Paediatric burn injuries requiring hospitalization in Fars, Southern Iran

The aim of this study was to determine the demographic characteristics of burnt children in need of hospitalization, causes of burns and associated complications in Fars province, Iran. This is a retrospective cross-sectional study. Files of all children under 15 years of age who were hospitalized in the only burn referral centre of Fars province were evaluated. Data regarding age, gender, location (urban, rural), burn surface area (BSA), cause of burn, length of hospital stay and complications were extracted from patients' files. Data were analyzed using SPSS, version 22 and the Chi-square test. A p-value of less than 0.05 was considered as statistically significant. A total of 122 patients (54.9% males) were studied. Children from rural areas were hospitalized 1.4 times more often than urban children. Overall, 31.2% of admissions occurred in winter. Burning with hot liquids (scalding) was the most common cause of burns (56.6%, n = 69). Mean BSA was 12.29 ± 21.18% and mean length of hospital stay was 7.59 ± 12.78 days. Burn complications were seen in 19 cases (15.6%). One child died due to inhalational thermal injury. This study showed that burns mostly occur in boys, in the winter and in rural areas of Fars province. Furthermore, scald burns are the most common type of burn injury. Since a significant number of children suffer from permanent complications following burn injuries, special planning is needed to prevent this type of injury.

The role of ultrasound in the visualization of the ingested medications in acute poisoning - a literature review

In the patients with medication poisoning, diagnosis and treatment may be complicated due to the decreased level of consciousness or lack of the patient cooperation. In this review, we tried to assess the role of ultrasonography in detection of the ingested medication in the stomach of the patients with suspected medication poisoning. Of the studies performed in this regard, only one managed to determine the extended phenytoin capsules in the stomach of a poisoned patient. In actual acute poisoning - even in the hands of an experienced ultrasonographer - detection of the medications in the patients' stomach seems to be difficult due to the presence of the food or lack of the water in their stomach. Also, after dissolution of the tablets or capsules or their passage from the pylorus, they can not further been visualized by ultrasound. We, therefore, conclude that ultrasonography is not an appropriate tool for diagnosis of the medication ingestion in acute poisoning.

How should the ophthalmologists treat the methanol-induced toxic optic neuropathy?

No abstract available.DOI: http://dx.doi.org/10.3126/nepjoph.v4i2.6563 Nepal J Ophthalmol 2012; 4 (2): 348-350 

Lipid emulsion improves Glasgow coma scale and decreases blood glucose level in the setting of acute non-local anesthetic drug poisoning--a randomized controlled trial

BACKGROUND

To date, no study has been performed to evaluate the antidotal effect of intravenous lipid emulsion on the poisoned patients' level of consciousness and routine metabolic profile tests in non-local anesthetic drug overdose.

OBJECTIVES

Our aim was to evaluate the effect of intravenous intralipid administration as an antidote on the poisoned patients' Glasgow Coma Scale (GCS), hemodynamic parameters, arterial blood gas analysis, and routine metabolic profile tests (i.e., urea, glucose, sodium, and potassium) in the setting of non-local anesthetic drug overdose.

MATERIAL AND METHODS

In this randomized controlled trial, a total of 30 patients with non-local anesthetic drug intoxication were enrolled and randomly assigned into case (n=15) and control (n=15) groups. In the case group, all patients received 10 cc/kg intralipid 10% infusion. The patients in the control group just received the supportive care. Patients' demographic and clinical characteristics and results of their laboratory tests were evaluated at presentation and 6 hours after that.

RESULTS

Mean age was 23 +/- 5 and 28 +/- 11 years in cases and controls, respectively. There were no significant statistical differences between these two groups regarding age, gender, elapsed time between intubation and extubation, and need for intubation and/or mechanical ventilation (p = 0.70 and p = 1.00, respectively). Also, systolic blood pressure, pulse rate, mean rate pressure product, respiratory rate, results of arterial blood gas analyses, serum sodium, potassium, urea, and creatinine on presentation and six hours later were not statistically significantly different between the two study groups. However, a significant difference was found between the two groups in terms of GCS difference (p = 0.048) and blood glucose six hours after presentation (p = 0.04).

CONCLUSIONS

In the setting of non-local anesthetic drug overdose, intravenous intralipid infusion can increase GCS and interestingly, decrease the blood glucose.

Tramadol-induced seizures and trauma

BACKGROUND AND OBJECTIVES

To determine the prevalence, type and site of the injuries due to tramadol-induced seizures in the patients who had referred after its overdose or use of its therapeutic dose.

MATERIAL AND METHODS

All patients referring to Loghman Hakim Poison Hospital (February 2009 to April 2010) due to tramadol-induced seizures were included. The patients' data including age, gender, ingested dose by history, route of exposure, manner of poisoning, previous history of suicidal attempts, previous history of drug or substance abuse, history of tramadol abuse, type of the seizure, number of episodes of seizure before presentation or after admission, site of the trauma, and type of injury were recorded.

