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.

Epidemiological, molecular characterization and risk factors of human brucellosis in Iran

Objective: To determine epidemiological, molecular characterization, and potential risk factors of human brucellosis. Methods: This descriptive study was carried out in the clinical setting in Iran between 2017 and 2018. A total of 297 participants enrolled in the study. The sample size was calculated based on the occurrence rate of brucellosis in different areas. Patients were assessed using serological tests and conventional culture methods. Phage and multiplex PCR methods typed all of Brucella isolates. Potential risk factors of disease were determined. Results: A total of 141 of 297 (47.5%) Brucella strains were isolated and all of them were detected as Brucella melitensis biovar 1. Based on serologic titers, high culture positivity was recorded at 1/640 titer (P< 0.006). The risk factors for brucellosis were patients older than 40 years (OR=2.23, 95%CI: 1.4-3.55, P=0.001), animal keeper (OR=7, 95%CI: 1.51-32.41, P=0.005), housewife (OR=8.76, 95%CI: 1.85-41.37, P=0.002), farmer (OR=6.42, 95%CI: 1.21-33.97, P=0.019), and contact with animal (OR=1.31, 95%CI: 0.60-2.85, P=0.005). Conclusions: To the best of our knowledge, this is the first comprehensive report from Iran presenting the detection of Brucella species by the multiplex PCR. Brucella melitensis biovar 1 is still the dominant causative agent in Iran. The consumption of unpasteurized dairy products, living in rural areas, and animal contact were risk factors of brucellosis.

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>

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>

[Effect of nail polish on pulse oximetry findings in healthy volunteers: a randomized clinical trail]

Pulse oximetry is the most common technique for monitoring hemoglobin oxygen saturation [SpO2]. Different colors and brands of nail polish may cause disturbance in the reading and interpretation of oxygen saturation. The aim of this study was to determine the effect of different colors of nail polish on oxygen saturation measured by pulse oximeter. Thirty healthy students with SpO2 >/= 95% and without obvious problems in nail bed and peripheral perfusion in ordinary room air, participated in this Clinical trial. Each volunteer sat in a chair for 10 minutes, maintaining the whole body at rest; then, the SpO2 baseline of CIean unpolished nail beds of all 10 fingers was measured and recorded. After this phase, the participants were asked to use each of 10 colors of nail polishes randomly and unrepeatedly to polish one of their fingernails. Nail polish was applied in two layers. After drying the nail polishes, the SpO2 was measured again. Data analysis was performed by statistical tests of Kolmogorov-Smirnov, paired t-, and Wilcoxon tests. Orange, pink, and purple nail polish had no effect on SpO2 [p>0.05], while other colors induced a statistically decrease in SpO2 [p<0.05], but this was not Clinically significant [<1.2%]. The results of this study revealed that nail polish has no Clinical effect on SpO2 measures by pulse oximeter in healthy subjects. Therefore, there is no need to spend time and money to Clean nail polish from individual's nails

[Validity and Reliability of Direct Observation of Procedural Skills in Evaluating Clinical Skills of midwifery Students of Kashan Nursing and Midwifery School]

Background: Direct observation is a method for objective assessment of practical skills and giving feedback to the students. This study investigated the reliability and validity testing direct observation of practical skills in the assessment of midwifery students' clinical skills.

Material and Method: In this cross-sectional study, participants included 44 midwifery students Internship of Kashan University Medical Sciences selected through census sampling method. Based on faculty members of Guilan, Kashan and Zahedan universities' opinions foure midwifery skills choosed among the basice clinical skills and prepared related check list. Students were obzerved over the procedure in a real work environment by the experimenter and recorded the results according to the check list and objective feedback was given to the students. Content validity - criterion validity [correlation between mean score of clinical and theoretical courses of midwifery and dops - Each item relationship with dops each skill] - validity [internal structure], reliability [internal consistency determination - rater reliability] was analyzed using the SPSS software.

Result: Dops test content validity index and content validity ratio were reported over 0.75% and 0.50%, respectively.Dops scores correlated with theoretical, 0.071 [p =0.647] and clinical 0.093 [p =0.548].The dops significantly correlated with the total score of each skill expressing the desired internal validity [p<0/001]. Reliability test was measured using Cronbach's alpha coefficient[0.814]. the Minimum and maximum values of the correlation coefficient of interrater reliability were 0.97 and 0.99, respectivelywhich were significant in all cases [p<0.001].Students' satisfaction was rated from satisfay to very satisfy with 78.2 percent.

