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Abstract Background Emergency medical services preparedness in mass casualty incidents is one of the most important concerns in emergency systems. A mass casualty incident is a sudden event with several injured individuals that overwhelms the local health care system. This study aimed to identify and validate the components of emergency medical services readiness in mass casualty incidents which ultimately led to designing a conceptual model. Methods This research was an explanatory mixed-method study conducted in five consecutive stages in Iran between November 2021 and September 2023. First, a systematic review was carried out to extract the components of emergency medical services preparedness in mass casualty incidents based on the PRISMA guideline. Second, a qualitative study was designed to explore the preparedness components through in-depth semi-structured interviews and analyzed using the content analysis approach. Third, the integration of the components extracted from the two stages of the systematic review and qualitative study was done by an expert panel. Fourth, the obtained components were validated using the Delphi technique. Two rounds were done in the Delphi phase. Finally, the conceptual model of emergency medical services preparedness in mass casualty incidents was designed by a panel of experts. Results 10 articles were included in the systematic review stage and sixteen main components were extracted and classified into four categories. In the second stage, thirteen components were extracted from the qualitative study and classified into five categories. Then, the components of the previous two phases were integrated into the panel of experts and 23 components were identified. After validation with the Delphi technique, 22 components were extracted. Lastly, the final components were examined by the panel of experts, and the conceptual schematic of the model was drawn. Conclusions It is necessary to have an integrated framework and model of emergency medical service readiness in the planning and management of mass casualty incidents. The components and the final model of this research were obtained after the systematic scientific steps, which can be used as a scheme to improve emergency medical service preparedness in response to mass casualty incidents.

Abstract The electromagnetic compatibility analysis of RF circuitry is essential due to the adverse effects on sensitive components. Two metamaterial unit cells with slow‐wave properties are presented for cross‐talk reduction in transmission lines. The analytical expressions for computing equivalent lumped elements of the lines are then provided. The dispersion diagram is obtained from the parameters extracted from the measurement. A microstrip as the generator line and five identical CRLH unit cells as the receptor line are then used and a significant reduction in cross‐talk is observed in comparison to conventional lines. A non‐uniform transmission line with two different CRLH unit cells as the receptor line is then employed and found effective in further cross‐talk reduction between the lines. The lengths of the lines and numbers of cells are kept the same in all lines for comparison. The simulated results are validated by measurements.

IntroductionIn most arid and semi-arid areas, the soils have a compact surface layer that is denser and less permeable than the underlying layers. These layers are referred to as surface coating when they are wet, and when they dry, they are referred to as surface crust. Surface crust can be divided into physical, chemical, and biological crusts depending on the nature of formation. Physical and biological soil crusts are the most significant types of soil crusts in arid and semi-arid regions. Two types of the physical crust are structural and depositional. Natural events, such as raindrops and the drying process, are the primary causes of the formation of surface crust. The process involves the creation of hard, thin layers on the surface of the soil. The thickness of the surface crusts is typically between 1 mm and 5 cm. Many researches have described different theoretical mechanisms for the formation of surface crusts in soil and reported their effective role in controlling wind erosion. The formation of crust in soil involves multiple stages, and the reaction of the soil surface to raindrop energy is divided into two main parts, as it was demonstrated. The first part involves the splashing of soil particles by raindrops' impact. A layer with a thickness of approximately 0. 1 mm is produced in this instance. The second component is composed of fine soil particles that penetrate the soil pores with water and cause the formation of a layer that is 2 mm thick. According to a study, soil loss control is not affected by the crust cover beyond 30%. There is a linear relationship between soil loss and surface crust coverage, as the surface crust cover develops gradually, soil loss differs between soil types. Material and MethodsDuring field surveys of dust storm sources in Khuzestan, it was observed that there are surface crusts that are strong enough to act as a barrier against wind erosion in certain locations. The suggestion was made to investigate the type and general characteristics of these surface crusts. The purpose of this study is to examine the general characteristics of these surface crusts and their effect on wind erosion control. The study was conducted by randomly obtaining 18 surface crust samples, each containing three sub-samples from a depth of 0 to 5 cm from the dust storm sources of Khuzestan province. After being air dried, they were then passed through a sieve of 2 mm. The factors of pH, EC, CaCo3, CEC, ESP, Ca, Mg, Po3-4 texture, initial moisture, and apparent density of the surface crusts were measured. The soil's sensitivity to crust formation was assessed by using soil stability index, Crusting Index, pressure resistance, and shear resistance. The stability of soil aggregates was assessed using the mean weight diameter and geometric mean diameter indices. Soil samples were collected and tested in a wind tunnel to examine the impact of these surface crusts on wind erosion control and the amount of soil loss and the speed of wind erosion were assessed. An orbital wind tunnel device was utilized for this purpose. Trays with soil were placed on the bottom of the tunnel in this manner. After the wind blew (speeds of 15, 10, 25 m/s) by measuring the difference in the weight of the tray before and after the wind blowing, the amount of erosion was calculated from a certain surface. Then, the threshold speed for wind erosion was determined. Statistical analysis was carried out using SPSS 26 software. The Kolmogorov-Smirnov test was used to verify data normality. Then, the data sets were entered into a step-by-step regression as independent components to determine their relationship with the index of crust formation and stability of soil aggregates, as well as the effect of crusts and stability of soil aggregates on the amount of wind erosion. The accuracy of the regression models was verified by using RMSE, RSE, MAE, and R2 statistics. The morphology of the crusts was finally determined by using a scanning electron microscope. Results and DiscussionThe results showed that the lowest amount of RMSE, and RSE statistics, and the lowest absolute error for evaluating the sensitivity of soil to crust formation in the dust storm sources of East Ahvaz, Southeast Ahvaz and Omidieh, Mahshahr and Hendijan, respectively belong to the index of compressive strength, soil stability and shear resistance. The scanning electron microscope images taken of the crusts of three dust storm sources indicated that small foreign matter is present in the soil's pores. The features of the sedimentary crust are displayed in all the images. The external materials in the crust structure reflect the different washing processes in soil particles, which cause adhesion and connection between the soil particles and make the crusts resistant to wind erosion. Based on the given explanations, it is possible that the crusts found in Khuzestan's dust storm sources are usually sedimentary crusts. Results also showed that the wind erosion threshold speed in the dust storm sources of East Ahvaz, South East Ahvaz and the sources of Mahshahr, Omidiye and Hendijan are 1. 44, 1. 62 and 2. 1 time their powdered state, respectively. These sources experience a soil loss of 3. 55, 2. 09, and 3. 01 times the intact crusts, respectively.

