Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 30 5 2025 10 01 The Potential Role of Ketamine in Preventing Delirium among Critically Ill Patients Following Coronary Artery Bypass Grafting: A Review 1560 1566 232668 10.30491/tm.2025.552666.1890 EN Mehrdad Mesbah Kiaei Department of Anesthesiology and pain medicine, School of Medicine, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran Mahmoud Reza Mohaghegh Dolatabadi Department of Anesthesiology and pain medicine, School of Medicine, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran Mohsen Abbasi Department of Anesthesiology and pain medicine, School of Medicine, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran Seyed Mohammadreza Amouzegar Zavareh Atherosclerosis research center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran 0000-0002-3587-6040 Ali Moshki Department of Anesthesiology and pain medicine, School of Medicine, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran Siavash Sangi Department of Anesthesiology and Operating Room, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 0000-0002-7833-0021 Maryam Aligholizade Department of Anesthesiology and Operating Room, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Journal Article 2025 10 11 <span style="font-size: 11.0pt; line-height: 107%; font-family: 'Calibri',sans-serif; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; color: #002060; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: FA;">Introduction: Coronary artery bypass grafting (CABG) remains a cornerstone procedure in cardiovascular medicine; however, postoperative delirium is a frequent and serious complication, particularly among critically ill patients in the intensive care unit. Ketamine, known for its analgesic and N-methyl-D-aspartate (NMDA) receptor–modulating properties, has been proposed as a potential agent to reduce the incidence of delirium following cardiac surgery. <span style="font-size: 11.0pt; line-height: 107%; font-family: 'Calibri',sans-serif; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; color: #002060; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: FA;">Method: A review was conducted by searching reputable scientific databases for studies addressing postoperative delirium, cardiac surgery, coronary artery bypass grafting, and postoperative cognitive dysfunction. Relevant literature examining the relationship between ketamine administration and the incidence or severity of post-CABG delirium was identified, analyzed, and synthesized. <span style="font-size: 11.0pt; line-height: 107%; font-family: 'Calibri',sans-serif; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; color: #002060; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: FA;">Result: Eight thematic areas were explored: definitions and diagnostic criteria of delirium; epidemiology of postoperative delirium; pathophysiological mechanisms; risk factors for post-cardiac surgery delirium; associations between pain control, sedation practices, and delirium; complications of delirium in the critical care setting; and the timing, dosage, and efficacy of ketamine administration during and after CABG. <span style="font-size: 11.0pt; line-height: 107%; font-family: 'Calibri',sans-serif; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; color: #002060; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: FA;">Conclusion: Current evidence regarding ketamine’s effectiveness in preventing postoperative delirium after CABG remains inconclusive, with studies reporting mixed outcomes. Further standardized, high-quality research is needed to clarify optimal dosing strategies, assess safety profiles, and determine ketamine’s true role in delirium prevention among critically ill cardiac surgery patients.

