Penile amputation (PA) is a rare genitourinary injury. Three main etiologies of PA consist of iatrogenic, accidental, and self-mutilation. Eighty-seven percent of the self-mutilated patients suffer from psychiatric disorders. Nowadays, microsurgical techniques with neurovascular anastomosis are the best approach for PA. This paper insists on psychiatric and legal consequences, which may involve health-care team. A 25-year-old male patient presented to our emergency department with self-inflicted PA. As he had a history of some psychiatric problems, psychiatric consultation was requested. The patient did not accept any surgical interventions. We informed his relatives completely; however, they did not agree with surgical intervention because they predicted that he might repeat amputation again. According to the forensic medicine specialist consultation, we took the coroner's warrant for emergency surgical intervention and transferred the patient to the operating room without any consent. Microsurgical penile replantation was performed. There was no leakage in retrograde pericatheter urethrography on the 3^rd postoperative week, and the urethral catheter was removed. The patient was able to void normally, and cystostomy tube was removed at the same time. Consent for all medical procedures is an important part of national and international human right law and medical ethics. Physicians should inform patients about their problem and take a reliable consent. If the patient was unreliable for informed consent, relatives could do it. However, in an emergency, there is an exception in the law that let surgeons do the operation without consent for these cases.

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Background: The aim of this study was to assess the accuracy of high-resolution ultrasonography (USG) in the evaluation of rotator cuff tendinopathies and tears with magnetic resonance imaging (MRI) correlation to determine its sensitivity and specificity. Materials and Methods: The prospective study was conducted on 40 patients referred to the Department of Radiology for the evaluation of rotator cuff pathologies over a period of 18 months. All the patients underwent high-frequency USG followed by MRI. Variables such as sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy of high-frequency USG and MRI were evaluated. Results: The sensitivity, specificity, NPV, PPV, and accuracy of high-frequency USG in the evaluation of rotator cuff pathologies in comparison to MRI as standard were 90.6%, 87.5%, 96.6%, 70%, and 90%, respectively. Conclusion: High-frequency USG is almost equally sensitive and specific as MRI for the diagnosis of rotator cuff pathologies, and due to its cost-effectiveness, easy affordability, ease of evaluating contralateral shoulder, more patient compliance, noninvasiveness, and wider applications, we recommend it to be used as a primary modality for evaluating rotator cuff. MRI should be performed in case some extra information is required.

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Background: Casting is the most common treatment for managing limb fractures. Casts that are not properly provided or are not correctly cared for may hinder the healing of fractures. However, no study assessed the quality of care before, during, and after casting. Objectives: This study aimed to investigate the quality of nursing care before, during, and after casting. Methods: A cross-sectional study was conducted on 188 patients with limb fractures referred to Shahid Beheshti Hospital in Kashan, Iran, from July to November 2018. The data collection instrument consisted of 57 items on the quality of care before, during, and after casting. Descriptive statistics and Fisher's exact test were used to analyze the data. Results: A total of 188 patients were assessed, 94 cases regarding the quality of care before and during casting and 94 additional cases for the quality of care after casting. The quality of care before, during, and after casting was at a moderate level in 83%, 58.5%, and 63.8% of patients, respectively. A significant connection was found between the quality of care before casting and the type of damage (P = 0.002). Significant connections were also found between the quality of care after casting and the nurses' work shift (P = 0.05) and gender (P = 0.05). Conclusion: The quality of care before, during, and after casting was mostly at a moderate level. Educational interventions are needed for nurses to improve the quality of cast care.

