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Objective: During the past few decades, many scoring systems have been developed to evaluate the severity of injury and predict the outcome in trauma patients. This study aimed to assess the capacity of three common trauma scoring systems: injury severity score (ISS), Glasgow coma scale (GCS), and revised trauma score (RTS) in predicting in-hospital mortality and ICU admission in patients with traumatic injury. Methods: This is a multicenter study of the hospital-based national trauma registry of Iran (NTRI), an ongoing registry-based trauma database. This study included trauma cases from 12 major trauma centers throughout the country admitted between July 2016 and November 2023. The inclusion criteria were all patients admitted to the emergency department due to trauma, hospitalized for at least 24 hours, deceased within the first 24 hours of admission, and patients transferred from the intensive care unit (ICU)s of other hospitals. Results: A total of 50,458 traumatic patients, with 38,740 (76.9%) being male, were included in this study. After adjustment for confounders, head, face, and neck injuries were associated with the highest odds of death (OR: 7.51, P-value<0.001), whereas abdominal injuries were associated with the highest odds of ICU admission (OR: 4.58, P-value<0.001). Each Unit increase in RTS score was accompanied by a 61% decrease in odds of death (OR: 0.39, P-value<0.001). The area under the ROC curve for predicting in-hospital mortality was 0.81 (0.79 to 0.82) in ISS, 0.78 (0.77 to 0.80) in GCS, and 0.75 (0.73 to 0.76) in RTS. There was a significant difference between RTS and GCS, aswell as RTS and ISS for in-hospital mortality prediction (P-values< 0.001). The area under the ROC curve for the prediction of ICU admission was 0.75 (0.74 to 0.75) in ISS, 0.63 (0.62 to 0.63) in GCS, and 0.62 (0.61 to 0.63) in RTS. There was a statistically significant difference between ISS and GCS, as well as ISS and RTS, for ICU admission prediction (P-value<0.001). Conclusion: ISS is the best predictor of in-hospital mortality and ICU admission, compared to GCS and RTS. [ABSTRACT FROM AUTHOR]

Objective: The main objective of this study was to determine various characteristics and outcomes of self-harm and suicide in men and women with data obtained from the National Trauma Registry of Iran (NTRI). Method: This retrospective multicenter study using data from the NTRI included all patients who went to the emergency department (ED) due to self-harm and suicide, considering the NTRI's specific inclusion criteria, from September 2016 to January 2023. We evaluated patients regarding demographics and clinical characteristics, various outcomes, and factors influencing in-hospital death. Statistical analyses were conducted using the STATA software version 15.0. The chisquare test was used to compare the distribution of variables between men and women. Also, the logistic regression models were applied to assess the predictors of in-hospital death. Results: Self-harm and suicide cases were gathered from eleven geographically diverse hospitals across the country, and our study included 511 men and 347 women out of 50,661 registered trauma cases. Among them, 443 men (86.7%) and 267 women (76.9%) were between 18 and 49 years old (P < 0.001). Single women constituted 130 (37.3%) of the female cases, while single men were 313 (61.6%) of the male cases (P < 0.001). The three most common methods among our patients were poisoning with 234 (45.8%) of men and 245 (70.6%) of women cases, stab/cut with 208 (40.7%) of men and 54 (15.6%) of women cases, and fall with 16 (3.1%) of men and 26 (7.5%) of women cases (P < 0.001). The risk of death in patients with a Glasgow Coma Scale (GCS) score of 3 to 8 was 46.22 (95% CI = 18.66 to 114.45) times more than patients with a GCS score of 13 to 15. Conclusion: Data on self-harm and suicide traumatology were gathered from eleven hospitals in Iran. Our findings indicated differences in the distribution of age and marital status between genders. Moreover, both genders used similar methods for self-harm and suicide, and gender did not affect the outcome. [ABSTRACT FROM AUTHOR]

Background: Trauma can lead to significant complications and mortality for victims of accidents. Objectives: The present study was conducted to determine the mortality caused by trauma and its related factors. Methods: The present study was conducted using the data available in the Isfahan Trauma Registration System (ITR) and Hospital Information Systems (HIS). The number of 1266 deceased trauma patients who were registered in this system over 18 months (between September 2020 and March 2022) were included in the study and analyzed. Results: Out of 1266 patients who died from trauma, 604 (47.7%) patients experienced early death, 427 (33.7%) delayed mortality, and 235 (18.6%) late mortality. The mechanism and type of trauma, and the pre-impact conditions were significantly different between the three death categories (P<0.05). There was a significant difference in oxygen level (SpO2), heart rate, and respiratory rate at the time of admission and at the time of death between the three categories of mortality (P<0.05). Glasgow Coma Scale (GCS) was a predictor of early, delayed, and late mortality. Injury Severity Score (ISS) was a predictor of delayed mortality and age was also a predictor of late mortality. Conclusion: The present study's results indicate that ISS and GCS are significant prognostic indicators of mortality in trauma patients, warranting greater attention during admission. The combination of GCS and ISS appears to improve the accuracy of outcome prediction, thereby enabling the creation of a novel predictive model. [ABSTRACT FROM AUTHOR]