https://www.traumamon.com/article_232668_34567bc8e9796897c84f1445ad7f5347.pdf

Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 30 5 2025 10 01 Safety and Foeto-Maternal Outcomes Following Emergency Laparoscopic Surgery in Pregnancy: A Systematic Review 1567 1574 231357 10.30491/tm.2025.548668.1880 EN Mahdis Akrami Department of gynecology, Kermanshah University of medical sciences, Kermanshah, Iran. Roghayeh Alizadeh Department of gynecology, Kermanshah University of medical sciences, Kermanshah, Iran. 0009-0003-7088-2088 Sima Aliyari Boroujeni Department of gynecology, Kermanshah University of medical sciences, Kermanshah, Iran. Fateme Abbasi Department of gynecology, Kermanshah University of medical sciences, Kermanshah, Iran. Journal Article 2025 09 22 Introduction: Common causes of non-obstetric surgeries include appendicitis, cholecystitis, and adnexal issues during pregnancy. This review study aims to assess various outcomes of laparoscopic surgery in pregnant women. Method: We searched databases like MEDLINE, EMBASE, CINAHL, and the Cochrane Library, focusing on studies published between January 2010 and August 2025. We included studies reporting laparoscopic surgeries in pregnant women, specifically those involving more than 10 patients. We gathered data on patient demographics, the type of surgery performed, the trimester, and details of the operation, maternal outcomes, and rates of fetal loss, incidences of preterm birth, and other complications. Due to differences across studies, we performed a narrative synthesis of the findings. Result: The majority of these procedures were appendectomies, cholecystectomies, or surgeries for adnexal pathologies. Overall, maternal outcomes were positive, with less than 1% experiencing major complications and no maternal deaths. Conversion to open surgery occurred in 0-5% of cases. The fetal loss rate was reported between 0 to 8%; usually, it was higher in cases of complicated appendicitis, while preterm birth was reported between 2 and 10% of cases. Notably, there was no significant rise in fetal anomalies, and the best outcomes were typically associated with surgeries performed during the second trimester. Conclusion: According to the outcomes, laparoscopic surgery during pregnancy generally carries a low risk for both mothers and their babies. Most women experience minimal complications, and the outcomes for the fetus are usually positive, mainly when the surgery occurs during the second trimester. It’s crucial to have careful monitoring and skilled surgical practices in place to help ensure a smooth, safe experience for both mother and child.

https://www.traumamon.com/article_231357_4e3fbe5ff145862fece72b3f45683d28.pdf

Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 30 5 2025 10 01 Identification of Targeted Therapeutic Compounds for the treatment of Traumatic Brain Injuries: An in-Silico Study 1575 1581 227240 10.30491/tm.2025.538185.1859 EN Mohammad Ali Akbar Esfahani Trauma Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran. Department of Genetics, Faculty of Advanced Sciences and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran Hossein Faghih Trauma Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran. Javad Zamani Amirzakaria National institute of genetic engineering and biotechnology, Tehran, Iran Samira Talebi National institute of genetic engineering and biotechnology, Tehran, Iran Mohammad Eslamian Trauma Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran. Hamid Reza Rasouli Trauma Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran. 0000-0003-2793-624X Fathollah Ahmadpour Trauma Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran. 0000-0003-2984-6897 Journal Article 2025 07 30 Introduction: Traumatic Brain Injury (TBI) is a significant public health problem. Detecting effective therapeutic compounds for the management of TBI patients is essential. Nuclear factor E2-related factor 2 (Nrf2) is a transcription factor that regulates oxidative stress and inflammation after TBI. This study aimed to assess Targeted Therapeutic Compounds by inhibiting the degradation of Nuclear Factor E2-Related Factor 2 for TBI management. Methods: The compounds that inhibit Nrf2 degradation by suppressing Nrf2 inhibitors, such as Kelch-like ECH-associated protein 1 (Keap1), E3 ligase adapter β-TrCP, and glycogen synthase kinase 3 (GSK-3), were identified by a literature review. Possible active sites for identified target proteins were determined. Molegro Virtual Docker (MVD) software predicted the protein-ligand interaction study. The interaction compounds that inhibit Nrf2 degradation (Keap1, GSK-3, and β-TrCP proteins) with over 274000 drug-like compounds from the ZINC database were analyzed by molecular docking. Selected compounds from the molecular docking analysis were subjected to ADME prediction for pass drug parameters. The molecules were imported to Swiss Similarity software, and screening was performed using the Food and Drug Administration (FDA) approved drugs library. To assess the structural stability of the hit compounds, molecular dynamics (MD) simulation using the GROMACS package version 2020.1 was performed. Results: Four molecules, including ZINC435885061, ZINC469515563, ZINC119772060, and ZINC550706912, can suppress all three Nrf2 inhibitors and are capable of penetrating the blood-brain barrier. The ADME analysis of the compounds showed that these four molecules could be used therapeutically. Nebivolol is an FDA-approved drug identified for neuroprotective effects and can be used as a potential candidate for treatment. Conclusion: Targeted therapeutic compounds that inhibit Nrf2 degradation can be used for TBI treatment. Nebivolol, an FDA-approved drug, has neuroprotective effects and can be used for TBI treatment, but further studies, such as animal studies and clinical trials, are necessary.

