shahrokh yousefzadeh chabok

Integrated trauma systems (ITS) have shown potential in reducing traffic crash-related injuries and mortality, although their structure and impact can vary. This study assessed the effectiveness of ITS in Guilan, Iran.

 A retrospective observational study.

Utilizing a cross-sectional analysis, this descriptive-analytical study was conducted in Northern Iran from 2015 to 2019 to compare road traffic crash (RTC) data in Guilan (with ITS) against Mazandaran (without ITS), considering weather as a confounder. The study involved pre- and post-ITS intervention analyses to evaluate changes in RTC, injury, and mortality rates.

Before ITS implementation, Guilan’s daily RTC mean was 38.4 (SD=16.7), which significantly decreased to 30.8 (SD=13.7) after the intervention. Conversely, in the control province of Mazandaran, the daily average number of RTCs increased from 37.29 (SD=14.1) to 42.55 (SD=16.4) post-ITS implementation in Guilan. Furthermore, the mortality rate in Guilan showed a marginal decline from 27.74 (SD=12.6) pre-ITS to 26.60 (SD=11.9) post-ITS, indicating the positive impact of the ITS. In contrast, Mazandaran demonstrated a significant increase in mortality from 32.16 (SD=14.5) to 51.75 (SD=15.7). The statistical analysis confirmed a significant reduction in mortality and injury incidence in Guilan at the time of the intervention, with a marked decrease observed post-intervention (P<0.001).

The findings revealed that RTC prevention is feasible in Iran, with ITS in Guilan significantly reducing RTCs, injuries, and mortalities, underscoring the importance of ongoing efforts to expand ITS components nationally.

Accumulation of inflammatory factors in the stroke area results in brain tissue damage and a patient’s disability. It has been demonstrated that curcumin has neuroprotective effects.

This study aims to evaluate the effects of nano-curcumin, a more stable and soluble form than the common curcumin, on the National Institutes of Health Stroke scale (NIHSS) and modified Rankin scale (mRS) scores and interleukin-6 (IL-6) serum levels in ischemic stroke patients.

Forty ischemic stroke patients were randomly divided into two groups of nano-curcumin and control, with 20 patients in each group. The curcumin group received nano-curcumin with a dose of 80 mg/d for one month, and the control group received placebo. Neurological disabilities were assessed by NIHSS and mRS over three time points. IL-6 serum levels were evaluated over two time points. Infarct area volume was evaluated in two time points.

NIHSS and mRS scores were significantly lower in the curcumin group than in the control group (P=0.038 and P<0.001, respectively). Serum levels of IL-6 were significantly lower in the curcumin group than in the controls (P<0.001). The cerebral infarct volume did not change significantly one week after the treatment with curcumin. 

Nano-curcumin improves the stroke clinical symptoms in ischemic stroke patients, as indicated by the reduction of NIHSS and mRS, in addition to a decrease in serum levels of IL-6.

Neuromarketing has provided deep insights into customers’ motivations and decisions by measuring consumers’ neural signals and studying their responses to marketing stimuli.
Neuromarketing analyzes neural signals and examines consumers’ reactions to marketing stimuli, offering profound insights into their motivations and decision-making.

This research aimed to study the brain waves of users before and during the viewing of native advertisements and the relationship between neural responses of the brain and self-report.

The data collection tools included a questionnaire, a video and an encephalography device. The sample consisted of 20 participants from the staff and students of Guilan University of Medical Sciences, Rasht City, Iran. The electroencephalography (EEG) data were converted to numerical values using MATLAB software, , version 2024. 

In the advertisement viewing state compared to the resting state, the average power spectral density (PSD) of theta at F4 decreased from 3.25 to 2.59. The average PSD of beta at F4 decreased from 0.67 to 0.53 and at F7 from 0.89 to 0.75. A significant difference was observed in these regions. A correlation coefficient of 0.447 was observed between native advertising components and the average beta PSD, and correlation coefficients between attitude and the average theta PSD (F7=0.244), alpha (F3=0.13) and beta (F3=0.457) were positive and significant.

The increase in the PSD of brain waves in the Fp1 during advertisement viewing indicated a positive attitude. The average absolute PSD of the beta wave was significantly aligned with individuals’ conscious reactions (attitudes) toward components of native advertising. The positive relationship between the advertisement’s impact on individuals’ attitudes (self-report) and neural responses during advertisement viewing in the F7 theta wave channel and the F3 alpha and beta wave showed that these responses were aligned with positive emotions.