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Introduction: Skeletal traction provides pain relief and temporary stability in patients anticipating surgery for a variety of lower-extremity fractures. Recent literature suggests that distal femoral traction provides pain relief and is safe; however, data regarding proximal tibial and calcaneal pins are primarily historical and limited. The purpose of this study is to document complications associated with distal femur, proximal tibia, and calcaneal traction pin placement. Materials and Methods: We identified patients with the distal femur, proximal tibia, and calcaneal traction pin placement from January 2013 to June 2016. Chart review was utilized to identify any complications, including nerve or vascular injuries, need for revision, or infection. Results: Five hundred and nineteen traction pins were eligible for review, consisting of 120 calcaneal traction pins, 129 distal femoral pins, and 270 proximal tibia traction pins. Primary diagnosis was defined as 305 femur fractures (58.8%), 60 tibial shaft fractures (11.6%), 60 acetabular fractures (11.6%), 38 pilon fractures (7.3%), 30 pelvic ring injuries (5.8%), 21 tibial plateau fractures (4.0%), and 5 hip dislocations (1.0%). We identified 17 (3.3%) adverse events potentially attributable to traction pin insertion. Pins that became infected were found to have been in place for a significantly longer duration (18.3 days compared to 5.8 days, P = 0.0001). Conclusions: Traction pin placement for skeletal traction is generally an uncomplicated procedure. Duration of pin placement is significantly related to the likelihood of pin site infection.

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Background: Athletes with trauma to the chest could be injured and suffer from an acute disturbing chest wall pain due to intercostal neuralgia. Pulsed radiofrequency (PRF) is an emerging safe therapy in many neurologic pain syndromes. Objectives: This study aimed to determine the effect of PRF on intercostal neuralgic pain in athletes complaining of severe chest pain and limited range of motion. Materials and Methods: This case-series study was conducted on athlete patients who suffered from severe chest pain that has limited their function. Eighteen athletes who were absent from physical training and sports activity due to intercostal neuralgia in their current season were admitted to our pain clinic. Intercostal nerve PRF was used to treat patients. Pain scale and return to sports activity were measured after PRF. Results: The mean time of absence from sports activity was 1.3 ± 0.6 weeks. The mean score of pain severity (numeric rating scale [NRS]) was 8.46 ± 1.85. In this study, 16 of 18 (88%) patients had effective pain relief (NRS <3) after PRF therapy. Besides, the NRS scores reduced by at least 90% in 16 of 18 (88%) patients as compared to the baseline. The mean NRS score was followed-up for 4 weeks. The scores significantly decreased at 1 (P = 0.001), 2 (P = 0.0015), and 4 (P = 0.0002) weeks following PRF compared to pre-PRF time. Conclusions: Pulsed radiofrequency is a suitable therapy for athletes with intercostal nerve entrapment pain, which provides adequate and quick pain relief, thus enabling them to resume their sport activities.

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Background: Posttraumatic stress disorder has a negative impact on the individual, family, and community due to disturbance in social functioning, increased stress, and life-threatening health status. Therefore, effective and useful therapeutic interventions in this area are very important. This study aimed at examining the effectiveness of acceptance and commitment therapy (ACT) on the posttraumatic cognitions of students with trauma exposure. Methods: In this quasi- experimental study, population included all students of Islamic Azad University in Roudehen, Tehran, Iran, during the academic year of 2018–2019. After administering trauma questionnaire, the second version of acceptance and action questionnaire (AAQ-II), and posttraumatic cognitions inventory (PTCI) to 500 people, 113 people who experienced trauma and had high scores in PTCI and low scores in AAQ-II were identified. Of whom 40 people were selected randomly. After the clinical interview, the subjects were randomly placed in the experimental group (who received ACT, n = 20) and placebo group (n = 20). Both groups were pre- and posttested using the PTCI and AAQ-II. Then, the obtained data were analyzed using covariance analysis. Results: The results showed that there was a significant difference in posttraumatic cognitions (negative cognitions about self, negative cognitions about the world, and self-blame) between the two groups. In addition, the results of posttest related to ACT had a significant impact on psychological inflexibility. In other words, ACT reduced posttraumatic cognitions and increased psychological flexibility of these students. Conclusion: The findings of the present study reveal that despite posttraumatic cognitions of students with trauma exposure, ACT increases value-based behaviors through increasing psychological flexibility and decreasing experiential avoidance.

