The Accuracy of GAP and MGAP Scoring Systems in Predicting Mortality in Trauma; a Diagnostic Accuracy Study

Introduction: Trauma scoring systems help physicians and nurses to be informed of injuries to a patient and assist their decision making in the cases of trauma and importantly prediction of their outcome and prognosis. Objective: This study aimed to compare the accuracy of GAP and MGAP scoring systems as predictors of mortality in trauma patients. Methods: This diagnostic accuracy study was conducted amongst 1861 trauma patients admitted to Rajaee Hospital in Shiraz, Iran, during 2017. The data on demographic features were extracted from the patients’ records. Then, trauma scoring systems including injury severity score (ISS), GAP, MGAP, and Glasgow coma scale (GCS) were compared to evaluate their accuracy in predicting mortality. Area under the receiver operating characteristic (ROC) curve was used to evaluate the accuracy of different trauma scoring systems and detect the sensitivity and specificity in order to predict status of discharge after 24 hours. Results: Based on the results, the area under the ROC curve was 0.8 for GCS. Moreover, Area Under Curve (AUC) of GAP was 0.91 and amongst different values, GAP value of ≤18 was selected as the cut-off point, since it exhibited the best sensitivity and specificity (72.99 and 95.52, respectively). In addition, the area under the ROC curve was 0.9 for MGAP, and value of ≤23 was selected as the cut-off point because it showed the best sensitivity and specificity (81.04 and 87.70, respectively). Additionally, AUC of ISS was 0.88. Conclusion: Both GAP and MGAP methods were able to appropriately predict mortality and were not significantly different; hence, both can be used for the right triage of patients and to predict the severity of injuries and subsequent mortality. Moreover, GAP and ISS had the best specificity and sensitivity, respectively

The Accuracy of GAP and MGAP Scoring Systems in Predicting Mortality in Trauma; a Diagnostic Accuracy Study

Introduction: Trauma scoring systems help physicians and nurses to be informed of injuries to a patient and assist their decision making in the cases of trauma and importantly prediction of their outcome and prognosis. Objective: This study aimed to compare the accuracy of GAP and MGAP scoring systems as predictors of mortality in trauma patients. Methods: This diagnostic accuracy study was conducted amongst 1861 trauma patients admitted to Rajaee Hospital in Shiraz, Iran, during 2017. The data on demographic features were extracted from the patients’ records. Then, trauma scoring systems including injury severity score (ISS), GAP, MGAP, and Glasgow coma scale (GCS) were compared to evaluate their accuracy in predicting mortality. Area under the receiver operating characteristic (ROC) curve was used to evaluate the accuracy of different trauma scoring systems and detect the sensitivity and specificity in order to predict status of discharge after 24 hours. Results: Based on the results, the area under the ROC curve was 0.8 for GCS. Moreover, Area Under Curve (AUC) of GAP was 0.91 and amongst different values, GAP value of ≤18 was selected as the cut-off point, since it exhibited the best sensitivity and specificity (72.99 and 95.52, respectively). In addition, the area under the ROC curve was 0.9 for MGAP, and value of ≤23 was selected as the cut-off point because it showed the best sensitivity and specificity (81.04 and 87.70, respectively). Additionally, AUC of ISS was 0.88. Conclusion: Both GAP and MGAP methods were able to appropriately predict mortality and were not significantly different; hence, both can be used for the right triage of patients and to predict the severity of injuries and subsequent mortality. Moreover, GAP and ISS had the best specificity and sensitivity, respectively

Niphargus sarii sp. n., a new subterranean niphargid (Crustacea: Amphipoda) from Iran based on molecular and morphological characters

Niphargus sarii sp. n. was collected from Jo-Khanem Spring in Ilam Province. This species hypothesis is based on the analysis of morphological characters and 28S ribosomal DNA sequences. In this paper, we describe the morphological traits of this new species. Then, its taxonomic status within the genus is discussed in comparison to the 15 known Iranian species. Results revealed that N. sarii sp. n. is phylogenetically close to N. sohrevardensis. This species is easily distinguished from other Iranian species by some characters, in particular the equal length of rami in uropod I, lack of lateral robust setae on telson and the situation of dactylus to posterior margin of propodus in gnathopod II

A multi-objective healthcare inventory routing problem; a fuzzy possibilistic approach

International audienceThis paper presents a new multi-objective mathematical model to address a Healthcare Inventory Routing Problem (HIRP) for medicinal drug distribution to healthcare facilities. The first part of objective function minimizes total inventory and transportation costs, while satisfaction is maximized by minimizing forecast error which caused by product shortage and the amount of expired drugs; Greenhouse Gas (GHG) emissions are also minimized. A demand forecast approach has been integrated into the mathematical model to decrease drug shortage risk. A hybridized possibilistic method is applied to cope with uncertainty and an interactive fuzzy approach is considered to solve an auxiliary crisp multi-objective model and find optimized solutions

The synergistic effect of honey and cinnamon against Streptococcus mutans bacteria