Conclusion: According to the results of tha study, dops has suitable validity and reliability to use for objective evaluation of onstetrical skills.

Effect of vitamin E and metformin on fatty liver disease in obese children- randomized clinical trial

We evaluated the effect of vitamin E and metformin on fatty liver disease in obese children. This interventional study has been done on 119 children with Non-alcoholic fatty liver disease [based on sonography results]. Patients were divided into four treatment groups; they received metformin 1gr daily [age< 12 years], metformin 1.5 gr daily [age> 12 years], vitamin E 800 U daily and vitamin E 400 U daily. Liver sonography was performed for patients for two periods of two months. This trial was registered in Iranian Registry of Clinical Trials [IRCT], No.IRCT2013021012421N1 The study group comprised 119 individuals [62 females, 57 males]. The mean age was 10 +/- 3.19 yr. There was no significant difference in terms of sex and BMI between the groups. Overall liver sonography showed normal liver in 66 patients [55.46%], 66.63% after two months and 33.37% after four months. After two months, the most therapeutic response observed in the group which received vitamin E 800 u daily [48.1%] and the least therapeutic response was in the group which received vitamin E 400 u daily [14.3%]. After four months, the greater response was seen in vitamin E 400 u daily group [45.8%] and the least response in the metformin 1 gram daily group [19%]. In comparison with metformin, vitamin E is more influential in remission; however both are efficient in treatment of fatty liver. Vitamin E 400 u daily responses better in four-month treatment

Timeliness of malaria surveillance system in Iran

We aimed to evaluate the timeliness of reporting of malaria surveillance system and understanding the existing problems. The timeliness of malaria surveillance system of Iran was evaluated in four provinces of Iran including Sistan and Baluchistan, Hormozgan, Kerman [as provinces with local malaria transmission] and Khuzestan [without local malaria transmission]. In this descriptive-analytic cross-sectional study two levels of Primary Health Care service providers including first level [Health Houses] and second level [Urban or Rural Health care units] were evaluated with regard to reporting of malaria surveillance system. Forms number 1 [87% reported within one day] and number 2 [reporting median: 2 days] are reported from first level to second level, and forms number 4 [median: 4 days], number 3 [median: 6 days], number 7 [median: 9 days], number 5 [median: 11 days] and number 6 [median: 19 days] are reported from second level to the third level respectively in a shorter time. Independent variables such as distance, local malaria transmission level, and case finding type, are the factors affecting the reporting delay. Reporting in the first level compared to the second level is done with lower delay. In the areas where there is a deadline set for reporting, reporting is done more timely. Whatever number of malaria cases is decreased, sensitivity and subsequently timeliness reduced. It is recommended that the studies of timeliness be done with sensitivity and usefulness analysis of surveillance system

[Conventional Vs. reverse nerve grafting for peripheral nerve repair in lower extremity of rats]

Autograft is the best option in nerve defects when end-to-end repair can not sufficiently preserve nerve continuity. Theoretically, if the severed nerve is reversely grafted, it may prevent axonal growth into nerve branches, and larger amounts of axons will reach the target organ and more satisfactory results will be obtained. In this study we aimed to compare conventional versus reverse nerve grafting. This study was performed in Animal laboratory of Hazrat Fatemeh Hospital from April till August 2011. We randomly divided 40 Wistar rats into two groups. We excised 1.5 cm of the right sciatic nerve and anastomosed it conventionally between the proximal and distal ends of the nerve in rats in group A and in a reverse manner in rats in group B. The rats' footprints were recorded in the first and 16[th] weeks after surgery. In week 16, the grafted nerves were removed under anesthesia for pathological examination and axon count. Subsequently, the results were compared clinically by sciatic functional index [SFI] through footprint analysis and paraclinically by axon count. A p-value smaller than 0.05 was considered statistically significant. Conventional and reverse nerve grafting no had statistically significant differences in clinical assessment in the first and 16[th] weeks [P=0.87] post-surgically and also no difference in paraclinical assessment in week 16 [P=0.68]. We had no significant clinically or para clinically differences between two approaches. It should be considered that the diameter and length of nerves and muscles in human is larger than rats, so the results of nerve repair may differ in human. We suggest a study in animal model which is anatomically more similar to human

Sensory evaluation of post traumatic thumb after reconstruction with reverse radial forearm flap