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Response time (RT) accounts as a common tool for emergency medical services (EMS) assessment. While the national standard RT has been established in Iran since 2007, its application has hardly been put into scrutiny. This study aimed at investigating the use of RT standard in assessing EMS in Iran. This systematic review included papers focusing on prehospital EMS assessment published in Google Scholar, Scopus, Embase, PubMed, and the Persian databases of Magiran and SID. Selection criteria involved all English and Persian studies focusing on RT as an assessment of prehospital EMS in the context of Iran. Repetitious papers and those presented in conferences were omitted, which left 21 papers published from 2007 to mid-2016 for systematic review. A data collection form was designed. This provided both inclusive information about the papers and indicators used to report RT in each paper (i.e., mean and percentages of RT below 8 min) as well as the use of these indicators vis-a-vis that of the standard. From among the 21 papers focusing on RT, seven (33%) reported RT as percentages of operations performed in <8 min according to the national standard and compared the percentage with the national standard. A total of 18 (86%) reported the means of RT; nine studies compared mean and the national standard as expressed in percentage. Limited use of the national standard to report RT was identified as a challenge to EMS assessment. Further, the inconsistency that exists when comparing RT in terms of means and percentage is a challenge to the validity of judgments expressed in some previous studies. Employment of uniform methods to report and evaluate performance based on the national standard will lead to greater transparency in emergency operation performance.

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Background: Postmortem examination is indispensable to ascertain the cause of an unnatural death and as such is mandatory by the law. From ages, traditional autopsy (TA) has proved its worth in establishing the cause of death in the deceased despite some inherent difficulties and challenges and has enjoyed an insurmountable status. The increasing use of application of the modern-day radiology for postmortem examination has however opened a new arena overcoming some of the difficulties of the TA. There are conflicting reports in the published literature regarding superiority of one modality of the postmortem over the other. Objective: The objective of this study was to compare the findings of postmortem computed tomography (CT) scan and TA in the victims of traumatic deaths and to analyze whether postmortem CT can be used to replace TA. Materials and Methods: All patients with a history of trauma that were declared brought dead on arrival in the emergency department were subjected to full-body CT scan. An experienced radiologist reported the findings of CT scan. Subsequently, a forensic expert subjected the patients to TA. The physician who performed autopsy was blinded to the findings of CT scan and vice versa. An individual who was not part of the radiology or forensic team then entered the findings of CT scan and autopsy in a predesigned Pro forma. An unbiased assessor finally compared the findings of the two modalities and analyzed the results. McNemar's test was used to ascertain the level of significance between the findings reported by these two modalities considering P = 0.05 as statistically significant. The agreement or disagreement on cause of death reported by these two modalities was also assessed. Results: About 95% of the deceased were males. The mean age of the corpses was 35 years (range 16–67 years). CT was found superior in picking up most of the bony injuries, air-containing lesions, hemothorax, and hemoperitoneum. However, autopsy was found more sensitive for soft-tissue and solid visceral injuries. Both modalities were equally helpful in identifying extremity fractures. Statistically significant agreement (>95%) on cause of death by both modalities was not achieved in any patient of trauma. Conclusion: Postmortem CT scan is promising in reporting injuries in traumatic deaths and can significantly complement the conventional autopsy. However, at present, it cannot be considered as a replacement for TA.

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Background: Due to the extensive use of subway transportation in high- and middle-income countries, the safety of passengers has become one of the important challenges in emergency management of subway station. Therefore, the present systematic review aimed to identify environmental and organizational management factors that affect the safe emergency evacuation in subway stations. Materials and Methods: In this systematic literature review, PubMed, Scopus, Web of Science, ProQuest, Google Scholar, Iran Medex, Magiran, and Scientific Information Database from 1990 to 2019 were searched to identify effective emergency management factors in safe emergency evacuation of the subways. A thematic content analysis was employed for data analysis. Results: Of 763 publications retrieved from the searches, 149 studies were included for data analysis. According to the findings, effective environmental and organizational management factors in safe emergency evacuation were discussed in eight subcategories, including infrastructure properties, evacuation-assisting resources, prevention of injuries and mitigation, preparedness for emergency evacuation, emergency response and reconstruction, and maintenance of evacuation facilities. Conclusion: The design of an optimal route for emergency evacuation is the main theme of most studies focusing on environmental factors. While a system approach for designer is needed for effective subway emergency evacuation, human-related factors focusing on injury prevention are also crucial.

