Kavous Shahsavarinia

War and armed conflict are among the most severe crises capable of profoundly disrupting a country’s critical infrastructure, particularly its health system. In situations of armed conflict, health...

Background: Crush syndrome is a life-threatening systemic complication of traumatic rhabdomyolysis and a leading cause of morbidity and mortality following earthquakes. Despite its clinical significance, a comprehensive synthesis of its global epidemiology, management, and outcomes is lacking. This systematic review and meta-analysis aimed to consolidate the evidence on CS in earthquake victims. Methods: We conducted a systematic review in accordance with PRISMA guidelines (PROSPERO: CRD420251177534). Electronic databases (PubMed/MEDLINE, Web of Science, CINAHL) were searched from inception through January 2024 for observational studies of earthquake casualties with CS. Outcomes included mortality, dialysis requirement, acute kidney injury (AKI), and other complications. Data were pooled using random-effects meta-analysis. Results: Fifty studies (1988–2023), primarily from Turkey, Iran, and China, were included. Substantial heterogeneity was observed, largely due to inconsistent definitions of CS. The pooled proportion of patients requiring dialysis was 0.49 (95% CI 0.40–0.58; I²=96.95%, 38 studies). The overall pooled mortality was 0.08 (95% CI 0.06–0.10; I²=93.0%, 39 studies), with significant regional variation (1% to 26%). AKI was the most frequent complication (pooled proportion 0.49; 95% CI 0.38–0.59). Marked creatine kinase elevation and metabolic derangements were consistently reported. Conclusions: CS following earthquakes carries a high burden of renal failure, with nearly half of affected patients requiring dialysis. Mortality is significant and influenced by geographic context and response capabilities. The profound heterogeneity in definitions and reported outcomes underscores an urgent need for standardized diagnostic criteria. Preparedness planning must prioritize early volume resuscitation, surge capacity for renal replacement therapy, and the development of context-adapted, evidence-based clinical guidelines.

Background: Personalized medicine (PM) is becoming increasingly feasible due to advancements in DNA sequencing technology. Our study aims to evaluate the general population’s understanding and attitudes toward PM in Tabriz city. Methods: In this cross-sectional study, data were collected through a self-administered questionnaire from various participants, including health centers, outpatient cases, and community populations. The research involved forming a panel of specialists, conducting a literature review, developing initial survey questions, seeking expert feedback, revising and refining questions, implementing a pilot study, and finalizing the survey instrument. Results: The mean (SD) age of 313 participants was 39.63 (14.41) years, with 36.7% being male. About 65% of participants were married, 55.3% were employed, and 79.6% residing in the urban areas. Most participants reported good physical (64.2%) and mental health (58.1%) status. Half of the participants evaluated the different dimensions of their lifestyle as moderate. The majority of respondents had not heard about PM (67.4%; 95% CI: 62.0%-72.4%), and most believed that PM is a promising healthcare approach (61%; 95% CI: 55.5%-66.2%), or can be an essential tool for preventing, diagnosing, and treating various diseases (60.1%; 95% CI: 54.6%-65.3%). Attitudes towards PM were influenced by education level. Economic status influenced knowledge about PM (P=0.002). Similarly, attitude toward PM was influenced by economic status (P<0.05). Conclusion: The study revealed that education and economic status significantly influence individuals’ awareness and attitudes towards PM. Education and income levels should be considered while planning for educational programs about PM. Our findings can inform the development of effective strategies for promoting PM in healthcare settings.

