فهرست مطالب roham borazjani

The knowledge of different types of ankle fractures based on plain radiographs and computed tomography (CT) images can help improve patients' management. This cross-sectional study assessed the plain radiographs and CT images of 1,000 consecutive patients observed in an emergency department between March 2015 and March 2020. Fractures were labeled as uni-, bi-, or trimalleolar. Malleolar fractures were classified into medial, lateral, and posterior ones based on Herscovici, DanisWeber, and Mason and Molloy classifications, respectively. Bi- and trimalleolar fractures, on the other hand, were categorized according to the Lauge-Hansen classification. This study included 1,000 patients with 1,003 ankle fractures. Of them, 901 were adults (mean±SD age: 41.6±16.7, male: 567 [62.9%]) with 904 fractures. In total, 53% of adult patients were 18 to 39 years old. Considering unilateral ankle fractures, the medial malleolar fracture was the most common unimalleolar fracture (62.6%), with Herscovici C being the most frequent subtype (65.3%). On the other hand, the most common type of lateral malleolar fracture was Danis-Weber type B (65.5%). There were also 209 (23.3%) bimalleolar and 114 (12.7%) trimalleolar fractures, 5.8% (16 fractures) of which could not be classified based on the Lauge-Hansen classification. Unimalleolar fractures were also observed in 87 (87.9%) children, with the medial malleolar fracture being the most common type (89.7%). Medial malleolar fractures were the most frequent malleoli in patients observed in the emergency department under study. Among bi- and trimalleolar ankle fractures, supination-external rotation and pronationexternal rotation injuries were the most common patterns. The Lauge-Hansen classification was not applicable in 5.8% of bi- and trimalleolar fractures. Level of evidence: IV

The effect of vaccination on the SARS-CoV-2 baseline viral load and clearance during COVID-19 infection is debatable. This study aimed to assess the effects of demographic and vaccination characteristics on the viral load of SARS-CoV-2.

We included the patients referred for outpatient SARS-CoV-2 qRT-PCR (reverse transcriptase quantitative polymerase chain reaction) test between July and September 2022. Cycle threshold (Ct) data were compared based on the demographic and vaccination characteristics. A generalized linear model was used to determine the factors associated with the SARS-CoV-2 PCR Ct value.

Of 657 participants, 390 (59.4%) were symptomatic and 308 (47.1%) were COVID-19 positive. Among 590 individuals with known vaccination status, 358 (60.6%) were booster vaccinated, 193 (32.6%) were fully vaccinated, 13 (2.2%) were partially vaccinated, and 26 (4.4%) were unvaccinated. Most vaccinated patients received inactivated vaccines (70.5%). The median Ct value was 20 [IQR: 18–23.75] with no significant difference between individuals with different vaccination statuses (P value = 0.182). There were significant differences in Ct value in terms of both symptom presence and onset (both P values < 0.001). Our regression model showed that inactivated vaccines (P value = 0.027), mRNA vaccines (P value = 0.037), and the presence and onset of symptoms (both P values < 0.001) were independent factors significantly associated with the viral load.

The SARS-CoV-2 baseline viral load is unaffected by vaccination status, yet vaccination might accelerate viral clearance. Furthermore, we demonstrated that the presence and onset of symptoms are independent variables substantially associated with the patient’s viral load.

This study aimed to determine the AKI prevalence and the contributing factors among trauma patients admitted to the ICU of the only level-one trauma center in south Iran.
The present study was a retrospective cohort of patients with post-traumatic AKI admitted to the intensive care units of Shahid Rajaee (Emtiaz) Trauma Hospital in Shiraz, Iran, between March 21, 2021, and February 20, 2022. The variables were obtained from the Iran Intensive Care Unit Registry program (IICUR). Demographic features (age, sex, height, weight), vital signs including heart rate, respiratory rate, temperature, blood pressure, outcome, and laboratory findings were gathered.
In total, 2271 trauma patients admitted to the ICUs were included in 398 cases (17.5%) developed with AKI. Most AKI patients, 249 (62.60%) were in stage 1 disease. Of 77(19.30%) individuals in stage 2, 72(18.10%) were in stage 3 of the disease. Most AKI patients were male, with a mean age of 52.92± 22.06 years. AKI patients were hospitalized in the intensive care unit for significantly more days than patients without AKI and were more severe regarding APACHE II and GCS (p-value <0.001).
Acute renal injury in ICU trauma patients is a common complication with significant mortality and length of hospital stay. Age, high APACHE II score, minimum systolic blood pressure, acute renal injury, and low GCS score are strong risk factors associated with mortality in intensive care unit patients. Patients with acute kidney injury are five times more likely to die.

In the name of extensive vaccine uptake, understanding the public’s attitude, perception, and intent toward COVID‑19 vaccination is a significant challenge for public health officials.

