Comparison of patient’s prognostic based on Madras Head Injury Prognostic Scale and Glasgow Outcome Scale in head trauma patients admitted in emergency ward of 5th Azar educative and therapeutic center in Gorgan, 2011

زمینه و هدف: آسیب‌ های تروماتیک سر بزرگترین علت مرگ و ناتوانی در میان بیماران ترومایی است. تخمین پیش‌ آگهی بیمار بلافاصله پس از بروز ضربه سر، می ‌تواند اساس تصمیمات بالینی صحیح در آینده، صرفه‌ جویی در هزینه‌ ها، توان بخشی به موقع و افزایش رضایت بیماران باشد؛ بنابراین این مطالعه با هدف تعیین پیش ‌آگهی بیماران ضربه سر مراجعه ‌کننده به بخش فوریت مرکز آموزشی درمانی پنجم آذر گرگان با مقیاس پیش‌ گویی کننده مدراس انجام گردید. روش بررسی: در این مطالعه توصیفی- همبستگی 117 نفر از بیماران ضربه سر مراجعه‌ کننده به بخش فوریت مرکز آموزشی درمانی پنجم آذر گرگان با روش نمونه‌ گیری در دسترس انتخاب و بررسی شدند. جمع ‌آوری داده ‌ها با استفاده از برگه اطلاعات دموگرافیک، مقیاس پیش ‌گویی جراحات سر مدراس و مقیاس برآیند گلاسکو (GOS) انجام شد. داده‌ ها در محیط نرم ‌افزار آماری SPSS با استفاده از آمار توصیفی و آزمون ‌های آنالیز واریانس، کای مجذور، ضریب همبستگی پیرسون و تی مستقل تحلیل شد. یافته‌ ها: میانگین و انحراف معیار سن بیماران 54/1±51/32 بود. بر حسب مقیاس پیش‌ گویی ضربه سر مدراس، پیش‌ آگهی اغلب بیماران (7/54) خوب بود. بیماران با ضایعات داخل جمجمه و شکستگی ‌های جمجمه از پیش ‌آگهی ضعیف ‌تری برخوردار بودند و این تفاوت از نظر آماری معنی ‌دار بود (001/0P<). بین نمرات حاصل از مقیاس پیش‌ گویی ضربه سر مدراس در بدو پذیرش با نتایج نهایی ضربه سر بر اساس مقیاس برآیند گلاسکو، ارتباط مستقیم و معنی‌ دار آماری وجود داشت (001/0P<، 688/0r=). نتیجه ‌گیری: با توجه به یافته ‌های این مطالعه، مقیاس پیش ‌گویی ضربه سر مدراس، در مقایسه با سایر مقیاس‌ های مورد استفاده در این زمینه مقیاسی دقیق، سریع و در عین حال ساده‌ تر و کاربردی ‌تر است؛ لذا انجام پژوهش‌ های بیشتر با هدف کاربرد جهت تریاژ بیماران در اورژانس توصیه می ‌شود

The prevalence of anxiety, stress, and depression with respect to coping strategies in caregivers of patients with head injuries

Context: Psychological problems are very common in traumatic patients' caregivers necessitating usage of appropriate coping strategies to promote their mental health. Aim: The aim of this study was to assess anxiety, stress, and depression as well as coping strategies in caregivers of patients with head injuries. Settings and Design: In this cross-sectional study, 127 caregivers of traumatic patients referred to educational hospitals of Zabol city were selected by convenience sampling method. Subjects and Methods: The data were collected using a demographic questionnaire, as well as Depression, Anxiety and Stress Scale-21 and the Jalowiec coping strategies tools. The data were analyzed using descriptive statistics, one-way ANOVA, independent samples Student's t-test, and multivariate regression model. Results: Our findings showed that more than 70 of the caregivers of patients with head injuries suffered from severe and very severe stress and anxiety. The multivariate regression model demonstrated a negative and significant relationship between either stress (B = -0.81 P = 0.001) or depression (B = -1.23 P = 0.000) and problem-based coping strategies. Furthermore, stress (B = 0.64 P = 0.006) and anxiety (B = 0.74 P = 0.002) were negatively associated with emotional-based coping strategies. Conclusion: Considering the high rates of anxiety, stress, and depression in caregivers of patients with head injuries and significant associations observed between these variables and problem-based strategies, it is necessary to identify and obviate factors leading to anxiety and to educate coping strategies to these individuals

