The Effects of Metformin on Thyroid Function among Patients with Subclinical Hypothyroidism and Coexisting Metabolic Syndrome

Background: The interference of metformin with thyroid function has been recently reported in several studies. In the present research, we assessed the effect of metformin on thyroid function tests in patients with subclinical hypothyroidism associated with metabolic syndrome. Method: In a double-blind clinical trial, 60 patients were selected among who referred to outpatient endocrine clinics and met the inclusion and exclusion criteria were considered for the study. Inclusion criteria were the presence of metabolic syndrome and subclinical hypothyroidism (2.5<TSH<10 mIU/l). Screened patients used no medications interfering with TSH level. Pregnancy, GFR less than 50 ml/min and intolerance of metformin were also considered as exclusion criteria. Patients were divided into case and a placebo groups. In the case group, patients received 1000 mg/day of metformin for 12 weeks. Anthropometry, liver and thyroid function tests, and lipid profile were evaluated before and after the intervention. Results: A total of 44 patients fully participated for the whole study period. The mean age was 44±14 years and 15 patients (34.1%) were male. The mean TSH and FT4 levels before and after intervention were 5.8±2.15, 4.8±2.7 and 1.10±0.19, 1.14±0.26, respectively. The positive TPO-ab was seen among 18 (40.9%) patients. TSH (4.12±2.07, p=0.013) and FT4 (1.18±0.23, p=0.007) levels were decreased and increased, respectively, compared to the placebo group. Furthermore, a reduction in metabolic element was observed. Conclusion: Our data showed that metformin reduced the TSH level in subclinical hypothyroid patients, especially in patients with TSH baseline level higher than 5mIU/l and TPO-ab positive patients

Challenges of Criminal Decisions in the Face of the Principle of Persuasion and Ways to Get Out of them in the Light of Ethics and Legal Formalism from the Perspective of Iranian Jurisprudence and Law

زمینه و هدف: آرای کیفری علاوه بر رسالت عدالت‌مداری و تلاش برای تحقق‌بخشیدن به آرمان‌های کلان نظام عدالت کیفری، تا حدودی در جستجوی تضمین و تحقق اصل اقناع‌کنندگی مردم و افکار عمومی جامعه نیز می‌باشند. برای آنکه بتوان از نفوذیابی این اصل که دارای مستندات و مبانی فقهی مسلم نیز می‌باشد، به کاربست نظام حقوقی جامعه سراغ گرفت، لازم است در حین صدور آرا یکسری استانداردها و شاخص‌های شکلی و ماهوی رعایت گردد تا مآلاً امیدوار بود افکار عمومی جامعه با کیفیت و محتوا و منطق آرای اصداری در محاکم همراهی کنند. مواد و روش‌ها: این تحقیق از نوع نظری است؛ ‌روش تحقیق به صورت توصیفی ـ تحلیلی می‏باشد و جمع‏آوری اطلاعات نیز به شیوه کتابخانه‏ای و با مراجعه به اسناد، کتب و مقالات، صورت گرفته است. ملاحظات اخلاقی: به منظور انجام پژوهش حاضر، ضمن رعایت اصالت متون، صداقت و امانتداری رعایت شده است. یافته‌ها: در شرایط و وضعیت کنونی نظام حقوقی ایران تحقق اصل اقناع‌کنندگی در مرحله صدور آرای کیفری با چالش‌های نظری و عملی عدیده‌ای مواجه است که بدون مرتفع‌سازی آن‌ها نمی‌توان امیدوار بود سطح رضایتمندی مردم از عملکرد مقامات قضایی در این مرحله، مطلوب و قابل توجه باشد. مشکلات و چالش‌هایی که برون‌رفت از آن‌ها مستلزم سیاستگذاری هدفمند و جامعی برای ارتقای سطح نظارت مردمی بر عملکرد دستگاه قضا، متعادل‌سازی رویه‌های قضایی عمومی در بستر سیاست اختیارات قضایی در جامعه و توجه به ملزومات منطقی و اجتماعی اصل رضایتمندی افکار عمومی می‌باشد. نتیجه‌گیری: نحوه تعیین مجازات و الگوی حاکم بر آن یکی از حساس‌ترین مسائل در دفاع از رویکرد سیاست جنایی قضایی جامعه یا مورد نقد قراردادن آن است. اساساً مردم و جامعه مدنی انتظار دارند مجازات‌های تعیین‌شده در آرای کیفری به نحوی باشند که به اخلاقیات، ارزش‌ها و توقعات آن‌ها توجه نماید. مجازات نباید و نمی‌تواند بدون توجه به فرهنگ و انتظارات جامعه مدنی تعیین شود.Background and Aim: Criminal decisions, in addition to the mission of justice and trying to realize the grand ideals of the criminal justice system, are also partially in search of guaranteeing and establishing the principle of persuasiveness of people and public opinion of the society. In order to be able to trace the influence of this principle, which also has certain jurisprudential foundations, to the application of the legal system of the society; it is necessary to observe a series of formal and substantive standards and indicators during the issuance of decisions so that it can be hoped that the public opinion of the society will accompany the quality and logic of the judgments issued in the courts.&nbsp; Materials and Methods: This research is of theoretical type and the research method is descriptive-analytical. The method of data collection is library and has been done by referring to documents, books and articles. Ethical Considerations: In order to organize this research, while observing the authenticity of the texts, honesty and fidelity have been observed. Findings: In the current situation of the Iranian legal system, the Confirmation of the principle of persuasion in the stage of issuing criminal verdicts faces many theoretical and practical challenges, without which it cannot be hoped that the level of public satisfaction with the performance of judicial authorities at this stage is desirable and significant. The problems and challenges that emerge from them require purposeful and comprehensive policy to improve the level of public oversight of the judiciary, balancing public judicial procedures in the context of the policy of judicial authority in society and paying attention to the logical and social requirements of public satisfaction. Conclusion: The way of determining the punishment and the pattern that governs it is one of the most sensitive issues in defending or criticizing the approach of the criminal justice policy of the society. Basically, people and civil society expect the punishments set out in criminal judgments to be in a way that addresses their morals, values and expectations. Punishment should not and cannot be determined without regard to the culture and expectations of civil society. &nbsp; Please cite this article as Mokhtari A, Bahrami Nezhad A, Ehsanpour SR. Challenges of Criminal Decisions in the Face of the Principle of Persuasion and Ways to Get Out of them in the Light of Ethics and Legal Formalism from the Perspective of Iranian Jurisprudence and Law. Bioethics Journal, Special Issue on Ethical &amp; Legal Reflections 2021; 253-271

