علت‌شناسی رنج و بیماری در کودکان و راهکارهای پیشگیری و مراقبت معنوی کودک از منظر آیات قرآن و علوم پزشکی

خلفية البحث وأهدافه: تعرض الأطفال إلی الأمراض ومعاناتهم من حالات الألم والإرهاق الناتج عن المشاکل الصحیة یجعل عوائل هؤلاء الأطفال في حالة قلق مستمر. وبما أنّ المعلومات اللازمة والضروریة حول أسباب تعرض الأطفال للأمراض شحیحة جداً، فإنّ تقییم الأسباب المؤدیة لتعرض الأطفال للمرض ومعرفة طرق مواجهة هذه الأمراض والوقایة منها والعنایة الروحیة لها أهمیة بالغة. لهذا تسعی هذه الدراسة لرصد أسباب الإرهاق والمرض لدی الأطفال وتقدیم طرق ناجعة للعنایة الروحیة من منظور القرآن الکریم وعلم الطب. منهجية البحث: المنهج الذي اعتمدت علیه الدراسة هو المنهج الوصفي-التحلیلي الذي اعتمد علی دراسة المصادر الإسلامیة کالقرآن، و روایات أهل البیت(ع)، ومواقع الکترونیة مثل جامع التفاسیر، وجامع الأحادیث، والبحث في المقالات العلمیة في المواقع الألکترونیة مثل اس آي دي، ومجیران، وإیران داک و ساینس دایرکت أو کلمات مفتاحیة مثل الطفل، وطرق الوقایة، والأمراض، والشیطان، والعنایة الروحیة في السنوات العشر الأخیرة. المعطیات: تقول معطیات البحث الحاصلة من آیات القرآن وروایات أهل البیت (ع)، أن الإضرار بالمریض وإصابة الإنسان بالمرض منذ الطفولة من أهم أهداف الشیطان؛ لأن مرحلة الطفولة هي المرحلة المثالیة لتعلیم الإنسان وتهذیبه، والإستثمار النفسي-الروحي والجسدي في جمیع مجالات التقدم والإرتقاء بالنفس. وفضلا عن العوامل الأخری مثل التشوهات ما قبل الولادة، والتشوهات الکرموسومیة، وصدمات الولادة، والإختلال في مرحلة الحمل ونقص المناعة، هناک عامل حاسم وهو الشیطان الذي یعد من أهم أسباب المرض والإرهاق في الأطفال. الاستنتاج: تؤکد النتائج التي حصل علیها البحث أنّ الشیطان بوصفه أحد ألدّ أعداء الإنسان، هو العامل الأساس في الألم والإرهاق والمرض لدی الأطفال؛ وأنّ طرق الوقایة والعنایة الروحیة أثناء الحمل هو اللجوء إلی الدعاء، والصلاة، والتصدّق طوال فترة الحمل والتغذیة السلیمة والطعام الحلال قبل الولادة وبعدها، وإقامة الصلاة قبل میلاد الطفل وبعده والدعاء، والتصدق، وقراءة القصص القرآئیة لها آثار کبیرة في مرحلة ماقبل الولادة، وإنجاب طفل صالح وسلیم من الأمراض. کل هذه العوامل تؤثر بشکل کبیر علی علاج الطفل، وتحسین حالاته النفسیة والجسدیة.Background and Objective: The affliction of children with various diseases and the resulting pain and suffering is one of the issues that families and children face. Given the limited information available about the causes of illnesses in children and considering the high prevalence of diseases in children and their threatening nature, it is very important to assess the factors that cause illness in children and introduce prevention and spiritual care strategies. This study aims to examine the causes of suffering and illness in children and to introduce spiritual care strategies from the perspective of the Holy Quran and medical science. Methods: This descriptive-analytical study was conducted by reviewing Islamic sources such as the Holy Quran, the narrations of the Ahl al-Bayt (peace be upon them), electronic databases like Jame' al-Tafasir and Jame' al-Ahadith, as well as searching for scientific articles in databases like SID, Magiran, IranDoc, and ScienceDirect using keywords such as child, prevention strategies, disease, devil, and spiritual care over the past 10 years. Results: Based on the findings obtained from the verses of the Holy Quran and the narrations of the Ahl al-Bayt (peace be upon them), causing harm and illness to humans from childhood is one of the goals pursued by the devil; because childhood is the best time for learning and investing spiritually, psychologically, and physically in all areas of progress and elevation. Additionally, besides factors such as prenatal disorders, chromosomal disorders, birth injuries, pregnancy abnormalities, and immune deficiencies, the devil is also recognized as a cause of suffering and illness in children. Conclusion: The findings indicate that the devil, as one of humanity's ancient enemies, is a factor in creating pain, suffering, and illness in children. Prevention and spiritual care strategies during the pre-pregnancy period, such as praying, performing prayers, and giving alms; during pregnancy, such as consuming halal and healthy food; and after the birth of the child, such as performing prayers on time, praying, giving alms, and reading Quranic stories play a significant role in the embryonic stages, giving birth to a healthy child, and promoting health, treatment, and recovery in children.سابقه و هدف: ابتلای کودکان به انواع بیماری‌ها و درد و رنج حاصل از آن یکی از مشکلاتی است که خانواده‌ها و کودکان را درگیر خود کرده است. از آنجایی که اطلاعات موجود دربارۀ علل بیماری‌ در کودکان ناچیز است و همچنین، با توجه به شیوع بالای بیماری در کودکان و ماهیت تهدیدکنندۀ آن، ارزیابی عوامل ایجادکنندۀ بیماری در کودکان و معرفی راهکارهای پیشگیری و مراقبت معنوی اهمیت بسیاری پیدا می‌کند. مطالعۀ حاضر با هدف بررسی علل رنج و بیماری‌ در کودکان و معرفی راهکارهای مراقبت معنوی از منظر آیات قرآن کریم و علوم پزشکی انجام شده است.    روش کار: مطالعۀ حاضر توصیفی - تحلیلی است که با بررسی منابع اسلامی مانند قرآن کریم، روایات اهل بیت (ع)، بانک­های الکترونیکی نظیر جامع‌التفاسیر و جامع‌الاحادیث و همچنین جست‌وجوی مقالات علمی در پایگاه‌های اطلاعاتی اس‌آی‌دی، مگیران، ایران‌داک و ساینس دایرکت با کلیدواژه‌های کودک، راهکارهای پیشگیری، بیماری، شیطان و مراقبت معنوی طی 10 سال اخیر انجام شده است. یافته‌ها: بر اساس یافته‌های به‌دست‌آمده از آیات قرآن کریم و روایات اهل بیت (ع)، آسیب‌رساندن و بیمار ساختن انسان از دوران کودکی یکی از اهدافی است که شیطان دنبال می‌کند؛ زیرا سنین کودکی بهترین زمان برای یادگیری و سرمایه‌گذاری روحی - روانی و جسمی در تمام زمینه‌های پیشرفت و تعالی است. همچنین، علاوه بر عواملی مانند اختلالات پیش از تولد، اختلالات کروموزومی، صدمات زایمانی، ناهنجاری‌های بارداری و نقص ایمنی، شیطان نیز از علل رنج و بیماری در کودکان شناخته می‌شود. نتیجه‌گیری: یافته‌ها نشان می‌دهد که شیطان به‌عنوان یکی از دشمنان دیرینۀ انسان، عامل ایجاد درد و رنج و بیماری در کودکان است که راهکارهای پیشگیری و مراقبت معنوی در دوران پیش از بارداری مانند دعا کردن، نماز خواندن، پرداخت صدقه؛ در طول بارداری مانند تغذیۀ حلال و سالم و پس از تولد فرزند مانند نماز اول وقت و دعا، صدقه‌دادن و خواندن قصه‌های قرآنی نقش بسزایی در طی مراحل جنینی؛ به دنیا آوردن فرزندی سالم؛ و ایجاد سلامتی، درمان و بهبودی کودکان ایفا می‌کند

