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Journal Cover Bulletin of Emergency And Trauma
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  This is an Open Access Journal Open Access journal
   ISSN (Print) 2322-2522 - ISSN (Online) 2322-3960
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  • Cisternostomy for Traumatic Brain Injury: A New Era Begins

    • Authors: Giovanni Grasso, Iype Cherian
      Pages: 119 - 120
      PubDate: 2016-07-01
      Issue No: Vol. 4, No. 3 JUL (2016)
  • Shiraz Trauma Transfusion Score: A Scoring System for Blood Transfusion in
           Trauma Patients

    • Authors: Shahram Paydar, Golnar Sabetian, Hosseinali Khalili, Hamid Reza Abbasi, Shahram Bolandparvaz, Zahra Ghahramani, Behnam Dalfardi, Donat R. Spahn
      Pages: 121 - 123
      PubDate: 2016-07-01
      Issue No: Vol. 4, No. 3 JUL (2016)
  • Importance of Site Selection for Stockpiling Field Hospitals for Upcoming

    • Authors: Mohammad Javad Moradian, Ali Ardalan, Amir Nejati, Ali Darvishi Boloorani, Ali Akbarisari, Behnaz Rastegarfar
      Pages: 124 - 125
      PubDate: 2016-07-01
      Issue No: Vol. 4, No. 3 JUL (2016)
  • Speed Management Strategies; A Systematic Review

    • Authors: Homayoun Sadeghi Bazargani, Mohammad Saadati
      Pages: 126 - 133
      Abstract: Objective: To systematically identify the various methods of speed management and their effects. Methods: A systematic search was performed in Science Direct, Ovid Medline, Scopus, PubMed and ProQuest databases from April to June 2015. Hand searching and reference of selected articles were used to improve article identification. Articles published after 1990 which had reported on efficacy/effectiveness of speed management strategies were included. Data were extracted using pre-defined extraction table.Results: Of the 803 retrieved articles, 22 articles were included in this review. Most of the included articles (63%) had before-after design and were done in European countries. Speed cameras, engineering schemes, intelligent speed adaption (ISA), speed limits and zones, vehicle activated sign and integrated strategies were the most common strategies reported in the literature. Various strategies had different effects on mean speed of the vehicles ranging from 1.6 to 10 km/h. Moreover, 8-65% and 11-71% reduction was reported in person injured accidents and fatal accidents, respectively as a result of employing various strategies.Conclusion: Literature revealed positive effects of various speed management strategies. Using various strategies was mostly dependent on road characteristics, driver’s attitude about the strategy as well as economic and technological capabilities of the country. Political support is considered as a main determinant in selecting speed management strategies.
      PubDate: 2016-07-01
      Issue No: Vol. 4, No. 3 JUL (2016)
  • Effects of Platelet Rich Plasma on Healing Rate of Long Bone Non-union
           Fractures: A Randomized Double-Blind Placebo Controlled Clinical Trial

    • Authors: Fariborz Ghaffarpasand, Mostafa Shahrezaei, Maryam Dehghankhalili
      Pages: 134 - 140
      Abstract: Objective: To determine the effects of platelet rich plasma PRP on healing rates of long bone non-union fracture.Method: This was a randomized double-blind placebo controlled clinical trial being performed in a 12-month period. We included 75 adult (>18 years) patients suffering from long bone (Femur, Tibia, Humerus and Ulna) non-union fracture who were randomly assigned to receive 5mL PRP (n=37) or 5mL normal saline as placebo (n=38) in the site of fracture after intramedullary nailing or open reduction and internal fixation (ORIF) along with autologous bone graft. Patients were followed each 45 days till 9 months and were evaluated both clinically and radiologically in each visit. The healing rate, failure rate, incidence of infection, mal-union and limb shortening were recorded and compared between groups after 9 months of follow-up.Results: The healing rate was significantly higher in PRP group compared to placebo (81.1% vs. 55.3%; p=0.025). The limb shortening was significantly higher in those who received placebo (2.61±1.5 vs. 1.88±1.2mm; p=0.030). Injection of PRP was also associated with lower pain scores (p=0.003) and shorter healing duration (p=0.046). The surgical site infection (p=0.262) and mal-union rate (p=0.736) were comparable between groups.Conclusion: Application of PRP along with autologous bone graft in the site of non-union of long bone after intramedullary nailing or ORIF results in higher cure rate, shorter healing duration, lower limb shortening and less postoperative pain. Higher infection rate might be a complication of PRP application.Keywords: Non-union; Long bone Fracture; Platelet rich plasma (PRP); Intramedullary nailing; Open reduction and internal fixation (ORIF).Clinical Trial Registry: This trial is registered with the Iranian Clinical Trials Registry (IRCT201208262445N1;
      PubDate: 2016-07-01
      Issue No: Vol. 4, No. 3 JUL (2016)
  • Assessment of Neuroprotective Effects of Local Administration of 17- Beta-
           Estradiol on Peripheral Nerve Regeneration in Ovariectomized Female Rats

