Objective: This study aimed to determine the epidemiological characteristics of elderly patients hospitalizedfor spinal fractures at Mousavi Referral Hospital in Zanjan, Iran, from 2021 to 2023.Methods: In this cross-sectional study, medical records of 261 elderly patients hospitalized with vertebralfractures were reviewed. Data on demographic characteristics, injury mechanisms, vertebral involvement,associated injuries, spinal cord damage, and patient outcomes were extracted and analyzed.Results: Of the 261 patients, 138 (52.9%) were men and 123 (47.1%) were women. The mean age was 70.4±8.37(range: 60-95). Women were significantly older than men (70±11 vs. 67±11, p=0.03). Male patients sustaineda significantly higher number of fractured vertebrae than females (p=0.02). The incidence of fractures variedsignificantly across seasons (p=0.001). The most common fracture site was the thoracolumbar junction (56.2%),and the main cause was falling (58.6%). Spinal cord injuries occurred in 7.3% of patients. The most frequentassociated fractures were pelvic (25.9%). The length of hospital stay increased significantly with the presenceof associated fractures (p=0.001), spinal cord injuries (p=0.02), and a greater number of fractured vertebrae(p=0.04).Conclusion: Elderly spinal fracture patients, particularly men and those with multiple vertebral fractures,are at an increased risk of spinal cord injury, associated fractures, prolonged hospitalization, and mortality.Falls remain the most frequent cause, and the thoracolumbar junction the most common site. These findingshighlighted the need for targeted prevention strategies, cautious clinical management, and early identificationof high-risk patients to improve outcomes.
Objective: Anticoagulation therapy is an exceptionally effective approach for preventing thromboembolic events, including both primary and secondary occurrences that can significantly affect patient health. Among the range of anticoagulants available for clinical use, warfarin is particularly prominent, having gained extensive recognition and acceptance within the medical field for its demonstrated efficacy in treating coagulation disorders. One of the main adverse effects linked to warfarin administration is the heightened risk of bleeding, which can present in various forms. However, it is important to note that sublingual hematoma remains a relatively rare complication, though it has the potential to cause serious airway obstruction if it occurs. In situations where a patient shows symptoms of an unstable airway due to such complications, performing an urgent surgical procedure, which may involve interventions such as tracheostomy—to restore airway patency and ensure sufficient ventilation is typically recommended.Case Presentation: This report outlines a clinical case involving a 69-year-old male patient who developed a sublingual hematoma as a direct result of warfarin therapy, which subsequently led to airway obstruction.Conclusion: Sublingual hematoma is a rare but potentially life-threatening complication of anticoagulation therapy. Early recognition, prompt airway management, and rapid reversal of coagulopathy using available resources are critical to preventing fatal airway obstruction in the emergency setting.
We present a rare case of a migratory fish bone into the thyroid gland with abscess formation and internal jugular vein (IJV) thrombosis. A 73-year-old woman was referred to our emergency department due to several syncopal attacks, a ground-level fall, drowsiness, and left-sided neck swelling, with a history of consuming fish three months ago. CT scan and ultrasound revealed abscess formation at the left side of the neck, a foreign body within the left lobe of the thyroid, and left IJV thrombosis. The fish bone was removed successfully, and a left thyroid lobectomy was performed. The postoperative course was uneventful, and the IJV reopened without further intervention. Fish bone migration into the thyroid gland is an unusual event, and its possibility should be considered, especially when the patient has persistent symptoms with negative findings on examination. In such cases, appropriate imaging and advanced interventions are essential for timely diagnosis and management
Objective:This study aimed to assess the status of early warning systems (EWS) for disaster and emergency response in hospitals affiliated with Mazandaran University of Medical Sciences in 2024. Methods:This descriptive-analytical study was conducted from April to December 2024 across all affiliated hospitals with Mazandaran University of Medical Sciences. Data were collected using a validated 55-item EWS checklist evaluating preparedness in both pre-incident and during-incident phases. Overall hospital preparedness was categorized as good (≥75%), moderate (50-74%), or poor (<50%). Results:In the pre-incident phase, 28 out of 32 hospitals (87.5%) demonstrated good preparedness score (mean±SD: 74.8±12.1). During the incident phase, overall preparedness declined, with only 25 hospitals (78.1%) classified as good (mean±SD: 61.7±14.9). Based on total performance scores, Hospital No. 29 and 30 ranked the highest, while Hospital No. 4 demonstrated the weakest overall preparedness across both phases. Conclusion:While most hospitals exhibited adequate preparedness in key EWS components, such as warning dissemination and response readiness, notable weaknesses were identified in hazard identification, hazard monitoring, and documentation. Strengthening targeted training programs, establishing integrated monitoring systems, and conducting regular simulation exercises are essential for enhancing operational effectiveness.
