Association of red blood cell distribution width with mortality among multiple trauma patients.

Background: Identifying the severity of trauma to provide timely and adequate treatment and predict the prognosis are some of the significant challenges in trauma management. Increased red blood cell distribution width (RDW) is associated with several pathologies and associated mortality. This study aims to evaluate the RDW in predicting 24 h and 30-day mortality among multiple trauma patients. Methods: In this retrospective study, multiple trauma patients with ISS ≤16 were included. Blood samples of the patients were collected at 1 h and 24 h of the referral to determine RDW. Demographic data, 24 h and 30-day mortality, injury severity score (ISS), and RDW outcomes were evaluated for all the patients. Results: Of the 300 patients included in the study, 52 patients died in the first 24 h, and 85 patients within 30 days. One hour and 24 h RDW were not significantly different in 30-day mortality patients, P=0.104 and P=0.156, respectively. RDW in 30-day mortality patients was not significantly different at 1 h and 24 h, P-value=0.875. The means ISS in 24 h, 30-day mortality and survivors was significantly different, P<0.001. Conclusion: Our study does not report a significant increase in RDW among 24 h and 30-day mortality and survivor patients. ISS was significantly different among the two groups.

The effect of dimethicone on preventing ileus in patients with pelvic and femoral fractures: A clinical trial.

Ileus and pseudo-obstruction are clinical syndromes that are among the most common postoperative complications. Identifying an effective treatment approach for these conditions is essential. Therefore, the aim of this study is to investigate the effect of Dimethicone on preventing ileus in patients with pelvic and femoral fractures. This study was conducted on 120 patients, with 60 individuals in the Dimethicone group and 60 individuals in the control group. After recording demographic information and clinical notes, bowel movements and defecation after surgery were also recorded. The statistical tests of Chi-square, Fisher's exact-test, Mann-Whitney, and independent t-test were utilized to compare the data. The primary outcome of the study determined the incidence of ileus in the intervention and control groups (intervention group = 1.7 % and control group = 3.3 %) (P = 0.99). The secondary outcome involved comparing the time of gas expulsion between the two groups, intervention, and control (intervention group = 21.05 h and control group = 22.03 h) (P = 0.065). Although the time of gas and feces expulsion, as well as the initiation of bowel movements and the occurrence of ileus, were lower in the intervention group, there was no statistically significant difference in the postoperative results, particularly regarding the occurrence of ileus and the reduction in the duration of feces and gas expulsion and the initiation of bowel movements in patients receiving Dimethicone compared to the control group. Considering the lack of statistical significance in the obtained results and the absence of similar studies using Dimethicone, further research and larger sample size studies with Dimethicone or other pharmacological methods are needed to find the most effective treatment approach in reducing the occurrence of ileus after surgery.

Sigmoid volvulus secondary to undescended testicle: Report of first case in the literatures.

Sigmoid volvulus accounts for 20%-50% of colonic obstructions in Eastern countries. This occurs mostly in patients with a lack of mobility and a history of chronic constipation. There are some very known complications of a undescended intra-abdominal testicle such as cancer, ischemia, and infertility; But the rotation of the colon around the spermatic cord of one UDT is a very rare phenomenon that there is no similar report. A 67-year-old man came to the emergency department with a complaint of abdominal pain and obstipation. On examination, patient was febrile (T: 38.5) and had mild general tenderness. According to the appearance of coffee beans in the X-ray, the diagnosis of sigmoid volvulus was made. In the requested tests, leukocytosis was observed. Rectosigmoidoscopy was unsuccessful. The patient underwent laparotomy. After manual untwisting, a tubular structure at the base of the meso-sigmoid was noticed. With further exploration, the testis was observed intra-abdominally. Orchidectomy and sigmoidectomy were performed by Hartmann's method. Sigmoid volvulus is one of the common cases that surgeons frequently encounter. The case scenarios are often the same, and from experience, most cases result from a long meso and an elongated sigmoid secondary to prolonged constipation. Therefore, it is clear that a scrotal examination would not be part of the routine examination of a patient with sigmoid volvulus. In this article, by reporting a very rare etiology for a very common pathology, we tried to point out the importance of head-to-toe examination in all patients.

Evaluation of Clinical Characteristics and Outcomes of Chest Trauma Patients with COVID-19 Infection Undergoing Emergency Surgeries.

