No abstract

Background: The rate of cesarean section is increasing in all over the world with different drafts in various countries. This growth increases unpleasant outcomes of delivery. Recent studies explained the benefits of date palm fruit on labor process improvement. Date fruit can be considered as a factor for increasing vaginal delivery and also reducing the frequency of caesarean section in order to prevent its great complications. This systematic review has been designed to review clinical studies that investigate the effects of date palm fruit on labor outcomes (duration of labor stages, bishop score, and frequency of cesarean section) compared with routine cares. Methods: This study was performed in 2019. Required data has been collected from electronic databases and manual searches. All randomized clinical trials evaluating the effects of date palm fruit on labor and delivery that in English and Persian languages, were incorporated in this systematic review. The methodological quality of the included studies was evaluated according to the risk of bias assessment of Cochrane handbook of systematic reviews, and were then reported using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Results: Eight studies were included in the qualitative and quantitative synthesis. Meta-Analysis showed that date fruit consumption can significantly reduce active phase of labor (three trials with 380 participants; (MD = − 109.3, 95%CI (− 196.32, − 22.29; I 2 = 89%), P = 0.01), and also it can significantly improve the bishop score (two trials with 320 participants; MD = 2.45, 95%CI (1.87, 3.04; I 2 = 0%), P < 0.00001). Date fruit consumption had no effects on the duration of first, second, and third stages of labor, and the frequency of cesarean section. Conclusion: Date can reduce the duration of active phase and improve the bishop score; however, due to from the low to mediate quality of the studies; it seems that the other studies are needed to prove these results better than this.

Level III. Randomized prospective study.

BackgroundDistal radius fractures are among common fractures in the elderly. Regarding the age, background diseases, and possible risks, analgesia method is of great importance in this group.ObjectivesThe aim of this study was to compare two analgesia methods including hematoma block and general anesthesia in people over 60 years in the orthopedic emergency department.Methods68 elderly patients referring to the emergency department of a medical teaching center were selected based on the inclusion criteria for a non-randomized clinical trial. The patients were placed in two groups of 34, which were matched for age and sex. Hematoma block was used as the analgesic method in one group and general anesthesia was used in the other group. These two groups were compared for pain intensity, analgesia duration, and anesthesia side effects. The SPSS software (Statistical Package for the Social Sciences, version 17.0, SPSS Inc., Chicago, Ill, USA) was used for data analysis.Results68 elderly patients (mean age of 70.3 ± 6.6) with a dislocated distal radius fracture which required closed reduction were examined. The duration of manipulation and surgery and discharging time were significantly different between two groups and they were all lower in the hematoma blocked group. Pain intensity evaluation indicated a statistically significant difference during initial hours after fracture reduction and fixation so that pain intensity was less in elderly patients under hematoma block than patients who underwent general anesthesia in one and six hours after surgery. Need for narcotic was 35.2% in the general anesthesia group which also showed a significant between-group difference.ConclusionsHematoma block analgesia used in distal radius fractures of the elderly is a very safe and effective method that seems preferable to general anesthesia in emergency departments.

BackgroundFemoral neck fractures are urgent injuries that require precise reduction and stable fixation. In some cases, however, early treatment is not possible.ObjectivesThe present study aimed to evaluate long-term results of delayed fixation of femoral neck fractures using cannulated screws.Patients and MethodsThis retrospective descriptive-analytical study was conducted on 26 patients with femoral neck fractures. The patients were treated through a closed reduction and fixation method using cannulated screws. Patients were followed up for at least five years and the rate of complications was determined.ResultsIn this study, 26 patients with mean age of 34.3 years were assessed. Average time interval from injury to surgery was 46.4 ± 12.2 hours; 18 patients (69%) were operated on with more than 36 hours of delay. Incidence of AVN and nonunion was reported in 10 (38.4%) and 3 (11.5%) patients, respectively.ConclusionsTime plays an important role in treatment results of femoral neck fractures. To treat the fractures, closed reduction and fixation using cannulated screws may still be the best option.

BackgroundEvaluating demographic characteristics, distribution and types of orthopedic injuries following major earthquakes may be helpful in future planning for disasters.ObjectivesThis study aimed to analyze data from trauma patients with extremity injury resulting from the earthquakes of East Azerbaijan, Iran.Patients and MethodsMedical records of 686 patients admitted to Shohada hospital, Trauma Center of Tabriz University of Medical Sciences were reviewed. There were 200 patients with extremity injury assessed. Demographic characteristics and patterns of injuries in these patients were evaluated.ResultsIn this study, there were 105 females (52.5%) and 95 males (47.5%), out of which, 6 (3%) patients with associated severe head injuries died. The most common sites of injury were lower extremities (81 patients, 41.5% of total victims) while 32 patients (16%) suffered from both upper and lower extremity injuries. Open Fractures were seen in lower extremities of 26 (13%) patients. Compartment syndrome was observed in 3 (1.5%) patients with lower limb fractures. Also, 42 (21%) patients living in Tabriz were injured while they were running away (falling down the stairs and jumping out of windows).ConclusionsExtremity injuries especially open fractures of lower limbs account for the majority of hospitalized victims. Compartment syndrome is one of the main problems that should be addressed. Our study demonstrates that people still need more education regarding earthquakes and the government should direct more attention to this issue.

Resumo Objetivo O presente estudo teve como objetivo comparar as incisões oblíquas e verticais na coleta dos tendões dos isquiotibiais na reconstrução do ligamento cruzado anterior (LCA) e na lesão do ramo infrapatelar do nervo safeno. Métodos O presente estudo foi realizado em um centro de referência terciário por 12 meses. Pacientes com indicação de reconstrução de uma ruptura do LCA foram incluídos no estudo, os quais foram randomizados em dois grupos (vertical [GV] e oblíquo [GO]). Após a exclusão de alguns casos, 92 pacientes foram elegíveis para análise posterior (GV: n= 44; GO: n = 48). Eles foram acompanhados por 9 meses após a cirurgia, e a perda de sensibilidade sobre o joelho e sobre o aspecto proximal da perna operada foi registrado. Resultados Os comprimentos médios da incisão foram de 27 mm e 38 mm para os grupos GO e GV, respectivamente. A taxa total de hipoestesia foi de 40% (27 pacientes). Um total de 12 (25%) e de 25 pacientes (56,8%) dos grupos GO e GV, respectivamente, relataram sintomas de hipoestesia. A presença de hipoestesia em pacientes no grupo GV foi duas vezes maior do que no grupo GO. Não foi observada correlação estatística entre a lesão do nervo e idade, gênero, escolaridade e demora entre a lesão e a reconstrução. Conclusão A incisão oblíqua, que apresentou menor risco de lesão nervosa, pode ser mais recomendada para a coleta do enxerto. Pacientes submetidos à reconstrução do LCA no grupo GO tiveram menor incidência de hipoestesia peri-incisional quando comparados aos pacientes do grupo GV.

According to the outcomes resulted from this study, genetic mutation in Prothrombin (Factor II [G20210A]) is one of the most important genetic variations involved in traumatic patients with DVT despite prophylaxis. Genetic mutation in Prothrombin appears to be predisposing factor for thrombosis associated with trauma.