The Results of Urine Toxicology Tests in Children With Drug Abuse Poisoning in Loghman Hakim Hospital in 2021

Background and Aim: Correct and rapid diagnosis and timely treatment of acute poisoningare of great importance, mainly in legally crucial drugs of abuse poisoning. Urine drugtoxicology (UDT) is an available, rapid, and cheap diagnostic tool. This study aims toevaluate the results of this study in children with acute poisoning.Methods: In this prospective descriptive cross-sectional study conducted on the urinetoxicology results of children admitted to Loghman-Hakim Hospital due to poisoning withopioids and cannabis in 2021, UDT was performed for all patients. Demographic data, type,method and time of poisoning, time of urine sample collection, urine pH and specific gravity(SG), and urine toxicology results were collected and statically analyzed using SPSS version26.Results: A total of 137 children were evaluated. The mean age was 4.11±3.45 years, and49.6% were boys. UDTs were positive in 106 of 137 patients (77.4%). The most commonpoisoning was methadone (61.32%) followed by opium (19.71%). No significant statisticaldifference was observed between the time of taking the urine sample as well as the type, pH,and specific gravity (SG) (P>0.05). Of the 84 methadone-poisoned patients, 74 (88%) testedpositive for UDT. The positive results for opium, cannabis, and buprenorphine were 77.77%,33.33%, and 50%, respectively.Conclusion: In our study, methadone was the most common poisoning, with urine toxicologyshowing a positive result in 88% of cases