Objective: To investigate the effect of Iranian honey, cinnamon and their combination against Streptococcus mutans bacteria. Methods: Nine experimental solutions were examined in this study, including two types of honey (pasteurized and sterilized), two types of cinnamon extract (dissolved in distilled water or dimethyl sulfoxide) and five different mixtures of cinnamon in honey (prepared by admixing 1%–5% w/w of cinnamon extract into 99%–95% w/w of honey, respectively). Meanwhile, each of mentioned agent was considered as the first solution while it was diluted into seven serially two-fold dilutions (from 1:2 to 1:128 v/v). Therefore, eight different concentrations of each agent were tested. The antibacterial tests were performed through blood agar well diffusion method, and the minimum inhibitory concentration (MIC) was determined. Ultimately, the data were subjected to statistical analysis incorporating Two-way ANOVA and Bonferroni post hoc tests (α = 0.01). Results: The highest zone of inhibition was recorded for the mixtures of honey and cinnamon while all the subgroups containing 95%–99% v/v of honey were in the same range (P < 0.01). The MIC for both honey solutions were obtained as 500 mg/mL whereas it was 50 mg/mL for both cinnamon solutions. Moreover, the MIC related to all honey/cinnamon mixtures were 200 mg/mL. Conclusions: A profound synergistic effect of honey and cinnamon was observed against Streptococcus mutans while there was no significant difference among extracts containing 99%–95% v/v of honey admixing with 1%–5% v/v of cinnamon, respectively

Hospitalization due to traffic accidents among the elderly, Shiraz, 2018; mortality, severity, and injury pattern

Background: Aging results in declined function, which leads to loss of capacity and respond to injury. Hence, the duration of treatment after traffic accident increases in these patients. The present study aimed to identify the factors affecting the elderly hospitalization. Study Design: This was a cross-sectional study. Materials and Methods: This cross-sectional study was conducted on 768 trauma patients aged 65 years and more due to traffic injuries, referred to Rajaee (Emtiaz) hospital trauma referral center, Shiraz, Iran, in 2018. Data were collected through the hospital's health information system, as well as readings and encoding patient's clinical records. Poisson regression was performed to evaluate the partial effects of each covariate on geriatric trauma patients. Results: The mean age of injured patients was 73.27 ± 6.88 years, of which 7.29 expired. Extremities and externals (58.20) and head and neck (18.36) were the most commonly injured regions of the body. Each year after 65 led to 0.03 times increase in the length of hospitalization. The male's hospital stay was 1.15 times more than females. Conclusion: According to the results, length of hospitalization had a direct correlation with aging among elderly trauma patients. Since the elderly population is on the rise, it is necessary for the policymakers to come up with preventive measures to reduce the number of accidents and casualties

Risk factors of the elderly falling in public hospitals: A systematic review study

Background: Falls are the most common and problematic issue of old age. There is the possibility of falls among the elderly in the hospitals. The present study was conducted to determine the risk factors for falls in the elderly in hospitals through systematic review.Method: This is a systematic review based on the PRISMA protocol. The IranMedex, SID, Magiran, IranDoc, Medlib, Pubmed, Scopus, Web of Science, Science Direct, Medline and Google Scholar databases were searched for keywords in the time frame of 1994-2017.Results: The mean age was 64-81 years old and the number of elderly people varied from 88 to 28524 people. Of these studies, six studies were performed in the acute care unit, three studies in the elderly care unit, three studies in the surgical and clinical department, one study in the rehabilitation department, one study in the psychiatric department and other studies were performed in several parts of the hospital. The results of this study referred to individual and external factors as risk factors for the falls in the elderly in the hospital. The use of medications, physical problems, and psychological problems were the most common risk factors for falls in the elderly.Conclusion: In acute care, chronic care, psychiatric care, and elderly care units, there are many risk factors for the falls in the elderly due to their physical and mental status. Identifying and resolving these risk factors may provide safety for the elderly. © 2020, Indian Journal of Forensic Medicine and Toxicology. All rights reserved

Prevalence of Mycoplasma pneumonia in Patients with Respiratory Infections from Shaheed Mostafa Khomeini and Khatam Hospitals by Culture and PCR Methods

Background and Aims: Mycoplasma pneumoniae is one of the most important pathogens causing human respiratory tract infection; especially in community-acquired pneumonia (responsible for 10 – 40% of these infections).The aim of this study was to evaluate the prevalence of Mycoplasma pneumonia in patients with respiratory infections from Mostafa Khomeini and Khatam hospitals, by culture and molecular methods. Materials and Methods: In this study, 100 samples of throat swab from patients with respiratory infections were collected. All samples were cultured in PPLO broth and PPLO agar. After culture and genomic DNA extraction, PCR was carried out using specific M. pneumoniae primers. Results: In this study, 14 (14%) colonies of Mycoplasma were isolated on PPLO agar medium. Using specific primers, 17 samples (17%) were detected as Mycoplasma genus and 6 samples (6%) were confirmed to be M. pneumoniae species.  Conclusions: Based on the results of this study, For the detection of M. pneumoniae among the respiratory infections cases PCR is a highly reliable and sensitive method compared to the culture media. Using specific primers, PCR can confidently detect and separate infectious agents even in the genesis and species level