This comprehensive review examines the expansive role of artificial intelligence (AI) in oncology, with a particular focus on breast and thyroid cancers. It delves into AI’s mechanisms, notably machine learning (ML) and deep learning (DL), which are instrumental in deciphering complex patterns across vast datasets, thereby augmenting diagnostic accuracy. ML facilitates AI’s ability to learn from data, while DL, a specialized branch of ML, employs neural networks for identifying subtle characteristics, offering profound insights into cancer research. This review synthesizes insights from various sources, including academic texts and pertinent articles, to provide a detailed overview of AI’s current applications, challenges, and breakthroughs in cancer care. It highlights the transformative impact of AI technologies on the diagnosis and treatment of cancer, offering a comprehensive analysis of how these innovations are revolutionizing oncological care across diagnostic and therapeutic domains.

Abstract Background and Aims The effective response of emergency medical services in mass casualty incidents (MCIs) calls for sufficient preparation. The components of preparation must be determined first to achieve this goal. This study aimed to describe the elements of preparedness of emergency medical services for MCIs. Methods A qualitative study was carried out on emergency medical service systems in Iran (from April 2022 to mid‐March 2023), using in‐depth semistructured interviews with participants who were managers and members of the incident command team, experts, technicians, paramedics, and telecommunicators of emergency medical services. Interviews were carried out face‐to‐face and via telephone. The data were collected using voice recorder and transcript and analyzed by content analysis method. This study was conducted using the consolidated criteria for reporting qualitative research. Results Thirty‐six participants were included in the study. A total of 834 codes were analyzed. Thirteen components were extracted from the study and classified as five categories including “Strengthening management and organization,” “individual and group empowerment,” “capacity expansion,” “technology and infrastructure development,” and “operational response measures.” Conclusion Emergency medical service preparedness in response to MCIs is a critical issue. For improving preparedness, the main components must be identified. The study results described the elements of emergency medical service preparedness, which could be used as a framework for developing the national model of emergency medical service preparedness in MCIs.

Long-term monitoring as well as the impacts of climate change on sand dune mobility play a crucial role in reducing their adverse effects, including creating dusty days, potential risks of reduced air quality, and other environmental and health risks. The main objectives of this study were to investigate the dust phenomenon and its origin, to analyze the mobility status of sand dunes using two indicators, to determine the effect of climatic conditions on mobility, and also to predict the effects of changes in climate parameters on sand dunes mobility in the strategic area of ​​Sarakhs, located on the northeastern border of the country, for a period of 27 years. The results on the number of dusty days showed that the local dust events at Sarakhs station had a significant increasing trend. The results of sand dune mobility using Lancaster and modified Lancaster indices showed that there was a significant relationship at 99% level with dusty days, based on which the ability to use the modified Lancaster index in this area is raised. It can also be acknowledged that in the study region, increasing environmental drought coming with the mobility of sand dunes increases the risk of desertification. Also, the results of sand mobility sensitivity analysis showed that the combined effect of the frequency of erosive winds or the potential of sand transport and evapotranspiration has the greatest effect on reducing and increasing sand activity in the future.

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

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.

Background: Disasters occur unexpectedly each year, killing thousands around the world. Millions are directly under the influence of the outcomes of these events and their survival depends on the immediate state and international aid. This supports should be obtained in early hours after disasters. The main important need after disasters is safe water supply, which along with providing shelter, medicine, and nutrition, is vital to prevent diseases. So, immediate actions are needed to replace suitable drinking water resources for affected people. Methods: This study was conducted in 2019 using Web of Science, PupMed, Springer, Scopus, Embase databases (from 2000 to 31 September 2019). The PRISMA guideline was used to compile the study. All articles included in this study were original articles, short communications, letters to editor, editorials, systematic reviews, and articles presented at conferences and international congresses on the main topic of the study. Only English full-text articles were included in this study. Results: According to the results, water resources supply in disasters and emergencies criteria were classified into 4 main and 30 sub-criteria. The main criteria include environmental, economic, technology performance, quantitative and qualitative characteristics of water resources, which have 4, 2, 12, and 12 sub-criteria, respectively. Conclusion: This study intends to assist disaster service officials and decision makers and supervisors to plan for drinking water supply from area water resources, before the disaster and based on the history and geographical characteristics of the area, to take actions and meet the drinking water needs of the region.

Purpose: Traumatic hemorrhagic shock is a life-threatening event worldwide. Severe brain trauma accompanying femoral fractures can trigger inflammatory responses in the body and increase pre-inflammatory cytokines such as TNF-α, IL-1. The primary treatment in these cases is hydration with crystalloids, which has both benefits and complications. The purpose of this study was to investigate the effects of fluid therapy on the hemodynamics, coagulation profiles, and blood gases in such patients. Methods: In this cross-sectional study, patients were divided into two groups: femoral fracture group and non-femoral group. The hemodynamic status, coagulation profile, and blood gases of patients in both groups were evaluated upon arrival at the hospital and again 2 h later. Data were analyzed by t-test and ANOVA with repeated data and paired samples t-test. Results: A total of 681 trauma patients (605 men and 76 women) participated in this study, including 69 (86.3%) men and 11 (13.8%) women in femoral fracture group and 536 men (89.2%) and 65 women (10.8%) in non-femoral group. The laboratory parameters were evaluated in response to the equal amount of crystalloid fluid given upon arrival and 2 h later. Blood gases decreased in the fracture group despite fluid therapy (p

In this article, exergoeconomic analysis of a hybrid desalination system driven by renewable geothermal energy source is investigated. Freshwater and electrical power are the products of this system. Humidification – dehumidification (HDH) unit works in parallel with reverse osmosis (RO) unit to produce freshwater and Kalina cycle is the power generator unit. Thermoelectric generator (TEG) is responsible for providing the energy required by RO unit. As both HDH and TEG can operate with low-grade energy, two different modes are suggested for the proposed system. In the first mode, the geothermal low grade energy stream is passed to TEG unit, while in the second, it goes through the HDH unit. The effect of different parameters on four main objective functions is examined in parametric study. Moreover, with the aid of selection maps, the objectives of modes can be compared in different operating conditions. The maximum attainable exergy efficiency is calculated to be 28.86% for mode 2. Single objective optimization studies revealed that the first mode produces the largest amount of freshwater at a rate of 22,072 (m3/day), while the minimum achievable freshwater cost and total product cost rate can be obtained in the second mode, which is calculated to be 21.94 (¢/m3) and 37.19 ($/GJ). Besides, Sankey diagrams for exergy flow and mass flow of saline water are presented to unravel the impact of each sub-system on exergy and salinity.

