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Narges Alizadeh,1 Sharad Ayyoubi,2 Mohammadreza Naghipour,3 Rasool Hassanzadeh,2 Zahra Mohtasham-Amiri,3 Shirin Zaresharifi,4 Kaveh Gharaei Nejad1 1Dermatology Department, School of Medicine, Guilan University of Medical Sciences, 2General Practice, School of Medicine, Guilan University of Medical Sciences, 3Community Medicine Department, School of Medicine, Guilan University of Medical Sciences, Rasht, 4General Practitioner, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Background: Hirsutism can have negative impacts on psychosocial aspects of women’s lives and reduce their quality of life (QOL). The aim of this study was to assess the QOL of these women during laser treatment. Patients and methods: Eighty-eight women with unwanted facial hair underwent laser therapy. Each patient completed a questionnaire consisting of a modified Dermatology Life Quality Index (DLQI) and visual analog scale (VAS) before the first, third, and fifth sessions of laser therapy. Interval between the sessions was 4–6 weeks. Statistical analyses were done using SPSS software version18. Results: The DLQI scores before treatment, and at third and fifth sessions were 7.75±2.36, 5.55±1.88, and 4.14±0.64, respectively (P

Introduction: Pediatric trauma is considered as a growing public health issue in the world. Trauma is the most common cause of mortality in children and puts a heavy burden on society. Objective: This study aimed to investigate the epidemiology of trauma in children admitted to Poursina Teaching Hospital. Materials and Methods: This descriptive cross-sectional study was conducted on children under 15 years of age admitted to Poursina Hospital in 2011. Sampling was performed using census method on hospital records. Information on demographic characteristics, type of trauma, season of trauma occurrence, length of hospital stay, trauma location, anatomic trauma site, and death due to trauma were collected and analyzed using SPSS (Version 18). To analyze the relationship between mortality and other variables, Chi-square and T-test were used. P<0.05 was considered as significance level. Results: Out of 641 traumatic children enrolled in study, 62.1% were male and 37.9% female. Their mean age was 6.62 ± 4.16 years. Most common locations of trauma occurrence included house (49.6%), followed by urban roads (32.9%). Most common mechanisms of trauma involved falling (40.4%) and accidents (35.1%). The most common anatomic sites of trauma were head (71.2%), followed by organs (15.5%). Most frequent seasons for people to refer were summer (36%) and spring (31%). A statistically significant difference was observed between treatment outcome (death or survival) and age category (P=0.04). The case with 5 deaths was the one with highest mortality on urban and suburban roads Conclusion: Given that most injuries occurred in heads and necks of children, using protective equipment such as child seat for infants and safety belt for adults in the car or using appropriate helmet while riding a motorcycle should be mandated in popular culture. [ABSTRACT FROM AUTHOR]

We determined the prevalence and risk factors for 3,4-methylenedioxy-methamphetamine (MDMA, 'ecstasy') use among college students in Astara, a northern border city of Iran. In a cross-sectional questionnaire survey of 1226 students, the lifetime prevalence of ecstasy use was 5.6%. The lifetime prevalence of use of other drugs, mostly cannabis and opium, was 4.6%. A fifth of students (21.8%) were current cigarette smokers and 24.8% had ever used alcohol. After logistic regression, the factors influencing ever use of ecstasy were ever use of other drugs, ever use of alcohol, current cigarette smoking and living alone or with friends. Targeted prevention programmes should be conducted in all colleges. [ABSTRACT FROM AUTHOR]

Background: Integrated trauma systems (ITS) have shown potential in reducing traffic crash-related injuries and mortality, although their structure and impact can vary. This study assessed the effectiveness of ITS in Guilan, Iran. Study Design: A retrospective observational study., Methods: Utilizing a cross-sectional analysis, this descriptive-analytical study was conducted in Northern Iran from 2015 to 2019 to compare road traffic crash (RTC) data in Guilan (with ITS) against Mazandaran (without ITS), considering weather as a confounder. The study involved pre- and post-ITS intervention analyses to evaluate changes in RTC, injury, and mortality rates., Results: Before ITS implementation, Guilan's daily RTC mean was 38.4 (SD=16.7), which significantly decreased to 30.8 (SD=13.7) after the intervention. Conversely, in the control province of Mazandaran, the daily average number of RTCs increased from 37.29 (SD=14.1) to 42.55 (SD=16.4) post-ITS implementation in Guilan. Furthermore, the mortality rate in Guilan showed a marginal decline from 27.74 (SD=12.6) pre-ITS to 26.60 (SD=11.9) post-ITS, indicating the positive impact of the ITS. In contrast, Mazandaran demonstrated a significant increase in mortality from 32.16 (SD=14.5) to 51.75 (SD=15.7). The statistical analysis confirmed a significant reduction in mortality and injury incidence in Guilan at the time of the intervention, with a marked decrease observed post-intervention ( P <0.001)., Conclusion: The findings revealed that RTC prevention is feasible in Iran, with ITS in Guilan significantly reducing RTCs, injuries, and mortalities, underscoring the importance of ongoing efforts to expand ITS components nationally., (© 2025 The Author(s); Published by Hamadan University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Background and Aims: Health policymakers face challenges in designing compulsory plan packages for medical students to encourage them to work in disadvantaged regions. Using a discrete choice experiment, this study assessed the preferences of medical students for selecting the compulsory service plan packages in Guilan Province, Iran., Methods: In total, 374 medical students responded to a survey inquiring about salary, distance from their residency city, availability of welfare amenities, work difficulty, the developmental status of their workplace, contract duration, and preference for urban or rural work settings., Results: The study revealed that students favor a compulsory service package that provides higher salaries and shorter contract duration. They also show a preference for working within their home province over other factors. For the opportunity to serve in their city of residence, they would forgo an average of US$77.93 per month., Conclusion: While financial incentives were the primary consideration for medical students when choosing compulsory service packages, a range of nonfinancial factors significantly influenced their decisions as well., Competing Interests: The authors declare no conflict of interest., (© 2024 The Author(s). Health Science Reports published by Wiley Periodicals LLC.)