Sumatriptan ameliorates renal injury induced by cisplatin in mice

Objective(s): Cisplatin (Cis) is an anticancer compound, which is used for the treatment of various cancers. Sumatriptan (Suma) is a selective agonist of 5-hydroxytryptamine 1B/1D (5HT1B/1D) receptor, which is prescribed for the management of migraine. It is well-established that Suma has anti-inflammatory and antioxidant properties. We have explored the protective effects of Suma in the mitigation of Cis-induced nephrotoxicity. Materials and Methods: The mice received a single IP injection of Cis (20 mg/kg) on the first day of the experiment. Suma treatment (0.1 and 0.3 mg/kg/day, IP) was started on day 1 and continued for 3 consecutive days. Results: Creatinine (Cr), blood urea nitrogen (BUN) and malondialdehyde (MDA) levels were elevated and glutathione peroxidase (GPx) as well as superoxide dismutase (SOD) activities were decreased in Cis-treated mice. Suma (more potently 0.3 mg/kg) reduced Cr, BUN and MDA levels and increased SOD and GPx levels. Suma also reduced the acute renal injury (tubular degeneration, tubular cells vacuolation, tubular necrosis and cast), which corresponded to kidney damage in Cis-treated mice. Conclusion: These findings demonstrate that Suma mitigates Cis-induced renal injury by inhibition of oxidative stress and enhancing the antioxidant enzymes activities

Extensive Hematoma in a Patient with HereditaryHypersegmentation of Neutrophils

 Erratum: The correct affiliation of corresponding author of this manuscript has been edited as follows:"Akbar Dorgalaleh: Department of Hematology and Blood Transfusion, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran."Hypercoagulable states are a group of conditions associated with an enhanced tendency toward blood clotting. Although usual clinical manifestations of hypercoagulable states are thrombotic events such as deep venous thrombosis, hematoma can also occurs as a result of hypercoagulability in some patients. Several inherited or acquired conditions may lead to hypercoagulable states. Some of them include myeloproliferative syndromes, over activity of coagulation factors and methyltetrahydrofolateee reductase (MTHFR) polymorphisms. MTHFR is required for convertingthe amino acid   homocysteine to methionine. Another significant role of an aptly functioning MTHFR enzyme is nucleic acid biosynthesis. Therefore MTHFR polymorphisms are expected to be associated with hypersegmentation of neutrophils because of a defect in DNA metabolism. Neutrophil hypersegmentation is one of the most sensitive haematological features of cobalamin or folate deficiency with normal serum vitamin B12-folic acid and iron levels. Hypersegmentation of neutrophils and hematoma which  both of them suspected to be  due to gene variations of MTHFR. Here we report a 37 years old female who simultaneously affected by hereditary hypersegmentation and extensive hematoma. Laboratory analysis revealed normal serum vitamin B12, folic acid and iron levels. Routine and specific coagulation tests were normal in except of factor VIIIc that was high. Results of complete blood cell count (CBC) test were normal. Although this is just an idea, but simultaneous presentations of these two conditions can have a common origin

Randomized Controlled Trial of a Peer Based Intervention on Cardiac Self-efficacy in Patients Undergoing Coronary Artery Bypass Graft Surgery: a 3-year Follow-up Results

Background: Self-efficacy is one's belief in ability to succeed in specific situations and considerable factor to maintaining healthy behaviors. It has an important role in person-centred care and significantly improves after effects of heart attacks. This study aimed to investigate the effects of a peer based intervention on cardiac self-efficacy of the patients after bypass surgery.Methods: In this clinical trial study, 60 patients undergoing bypass surgery were chosen and assigned equally into the control and intervention groups. The patients were assigned into two groups by block randomization. While routine education was presented to the patients in the control group, intervention group were taught using the peer education in two sessions. Cardiac self-efficacy of all the selected patients was assessed orderly in 36-month (3 years) follow-up after surgery. Inclusion criteria used to choose the suitable patients were as the following: no record of CABG surgery, understanding and talking Persian language, willingness to participate in the research, age between 40 and 70 years, no dementia, confusion, mental and psychological problems which might hinder their participation. In addition, exclusion criteria in this study were patient’s death, serious physical problems after CABG surgery, emergency and unexpected surgeries, or cancellation the CABG surgery due to patient’s situation. Data was collected using cardiac self-efficacy scale and analyzed using chi-square, independent t-test and Kolmogorov-Smirnov tests. Results: The patients in both groups were homogenous in terms of demographic data. The mean score of cardiac self-efficacy in the intervention group was significantly different from control group in 3- year follow-up after surgery (P<0.038).Conclusions: Based on this study, accomplishment of peer based intervention can be a beneficial educative-supportive approach in cardiac surgery fields.

