https://www.traumamon.com/ Trauma Monthly en daily 1 Wed, 01 Jul 2026 00:00:00 +0330 Wed, 01 Jul 2026 00:00:00 +0330 https://www.traumamon.com/article_253271.html Introduction: Chronic non-specific low back pain (LBP) combined with hamstring tightness may disrupt lumbopelvic mechanics and alter lower-limb neuromuscular control during gait. Although ACSM-based exercise programs are widely recommended for chronic LBP, their effects on phase-specific lower-limb muscle activation during walking remain unclear. This study investigated the effect of an 8-week ACSM-based exercise program on lower-limb electrical activity during walking in young men with hamstring tightness and chronic LBP. Method: In this semi-experimental laboratory study, 30 young men with chronic non-specific LBP and hamstring tightness were assigned to either an exercise group (n=15) or a control group (n=15). The exercise group completed an 8-week supervised ACSM-based program, three sessions per week, consisting of hamstring stretching, core stabilization, and lower-limb strengthening exercises. Surface electromyography (EMG) was used to record the electrical activity of the tibialis anterior (TA), medial gastrocnemius(MG), gluteus medius (GM), biceps femoris (BF), semitendinosus (ST), rectus femoris (RF), vastus medialis (VM), and vastus lateralis (VL) muscles of the dominant lower limb during walking at 1.3 m/s (±5%). EMG amplitudes were normalized to maximum voluntary isometric contraction (MVIC) and expressed as %MVIC across the loading response, midstance, and push-off phases. Data were analyzed using a 2×2 mixed repeated-measures ANOVA with Bonferroni-adjusted post hoc tests, and effect sizes were reported as partial eta squared (η2p). Result: Significant time×group interactions were observed in loading response for TA (p=0.030, η2p=0.157) and GM (p=0.030, η2p​=0.158); in midstance for VM (p=0.005, η2p=0.250) and GM (p=0.012, η2p​=0.210); and in push-off for MG (p=0.010, η2p​=0.218) and BF (p=0.024, η2p​=0.174). The exercise group showed reduced activation from pre- to post-intervention in TA, GM during loading response, VM and GM during midstance, and MG and BF during push-off, whereas the control group remained relatively stable. Conclusion: An 8-week ACSM-based exercise program induced selective, phase-dependent reductions in lower-limb EMG activity during walking in young men with chronic LBP and hamstring tightness. These findings indicate selective, phase-dependent reductions in lower-limb EMG activity after an 8-week ACSM-based exercise program. Although consistent with a shift away from compensatory overactivation, reduced EMG amplitude could also reflect decreased effort or motivation, reduced muscle capacity, or altered gait mechanics; concurrent kinematic, kinetic, or metabolic measures would be needed to confirm improved movement efficiency. https://www.traumamon.com/article_253279.html Introduction: This study evaluated whether intraoperative milrinone improves cardiac diastolic and systolic function in patients undergoing elective on-pump CABG.Method: In this prospective study, 30 patients undergoing elective on-pump CABG were allocated equally to a milrinone group (n=15) or a control group (n=15). After anesthesia induction and before CPB, the milrinone group received a loading dose of 50 µg/kg over 10 minutes, followed by an infusion of 0.5 µg/kg/min continued for 6 hours postoperatively; the control group received an identical volume of normal saline. TEE was performed at two time points: after induction (baseline) and after separation from CPB. Baseline diastolic function was characterized using standard Doppler indices; however, patients were not preselected or stratified by diastolic dysfunction grade, which represents a limitation of the study design. Echocardiographic indices (fractional area change [FAC], pulmonary venous flow velocity [PV], deceleration time [DT], E/PV, A-wave duration [Adur], atrial reversal duration [ARdur]), hemodynamic variables, vasoactive requirements, and intensive care unit (ICU) length of stay were compared between groups.Result: Baseline characteristics, including age, sex, weight, height, comorbidities, left ventricular ejection fraction (p=0.10), surgical duration (p=0.18), and CPB duration (p=0.10) were comparable between groups. Milrinone significantly increased FAC after CPB relative to control (55.39±10.86% vs 45.71±12.04%; p=0.028) and relative to its own baseline (vs 42.77±11.27%; p<0.001). Pulmonary venous flow velocity after CPB was significantly higher in the milrinone group than in controls (96.95±31.08 vs 76.03±22.54 cm/s; p=0.049) and