Background: Blunt abdominal trauma (BAT) is one of the major causes of mortality and morbidity, and its diagnosis and treatment are still challenging.Objectives: This study aimed to evaluate the association between intra-abdominal injuries and clinical, imaging, and laboratory findings in children with BAT.Methods: This cross-sectional study evaluated children diagnosed with BAT who were candidates for computed tomography (CT) of the abdomen and pelvis referred to the level-1 trauma center of Hashminejad, Taleghani, and Emdadi Hospitals of Mashhad. The demographic information, results of physical examination, CT, Sonography for Trauma (FAST), vital signs, and laboratory tests were recorded. Results: A total of 96 children with BAT, with a median age of 10.5 (Q1, 8, Q3, 13), were enrolled. Organ injury was observed in 33% of patients on CT, 20% on FAST, and 54% on physical examination. Moreover, abnormal amylase, lipase, ALT, and AST were found in 23%, 12%, 31%, and 34% of cases, respectively. The abnormal levels of amylase and lipase showed 91.3% and 52% sensitivity, 97% and 100% specificity, and an AUC of 0.99 (95% CI 0.975-1.00) and 0.973 (95% CI 0.947-0.99), respectively. Moreover, abnormal AST and ALT levels had a sensitivity of 91.3% and 87.0%, specificity of 88% and 85.0%, and AUC of 0.95 (95% CI 0.88-1.00) and 0.928 (95% CI 0.84-1.00). The logistic regression results showed that the odds ratio for ALT>45 IU/L was 8.18 (95% CI 2.20, 30.31, P=0.002). Conclusion: Serum ALT, AST, amylase, and lipase levels may be valuable in predicting BAT in children. However, further studies with more patients are necessary to confirm the results of the present study.
Background: Displaced humeral shaft fractures are among the most frequent long-bone fractures that often require surgical fixation. However, the optimal surgical method remains controversial. Objectives: This study aimed to compare the outcomes of open reduction and internal fixation (ORIF) with plating versus intramedullary Methods: This prospective cohort study included patients undergoing surgery for displaced humeral shaft fractures at Kashani Hospital, Isfahan, Iran, between 2020 and 2022. Demographic and clinical data were collected. Patients were evaluated postoperatively using the Visual Analogue Scale (VAS), Constant-Murley Score, the Mayo Elbow Performance Index (MEPI), and union time. Complication rates and surgical duration were also recorded. Results: Of 85 patients, 43 received plating and 42 underwent nailing. The plating group had higher rates of infection (superficial: 21.4%, deep: 9.5%) and nerve damage (23%) compared to the nailing group (0% and 3%, respectively). Reoperation was required in 9% of plating cases compared to 3% in the nailing group. Shoulder impingement occurred only in the nailing group (33%). The nailing group had a shorter operative time (63.8 +/- 8.3 min vs. 94.1 +/- 11.2 min) and a faster fracture union (15.3 +/- 2.2 weeks vs. 18.8 +/- 2.1 weeks). Functional and pain scores showed statistically significant differences, favoring nailing in terms of MEPI, while favoring plating in terms of the Conclusions: Both ORIF with plating and IMN achieved satisfactory outcomes. However, intramedullary nailing may be preferable in patients at high risk of nonunion due to faster recovery and lower complication rates.