Objective: This study aimed to evaluate the diagnostic accuracy of a clinical scoring system, both aloneand in combination with D-dimer assay, for suspected cerebral venous thrombosis (CVT) in the emergencydepartment.Methods: This prospective observational study was conducted in the Emergency Department of a tertiary careteaching hospital in India. Patients who met the inclusion criteria were assessed using a CVT scoring system.They underwent non-contrast computed tomogography of the brain to rule out other types of strokes and todetect signs of CVT. D-dimer testing was also performed. The diagnosis of CVT was subsequently confirmedby magnetic resonance venography (MRV).Results: Among the75 study subjects, the frequency of CVT, as confirmed by MRV, was 53.33%. ElevatedD-dimer levels were observed in 32 out of 75 patients, of whom 26 (65%) patients had CVT. A low-probabilityclinical score demonstrated a sensitivity of 73.33% and a pecificity of 71.1% for ruling out CVT. When alow-probability score was combined with D-dimer values below 500 μg/L, the sensitivity for ruling out CVTimproved to 92.5%.Conclusion: The present study indicated that moderate- and high-probability clinical scores were associatedwith a higher likelihood of CVT. In this cohort, a low-probability clinical score combined with a negativeD-dimer assay had a high negative predictive value for CVT. While a moderate or high-probability scorewarranted urgent imaging, it could not confirm the diagnosis on its own. This approach is particularly useful inresource-limited settings for triaging and referring patients for the early initiation of treatment.
Objective: Diaphragmatic eventration (DE) is a rare condition that can mimic a traumatic diaphragmatic hernia, particularly in trauma cases. We present a case of DE initially misdiagnosed as a diaphragmatic hernia following a road traffic accident, highlighting diagnostic challenges and surgical management.Case Presentation: A 50-year-old man presented to the hospital after a road traffic accident with chest discomfort and decreased air entry on the left side. Chest X-ray revealed a left paracardiac opacity. Contrast-enhanced CT (CECT) of the thorax suggested a central diaphragmatic defect with herniation of the transverse colon and mesocolon. An exploratory laparotomy, however, revealed no diaphragmatic rupture but instead a central eventration measuring 10×5×7 cm containing bowel loops. The contents were reduced, and diaphragmatic plication was performed using non-absorbable polypropylene sutures. The patient’s postoperative recovery was uneventful, and he was discharged on the eighth day. At follow-up, he remained asymptomatic.Conclusion: This case underscored the importance of considering DE as a differential diagnosis in trauma patients. Surgical exploration is crucial for definitive diagnosis, and plication could provide an effective and durable management strategy.
Objectives: This systematic review aimed to evaluate and compare emergency hemorrhage controlinterventions for hemodynamically unstable pelvic fracture trauma, assessing clinical outcomes, includingmortality, transfusion requirements, and complication rates.Methods: A comprehensive literature search of PubMed, Scopus, Web of Science, and Google Scholar wasconducted in December 2024. Studies were selected based on predefined inclusion criteria, which consideredadult patients (≥18 years) with hemodynamically unstable pelvic fractures. Data extraction and qualityassessment were performed using standardized tools. Interventions of interest included preperitoneal pelvicpacking (PPP), angioembolization (AE), resuscitative endovascular balloon occlusion of the aorta (REBOA),and mechanical stabilization.Results: Ten studies were included. PPP and AE demonstrated comparable in-hospital mortality rates. However,PPP was associated with shorter intervention times and reduced early transfusion requirements. Mechanicalstabilization was universally recommended as an initial step, while REBOA served as a temporizing measure.The overall strength of evidence was moderate, derived primarily from retrospective studies and meta-analyses,with no randomized controlled trials identified.Conclusion: Both PP and AE were effective for hemorrhage control in hemodynamically unstable pelvic fractures,with the choice of first-line intervention often dependent on logistical factors. The development of standardizedprotocols and prospective studies should be prioritized in future work to optimize management strategies.