BACKGROUND: This study aims to examine the clinical characteristics and prognosis of patients with chest trauma who were infected with COVID-19 and underwent emergency surgery. OBJECTIVE: In light of the COVID-19 pandemic, this research investigates the impact of COVID-19 on patients with chest trauma who underwent emergency surgery. METHODS: This retrospective cohort study was conducted on 56 patients with chest trauma in two groups with COVID-19, and no covid who underwent surgery in Shahid Madani Hospital. RESULTS: Among the trauma patients, 21 were infected with COVID-19, and 35 were not. The predominant causes of trauma were car and motorcycle accidents. Among COVID-19 patients, 3.3% exhibited symptoms of fever, chills, cough, shortness of breath, and gastrointestinal symptoms, while 5.9% had severe lung involvement confirmed by CT scan. Following surgery, 1.57% (12 individuals) of COVID-19 patients were transferred to the ICU, with an average hospitalization duration of 1.11 days. In contrast, the average hospitalization duration for non-COVID-19 chest trauma patients was 1.9 days (p =0.015). CONCLUSION: Patients with chest trauma who underwent surgery and were infected with COVID-19 demonstrated significant differences in average length of stay, ICU admissions, and pneumonia incidence. However, there was no significant distinction in the mortality rate between the two groups.

Safety and efficacy of injection of human placenta mesenchymal stem cells derived exosomes for treatment of complex perianal fistula in non-Crohn's cases: Clinical trial phase I.

BACKGROUND AND AIM: A perianal fistula is an abnormal tract that connects anal canal to skin. Current medical and surgical interventions have a high failure rate particularly in complex and refractory cases. MSC-derived exosomes have demonstrated immunomodulatory effects without the conventional complications; hence, in this study, we evaluated the safety of their application for complex perianal fistula. METHODS: Placenta-derived MSCs were cultured, and exosomes were isolated using ultracentrifugation. Exosome injections were administered in the operating room to 11 patients with complex perianal fistula (presence of fistulas for at least 1 year alongside medical and surgical treatment). The patients were followed for 6 months, and the patients were evaluated using physical examination, face-to-face interviews, and magnetic resonance imaging (MRI). RESULTS: Among 11 patients only one did not show any improvement upon physical examination. Five patients showed complete tract resolve. While the discharge was stopped in eight patients, two patients showed only reduction. None of the patients showed any acute or latent allergic reaction or injection related complications. CONCLUSION: Administration of exosomes isolated from MSCs demonstrates safety and a satisfactory therapeutic effect in treatment complex perianal fistulae; therefore, it can be a candidate for future studies and might play a significant role in treatment.

Bronchoalveolar lavage of ventilator-associated pneumonia patients for antibiotic resistance and susceptibility test.

BACKGROUND AND AIMS: Ventilator-associated pneumonia is highly prevalent nosocomial infection among patients under mechanical ventilation. Bronchoalveolar lavage (BAL) is effective in identifying the type of pathogen involved and determine the course of antibiotic. The aim of this study was to evaluate the prevalence of different pathogens involved in ventilator-associated pneumonia (VAP) and associated antibiotic resistance and sensitivity pattern. METHODS: In this descriptive cross-sectional study, patients admitted to the intensive care unit under mechanical ventilation at Shahid Madani Educational and Medical Center in Karaj during 2018 and 2020 were included. BAL samples were obtained from the patients. Demographic data, duration of hospitalization, duration of mechanical ventilation, and antibiotic susceptibility and resistance tests were recorded for all the patients. RESULTS: Among 335 patients included in the study, 215 (64.2%) were males. The mean age of the patients was 55.06 ± 14.90 years. The most common pathogens reported were Acinetobacter baumannii (40%), Pseudomonas aeruginosa (21.2%), and Staphylococcus aureus (13.4%). The mean age of the patients, gender, duration of mechanical ventilation, and duration of hospitalization were not associated with the type of pathogen, P > .05, respectively. CONCLUSION: BAL of these patients indicated that various pathogens are responsible for VAP, and can vary from patient to patient. Antibiotic resistance and susceptibility pattern of these pathogens vary and therefore is important in determining the course of the treatment.

A retrospective study on the cardiac assessment of isolated sternal fracture patients based on radiographic and clinical outcomes.

