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   Table of Contents - Current issue
Coverpage
April-June 2018
Volume 7 | Issue 2
Page Nos. 37-86

Online since Sunday, November 18, 2018

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EDITORIAL  

The economic burden of road traffic accidents in Iran: The time to sound the alarm p. 37
Mehrdad Mahdian
DOI:10.4103/atr.atr_77_18  
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ORIGINAL ARTICLES Top

Comparison of risk factors for pedestrian fatality in urban and suburban traffic accidents p. 39
Jalil Hasani, Ali Khorshidi, Saeed Erfanpoor, Bashir Nazparvar, Seyed Saeed Hashemi Nazari
DOI:10.4103/atr.atr_7_18  
Background: The burden of traffic accidents on pedestrians is very high in Iran. Since the pattern of injury is different in urban and suburban accidents, this study was conducted to identify the risk factors associated with pedestrian mortality in urban and suburban traffic accidents in Tehran and Alborz Provinces. Materials and Methods: The data of all traffic accidents related to pedestrians in Tehran and Alborz Provinces were investigated from two databases of traffic police and forensic medicine. The effects of demographic variables (age and gender) and pedestrian position, time, accident location, and vehicle type on the outcome of pedestrian death were investigated. Multiple logistic regression was used to analyze the data. The significance level was considered <0.05 and statistical analyses were performed using STATA version 12. Results: From a total of 10742 pedestrians, 6804 males (63.3%) and 3938 females (36.7%) were studied in traffic accidents. In urban accidents, the effects of pedestrian age such as 35–64 years and >65 years compared to 15–24 years (odds ratio [OR]: 2.04, confidence interval [CI]: 1.26–3.3), (OR: 4.8, CI: 2.9–7.9), male gender (OR: 2.26, CI: 1.6–3.1), lighting condition at night compared to day (OR: 1.6, CI: 1.2–2.1), two-way not divided road versus one-way road (OR: 1.6, CI: 1.12–2.3), the status of day after holidays compared to normal days (OR: 1.53, CI: 1.09–2.14), type of vehicle such as heavy or semi-heavy and conventional or pickup versus motorcycles or bicycles (OR: 5.4, CI: 3.1–8.9) and (OR: 1.8, CI: 1.2–2.7) and pedestrian position at crossing the road from an unauthorized route compared to crossing the road from the authorized route (OR: 1.94, CI: 1.4–2.6) were significant on the fatality. Whereas in suburban accidents, there was a statistically significant correlation with pedestrian fatality only in two-way divided road compared to one-way (OR: 0.2, CI: 0.05–0.77). Conclusion: The present study showed that risk factors for pedestrian mortality are different in urban and suburban traffic accidents. It is necessary to take appropriate measures in urban and suburban areas to reduce the severity of injuries in pedestrians.
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A comparison of difficulties in emotional regulations of patients with mild traumatic brain injury and normal controls p. 45
Elham Shafiei, Esmaeil Fakharian, Arash Nademi, Abdollah Omidi, Ali Sharifi, Hossein Akbari
DOI:10.4103/atr.atr_7_17  
Background: Many individuals with traumatic brain injury experience difficulties with social behavior, some of which are attributed to difficulties in regulation of emotions. Objectives: The aim of this study was to compare the difficulties in emotional regulations of patients with mild traumatic brain injury (MTBI) and normal controls. Patients and Methods: In this cohort study, 72 patients with MTBI and 72 normal controls with similar gender were selected. Difficulties in Emotion Regulation Scale (DERS) and Positive and Negative Affect Schedule (PANAS) questionnaires were completed for both the study groups at the beginning of the study and 6 months later. The data were analyzed using multiple linear regression, Chi-square, and paired t-test. Results: The results showed that there was a significant difference between MTBI patients and normal controls in all subscales 6 months after MTBI, and in the total score of DERS, except for the nonaccepted scale and PANAS (P = 0.001), in which no significant difference was observed. In addition, the results of multivariate regression showed that trauma (β = 0.493), age (β = −0.196), familial history of mental disorders (β = −0.185), and financial status could predict emotional regulation (β = 0.148). Conclusions: It seems that mild traumatic brain injuries may be the cause of problems in social behaviors.
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Fear of falling and related factors in older adults in the city of Kashan in 2017 p. 50
Mohsen Taghadosi, Elhamsadat Motaharian, Hamidreza Gilasi
DOI:10.4103/atr.atr_27_18  
Background: Fear of falling has been reported in various societies for different reasons and affects the quality of life of older adults. The present study was conducted to determine the level of fear of falling and related factors in older adults in the city of Kashan in 2017. Materials and Methods: In this cross-sectional study, 414 older adults living in the city of Kashan, in 2017, were selected by cluster sampling. Data were collected using a demographic questionnaire (including age, gender, number of children, having a caregiver, education, marital status, occupation, smoking, alcohol use, use of anxiolytic medication, history of diseases, ability to carry out daily tasks, history of fall, injury due to fall, osteoporosis, access to medical care, access to social supports, walking aids, living alone, income, housing, insurance, and insomnia), and Falls Efficacy Scale-International (FES-I), and then were analyzed using Chi-square and logistic regression. Results: Fear of falling was low in 63.3% of the older adults, moderate in 22.7%, and intense in 4.3%. Fear of falling showed a significant relationship with age, having a caregiver, education, history of taking anxiolytic and hypnotic medications, history of psychosomatic diseases, ability to perform daily tasks, history of falling, injury caused by falling, use of walking aids, access to social support in case of emergency, and income. Multivariate analysis showed that fear of falling in older adults had a direct relationship with age of over 70 years (odds ratio [OR] = 3.24), history of use of anxiolytic and hypnotic medications (OR = 0.26), and illiteracy (OR = 0.37). Conclusion: The results showed that a high percentage of participants suffered fear of falling, of whom one-third had moderate-to-severe fear. Age, use of anxiolytic medications, and illiteracy were effective in increasing the risk of fear of falling in older adults. Further studies and appropriate measures are required in this regard.
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The effect of angiotensin receptor type 2 inhibition and estrogen on experimental traumatic brain injury p. 56
Mojdeh Hajmohammadi, Mohammad Khaksari, Gholamreza Sepehri
DOI:10.4103/atr.atr_51_17  
