Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 30 6 2026 11 01 Dimensions of Intervertebral Discs, Bodies, and Foramina of Lumbar Vertebrae Based on Gender and Ethnicity Using Computed Tomography in North of Iran 1609 1616 234047 10.30491/tm.2025.490610.1785 EN Sakineh Momeni MSc, Department of Anatomical Sciences, Golestan University of Medical Sciences, Gorgan, Iran. 0000-0002-9725-9101 Kamran Haidari Associate Professor, Department of Anatomical Sciences Golestan University of Medical Sciences, Gorgan, Iran. 0000-0003-4347-5412 Mohammad Hadi Gharib Assistant Professor, Department of Radiology, Golestan University of Medical Sciences, Gorgan, Iran. Mohammad Reza Mohammadi Associate Professor, Department of Neurosurgery, Golestan University of Medical Sciences, Gorgan, Iran. Mohammad Jafar Golalipour Professor, Gorgan Congenital Malformations Research Center, Department of Anatomical Sciences, Golestan University of Medical Sciences, Gorgan, Iran. 0000-0002-0646-7096 Journal Article 2024 11 25 Introduction: Physical anthropometry, which includes the measurement of human anatomical structures such as lumbar vertebrae, is generally used to evaluate and measure human body dimensions. Its morphometry branch is used to define these structures. Today, the best standard for fusion inside the spine uses pedicular screw fixation. Objectives: This study aimed to analyze the three-dimensional tomography of the lumbar vertebrae based on gender and ethnicity in Gorgan, North of Iran. Methods: This descriptive-analytical study was performed on three different ethnical populations: Native Fars, Turkmen, and Sistani, which included 120 participants divided into three groups of 40 cases (20 females and 20 male), in the age group of 18-45 years, with the average heights of 165-180 cm for men and 165-170 cm for women. The dimensions of the intervertebral discs, bodies, and foramina of lumbar vertebrae were determined from the main axial view by coronal and sagittal reconstruction in 1.5 mm slices by a Computed Tomography (CT) scan. Results: Based on the findings, differences were observed in the dimensions of intervertebral discs, bodies, and foramina of lumbar vertebrae based on gender and ethnicity using CT between the two genders (P<0.05). The above dimensions were higher in men than in women. The evaluation of the height and width of the vertebral body based on ethnicity showed a difference only in the width of the L1 lumbar vertebrae between Native Fars and Turkmen (P<0.05). Also, there were differences in the width of the foramina in the L3, L4, and L5 vertebrae among the Native Fars, Turkmen, and Sistani groups. Conclusion: The present study found that dimensions of the intervertebral discs, bodies, and foramina of lumbar vertebrae were different based on gender and ethnicity, though, in terms of the lumbar disc, the difference was only observed in the two genders.