Background: Recognizing and determining severe trauma is essential for choosing the appropriate treatment strategy. Objectives: The aim of this study was to find the predictive value of the quick sequential organ failure assessment (qSOFA) score for in-hospital mortality in adult trauma patients. Methods: This prospective observational study was conducted on adult patients with multiple trauma presenting to the emergency department. The qSOFA score was calculated according to the initially recorded variables. The primary outcome was in-hospital mortality. The predictive value of qSOFA was evaluated using the Area Under Receiver Operating Characteristic (AUC) analysis. Results: Finally, 775 multiple trauma patients with a mean age of 38.68±18.74 were admitted. Of these, 34 people (4.39%) died and 741 subjects were discharged from hospital. The mean qSOFA score was 0.41±0.64, significantly higher in the survived patients than in the non-survived patients (P < 0.001). The AUC of qSOFA score to predict in-hospital mortality was 0.878 (95% confidence interval: 0.853-0.900); thus, qSOFA was a good predictor of in-hospital mortality in multiple trauma patients. Conclusion: The qSOFA score can be considered a simple and rapid screening tool for identifying multiple-trauma patients. [ABSTRACT FROM AUTHOR]

Background: There are many debates on socioeconomic indicators influencing trauma outcomes. Objectives: This study aimed to determine the association between education as a socioeconomic indicator and trauma outcomes. Methods: This descriptive-analytical study was conducted on 30,448 trauma patients during 2016-2021. The data were based on the minimum dataset of the National Trauma Registry of Iran (NTRI) from six different trauma centers in various cities of the country. The variables used in this study included age, education level, marital status, cause of injury, Glasgow Coma Scale (GCS), intensive care unit (ICU) admission, Injury Severity Score (ISS), and in-hospital mortality. Logistic regression was used to investigate the association between independent variables and trauma outcomes. Results: The study included 30,448 trauma patients with male predominance (75.8%). The mean age was 36.9 years. The most frequent education level was secondary education, with 14,228 (46.6%). Education levels had significant relationships with ISS, death, and ICU admission (P<0.001). Moreover, after applying the multiple logistic regression, the odds of deaths for trauma patients with no formal, primary, and secondary education levels were 3.36, 5.03, and 3.65 times, respectively, more than the odds of deaths at the higher education level after controlling for other factors (all Ps<0.05). However, there were no such relationships between education levels and the odds of ICU admission. Conclusion: Findings of the present study showed a significant association between the education levels and trauma outcomes. Adjusted for other covariates, the chance of death for trauma patients with no formal, primary, or secondary education levels was higher than that at the higher education level. [ABSTRACT FROM AUTHOR]

Background: In the past decade, factors such as population growth, increased environmental incidents, and substance abuse have caused patient-overcrowding in emergency departments (EDs). Our main objective was to assess the effects of a discharge lounge on decreasing the patient waiting time and ED overcrowding by computer simulation. Methods: In this cross-sectional retrospective study, the statistical population consisted of 39264 persons referred to the ED of Al-Zahra Hospital. The sample size was calculated as 1275 through systematic random sampling at 99% confidence. To increase research accuracy, the number of patients was increased to 2515. Data were collected by standardized checklists and hospital information systems. Results: Mean waiting time for level 2 patients who left the ED against medical advice after completing the treatment was declined from 56 min to 44 min and before completing the treatment process from 80 min to 50 min. Average waiting time for level 3 patients for personal satisfaction after completing the treatment process decreased from 15 min to 13 min and before the completion of the treatment process from 67 min to 41 min; the number of discharged patients awaiting discharge was decreased at level 2 from 3 to 2 and at level 3 from 2 to 1. The number of patients waiting for admission at triage stations reduced from 44 to 39%, and the average number of patients discharged from emergency room was increased from 7 to 12. Conclusions: ED overcrowding is the hallmark of a mismatch between the availability of health care resources and patient demand for emergency care. Among major factors contributing to these situations are hindrances in patient flow and occupation of ED beds by nonurgent patients. The establishment of a discharge unit in the ED could be a practical solution to ED overcrowding. [ABSTRACT FROM AUTHOR]

