简介：AbstractPurpose:Boarding is a common problem in the emergency department (ED) and is associated with poor health care and outcome. Imam Khomeini Hospital is the main healthcare center in Urmia, a metropolis in the northwest of Iran. Due to the overcrowding and high patient load, we aim to characterize the rate, cause and consequence of boarding in the ED of this center.Methods:All medical records of patients who presented to the ED of Imam Khomeini Hospital from August 1, 2017 to August 1, 2018 were retrospectively analyzed. Patients with uncompleted records were excluded. Boarding was defined as the inability to transfer the admitted ED patients to a downstream ward in ≥2 h after the admission order. Demographic data, boarding rate, mortality and triage levels (1-5) assessed by emergency severity index were collected and analyzed. The first present time of patients was classified into 4 ranges as 0:00-5:59, 6:00-11:59, 12:00-17:59 and 18:00-23:59. Descriptive, parametric and non-parametric statistical tests were performed and the risk of boarding was determined by Pearson Chi-square test.Results:Demographic data analysis showed that 941 (58.5%) male and 667 (41.5%) female, altogether 1608 patients were included in this study. Five patients (0.3%) died. The distribution of patients with the triage levels 1-5 was respectively 79 (4.9%), 1150 (71.5%), 374 (23.3%), 4 (0.2%) and 0 (0%). Most patients were of level 2. Only 75 (4.7%) patients required intensive care. The majority of patients (84.2%) were presented at weekdays. The maximum patient load was observed between 12:00-17:59. Of the 1608 patients, 340 (21.1%) experienced boarding within a mean admission time of 13.70 h. Among the 340-boarded patients, 20.1% belonged to surgery, 12.1% to orthopedics, 10.9% to neurosurgery and 10.3% to neurology. The boarding rate was higher in females, patients requiring intensive care and those with low triage levels. Compared with the non-boarded, the boarded patients had a higher mean age.Conclusion:The boarding rate is higher in the older and female patients. Moreover, boarding is dependent on the downstream ward sections: patients requiring surgical management experience the maximum boarding rate.

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简介：AbstractPurpose:Traffic accidents are one of the major health problems in the world, being the first cause of burden of illness and the second leading cause of death in Iran. The Sistan-Baluchestan province is one of the most accidental provinces of Iran with the highest rate of accidents-caused deaths. This study was conducted to determine the risk factors associated with traffic accidents in Zahedan through 2013 to 2016.Methods:This analytical cross-sectional study was carried out on 223 drivers from Zahedan who were traumatized by traffic accident and sent to Zahedan hospitals. The data were obtained through interviews taken by the trained interviewers via refereeing to the medical records and collected in the researcher-made checklist. Census was obtained from the study subjects. For data analysis, independent t-test, one-way ANOVA, Chi-square and logistic regression were used with the Stata software version 11.0.Results:In this study, 223 male subjects with the mean age of (32.54 ± 12.95) years, 39.8% single and 60.2% married, entered for investigation. Most accidents (38.8%) occurred between 12:00 to 17:59. While driving, 47.1% of the study subjects were using cell phones, 89.1% had manual use of mobile phones, 21.9% had a habit of sending short message service (SMS) and 23.4% had sent SMS within 10 min before the accident. The one way analysis of variance showed that the mean age of individuals with marital status, driving experience, education and accident with motorcycle were significantly different (p < 0.05). Also, the multivariate logistic regression test indicated a significant relationship of smoking, ethnicity, insurance and SMS typing while driving with motorcycle accident (p < 0.05).Conclusion:In this study, SMS and smoking while driving had the highest risk among the variables studied in the motorcycle accidents. Therefore, effective education attempting to enhance people's awareness about the consequences of using cell phone and smoking during driving to reduce traffic accidents seems necessary.

