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Hadi Khoshmohabat,1 Shahram Paydar,2 Alireza Makarem,1,3 Mohammad Yasin Karami,2 Niloofar Dastgheib,4 Seyed Ali Hossein Zahraei,4 Rohallah Rezaei,2 Golnoush Sadat Mahmoudi Nezhad21Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran; 2Trauma Research Center, Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran; 3Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran; 4Student Research Committee, Shiraz University of Medical Sciences, Shiraz, IranIntroduction: Planning for management of bleeding in trauma injuries is very important. The initial purpose in emergency situations should be immediate establishment of an efficient hemostasis, principally in its topical application. In this study, we aimed to review the major relevant articles in the case of application of cellulose hemostatic agent on trauma injuries.Methods: We searched the online databases such as PubMed, MEDLINE, Wiley, EMBASE, ISI Web of Knowledge, and Scopus. Two reviewers independently searched and assessed the titles and abstracts of all articles.Results: Upon screening the titles and abstracts, 24 studies were identified for full-text review. The oxidized cellulose had the best clotting times, while it demonstrated low absorption ability. Surgical and thermosensitive chitosan hemostatic could be valuable for managing hemorrhage from liver injuries in trauma patients.Conclusion: Recently, the application of cellulose hemostatic agents has been one of the main improvements obtained for controlling bleeding in trauma injuries. However, generally according to the literature review, the decision about using each agent should be made on a case-by-case basis. However, it can be mentioned that the perfect hemostatic agent has not been still identified.Keywords: cellulose hemostatic agent, trauma, injury

Pelvic fracture is a result of devastating injuries and is usually encountered in conjunction with other life- threatening injuries. The aim of the current study was to determine the outcome determinants of patients with pelvic fractures referred to a large trauma center in southern Iran. This retrospective cross-sectional study was conducted in a level I trauma center over a period of three years from 2012 to 2015. We included all patients with pelvic fractures whose medical records had sufficient data. Data were compared between good condition and poor conditions. A total of 327 patients with mean age of 40.1 ± 19.7 years were included. Poor condition was defined as being associated with higher heart rate (p=0.002), lower systolic blood pressure (p

A novel cathode material of (Nd0.9La0.1)1.6Sr0.4Ni0.75Cu0.25O3.8 (NLSNC4), is synthesized by solid state reaction and is further investigated in combination with samarium doped ceria (SDC) as composite cathodes including 0, 10, 30, 50, and 70 of SDC electrolyte phase. The X‐ray diffraction analysis showed that NLSNC4 was produced in pure phase and was chemically compatible with SDC electrolyte. Electrical conductivities of single phase and composite cathode materials along with their electrochemical performances on SDC electrolytes in symmetric cells were measured by DC four‐probe method and electrochemical impedance spectroscopy (EIS), respectively. Results indicated that the maximum electrical conductivity is 135.56 S cm−1 at 350 °C, measured for single phase NLSNC4, sintered at 1,300 °C. Polarization resistance of pure NLSNC4 cathode was 2.71 Ω cm2 at 800 °C, and NLSNC4‐x wt.% SDC composite cathodes displayed Rp value of 0.35, 0.14, 0.12, and 0.32 Ω cm2 at 800 °C, for x = 10, 30, 50, and 70, respectively. [ABSTRACT FROM AUTHOR]

Minimum Data Set (MDS) enables integration in data collection, uniform data reporting, and data exchange across clinical and research information systems. The current study was conducted to determine a comprehensive national MDS for the Epidermolysis Bullosa (EB) information management system in Iran. This cross-sectional descriptive study consists of three steps: systematic review, focus group discussion, and the Delphi technique. A systematic review was conducted using relevant databases. Then, a focus group discussion was held to determine the extracted data elements with the help of contributing multidisciplinary experts. Finally, MDSs were selected through the Delphi technique in two rounds. The collected data were analyzed using Microsoft Excel 2019. In total, 103 data elements were included in the Delphi survey. The data elements, based on the experts' opinions, were classified into two main categories: administrative data and clinical data. The final categories of data elements consisted of 11 administrative items and 92 clinical items. The national MDS, as the core of the EB surveillance program, is essential for enabling appropriate and informed decisions by healthcare policymakers, physicians, and healthcare providers. In this study, a MDS was developed and internally validated for EB. This research generated new knowledge to enable healthcare professionals to collect relevant and meaningful data for use. The use of this standardized approach can help benchmark clinical practice and target improvements worldwide., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Paydar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This perspective discusses the convergence of digital twin (DT) technology and on-the-chip systems as pivotal innovations in precision medicine, substantially advancing drug discovery. DT leverages extensive health data to create dynamic virtual patient models, enabling predictive insights and optimized treatment strategies. Concurrently, on-the-chip systems from the Carbon world replicate human biological processes on microfluidic platforms, providing detailed insights into disease mechanisms and pharmacological interactions. The convergence of these technologies promises to revolutionize drug development by enhancing therapeutic precision, accelerating discovery timelines, and reducing costs. Specifically, it assesses their role in drug development, from refining therapeutic precision to expediting discovery timelines and reducing the final price. Nevertheless, integrating these technologies faces challenges, including data collection and privacy concerns, technical intricacies, and clinical adoption barriers. This manuscript argues for interdisciplinary cooperation to navigate these challenges, positing DTs and on-the-chip technologies as foundational elements in personalized healthcare and drug discovery., Competing Interests: Competing interests: The authors declare no competing interests. Ethics Approval: As the nature of this study did not involve any human or animal subjects, interventions, or data collection, ethics committee approval was not required., (© 2024. The Author(s).)