Background: The main purpose of this study was to evaluate the effectiveness of triamcinolone acetonide (TA) mucoadhesive films versus placebo as a preventive and therapeutic intervention of oral mucositis (OM) induced by radiotherapy for head and neck cancer (HNC) patients. Materials and Methods: In this double blind, randomized case controlled clinical trial, 60 HNC patients were randomized to receive TA mucoadhesive films (n = 30) or placebo mucoadhesive films (n = 30) taken four times daily. Mucositis severity was assessed during the course of radiation therapy using the World Health Organization scales, and pain scores were assessed using visual analog scale. Repeated measures ANOVA was used for data analysis. Results: Mean ± standard deviation age of the TA group was 58.53 ± 8.89 years and 60% were male, whereas in the placebo group, it was 56.46 ± 9.36 years and 56.7% were male (P > 0.05). The mean value of pain score was significantly reduced in the TA group (5.36 ± 1.29 vs. 2.20 ± 2.02) compared with the placebo group (5.34 ± 0.78 vs. 4.69 ± 0.77) during 4 weeks (P < 0.001); repeated measures ANOVA analysis showed that the mean value of grade mucositis was significantly reduced in the TA group (2.40 ± 0.49 vs. 0.96 ± 0.81) compared with the placebo group (2.36 ± 0.80 vs. 1.86 ± 0.93) during 4 weeks (P < 0.001). Conclusion: TA film could be considered as an effective approach for reducing the mucositis grading and pain score in the patients with OM. [ABSTRACT FROM AUTHOR]

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Background: We assessed the effects of low-dose IV ketamine-midazolam versus morphine on pain control in patients with closed limb fracture(s); and also compared the incidence of adverse events (cardio-pulmonary) between two groups. Materials and Methods: This prospective, single-blind, non-inferiority trial randomized consecutive emergency department (ED) patients aged 18-60 years to two groups: Receiving 300-500 mcg/kg ketamine plus 0.03 mg/kg midazolam, or 0.05-0.1 mg/kg morphine. Visual analogue score (VAS) and adverse events were verified during an interval of 30 minutes. Results: Two hundred and thirty -- six patients were selected, among whom 207 were males (87.3%). The average age was 29 ± 2, (range, 18-60 years). The VAS score at T30 (i.e., 30 minutes after initial analgesic dose) was significantly decreased compared with VAS score at T0, in both groups. No statistically significant difference, however, was observed between the two groups (-6.1 ± 1.1 versus -6.2 ± 1.0; P = 0.16). With regard to systolic blood pressure and respiratory rate, however, a meaningful difference was noted between the two groups (1.5 ± 6.4 versus -2.1 ± 6.6; P = 0.000 for SBP, and -0.2 ± 1.1 versus -1.1 ± 6.1; P = 0.048 for RR). Conclusion: "Low-dose" intravenous ketamine plus midazolam has the same analgesic effects as morphine on pain control in trauma patients with closed limb fracture(s), in addition to less respiratory adverse events. [ABSTRACT FROM AUTHOR]

Background: This article introduces the first national guidelines for the management including diagnosis, treatment, and secondary prevention of acute coronary syndrome (ACS) in Iran., Materials and Methods: The members of the guideline development group (GDG) were specialists and experts in fields related to ACS and were affiliated with universities of medical sciences or scientific associations in the country. They carefully examined the evidence and clinical concerns related to ACS management and formulated 13 clinical questions that were sent to systematic review group who developed related evidence using Grade method. Finally the GDG developed the recommendations and suggestions of the guideline., Results: The first three questions in the guideline focus on providing recommendations for handling a patient who experience chest pain at home, in a health house or center, during ambulance transportation, and upon arrival at the emergency department (ED) as well as the initial diagnostic measures in the ED. Subsequently, the recommendations related to the criteria for categorizing patients into low, intermediate and high-risk groups are presented. The guideline addressed primary treatment measures for ACS patients in hospitals with and without code 247 or having primary percutaneous coronary intervention (PCI) facilities, and the appropriate timing for PCI based on the risk assessment. In addition, the most efficacious antiplatelet medications for ACS patients in the ED as well as its optimal duration of treatment are presented. The guideline details the recommendations for therapeutic interventions in patients with ACS and acute heart failure, cardiogenic shock, myocardial infarction with nonobstructive coronary arteries (MINOCA), multivessel occlusion, as well as the indication for prescribing a combined use of anticoagulants and antiplatelet during hospitalization and upon discharge. Regarding secondary prevention, while emphasizing the referral of these patients to rehabilitation centers, other interventions that include pharmaceutical and nonpharmacological ones are addressed, In addition, necessary recommendations for enhancing lifestyle and posthospital discharge pharmaceutical treatments, including their duration, are provided. There are specific recommendations and suggestions for subgroups, such as patients aged over 75 years and individuals with heart failure, diabetes, and chronic kidney disease., Conclusion: Developing guidelines for ACS diagnosis, treatment and secondary prevention according to the local context in Iran can improve the adherence of our health care providers, patients health, and policy makers plans., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Research in Medical Sciences.)