Archives of Trauma Research (ATR) (eISSN: 2251-9599) has steadily evolved into a platform for disseminating interdisciplinary insights into trauma care, prevention, rehabilitation, and outcomes. Since its inception in 2012, the journal has built a substantial corpus of knowledge, publishing over 450 articles across 56 issues (14 volumes).[1] As the field of trauma research continues to expand in complexity and scope, our journal aims to stand at the intersection of clinical science, policy development, and human resilience. This editorial highlights emerging directions in trauma research, global publication trends, and the evolving methodological and ethical frameworks shaping the discipline. By reflecting on current evidence and future priorities, we reaffirm our commitment to fostering impactful scholarship and collaborative scientific exchange.Trauma as an irregular and disordered event is a major cause of mortality and long-term disabilities on one hand and may lead to profound psychological, social, and economic consequences on the other hand, many of which are themselves the result of a continuing process initiated by the primary irregularity, with an indefinite final outcome. As Schnyder emphasized, trauma is a global issue requiring comprehensive research agendas and equitable access to evidence-based care.[2] The need for integrated, multidisciplinary trauma research is particularly pressing in low- and middle-income countries (LMICs), where trauma-related mortality remains disproportionately high and data infrastructure is often limited.[3]In this context, ATR seeks to serve as a conduit between regions, institutions, and disciplines-bridging surgical, psychological, and public health perspectives. This role is reflected in our diverse international contributions, with published articles from Iran, the USA, Brazil, Turkey, India, Mexico, South Africa, Saudi Arabia, China, Germany, Ireland, the UAE, Thailand, Italy, and others.[1] By publishing case reports, cross-sectional studies, various types of cohort studies, and interventional research, ATR aims to clarify traumatic events and their underlying causes, ultimately contributing to the development of well-defined and organized knowledge. Our mission aligns with the global shift toward inclusive and outcome-oriented trauma research, first articulated by Ekkernkamp,[4] who called for platforms that emphasize interdisciplinary and patient-centered approaches.Recent bibliometric analyses illuminate the field's rapid growth and thematic evolution. Research has dynamically shifted toward system-based management, prehospital care, and patient-centered recovery.[5] The field has also diversified significantly into domains like psychological trauma and rehabilitation.[6] In response, ATR proactively adapts its editorial priorities to encourage methodological rigor and promote underrepresented areas, including trauma in low-resource settings and long-term outcomes for pediatric and geriatric populations. Our scope encompasses trauma, emergency medicine, orthopedics, neurosurgery, and related specialties, and we are actively pursuing international development programs to increase our global presence.[1]Robust methodology is the cornerstone of credible trauma research. The field increasingly relies on large-scale registries and multicenter trials to generate generalizable insights.[7] The ATR champions this rigor while also grappling with challenges like data quality variability. Our international editorial operations are underpinned by strict quality policies and diligent peer-review follow-up to ensure accountability and enhance the quality and quantity of submissions.[1] Furthermore, the journal encourages exploration of artificial intelligence (AI) to predict trauma outcomes, optimize resource allocation, and personalize rehabilitation pathways. Aligning with calls for a coherent, translational research strategy, the journal advocates for responsible data sharing through data availability statements and open-access ethics, ensuring transparency while protecting vulnerable populations.Setting global research priorities has become a collaborative effort. Recent initiatives, such as the James Lind Alliance partnership, have identified critical needs in hemorrhage control, rehabilitation, and posttraumatic psychological care.[8] The ATR is aligned with this collaborative vision, serving as an inclusive platform for studies that span from molecular biology to prehospital logistics and social determinants of health. The journal supports the formation of national trauma research networks to reduce fragmentation and accelerate knowledge translation.[9]The journal recognizes trauma studies as integral to a holistic understanding of psychological injury. It publishes research on the growing attention to Post-Traumatic Stress Disorder (PTSD), its comorbidities, and neurobiological underpinnings, including the long-term health impacts on aging populations.[10] Furthermore, ATR provides a platform for critical work on historical and intergenerational trauma, emphasizing the need for culturally competent care.The journal has also actively addressed urgent global health and humanitarian emergencies, including the widespread mortality associated with the COVID-19 pandemic[11-13] and the humanitarian consequences of regional conflicts such as the Iran–Israel crisis,[14] by promoting timely scientific discourse and evidence-based reflection. Ethical stewardship is the foundation of trauma research. Jefferson et al.,[15] systematically reviewed recommendations for research involving trauma-exposed populations, emphasizing informed consent, researcher safety, and mitigation of vicarious trauma. At ATR, we are committed to upholding the highest ethical standards by requiring clear statements on participant welfare, data confidentiality, and conflict of interest disclosures. Conclusion: A Commitment to Global ImpactThe future of trauma research is unequivocally interdisciplinary, collaborative, and global, and ATR is dedicated to being a cornerstone of this progress by publishing high-quality studies that inform policy, refine practice, and ultimately reduce the global burden of trauma. Our indexed presence in databases such as the Web of Science Emerging Sources Citation Index (ESCI), EMBASE, IMEMR, and DOAJ, along with abstracting partnerships with EBSCO, ProQuest, and Hinari, ensures the global discoverability of this work. Our growing impact is reflected in our Journal Impact Factor, which was first awarded in 2022 (0.4), and we continue to build our scholarly influence.[1] Our commitment extends beyond publishing; it is about actively cultivating a global research community that is equitable, rigorous, and impactful. We will continue to champion research that bridges the critical gap between high-income and low-resource settings, ensuring that advancements in trauma science benefit all populations. By prioritizing open science, ethical stewardship, and the integration of diverse perspectives -from the molecular to the societal- the journal empowers a generation of scholars. Our ultimate goal is to ensure that the knowledge disseminated through our pages directly translates into saved lives, restored health, and the strengthening of health systems worldwide, thereby meaningfully reducing the global burden of trauma.
