---

Background & Objective: Nutritional support is a basic process for survival in trauma patients. The purpose of this study was to evaluate the daily nutritional support practice in head injury patients admitted to Neurosurgery Intensive Care Unit.

 

Materials & Methods: This descriptive cross-sectional study was done on 115 Head injury adults patients who received enteral nutrition for at least 48h in Rasht Poursina hospital during 2005. Nutritional measurements were included the number of patients who received enteral nutrition, the time to initiate nutritional support, amount of initial feeding and clinical outcome were included the duration of mechanical ventilation, ICU and in-hospital length of stay (loss), in-hospital mortality rates .Data was reported as Mean±SD and percent. T-test analysis was used for comparing of calorie and nutrient intakes and requirements.

 

Results: Mean±SD of age patient was 41.22±21.9, 84% of patients received enteral nutrition. The time to feeding and the amount of initial feeding was 4.6±1 day and 52.79±27.83 ml/h respectively. Duration of ventilation was 12±13.4 day and ICU length of stay 18.96±18.3 day, Hospital length of stays 24.47±19.84 day. Mortality rate in six month was 48%. Mean of energy, carbohydrate, fat and protein (P<0.05) intakes had significant differences compared with requirements.

 

Conclusion: The recording process has revealed undesirable feeding practice in head injury patients. Nutritional outcomes would be improved with implementation of standard protocol in neurosurgery intensive care unit.

---

Background & Objective: Trauma is the second most common cause of death regardless of age in Iran and the health system annually defrays a vast cost for trauma patients. The majority of cases comprise abdominal trauma. This study was performed to determine individual and pathologic characteristics of patients with blunt abdominal trauma in Gorgan – Iran. Materials & Methods: This descriptive and retrospective study was done on 239 patients with blunt abdominal trauma in 5 Azar hospital, Gorgan - Iran from March 2001 to March 2005. Results: 197 (82.4%) of cases were male and 42 (17.6%) were female. The mean age of patients was 23.4 years. The mean of hospital stay was 8.8 days. The most common cause of blunt abdominal trauma was traffic injury. The most common damaged organs were spleen (49.4%) and liver (21.3%) respectivly. Mortality rate was 16.3%. The hypovolumic shock was the major cause of mortality. Conclusion: This study showed that epidemiology of trauma is similar to those in other regions of our country. Therefore, programming and attempts of governmental organizations are needed to prevent and decrease traffic accidents.

---

Background and Objective: Maternal position during the second stage of labor can be considered to be an intervention in the natural course of labor. This study aimed to establish the effect of sitting versus lithotomic position on duration of second stage of labor, preneal truma and neonatal outcome.

Materials and Methods: This clinical trial study was done on 110 term nuliparuse women with normal conducte of labor in second stage, which divided randomly in sitting position, (n=55) and lithotomic position (n=55) in teaching hospital in Yazd, Iran during 2005-06. Duration of second stage, Perinea trauma and first 5 minutes APGAR evaluated and compared in two groups. Data analyzed by SPSS-11.5 with T student and Chi square tests. P<0.05 was significant.

Results: Duration of second stage of labor was 34 and 42 minutes in sitting and lithotomic position respectively (P<0.05). Perinea damage was seen in 15 (27.3%) and 24 (43.6%) women of sitting and lithotomic position respectively (P<0.05). No significant difference existed between the groups in neonatal first 5 minutes APGAR.

Conclusion: This study showed that sitting position reduce second stage duration and perinea trauma versus lithotomic position.

