Ophthalmic Science and Research

Editorial Sharmila Devi Vadivelu TNOA Journal of Ophthalmic Science and Research 2018 56(4):213-214

Experience with keratoprosthesis at a tertiary eye care center: A report from North-East India Saurabh Deshmukh, Jnanankar Medhi, Balmukund Agarwal, Prafulla Sarma, Krati Gupta TNOA Journal of Ophthalmic Science and Research 2018 56(4):215-218 Aim: To evaluate the preservation of visual acuity (VA) and the development of complications after keratoprosthesis (KPro) implantation (Boston KPro and Auro KPro) over a long follow-up period at a tertiary eye center in North-East India. Materials and Methods: This was a single-center retrospective case series. The records of all patients who underwent KPro implantation between March 2013 and August 2017 were analyzed. The preoperative characteristics, postoperative outcomes, complications, its management, and retention rates were reviewed. Results: Ten cases were included in the study. Preoperative VA ranged from counting finger close to face to hand movement close to face. The cause for KPro implantation included multiple graft failures (5 eyes, 50%), chemical injury (3 eyes, 30%), and Stevens–Johnson syndrome (2 eyes, 20%). Mean follow-up duration was 26.9 months (range, 12–54 months). At 1-month follow-up, eight patients had a vision ≥6/60 (80%). At 1-year follow-up, eight patients had a VA ≥6/24. Glaucoma was newly diagnosed in three eyes (30%); progression was noted in one eye (10%). Glaucoma drainage device was implanted in one eye (10%). Retroprosthetic membrane formed in seven eyes (70%) and one eye (10%) underwent KPro replacement. The initial KPro was retained in nine eyes (90%). Conclusions: KPro is an effective and a viable option for treating end-stage corneal diseases for salvaging vision. A significant number of patients lose vision following KPro implantation due to glaucoma and corneal melts. Our study reiterates the importance of regular and long-term follow-up and a comprehensive team approach for management of postoperative complications.

Clinico-microbial profile of fungal keratitis and detection of Pythium insidiosum: A pilot study Prasoon Garg, Rakesh Singh, Ramesh Babu TNOA Journal of Ophthalmic Science and Research 2018 56(4):219-221 Background: Infectious keratitis is a leading cause of blindness, more so in developing countries where rates of corneal ulceration are much more than those of industrialized countries. The organisms responsible for infectious keratitis differ regionally, with bacterial organisms more common in temperate climates and fungal organisms more common in tropical climates. A large fraction of infectious corneal ulcers that are referred to tertiary care centers in South India is fungal in etiology. Methods: Parameters studied were age, sex, residential district, occupation, risk factor, clinical presentation, microscopic examination of the sample, fungal culture, and Pythium insidiosum. Results: History of trauma was observed in half the cases. History of contact lens usage or diabetes mellitus was not seen in any case. Hypopyon was seen in 50% of the cases of which 33.33% were immobile. KOH preparation for all the samples was negative. Of the 15 samples sent for culture, 12 grew no fungus and 2 were contaminated. One fungus grew and was identified as Aspergillus terreus. P. insidiosum could not be isolated.

Perspective about blindness and vision 2020-national program for control of blindness among students of different disciplines and general population Annamalai Sowmiya, Sankar Muthuramalingam, Krishnamoorthy Ilango TNOA Journal of Ophthalmic Science and Research 2018 56(4):222-225 Objectives: To study the awareness about causes of blindness, Eye donation, NPCB and Vision 2020 among students of Medical, Paramedical, Engineering College and General Public in a semi-urban centre. Materials and Methods: A cross sectional descriptive study was conducted at the Velammal Medical College Hospital in 4 months duration, which recruited around 2000 individuals from general public, students from various disciplines. A semi structured Questionnaire was presented and responses were recorded. They were analysed statistically. Results: Almost half of the respondents were not aware about existence of NPCB programme and awareness about existence of programme is high among Nursing Students (96.92%). Awareness about causes of blindness is significantly higher among Medical students (99.23%).Awareness about eye donation is only about 74.5%. Awareness about various aspects of Childhood eye diseases is about 70-80%. Conclusion: There is an improper utilisation of NPCB programme services due to lack of awareness about the same. Some of the strategies that the students were willing to participate were widespread awareness programmes in media and outreach programmes at gross root level. So we should utilise the resources and potential of student community in educating the public.

Ophthalmological and medical long-term follow-up of patients with central retinal vein occlusion Shadi Alashwal, Vittoria Murro, Andrea Sodi, Gianni Virgili, Rossella Marcucci TNOA Journal of Ophthalmic Science and Research 2018 56(4):226-231 Purpose: The purpose of this study was to evaluate the ophthalmological and medical aspects of patients with a history of central retinal vein occlusion (CRVO) after a long-term follow-up. Design: This was a retrospective case–control study. Materials and Methods: Twenty-seven consecutive CRVO patients (29 eyes) were enrolled between April 2011 and April 2012, each participant underwent a comprehensive and detailed interview and also they had an ophthalmic examination with investigations such as color retinography and optical coherence tomography. Finally, medical and cardiologic examinations, including the laboratory analysis of blood specimens, were performed to all participants. Results: Our data confirm the significant association of CRVO with age (P = 0.025) and with ischemia (P = 0.022) and also treatment with low-molecular-weight heparin. Main risk factors of developing CRVO were as follows: hypertension (59.0%), dyslipidemia (48.0%), blood diseases (15.0%), and high body mass index (15.0%). There was no any significant association between all of the thrombophilic factors (laboratory parameters) and visual acuity (VA), except IgG anticardiolipin antibodies (P = 0.004). Two patients had myocardial infarction during the follow-up period. There was a parallel reduction of VA and foveal thickness during a long follow-up period. Conclusions: VA and central foveal thickness decreased during the follow-up period probably because of a progressive atrophy of the central retinal area, which suggest an early treatment of the macular edema prior an unfavorable evolution of the clinical situation, only one laboratory parameter had association with VA, small minority of patients developed serious cardiovascular events during the follow-up period after CRVO; these data suggest no overall association of CRVO with cardiovascular events.