Thumb is with a special role in hand function. Therefore, in addition to the significance of using thin, pliable, color-matched, and hairless cover in resurfacing the lesion in this area, recovery of sensation should also be taken into consideration. Thirteen patients with thumb degloving injuries were candidates for sensate reverse island radial forearm surgery. After transferring the flap, forearm lateral sensory nerve was sewn to the thumb digital nerve. At least for two years, these patients received regular diagnosis, and monofilament, static two point discrimination [S- 2PD], and moving two point discrimination [M-2PD] tests were taken from them. Monofilament test did not show normal sensation recovery, at protective sensation threshold, in the parents. The difference between monofilament test and normal thumb was statistically significant [p<0.0001]. In spite of this, the protective sensation was restored in all flaps after two years. According to the results from S-2PD and M-2PD tests, the restored sensation was at protective threshold or reduced, and the difference was statistically significant [p<0.0001]. Given difficulties of performing free flaps, and also deficiencies of pedicle flaps, the forearm radial island flap is known as one of the primary choices in most of the thumb soft tissue and hand defects reconstruction, due to its advantages, especially restoring the sensation of the injured site

Acute appendicitis following laparoscopic hysterectomy

Appendicitis after age 40 is unusual, and appendicitis two days after laparoscopic hysterectomy is very rare and has not been reported to date. We describe a 44-year-old woman who had abdominal pain two days after laparoscopic hysterectomy. The pathology report indicated early appendicitis and the pain disappeared after appendectomy. In our opinion, the cause of appendicitis may have been related to the use of monopolar and bipolar coagulation during laparoscopic hysterectomy, although the coincidence of appendicitis and laparoscopic surgery may be accidental

[Evaluation of the result of hand and foot pulse oximetry in the early detection of cyanotic congenital heart diseases in newborns delivered at Kashan Shabihkhani hospital during the first 6 months of 2006]

Delayed diagnosis of critical and cyanotic congenital heart diseases in asymptomatic newborns can lead to significant morbidity and mortality in this age group. The aim of this study was to determine the utility of hand and foot oxygen saturation as a screening test for the early detection of critical and cyanotic congenital heart diseases in asymptomatic newborns in the first day of life. In this cross-sectional study during a 6 month period we performed hand and foot pulse oximetry in 1506 term and healthy newborns in Shabihkhani Maternity Hospital. Babies with functional oxygen saturation below 95% in either right hand or right foot were considered abnormal and a second saturation measurement was performed 2 hours later. If the repeated measurement was again below 95% they were referred for performing an echocardiogram. The data was analyzed by SPSS version 11. During the study period a total of 1506 newborns were screened; of whom 1406 cases had SPO[2] >/= 95% in both extremities [mean%97.12 +/- 2.20 in right hand and mean%96.9 +/- 2.13 in right foot] and 100 babies had SPO[2]<95% [mean%93.35 +/- 3.17 in right hand and%92.41 +/- 3.01 in right foot]. The mean SPO[2] in the right foot was lower than the right hand in the both groups. The second saturation measurement was performed 2 hours later on 100 newborns with SPO[2] <95%, of whom 29 had persistent low saturation who were referred for echocardiography. Six asymptomatic babies out of 29 had critical and cyanotic congenital heart diseases [incidence of 4/1000 live births]. These diseases were: transposition of great vessels, truncus arteriosus, total anomalous pulmonary venous return and tetralogy of fallot. There was a meaningful correlation between right foot SPO[2] and echocardiography results in newborns with these types of congenital heart diseases [p=0.004] According to the significance of diagnosis of congenital heart disease, pulse oximetry screening along with clinical examination could help in the early detection of critical and cyanotic congenital heart diseases in asymptomatic newborns. Performing right foot pulse oximetry seems to be adequate for screening, because in all the circumstances it was lower than hand saturation

