Official Publication of the National Center for Trauma ResearchTrauma Monthly2251-746429620241201The efficacy of Massive Transfusion Protocol / whole blood transfusion: An umbrella review1262128121202310.30491/tm.2024.449466.1709ENHadiSahraiStudent Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran0000-0001-8877-7882KosarArefdehganiStudent Research Committee, Tabriz University of Medical Sciences, Tabriz, IranNasimHajipoor KashgsarayEmergency and Trauma Care Research Center, Tabriz University of Medical Sciences, Tabriz, Iran0000-0001-6677-8358MoloudBalafarEmergency and Trauma Care Research Center, Tabriz University of Medical Sciences, Tabriz, Iran0000-0002-3097-6042SinaHamzehzadehStudent Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran0000-0001-5344-4885KavousShahsavariniaResearch Center for Evidence-based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran0000-0001-7359-4880HaniehSalehi-PourmehrResearch Center for Evidence-based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, IranMedical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran0000-0001-9030-2106Journal Article20240321<strong>Introduction: </strong>Although massive transfusion protocol (MTP) has been used extensively in the treatment of patients with bleeding trauma, its actual efficacy remains unknown. This umbrella review of systematic reviews and meta-analyses aims to update the evidence and assess the impact of implementing MTP/ whole blood transfusion on the mortality of trauma patients.<br /><strong>Methods:</strong> Data sources: This umbrella review searched Medline (via Ovid), Embase, PubMed, Cochrane Library, CINAHL databases, JBISRIR, Epistemonikos, EPPI-Centre, CRD, and PROSPERO for possible systematic reviews from inception until October 2023. Study eligibility criteria, participants, and interventions: Reviews that reported data comparing different types of massive blood perfusion were included. The quality of studies was evaluated using the Joanna Briggs Institute (JBI) critical appraisal tool. Our study outcomes, 30-day mortality, and 24-hour mortality, were re-analyzed using Comprehensive Meta-Analysis Software (CMA 3.0).<br /><strong>Results: </strong>Thirty studies met the eligibility criteria. Eventually, we included eight studies in the current meta-analysis. The calculated odds ratio (OR) and 95% confidence interval (CI) for 30-day mortality in MTP and non-MTP comparison was OR = 0.654, 95% CI: 0.576, 0.741, P-value <0.001, and similarly, when comparing the whole blood group and blood component group, significant differences were found between the groups in terms of 24h-mortality 0.763, (95% CI: 0.608, 0.957), and P-value = 0.020. The results showed low heterogeneity among the studies.<br /><strong>Conclusion: </strong>Our results support that MTP decreases 30-day mortality compared to non-MTP. Furthermore, our analysis showed that whole blood transfusion decreases the odds of 24-hour mortality compared to blood components.https://www.traumamon.com/article_212023_e3aa0119571f7dc5e1ffb1b76faaea66.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746429620241201A Comparative Study of the Elderly Needs and Coping Capacities in Disasters and Emergencies: Implications for Healthcare Systems1282129221202910.30491/tm.2024.458232.1735ENSanazSohrabizadehAir Quality and Climate Change Research Center, Research Institute for Health Sciences and Environment, Shahid Beheshti University of Medical Sciences, Tehran, IranDepartment of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran0000-0002-9170-178XLuisMöckelDeutsche Gesellschaft für Rettungswissenschaften, Aachen, GermanyJournal Article20240518<strong>Introduction: </strong>The elderly has special needs in disasters, and their lives and health status are affected by disasters. Two countries, Iran and Germany, were selected to study and analyze the different aspects of the elderly's needs and capabilities in disasters. This study aims to identify and compare the needs and capacities of the elderly in disasters in Iran and Germany and suggest implications for healthcare systems.
<strong>Method:</strong> The present research is a comparative study using a scoping review. Relevant keywords were searched on the Web of Sciences, PubMed, and Scopus. Two researchers selected the final references using title and abstract screening based on the inclusion and exclusion criteria.
<strong>Results</strong>: A total of 18 references were selected for the final analysis. Earthquakes and heat waves were the most common disasters in the studies of Iran and Germany. The elderly status in disasters was explained in terms of vulnerability/needs, capacities/capabilities, assessment/measurement, and the interventional approach.
