Archives of Trauma Research
Volume:13 Issue: 2, Apr-Jun 2024

Trauma is the sixth cause of death worldwide and the fifth main cause of significant disability and carries a great economic and social burden. This study was carried out to investigate the epidemiological and clinical characteristics of trauma and to assess the correlation between the cause of trauma and its severity in different body areas. Patients with all kinds of injuries referred to the Emergency Department (ED) of Al-Zahra University Hospital in Isfahan, Iran, who met the inclusion criteria, were recruited to this study from September 2019 to January 2023. Among the 869 trauma patients admitted to the hospital during this period, 444 (51.1%) were married. There was a statistically significant difference in the pattern of trauma between males and females (P = 0.003). There was also a significant relationship between the average age of people and different causes of injury (P <0.001). Individuals who suffered from falling from height (FFH) trauma had a significantly higher average age than those who experienced trauma due to different reasons. There was a statistically significant difference between the injury patterns to different parts of the body according to the cause of injury (P <0.001). The most common causes of trauma were road traffic crashes (RTCs) (60%), FFH (18.4%), and poisoning (12.7%). Of the 520 victims with RTC injuries and 160 victims with FFH injuries, 39.4% and 52.5% respectively have an abbreviated injury scale (AIS) severity greater than 3, which was higher than other traumatic mechanisms. Falls and car accidents were identified as the primary causes of severe injuries with AIS > 3, according to our findings. These research endeavors will aid in devising improved methods to prevent occurrences and enhance healthcare approaches. To prevent and manage traumatic injuries, a multi-sectoral approach and collaboration between different stakeholders is needed.

Traffic accidents are one of the most important factors contributing to the deaths and injuries of humans around the world. One of the factors causing traffic accidents is hotspots, which increase the possibility of crashes occurring due to the kind of path geometry. One of the ways of preventing crashes and increasing drivers' caution is to utilize technologies such as a hotspot warning system.
In this study, the impact of this system on narrowing the road was examined on the drivers' behavior in both clear and foggy weather.
This experimental study was performed on a simulator with 40 drivers, including men and women. The warning system is an audio and visual kind, so a hotspot was shown in the path of the map on the system screen, and the driver received an alarm. The range in this scenario includes prewarning, from a warning to the onset of a hotspot, a hotspot zone, and after-warning. Data were analyzed using SPSS software version 20, and the significant level of tests was considered 0.05.
The results indicated that a hotspot warning system could affect the drivers' performance, and this effect was observed in variables including speed, steering angle, deceleration, and gas pedal performance. Moreover, the driver's behavior was significant in both clear and foggy weather.
These findings can be used to correct the warning locations and times in the hotspot warning systems when approaching a narrow road.

No bibliometric analysis is available in emergency medicine in the field of trauma.
To evaluate the bibliometric parameters of the articles in the field of trauma published in emergency medicine (EM) journals and perform machine learning-based analyses, including current approaches, variability in the subject selection, and impact power and sentiment analysis of publications in this field.
We searched for articles published in EM journals by searching the SCOPUS database with the keyword "trauma" between January 1, 2012, and December 31, 2021. We created the database of the study from the bibliometric parameters of these articles. We downloaded the study data to the artificial intelligence database using computer programs and performed the analysis.
We included 8528 articles contributed by 33572 authors. The most used keywords were trauma (n=1887), mortality (n=285), and injury (n=269). Trend topic: delinquency, pulmonary contusion, and NF-κB at the beginning of the study, recently COVID-19, pandemic, and coronavirus. In correlation analysis, we found a correlation between the number of citations and the author's h-indexes (r=0.916, p=0.001), between the number of citations and the number of articles (r=0.698, p=0.001), between the number of articles and the year (r=0.921, p=0.001), between the number of articles and the total number of citations per article (r=-0.909, p=0.001), and between the number of articles and year (r=0.921, p=0.001). We found that EPs had negative sentiments about trauma (n=6435, 75.46%).
This study includes a cross-sectional review of trauma publications in EM and offers EPs a new perspective on trauma studies.