简介：AbstractPurpose:Some surgeons believe that chest computed tomography (CT) scan should be used more prudently in management of blunt chest trauma patients. This study aimed to evaluate the clinical predictors of abnormal chest CT scan findings in trauma patients.Methods:This cross-sectional study was conducted on blunt chest trauma patients aged ≥18 years who were referred to the emergency departments of two educational hospitals and underwent chest CT scan. These patients were enrolled in the study using a non-probability sampling method. The exclusion criteria included: class III or IV hemodynamic shock, need for immediate surgical or neurosurgical interventions, penetrating trauma, lack of required information, and pregnancy. Demographic factors, accident details, trauma mechanism, vital signs, and level of consciousness in predicting abnormal chest CT scan findings were evaluated. Analysis was performed using IBM SPSS statistics 21.Results:A total of 977 patients (male 51.5%, female 48.5%) with the mean age of (41.71 ± 14.24) years, range 18-88 years were studied; 34.2% of them with high energy trauma mechanism. With 334 (34.2%) patients had abnormal findings on chest X-ray (CXR) and 332 (34.0%) cases had an abnormal findings on chest CT scan (agreement rate was 99.4%). There was a significant correlation between male gender (p < 0.0001), GCS<15 (p < 0.0001), high energy trauma mechanism (p < 0.0001), unstable hemodynamics (p < 0.01), and clinical signs and symptoms (p < 0.0001) with chest CT findings. Chest wall deformity (odds = 8; p < 0.0001), generalized tenderness (odds = 6.6, p < 0.0001), and decreased cardiac sound (odds = 3.8, p < 0.0001) were the important and independent clinical predictors of abnormal chest CT scan findings.Conclusion:Based on the findings, chest wall deformity, generalized tenderness, decreased cardiac sound, distracting pain, chest wall tenderness, high energy trauma mechanism, male gender, respiratory rate > 20 breathes/min, decreased pulmonary sound, and chest wall crepitation were independent clinical predictors of abnormal chest CT scan findings following blunt trauma.

简介：AbstractBackground:As a congenital malformation that results in infertility and an inability to have vaginal intercourse, Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome places a considerable psychological burden on patients, which results in anxiety symptoms. However, only single case studies or a few small to medium-sized cross-sectional studies were identified to focus on anxiety symptoms in MRKH patients. Thus, the aim of this study was to explore the status of anxiety symptoms and the related factors in patients with MRKH syndrome.Methods:This cross-sectional study involving 141 patients with MRKH syndrome and 178 healthy women was conducted from January 2018 to December 2018. All participants were required to complete a demographic questionnaire and the Generalized Anxiety Disorder 7-item scale (GAD-7), Patient Health Questionnaire-9, Eysenck Personality Questionnaire-Revised, Short Scale for Chinese, and Chinese Version of the Female Sexual Function Index. The main outcome was the anxiety symptoms measured by the GAD-7. Main outcome was compared between the MRKH syndrome group and the healthy control group. Then, we explored the related factors by comparing patients with and without anxiety symptoms.Results:Of the respondents, 24.1% experienced moderate to severe anxiety symptoms. Patients with MRKH syndrome manifested more severe anxiety symptoms than healthy women. Negative self-evaluation of femininity (odds ratio [OR] 2.706, 95% confidence interval [CI] 1.010-7.247), neurotic personality traits (OR 1.100, 95% CI 1.029-1.175), and coexisting depressive symptoms (OR 4.422, 95% CI 1.498-13.049) were more prevalent in anxious patients.Conclusion:The findings stress the importance of anxiety symptom screening in MRKH patients and identify patients at risk of anxiety symptoms, providing a possible basis for future intervention.