https://www.traumamon.com/article_234047_c34a66c8c63c2139360da43c30884bc5.pdf

Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 30 6 2026 11 01 Exploring the Challenges Faced by Nursing Internship Students in Trauma Wards: A Qualitative Content Analysis Study 1617 1626 238162 10.30491/tm.2025.540840.1873 EN Saeed Hashemi PhD, MSc, BSc. Nursing Care Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran. PhD, MScN, BScN. Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran. 0000-0003-4039-2232 Mohammad Motamedzadeh PhD Student Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran Davoud Shakeri PhD Student Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran 0009-0004-8462-6349 Jamileh Mokhtari Nori PhD, MScN, BScN. Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran 0000-0001-9609-7684 Journal Article 2025 08 18 Introduction: Clinical education in trauma wards presents unique challenges for nursing internship students, which can adversely affect their learning outcomes and professional development. Understanding these challenges is critical to enhancing the quality of nursing education and student preparedness. This study aimed to explain the challenges faced by nursing internship students in trauma departments of hospitals not affiliated with Baqiyatallah University of Medical Sciences. Method: Seventeen participants, including 12 nursing trainees (mean age 22.3 years) and five clinical instructors (mean age 42.4 years), were purposively sampled to achieve maximum diversity. Data were collected through semi-structured interviews conducted in Tehran from September 2024 to December 2024. Conventional content analysis was conducted using the Graneheim and Lundman approach and MAXQDA version 10 software to identify categories and subcategories reflecting the participants' experiences. Result: In this study, 12 nursing students with a mean age of 22.3 and 5 nursing instructors with a mean age of 42.4 were identified. Their experiences of trauma ward challenges were categorized into three main categories and seven subcategories. The main categories included psychological factors with two subcategories: fear and stress of violence and high workload; organizational factors with three subcategories: irregular shuttle service, lack of staff familiarity with event recording objectives, inadequate facilities and equipment; and educational factors with two subcategories: poor collaboration between nursing staff and students, and limited time available. Conclusion: Nursing trainees in trauma units face multifaceted psychological, organizational, and educational challenges that hinder optimal clinical learning. Addressing these challenges requires targeted interventions such as improving clinical staff awareness of students' educational goals, ensuring adequate resources, strengthening supportive relationships between staff and students, and optimizing logistical arrangements. Such measures can improve the clinical learning environment and better prepare students for professional roles in trauma care. Given that the study was conducted in selected trauma units affiliated with non-university hospitals in Tehran, the study's findings cannot be generalized to other healthcare settings.

https://www.traumamon.com/article_238162_f98c214ef8193827e331f500d9809c47.pdf

Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 30 6 2026 11 01 Drowning Mortality and Risk Factors in Coastal Iran: A Cross-Sectional Study Using GIS 1627 1634 238163 10.30491/tm.2025.519420.1831 EN Yousef Veisani Non-Communicable Diseases Research Center, Ilam University of Medical Sciences, Ilam, IR Iran 0000-0002-9131-3744 Ali Sahebi Non-Communicable Diseases Research Center, Ilam University of Medical Sciences, Ilam, IR Iran 0000-0003-4662-8998 Masoud Jobaneh Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, I.R.Iran Technical and Operations Deputy of the Pre-Hospital Emergency and Disaster Management, Guilan University of Medical Sciences, Guilan, I.R.Iran Jamshid Mohammadi Head of the Pre-Hospital Emergency and Disaster Management Center, Guilan University of Medical Sciences, Guilan, I.R.Iran Amir Ahmad Zamani Far Non-Communicable Diseases Research Center, Ilam University of Medical Sciences, Ilam, IR Iran Zohreh Ghomian Safety Promotion and Injury Prevention Research Center, Institute for Health Sciences and Environment, Shahid Beheshti University of Medical Sciences, Tehran, Iran. School of Public Health and Safety, Department of Health in Disasters and Emergencies, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Journal Article 2025 04 26 Introduction: Drowning is a leading cause of unintentional injury-related deaths worldwide, with significant geographical variations in mortality rates. This study aims to identify high-risk drowning areas and assess epidemiological trends using Geographic Information Systems (GIS) from 2016 to 2022. Method: A cross-sectional analytical study was conducted using data recorded by the Emergency and Medical Incident Management Center of Gilan Province. A total of 588 drowning incidents were analyzed, considering variables such as age, gender, seasonality, and geographical location. GIS software was used to map high-risk areas using Spot and Heatmap techniques, while statistical analyses were conducted in Stata. The Odds Ratio (OR) index was used to assess risk levels. Result: Of the 588 reported drowning incidents, 497 were non-fatal, while 91 resulted in fatalities. The majority of incidents (474 cases) occurred in high-risk locations. Male individuals accounted for 77.21% of the total cases and 81.98% of fatalities, highlighting gender disparities in drowning rates. Rasht County recorded the highest number of fatalities (20 deaths), while Shaft and Sowme'eh Sara had zero reported drowning deaths. Geographic analysis using GIS mapping revealed that most drowning incidents occurred along the shorelines and river confluences, particularly in Bandar Anzali, Rasht, Astarabad, and Rudsar. Odds Ratio (OR) indicated that men had significantly higher drowning risks than women (OR = 2.57, 95% CI: 2.21–2.96), and drowning risk was notably elevated in coastal zones (OR = 3.19, 95% CI: 2.65–3.85) Conclusion: Drowning mortality in Gilan Province is disproportionately higher among older men, primarily due to occupational exposure, risky behaviors, and environmental factors. Preventive measures such as enhanced safety regulations, swimming education programs, improved tourist signage, and stricter enforcement of occupational safety standards are recommended to reduce drowning incidents. Identifying high-risk zones through GIS analysis provides valuable insights for targeted interventions and policy development.