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Background: Identification of risk factors involved in road traffic deaths (RTDs) could help policymakers and road traffic managers to adopt effective strategies and approaches for the prevention and control of these incidents, while the lack of accurate data on the risk factors of RTDs causes the problem to persist. This systematic review aimed at assessing the national studies regarding the risk factors of RTDs in the regions covered by the World Health Organization (WHO). Methods: This review study was conducted during 2008–2018 via searching in databases of PubMed, Science Direct, Scopus, Cochrane, Thomson Reuters, Web of Science, EMBASE, ProQuest, and Trip databases. Initially, a literature review was performed to find similar systematic reviews, followed by another literature review to retrieve the published or registered protocols. At the next stage, PECOTS was developed for the search strategy, followed by the quality assessment. The eligibility criteria in this study were the national-level studies about the risk factors related to RTDs, English-language studies, and studies published during 2008–2018. Results: In total, 169 articles were included in this study, with the highest and lowest number of the published articles in the United States and African countries, respectively. According to the reviewed studies, human factors accounted for the most common risk factors involved in RTDs. In the southeastern regions of Asia, the main road-related risk factor for RTDs was reported to be the type of roads. Furthermore, roadside departure to the right side and long roads were denoted in the national data of the Western Pacific region on the incidence of RTDs. Differences were observed between the six regions covered by the WHO in terms of the time-related risk factors for RTDs. Conclusions: Several risk factors have been reported for RTDs in the countries covered by the WHO, and each risk factor is considered to have various subcategories. Therefore, it could be concluded that there are different epidemiological patterns for road traffic accidents and RTDs.

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Background: There is an ongoing debate if bone graft substitutes (BGSs) are beneficial in the treatment of displaced intra-articular calcaneal fractures (DIACFs). The purpose of this study was to evaluate the effect of an injectable calcium sulfate/hydroxyapatite BGS (CERAMENT^TM iBONE VOID FILLER, BONESUPPORT AB, Lund, Sweden) in internal fixation of calcaneal fractures. Methods: The records of patients presenting with calcaneal fractures type Sanders III and IV and treated with internal fixation plus BGS were reviewed. Radiographs were analyzed using different measurements (including Böhler's angle and calcaneal facet height). The clinical outcome was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale. Results: A total of 20 fractures were available for radiographic and clinical examination at a minimum follow-up of 12 months. No decrease in Böhler's angle was recorded in six fractures, a reduction of <5° in 6 and of more than 5° in 8 fractures. In all fractures, the BGS was completely resorbed at 12 months on radiographs. The AOFAS score was on an average 89.8 (range, 68–99) at 1-year follow-up and indicated an excellent outcome in 11, a good outcome in 8, and a fair outcome in 1 fracture. Conclusions: The study results support the use of an injectable, in situ hardening calcium sulfate/hydroxyapatite BGS in DIACFs. The BGS is easy and safe to use as an augment to open reduction and internal fixation.

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Background: Injuries caused by home injuries in children under 5 years of age is one of the main causes of death in this group and also constitutes a significant public health burden. This review aimed at summarizing the literature on the effectiveness of interventions to prevent home injuries in children under 5 years of age. Methods: Magiran, Iran Medex, and SID in Persian Scientific databases and BioMed Central, PubMed, ScienceDirect, Web of Science, and Scopus were systematically searched for articles published up to June 2016. Then, two researchers reviewed the papers independently and finally, 14 studies fulfilled the inclusion criteria. Results: The results showed the effectiveness of intervention measures including training sessions at home, home visit, group discussions, and interviews as the educational tools. The educational approach was used as the intervention in 11 studies; legislative/incentive approach and engineering/technology approaches had not been used in papers; and three studies had used the educational intervention and engineering/technological approaches. Conclusions: Most of the effective inventions included studies that used the combination of effective methods to reduce the risk of injuries. Since the accidents are preventable, the appropriate intervention strategies, especially active intervention or a combination of interventional measures are effective to reduce the risk of home accidents and injuries in children.

