hadi khoshmohabat

Traditional medicine may play an essential role in wound healing. This study aimed to assess the effect of a natural ointment on wound healing in the first stage of an open wound.  This randomized clinical trial study included 80 patients with pilonidal sinus referred to our hospital in Tehran from 2020 to 2021 who underwent open surgery. Patients were divided into two groups receiving medication and the control group using the block randomization method. Chi-square was used to describe qualitative variables, and T-test was used to describe quantitative variables. Parametric and non-parametric tests were used according to the type of variable distribution. It was used to compare the means of each group. A P-value less than 0.05 was considered significant. Wound healing time, pain intensity, need for analgesic compounds, and wound secretion were significantly shorter in the study group than in the control group (P <0.001).  The effect of this natural ointment on wound healing appears promising. Further studies are recommended.

Gunshot injuries to the head and neck usually result in severe trauma due to damage to major vessels and pose challenging surgical management. A penetrating neck injury places numerous organs at a significant risk.

Presentation: 

We present a 39-year-old female transferred to the level I trauma center due to multiple pellet injuries to the neck and jaw.

Diagnosis:

 Computed tomography (CT) angiography showed the presence of multiple metal densities, an intimal flap, and a local thrombus in the left common carotid artery.

Intervention: 

The patient underwent surgical exploration, which revealed neck hematoma and near-total transection of the left common carotid artery. She received a carotid interposition graft (CIP) using the greater saphenous vein to reconstruct the artery.

Outcomes:

 Following an uneventful recovery, the patient was discharged three days after the surgery without any neurological side effects or hematoma. A follow-up CT angiography six weeks after the discharge showed a successful graft.

 This case presents a rare scenario of a penetrating neck injury with foreign objects in zone 2, necessitating a specialized surgical approach. Therefore, it contributes to the current literature and aids surgeons in managing similar patients.

Artificial intelligence is a set of different technologies that, by working together, enable machines to make decisions like humans and behave in terms of functionality similar to human intelligence. The increasing development of the use of artificial intelligence in various branches of medical sciences, pharmacy, genetics, etc. has led to the improvement of effectiveness and reduction of human errors in the diagnosis and treatment of various diseases and the provision of new methods in order to expand the boundaries of medical knowledge. In the field of trauma, which has always been considered a very important cause of death and disability in most countries of the world, the need to investigate and study the capacities and expand the use of artificial intelligence in the management of trauma victims seems essential. In this article, by briefly introducing the basics of artificial intelligence and its capabilities, the capacities of this field in the management of trauma victims have been examined, and finally, the optimal features for the design and application of systems based on artificial intelligence have been presented.

Trauma injuries in overcrowding ceremonies are frequent. This study assessed the health system's challenges in preventing trauma incidents at the Arbaeen ceremony. This qualitative research from June 2021 to January 2022 included ten experts: three trauma professors, four crisis management professors, and three emergency medicine professors. Semi-structured interviews were used for the assessment of data. Challenges and suggestions regarding trauma prevention in the Arbaeen pilgrimage were coded and extracted. The findings related to the factors causing trauma in the Arbaeen ceremony were identified in four themes: management and policy-making, education, resort locations, and traffic. These themes were extracted from a total of 71 codes. The education content included general education, specialized health education, and education in spiritual health. The traffic issues included three subcategories in Iran, Iraq, and around the holy shrines, and resorts and settlements with three subcategories of processions, places of rest, and medical centers. Pilgrim-oriented education, planning, and control of other challenges can reduce threats into opportunities and improve participants' health in the Arbaeen community.

Presence of any blood or fluid in abdominal cavity probably resulted by sever harms in abdomen causing of trauma, usually makes it easy to perform an emergency laparotomy. In battlefield medical centers which reception of traumatized patient performed, access to more rapid diagnosis would be so important because if the intrabdominal bleeding was discovered, the saving life of injured people could be accessible with on time and rapid therapeutic actions, too. This approach causes the saving time and frugality of facilities that can avoid from additional works and prolonged diagnosis. Using the focused assessment with sonography for trauma on abdomen has important position for verifying or rejecting of abdominal injuries in urban traumatic centers but this facility was not usually utilized at battlefield medical units stablished in front lines of the war. The aim of this article is the assess of usefulness level and necessity for the employment of focused assessment with sonography for trauma (FAST) in battlefield medical centers. The present study has been performed with fulfilling of questioner and also to face to face and calling interviewing by surgeons and emergency medicine's specialist participated in battlefields medical centers during the holy war. Results of this study showed that surgeons are agreeing with this equipment, and they recommend adding this facility in emergency military units. Examination with focused assessment with sonography for trauma (FAST) is very reliable for triage and better management in traumatized patient. Presence of any blood or fluid in abdominal cavity makes it easy to perform an emergency laparotomy. All surgeon participated in this study were emphasized to importance and necessity of using this equipment in battlefield surgical units, too.