Background and Aim: The use of helmets has been reported to reduce the incidence and severity of head injuries in motorcyclists. However, there remains a significant gap in knowledge regarding the effectiveness of helmets, especially in preventing jaw and tooth injuries., Patients and Methods: In this retrospective analytical study record, all traffic accidents that occurred continuously from 2017 to 2019 in which the motorcyclists were on at least one side of the collision based on inclusion criteria. Data from injury variables in medical records were merged with data related to helmet use in the trauma registration system in Excel software. Then, the final analysis was performed with STATA software version 14 at a significance level of < 0.05., Results: In total, 1807 people participated in the study, and 160 (9.37) people used helmets. The incidence rate of jaw and tooth injuries was 86 (5.04%). Logistic regression implied that the odds ratio for helmet use was 0.7, which considering the p value of 0.419, shows no significant relationship between wearing helmets and jaw and tooth injuries., Conclusion: Helmets alone cannot prevent jaw and tooth injuries, and designers should design helmets that protect the head and the jaw and tooth. In prevention programs and campaigns for motorcyclists, every age, gender, job, grade group and marital status are target groups., Competing Interests: Conflict of interestThe authors declare that they have no competing interests., (© The Association of Oral and Maxillofacial Surgeons of India 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Despite advances in clinical research, the long-term effects of COVID-19 on patients are not clear. Many studies revealed persistent long-term signs and symptoms. In a survey study, 259 hospitalized confirmed COVID-19 patients between 18 and 59 years were interviewed. Demographic characteristics and complaints were studied through telephone interviews. Any patient-reported symptoms that continued or developed from 4 weeks up to 12 weeks after the onset of the disease were recorded only if they did not exist prior to infection. The 12-Item General Health Questionnaire was used for screening and assessing mental symptoms and psychosocial well-being. The mean age of participants was 43.8 ± 9.9 years. About 37% had at least one underlying disease. 92.5% showed ongoing symptoms that the most prevalent complications were hair loss (61.4%), fatigue (54.1%), shortness of breath (40.2%), altered smell (34.4%), and aggression (34.4%), respectively. In terms of factors affecting patients' complaints, there were significant differences between age, sex, and underlying disease with long-remaining complications. This study shows a high rate of long COVID-19 conditions that should be considered by physicians, policymakers, and managers., (© 2023. The Author(s).)

Background/aim: Post-traumatic stress disorders, depression, and pain are rarely discussed in the literature on maxillofacial injuries, and psychiatric symptoms and pain are not identified and managed in such patients. The aim of this study was to determine the symptoms of post-traumatic stress disorders, depression, and pain in people with maxillofacial injuries following motor vehicle accidents., Material and Methods: In this cross-sectional study, people injured in motor vehicle accidents from March to September 2015 who were referred to a medical educational center in the northern part of Iran for treatment follow-up were sampled. The existing symptoms of post-traumatic stress disorder by PSS, depression by BDI-II, and pain by NRS were assessed. SPSS software version 21 was used for analysis., Results: Maxillofacial injured patients had significant differences in terms of post-traumatic stress disorder (p = .006), depression (p = .001), pain (p = .001), and length of hospital stay (p = .002) than patients without maxillofacial injuries., Conclusions: Motor vehicle accident victims with maxillofacial injuries suffered significantly more from post-traumatic stress disorders and depression, pain and length of hospital stay than patients with other injuries., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: Traumatic brain injury (TBI) is preventable and expensive. The medical costs of TBI can be too high for some households and might lead to poverty, malnutrition, and loss of assets, which are called catastrophic expenditures. In this study, we investigated the incidence of catastrophic costs associated with TBI caused by road accidents in a province in northern Iran., Methods: This prospective study involved a 1-year follow-up after the accident. Data of 220 patients were collected from the medical records of the Poursina Hospital, Rasht, Iran from March 2018 to February 2020. Direct and indirect costs faced by the households of patients with TBI and catastrophic costs related to TBI were calculated. Regression models were obtained and sensitivity analyses were performed at the end of the study., Results: In total, the prevalence of households TBI-related catastrophic costs (TBICC) was 45.5% . Households of female patients (odds ratio [OR]: 0.289, p =0.042), households of retired patients (OR: 0.053, p =0.005), and households falling in the fifth quintile of wealth (OR: 0.370, p =0.050) faced lower TBICC compared to other groups. The Activities of Daily Living scores had a significant negative relationship with TBICC., Conclusions: Political interventions such as implementation of insurance schemes, exemptions from payment for certain groups, identification of poor households, and coverage of assistance services can protect households from catastrophic health expenditures., Competing Interests: Conflict of Interest: The authors have no financial conflicts of interest., (Copyright © 2023 Korean Neurotraumatology Society.)

Objective: To find out factors that influence the use/non-use of pedestrian bridges in Northern Iran., Methods: In this observational study, 4 pedestrian bridges at four different places in Rasht, North of Iran was studied. In addition to demographic data, pedestrians were interviewed for reasons of use/not use the pedestrian bridge. The data analyzed with SPSS software version 18 by non-parametric tests such as Chi Square., Results: From all 499 participants, more than one-third of pedestrians had not used pedestrian bridges. The most reasons for bridges use among respondents were feeling of safety and security (79.2%) and obey the rules (53.6%). The reasons for the non-use of bridges were time saving (63.7%), laziness (48.7%) and inappropriate of the bridge (34.2%). There were no significant differences in age, sex, education level, and road accidents' history with use of bridge but there was a significant difference between the bridge usage with having a driver's license, rash-hour time, and the presence of a mechanical elevator ( p <0.001)., Conclusion: The results of this study show that in order to increase the pedestrian bridges use, it is necessary to pay more attention to make standard facilities such as installing escalators or elevators of these bridges., Competing Interests: There are no conflicts of interest.