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简介：AbstractPurpose:Road traffic accidents (RTAs) are a public health issue and cost a lot to individuals, families, communities and nations. Trauma care systems in India are at a nascent stage of development. There is gross disparity between trauma services available in various parts of the country. Rural area in India has inefficient services for trauma care, due to the varied topography, financial constraints, and lack of appropriate health infrastructure. The present study is to study the trends of occurrence of RTA cases by month, week and time of accident occurrence as well as to research the types of vehicle involved in accidents and other various risk factors related to them.Methods:During 1st January 2017 to 31st December 2017, a hospital-based and cross-sectional study of RTA victims was conducted. The patients were admitted in emergency department of Uttar Pradesh University of Medical Sciences, Saifai, Etawah, when stabilized, they were shifted to the orthopaedics and surgery ward.Results:In the study, 654 road accident victims were included, of which the majority were males (77.5%) and the most of them belonged to rural (67%). RTA victims according to the month of occurrence majority were found in January (12.5%) and evening was time of a day with maximum accidents (32.1%). Mortality cases of RTA victims based on type of road user and it shows decreasing trend of mortality of motor-cyclists (54.2%) followed by pedestrian (25.1%).Conclusion:There should be control over people driving vehicles under the influence of alcohol and drivers over-speeding and rash driving on urban roads as well as rural village roads.

简介：AbstractBackground:Human epididymis secretory protein 4 (HE4) is a new ovarian cancer biomarker. The factors influencing HE4 levels are not clear, and the reference data in China are limited. Here, we aim to evaluate the effects of menopause and age on HE4 levels and to provide a possible reference value for HE4 in healthy Chinese people.Methods:A total of 2493 healthy females aged 40 years or older were recruited from March 2013 to March 2017 with the cooperation of four medical institutions across Beijing, China. The serum levels of HE4 and cancer antigen 125 (CA125) were measured by enzyme-linked immunosorbent assay. The Wilcoxon rank-sum test of variance and a stratified analysis were used to analyze the relationships among age, menopausal status, and levels of HE4 or CA125. Confidence intervals (5%-95%) were determined for reference ranges in different populations.Results:There was a statistically significant difference in median HE4 levels between the post-menopausal (n = 2168) and premenopausal groups (n = 325) (36.46 vs. 24.04 pmol/L, Z = -14.41, P < 0.001). HE4 increased significantly with age in the post-menopausal groups (H= 408.18, P < 0.001) but not in the pre-menopausal subjects (Z=-0.43, P= 0.67). The upper 95th percentile of HE4 levels were 44.63 pmol/L for pre-menopausal women, 78.17 pmol/L for post-menopausal women, and 73.3 pmol/L for all women. In the post-menopausal population, the HE4 reference ranges were 13.15 to 47.31, 14.31 to 58.04, 17.06 to 73.51, 24.50 to 115.25, and 35.71 to 212.37 pmol/L for different age groups from forty divided by decade. The CA125 level was affected mainly by menopausal status and not age.Conclusions:Menopausal status and age were both important factors influencing the level of HE4, and age affected HE4 levels mainly in post-menopausal women. The HE4 level was higher in the post-menopausal population than in the pre-menopausal population and increased with age.

简介：AbstractObjective:Health-care workers (HCWs) in Indonesia have been participating in the war against the coronavirus disease-2019 since March 2020. Ever since HCWs were exposed to the regular use of personal protective equipment (PPE) with varying levels and maintain hand hygiene more as recommended by the World Health Organization. Adverse skin reactions to PPE in Indonesia has yet to be acknowledged. This study aimed to study the prevalence and characteristics-, possible risk factors-, and suggest possible solutions towards adverse skin reactions to PPE among HCWs in a multi-center setting of Indonesia.Methods:A cross-sectional survey was conducted online among HCWs in the Siloam Hospitals Group of Banten province. HCWs of Banten Province were surveyed from June 1 to August 31, 2020. The data was obtained using avalidated online survey questionnaire including (1) demographic characteristics; (2) occupational-related characteristics; (3) adverse skin reactions.Results:A response rate of 40.2% was obtained and 200 valid respondents were yielded. The mean age of respondents was (26.94 ± 7.23) years old. Adverse skin reactions (66.5%) were reported primarily in female (73.7%) working as doctors (82.7%) of a non-referral center for coronavirus disease-2019 (60.2%) wearing level 2 and 3 PPE (43.6% and 37.6%, respectively). The cheeks and chin was the most common site involved (69.9%) with dryness/tightness (63.9%) and acne (77.4%) as the highest symptoms and signs reported. Sex, age group classification, level of PPE worn, hand hygiene frequency, and duration of PPE worn daily were factors considerably associated with adverse skin reactions to PPE (P < 0.05).Conclusions:Adverse skin reactions to PPE are common among HCWs in Indonesia. Comprehensive strengthening of the skin condition and awareness on adverse skin reactions should be advocated.

