Objective Coronavirus disease 19 (COVID-19) caused by the highly pathogenic SARS-CoV-2, was first reported from Wuhan, China, in December 2019. The present study assessed possible associations between one-month mortality and demographic data, SpO 2 , underlying diseases and laboratory findings, in COVID-19 patients. Also, since recent studies on COVID-19, have focused on Neutrophil-to-lymphocyte ratio (NLR) as an independent risk factor of the in-hospital death and a significant prognostic biomarker of outcomes in critically ill patients, in this study, we assessed predictive potential of this factor in terms of one-month mortality. Methods Patients admitted to Imam Reza hospital, affiliated to Mashhad University of Medical Sciences, Mashhad, Iran, from March to June 2020, with positive RT-PCR results for SARS-CoV-2, were included in this study. Kaplan-Meier survival analysis and Cox proportional hazard model were used to respectively estimate one-month mortality since admission and determine factors associated with one-month mortality. Results In this retrospective cohort study, 219 patients were included (137 men and 82 women (mean age 58.2 ± 16 and 57 ± 17.3 years old, respectively)). Hypertension, ischemic heart disease and diabetes were respectively the most common comorbidities. Among these patients, 63 patients were admitted to the ICU and 31 deaths occurred during one-month follow-up. With respect to mean peripheral capillary oxygen saturation (SpO 2 ), 142 patients had SpO 2 ≤ 90%. Based on our analysis, older age and increased Neutrophil-to-lymphocyte ratio (NLR), and White blood cells (WBC) count were associated with increased risk of one-month mortality. Patients with SpO 2 ≤ 90% had a 3.8-fold increase in risk of one-month death compared to those with SpO 2 > 90%, although the difference did not reach a significant level. Conclusion Multivariate analysis introduced age, WBC count, and NLR as predictors of one-month mortality in COVID-19 patients.

To study the prevalence of resistant strains of S. aureus isolated from surfaces, beds and various equipment of an Iranian hospital emergency ward. Methods: Two hundred swab samples were collected from the surfaces, beds, trolleys, surgical equipment and diagnostic medical devices in emergency ward. Samples were cultured and those that were S. aureus-positive were confirmed using polymerase chain reaction (PCR). Antimicrobial resistance pattern was analyzed using disk diffusion method. Results: Nine of 200 samples (4.5 %) collected were positive for S. aureus. Surfaces (8.8 %), beds (5 %) and trolleys (5 %) were the most commonly contaminated. S. aureus isolates exhibited varying levels of resistance against antibiotics with the following being the highest: tetracycline (88.8 %), penicillin (88.8 %) and ampicillin (77.7 %). The prevalence of resistance against methicillin, oxacillin and azithromycin were 44.4, 33.3 and 33.3 %, respectively. There was no pattern of resistance against imipenem. Conclusion: Efficient disinfection of surfaces, beds, trolleys and surgical instruments should be performed periodically to reduce colonization of resistant strains of S. aureus in various areas of emergency health care centers.