Background: Hepatitis C is a major cause of liver failure and liver transplantation. The known risk factors of this disease include blood transfusion, injection drug use, high risk sexual behaviors, tattoos, and use of shared blades and syringes. Due to the higher risk of viral hepatitis among people in prison, this study was done to find the seroprevalence of hepatitis C virus (HCV) and associated risk factors in Lakan Prison in Rasht., Methods: Prisoners in Lakan Prison underwent a cross-sectional study in 2018. A questionnaire containing demographic information and risk factors was distributed to the inmates and they were asked complete them. High-risk individuals were selected and a blood sample was taken and tested. Data were collected and analyzed by SPSS18 software., Results: Out of 2215 prisoners, 1238 people had at least one risk factor, of whom 408 individuals were selected by random sampling. One hundred inmates were positive for anti-HCV antibody, yielding a prevalence of 24.5% (95% CI: 20.4%-28.7%) of whom 42.6% were people who injected drugs and 4 cases were found positive for the hepatitis B surface antigen, yielding a 1% prevalence (95% CI, 0.2%-2%.). A history of injecting drug use (OR 4.28, 95% CI: 2.55-7.17), and previous history of imprisonment (OR 2.94, 95% CI: 1.34-6.53) had association with HCV infection., Conclusion: The present study shows that hepatitis C is prevalent in prisons and preventive and screening programs should be implemented with necessary training for inmates., (© 2021 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Introduction: Isolation of COVID-19 patients is a vital strategy for preventing the spread of the virus. Isolation without any incentive or compensation for the patients cannot be effective. We sought to find the monetary value of the willingness to accept (WTA) being isolated for COVID-19 in Iran., Methods: In this discrete choice experiment, scenarios were designed by reviewing the literature and semi-structural interviews. Fourteen choice sets with two scenarios were included in an internet-based questionnaire that was sent to the Telegram Social Network. A total of 617 individuals completed the questionnaire. A random-effects logistic regression model was used for the main analysis., Results: The average monetary value of a WTA 7 days of isolation was US$51.71 (95% confidence interval [CI] 43.09-60.33). The WTA for one day of isolation was US$1.48 (95% CI 1.11-1.85) for unemployed groups, US$1.49 (95% CI 1.18-1.79) for office employees and US$1.36 (95% CI 0.73-2.01) for manual workers. The WTA was 0.44 (95% CI 0.35-0.53) US$ for low-income groups, US$0.68 (95% CI 0.52-0.84) for middle-income groups and US$0.77 (95% CI 0.35-1.18) for high-income groups., Conclusions: Our findings suggested that financial preferences for being isolated vary widely across individuals within different socioeconomic groups. Policymakers should consider these differences when designing effective intervention to increase compliance with the isolation protocols during infectious disease outbreaks., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Geriatric health care has become a worldwide concern, but a few statistical studies were carried out about skin diseases in this age group in the nursing home of Iran., Aims: In this study, we set out to determine the frequency as well as the age and gender distribution of dermatological diseases in nursing home old age residents., Methods: In a cross-sectional study, all patients over 60 years who were living in a charity nursing home complex of Rasht in 2017 participated in this study. Baseline information on sociodemographic variables, past medical history, and medication were gathered by medical staff during a face-to-face interview. Full-body skin examination was done by dermatologists. Biopsy, and pathological and laboratory methods were used to confirm the diagnosis of suspected lesions or disease., Results: In this study, 259 people underwent the study. 52.9% were male, and their mean age was 73.5 years (SD = 9.1 years). Hypertension (20.9%); diabetes mellitus (9.7%), and hypothyroidism (2.3%) were the most common underlying diseases. Most of them (85.7%) had age-related skin changes. The benign neoplasm was the most common skin disease among patients (68.3%), followed by infectious diseases (46.3%) and erythemo-squamous (31.6%). None of them had precancerous lesions or skin cancers. There were not any differences between skin disorders and gender or age groups in this study., Conclusion: Our study suggests that skin manifestations and diseases are common among nursing home old age residents in this area. Therefore, this should constitute one of the top priorities of aged care physicians and nurses., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Abbas Darjani et al.)

Background: The National Traumatic Spinal Cord Injury Registry in Iran (NSCIR-IR), was implemented initially in three hospitals as a pilot phase from 11 Oct 2015 to 19 Jun 2016 and has been active in eight centers from 19 Jun 2016. Poursina Hospital, a trauma care referral center in Rasht, Guilan Province of Iran is one of the registry sites, and has been involved in registering eligible patients since 1 Jan 2016. This study aimed to identify the challenges and solutions for sustaining the NSCIR-IR in a regional center., Methods: This was a mixed-methods study. For the quantitative analysis, a retrospective observational design was used to measure case capture or case identification rate, mapping cases in the registry against those eligible for registry inclusion amongst the register of hospital admissions. For the qualitative component, data was collected using focus group discussions and semi-structured interviews, followed by thematic analysis., Results: From 19 Jun 2016 to 24 Jan 2018, the proportion of case capture (case identification rate) was 17%. The median time between case identification and data entry to the system was 30.5 d (range: 2 to 193 d). Thematic analysis identified a lack of trained human resources as the most important cause of low case identification rate and delay in data completion., Conclusion: Recruitment and education to increase trained human resources are needed to improve case capture, the timeliness of data input and registry sustainability in a regional participating site., Competing Interests: Conflict of interests Alexander R Vaccaro has these conflicts of interest: Receipt of Royalty Payments of Elseviere; Thieme; Atlas Spine and Jaypee, Stock / Stock Option Ownership Interests for Franklin Bioscience; Prime Surgeons; Avaz Surgical; Vertiflex; Rothman Institute and Related Properties; FlowPharma; Insight Therapeutics; Electrocore; Flagship Surgical; Spinology; Computational Biodynamics ; Spine Medica; Progressive Spinal Technologies; Paradigm Spine and Replication Medica, Consulting / Independent Contractor for Atlas Spine; SpineWave; Expert testimony; Orthobul-lets; Innovative Surgical Design; Stout Medical; Medtronics; Stryker Spine and Globus, Deputy editor/ Editor/Editorial Board for Spine Journal; Clinical Spine Surgery and Thieme, Board of Directors of Sentryx; Parvizi Surgical Innovation; Spine Therapy Network, Inc; Prime Surgeons; Innovative Surgical Design; Flagship Surgical; Progressive Spinal Technologies. The other authors declare no conflict of interest., (Copyright © Iranian Public Health Association & Tehran University of Medical Sciences.)

