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Objectives: To review the calendar, mortality and morbidity of Iraq-Iran chemical war among Iranians based on researchers’ reports. Methods: We used national and international databanks such as PubMed, ISI, Scopus, Irandoc and Iranmedex and studied 350 articles related to chemical agents and their effects on different organs. The main criteria for qualification of articles were relevancy orientation and being published in approved medical journals. Results: The Iraqi army invaded to west and southwest Iran using chemical weapons such as nerve agents (NAs) and sulfur mustard (SM). Most victims were civilians including women and children. These attacks had imposed more than 150 types of diseases and complications on Iranians and the frequency of death was 2%-3%. Most reports were about respiratory problems and a few were in the domain of socio-economic damages. Conclusion: At present, 25 years after the end of war, the victims are faced with different complications induced by chemical agents and it is estimated that they will be continuously troubled by these problems in future. Key words: Chemical warfare; Wounds and injuries; Iran; Iraq

Background: Trauma is the sixth cause of death worldwide and the fifth main cause of significant disability and carries a great economic and social burden.Objective: 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.Methods: 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.Results: 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 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.

【Abstract】To review long-term respiratory effects of mustard gas on Iranian veterans having undergone Iraq-Iran war. Electronic databases of Scopus, Medline, ISI, IranMedex, and Irandoc sites were searched. We accepted articles published in scientific journals as a quality criterion. The main pathogenic factors are free radical mediators. Preva-lence of pulmonary involvement is approximately 42.5%. The most common complaints are cough and dyspnea. Major respiratory complications are chronic obstructive pulmo-nary disease, bronchiectasis, and asthma. Spirometry re-sults can reveal restrictive and obstructive pulmonary disease. Plain chest X-ray does not help in about 50% of lung diseases. High-resolution CT of the lung is the best modality for diagnostic assessment of parenchymal lung and bronchi. There is no definite curative treatment for mus-tard lung. The effective treatment regimens consist of oxy-gen administration, use of vaporized moist air, respiratory physiotherapy, administration of mucolytic agents, bronchodilators, corticosteroids, and long-acting beta-2 agonists, antioxidants, surfactant, magnesium ions, thera-peutic bronchoscopy, laser therapy, placement of respira-tory stents, early tracheostomy in laryngospasm, and ulti-mately lung transplantation. High-resolution CT of the lung is the most accurate modality for the evaluation of the lung parenchyma and bronchi. The treatment efficacy of patients exposed to mustard gas depends on patient conditions (acute or chronic, upper or lower respiratory tract involvement). There are various treatment protocols, but unfortunately none of them is definitely curable. Key words: Lung injury; Chemical warfare; Mustard gas

Background: Acute gastroenteritis is a major cause of morbidity and mortality among children in developing countries. Rotaviruses are recognized as the most common etiologic factors of gastroenteritis. In this study, we determined the epidemiologic features, clinical symptoms and molecular structure of rotavirus VP4(P) genotypes in children with acute diarrhea in Bahrami Hospital in Tehran Iran, during 2009 for justifying the routine use of rotavirus vaccines in children. Methods: One hundred fifty fecal samples from 150 children with acute diarrhea in Bahrami Pediatric Hospital in Tehran, Iran were collected from January to December 2009. The patients’ mean age was 20.90+18.19 years (ranging from 1 month to 14 years). Fecal samples were transported on ice to the laboratory of virology department of Pasture Institute of Iran. The demographic and clinical data for each case were entered in an author-devised questionnaire. Group A rotavirus was detected by dsRNA-PAGE. Subsequently, rotavirus genotyping (VP4) was performed by semi-nested multiple RT-PCR and the phylogenetic tree of the Rotavirus nucleotides was constructed. The data were analyzed by statistical tests including Wilcoxon signed and Mann-Whitney U. Results: Rotavirus was isolated in 19.3% of the samples, more than 90% of which had long RNA patterns. The predominant genotype (VP4) was P[8] (86%) and other genotypes respectively were P[6] (6.9%) and P[4] (6.9%). Conclusion: A high prevalence of the P[8] genotype was found to be the cause of acute diarrhea. The analysis of P[8] genotype sequence showed a high level of similarity of the virus in this study with those of other Asian countries.

"nBackground: Ekiri syndrome or lethal toxic encephalopathy is a complication of shigellosis with dysentery, hyperpyrexia, seizures, headache and altered level of consiousness, which rapidly progresses to death. These children die at the beginning of the disease (8-48 hours from the beginning of symptoms), from brain edema. However they had no symptoms or signs of sepsis, dehydration, DIC or Hemolytic Uremic Syndrome (HUS). "nMethods: This survey is a case series study of children with Ekiri syndrome in Bahrami hospital from October 1998-2008 presented with loss of consciousness, colitis and high fever shortly after admission. Information about the patients was gathered from the documents according to physical signs and symptoms, lab data of those whom Ekiri syndrome had been diagnosed for them. Studied variables in this assessment were age, sex, fever, convulsions and loss of consciousness. Headache, encephalopathy, dehydration, elevated ICP, colitis, underline disease, stool, blood and CSF cultures. "nResults: The subjects contain 13 cases (10 male, 3 female), averaged 30/5 months of age. All had seizure, elevated ICP, encephalopathy and coma. All of the patients had fever between 39 and 40, averaged 39.5 degree of centigrade. Seven patients had headache and three ones was dehydrated. The first presentation symptom in three patients was gastroenteritis, in 9 was siezure and in 1 patient was headache. Stool culture in all patients was positive, but blood culture was positive in only one of them. CSF culture was negative in all of the patients. Mortality was 100%. "nConclusion: Symptoms, signs and presentation of Ekiri syndrome, a rare complication of infection with shigella, in the patients in Bahrami hospital was similar with the other studies beforehand in other countries. In this study, all the patients were died and supportive treatments were ineffective.

