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   Table of Contents - Current issue
January-March 2023
Volume 12 | Issue 1
Page Nos. 1-60

Online since Saturday, April 29, 2023

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The frequency of road traffic injuries and deaths in Eastern Mediterranean Region: A systematic review and meta-analysis p. 1
Leili Abedi-Gheshlaghi, Marjan Rasoulian-Kasrineh, Moslem Taheri-Soodejani, Zahra Mandegari, Seyyed-Mohammad Tabatabaei
Background and Objectives: Deaths and injuries due to road traffic accidents are important public health problems in the world and the Eastern Mediterranean Region (EMR). The current study aimed to review published articles and registry-based reports on the burden of road traffic injuries and deaths in the EMR for all road users. Methods: PubMed, Scopus, Web of Science, and Index Medicos for Eastern Mediterranean Region databases were searched to identify all related articles published until January 9, 2023. The search strategy included a thorough search of the keywords as follows: (burden OR disability-adjusted life years OR DALY OR incidence OR prevalence OR morbidity OR mortality OR death) AND (road traffic accident OR road traffic injury OR road traffic crash) AND (EMRO OR “Eastern Mediterranean Region” OR name of countries in EMRO). The population-based or registry-based data, and hospital-based data with underlying causes of death (codes V01–V99) were included. The death of other transportation, literature reviews, viewpoints, and commentaries was excluded. The quality of papers was assessed using the STROBE checklist. Available data for all road users based on their type were extracted and analyzed. Finally, a random-effects meta-analysis was performed, and pooled rates of road traffic injuries and deaths were estimated. Moreover, meta-regression was performed to identify the potential sources of heterogeneity. Results: The review of 69 studies showed that the pooled rate was 173.9/100,000 population (95% confidence interval [CI]: 165.1–182.9). The pooled fatal and crash injury rates were 31.4 deaths (95% CI: 30.3–32.7) and 218.6 injuries (95% CI: 212.5–224.6) per 100,000 population. The highest road traffic crash rates belonged to motorized four-wheeler users at 73.8/100,000 population (95% CI: 70.7–77.0), followed by motorized two–three wheelers/cyclists at 30.2/100,000 population (95% CI: 4.1–64.5). Conclusions: The burden of road traffic injury and death was high in EMR. Therefore, the modification of the traffic crash data logging system and active monitoring of the consequences of traffic crashes in this region are required.
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Assessment of temporomandibular joint following maxillomandibular fixation in mandibular fracture patients: A case series p. 17
Aysenur Genc
Background and Objectives: Mandibular fractures are one of the most commonly encountered injuries in trauma clinics. The basic principles of the treatment of mandibular fractures include closed treatment and maxillomandibular fixation (MMF). This study assessed the temporomandibular joint (TMJ) functions in patients treated with MMF. Methods: This prospective case series included eight patients with a clinically and radiologically confirmed diagnosis of mandibular fracture who were treated with MMF in 2019. The range of mandibular motions, pain intensity, and body weight were followed up. Psychological distress and patients' ability to return to work were assessed with self-report questionnaires at the end of the 12th week. Results: The study included eight patients (six men and two women; mean age: 30.25 ± 4.80 years; range: 22–36 years) who sustained 10 fractures. Eight volunteers were the individuals of the control group (two men and six women, mean age of 26.00 ± 6.97). There was a significant decrease in the range of mandibular motion after the treatment. The patients had significantly lower maximum mouth opening and lateral and protrusive excursions than healthy controls at postoperative 12 weeks. They had a mean change of −7.34% of their initial body weight. Pain intensity was mild to moderate. Of the patients, 37.5% started a different job and 12.5% reported failure to work. The health questionnaire indicated mild depressive symptoms. Conclusions: MMF causes significant morbidity and leads to functional decline, pain in TMJ, weight loss, cooperation problems in the work life, and depression.