We evaluated the recent prospective study by Hamidnezhad et al. comparing Trauma and Injury Severity Score (TRISS) and Madras Head Injury Prognostic Scale (MHIPS) in traumatic brain injury. The authors showed that both tools are good predictors of mortality and ICU admission, with higher specificity for TRISS and higher sensitivity for MHIPS. Their two-endpoint methodology, sound approach, and robust statistical methodology greatly enhance confidence in the result. However, several areas for future improvement still exist. Calibration, necessary to evaluate agreement between predicted and observed outcomes, was not assessed, although it is key to prognostic modelling. Further, Decision Curve Analysis might illuminate net clinical benefit over threshold probabilities. Wider issues in trauma prognostic models, like small sample sizes, sparse external validation, unsatisfactory treatment of missing data, and dichotomizing of continuous predictors, also need to be improved. Lastly, stability of models deserves more consideration to permit transportability to other settings. We praise the authors' contribution and issue these improvements as recommendations for future prognostic studies in head injury.
Objective:This systematic review and meta-analysis aimed to evaluate the impact of albumin administration on mortality and total resuscitation volume in burn patients. Methods:We systematically searched ScienceDirect, Cochrane, PubMed, MEDLINE, Scopus, and ProQuest in June 2025 using the terms "Burns," "Resuscitation," and "Albumin." Studies were included if they investigated albumin as part of burn resuscitation in adult patients and reported on mortality and total resuscitation volume. Pediatric studies, studies using albumin for other purposes, and those using other colloids were excluded. Reviewers independently extracted data on study characteristics, patient demographics, and outcomes. The risk of bias was assessed using RoB 2 for RCTs and ROBINS-I for non-randomized studies (NRCTs). Pooled analyses were performed using Review Manager 9.3.0, applying random-effects models. Results:Eleven of the 7,365 identified articles were included. Albumin administration did not significantly affect mortality (OR=1.19 [0.62-2.28], p=0.57) or total resuscitation volume (OR=0.69 [-0.93-2.31], p=0.34). However, albumin use was associated with a reduced incidence of sepsis (OR=1.18 [1.02-1.38], p=0.03) and ARDS (OR=2.64 [1.43-4.86], p=0.02). Conclusion:The administration of albumin did not significantly impact mortality or resuscitation volume in burn patients. While there is some evidence of potential benefits in reducing complications, this is limited by heterogeneity, underscoring the need for further high-quality RCTs.
Marin-Amat syndrome is a rare form of facial synkinesis resulting from aberrant connections between thetrigeminal and facial nerves. This condition manifests as involuntary eyelid closure upon voluntary jawmovement. It is distinct from the more common Marcus Gunn jaw-winking syndrome (MGJWS), whichinvolves upper eyelid elevation during mastication. Here, we reported a case of a 64-year-old woman whodeveloped this syndrome following combat-related maxillofacial trauma to the lateral mandible, which resultedin a left facial nerve injury. After her mandibular fractures were stabilized using 2 mm plates, her medicalhistory was notable only for hypothyroidism. Six months post-injury, and following an attempted free fibula flapprocedure, the patient began experiencing involuntary facial movements. These symptoms caused significantsocial discomfort and difficulty with eating. Treatment options, including botulinum toxin and surgery, werediscussed; however, the patient opted for a conservative management approach.
Objective: This systematic review and meta-analysis aimed to evaluate the efficacy of urine alkalinization in preventing acute kidney injury (AKI) and the need for dialysis in patients with rhabdomyolysis.Methods: This study was conducted in accordance with the PRISMA guideline. A systematic literature search of MEDLINE/ PubMed, Scopus, Web of Science, and Embase databases was conducted. No time or language restrictions were applied to maximize the scope of the results. After removing duplicates, the remaining articles were screened by title, abstract, and study criteria. Two researchers independently assessed the full texts of the remaining studies, with any discrepancies resolved through discussion. The risk of bias was assessed using the ROBINS-I tool, and studies with a critical risk of bias were excluded from the final analysis.Results: Out of 9,230 initially identified articles, five studies met the inclusion criteria for the meta-analysis. The analysis revealed that urine alkalinization was not significantly effective in preventing AKI (OR: 2.11; 95% CI: 0.09-47.72; p=0.3), preventing acute renal failure (OR: 1.26; 95% CI: 0.86-1.84; p=0.36), or reducing the need for dialysis (OR: 4.25; 95% CI: 0-3.8e+07; p=0.25).Conclusion: The addition of sodium bicarbonate to fluid therapy solution did not appear to provide significant protection against AKI, acute renal failure, or the need for dialysis in patients with rhabdomyolysis. Further insight should be sought through controlled randomized clinical trials with larger sample sizes.