Evaluation of high-sensitivity C-reactive protein in acute asthma

High sensitivity C-reactive protein [hs-CRP] is an inflammatory marker known to be related to inflammation, infection, and cardiovascular diseases. The aim of this study was to evaluate hs-CRP level in serum of asthmatics and its relationship with pulmonary function tests, serum IgE levels, and peripheral blood white blood cell [WBC] counts. The under study subjects were 108 patients with acute asthma and 93 healthy volunteers. The levels of hs-CRP of 108 patients with acute bronchial asthma and 93 non-asthmatic control subjects were measured. Spirometry, serum immunoglobulin-E [IgE] measurement, and WBC counts were done for patient and control groups. The mean serum hs-CRP levels were significantly higher in patients with acute asthma compared with controls [5.47 +/- 7.33 mg/l versus 1.46 +/- 1.89 mg/l, p<0.001]. Among asthmatic patients, mean hs-CRP levels were not correlated with indices of pulmonary function tests [forced expiratory volume in one second, forced vital capacity and forced mid-expiratory flow], serum IgE level, eosinophil count or WBC count. Serum C-reactive protein levels measured by high-sensitivity assays increase in acute asthma and may be useful as a diagnostic tool for detecting and monitoring inflammation in these patients. In our study on patients with acute asthma, no significant correlation was revealed between hs-CRP and pulmonary function tests, total serum IgE, or peripheral blood white blood cell counts

prospective study on the seasonal frequencies of insect bites [Diptera: Culicidae and Phlebotominae] and the related environmental and protective method factors in the city of Kashan, central of Iran, 2009

The current study was carried out in Kashan, central Iran, to find and interpret the factors which influence the mosquito and sand fly biting on human body. In this study five hundred residential houses were selected and checked out to determine the frequencies of mosquito and sand fly biting in the different regions of Kashan. Results of this study showed that 64.6% of the family residents, who took part in this study, were bitten by means of the insects [Culicidae and Phlebotominae insects] over one year. The Diptera insect biting [Culicidae and Phlebotominae] is a multi-factor activity. By knowing these factors we can make plan to reduce the insect population using different tools and methods which are discussed in this study

Prinzmetal's angina in a pregnant woman: a case report

Acute myocardial infarction [MI] during pregnancy is rare and MI due to Prinzmetal's angina is much rarer. We present a 35-year-old, obese, multigravida, and pre-eclamptic woman, who developed acute anterior wall MI at the 30th week of gestation. On coronary angiography, the second obtuse marginal branch was totally occluded and the right coronary artery [RCA] was normal. Three days later, she had chest pain and ST elevation in the inferior leads. On second angiography, there was narrowing in the RCA, while the obtuse marginal branch was patent. We presume that this discrepancy between the first and second electrocardiograms and angiographic findings was due to Prinzmetal's angina

Evaluation of effectiveness of herbal medication in cancer care: a review study

Based on a common belief, herbal medicine with the least possible side effects should be the center of attention in cancer care; however, in many cases they have not been properly studied with reliable clinical trials in human subjects. In this review, it was attempted to identify the available evidence on the use and clinical effects of herbs in cancer care. The research consists of two major parts including immunomodulator and chemopreventive herbal compounds whose mechanism, biological response, anticancer element of extract and related benefits were completely studied. Also, the safety of herbal anticancer compounds was discussed. Although the use of herbal medicines in treating cancer shows less chemotherapy-induced, toxicity, more researches are required to reach their full therapeutic potentials

unusual cause of bilateral anterior shoulder dislocation

We present an unusual case of a traumatic bilateral simultaneous dislocation of shoulder in a healthy young male. Bilateral shoulder dislocation are rare and the reported cases, have been mostly associated with trauma or seizure. Only a few cases [about 4] have been reported in the literature so far and all of these are associated with trauma. The one we present is a bilateral anterior shoulder dislocation without traumatic history but associated with newly occurred seizures

Timing of prophylactic antibiotic administration in term cesarean section: a randomized clinical trial

Antibiotic prophylaxis would benefit all cesarean section patients and may decrease morbidity and length of hospital stay. The present study was conducted to determine whether the administration of cefazolin prior to skin incision was superior to administration at the time of umbilical cord clamping for prevention of post-cesarean maternal-neonatal infections morbidity. This was a randomized, double-blinded clinical trial. During the study period, 287 cesarean sections for singleton term pregnancies with intact membranes or passed less than 18 hours from rupture of membrane were entered. A total of 196 patients received 2gr cefazolin before incision and 91 patients received 2gr cefazolin after cord clamping. The occurrence of surgical site opening, total infectious morbidity and neonatal complications were compared between these groups. Two groups were demographically identical. Rate of IV line need [RR=1.87, 95%CI:0.21-17.02], neonatal sepsis [RR=1.39, 95% Cl:0.14-13.64] and NICU admission [RR=0.19, 95%Cl: 0.21-17.02] were not significantly differed between groups. We suggest the standard cefazolin prophylaxis [after cord clamping] for elective cesarean section and cefazolin before incision for non elective cesarean section. Therefore, administration of prophylactic cefazolin prior to incision will not increase the rate of neonatal sepsis