Morphine Suppository versus Indomethacin Suppository in the Management of Renal Colic: Randomized Clinical Trial

Background. Renal colic is a medical emergency due to the rapid onset and devastating nature of its pain. Opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) are both used as first-line choices in its management. Aim. This study aimed to compare the efficacy and safety of opioids and NSAIDs in the management of acute renal colic. Methods. One hundred and fifty-eight patients were divided into two groups (n=79) and received either 10 mg morphine or 100 mg indomethacin suppositories. The severity of pain was measured using verbal numeric rating scale at baseline and 20, 40, 60, and 90 minutes after the administration of analgesics. Drug side effects as well as patients' vital signs were also recorded. Results. The mean decrease in the pain score during the first 20 minutes was significantly higher among those who received morphine suppository. However, no significant difference was observed between the two groups regarding the mean decrease in pain score during the first 40, 60, and 90 minutes after the admission. Prevalence of drug side effects or changes in the vital signs was not significantly different between the two groups. Conclusions. Morphine suppositories seem to be more efficient in achieving rapid pain relief comparing to indomethacin. © 2016 Forough Zamanian et al

Prehypertension; patient awareness and associated cardiovascular risk factors in an urban population in Iran

Background: This study was to estimate the frequency of prehypertension and to characterize patient awareness and associated cardiovascular risk factors in an urban population in Iran. Methods: During a hypertensive awareness program, a cross-sectional study was conducted on 2036 people. All participants completed a questionnaire about their demographic and anthropometric indices and were asked about symptoms, risk factors and preventive measures of hypertension. Data were compared between prehypertensive and non-hypertensive groups. Results: Prehypertension was detected in 30 (n=611) of the subjects. Previous CHD, diabetes, and hyperlipidemia were more prevalent in low prehypertension group compared to high normal blood pressure. The male sex, increasing age and body weight were positively associated with the rate of prehypertension. Only 8 of participants with prehypertension were aware about the symptoms of hypertension, 12 correctly mentioned at least three risk factors of hypertension, and 48 explained appropriate preventive measures. Conclusion: Prehypertension was prevalent in this population. Age, body weight, male sex, and previous CHD were the major determinants. Furthermore, hypertension awareness was alarmingly poor. Therefore, hypertension prevention programs focused on increasing public awareness are essential

Perturbation method for linear and non-linear fractional order systems and integral representation for evaluation of integrals

In the present work, the authors used the Laplace transform - perturbation method to solve certain linear and non-linear systems of fractional differential and difference equations with constant coefficients with the fractional derivatives in the Caputo sense. We also considered the problems of string vibrations in different cases with fractional damping. Another purpose of this article is to evaluate certain integrals. Illustrative examples are also provided

Rocker outsole shoes and margin of stability during walking: a preliminary study

Rocker outsole shoes are commonly prescribed to diabetic patients to redistribute peak plantar pressures at high risk areas such as forefoot thereby decreasing risks of plantar ulceration. However, there are evidences of postural destabilizing effect of the rocker outsole shoes. Patients with diabetes, particularly those suffering from neuropathy, are at a higher risk of falling. Then, beside primary role of rocker outsole in offloading, it is essential to explore the effect of the rocker outsole on postural stability of these patients. The smaller base of support (BOS) of the rocker outsoles due to their specific geometry has been previously mentioned as a threat to postural stability. Margin of stability (MOS) appeared to be an appropriate method for measuring postural stability during walking by considering the dynamicity of BOS in its equation. MOS is defined as the distance between the velocity adjusted position of the centre of mass (COM) and the boundaries of the BOS which constantly changes during walking. Then, this study proposes how we can use MOS concept to investigate the impact of the rocker outsoles on dynamic stability. In this study the kinematic data from a single subject with diabetic neuropathy was used to explain the efficiency of the methodology. Conclusive results are expected after carrying out systematic tests using a statistically representative sample size.This project is funded by Iran University of Medical Sciences (IR.IUMS.REC. 1395.9211503202).info:eu-repo/semantics/publishedVersio

Health information prescription system for non communicable diseases: A systematic review and thematic analysis