OBJECTIVE: Sternal fracture may be associated with major and serious injuries. In this study, the complications associated with isolated sternal fracture in trauma patients are evaluated based on radiographic and cardiac findings. METHODS: This retrospective study was performed on patients with isolated sternal fractures admitted to the emergency department of (XXX) Madani Educational-Medical. Data regarding demographic information, mechanism of trauma, length of hospitalization, electrocardiography (ECG), cardiac enzyme, and chest radiography were recorded in the questionnaire for each patient. RESULTS: The mean age of patients 41.2 + 11.04 years and 63.9% were male. The most common cause of the trauma was car accidents in 41% (25 cases). The mean duration of hospitalization was 1.54 ± 0.90 days. The mechanism of trauma was not associated with x-ray and computed tomography findings, p = 0.53 and p = 0.86, respectively. ECG findings were significantly related to x-ray and computed tomography outcomes, p < 0.001, respectively. CONCLUSION: Patients with isolated sternal fracture with displacement >0.5 cm and hematoma are likely to require cardiac consultation.

A cross-sectional study on evaluation of complete blood count-associated parameters for the diagnosis of acute appendicitis.

BACKGROUND AND AIMS: Acute appendicitis is one of the common causes of abdominal surgeries, however, the rate of negative appendectomy is as high as 20% as the diagnosis of appendicitis is challenging. The study aimed to evaluate complete blood count (CBC)-associated parameters among positive and negative appendectomy patients and determine their diagnostic importance. METHODS: In this cross-sectional study, patients who suspected of acute appendicitis were included. Preoperative blood samples taken from these patients for a complete blood count. Following parameters evaluated from their CBC: white blood cell (WBC), platelet (PLT), mean platelet volume (MPV), neutrophils-to-lymphocytes ratio, platelets-to-lymphocytes ratio, red cell distribution width (RDW), and platelet distribution width (PDW). These parameters analyzed for the positive and negative appendectomy patients using statistical analysis. RESULTS: Of 200 patients included in the study, 30 patients (15%) underwent negative appendectomy. The mean neutrophils, WBC, red blood cells, neutrophils-to-lymphocytes, and platelets-to-lymphocytes ratio was significantly high among positive appendectomy patients, (P < .05), whereas MPV to platelet ratio was significantly less in this group. The highest diagnostic power for the diagnosis of appendicitis was of neutrophils-to-lymphocytes ratio with the sensitivity of 83.5% and the specificity of 90%. CONCLUSION: The findings of our study indicate that neutrophils-to-lymphocytes ratio alone is not sufficient for preoperative diagnosis of acute appendicitis and other CBC-related parameters did not have good sensitivity and specificity. Further studies are therefore required in this area.

A rare presentation of xanthogranulomatous pyelonephritis and emphysematous pyelonephritis complicated with necrotizing fasciitis of scrotum and perineum (fournier gangrene).

We report a case of cooccurrence of xanthogranulomatous and emphysematous pyelonephritis along with necrotizing fasciitis (NF) of scrotum and premium in a patient was nondiabetic and the history of kidney stones. This case a unique presentation of NF due to two pyelonephritis causing fournier gangrene. Surgical management and antibiotics provide an effective management of the disease.

Surgical complications in colorectal cancer patients.

BACKGROUND: Advancements in diagnostic and therapeutic sciences have allowed early diagnosis and treatment of cancer. Colorectal cancer is one of the most commonly reported cancers, particularly in elderly patients. METHODS: Open and laparoscopic surgeries are used for the removal of the tumor, along with chemotherapy, depending on the stage of cancer. However, colorectal cancer surgery is associated with a great number of complications, that affect the efficacy of the surgery and overall health and survival of the patient. RESULTS: Prevalence of these complications have shown discrepancies depending on the condition of the patient and disease and surgical skills of the surgeon. Preoperative evaluation, intraoperative care and postoperative measures can reduce the incidence of these complications. CONCLUSION: This review highlights some frequently reported complications associated with colorectal cancer surgery, their risk factors and subsequent therapeutic measures to treat them.

Abdominal pain in the patient with antiphospholipid antibody syndrome: A case report.

Antiphospholipid antibody syndrome (APS) is known to cause hypercoagulability, affecting a wide range of vessels, systematically. A 56-year-old woman was referred to our center with severe epigastric pain, with the history of APS. She was treated with packed cells, fresh frozen plasma and anticoagulation therapies.

Pelvic Schwannoma: In light of a case report.

A 41-year-old man with abdominal enlargement, as a result of large retroperitoneal Schwannoma, was reported to our center. It was seen to have caused the displacement of the colon and was attached to the presacral region of the spine. Following the diagnosis, successful resection of Schwannoma was achieved.