---

Background and Objective: An increased risk of invasive infections with encapsulated bacteria such as Streptococcus pneumoniae has been described among splenectomized patients. Pneumococcal vaccination has been recommended in these patients. In this study, the serum antibody response to pneumococcal polysaccharide antigens in splenectomized patients with idiopathic thrombocytopenic purpura (ITP) or trauma who immunized with Pneumovax 23 was evaluated. Materials and Methods: This case - control study was performed on two groups of patients including fifteen cases of trauma patients (11 male, 4 female) and twenty patients with ITP (10 male, 10 female) along with 40 healthy volunteers as controls who were immunized with Pneumovax 23 to prevent pneumococcal infections. All patients received the pneumococcal vaccine before splenectomy. The serum antibody response (IgG and IgG2) to pneumococcal antigens was determined by enzyme-linked immunosorbent assay (ELISA) technique prior to vaccination and 4 weeks post-vaccination. Analyzing of data was performed using student t-test and linear regression test. Results: The mean of post-vaccination IgG or IgG2 titer to the pneumococcal antigens in ITP patient group was significantly lower than those in controls or in trauma group (P<0.05). No significant differences in IgG or IgG2 antibody titer increase were found between trauma group and healthy control group. Response to immunization was poor in 9 of 20 ITP patients. Conclusion: This study indicated that 45 percent of patients suffered from ITP who have undergone splenectomy responded poorly to pneumococcal antigens.

---

Background and Objective: Musculoskeletal injuries are the common causes of disabilities among young patients. This study was done to establish the causes and clinical evidences of bone and joint injuries among young patients in Gorgan, Iran. Materials and Methods: This cross-sectional study was carried out on 600 subjects with musculoskeletal injuries reffered to 5 Azar teaching hospital in Gorgan, north of Iran during 2009. Age, sex, type of initial treatment, location of injury and medical treatment for subjects were completed. Data were analyzed using SPSS-16, Chi-Square and student t-tests. Results: The mean age of subjects was 25±7 years. 83% of subjects were male. In 37% of injured people, time of accident was between 12 to 18 o’clock. The most common causes were car accident (49.7%), workplace injury (15.3%), falling down (10.3%), respectively. Street (38.3%) and road (18.7%) were the location with high accident. Fractures (71.7%), soft tissue injuries (48.3%) and dislocation (8.7%) were the most common injuries. Upper and lower limb were the most common in injury and fractur, respectively. Conclusion: This study showed that young men are more prone to accident and occupation injuries.

---

Background and Objective: Trauma is the most common cause of death in all individuals between 1 and 44 years and the third most common cause of death regardless of age. The abdomen is the third most commonly injured region of the body. Some intra abdominal organ injured more than others, related to mechanism of injury, size and location of organ in abdominal cavity. This study was carried out to determine the prevalence of intra abdominal injuries due to penetrating trauma. Materials and Methods: This retrospective descriptive study was done on 114 patients admitted to 5 Azar hospital in Gorgan, Iran due to penetrating abdominal trauma during 2002-07. Gender, age, type of injury causes of trauma and hospitlalization period were obtained form patients files. Results: 92.1% of patients were male. The mean age of subjects was 24.8 years (9-70 years) with highest frequency between 20-24 years. Two (1.8%) deaths directly related to abdominal stab wounds related to hemorrhagic shock. The most common cause of penetrating abdominal injury was knife wound (78.9%). The mean time spent in hospital was 4.6±2.8 days. In 53 patients, cause of trauma were either related to pentration into peritoneum or passing through in. Small intestine injuries (14 %), rupture of diaphragm and concurrent lung injuries (7%) were the common damage organs. Conclusion: This study showed that the knife was the main cause of abdominal penetrate trauma and peritoneum was the most common damage tissue.

---

Background and Objective: Post-traumatic stress disorder (PTSD) impairs spatial learning and memory. Desmopressin acetate ameliorates the cognitive deficits induced by electroconvulsive shock. This study was designed to evaluate the protective effects of Desmopressin acetate on retention of spatial memory deficits induced by post-traumatic stress disorder in rats. Materials and Methods: In this experimental study twenty one male Wistar rats were used. Animals were trained for 5 consecutive days in Morris water maze and then were randomly assigned in three groups (Vehicle + Sham, Saline + PTSD and Desmopressin acetate + PTSD) and tested in a probe 60 sec in 24h after the last acquisition trial. The groups of PTSD+Desmopressin acetate rats and vehicle+sham, saline+PTSD were injected Desmopressin acetate (10 micro gr/kg body weight) and saline (IP), respectively. Injections performed ten minute prior to PTSD and spatial memory was tested ten minutes later. Data were analyzed using SPSS-16, One-Way ANOVA and Tukey tests. Results: The platform location latency of the Desmopressin acetate+PTSD group was significantly shorter (4.24 sec) than the control group (P<0.05) and also, had significantly smaller average proximity values (33.87 cm) compared to the saline+PTSD group (P<0.05). Desmopressin acetate + PTSD spent significantly more time (21.65%) in the target zone (P<0.05). Conclusion: This study indicated that Desmopressin acetate blocks the ability of PTSD to impair spatial memory retention.

