.

Purpose: Traumatic hemorrhagic shock is a life-threatening event worldwide. Severe brain trauma accompanying femoral fractures can trigger inflammatory responses in the body and increase pre-inflammatory cytokines such as TNF-α, IL-1. The primary treatment in these cases is hydration with crystalloids, which has both benefits and complications. The purpose of this study was to investigate the effects of fluid therapy on the hemodynamics, coagulation profiles, and blood gases in such patients.

Methods: In this cross-sectional study, patients were divided into two groups: femoral fracture group and non-femoral group. The hemodynamic status, coagulation profile, and blood gases of patients in both groups were evaluated upon arrival at the hospital and again 2 h later. Data were analyzed by t-test and ANOVA with repeated data and paired samples t-test.

Results: A total of 681 trauma patients (605 men and 76 women) participated in this study, including 69 (86.3%) men and 11 (13.8%) women in femoral fracture group and 536 men (89.2%) and 65 women (10.8%) in non-femoral group. The laboratory parameters were evaluated in response to the equal amount of crystalloid fluid given upon arrival and 2 h later. Blood gases decreased in the fracture group despite fluid therapy (p < 0.003), and the coagulation profile worsened although the change was not statistically significant.

Conclusion: The treatment of multiple-trauma patients with femoral bone fractures should be more concerned with the need for the infusion of vasopressors such as norepinephrine. If there is evidence of clinical shock, excessive crystalloid infusion (limited to 1 L) should be avoided, and blood and blood products should be started as soon as possible.
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http://dx.doi.org/10.1016/j.cjtee.2020.08.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7878457PMC
February 2021

Tranexamic Acid; A Glittering Player in the Field of Trauma.

Bull Emerg Trauma 2020 Apr;8(2):53-55

Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.

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http://dx.doi.org/10.30476/BEAT.2020.46443DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7211392PMC
April 2020

Determinants of reoperation after decompressive craniectomy in patients with traumatic brain injury: A comparative study.

Clin Neurol Neurosurg 2019 06 1;181:1-6. Epub 2019 Apr 1.

Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address:

Objectives: Reoperation after decompressive craniectomy (DC) in patients with traumatic brain injury (TBI) remains a dilemma and the risk factors are to be identified. The aim of the current study was to determine the determinants and risk factors of reoperation after DC in patients with TBI.

Patients And Methods: This retrospective case-controlled study was conducted during a 4-year period from September 2013 to October 2017 in a level I trauma center affiliated with Shiraz University of Medical Sciences in southern Iran. We included all the adult (≥18 years) patients with TBI who underwent primary or secondary DC in our center during the study period. Those who underwent reoperation were compared to those who underwent DC only regarding the demographic findings, clinical features and neuroimaging findings. A univariate and multivariate logistic regression analysis was performed to determine the determining factors of reoperation.

Results: Overall we included 371 patients with mean age of 36.45 ± 14.18 years. Among the patients there were 325 (87.6%) men and 46 (12.4%) women. The reoperation in patients undergoing DC due to TBI was associated with primary DC (p = 0.039) and higher Marshall grade (p = 0.027). Those who underwent reoperation after DC for TBI had significantly higher ICU (p = 0.007) and hospital LOS (p = 0.001) and lower 6-month GOSE (p = 0.010). Age (p < 0.001), GCS (p < 0.001) and pupils (p = 0.027) were predictors of outcome in reoperation group. Reoperation in primary DC group was associated with pupil reactivity (p = 0.002) and number of episodes with INR above 1.5 (p = 0.037) Conclusion: Reoperation after DC for TBI is associated with primary DC, and Marshall grade. The reoperation after DC is associated with worse outcome and longer ICU and hospital stay. The age, GCS and pupil reactivity are the main predictors of outcome in those with reoperation after DC for TBI.
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http://dx.doi.org/10.1016/j.clineuro.2019.03.030DOI Listing
June 2019

Jejunostomy with Enteroenterostomy for Enteral Nutrition in Critically Ill Trauma Patients. A Novel Technique.

Cureus 2018 Oct 9;10(10):e3431. Epub 2018 Oct 9.

General Surgery, Shiraz University of Medical Sciences, Shiraz, IRN.

