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   Table of Contents - Current issue
Coverpage
January-March 2021
Volume 10 | Issue 1
Page Nos. 1-52

Online since Friday, April 9, 2021

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REVIEW ARTICLE  

How to manage emergency response of health teams to natural disasters in Iran: A systematic review p. 1
Hamid Reza Mehryar, Omid Garkaz, Mojtaba Sepandi, Maryam Taghdir, Sahar Paryab
DOI:10.4103/atr.atr_20_20  
Background and Objectives: Disaster as a natural devastating event leads to terrific injuries, morbidities, and mortalities, particularly in developing countries. The aim of this study was to evaluate the management of emergency response of health teams to natural disasters in Iran. Materials and Methods: Some international databases, such as PubMed, ISI, and Scopus, were searched to find English articles between May 2000 and May 2019. Finally, 22 published articles were entered into the study. Keywords included “disaster,” “flood,” “earthquake,” “wildfires,” “tornadoes,” “hurricanes,” “drought,” “famine,” “natural catastrophe,” “storms,” “avalanche,” “health team,” and “Iran” or a combination of them in the title/abstracts. Results: There were >12618 relevant research articles; in this systematic review, 22 published articles consisted of two interventional, one modeling, nine qualitative and ten cross-sectional studies were included. We used Strengthening the Reporting of Observational Studies in Epidemiology Checklist, a checklist of items that should be included in reports of observational studies for selected articles. The summary of the selected articles the selection process using Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Conclusions: The findings of the current study revealed that two subjects were important; extra education in the college course and in-service training at hospitals using educational pamphlets and having a special committee to manage the disaster.
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ORIGINAL ARTICLES Top

