Introduction: One of the basic pillars of hemodialysis is its adequacy, which is achieved by stabilizing hemodynamic parameters. This is especially important in the hemodialysis adequacy of diabetic patients. The current study aims to determine the effect of lowering the dialysate temperature on hemodynamic indices and dialysis adequacy of diabetic patients. Materials and methods: This is a clinical trial that was performed on 32 diabetic patients admitted to the Dialysis Ward of Ali ibn Abi Talib Hospital affiliated with Zahedan University of Medical Sciences in 2017. The research subjects were selected using the convenience sampling method from eligible patients. Each patient underwent hemodialysis twice; i.e. routine dialysate temperature (37° C) and cold dialysate temperature (36 °C). Except for lowering the dialysate temperature to (36 °C), all other conditions were the same during the study. Blood pressure (BP) and pulse rate of patients were monitored before and after dialysis and during the first, second, and third hours after dialysis; however, the body temperature and weight of patients were monitored before and after each dialysis session. Patients' blood samples were collected at each stage before and after dialysis to evaluate urea and calculate dialysis adequacy. Data analysis was carried out using descriptive statistics, paired t-test, and one-way repeated measures ANOVA in SPSS Ver. 21. P-value <0.05 was considered as the significant level. Results: Systolic, diastolic, and mean arterial blood pressure among patients who underwent hemodialysis with normal dialysate temperature were significantly lower than those who underwent hemodialysis with cold dialysate temperature (p<0.05). There were no significant differences between cold and routine dialysis in terms of changes in body temperature before and after dialysis. The dialysis adequacy at 36 °C showed a significant increase as compared to 37° C. Conclusion: The results of the present study showed that hemodialysis with cold solution (36 °C) stabilized hemodynamic variables and improved dialysis adequacy among diabetic patients, therefore, this treatment is recommended in hemodialysis wards.
Backgrounds: Medication errors are one of the most common errors that are associated with adverse effects on patients and may even lead to mortality. One of the methods for determining patient safety in hospitals is assessing the prevalence of medication errors. In this regard, medication reconciliation is used to improve drug safety in the treatment process. The present study was conducted on 7564 patients in the emergency department of one of the hospitals in Tehran, Iran. Methods: In total, 256 adult patients with a mean of 45 years, who had been admitted to the emergency department of a hospital in the past six months and had used at least three drugs before admission, were entered into the study. In this study, the effect of medication reconciliation on admitted patients was assessed to prevent drug errors at the time of admission by pharmacists. The main outcome measure was Type and Frequency Percentage of Drug Differences Observed during Medication Reconciliation were measured. Results: According to the results, the presence of a trained pharmacist was significantly effective in medication reconciliation for enhancing patient safety and treatment process accuracy. In addition, it was concluded that age, the condition of hospitalization, and medical center personnel had a direct relationship with the frequency of medication discrepancies. Conclusion: The presence of a trained pharmacist to perform the medication reconciliation process significantly affected the improvement of patient safety and the accuracy of the treatment process.
Colorectal cancer is an important health problem, being the third most frequent cancer pathology both in men and women. Programmes have been developed to decrease CRC incidence and mortality, including primary prevention strategies focusing on population education regarding diet and physical activity and secondary prevention programmes such as screening. Modifiable risk factors are known to be diet, obesity, smoking, alcohol and read meat consumption. Non-modifiable risk factors are age, inflammatory bowel disease, genetic syndromes and family history of colorectal cancer.
