The relationship between maternal mental health and communication skills in children in Shiraz, Iran / 한국역학회지

OBJECTIVES@#Child development is a significant issue in global public health, and maternal mental health (MMH) can have a remarkable effect on children's development of communication skills. We aimed to investigate the association between MMH and communication skills in a sample of Iranian children.@*METHODS@#This study was conducted in Shiraz, Iran during 2016. In total, 640 mothers who lived in Shiraz and were registered in the Fars Birth Cohort (FBC) study were invited to attend the FBC clinic with their children. A trained physician evaluated MMH using the General Health Questionnaire (GHQ). Additionally, a trained nurse assessed the children's communication development status using the Ages and Stages Questionnaire for 60-month old children.@*RESULTS@#The majority of the mothers were homemakers (82.8%) and had high school diplomas (38.9%). The mothers' mean age was 33.7±4.6 years. Seventy-nine (12.3%) children had delayed communication skills, but no significant association was found between children's communication skills and the mothers' total GHQ score (p=0.43). In total, 493 mothers (77.0%) had abnormal somatic symptoms, 497 (77.7%) had abnormal anxiety/insomnia, 337 (52.7%) had social dysfunction, and 232 (36.3%) suffered from depression. Logistic regression indicated that after adjusting for confounders, the odds of delayed communication skills were 3-fold higher among the children of mothers with abnormal somatic symptoms than among other children (p=0.01).@*CONCLUSIONS@#The study results confirmed that MMH had a significant impact on children's communication skills. Moreover, maternal abnormal somatic symptoms exerted the strongest impact on the development of communication skills in 5-year-old children.

The relationship between maternal mental health and communication skills in children in Shiraz, Iran / 한국역학회지

OBJECTIVES: Child development is a significant issue in global public health, and maternal mental health (MMH) can have a remarkable effect on children’s development of communication skills. We aimed to investigate the association between MMH and communication skills in a sample of Iranian children. METHODS: This study was conducted in Shiraz, Iran during 2016. In total, 640 mothers who lived in Shiraz and were registered in the Fars Birth Cohort (FBC) study were invited to attend the FBC clinic with their children. A trained physician evaluated MMH using the General Health Questionnaire (GHQ). Additionally, a trained nurse assessed the children’s communication development status using the Ages and Stages Questionnaire for 60-month old children. RESULTS: The majority of the mothers were homemakers (82.8%) and had high school diplomas (38.9%). The mothers’ mean age was 33.7±4.6 years. Seventy-nine (12.3%) children had delayed communication skills, but no significant association was found between children’s communication skills and the mothers’ total GHQ score (p=0.43). In total, 493 mothers (77.0%) had abnormal somatic symptoms, 497 (77.7%) had abnormal anxiety/insomnia, 337 (52.7%) had social dysfunction, and 232 (36.3%) suffered from depression. Logistic regression indicated that after adjusting for confounders, the odds of delayed communication skills were 3-fold higher among the children of mothers with abnormal somatic symptoms than among other children (p=0.01). CONCLUSIONS: The study results confirmed that MMH had a significant impact on children’s communication skills. Moreover, maternal abnormal somatic symptoms exerted the strongest impact on the development of communication skills in 5-year-old children.

The relationship between maternal mental health and communication skills in children in Shiraz, Iran / 한국역학회지

OBJECTIVES: Child development is a significant issue in global public health, and maternal mental health (MMH) can have a remarkable effect on children's development of communication skills. We aimed to investigate the association between MMH and communication skills in a sample of Iranian children.METHODS: This study was conducted in Shiraz, Iran during 2016. In total, 640 mothers who lived in Shiraz and were registered in the Fars Birth Cohort (FBC) study were invited to attend the FBC clinic with their children. A trained physician evaluated MMH using the General Health Questionnaire (GHQ). Additionally, a trained nurse assessed the children's communication development status using the Ages and Stages Questionnaire for 60-month old children.RESULTS: The majority of the mothers were homemakers (82.8%) and had high school diplomas (38.9%). The mothers' mean age was 33.7±4.6 years. Seventy-nine (12.3%) children had delayed communication skills, but no significant association was found between children's communication skills and the mothers' total GHQ score (p=0.43). In total, 493 mothers (77.0%) had abnormal somatic symptoms, 497 (77.7%) had abnormal anxiety/insomnia, 337 (52.7%) had social dysfunction, and 232 (36.3%) suffered from depression. Logistic regression indicated that after adjusting for confounders, the odds of delayed communication skills were 3-fold higher among the children of mothers with abnormal somatic symptoms than among other children (p=0.01).CONCLUSIONS: The study results confirmed that MMH had a significant impact on children's communication skills. Moreover, maternal abnormal somatic symptoms exerted the strongest impact on the development of communication skills in 5-year-old children.