This study reviewed the association between gut microbiota and primary brain malignancies, with a focus on underlying metabolic and immunologic mechanisms, and possible therapeutic approaches.

Methods and Materials/Patients:

 A literature search was carried out for a narrative review related to the microbial components of the gut-brain axis (GBA) and their potential effects on brain tumors’ formation, growth, and course of treatment with a focus on recent publications.

Studies have highlighted likely mechanisms of the crosstalk between the gut and brain through an anatomical and physiological pathway, known as the GBA. Moreover, the metabolites and signaling molecules produced by gut microbiota were found to be involved in maintaining the blood-brain barrier (BBB) integrity and brain homeostasis. In addition, studies have revealed the potential negative effect of gut dysbiosis on tumorigenesis and deleterious inflammatory and immunological cascades within the brain. Pre-clinical and clinical investigations indicated the role of modulation of gut microbiome in brain tumors.

Previous investigations on interactions between gut microbiome and central nervous system (CNS) have revealed potential pathways through which interventions on microbiota can regulate brain tumor epigenetics and microenvironment. The findings on modifying microbiota utilizing probiotics, fecal microbial transplantation, and supplemented dietary regimen were promising; nonetheless, further investigation is needed to translate these findings into clinical brain cancer treatment applications.

One of the common complications in craniotomy surgery is bleeding, which is associated with serious and sometimes life-threatening complications. It is essential to accurately estimate the amount of blood lost and compensate for it. This study was conducted to examine the relationship between suctioned blood volume, blood gauze volume, and hemoglobin (Hb) drop rate after craniotomy surgery and identify factors affecting it in hospitalized patients. The results of this research can help doctors accurately predict the amount of blood loss during the operation and avoid unnecessary blood transfusions.

Methods and Materials/Patients:

 Ninety-seven patients with a history of craniotomy surgery in the first 6 months of 2019 were included in the study. The information on the patients was recorded based on laboratory documentation. To calculate the volume of blood lost during the operation, the volume of blood suctioned from the operation description sheet and the volume of blood absorbed by gauzes were calculated and recorded by weighing them. Data were analyzed with SPSS software, version 22.

In this study, 32% of patients received blood during craniotomy. According to the obtained results, the blood volume obtained from blood gauze and suctioned blood and the total blood volume were significantly related to Hb drop, and their ability to predict Hb drop were 6.6%, 14.1%, and 11.2%, respectively. Based on Spearman’s correlation coefficient, the intensity of the correlation between the number of blood gauzes and the amount of blood obtained from blood gauzes was greater than the change in the volume of blood sucked and the amount of total bleeding.

This study showed that measuring the blood volume of gauze consumed in craniotomy surgery can be more effective in predicting the amount of blood loss and Hb drop of the patient after the operation even than the amount of suctioned blood.

Axial neck pain due to degenerative cervical myelopathy can be improved after repairing anterior cervical discectomy with fusion (ACDF) surgery. However, whether changes in postoperative pain can be associated with improvement in the Cobb angle following surgery is still controversial. This study aims to assess the trends of the changes in pain severity and also Cobb angle and then test the relationship between the changes in two parameters.

Methods and Materials/Patients: 

This longitudinal study was performed on 60 consecutive patients who were scheduled to undergo ACDF surgery due to neck disc or degenerative cervical myelopathy (DCM) and had axial neck pain before the operation. Before operation as well as 2 weeks, 2 months and 6 months after surgery, the pain score and value of Cobb angle were measured.

Before surgery, the patients suffered from significant axial neck pain with a mean pain score of 7.47±2.02, but after surgery, patients experienced a downward trend of changes in pain score as the mean pain score of 0.92±1.46 at two weeks, 1.31±1.63 at two months and 1.32±1.64at six months after operation. The repeated measure analysis of variance (ANOVA) test showed a significant reduction in pain scores within follow-up time (P<0.001). A significant improvement was also revealed in the Cobb angle after the operation and the mean value of this angle was significantly lower at two weeks, two months, and six months after surgery than before surgery. Using the multivariate linear regression modeling with the presence of baseline parameters, the relationship between pain score and Cobb angle remained insignificant (P=0.387).

Following ACDF surgery, the improvement in axial neck pain and Cobb angle is predictable, but the relationship between these two indicators will not necessarily be significant.