Pediatric intraocular lens power calculation Sandra Chandramouli Ganesh, Shilpa G Rao, Farhadul Alam TNOA Journal of Ophthalmic Science and Research 2018 56(4):232-236 Pediatric cataracts pose multiple challenges in terms of management and postoperative rehabilitation. Difficulties in obtaining accurate measurements for axial length and keratometry are encountered due to poor cooperation in children and instrumentation errors. There exist multiple formulae for intraocular lens (IOL) power calculation, which are based on various factors and have varying degrees of accuracy. Children exhibit a tendency for myopic shift due to the anatomical differences from adult eyes and due to the growth of eyeball, as a result of which they require undercorrection, when IOL implantation is planned.

Scleral-fixated intraocular lenses VG Madanagopalan, Parveen Sen, Prabu Baskaran TNOA Journal of Ophthalmic Science and Research 2018 56(4):237-243 Scleral-fixated intraocular lenses (SFIOLs) are important tools for an ophthalmologist when dealing with the eyes that have inadequate capsular support. Since the time of its introduction, SFIOLs and techniques for their implantation have seen many innovations. Initially, sutured SFIOLs were widely performed. In the last two decades, sutureless SFIOLs are gaining popularity. Both these methods and the different surgical techniques to perform them offer unique advantages to the surgeon. Therefore, careful consideration is to be given to the choice of technique and steps to be employed for a particular eye. In this article, we aim to provide an overview of the commonly used techniques in SFIOL surgery and provide certain surgical tips that may help the surgeon in the operating room.

Cerebral visual impairment Meenakshi Swaminathan, Yamini Patial TNOA Journal of Ophthalmic Science and Research 2018 56(4):244-246 In developing countries like India, cerebral visual impairment (CVI) is becoming common cause of visual impairment due to better neonatal care and advancement in technology. CVI is characterized by visual malfunction due to the retrochiasmal and visual association pathway pathology. The visual malfunction can present in any combination and any severity in the setting of developing brain functions. Higher centers damage may lead to cognitive dysfunction. Most common cause of CVI is hypoxic ischemic encephalopathy, due to reduced blood flow in immature brain blood vessels in watershed zones. Early identification of impairment and early intervention help these children to achieve higher level of vision. Customized and integrated approach needed between ophthalmologist, paediatrician and other interventional professional. Counselling of parents also have very important role in the treatment.

Bilateral inferior lens coloboma in a case of Marfan's syndrome Krati Gupta, Saurabh Deshmukh, Damaris Magdalene TNOA Journal of Ophthalmic Science and Research 2018 56(4):247-248

