Comparing epidemiologic features, outcomes, and diagnostic and therapeutic procedures of traumatic patients before and during COVID-19 pandemic: Data from the National Trauma Registry of Iran.

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 < 0.001). In the ≤ 15 years and ≥ 65 years age groups, injuries decreased significantly during the COVID-19 pandemic (p < 0.001). The frequency of intensive care unit (ICU) admission decreased from 694 (16.4%) to 88 (11.4%) (p < 0.001). The mean length of stay at the hospital (days) and at the ICU (days) declined as follow: 8.3 (SD = 17.2) vs. 5.5 (SD = 6.1), p < 0.001 and 7.5 (SD = 11.5) vs. 4.5 (SD = 6.3), p < 0.022. The frequency of diagnostic and therapeutic procedures before and during the pandemic was as follows, respectively: ultrasonography 905 (21.3%) vs. 417 (53.9%) (p < 0.001), echocardiography 313 (7.4%) vs. 107 (13.8%) (p < 0.001), angiography 1597 (37.7%) vs. 534 (69.1%) (p < 0.001), MRI 166 (3.9%) vs. 51 (6.6%) (p < 0.001), surgery 3407 (80.3%) vs. 654 (84.6%) (p < 0.001), and internal/external fixation 1215 (28.6%) vs. 336 (43.5%) (p < 0.001). CONCLUSION: The pandemic affected the epidemiology of traumatic patients in terms of gender, age, educational level, and trauma mechanism. It changed the outcomes of injured patients: ICU admission, length of stay at the hospital and ICU decreased. The patients received more diagnostic and therapeutic procedures during the pandemic. To be more precise, more research is needed on the details.

Adverse Impacts of Imposing International Economic Sanctions on Health.

BACKGROUND: International economic sanctions (IES) influence a country's economic development and the overall welfare of a nation's population. METHODS: An electronic search of PubMed, Embase and Web of Science was conducted until July 31, 2019. Additionally, a list of references to related articles was reviewed. Key search terms were "Economics", "Health", "Sanction", and their equivalents with no language or time restriction. RESULTS: Totally, 8624 records were identified of which 2869 duplicates were deleted. Finally, 24 papers met the inclusion criteria and were selected for drafting. The number of papers included for evaluating each factor included healthcare (n=16) and pharmaceutical industry (n=10). Nine and eight studies examined the effect of sanctions imposed on Iran and Iraq, respectively. France, Haiti, Serbia, Cuba, Syria, and other areas such as Africa were also evaluated. Sanctions lead to a decrease in immunization rates and government health care expenditures. Sanctions increase infant and under-five mortality rate, road traffic injuries and fatalities, severe malnutrition, infective diseases, neurologic and visual disorders, as well as shortage of medical or dental instruments and a variety of medicines. Sanctions have adverse impacts on female labor and are associated with disabling hospitals, dispersing medical workers, and facilities for radiation therapy. CONCLUSION: The health status of sanctioned nations in terms of healthcare, and pharmaceutical industry was adversely affected in targeted countries.

The completeness of the registration system and the economic burden of fatal injuries in Iran.

BACKGROUND: The present study aims to calculate completeness of the current registration system of fatal injuries in the legal Medicine Organization (LMO) and to estimate the economic burden of fatal injuries at the national level of Iran. METHODS: We estimated the completeness of registered fatal injuries using a three-source capture-recapture method among the Legal Medicine Organization, health departments and Traffic police in Hamedan County (HC) from June 22, 2015 to June 21, 2016. We also estimated the economic burden of fatal injuries using Years of Life Lost (YLL) during one year. Then, using appropriate statistical methods, we generalized the estimates to the national level. RESULTS: There were 487 registered fatal injuries in the LMO of HC. The male to female ratio was 2.89. Road Traffic Crashes (RTC) and suicide pertained 45 and 21 percent of deaths, respectively. The completeness of fatal injuries registration was estimated at 86.9%. Based on LMO information of HC, the percentage of fatal injuries numbering errors at the national level was estimated 1.1 times that was reported by LMO in the same period (41,936 vs. 36442). YLL and the economic burden of fatal injuries were estimated 1,706,373 years and 8,692,264,432 US$ at the national level, respectively. CONCLUSION: The completeness of the current registration system of fatal injuries is good. The economic burden of fatal injuries, especially due to motor vehicle crashes in Iran, is substantial. Strategies, legislative actions, and preventive programs should be considered to decrease the number of fatal injuries in our country.

Paraclinical findings in Iranian veterans exposed to sulfur mustard gas: A literature review.