    • Authors: Ahmadreza Nobakhti-Afshar, Alireza Najafpour, Rahim Mohammadi, Leila Zarei
      Pages: 141 - 149
      Abstract: Objective: To assess the neuroprotective effects of local administration of 17- beta- estradiol on nerve regeneration.Methods: Sixty female Wistar rats were overiectomized and divided into four experimental groups (n = 15), randomly: In autograft group a segment of sciatic nerve was transected and re-implanted reversely. In sham-surgery group sciatic nerve was exposed and manipulated. In transected group left sciatic nerve was transected and stumps were fixed in adjacent muscle. In treatment group defect was bridged using a silicon conduit filled with 10 µL (0.1 mg/mL) 17- beta- estradiol. Each group was subdivided into four subgroups of five animals each and nerve fibers were studied in a 12-week period.Results: Behavioral, functional, biomechanical, electrophysiological and gastrocnemius muscle mass findings and morphometric indices confirmed faster recovery of regenerated axons in treatment group than in other groups (p<0.05). Immunohistochemical reactions to S-100 in treatment group were more positive than that in other groups.Conclusion: Local administration of 17-beta-estradiol improved functional recovery and morphometric indices of sciatic nerve. It could have clinical implications for the surgical management of patients after facial nerve transection.
      PubDate: 2016-07-01
      Issue No: Vol. 4, No. 3 JUL (2016)
  • Thorax Trauma Severity Score: Is it reliable for Patient’s Evaluation in
           a Secondary Level Hospital'

    • Authors: Isidro Martínez Casas, María Auxiliadora Amador Marchante, Mihai Paduraru, Ana Isabel Fabregues Olea, Andreu Nolasco Bonmatí, Juan Carlos Medina
      Pages: 150 - 155
      Abstract: Objective: To determine the predictive and diagnostic value of thorax trauma severity score (TTSS) in a population of thoracic trauma patients admitted to a secondary level trauma center.Methods: A Retrospective analysis of patients admitted over a period of two years with IDC-9 codes related to thoracic trauma was undertaken. The association of TTSS with complications and mortality was evaluated. We also determined the predictive value of TTSS using receiver operating characteristic curve (ROC).Results: 238 patients with thoracic trauma, mostly middle-aged (62.2 ± 15 years), were included. The main mechanisms of injury were falls and traffic accidents. Thirty-three patients had important extra-thoracic injuries, but only 9 presented an ISS> 15. The average ISS was 3 ± 5; Morbidity was 2.5% and mortality was 2.1% as a result of thoracic injury and these patients had significantly higherTTSS values. Each score component was analyzed separately, showing significant association with complications and mortality. The area under the curve for TTSS was significant for predicting complications (0.848) and mortality (0.856) values. TTSS with a cut off value of 8 points had a sensitivity of 66% and specificity of 94% to predict complications and 80% sensitivity and 94% specificity for predicting mortality.Conclusions: The TTSS is an appropriate and feasible tool to predict the development of complications or mortality in a population of mostly mild thoracic trauma.
      PubDate: 2016-07-01
      Issue No: Vol. 4, No. 3 JUL (2016)
  • Effects of Intraperitoneal Administration of Simvastatin in Prevention of
           Postoperative Intra-abdominal Adhesion Formation in Animal Model of Rat

