Comparing epidemiologic features, outcomes, and diagnostic and therapeutic procedures of traumatic patients before and during COVID-19 pandemic: Data from the National Trauma Registry of Iran / 中华创伤杂志(英文版)

PURPOSE@#To prepare for future possible communicable disease epidemics/pandemics, health care providers should know how the COVID-19 pandemic influenced injured patients. This study aimed to compare epidemiologic features, outcomes, and diagnostic and therapeutic procedures of trauma patients admitted to a university-affiliated hospital before and during the pandemic.@*METHODS@#This retrospective study was performed on data from the National Trauma Registry of Iran. All injured patients admitted to the hospital from July 25, 2016 to March 10, 2021 were included in the study. The patients were excluded if they had hospital length of stay less than 24 h. The injury outcomes, trauma mechanisms, and therapeutic and diagnostic procedures of the 2 periods: before (from July 25, 2016 to February 18, 2020) and during (from February 19, 2020 to March 10, 2021) COVID-19 pandemic were compared. All analyses were performed using STATA version 14.0 software (Stata Corporation, College Station, TX).@*RESULTS@#Totally, 5014 patients were included in the registry. Of them, 773 (15.4%) were registered after the beginning of the COVID-19 pandemic on February 19, 2020, while 4241 were registered before that. Gender, education level, and cause of injury were significantly different among the patients before and after the beginning of the pandemic (p < 0.001). In the ≤ 15 years and ≥ 65 years age groups, injuries decreased significantly during the COVID-19 pandemic (p < 0.001). The frequency of intensive care unit (ICU) admission decreased from 694 (16.4%) to 88 (11.4%) (p < 0.001). The mean length of stay at the hospital (days) and at the ICU (days) declined as follow: 8.3 (SD = 17.2) vs. 5.5 (SD = 6.1), p < 0.001 and 7.5 (SD = 11.5) vs. 4.5 (SD = 6.3), p < 0.022. The frequency of diagnostic and therapeutic procedures before and during the pandemic was as follows, respectively: ultrasonography 905 (21.3%) vs. 417 (53.9%) (p < 0.001), echocardiography 313 (7.4%) vs. 107 (13.8%) (p < 0.001), angiography 1597 (37.7%) vs. 534 (69.1%) (p < 0.001), MRI 166 (3.9%) vs. 51 (6.6%) (p < 0.001), surgery 3407 (80.3%) vs. 654 (84.6%) (p < 0.001), and internal/external fixation 1215 (28.6%) vs. 336 (43.5%) (p < 0.001).@*CONCLUSION@#The pandemic affected the epidemiology of traumatic patients in terms of gender, age, educational level, and trauma mechanism. It changed the outcomes of injured patients: ICU admission, length of stay at the hospital and ICU decreased. The patients received more diagnostic and therapeutic procedures during the pandemic. To be more precise, more research is needed on the details.

Evaluating mechanism and severity of injuries among trauma patients admitted to Sina Hospital, the National Trauma Registry of Iran / 中华创伤杂志(英文版)

PURPOSE@#Injuries are one of the leading causes of death and lead to a high social and financial burden. Injury patterns can vary significantly among different age groups and body regions. This study aimed to evaluate the relationship between mechanism of injury, patient comorbidities and severity of injuries.@*METHODS@#The study included trauma patients from July 2016 to June 2018, who were admitted to Sina Hospital, Tehran, Iran. The inclusion criteria were all injured patients who had at least one of the following: hospital length of stay more than 24 h, death in hospital, and transfer from the intensive care unit of another hospital. Data collection was performed using the National Trauma Registry of Iran minimum dataset.@*RESULTS@#The most common injury mechanism was road traffic injuries (49.0%), followed by falls (25.5%). The mean age of those who fell was significantly higher in comparison with other mechanisms (p < 0.001). Severe extremity injuries occurred more often in the fall group than in the vehicle collision group (69.0% vs. 43.5%, p < 0.001). Moreover, cases of severe multiple trauma were higher amongst vehicle collisions than injuries caused by falls (27.8% vs. 12.9%, p = 0.003).@*CONCLUSION@#Comparing falls with motor vehicle collisions, patients who fell were older and sustained more extremity injuries. Patients injured by motor vehicle collision were more likely to have sustained multiple trauma than those presenting with falls. Recognition of the relationship between mechanisms and consequences of injuries may lead to more effective interventions.