Background: Horner’s syndrome is characterized by the triad of miosis, ptosis, and anhidrosis, indicating disruption in the oculosympathetic pathway. It typically occurs following injury to the cervical sympathetic chain, often secondary to neoplasms or surgical procedures. This syndrome occurring after chest trauma is rare and has been documented only in a limited number of case reports. Case presentation: A 42-year-old man was admitted with a stab wound to the left subclavicular region. He had a massive left hemothorax, rupture of the left subclavian vein, and a laceration of the superior lobe of the left lung, all of which were successfully managed. A miotic left pupil was noted on admission, and anhidrosis of the face and hand on the same side was reported the following day. The symptoms were attributed to the compressive effect of an apical lung hematoma. The patient’s symptoms remained unchanged during a 6-month follow-up period. Discussion: Horner’s syndrome following trauma may aid clinicians in recognizing serious and potentially life-threatening conditions, such as aortic dissection, highlighting the importance of a thorough evaluation of the neural pathways in thoracic injuries.
Background: Hand extensor tendons, which are prone to injury due to their superficial location and limited protection, have traditionally been repaired using non-absorbable sutures. However, these sutures can lead to complications such as irritation and contour defects.Objectives: The aim of this study was to explore the potential of absorbable Polyglactin 910 sutures in improving functional recovery in extensor tendon repair compared to nylon, with the aim of reducing postoperative complications.Methods: This prospective cohort study included 118 patients who underwent extensor tendon repair using Polyglactin 910 or nylon sutures at Kashan Shahid Beheshti and Naghavi Hospitals in 2024. Demographic data, injury characteristics, and postoperative outcomes were collected from hospital records and follow-up assessments. Statistical analysis was conducted using SPSS version 26, with significance set at p < 0.05.Results: The two groups were clinically and demographically comparable, with no significant differences in baseline characteristics, injury severity, or surgeon distribution. Postoperative outcomes showed no significant differences in infection, pain, or wound dehiscence. However, reduced range of motion at 1 month was observed more frequently in the nylon group (30.4% vs. 13.6%, p = 0.043), and foreign body sensation at 3 months was also higher in the nylon group (10.8% vs. 1.8%, p = 0.048). These findings suggest that Polyglactin 910 sutures may provide improved early mobility and a lower incidence of late inflammatory reactions compared with nylon sutures. Conclusion: Polyglactin 910 sutures were associated with reduced complications, such as improved range of motion and lower foreign-body sensation while showing no significant differences in infection rates or pain compared to nylon sutures. These findings suggest that Polyglactin 910 is preferable for extensor tendon repair, particularly in cases where minimizing inflammatory reactions and preserving mobility are of critical importance. Further studies with more extended follow-up periods are recommended to confirm these results.
Background: Kirschner wire [K-wire] is commonly used to fix a wrist fracture; however, it may damage the (K-wire) surrounding nerves. Although ulnar-nerve injury is uncommon, when it occurs, it can lead to symptoms like numbness, tingling, or hand-muscle atrophy, such as clawing. Sometimes, the complexity of manifestations presents both diagnostic and therapeutic challenges, as encountered in our case, and these symptoms are often overlooked by clinicians. Early detection is vital for effective management and improved outcomes. Case Presentation: A 59-year-old man presented with intense convulsions in his left forearm and hand, which felt like electric shocks. This distressing sensation was triggered by any movement of his hand, and he reported a strange sensation of having lost his three medial fingers, despite having normal sensations elsewhere. He had been experiencing these symptoms for two years and had been treated with anticonvulsant medications. After surgery, we removed an unusual connection between the nerves, and subsequently the symptoms resolved. Discussion: It is essential to pay close attention to injuries related to K-wires fixation, especially when they involve the major motor nerves of the hand. Overlooking these injuries can lead to serious consequences.