Background: The relationship between weight indices and injuries and mortality in motor vehicle accidents is unknown. Systematic review studies addressing the collection and analysis of the relationship in investigations are very limited. The purpose of this systematic review is to determine the relationship between BMI, obesity and overweight with mortality and injuries and their severity and vulnerable organs after the motor vehicle accident., Methods: The databases (MEDLINE/PUBMED, EMBASE, Web of Science, etc) were searched for relevant abstracts using certain keywords. Of all the articles, similar ones were removed considering different filters. The collected data were entered into the STATA SE v 13.1. The heterogeneity of the data was analyzed using i2 statistics. In addition, the estimates of the study were done based on the age group (children and adults) and the impact of obesity on different regions of the body., Results: A direct relationship was observed between the overall BMI and the degrees of injuries (CI=0.503-1.139), and mortality due to motor vehicle accident (CI=1.267-1.471). A positive relationship was found between obesity and AIS+2 (CI=0.653-1.426), and AIS+3 (CI=1.184-1.741), and ISS (CI=1.086-1.589). Also, a negative relationship between overweight and injuries rates, and a direct relationship between overweight and mortality (CI=0.979-1.167), and injuries with index of AIS+2 (CI=1.178-0.768) and AIS+3 (CI=0.48-2.186) were found., Conclusions: The prediction of injury, mortality and severity of injuries in the motor vehicle accident by the variable of obesity and overweight determines the need to design prevention programs for this vulnerable group at all levels.

Objective: To determine the status of pre-hospital emergency care and its associated factors in traumatic patients., Methods: In across-sectional study, 577 traumatic patients who were transferred to Poursina hospital by EMS (Emergency Medical Services) personnel were selected by simple random sampling method. Pre-hospital emergency services were observed. Then the mean of taken measures scores for each domain was determined in percent and evaluated in terms of associated factors (age, working experience of staff and number of missions per day) and compared using Spearman's test., Results: Out of 577 patients, 454 were men (78.7%) and 123 women (21.3%). Their mean age was 35.1 years old. Accident (82.7%) was the most common mechanism of injury. Most vehicles involved in the accident were light -weight cars (48.5%) and motorcycles (32.2%). A significant relationship was found between age, general domain (p=0.039) and hemodynamic (p=0.019) as well as between work experience and general domain (p=0.018)., Conclusion: Given that pre-hospital emergency services provided in most of the domains are relatively far from world standard, results of this research can provide information for managers to improve strategic planning on care and medical services, appropriation of budget, knowledge of personnel and necessary equipment., Competing Interests: None declared.

Background: Burn is the most devastating condition in emergency medicine leading to chronic disabilities. This study aimed to compare the effect of Lithospermum officinale , silver sulfadiazine and alpha ointments on healing of burn wounds in rat., Methods: Ninety-five rats were divided into 5 groups. Group 1 just underwent burn injury, and groups 2-5 received alpha ointment, silver sulfadiazine (SSD), gel base and L. officinale extract, respectively. A hot plate was used for induction of a standard 3 rd degree burn wound. Burn wounds were macroscopically and microscopically evaluated on days 7 th , 14 th and 21 st after burn induction., Results: A decrease in the number of inflammatory cells was noted when L. officinale and SSD were applied while the most inflammatory response was seen after administration of alpha ointment. The number of macrophages alone decreased after burn injury, while the frequency was the most when L. officinale and alpha ointment were applied. Re-epithelialization, angiogenesis and formation of granulation tissue were the best in relation to L. officinale and alpha ointment while, the worst results belonged to burn injury group and SSD regarding granulation tissue formation. Considering histological assessment, the best results were observed for scoring of inflammation, re-epithelialization, angiogenesis, formation of granulation tissue and number of macrophage when L. officinale and alpha ointment were used after burn injury., Conclusion: It can be concluded that topical application of L. officinale as a non-toxic, inexpensive and easy to produce herbal can lead to a rapid epithelialization and wound healing and these findings can be added to the literature on burn wound healing., Competing Interests: The authors declare no conflict of interest.

Background: Trauma is the fifth leading cause of death in patients 65 years and older. This study is a comparison of results of Revised Trauma Score (RTS), Injury Severity Score (ISS), and Trauma and Injury Severity Score (TRISS) in prediction of mortality in cases of geriatric trauma., Methods: This is a cross-sectional study of records of 352 elderly trauma patients who were admitted to Pour-Sina Hospital in Rasht between 2010 and 2011. Injury scoring systems were compared in terms of specificity, sensitivity, and cut-off points using receiver operating characteristic curve of patient prognosis., Results: Mean age of patients was 71.5 years. Most common mechanism of injury was traffic accident (53.7%). Of the total, 13.9% of patients died. Mean ISS was higher for patients who did not survive. Mean of TRISS and RTS scores in elderly survivors was higher than non-survivors and difference in all 3 scores was statistically significant (p<0.001). Best cut-off points for predicting mortality in elderly trauma patients in RTS, ISS, and TRISS systems were ≤6, ≥13.5, and ≤2, with sensitivity of 99%, 84%, and 95% and specificity of 62%, 62%, and 72%, respectively., Conclusion: TRISS was the strongest predictor of mortality in elderly trauma patients as result of combination of both anatomical and physiological parameters.

