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   2018| May  | Volume 7 | Issue 3  
    Online since July 23, 2018

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The chest X ray in pulmonary embolism: Westermark sign, Hampton's Hump and Palla's sign. What's the difference?
Tan Si Hong Shawn, Lim Xin Yan, Fatimah Lateef
May 2018, 7(3):99-102
Pulmonary embolism (PE), with the incidence of about 60 per 100 000 annually, can be a life- threatening disease if it is not treated promptly. It has been estimated that some 10% of PE patients die within the first hour of the event. Untreated PE has a mortality of about 30%. PE is a condition that is treatable if suspected and diagnosed early. The chest radiograph is still the first investigation that is ordered in patients presenting with cardiorespiratory symptoms or symptoms suggestive of PE. The CXR is also helpful in identifying or excluding other conditions or diagnoses. Thus, knowing and understanding some of the more specific CXR signs can be useful. We suggest that physicians to be aware of and utilize CXR findings such as Palla's sign, Westermark sign and Hamptons hump to help with the diagnosis of PE and to exclude other conditions that can mimic venous thrombo-embolism. Even if these signs are not common, their presence, even in an unsuspected patient without a high pretest probability of PE, should prompt further investigations such as a D-dimer test, lung scintigraphy or computed tomography pulmonary angiography as required.
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Hyponatremia in the acute phase of spinal cord trauma: Review
Luis Rafael Moscote Salazar, Amit Agrawal, Guru Dutta Satyarthee, Huber S Padilla-Zambrano, Boris Vladimir Cabrera-Nanclares, Romario Mendoza-Flórez, Samer Hoz, Alexis Narvaez-Rojas
May 2018, 7(3):103-107
Hyponatremia is a common electrolyte disturbance usually observed in neurosurgical patients undergoing surgical management of traumatic, as well as, nontraumatic intracranial pathology. The spinal cord trauma is also associated with occasional development of such hyponatremia; it usually occurs within the first two-weeks of the injury. Hyponatremia can lead to alterations of consciousness, convulsions, coma, cardiac arrhythmias and on rare occasions, death. Authors present a practical oriented review of the literature.
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Earthquake planning and crisis management with an emphasis on the facilities, utilities, and services of the health care centers of Tiran and Karvan County, Isfahan Province, Iran: A case study
Rouhullah Dehghani, Narges Mohammadzadeh, Maryam Salehi, Hamid Kassiri
May 2018, 7(3):115-121
Objective: To study earthquake planning and crisis management with an emphasis on the facilities, utilities, and services of the health care centers of Tiran and Karvan County, Isfahan Province. Methods: This is a descriptive-analytical survey based on the quantitative and qualitative characteristics of Tiran and Karvan County Health Care Centers(HCCs). Twenty quantitative and qualitative indicators were derived from the studied HCCs and analyzed using the strengths, weaknesses, opportunities and threats analysis technique. The top crisis management strategies were identified and a number of strategies and solutions were proposed. Results: The HCC utilities such as water, electricity, gas, and heating and cooling systems were in average condition, whereas the facilities of the majority of HCCs were in vulnerable-to-average condition. In addition, they sustained relatively high degree of instability which calls for reassessment and effective policies to minimize weaknesses and eliminate threats using strengths and opportunities. Conclusions: It is recommended that the condition of Tiran and Karvan County HCCs be enhanced by distributing new HCCs based on the population density, expanding the road network and creating vast, wide-open spaces to enable field hospital construction in times of crisis.
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Traumatic optic neuropathy secondary to acupuncture treatment for glaucoma: A case report
Wen Yee Lee, Wee Min Teh, Norlina Mohd Ramli, Ahmad Mt Saad
May 2018, 7(3):134-136
Internal organ injuries have been recognized as a major complication of acupuncture. Reported ocular adverse events include traumatic cataract, oculomotor nerve injury, endophthalmitis and retinal puncture. We report a case of traumatic optic neuropathy and self-sealed globe perforation following acupuncture. A Chinese gentleman with primary open angle glaucoma presented with sudden loss of vision in the right eye after acupuncture therapy. The vision dropped to 2/60 from 6/6 premorbid. Relative afferent pupillary defect was present. Fundus examination showed hemorrhage from the optic disc into the vitreous. It is likely that the optic nerve injury occurred when the acupuncture needle was advanced deep into locations near the optic nerve. Main acupoints used in acupuncture treatment of glaucoma include Tongziliao GB-1, Jingming BL-1 and Chengqi ST-1. It is crucial to have a good understanding of ocular anatomy to avoid potentially blinding complications.