OBJECTIVE: Sulfur mustard (SM) causes various systemic disturbances in human beings. This study aimed to assess paraclinical changes caused by exposure to SM gas in Iranian veterans during the war between Iraq and Iran. METHODS: A literature review was carried out in international and national medical databases including ISI, Medline, Scopus, Iranmedex and Irandoc. Both Farsi and English literature were searched. RESULTS: Search of the literature yielded 422 medical articles related to SM poisoning. Among them, 30 relevant articles were thoroughly reviewed. The most important reported complications were leukopenia, neutropenia, lymphopenia, eosinophilia, thrombocytopenia, increased bleeding time, positive C-reactive protein (CRP), rheumatoid factor (RF), antinuclear antibody (ANA), decreased T helper cells, natural killer cells, IL6, and IL8 levels, elevation of serum immunoglobulins, decreased levels of T3, T4 and cortisol, increased level of adrenocorticotropic hormone (ACTH), proteinuria, hematuria, and elevated liver enzymes. Also, there were some changes in chest assessments. CONCLUSIONS: SM causes profound systemic complications in victims, even years after exposure. The paraclinical changes can be observed in hematology, immune system, biochemistry, hormonal profile and some imaging studies.

Cancer Events After Acute or Chronic Exposure to Sulfur Mustard: A Review of the Literature.

BACKGROUND: Sulfur mustard (SM) has been considered as a carcinogen in the laboratory studies. However, its carcinogenic effects on human beings were not well discussed. The main purpose of our study is to assess carcinogenesis of SM following acute and/or chronic exposures in human beings. METHODS: The valid scientific English and Persian databases including PubMed, Web of Science, Scopus, IranMedex, and Irandoc were searched and the collected papers reviewed. The used keywords were in two languages: English and Persian. The inclusion criteria were the published original articles indexed in above-mentioned databases. Eleven full-texts out of 296 articles were found relevant and then assessed. RESULTS: Studies on the workers of the SM factories during the World Wars showed that the long-term chronic exposure to mustards can cause a variety of cancers in the organs such as oral cavity, larynx, lung, and skin. Respiratory system was the most important affected system. Acute single exposure to SM was assumed as the carcinogenic inducer in the lung and blood and for few cancers including basal cell carcinoma and squamous cell carcinoma. CONCLUSIONS: SM is a proven carcinogen in chronic situations although data are not enough to strongly conclude in acute exposure.

Treatment and prevention of acute respiratory infections among Iranian hajj pilgrims: a 5-year follow up study and review of the literature.

UNLABELLED: Background Respiratory diseases/syndromes are the most common causes of referring to physicians among pilgrims in Hajj. They lead to high morbidity, impose high costs on the health system and are among the major obstacles for pilgrims to perform Hajj duties. The main aim of our study was to determine types, frequencies, etiologies, and epidemiologic factors of respiratory diseases among Iranian Hajj pilgrims and to suggest some preventive and treatment strategies. METHODS: To determine the types and frequencies of respiratory syndromes, we implemented a syndromic surveillance method in Iranian health care system for Hajj during 5 consecutive years. To achieve the etiology of these diseases, we performed 4 concurrent before and after studies. We also evaluated efficacy of the flu and pneumovax vaccines among Iranian Hajj pilgrims in 2 studies. To determine some other epidemiological factors, we conducted 4 additional studies. RESULTS: The most common problem was common cold like syndrome. Origins of the most upper respiratory problems were infections, and allergies were less involved. Among infectious agents, viruses were the most common agents and their frequencies were as follows respectively: Adenoviruses 38 (36.2 %), Rhinoviruses 31 (30%), Influenza type B virus 21 (20%). Bacteria were often the secondary causes and their frequencies were as follows respectively: Intestine bacillus 69 (19.4%), Chlamydia pneumonia 20(15.8%), Haemophiluses 32 (9.1%) and Streptococcus (A,C and G) 30 ( 8.5%). We introduced some epidemiological factors as effective in creating respiratory diseases. CONCLUSION: In this paper, we suggested some applied points for prevention, treatment, and correction of common malpractices in the treatment of respiratory diseases of the pilgrims.

SWOT analysis in Sina Trauma and Surgery Research Center.

The present study was conducted with the aim of identifying and evaluating the internal and external factors, affecting the Sina Trauma and Surgery Research Center, affiliated to Tehran University of Medical Sciences and propose some of related strategies to senior managers. We used a combined quantitative and qualitative methodology. Our study population consisted of personnel (18 individuals) at Sina Trauma and Surgery Research Center. Data-collection tools were the group discussions and the questionnaires. Data were analyzed with descriptive statistics and SWOT (Strength, Weakness, Opportunities and Threats) analysis. 18 individuals participated in sessions, consisting of 8 women (44.4%) and 10 men (55.6%). The final scores were 2.45 for internal factors (strength-weakness) and 2.17 for external factors (opportunities-threats). In this study, we proposed 36 strategies (10 weakness-threat strategies, 10 weakness-opportunity strategies, 7 strength-threat strategies, and 9 strength-opportunity strategies). The current status of Sina Trauma and Surgery Research Center is threatened weak. We recommend the center to implement the proposed strategies.