Paraclinical findings in Iranian veterans exposed to sulfur mustard gas: A literature review / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Sulfur mustard (SM) causes various systemic disturbances in human beings. This study aimed to assess paraclinical changes caused by exposure to SM gas in Iranian veterans during the war between Iraq and Iran.</p><p><b>METHODS</b>A literature review was carried out in international and national medical databases including ISI, Medline, Scopus, Iranmedex and Irandoc. Both Farsi and English literature were searched.</p><p><b>RESULTS</b>Search of the literature yielded 422 medical articles related to SM poisoning. Among them, 30 relevant articles were thoroughly reviewed. The most important reported complications were leukopenia, neutropenia, lymphopenia, eosinophilia, thrombocytopenia, increased bleeding time, positive C-reactive protein (CRP), rheumatoid factor (RF), antinuclear antibody (ANA), decreased T helper cells, natural killer cells, IL6, and IL8 levels, elevation of serum immunoglobulins, decreased levels of T3, T4 and cortisol, increased level of adrenocorticotropic hormone (ACTH), proteinuria, hematuria, and elevated liver enzymes. Also, there were some changes in chest assessments.</p><p><b>CONCLUSIONS</b>SM causes profound systemic complications in victims, even years after exposure. The paraclinical changes can be observed in hematology, immune system, biochemistry, hormonal profile and some imaging studies.</p>

Alcohol consumption for simulated driving performance: A systematic review / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Alcohol consumption can lead to risky driving and increase the frequency of traffic accidents, injuries and mortalities. The main purpose of our study was to compare simulated driving performance between two groups of drivers, one consumed alcohol and the other not consumed, using a systematic review.</p><p><b>METHODS</b>In this systematic review, electronic resources and databases including Medline via Ovid SP, EMBASE via Ovid SP, PsycINFO via Ovid SP, PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINHAL) via EBSCOhost were comprehensively and systematically searched. The randomized controlled clinical trials that compared simulated driving performance between two groups of drivers, one consumed alcohol and the other not consumed, were included. Lane position standard deviation (LPSD), mean of lane position deviation (MLPD), speed, mean of speed deviation (MSD), standard deviation of speed deviation (SDSD), number of accidents (NA) and line crossing (LC) were considered as the main parameters evaluating outcomes. After title and abstract screening, the articles were enrolled for data extraction and they were evaluated for risk of biases.</p><p><b>RESULTS</b>Thirteen papers were included in our qualitative synthesis. All included papers were classified as high risk of biases. Alcohol consumption mostly deteriorated the following performance outcomes in descending order: SDSD, LPSD, speed, MLPD, LC and NA. Our systematic review had troublesome heterogeneity.</p><p><b>CONCLUSION</b>Alcohol consumption may decrease simulated driving performance in alcohol consumed people compared with non-alcohol consumed people via changes in SDSD, LPSD, speed, MLPD, LC and NA. More well-designed randomized controlled clinical trials are recommended.</p>