Animal-Vehicle Collisions in North of Iran: What's to Be Done? p. 7
Naema Khodadadi-Hassankiadeh, Farzad Sedaghati, Leila Kouchakinejad-Eramsadati, Ali Davoudi-Kiakalayeh, Shahrokh Yousefzadeh-Chabok, Zahra Mohtasham-Amiri, Enayatollah Homaie Rad
DOI:10.4103/atr.atr_1_20  
Introduction: Animal-vehicle accidents are a growing concern in many parts of the world not only because of its environmental consequences but also because of its economic and social costs. The purpose of this study was to investigate the epidemiology of accidents involving animals in Northern Iran. Materials and Methods: In this retrospective cross-sectional study, the data of all animal-vehicle accidents which had occurred during 2014–2018 were obtained from the traffic police database. Results: According to the regression model, fatalities and injuries associated with animal-vehicle collisions on main roads were significantly lower than those on the secondary and rural roads (P < 0.001). The reports showed a significantly lower number of accidents on wet, slippery than the dry roads (P < 0.001). Conclusion: This study reports on the high number of accidents involving animals in Guilan which lead to injuries and fatalities of both humans and animals. Importantly, the pattern of such accidents was found to be different from that of motor vehicle collisions, suggesting a model for changing human behavior and reducing accidents that involve animals.
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The accuracy of various types of urinalysis in terms of predicting intra-abdominal injury in emergency trauma patients: A diagnostic accuracy study p. 13
Mohammad Afzalimoghaddam, Mohammadreza Fattahi, Ramin Pourghorban, Mohammad Eftekhari, Atefeh Abdollahi
DOI:10.4103/atr.atr_28_20  
Background and Objectives: Given the importance and prevalence of trauma patients in the emergency department and the questioning of urinalysis value in predicting intra-abdominal injury, this study was conducted to examine the accuracy of various types of this test. Methods: This diagnostic accuracy study was conducted on adult patients with abdominal trauma. Data gathering were performed retrospectively until sample size completion using a preprepared checklist. Required data, including demographic characteristics, diseases confounding urinalysis, trauma mechanism, important associated injuries, vital signs, etc., were recorded. Accuracy of urinalysis (including macroscopic, microscopic and dipstick) results was compared with findings of patients' enhanced computed tomography (CT) scan findings that was considered as the gold standard, reported by a radiologist. Results: Totally, 152 multiple trauma patients with the mean age of 37.9 ± 17.7 years were enrolled (90.8% males), of whom 66 (43.42%) patients had hematuria and the CT scan was abnormal in 30 (19.73%) cases. There was a significant correlation between gross hematuria and abnormal CT scan (P < 0.01) as opposed to microscopic or dipstick hematuria (P > 0.05). Based on the findings, the highest sensitivity was for dipstick and microscopic equally and highest specificity, positive predictive value, negative predictive value, positive and negative likelihood ratios, NLR and accuracy were for the gross test. Conclusions: Microscopic hematuria and dipstick had no significant correlation with abnormal CT scan findings and cannot predict the intra-abdominal injuries in multiple trauma patients. But, macroscopic hematuria could be valuable in this regard.
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The effect of subcutaneous unfractionated heparin and low-molecular weight heparin toward modification of diabetic acute influence on surgical wound healing in rats p. 19
Shima Shafagh, Amirhasan Matini, Mahdi Noureddini, Mojtaba Sehat, Alireza Kalani, Majid Kalbasi Gharavi
DOI:10.4103/atr.atr_9_20  
Background and Objectives: Diabetes mellitus is one of the disturbing factors in surgical wound repair that recognizing these mechanisms, and modifying them can be useful in preventing surgical wound complications. The aim of this study is to assess the effect of unfractionated heparin (UH) and low-molecular weight heparin (LMWH) on diabetic wounds in the rats. Materials and Methods: This study as a clinical trial in the animal phase was done in two groups that each group consists of three subgroups containing eight rats in each. Initially, under anesthesia, the skin was incised surgically, and interventions with UH in the first subgroup of each group, LMWH in the second subgroup, and normal saline in the third subgroup were performed. In the first group on the 7th day and the second group on the 10th day, wound biopsy was taken and examined pathologically. Finally, data were analyzed using Kruskal–Wallis and one-way analysis of variance statically test. Results: The results of this study showed in every two groups, there was a statistically significant difference between the subgroups for fibroblast and vascularity status, but this difference was not significant for epithelialization and collagen level. In addition, wound length in both the groups had a significant difference between subgroups. Conclusion: In this study, there was a relative difference between the administration of UH and low-molecular weight and surgical wound healing in diabetic rats.
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Relationship between YKL-40, neuron-specific enolase, tumor necrosis factor-a, interleukin-6, and clinical assessment scores in traumatic brain injury p. 23
Maria Hristova Kazakova, Georgi Angelov Pavlov, Valentin Dichev Dichev, Kiril Kostov Simitchiev, Chavdar Stefanov Stefanov, Victoria Stepan Sarafian
DOI:10.4103/atr.atr_43_20  
Background and Objectives: The aim of the present study is to determine plasma and cerebrospinal levels of YKL-40, in combination with neuron-specific enolase (NSE), interleukin (IL)-6, tumor necrosis factor (TNF)-α, and the clinical scales such as Glasgow Coma Scale, Acute Physiology and Chronic Health Evaluation a III, and MARSHALL classification in traumatic brain injury (TBI). Materials and Methods: This was a prospective study conducted on patient cohort of 27 patients with isolated severe TBI. Cerebrospinal fluid (CSF) and plasma were collected on the 24th and 96th h after trauma. CSF samples were obtained also from forensic autopsies of 29 adult healthy cadavers. Results: The CSF level of YKL-40 in TBI patients was higher compared to controls, while no significant change between CSF NSE levels in patients and controls was found. We determined a strong correlation between YKL-40 and NSE levels and TBI clinical assessment scores. The analysis of the influence of independent prognostic factors on the outcome of TBI patients showed that plasma NSE concentrations are the major independent variable which is associated with the survival of TBI patients. Still, changes in IL-6 and TNF-α levels could not be considered as reliable predictors of mortality. Conclusion: We present data for correlation of YKL-40 and NSE levels with clinical scores for assessment of trauma severity and the outcome of TBI patients. Even though further large-scale investigations are required to clarify and evaluate the clinical significance of both biomarkers, our findings suggest that YKL-40 and NSE might be implicated in the pathogenesis of TBI and could indicate the degree of neuroinflammation and brain damage.
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Time of return to work and associated factors in rib fracture victims p. 30
Enayatollah Homaie Rad, Abraha Woldemichae, Vahid Monsef-Kasamei, Naema Khodadadi-Hassankiadeh
DOI:10.4103/atr.atr_53_20  
Background: Rib fracture is one of the leading causes of trauma-related deaths globally. The time elapsed to return to work (RTW) following the injury is an important indicator of treatment outcomes. It is subject to the influences of the complications of the injury. The aim of this study was to determine the time of RTW and the associated factors in patients with rib fractures. Methods: This is a retrospective study, in which the sociodemographic variables including age, sex, marital status, residency, and clinical conditions (the type of accident, days of hospitalization, having surgery, Glasgow Coma Scale [GCS], and the number of rib fractures) were obtained from the database. The variables related to RTW were obtained through telephone interviews. We performed a survival analysis to evaluate the time of RTW of 193 victims with rib fractures managed during 2017 and 2018 in Poursina Hospital in Rasht, Iran. We used the Cox regression to determine the factors associated with the time of RTW. Results: The mean time of RTW was 18.80 ± 11.405 weeks and 97.9% of the victims returned to work. The age of the victims, length of hospitalization, GCS, and type of work were significantly (P < 0.05) associated with the time of RTW. Conclusion: Improving the interventions for the older adults and for those with long-term hospitalization, and low GCS, as well as strengthening preventive measures for victims with high risk of accidental trauma can effectively increase the rate of RTW.
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Outcomes of transconjunctival approach and its modifications for the treatment of orbito-zygomatic complex fractures: A pilot study p. 37
Harish Saluja, Arunima Raut, Shivani Sachdeva, Seemit Shah, Anuj Dadhich, Pulkit Khandelwal
DOI:10.4103/atr.atr_60_20  
Background and Objectives: Transconjunctival incision is used to access the floor of orbit and infraorbital rim; however, when continued with lateral canthotomy, it becomes a versatile approach to treat various types of zygomaticomaxillary fractures. The aim of this study was to evaluate the outcomes of transconjunctival approach and its modifications in terms of accessibility, esthetic outcome, and postoperative complications for the treatment of patients of orbito-zygomaticomaxillary complex fractures. Methods: In the hospital, a total of five cases of zygomatic complex fractures were operated from October 2019 to December 2019. The transconjunctival approach was assessed on the following criteria: adequacy and ease of exposure, time required for exposure of fracture site, accuracy of reduction of fracture, esthetic outcome, and postoperative complications (e.g., ectropion, entropion, chemosis, infection, and scarring). The patients were kept on follow-up for 6 weeks. Results: The average age of the patients was 26 years. The average time required for exposure of fracture site was 25.2 min. Exposure obtained in all the cases was adequate according to the operating surgeon. During postoperative follow-up, all the patients were evaluated for ectropion, entropion, chemosis, and infection. None of the patients reported with any complications, and the postoperative esthetic results were satisfactory (according to the patient). Conclusion: The transconjunctival approach is an efficient approach to gain surgical access to infraorbital rim and zygomatic complex fractures. With good exposure and nonvisible scar, transconjunctival approach is superior to other techniques. The numerous advantages of this approach nullify the longer time taken for the procedure.
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The clinical outcome of combined distal third tibial and fibular fracture treatment with or without fibular fixation: A retrospective study p. 42
Mohsen Khorrami, Payam Mohammadhoseini, Milad Vakilian, Amir Khorrami, Yasaman Khorrami
DOI:10.4103/atr.atr_62_20  
Background and Objectives: Distal tibial and concomitant fibular fracture is a common fracture. Fibular fixation in conjugation with tibial fixation with a locking plate is controversial. This study aimed to determine the effect of fibular fixation in distal tibial fracture fixed with a distal medial locking plate. Methods: This retrospective study was conducted on 33 patients with mixed distal tibial and fibular fractures referred to the trauma centers of Golestan and Aria hospitals in Ahvaz, Iran, and underwent surgery between September 2018 and January 2019. The patients were categorized into Group I with fibular fixation (n = 17) and Group II without fibular fixation (n = 16). Then, they were divided into two subgroups according to the level of fibular fracture. For the subgroup (a), fracture was at 7.5 cm distal fibular (n = 11) and for the subgroup (b), proximal to group “a” at distal third (n = 6). Data were collected by asking patients about their function and pain in daily activities and performing examination and radiographs 6 months postoperatively. The assessment of the ankle was performed using the AOFAS. Data were analyzed using Chi-square and t-test by the SPSS version 26. Results: Six months post operation, there were no cases of malunion or wound complication in both groups. There was an osteomyelitis case in Group II, but none in Group I. There were six nonunions in total: two in Group I and four in Group II (P = 0.325). Furthermore, AOFAS was significantly greater in Group I compared to Group II (76.18 ± 17.45 vs. 50.62 ± 18.88, P < 0.001). Conclusions: According to the findings of the present study, there is a positive and crucial relationship between fibular fixation and AOFAS in ankles with the combined distal third tibial and fibular fracture. There are no crucial differences in nonunion of tibia, malunion, wound complication, deep infection, and osteomyelitis between nonfixation and fibular fixation.
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CASE REPORTS Top