higher than its own baseline (vs 63.59±20.72 cm/s; p<0.001). No significant between-group differences were observed in DT, E/PV, Adur, or ARdur. Hemodynamic parameters, norepinephrine requirement during CPB (p=0.92), inotrope and nitroglycerin dosing, cardiac rhythm, and ICU length of stay did not differ significantly between groupsConclusion: Intraoperative milrinone significantly improved systolic performance (FAC) and pulmonary venous flow in patients undergoing elective on-pump CABG, with a relative improvement in selected diastolic indices and no adverse hemodynamic effects. However, because patients were not preselected for baseline diastolic dysfunction, the study was underpowered to detect a dedicated diastolic benefit. These findings suggest a potential role for milrinone in the perioperative management of CABG patients, particularly those with preexisting diastolic dysfunction. Adequately powered multicenter trials are warranted to confirm a dedicated diastolic benefit and to evaluate its impact on clinical outcomes, particularly in higher-risk or critically ill subpopulations. https://www.traumamon.com/article_253282.html Introduction: Epilepsy is a chronic neurological disorder that has an impact on a person's social and psychological health. Social stigma and isolation are major psychosocial traumas affecting mental health, quality of life, and social participation. These factors critically influence mental health, quality of life, and social participation, yet they remain underrecognized in routine clinical care. This study aimed to (1) assess the effects of psychosocial factors—specifically stigma and social isolation—on patients with epilepsy, and (2) examine the association between patients' demographic and clinical characteristics and their psychosocial outcomes Method: A descriptive cross-sectional study was conducted from 16/5/2024 to 20/10/2024, using purposive non-probability sampling to select 100 patients with epilepsy from the Middle Euphrates Neurological Center in Najaf Governorate, Iraq. Result: Most participants were male, aged 20 to 30 years, married, and illiterate; disease onset was at age 21 or older; most were non-smokers; and the pathology was idiopathic. Lastly, overall psychosocial aspects of the patients with stigma were at a moderate level and a severe level according to social isolation, so the overall effect of psychological aspects was at a moderate level psychosocially. Conclusion: Patients with epilepsy experience considerable psychosocial trauma, with moderate levels of stigma and severe social isolation. These findings emphasize the urgent need to combine routine psychosocial assessment and trauma-informed supportive interventions into epilepsy care to improve patients' overall well-being and clinical outcomes. https://www.traumamon.com/article_253284.html Introduction: Neuromuscular deficits may persist after anterior cruciate ligament reconstruction (ACLR) despite restoration of mechanical stability, and these alterations may become more evident under fatigue. Whether graft type influences fatigue-related changes in EMG spectral behavior during gait remains unclear. This study investigated the effect of an acute fatigue protocol on EMG median frequency (MF) during the swing phase of walking in individuals following ACLR with different graft types. Method: In this cross-sectional laboratory study, 53 physically active men were included, including 38 individuals with unilateral ACLR reconstructed using single-bundle hamstring tendon autograft (SB-HT, n=12), double-bundle hamstring tendon autograft (DB-HT, n=16), or allograft (n=10), and 15 healthy controls. Participants completed a progressive treadmill running protocol designed to induce systemic fatigue, terminated when Borg rating of perceived exertion exceeded 17 for at least 2 min or heart rate reached at least 85% of age-predicted maximum. Surface EMG was recorded from TA, GC, VL, VM, RF, BF, ST, and GM during walking before and immediately after fatigue. We calculated EMGMF for gait phases, focusing on swing. A two-way mixed-model repeated-measures ANOVA tested the main effects of fatigue and group and their interaction. Result: No significant main effects of fatigue or group, and no fatigue×group interactions, were observed for the quadriceps (VL, RF, VM), hamstrings (BF, ST), or distal lower-leg muscles (TA, GC) during swing (all interaction p>0.05). A trend toward a group effect was observed for semitendinosus (p=0.065). In contrast, GM MF increased significantly following fatigue across groups (main effect of fatigue: p=0.025, ηp²=0.111), with no significant