Spinal cord injury patients are faced with many neglected side effects that threaten the health, wealth, and life of the patients and their families. For this purpose, the international spinal cord injury survey (InSCI) was conducted in 2017 by adding 22 countries to follow up the patients facing spinal cord injury. Iran as a developing country was added to the survey in 2022 focusing on the catastrophic health expenditures of spinal cord injury patients. The survey is named: The International spinal cord injury survey in Iran (InSCI -IR).

Methods and Materials/Patients: 

This study will be performed in Guilan Province, Iran and the primary data of the patients will be gathered from the Poursina Hospital of Rasht and the Iranian National Registry of Spinal Cord Injury Patients. InSCI-IR contains two parts; the general questionnaire which gathers the data for the InSCI and the specific questionnaire which gathers data for calculating catastrophic expenditures.

It is estimated that 600 patients will participate in the study and more than 200 cases are faced with paraplegia or tetraplegia. The international questionnaire contains 11 sections on the living situation of patients with SCI, sociodemographic questions, injury characteristics, mental and physical health, feeling and work conditions, environmental factors, and access to health services. The catastrophic expenditure part contains questions about the cost of treatment, medication, caregiving, transportation, and household income loss related to spinal cord injury, wealth index, and household total income. Both parts will be edited in psychometrics processes.

Although patients with mild traumatic brain injury (mTBI) rarely exhibit an identifiable lesion on neuroimaging, they frequently experience neurocognitive problems. The present study aimed to determine the cut-off point, sensitivity, and specificity of the Montreal Cognitive Assessment (MoCA) test in mTBI patients. In this cross-sectional-analytical study, the case group included 79 patients with mTBI were enrolled in the trauma, neurosurgery, and ICU ward of PourSina hospital (northern Iran), and there were 79 healthy individuals in the control group. Both groups were participating in this study were cognitively evaluated by the MoCA and MMSE test. Moreover, as retesting reliability and determining the concurrent and convergent validity of the MoCA, and Pearson correlation coefficient between two groups, MMSE test was performed on 20 mTBI patients with an average time interval of 3 days. The independent t-test, Cronbach’s alpha and discriminant analysis used for determining the distribution, internal consistency reliability and sensitivity, specificity, and diagnostic value of the MoCA test between groups respectively. The results showed a cut-off point of 26/27 as the probable point of cognitive impairment in mTBI. Also, in order to identify cognitive impairment in mTBI patients, this test reported sensitivity of 0.62 and   specificity of 0.81 with Youden's index of 0.43. In screening for possible mild cognitive impairment in mTBI patients, the MoCA is relatively useful and should not be used only as a substitute for a complete neuropsychological assessment with diagnostic purposes.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with an increased risk of acute cerebrovascular disease.

In this study, we compared the relative frequency of ischemic stroke (IS) and intraparenchymal hemorrhage (IPH) during the SARS-CoV-2 pandemic with a similar period in the previous year.

This comparative cross-sectional study was conducted on patients with acute ischemic stroke and IPH. They were admitted to an academic stroke referral hospital in Guilan Province, Iran, between December 2019 and June 2020 (COVID-19 pandemic period) and a similar 6-month period in the previous year. This study compared the patients’ demographic data, clinical information, risk factors, comorbidities, and outcomes.

A remarkable reduction of 28.6% in the relative frequency of stroke admission was observed during the COVID-19 pandemic period compared with the same period in the previous year (P<0.001). The ratio of ischemic stroke to hemorrhagic stroke decreased from 2.6 in the corresponding period during the last year to 2.2 during the SARS-CoV-2 pandemic period. However, this change was not significant (P=0.232).

This study revealed that the relative frequency of stroke significantly declined at the pandemic’s peak compared to the same time in the previous year despite cerebrovascular complications associated with COVID-19. However, the ratio of ischemic stroke to hemorrhagic stroke did not change significantly.

The present study was conducted with the aim of analyzing the spatial distribution of the most accident-prone points of damage, injury and death of heavy vehicle traffic accidents in Guilan province between 2014 and 2018.

In this descriptive- analytical study, all data related to traffic accidents with heavy vehicle referred to the NAJA traffic police in Guilan province were collected and reviewed, and the cases of damages, injuries and deaths of these accidents in these years were calculated and spatial analysis of accident prone points was calculated and analyzed using ARC GIS software.