Effects of neurofeedback on the short-term memory and continuous attention of patients with moderate traumatic brain injury: A preliminary randomized controlled clinical trial / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>There are some studies which showed neurofeedback therapy (NFT) can be effective in clients with traumatic brain injury (TBI) history. However, randomized controlled clinical trials are still needed for evaluation of this treatment as a standard option. This preliminary study was aimed to evaluate the effect of NFT on continuous attention (CA) and short-term memory (STM) of clients with moderate TBI using a randomized controlled clinical trial (RCT).</p><p><b>METHODS</b>In this preliminary RCT, seventeen eligible patients with moderate TBI were randomly allocated in two intervention and control groups. All the patients were evaluated for CA and STM using the visual continuous attention test and Wechsler memory scale-4th edition (WMS-IV) test, respectively, both at the time of inclusion to the project and four weeks later. The intervention group participated in 20 sessions of NFT through the first four weeks. Conversely, the control group participated in the same NF sessions from the fifth week to eighth week of the project.</p><p><b>RESULTS</b>Eight subjects in the intervention group and five subjects in the control group completed the study. The mean and standard deviation of participants' age were (26.75 ± 15.16) years and (27.60 ± 8.17) years in experiment and control groups, respectively. All of the subjects were male. No significant improvement was observed in any variables of the visual continuous attention test and WMS-IV test between two groups (p ≥ 0.05).</p><p><b>CONCLUSION</b>Based on our literature review, it seems that our study is the only study performed on the effect of NFT on TBI patients with control group. NFT has no effect on CA and STM in patients with moderate TBI. More RCTs with large sample sizes, more sessions of treatment, longer time of follow-up and different protocols are recommended.</p>

Social network analysis of Iranian researchers in the field of violence / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>The social network analysis (SNA) is a paradigm for analyzing structural patterns in social re- lations, testing knowledge sharing process and identifying bottlenecks of information flow. The purpose of this study was to determine the status of research in the fleld of violence in Iran using SNA.</p><p><b>METHODS</b>Research population included all the papers with at least one Iranian affiliation published in violence fleld indexed in SCIE, PubMed and Scopus databases. The co-word maps, co-authorship network and structural holes were drawn using related software. In the next step, the active authors and some measures of our network including degree centrality (DC), closeness, eigenvector, betweeness, density, diameter, compactness and size of the main component were assessed. Likewise, the trend of the published articles was evaluated based on the number of documents and their citations from 1972 to 2014.</p><p><b>RESULTS</b>Five hundred and seventy one records were obtained. The five main clusters and hot spots were mental health, violence, war, psychiatric disorders and suicide. The co-authorship network was complex, tangled and scale free. The top nine authors with cut point role and top ten active authors were identified. The mean (standard deviation) of normalized DC, closeness, eigenvector and betweeness were 0.449 (0.805), 0.609 (0.214), 2.373 (7.353) and 0.338 (1.122), respectively. The density, diameter and mean compactness of our co-authorship network were 0.0494, 3.955 and 0.125, respectively. The main component consisted of 216 nodes that formed 17% of total size of the network. Both the number of the documents and their citations has increased in the field of violence in the recent years.</p><p><b>CONCLUSION</b>Although the number of the documents has recently increased in the field of violence, the information flow is slow and there are not many relations among the authors in the network. However, the active authors have ability to influence the flow of knowledge within the network.</p>

Iraq-Iran chemical war: calendar, mortality and morbidity / 中华创伤杂志(英文版)

<p><b>OBJECTIVES</b>To review the calendar, mortality and morbidity of Iraq-Iran chemical war among Iranians based on researchers'reports.</p><p><b>METHODS</b>We used national and international databanks such as PubMed, ISI, Scopus, Irandoc and Iranmedex and studied 350 articles related to chemical agents and their effects on different organs. The main criteria for qualification of articles were relevancy orientation and being published in approved medical journals.</p><p><b>RESULTS</b>The Iraqi army invaded to west and southwest Iran using chemical weapons such as nerve agents (NAs) and sulfur mustard (SM). Most victims were civilians including women and children. These attacks had imposed more than 150 types of diseases and complications on Iranians and the frequency of death was 2%-3%. Most reports were about respiratory problems and a few were in the domain of socio-economic damages.</p><p><b>CONCLUSION</b>At present, 25 years after the end of war, the victims are faced with different complications induced by chemical agents and it is estimated that they will be continuously troubled by these problems in future.</p>