نقش جو اخلاقی مدرسه و انسجام روان‌شناختی در کیفیت زندگی تحصیلی دانش‌آموزان

Background and Aim: Identifying the factors influencing students' academic quality of life is of great importance for facilitating their scientific advancement and comprehensive development, which is one of the key responsibilities of the educational system. Therefore, the present study was conducted to examine the role of the school's ethical climate and psychological coherence in students' academic quality of life. Methods: The present research method was descriptive-correlation. The statistical population of the research included all the male students of the first secondary school in district 5 of Tehran in the academic year of 2023-24 and 120 people were selected as a sample using available sampling method. The research tools included the school moral climate questionnaires of Schulte et al. (2002), psychological coherence of Antonovsky (1987) and the quality of academic life of Bourke & Smith (1989). Data were analyzed using Pearson's correlation test and multiple regressions with the help of SPSS 22 statistical software. Ethical Considerations: Verbal consent of the participants was obtained and they were assured about the confidentiality of the information. Results: The results showed that there was a direct relationship between the components of school moral atmosphere and psychological cohesion with the quality of academic life (P<0.01). Also, the components of school moral atmosphere and psychological cohesion explain 58% of the variance of the quality of academic life. Conclusion: Based on the results, in order to improve students' academic quality of life, programs can be developed to enhance the school's ethical climate and, consequently, strengthen students' psychological coherence.زمینه و هدف: شناسایی عوامل مؤثر در کیفیت زندگی تحصیلی دانش‌آموزان، برای تمهید پیشرفت علمی و رشد همه‌جانبه آنان که یکی از وظایف مهم نظام آموزشی است، اهمیت به سزایی دارد، بنابراین مطالعه حاضر با هدف بررسی نقش جو اخلاقی مدرسه و انسجام روان‌شناختی در کیفیت زندگی تحصیلی دانش‌آموزان انجام شد. روش: روش پژوهش حاضر توصیفی ـ همبستگی بود. جامعه آماری پژوهش شامل تمام دانش‌آموزان پسر متوسطه اول ناحیه پنج تهران در سال تحصیلی 03-1402 بودند که 120 نفر به روش نمونه‌گیری در دسترس به عنوان نمونه انتخاب شدند. ابزار پژوهش شامل پرسشنامه‌های جو اخلاقی مدرسه شولت و همکاران (۲۰۰۲ م.)، انسجام روان‌شناختی آنتونووسکی (1987 م.) و کیفیت زندگی تحصیلی بورک و اسمیت (1989 م.) بودند. داده‌ها با استفاده از آزمون همبستگی پیرسون و رگرسیون چندگانه با کمک نرم‌افزار آماری SPSS 22 تحلیل شدند. ملاحظات اخلاقی: رضایت شفاهی مشارکت‌کنندگان اخذ و درباره محرمانه‌ماندن اطلاعات به آن‏ها اطمینان خاطر داده ‌شد. یافته‌ها: نتایج نشان داد بین مؤلفه‌های جو اخلاقی مدرسه و انسجام روان‌شناختی با کیفیت زندگی تحصیلی ارتباط مستقیم وجود داشت (01/0>P). همچنین مؤلفه‌های جو اخلاقی مدرسه و انسجام روان‌شناختی، 58 درصد از واریانس کیفیت زندگی تحصیلی را تبیین می‌کنند. نتیجه‌گیری: بر اساس نتایج به‌ منظور بهبود کیفیت زندگی تحصیلی دانش‌آموزان می‌توان به تدوین برنامه‌هایی در جهت بهبود جو اخلاقی مدرسه و به ‌تبع آن انسجام روان‌شناختی دانش‌آموزان اقدام کرد

A Graph-Based Statistical Approach to Identifying Functional Connectivity Networks in Patients with Traumatic Brain Injury

ObjectivesTraumatic brain injury (TBI) is one of the most common types of brain injuries associated with cognitive impairments. Functional magnetic resonance imaging (fMRI) studies can provide a unique opportunity to examine brain connectivity patterns and understand the neural substrates of cognitive outcomes following traumatic injury. Therefore, this study aims to determine changes in functional connectivity patterns in patients with TBI compared to healthy individuals using two graph models, adaptive dense subgraph discovery (ADSD) and variance component.Materials & MethodsThis study used fMRI data downloaded from https://openneuro.org. These data included 14 patients with TBI aged between 18 and 36 and 12 healthy individuals (female: N=6, male: N=6) aged between 19 and 52. Out of the 74 regions examined, a cluster of 18 regions related to TBI was identified using the ADSD model. Subsequently, these identified regions were used as input for the variance component model to investigate changes in connectivity patterns.ResultsFunctional connectivity between an 18-brain region cluster, such as the Rectus (Left, Right), Supp_Motor_Area (Left, Right), and Middle Cingulum (Left, Right), differed between the patient and healthy groups. Based on the analysis of functional connectivity between pairs of brain regions, 153 connections between pairs of brain regions were compared in the two groups, out of which 63 connections showed significant differences between the two groups. Compared to other regions, Supp_Motor_Area_Right and Rectus_Left had more connections.ConclusionThe study’s results indicate that the functional connectivity between the Cingulum, Hippocampus, Fusiform, Supp_Motor_Area, and Precentral regions differs between the two groups. Since these regions are involved in processes such as memory, learning, spatial orientation, face recognition, coordination, and motor control, changes in their functional connectivity may lead to impairments in these areas

Utilization of Mean Platelet Volume for Predicting Ischemic Heart Disease in Diabetic and Non-Diabetic Patients

Background: This study aimed to evaluate the relationship between mean platelet volume (MPV) and myocardial perfusion abnormalities in patients with and without Type 2 diabetes mellitus (DM) using myocardial perfusion scans. Materials and Methods: This cross-sectional study compared 49 patients with Type 2 DM without overt cardiovascular symptoms with 49 healthy controls. Both groups underwent myocardial perfusion scans at rest and under stress conditions. Risk factors were assessed and recorded using a special research-made questionnaire. A complete blood count and MPV results were obtained using the Sysmex - KX-21 system. Data were analyzed using SPSS, with a p-value below 0.05 considered statistically significant. Results: No significant differences were observed between the two groups in terms of Summed Stress Score (SSS), Summed Rest Score (SRS), Summed Difference Score (SDS), Ejection Fraction (EF), and End Systolic Volume (ESV). The only marked variance was a higher average platelet count in the control group. Regression analysis revealed that a one-unit increase in MPV correlated with a 0.46 average increase in SRS in the control group (CI: 0.08-0.83, β: 0.46). Conclusion: MPV may serve as a predictive marker for myocardial perfusion abnormalities, especially in individuals without diabetes. This simple metric could act as an early indicator for coronary artery disease