Establishment of an early warning system for cutaneous leishmaniasis in Fars province, Iran

Objective: To establish an early warning system for cutaneous leishmaniasis in Fars province, Iran in 2016. Methods: Time-series data were recorded from 29 201 cutaneous leishmaniasis cases in 25 cities of Fars province from 2010 to 2015 and were used to fit and predict the cases using time-series models. Different models were compared via Akaike information criterion/Bayesian information criterion statistics, residual analysis, autocorrelation function, and partial autocorrelation function sample/model. To decide on an outbreak, four endemic scores were evaluated including mean, median, mean + 2 standard deviations, and median + interquartile range of the past five years. Patients whose symptoms of cutaneous leishmaniasis began from 1 January 2010 to 31 December 2015 were included, and there were no exclusion criteria. Results: Regarding four statistically significant endemic values, four different cutaneous leishmaniasis space-time outbreaks were detected in 2016. The accuracy of all four endemic values was statistically significant (P<0.05). Conclusions: This study presents a protocol to set early warning systems regarding time and space features of cutaneous leishmaniasis in four steps: (i) to define endemic values based on which we could verify if there is an outbreak, (ii) to set different time-series models to forecast cutaneous leishmaniasis in future, (iii) to compare the forecasts with endemic values and decide on space-time outbreaks, and (iv) to set an alarm to health managers.

Determining endemic values of cutaneous leishmaniasis in Iranian Fars province by retrospectively detected clusters and receiver operating characteristic curve analysis

Objective: To determine the endemic values of cutaneous leishmaniasis in different cities of Fars province, Iran. Methods: Totally, 29 201 cases registered from 2010 to 2015 in Iranian Fars province were selected, and the endemic values of cutaneous leishmaniasis were determined by retrospective clusters derived from spatiotemporal permutation modeling on a time-series design. The accuracy of the values was assessed using receiver operating characteristic (ROC) curve. SPSS version 22, ArcGIS, and ITSM 2002 software tools were used for analysis. Results: Nine statistically significant retrospective clusters (P<0.05) resulted in finding seven significant and accurate endemic values (P<0.1). These valid endemic scores were generalized to the other 18 cities based on 6 different climates in the province. Conclusions: Retrospectively detected clusters with the help of ROC curve analysis could help determine cutaneous leishmaniasis endemic values which are essential for future prediction and prevention policies in the area.

Does prospective permutation scan statistics work well with cutaneous leishmaniais as a high-frequency or malaria as a low-frequency infection in Fars province, Iran?

Objective: To determine whether permutation scan statistics was more efficient in finding prospective spatial-temporal outbreaks for cutaneous leishmaniasis (CL) or for malaria in Fars province, Iran in 2016. Methods: Using time-series data including 29 177 CL cases recorded during 2010-2015 and 357 malaria cases recorded during 2010-2015, CL and malaria cases were predicted in 2016. Predicted cases were used to verify if they followed uniform distribution over time and space using space-time analysis. To testify the uniformity of distributions, permutation scan statistics was applied prospectively to detect statistically significant and non-significant outbreaks. Finally, the findings were compared to determine whether permutation scan statistics worked better for CL or for malaria in the area. Prospective permutation scan modeling was performed using SatScan software. Results: A total of 5 359 CL and 23 malaria cases were predicted in 2016 using time-series models. Applied time-series models were well-fitted regarding auto correlation function, partial auto correlation function sample/model, and residual analysis criteria (P

Prognostic Factors of Breast Cancer Survival in the Islamic Republic of Iran: an Additive Empirical Bayesian Approach

