The increasing prevalence of drug-resistant Pseudomonas aeruginosa in burned patients is one of the main public health problems worldwide. Although drug-resistant P. aeruginosa in burn units is frequent in some countries and unusual in others, the level of this conditions is not precisely known in Iran. Imipenem is one of the most potent agents against P. aeruginosa. Imipenem resistance is a major obstacle to treatment of P. aeruginosa infections. We aimed to determine the true prevalence of imipenem-resistant P. aeruginosa in Iranian burned patients according to the Preferred Reporting Items for Meta-Analyses statement. Moreover, resistance to several potent anti-P. aerugi nosa drugs were indicated according to the Clinical and Laboratory Standards Institute guidelines for the disc diffusion method. Several databases including Web of Science, Scopus, PubMed, Scientific Information Database, Magiran, Iranmedex, and science direct were searched to get studies addressing drug-resistant P. aeruginosa in Iranian burned patients from March 2006 to May 2015. A total of 34 reports available from different areas of Iran were included in the current study. The meta-analyses showed that 54.9% of P. aeruginosa were resistant to imipenem. The most common resistance was seen against ceftazidime (66.9%), followed by ciprofloxacin (52.9%) and cefepime (52.3%). It is necessary to know the epidemiology of drug-resistant P. aeruginosa because it can promote control strategies for decreasing their prevalence. The high incidence of drug-resistant P. aeruginosa in Iran emphasizes the need for precise drug susceptibility testing, continuous monitoring of drug resistance, especially in burn units, use of sensitive methods for the laboratory diagnosis, and close relation between physician and laboratories.

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Background and Objectives: The complex relation between trauma and alcohol abuse is still far to be recognized. Traumatic experiences can prompt and facilitate an excessive use of alcohol. On the other hand, alcohol use may increase the possibility to be involved in traumatic events or reduce post-trauma resilience. This study aimed to explore alcohol use and abuse in a sample of traumatized participants, with or without posttraumatic stress disorder (PTSD). Methods: Thirty-five outpatients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnosis of PTSD and 35 outpatients with trauma exposure who did not develop PTSD were recruited. The clinical assessment of the participants comprised the following scales: The Structured Clinical Interview for DSM-IV, the Clinician-Administered PTSD Scale, and the Alcohol Use Disorders Identification Test (AUDIT). Results: Correlation analysis conducted on all participants showed a significant positive correlation between the AUDIT score and trauma load. When considering the two groups separately, the same correlation reached statistical significance in the PTSD group only. Analysis of beta-coefficients of regressions confirmed a significant influence of trauma load on the AUDIT score. Conclusion: A greater use of alcohol significantly correlated with trauma load only in the PTSD group. This data indicates that trauma itself is not sufficient to determine drinking problems, whereas PTSD symptoms may lead to alcohol use. A circular relation, rather than a linear one, can therefore be considered when traumatic experiences and alcohol use are taken into account. Specifically, traumatic experiences could cause the PTSD development, which could, in turn, lead to alcohol use or abuse as a self-medication. Such outcome could develop in alcohol use disorder that, circularly, enhances the risk of traumatic experiences. Hence, in the clinical evaluation of PTSD patients, a deep investigation of drinking patterns is highly recommended.

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Background: Athletes with trauma to the chest could be injured and suffer from an acute disturbing chest wall pain due to intercostal neuralgia. Pulsed radiofrequency (PRF) is an emerging safe therapy in many neurologic pain syndromes. Objectives: This study aimed to determine the effect of PRF on intercostal neuralgic pain in athletes complaining of severe chest pain and limited range of motion. Materials and Methods: This case-series study was conducted on athlete patients who suffered from severe chest pain that has limited their function. Eighteen athletes who were absent from physical training and sports activity due to intercostal neuralgia in their current season were admitted to our pain clinic. Intercostal nerve PRF was used to treat patients. Pain scale and return to sports activity were measured after PRF. Results: The mean time of absence from sports activity was 1.3 ± 0.6 weeks. The mean score of pain severity (numeric rating scale [NRS]) was 8.46 ± 1.85. In this study, 16 of 18 (88%) patients had effective pain relief (NRS <3) after PRF therapy. Besides, the NRS scores reduced by at least 90% in 16 of 18 (88%) patients as compared to the baseline. The mean NRS score was followed-up for 4 weeks. The scores significantly decreased at 1 (P = 0.001), 2 (P = 0.0015), and 4 (P = 0.0002) weeks following PRF compared to pre-PRF time. Conclusions: Pulsed radiofrequency is a suitable therapy for athletes with intercostal nerve entrapment pain, which provides adequate and quick pain relief, thus enabling them to resume their sport activities.