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Simultaneous dislocation of the thumb carpometacarpal and metacarpophalangeal joints is an uncommon injury. Stability is the most important factor in the decision of treatment in these rare injuries. The treatment methods range from closed reduction and maintaining reduction with cast or percutaneous k-wires to complex reconstruction surgeries. In this paper, a case of 28-year-old female with complete dislocation of the left thumb metacarpal has been reported. She was treated with closed reduction and cast immobilization with excellent result. Treatment decision should be based on postreduction stability in complete dislocation of thumb metacarpal; cast immobilization is a management option in case of stable reduction.

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Background: Road crashes as a major global public health problem cost 3% of most countries and 5% of low- and middle-income countries' gross domestic product (GDP). The World Health Organization has predicted that without sustained action, road traffic crashes will become the seventh leading cause of death by 2030. Objectives: The aim of this study was to analyze the death rate, severity of injuries, and direct medical costs caused by road traffic injuries (RTI) in the city of Tabriz in 2014. Methods: Trauma injury admissions due to RTI in Imam Reza Hospital in Tabriz City were investigated in terms of etiology and the direct medical costs during 2014–2015. Data were collected using a researcher-made checklist after being confirmed by relevant experts in terms of face validity. All information on direct medical costs are extracted from several sources including hospitals, database of the Ministry of Health and Medical Education, disaster and emergency medical management center, and public and private physiotherapy clinics across the city. Results: Review of the hospital records showed that the mean age of the patients (67.9% males and 32.1% females) was 34 ± 17.3 years. In addition, 79.2% of the patients were treated on an outpatient basis, and 20.8% were treated on a hospitalization basis (hospitalization or death). The mean times of inpatient and outpatient hospitalization for injuries were 3 h and 6.7 ± 5.3 days, respectively. Total direct medical costs were 11.631 dollars, of which 8% was for hospital costs, 9.7% for prehospital costs, and 2.3% for physiotherapy costs. Chest and lower part injuries had highest medical costs. From etiological standpoints, the greatest reason of being injured and hospitalization is multiple injuries and bruises, and the prominent cause of death was blow to the head and neck (70%). Conclusions: The results of the present study showed that direct medical costs in Tabriz during 2014–2015 were equal to 0.1% of GDP, which is a considerable amount. High economic and social costs of road accidents and their harmful physical and psychological effects on individuals and community require the attention of professionals and experts in the transportation industry and health-care system to determine appropriate strategies for interventions in reducing accidents' burden and injuries.

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Background: Problems of emotional regulation and lack of social skills in veterans' families are very common and like psychological complications have unpleasant consequences for them. Therefore, effective and helpful interventions and therapies are highly important. Objectives: The current study aimed at evaluating the effect of mindfulness-based stress reduction (MBSR) on the improvement of emotional regulation and psychological well-being in veterans' homemakers with secondary posttraumatic stress disorder. Patients and Methods: In the current study, the permuted blocked randomization method was used. Participants were selected from veterans' homemakers referred to the counseling center of veterans in Kashan city (Iran) in 2015. They were randomly assigned into two groups (30 controls and 31 cases). The case group underwent the MBSR treatment. Results: Results showed no significant difference between the two groups at the baseline (P < 0.05). No significant difference was observed in the total score of MBSR on emotional regulation between the groups. However, the difference between pre- and post-test of rejection of emotional response subscale was significant. In addition, the total score in the psychological well-being at pre- and post-test was significant. Conclusions: It seems that MBSR significantly affects the psychological well-being, but it has no effect on the emotional regulation except the subscale of emotional response rejection.