Breast cancer is a public health challenge in the Islamic Republic of Iran. Relatively few studies have dealt with large dataset and advanced statistical methods. Therefore, we aimed to investigate the role of prognostic factors on breast cancer survival using Additive Empirical Bayesian model with large data set. Breast cancer data set included 1574 women diagnosed with breast cancer from 2002 to 2012 that registered from Cancer Registry in Fars Province, Islamic Republic of Iran. Overall survival rates at 2, 3, 5 and 10 years were 0.98, 0.94, 0.87 and 0.76, respectively. Five years survival at stages 1, 2 and 3 were 0.94, 0.92 and 0.74, respectively. The younger patients with characteristics such as zero involved nodes, negative progesterone receptor, free skin and good prognostic level had a higher survival chance than others. The 5-year survival probability by stage in Fars Province was nearly the same as that reported by the American Cancer Society. The Nottingham prognostic index [NPI] related to nodal status, tumour size and nuclear grade was the main indicator of breast cancer mortality

incidence of uterus cancer in Iran: a systematic review

Background: Uterus cancer is one of the main causes of death in the female population, which mostly occurs in low- or middle-income countries. Up to now, many descriptive studies have been conducted on the prevalence of uterus cancer in Iran and its relationship with various factors. Thus, the present study aimed to summarize the data relevant to the incidence of uterus cancer in Iran

Methods: All the published reports on the incidence of uterus cancer in Iran were gathered through exploration of international journals. Accordingly, population-based articles and those that defined the topic clearly and reported age-specific rate [ASR] were included in the study. In order to extract the required information, all the articles were studied carefully and some were entered in the report

Results: Out of the 130 articles, three were selected through careful screening for the final report. These studies were performed on 1086, 8359 and 652 cases and reported ASRs of 0.01, 0.027, and 0.026 in 1000 individuals, respectively

Discussion: In this study, the incidence of uterus cancer and its geographical diversity in Iran was systematically taken into consideration for the first time. A total of 19875 individuals were studied in three selected articles. The results indicated that the incidence of this cancer followed an ascending trend

Spatiotemporal clustering of cutaneous leishmaniasis in Fars province, Iran

Objective To assess the spatiotemporal trait of cutaneous leishmaniasis (CL) in Fars province, Iran. Methods Spatiotemporal cluster analysis was conducted retrospectively to find spatiotemporal clusters of CL cases. Time-series data were recorded from 29 201 cases in Fars province, Iran from 2010 to 2015, which were used to verify if the cases were distributed randomly over time and place. Then, subgroup analysis was applied to find significant sub-clusters within large clusters. Spatiotemporal permutation scans statistics in addition to subgroup analysis were implemented using SaTScan software. Results This study resulted in statistically significant spatiotemporal clusters of CL (P < 0.05). The most likely cluster contained 350 cases from 1 July 2010 to 30 November 2010. Besides, 5 secondary clusters were detected in different periods of time. Finally, statistically significant sub-clusters were found within the three large clusters (P < 0.05). Conclusions Transmission of CL followed spatiotemporal pattern in Fars province, Iran. This can have an important effect on future studies on prediction and prevention of CL.

Nutritional assessment in critically III patients

Background: Malnutrition is an important factor in the survival of critically ill patients. The purpose of the present study was to assess the nutritional status of patients in the intensive care unit [ICU] on the days of admission and discharge via a detailed nutritional assessment

Methods: Totally, 125 patients were followed up from admission to discharge at SICUs in Shiraz, Iran. The patients' nutritional status was assessed using subjective global assessment [SGA], anthropometric measurements, biochemical indices, and body composition indicators. Diet prescription and intake was also evaluated

Results: Malnutrition prevalence significantly increased on the day of discharge [58.62%] compared to the day of admission [28.8%] according to SGA [P<0.001]. The patients' weight, mid-upper-arm circumference, mid-arm muscle circumference, triceps skinfold thickness, and calf circumference decreased significantly as well [P<0.001]. Lean mass weight and body cell mass also decreased significantly [P<0.001]. Biochemical indices showed no notable changes except for magnesium, which decreased significantly [P=0.013]. A negative significant correlation was observed between malnutrition on discharge day and anthropometric measurements. Positive and significant correlations were observed between the number of days without enteral feeding, days delayed from ICU admission to the commencement of enteral feeding, and the length of ICU stay and malnutrition on discharge day. Energy and protein intakes were significantly less than the prescribed diet [26.26% ancf 26.48%, respectively]

Conclusion: Malnutrition on discharge day increased in the patients in the ICU according to SGA. Anthropometric measurements were better predictors of the nutritional outcome of our critically ill patients than were biochemical tests

Early acute kidney injury based on serum creatinine or cystatin C in intensive care unit after major trauma

Background: Acute kidney injury [AKI] is a common problem in critically ill patients and is independently associated with increased morbidity and mortality. Recently, serum cystatin C has been shown to be superior to creatinine in early detection of renal function impairment. We compared estimated GFR based on serum cystatin C with estimated GFR based on serum creatinine for early detection of renal dysfunction according to the RIFLE criteria