Patellofemoral pain syndrome (PFPS) is one of the common causes of anterior knee pain in young people. This study investigated the length difference of lower limbs in patients with PFPS syndrome. In this descriptive cross-sectional study, the difference in the length of the lower limbs of patients in the supine position was assessed using five different clinical methods. These five methods included: 1- the measurements of the actual length of the lower limb, 2- the apparent length of the lower limb, 3- the method of Iliac Crest Palpation and Book Correction (ICPBC) under the short leg of the patient, 4- evaluation of the internal ankles, and 5- bilateral anterior superior iliac spine (ASIS). Data were analyzed using the SPSS software. Nearly 60% of the patients with PFPS felt pain in both knees. The average actual length difference of the lower limbs in patients was 7.00±4.04 mm. Moreover, 75% of the patients had a limb length difference of more than 4 mm. There was no significant difference in the actual length of the limbs regarding age, BMI, employment status, and history of underlying diseases. However, these factors were significantly higher among women than men (p=0.047). Moreover, the results showed that the average length of limbs was significantly lower among patients who exercised during the week (p=0.015). Measurement of lower limb length had moderately correlated using two methods of actual limb length and ICPBC (p=0.001, Kappa=0.421) and two methods of apparent limb length and medial ankle (p=0.032, Kappa=0.317). The difference in lower limb length was more than 4 mm in most patients (75%). Furthermore, in most patients with knee pain on the left side (unilateral/bilateral left more severe), their right side was short and vice versa.

The alarming rise of resistant microorganisms is becoming a serious health threat today. Consequently, there is a pressing need to obtain novel compounds with antimicrobial properties.  In this regard, lichens are promising substances with antimicrobial potential to control different microbial strains, including fungi, gram-positive and gram-negative bacteria, and viruses.  
This study explores the efficacy of Dermatocarpon miniatum in treating burn wound infections. We examined twenty-four Methicillin-Resistant Staphylococcus aureus (MRSA) isolated from patients admitted to Imam Moussa Kazem Hospital of Isfahan, Iran.
We assessed the antibacterial activity of D. miniatum against MRSA using the microdilution broth method.  Biofilm inhibitory was evaluated through microtiter plate technique. Additionally, the effect of D. miniatum on the icaA gene expression was analyzed via real-time PCR. 
The methanolic extract of D. miniatum exhibited significant antibacterial activity against MRSA strains. Additionally, at a concentration of ½ MIC, the extract demonstrated a 65% inhibition of biofilm formation. Moreover, a sub-MIC concentration (1/4) of D. miniatum was effective in reducing the expression of the icaA gene.
The results of the present study reveal that D. miniatum extract can be used as a promising antibacterial agent against MRSA strains commonly found in wound biofilms.

Methamphetamine (METH) is one of the most popular drugs used by drivers. Recent research has indicated an increase in the utilization of amphetamine-type stimulants over the past 15 years.

The purpose of this study was to assess the prevalence of amphetamine use among fatally injured motorcyclists in the world.

All available databases including PubMed, Scopus, Wos, Google Scholar, Magiran, and SID were searched to locate published studies up to the year 2023. Heterogeneity among the studies was tested by Q-Cochran with a significant level below 0.1. The researcher assessed the Index of changes ascribed to heterogeneity (I2). Due to the heterogeneity of studies, the random-effects model was applied to integrate the results of the studies, and a 95% CI was reported. Meta-analysis in STATA 14SE was used to perform statistical analyses.

Out of a total of 222 articles that met the inclusion criteria, seven studies were examined and analyzed. The prevalence of amphetamine uses among motorcyclists who have been fatally injured was %14 (95%CI = 0.08-0.20) in the world. This result demonstrates that almost no study has documented mortality associated with amphetamine use among motorcyclists in developing countries.

Early-stage recognition and identification of motorcyclists who use amphetamines and other drugs is necessary. Furthermore, the development of educational campaigns to promote knowledge specific to that particular population is imperative. To reduce the possibility of relapsing and improve traffic safety, motorcyclists who experience difficulties resulting from amphetamine use must participate in specialized programs, treatment, psychological counseling, and rehabilitation.