https://www.traumamon.com/article_238163_6c449c02269444e5a6557244cb4bbde9.pdf

Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 30 6 2025 11 01 Management of Shotgun Injures 1635 1639 238166 10.30491/tm.2025.538943.1862 EN Shaban Mehrvarz Trauma Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran. 0000-0003-1263-1857 Mohammad Javad Behzadnia Trauma Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran. Hadi Khoshmohabat Trauma Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran Mehri Farhang Ranjbar Research Center for Trauma in Police Operations, Directorate of Health, Rescue & Treatment, Police Headquarter, Tehran, Iran. Department of Support and Services Management, Institute of Management and Organizational Resources, Policing Sciences and Social Studies Research Institute, Tehran, Iran. 0000-0002-3119-398X Amirhossein Karimnezhad Trauma Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran. 0000-0002-4401-5859 Journal Article 2025 08 03 Introduction: This study aimed to determine the types of trauma inflicted on different areas of the body as a result of shotgun injuries, while also evaluating the diagnostic and therapeutic interventions performed. Method: This was a descriptive-analytical cross-sectional study conducted on individuals injured by a shotgun during the 2022 unrest in Tehran. A total of 180 individuals were included. Injured individuals were categorized into police or security and protester groups and compared in terms of type of injury and severity. Data were collected from hospital records, including demographic information, injured body areas, trauma-related complications, and diagnostic and therapeutic measures. The Injury Severity Score (ISS) and Abbreviated Injury Scale (AIS) were calculated based on available data. Statistical analysis was performed using SPSS software. Result: Out of 180 injured patients included in the study, 172 were male and eight were female. The mean age was 31.82 ± 11.47 years, ranging from 10 to 63 years. Among them, 106 were police or security personnel and 74 were protesters. The mean ISS for all patients was 1.48 ± 0.96. Comparison between the two groups showed that police or security personnel sustained more severe injuries (1.69 ± 1.24 vs. 1.18 ± 0.55; P = 0.01). Injuries to the head, face, neck, and chest were significantly more common among police or security personnel (P = 0.024), while abdominal, pelvic, and lower limb injuries were more prevalent among protesters (P = 0.015). Imaging tools such as plain radiography and CT scans were used for diagnostic evaluation. All 21 cases of chest trauma were diagnosed by chest X-rays. Two cases required chest CT scans, which showed no lung or cardiac injury. In abdominal injuries, 51% of radiological assessments had positive findings. Among 40 cases of head and neck trauma, only one showed pellet penetration of the skull bone, and no brain tissue injury was observed. Regarding treatment, 42 patients (23.3%) required hospitalization, while 138 (76.7%) were treated on an outpatient basis. None required CPR or airway management. Conclusion: Shotgun pellets has not high energy and usually cause minor injury but sometime may cause serious injuries. Removal during early hospitalization is not recommended. Deep pellets in limbs generally do not require removal unless surgery is indicated due to vascular or neurological damage. Chest injuries with deep or multiple wounds require more radiographic study. Deep or multiple wounds in the abdomen need additional evaluation to rule out serious intra-abdominal injuries. Greater caution is needed in managing facial and neck injuries, necessitating more intensive care.