Methods: During 9months, three hundred post trauma patients that were referred to the intensive care unit of a referral trauma hospital were recruited. Serum creatinine and serum cystatin C were measured and the estimated GFR within 24 hours of ICU admission was calculated. The primary outcome was the incidence of AKI according to the RIFLE criteria within 2[nd] to 7[th] day of admission

Results: During the first week of ICU admission, 21% of patients experienced AKI. After adjusting for major confounders, only the patients with first day's serum cystatin level higher than 0.78mg/l were at higher risk of first week AKI [OR=6.14, 95% CI: 2.5-14.7, P<0.001]. First day's serum cystatin C and injury severity score were the major risk factors for ICU mortality [OR=3.54, 95% CI: 1.7-7.4, P=0.001] and [OR=4.6, 95% CI: 1.5-14, P=0.007], respectively

Conclusion: Within 24 hours after admission in ICU due to multiple trauma, high serum cystatin C level may have prognostic value in predicting early AKI and mortality during ICU admission. However, such correlation was not seen neither with creatinine nor cystatin C based GFR

Intensified or routine case finding for pulmonary tuberculosis among HIV-infected patients: which is better?

Background: Intensified strategy includes special attention to the symptoms such as cough [more than two weeks], fever [more than three weeks], night sweats [more than three weeks], and weight loss [more than 3 kg per month]. If any of the above symptoms was positive, in suspected individuals for TB, more assessment should be done. The aim of this study was to compare between intensified and routine case finding for a better case selection method for diagnosis of pulmonary tuberculosis among HIV-Infected Persons

Methods: The sample size was calculated 237 patients [474 for the two groups]. In the current study, the patients were divided randomly into two groups: A] intensified case finding group and B] routine case finding group. Considering the sputum culture as the gold standard, we calculated the sensitivity and specificity, Positive predictive value [PPV], Negative predictive value [NPV] for fever, weight loss, coughing more than two week, night sweats, and PPD test

Result: A total of eight positive cases of tuberculosis were detected in the intensified while four were found in the routine case finding group. Sensitivity, specificity, PPV, and NPV for cough in diagnosis of TB were 25%, 87%, 6%, and 97%, respectively. For weight loss, they were 62.5%, 83%, 10.8%, and 98.5% respectively while these amounts were, 7%, 85%, 97.6, 37.5 for night sweats. For fever, they were, 25%, 92.9%, 10.5%, and 97% respectively, and for PPD they were 87.5%, 40%, 4.6%, and 98.9%, respectively

Conclusion: Key symptom screening, such as cough, fever, weight loss and night sweats, has an important role in detecting TB among HIV-infected patients

Effect of behavioral intention model-based education on decrease the rate of caesarean delivery among pregnant women

Caesarean section is considered as a major surgery which is accompanied by several complications. The present study aimed to determine the effect of behavioral intention model-based educational intervention on reducing the caesarean section among pregnant women. The present interventional study was conducted on 100 primiparous women in the third trimester of pregnancy who were covered by the health and treatment centers of Fasa city, placed in Fars province, Iran. The subjects were selected through simple random sampling and divided into an intervention and a control group. After the pre-test, the intervention group underwent exclusive training based on the behavioral intention model. Then, both groups took part in the post-test and the data were analyzed using paired t-test, independent t-test, and chi-square tests. The results of the study revealed a significant difference between the two groups regarding knowledge, evaluation of the outcomes, attitude, and intention [P<0.001]. The results of the chi-square test also showed a significant difference between the two groups regarding their performance [P<0.001]. According to the results, the present intervention was effective in increasing the pregnant women's knowledge, evaluation of outcomes, attitude and strengthening their intention as well as performance. Thus, this model and other systematic trainings are suggested to be used for pregnant women in order to decrease the rate of caesarean section

Association between Iron deficiency anemia and febrile convulsion in 3- to 60-month-old children: a systematic review and meta-analysis