Objectives: This study aimed to systematically review and quantify the association between D-dimer levels and injury outcomes in trauma patients through a meta-analysis.Methods: A systematic literature search of PubMed, MEDLINE/PubMed, and Web of Science was conducted from 2011 to 2023, supplemented by manual reference list searches. Two independent reviewers assessed the risk of bias using the Newcastle-Ottawa Scale. The primary outcomes were mortality and deep vein thrombosis (DVT).Results: Of 84 identified articles, 17 were eligible for full-text assessment, and 12 were included in the final analysis. A random-effects model was used to pool the study results. The analysis revealed a statistically significant difference in mean D-dimer levels between patients with poor outcomes and those without poor outcomes (p=0.0003). The standardized mean difference (SMD) was 0.51 (95% confidence interval [CI]:0.24 to 0.79). Furthermore, a significant difference in mean D-dimer levels was observed between survivors and non-survivors (p=0.03, SMD:0.42, 95% CI:0.04-0.79) and between patients with DVT and those without DVT (p=0.0008, SMD:0.79, 95% CI:0.32-1.25).Conclusion: This meta-analysis indicated that elevated D-dimer levels upon admission could be a valuable prognostic marker in trauma patients and might help predict poor outcomes.
Objective:The primary outcome was the management of acute agitation, as measured by the Richmond Agitation-Sedation Scale (RASS). Secondary outcomes included the incidence of adverse effects and the time to onset of the therapeutic effect. Methods:This randomized clinical trial was conducted between March 2021 and March 2022. Participants were recruited from patients presenting with acute agitation who required pharmacological intervention at Emam Reza and Shahid Hasheminejad hospitals (Mashhad, Iran). Eligible participants were adults aged 18 to 65 years. Using a block randomization method with a block size of four, patients were assigned to receive either 5 mg of intravenous (IV) haloperidol or 2 mg/Kg of IV ketamine. Data were analyzed using SPSS software (version 22). Results:A total of 120 participants were randomized. The majority were male, comprising 43 (73%) in the haloperidol group and 45 (75%) in the ketamine group. The mean age was 45.42±16.65 in the ketamine group and 48.28±16.75 years in the haloperidol group (p=0.34). In the haloperidol group, the mean admission RASS score was 1.73±0.75, which decreased to 0.07±1.25 post-intervention. In the ketamine group, the mean admission RASS score was 1.58±0.61, which improved to -0.92±1.19 following treatment. Conclusion:Ketamine demonstrated a faster onset of action in managing acute agitation than haloperidol. These findings suggested that ketamine might represent a viable first-line therapeutic option for acutely agitated patients, particularly in clinical scenarios where rapid symptom control is critical.
Objective: This study aimed to assess the potential of the Systemic Inflammatory Response Index (SIRI) fordiagnosing AA, its possible advantages over current methods, and its utility in distinguishing uncomplicatedfrom complicated appendicitis.Methods: In this cross-sectional study, 240 patients scheduled for appendectomy with a diagnosis of AA wereenrolled. Demographic information, clinical and paraclinical findings, including complete blood count (CBC),Alvarado score, SIRI, sonography findings, and pathology results, were documented. Data were analyzed usingSPSS software version 26.Results: Of the 240 patients, 106 (44.2%) were men, and 134 (55.8%) were women, with a mean age of 37.49±15.55years. Final pathology reports identified 26 (10.8%) cases of a normal appendix, 176 (73.3%) with uncomplicatedappendicitis, 23 (9.6%) with complicated appendicitis, and 15 (6.3%) with reactive lymphoid hyperplasia. SIRIdemonstrated significant differences across the pathology groups (P<0.0001). It showed notable discriminationbetween normal and complicated appendicitis (P=0.005), normal and combined appendicitis (P=0.008), andsuggestive differences for normal versus uncomplicated (P=0.021) and uncomplicated versus complicatedcases (P=0.044). Similarly, Alvarado scores showed significant differences, particularly between the normaland complicated appendicitis groups.Conclusion: The SIRI and Alvarado scoring systems showed significant potential for diagnosing appendicitiswith acceptable sensitivity and specificity. They might also assist in differentiating between uncomplicated andcomplicated appendicitis.
I commend the authors for their insightful manuscript "Comparing the Performance of Emergency Department Personnel and Patients’ Preferences in Breaking Bad News."(1) This study examines a sensitive yet essential aspect of emergency care—effectively delivering bad news in high-stress environments. The findings highlight a notable discrepancy between emergency department (ED) personnel's communication practices and patients' expectations, underscoring the need for structured training and improved communication protocols in emergency medicine. The article provides valuable insights into the gap between ED personnel performance and patient preferences in BBN, supported by a solid methodological foundation. However, its impact is curtailed by limited generalizability, subjective performance measures, and a lack of nuanced interpretation or practical solutions. Future research should incorporate observer validation, and categorize bad news scenarios by severity. Time constraints in EDs should be quantified to explain performance gaps. A structured BBN protocol integrating patient preferences and cultural factors would enhance communication strategies. Addressing these weaknesses could elevate the study from a descriptive snapshot to a transformative contribution to emergency medicine communication practices.
