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   Table of Contents - Current issue
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October-December 2020
Volume 9 | Issue 4
Page Nos. 149-202

Online since Saturday, December 26, 2020

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STUDY PROTOCOL  

Development of the Iranian National road safety plan: Study protocol p. 149
Homayoun Sadeghi-Bazargani, Alireza Razzaghi, Mohammad Hossein Somi, Shahriar Behzad Basirat, Reza Deljavan Anvari, Leila Doshmangir, Alireza Esmaeili, Sedighe Etemad Saeid, Mina Golestani, Javad Hedayati, Einollah Jahani, Hamidreza Khankeh, Alireza Khavandi Khiavi, Reza Masoudi Far, Iraj Mohebbi, Pooria Mohammadian, Saeid Pour-Doulati, Mahdi Rezaei, Mohammad Saadati, Vahideh Sadeghi, Mehdi Shafieian, Hamid Soori, Ebrahim Vahabzadeh, Jabbar Ali Zakeri
DOI:10.4103/atr.atr_84_20  
Introduction: A national road safety strategic plan (NRSSP) is considered as one of the main road safety management issues in different countries. Such a plan not only determines the vision and relevant strategies but also causes the implementation of appropriate interventions to be coordinated and strengthened to achieve the goals set by partner organizations. The present study mainly aims to report Iran's NRSSP 2021–2031 development protocol. Methods: According to a schedule, the study protocol consists of ten sections: (1) Determining a core planning center, (2) Establishment of a steering committee, (3) Stakeholder identification, (4) Identification and development of Goals and Strategies, (5) Vision development, (6) Establishment of committees, (7) Integration of Goals and Strategies, (8) Goals and Strategies assessment, (9) Action plans development, (10) Monitoring and evaluation. An appropriate study method is performed for each of the concerned steps. Conclusion: The road safety strategy plan is a critical component to promote the effectiveness of activities and achieve the goals determined for road safety purposes. The Decade of Action for Road Safety is just being closed to its end; hence, reviewing and drawing up a road safety document concerning authentic scientific models and evidence is of paramount importance in Iran. The present study takes over the mission to address this gap.
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ORIGINAL ARTICLES Top

Injury pattern and outcome of assault victims: An emergency department perspective p. 154
Darpanarayan Hazra, Ankita Chowdary Nekkanti, Kundavaram Paul Prabhakar Abhilash
DOI:10.4103/atr.atr_47_20  
Background: Violence-related injuries top the list as a cause of mortality in the 15–40 years' age group in India. In contrast to the West, the spectrum of assault injuries in Southeast Asian countries is different. Our main aim was to profile intentional injuries due to interpersonal violence treated in the emergency department (ED) and to describe the severity, pattern, etiology, and outcome in such patients. Materials and Methods: We conducted a case-series analysis of assault victims who presented to the ED of Christian Medical College and Hospital, Vellore, India, from January 2017 to December 2018. Data were retrieved electronically from the clinical workstation. Categorized variables were summarized using counts and percentages. Quantitative variables were summarized using mean and standard deviation (SD). Results: During the study period, a total of 381 patients with a mean age of 36.16 (SD: 13.9) years presented to the ED. Male (81.9%) predominance was noted among these victims. A majority of them, i.e., 257 (67%) victims, were assaulted by people that were known to them, of which 66 (17.3%) victims were reported as domestic violence. Blunt objects were used in most, i.e., 234 (61.4%) cases. A spike in the incidence of assault, in general, was noted in the month of September during the South Indian festival season. Approximately one-fourth (21.3%) of the victims required hospital admission. Overall, 15.74% of the victims had to undergo major surgical procedures. There were no mortalities recorded among these study participants. Conclusions: Violence and its consequences lead to severe injuries and levy a heavy burden on health care. There is an urgent need to address the social and emotional needs of adolescents and young adults who are most at risk of being the victims of assault.