Background: Uncontrolled bleeding is still the major factor leading to preventable deaths following trauma. This study sought to assess the effectiveness of mini sponge-based wound stasis, cellulose-based local hemostatic, and traditional gauze dressings for the control of hemorrhages resulting from grade 4 liver injuries in rats., Methods: Thirty Sprague-Dawley rats were divided into three equal groups. In the first group, a liver laceration was treated with gauze packing. The second group received XStat minisponge dressing (MDS), and the third group was administered a combination of MDS dressing and Surgicel hemostatic agent. After gaining access to the intra-abdominal cavity, a liver laceration measuring 10 mm in length, 5 mm in depth, and extending to the middle lobe was created. The dressings were removed after 2 and 10 min to assess the amount of bleeding, and any bleeding was documented again after 48 h. Intraperitoneal adhesions were evaluated during euthanasia., Results: At 2 min post-injury, the gauze packing group had an average bleeding volume of 0.97 ± 0.15 mL, compared to 1.08 ± 0.25 mL in the MDS group (P = 0.26) and 1.02 ± 0.18 mL in the MDS + Surgicel group (P = 0.69). At 10 min, the bleeding volumes were 0.13 ± 0.05 mL, 0.22 ± 0.01 mL (P = 0.09), and 0.14 ± 0.05 mL (P = 0.19), respectively. At 48 h, significant differences were observed in bleeding volumes (gauze: 0.55 ± 0.18 mL, MDS: 1.15 ± 0.21 mL, MDS + Surgicel: 0.82 ± 0.06 mL, P < 0.001). Mortality rates after 14 days were 0 % in the gauze packing group, 60 % in the MDS group (P = 0.001), and 60 % in the MDS + Surgicel group (P = 0.001). The gauze packing group displayed no adhesions, while the other groups exhibited adhesions in the liver, bowel, omentum, and abdominal wall., Conclusion: Our results indicate that, when it comes to managing bleeding in severe liver injuries, traditional gauze packing remains the tried-and-true method, showing superior effectiveness in terms of blood loss and mortality when compared to XStat minisponge dressings and the fibrillar Surgicel hemostatic agents., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Shahram Paydar reports financial support was provided by 10.13039/501100004320Shiraz University of Medical Sciences. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: In the recent years, National Early Warning Score2 (NEWS2) is utilized to predict early on, the worsening of clinical status in patients. To this date the predictive accuracy of National Early Warning Score (NEWS2), Revised Trauma Score (RTS), and Trauma and injury severity score (TRISS) regarding the trauma patients' mortality rate have not been compared. Therefore, the objective of this study is comparing NEWS2, TRISS, and RTS in predicting mortality rate in trauma patients based on prehospital data set., Methods: This cross-sectional retrospective diagnostic study performed on 6905 trauma patients, of which 4191 were found eligible, referred to the largest trauma center in southern Iran, Shiraz, during 2022-2023 based on their prehospital data set in order to compare the prognostic power of NEWS2, RTS, and TRISS in predicting in-hospital mortality rate. Patients are divided into deceased and survived groups. Demographic data, vital signs, and GCS were obtained from the patients and scoring systems were calculated and compared between the two groups. TRISS and ISS are calculated with in-hospital data set; others are based on prehospital data set., Results: A total of 129 patients have deceased. Age, cause of injury, length of hospital stay, SBP, RR, HR, temperature, SpO2, and GCS were associated with mortality (p-value < 0.001). TRISS and RTS had the highest sensitivity and specificity respectively (77.52, CI 95% [69.3-84.4] and 93.99, CI 95% [93.2-94.7]). TRISS had the highest area under the ROC curve (0.934) followed by NEWS2 (0.879), GCS (0.815), RTS (0.812), and ISS (0.774). TRISS and NEWS were superior to RTS, GCS, and ISS (p-value < 0.0001)., Conclusion: This novel study compares the accuracy of NEWS2, TRISS, and RTS scoring systems in predicting mortality rate based on prehospital data. The findings suggest that all the scoring systems can predict mortality, with TRISS being the most accurate of them, followed by NEWS2. Considering the time consumption and ease of use, NEWS2 seems to be accurate and quick in predicting mortality based on prehospital data set., (© 2024. The Author(s).)

Early resuscitation using blood products is critical for patients with severe hemorrhagic shock. We aimed to develop and validate a new scoring system, hemorrhagic shock transfusion prediction (HSTP) score, to predict the need for massive transfusion (MT) in these patients, compared to the widely used Assessment of Blood Consumption (ABC) score. Trauma patients admitted to Emtiaz Hospital in Iran from 2017 to 2021 were retrospectively included. Patients assigned a code 1 or 2 according to the Emergency severity index (ESI) triage system have been divided into MT and non-MT groups. MT was defined as receiving ≥ 10 units of packed cells (PCs) in 24 h. Demographic information, admission vital signs, and lab results available within 15 min were compared between the groups. A new predictive score was developed using logistic regression of statistically significant parameters. Out of 1029 patients, 651 (63.3%) required MT. An arrival, diastolic blood pressure < 79.5 mm Hg, absolute lymphocyte count > 1850/μL, base excess < - 4.25, and blood glucose > 156 mg/dL were independent predictors included in the HSTP score. The sensitivity and specificity were 74.36% and 53.87% for the HSTP score, compared to 31.03% and 76.16% for the ABC score. Moreover, the positive and negative predictive values were 77.88% and 49.03% for the HSTP score, versus 74.15% and 33.66% for ABC. The new scoring system demonstrated higher sensitivity and improved positive and negative predictive values compared to the ABC score. This score can assist physicians in making accurate transfusion decisions quickly, but further prospective studies are warranted to validate its clinical utility., (© 2024. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).)