<strong>Conclusion:</strong> Comparing the elderly conditions in disasters in Iran and Germany can result in useful implications for policy-making and management. Hazard risk analysis and assessment, special training for nursing home staff, and improving the elderly's disaster risk perception are highly suggested.https://www.traumamon.com/article_212029_43686b4a872e7dccd4f0a9632acb8581.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746429620241201Prevalence of Substance Abuse in Orthopedic Patients; A Cross-Sectional Study in a Referral Center1293129721203310.30491/tm.2024.459424.1737ENMohammad AliOkhovatpourAssociate professor, Bone Joint and Related Tissues Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran0000-0001-6779-6662ZahraAzimzadehShahid Beheshti University of medical sciences, Tehran, Iran.0000-0002-5479-8025Mohammadreza Minator SajjadiMinator SajjadiAssociate professor of Department of Orthopedics, Taleghani Hospital Research Development committee, Medical school, Shahid Beheshti University of medical sciences, Tehran, Iran.RezaZandiAssociate professor of Department of Orthopedics, Taleghani Hospital Research Development committee, Medical school, Shahid Beheshti University of medical sciences, Tehran, Iran.0000-0002-0095-6745Mohammad KazemEmami MeybodiTrauma Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.Mohammad AliAsghariShahid Beheshti University of medical sciences, Tehran, Iran.0000-0002-9094-1108Journal Article20240525<strong>Introduction: </strong>To evaluate the prevalence of substance abuse in orthopedic patients referred to a specialized orthopedic surgery center in Iran. Substance abuse is a significant public health issue in many societies, leading to various physical, mental, and social problems. To address this concern, it is crucial to raise awareness and knowledge about the prevalence of substance and alcohol abuse, as well as to study the factors that contribute to its development. This issue is critical in Iran, which is one of the centers for opioid consumption globally. Previous studies have estimated that between 700,000 and 4,000,000 individuals are struggling with addiction in Iran, with a reported prevalence of substance abuse at approximately 2.7%.<br /><strong>Methods: </strong>After creating a checklist for data collection, we gathered information on patients' demographics, marital status, type of substance used, occupational status, type of surgical procedure, and length of hospitalization. Data related to substance use was collected privately in the operating room before anesthesia was administered, while the other information was collected in the orthopedic ward.<br /><strong>Results:</strong> Among the 292 patients surveyed, 74.3% were male, and 25.7% were female, with an average age of 41 (± 17.9 years). The assessment revealed that 42.1% of the patients were smokers, while 30.1% reported using hookah. Additionally, alcohol use was reported by 27.7% of the patients, and 24% were identified as substance abusers. The data indicated that males, individuals with higher education, and those who were employed were significantly more susceptible to substance abuse. Traumatic patients, especially those involved in motorcycle-related accidents or with fractures, exhibited a higher history of substance abuse compared to other groups. Furthermore, the duration of hospitalization was notably longer for substance abusers.<br /><strong>Conclusion:</strong> The rate of substance and alcohol abuse has increased in Iran recently. Opium remains the most commonly used drug, followed by cannabis. It is essential to implement preventive measures to reduce substance abuse in the country.https://www.traumamon.com/article_212033_9d273e93152e25dafed3fc08e9134ff7.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746429620241201Comparison of the Surgical Outcome of Intertrochanteric Fracture with Gamma Nail Insertion Through Inferior-Center and Center-Center Blade Entry Point; A Randomized Control Study1298130521203510.30491/tm.2024.451361.1713ENRezaZandiAssociate professor, Department of orthopedics, Taleghani Hospital Research Development Committee, Shahid Beheshti University of medical sciences, Tehran, Iran.0000-0002-0095-6745NimaKeihani NejadResident of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.0000-0002-8488-0767AhmadrezaAhmadi AbdashtiResident of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.AkbarEhsaniResident of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.0000-0002-2762-1494NasimNouriMedical Student, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Mohammad KazemEmami MeybodiTrauma Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.Mohammad AliOkhovatpourAssociate professor, Department of orthopedics, Taleghani Hospital Research Development Committee, Shahid Beheshti