Background: This systematic review and meta-analysis aimed to evaluate the prevalence of post-traumatic stress disorder (PTSD) among road traffic accident (RTA) survivors, a demographic impacted by over 50 million disabilities globally each year. Methods: An initial systematic search was conducted in November 2021, with an updated search performed in October 2024. Relevant databases were comprehensively searched using keywords related to "traffic accidents," "road accidents," "motor vehicle accidents," "PTSD," and "Post-Traumatic Stress Disorder." This systematic review and meta-analysis were conducted in accordance with the PRISMA 2020 guidelines and the PICO framework established by Cochrane. The review included studies that involved RTA survivors diagnosed with PTSD, focusing on time frames from one to six months post-accident and utilizing DSM criteria. Eligible studies were reviewed for quality using the standardized critical appraisal instruments from the Joanna Briggs Institute (JBI) Checklist, by two independent reviewers. Meta-analysis was performed using Comprehensive Meta-Analysis statistical software and STATA16 to estimate overall prevalence rates and subgroup analyses to explore variations. Results: A comprehensive search across multiple databases identified 11,142 articles, of which 92 were reviewed, and 82 were included in the meta-analysis. The findings revealed an overall PTSD prevalence of 20.3% (95% confidence interval [CI]: 18.1%-22.8%; I2 :93.86%); 18.7% (95% CI: 16.0%-21.8%; I2: 93.47%) based on clinician-administered assessments and 22.8% (95% CI: 18.8%-27.3%; I2: 93.92%) from self-reported questionnaires. After removing outliers, the total prevalence was decreased to 18.1% (95% CI: 15.4%-21.0%; I2 :93.09%), in clinician-administered and 20.8% (95% CI: 17.5%-24.4%; I2 : 91.51%) in self-reported questionnaires. Notably, the prevalence was 29.4% (95% CI: 22.4%-37.5%) one-month post-RTA, decreasing to 18.8% (95% CI: 14.8%-23.5%); P<0.001 at three months. Age did not significantly predict PTSD prevalence rates. The quality assessment of the studies included demonstrated moderate to high quality according to the Joanna Briggs Institute standards, ensuring the reliability of the findings. Geographic variability in PTSD prevalence was observed, with lower rates reported in Switzerland, Australia, Germany, and Japan, while higher rates were found in Spain, China, and Iran. Conclusion: This review highlights a significant PTSD prevalence of 20.3% among traffic accident survivors, emphasizing the need for early intervention and targeted mental health support to mitigate long-term psychological impacts and improve recovery outcomes in this vulnerable population. Screening and public awareness of disease symptoms are recommended.

Background: Therapeutic hypothermia (TH) is an intervention conducted to reduce brain damage in neonatal asphyxia and postcardiac arrest patients. Traumatic brain injury (TBI) dysregulates cerebral blood flow and causes ischemic brain damage. TH could lower brain damage by reducing the metabolism rate and need for oxygen. In this umbrella review, we aim to investigate different aspects of TH intervention in TBI patients. Methods: We searched MEDLINE, Scopus, Embase, Cinahl, Epistemonikos, Cochrane Library, Web of Science, and Google Scholar for relevant systematic reviews until August 03, 2025. Then, studies entered the screening process, and systematic reviews of TH`s effect on TBI patients were included. We excluded studies without any quality assessments. Data for mortality, favorable and unfavorable neurologic outcomes, and possible complications of TH were extracted from the included studies. We avoided meta-analysis due to the vast heterogeneity between the studies’ methodologies. Results: Of the 1466 studies identified from the primary search, 30 met our inclusion criteria. According to the JBI critical appraisal tool for systematic reviews, 29 studies were of high quality, and 1 was of medium quality. Studies had different methodologies, such as different induction methods and durations, different age groups, target temperatures, and rewarming rates. Mortality was the most common outcome assessed by the studies. Morbidity was assessed as either favorable or unfavorable neurological outcomes at a follow-up of 1,3,6,12,24 months. Pneumonia was the most investigated side-effect of TH, and most studies reported a greater chance of pneumonia in the TH group. Other investigated complications of TH were electrolyte abnormalities, coagulopathy, and arrhythmia. Conclusion: Studies have shown controversial results regarding the effect of TH on mortality and morbidity. Differences in the target population, hypothermia protocol, and quality of included studies may be responsible for part of this controversy. Some of the important parameters that may affect the results are the age of TBI patients, the use of barbiturates, target TH temperature, rewarming rates, and method of cooling. Additionally, the subgroup analysis of high-quality studies differed from the pooled analysis provided by each study. More high-quality studies with specific protocols are needed to better understand TH’s role in TBI patients.