Assessing the oldness and capacity of radiography and ultrasound equipments in tehran university of medical sciences.

BACKGROUND: Maintenance of imaging equipment is a very important part of the management of all medical imaging centers. OBJECTIVES: To assess the oldness and capacity of radiography and ultrasound equipment in Tehran University of Medical Sciences. MATERIALS AND METHODS: The study was performed in 16 hospitals, 4 faculties and three healthcare centers of Tehran University of Medical Sciences. We evaluated all the X-ray equipment (including the simple plain and dental, panorex, mammography, fluoroscopy and C-arm X-Ray devices) and also simple and Doppler ultrasound machines in terms of the type and usage of the device, production year, quantity of utilization, location, brand and current condition. RESULTS: Among fixed X-ray systems, 15 were currently in use, two were junk, two were damaged, and one was not utilized. The mean (SD) of the usage of these was 2151 (2230) cliché/month, and the mean (SD) of the oldness was 16.9 (13.6) years. The oldness of radiography equipment in our study was more than 20 years in 16, between 11 and 20 in 46, and less than 10 years in 76 devices. The mean (SD) usage (patients/month) of simple and color Doppler devices were 234.1 (365.2) and 597.5 (505.3), respectively. The oldness of ultrasonography equipment in our study was more than 11 years in 12 and less than 10 years in 55 devices. We found that 22 (15.9%) of the radiography systems and two (3%) of the ultrasonography systems had been used for more than 20 years. CONCLUSION: Radiology equipment in Tehran University of Medical Sciences have potential capacity, but they need repair, and better maintenance and management and application of standards for the imaging system needs organized supervisory mechanisms.

Long-term effects of mustard gas on respiratory system of Iranian veterans after Iraq-Iran war: a review.

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. Prevalence of pulmonary involvement is approximately 42.5%. The most common complaints are cough and dyspnea. Major respiratory complications are chronic obstructive pulmonary disease, bronchiectasis, and asthma. Spirometry results 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 mustard lung. The effective treatment regimens consist of oxygen administration, use of vaporized moist air, respiratory physiotherapy, administration of mucolytic agents, bronchodilators, corticosteroids, and long-acting beta-2 agonists, antioxidants, surfactant, magnesium ions, therapeutic bronchoscopy, laser therapy, placement of respiratory stents, early tracheostomy in laryngospasm, and ultimately 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.

Preventive measures against the mustard gas: a review.

The main aim in this study was to collect the experiences of Iranian researchers about sulfur mustard (SM) and provide a guideline for the prevention of abuse for this dangerous agent. We searched valid national and international databases using related key words in the two languages. We found 193 articles which had been published in medical journals. Among them, 25 articles had some implications about prevention measures. In this study, we have mentioned 8 preventive points before the attacks, 10 points during and 2 points afterwards, we also found 12 points for the prevention of people who were exposed with SM and suffering from respiratory, ocular, dermatologic and psychological complications. In conclusion, most of the published studies on chemical war victims in Iran are focused on diagnosis and treatment of late SM-induced complications. Hence, a research should be conducted separately in relation to the prevention.

Diagnostic accuracy of ultrasound in determining the cause of bilious vomiting in neonates.

BACKGROUND: Plain radiography and contrast radiologic studies are traditionally the main options in evaluating neonates presenting with bilious vomiting. While ultrasonography (US) is more available, its diagnostic accuracy is in question. OBJECTIVES: The purpose of this study is to determine the diagnostic accuracy of US in evaluating these patients with bilious vomiting. PATIENTS AND METHODS: All neonates with bilious vomiting or bilious nasogastric tube drainage presented to a children's hospital in a 1.5-year period were included. US were performed in all patients. The results were compared with clinical and radiological data and the final diagnosis. We used chi-square and Fisher's exact tests for analysis. RESULTS: The cause of bilious vomiting for 18 of the 23 included patients was surgical. All patients labeled as surgical candidates by US ended in surgery [positive predictive value (PPV) = 100%], while only 50% of the patients with inconclusive US were operated [negative predictive value (NPV) = 50%, Confidence Interval (CI) 95%: 29%-71%]. The sensitivity and specificity of US in diagnosing intestinal atresia (n = 9) was 89% [CI 95%: (68% - 100%)] and 100%. In cases with malrotation (n = 4) and midgut volvulus (n = 2), sonographic diagnosis was in concordance with final surgical diagnosis. CONCLUSION: This study suggested that in cases in which US makes a certain diagnosis, its accuracy eliminates the need for further diagnostic tests, but if it is inconclusive, further radiological contrast studies should be tried to make the final diagnosis.

