Background and Aims Ventilator‐associated pneumonia is highly prevalent nosocomial infection among patients under mechanical ventilation. Bronchoalveolar lavage (BAL) is effective in identifying the type of pathogen involved and determine the course of antibiotic. The aim of this study was to evaluate the prevalence of different pathogens involved in ventilator‐associated pneumonia (VAP) and associated antibiotic resistance and sensitivity pattern. Methods In this descriptive cross‐sectional study, patients admitted to the intensive care unit under mechanical ventilation at Shahid Madani Educational and Medical Center in Karaj during 2018 and 2020 were included. BAL samples were obtained from the patients. Demographic data, duration of hospitalization, duration of mechanical ventilation, and antibiotic susceptibility and resistance tests were recorded for all the patients. Results Among 335 patients included in the study, 215 (64.2%) were males. The mean age of the patients was 55.06 ± 14.90 years. The most common pathogens reported were Acinetobacter baumannii (40%), Pseudomonas aeruginosa (21.2%), and Staphylococcus aureus (13.4%). The mean age of the patients, gender, duration of mechanical ventilation, and duration of hospitalization were not associated with the type of pathogen, P > .05, respectively. Conclusion BAL of these patients indicated that various pathogens are responsible for VAP, and can vary from patient to patient. Antibiotic resistance and susceptibility pattern of these pathogens vary and therefore is important in determining the course of the treatment.
Background: Trauma is known as a third leading cause of mortality among all-aged patients. Objective: The aim of this study is to investigate pre-trauma physiological factors and trauma-related factors that can increase the risk of mortality among the adult and geriatric patients. Method: In this longitudinal data analysis study, 500 non-penetrating adult trauma patients who were referred to (Shahid Madani Hospital) from January 2019–December 2019 were enrolled. Information such as age, sex, occupation, place of residence, hospitalization and surgical history, underlying illnesses, medications (such as antihypertensive drugs, etc.), lab findings (complete blood cell and creatinine levels) were recorded in the form of a questionnaire. The patients were divided in group A (aged 65 and above) and group B (aged below 65 years). The data obtained was analyzed statistically using SPSSv18. Result: The mean age of all patients under study was 51.6 years. Among all participants, 68% (341) were male and 32% (159) were female. Regarding the cause of trauma, group A had significantly greater incidence (p-value = 0.001). The two groups were also significantly different in terms of the region of the injury (p-value = 0.014). Furthermore, underlying diseases were also statistically significant among the two groups (p-value = 0.0093). There was a significant difference between the two groups in terms of smoking and drugs (p-value = 0.01 and 0.001, respectively). Finally, the mortality rate in patients older than 65 years old (4.3%) was significantly higher than those in patients under the age of 65 years (2.9%) (p-value = 0.0001). Conclusion: The results of this study showed that among the trauma patients aged below 65 years and those aged 65 years and above, underlying illness, mortality rate, usage of drugs, cause of trauma, type of injury, vital signs, white blood cell count and platelet count, hemoglobin and serum creatinine vary significantly. Highlights
Background: Cardiac penetrating trauma is a medical emergency that mostly affects young people. Based on the type of injury and associated complications, it can present as a surgical challenge and can lead to mortality. Objective: The aim of this study is to evaluate the complications of penetrating heart trauma among patients referred to Shahid Madani Hospital. Methods: In this retrospective descriptive study, the data of penetrating cardiac trauma patients referred to Shahid Madani hospital, Karaj, Tehran, from 2016-2019, were investigated. Information, including age, sex, cause of trauma, traumatized area and complications, was extracted and recorded in a data collection form. The data were evaluated statistically using SPSS v18. Results: A total of 44 patients were included in the study, where the mean age of the patients was 25 years. 73.3% of these patients were men and 26.7% were women. Knife stab wounds were the most prevalent cause of the trauma, present in 93.3% of patients. 73.3% of the patients had cardiac tamponade and 20% had a pneumothorax. The right ventricle was the most common site of the injury in 46.7% of the patients. A mortality rate of 3.4% was reported in this study. Conclusion: The results of this study showed that the highest penetrating heart rate trauma occurred among young people, and the most common cause of the trauma was a knife stab. The most common area of the injury was the right ventricular, and cardiac tamponade was the most common complication.
Introduction Coronavirus pandemic-initiated Wuhan city, Hubei Province, China. It mainly involves respiratory system and cause fever, cough. However, it has other manifestations such as GI system, CNS and skin involvement. It is transmitted mostly through respiratory system, but some researchers claim that in can potentially spread by oral, fecal or intestinal gas. During colorectal surgeries such as volvulus sigmoid, surgeons are at risk of exposure to intestinal gas. Case presentation A 57-year-old mentally retarded man came to our emergency department with complain of abdominal pain, constipation, obstipation, nausea, vomiting and abdominal distention. His vital sign was stable and his laboratory data revealed no abnormality. His abdominal x-ray showed intestinal obstruction with suspicious of sigmoid volvulus. His PCR for COVID 19 was positive and his chest CT scan has manifestations of lung involvement. He was proceeded for surgery. Conclusion Owing to odds of spread of coronavirus through intestinal gas, in this case, sigmoid colon was removed without evacuation of intestinal gas.
Objectives: Patients presented with penetrating trauma are immediately given an initial x-ray scan followed by the desired treatment. Intercostal nerve block in chest trauma patients is effective in pain management. The aim of this study is to investigate the need of second chest x-ray in penetrating chest trauma patients, following intercostal nerve block and evaluation of pain and other clinical parameters. Method: In this a randomized controlled trail, 100 patients with thoracic trauma were examined from June 2019–December 2019. All patients who entered the study underwent an intercostal nerve block by 5 mg of lidocaine. The results from normal and abnormal chest x-ray groups were compared following the block, in terms of the VAS (Visual Analogue Scale) score and hemodynamic parameters. Result: Among the two groups, normal second x-ray vs delayed hemopneumothorax, systolic blood pressure, rate of respiration and heart rate were not significantly at the time of admission and the time following the nerve block. However, this difference was significant in terms of visual analog scale score among the two groups.We also report that the VAS difference of more than 2.5 points has the specify of 76.5 and a sensitivity of 92.8 for the diagnosis of normal/stable patients. Conclusions: Intercostal nerve block reduces pain in patients who are not presented with hemopneumothorax, whereas, patients otherwise are presented with the significant pain. Second x-ray in patients with reduced pain in response to the nerve block, might not be necessarily required. Highlights
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