During the past few months, the novel coronavirus 2019 (COVID-19) pandemic has significantly affected medical service provision. In Iran, it has caused around 197,000 inflictions and 9200 deaths up to June 18, 2020. While many departments turned to telehealth in this era, the trauma service should provide non-stop in presence service to the trauma victims. Our trauma center is the largest in the southwest of Iran, with the mean annual admission of 18,500 polytrauma patients. In this center, we designed a safety protocol to mitigate the spread of disease and also have a more robust case finding system, especially among asymptomatic carriers who attend hospitals based on their trauma. In brief, all unstable patients were considered SARS-COV-2 positive and were directed toward the Specialized COVID-19 related ICU. For all stable patients, history, physical examination, CXR, and lab test (Complete Blood Count, Erythrocyte Sedimentation Rate, C-Reactive Protein) were ordered before entering the wards. If there was any suspicion of COVID-19, the stable patient was admitted to the COVID-19 specialized ward. Among all 1805 patients admitted during a ten weeks interval (from January 30, 2020, to April 14, 2020), 84 had a red flag and toward to COVID-19 related wards. Of those, 67 had positive PCR or evidence in CT in favor of the COOVID-19. Moreover, during regular workups, we found that 19 completely asymptomatic trauma victims had typical Chest CT scan findings of COVID-19.

Trauma is still the leading cause of mortality and morbidity worldwide with an estimated 5.8 million mortalities every year [1] and approximately 60 million traumatic brain injuries (TBI) annually [2]. Hemorrhage remains the most common preventable cause of mortality and morbidity following trauma either in civilian or military settings [3, 4]. Intracranial bleeding following TBI results in increased intracranial pressure (ICP), brain herniation and cerebral edema which are all secondary insults to the brain parenchyma leading to increase disability and mortality [5]. Thus, the development and administration of antifibrinolytic agents have been the focus of traumatic injuries during the previous decades with the hypothesis of hemorrhage cessation and hemostasis with a medical agent rather than a surgical intervention. These efforts resulted in developing several agents and subsequent large multicenter clinical trials to define the best antifibrinolytic agent for prevention of death following TBI.

Introduction: One of the concerns of specialists of drug abuse treatment is stabilization in the treatment. The aim of this study was to determine the effective factors in the successful treatment of drug abuse. Method: This qualitative study with Grounded theory approach, was conducted in Zanjan in 2016. Fifteen subjects with a history of drug abuse, who were treated for at least 4 years, were selected through snowball sampling. Data were collected through semi-structured interviews and analyzed using constant comparative analysis method (Strauss and Corbin) by Nvivo 10 software. Results: Using open, axial, and selective coding, the main theme of this study was "Steps to successful treatment of drug abuse". Contextual conditions include the uncensored look at life, the hope of return, the awareness of the return path, and the causative conditions include motivational helplessness, motivational resources, personality traits, and choosing an efficient treatment method. Intervening conditions include religion, helpful resources, and attitude change. And strategies include mechanisms of self-disclosure, trust in God, getting away from the environments conducive to drug consumption, recalling the difficulties of addiction period and social networking. The main outcomes of the successful treatment include retaking family and social responsibilities, comprehending new pleasures of life, and development and growth of efficient personality traits. Conclusion: Successful treatment of drug abuse doesn’t occur suddenly and requires some conditions and strategies leading to observable outcomes that encourage people to not leave the path of treatment and consequently, stabilize the treatment. The results of this study can be useful for drug abusers and specialists of drug abuse treatment.

The present study was carried out to investigate the effectiveness of cooperative Teaching-learning method Jig-Saw on academic performance of students of educational sciences in Shahid Motahari pardis at Farhangian University in Sistan and Baluchestan Province in 1395. A quasi-experimental research was a pretest-posttest and follow-up study with control group. The statistical population consisted of all undergraduate students in the field of educational science of the pre-school-elementary school of shahid Motahari Pardis at Farhangian university of Sistan and Balouchestan province in the year 1395.60 subjects(30 experimental group and 30 control group) were selected using purposeful sampling. For data analysis, one-factor and multi-variable covariance analysis (MANCOVA) and repeated measures variance (ANOVA) analysis were used. The results showed that there is a significant difference in the control group between the mean of academic performance of the follow-up period with pre-test and post-test.In other words,the passage of time has reduced the academic performance of students over the pre-test and post-test time.

The elevated neutrophil-to-lymphocyte ratio (NLR) is associated with poor clinical outcomes, especially in pro-inflammatory states such as surgical injuries and severe hemorrhages. Therefore, it was hypothesized whether NLR value at the time of admission could be a prognostic indicator of hospital mortality in trauma patients. This retrospective cohort study was conducted on 865 trauma patients referred to Rajaee Hospital between April 2016 and July 2019. The NLR value was calculated at the time of admission, and receiver operating characteristics (ROC) curve analysis was used to determine the cut-off point value of admission NLR related to hospital mortality of trauma patients. Furthermore, Kaplan-Meier survival analysis and Cox regression models have been applied to determine the effectiveness and prognostic potential of the admission NLR in the hospital mortality of trauma patients. The median age of the trauma patients was 32 years with an interquartile range (IQR) of 23 to 48 years, and most of them were male (83.9%). Also, trauma patients had a median injury severity score (ISS) of 9 (IQR=4-16) and a median Glasgow coma scale (GCS) of 14 (IQR=9-15). The cut-off value for admission NLR was 5.27 (area under the curve: 0.642, 95%CI: 0.559-0.726, p=0.001). In Kaplan-Meier survival analysis, the admission NLR>5.27 was an indicator of hospital mortality in trauma patients (p=0.001). Multivariate Cox regression models demonstrated that trauma patients with an admission NLR>5.27 had a 2.33-fold risk of hospital mortality (hazard ratio=2.33, 95%CI: 1.02-5.38, p=0.041). Furthermore, the admission NLR>5.27 was associated with a higher risk of hospital mortality in trauma patients with age≥65 years, systolic blood pressure≤90 mmHg, blood potassium>4.5 mmol/L, blood sodium>144 mEq/L, blood potential hydrogen (pH)≤7.28, GCS≤8, ISS>24 and blood base excess≤-6.1 mEq/L. The NLR value greater than 5.27 at the time of admission was associated with poorer outcomes, and it can be considered an independent prognostic indicator of hospital mortality in trauma patients.

