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   Table of Contents - Current issue
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July-September 2020
Volume 9 | Issue 3
Page Nos. 99-148

Online since Saturday, August 22, 2020

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ORIGINAL ARTICLES  

Social and medical determinants of burn-related mortality in Isfahan, Iran p. 99
Mohammad Javad Mohammadzade, Mostafa Amini Rarani, Mahmoud Keyvanara
DOI:10.4103/atr.atr_97_18  
Background: Burns and heat-related injuries often lead to mortality and great financial and social costs. This study aimed at investigating the social determinants of burn-related mortalities in a burn specialized hospital in Isfahan, Iran. Materials and Methods: This cross-sectional data secondary analysis study was conducted through the data related to burn patients hospitalized to burn specialized Imam Musa Kazim hospital, Isfahan, Iran, in a 4-year period. The data were extracted using Hospital's Information System, and analyzed descriptively and inferentially. Results: Among 3290 burn patients, 740 (22.49%) had passed away. The highest mortality percentage was observed in women (31.1%), aged higher than 60 years old (35.8%), in patients with low-financial status (27.4%), patients come from cities other than Isfahan (25.4%), and in Total Burn Surface Area (TBSA) of higher than 71% (86.6%). The results of logistic regression test showed that burn-related mortality is 50% lower in men compared to women (odds ratio [OR] = 0.50), 16% lower in 41-60 years of age group compared to over 60 years of age group (OR = 0.16), 41% higher in people with low financial status compared to those with high financial status (OR = 1.41) and 4% lower in people with 31–70 TBSA compared to those with TBCA higher than 71% (OR = 0.04). Conclusion: Burn-related mortality could be associated with treatment and health care as well as social factors. Therefore, parallel to hospital care and physical conditions of the burn patients, social factors including gender, age, income level, and place residence need to be addressed in burn policies to reduce burn-related mortalities.
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Hospitalization due to traffic accidents among the elderly, Shiraz, 2018; mortality, severity, and injury pattern p. 106
Mahnaz Yadollahi, Forough Pazhuheian, Kazem Jamali, Mohammad Hadi Niakan
DOI:10.4103/atr.atr_105_19  
Background: Aging results in declined function, which leads to loss of capacity and respond to injury. Hence, the duration of treatment after traffic accident increases in these patients. The present study aimed to identify the factors affecting the elderly hospitalization. Study Design: This was a cross-sectional study. Materials and Methods: This cross-sectional study was conducted on 768 trauma patients aged 65 years and more due to traffic injuries, referred to Rajaee (Emtiaz) hospital trauma referral center, Shiraz, Iran, in 2018. Data were collected through the hospital's health information system, as well as readings and encoding patient's clinical records. Poisson regression was performed to evaluate the partial effects of each covariate on geriatric trauma patients. Results: The mean age of injured patients was 73.27 ± 6.88 years, of which 7.29% expired. Extremities and externals (58.20%) and head and neck (18.36%) were the most commonly injured regions of the body. Each year after 65 led to 0.03 times increase in the length of hospitalization. The male's hospital stay was 1.15 times more than females. Conclusion: According to the results, length of hospitalization had a direct correlation with aging among elderly trauma patients. Since the elderly population is on the rise, it is necessary for the policymakers to come up with preventive measures to reduce the number of accidents and casualties.
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Trend of mortality rate due to drowning in Iran (2013–2018) p. 111
Fatemeh Shahbazi, Seyed Davood Mirtorabi, Seyed Amir Hosein Mahdavi, Seyed Saeed Hashemi Nazari
DOI:10.4103/atr.atr_110_19  
Background and Objectives: According to the World Health Organization, drowning is the 3rd leading cause of unintentional injury-related deaths worldwide, accounting for 360,000 annual deaths and 7% of all injury-related deaths. Low- and middle-income countries are the most affected, accounting for 90% of unintentional drowning deaths. This study aimed to calculate the rate of drowning mortality rate and to investigate its trend in Iran. Materials and Methods: Information on death due to drowning in Iran was extracted from Iranian Legal Medicine Organization. The crude mortality rate was calculated each year according to gender and province of the country. To examine the trend for different years, joinpoint regression was used. Results: From 2013 to 2018, a total of 5853 persons suffered from fatal drowning in Iran. The crude mortality rate in men was significantly higher than in women. The drowning mortality rate has decreased during the study period in both genders. The annual percent change in mortality rate was 3.2%. Conclusions: Although the death rate from drowning has declined in the country, targeted scale-up of known effective interventions such as swimmers supervision and basic survival skills are still needed for reducing mortality due to drowning, particularly in provinces with high mortality rates.