Deproteinization Process of Chitin from Dried Shrimp Shells (Litopenaeus vannamei) Using Papain and Nanochitin Characterizations

Background and Objective: Chemical treatments in chitin extraction from shrimp shell wastes have affected the environment. Shrimp shell primarily bonds chitin with inorganic salts, lipids, proteins and pigments. Extraction of chitin from shrimp shells involves protein separation processes. Deproteinization process of chitin from dried shrimp (Litopenaeus vannamei) shells with papain enzyme was optimized and nanochitin as a derivative product of chitin was characterized. Material and Methods: Effect of hydrolysis time, temperature and enzyme concentration were optimized using RSM Box-Behnken method to maximize chitin yields. Nanochitin was prepared using dialysis and ultrasonic methods and characterized for physical characteristics using scanning electron microscope, particle size analysis and Fourier transforms infrared spectroscopy. Results and Conclusion: Optimum conditions using enzymatic hydrolysis at 6 h, 50 oC and 1.25% papain decreased the protein content from 33.66 to 2.31% and produced a high chitin yield (46.03%). Deproteinization using enzymatic hydrolysis method was more efficient than that using fermentation. Data of scanning electron microscope, particle size analysis and Fourier transforms infrared spectroscopy showed that the characteristics of chitin and nanochitin products were similar to those of chemical treatments for chitin products. Conflict of interest: The authors declare no conflict of interest. Introduction   Litopenaeus vannamei is one of the shrimp species that includes high commercial values and produces abundant shrimp shell wastes. Production of shell wastes from crustaceans was predicted to be 3.14 million metric tons per year worldwide [1]. Hundreds of shellfish wastes are generated from seafood manufacturing and daily Asian consumption [2]. Shell wastes from crustaceans contain a high quantity of chitin, a polysaccharide material that is important in biological functions and is biodegradable and compatible. Chitin and its derivatives are used in various fields such as pharmaceutical, food, textile and waste water-treatment industries [3]. Chitin in the shrimp shells is bonded with majorly inorganic salts, calcium carbonate, proteins, lipids and pigments. Therefore, isolation of chitin from shrimp shells involves protein separation processes and mineral separation [4]. Structure of chitin is arranged with N-acetylated glucosamine and glucosamine units, linked by β(1,4) covalent bonds. Corresponding to this structure, chitin is stable to chemical and biological actions and the linkage of chitin is similar to the linkage of cellulose [5]. Generally, chitin is extracted through demin-eralization using acid treatment and deproteinization using alkali treatment. These treatments affect the environment and finding an alternative process that is more friendly to the environment is still necessary. Deproteinization process for chitin extraction from shrimp shells can be carried out via chemical, enzymatic and microbial processes [6, 2]. The chemical treatment involves mineral acid at high temperatures, resulting in high volumes of polluted waste containing mineral acids in the washing process. These treatments are harmful to the environment due to high concentrations of mineral acids [7]. Deproteinization with enzymes is a zero waste system resulting in high yields of chitin products. Protease hydrolyzes proteins in the matrix efficiently [8]. Commercially purified enzymes such as alcalase, papain, pepsin and trypsin have been used in chitin extraction studies to remove protein from crustacean shells [9].  Chitin is a biopolymer containing microfibrillar and semicrystalline structures. Based on data of the infrared (IR) spectra and X-ray crystallography (XRD), chitin is naturally in the forms of α-chitin, β-chitin and ɣ-chitin. Characteristics of chitin such as solubility, porosity and surface area restrict its uses. To solve this problem, various derivatives such as chitosan, chitin nanofibers and chitin nanowhiskers are produced [10]. Chitin nanofibers have been prepared via several methods such as ultrasonication, mechanical treatment, gelation and electrospinning [11]. Chitin nanofibers from species such as crabs, prawns and mushrooms have been prepared using mechanical and chemical treatments. The acidic medium was verified in the decrease of chitin nanofibers extracted from crab shells [12]. Under certain extraction conditions, chitin microfibrils are isolated in the form of nanocrystals and nanofibers. Their unique characteristics have been studied and used in food, cosmetics and medical industries [13]. Characteristics of chitin depend on the organisms and chitins may lay in α and β allomorphs shapes. These forms were assessed by the orientation of microfibrils that could be characterized using infrared, nuclear magnetic resonance (NMR) spectroscopy and XRD analysis [14]. Probiotic microorganisms have been studied for the demineralization treatment of crustacean shells. Chitin extraction using microorganisms was carried out simultaneously. Shrimp shells (Penaeus monodon) were fermented with lactic acid bacteria (LAB) and chitin was separated by adding carbohydrates [10]. Based on XRD and NMR data, chitin extraction via enzymatic process is an alternative method to preserve its native structure [1]. Shelma et al. reported the