We present an unusual case of a penetrating toothbrush injury in a 6-year old child. The injury was sustained due to a fall at home and resulted in accidental implantation of an adult toothbrush in the facial soft tissues. The toothbrush was removed under general anaesthesia without any complications. This case highlights a rare presentation involving extra oral penetration of a toothbrush which is not reported previously in the literature.
Wounds and Injuries ; Toothbrushing ; Child

Needle breakage following inferior alveolar nerve block is an unusual yet alarming complication in contemporary dental practice. We report a case of surgical retrieval of a broken needle in the pterygomandibular space following an inferior alveolar block in a 21 years old male. The postoperative recovery was uneventful and no complications were observed. Prompt removal of a broken needle is advisable to avoid complications.

Osteomyelitis of the mandible, a serious complication of untreated odontogenic infection has been reported. This case report describes an interesting presentation of chronic suppurative osteomyelitis (CSO) of the mandible in a 13 years old anaemic male patient. Investigations revealed inversion of his permanent teeth leading to trans-cutaneous extra-oral eruption along with marked destruction of mandible on the affected side. The treatment included a pre surgical course of antibiotics followed by the removal of the retained second premolar tooth, surgical debridement of the affected bone, and resection of the cutaneous sinus tract. The post-operative healing was uneventful. A combination of antibiotic therapy and surgical debridement were effective in the treatment of chronic suppurative osteomyelitis.

Discharge planning is an integral component of transitional care. Patients need to have their care needs assessed early in the admission to put in place a robust care plan that can meet the medical, functional, and social needs of the patient. The care plan must then be clearly communicated to the next care provider as well as the patient and his caregiver to avoid gaps during transition across different settings and providers. For patients with complex care needs in the community, an intensive form of primary care far beyond what is offered in traditional primary care is needed. This can be achieved by being connected to the health system and resources, additional efforts in providing the care coordination to navigate the health system, and optimising clinical and social care around the patient’s needs.

In this case series report we aim to report a Disseminated Intravascular Coagulation (DIC)-like syndrome associated with Hemiscorpius lepturus sting in 4 individuals and a novel management protocol for this life-threatening condition that comprised partial exchange transfusion in severe scorpionism.

OBJECTIVES: The aim of this study was to explore the spatial pattern of female breast cancer (BC) incidence at the neighborhood level in Tehran, Iran. METHODS: The present study included all registered incident cases of female BC from March 2008 to March 2011. The raw standardized incidence ratio (SIR) of BC for each neighborhood was estimated by comparing observed cases relative to expected cases. The estimated raw SIRs were smoothed by a Besag, York, and Mollie spatial model and the spatial empirical Bayesian method. The purely spatial scan statistic was used to identify spatial clusters. RESULTS: There were 4,175 incident BC cases in the study area from 2008 to 2011, of which 3,080 were successfully geocoded to the neighborhood level. Higher than expected rates of BC were found in neighborhoods located in northern and central Tehran, whereas lower rates appeared in southern areas. The most likely cluster of higher than expected BC incidence involved neighborhoods in districts 3 and 6, with an observed-to-expected ratio of 3.92 (p < 0.001), whereas the most likely cluster of lower than expected rates involved neighborhoods in districts 17, 18, and 19, with an observed-to-expected ratio of 0.05 (p < 0.001). CONCLUSIONS: Neighborhood-level inequality in the incidence of BC exists in Tehran. These findings can serve as a basis for resource allocation and preventive strategies in at-risk areas.
Bayes Theorem ; Breast Neoplasms* ; Breast* ; Female* ; Health Status Disparities ; Humans ; Incidence* ; Iran ; Residence Characteristics* ; Resource Allocation ; Socioeconomic Factors* ; Spatial Analysis

OBJECTIVES: The aim of this study was to explore the spatial pattern of female breast cancer (BC) incidence at the neighborhood level in Tehran, Iran.METHODS: The present study included all registered incident cases of female BC from March 2008 to March 2011. The raw standardized incidence ratio (SIR) of BC for each neighborhood was estimated by comparing observed cases relative to expected cases. The estimated raw SIRs were smoothed by a Besag, York, and Mollie spatial model and the spatial empirical Bayesian method. The purely spatial scan statistic was used to identify spatial clusters.RESULTS: There were 4,175 incident BC cases in the study area from 2008 to 2011, of which 3,080 were successfully geocoded to the neighborhood level. Higher than expected rates of BC were found in neighborhoods located in northern and central Tehran, whereas lower rates appeared in southern areas. The most likely cluster of higher than expected BC incidence involved neighborhoods in districts 3 and 6, with an observed-to-expected ratio of 3.92 (p < 0.001), whereas the most likely cluster of lower than expected rates involved neighborhoods in districts 17, 18, and 19, with an observed-to-expected ratio of 0.05 (p < 0.001).CONCLUSIONS: Neighborhood-level inequality in the incidence of BC exists in Tehran. These findings can serve as a basis for resource allocation and preventive strategies in at-risk areas.
Bayes Theorem ; Breast Neoplasms ; Breast ; Female ; Health Status Disparities ; Humans ; Incidence ; Iran ; Residence Characteristics ; Resource Allocation ; Socioeconomic Factors ; Spatial Analysis