Objective: To determine the epidemiological characteristics of the road traffic injuries (RTIs) in Guilan province, northern Iran., Methods: This study was a cross-sectional study which included all of RTIs admitted to medical centers of Guilan province (northern Iran) during 2012. ICD-10 was used as diagnostic criteria. Demographic variables also injury circumstance and in hospital variables such as length of stay, time of admission, type of surgery, ICU admission, final outcome and mechanism of injury, anatomical part of injury according to Abbreviated Injury Scale (AIS) classification were derives from records by trained research team. Descriptive data is reported. The predictors of mortality were also determined., Results: The prevalence of road traffic injuries in Guilan province was 31 in 10,000 populations. Of total 7671 accidents, 5976 (77.9%) were men and 1695 (22.1%) were women. Mean age of these victims was 33.3 ± 17.289 years (32.64±16.939 for men, 35.62±18.312 for women). Most of them (32.5%) were 20-29 years old. Motorcycle-car accidents had the highest frequency followed by car-car crashes and car accidents involving pedestrians. Most of the patients (85.9%) were hospitalized and 280 injured died (3.7%). Upper extremities were the most sites of injuries. Male sex, length of hospital stay, multiple injuries and increased age were associated with road traffic accident associated mortality., Conclusion: RTIs cause enormous death and disability in this area and more road traffic preventive programs should be enforcement in these areas to reduce incidences RTI.

Background: Trauma is a major cause of disability and death among children worldwide, particularly in developed countries. The present aim was to compare efficacies of the Pediatric Trauma score (PTS), the Glasgow Coma Scale score (GCS), and the Injury Severity Score (ISS) in the prediction of mortality in children injured by trauma., Methods: A total of 588 children admitted to the emergency ward of the Poursina Medical and Educational Center from 2010-2011 with trauma were included. The PTS, GCS, and ISS were calculated for all patients. Predictive efficacy of these scores was compared using receiver operating characteristic (ROC) curve with 95% confidence interval., Results: Of the patient population, 62.1% were male and 37.9% female, with a mean age of 7.31±3.8 years. Road accident (42.2%) was the most common cause of injury. Overall, 2.4% of participants died. Regarding the prediction of mortality, the best cut-off point for the GCS was ≤8, with 98.4% sensitivity and 92.3% specificity. The same point for the PTS was ≤0.5, with 100% sensitivity and 31% specificity. For the ISS it was ≥16.5, with 92.5% sensitivity and 62% specificity. All variables based on mortality prediction were statistically significant (p<0.0001)., Conclusion: When compared to the PTS and ISS, the GCS may be a better predictor of mortality in cases of childhood trauma.

Introduction: Focused assessment with sonography for trauma (FAST) is a highly effective first screening tool for initial classification of abdominal trauma patients. The present study was designed to evaluate the outcome of patients with blunt abdominal trauma and positive FAST findings., Methods: The present prospective cross-sectional study was done on patients over 7 years old with normal abdominal examination, positive FAST findings, and available abdominopelvic computed tomography (CT) scan findings. The frequency of need for laparotomy as well as its probable risk factors were calculated., Results: 180 patients were enrolled (mean age: 28.0 ± 11.5 years; 76.7% male). FAST findings were confirmed by abdominopelvic CT scan in only 124 (68.9%) cases. Finally, 12 (6.6%) patients needed laparotomy. Mean age of those in need of laparotomy was significantly higher than others (36.75 ± 11.37 versus 27.34 ± 11.37, p = 0.006). Higher grading of spleen (p = 0.001) and hepatic (p = 0.038) ruptures increased the probability of need for laparotomy., Conclusion: 68.9% of the positive FAST findings in patients with blunt abdominal trauma and stable hemodynamics was confirmed by abdominopelvic CT scan and only 6.6% needed laparotomy. Simultaneous presence of free fluid and air in the abdominal area, old age, and higher grading o solid organ injuries were factors that had a significant correlation with need for laparotomy.

Background: Hepatitis C virus (HCV) is the leading cause of transfusion transmitted infections (TTIs) among patients with β-thalassemia major. A high prevalence of HCV was reported among these patients. The aim of this study is seeking the trend of the prevalence of HCV infection among the patients with b-thalassemia major in Guilan province, Northern Iran over a 10-year period., Methods: A retrospective study was conducted on 1113 patients with b-thalassemia major in the Guilan province, northern Iran from 2002 to 2012, using multiple data sources. A blood sample was taken from each patient, and a questionnaire regarding demographic data and risk factors was completed for them. Enzyme-linked immunosorbent assay and recombinant immunoblot assay for HCV were performed in all cases. A stepwise forward logistic regression analysis was done., Results: The prevalence of hepatitis C infection among β-thalassemia major patients was 13.6%. The risk of hepatitis C among β-thalassemia major patients was greater before screening program for HCV (odds ratio = 9.6, 95% confidence interval: 2.3-40.5). In addition, the prevalence of anti-HCV seropositivity was decreased dramatically among patients who have received transfusions after implementation of blood donor screening for HCV. There were no positive HCV cases in the patients younger than 10 years., Conclusions: The risk of TTIs including HCV can be reduced by implementing screening program for healthy blood.

Background: Trauma is the most common cause of death in people aged 1 - 44 years and the third leading cause of death regardless of age. Early diagnosis can expedite emergency care and thus patients can be transferred more quickly to a treatment center., Objectives: The purpose of this study was to evaluate the mechanism of injury, Glasgow coma scale, age, and arterial pressure (MGAP) scoring system in predicting mortality in trauma patients., Patients and Methods: In this cross-sectional study, 5,484 victims over 12 years of age referred to a trauma referral hospital and were evaluated. The MGAP score was assessed based on type of injury, Glasgow coma scale (GCS), systolic blood pressure (BP) and patient's age. The area under the receiver operating characteristic (AUROC) curve was used as a measure of predictive performance. Data were analyzed using SPSS software version 16., Results: Patients were divided into three groups : scores of less than 18, 18 - 22 and greater than 22; in which the mortality rates were 75.2%, 9.5% and 0.1%, respectively (P < 0.0001). The best cut-off point was 22 in our study, and the MGAP scoring system had 93.7% sensitivity and 91.3% specificity., Conclusions: The MGAP scoring system can be used as an appropriate scoring system to predict mortality in triage trauma patients.

