Archives of Trauma Research Archives of Trauma Research Arch Trauma Res http://www.archtrauma.com 2251-953X 2251-9599 10.5812/atr. en jalali 2018 1 22 gregorian 2018 1 22 1 3
en BOARDS and COMMITTEES BOARDS and COMMITTEES issue-information issue-information - - http://www.archtrauma.com/index.php?page=article&article_id=10828
en Table of Contents Table of Contents issue-information issue-information - - http://www.archtrauma.com/index.php?page=article&article_id=12083
en 10.5812/atr.8487 National Trauma Registry Center, as a Backbone of Trauma Management and Research National Trauma Registry Center, as a Backbone of Trauma Management and Research editorial editorial Wound and Injury; Trauma Management; Research Wound and Injury; Trauma Management; Research 87 88 http://www.archtrauma.com/index.php?page=article&article_id=8487 Mohammad Hossein Ebrahimzadeh Mohammad Hossein Ebrahimzadeh Orthopedic and Trauma Research Center, Mashhad University of Medical Sciences, IR Iran +98-5118012610, ebrahimzadehmh@mums.ac.ir; Orthopedic and Trauma Research Center, Mashhad University of Medical Sciences, IR Iran +98-5118012610, ebrahimzadehmh@mums.ac.ir Orthopedic and Trauma Research Center, Mashhad University of Medical Sciences, IR Iran +98-5118012610, ebrahimzadehmh@mums.ac.ir; Orthopedic and Trauma Research Center, Mashhad University of Medical Sciences, IR Iran +98-5118012610, ebrahimzadehmh@mums.ac.ir
en 10.5812/atr.7593 Blunt Traumatic Hernia of Diaphragm With Late Presentation Blunt Traumatic Hernia of Diaphragm With Late Presentation research-article research-article Background

Diaphragmatic hernia after blunt trauma is an uncommon and often undiagnosed condition.

Objectives

We aimed to review patients who presented with delayed blunt traumatic hernia of diaphragm.

Patients and Methods

In this retrospective study, the medical records of six patients treated for blunt diaphragmatic hernias who were admitted to Kashan Shahid Beheshti hospital between June 2007 and June 2011 were analyzed.

Results

Six patients with mean age of 41 years were included in the study. Male to female ratio was 2:1. Mean duration between trauma and admission to the hospital was 6.5 years (2 – 26 years). Five patients had left-sided diaphragmatic hernia. Chest X-ray was obtained from all patients which was diagnostic in 50 percent of the cases (n = 4). Additional diagnostic imaging with computerized tomography (CT) was used in six patients and upper gastrointestinal (GI) contrast study was performed in one patient. All patients underwent thoracotomy incision. Mesh repair was utilized in one patient. The mean hospitalization time was 14.1 days. There was one postoperative death (16.7%).

Conclusions

Late presentation of blunt diaphragmatic hernia is an uncommon and challenging situation for the surgeon. Prompt diagnosis and treatment prevent serious morbidity and mortality associated with complications such as gangrene and perforation of herniated organ.

Background

Diaphragmatic hernia after blunt trauma is an uncommon and often undiagnosed condition.

Objectives

We aimed to review patients who presented with delayed blunt traumatic hernia of diaphragm.

Patients and Methods

In this retrospective study, the medical records of six patients treated for blunt diaphragmatic hernias who were admitted to Kashan Shahid Beheshti hospital between June 2007 and June 2011 were analyzed.

Results

Six patients with mean age of 41 years were included in the study. Male to female ratio was 2:1. Mean duration between trauma and admission to the hospital was 6.5 years (2 – 26 years). Five patients had left-sided diaphragmatic hernia. Chest X-ray was obtained from all patients which was diagnostic in 50 percent of the cases (n = 4). Additional diagnostic imaging with computerized tomography (CT) was used in six patients and upper gastrointestinal (GI) contrast study was performed in one patient. All patients underwent thoracotomy incision. Mesh repair was utilized in one patient. The mean hospitalization time was 14.1 days. There was one postoperative death (16.7%).

Conclusions

Late presentation of blunt diaphragmatic hernia is an uncommon and challenging situation for the surgeon. Prompt diagnosis and treatment prevent serious morbidity and mortality associated with complications such as gangrene and perforation of herniated organ.

Diaphragmatic Hernia;Trauma;Diaphragm Diaphragmatic Hernia;Trauma;Diaphragm 89 92 http://www.archtrauma.com/index.php?page=article&article_id=7593 Abdolhossein Davoodabadi Abdolhossein Davoodabadi Trauma Research Center, Kashan University of Medical Sciences, IR Iran +98-9132632168, dmmzn58@gmail.com Trauma Research Center, Kashan University of Medical Sciences, IR Iran +98-9132632168, dmmzn58@gmail.com Esmaeil Fakharian Esmaeil Fakharian Trauma Research Center, Kashan University of Medical Sciences, IR Iran +98-9132632168, dmmzn58@gmail.com Trauma Research Center, Kashan University of Medical Sciences, IR Iran +98-9132632168, dmmzn58@gmail.com Mahdi Mohammadzadeh Mahdi Mohammadzadeh Trauma Research Center, Kashan University of Medical Sciences, IR Iran +98-9132632168, dmmzn58@gmail.com ; Trauma Research Center, Kashan University of Medical Sciences, IR Iran +98-9132632168, dmmzn58@gmail.com Trauma Research Center, Kashan University of Medical Sciences, IR Iran +98-9132632168, dmmzn58@gmail.com ; Trauma Research Center, Kashan University of Medical Sciences, IR Iran +98-9132632168, dmmzn58@gmail.com Esmaeil Abdorrahim Kashi Esmaeil Abdorrahim Kashi Trauma Research Center, Kashan University of Medical Sciences, IR Iran +98-9132632168, dmmzn58@gmail.com Trauma Research Center, Kashan University of Medical Sciences, IR Iran +98-9132632168, dmmzn58@gmail.com Azadeh Sadat Mirzadeh Azadeh Sadat Mirzadeh Student Research Center Committee, Kashan University of Medical Sciences, IR Iran Student Research Center Committee, Kashan University of Medical Sciences, IR Iran
en 10.5812/atr.6546 Effects of Neurosurgical Treatment and Severity of Head Injury on Cognitive Functioning, General Health and Incidence of Mental Disorders in Patients With Traumatic Brain Injury Effects of Neurosurgical Treatment and Severity of Head Injury on Cognitive Functioning, General Health and Incidence of Mental Disorders in Patients With Traumatic Brain Injury research-article research-article Background

Neurosurgical treatment and the severity of head injury (HI) can have remarkable effect on patients’ neuropsychiatric outcomes.