This study explores the impact of A-site deficiency and Sr/Ca ratio on the electrochemical and crystallographic properties of a (Nd 0.2 Sr 0.7- x Ca x ) y Ti 0.95 Fe 0.05 O 3-δ hydrogen electrode for solid oxide cells under reducing and air atmospheres. 5% and 10% A-site deficient (Nd 0.2 Sr 0.7- x Ca x ) y Ti 0.95 Fe 0.05 O 3-δ ( x = 0.35-0.45, y = 1.05, 1) (referred to as 5NSCTF- x and 10NSCTF- x ) materials were studied, while the ratio between A-site cations was kept the same with both deficiencies. The results demonstrate that the extent of A-site deficiency and the Ca concentration in the A-site have a significant impact on the microstructure (sinterability), conductivity, and catalytic activity of electrodes. Segregation of Nd from the lattice with 5% A-site deficiency was observed as a result of thermal treatment at low pO 2 . Among the studied materials, the highest total electrical conductivity of porous electrode layer at 850 °C and in 97% H 2 + 3% H 2 O atmosphere was 4.8 S cm -1 observed for the Nd 0.2 Sr 0.35 Ca 0.35 Ti 0.95 Fe 0.05 O 3-δ (10NSCTF-35). The highest electrochemical performance was observed in the case of Nd 0.2 Sr 0.25 Ca 0.45 Ti 0.95 Fe 0.05 O 3-δ (10NSCTF-45), which showed a polarization resistance value equal to 0.19 Ω cm 2 after 100 h of stabilization at 800 °C in a humidified (1.7% H 2 O) H 2 atmosphere. The best electrochemical performance with 606 mW cm -2 power density at 850 °C in 98.3% H 2 + 1.7% H 2 O atmosphere was demonstrated by a 50 wt % Nd 0.2 Sr 0.25 Ca 0.45 Ti 0.95 Fe 0.05 O 3-δ + 50 wt % Ce 0.9 Gd 0.1 O 2-δ composite., Competing Interests: The authors declare no competing financial interest., (© 2024 The Authors. Published by American Chemical Society.)

Competing Interests: Declaration of competing interest The authors declare no conflict of interest.

Purpose: Prolonged mechanical ventilation (MV) subjects multiple trauma patients to ventilator-induced diaphragmatic dysfunction. There is limited evidence on the predictive role of diaphragm ultrasound (DUS) for weaning success in multiple trauma patients. Therefore, we evaluated Ultrasound of the diaphragm as a valuable indicator of weaning outcomes, in trauma patients., Material and Methods: This prospective cohort study included 50 trauma patients from September 2018 to February 2019. DUS was performed twice: upon ICU admission and the first weaning attempt. The diagnostic accuracy of indexes was evaluated by ROC curves., Results: The study included patients with a mean age of 35.4 ± 17.37, and 78% being male. The median injury severity score was 75 (42-75). The failure group exhibited significantly lower right diaphragmatic excursion (DE) compared to the success group (P = 0.006). In addition, the failure group experienced a significant decrease in both right and left DE from admission to the first attempt of weaning from MV (P < 0.001). Both groups showed a significant decrease in inspiratory and expiratory thickness on both sides during weaning from MV compared to the admission time (P < 0.001). The findings from the ROC analysis indicated that the Rapid shallow breathing index (RSBI) (Sensitivity = 91.67, Specificity = 100), respiratory rate (RR)/DE (Right: Sensitivity = 87.5, Specificity = 92.31), and RR/TF (Thickening Fraction) (Right: Sensitivity = 83.33, Specificity = 80.77) demonstrated high sensitivity and specificity in predicting weaning outcome., Conclusion: In the context of patients with multiple trauma, employing DUC and assessing diaphragmatic excursion, thickness, RR/DE index, RR/TF index, and RSBI can aid in determining successful ventilator weaning., (© 2024. The Author(s) under exclusive licence to Japanese Society of Anesthesiologists.)

Background: Papillary thyroid carcinoma (PTC), being the most common thyroid malignancy, is a slow-growing tumor and is usually limited to the thyroid. Extra thyroid extension is uncommon; besides, invasion to the vasculature seems to be extremely rare and usually indicates aggressive nature of the disease., Case Presentation: We present a case of a 40-year-old lady who referred with a palpable neck mass a month after total thyroidectomy which its histopathologic examination revealed follicular variant of PTC; the same variant as prior thyroidectomy. Preoperative ultrasonography failed to comment on the intravascular component of the mass. Surgical procedure confirmed a mass attaching and infiltrating to the internal jugular vein, which turned out to be persistent disease., Conclusions: Awareness of this entity is important for surgeons, oncologists and radiologist as it can influence patient management., (© 2024. The Author(s).)