Purpose The aim of the current study was to report the surgical outcome and complications of jejunostomy with enteroenterostomy for enteral nutrition (EN) in critically ill trauma patients with prolonged nasogastric (NG) nutrition. Methods This cross-sectional study was carried out in a level I trauma center in Shiraz, southern Iran during a one-year period from 2016 to 2017. We included a total number of 30 patients with severe trauma admitted to the intensive care unit (ICU) with more than three months NG nutrition and bowel atrophy. We performed a novel jejunostomy with an enteroenterostomy procedure for providing a route for enteral nutrition in all 30 patients. The rate of complications, such as dislodgement, clogging, obstruction, leakage, mucosal bleeding, and infection, were recorded and reported. We also recorded the hospital and ICU length of stay (LOS). Results We included a total number of 30 patients with a mean age of 35.64 ± 8.91 years, and there were 23 (76.6%) men and seven (23.4%) women among the patients. Overall, 14 (46.6%) patients experienced complications related to the jejunostomy with enteroenterostomy. The most common complication was nausea and vomiting (33.3%) and distention (33.3%), followed by surgical site infection (30.0%). The mean ICU LOS and hospital LOS was found to be 16.8 ± 3.7 and 24.3 ± 4.1 days, respectively. The overall mortality rate was 17 (56.6%), which was secondary to the primary injury and was not related to the procedure. Conclusion Jejunostomy with enteroenterostomy is a safe and feasible method for providing a route for EN in critically ill trauma patients with prolonged NG nutrition and bowel atrophy.
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http://dx.doi.org/10.7759/cureus.3431DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6289558PMC
October 2018

Antimicrobial Survey of Local Herbal Drugs against Isolated from Patients Admitted to a Level-I Trauma Center.

Bull Emerg Trauma 2018 10;6(4):355-362

Medicinal and Natural Products Chemistry Research Center (MNCRC), Shiraz University of Medical Sciences, Shiraz, Iran.

Objective: To determine the antimicrobial activity and entity of several local herbal plants against isolated from trauma patients admitted to a Level-I trauma center.

Methods: The antibacterial activities of the oil and someselected Iranian medicinal plants ( and belonging to the Asteraceae/Compositae; and belonging to the Lamiaceae/Labiatae) were assayed on by microdilution and agar disc diffusion methods. Having obtained the acceptable antibacterial data, the shade-dried aerial parts of the plants were extracted by hydrodistillation method using Clevenger apparatus according to European pharmacopeia for 3 h. The analysis of essential oil accompanied by other herbal drug oils were performed by using GC/FID and GC/MS methods.

Results: Outcomes revealed that the essential oil exhibited the potent antibacterial capability against strains in comparison with Colistin, as a positive control. For ,the growth inhibition zone and minimum inhibitory concentration (MIC) values were 21 mm and 0.5 mg/ml, while, for Colistin, the data were in order: 8 mm and 0.016 mg/ml. Consequently, GC/MS outcomes demonstrated that the major components of the essence were carvacrol (48.6%), followed by -Cymene (16.6%), -terpinene (6.9%) and linalool (5.3%).

Conclusion: Based on the considerable inhibitory activity against nosocomial infections by essential oil of , it could be considered as the suitable candidate in the food industry and pharmaceutical uses.
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http://dx.doi.org/10.29252/beat-060414DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6215076PMC
October 2018

Exclusive versus Inclusive Trauma System Model in High Volume Trauma Regions.

Bull Emerg Trauma 2018 Oct;6(4):269-270

Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.

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http://dx.doi.org/10.29252/beat-060401DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6215069PMC
October 2018

Injury patterns among various age and gender groups of trauma patients in southern Iran: A cross-sectional study.

