Medical Journal of The Islamic Republic of Iran (MJIRI)

---

We evaluated the specific pattern of pre- and postoperative neurological signs and symptoms of cervical spondylotic myelopathy (CSM) to determine [mdings which had a predictive value for surgical outcome. Consecutive patients with CSM caused by osteophytic ridge or intervertebral disc herniation who underwent anterior cervical decompression and fusion in Loghman Hakim Hospital from 1999-2003 were prospectively enrolled. Patients were evaluated postoperatively by office visit. Outcome was assessed by objective neurological examination and scoring with multiple functional rating scales. Forty - three patients (30 male, 13 female) with a mean age of 48.8 years fulfilled our inclusion criteria. The most common preoperative symptoms were sensory deficit in distal upper limbs (88.4%), gait disturbance (69.8%) and sensory deficit of distal lower limbs (58.1 %). The most common signs were hyperreflexia (95.3%), Hoffman's sign (93%) and Babinski's sign (83.7%). Vertebral osteophyte and soft disc herniation were found in 86% and 14% of the patients, respectively. Overall functional improvement, evaluated by using a modification of the Japanese Orthopedic Association Scale was noted in 79.7% of the patients who had an abnormal scale preoperatively. Strength improved considerably and significantly after operation. However, less than half of the patients experienced functional improvement in the lower limbs, a discrepancy that was probably caused by persistent spasticity. Atrophy of the hand muscles, preoperative spastic gait and cord atrophy as shown in MRI were poor prognostic factors.

---

    Background: In Iran, Road Traffic Injuries (RTIs)  is the second-leading cause of deaths, and the first leading cause of  disability-adjusted life year, and has one of the highest rates of death (32.1 per 100 000 population) all over the world. This study’s aim was to investigate the epidemiological pattern and underlying components of hospitalized RTIs in 31 provinces of Iran in 2011.
   Methods: This study conducted on all hospitalized RTIs during one-year period (March 21, 2011 to March 21, 2012). Data extracted from a hospital-based traffic injury registration system. According to a national law passed in 2005, all hospital expenses of traffic injuries should be covered by ministry of health based on governmental tariffs. The medical costs of eligible patients will be paid to the hospitals only if the patient data are sent to the above mentioned database. Statistical analysis was performed using SPSS v.16 (SPSS Inc., Chicago, USA), and spatial maps are provided using GIS 10.2. Descriptive statistics and t-test were used to compare means. World (WHO 2000-2025) standard population used to calculate age-adjusted incidence rate. All statistical tests were performed at the 5% level of statistical significance.
   Results: There were 322,064 injured cases recorded in the registration system during the study period. The national age-adjusted incidence rate of RTIs was 405 per 100,000 population. The highest incidence rates were in the age group of 15-29 years (643 per 100,000 population), followed by 30-44 year age groups (401 per 100,000 population). The incidence rate in men was 3.36 times more than women. Motorcyclist were the most frequent type of road users (39.2%) who involved in RTIs, followed by passengers (28.9%) and pedestrians (20.0%). Head injuries were among the most affected part of the body which occurred in 27.2% of the patients. The proportion of urban crashes was 60.7%.
   Conclusion: The results of this study indicated that the majority of RTI occurred on motorcyclists and head injuries was the most commonly affected body part. Therefore, in order to reduce motorcycle accidents and avoiding head injury among them, stricter law enforcement is urgently needed for helmet use and promotion of safety behaviors among motorcycle riders.
 

---

Background: Violent patients constitute 10% of all psychiatric admissions. Treatment options and clinical practice interventions vary across the globe and no survey of practice in a Middle Eastern setting exists. Surveying treatments in Lebanon will show treatment interventions used in this part of the world and, most importantly, provide the treatment options that could potentially be used for clinical trials pertaining to emergency psychiatry.
   Methods: A survey of clinicians’ opinions and practice was conducted between July and August 2017 at the largest psychiatric hospital in Lebanon.
   Results: Five of seven experienced psychiatrists provided opinions when interviewed of their preferred intervention when dealing with an emergency psychiatric episode. Whilst this varied in detail, there was a consistent view that there should first be verbal control, then use of medications, and finally physical restrain of the patient. A total of 39 emergency episodes (28 people) occurred in the one month (64% men in their 30s). Bipolar disorder was the most frequent single diagnosis behind the aggression (n=16, 41%; 12 people 43%) but the combined schizophrenia-like illnesses underlay 18 of the 39 episodes (46%; 13/28 people 46%). In clinical life, we found evidence of high family involvement, but little attempts made at initial verbal control in the hospital. All 39 episodes involved administration of pharmacological interventions. Medications were used in 29 of cases (74%) and non-medication interventions used in the remaining 10/39 (26%).
   Conclusion: This survey provides some evidence that clinicians’ preferences may not fully reflect clinical practice but also that experienced clinicians are using several clearly effective techniques to manage these very difficult situations. However, as for other parts of the world, treatment in Lebanon has limited or no underpinning by evidence from well-designed, conducted and reported evaluative studies.