Spermatic cord hematoma in an adult patient with testicular trauma: Sonological appearances of a rare entity p. 46
Reddy Ravikanth
DOI:10.4103/atr.atr_121_20  
Acute scrotal injuries with resultant testicular contusions, testicular torsion, testicular infarction, and testicular rupture have been well documented in the literature. Spermatic cord hematoma has been rarely reported, and this case report describes the sonological appearances of the above-mentioned entity in an 18-year-old male.
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Pulmonary langerhans cell histiocytosis: Can it originate from chest trauma? p. 48
Emel Alhaja, Irem Karaman, Dilek Erdem, Sevket Ozkaya
DOI:10.4103/atr.atr_85_20  
Langerhans cell histiocytosis (LCH) is a rare medical condition which is defined by abnormal accumulation of a heterogeneous population of Langerhans cells that form nodules in certain tissues such as the skin, bone, and lungs. When the lungs are involved, the disease is called pulmonary LCH (PLCH). It is well established that PLCH is frequently observed in young adult smokers with equal gender distribution. Despite the clear role of smoking in PLCH pathogenesis, being a smoker rarely induces the disease, suggesting that host-related factors, inhaled antigens, or other stress-related factors may contribute to the pathogenesis. Here, we reported two cases of PLCH which both presented after chest trauma. Based on the findings from both the cases, it is concluded that the overstimulated inflammatory response in the posttraumatic lungs might be the responsible etiology resulting in the LCH if the lungs are already damaged and more sensitive due to smoking. We suggest that the differential diagnosis of PLCH should be especially considered in young adults with sudden or insidious onset of symptoms following chest trauma.
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