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Background and Objectives: Due to the high rate of pedestrian deaths in traffic accidents and given that describing demographic profiles of pedestrian deaths and features of accident locations is an important factor in the prevention, management, and analysis of road traffic accidents, this study aimed at describing the demographic and personal patterns as well as environmental factors affecting the occurrence of road traffic accidents among pedestrians in Iran. Materials and Methods: This cross-sectional study was conducted on all pedestrian deaths caused by traffic accidents referred to the Forensic Medicine Organization in Iran from March 20, 2012, to March 19, 2013. In this study, demographic information as well as the information related to the accidents and other information including trauma location, the final cause of death, date of accident, date of death, time of death, and time of accident were examined. The information received from the Forensic Medicine Organization was first controlled and then analyzed using the Stata 11 software. Results: From a total of 4371 pedestrians died in 2012 due to traffic accidents, 3201 cases (73.2%) were males with a mean age of 48.1 ± 0.46 years, and 1170 cases (23.8%) were females with the mean age of 46.1 ± 0.77 years. In terms of age, education, and marital status, the highest frequencies of pedestrian deaths were, respectively, observed in the age group 65 years old and above (33.4%), the illiterate group (44.5%), and married people (67.9%). The highest and the lowest incidence rates of death were seen in Gilan (11 per 1000 people) and South Khorasan Provinces (2.4 per 100,000), respectively. Conclusions: Pedestrians as the most vulnerable people in traffic accidents comprise a large proportion of deaths and disabilities caused by road traffic accidents. It seems necessary to take some measures including paying special attention to physiological characteristics of the age group above 65 years old, doing close monitoring by the traffic police in October and the rush hours, and providing facilities for pedestrians to cross in busy locations of suburban areas.

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The increasing prevalence of drug-resistant Pseudomonas aeruginosa in burned patients is one of the main public health problems worldwide. Although drug-resistant P. aeruginosa in burn units is frequent in some countries and unusual in others, the level of this conditions is not precisely known in Iran. Imipenem is one of the most potent agents against P. aeruginosa. Imipenem resistance is a major obstacle to treatment of P. aeruginosa infections. We aimed to determine the true prevalence of imipenem-resistant P. aeruginosa in Iranian burned patients according to the Preferred Reporting Items for Meta-Analyses statement. Moreover, resistance to several potent anti-P. aerugi nosa drugs were indicated according to the Clinical and Laboratory Standards Institute guidelines for the disc diffusion method. Several databases including Web of Science, Scopus, PubMed, Scientific Information Database, Magiran, Iranmedex, and science direct were searched to get studies addressing drug-resistant P. aeruginosa in Iranian burned patients from March 2006 to May 2015. A total of 34 reports available from different areas of Iran were included in the current study. The meta-analyses showed that 54.9% of P. aeruginosa were resistant to imipenem. The most common resistance was seen against ceftazidime (66.9%), followed by ciprofloxacin (52.9%) and cefepime (52.3%). It is necessary to know the epidemiology of drug-resistant P. aeruginosa because it can promote control strategies for decreasing their prevalence. The high incidence of drug-resistant P. aeruginosa in Iran emphasizes the need for precise drug susceptibility testing, continuous monitoring of drug resistance, especially in burn units, use of sensitive methods for the laboratory diagnosis, and close relation between physician and laboratories.