A 23-year-old male was brought in the emergency department by Emergency Medical Service (EMS) after a motor vehicle collision. He was lying on a backboard but alert and responsive. His vitals on arrival were respiratory rate of 18 breaths per minute, pulse rate of 88 beats per minute, temperature of 37.3°C, blood pressure of 122/85 mmHg and O 2 saturation of 95% in room air. We detected no superficial abrasions or bruise. He complained of posterior pelvic pain and had mild localized swelling and tenderness over the symphysis pubis on physical examination. He had normal range of motion of the both hips, without any limb shortening or rotational deformity. Other physical examination findings were unremarkable. A pelvic plain radiograph was obtained and no obvious pathology was detected [Table/ Fig-1]. A pelvic Computed Tomography (CT) scan was performed to evaluate for posterior arc injuries. The CT scan revealed no fracture line or pelvic hematoma. Incidentally, a welldefined 207mm lobulated lesion was detected within the right ilium adjacent to the sacroiliac joint. The lesion contained gas densities with a mean Hounsfield number of -666 and had a thin sclerotic rim [Table/ Fig-2]. There was no surrounding soft tissue swelling. The lesion was not visible on plain radiograph. The patient had no pain on the right side of pelvis and did not mention any previous history of pain or trauma except that recent one. He was followed on the outpatient service and the pain disappeared after a week. He had no complaints after 3 months of follow-up. Orthopaedics SectionGas Bubbles in the Bone:A Case Report aBstRaCtIntraosseous pneumatocysts are benign gas-filled cavities within bones which are most commonly found in ilium, sacrum and vertebrae. The lesions are asymptomatic and found incidentally while evaluating for other injuries. Here, we present an intraosseous pneumatocyst of ilium in a 23-year-old male patient. Although once thought to be rare, intraossseous pneumatocyst are now believed to be more common. Thus, familiarity with their appearance is essential to avoid unnecessary workup. Intraosseous pneumatocysts are differentiated from more clinically significant differential diagnoses like osteonecrosis and osteomyelitis by their characteristic appearance of intraosseous air collections with sclerotic rim.

Background: Sickle cell disease (SCD) is a congenital hemoglobinopathy. A low Hb level and high hemoglobin-to-hematocrit ratio may lead to the vaso-occlusive crisis in patients, for the management of which hyperbaric oxygen, hydration, and pain relief therapy are proposed. Objectives: In this study, we sought to compare the effects of morphine and ketorolac on relieving painful sickle cell crisis. Methods: In this double-blind, randomized clinical trial, we recruited 92 SCD patients who referred to the Emergency Department of a university-affiliated hospital, in Mashhad, Iran, from December 2016 to May 2017. The patients were randomly assigned to two groups of ketorolac and morphine injections for relieving pain crisis according to the clinical conditions of the patients. Pain severity was measured by the visual analogue scale before and after the intervention. Data were analyzed using SPSS software. Results: A total of 92 SCD patients were evaluated, while, 19 (21%) were female and 73 (79%) were male, with the mean age of 20.77 ± 8.6 years. At the pre-injection phase, the mean pain scores were 9.1 ± 0.4 and 9.1 ± 0.7 in the ketorolac and morphine groups, respectively. After the intervention, the mean pain scores were 3.7 ± 1.2 and 4.9 ± 2.1 in the ketorolac and morphine groups, respectively. A significant association was found between the pain score after drug injection and the administered drug (P = 0.006). Conclusions: The management of pain crisis with ketorolac injection yielded the same results as the morphine injection in SCD patients. However, ketorolac was found to be associated with fewer side effects than morphine; thus, it can be beneficial for managing SCD patients suffering pain crisis.

BACKGROUND:Due to the prevalence of shoulder injuries among athletes and other people and the prevalence of radiography for these injuries, there are still no valid criteria for indication of doing shoulder radiography.AIM:This study aimed to examine the relationship between some signs and clinical examinations of the shoulder with shoulder bone injuries and the need for radiography.METHODS:This is a cross-sectional study. All patients aged 18-70 years who referred to the emergency ward of Imam Reza and Hasheminejad Hospital in the year 2014 due to blunt trauma and had criteria for entering the study and lacking exclusion criteria were included in the study process. Data on clinical symptoms, radiographic results, and final diagnosis were extracted from the patients’ records through a questionnaire and analysed statistically.RESULTS:There was a significant relationship between the clinical signs of patients Existence of ecchymosis in the shoulder fractures with glenoid and humerus fractures (p = 0.029, p = 0.004 respectively). There was also a significant relationship between clavicle fracture and limitation in shoulder rotation and abduction (p = 0.000 and p = 0.001 respectively). Other clinical symptoms did not show any significant relationship with radiographs indicative of the problem requiring specific treatment.CONCLUSION:Although it is possible to define critters based on clinical symptoms that reduce the need for unnecessary radiographs that the does not reliably help inpatient treatment, but finding these critters to indicate the performance of the graphs in shoulder injuries requires further studies with the higher population and more clinical variables.