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   Table of Contents - Current issue
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April-June 2021
Volume 10 | Issue 2
Page Nos. 53-108

Online since Monday, June 28, 2021

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REVIEW ARTICLE  

A study of the therapeutic effects of progesterone in patients with traumatic brain injury: A systematic review and meta-analysis p. 53
Rezvan Bazgir, Ali Siahposht-Khachaki, Esmaeil Akbari, Davood Farzin
DOI:10.4103/atr.atr_106_19  
Background and Objectives: Traumatic brain injury (TBI) is one of the main causes of death and disability in affected people. Progesterone, an endogenous steroid hormone, is known to have a function in the central nervous system. The aim of this study was to investigate the therapeutic effects of progesterone in patients with severe TBIs through systematic review and meta-analysis of randomized clinical trials. Methods: This systematic review and meta-analysis was conducted based on the preferred reporting items for systematic reviews and meta-analyses guidelines for systematic reviews. A systematic search was conducted at PubMed, EMBASE, Web of Science, and Scopus. The keywords, including “progesterone,” “progestin,” “traumatic brain damage,” “TBI,” “head injury,” and “stroke” were searched. There was no time or language limit . Inclusion criteria were as follows: (a) study type: randomized controlled trial; (b) participants: patients with acute TBI; (c) intervention: progesterone; and (d) outcomes: favorable outcome based on mortality rate. Exclusion criteria were as follows: (a) study types: case reports, case reviews, retrospective study, and cohort studies and (b) control: positive control. The data were then collected and analyzed using randomized pooled analysis of risk ratio (RR) for mortality. Results: In the study, 721 articles were selected. Finally, 11 studies were analyzed and entered into meta-analysis. All studies are classified as high quality (with a score of more than 7) and therefore no studies were evaluated based on quality assessment. The result of the fixed pooled analysis of RR for mortality was 0.95 with a P value of 0.495. Conclusions: The results of the present study suggest that progesterone does not decrease the mortality rate despite the various data, suggesting the positive effects of progesterone on the treatment of TBIs.
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ORIGINAL ARTICLES Top

Comparative evaluation of revised trauma score and injury severity score as prognosis predictor among polytrauma patients p. 59
Diwakar Verma, Nitesh Kumar, Anshul Jain, Binod Krishna Gouda, Suman Kumawat
DOI:10.4103/atr.atr_54_20  
Background and Objectives: The trauma is a major reason for various disabilities and even death around the world. Prompt actions and appropriate management are needed to minimize the level of injuries and mortality. An effective tool is needed to assess the prognosis of the patient in trauma. The objective of the study was to compare the evaluation of RTS and injury severity score (ISS) as a prognosis predictor among trauma patients. Methodology: A cross-sectional clinical observational study was conducted in the emergency department. A total of 88 samples were selected by random sampling technique. The data collection was done using demographic and clinical tools, Glasgow Coma Scale, Revised Trauma Score (RTS), and ISS. Data analysis was performed using SPSS 18. Results: In the present study, the majority of the participants (79.54%) were male. The most common mode of injury among the patients was road traffic accidents (54.54%) with blunt trauma. The findings revealed a negative correlation (‒0.368) between RTS and ISS scores with significant P = 0.0004. RTS (<10) and ISS (≥20) have significant association with mortality and hospital stay. The sensitivities of ISS and RTS with mortality were 84.2% and 89.4%, respectively. Conclusion: RTS is a comparatively better predictor of prognosis than ISS among trauma patients. Lower RTS and higher ISS are significantly associated with mortality and long hospital stay. Early evaluation of the injury level can be effective in patient management.