Bisphenol A (BPA) is one of key raw materials used in the production of epoxy resins and plastics, which has toxicological effects on humans by disrupting cell functions through a variety of cell signaling pathways. Therefore, it is of great significance to develop a simple, rapid, and accurate BPA detection method in real water samples. In this study, a ratiometric fluorescence method based on yellow-emitting surface-functionalized polymer dots (PFBT@L Pdots) and blue-emitting carbon dots (Cdots) was described for the detection of BPA. Pdots as the detecting part were synthesized by using highly fluorescent hydrophobic Poly[(9,9-dioctylfluorenyl-2,7-diyl)-alt-co-(1,4-benzo-(2,1',3)-thiadiazole)] (PFBT) polymer and (R)-5,11,17,23-Tetra-tert-butyl-25,27-bis[(diphenylphosphinoyl)methoxy]-26-(3-oxabutyloxy)-28-[(1-phenylethyl)- carbamoylmethoxy]calix [4]arene (L) functionalizing ligand, and Cdots as internal reference were prepared by hydrothermal treatment of citric acid and urea. In the presence of BPA, chemical binding of the phosphorus atoms of nearby PFBT@L Pdots with BPA hydroxyl functional groups led to the aggregation of the PFBT@L Pdots aggregation and quenching their yellow emission, but the blue emission of Cdots, on the other hand, remained stable. The proposed PFBT@L Pdots probe was successfully applied for the detection of BPA in real water samples, and the results were in good agreement with those obtained by HPLC-FLD. To the best of our knowledge, this is the first report that the calixarene has been utilized to modify Pdots., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background and Aims: The COVID-19 pandemic has reshaped the epidemiology of various clinical conditions, including trauma which is closely tied to social policies. This study examines and compares the characteristics of trauma mortality patients, and their initial prognostic trauma scores, in the pre-pandemic and pandemic periods., Methods: We conducted a retrospective observational study involving patients who passed away at a level 1 trauma center from July 23, 2018, to February 19, 2020 (prepandemic), and from February 20, 2020, to September 22, 2021 (pandemic). A subgroup analysis that matched 12 of the same months of the year in the two periods was also done. Patients who arrived deceased or passed away immediately upon arrival were excluded from data analysis. We collected and analyzed demographic and clinical data, employing the Abbreviated Injury Score (AIS), Injury Severity Score (ISS), Revised Trauma Score (RTS), and Trauma and ISS (TRISS) to compare initial prognoses., Results: Our study encompassed 1128 patients, with 529 in the prepandemic group and 599 in the pandemic group. Demographic characteristics showed no significant differences in the number of patients in the two periods. Motor vehicle accidents remained the predominant injury mechanism in both periods. While the mean ISS increased insignificantly (22.80 vs. 22.91, p  = 0.902), the mean RTS decreased (6.32 vs. 5.82), and TRISS increased (23.97% vs. 28.93%) during the pandemic ( p  < 0.05). Hospital length of stay decreased in the pandemic period (15.57 vs. 12.54 days, p  < 0.05). Subgroup analysis revealed increased ISS, decreased RTS, and increased TRISS during the pandemic ( p  < 0.05)., Conclusion: In conclusion, while overall demographics and injury mechanisms remained virtually unchanged, trauma patients during the pandemic displayed worse estimated clinical prognoses, particularly in physiological trauma scores. The heightened mortality rate was attributed to poorer clinical conditions of patients., Competing Interests: The authors declare no conflict of interest., (© 2024 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Objective: This study aimed to determine the prevalence and survival rate of trauma patients who underwent resuscitative thoracotomy (RT) in a level I trauma center in southern Iran., Methods: This cross-sectional descriptive study conducted at Rajaee Hospital (Shiraz, Iran) from March 2018 to October 2022, included trauma patients who underwent RT surgery. Demographic information, vital signs at arrival, mechanism of injury, type of trauma, admission and discharge dates, length of hospital stay, blood transfusions, associated injuries, and clinical and laboratory parameters were evaluated. Statistical analyses were conducted using SPSS software., Results: A total of 147 trauma patients underwent RT. The patients' mean age was 39±18.49 years. The majority of participants were men (82.40%). The most prevalent type of damage was blunt trauma, with a survival rate of 3%, followed by penetrating trauma, which had a 20% survival rate. The leading cause of trauma-related fatalities was road traffic accidents (78.9%). The majority of RT procedures (75.5%) took place in cardiopulmonary resuscitation (CPR) rooms. The survival group had lower systolic and diastolic blood pressure levels than the non-survival (83.0±34.96 vs. 97.83±33.10) and (40.75±20.91 vs. 62.48±25.36), respectively. Survivors exhibited a significantly higher Glasgow Coma Scale than non-survivors (8.40±6.14 vs. 4.75±3.84)., Conclusion: The study revealed a low survival rate among trauma patients undergoing RT. Blunt chest trauma emerged as an independent predictor of poor outcomes. Future studies should further explore indications and outcomes of RT to better inform clinical practice., Competing Interests: The authors declared that they had no conflict of interest., (© Bulletin of Emergency And Trauma (BEAT).)

Competing Interests: The authors declared that they had no conflict of interest.