Traumatic brain injury (TBI) is a significant cause of morbidity and mortality worldwide. Cognitive impairments following TBI are the most disabling and prevalent after-effects. These impairments have substantial and lasting implications on an individual's daily functioning and quality of life. In the acute and chronic phases after TBI, they can affect various cognitive domains, including attention, executive functions, learning and memory, language, perceptual-motor function, and social cognition. The significance of these cognitive deficits is underscored by their association with difficulties in vocational reintegration, social interactions, and overall independence. Furthermore, the long-term consequences of TBI-related cognitive deficits extend to increased risk for mood disorders. Addressing these challenges necessitates practical assessment and management. Comprehensive neuropsychological assessments play a pivotal role in diagnosing and characterizing cognitive deficits. In addition to medication, cognitive rehabilitation therapy suggests using rehabilitation methods such as cognitive training, compensatory strategies, and assistive technologies. By recognizing the substantial impact of cognitive impairments post-TBI and implementing evidence-based techniques, clinicians and caregivers can optimize recovery and enhance the quality of life for those affected. This article aims to provide an overview of the epidemiology, pathophysiology, assessment, rehabilitation approaches, and challenges of cognitive impairment in patients with TBI.

Traumatic brain injury (TBI) is a leading cause of morbidity and mortality worldwide, characterized by a complex cascade of pathophysiological events that can result in diverse clinical outcomes ranging from mild cognitive impairments to severe disability. The pathophysiology of TBI involves a complex interplay of cellular and molecular events that contribute to secondary brain injury and neurodegeneration. Predicting neurological outcomes in TBI patients is crucial for guiding treatment decisions and enhancing patient care. Traditional methods of assessing TBI severity and prognosis have limitations in accurately predicting long-term outcomes. In recent years, microRNAs (miRNAs) have emerged as promising biomarkers for evaluating TBI severity and prognosis. MicroRNAs are small non-coding RNA molecules that regulate gene expression and have been implicated in various physiological and pathological processes, including neurodevelopment, neuronal function, and neurodegeneration. Several studies have identified specific miRNAs as potential biomarkers for assessing TBI severity and predicting patient outcomes. MiR-21, miR-155, miR-146a, and miR-124 are among the most studied miRNAs in the context of TBI biomarkers. Elevated levels of these miRNAs in blood, cerebrospinal fluid, and brain tissue have been associated with TBI severity, neuroinflammation, and poor neurological outcomes. Understanding the role of miRNAs in TBI pathophysiology can provide valuable insights into the mechanisms underlying neuroinflammation and neurodegeneration. Furthermore, miRNA signatures have shown promise in distinguishing between different TBI phenotypes, such as mild, moderate, and severe TBI, and predicting long-term cognitive deficits and functional impairments in TBI survivors. This suggests that miRNAs could serve as valuable tools for improving TBI patient care and outcomes.[1,2] Role of miRNAs in TBI PathophysiologyMicroRNAs play a crucial role in modulating neuroinflammatory responses and neurodegenerative processes in traumatic brain injury. Dysregulated expression of specific miRNAs contributes to secondary brain injury, neuronal apoptosis, neuroinflammation, blood-brain barrier disruption, neurodegeneration, and cognitive impairments following TBI.[2]Neuroinflammation is a hallmark feature of TBI, characterized by the activation of microglia, astrocytes, and peripheral immune cells in response to brain injury. Dysregulated expression of specific miRNAs has been implicated in modulating neuroinflammatory responses following TBI. For example, miR-155 has been shown to promote microglial activation and pro-inflammatory cytokine production, exacerbating neuroinflammation and neuronal damage. In contrast, miR-146a acts as a negative regulator of inflammatory signaling pathways, attenuating neuroinflammatory responses and promoting neuroprotection in TBI models. The dynamic interplay between miRNAs and inflammatory mediators in the injured brain highlights the intricate regulatory mechanisms underlying neuroinflammation in TBI.