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.