"nBackground: Acute pyelonephritis may lead to permanent renal scarring. The standard recommendation for treatment of febrile children with urinary tract infection (UTI) is hospitalization for intravenous antibiotics. The purpose of this study was to compare the efficacy of outpatient intravenous ceftriaxone and cefixime versus inpatient of the same regimen for children with febrile UTI. "nMethods: In a randomized clinical trial, we compared the efficacy of administration two days intravenous ceftriaxone followed by an oral cefixime for eight days (as outpatient group) versus four days intravenous ceftriaxone followed by an oral cefixime for six days (as inpatient group), in 203 children (99 cases in outpatient group and 104 cases in inpatient group) 3 months to 15 years of age with febrile UTI, in terms of short-term clinical outcomes (sterilization of the urine and defeverescence) and long-term morbidity (incidence of reinfection and renal scarring documented by DMSA scintigraphy. "nResults: Repeat urine cultures were sterile within 48 hours in all children, mean time to defeverescence was 27.58 (SD=±12.62) and 31.44 (SD=±17.06) hours for children in outpatient and inpatient groups, respectively (P=0.067). Reinfection occurred in 9.1% of outpatient and 13.4% of inpatient group (P=0.326). Renal scarring developed in 11% of children of outpatient and 7.6% of children of inpatient group (P=0.884). There was no significant difference between the two groups in respect of renal scarring. "nConclusions: Outpatient ceftriaxone for two days followed by cefixime to complete a 10 days course can be recommended as a safe and effective treatment for children with febrile UTI.

"nBackground: Hypopharyngeal cancer usually presents with cervical mass, hoarseness, radiated otalgia, and dysphagea in the advanced stages. Radical surgery followed by radiotherapy plays an important role in the treatment of patients with hypopharyngeal cancer. However, there is no general consensus as to which is the best method of reconstruction after surgical resection. The aim of this study was to evaluate the complications of pectoralis major myocutaneous flap (PMMF) and gastric pull-up (GPU) techniques to reconstruct a circumferential defect after laryngopharyngoeso- phagectomy. "nMethods: We retrospectively reviewed the records of 64 patients who underwent radical surgery and reconstruction with either PMMF or GPU technique. Demographic characteristics, tumor location, proximal margin involvement, history of radiotherapy, presence of lymphadenopathy, cervical dissection, and postoperative complications such as fistula, anastomotic site stenosis, swallowing dysfunction, and stoma stenosis were compared between the two groups. Postoperative complications of the reconstruction methods were compared. "nResults: A total of 64 patients, 43(67%) in GPU group and 21(33%) in PMMF group, were studied. The groups did not differ in demographic characteristics. The locations of the tumoral lesions were in larynx (n=7), proximal esophagus (n=5), posterior cricoid (n=5), pyriformis sinus (n=7), posterior wall (n=7), and miscellaneous (n=41). Six patients (6.3%) had proximal margin involvement, 19 patients (29.9%) had history of radiotherapy, 26 cases (40.6%) had lymphadenopathy, and 49 cases (76.5%) had cervical dissection. There was no significant difference between the two groups regarding stenosis or swallowing dysfunction rates, but fistula was seen lower following GPU compared with PMMF (p

Abstract Background Injury is one of the leading causes of death worldwide, and the abdomen is the most common area of trauma after the head and extremities. Abdominal injury is often divided into two categories: blunt and penetrating injuries. This study aims to determine the epidemiological and clinical characteristics of these two types of abdominal injuries in patients registered with the National Trauma Registry of Iran (NTRI). Methods This multicenter cross-sectional study was conducted with data from the NTRI from July 24, 2016, to May 21, 2023. All abdominal trauma patients defined by the International Classification of Diseases; 10th Revision (ICD-10) codes were enrolled in this study. The inclusion criteria were one of the following: hospital length of stay (LOS) of more than 24 h, fatal injuries, and trauma patients transferred from the ICU of other hospitals. Results Among 532 patients with abdominal injuries, 420 (78.9%) had a blunt injury, and 435 (81.7%) of the victims were men. The most injured organs in blunt trauma were the spleen, with 200 (47.6%) and the liver, with 171 (40.7%) cases, respectively. Also, the colon and small intestine, with 42 (37.5%) cases, had the highest number of injuries in penetrating injuries. Blood was transfused in 103 (23.5%) of blunt injured victims and 17 (15.2%) of penetrating traumas (p = 0.03). ICU admission was significantly varied between the two groups, with 266 (63.6%) patients in the blunt group and 47 (42%) in penetrating (p

