shahrokh yousefzadeh-chabok

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.

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.

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.

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.

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.

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.

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.

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.

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.

Early and sufficient nutritional support is vital to improve outcomes in patients with traumatic brain injury. This study aims to determine the effects of dietitian involvementin the nutritional and clinical outcomes inpatients with traumatic brain injuries admitted tothe neurosurgical ICU.

Forty-eight male patients with traumatic brain injuries admitted to Poursina Hospital neurosurgical ICU were studied, retrospectively. Patients were divided to either receive dietitian intervention or without any nutritional recommendation(control). Demographic information, Glasgow Coma Scale and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, the timing of initial enteral feeding, the amount of energy and protein intakeon day 4, the duration of mechanical ventilation and ICU length of stay were recorded.

Patients under the dietitian recommendation had significantly lower timing of initial enteral nutrition compared to the other cases (P=0.02). The average energy or protein intake and the percentage of target energy or protein intake on day4 appeared to be significantly lower in the subjects in the control group than in those with nutritional intervention(P≤0.001). There was no statistically significant difference in the duration of mechanical ventilation and ICU length of staybetween different groups of patients.

Instead of occasional consultations for exclusive cases, the daily attendance of dietitians during multidisciplinary rounds of ICU is required to assess the nutritional needs of patients.

Self-medication is the use of drugs which have not been prescribed by health professionals. It is considered an important issue especially in developing countries because of side effects of irrational use of drugs and economic burden of disease. This study aim to analyze the prevalence of self-medication in Iran by provinces and socio economic and demographic factors that affect it. Data of Iranian household income and expenditures survey (HEIS) in 2016 (source Iranian Statistical Center) was used in this study. Multilevel mixed effect regression was used to find relation between explanatory variables and self-medication ratio. STATA SE v 14 was used to perform the analysis. the results of this study showed that income (coefficient = - 0.00286) and socioeconomic status had negative significant relationship with self-medication ratio, while self-medication ratio was higher in some provinces like Ardebil, Sistan va Baluchistan and Ilam and it was lower in some provinces like Khuzestan and Kurdistan. The prevalence of self-medication among Iranian people was relatively high and this ratio varies in provinces. In addition to promote population awareness about undesirable effects of the irrational drug consumption, developing strategies for drug consumption by improving prescribing pattern, OTC drugs and also increasing inspection of pharmacies is needed.

The aim of this study was to assess the pre-hospital emergency services, non-surgical interventions, and clinical outcomes in patients with traumatic spine referred to Poursina hospital in Guilan.
Methods and Materials/Patients: Spine trauma registry of Poursina hospital of Rasht were used. Records of patients with traumatic spine were reviewed for pre-hospital emergency services, non-surgical interventions, and clinical outcomes during 2015 to 2019.

197 patients with traumatic spine were reviewed. 80.2% of the patients were transferred by ambulance. Pre-hospital fixation was performed in 59.4% of the patients (n=117). Pre-hospital intubation was required in 1% of patients (n=2). 4.6% of the patients had Glasgow Comma Scale (GCS) <9; 3% of them (n=6) had 9< GCS<12; and 92.4% had GCS≥13. 11.7% of the patients experienced SCI. 6.1%, 1%, 3%, 0.5%, and 1% of the patients suffered from paraplegia, paraparesis, quadriplegia, quadriparesis, hemiparesis respectively. Surgery was performed in 89.8% of the patients. Traction was performed for 3.6% of the patients. Good recovery, moderate disabilities, severe disabilities, persistent vegetative state, and death were found in 85.8%, 2%, 5.1%, 1.5%, and 2.5% of the patients, respectively, according to Glasgow Outcome Scale.

Most of the patients were transferred to the hospital by ambulance. Pre-hospital fixation was required in more than half of the patients. Most of the patients showed GCS≥13 and a good recovery outcome, according to GCS.

Spinal cord injury (SCI) is one of the main causes of severe disability and mortality following trauma. Complications and outcomes of patients with spine trauma, especially those who undergo surgery, are a less divulged topic in Iran. Therefore, we designed the present study to evaluate complications and outcomes of patients with traumatic spine in Poursina hospital of Rasht.
Methods and Materials/Patients: In the present cross-sectional study, we referred to registry of spinal cord injuries of Poursina Hospital, which is a referral center for trauma in Rasht in the north of Iran. We investigated records of all the patients with traumatic spine confirmed by Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI) during 2016-2018. Demographic data, types of SCI, types of surgical interventions, time from injury to surgery, number of fixed and fused vertebrae, complications, and outcome (based on Glasgow Outcome Scale (GOS) criteria) of the patients were evaluated upon discharge.