Objectives

This research aimed to study the effect of these factors on cognitive functioning, general health and incidence of mental disorders in patients with a traumatic brain injury (TBI).

Patients and Methods

In this descriptive, longitudinal study, 206 TBI patients entered the study by consecutive sampling; they were then compared according to neurosurgery status and severity of their HI. Both groups underwent neurosurgical and psychological examinations. The mini mental state examination (MMSE) and general health questionnaire–28 items (GHQ-28) were administered to the study participants. At follow-up, four months later, the groups underwent a structured clinical interview by a psychiatrist based on the diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV) diagnostic criteria regarding the presence of mental disorders.

Results

Analysis of covariance (ANCOVA) and multivariate analysis of covariance (MANCOVA) were performed and adjusted for the effect of confounding variables (age, gender, Glasgow outcome scale (GOS) , and level of education). The severity of HI had the most significant effect for the following variables; cognitive functioning and physical symptoms (P < 0.05). The effect of the neurosurgical treatment factor was not significant; however, the interaction effect of the two variables on social dysfunction, and total score of the GHQ-28 questionnaire appeared to be significant (P < 0.05). Fisher\'s exact test indicated that after a four month follow-up period, no significant differences were seen between the two groups (with or without neurosurgery) in the incidence of mental disorders, while x2 Test showed that having a more severe HI is significantly correlated with the incidence of mental disorders (P < 0.01).

Conclusions

The implications of this study should be discussed with an emphasis on negative, effective factors on the cognitive – behavioral and neuropsychiatric outcomes of a TBI.

Background

Neurosurgical treatment and the severity of head injury (HI) can have remarkable effect on patients’ neuropsychiatric outcomes.

Objectives

This research aimed to study the effect of these factors on cognitive functioning, general health and incidence of mental disorders in patients with a traumatic brain injury (TBI).

Patients and Methods

In this descriptive, longitudinal study, 206 TBI patients entered the study by consecutive sampling; they were then compared according to neurosurgery status and severity of their HI. Both groups underwent neurosurgical and psychological examinations. The mini mental state examination (MMSE) and general health questionnaire–28 items (GHQ-28) were administered to the study participants. At follow-up, four months later, the groups underwent a structured clinical interview by a psychiatrist based on the diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV) diagnostic criteria regarding the presence of mental disorders.

Results

Analysis of covariance (ANCOVA) and multivariate analysis of covariance (MANCOVA) were performed and adjusted for the effect of confounding variables (age, gender, Glasgow outcome scale (GOS) , and level of education). The severity of HI had the most significant effect for the following variables; cognitive functioning and physical symptoms (P < 0.05). The effect of the neurosurgical treatment factor was not significant; however, the interaction effect of the two variables on social dysfunction, and total score of the GHQ-28 questionnaire appeared to be significant (P < 0.05). Fisher\'s exact test indicated that after a four month follow-up period, no significant differences were seen between the two groups (with or without neurosurgery) in the incidence of mental disorders, while x2 Test showed that having a more severe HI is significantly correlated with the incidence of mental disorders (P < 0.01).

Conclusions

The implications of this study should be discussed with an emphasis on negative, effective factors on the cognitive – behavioral and neuropsychiatric outcomes of a TBI.

Brain Injury;Neurosurgery;Cognitive Aspect;Mental Health Brain Injury;Neurosurgery;Cognitive Aspect;Mental Health 93 100 http://www.archtrauma.com/index.php?page=article&article_id=6546 Sajjad Rezaei Sajjad Rezaei Guilan Road Trauma Research Center, Department of Psychology, University of Isfahan, IR Iran +98-9113390785, Rezaei_psy@hotmail.com; Guilan Road Trauma Research Center, Department of Psychology, University of Isfahan, IR Iran +98-9113390785, Rezaei_psy@hotmail.com Guilan Road Trauma Research Center, Department of Psychology, University of Isfahan, IR Iran +98-9113390785, Rezaei_psy@hotmail.com; Guilan Road Trauma Research Center, Department of Psychology, University of Isfahan, IR Iran +98-9113390785, Rezaei_psy@hotmail.com Karim Asgari Karim Asgari Department of Psychology, University of Isfahan, IR Iran Department of Psychology, University of Isfahan, IR Iran Shahrokh Yousefzadeh Shahrokh Yousefzadeh Guilan Road Trauma Research Center, Guilan University of Medical Sciences, IR Iran Guilan Road Trauma Research Center, Guilan University of Medical Sciences, IR Iran Heshmat-Allah Moosavi Heshmat-Allah Moosavi Department of Psychiatry, Guilan University of Medical Sciences, IR Iran Department of Psychiatry, Guilan University of Medical Sciences, IR Iran Ehsan Kazemnejad Ehsan Kazemnejad Guilan Road Trauma Research Center, Guilan University of Medical Sciences, IR Iran Guilan Road Trauma Research Center, Guilan University of Medical Sciences, IR Iran
en 10.5812/atr.7177 Application of Queuing Analytic Theory to Decrease Waiting Times in Emergency Department: Does it Make Sense? Application of Queuing Analytic Theory to Decrease Waiting Times in Emergency Department: Does it Make Sense? research-article research-article Conclusions

Application of queuing theory analysis can improve movement and reduce the waiting times of patients in bottlenecks within the ED throughput.

Objectives

This study was done to determine, whether the application of queuing theory analysis might shorten the waiting times of patients admitted to emergency wards.

Patients and Methods

This was an operational study to use queuing theory analysis in the ED. In the first phase, a field study was conducted to delineate the performance of the ED and enter the data obtained into simulator software. In the second phase, "ARENA" software was used for modeling, analysis, creating a simulation and improving the movement of patients in the ED. Validity of the model was confirmed through comparison of the results with the real data using the same instrument. The third phase of the study concerned modeling in order to assess the effect of various operational strategies, on the queue waiting time of patients who were receiving care in the ED.