Background — The ongoing COVID-19 pandemic has significantly impacted various industries, including transportation. Taxi drivers and amateur drivers have been on the frontline providing essential services while facing an increased risk of contracting the virus. Objective — This study aims to examine and compare the personal health behaviors adopted by taxi drivers vs. private vehicle drivers in the fight against COVID-19. Understanding these behaviors can help develop strategies to protect and support the health and safety of drivers and passengers. Methods — This cross-sectional study was conducted in 2022 in Tabriz, East Azerbaijan Province, Iran. A total of 700 drivers participated in the study, including 343 (49%) taxi drivers and 357 (51%) amateur drivers. The research team developed a questionnaire on personal health behaviors regarding COVID-19. The validity and reliability of the instrument were assessed. The personal health behaviors of taxi drivers vs. private vehicle drivers regarding COVID-19 were then examined. Results — Our findings showed that the percentage of health-promoting behaviors (such as wearing masks in public places, disposing of masks in a trash can with a lid, using masks correctly, washing hands with soap and water, and using alcohol-based hand sanitizers) were significantly higher among private vehicle drivers than among taxi drivers (p<0.001). Conclusion — The results show that private vehicle drivers adhere stricter to health guidelines than taxi drivers. Improving taxi drivers’ awareness and responsibility can help prevent COVID-19. Targeted interventions by policymakers and transportation companies can improve the safety and health of taxi drivers and their passengers.

Background. Vitamin A plays an important role in various bodily functions, including vision. This systematic review aimed to synthesize the available evidence on the effects of vitamin A supplementation on visual function in healthy adults. Methods. A comprehensive search of electronic databases was conducted to identify randomized controlled trials investigating the effects of vitamin A supplementation on visual function in healthy adults. The methodological quality of the included studies was assessed using the Cochrane Collaboration tool. Data extraction and analysis were performed to determine the overall effect of vitamin A supplementation on visual outcomes. Two reviewers independently assessed the studies for biases, with disagreements resolved by a third reviewer. The quality of the articles was evaluated in accordance with existing standards, with any disagreements resolved through discussion or referral. Results. A search of 12945 articles from databases led to 276 full-text articles being evaluated, resulting in 17 studies. These studies examined the effects of lutein and zeaxanthin supplementation on macular pigment optical density (MPOD) and visual function. Results showed a positive correlation between MPOD and temporal contrast sensitivity function, with both improving after supplementation. However, a study by Bartlett did not find significant improvements in visual function. Most studies showed positive effects on MPOD and visual function, but the clinical significance and optimal dosage and duration remain unclear. Most studies had medium to high quality evidence. Conclusion. Vitamin A, Lutein, and zeaxanthin supplementation may improve visual function, but optimal dosage, duration, and carotenoid combination are not yet established. Long-term safety and efficacy require further investigation, including standardized assessments, longer follow-ups, diverse populations, and mechanistic studies. Practical Implications. While current research indicates that supplementing with lutein and zeaxanthin may offer benefits like improved contrast sensitivity and macular pigment density, the inconsistent findings highlight that we don't yet have a clear understanding of who will benefit most, the ideal dosage, or how long supplementation is effective for healthy adults. Therefore, widespread recommendations for these supplements to enhance vision in the general healthy population cannot be made at this time, and individuals should consult with healthcare professionals before starting any supplementation.

Introduction and Hypothesis Trauma complications have been one of the most serious public health concerns worldwide. In most reports, urogenital injuries (UGIs) are seen in approximately 10% of adult traumatic patients and less than 3% of children with multiple/severe trauma to the abdomen or pelvis. Traffic accidents are the most common cause of UGIs. The purpose of this study is to systematically determine the prevalence and types of UGIs after car accidents. Methods The search strategy was aimed at finding relevant studies in October 2023. No restrictions on language or date were applied. The following criteria were considered eligibility criteria: reporting at least one epidemiological aspect of UGIs in people with road traffic injury (RTI) and a separate epidemiological analysis of RTIs in UGI (we also included those articles that pointed out all RTIs but separately mentioned UGIs). Two experts assessed the reporting quality of articles using standardized critical appraisal instruments from the Joanna Briggs Institute. Statistical analysis for this study was conducted using the CMA statistical software version 3.2.0. Results A total of 1,466,024 cases following RTIs through 107 studies were included in our review. Of these, 29 studies were related to children (20,036), and the others reported RTIs in adults (1,445,988). The total prevalence was 4.7%, and car accidents were responsible in 36 studies, followed by motorcycle accidents in 25, bicycles in 17 studies, and automobile–pedestrian collisions in 23 related studies. In subgroup analysis based on the damaged organ, the rate of bladder injury was 3.5%. This rate was 5.3% for kidneys. Conclusion This systematic review and meta-analysis found that the prevalence of UGI following RTIs was 4.7%, with car accidents being the most common cause. UGIs were more prevalent in adults than in children, and bladder and kidney injuries were the most commonly reported types. The prevalence of UGI varied by country and study design.