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Investigation of the parameters affecting the functional results in conservatively followed distal radius fractures p. 23
Tamer Coskun, Emre Kaya, Oguzhan Gok
Background and Objectives: Distal radius fractures are the most commonly treated fractures by orthopedic surgeons. We investigated the relationship between demographic and radiological parameters and functional outcomes in conservatively treated distal radius fractures. Methods: The study included 101 patients with displaced distal radius fractures who were treated conservatively. All fractures were grouped according to demographic (sex and age) and radiological parameters (Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, accompanying ulna styloid fracture, radial inclination, radial height, volar tilt, and ulnar variance). The effects of these parameters on functional results were evaluated statistically. Mayo and QuickDASH scores were used for functional assessment. Results: Of 101 cases, 39 were male and 62 were female. The mean age of the patients was 50 (20–79). According to the AO classification, 82 (81.2%) were type A, 4 (4%) were type B, and 15 (14.9%) were type C. While 54 (53.5%) cases had ulna styloid fractures, the remaining 47 (46.5%) did not. The mean radial height of all cases was 11 mm, the radial inclination was 21°, and the volar tilt was 6°. The mean Mayo score of all cases was 80 and the QuickDASH score was 13.6. Conclusion: The functional outcomes of displaced distal radius fractures were not always correlated with radiological parameters. Malunion results were often nonsymptomatic, especially in elderly patients with AO types A and B. Care should be taken to ensure the reduction is complete in AO type C fractures in young male patients.
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Risk assessment of reheating furnace by failure modes and effect analysis method in steel complexes p. 27
Peyman Khaleghi Dehabadi, Mohsen Hesami Arani, Hossein Akbari, Masoome Sadat Shamsi, Fahimeh Karamali
Background and Objectives: Workers of the steel industry are exposed to many hazardous risks of nonfatal injuries and diseases considering the structure of their working environment. The aim of this study was to evaluate and identify the risks associated with the furnace in one of the north of Isfahan (Iran) Steel Complexes. Methods: The data were gathered through meeting sessions, observation, and documents surveys and were documented in failure modes and effects analysis (FMEA) worksheets. In this way, the weight of each failure was considered of risk priority number. Data surveys were documented in FMEA worksheets. Results: The results showed that explosion hazards and gas leaks were among the most dangerous hazards with the highest number of risks, respectively. After identifying the control measures and applying them, the percentage of identified risks is 77% at the acceptable level, 22.2% at the acceptable level under the condition of control, and 0% at the unacceptable level. Hazards found in workplaces were greater in the steel industries and iron industries. Conclusions: It can be concluded that education and training regarding related risk factors, providing personal protective equipment, and development of programs that can ensure safety in industries may lessen and prevent hazards associated with working place.
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A study of pattern, management, and outcome of complex soft-tissue injuries p. 34
Jayabal Pandiaraja, Arumugam Shalini
Background and Objectives: Complex soft-tissue injuries are one of the leading causes of morbidity and mortality following road traffic accidents (RTA). This article is regarding the pattern, management, and outcome of complex soft-tissue injuries. Methods: This observational study was conducted on 519 patients, from January 01, 2010, to April 30, 2013, at a tertiary care center in southern India. We analyzed the demographic profile, mechanism of injuries, management, and outcome of complex soft-tissue injuries during this study. Results: Of 519 patients with soft-tissue injury, blunt and penetrating injuries were seen in 81.7% and 18.3% of all cases, respectively. The most common cause of injury was RTA 74.3%. Isolated moral Lavelle injuries without associated neurovascular injuries occurred in 26.3% of patients. Soft-tissue injury was associated with bony, vascular, nerve, and tendon injuries in 52.0%, 44.7%, 20.0%, and 16.3% of all the cases, respectively. Patients who presented early (within 6 h of injuries) and patients with bone-only injuries had higher limb salvage rates. The overall morbidity rate among adults was 16.3% and the mortality rate was 1.9% and the most common cause of death was hemorrhagic shock. Mortality and morbidity in the pediatric group are higher than in the adult group. Conclusions: In summary, health education about road safety and proper safety protocol for two-wheelers and four-wheelers will reduce the incidence of RTA, thereby reducing the incidence of complex soft-tissue injury. The early and aggressive intervention will prevent a high amputation rate in bony injuries combined with vascular injury. A low threshold of blood transfusion and early aggressive treatment in the pediatric population will reduce the high mortality rate.
