Rare incidence of parietal lobe metastasis in an adult with desmoplastic/nodular medulloblastoma: A case report and review of the literature.

INTRODUCTION AND IMPORTANCE: Medulloblastoma in adults is a rare and highly aggressive central nervous system (CNS) tumor, representing less than 1 % of all brain tumors. Supratentorial metastasis is uncommon, and extra-neural metastasis occurs in approximately 5 % of cases, primarily in frontal and temporal lobes. Here, we present an exceptional case of parietal lobe metastasis in an adult with desmoplastic/nodular medulloblastoma. To explore prior cases and establish the uniqueness of our case, we conducted a thorough search on the PubMed database. CASE PRESENTATION: A 46-year-old male, who was previously treated for medulloblastoma with surgery and adjuvant chemoradiotherapy seven years ago, presented with clinical symptoms suggestive of potential tumor recurrence. Despite two years of dedicated adjuvant chemoradiotherapy, the patient exhibited progressive right hemiparesis, ataxia, and gait disturbances. Subsequent brain magnetic resonance imaging (MRI) revealed a distinct 6 × 4 × 2 cm lesion in the left parietal lobe, which, upon post-operative histopathological examination, was identified as a supratentorial metastasis originating from desmoplastic/nodular medulloblastoma. CLINICAL DISCUSSION: Medulloblastomas, once categorized as primitive neuroectodermal tumors (PNET), are now distinctly classified as high-grade embryonal tumors, mainly characterized by their histological features and cellular origin. Common clinical presentations include hydrocephalus, headache, unsteady gait, and truncal ataxia. Surgical intervention aims for radical excision, complemented by vital adjuvant chemoradiotherapy to minimize recurrence risk. CONCLUSION: Considering the possibility of tumor recurrence or intracranial metastasis in patients with medulloblastoma is crucial. Therefore, regular follow-ups are strongly recommended to promptly detect any signs of reoccurrence in these atypical presentations.

Suitability of existing definitions for drowning to meet the new definition: a scoping review.

BACKGROUND: Past studies have shown a lack of consensus on the definition and terminology of drowning among experts in the field and relevant organizations. There is a need for a new look at the definition of drowning to improve the understanding of drowning events. METHODS: A literature search of seven electronic databases, including PubMed, EMBASE, CINHAL, MEDLINE, Sport Discus, and Social Sciences from 1960 to 2020 was conducted using the MESH search terms "drowning", "near-drowning", "submersion", and "immersion". Cochrane databases were also searched for systematic reviews The items were searched in all fields of publication, including title, abstract, and keyword. RESULTS: The search identified approximately 2500 articles, 230 of which were reviewed. The inclusion criteria were applied to the full text of 230 articles, and 25 articles addressing the different definitions of drowning were assessed. They were reviewed critically by authors using a standard review form. The search identified that there were at least 20 different outcome measures for drowning incidents reported. Definitions of drowning in the literature were found for the following terms: dry versus wet drowning, secondary drowning, drowned and near-drowned, drowning without aspiration and drowning with aspiration, near drowning without aspiration or with aspiration, active drowning, passive drowning, silent drowning, witnessed and unwitnessed, immersion, submersion, death certificate records drowning, unintentional submersion, road traffic injury leading to passenger vehicle drowning, drowning, near drowning, salt or freshwater drowning, and cold water drowning. CONCLUSIONS: In the literature, a lack of consensus was observed but the following terms should not be abandoned; "Non-fatal drowning" which is used to describe death following rescue and life with at least 24 hours of in-hospital survival and the development of one or more complications and "Fatal drowning" which implies death occurring at the scene or 24 h of a submersion incident.

Assessing the design of road traffic death information systems in Iran: A participatory systems approach.

AIM: To describe and analyze the information architecture and information pathways of the road traffic death recording, registration and reporting system in Guilan Province, northernIran. METHODS: We used Business Process Mapping, a qualitative approach. This participatory and iterative approach consists of a document review, key informant interviews, development of a process map and a participatory workshop with key stakeholders to illuminate and validate the findings. We classified the tasks performed in the system into three phases: (1) Identification and recording; (2) Notification and registration, and (3) Production of statistics. RESULTS: We identified 13 stakeholders, with operating and influencing roles in the process of identification, registration and production of statistics about road traffic deaths in Guilan province. The three main sources of road traffic death statistics are the Ministry of Health and Medical Education, the National Organization for Civil Registration and the Forensic Medicine Organization. Our results reveal a highly fragmented system with minimal cross-sectoral data exchange. Each stakeholder operates in a silo resulting in delays and redundancies in the operating system. In the absence of an effective communication among stakeholders, the information exchange was dependent on the family of the deceased. These fragmented information silos alter the compilation of cause of death statistics and result in under-reporting and discrepancies in road traffic deaths figures. CONCLUSIONS: Designing a comprehensive road traffic information system that provides accurate and timely information requires an understanding of the information flow and the entangled web of different stakeholders operating in the system. Participatory systems approaches such as process mapping can assist in capturing the complexity of the system and the integration process by facilitating stakeholders' engagement and ownership in improving the design of the system.