Most heavy vehicle traffic accidents in Rudbar with 92.6, at 4 am (1.012), in clear air 4227 (72.33%), on main roads 3212 (54.79%) and direct roads and It was related to the conflict with an unknown device 2373 (40.49%).

traffic Accident-prone points in heavy vehicle traffic accidents were identified, with appropriate interventions, accidents should be prevented in these points and the traffic safety of these vehicles should be increased. The traffic transportation organization, in cooperation with the police, should install traffic signs that indicate the speed limit for more awareness of these drivers when traveling on the main roads and direct geometric conditions and monitor the compliance of driving rules by these drivers.

 The quantitative studies have shown that cyclists around the world have different attitudes and perceptions of safety needs. Therefore, in this study, we want to examine the experiences of injured cyclists about safety needs in a qualitative study.

 The present study was a qualitative study witha  content analysis method. The study population consisted of male or female cyclists over 18 years of age who were injured in a crash or fall while cycling and one or more of their limbs were injured and hospitalized in Poursina Medical Center. Excel details of these clients were obtained from the registration system ofthe  Guilan Road Trauma Research Center. People with various characteristics in terms of age, sex, education, marriage, sex, occupation, length of hospital stay, etc. were included in the study. The number of participants was twenty. Interviews were conducted by medical students with the cooperation and supervision of supervisors.

 Safety factors from the experiences of injured cyclists included nine categories, which were: orderly cycling, holding training courses, supervising cycling, observing the principles of cycling, being equipped with safety equipment, having the right to an exclusive route , Reviewing exclusive routes, creating a sense of security and creating peace in women cyclists.

 Authorities should try to make the factors that were safe in the experiences of these injured as much as possible to give these users a sense of calm and security, thereby encouraging others to ride a bicycle as a clean vehicle for the environment.

It is still unclear whether the surgical or conservative approach has the best recovery and the least adverse outcomes after the treatment of patients with traumatic brain injury (TBI), especially the elderly. The use of invasive versus conservative therapies in elderly patients with TBI is controversial, and the current brain surgery procedures for the elderly require further evaluation.

Methods and Materials/Patients:

 In this retrospective cohort study, the medical records of 238 patients with TBI (119 surgical patients and 119 patients treated with conservative methods) over the age of 65 were reviewed. The patients were compared for the degree of recovery indicated by the Glasgow Outcome Score (GOS) and postoperative complications.

No difference was found in the primary Glasgow Coma Scale (GCS) between surgical and conservative approaches, but after two treatment protocols, the assessment of GCS and GOS showed a significant difference between the two groups; however, after adjusting baseline parameters in a multivariable logistic regression model, the difference between the two groups in CGS and recovery state turned to insignificance. There was no difference between surgical and conservative management in the post-treatment sequels, including contusion, hydrocephalus, myocardial infarction, pulmonary infection, and death. However, the recurrence of hematoma was significantly higher in those who were treated by the conservative method even after multivariate regression modeling.

In TBI patients aged over 65 years, surgical management can result in more favorable outcomes compared with the conservative approach.

In patients with spondylolisthesis, both conservative and surgical approaches are considered based on the stage of the disease. However, in addition to the technical characteristics of the surgery and the stage of the disease, the underlying characteristics of the patients may also affect the therapeutic prognosis. In this regard, some studies have indicated that the surgical prognosis is worse in diabetic and hypertensive patients and also preoperative medical treatments, such as anticoagulants may be effective in the prognosis of the disease. The aim of this study was to evaluate the role of underlying risk factors, such as diabetes mellitus, hypertension, and anticoagulant conditions (such as aspirin) in worsening outcomes after surgery in patients with spondylolisthesis.

Methods and Materials/Patients: 

This cross-sectional study was conducted on 130 patients suffering from spondylolisthesis and scheduled for surgery. According to baseline characteristics, 65 patients with a history of diabetes mellitus, hypertension, and receiving aspirin were categorized as the case group, and 65 sex- and age matched individuals without such comorbidities as the control group. Preoperative and postoperative radicular pain intensity, wound healing, and discharge from the surgical site were considered the study outcomes.

The two groups with and without comorbidities were matched for gender, mean age, mean body mass index, and time of operation. Preoperative pain intensity was similar in the groups, but those with comorbidities experienced higher radicular pain severity postoperatively. We showed no difference in the rate of surgical site discharging, but the lack of wound healing was significantly higher in those with comorbidities.

