Epidemiology and short-term mortality in traumatic patients admitted to Shariati Hospital in Iran between 2012 and 2013

Purpose: Trauma is an inevitable part of the health burden in every country. Both the preventive and rehabilitative aspects of traumatic injuries are expensive. Since most of the injuries happen in low- and middle-income developing countries, a judicious allocation of the limited resources to the most costefficient strategies is necessary. The present study was designed to report the causes of trauma, injured body regions, trauma severity scores and the one year survival rate of a randomly selected sample of trauma patients in a major referral hospital in Tehran, Iran. Methods: We chose and analyzed a random subgroup of traumatic patients admitted during the oneyear period of May 2012 to May 2013 to Shariati Hospital, a major University Teaching Hospital in Tehran, Iran. Patients who stayed at the hospital for less than 24 h were excluded. In total, 73 traumatic patients were registered. The mean age was (40.19 ± 20.34) years and 67.1% of them were male. Results: In general, the most common cause of injury was falls (47.9%), followed by road traffic crashes (RTCs, 40.8%). Assault and exposure to inanimate mechanical forces each were only associated with 5.6% of all injuries. The only cause of injury in ages of more than 65 years was fall. The most common cause of injury in ages between 15 and 45 years was RTCs. During the study, two deaths occurred: one was at ICU and the other was at home. The most commonly injured body region was the head (23.8%), followed by the elbow and forearm (19%), hip and thigh (15.9%), and multiple body regions (14.3%). The mean abbreviated injury score was 2.23±1.02; injury severity index was 7.26±7.06; and revised trauma score was 7.84, calculated for 38 patients. Conclusion: Prevention strategy of traumatic injury should focus on falls and RTCs, which are respectively the most common cause of trauma in older aged people and young males.     

Spinal cord injury in Parkour sport （free runn,ng）： a rare case report

A 24-year-old male was transferred to the emergency department while being in the state of quadriplegia with a history of performing Parkour sport, which is also called double front flip. Neurological examination revealed that the patient＇s muscle power was 0/5 at all extremities. The patient did not show any sense of light touch or pain in his extremities. In radiological studies, cervical spine X-ray and CT scan images showed C4-C5 subluxation with bilateral locked facets and spinal cord injury. The results of this very rare case study revealed that exercising Parkour sport without taking into account safety standards could result in irreversible injuries to the cervical spinal cord with fatal outcome.     

Modern concepts of transport in multiple trauma: a narrative review

Multiple variables can influence triage decision in multiple trauma. Recognition of priorities and selection of the destination can be successfully achieved by field triage and individualized clinical judgment. This narrative review summarizes the new options and protocols for transport of injured subjects. There are four levels of emergency medical providers including first responders and three levels of emergency medical technicians. Two distinct accepted protocols for transport are known as scoop and run and treat and then transfer. The former provides minimum lifesaving treatment at the scene of accident followed by transferring the patient(s) as soon as possible, and the latter mainly emphasizes the need for complete stabilization as a prerequisite for safe transport. The destination and mode of transport are selected according to clinical capabilities of the receiving hospital, transfer time from the scene to the facility, patient’s medical condition, accessibility of the scene, and weather. Two common methods of transfer are ground transport, including various type of ambulances, and air medical transport, i.e. helicopter and airplane.     

Personal,family and societal educational needs assessment of individuals with spinal cord injury in Iran

Objectives:To explore individuals’ perception of the personal, family and societal educational needs following a spinal cord injury (SCI).Methods:Sixty-one patients who sustained a traumatic SCI between March 2015 and June 2016 referred to Brain and Spinal Cord Injury Research Center (BASIR) were included in a cross sectional study and completed an online survey containing open-and closed-ended questions, in Iran. Participants’ responses were analyzed i using a qualitative approach with a thematic analysis.Results:Following a thematic analysis of the patient’s perceived educational needs, 3 themes and 14 subthemes were identified. The 3 themes included personal, family, and societal educational perceived needs. Within personal educational needs, there were 7 subthemes which included personal independence and transportation, financial independence, life skills modification, knowledge about SCI, prevention of SCI complications, relationships and sexual function, and psychological adjustments. Among family educational needs, the 3 subthemes were caregiver skills and communication, first aid and emergency skills, and emotional and psychological support. For societal educational needs, the 4 subthemes described were social integration, interpersonal communication skills, SCI awareness and injury prevention, sympathize while avoiding pity.Conclusion:According to our findings, people with SCI have various needs that need to be addressed. Educational support should be a part of a comprehensive rehabilitation program and geared towards addressing the patients’ personal and family needs, while educating the community about SCI in order to allow for reintegration into society.