Foveal simple hamartoma of retinal pigment epithelium Prabu Baskaran, Nagesha Chokahalli, Pratyusha Ganne TNOA Journal of Ophthalmic Science and Research 2018 56(4):249-250 Congenital anomalies of retinal pigment epithelium (RPE) are rare entities among which simple hamartoma of RPE is extremely rare. Majority of reported cases of congenital simple hamartoma were extrafoveal and patients were asymptomatic. These lesions may pose diagnostic challenge if not aware. Here, we present two cases of simple congenital hamartoma involving fovea presenting with diminished vision and also discuss the review of literature in brief.  EDITORIAL   Editorial  p. 213 Sharmila Devi Vadivelu DOI:10.4103/tjosr.tjosr_117_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta ORIGINAL ARTICLES Experience with keratoprosthesis at a tertiary eye care center: A report from North-East India  p. 215 Saurabh Deshmukh, Jnanankar Medhi, Balmukund Agarwal, Prafulla Sarma, Krati Gupta DOI:10.4103/tjosr.tjosr_83_18   Aim: To evaluate the preservation of visual acuity (VA) and the development of complications after keratoprosthesis (KPro) implantation (Boston KPro and Auro KPro) over a long follow-up period at a tertiary eye center in North-East India. Materials and Methods: This was a single-center retrospective case series. The records of all patients who underwent KPro implantation between March 2013 and August 2017 were analyzed. The preoperative characteristics, postoperative outcomes, complications, its management, and retention rates were reviewed. Results: Ten cases were included in the study. Preoperative VA ranged from counting finger close to face to hand movement close to face. The cause for KPro implantation included multiple graft failures (5 eyes, 50%), chemical injury (3 eyes, 30%), and Stevens–Johnson syndrome (2 eyes, 20%). Mean follow-up duration was 26.9 months (range, 12–54 months). At 1-month follow-up, eight patients had a vision ≥6/60 (80%). At 1-year follow-up, eight patients had a VA ≥6/24. Glaucoma was newly diagnosed in three eyes (30%); progression was noted in one eye (10%). Glaucoma drainage device was implanted in one eye (10%). Retroprosthetic membrane formed in seven eyes (70%) and one eye (10%) underwent KPro replacement. The initial KPro was retained in nine eyes (90%). Conclusions: KPro is an effective and a viable option for treating end-stage corneal diseases for salvaging vision. A significant number of patients lose vision following KPro implantation due to glaucoma and corneal melts. Our study reiterates the importance of regular and long-term follow-up and a comprehensive team approach for management of postoperative complications. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Clinico-microbial profile of fungal keratitis and detection of Pythium insidiosum: A pilot study  p. 219 Prasoon Garg, Rakesh Singh, Ramesh Babu DOI:10.4103/tjosr.tjosr_84_18   Background: Infectious keratitis is a leading cause of blindness, more so in developing countries where rates of corneal ulceration are much more than those of industrialized countries. The organisms responsible for infectious keratitis differ regionally, with bacterial organisms more common in temperate climates and fungal organisms more common in tropical climates. A large fraction of infectious corneal ulcers that are referred to tertiary care centers in South India is fungal in etiology. Methods: Parameters studied were age, sex, residential district, occupation, risk factor, clinical presentation, microscopic examination of the sample, fungal culture, and Pythium insidiosum. Results: History of trauma was observed in half the cases. History of contact lens usage or diabetes mellitus was not seen in any case. Hypopyon was seen in 50% of the cases of which 33.33% were immobile. KOH preparation for all the samples was negative. Of the 15 samples sent for culture, 12 grew no fungus and 2 were contaminated. One fungus grew and was identified as Aspergillus terreus. P. insidiosum could not be isolated. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Perspective about blindness and vision 2020-national program for control of blindness among students of different disciplines and general population p. 222 Annamalai Sowmiya, Sankar Muthuramalingam, Krishnamoorthy Ilango DOI:10.4103/tjosr.tjosr_82_18   Objectives: To study the awareness about causes of blindness, Eye donation, NPCB and Vision 2020 among students of Medical, Paramedical, Engineering College and General Public in a semi-urban centre. Materials and Methods: A cross sectional descriptive study was conducted at the Velammal Medical College Hospital in 4 months duration, which recruited around 2000 individuals from general public, students from various disciplines. A semi structured Questionnaire was presented and responses were recorded. They were analysed statistically. Results: Almost half of the respondents were not aware about existence of NPCB programme and awareness about existence of programme is high among Nursing Students (96.92%). Awareness about causes of blindness is significantly higher among Medical students (99.23%).Awareness about eye donation is only about 74.5%. Awareness about various aspects of Childhood eye diseases is about 70-80%. Conclusion: There is an improper utilisation of NPCB programme services due to lack of awareness about the same. Some of the strategies that the students were willing to participate were widespread awareness programmes in media and outreach programmes at gross root level. So we should utilise the resources and potential of student community in educating the public. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Ophthalmological and medical long-term follow-up of patients with central retinal vein occlusion  p. 226 Shadi Alashwal, Vittoria Murro, Andrea Sodi, Gianni Virgili, Rossella Marcucci DOI:10.4103/tjosr.tjosr_97_18   Purpose: The purpose of this study was to evaluate the ophthalmological and medical aspects of patients with a history of central retinal vein occlusion (CRVO) after a long-term follow-up. Design: This was a retrospective case–control study. Materials and Methods: Twenty-seven consecutive CRVO patients (29 eyes) were enrolled between April 2011 and April 2012, each participant underwent a comprehensive and detailed interview and also they had an ophthalmic examination with investigations such as color retinography and optical coherence tomography. Finally, medical and cardiologic examinations, including the laboratory analysis of blood specimens, were performed to all participants. Results: Our data confirm the significant association of CRVO with age (P = 0.025) and with ischemia (P = 0.022) and also treatment with low-molecular-weight heparin. Main risk factors of developing CRVO were as follows: hypertension (59.0%), dyslipidemia (48.0%), blood diseases (15.0%), and high body mass index (15.0%). There was no any significant association between all of the thrombophilic factors (laboratory parameters) and visual acuity (VA), except IgG anticardiolipin antibodies (P = 0.004). Two patients had myocardial infarction during the follow-up period. There was a parallel reduction of VA and foveal thickness during a long follow-up period. Conclusions: VA and central foveal thickness decreased during the follow-up period probably because of a progressive atrophy of the central retinal area, which suggest an early treatment of the macular edema prior an unfavorable evolution of the clinical situation, only one laboratory parameter had association with VA, small minority of patients developed serious cardiovascular events during the follow-up period after CRVO; these data suggest no overall association of CRVO with cardiovascular events. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta REVIEW ARTICLES Pediatric intraocular lens power calculation p. 232 Sandra Chandramouli Ganesh, Shilpa G Rao, Farhadul Alam DOI:10.4103/tjosr.tjosr_105_18   Pediatric cataracts pose multiple challenges in terms of management and postoperative rehabilitation. Difficulties in obtaining accurate measurements for axial length and keratometry are encountered due to poor cooperation in children and instrumentation errors. There exist multiple formulae for intraocular lens (IOL) power calculation, which are based on various factors and have varying degrees of accuracy. Children exhibit a tendency for myopic shift due to the anatomical differences from adult eyes and due to the growth of eyeball, as a result of which they require undercorrection, when IOL implantation is planned. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Scleral-fixated intraocular lenses p. 237 VG Madanagopalan, Parveen Sen, Prabu Baskaran DOI:10.4103/tjosr.tjosr_99_18   Scleral-fixated intraocular lenses (SFIOLs) are important tools for an ophthalmologist when dealing with the eyes that have inadequate capsular support. Since the time of its introduction, SFIOLs and techniques for their implantation have seen many innovations. Initially, sutured SFIOLs were widely performed. In the last two decades, sutureless SFIOLs are gaining popularity. Both these methods and the different surgical techniques to perform them offer unique advantages to the surgeon. Therefore, careful consideration is to be given to the choice of technique and steps to be employed for a particular eye. In this article, we aim to provide an overview of the commonly used techniques in SFIOL surgery and provide certain surgical tips that may help the surgeon in the operating room. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Cerebral visual impairment p. 244 Meenakshi Swaminathan, Yamini Patial DOI:10.4103/tjosr.tjosr_108_18   In developing countries like India, cerebral visual impairment (CVI) is becoming common cause of visual impairment due to better neonatal care and advancement in technology. CVI is characterized by visual malfunction due to the retrochiasmal and visual association pathway pathology. The visual malfunction can present in any combination and any severity in the setting of developing brain functions. Higher centers damage may lead to cognitive dysfunction. Most common cause of CVI is hypoxic ischemic encephalopathy, due to reduced blood flow in immature brain blood vessels in watershed zones. Early identification of impairment and early intervention help these children to achieve higher level of vision. Customized and integrated approach needed between ophthalmologist, paediatrician and other interventional professional. Counselling of parents also have very important role in the treatment. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta CASE REPORTS Bilateral inferior lens coloboma in a case of Marfan's syndrome p. 247 Krati Gupta, Saurabh Deshmukh, Damaris Magdalene DOI:10.4103/tjosr.tjosr_81_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Foveal simple hamartoma of retinal pigment epithelium p. 249 Prabu Baskaran, Nagesha Chokahalli, Pratyusha Ganne DOI:10.4103/tjosr.tjosr_90_18   Congenital anomalies of retinal pigment epithelium (RPE) are rare entities among which simple hamartoma of RPE is extremely rare. Majority of reported cases of congenital simple hamartoma were extrafoveal and patients were asymptomatic. These lesions may pose diagnostic challenge if not aware. Here, we present two cases of simple congenital hamartoma involving fovea presenting with diminished vision and also discuss the review of literature in brief. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Combined penetrating keratoplasty with extraocular needle-guided haptic insertion technique p. 251 Prabu Baskaran, Seema Ramakrishnan, Pratyusha Ganne, Nagesha Chokahalli Krishnappa, Rengaraj Venkatesh DOI:10.4103/tjosr.tjosr_92_18   Scleral fixation of intraocular lens (SFIOL) is a challenge in eyes with opaque corneas. It is preferable to implant the IOL before performing penetrating keratoplasty. Most techniques described so far involve SFIOL following corneal trephination (open sky) which increases the risk of expulsive choroidal hemorrhage. Extraocular needle-guided haptic insertion technique involves extraocular docking of the IOL haptic into a bent 26-gauge needle followed by its exteriorization. Since this crucial step of SFIOL surgery is completely extraocular, this method can be used to safely place an SFIOL in a well-formed globe even before corneal trephination. Use of a silicone stopper over the leading haptic prevents intraocular rebound of the haptic. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Congenital rubella syndrome p. 254 B Pramila, M Bharathi Mohan, K Kavitha DOI:10.4103/tjosr.tjosr_89_18   This is a report of a very rare case of congenital rubella syndrome with congenital sensorineural hearing loss, rubella retinopathy, and congenital heart disease with patent ductus arteriosus. After the introduction of the rubella vaccine in 1969, the number of babies born with congenital rubella is much less and rare. Not all the babies born with congenital rubella have the classical triad. Hence, our patient who has all the features of the classical triad is an extremely rare one. The baby underwent surgery for patent ductus arteriosus and cochlear implant procedure for sensorineural hearing loss. She is now under follow-up with us for pigmentary retinopathy. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Misdiagnosis of missed diagnosis p. 257 Sadiqha S Banu, Malarchelvi Palani, Pratheeba Devi Nivean, M Nivean DOI:10.4103/tjosr.tjosr_94_18   Papilledema is swelling of the optic nerve head, a sign of increased intracranial pressure. It can have underlying life-threatening etiologies such as intracranial space-occupying lesions or meningitis. However, pseudopapilledema is elevation of the optic disc secondary to local underlying structural conditions. Distinguishing between papilledema and pseudopapilledema is needed to avoid subjecting the patient to unnecessary tests and anxiety associated with it. We report a case of an 18-year-old male who presented to us with the clinical suspicion of disc edema. Simple noninvasive investigations such as red-free fundus photography and ultrasound B-scan aided us to diagnose it as a case of pseudopapilledema-optic nerve head drusen. Thus, a high index of suspicion along with the ancillary tests is helpful in differentiating pseudopapilledema from true papilledema. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta A case of hypotony maculopathy after aqueous drainage implant p. 261 A Sudarvizhi, V Sharmila Devi, M Ananda Babu DOI:10.4103/tjosr.tjosr_101_18   A 60-year-old male presented with defective vision and low intraocular pressure (IOP) in the left eye (LE) following cataract surgery combined with aqueous drainage implant which was done elsewhere 2 months ago. In the right eye (RE), he presented with primary angle closure glaucoma and Grade 2 nuclear sclerosis. In LE, scleral patch graft with loose sutures with shallow anterior chamber and nonvalved aqueous drainage implant with fundus features suggestive of hypotony maculopathy were noted. The patient underwent tight compression suturing of scleral patch graft with intracameral sodium hyaluronate injection for LE and clear corneal phacoemulsification with trabeculectomy with releasable sutures with Mitomycin-C 0.02% for RE. Postoperatively, visual acuity and IOP in LE were improved and in RE postoperative outcome was successful with no complications. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Caruncular dermoid: A report of a rare case p. 263 P Saravana Sankar, Shanmugam Rajeswari, K Kavitha DOI:10.4103/tjosr.tjosr_95_18   A dermoid is an overgrowth of normal, noncancerous tissue in an abnormal location. Dermoids occur all over the body. The one in and around the eye usually comprised skin, hair, and/or fat. Our patient had an unusual presentation of dermoid in caruncle of the left eye. The mass was excised and histology confirmed the diagnosis. The patient followed up postoperatively and was uneventful. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Intraocular cilia – A rare case report p. 266 Malarvizhi Raman, A Anuradha, K Vasumathi, S Sheela, Gomathi Nayagam Subbiah DOI:10.4103/tjosr.tjosr_98_18   Intraocular cilium is a very rare intraocular foreign body. We report a middle-aged female patient who presented with a cilium in the anterior chamber of the right eye with iritis, following an injury with a stick. In view of anterior chamber reaction, the eyelash was removed. Postoperatively, the iritis resolved in 2 weeks with periocular and topical steroids. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta CURRENT OPINION Expert corner: Cornea consultation p. 268 N Venkatesh Prajna, R Revathi, Sujatha Mohan, Bhaskar Srinivasan, Sharmila Devi Vadivelu DOI:10.4103/tjosr.tjosr_103_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta CLINICAL PRACTICE GUIDELINES Postgraduate's corner: Ocular trauma score p. 273 Akruti Desai, Bhavik Panchal DOI:10.4103/tjosr.tjosr_5_19   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta EXPERT COMMENT Expert opinion on ocular trauma score p. 275 Gangadhara Sundar DOI:10.4103/tjosr.tjosr_4_19   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta PHOTO IMAGES Anteriorly migrated dexamethasone implant p. 276 Premanand Chandran, Ganesh V Raman, Veerappan R Saravanan DOI:10.4103/tjosr.tjosr_107_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Lattice dystrophy in retroillumination p. 277 Naveen Radhakrishnan, Venkatesh N Prajna DOI:10.4103/tjosr.tjosr_86_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta JOURNAL REVIEW Journal scan p. 278 Shruti Nishanth, Murali Ariga DOI:10.4103/tjosr.tjosr_102_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta PHOTO QUIZ Photo Quiz Questions p. 281 Jiz Mary Santhosh DOI:10.4103/tjosr.tjosr_96_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta PHOTO QUIZ ANSWERS Answers to previous issue Photo Quiz p. 283 Shruti Nishanth, Atheek Shaik DOI:10.4103/tjosr.tjosr_59_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Trauma