Background: Estrogen interferes with renin-angiotensin system (RAS). Increasing evidence suggests that estrogen interferes with the RAS such as decreasing angiotensin receptor in the brain. Objectives: This study aimed at investigating the mutual interaction between estrogen and candesartan (an angiotensin receptor blocker) to inhibit or amplify each other's neuroprotective effects after traumatic brain injury (TBI). Materials and Methods: Female rats were divided into 11 groups and the ovaries were removed in nine groups. Study groups included sham, TBI, oil, vehicle (Veh), a low dose (LC) and a high dose (HC) of candesartan, estrogen (E2), Veh + Veh, and a combination of estrogen with a low dose (E2 + LC) and a high dose (E2 + HC) of candesartan. TBI was induced by the Marmarou's method. Brain edema and integrity of blood–brain barrier (BBB) were assayed by calculating brain water content (BWC) and Evans blue content, respectively. The neurological outcome was evaluated using the veterinary coma scale (VCS). Results: The results showed that the BWC in the E2 group was less than that of the oil group (P < 0.01) and in the HC group was also less than that of the Veh group (P < 0.05). Posttraumatic Evans blue content in the TBI, oil, and Veh groups was higher than that in the E2 (P < 0.001) and HC (P < 0.001) groups. Although there was no significant difference in the above indicators between the LC and Veh groups, both the BWC and Evans blue content in the E2 + LC group were lower compared to the oil + Veh group (P < 0.001). In addition, the VCS increased in the E2, HC, and combined groups after TBI (P < 0.01). Conclusion: Prescribing estrogen alone and a high dose of candesartan and a low dose of candesartan with estrogen has a neuroprotective effect on brain edema, permeability of BBB, and neurological scores. This may suggest that estrogen and candesartan (especially in a low dose) act via similar paths.
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Patterns of mandibular fractures related to interaction with horses p. 64
Rebecca Stier, Maria Rüter, Rüdiger Zimmerer, Nils-Claudius Gellrich, Frank Tavassol
DOI:10.4103/atr.atr_11_18  
Background: The risks of facial injuries with horse-related activities are much higher than in other sports. There are just a few studies about horse-related maxillofacial injuries, and there are even less data in particular about mandibular fractures. However, the aim of this study was to determine the patterns for mandibular fractures caused by horse contact or horseback riding. Materials and Methods: Data from patient records were collected over 15 years from January 2000 to March 2015. All patients who suffer a mandibular fracture caused by horse contact or horseback riding were included in this study. The analysis contained demographical data, trauma mechanism, type of mandible fracture, and type of protective clothing. Results: Overall, 23 patients within 37 fractures were included in the study. Of those, 87% were females and 13% males. More than the half (52.2%) were aged between 16 and 30 years. The most common trauma mechanism was a horse kick (78.3%). The most common site of fractures was the parasymphysis (32.4%) and the condylar region (32.4%), followed by the angle (21.7%). In addition, 52.2% of the patients had a single and 47.8% a combined fracture of the mandible. Nearly all patients (95.7%) underwent surgery. Open reduction and internal fixation was the treatment of choice. Only 17.4% of the patients wore a helmet. Conclusion: Mandibular fractures are not the leading trauma in horse relating accidents; however, they are often associated with functional loss. The most frequent cause is a kick from the horse while unmounted. Hence, there is a need for protective equipment usage at all times around horses especially wearing a helmet with a face guard.
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Road traffic accidents in Yazd province, Iran: A longitudinal study (2012–2016) p. 68
Mohammad Hasan Lotfi, Mohammad Montazer, Hossein Lashkardoost, Farimah Shamsi, Maryam Askari, Elham Hamedi, Andishe Hamedi
DOI:10.4103/atr.atr_9_18  
Background and Objectives: The victims of road traffic accidents (RTAs) are mainly young. Hence, reduction of mortality from RTAs should be considered as one of the most important priorities for health-care systems. This study aimed at assessing the mortality rate of RTAs in Yazd Province during 2012–2016. Subjects and Methods: In this descriptive-analytic study, data were obtained from data collection forms of forensic medicine organizations in Yazd. The general equation estimation method was used to compare the number of accidents by distinguishing independent variables. To investigate the trend, a decomposition method was used to analyze a time series with a trend and a seasonal pattern in the Minitab software. Results: In this study, 1437 people who died due to RTAs during 2012–2016 were studied. The number of deaths in men was 1076 (75%), almost three times of women. The risk of death from RTAs in married couples, the main road, heavy car driving and driving out-of-town were 1.6, 3.6, 1.9, and 3.2, respectively. An indirect and significant linear relationship was found between the number of accidents and time during 2012–2016. Conclusion: According to the results of this study, the most cases of events are in the age group of 20–30 years. Therefore, prevention should be done for this age group. Furthermore, findings of this study show that decreasing in fatal RTA can be attributed to the exacerbation of traffic regulations and its implementation.
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Mining relationships among knowledge, attitude, and practice of drivers using self-organizing map and decision tree: The case of Bandar Abbas city taxi drivers p. 73
Esmaeil Hadavandi, Leila Omidi, Abdolhamid Tajvar, Ali Ghanbari
DOI:10.4103/atr.atr_30_18  
Background and Objectives: Traffic accidents are the leading causes of fatal or nonfatal work-related injuries in many countries. Analyzing influencing factors on knowledge, attitude, and practice of drivers is a topic of interest for policymakers to decrease traffic accident injury victims. Materials and Methods: In this article, a two-stage data mining approach was presented for determining the mining relationships among knowledge, attitude, and practice of drivers. In the first stage, because of existing multidimensional practice variables, self-organizing map neural network was utilized to automatically arrange drivers into two safe and unsafe driving practice clusters. In the second stage, a decision tree was used to model relationships among knowledge and attitude of drivers and practice clusters. The authors' designed questionnaires were used to collect data in 235 male taxi drivers of Bandar Abbas city in Iran regarding the drivers' knowledge and attitude toward traffic regulations. The driving practices were assessed using a prepared checklist. Results: The most important attribute affecting practice of drivers was the maximum safe speed in the city. Conclusions: The results of this investigation showed that drivers' knowledge toward traffic regulations had a dramatic impact on safe driving practices. Levels of drivers' education can influence practice of drivers.
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CASE REPORTS Top