Objective - Prescribing health information is very important to empower informed patients. The goal of present study is to recognize challenges for developing health information prescription on non-communicable diseases. Material and Methods - Six data bases related to health information prescription were investigated. They included Web of Science, Scopus, PubMed, Google Scholar, Ovid and EMBASE. The investigated studies were published from 2000 to 2019. The language of the articles was English and the access to full text was one of the inclusion criteria. The research was evaluated by Prisma checklist and critical apprising. Different dimensions of health Information prescription system were recognized by thematic analysis. Results - 54 studies were recognized based on the inclusion criteria. The results showed that there were three main concepts related to primary dimensions of the system in designing health information prescription system: determination of system functional goals, recognition of implementation barriers and recognition of developmental sub-structures. There were 16 subcategories including primary goals for accessibility, the concerns related to patients information confidentiality, individual differences and interests and personalizing the process of information prescription, the lack of integrity in health Information system for providing pattern of health Information system related to diabetic patients. Conclusion - The goals, implementing barriers and functional substructures of health information prescription system should be recognized in order to improve self-care behaviors of diabetic patients in clinic. It is recommended that the future investigations focus on research gaps in personalizing health information prescription and integration of health information prescription process in health care system. © 2020, LLC Science and Innovations

The Association between Presence of Comorbidities and COVID-19 Severity: A Systematic Review and Meta-Analysis

Aim: Several studies reported the accompaniment of severe COVID-19 with comorbidities. However, there is not a systematic evaluation of all aspects of this association. Therefore, this meta-analysis aimed to assess the association between all underlying comorbidities in COVID-19 infection severity. Methods: Electronic literature search was performed via scientific search engines. After the removal of duplicates and selection of articles of interest, 28 studies were included. A fixed-effects model was used; however, if heterogeneity was high (I2 > 50) a random-effects model was applied to combine the data. Results: A total of 6,270 individuals were assessed (1,615 severe and 4,655 non-severe patients). The median age was 63 (95 confidence interval CI: 49-74) and 47 (95% CI: 19-63) years in the severe and non-severe groups, respectively. Moreover, about 41% of patients had comorbidities. Severity was higher in patients with a history of cerebrovascular disease: OR 4.85 (95% CI: 3.11-7.57). The odds of being in a severe group increase by 4.81 (95% CI: 3.43-6.74) for a history of cardiovascular disease (CVD). This was 4.19 (95% CI: 2.84-6.19) for chronic lung disease and 3.18, 95% CI: 2.09-4.82 for cancer. The odds ratios of diabetes and hypertension were 2.61 (95% CI: 2.02-3.3) and 2.37 (95% CI: 1.80-3.13), respectively. Conclusions: The presence of comorbidities is associated with severity of COVID-19 infection. The strongest association was observed for cerebrovascular disease, followed by CVD, chronic lung disease, cancer, diabetes, and hypertension. © 2021 S. Karger AG, Basel. All rights reserved

Biphasic insulin Aspart 30 vs. NPH plus regular human insulin in type 2 diabetes patients; a cost-effectiveness study

Background: The aim of this study was to compare the efficacy, safety, costs, and cost-effectiveness of biphasic insulin aspart 30 (BIAsp 30) with NPH plus regular human insulin (NPH/Reg) in patients with type 2 diabetes mellitus (T2DM). Methods: It was a Single-center, parallel-group, randomized, clinical trial (Trial Registration: NCT01889095). One hundred and seventy four T2DM patients with poorly controlled diabetes (HbA1c � 8 (63.9 mmol/mol)) were randomly assigned to trial arms (BIAsp 30 and NPH/Reg) and were followed up for 48 weeks. BIAsp 30 was started at an initial dose of 0.2-0.6 IU/Kg in two divided doses and was titrated according to the glycemic status of the patient. Similarly, NPH/Reg insulin was initiated at a dose of 0.2-0.6 IU/Kg with a 2:1 ratio and was subsequently titrated. Level of glycemic control, hypoglycemic events, direct and indirect costs, quality adjusted life year (QALY) and incremental cost-effectiveness ratio have been assessed. Results: HbA1c, Fasting plasma glucose (FPG), and two-hour post-prandial glucose (PPG) were improved in both groups during the study (P < 0.05 for all analyses). Lower frequencies of minor, major, and nocturnal hypoglycemic episodes were observed with BIAsp 30 (P < 0.05). Additionally, BIAsp 30 was associated with less weight gain and also higher QALYs (P < 0.05). Total medical and non-medical costs were significantly lower with BIAsp 30 as compared with NPH/Reg (930.55 ± 81.43 USD vs. 1101.24 ± 165.49 USD, P = 0.004). Moreover, BIAsp 30 showed lower ICER as a dominant alternative. Conclusions: Despite being more expensive, BIAsp 30 offers the same glycemic control as to NPH/Reg dose-dependently and also appears to cause fewer hypoglycemic events and to be more cost-effective in Iranian patients with type 2 diabetes. © 2016 The Author(s)

