Comparison of the predictive value of the Helsinki, Rotterdam, and Stockholm CT scores in predicting 6-month outcomes in patients with blunt traumatic brain injuries / 中华创伤杂志(英文版)

PURPOSE@#Despite advances in modern medicine, traumatic brain injuries (TBIs) are still a major medical problem. Early diagnosis of TBI is crucial for clinical decision-making and prognosis. This study aims to compare the predictive value of Helsinki, Rotterdam, and Stockholm CT scores in predicting the 6-month outcomes in blunt TBI patients.@*METHODS@#This cohort study was conducted on blunt TBI patients of 15 years or older. All of them were admitted to the surgical emergency department of Shahid Beheshti Hospital in Kashan, Iran from 2020 to 2021 and had abnormal trauma-related findings on brain CT images. The patients' demographic data such as age, gender, history of comorbid conditions, mechanism of trauma, Glasgow coma scale, CT images, length of hospital stay, and surgical procedures were recorded. The Helsinki, Rotterdam, and Stockholm CT scores were simultaneously determined according to the existing guidelines. The included patients' 6-month outcome was determined using the Glasgow outcome scale extended. M Data were analyzed by SPSS software version 16.0. Sensitivity, specificity, negative/positive predictive value and the area under the receiver operating characteristic curve were calculated for each test. The Kappa agreement coefficient and Kuder Richardson-20 were used to compare the scoring systems.@*RESULTS@#Altogether 171 TBI patients met the inclusion and exclusion criteria, with the mean age of (44.9 ± 20.2) years. Most patients were male (80.7%), had traffic related injuries (83.1%) and mild TBIs (64.3%). Patients with lower Glasgow coma scale had higher Helsinki, Rotterdam, and Stockholm CT scores and lower Glasgow outcome scale extended scores. Among all the scoring systems, the Helsinki and Stockholm scores showed the highest agreement in predicting patients' outcomes (kappa = 0.657, p < 0.001). The Rotterdam scoring system had the highest sensitivity (90.1%) in predicting death of TBI patients, whereas the Helsinki scoring system had the highest sensitivity (89.8%) in predicting the 6-month outcome in TBI patients.@*CONCLUSION@#The Rotterdam scoring system was superior in predicting death in TBI patients, whereas the Helsinki scoring system was more sensitive in predicting the 6-month outcome.

Return to work after trauma: A survival analysis / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>To evaluate the return to work (RTW) rate, time and predictors among trauma patients using survival analysis.</p><p><b>METHODS</b>This cohort study was conducted with a three-month follow-up on 300 trauma patients hospitalized in Shahid Beheshti Hospital, Kashan, Iran in 2014. The data were collected through conducting interviews and referring to patients' medical records during their hospital stay and follow-up information at one & three months after discharge from hospital. Final analysis was conducted on the data retrieved from 273 patients. Data were analyzed by chi-square test, Mann-Whitney U test and survival analysis method.</p><p><b>RESULTS</b>The rate of RTW at the end of the first and the third follow-up months was respectively 21.6% and 61.2%. Survival analysis showed that the RTW time (Time between admission to first return to work) was significantly longer among patients with illiteracy, drug abuse, hospitalization history in the intensive care unit, low socioeconomic status, non-insurance coverage, longer hospital stay, multiple and severe injuries as well as severe disability.</p><p><b>CONCLUSION</b>Our findings indicated that trauma has profound effects on the rate and time of RTW. Besides disability, many personal and clinical factors can affect the outcome of RTW.</p>

[ effect of letrozole on symptomatic uterine leiomyomas]

Uterine leiomyomas are the most common benign tumors of the uterine, and several medical treatments have been suggested for these myomas. This study was conducted with the aim of determining the effect of letrozole on symptomatic uterine leiomyomas in patients referring to Naghavi Clinic in Kashan city. This study is a before and after clinical trial, in which 30 premenopausal women with large symptomatic uterine leiomyoma equal to 3cm received 2.5mg letrozole daily for 90 days continuously. Then, the effect of letrozol on uterine and myoma size, hemoglobin, FSH, LH, and estradiol levels and also accompanied symptoms such as amount and duration of menstrual bleeding and dysmenorrhea were evaluated. Data were analyzed by statistical tests such as paired t-test and test. Levels of p<0.05 were considered as significant. In this study, letrozole had significant effect on decrease in uterine volume [p=0.001] and myoma volume [p<0.001]. Also, the means of amount [p<0.001] and duration [p=0.007] of menstrual bleeding decreased and hemoglobin increased by 8% [p<0.001], but have no effect on FSH, LH and, estradiol levels. The results of this study showed that letrozole leads to decrease in leiomyoma and uterine size, amount and duration of menstruation, and increase in hemoglobin level. Therefore, this drug can be used for treatment of symptomatic uterine leiomyomas

duration of the third stage of labor and related factors

Third stage of labor has been defined as the most dangerous stage. Due to the importance of the third stage, this study was performed in order to determine its length and related factors. This research is a cross sectional study which was carried out on 1000 deliveries in Shabihkhani Hospital [Kashan-Iran]. Inclusion criteria consist of gestational age of higher than 20 weeks, singleton pregnancy, and vaginal delivery without any instrument. The mean, median and standard deviation of the third stage of labor were 6.03, 5 and 5.15 minutes respectively. The finding also showed that there was a significant association between Para, Induction of labor, use of analgesic drugs during labor [pethidin], and umbilical drainage for third stage management [p < 0.05]. There was no significant association between a history of Abortion, Gestational age and Third stage management [Oxytosine]. The use of Induction, analgesic drugs during labor and umbilical drainage prolonged the third stage of labor, but multiparity decreased the duration of this stage. The diagnosis of these factors is recommended in order to predict and prevent the occurrence of the third stage dangers.