    • Authors: Mojtaba Javaherzadeh, Ali Shekarchizadeh, Marjan Kafaei, Abass Mirafshrieh, Nariman Mosaffa, Babak Sabet
      Pages: 156 - 160
      Abstract: Objective: To determine the preventive effects of local administration of simvastatin for postoperative intra-abdominal adhesion formation in animal model of rat.Methods: In this experimental study, 32 Wistar albino rats as the animal model of intra-abdominal adhesion formation were included. Adhesions were induced in all the animals via abrasion of the peritoneal and intestinal surface during laparotomy. Afterwards, the rats were randomly assigned to receive simvastatin (30 mg/kg body weight) as a single intraperitoneal dose at the time of laparotomy (n=16) or normal saline in same volume at the same time (n=16). At the day 21, animals were euthanized and the adhesions were quantified clinically (via repeated laparotomy) and pathologically and compared between the two groups.Results: The baseline characteristics of the animals were comparable between two study groups. Clinically, in simvastatin group, 10 rats (62.5%) did not develop any adhesion and 6 (37.5%) had first-grade adhesion; whereas in the control group, 11 (68.8%) rats had first- and 5 (31.2%) had second-grade adhesions (p<0.001). Pathologically, in simvastatin group, 6 rats (37.5%) had first-grade adhesion, while in control group, 11 rats (68.8%) had first- and 5 (31.2%) had second-grade adhesions (p<0.001).Conclusion: Our findings suggest that intraperitoneal administration of simvastatin is an effective method for prevention of postoperative intra-abdominal adhesion formation in animal model of rat.  
      PubDate: 2016-07-01
      Issue No: Vol. 4, No. 3 JUL (2016)
  • Cisternostomy for Management of Intracranial Hypertension in Severe
           Traumatic Brain Injury; Case Report and Literature Review

    • Authors: Mohammad Sadegh Masoudi, Elahe Rezaee, Hasan Ali Hakiminejad, Maryam Tavakoli, Tayebe Sadeghpoor
      Pages: 161 - 164
      Abstract: Main goal in the management of patients with severe traumatic brain injury (TBI) is control of intracranial pressure (ICP). Decompressive craniectomy is an accepted technique for control of refractory intracranial hypertension in patients with severe TBI. Because of high complication rate after decompressive craniectomy, new techniques such as basal cisternostomy have developed. We herein report a case of severe TBI in a 13-year-old boy treated by cisternostomy. The patient was admitted following a motor vehicle accident. Brain CT scan showed diffuse brain edema, left frontal contusion and posterior interhemispheric subdural hematoma. The patient underwent ICP monitoring. Subsequently, with 26 mmHg mean-value of ICP, he was treated surgically by cisternostomy technique. A progressive improvement of the neurological conditions in the following hours. After 5 days the boy was discharged and in the 3-months follow-up he was completely recovered. Cisternostomy could be an appropriate alternative to decompressive craniectomy for management of intracranial hypertension in patietns with sever TBI.
      PubDate: 2016-07-01
      Issue No: Vol. 4, No. 3 JUL (2016)
  • Ketamine Infusion Therapy as an Alternative Pain Control Strategy in
           Patients with Multi-Trauma including Rib Fracture; Case Report and
           Literature Review

    • Authors: Ashley K Losing, Justin M Jones, Adis Keric, Steven E Briggs, David D Leedahl
      Pages: 165 - 169
      Abstract: Ketamine is a promising alternative agent for pain control that offers benefit to traditional strategies, particularly in the setting of rib fracture. Current pharmacologic therapies have clear adverse effects, and other options may be invasive, cost prohibitive, or marginally effective. We describe three consecutive patients with traumatic injuries including rib fracture for which a ketamine infusion was utilized as part of their pain control strategy.  For each patient, use of a ketamine infusion trended toward reduced opioid requirements with stable pain scores. One patient experienced a dissociative adverse effect prompting decrease and discontinuation of ketamine. No pulmonary complications in the form of emergent intubation or new diagnosis of pneumonia were observed. We believe the addition of ketamine infusion to be a valid alternative strategy for managing pain associated with rib fracture.
      PubDate: 2016-07-01
      Issue No: Vol. 4, No. 3 JUL (2016)
  • Traumatic Retrolisthesis of L5 and L5/S1 Extruded Disc Herniation; A Case
           Report and Review of the Literature