University of medical sciences, Tehran, Iran.0000-0001-6779-6662Journal Article20240406<strong>Introduction: </strong>Cephalomedullary nails (CMNs) are preferred over sliding hip screws (SHS) for treating intertrochanteric fractures (ITF) due to less intraoperative blood loss, operating time, varus collapse, and femoral shortening. However, the optimal blade position in the femoral head remains controversial despite its critical role in preventing complications. This study aims to determine the best blade position to enhance outcomes and reduce implant failure in ITF patients treated with CMNs. The purpose of this study was to determine the optimum helical blade position in intertrochanteric fractures fixed via cephalo-medullary nail. The results of this study will help orthopedic surgeons choose the best blade position in patients with ITF treated with CMN to reduce implant failure.<br /><strong>Methods</strong>: 167 patients with intertrochanteric fractures were randomly assigned to two study groups. The helical blade was applied inferior-center (I-C) in the first group, and the second group applied center-center (C-C). Tip-apex distance (TAD), neck shaft angle (NSA), and femoral neck axis length (FNAL) were measured in early postoperative and six months postoperative.<br /><strong>Results:</strong> In the C-C group, the immediate and six-month postoperative NSA was 132.9 ± 5.72 and 131.1 ± 5.78, TAD was 18.7 ± 5.39 and 18.8 ± 5.8, and FNAL was 114.7 ± 13.6 and 110.7 ± 11.1, respectively. In the I-C group, the immediate and six-month postoperative NSA was 134.7 ± 5.19 and 131.6 ± 5.76, TAD was 20.4 ± 6.4 and 20.5 ± 8.24, and FNAL was 112.1 ± 10.5 and 108.5 ± 12.6, respectively.<br /><strong>Conclusion:</strong> Regarding radiologic parameters, the I-C helical blade position achieved the same results as the C-C blade position.https://www.traumamon.com/article_212035_a062c3a6656484201f0cb196d616bdbb.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746429620241201Effectiveness of Modified Sleeper Stretch Combined with Modified Cross-Body Adduction in Alleviating Shoulder Stiffness Among Overhead Throwing Athletes: A Retrospective Cohort Study1305131421203810.30491/tm.2024.466150.1747ENAlessandroCastagnaHumanitas Clinical and Research Center, Milan, ItalyFarzadAmouzadeh OmraniShahid Beheshti University of Medical Sciences, Tehran, Iran0000-0002-4073-9876SinaAfzalShahid Beheshti University of Medical Sciences, Tehran, Iran0009-0000-6666-9207MojtabaBaroutkoubShahid Beheshti University of Medical Sciences, Tehran, Iran0000-0003-1318-4753BardiaHajikarimlooStudent Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.SinaAzadnajafabadLeeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UKGhasemMohammad SharifiDepartment of Orthopedic Surgery, Isfahan University of Medical Sciences, Isfahan, IranSaeedKoklyJoint, Bone, Connective Tissue and Rheumatology Research Center (JBCRC), Golestan University of Medical Sciences, Gorgan, Iran0000-0002-0678-0920Journal Article20240704<strong>Introduction: </strong>Overhead-throwing athletes frequently experience shoulder joint issues, specifically reduced internal rotation and posterior capsule tightness. This study aimed to compare the effects of two interventions on shoulder internal rotation, pain, and joint function: one involving a combination of modified sleeper stretch and cross-body adduction and the other, conventional physiotherapy.
<strong>Methods:</strong> This retrospective cohort study compared two groups of overhead-throwing athletes: one undergoing conventional physiotherapy from 2016 to 2019 and another receiving a combination of modified sleeper stretch and cross-body adduction exercises from 2020 to 2021. The conventional physiotherapy cohort focused on Codman’s exercises, while the later cohort received modified sleeper stretch combined with cross-body adduction exercise. Outcome measures included pain intensity (visual analog scale), glen humeral internal rotation (GHIR), and shoulder function (Constant Score).
<strong>Results:</strong> The study enrolled 160 patients, equally divided into two cohorts. Both cohorts showed similar baseline characteristics regarding age, sex, VAS score, GHIR degree, and Constant Score, with no statistically significant differences. Post-treatment, the second cohort (sleeper stretch and cross-body adduction) exhibited more significant improvements: GHIR increased from 49.0 ± 6.4 to 71.0 ± 5.8 degrees compared to 48.0 ± 5.2 to 59.2 ± 5.4 degrees in the first cohort. VAS scores decreased more significantly in the second cohort, from 4.5 ± 1.2 to 0.9 ± 0.8, compared to 4.8 ± 1.0 to 2.6 ± 0.8 in the first cohort. Similarly, Constant Scores improved more in the second cohort, from 49.0 ± 6.4 to 88.0 ± 4.0, in contrast to 48.0 ± 5.2 to 79.2 ± 3.8 in the first cohort.