Controversy exists regarding the association between Iron Deficiency Anemia [IDA], iron status, and Febrile Convulsion [FC] during childhood. In this article, a systematic review and meta-analysis is conducted in order to determine possible association and the degree of association between these statuses and FC. To identify all studies related to IDA and FC, various references such as MEDLINE [PubMed], Embase [OVID], Web of sciences [Thomson Reuters] and Google scholar were searched [up until 15 January 2013]. Heterogeneity was assessed using the Q statistic, Tau[2], and I[2]. Additionally, subgroup analyses were performed. The outcome of primary interest was the overall Odds Ratio [OR] of FC for IDA and standard mean differences [SMD] of ferritin level. In total, 21 articles were considered to assess the association between IDA and FC. Anemia was more prevalent among the FC patients compared with the controls and the overall OR was 1.52 [95% CI=1.03 to 2.25]. In addition, the pooled OR for 17 studies performed in the populations with low and moderate prevalence of anemia was 2.04 [95% CI=1.46 to 2.85]. Furthermore, 12 studies assessed the association between the ferritin level and FC. The overall SMD was -0.02 with a 95% CI of -0.09 to 0.06. Besides, the pooled SMD of ferritin was -0.57 [95% CI=-0.7 to -0.46] in 6 studies reporting no difference between the FC and the control group with respect to temperature. IDA was associated with a moderate increased risk of FC in children, particularly in the areas with low and moderate prevalence of anemia

effect of quercetin supplementation on oxidative stress, glycemic control, lipid profile and insulin resistance in type 2 diabetes: a randomized clinical trial

Background: Diabetes Mellitus [DM] is closely associated with reduction of antioxidant defense system. In the present study, we investigated the antioxidant effect of quercetin supplementation on the glycemic control, lipid profile and oxidative stress indices in patients with type 2diabetes

Methods: Forty seven patients with type 2 diabetes, aged 30-60 years old, were randomly assigned to supplement their daily diet with either an oral quercetin [250 mg/d] or identical placebo [cellulose] capsules for 8 weeks. The supplements were provided to the patients biweekly. Anthropometric data as well as glycemic indices, lipid profile and oxidative stress parameters of blood samples were determined at the baseline and endpoint of the study

Results: Dietary quercetin supplementation significantly improved the total antioxidant capacity [TAC] in the intervention group, when compared to the placebo group [P=0.043]. It also resulted in a statistically significant reduction in serum concentration of atherogenic oxidized LDL [ox-LDL] [P<0.001]. However, the 8-week supplementation of this natural flavonol neither altered glycemic parameters [FBS, serum insulin and glycosylated Hb [HbA1c] level] nor lipid profile and insulin function measurement in diabetic patients [P>0.05]

Conclusions: Oral quercetin supplementation was beneficial in improving the antioxidant status of patients with type 2 diabetes while having no other significant effect on glycemic control and lipid profile; however, conducting further studies, using different doses, on the glycemiccontrol and/or hyperlipidemia of thepopulation seems to be valuable

performance of Trauma Research Centers of Iran during the past 10 years; a science monitor survey

Objective: To compare and evaluation of scores of trauma research center of Shiraz University of Medical Sciences in Iran with other trauma research centers in Iran

Methods: The assessment scores of each center were gathered from Iran medical research and Ministry of Health and Medical Education website. Each score is recorded in helical year which is defined from the 21[th] of March of every year until the 20[th] of March of the next. They are ranked and scored by knowledge production, capacity development, and research projects

Results: The total evaluation scores of the trauma research center of Iran's Universities of Medical Sciences have increased from establishment. The highest increase in assessment scores was related to Tehran Trauma Research Center. An upward trend was observed in the total indicators of knowledge production index of all the trauma research centers from 2001/2002 to 2011/2012. An ascending trend was showed in the published articles score of Shiraz and Kashan Trauma Research Centers through the recent years

Conclusion: The increasing trend in scores of trauma research centers in Iran indicated a significant role in the knowledge production but it is need to find barriers of research and doing interventional projects to promote trauma care and prevention

Erythropoietin plus methylprednisolone or methylprednisolone in the treatment of acute spinal cord injury: a preliminary report

Recent studies in animal models indicate that recombinant human erythropoietin [rhEPO] is very effective in enhancing neurological recovery after spinal cord injury [SCI]. We aimed to evaluate the effect of rhEPO plus methylprednisolone sodium succinate [MPSS] compared to MPSS alone to improve neurological function of patients after SCI in a randomized clinical trial. During a 15-month period 30 patients presenting to emergency departments of two university affiliated hospitals within less than 6 hours after acute SCI were randomized to two groups. Both groups received MPSS 30 mg/kg initially and 5.4 mg/kg every hour till 23 hours if admitted within 3 hours and till 47 hours if recruited within 3-6 hours after injury. Group EPO also received 500unit/kg rhEPO on admission and another 500 unit/kg 24 hours later instead of placebo in group MPSS. Neurologic evaluation was performed on admission, 24, 48, 72 hours and one and 6 months later. Range of patients' age was 18-65 years. There was no significant difference between patients receiving two types of treatment in neurological exam on admission [P=0.125], 24 hours after admission [P=0.108] and 48 hours after admission [P=0.085]. However, one week [P=0.046], one month [P=0.021] and six months [P=0.018] after admission these differences were significant. MPSS plus rhEPO started within 6 hours after acute spinal injury may be more effective than MPSS plus placebo in improvement of neurologic dysfunction. More studies with larger sample sizes are warranted