Objective: To investigate the relationship between blood pressure, anthropometric indices and metabolic profile in adolescents., Methods: The present cross sectional study was conducted in 1005, 12-y-old junior students referred to 15 urban health centers of Rasht. Samples were recruited randomly and data were collected in a form which consisted of demographic characteristics, history of disease in samples and their immediate families, birth weight, physical examination and clinical examination including height, weight, blood pressure and body mass index. Also, metabolic profiles including fasting blood sugar (FBS), blood sugar (BS), cholesterol, and triglyceride (TG), low density lipoprotein (LDL), high-density lipoprotein (HDL) and insulin levels were measured. Data were analyzed in SPSS software, by descriptive and analytic statistics and p value 0.05 was considered statistically significant., Results: Eight hundred fifty nine adolescents consisting of 550 (64 %) boys and 309 (34 %) girls participated in this study; 11.4 % (84/739 cases) of the participants had hypertension. The strongest correlation was seen between systolic blood pressure and weight, waist or hip circumferences and insulin levels. Also, FBS had very weak correlation with blood pressure., Conclusions: Thus, weight, waist and hip circumferences, insulin levels, high TG and low HDL have been indicated as the strongest correlating factors for high blood pressure.Thus, these factors should be investigated in high risk children and followed in hypertensive child to monitor cardiometabolic risk factors.

Background: Clinical outcome in patients with severe traumatic brain injury (TBI) depends on both primary and secondary brain injuries. Neuroinflammation is an important secondary mechanism, which occurs by releasing interleukins (ILs). Increased levels of ILs may affect clinical outcome following TBI., Objectives: This study aimed to determine the relationship between the serum levels of interleukins 6, 8 and 10 and clinical outcome in patients with severe TBI 6 months after injury., Patients and Methods: In a descriptive-analytical study, 44 patients with GCS ≤ 8 (Glasgow coma scale) and age ≥ 14 years were included. Their blood samples were collected at first 6 hours after injury. Clinical outcome was determined based on GOS (Glasgow Outcome Scale) at 6 months after head injury. Serum levels of interleukins 6, 8 and 10 were measured using the ELISA method. Spearman's rho, independent T-Test, and Mann-Whitney Test were used for data analysis., Results: Comparing the serum levels of interleukins in two groups with favorable and unfavorable clinical outcomes showed that the mean serum levels of interleukins 6 and 8 in group with favorable outcome was 85.2 ± 51.6 and 52.2 ± 31.9, respectively lower than those of group with unfavorable outcome with 162.3 ± 141.1 and 173.6 ± 257.3 (P < 0.03) and (P < 0.01)., Conclusions: Increased serum levels of interleukins 6 and 8 as a predictive marker might be associated with unfavorable clinical outcome in patients with severe TBI.

Social capital is a multi-faceted phenomenon in social sciences that massively affects many social fields. It can be a helpful factor in promoting health. Among the groups with high burnout, nurses have always shown higher levels of burnout. Studies have revealed that social capital can be an important factor affecting burnout. This study aimed to determine the extent of the effect of social capital on burnout in nurses of a trauma referral teaching hospital in Rasht. This was a descriptive correlational study conducted on 214 nurses of a trauma referral teaching hospital. Maslach standard questionnaire and the social capital questionnaire devised by Boyas and colleagues were used. Data were analyzed using descriptive statistics, Pearson correlation coefficient, and linear regression analysis to determine the extent of the effect of social capital on burnout. The study showed an inverse association between social capital and burnout. The intensity of the relationship was -0.451 (P<0.0001). Also, the linear regression model of social capital on burnout variable showed that the regression coefficient of social capital equaled -0.34. The determination coefficient of this regression model indicated that social capital explained 20% of burnout changes. The results showed high burnout in emotional exhaustion dimension and an inverse association between social capital and burnout. Thus, attempts should be made to promote social capital dimensions among nurses. Given the inevitability of job stress in a nursing environment, and managers should plan on improving the working conditions and training techniques to deal with such stress.

One of the most preventable causes of mental and growth retardation is congenital hypothyroidism (CH). This study tries to investigate growth and mental outcome of patients with CH. Since November 2006 and November 2007 in Guilan province, north of Iran, all neonates who were diagnosed with CH, evaluated for etiology of CH by laboratory follow up, thyroid sonography or scan. Growth and development of patients with CH were compared with healthy children in same age, geographical area, social and economical classes in four years old. Demographic characteristics including height, weight, and head circumference at birth, follow up time (four years old) and IQ (Good enough test) were recorded in questionnaires. Among 28904 screened neonates, 37 patients with CH were diagnosed. Incidence of CH was 1:781 in live births, 20 (54%) in female neonates and 17 (46%) in male neonates. The incidences of permanent and transient hypothyroidism were 43.2% (16 cases) and 56. 8% (21 cases) respectively. The incidence of permanent and transient hypothyroidism were 16 (43.2%) and 21 (56, 8%), respectively. In permanent CH, 11 cases (%.68.2) had dyshormonogenesis and 5 cases (%.31.2) had thyroid dysgenesis. Significant statistical difference was only in family history of thyroid disease (34, 3% Positive family history in CH vs. 13.2% in control group, P-value 0.03). All other demographic characteristics and IQ had no statistical difference. Patients with CH diagnosed through neonatal screening and treated had normal growth as general population that indicates effective screening program and treatment in this area (3.2%).