Study of penculture of the common carp (Cyprinus carpio L.) fingerlings at the Gorgan Bay to the maturity stage (broodstock management)

The aim of present project is study on the possibilities of brood stock production from fingerlings in the penculture condition and the effect of density on it .this project was done during three years with two different treatment and three repetitions in the Gorgan Bay. First treatment with two fingerlings per square meter and the 2nd with four fingerlings per square meter in each pen.To carry out the project at first fingerlings were brought from breeding and recruitment centre –Sijeval (Kolmeh) and the stocked at the earthen pound with concentrated food .After that they were adaptated with brakish water between 7-10 days and transferred to Gorgan Bay for cultivation with average weight of 93.78±32.66 grams and 20.53±2.37 cm in length. It should be noted that 6 pens (which surrounded by nets in the water) were fixed using mast with 15-20 cm in diameter and 5.5 meter in length , Net mesh size was 16 mm with string number 33 of kapron.Feeding was done according to the program two times by giving concentrated food at the period of cultivation Physic -o -chemical factors were measured. biometery was done monthly at each pen and other fishes (unwanted) were observed at the same time. results indicate that in the 1st and 2nd treatments average survival rate was 52.3 and 41 percent respectively with average weight of 410±64.98 grams and 390±52.8 and 28.3±1.79 cm and 27.66±1.57in length. SPSS used to analysethe data such as average length and weight of fish in the treatments and in different months with ANOVA method (p≤ 0.05) . results show that there is no significant difference between treatments. Autopsy observation also showed that fishes (female and male) are mature and histological studies showed that most of observed eggs are entirely mature with 800-1200 micron diameter gonad ( male) were mature at the pen in the Gorgan Bay condition .The male and female hormones were evaluated. 17-B- Estradiol and 11-keto testosterone hormones for adult fish (female and male) parents respectively are similar in dense with those adult fish before injection to use at the artificial breeding. Maturation were verified by autopsy, histology and hormone studies

Hospital managers' skills required and onward challenges: A qualitative study

Introduction: The qualification of managers in terms of management skills is one of the most important factors in the continuous success of each organization, and utilizing such skills can have a positive contribution in the effectiveness of the organization while improving the performance of the employees in line with the objectives and goals of the organization. The study's primary objective was to examine the necessary skills of the hospital managers and their capabilities to manage the challenges in providing health care facilities to their patients and employees. Materials and Methods: This study is a qualitative that deep interviews were performed with 22 managers (senior and middle managers) of educational hospitals of Kermanshah city, and the sample size was 22 individuals. The interviews were analyzed by a MAXQDA software application after transcription. Results: This study includes 8 themes and 23 subthemes. The strategic skill, the perceptive skill, the human relations skill, work experience, and personal characteristics were among the skills necessary for hospital managers. Some of the challenges facing the hospital managers included rapid changes in the policies, the limitations of financial resources, and lack of proportion between the educational and occupational spheres. Conclusion: Because of their existential philosophy and differences with other service sectors, managing hospitals poses a particular sensitivity. In this regard, the role of the hospital manager is very important. Therefore, in order to meet the satisfaction of those receiving services, decision.makers and policy.makers must think twice when selecting and appointing hospital managers and evaluate and appraise this group in terms of abilities and skills necessary for managing such an important service section. © 2020 Journal of Education and Health Promotion