Background and Aims: Electronic logbook (E-Logbook) is one of the practical software in medical science that serves as an auxiliary tool for comprehensive education, formative evaluation, and student learning documentation in clinical education. E-logbooks are available to people on the Internet without any time or place restrictions. Experts' familiarity with e-logbooks and their advantages and disadvantages can be effective in their better design so professors and students can use their potential benefits. Therefore, this study examines the advantages and disadvantages of an e-logbook., Methods: This systematic review was conducted until June 13, 2022, by searching relevant keywords such as logbook, e-logbook, and medical students in PubMed, Scopus, and Web of Science databases. Data were extracted using the data extraction form. The contents of the studies were analyzed based on the study's aim. The results of the analyses were presented in the form of descriptive statistics (tables and figures)., Results: Out of 365 retrieved studies, 13 were selected to investigate the advantages and disadvantages of e-logbooks. Most studies were conducted in Pakistan ( n  = 4) and focused on medical students with different specialties ( n  = 10). The advantages and disadvantages of e-logbooks were classified into nine and four categories, respectively. Most advantages of e-logbooks were related to monitoring and evaluating the performance of students and instructors ( n  = 11). Their most disadvantages were associated with hardware and software ( n  = 8)., Conclusion: According to the results, e-logbooks can improve clinical education, provide feedback to people, control the achievement of educational goals, and increase professor-student interaction. Hence, it is recommended to address their disadvantages and barriers to improve the quality of students' performance., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Background: Trauma has a significant impact on the overall health of individuals worldwide, being a leading cause of morbidity and mortality with long-lasting effects. The identification of suitable biomarkers is crucial to predict patient outcomes, providing information about the severity of a condition or the probability of a specific outcome. Hence, in this study, we addressed a new biomarker, copeptin, and discussed its prognostic roles in various trauma researches., Main Body: Copeptin is a peptide derived from the precursor of the hormone vasopressin, which is released in response to stress. Copeptin can serve as a valuable biomarker for determining the severity, prognosis, and outcome of trauma patients. Elevated levels of copeptin are associated with increased mortality and poor clinical outcomes in patients with severe injuries or bleeding. Implementing copeptin measurements in clinical practice can enable healthcare providers to more accurately gauge the degree of trauma and predict patient mortality and morbidity outcomes facilitating prompt interventions and personalized treatment., Conclusion: The measurement of novel biomarker copeptin can serve as a prognostic molecule for further outcomes in trauma patients. Nevertheless, supplementary research is needed to fully comprehend its role in the development and progression of traumatic injuries., (© 2023. The Author(s).)

Introduction: Although hydatid cyst remains one of the prevalent parasitic infections in humans, hydatid cyst of the thyroid is extremely rare, even in endemic areas. Here we present two cases of thyroid hydatid cysts., Case Presentation: A 35 and a 50 year-old Iranian female with a positive history of animal contact were presented with a neck lump without any compressive symptoms. A physical exam revealed neck masses that elevated with swallowing. Thyroid gland ultrasonography showed cystic thyroid lesions, and fine needle aspiration (FNA) suggested a thyroid hydatic cyst. Thyroid lobectomy and isthmectomy were done for the first patient, and near-total thyroidectomy was done for the other. The pathology report confirmed the diagnosis of a hydatid cyst. None of the patients had hydatid cysts in other sites. Patients were discharged without an antiparasitic drug, and no recurrence was detected at the six-month follow-up., Conclusion: It is necessary to consider hydatid cysts in the differential diagnosis of cystic lesions of the thyroid gland in endemic areas, especially in people with a positive history of animal contact., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Personal Health Records (PHRs) are designed to fulfill the goals of electronic health (eHealth) and empower the individual in the process of self-care. Integrated PHR can improve the quality of care, strengthen the patient-healthcare provider relationship, and reduce healthcare costs. Still, the process of PHR acceptance and use has been slow and mainly hindered by people's concerns about the security of their personal health information. Thus, the present study aimed to identify the Integrated PHR security requirements and mechanisms., Methods: In this applied study, PHR security requirements were identified with a literature review of (library sources, research articles, scientific documents, and reliable websites). The identified requirements were classified, and a questionnaire was developed accordingly. Thirty experts completed the questionnaire in a two-round Delphi technique, and the data were analyzed by descriptive statistics., Results: The PHR security requirements were identified and classified into seven dimensions confidentiality, availability, integrity, authentication, authorization, non-repudiation, and right of access, each dimension having certain mechanisms. On average, the experts reached an agreement about the mechanisms of confidentiality (94.67%), availability (96.67%), integrity (93.33%), authentication (100%), authorization (97.78%), non-repudiation (100%), and right of access (90%)., Conclusion: Integrated PHR security is a requirement for its acceptance and use. To design a useful and reliable integrated PHR, system designers, health policymakers, and healthcare organizations must identify and apply security requirements to guarantee the privacy and confidentiality of data., (© 2023. The Author(s).)