Rising obesity incidence and its complications have lead to change of our view about cardio-metabolic risk factors and need of reassessment of these complications in childhood age. The aim of current study was to evaluate prevalence of obesity and related cardio-metabolic risk factors of children. This was a cross-sectional study in a representative sample of 12 years old children in Rasht, the biggest city in north of Iran. Participants were interviewed and examined by a trained research team and demographic characteristics, detailed examination (height - weight - blood pressure) were recorded. Blood samples were drawn for biochemical testing including Fasting blood sugar, Triglyceride, Cholesterol, HDL & LDL. Data analysis was done using SPSS software. Total participants were 858 children and 550(64%) were male. Prevalence of underweight, normal weight, overweight, obese were 22.5%, 54.4%, 11.3%, 11.8%, respectively. The prevalence of cardio-metabolic risk factors included hypercholesterolemia (6.7%), hypertriglyceridemia (33.6%), high LDL (5.9%), low HDL (28 %), high systolic (7.6%) & diastolic blood pressure (10.6%) (> percentile) and abnormal carbohydrate metabolism (12%) revealed hypertriglyceridemia as the most common dyslipidemia. Correlation analysis didn't show significant correlation between BMI & FBS but LDL, Cholesterol and TG had week positive correlation with BMI (Pearson correlation: 0.161, 0.285, 0.222 respectively, p value <0.001). Obesity and dyslipidemia are common problems in this area and we should note to screen cardiometabolic risk factors in addition of obesity, especially in children with rapid weight gain. This study highly recommended more investigation to evaluate final effect of these factors in adulthood.

Background: Trauma, especially chest and abdominal trauma are increasing due to the growing number of vehicles on the roads, which leads to an increased incidence of road accidents. Urbanization, industrialization and additional problems are the other associated factors which accelerate this phenomenon. A better understanding of the etiology and pattern of such injuries can help to improve the management and ultimate the outcomes of these patients., Objectives: This study aimed to evaluate the patients with chest and abdominal trauma hospitalized in the surgery ward of Poursina teaching hospital, Guilan, Iran., Patients and Methods: In this cross-sectional study, the data of all chest and abdominal trauma patients hospitalized in the surgery ward of Poursina teaching hospital were collected from March 2011 to March 2012. Information about age, gender, injured areas, type of injury (penetrating or blunt), etiology of the injury, accident location (urban or rural) and patients' discharge outcomes were collected by a questionnaire., Results: In total, 211 patients with a mean age of 34.1 ± 1.68 years was entered into the study. The most common cause of trauma was traffic accidents (51.7%). Among patients with chest trauma, 45 cases (35.4%) had penetrating injuries and 82 cases (64.6%) blunt lesions. The prevalence of chest injuries was 35.5% and rib fractures 26.5%. In chest injuries, the prevalence of hemothorax was 65.3%, pneumothorax 2.7%, lung contusion 4% and emphysema 1.3%, respectively. There were 24 cases (27.9%) with abdominal trauma which had penetrating lesions and 62 cases (72.1%) with blunt lesions. The most common lesions in patients with penetrating abdominal injuries were spleen (24.2%) and liver (12.1%) lesions. The outcomes of the patients were as follow: 95.7% recovery and 4.3% death. The majority of deaths were observed among road traffic victims (77.7%)., Conclusions: Considering the fact that road-related accidents are quite predictable and controllable; therefore, the quality promotion of traumatic patients' care, and the road safety should be noted as problems associated with public health.

Background. Geriatric health care has become a worldwide concern, but a few statistical studies were carried out about skin diseases in this age group. In this study, we set out to determine the frequency as well as the age and gender distribution of dermatological diseases in geriatric patients. Materials and Methods. In a cross-sectional study, all patients over 60 years who were accepted to department of dermatology in north of Iran participated in this study. Baseline information and clinical examination were done by a group of dermatologists. Biopsy, Pathological and laboratory methods were used in order to confirm the diagnosis. Results. 440 patients were accepted to the department that 232 patients were male (52.7%). Benign neoplasm was as the common skin disease among patients (65%), followed by erythemo-squamous (35.3%) and precancerous lesions (26.1%). The most common precancerous lesion was actinic keratosis (24.3%). BCC by 8.8% was the most prevalent skin carcinoma. Pruritus was the common problem in other dermatological disease (22%). Conclusion. Skin disorders especially precancerous lesion are among those important health problems in elderly patients in this geographic area. Increasing general awareness about risk factors of these diseases and doing more researches in other regions are highly recommended.