Clinical Significance and Different Expression of Dipeptidyl Peptidase IV and Procalcitonin in Mild and Severe COVID-19

Background: Coronavirus has become a global concern in 2019-20. The virus belongs to the coronavirus family, which has been able to infect many patients and victims around the world. The virus originated in the Chinese city of Wuhan, which eventually spread around the world and became a pandemic. Materials and Methods: A total of 60 Patients with severe (n=30) and mild (n=30) symptoms of COIVD-19 were included in this study. Peripheral blood samples were collected from the patients. Real-time PCR was used to compare the relative expression levels of Procalcitonin and dipeptidyl peptidase IV (DPPIV) in a patient with severe and mild Covid-19 infection. Results: Procalcitonin and dipeptidyl peptidase IV markers in the peripheral blood of patients with severe symptoms, were positive in 29 (96.60%) and 26 (86.60%), respectively (n=30); however, positive rates in the mild symptoms patients group were 27 (90%) and 25 (83.30%), respectively. There was a statistically significant difference between these two groups in terms of DDPIV and Procalcitonin (p&lt;0.001). Conclusion: Procalcitonin and DPPIV increase in patients with COVID-19 infection, significantly higher in the patients with more severe clinical symptoms than those with milder ones. More studies will be needed to verify the reliability of the current findings. Keywords: Procalcitonin, DPPIV, Severe symptoms, Mild symptoms, COVID-1

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019 : a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019

A Study on the Level of Learners\' Readiness for Learning from the View Point of B.S. Students in Isfahan Medical University in 2001

