Archives of Iranian Medicine最新文献

Traumatic deaths are common, with cardiac trauma affecting 7‒12% of patients with thoracic injuries. Blunt cardiac injury (BCI), although rare, is associated with a high mortality rate. This report presents a case of blunt cardiac rupture (BCR) observed at autopsy despite the absence of external chest trauma, suggesting the presence of severe internal injuries. A 19-year-old male was found dead in his vehicle which had collided with a wall. At the crime scene investigation, external examination revealed no substantial chest wall injuries in the individual despite significant damage to the vehicle. Autopsy revealed a 2-cm rupture of the right ventricle (heart), accompanied by 400 cc of partially coagulated blood in the pericardial cavity, consistent with cardiac tamponade. Pregabalin was detected in the toxicology analysis, but not in lethal concentrations. Traffic accidents are a major cause of BCI, typically resulting from compression of the heart between the thoracic structures during high-energy impacts. BCR is particularly fatal and often results in rapid death before arrival to the hospital. The absence of external trauma in the current case underscores the need for thorough internal examination in trauma-related deaths.

Background: The Eastern Mediterranean Region, including Iran, has the highest incidence and mortality of breast cancer (BC) in women. This study examined changes in BC mortality trends among Iranian women by age period cohort (APC) from 1990 to 2021.

Methods: BC deaths and population by age (1990‒2021) were collected from the 2021 Global Burden of Disease (GBD) study and the average annual percentage change (AAPC) and relative risks (RRs) analyzed by joinpoint regression and the APC model.

Results: From 1990 to 2021, the crude and adjusted BC mortality rates showed an increasing (AAPC=0.913%; 95% CI: 0.436%, 1.393%) and decreasing (AAPC=-0.384%, 95% CI: -0.759%, -0.008%) trend, respectively. The APC analysis exhibited an increasing trend in age effect except in the 60‒74 and 80‒84 age group. The period effect also presented an increasing trend from 1992 (RR=0.716; 95% CI: 0.697, 0.734) to 2021 (RR=1.410; 95% CI: 1.381, 1.441). Additionally, the cohort effect illustrated that the mortality rate decreased consistently from the earlier birth cohort to the later birth cohort (Coef=1.017 in<1901 cohort versus Coef=-0.928 in 2002-2006 cohort).

Conclusion: Between 1990 and 2021, BC mortality in Iran showed an increase in crude rates but a decline in age-adjusted rates, with rising age and period effects and a decreasing cohort effect. These patterns may reflect improvements in early detection and treatment alongside demographic shifts, highlighting the need for continued monitoring to guide control strategies.

Background: Personnel working in prehospital emergency medical services (EMS) frequently encounter violence during their duties. This situation negatively affects the safety of healthcare workers and the delivery of services. The aim of this study was to identify the incidence of violence exposure among prehospital care EMS personnel and to evaluate the impact of violence risk on service provision.

Methods: This descriptive, cross-sectional study was conducted among prehospital care EMS personnel in Turkey, with a total of 501 participants. Data were gathered through a structured questionnaire designed to capture instances of violence exposure.

Results: Totally, 40.1% (201) of participants reported experiencing physical violence from at least one patient during their career, while 26.0% (130) reported experiencing physical violence from at least one patient's relative during their career. Younger participants, those working in urban areas, and those with higher average daily call-out rates experienced higher levels of violence exposure (P<.05). Also, 38.5% of the participants reported instances where they could not intervene for the patient due to the risk of violence, and 51.9% reported instances where they did not intervene for the patient until law enforcement arrived due to the risk of violence.

Conclusion: The incidence of violence exposure among prehospital care EMS personnel is notably high. The high rates of violence in urban areas and the time lost in withdrawing from service and waiting for law enforcement intervention indicate that violence is a significant factor affecting service quality.

Background: Food frequency questionnaires (FFQs) are widely used in epidemiologic studies to assess the dietary intake of individuals. In this study, we evaluated the validity and reproducibility of the FFQ used in the Prospective Epidemiological Research Studies in IrAN (PERSIAN) for assessing nutrient intakes.

Methods: Individuals (n=978) from seven PERSIAN cohort centers participated in this study; an initial FFQ was completed for each person upon enrollment (FFQ1), followed by two 24-hour dietary recalls (24HR) each month, for twelve months, and finally, another FFQ at the end of the study (FFQ2). Serum and 24-hour urine (24H-U) samples were also collected each season, and selected biomarkers were measured. To assess validity, correlation coefficients between the 24HRs and the FFQs were obtained. The triad method was used to compare the biomarkers to the FFQs. Correlations between FFQ1 and FFQ2 were evaluated to assess the reproducibility of the questionnaire.

Results: Correlations obtained for energy and macronutrients, in comparing FFQ1 and FFQ2 to the 24HRs were 0.57,0.63 (energy), 0.56,0.62 (protein), 0.51,0.55 (lipids) and 0.42,0.51 (carbohydrates), respectively. Moderate (0.4‒0.6) and high (>0.6) correlations were seen for micronutrients, with only vitamins B6 and B12 being poorly correlated (<0.4). Validity coefficients obtained for urinary protein and sodium, as well as serum folate and selected fatty acids were acceptably above 0.4. Reproducibility correlations ranged from 0.18 (alpha-linoleic acid) to 0.78 (selenium), with 19 of the 30 evaluated nutrients showing high and 2 showing poor correlations.