Introduction: Trauma is one of the most common causes of death in the world. E-Fast ultrasound can detect the haemoperitoneum, intravenous pneumothorax, and hemothorax. In this study, we evaluated the accuracy of E-FAST focused ultrasound in blunt trauma patients referred to the Emergency Department. Methods: In this study 167 blunt trauma patients were included. E-FAST is performed from four standard spaces in terms of free fluid, chest in terms of hemothorax, and pneumothorax. Ultrasound is performed on the trauma patient and the obtained results were compared with the result of the standard gold CT scan test. All patient information including age, sex, mechanism of trauma, patient ISS, E-FAST result, and CT scan result were registered. Results: Overall, 174 patients were included that 45 (25.9%) of them were females. The mean age of the patients was 38.39±12.31 years. E-FAST had a sensitivity of 66.7 and a specificity of 100% in the diagnosis of hemothorax. Also, a positive predictive value of 100% and a negative predictive value of 99.4% were detected for 120 people in both normal tests. Conclusion: The results show E-FAST is a suitable alternative to CT scan in the diagnosis of hemothorax, pneumothorax, and free fluid in the abdomen, vulva, and pericardial cavity. Due to portability, safe body, no need for contrast, fast performance, as well as cheapness, and reproducibility, it will be a great help in diagnosing trauma-related lesions and prompt and timely treatment. CT scan should be used only in limited cases and special indications.
Acute intentional poisonings represent an important part of emergency pediatric pathology, as well as a psychiatric one, with an escalation tendency over the past years. The current paper consists of a descriptive prospective study, which took place over 12 months, and included 342 children within the age range 6-18 years, that presented in the Emergency Unit, being subsequently treated as in-patients of the Pediatric Poisoning Center of “Grigore Alexandrescu” Emergency Clinical Hospital for Children. The number of pediatric acute intentional poisonings hospitalized within the time frame of the study was 819 cases. Of these, 342 were intentional, which constitutes a percentage of 41.75%, and 477 were accidental, i.e. 58.24%. The etiology of the acute intentional poisonings is varied; however, medication (54.38%), ethanol (28.65%), and drugs of abuse (12.28%) were predominant. A higher frequency of acute intentional poisonings was noticed in girls (65.49%) as compared to boys (34.50%), probably due to the particularities the psychological profile of this sex shown at this age, i.e. higher emotional instability and display tendency. Out of the total number of acute intentional poisonings, we identified 20 cases of suicide attempts, which represent 5.83% of the total acute voluntary poisonings. Moreover, some of these cases constitute a repeated suicide attempts. The studied group included 30 cases of chronic substance abuse and 6 chronic alcohol abuse cases, with ages within the 13-17 years range, 12 of which were females and 24 males. Out of the 36 chronic substance/alcohol abuse patients, 4 were social cases. Pediatric acute intentional self- poisoning is an important public health issue, alarming through its consequences and its hidden neuropsychiatric and behavioral substrate. This is because adolescence is a period of marked emotional fragility, sensitive to all sorts of influences.
HBOT has been used quite extensively in the last couple of decades. But there are not many centers that offer this treatment, even in civilian situations. This review has described the rationale and clinical evidence for equipping medical centers with HBO systems, especially in military areas. A narrative review of all the literature available on HBOT in combat-related injuries, studies were retrieved from systematic searches on Science Direct, PubMed, SCOPUS, ISC, Google Scholar, and by cross-referencing until 2020. First, the etiological mechanisms of action of HBOT were discussed. Furthermore, we have provided an overview of 117 studies that clinically investigated the effect of HBOT in the last couple of decades. Therefore, based on the number of studies showing a positive effect, to speed up the treatment process, especially in war-related injuries, it is better to provide its infrastructure and equip hospitals and centers with HBO.