SWOT analysis in Sina trauma and surgery research center

The present study was conducted with the aim of identifying and evaluating the internal and external factors, affecting the Sina Trauma and Surgery Research Center, affiliated to Tehran University of Medical Sciences and propose some of related strategies to senior managers. We used a combined quantitative and qualitative methodology. Our study population consisted of personnel [18 individuals] at Sina Trauma and Surgery Research Center. Data-collection tools were the group discussions and the questionnaires. Data were analyzed with descriptive statistics and SWOT [Strength, Weakness, Opportunities and Threats] analysis. 18 individuals participated in sessions, consisting of 8 women [44.4%] and 10 men [55.6%]. The final scores were 2.45 for internal factors [strength - weakness] and 2.17 for external factors [opportunities - threats]. In this study, we proposed 36 strategies [10 weakness - threat strategies, 10 weakness - opportunity strategies, 7 strength - threat strategies, and 9 strength - opportunity strategies]. The current status of Sina Trauma and Surgery Research Center is threatened weak. We recommend the center to implement the proposed strategies

Long-term effects of mustard gas on respiratory system of Iranian veterans after Iraq-Iran war: a review / 中华创伤杂志(英文版)

To review long-term respiratory effects of mustard gas on Iranian veterans having undergone Iraq-Iran war. Electronic databases of Scopus, Medline, ISI, IranMedex, and Irandoc sites were searched. We accepted articles published in scientific journals as a quality criterion.The main pathogenic factors are free radical mediators. Prevalence of pulmonary involvement is approximately 42.5%. The most common complaints are cough and dyspnea. Major respiratory complications are chronic obstructive pulmonary disease, bronchiectasis, and asthma. Spirometry results can reveal restrictive and obstructive pulmonary disease. Plain chest X-ray does not help in about 50% of lung diseases. High-resolution CT of the lung is the best modality for diagnostic assessment of parenchymal lung and bronchi. There is no definite curative treatment for mustard lung. The effective treatment regimens consist of oxygen administration, use of vaporized moist air, respiratory physiotherapy, administration of mucolytic agents, bronchodilators, corticosteroids, and long-acting beta-2 agonists, antioxidants, surfactant, magnesium ions, therapeutic bronchoscopy, laser therapy, placement of respiratory stents, early tracheostomy in laryngospasm, and ultimately lung transplantation. High-resolution CT of the lung is the most accurate modality for the evaluation of the lung parenchyma and bronchi. The treatment efficacy of patients exposed to mustard gas depends on patient conditions (acute or chronic, upper or lower respiratory tract involvement). There are various treatment protocols, but unfortunately none of them is definitely curable.

Prevention and treatment of respiratory consequences induced by sulfur mustard in Iranian casualties

About 100,000 Iranian have been exposed to chemical weapons during Iraq-Iran conflict [1980-88]. After being spent of more than two decades, still about 30,000 of them are under follow-up treatment. The main aim of this study was to review various preventive and therapeutic methods for injured patients with sulfur mustard in different phases. For gathering information, we have used the electronic databases including Scopus, Medline, ISI, IranMedex, Irandoc sites. According to this search strategy, 104 published articles associated to respiratory problems and among them 50 articles related to prevention and treatment of respiratory problems were found and reviewed. There is not any curative treatment for sulfur mustard induced lung injuries, but some valuable experienced measures for prevention and palliative treatments are available. Some useful measures in acute phase include: Symptomatic management, oxygen supplementation, tracheostomy in laryngospasm, use of moist air, respiratory physical therapy, mucolytic agents and bronchodilators. In the chronic phases, these measures include: Periodic clinical examinations, administration of inhaled corticosteroids alone or with long-acting beta 2 agonists, use of antioxidants, magnesium ions, long term oxygen supplement, therapeutic bronchoscopy, laser therapy, and use of respiratory tract stents. Most treatments are symptomatic but using preventive points immediately after exposure could improve following outcomes

Effectiveness of motivational interviewing in promoting hand hygiene of nursing personnel

