Objective: To assess acute otitis media with facial nerve paralysis, its prognosis, and treatment. Methods: It is a retrospective study. Thriteen patients of acute otitis media associated with facial nerve paralysis attended the outpatient department of otorhinolaryngology between May 2017 and April 2019. All patients were clinically assessed with appropriate investigations, prognosis, and treatment. Results: Out of 13 patients, 2 were identified with complete facial paralysis and the remaining 11 patients presented with incomplete paralysis. Medical treatment including antibiotics and corticosteroids failed, while myringotomy and facial nerve decompression were done with a favorable outcome. Eleven patients recovered to grade-I (House-Brackmann) and 2 cases to grade-II (House-Brackmann). Conclusion: Peripheral facial nerve paralysis in acute otitis media is rare. Antibiotics and steroids yield good outcome as conservative management. In case of failure by conservative treatment, facial nerve decompression yields a favorable outcome.

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Rationale: Acute myocardial infarction in the presence of right bundle branch block. Patient concerns: A 70-year-old, male heavy smoker presented with angina and hypertension. Interventions: Electrocardiography, intravenous nitroglycerin infusion, intravenous streptokinase infusion. Diagnosis: Acute myocardial infarction in the presence of with changeable trifascicular heart block. Outcomes: Dramatic clinical improvement with electrocardiographic ST-segment (whether elevation or reciprocal ST-depression) resolution. Lessons: Acute myocardial infarction may be associated right bundle branch block. Accompanied trifascicular heart block had pre-streptokinase left anterior fascicular block with left axis deviation and post-streptokinase left posterior fascicular block with right axis deviation.

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Objective: To determine the effect of self-management program on the health status of elderly patients with heart failure. Methods: The present study was a single-blind, randomized clinical trial, and conducted on 90 patients with heart failure of stages II-III at one teaching hospital in eastern Iran in 2017. The participants were randomly assigned into two groups: the intervention group and the control groups, with 45 patients in each group. Self-management programs including awareness and recognition, problem-solving process, diet, exercise, and stress management were carried out. The participants were trained for six weeks and were followed for two months. Data of the health status were collected before, after and eight weeks after intervention by Kansas City Cardiomyopathy Questionnaire. Data analysis by chi-square, independent t-test, Fisher, ANOVA with repeated measures was conducted. Results: Patients in both groups were matched in terms of demographic characteristics before the intervention. There was no significant difference in the mean scores of health status between the two groups (P=0.1) before the intervention. However, the second measurement after intervention showed a significant difference in the mean scores between the two groups (P=0.001). Conclusions: Self-management program can improve the different dimensions of health (except in the subscale of sign and symptoms). Therefore, this supportive method can be used to improve the health of patients and manage problems caused by heart failure.

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Dorsal midbrain syndrome or Parinaud syndrome is a supranuclear brainstem syndrome involving the vertical gaze centre. These are case series with three patients who were diagnosed with dorsal midbrain syndrome secondary to pineal gland tumours. The prognosis varied depending on tumour types, age of presentation and treatment received. All of them were presented with life-threatening obstructive hydrocephalus. Our first patient was successfully treated with emergency surgery followed by radiotherapy. He regained normal visual acuity and full recovery of his ocular movement. Second and third patients had undergone surgery for raised intracranial pressure. Both had an inoperable pineal gland tumour. As for our second patient, we detected a worsening of vertical gaze during his four years follow-up. However, his bilateral good visual acuity was preserved. The third patient passed away as a result of uncontrolled enlarging tumour. We also briefly reviewed the clinical presentation, diagnosis, and therapeutic approach of the three patients. One of the caveats is that urgent radiological study is crucial to differentiate the tumour type via the pathognomonic features and to delineate the tumour extension. The preferable treatment options vary among each tumour type. A multidisciplinary approach is crucial in early detection, in addition to treatment initiation and long term follow up to achieve a better outcome.