In patients with spondylolisthesis and candidates for surgical treatment, a history of diabetes mellitus, hypertension, and aspirin can be associated with a worse prognosis, including no improvement in pain and lack of wound healing.

The present study was conducted to investigate the effects of granulocyte colony-stimulating factor (G-CSF) after acute spinal cord injury on increasing a grade of improvement entitled American spinal cord injury association impairment scale (AIS) as an individual participant data (IPD) meta-regression analysis of clinical trials. Methods and Materials/Patients: According to our search strategy, four studies were selected. Multilevel ordered logistic regression modeling was used to predict AIS grade with G-CSF administration and time variable (first day and a 3-month follow-up). The IDs of the studies as well as the time series variable were imported to the random part of the model. Odds ratio (OR) and 95% confidence interval (CI) were reported.

A total of 277 samples were studied. A fixed effect model was performed at first. Accordingly, using G-CSF was associated with increased AIS grade (lower impairment) (OR=1.503, 95% CI=1.110-2.035) adjusted with time series (OR=1.868, 95% CI=1.378-2.532). In the mixed effect model, G-CSF was again associated with increased AIS grade (OR=1.780, 95% CI=1.301- 2.436) adjusted with time series (OR=2.152, 95% CI=1.406-3.294).

The present meta-analysis showed the protective effect of GCS-F observed as an improvement in AIS grade. This protecting effect was further after adjusting the random effects of time series and individual studies. Although multilevel modeling could reduce our limitations, it should be regarded that the number of trials was not enough to establish strong conclusions.

Improvement of neurological disorders in patients with incomplete spinal cord injury (SCI) remains an important issue worldwide. This study aimed to explore the outcomes and complications of patients with incomplete SCI in the thoracolumbar region within one year after trauma.

Methods and Materials/Patients:

 In this longitudinal prospective study, patients with traumatic incomplete SCI were studied. The demographic and clinical variables including age, sex, site of injury, motor force, sensory disorder, and sphincter dysfunction were recorded on admission and 3, 6, 9, and 12 months after discharge. SPSS software, version 28 was used for data analysis.

Out of 120 patients with incomplete SCI, 100 patients were included. The mean age of the participants was 32.39±7.47 years and the mean duration of hospitalization was 14.78±3.81 days. The most common injury site was T12-L1 (43%). Over time, the average motor force of patients increased. The lowest and highest averages were observed during hospitalization and 12 months after discharge,
respectively. No significant difference was observed in the paired comparison of motor force at 3, 6, 9, and 12 months after discharge. The frequency of sensory disorders decreased over time. The highest and lowest frequencies belonged to the hospitalization time (81%) and 12 months after discharge (9%). No significant difference was observed between the time intervals of 6, 9, and 12 months, as well as
the time of hospitalization and discharge. Over time, the frequency of sphincter dysfunction decreased. Pulmonary infection (12%) and bed sores (9%) were the complications observed during hospitalization. Complications observed 12 months after admission were bed sores (21%) and venous thrombosis (17%).

The highest recovery rate of motor force was recorded within the first three months. The frequency of sensory and sphincter disturbances in patients decreased over time with the highest recovery rate during the first six months after the injury.

Over the past 2 decades, endoscopy has become an integral part of the surgical repertoire for pituitary procedures and over the past several decades, the endoscopic endonasal trans sphenoidal approach (EETA) has gradually become an accepted option for pituitary tumors with intra-,supra-,and para-sellar location and extension, because of its minimal invasiveness and high efficiency. Over the past several decades EETA offers improved illumination and superior panoramic visualization of the sella and the surrounding structures. Compared with traditional sub labial or trans septal microscopic approach, EETA offers minimal invasiveness, fewer complications, and overall improved outcomes. However, some EETA operations are performed through one nostril (mononostril endoscopic Trans sphenoidal approach [META]), while other EETA operations are performed through both nostrils (binostril endoscopic Tranchr(chr('39')39chr('39'))s sphenoidal approach [BETA]) and recently through one and a half nostril approach [OETA]. Both of these three approaches have some pros and cons.The real aim of this study is to compare between 3different EETAs from pros and cons viewpoint of these three approaches and some comparison between traditional microsurgery (microscopic trans sphenoidal approach) and transcranial approach and EETA in pituitary adenoma.