Responses for medical emergencies can be different during most terrorist attacks in which civilians and military personnel might be killed or wounded. The present study aimed to reflect on injury patterns and the outcome of victims in terrorist attacks. A retrospective research design study was conducted on the data obtained from terrorist attacks in the city of Ahvaz, Iran, on September 22, 2018. In this deadly incident, 92 military and civilian victims had been transferred to hospitals within the first 24 hours. To this end, the data including age, gender, causes, site of injuries, outcomes, and the Injury Severity Score (ISS) values were analyzed.  Data were acquired from the Iranian Legal Medicine Organization, the Iranian Emergency Department, as well as health care facilities. The findings revealed that, out of 92 victims of Ahvaz terrorist attack, 85 cases (92.4%) were men. The mean age of these individuals was about 28.68±11.22 years and 41.3% of them were in need of urgent surgical interventions. There was no information regarding casualties in 22.3% of the cases. Moreover, 25% of the causalities had led to death. The mean of ISS was 8.19±13. Besides, there was a significant relationship between ISS values and patient outcomes (p <0.0001). A relationship was also observed between multiple injuries and mortality rates although it did not include main body parts. The results showed that the mortality rate of casualties in the Ahvaz terrorist attack was high. With respect to the findings, extensive actions are needed to maintain the readiness of the emergency medical care services and to manage such events.

The Islamic Revolution of Iran, which began and came to fruition with the collective uprising of our dear people against oppression and dependence, had opponents and enemies from the very beginning who did not accept our independence and dignity for a moment, and by forming a united front with round-the-clock effort intend to collapse the regime as well as trying to return the country to the humiliating past. In this regard, the imposition of a large-scale military war and terrorist operations in the country has been one of the ways to defeat our people. However, thanks to God, the efforts of the people and the measures of the two wise leaders of the Islamic revolution, this trend has been declining; but it still more or less continues with new methods. The need to familiarize the people and the health staff of the country with the pattern of explosive and terrorist trauma injuries and how to reduce its effects on the injured is an important and vital issue.

Despite exist several centers of excellence in the various medical field in the country, most of them lack a single procedure and organizational structures in their functioning, organizing, targeting, etc. So the study aimed to design an organizational model that meets the goals and mission of them in the field of medical sciences.

This qualitative and applied research was conducted in two comparative and analytical stages from May 2016 to February 2017 in Iran. The location of the study includes a university, research institute, health center, or research center known as a center of excellence. In the analytical stage, 10 experts and managers of the top centers were selected through a targeted sampling method as a study sample. In the comparative section, all 50 centers of excellence and similar specimens in the world were selected. The data collection tool was a semi-structured interview in the analytical section and the ministry of health's documents. In comparative section data, bases and official sites of the centers were analyzed.

The term "center of excellence" for units that play a role in one or two of the three dimensions of education, research, and treatment, and the term "comprehensive center of excellence" for a unit that plays a role in all three dimensions, in addition to knowledge management have been agreed upon. Seven missions (national and international) for the comprehensive center of excellence and five different missions for center of excellence were formulated. The role of the ministry of health in the guidance of these centers was agreed in the seven items. Ultimately, the macro model of organizing "comprehensive centers of excellence" and "centers of excellence" at the university level and ministry of health level was designed and presented.

Correcting the governance structure of these centers in ministry, unit command at the highest level of management by reorganizing of duties, the authority of High Council for the Center of Excellences and the establishment of a systematic relationship between ministry and vices are the part of the requirements for fulfilling the roles and mission of center of excellence.

The communicable and highly contagious pandemic caused by the coronavirus, has caused spirituality to increase in the Islamic Republic of Iran.

In this study Islamic literature such as the Holy Quran, hadiths and articles were used to explain the increase of "spiritual health" during the Corona crisis.

Although during the Corona crisis, closure of religious centers was one of the most important concerns of the experts in spiritual health, we observed  a considerable increase in spiritual health. Patience, trust in God, and hope for divine kindness, as well as faith are the most important issues promoting spiritual health in the society.Patients: The feeling of imminent death is one of the most important issues promoting spiritual health. Patients' relatives often pray more than before and request "health and well-being from God."Therapists often show characteristics of self-sacrifice in caring for patients, and this has been shown to have a long lasting effect on members of the health system, elevating their rank in society.The invoking of the community to instigate and implement the recommendations of the healthcare officials by the Supreme Leader of Iran played an important role in motivation of the caregivers as well as promotion of the healthcare system.