Anterior cruciate ligament reconstruction surgery timing with respect to meniscal-chondral damage Mohammadreza Minator Sajjadi, Mohammad Ali Okhovatpour, Adel Ebrahimpour, Reza Zandi, Meysam Jafari Kafi-Abadi, Mehrdad Sadighi Archives of Trauma Research 2018 7(3):87-91 Background: Anterior cruciate ligament (ACL) tear is one of the most common types of knee injuries. Delay in diagnosis and treatment of ACL injuries can lead to further damage of the meniscus and cartilage. In this study, we tried to show the distribution of injuries over time and types. Methods: This retrospective study was performed on 336 patients with the diagnosis of primary ACL tear without other ligament injuries. The data including site and grade of the meniscal tear and cartilage damage, based on the International Cartilage Repair Society Classification, the time between diagnosis and surgical procedure, and the treatment method were collected. In this study, we divided patients into four groups according to injury to surgery time. Groups were 3 months, 3–6 months, 6–12 months, and over 12 months to surgery. Results: The results showed that a rate of cartilage damage had no significant correlation with a time interval between injury and surgery (P = 0.54). Furthermore, no significant correlation was found between the site of cartilage damage and the interval time after injury to surgery. The results indicated that the meniscal tear increases in case of a delay to perform surgery (P = 0.004). However, no significant relation was found between the site and pattern of meniscal injury and time. Moreover, patients with a complete ACL tear had a significantly higher rate of meniscus injury compared to those with a partial ACL tear (0.048). Conclusion: The findings of this study show that there is no significant relationship between the time of surgery and the risk of chondral damage after the ACL tear over time. ACL-ruptured patients should undergo the ACL reconstruction surgery up to 3 months from knee trauma to prevent further meniscal injuries.