Medicine (Baltimore) 2017 Oct;96(41):e7812

Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Administrative data from trauma referral centers are useful sources while studying epidemiologic aspects of injuries. We aimed to provide a hospital-based view of injuries in Shiraz considering victims' age and gender, using administrative data from trauma research center.A cross-sectional registry-based study of adult trauma patients (age ≥15 years) sustaining injury through traffic accidents, violence, and unintentional incidents was conducted. Information was retrieved from 3 hospital administrative databases. Data on demographics, injury mechanisms, injured body regions, and injury descriptions; outcomes of hospitalization; and development of nosocomial infections were recorded. Injury Severity Score (ISS) was calculated by crosswalking from ICD-10 (International Classification of Diseases) injury diagnosis codes to AIS-98 (Abbreviated Injury Scale) severity codes. Patients were compared based on age groups and gender differences.A total of 47,295 trauma patients with a median age of 30 (interquartile range: 24-44 years) were studied, of whom 73.1% were male and the remaining 26.9% were female (M/F = 2.7:1.0). The most common injury mechanisms in the male group were car and motorcycle accidents whereas females were mostly victims of falls and pedestrian accidents (P < .01). As age increased, a shift from transportation-related to unintentionally caused injuries occurred. Overall, young men had their most severe injuries on head, whereas elderly women suffered more severe extremity injuries. Injury severity was similar between men and women; however, elderly had a significantly higher ISS. Although incidence of nosocomial infections was independent of victims' age and gender, elderly men had a significantly higher mortality rate.Based on administrative data from our trauma center, male gender and age >65 years are associated with increased risk of injury incidence, prolonged hospitalizations, and in-hospital death following trauma. Development of a regional trauma surveillance system may provide further opportunities for studying injuries and evaluating preventive actions.
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http://dx.doi.org/10.1097/MD.0000000000007812DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5662297PMC
October 2017

Objective Structured Clinical Examination (OSCE)-based Assessment of the Advanced Trauma Life Support (ATLS) Course in Iran.

Bull Emerg Trauma 2016 Apr;4(2):75-9

Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Objective: To evaluate the effect of advance trauma life support (ATLS®) training on general surgery residents clinical reasoning skills using the national boards-style objective structured clinical examination (OSCE).

Methods: This cross-sectional single-center study was conducted in Shiraz University of Medical Sciences including 51 surgery residents that participated in a mandatory national board style OSCE between May 2014 and May 2015. OSCE scores of two groups of general surgery residents including 23 ATLS® trained and 28 non-ATLS® trained were compared using Mann-Whitney U test. The exam was graded out of 20 points and the passing score was ≥14 including 40% trauma cases.

Results: There were 8(15.7%) women and 43(84.3%) men among the participants with mean age of 31.12 ± 2.69 and 33.67 ± 4.39 years in women and men respectively. Overall 7 (87.5%) women and 34 (79.07%) men passed the OSCE. The trauma section OSCE score was significantly higher in the ATLS® trained participants when compared to non-ATLS®(7.79 ± 0.81vs.6.90 ± 1.00; p=0.001). In addition, the total score was also significantly higher in ATLS® trained residents (16.07 ± 1.41 vs. 14.60 ± 1.40; p=0.001). There was no association between gender and ATLS® score (p=0.245) or passing the OSCE (p=0.503).

Conclusion: ATLS® training is associated with improved overall OSCE scores of general surgery residents completing the board examinations suggesting a positive transfer of ATLS learned skills to management of simulated surgical patients including trauma cases.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4897987PMC
April 2016

Management of Deep Vein Thrombosis (DVT) Prophylaxis in Trauma Patients.

Bull Emerg Trauma 2016 Jan;4(1):1-7

Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.

Deep vein thrombosis (DVT) and pulmonary embolism (PTE) are known as venous thromboembolism (VTE). DVT occurs when a thrombus (a blood clot) forms in deep veins of the body, usually in the lower extremities. It can cause swelling or leg pain, but sometimes may occur with no symptoms. Awareness of DVT is the best way to prevent the VTE. Patients with trauma are at increased risk of DVT and subsequent PE because of coagulopathy in patients with multiple trauma, DVT prophylaxis is essential but the VTE prophylaxis strategy is controversial for the trauma patients. The risk factors for VTE includes pelvic and lower extremity fractures, and head injury.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4779464PMC
January 2016

Necessity of Defining Different Transfusion Protocols for Different Kinds of Trauma Injuries.

Bull Emerg Trauma 2015 Oct;3(4):118-21

Trauma Research Center, Shahid Rajaee (Emtiaz) Hospital, Shiraz University of Medical Sciences, Shiraz, Iran  

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4771304PMC
October 2015

Tube Thoracostomy (Chest Tube) Removal in Traumatic Patients: What Do We Know? What Can We Do?

Bull Emerg Trauma 2015 Apr;3(2):37-40

Trauma Research Center, Shahid Rajaee (Emtiaz) Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.