https://www.traumamon.com/article_238166_59f60b39cd868a3bc31d0fb9e9d76ad4.pdf

Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 30 6 2026 11 01 Modelling Prognostic Factors on Traumatic Care Pathways: An Application of Multistate Models 1640 1648 236055 10.30491/tm.2025.469561.1751 EN Fatemeh Javanmardi Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran Zahra Shayan Department of Biostatistics, Trauma Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. 0000-0002-3172-6862 Parisa Safarinejadian Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran Shahram Paydar Trauma Research Center, Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. 0000-0002-6980-2576 Leila Shayan Trauma Research Center, Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. Journal Article 2024 07 24 Introduction: Traumatic experiences are commonplace worldwide and have been proven to have detrimental effects on health. Unlike traditional survival analysis, which focuses on a single endpoint, multistate models are beneficial for evaluating the progression of multiple health conditions over time. The primary goal of this paper is to employ a multistate model to ascertain the patterns in hospitalizations among traumatic patients. Method: In this longitudinal study, 502 eligible trauma patients who were referred to Shahid Rajaee Hospital in Shiraz, Iran, were chosen and followed from July 2018 to March 2019. A Semi-Markov Multistate model was utilized in the current study. Patients were assumed to transition between five states. Transition times (triage → general ward, triage → death, general ward → Intensive Care Unit [ICU], general ward → death, and surgical ward → death) were assumed to follow an exponential distribution. The hazard ratio (HR) for each covariate was estimated for each transition. Result: Based on in-hospital triage evaluations, some patients needed surgery. Injury Severity Score (ISS) more than 15 (HR= 1.41), blunt trauma with brain injury (HR=2.15), hypotension (HR=1.41), and low pulse rate (HR=1.40) increased the probable requirements of the surgery. Following surgical treatments, patients with moderate Glasgow Coma Scale (GCS) were more likely to die (HR=1.42). Further, those who had experienced blunt trauma and brain damage had a lower chance of death following surgery (HR=0.62). The need for intensive care directly after triage is more likely in cases with a severely low GCS score. Conclusion: This study confirmed that elderly patients are at lower risk of surgical interventions after ICU. Cases with more injuries were more likely to require surgery after triage. Identifying specific prognostic factors that significantly impact the progression and outcomes of traumatic care can help healthcare providers prioritize interventions and allocate resources more effectively, ultimately enhancing patient outcomes.

https://www.traumamon.com/article_236055_4bc4991ebc3bd722765f157c77924e7a.pdf

Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 30 6 2026 11 01 Pain and Surgical Outcomes in Ankle Fracture and Syndesmosis Injury: Comparing Screw and Flexible Fixation Methods in a Cohort Study 1649 1656 234046 10.30491/tm.2025.489826.1786 EN Arash Aris Department of Orthopedics, Orthopedic Research Center, Trauma Institute, Poursina Hospital, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran 0000-0002-0446-3489 Kamran Asadi Department of Orthopedics, Orthopedic Research Center, Trauma Institute, Poursina Hospital, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran 0000-0003-3885-1057 Amir Farhangi Department of Orthopedics, Orthopedic Research Center, Trauma Institute, Poursina Hospital, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran 0009-0009-0103-6543 Mohammadali Yazdanipour Neuroscience Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran 0000-0001-9084-0887 Nima Faghirpour Guilan Road Trauma Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran 0009-0004-9270-9478 Journal Article 2024 11 26 Introduction: Although the importance of anatomical repair and fixation for syndesmotic injury has been emphasized, the best surgical approach remains a topic of discussion. This study sought to evaluate and compare the post-operative pain and surgical outcomes between screw fixation and the suture endobutton method in patients with Weber type C ankle fractures. Methods: A total of 56 consecutive patients with Weber type C ankle fractures participated in this prospective cohort study and underwent either screw fixation or suture endobutton surgery in 2022. Pain, infection, and the Foot and Ankle Outcome Score (FAOS) were monitored 3, 6, and 12 months’ post-operation. Results: The study included 14 women and 42 men, aged 18 to 47 years. There were no differences in age and sex between the two surgical groups. The pain score was significantly lower in the suture endobutton group compared to the screw fixation group three months after the operation (P=0.042). However, the two groups had no significant differences in pain scores at six and twelve months. Within each treatment method, the pain scores were statistically significantly different over time (Ptotal<0.001 in two groups). The suture endobutton method resulted in higher FAOS scores compared to the screw fixation method at three, six, and twelve months after surgery. The difference in this score within each group during the follow-up period was statistically significant (Ptotal<0.001 in two groups). Conclusion: The suture endobutton method has demonstrated advantages over screw fixation surgery. Patients have improved performance at three, six, and twelve months’ post-surgery, indicating that it may be a potentially superior approach to treating syndesmosis injuries.