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Objectives: To study the rate of survival to discharge after in-hospital cardiac arrest and its associated factors in an emergency department of a tertiary care hospital, South India. Methods: This prospective observational study was conducted between December 2016 and May 2017 among all patients above 12 years old, who suffered witnessed cardiac arrest, after arrival in the emergency department. A semi-structured questionnaire was used to collect data (socio demographic details, chief complaints, comorbidities). Initial documented rhythm, duration of CPR, use of defibrillator, and presumed cause of cardiac arrest and others were collected from the case records. Results: The study cohort contained 252 participants. The age was (50.0+17.2) years and male patients accounted for 54.4%. The most common complaint was breathlessness (29%), followed by chest pain (20.2%) and trauma (17.5%). The proportion of non-shockable rhythm (77.4 %) was higher than shockable rhythm (22.6%). Pulseless electrical activity (53.9%) was the most common initially documented rhythm. The predominant presumed cause of arrest was cardiac origin (29.7%). The overall rate of survival to discharge was 17.5%. Logistic regression analysis showed age >60 years [odds ratio (OR): 3.4, 95% confidence interval (CI): 1.03-11.22, P=0.04], males (OR: 3.45, 95% CI: 1.00-11.44; P=0.04), presumed respiratory cause (OR: 11.8, 95% CI: 1.0-160.0, P=0.05), initial rhythm ventricular fibrillation (OR: 9.1, 95% CI: 1.0-92.0, P=0.05) as individual predictors of survival rate to discharge after in-hospital cardiac arrest. Conclusions: Our study shows that less than one-fifth of patients survive to discharge after inhospital cardiac arrest. This signifies the need to identify and to make the necessary changes at all levels of organization, service delivery and patient care, so as to improve the overall survival rate following cardiac arrest.

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Objective: To determine the frequency and causes of injuries from sharp instruments contaminated by blood in hospital staff. Methods: The study was cross-sectional and conducted at an educational hospital supervised by Kerman University of Medical Sciences in 2018. Using a researcher-made questionnaire, we determine the frequency and causes of injuries from sharp instruments contaminated by blood in 142 hospital staff. Results: Of the 142 patients, 68 persons (48%) did not have a history of needle stick injury, but 74 persons (52%) had suffered needle stick injury 1 to more than 5 times. Among those who suffered a needle stick, 74.3% were trained, while 70.7% of those who did not suffer needle stick had been trained. The results indicated that the needle was the most common sharp instrument causing needle stick injury. Conclusions: The study showed a high prevalence of needle stick injury among hospital personnel specifically in ICU, orthopaedic and surgery departments. Supportive measures such as improving injection practices, modification of working schedule, planning training programs targeted at using personal protective equipment, and an adequate number of safety facilities for the effective prevention of needle stick injury incidents are needed.

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Objective: To investigate the epidemiological pattern of animal bites in Yazd Province, central Iran. Methods: In this cross-sectional study, 8 545 individuals with animal bites who were referred to the Yazd Province Rabies Treatment Center were investigated using the census method from April 2013 to March 2017. The variables included: demographic information, household living condition, the type of biting animals, the domesticated and wild animals, the time of biting based on year, the residence location (urban or rural), and the treatment status. Data were analyzed by descriptive statistics using Excel 2013, SPSS version 25 and Arc GIS 14.1 Software. Results: A total of 8 545 cases of animal bites were reported in Yazd province from 2013 to 2017. The most animal bites (with 4 253 case of bites) and the lowest animal bites (with 121 case of bites) occurred in Yazd and Bahabad district, respectively. The incidence of animal bites was 168.4 per 100 000 people during the five-year period. Most of cases (73.9%) occurred in urban areas. Dog and cat bites accounted for 47.6% and 47.4% of all cases, respectively. Most of animal bites were reported in the summer (29.4%). Sixty percent of the cases received incomplete treatments, while 40% of them received complete treatments. During this study, three positive cases of fatal rabies from dog bites were reported. Conclusions: The incidence of animal bites is high in Yazd province, and more patients are bitten by dog and cat. Hence, educational, preventive, and informative programs are required to reduce the incidence of animal bites.

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Objective: To retrospectively analyze patients aged 65 years and over, who were admitted to a level II trauma center in Turkey due to minor spinal trauma in a period of 4 years. Methods: The study included 64 patients aged 65 years and over, who were admitted to the Emergency Department of Baskent University Ankara Hospital between January 2011 and January 2015 and diagnosed with vertebral trauma. The information of the patients was obtained from the medical records. The clinical characteristics of patients including localizations and types of fracture, presence of additional system injuries and treatment options were investigated. Results: The most common cause was fall, accounting for 51 (79.7%), with 7 (10.9%) due to intra-vehicle traffic accident, and 6 (9.4%) due to out-of-vehicle pedestrian injury. The most common site of trauma was the lumbar region. Of the fractures, 46.9% (n=30) were in the lumbar region, 37.5% (n=24) in the thoracic region and 15.6% (n=10) were in the cervical vertebra region. Fourteen (21.9%) patients had an additional injury. Given the fracture types, 47 fractures (74.6%) were compression, 14 fractures (22.2%) were spinous process and 2 fractures (3.2%) were burst fractures. Twenty patients (31.2%) had multilevel vertebral fractures. Conclusions: The results of our study demonstrated the importance of vertebral fractures in the geriatric age group. In this age group, falls and motor vehicle accidents are the leading causes of vertebral traumas. Taking the necessary measures to prevent the risk factors which increase with aging is the most important step in preventing the mortality and morbidity that may occur as a result of vertebral fracture.

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