Abstract Hereby, we aimed to comprehensively compare different scoring systems for pediatric trauma and their ability to predict in-hospital mortality and intensive care unit (ICU) admission. The current registry-based multicenter study encompassed a comprehensive dataset of 6709 pediatric trauma patients aged ≤ 18 years from July 2016 to September 2023. To ascertain the predictive efficacy of the scoring systems, the area under the receiver operating characteristic curve (AUC) was calculated. A total of 720 individuals (10.7%) required admission to the ICU. The mortality rate was 1.1% (n = 72). The most predictive scoring system for in-hospital mortality was the adjusted trauma and injury severity score (aTRISS) (AUC = 0.982), followed by trauma and injury severity score (TRISS) (AUC = 0.980), new trauma and injury severity score (NTRISS) (AUC = 0.972), Glasgow coma scale (GCS) (AUC = 0.9546), revised trauma score (RTS) (AUC = 0.944), pre-hospital index (PHI) (AUC = 0.936), injury severity score (ISS) (AUC = 0.901), new injury severity score (NISS) (AUC = 0.900), and abbreviated injury scale (AIS) (AUC = 0.734). Given the predictive performance of the scoring systems for ICU admission, NTRISS had the highest predictive performance (AUC = 0.837), followed by aTRISS (AUC = 0.836), TRISS (AUC = 0.823), ISS (AUC = 0.807), NISS (AUC = 0.805), GCS (AUC = 0.735), RTS (AUC = 0.698), PHI (AUC = 0.662), and AIS (AUC = 0.651). In the present study, we concluded the superiority of the TRISS and its two derived counterparts, aTRISS and NTRISS, compared to other scoring systems, to efficiently discerning individuals who possess a heightened susceptibility to unfavorable consequences. The significance of these findings underscores the necessity of incorporating these metrics into the realm of clinical practice.

Purpose: to compare the refractive error measurements achieved through three distinct techniques: retinoscopy, subjective method, and the subjective fogging method. Methods: Participants included 223 young adults aged 18 to 36 years (mean age: 25.63±5.31). The refractive error of one eye was measured under three different accommodation control conditions: subjective refraction, fogging subjective refraction and retinoscopy.Results: Data were collected for 223 young adults. The average Spherical value obtained by the retinoscopy method was 0.21 and the average cylinder was -0.76. These values were -0.01 and -0.75, respectively, in the subjective with fog method: The Spherical value and cylinder obtained by the regular subjective method were -0.13 and -0.74 D, respectively; The mean spherical equivalent with subjective refraction method was more minus than fogging subjective refraction and retinoscopy provided the most plus results. the difference in spherical and spherical equivalent value between three methods was significant (p- value< 0.001) but the difference in cylindrical value between three groups was not significant (p- value> 0.05). According to the Intraclass Correlation Coefficient analysis, the agreement between three methods for measuring sphere (ICC= 0.99), cylinder (ICC= 0.95) and spherical equivalent (ICC= 0.99) was good.Conclusions: The results showed that retinoscopy and fogging subjective refraction were the most similar methods, with a small mean difference. However, the comparison between retinoscopy and subjective refraction had wider limits of agreement than retinoscopy and fogging subjective refraction. Key words: Retinoscopy, subjective, refraction, fogging

Background: According to the reports, the road traffic injuries (RTI) mortality rate in Iran as a middle-income country in the Eastern Mediterranean Region (EMR) decreased in past decades but is higher than the global level and remained a health problem.Objectives: This study aimed to report the characteristics of registered patients injured by different trauma mechanisms in Yazd City, Iran.Methods: In this study, the patients were registered from September 28, 2016, to December 31, 2022, at Shahid Rahnamoon Hospital, affiliated with the National Trauma Registry of Iran (NTRI) for its first phase. Inclusion criteria were hospital length of stay (LOS) of more than 24 hours, death due to injury in the hospital, or transfer from other hospitals' intensive care units (ICU). Age, gender, Glasgow Coma Scale (GCS), systolic blood pressure (SBP), cause of injury, LOS, injury severity score (ISS), and in-hospital mortality were assessed.Results: Among 3960 participants, 2307 (58.2%) patients were injured due to RTI as the most common cause of injury. Also, 949 (23.9%) and 359 (9.1%) of the participants experienced fall and stab/cut injuries, respectively. Men were affected more than women in all injury causes (p

Objective(s): To study characteristics and opium use pattern in patients attended to Ardebil addiction treatment center. Methods: In this retrospective and descriptive analytic study the characteristics of the self-introduced addicts attended to Ardebil admission and treatment office of the welfare organization were studied using their records (N=384). Results: 97.8% of the clients were male with mean age of 38.4 years old and 86.9% were married with average of 4 children. 85.3% of the samples were smoker and 10.7% of the cases had the history of opium consumption in their first-degree family members. The mean age of starting drug abuse was 28.8 and the average time between addiction and attending for giving up was 8 years. 37.9% of the samples had 1-2 times history of abandonment of addiction; 3.6% of them had used syringe in common and 8% of them had committed other offences in addition to addiction. The consumed narcotics were opium (81.9%), heroin (9.9%), both opium and heroin (1.9%). The common ways of consumption were: Fumigation (41.7%), eating (30.5%), injection (6.7%), and both eating and fumigation (21.1%). There was a significant relation between kind of consumed narcotics and age, consumption way and marital status (P

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 chi-square 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.