Background: Multi-organ dysfunction syndrome and multi-organ failure are the leading causes of late death in patients sustaining severe blunt trauma. So far, there is no established protocol to mitigate these sequelae. This study assessed the effect of hemoperfusion using resin-hemoadsorption 330 (HA330) cartridges on mortality and complications such as acute respiratory distress syndrome (ARDS) and systemic inflammatory response syndrome (SIRS) among such patients., Methods: This quasi-experimental study recruited patients ≥ 15 years of age with blunt trauma, injury severity score (ISS) ≥ 15, or initial clinical presentation consistent with SIRS. They were divided into two groups: the Control group received only conventional acute care, while the case group received adjunctive hemoperfusion. P-values less than 0.05 were statistically significant., Results: Twenty-five patients were included (Control and Case groups: 13 and 12 patients). The presenting vital signs, demographic and injury-related features (except for thoracic injury severity) were similar (p > 0.05). The Case group experienced significantly more severe thoracic injuries than the Control group (Thoracic AIS, median [IQR]: 3 [2-4] vs. 2 [0-2], p = 0.01). Eleven and twelve patients in the Case group had ARDS and SIRS before the hemoperfusion, respectively, and these complications were decreased considerably after hemoperfusion. Meanwhile, the frequency of ARDS and SIRS did not decrease in the Control group. Hemoperfusion significantly reduced the mortality rate in the Case group compared to the Control group (three vs. nine patients, p = 0.027)., Conclusions: Adjunctive Hemoperfusion using an HA330 cartridge decreases morbidity and improves outcomes in patients suffering from severe blunt trauma., (© 2023. The Author(s).)

The goal of this study was to develop a predictive machine learning model to predict the risk of prolonged mechanical ventilation (PMV) in patients admitted to the intensive care unit (ICU), with a focus on laboratory and Arterial Blood Gas (ABG) data. This retrospective cohort study included ICU patients admitted to Rajaei Hospital in Shiraz between 2016 and March 20, 2022. All adult patients requiring mechanical ventilation and seeking ICU admission had their data analyzed. Six models were created in this study using five machine learning models (PMV more than 3, 5, 7, 10, 14, and 23 days). Patients' demographic characteristics, Apache II, laboratory information, ABG, and comorbidity were predictors. This study used Logistic regression (LR), artificial neural networks (ANN), support vector machines (SVM), random forest (RF), and C.5 decision tree (C.5 DT) to predict PMV. The study enrolled 1138 eligible patients, excluding brain-dead patients and those without mechanical ventilation or a tracheostomy. The model PMV > 14 days showed the best performance (Accuracy: 83.63-98.54). The essential ABG variables in our two optimal models (artificial neural network and decision tree) in the PMV > 14 models include FiO 2 , paCO 2 , and paO 2 . This study provides evidence that machine learning methods outperform traditional methods and offer a perspective for achieving a consensus definition of PMV. It also introduces ABG and laboratory information as the two most important variables for predicting PMV. Therefore, there is significant value in deploying such models in clinical practice and making them accessible to clinicians to support their decision-making., (© 2023. The Author(s).)

Introduction: Altered immune responses, in particular neutrophil changes, are perceived to play a key role in immune responses to trauma. This study aimed to evaluate the association of neutrophil changes with patients' survival in severe multiple trauma cases., Methods: The current retrospective cohort study was conducted using data from patients admitted in the intensive care unit (ICU) of a trauma center in Shiraz, Iran, between 2016 and 2021. Patients were divided into three groups (i.e., normal, neutropenia, and neutrophilia) based on neutrophil count at the time of ICU admission, and the association of neutrophil count with in-hospital mortality was analyzed., Results: 2176 patients with the mean age of 37.90 ± 18.57 years were evaluated (84.04% male). The median trauma severity based on injury severity score (ISS) in this series was 9 (4 -17). Patients were divided in to three groups of neutrophilia (n = 1805), normal (n = 357), and neutropenia (n = 14). There were not any significant differences between groups regarding age distribution (p = 0.634), gender (p = 0.544), and trauma severity (p = 0.197). The median survival times for the normal, neutropenia, and neutrophilia groups were 49 (IQR: 33 -47) days, 51 (IQR: 8- 51) days, and 38 (IQR: 26 - 52) days, respectively (p = 0.346). The log-rank test showed a statistically significant difference between the three groups adjustment for ISS (p ≤ 0.001). For each unit increase in ISS, the hazard ratio increased by 2%. In ISS 9-17, the hazard ratio increased by 11% compared to ISS<4. Also, in ISS>17, the hazard ratio increased by 76% compared to ISS<4 in ICU-hospitalized patients., Conclusions: In general, the findings of the present study showed that the survival rate of patients in the normal group after ISS adjustment was higher than the other two groups. Also, the Cox model showed that the mortality risk ratio in the neutropenia group was 15 times higher than the normal group., Competing Interests: The authors of this study declared no competing interests.