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A study of the causes of occupational accidents in manufacturing companies p. 64
Abolfazl Ghahramani, Ahad Amirbahmani
DOI:10.4103/atr.atr_56_20  
Background: Studies have found that several individual and organizational factors influence the occurrence of accidents. Researchers have also highlighted the need for the development of new accident models. The main aim of this study was to assess the contributing causes of occupational accidents using a questionnaire. Methods: A total of 365 managers and employees participated in the current study from 9 manufacturing companies located in the northwest of Iran. A questionnaire comprising 100 accident causes was used to gather the required data for this study. Results: Exploratory factor analysis (EFA) yielded 14 factors contributing to accidents, and confirmatory factor analysis found satisfactory fit indices for the EFA model. The participants reported unsafe acts as the most important factor for the occurrence of accidents. A t-test revealed that participants who received safety training experienced fewer occupational accidents than other respondents. The one-way analysis of variance showed that the companies significantly differed in the perception of accident causes. Structural equation modeling indicated that organizational-managerial factors had a larger effect on individual factors than external factors. Conclusion: The results indicate that providing safety training is necessary to control the employees' unsafe acts. Managers of the companies should pay special attention to the organizational factors affecting the occurrence of accidents. The findings of this study might help the managers to develop more targeted countermeasures for reducing occupational accidents.
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Evaluation of disability glare caused by headlights of most common vehicles in Iran p. 73
Ahmad Mehri, Milad Abbasi, Seyed Abolfazl Zakerian, Reza Yeganeh, Seyed Hojat Mousavi Kordmiri, Farough Mohammadian, Javad Sajedifar
DOI:10.4103/atr.atr_39_20  
Background and Objectives: Road traffic accident is one of the leading causes of death in some countries such as Iran. Disability glare due to headlights of vehicles can increase the risk of crashes and make dangerous conditions. This study aimed to investigate the level of glare induced by the headlights of most common vehicles in Iran. Materials and Methods: This cross-sectional study was conducted in a suburban road of Ilam province in 2019. The disability glare resulted from the headlights of Pride Saba GTX, Pride 131SL, Samand Soren, Peugeot 405, Megan, and Peugeot Pars was measured at the distances of 10–100 m away from the headlights. The Threshold Elevation index under the high-beam and low-beam conditions (headlight's operation modes) was obtained for the background luminance condition including 1 and 50 cd/m2 for the age groups of 20, 35, 70, and 83 years old. Results: When the background luminance was 1 cd/m2, the mean glare level caused by the high-beam mode of illumination exceeded the recommended disability glare thresholds of all age groups. When the background luminance was 50 cd/m2, at certain longitudinal distances, glare level exceeded the disability glare thresholds of the elderly drivers (aged 70 and 83 years). At the background luminance of 1 cd/m2, low-beam mode of illumination caused disability glare at certain distances but not in general. At the background luminance of 50 cd/m2, low-beam mode of illumination did not cause disability glare at any distance. Conclusion: The results showed the mutual effect of luminance and the angle of line of sight with respect to glare source on the emergence of disability glare. The age also exhibited a significant association with the disability glare, as the highest glare levels were obtained for older drivers.
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Accuracy of plain radiography in cervical spine injury p. 80
Farideh Gharekhanloo, Mehrdad Gharekhanloo, Hamid Golmohammadi, Ebrahim Jalili, Azar Pirdehghan
DOI:10.4103/atr.atr_30_20  
Background and Objectives: Routine clinical examination and plain radiography are reportedly inadequate for the determination of cervical injury. Accordingly, it is required to perform computed tomography (CT) scan on the cervical spine in suspected trauma cases, even in those with normal clinical examination findings. However, the risk of radiation and financial charges should be also considered in these cases. Therefore, the present study was conducted to compare the accuracy of plain radiography with that of CT (a gold standard) in the evaluation of cervical spine injury. Materials and Methods: This diagnostic study was conducted on 220 trauma patients (the mean age of 38.25 ± 5.13 years) referred to the Emergency Department of Besat Hospital, Hamadan, Iran, from April 2019 to March 2020. The patients with the National Emergency X-Radiography Utilization Study low-risk criteria underwent CT and plain radiography. Results: According to the results, 210 (95.5%) patients were normal in both imaging modalities. Out of 10 patients with abnormal CT, four patients were detected by the plain radiography. Therefore, the plain radiography had the sensitivity, specificity, negative predictive value, and positive predictive value of 40%, 100%, 97.2%, and 100%, respectively. Conclusions: As the findings indicated, plain radiography was inadequate for the definite exclusion of cervical spine injury. Therefore, this modality should be considered only in low-risk patients. On the other hand, patients with moderate and high probability of injuries need to undergo a CT scan as the only and first screening imaging modality. However, a low-dose CT scan is a preferred protocol for this group of patients.