Background. The lack of enough medical evidence about COVID-19 regarding optimal prevention, diagnosis, and treatment contributes negatively to the rapid increase in the number of cases globally. A chest computerized tomography (CT) scan has been introduced as the most sensitive diagnostic method. Therefore, this research aimed to examine and evaluate the chest CT scan as a screening measure of COVID-19 in trauma patients. Methods. This cross-sectional study was conducted in Rajaee Hospital in Shiraz from February to May 2020. All patients underwent unenhanced CT with a 16-slice CT scanner. The CT scans were evaluated in a blinded manner, and the main CT scan features were described and classified into four groups according to RSNA recommendation. Subsequently, the first two Radiological Society of North America (RSNA) categories with the highest probability of COVID-19 pneumonia (i.e., typical and indeterminate) were merged into the “positive CT scan group” and those with radiologic features with the least probability of COVID-19 pneumonia into “negative CT scan group.” Results. Chest CT scan had a sensitivity of 68%, specificity of 56%, positive predictive value of 34.8%, negative predictive value of 83.7%, and accuracy of 59.3% in detecting COVID-19 among trauma patients. Moreover, for the diagnosis of COVID-19 by CT scan in asymptomatic individuals, a sensitivity of 100%, specificity of 66.7%, and negative predictive value of 100% were obtained (p value: 0.05). Conclusion. Findings of the study indicated that the CT scan’s sensitivity and specificity is less effective in diagnosing trauma patients with COVID-19 compared with nontraumatic people.

Objective: To determine the antimicrobial activity and entity of several local herbal plants against Acintobacters isolated from trauma patients admitted to a Level-I trauma center.Methods: The antibacterial activities of the Satureja bachtiarica oil and some selected Iranian medicinal plants (Artemisia sieberi and Tanacetum dumosum belonging to the Asteraceae/Compositae; Salvia mirzayanii and Mentha mozaffarianii belonging to the Lamiaceae/Labiatae) were assayed on A. baumannii by microdilution and agar disc diffusion methods. Having obtained the acceptable antibacterial data, the shade-dried aerial parts of the plants were extracted by hydrodistillation method using Clevenger apparatus according to European pharmacopeia for 3 h. The analysis of S. bachtiarica essential oil accompanied by other herbal drug oils were performed by using GC/FID and GC/MS methods.Results: Outcomes revealed that the S. bachtiarica essential oil exhibited the potent antibacterial capability against Acinetobacter strains in comparison with Colistin, as a positive control. For S. bachtiarica, the growth inhibition zone and minimum inhibitory concentration (MIC) values were 21 mm and 0.5 mg/ml, while, for Colistin, the data were in order: 8 mm and 0.016 mg/ml. Consequently, GC/MS outcomes demonstrated that the major components of the essence were carvacrol (48.6%), followed by p-Cymene (16.6%), γ-terpinene (6.9%) and linalool (5.3%).Conclusion: Based on the considerable inhibitory activity against nosocomial infections by essential oil of S. bachtiarica, it could be considered as the suitable candidate in the food industry and pharmaceutical uses.

Background: Disasters occur unexpectedly each year, killing thousands around the world. Millions are directly under the influence of the outcomes of these events and their survival depends on the immediate state and international aid. This supports should be obtained in early hours after disasters. The main important need after disasters is safe water supply, which along with providing shelter, medicine, and nutrition, is vital to prevent diseases. So, immediate actions are needed to replace suitable drinking water resources for affected people. Methods: This study was conducted in 2019 using Web of Science, PupMed, Springer, Scopus, Embase databases (from 2000 to 31 September 2019). The PRISMA guideline was used to compile the study. All articles included in this study were original articles, short communications, letters to editor, editorials, systematic reviews, and articles presented at conferences and international congresses on the main topic of the study. Only English full-text articles were included in this study. Results: According to the results, water resources supply in disasters and emergencies criteria were classified into 4 main and 30 sub-criteria. The main criteria include environmental, economic, technology performance, quantitative and qualitative characteristics of water resources, which have 4, 2, 12, and 12 sub-criteria, respectively. Conclusion: This study intends to assist disaster service officials and decision makers and supervisors to plan for drinking water supply from area water resources, before the disaster and based on the history and geographical characteristics of the area, to take actions and meet the drinking water needs of the region.

Objective: To evaluate the effect of advance trauma life support (ATLS®) training on general surgery residents clinical reasoning skills using the national boards-style objective structured clinical examination (OSCE). Methods: This cross-sectional single-center study was conducted in Shiraz University of Medical Sciences including 51 surgery residents that participated in a mandatory national board style OSCE between May 2014 and May 2015. OSCE scores of two groups of general surgery residents including 23 ATLS® trained and 28 non-ATLS® trained were compared using Mann-Whitney U test. The exam was graded out of 20 points and the passing score was ≥14 including 40% trauma cases. Results: There were 8(15.7%) women and 43(84.3%) men among the participants with mean age of 31.12 ± 2.69 and 33.67 ± 4.39 years in women and men respectively. Overall 7 (87.5%) women and 34 (79.07%) men passed the OSCE. The trauma section OSCE score was significantly higher in the ATLS® trained participants when compared to non-ATLS®(7.79 ± 0.81vs.6.90 ± 1.00; p=0.001). In addition, the total score was also significantly higher in ATLS® trained residents (16.07 ± 1.41 vs. 14.60 ± 1.40; p=0.001). There was no association between gender and ATLS® score (p=0.245) or passing the OSCE (p=0.503). Conclusion: ATLS® training is associated with improved overall OSCE scores of general surgery residents completing the board examinations suggesting a positive transfer of ATLS learned skills to management of simulated surgical patients including trauma cases.

