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Background: The purpose of this study was to compare the effect of magnesium sulfate adjunct to dexmedetomidine on increasing the duration of sensory and motor block in axillary block. Materials and methods: This study is a double-blind clinical trial. Ninety-nine patients were included in the study. They were undergoing forearm and hand surgery and were referred to Vali-e-Asr Hospital in Arak. The patients were divided into three groups. The first group received lidocaine (1.5%) and dexmedetomidine (0.5 μg/kg). The second group patients were given lidocaine (1.5%) plus magnesium. In the control group, lidocaine (1.5%) was adjusted to 35 cc with normal saline. The final volume was 35 cc in the three groups. Sensory and motor block and pain were measured and data were analyzed using SPSS v. 20. The final volume was 35 cc in the three groups. Results: The sensory and motor block onset time and the stabilization time of the sensory and motor block in the magnesium sulfate group were lower (p<0/001). Pain in recovery, 2, 4, 6, 12, and 24 hours after surgery was lower in the magnesium sulfate group when compared with the dexmedetomidine group (p<0.001). The lowest dose of opioid was used in the dexmedetomidine group 24 hours after surgery (p<0.001). Conclusion: The results showed that dexmedetomidine decreases pain. Magnesium sulfate increased the sensory and motor block onset time, and the sensory and motor block stabilization time, but dexmedetomidine increases the motor block duration.

Oxford Elbow Score (OES) is a patient-reported questionnaire used to assess outcomes after elbow surgery. The aim of this study was to validate and adapt the OES into Persian language. After forward-backward translation of the OES into Persian, a total number of 92 patients after elbow surgeries completed the Persian OES along with the Persian DASH and SF-36. To assess test-retest reliability, 31 randomly selected patients (34%) completed the Persian OES again after three days while abstaining from all forms of therapeutic regimens. Reliability of the Persian OES was assessed by measuring intraclass correlation coefficient (ICC) for test-retest reliability and Cronbach’s alpha for internal consistency. Spearman’s correlation coefficient was used to test the construct validity. Cronbach’s alpha coefficient was 0.92 showing excellent reliability. Cronbach’s alpha for function, pain, and social-psychological subscales was 0.95, 0.86, and 0.85, respectively. Intraclass correlation coefficient (ICC) was 0.85 for the overall questionnaire and 0.90, 0.76, and 0.75 for function, pain, and social-psychological subscales, respectively. Construct validity was confirmed as the Spearman correlation between OES and DASH was 0.80. Persian OES is a valid and reliable patient-reported outcome measure to assess postsurgical elbow status in Persian speaking population.

This trial-based paper strives to address the comparative efficacy of some ropivacaine adjuvant options, comprising dexmedetomidine, granisetron, and nitroglycerin, on pain and hemodynamic changes in intravenous anesthesia for forearm surgeries. This double-blind, placebo-controlled study enrolled four block-randomized eligible groups with patients (overall, n=128) undergoing orthopedic forearm surgeries in the dexmedetomidine, nitroglycerin, granisetron, and placebo groups. Intra- and post-operative vital signs (mean arterial pressure/heart rate/ oxygen saturation) were monitored at baseline and captured every 10 minutes until the end of the surgery, as well as the onset of sensory and motor block and length and duration of the block and mean opioid use within 24 hours. Lastly, pain was noted after tourniquet inflation (at 15, 30, and 45 minutes every 15 minutes until the end of surgery) and after deflation (every 30 minutes to 2 hours at 30, 60, 90, and 120 minutes), as well as 6, 12, and 24 hours after the tourniquet was deflated. The dexmedetomidine-sedated subjects appeared to demonstrate quicker onset and longer length and duration of sensory and motor block, plus less pain and opioid use at all scheduled times (both P = 0.0001). Dexmedetomidine is recommended as an adjuvant to regional anesthesia (Bier's block), while being coupled with the rapid onset and prolonged length and duration of sensory and motor blocks, in addition to soothed pain and diminished opioid use within postoperative 24 hours. The study was approved by Ethics Committee of Arak University of Medical Sciences (approval No. IR.ARAKMU.REC.1398.112) on July 21, 2019, and registered at Iranian Registry of Clinical Trials (registration number IRCT20141209020258N123) on November 2, 2019.

