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   Table of Contents - Current issue
Coverpage
October-December 2018
Volume 7 | Issue 4
Page Nos. 133-172

Online since Friday, May 31, 2019

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ORIGINAL ARTICLES  

Spatial factors related to traffic crashes on pedestrians in all districts of Tehran p. 133
Ali Moradi, Hamid Soori, Amir Kavousi, Farshid Eshghabadi, Khaled Rahmani, Shahrzad Nematollahi, Salahdin Zeini
DOI:10.4103/atr.atr_107_18  
Background: A great proportion of deaths due to traffic crashes occur for pedestrians, both in developing and developed countries. Objectives: The aim of the present study was to determine the spatial factors related to the frequency of traffic crashes on pedestrians in districts of Tehran city. Methods: This was a cross-sectional study. All traffic crashes on pedestrians during 2013–2015 were included in this study. The data were extracted from different sources such as traffic police main office, Tehran municipal office, and Iran statistics center. Poisson and negative binomial regression models were used to analyze the role of environment and district on frequency of traffic crashes. Moreover, the likelihood-ratio test has been used for comparison between models, while assessment of goodness-of-fit has been reported using R2, Akaike information criteria, and Bayesian information criteria. Results: Of 12,090 crashes, 11,895 (98.4%) had led to injuries, while 195 (1.6%) had led to deaths. The frequency of crashes varied substantially in different districts of Tehran. The incidence of injuries did not show any particular pattern, whereas the pattern of incidence of deaths was lower in central districts in comparison to higher incidence in marginal districts (e.g., north, south, west, and east of Tehran). The results of the final model showed a statistically significant association among various variables such as demographics, web of roads, rate of traveling, and land use with the outcome as number of crashes in geographic units. Conclusions: Frequency distribution of traffic crashes leading to injury and/or death is completely different in various districts of Tehran. Demographic as well as spatial characteristics also play an important role in determining this distribution. Regional planning, appropriate traffic management, control measures on spatial risk factors, and educational programs could substantially improve the safety of pedestrians in Tehran.
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The role of interaction-based effects on fatal accidents using logic regression p. 140
Marzieh Rohani-Rasaf, Yadollah Mehrabi, Saeed Seyed Hashemi-Nazari, Mehdi Azizmohammad Looha, Hamid Soori
DOI:10.4103/atr.atr_105_18  
Background and Objectives: Road traffic accidents (RTAs) were estimated to be the eighth major cause of death worldwide in 2016. Investigation of various factors alone can distort the results. Thus, it is important to consider interactions among the various factors associated with RTAs. Logic regression was used to investigate the important combinations among traffic accident variables. <b>Methods: In this analytical study, the existing 1-year data from the police accident database in 2014 were examined. The Legal Medicine Organization database was also used to correct death after 30 days. Logic regression, a generalized regression model, was used to explore the interactions among different factors of the accident. Results: Cross-validation results showed the best model in the form of three trees and eight leaves. Being a professional driver and exposure to a heavy vehicle on sandy or earthy road double the chance of death. Operating an unsafe car on a road with curve increases the odds of a fatal crash by 1.65 times. Driver error on a nonresidential road without any shoulders adds 90% to the odds of having a deadly crash. Conclusions: The significance of the interactions between the road and driver factors shows that roads with poor design can cause a driver to make mistakes and increase fatal accidents. Therefore, politicians must consider constructing structures alongside nonresidential roads and proper shoulders, install signs at curves, and repair pavement in order to reduce the fatality of accidents. It is also recommended that manufacturers of commercial vehicles install proper safeguards in all heavy vehicles to reduce fatal accidents.