A spinal cord injury (SCI) is an insult to the spinal cord resulting in devastating and commonly occurs following a traumatic event.1 The global prevalence and annual incidence of SCI is estimated to be 236-4,187 cases per million and 10.4-83 cases per million, respectively.2 In Iran the prevalence of SCI is estimated to be 318 cases per million.3,4 Patients with SCI often have devastating and permanent neurological changes resulting in significant and unique disabilities. Individuals with SCI are especially at risk for debilitating consequences such as chronic pain, pressure ulcers, deep vein thrombosis, urinary tract infections, muscle spasms, osteoporosis,5 and respiratory complications which are the main causes of death in low-income countries.1 Moreover, SCI can lead to a loss of bowel and bladder control, sexual dysfunction, limitations of limbs sense and movement, and difficulty breathing.6 In addition, SCI is frequently associated with depression and other mental comorbidities which result in significant psychosocial disability.7,8 About 20-30% of patients show clinical signs of depression, which negatively impacts functional status and overall health.1 Individuals with SCI also encounter unique challenges which limit their ability to fully participate in society as demonstrated by a nearly 60% unemployment rate.1 Many of these barriers can be mitigated by educating patients early and often by using different teaching strategies.9All patients with a SCI should undergo a thorough assessment of their needs. Patient’s needs might be different across multiple societies with various cultures and socioeconomic status. There are significant implications on functional status, psychosocial support, emotional needs, and vocation for patients, family, and society. Patients depend on others to assist them with activities of daily living such as toileting, bathing, eating, and transferring. Educating patients, family, and the community has a significant impact on improving delivery of care, preventing complications, and improving the quality of life for individuals with SCI. Categorizing educational needs as personal, family-related, and society-related can help better organize the aftercare. Due to the paucity of literature, we aim to analyze and better understand these areas of needs for individuals with SCI in order to enhance their quality of life through needs-based education and rehabilitation.     

Efficacy of surgical decompression in regard to motor recovery in the setting of conus medullaris injury

Background/Objective:     

The impact of bam earthquake on substance users in the first 2 weeks: A rapid assessment

In the final days of the year 2003, an earthquake in the city of Bam, Iran, led to the death of some 35,000 of its inhabitants. The rate of opium abuse, which had been high among the male population in this city, caused problems after the earthquake. The aim of the following study was to examine the status of substance abusers during the first 2 weeks after the earthquake. The study was carried out in the city of Bam, one of its nearby villages and eight hospitals admitting earthquake victims. One hundred and sixty-three individuals were interviewed, including substance abusers, their family members, people living in Bam, service providers, and the authorities. During the first 2 weeks after the earthquake, about half of drug-dependent interviewees suffered from withdrawal symptoms. About half reported their problems to health care providers and asked for morphine or other analgesics. Around one third had used opium on the first day and two thirds in the course of the second day to the end of the second week after the earthquake. Although smoking had been the most common means of abuse before the earthquake, oral intake has become the most prevalent route after the disaster. Almost all obtained their opium from inhabitants of other cities as gifts. Members of rescue and health delivery systems had a lot of encounters with opium abusers, especially in the first 3 days after the earthquake, and had prescribed morphine and other analgesics. In societies with a considerable prevalence of substance abuse, this issue becomes a matter of utmost health care and social importance at times of disasters, and the necessary arrangements to deal with it should be present beforehand.     

BK Virus replication in vitro: limited effect of drugs interfering with viral uptake and intracellular transport

BK virus is an important pathogen in kidney transplant recipients. In vitro studies demonstrated slight antiviral activity for chloroquine and nystatin. A sialic acid derivative, BTB11968, was identified as a lead compound for further development.     

Modern concepts of transport in multiple trauma: a narrative review

Multiple variables can influence triage decision in multiple trauma.Recognition of priorities and selection of the destination can be successfully achieved by field triage and individualized clinical j...