To provide up-to-date information on these three approaches, we concisely reviewed these three approaches and their pros and cons. Using the keywords, neuroendoscopy, META ,OETA , BETA ,pituitary adenoma,EETA,endoscopy, pituitary surgery, trans sphenoidal approach, binostril, mononostril, one and a half nostril, transcranial approach for pituitary adenoma, microscopic trans sphenoidal approach all the relevant articles were retrieved from Google Scholar,PubMed,and Medline reviewed, and critically analyzed.

Because of maneuverability of instruments and a wider view in the sphenoid sinus, the binostril technique is superior for resection of large tumors with parasellar and suprasellar extension and tumors requiring extended approaches. The mononostril technique is preferable for tumors with limited extension in the intra- and suprasellar area. Limitations to the mononostril approach may be as following: a crowded narrow nasal cavity, a harder tumor with invasive appearance or significant suprasellar extension, and lesions other than pituitary adenomas. The mononostril surgery may then be simply turned into a binostril, wider and more dynamic approach to allow for better dissection of such larger, harder, and more extensive tumors. However, we believe that these limitations resolve with changing in the lens of endoscope and some maneuver in creation of visual field in nasal cavity and transsphenoidal rout. The one-and-a-half nostril endoscopic trans sphenoidal approach is a simple and reliable technique. It provides not only a sufficient surgical corridor for a 2-surgeon/4 or 3-hands technique, but also ensures minimal invasion of the nasal canal.Its clinical results with respect to surgical outcome, maneuverability of instruments, postoperative morbidity, and postoperative quality of life support the theory that this is a highly efficient technique.

Based on the results of this study for selecting suitable EETA as META or BETA or OETA, the size and consistency of tumor,general versus invasive pituitary adenoma, and the extent of parasellar and suprasellar extension are important and transcranial approach is effective when resection becomes necessary for a portion or all of a pituitary macroadenoma that is judged to be inaccessible from the transsphenoidal route and looks like microscopic transsphenoidal approach is suitable for pediatrics pituitary adenoma, but for more reliable conclusion further studies are needed to prove this more conclusively.

Animal-vehicle accidents are a growing concern in many parts of the world not only because of its environmental consequences but also because of its economic and social costs. The purpose of this study was to investigate the epidemiology of accidents involving animals in Northern Iran.

In this retrospective cross-sectional study, the data of all animal-vehicle accidents which had occurred during 2014–2018 were obtained from the traffic police database.

According to the regression model, fatalities and injuries associated with animal-vehicle collisions on main roads were significantly lower than those on the secondary and rural roads (P < 0.001). The reports showed a significantly lower number of accidents on wet, slippery than the dry roads (P < 0.001).

This study reports on the high number of accidents involving animals in Guilan which lead to injuries and fatalities of both humans and animals. Importantly, the pattern of such accidents was found to be different from that of motor vehicle collisions, suggesting a model for changing human behavior and reducing accidents that involve animals.

Previous studies have reported the important effect of age, sex, heredity, and occupational status on intervertebral degenerative dick diseases, which are among the most important causes of low back pain. However, their results are not always so conclusive. This study was performed to investigate the demographic characteristics and family history of lumbar problems in patients with lumbar degenerative dick diseases due to causes other than acute trauma.

Methods and Materials/Patients: 

This cross-sectional descriptive study included patients without acute trauma who were candidates for surgery of lumbar degenerative dick diseases from 2017 to 2018 in the only state hospital admitting these patients in Rasht, Iran. The data related to the disease were obtained from the patientschr('39') medical records. Their demographic characteristics and family history of lumbar vertebrae diseases in their relatives were collected using a researcher-made questionnaire through face-to-face interview by the researcher. The data were analyzed using SPSS (Version 16). Descriptive statistics and the chi-square test were conducted at a significance level of 0.05.

More than half of the patients were in their 4th to 6th decades of life, and the number of men was 1.8 times as women. The frequency of herniated discs was more than that of both spinal canal stenosis and spondylolisthesis, and most people had no history of low back trauma. The duration of disease in 73% of the patients was more than 1 year and the mean duration was about 4.5 years. More than half of the patients reported problems with the lumbar vertebrae in at least 1 of their first-degree relatives. About one-third of the patients reported a history of vertebrae surgery in their first-degree relatives and the maximum number of reported surgeries in 1 family was 5. Most of the patients were low-literate and illiterate, and about one-third of the patients were workers/farmers. More than one-third of them were housewives and the number of patients working in administrative and driving jobs was very low. There was no significant relationship between study variables and the type of degenerative problems of the lumbar vertebrae.