Objectives: This study aimed to explore experts’ perspectives on the factors influencing pedestrian trafficcollisions in Iran.Methods: This qualitative study was conducted using conventional content analysis with an inductive approachfrom September 2023 to March 2024. Twenty-six experts were purposefully selected from across Iran. Datawere collected through individual face-to-face interviews, guided by a semi-structured interview, developedby a panel of experts and contained open-ended questions. Data analysis was performed manually using theGraneheim and Lundman approach (2004). To ensure trustworthiness, four strategies proposed by Lincoln andGuba were employed.Results: The results revealed two main categories: direct factors and underlying factors, comprising ninesubcategories. Direct factors included five subcategories: driver, pedestrian, roads and streets, vehicle, andgeographic factors. Underlying factors included four subcategories: governance factors, social determinants,cultural conditions, and economic status.Conclusion: The study identified key risk factors associated with pedestrian collisions according to experts’experiences. We recommend further qualitative studies to explore high-risk behaviors among pedestrians anddrivers in depth. Additionally, systematic reviews should examine strategies employed by developing andsuccessful countries to prevent or reduce pedestrian collisions.
Objectives: This study aimed to determine the prevalence of dental trauma (DT) in pediatrics and adolescentsin Ilam.Methods: This retrospective study was conducted in Ilam (Iran) on a group of pediatric and adolescent patientswith DT between 2017 and 2021. The researchers reviewed patient records from hospital-based specialty clinicsproviding DT treatment. Using a predefined checklist, they extracted the relevant data from the patients’medical files.Results: In this study, 246 pediatrics and adolescents were examined, including 144 (58.5%) boys and 102(41.5%) girls. Regarding age distribution, 104 (42.3%) patients were in the pediatric age group (mean age:7.1±3.2 years) and 142 (57.7%) were adolescents (14.8±5.1 years). A significant relationship was found betweenplace of occurrence with sex (OR=0.77; 95% CI=0.64-0.93; p=0.008) and age group (OR=0.73; 95% CI=0.6-0.89; p=0.002). Additionally, the type of trauma showed a significant association with sex (OR=1.24; 95%CI=1.08-1.43; p=0.002), while the treatment provided was significantly associated with school type (OR=0.79;95% CI=0.65-0.96; p=0.02). In addition, there was no significant relationship between the demographicvariables and dental injury-related factors (p>0.05).Conclusion: The present study found a higher prevalence of DT in boys than in girls. However, this trendreversed in the adolescent age group. In addition, public schools had a higher rate of DT, which influenced thetypes of treatments provided.
Objectives: This randomized controlled trial aimed to evaluate the effect of pre-extubation intravenouslidocaine (1 mg/Kg) on the incidence of airway complications and hemodynamic stability in patients undergoingemergency laparoscopic cholecystectomy, while accounting for age differences.Methods: The study was a prospective, single-center, randomized controlled trial conducted from 2021 to 2023at Imam Khomeini Hospital, Ilam, Iran. Ninety patients undergoing emergency laparoscopic cholecystectomywere classified into two age groups (<50 and ≥50 years) and randomly assigned to receive either intravenouslidocaine (1 mg/Kg) or a standard extubation protocol. The primary outcomes included post-extubationairway complications, such as laryngospasm, cough, and sore throat, and the secondary outcomes includedhemodynamic and respiratory parameters.Results: Lidocaine produced hemodynamic effects that differed by age group. In patients <50 years, systolicblood pressure (SBP) increased from 129.2±16.4 mmHg to 133.1±23.1 mmHg, while diastolic blood pressure(DBP) rose from 83.9±14.4 mmHg to 92.3±19.4 mmHg (both p<0.001). Conversely, in patients ≥50 years old,SBP decreased from 160.5±26.7 mmHg to 145.2±19.7 mmHg, and DBP decreased from 107.9±19.5 mmHg to99.0±16.1 mmHg (both p<0.001). Airway complications exhibited non-significant tendencies, with a decreasedincidence of cough in the older age group (15.6% vs. 31.8%) and an absence of laryngospasm in this age group.There were no serious adverse events (e.g., bronchospasm, arrhythmias).Conclusion: Intravenous lidocaine was safe and demonstrated a trend toward reducing airway complicationsat extubation in patients undergoing emergency laparoscopic cholecystectomy, particularly in elderly patients.However, this trend did not reach statistical significance, most likely due to insufficient statistical power.