Motivational interviewing [M.I.] is an option for modifying an individual's behavior. It is used as an educational method in recent years. The aim of our study was to indicate whether or not education, using lecture alone and lecture with M.I., would affect the performance of nursing personnel regarding their hand hygiene. If so, which of these two methods were most effective for this purpose? This was an interventional study conducted in Bahrami Pediatric Hospital in Tehran. The study population consisted of all nursing personnel in the hospital. Considering the responsibilities of different nurses and their educational status, we divided them into three classes. The participants of each class were randomly assigned to either the control or experiment groups training lecture alone or lecture with M.I., respectively. We used Independent-t, Paired-t, Mann-Whitney U and Wilcoxon signed ranks tests for analysis. Education using lecture alone improved the hand hygiene performance of nursing personnel only in the first and third classes [P = 0.002 and P = 0.001, respectively]. Similarly, lecture combined with M.I. improved the hand hygiene performance of personnel in the first and third classes [P < 0.001 and P = 0.004, respectively]. The latter method was more effective compared to lecture alone in the first and third classes [P < 0.001 and P = 0.013, respectively]. Education based on lecturing improves hand hygiene performance among nursing personnel. It will be more effective if combined with M.I

Concurrent validity of Persian version of Wechsler intelligence scale for children -fourth edition and cognitive assessment system in patients with learning disorder

The aim of this study was to compare the Persian version of the wechsler intelligence scale for children - fourth edition [WISC-IV] and cognitive assessment system [GAS] tests, to determine the correlation between their scales and to evaluate the probable concurrent validity of these tests in patients with learning disorders. One-hundered-sixty-two children with learning disorder who were presented at Atieh Comprehensive Psychiatry Center were selected in a consecutive non-randomized order. All of the patients were assessed based on WISC-IV and CAS scores questionnaires. Pearson correlation coefficient was used to analyze the correlation between the data and to assess the concurrent validity of the two tests. Linear regression was used for statistical modeling. The type one error was considered 5% in maximum. There was a strong correlation between total score of WISC-IV test and total score of CAS test in the patients [r=0.75, P<0.001]. The correlations among the other scales were mostly high and all of them were statistically significant [P<0.001]. A linear regression model was obtained [alpha=0.51, [beta=0.81 and P<0.001]. There is an acceptable correlation between the WISC-IV scales and CAS test in children with learning disorders. A concurrent validity is established between the two tests and their scales

Effects of mustard gas on immune system of exposed Iranian people: a review of conducted studies

Exposure to high dosages of sulfur mustard [SM] can cause bone marrow depression, immune system suppression, impairment of the immune functions, and eventually results in diseases due to secondary immune disorders. In this article, we have studied the effects of this poison on Iranian veterans by analysis of related published studies. In a systematic search, the effects of SM gas on Iranian victims were reviewed. We used known international medical databases such as ISI, Medline, Scopus and Iranian databases such as Iranmedex and Irandoc. About 350 published articles were assessed. Among them, 43 articles were related to immunologic field. No special evaluation was conducted on the quality of the reviewed manuscripts and the credit of journal was considered sufficient. In accomplished studies conducted on Iranian people, both cellular and humoral immunity were affected. The reported changes were as follows: increasing the number of inflammatory cells in chronic phase which indicates ongoing active alveolitis, neutrophils [in chronic bronchitis], eosinophils, CRP titer, RF titer, IgG [especially in asthmatic patterns] ,IgM, Ig E, IL-6, TFG-beta1target protein in bronchoalveolar lavage fluid, and decreasing the number of leukocytes, lymphocytes, natural killer cells [NKCs], IL-8and IL-6 in blood. Eventually, in reported changes, chemo taxis factors, plasma opsonins and nitroblue tetrazolium [NBT] test were normal. In sever and prolonged exposure to mustard gas, the immune system would be suppressed. Therefore, the victims should be monitored for infections and even cancers