A cross‑sectional survey via an online questionnaire rooted in the Health Belief Model and Integrated Behavioral Model was conducted to evaluate COVID‑19 vaccination intent and its associated factors. Factor analysis and multivariate logistic regression were operated to be satisfactory.

Among the 4,933 respondents, 24.7% were health care workers, and 64.2% intended to accept COVID‑19 vaccination. The adjusted odds (aOR) of COVID‑19 vaccination intent was higher for individuals with greater exposure to social norms supportive of COVID‑19 vaccination (aOR = 3.07, 95% Confidence Interval (CI) = 2.71, 3.47) and higher perceived benefits of COVID‑19 vaccination (aOR = 2.9, 95% CI = 2.49, 3.38). The adjusted odds of vaccination intent were lower for individuals with greater COVID‑19 vaccine safety concerns (aOR = 0.28, 95%CI = 0.25, 0.31). Lower vaccination intent was also associated with increasing age ((aOR = 0.99, 95% CI = 0.98, 0.999), female sex (aOR = 0.76, 95% CI = 0.65, 0.88), and working in the health care field (aOR = 0.75, 95% CI = 0.63, 0.9).

The odds of COVID‑19 vaccination intent were higher three or more times among those with a greater belief in vaccine effectiveness, lower concerns about vaccine safety, and greater exposure to cues to vaccinate, including from doctors. This last finding is concerning as vaccine acceptance was surprisingly lower among health care workers compared to others. The remarkable results of factor analysis and reliability of the questionnaire may encourage local health authorities to apply it to their regional population

To evaluate the presence/severity of depression, anxiety, and stress among health care workers(HCWs) who work on the specially allocated COVID-19 ward (Group A) and HCWs on the other wards(Group B). This questionnaire-based study was conducted from January 25 to February 28, 2021. The mentalstatus was assessed using the Persian version of the 42-item Depression, Anxiety, and Stress score (DASS-42).Gathered data was analyzed using SPSS version 25. The independent T-test and Chi-square tests were used tocompare quantitative and qualitative variables. Two-hundred and twenty two questionnaires were eligible for analysis. Group A consisted of 33HCWs, and 189 (85.1%) individuals were working on the other wards. No statistically significant differenceswere seen regarding the Socio-demographic features except for the marital status (p=0.005). The depressions’mean score was comparable between group A and B (p=0.102). The mean scores of anxiety and stress weresignificantly lower in group A than group B (p=0.006), although the frequency of DASS-42 parameters did notdiffer between these two groups (p>0.05). Contrary to our assumptions, this study showed that the DASS-42 parameters were not higher inHCWs working on the COVID-19 wards. This might be justified by developing coping mechanisms, being onthe honeymoon phase of the disaster, compassion satisfaction, promising vaccine news, and working on theless impacted hospital.

Anthracyclines can induce injuries to cardiac myocytes. Performance of echocardiography to detect Anthracycline Induced Cardiotoxicity (ACIC) for all patients under chemotherapeutic regimens is neither feasible nor cost-effective.

This study aimed to investigate the changes in the serum levels of cardiac novel biomarkers after anthracycline usage to determine whether they are suitable candidates for screening or diagnosing ACIC.

In this pre-post study, patients without previous cardiovascular diseases who were candidates for chemotherapy with anthracyclines were recruited. The study was conducted on 30 patients selected through simple random sampling. Echocardiography and measurement of the serum levels of NT-pro Brain Natriuretic Peptide (BNP), soluble ST2, Galectin 3, and Growth Differentiation Factor-15 (GDF-15) were performed before chemotherapy and six months after the last session. ACIC was defined based on the echocardiographic criteria. Paired sample t-test was used to compare the biomarker levels. In addition, Receiver Operating Characteristic (ROC) curve was used to assess the specificity and sensitivity of the significant biomarkers in predicting the changes in Left Ventricular Ejection Fraction (LVEF).

This study was conducted on 30 patients, 16 ones of whom had developed ACIC. The results revealed a significant increase in the serum levels of soluble ST2 (134.71 ± 60.46 vs. 137.49 ± 61.38, P = 0.011) and galectin 3 (6.82 ± 3.18 vs. 7.19 ± 3.29 ng/mL, P < 0.001) among the patients who had developed ACIC. ROC curve analysis showed that a soluble ST2 level ≥ 46.63 ng/ml could predict the occurrence of ACIC with 62.5% sensitivity and 100% specificity (AUC = 0.835, P < 0.001, NPV = 70%, PPV = 100%).

This was the first study, which simultaneously evaluated multiple biomarkers for the detection of ACIC. Among these biomarkers, only soluble ST2 demonstrated a promising ability for the detection of ACIC.

The necessity of easing pandemic restrictions is explicit. Due to the harsh consequences of lockdowns, governments are willing to find reasonable pathways to reopen their activities.

