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   Table of Contents - Current issue
Coverpage
July-September 2019
Volume 8 | Issue 3
Page Nos. 119-181

Online since Tuesday, November 26, 2019

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REVIEW ARTICLE  

A system approach on safe emergency evacuation in Subways: A systematic literature review p. 119
Fatemeh Nouri, Davoud Khorasani-Zavareh, Amir Kavousi, Reza Mohammadi
DOI:10.4103/atr.atr_40_19  
Background: Due to the extensive use of subway transportation in high- and middle-income countries, the safety of passengers has become one of the important challenges in emergency management of subway station. Therefore, the present systematic review aimed to identify environmental and organizational management factors that affect the safe emergency evacuation in subway stations. Materials and Methods: In this systematic literature review, PubMed, Scopus, Web of Science, ProQuest, Google Scholar, Iran Medex, Magiran, and Scientific Information Database from 1990 to 2019 were searched to identify effective emergency management factors in safe emergency evacuation of the subways. A thematic content analysis was employed for data analysis. Results: Of 763 publications retrieved from the searches, 149 studies were included for data analysis. According to the findings, effective environmental and organizational management factors in safe emergency evacuation were discussed in eight subcategories, including infrastructure properties, evacuation-assisting resources, prevention of injuries and mitigation, preparedness for emergency evacuation, emergency response and reconstruction, and maintenance of evacuation facilities. Conclusion: The design of an optimal route for emergency evacuation is the main theme of most studies focusing on environmental factors. While a system approach for designer is needed for effective subway emergency evacuation, human-related factors focusing on injury prevention are also crucial.
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ORIGINAL ARTICLES Top

Etiology and outcome of burns in Hamadan, Iran: A registry-based study p. 144
Salman Khazaei, Fatemeh Shirani, Maryam Afshari, Ensiyeh Jenabi, Zahra Hamzei, Mohammad Torabi, Tayebeh Bathaei
DOI:10.4103/atr.atr_47_19  
Background: Burn prevention strategies are most effective when they are based on knowledge of etiological patterns of burn injuries and considering the geographical variations and socioeconomic differences in burn epidemiology. In this regard, this study aimed to investigate the etiology and outcome of burns in Hamadan, Iran. Materials and Methods: This registry-based, cross-sectional study was conducted on 798 burn patients admitted to the Besat Hospital from March 2013 to February 2018. The medical records of all the patients were extracted from hospital information system. Results: In males, the most common cause of burn was gas explosion (41.4%), whereas in females, the most common cause was hot liquids (37.1%). In below 5 years and 6–15 years age group, burning with hot liquids was the common cause of burn, whereas in other age groups, gas explosion was the common cause of burn. In the present study, 6.9% of the patients died because of their burns. With increasing age, the odds of death increases, so that patients between 30 and 59 years had 2.2 fold (P = 0.02) and patients ≥60 years had 3.5 fold (P = 0.006) higher odds of death compared to patients aged <30 years. Conclusion: Findings of the present study show that males and people aged 26–40 years and children 0–5 years were at a greater risk of burns. Furthermore, this study shows that self-immolation with a high rate of case fatality should be considered as a mental health challenge, and it is necessary to design preventive strategies to reduce it.
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Histological Survey of the Effect of Granulocyte-colony-stimulating Factor(G-CSF) on Bacterial Translocation and Wound Healing in Burned Mice p. 149
Somayeh Soleymanzadeh Moghadam, Zeinab Fagheei Aghmiyuni, Nazanin Mohammad, Ali Anissian, Maryam Azimi, Ali Majidpour, Farinaz Nasirinezhad, Maryam Roham
DOI:10.4103/atr.atr_20_19  
Background: Burn wound is an important cause of morbidity and mortality worldwide. Improving the host's immune system and removing the infection can be effective in healing wounds caused by burns. Granulocyte-colony-stimulating factor (G-CSF) stimulates both the bone marrow to produce granulocytes and the function of neutrophil precursors. The aim of this study was to examine the effect of G-CSF on removing infection and healing wound. Materials and Methods: A burn model was used to induce burns in 18 adult Balb/c mice, and their wounds were infected by Acinetobacter baumannii strains. Burned mice were divided into two groups (control and G-CSF) and treated daily by subcutaneous injections of normal saline (0.1 mL) and G-CSF (10 μg/kg). The wound healing process was evaluated by the morphological and histological assessments. Results: In morphological assay, the mean size of the wounds in the 3rd and 7th days of the treatment was significantly lower in the G-CSF treated group compared to the control group. Some of the histological parameters were evaluated, including the level of inflammation, re-epithelialization, angiogenesis, collagen deposition, the amount of granulation tissue, and fibroblast maturation. The results showed that inflammation was reduced in the G-CSF-treated group, and re-epithelialization and collagen deposition were increased insignificantly compared to the normal saline-treated group. Furthermore, bacterial translocation was reduced significantly in the G-CSF-treated group. Conclusion: G-CSF enhances wound closure and helps in wound healing by improving the immune system. It has also an anti-inflammatory role and reduces bacterial translocation.