Background: Respecting patients’ rights in intensive care units (ICUs) requires a delicate balance between clinical imperatives and religious obligations, including ritual requirements, jurisprudential rulings, ethical norms, and organizational policies. Practical and interdisciplinary evidence on the feasibility of designing and implementing ICUs that systematically integrate these dimensions in accordance with religious regulations remains limited. Objectives: This study aimed to explore the principles, barriers, and operational strategies for adapting ICUs to religious considerations.Methods: This qualitative research was conducted using a thematic analysis approach among 29 participants, including specialists in anesthesiology, medical ethics, ICU nursing, hospital management, hospital engineering, and family members of patients, across two university hospitals selected by purposive sampling. Semi-structured interviews were conducted until data saturation was achieved. Data were analyzed using MAXQDA software based on Braun and Clarke’s six-phase framework, and the trustworthiness of the findings was ensured according to Lincoln and Guba’s criteria. Results: Data analysis yielded three main themes, 12 categories, 31 subcategories, and 84 codes. Theme 1, Religious Obligations and Patients’ Rights: This theme emphasizes ensuring opportunities for worship, maintaining privacy and dignity, providing transparent information, observing end-of-life religious principles, and guaranteeing halal nutrition and medication. Theme 2, Implementation Challenges: This theme highlighted constraints in human and physical resources, alongside the critical condition of patients, as significant barriers to fulfilling religious requirements. Theme 3, Operational Strategies: This theme focused on faith-based technical and managerial design, family involvement, and Islamic financial support as practical pathways for establishing religiously compliant ICUs.Conclusion: Adapting ICUs to religious regulations requires a multidimensional and phased approach that integrates jurisprudence, engineering, and clinical medicine. Implementing the recommendations of this study may provide a robust foundation for developing a context-specific model of religiously compliant ICUs, along with protocols, monitoring indicators, and ethical-religious policies for hospital design.
Background: Road traffic injuries (RTIs) are a leading cause of mortality and disability worldwide, particularly in low- and middleincome countries (LMICs). In Iran, RTIs remain a significant public health challenge, especially in provinces such as Khorasan Razavi. Understanding the trends and patterns of RTI mortality is essential for developing effective public health strategies and interventions. Objectives: The primary objective of this study was to analyze the temporal trends in road traffic-related mortality in Khorasan Razavi Province over an 11-year period (2013-2023) and identify demographic groups most at risk. Methods: This descriptive-analytical cross-sectional study used mortality data from the Mashhad University of Medical Sciences registry, which records all RTI-related deaths. We calculated crude and age-specific mortality rates, analyzed the temporal trends, and computed Years of Potential Life Lost (YPLL) to estimate the societal impact of premature deaths. Results: A total of 10,308 RTI-related deaths were recorded. The Cause-Specific Mortality Rate (CSMR) declined by 33.96%, from 27.31 per 100,000 in 2013 to 18.04 per 100,000 in 2023. Young adults (15-24 years) and the elderly (>= 70 years) were the most vulnerable groups, with pedestrian fatalities remaining the leading cause of death. Additionally, bicycle and light vehicle-related fatalities saw a significant increase. The YPLL was highest among younger individuals, indicating the long-term societal cost of these deaths. Conclusion: Although the overall mortality rate from road traffic accidents has decreased, RTIs continue to pose a significant public health issue in Khorasan Razavi Province. The findings highlight the need for targeted interventions for vulnerable groups, including youth, the elderly, and pedestrians, as well as improvements in infrastructure and road safety measures.