Results

In the first phase, it was shown that 47.7% of the 3000 patient records were cases referred for trauma treatment, and the remaining 52.3% were referred for non-trauma services. A total of 56% of the cases were male and 44% female. Maximum input was 4.5 patients per hour and the minimum input was 0.5 per hour. The average length of stay for patients in the trauma section was three hours, while for the non-trauma section it was four hours. In the second phase, modeling was tested with common scenarios. In the third phase, the scenario with the addition of one or more senior emergency resident(s) on each shift resulted in a decreased length of stay from 4 to 3.75 hours. Moreover, the addition of one bed to the Intensive Care Unit (ICU) and/or Critical Care Unit (CCU) in the study hospital, reduced the occupancy rate of the nursing service from 76% to 67%. By adding another clerk to take electrocardiograms (ECG) in the ED, the average time from a request to performing the procedure is reduced from 26 to 18 minutes. Furthermore, the addition of 50% more staff to the laboratory and specialist consultations led to a 90 minute reduction in the length of stay. It was also shown that earlier consultations had no effect on the length of stay.

Background

Patients who receive care in an emergency department (ED), are usually unattended while waiting in queues.

Conclusions

Application of queuing theory analysis can improve movement and reduce the waiting times of patients in bottlenecks within the ED throughput.

Objectives

This study was done to determine, whether the application of queuing theory analysis might shorten the waiting times of patients admitted to emergency wards.

Patients and Methods

This was an operational study to use queuing theory analysis in the ED. In the first phase, a field study was conducted to delineate the performance of the ED and enter the data obtained into simulator software. In the second phase, "ARENA" software was used for modeling, analysis, creating a simulation and improving the movement of patients in the ED. Validity of the model was confirmed through comparison of the results with the real data using the same instrument. The third phase of the study concerned modeling in order to assess the effect of various operational strategies, on the queue waiting time of patients who were receiving care in the ED.

Results

In the first phase, it was shown that 47.7% of the 3000 patient records were cases referred for trauma treatment, and the remaining 52.3% were referred for non-trauma services. A total of 56% of the cases were male and 44% female. Maximum input was 4.5 patients per hour and the minimum input was 0.5 per hour. The average length of stay for patients in the trauma section was three hours, while for the non-trauma section it was four hours. In the second phase, modeling was tested with common scenarios. In the third phase, the scenario with the addition of one or more senior emergency resident(s) on each shift resulted in a decreased length of stay from 4 to 3.75 hours. Moreover, the addition of one bed to the Intensive Care Unit (ICU) and/or Critical Care Unit (CCU) in the study hospital, reduced the occupancy rate of the nursing service from 76% to 67%. By adding another clerk to take electrocardiograms (ECG) in the ED, the average time from a request to performing the procedure is reduced from 26 to 18 minutes. Furthermore, the addition of 50% more staff to the laboratory and specialist consultations led to a 90 minute reduction in the length of stay. It was also shown that earlier consultations had no effect on the length of stay.

Background

Patients who receive care in an emergency department (ED), are usually unattended while waiting in queues.

Emergency Department;Operational Research;Queuing;Quality Improvement Emergency Department;Operational Research;Queuing;Quality Improvement 101 107 http://www.archtrauma.com/index.php?page=article&article_id=7177 Mostafa Alavi-Moghaddam Mostafa Alavi-Moghaddam Emergency Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Emergency Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Reza Forouzanfar Reza Forouzanfar Emergency Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Corresponding author: Reza Forouzanfar, Emergency Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel.: +98-2177548395, Fax: +98-2177558081 Emergency Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Corresponding author: Reza Forouzanfar, Emergency Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel.: +98-2177548395, Fax: +98-2177558081 Shahram Alamdari Shahram Alamdari Emergency Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Emergency Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Ali Shahrami Ali Shahrami Emergency Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Emergency Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Hamid Kariman Hamid Kariman Emergency Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Emergency Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Afshin Amini Afshin Amini Emergency Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Emergency Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Shokooh Pourbabaee Shokooh Pourbabaee Emergency Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Emergency Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Armin Shirvani Armin Shirvani Office of Health And Medical Education Hospital Standards, Ministry of Health, Tehran, IR Iran Office of Health And Medical Education Hospital Standards, Ministry of Health, Tehran, IR Iran
en 10.5812/atr.7931 Comparison of Analgesic Effect Between Gabapentin and Diclofenac on Post-Operative Pain in Patients Undergoing Tonsillectomy Comparison of Analgesic Effect Between Gabapentin and Diclofenac on Post-Operative Pain in Patients Undergoing Tonsillectomy research-article research-article Background

Tonsillectomy is a common procedure causing considerable postoperative pain. Postoperative pain intensity of 60 - 70 in the scale of visual analog scale (VAS) has been reported up to 3 - 4 days which could continue until 11 days after the surgery.

Objectives

The current study aimed to compare the analgesic effect of gabapentin and diclofenac on pain after tonsillectomy with the control group.

Patients and Methods

In this double-blind, placebo-controlled clinical trial, 90 patients aged 10-25 years, ASA classes I and II were randomly selected to receive 20 mg/kg oral gabapentin (n = 30), 1.0 mg / kg rectal diclofenac (n = 30) or placebo (n = 30) preoperatively. Pain was evaluated postoperatively on a visual analogue scale at 2, 6, 12 and 24 h. Opioid consumption in the first 24 h after surgery and the side effects were also recorded.

Results

There was no significant difference in terms of age, sex, and time of surgery in the three groups. Patients in the gabapentin and diclofenac groups had significantly lower pain scores at all-time intervals than those in the placebo group. The total meperidine consumed in the gabapentin (14.16 ± 6.97 P = 0.001) and diclofenac (16.66 ± 8.95, P = 0.004) groups was significantly less than that of the placebo (33.4 ± 13.97) group. The frequency of side effects such as vomiting, dizziness, and headache was not significantly different among the groups.

Conclusions

It can be concluded that gabapentin and diclofenac reduced postoperative pain and opioid consumption without obvious side effects.

Background

Tonsillectomy is a common procedure causing considerable postoperative pain. Postoperative pain intensity of 60 - 70 in the scale of visual analog scale (VAS) has been reported up to 3 - 4 days which could continue until 11 days after the surgery.

Objectives

The current study aimed to compare the analgesic effect of gabapentin and diclofenac on pain after tonsillectomy with the control group.