Chest tube (CT) or tube thoracostomy placement is often indicated following traumatic injuries. Premature movement of the chest tube leads to increased hospital complications and costs for patients. Placement of a chest tube is indicated in drainage of blood, bile, pus, drain air, and other fluids. Although there is a general agreement for the placement of a chest tube, there is little consensus on the subsequent management. Chest tube removal in trauma patients increases morbidity and hospital expense if not done at the right time. A review of relevant literature showed that the best answers to some questions about time and decision-making have been long sought. Issues discussed in this manuscript include chest tube removal conditions, the need for chest radiography before and after chest tuberemoval, the need to clamp the chest tube prior to removal, and drainage rate and acceptability prior to removal.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4771264PMC
April 2015

Learning operational strategies in surgery training.

J Adv Med Educ Prof 2014 Apr;2(2):92-4

Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran;

Introduction: Education and training in surgery is in the middle of apprenticeship style of learning especially in operating room with little importance of understanding on how trainees learn.

Methods: This training is one of the most difficult types of training. Medical training and expertise are the specialty of this education system. We can name these complex fields as "Operational Strategies". The strategies are includes of "what to do", "what to think" and "what to create". These strategies are good to test and train higher functions in persons who have professional's positions.

Results: Most of educational fields are complex. It means that the training is not limited in an area and includes of theory fields, areas of decision making and areas of handy and practical skills. These fields are the most relevant skills or expertise which individual must be informed of the performance of maintenance and repair or upgrade and make a new system.

Conclusion:   The operational strategy is a new training strategy for surgery students. It is useful to train surgery students to modify and improve their practices and doing surgeries and treating patients in best conditions.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235553PMC
April 2014

Acute Trauma Pain Control Algorithm.

Bull Emerg Trauma 2014 Oct;2(4):170-1

Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4771294PMC
October 2014

Early abdominal closure for open abdomens.

J Trauma Acute Care Surg 2014 May;76(5):1336

Trauma Research Center Department of Surgery Shiraz University of Medical Sciences Shiraz, Iran.

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http://dx.doi.org/10.1097/TA.0000000000000190DOI Listing
May 2014

Teamwork improvement in emergency trauma departments.

Iran J Nurs Midwifery Res 2013 Jul;18(4):333-9

Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Interprofessional teamwork is considered as the key to improve the quality of patient management in critical settings such as trauma emergency departments, but it is not fully conceptualized in these areas to guide practice. The aim of this article is to explore interprofessional teamwork and its improvement strategies in trauma emergency departments.

Materials And Methods: Participants of this qualitative study consisted of 11 nurses and 6 supervisors recruited from the emergency departments of a newly established trauma center using purposive sampling. Data were generated using two focus group and six in-depth individual interviews, and analyzed using qualitative content analysis.

Results: Interprofessional teamwork attributes and improvement strategies were emerged in three main themes related to team, context, and goal. These were categorized as the effective presence of team members, role definition in team framework, managerial and physical context, effective patient management, and overcoming competing goals.

Conclusions: Interprofessional teamwork in trauma emergency departments is explained as interdependence of team, context, and goal; so, it may be improved by strengthening these themes. The findings also provide a basis to evaluate, teach, and do research on teamwork.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3872871PMC
July 2013

After One Year of Publication; Achievements and Horizons.

Bull Emerg Trauma 2014 Jan;2(1):1-2

Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4771252PMC
January 2014

Analgesic Effects of Intravenous Ketamine during Spinal Anesthesia in Pregnant Women Undergone Caesarean Section; A Randomized Clinical Trial.

Anesth Pain Med 2013 Sep 1;3(2):230-3. Epub 2013 Sep 1.

Department of Anesthesiology, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran.

Background: Suitable analgesia after cesarean section helps mothers to be more comfortable and increases their mobility and ability to take better care of their infants.

Objectives: Pain relief properties of ketamine prescription were assessed in women with elective cesarean section who underwent spinal anesthesia with low dose intravenous ketamine and midazolam and intravenous midazolam alone.

Patients And Methods: Sixty pregnant women scheduled for spinal anesthesia for cesarean section were randomized into two study groups. Ketamine (30 mg) + midazolam (1 mg = 2CC) or 1mg midazolam (2CC) alone, was given immediately after spinal anesthesia. Pain scores at first, second and third hours after CS operation, analgesic requirement and drug adverse effects were recorded in all patients.