Background: Deep vein thrombosis (DVT) is a serious condition, particularly prevalent among hip fracture patients, with high morbidity and mortality. Objectives: This study applied the Walker and Avant model to clarify the concept of DVT and enhance clinical understanding.Methods: A systematic concept analysis was undertaken in accordance with the Walker and Avant framework, which delineates eight essential steps from concept selection to the identification of empirical referents. The literature review was conducted using the PRISMA methodology, encompassing a comprehensive search across multiple databases, including PubMed and Google Scholar, covering the period from 2019 to 2023. Studies were included based on their relevance to DVT, publication in English, and the presence of pertinent keywords within titles and abstracts.Results: The analysis confirmed the high incidence of DVT following surgery in patients with hip fractures and identified key risk factors, including immobility and inadequate post-operative care. Prophylactic interventions were shown to reduce the incidence of DVT, underscoring the critical importance of preventive strategies in clinical practice.Conclusion: DVT presents a major postoperative risk, especially in orthopedic patients. This analysis outlines its pathophysiology, key risk factors, and evidence-based strategies to enhance prevention and perioperative care, guiding clinical teams to reduce its incidence and improve outcomes.
Background: Hip fractures are associated with increased mortality, with men experiencing worse outcomes than women following osteoporotic fractures. Hand Grip Strength (HGS) may serve as a significant predictor of outcomes among patients with hip fractures. Objectives: This study aimed to investigate the association between low HGS and early mortality risk in elderly male patients with osteoporotic hip fractures treated at a tertiary hospital in Mexico. Methods: This cohort study was conducted at a tertiary hospital and included patients aged >= 70 years who were admitted with a diagnosis of hip fracture. Data were obtained from the patients and their caregivers within 48 hours of admission and before surgery. Medical history was obtained, and HGS was measured using a Hydraulic Hand Dynamometer. The data were subsequently categorized into tertiles. Participants were followed up for one year after surgery. Results: The study involved 207 patients who were categorized into different tertiles based on their HGS, with the first tertile representing the weakest individuals. A total of 40 patients died within the first year of follow-up; 19 (47.5%) were in tertile 1, 18 (45%) in tertile 2, and 3 (7.5%) in tertile 3. The mean age of deceased patients was 83 years, compared with 80 years among survivors. Patients who died also had comorbidities and a lower pre-fracture Barthel's index. Conclusion: In elderly men experiencing low-trauma hip fractures, preoperative low HGS is a crucial indicator of increased mortality risk within the subsequent year.
Background: Pediatric acetabular fractures are rare, typically only resulting from a high-energy trauma. The same applies to pediatric proximal femoral fractures. The combination of both fractures is exceptionally uncommon and carries a high risk of complications, including avascular necrosis, nonunion, coxa vara, and premature physeal closure. Case presentation: An 11-year-old female patient presented with severe right hip pain following a fall down stairs. There was no gross limb shortening or rotational deformity. Anteroposterior, lateral, and Lowenstein projection radiographs revealed a proximal epiphysiolysis fracture of the right femur with severe displacement, associated with a fracture of the ipsilateral posterior acetabular wall. A posterior surgical approach to the right hip was used to carefully reduce both the femoral epiphysiolysis and acetabular fracture. Fixation of the acetabulum was achieved using a small reconstruction plate and screws, while the femoral neck was stabilized with a 7.0-mm partially threaded cannulated screw. Although satisfactory reduction and fixation were achieved, follow-up assessments revealed signs of articular deformity and secondary osteoarthritis. Conclusion: Although rare, the pathology presented in this case report highlights the clinical importance of this injury. The post-operative complications following both isolated fractures are high. When these fractures occur in association, we postulate that the risk of complications is significantly increased and may lead to more severe functional impairment.
Background: Hip fractures are associated with increased mortality, with men experiencing worse outcomes than women following osteoporotic fractures. Hand Grip Strength (HGS) may serve as a significant predictor of outcomes among patients with hip fractures. Objectives: This study aimed to investigate the association between low HGS and early mortality risk in elderly male patients with osteoporotic hip fractures treated at a tertiary hospital in Mexico.Methods: This cohort study was conducted at a tertiary hospital and included patients aged ≥70 years who were admitted with a diagnosis of hip fracture. Data were obtained from the patients and their caregivers within 48 hours of admission and before surgery. Medical history was obtained, and HGS was measured using a Hydraulic Hand Dynamometer. The data were subsequently categorized into tertiles. Participants were followed up for one year after surgery.Results: The study involved 207 patients who were categorized into different tertiles based on their HGS, with the first tertile representing the weakest individuals. A total of 40 patients died within the first year of follow-up; 19 (47.5%) were in tertile 1, 18 (45%) in tertile 2, and 3 (7.5%) in tertile 3. The mean age of deceased patients was 83 years, compared with 80 years among survivors. Patients who died also had comorbidities and a lower pre-fracture Barthel’s index. Conclusion: In elderly men experiencing low-trauma hip fractures, preoperative low HGS is a crucial indicator of increased mortality risk within the subsequent year.