Deep vein thrombosis (DVT) and pulmonary embolism (PTE) are known as venous thromboembolism (VTE). DVT occurs when a thrombus (a blood clot) forms in deep veins of the body, usually in the lower extremities. It can cause swelling or leg pain, but sometimes may occur with no symptoms. Awareness of DVT is the best way to prevent the VTE. Patients with trauma are at increased risk of DVT and subsequent PE because of coagulopathy in patients with multiple trauma, DVT prophylaxis is essential but the VTE prophylaxis strategy is controversial for the trauma patients. The risk factors for VTE includes pelvic and lower extremity fractures, and head injury.

Background: Clinically frank thyroid nodules are common and believed to be present in 4% to 10% of the adult population in the United States. In the current literature, fine needle aspiration biopsies are considered to be the milestone of a model which helps the physician decide whether a certain thyroid nodule needs a surgical approach or not. A considerable fact is that sensitivity and specificity of the fine needle aspiration varies significantly as it remains highly dependent on the operator as well as the cytologist’s skills. Practically, in the above group of patients, thyroid lobectomy/isthmusectomy becomes mandatory for attaining a definitive diagnosis where the majority (70%-80%) have a benign surgical pathology. The scattered nature of clinically gathered data and analysis of their relevant variables need a compliant statistical method. The artificial neural network is a branch of artificial intelligence. We have hypothesized that conduction of an artificial neural network applied to certain clinical attributes could develop a malignancy risk assessment tool to help physicians interpret the fine needle aspiration biopsy results of thyroid nodules in a context composed of patient’s clinical variables, known as malignancy related risk factors. Methods: We designed and trained an artificial neural network on a prospectively formed cohort gathered over a four year period (2007-2011). The study population comprised 345 subjects who underwent thyroid resection at Nemazee and Rajaee hospitals, tertiary care centers of Shiraz University of Medical Sciences, and Rajaee Hospital as a level I trauma center in Shiraz, Iran after having undergone thyroid fine needle aspiration. Histopathological results of the fine needle aspirations and surgical specimens were analyzed and compared by experienced, board-certified pathologists who lacked knowledge of the fine needle aspiration results for thyroid malignancy. Results: We compared the preoperative fine needle aspiration and surgical histopathology results. The results matched in 63.5% of subjects. On the other hand, fine needle aspiration biopsy results falsely predicted malignant thyroid nodules in 16% of cases (false-negative). In 20.5% of subjects, fine needle aspiration was falsely positive for thyroid malignancy. The Resilient back Propagation (RP) training algorithm lead to acceptable accuracy in prediction for the designed artificial neural network (64.66%) by the cross- validation method. Under the cross-validation method, a back propagation algorithm that used the resilient back propagation protocol - the accuracy in prediction for the trained artificial neural network was 64.66%. Conclusion: An extensive bio-statistically validated artificial neural network of certain clinical, paraclinical and individual given inputs (predictors) has the capability to stratify the malignancy risk of a thyroid nodule in order to individualize patient care. This risk assessment model (tool) can virtually minimize unnecessary diagnostic thyroid surgeries as well as FNA misleading.

Chest tube (CT) or tube thoracostomy placement is often indicated following traumatic injuries. Premature movement of the chest tube leads to increased hospital complications and costs for patients. Placement of a chest tube is indicated in drainage of blood, bile, pus, drain air, and other fluids. Although there is a general agreement for the placement of a chest tube, there is little consensus on the subsequent management. Chest tube removal in trauma patients increases morbidity and hospital expense if not done at the right time. A review of relevant literature showed that the best answers to some questions about time and decision-making have been long sought. Issues discussed in this manuscript include chest tube removal conditions, the need for chest radiography before and after chest tuberemoval, the need to clamp the chest tube prior to removal, and drainage rate and acceptability prior to removal.

This paper studies the impacts of four components of organizational culture on brand promise in one of Iranian producer of detergent and sanitary products. The proposed study uses two questionnaires, one for measuring the effects of organizational culture and the other for brand promise in Likert scale. Cronbach alphas for organizational culture and brand promise are calculated as 0.83 and 0.91, respectively. The study has been implemented among 211 regular customers of producer of detergent and sanitary products. Using Spearman correlation ratio as well as stepwise regression analysis, the study has detected that three components of organizational culture including tribal culture, entrepreneurial culture, and market culture influence positively on brand promise and bureaucratic culture influences negatively on brand promise.

This paper investigates the effects of different green marketing on brand fascination for a south Korean electronic producer, Samsung. The proposed study designs two questionnaires, one for measuring the effects of green marketing and the other for brand fascination in Likert scale. Cronbach alphas for green marketing and brand fascination are calculated as 0.72 and 0.79, respectively. The study has been implemented among 385 regular customers of Samsung’s electronic devices. Using Spearman correlation ratio as well as stepwise regression analysis, the study has concluded that two components of green marketing including green product and green promotion influence positively on brand fascination, positively.

This paper investigates the effects of three components of organizational justice on development e-banking in one of Iranian banks. The proposed study uses two questionnaires, one for measuring the effects of organizational justice and the other for e-banking in Likert scale. Cronbach alphas for organizational justice and e-banking are calculated as 0.831 and 0.749, respectively. The study has been implemented among 385 regular customers of an Iranian bank. Using Spearman correlation ratio as well as stepwise regression analysis, the study has detected that two components of organizational justice including distributive justice and procedural justice influence on e-banking, positively.