Purpose: Patients with multiple traumas are at high risk of developing respiratory complications, including pneumonia and acute respiratory distress syndrome. Many pulmonary complications are associated with systemic inflammation and pulmonary neutrophilic infiltration. Leukotriene-receptor antagonists are anti-inflammatory and anti-oxidant drugs subsiding airway inflammation. The present study investigates the effectiveness of montelukast in reducing pulmonary complications among trauma patients., Methods: This randomized, double-blind, placebo-control trial was conducted in patients with multiple blunt traumas and evidence of lung contusion detected via CT scan. We excluded patients if they met at least one of the following conditions: < 16 years old, history of cardiopulmonary diseases or positive history of montelukast-induced hypersensitivity reactions. Patients were allocated to the treatment (10 mg of montelukast) or placebo group using permuted block randomization method. The primary measured outcome was the volume of pulmonary contusion at the end of the trial. The secondary outcomes were intensive care unit and hospital length of stay, ventilation days, multi-organ failure, and the in-hospital mortality rate., Results: In total, 65 eligible patients (treatment = 31, placebo = 34) were included for the final analysis. The treatment group had more pulmonary contusion volume (mean (SD), mm 3 ) at the right (68726.97 (93656.54) vs. 59730.27 (76551.74)) and the left side (67501.71 (91514.04) vs. 46502.21 (80604.21)), higher initial C-reactive peptide level (12.16 (10.58) vs. 10.85 (17.87)) compared to the placebo group, but the differences were not statistically significant (p > 0.05). At the end of the study, the mean (SD) of pulmonary contusion volume (mm 3 ) (right side = 116748.74 (361705.12), left side = 64522.03 (117266.17)) of the treatment group were comparable to that of the placebo group (right side = 40051.26 (64081.56), left side = 25929.12 (47417.13), p = 0.228 and 0.082, respectively). Moreover, both groups have statistically similar hospital (mean (SD), days) (10.87 (9.83) vs. 13.05 (10.12)) and intensive care unit length of stays (mean (SD), days) (7.16 (8.15) vs. 7.82 (7.48)). Of note, the frequency of the in-hospital complications (treatment vs. control group) including acute respiratory distress syndrome (12.9% vs. 8.8%, p = 0.71), pneumonia (19.4% vs. 17.6%, p = 0.85), multi-organ failure (12.9% vs. 17.6%, p = 0.58) and the mortality rate (22.6% vs. 14.7%, p = 0.41) were comparable between the groups., Conclusion: Administrating montelukast has no preventive or therapeutic effects on lung contusion or its complications., (Copyright © 2022. Production and hosting by Elsevier B.V.)

Since the pandemic began in December 2019, SARS-Cov2 has accentuated the wide gap and disparities in socioeconomic and healthcare access at individual, community, country, and regional levels. More than two years into the current pandemic, up to three-fourths of the patients are reporting continued signs and symptoms beyond the acute phase of COVID-19, and Long COVID portends to be a major challenge in the future ahead. With a comprehensive overview of the literature, we found that most studies concerning long COVID came from high and upper-middle income countries, and people of low-income and lower-and-middle income regions and vulnerable groups with comorbid conditions have been neglected. Apart from the level of income, there is a significant geographical heterogeneity in investigating the Post-Acute Sequelae of COVID-19 (PASC) or what we call now, long COVID. We believe that these recognizing health disparities is crucial from equity perspective and is the first step toward global health promotion.

Background: Distal femur fracture is considered one of the most common fractures due to high-energy traumas such as car accidents or low-energy traumas such as osteoporosis. Locking plates are orthopedic implants used for stabilized femur fracture. Thus, designing a bone plate fitted exactly with the patient's bone and correctly fixing bone segments are required for better fracture healing., Objectives: This study aims to design a bone plate based on anthropometric characteristics of patients' femurs and compare performing custom-designed bone plates (CDBP) with the locking compression plate (LCP) by finite element method., Materials and Methods: In this analytical study, a 3D model of four patients' femur and CDBP were firstly designed in MIMICS 19.0 based on the patient's femur anatomy. After designing the bone plate, the CDBPs and LCP were fixed on the bone and analyzed by finite element method (FEM) in ANSYS, and stress and strain of bone plates were also compared., Results: The maximum principal stress for all 3D models of patients' fracture femur by CDBPs was stabilized better than LCP with a decrease by 39.79, 12.54, 9.49, and 20.29% in 4 models, respectively. Also, in all models, the strain of CDBPs is less than LCP. Among the different thicknesses considered, the bone plate with 5 mm thickness showed better stress and strain distribution than other thicknesses., Conclusion: Customized bone plate designed based on patient's femur anatomical morphology shows better bone-matching plate, resulting in increasing the quality of the fracture healing and fails to any need for additional shaping., Trial Registration Number: Design and analysis of an implant were investigated in this study. There was no intervention in the diagnosis and treatment of patients and the study was not a clinical trial., (© 2021. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Purpose: One of the most critical concerns in the intensive care unit (ICU) section is identifying the best criteria for entering patients to this part. This study aimed to predict the best compatible criteria for entering trauma patients in the ICU section., Method: The present study was a historical cohort study. The data were collected from 2448 trauma patients referring to Shahid Rajaee Hospital between January 2015 and January 2017 in Shiraz, Iran. The artificial neural network (ANN) models with cross-validation and logistic regression (LR) with a backward method was used for data analysis. The final analysis was performed on a total of 958 patients who were transferred to the ICU section., Results: Based on the present results, the motor component of the GCS score at each cutoff point had the highest importance. The results also showed better performance for the AUC and accuracy rate for ANN compared with LR., Conclusion: The most critical indicators in predicting the optimal use of ICU services in this study were the Motor component of the GCS. Results revealed that the ANN had a better performance than the LR in predicting the main outcomes of the traumatic patients in both the accuracy and AUC index. Trauma section surgeons and ICU specialists will benefit from this study's results and can assist them in making decisions to predict the patient outcomes before entering the ICU., Competing Interests: Declaration of competing interest There is no conflict of interest in this study., (Copyright © 2021 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.)