With the global surge of urbanization and population growth, the well-being of children within modern urban developments has been largely overlooked, necessitating an urgent need for attentiveness towards their needs in cities. Consequently, the assessment of urban neighborhoods in terms of child-friendly city components becomes an essential area of research. This study employs a survey method to evaluate the dimensions and components associated with a child-friendly city. Utilizing a cluster-spatial sampling approach, ten neighborhoods from five regions of Ardabil are selected as representative samples (two neighborhoods per region). A total of 400 researcher-developed questionnaires are then distributed proportionally based on the population of each selected neighborhood. The collected data is subsequently analyzed using one-sample t-statistics in SPSS software, as well as multi-criteria decision-making models to prioritize the neighborhoods according to the research criteria. The findings reveal distinctive characteristics of child-friendly city dimensions and components across the various neighborhoods of Ardabil. Interestingly, when comparing the dimensions, the environmental-physical and organizational-managerial dimensions emerge as the most problematic areas within the studied neighborhoods. Additionally, it is noteworthy that despite the inherent spatial disparities between neighborhoods, Neighborhood No. 1 in District 4 and Neighborhood No. 3 in District 2 of Ardabil Municipality exhibit greater challenges compared to other neighborhoods under investigation. Introduction With the rapid global urbanization and population growth, the well-being of children has been largely overlooked in modern urban planning and development. Consequently, there is a pressing need to prioritize the consideration of children in urban environments like never before. Thus, it becomes imperative to conduct an in-depth investigation into the state of neighborhoods within the city of Ardabil, specifically in relation to the key indicators and criteria of a child-friendly city. This study aims to assess and prioritize the neighborhoods based on their adherence to these criteria, aiming to provide an accurate depiction of their current state and identify those in most need of improvement. To address the research inquiries and establish a logical framework, the following assumptions were formulated: - The nature of the components that contribute to a child-friendly city varies across different localities within Ardabil city. Of these components, the dimensions pertaining to physical and management are anticipated to pose the greatest challenges in the investigated areas, as evident from comparative examination. -The ranking of different neighborhoods of Ardabil city are different in terms of the components of a child-friendly city. Literature Review Permanasari et al. (2019) conducted a study entitled "Political pattern of public space in creating a child-friendly city in Jakarta," which emphasizes the significance of employing a bottom-up participatory approach in fostering heightened utilization and engagement among children. In their research titled "Child-friendly city survey focusing on children's health," Brown et al. (2019) underscore the influence of the environment on children's well-being. Accordingly, they assert the necessity for cities to possess comprehensive knowledge concerning the factors that impact children's health. Furthermore, it is imperative to prioritize understanding and promoting interactions between children and their environment, thereby enhancing their overall health. Examining the role of child-friendly urban structures in neighborhood development, Ahmadi et al. (2018) present their findings in an article entitled "Evaluation of the role of child-friendly city structure in the realization of development: case study of neighborhoods in Yazd city." Their research demonstrates significant variation in child-friendly city indicators within Yazd city, with certain neighborhoods exhibiting a high level of prosperity while others languish at a considerably lower level. Safaiyeh neighborhood emerges as the most prosperous, securing the top rank in the city. Conversely, Fahadan, Mahdiabad, Sajjadiyeh, Amirabad, and Kashtargah neighborhoods are positioned at the bottom, highlighting their limited prosperity. In their study on "Evaluation of child-friendly city indicators in Mashhad metropolis," Kharazmi et al. (2019) reveal the impact of these indicators and discern a discrepancy between the current state and the desired outcomes. The analysis uncovers a significant gap concerning access to play areas, green spaces, and vital services, suggesting the need for noteworthy improvements in these localized indicators within the context of Mashhad. Methodology The present study adopts an applied research design with a descriptive-analytical nature. Spatial cluster sampling was employed to randomly select 10 neighborhoods, comprising two neighborhoods from each of the five regions in Ardabil city, to serve as the sample. The target population for this research consists of households with children residing in the selected neighborhoods. To determine the appropriate sample size for the questionnaire, Cochran's statistical population formula was utilized, considering a 95% confidence level. As a result, 380 households were initially determined; however, to ensure increased accuracy, the sample size was expanded to 400 households. The distribution of the questionnaire was proportional to the number of households in each neighborhood. The evaluation of the problematic conditions of Ardabil city's neighborhoods regarding the components of a child-friendly city was conducted using the t-test. Subsequently, in the Excel environment, various multi-criteria decision-making models, including Topsis, Vicor, Electre, and Copeland integration model, were employed to rank the ten selected neighborhoods from the five regions of Ardabil city based on their problematic status in relation to the components of a child-friendly city. The selection of weights for the criteria was determined using Shannon's entropy method. Results The findings indicate significant variations among the localities within Ardabil city concerning the identified issues. Upon comparing the dimensions, it was observed that the organizational-management and environmental-physical dimensions exhibited the highest frequency of confirmation, thus suggesting their prominence as the most problematic dimensions across the studied localities. Moreover, employing multi-criteria decision-making models unveiled that Neighborhood No. 1 in Region 4 of Ardabil Municipality exhibited the highest number of neighborhood issues, primarily associated with concerns related to environmental-physical, cultural-social, and organizational-management aspects. On the other hand, Neighborhood No. 10 in Region 2 of Ardabil Municipality showcased the lowest number of neighborhood issues when compared to the other localities. It is essential to note that the localities examined in this research were selected based on their adherence to the dimensions and components of a child-friendly city. Conclusion One of the fundamental factors contributing to the spatial differentiation of localities, as evidenced by research indicators, is social and occupational inequality, which leads to unequal social and structural positions. This inequality in turn influences the access individuals and groups have to scarce social resources and benefits, including wealth, power, and status. Consequently, these factors significantly impact individuals' rights, opportunities, rewards, and social standing. Given the interconnectedness between social and spatial processes, this issue within Ardabil city exacerbates disparities in accessing urban services, opportunities, and amenities, particularly for children. These include aspects such as transportation and independent mobility, access to diverse services and activities, safety and security, friendly green spaces, and environmental concerns. Therefore, addressing social inequalities and enhancing urban infrastructure and facilities constitute crucial steps towards creating a child-friendly city. Furthermore, based on the authors' personal experiences and feedback from residents residing in localities with a higher prevalence of neighborhood issues, it becomes evident that urban management, particularly the municipality, plays a significant role in the environmental and physical realms. Through wielding influence and exerting power over other involved institutions, the municipality has had a notable impact on the problems faced by such neighborhoods. This influence stems from the limited awareness and economic poverty experienced by neighborhood residents, as well as the functional shortcomings of local institutions. Consequently, existing policies geared towards the development of socially, economically, and physically deprived populations – who predominantly reside in the most problematic areas identified in this study – have been ineffective. Instead, the current conditions have created a situation where high-income groups benefit disproportionately from the existing state of affairs. The lack of specific plans and programs targeting these problem areas, coupled with the failure to delegate approved plans for implementation at lower levels (such as regional municipalities), has exacerbated inequalities between localities. Hence, adopting a justice-oriented perspective in urban management is paramount. By doing so, attention can be directed towards improving conditions in deprived and problematic areas, thereby working towards a more equitable urban landscape.