Results: Ketamine group had significant pain relief properties in compare with control group in first hours after cesarean section (0.78 ± 1.09 vs. 1.72 ± 1.22, VAS score, P = 0.00). Total dose of meperidine consumption in women of ketamine group was significantly lower than women of control group (54.17 ± 12.86 vs. 74.44 ± 33.82 mg, P = 0.02). There were no significant drug side effects in participated patients.

Conclusions: Intravenous low-dose ketamine combined with midazolam for sedation during spinal anesthesia for elective Caesarean section provides more effective and long lasting pain relief than control group.
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http://dx.doi.org/10.5812/aapm.7034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3833040PMC
September 2013

Unwanted intra-operative penile erection during pediatric hypospadiasis repair. Comparison of propofol and halothane.

Urol J 2013 Sep 26;10(3):988-92. Epub 2013 Sep 26.

Department of Anesthesiology and Critical Care Medicine, Parsian Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: To compare the erectile effect of propofol and halothane on unwanted intraoperative penile erection (UIOPE) during pediatric hypospadiasis repair.

Materials And Methods: One hundred and seventeen boys who were in the age range of 6 months to 6 years and referred for hypospadiasis repair to our referral teaching hospital were included in this randomized clinical trial. Patients were randomly assigned to one of the two study groups before anesthesia induction. Anesthesia was maintained with a continuous intravenous infusion of propofol and inhalational halothane in the propofol (P) and halothane (H) groups, respectively. Data regarding the patients’ age, weight, pre- and intra-operative chordee, UIOPE, anesthesia time, surgery time, hematoma formation, and wound infection were collected. The Chi-Square and Fisher’s exact tests were used for comparison.

Results: No statistically significant differences were noted regarding age, weight, and pre and intra-operative chordee between the two groups. The incidence of UIOPE (10.34% versus 57.63%; P = .000), anesthesia time (174.15 +/- 15.02 versus 181.26 +/- 15.19; P =.012), and surgery time (162.34 +/- 12.99 versus 167.69 +/- 13.90 +/- 13.90; P = .034) were significantly lower in group P compared with group H.

Conclusion: The use of propofol during hypospadiasis surgical repair is more safe and effective than halothane in preventing UIOPE and reducing surgery and anesthesia time.
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September 2013

Accuracy of Ultrasonography in Diagnosing Acute Appendicitis.

Bull Emerg Trauma 2013 Oct;1(4):158-63

Trauma Research Center, Shiraz University of Medical Sciences,Shiraz, Iran.

Objectives: To evaluate the accuracy of sonography in diagnosing acute appendicitis in patients with Alvarado score 4-7.

Methods: This is a retrospective cross-sectional study being performed in Namazee hospital affiliated with Shiraz University of Medical sciences during a one year period from 9/2007 to 9/2008. We evaluated all patients with Alvarado score 4-7 and divided them in two groups: those with Ultrasound study prior to surgery and those without any imaging modalities for diagnosis of AA. The demographic information, histopathology, physical examination, laboratory data, sonography report and histopathological reports of patients were gathered.

Results: A total of 238 patients had Alvarado scores 4-7 including 160 males and 78 females. 110 patients did not have any imaging and 128 had undergone sonography before operation. Ultrasound had overall sensitivity of 75 %, specificity 69.2 %, PPV 88 %, NPV 46.1% and accuracy of 73.6 %. Negative appendectomy rate was 20.9 % and 23.4 % in those without sonography and inpatients with sonography respectively, with a higher rate in females.

Conclusion: Ultrasound is more useful when the patient is female and the result of sonography is positive; however, it is not reliable when the result is negative and maybe other diagnostic modalities such as CT scan can help us in better diagnosis of Acute Appendicitis.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4789451PMC
October 2013

The Spatiotemporal Pattern of Trauma in Victims of Violence Visited in Emergency Room of Rajaei Hospital, Shiraz, Iran.

Bull Emerg Trauma 2013 Oct;1(4):141-6

Trauma Research Center, Shiraz University of Medical Science, Shiraz, Iran.

Objective: To explain an important aspect of violence, the spatiotemporal pattern of trauma in victims of violence visited in emergency room of Rajaei hospital, Shiraz, Iran.