chitin nanofiber preparation via acid hydrolysis of the chitin powder followed by dialysis and ultrasonication [15]. Chitin from P. vannamae byproducts was prepared by associating enzymatic acid-alkaline strategies to achieve further sustainable processes [16]. Moreover, chitosan was produced through papain extract to help deproteinization process. Papain is achieved from the papaya plant with the endopeptidase, dipeptidase and exopeptidase activities. The optimum condition of this process was at 7 h of enzymatic hydrolysis and 25% of papain [8]. The current study was aimed to optimize deproteinization process of chitin from dried shrimp (L. vannamei) shells using low concentration papain (0.75–1.25%) and to achieve nanochitin, which was prepared via dialysis and ultrasonic methods. Furthermore, nanochitin products were characterized through physicochemical characteristics to verify their quality. Materials and Methods 2.1. Materials               Dried white-shrimp (L. vannamei) shells were provided as byproducts of a shrimp processing industry at Muara Gading City Bekasi, West Java, Indonesia. Commercial papain (CAS no. 2323.627-2) (Xian Arisun ChemParm, Shaanxi, China) was purchased in powder form. All chemicals used included laboratory grades. 2.2. Chitin extraction from the shrimp shells Chitin from the sample was extracted using method of Hongkulsup et al. [1] with some modification. The extraction was carried out at two steps, including demineralization and deproteinization. In demineralization process, shrimp shells were ground to achieve a size of 100 mesh. Shrimp shell powder was extracted using 1.5 M HCl (ratio 1:10, w/v) at 25 oC for 6 h and at 150 rpm. Mixture was filtered using vacuum filter and the residue was mixed with distilled water (DW) to achieve neutral pH. Then, residue was dried at 50 oC for 6 h. Dried residue was mixed with 0.75–1.25% w/v papain in a phosphate buffer pH 7 and heated at 40–50 oC for 3–6 h. Hydrolysis was stopped at 90 oC and set for 20 min. Mixture was filtered and the residue was mixed with DW until neutral pH was achieved. Then, residue was dried at 50 oC for 6 h. Total residue was assessed gravimetrically and the soluble proein content in the residue was analyzed using modified Lowry method. Briefly, 1 g of residue was diluted with DW up to 1 ml and filtered using Whatman filter papers. Then, 0.5 ml filtrate was mixed with 5.5 ml of alkaline CuSO4 reagent and incubated at room temperature (RT) for 10 min. Solution was mixed with 0.5 ml of folin phenol reagent. Then, sample solution was mixed with 3.5 ml of DW and the absorbance was measured at 650 nm. The protein soluble content was assessed by plotting bovine serum albumin (BSA) standard curve [17]. 2.3. Optimization of deproteinization of shrimp shells using Box-Behnken method                Optimum condition of the deproteinization process was predicted using response surface methodology (RSM)- Box-Behnken method. Optimization of deproteinization was carried out using three factors of effects of hydrolysis time, temperature and enzyme concentration (Table 1). Proportions of total residue, chitin and protein concentration were used as the responses data. Fifteen trials were carried out indiscriminately. The center value was chosen based on the references, which were 1% papain, 45 oC and 6 h [18, 19]. Design Expert 13.0 software was used in this study. 2.4. Assessment of chitin               Chitin content was assessed using adaptation of the Morrow method [20] with some modification. One gram of the sample was mixed with 40 ml of 1 M HCI and mixed at RT for 2 h. Chitin residue was separated using vacuum filter with a porous sintered glass disc and washed several times with water to reach a neutral pH. The residue was washed off and transferred into a beaker containing 40 ml of 5% NaOH and stirred at 100 °C for 2 h. Chitin product was separated using filter paper (Whatman no. 41, USA) and then rinsed with water until a neutral pH was achieved. Content of the chitin (%) was assessed gravimetrically. 2.5. Nanochitin preparation               The selected chitin sample, which was prepared at optimized conditions, was soaked in 3 M HCl for 90 min at 90  oC. Suspension was precipitated by centrifugation at 6000 rpm for 10 min. Nanochitin from the precipitated fraction was prepared for dialysis and ultrasonic treatments using Mincea method [11] with modifications. Suspension of chitin was transferred to a dialysis bag (cellulose membrane with cut-off proteins mol. wt ≥ 12,000) and dialyzed in DW by changing the water every 2 h for three times. Dialysis was carried out until pH 6 was reached. Ultrasonic treatment of the chitin sample was carried out at pulse of 1/1 and amplitude of 60% (750 W, 20 kHz) for 6 h to 0.1% (w/v) of the suspension. Based on the modification of Wu and Meredith method [21], these samples were freeze-dried at -60 oC for 10 h. 2.6. Microstructure identification               Microstructure of the freeze-dried samples was assessed using scanning electron microscope (SEM) (JSM-IT30, Jeol., Akhishima, Tokyo, Japan). These samples were put in a sample holder and layered with a thin layer of gold (±10 nm). Observation was carried out by accelerating voltage at 20 kV based on a previous method. 2.7. Particle size distribution               Particle size distribution of the samples was analyzed using particle size analyzer (Zetasizer Nano ZS Malvern,UK)  based on Shelma et al. method [15] with modifications. Sample was dispersed in Tween 80 (0,4%; w/v) with a ratio of 1:4. 