---

Background and Objective: Post-traumatic stress disorder (PTSD) is an anxiety, which is induced by exposure to life-threatening trauma and produces memory dysfunctions. This study was done to evaluate the effect of β-estradiol on traumatic memory after post-traumatic stress disorder induced by modified single-prolonged stress model in male rats. Materials and Methods: This experimental study was done on 70 male Wistar rats, weighted 200-250 grams. Initially 30 rats randomly allocated into control, shock and single prolonged stress accompanied shock (SPS&S). In SPS&S group immobilized for 2h, followed immediately with a 20 min forced swim conducted in a cylindrical filled with water. After recuperating for 15 min, animals anesthetized with ether. After 30 min recovery, stressed rats placed in the conditioned fear system (CFS). They received one 1mA, 4 second electric foot shock and remained in the chamber for another 60 second before being returned to their home cages. Shock group: Animals placed in CFS and only received the same shock as previous experiment. Naive group: Animals were removed from their home cages and exposed to chamber without receiving any foot shock. 1, 2 and 3 week later, animals in all groups were re-exposed to the shock chamber for 3 min, in order to examine conditioned fear response. In the second experiment rats were injected with β-estradiol (90 µg/kg), one and two week after training. Date were analyzed using SPSS-16, ANOVA and LSD tests. Results: SPS&S significantly induced freezing response (traumatic memory) compared with controls and shock groups (P<0.05) following three weeks. This response significantly reduced due to repetitive injection of β-estradiol in rats (P<0.05). After three weeks causes of enhanced freezing response (traumatic memory) compare with both, shock and sham groups (P<0.001). β-estradiol significantly reduced this response in rats (P<0.001). Conclusion: β-estradiol's administration following PTSD induction by modified single-prolonged stress, significantly decreased the freezing response. Therefore, β-estradiol can prevent the formation of traumatic memory.

---

Obsessive-compulsive disorder is manifested by a group of symptoms including intrusive thoughts, rituals, mental obsessions and compulsions which creates great distress for the individual. Traumatic brain injurie known as one of the rare reasons of obsessive-compulsive disorder. This report is about 3 patients that suffer from obsessive-compulsive disorder after a traumatic brain injury and loss of consciousness. All 3 patients had no sign of obsessive-compulsive disorder before the trauma. Information on these reports, examine the relationship between obsessive-compulsive disorder and traumatic brain injury. Findings from the neuroimaging methods for these patients have been reported. In this study, all the reported cases that had sever traumatic brain injuries were assessed by neuroimaging methods and brain injuries were obsereved in the right temporal in first case, in the right temporal and both frontal sides in second case, in the splenium corpus callosum and the right brain tegmentums and diffused axonal injury and extra-axial hematoma in the left temporal lobein the thirtd patient. Based on the findings of this study obsessive-compulsive disorder can rarely be developed after a traumatic brain injury and by assessing the neuroimaging findings, we can conclude that there is a relationship between the brain injuries and the symptoms of obsessive-compulsive.

---

Background and Objective: Trauma is the third cause of death and the main cause of disability in Iran. Children are more susceptible to trauma due to physiological conditions and the growth process. This study was done to evaluate the epidemiolog of pediatric trauma in Hamedan, Iran during 2016-2017.