Methods: This cross-sectional prospective study comprised 109 randomly selected victims of violence visited in emergency room of Rajaei hospital, a tertiary referral hospital affiliated to Shiraz University of Medical Sciences in winter 2013. We recorded the demographic information as well as data regarding the type and time of the injuries. The data collected for each victim was then entered in a data gathering form.

Results: The study included 88% males with mean age 27.8 ± 8.8 years, which encompassed more than 60% young adults. Our study showed a temporal pattern with triple peaks. Moreover, 64% of assault trauma occurred at night. Furthermore, our study showed the majority of our patients suffered from stab wounds and about 57% of patients studied lacked high school diploma. Moreover it was revealed that violence was more common in downtown Shiraz, especially in the Fifth city district with simultaneous presence of many risk factors for violence.

Conclusion: The result of this study showed that age, gender, educational status and temporal peak of violence were shown to be similar to other investigations conducted  in other countries. Despite these similarities, stabbing were more prevalent in our study. Additionally, the Fifth city district of Shiraz seems to be the main city district where preventive intervention is needed to reduce violence- related injuries.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4789448PMC
October 2013

Short-term Outcome of Open Appendectomy in Southern Iran: A Single Center Experience.

Bull Emerg Trauma 2013 Jul;1(3):123-6

Trauma Research Center of Shiraz University of Medical Sciences, Shiraz, Iran.

Objectives: To evaluate the short-term outcome of open appendectomy, the rate of negative appendectomy as well as pathology reports after surgery in patients with suspected acute appendicitis.

Methods: This was a retrospective cross-sectional study being performed in Nemazee hospital affiliated with Shiraz University of Medical Science during a 2-year period between 2008 and 2010. The medical records of all consecutive patients who underwent open appendectomy in our center due to acute appendicitis were included in the study. The elective and laparoscopic appendectomies were excluded. The demographic information, clinical findings, laboratory investigations and the histopathological examination of the appendix were recorded and reported.

Results: A total of 337 patient including 137 (36.4%) females, and 240 (63.6%) males with the mean age of 16.26 ± 9.81 (range 3 to 76) years were stduied. Anorexia (64.7%) and fever (20.7%) were more prevalent symptoms. The mean duration between pain initiation and operation ranged from 0 to 14 days with mean 1.88 ± 1.63 days. Right lower quadrant (RLQ), periumbilical, epigastria, left lower quadrant (LLQ), and Right upper quadrant (RUQ), pain were manifest in 78.8%, 41.6%, 12.2%, 3.2%, and    1.3% of patients, respectively. Pathological evaluation of the appendix showed appendicitis in 70.4% of patients.

Conclusion: The higher rate of negative appendectomy accounts for wasteful tapping of medical resources and causing further complication in patients. Therefore it is essential to conduct more accurate studies to detect the root cause of the disease. This would help improve the management of appendicitis which is an emergency condition with high incidence.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4779173PMC
July 2013

Pattern of Traumatic Injuries and Injury Severity Score in a Major Trauma Center in Shiraz, Southern Iran.

Bull Emerg Trauma 2013 Apr;1(2):81-5

Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Objective: To record and classify mechanisms of injury and injury severity score (ISS) in trauma patients admitted to the largest trauma center in Southern Iran.

Methods: This was a prospective cross-sectional study including all the patients who were admitted to Nemazee hospital from 2009 to 2010. We recorded the trauma injury information of 1217 patients who were admitted to of emergency room of the Nemazee hospital during a 13-months period by means of a standard questionnaire. ISS was then obtained for every single patient.

Results: The mean age of patients was 26.6 ± 15.1 (range 1-95) years. The commonest type of trauma including 279 cases (22.9%) was car accident and the least resulted from shotgun injuries in 13 (1.1%) patients. The lowest ISS was due to assault multiple blunt traumas and the highest ISS resulted from shotgun injury. The mean ISS was about 6.3 ± 1.8 (range 1-66). Overall, 86 patients had scores above 17 (7.1%). A total of 69 male patients (7.5%) compared to 17 females (5.7%) had severe injury (ISS>17). Trauma injuries were significantly more severe in males compared to females (p=0.014). In the sunny and hot seasons total number of patient was higher. The mean ISS was highest in during spring (p<0.001).