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Background: The number of total ankle replacements (TARs) is rapidly increasing in consequence of the availability of new designs allowing to save the range of motion and to preserve against adjacent joints degeneration. This study aimed to compare participation in sports 12 months after TAR with either mobile-bearing or fix-bearing prosthesis. Materials and Methods: One hundred and seventeen primary TARs were performed (77 Hintegra, 40 Zimmer Trabecular Metal Total Ankle). We retrospectively assessed pain and function using the visual analogue scale (VAS) pain scale, American Orthopedic Foot and Ankle Society (AOFAS), Short-Form Health Survey (SF-12 divided into Mental (MCS) and Physical (PCS) score) obtained preoperatively, 6 and 12 months postoperatively. Activity levels were determined using the Halasi ankle activity scale and the University of California at Los Angeles (UCLA) score obtained preoperatively and 12 months after the surgery. Radiographic examination included plain radiographs with full weight-bearing taken preoperatively and 12 months postoperatively. Results: All patients showed a significant improvement for AOFAS, VAS, and SF-12 scores (P < 0.05). The Halasi activity scale and UCLA score were 4.2 ± 1.2 and 6.6 ± 1.8, respectively, for the fix-bearing group and 3.7 ± 1.5 and 6.3 ± 2.3 for the mobile-bearing 12 months after the surgery. In our series, jogging, dancing, and skiing represented the three most frequent sports. In the fix-bearing group, 60% of the patients practiced sport 1 year after surgery and 49.4% in the mobile-bearing group. The fix-bearing prosthesis had a quicker recovery and better functional outcomes within the first 6 months after the operation. At 1 year, there was not a significant difference in return to sport and physical activities between patients treated with a mobile-bearing implant and a fix-bearing implant. Conclusions: At 1 year, both fixed and mobile bearing present significant improvements in functional and recreational scores, with neither prove superior.

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Introduction: Numerous geometrically simplified models may be found in the literature on simulation of the traumatic brain injuries due to the increased intracranial pressure induced by severe translational accelerations of the brain inside the cranium following the impact waves. While numerous researchers have utilized viscoelastic models, some have employed specific hyperelastic models for behavior analysis of the brain tissue. No research has been presented so far based on the more realistic visco-hyperelastic model. Materials and Methods: In the present research, a realistic finite element model and four visco-hyperelastic constitutive models (viscoelastic models on the basis of the polynomial, Yeoh, Arruda-Boyce, and Ogden hyperelastic models) are employed to accomplish the outlined task. Therefore, the main motivation of the present research is checking the accuracy of the modeling procedure rather than presenting clinical results. In this regard, a realistic skull-brain model is constructed in CATIA computer code based on the magnetic resonance imaging scans and optimized in the HYPERMESH finite element software. Results: Influence of the contact and nonlinear characteristics of the brain tissue are considered in the simulation of the relative motions in LS-DYNA software to predict time histories of the acceleration and the coup and countercoup pressures by means of ANSYS finite element analysis software. Discussion: Comparing results of the four proposed visco-hyperelastic constitutive models with the available experimental reveals that employing Arruda–Boyce or Ogden-type viscoelastic models may lead to inaccurate or even erroneous results.

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Objective: Venous thromboembolism (VTE) which includes deep vein thrombosis (DVT) and pulmonary embolism is a preventable complication in hospitalized trauma patients. Currently, the VTE guideline is the standard of care. However, underutilization of the guideline was reported. This study aimed to report the adherence to the VTE guideline in a Level 1 trauma center in Thailand. Methods: A retrospective review was performed on adult trauma patients admitted between January and December 2013. The inclusion criteria were Injury Severity Score ≥9 and admission in the hospital ≥7 days. The patients were classified into “very high risk of DVT,” “high risk of DVT,” and “high risk of bleeding” groups according to the hospital guideline. Adherence to the guideline, utility of the prophylaxis, and VTE occurrence were recorded. Results: During a 12-month period, 352 cases met the inclusion criteria. The overall adherence to the guideline was 28.9%, 5.2% in the “very high risk of DVT” group, 18.4% in the “high risk of DVT” group, and 57.9% in the “high risk of bleeding” group. VTE occurrence was 11 incidences in 10 patients (2.8%). The “high risk of bleeding” group had the highest in VTE occurrence (10 of 11 incidences). Conclusions: The adherence to the VTE prophylaxis guideline in Thailand was higher than previous studies. The pharmacological prophylaxis should be initiated as soon as possible.