Introduction. One of the basic human activities is learning and education. Indeed the role of education is to facilitate learning but many internal or external factors affect the learning process such as learners’ physical, affective and mental readiness. If we don’t pay attention to these factors, they will lead to a superficial learning and finally the trained and graduated students won't be efficient enough. If we determine the factors affecting students' readiness for learning, we will be able to adopt a proper strategy for teaching. Therefore this research was planned to determine the level of learners’ readiness for learning according to B.S. students and also to determine its correlation with some of their demographic characteristics. Methods. This research was a cross-sectional survey. The research samples consisted of 298 B.S. students from four schools including: Health, Nursing and Midwifery, Management & Informatics and Rehabilitation, selected based on simple stratified sampling. The tool for collecting data was a questionnaire whose validity and reliability were determined by content validity and test re-test respectively. Descriptive analytic statistics was used for data analysis. Results. The mean score of physical, affective and mental readiness for learning in four schools were calculated. Although a significant difference was observed for some factors related to learners' readiness between the schools, but ANOVA didn’t show a significant difference between the mean score of physical readiness, affective readiness and mental readiness in four schools. Also, other tests including Mann-Whitney, students t test, ANOVA and Pearson correlation coefficient showed a significant relationship between participants’ characteristics and their readiness for learning. Conclusion. Students' physical readiness is more affected by life conditions while affective and mental readiness has to be under special consideration by people in charge of medical education. Holding talking sessions with students, supervising educational programs and improving faculty members' performance can facilitate students' learning

Assessing the degree of readiness for the implementation of TPM (Case study conducted at SHASI SAZ IRAN Co.)

The concept of this research is, assessing the level of readiness for the implementation of Total Productive Maintenance in the SHASI SAZ IRAN Co. In order to satisfy the main goal of this research, “assessing the level of readiness for the implementation of Total Productive Maintenance in the SHASI SAZ IRAN Co” assessment conducted in four areas. 1. The senior management committed to the implementation and execution of TPM. 2. The employee participation regarding the implementation and execution of TPM. 3. The usage level of statistical process control tools. 4. The usage level of maintenance procedures. The statistical target group is SHASI SAZ IRAN Company’s managers, experts and production line supervisors. This research based on the method of data collection, is of the descriptive kind. Collection of data was based on library findings and field studies. In order to analyze the data, the comparison of target group average with assumed average test was employed. After analysis, the readiness information of the SHASI SAZ IRAN Company based on the four questions of the research and as a result, the main question, were all placed below average. Overall, considering the individual answers, employee participation achieved first place in terms of readiness and following were maintenance procedures, management commitment and SPC tools

Instructional Games Effect on Learning of Some Mathematics Concepts in Boy Students with Educable Mentally Retarded

Objective: The purpose of this research is determining the instructional games effect on learning of some mathematics concepts in boy students with educable mentally retarded. Materials & Methods: The method of this research is quasi-experimental. By convenient sampling two elementary schools mentally retarded boys were selected and all of their first grade students were assigned to experimental and control groups randomly (8 students in each group). The mathematical concepts presented to experimental group via instructional games and regulatory teaching style conduced to control group. The instruments consist of four investigator’s inventive instructional games, four investigator’s inventive sub-tests and an investigator’s inventive post-test. Data were analyzed by Mann-Whitney U test. Results: There was significant difference between two groups in total score of mathematics concepts (P=0.025). As well as, the intervention caused increased the means of numbers in experimental group in each of concept than of control group, but their difference was not significant. Conclusion: Instructional games can improve learning of mathematics concept in mentally retarded students

The influence of bath and probe sonication on the physicochemical and microstructural properties of wheat starch

Ultrasound has been rapidly applied successfully in diverse food technological aspects including improvement of functional properties of food ingredients such as starch. This work was carried out to compare the influence of two types of sonication, bath and probe, on several physicochemical and microstructural properties of wheat starch. Two sonication probes (200 and 400 W) and a sonication bath (690 W) were applied to treat wheat starch suspensions at 15 and 30 min. Sonication time in 400 W probe was intermittent while for the other treatments, it was continuous. Swelling capacity (SC), solubility (SB), turbidity (TB), and oil absorption (OA) parameters were investigated for native (control) and sonicated wheat starch. Moreover, scanning electron microscopy (SEM) was performed to determine the influence of sonication treatments on the morphology of wheat starch granules. The highest level of SB and OA, as well as the lowest SC, was obtained for starch samples treated with 200 W sonication probe, while no significant difference (p &lt; 0.05) was observed between two sonication times (15 and 30 min). The SEM images showed significant and nonuniform impact of ultrasound on the structure of starch granules in which some granules remained almost smooth, but some showed high irregular surfaces or even in some cases structure collapse. The highest disintegration of granules was obtained in probe 200 W treatments