Investigation of the role of traffic police function in reducing geographical inequalities in mortality from road traffic accidents Fatemeh Shahbazi, Hamid Soori, Soheila Khodakarim, Mohammad Reza Ghadirzadeh, Ahmad Shojaei, Seyed Saeed Hashemi Nazari Archives of Trauma Research 2018 7(3):92-97 Background and Objectives: Road traffic accident (RTA) is one of the major public health problems. Inequality in this problem and its trend has not been yet investigated in Iran. A better understanding of different contributing factors to RTA like inequalities can be helpful to reduce the negative influence of road crashes. Hence, this study aimed at examining geographical inequality in mortality from RTAs over the previous decades. Materials and Methods: In this cross-sectional study, all people who died from RTAs from March 2006 to February 2015 were selected. The data were taken from Legal Medicine Organization in Iran. The Theil index was used to estimate geographical inequality in mortality from RTA. Data were then analyzed using the Stata software. Results: During the 10-year period of this study, 210,582 people in Iran died due to RTA. The mortality rate that caused by RTAs has decreased during the study. We found a larger reduction in a mortality rate in suburban RTAs. In spite of the reduction in RTAs death, geographical inequality increased during the 10-year study. Conclusions: The findings of this study indicate that there is a geographical inequality in mortality from RTAs in Iran. This implies that effective interventions in reducing the RTAs should be distributed equally among regions of the country. Further research can be performed to investigate the causes of this inequality.

Predictors for emergency hemostasis in severe trauma patients Wongsakorn Chaochankit, Osaree Akaraborworn, Khanitta Kaewsaengrueang Archives of Trauma Research 2018 7(3):98-101 Background: Exsanguination is the main cause of death in trauma patients. Early determination that a patient requires an emergency operation is crucial for saving of life. We challenge the defining predictors that guide the intervention or emergency operation for hemorrhage control in severe trauma patients. Aims: The aim of this study was to define the predictors that guide the intervention or emergency operation to resuscitate severe trauma patients. Methods: This study was a retrospective study in trauma patients from Songklanagarind hospital. Data were retrospectively collected from a prospective collection registry that included 131 trauma patients who met the trauma activation criteria at Songklanagarind Hospital from January 2014 to December 2014. Emergency operation or intervention was defined as the procedures needed to improve hemostasis within 4 h. Categorical data were compared. Logistic regression was used to measure the relationship between dependent and one or more independent variables. Results: The study population was 81.7% male. The age range was 31–35 years. The most frequent mechanism was blunt injury (78%). The emergency hemostasis patients had 27 patients (20.6%). The factors relate to an emergency operation or intervention to improve the hemostasis within 4 h were focused assessment with sonography for trauma (FAST)-positive (P < 0.001), male (P = 0.02), Injury Severity Score (ISS) ≥25 (P = 0.013), and penetrating injury (P = 0.016). The preventive factors to an emergency hemostasis were platelet ≥100,000 (P = 0.039) and age ≥50 (P = 0.005). Conclusion: The palate count, FAST, male, age, ISS, and penetrating injury are factors that relate to an emergency operation or intervention within the first 4 h.

Science mapping of "Trauma Surgery" by co-word analysis and thematic clustering in MEDLINE Mohammad Raeeszadeh, Mazyar Karamali, Amin Sohrabi Archives of Trauma Research 2018 7(3):102-108 Background: Trauma surgery has an interdisciplinary nature among the surgical specialties, and trauma surgeons are required to identify its related scientific fields to acquire the needed skills in controlling the injuries. This study was conducted to investigate the science mapping of trauma surgery based on the bibliographic data of MEDLINE. Methodology: Based on the bibliographic data from the MEDLINE database, the visualizing techniques of bibliometric networks and all the scientific products of the trauma surgery realm indexed at MEDLINE from 2008 to 2017 were investigated. Data analysis was performed using co-word analysis and cluster analysis using the VOSviewer. Results: The growth trend of scientific productions in the field of trauma surgery has been on the rise in the past 10 years. The keyword “trauma,” followed by “osteoporosis,” “fracture outcome,” “trauma surgery,” and “mortality” had respectively the highest frequency. The results of cluster analysis identified the most important basic research subjects of trauma surgery published in MEDLINE in the past 10 years and categorized them into five clusters. Trauma surgery field had a close relationship with the field of orthopedics, basic studies, and laboratory research in comparison with its clinical domains. Conclusion: We attempted to identify the vastness of the knowledge subjects of trauma surgery and to conduct educational research, and technological planning so that the managers and stakeholders can trace the path of future scientific activities in the field of trauma surgery. The identification of this important realm and provision of the required information on the core issues for the users can be facilitated by drawing up a science map and visualizing the main traumatic sciences.