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The diagnostic value of chest and abdominopelvic computed tomography in detecting thoracolumbar fractures among patients with blunt trauma p. 160
Hamid Reza Talari, Nooshin Mousavi, Masoumeh Abedzadeh-Kalahroudi, Hossein Akbari, Abolfazl Kargar
DOI:10.4103/atr.atr_33_20  
Background: Thoracolumbar fracture (TLF) is one of the common problems associated with trauma. This study evaluated the diagnostic value of chest and abdominopelvic computed tomography (CT) in detecting TLFs among patients with blunt trauma. Methods: This prospective diagnostic assessment study was conducted during 2016-2017. Participants were 256 patients above 18 years with blunt multiple trauma who had undergone chest and abdominopelvic CT at their admission to the emergency department and were subjected to thoracolumbar CT (TL CT) for the further assessment of TLFs. The sensitivity, specificity, and positive and negative predictive values of chest and abdominopelvic CT were calculated based on TL CT findings. Results: The total sensitivity, specificity, and positive and negative predictive values of chest and abdominopelvic CT in detecting TLFs were 89.55%, 100%, 100%, and 89.71%, respectively. These values were, respectively, 95.56%, 100%, 100%, and 98.39% in detecting transverse process fractures; 50%, 100%, 100%, and 91.04% in detecting vertebral body fractures; and 80%, 100%, 100%, and 65.24% in detecting vertebral body and posterior element fractures. Chest and abdominopelvic CT sensitivity and specificity were, respectively, 97.5% and 100% among patients younger than 40 years and 77.4% and 100% among patients older than 40 years. There was a significant agreement between chest and abdominopelvic CT and TL CT findings (kappa coefficient = 0.896; P < 0.001). Conclusion: Chest and abdominopelvic CT has acceptable sensitivity and specificity in detecting TLFs. However, due to low sensitivity and specificity in detecting vertebral body fractures without posterior element involvement and clinical importance of these fractures, image reformatting is suggested. Of course, TL CT can be used in case of suspicious fractures or older patients.
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Translation, validity, and reliability of disability rating scale in Iranian patients with traumatic brain injury p. 166
Kamran Ezzati, Shahrokh Yousefzadeh-Chabok, Sajjad Rezaei, Zoheir Reihanian
DOI:10.4103/atr.atr_14_20  
Background: The Disability Rating Scale (DRS) is a short, efficient, and rapid instrument for assessing levels of functional disability, but little information is available on the translation and psychometric properties of its Persian version, especially for traumatic brain injury (TBI) patients. The aim of this study was to translate and adapt the Persian version of DRS and to determine the psychometric properties of the Persian version of this scale in patients with TBI. Materials and Methods: In this analytical cross-sectional study, 191 TBI patients (age range, 16–86 years) referred to the physiotherapy Center of PourSina Hospital in Rasht, Iran, were selected through census sampling. First, the DRS was translated into Persian, and then, the validity, reliability, and repeatability of DRS scores were evaluated. All patients were evaluated on admission and at discharge through the Glasgow Coma Scale (GCS) and Functional Independence Measure (FIM). Results: According to the reports of the translators, translation of the DRS into Persian language was easy. The quality of translation (including translation clarity, common language usage, conceptual equivalence, and overall quality of translation) was generally favorable. Inter-raters' reliability on admission and at discharge stages was excellent (intraclass correlation coefficient = 0.93–0.94). Cronbach's alpha values for the internal consistency of DRS on admission and at discharge stages were 0.96 and 0.97, respectively. The results showed a strong inverse relationship of DRS scores on admission and at discharge with GCS and FIM scores (in all cases more than 0.70, P < 0.0001). Conclusion: The validity, reliability, and repeatability of the DRS scores for the Persian version were confirmed. These results reflect that DRS can be used to determine the effects of therapeutic/rehabilitation interventions on levels of functional disability in Iranian patients with TBI.