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Pattern of meniscal tear in patients with anterior cruciate ligament injury at a rural tertiary care center of Central India: A prospective study p. 155
Chandrashekhar Martand Badole, Rohan Raosaheb Patil, Prashant Parate, Sanjay Marwah, Ankit Waghela
DOI:10.4103/atr.atr_80_18  
Background: Various studies have reported the incidence of meniscal injuries in anterior cruciate ligament (ACL)-deficient knee. It is responsible for the development and progression of knee osteoarthritis (OA) in patients with ACL injury and concomitant meniscal tear. Objective: The objective of this study is to find out an occurrence of meniscal tear and its pattern in patients with ACL injury. Materials and Methods: We studied 124 patients diagnosed with ACL injury by arthroscopy at a rural tertiary care center of Central India region. The study was conducted from July 2016 to June 2018. Standard protocol was used to collect information for sociodemographic characteristics. Condition of the injury was assessed at the time of arthroscopic procedure and noted. Data were collected and analyzed by Epi Info software. Results: We diagnosed 124 patients with ACL injury, out of which 106 (85.5%) were male and 18 were female (14.5%). The mean age of the patients was found to be 28.7 years (±10.7), with a range of 14–59 years. The present study observed the incidence of medial meniscus tear in 30 (24.2%) and lateral meniscal tear in 18 (14.5%) study participants. Conclusion: The present study showed a substantial number of cases with meniscal damage. Hence, it is imperative to screen patients with ACL tear clinically and radiologically and even during arthroscopic procedure so that chances of OA association can be minimized by early intervention.
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Productivity and years of life lost due to fatal traffic injuries in Shiraz Shahid Rajaei Hospital during 2009–2013 p. 160
Mojtaba Sepandi, Yousef Alimohamadi, Fatima Muhammad Mahmud, Meysam Enaami
DOI:10.4103/atr.atr_43_19  
Background: Road traffic injuries (RTIs) are an important public health concern, and one of the main causes of death leading to loss of productive and effectual years of life. This study aimed to determine the economic burden of fatal crashes for about 5 years in Shahid Rajaei Hospital in Shiraz. Methods: In this cross-sectional study, cost and demographic data related to the people who died in the hospital due to RTIs, during 2009–2013, were obtained from medical records. Economic burden of traffic accidents that led to death was estimated using human capital as direct costs of treatment and potential years of life lost (PYLL) and lost productivity as indirect costs. Results: During 2009–2013, 989 individuals died from traffic accidents in Shiraz, imposing 1.58 million US dollars to hospital costs, 41,298 PYLL, and 67 million US dollars productivity lost. In this study, the mean age of the dead people was 43.3 ± 22.24, and the productivity lost per capita was 67,000 $US. Conclusions: The economic burdens of traumatic brain injuries were high in fatal accidents in Fars Province equivalent to 0.0003% of Iran's gross domestic product in 2013. Thus, special attention should be directed toward prevention measures for fatal traffic accidents.