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Accessory nerve is one of the most sensitive cranial nerves to injury, and its injuries are usually caused by iatrogenic interventions. As many other causes can mimic its clinical presentation, careful physical examination should be performed while evaluating a patient suspected of accessory neuropathy. In this report, we aimed to illustrate a very rare case with concurrent traumatic cranial neuropathies of accessory nerve, suprascapular nerve, and long thoracicus. A 16-year-old boy was admitted with complaints of shoulder weakness and pain following a trauma of strain injury. He had first taken the misdiagnosis of brachial plexopathy; however, after a detailed physical examination and electrophysiological study, the diagnosis of concurrent traumatic neuropathies of accessory, suprascapular, and long thoracicus nerves was made. In our opinion, during evaluation of these rare traumatic neuropathies, detailed clinical evaluations combined with detailed electromyography investigations may give crucial data for the proper diagnosis.

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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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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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Background: Field hockey is one of the most popular sports in the world, yet little is known about patient outcome following fracture injuries sustained during this sport. Objectives: The aim of this study is to describe the epidemiology, management, and outcome of field hockey-related fractures in a known UK population at all skill levels. Materials and Methods: All fractures sustained during field hockey from 2007 to 2008 within the adult Lothian population were prospectively recorded and confirmed by an orthopedic surgeon during treatment at the sole adult orthopedic center in the region. Nonresident individuals were not included in the study. Follow-up data were obtained in September 2010 to determine return rates and times to field hockey. Results: Nineteen fractures were recorded over the study period in 19 patients. Seventeen (89%) of the fractures were recorded in the upper limb, with 15 (79%) recorded in hand. Eighteen fractures (85%) in 18 patients (95%) were followed up at a mean interval of 31 months (range: 25-37 months; standard deviation [SD] 2.1 months). The mean time for return to field hockey from injury was 10.8 weeks (range: 3-26 weeks; SD 7.1 weeks). For patients with upper limb injuries, the mean time was 9.2 weeks (range: 3-20 weeks; SD 5.7 weeks), compared to 22 weeks (range: 18-26 weeks; SD 5.7 weeks) for patients with lower limb injuries. Eleven percent of the cohort did not return to field hockey. Seventy-eight percent of the cohort returned to field hockey at the same level or higher. Fifty percent had ongoing related problems, yet only 17% had impaired field hockey ability because of these problems. Fractures with the highest morbidity in not returning to field hockey were as follows: Metacarpal 14% and finger phalanx 13%. Conclusions: The significant majority of field hockey-related fractures are sustained in the upper limb, notably the hand. Around ninety percent of patients sustaining a fracture during field hockey will return to this sport at a similar level. While half of these will have persisting symptoms 2 years postinjury, only one-third of symptomatic patients will have impaired field hockey ability because of this.

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Background: Prehospital scores are used for determining the prognosis of trauma severity in trauma patients. Objectives: This study aimed at developing a new prehospital score for emergency medical service (EMS) staff to predict hospitalization in trauma patients transferred to the hospital. Patients and Methods: This study was a diagnostic test evaluation conducted on data of 1185 traumatic patients transferred through EMS to Poursina Hospital of Rasht between March 2012 and March 2013. Data were collected using a questionnaire with two parts. The first part included data on demography, injury, and type of interventions performed at the scene of the accident. The second part consisted of initial evaluations (Glasgow coma scale (GCS), oxygen saturation (O₂S), pulse rate (PR), systolic blood pressure (SBP), the ability to walk, and outcome (hospitalization, nonhospitalization). The questionnaire was filled out by EMS staff at the scene or during transfer to the hospital with respect to clinical observations. Data were analyzed using the logistic regression model. The Hosmer–Lemeshow test was also used to examine the good fit of model. Results: A total of 1185 patients were evaluated using prehospital data. Of seven variables evaluated by the scoring system, only four variables were identified in the regression analysis as predictors of hospitalization including age, SBP, O₂S, and walking ability. Sensitivity, specificity, and positive and negative likelihood ratios were 0.67, 0.68, 2.09, and 0.48, respectively. Conclusions: The GOMAAPS (GCS, O2S, mechanism of injury, age, ability to walk, PR, and SBP) score serves as a guide for the EMS staff at the scene to be understood of the necessity of transfer and predicting hospitalization.

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