Background: Many motorcyclists choose not to wear helmets, yet it remains unclear why they are not being fined by police or other authorities.Objectives: The aim of this study was to explore legislators’ perspectives on the factors contributing to the lack of enforcement of motorcycle helmet laws by police and legislative bodies.Methods: This qualitative study was conducted in northern Iran and employed a conventional content analysis with an inductive approach. Participants were recruited through snowball sampling. The research took place from 2019 to 2020, with interview locations chosen based on participants’ preferences, including both private and public settings. Data collection was guided by a semi-structured interview framework. Data analysis was carried out using the methodology developed by Graneheim and Lundman (2004).Results: Based on the experiences of 20 participants, three main categories and twenty subcategories were identified. The primary reasons cited by legislators for the non-enforcement of motorcycle helmet laws included legislators’ own needs, challenges in accessing offenders, and poor management.Conclusion: The findings suggest that addressing legislators’ needs, improving access to motorcyclist offenders, and enhancing offender identification could help overcome enforcement challenges. Furthermore, implementing a stronger management system and more robust policies may improve the enforcement of helmet laws.
Background: Road traffic accidents remain a leading cause of injuries and fatalities worldwide, with human error as a major contributing factor. Advanced Driver Assistance Systems (ADAS) play a crucial role in reducing such accidents by supporting drivers in the decision-making process. However, drivers' awareness, perception, and trust in ADAS are critical to ensuring their effective use. Objectives: The aim of this study was to assess the level of awareness, perception, and trust regarding ADAS among drivers in Tabriz, Iran, and to identify the demographic and vehicle-related factors influencing these variables. Methods: This study used a cross-sectional survey design with a quantitative approach. A self-administered questionnaire was distributed among 450 drivers. The data were analyzed using descriptive statistics, chi-square tests, Pearson correlations, and ordinal logistic regression models to determine significant relationships and predictive factors. Results: The results of the present study revealed that gender, age, driving experience, and vehicle type significantly influenced drivers' awareness of ADAS. A strong positive correlation was found between ADAS awareness and the level of trust in the system (r = 0.62, p < 0.001). Ordinal logistic regression analysis showed that demographic factors significantly predicted ADAS awareness, explaining 37% of the variance (Pseudo R-2 = 0.37). Conclusion: Drivers' awareness and perception of ADAS are influenced by several key demographic and vehicle-related factors. Promoting educational and advertising campaigns may enhance knowledge and trust in these technologies, ultimately improving road safety and reducing traffic accidents.
Background: Road Traffic Injuries (RTIs) represent a significant public health challenge in Iran. Although the Iranian Red Crescent Society (IRCS) is a key humanitarian organization with extensive operational capacity, its role in RTI prevention remains inadequately articulated. Clarifying and expanding the roles of the IRCS can improve interagency coordination, optimize resource allocation, and facilitate evidence-based policymaking to alleviate the burden of traffic-related injuries. Objectives: This study employed a multimethod qualitative design to systematically define and develop the roles of the IRCS in RTI prevention. Methods: The study was conducted in Iran in 2024 using a multimethod qualitative approach. The first phase involved a scoping review of international literature and official documents to identify existing roles of Red Cross and Red Crescent Societies in RTI prevention. In the second phase, semi-structured interviews were conducted with 22 participants, including IRCS officials, RTI specialists, and relevant stakeholders, selected via purposive sampling with maximum variation (e.g., organizational position, geographic distribution, and professional experience). Interview transcripts were analyzed using conventional content analysis. The third phase consisted of two Delphi rounds with a panel of 15 experts who assessed the relevance and feasibility of the proposed roles through a structured questionnaire. Data from all phases were integrated iteratively, and validity was ensured through triangulation, member checking, and peer debriefing. Results: The scoping review identified 15 relevant publications, from which 14 preliminary roles were extracted and categorized into four thematic areas. The interview data contributed additional roles and contextual insights, resulting in an expanded framework of 20 roles. The Delphi process achieved consensus (defined as >= 80% agreement) on 18 roles. The most highly endorsed roles included public education, integration into national traffic safety initiatives, and volunteer training. Divergent opinions primarily concerned the extent of the IRCS's involvement in advocacy and policymaking. The final framework comprises 5 themes and 18 roles, providing a context-specific, evidence-informed strategy for IRCS engagement in RTI prevention-thereby addressing a critical gap in Iran's current public health approach. Conclusion: The findings suggest that the IRCS can play a substantial role in RTI prevention through public education and empowerment, knowledge translation, and enhancing both the quality and scope of services provided to RTI victims.