Background: Road traffic accidents (RTAs) are the leading cause of death for children and young adults aged 5 to 39 and the third-leading cause of death in Iran.Objectives: The aim of this study was to assess in-hospital costs of patients following RTAs and identify associated factors among the patients admitted to Sina Hospital, a collaborating hospital with the National Trauma Registry of Iran (NTRI).Methods: A hospital-based registry study was conducted between September 17, 2016, and April 30, 2022, involving 3245 patients affected by RTAs. Data collection utilized the NTRI minimum dataset. To assess the factors influencing in-hospital costs of RTAs, various statistical analyses were performed, including independent sample t-tests, one-way ANOVA, and multiple linear regression analysis.Results: The distribution of studied subjects based on sex, age, and road user group revealed that the majority were male (91%), within the working age range of 21-60 years (78.2%), and motorcyclists (55.2%). The mean in-hospital cost per patient following RTAs was 152.3 million Iranian Rial (IRR) ($609.35). In the multiple linear regression analysis, several factors were significantly associated with higher in-hospital costs (ps

Background: The registry systems are a tool to provide information which can be used for improvement of medical care and preventive policies over time. The efficacy of trauma registries in improving the quality of care depends on the quality of their data. Objectives: This study aimed to determine the completeness, reliability, validity, and patient coverage of the Sina Hospital Trauma Registry (SHTR). Methods: The data collected in the SHTR by May 28, 2021, were used to assess the data completeness. A random sample of 250 patients was re-registered to evaluate the reliability and validity. The intraclass correlation coefficient (ICC) and the kappa and weighted kappa statistics were used to assess the reliability of data and agreement. The coverage was determined by comparing the list of trauma patients obtained from the trauma registry and the one from the hospital information system. Results: The overall average completeness for all variables was 97.9%. The inter-rater agreement on important variables including Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), and final outcomes was, respectively, perfect (kappa= 0.90) optimal (ICC = 0.72), and substantial (kappa= 0.71). The patient coverage was 79.6%. Conclusion: The results confirm that the data quality and patient coverage were high. In addition, although the reliability of most variables was acceptable, the agreement between NTRI’s data and the medical record for AIS codes and ISS was moderate.

The objective of the present study was to conduct field studies for direct measurement of canola under farmers' management in one crop season (2019-2020) in 27 farms in Behbahan, Khuzestan province. Water requirement was calculated based on the FAO Penman-Monteith model using the daily statistics of the Behbahan synoptic meteorological station. A T-test was used to statistically compare the results such as the depth of irrigation and applied water productivity in the field in different irrigation systems. Linear multivariate regression analysis was used to investigate the effects of the independent variable on the dependent parameter of water productivity. The volume of applied water in the fields ranged from 4085.5 to 7865.3 m3/ha. The results of comparing the average yield of two irrigation systems in the t-test showed that the two sprinkler and surface irrigation systems with yields of 2614 and 2330 kg/ha, respectively, were not significantly different. Applied water productivity in traditional and modern irrigation systems was calculated to be 0.386 and 0.486 kg/m3, respectively, which had significant differences. The results of the analysis of variance in the regression model showed that among the independent variables, yield with t-statistic (23.997) and equivalent beta coefficient (0.880) had the most significant positive effect at a 1% level on applied water productivity. After that, the volume of applied water (irrigation water + effective rainfall) with a t-statistic of (-11.702) and a beta coefficient of equivalent (-0.793) had the most negative and significant effect at the level of 1% on the applied water productivity. The results of the Pearson correlation coefficient showed that irrigation events had a positive and significant correlation at a 5% level with applied water and yield. These correlations were 0.455 and 0.380, respectively. By increasing irrigation events, the volume of applied water has practically decreased and has become as close as the plant needs, and has increased water productivity.