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Predictive value of the glasgow coma scale, age, and arterial blood pressure and the new trauma score indicators to determine the hospital mortality of multiple trauma patients p. 86
Rahimeh Khajoei, Mohammadreza Zeid Abadi, Tania Dehesh, Nabiollah Heydarpour, Sajad Shokohian, Farzad Rahmani
DOI:10.4103/atr.atr_72_20  
Background: Authoritative trauma scoring systems can quickly assess the damage and show its severity plus prognosis. The purpose of this study was to investigate the predictive value of the new Glasgow Coma Scale, age, and systolic blood pressure (GAP) and the new trauma score (NTS) indicators to determine the mortality of trauma patients in hospitals in Sirjan in 2019. Materials and Methods: In a descriptive-analytical study, 2570 patients with multitrauma caused by traffic accidents transferred by the prehospital emergency were enrolled in the study. Demographic variables of patients as well as GAP and NTSs were collected and calculated, with the outcome of patients followed up and recorded during hospitalization. The predictive value of these scores was determined in clarifying the outcome of patients using SPSS software. Results: Of the total number of patients studied, 14 (0.5%) patients died during hospitalization. The mean GAP and NTS scores in dead patients were 12.78 ± 6.92 and 11.64 ± 7.36, respectively. Furthermore, in surviving patients, they were 22.19 ± 1.12 and 22.30 ± 1.22, respectively, with a P < 0.05 in each case. Based on the above tools with 95% confidence level, the area under the curve for the mortality was 0.932 for the GAP system and 0.944 for the NTS (P > 0.001). Conclusions: Both indicators could predict the mortality of patients with multitrauma. It could also be used to determine the priority of dispatch at the scene of the accident and the triage of the injured (people). Based on the results of the receiver operating characteristic curve, the NTS score has a higher accuracy.
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Wisconsin criteria and necessity for computed tomography in patients with maxillofacial trauma: A diagnostic value study p. 92
Hamid Reza Talari, Nushin Moussavi, Amin Hoseinzadeh, Hossein Akbari, Tahereh Shaghaghi, Mehrdad Mahdian
DOI:10.4103/atr.atr_109_20  
Background and Objectives: Wisconsin criteria have already been introduced to diagnosis maxillofacial fractures and reduce unnecessary computed tomography (CT) and as a result radiation exposure. Given that its use in different centers has had different results, this study tries to investigate the diagnostic value of these criteria in a Level III trauma center. Methods: Over the study period, all patients with facial trauma presenting to the hospital emergency evaluated for the study eligibility criteria. Maxillofacial CT in all patients was performed. A senior radiology resident who was blinded to the study reviewed the CT images. The diagnostic value of the Wisconsin criteria, including correct classification (CC), sensitivity (SEN) and specificity (SP), and positive and negative predictive values (NPV) was calculated. Results: A total of 300 patients most of whom were injured in traffic accidents (74%) met the inclusion criteria; most of whom were men (90.7%). The mean age of the patients was 33 years. The highest diagnostic value of the Wisconsin criteria is in identifying fractures in the frontal region with a CC of 80.2%. The SP and positive predictive value (PPV) of Wisconsin criteria at the cutoff point of 2 was 85.7% and 87.1%, respectively. SEN and NPV were obtained 23.9% and 21.8%, respectively. Conclusions: Regarding poor obtained SEN and NPV and the not so high SP and PPV of the test, our study could not validate Wisconsin criteria for predicting facial fractures. It seems that these criteria are institutionally dependent and cannot be generalized to all medical centers.