Attitudes, concerns, perceived impact and coping strategies for avian influenza among the first year medical students and interns in Tehran university of medical sciences

To study and compare the attitudes, concerns, perceived impact and coping strategies for avian influenza [AI] among the first year medical students [FYMS] and interns in Tehran University of Medical Sciences. This was a cross sectional study carried out on FYMS [n=158] and interns [n=158] in 2008. The data collection tool was a questionnaire containing 37 questions in five parts. The three choices including "agree, disagree and unsure" were considered for all questions. We used Chi-square and Fisher's exact tests for analysis. Most of FYMS and interns [78.2%] believed their health would be depended on the care of their selves. Most of them [95.3%] believed that if they knew avian flu better, they could be more prepared for it. The majority were concerned about risk to their health from their work [62.7%]. Most [67.7%] accepted the risk and only 5 [1.6%] would consider stopping work. For non-work concerns, 70.9% were concerned about their spouses/sexual partners and 65.8% about their children. For perceived impact, most [66.5%] believed that they would feel stressed at work and the majority [74.4%] expected an increased workload. FYMS and interns have positive attitudes but major concerns about contracting AI and its relation to medical practice.

Validation of pediatric index of mortality-2 scoring system in a single pediatric intensive care unit in Iran

A study to validate and calibrate Pediatric Index of Mortality-2 [PIM2] in children admitted to our pediatric intensive care unit [PICU]. This is a prospective cohort study performed in Bahrami Children's Hospital affiliated to Tehran University of Medical Sciences. We studied the patients admitted to PICU from May 2007 to November 2008. Clinical measures were identified upon arrival in PICU. We used PIM2 score and logistic regression analysis to compare expected mortality risk with observed mortality rate. Receiver operating characteristics [ROC] curve analysis was done and standardized mortality ratio was calculated. PIM2 Index assessment was performed by use of Hosmer and Lemeshow goodness-of-fit test. 240 patients were included in this study. The model fit was achieved adequately [P value = 0.741]. The area under the ROC curve was 0.795 [0.715-0.875 for 95% confidence interval] and standardized mortality ratio was 1.8 [1.28-2.465 for 95% confidence interval] High-risk group diagnosis with adjusted odds ratio [AOR] =14.75, pupil reaction to light [AOR=0.13] and duration of stay in PICU [AOR=1.03] had significant statistical association to pediatric mortality. PIM2 is a good index for prediction of mortality in our pediatric intensive care unit. This study revealed that there is significant statistical association between the children mortality and the length of hspita;ization, pupillary light reflex and the risk level category on admission

Home based training: main strategy of community based rehabilitation in Iran

Study of effectiveness of "home based training" in community based rehabilitation program on disabled people, who were trained and evaluated at the end of the course, under supervision of 21 pilot health and medical networks. In a cross-sectional study, 614 disabled people who had participated in "home based training" were selected with stratified random sampling method. They were evaluated according to function progress level variables by community based rehabilitation program experts. Age groups, sex, disability groups, employment state and teacher's relation variables were studied from their files and recording data. Statistical analysis was performed with Chi-square test. There was a relationship between age group and disability group with functional progress level [P value =0.014 and P value <0.001]. Low age groups, visual disabled group, epileptic patients and individuals with learning disability had the best results. High age groups, mixed age disability group and individuals with verbal and hearing problems had the least favorable results. There was a relationship between teacher's relation with progress or no progress state [P value = 0.038]. Individuals that were teachers had the best results and individuals with teachers other than first or second relation or health worker had the least favorable results. Home based training in community based rehabilitation program is an effective method for improving the functions of disabled people in some selected groups