2.8. Fourier transforms infrared spectroscopy (FTIR)               Spectra of the samples were analyzed using Fourier transforms infrared spectroscopy (FTIR 1000, Perkin-Elmer, USA) at mild conditions and method of KBr pellet scanning. Based on previous studies, KBr (100 mg) and the sample (1 mg) were mixed entirely until KBr pellet was formed. Then, samples were scanned at spectral ranges of 400, 4200 and 4200 cm-1. Results and Discussion 3.1. Optimization of deproteinization of the shrimp shells               The optimum conditions of the enzymatic hydrolysis in the deproteinization process of white shrimp shell powder were predicted using RSM. Fifteen trials were carried out based on the RSM-Box Behnken design. The Box–Behnken design (BBD) is a widely used RSM design that is useful for ascertaining cause-and-effect correlations between factors and responses in experiments. The BBD needs three levels and can be used for factors of 3–21 [22]. Hydrolysis factors and their responses are provided in Table 1. Data showed that the total residue of the products ranged 74.14–80.76%, chitin content ranged 41.52–49.06% and protein content ranged 2.31–6.82%. Analysis of variances (ANOVA) was calculated and p-values of the total residue, soluble protein and chitin content are present in Table 2. Papain concentration (C) and its interaction with temperature (AC) and hydrolysis time (BC) significantly (p < 0.05) affected the total residue of shrimp shell powder. The hydrolysis time (A) and its interaction with the papain concentration (AC) significantly (p < 0.05) affected the chitin content. However, p-values of the soluble protein contents showed that treatments were not significant (p > 0.05). The equation for estimating the optimal condition for all responses (Y1, Y2 and Y3) from the shrimp shells is present in Table 3. Total residue included the yield of the dried product after the deproteinization process with the papain enzyme. Chitin extraction via enzymatic hydrolysis needs removing proteins from the crustacean shells, minimizing the deacetylation and depolymerization processes. This process may be carried out before or after the demineralization step of solid materials for accessibility of the reactants. Efficiency of the enzymatic treatments is inferior to chemical methods ranging 5–10% of the residual protein attached to chitin [9]. Commercial enzymes such as alcalase, econase, pancreatin and other proteases were used in the chitin extraction of shrimp and crustacean shells. The objective of these treatments was to eliminate the protein contained in the waste of shells. Proportion of the chitin ranged 16.5–22% [7]. Combination of the chemical agents and enzymes has been studied to increase yields of the chitin products. Use of sodium sulfite and alcalase was the best treatment for protein recovery. Characteristics of the chitin sample were similar to those of the commercial food-grade products [6]. Three-dimensional (3D) response surfaces of the response; of which, one of the factors is fixed at the central point and the other is varied, are present in Figure 1. The highest predicted chitin content is indicated by the surface confined in the smallest ellipse in two-dimensional (2D) contour plots. This indication was correlated with the interaction between hydrolysis time and papain concentration significantly. This was similar to the results of ANOVA analysis (Table 2). The 2D contour plots showed effects of hydrolysis time (A) in the chitin content prediction (Fig. 1c). However, stagnation was observed in the chitin content with increasing temperature (Fig. 1b). To achieve the optimum condition of the deproteinization process, an optimization process was analyzed using Design Expert 13.0 RSM optimizer software. The three factors (time, temperature and papain concentration) were adjusted in the importance level 3 (+++) and responses (total residue, soluble protein and chitin yield) were adjusted in the importance level 5 (+++++). The optimum condition with desirability of 0.619 was observed for chitin extraction at 6 h, 50 oC and 1.25% papain. Further, all the responses of the products were validated through laboratory experiments. The experimental and predicted values are present in Table 4. Data showed that the experimental and predicted values were in the range (95% prediction interval); thus, reliability of the optimized condition was verified. The RSM-Box Behnken design was successfully used to assess effects of hydrolysis time, temperature and papain concentration on deproteinization process to produce higher chitin contents. Chitin from the molted shrimp shells was extracted using a chemical method. The optimum condition of deproteinization was achieved in 3% NaOH at 50 oC for 6 h with a residual protein content ≤ 1% [23]. Yulirohyami et al. (2024) reported that chitosan was prepared through processes, including depigmentation, demineralization, deproteiniza-tion and deacetylation. The optimum condition of depro-teinization process was reached at 25% of papain for 7 h of hydrolysis. This study showed that the hydrolysis time of chitin deproteinization affected deacetylation degrees of chitosan [8].               