A study of students' use of restraint systems in school transportation services in primary and secondary schools in northern Iran: an observational study.

BACKGROUND: Traffic accidents are one of the leading causes of death and severe injury among child occupants of vehicles in most countries. This has led to the consideration of how to use restraint systems for students in school buses. The purpose of the present study was to determine the percentage of students' use of restraint systems in school transportation services in 2020. METHODS: In the present cross-sectional observational study, seatbelt use was assessed in 400 students in school transport vehicles using a checklist. The observation team sat at their vehicle, at the nearest location on one of the three sides of the school's entrance: they had by manually registering the variable in the checklist. They focused on exactly the first vehicle parked next to the school entrance. There were two other observers to validate the observations. Data were analyzed by SPSS software (version 21). RESULTS: The rate of using restraint systems was 11.3%, use of restraint systems in the Sport Utility Vehicles (SUVs) was significantly higher (P < 0.03), in areas with medium income (P < 0.009) and low income (p < 0.012) as well as when the students were sitting in the rear seats, using the seatbelt were significantly lower (P < 0.001). Seatbelt use in students was less in services driven by drivers over the age of 40 (P < 0.01) and more in vehicles driven by female drivers (P < 0.003) and newer vehicles (p < 0.001). CONCLUSION: School authorities must enforce traffic safety rules for school transportation services. These rules should be taught to drivers, families, and students. A restraint system must be mandatory for all students. School officials must equip their buses with seatbelts and employ school bus assistants to encourage wearing seatbelts and prevent students from standing.

Road traffic crashes in rural setting: an experience of a middle-income country.

OBJECTIVE: To date, there has been little information published on the death of rural road accident deaths. This study uses burden of injury method to explore a more accurate estimate of years of life lost due to road traffic crashes occurring over a four-year period in Guilan province, northern Iran. METHODS: Rural road accident deaths from 2009 to 2013 were extracted from Iran's Forensic Medicine System, Death Registry System and Road Trauma Research center database. RESULTS: During the study period, the average years of life lost due to motor vehicle crashes was 13.8 per 1 000 persons, ranging from 11.9 during March 2011-2012 to 15.8 per 1 000 persons during March 2012-2013. CONCLUSION: Road accident deaths in 2013 remained at the same high level as in 2009. The information obtained from this study provides a new perspective on fatal road traffic crash victims in rural settings and show us that more attention is needed in this area.

Maternal Beliefs and Socioeconomic Correlated Factors on Child Mortality from Drowning in Caspian Sea Coastline.

OBJECTIVE: To investigate maternal beliefs, practices about causes and determinant factors on drowning and maternal socioeconomic correlated factors on child mortality from drowning. METHODS: From March 2005 to March 2009, in a register-based cohort study and household survey, individual records utilizing drowning registry data of northern Iran were enrolled.   Mothers (n=276) who responded to multiple questions in a household survey were included. The patterns, interrelationships and effects of socioeconomic correlated factors on child mortality were analyzed. RESULTS: A significant difference in relation to mother's educational level and age and family income distribution was noticed. Participants in household survey also reported that establishment of a multi-sectorial collaboration, integration of public health messages into local television, additional rescue stations and lifeguard, hazard environment fencing, increasing adult supervision, more support on increasing swimming ability among the children were all effective on reducing of drowning death. CONCLUSION: Due to the high rate of drowning in children and lack of attention among olders, a greater emphasis should be placed on educating mothers to assist a better supervision on their children.

Estimating drowning deaths in Northern Iran using capture-recapture method.

BACKGROUND: Descriptive epidemiological study has shown that drowning is a problem health in low and middle income countries. To analyze records of drowning deaths from two injury registry systems, to ascertain a true estimate of drowning-mortality, it can help to follow up drowning prevention policy. METHODS: This study uses capture-recapture methods to arrive at a more accurate estimate of the number of drowning events occurring over a one-year period in Guilan and Mazandran Provinces, in northern Iran. Records from the Iran's Forensic Medical System and Death Registry System were compared, using five matching approaches based on various combinations of the following variables: gender, place of drowning, date of death, victim age, name, region of residence, and/or place of residence. RESULTS: The results revealed that the estimated number of drowning cases in the study population is much higher than official figures, ranging from 5.26 to 8.25 per 100,000 residents compared to the national figure of 4.5 per 100,000. The completeness of Death Registry System records for drowning was 70% of corrected estimates while the completeness of records from Forensic Medicine was 54.4%. CONCLUSION: We conclude that the use of capture-recapture methodology may provide better accuracy in measuring drowning events. This method may also help reduce bias in the estimate of incidence rates and comparison of different populations.