Patients and Methods

In this double-blind, placebo-controlled clinical trial, 90 patients aged 10-25 years, ASA classes I and II were randomly selected to receive 20 mg/kg oral gabapentin (n = 30), 1.0 mg / kg rectal diclofenac (n = 30) or placebo (n = 30) preoperatively. Pain was evaluated postoperatively on a visual analogue scale at 2, 6, 12 and 24 h. Opioid consumption in the first 24 h after surgery and the side effects were also recorded.

Results

There was no significant difference in terms of age, sex, and time of surgery in the three groups. Patients in the gabapentin and diclofenac groups had significantly lower pain scores at all-time intervals than those in the placebo group. The total meperidine consumed in the gabapentin (14.16 ± 6.97 P = 0.001) and diclofenac (16.66 ± 8.95, P = 0.004) groups was significantly less than that of the placebo (33.4 ± 13.97) group. The frequency of side effects such as vomiting, dizziness, and headache was not significantly different among the groups.

Conclusions

It can be concluded that gabapentin and diclofenac reduced postoperative pain and opioid consumption without obvious side effects.

Pain; Gabapentin; Diclofenac; Tonsillectomy Pain; Gabapentin; Diclofenac; Tonsillectomy 108 111 http://www.archtrauma.com/index.php?page=article&article_id=7931 Ahmad Yeganeh Mogadam Ahmad Yeganeh Mogadam Trauma Research Center, Kashan University of Medical Sciences, IR Iran +98-9132760380, drmfazel@yahoo.com Trauma Research Center, Kashan University of Medical Sciences, IR Iran +98-9132760380, drmfazel@yahoo.com Mohammad Reza Reza Fazel Mohammad Reza Reza Fazel Trauma Research Center, Kashan University of Medical Sciences, IR Iran +98-9132760380, drmfazel@yahoo.com; Trauma Research Center, Kashan University of Medical Sciences, IR Iran +98-9132760380, drmfazel@yahoo.com Trauma Research Center, Kashan University of Medical Sciences, IR Iran +98-9132760380, drmfazel@yahoo.com; Trauma Research Center, Kashan University of Medical Sciences, IR Iran +98-9132760380, drmfazel@yahoo.com Shohreh Parviz Shohreh Parviz Shahid Beheshti Hospital, Kashan University of Medical Sciences, IR Iran Shahid Beheshti Hospital, Kashan University of Medical Sciences, IR Iran
en 10.5812/atr.7690 Prevention of Drowning by Community-Based Intervention: Implications for Low- and Middle- Income Countries Prevention of Drowning by Community-Based Intervention: Implications for Low- and Middle- Income Countries research-article research-article Background

Drowning is a serious but neglected health problem in low-and middle-income countries.

Objectives

To describe the effectiveness of drowning prevention program on the reduction of drowning mortality rates in rural settings at the north of Iran, and guide its replication elsewhere.

Patients and Methods

This interventional design included pre- and post-intervention observations in the rural area of the Caspian Sea coastline without a comparison community. Cross-sectional data were collected at pre- and post-intervention phases. Outcome evaluation was based on a four-year period (March 2005-March 2009) utilizing drowning registry data for the north of Iran.

Results

The implementation program increased the rate of membership in an organization responsible for promoting safety in high risk areas near the Caspian Sea. Compared to a WHO standardized population, drowning incidence in rural areas of the study demonstrated a continuous decrease in age-specific drowning rate among the oldest victims with a gradual decline during the implementation. In the study area, the epidemiological aspects of the study population were exposed and contributing factors were highlighted.

Conclusions

This study showed that the promotion of passive interventions had a greater effect on drowning rate than that of active interventions.

Background

Drowning is a serious but neglected health problem in low-and middle-income countries.

Objectives

To describe the effectiveness of drowning prevention program on the reduction of drowning mortality rates in rural settings at the north of Iran, and guide its replication elsewhere.

Patients and Methods

This interventional design included pre- and post-intervention observations in the rural area of the Caspian Sea coastline without a comparison community. Cross-sectional data were collected at pre- and post-intervention phases. Outcome evaluation was based on a four-year period (March 2005-March 2009) utilizing drowning registry data for the north of Iran.

Results

The implementation program increased the rate of membership in an organization responsible for promoting safety in high risk areas near the Caspian Sea. Compared to a WHO standardized population, drowning incidence in rural areas of the study demonstrated a continuous decrease in age-specific drowning rate among the oldest victims with a gradual decline during the implementation. In the study area, the epidemiological aspects of the study population were exposed and contributing factors were highlighted.

Conclusions

This study showed that the promotion of passive interventions had a greater effect on drowning rate than that of active interventions.

Drowning;Prevention and Control;Intervention;Community Based;Iran Drowning;Prevention and Control;Intervention;Community Based;Iran 112 117 http://www.archtrauma.com/index.php?page=article&article_id=7690 Ali Davoudi-Kiakalayeh Ali Davoudi-Kiakalayeh Trauma Research Center, Guilan University of Medical Sciences, IR Iran +98-1313226006, davoudikiakalayeh@gmail.com; Trauma Research Center, Guilan University of Medical Sciences, IR Iran +98-1313226006, davoudikiakalayeh@gmail.com Trauma Research Center, Guilan University of Medical Sciences, IR Iran +98-1313226006, davoudikiakalayeh@gmail.com; Trauma Research Center, Guilan University of Medical Sciences, IR Iran +98-1313226006, davoudikiakalayeh@gmail.com Reza Mohammadi Reza Mohammadi Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Sweden Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Sweden Shahrokh Yousefzadeh-Chabok Shahrokh Yousefzadeh-Chabok Trauma Research Center, Guilan University of Medical Sciences, IR Iran +98-1313226006, davoudikiakalayeh@gmail.com Trauma Research Center, Guilan University of Medical Sciences, IR Iran +98-1313226006, davoudikiakalayeh@gmail.com
en 10.5812/atr.7709 Epidemiology of Home-Related Injuries During a Six-Year Period in Kashan, Iran Epidemiology of Home-Related Injuries During a Six-Year Period in Kashan, Iran research-article research-article Objectives

This study is designed to investigate the epidemiology of home-related injuries in Kashan, Iran.

Background

Injury is one of the leading causes of morbidity and mortality in the world, and the home is one of the most common places for these types of injuries.

Patients and Methods

This investigation is a retrospective cross-sectional study on existing data from the data bank of the Trauma Research Center at Kashan University of Medical Sciences during a six-year period. Demographic data such as; sex, age, place of residence, educational and occupational status, injury mechanism, injured organs and injury outcomes, were analyzed using a chi-squared test and P < 0.05 was considered significant.