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The effect of age on driving performance in Iran using driving simulator p. 116
Iraj Alimohammadi, Nammam Ali Azadi, Zabihollah Damiri, Hossein Ebrahimi, Reza Yeganeh
DOI:10.4103/atr.atr_113_19  
Background and Objectives: Nearly 16,000 people are killed in driving accidents in Iran each year. The purpose of this study was, therefore, to determine the effect of age on driving performance, using a driving simulator. Methods: This cross-sectional study was carried out on 16 young drivers, 16 middle-aged drivers, and 16 elderly drivers in Tehran. Driving simulators were used to check the drivers' performances. The main scenario was driving on a freeway at an average speed of 50 km/h, when pedestrians suddenly appeared at a distance of 40 m and the drivers had to brake immediately after noticing the pedestrian. The time interval between the emergence of the pedestrian and stepping on the brake pedal was continuously recorded as the reaction time and the amount of vehicle deviation from the center of the road as the lateral deviation of the vehicle. The drivers' mental workload was recorded after the simulated driving test, using the verbal online subjective opinion scale. Results: The elderly drivers had the highest mean reaction time, 963.8 ms, and there was no significant difference between the mean reaction time for youth and middle-aged drivers (858.3 ms vs. 860 ms). Elderly drivers showed high lateral deviation, 0.69 m, and mental workload, 6.19, whereas youth drivers had the lowest lateral deviation (0.55 m) and mental workload (3.60). MANOVA revealed a significant effect of age (Pillai's trace, V = 0.55, P < 0.001). Univariate ANOVA showed that age significantly affected the lateral deviation (P < 0.001) and mental workload (P < 0.001), but reaction time wa not age dependent (P = 0.101). Poisson regression revealed no significant effect for age on the number of collisions (P = 0.357). Conclusion: Based on the variables under study, driving performance of the elderly group was poor as compared to that of the middle-aged and young ones. Old drivers were subjected to greater mental workload when responding to the stimulus of the driving environment.
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An epidemiologic study of wednesday eve festival “Charshanbe-Soori” in Iran - 2017 p. 124
Hossein Akbari, Mohammad Hajijafari, Malihe Mohammadzade Sabbaghi, Mehrdad Jazayeri, Fatemeh Sadat Asgarian
DOI:10.4103/atr.atr_1_19  
Background and Purpose: Wednesday Eve Festival “Charshanbe-Soori” is one of the famous Iranian festivals that is held on the last Wednesday of each Solar Hijri year. The ceremony is accompanied by lighting fires and fireworks. The purpose of this study was the epidemiologic investigation of incidents of Wednesday Eve Festival in 2017. Materials and Methods: This ecological study was conducted to evaluate the epidemiological features of the Wednesday Eve Festival in 2017. The research population included all patients referred to all hospitals in Iran on the last Wednesday night of the year. Two-part questionnaire containing demographic information and burns-related factors were used for data collection. To analyze the data, the incidents in different provinces were calculated based on factors such as age, sex, occupation, and education. Results: A total of 3285 incidents related to the Persian Wednesday Eve Festival were reported from March 2 to March 15, 2017,. The injury rate in 2017 was 4.2/100000. The highest incidence rate was found in Qazvin (15.92) and Kurdistan (13.7) cities, and the lowest incidence rate was reported in Kerman (0.13) Sistan and Balochestan and Yazd (0.23)/100,000. Conclusion: Fireworks in Wednesday Eve Festival have become serious trouble, not only because nowadays principles and its traditional aspects are ignored but also it inflicts considerable harm and damage on families and our country by using destructive incendiary equipment. To prevent upcoming incidents, educating the community, especially the youth and teenagers, are necessary.
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Comparative evaluation of behaviors of three naturally occurring products, namely propolis, milk, and egg albumin when used as storage media in extracted teeth for orthodontic purpose p. 129
Poonam Shingare, Vishwas Chaugule
DOI:10.4103/atr.atr_16_20  
Background: The reasonably successful prognosis in retaining avulsed tooth in its respective position depends on the maintenance of the viability of the periodontal ligament (PDL) cells during the replantation procedure. Various synthetic media have been tried for preserving the viability of PDL cells with considerable success. However, easy availability of these media had been a problem at various occasions. Hence, an attempt was made to test the properties of easily available natural products such as Propolis, milk, and egg albumin. Aim: This study was aimed at comparing the behaviors of three naturally available media, namely propolis, milk, and egg albumin when used as the storage media in preserving the viability of traumatized periodontal cells in an avulsed tooth. Materials and Methods: A total of 50 premolars with closed root apices indicated for the extractions for orthodontic treatment were selected. Initially, these teeth in the experimental group were stored dry immediately after the extraction for 30 minutes, and then, immersed in the respective storage media for 45 minutes. The teeth in the positive control group were assessed immediately after the extraction, whereas the negative control teeth were bench dried for 8 hrs. All the five group samples were then incubated with collagenase and phosphate-buffered saline for 30 minutes, centrifuged and labeled with 0.5% trypan blue for the determination of cell viability. The cells were counted under the light microscope. The statistical analysis was carried out by applying the unpaired t-test. Results: No statistically significant difference was observed in viable PDL cell counts when compared among propolis, milk, and egg albumin. Conclusions: Propolis, milk, or egg albumin could be a good naturally available storage media for avulsed teeth.