---

Background: In a resource-demanding COVID-19 pandemic, guidelines can free up health care resources needed for providing better care to those with COVID-19 and other patients. This study was performed to design a guideline to manage patients with colorectal cancers during the COVID-19pandemic.
   Methods: To design this guideline, major topics and headings of colon and rectal cancers (CRC) were selected and included. Based on the extent of COVID-19 infection in the community and availability of hospital resources, the guideline has been designed for 2 major COVID-19 phases. Several multidisciplinary discussion sessions were held to review the comments of experts, finalize the data, and write the guideline.
   Results: This guideline has been prepared in 2 main COVID-19 phases of the community/hospital. Phase A refers to the condition where a large number of COVID-19 patients are admitted to the hospital, but limited surgical ICU beds and facilities are still accessible. In phase B, many people are affected by COVID-19, and all hospital resources are allocated for COVID 19 patients. In phase A, 4 major groups are discussed, including malignant and suspicious colorectal polyps, colon cancers, rectal cancers, and recurrent cancers. The approach to emergent cases, including obstruction, bleeding, and perforation, will be presented in phase B.
   Conclusion: This guideline is a comprehensive instruction on the approach to colorectal cancers during the COVID-19 pandemic that covers the major topics of colon and rectal cancers in detail.

---

Background: The first case of Covid-19 disease was identified in Iran on February 19, 2020, and spread rapidly throughout the country. The aim of this study was to investigate the characteristics of COVID-19 hospitalized patients in Isfahan province of Iran from February 29, 2020, to July 21, 2020, and evaluate the effect of health system screening on the final outcome patients.
   Methods: In this cross-sectional study, all patients with positive COVID-19 PCR test and patients with negative PCR test but suspected clinical symptoms of COVID 19, admitted to Isfahan hospitals from February 29 to July 21were included in the study and the epidemiological characteristics of patients such as demographic characteristics, underlying disease, early signs and symptoms and the final outcomes of patients were analyzed using SPSS software version 20.
   Results: Of 11817 inpatients with COVID-19, 6590 (55.9%) were male, 1222 (10.4%) died, 9759 (82.8%) were discharged, and 4324 (36.7%) of hospitalized patients were asymptomatic. Among the hospitalized patients, 4642 (35.8%) had received primary screening services, and the mean age of the screened patients was statistically significantly higher than the group without primary screening (58.9±20.61, 55.08±21.57, P=0.068). 6914 (64.6%) of hospitalized patients had a positive initial PCR test, which was statistically significantly higher in patients with diabetes and an early symptom of sore throat. The Odds Ratio (OR) of readmission was most significantly associated with underlying cancer (OR=3.05, CI 95% 1.31-7.1) (P=0.011). The rate of readmission was statistically significantly higher in elderly, rural residents, and patients with underlying disease, diabetic, and hypertensive patients (P<0.05). 
   Conclusion: This study showed that about half of the people who tested positive for COVID- 19 needed to be hospitalized, and about 9 percent mostly diabetic and hypertensive patients, needed readmission. More than half of the hospitalized people were not screened by the health system. However, screening by the health system had no effect on the length of hospital stay and disease outcome.

---

Proclaiming the second Decade of Action for Road Safety 2021-2030 with the ambitious target of preventing at least 50% of road traffic deaths and serious injuries by 2030, in continuation of the first UN call for the Decade of Action on Road Safety (2010-2020) encouraged countries to intensify national, regional and international collaboration, with a view to meeting the ambitious road safety-related targets.
In this regard, Iran has implemented the national road safety strategy and action plan under the supervision of the road safety commission as the lead agency in which the MOHME is one of the members. Moreover, as the main burden of road traffic injuries is on the health sector, to ensure universal access to health care services in the pre-hospital, hospital, post-hospital, and rehabilitation centers for road traffic victims and families, the road traffic injuries sub-committee affiliated with the Iranian Non-Communicable Diseases Committee (INCDC), developed the National Service Framework for Road Traffic Injuries through a multi-sectoral mechanism. The aim of this paper is to share Iran’s experience in terms of policy implications for RTI prevention and control. Sharing the lessons learned on the role of the health sector in meeting the ambitious road safety targets will help other countries to strengthen political commitment to road safety and move toward setting regional and global road traffic casualty reduction targets.