This paper investigates the effects of different marketing strategies including basic marketing, reactive marketing, accountable marketing, proactive marketing and partnership marketing on brand equity. The proposed study uses two questionnaires, one for measuring the effects of different marketing strategies and the other for brand equity in Likert scale. Cronbach alphas for brand equity and marketing strategies are calculated as 0.71 and 0.86, respectively. The study has been implemented among 385 regular customers of a Picnic Gas distributer in city of Karaj, Iran. Using Spearman correlation ratio as well as stepwise regression analysis, the study has detected that there were positive and meaningful relationship between marketing strategies and brand equity.

To improve the nutritional status of Acer negundo trees, a three- year experiment was conducted in the National Botanical Garden of Iran which is currently suffering under low soil nutrient availability and occasional symptoms of yellow leaves. Firstly, samples were taken from both weak and vigorous trees in different stands located inside and outside the project site. Next, a factorial experiment based on a randomized complete block design with four replications was conducted, in which the factor A included the application of organic, inorganic and mixed fertilizers. The factor B included two levels of applying fertilizer via 1) solution in the irrigation water and 2) deep placement. The leaf samples were analyzed at growing season for NPK. Statistical comparison of means based Duncan's test showed an increment of N and K elements in leaves compared to control samples following two-year fertilization. Furthermore, an analysis tree vitality based on leaf chlorophyll availability and leaf nutritional status showed no differences in leaf P concentration between fertilizer treatments as a function of fertilizing method. As a conclusion, optimum levels of N and K content in A. negundo leaves are 1.90 % and 1.20 %, respectively.

Objective: To evaluate the accuracy of surgeons’ intraoperative diagnosis in open appendectomy and compare it with the histopathology examination results afterwards. Methods: This was a cross-sectional retrospective study accomplished in Namazee hospital affiliated with Shiraz University of Medical Sciences, in a one-year period from 2007 to 2008. Medical charts of all the patients who were admitted with impression of acute appendicitis and underwent open appendectomy in our center were included. Demographic information, intraoperative findings as in the operation note based on a method used by our surgeons, and histopathology examination of the removed appendix were recorded and reported. Results: A total of 342 patients were studied including 229 (67%) males and 113 (33%) females, with the mean age of 16.02 ± 9.89 (range 3 to 76) years, with a large proportion from 10 to 15 years. Surgeons reported 97.4% of the patients to have acute appendicitis, 29.5%, 10.2% and 5.6% with severe, moderate and mild inflammation respectively, whereas 26.6% and 9.4% with suppurated and gangrenous appendicitis separately, 14.6% to have perforated appendicitis and only 1.5%hadperforated appendicitis with peritonitis. However, 79.5% of cases showed appendicitis in the histopathology review. The accuracy of surgeons’ intraoperative diagnosis is 81.6%, 85.2% for men and 72.6% for women. Conclusion: The method used by our surgeon is not completely indicative in mild to severe inflamed appendix but it is almost always compatible with the pathology results in suppurated, gangrened, and perforated appendix. Therefore surgeons’ gross observation of the inflamed appendix may not always be in concordance with the histopathology examination of the resected appendix.

Objective: To explain an important aspect of violence, the spatiotemporal pattern of trauma in victims of violence visited in emergency room of Rajaei hospital, Shiraz, IranMethods: This cross-sectional prospective study comprised 109 randomly selected victims of violence visited in emergency room of Rajaei hospital, a tertiary referral hospital affiliated to Shiraz University of Medical Sciences in winter 2013. We recorded the demographic information as well as data regarding the type and time of the injuries. The data collected for each victim was then entered in a data gathering form.Results: The study included 88% males with mean age 27.8 ± 8.8 years, which encompassed more than 60% young adults. Our study showed a temporal pattern with triple peaks. Moreover, 64% of assault trauma occurred at night. Furthermore, our study showed the majority of our patients suffered from stab wounds and about 57% of patients studied lacked high school diploma. Moreover it was revealed that violence was more common in downtown Shiraz, especially in the Fifth city district with simultaneous presence of many risk factors for violence.Conclusion: The result of this study showed that age, gender, educational status and temporal peak of violence were shown to be similar to other investigations conducted in other countries. Despite these similarities, stabbing were more prevalent in our study. Additionally, the Fifth city district of Shiraz seems to be the main city district where preventive intervention is needed to reduce violence- related injuries.

Purpose: To compare the erectile effect of propofol and halothane on unwanted intraoperativepenile erection (UIOPE) during pediatric hypospadiasis repair.Materials and Methods: One hundred and seventeen boys who were in the age range of6 months to 6 years and referred for hypospadiasis repair to our referral teaching hospitalwere included in this randomized clinical trial. Patients were randomly assigned to oneof the two study groups before anesthesia induction. Anesthesia was maintained with acontinuous intravenous infusion of propofol and inhalational halothane in the propofol (P)and halothane (H) groups, respectively. Data regarding the patients’ age, weight, pre- andintra-operative chordee, UIOPE, anesthesia time, surgery time, hematoma formation, andwound infection were collected. The Chi-Square and Fisher’s exact tests were used forcomparison.Results: No statistically significant differences were noted regarding age, weight, and preandintra-operative chordee between the two groups. The incidence of UIOPE (10.34%versus 57.63%; P = .000), anesthesia time (174.15 ± 15.02 versus 181.26 ± 15.19; P =.012), and surgery time (162.34 ± 12.99 versus 167.69 ± 13.90; P = .034) were significantlylower in group P compared with group H.Conclusion: The use of propofol during hypospadiasis surgical repair is more safe andeffective than halothane in preventing UIOPE and reducing surgery and anesthesia time.

Objectives: To evaluate the short-term outcome of open appendectomy, the rate of negative appendectomy as well as pathology reports after surgery in patients with suspected acute appendicitis.Methods: This was a retrospective cross-sectional study being performed in Nemazee hospital affiliated with Shiraz University of Medical Science during a 2-year period between 2008 and 2010. The medical records of all consecutive patients who underwent open appendectomy in our center due to acute appendicitis were included in the study. The elective and laparoscopic appendectomies were excluded. The demographic information, clinical findings, laboratory investigations and the histopathological examination of the appendix were recorded and reported.Results: A total of 337 patient including 137 (36.4%) females, and 240 (63.6%) males with the mean age of 16.26± 9.81 (range 3 to 76) years were stduied. Anorexia (64.7%) and fever (20.7%) were more prevalent symptoms. The mean duration between pain initiation and operation ranged from 0 to 14 days with mean 1.88 ± 1.63 days. Right lower quadrant (RLQ), periumbilical, epigastria, left lower quadrant (LLQ), and Right upper quadrant (RUQ), pain were manifest in 78.8%, 41.6%, 12.2%, 3.2%, and 1.3% of patients, respectively. Pathological evaluation of the appendix showed appendicitis in 70.4% of patients.Conclusion: The higher rate of negative appendectomy accounts for wasteful tapping of medical resources and causing further complication in patients. Therefore it is essential to conduct more accurate studies to detect the root cause of the disease. This would help improve the management of appendicitis which is an emergency condition with high incidence.