The coordinated actions and the relentless efforts and endeavors of the various groups of the people involved in the Corona crisis, underscored the enormous capacity of the Islamic Republic to act as an ethical paradigm that can be a model for implementing the role of the Supreme Leader throughout the world.

In today's modern world, despite numerous advances in medicine, the hemorrhagic shock is still the leading cause of death on the battlefield and the second most common cause of death in civilian trauma. Hemostatic agents can play a key role in establishing hemostasis in the prehospital setting and preventing hemorrhage-associated death. In this regard, the purpose of this article is to investigate the various aspects of known hemostatic factors.

A comprehensive search of academic scientific databases for related keywords was performed. Related articles were evaluated.

Hemostatic agents can cause hemostasis by different mechanisms, including concentrating coagulation factors, adhesion to the tissues in which traumatic hemorrhage occurred, and delivering procoagulant factors to the hemorrhage site. At present, these hemostatics have been significantly improved with regard to efficacy and adverse consequences resulting from their use. Several hemostatic dressings have been developed to receive FDA approval and are being used practically on the battlefield. In addition, there are currently several reports on the use of such hemostatics in the hospital setting, in conditions where commonly known approaches fail to stop life-threatening bleeding.

The use of hemostatic dressings and agents is one of the main advancements achieved in recent decades. However, it can be claimed that the ideal hemostatic has not been recognized yet; therefore, this topic needs to be brought into focus and further addressed.

Dialysis access puncture wound bleeding after needle extraction at the end of each hemodialysis session is a very important problem. This study evaluated the effect of HemoFoam® compared to conventional gauze dressing on hemostasis of dialysis access puncture wound bleeding in hemodialysis patients.

This one-group, before-after, clinical-trial was conducted on 60 hemodialysis patients selected by convenience sampling who underwent hemodialysis through arteriovenous fistula in Shahid Rahnemoon Hospital, Yazd, Iran in 2017. After reviewing the eligibility criteria, the study was performed in two separate sessions. In the first session, only HemoFoam® was used while in the second session; the only conventional dressing was used. Time of hemostasis in each puncture wound was evaluated. Data were analyzed by SPSS 22 (IBM SPSS Statistics for Windows, Armonk, NY: IBM Corp, United States) using paired T-test and Chi-square tests.

The mean age of the patients was 55.20±14.25 years. Hemostasis was achieved in 76.6% of cases at the arterial access site in the first two minutes in the HemoFoam® group. The mean homeostasis time in the HemoFoam® group was 2.86±1.87 min at the venous access site and 3.15±1.97 min at the arterial access site (P<0.001). The mean homeostasis time in the conventional dressing group was 10.54±6.65 min at venous access site and 12.74±9.28 min at the arterial access site, which was significantly different between the two groups (P<0.001).

HemoFoam® is effective in reducing the time of homeostasis in the vascular access site of hemodialysis patients. Therefore, its use in hemodialysis wards is recommended for hemostasis in the dialysis access puncture wound bleeding.

Head, face, and neck injuries are an important source of combat mortality and morbidity. Depending on which one is the cause of the injury, and the traumatic fracture patterns are different between both of the civilian population and military personnel. Accordingly, the aim of this study is a review of the evaluation of various medical aspects of maxillofacial surgery in military personnel.

This study was prepared by the published researches containing the survey in the surgery of combat and military-associated maxillofacial injuries before January 2019. We investigated in online databases including ISI Web of Knowledge, MEDLINE, EMBASE, PubMed, Wiley, and Scopus. The words used to identify these papers in web-based and online investigate contained maxillofacial trauma, maxillofacial surgery, trauma, military-associated maxillofacial injuries. Headings and summaries of all articles found by the investigating method were separately appraised by two reviewers and then incorporated them relevantly.

The outcomes of this study demonstrated maxillofacial hurts were increasing in trauma related to the military. In addition, the number of maxillofacial trauma has rising more within the last many years. There is a high incidence of airway hurt in maxillofacial trauma. CT scan with 3D reformatting can prompt clinical recognitions of maxillofacial trauma in military operations. The main causes of maxillofacial injury were explosive systems, gunshot sores, and aircraft events.

The maxillofacial fracture templates are different among both the civilian society and military personnel. Thus, the valuation of different sides of maxillofacial surgery seems in military personnel crucial.