In total, records of 274 patients with spine trauma were reviewed. The mean±SD of age of the patients was 42.27±16.83 years. There were 76 women (27.7%) and 198 males (72.3%). Surgical interventions were done for 148 patients (54%). The median of time of surgical interventions for displacement of the vertebrae and the median of time for removal of pressure from spinal cord in the patients were 5 hours (range =82 hours). Median of duration of hospital stay was 2 days (range =167 days). 2.2% of the patients experienced complications. 85% of the patients showed good recovery according to GOS.

The evidence from the present study indicates that approximately half of the patients with spine trauma underwent operation. Good recovery was seen in roughly four fifth of all of the patients with spine trauma. Most of the patients had no complications during their stay in the hospital.

Considering the role of Intracranial Pressure Amplitude [AMP(ICP)] in evaluating the rate of craniospinal compliance (CC) and intracranial pressure (ICP) and in estimating the degree of brain damage, the aim of the present study was to evaluate the correlation of AMP(ICP) with the degree of brain damage in patients with traumatic brain injury (TBI).

Thirty-four patients were enrolled in the present study. Patients underwent intraventricular ICP monitoring. During the first 24 hours, AMP(ICP) was recorded every hour, and its total mean was calculated. Correlation of AMP(ICP) and Glasgow outcome scale (GOS) was analyzed.

There was a negative correlation between mean AMP(ICP) within 24 hours and GOS values on the first, third, and sixth month (r = -0.476, -0.563, and -0.627, respectively).

The findings of the present study suggest that AMP(ICP) index can determine GOS in patients with TBI.

Spine trauma is an important health problem. Traumatic spinal cord injury (SCI) due to motor vehicle accident (MVA) might have a different epidemiologic pattern in Guilan province of Iran owing to its geographical characteristics. Therefore, the present study was conducted to the study epidemiology of SCI injuries due to road accidents in a trauma referral center in Guilan.

In this cross-sectional study, we used data SCI registry of Poursina Hospital. All the patients with spine trauma, due to MVA, hospitalized in the trauma center of Poursina Hospital, Rasht, Guilan, Iran between March 2015 and March 2018 were studied.

A total of 127 patients with spine trauma due to MVA were reviewed. The mean±SD age of patients was 38.27±16.22 years. We observed that 93.7%, 1.6%, and 4.7% of the patients had initial Glasgow Comma Scale (GCS≥13, 9≤GCS≤12, and GCS<9, respectively). SCIs were found several anatomical regions including cervical (n=54, 42.5%), lumbar (n=39, 30.7%), thoracic (n=23, 18.1%), thoracic and lumbar (n=7, 5.5%), thoracic and cervical (n=3, 2.4%), and lumbar and cervical (n=1, 0.8%) regions. Evaluated by Glasgow Outcome Scale (GOS), good recovery, moderate disability, severe disability, vegetative state, and death were found in 114 (91.2%), 4 (3.1%), 4 (3.1%), 1 (0.8%), 2 (1.6%) of the patients, respectively. Two patients were discharged by their personal contest.

Spine trauma due to MVA is mostly seen in the young. SCI due to such trauma is mostly found in the cervical region. Good recovery was seen in most of the subjects.

Traumatic spinal cord injury (SCI) is one of the most traumatic events threatening patients’ well-being and places a financial burden on health care system. The first step in determination of the exact impact of SCI is to estimate the pattern of traumatic injuries in a population and also the type of frequently occurred co-injuries. Hence, this study was conducted to assess the frequency of anatomy, type of spine injuries, and associated co-injuries in patients with trauma in Poursina Hospital of Guilan province in Iran.

A descriptive cross-sectional study was carried out on traumatic spine patients admitted to the Poursina hospital of Rasht, a referral therapeutic center for trauma in north of Iran, in Rasht during 2015 to 2019. Data were extracted from the SCI registry of Poursina Hospital, Rasht, Guilan, Iran.

A total of 274 records were reviewed. Seventy-six patients were females and 198 patients were males. Mean±SD of age of the patients was 42.27±16.83 years. Based on this survey, most of the patients (43.8%) had SCI in lumbar region. Locked facet was seen in 12 patients. Fifty-seven patients (20.8%) complained about having pain. The median of VAS score was 6 (range=6). Co-existence of associated injuries (e.g. limb fractures, TBI, Internal bleeding, etc.) was found in 27.4% of the patients. According to ASIA (The American Spinal Injury Association) impairment scale, three patients (2.9%) had score A, and 100 patients (97.1%) had score E neurological defects.

The most telling reiteration to be drawn is that men mostly suffered from spine trauma. Lumbar region was the most susceptible location of SCI. Moreover, most of the patients experienced score E (normal neurological charcteristics) according to ASIA.