<strong>Conclusion: </strong>These findings indicate the superior effectiveness of posterior shoulder stretching exercises in enhancing shoulder function and reducing pain among overhead-throwing athletes compared to conventional physiotherapy.https://www.traumamon.com/article_212038_aa0092a1e46ee2b78ff05b60088f3a77.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746429620241201Overview of Artificial Intelligence in the Anesthesiology Field of Critical Care Patients1315132121203910.30491/tm.2024.494157.1792ENSeyed MohammadrezaAmouzegar ZavarehAtherosclerosis research center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran0000-0002-3587-6040MasoudLatifi-PourChemical Injuries Research Center and Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, IranJournal Article20241215<strong>Introduction: </strong>Artificial intelligence (AI) is transforming various medical fields, including pathology, radiology, cardiology, and surgery, by offering innovative therapeutic and interventional solutions. AI is revolutionizing medical research and has become vital in advancing medical technology. This study assessed the role of artificial intelligence in the anesthesiology field.<br /><strong>Methods:</strong> We search studies in the online databases such as PubMed, Scopus and google scholar. Related records were included in this study.<br /><strong>Results</strong>: Its role in enhancing patient care is particularly reassuring, as it allows healthcare professionals to offer superior services through the integration of AI in medicine. Moreover, AI's indispensable role in the progress of the anesthesia field, having made significant contributions across various anesthetic applications since its early adoption, further reinforces this reassurance. Embracing AI in healthcare not only enhances treatment outcomes but also sets the stage for a healthier future. AI applications include screening symptoms, predicting adverse actions, personalizing medication dosages, and streamlining record-keeping, all of which aim to enhance patient outcomes. While integrating AI offers exciting opportunities, challenges such as data quality, technical limitations, ethical considerations, and high costs must be addressed. Inaccurate data can compromise patient safety, and insufficient security measures can lead to privacy breaches. Moreover, legal accountability for AI errors in patient management is complex.<br /><strong>Conclusion:</strong> The future is promising, with AI capable of enhancing training and education. It can modernize anesthesia education through chronic pain management tools and realistic training simulations, ultimately preparing the next generation of healthcare providers.https://www.traumamon.com/article_212039_3845b0a42e37a4684bb64b39c7fa445d.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746429620241201Evaluation of Various Methods of Scaphocapitate Fixations in Kienbock Disease, A Finite Element Study1322132621204010.30491/tm.2024.451238.1712ENHamidNamaziOrthopaedic and Rehabilitation Research Center, Shiraz University of Medical Sciences, Shiraz Iran.FarshadSalehiOrthopaedic and Rehabilitation Research Center, Shiraz University of Medical Sciences, Shiraz Iran.Mohammad TaghiKarimiOrthopaedic and Rehabilitation Research Center, Shiraz University of Medical Sciences, Shiraz Iran.Orthotics and Prosthetics Department, Rehabilitation Faculty of Shiraz University of Medical Sciences, Shiraz Iran.0000-0001-6162-8131Journal Article20240405<strong>Introduction: </strong>Kienbock's disease is characterized by lunate osteonecrosis. The management of this disease poses a medical challenge, and the optimal surgical approach for its treatment has yet to be determined. Scaphocapitate fusion is one surgical option that can be considered for patients, as it has shown good functional outcomes. This study aimed to evaluate the most effective orthopedic devices for scaphocapitate fusion.
<strong>Methods:</strong> A wrist CT scan of a normal subject was used in this study to create a three-dimensional model using MIMICS, 3 Mat, Free CAD, and OpenSIM software. Scaphocapitate fusion was simulated in the model using one pin, one screw, two pins, two screws, and one pin and a screw. The displacement of the scaphoid bone, Von Mises stress of the scaphoid and capitate bones, and the orthopedic devices were calculated.
<strong>Results:</strong> The study revealed that the scaphoid bone could move 2.37 mm in the proximal direction in normal conditions. However, in scaphocapitate fusion, the bone only moved in the distal direction, with the least movement observed when using two pins (1.9 mm). The most effective control over mediolateral and vertical motions was achieved with two pins (2.38 mm vs. 1.35 mm) and one screw (5.60 mm vs. 3.13 mm), respectively. All methods significantly reduced the angular motion of the scaphoid bone.
<strong>Conclusion:</strong> While the various methods of scaphocapitate fusion show minimal differences, using one screw may be the most effective option for this operation.https://www.traumamon.com/article_212040_910fe18cf2bdd6f618f9e0e33368c339.pdf