https://www.traumamon.com/article_227240_9e8a0461b00ae52fd2935160b3a3fca9.pdf

Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 30 5 2025 10 01 Current Trends and Associated Factors of Traumatic Amputations in Shiraz 1582 1590 234049 10.30491/tm.2025.512354.1815 EN Mojtaba Norouzi Department of Epidemiology and Biostatistics, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran. 0000-0002-3642-4265 Neda Malek Mohammadi Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran. Hossein Moameri Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran. Mahnaz Yadollahi Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. 0000-0002-6434-0931 Journal Article 2025 03 14 Introduction: Amputations from trauma can lead to disability and pose a challenge for health care services. This study hopes to shed light on the trend, the changes, outcomes, and factors associated with trauma leading to amputations in Shiraz, Iran. Method: A cross-sectional study was conducted to assess patients who experience amputations due to trauma in Shiraz from 2017 to 2023. The sampling method consisted of patients hospitalized at Shahid Rajaee Hospital in Shiraz. We included participants who were hospitalized for traumatic amputations. Outpatients, follow-up cases, and non-trauma-related amputations were excluded from the analysis. Data collection included variables such as admission year, gender, age, and level of amputation. Result: 435 patients were included, and 92.2% were males. The average age of patients was 36.1 years, and the majority of patients (88.8%) underwent minor amputations. Amputation was most common among motorcycle riders (47.5%), while traffic accidents and lower limb injuries significantly contributed to major amputations, accounting for 21.9% and 51.3% of cases, respectively. The average hospital stay was 5 days. The majority of patients stayed over two days. Upper limb injuries and amputations had a significant association (p < 0.001), as well as contact with a blunt object and amputation (p = 0.002). The presence of many injuries was associated with shorter stays in a hospital (p = 0.045). We found a statistically significant increase in amputations by gender (p <0.001) and type (p=0.006) during the study period. The overall trend peaked in 2022. Conclusion: The pattern of limb loss rates among participants, mostly men, was worrisome. Motorbike drivers are clearly at greater danger, and road accidents play a big part in severe amputations. The association between arm injuries and amputations shows the need for focused ways to stop this.

https://www.traumamon.com/article_234049_cd3006656ff803042fd9ac99a3f0f9f5.pdf

Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 30 5 2025 10 01 Investigation and Comparison of Therapeutic Outcomes Due to Penetrating Vascular Trauma of the Upper and Lower Limbs in Patients Referred to Ahvaz Golestan Hospital 1591 1598 234048 10.30491/tm.2025.494543.1793 EN Hossein Ghaedamini Department of General Surgery, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, I.R.Iran. 0000-0002-2923-1510 Seyed Masood Mousavi Department of General Surgery, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, I.R.Iran. Mohammadamin Zargar Department of General Surgery, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, I.R.Iran. Iraj Nazari Department of General Surgery, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, I.R.Iran. Zohreh Fadaei Department of Anesthesiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, I.R.Iran. Amirmahdi Ghaedamini Student Research Committee, School of Medicine, Tehran University of Medical Sciences, Tehran, I.R.Iran. Journal Article 2024 12 17 Introduction: Limited research has been done on vascular traumas of the upper limb and their comparison with those of the lower limb. This research was conducted to determine and compare the therapeutic outcomes of penetrating vascular trauma of the upper and lower limbs in patients referred to Golestan Ahvaz Hospital in 2024. Methods: This was a descriptive-analytical and prospective study. The sample size was determined using the census (820 participants). Information was obtained through the medical records and entered into the checklist. Primary outcomes included mortality, rehospitalization, amputation, and revascularization interventions, and other outcomes included operative complications and neurological deficits, which were compared in two groups of upper and lower limb injuries. Results: The frequency of arterial involvement (P=0.003), compartment syndrome (P=0.014), and nerve injury (P=0.005) was higher in the upper limb group. The duration of hospitalization in the lower limb group was significantly longer (P=0.003). In treating penetrating arterial injuries, the rate of primary anastomosis (P=0.006) and ligation of arterioles (P=0.039) was significantly higher in the upper limb group. In comparison, the rate of using venous interposition graft (P=0.032) was significantly higher in the lower limb group. In treating venous injuries, the rate of fasciotomy (P=0.031) was significantly higher in the lower limb group. Mortality rate (P=0.023), amputation (P=0.001), need for reoperation (P=0.041), and need for therapeutic fasciotomy (P=0.001) in the lower limb group were significantly higher. At the same time, the frequency of nerve damage (P=0.003) was significantly higher in the upper limb group. Conclusions: The results show a difference between the initial manifestations, management, and surgery and the outcomes of penetrating injury of the upper and lower limbs, which suggests that attention to penetrating injury seems necessary to prevent mortality and morbidity.