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Introduction: Numerous geometrically simplified models may be found in the literature on simulation of the traumatic brain injuries due to the increased intracranial pressure induced by severe translational accelerations of the brain inside the cranium following the impact waves. While numerous researchers have utilized viscoelastic models, some have employed specific hyperelastic models for behavior analysis of the brain tissue. No research has been presented so far based on the more realistic visco-hyperelastic model. Materials and Methods: In the present research, a realistic finite element model and four visco-hyperelastic constitutive models (viscoelastic models on the basis of the polynomial, Yeoh, Arruda-Boyce, and Ogden hyperelastic models) are employed to accomplish the outlined task. Therefore, the main motivation of the present research is checking the accuracy of the modeling procedure rather than presenting clinical results. In this regard, a realistic skull-brain model is constructed in CATIA computer code based on the magnetic resonance imaging scans and optimized in the HYPERMESH finite element software. Results: Influence of the contact and nonlinear characteristics of the brain tissue are considered in the simulation of the relative motions in LS-DYNA software to predict time histories of the acceleration and the coup and countercoup pressures by means of ANSYS finite element analysis software. Discussion: Comparing results of the four proposed visco-hyperelastic constitutive models with the available experimental reveals that employing Arruda–Boyce or Ogden-type viscoelastic models may lead to inaccurate or even erroneous results.

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Open total talar dislocation without associated fractures is an extremely rare injury. There are scant reports in the literature. Accordingly, there is no consensus about the appropriate treatment of the extruded talus. We present the case of a 33-year-old man who sustained an isolated open total talar dislocation focusing on its management and outcome and review the literature. Open total talar dislocation is a terrible injury and its treatment is demanding. Early reimplantation of the talus appears to be a relatively risk-free and feasible procedure. Talectomy should be considered as a salvage procedure.

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Background: To improve utilization of resources and reduce overtriage, two-tiered trauma team activation (TTA) system was implemented. The system activates a complete or selective trauma team (CTT, STT). Activation is based on the mechanism of injury (MOI), prehospital vital signs and injuries. Objectives: The objective was to evaluate the feasibility, effectiveness and safety of the implementation of a two-tiered system and whether the triage is done according to the TTA criteria. Methods: A prospective observational study was performed at the emergency department (ED) of a Level I trauma center. Data were collected on TTA criteria, patient demographics, MOI, prehospital vital signs, imaging modalities and blood gas analysis in the ED and inhospital data. Results: In 3 months, 186 patients were presented to the trauma resuscitation room. Thirty-four patients were excluded, 152 patients were included for analysis. Median age was 48 years (range 1–93), 64% were males. In 73%, the CTT was activated, in 27% the STT, the STT was upgraded three times. Seventy-nine patients had to be admitted, the median length of stay was 5 days (range 1–62). Thirty-eight patients needed Intensive Care Unit (ICU) admission; the median ICU stay was 3 days (range 1–33). Three patients died in the resuscitation room, in total, nine patients died. Overtriage was 29% and undertriage 7%. No significant difference was found for mortality, duration of hospital admission or ICU admission across the four groups (correct activation STT, undertriage, overtriage, and correct activation CTT). Conclusions: This TTA system identifies those patients in need of a CTT adequately with an undertriage percentage of 7%, indicative of improved care for the severely injured and a more appropriate use of resources. With this model, the overtriage is set to an acceptable percentage of 29%.