Objective and Background: Linguistic function is one of vulnerable aspects of traumatic brain injury (TBI) which may have destructive effects on patients' communicative activities and daily life, years following trauma. This paper attempts to answer the controversy whether surgery affects increase and decrease of linguistic impairment or not., Materials and Methods: Two hundred forty-one TBI patients aged 18-65 with abnormal CT findings and at least 20 minute post-trauma amnesia (PTA), who were conscious at discharge, participated in this study. Based on operative intervention, the samples were divided into two groups: operative and nonoperative. Cognitive and aphasic deficits were inspected formally and pragmatic disorder was informally appraised at discharge., Results: The groups had no significant differences in aphasia incidence and language pragmatic impairment, though they were significantly distinctive in aphasia subcategories and cognitive deficit after trauma. Fluent aphasia was more common in both groups alike. In aphasia subcategories, however, transcortical sensory aphasia (TSA) in operative and anomia in nonoperative group were the most prevalent. Several variables appeared strikingly related to higher aphasia in operative groups as follows: moderate to severe injury, 18-35 and over 50 years of age, more than 1 week PTA, intracranial surgery of multiple lesions in left or bilateral hemisphere fronto-temporal cortex plus post-trauma cognitive and pragmatic impairments, and diffuse axonal injuries., Discussion: Almost certainly, meaningful drop of cognitive function post surgery roots back in significant loss of initial consciousness level. Related factors to postoperative aphasia suggest taking policies through surgery intervention. Discerning the indispensable contributions of neurosurgeons, neurolinguists, and neuroscientists, results inspire more clinical future studies., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Traumatic brain injury (TBI) has been known to be the leading cause of breakdown and long-term disability in people under 45 years of age. This study highlights the effective factors on post-traumatic (PT) linguistic disorder and relations between linguistic and cognitive function after trauma in adults with acute TBI. A cross-sectional design was employed to study 60 post-TBI hospitalized adults aged 18-65 years. Post-traumatic (PT) linguistic disorder and cognitive deficit after TBI were respectively diagnosed using the Persian Aphasia Test (PAT) and Persian version of Mini-Mental State Examination (MMSE) at discharge. Primary post-resuscitation consciousness level was determined using the Glasgow Coma Scale (GCS). Paracilinical data was obtained by CT scan technique. Multiple logistic regression analysis illustrated that brain injury severity was the first powerful significant predictor of PT linguistic disorder after TBI and frontotemporal lesion was the second. It was also revealed that cognitive function score was significantly correlated with score of each language skill except repetition. Subsequences of TBI are more commonly language dysfunctions that demand cognitive flexibility. Moderate, severe and fronto-temporal lesion can increase the risk of processing deficit in linguistic macrostructure production and comprehension. The dissociation risk of cortical and subcortical pathways related to cognitive-linguistic processing due to intracranial lesions can augment possibility of lexical-semantic processing deficit in acute phase which probably contributes to later cognitive-communication disorder., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objectives: Postural instability (PI) is an important risk factor for falls, especially in the frail older population. In this study, we investigated the impact of vitamin D deficiency on PI in a sample of community dwelling older subjects. Our objective was to determine the potential association between vitamin D deficiency and PI in older fallers., Design: Cross-sectional study., Setting: Falls and Fractures Clinic, Department of Geriatric Medicine, Nepean Hospital, Penrith, Australia., Participants: One hundred and forty-five adults aged 65 years and older who have had at least one episode of a fall within the six months prior to assessment at the Falls and Fractures Clinic., Measurements: Serum 25(OH) vitamin D3 [25(OH)D3] and parathyroid hormone concentrations were determined at baseline. Subjects were separated into 3 groups based on serum 25(OH)D3 levels with the following cut-off values: < 30 nmol/L (deficient), 30-50 nmol/L (insufficient) and > 50 nmol/L (normal). Other baseline measurements included body mass index, mini-nutritional assessment, grip strength, serum calcium concentration and creatinine clearance, which were used as covariables. PI was assessed using a computerized virtual reality system (Medicaa, Uruguay). Measured parameters included limits of stability (LOS) and centre of pressure (COP) under eyes closed on foam (ECF) and visio-vestibular stimulation. The estimated swaying area, computed from the ellipse of confidence under eyes closed standing on foam (ECF), was also used as a PI parameter. Gait velocity (GV) was measured using a GaitRITE walkway system., Results: Posture was impaired in vitamin D deficiency (<30 nmol/L) as indicated by lower LOS (90 +/- 18), higher ECF (25 +/- 10) and slower GV (55 +/- 7) as compared with the insufficient and normal groups. After adjustment for demographic, biochemical and anthropometric variables, vitamin D deficiency significantly correlated with low LOS and high COP under ECF., Conclusion: Low levels of vitamin D were associated with PI. This association could also have an effect on slow GV and increased risk of falls. In conclusion, using an objective method to measure balance in older fallers we have identified a novel role of vitamin D in balance control. Prospective studies are required to confirm the effect of vitamin D on PI and elucidate the mechanisms of this association.

Comparison of the prevalence of iodine deficiency disorder (IDD) in neonates and school children using two different WHO indicators. From 2006 to 2010, 119701 newborns were screened by measurement of serum TSH level by heel prick. Neonates who had blood TSH ≥ 5 mIU/l were recalled for more evaluation. In the same period of time, urine iodine was measured in 1200 school-aged children. The severity of IDD was classified using WHO, UNICEF, ICCIDD criteria. Between 2006 and 2010 a total of 138832 neonates were screened in Guilan province and the total recall rate (neonates with TSH level ≥ 5 mIU/l) was 1.8 %. The incidence rate of Congenital Hypothyroidism (CH) was 1/625. The median urine iodine level in school-aged children was 200-299 μg/l. Considering the WHO, UNICEF, ICCIDD criteria, Guilan province would be classified as a none-IDD endemic area. However, health care systems should pay attention to the iodine excess and the risk of iodine induced hyperthyroidism in this population., (© 2012 Tehran University of Medical Sciences. All rights reserved.)

This was a cross-sectional prevalence study to determine the prevalence of hepatitis C virus (HCV) and high-risk behaviours in drug abusers admitted to prison in Guilan province, northern Islamic Republic of Iran. Subjects were asked about risk behaviours for acquiring HCV and blood was drawn for HCV antibody testing using ELISA techniques. Of 460 inmates, the mean duration of drug use was 8.9 years; 51.7% were opium users and 18.3% heroin users. HCV risk behaviours were common in this population and 209 inmates (45.4%) were HCV antibody positive (88.9% of intravenous drug abusers). HCV-positive status was significantly associated with intravenous drug use, having skin tattoos and number of times in prison.

This study determined the relationship between anthropometric status of 3-5-year-old urban children and theirs mothers' educational levels and employment status in Rasht City, northern Iran. A total of 1319 children (638 girls and 681 boys) at the ages of 3 and 6 years in all day-care centres in Rasht City were studied, using a cross-sectional design. Height and weight of the children were measured, and data on mothers' educational levels, employment status and duration of any breastfeeding were collected. Height for age, weight for age and weight for height of the children were compared with the National Center for Health Statistics (NCHS) reference population of the United States, and z-values 12 years of schooling, OR = 1.87; 95% CI: 1.08-2.4) had higher relative risk for underweight than children of mothers with an intermediate level of education (5-12 years of schooling). Children of mothers with college education were also more at risk for development of stunting (OR = 1.41; 95% CI: 1.14-4.22). In addition, children of employed mothers were more likely to be underweight (OR = 1.52; 95% CI: 1.05-2.31), stunted (OR = 2.42; 95% CI: 1.21-6.35) and wasted (OR = 3.35; 95% CI: 1.21-5.58) than children of non-employed mothers. The relative risk for undernutrition was higher in the children of both less and highly educated mothers compared with children of mothers with an intermediate level of education. Mothers' employment was also negatively related to nutritional status of these children in day-care centres in Rasht City.