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The prevalence of anxiety, stress, and depression with respect to coping strategies in caregivers of patients with head injuries p. 165
Maryam Keramati, Hossein Ebrahimi, Mohammad Hasan Basirinezhad, Morteza Shamsizadeh, Reza Mohammadpourhodki
DOI:10.4103/atr.atr_35_19  
Context: Psychological problems are very common in traumatic patients' caregivers necessitating usage of appropriate coping strategies to promote their mental health. Aim: The aim of this study was to assess anxiety, stress, and depression as well as coping strategies in caregivers of patients with head injuries. Settings and Design: In this cross-sectional study, 127 caregivers of traumatic patients referred to educational hospitals of Zabol city were selected by convenience sampling method. Subjects and Methods: The data were collected using a demographic questionnaire, as well as Depression, Anxiety and Stress Scale-21 and the Jalowiec coping strategies tools. The data were analyzed using descriptive statistics, one-way ANOVA, independent samples Student's t-test, and multivariate regression model. Results: Our findings showed that more than 70% of the caregivers of patients with head injuries suffered from severe and very severe stress and anxiety. The multivariate regression model demonstrated a negative and significant relationship between either stress (B = −0.81 P = 0.001) or depression (B = −1.23 P = 0.000) and problem-based coping strategies. Furthermore, stress (B = 0.64 P = 0.006) and anxiety (B = 0.74 P = 0.002) were negatively associated with emotional-based coping strategies. Conclusion: Considering the high rates of anxiety, stress, and depression in caregivers of patients with head injuries and significant associations observed between these variables and problem-based strategies, it is necessary to identify and obviate factors leading to anxiety and to educate coping strategies to these individuals.
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Development and psychometric evaluation of data collection tools for Iranian integrated road traffic injury registry: Registrar-station data collection tool p. 170
Soudabeh Marin, Faramarz Pourasghar, Alireza Moghisi, Bahram Samadirad, Mashyaneh Haddadi, Davoud Khorasani-Zavareh, Homayoun Sadeghi-Bazargani
DOI:10.4103/atr.atr_40_18  
Background: Comprehensive and accurate data are fundamentally needed for effective management of road traffic injuries (RTIs). Existing sources of RTI reports have a huge underestimation and inaccuracy at some levels. The aim of this study was to develop and validate the registrar-station data collection tool as a part of the Iranian Integrated Road Traffic Injury Registry (IRTIR). Materials and Methods: This study was conducted in Tabriz University of Medical Sciences in 2018. A data collection tool was developed to be used by the registrar for inpatient section of IRTIR by information retrieved from the literature review and road traffic experts' need assessment. The content validity of the preliminary tool was assessed. The feasibility of the tool was tested in two regional referral injury hospitals. Intra- and inter-rater reliability of the tool was evaluated using the individual/absolute intra-class correlation coefficient (ICC) and Kappa. Validity was revisited after 1 year of the pilot study. Results: The registrar-station data collection tool of IRTIR included 53 items, in five categories. Content validity was approved (modified content validity index was 0.8–1 and content validity ratio was one for all items). ICC was >0.6 for all items, and kappa index ranged between 0.69 and 0.92. The nurse data collection tool of IRTIR was applicable in the pilot phase. Conclusions: The Registrar-Station data collection tool of IRTIR was confirmed as a valid and reliable tool for inpatient traffic injuries as a part of the Iranian IRTIR.
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Patterns of road traffic fatalities in the six most populous provinces of Iran, 2011–2015 p. 177
Mohammad Mehdi Besharati, Moslem Azizi Bondarabadi, Masood Memariyan, Ali Tavakoli Kashani
DOI:10.4103/atr.atr_91_18  
Background: The aim of this study was to compare the traffic safety condition as well as monthly pattern of fatalities in the six most populated provinces in Iran. Materials and Methods: This was a descriptive study. The data pertaining to fatalities and injuries during 2011–2015 were obtained from Iran Legal Medicine Organization. Results: Fatalities per 100,000 population in Kerman and Fars were significantly higher than the other four provinces, and Tehran had the lowest fatality rate per 100,000 population. To control for exposure, the number of fatalities per 100 injuries was calculated as an indicator of crash severity in the six provinces. The crashes were found to be more severe in Kerman (7.72 fatalities per 100 injuries) and Fars (5.97 fatalities per 100 injuries) compared to the other four provinces. Moreover, monthly pattern of fatalities was found to be significantly different among the six provinces. Conclusion: Results revealed several differences in the fatality patterns with the Kerman and Fars provinces having the most critical situation in the road safety among the six provinces. This could be due to the differences among these provinces in (1) quality and quantity of emergency and medical services, (2) road safety status, or (3) the share of vulnerable road user fatalities. Finally, our results suggest that to improve the efficiency and effectiveness of policies and countermeasure regarding traffic safety, policy-makers should consider the differences in the safety status and fatality patterns at provincial level.
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