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Traditional Chinese medicine and its protective function over brain-injured patients
Adrián Angel Inchauspe
May 2018, 7(3):93-98
Acupuncture is actually convoked for supporting Western Medicine. Its “Golden Points” can undoubtedly help patients during its neurological recovery. After almost thirty years of experience in saving patients at impending death situations and having made numerous contributions on the field, the author herein provides a reasoned survival bio-energetic circuit based on a detailed methodological and functional analysis of the Main Channels and the Wondrous Vessels (Qi jing ba mai) participating in it. K-1 Yongquan complementary resuscitation maneuver, systematized since 1987, has been consistently performed in sudden death and cardiac arrest conditions as a final resource in both basic and advanced CPR failure. Experimental analytical studies identify the prevention, control and assessment of treatments set up as well as the determination of their efficiency. Acupuncture K-1 Yongquan Resuscitation Maneuver is presented not only as a complementary CPR rescuer but as a protective aid for both traumatic and vascular acute brain injury. Current indications of KI-1 Yongquan are not limited to actuarial results in cardiac arrest resuscitations, but it functions as a brain protector in both traumatic and vascular brain injury situations should be included. Although many acupuncturists indicate only standard techniques for bio-energetic rehabilitation, it has not been noticed that they insist with greater emphasis in those specific points to stimulate the “Sea of Marrow” (encephalon). Divulgation of K-1 emergency therapeutic possibilities look for its inclusion into Critical Care Protocols, in order to upgrade survival rates in both cardiac arrest and stroke victims. Traditional Chinese Medical balancing effect principle can improve cognitive, intellectual and psycho-motor patterns after even severe brain injuries. Beyond the scientific methodology that supports it the efficiency of the maneuver derives mainly from the sustained increase in survival rates presented in the successive statistics published in renowned scientific journals since its application..
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A survey on the epidemiology of trauma and China trauma care training in subtropical regions of Hainan Province
Jiang-Ling Yao, Chang-Xi Zhou, Ji-Min Fu, Jian Fu, Yun-Tao Gu, Zhu-Long Meng, Lei Peng, Zhong-Lin Zhou
May 2018, 7(3):108-114
Objective: To investigate the epidemiology of trauma patients in subtropical areas of Hainan Province and the improvement of the level of trauma treatment in China trauma care training (CTCT). Methods: From 01-01-2015 to 01-01-2016, the epidemiological data of 2 476 patients with trauma were collected. From 01-01-2016 to 01-01-2017, 105 professional doctors and nurses in emergency surgery took part in CTCT, and their knowledge were compared before and after training. Results: There were 1 656 male and 820 female trauma patients with 1 614 cases in the middle and young age and 478 cases were the elderly. In terms of occupational distribution, 736 peasants, 574 workers and 458 retirees were involved. In May, the number of patients was the highest 332. October to January was the high-incidence season of trauma. In 24 hours a day: 11:00-13:00, 18:00-19:00, 23:00-03:00 were the high incidence periods. Referred to trauma sites, 904 cases of trauma happened on roads, 540 cases in family and 370 cases in restaurants or entertainment facilities. Through CTCT, the scores of the theoretical examination, the assessment of the trauma treatment skills and the field test scores of the emergency surgery practitioners were better than before (P<0.05). The misdiagnosis rate of severe trauma patients decreased from 26.21% to 15.36% (P<0.05). The mortality rate of severe trauma patients decreased from 18.67% to 13.94% (P<0.05). Conclusions: Trauma epidemiology in Hainan is closely related to its special geographical environment, which provides a reference for the prevention and treatment of trauma in Hainan, and some information for the government to formulate corresponding laws and regulations, as well as emergency plans and other relevant strategies. CTCT training improves the level of theoretical knowledge and first aid skills of medical personnel involved in trauma treatment. Health departments and medical education departments may consider extending CTCT training and continuing education programs to Hainan and other parts of China.