https://www.traumamon.com/article_234046_b43fba34744ea1a43572e6b3fd59d58f.pdf

Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 30 6 2026 11 01 Evaluation of Trauma Injury Patterns and Treatments of Urban Riots in Tehran 1657 1663 238178 10.30491/tm.2025.498090.1797 EN Hadi Khoshmohabat Trauma Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran 0000-0003-4881-8613 Mohammad Javad Behzadnia Trauma Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran Mahdi Rasoolian Trauma Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran 0009-0005-0619-7013 Journal Article 2025 01 05 Introduction: Trauma is one of the leading causes of death and disability worldwide. This study aimed to investigate the severity and patterns of trauma, as well as to analyze the treatment outcomes for victims of urban riots who were referred to a general hospital in Tehran from October to December 2022. Methods: This cohort study involved 1,032 individuals injured during urban riots, all of whom were referred to a Hospital in Tehran between October and December 2022. The severity of their injuries was assessed based on operational descriptions, CT scans of the brain and other organs, and ultrasound examinations, all of which were obtained from patient records. The likelihood of survival for each patient was calculated using the TRISS method. Results: One thousand thirty-two individuals were injured, consisting of 1,030 males and two females. The patients ranged in age from 14 to 65, with an average age of 30.9 ± 9.9 years (median age of 30 years). Among the injured, two people (0.19%) were aged between 0 and 15, 1,008 people (97.7%) were between 15 and 55, and 22 people (2.1%) were over 55 years old. The average Injury Severity Score (ISS) was 1.8 ± 3, with a median score of 1. The average survival probability of patients using the TRISS model was 99.487 ± 2.7%. The overall average TRISS score was 0.513 ± 2.7%. Conclusion: TRISS can be utilized to evaluate the quality of various programs, such as educational initiatives, the establishment of cardiopulmonary resuscitation teams, and trauma surgical teams. Given the potential for urban accidents, it is essential to develop trauma care protocols based on the severity of patients' injuries. Additionally, it is recommended to establish a trauma registration center that utilizes standard questionnaires and checklists.

https://www.traumamon.com/article_238178_512623b71bfaeea5b53cc62dd60c22f6.pdf

Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 30 6 2026 11 01 Zionist-US Military Aggression and the Iranian Medical Community 1664 1665 238179 10.30491/tm.2025.563706.1913 EN Hassan Ali Mohebbi The Center of Excellence for Trauma, Baqiyatallah University of Medical Sciences, Tehran, I.R. Iran Trauma Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Science, Tehran, I.R Iran. M.R. Heidary Educational Development Office, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, I.R. Iran. Journal Article 2025 12 02 The Zionist state of Israel struck the Islamic Republic of Iran on 13th June 2025 with sudden and unprovoked air attacks in a blatant act of aggression assassinating many military commanders, nuclear scientists, and killing civilians, mostly women and children. This 12 days of US-Israeli aggression also destroyed houses, apartments, schools, clinics, hospitals, industrial areas and defense and military facilities. It was condemned by the world community including UN. International Organizations should be reminded and are hereby emphasized to observe ethical and humanitarian principles in wars, especially not to harm relief and medical personnel.

https://www.traumamon.com/article_238179_23363e9a5104d797987048558121b51f.pdf