group effect (p=0.437) or interaction (p=0.431). Conclusion: Acute fatigue did not meaningfully alter GMMF in most lower-limb muscles during the swing phase of walking after ACLR, and these responses did not differ between graft types. The selective post-fatigue increase in GMMF suggests that hip stabilizer activity may respond to fatigue; however, further research is needed before clinical recommendations can be made. https://www.traumamon.com/article_253285.html Introduction: The June 2025 “12-Day War of Iran- Israel” between Iran and Israel inflicted substantial human and infrastructural losses, generating a psychosocial emergency affecting both civilians and mental health professionals. This study investigates the psycho-occupational challenges and adaptive responses of psychologists and counselors during this acute, short-term conflict.Method: Employing a qualitative interpretive phenomenological design, semi-structured interviews were conducted with 12 mental health practitioners in Tehran.Result: Data analysis via MAXQDA identified seven interconnected themes: emotional reactions (shock, fear, anger), cognitive responses (catastrophic scenario construction, disruption in Cognitive Processes, hypervigilance), physiological manifestations (fight-or-flight activation, psychosomatic symptoms), behavioral adaptations (avoidance, role conflict, disrupted routines), occupational-economic pressures (income loss, job insecurity), work-related professional stress (occupational burnout, self-reliance Stereotype, transference of emotional burden to family, demand–Capacity Paradox), and foundational-structural challenges (work structure paralysis, lack of safe occupational Space).Conclusion: Findings demonstrate that even brief armed conflicts can profoundly compromise mental health professionals’ well-being, blurring personal-professional boundaries and exacerbating role strain. Recommendations include structured support programs, culturally adapted self-care protocols, and organizational policy reforms to mitigate therapist workload and enhance resilience. Limitations include generalizability to long-term conflicts and reliance on self-reported data. Future research should employ longitudinal designs, cross-cultural evaluations, and diverse sampling to optimize interventions for mental health practitioners in crisis contexts. https://www.traumamon.com/article_253288.html Introduction: Due to the physically demanding and high-stress nature of emergency medical services, Emergency Medical Services (EMS) personnel are at increased risk of musculoskeletal disorders (MSDs) and reduced quality of life. Safety behavior may be associated with lower occupational health risks in this population. This study investigated the relationship between safety behavior, MSDs, and quality of life among EMS personnel.Method: This cross-sectional study was conducted in 2025 among 232 EMS personnel in Yazd Province, selected through stratified random sampling. We collected data using the Safety Behavior Questionnaire developed by Mehdinia et al., the Nordic Musculoskeletal Questionnaire, and the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF). We analyzed the data using SPSS version 27 with descriptive and inferential statistical tests, including the Mann-Whitney U test, Kruskal-Wallis test, Spearman correlation coefficient, and multiple linear regression analysis.Result: The mean scores for safety behavior, MSDs, and quality of life were 3.19 +/- 0.25, 4.60 +/- 1.54, and 46.28 +/- 19.08, respectively. Safety participation showed significant positive correlations with mental health (r = 0.154, p = 0.019) and social relationships (r = 0.150, p = 0.010). Safety behavior was also significantly associated with MSDs (p < 0.05). Regression analysis showed that MSDs were significantly associated with safety behavior (B = -0.022, p = 0.030), whereas quality of life did not significantly predict safety behavior (p = 0.48). In addition, age (p = 0.014), educational level (p = 0.038), body mass index (p = 0.032), and weekly working hours (p = 0.014) were significantly related to safety behavior, whereas work shift was not (p = 0.825).Conclusion: The findings indicate that MSDs are a common occupational health concern among EMS personnel in Yazd Province. Safety behavior showed a statistically significant association with MSDs, although the observed relationships were weak. Therefore, safety-related behaviors, along with other occupational factors, should be considered when evaluating EMS personnel's occupational health status. https://www.traumamon.com/article_253291.html Introduction: Prehospital