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

Abstract Purpose To compare the accuracy of five different tooth‐implant impression techniques. Materials and Methods In this in vitro, experimental study, an acrylic model containing one bone‐level Straumann dental implant at the site of maxillary first molar and an adjacent second premolar prepared for a porcelain fused to metal restoration was used. Impressions were made from the model using five different one‐step tooth‐implant impression techniques including scanning with an intraoral scanner, occlusal matrix, wax relief, closed‐tray, and open‐tray techniques. Each technique was repeated 15 times. The impressions were poured with dental stone, and the obtained casts were scanned by a laboratory scanner. The scan file of each technique was compared with the scan file of the original acrylic model by Geomagic Design X software. Data were analyzed by one‐way analysis of variance, and Tamhane's post‐hoc test (α = 0.05). Results For dental implant, intraoral scanning had the highest accuracy (0.1004 mm2) followed by open‐tray (0.1914 mm2), occlusal matrix (0.2101 mm2), closed‐tray (0.2422 mm2), and wax relief (0.2585 mm2) techniques (p 0.05). Conclusion The compared simultaneous tooth‐implant impression techniques had comparable accuracy with no significant difference.

Abstract Background Trauma care is one of the most expensive medical procedures that is significantly affected by factors like insurance status. Providing medical care to injured patients has a significant impact on patients’ prognosis. This study examined whether insurance status was associated with different outcomes, including hospital length of stay (HLOS), mortality, and Intensive Care Unit (ICU) admission. Methods This prospective study analyzed the data of traumatized patients who had been registered in the National Trauma Registry of Iran (NTRI), and hospitalized at Sina Hospital, Tehran, Iran, from March 22, 2016, to February 8, 2021. Given the type of insurance, the insured patients were classified as basic, road traffic, and foreign nationality. The outcomes of in-hospital death, ICU admission, and HLOS between insured and uninsured patients, and then different insurance statuses, were compared using regression models. Result A total of 5014 patients were included in the study. 49% of patients (n = 2458) had road traffic insurance, 35.2% (n = 1766) basic insurance, 10.5% (n = 528) were uninsured, and 5.2% (n = 262) had foreign nationality insurance. The mean age of patients with basic, road traffic insurance, foreign nationality, and uninsured patients was 45.2 (SD = 22.3), 37.8 (SD = 15.8), 27.8 (SD = 13.3), and 32.4 (SD = 11.9) years, respectively. There was a statistically significant association between insurance status and mean age. Based on these results, the mean age of patients with basic insurance was higher than other groups (p

Purpose: To prepare for future possible communicable disease epidemics/pandemics, health care providers should know how the COVID-19 pandemic influenced injured patients. This study aimed to compare epidemiologic features, outcomes, and diagnostic and therapeutic procedures of trauma patients admitted to a university-affiliated hospital before and during the pandemic. Methods: This retrospective study was performed on data from the National Trauma Registry of Iran. All injured patients admitted to the hospital from July 25, 2016 to March 10, 2021 were included in the study. The patients were excluded if they had hospital length of stay less than 24 h. The injury outcomes, trauma mechanisms, and therapeutic and diagnostic procedures of the 2 periods: before (from July 25, 2016 to February 18, 2020) and during (from February 19, 2020 to March 10, 2021) COVID-19 pandemic were compared. All analyses were performed using STATA version 14.0 software (Stata Corporation, College Station, TX). Results: Totally, 5014 patients were included in the registry. Of them, 773 (15.4%) were registered after the beginning of the COVID-19 pandemic on February 19, 2020, while 4241 were registered before that. Gender, education level, and cause of injury were significantly different among the patients before and after the beginning of the pandemic (p

Objective(s): To study the prevalence of Stereotypic Movements (SM) in children. Methods: Using a multistage sampling method, we selected 300 children from 13 day care centers and primary schools in Urmia (Western Azerbaijan Province). Data collection involved parent interviews in the presence of the children. Results: Three hundreds children (167 boys and 133 girls) were included in the study. Nearly 50% (149 out of 300) had one type of SM. The prevalence of different type of stereotypic movements were as follows: bruxism 16%, head banging 13%, hair pulling 8%, nail biting 7% and thumb sucking 6%; each of the affected subjects had only one type of SM .There were not any significant relationships between sex and various SM varieties- except for head banging, which was more common in boys (P 0.05). Conclusion: The prevalence of Stereotypic Movements is high in children. To confirm the findings more comprehensive studies are recommended.