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Investigating the possibility of using noninvasive basic monitoring in patients with acute burns undergoing general anesthesia p. 173
Ali Akbar Jafarian, Ali Farhoodi, Zahra Jafarian, Azadeh Emami, Mohaddeseh Jafarian, Reza Salehi
DOI:10.4103/atr.atr_6_20  
Background: Basic noninvasive monitoring is considered as the standard procedure in patients with acute burns under general anesthesia. In such cases, noninvasive monitoring probes may often be ineffective on damaged skin due to the nature of burns pathology. Hence, the noninvasive monitoring is very challenging. Because of such limitations, we conducted this study to examine the practical difficulties or possibility of noninvasive monitoring utilization. Methods: Over the period of 2016–2017, 100 patients who were injured by acute burns with 20%–90% of TBS and undergoing general anesthesia at Motahari Burn Hospital were enrolled in this descriptive study. Basic monitoring techniques including noninvasive blood pressure (NIBP), cardiac monitoring, and pulse oximetry were applied throughout all surgeries as much as possible. Results: Evidence demonstrated that the application of NIBP monitoring in 23% of cases, cardiac monitoring in 63% of patients, and also even pulse oximetry in 7% of them were impossible. Conclusion: Limited usage of invasive monitoring due to vulnerability to sepsis leads to the noninvasive approach. Hence, technical innovations in noninvasive monitoring may help clinicians to monitor physiological indices, more safely.
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Delay in anesthesia assessment time – A cause of postponement in orthopedic trauma surgery p. 176
Mohammad Zarei, Alireza Moharrami, Babak Haghpanah
DOI:10.4103/atr.atr_72_19  
Background: Postponement of surgery increases the length of hospitalization and medical expenses, the mortality rate, and the prevalence of major medical complications. There is a limited study about the role of anesthesia assessment in developing these complications. Thus, the aim of the present study was to examine the anesthesia assessment time for traumatic patients aged over 50 years and also to investigate the role of anesthesia service in surgery postponement. Materials and Methods: This descriptive retrospective study was performed on 110 patients with traumatic injuries referred to Imam Khomeini Hospital Complex (Tehran, Iran) from March to September 2017. The information was extracted retrospectively from the hospital information system. The standard definitions in the International Classification of Diseases 10 code S00-T88 were used to identify traumatic injuries and fractures. Results: The results of the present study showed that the mean of anesthesia assessment time was significantly different in terms of the type of trauma, and femoral fractures had a higher anesthesia assessment time (P = 0.009). Furthermore, the anesthesia assessment time in patients who underwent echocardiography was significantly higher than those with no echocardiography (P < 0.05). The current study explored that the mean anesthesia assessment time was substantially higher in patients who underwent myocardial perfusion imaging (MPI) (7.1 vs. 1.84 days). Furthermore, the results revealed that there was no significant difference in anesthesia assessment time regarding gender of the patients (3 vs. 2.7 days). Finally, patients aged between 61 and 70 years had a higher anesthesia assessment time with a mean of 4.41 days (P < 0.05). Conclusions: The study concluded that the mean of anesthesia assessment time was significantly higher (3.6 days) in patients with a femoral fracture. Furthermore, this study has shown that diagnostic assessments, including echocardiography, MPI, and angiography, which were performed in some patients, did not change the surgery plan.
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Preparation, characterization, and antibacterial studies of N, O-carboxymethyl chitosan as a wound dressing for bedsore application p. 181
Atiyeh Raisi, Azadeh Asefnejad, Maryam Shahali, Zeinab Alsadat Sadat Kazerouni, Amin Kolooshani, Saeed Saber-Samandari, Bahareh Kamyab Moghadas, Amirsalar Khandan
DOI:10.4103/atr.atr_10_20  
Background: A study conducted on wound treatment by antibacterial wound dressings can reduce the need for using antibiotics to a minimum amount. These wound dressings can create a moist environment at the wound surface to speed the healing process up. In recent years, researchers have paid much attention to polymeric wound dressings. Chitosan can help heal the wounds because of its similar structure to glycosaminoglycans in the skin. In this regard, the aim of the present study was to fabricate and characterize a novel biolayer wound dressing based on the carboxymethyl chitosan polymer with ceramic nanoparticles as a reinforcement and antibacterial agent using the freeze-drying method. Methods: In this study, to make a flexible wound dressing from a biocompatible and biodegradable polymer, N-O-carboxymethyl chitosan, diopside was added to improve the mechanical and hydrophobic properties of the soft tissue and cell proliferation was fabricated. After making the samples, a variety of chemical and biological tests and analyses were performed on the samples, including scanning electron microscope and Fourier-transform infrared spectroscopy. Results: The results showed that the use of this wound dress significantly reduced the risk of infection at the wound site. Conclusions: An antibacterial product with the proper mechanical behavior as a soft tissue was produced and evaluated in this study. The chemical and biological investigation represented that the sample with 5 wt% magnetite nanoparticles has excellent characteristics and can be introduced as a wound dressing application.