Methods: This descriptive-analytical study was done on 482 traumatic children (330 boys, 152 girls) at the age of 0 to 14 years whom referred to Besat Hospital in Hamedan, Iran during April 2016 to March 2017. Age, gender, season, type of troma and the outcome of trouma were recorded for each subject.

Results: The highest rate of trauma was observed between the ages of 7-14 years old (40.5%). The rate of trauma was significantly higher in boys than the girls (P<0.05). The most rate of trauma occured in summer (36.9%). The most common, place, cause, type, region of traumas were home (44%), falling down (53%), fracture (35%), and region (41%) respectively. Regarding the subsequence of discharge of subjects, 10 deaths and 42 disabilities after trauma were observed.

Conclusion: Regarding the most common type and place of accidents, providing safety at home and knowledge of parents are nesscery for preventing of pediatric teruma in Iran.

---

Background and Objective: Gingival recession is a common disease leads to esthetic problems, increased sensitivity of teeth and root caries. This study was done to determine the prevalence of gingival recession in dental students with high level of oral hygiene.
Methods: This descriptive-analytic study was performed on 214 dental students of Golestan University of Medical Sciences, Gorgan, Iran during 2017-2018. After collecting demographic information, clinical examination including Oral Hygiene Index (OHI) and Gingival Index (GI), Severity of gingival recession, width of keratinized gingival, attachment of frenulum, toothbrush trauma, tooth malpositions, periodontal diseases and other iatrogenic factors was measured.
Results: Prevalence of gingival recession was 23.8% .Class 1 and 2 of gingival recession was 84.62 % and 15.38%, respectively. Class 3 and 4 of gingival recession did not observe in any subjects. Toothbrush trauma was the most etiologic factor in 35.4% of dental students suffering of gingival recession (P<0.05). Also, dental malposition with 20.83%, loss of keratinized gingival with 14.58%, orthodontics procedures with 12.5%, periodontal diseases with 10.4% were the other factors in gingival recession.
Conclusion: Toothbrush trauma and dental malposition are the most important etiologic factors in dentistry students suffering from gingival recession.

---

Background and Objective: Trauma is the most important causes of lossing effective life in human comunities, and it is the second leading cause of death in Iran. This study was done to determine the pattern of penetrating injuries and intrathoracic organ damage in Gorgan, north of Iran.
Methods: In this descriptive study, data of 107 patients with penetrating injuries whom referred to
5th Azar hospital in Gorgan-Iran during 2016-17 were collected. Age, gender, job, type, location and cause of injury were recorded for eacgh subject.
Results: The mean age of patients was 26.13 years. The most frequent job was related to unemployed group (39.25%). The most freqent causes of trauma were quarrel with 78.5%. The most divice were knife with 66.35%. Lung was the most injured organ with 11.21%. The least damage was to the large vessels with one case (0.93%). The two patients died due to heart and subclavin vessels injuries.
Conclusion: This study showed that injury due to knife was the most prevalent of penetrating trauma in street strife in northern Iran.

---

Background and Objective: Car accidents are one of the most common causes of traumatic mental disorders. This study was done to evaluate the symptoms of post-traumatic stress disorder (PTSD) in patients with lumbar spinal dislocation fractures caused by road accidents.
Methods: This case-control study was performed on 100 patients with lumbar spine dislocation fractures due to road accidents. After the seventh day, they were admitted to the orthopedic and trauma wards of Imam Khomeini Hospital in Sari. It was done six months after hospitalization. Data collected from 100 non-injured individuals using the Marmar and Weiss Revised Event Impact Questionnaire (Impact of Event Scale - Revised: IES-R) were compared.
Results: There was no statistically significant relationship between PTSD and age, sex, marital status, education of the two groups. In all subscales related to the effect of the event, ie avoidance, disturbing thoughts, and over stimulation indices, the mean score of the participants in the case group was significantly higher than the mean scores of the individuals in the control group (P<0.05). The mean in case group was significantly higher than the mean in the control group (P<0.05).
Conclusion: The results of this study indicate the important role of road accidents in the formation of PTSD symptoms.