Results

The number of home injuries was 10146 in total, that included about 25.2% of all injuries in Kashan City. Most of the injured people were men (58.3%), 87.4% lived in the city and 18.6% were aged more than 64 years. The majority (42.7%) had a primary or secondary school education and 27.2% were housewives. Falling from a height was the most common cause of injury (55.3%). Limbs were the most common body region that was injured (73.7%). Young men (under 15 years) and older women (over 65 years) had more injuries, especially from falls. There was a statistically significant difference between the sex and age of the injured people (P < 0.001), sex and injury mechanism (P < 0.001), and also between the injury mechanism and sex in the age groups (P < 0.001).

Conclusions

The most common injury mechanism in regard to home accidents was falls; therefore fall-related injury prevention programs should be designed to make homes safer and education should focus on changes in lifestyle to reduce fall susceptibility.

Objectives

This study is designed to investigate the epidemiology of home-related injuries in Kashan, Iran.

Background

Injury is one of the leading causes of morbidity and mortality in the world, and the home is one of the most common places for these types of injuries.

Patients and Methods

This investigation is a retrospective cross-sectional study on existing data from the data bank of the Trauma Research Center at Kashan University of Medical Sciences during a six-year period. Demographic data such as; sex, age, place of residence, educational and occupational status, injury mechanism, injured organs and injury outcomes, were analyzed using a chi-squared test and P < 0.05 was considered significant.

Results

The number of home injuries was 10146 in total, that included about 25.2% of all injuries in Kashan City. Most of the injured people were men (58.3%), 87.4% lived in the city and 18.6% were aged more than 64 years. The majority (42.7%) had a primary or secondary school education and 27.2% were housewives. Falling from a height was the most common cause of injury (55.3%). Limbs were the most common body region that was injured (73.7%). Young men (under 15 years) and older women (over 65 years) had more injuries, especially from falls. There was a statistically significant difference between the sex and age of the injured people (P < 0.001), sex and injury mechanism (P < 0.001), and also between the injury mechanism and sex in the age groups (P < 0.001).

Conclusions

The most common injury mechanism in regard to home accidents was falls; therefore fall-related injury prevention programs should be designed to make homes safer and education should focus on changes in lifestyle to reduce fall susceptibility.

Epidemiology; Home; Injury Epidemiology; Home; Injury 118 122 http://www.archtrauma.com/index.php?page=article&article_id=7709 Mohammad Reza Fazel Mohammad Reza Fazel _smumsowe{mavsiuoenvesma{c{hconuo{~e{s{|ynownmwe{si|ysooeoge{cal Sciences, IR Iran +98-3615620634, Abedzadeh@kaums.ac.ir _smumsowe{mavsiuoenvesma{c{hconuo{~e{s{|ynownmwe{si|ysooeoge{cal Sciences, IR Iran +98-3615620634, Abedzadeh@kaums.ac.ir Esmaeil Fakharian Esmaeil Fakharian _smumsowe{mavsiuoenvesma{c{hconuo{~e{s{|ynownmwe{si|ysooeoge{cal Sciences, IR Iran +98-3615620634, Abedzadeh@kaums.ac.ir _smumsowe{mavsiuoenvesma{c{hconuo{~e{s{|ynownmwe{si|ysooeoge{cal Sciences, IR Iran +98-3615620634, Abedzadeh@kaums.ac.ir Ebrahim Razi Ebrahim Razi _smumsowe{mavsiuoenvesma{c{hconuo{~e{s{|ynownmwe{si|ysooeoge{cal Sciences, IR Iran +98-3615620634, Abedzadeh@kaums.ac.ir _smumsowe{mavsiuoenvesma{c{hconuo{~e{s{|ynownmwe{si|ysooeoge{cal Sciences, IR Iran +98-3615620634, Abedzadeh@kaums.ac.ir Masoumeh Abedzadeh- Kalahroudi Masoumeh Abedzadeh- Kalahroudi _smumsowe{mavsiuoenvesma{c{hconuo{~e{s{|ynownmwe{si|ysooeoge{cal Sciences, IR Iran +98-3615620634, Abedzadeh@kaums.ac.ir; _smumsowe{mavsiuoenvesma{c{hconuo{~e{s{|ynownmwe{si|ysooeoge{cal Sciences, IR Iran +98-3615620634, Abedzadeh@kaums.ac.ir _smumsowe{mavsiuoenvesma{c{hconuo{~e{s{|ynownmwe{si|ysooeoge{cal Sciences, IR Iran +98-3615620634, Abedzadeh@kaums.ac.ir; _smumsowe{mavsiuoenvesma{c{hconuo{~e{s{|ynownmwe{si|ysooeoge{cal Sciences, IR Iran +98-3615620634, Abedzadeh@kaums.ac.ir Mehrdad Mahdian Mehrdad Mahdian _smumsowe{mavsiuoenvesma{c{hconuo{~e{s{|ynownmwe{si|ysooeoge{cal Sciences, IR Iran +98-3615620634, Abedzadeh@kaums.ac.ir _smumsowe{mavsiuoenvesma{c{hconuo{~e{s{|ynownmwe{si|ysooeoge{cal Sciences, IR Iran +98-3615620634, Abedzadeh@kaums.ac.ir Mahdi Mohammadzadeh Mahdi Mohammadzadeh _smumsowe{mavsiuoenvesma{c{hconuo{~e{s{|ynownmwe{si|ysooeoge{cal Sciences, IR Iran +98-3615620634, Abedzadeh@kaums.ac.ir _smumsowe{mavsiuoenvesma{c{hconuo{~e{s{|ynownmwe{si|ysooeoge{cal Sciences, IR Iran +98-3615620634, Abedzadeh@kaums.ac.ir Mohaddeseh Pourpooneh Mohaddeseh Pourpooneh Student Research Committee, Kashan University of Medical Sciences, IR Iran Student Research Committee, Kashan University of Medical Sciences, IR Iran
en 10.5812/atr.6847 Clinical Utility of Intra-Operative 6% Hydroxyethyl Starch (130 / 0.4) Supplementation in Hypoxemic Femur Injury Patients: A Preliminary Report of Twenty Cases Clinical Utility of Intra-Operative 6% Hydroxyethyl Starch (130 / 0.4) Supplementation in Hypoxemic Femur Injury Patients: A Preliminary Report of Twenty Cases discussion discussion Abstract