Randomized Controlled Trial of a Peer Based Intervention on Cardiac Self-efficacy in Patients Undergoing Coronary Artery Bypass Graft Surgery: a 3-year Follow-up Results

Background: Self-efficacy is one's belief in ability to succeed in specific situations and considerable factor to maintaining healthy behaviors. It has an important role in person-centred care and significantly improves after effects of heart attacks. This study aimed to investigate the effects of a peer based intervention on cardiac self-efficacy of the patients after bypass surgery.Methods: In this clinical trial study, 60 patients undergoing bypass surgery were chosen and assigned equally into the control and intervention groups. The patients were assigned into two groups by block randomization. While routine education was presented to the patients in the control group, intervention group were taught using the peer education in two sessions. Cardiac self-efficacy of all the selected patients was assessed orderly in 36-month (3 years) follow-up after surgery. Inclusion criteria used to choose the suitable patients were as the following: no record of CABG surgery, understanding and talking Persian language, willingness to participate in the research, age between 40 and 70 years, no dementia, confusion, mental and psychological problems which might hinder their participation. In addition, exclusion criteria in this study were patient’s death, serious physical problems after CABG surgery, emergency and unexpected surgeries, or cancellation the CABG surgery due to patient’s situation. Data was collected using cardiac self-efficacy scale and analyzed using chi-square, independent t-test and Kolmogorov-Smirnov tests. Results: The patients in both groups were homogenous in terms of demographic data. The mean score of cardiac self-efficacy in the intervention group was significantly different from control group in 3- year follow-up after surgery (P<0.038).Conclusions: Based on this study, accomplishment of peer based intervention can be a beneficial educative-supportive approach in cardiac surgery fields.

Morbidity and mortality from road injuries: results from the Global Burden of Disease Study 2017

BackgroundThe global burden of road injuries is known to follow complex geographical, temporal and demographic patterns. While health loss from road injuries is a major topic of global importance, there has been no recent comprehensive assessment that includes estimates for every age group, sex and country over recent years.MethodsWe used results from the Global Burden of Disease (GBD) 2017 study to report incidence, prevalence, years lived with disability, deaths, years of life lost and disability-adjusted life years for all locations in the GBD 2017 hierarchy from 1990 to 2017 for road injuries. Second, we measured mortality-to-incidence ratios by location. Third, we assessed the distribution of the natures of injury (eg, traumatic brain injury) that result from each road injury.ResultsGlobally, 1 243 068 (95% uncertainty interval 1 191 889 to 1 276 940) people died from road injuries in 2017 out of 54 192 330 (47 381 583 to 61 645 891) new cases of road injuries. Age-standardised incidence rates of road injuries increased between 1990 and 2017, while mortality rates decreased. Regionally, age-standardised mortality rates decreased in all but two regions, South Asia and Southern Latin America, where rates did not change significantly. Nine of 21 GBD regions experienced significant increases in age-standardised incidence rates, while 10 experienced significant decreases and two experienced no significant change.ConclusionsWhile road injury mortality has improved in recent decades, there are worsening rates of incidence and significant geographical heterogeneity. These findings indicate that more research is needed to better understand how road injuries can be prevented

The global, regional, and national burden of oesophageal cancer and its attributable risk factors in 195 countries and territories, 1990-2017: A systematic analysis for the global burden of disease study 2017