Conclusion: In Shiraz, most of the trauma injuries are occurred during summer and hot weather. Men have greater number of injuries and higher ISS compared to women. The lowest ISS was due to assault multiple blunt trauma and the highest ISS was caused by shotgun injury, and car accident was the commonest cause of trauma with head and neck being the most frequent sites in our patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4771228PMC
April 2013

Emergency Operating Room Workload Pattern: A Single Center Experience from Southern Iran.

Bull Emerg Trauma 2013 Jan;1(1):38-42

Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Objective: To determine the epidemiology and pattern of emergency operating room workload in Nemazee hospital affiliated with Shiraz University of Medical Sciences, Shiraz, Iran.

Methods: All surgical emergency operations which were performed in Nemazee hospital, Shiraz, Iran were collected over twelve months (September 2007 to September 2008). The data obtained included indications, presenting symptoms the services provided and the demographic information of the patients.

Results: Overall number of recorded emergency operations in this cross sectional descriptive study was 3946, with males constituting 72% of the patients. The highest male/female ratio reported in trauma patients was 6.4:1 with the median age of 23 years, and the mean age of the operated patients was 27.8 years. Second to neurosurgery (19.64%) the general surgery was the busiest discipline in emergency operations (59.14%). Appendectomy (11.77%), double/triple lumen/central venous catheter insertion (9.4%), and fiber optic/rigid bronchoscopy (3.27%) were the commonest general surgical operations. Among trauma patients, neurotrauma was the commonest reason for operation (10%).

Conclusion: Based on a new approach toward emergency operating room workload, in our country and centre, we showed that it is necessary to devote particular and individualized attention to the fields of agenda and hospital management of emergency operations. This is due to a high emergency operating room workload and its unique characteristics in our centre in contrast to other hospitals and departments. Although a decision making and operational strategy is recently seen to improve the quality and quantity of emergency services available to our patients, there is still a gap between present and optimal emergency healthcare which should be provided for our residents.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4771241PMC
January 2013

Predictive Value of Biochemical Markers for Extremity Vascular Trauma Outcome.

Bull Emerg Trauma 2013 Jan;1(1):34-7

Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Objective: To evaluate the predictive value of some biochemical markers in the outcome of extremity vascular trauma.

Methods: This study comprised 30 patients with traumatic arterial injury and acute limb ischemia referred to Namazi hospital affiliated with Shiraz University of Medical Ssciences, over a period of 8 months, from Sep 2009 to Jul 2010. Venous blood samples were drawn from distal ischemic limb to determine pH, HCO3, PCO2, PO2, Na and K before definitive surgical intervention. Comparable samples were also obtained from veins of non-ischemic upper extremities. The biochemical assays were compared after monitoring the revasculurized limbs and evaluation of viability during a period of 7 days.

Results: The mean age of the patients was 28.3 ± 7.8 (range: 18-56) years. Two (6.6%) patients underwent amputation because of developing irreversible limb ischemia after vascular reconstruction. Both patients had blunt traumatic knee injury accompanied by nerve, vein and soft tissue damage. The statistical analysis showed correlations between parameters, except for Na of local (ischemic limb) and systemic samples. In this context, the highest correlation was observed in regard to HCO3.

Conclusion: The correlation was most pronounced with respect to HCO3. Ischemic limbs exhibited reduction in pH and PO but, PCO2 and K increased after ischemia of injured limbs. PO2 reflects tissue perfusion and is of value in predicting the outcome. We believe that blunt trauma and associated nerve, vein and soft tissue injuries pose negative prognostic effects on limb survival postoperatively.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4771240PMC
January 2013

Modified Perihepatic Packing; A Creative and Beneficial Method for Management of High Grade Liver Injury.

Bull Emerg Trauma 2013 Jan;1(1):22-7

Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.

Objective: To evaluate the efficacy of modified perihepatic packing (MPHP) in reducing the rate of re-bleeding rate after packing removal.

Methods: This was an experimental study being performed in Shiraz animal laboratory. High grade liver parenchymal injury was induced in 30 transgenic Australian rabbits which were then divided into two groups. Group A (control) included 14 and group B (experimental) comprised 16 rabbits. The animals in group A underwent standard perihepatic packing (SPHP) and those in group B were subjected to MPHP. Re-bleeding was assessed and compared between the two groups, after removal of perihepatic packings.