Neuroendocrine tumors are classified as rare tumors that are mostly seen in lung or gastrointestinal tract and can cause many specific sign and symptoms such as flushing, diarrhea, heart failure, tachcardia, emesis and bronchoconstriction. In this case, the tumor is located in gallbladder with classic presentations.

A 59 year-old female attended to our clinic with nausea and vomiting, heartburn, weight loss and flushing. The patient’s ultrasound showed a hypo echo and heterogenic mass (24×36 mm) in the anterior wall of gallbladder which continued to the common hepatic duct and the CT scan reported a 40×21 mm mass like lesion in porto-hepatic area with pressure effect on distal of gallbladder and cystic duct suspicious for lymphadenopathy. The postoperative pathological findings were compatible with typical perineural carcinoid tumor.

Carcinoid or neuroendocrine (NETs) tumors are a type of slow growing tumors that are typically originated from several places of the body and usually begin in gastrointestinal (GI) tract or lung. Carcinoid tumor is a rare GI tract disease which consists about 1% of GI tract tumors. The NETs of gallbladder are very rare. This is necessary for surgeons to consider rare types in order to conduct proper management for this condition.

The staging of gastric cancer has an important role in the management of tumors. Surgeons & oncologists may use many diagnostic tests to measure the stage of tumors. There is a need of study about the reliability of diagnostic endosonography as one of the most important tests for evaluating tumoral stages. The aim of current study is to determine the efficacy of endosonography (EUS) for the staging of gastric tumors pre-operatively. This cross-sectional study was performed on 120 patients with gastric cancer who underwent gastrectomy operation and admitted to a tertiary hospital between 2014 and 2015. At the beginning, the tumors were staged by using endosonography. Also, the tumors re-staged after surgery by histopathologic studies. The results of the two methods were compared. Diagnostic indicators such as sensitivity, specificity, accuracy, positive predictive value and negative predictive value were compared between the two methods and the level of 0.05 was considered as statistically significant. Mean age of the patients was 65.44±12.3 years. Of the total patients, 87 patients (72.5%) were male and 33 (25.5%) were female. The accuracy of endosonography method was 82.5% for tumor size. Also, the accuracy of evaluating lymph node involvement by endosonography was 79.2% and for metastasis was 25.0%. Endosonography is a precise method for evaluating tumoral invasion and lymph node involvement with a high accuracy in our hospital and is recommended to be used forpre-operative staging of gastric cancers.

In recent years, the prevalence of attacks perpetrated by humans against other humans has increased worldwide. The injuries suffered by attack victims are severe and multi-organ. Iran’s neighboring countries have been the scenes of attacks in the recent past. This study assessed the type and severity of injuries sustained by victims transferred to Iran during the time period 2005-2007.

This study was conducted on injured civilians transferred to hospitals in Iran. Data regarding cause of injury, type and severity of injuries, diagnostic-therapeutic interventions, and patient outcomes was collected and statistically analyzed using SPSS version 14 software.

In the studied time period, 214 attack victims were transferred to 3 Level 1 trauma centers in Iran. The mechanisms of injury were explosion in 130 cases, gunshot in 48, and other causes in the remaining victims. The mean Injury Severity Score (ISS) was 5.91 ± 4.54 (range = 1-34), and the median was 4; 109 cases (51%) had an ISS between 1 and 8, 73 cases (34%) were scored between 9 and 14, 15 cases (7%) were scored from 16 to 24, and 17 cases (8%) had an ISS ≥25. In terms of the number of injured organs, 42 patients (20%) had one, 124 (58%) had 2, 36 (17%) had 3, and 12 patients (5%) had 4 or more injured organs. Procedures included 86 orthopedic, 25 general surgical, 21 ear, nose, and throat (ENT), 18 plastic, 15 neurosurgical, and 10 ophthalmic operations; 25 patients received psychiatric counseling. The mean (±SD) hospital stay was 13.43 (±19.76) days (range = 1-230).

The injury pattern in attacks is more severe and differs from other traumas. The medical team should have adequate knowledge in this respect to provide comprehensive healthcare.