Background: The prevalence of drug poisoning is on the rise in Iran due to the increased public access to drugs. A national drug poisoning registry system is a suitable tool for better management, control, and prevention of drug poisoning., Objectives: This study aimed to propose a national drug poisoning registry model for Iran., Methods: This was an applied research conducted in two major phases. In the first phase, all sources pertaining to drug poisoning registries were reviewed, and a national drug poisoning registry model was proposed. In the second phase, this model was validated and finalized using a researcher-made questionnaire and through a two-stage Delphi technique., Results: The focus of national drug poisoning activities and registry management reached the 100% consensus of experts at the Drug and Poison Information Center of the Food and Drug Organization (Ministry of Health and Medical Education). Goals, data sources, registry system structure, data set, standards, data exchange, registry features, and processes of the proposed model also achieved unanimous expert consensus., Conclusions: Given the importance of a national drug poisoning registry in gathering, storing, analyzing, and reporting the data of patients, it is essential to provide a framework for evaluating and controlling drug poisoning and for generating valuable data for decision-making. The model proposed herein can offer the information infrastructure for designing and implementing such a system., Competing Interests: Conflict of Interests: The authors declare that there are no conflicts of interest., (Copyright © 2022, Author(s).)

Objective: To evaluate the presence/severity of depression, anxiety, and stress among health care workers (HCWs) who work on the specially allocated COVID-19 ward (Group A) and HCWs on the other wards (Group B)., Methods: This questionnaire-based study was conducted from January 25 to February 28, 2021. The mental status was assessed using the Persian version of the 42-item Depression, Anxiety, and Stress score (DASS-42). Gathered data was analyzed using SPSS version 25. The independent T-test and Chi-square tests were used to compare quantitative and qualitative variables., Results: Two-hundred and twenty two questionnaires were eligible for analysis. Group A consisted of 33 HCWs, and 189 (85.1%) individuals were working on the other wards. No statistically significant differences were seen regarding the Socio-demographic features except for the marital status ( p =0.005). The depressions' mean score was comparable between group A and B ( p =0.102). The mean scores of anxiety and stress were significantly lower in group A than group B ( p =0.006), although the frequency of DASS-42 parameters did not differ between these two groups ( p >0.05)., Conclusion: Contrary to our assumptions, this study showed that the DASS-42 parameters were not higher in HCWs working on the COVID-19 wards. This might be justified by developing coping mechanisms, being on the honeymoon phase of the disaster, compassion satisfaction, promising vaccine news, and working on the less impacted hospital., Competing Interests: The authors declare that there are no conflicts of interests.

Propose: In this study, we re-assessed the criteria defined by the radiological society of North America (RSNA) to determine novel radiological findings helping the physicians differentiating COVID-19 from pulmonary contusion., Methods: All trauma patients with blunt chest wall trauma and subsequent pulmonary contusion, COVID-19-related signs and symptoms before the trauma were enrolled in this retrospective study from February to May 2020. Included patients (Group P) were then classified into two groups based on polymerase chain reaction tests (Group Pa for positive patients and Pb for negative ones). Moreover, 44 patients from the pre-pandemic period (Group PP) were enrolled. They were matched to Group P regarding age, sex, and trauma-related scores. Two radiologists blindly reviewed the CT images of all enrolled patients according to criteria defined by the RSNA criteria. The radiological findings were compared between Group P and Group PP; statistically significant ones were re-evaluated between Group Pa and Group Pb thereafter. Finally, the sensitivity and specificity of each significant findings were calculated. The Chi-square test was used to compare the radiological findings between Group P and Group PP., Results: In the Group PP, 73.7% of all ground-glass opacities (GGOs) and 80% of all multiple bilateral GGOs were detected (p < 0.001 and p = 0.25, respectively). Single bilateral GGOs were only seen among the Group PP. The Chi-square tests showed that the prevalence of diffused GGOs, multiple unilateral GGOs, multiple consolidations, and multiple bilateral consolidations were significantly higher in the Group P (p = 0.001, 0.01, 0.003, and 0.003, respectively). However, GGOs with irregular borders and single consolidations were more significant among the Group PP (p = 0.01 and 0.003, respectively). Of note, reticular distortions and subpleural spares were exclusively detected in the Group PP., Conclusion: We concluded that the criteria set by RSNA for the diagnosis of COVID-19 are not appropriate in trauma patients. The clinical signs and symptoms are not always useful either. The presence of multiple unilateral GGOs, diffused GGOs, and multiple bilateral consolidations favor COVID-19 with 88%, 97.62%, and 77.7% diagnostic accuracy., (Copyright © 2022 Chinese Medical Association. Production and hosting by Elsevier B.V. All rights reserved.)

Objective: To investigate the impact of peer-assisted learning (PAL) in chest tube insertion education on surgical residents., Methods: This study is a quasi-experimental study conducted on thirty general surgeon residents enrolled in the PAL program. They were divided into two learner groups (A and B) based on the period of residency start. Group A and B had six and one months of general surgery residency experience, respectively. All participants received adequate training for chest tube insertion by a recently graduated general surgeon. Chest tubes insertion skill was assessed using the tool for assessing chest tube insertion competency (TACTIC) test., Results: Post-TACTIC test score was significantly higher ( p =0.001) than Pre-TACTIC test score in both groups. However, a comparison of mean Pre-TACTIC test scores and mean Post-TACTIC test scores between group A and group B showed that PAL effectiveness in group A was significantly higher ( p =0.001) than group B., Conclusion: There was a positive relationship between the PAL program and the improvement of chest tube insertion technical skills in surgical residents. Based on our findings and similar studies, it can be concluded that the PAL program can increase the chest tube insertion skill of surgical residents., Competing Interests: The authors declare that they have no conflict of interest.