RESULTS

A total of 232 patients were included in the study. Of them, 185 (79.7%) had referred within the first 6 hours after ingestion. The mean dose ingested by the history was 1416 +/- 1124 mg. History of tramadol abuse was positive in 114 (49.1%) patients. Seizure episodes had occurred once in 207 (89.2%), twice in 21 (9.1%), and three times in 4 (1.7%) patients. The prevalence of trauma was 24.6% (in 57 patients) with the most frequent site of trauma to the face (9.5%) followed by shoulder (4.3%), head (3%), trunk (1.7%), and upper extremities (1.3%). No statistically significant difference was found between patients with and without trauma associated with tramadol-induced seizures in terms of age, gender, ingested dose by history, positive history of addiction to other opioids, and number of episodes of seizure.

CONCLUSIONS

The only serious injury associated with this type of seizure was the head injury, present in approximately 1% of the patients.

Prevalence of pituitary incidentaloma in the Iranian cadavers

AIM

Although one-fourth of the pituitary tumors are inactive and silent, increased total volume of the pituitary gland exerts pressure on sella turcica and corrodes the clinoid processes, resulting in several problems. Therefore, determination of the prevalence of the concealed pituitary tumors is of major concern among clinical practitioners. This study was performed to determine the prevalence of these tumors in cadavers referred to the Iranian Legal Medicine Organization (Kahrizak, Tehran).

MATERIALS AND METHODS

This cross-sectional descriptive study was performed between June 2007 and February 2008. A total of 485 cadavers were selected by simple random sampling method. Pituitary glands were removed and then horizontally cut and four slides were prepared from each of them, stained by hematoxylin and eosin, and evaluated by a light microscope. For statistical analysis, SPSS software (version 16), Mann-Whitney U test, Kolmogorov-Smirnov nonparametric test (K-S test), and Chi-square test were used.

RESULTS

Of the 485 investigated cadavers, 365 (75.3%) were males with an average age of 42 ± 20.5 years and 120 (24.7%) were females with an average age of 44 ± 22 years. A total of 61 (12.6%) had concealed pituitary masses. No statistically significant difference was found between the mean age, sex, and body mass index (BMI) of the cadavers with and without concealed tumors (P=0.380 P=0.450, and P=0.884, respectively).

CONCLUSIONS

In the present study, the prevalence of the concealed pituitary adenomas was 12.6%. There was no correlation between age, sex, and BMI and the prevalence of the concealed masses.

An epidemiological study and determination of causes of traffic accident-related deaths in Tehran, Iran (during 2000-2001)

Traffic accidents are an important cause of traumatic death particularly in developing countries such as Iran. One of the most principal steps in prevention and control of traffic accident-related trauma and its deaths is having information about demographic characters of its victims and their cause of deaths. Our cross sectional study deals with all of the cases of traffic accident-related deaths which were referred to the Tehran Legal Medicine Organization. This survey covers one year from March 20th, 2000 to March 24th, 2001. All the victims' files were studied. Number of traffic accident-related deaths were 2128 (25% of all of cases which were referred to this centre for determination of cause of death). Male to female ratio was 4.1 to 1. Most of deaths have been between 21 and 30 years old (22.1%). Mean age was 39.4 year (SD: 21.9 yr). Seasonal variation was not seen. Twenty-seven percent of cases were died at the scene and 72.7% in hospital. The most common cause of death was head injury (49.8%), the other causes were multiple trauma (35%), internal bleeding and visceral laceration(11.1%), cervical spinal cord injury (1.9%), complications of trauma (1.6%) and others (0.6%), respectively. These findings were compared with other surveys and authors recommend some suggestions such as public education of traffic rules, obligatory use of seat-belts, wearing of crash-helmet, attention to preventable causes of death, etc.

Seroprevalence of HIV, HBV and HCV in forensic autopsies, of presumed low risk, in Tehran, the capital of Iran

The purpose of this study is to determine whether autopsies of bodies believed to be from low risk groups, are safe or not. A research study was undertaken to identify the seroprevalence of HIV, HBV and HCV in a presumed low risk forensic autopsy population in Tehran, the capital of Iran. One hundred and seventy three blood samples were collected from cases autopsied at the Tehran Legal Medicine Organization between September 2000 and October 2001. Eight serum samples were positive for HbsAg; 7 were positive for anti-HCV; None was positive for anti-HIV-1, 2. The authors advise that all forensic specimens-even those from bodies presumed to be of low risk, should be treated as potentially infectious and appropriate precautions should be taken when performing autopsies.

Firearm fatalities. A preliminary study report from Iran

During the one-year period from March 2002 to March 2003 there were 89 firearm fatalities investigated by the Legal Medicine Organization of Iran in Tehran. We determined the characteristics of these 89 firearm deaths which comprised 0.83% of all postmortem examinations. Of these, 60.7% were homicides, 30.3% suicides, 4.5% accidental, and 4.5% unclassifiable. Most victims were young male. Military rifles were responsible for almost all suicides, whereas in homicide handguns were the preferred weapons. The most common site of entrance wounds in suicides were the under the chin (37%) and chest (25.9%). In homicide group, 42.6% of entrance wounds were located in the head. The suicidal gunshots were fired from contact/near contact range in 84.6% while this was the case in only two cases of the homicides. All but one of the suicides were committed at the garrisons or police stations. The unique pattern of suicide that was found in this series was not similar to that reported in earlier studies. We believe our pattern of firearm fatalities must be in great part due to the Iran's strict gun control regulations and cultural background.