Simultaneous-bilateral TKA: double trouble - affirms.

In this paper, we will consider the current role of simultaneous-bilateral TKA. Based on available evidence, it is our opinion that simultaneous bilateral TKA carries a higher risk of morbidity and mortality and should be reserved for select few.

Epidemiology of injuries and poisonings in emergency departments in Iran.

OBJECTIVES: There are few reports on epidemiological patterns of injury and injury-related mortality in developing countries. This study aimed to report the epidemiology of injuries and poisonings in emergency departments in Iran. STUDY DESIGN: Retrospective study using available data from 20 March 2005 to 19 March 2008. METHODS: Recorded Injury Surveillance System (ISS) data including demographics, place of residence, type of injury, and outcome during emergency department stay were extracted from the databank of the national ISS and included in the final analysis. RESULTS: In total, 2,991,624 emergency department admissions due to injury were recorded at university hospitals during the study period. According to the national census in 2006, Iran had a population of 70,472,846, so the injury admission rate to university hospital emergency departments was 1.4%/year in Iran. The mean age of the patients was 26.5 [standard deviation (SD) 16.9] years, and 72.7% of the cases were male. The most common cause of injury was road traffic accidents (RTAs) (31.9%), followed by hit (25.5%) and falls (10.9%). Intoxication was associated with 5.3% of all injuries. The overall emergency department mortality rate was 0.6%. Of those who died, the mean age was 32.6 (SD 21.1) years. All fatal injuries, except burn injuries, were more common in males. Intoxication-related deaths occurred in 3.8% of cases. In patients aged <13, 13-65 and >65 years, hit (28.2%), RTAs (34%) and RTAs (27.9%) were, respectively, the most common causes of injury. In all age groups, RTAs were the most common cause of death. CONCLUSIONS: This study determined the epidemiology of injuries and poisonings in emergency departments in Iran. The mortality rate in this study was low in comparison with other research, which may be explained in the context of inappropriate prehospital or interhospital care in Iran. This finding can be employed to formulate targeted preventive strategies based on the incidence of the more common types of injury.

Synbiotic preparation in men suffering from functional constipation: a randomised controlled trial.

BACKGROUND: Evaluating the effects of a commercially available synbiotic preparation (contains both prebiotic and probiotic elements) on functional constipation in males. METHODS: In a randomised controlled trial, a total of 66 adult men with functional constipation were equally allocated to receive a synbiotic mixture or a placebo. The synbiotic mixture or placebo was given as capsules with the same shape and colour, and patients received the capsules twice a day for 4 weeks. RESULTS: A total of 60 patients (31 in the synbiotic group) completed the study. At baseline evaluation, there was no significant difference between the mean stool frequency per week in synbiotic and placebo groups [mean difference of 0.11 times (95% CI: -0.31-0.55), p = 0.58]. However, mean stool frequency increased significantly at weeks 2 [mean difference of 1.32 times (95% CI: 0.21-2.43)] and 4 [mean difference of 1.58 times (95% CI: 0.18-2.99)] in the synbiotic group compared with the placebo group (p = 0.02). A significant difference (p = 0.006) was found at weeks 2 [mean difference of 0.83 (95% CI: 0.20-1.45)] and 4 [mean difference of 0.91 (95% CI: 0.3-1.51)] between the synbiotic and placebo groups regarding the Bristol stool form score. No adverse effect was seen in the synbiotic group. CONCLUSION: The results of this study indicated that this specific commercial product seemed to be effective in increasing stool frequency and improving consistency in this sample of males with functional constipation. However, further studies with longer follow ups, and including females and elderly patients are required to confirm the efficacy of this product for treatment of functional constipation.

Burden of spinal cord injury in Tehran, Iran.