Proteases have been used for chitin extraction from shrimp byproducts. Residual proteins in shrimp wastes included 1.3 and 2.8% after treatment with chymotrypsin and papain enzymes. Combination of papain with other proteases that was used for deproteinization of shrimp wastes showed that the protein removal rates were low [24]. As an alternative to chemicals and decreasing shrimp wastes, 0.2% alcalase was shown to include activities in decreasing protein contents in shrimp wastes from 49.43 to 4.12% [25]. The enzymatic deproteinization of shrimp processing wastes has limited chitin yields nealy  4.4 to 7.9% of the total weight. This might be due to the residual of short peptides appropriately bonded to the compound of chitin. Use of combination agents with protease significantly decreased the protein fraction. Through this combination, protein fraction significantly decreased, assuming that protease degraded disulfide bonds of the shrimp head waste proteins that facilitated entry of sulfite ions [6]. Use of exoenzymes and proteolytic bacteria in deproteinization of demineralized shells produced liquid protein and solid chitin fractions [2]. Papain is a commercial enzyme, which includes endopeptidase, dipeptidase and exopeptidase activities. Binding affinity and catalytic efficiency of papain are affected by the substrate, temperature and incubation time [8]. 3.2 Physicochemical characterization of Chitin Characteristics of chitin, including degree of deacetylation, morphology and molecular mass, vary depending on the extraction method and origin of chitin [14]. For example, chitin achieved by the chemical extraction showed a tightly packed morphology, while a slightly microfibrillar structure was shown by chitins extracted via enzyme treatment [1]. Use of chitin increased significantly due to the prominent characteristics of its derivatives and nanostructure configuration, which are met for industrial processing. Techniques have been developed to produce chitin derivatives. For example, dialysis and ultrasonic methods  to produce nanochitin from shrimp shells; similar to those of the present study. Surface morphologies of the prepared chitin and nanochitin are present in Figure 2. Accordingly, porous-like honeycomb structure with no nanofibers on the surfaces was observed in the chitins (Figure 2a) and nanochitin achieved via dialysis process (Figure 2b). The only difference between these two products was in the pore size as the pore width of chitin (3 μm ±5) was smaller than that of nanochitin (5–15 μm). This result indicated that during the acid hydrolysis process of nanochitin preparation, the amorphous part of chitin was removed, leaving the crystalline side and leading to increases in pore size. The nanochitin generated from the ultrasonic technique (Figure 2c) showed a nanofibrillar structure with a diameter of nearly 160 nm. This reveals that hydrolysis with a strong acid followed by the ultrasonication treatment further facilitated dissolution process of the amorphous chitin [16]. Ultrasonication is a method to change the natural cithin into chitin nanofibers. Fibrillating chitin at 900–1000 W and 20 kHz in water (pH ±7) created nanofiber widths of 25–120 nm. High frequency of ultrasonication induced startling waves on the chitin surface that promoted their factorization with the axial way [26].  Chitin is naturally detected in crystalline microfibrils as a structural component, serving as a functional material that is needed by many organisms [14]. The pH of a solution in chitin treatment affects the surface morphology of chitin nanostructures, as a previous study demonstrated that the nanofiber structures of chitin were destroyed to small irregular shapes under high alkaline environments [23]. Furthermore, chitin nanofibrous structure formed due to chitin nanofibers are not soluble and result in versatile porous structures of the products by adjusting the freezing temperature. Freeze-drying technique includes the potential for the assembly of the nanofibrous structure of water-dispersible materials [21]. Particle size distribution is an important characteristic that affects functionality of the chitin products. The chitin sample included two peaks in the spectra, which were dissolved in 0.4% of Tween 80 solution (Fig. 3a). The Z-average of chitin from the shrimp shells was 511.7 nm and the highest intensity was 21.8%. Moreover, nanochitin samples showed three peaks with Z-averages of 101.7 (Fig. 3b) and 345.4 nm (Fig. 3c), respectively. Nanochitin produced via dialysis method showed a Z-average of the particles smaller than that produced by the ultrasonic method. However, the intensity of nanochitin products was still lower than that of untreated chitin samples. Particle size distribution of the chitin nanofibers demonstrated a bimodal curve with majority sizes of 20–300 nm [15]. In this study, additional peaks in nanochitin products were assumed as degraded chitin products. Temperature of the experiments affected number of the peaks in spectra. For higher temperatures, large particles were observed, which might be caused by degradation of the chitin particles. The lower temperature of ionic liquids was further favorable, resulting in a narrow particle range of particle size distribution spectra [27]. Ionic liquids could change the chitin structure, able to modify the particle size [28]. The FTIR spectrum of chitin is present in Figure 4. Chitin sample showed similar spectra with nanochitin, which was prepared via dialysis and ultrasonic methods. Spectra at 3258 and 2924 cm-1 were recognized as N-H and C-H stretching vibrations. The amide I band wa