Background: Rheumatoid arthritis (RA) is one of the most common chronic inflammatory diseases. Previous studies have reported an association between stress and salivary alpha-amylase. The aim of this study was to investigate the concentration of salivary alpha-amylase in patients with RA (by elimination of stress factor)., Materials and Methods: In this case-control study, we enrolled 50 patients with RA and 48 healthy patients as the control group. The perceived stress scale questionnaire was used to evaluate scores of stress in both case and control groups, and then the participants with high scores of stress were excluded from the study. Moreover, the alpha-amylase activity kit was used for the assessment of the levels of salivary alpha-amylase. In all analyses, the significance level was considered to be < 0.05. Finally, the obtained data were analyzed by SPSS22., Results: Our results indicated a high score of stress in the case group (19.42 ± 5.83 units) compared with the control group (18.02 ± 6.07 units) which was not statistically significant ( P < 0.248). Moreover, we demonstrated a high salivary alpha-amylase concentration in the case group (340.65 ± 38.04 units) compared to the control group (302.62 ± 58.72 units), which was statistically significant ( P < 0.001). The sensitivity and specificity of this method, at >312 alpha-amylase concentrations, were 80% and 46%, respectively., Conclusion: In general, we indicated that the alpha-amylase concentration in patients with RA is higher than the healthy controls, and can be used as a codiagnostic factor., Competing Interests: The authors of this manuscript declare that they have no conflicts of interest, real or perceived, financial or nonfinancial in this article., (Copyright: © 2023 Dental Research Journal.)

Background: The emergency departments of the hospitals and emergency medical services (EMSs) centers have a critical role for providing urgent medical care for patients. The statistical data of the present study were provided by the EMS headquarters of the city of Isfahan, from August to November 2017., Results: The findings showed that on average, 210 missions were accomplished each day by the emergency call center, with an average duration of about 53 minutes, for each mission. In addition, the average time for response time (the time between a call and dispatch of the ambulance) was less than 3 minutes, and the average time for arrival time (the time between request of ambulance and the arrival to the scene) was 8.1 minutes. Adequacy of current number of ambulances and staff is evaluated., Conclusion: Considering an average of 8.1 minutes for arrival time, we conclude that the EMS of Isfahan is within an acceptable range, compared to the international standards. In fact, it is shown that the infrastructures of EMS system including ambulance fleets, staff, and equipment are sufficient, and as an effective step for reducing the total time of the mission, the EMS has to operate seamlessly with the patient's admission process in hospitals. Information such as workload hours, availability of resources and staff, etc. ought to be shared between the EMS and the hospital.

Background: Oral mucositis is a common complication induced by radiation in head and neck cancer patients. OM can cause pain, dysphagia, dehydration and impaired quality of life. The main objective of this study was to assess the effectiveness of licorice mucoadhesive film on symptoms of head and neck radiotherapy-induced mucositis., Methods: sixty head and neck cancer patients who have been scheduled to undergo radiotherapy were randomly assigned to receive radiotherapy plus licorice mucoadhesive film (30) or radiotherapy plus placebo mucoadhesive film. In this double blinded randomized clinical trial, oral mucositis was estimated by world health organization scales, a quantitative scale, and symptoms were evaluated by visual analog scale., Results: The results showed a meaningful difference in pain score between two groups in third and fourth weeks (P-value <0.05). Also, there was a significant difference in scale of mucositis between the two groups in weeks 3 and 4 (P-value <0.05). However, there were no meaningful differences with regard to pain and scale of mucositis in weeks 0, 1, 2. (P-value>0.05)., Conclusion: This study showed that licorice mucoadhesive film can be effective in decreasing pain and level of radiation-induced mucositis and it could be administered as an alternative agent in OM management. Key words: Oral mucositis, Radiotherapy, Licorice, Mucoadhesive film, Placebo.