Introduction : In the absence of microvascular replantation or in crash injury cases in which obtaining an acceptable function is not possible, amputation of the injured finger seems to be the best treatment modality. Some studies recommended leech therapy for this kind of injury after vascular repair to decrease venous congestion. Case Presentation : In this case report, the authors presented a case of leech therapy after near total amputation of the fingers. A 25-year-old patient was admitted following a sawing injury with crashed bundles of the third, fourth and fifth fingers. Microvascular surgery was not performed because of crush injury. Discussion : After a simple repair and pin fixation, the patient was treated using leech therapy. The result was satisfactory. The third and fourth fingers were salvaged. It seems that in cases where a small part of the skin is still attached to the amputated part, even with complete crash of both bundles, leech therapy can help salvage the amputated fingers.

Calcaneus has the most fracture prevalence among tarsal bones. About 3/4 of calcaneal fractures are intra-articular fractures with displacement. The majority of calcaneal fractures occur in 21 - 35 year old young men, and that are mostly active people, these fractures cause complete disability for 15 months. Moreover, inappropriate treatment leads to lots of social and economical damages. In this study we compared the incidence and the severity of peroneal tenosynovitis as a complication of non-operative and operative treatment of intra-articular calcaneal fractures. In this study, some other complications of this fracture were also analyzed and the prevalence of the complication was higher in non-operated patients. A total of 140 patients with intra-articular calcaneal fracture were analyzed prospectively. These patients were divided into 2 groups: operated group and non-operated group. In non-operated group (56 patients), 22 patients were complicated by peroneal tenosynovitis. In operated group (84 patients), 8 patients had the same complication. Statistical analysis revealed that the prevalence, and the severity of this complication in the mentioned groups had a meaningful difference. The results in operated group were much better than the non-operated one. Although some of the orthopedic surgeons are not interested to manage these fractures surgically and most of them treat these cases conservatively (casting, etc.), in most displaced intra-articular calcaneal fractures, surgical treatment is the method of choice. Moreover, in non-surgical treatment the prevalence of these complications among the patients is more and as a result, inevitable social, occupational and familial damages occur.

Background Health literacy(HL) is defined as the degree to which individuals have the capacity to obtain process and understand basic health information and services required for making appropriate health decisions. Effective interventions to improve older people’s HL have become increasingly important. The purpose of this study is to conduct a review of interventions aimed at enhancing the HL of older people. Methodology Relevant information was gathered from various databases including PubMed, Scopus, Cochrane Library, Science Direct, and Web of Science. Additionally, a manual search of related journals and Google Scholar, a search of the reference lists of selected articles, and a search of unpublished sources were also conducted up to 30 August 2024. Reporting quality assessment was performed using CONSORT: 2010, JBI Critical Appraisal Checklist for Quasi-Experimental Studies, and “Quality Assessment Criteria for Survey Research Reports”. Results A total of 21 articles were included in this study. The interventions conducted in high-income countries were found to be more effective compared to those conducted in middle and low-income countries. Furthermore, interventions carried out at the community level were more effective than those performed in nursing homes. Educational interventions were more effective than lifestyle modification interventions, and interventions carried out in a single dimension were more effective than multidimensional interventions. Additionally, interventions that utilized technology were found to be more effective. Conclusion Based on the findings, community-based interventions that encompass a one-dimensional approach, incorporating the use of technology and considering the duration of the intervention, are more recommended.