Burden of injuries is an important public health problem, especially in developing countries. However, a national standard tool for data collection of trauma registry has not been developed in Iran yet.
The present study aimed to describe the steps undertaken in the development of the minimum dataset (MDS) and define the inclusion and exclusion criteria for a case of trauma registry by the national trauma registry of Iran (NTRI).
The working group consists of sixteen elected expert representatives from seven established countrywide active trauma research centers. Following a structured extensive review of the literature, the working party identified the data variables that included key registry goals for pre-hospital and hospital, outcome and quality assurance information. We used data variables from three trauma registry centers: National trauma data standard questionnaire, European trauma care (UT stein version), and Sina trauma and surgery research center. Then, we performed two email surveys and three focus group discussions and adapted, modified and finally developed the optimized MDS in order to prepare the quality care registry for injured patients.
The finalized MDS consisted of 109 data variables including demographic information (n = 24), injury information (n = 19), prehospital information (n = 26), emergency department information (n = 25), hospital procedures (n = 2), diagnosis (n = 2), injury severity (n = 3), outcomes (n = 5), financial (n = 2), and quality assurance (n = 1). For a patient sustained one or more traumatic injury in a defined diagnostic ICD-10 codes, the inclusion criteria considered as one of the followings: If the patient stayed > 24 hours in the hospital, any death after hospital arrival, any transfer from another hospital during the first 24 hours from injury.
This study presents how we developed the MDS in order to uniform data reporting in the NTRI and define our inclusion and exclusion criteria for trauma registry. Applying the MDS and the case definition in pilot studies are needed in next steps.

Knowing the direction of traumatic injury is important as the information can help avoid death after trauma. A trauma registry usually entails detailed information about the demographics, cause, intensity of the injury, and the final diagnosis and outcome of the trauma-affected patient. Researchers should be able to evaluate all aspects of trauma injury and the patient’s status.

The purpose of this study was to develop a trauma data collection form.

The development of the trauma registry form began in February 2013. The variables were finalized by a team consisting of general and trauma surgeons, specialists in emergency medicine, orthopedists, neurosurgeons, and public health professionals who have special interest in trauma research. The scale was sent to 10 specialists for validation.

After assessing the scale validity twice, it was accepted with an integrator agreement of 0.89. The test-retest reliability was assessed in a convenience sample of 20 physicians (Kendall t = 0.97; P < 0.001). Such a high reliability may reflect redundancy of some items.

It is essential to establish a secure multicenter trauma registry in Iran for data collection, storage, and assessment of traumatic injury and these registries must be easy to install and use.

In today’s modern world, despite the multiple advances made in the field of medicine, hemorrhagic shock is still the main cause of battlefield mortality and the second most prevalent cause of mortality in civilian trauma. Hemostatic agents can play a key role in establishing hemostasis in prehospital situations and preventing hemorrhage-associated death. In this respect, this article aims to review different aspects of known hemostatic agents. Evidence Acquisition: A comprehensive search of the academic scientific databases for relevant keywords was conducted; relevant articles were compiled and assessed.

Hemostatic agents can establish hemostasis by means of different mechanisms, including concentrating coagulation factors, adhesion to the tissues, in which traumatic hemorrhage occurred, and delivering procoagulant factors to the hemorrhage site. Presently, these hemostatics have been significantly improved with regard to efficacy and in adverse consequences, resulting from their use. Several hemostatic dressings have been developed to the degree that they have received FDA approval and are being used practically on the battlefield. In addition, there are currently several case reports on the use of such hemostatics in the hospital setting, in conditions where commonly known approaches fail to stop life-threatening bleeding.

The use of hemostatic dressings and agents is one of the main advancements achieved in recent decades. However, it can be claimed that the ideal hemostatic has not been recognized yet; therefore, this topic needs to be brought into focus and further addressed.

Inguinal hernia is one of the most common male diseases all over the world with an incidence rate of 18-24% throughout life. Chronic inguinal pain is one of the complications that prolong return to work time.

The main aim of this study was to determine the effect of ilioinguinal neurectomy on postoperative chronic pain (PCP) in patients that underwent open inguinal hernia repair via the Lichtenstein method.

In this randomised controlled clinical trial, male patients with unilateral inguinal hernia were randomized into two groups: 74 cases in the preserved-nerve group and 66 cases in the nerve-excised group. The method of herniorrhaphy was the classic Lichtenstein method. Pain and numbness were evaluated at 1 day, 1 week, 1 month, 6 months and 1 year after surgery via visual analogue scale (VAS) system. We used SPSS ver.16 for analysis.

All patients were male with mean age of 39.1 years (with a range of 18 to 68 years). The follow-up rate was 100% after 1 year. Pain severity was significantly lower in nerve-excised patients at 1 day, 1week, 1 month and 6 months after surgery; but it was not significant after one year, although overall pain severity was low. Numbness was significantly higher in excised patients at all endpoints (1 day, 1month, 3 months, 6 months and one year after surgery).

Ilioinguinal nerve excision at the time of inguinal hernia repair decreased post-surgical inguinal pain, and it can be used as a routine method in herniorrhaphy.