Objective: To record and classify mechanisms of injury and injury severity score (ISS) in trauma patients admitted to the largest trauma center in Southern Iran.Methods: This was a prospective cross-sectional study including all the patients who were admitted to Nemazee hospital from 2009 to 2010. We recorded the trauma injury information of 1217 patients who were admitted to of emergency room of the Nemazee hospital during a 13-months period by means of a standard questionnaire. ISS was then obtained for every single patient.Results: The mean age of patients was 26.6 ± 15.1 (range 1–95) years. The commonest type of trauma including 279 cases (22.9%) was car accident and the least resulted from shotgun injuries in 13 (1.1%) patients. The lowest ISS was due to assault multiple blunt traumas and the highest ISS resulted from shotgun injury. The mean ISS was about 6.3 ± 1.8 (range 1-66). Overall, 86 patients had scores above 17 (7.1%). A total of 69 male patients (7.5%) compared to 17 females (5.7%) had severe injury (ISS>17). Trauma injuries were significantly more severe in males compared to females (p=0.014). In the sunny and hot seasons total number of patient was higher. The mean ISS was highest in during spring (p

Deserts have been described in different aspects of the natural environment. In this article, we try to determine desert territory using soil properties. Those selected soil properties which identify desert soil criterion were: soil salinity (EC), soil reaction (pH), gypsum, calcareous, SAR, organic matter, soil texture and clay pan. The soil properties were used as limiting factor for plant growth. Using available soil information, digital maps in GIS for every province were prepared. After their overlying, we prepared a map for Iran desert areas. The results showed that 544320 km2 of Iran known as a desert which formed under soil properties conditions. In these areas the soil EC is more than 8 dS/m, pH more than 8.5, SAR greater than 12; genetic and biological soil horizons have no significant distinction. The saline soil puffy, desert pavement, clay pan and active and non active sand dunes are also visible in the desert. Also the results showed that greater Khorasan and Markazi provinces have the highest and lowest soil-desert areas of 137665 and 1932 km2, respectively.

Objective: To evaluate the efficacy of modified perihepatic packing (MPHP) in reducing the rate of re-bleeding rate after packing removal.Methods: This was an experimental study being performed in Shiraz animal laboratory. High grade liver parenchymal injury was induced in 30 transgenic Australian rabbits which were then divided into two groups. Group A (control) included 14 and group B (experimental) comprised 16 rabbits. The animals in group A underwent standard perihepatic packing (SPHP) and those in group B were subjected to MPHP. Re-bleeding was assessed and compared between the two groups, after removal of perihepatic packings.Results: There was no significant difference between two study groups regarding baseline and perioperative characteristics. Rabbits in group A had significantly lower rate of postoperative re-bleeding compared to those in group A (57.1% vs. 12.5%; p=0.019). The mean bleeding volume was also significantly lower in group B compared to group A (76.88 ± 22.12 vs. 98.93 ± 33.8 mL; p

Objective: To determine the epidemiology and pattern of emergency operating room workload in Nemazee hospital affiliated with Shiraz University of Medical Sciences, Shiraz, Iran.Methods: All surgical emergency operations which were performed in Nemazee hospital, Shiraz, Iran were collected over twelve months (September 2007 to September 2008). The data obtained included indications, presenting symptoms the services provided and the demographic information of the patients.Results: Overall number of recorded emergency operations in this cross sectional descriptive study was 3946, with males constituting 72% of the patients. The highest male/female ratio reported in trauma patients was 6.4:1 with the median age of 23 years, and the mean age of the operated patients was 27.8 years. Second to neurosurgery (19.64%) the general surgery was the busiest discipline in emergency operations (59.14%). Appendectomy (11.77%), double/triple lumen/central venous catheter insertion (9.4%), and fiber optic/rigid bronchoscopy (3.27%) were the commonest general surgical operations. Among trauma patients, neurotrauma was the commonest reason for operation (10%).Conclusion: Based on a new approach toward emergency operating room workload, in our country and centre, we showed that it is necessary to devote particular and individualized attention to the fields of agenda and hospital management of emergency operations. This is due to a high emergency operating room workload and its unique characteristics in our centre in contrast to other hospitals and departments. Although a decision making and operational strategy is recently seen to improve the quality and quantity of emergency services available to our patients, there is still a gap between present and optimal emergency healthcare which should be provided for our residents.

Objective: To determine the removal time of the chest tube in ICU trauma patients under positive ventilation pressure (PVP).Methods: This was randomized clinical trial being performed in ICU department of Rajaei trauma hospital from March to December 2011. A total number of 92 trauma patients who were admitted in ICU and were under ventilation and had chest tube were randomly assigned into two groups. In case group, chest tube was clamped after 5–7 days. In the control group, chest tube was retained until the patients were under PVP. The chest tube was removed if there was no air leak or the drainage was less than 300 mL.Results: Complications observed in the case and control groups were 4.4% of 4.3% respectively (p=0.862). Among case group with hemothorax, 6.7% developed complication while this ratio for pneumothorax was 7.1% and zero in those with hemopneumothorax (p=0.561), whereas respective values for the control group were 11.1%, 8.3% and zero (p=0.262). Complications were noticed in 10.5% of those with more than 300 ml of pulmonary drainage. There were no complications in patients without air leak. In mild leak, 4.8% of subjects experienced complication, in moderate leak, no complication occurred and in severe ones, complication was visible in 7.7% of patients (p=0.842).Conclusion: The present study showed that the removal of chest tube in patients under ventilation within 5-7 days after its insertion is safe without any complications.