https://www.traumamon.com/article_234048_9733ec72d501f31c36cf976bf98fd3d5.pdf

Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 30 5 2025 10 01 Artificial Intelligence and Disasters Management: Approaches and Strategies 1599 1600 234872 10.30491/tm.2025.526015.1842 EN Adel Eftekhari Assistant Professor, Health in Disasters and Emergencies, Department of Nursing, Meybod School of Medical Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 0000-0001-7961-2699 Farzan Madadizadeh Associate Professor, Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran 0000-0002-5757-182X Najmeh Baghian PhD in Healthcare Services Management, Clinical Research Development Center, Shahid Rahnemoon Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 0000-0003-1837-0408 Journal Article 2025 05 25 Artificial intelligence (AI) is transforming crisis management by enabling rapid data processing, predictive analytics, and informed decision-making for disasters, cyber threats, and pandemics. Key applications include scenario modeling, big data analysis, relief team support, and public communication.

https://www.traumamon.com/article_234872_0a983fa73815cecc3dfe37c103e84926.pdf

Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 30 5 2025 10 01 Management of Pain, Agitation, and Delirium in Critical Care Patients: A Systematic Review 1601 1608 230004 10.30491/tm.2025.541825.1872 EN Abasali Delavari Trauma Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran Marzieh Lak Trauma Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran Journal Article 2025 08 17 Introduction: Pain, agitation, and delirium (PAD) are frequent complications in ICU patients. This review assesses guideline recommendations for managing PAD in critically ill adults. Method: This systematic review synthesized recommendations from ICU guidelines with recent literature on PAD. We searched the PubMed, Scopus, and Web of Science databases using relevant keywords and MeSH terms. Result: Seven guidelines from North America (SCCM 2013, 2018, 2022, 2025), Europe (ESICM 2025, NICE 2019), Asia (KSCCM 2021), and LMICs (Indian ABCDEF 2023) were included. Recent guidelines emphasize the importance of integrating digital innovations, such as electronic health record systems and AI monitoring. The guidelines from 2022 to 2025 also emphasize intervals in care for special populations by introducing reliable protocols for pediatric patients and by adjusting care to specific needs. Light, titratable sedation agents, such as dexmedetomidine, are recommended to decrease oversedation and the duration of ventilator. Pharmacologic interventions are reserved for refractory cases, utilizing opioids, adjuncts, and emerging agents tailored to individual needs. The guidelines have shifted from a focus on sedation to a patient-centered approach, integrating PAD protocols that emphasize multimodal management and early intervention. Conclusion: The finding showed that managing PAD in the ICU needs a multimodal, guideline-directed procedure that includes both pharmacologic and non-pharmacologic strategies with comprehensive assessment. Future research should evaluate new therapies and develop evidence-based protocols that balance efficacy, safety, and patient-centered outcomes.

https://www.traumamon.com/article_230004_802746f5d21d17c67e5ae82f4690de2c.pdf