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   Table of Contents - Current issue
Coverpage
July-September 2022
Volume 11 | Issue 3
Page Nos. 105-163

Online since Tuesday, December 20, 2022

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ORIGINAL ARTICLES  

Measuring the Psychometric Properties of Adolescent Pedestrian Behavior Questionnaire p. 105
Forouzan Rezapur-Shahkolai, Shahnaz Maleki, Majid Barati, Leili Tapak, Mohammadreza Shokouhi
DOI:10.4103/atr.atr_12_22  
Background: Road traffic injuries are among the main causes of mortality in adolescents. The aim of this study was to determine the psychometric properties of an adjusted adolescent pedestrian behavior questionnaire (APBQ). Materials and Methods: Using the 29-item self-report pedestrian behavior questionnaire designed by Sadeghi-Bazargani et al. for all age groups as the framework, some of the items were removed depending on the type of behaviors among adolescents and some new questions were added. Eventually, the primary questionnaire was developed with 26 items, including 19 questions from Sadeghi-Bazargani et al.'s questionnaire and seven new questions. The tool was adjusted for adolescents and the psychometric properties were determined among a randomly selected group of 300 Junior high school students in Rasht City, Iran. After determining face validity, content validity and construct validity of the tool by experts, the reliability of the tool was examined based on explorative factor analysis (EFA) with Promax rotation and confirmatory factor analysis in AMOS. Eventually, a self-report questionnaire with 14 items was developed to assess the self-report behavior of adolescent pedestrians. Results: The mean age of the participants was 13.59 (±0.92) years. The Kasier-Meyer-Olkin value was 0.828, which confirmed the EFA. The analysis by the maximum likelihood method with Promax rotation identified four factors with eigenvalues >1 and factor loading ≥0.5. Therefore, pedestrian behaviors were categorized into four groups (unsafe road crossing behavior, distraction, positive behavior, and playing on the road). Conclusion: The APBQ can be a proper tool for self-reporting adolescent pedestrians' behaviors. It can also be used for studies on safe behaviors in adolescent pedestrians.
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Epidemiology, incidence, and trend of injuries in Iran: A national study p. 113
Hossein Akbari, Mehrdad Mahdian, Masoud Motalebi, Fatemeh Sadat Asgarian, Mojdeh Motalebi Kashani
DOI:10.4103/atr.atr_50_22  
Introduction: Injuries are one of the well-known leading causes of disability and mortality in all societies. This study aims to determine the incidence and trend of injuries and their epidemiologic characteristics in Iran. Methods: In a cross-sectional study, injury fatality data from 2008 to 2016 were obtained from the registry of the Ministry of Health and Medical Education (Iran) and analyzed to determine the epidemiological pattern of injuries. Data were analyzed using descriptive analysis. Excel and the statistical package of SPSS version 22 were used for data analysis. P ≤ 0.05 was considered statistically significant. Results: The highest incidence of injuries was related to traffic injuries with 546.4/100,000 population, followed by trauma and falls from heights with 497.7 and 195.2/100,000 population, respectively. The highest incidence of traffic injuries in Iran had occurred in 2011 with 628.1/100,000 population. Conclusion: Regarding the high incidence of injuries, especially traffic crashes, traumas, and falls, the priorities for close monitoring of these injuries during the high-risk periods to decrease and control the rate of the injuries strongly felt.
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General surgery admissions, operations, and patient outcomes during the COVID-19 pandemic p. 118
Esmail Abdorrahim-Kashi, Mohammad Javad Azadchehr, Mohammadreza Aminipour, Hamidreza Talari, Leila Ghafoor, Masoumeh Abedzadeh-Kalahroudi, Nushin Moussavi
DOI:10.4103/atr.atr_42_22  
Background and Objectives: During the COVID-19 pandemic, hospitals were overwhelmed and non-COVID admissions were restricted due to national guidelines and decreased references. The aim of this study was to evaluate the collateral effect of the pandemic on general surgery admissions, operations, and patient outcomes. Patients and Methods: After the ethics committee approval for this retrospective descriptive study, all general surgery patients from February 23 to May 21, 2020, were compared with a similar timeframe in 2019. Time from symptom onset to admission, final diagnosis, and type of surgery was documented. Morbidity and mortality rate, intensive care unit (ICU) admission time, and total admission time were compared. Results: During the first COVID-19 surge, a 64% decrease in admissions was observed. The mean time from symptom onset to admission showed a significant delay of 1.2 days. Fewer patients were admitted to the ICU, but ICU admission time was longer. Total admission time and postoperative surgical and nonsurgical complications showed no significant difference. The rate of complicated appendicitis increased from 2.8% to 12.3% of total surgeries. A decrease in total trauma admissions was observed, but trauma operations remained unchanged, and penetrating trauma admissions had doubled. Conclusion: Although morbidity and mortality were not increased during the pandemic, increased time to admission, under triage of trauma patients, shortage of ICU beds, and a higher rate of complicated appendicitis portray the collateral effects of the pandemic on general surgery patient care. The increased number of penetrating injuries demands psychological support during home confinement. Efforts should be made to maintain maximal surgical care during pandemics.