Background: Congenital ductal-dependent cyanotic congenital heart disease (CHD) is a group of diseases that require early intervention during early infancy or the neonatal period. In this study, we compared the effectiveness, safety, and side effects of stenting patent ductus arteriosus versus a modified Blalock-Taussig (BT) shunt. Materials and Methods: Thirty-six neonates and infants with cyanotic CHD who were

Abstract Drought, rising demand for water, declining water resources, and mismanagement have put society at serious risk. Therefore, it is essential to provide appropriate solutions to increase water productivity (WP). As an element of research, this study presents a hybrid machine learning approach and investigates its potential for estimating date palm crop yield and WP under different levels of subsurface drip irrigation (SDI). The amount of applied water in the SDI system was compared at three levels of 125% (T1), 100% (T2), and 75% (T3) of water requirement. The proposed ACVO-ANFIS approach is composed of an anti-coronavirus optimization algorithm (ACVO) and an adaptive neuro-fuzzy inference system (ANFIS). Since the effect of irrigation factors, climate, and crop characteristics are not equal in estimating the WP and yield, the importance of these factors should be measured in the estimation phase. To fulfill this aim, ACVO-ANFIS employed eight different feature combination models based on irrigation factors, climate, and crop characteristics. The proposed approach was evaluated on a benchmark dataset that contains information about the groves of Behbahan agricultural research station located in southeast Khuzestan, Iran. The results explained that the treatment T3 advanced data palm crop yield by 3.91 and 1.31%, and WP by 35.50 and 20.40 kg/m3, corresponding to T1 and T2 treatments, respectively. The amount of applied water in treatment T3 was 7528.80 m3/ha, which suggests a decrease of 5019.20 and 2509.6 m3/ha of applied water compared to the T1 and T2 treatments. The modeling results of the ACVO-ANFIS approach using a model with factors of crop variety, irrigation (75% water requirement of SDI system), and effective rainfall achieved RMSE = 0.005, δ = 0.603, and AICC = 183.25. The results confirmed that the ACVO-ANFIS outperformed its counterparts in terms of performance criteria.

Increasing crop production per unit volume of water consumption requires recognizing the most dependent variable in drip irrigation to the volume of water consumption and also identifying the most important variables independent of water productivity in surface and subsurface drip irrigation for optimal use of available water resources. The present research was carried out in Behbahan Agricultural Research Station during four cropping seasons (2013-2017) on a Kabkab date variety. Experimental treatments include the amount of water in the subsurface drip irrigation method based on two levels of 75% and 100% water requirement and in surface drip irrigation based on 100% water demand. Data were analyzed using a randomized complete block design with three replications. The results of the analysis of variance of the mean of different irrigation treatments in quantitative traits showed that the effect of irrigation was significant at the level of 1% in terms of cluster weight index, fruit weight, and fruit flesh to kernel weight ratio. The results of regression analysis of variance showed that in the dependent variable of cluster weight, the consumption water volume explained 19.1% (R2 = 0.191) of the fluctuations of the dependent variable (cluster weight). Among all the studied variables, the volume of water consumption explained the most significant changes in date cluster drying. Fruit moisture with t (2.096) and equivalent beta coefficient (0.046) had a significant positive effect on water productivity at the level of 5%. The results of the Pearson correlation coefficient showed that the effect of yield on changes in water productivity was much greater than the volume of water consumed so the yield caused significant changes in water productivity. While the effect of water consumption on water productivity was not significant.

Summary: Background: The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well as a robust global system for pandemic preparedness. We aimed to provide a comparative assessment of global health spending at the onset of the pandemic; characterise the amount of development assistance for pandemic preparedness and response disbursed in the first 2 years of the COVID-19 pandemic; and examine expectations for future health spending and put into context the expected need for investment in pandemic preparedness. Methods: In this analysis of global health spending between 1990 and 2021, and prediction from 2021 to 2026, we estimated four sources of health spending: development assistance for health (DAH), government spending, out-of-pocket spending, and prepaid private spending across 204 countries and territories. We used the Organisation for Economic Co-operation and Development (OECD)'s Creditor Reporting System (CRS) and the WHO Global Health Expenditure Database (GHED) to estimate spending. We estimated development assistance for general health, COVID-19 response, and pandemic preparedness and response using a keyword search. Health spending estimates were combined with estimates of resources needed for pandemic prevention and preparedness to analyse future health spending patterns, relative to need. Findings: In 2019, at the onset of the COVID-19 pandemic, US$9·2 trillion (95% uncertainty interval [UI] 9·1–9·3) was spent on health worldwide. We found great disparities in the amount of resources devoted to health, with high-income countries spending $7·3 trillion (95% UI 7·2–7·4) in 2019; 293·7 times the $24·8 billion (95% UI 24·3–25·3) spent by low-income countries in 2019. That same year, $43·1 billion in development assistance was provided to maintain or improve health. The pandemic led to an unprecedented increase in development assistance targeted towards health; in 2020 and 2021, $1·8 billion in DAH contributions was provided towards pandemic preparedness in LMICs, and $37·8 billion was provided for the health-related COVID-19 response. Although the support for pandemic preparedness is 12·2% of the recommended target by the High-Level Independent Panel (HLIP), the support provided for the health-related COVID-19 response is 252·2% of the recommended target. Additionally, projected spending estimates suggest that between 2022 and 2026, governments in 17 (95% UI 11–21) of the 137 LMICs will observe an increase in national government health spending equivalent to an addition of 1% of GDP, as recommended by the HLIP. Interpretation: There was an unprecedented scale-up in DAH in 2020 and 2021. We have a unique opportunity at this time to sustain funding for crucial global health functions, including pandemic preparedness. However, historical patterns of underfunding of pandemic preparedness suggest that deliberate effort must be made to ensure funding is maintained. Funding: Bill & Melinda Gates Foundation.

