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      Genitourinary system trauma after 2003 Bam earthquake in Kerman, Iran

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          Abstract

          Background:

          Natural disasters, especially earthquakes, result in many health problems all over the world, of which urological injuries should not be underestimated. Car accidents and falling from a height are the most common causes of genitourinary system injury. The lack of specific data in the literature regarding the outcome of earthquake-related genitourinary system trauma prompted us to undertake this study.

          Methods:

          We retrospectively evaluated the genitourinary system injury in patients who had survived the Bam earthquake. In this study, all patients admitted to two main back-up hospitals of Kerman were included. Of 256 patients who had been referred to Kerman hospitals, 28 cases were found to have urologic damage on physical examination, intravenous pyelography, abdominopelvic X-ray, and ultrasonography.

          Results:

          Of 28 patients with urologic damage, 22 (78.5%) were male and six (21.5%) were female. Their age ranged from 18 to 65 years. The injures included urethral disruption in 21 cases (75.5%), vesicovaginal fistula in four cases (14%), kidney rupture in two cases (7%) and bladder neck disruption accompanied with total right ureteral disruption and vesicovaginal fistula in a female patient (3.5%).

          Conclusion:

          We have evaluated the incidence of genitourinary injuries after an earthquake disaster for the first time. The most and least common urologic injury in our patients was urethral disruption and ureteral injury, respectively.

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          Most cited references 9

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          Factors affecting management and outcome in blunt renal injury.

          Blunt renal trauma patients often have multiple injuries. We retrospectively analyzed factors that could be predictive of outcome and the need for nephrectomy in this population. Blunt renal injury patients admitted to a Level I trauma center from January 1989 to July 1997 were identified and their charts reviewed. Multiple factors were examined. Using logistic regression analysis, factors predictive of mortality and the need for nephrectomy were determined. Of 11,847 trauma patients admitted, 95 (0.80%) suffered blunt renal injury. Mean age and ISS were 31.4 and 23.7, respectively. The number of deaths and nephrectomies was 11 and 10, respectively. Higher renal injury grade, as well as higher ISS values and 24-hour transfusion needs, directly correlated with the need for nephrectomy. Greater age, higher ISS, and higher 24-hour transfusion requirements lowered probability for survival. Patients with blunt renal injuries often sustain multiple injuries. The grade of renal injury, the overall injury severity of the patient, and the requirement of blood transfusion are the primary factors in determining the patient's need for nephrectomy and overall outcome.
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            The neurological outcome of spinal cord injured victims of the Bam earthquake, Kerman, Iran.

            Car accidents and gun-shot injuries are the most common causes of spinal cord injury. Five percent of those patients who have a complete spinal cord injury will experience improvement, to some extent. The lack of specific data in the literature regarding the outcome of earthquake related spinal cord injury justified us to design this study where we evaluated the neurological outcome and related factors of SCI in the Bam earthquake. We retrospectively evaluated the neurological outcome of patients with spinal cord injury who survived the Bam earthquake. In this study all patients with spinal cord injury that resulted from the Bam earthquake who registered in the Welfare Organization of Kerman were studied. The neurological conditions of patients eighteen months after the earthquake were compared with their neurological conditions at the time of the earthquake. A total of 17 (23.9%) patients with grade A impairment based on ASIA impairment Scale (AIS) at the time of the earthquake had significant neurological recovery. In addition, younger patients had better neurological outcomes. Those who had fracture dislocations had a worse outcome. Spinal cord injuries that are due to earthquakes have a better neurological outcome in comparison with other causes of this injury. The patients' ages and types of spinal fractures were significantly related to the neurological outcome.
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              Epidemiology of urogenital trauma in Iran: results of the Iranian National Trauma Project.

              We report the incidence, distribution, etiology, and outcome of the urogenital trauma in 8 major cities of Iran according to the database of national trauma project. Between 2000 and 2004, we prospectively collected the data of all the traumatic patients hospitalized for more than 24 hours in 8 cities (Tehran, Mashad, Ahwaz, Shiraz, Tabriz, Qom, Kermanshah, and Babol). We analysed the data taken from 17,753 trauma admissions. Patients with sustained urogenital traumas were identified and studied. A total of 175 patients (0.98%) had injuries to the urogenital system. Male to female ratio was 4. The patients' mean age was 25 +/- 16 years (range, 2 to 80 years). Of 175 patients, 159 (90.9%) had blunt trauma and 16 (9.1%) had penetrating trauma. Road traffic accident was the most common cause of trauma (65.1%). The most common injured organs were the kidney in 61.1% and the bladder in 13.7%. One hundred and forty-two patients (81.1%) had associated intra-abdominal injuries and 129 (73.7%) had other accompanying injuries. Sixty (34.2%) patients required surgical intervention. Nine patients (5.2%) died due to the severity of the injuries. All patients who died had severe injuries (Injury Severity Score >12). In Iran, blunt traumas including road traffic accidents are the main cause of urogenital traumas. The majority of the patients with urogenital trauma have multiple injuries and require a multidisciplinary approach.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                2011
                2011
                09 February 2011
                : 7
                : 49-52
                Affiliations
                [1 ]Department of Urology, Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran;
                [2 ]Department of Urology, Moradi Hospital, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran;
                [3 ]Department of Urology, Kamkar Hospital, School of Medicine, Qom University of Medical Sciences, Qom, Iran
                Author notes
                Correspondence: Mohammad Kazem Moslemi, Department of Urology, Kamkar Hospital, School of Medicine, Qom University of Medical Sciences, Qom, Iran, Tel +98 912 252 1646, Fax +98 251 771 3473, Email mkmoslemi@ 123456gmail.com
                Article
                tcrm-7-049
                10.2147/TCRM.S17133
                3061843
                21445278
                © 2011 Firoozabadi et al, publisher and licensee Dove Medical Press Ltd.

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                Categories
                Original Research

                Medicine

                emergency department, trauma, urethral injury, genitourinary system, renal injury, earthquake

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