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Functional Results following Acromioclavicular Joint Reconstruction Using Gracilis Tendon Augmented with Fibertape: A Prospective Study p. 123
C Yashavanth Kumar, Srinivas B S. Kambhampati, P Rahul, NR Chirag
DOI:10.4103/atr.atr_24_22  
Background and Objectives: Acromioclavicular joint (ACJ) injuries are one of the common shoulder problems. Various autografts are being used in the reconstruction of higher grades of ACJ disruptions. The present study evaluates functional and radiological results of acute ACJ disruptions treated using gracilis tendon autograft and FiberTape. Materials and Methods: Our study included 16 cases of acute ACJ disruptions. After a thorough clinicoradiological evaluation, the patient received ACJ reconstruction using a gracilis autograft and FiberTape by mini-open technique. The patient was followed up postoperatively at 3 weeks, 6 weeks, 3, and 6 months. At each follow-up, functional results were studied using Disability of the Arm, Shoulder, and Hand (DASH) scores. Results: The mean (standard deviation) preoperative coracoclavicular distance (CCD) was 18.32 (1.84) and postoperative CCD was 10.41 (2.74) mm. Mean DASH scores during follow-up were 71, 59, 31, and 1 at 3 weeks, 6 weeks, 3 months, and 6 months, respectively. A significant difference was found in the pre- and postoperative CCD and DASH t scores (P < 0.001). Conclusion: The present study shows good functional and radiological results following mini-open ACJ reconstruction using gracilis autograft and FibreTape without postoperative complications and donor site morbidity.
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Complex Pinna Lacerations and their Management p. 129
Kartikesh Gupta, Rachit Sood, Priyanshi Awasthi, Amit Kumar
DOI:10.4103/atr.atr_38_22  
Context: External ear trauma is common and may range from simple abrasion to complete amputations. The auricle is an exposed part of the head which can be easily damaged by road traffic accidents. Early treatment in such patients may prevent cosmetic disfigurement and multiple sittings for secondary repair. Aims: The aim was to study the presentation and management of patients with cartilage-involving untidy complex lacerations of the pinna. This article mainly focuses on the management of such traumatic ear wounds. Settings and Design: A retrospective study was done in a tertiary care hospital from January 2019 to January 2020. Subjects and Methods: All patients with cartilage-involving complex lacerations of the pinna were included in the study. Results: All patients had a successful recovery. The pinna wounds have a higher success rate even after primary repair despite the wound often being contaminated. Conclusions: Primary repair of the pinna is a straightforward and reliable treatment method as it can survive even with a narrow pedicle (superiorly or inferiorly based) due to its rich dual vascular network. Cosmesis being the realm of plastic surgeons, the majority of such cases can be managed with primary wound closure by otolaryngologists and physicians without causing much inconvenience, delay, and higher cost to the patient.
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The impact of tranexamic acid on brain contusion and intraparenchymal hemorrhage in patients with head injury p. 133
Esmaeil Fakharian, Masoumeh Abedzadeh-Kalahroudi, Fatemeh Atoof, Voorya Nooranipour, Javid Azadbakht
DOI:10.4103/atr.atr_43_22  
Background and Objectives: Traumatic brain injuries (TBIs) are among leading causes of debility and death at a global scale. The current study aimed at investigating the possible advantage of administrating tranexamic acid (TXA) in patients with post-TBI brain contusion and intraparenchymal hemorrhage (IPH). Materials and Methods: This double-blind randomized clinical trial was conducted on patients who had brain contusion/IPH according to their on-admission brain computed tomography (CT) scan, referring to Shahid Beheshti Hospital, Kashan University of Medical Sciences, during 2018-2021. The patients were randomly allocated to either the intervention group (receiving TXA through an antecubital vein access) or the control group (receiving Normal Saline via a similar route). TBI severity, ICH volume, and compressive effects of hemorrhagic mass on admission, 24 h, and 72 h after treatment were assessed. Then 3-month outcome estimated by Glasgow Outcome Scale (GOS). Results: There was no significant difference between patients' age, gender, TBI etiology (traffic collision or fall from height), and skull fracture between the study groups. Compressive effects of hemorrhagic mass, new bleeding and brain edema during 24 and 72 hours after intervention were not significantly different between the TXA and placebo groups. The alterations in ICH volume from preintervention to 24/72 h postintervention were similar between the intervention and placebo subgroups (P > 0.05). Majority of participants (82.5%) showed a good 3-month neurological outcome according to GOS, but that was not significantly different between the study groups. One case of death occurred in each subgroup, and both of them died after hospital discharge. Conclusion: TXA neither has a preventive effect against in-hospital post-TBI hemorrhage enlargement nor on neurological outcomes three months after hospital discharge.