简介：摘要BACKGROUNDCorona Virus Disease-2019 (COVID-19) pandemic is quickly spreading, putting under heavy stress health systems worldwide and especially Intensive Care Units (ICU). Rehabilitation Units have a crucial role in reducing disability in order to reintroduce patients in the community.OBJECTIVETo characterize pulmonary function and disability status and to propose an early rehabilitation protocol in a cohort of post-acute COVID-19 patients admitted to an Italian Rehabilitation Unit.METHODSDemographic, anamnestic and clinical characteristics, laboratory exams and medical imaging findings were collected for the entire cohort. Outcome measures evaluated at the admission in Rehabilitation Unit were: type of respiratory supports needed, fraction of inspired oxygen (FIO2), partial pressure of oxygen (PaO2), FIO2/PaO2, Barthel Index (BI), modified Medical Research Council (mMRC) Dyspnoea Scale, and 6-Minute Walking Test (6-MWT). Furthermore, we proposed an early rehabilitation protocol for COVID-19 patients based on baseline FiO2.RESULTSWe included 32 post-acute COVID-19 patients (22 male and 10 female), mean aged 72.6±10.9 years. BI was 45.2±27.6, with patients in need of higher FIO2 (≥ 40%) showing lower values: 39.6±25.7 vs 53.3±29.3. All patients had grade 4 or 5 on the mMRC Dyspnoea Scale. Only 14 COVID-19 patients were able to walk (43.7%). 6-MWT was feasible in 6 (18.8%) patients with a mean distance of 45.0±100.6 meters.CONCLUSIONSTaken together, our findings suggest that post-acute COVID-19 patients suffered from dyspnoea and shortness of breath even for minimal activities, with a resulting severe disability, and only a few of them were able to perform 6-MWT with poor results. An early rehabilitation protocol was proposed according to the baseline conditions of the patients.

简介：AbstractBackground:Human immunodeficiency virus (HIV) prevalence among student men who have sex with men (MSM) in college is more than 5.0% and keeps on increasing in China. This study aims to clarify the proportion of HIV recent infection, its propeller and the source among college student MSM.Methods:We conducted a multicenter cross-sectional study in seven major Chinese cities during 2012-2013. HIV recent infections (≤168 days) and incidence was measured and estimated by BED HIV-1 capture enzyme immunoassay (BED-CEIA) testing strategy. HIV-related behaviors and transmitted drug resistance (TDR) were investigated and compared between the college student MSM, < 25-year-old non-student youth MSM (NSYM), and ≥25-year-old non-student non-youth MSM (NSNYM), using structured survey, and analyses of drug resistance.Results:Overall, 4496 (4496/4526, 99.3%) were eligible for enrollment, comprising 565 college student MSM, 1094 NSYM, and 2837 NSNYM. The proportion of HIV recent infection were 70.3% (26/37), 50.8% (65/128) and 35.1% (95/271), the HIV incidence rate were 10.0 (95% CI: 6.2-13.9)/100 person-year (PY), 12.9 (95% CI: 9.8-16.1 )/100PY, 6.8 (95% CI: 5.4-8.2)/100 PY, and TDR prevalences were 7.4% (2/27), 2.0%, (2/98) and 4.9% (11/226), among student MSM, NSYM, and NSNYM, respectively. Among HIV positive student MSM with age <21 years, the proportion of HIV recent infection is 90.9% (10/11). Factors independently associated with HIV recent infection in student MSM was usage of recreational drug in the past 6 months (adjusted odds ratio [aOR]: 2.5; 95% CI: 1.0-5.8).Conclusions:College student MSM had higher proportion of HIV recent infection and TDR than the youth and older MSM in China during 2012-2013. The HIV infections were more likely to happen during the early year of college life among student MSM.