[3]Neuronal cell death and neurodegeneration are other common pathological features of TBI, contributing to long-term cognitive impairments and functional deficits. Dysregulated expression of miRNAs has been associated with apoptotic cell death, synaptic dysfunction, and axonal injury in TBI. MiR-21, for instance, has been shown to promote neuronal apoptosis and glial scar formation following brain injury, exacerbating neurodegenerative processes. In contrast, miR-124 plays a neuroprotective role by regulating neuronal differentiation, synaptic plasticity, and axonal regeneration in response to TBI. The complex interplay between miRNAs and neurodegenerative pathways underscores their potential as therapeutic targets for mitigating neuronal damage and promoting recovery after TBI.[3]Targeting dysregulated miRNAs represents a promising therapeutic strategy for modulating neuroinflammation and neurodegeneration in TBI. MiRNA-based interventions, such as antagomirs or mimics, offer potential avenues for restoring miRNA homeostasis and promoting neuroprotective effects in the injured brain. Future research efforts should focus on identifying specific miRNA targets involved in TBI pathophysiology, elucidating their functional roles in neuroinflammation and neurodegeneration, and exploring innovative therapeutic approaches for TBI management. Collaborative initiatives between researchers, clinicians, and pharmaceutical companies are essential for translating miRNA research into clinical applications and improving outcomes for TBI patients.[4] MiRNA Biomarkers for Predicting Neurological RecoveryThe utilization of miRNA biomarkers in clinical practice holds the potential to revolutionize prognostication and treatment decision-making in TBI. By pinpointing specific miRNA signatures linked to neurological outcomes, clinicians can categorize patients based on their likelihood of developing complications, cognitive impairments, or disability post-TBI. Numerous studies have documented distinct expression patterns of miRNAs in TBI patients with varying levels of cognitive impairment, functional disability, and neurobehavioral deficits. MiR-21, miR-146a, and miR-132 have emerged as promising biomarkers for forecasting neurological recovery and functional outcomes in TBI. The integration of miRNA profiles with clinical evaluations and neuroimaging data has the potential to enhance the precision of outcome predictions and facilitate personalized treatment approaches for TBI patients. Further research is imperative to validate miRNA signatures, establish standardized protocols for miRNA profiling, and implement predictive models that amalgamate clinical, imaging, and molecular data to enhance prognostication and treatment strategies for TBI patients. Future research endeavors should prioritize the validation of miRNA biomarkers in extensive prospective cohorts, elucidate their mechanistic roles in TBI pathophysiology, and incorporate them into multidimensional prognostic models for tailored patient care. Collaborative initiatives involving researchers, clinicians, and industry partners are paramount for translating miRNA research into clinical applications and enhancing outcomes for TBI patients.[5,6] Challenges and Opportunities for Advancing MiRNA Biomarker in TBIDespite the growing interest in miRNA biomarkers for TBI, several challenges need to be addressed before their clinical implementation. Standardization of sample collection and processing protocols, validation of miRNA signatures in large patient cohorts, and integration of miRNA data with other clinical variables are critical steps towards translating miRNA research into clinical practice. Additionally, the lack of standardized protocols for miRNA profiling and validation poses obstacles to comparing results across different studies. The heterogeneity of TBI phenotypes and patient populations further complicates the identification of robust miRNA signatures predictive of neurological outcomes.[4,5] Despite the challenges, there are promising opportunities for advancing miRNA biomarker research in TBI. Technological advancements in high-throughput sequencing and bioinformatics tools enable comprehensive profiling of miRNA expression patterns in TBI patients. Collaborative efforts among researchers, clinicians, and industry partners can facilitate the validation of miRNA biomarkers in large multicenter cohorts, enhancing their clinical utility. Integrating miRNA profiles with other omics data, neuroimaging findings, and clinical assessments holds potential for developing multidimensional prognostic models for personalized TBI management.[6] ConclusionFuture research directions should focus on standardizing methodologies for miRNA biomarker discovery, validation, and implementation in TBI clinical practice. Large-scale prospective studies are needed to validate miRNA signatures associated with specific TBI outcomes and refine predictive models for patient stratification. Incorporating miRNA biomarkers into existing prognostic tools and treatment algorithms may improve risk assessment, therapeutic decision-making, and long-term outcomes for TBI patients. Collaborative initiatives aimed at translating miRNA research findings into actionable clinical insights are essential for realizing the full potential of miRNA biomarkers in TBI management.