Background Since the COVID-19 outbreak, preliminary research has shown that some risk-associated conditions increase death and severe complications of the disease, hypertension being one of them. Thus, numerous meta-analyses have been conducted to explore this issue. Therefore, this umbrella review aims to perform a meta-analysis of the meta-analyses to estimate the prevalence and associated risks of hypertension in patients with COVID-19. Methods PubMed, Scopus, Web of Knowledge, Embase, and Cochrane databases were searched for the published meta-analyses up to January 1, 2022. Google Scholar, citation check, reference check, and Grey literature were also manually searched. A random-effect model approach was used for analysis. Results The overall death rate was estimated at 12%. Hypertension was present in 25% of the patients as a comorbid disease. The overall RR for death, disease severity, and the possibility of ICU admission were estimated at 1.79 [1.68–1.89 with 95% CI], 1.74 [1.66–1.83 with 95% CI], and 1.91 [1.48–2.34 with 95% CI], respectively. The meta-regression results showed that being “male” significantly increases the risk of disease severity and ICU admission. Conclusions The results indicated that hypertension is a common comorbid disease in hospitalized patients with COVID-19, which significantly increases mortality risk, the severity of the disease, and the probability of ICU admission. Systematic review registration This study has been registered in PROSPERO (CRD42021231844).

Introduction and objective Road Traffic Injuries (RTIs) represent the predominant cause of morbidity and mortality globally. Thus, impactful interventions and trustworthy authorities are imperative to mitigate traffic accidents. The present study seeks to assess public trust in traffic accident diminution policies and measures within the country of Iran. Method This cross-sectional study utilized a questionnaire comprising 31 questions distributed across eight dimensions. The questionnaire’s design was informed by a literature review and semi-structured interviews with experts specializing in traffic accidents. The target population consisted of Tabriz city residents, who were selected via convenience sampling. The collected data were then analyzed using SPSS-16 software, employing the T-test, One-way ANOVA, and Pearson correlation coefficient to present the study’s results. structural equation modeling (SEM) was conducted using R 4-4-2 programming language. Results A total of 681 participants completed the questionnaire, yielding a commendable response rate of 88.6%. The majority of participants were male (60.8%), and 86.2% identified as drivers, with 61.8% having experienced driving accidents. The overall score for public trust in RTIs policies was calculated to be 46.9%. The individual scores for specific domains of trust in traffic safety were as follows: safer roads (43.1%), safe vehicle (43.3%), safety laws (48.8%), safe user (51.1%), safe technology (51.5%), road safety management (46.8%). All the latent variables except education are significantly effective on public trust. Conclusion The study findings indicate relatively low levels of public trust in RTIs policies among the Iranian population. These results emphasize the need for targeted interventions to enhance public confidence in specific aspects of traffic safety. Policymakers can use these insights to implement effective measures, thus contributing to the RTIs and the promotion of road safety in the country.

Introduction In recent years, Professional Oral Health Care (POHC) has received serious attention for improving Oral Health Indicators (OHIs) in older people. Therefore, the present study aims to evaluate the impact of POHC on the oral health of older people through a systematic review and meta-analysis of existing studies and evidence. Methods Published articles until August 1, 2023, were searched in databases such as Scopus, PubMed, and Web of Science. Manual searches on Google Scholar, reference checks, citation checks, and gray literature were also conducted. Stata software was utilized for meta-analysis using a random-effects model. Results Out of 488 studies reviewed, 13 articles were included. All studies were conducted in high-income countries, with 11 studies conducted in elderly care centers. The status of dental plaque, oral health, and mucosal plaque in the POHC group was significantly better compared to the control group. The average dental plaque index score was significantly better than before the intervention. Despite improvement in both groups, the tongue coating index did not show statistically significant improvement. Results of other unaudited indicators also indicated a significantly better status in the intervention group than in the control group. Conclusion Although the results of the current study demonstrated the high effectiveness of professional oral health care, improving almost all OHIs in older people, further well-established studies in this field are still needed.