Traumatic arteriovenous malformation of scalp: A case report p. 80
Esmaeil Fakharian, Afsaneh Gholipour Baboly, Payam Yazdipur
DOI:10.4103/atr.atr_78_18  
Scalp arteriovenous malformation (SAVM) as a rare lesion may be a complication of head injury. A case and its management are presented in this article and literature is reviewed. A 27-year-old man came to us with a slowly growing pulsatile mass in his right retroauricular and parietal region of the scalp. On examination, there was a compressible mass with loud bruit. Paraclinical studies revealed a large, tortuous tuft of vessels with two different feeders. Intracranial vessels were 3 normal. The lesion excised totally by direct surgical intervention after ligation of its feeders. The patient recovered and discharged without any abnormal findings. Increased number of reports of SAVM in the past decade may be due to improved diagnostic facilities; however, the high incidence of trauma and even its increasing pattern in developing countries may be another important factor.
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Thoracoscopic removal of K-wire penetrating lung and mediastinum p. 85
Roman Dutta, Harish Pal, Love Milankumar Patel, Tarun Kumar Singh
DOI:10.4103/atr.atr_33_18  
Kirschner wire (K-wire) migration into thoracic cavity and organs are uncommon but can have fatal complications. A 60-year-old gentleman had repair of dislocated left acromioclavicular joint with K-wire, which migrated, from the joint into left lung and mediastinum. He was successfully treated by thoracoscopic retrieval of migrated K-wire.
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