Quality of life and knee function in patients with knee dislocation Mohammad Hosein Ebrahimzadeh, Farshid Bagheri, Ali Moradi, Ali Birjandi Nejad Archives of Trauma Research 2018 7(3):109-113 Background: Knee dislocations are uncommon (<0.5% of all dislocations); however, they may result in catastrophic outcomes secondary to their high-energy nature and neurovascular injuries. Objectives: The objective of this study was to evaluate the clinical outcome of knee dislocation management. Subjects and Methods: A total of 20 consecutive adult patients with knee dislocation were enrolled in this cross-sectional study between 2011 and 2014. A single knee surgeon examined all the patients for knee instability for subjective evaluation of knee function using the Lysholm Knee Questionnaire, Knee Society Score (KSS), and Short Form-36 (SF-36). Results: The average Lysholm Knee Scores and KSS were 68 (range: 18–100) and 65 (range: 15–97), respectively. All domains of SF-36 among the studied patients were lower than that of the normal population. We could not find any correlation between age, body mass index, and interval between initial trauma and operation with outcome variables (Lysholm Knee Score, KSS, and SF-36 Physical Component Score, and SF-36 Mental Component Score). Conclusions: The knee function after proper management of dislocation is reasonable, but prolonged course of management and multiple operations may decrease the patients' quality of life.

Comparison of efficacy of nebulized ketamine with morphine and intravenous morphine in pain reduction in patients with traumatic long-bone fractures admitted to emergency department Reza Azizkhani, Kourosh Akhbari, Babak Masoumi, Abdolrahman Parna, Keihan Golshani Archives of Trauma Research 2018 7(3):114-120 Background: Traumatic long-bone fracture is a common cause of referring to the emergency department (ED). The aim of this study was to compare the efficacy of nebulized ketamine and morphine and intravenous (IV) morphine in reducing pain in these patients. Materials and Methods: In this clinical trial study, 88 patients with traumatic long-bone fractures referred to the ED were randomly selected and divided into two groups of nebulized ketamine and morphine and IV morphine using block randomization. Changes in pain intensity according to visual analog scale (VAS), patient satisfaction, and clinical features, including oxygen saturation (O2 sat), systolic blood pressure (SBP), respiratory rate, and pulse rate (PR) were assessed at baseline and 15 and 30 min after the intervention and finally, data were analyzed using the SPSS software. Results: Demographic characteristics including sex, age, and site of fracture were similar in the two groups (P > 0.05). In the IV morphine group, O2 sat (P < 0.001), SBP (P = 0.005), and PR (P < 0.001) significantly decreased, but in the nebulized group, SBP (P < 0.001) and PR (P < 0.001) significantly increased, but O2 sat did not significantly decrease (P > 0.05). The VAS results in the IV group were better at 15 min (P < 0.001), but after 30 min, both methods were equally effective in pain reduction (P = 0.508). Conclusion: According to the results of this study, the pain reduction was similar in both groups after 30 min, but regarding other parameters such as patients' satisfaction and fewer side effects, it can be concluded that the long-term effect of nebulized morphine and ketamine would be more beneficial.

The effect of cardiopulmonary resuscitation clinical audit on the patient survival in the emergency room Jafar Moridi, Hosein Mahmoudi, Abbas Ebadi, Ali Rahmani, Seyed Tayeb Moradian Archives of Trauma Research 2018 7(3):121-126 Background: The ability to perform cardiopulmonary resuscitation (CPR) is among the most important professional skills for physicians and nurses. There is a wide difference among different countries respecting resuscitation success rate. Studies show weaknesses in performing resuscitation. Objectives: This study aimed at assessing the effects of clinical audit of CPR in the emergency room based on the Situation Stabilization Model (SSM). Materials and Methods: This quasi-experimental study was done in 2017 in the emergency room of Baqiyatallah Hospital, Tehran, Iran. Using the Adib checklist, 35 resuscitations were assessed based on the steps of clinical audit. Then, a 1-month educational program was held for the resuscitation staffs in the study setting. Then, 35 new resuscitations were assessed using the same checklist. Finally, the results of the two measurements were compared. Results: There were significant differences between two measurement time points regarding the mean scores of different resuscitation skills (P < 0.001). Primary resuscitation success rate increased from 6 (17.1%) cases at baseline to 8 (22.9%) of the cases after the intervention. This increase was not statistically significant (P = 0.47). Conclusions: Clinical audit in the emergency room based on the SSM improves the quality and the success rate of CPR. The success rate is in our study increased. Furthermore, the reported data were not statistically significant for improving the success rate; it is clinically important. Because primary resuscitation success rate increased from 6 (17.1%) cases at baseline to 8 (22.9%) cases after the intervention. These findings highlight the necessity and the importance of the clinical audit of care services as well as the implementation of educational interventions based on the existing weaknesses. Given the great importance and sensitivity of resuscitation, health-care staffs need to receive regular theoretical and practical in-service resuscitation-related training.

Chest tube malposition inserted in thorax increases morbidity at thoracoabdominal injury Cem Donmez, Ahmet Korkut Belli, Sercan Subasi Archives of Trauma Research 2018 7(3):127-129 Thoracoabdominal penetrating trauma management is challenging when diaphragm injuries are involved. Thorax tube is golden standard for penetrating thoracoabdominal injuries. It has some complications. A 27-year-old male had stabbed thoracoabdominal penetrating trauma thorax tube inserted at another hospital. We decided to explore abdomen laparoscopy when he has symptoms at abdomen. We saw thorax tube ruptured diaphragm. We saturated diaphragm intracorporeally with laparoscopic protege. The clinician should not insert tube from penetrating trauma area. Tube must be inserted from its usual anatomical intercostal space.