emergency personnel are exposed to physical and psychological harm due to their continuous encounter with critical situations. These factors can significantly affect health and quality of life. This study was conducted to determine the association between resilience and quality of life among prehospital emergency personnel.Method: This analytical cross‑sectional study included 116 personnel affiliated with Golestan University of Medical Sciences who were on active duty during the COVID‑19 pandemic in 2020. Participants were recruited via convenience sampling. Data were collected using the Connor‑Davidson Resilience Scale (CD‑RISC) and the World Health Organization Quality of Life‑Brief Version (WHOQOL‑BREF). We performed statistical analyses using SPSS version 26, employing descriptive statistics, Pearson’s correlation coefficient, and multiple linear regression.Result: The mean resilience score was 66.77 (SD = 15.29), and the mean quality of life score was 86.58 (SD = 15.23). Resilience was positively correlated with overall quality of life (r = 0.61, P < 0.001), and all resilience subscales showed significant positive correlations with the quality-of-life domains. In the adjusted regression model, marital status and employment type predicted resilience. Single personnel had lower resilience scores than married personnel (B = −7.56, P = 0.049), whereas contract-based (B = 14.68, P = 0.001) and plan-based employees (B = 12.36, P = 0.003) had higher resilience scores than permanent employees. For quality of life, tobacco use (B = −9.93, P = 0.012) and resilience (B = 0.56, P < 0.001) remained significant independent predictors.Conclusion: The findings indicated a significant positive relationship between resilience and quality of life among personnel. These results underscore the importance of attending to psychological resilience alongside individual and organizational determinants of quality of life in this workforce. https://www.traumamon.com/article_253293.html Background: Massive non-missile penetrating brain injury (PBI) caused by large industrial or automotive objects is rare and often associated with high mortality. Management becomes particularly challenging when the foreign body is large enough to prevent standard surgical exposure and produces severe metallic artifacts that preclude reliable preoperative vascular imaging. Case Presentation: A 26-year-old male motorcyclist sustained a right frontal penetrating brain injury caused by a 15-cm-long, 2-cm-diameter metal bolt from a pickup truck’s roof rack. On arrival, his Glasgow Coma Scale (GCS) score was 3T (T indicating intubation), and he was hemodynamically stable. Computed tomography (CT) demonstrated transcranial penetration into the right frontal lobe but was severely limited by beam-hardening artifact. Preoperative CT angiography (CTA) was not feasible. Because the size of the impaled object precluded craniotomy prior to removal, emergency extraction was performed along the trajectory, followed immediately by craniotomy, meticulous debridement, duraplasty, and hemostasis. Serial postoperative CTA at 24 hours and 1 week revealed no vascular injury or traumatic aneurysm. The patient regained full consciousness (GCS 15) within 7 days and demonstrated no motor deficits. Mild persistent apathy was noted at 1-month follow-up; however, he had returned to independent daily activities and work. Conclusion: In selected cases of massive non-missile PBI in which standard preoperative craniotomy and CTA are not feasible, immediate extraction followed by prompt decompression and serial vascular imaging may result in favorable neurological outcomes. Early surgical adaptability and close postoperative surveillance are essential. https://www.traumamon.com/article_253294.html Introduction: Literature is rife with discordant results regarding the use of antiepileptic drugs for prophylaxis of Post-traumatic epilepsy. This study was conducted in Isfahan hospitals to compare the effectiveness of Sodium Valproate and Levetiracetam in preventing early seizures in patients with traumatic brain injuries.Method: A total of 160 patients with traumatic brain injury treated in Kashani Hospital (Isfahan, Iran) from 2024 to 2025 were enrolled and divided into group A (n=80) and group B (n=80) according to random sampling. The medication was continued for 3 months after the injury.Result: There were no statistically significant differences in demographic and clinical information between the two groups (P>0.05). We failed to determine a significant relationship between the antiepileptic drug used and the initial EEG (P=0.584) and seizure