Patients Survival After Paraquat Poisoning: A Report of Three Cases

Background: Paraquat poisoning is a common and often fatal herbicide poisoning in society. This study presents a clinical case series of patients who survived after paraquat poisoning.Cases Presentation: This study evaluated patients hospitalized between March 2016 and March 2021 with paraquat (PQ) poisoning who survived. Out of 115 patients with PQ poisoning, three cases of severe toxicity with an average age of 24.33 years are presented here. The urinary sodium dithionate test result was positive in all three surviving patients. All patients arrived at the poisoning emergency center within an hour of ingestion and received gastric lavage and charcoal therapy. They were also treated with corticosteroids, N-acetylcysteine (NAC), vitamins C and E, Curcumin, and Livergel. Hemodialysis was performed for the patients, with one undergoing hemodialysis and hemoperfusion after ingesting 250 mL of PQ 20%. After a six-month follow-up, all surviving patients were in good health.Conclusion: Various factors, such as early admission after exposure, prompt gastrointestinal (GI) decontamination, corticosteroids with Curcumin and Livergel, antioxidants, hemodialysis, and hemoperfusion in one case may have contributed to the survival of patients with PQ poisoning in this study. However, individual vulnerability should also be considered a crucial factor requiring further investigation

Investigating the Abnormal Presentation of Ureteropelvic Junction Obstruction in Adolescence: A Case Report: Ureteropelvic Junction Obstruction in Adolescence

Background and Aim: Ureteropelvic junction obstruction (UPJO) is a common cause ofhydronephrosis and is typically diagnosed antenatally. About 70% of these cases will selfresolve;however, symptomatic children may present with abdominal pain (i.e. Dietl crisis),vomiting, rash, or fever.Case Presentation: A 14-year-old male patient presented with cyclical vomiting every twomonths for the past two years. The patient’s mother also described an eight-year historyof headaches and intermittent abdominal pain. A renal magnetic resonance urographyscan revealed decreased right kidney function and delayed cortex to ureter transit time. Apyeloplasty and stent placement were performed to correct the obstructing vessel.Conclusion: Clinical guidelines for abdominal pain and cyclical vomiting earlier in thepatients’ healthcare may have led to an appropriate workup and treatment years before. Werecommend physicians consider UPJO as a differential diagnosis in adolescent patients withcyclical vomiting and abdominal pain and consult the North American Society for PediatricGastroenterology, Hepatology, and Nutrition (NASPGHN) guidelines to better guide thediagnosis

Effect of Co-administration of Ketoconazole on Attainment of Desired Blood Concentration of Tacrolimus in Renal Transplant Recipients: Ketoconazole impact on tacrolimus in renal transplant

Achieving and maintaining optimal tacrolimus trough levels for immunosuppression is challenging in kidney transplant patients due to its narrow therapeutic index. Ketoconazole is known for inhibiting the drug efflux activity of P-glycoprotein and CYP3A enzymes, which are involved in tacrolimus pharmacokinetics. Therefore, there is a need to investigate tacrolimus–ketoconazole coadministration. The study aims to assess the effect and safety of tacrolimus-ketoconazole coadministration in renal transplant recipients. Ethical approval was obtained from the Institutional Human Ethics Committee (IHEC/2023/038) to conduct an ambispective observational study on 14 renal transplant recipients. Tacrolimus total daily dose (TDD) and trough levels were measured before and after initiating oral ketoconazole. The concentration/dose (C0/D) ratio was calculated, followed by safety assessments, including blood counts and renal function tests. Statistical analyses employed paired t-tests, and the significance level was <0.05. Coadministration resulted in a significant 102.45% increase in tacrolimus trough levels (p<0.001) and a 2.19% reduction (p=0.33) in TDD. The C0/D ratio showed a mean increase of 127.74%. Blood counts remained within normal ranges, but a significant decrease in sodium (p=0.01) and an increase in potassium (p=0.03) were observed within the normal range. Tacrolimus-ketoconazole co-administration in renal transplant recipients demonstrated a substantial elevation in tacrolimus trough levels, suggesting a potential strategy for achieving therapeutic concentrations without escalating tacrolimus doses. Despite significant changes in sodium and potassium, they remained within acceptable ranges, supporting the safety of this coadministration strategy

Exploring Maxillary Sinus Ostium Characteristics and Insights for Pathology Prediction and Anatomical Variations: A Cone Beam Computed Tomography (CBCT) Analysis: Maxillary sinus characteristics according to CBCT

Objectives: Understanding the anatomy of the maxillary sinus is essential for ensuring a successful surgical procedure. This study utilized CBCT to evaluate the relationship between maxillary sinus ostium characteristics, adjacent anatomical structures, and pathologies. Methods: A retrospective evaluation was conducted on CBCT images of 400 maxillary sinuses. Measurements included the height and dimensions of the ostium, as well as the length of the infundibulum. The study investigated maxillary sinus pathologies, anatomical variations, and the associations between the characteristics of the maxillary sinus ostium and adjacent anatomical structures. Statistical analyses were performed using Pearson’s Chi-Square test, simple logistic regression, multiple logistic regression, and multiple linear regression models at p<0.05. Results: The mean ±SD for ostium height, size of the ostium entry, and infundibulum length were 31.08±4.99mm, 1.72±2.03 mm, and 7.81±1.73 mm, respectively. An increase in Haller cell and infundibulum length raised the risk of a mucosal membrane in the ostium area. The Ostium height was significantly higher in males (P<0.05). Mucosal thickening (MT) was considerably higher in patients with positive maxillary sinus septum (P<0.005). Infundibulum length, nasal septum deviation, and Haller cell significantly affected sinus opacity rate (P<0.001). In cases where the deviation was towards the sinuses, maxillary sinus pathologies occurred more frequently. Age and gender significantly affected MT, the mucous membrane in the ostium, and at least one sinus pathology (P<0.05). Conclusion: Maxillary sinus pathologies can be evaluated by increasing the infundibulum length and reducing the ostium size. CBCT evaluation is crucial for successful surgery and preventing complications. Accurate assessment of sinuses and nasal passages in the elderly is recommended