© 2020 The Author(s). Background Oesophageal cancer is a common and often fatal cancer that has two main histological subtypes: oesophageal squamous cell carcinoma and oesophageal adenocarcinoma. Updated statistics on the incidence and mortality of oesophageal cancer, and on the disability-adjusted life-years (DALYs) caused by the disease, can assist policy makers in allocating resources for prevention, treatment, and care of oesophageal cancer. We report the latest estimates of these statistics for 195 countries and territories between 1990 and 2017, by age, sex, and Socio-demographic Index (SDI), using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD). Methods We used data from vital registration systems, vital registration-samples, verbal autopsy records, and cancer registries, combined with relevant modelling, to estimate the mortality, incidence, and burden of oesophageal cancer from 1990 to 2017. Mortality-to-incidence ratios (MIRs) were estimated and fed into a Cause of Death Ensemble model (CODEm) including risk factors. MIRs were used for mortality and non-fatal modelling. Estimates of DALYs attributable to the main risk factors of oesophageal cancer available in GBD were also calculated. The proportion of oesophageal squamous cell carcinoma to all oesophageal cancers was extracted by use of publicly available data, and its variation was examined against SDI, the Healthcare Access and Quality (HAQ) Index, and available risk factors in GBD that are specific for oesophageal squamous cell carcinoma (eg, unimproved water source and indoor air pollution) and for oesophageal adenocarcinoma (gastro-oesophageal reflux disease). Findings There were 473 000 (95% uncertainty interval [95% UI] 459 000-485 000) new cases of oesophageal cancer and 436 000 (425 000-448 000) deaths due to oesophageal cancer in 2017. Age-standardised incidence was 5.9 (5.7-6.1) per 100 000 population and age-standardised mortality was 5.5 (5.3-5.6) per 100 000. Oesophageal cancer caused 9.78 million (9.53-10.03) DALYs, with an age-standardised rate of 120 (117-123) per 100 000 population. Between 1990 and 2017, age-standardised incidence decreased by 22.0% (18.6-25.2), mortality decreased by 29.0% (25.8-32.0), and DALYs decreased by 33.4% (30.4-36.1) globally. However, as a result of population growth and ageing, the total number of new cases increased by 52.3% (45.9-58.9), from 310 000 (300 000-322 000) to 473 000 (459 000-485 000); the number of deaths increased by 40.0% (34.1-46.3), from 311 000 (301 000-323 000) to 436 000 (425 000-448 000); and total DALYs increased by 27.4% (22.1-33.1), from 7.68 million (7.42-7.97) to 9.78 million (9.53-10.03). At the national level, China had the highest number of incident cases (235 000 [223 000-246 000]), deaths (213 000 [203 000-223 000]), and DALYs (4.46 million [4.25-4.69]) in 2017. The highest national-level agestandardised incidence rates in 2017 were observed in Malawi (23.0 [19.4-26.5] per 100 000 population) and Mongolia (18.5 [16.4-20.8] per 100 000). In 2017, age-standardised incidence was 2.7 times higher, mortality 2.9 times higher, and DALYs 3.0 times higher in males than in females. In 2017, a substantial proportion of oesophageal cancer DALYs were attributable to known risk factors: tobacco smoking (39.0% [35.5-42.2]), alcohol consumption (33.8% [27.3-39.9]), high BMI (19.5% [6.3-36.0]), a diet low in fruits (19.1% [4.2-34.6]), and use of chewing tobacco (7.5% [5.2-9.6]). Countries with a low SDI and HAQ Index and high levels of indoor air pollution had a higher proportion of oesophageal squamous cell carcinoma to all oesophageal cancer cases than did countries with a high SDI and HAQ Index and with low levels of indoor air pollution. Interpretation Despite reductions in age-standardised incidence and mortality rates, oesophageal cancer remains a major cause of cancer mortality and burden across the world. Oesophageal cancer is a highly fatal disease, requiring increased primary prevention efforts and, possibly, screening in some high-risk areas. Substantial variation exists in age-standardised incidence rates across regions and countries, for reasons that are unclear

Neonatal, infant, and under-5 mortality and morbidity burden in the Eastern Mediterranean region: findings from the Global Burden of Disease 2015 study

Objectives Although substantial reductions in under-5 mortality have been observed during the past 35 years, progress in the Eastern Mediterranean Region (EMR) has been uneven. This paper provides an overview of child mortality and morbidity in the EMR based on the Global Burden of Disease (GBD) study. Methods We used GBD 2015 study results to explore under-5 mortality and morbidity in EMR countries. Results In 2015, 755,844 (95% uncertainty interval (UI) 712,064–801,565) children under 5 died in the EMR. In the early neonatal category, deaths in the EMR decreased by 22.4%, compared to 42.4% globally. The rate of years of life lost per 100,000 population under 5 decreased 54.38% from 177,537 (173,812–181,463) in 1990 to 80,985 (76,308–85,876) in 2015; the rate of years lived with disability decreased by 0.57% in the EMR compared to 9.97% globally. Conclusions Our findings call for accelerated action to decrease child morbidity and mortality in the EMR. Governments and organizations should coordinate efforts to address this burden. Political commitment is needed to ensure that child health receives the resources needed to end preventable deaths

Transport injuries and deaths in the Eastern Mediterranean Region : findings from the Global Burden of Disease 2015 Study

Transport injuries (TI) are ranked as one of the leading causes of death, disability, and property loss worldwide. This paper provides an overview of the burden of TI in the Eastern Mediterranean Region (EMR) by age and sex from 1990 to 2015. Transport injuries mortality in the EMR was estimated using the Global Burden of Disease mortality database, with corrections for ill-defined causes of death, using the cause of death ensemble modeling tool. Morbidity estimation was based on inpatient and outpatient datasets, 26 cause-of-injury and 47 nature-of-injury categories. In 2015, 152,855 (95% uncertainty interval: 137,900-168,100) people died from TI in the EMR countries. Between 1990 and 2015, the years of life lost (YLL) rate per 100,000 due to TI decreased by 15.5%, while the years lived with disability (YLD) rate decreased by 10%, and the age-standardized disability-adjusted life years (DALYs) rate decreased by 16%. Although the burden of TI mortality and morbidity decreased over the last two decades, there is still a considerable burden that needs to be addressed by increasing awareness, enforcing laws, and improving road conditions.Peer reviewe