Posttraumatic intravasation of fat and debris can lead to a cascade of events. Hydroxyethyl starches (HES) markedly suppress neutrophil influx by decreasing pulmonary capillary permeability and facilitating tissue oxygenation by improving microcirculation. It was hypothesized that in hypoxemic femur injury patients undergoing operative stabilization, HES administration will prevent the deterioration of respiratory variables and facilitates recovery. This prospective, double-blind, randomized preliminary study, enrolled twenty posttraumatic hypoxemic patients (room air PaO2 < 70 mmHg, Schonfeld fat embolism index score (SS) > 5) scheduled for femur fracture stabilization under general anesthesia. Patients were allocated to receive either; 6% HES 130/0.42, 15 mL/kg or 0.9% normal saline (NS) to maintain their central venous pressure (CVP) 12 + 2 mm Hg. Blood was transfused according to the maximum allowable blood loss and by serial hematocrit estimations. Perioperative Glasgow Coma Scale (GCS), physiological variables, arterial oxygen saturation (SpO2), arterial blood gas (ABG), SS and P/F ratios were recorded until recovery. The partial pressure of oxygen in arterial blood / fraction of inspired oxygen ratio (PaO2/FiO2) improved from a preoperative value of 273.33 ± 13.05 to 435.70 in the 6% Hydroxyethyl starch group (HES) and from 275.24 ± 15.34 to 302.25 ± 70.35 in the NS group over a period of six days (P values =0.970, 0.791, 0.345, 0.226, 0.855, 0.083, 0.221). Time taken to achieve a P/F ratio > 300 and for persistent reduction of Murray’s lung injury score (LIS) were comparable (P = 0.755 and 0.348, respectively). The number of ventilator, intensive care unit (ICU) and hospital stay days, did not differ (P value = 0.234, 1.00, 0. 301, respectively). There were no adverse sequelae or mortalities. A trend showing relatively fast improvement in the P/F ratio and an early reduction in LIS values was observed in hypoxemic, femur injury patients receiving intraoperative colloid supplementation.

Abstract

Posttraumatic intravasation of fat and debris can lead to a cascade of events. Hydroxyethyl starches (HES) markedly suppress neutrophil influx by decreasing pulmonary capillary permeability and facilitating tissue oxygenation by improving microcirculation. It was hypothesized that in hypoxemic femur injury patients undergoing operative stabilization, HES administration will prevent the deterioration of respiratory variables and facilitates recovery. This prospective, double-blind, randomized preliminary study, enrolled twenty posttraumatic hypoxemic patients (room air PaO2 < 70 mmHg, Schonfeld fat embolism index score (SS) > 5) scheduled for femur fracture stabilization under general anesthesia. Patients were allocated to receive either; 6% HES 130/0.42, 15 mL/kg or 0.9% normal saline (NS) to maintain their central venous pressure (CVP) 12 + 2 mm Hg. Blood was transfused according to the maximum allowable blood loss and by serial hematocrit estimations. Perioperative Glasgow Coma Scale (GCS), physiological variables, arterial oxygen saturation (SpO2), arterial blood gas (ABG), SS and P/F ratios were recorded until recovery. The partial pressure of oxygen in arterial blood / fraction of inspired oxygen ratio (PaO2/FiO2) improved from a preoperative value of 273.33 ± 13.05 to 435.70 in the 6% Hydroxyethyl starch group (HES) and from 275.24 ± 15.34 to 302.25 ± 70.35 in the NS group over a period of six days (P values =0.970, 0.791, 0.345, 0.226, 0.855, 0.083, 0.221). Time taken to achieve a P/F ratio > 300 and for persistent reduction of Murray’s lung injury score (LIS) were comparable (P = 0.755 and 0.348, respectively). The number of ventilator, intensive care unit (ICU) and hospital stay days, did not differ (P value = 0.234, 1.00, 0. 301, respectively). There were no adverse sequelae or mortalities. A trend showing relatively fast improvement in the P/F ratio and an early reduction in LIS values was observed in hypoxemic, femur injury patients receiving intraoperative colloid supplementation.

Intravenous Fluids;Trauma Surgery;Hydroxyethyl Starch Intravenous Fluids;Trauma Surgery;Hydroxyethyl Starch 126 130 http://www.archtrauma.com/index.php?page=article&article_id=6847 Indu Sen Indu Sen Anaesthesia and Intensive Care Department, Post Graduate Institute of Medical Education and Research, India +91-9914209532, indumohini@gmail.com; Anaesthesia and Intensive Care Department, Post Graduate Institute of Medical Education and Research, India +91-9914209532, indumohini@gmail.com Anaesthesia and Intensive Care Department, Post Graduate Institute of Medical Education and Research, India +91-9914209532, indumohini@gmail.com; Anaesthesia and Intensive Care Department, Post Graduate Institute of Medical Education and Research, India +91-9914209532, indumohini@gmail.com Vinod Kumar Vinod Kumar Anaesthesia and Intensive Care Department, Post Graduate Institute of Medical Education and Research, India +91-9914209532, indumohini@gmail.com Anaesthesia and Intensive Care Department, Post Graduate Institute of Medical Education and Research, India +91-9914209532, indumohini@gmail.com Govedhan Das Puri Govedhan Das Puri Anaesthesia and Intensive Care Department, Post Graduate Institute of Medical Education and Research, India +91-9914209532, indumohini@gmail.com Anaesthesia and Intensive Care Department, Post Graduate Institute of Medical Education and Research, India +91-9914209532, indumohini@gmail.com Ramesh K Sen Ramesh K Sen Orthopedic Surgery Department, Post Graduate Institute of Medical Education and Research, India Orthopedic Surgery Department, Post Graduate Institute of Medical Education and Research, India
en 10.5812/atr.8009 Neiguan and Jianshi Acupoint Stimulation Aids Hemodynamic Stability in a Cervical Cord Trauma Patient Neiguan and Jianshi Acupoint Stimulation Aids Hemodynamic Stability in a Cervical Cord Trauma Patient case-report case-report A B S T R A C T

A 36-year-old male patient with posttraumatic cervical cord damage and resultant quadriparesis, demonstrated hypotension and periods of bradycardia. For most of his two-month stay in the Intensive Care Unit (ICU), he was dependent on dopamine support to maintain hemodynamic stability. Keeping in mind evidence from the literature, that electrostimulation of acupoints Neiguan (PC - 6) and Jianshi (PC - 5) has therapeutic efficacy in restoring hypotension, we treated this patient with two six-hour periods of electrostimulation at these acupoints. We noted beneficial hemodynamic effects, with a resultant successful withdrawal of dopamine support lasting for up to 48 hours. This case report demonstrates the therapeutic efficacy of electrostimulation of PC - 5 and PC - 6 acupoints to wean a patient off chronic dopamine support, and this warrants further investigation.