Background: Driver drowsiness is one of the most significant causes of traffic accidents worldwide. As accident rates increase, scientific studies in this field have grown. Objectives: This study examines trends in research related to risk factors and outcomes of driver drowsiness, providing comprehensive insights into the current state of science and existing gaps through performance, network, and content analyses in a bibliometric review.Methods: Articles with relevant keywords were searched and extracted from the Web of Science database. After initial screening, the bibliometric R software was used for performance analysis, and VOS viewer was employed to analyze and visualize key terms and create scientific maps.Results: The analysis included 369 articles from 1971 to 2023, with a growth rate of 4.44%, written by 1,363 authors from 55 countries and 548 institutions. Most articles were published in English (363), with single articles in Turkish, Spanish, Russian, Portuguese, German, and French. Based on document count, citations, and normalized citations, the USA, Australia, and Sweden ranked first, second, and third, respectively. There were 108 scientific collaborations between countries, with the USA having the highest total link strength (102). France and the Netherlands ranked second and third with total link strengths of 21 and 19, respectively. New Zealand and Fiji had the highest collaboration (six joint articles), followed by Sweden and France with five joint articles. Conclusion: This study highlights the growing research trend in driver fatigue and related accidents. Since fatigue seriously impacts road safety, further research is essential on fatigue prevention and utilizing modern technologies for the simulation and detection of driver fatigue risks.
The recent twelve-day armed conflict in Iran has once again exposed critical weaknesses in the country's health system when facing large-scale emergencies. Despite earlier warnings about rising geopolitical tensions, healthcare infrastructure -similar to failures seen during earthquakes, floods, the COVID-19 pandemic, and climate-related disasters- proved ill-prepared for the disruption’s scale and complexity.[1] Iran’s digital infrastructure experienced limitations during the conflict. Reports of severe disturbances are available in the literature, namely Northern Ethiopia (Tigray) Conflict, where digital health systems -including patient records- were destroyed, highlighting the need to transition from fragile, outdated systems to resilient digital health architecture.[2] Research emphasizes that digital resilience demands not just technical backups but adaptive and transformative capacity to resist cyber threats and infrastructure breakdowns.[3] Communication among healthcare personnel also failed. Social media platforms, often used for coordination, were inaccessible, which hindered real-time team response. The EU’s Critical Communication System (EUCCS) offers a model for secure communication during crises.[4] Healthcare workers -from students to professionals-demonstrated commitment, but faced immense psychological and financial burdens. In the absence of structured support, this underscores the urgent need to invest in health workforce resilience. According to WHO and OECD guidelines, this involves workforce planning, crisis training, and well-being programs.[5, 6] To enhance health system resilience, we urge immediate action in the following areas: · Integrate academic and clinical institutions into emergency preparedness. · Establish health policy think tanks linked to crisis response bodies. · Develop secure, redundant systems for health data and server access. · Equip health systems to function during infrastructure failures and displacement. · Stockpile critical resources for high-risk critical regions. · Train formal rapid response teams with institutional support. · Include disaster preparedness and trauma training (e.g., ATLS) in medical education.[7] Iran’s experience is not unique. Global crises are increasingly outpacing health system responsiveness. OECD’s post-pandemic findings affirm that resilience must be a pillar of national security -alongside defense-requiring long-term commitment.[5] This crisis presents an opportunity to reform, rebuild, and embed health security into national resilience frameworks. Post-crisis evaluations should be standard and used to guide future preparedness.