These findings showed similarities with previous studies in terms of age groups, occupational status, and a history of family lumbar problems in patients with lumbar degenerative disc diseases.

Diagnosing the status of the posterior ligament complex (PLC) plays an essential role in the management of patients with thoracolumbar fractures. In this study, due to the inefficiency of existing imaging modalities in the accurate detection of PLC damage, we investigated the relevance of some imaging parameters to specific guidelines for rapid PLC injury detection.

Methods and Materials/Patients: 

In this study, 50 patients with and 50 patients without PLC injury were included. MRI, CT scan, and radiographic imaging of the thoracolumbar spine (T12-L1) were evaluated. The thoracolumbar injury classification systems such as Denis, TLICS (Thoracolumbar Injury Classification and Scoring System), and McCormack Load Sharing and radiographic parameters such as Superior Inferior Endplate Angle (SIEA), Body Height (BH), Local Kyphosis (LK), Interspinous Distance (ISD), and Interpedicular Distance (IPD) were investigated in these patients for each imaging method. Statistical analysis was performed using SPSS (Version 21).

The ISD and LK and BHp (Body Height Posterior) were significant predictors of PLC injury. On radiographs, the mean LK with and without PLC damage was 25.67° and 20.92°, respectively (p<0.001). The ISD difference was 6.75 mm in cases with PLC damage and 2.84 mm in cases with an intact PLC (p<0.0001). In CT images, the mean LK was 25.77° in cases with PLC damage and 18.63° in cases with an intact PLC (p<0.037). The ISD difference was 4.14 mm in patients with PLC damage and 2.19 mm in patients without PLC damage (p<0.002). The BHp difference was 9.44 mm in cases with PLC damage and 11.09 mm in cases without PLC damage (p<0.002).

The current study suggests formulating a predictive radiological index to identify PLC injury successfully. These guidelines can be very helpful in emergency room decision-makings, especially when the cost, availability, and time of performing MRI are important concerns in patients with multiple trauma.

Nonspecific chronic neck pain is increasing according to work-related gestures and modern lifestyle. Myofascial pain syndrome is a common problem and may be a primary disease. This study was designed to evaluate the prevalence of cervical myofascial pain syndrome in patients with chronic non-specific neck pain with normal MRI. We also examined the correlation between patients’ age as well as pain severity and duration. Patients with neck pain radiating to their upper extremity were examined despite normal MRI findings. We evaluated 10 different muscles based on myofascial pain syndrome criteria and also recorded pain intensity and functional ability using visual analogue scale and neck disability index, respectively. A physical therapist with at least 10 years of clinical experience with myofascial pain syndrome performed all physical examinations A total of 126 patients (69 females and 57 males) participated in this study, out of whom, 14 patients (11.1%) had no muscular involvement, while 112 cases (88.9%) revealed at least one trigger point. The infraspinatus and scalene muscles were the most commonly involved muscles accounting for 38.9% and 34.9% of all the involvements, respectively. The severity of pain was significantly associated with the disability of the patients (r=0.64, P<0.001). However, the correlation between pain and the number of trigger points was not significant (r=-0.19, P=0.31). Finally, the least significantly correlated variables were disability and the number of trigger points (r=-0.17, P=0.05). Patient’s age was significantly correlated neither with the number of trigger points (r=-0.04, P=0.62), nor the pain duration (r=0.07, P=0.39). Myofascial pain syndrome is a common disorder in patients with nonspecific chronic neck pain, despite normal MRI findings. Although, pain is not correlated with the number of trigger points in these patients, we demonstrated a small correlation between patients’ disability and the latter variable. Level of evidence: II

The Disability Rating Scale (DRS) is a short, efficient, and rapid instrument for assessing levels of functional disability, but little information is available on the translation and psychometric properties of its Persian version, especially for traumatic brain injury (TBI) patients. The aim of this study was to translate and adapt the Persian version of DRS and to determine the psychometric properties of the Persian version of this scale in patients with TBI.