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Explaining gender differences in transfer time to a trauma center in Northern Iran p. 189
Enayatollah Homaie Rad, Mohammad Hajizadeh, Satar Rezaei, Leila Kouchakinejad-Eramsadati, Hamid Heydari, Naema Khodadadi-Hassankiadeh
DOI:10.4103/atr.atr_2_20  
Background: The association between gender and time of receiving services (TRS) after traumatic injuries is rarely documented in developing countries. This study aimed to examine gender differences in time between occurring injuries and receiving services in hospital after trauma injuries in northern Iran. Materials and Methods: A total of 7085 injured patients were included in this study. Data on sociodemographic and clinical characteristics were extracted from the Guilan province trauma system registry (GTSR) from July 2017 to July 2018. The Oaxaca–Blinder (OB) method was used to explain the gender differences in the TRS after traumatic injuries. Results: There were significant differences between men and women in marital statues (P < 0.001), education level (P < 0.001), time of injury (P = 0.025), occupation (P < 0.001), type of trauma (P < 0.001), mode of transfer (P < 0.001), mean age (P < 0.001), average distance from hospital (P = 0.052), and average transfer time to the hospital (P < 0.001). We found gender differences in TRS after falling trauma (P = 0.006) when the transfer was performed by emergency medical services (EMSs) and in penetrating trauma (P < 0.001) when the transfer was performed by private vehicles. The difference in the observed characteristics of men and women explained 67% of gender differences in TRS (P = 0.06). Conclusion: The gender difference in the transfer of injured patients was in favor of men, depending on the socio-demographic and clinical factors. In OB analysis, the gender differences in falling trauma and transfer by EMS and the gender differences in penetrating trauma and private transmission to the hospital were also confirmed. Steps need to be taken to ensure that services are equally beneficial to both men and women.
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CASE REPORTS Top

Otitic barotrauma causing facial baroparesis p. 197
Santosh Kumar Swain, Sampada Munjal
DOI:10.4103/atr.atr_17_20  
Facial baroparesis is an extremely rare clinical entity which occurs due to otitic barotraumas. It is rarely reported in medical literature which can happen among persons those ascend to high altitude in flight or scuba diving. The overpressure in the middle ear cavity due to eustachian dysfunction may cause exertion of the excessive pressure over the facial nerve through a dehiscence of the horizontal segment of the fallopian canal leading to facial nerve paralysis. The clinical history and imaging help to diagnose this rare cause of facial nerve paralysis. Here, we report a case of a 38-year-old female who experiences unilateral facial nerve paralysis on ascent to high altitude on a flight, with relieve from symptoms shortly after descent.
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Dislocation of the first carpometacarpal joint p. 200
Golnaz Latifian Esfahani, Tahere Ghasemi, Behrang Rezvani Kakhki, Sayyed Majid Sadrzadeh, Elnaz Vafadar Moradi
DOI:10.4103/atr.atr_64_20  
First carpometacarpal (CMC1) joint dislocations are uncommon injuries. However, they can limit hand functions and lead to serious complications. Herein, we report the case of a multiple trauma man with dorsal dislocation of thumb CMC joint that was successfully treated with closed reduction and casting. The patient was a 47-year-old male with multiple traumas complaining of right wrist pain. Tenderness, deformity, and reduced range of motion of the right thumb CMC joint were observed. X-ray showed dorsal dislocation of the CMC1 joint. Closed reduction of the dislocated joint was performed under general anesthesia, and the joint was immobilized by a thumb-spica cast for 14 days. The patient was eventually discharged in good condition and had no complications or manual dysfunction after a 1-month follow-up. The optimal management of the CMC1 joint dislocations is controversial. The closed reduction seems adequate for these injuries. However, patients whose joints remain unstable after closed reduction, especially those with manual activities, should be considered for open reduction and surgical ligament repair.
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