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Preoperative topical intranasal fluorescein in diagnosis of cerebrospinal fluid rhinorrhea p. 146
Seyed Mostafa Hashemi Jazi, Zhale Amini, Masih Saboori, Mostafa Raisi
DOI:10.4103/atr.atr_87_18  
Background and Objectives: The preoperative diagnosis of cerebrospinal fluid (CSF) leak site is necessary for the management of CSF rhinorrhea. At present, intrathecal fluorescein is a common approach for it; however, regarding drawbacks, its value is limited. This study aimed at examining the effects of topical intranasal fluorescein (TINF) on the preoperative diagnosis of CSF rhinorrhea and intraoperative localization of CSF fistula. Patients and Methods: In this cross-sectional study, 32 consecutive patients with CSF rhinorrhea were recruited. Topical intranasal 10% fluorescein was placed in common sites of leakage, the middle turbinate meatus, the roof of the ethmoid plate, and sphenoethmoidal recesses. Change of the color of fluorescein indicated the presence of CSF, and thus, the site of the fistula could be outlined. The accuracy rates of diagnosis of leak site identified by TINF were compared with those by available imaging modalities, CSF analysis, intraoperative findings, and follow-up. Results: The cause of the leak was traumatic in 22 patients and nontraumatic in 10 patients. Preoperative accuracy rate of the location of CSF fistula was estimated 58.3% by available imaging study. The preoperative diagnosis rate of CSF rhinorrhea and the CSF fistula site localization rate by TINF were both 100%. No recurrence was found during the follow-up for 2–12 months. No complication had been reported. Conclusions: Preoperative TINF is an easy, quick, sensitive, safe, and accurate tool in localization of the site of the CSF fistulas and can be considered as a viable noninvasive alternative to the intrathecal fluorescein technique for preoperative diagnosis of CSF rhinorrhea.
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Predictors of pleural decompression in blunt traumatic occult hemothorax: A retrospective study p. 150
Pawit Sriprasit, Osaree Akaraborworn, Nantaka Kiranantawat, Jitpreedee Sungsiri, Chanon Kongkamol
DOI:10.4103/atr.atr_52_18  
Background: The increased use of computed tomography (CT) results in higher occult hemothorax detection in blunt chest trauma. The indication for pleural decompression is not well defined. This research aims to study the overall factors determining pleural decompression. Methods: All blunt chest injury patients were retrospectively reviewed from the institutional trauma registry. Patients who underwent chest or whole-abdomen CT within 24 h were reviewed by a radiologist to identify initial occult hemothorax defined as a negative chest X-ray with the presence of hemothorax in the CT. The data included demographic data, mechanism of injury, complications, treatments, and characteristics of the hemothorax from the CT. Results: Six hundred and eighty-six blunt chest injury patients were reviewed over a period of 30 months. Eighty-one (24.9%) patients had occult hemothorax. The mean time from injury to CT was 5.7 h. Most patients (87.6%) were male. Most patients (70.2%) suffered from traffic collisions and 84.4% had rib fractures. Pleural decompression was performed in 25 patients who had significantly thicker hemothorax (1.1 cm vs. 0.8 cm,P < 0.01), higher rate of occult pneumothorax (88% vs. 53.8%,P < 0.01), and lung contusion (44% vs. 15%,P < 0.05) than those who did not undergo decompression. Multivariable logistic regression showed that a thickness of hemothorax >1.1 cm was associated with increased risk of pleural decompression (odds ratio [OR]: 5.51, 95% confidence interval [CI]: 1.42–21.42) and occult pneumothorax (OR: 6.93, 95% CI: 1.56–30.77). Conclusions: Drainage of occult hemothorax after blunt chest trauma was significantly associated with concomitant occult pneumothorax, lung contusion, and hemothorax thicker than 1.1 cm.
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Quality of care before, during, and after casting: A cross-sectional study p. 155
Mohsen Adib-Hajbaghery, Razieh Mokhtari
DOI:10.4103/atr.atr_99_18  
Background: Casting is the most common treatment for managing limb fractures. Casts that are not properly provided or are not correctly cared for may hinder the healing of fractures. However, no study assessed the quality of care before, during, and after casting. Objectives: This study aimed to investigate the quality of nursing care before, during, and after casting. Methods: A cross-sectional study was conducted on 188 patients with limb fractures referred to Shahid Beheshti Hospital in Kashan, Iran, from July to November 2018. The data collection instrument consisted of 57 items on the quality of care before, during, and after casting. Descriptive statistics and Fisher's exact test were used to analyze the data. Results: A total of 188 patients were assessed, 94 cases regarding the quality of care before and during casting and 94 additional cases for the quality of care after casting. The quality of care before, during, and after casting was at a moderate level in 83%, 58.5%, and 63.8% of patients, respectively. A significant connection was found between the quality of care before casting and the type of damage (P = 0.002). Significant connections were also found between the quality of care after casting and the nurses' work shift (P = 0.05) and gender (P = 0.05). Conclusion: The quality of care before, during, and after casting was mostly at a moderate level. Educational interventions are needed for nurses to improve the quality of cast care.