Introduction. The primary tonsillar neoplasm is a common malignancy of the head and neck, alcohol and/or cigarette smoke and Human Papilloma Virus is the main etiological agent. This study offers a retrospective analysis of the tonsillar neoplasm cases in a tertiary medical center from Romania. Patients and methods. We present a 4-year (2015-2018) retrospective study on 72 patients diagnosed with tonsillar neoplasm in our clinic, previously untreated patients. The study was included only the patients diagnosed through histopathological evaluation with tonsillar neoplasm. We searched the cases in our clinic database, and we collected data about age, gender, symptoms on admission, findings of the objective physical examination, oro-pharyngoscopy, medical imaging examination results, histopathological results, stage of the disease, therapeutic management. Results. The group composition is: 75% men and 25% women, 62.5% of them are smokers. Dysphagia/swallowing discomfort was the most common symptom identified, and the non-keratinized squamous cell carcinoma was the most common histopathological form. Stage I tonsil carcinoma was diagnosed in 25% of the cases, stage II in 15.3%, while 47.2% of the cases had stage III or IV. None of the patients presented distant metastases. Lymphoma was diagnosed in 12.5% of the cases. We performed for all patients in stages I and II underwent total unilateral tonsillectomy. For the patients in stages III and IV, we performed surgery after radiotherapy-chemotherapy treatment or only radiotherapy-chemotherapy. Conclusions. In Romania, smoking is still the most important risk factor for tonsil cancer. The majority of patients have visited a doctor only when dysphagia and, above all, palpable cervical adenopathy, were present, and the tumor was in the advanced stage. In Romania, the ENT-oncology integrated medical services are few, in most cases patients are lost from otorhinolaryngological follow-up. 1 Department of Head-Neck Surgery and Otorhinolaryngology, University Clinical Hospital of Railway Company, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania 2 Department of Anatomy and Embryology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania 3 Department of Pathology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania 4 Department of Pathology, University Clinical Hospital of Railway Company, Cluj-Napoca, Romania 5 Department of Pathology, Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania 6 Department of Medical Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania 7 Department of Head and Neck Surgery and Otorhinolaryngology, University Emergency Hospital, Bucharest, Romania 8 Department of Anatomy and Embryology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania 9 Department of Oral Health, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania 356
Introduction: Investigating and recognizing the epidemiological structure of earthquake damages in earthquake- prone countries is of great importance. The aim of this study was to evaluation of traumatic injuries in1028 patients referred to the Ayatollah Taleghani Hospital from the Sarpul-Zahab earthquake (November 12, 2017). Method: This study is a cross-sectional study that includes 1028 traumatic patients from the Kermanshah earthquake. The patients, including outpatients in the emergency department, admitted in orthopedic, general surgery and neurosurgery, or even patients who needed to be transferred to other treatment centers. Result: Of the 1,028 patients, 488 were men (47.5%). The number of men with high injury severity was 51 (10.4%) and the number of women with high severity of the injury was 58 (10.7%). The average age of the injured was 33.04±15.01 years. The mean ISS measure in this study was 8.9±1.6. A total of 109 (10.6%) had scores above 17. The number of cases with head and neck injury was 328 (24%), 233 cases (17%), chest 114 (8.3%), The abdomen or pelvis is 190 (13.9%), the spine is 200 patients (14.6%). After examining the type of trauma in 1791 injuries, 1074 injuries (59.9%) had penetrating trauma and 717 injuries (40.1%) of blunt trauma were calculated. Of patients with severe trauma, 83 patients suffered severe injuries (7.7%) and in patients with blunt trauma, 68 patients suffered severe injuries (9.4%). The mortality rate was 5 (0.5%). Conclusion: This study established a fracture pattern in the referred patient of the Sarpul-Zahab earthquake to the Ayatollah Taleghani Hospital and is practical for clinicians to increase understanding of this natural disaster and permits superior selection of the triage management and therapeutic process.
The applications of negative-pressure wound therapy (NPWT) have achieved remarkable diversification. Initially used in the therapy of soft tissue wounds related to open fractures, this technique led to the understanding of the complex mechanisms underlying it. This paper aims to analyze the evolutionary scenarios of a group of patients with heterogeneous lesions under negative pressure aspiration treatment. We aimed to identify and analyze various associated pathologies that have the potential to negatively influence the healing process under negative pressure treatment and implicitly analyze the particularities of representative cases for the group whose evolution under treatment proved to be unfavorable. Retrospective, observational study, type series of cases focused on a group of 17 hospitalized patients, who received treatment by negative aspiration, between 2015-2019 in the Surgery Department of the University Emergency Hospital Bucharest. Regarding the obtained results, diabetes mellitus, obliterating arteriopathy, and anemia had a prevalent distribution in the group with unfavorable evolution. The glycemic value can predict 17% of the evolutionary scenario of a patient (favorable/unfavorable) being necessary an integrative therapeutic conduct. Concluding, although an extremely promising therapeutic option, NPWT can prove to be disappointing given its impact in the background of suboptimally managed comorbidities.