validity of ultrasound in diagnosing hypertrophic pyloric stenosis

To evaluate the validity of ultrasound for diagnosis and exclusion of pyloric stenosis in the infants with nonbilious vomiting. In a cross-sectional study, 444 consecutive infants with clinical suspicion of pyloric stenosis were evaluated by ultrasound [US] and categorized as pyloric stenosis or not according measuring parameters as muscle thickness, muscle width and canal length of pylorus. Positive findings were confirmed at surgery; Negative findings were confirmed by means of follow up. Sensitivity, specificity and accuracy were calculated. Sensitivity, specificity and accuracy of ultrasound were 100% if pyloric muscle thickness of >3mm was chosen as diagnostic. When muscle thickness more than 4mm was used, sensitivity, specificity and accuracy were 96%, 100% and 99.32% respectively. Ultrasound is highly sensitive and specific if pyloric muscle thickness 3 mm is used as cut off point. By virtue of direct visualization of the pyloric muscle, ultrasound is method of choice for both the diagnosis and exclusion of pyloric stenosis in infants

Ceftriaxone induced biliary pseudolithiasis in children: report of 14 cases

Biliary pseudolithiasis has been reported in patients who received ceftriaxone therapy. In this study we evaluated children with ceftriaxone associated pseudolithiasis that was discovered incidentally in US examination. The study includes 14 children with gallstones in Ultrasound without biliary symptoms with recent ceftriaxone administration. All of them were treated for suspected or definite bacterial infection with ceftriaxone 50-100mg/kg/day divided into 2 equal intravenous doses under conditions of adequate hydration. There were no other known underlying diseases for gallstone. Fourteen patients [11 boys and 3 girls] with mean age of 4.5 years [range: 2 months to 14 years] were studied. Following cessation of treatment with ceftriaxone, a complete resolution of the lithiasis was seen in most of followed cases. All patients were free from biliary symptoms [Right upper quadrant pain, Cholestasis] during observation. Consultations with surgeon or subspecialist due to reported "gallstone in the Ultrasound" were performed in about two-thirds of patients. Development of pseudolithiasis after ceftriaxone administration is not uncommon and should be known by pediatricians and radiologists in order to avoid unnecessary surgery or additional consultations

Earlobe crease and coronary artery disease

Diagonal ear lobe crease [ELC] has been introduced as a diagnostic physical sign for coronary artery disease [CAD] and the aim of this study was to evaluate the association between ELC and CAD in Iranians. In a cross- sectional study, 106 consecutive patients, referred from cardiologists for angiography, were studied for presence of ELC and CAD in four academic hospitals in Tehran. ELC categorized based on Ishii classification and CAD defined as at least 50% narrowing in one of the three major epicardial vessels. The average age in 70 men and 36 women was 50.14 +/- 14.11 years. Based on angiographic results, patients were divided in two groups. In 57 patients of CAD positive group, 34 patients had ELC and in 49 patients of CAD negative group only 13 patients had ELC. [P<0.05] After adjusting for age, ELC was a significant predictor of CAD [P<0.05]. The severity of ELC [size and unilateral or bilateral] was significantly related to presence of CAD [P<0.05]. The observed sensitivity, specificity, positive predictive value and negative predictive value of ELC for diagnosis of CAD were in the following order: 59.6%, 73.5%, 72.3% and 61%. In Iranians, the presence of ELC is associated with CAD

Excessive crying of infancy; a report of 200 cases

Excessive crying of infancy; a single continuous episode of crying more than 2 common and often serious problem for parents. The objective of this study was to determine the incidence and etiology of acute episodes of excessive infant crying and to propose an approach for taking care of them. In this cross sectional study all patients less than 2 years old presented to the Emergency Department [ED] with >/= 2 hours of crying with an unapparent cause for their parents were included in this study. Patients with fever, chronic disease and any disease 72 hours proceeding the crying were excluded. The incidence of excessive crying was 200 [1.74%] among the 13600 ED visits in 2 consecutive years .The three most common causes were colic [29.5%], acute otitis media [15.5%] and constipation [5.5%]. History and physical examination led to diagnosis in 86% of cases. Many conditions and diseases may cause excessive crying in infants. Complete history and physical examination of all parts of the body provide clues for the diagnosis in most cases and help the physician to avoid over diagnosis and over treatment