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Forearm longitudinal discrepancy after forearm fractures' fixation in pediatric: A case series study p. 39
Ali Tabrizi, Ahmadreza Afshar, Meisam Haghmoradi
Background and Objectives: Forearm fractures in childhood are one of the most common traumatic injuries to the upper extremities. The aim of this study was to investigate the development of growth disturbance after surgical treatment of pediatric forearm fractures and the related factors. Methods: This retrospective descriptive study was conducted on, 38 children with unstable forearm fractures undergoing surgical treatment. Growth disorder, either overgrowth or undergrowth, was investigated using imaging findings. Functional dysfunction, loss of motion, and pain severity were also evaluated in children with developmental disorders. Results: In 13 children (34.2%), forearm longitudinal growth disorder had occurred as overgrowth and no undergrowth was observed in any of the pediatric follow-up periods. The minimum increase in longitudinal growth was 4 mm and the maximum was 10 mm. The mean longitudinal growth was 5.8 ± 1.6 mm. All cases of increased longitudinal overgrowth occurred in the radius. In one case, the longitudinal overgrowth was followed by fixation with Titanium Elastic Nail, and in 12 cases, it was followed by plate fixation. In cases with the increase in longitudinal growth, 12 cases (92.4%) of fractures were in the distal third and 1 case (7.6%) was in the midshaft third. Based on age, there was a significant negative correlation between longitudinal growth and age, so that with decreasing the age of children, the amount of forearm growth increases (P = 0.002, R = −0.8) Conclusions: The most common finding of surgical treatment of pediatric forearm fractures is longitudinal overgrowth. Young age, fractures in the distal third, and the use of plate for fixation appear to be associated with forearm longitudinal overgrowth.
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A study on the predictive value of glial fibrillary acidic protein for prediction of traumatic brain injury severity p. 44
Esmaeil Fakharian, Masoumeh Abedzadeh-Kalahroudi, Mojtaba Sehat, Payam Yazdipour, Majid Nejati
Background and Objectives: Head injury is an increasing consequence of different kinds of trauma. It may result in release of substances such as glial fibrillary acidic protein (GFAP) within the cerebrospinal fluid or in serum, which can be used for the measurement of severity of damage. The aim of this study was to assess the predictive value of GFAP in prediction of trauma severity in head-injured patients. Methods: In this cross-sectional study, 98 patients with head injury admitted to Shahid Beheshti Hospital of Kashan University of Medical Sciences (KAUMS) enrolled in this study during 2020-2021. The GFAP serum level, the Extended Glasgow Coma Outcome Score (EGOS), Glasgow Coma Scale (GCS), and Rotterdam computed tomography score were assessed and then analyzed by SPSS V20. Results: The mean of GCS at the time of admission and discharge and EGOS and Rotterdam scores at a 3-month follow-up all were within a mild range. In addition, on the base of EGOS, all of the patients had recovered to a good state 3 months after their injury. Statistical analysis revealed a meaningful correlation between GFAP and GCS and EGOS (P < 0.05). GFAP with sensitivity of 80.8%, specificity of 65.3%, and area under the curve of 0.804 has appropriate strength for prediction of severity of head injury. Conclusions: The sensitivity and specificity of GFAP revealed acceptable strength for prediction of severity of head injury, even when confounding factors are considered. The mean of EGOS and GCS and Rotterdam score were all within the range of mild injury. However, further detailed and multicenter studies are recommended for better clarification of the role of GFAP as a biomarker of traumatic brain injury.