Conclusion: Overall, the PERSIAN Cohort FFQ is acceptable to rank individuals based on their nutrient intakes.

Background: Ambient air pollution, especially particulate matter (PM₁₀) and sulfur dioxide (SO₂), has been implicated in exacerbating cardiopulmonary diseases. While emergency department visits have been widely studied, the impact of pollution on intensive care unit (ICU) admissions and mortality is less understood. This retrospective observational study aimed to evaluate the association between monthly air pollutant levels and ICU admissions for cardiopulmonary conditions, as well as in-hospital mortality.

Methods: We retrospectively analyzed 6,112 ICU admissions in a tertiary hospital from January 2012 to November 2019. Using defined inclusion criteria, 227 pulmonary and 344 cardiovascular ICU admissions were selected. Monthly PM₁₀ and SO₂ levels were obtained from official air monitoring stations. A one-month lag model was applied for cardiovascular admissions. Multivariate models were used to assess associations, and results were reported with 95% confidence intervals (CIs).

Results: Higher PM₁₀ levels were significantly associated with pulmonary ICU admissions (β=0.017; 95% CI: 0.003-0.031; P=0.020) and with cardiovascular admissions using a one-month lag structure (β=0.018; 95% CI: 0.005-0.030; P=0.006). SO₂ showed no significant associations. No significant relationship was observed between air pollution and in-hospital mortality. Chronic kidney disease (HR=1.309; 95% CI: 1.031-1.663; P=0.027) and higher Simplified Acute Physiology Score (SAPS) scores (HR=1.012; 95% CI: 1.006-1.017; P<0.001) were independent mortality predictors.

Conclusion: This study indicates that long-term exposure to PM₁₀ significantly affects ICU hospitalization rates for both pulmonary and cardiac conditions, particularly reflecting delayed effects in cardiovascular admissions, without a corresponding impact on in-hospital mortality.

Background: Surgical site infections (SSIs), particularly after spinal procedures, remain a major concern despite advances in infection control. This study aimed to determine the prevalence and associated risk factors of postoperative spinal infections in northwestern Iran.

Methods: A cross-sectional study was conducted on 500 adult patients (≥18 years) who underwent spinal surgery in two referral hospitals in Tabriz (Imam Reza and Shohada) between March 2019 and February 2024. Postoperative infections were confirmed by infectious disease specialists. Data on demographics and surgical variables (including surgical site, approach, duration, blood loss, and transfusion) were collected using a standardized checklist. Statistical analyses were conducted in SPSS version 23.0 using Chi-squared and independent samples t-tests. Logistic regression was performed to estimate adjusted odds ratios (ORs) with 95% confidence intervals (CIs).

Results: The prevalence of postoperative spinal infections was 6%. Staphylococcus aureus was the most common pathogen (66.7%). Significant risk factors included female sex, older age, corticosteroid use, diabetes mellitus, longer surgery duration (>4 hours), blood loss (>1 liter), and blood transfusion (P<0.05). Diabetes (OR=5.90, 95% CI: 2.30-15.20) and prolonged surgery (OR=6.90, 95% CI: 2.50-19.00) showed the strongest associations. No significant associations were found for BMI, smoking, hypertension, CRP, ESR, surgical site, or technique.

Conclusion: A 6% infection rate was identified, with several clinical and demographic factors increasing risk. Recognizing these predictors is essential for prevention. Broader, multi-center studies are recommended to validate findings and inform national surgical infection control policies.

Background: Chronic low-grade inflammation is implicated in diabetic microvascular complications, but the relationship between circulating high-sensitivity C-reactive protein (hs-CRP) and diabetic retinopathy (DR) in type 2 diabetes mellitus (T2DM) remains incompletely defined. We evaluated whether plasma hs-CRP levels are independently associated with DR presence and severity in a cohort of T2DM patients.

Methods: In this analytical cross-sectional study, 149 T2DM patients referring to endocrinology and ophthalmology clinics at Babol University of Medical Sciences (April 2022-June 2023) were categorized into no DR (n=50), non-proliferative DR (NPDR; n=49), and proliferative DR (PDR; n=50) groups. Comprehensive ophthalmic examination classified DR stage. We measured hs-CRP (low: 0-1 mg/L, moderate: 1-3 mg/mL, high:>3 mg/mL), HbA1c, fasting blood sugar (FBS), and total cholesterol in fasting blood samples. Statistical analysis was performed with SPSS v.22.

Results: Mean hs-CRP concentrations rose progressively with DR severity: 2.71±1.14 mg/L (no DR), 4.89±5.31 mg/L (NPDR), and 10.60±9.24 mg/L (PDR; P=0.023). After adjusting for age, sex, diabetes duration, HbA1c, BMI, hypertension, smoking, cholesterol, and treatment, each 1 mg/L increase in hs-CRP was associated with 1.40-fold higher odds of DR (OR 1.40; 95% CI 1.08-1.94; P=0.011). Other independent predictors included longer diabetes duration (OR 1.19 per year; 95% CI 1.10-1.29; P<0.001), higher HbA1c (OR 1.62 per %; 95% CI 1.06-2.48; P=0.023), and female sex (OR 3.25; 95% CI 1.11-9.52; P=0.031).

Conclusion: High hs-CRP levels correlate with DR severity in T2DM, highlighting inflammation's role and potential for early detection strategies.