A B S T R A C T

A 36-year-old male patient with posttraumatic cervical cord damage and resultant quadriparesis, demonstrated hypotension and periods of bradycardia. For most of his two-month stay in the Intensive Care Unit (ICU), he was dependent on dopamine support to maintain hemodynamic stability. Keeping in mind evidence from the literature, that electrostimulation of acupoints Neiguan (PC - 6) and Jianshi (PC - 5) has therapeutic efficacy in restoring hypotension, we treated this patient with two six-hour periods of electrostimulation at these acupoints. We noted beneficial hemodynamic effects, with a resultant successful withdrawal of dopamine support lasting for up to 48 hours. This case report demonstrates the therapeutic efficacy of electrostimulation of PC - 5 and PC - 6 acupoints to wean a patient off chronic dopamine support, and this warrants further investigation.

Acupuncture;Hypotension;Shock;Hemodynamic Acupuncture;Hypotension;Shock;Hemodynamic 123 125 http://www.archtrauma.com/index.php?page=article&article_id=8009 Shalini T T Adhikari Shalini T T Adhikari Department of Anesthesia and ICU, National Trauma Centre, Khoula Hospital, Oman +96-824480155, nassn@gmail.com Department of Anesthesia and ICU, National Trauma Centre, Khoula Hospital, Oman +96-824480155, nassn@gmail.com Mohammed Juma Juma Suliman Al-Nabi Mohammed Juma Juma Suliman Al-Nabi Department of Anesthesia and ICU, National Trauma Centre, Khoula Hospital, Oman +96-824480155, nassn@gmail.com Department of Anesthesia and ICU, National Trauma Centre, Khoula Hospital, Oman +96-824480155, nassn@gmail.com Neelam Suri Neelam Suri Department of Anesthesia and ICU, National Trauma Centre, Khoula Hospital, Oman +96-824480155, nassn@gmail.com Department of Anesthesia and ICU, National Trauma Centre, Khoula Hospital, Oman +96-824480155, nassn@gmail.com Rashid M M Khan Rashid M M Khan Department of Anesthesia and ICU, National Trauma Centre, Khoula Hospital, Oman +96-824480155, nassn@gmail.com Department of Anesthesia and ICU, National Trauma Centre, Khoula Hospital, Oman +96-824480155, nassn@gmail.com Naresh K K Kaul Naresh K K Kaul Department of Anesthesia and ICU, National Trauma Centre, Khoula Hospital, Oman +96-824480155, nassn@gmail.com; Department of Anesthesia and ICU, National Trauma Centre, Khoula Hospital, Oman +96-824480155, nassn@gmail.com Department of Anesthesia and ICU, National Trauma Centre, Khoula Hospital, Oman +96-824480155, nassn@gmail.com; Department of Anesthesia and ICU, National Trauma Centre, Khoula Hospital, Oman +96-824480155, nassn@gmail.com Neelam Suri Neelam Suri Department of Anesthesia and ICU, National Trauma Centre, Khoula Hospital, Oman +96-824480155, nassn@gmail.com Department of Anesthesia and ICU, National Trauma Centre, Khoula Hospital, Oman +96-824480155, nassn@gmail.com
en 10.5812/atr.7859 Results of Primary Extensor Tendon Repair of the Hand With Respect to the Zone of Injury Results of Primary Extensor Tendon Repair of the Hand With Respect to the Zone of Injury discussion discussion Background

Laceration of the hand extensor tendons is common in the upper extremities, causing soft tissue trauma. These tendons, because of their superficial location and lying adjacent to bones, have a greater tendency to be injured than flexor tendons.

Objectives

The aim of this study was to determine the results of primary repairs of lacerated extensor tendons of the fingers, with respect to the zone of injury, and also whether the results are different according to the anatomical zone in which they occur.

Patients and Methods

During a period of two years and four months, 32 patients with open wounds and lacerated extensor tendons of the hand were hospitalized and underwent surgery. Repairs were done by a modified Kessler technique using 0 - 4 nylon suture. After repairing, the wrist was splinted for four weeks. Patients were followed-up for 12 months and the results were evaluated according to the Miller’s scoring system.

Results

A total of 72 extensor tendons were repaired. The mean age of the patients was 24.6 years. The best results were obtained in zones 3 and 5 (84% and 88% respectively), and the worst results were seen in zones 1, 2 and 4, P = 0.01. Wound infections or re-ruptures were not seen.

Conclusions

Repair of extensor tendon cuts on the dorsal surface of the hand and forearm were associated with better results in zones 3 and 5 than in zones 1, 2 and 4. Repair by the modified Kessler suture method provides proper stability at the site of the tendon cut.

Background

Laceration of the hand extensor tendons is common in the upper extremities, causing soft tissue trauma. These tendons, because of their superficial location and lying adjacent to bones, have a greater tendency to be injured than flexor tendons.

Objectives

The aim of this study was to determine the results of primary repairs of lacerated extensor tendons of the fingers, with respect to the zone of injury, and also whether the results are different according to the anatomical zone in which they occur.

Patients and Methods

During a period of two years and four months, 32 patients with open wounds and lacerated extensor tendons of the hand were hospitalized and underwent surgery. Repairs were done by a modified Kessler technique using 0 - 4 nylon suture. After repairing, the wrist was splinted for four weeks. Patients were followed-up for 12 months and the results were evaluated according to the Miller’s scoring system.

Results

A total of 72 extensor tendons were repaired. The mean age of the patients was 24.6 years. The best results were obtained in zones 3 and 5 (84% and 88% respectively), and the worst results were seen in zones 1, 2 and 4, P = 0.01. Wound infections or re-ruptures were not seen.

Conclusions

Repair of extensor tendon cuts on the dorsal surface of the hand and forearm were associated with better results in zones 3 and 5 than in zones 1, 2 and 4. Repair by the modified Kessler suture method provides proper stability at the site of the tendon cut.