To find out the basics of developing a reopening roadmap, on 6th-10th July 2020, we conducted a systematic search on PubMed, Scopus, and Web of Science to review the databases; and Google by manual to review the grey literature. Two independent authors extracted the data, and the senior author solved the discrepancies.

Sixteen documents were included. Data categorized into four sections: principals, general recommendations for individuals, health key metrics, and in-phases strategy. The number of phases or stages differed from three to six, with a minimum of two weeks considered for each one. Health key metrics were categorized into four subsets: sufficient preventive capacities, appropriate diagnostic capacity, appropriate epidemiological monitoring, and sufficient health system capacity. These metrics were used as the criteria for progressing or returning over the roadmap, which guarantees a roadmap's dynamicity. Noticeably, few roadmaps did not mention the criteria that may alter the dynamicity of their roadmap. When some areas face new surges, the roadmap's dynamicity is essential, and it is vital to describe the criteria to stop the reopening process and implement the restrictions again.

Providing evidence for policymaking about lifting the COVID-19 restrictions seems to be missed in the literature should be addressed more, and further studies are recommended.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the leading cause of death since December 2019. The most common clinical manifestations are cough, fever, and dyspnea; however, non-specific findings are also reported. This virus affects all age groups with a predilection to the adults, but children and neonates can also be affected.

An 11-days-old male neonate was brought to the hospital with chief complaints of vomiting and severe watery diarrhea. All laboratory data, including the stool OB/OP test, were normal except for leukocytosis. His parents were asymptomatic. In the following, qRT-PCR from neonate’s nasopharynx reported positive. Supportive and symptomatic treatments were done. The neonate discharged from the hospital without any significant sequelae.

Extrapulmonary manifestation of COVID-19, especially gastrointestinal findings, should be considered in neonates to avoid possible complications and further spread of the disease.

The COVID-19 pandemic has raised a huge sense of anxiety in people and health care staff. Yet, there are concerns regarding the exact routes of transmission and the best protective measures in health centers. It seems that a major route of transmission is via respiratory droplets, but it could be spread in an airborne mode in some airborne-producing procedures. This study provides a protocol as a quick, concise infection control module for those who work in operating rooms at the time of the outbreak of COVID-19 or similar infectious diseases.

Since December 2019, a novel coronavirus disease (COVID-19) began its journey around the world. Medical students, as frontline healthcare workers, are more susceptible to be infected by the virus. The aim of this study was to assess COVID-19 related knowledge, self-reported preventive behaviors and risk perception among Iranian medical students within the first week after the onset of the outbreak in Iran.

This cross-sectional study was conducted from 26th to 28th of February, 2020. Participants were Iranian medical students (5th-7th year) whose knowledge, preventive behaviors and risk perceptions of COVID-19 were assessed using an online questionnaire. The questionnaire consisted of 26 questions including 15 items about COVID-19 related knowledge, 9 items regarding preventive measures and 2 items about COVID-19 risk perception. The validity and reliability of the questionnaire were shown to be satisfactory.

A total of 240 medical students completed the questionnaire. The mean age of participants was 23.67 years. The average of correct answers of knowledge was 86.96%; and 79.60% had high level of related knowledge. The average rate of practicing preventive behaviors was 94.47%; and 94.2% had high level of performance in preventive behaviors. The cumulative score of risk perception was 4.08 out of 8 which was in moderate range. Risk perception was significantly different between stagers and interns and between those being trained in emergency room (ER) and non-ER wards. There was a significant negative correlation between preventive behaviors and risk perception.

We found a high level of COVID-19 related knowledge and self-reported preventive behaviors and moderate risk perception among Iranian medical students.

Cutaneous leishmaniasis (CL), caused by the intracellular protozoa Leishmania, causes full-thickness skin wounds and scar formation afterwards, which may bring about some complications such as scar formation, secondary infection, and wound expansion. This investigation was conducted to determine the effect of hydroalcoholic extract of silymarin, as an anti-oxidant, anti-inflammatory, and anti-scar, for treatment of CL caused by Leishmania major. A total of 28 female BALB/C mice were injected with amastigotes of Leishmania major and after the wounds came up on their tail-base they were randomly divided into four groups (n = 7): E1 and E2, which received silymarin 5% and 10% gel, respectively, and C1 and C2 were treated with normal saline and vehicle gel, respectively, every 24 hours for 20 days. Wound size was measured every three days. Finally, the mice were sacrificed with high dose of ether, and full-thickness skin samples from the wound site was obtained for stereological estimation of collagen and vessel volume densities, fibroblasts population, vascular length density, and mean diameter of the vessels. Silymarin gel in either concentration of 5% and 10% accelerates wound closure (P < 0.05) and also improves collagen synthesis and revascularization by means of increasing length density, volume density, and mean diameter of blood vessels (P < 0.05). Topical administration of silymarin extract in both doses of 5% and 10% showed promising effects on the healing process of CL-induced wounds.