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Occupational trauma in industrial and mining accidents in Iran during 2016–2017 p. 161
Rasoul Yarahmadi, Hakime Zamani-Badi, Poorya Fazeli, Masoud Motalebi Kashani, Ali Asghar Khajevandi
DOI:10.4103/atr.atr_8_19  
Background and Objectives: Occupational diseases and accidents have been known as one of the leading causes of mortality in the world and are considered as one of the most important health, social, and economic risk factors in industrialized and developing societies. The present study aimed at investigating traumatic occupational accidents in Iranian mining and industrial sectors during 2016–2017. Methodology: This was a descriptive study conducted on the basis of registered data analysis from industrial and mining sector events in Iran by the relevant executive agency during a 1-year period. The collected data were analyzed using SPSS and Microsoft Excel software. Results: Investigating the records of accidents in the given year suggested a total of 441 accidents including 379 industrial (85.9%) and 62 mining accidents (14.1%) in Iran. In this study, the number of lost work-days was 1,585,383. Direct and indirect costs due to accidents were 638,746,428.56 (US $). The most common type of incidents included fire, falling, and caught in or between objects, respectively. Conclusion: Human being plays a significant role in production cycle, and the deaths associated with work-related accidents, in addition to the loss of hardware investment, may result in a loss of life, lost years of employment, and related costs. Improving employer and employees' perception of management safety practices can be important to prevent the development of job injuries and to promote workers' safety and well-being.
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CASE REPORTS Top

A rare and fatal complication of ear syringing: Rupture of pseudoaneurysm at petrous internal carotid artery p. 166
Santosh Kumar Swain, Satya Sundar Gajendra Mohapatra
DOI:10.4103/atr.atr_28_18  
Ear syringing is a common procedure done for cleaning wax from the ear canal. Rupture of the pseudoaneurysm at the petrous part of the internal carotid artery (ICA) due to ear syringing is an extremely rare incidence in clinical practice. Sudden and profuse bleeding from the ear is the clinical presentation in case of ruptured pseudoaneurysm of ICA at the petrous part. Presence of the cholesteatoma at the middle ear cleft may be an etiology causing rupture of the pseudoaneurysm at the petrous part of the ICA, but the forceful ear syringing is an uncommon cause for the rupture of pseudoaneurysm. Radiological imaging is an important tool for the diagnosis. Endovascular technique is often used for the treatment of pseudoaneurysm of the ICA. Here, we are reporting an uncommon complication of forceful ear syringing making rupture of the pseudoaneurysm of petrous ICA leading to fatal spontaneous and profuse bleeding from the ear.
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Interdisciplinary sequential management of combination traumatic dental injuries p. 169
Prabhat Kumar Chaudhari, Nitesh Tewari, Sandhya Maheshwari, Syed Sayeed Ahmed, Sanjeev Kumar Verma, Mohammed Tariq
DOI:10.4103/atr.atr_96_18  
Combination dental trauma or combination traumatic dental injuries (C-TDIs) are often seen with unique presentations. Although most guidelines address the evidence-based management of such injuries in detail, a sequential protocol and classifications for C-TDI are lacking. In these scenarios, clinical details with imaging tools play an essential role by helping the clinician apply the elements of the TDI protocol in the correct sequence. However, most cases of C-TDI are attended by a general dentist, who often finds it difficult to make such clinical decisions, adversely affecting the prognosis. This article reports a case of a 14-year-old male patient with avulsion of 12, intrusion of 11, 21, and 13, and uncomplicated crown fracture of 11, 21, and 14, with a sequential interdisciplinary approach for the management and long-term follow-up of 10 years.
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