Results: There was no significant difference between two study groups regarding baseline and perioperative characteristics. Rabbits in group A had significantly lower rate of postoperative re-bleeding compared to those in group A (57.1% vs. 12.5%; p=0.019). The mean bleeding volume was also significantly lower in group B compared to group A (76.88 ± 22.12 vs. 98.93 ± 33.8 mL; p<001). Although the survival rate was higher in group A compared to group B (93.8% vs. 78.6%) but the difference was not statistically significant (p=0.315).

Conclusion: MPHP is a simple and safe procedure for surgical management of high grade liver parenchymal injury concomitant with severe loss of glisson's capsule. This procedure significantly decreases re-bleeding after packing removal in comparison with SPHP.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4771238PMC
January 2013

Chest Tube Removal Time in Trauma Patients on Positive Ventilation Pressure: A Randomized Clinical Trial.

Bull Emerg Trauma 2013 Jan;1(1):17-21

Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Objective: To determine the removal time of the chest tube in ICU trauma patients under positive ventilation pressure (PVP).

Methods: This was randomized clinical trial being performed in ICU department of Rajaei trauma hospital from March to December 2011. A total number of 92 trauma patients who were admitted in ICU and were under ventilation and had chest tube were randomly assigned into two groups. In case group, chest tube was clamped after 5-7 days. In the control group, chest tube was retained until the patients were under PVP. The chest tube was removed if there was no air leak or the drainage was less than 300 mL.

Results: Complications observed in the case and control groups were 4.4% of 4.3% respectively (p=0.862). Among case group with hemothorax, 6.7% developed complication while this ratio for pneumothorax was 7.1% and zero in those with hemopneumothorax (p=0.561), whereas respective values for the control group were 11.1%, 8.3% and zero (p=0.262). Complications were noticed in 10.5% of those with more than 300 ml of pulmonary drainage. There were no complications in patients without air leak. In mild leak, 4.8% of subjects experienced complication, in moderate leak, no complication occurred and in severe ones, complication was visible in 7.7% of patients (p=0.842).

Conclusion: The present study showed that the removal of chest tube in patients under ventilation within 5-7 days after its insertion is safe without any complications.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4771237PMC
January 2013

Explosive attack: Lessons learned in Seyed Al Shohada mosque attack, April 2008, Shiraz, Iran.

J Emerg Trauma Shock 2012 Oct;5(4):296-8

Department of General Surgery, Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Introduction: The threat of explosive attacks has become a worldwide problem. Bombing is the preferred method of attacks. These attacks result in specific physical and psychiatric trauma. In this paper, we present an epidemiologic description of the physical injuries of patients who survived the explosive attack in Seyed Al Shohada mosque April 2008 Shiraz, Iran.

Materials And Methods: All medical records of the patients admitted at Shiraz Hospitals on April 2008 due to Seyed Al Shohada mosque bombing attacks, Shiraz, Iran, were reviewed.

Results: A total of 202 patients were referred to the hospitals over 24 h following the terrorist attack. One hundred sixty-four patients were admitted for short periods of observation (<24 h). Thirty-eight patients needed more than 1 day of hospitalization. The mean age of the patients was 26.2 (range 2 to 51) years. One hundred thirty-five (66.8%) patients were males. Twenty-six (12.8%) were children. Burn was the most prevalent cause of admission. Five (13.5%) patients needed chest tube insertion and eight (21%) needed skin grafts due to burn. Overall, 12 patients expired (5%). Three (25%) of them were children (2 and 6, and 11 years old). Mortality rate was significantly higher among the children than adults (P value <0.05). The most important cause of death was head trauma which was seen in five (41.6%) of the expired patients followed by burn (including air way burn) in four (33%), and internal bleeding in three (25%). Patients with head trauma had significantly a higher rate of mortality than other patients (P value <0.05).

Discussion: Following a bombing attack, numerous victims were brought to the emergency unit suffering from a combination of multi-organ injuries caused by the blast, penetrating injuries caused by shrapnel and other debris, and burns. It is important for a physician to be familiar with the clinical features and treatments of explosive attacks victims. Early management of patients at the scene and hospital may save their life.
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http://dx.doi.org/10.4103/0974-2700.102363DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3519040PMC
October 2012