Interposition of ileal J-pouch for rectum reconstruction in dog

Background: The gold standard of the management of rectal cancer in the middle and lower parts is low anterior resection with coloanal anastomosis. About 50% of the patients undergoing this procedure might experience some complications because of the low capacity of the neorectum. The aim of this study was to evaluate ileal J-pouch interposition as a neorectum between the anal canal and the remaining colon in comparison to coloanal anastomosis and transverse coloplasty

Methods: Twelve dogs, weighing 23-27 kg, were divided into three groups. After laparotomy, the volume of the primary rectum was measured so that it could be compared with that of the neorectum at the end of the study. After rectal resection in Group A, the colon was directly anastomosed to the anus. In Group B, a 5-cm longitudinal incision was made 2 cm proximal to the anastomosis and was sutured transversely [coloplasty]. In Group C, a 5-cm ileal J-pouch was interposed between the colon and anus. After 8 weeks, the neorectum was evaluated for volume, radiology, and pathology

Results: All the samples were alive until the end of the study. The healing of the anastomotic lines was acceptable [pathologically] in all. The mean volume expansion was 20.9% in Group A, 21.7% in Group B, and 118.2% in Group C, with the latter being significantly higher than that of the other groups [P=0.03]. Colon J-pouch and coloplasty after proctectomy in some situations have not been performable. This study evaluated the performance of ileal J-pouch interposition

Conclusion: This study showed that ileal J-pouch interposition might produce an acceptable reservoir function and that it seems feasible and safe in selected cases

Socioeconomic inequity in health care utilization, Iran

Reducing poor-rich inequities in health is one of the priorities of both national and international organizations and is also one of the main challenges of health sectors in Iran. Since, in the view of policy making, quantifying the size of inequity in health care utilization [HCU] is a prerequisite for achieving this goal, the current study aimed to determine and compare the socioeconomic inequity in HCU by concentration [C] index and odds ratio [OR]. A total of 758 households, consisting of 2,131 subjects who were aged 15 or older, were involved in this cross-sectional study, and their data were gathered through interviews. Household economic index [HEI] was created by the factor analysis from the asset data. The C index and OR were used as measures to determine the overall inequity in HCU according to sex [male/female], living area [urban/rural], insurance, and types of HCU [general physician [GP], specialist, and Health Workers [HWs]]. The overall rate of HCU was 66.4%. The rates of using GP, specialist care, and HW care were 21.4%, 21.6% and 21.8%, respectively. The overall inequity in HCU was equal to 0.05 [95% confidence interval; -0.069 to 0.165]. The C indexes in HCU, according to the subgroups of HCU, were measured as 0.11 [0.09-0.12] for GP, 0.115 [0.01-0.13] for specialist and -0.065 [-0.08 to -0.05] for HWs. Although the rate of utilization increased from poor to rich quintiles, the inequity regarding sex and living area was also low and non-significant. People with higher HEI used more specialist and GP care, while people with lower HEI used more HW care. The inequity in HCU was low and non-significant in different quintiles of males, females, urban and rural, as well as those who were insured

Role of physical examination in decision making for selective exploration in patients with penetrating zone ii neck injury

Objective: To evaluate the role of physical examination in decision making for exploring patients with penetrating zone II neck injury

Methods: This was a cross-sectional study being performed in a level I trauma center between 2006 and 2010. The present study reviewed the records of 150 patients with penetrating neck injuries. Of 46 cases with zone II deep platysma neck injuries, 3 patients died before taking any significant medical measure

Results: Thirty of 43 patients [70%] presented with hard sings while 13 [30%] did not show these sings. All patients underwent neck exploration. Two patients [4.6%] without hard sings exhibited positive findings, whereas 29 cases [67%] with hard sings reported positive on exploration

Conclusion: Briefly, we hold the view that it seems reasonable to follow an algorithmic approach by using physical examination of the patients with zone II penetrating neck injuries. This prevents unnecessary exploration for management of such patients