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Citicoline for traumatic brain injuries: A systematic review and implications for future research p. 140
Moein Khormali, Fatemeh Mohammadi, Maede Amouzade, Vali Baigi, Mahdi Sharif-Alhosein
DOI:10.4103/atr.atr_51_22  
Background and Objectives: Traumatic brain injury (TBI) is a catastrophic condition that exerts a high burden on individuals, families, and societies. The objective of this study was to systematically review the human studies on the efficacy and safety of citicoline for the management of TBIs. Materials and Methods: Relevant articles were identified by searching PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials on July 1, 2022. Results: Eighteen studies met the predefined eligibility criteria, including 12 randomized controlled trials (RCTs). Citicoline was administered via injectional (n = 11, 61.1%), enteral (n = 5, 27.8%), both injectional and enteral (n = 1, 5.5%), and unknown (n = 1, 5.5%) routes. Numerically, studies reporting the favorable impact of citicoline on patient outcome outnumbered (n = 13, 72.2%). However, the largest RCT could not demonstrate positive results. Only two studies reported complications, and the observed difference between citicoline and placebo groups was not statistically significant in either of them. Conclusion: Despite promising results in animal studies, human studies have shown inconsistent results regarding the role of citicoline in TBI management. Homogeneity of patients, subgroups of patients who might benefit more, the efficacy of citicoline as a part of combination therapies, and factors that could potentially influence the pharmacokinetics and brain uptake of citicoline should be considered when designing future studies.
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Investigation into changes in blood transfusion indicators and returning blood products along with the cause of returning and cost calculation p. 150
Farhad Madani, Javad Fath Gharib Bidgoli, Seyed Amir Hassan Matini, Hossein Akbari
DOI:10.4103/atr.atr_26_22  
Background and Objectives: Blood is a valuable source, and the wastage of blood products could impose severe impacts on healthcare. This study investigates the changes in blood transfusion indices and blood product transfusion from 2018 to 2019 in public hospitals affiliated to Kashan University of Medical Sciences. Materials and Methods: This descriptive cross-sectional study was carried out using a researcher-made checklist across five public hospitals in Kashan, Iran. The amount of cross-match/transfusion, transfusion index (TI), and T% (transfusion probability) indices were calculated and analyzed. Results: In 2018, we ordered a total of 19741 blood product units, among which 18,723 units (94.8%) were transfused. In addition, we ordered a total of 15,323 units of blood products in 2019, and 14,223 units (92.8%) were transfused. The CT ratio was 1.04 in 2018 and 1.06 in 2019, with a 2% increase. The transfused probability (T %) percentage in the studied public hospitals in 2018 was 38.04%, whereas the rate was 36.7% in 2019, with a 3.5% decline. In 2018, the TI in the studied hospitals was 0.96 and decreased to 0.85 (11%) in 2019. Moreover, the TI was higher than 0.5 in hospitals, except for Shahid Rajaei Hospital. Based on the results, the cost of blood products was 74459499405 Rials ($ 690526) in 2018 and 79073079143 Rials ($ 612115) in 2019, with a 6% increase. Conclusions: Blood order and transfusion enjoyed good conditions in public hospitals affiliated to Kashan University of Medical Sciences, though the blood order pattern was unfavorable in Shahid Rajaei Hospital.
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CASE REPORTS Top

Nickel allergy requiring plate removal after implantation of stainless steel and titanium plates after polytrauma p. 158
Gregory J Kirchner, Nicholas I Pilla, Andrew H Kim, Henry A Boateng
DOI:10.4103/atr.atr_44_22  
The patient was a 23-year-old female involved in a motor vehicle collision. She sustained a left humerus fracture and a left posterior wall acetabular fracture, for which she underwent open reduction and internal fixation with stainless steel implants and titanium implants, respectively. At her postoperative visits, she had erythema and itching along the humeral incision. She returned to the operating room for revision fixation with a titanium implant and reported the resolution of her symptoms. Metal hypersensitivities (MHSs) resulting in surgical complications in orthopedic trauma are rare. Patients should be screened for a history of MHS before implant selection.
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Fatal cut-throat injury of the neck by kite string p. 161
Santosh Kumar Swain
DOI:10.4103/atr.atr_10_22  
Flying kite is a common sport among children and even in the adult age group. Falls, cut wounds, head injuries, and fractures account for the bulk of accidents and injuries encountered while flying kites. Neck injury from a basic kite string is uncommon. Injury by kite string ranges from small cuts to major lacerations or even head trauma. The amount of abrasive material that is commonly placed on the kite's string to boost its cutting capacity determines the severity of the laceration injury. The preventive measures are to fly kites in a safe area and requirement of raising awareness of potential complications of this sport. A 56-year-old man arrived with a clean-cut, deep-incised wound that exposed the strap muscles and fat and required primary closure.
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