activity (P= 0.680) between the two drug groups. However, a significant correlation between the antiepileptic drug used and seizure activity was found at subsequent follow-ups (10, 180 days); patients who took levetiracetam had a decreased incidence of seizure activity at follow-ups. There was no significant correlation between the GCS score, both initially and on two follow-ups, and the antiepileptic drug used.Conclusion: Logically, it would seem that the long-lasting high risk of epilepsy after brain injury might be reduced if prophylactic antiepileptic drugs are administered. Looked specifically at prophylactic antiepileptic drugs post-TBI and reported a better safety profile, with a lower adverse drug reaction rate, for Levetiracetam versus Sodium Valproate. https://www.traumamon.com/article_253300.html Introduction: Suicidal thoughts (ST) and attempts (SA) are significant concerns among individuals with primary depression. This systematic review aims to explore risk factors associated with these phenomena to inform better prevention strategies.Methods: A systematic review was conducted. We searched 4 databases (PubMed, Embase, Scopus, Web of Science) from 2000 to the 7 February 2026, using "suicide," "self-killing," "suicidal," and "suicidium," while "depression" and "depressive" were used for depression, and "risk factor," "risk factors," "risk scores," and "relative risk” as keywords, and assessed for quality using the Newcastle-Ottawa Quality Assessment Form checklist. Relevant data were extracted and recorded from the eligible articles. Results: In 47 cohort studies (687,156 participants), key risk factors for ST and SA in primary depression across MDD, BD, and dysthymia included depressive severity, hopelessness, childhood trauma, and prior attempts. ST were linked to cognitive-emotional factors (rumination, perceived burdensomeness, anxiety). In contrast, SA were predicted by behavioral/clinical indicators (psychiatric hospitalization, substance use, unemployment, personality pathology, especially Cluster B in BD). Age patterns emerged: younger age/early onset increased SA risk in BD, while older age/social isolation were prominent in MDD. Biological (lipid abnormalities) and medication factors showed diagnosis-specific associations.Conclusion: Suicide risk in primary depression follows a progressive cascade from early trauma and personality vulnerabilities to clinical deterioration and behavioral manifestation. Prevention requires diagnosis-specific, age-sensitive strategies incorporating routine trauma screening, severity monitoring, and comorbidity management. https://www.traumamon.com/article_247118.html Background:Early and accurate diagnosis of any internal injury in cases of multiple trauma is crucial in decreasing morbidity and mortality. Focused Assessment with Sonography for Trauma (FAST) is a quick, non-invasive imaging method widely used in emergency departments. The current research aimed to assess the diagnostic accuracy of FAST with regards to hemodynamic, clinical, and paraclinical features, and also to analyze the characteristics and the clinical relevance of the false-negative FAST results. Methods:This cross-sectional research comprised 300 cases of multiple trauma patients admitted to Kosar Hospital, Sanandaj, during 2021 and 2023 years. Pneumothorax and intraabdominal free fluid results of FAST were compared with results of contrast-enhanced computed tomography (CT) scans. The vital signs and laboratory values were assessed, and diagnostic performance indicators were measured (including sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]). Results:In the presence of positive FAST test for pneumothorax, 96.9% were confirmed by CT (false-positive rate: 3.1%). Nevertheless, FAST missed 21.3% of pneumothoraxes. For detection of free fluid, 97% agreement between FAST and CT was established, with a false-negative rate of 20.1%. Patients with a positive FAST test had significantly lower blood pressure, elevated heart rate, and low oxygen saturation. In contrast, patients with a false-negative FAST test exhibited rather stable hemodynamic and laboratory parameters. Mortality rate reached 36.7%, and there was significantly higher mortality among patients with positive FAST results. Conclusion:FAST is an effective and fast diagnostic method, which is highly specific. Nevertheless, the relatively high rate of false-negative results remains the major limitation of this test, especially particularly in hemodynamically stable patients. Consequently, the absence of fluid on FAST scan warrants careful interpretation and further imaging in case of doubt.