Immunogenicity of trivalent influenza vaccine in children with acute lymphoblastic leukemia during maintenance therapy.

PURPOSE: The aim of this study was to assess the immune response of children with acute lymphoblastic leukemia (ALL) to influenza vaccine and to compare it with healthy controls. PROCEDURE: Thirty-two children aged 1-18 years with ALL on maintenance therapy and 30 healthy sibling controls were enrolled in the study. All children were vaccinated with trivalent inactivated influenza vaccine. Hemagglutinin-inhibition (HI) antibody titers were determined in sera of both patient and control groups just before and 4 weeks after vaccination. The ability of each group to mount a protective (> or =40) and/or fourfold titer was measured. RESULTS: The protective response for virus subunits among patients and healthy controls were 43.4% versus 88% for H1N1 (P = 0.04), 63.3% versus 80% for H3N2 antigens (P = 0.06), and 26% versus 73% for B antigen (P = 0.001). Responses for H1N1 and B subunits were significantly lower in patients than controls. In the patient group, the significant response to each virus was demonstrated in the analysis of pre- and post-vaccination geometric mean titer (GMT) (P = 0.001). The percentage of patients and controls with fourfold increase in HI titers were 56.2% versus 80% for H1N1 (P = 0.04), 40.6% versus 53.3% for H3N2 (P = 0.31), and 59.4% versus 83.3% for B (P = 0.038). Immune responses for H1N1 and B subunits were significantly lower in patients than controls. CONCLUSIONS: Influenza vaccine is tolerated well in ALL patients with acceptable but limited immune response compared to healthy controls. These findings support the recommendation for annual influenza vaccination in children with ALL.

Neonatal nosocomial infections in Bahrami Children Hospital.

OBJECTIVE: Nosocomial infections are one of the most important causes of mortality and morbidity in hospitals. These are major public health problems worldwide, but particularly in developing countries. These infections have the most common frequency in pediatric hospitals-especially in neonatal wards- second to burn hospitals. In the present study, neonatal nosocomial infections have been reviewed in Bahrami Children Hospital from fall of 1999 through fall of 2004. METHODS: Nosocomial infected patients were defined as all patients who were neither infected not were in incubation period at the admission time and had positive culture after third day of admission. The incidence of nosocomial infections computed as infections per 100 hospital discharges and infections per 100 hospital days. Chi square test was used for comparison of rates. RESULTS: Fifty-two patients had been diagnosed having nosocomial infections. NICU (Neonatal Intensive Care Unit) showed the highest portion of infections (40%) followed by neonatal surgery ward (35%) and neonates ward (25%). Frequencies of nosocomial infection by site were as follows: eyes (27%), septicemia, surgical wounds and location of drain or catheter (each one 21%), CSF (7%) and urinary (2%). The most common pathogenic organisms were Enterobacter (27%), aurues Staphilococcus (21%), Klebsiella (18%), E.coli (14%) and epidermis Staphilococcus (9%). Total number of hospitalized patients was 5990 and total number of hospitalized days was 39,095 in the five years. Infections per 100 hospital discharges and 100 hospital days by service were as follows, respectively: NICU (2.9, 0.26), neonatal surgery (1.7, 0.18) and neonates (0.3, 0.06). The differences were significantly meaningful (p value< 0.001). CONCLUSION: These findings provide useful information for future surveillance in association with prevention programs. Subsequently, surveillance should be focused on high-risk patients in intensive care unit and/or who have undergone surgery and invasive procedures.

Sweat test in asthmatic children; a single center study.

Asthma and Cystic Fibrosis (CF) have some identical manifestations. In the present study, the frequency of positive sweat test was assessed in asthmatic children. This cross-sectional study was performed in asthmatic children, who were referred to Bahrami Children Hospital, Tehran, during July 2003 to July 2005. Sweat test was performed for all children. One hundred and thirty five (95 males and 40 females) asthmatic were studied. Sweat test was positive in 35 (26%) patients. Major signs and symptoms among these 35 patients were: Cough (35/35), Dyspnea (7/35), Chronic Diarrhea (6/35), and steatorrhea (1/35). Failure to thrive was found in 31 of 35 patients. The mean duration of asthma in patients with positive test was 49.3 months, which was significantly higher than 18.1 months in the group with negative test (P=0.001). Significant relations between recurrent respiratory tract infections (P=0.029), chronic diarrhea (P=0.001), failure to thrive (P=0.0001), and positive sweat test were found. Sweat test should be recommended in asthmatic children with recurrent upper respiratory tract infections, long duration of asthma, chronic diarrhea, and failure to thrive.