Lack of evidence for conducting meta-analysis of prevalence of drug-resistant Pseudomonas aeruginosa in iranian burned patients Amir Emami, Fatemeh Javanmardi, Mahrokh Rajaee, Neda Pirbonyeh Archives of Trauma Research 2018 7(3):130-131 ORIGINAL ARTICLES   Anterior cruciate ligament reconstruction surgery timing with respect to meniscal-chondral damage p. 87 Mohammadreza Minator Sajjadi, Mohammad Ali Okhovatpour, Adel Ebrahimpour, Reza Zandi, Meysam Jafari Kafi-Abadi, Mehrdad Sadighi DOI:10.4103/atr.atr_29_18   Background: Anterior cruciate ligament (ACL) tear is one of the most common types of knee injuries. Delay in diagnosis and treatment of ACL injuries can lead to further damage of the meniscus and cartilage. In this study, we tried to show the distribution of injuries over time and types. Methods: This retrospective study was performed on 336 patients with the diagnosis of primary ACL tear without other ligament injuries. The data including site and grade of the meniscal tear and cartilage damage, based on the International Cartilage Repair Society Classification, the time between diagnosis and surgical procedure, and the treatment method were collected. In this study, we divided patients into four groups according to injury to surgery time. Groups were 3 months, 3–6 months, 6–12 months, and over 12 months to surgery. Results: The results showed that a rate of cartilage damage had no significant correlation with a time interval between injury and surgery (P = 0.54). Furthermore, no significant correlation was found between the site of cartilage damage and the interval time after injury to surgery. The results indicated that the meniscal tear increases in case of a delay to perform surgery (P = 0.004). However, no significant relation was found between the site and pattern of meniscal injury and time. Moreover, patients with a complete ACL tear had a significantly higher rate of meniscus injury compared to those with a partial ACL tear (0.048). Conclusion: The findings of this study show that there is no significant relationship between the time of surgery and the risk of chondral damage after the ACL tear over time. ACL-ruptured patients should undergo the ACL reconstruction surgery up to 3 months from knee trauma to prevent further meniscal injuries. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Investigation of the role of traffic police function in reducing geographical inequalities in mortality from road traffic accidents p. 92 Fatemeh Shahbazi, Hamid Soori, Soheila Khodakarim, Mohammad Reza Ghadirzadeh, Ahmad Shojaei, Seyed Saeed Hashemi Nazari DOI:10.4103/atr.atr_46_18   Background and Objectives: Road traffic accident (RTA) is one of the major public health problems. Inequality in this problem and its trend has not been yet investigated in Iran. A better understanding of different contributing factors to RTA like inequalities can be helpful to reduce the negative influence of road crashes. Hence, this study aimed at examining geographical inequality in mortality from RTAs over the previous decades. Materials and Methods: In this cross-sectional study, all people who died from RTAs from March 2006 to February 2015 were selected. The data were taken from Legal Medicine Organization in Iran. The Theil index was used to estimate geographical inequality in mortality from RTA. Data were then analyzed using the Stata software. Results:During the 10-year period of this study, 210,582 people in Iran died due to RTA. The mortality rate that caused by RTAs has decreased during the study. We found a larger reduction in a mortality rate in suburban RTAs. In spite of the reduction in RTAs death, geographical inequality increased during the 10-year study. Conclusions: The findings of this study indicate that there is a geographical inequality in mortality from RTAs in Iran. This implies that effective interventions in reducing the RTAs should be distributed equally among regions of the country. Further research can be performed to investigate the causes of this inequality. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Predictors for emergency hemostasis in severe trauma patients p. 98 Wongsakorn Chaochankit, Osaree Akaraborworn, Khanitta Kaewsaengrueang DOI:10.4103/atr.atr_19_18   Background: Exsanguination is the main cause of death in trauma patients. Early determination that a patient requires an emergency operation is crucial for saving of life. We challenge the defining predictors that guide the intervention or emergency operation for hemorrhage control in severe trauma patients. Aims: The aim of this study was to define the predictors that guide the intervention or emergency operation to resuscitate severe trauma patients. Methods: This study was a retrospective study in trauma patients from Songklanagarind hospital. Data were retrospectively collected from a prospective collection registry that included 131 trauma patients who met the trauma activation criteria at Songklanagarind Hospital from January 2014 to December 2014. Emergency operation or intervention was defined as the procedures needed to improve hemostasis within 4 h. Categorical data were compared. Logistic regression was used to measure the relationship between dependent and one or more independent variables. Results: The study population was 81.7% male. The age range was 31–35 years. The most frequent mechanism was blunt injury (78%). The emergency hemostasis patients had 27 patients (20.6%). The factors relate to an emergency operation or intervention to improve the hemostasis within 4 h were focused assessment with sonography for trauma (FAST)-positive (P < 0.001), male (P = 0.02), Injury Severity Score (ISS) ≥25 (P = 0.013), and penetrating injury (P = 0.016). The preventive factors to an emergency hemostasis were platelet ≥100,000 (P = 0.039) and age ≥50 (P = 0.005). Conclusion: The palate count, FAST, male, age, ISS, and penetrating injury are factors that relate to an emergency operation or intervention within the first 4 h. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Science mapping of "Trauma Surgery" by co-word analysis and thematic clustering in MEDLINE p. 102 Mohammad Raeeszadeh, Mazyar Karamali, Amin Sohrabi DOI:10.4103/atr.atr_48_18   Background: Trauma surgery has an interdisciplinary nature among the surgical specialties, and trauma surgeons are required to identify its related scientific fields to acquire the needed skills in controlling the injuries. This study was conducted to investigate the science mapping of trauma surgery based on the bibliographic data of MEDLINE. Methodology: Based on the bibliographic data from the MEDLINE database, the visualizing techniques of bibliometric networks and all the scientific products of the trauma surgery realm indexed at MEDLINE from 2008 to 2017 were investigated. Data analysis was performed using co-word analysis and cluster analysis using the VOSviewer. Results: The growth trend of scientific productions in the field of trauma surgery has been on the rise in the past 10 years. The keyword "trauma," followed by "osteoporosis," "fracture outcome," "trauma surgery," and "mortality" had respectively the highest frequency. The results of cluster analysis identified the most important basic research subjects of trauma surgery published in MEDLINE in the past 10 years and categorized them into five clusters. Trauma surgery field had a close relationship with the field of orthopedics, basic studies, and laboratory research in comparison with its clinical domains. Conclusion: We attempted to identify the vastness of the knowledge subjects of trauma surgery and to conduct educational research, and technological planning so that the managers and stakeholders can trace the path of future scientific activities in the field of trauma surgery. The identification of this important realm and provision of the required information on the core issues for the users can be facilitated by drawing up a science map and visualizing the main traumatic sciences. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Quality of life and knee function in patients with knee dislocation p. 109 Mohammad Hosein Ebrahimzadeh, Farshid Bagheri, Ali Moradi, Ali Birjandi Nejad DOI:10.4103/atr.atr_2_18   Background: Knee dislocations are uncommon (<0.5% of all dislocations); however, they may result in catastrophic outcomes secondary to their high-energy nature and neurovascular injuries. Objectives: The objective of this study was to evaluate the clinical outcome of knee dislocation management. Subjects and Methods: A total of 20 consecutive adult patients with knee dislocation were enrolled in this cross-sectional study between 2011 and 2014. A single knee surgeon examined all the patients for knee instability for subjective evaluation of knee function using the Lysholm Knee Questionnaire, Knee Society Score (KSS), and Short Form-36 (SF-36). Results: The average Lysholm Knee Scores and KSS were 68 (range: 18–100) and 65 (range: 15–97), respectively. All domains of SF-36 among the studied patients were lower than that of the normal population. We could not find any correlation between age, body mass index, and interval between initial trauma and operation with outcome variables (Lysholm Knee Score, KSS, and SF-36 Physical Component Score, and SF-36 Mental Component Score). Conclusions: The knee function after proper management of dislocation is reasonable, but prolonged course of management and multiple operations may decrease the patients' quality of life. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Comparison of efficacy of nebulized ketamine with morphine and intravenous morphine in pain reduction in patients with traumatic long-bone fractures admitted to emergency department p. 114 Reza Azizkhani, Kourosh Akhbari, Babak Masoumi, Abdolrahman Parna, Keihan Golshani DOI:10.4103/atr.atr_13_18   Background: Traumatic long-bone fracture is a common cause of referring to the emergency department (ED). The aim of this study was to compare the efficacy of nebulized ketamine and morphine and intravenous (IV) morphine in reducing pain in these patients. Materials and Methods: In this clinical trial study, 88 patients with traumatic long-bone fractures referred to the ED were randomly selected and divided into two groups of nebulized ketamine and morphine and IV morphine using block randomization. Changes in pain intensity according to visual analog scale (VAS), patient satisfaction, and clinical features, including oxygen saturation (O2sat), systolic blood pressure (SBP), respiratory rate, and pulse rate (PR) were assessed at baseline and 15 and 30 min after the intervention and finally, data were analyzed using the SPSS software. Results: Demographic characteristics including sex, age, and site of fracture were similar in the two groups (P > 0.05). In the IV morphine group, O2 sat (P < 0.001), SBP (P = 0.005), and PR (P < 0.001) significantly decreased, but in the nebulized group, SBP (P < 0.001) and PR (P < 0.001) significantly increased, but O2 sat did not significantly decrease (P > 0.05). The VAS results in the IV group were better at 15 min (P < 0.001), but after 30 min, both methods were equally effective in pain reduction (P = 0.508). Conclusion: According to the results of this study, the pain reduction was similar in both groups after 30 min, but regarding other parameters such as patients' satisfaction and fewer side effects, it can be concluded that the long-term effect of nebulized morphine and ketamine would be more beneficial. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta The effect of cardiopulmonary resuscitation clinical audit on the patient survival in the emergency room p. 121 Jafar Moridi, Hosein Mahmoudi, Abbas Ebadi, Ali Rahmani, Seyed Tayeb Moradian DOI:10.4103/atr.atr_58_18   Background: The ability to perform cardiopulmonary resuscitation (CPR) is among the most important professional skills for physicians and nurses. There is a wide difference among different countries respecting resuscitation success rate. Studies show weaknesses in performing resuscitation. Objectives: This study aimed at assessing the effects of clinical audit of CPR in the emergency room based on the Situation Stabilization Model (SSM). Materials and Methods: This quasi-experimental study was done in 2017 in the emergency room of Baqiyatallah Hospital, Tehran, Iran. Using the Adib checklist, 35 resuscitations were assessed based on the steps of clinical audit. Then, a 1-month educational program was held for the resuscitation staffs in the study setting. Then, 35 new resuscitations were assessed using the same checklist. Finally, the results of the two measurements were compared. Results: There were significant differences between two measurement time points regarding the mean scores of different resuscitation skills (P < 0.001). Primary resuscitation success rate increased from 6 (17.1%) cases at baseline to 8 (22.9%) of the cases after the intervention. This increase was not statistically significant (P = 0.47). Conclusions: Clinical audit in the emergency room based on the SSM improves the quality and the success rate of CPR. The success rate is in our study increased. Furthermore, the reported data were not statistically significant for improving the success rate; it is clinically important. Because primary resuscitation success rate increased from 6 (17.1%) cases at baseline to 8 (22.9%) cases after the intervention. These findings highlight the necessity and the importance of the clinical audit of care services as well as the implementation of educational interventions based on the existing weaknesses. Given the great importance and sensitivity of resuscitation, health-care staffs need to receive regular theoretical and practical in-service resuscitation-related training. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta CASE REPORT Chest tube malposition inserted in thorax increases morbidity at thoracoabdominal injury p. 127 Cem Donmez, Ahmet Korkut Belli, Sercan Subasi DOI:10.4103/atr.atr_74_18   Thoracoabdominal penetrating trauma management is challenging when diaphragm injuries are involved. Thorax tube is golden standard for penetrating thoracoabdominal injuries. It has some complications. A 27-year-old male had stabbed thoracoabdominal penetrating trauma thorax tube inserted at another hospital. We decided to explore abdomen laparoscopy when he has symptoms at abdomen. We saw thorax tube ruptured diaphragm. We saturated diaphragm intracorporeally with laparoscopic protege. The clinician should not insert tube from penetrating trauma area. Tube must be inserted from its usual anatomical intercostal space. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta LETTER TO EDITOR Lack of evidence for conducting meta-analysis of prevalence of drug-resistant Pseudomonas aeruginosa in iranian burned patients p. 130 Amir Emami, Fatemeh Javanmardi, Mahrokh Rajaee, Neda Pirbonyeh DOI:10.4103/atr.atr_64_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

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