Extensor Tendon Injuries; Hand Injury; Lacerations Extensor Tendon Injuries; Hand Injury; Lacerations 131 134 http://www.archtrauma.com/index.php?page=article&article_id=7859 Seyed Abdolhossein Mehdinasab Seyed Abdolhossein Mehdinasab Department of Orthopedic Surgery, Jundishapur University of Medical Sciences, IR Iran Department of Orthopedic Surgery, Jundishapur University of Medical Sciences, IR Iran Mohammad Reza Pipelzadeh Mohammad Reza Pipelzadeh Department of Anesthesiology, Kodmwiopwvruo}~e{i}ykoommmniciossk}enoe{undishapur University of medical sciences, IR Iran +98-9166167018, dr_rpipel@yahoo.com; Department of Anesthesiology, Kodmwiopwvruo}~e{i}ykoommmniciossk}enoe{undishapur University of medical sciences, IR Iran +98-9166167018, dr_rpipel@yahoo.com Department of Anesthesiology, Kodmwiopwvruo}~e{i}ykoommmniciossk}enoe{undishapur University of medical sciences, IR Iran +98-9166167018, dr_rpipel@yahoo.com; Department of Anesthesiology, Kodmwiopwvruo}~e{i}ykoommmniciossk}enoe{undishapur University of medical sciences, IR Iran +98-9166167018, dr_rpipel@yahoo.com Nasser Sarrafan Nasser Sarrafan Department of Orthopedic Surgery, Jundishapur University of Medical Sciences, IR Iran Department of Orthopedic Surgery, Jundishapur University of Medical Sciences, IR Iran
en 10.5812/atr.6833 Regional Anesthesia for Lower Limb Burn Wound Debridements Regional Anesthesia for Lower Limb Burn Wound Debridements letter letter Regional Anesthesia;Lower Limb;Burn Regional Anesthesia;Lower Limb;Burn 135 136 http://www.archtrauma.com/index.php?page=article&article_id=6833 Indu M Sen Indu M Sen Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, India +91-1722726677, indumohini@gmail.com; Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, India +91-1722726677, indumohini@gmail.com Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, India +91-1722726677, indumohini@gmail.com; Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, India +91-1722726677, indumohini@gmail.com Ramesh K Sen Ramesh K Sen Department of Orthopedic Surgery, Post Graduate Institute of Medical Education and Research, India Department of Orthopedic Surgery, Post Graduate Institute of Medical Education and Research, India
en 10.5812/atr.7068 Gabapentin for Pain Control in Burn Patients for Surgical Debridement: Pharmacokinetic Properties Consideration Gabapentin for Pain Control in Burn Patients for Surgical Debridement: Pharmacokinetic Properties Consideration letter letter Gabapentin; Burns; Pain Gabapentin; Burns; Pain 137 138 http://www.archtrauma.com/index.php?page=article&article_id=7068 Tun Hing Lui Tun Hing Lui Department of Anaesthesiology and Operating Services, Alice Ho Miu Ling Nethersole Hospital and North District Hospital, China +85-226837588, luithderek@yahoo.co.uk; Department of Anaesthesiology and Operating Services, Alice Ho Miu Ling Nethersole Hospital and North District Hospital, China +85-226837588, luithderek@yahoo.co.uk Department of Anaesthesiology and Operating Services, Alice Ho Miu Ling Nethersole Hospital and North District Hospital, China +85-226837588, luithderek@yahoo.co.uk; Department of Anaesthesiology and Operating Services, Alice Ho Miu Ling Nethersole Hospital and North District Hospital, China +85-226837588, luithderek@yahoo.co.uk Chi Shan Lam Chi Shan Lam Department of Anaesthesiology and Operating Services, Alice Ho Miu Ling Nethersole Hospital and North District Hospital, China +85-226837588, luithderek@yahoo.co.uk Department of Anaesthesiology and Operating Services, Alice Ho Miu Ling Nethersole Hospital and North District Hospital, China +85-226837588, luithderek@yahoo.co.uk
en 10.5812/atr.7451 The Importance of Perioperative Administration of an Anti-Hyperalgesic Drug in Burn Wounds The Importance of Perioperative Administration of an Anti-Hyperalgesic Drug in Burn Wounds letter letter Burns; Wounds; Pain Burns; Wounds; Pain 139 140 http://www.archtrauma.com/index.php?page=article&article_id=7451 Luca Dalle Carbonare Luca Dalle Carbonare Department of Medicine, Clinic of Internal Medicine, University of Verona, Italy +39-0458124684, luca.dallecarbonare@univr.it; Department of Medicine, Clinic of Internal Medicine, University of Verona, Italy +39-0458124684, luca.dallecarbonare@univr.it Department of Medicine, Clinic of Internal Medicine, University of Verona, Italy +39-0458124684, luca.dallecarbonare@univr.it; Department of Medicine, Clinic of Internal Medicine, University of Verona, Italy +39-0458124684, luca.dallecarbonare@univr.it Micol Sandri Micol Sandri Intensive Care and Pain Therapy Centre, Department of Surgical Sciences, University of Verona, Italy Intensive Care and Pain Therapy Centre, Department of Surgical Sciences, University of Verona, Italy Vittorio Schweiger Vittorio Schweiger Intensive Care and Pain Therapy Centre, Department of Surgical Sciences, University of Verona, Italy Intensive Care and Pain Therapy Centre, Department of Surgical Sciences, University of Verona, Italy
en 10.5812/atr.7589 Epidemiology of Pediatric Head Trauma in Guilan Epidemiology of Pediatric Head Trauma in Guilan letter letter

Head Trauma; Pediatric; Epidemiology Head Trauma; Pediatric; Epidemiology 141 142 http://www.archtrauma.com/index.php?page=article&article_id=7589 Bruno Ramos Chrcanovic Bruno Ramos Chrcanovic Department of Prosthodontics, Faculty of Odontology, Malmö University, Sweden +46-725541545, brunochrcanovic@hotmail.com; Department of Prosthodontics, Faculty of Odontology, Malmö University, Sweden +46-725541545, brunochrcanovic@hotmail.com Department of Prosthodontics, Faculty of Odontology, Malmö University, Sweden +46-725541545, brunochrcanovic@hotmail.com; Department of Prosthodontics, Faculty of Odontology, Malmö University, Sweden +46-725541545, brunochrcanovic@hotmail.com