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An epidemiologic study of traumatic brain injury in children, middle-aged patients, and elderly presenting to the emergency department p. 48
Farhad Heydari, Babak Masoumi, Alireza Abootalebi, Amir Bahador Boroumand, Reyhane Qasemi
Background and Objectives: Traumatic brain injury (TBI) is one of the major health and socioeconomic problems in the world. How clinicopathological features of TBI differ by age is unclear. The present study evaluated the epidemiology of TBI and identified any variable that differs among pediatric, middle-aged, and elderly patients. Methods: The descriptive cross-sectional study was conducted on patients with TBI from April 2019 to April 2021. The study population consisted of all patients with TBI who were admitted to the Emergency Department. The inclusion criteria were all TBI patients who were a candidate for head computed tomography (CT) scans. The patients' clinicopathological parameters were recorded. Results: Among 3513 patients with TBI who underwent CT scans, 212 patients died (6.0%). The mean age of subjects was 30.67 ± 19.42, and 69.2% of the patients (2430 cases) were male. Motor vehicle accidents (48.4%) were the most prevalent mechanisms of injury. Intracranial lesions were seen on the head CT scan in 509 (14.5%) patients. The highest mortality rate was shown in elderly patients and the lowest in children (P < 0.001). Falls were the most common mechanism of injury in the elderly subjects (65.2%), while motor vehicle accidents were the most common in the children and middle-aged groups (40.9% and 54.0%). The incidence of intracranial lesions and moderate-to-severe head injuries was significantly higher in the elderly subjects (P < 0.001). Subdural hematoma and subarachnoid hemorrhage were the most common CT findings in elderly patients (13.3% and 11.3%). Brain contusion and skull fracture were the most common findings in the children (6.0% and 4.3%). Conclusions: The present study found that the clinicopathological parameters were significantly different among children, middle-aged patients, and elderly patients.
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Nonoperative treatment of talonavicular joint dislocation associated with jones fracture p. 55
M Vijaya Shankar, Arun Kumar Chandhuru, Prem Kumar Kothimbakkam
Chopart luxation or talonavicular dislocations are rare injuries seen in clinical practice which constitute only 3.6:1 lakh per year. A proper evaluation involving both plain roentgenogram and computed tomography is necessary for preoperative planning for the management of dislocation. The two common varieties of Chopart luxations are medial and lateral types. In this case report, we discuss about a closed medial type of talonavicular dislocation associated with an undisplaced fracture fifth metatarsal base (Jones fracture) which was managed effectively with closed reduction and Plaster of paris (POP) immobilization. The patient was regularly followed up till 12 weeks post reduction. He was allowed to weight bear at the end of 9 weeks, and the range of movements was assessed at the end of 12 weeks which was found satisfactory. In our case, there is talonavicular medial dislocation with fifth metatarsal base fracture, without any associated ligamentous compromise, which leads us to propose a hypothesis that the fracture of the fifth metatarsal base along with talonavicular disruption may alleviate the other ligamentous injuries. Further studies should be conducted to find out the association between talonavicular dislocations with other metatarsal fractures, which might influence the ligamentous compromise at initial presentation.
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A nonsurgical trauma causing bilateral adductor palsy of the vocal folds following total thyroidectomy p. 58
Santosh Kumar Swain, Debasmita Dubey
Vocal fold palsy is an uncommon cause of hoarseness of voice following thyroidectomy. The vocal fold palsy can be unilateral or bilateral, with presentation varying accordingly. There are often surgeons blamed for postthyroidectomy vocal fold palsy. However, there are certain subtle factors associated with vocal fold palsy that should be known to clinicians. Bilateral adductor palsy following thyroidectomy is a morbid clinical situation where the patient presents with aphonia and aspiration. Here, we present a case of postop-total thyroidectomy with adductor palsy of bilateral vocal folds. A nonsurgical reason for the vocal fold palsy was suggested by the clinical findings and the patient's recovery. The knowledge of this case management is very important for surgeons to avoid such morbidity among patients.
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