Objective: To evaluate the predictive value of some biochemical markers in the outcome of extremity vascular trauma.Methods: This study comprised 30 patients with traumatic arterial injury and acute limb ischemia referred to Namazi hospital affiliated with Shiraz University of Medical Ssciences, over a period of 8 months, from Sep 2009 to Jul 2010. Venous blood samples were drawn from distal ischemic limb to determine pH, HCO3 - , PCO2 , PO2 , Na+, and K+ before definitive surgical intervention. Comparable samples were also obtained from veins of non- ischemic upper extremities. The biochemical assays were compared after monitoring the revasculurized limbs and evaluation of viability during a period of 7 days.Results: The mean age of the patients was 28.3 ± 7.8 (range: 18–56) years. Two (6.6%) patients underwent amputation because of developing irreversible limb ischemia after vascular reconstruction. Both patients had blunt traumatic knee injury accompanied by nerve, vein and soft tissue damage. The statistical analysis showed correlations between parameters, except for Na+, of local (ischemic limb) and systemic samples. In this context, the highest correlation was observed in regard to HCO3 - .Conclusion: The correlation was most pronounced with respect to HCO3 - . Ischemic limbs exhibited reduction in pH and PO2 but, PCO2 and K increased after ischemia of injured limbs. PO2 reflects tissue perfusion and is of value in predicting the outcome. We believe that blunt trauma and associated nerve, vein and soft tissue injuries pose negative prognostic effects on limb survival postoperatively.

Background: Postanesthetic shivering is one of the most common complications of anesthesia. We compared the efficacy of meperidine and two low doses of ketamine with placebo to prevent postanesthetic shivering after general anesthesia. Methods: This was a prospective, randomized double-blind placebo controlled clinical trial involving 120 ASA I-II patients aging 20-50 years, undergoing endoscopic sinus surgery with general anesthesia. Patients were randomly allocated to receive meperidine 0.4 mg/kg (Group M, n = 30), ketamine 0.3 mg/kg (Group K 1 , n = 30), ketamine 0.5 mg/kg (Group K 2 , n = 30), or normal saline (Group N, n = 30) 20 minutes before completion of the surgery. Tympanic temperature, blood pressure, and heart rate were measured before and immediately after induction of anesthesia, 30 minutes after induction, and before administration of the study drugs. The drugs were prepared and diluted to a volume of 2 ml and presented as coded syringes. An investigator, blinded to the groups, graded postanesthetic shivering using a four-point scale. Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) Windows version 16. A p-value < 0.05 was considered statistically significant. Results: Patient characteristics of the four groups were similar. The number of patients with observed shivering in groups was 0, 3, 1, and 9 in Groups M, K 1 , K 2 and N, respectively. The difference between groups M, K 1 , and K 2 with Group N was statistically significant. However, differences between groups M and K 1 , M and K 2 , and K 1 and K 2 were not significant. The number of patients with a shivering score of 2 or 3 was higher in Group N compared with other groups. Conclusions: Prophylactic use of low doses of intravenous ketamine (0.3 or 0.5 mg/kg) was found to be effective to prevent postanesthetic shivering. However, administration of 0.3 mg/kg ketamine lowered the rate of hallucination as compared with 0.5 mg/kg.

Introduction: Education and training in surgery is in the middle of apprenticeship style of learning especially in operating room with little importance of understanding on how trainees learn. Methods: This training is one of the most difficult types of training. Medical training and expertise are the specialty of this education system. We can name these complex fields as “Operational Strategies”. The strategies are includes of “what to do”, “what to think” and “what to create”. These strategies are good to test and train higher functions in persons who have professional’s positions. Results: Most of educational fields are complex. It means that the training is not limited in an area and includes of theory fields, areas of decision making and areas of handy and practical skills. These fields are the most relevant skills or expertise which individual must be informed of the performance of maintenance and repair or upgrade and make a new system. Conclusions: The operational strategy is a new training strategy for surgery students. It is useful to train surgery students to modify and improve their practices and doing surgeries and treating patients in best conditions.

Cystic hygroma (CH) in the cervical region presents as a challenge to the anesthetist. The anaesthetic difficulties are usually associated with CH because of tumor extension into the mouth, airway management, thoracic extension, hemorrhage, involvement of pretracheal region, Post operative respiratory obstruction and coexisting anomalies (Down syndromes, Turner syndromes and congenital cardiac defects). Disorders of the CH relevant to anaesthesia and intensive care medicine are discussed in this review.KEYWORDS: Cystic Hygroma, Anesthesia, Lymphangioma, Lymphatic Vesssel.

Primary repair of traumatic colonic perforation is progressively gaining acceptance as the best method of management. However, when delayed, the risk of infection-related complications may increase. Here, we present a new method of repairing colon perforation in the presence of peritonitis. Acute colon injury was simulated in 22 German shepherd dogs. The dogs were randomly divided into two groups of 11 and after 24 hours they were operated on. The perforations were repaired by subserosal suture technique. In the first group (group A), ileal patch was used. In the other group (group B), the colon was closed by debridement and anastomosis. After 6 weeks, the repairs were assessed on the basis of survival, gross and histological assessments. Nine (82%) dogs in group A and six (56%) in group B survived. Ileal patch utilization significantly decreased the mortality rate (p < 0.05). The cause of death in two group A dogs and five group B dogs was peritonitis and intra-abdominal abscess formation. None of the surviving dogs showed evidence of anastomotic leakage or breakdown. Small bowel patch used in primary repair of colon injury in the presence of peritonitis may decrease the risk of postoperative infection-related complications and the mortality rate.

Introduction: The threat of explosive attacks has become a worldwide problem. Bombing is the preferred method of attacks. These attacks result in specific physical and psychiatric trauma. In this paper, we present an epidemiologic description of the physical injuries of patients who survived the explosive attack in Seyed Al Shohada mosque April 2008 Shiraz, Iran. Materials and Methods: All medical records of the patients admitted at Shiraz Hospitals on April 2008 due to Seyed Al Shohada mosque bombing attacks, Shiraz, Iran, were reviewed. Results: A total of 202 patients were referred to the hospitals over 24 h following the terrorist attack. One hundred sixty-four patients were admitted for short periods of observation (