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Protocol of identification of effective factors in reducing fall among the hospitalized patients: A systematic review p. 135
Sayedeh Somayyeh Mousavipour, Zohre Ghomian, Fatemeh Nouri, Davoud Khorasani-Zavareh
DOI:10.4103/atr.atr_40_20  
Background: The patient's fall is one of the factors threatening the patient's health in hospitals and medical centers. More than 12% of patients fall once during the hospitalization period, which in some cases leads to disability or death. Therefore, falling prevention is one of the essential issues in the hospital and requires interventions. Objectives: The aim of this study was to examine the effective factors in controlling the hurts caused by patient fall. Methods: This study was conducted to present a protocol for identifying the effective factors of patient fall in hospitals. For this purpose, four international databases were investigated and searched, in two phases (databases are Scopus, PubMed, Web of Science, and ScienceDirect, along with Google Scholar). First, we selected and categorized the articles, using PRISMA instruction for systematic review studies. In the second phase, the findings were analyzed using thematic analysis; then, categories and subcategories were extracted. To examine the quality of studies, critical appraisal skills program, Newcastle–Ottawa Scale, and Strengthening the Reporting of Observational Studies in Epidemiology checklists were applied. Systematic Review Registration: PROSPERO CRD42020161328. Ethics and Dissemination: There is no human participation in the study, and after data analysis, the author prepared an article for a specialized journal. Permission to the study was obtained from the ethics committee of the Faculty of Health and Safety, affiliated to Shahid Beheshti University of Medical Sciences.
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The impact of prehospital emergency services on the outcome of trauma patients p. 139
Mahboub Pouraghaei, Samad Shams Vahdati, Payman Moharamzadeh, Laleh Abrishami, Moloud Balafar
DOI:10.4103/atr.atr_75_19  
Background and Objectives: Trauma is one of the most important health problems in the world, and shock index is a good tool for evaluating trauma patients in emergency. The aim of this study was to evaluate the impact of prehospital emergency on the outcome of trauma patients. Methods: In this cross-sectional study, we investigated the records of 359 patients referred to the emergency department; they were selected non-randomly. Demographic information, trauma mechanism, patients' transportation, location and duration of hospitalization and the final outcomes of the patients were evaluated. the predictive power of the shock index in hospitalization and mortality was studied. The data were analyzed by SPSS software using descriptive and analytical statistics. Results: The results of study showed that 73.3% of patients were male and 26.7% were female with a median of 30 years. Car and motorcycle accidents and falling from altitude were the most common mechanisms of trauma and cause of death. Time interval between trauma and emergency shock index and patient status was normal and significant ( P < 0.7). Conclusion: The rate of patients who were transferred by EMS is equal with those transferred by witness. Patients who had normal shock index with delay transfer time had a significantly high mortality rate.
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CASE REPORTS Top

Management of shaft of femur fracture in a patient with underlying arteriovenous malformation with an intramedullary nail p. 143
Deepak Kumar, Praveen Sodavarapu, K Nikhil Raj, Vishnu Baburaj
DOI:10.4103/atr.atr_95_19  
We present a rare case of pathological shaft of femur fracture in an 18-year-old male, with an underlying arteriovenous malformation (AVM). Magnetic resonance imaging showed extensive intraosseous femoral involvement of the vascular malformation, and the canal was deemed to be wide enough for a nail based on the radiograph templates and computed tomography (CT) scan. The patient was given four sessions of stereotactic external beam radiotherapy preoperatively, and closed reduction and internal fixation was performed using a proximal femoral nail without any complications. Radiographic evidence of fracture union was observed at 4 months. Fracture fixation by closed reduction can be either intramedullary fixation or external fixation based on the adequacy of the canal as determined by radiograph and CT scan. Preoperative measures to decrease vascularity such as stereotactic radiotherapy and angiographic embolization can be undertaken to reduce bleeding. A multidisciplinary approach is essential to improve the management of fractures in a patient with AVM.
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A woman with knife In situ of chest p. 147
Sayyed Majid Sadrzadeh, Behrang Rezvani Kakhki, Elnaz Vafadar Moradi, Paria Khosravi
DOI:10.4103/atr.atr_35_20  
The violence can be physical, psychological or sexual. Physical violence can be by the use of sharp objects. Chest stab wounds with retained penetrating objects are rare. Here, we have reported a case with a knife impaled in her upper back who was treated successfully without any complications. A 35-year-old woman presented to our emergency department with an in situ knife at T4–T5 level. Neurologic examination revealed normal and bed side sonography reveals no free fluid in the abdomen, but lung sliding was disrupted on the left hemithorax without evidence of tamponade. A portable chest-x ray showed that the knife passes through an oblique track from right to left. The patient transferred to the operating room and the 50 cm knife removed without traumatic force. Limited thoracotomy with chest tube placement was done. We have reported a case report of an in situ knife at the upper back of a young woman who was successfully treated. The patient was stabbed in the upper back due to her husband's violence and the knife passes through an oblique track from right to left without any vascular injury. We stabilized the patient and used bedside sonography as a modality for diagnosis and decision making.
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