STUDY DESIGN: Investigation of burden of traumatic spinal cord injury (SCI) using disease modeling. OBJECTIVES: The present paper is intended to estimate the SCI burden for the year 2008. SETTING: Tehran, capital of Iran. METHODS: Epidemiological data needed to calculate Disability-Adjusted Life-Years (DALYs) for SCI, was estimated according to prevalence, duration and relative risk of mortality using DISMOD software. For DALY calculation, the years of life lost because of premature mortality (YLL) was added to the number of years lost because of disability (YLD). To calculate DALYs for SCI, first year DALY calculated separately and for the next years, the DALY was assessed for six different clinical presentations of traumatic SCI including quadriplegia, quadriparesis, paraplegia, paraparesis, hemiplegia and hemiparesis. RESULTS: In first year following SCI, the DALY was 3772 years, which has 0.5 DALY per 1000 people and YLL/DALY was 89.3%. Following the first year, the DALY was 435 for quadriplegia, 163 for quadriparesis, 868 for paraplegia, 164 for paraparesis, 26 for hemiplegia and 14 for hemiparesis. The total YLL for traumatic SCI was 4077 years and total YLD was 1364 years (total YLL/DALY was 74.9%) and total DALY was 5441 years, (M/F=2.0), which has 0.7 DALY per 1000 people in Tehran in 2008. CONCLUSIONS: This study showed a high burden for SCI. Identifying the risk factors of SCI, and performing cost-effective preventive interventions for reducing burden of SCI is recommended.

Role of dipstick in detection of haeme pigment due to rhabdomyolysis in victims of Bam earthquake.

Avoiding life-threatening complications of rhabdomyolysis depends on early diagnosis and prompt management. The aim of this study was to evaluate the role of urinary dipstick test in the detection of haeme pigment in patients who were at risk of acute renal failure (ARF) due to rhabdomyolysis after suffering injury in the Bam earthquake. Serum creatine phosphokinase (CPK) level was used as the gold standard for prediction of ARF. ARF developed in 8 (10%) of 79 patients studied. We found no significant differences in the sensitivity, specificity and accuracy of dipstick urine and serum CPK tests for identifying patients who were at risk of ARF. However, dipstick urine test is an easy test that can be performed quickly at an earthquake site.

Role of dipstick in detection of haeme pigment due to rhabdomyolysis in victims of Bam earthquake

Avoiding life-threatening complications of rhabdomyolysis depends on early diagnosis and prompt management. The aim of this study was to evaluate the role of urinary dipstick test in the detection of haeme pigment in patients who were at risk of acute renal failure [ARF] due to rhabdomyolysis after suffering injury in the Bam earthquake. Serum creatine phosphokinase [CPK] level was used as the gold standard for prediction of ARF. ARF developed in 8 [10%] of 79 patients studied. We found no significant differences in the sensitivity, specificity and accuracy of dipstick urine and serum CPK tests for identifying patients who were at risk of ARF. However, dipstick urine test is an easy test that can be performed quickly at an earthquake site

Management of femoral artery pseudo-aneurysms in Iran: a single centre report of 50 cases.

The aim of this study was to review the aetiology and surgical technique of treatment of all femoral artery pseudo-aneurysms that had presented to our centre during the previous 9 years and to compare the results of infected femoral artery pseudo-aneurysms and other kinds of pseudo-aneurysm. This retrospective case-note study consists of all femoral pseudo-aneurysms that have been managed in Sina hospital from 1996 to 2005. The intravenous injection of drugs (n = 26), arterial access for angiography (n = 17), trauma (n = 6) and vasculitis (n = 1) were the causes of pseudo-aneurysms. Surgical repair was indicated for all patients; however, routine surgical repair techniques were modified in some patients. Two deaths and one amputation occurred in intravenous drug abusers. The most frequent cause of femoral artery pseudo-aneurysm formation in our hospital is intravenous injection of drugs, which is associated with higher mortality and morbidity than other causes. In contrast to previous reports, our experience shows that triple vessel ligation (common, superficial and deep femoral arteries) can be a safe treatment for infected femoral artery pseudo-aneurysms. In addition, our results did not show the safety of common femoral artery ligation as a treatment of choice. However, it is recommended, due to the better results of elective extra-anatomic bypass than emergent extra-anatomic bypass. Repair of post-angiographic pseudo-aneurysms by interrupted sutures or patch angioplasty is associated with good results. Surgical repair of traumatic pseudo-aneurysms should be determined per case and can vary from local control to extra-anatomic bypass.