Road traffic deaths in Kashan region, Iran: An eight-year study (2006-2013) / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>The aim of this study was to analyze the trend of road traffic fatalities in Kashan Region, Iran, in a period of eight years.</p><p><b>METHODS</b>Through a cross-sectional study, all road traffic deaths classified under the V01V99 codes according to ICD-10 in Kashan region, central Iran, from March 2006 to March 2013 and population data were collected from the registration system of Kashan University of Medical Sciences. Years of lost life (YLL) and mortality rates were calculated regarding age, gender and year of the accident. Generalized linear model (GLM) with Poisson log-linear link was used to evaluate the effects of the mentioned variables on mortality rate.</p><p><b>RESULTS</b>During the period of the study (8 years), 928 people (767 men) died due to road traffic injuries (RTIs). The total YLL was 20,818. The mortality rate due to RTIs has been declined constantly from 43.1 in March 2006 to 21.1 per 100,000 in March 2013. The highest mortality rate was found in the age group of over 60 years old and the lowest in the age group of 0-14 years old. Both mortality rate and YLL was greater in men than in women. Poisson regression showed that age, gender and year of the accidents had a significant effect on mortality rate (p < 0.001).</p><p><b>CONCLUSION</b>Although there has been a constant decline of mortality rate in Kashan area within the study period, the value remains higher than the mean level of Eastern Mediterranean region and the global average, which is a notable fact for policymakers and authorities.</p>

Cervical length versus vaginal PH in the second trimester as preterm birth predictor

To evaluate diagnostic value of vaginal pH and cervical length measurement in the second trimester of pregnancy as a preterm labor [PTL] predictor. During a prospective cohort study 438 uncomplicated singleton pregnant women between 18 and 24 weeks of gestation were assessed regarding vaginal PH and cervical length. Vaginal pH was measured using Ph-indicator strips and cervical length was determined using transvaginal ultrasound. The cut-off values for vaginal PH and cervical length were defined as 5 and <30 mm respectively. Vaginal pH of 5 and above was found in 162/438 women [37%] while cervical length <30 mm was found in 38/438 [8.7%]. The incidence of PTL < 37 weeks was 87/438 [19.9%] while the incidence of early [PTL <34 weeks] was 51/438 [11.6%]. Predictive value of higher vaginal PH was significantly more [31%] than vaginal PH<5 [13%] in predicting PTL. As a result, alkaline vaginal PH significantly increases the odds of preterm labor [OR=3.06]. Shortened cervical length is better predictor of PTL than higher vaginal PH with positive predictive value of 71% and negative predictive value of 85%. Cervical length less than 30 mm nearly 14-fold increases odds of preterm birth [OR=13.9]. Compared to alkaline vaginal PH, shortened cervical length has better value to predict PTL overall. However, regarding early or late PTL, vaginal PH is more accurate to predict late PTL, while cervical length measurement is more appropriate to predict early PTL [<34 weeks]

Cerebral state index versus Glasgow coma scale as a predictor for in-hospital mortality in brain-injured patients / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To compare the value of Glasgow coma scale (GCS) and cerebral state index (CSI) on predicting hospital discharge status of acute brain-injured patients.</p><p><b>METHODS</b>In 60 brain-injured patients who did not receive sedatives, GCS and CSI were measured daily during the first 10 days of hospitalization. The outcome of prognostic cut-off points was calculated by GCS and CSI using receiver operating characteristic (ROC) curve regarding the time of admission and third day of hospitalization. Sensitivity, specificity and other predictive values for both indices were calculated.</p><p><b>RESULTS</b>Of the 60 assessed patients, 14 patients had mild, 13 patients had moderate and 33 patients had severe injuries. During the course of the study, 17 patients (28.3%) deteriorated in their situation and died. The mean GCS and CSI in patients who deceased during hospitalization was significantly lower than those who were discharged from the hospital. GCS<4.5 and CSI<64.5 at the time of admission was associated with higher mortality risk in traumatic brain injury patients and GCS was more sensitive than CSI to predict in-hospital death in these patients. For the first day of hospitalization, the area under ROC curve was 0.947 for GCS and 0.732 for CSI.</p><p><b>CONCLUSION</b>GCS score at ICU admission is a good predictor of in-hospital mortality. GCS<4.5 and CSI<64.5 at the time of admission is associated with higher mortality risk in traumatic brain injury patients and GCS is more sensitive than CSI in predicting death in these patients.</p>

Misoprostol Abortion: ultrasonography versus Beta-hCG testing for verification of effectiveness

Miscarriage is a common complication of early pregnancy with medical and * psychological consequences. Dilation and Curettage are considered as two standard caring ways for early I pregnancy failure. Alternatively misoprostol has been used as a single agent for termination of early I pregnancy. Aim of the present study was to compare the usefulness of serum B-hCG measurement and ultrasound examination to predict complete abortion after medical induction. There were one hundred and thirty three patients experiencing missed abortion or blighted ovum. Ultrasound examination and serum 6-hCG test were performed before treatment and during follow-up in all these patients. Treatment was successful without any need for surgical intervention in 92.4% of the cases. Both methods could verify the complete abortion among all the patients at the end of the study [4[th] week]. Kappa agreement coefficient for the two methods of diagnosis was 0.327 [P < 0.5]. Based on our results, B- hCG is as effective as ultrasound in confirming a successful medically induced abortion in early pregnancy, but it should be used as supplements to clinical assessments

Use of letrozole versus clomiphene citrate combined with gonadotropins in patients with clomiphene resistant polycystic ovarian syndrome: a comparative study

To compare the clinical outcomes between letrozole and clomiphene citrate [cc] combined with gonadotropins in Clomiphene - resistant polycystic ovary syndrome [PCOS] patients. One hundred and twenty PCOS women after clomiphene response failure were randomly divided into two equal groups to receive clomiphene [100 mg/day] or letrozole [5mg/ day] on days 3-7 of menstrual cycle, combined with human menopausal gonadotropin at a dose 150 IU on days 5-8. The number of dominant follicles, consumed gonadotropin ampoules, endometrial thickness, and clinical pregnancy rates were compared. No significant difference was found regarding the number of dominant follicles, endometrial thickness and consumed gonadotropin ampoules between letrozole and CC groups. Although, the pregnancy rate in letrozole group was higher than that of the CC, the difference was not significant [36.7% vs. 33.3%, p=0.702]. In clomiphene - resistant PCOS patients, similar to Clomiphene, letrozole in combined regimens with gonadotropin can be effective for the induction of ovulation