Ictal verbal help-seeking: Occurrence and the underlying etiology.

PURPOSE: Ictal verbal help-seeking has never been systematically studied before. In this study, we evaluated a series of patients with ictal verbal help-seeking to characterize its frequency and underlying etiology. METHODS: We retrospectively reviewed all the long-term video-EEG reports from Jefferson Comprehensive Epilepsy Center over a 12-year period (2004-2015) for the occurrence of the term help in the text body. All the extracted reports were reviewed and patients with at least one episode of documented ictal verbal help-seeking in epilepsy monitoring unit (EMU) were studied. For each patient, the data were reviewed from the electronic medical records, EMU report, and neuroimaging records. RESULTS: During the study period, 5133 patients were investigated in our EMU. Twelve patients (0.23%) had at least one episode of documented ictal verbal help-seeking. Nine patients (six women and three men) had epilepsy and three patients (two women and one man) had psychogenic nonepileptic seizures (PNES). Seven out of nine patients with epilepsy had temporal lobe epilepsy; six patients had right temporal lobe epilepsy. CONCLUSION: Ictal verbal help-seeking is a rare finding among patients evaluated in epilepsy monitoring units. Ictal verbal help-seeking may suggest that seizures arise in or propagate to the right temporal lobe

Influenza vaccination coverage and obstacles in healthcare workers (HCWs) and the follow up of side effects: A multicenter investigation in Iran

Introduction. Influenza is a highly contagious acute respiratory illness. Due to the high exposure of hospital personnel, widespread vaccination of these high-risk groups seems to be a necessity in healthcare centers. To determine vaccination coverage in the personnel of four tertiary referral collegiate hospitals in 2019, and to further investigate individual obstacles for Influenza vaccination. Methods. In this cross-sectional descriptive study, 637 personnel were selected randomly from distinctive hospitals in a list-wised. Ones vaccinated filled the side effects questionnaire and who not vaccinated filled the vaccination obstacles questionnaire. Results. The mean vaccination coverage was 29.4% and the coverage difference among centers was not statistically significant (p=0.192). The following items had the most impact on personnel decision: confidence about one’s immune system (p<0.05), the experience of side effects from previous vaccinations (p=0.011), attitude about vaccination in colleagues (p=0.021) and work experience (p<0.05). About 23% of vaccinated individuals reported side effects following vaccination and the most common side effect was mild cold symptoms with 12.3% prevalence. Conclusion. The results of the current study revealed that influenza vaccination coverage among HCWs is not satisfactory in Iran. Hospital authorities and infection control units should plan to remove the obstacles of influenza vaccination

Bilateral Breast Masses in a Case of Mast Cell Leukemia Without Common KIT Mutations and No Response to Imatinib

Systemic mastocytosis (SM) is a hematopoietic stem cells neoplasm that presents a range of asymptomatic indolent course to an aggressive fatal condition. Acute mast cell leukemia (aMCL) is a rare rapidly progressive SM variant which traditionally was treated with tyrosine kinase inhibitors such as imatinib due to the involved KIT pathway in the pathogenesis of aMCL with unsatisfactory results. Therefore, polychemotherapy (Poly-CT) and allogeneic hematopoietic stem cell transplantation (HSCT) is now recommended. We report a case of primary leukemic aMCL presented with bilateral breast masses, without response to imatinib despite no common KIT mutations. we suggest Poly-CT, and HSCT for optimal management as soon as possible

Infectious Mononucleosis Complicated with Bilateral Peritonsillar Abscess and Splenic Infarction

Infectious mononucleosis (IM) due to Epstein–Barr virus (EBV) infection is usually self-limited. It presents with fever, pharyngitis, fatigue, and cervical lymph node enlargement. It is common among adolescents and young adults. Although most patients recovered without any sequelae, rare complications have been reported. We described a 28-year-old man with fever, sore throat, dysphagia, and a positive IgM viral capsid Ag (VCA Ag) for EBV infection. He was admitted and received dexamethasone. He developed bilateral peritonsillar abscess (PTA) and splenic infarction, rare complications of acute EBV infection, two days after discharge. Although early reports noted PTA might occur following dexamethasone administration, recently, no obvious evidence supports it. However, high erythrocyte sedimentation rate level in our patient might indicate bacterial superinfection, which could exacerbate with dexamethasone administration. Several mechanisms such as transient hypercoagulable state and insufficient blood supply due to splenomegaly were proposed for splenic infarction due to EBV infection. Since our patient remained asymptomatic during the disease, IM-associated splenic complications, including splenic infarction, should be kept in mind. Our patient underwent bilateral tonsillectomy and received conservative management for the splenic infarction. These two rare complications of acute EBV infection have not been reported simultaneously yet

Spontaneous Complete Remission in a Patient with Acute Myeloid Leukemia and Severe Sepsis

Without treatment, acute myeloid leukemia (AML) is almost always fatal. Spontaneous remission of AML is a rare phenomenon and usually with a short duration. The exact mechanisms are unknown. However, its association with infection and blood transfusions has been described. We report a 53-year-old male who presented with severe sepsis and who was diagnosed with AML (M4). He has experienced complete spontaneous remission with relatively long duration. To the best of our knowledge, it is the first case of spontaneous remission described in Iran

Effective’s internal controls in Investment companies from the viewpoint of independent auditors

This research examines the effective internal controls in Investment firms from the viewpoint of external auditors. Due to the special nature of investment firms and complex transactions (online Transactions and future Transactions and …) and also lack of resources for internal controls being responsive to investment firms, research in this area seems necessary. In this research using library resources and query and consulting with investment firms' managers and the independent auditors responsible for auditing investment firms, a questionnaire containing effective internal controls in investments firms has been provided for the external auditors to express their opinion. The sample consists of 100 external auditors. This study is descriptive and the questionnaires have been used for research purposes. To analyze the data, the mean and a binomial test (ratio) by software SPSS have been used. The results of research display a list (Transactions Regulations adopted by the Board, Separation of duties, Periodic review by the Office of transactions and compliance with the CEO and…) of internal controls in investment firms

Lung Involvement Found on Chest CT Scan in a Pre-Symptomatic Person with SARS-CoV-2 Infection: A Case Report

The novel coronavirus SARS-CoV-2 infection is spreading worldwide, and there are many reports of acute respiratory distress syndrome caused by this infection. However, asymptomatic lung involvement has not been reported. We hereby present the case of a 44-year-old health-care worker, who was found to be infected with the SARS-CoV-2 virus after a CT-scan performed for an unrelated condition revealed a lesion in the lung field compatible with COVID-19 infection. His condition deteriorated initially, but eventually improved with supportive treatment and the compassionate use of antivirals and antimalarials and is now in a stable condition

Study of Social and Cultural Characteristics of Drug Offenders in Ahwaz Municipal Areas Using Geographic Information System (GIS)

Objective: This study examines the social and cultural structure of drug offenses in Ahwaz municipal areas using GIS. Method: The population of the study consisted of drug offenders in Correction and Rehabilitation Center of Ahwaz in 2013. Statistical tests and graphs, including Mean Center test, Standard Deviation Ellipse, Kernel Density Estimation were used in this study. Results: The most important centers of drug crime are in the same border with informal settlement areas, such as Kut Abdullah, Lashkar Abad, and Khashayar (urban areas 5 and 6 of Ahwaz city). In addition, there is a direct relationship between illiteracy rate & population density and crime rate. Discussion and Conclusion: Spatial analysis of geographic crime and punishment can act as a means for security and safety policy making in the fight against drugs