IntroductionPrecipitation as the most important climatic element is always studied from two perspectives of time and place. Emphasis on the time perspective determines temporal changes and emphasis on the location perspective determines the spatial variation of precipitation. Since Iran is located in an arid and semi-arid region, it lacks large internal and adjacent water resources to supply moisture to its precipitation, and as a result, most of its precipitation moisture sources must be supplied from the surrounding water levels. One of the methods that can be used to study the course of rainfall in the past and present is to analyze the trend of time series at different scales. So far, statistical methods have been presented for the analysis of time series routines, which can be divided into two general categories: parametric and non-parametric methods. Southeastern Iran, which includes Sistan-Baluchestan province, Kerman, southern Khorasan and the eastern parts of Hormozgan province, They are one of the arid regions of Iran. Restriction on water resources and annual precipitation in this part of the country have severely limited agricultural and industrial activities. The lives and deaths of the majority of people are also related to the low precipitation that falls throughout the year. Therefore, considering that a comprehensive study on precipitation trends in the region has not been done, the purpose of this study is to investigate the annual and seasonal precipitation trends by stations in southeastern Iran. The results of this study can play an important role in understanding the precipitation trend in the southeast region for planning related to water resources management, management of unexpected events such as floods and also the optimal utilization of those precipitations.MethodologyIn order to conduct this study, in order to recruit rainy periods, daily precipitation data were obtained from synoptic stations in the southeast of the country, including selected stations in the three provinces of Hormozgan, Sistan and Baluchestan and Kerman during a 30-year period (1987-2016). Two Mann-Kendall tests and the Sen’s Slope Estimate are among the most common non-parametric methods of trend analysis when considering hydrometeorology. Various studies conducted using these two methods indicate the importance of their widespread use in the rapid evolution of time. Identify the data change using the Man-Kendall method, specify its type and time. The non-parametric Kendall test was proposed by Mann and then developed by Kendall (1975) based on ranking data in a time series. This method is widely and widely used in the analysis of the process of hydrological and meteorological series.Discussion and resultsThe trend of average annual, seasonal precipitation and maximum 24-hour precipitation in southeastern IranConsidering that in the annual, seasonal and maximum 24-hour precipitation trend diagrams, the intersection of the U and U' sequences above and below the significant lines did not occur, which means that acceptance is random (acceptance of H0 hypothesis) and there is no significant trend (H1) variable. Precipitation is in the southeast of Iran and in fact the condition is -1.96 (ti)< U or 1.96 (ti) >U and has a static series.In the Sen's Slope Estimate test, the total reduction of winter precipitation slope was equal to -0.350 mm, which in the case of 95% confidence of the upper and lower slopes of this slope is equal to -0.123 and -0.835, respectively, and in the case of 99% of the slopes. High and low are 1.604 and -2.318, respectively, per year. The Sen’s Slope Estimate test for annual rainfall, summer, autumn, winter and maximum 24-hour precipitation has estimated the negative precipitation slope. Mann Kendall test estimate shows a decrease in precipitation in winter of -1.71 per year.Annual, seasonal and maximum 24-hour precipitation trend by stations in southeastern IranIn the study of changes in annual precipitation using Mann-Kendall test, it is observed that the annual precipitation trend in most stations in the southeast (except Bam and Chabahar) has a decreasing trend. The Sen’s Slope Estimate showed is the highest precipitation at any given time at Bandar-Lengeh station at -4.16 mm per year. The time series of Man-Kendall test in the seasons of the year indicates that in spring, summer and autumn, the precipitation trend in most stations is decreasing, but this trend is not significant in any of the stations in southeastern Iran and only in winter precipitation In Bandar-Lengeh, Jask and Kish stations, it has a decreasing trend at 95% significance level. Sen’s Slope Estimate data showed that the amount of precipitation decreases in the mentioned stations.ConclusionThe results of by using Methods the Mann-Kendall test showed that the mean annual precipitation trend as well as spring, summer and autumn seasons of southeast Iran was not significant and only winter precipitation had a significant and decreasing trend. Estimates of the slope of sen indicate that the slope of precipitation in southeastern Iran in winter is -0.350 mm in year. The annual precipitation trend of BandarAbbas, BandarLengeh, Abumousa and Kish stations at 95% and Jask and Iranshahr stations at 90% were significant. Test statistics showed that the highest annual precipitation reduction was at the Bandar-e-Lange station at -4.16 mm in year. In spring, summer, and fall, precipitation was not significant in any of the stations in the southeast of Iran and winter precipitation in Bandar-e-Lengh, Jask, and Kish stations had a 95% significant decrease. Assessment of 24-hour rainfall variations showed that the above mentioned precipitation had a decreasing trend at 99.9% at BandarAbbas stations and 95% at Bandarlange, Jask, Abumousa and Kish stations. According to the tests and analyzes performed in this study, what is certain is that in all stations in southeastern Iran, a significant positive trend in annual, seasonal and maximum 24-hour rainfall was not observed at the level of 99% and 95%, and most precipitation trends from It is a kind of decrease and has revealed the fact of decrease in rainfall in the southeastern climate of Iran during the years 1987 to 2016, which decrease in annual rainfall is mostly related to the winter of -1.71 per year.