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A comparison of culture and PCR methods for identification of Aggregatibacter actinomycetemcomitans isolated from acute necrotizing ulcerative gingivitis
Maryam Ramez, Faramarz Masjedian Jazi, Hamed Tavakoli, Abazar Pournajaf, Gholamreza Irajian, Meysam Hasannejad Bibalan, Behzad Emadi, Behrooz Yasini
May 2018, 7(3):126-129
Objective: To determine Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) isolated from periodontal patients and healthy subjects using culture and PCR methods. Methods: Duplicate paper point needles were taken from 100 samples (50 healthy subjects and 50 patients), who referred to the specialized dental clinic from Oct. 2015 to Mar. 2016. In laboratory after incubation period and observing the star-shaped colony A. actinomycetemcomitans, the confirmation tests, including gram staining and catalase test were carried out. For PCR, samples were analyzed with genus specific primers. These primers set, amplified a 500 bp fragment. Results: Of the 100 samples, A. actinomycetemcomitans was isolated from 31 patients (31%), (24 isolate of patients, and 7 isolate of healthy subjects) by using a selective Aggregatibacter isolation medium. Using PCR, a total of 49 (49%) samples were found to be positive for A. actinomycetemcomitans (35 isolate of patients, and 14 isolate of healthy subjects). Conclusion: PCR was found to be highly sensitive when genus specific primers were used for diagnosis of A. actinomycetemcomitans in comparison with culture method.
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Scoring systems in prediciting mortality rate of patients applying emergency department
Tahtaci Rezan, Arslan Engin Deniz, Kavalci Cemil
May 2018, 7(3):122-125
Objective: To compare the scoring systems used in intensive care units in terms of predicting the mortality in emergency patients and to determine the most appropriate scoring system for urgent care. Methods: This study was carried out by retrospectively reviewing the files of patients admitted to Ankara Numune Training and Research Hospital emergency medicine clinic between October 1, 2010 and October 31, 2010 for non-traumatic reasons and admitted to any service of the hospital. This study calculated automatically with the data obtained from the patients files and records, and Acute Physiology and Chronic Health Evaluation (APACHE II), Simplified Acute Physiology Score (SAPS II), Modified Early Warning Score (MEW) and Sequential Organ Failure Assessment (SOFA) scores via internet. Patient files were reviewed and their outcomes (hospitalization, discharge, referral and mortality) were recorded. The obtained data were entered in SPSS 18 and compared with the scores of APACHE II, SAPS II, MEW and SOFA. Results: Based on area under the curve analysis, APACE II (0.799; 95% CI: 0.746 to 0.845) showed the biggest area under the curve in terms of predicting the patients mortality. However, there was no difference between four scoring system in terms of predicting the mortality. Age (P<0.001, odd's ratio 1.055) pulse (P<0.007, odd's ratio 1.025) and SO2 (P<0.003, odd's ratio 0.952) variables were found to be independent risk factors for mortality. Conclusions: Scores such as APACHE II, SAPS II, and SOFA, can not be used to make an urgent decision on the first encounter with the patient even though they are successful in predicting mortality. In this case, MEW could be recommended as the most useful system. As a result, the use of scoring systems in emergency departments is useful and necessary. But, multi-centered and large patient group studies are needed.
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Cost analysis and characteristics of the patients admitted to emergency service with poisoning
Kilicli Elif, Kavalci Cemil, Findik Meliha, Muratoglu Murat
May 2018, 7(3):130-133
Objective: To investigate the cost analysis and hospitalization rates and modes of poisoning of patients who applied to Bakent University Ankara Hospital Adult Emergency Service. Methods: Poisoning Patients who applied to emergency service due to suicide attempt between 01.01.2011- 31.12.2014 were included in the study. Patients’ age, gender, date of admission, definite diagnosis, the rate of hospitalization, and hospital costs were examined. A total of 646 patients were included in the study. 208 (32.2%) of the patients were male. The median age of the patients was 29 years. Results: The most causes of poisoning was drug intake. The median cost of the patients was 75.14 TL (IQR: 66.5). Conclusion: There was a positive correlation between age and cost (P<0.05). The majority of the patients apply to emergency dapartment with drug poisoning and female.
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Survival after prolonged cardiopulmonary resuscitation in cardiac arrest due to electric shock
Dhiraj R Jadhav, Lakshmi Vijaya, Joseph Alexis, Vinay Pandit
May 2018, 7(3):137-138
Cardiac arrhythmias and respiratory paralysis are among the common causes of death in electric shock victims. Emergency physicians face unique challenges in stabilizing airway and spine apart from fibrillating myocardium. Early and prolonged cardiopulmonary resuscitation may result in good outcome.
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