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Descriptive epidemiology of road traffic mortality caused by heavy vehicles in Iran in 2018 p. 97
Saeideh Shojaei, Seyed Amirhosein Mahdavi, Seyed Davood Mirtorabi, Mehdi Forouzesh, Seyed Saeed Hashemi Nazari
DOI:10.4103/atr.atr_103_20  
Background: Road traffic accidents (RTAs) have become an important public health problem and the mortality rate due to RTAs in Iran is significantly higher than the international standards. There is no accurate information about the mortality rate caused by heavy vehicles in Iran. Therefore, this study aimed at evaluating road traffic mortality caused by heavy vehicles in Iran. Materials and Methods: In this cross-sectional study, the mortality rate caused by heavy vehicles was evaluated regarding age, sex, marital status, education, place and type of accident, and traffic classification. The relative frequency percentage was used for descriptive analysis. T-test, Chi-square, and one-way ANOVA were used to examine the relationship between the variables. Results: A total of 3560 persons died only due to heavy vehicle accidents, and the age-standardized mortality rate was 4.34 per 100,000 populations. The mean age of the victims was 38.9 ± 20.8 years. Furthermore, 80% of the victims were male. Results showed that 83% of all deaths occurred outside cities, and the most common type of vehicle used by the victims was truck and trailer. The highest percentage (57.3%) of accidents was related to heavy and light vehicles. Conclusions: The rate of RTAs-related mortality rate caused by heavy vehicles in Iran is higher than the basic international rate, and there is a need to investigate the causes of this issue.
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CASE REPORTS Top

Tibial tuberosity avulsion fractures in an obese adolescent: A rare injury p. 104
C Yashavntha Kumar, Naveen Raikar
DOI:10.4103/atr.atr_45_20  
Avulsion of tibial tuberosity is very rare injuries seen in adolescent boys. We hereby report a case of a 16-year-old obese boy with acute tibial tuberosity avulsion. The patient was obese weighing 110 kg. Fixation and rehabilitation was a challenge and hence we want publish this rare combination. To best of our knowledge, no such cases are reported. A 16-year-old boy presented to emergency department with a history of tripping from stairs. Clinicoradiological examination revealed closed acute tibial tuberosity avulsion. The patient was obese weighing 110 kg. The patient underwent fixation with cancellous screws and 5.5 mm suture anchor. Following a comprehensive rehabilitation, the patient regained complete range of motion and back to routine activities. Acute tibial tuberosity injuries are very rare injuries commonly seen in adolescent age. Associated injuries and comorbidities make the optimal treatment of such injuries challenging.
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Globe rupture and total traumatic aniridia following blunt facial trauma 30 years after cataract surgery p. 107
Michael Dong, Daniel T Hogarty, Brandon Thia, Robin Meusemann
DOI:10.4103/atr.atr_97_20  
Modern advancements in surgical technique and intraocular implants have reduced the size of the incision required for cataract surgery. However, despite their small size, these wounds may constitute areas of weakness in the globe many years after healing. The inherent weakness from the healed incision may be the site of globe rupture following sudden, severe increases in intraocular pressure from blunt trauma to the eye or face. This case report discusses a 92-year-old woman who presented with a macrohyphema and globe rupture of the left eye following blunt facial trauma. Surgical globe repair was performed which revealed total traumatic aniridia and a posteriorly tilted intraocular lens. The patient progressed without complications and achieved a final visual acuity of 6/18 in the affected eye. This case highlights the lasting structural weakness following cataract surgery which may persist for years and leave the globe susceptible to rupture.
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