In this analytical cross‑sectional study, 191 TBI patients(age range, 16–86 years) referred to the physiotherapy Center of PourSina Hospital in Rasht, Iran, were selected through census sampling. First, the DRS was translated into Persian, and then, the validity, reliability, and repeatability of DRS scores were evaluated. All patients were evaluated on admission and at discharge through the Glasgow Coma Scale (GCS) and Functional Independence Measure (FIM).

According to the reports of the translators, translation of the DRS into Persian language was easy. The quality of translation (including translation clarity, common language usage, conceptual equivalence, and overall quality of translation) was generally favorable. Inter‑raters’ reliability on admission and at discharge stages was excellent (intraclass correlation coefficient = 0.93–0.94). Cronbach’s alpha values for the internal consistency of DRS on admission and at discharge stages were 0.96 and 0.97, respectively. The results showed a strong inverse relationship of DRS scores on admission and at discharge with GCS and FIM scores (in all cases more than 0.70, P < 0.0001).

The validity, reliability, and repeatability of the DRS scores for the Persian version were confirmed. These results reflect that DRS can be used to determine the effects of therapeutic/rehabilitation interventions on levels of functional disability in Iranian patients with TBI.

TBI, standing for Traumatic Brain Injury, is a leading cause of death worldwide; nonetheless, data on its management has hitherto been sparse. In view of the fact that brain lobectomy is a contentious issue in the management of TBI, we set out the currentstudy to assess the mortality rate and outcomes of TBI with delayed contusion or Intracerebral Hemorrhage (ICH) undergoing lobectomy.

We evaluated 135 TBI patients with delayed contusion or ICH undergoing brain lobectomy from 2001 to 2013. Withal, the mortality and Glasgow Outcome Scale (GOS) and Glasgow Comma Scale (GCS) rates were assessed in these patients and the association in between was sought.

The TBI patients undergoing brain lobectomy (77% male versus 23 % female) had a mean age of 43.4±20.3 years and experienced a survival rate of 62.2% (71% in females versus 60% in males). Favorable GOS was observed in 53% of male patients, compared with 27% in the females. Age was demonstrated to significantly affect the mortality rate (p=0.0001). Initial GCS score was associated with GOS as 79.1% of the survived patients with a GCS of higher than 9 on admission were discharged with favorable GOS.

The evidence from the present study indicates that lobectomy can be an acceptable surgical procedure in management of TBI patients with delayed contusion or ICH.

 The relationship between weight indices and injuries and mortality in motor vehicle accidents is unknown. Systematic review studies addressing the collection and analysis of the re-lationship in investigations are very limited. The purpose of this systematic review is to determine the relationship between BMI, obesity and overweight with mortality and injuries and their severity and vulnerable organs after the motor vehicle accident.

 The databases (MEDLINE/PUBMED, EMBASE, Web of Science, etc) were searched for relevant abstracts using certain keywords. Of all the articles, similar ones were removed consid-ering different filters. The collected data were entered into the STATA SE v 13.1. The heteroge-neity of the data was analyzed using i2 statistics. In addition, the estimates of the study were done based on the age group (children and adults) and the impact of obesity on different regions of the body.

 A direct relationship was observed between the overall BMI and the degrees of injuries (CI=0.503-1.139), and mortality due to motor vehicle accident (CI=1.267-1.471). A positive re-lationship was found between obesity and AIS+2 (CI=0.653-1.426), and AIS+3 (CI=1.184-1.741), and ISS (CI=1.086-1.589).
Also, a negative relationship between overweight and injuries rates, and a direct relationship between overweight and mortality (CI=0.979-1.167), and injuries with index of AIS+2 (CI=1.178-0.768) and AIS+3 (CI=0.48-2.186) were found.

 The prediction of injury, mortality and severity of injuries in the motor vehicle acci-dent by the variable of obesity and overweight determines the need to design prevention pro-grams for this vulnerable group at all levels.

Vascular malformation as a cause of cubital tunnel syndrome has not yet been reported. Cubital tunnel syndrome (CuTS), the most common entrapment neuropathy of the ulnar nerve at elbow level, is also the second most common entrapment neuropathy in the upper extremity, regardless of carpal tunnel syndrome. Here, we report CuTS due to vascular malformation in a 63-year-old woman. The ulnar nerve at the distal part of tunnel was markedly compressed. There was no connection between the lesion and the ulnar nerve. The diagnosis was made by using histopathology, and thereafter the lesion was fully resected. Pain in her ring and little fingers disappeared one month after resection of the malformation.