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Background: Intramedullary nailing is an accepted method of management for femoral diaphyseal fractures. There are, however, risks associated with surgery such as nonunion, infection, and venous thromboembolism (VTE). Objectives: Our objective was to identify independent predictors of complications following intramedullary nailing of femoral diaphyseal fractures in young adults. Patients and Methods: During a 3-year period, 59 patients (aged 13–55 years) underwent intramedullary nailing for high energy femoral diaphyseal fracture. These patients were identified from a radiographic database. Patient demographics, socioeconomic status, smoking status, alcohol intake, diagnosis of diabetes, intravenous drug use, fracture comminution, and if it was open were recorded retrospectively. Complications assessed were nonunion, deep infection, VTE, amputation, and revision of the nail. Results: Univariate analysis identified that socioeconomic status, excess alcohol intake, intravenous drug use, fracture comminution, and an open fracture were predictors of complications. Logistic regression analysis identified that intravenous drug use (P = 0.036) and open fractures (P = 0.05) were significant independent predictors of nonunion. There was a trend toward significance (P = 0.07) for excess alcohol intake as a predictor of deep infection. Fracture comminution (P = 0.015) was an independent predictor of VTE. Logistic regression analysis failed to identify any significant independent predictors of amputation or revision after adjusting for confounding variables. Conclusions: Intravenous drug use, open fractures, and fracture comminution are independent predictors of nonunion and/or VTE. These patient factors could be used to identify those at risk of nonunion and VTE who may benefit from early preventative measures.

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Background: Prehospital scores are used for determining the prognosis of trauma severity in trauma patients. Objectives: This study aimed at developing a new prehospital score for emergency medical service (EMS) staff to predict hospitalization in trauma patients transferred to the hospital. Patients and Methods: This study was a diagnostic test evaluation conducted on data of 1185 traumatic patients transferred through EMS to Poursina Hospital of Rasht between March 2012 and March 2013. Data were collected using a questionnaire with two parts. The first part included data on demography, injury, and type of interventions performed at the scene of the accident. The second part consisted of initial evaluations (Glasgow coma scale (GCS), oxygen saturation (O₂S), pulse rate (PR), systolic blood pressure (SBP), the ability to walk, and outcome (hospitalization, nonhospitalization). The questionnaire was filled out by EMS staff at the scene or during transfer to the hospital with respect to clinical observations. Data were analyzed using the logistic regression model. The Hosmer–Lemeshow test was also used to examine the good fit of model. Results: A total of 1185 patients were evaluated using prehospital data. Of seven variables evaluated by the scoring system, only four variables were identified in the regression analysis as predictors of hospitalization including age, SBP, O₂S, and walking ability. Sensitivity, specificity, and positive and negative likelihood ratios were 0.67, 0.68, 2.09, and 0.48, respectively. Conclusions: The GOMAAPS (GCS, O2S, mechanism of injury, age, ability to walk, PR, and SBP) score serves as a guide for the EMS staff at the scene to be understood of the necessity of transfer and predicting hospitalization.

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Background: The number of total ankle replacements (TARs) is rapidly increasing in consequence of the availability of new designs allowing to save the range of motion and to preserve against adjacent joints degeneration. This study aimed to compare participation in sports 12 months after TAR with either mobile-bearing or fix-bearing prosthesis. Materials and Methods: One hundred and seventeen primary TARs were performed (77 Hintegra, 40 Zimmer Trabecular Metal Total Ankle). We retrospectively assessed pain and function using the visual analogue scale (VAS) pain scale, American Orthopedic Foot and Ankle Society (AOFAS), Short-Form Health Survey (SF-12 divided into Mental (MCS) and Physical (PCS) score) obtained preoperatively, 6 and 12 months postoperatively. Activity levels were determined using the Halasi ankle activity scale and the University of California at Los Angeles (UCLA) score obtained preoperatively and 12 months after the surgery. Radiographic examination included plain radiographs with full weight-bearing taken preoperatively and 12 months postoperatively. Results: All patients showed a significant improvement for AOFAS, VAS, and SF-12 scores (P < 0.05). The Halasi activity scale and UCLA score were 4.2 ± 1.2 and 6.6 ± 1.8, respectively, for the fix-bearing group and 3.7 ± 1.5 and 6.3 ± 2.3 for the mobile-bearing 12 months after the surgery. In our series, jogging, dancing, and skiing represented the three most frequent sports. In the fix-bearing group, 60% of the patients practiced sport 1 year after surgery and 49.4% in the mobile-bearing group. The fix-bearing prosthesis had a quicker recovery and better functional outcomes within the first 6 months after the operation. At 1 year, there was not a significant difference in return to sport and physical activities between patients treated with a mobile-bearing implant and a fix-bearing implant. Conclusions: At 1 year, both fixed and mobile bearing present significant improvements in functional and recreational scores, with neither prove superior.

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