    • Authors: Babak Pourabbas, Mohammad Ali Effani, Asghar Namdari
      Pages: 170 - 173
      Abstract: Traumatic retrolisthesis is a rare injury and may result in intervertebral disc extrusion and nerve root injury. These injuries are highly unstable and require surgery for decompression and stabilization. Traumatic retrolisthesis of L5 with acute L5/S1 disc extrusion associated with nerve root injury has not been reported previously in English literatures. We herein report a case of traumatic retrolisthesis of L5 and extruded disc. A 22 year-old patient presented with lower extremity weakness due to L5/S1 retrolisthesis and traumatic acute L5/S1 disc extrusion after falling of 8 meters height. The patient underwent surgical decompression and reduction with instrumentation. Accordingly complete recovery of neurologic deficit was occurred. Therefore, early decompression of the nerve roots followed by circumferential instrumentation and fusion of the involved segment results in dramatic improvement in neurologic symptoms. 
      PubDate: 2016-07-01
      Issue No: Vol. 4, No. 3 JUL (2016)
  • Community Acquired Spondylodiscitis caused by Escherichia Coli; Case
           Report and Literature Review

    • Authors: F Javier Fonseca del Pozo, Joaquín Valle Alonso, Miguel Ángel Caracuel Ruiz, Siyamini Vythilingam, Daniel Lopez Ruiz
      Pages: 174 - 179
      Abstract: Vertebral osteomyelitis, or spondylodiscitis, is a rare disease with increasing prevalence in recent years due to a greater number of spinal surgical procedures, nosocomial bacteraemia, an aging population and intravenous drug addiction. Haematogenous infection is the most common cause of spondylodiscitis. We report a 47-year-old man diagnosed with Escherichia coli spondylodiscitis. The patient initially presented with a 4-day history of inflammatory, mechanical pain in the lower back suggesting sciatica. Treatment included NSAIDs and opioids. Two days after discharge from hospital following an admission due to an upper GI bleeding, the back pain intensified, precipitating a new attendance to the emergency department; during which lumbosacral radiography showed marked reduction of L2/L3 intervertebral space. After a new admission to the rheumatology unit due to worsening of symptoms and raised inflammatory markers, an expedited MRI showed loss of intervertebral disc space at L2/L3, with an irregular high intensity area at L2; suggesting a fluid collection extending to adjacent soft tissues. Fluoroscopy-guided core needle bone biopsies were reported positive for Escherichia coli sensitive to ceftriaxone. The patient was treated (received treatment) with a three week course of ceftriaxone following a formal diagnosis of E. coli spondylodiscitis. Follow-up MRI demonstrated complete recovery with the patient able to return (has returned) to normal activity. In this case we highlight the importance of correct and timely diagnosis of spondylodiscitis. Diagnosis of spondylodiscitis is often difficult, delayed or even missed due to the rarity of the disease but can lead to devastating consequences. Therefore a high index of suspicion is needed for prompt diagnosis to ensure improved long-term outcomes.
      PubDate: 2016-07-01
      Issue No: Vol. 4, No. 3 JUL (2016)
  • Diffuse Punched out Lesions in Multiple Myeloma

    • Authors: Rohat Ak, Ebru Ünal Akoğlu, Özge Ecmel Onur
      Pages: 180 - 181
      PubDate: 2016-07-01
      Issue No: Vol. 4, No. 3 JUL (2016)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Tel: +00 44 (0)131 4513762
Fax: +00 44 (0)131 4513327
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