Background: Anterior teeth are particularly vulnerable to traumatic injuries during physical activities, which can significantly affect the pulp and periapical tissues. This case report aims to present a strategy for managing combined traumatic lateral and extrusive luxation in an immature permanent tooth.Case Presentation: A 10-year-old male patient presented to the Pediatric Dentistry Department at the Hamadan School of Dentistry with an anterior tooth injury that had occurred less than 24 hours earlier, resulting in lateral luxation and extrusion of the upper left permanent central incisor. Following radiographic assessment, the luxated tooth was repositioned under local anesthesia and splinted to two adjacent teeth on each side. At the two-week follow-up, the repositioned tooth exhibited signs and symptoms of pulpal necrosis. Complete pulp extirpation was performed, followed by the placement of a calcium hydroxide dressing. One week later, an apexification procedure was performed using a mineral trioxide aggregate (MTA) apical plug to establish an adequate apical seal and create an artificial apical stop for the obturation material. Radiographic evaluations at six and twelve months confirmed successful periapical healing.Discussion: The promising short-term outcomes of this case report demonstrate the effectiveness of repositioning, splinting, and MTA apexification in managing necrotic immature teeth resulting from combined traumatic injuries.
Background: Warfarin is a commonly used anticoagulant for the prophylaxis in patients with various cardiovascular conditions like atrial fibrillation, venous thromboembolism, and prosthetic heart valves. A significant side effect of Warfarin overdose is bleeding, which may occur spontaneously or following trauma. The sublingual space is an unusual site for bleeding; however, when it occurs, it represents a life-threatening complication. A hematoma formed at this site must be treated as a medical emergency to secure the patient's airway.Case presentation: We report a case of a hematoma involving the sublingual and deep neck spaces in a female patient who was on warfarin therapy following mitral and aortic valve replacement. While on anticoagulant treatment, she had a fall and blunt injury to the lower back, which was not considered serious. However, after 10 days, she presented with an increasing hematoma in the sublingual space, which progressed to involve the deep neck spacesDiscussion: With appropriate measures to counter the effect of Warfarin, the hematoma subsided without much compromise in the airway. In severe sublingual hematoma, immediate reversal of anticoagulation treatment, with vitamin K and Fresh Frozen Plasma (FFP), along with discontinuation of anticoagulants, is recommended. Close monitoring is required to detect potential airway obstruction, and the patient should be informed about the possible need for endotracheal intubation or tracheostomy.
Background: Various factors contribute to the occurrence of road traffic crashes (RTCs), among which human factors play a significant role. These factors can be significantly influenced by the sociocultural background of drivers.Objectives: The aim of this study was to explore and develop sociocultural factors (SCFs) affecting the occurrence of RTCs among drivers, based on stakeholders’ experiences.Methods: This qualitative study was conducted in Iran in 2021 using purposive sampling. Semi-structured interviews were carried out with 25 participants who were experts and specialists in fields of road traffic, psychology, and sociology. They had experience with factors contributing to the occurrence of RTCs, as well as with the prevention and treatment of injuries and the promotion of safety. Data collection continued until conceptual saturation was reached. The data were then manually analyzed using conventional content analysis.Results: After analyzing the data, four main categories and 13 sub-categories appeared: 1) sociodemographic factors (sociodemographic characteristics, social influence, and norms and beliefs); 2) personality traits (sensation-seeking and risky behaviors, violence and anger, anxiety and poor time management skills, selfishness, and individualism); 3) driver behavior (inadequate adherence to traffic laws, insistence on violation, malice and revenge, mental preoccupation, and distraction); and 4) driver skills (perceptual-motor skills and safety skills).Conclusions: SCFs influencing the occurrence of RTCs originate from individual characteristics, psychological status, public culture, and the seriousness of traffic law enforcement. Understanding these factors based on stakeholders’ experiences, along with efforts to control and improve them, can be recognized as an effective step toward improving traffic safety in Iran.