Background: One of the important actions for enhancing human reliability in any industry is assessing human error probability (HEP). The HEART technique is a robust tool for calculating HEP in various industries. The traditional HEART has some weaknesses due to expert judgment. For these reasons, a hybrid model is presented in this study to integrate HEART with Best-Worst Method.Materials MethodIn this study, the blasting process in an iron ore mine was investigated as a case study. The proposed HEART-BWM was used to increase the sensitivity of APOA calculation. Then the HEP was calculated using conventional HEART formula. A consistency ratio was calculated using BWM. Finally, for verification of the HEART-BWM, HEP calculation was done by traditional HEART and HEART-BWM. Results: In the view of determined HEPs, the results showed that the mean of HEP in the blasting of the iron ore process was 2.57E-01. Checking the full blast of all the holes after the blasting sub-task was the most dangerous task due to the highest HEP value, and it was found 9.646E-01. On the other side, obtaining a permit to receive and transport materials was the most reliable task, and the HEP was 8.54E-04. Conclusion The results showed a good consistency for the proposed technique. Comparing the two techniques confirmed that the BWM makes the traditional HEART faster and more reliable by performing the basic comparisons.

BACKGROUND: GeneXpert MTB/RIF is a real-time PCR assay with established diagnostic performance in pulmonary and extra-pulmonary forms of tuberculosis. The aim of this study was to assess the contribution of GeneXpert MTB/RIF assay to the management of patients with any form of active tuberculosis in a single large tertiary center in Saudi Arabia, with a special focus on the impact on time to start of antituberculous therapy compared with Ziehl-Neelsen (ZN) smears and mycobacterial cultures. MATERIALS AND METHODS: Clinical, radiological and laboratory records for all patients who were commenced on antituberculous therapy between March 2011 and February 2013 were retrospectively reviewed. RESULTS: A total of 140 patients were included, 38.6% of which had pulmonary tuberculosis. GeneXpert MTB/RIF was requested for only 39.2% of patients and was the only reason for starting antituberculous therapy for only 12.1%. The median time to a positive GeneXpert MTB/RIF result was 0 days (IQR 3) compared with 0 day (IQR 1) for smear microscopy (P > 0.999) and 22 days (IQR 21) for mycobacterial cultures (P < 0.001). No patients discontinued antituberculous therapy because of a negative GeneXpert MTB/RIF result. CONCLUSIONS: In a setting wherein physicians are highly experienced in the diagnosis and treatment of tuberculosis, GeneXpert MTB/RIF was remarkably under-utilized and had only a limited impact on decisions related to starting or stopping antituberculous therapy. Cost-effectiveness and clinical utility of routine testing of all smear-negative clinical samples submitted for tuberculosis investigations by GeneXpert MTB/RIF warrant further study.
Diagnosis ; Humans ; Life Change Events* ; Microscopy ; Real-Time Polymerase Chain Reaction ; Retrospective Studies ; Saudi Arabia* ; Tuberculosis* ; Tuberculosis, Pulmonary

PURPOSEThe aim of this present study is to investigate the prevalence of alcohol and substance abuse (ASA) and its relationship with other risky driving behaviors among motorcycle drivers.

METHODSThis is a cross sectional study which is performed at Shiraz city of Iran. Data from motorcycle drivers were collected using a standard questionnaire in eight major streets at different times of the day. The data includes consumption of alcohol and other substances two hours before driving and some of the risky behaviors during driving.

RESULTSA total of 414 drivers with a mean ± SD age of (27.0 ± 9.3) years participated in the study. Alcohol or substance consumptions two hours before driving was significantly associated with risky driving behaviors such as using mobile phone during driving, poor maneuvering, and driving over the speed limit (both p < 0.001). It was also associated with carelessness about safety such as driving with technical defects (p < 0.001) and not wearing a crash helmet (p=0.008).

CONCLUSIONScreening for alcohol and substance consumption among motorcycle drivers is an efficient way to identify drivers that are at a greater risk for road traffic accidents.

Accidents, Traffic ; mortality ; statistics & numerical data ; Adult ; Age Distribution ; Alcoholism ; complications ; epidemiology ; Chi-Square Distribution ; Confidence Intervals ; Cross-Sectional Studies ; Developing Countries ; Humans ; Iran ; Male ; Middle Aged ; Motorcycles ; statistics & numerical data ; Odds Ratio ; Prevalence ; Risk Factors ; Risk-Taking ; Substance-Related Disorders ; complications ; epidemiology ; Survival Rate ; Urban Population ; Young Adult